2颈部解剖.pptx

January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈颈 部部一、概述一、概述 二、浅层结构二、浅层结构三、颈部深筋膜三、颈部深筋膜 四、颈前区四、颈前区五、胸锁乳突肌区五、胸锁乳突肌区 六、颈根部六、颈根部七、颈侧区七、颈侧区January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 一、概述一、概述 境界：境界：内容：内容：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈部分区：颈部分区：项部项部 固有颈部（颈部）固有颈部（颈部）颈前区颈前区 胸锁乳突肌区胸锁乳突肌区 颈侧区颈侧区 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 舌骨上区舌骨上区:下颌下三角下颌下三角 颏下三角颏下三角 舌骨下区舌骨下区:颈动脉三角颈动脉三角 肌三角肌三角颈前区：颈前区：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 胸锁乳突肌区胸锁乳突肌区颈侧区：颈侧区：枕三角枕三角 锁骨上大窝锁骨上大窝January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 二、二、浅层结构浅层结构1.颈阔肌颈阔肌2.浅静脉浅静脉 3.皮神经皮神经 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 1.颈阔肌颈阔肌起点：起点：三角肌和三角肌和胸大肌表面的筋胸大肌表面的筋膜。膜。止点：止点：口角口角颈阔肌深面有浅颈阔肌深面有浅静脉和皮神经静脉和皮神经。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2.浅静脉浅静脉 颈前静脉颈前静脉 注入颈外静脉注入颈外静脉 颈外静脉颈外静脉 注注入入锁锁骨骨下下静静脉或静脉角脉或静脉角January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 3.皮神经皮神经(1)为为颈颈丛丛的的皮皮支支:颈横神经颈横神经 耳大神经耳大神经 枕小神经枕小神经 锁骨上神经锁骨上神经 颈部麻醉点：颈部麻醉点：(2)面神经颈支面神经颈支January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 三、颈部深筋膜三、颈部深筋膜 分分 浅浅、中中、深深 三层。三层。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 包包裹裹二二肌肌二二腺腺，形形成肌鞘和腺鞘。成肌鞘和腺鞘。二二肌肌：斜斜方方肌肌 胸锁乳突肌胸锁乳突肌 二腺：下颌下腺二腺：下颌下腺 腮腮 腺腺 1.深筋膜浅层深筋膜浅层（封套（封套筋膜筋膜）January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 位位于于舌舌骨骨下下肌肌群群的的后后方方，上上附附于于舌舌骨骨，下下续续纤纤维维性性心心包包，分分二二层层包包绕绕甲甲状状腺腺，形形成成甲甲状腺鞘。状腺鞘。2.深筋膜中层深筋膜中层 （气管前筋膜）（气管前筋膜）January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 上上自自颅颅底底，下下续续前前纵纵韧韧带带与与胸胸内内筋筋膜膜，并并向向下下外外包包绕绕腋腋血血管管及及臂臂丛丛，形形成腋鞘。成腋鞘。3.深层（椎前筋膜）深层（椎前筋膜）January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 为包绕颈为包绕颈部大血管部大血管和迷走神和迷走神经的筋膜经的筋膜鞘。鞘。颈动脉鞘：颈动脉鞘：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈动脉鞘内上部颈动脉鞘内上部有颈内动脉、下有颈内动脉、下部有颈总动脉，部有颈总动脉，颈内静脉位于动颈内静脉位于动脉的外侧，迷走脉的外侧，迷走神经位于两者之神经位于两者之间的后方。间的后方。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈部的筋膜间隙颈部的筋膜间隙：主要有：主要有：(1)胸骨上间隙胸骨上间隙 (2)气管前间隙气管前间隙 (3)咽后间隙咽后间隙 (4)椎前间隙椎前间隙January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 位于胸骨柄上方位于胸骨柄上方深筋膜浅层的二深筋膜浅层的二层之间。层之间。内有颈前静脉下内有颈前静脉下段、颈静脉弓、段、颈静脉弓、淋巴结、脂肪组淋巴结、脂肪组织等。织等。(1)胸骨上间隙胸骨上间隙January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 位于气管前位于气管前筋膜与气管筋膜与气管之间。之间。通向：通向：向下向下通上纵隔。通上纵隔。(2)气管前间隙气管前间隙January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 甲状腺下静脉甲状腺下静脉 奇静脉丛奇静脉丛 头臂干头臂干甲状腺最下动脉甲状腺最下动脉 左头臂静脉左头臂静脉 小儿有胸腺上部小儿有胸腺上部 气管前间隙内有气管前间隙内有January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 位于椎前筋膜与位于椎前筋膜与咽颅底筋膜之间。咽颅底筋膜之间。内有淋巴结及结内有淋巴结及结缔组织。咽壁侧缔组织。咽壁侧方的部分为咽旁方的部分为咽旁间隙。间隙。(3)咽后间隙咽后间隙January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 位于脊柱颈段位于脊柱颈段与椎前筋膜之与椎前筋膜之间。颈椎结核间。颈椎结核脓肿多积于此脓肿多积于此间隙。向下通间隙。向下通后纵隔。后纵隔。(4)椎前间隙椎前间隙January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG（一）（一）舌骨上区舌骨上区 下颌下三角下颌下三角 颏下三角颏下三角（二）（二）舌骨下区舌骨下区 颈动脉三角颈动脉三角 肌三角肌三角四、颈前区四、颈前区 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG （一）（一）舌骨上区舌骨上区 1.下颌下三角下颌下三角周界：周界：位于下颌位于下颌骨下缘与二腹肌骨下缘与二腹肌前、后腹之间。前、后腹之间。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 主要为下主要为下颌下腺及其周颌下腺及其周围的血管神经。围的血管神经。内容内容January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 浅面有：面静脉浅面有：面静脉 深面有：面动脉深面有：面动脉 内下方有：舌下神经内下方有：舌下神经 舌动脉、舌静脉舌动脉、舌静脉 内上方有：舌神经内上方有：舌神经 下颌下神经节下颌下神经节 下颌下腺周围的结构：下颌下腺周围的结构：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG （二）（二）舌骨下区舌骨下区颈动脉三角颈动脉三角肌三角肌三角January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 1.颈动脉三角颈动脉三角境界：境界：胸锁乳突肌前缘上份胸锁乳突肌前缘上份 二腹肌后腹二腹肌后腹 肩胛舌骨肌上腹肩胛舌骨肌上腹 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈总动脉及其分支颈总动脉及其分支 颈内静脉及其属支颈内静脉及其属支 迷走神经迷走神经 副神经副神经 舌下神经舌下神经 主要内容：主要内容：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈外动脉颈外动脉 颈内动脉颈内动脉 颈总动脉及其分支：颈总动脉及其分支：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 甲状腺上动脉甲状腺上动脉 舌动脉舌动脉 面动脉面动脉 枕动脉枕动脉 颈外动脉的分支：颈外动脉的分支：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2.肌三角肌三角 周界：周界：颈前正中线颈前正中线 肩胛舌骨肌上腹肩胛舌骨肌上腹 胸锁乳突肌前缘胸锁乳突肌前缘January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 肌肉：舌骨下肌群肌肉：舌骨下肌群 4对对 功能功能:下降舌骨和喉下降舌骨和喉 胸骨舌骨肌胸骨舌骨肌肩胛舌骨肌肩胛舌骨肌胸骨甲状肌胸骨甲状肌甲状舌骨肌甲状舌骨肌January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 甲状腺甲状腺 甲状旁腺甲状旁腺 气管颈段气管颈段食管颈段食管颈段内容：内容：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 甲状腺甲状腺 thyroid gland 1.外形外形:“H”形形 有有二二个个侧侧叶叶和和一一个个峡峡部部。一一半半以以上上（约约70%）的的人人有锥状叶。有锥状叶。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 甲甲状状腺腺位位于于喉喉下下部部和和气气管管上上部部的的两两侧侧。侧侧叶叶上上端端平平甲甲状状软软骨骨中中部部，下下端端达达第第6气气管管软软骨骨环环；峡峡部部位位于于第第24气气管管软软骨骨环环的的前面。前面。2.位置位置 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 3.甲状腺的被膜甲状腺的被膜 甲甲状状腺腺的的表表面面包包有有内内、外层被膜，即：外层被膜，即：内层：纤维囊内层：纤维囊 （真被膜）（真被膜）外层：甲状腺鞘外层：甲状腺鞘 （假被膜）（假被膜）January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 假被膜增厚形成的假被膜增厚形成的甲状腺悬韧带将甲甲状腺悬韧带将甲状腺连于喉和气管，状腺连于喉和气管，故吞咽时，甲状腺故吞咽时，甲状腺可随喉上、下移动。可随喉上、下移动。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 4.甲状腺的毗邻甲状腺的毗邻甲状腺前面邻甲状腺前面邻(层次）层次）皮肤皮肤 浅筋膜浅筋膜 深筋膜浅层深筋膜浅层 舌骨下肌群舌骨下肌群January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 喉喉 气管气管 咽咽 食管食管 喉返神经喉返神经 甲状腺侧叶内侧邻：甲状腺侧叶内侧邻：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈鞘及其内容颈鞘及其内容 颈交感干颈交感干 甲状腺侧叶后外侧邻：甲状腺侧叶后外侧邻：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 5.甲状腺的动脉与喉的神经的关系甲状腺的动脉与喉的神经的关系 甲状腺上动脉与甲状腺上动脉与喉上神经外支伴行，喉上神经外支伴行，在距腺上极约在距腺上极约1 cm 处，二者又分开，故处，二者又分开，故甲状腺手术结扎甲状甲状腺手术结扎甲状腺上动脉时应紧贴腺腺上动脉时应紧贴腺上极进行。上极进行。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 甲状腺下动脉与喉返神经的关系：甲状腺下动脉与喉返神经的关系：甲状腺下动脉甲状腺下动脉与喉返神经关系密与喉返神经关系密切，左侧喉返神经切，左侧喉返神经位置较深，多经动位置较深，多经动脉后方上行；右侧脉后方上行；右侧喉返神经位置较浅，喉返神经位置较浅，多经动脉前方。多经动脉前方。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 左右喉返左右喉返神经入喉之前神经入喉之前都经环甲关节都经环甲关节后方，故甲状后方，故甲状软骨下角可作软骨下角可作为寻找喉返神为寻找喉返神经的标志。经的标志。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 在甲状腺手术在甲状腺手术结扎甲状腺下动脉时结扎甲状腺下动脉时应远离腺的下极，避应远离腺的下极，避免伤及喉返神经，引免伤及喉返神经，引起声音嘶哑。起声音嘶哑。同时要注意保留同时要注意保留甲旁状腺。甲旁状腺。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 6.甲状腺的静脉甲状腺的静脉 有三对：有三对：甲状腺上静脉甲状腺上静脉 甲状腺中静脉甲状腺中静脉 甲状腺下静脉甲状腺下静脉 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 作甲状腺手术切口所经过的层次作甲状腺手术切口所经过的层次皮肤皮肤浅筋膜浅筋膜 深筋膜浅层深筋膜浅层 舌骨下肌群舌骨下肌群 气管前筋膜气管前筋膜January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 气气 管管 颈颈 部部 有有一一定定的的移移动动性性，上上段段位位置置表表浅浅，下下段段位位置置深深。故故常常规规气气管管切切开开术术应应保保持持头头正正中中位位，并尽量后仰。并尽量后仰。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 气管切开经过层次：气管切开经过层次：皮肤皮肤 浅筋膜浅筋膜 深筋膜浅层深筋膜浅层胸骨上间隙胸骨上间隙舌骨下肌群舌骨下肌群气管前筋膜气管前筋膜January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 气管颈部的毗邻：气管颈部的毗邻：两侧：甲状腺侧叶两侧：甲状腺侧叶 后方：食管后方：食管 气管食管沟内有气管食管沟内有 喉返神经喉返神经 后外侧：颈动脉鞘后外侧：颈动脉鞘 颈交感干颈交感干January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 六、胸锁乳突肌区六、胸锁乳突肌区位置：位置：主要结构：主要结构：颈袢颈袢January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 组成组成:由颈袢上、由颈袢上、下根在第下根在第6颈颈椎平面汇合椎平面汇合成袢。成袢。颈袢颈袢January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈袢上根：由颈颈袢上根：由颈1前支构成。前支构成。颈袢下根：由颈颈袢下根：由颈2、3前支经颈丛前支经颈丛发出下行构成。发出下行构成。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 分布分布:颈颈1发支至甲状发支至甲状舌骨肌，袢上舌骨肌，袢上发支至其余发支至其余3个舌骨下肌群。个舌骨下肌群。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 七、颈根部七、颈根部 位置：位置：颈颈部部和和胸胸部部之之间间的的过过渡渡区。区。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 纵行结构纵行结构横行结构横行结构 以前斜角肌为标志分为以前斜角肌为标志分为：结构：结构：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 在前斜角在前斜角肌的前内侧，肌的前内侧，为来源于颈、为来源于颈、胸之间的结胸之间的结构。构。纵行结构：纵行结构：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈内静脉颈内静脉 颈总动脉颈总动脉 膈神经膈神经 迷走神经迷走神经 颈交感干颈交感干 胸膜顶胸膜顶胸胸 导导 管管 及及 右右 淋巴导管淋巴导管 纵行结构有：纵行结构有：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 在前斜角肌在前斜角肌的前、后方和的前、后方和外侧，主要是外侧，主要是来源于颈、胸来源于颈、胸与上肢之间的与上肢之间的结构。结构。横行结构：横行结构：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 锁骨下动脉锁骨下动脉及其分支及其分支 锁骨下静脉锁骨下静脉及其属支及其属支 臂丛臂丛 横行结构有横行结构有January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 锁骨下动脉：锁骨下动脉：被前斜角肌分为被前斜角肌分为三段。三段。主要分支有：主要分支有：椎动脉椎动脉 胸廓内动脉胸廓内动脉 甲状颈干甲状颈干 甲状腺下动脉甲状腺下动脉 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 胸胸 导导 管管注注入入左左静静脉脉角角，右右淋淋巴巴导导管管注注入入右右静脉角。静脉角。胸导管及右淋巴导管：胸导管及右淋巴导管：January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 斜角肌间隙：斜角肌间隙：由由前前、中中斜斜角角肌肌和和第第1肋肋之之间的空隙。间的空隙。通过结构：通过结构：臂丛臂丛 锁骨下动脉锁骨下动脉 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 八、颈侧区八、颈侧区 枕三角枕三角 锁骨上三角锁骨上三角January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 枕三角：枕三角：主要结构：主要结构：颈丛皮神经颈丛皮神经 臂丛分支臂丛分支 副神经副神经支配：胸锁乳突肌支配：胸锁乳突肌 斜方肌斜方肌 January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 锁骨上三角：锁骨上三角：主要结构：主要结构：锁骨下动脉锁骨下动脉 锁骨下静脉锁骨下静脉 静脉角静脉角 臂丛臂丛January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 锁骨下静脉：锁骨下静脉：位于锁骨位于锁骨内侧段上方，内侧段上方，锁骨下动脉前锁骨下动脉前面，直径面，直径12cm。January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 左侧有胸导左侧有胸导管的注入，右管的注入，右侧侧 有右淋巴导有右淋巴导管的注入。管的注入。静脉角静脉角January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 臂臂丛丛从从颈颈部部斜斜角角肌肌间间隙隙经经锁锁骨骨中中点点后后方方到到腋腋窝窝，临临床床上上作作臂臂丛丛阻阻滞滞麻麻醉醉 常常在在锁锁骨骨中点上方进行。中点上方进行。臂丛臂丛January,2007Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 小结小结1.颈部深筋膜的配布及筋膜间隙。颈部深筋膜的配布及筋膜间隙。2.颈动脉鞘。颈动脉鞘。2.甲状腺的毗邻。甲状腺的毗邻。3.甲状腺手术及气管切开手术经过甲状腺手术及气管切开手术经过的层次。的层次。