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1、1.额顶枕区层次结构如何?皮下、腱膜下、骨膜下血肿的扩展范 围有何不同?,课前复习题,2.颅顶部的血管、神经及其来源如何？,颈部浅层结构、舌骨上区Superficial Structures of the Neck and Suprahyoid Region,Departemnt of Human Anatomy，the Second Military Medical University,上界：下颌骨下缘、下颌角、乳突、上项线与枕外隆突的连线,下界：胸骨上缘、锁骨和肩峰至第7颈椎棘突的连线,颈部的境界Boundary of the neck,颈部(胸锁乳突肌)：颈前区anterior reg
2、ion 胸锁乳突肌区 sternocleidomastoid region 颈外侧区lateral region,颈部(斜方肌前缘)：固有颈部proper neck 项部nape,颈部分区Distriction of the neck,颈部三角Triangles of the neck,颈外侧区(肩胛舌骨肌下腹)：枕三角和锁骨上三角,颈前区(舌骨),舌骨上区,舌骨下区,下颌下三角,颏下三角,颈动脉三角,肌三角,触摸颈部表面标志Surface landmark of the neck,舌骨hyhoid(H)甲状软骨 thyroid cartilage(T)喉结节 laryngeal promin
3、ence(P)环状软骨 cricoid cartilage(C)第1气管环 1st tracheal ringe(1)甲状腺峡 isthmus(S),浅筋膜sup.fascia,颈筋膜浅层 superficial layer of cervical fascia,皮肤skin,颈阔肌platysma,颈丛皮支superficial br.of cervical plexus,浅静脉sup.veins of the neck,颈浅淋巴结sup.cervical lymph nodes,颈部浅层结构 Superficial structures of the neck,皮肤切口Incision o
4、f the skin,1.颈阔肌 2.颈深筋膜浅层 3.颈前V,解剖颈阔肌Platysma,解剖颈部浅静脉Superficial veins of the neck,观察颈浅淋巴结Superficial cervical lymph nodes,颈丛皮支：耳大N，颈横N，锁骨上N，肩胛上N,解剖颈丛皮支Superficial br.of cervical plexus,颈筋膜及筋膜间隙Cervical fascia and fascial spaces,浅层-封套筋膜,中层-气管前筋膜 甲状腺鞘 颈动脉鞘,深层-椎前筋膜,斜方肌,胸锁乳突肌,斜角肌,颈筋膜及筋膜间隙Cervical fasci
5、a and fascial spaces,胸骨上间隙、气管前间隙、咽后间隙、椎前间隙,解剖舌骨上区Suprahyoid region,二腹肌digastric；下颌舌骨肌mylohyoid；茎突舌骨肌stylohyoid；颏舌骨肌geniohyoid,二腹肌后腹,二腹肌前腹,下颌舌骨肌,颏舌骨肌,mylohyoid,digastric,舌骨上肌suprahyoid muscles：,下颌下腺submandibular gland的位置：,解剖下颌下三角Submandibular triangle,舌神经,舌咽神经,舌下神经,下颌下腺,舌动脉,下颌下腺导管,舌骨舌肌,茎突咽肌,茎突舌肌,舌下腺,
6、下颌下腺submandibular gland的毗邻：,解剖下颌下三角Submandibular triangle,下颌下腺submandibular gland的毗邻：,周围：下颌下淋巴结submandibular lymph nodes上方：舌N glossal n.下方：舌下N hypoglossal n.外侧：面A、V facial a.&v.内侧：下颌下腺导管 submandibular duct 舌骨舌肌 hyoglossus,解剖下颌下三角Submandibular triangle,1.颈部的境界与分区及重要体表标志。2.颈丛皮支的浅出点及其临床意义，各 皮支的分布。3.下颌下
7、淋巴结的位置。4.下颌下腺的位置和毗邻。,重点内容,1.颈部阻滞麻醉的应用解剖2.二腹肌后腹的毗邻关系3.下颌下腺的位置和毗邻,小 结,颈浅丛阻滞麻醉在胸锁乳突肌后缘中点进针，向上、向下注射。,颈丛阻滞麻醉的应用解剖Applied anatomy of block anesthesia of the cervical plexus,颈深丛阻滞麻醉：体位和方向：仰卧位，头转向头侧；垂直并稍向尾侧倾斜，注向24颈椎横突。层次：皮肤浅筋膜 颈阔肌深筋膜 椎前筋膜椎前肌注意事项：蛛网膜下隙、膈神经、喉返神经、颈交感干、椎动脉,颈丛阻滞麻醉的应用解剖Applied anatomy of block an
8、esthesia of the cervical plexus,二腹肌后腹的毗邻关系Adjacent structures of the posterior belly of digastric,浅面：耳大神经、下颌后静脉、面神经颈支深面：颈内动、静脉、颈外动脉、迷走神经、副神经、舌下神经、颈交感干上缘：耳后动脉、面神经、舌咽神经下缘：枕动脉、舌下神经,下颌下腺的位置和毗邻Adjacents and Location of the Submandibular Gland,周围：下颌下淋巴结submandibular lymph nodes上方：舌N glossal n.下方：舌下N hypoglossal n.外侧：面A、V facial a.&v.内侧：下颌下腺导管 submandibular duct 舌骨舌肌 hyoglossus,1.叙述颈丛阻滞麻醉的解剖学基础。2.颈筋膜分几层？颈筋膜间隙有哪些？其临床意义如何？3.下颌下腺的位置和毗邻关系如何？,复习思考题,
