局部解刨学--胸部.pptVIP

The Bony Thorax Sternum Manubrium, Body (Gladiolus), Xiphoid Process Ribs 7 True Ribs 5 False Ribs Clavicle Scapula Vertebrae Cervicle,Thoracic, Lumbar, Sacral (Sacrum), Coccygeal (Coccyx) The Sternum (Composed of fused sternebrae) Manubrium Jugular (sternal) notch Articulation with rib #1 2 Clavicular Articular facets Sternal Angle – 2nd rib Body (Gladiolus) Articulates w/ribs 2-7 Xiphosternal joint Xiphoid process Cartilage-calcifies thru time Partial attachment of many muscles Typical Rib Articulation Dorsal (P) Attachment Thoracic Vertebrae Head of Rib ? 2 Demifacets Superior demifacet Inferior demifacet of vertebra above it Intervertebral disc Tubercle of Rib ? Transverse Costal Facet e.g. Rib #4 articulates with Superior Demifacet and Transverse Costal Facet of T4 Inferior demifacet of T3 Ventral (A) Attachment to Sternum Via costal cartilage Intervertebral Discs Annulus Fibrosus Outer collar of concentric rings Outer rings = ligaments Inner rings = fibrocartilage Supportive/Structural Nucleus Pulposus Inner disc, cushiony pad Remnants of notocord Shock Absorber Anterior Surface of Thorax Palpate the following Sternum (3 parts) Jugular notch Sternal Angle (= 2nd rib) Clavicle Costal margin Infrasternal angle Xiphosternal joint Midclavicular Line Midaxillary Line 一、胸前外侧壁解剖程序 (一)尸位 (二)摸认体表标志 (三)翻开浅部结构 (四)解剖肋间隙． 1．肋间肌 2．肋间后动、静脉和肋间神经． (五)打开胸前壁 1．断离锁骨 2．切断肋间肌 3．剪断肋骨 4．切断胸锁乳突肌与舌骨下肌的起点 5．掀开胸前壁 6．切断膈的前部起点 (六)剖查胸前壁内面的结构 1．胸内筋膜和胸横肌 2．胸廓内动、静脉和胸骨旁淋巴结 （一） 胸前外侧壁 1．尸位：取仰卧位。 2．摸认体表标志：颈静脉切迹、胸骨角、剑突、肋、肋间隙、肋弓、胸骨下角、剑肋角。 3．解剖胸壁结构：胸前外侧壁浅部结构已在上肢解剖时剖查，现逐层翻开皮片、筋膜、胸大肌、胸小肌、复查肋间神经前皮支和外侧皮支穿出部位，清理胸大、小肌在胸壁上的附着部分，将前踞肌自起点剥离，连同支配该肌的胸长神经一起翻向外侧，并观察其与腹外斜肌肌齿的交错。　 Mammary Gland Neurovascular Bundle of Intercostals VAN (vein, artery, nerve) Intercostal vein Intercostal artery Intercostal nerve Sit in Subcostal Groove Between Internal Intercostal and Innermost intercostal muscles 二、胸腔解剖程序 (一)观察胸腔分部和内容 (二)探查胸膜腔 1．切开壁胸膜 2探查壁胸膜 3．观察上、下胸膜间区 4．探查肋膈隐窝和左肋纵隔隐窝 5．探查肺韧