胸部的局部解剖与操作1-人体局解剖学-课件-12

（一）The
Superficial Structures
• The skin 皮肤 • The superficial fascia 浅筋膜 – The superficial blood vessels 浅血管 – The cutaneous nerves皮神经 – The superficial lymphatic vessels 浅淋巴管 – The breast 乳房
joins the left pulmonary 与主动脉弓之处； artery to the aortic arch
⑥The azygos vein ⑥奇静脉汇入上腔 enters the superior 静脉处； vena cava
⑦ The boundary line ⑦ 上、下纵隔的 between the superior and 分界线； inferior mediastina
3. The intercostal Spaces
• The intercostal muscles 肋间肌 • Nerves 神经 • Vessels 血管(the intercostal vessels 肋间血管, the internal thoracic vessels 胸廓内血管)
2.Region
Thoracic wall and cavity
The thoracic cavity, surrounded by the The thoracic wall consists of skin, fascia, thoracic wall, contains the lungs, pleura nerves, vessels, muscles, and bones. and pleural cavity and mediastinum
1. Boundary
•胸部是躯干的上部，位于颈部与腹部之 间。 The thorax (chest) is the upper part of the trunk between the neck and the abdomen．
1. Boundary
•Its upper boundary is formed by a line •其上界是从颈静脉切迹沿锁骨上 drawing from the suprasternal notch， along the superior margins of the clavicles 缘至肩峰，然后至第七颈椎棘突的 to the acromions，and then to the spinous 连线。 of the 7th cervical vertebra． process
（1）The intercostal muscles
肋间外膜 ① The external intercostal muscle and membrane ② The internal intercostal muscle and membrane ③ The innermost intercostal muscle 肋间外肌 肋间内肌 肋间最内肌
胸 部 标 志 线
The Lines of Orientation on the Thorax
The Lines of Orientation on the Thorax
parasternal line
sternal line
The Lines of Orientation on the Thorax
经剑肋角的心包（液）穿刺术
Clavicle
Lesser supraclavicular fossa
Greater supraclavicular fossa
Inferior fossa of clavicle
Nipple
Sternal angle 胸 Louis) 骨角 (of
胸骨角 The sternal Angle (of Louis)
颈静脉切迹 The jugular notch
Xiphoid 剑 突 process
Costal arch 肋 弓
costal arch
The infrasternal骨 下 角 胸 ( subcostal) angle
肩胛骨下角
The inferior angle of scapula
剑 肋 角
肋间内膜
（2）The course and Relationship of the intercostal Nerve and Vessels
Anterior and posterior intercostal artery
肋间后动脉
胸主动脉 肋间前动脉
胸廓内动脉
Before reaching to the costal angle, the intercostal nerve and 在达肋角之前，肋间血管和神经位于肋间隙中 vessels run in the middle of the intercostal space and their 部，彼此排列关系不恒定；然后行于肋沟内、肋 arrangement is inconstant; Then they lie between the 间内肌与肋间最内肌之间。 muscles. innermost and internal intercostal
锁胸筋膜及其穿行结构
2. The muscles
• • • • • • • • • • • The pectoralis major 胸大肌 The subclavius 锁骨下肌 The pectoralis minor 胸小肌 The serratus anterior 前锯肌 The obliquus externus abdominis 腹外斜肌 The trapezius 斜方肌 The rhomboids 菱形肌 The latissimus dorsi 背阔肌 The transversus thoracis 胸横肌 The rectus abdominis 腹直肌 The intercostal muscles 肋间肌
• In the costal groove of the rib, the arrangement •肋间血管和神经循肋沟前行，在肋角前方，三者 from up downwards is the vein, artery and 排列顺序自上而下为静脉、动脉、神经。 nerve.
胸廓内动脉: 腹壁上动脉、肌膈动脉、肋间前动脉
Clavipectoral fascia
Suspensory ligament of axilla
Clavipectoral fascia
is pierced by the cephalic vein头静脉, lymphatic vessels淋
巴管,thoracoacromial artery and vein胸肩峰动、静脉, lateral pectoral nerve胸外侧神经. “二进二出”
（二）The Deep Structures
深筋膜 deep fascia 胸壁浅层肌 superior muscles of thoracic wall 肋及肋间隙 ribs and intercostal space 胸内筋膜 internal thoracic fascia
1. 深 筋 膜 deep fc fascia
4. 胸 内 筋 膜
• 气胸
pneumothorax
• 水胸
hydrothorax
• 血胸
hemothorax
• 乳糜胸
chylothorax
•行胸膜腔穿刺术（抽液）在何部位进行？
①在肋角内侧： 不宜穿刺；
②在肋角之前： 可在肋间隙的中部或肋上缘稍上方进针。
The sternal angle marks the following items
①The lower border ①向后平对第4 of the 4th thoracic 胸椎下缘； vertebra
②The level where the trachea divides ②气管分为左、右主支气管的水 into the right and left principal (main) 平，即气管杈水平； bronchi.
③平左主支气管 ③ The second 与食管交叉处， constriction of 即食管的第2狭窄 the esophagus 处；
④平主动脉弓的起、 The origin and end of the aortic arch 止处；
⑤The ligamentum arteriosum ⑤动脉韧带连与左肺动脉
1. Boundary
•The lateral boundaries of the thorax separating from the upper •两外侧界为三角肌的前、后缘。 limb are the anterior and posterior margins of the deltoid．
The Lines of Orientation on the Thorax
二、胸 壁 The Thoracic Wall
The thoracic wall may be divided into • The superficial structures • The deep structures 胸壁可分为浅层结构和深层结构。
3.表面标志 Surface Landmarks
① ② ③ ④ ⑤ ⑥ ⑦ ⑧ 颈静脉切迹 The jugular notch 胸骨角The sternal angle (of Louis) 剑突The xiphoid process 肋弓The costal margin (costal arch) 胸骨下角The infrasternal angle 锁骨 The clavicle 肩胛骨下角The inferior angle of scapula 乳头The nipple