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1、1,重要内容：颈深筋膜的区分、各层的包被关系和形成的结构 下颌下三角、颈动脉三角、肌三角的境界和内容甲状腺的形态、位置和毗邻，被膜和血管气管颈部切开的层次颈外侧深淋巴结的区分、魏尔啸淋巴结的位置与临床意义颈根部的境界、内容和毗邻前斜角肌、二腹肌后腹的毗邻枕三角、锁骨上大窝、椎动脉三角的境界和内容 概念：颈动脉鞘、胸膜顶、斜角肌间隙、颈袢、胸膜上膜,2,颈 部,局 部 解 剖 学,颈 部,人体解剖学教研室,3,第一节 概 述,一、境界与分区,1. 境界上界：下颌骨下缘、下颌角、乳突尖、上项线和枕外隆凸下界：胸骨颈静脉切迹、胸锁关节、锁骨上缘和肩峰至第7颈椎棘突,4,舌骨,甲状软骨,甲状舌骨正中韧
2、带,甲状舌骨外侧韧带,5,甲状软骨,环状软骨,会厌软骨,杓状软骨,6,甲状软骨,前角,喉结,上切迹,上角,下角,7,环状软骨,喉软骨中唯一完整的软骨环。,前面,后面,侧面,环状软骨弓,环状软骨板,甲关节面,杓关节面,甲关节面,杓关节面,8,9,10,11,12,二腹肌后腹,茎突舌骨肌,颏舌骨肌,下颌舌骨肌,二腹肌前腹,13,胸骨舌骨肌,肩胛舌骨肌,胸骨甲状肌,甲状舌骨肌,舌骨,14,斜角肌间隙：前、中斜 角肌与第1肋之间的空隙，有锁骨下动脉和臂丛通过。,三、颈深肌,（一）外侧群,前斜角肌 中斜角肌 后斜角肌,（二）内群侧,四、颈部筋膜,15,前斜角肌,中斜角肌,后斜角肌,头长肌,颈长肌,16,
3、17,The arteries of neck,Common carotid artery 颈总动脉 Origin (arises from) Brachiocephalic trunk on the right Aortic arch on the left Ascends in neck to upper border of thyroid cartilage; bifurcates into internal and external carotid arteries,18,Carotid sinus 颈动脉窦(baroreceptor), located at a localizes
4、dilation of terminal part of common carotid artery or beginning of internal carotid artery, sensitive to blood pressure changes Carotid glomus 颈动脉小球 (chemoreceptor), lies posterior to the point of bifurcation of common carotid artery, senses changes in blood carbon dioxide (oxygen) levels,19,Branche
5、s of external carotid a. Superior thyroid a. 甲状腺上动脉descends to supply upper pole of thyroid gland and larynx Lingual a. 舌动脉 Facial a. 面动脉 Occipital a.枕动脉 Posterior auricular a. 耳后动脉 Maxillary a. 上颌动脉 Superficial temporal a. 颞浅动脉,20,Subclavian artery 锁骨下动脉 Origin (arises from) Brachiocephalic trunk o
6、n right Aortic arch on left Becomes axillary artery at lateral border of first rib Branches Vertebral a. 椎动脉 Internal thoracic a. 胸廓内动脉 Thyrocervical trunk 甲状颈干 Inferior thyroid artery 甲状腺下动脉supplies inferior pole of thyroid gland Costocervical trunk 肋颈干,21,Veins Draining the neck,Internal jugular v
7、ein 颈内静脉 Begin at jugular foramen, descending to join the subclavian vein to form brachiocephalic vein Lies lateral first to internal and then to common carotid a. within carotid sheath Chief extracranial tributaries Common facial vein 面总静脉 Lingual v. 舌静脉 Pharyngeal v. 咽静脉 Superior thyroid v.甲状腺上静脉
8、Middle thyroid v. 甲状腺中静脉,22,23,Subclavian vein It is an continuation of axillary vein at the lateral border of first rib Joins internal jugular vein to form the brachiocephalic vein. Angle of union is termed venous angle 静脉角,24,External jugular vein 颈外静脉 Formed behind angle of mandible by union of p
9、osterior auricular, posterior branch of retromandibular and occipital vein Crossing sternocleidomastoid to enter subclavian veinAnterior jugular vein 颈前静脉 Drains submandibular and anterior neck regions Descends near midline, runs posterior to sternal end of sternocleidomastoid to drain into external
10、 jugular vein or subclavian vein,25,一、颈上部淋巴结,腮腺淋巴结,乳突淋巴结,枕淋巴结,颏下淋巴结,下颌下淋巴结,（一）头部淋巴结,注入颈外侧上深淋巴结,26,（二）颈前区淋巴结,1.颈前淋巴结,（1）颈前浅淋巴结 （2）颈前深淋巴结1）喉前淋巴结2）甲状腺淋巴结 3）气管前淋巴结4）气管旁淋巴结,(1),1),2),3),4),注入颈外侧下深淋巴结,27,2颈外侧淋巴结,（1）颈外侧浅淋巴结,（2）,颈外侧深淋巴结,颈干,(1),1）颈外侧上深淋巴结颈内静脉二腹肌淋巴结颈内静脉肩胛舌骨肌淋巴结 副神经淋巴结 2）颈外侧下深淋巴结锁骨上淋巴结斜角肌淋巴结(V
11、irchow淋巴结)咽后淋巴结,28,Right lymphatic duct 右淋巴导管 Formed by union of right jugular, subclavian, and bronchomediastinal trunks Ends by entering the right venous angle Receives lymph from right half of head, neck, thorax and right upper limb Thoracic duct 胸导管 At the roof of the neck, it turns laterally an
12、d arches forwards and descends to enter the left venous angle Just before termination, it receives the left jugular, subclavian and bronchomediastinal trunks,29,C1,C2,C3,C4,一、颈丛,（一）颈丛的组成和位置,组成：C1C4前支C5前支的一部分位置：胸锁乳突肌上部深面，中斜角肌和肩胛提肌起始端的前方。,颈丛组成模式图,C5,30,（二）颈丛的分支,皮支：,枕小神经,耳大神经,颈横神经,锁骨上神经,麻醉点,31,肌支：,膈神经(
13、C3C5),走行： 前斜角肌前方 锁骨下动、静脉之间 经胸廓上口 与心包膈血管伴行 分布于膈肌,32,交通支：,C1,舌下神经,舌下神经降支,颈袢,颈神经降支,C3,C2,(舌下神经袢),33,34,走行,延髓橄榄后沟上部出脑 与迷走N、副N同穿颈静脉孔出颅 行于颈内动、静脉之间 经舌骨舌肌内侧达舌根,35,走行,橄榄后沟出延髓颈静脉孔出颅 在颈动脉鞘内下行达颈根部,左迷走N越过主动脉弓前面 左肺根后方食管前面 食管前丛迷走N前干,右迷走N越过右锁骨下A前面 右肺根后方食管后面 食管后丛迷走N后干,36,分支,37,喉上神经与喉返神经,喉上神经：外支伴甲状腺上A下行，支配环甲肌内支与喉上A伴行
14、入喉，分布于声门裂以上的喉粘膜以及咽、会厌、舌根,喉返神经：,环甲肌以外所有喉肌 声门裂以下喉粘膜,38,副神经,特殊内脏运动f,疑核脑根加入迷走N咽喉肌,副N核脊髓根胸锁乳突肌、斜方肌,39,舌下神经,一般躯体运动f,舌下N核舌下神经,舌肌,40,41,Cervical part of sympathetic trunk 颈交感干 Formed by superior , middle and inferior cervical ganglia and interganglionic branches Superior cervical ganglion: largest, situated
15、 in front of transverse processes of C1C3 vertebra Middle cervical ganglion: smallest, is at level of transverse processes of C6 vertebra Inferior cervical ganglion: situated at level of C7 vertebra, and may be fused with first thoracic ganglion to form cervicothoracic ganglion 颈胸神经节,42,2. 分区,43,表面解
16、剖,体表标志,甲状软骨环状软骨舌骨胸锁乳突肌起点两头之间为锁骨上小窝颈动脉结节锁骨上大窝（锁骨上三角）胸骨上窝,44,环状软骨(弓)的意义 第6颈椎水平 The level of the 6th cervical vertebra. 喉与气管交界 The junction of the larynx with the trachea. 咽与食管交界 The junction of the pharynx with the esophagus.,45,46,47,The level at which the superior belly of the omohyoid muscle crosses the carotid sheath.,
