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脊柱区axillary vein.贵要静脉Basilic veinMuscles of BackTriangle ofauscultation听诊三角（肩月甲旁三Superficial group•Arises from the medial side of the dorsal venous斜方肌-Trapezius reteof hand背阔肌-Latissimus dorsi•Winds around the medial border of the forearm一Levator scapulae肩胛提肌•Then ascends into the cubital fossa and up the菱形肌front of the arm on the medial side of the biceps-Rhomboideusto middle of the arm where it pierces the deepDeepgroup夹肌fascia andjoins the brachial veinor axillaryvein-Splenius肘正中静脉竖脊肌Median cubitalvein-Erector spinae角｝Links cephalicvein andbasilic veinin theBoundariescubitalfossa•Latissimus dorsiIt is afrequent sitefor venipunctureto removea•Trapeziussample ofblood or add fluidto theblood•The medial border of thescapulaInferior lumbartriangle下三角Axillary fossa:窝-Boundaries Boundaries•Lower part of the lateral•Apexmargin oflatissimus dorsiMiddle1/3of clavicle•Posterior free border of the Lateral border of first ribobliquus externus abdominisUpper border of thescapula•Iliac crestSuperior lumbarBasetriangle腰上三角一Skin-Superficial fasciaBoundaries-Axillary fascia腋筋膜（cribriform•Serratus posteriorinferior筛状筋膜）fascia•Erector spinaeThemedial wall•Obliquus internus-Serratus anteriorabdomins-Upper fourribs andintercostal spacesThelateral wall上肢-Intertubercular groove-Long headand shorthead ofbiceps头静脉Cephalic veinbrachiiArises from the lateral side of the dorsalvenous-Coracobrachialisrete on the back of handTheanterior wallWindsaroundthe lateral border of theforearm;it-Pectoralis majorthenascendsinto thecubitalfossaandupthe-Pectoralis minorfrontof thearmon thelateral side of the biceps.一SubclaviusIt continuesup in the deltopectoralgroove and锁胸筋膜-Clavipectoral fasciathento theinfraclavicular fossa,where itpiercesThe posterior wallclavipectoral fascia to drain into-SubscapularisRelationship ofarteries to the laryngeal nerves颈动脉鞘Carotid sheath•The superior thyroid a.is closely related nearits■Formed bycomponents ofall threelayers of deeporigin to the superior laryngeal n.cervical fascia•Section of the nervewould anaesthetisethe■Contains commonand internal carotid arteries,laryngeal mucosaand abolishthe coughreflex,internal jugularvein,and vagus nerveso increasingthe riskof foodoraforeign bodyenteringthe trachea.胸部•The inferior thyroid a.is closelyrelated to therecurrent laryngeal n.as itenters the gland.Landmarks of thorax•Section of the nervewould resultin paralysisof■Jugular notchcorresponds withmusclesthat movethe vocalcords onthat side.-The2th thoracicvertebra inmale,the3th甲状旁腺Parathyroid glandthoracicvertebra infemale•Position•Sternal anglecorresponds with-Two superiorparathyroid glands:lie at-Connects2nd costalcartilage laterallyjunctionof superior and middlethird of一The lower border of4th thoracicvertebraposterior border of thyroid gland-The bifurcationof tracheain theadult-Two inferiorparathyroid glands:lie near-The beginningof aortic arch whichthe inferiorthyroid artery,close to theends posteriorlyat thesame levelinferiorpoles of thyroid gland-The esophagusis crossedby the leftRelations of cervical part of tracheamainbronchus•Anteriorly•Xiphoid process-xiphisternal synchondrosislies-Skinopposite thebody of the9th thoracicvertebra-Superficial fascia•Clavicle-Investing fascia-Inferior fossaof clavicle一Suprasternal spaceand jugulararch一Coracoid process一Infrahyoid musclesand pretracheal•Ribs andintercostal spacesfascia•Costal arch一Isthmus of thyroid glandin frontof the胸骨下角-Infrasternal angle2nd to4th trachealcartilage剑肋角-Xiphocostal angle-Inferior thyroidv.and unpairedthyroid乳头•Mammary papillavenous plexus胸壁层次Thoracic wall-Arteria thyroidima ifpresentSuperficial structures-Thymus,left brachiocephalicv.and•Skinaortic archin child•Superficial fascia-Superficial n.•Superolaterally•Supraclavicular n.一lobes of the thyroid gland downas faras•Anterior andlateral cutaneouthesixth ringsbranchesof intercostaln.•PosteriorlyT2Sternal angle-EsophagusT4Nipple-R.L.recurrent laryngeal nervesT6Xiphoid process•Poster!aterallyT8Costal arch-Cervical sympathetictrunkT10Umbilicus-Carotid sheathT12Midpoint betweenumbilicus andsymphysispubis•Eleven spacesbetween ribs一•Intercostal musclesSuperficiala.肋间外肌-Intercostales externi-Superficial v.•Extends down and anteriorly胸腹壁静•Thoracoepigastric v.from ribabove to rib below脉•Replaced anteriorlyby•Lateral thoracicv.external intercostal乳房MammamembraneStructures•Action:raise ribsfor forced•Contains skin,mammary glandsand adiposeinspirationtissue肋间内肌-Intercostales interni乳•Consists of15to20Lobes ofmammary gland•Extends upand anteriorly腺小叶that radiateoutward from the nipplefromrib belowtoribabove输乳管•lactiferous duct•Replaced posteriorlyby输乳管窦•lactiferous sinusexternal intercostals乳房悬韧带membrane•Suspensory ligamentsof breast•Action:depress ribsfor forcedcoopersligaments:connective tissuesepta thatexpirationextend from theskin to the deep fascia肋间最内肌Lymphatic drainageof breast-Intercostales intimi•Into pectoralIn.from lateral and central parts of•Incomplete,thin,closely appliedbreastto intercostalesinterni•Into apicaland supraclavicularIn.from superior•Intercostal a.and v.part ofbreast一肋间后动Posterior intercostalsarteries•Into parasternalIn.from medialpart ofbreast脉•Into interpectoralIn.from deeppart ofbreast肋下动脉-subcostal artery•The lymphaticcapillaries ofbreast forman•Intercostal n.anastomosing networkwhich iscontinuous肋间神经-Intercostal nervesanterioracross the midline withthat of the oppositesiderami ofTl-Tlland withthat of the abdominal wall肋下神经-Subcostal nerveanteriorDeep structuresramusof T12•Deep fascia-from superior to inferior:vein,artery,-Superficial layernerveVAN-Deep layer-clavipectoral fasciaInternal thoracic vessels•Musclesofthorax胸廓内动脉•Internal thoracica.胸大肌-Pectoralis major,胸廓内静脉•Internalthoracicv一胸小肌Pectoralis minor胸内筋膜Endothoracic fascia锁骨下肌-Subclavius-A thinlayer ofconnective tissue前锯肌-Serratus anterior-Separates the parietal pleurafrom the肋间外肌-Intercostales externithoracic wall肋间内肌-Intercostales internioverthe apex of lung,
2.5cm abovethe medialthird of肋间最内肌-Intercostales intimiclavicle胸横肌-Transverses thoracis胸膜腔Pleural cavityIntercostalspace-Potential space between visceraland TheMediastinum纵隔parietal pleuralConcept-Contains asmall amountof pleuralfluid•A broadcentral partitionthat separatesthe two-Subatmospheric pressurein itPleuralaterally placedpleural cavities.胸膜隐窝recesses•It extends from thesternum to the bodiesof the•Potential spacesof pleural cavity whichlungs arevertebrae,and from the superior thoracic aperturenotoccupied inquiet respirationto thediaphragm.•Costodiaphragmatic recess肋膈隐窝Subdivisions ofmediastinum上纵隔-slit-like spacebetween costaland Superiormediastinumdiaphragmatic pleuraeon each side Locating—from inletofthoraxto planeextending-The lowestarea ofpleuralcavity•from level of sternalangle anteriorlyto lower borderCostomediastinal recess肋纵隔隐窝of T4vertebra posteriorlyContents一On the left sidebetween themediastinalSuperficial layerpleuraland costalpleura Lowermargins ofpleuraThymuscross the8th,Three veins10th,11th ribs,and12th ribsat themidclavicular lines,theLeft brachiocephalicv.midaxillary lines,scapular line,and thesides of theRight brachiocephalicv.vertebral column,respectively.Superior vena cava月市门Hilum of lungMiddle layermiddleof medial surface,which isaAotic archand itsthree branchesdepressionwhere thebronchi,vessels,and nervesenterPhrenic n.肺根the lungRoot of lungVagus n.ContentsPosterior layerPrincipalbronchusTracheaPulmonary artery and veinNervesEsophagusand lymphatic vessels SuiToundedbyThoracic ductconnective tissue Order of structures in the下纵隔Inferior mediastinumrootof lungFrom beforebackward:V.A.B.前纵隔Anterior mediastinumLocationFrom abovedownward:Posterior tobody ofsternum andL:A.B.V.attached costal cartilages,Anterior toR:B.A.V.heart andpericardiumRelations ofleft rootoflung中纵隔Middle mediastinumLocationAnterior:phrenic n.and—between anteriormediastinum andpericardiacophrenicvesselsposterior mediastinumPosterior:thoracic aorta and vagusn.后纵隔Superior:aorticarchPosterior mediastinumInferior:pulmonary lig.Location Posterior to heartandRelations ofsioht rootoflungpericardium,Anterior tovertebrae T5Anterior:phrenic n.,pericardiacophrenic-T12vessels,superior venacava,part Relations of aorticarchpericardium,and rightatrium•Anteriorly and to the leftPosterior:vagusn.一PleuraSuperior:azygos v.-Lung-Phrenic n.Inferior:pulmonary lig.心包横窦一Transverse sinusof pericardiumPericardiacophrenicvesselsPosterior toascending aortaand pulmonary-Vagus n.trunk•Posteriorly and to the rightAnterior to superior venacava and left-Tracheaatrium-Esophagus心包斜窦Oblique sinusof pericardiumPosteriorto一Left recurrent laryngealn.一heartThoracic ductBounded by pulmonaryveins on either side-Deep cardiacplexus心包前下窦•Superiorly Anteriorinferior sinusof pericardium-Its threebranches胸段Relationsofesophagus-Left brachiocephalicv.Anteriorly一thymus Trachea•Inferiorly Bifurcationof tracheaLeft principal-Pulmonary a.branchus Left recurrent laryngealn.Anterior-Arterial ligamentesophageal plexusPericardium-Left recurrentn.Left atriumDiaphragm一Left principalbronchusPosteriorly一Superficial cardiacplexusPosterior esophagealplexus动脉导管三角Triangle ofductus arteriosusThoracicaortaBoundariesThoracic ductLeftphrenic n.Azygos v.Left vagusn.Hemiazygos v.Left pulmonarya.Accessory hemiazygos v.ContentsRight posteriorintercostal a.Arterial ligamentLeftrecurrentn.LeftSuperficial cardiacplexusesLeft subclaviana.心包PericardiumAortic arch纤维心包•Fibrous pericardiumSuperiorpart ofthoracic ductLeft-Attached tocentral tendon of diaphragmmediastinalpleura Thoracicaortainferiorly•Right-Blends withouter coatof greatvessels-Arch of azygosv.superiorly一Right mediastinalpleura浆膜心包•Serous pericardium胸导管Thoracic duct-Visceral layerepicardiumCourse-Parietal layer•Begins atupper end of cisternachyli inabdomen心包腔•Pericardial cavity•Enters thoraxon rightside ofaorta bypassing-Potential spacebetween visceralandthrough theaortic hiatusof thediaphragmparietal layers•Travels upwardbetween thoracicaortaand-Contains filmof pericardiumfluid as aazygos veinlubricantto facilitatecardiac•Veering to the leftat the level of T5,posterior tomovementsesophagus心包窦Pericardium sinus•At theroof of the neck,it turnslaterally andarchesforwards anddescends toenter the left•Originvenous angle-Lateral1/2of inguinal ligament-Iliac crest腹部一Thoracolumbar fascia•InsertionLandmarks ofabdomen-Extension ofmost fibersupwards and佥突•Xiphoid processijmedially•Costal arch肋弓•To lower3ribs andcostal骼前上棘cartilages•Anterior superioriliac spine•Into broad aponeurosis,which骼崎•Iliac crestsplitsinto anteriorand耻骨联合•Pubic symphysisposteriorleaves toenclose耻骨结节•Pubic tuberclerectusabdominis,meeting at脐•Umbiicus at the levelof L3〜L4linea alba白线•Linea alba一Fibers frominguinal ligament-arch over半月线•Linea semilunarisspermatic cord,inserted withAnterolateralMuscles transversusabdominis fibersinto pubic腹外斜肌Obliquus externus abdominis crest and adjacentpecten of pubis to腹股沟镰General directionof fibers:downward,forward andform inguinalfalxmedially rundown andinward•Derivation ofcremaster muscleand fascia•Origin—from outersurface oflower eightribs Transversusabdominis腹横肌•Insertion•Deep toobliquus internus•Posterior fibersextends vertically•General directionof fibers:run horizontallydownwardto anteriorhalf ofiliac crestforward•Remainder extenddownand medially•Origininto abroadaponeurosis,which meets一Lateral1/3of inguinal ligamentits fellow at lineaalba bycrossing-Iliac crestanterior to rectusabdominis•Attaches to anterior superioriliac spineand pubictubercleto forma freelower borderthe inguinal ligament腹股沟韧带between thesetwo points腹股沟管浅环•Superficial inguinal ring•triangular-shaped defectin aponeurosis ofobliquus externus abdominis abovepubictubercle腔隙韧带•Lacunar ligament•Extention of inguinal ligamentcurvingdownward andposteriorly frompubic tubercle耻骨梳韧带•Pectineal ligamentCooper^•Continuation offibers oflacunar ligamentalongthe pectenofpubis腹内斜肌Obliquus internus abdominis•Deep toobliquus externusabdominis-Thoracolumbar fascia弓状线line-Lower sixribs andcostalcartilages-Below thisline rectusabdominis in•Insertioncontact withtransverse fascia一Most fibers—run horizontallyinto aInguinal region腹股沟区broad aponurosis,most ofwhich passesBoundariesposterior to rectusabdominis andmeets•Inguinal ligamentitsfellowat the lineaalba•Lateral margin of rectusabdominis腹股沟镰•Inguinal falx•A horizontalline stretchingfrom anterioriliac-Formed byinsertion of obliquus internusInguinalcanal股沟管abdominis andtransversus abdominisspineto lateralmarginof rectus abdominisfibersinto pubic crestandadjacentPosition:oblique passage,4cm long,located
1.5cmpecten ofpubisabove medialhalf of inguinal ligamentBoundaries-Strengthens abdominal wall posteriortoFour wallssuperficialring提睾肌Anterior wall•CremasterAponeurosis ofobliquusexternusabdominis-Derived from the lowerfibers of theObliquus internus abdominis lateralthird ofobliquus internusabdominis andwalltransversus abdominisPosterior wall-Around thespermaticcord and testisTransversefascia腹直肌Rectus abdominisInguinalflax mediallyPosition:lie onto eitherof midlineRoofOrigin:pubic crestand symphysisarchingfibers ofobliquus internus andInsertion:xiphoid and5th-7th costalcartilagestransversus abdominis腱戈Has threetendinous intersectionsattached toFlooranteriorrectus sheath—inguinalligament半月线Linea semiluaris直肌鞘Two openingsSheathofrectusabdominis腹股沟管浅环Superficial inguinalring aEnclosesrectus abdoministriangular-shaped defectin theaponeurosis of theAnterior layerobliquusexternusabdominis一Formed byfusion ofaponeurosis ofliesimmediately aboveandmedial to theobliquusexternusabdominisandpubic tubercleanteriorleaf ofobliquusinternus腹股沟管深环Deep inguinalring anoval openinginabdoministransverse fascialies approximately
1.5cm above-Lowest%formed byaponeurosis ofallmidpoint ofinguinal ligamentthreemusclesInguinal Triangleof HesselbachPosteriorlayerBoundaries-Formed byfusion of posterior leafof•Lateralborder of rectusaponeurosisofobliquusinternusabdominismedially股沟三角abdominisandtransversus aponeurosis•Inferior epigastricartery laterally-Absent inabout4-5cm below the•Inguinal ligamentinferiorlyumbilicus,where aponeurosesof allthreemuscles formanterior sheath.Thelower free border namedarcuate Indirectinguinal hernia股沟斜疝Follow pathof testisthrough deepinguinalring,inguinal Inferior—superior part of duodenumcanal,and superficialinguinal ringAnteriorly—freeborder of hepatoduodenal ligamentPosteriorly-peritoneum covering the inferior venaDirect inguinalhernia:股沟直cava•Protrude throughposterior wall ofinguinalcanal胃transverse fasciaor inguinalfalx,medialtoStomachinferior epigastrica.,i.e.,through areaofinguinalLocationtriangle Mainlyparts is situated in theleft hypochondriacPeritoneum isa thinserous membranethat linethe regionwallsof theabdominal andpelvic cavitiesSmall in the epigastric regionThe cardiaissituatedto theleft of Til,the pylorusliesto the right ofLIRelationshipsPeritoneal cavity•Anteriorly:and coverthe organswithin thesecavities一Liver rightpart—the potentialspacebetween theparietaland-Diaphragm leftupper partviscerallayer ofperitoneum.-Anterior abdominalwall leftlower•In themale,this isa closedcavity,but infemale,partthere iscommunication with the exteriorthrough•Posteriorly-separated byperitoneum oflesser sactheuterine tubes,the uterus,and thevaginafrom the following stomach-bed网膜囊Omental bursa-PancreasPosition-lies behind the lesser omentum andstomach一Left suprarenal glandWalls-Left kidney•Superiorly—peritoneum whichcovers thecaudate lobe of liver anddiaphragm一Spleen•Anteriorly-formed bylesser omentum,-Transverse colonand transverseperitoneumofposteriorwallof stomach,andmesocolonanterior twolayers ofgreater omentumArteries ofstomach•Inferiorly—conjunctive areaof anteriorand•Left andright gastricarteriesposterior twolayers ofgreater omentum一Arise fromceliac trunk and proper•Posteriorly—formed byposterior twolayers ofhepatic artery,respectivelygreater omentum,transverse colonand transverse-Run inlesseromentumalong lessermesocolon,peritoneum coveringpancreas,leftcurvature,and anastomoseend-to-endkidney andsuprarenal gland•Right andleft gastroepiploicarteries•Left-Arise fromthe gastroduodenaland•Spleensplenic artery,respectively.胃脾韧带•gastrosplenic ligament-These twovessels passinto thegreater牌肾韧带•splenorenal ligamentomentum,run parallelto thegreater•Right—omental foramencurvature,and anastomoseend-to-end•Communication•Short gastricarteriesThe omentalbursa lessersac communicates with-Branches ofsplenic arterythegreater sacthrough theomental foramen.-Course through the gastrosplenicOmental foramen网膜孔ligamentBehind theright borderof hepatoduodenalligament一Supply thefundus ofstomach•Posterior gastricartery72%Superior—caudatelobe of liver-Arise fromthe splenicartery•These structureswhich aresurrounded by-Course through the gastrophrenicconnective tissuein thefreeborderofligament andsupply theposteriorwallhepatoduodenalligamentcalled hepaticpedicleof fundusofstomach肝蒂肝Liver胆:GallbladderPosition:RelationshipsMost ofliver lies in theright hypochondriac-Superior-liverregion andepigastricregion-inferior—duodenum andtransverseless partextending into theleftcolonhypochondriac region-Left-pylorusSurface projection-Right-right colicflexureNormally,therightlobe extendsjust beneathCystohepatic triangleCalots Triangle胆囊三角the costal margin,it doesntdown•Boundariesbeyond thecostalmargin;-Common hepaticduct onthe leftonthe anteriormedian lineits lowerborder一Cystic ductontherightcrosses apoint about3〜5cm belowthe-Liver superiorlyxiphoidprocess.•Content-cystic arteryInchildren,the liverbeing largerin胆总管Common bileduct Divisionsproportionto thebody thanin theadult十二指肠上段•Supraduodenal segmentstage,it extendsbelowthecostal arch十二指肠后段•Retroduodenal segmentwithinin2cm.胰腺段•Pancreatic segmentRelationships十二指肠壁段•Intraduodenal segmentPancreas•Diaphragmatic surface胰-Separated bydiaphragm fromthefollowing•Right costodiaphramatic•Positionrecess andlung-Lies inepigastric andlefthypochondriac•Diaphragmatic surfaceof redions,behind the peritoneum ontheheart posteriorabdominalwall,roughly atthe•Visceral surfacelevel ofLl~L2-Left lobeis relatedto thestomach and•Descriptive partsand relationsabdominalpart ofesophagus-Head of pancreas•Lies within the C-shapcd一Right lobeis relatedtotheright coliccurvatureof duodenumflexureanterioly,gallbladder and钩突•Uncinate processAsuperior duodenalflexure medially,right kidney,superarenal glandprojection totheleftfrom theposteriorlylower part of thehead behind肝门the superiorPortahepatismesenteric vesselsrelations•Traversed byAnteriorly-Right andleft hepaticductsTransverse mesocolonjejunum-Left andright branchesof properhepaticPosteriorlyarteryInferior venacava Rightrenal一Left andright branchesof hepatic portalvessels Commonbile ductveinSuperiorly-Nerves andlymphatic vesselsPylorusSurrounds openingof ileumintoSuperior part of duodenumposteromedial wallof cecumProperhepaticarteryHepatic Consists of twoalmost horizontalfolds,portal veinPortocaval In.formed bycircular mescleof ileum,Omental foramenCaudate lobeprojecting intolumenof liverProbably delaysflow ofileal contentsintoSuperior recessof omentallarge intestinebursaVermiform appendix-Neck ofpancreas Surfacemarking of the baseis atthe so-called•narrow partMcBurneys pointwhich isat junctionof lateral•overlies thesuperior mesentericand middlethirds ofline joiningright anteriorvessels and beginningof theportal veinrelations superioriliac spineand umbilicusAnteriorlyHepatic portal vein肝门静脉pylorusGeneral featuresPosteriorly•Formed behindthe neck ofpancreasby theunionbeginning ofhepatic portalv.of superiormesenteric vein and splenic vein•Body ofpancreas•Ascends upwardsandtotheright,posteriortothe-triangular incross section,passes upwardand tofirstpartofduodenum and then entersthe lessertheleft acrossthe midlineomentumtotheporta hepatis,whereitdividesrelationsinto rightandleftbranches一Anteriorly•There areno functioningvalves inhepatic portal•Separated fromstomach byomental systembursa•Drains bloodfrom gastrointestinaltract fromthe-Posteriorly lower end ofoesophagus tothe upperendof anal•Abdominal aortacanal,pancreas,gall bladder,bile ductsand•Left suprarenalgland spleen•Left kidneyTributaries ofhepaticportalv.•Left renalvessels肠系膜上静脉
1.Superior mesentericv.•Spleen vein肠系膜下静脉
2.Inferior mesentericv.-Superiorly脾静脉
3.Splenic v.•Celiac trunk胃左静脉
4.Left gastricv.•Celiac plexus胃右静脉
5.Right gastricv.•Splenic a..胆囊静脉
6.Cystic v•Tail ofpancreas附脐静脉
7.Paraumbilical v.-extends tothe hilumof spleenin thePortosystemicanastomosessplenorenal ligament
1.At the lowerendof theoesophagusrelationsHepatic portalvein fleft gastricvein fesophageal-Runs insplenorenal ligamentto reachvenousplexus fesophageal vein fazygosvein f superiorhilum ofspleenvena cava
2.At rectalvenousplexus-Accompanies withsplenic vessels盲肠Hepatic portalvein fsplenicveinf inferiorCecummesentericvein superiorrectal veinf rectalvenous plexusPosition:f inferior rectal andanal veins f internaliliac veinf inferiorliesin rightiliac fossavenacava
3.At periumbilicalvenous rete回盲Ileocecal valveHepaticportalveinf paraumbilicalveinf-Three musclesperiumbilicalvenous rete-1•Diaphragm pleuralcavity一•Psoas majorthoracoepigastricand superiorepigastric•Quadratus lumborumveinfsuperiorvenacava-Three nerves-superficial epigastricand inferiorepigastric•Subcostal n.veinsfinferior venacava•Iliohypogastric n.
4.Portal-retroperitoneal anastomosis•Ilioinguinal n.Between theretroperitoneal branchesofthe•Inferomedialcolic veins and thelumbar veins,-Renal pelvispancreaticoduodenalveins with the-Ureterrenal veinsand thesubcapsular veinsof•Posterointernalthe liverwiththephrenic veins,twigs of-Lumbar sympathetictrunkcolic veinsportal anastomosingwith•Anteriorlysystemic retroperitonealveins-Left kidney肾Kidney•Stomach superiorPosition•Tail ofpancreas andsplenic vessels•Lie behindtheperitoneumhigh upon themiddleposteriorabdominalwalloneither side ofthe•Loops ofintestine andleft colicvertebralcolumnflexure inferior•Upper polenearer tomedia planthan lowerpole-Right kidneyPosition•Right lobeofliversuperior•Left kidney-Teres major-Lies atthelevelfromthe lowerborderofTi一Latissimus dorsilto L2-The12th ribis behindits middlepartofthe-Scapulapost surfaceContents•Right kidney•Axillary a.and principalbranches-Lies slightlylower thantheleftkidney,atthe•Axillary v.and tributarieslevelfromtheupper borderofT12to L3•Brachial plexusand branches•Axillary lymph nodes一The12th ribis behindits upper partofthe•Loose connectivetissuepost surface三边孔Trilateral foramen肾门•Renal hilum（三边隙）trilateral space-At thelevelofLI,is about5cm fromtheposterior medianline•Boundaries肾区-Superior:teres minorsubscapularis•Renal regionlateral borderofscapula,articular-The areabetween12th riband thelateralcapsule of shoulder jointmarginof erectorspinae-Inferior:teres majorRelations-Lateral:long head of triceps brachii•Superiorly—suprarenalgland•Structures passthrough thetrilateral foramen•Medial-Left kidney-abdominal aorta-Circumflex scapulara.and v.一Right kidney-inferiorvenacava Quadrilateralforamen四边孔（quadrilateral space四边隙）•Posteriorly•Boundaries尺侧•Inferior ulnarcollateral a.-Superior:teres minorsubscapularis下副动脉articular capsule ofshoulderjoint一Takes partinthe一Inferior:teres majoranastomosisaround-Medial:long head of tricepsbrachii theelbow joint.一Lateral:surgical neckof humerusMedian nerve正中神经•Structures passthrough thequadrilateral一Originforamen•Arises fromthe medial and-Axillary n.lateral cordofthebrachial-Posterior humeralcircumflex a.andplexusv.-CourseAxillary artery•Descends onthelateralsideof•Begins atthe atlateral borderoffirstrib asabrachial arterycontinuation of subclavianartery•Halfway downthearm,it•At thelowerborderof teresmajor itbecomes thecrossesthebrachialartery tobrachialartery.•Right colicflexure inferior•Divided into three partsby overlyingpectoral is•Descending partof duodenumminormediallyBranches肾门•Renal hilum•First part-A verticalslit onthemedialborderof-superiorthoracica.kidney-thoracoacromial a.肾蒂•Renal pedicle•Second part-The structureswhich enterand leavethe-lateral thoracica.renal hilum,including the renal vein,•Third partrenalartery,renal pelvis,lymphatic-subscapular a.vessels and nerves•throcodorsal a.-Orderofstructuresinthe renalpedicle•circumflex scapulara.•From anteriorto posterior—V.-anterior humeralcircumflex a.A.P.-posterior humeralcircumflex a.•From superiorto inferior—A.肱动脉Brachial arteryV.P.-Begins atthelowerborderofthe teres肾窦•Renal sinusmajorasacontinuationofaxillary artery一The renalhilum extendsinto alarge-Terminates oppositethe neckof radiuscavitywithinthe kidneyby dividinginto radialand ulnararteries一Occupied by therenalvessels,minorBranchesrenal calices,major renalcalices,renal肱深动脉•Deep brachiala.pelvis andsome adiposetissue-Follows theradial nerveCoveringsof kidneyintothe spinalgroove纤维囊•Fibrous capsuleofthe humerus-a strongfibrous capsulewhich stripseasily尺侧上•Superior ulnarcollaeral a.from anormal kidneysurface but副动脉adheres firmlytoanorgan thathas been-follows theulnar nerveinflamed•Fatty renalcapsule脂肪囊-Sacrum andcoccyx一一Piriformisa thickadipose connectivetissue capsule,一Median andlateral sacralvesselssurrounds thefibrous capsule.It actsas ashockabsorber toprotect the kidney-Anterior branchesof sacralandfrom joltingand jarringcoccygeal nerves肾筋膜-Sacral sympathetictrunkand•Renal fasciaganglionimpar-on outside,surrounds boththekidneyand•Laterallysuprarenal gland,holding theseorgans-Pelvic plexusinplace-Superior andinferiorrectalvessels肾上腺Suprarenal gland-Levator ani•Shape andposition膀胱Bladder-Right ispyramidal inshape,left oneisRelationssemilunar inshape,consisting ofcortex•Superior surfacecovered byperitoneum-Smalland medullaintestine-Located retroperitoneally,-Sigmoid colonsuperomedialtosuperiorpoles ofeach-Body of uterus,when bladderif emptykidney,enclose withthekidneybythe•Posterior surfacerenalfascia-In males•Blood supply•Seminal vesicle-Arteries•Ampulla ofductus deferens•Superior suprarenala.•Rectum•Middle suprarenala.-In females•Inferior suprarenala.•Vagina-Venous drain•Right suprarenalv.drains into•Neck of uterusinferior venacava•Inferolateral surfacesdevoid ofperitoneum•Left suprarenalv.joins left-Anteriorly-retropubic padof fatandrenal v.pubic bone-Posteriorly-fascia overlyingobturator盆部与会阴internusandlevator animuscles•Apex-pubic symphysis•Neck belowand leastmobile直肠Rectum一In themale,rests ofprostate andRelationsurogenitaldiaphragm•Anteriorly inmale-In thefemale,rests directlyon pelvicfascia一Fundus ofbladdersurrounding theshort urethra一Seminal vesicle子宫一UterusProstatePosition-Ampulla ductusdeferentis•Lies inthe centerofthepelvic cavity,between-Pelvic partof ureterbladder,anteriorly,and rectum,posteriorly•Anteriorly infemale•usually it is anteversionand anteflexion一Neck of uterusRelations-Vagina•Anteriorly•Posteriorly—separated byvesicouterine pouchfromsuperior surfaceof urinarybladder betweengluteus maximus,•Posteriorly sacrotuberousligament and—separated byrectouterine pouchand coccygeusrectovaginalseptum fromrectum•ContentsSupports of uterus-Fat•Urogenital diaphragm-Internal pudendalarteryand its branches•Pelvic diaphragm一Internal pudendalveinand its tributaries•Surrounding organs:vagina一Pudendal nerveand itsbranches•Ligaments阴部管-Pudental canalAlcocks子宫阔韧-Broad ligamentofuterus-444-市子宫圆韧-Round ligamentofuterus带子宫主韧-Cardinal ligamentofuterus带苜氏子-sacrouterine ligamentofuterus宫韧带坐骨肛门窝Ischioanal fossa•Paired,wedge-shaped,fat-filled spaceson eithersideofanalcanal•Boundaries-Apex•Conjunctive areaof inferiorfascia of pelvic diaphragm andfascia coveringtheobturatorintemus一Base•Skin ofanal region-Medially•External analsphincter,levatorani,coccygeus andinferiorfascia ofpelvicdiaphragm-Laterally•Ischial tuberosity,obturatorinternus andfascia-Anteriorly•Forward projectionof anteriorrecessof fossabetween pelvicdiaphragmabove andurogenitaldiaphragm below一Posteriorly•Backward projectionofposterior recessof fossa—onthelateral wallof fossa•Pudendal n.•Internal pudendala.and v.尿生殖膈Urogenital diaphragm•Triangular inshape•Formed bysphincter ofurethra,deep transverseperinealmuscle,superiorandinferior fasciaofurogenital diaphragm行会阴浅隙Super cialperineal space•Lies betweeninferior fasciaof urogenitaldiaphragmand superficial fasciaof perineum•It isclosed behindand laterally•Anteriorly,the spacecommunicateswiththepotential spacelying between the Scarpas fasciaand theanterior abdominalmuscles.•In ruptureof cavernouspartofurethra,urine canextravasatefrom scrotumupward in front ofsymphysispubis intoanterior abdominalwalldeep toScarpasfascia•Contents•Posterior part—superficial transversemuscle ofperineum•Lateral part-crus penismale,crus ofclitorisfemale andischiocavernousus坐骨海绵体肌covering them•Central part-bulb ofurethra male,bulbof vestibulefemale and球海绵体肌bulbocavernoususcovering them•Branches ofpudendal nervesandinternal pudendalvessels会阴深隙Deep perinealspace•The closedspace thatis containedbetweensuperior andinferior fasciaof urogenitaldiaphragm•Contents-Deep transversemuscleofperineum-Bulbourethral glandmale尿道括约肌-Sphincter ofurethra-Arteries,veinsand nervesreach itsmedial sidesuperficialis指浅屈肌andHumeromuscular tunnel肱骨肌管flexor digitorumprofundus指•Composition深屈肌enclosed bycommon肱三头肌-Formed bytricepsbrachiiand屈肌总flexor synovialsheath肱骨groove forradial nerveof humerus腱鞘槎神经沟•Tendon offlexor pollicis•Structures passing through thetunnel拇长屈肌longus enclosedby梯神经-Radial nervesynovialsheath forflexor-Deep brachiala.and v.肱深动静脉pollicis longus拇长屈肌腱鞘掌浅弓Superficial palmararch梯侧副动•Radial collaterala.•Formed byulnar arteryand superficialpalmar脉branch ofradial artery中副动脉•Middle collaterala.•The curveof archlies acrossthe palm,level with肘窝Cubital fossathe distal borderof fullyextended thumbBoundaries•Gives riseto threecommon palmar digital一肱槎肌Laterally:brachioradialis指掌侧总动脉（arteries eachthen divides into旋前圆肌-Medially:pronator teres指掌侧固有动two properpalmardigital arteries一Roof:skin,superficial facia,deep fascia脉）and oneulnar palmarartery ofquinary Rngerandaponeurosisofbiceps小指尺掌侧动脉肱肌，旋后-Floor:brachial issupinator掌深弓Deep palmararch肌肘关节and capsuleof elbowjoint•Formed byradial arteryand deeppalmar branch囊of ulnararteryContents•The curveof archlies acrossupperpartof palmar肱二头肌腱•biceps brachii tendonat levelwith proximalborderofextended thumb•Medial tobiceps brachiitendon•Gives risetothreepalmar metacarpalarteries掌心动脉一肱动脉一to jointthedistalends oftheBrachial a.dividesintoradialand ulnara.,usually atapexoffossa correspondingcommon palmardigitalarteries-Brachial v.肱静脉Median n,正中神经-Median n.正中神经一Muscular branches:supply thenar•Lateral tothebicepsbrachiitendonexcept adductor pollicis,first two-Radial n.梯神经lumbricales-Cutaneus branches:supply skinof前臂外侧-Lateral antebrachialcutaneous n.thenar,centralpartof palm,palmar皮神经aspect ofradial threeand one-half•Deep cubitallymph nodesfingers,including middleand distal腕管Carpal canalfingerson dorsum一Composition:Formed byflexor-Recurrent branchofthemedian屈肌支持带retinaculum andcarpal正中神经返支nerve腕骨沟groove一lies deeptotheskin anddeep-Structures passing throughthecarpalfascia overlyingthe anteriortunnelmarginofthethenar nearthe正中神经•Median n.midline ofthe palm•Tendons offlexor digitorumUlnarn・尺神经-tuberosity offifth metatarsalbone第五一Muscular branchessupply hypothenar跖骨粗隆muscles,interossei,3rdand4thSuperficial veins:lumbricales andadductorpollicis大隐静脉-Great saphenousvein-Cutaneus branchessupply skinof•Drains themedial endof dorsalhypothenar,palmar surfaceof ulnaronevenous arch of footand passesandone-half fingers,ulnar halfofupward directlyin frontof thedorsumof hand,posterior aspectof ulnarmedialmalleolus.two andone-half fingers•Then ascendsin company withthe saphenousn.inthe下肢superficial fasciaover themedial sideofthe leg.Landmarks oflower limb小隐静脉Small saphenousv.•Gluteal regionand thigh一Arises fromthelateralpartofthedorsal-anterior superioriliac spinesanteriorvenous arch of foot骼前下棘inferior iliacspines-Ascends behindlateral malleolusand骼结节-tubercle ofiliac crestthenruns upthemidline oftheback of坐骨结节-ischial tuberositythe leg大转子-greater trochanter一Pierces the deep fasciaand entersthe耻骨结节-pubic tuberclepoplitealv.-pubiccrest耻骨喳-Drains thelateralsideofthefoot andankleandtheback oftheleg-superior borderof pubicsymphysisStructures passingthrough suprapirifoirnforamen•Knee骰韧带from lateral to medialside-patella ligament臀上神经-Superior glutealn.胫骨粗隆-tuberosity of tibia臀上动脉-Superior gluteala.内夕卜侧-medial andlateral condyles臀上静脉-Superior glutealv.内、外Structures passingthrough infrapiriformforamen-medial andlateral epicondylesfrom lateral to medialside上股坐骨神经-Sciatic n.股二头肌腱-tendonofbiceps femoris一tendons ofsemitendinosus and一Posterior femoralcutaneous n.股后皮神半腱、半膜肌腱semimembranosus经•Leg臀下神经-Inferior glutealn.胫骨前缘-anterior borderoftibia臀下动、静脉-Inferior gluteala.,v.腓骨头-headoffibula阴部内动、静脉-Internal pudendalv.,a.腓骨颈-neckoffibula阴部神经-Pudendal n.•Ankle andfootStructures passingthrough smallsciatic foramen内、外侧-medialandlateral malleolusfrom lateralto medialside踝阴部内动、静脉-Internal pudendalv.,a.跟骨结节-calcaneal tuberosity阴部神经-Pudendal n.舟骨粗隆-tuberosity ofnavicular boneSuperficialinguinal lymphnodes-Superior group:外侧皮神经•Lies justdistal tothe inguinal血管腔隙Lacuna vasommligament一Boundaries:•Receive lymphvessels from•Anteriorly:medial portionofanterior abdominalwallinguinal ligamentbelowumbilicus,gluteal region,•Posteriorly:fascia ofperinealregion,pecteineus andpectinealexternal genitalorgansligament-Inferior group:•Medially:lacuna ligament•Lies verticalalong the•Laterally:iliopectinal archterminalgreat saphenousv.-Contents:•Receives allsuperficial股鞘•Femoral sheathlymphvessels oflower limb,股动、静•Femoral a.and v.except forthose fromthe posterolateralpartof calf-Efferent vesselsdrainintothedeep脉inguinal In.or externaliliac In.•Femoral branchof阔筋膜Fascia lata生殖股神经genitofemoral n.骼胫束股支-Iliotibial tract•laterally thedeep fasciaforms a•Lymphatic vesselsthickband Femoraltriangle股三角•fromtheiliac tubercletothe一Boundarieslateral condyleof tibial•Superiorly base:inguinal隐静脉裂孔-Saphenous hiatus腹股沟韧带ligament•A gapinthedeep fasicawhich•Laterally:medialborderoflies about4cm belowand缝匠肌内侧缘sartoriuslateral tothe pubictubercle.•Medially:medialborderof镰状缘The falciformmargin长收肌内侧adductor longusisthelowerlateralborderofthe缘opening,which liesanteriorto•Apex:continuous withthefemoral vessels.收肌管adductor canal•Filled withloose connectivetissuecalled thecribriform阔筋•Anterior wall:fascia lata筛筋膜fascia膜肌腔隙Lacuna musculomm•Posteriorwall:consists of骼腰肌,耻-Boundaries:iliopsoas pectineus骨肌长收•Anteriorly:lateral portionof andadductor longus肌inguinalligamentfromlateraltomedialside•Posterolaterally:ilium-Contentsfromlateraltomedial•Medially:iliopectinal arch股神经•Femoral n.-Contents:股鞘•Femoral sheath骼腰肌Iliopsoas股动脉•Femoral a.股神经•femoral n.股静脉•Femoral v.股•lateral femoralcutaneous n.股管•Femoral canal•Deep inguinal-Normally dividedinto tibialandcommon peronealnerves justabove popliteal腹股沟lymph nodesfossa深淋巴结•Innervates脂肪组织•Fatty tissue半腱肌-Semitendinosus股管Femoral canal半膜肌-Semimembranosus一股环Femoral ring股二头肌-Biceps femoris•Anteriorly:inguinalligament懿关节和膝关节-Hip andknee joints腔隙韧带•Medially:lacuna lig.Popliteal fossa耻骨•Posteriorly:pecteneal lig.Boundaries:梳韧带股二-Superolaterally:Biceps femoris股静脉•Laterally:femoral v.头肌•Superior:covered byfemoral-Superomedially:semitendinosus and股环隔septum半腱肌和半膜肌semimembranosus收肌管Adductor canal一Inferiorly:lateralandmedial headsof-Boundies腓肠肌内、外侧头gastrocnemius•Anterior wall:adductor lamina-Roof:deepfascia大收肌腱板缝匠and sartorius-Floor:肌•popliteal surfaceofthefemur股•Lateral wall:vastus medialis•posterior capsuleoftheknee内侧肌joint•Posteomedial wall:adductor•fasciacoveringpopliteus长收肌longus andadductor一Contents大收肌magmus一Nerves-Contents胫神经•Tibial nerve隐神经•Saphenous n.腓总•Common peronealnerve股动、•Femoral a.and femoralv.神经静脉一胭静脉Popliteal veinand itstributaries•lymphaticvesselsand loose及属支connectivetissue胭动脉-Popliteal arteryand itsbranches坐骨神经Sciatic nerve及分支•Course胭淋巴结-Popliteal lymphnodes一Arisesfromthe sacralplexus踝管Malleolar canal-Leaves pelvisthrough infrapiriform•Boundariesforamen toenter glutealregion-Formed bymedialsurfaceof calcaneus,-Runs inferiorlylaterally deepto gluteusflexorretinaculum andmedial malleolusmaximus•Structures passingthroughthemalleolar canal-Passing midwaybetweenthegreater胫骨后肌-Tibialis posteriortrochanterof femurand ischial趾长屈肌-Flexor digitirumlongustuberosity tobackofthigh月空后动-Posterior tibiala.v.andn.一Lying deepto longheadofbiceps脉、静脉femoris,-Tibial n.胫神经Consists offive layers长屈肌The superficial3layer areclosely knittogether,-Flexor hallucislongus头皮called scalp头部皮肤
1.Skinthick andhair bearingand containsnumerous•眉弓superciliary archsebaceous glands•口匡上切迹supraorbital notch皮厚、腺多、血运丰富•眶下孑L infraorbitalforamen浅筋膜
2.The superficial fascia•颂孔mentalforamen•Dense connectivetissue thatbinds theskin tothe•翼点pterionunderlying epicranialaponeurosis•额弓zygomatic arch•The vasculatureofthe scalp runsprimarily inthis•耳屏traguslayer.Itisrich andwidely anastomosis.•牌突condylar process•Wounds ofthescalpbleed profuselybut heal•乳突mastoid processwell.•前卤点bregmaa.v.andn.in superficial fascia•人字点lambda•Anterior group•枕夕卜隆突external occipitalprotuberance滑车上动、静脉和-Supratrochlear a.v.n.腮腺管Parotid duct神经•Arises frontanterior borderof gland眶上动、静脉和神经-Supraorbital a.v.n.•Lies
1.5cm belowand parallelto•Posterior groupzygomaticarch枕动、静脉-Occipital a.v.•Passes forwardover masseter,枕大神经-Greater occipitaln.piercesthebuccinator andoral帽状
3.Epicranial aponeurosisand occipitofrontalismucosato openopposite second腱膜和枕额肌upper molartooth•Structures verticalpassingthroughthe parotidMaud Itis interposedbetweenthefrontalis andoccipitalisportions ofthe occipitofrontalis颈外动脉•External carotid a.muscle.颍浅动脉•Superficial temporala.•These musclesplace theaponeurosis under聂页浅静脉•Superficial temporalv.tension sothat deeptransverse lacerationsofthe下颌后静脉•Retromandibular veinscalpgape widely耳聂页神经•Auriculotemporal n.•坚韧致密，前连额腹，后连枕腹，Structures transversalpassingthroughthe parotid
4.Subaponeurotic loose connective tissuespaceMgland膜下疏松结缔组织间隙上颌动、静脉•Maxillary a.v.•Contains arich networkofdeeparteries andveins.面横动、青争•Transverse faciala.v.Therefore,this layerhas beencalled the脉dangerous area”.面神经的分支•Branches offacial n.The•Infection mayspread tothe substanceofthe行structures fromsuper dalto deepbones,to venouschannels withinthe cranial面神经的分支•Branches offacial nervecavity,ortothe brain.下颌后静脉•Retromandibular vein颅骨外膜
5.Pericranium颈外动脉•External carotida.and•Fuses firmlywith boneatthesutures andwith耳聂页神经Auriculotemporal n.Layers offrontoparietooccipital reqiontheperiosteum ofthe adjacentbone,thus limitingthe Superficiallayer ofcervical fascia颈筋膜浅层subperiosteal space.（封套筋膜）investing fascia•薄而致密，易于颅骨分离，如有血肿，与骨一■Encloses trapezius,sternocleidomastoid,致posterior bellyof digastricand parotidand垂体与垂体窝Hypophysis andhypiphyseal fossasubmandibular glands■Attached tobony landmarksof upperand lower•Shape andposition-Pea-sized organ,attached byinfundibulum boundariesof neckand zygomaticarch offaceto hypothalamus,liesinhypophysial气管前层Pretracheal layerfossa■Lies deeptotheinfrahyoid muscle一Consistsoftwo parts:■Encloses visceraof neck:pharynx,larynx,trachea,•Adenohypophysis esophagus,thyroid gland and parathyroid glands•Neurohypophysis■Completely surroundsthyroidgland,forming a•Relationshipsheath forit,and bindtheglandto larynxto form-Anterior—tuberculum sellae甲状腺悬suspensory ligamentofthyroidgland-Posterior-dorsum sellae韧带-Anterolateraly—optic canal■Extends fromarchofcricoid cartilage,thyroid一Above-diaphragm sellae,optic chiasmacartilage andhyoid boneto fibrouspericardium ofandoptic nervesuperior mediastinum-Laterally-cavernous sinusPrevertebral layer椎前层-Below—sphenoid sinus■Lies anteriorto bodiesofcervicalvertebrae and海绵窦Cavernous sinusprevertebral muscles;extendsfrombase ofskull•Position:lies oneachsideof sellaturcica downwardintothesuperior mediastinum,•Traversing thecavernous sinuscontinuous withanterior-internalcarotidartery颈内动脉longitudinal lig.and endothoracicfascia展神经■Covers subclavianvesselsandroots ofbrachial-abducent nerveplexus•Traversing thelateral wallofthecavernous sinus■Extends intoupper limbas axillarysheath动眼神经-oculomotor nerve★Carotid triangle颈动脉三角滑车神经-trochlear nerve■Boundaries眼神经-ophthalmic nerve□Anterior borderof上颌神经-maxillary nervesternocleidomastoid□Superior bellyof omohyoid颈部□Posterior bellyof digastic■Covered byskin,superficialfascia,platysma andLandmarksofthe neckinvesting fascia舌骨■Hyoid bone■Deep—prevertebral fascia甲状软骨■Thyroid cartilage■Medial—lateral wallof pharynx环状软骨■Cricoid cartilageContents颈动脉结节■Catotid tubercle□Common carotida.anditsbranches胸锁乳突肌■Sternocleidomastoid□Internal jugularv.anditstributaries胸骨上窝■Suprasternal fossa□Hypoglossal n.with itsdescendingbranchesCervical fascia颈筋锁骨上大窝□Vagus nerve■Greater supraclaviclarfossa□Accessory nerveinternal jugularv.,and vagusn.□Deep cervicallymphnodes-Cervical sympathetictrunkMuscular triangle肌三角Arteries ofthe thyroidgland甲状腺上动脉•Boundedbymidlineoftheneck,superior bellyof•Superior thyroida.the omohyoidand anteriorborderofthe-Branch ofexternal carotida.sternocleidomastoid.-Runs superficialand paralleltothe•Covered byskin,superficialfascia,platysma,external branchof superiorlaryngealn.anterior jugularv.,and investing fasciatoreach theupper pole ofthyroidgland•Deep-prevertebral fascia-Gives offsuperiorlaryngeala.inThyroid gland甲状腺companywithinternal branchofsuperior laryngealn.•Shape andposition甲状腺下动脉-H-shape•Inferior thyroidartery-Left andright lobes:lie oneithersideof-Branch ofthyrocervical trunkofinferior partof larynxand superiorpart subclaviana.of trachea,extendfrommiddleof-Turns mediallyand downward,reachesthyroid cartilageto levelof sixthtrachea theposterior borderofthe thyroidgland,cartilage whereitiscloselyrelatedtothe-Isthmus:overlies2ndto4th trachealrecurrentlaryngealn.cartilage-Supplies inferiorpoleofthyroidgland甲状腺最下动脉一•Arteria thyroideaimaPyramidal lobe:some timesarises fromisthmus一May arise4%fromthebrachiocephalicCoverings ofthe thyroidglanda.or aorticarch•False capsule:a sheathof pretrachealfascia喉上神经Superior laryngealn.which isattached toarchofcricoid andthyroid内支•Internal branchwhich piercesthyrohyoidcartilages toform thesuspensory ligamentofmembrane toinnervates mucousmembrane ofthyroidgland,hence,the thyroidgland moveslarynxabove fissureof glottiswithlarynx duringswallowing andoscillates外支:•External branchis finen.,which descendsduringspeakingin companywiththesuperiorthyroida.and•True capsule:fibrous capsulesuppliescricothyroid•Space betweensheath andcapsuleofthyroid喉返神经Recurrent larynqealnervesgland:there arelooseconnectivetissue,vessels,•Ascend intracheo-esophageal groovenervesand parathyroidglands•Pass deeptothelobeofthethyroidgland andRelationsofthethyroid glandcomeinto closerelationship withtheinferior•Anteriorly:thyroida.-Skin•Cross eitherinfrontof orbehindtheartery-superficialfascia•Nerves enterlarynx posteriorto cricothyroidjoint,-investingfascia喉the nerveis nowcalled inferiorlaryngealnerve一Infrahyoid musclesand pretrachealfascia下神经•Posteromedially:•Innervations:laryngeal mucosabelow fissureof-Larynx andtracheaglottis,all laryngeallaryngeal musclesexcept-Pharynx andesophaguscricothyroid-Recurrent laryngealnerve•Posterolaterally:-Carotid sheathwith commoncarotida.,。
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