局解总结

脊柱区Muscles of BackSuperficial group–Trapezius 斜方肌–Latissimus dorsi 背阔肌–Levator scapulae 肩胛提肌–Rhomboideus 菱形肌Deep group–Splenius 夹肌–Erector spinae 竖脊肌Triangle of auscultation 听诊三角(肩胛旁三角)Boundaries•Latissimus dorsi•Trapezius•The medial border of thescapulaInferior lumbar triangle 腰下三角–Boundaries•Lower part of the lateralmargin of latissimusdorsi•Posterior free border ofthe obliquus externusabdominis•Iliac crestSuperior lumbar triangle腰上三角–Boundaries•Serratus posteriorinferior•Erector spinae•Obliquus internusabdomins上肢Cephalic vein 头静脉•Arises from the lateral side of the dorsal venous rete on the back of hand •Winds around the lateral border of the forearm; it then ascends into thecubital fossa and up the front of the armon the lateral side of the biceps.•It continues up in the deltopectoralgroove and then to the infraclavicularfossa, where it pierces clavipectoralfascia to drain into axillary vein. Basilic vein 贵要静脉•Arises from the medial side of the dorsal venous rete of hand•Winds around the medial border of the forearm•Then ascends into the cubital fossa and up the front of the arm on the medialside of the biceps to middle of the armwhere it pierces the deep fascia andjoins the brachial vein or axillary vein Median cubital vein 肘正中静脉•Links cephalic vein and basilic vein in the cubital fossa•It is a frequent site for venipuncture to remove a sample of blood or add fluidto the bloodAxillary fossa 腋窝Boundaries•Apex–Middle 1/3 of clavicle–Lateral border of first rib–Upper border of the scapula •Base–Skin–Superficial fascia–Axillary fascia 腋筋膜(cribriform fascia 筛状筋膜)•The medial wall–Serratus anterior–Upper four ribs and intercostalspaces•The lateral wall–Intertubercular groove–Long head and short head ofbiceps brachii–Coracobrachialis•The anterior wall–Pectoralis major–Pectoralis minor–Subclavius–Clavipectoral fascia 锁胸筋膜•The posterior wall–Subscapularis–Teres major–Latissimus dorsi–ScapulaContents•Axillary a. and principal branches•Axillary v. and tributaries•Brachial plexus and branches•Axillary lymph nodes•Loose connective tissue Trilateral foramen 三边孔(trilateral space 三边隙)•Boundaries–Superior: teres minorsubscapularislateral border of scapula,articular capsule of shoulder joint–Inferior: teres major–Lateral: long head of tricepsbrachii•Structures pass through the trilateral foramen–Circumflex scapular a. and v. Quadrilateral foramen 四边孔(quadrilateral space 四边隙)•Boundaries–Superior: teres minorsubscapularisarticular capsule of shoulder joint–Inferior: teres major–Medial: long head of tricepsbrachii–Lateral: surgical neck ofhumerus•Structures pass through the quadrilateral foramen–Axillary n.–Posterior humeral circumflex a.and v.Axillary artery•Begins at the at lateral border of first rib as a continuation of subclavianartery•At the lower border of teres major it becomes the brachial artery.•Divided into three parts by overlying pectoralis minorBranches•First part–superior thoracic a.–thoracoacromial a.•Second part–lateral thoracic a.•Third part– subscapular a.•throcodorsal a.•circumflex scapular a.–anterior humeral circumflex a.–posterior humeral circumflex a. Brachial artery 肱动脉–Begins at the lower border of theteres major as a continuation ofaxillary artery–Terminates opposite the neck ofradius by dividing into radialand ulnar arteriesBranches•Deep brachial a. 肱深动脉–Follows theradial nerve intothe spinal grooveof the humerus•Superior ulnar collaerala. 尺侧上副动脉–follows the ulnarnerve•Inferior ulnarcollateral a.尺侧下副动脉–Takes part in theanastomosisaround the elbowjoint.Median nerve 正中神经–Origin•Arises from the medialand lateral cord of thebrachial plexus–Course•Descends on the lateralside of brachial artery•Halfway down the arm, itcrosses the brachialartery to reach itsmedial side Humeromuscular tunnel 肱骨肌管•Composition–Formed by triceps brachii肱三头肌and groove for radial nerveof humerus 肱骨桡神经沟•Structures passing through the tunnel–Radial nerve 桡神经–Deep brachial a. and v. 肱深动静脉•Radial collateral a. 桡侧副动脉•Middle collateral a. 中副动脉Cubital fossa 肘窝Boundaries–Laterally: brachioradialis肱桡肌–Medially: pronator teres旋前圆肌–Roof: skin, superficial facia,deep fascia and aponeurosis ofbiceps–Floor: brachialis 肱肌,supinator 旋后肌and capsule ofelbow joint 肘关节囊Contents•biceps brachii tendon 肱二头肌腱•Medial to biceps brachii tendon–Brachial a. 肱动脉－dividesinto radial and ulnar a.,usually at apex of fossa–Brachial v. 肱静脉–Median n. 正中神经•Lateral to the biceps brachii tendon–Radial n. 桡神经–Lateral antebrachial cutaneousn. 前臂外侧皮神经•Deep cubital lymph nodesCarpal canal 腕管–Composition:Formed by flexorretinaculum 屈肌支持带andcarpal groove 腕骨沟–Structures passing through thecarpal tunnel•Median n. 正中神经•Tendons of flexordigitorum superficialis指浅屈肌and flexordigitorum profundus 指深屈肌enclosed by commonflexor synovial sheath屈肌总腱鞘•Tendon of flexorpollicis longus 拇长屈肌enclosed by synovialsheath for flexorpollicis longus 拇长屈肌腱鞘Superficial palmar arch 掌浅弓•Formed by ulnar artery and superficial palmar branch of radial artery•The curve of arch lies across the palm, level with the distal border of fullyextended thumb•Gives rise to three common palmar digital arteries 指掌侧总动脉 (eachthen divides into twoproper palmar digital arteries 指掌侧固有动脉) and one ulnar palmar artery ofquinary finger 小指尺掌侧动脉Deep palmar arch 掌深弓•Formed by radial artery and deep palmar branch of ulnar artery•The curve of arch lies across upper part of palmar at level with proximal borderof extended thumb•Gives rise to three palmar metacarpal arteries 掌心动脉to joint the distalends of the corresponding common palmardigital arteriesMedian n. 正中神经–Muscular branches: supplythenar except adductor pollicis,first two lumbricales–Cutaneus branches: supply skinof thenar, central part of palm,palmar aspect of radial threeand one-half fingers, includingmiddle and distal fingers ondorsum–Recurrent branch of the mediannerve正中神经返支–lies deep to the skin anddeep fascia overlyingthe anterior margin ofthe thenar near themidline of the palm Ulnar n. 尺神经–Muscular branches supplyhypothenar muscles, interossei,3rd and 4th lumbricales andadductor pollicis–Cutaneus branches supply skin ofhypothenar, palmar surface ofulnar one and one-half fingers,ulnar half of dorsum of hand,posterior aspect of ulnar twoand one-half fingers下肢Landmarks of lower limb•Gluteal region and thigh–anterior superior iliac spinesanterior inferior iliac spines髂前下棘–tubercle of iliac crest 髂结节–ischial tuberosity 坐骨结节–greater trochanter 大转子–pubic tubercle 耻骨结节–pubic crest 耻骨嵴–superior border of pubicsymphysis•Knee–patella ligament 髌韧带–tuberosity of tibia 胫骨粗隆–medial and lateral condyles 内外侧髁–medial and lateral epicondyles内、外上髁–tendon of biceps femoris 股二头肌腱–tendons of semitendinosus andsemimembranosus 半腱、半膜肌腱•Leg–anterior border of tibia 胫骨前缘–head of fibula 腓骨头–neck of fibula 腓骨颈•Ankle and foot–medial and lateral malleolus内、外侧踝–calcaneal tuberosity 跟骨结节–tuberosity of navicular bone 舟骨粗隆–tuberosity of fifth metatarsalbone 第五跖骨粗隆Superficial veins:–Great saphenous vein 大隐静脉•Drains the medial end ofdorsal venous arch offoot and passes upwarddirectly in front of themedial malleolus.•Then ascends in companywith the saphenous n. inthe superficial fasciaover the medial side ofthe leg.Small saphenous v. 小隐静脉–Arises from the lateral part ofthe dorsal venous arch of foot–Ascends behind lateralmalleolus and then runs up themidline of the back of the leg –Pierces the deep fascia andenters the popliteal v.–Drains the lateral side of thefoot and ankle and the back ofthe legStructures passing through suprapiriform foramen (from lateral to medial side)–Superior gluteal n. 臀上神经–Superior gluteal a. 臀上动脉–Superior gluteal v. 臀上静脉Structures passing through infrapiriform foramen (from lateral to medial side)–Sciatic n. 坐骨神经–Posterior femoral cutaneous n.股后皮神经–Inferior gluteal n. 臀下神经–Inferior gluteal a., v. 臀下动、静脉–Internal pudendal v., a.阴部内动、静脉–Pudendal n. 阴部神经Structures passing through small sciatic foramen (from lateral to medial side)–Internal pudendal v., a.阴部内动、静脉–Pudendal n. 阴部神经Superficial inguinal lymph nodes–Superior group:•Lies just distal to theinguinal ligament•Receive lymph vesselsfrom anterior abdominalwall below umbilicus,gluteal region, perinealregion, external genitalorgans–Inferior group:•Lies vertical along theterminal great saphenousv.•Receives all superficiallymph vessels of lowerlimb, except for thosefrom the posterolateralpart of calf–Efferent vessels drain into thedeep inguinal ln. or externaliliac ln.Fascia lata 阔筋膜–Iliotibial tract 髂胫束•laterally the deepfascia forms a thick band•from the iliac tubercleto the lateral condyle oftibial–Saphenous hiatus 隐静脉裂孔• A gap in the deep fasicawhich lies about 4 cmbelow and lateral to thepubic tubercle. Thefalciform margin 镰状缘is the lower lateralborder of the opening,which lies anterior tothe femoral vessels.•Filled with looseconnective tissue calledthe cribriform fascia筛筋膜Lacuna musculorum 肌腔隙–Boundaries:•Anteriorly: lateralportion of inguinalligament•Posterolaterally: ilium•Medially: iliopectinalarch–Contents:Iliopsoas 髂腰肌•femoral n. 股神经•lateral femoralcutaneous n. 股外侧皮神经Lacuna vasorum 血管腔隙–Boundaries:•Anteriorly: medialportion of inguinalligament•Posteriorly: fascia ofpecteineus and pectinealligament•Medially: lacunaligament•Laterally: iliopectinalarch–Contents:•Femoral sheath 股鞘•Femoral a. and v. 股动、静脉•Femoral branch ofgenitofemoral n. 生殖股神经股支•Lymphatic vesselsFemoral triangle 股三角–Boundaries•Superiorly (base) :inguinal ligament 腹股沟韧带•Laterally: medial borderof sartorius 缝匠肌内侧缘•Medially: medial borderof adductor longus 长收肌内侧缘•Apex: continuous withadductor canal 收肌管•Anterior wall: fascialata 阔筋膜•Posterior wall: consistsof iliopsoas 髂腰肌,pectineus 耻骨肌andadductor longus 长收肌from lateral to medialside–Contents：from lateral to medial•Femoral n. 股神经•Femoral sheath 股鞘•Femoral a. 股动脉•Femoral v. 股静脉•Femoral canal 股管•Deep inguinallymph nodes 腹股沟深淋巴结•Fatty tissue 脂肪组织Femoral canal 股管–Femoral ring 股环•Anteriorly:inguinalligament•Medially: lacuna lig. 腔隙韧带•Posteriorly: pecteneallig. 耻骨梳韧带•Laterally: femoral v. 股静脉•Superior: covered byfemoral septum 股环隔Adductor canal 收肌管–Boundies•Anterior wall: adductorlamina大收肌腱板andsartorius 缝匠肌•Lateral wall: vastusmedialis 股内侧肌•Posteomedial wall:adductor longus 长收肌and adductor magmus 大收肌–Contents•Saphenous n. 隐神经•Femoral a. and femoral v.股动、静脉•lymphatic vessels andloose connective tissue Sciatic nerve 坐骨神经•Course–Arises from the sacral plexus–Leaves pelvis throughinfrapiriform foramen to entergluteal region–Runs inferiorly laterally deepto gluteus maximus–Passing midway between thegreater trochanter of femur andischial tuberosity to back ofthigh–Lying deep to long head of bicepsfemoris,–Normally divided into tibial andcommon peroneal nerves justabove popliteal fossa•Innervates–Semitendinosus 半腱肌–Semimembranosus 半膜肌–Biceps femoris 股二头肌–Hip and knee joints 髋关节和膝关节Popliteal fossaBoundaries:–Superolaterally: Biceps femoris股二头肌–Superomedially: semitendinosusand semimembranosus 半腱肌和半膜肌–Inferiorly: lateral and medialheads of gastrocnemius 腓肠肌内、外侧头–Roof: deep fascia–Floor:•popliteal surface of thefemur•posterior capsule of theknee joint•fascia coveringpopliteus–Contents–Nerves•Tibial nerve 胫神经•Common peroneal nerve 腓总神经–Popliteal vein and itstributaries 腘静脉及属支–Popliteal artery and itsbranches 腘动脉及分支–Popliteal lymph nodes 腘淋巴结Malleolar canal 踝管•Boundaries–Formed by medial surface ofcalcaneus, flexor retinaculumand medial malleolus•Structures passing through the malleolar canal–Tibialis posterior 胫骨后肌–Flexor digitirum longus 趾长屈肌–Posterior tibial a. v. and n. 胫后动脉、静脉–Tibial n. 胫神经–Flexor hallucis longus 长屈肌头部•眉弓 superciliary arch•眶上切迹 supraorbital notch•眶下孔 infraorbital foramen•颏孔 mental foramen•翼点 pterion•颧弓 zygomatic arch•耳屏 tragus•髁突 condylar process•乳突 mastoid process•前囟点 bregma•人字点 lambda•枕外隆突external occipital protuberanceParotid duct 腮腺管•Arises front anterior border ofgland•Lies 1.5 cm below and parallel tozygomatic arch•Passes forward over masseter,pierces the buccinator and oralmucosa to open opposite secondupper molar toothStructures vertical passing through the parotid gland•External carotid a. 颈外动脉•Superficial temporal a.颞浅动脉•Superficial temporal v.颞浅静脉•Retromandibular vein下颌后静脉•Auriculotemporal n.耳颞神经Structures transversal passing through the parotid gland•Maxillary a. & v.上颌动、静脉•Transverse facial a. & v.面横动、静脉•Branches of facial n.面神经的分支The structures from superficial to deep•Branches of facial nerve 面神经的分支•Retromandibular vein 下颌后静脉•External carotid a. 颈外动脉and Auriculotemporal n. 耳颞神经Layers of frontoparietooccipital region Consists of five layers The superficial 3 layer are closely knit together, called scalp 头皮1. Skin 皮肤thick and hair bearing and contains numerous sebaceous glands皮厚、腺多、血运丰富2. The superficial fascia 浅筋膜•Dense connective tissue that binds the skin to the underlying epicranialaponeurosis•The vasculature of the scalp runs primarily in this layer. It is rich andwidely anastomosis.•Wounds of the scalp bleed profusely but heal well.a. v. and n. in superficial fascia•Anterior group–Supratrochlear a. v. n. 滑车上动、静脉和神经–Supraorbital a. v. n. 眶上动、静脉和神经•Posterior group–Occipital a. v. 枕动、静脉–Greater occipital n. 枕大神经3. Epicranial aponeurosis and occipitofrontalis 帽状腱膜和枕额肌•It is interposed between the frontalis and occipitalis portions of theoccipitofrontalis muscle.•These muscles place the aponeurosis under tension so that deep transverselacerations of the scalp gape widely •坚韧致密，前连额腹，后连枕腹，4. Subaponeurotic loose connective tissue(space)腱膜下疏松结缔组织(间隙)•Contains a rich network of deep arteries and veins. Therefore, thislayer has been called the “dangerousarea”.•Infection may spread to the substance of the bones, to venous channels within thecranial cavity, or to the brain.5. Pericranium 颅骨外膜•Fuses firmly with bone at the sutures and with the periosteum of the adjacentbone, thus limiting the subperiostealspace.•薄而致密，易于颅骨分离，如有血肿，与骨一致Hypophysis and hypiphyseal fossa 垂体与垂体窝•Shape and position–Pea-sized organ, attached byinfundibulum to hypothalamus,lies in hypophysial fossa–Consists of two parts:•Adenohypophysis•Neurohypophysis•Relationship–Anterior－tuberculum sellae–Posterior－dorsum sellae–Anterolateraly－optic canal–Above－diaphragm sellae, opticchiasma and optic nerve–Laterally－cavernous sinus–Below－sphenoid sinus Cavernous sinus 海绵窦•Position: lies on each side of sella turcica•Traversing the cavernous sinus–internal carotid artery 颈内动脉–abducent nerve 展神经•Traversing the lateral wall of the cavernous sinus–oculomotor nerve 动眼神经–trochlear nerve 滑车神经–ophthalmic nerve 眼神经–maxillary nerve 上颌神经颈部Landmarks of the neck⏹Hyoid bone 舌骨⏹Thyroid cartilage 甲状软骨⏹Cricoid cartilage 环状软骨⏹Catotid tubercle 颈动脉结节⏹Sternocleidomastoid 胸锁乳突肌⏹Suprasternal fossa 胸骨上窝⏹Greater supraclaviclar fossa 锁骨上大窝Cervical fascia 颈筋膜Superficial layer of cervical fascia 颈筋膜浅层 (investing fascia 封套筋膜)⏹Encloses trapezius,sternocleidomastoid, posterior bellyof digastric and parotid andsubmandibular glands⏹Attached to bony landmarks of upper andlower boundaries of neck and zygomaticarch of facePretracheal layer 气管前层⏹Lies deep to the infrahyoid muscle⏹Encloses viscera of neck: pharynx,larynx, trachea, esophagus, thyroidgland and parathyroid glands⏹Completely surrounds thyroid gland,forming a sheath for it, and bind thegland to larynx to form suspensoryligament of thyroid gland 甲状腺悬韧带⏹Extends from arch of cricoid cartilage,thyroid cartilage and hyoid bone tofibrous pericardium of superiormediastinumPrevertebral layer 椎前层⏹Lies anterior to bodies of cervicalvertebrae and prevertebral muscles;extends from base of skull downward intothe superior mediastinum, continuouswith anterior longitudinal lig. andendothoracic fascia⏹Covers subclavian vessels and roots ofbrachial plexus⏹Extends into upper limb as axillarysheath★ Carotid triangle 颈动脉三角⏹Boundaries❑Anterior border ofsternocleidomastoid❑Superior belly of omohyoid❑Posterior belly of digastic⏹Covered by skin, superficial fascia,platysma and investing fascia⏹Deep－prevertebral fascia⏹Medial － lateral wall of pharynxContents❑Common carotid a. and itsbranches❑Internal jugular v. and itstributaries❑Hypoglossal n. with itsdescending branches❑Vagus nerve❑Accessory nerve❑Deep cervical lymph nodes Muscular triangle 肌三角•Bounded by midline of the neck, superior belly of the omohyoid and anteriorborder of the sternocleidomastoid.•Covered by skin, superficial fascia, platysma, anterior jugular v., andinvesting fascia•Deep－prevertebral fasciaThyroid gland 甲状腺•Shape and position–H-shape–Left and right lobes: lie oneither side of inferior part oflarynx and superior part oftrachea, extend from middle ofthyroid cartilage to level ofsixth trachea cartilage–Isthmus: overlies 2nd to 4thtracheal cartilage–Pyramidal lobe: some timesarises from isthmusCoverings of the thyroid gland•False capsule: a sheath of pretracheal fascia which is attached to arch ofcricoid and thyroid cartilages to formthe suspensory ligament of thyroidgland, hence, the thyroid gland moveswith larynx during swallowing andoscillates during speaking•True capsule: fibrous capsule•Space between sheath and capsule of thyroid gland: there are looseconnective tissue, vessels, nerves andparathyroid glandsRelations of the thyroid gland•Anteriorly:–Skin–superficial fascia–investing fascia–Infrahyoid muscles andpretracheal fascia•Posteromedially:–Larynx and trachea–Pharynx and esophagus–Recurrent laryngeal nerve •Posterolaterally:–Carotid sheath with commoncarotid a., internal jugularv., and vagus n.–Cervical sympathetic trunk Arteries of the thyroid gland•Superior thyroid a. 甲状腺上动脉–Branch of external carotid a.–Runs superficial and parallel tothe external branch of superiorlaryngeal n. to reach the upperpole of thyroid gland–Gives off superior laryngeal a.in company with internal branchof superior laryngeal n.•Inferior thyroid artery 甲状腺下动脉–Branch of thyrocervical trunk ofsubclavian a.–Turns medially and downward,reaches the posterior border ofthe thyroid gland, where it isclosely related to the recurrentlaryngeal n.–Supplies inferior pole ofthyroid gland•Arteria thyroidea ima 甲状腺最下动脉–May arise (4%) from thebrachiocephalic a. or aorticarchSuperior laryngeal n. 喉上神经•Internal branch 内支：which pierces thyrohyoid membrane to innervatesmucous membrane of larynx above fissureof glottis•External branch 外支：is fine n., which descends in company with the superiorthyroid a. and supplies cricothyroid Recurrent laryngeal nerves 喉返神经•Ascend in tracheo-esophageal groove•Pass deep to the lobe of the thyroid gland and come into close relationshipwith the inferior thyroid a.•Cross either in front of or behind the artery•Nerves enter larynx posterior to cricothyroid joint, the nerve is nowcalled inferior laryngeal nerve喉下神经•Innervations: laryngeal mucosa below fissure of glottis, all laryngeallaryngeal muscles except cricothyroid Relationship of arteries to the laryngeal nerves•The superior thyroid a. is closely related near its origin to the superiorlaryngeal n.•Section of the nerve would anaesthetise the laryngeal mucosa and abolish thecough reflex, so increasing the risk offood or a foreign body entering thetrachea.•The inferior thyroid a. is closely related to the recurrent laryngeal n. asit enters the gland.•Section of the nerve would result in paralysis of muscles that move thevocal cords on that side. Parathyroid gland 甲状旁腺•Position–Two superior parathyroid glands:lie at junction of superior andmiddle third of posterior borderof thyroid gland–Two inferior parathyroid glands:lie near the inferior thyroidartery, close to the inferiorpoles of thyroid glandRelations of cervical part of trachea •Anteriorly–Skin–Superficial fascia–Investing fascia–Suprasternal space and jugulararch–Infrahyoid muscles andpretracheal fascia–Isthmus of thyroid gland ( infront of the 2nd to 4thtracheal cartilage)–Inferior thyroid v. and unpairedthyroid venous plexus–Arteria thyroid ima (if present)–Thymus, left brachiocephalic v.and aortic arch in child•Superolaterally–lobes of the thyroid gland (downas far as the sixth ring) •Posteriorly–Esophagus–R. & L. recurrent laryngealnerves•Posterlaterally–Cervical sympathetic trunk–Carotid sheathCarotid sheath 颈动脉鞘⏹Formed by components of all three layersof deep cervical fascia⏹Contains common and internal carotidarteries, internal jugular vein, andvagus nerve胸部Landmarks of thorax•Jugular notch corresponds with–The 2th thoracic vertebra inmale, the 3th thoracic vertebrain female•Sternal angle corresponds with–Connects 2nd costal cartilagelaterally–The lower border of 4th thoracicvertebra–The bifurcation of trachea inthe adult–The beginning of aortic archwhich ends posteriorly at thesame level–The esophagus is crossed by theleft main bronchus•Xiphoid process－xiphisternal synchondrosis lies opposite the body ofthe 9th thoracic vertebra•Clavicle–Inferior fossa of clavicle–Coracoid process•Ribs and intercostal spaces•Costal arch–Infrasternal angle 胸骨下角–Xiphocostal angle 剑肋角•Mammary papilla 乳头Thoracic wall 胸壁（层次）Superficial structures•Skin•Superficial fascia–Superficial n.•Supraclavicular n.•Anterior and lateralcutaneou sbranches ofintercostal n.T2 Sternal angleT4 NippleT6 Xiphoid processT8 Costal archT10 UmbilicusT12 Midpoint between umbilicusand symphysis pubis–Superficial a.–Superficial v.•Thoracoepigastric v.胸腹壁静脉•Lateral thoracic v. Mamma 乳房Structures•Contains skin, mammary glands and adipose tissue•Consists of 15 to 20 Lobes of mammary gland 乳腺小叶that radiate outwardfrom the nipple•lactiferous duct 输乳管•lactiferous sinus 输乳管窦•Suspensory ligaments of breast 乳房悬韧带(cooper’s ligaments): connectivetissue septa that extend from the skinto the deep fasciaLymphatic drainage of breast•Into pectoral ln. from lateral and central parts of breast•Into apical and supraclavicular ln.from superior part of breast•Into parasternal ln. from medial part of breast•Into interpectoral ln. from deep part of breast•The lymphatic capillaries of breast form an anastomosing network which iscontinuous across the midline with thatof the opposite side and with that of theabdominal wallDeep structures•Deep fascia–Superficial layer–Deep layer—clavipectoralfascia•Muscles of thorax–Pectoralis major 胸大肌–Pectoralis minor 胸小肌–Subclavius 锁骨下肌–Serratus anterior 前锯肌–Intercostales externi 肋间外肌–Intercostales interni 肋间内肌–Intercostales intimi 肋间最内肌–Transverses thoracis 胸横肌Intercostal space•Eleven spaces between ribs•Intercostal muscles–Intercostales externi 肋间外肌•Extends down andanteriorly from ribabove to rib below•Replaced anteriorly byexternal intercostalmembrane•Action: raise ribs forforced inspiration–Intercostales interni 肋间内肌•Extends up andanteriorly from ribbelow to rib above•Replaced posteriorly byexternal intercostalsmembrane•Action: depress ribs forforced expiration–Intercostales intimi 肋间最内肌•Incomplete, thin,closely applied tointercostales interni •Intercostal a. and v.–Posterior intercostals arteries肋间后动脉–subcostal artery 肋下动脉•Intercostal n.–Intercostal nerves 肋间神经(anterior rami of T1- T11)– Subcostal nerve 肋下神经(anterior ramus of T12)–from superior to inferior: vein,artery, nerve (VAN)Internal thoracic vessels•Internal thoracic a. 胸廓内动脉•Internal thoracic v. 胸廓内静脉Endothoracic fascia 胸内筋膜– A thin layer of connectivetissue–Separates the parietal pleurafrom the thoracic wallCupula of pleura 胸膜顶: extends up into theneck, over the apex of lung, 2.5cm above the medial third of claviclePleural cavity 胸膜腔–Potential space betweenvisceral and parietal pleural–Contains a small amount ofpleural fluid–Subatmospheric pressure in itPleura recesses 胸膜隐窝•Potential spaces of pleural cavitywhich lungs are not occupied in quietrespiration•Costodiaphragmatic recess 肋膈隐窝–slit-like space between costaland diaphragmatic pleurae oneach side–The lowest area of pleuralcavity•Costomediastinal recess 肋纵隔隐窝–On the left side between themediastinal pleural and costalpleuraLower margins of pleura cross the 8th,10th, 11th ribs, and 12th ribs at the midclavicular lines, the midaxillary lines,scapular line, and the sides of the vertebralcolumn, respectively.Hilum of lung 肺门middle of medial surface, which isa depression where the bronchi,vessels, and nerves enter thelungRoot of lung 肺根ContentsPrincipal bronchusPulmonary artery and veinNerves and lymphatic vesselsSurrounded by connective tissueOrder of structures in the root oflungFrom before backward: V. A. B.From above downward:L: A. B. V.R: B. A. V. Relations of left root of lungAnterior: phrenic n .andpericardiacophrenic vesselsPosterior: thoracic aorta and vagusn.Superior: aortic archInferior: pulmonary lig.Relations of right root of lungAnterior: phrenic n.,pericardiacophrenic vessels,superior vena cava, partpericardium, and right atriumPosterior: vagus n.Superior: azygos v.Inferior: pulmonary lig.The Mediastinum 纵隔Concept• A broad central partition that separates the two laterally placedpleural cavities.•It extends from the sternum to the bodies of the vertebrae, and from thesuperior thoracic aperture to thediaphragm.Subdivisions of mediastinumSuperior mediastinum 上纵隔Locating－from inlet of thorax to plane extending from level of sternal angle anteriorly to lower border of T4 vertebra posteriorlyContentsSuperficial layerThymusThree veinsLeft brachiocephalic v.Right brachiocephalic v.Superior vena cavaMiddle layerAotic arch and its three branchesPhrenic n.Vagus n.Posterior layerTracheaEsophagusThoracic ductInferior mediastinum下纵隔Anterior mediastinum 前纵隔Location Posterior to body ofsternum and attached costalcartilages, Anterior to heartand pericardiumMiddle mediastinum 中纵隔Location－between anterior mediastinumand posterior mediastinumPosterior mediastinum 后纵隔Location Posterior to heartand pericardium, Anterior tovertebrae T5－T12Relations of aortic arch•Anteriorly and to the left–Pleura–Lung–Phrenic n.–Pericardiacophrenic vessels–Vagus n.•Posteriorly and to the right–Trachea–Esophagus–Left recurrent laryngeal n.–Thoracic duct–Deep cardiac plexus。