局部解剖學(xué) 3 Regional anatomy of the upper limb for 8yrs2 學(xué)習(xí)資料VIP

Regionalanatomyofupperlimb

丁兆習(xí)山東大學(xué)醫(yī)學(xué)院人體解剖學(xué)教研室Office:1205dingzhaoxi@Partsandregions

Shoulderregion－junctionofarmandtrunkArm－betweenshouldandelbowElbow－bendofarm,jointbetweenarmandforearmForearm－betweenelbowandhandHand★SurfaceanatomyShoulderregion:acromion,spineofscapula,coracoidprocess,greatertubercle,anteriorandposterioraxillaryfoldsArm:medialandlateralbicepsbrachiifurrow,deltoidtuberosity

Elbow:medialandlateralepicondylesofhumerus,headofradius,olecranon,tendonofbicepsbrachiiForearmHand:styloidprocess,dorsaltubercleMensuration

Carringangle

提攜角Whentheelbowisextendedwiththeforearmsupinated(anatomicalposition),theforearmisdirectedsomewhatlaterally,formingacarryingangleofabout10o~15o.Thesupplementary

angleisabout165ointhefemaleand175ointhemale直肘straightelbow

：carryingangleisbetween0o~10o。肘內(nèi)翻inversionofelbow

：carryingangleissmallerthan0o~-10o。肘外翻enversionofelbow：carryingangleislargerthan20o。Mensuration

Posteriorcubitaltriangle

Whentheelbowisbeentoarightangle,theolecranon,medialandlateralepicondylesofthehumerusformanisoscelestriangle(Posterior

cubitaltriangle).Whentheelbowisstraightedouttoafullextension,theylieinthesamehoriaontalplaneDuringthedislocationofelbowjoint,theirrelativepositionwillbechanged.Lateralcubitaltriangle：Inflexion900,lateralepicondylesandtheheadofradiusandthetopoftheolecranonprocessformtheboundariesofanequilateraltriangleSurfaceprojectionAxillarya.andbrachiala.whenthearmisabductedtoarightangle,thelinedrawingfromthemidpointofclavicletoapoint2cmbelowthemidpointofanteriorcubitalgrainoftheelbow.在鎖骨中點(diǎn)至肘前橫紋中點(diǎn)遠(yuǎn)側(cè)2cm處的連線上。

Radiala.alinedrawingfromthepoint2cmbelowthemidpointofanteriorcubitalgrainoftheelbowtothestyloidprocessofradius.肘前橫紋中點(diǎn)遠(yuǎn)側(cè)2cm處至橈骨莖突的連線上。SurfaceprojectionUlnara：Thelinedrawingfromapoint2cmbeyondthecenterofthebendoftheelbowcurvesdownwardstotheradialborderofthepisiform.肘前橫紋中點(diǎn)遠(yuǎn)側(cè)2cm處至豌豆骨橈側(cè)的連線上。

Mediann：

ThecourseofmedianN.inthearmissimilartothatofthebrachiala.intheforearm,Itispresentedbyalinefromthepointmedialtothepulsationofthebrachaiala.attheelbowtothepointbetweenthetendonofpalmaris

longusandflexorcapi

radialisatthewrist在臂部與肱動脈一致，在前臂位于內(nèi)上髁與肱二頭肌腱連線中點(diǎn)至腕橫紋中點(diǎn)。UlnarN.：Mappedbyalinedrawingfromapointmedialtothecorocobrachalisatthelowerborderoftheteremajortothemedialepicondyleofhumerusattheelnbow,andtothelateralborderofthepisiformboneatthewrist.大圓肌下緣與喙肱肌交點(diǎn)內(nèi)側(cè)至肘窩肱骨內(nèi)上髁，再到豌豆股外側(cè)緣的連線SurfaceprojectionAnatomicalsnuffbox

鼻煙壺Whenthethumbisabductedandextended,atriangularhollowappearsbetweenthetendonoftheextensorpollicislongsmediallyandthetendonsoftheextensorpollicis

brevisandabductorpollicis

longuslaterally.Thefloorofthesnuffboxisthescaphoidandtrapeziumbonesandcrossedbytheradiala.SuperficialstructuresSkinSuperficialfasciamammaryglandsCephalicv.Supraclaviclularn.Ant.cutaneousbr.ofintercostaln.lat.cutaneousbr.ofintercostaln.DeepstructuresPectoralismajorPectoralisminorClavipectoralfasciaAnteriorregionofthorax

Mamma乳房PositionLieinsuperficialfasciaoverthepectoralsmajorandpectoralfasciaExtendfrom3rdto7thribsvertically,andfromparasternallinetomidaxillarylinetransversallyClinicaltips：腋突axillaryprocessofmamma

隆胸breastimplantMamma乳房Structuresskin,mammaryglandsandadiposetissueEachbreasthasabout15～20lobesofmammaryglandEachloberadiatesoutfromthenippleandhasalactiferousduct輸乳管

whichopensseparatelyonthesummitofthenippleandpossessesadilatedlactiferoussinuses輸乳管竇

justpriortoitsterminationClinicaltips：乳腺炎mastitisMamma乳房Suspensoryligamentsofbreast乳房懸韌帶(Cooper’sligaments)－strandsofconnectivetissuerunsbetweenskinanddeepfasciaandservetosupportthemammaryglandsClinicaltips：桔皮樣變orangeskin★L(fēng)ymphdrainageofbreastlateralandcentralpartsofbreastpectoralln.superiorpartofbreastapicalandsupraclavicular

ln.medialpartofbreastparasternal

ln.deeppartofbreastIntointerpectoral

ln.andsuperiorphrenic

ln.ThelymphaticcapillariesofbothbreastformananastomosingnetworkacrossthemidlineandwiththatoftheabdominalwallClinicaltips：乳腺癌breastcarcinomaAxillaryregion腋區(qū)TheAxillaisapyramidregionsituatedbetweenthelateralsurfaceoftheupperchestwallandthemedailsideofthearm.Theskinundertheshoulderjointisconvexupwards,termedaxillary

fossa(armpit)Axillarycavityisapyramid-shapedspacedeeptothearmpit,throughwhichmajorneurovascularstructurespassbetweenthethoraxandupperextremity★BoundariesoftheAxillaryCavityAnteriorwall:

Pectoralismajor,pectoralisminorandsubclaviusmuscles,ClavipectoralfasciaPosteriorwall:

latissimus

dorsi,teresmajor,subscapularisandscapulaMedialwall:

serratusanterior，intercostalmusclesandupperfourribsLateralwall:

coracobrachialis,bicepsbrachiiandintertuberculargroove★BoundariesoftheAxillaryCavityApex

atriangularspacelimitedbythefirstrib,thescapula,andthemiddlethirdofclavicle.Baseskinandfasciaofaxillary

fossastretchingbetweentheanteriorandposteriorwallsBoundariesoftheAxillaryCavityTheanteriorwallpectoralismajorpectoralisminorsubclaviusmuscles★Clavipectoralfascia

鎖胸筋膜Thedeepfasciawhichextendsbetweensubclavius,coracoidprocessandpectoralisminormusclesThestructurespassthroughtheclavipectoralfasciaCephalicv.頭靜脈Thoracoacromiala.胸肩峰動脈Lateralpectoraln.胸外側(cè)神經(jīng)BoundariesoftheAxillaryCavityPectoralismajor

Location:anteriortotheupperpartofthechestOrigin:medialhalfoftheclavicle,anteriorsurfaceofthesternumand1-6thcostalcartilagesInsertion:crestofthegreatertubercleAction:

flexes,adductsrotatesthehumerusmediallydrawthebodyupward(armfixed)elevatestheribs(scapulafixed)BoundariesoftheAxillaryCavityPectoralisminor

Location:deeptothepectoralismajorOrigin:3-5thribInsertion:

acromoidprocessAction:drawtheshoulderforwardBoundariesoftheAxillaryCavityTheposteriorwallSubscapularis

肩胛下肌Teresmajor大圓肌Latissimus

dorsi

背闊肌Scapula肩胛骨

BoundariesoftheAxillaryCavityTheposteriorwall★Trilateralforamen三邊孔Spaceboundedbyteresminor,subscapularissuperiorly;teresmajorinferiorlyandlongheadoftricepsbrachiilaterallyTransmitcircumflexscapulara.v.★Quadrilateralforamen

四邊孔

Spaceboundedbyteresminor,subscapularissuperiorly;teresmajorinferiorlyandlongheadoftricepsbrachiimediallyandsurgicalneckofhumeruslaterally.Transmittheposteriorhumeralcircumflexa.v.andaxillaryn.BoundariesoftheAxillaryCavityThemedialwall(broad)serratusanteriorintercostalmusclesupperfourribsBoundariesoftheAxillaryCavitySerratusanterior

Location:lateraltothechestOrigin:1-8/9thribInsertion:ScapulaAction:DrawthescapulaforwardBoundariesoftheAxillaryCavityThelateralwall(narrow)CoracobrachialisBicepsbrachii

IntertuberculargrooveBoundariesoftheAxillaryCavityMusculotendinouscuff肌腱袖Thenamegiventothetendonsofsupraspinatus

岡上肌,infraspinatus

岡下肌,teresminormuscles小圓肌,andsubscapularis

肩胛下肌，whicharefusedtotheunderlyingcapsuleoftheshoulderjointontheanterior,superiorandposteriorwall.Thecuffisimportantinstabilizingtheshoulderjoint★

Contentsinaxillary

fosssaAxillarya.andprincipalbranchesAxillaryv.andtributariesBrachialplexusandbranchesAxillarylymphnodes

LooseconnectivetissueAxillarysheath★AxillaryarteryContinuationofsubclavianarteryatlateralborderoffirstribBecomesbrachialarteryatlowerborderofteresmajorDividedintothreepartsbyoverlyingpectoralisminorsuperiorthoracica.

胸上動脈

thoracoacromiala.胸肩峰動脈lateralthoracica.

胸外側(cè)動脈subscapulara.肩胛下動脈throcodorsala.胸背動脈

circumflexscapulara.旋肩胛動脈anteriorcircumflexhumerala.旋肱前動脈posteriorcircumflexhumerala.旋肱后動脈★AxillaryarteryRelationshipofaxillarya.1stsegmentAnterior:

pectoralismajor,Clavipectoralfascia,andthestructurespassthroughtheclavipectoral

fascia(Cephalic

v.,Thoracoacromiala.andv.,Lateralpectoraln.)Posterior:Medialcordofbrachialplexus,longusthoracicnerveLateral:LateralandPosteriorcordofbrachialplexusMedial:axillaryv,superiorthoracica,apicallymphnodes★Axillaryartery2ndsegmentAnterior:

pectoralismajor,pectoralisminorPosterior:

Posteriorcordofbrachialplexus,subscapularisLateral:

Lateralcord,Medial:

medialcordofbrachialplexus,axillaryv,★Axillaryartery3rdsegmentAnterior:

pectoralismajor,medialrootofmediann.Posterior:

radialn.,axillaryn.posteriorcircumflexhumerala.andv.,subscapularis,latissimus

dorsi,tendonofteresmajor

Lateral:

Lateralrootofmediann.,Musculocutaneousn.bicepsbrachii(shorthead),coracobrachialis

Medial:

axillaryv,

ulnarn.,Medialantebrachial

cutaneousn.Axillaryvein腋靜脈Axillaryvein

腋靜脈Continuedwithbrachialveinatthelowerborderoftheteresmajor.Runsupwardonthemedialsideoftheaxillary

artery.EndsatthelateralborderofthefirstribbybecomingthesubclavianveinRelationship:Laterally:

axillarya.,medialcordofbrachialplexus,ulnarn.andantebrachial

cutaneousn.Medially:medialbrachialcutaneousn.Brachialplexus臂叢

FormationFiverootsformedbyanteriorramiofC5-C8andT1spinalnerves.ThreetrunksTheuppertrunkisformedbythejoiningofrootC4,C5,C6.ThemiddletrunkisthecontinuationofrootC7.ThelowertrunkisformedbythejoiningofrootC8andT1.Sixdivisions:aboveclavicle,trunksformanteriorandposteriordivisionsThreecords:belowclavicle,divisionsformthreecordsthatsurroundthesecondportionofaxillarya.Brachialplexus臂叢

Position

Passesthroughthescalenefissureposterosuperiortosubclavianartery,thenenterstheaxillatoformthreecordsBrachialplexus臂叢MainbranchesofSupraclavicularpartLongthoracicn.

胸長神經(jīng)ArisefromRootsC5～C7companieswiththelateralthoracica.,suppliesserratusanteriorParalysisoftheserratusanterior:Whentheserratusanteriorparalyzedbecauseofinjurytothelongthoracicnerve,themedialborderofthescapulamoveslaterallyandposteriorlyawayfromthethoracicwall,givingthescapulatheappearanceofawing.Suprascapularn.肩胛上神經(jīng)

Arisefromsuperiortrunktosupraspinous

fossaBrachialplexus臂叢MainbranchesofinfraclavicularpartLateralcord

Musculocutaneousn.肌皮神經(jīng)Lateralroottomediann.正中神經(jīng)外側(cè)根Lateralthoracicn.胸外側(cè)神經(jīng)Medialcord

Medialroottomediann.正中神經(jīng)內(nèi)側(cè)根Ulnarn.尺神經(jīng)medialthoracicn.胸內(nèi)側(cè)神經(jīng)Medialbrachialcutaneousn.臂內(nèi)側(cè)皮神經(jīng)Medialantebrachial

cutaneousn.前臂內(nèi)側(cè)皮神經(jīng)Posteriorcord

axillaryn.腋神經(jīng)radialn.橈神經(jīng)thoracodorsaln.胸背神經(jīng)subscapularn.

肩胛下神經(jīng)Brachialplexus臂叢Posteriorcord

axillaryn.腋神經(jīng)radialn.橈神經(jīng)thoracodorsaln.胸背神經(jīng)subscapularn.

肩胛下神經(jīng)★Axillarysheath腋鞘Extensionofdeepcervicalfasciaoftheneckintotheaxillaandformingatubularsheaththatsurroundsaxillarya.,axillaryv.andbrachialplexusClinicaltips：

Brachialplexusanesthesia鎖骨下臂叢麻醉

Spreadofinflammation感染蔓延★AxillarylymphnodearrangedinfivegroupsLaterallymphnodesliearoundthedistalendofaxillaryarteryveinreceiveafferentvesselsfromupperlimb.Pectorallymphnodesliealonglateralthoracicvessels,receiveafferentsfromanteriorthoracicwallincludingcentralandlateralportionofmammaSubscapularlymphnodealongsubscapularvesselsreceivelymphfromnapeandscapularregionEfferentsofabovethreegroupspasstocentrallymphnode★AxillarylymphnodeCentrallymphnodelieinfatofaxillary

fossareceivelymphfromalltheabovenodes,efferentspasstoapicallymphnodeApicallymphnodelieintheapexoftheaxilla,alongtheproximalendofaxillaryvesselsreceiveafferentschieflyfromcentrallymphnode,upperportionofmammaefferentsoftheapicalln.formsubclaviantrunk.Therightsubclaviantrunkjointstherightlymphaticduct,leftoneusuallydrainsdirectlyintothoracicductAnteriorbrachialregion臂前區(qū)SuperficialstructuresSkinSuperficialfasciaCephalicvBasilicvCutaneousn.Sup.Lat.brachialcutaneousn.臂外側(cè)上皮神經(jīng)(fromaxillaryn.)Inf.Lat.brachialcutaneousn.臂外側(cè)下皮神經(jīng)(fromradialn.)Intercoastobrachialn.肋間臂神經(jīng)Medialbrachialcutaneousn.臂內(nèi)側(cè)皮神經(jīng)Medialantebrachial

cutaneousn.前臂內(nèi)側(cè)皮神經(jīng)Superficial

veinsoftheupperlimb

★

Cephalicvein

頭靜脈Arisesfromthelateralsideofthedorsalvenousreteofhand

Windsaroundthelateralborderoftheforearm;itthenascendsintothecubital

fossaandupthefrontofthearmonthelateralsideofthebicepsbrachiiItcontinuesupinthedeltopectoralgrooveandthenpiercesdeepfasciatodraininto

axillaryveinorsubclavianvein頭靜脈貴要靜脈肘正中靜脈前臂正中靜脈頭靜脈Superficial

veinsoftheupperlimb★

Basilicvein貴要靜脈ArisesfromthemedialsideofthedorsalvenousreteofhandWindsaroundthemedialborderoftheforearmThenascendsintothecubital

fossaandupthefrontofthearmonthemedialsideofthebicepstomiddleofthearmwhereitpiercesthedeepfasciaandjoinsthebrachialveinoraxillaryvein頭靜脈貴要靜脈肘正中靜脈前臂正中靜脈頭靜脈DeepstructuresDeepfascia

EnclosesthearmandsendsintermuscularseptabetweenthevariousgroupsofmusclestoallowthemtoslideoneachotherandtogiveanincreasedareaoforiginfortheirfibersThelateralandmedialintermuscularseptadividethedistalpartofthearmintoanteriorandposteriorosseofascialcompartments

Contentsofanteriorosseofascialcompartmentofthearm

Muscles肱二頭肌bicepsbrachii

喙肱肌coracobrachialis

肱肌brachialis

brachiala.andv.deepbrachiala.andv.superiorulnarcollaterala.inferiorulnarcollaterala.musculocutaneousn.

Lateralantebrachial

cutaneousn.Mediann.Ulnarn.medialbrachialcutaneousn.medialantebrachial

cutaneousn.

ContentsofanteriorosseofascialcompartmentofthearmBicepsbrachii

肱二頭肌

Coracobrachialis

喙肱肌Brachialis

肱肌ContentsofanteriorosseofascialcompartmentofthearmBrachialartery

肱動脈BeginsatthelowerborderoftheteresmajorasacontinuationofaxillaryarteryTerminatesoppositetheneckofradiusbydividingintoradialandulnararteriesBranchesDeepbrachiala.

肱深動脈

FollowstheradialnerveintothespinalgrooveofthehumerusSuperiorulnar

collaerala.

尺側(cè)上副動脈

followstheulnarnerveInferiorulnarcollaterala.尺側(cè)下副動脈

Takespartintheanastomosisaroundtheelbowjoint.Clinicaltips:presstostopbloodflowContentsofanteriorosseofascialcompartmentofthearmMusculocutaneousnerve

肌皮神經(jīng)Origin:arisesfromthelateralcordofthebrachialplexus.Distribution:

BicepsbrachiiBrachalis

BBCnerve

Coracobrachialis

lateralantebrachial

cutaneousn.前臂外側(cè)皮神經(jīng)

Atthelateralmarginofbicepstendonitpiercesthedeepfasciajustabovetheelbow,thenrunsdownthelateralaspectoftheforearmSupplyskinonanterioraspectofforearmContentsofanteriorosseofascialcompartmentofthearmMediannerve

正中神經(jīng)Origin：ArisesfromthemedialandlateralcordofthebrachialplexusCourseDescendsonthelateralsideofbrachialarteryHalfwaydownthearm,itcrossesthebrachialarterytoreachitsmedialsideContentsofanteriorosseofascialcompartmentofthearmUlnarnerve

尺神經(jīng)OriginArisesfromthemedialcordofthebrachialplexusCourseDescendsonthemedialsideofbrachiala.Atthemiddleofthearm,itpiercesthemedialintermuscularseptumandpassesdownbehindthemedialepicondyleofthehumerusAnteriorregionoftheelbowSuperficialstructuresSkinSuperficialfasciaCephalicvBasilicvMediancubitalvLateralantebrachial

cutaneousn.Medialantebrachial

cutaneousn.SupratrochlearlymphnodesClinicaltips：thesupericialveinsarebig,fixedandsuperficial,aoptimalsiteforIntravenouspuncture靜脈穿刺andcatheterization導(dǎo)管插入術(shù)DeepStructures★

Cubital

fossa

肘窩★

Boundaries

Base－linedrawnthroughepicondylesofhumerusApex－brachioradialislaterallyandpronator

teresmediallyRoof－skin,superficialfascia,deepfasciaandaponeurosisofbicepsbrachiiFloor－brachialis,supinatorandcapsuleofelbowjoint★ContentsMiddle:Tendonofbicepsbrachii,

aponeurosisofbicepsbrachiiMedialtothebicepsbrachiitendon－fromlateraltomedialBrachiala.

－dividesintoradialandulnara.attheapexoffossaBrachialv.Mediann.Lateraltothebicepsbrachiitendonradialn.lateralantebrachial

cutaneousn.AnteriorregionoftheforearmSkinSuperficialfascia★Cephalicv.★Basilicv.Medianantebrachialv.Lateralantebrachial

cutaneousn.Medialantebrachial

cutaneousn.SuperficialstructuresDeepstructuresDeepfasciaintermuscularseptumandosseofibroussheathContentsofanterior

osseofascialsheathoftheforearmMuscle(9)Bloodsupplytothemuscles:ulnararteryandveinradialarteryandveinNervesupplytothemuscles:mediannerveulnarnerve

RadialnerveDeepbranchSuperficialbranchContentsofanterior

osseofascialsheathoftheforearmMuscle(9)Bloodsupplytothemuscles:ulnararteryandveinradialarteryandveinNervesupplytothemuscles:mediannerveulnarnerve

Contentsofanterior

osseofascialsheathoftheforearmMusclesinforearm(anterior)SuperficiallayerBrachioradialis

肱橈肌Pronator

teres

旋前圓肌Flexorcarpi

radialis

橈側(cè)腕屈肌Palmaris

longus

掌長肌Flexorcarpi

ulnaris

尺側(cè)腕屈肌Secondlayer指淺屈肌flexordigitorum

superficialisContentsofanterior

osseofascialsheathoftheforearmSecondlayerflexordigitorum

superficialis

指淺屈肌Thirdlayerflexordigitorum

profundus指深屈肌flexorpollicis

longus拇長屈肌FourthlayerPronator

quadratus旋前方肌Contentsofanterior

osseofascialsheathoftheforearmRadialartery

橈動脈Begins:branchofbrachiala.attheleveloftheneckofradiusinthecubital

fossa

Course:

passesdownwardandlaterallybetweentheBrachioradialisandPronatorteres(upper1/3),Flexorcarpi

radialis(lower2/3)BranchesRadialrecurrenta.橈側(cè)返動脈Superfical

palmarbranch

掌淺支Principalarteryofthumb

拇主要動脈Contentsofanterior

osseofascialsheathoftheforearmUlnarartery

尺動脈Begins：branchofbrachiala.attheleveloftheneckofradiusinthecubital

fossa

Course:passesdownwardandmediallydeeptothepronator

teres,flexordigitorum

superficialis(upper1/3)，thenbetweenflexordigitorum

superficialisandFlexorcarpi

ulnaris(lower2/3)BranchesUlnarrecurrenta.

尺側(cè)返動脈Commoninterosseousa.

骨間總動脈Anteriorinterossousa.骨間前動脈Posteriorinterosseousa.骨間后動脈Deeppalmarbranch

掌深支Contentsofanterior

osseofascialsheathoftheforearmMedian正中神經(jīng)CoursePassesbetweenthetwoheadsofthepronator

tereswheregivesrisetotheanteriorinterosseousnerve.Itcontinuesdownwarddeeptotheflexordigitorum

superficialisAtthewrist,itrunsdeeptopalmaris

longusandbetweenthetendonsofflexordigitorum

superficialisandflexorcarpi

radialis,thenentersthepalmbypassingbehindtheflexorretinaculumDistributionFlexorofforearmexceptbrachioradialis,flexorcarpi

ulnarisandulnarhalfofflexordigitorum

profundusContentsofanterior

osseofascialsheathoftheforearmUlnarnerve尺神經(jīng)

CoursePassesfrombehindthemedialepicondyleofthehumerus,andentersthefrontoftheforearmbypassingbetweenthetwoheadsoftheflexorcapiulnaris.Inthedistaltwo-thirdoftheforearm,theulnararteryliesonthelateralsideoftheulnarnerve.Atthewrist,itentersthepalmofthehandpassinginfrontoftheflexorretinaculumandlateraltothepisiformboneDistributionFlexorcarpi

ulnarisandulnarhalfofflexordigitorum

profundusContentsofanterior

osseofascialsheathoftheforearmSuperficialbranchoftheradialnerve橈神經(jīng)淺支CourseRunsdownonthelateralsideoftheradialarteryInthedistalpartoftheforearm,itleavesthearteryandpassesbackward,reachestheposteriorsurfaceofthewristandhandDistribution:

brachioradialis

Contentsofanterior

osseofascialsheathoftheforearm★

Nerve-bloodvesselboundsinforearmUlnarn.andbloodvesselboundulnarnerveulnararteryandulnarvein.Radialn.andbloodvesselboundsuperificalbranchofradialnerveradialarteryandradialveinMediann.andbloodvesselboundmediann.mediaa.andv.Anteriorinterosseousn.bloodvesselboundanteriorinterosseousnerveanteriorinterosseousarteryandveinAnteriorRegionofWristSuperficialstructureDeepstructureDeepfasciaSuperficiallayer

-palmarcarpallig.(volarcarpallig.)

coversallofthelongtendonsofthisregionDeeplayer

-flexorretinaculum（transversecarpallig.）Thickeningpartofdeepfasciainthehand.Attachedlaterallytoscaphoidandtrapeziunandmediallytopisiformandhamate，enclosesthelongtendonsofforearmexceptthepalmaris

longusandtheflexorcarpi

ulnaris★

Carpalcanal

腕管Anosseofibroustunnelformedbyflexorretinaculumandthegrooveofthecarpalbonestransmits

mediann.,tendonsofflexordigitorum

supericialis,tendonsofflexordigitorum

profundus,andtendonofflexorpollicus

longusfromforearmintohandAnteriorRegionofWristAnteriorRegionofWristUlnarcarpalcanal:theulnarendoftheflexorretinacumattachedtothepisiformandthehookofhamateandformstheulnarcarpalcanalwiththedistalpartofpalmarcarpal

lig.totransmittheulnarnerveandbloodvesselsRadialcarpalcanal:theradialendoftheflexorretinacumdividedintotwolayersandattachedtothetubercleofscaphoidandtrapezium,andformstheradialcarpalcanaltotransmitthetendonandtendoneoussheathoftheflexorcarpi

radialisAnteriorRegionofWristCommonflexorsheathTeninoussheathofflexorpollicis

longusAnteriorRegionofWrist手掌palmSkinSuperficialfasciaDeepfasciaTheosseofascialcompartmentofpalmMusclesofthehandBloodvesselsNervesPalmar

fascialspace手掌palmSkinSuperificialfasciaPalmar

cutaneous

brancheofulnarn.Palmar

cutaneous

brancheofmediann.Superficialbranchofradialn.Lateralantebrachial

cutaneousn.手掌palmDeepfasciaeThesuperficiallayerofdeepfasciaPalmar

aponeurosisThenarfasciaHypothenarfasciaWebspaceThedeeplayerofdeepfasciaPalmar

interosseousfasciaFasciaofadductorpollicisSeptumLateralintermuscularseptumofpalmMedialintermuscularseptumofpalm★

TheosseofascialcompartmentsofpalmLateral(thenar)compartment:外側(cè)鞘(魚際鞘)thenar

muscle(exceptfortheadductorpollicis)Tendonandtendinoussheathofflexorpollicis

longusBloodvesselsandnervesofthethumb★

Intermediate(central)compartment

中間鞘tendonsofflexordigitorum

superficialisandprofundus,andlumbricalescommonflexorsheathsuperficialpalmararchbranchesofmediann.andulnarn.palmarfasciaspaceMedial(hypothenar)compartment內(nèi)側(cè)鞘(小魚際鞘)HypothenarmusclesBloodvesselsandnervesofthelittlefinger

Theosseofascialcompartmentsofpalm★

PalmarfasciaspaceLocatedintheintermediatecompartmentofpalmonthefasciaofinterosseiandadductorpollicis.Thepalmar

intermediate(midpalmar)septumpassthemedialsideofflexortendonsofindexfingerandthefirstlumbricalmuscletothethirdmetarcarpalboneanddividesthespaceintotwoportionsThemidpalmarspace掌中間隙

proximallycommunicatewiththedeepspaceofforearmthroughthecarpalcanal,distallycommunicatewiththe2,3,4lumbricalcanalstotheweb’sspaceandthebackofthefingersThethenarspace魚際間隙

blindatproximalend,distallycommunicatewiththebackoftheindexfingerbythefirstlumbricalcanal.手掌palmMusclesofthehandLateralgroup－thenar魚際(4)Abductorpollicis

brevis拇短展肌Flexorpollicis

brevis

拇短屈肌Opponens

pollicis

拇對掌肌Adductorpollicis

拇收肌Medialgroup－h(huán)ypothenar小魚際(3)Abductordigiti

minimi

小指展肌Flexordigiti

minimi

brevis小指短屈肌Opponens

digiti

minimi小指對掌肌IntermedialgroupLumbricales(4)蚓狀肌Palmar

interossei(3)骨間掌側(cè)肌Dorsalinterossei(4)骨間背側(cè)肌手掌palmBloodvesslesSuperficialpalmararch掌淺弓Formedby

ulnara.andSuperficialpalmarbranchofradialartery.Crosstheflexortendonanddigitalbranchesofmediann.superficially.Branchescommonpalmardigitalarteries指掌側(cè)總動脈properpalmardigitalarteries指掌側(cè)固有動脈properpalmardigitalarteryof5thfinger小指掌側(cè)固有動脈手掌palmDeeppalmararch

掌深弓Formedbyradiala.anddeeppalmarbranchofulnara.Liesacrossthemetacarpalbonesjustdistaltotheirbases,accompaniedbythedeepbrabchesofulnarn.andv.Branchespalmarmetacarpalarteries掌心動脈手掌palmNervesofthehandTheulnarnerveDeepbranchSuperficialbranchesCommonpalmardigitaln.--properpalmardigitaln.Supply--

hypothenarmuscles,interossei,3rdand4thlumbricalsandadductorpollicis;skinofhypothenar,palmarsurfaceofulnaroneandone-halffingersMediannerveRecurentbranchCommonpalmardigitaln.--properpalmardigita