2. Regional Anatomy Ling Shucai

3. ① Head ② Neck ③ Thorax ④ Abdomen ⑤ Pelvis ⑥ Limbs ⑦ Back ⑧ Vertebral region 头部颈部胸部 腹部盆部 四肢 背部脊柱区

4. The pectoral region and axillary region Regional anatomy of upper limb Ling Shucai

5. Ⅰ. The pectoral region

6. 1. Surface anatomy 表面解剖 2. The superficial structures 浅层结构 Superficial veins 浅静脉 Superficial lymph vessels 浅淋巴管 Cutaneous nerves 皮神经 3. The deep structures 深层结构 The deep fascia 深筋膜 The muscles 肌肉 The vessels 血管 The nerves 神经 4. Regional anatomy 局部解剖 The breast (mamma) 乳房 The clavipectoral fascia 锁胸筋膜 Main contents

7. 1. Surface anatomy

8. 剑 肋 角 剑 肋 角

9. Skin incisions

10. 2. The superficial structures

11. The cutaneous nerves 皮神经 The superficial blood vessels 浅血管 The superficial lymphatic vessels 浅淋巴管 The breast 乳房 Superficial Structures

12. Cephalic v. Lateral cutaneous branch Anterior cutaneous branch

14. 3. The deep structures

15. The muscles of thorax Extrinsic muscles Pectoralis major 胸大肌 Pectoralis minor 胸小肌 Serratus anterior 前锯肌 Intrinsic muscles Intercostales externi 肋间外肌 Intercostales interni 肋间内肌 Intercostales intimi 肋间最内肌

16. 4. Regional anatomy

17. Mamma 乳房 Mamma 乳房 Position Lie in superficial fascia over the pectorals major and pectoral fascia Extend from 3rd to 7th ribs vertically, and from parasternal line to midaxillary line transversally

18. Structures － contains skin, mammary glands and adipose tissue Each brest has about 15 ～ 20 lobes of mammary gland Each lobe radiates out from the nipple and has a lactiferous duct 输乳管 which opens separately on the summit of the nipple and possesses a dilated lactiferous sinuses 输乳管 窦 just prior to its termination

19. Suspensory ligaments of breast 乳房悬韧带 (cooper’s ligaments ) － strands of connective tissue runs between skin and deep fascia and serve to support the mammary glands

21. The deep faxcia which extends between subclavius, coracoid process and pectoralis minor muscles The structures pass through the clavipectoral faxcia Cephalic v. Cephalic v. Thoracoacromial a. Thoracoacromial a. Lateral pectoral n. Lateral pectoral n. Clavipectoral fascia 锁胸筋膜

22. 锁胸筋膜及其穿行结构 Clavipectoral fascia Suspensory ligament of axilla

23. 锁胸筋膜及其穿行结构 is pierced by the cephalic vein 头静脉, lymphatic vessels 淋巴 管,thoracoacromial artery and vein 胸肩峰动、静脉, lateral pectoral nerve 胸外侧神经. “ 二进二出 ” Clavipectoral fascia

24. Ⅱ. The axillary region

25. 1. Boundaries of the axilla 2. Contents of the axilla 3. Regional anatomy Main contents

26. Axillary fossa 腋窝 一尖一底四个壁 The axillary fossa is a pyramid-shaped space through which major neurovascular structures pass between the thorax and upper extremity 1. Boundaries of the axilla

27. The apex is a triangular space limited by the first rib, the scapula, and the middle third of clavicle. The base － skin and fascia of the axillary fossa Boundaries of the axilla

28. The anterior wall Pectoralis major, pectoralis minor and subclavius muscles Pectoralis major, pectoralis minor and subclavius muscles Clavipectoral fascia 锁胸筋膜 Clavipectoral fascia 锁胸筋膜

29. The broad medial wall － serratus anterior ， intercostal muscles and upper four ribs The narrow lateral wall － coracobrachialis, biceps brachii and intertubercular groove

30. The posterior wall subscapularis 肩胛下肌, teres major 大圆肌 subscapularis 肩胛下肌, teres major 大圆肌 latissimus dorsi 背阔肌, scapula 肩胛骨 latissimus dorsi 背阔肌, scapula 肩胛骨

31. Boundaries of the axilla Apex Base ： axillary fascia 腋筋膜 Anterior wall ： pectoralis major and pectoralis minor 胸大、小肌 subclavius muscles 锁骨下肌 clavipectoral fascia 锁胸筋膜 Posterior wall ： subscapularis 肩胛下肌, teres major 大圆肌 latissimus dorsi 背阔肌, scapula 肩胛骨 Medial wall ： serratus anterior 前锯肌， intercostal muscles 肋间内肌 and upper four ribs Lateral wall ： coracobrachialis 喙肱肌, biceps brachii 肱二头肌 intertubercular groove 结节间沟

32. 2. Contents of the axilla Axillary artery Axillary vein Infraclavicular part of brachial plexus Axillary sheath Axillary lymph nodes

33. Axillary artery Continuation of subclavian artery at lateral border of first rib Becomes brachial artery at lower border of teres major Divided into three parts by overlying pectoralis minor thoracoacromial a. 胸肩峰动脉 lateral thoracic a. 胸外侧动脉 subscapular a. 肩胛下动脉, throcodorsal a. 胸背动脉 and circumflex scapular a. 旋肩胛动脉 anterior and posterior humeral circumflex a. 旋肱前、后动脉 ;

34. Axillary artery were divided into three parts:

35. Axillary a. Thoracoacromial a. Musculocutaneous n. Median n. Medial antebrachial cutaneous n. Ulnar n. Medial brachial cutaneous n. Intercostobrachial n. Thoracodorsal n. & a. Long thoracic n. & lateral thoracic a. Lateral pectoral n. Axillary vein

36. Brachial plexus 臂丛 Formation : （根、干、股、束） Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5 ～ C7give rise to long thoracic n. Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5 ～ C7give rise to long thoracic n. 胸长神经 Three trunks Six divisions Three cords: below clavicle, divisions form three cords that surround the second portion of axillary a.

37. Main branches Lateral cord Musculocutaneous n. Musculocutaneous n. 肌皮神经 Lateral root to median n. Lateral root to median n. 正中神经外侧根 Medial cord Medial root to median n. Medial root to median n. 正中神经内侧根 Ulnar n. Ulnar n. 尺神经 Medial brachial cutaneous n. Medial brachial cutaneous n. 臂内侧皮神经 Medial antebrachial cutaneous n. Medial antebrachial cutaneous n. 前臂内侧皮神经

38. Posterior cord radial n. radial n. 桡神经 axillary n. axillary n. 腋神经 thoracodorsal n. thoracodorsal n. 胸背神经

39. Musculocutaneous Musculocutaneous 肌皮神经

40. Median nerve 正中神经 Distribution Distribution Injury: Injury: ape-like hand 猿掌 ape-like hand 猿掌

41. Ulnar nerve 尺神经 Distribution Distribution Injury: Injury: clawhand 爪形手 clawhand 爪形手

42. Radial nerve 桡神经 Distribution: Distribution: Injury: Injury: Wristdrop 垂腕 Wristdrop 垂腕

43. Axillary nerve Distribution: Distribution: Injury: result in deltoid and teres minor paralysis Injury: result in deltoid and teres minor paralysis

44. Axillary lymph nodes － arranged in five groups Lateral lymph nodes 外侧淋巴结 Pectoral lymph nodes 胸肌淋巴结 Subscapular lymph node 肩胛下淋巴结 Efferents above three groups pass to central lymph node 中央淋巴结 中央淋巴结

45. Central lymph node 中央淋巴结 Apical lymph node 尖淋巴结

46. 3. Regional anatomy Trilateral and quadrilateral foramina 三边孔和四边孔 Axillary sheath 腋鞘 Lymph vessels and node of mammary gland

47. Trilateral and quadrilateral foramina 三边孔和四边孔 posterior humeral circumflex a. and axillary n. pass through the quadrilateral foramen. The circumflex scapular a. passes through the triangular space to reach the dorsum of the scapula.

48. Axillary sheath Axillary sheath 腋鞘 － extension of deep cervical fascia （颈深筋 膜） of the neck, forming a tubular sheath that surrounds axillary a. and v., and brachial plexus

49. 乳房的淋巴引流乳房的淋巴引流乳房的淋巴引流乳房的淋巴引流

50. The superficial structures of anterior and medial regions of the thigh

52. Superficial epigastric v. External pudendal v. Superficial circumflex iliac v. Lateral cutaneous n. of thigh Anterior cutaneous n. of thigh Great saphenous v. Dissection Superficial lateral femoral v. Superficial medial femoral v.

54. 思考题 1. 试述腋腔的境界、内容及排列关系。 2. 肱二头肌内侧沟内有哪些结构走行，其位置关系如何？ 3. 试述腋动脉的分段，各段有哪些分支？ 4. 试述臂丛的三个束的位置及主要分支。 5. 试述正中神经、肌皮神经、尺神经、桡神经和腋神经的支配情 况及其损伤表现。 6. 试述腋淋巴结的分群及回流途径，思考乳腺癌的淋巴转移途径。 7. 名词解释：锁胸筋膜、腋鞘、三边孔、四边孔