anaesthesia anatomy
DESCRIPTION
ANAESTHESIA ANATOMY. Li Xuetao DEPARTMENTOF HUMAN ANATOMY KUNMING MEDICAL UNIVERSITY. BACK (VERTEBRAL REGION). Vertebrae 椎骨、脊柱. Case: Tension Headache. a 53-year-old lorry driver headaches in the occipital region (枕区) Pain start with driving lying down brought relief - PowerPoint PPT PresentationTRANSCRIPT
ANAESTHESIA ANATOMYANAESTHESIA ANATOMY
Li XuetaoLi Xuetao
DEPARTMENTOF HUMAN ANATOMY DEPARTMENTOF HUMAN ANATOMY
KUNMING MEDICAL UNIVERSITYKUNMING MEDICAL UNIVERSITY
BACKBACK
(VERTEBRAL REGION)(VERTEBRAL REGION)
VertebraeVertebrae 椎骨、脊柱椎骨、脊柱
Case: Tension HeadacheCase: Tension Headache
Mr. PortMr. Port
a 53-year-old lorry drivera 53-year-old lorry driver
headaches in the headaches in the
occipital regionoccipital region (枕区)(枕区)Pain start with drivingPain start with driving
lying down brought relieflying down brought relief
pain for six monthspain for six months
Slight wear and tear between Slight wear and tear between the cervical vertebrae bodythe cervical vertebrae body
Sitting posture correctionSitting posture correction
Answer the questions regarding Answer the questions regarding the case at the end of this the case at the end of this
chapter chapter
1. What classes of joints are there 1. What classes of joints are there between typical cervical vertebrae? between typical cervical vertebrae?
2. What are the normal curvatures of the 2. What are the normal curvatures of the vertebral column? vertebral column?
3. What movements occur between typical 3. What movements occur between typical cervical vertebrae? What movements cervical vertebrae? What movements occur at the atlanto-occipital (occur at the atlanto-occipital ( 寰枕关寰枕关节)节) and the atlanto-axialand the atlanto-axial (寰枢关节)(寰枢关节) joints? joints?
4. Where does the vertebral artery lie in 4. Where does the vertebral artery lie in relation to the cervical vertebrae? relation to the cervical vertebrae?
5. How might the function of the vertebral 5. How might the function of the vertebral artery be assessed? artery be assessed?
6. Why was the headache felt in the 6. Why was the headache felt in the occipital region? occipital region?
Surface Surface Anatomy Anatomy
11.. 棘突 :第棘突 :第 77 颈椎棘突较长,常作为 颈椎棘突较长,常作为 辨认椎体序数的标志; 辨认椎体序数的标志;
两侧肩胛冈内侧端的连线平第两侧肩胛冈内侧端的连线平第 33 胸椎胸椎棘突; 棘突;
两侧髂嵴最高点的连线平第两侧髂嵴最高点的连线平第 44 腰椎棘腰椎棘突。突。
2.2. 枕外隆凸:颅后部明显的骨性突起。枕外隆凸:颅后部明显的骨性突起。 3.3. 乳突:在耳廓的后方。乳突:在耳廓的后方。 4.4. 肩胛冈:外侧端为肩峰。肩胛冈:外侧端为肩峰。
5.5. 肩胛骨下角:两肩胛骨下角的连线肩胛骨下角:两肩胛骨下角的连线平对第平对第 77 胸椎棘突。胸椎棘突。
6.6. 骶管裂孔和骶角:骶管裂孔是椎管骶管裂孔和骶角:骶管裂孔是椎管的下口,裂孔两侧向下的突起为骶角,的下口,裂孔两侧向下的突起为骶角,是骶管麻醉的进针定位标志。是骶管麻醉的进针定位标志。
7.7. 髂嵴和髂后上棘:两侧髂嵴最高点髂嵴和髂后上棘:两侧髂嵴最高点的连线平第的连线平第 44 腰椎棘突。两侧髂后上腰椎棘突。两侧髂后上棘的连线平第棘的连线平第 22 骶椎棘突。骶椎棘突。
LAYERSLAYERS
Superficial Superficial layerslayers
Deep fasciaDeep fascia MusclesMuscles
Superficial layersSuperficial layers
SkinSkin Superficial fasciaSuperficial fascia
SkinSkin
Thick Thick Full of hairFull of hair folliclesfollicles, , sweat glands & sebaceous glands sweat glands & sebaceous glands
Superficial fasciaSuperficial fascia
Dense, especially the Nuchal regionDense, especially the Nuchal regionFull of FatFull of FatCutaneous nerve & Superficial Cutaneous nerve & Superficial
blood vesselsblood vessels
Cutaneous nerveCutaneous nerve
Greater occipital nerveGreater occipital nerve
3rd occipital nerve3rd occipital nerve
Spinal nerve (cutaneous Spinal nerve (cutaneous branches of dorsal rami)branches of dorsal rami)Superior cluneal nerve Superior cluneal nerve (cutaneous branches of (cutaneous branches of dorsal rami)dorsal rami)
Middle cluneal nerve Middle cluneal nerve (cutaneous branches of (cutaneous branches of dorsal rami)dorsal rami)
Inferior cluneal nerve Inferior cluneal nerve (posterior femoral (posterior femoral cutaneous nerve cutaneous nerve
Herpes Zoster
Infections (Shingles)
Superficial Blood VesselsSuperficial Blood Vessels
NuchalNuchalOccipital arteryOccipital artery
Superficial cervical arterySuperficial cervical artery
dorsal scapular arterydorsal scapular artery
Thoracic Thoracic dorsal dorsal
Posterior intercostals arteryPosterior intercostals artery
dorsal scapular arterydorsal scapular artery
thoracodorsal arterythoracodorsal artery
Lumber Lumber Lumbar arteryLumbar artery
SacrococcygeaSacrococcygeall
Superior Cluneal arterySuperior Cluneal artery
Inferior cluneal arteryInferior cluneal artery
Deep FasciaDeep Fascia
Nuchal fasciaNuchal fascia: a deep investing : a deep investing
membrane which covers the deep membrane which covers the deep
muscles of the back of the neck.muscles of the back of the neck.
Thoracolumbar fasciaThoracolumbar fascia: a deep investing : a deep investing
membrane which covers the deep membrane which covers the deep
muscles of the back of the trunk.muscles of the back of the trunk.
Nuchal FasciaNuchal Fascia
ThoracolumbaThoracolumbar Fasciar Fascia
a deep investing a deep investing membrane which membrane which covers the deep covers the deep muscles of the muscles of the back of the trunkback of the trunk
3 layers in 3 layers in lumbar regionlumbar region
Q.L
Erector spinae
MUSCLESMUSCLES
intrinsic back intrinsic back musclesmuscles
movement and movement and stabilization of stabilization of the vertebral the vertebral
columncolumn
respiration and respiration and movements of movements of
the upper the upper extremityextremity
extrinsic back extrinsic back musclesmuscles
IntermediaIntermediate groupte group
Deep Deep groupgroup
Superficial Superficial groupgroup
TrapeziusTrapezius
levator scapulaelevator scapulae
Rhomboid minorRhomboid minor
Rhomboid majorRhomboid major
Latissimus dorsiLatissimus dorsi
Superficial GroupSuperficial Group
Triangle Of AuscultationTriangle Of AuscultationS
UP
ER
IOR
SU
PE
RIO
R
INF
ER
IOR
INF
ER
IOR
Latissimus dorsi
Latissimus dorsi
TrapeziusTrapezius
medial border o
f scapula
medial border o
f scapula
Serratus posterior Serratus posterior superiorsuperior
Serratus posterior inferiorSerratus posterior inferior
Intermediate GroupIntermediate Group
DEEP GROUPDEEP GROUP
Spinotransversales MusclesSpinotransversales Muscles
Splenius CapitisSplenius Capitis
Splenius CervicisSplenius Cervicis
ErectorErector Spine Muscles Spine Muscles
IliocostalisIliocostalis
Longissimus Longissimus
SpinalisSpinalis
DEEP GROUPDEEP GROUP
Transversospinales musclesTransversospinales muscles
SemispinalisSemispinalis
RotatoresRotatores
MultifidusMultifidus
Segmental back musclesSegmental back muscles
Levatores costarumLevatores costarum
InterspinalesInterspinales
IntertransversariiIntertransversarii
P59P59
DEEP GROUPDEEP GROUP
Suboccipital MusclesSuboccipital Muscles
Rectus Capitis Posterior Rectus Capitis Posterior MinorMinor
Rectus Capitis Posterior Rectus Capitis Posterior MajorMajor
Superior Oblique Superior Oblique
Inferior ObliqueInferior Oblique
Rectus Capitis Rectus Capitis Posterior MajorPosterior Major
Superior Rectus Superior Rectus ObliqueOblique
Inferior Rectus Inferior Rectus ObliqueOblique
Vertebral Artery Suboccipital N
(Dorsal Ramus Of CⅠ)
Suboccipital Suboccipital TriangleTriangle
Superior Lumbar TriangleSuperior Lumbar Triangle(Triangle Of Grynfeltt-Lesshaft )(Triangle Of Grynfeltt-Lesshaft )
twelfth ribtwelfth ribSerratus Serratus
posterior posterior inferior inferior
Erector spinae Erector spinae internal obliqueinternal oblique
External External Abdominal Abdominal ObliqueOblique
Latissimus DorsiLatissimus Dorsi Iliac CrestIliac Crest
Inferior Lumbar TriangleInferior Lumbar Triangle(Petit's Lumbar Triangle)(Petit's Lumbar Triangle)
Deep ArteriesDeep Arteries
Nuchal RegionNuchal Region
Occipital ArteryOccipital Artery
Superficial Cervical ArterySuperficial Cervical Artery
Dorsal Scapular ArteryDorsal Scapular Artery
Vertebral ArteryVertebral Artery
Thoracic RegionThoracic Region
Posterior Intercostals ArteryPosterior Intercostals Artery
Dorsal Scapular ArteryDorsal Scapular Artery
Thoracodorsal ArteryThoracodorsal Artery
Lumber RegionLumber RegionLumbar ArteryLumbar Artery
Subcostal ArterySubcostal Artery
Sacrococcygeal Sacrococcygeal RegionRegion
Superior Cluneal ArterySuperior Cluneal Artery
Inferior Cluneal ArteryInferior Cluneal Artery
NuchalNuchalVertebral veinVertebral vein
Internal jugular veinInternal jugular vein
Subclavian veinSubclavian vein
ThoraciThoracicc
Posterior Intercostals vein – azygos Posterior Intercostals vein – azygos veinvein
Subclavian veinSubclavian vein
Axillary veinAxillary vein
LumberLumber Lumbar vein – inferior vena cavaLumbar vein – inferior vena cava
SacrocoSacrococcygeal ccygeal Internal iliac veinInternal iliac vein
DEEP VEINSDEEP VEINS
Vertebral Vertebral ArteryArtery
AtlasAtlas
Vertebral VeinsVertebral Veins
Deep NerversDeep Nervers
Dorsal rami of spinal nerveDorsal rami of spinal nerve
Accessory nerveAccessory nerve
Thoracodorsal nerveThoracodorsal nerve
Dorsal scapular nerveDorsal scapular nerve
Dorsal Rami of Spinal NerveDorsal Rami of Spinal Nerve
Accessory NerveAccessory Nerve
Transient Transient postoperativpostoperative paralysis of e paralysis of
spinal spinal accessory accessory
nervenerve
Thoracodorsal Nerve
Dorsal Scapular Dorsal Scapular NerveNerve
Vertebral ColumnVertebral Column
Osteology and ArthrologyOsteology and Arthrology
OsteologyOsteology
7 C, 12 T, 5 L, 5 S (Fused as Sacrum), 4 7 C, 12 T, 5 L, 5 S (Fused as Sacrum), 4 coccygealcoccygeal
Primary CurvesPrimary CurvesSecondary CurvesSecondary CurvesAnterior/Posterior alignmentAnterior/Posterior alignment
Vertebral SegmentsVertebral Segments
Primary CurvePrimary Curve
Secondary Curves LateralSecondary Curves Lateral
Vertebral ColumnVertebral Column
OsteologyOsteology Typical VertebraeTypical Vertebrae BodyBody 椎体椎体
Superior and inferior surfaces of body (plateaus)Superior and inferior surfaces of body (plateaus) Thickened around the rim, location of epiphyseal platesThickened around the rim, location of epiphyseal plates Cartilaginous end-platesCartilaginous end-plates
Vertebral ArchVertebral Arch 椎弓椎弓 Pedicles, LaminaePedicles, Laminae Transverse ProcessesTransverse Processes Spinous ProcessSpinous Process Facets – superior articular and inferior articular Facets – superior articular and inferior articular
Spinal ForamenSpinal Foramen 椎孔椎孔 Intervertebral ForamenIntervertebral Foramen 椎间孔椎间孔
Typical VertebraeTypical Vertebrae
Typical VertebraeTypical Vertebrae
Typical CTypical C
Luschka JoinLuschka Join 钩椎关节钩椎关节
钩椎关节及其毗邻钩椎关节及其毗邻
Typical CTypical C
C6C6
C1/C2C1/C2
Typical ThoracicTypical Thoracic
Facet Joints (C and T)Facet Joints (C and T)
Facets LFacets L
Typical LumbarTypical Lumbar
Sacrum and CoccyxSacrum and Coccyx
Vertebral ColumnVertebral Column
ArthrologyArthrology
Intervertebral DiscsIntervertebral Discs 椎间盘椎间盘Fibrocartilaginous jointsFibrocartilaginous joints 纤维软骨连接纤维软骨连接 Increase in size from C to L (3mm to 9 Increase in size from C to L (3mm to 9
mm)mm)Ratio remains the sameRatio remains the sameMake up 20-30% of length of columnMake up 20-30% of length of column
Intervertebal DiscsIntervertebal Discs
Discs Discs
DiscsDiscs
ArthrologyArthrology
Facet Joints (Typical)Facet Joints (Typical) Superior articular facets of one vertebrae with Superior articular facets of one vertebrae with
inferior facets of vertebrae aboveinferior facets of vertebrae above Synovial gliding joints Synovial gliding joints Surrounded by joint capsule and small capsular Surrounded by joint capsule and small capsular
ligamentsligaments The type and amount of motion in any given part The type and amount of motion in any given part
of the spine is dictated by the orientation of the of the spine is dictated by the orientation of the articular facets as well as the fluidity, elasticity and articular facets as well as the fluidity, elasticity and thickness of the intervertebral discsthickness of the intervertebral discs
ArthrologyArthrology
Typical movements in sections of the Typical movements in sections of the spinespine
LumbarLumbarThoracicThoracicCervicalCervical
Major Ligaments of the SpineMajor Ligaments of the Spine
Anterior Longitudinal Ligament - ALLAnterior Longitudinal Ligament - ALL Dense band along anterior and lateral surface of Dense band along anterior and lateral surface of
the vertebral bodies from C2 to sacrumthe vertebral bodies from C2 to sacrum Superficial - bridge several vertebraeSuperficial - bridge several vertebrae Deep – short, run from V to V, blends with fibers of anulus Deep – short, run from V to V, blends with fibers of anulus
fibrosusfibrosus Limits extension of V columnLimits extension of V column
From C1 to skull, called From C1 to skull, called Atlanto-Occipital Atlanto-Occipital MembraneMembrane
ALLALL
Atlanto-Occipital MembraneAtlanto-Occipital Membrane
A and P Longitudinal LigamentA and P Longitudinal Ligament
Major LigamentsMajor Ligaments
Posterior Longitudinal LigamentPosterior Longitudinal LigamentRuns along posterior surface of vertebral Runs along posterior surface of vertebral
bodies (anterior to spinal canal) bodies (anterior to spinal canal) C2 to SacrumC2 to SacrumShort fibers attach ligament to posterior disc, Short fibers attach ligament to posterior disc,
reinforce disc posteriorlyreinforce disc posteriorlySuperiorly, continues to occiput, called Superiorly, continues to occiput, called
Tectorial MembraneTectorial MembraneLimits flexionLimits flexion
PLLPLL
Tectorial MembraneTectorial Membrane
LigamentsLigaments
SupraspinousSupraspinous 棘上韧带棘上韧带Spinous process to spinous process – tip to Spinous process to spinous process – tip to
tiptipC7 to sacrumC7 to sacrum
Limits flexionLimits flexion In cervical region, becomes much thicker In cervical region, becomes much thicker
with a greater elastic contentwith a greater elastic contentCalled Called Ligamentum NuchaeLigamentum Nuchae
SupraspinousSupraspinous
Ligamentum NuchaeLigamentum Nuchae
LigamentsLigaments
InterspinousInterspinous 棘间韧带棘间韧带Found between spinous processesFound between spinous processesMost well developed in lumbar regionMost well developed in lumbar regionsupportsupport
InterspinousInterspinous
InterspinousInterspinous
LigamentsLigaments
Ligamentum FlavumLigamentum Flavum 黄韧带黄韧带Connects laminaConnects lamina 椎板椎板 of one to lamina of of one to lamina of
the otherthe otherFound from axisFound from axis 枢椎枢椎 to sacrumto sacrum 骶骨骶骨Limit flexionLimit flexionContinuation to the skullContinuation to the skull 颅骨颅骨 is called is called
Posterior Atlanto-Occipital membranePosterior Atlanto-Occipital membrane
后寰枕关节膜后寰枕关节膜
Ligamentum FlavumLigamentum Flavum 黄韧带黄韧带
Atlanto-Occipital Membrane-Atlanto-Occipital Membrane-PosteriorPosterior
LigamentsLigaments
IntertransverseIntertransverse 横突间韧带横突间韧带Only well-developed in Lumbar RegionOnly well-developed in Lumbar RegionBetween transverse processesBetween transverse processesLimit lateral flexionLimit lateral flexion 侧曲侧曲
Atlanto-Axial JointAtlanto-Axial Joint寰枢关节寰枢关节
Atlas and AxisAtlas and Axis PivotPivot 旋转运动旋转运动 Two convex superior facets of axis with two Two convex superior facets of axis with two
concave inferior facets of the atlasconcave inferior facets of the atlas Atlas also posses a facet on the internal surface of Atlas also posses a facet on the internal surface of
the anterior arch which articulates with the dens of the anterior arch which articulates with the dens of the axisthe axis
Major ligaments from spine support – Major ligaments from spine support – Ant. Ant. Atlanto-Occipital, Tectorial Membrane, Post. A-Atlanto-Occipital, Tectorial Membrane, Post. A-OO
C1/C2C1/C2
C1/C2C1/C2
C1/C2C1/C2
A-A JointA-A Joint
Alar – from dens to occiputAlar – from dens to occiputTransverse - around dens Transverse - around dens CruciateCruciate
Sup. Longitudinal BandSup. Longitudinal Band Inferior Longitudinal BandInferior Longitudinal BandTransverseTransverse
Atlanto-Occipital JointAtlanto-Occipital Joint寰枕环节寰枕环节
Two concave superior facets of atlas Two concave superior facets of atlas articulate with two convex surfaces of articulate with two convex surfaces of occipital condyles of the skulloccipital condyles of the skull
Supported by major ligamentsSupported by major ligamentsSmall saddle jointSmall saddle jointVery limited motion Very limited motion – nodding type – nodding type
motions in all directions.motions in all directions.
Atlanto-OccipitalAtlanto-Occipital
Atlanto-OccipitalAtlanto-Occipital
Movement of the Vertebral ColumnMovement of the Vertebral Column
Flex Flex 屈屈Extend Extend 伸伸Rotation Rotation 旋转旋转Lateral flex Lateral flex 侧曲侧曲
Thank youThank you
That’s all for today! That’s all for today!