anaesthesia anatomy

101
ANAESTHESIA ANATOMY ANAESTHESIA ANATOMY Li Xuetao Li Xuetao DEPARTMENTOF HUMAN ANATOMY DEPARTMENTOF HUMAN ANATOMY KUNMING MEDICAL UNIVERSITY KUNMING MEDICAL UNIVERSITY

Upload: hung

Post on 12-Jan-2016

26 views

Category:

Documents


3 download

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 Presentation

TRANSCRIPT

Page 1: ANAESTHESIA ANATOMY

ANAESTHESIA ANATOMYANAESTHESIA ANATOMY

Li XuetaoLi Xuetao

DEPARTMENTOF HUMAN ANATOMY DEPARTMENTOF HUMAN ANATOMY

KUNMING MEDICAL UNIVERSITYKUNMING MEDICAL UNIVERSITY

Page 2: ANAESTHESIA ANATOMY

BACKBACK

(VERTEBRAL REGION)(VERTEBRAL REGION)

Page 3: ANAESTHESIA ANATOMY

VertebraeVertebrae 椎骨、脊柱椎骨、脊柱

Page 4: ANAESTHESIA ANATOMY

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

Page 5: ANAESTHESIA ANATOMY

Slight wear and tear between Slight wear and tear between the cervical vertebrae bodythe cervical vertebrae body

Page 6: ANAESTHESIA ANATOMY

Sitting posture correctionSitting posture correction

Page 7: ANAESTHESIA ANATOMY

Answer the questions regarding Answer the questions regarding the case at the end of this the case at the end of this

chapter chapter

Page 8: ANAESTHESIA ANATOMY

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?

Page 9: ANAESTHESIA ANATOMY

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?

Page 10: ANAESTHESIA ANATOMY

Surface Surface Anatomy Anatomy

Page 11: ANAESTHESIA 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。

Page 12: ANAESTHESIA ANATOMY

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。

Page 13: ANAESTHESIA ANATOMY

LAYERSLAYERS

Superficial Superficial layerslayers

Deep fasciaDeep fascia MusclesMuscles

Page 14: ANAESTHESIA ANATOMY

Superficial layersSuperficial layers

SkinSkin Superficial fasciaSuperficial fascia

Page 15: ANAESTHESIA ANATOMY

SkinSkin

Thick Thick Full of hairFull of hair folliclesfollicles, , sweat glands & sebaceous glands sweat glands & sebaceous glands

Page 16: ANAESTHESIA ANATOMY

Superficial fasciaSuperficial fascia

Dense, especially the Nuchal regionDense, especially the Nuchal regionFull of FatFull of FatCutaneous nerve & Superficial Cutaneous nerve & Superficial

blood vesselsblood vessels

Page 17: ANAESTHESIA ANATOMY

Cutaneous nerveCutaneous nerve

Page 18: ANAESTHESIA ANATOMY

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

Page 19: ANAESTHESIA ANATOMY

Herpes Zoster

Infections (Shingles)

Page 20: ANAESTHESIA ANATOMY

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

Page 21: ANAESTHESIA ANATOMY

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.

Page 22: ANAESTHESIA ANATOMY

Nuchal FasciaNuchal Fascia

Page 23: ANAESTHESIA ANATOMY

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

Page 24: ANAESTHESIA ANATOMY

Q.L

Erector spinae

Page 25: ANAESTHESIA ANATOMY

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

Page 26: ANAESTHESIA ANATOMY

TrapeziusTrapezius

levator scapulaelevator scapulae

Rhomboid minorRhomboid minor

Rhomboid majorRhomboid major

Latissimus dorsiLatissimus dorsi

Superficial GroupSuperficial Group

Page 27: ANAESTHESIA ANATOMY

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

Page 28: ANAESTHESIA ANATOMY

Serratus posterior Serratus posterior superiorsuperior

Serratus posterior inferiorSerratus posterior inferior

Intermediate GroupIntermediate Group

Page 29: ANAESTHESIA ANATOMY

DEEP GROUPDEEP GROUP

Spinotransversales MusclesSpinotransversales Muscles

Splenius CapitisSplenius Capitis

Splenius CervicisSplenius Cervicis

ErectorErector Spine Muscles Spine Muscles

IliocostalisIliocostalis

Longissimus Longissimus

SpinalisSpinalis

Page 30: ANAESTHESIA ANATOMY

DEEP GROUPDEEP GROUP

Transversospinales musclesTransversospinales muscles

SemispinalisSemispinalis

RotatoresRotatores

MultifidusMultifidus

Segmental back musclesSegmental back muscles

Levatores costarumLevatores costarum

InterspinalesInterspinales

IntertransversariiIntertransversarii

P59P59

Page 31: ANAESTHESIA ANATOMY

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

Page 32: ANAESTHESIA ANATOMY

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

Page 33: ANAESTHESIA ANATOMY

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

Page 34: ANAESTHESIA ANATOMY

External External Abdominal Abdominal ObliqueOblique

Latissimus DorsiLatissimus Dorsi Iliac CrestIliac Crest

Inferior Lumbar TriangleInferior Lumbar Triangle(Petit's Lumbar Triangle)(Petit's Lumbar Triangle)

Page 35: ANAESTHESIA ANATOMY

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

Page 36: ANAESTHESIA ANATOMY
Page 37: ANAESTHESIA ANATOMY

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

Page 38: ANAESTHESIA ANATOMY

Vertebral Vertebral ArteryArtery

AtlasAtlas

Page 39: ANAESTHESIA ANATOMY

Vertebral VeinsVertebral Veins

Page 40: ANAESTHESIA ANATOMY

Deep NerversDeep Nervers

Dorsal rami of spinal nerveDorsal rami of spinal nerve

Accessory nerveAccessory nerve

Thoracodorsal nerveThoracodorsal nerve

Dorsal scapular nerveDorsal scapular nerve

Page 41: ANAESTHESIA ANATOMY

Dorsal Rami of Spinal NerveDorsal Rami of Spinal Nerve

The term spinal nerve generally refers to the mixed spinal nerve, which is formed from the dorsal and ventral roots that come out of the spinal cord. The spinal nerve is the bit that passes out of the vertebrae through the intervertebral foramen.There are a total of 31 bilaterally-paired spinal nerves :8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal The first to seventh cervical nerves (C1 to C7) exit from the vertebral canal above the respective cervical vertebra (that is to say, C1 exits above the first cervical vertebra; C2 exits above the second, and so forth). The C8 spinal nerve exits below the seventh cervical vertebra, and all the other spinal nerves leave below their corresponding vertebra.Formation of the spinal nervesInside the spinal cord, there is grey matter, surrounded by white matter. From out of the grey matter, two dorsal roots (one on the left side, and one on the right side) and two ventral roots emerge. The dorsal roots contain afferent sensory axons, and the ventral roots contain efferent motor axons.Dorsal means back, ventral means front. As the body is symmetrical, the same thing happens on both the left and right side of the body. This happens in each vertebra of the spine.The dorsal roots of each side continue outwards, along the way forming a dorsal root ganglion (also called a spinal ganglion).The ventral roots similarly continue out from the spinal column, and meet and mix with their corresponding dorsal nerve root at a point after the ganglion. At this point they are called a mixed spinal nerveFate of the spinal nerveAfter the dorsal and ventral roots fuse to form a spinal nerve, the nerve bifurcates into dorsal and ventral primary rami. The dorsal primary ramus supplies the muscles and sensory nerves of the back, while the ventral primary ramus supplies the rest of the body wall.Each primary ramus has two branches: from the dorsal primary ramus emerges a lateral and medial branch; from the ventral primary ramus sprout an anterior and lateral cutaneous branch. In addition, the anterior cutaneous bifurcates, forming a medial and lateral branch, while the lateral cutaneous branch splits into an anterior and posterior branch. These secondary and tertiary branches themselves typically have muscular and sensory branches that innervate the body wall.The ventral primary rami also give rise to the roots of the various nervous plexuses (e.g. the brachial plexus), which become the sensory and motor nerves of the limbs.Before forming the plexuses, the ventral rami have two branches leading to a sympathetic ganglion. These ganglia connect to the one above and below them, forming the sympathetic chain.Importance of the spinal nervesThe muscles that one particular spinal root supplies are that nerve's myotome, and the dermatomes are the areas of sensory innervation on the skin for each spinal nerve. This is of great importance in the diagnosis of neurological disorders, as lesions of one or more nerve roots result in typical patterns of neurologic defects (muscle weakness, loss of sensation) that allow localisation of the causating lesion.
Page 42: ANAESTHESIA ANATOMY

Accessory NerveAccessory Nerve

Page 43: ANAESTHESIA ANATOMY

Transient Transient postoperativpostoperative paralysis of e paralysis of

spinal spinal accessory accessory

nervenerve

Page 44: ANAESTHESIA ANATOMY

Thoracodorsal Nerve

Page 45: ANAESTHESIA ANATOMY

Dorsal Scapular Dorsal Scapular NerveNerve

Page 46: ANAESTHESIA ANATOMY

Vertebral ColumnVertebral Column

Osteology and ArthrologyOsteology and Arthrology

Page 47: ANAESTHESIA ANATOMY

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

Page 48: ANAESTHESIA ANATOMY

Vertebral SegmentsVertebral Segments

Page 49: ANAESTHESIA ANATOMY

Primary CurvePrimary Curve

Page 50: ANAESTHESIA ANATOMY

Secondary Curves LateralSecondary Curves Lateral

Page 51: ANAESTHESIA ANATOMY

Vertebral ColumnVertebral Column

Page 52: ANAESTHESIA ANATOMY

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

Page 53: ANAESTHESIA ANATOMY

Typical VertebraeTypical Vertebrae

Page 54: ANAESTHESIA ANATOMY

Typical VertebraeTypical Vertebrae

Page 55: ANAESTHESIA ANATOMY

Typical CTypical C

Page 56: ANAESTHESIA ANATOMY

Luschka JoinLuschka Join 钩椎关节钩椎关节

Page 57: ANAESTHESIA ANATOMY

钩椎关节及其毗邻钩椎关节及其毗邻

Page 58: ANAESTHESIA ANATOMY

Typical CTypical C

Page 59: ANAESTHESIA ANATOMY

C6C6

Page 60: ANAESTHESIA ANATOMY

C1/C2C1/C2

Page 61: ANAESTHESIA ANATOMY

Typical ThoracicTypical Thoracic

Page 62: ANAESTHESIA ANATOMY

Facet Joints (C and T)Facet Joints (C and T)

Page 63: ANAESTHESIA ANATOMY

Facets LFacets L

Page 64: ANAESTHESIA ANATOMY

Typical LumbarTypical Lumbar

Page 65: ANAESTHESIA ANATOMY

Sacrum and CoccyxSacrum and Coccyx

Page 66: ANAESTHESIA ANATOMY
Page 67: ANAESTHESIA ANATOMY
Page 68: ANAESTHESIA ANATOMY

Vertebral ColumnVertebral Column

Page 69: ANAESTHESIA ANATOMY

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

Page 70: ANAESTHESIA ANATOMY

Intervertebal DiscsIntervertebal Discs

Page 71: ANAESTHESIA ANATOMY

Discs Discs

Page 72: ANAESTHESIA ANATOMY

DiscsDiscs

Page 73: ANAESTHESIA ANATOMY

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

Page 74: ANAESTHESIA ANATOMY

ArthrologyArthrology

Typical movements in sections of the Typical movements in sections of the spinespine

LumbarLumbarThoracicThoracicCervicalCervical

Page 75: ANAESTHESIA ANATOMY

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

Page 76: ANAESTHESIA ANATOMY

ALLALL

Page 77: ANAESTHESIA ANATOMY

Atlanto-Occipital MembraneAtlanto-Occipital Membrane

Page 78: ANAESTHESIA ANATOMY

A and P Longitudinal LigamentA and P Longitudinal Ligament

Page 79: ANAESTHESIA ANATOMY

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

Page 80: ANAESTHESIA ANATOMY

PLLPLL

Page 81: ANAESTHESIA ANATOMY

Tectorial MembraneTectorial Membrane

Page 82: ANAESTHESIA ANATOMY

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

Page 83: ANAESTHESIA ANATOMY

SupraspinousSupraspinous

Page 84: ANAESTHESIA ANATOMY

Ligamentum NuchaeLigamentum Nuchae

Page 85: ANAESTHESIA ANATOMY

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

Page 86: ANAESTHESIA ANATOMY

InterspinousInterspinous

Page 87: ANAESTHESIA ANATOMY

InterspinousInterspinous

Page 88: ANAESTHESIA ANATOMY

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

Page 89: ANAESTHESIA ANATOMY

Ligamentum FlavumLigamentum Flavum 黄韧带黄韧带

Page 90: ANAESTHESIA ANATOMY

Atlanto-Occipital Membrane-Atlanto-Occipital Membrane-PosteriorPosterior

Page 91: ANAESTHESIA ANATOMY

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

Page 92: ANAESTHESIA ANATOMY

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

Page 93: ANAESTHESIA ANATOMY

C1/C2C1/C2

Page 94: ANAESTHESIA ANATOMY

C1/C2C1/C2

Page 95: ANAESTHESIA ANATOMY

C1/C2C1/C2

Page 96: ANAESTHESIA ANATOMY

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

Page 97: ANAESTHESIA ANATOMY

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.

Page 98: ANAESTHESIA ANATOMY

Atlanto-OccipitalAtlanto-Occipital

Page 99: ANAESTHESIA ANATOMY

Atlanto-OccipitalAtlanto-Occipital

Page 100: ANAESTHESIA ANATOMY

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

Page 101: ANAESTHESIA ANATOMY

Thank youThank you

That’s all for today! That’s all for today!