Regionalanatomyoftheback丁兆習山東大學醫(yī)學院人體解剖學教研室Office:1205dingzhaoxi@Vertebralregion脊柱區(qū)BoundariesDivisionsNapeDorsalthoracicregionLumbarregionSacracoccygealregionVertebralregion脊柱區(qū)★SurfacelandmarksSpinousprocessSacralhiatusSacralcornuCoccyxIliaccrestPosteriorsuperioriliacspineSpineofscapulaInferiorangleofscapulaTwelfthribErectorspinaeSuperficialstructuresSkinSuperficialfasciaGreateroccipitaln.(C2):emergebelowtheinsertionoftrapezius(superiornuchalline)Thirdoccipitaln.(C3)：emergefromtrapezius,inferiorandmedialtogreateroccipitaln.Cutaneous

brabchesofposteriorbranchesofthoracicn.Superiorclunealn.(L1-3)Middle(medial)clunealn.(S1-3)SuperficialbloodvesselsDeepstructuresDeepfasciaInthenape

-partoftheinvestingfasciaSuperficiallayerDeeplayer-

NuchalfasciaInthethoracolumbarregionSuperficiallayer★

Deeplayer-Thoracolumbarfascia胸腰筋膜Adeepinvestingmembranewhichcoversthedeepmusclesofthebackofthetrunk.Above,itiscontinuouswiththenuchalfascia.Inthethoracicregionthelumbodorsalfasciaisathinfibrouslaminawhichservestoseparateerectorspinaefromthemusclesconnectingthevertebralcolumntotheupperextremity.Itisattachedtothespinousprocessesofthethoracicvertebr?mediallyandtotheanglesoftheribslaterally.Inthelumbarregion,thelumbodorsalfasciaisthick,andismadeupofthreelayersandenclosedtheerectorspinae（seathoferectorspinae

）andquadratus

lumborum(seathofquadratus

lumborum)InthesacrococcygealregionMergedwithperiosteumofsacrumandcoccyxDeepstructures★

Thoracolumbar

fascia胸腰筋膜InthelumbarregionAnteriorlayer：fasciaofquadratus

lumborum,medialandlateralarcuate

lig.Middlelayer：lumbocostalligament(between12thribandtransverseprocessof1stlumbarvertebra)Posteriorlayer：DeepstructuresMusclesFirstlayertrapeziuslatissimus

dorsiposteriorpartofobliquus

externus

abdominis

Secondlayersplenius

capitisandcervicissemispinalis(fourthlayer)levatorscapulaerhomboideusmajorandminorserratusposteriorsuperior&inferiorposteriorpartofobliquus

internus

abdominis

Thirdlayererectorspinaeposteriorpartoftransversus

abdominisFourthlayersuboccipitalis(rectus

capitisposteriorminorandmajor,obliquus

capitisinferiorandsuperior)transversospinalis(semispinalis,multifidus,rotators)intertransversarriMusclesofTrunk軀干肌DeepstructuresErectorSpinae★Trianglesontheback★AuditorytiangleSpaceboundedbymedialborderofscapulalaterally,superiorborderoflatissimus

dorsiinferiorly,inferiolateralborderoftrapezius

superomedially.

Theflooris6thintercostalspaceandroofisskinandsuperficialfascia.Clinicaltips:ausculation★Trianglesontheback★Inferiorlumbartriangle

Spaceboundedbylowerpartoftheantriolateralborderoflatissimus

dorsi,theposteriorfreeborderofobliquus

externus

abdominisandtheiliaccrest.Thefloorisobliquus

internus

abdominis.TheroofisonlythesuperificialfasciaandskinClinicaltips:weakareaontheposteriorabdominalwall.lumbarhernia

cecumandvermiformappendixlocatedifrontdeeplumbarabscess★Trianglesontheback★

SuperiorlumbartriangleTrilateralorqudralateralspacebelowthe12ribanddeeptothelatissimus

dorsi.Itisboundedbylateralborderoftheerectorspinae

inferomedially,posteriorborderofobliquus

internus

abdominis

inferiolaterally,andserratusposteriorinferiorsuperomedially.Sometimethe12thribmakesanotherborder.Theflooristransversus

abdominis,andiscrossedbythesubcostaln.,iliohypogastricandilioinguinaln..Infrontlocatedthequadratus

lumborumandkidneyClinicaltips:weakareaontheposteriorabdominalwall.lumbarherniarenaloperationandperirenaldrainageTrianglesonthebackSuboccipitaltriangleSpacebounded

by

rectus

capitisposteriormajor,obliquus

capitissuperiorandobliquus

capitisinferior.Thefloorisposterioratlantooccipitalmembraneandposteriorarchofatlas.Theroofisspelniusandsemispinalis,andgreateroccipitaln.betweenthemContents:

suboccipitalnerveandvertebralarteryClinicaltips:cerebralischemiaVertebrala.pressedbyhyperostosis,excessiverotationofhead,spasmofsuboccipitalmusclesDeepstructuresBloodvesselsOccipitala.:runsposteriorlymedialtothemastoidprocess,thendeeptosplenius

capitis,restingupontherectus

capitis

lateralis,theobliquussuperior,andlateraltothesemispinalis

capitis.Finallyitrunsverticallyupward,piercesthefasciaoftrapeziusandaccompanywiththegreateroccipitaln.Superficialcervicala.:

runsposteriorly

crossinginfrontofthephrenicnerveandthescalenemuscles,totheanteriormarginofthetrapezius,thenrunsdownwardsaccompanyingwithaccessoryn.undertrapeziusDorsalscapulara.:

runsposteriorly

crossinginfrontofthephrenicnerveandthescalenemuscles,thenpassesbeneaththelevatorscapulaetothesuperiorangleofthescapula,andthendescendsundertherhomboidmusclesalongthevertebralborderofthescapulaasfarastheinferiorangle.Vertebrala.:branchesfromthetransversepartThoracodorsala.PosteriorcostalarteryLumbararterySup.andinf.glutealarteryDeepstructuresNerveExternalbranchofaccessoryn.Thoracodorsaln.:arisesfromtheposteriorcordofbrachialplexus,runswiththethoracodorsala.onandinnervatethelatissimus

dorsiDorsalscapularn.:

arisesfromthebrachialplexus,passthroughthesclaneus

mediusandunderthelevatorscapulae,thendescendsaccompanyingthedorsalscapulara.undertherhomboidmusclesalongthevertebralborderofthescapula.Innervatethelevatorscapulaeandrhomboidmuscles

Posteriorramiofspinaln.:arisesfromthespinaln.attheintervertebralforamen,curvesbackwardonthelateralsurfaceofthesuperiorarticularprocesstotheintertransversarriwhereitdividesintomedialandlateralbranchesDeepstructuresInthelumbarregion:Ostefiberousforamen(forposteriorramusoflumbarn.):locatedposterolateraltotheintervertebralforamen,andtransmitstheposteriorramusoflumbarn..Itisboundedby

intertransverse

lig.superolaterally,transverseprocessinferiorly,superiorarticularprocessmedially.Osteofiberouscanal(formedialbrancheofposteriorramusoflumbarn.):

locatedinthegroovebetweentheaccessoryandmamillaryprocess,transmitsthemedialbranchofposteriorramusoflumbarn..Itisboundedbythegrooveanteriorly,accessoryprocessinferiorly,mamillaryprocesssuperiorly,andligamentbetweentheprocessesposteriorly.Clinicaltips:lumbagos腰痛:narroworvarriationoftheforamneorcanalcanpressthenerveDeepstructuresVertebralcolumnandcontents

VertebralcanalMeningesandspaceofspinalcordEpiduralspace：skin,superficialfascia,deepfascia,supraspinous

lin.,interspinous

lig.,ligamentum

flavum,epiduralspaceSubarachnoidspace：

skin,superficialfascia,deepfascia,supraspinous

lin.,interspinous

lig.,ligamentum

flavum,epiduralspace,duramater,arachnoidmater,terminalcistern(Subarachnoidspace)RootofspinalnerveBloodvesslesofspinalcordYoumustidentifyfollowstructures！MusclesTrapezius

斜方肌Levatorscapulae肩胛提肌Rhomboideus

菱形肌Latissimus

dorsi

背闊肌Thoracolumbarfascia胸腰筋膜Deltoid三角肌Supraspinatus

岡上肌Infraspinatus

岡下肌Teresminor小圓肌Teresmajor大圓肌Tricepsbrachii

肱三頭肌Extensorcarpi

radialis

longus

橈側(cè)腕長伸肌Extensorcarpi

radialis

brevis

橈側(cè)腕短伸肌Extensordigitorum

指伸肌Extensordigiti

minimi

小指伸肌Extensorcarpi

ulnaris

尺側(cè)腕伸肌Supinator

旋后肌Abductorpollicis

longus

拇長展肌Extensorpollicis

brevis

拇短伸肌Extensorpollicis

longus

拇長伸肌Extensorindicis

示指伸肌Youmustidentifyfollowstructures！VesselsSuprascapulara.Posteriorhumeralcircumflexa.Deepbrachiala.NervesAccessoryn.Suprascapularn.Axillaryn.Radialn.deepbranchoftheradialn.Youmustidentifyfollowstructures！PectoralregionandAxilla

MusclesPectoralismajorPectoralisminorSerratusanteriorArteriesandveinsAxillaryarterythoracoacromiala.lateralthoracica.subscapulara.Throcodorsala.Circumflexscapulara.Posteriorhumeralcircumflexa.AxillaryveinNervesLongthoracicn.Lateralcordmusculocutaneousn.lateralrootofmediann.MedialcordMedialrootofmediann.Ulnarn.PosteriorcordRadialn.Axillaryn.Thoracodorsaln.Youmustidentifyfollowstructures！Superficialvv.Cephalicv.Basilicv.Mediancubitalv.ArmBicepsbrachiiCoracobrachilis

BracialisMusculocutaneousn.Mediann.Ulnarn.Brachiala.Profunda

brachiia.ForearmBrachioradialis

Pronator

teresFlexorcarpi

radialisPalmarislongusFlexorcarpi

ulnarisFlexordigitorum

superficialisFlexordigitorum

profundusFlexorpollicis

longusPronator

quadratusUlnarn.Radialn.Mediann.Ulnara.Radiala.Review1.Describetheboundariesandcontentsofthe①axilla,②cubital

fossa,③carpaltunnel.