《斯坦福大学公开课临床解剖学 1314集》英中字幕.docx
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《斯坦福大学公开课临床解剖学 1314集》英中字幕.docx
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《斯坦福大学公开课临床解剖学1314集》英中字幕
目录
[第13集]人类腹股沟区及大腿解剖图(第二部分)2
[第14集]人类腹股沟区及大腿解剖图(第三部分)27
[第10集]人乳解剖图(第一部分)41
[第11集]人乳解剖图(第二部分)57
[第13集]人类腹股沟区及大腿解剖图(第二部分)
AnatomyoftheHumanInguinalAreaandThighPart2
WellnowIwanttodealwith
theanteriorsurfaceofthethigh.
And,firstofallwewillputinthe
anteriorsuperioriliacspine
andwewillindicatethepositionof
thesuperficialinguinalring,
whichyouwillrememberisanopening
intheaponeurosisoftheexternalobliquemuscle.
AndhereIcanjustindicate
thepositionofthepubiccubicle.
Nowontheskinofthelateralsurfaceofthethigh
extendsdowninthismanner.
Andtheskinonthemedialsurfaceofthethigh
extendsdowninthatway.
AndIwilljustindicatethepositionofthe
underlyingpatellainthatmanner.
Nowextendingbetweentheanteriorsuperioriliacspine
andthepubiccubiclewehavetheinguinalligament.
Andyouwillrememberthat
theinguinalligamentisthelowerthickenedmargin
oftheaponeurosisoftheexternaloblique.
NowIwilljustindicate
thepositionofthatligamentinthatmanner.
Nowletusputinthesensorynerve
suppliedtotheskinofthefrontofthethigh.
Youwillrememberthatthe12ththoracicnerve,
thesubcostalnerve,sweepsaroundthesideof
theabdominalwallandthensendsoffabranchthat
extendsintotheupperlateralpartofthethigh.
Sothisisthelateralcutaneousbranchof
the12ththoracicnerve.
Comingdownundertheinguinalligamentwehave
thefemoralbranchofthegenitalfemoralnerve.
Yourememberthegenitalbranchofthe
genitalfemoralnervesuppliedthecremastermuscle.
Thisisthefemoralbranchofthegenitalfemoralnerve.
Sothestimulationofthenervewillcausecontraction
ofthecremastermuscleinthemale.
Comingdownthroughtheinguinalcanalwehave
fromthefirstlumbarnervetheilioinguinalnerve.
Andhavingemergedfromthesuperficialinguinalring
itsuppliestheskinatthe
rootofthepenisorlabiainthisregionhere.
Nowwhataboutthesensorysuppliedto
thefrontofthethighbelowthatlevel?
Remembercomingdownunderneath
theinguinalligamentdeeptothefascialata
wehavethelateralfemoralcutaneousnerve.
Thispiercesthefascialataaboutahandswidth
belowtheanteriorsuperioriliacspineand
suppliestheskinonthelateralpartofthethigh,
usuallysendingabranchtotheposteriorsurface.
Andthenanothernerveherecomingthrough
thedeepfasciaistheintermediatefemoralcutaneous.
Theintermediatefemoralcutaneousnerveofthethigh.
Theintermediatefemoralcutaneousnerve
whicharebranchesofthefemoralnerve
andtheypiercethedeepfasciaandcomeondownto
supplytheskinrightdownthisfartothepatella.
Theintermediatefemoralcutaneousnervebranches
ofthefemoralnerve.
Andlastlydownherewehave
themedialfemoralcutaneousnerves.
Themedialfemoralcutaneousnervesare
branchesofthefemoralnerve
andtheycomedownonthemedialsideofthepatella
rightdownasfarasthemedialsideofthekneejoint.
Nowthisleavesavariableareahere,
whichissupplied,byasmallbranchofthe
anteriordivisionoftheobturatornerve.
Sonowwehavethewholeofthesensorynerve
suppleofthefrontofthethigh.
Sowecanseethatthesensorynerve
supplytothefrontofthethighisasfollows:
wehaveherethebranchfromthe12ththoracicnerve,
wehaveherethelateralfemoralcutaneousnerve
comingdownthelateralsideofthethigh
sendingabranchposteriorly,
wehavehereinthemiddlethe
intermediatefemoralcutaneousnerve,
branchesofthefemoralnerve,
wehaveherethefemoralbranchofthegenitalnerve,
andwehavedownonthemedialsidehere
themedialfemoralcutaneousnerves,
whichsupplethemedialsideofthethighdown
asfarasthemedialsideofthekneejoint.
Wehaveupheretheilioinguinalnervecomingthrough
thesuperficialinguinalringhere
supplyingthemedialsideofthethigh
totheadjacentsideofthegenitalia.
Andlastlywehaveasmallvariableareahere
thatissuppliedbythe
anteriordivisionoftheobturatornerve.
Thesuperficialveinsofthelimb
areveryimportantclinically.
Idon'tthinkitisappreciatedbymanythat
thesuperficialveinsarecommonlydiseased
andcausevaricoseveins.
Andvaricoseveinscostthiscountry
millionsofdollarsayearintreatmentcosts.
Soletusfirstofallconsiderthedistributionof
thesuperficialveinsoftheleg.
Nowifthisisagaintheregionof
theanteriorsuperioriliacspinewecancontinue
theskindownthelateralsideofthethigh,
lateralsideoftheknee,
lateralsideofthecalfand
goontothelateralsideofthefoot.
Andinthesamewaywecanconsiderthisbeing
themedialsideofthethigh,
medialsideofthecalfandthen
themedialmalleolusofthetibiaandtheheelof
thefootgoingdownthemedialsideofthefoot.
Andwecanjustsortofindicatethepositionof
thepatellainthatsortofway.
Nowyoumayrememberthatupinthefrontofthethigh,
belowtheregionoftheinguinalligament,
thedeepfasciahasanopening
calledthesaphenousopening.
AndIwilljustindicatethepositionof
theopeninginthatsortofmanner.
Nowthegreatorlongsaphenousvein
startsinthefootbybeingacontinuationofthe
medialsideofthedorsalvenousarch.
AndIwillindicatethepositionofthe
dorsalvenousarchinthatmanner.
Nowcomingoffthemedialsideofthat
dorsalvenousarchthegreatorlongsaphenousvein
passesupinfrontofthemedialmalleolus.
Directlyinfrontofthemedialmalleolusofthetibia.
Itthenrunsupthemedialsideofthecalf
andthenpassesbehindthekneeinthatway
onlytoemergeonthefrontofthethighagain
andpassupinthiswayacrossthemedialsurfaceof
thethighfinallypassingthroughthesaphenousopening
todrainintofemoralvein,
whichislyinginthisarea.
Soherethenisthegreatsaphenousvein
drainingthemedialsideofthedorsalvenousarch,
passingupinfrontofthe
medialmalleolusofthetibia,
runningupthemedialsideofthecalf,
passingbehindthekneeandthenrunningacrossthe
medialsideofthethightodrainintothefemoralvein.
Andthesurfacemarkingatthispointisabout
1.5inchesbelowandlateraltothepubiccubiclepoint.
Nowwhatarethetributariesofthisimportantvein?
Wellclearlyitisreceivingtributariesfromsmall
veinsasitispassingupthemedialsideofthecalf
andthereisusuallyaverylargetributary
knownastheaccessoryveinofthethigh
asitiscrossingthefrontofthethigh.
Asitispassingthroughthesaphenousopening
itreceivesthreeimportanttributaries.
Onefromthegenitaliaisknownas
thesuperficialexternalpudendalvein.
Thisjoinsthegreatsaphenousvein
asitispassingthroughthesaphenousopening.
Thenthereisthesuperficialepigastricvein,
whichiscomingdownfromtheskinbelowtheumbilicus
anddrainingintothegreatsaphenousvein
asitispiercingthesaphenousopening.
Andfinallyupherewehave
thesuperficialsuperflexiliacvein
whichcomesfromtheskinoftheregionof
theanteriorsuperioriliacspineandpassesdown
andjoinsthegreatsaphenousveinatthispoint.
Clearlyanytreatmentofthegreatsaphenousvein
wheretheoperationofstripingtheveinor
ligatingtheveinrequiresthat
thesesmallerveinsareligatedalso.
Nowifwepassovertoapictureonthisside
andlookatthebackoftheleg.
Weindicatethepositionofthebackof
thethighcomingdownintothepoplitealspace
thenwillindicatethepositionofthecalf
andthelateralmalleolus.
Andthenwewillshowheretheheelandthe
soleofthefootinthatmanner.
Sothisisthelateralsideoftheleg.
Wehaveturnedthelegaround
sothisisthelateralmalleolus.
Nowpassingupfromthelateralsideofthe
dorsalvenousarchisthesmallsaphenousvein.
Andthispassesbehindthelateralmalleolus.
Noticethattheshortorsmallsaphenousvein
passesbehindthelateralmalleoluswherethe
greatsaphenouspassesinfrontofthemedialmalleolus.
Sothesmallsaphenousveinpasses
behindthelateralmalleolusandsoweseeit
cominguphereandpassinguponthe
posteriorsurfaceofthecalfinthismanner.
Piercingthedeepfascia,
overthepoplitealspaceand
herejoiningthepoplitealveinas
itispassingupthroughthepoplitealspace.
Nowtocompetethisdrawingofcourseweshould
putinasmallareahereofthegreatsaphenousvein
asitispassingbehindtheknee.
Hereitispassingbehindthekneeand
wecanshowanimportantcommunicationthat
existsbetweenthetwoveinsinthisarea.
Nowwhatarethetributariesofthisvein?
Clearlyitdrainsthe
lateralsideofthedorsalvenousarchofthefoot
andasitispassinguponthebackofthecalf
itisreceivingadditionaltributaries
anditisreceivingthiscommunicationbetween
thegreatsaphenousveinandtheshortsaphenousvein,
smallsaphenousveininthepoplitealspace.
Nowarethereanyothercommunications?
Ithinkwehavetoconsideraseparatediagram
andseethedeepveinsoftheleg.
NowwhatIamgoingtodohereonthisdiagram
isputinadeepartery.
Thetibialartery.
Andindicatetoyouthepositionofthevenacomitans
asitwindsaroundthisarteryand
communicatesonewiththeotherinthissortofmanner.
Sothesearethevenacomitansofthetibialartery.
Nowcloselyrelatedtothesearteries
sincewheretheyaredeeplysituated,
wehavesomeofthedeepmusclesoftheleg.
Andtheseareenclosedindeepfascia,andiwill
indicatethefascialcompartmentinthatmanner.
Nowsuperficialtothedeepfasciawehave
thesubcutaneoustissue.
Anditisinthis
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