INTRODUCTION _ BACK

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INTRODUCTION _ BACK Powered By Docstoc
					    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
            pain for six months




Mr. Port
Slight wear and tear between
 the cervical vertebrae body
Sitting posture correction
Answer the questions regarding
  the case at the end of this
           chapter
   1. What classes of joints are there
    between typical cervical vertebrae?

   2. What are the normal curvatures of the
    vertebral column?

   3. What movements occur between typical
    cervical vertebrae? What movements
    occur at the atlanto-occipital (寰枕关节)
    and the atlanto-axial(寰枢关节) joints?
   4. Where does the vertebral artery lie in
    relation to the cervical vertebrae?

   5. How might the function of the vertebral
    artery be assessed?

   6. Why was the headache felt in the
    occipital region?
Surface
    Anatomy
   1.棘突 :第7颈椎棘突较长,常作为
    辨认椎体序数的标志;
    两侧肩胛冈内侧端的连线平第3胸椎棘
    突;
    两侧髂嵴最高点的连线平第4腰椎棘
    突。
   2.枕外隆凸:颅后部明显的骨性突
    起。
   3.乳突:在耳廓的后方。
   4.肩胛冈:外侧端为肩峰。
   5.肩胛骨下角:两肩胛骨下角的连线
    平对第7胸椎棘突。

   6.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,
    是骶管麻醉的进针定位标志。

   7.髂嵴和髂后上棘:两侧髂嵴最高点
    的连线平第4腰椎棘突。两侧髂后上棘
    的连线平第2骶椎棘突。
       LAYERS

   Superficial layers
   Deep fascia
   Muscles
     Superficial layers

   Skin
   Superficial fascia
                       Skin




                          Thick
Full of hair follicles, sweat glands & sebaceous glands
    Superficial fascia

 Dense, especially the Nuchal region
 Full of Fat
 Cutaneous nerve & Superficial blood
  vessels
Cutaneous nerve
Greater occipital nerve
3rd occipital nerve
Spinal nerve (cutaneous
branches of dorsal rami)
Superior cluneal nerve
(cutaneous branches of
dorsal rami)
Middle cluneal nerve
(cutaneous branches of
dorsal rami)
Inferior cluneal nerve
(posterior femoral
cutaneous nerve
Herpes Zoster
 Infections
  (Shingles)
    Superficial Blood Vessels
                Occipital artery
    Nuchal      Superficial cervical artery
                dorsal scapular artery
                Posterior intercostals artery
Thoracic dorsal dorsal scapular artery
                thoracodorsal artery
   Lumber       Lumbar artery
               Superior Cluneal artery
Sacrococcygeal
               Inferior cluneal artery
                Deep Fascia
   Nuchal fascia: a deep investing membrane
    which covers the deep muscles of the back
    of the neck.
Thoracolumbar fascia: a deep investing
 membrane which covers the deep muscles
 of the back of the trunk.
Nuchal Fascia
Thoracolumbar
    Fascia
a deep investing
 membrane which
 covers the deep
 muscles of the
 back of the trunk
 3 layers in
 lumbar region
             Q.L

Erector spinae
              MUSCLES
Superficial     Intermediat          Deep
  group           e group            group


 extrinsic back muscles       intrinsic back
                                 muscles

    respiration and        movement and
   movements of the       stabilization of
   upper extremity         the vertebral
                              column
         Superficial Group
Trapezius

levator scapulae

Rhomboid minor

Rhomboid major

Latissimus dorsi
           Triangle Of Auscultation




                                      SUPERIOR
INFERIOR
        Intermediate Group


Serratus posterior superior



Serratus posterior inferior
          DEEP GROUP

Spinotransversales Muscles
  Splenius Capitis
  Splenius Cervicis
Erector Spine Muscles
  Iliocostalis
  Longissimus
  Spinalis
   DEEP GROUP

Transversospinales muscles
  Semispinalis
  Rotatores
  Multifidus
Segmental back muscles
  Levatores costarum
  Interspinales
  Intertransversarii

       P59
                 DEEP GROUP
Suboccipital Muscles
  Rectus Capitis Posterior Minor
  Rectus Capitis Posterior Major
  Superior Oblique
  Inferior Oblique
Suboccipital Triangle

   Rectus Capitis
    Posterior Major
   Superior Rectus
    Oblique
   Inferior Rectus
    Oblique
   Vertebral Artery
   Suboccipital N
    (Dorsal Ramus Of
    CⅠ)
    Superior Lumbar Triangle
(Triangle Of Grynfeltt-Lesshaft )

 twelfth rib
 Serratus
  posterior inferior
 Erector spinae
 internal oblique
Inferior Lumbar Triangle
(Petit's Lumbar Triangle)

   External
    Abdominal
    Oblique
   Latissimus Dorsi
   Iliac Crest
           Deep Arteries
                        Occipital Artery
                   Superficial Cervical Artery
Nuchal Region
                      Dorsal Scapular Artery
                         Vertebral Artery
                  Posterior Intercostals Artery
Thoracic Region       Dorsal Scapular Artery
                      Thoracodorsal Artery
                         Lumbar Artery
Lumber Region
                        Subcostal Artery
Sacrococcygeal       Superior Cluneal Artery
    Region           Inferior Cluneal Artery
              DEEP VEINS
                       Vertebral vein
Nuchal              Internal jugular vein
                      Subclavian vein
         Posterior Intercostals vein – azygos vein
Thoracic              Subclavian vein
                       Axillary vein
Lumber        Lumbar vein – inferior vena cava
Sacroco
                     Internal iliac vein
ccygeal
Vertebral
 Artery


 Atlas
Vertebral Veins
     Deep Nervers

   Dorsal rami of spinal nerve
   Accessory nerve
   Thoracodorsal nerve
   Dorsal scapular nerve
Dorsal Rami of Spinal Nerve
Accessory Nerve
  Transient
postoperative
 paralysis of
    spinal
  accessory
    nerve
Thoracodorsal
   Nerve
Dorsal Scapular Nerve
Vertebral Column

Osteology and Arthrology
               Osteology
 7 C, 12 T, 5 L, 5 S (Fused as Sacrum), 4
  coccygeal
 Primary Curves
 Secondary Curves
 Anterior/Posterior alignment
Vertebral Segments
Primary Curve
Secondary Curves Lateral
Vertebral Column
                           Osteology
   Typical Vertebrae
   Body椎体
       Superior and inferior surfaces of body (plateaus)
       Thickened around the rim, location of epiphyseal plates
       Cartilaginous end-plates
   Vertebral Arch椎弓
       Pedicles, Laminae
       Transverse Processes
       Spinous Process
       Facets – superior articular and inferior articular
   Spinal Foramen椎孔
   Intervertebral Foramen椎间孔
Typical Vertebrae
Typical Vertebrae
Typical C
Luschka Join钩椎关节
钩椎关节及其毗邻
Typical C
C6
C1/C2
Typical Thoracic
Facet Joints (C and T)
Facets L
Typical Lumbar
Sacrum and Coccyx
Vertebral Column
               Arthrology
 Intervertebral Discs椎间盘
 Fibrocartilaginous joints纤维软骨连接
 Increase in size from C to L (3mm to 9
  mm)
 Ratio remains the same
 Make up 20-30% of length of column
Intervertebal Discs
Discs
Discs
                     Arthrology
   Facet Joints (Typical)
   Superior articular facets of one vertebrae with
    inferior facets of vertebrae above
   Synovial gliding joints
   Surrounded by joint capsule and small capsular
    ligaments
   The type and amount of motion in any given part
    of the spine is dictated by the orientation of the
    articular facets as well as the fluidity, elasticity and
    thickness of the intervertebral discs
              Arthrology
 Typical movements in sections of the
  spine
 Lumbar
 Thoracic
 Cervical
    Major Ligaments of the Spine
   Anterior Longitudinal Ligament - ALL
   Dense band along anterior and lateral surface of
    the vertebral bodies from C2 to sacrum
       Superficial - bridge several vertebrae
       Deep – short, run from V to V, blends with fibers of anulus
        fibrosus
       Limits extension of V column
   From C1 to skull, called Atlanto-Occipital
    Membrane
ALL
Atlanto-Occipital Membrane
A and P Longitudinal Ligament
              Major Ligaments
   Posterior Longitudinal Ligament
     Runs along posterior surface of vertebral
      bodies (anterior to spinal canal)
     C2 to Sacrum
     Short fibers attach ligament to posterior disc,
      reinforce disc posteriorly
 Superiorly, continues to occiput, called
  Tectorial Membrane
 Limits flexion
PLL
Tectorial Membrane
                  Ligaments
   Supraspinous棘上韧带
     Spinous process to spinous process – tip to
      tip
     C7 to sacrum

 Limits flexion
 In cervical region, becomes much thicker
  with a greater elastic content
 Called Ligamentum Nuchae
Supraspinous
Ligamentum Nuchae
              Ligaments
 Interspinous棘间韧带
 Found between spinous processes
 Most well developed in lumbar region
 support
Interspinous
Interspinous
             Ligaments
 Ligamentum Flavum黄韧带
 Connects lamina椎板 of one to lamina of
  the other
 Found from axis枢椎 to sacrum骶骨
 Limit flexion
 Continuation to the skull颅骨 is called
  Posterior Atlanto-Occipital membrane
  后寰枕关节膜
Ligamentum Flavum黄韧带
Atlanto-Occipital Membrane-
         Posterior
              Ligaments
 Intertransverse横突间韧带
 Only well-developed in Lumbar Region
 Between transverse processes
 Limit lateral flexion侧曲
             Atlanto-Axial Joint
                 寰枢关节
   Atlas and Axis
   Pivot旋转运动
   Two convex superior facets of axis with two
    concave inferior facets of the atlas
   Atlas also posses a facet on the internal surface of
    the anterior arch which articulates with the dens of
    the axis
   Major ligaments from spine support – Ant.
    Atlanto-Occipital, Tectorial Membrane, Post. A-
    O
C1/C2
C1/C2
C1/C2
                   A-A Joint
 Alar – from dens to occiput
 Transverse - around dens
 Cruciate
     Sup. Longitudinal Band
     Inferior Longitudinal Band
     Transverse
       Atlanto-Occipital Joint
             寰枕环节
 Two concave superior facets of atlas
  articulate with two convex surfaces of
  occipital condyles of the skull
 Supported by major ligaments
 Small saddle joint
 Very limited motion – nodding type
  motions in all directions.
Atlanto-Occipital
Atlanto-Occipital
Movement of the Vertebral Column
  Flex 屈
  Extend 伸
  Rotation 旋转
  Lateral flex 侧曲
  Thank you
That’s all for today!

				
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