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ANAESTHESIA ANATOMY

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

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ANAESTHESIA ANATOMY

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  1. ANAESTHESIA ANATOMY Li Xuetao DEPARTMENTOF HUMAN ANATOMY KUNMING MEDICAL UNIVERSITY

  2. BACK(VERTEBRAL REGION)

  3. Vertebrae椎骨、脊柱

  4. 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

  5. Slight wear and tear between the cervical vertebrae body

  6. Sitting posture correction

  7. Answer the questions regarding the case at the end of this chapter

  8. 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?

  9. 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?

  10. Surface Anatomy

  11. 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。

  12. 5.肩胛骨下角：两肩胛骨下角的连线平对第7胸椎棘突。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。

  13. LAYERS • Superficial layers • Deep fascia • Muscles

  14. Superficial layers • Skin • Superficial fascia

  15. Skin Thick Full of hairfollicles, sweat glands & sebaceous glands

  16. Superficial fascia • Dense, especially the Nuchal region • Full of Fat • Cutaneous nerve & Superficial blood vessels

  17. Cutaneous nerve

  18. Greater occipital nerve 3rd occipital nerve Spinal nerve (cutaneousbranches 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

  19. Herpes Zoster Infections (Shingles)

  20. Superficial Blood Vessels

  21. 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.

  22. Nuchal Fascia

  23. Thoracolumbar Fascia • a deep investing membrane which covers the deep muscles of the back of the trunk • 3 layers in lumbar region

  24. Q.L Erector spinae

  25. MUSCLES Superficial group Intermediate group Deep group extrinsic back muscles intrinsic back muscles respiration and movements of the upper extremity movement and stabilization of the vertebral column

  26. Superficial Group Trapezius levator scapulae Rhomboid minor Rhomboid major Latissimus dorsi

  27. Triangle Of Auscultation SUPERIOR INFERIOR Trapezius Latissimusdorsi medial border of scapula

  28. Intermediate Group Serratus posterior superior Serratus posterior inferior

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

  30. DEEP GROUP Transversospinales muscles Semispinalis Rotatores Multifidus Segmental back muscles Levatores costarum Interspinales Intertransversarii P59

  31. DEEP GROUP Suboccipital Muscles Rectus Capitis Posterior Minor Rectus Capitis Posterior Major Superior Oblique Inferior Oblique

  32. Suboccipital Triangle • Rectus Capitis Posterior Major • Superior Rectus Oblique • Inferior Rectus Oblique • Vertebral Artery • Suboccipital N (Dorsal Ramus Of CⅠ)

  33. Superior Lumbar Triangle(Triangle Of Grynfeltt-Lesshaft ) • twelfth rib • Serratus posterior inferior • Erector spinae • internal oblique

  34. Inferior Lumbar Triangle(Petit's Lumbar Triangle) • External Abdominal Oblique • Latissimus Dorsi • Iliac Crest

  35. Deep Arteries

  36. DEEP VEINS

  37. Vertebral Artery Atlas

  38. Vertebral Veins

  39. Deep Nervers • Dorsal rami of spinal nerve • Accessory nerve • Thoracodorsal nerve • Dorsal scapular nerve

  40. Dorsal Rami of Spinal Nerve

  41. Accessory Nerve

  42. Transient postoperative paralysis of spinal accessory nerve

  43. Thoracodorsal Nerve

  44. Dorsal Scapular Nerve

  45. Vertebral Column Osteology and Arthrology

  46. Osteology • 7 C, 12 T, 5 L, 5 S (Fused as Sacrum), 4 coccygeal • Primary Curves • Secondary Curves • Anterior/Posterior alignment

  47. Vertebral Segments

  48. Primary Curve

  49. Secondary Curves Lateral

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