临床解剖学精要Essential Clinical Anatomy, 4th ed.pdf

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1、 P x Acknowledgments We wish to thank the following colleagues who were invited by the publisher to assist with the development of this fourth edition List of Reviewers Saad Al AliDepartment of Anatomy with RadiologyUniversity of AucklandAuckland New Zealand Claire AlandSchool of Biomedical Sciences

2、The University of QueenslandBrisbane Queensland Australia Dr Roscoe BowenHuman Performance former Chair Mayo Medical School former Editor in Chief of Clinical Anatomy Rochester Minnesota Dr Joan Campbell Assistant Professor of Medical Imaging University of Toronto Faculty of Medicine Toronto Ontario

3、 Dr Stephen W Carmichael Professor Emeritus Mayo Medical School Editor in Chief of Clinical Anatomy Rochester Minnesota Dr Carmine D Clemente Professor of Anatomy and Cell Biology and Professor of Neurobiology Emeritus Recalled University of California Los Angeles School of Medicine Los Angeles Cali

4、fornia Dr James D Collins Distinguished Professor of Radiological Sciences University of California Los Angeles School of Medicine Center for Health Sciences Los Angeles California Dr Raymond F Gasser Emeritus Professor of Cell Biology and Anatomy and Adjunct Professor of Obstetrics and Gynecology L

5、ouisiana State University School of Medicine New Orleans Louisiana Dr Ralph Ger Professor of Anatomy and Structural Biology Albert Einstein College of Medicine Bronx New York Dr Douglas J Gould Associate Professor The Ohio State University Columbus Ohio Dr Daniel O Graney Professor of Biological Str

6、ucture University of Washington School of Medicine Seattle Washington Dr David G Greathouse former Professor and Chair Belmont University School of Physical Therapy Nashville Tennessee Dr Masoom Haider Associate Professor of Medical Imaging University of Toronto Faculty of Medicine Toronto Ontario D

7、r John S Halle Professor and Chair Belmont University School of Physical Therapy Nashville Tennessee Dr Jennifer L Halpern Associate Professor Department of Orthopaedic Surgery and Rehabilitation Vanderbilt University Nashville Tennessee Dr Walter Kuchareczyk Professor Department of Medical Imaging

8、Faculty of Medicine University of Toronto Toronto Ontario Dr Nirusha Lachman Professor of Anatomy Mayo Medical School Rochester Minnesota Dr H Wayne Lambert Associate Professor Department of Neurobiology and Anatomy West Virginia University School of Medicine Morgantown West Virginia Dr Michael von

9、L dinghausen University Professor Anatomy Institute University of W rzburg W rzburg Germany Dr Shirley McCarthy Director of MRI Department of Diagnostic Radiology Yale University School of Medicine New Haven Connecticut Dr Lillian Nanney Professor of Plastic Surgery and Cell and Developmental Biolog

10、y Vanderbilt University School of Medicine Nashville Tennessee Dr Todd R Olson Professor of Anatomy and Structural Biology Albert Einstein College of Medicine Bronx New York Dr Wojciech Pawlina Professor and Chair of Anatomy Mayo Medical School Rochester Minnesota Dr T V N Persaud Professor Emeritus

11、 of Human Anatomy and Cell Science Faculties of Medicine and Dentistry University of Manitoba Winnipeg Manitoba Canada Professor of Anatomy and Embryology St George s University Granada West Indies Dr Cathleen C Pettepher Professor of Cancer Biology and Cell and Developmental Biology Vanderbilt Univ

12、ersity School of Medicine Nashville Tennessee Dr Thomas H Quinn Professor of Biomedical Sciences Creighton University School of Medicine Omaha Nebraska Dr George E Salter Professor of Anatomy Department of Cell Biology University of Alabama Birmingham Alabama Dr Tatsuo Sato Professor and Head retire

13、d Second Department of Anatomy Tokyo Medical and Dental University Faculty of Medicine Tokyo Ryckie Wade MB BS MClinEd Yr4 President UEA Surgical Society University of East Anglia School of Medicine Norwich United Kingdom Professor Colin P Wendell Smith Department of Anatomy and Physiology Universit

14、y of Tasmania Hobart Tasmania Australia Dr Andreas H Weiglein Associate Professor Institut fur Anatomie Medical University Graz Graz Austria Dr David G Whitlock Professor of Anatomy University of Colorado Medical School Denver Colorado All the new illustrations and changes to the existing artwork we

15、re done by Paulette Dennis and Valerie Oxorn both talented medical illustrators Their meticulous work and insight into anatomy is invaluable We also thank Kam Yu who prepared the illustrations for the first edition Other illustrations from the sixth edition of Clinically Oriented Anatomy and the twe

16、lfth edition of Grant s Atlas were prepared by Angela Cluer Nina Kilpatrick Stephen Mader David Mazierski Sari O Sullivan Bart Vallecoccia Valerie Oxorn J B Woolsey Associates and Dragonfly Media Group We continue to benefit from the extensive surface anatomy project photographed by E Anne Raynor Se

17、nior Photographer Vanderbilt Medical Art Group under the direction of authors Art Dalley and Anne Agur with the support of Lippincott Williams and Wilkins Our appreciation and thanks are extended to the editorial and production team at Lippincott Williams Julie Montalbano Product Manager Jennifer Cl

18、ements and Doug Smock Art Directors and Catherine Noonan Editorial Assistant We also wish to acknowledge Kathleen Scogna former Senior Developmental Editor for her work on the early part of this edition Finally thanks to the Sales Division at LWW which has played a key role in the success of this bo

19、ok Keith L Moore Anne M R Agur Arthur F Dalley II Authors Keith L Moore PhD FIAC FRSM FAAA Professor Emeritus Division of Anatomy Department of Surgery Former Chair of Anatomy and Associate Dean for Basic Medical Sciences Faculty of Medicine University of Toronto Toronto Ontario Canada Anne M R Agur

20、 BSc OT MSc PhD Professor Division of Anatomy Department of Surgery Faculty of Medicine Department of Physical Therapy Department of Occupational Science Present an appropriate amount of clinically relevant anatomical material in a readable and interesting form Place emphasis on clinical anatomy tha

21、t is important for practice Provide a concise clinically oriented anatomical overview for clinical courses in subsequent years Serve as a rapid review when preparing for examinations particularly those prepared by the National Board of Medical Examiners and Offer enough information for those wishing

22、 to refresh their knowledge of clinical anatomy This edition has been thoroughly revised keeping in mind the many invaluable comments received from students colleagues and reviewers The key features include Revised text with a stronger clinical orientation A number of new illustrations have been cre

23、ated and many existing illustrations have been revised re colored and resized Most illustrations are in full color and designed to highlight important facts and show their relationship to clinical medicine and surgery A great effort has been made to further improve clarity of labeling to place illus

24、trations on the pages being viewed as the illustrations are cited in the text and to eliminate disruptions in the continuity of the running text More illustrated clinical correlations known as blue boxes have been included to help with the understanding of the practical value of anatomy In response

25、to our readers suggestions the blue boxes have been grouped They are also classified by the following icons to indicate the type of clinical information covered P viii Anatomical variations icon These blue boxes feature anatomical variations that may be encountered in the dissection lab or in practi

26、ce emphasizing the clinical importance of awareness of such variations Life cycle icon These blue boxes emphasize prenatal developmental factors that affect postnatal anatomy and anatomical phenomena specifically associated with stages of life childhood adolescence adult and advanced age Trauma icon

27、 The effect of traumatic events such as fractures of bones or dislocations of joints on normal anatomy and the clinical manifestations and dysfunction resulting from such injuries are featured in these blue boxes Diagnostic procedures icon Anatomical features and observations that play a role in phy

28、sical diagnosis are targeted in these blue boxes Surgical procedures icon These blue boxes address such topics as the anatomical basis of surgical procedures such as the planning of incisions and the anatomical basis of regional anesthesia Pathology icon The effect of disease on normal anatomy such

29、as cancer of the breast and anatomical structures or principles involved in the confinement or dissemination of disease within the body are the types of topics covered in these blue boxes Surface anatomy is integrated into the chapter at the time each region is being discussed to demonstrate the rel

30、ationship between anatomy and physical examination diagnosis and clinical procedures Medical images radiographic CT MRI and ultrasonography studies have been included often with correlative illustrations Current diagnostic imaging techniques demonstrate anatomy as it is often viewed clinically Case

31、studies accompanied by clinico anatomical problems and USMLE style multiple choice questions Interactive case studies and multiple choice questions are available to our readers online at http thePoint lww com ECA4e providing a convenient and comprehensive means of selftesting and review Instructor s

32、 resources and supplemental materials including images exportable for Power Point presentation are available through http theP The terminology adheres to the Terminologica Anatomica 1998 approved by the International Federation of Anatomists IFAA The official English equivalent terms are used throug

33、hout the present edition When new terms are introduced however the Latin forms as used in Europe Asia and other parts of the world appear in parentheses The roots and derivation of terms are included to help students understand the meaning of the terminology Eponyms although not endorsed by the IFAA

34、 appear in parentheses to assist students during their clinical studies The parent of this book Clinically Oriented Anatomy COA is recommended as a resource for more detailed descriptions of human anatomy and its relationship and importance to medicine and surgery It is a pleasure to welcome Arthur

35、F Dalley II to or team of authors Essential Clinical Anatomy in addition to its own unique illustrations and manuscript has utilized from the outset materials from Clinically Oriented Anatomy and Grant s Atlas Arthur s expertise extensive knowledge of clinical anatomy and innovative eaching methods

36、have enhanced this the fourth edition of Essential Clinical Anatomy We again welcome your comments and suggestions for improvements in future editions Keith L Moore University of Toronto Faculty of Medicine Anne M R Agur University of Toronto Faculty of Medicine Arthur F Dalley II Vanderbilt Univers

37、ity School of Medicine P 48 Chapter 1 Thorax The thorax is the superior part of the trunk between the neck and abdomen The thoracic cavity surrounded by the thoracic wall contains the heart lungs thymus distal part of the trachea and most of the esophagus To perform a physical examination of the tho

38、rax a working knowledge of its structure and vital organs is required THORACIC WALL The thoracic wall consists of skin fascia nerves vessels muscles cartilages and bones The functions of the thoracic wall include protecting the thoracic and abdominal internal organs resisting the negative internal p

39、ressures generated by the elastic recoil of the lungs and inspiratory movements providing attachment for and supporting the weight of the upper limbs and providing attachment for many of the muscles of the upper limbs neck abdomen and back and the muscles of respiration The mammary glands of the bre

40、asts are in the subcutaneous tissue overlying the pectoral muscles covering the anterolateral thoracic wall Skeleton of Thoracic Wall The thoracic skeleton forms the osteocartilaginous thoracic cage Fig 1 1 The thoracic skeleton includes 12 pairs of ribs and costal cartilages 12 thoracic vertebrae a

41、nd intervertebral IV discs and the sternum Costal cartilages form the anterior continuation of the ribs providing a flexible attachment at their articulation with the sternum Fig 1 1A The ribs and their cartilages are separated by intercostal spaces which are occupied by intercostal muscles vessels

42、and nerves Thoracic Apertures The thoracic cavity communicates with the neck and upper limb through the superior thoracic aperture the anatomical thoracic inlet Fig 1 1A Structures entering and leaving the thoracic cavity through this aperture include the trachea esophagus vessels and nerves The adu

43、lt superior thoracic aperture measures approximately 6 5 cm anteroposteriorly and 11 cm transversely Because of the obliquity of the first pair of ribs the superior thoracic aperture slopes anteroinferiorly The superior thoracic aperture is bounded Posteriorly by the T1 vertebra Laterally by the fir

44、st pair of ribs and their costal cartilages Anteriorly by the superior border of the manubrium The thoracic cavity communicates with the abdomen through the inferior thoracic aperture the anatomical thoracic outlet Fig 1 1A In closing the inferior thoracic aperture the diaphragm separates the thorac

45、ic and abdominal cavities almost completely The inferior thoracic aperture is more spacious than the superior thoracic aperture Structures passing to or from the thorax to the abdomen pass through openings in the diaphragm e g the inferior vena cava and esophagus or posterior to it e g aorta The inf

46、erior thoracic aperture is bounded Posteriorly by the T12 vertebra Posterolaterally by the eleventh and twelfth pairs of ribs Anterolaterally by the joined costal cartilages of ribs 7 10 forming the costal margin Anteriorly by the xiphisternal joint P 49 RIBS AND COSTAL CARTILAGES The ribs are curve

47、d flat bones that form most of the thoracic cage Fig 1 1 They are remarkably light in weight yet highly resilient Each rib has a spongy interior containing bone marrow Fig 1 2 which forms blood cells hematopoietic tissue There are three types of ribs True vertebrocostal ribs first through seventh ri

48、bs attach directly to the sternum through their own costal cartilages False vertebrochondral ribs eighth through tenth ribs have cartilages that are joined to the cartilage of the rib just superior to them thus their connection with the sternum is indirect Floating free ribs eleventh and twelfth rib

49、s sometimes the tenth rib have rudimentary cartilages that do not connect even indirectly with the sternum instead they end in the posterior abdominal musculature Typical ribs third through ninth have a Head that is wedge shaped and two facets that are separated by the crest of the head Fig 1 2A One

50、 facet is for articulation with the numerically corresponding vertebra and one facet is for the vertebra superior to it Neck that connects the head with the body shaft at the level of the tubercle Tubercle at the junction of the neck and body The tubercle has a smooth articular part for articulating