|
|
 
|
NECK ANATOMY
Ⅰ. GENERAL NECK
1> Landmark of neck
a) transverse process of atlas
b)
ant. tubercle of transverse process of C6
c)
Hyoid Bone
d)
thyroid cartilage or adam's apple
e)
Cricoid cortilage
f)
Supra sternal notch
g)
trachea
그림7-1 landmark of neck
From. Clinical oriented Anatomy
by
Keith L. Moore P. 785에서 인용.
2> Boundaries of
neck
above - inferior border of mand.
laterally-
mastoid process of temporal bone
below
- clavicle, manubrium
3> 5 Cutanous N.
of NECK
a) lesser occiptal N. - C₂
b)
Grater Auricular N - C₂C₃
c)
ant. cutanous N. - C₂C₃
d)
Supra clavicular N. - C₃C₄
e)
Cervical branch of facial N.
4> Cutaneous vein
- ant. jugular vein
-
external jugular vein
5> Side of neck Boundaries
a) Supeior-inferior Border of
Mand.
b)
below - clavicle
c)
anterior - median plane
d)
Posterior - ant. Border of trapezius
6> Triangle of neck 그림 7-2, 7-3
그림
7-2 From Clinical
oriented Anatomy
by
Keith L. Moore P. 787에서 인용.
그림7-3 From Clinical oriented Anatomy by Keith L. Moore
P.
787에서 인용.
A> anterior triangle boundaries
1) above - inferior border of
MAND.
2)
below -ant. Border of SCM
3)
ant. - median plane of neck
B> ANT. Small triangle
1) Sub mental triangle = suprahyoid triangle
boundaries
laterally
- digastric m.
medially
- mid line of neck
Inf.
- hyoid bone
2) sub mandibular triangle=digastric
triangle boundaries
sup. - mandbular triangle
ant
- ant.belly digastric muscle
post
- post.belly digastric muscle
3) Muscular triangle
boundaries=Trianangle of Necessity
boundaries
sup.post - ant belly of omohyoid
inf
.post.- SCM muscle
anterior
-median plane of neck
4) Carotid triangle
= Sup.Carotid triangleboundaries
above - digastric m
post
.inf. - ant border of SCM
ant,inf
- superior belly of omohyoid
C> Posterior Triangle
Boundaries
ant.superiorly-post. boarder
of SCM
inferior
- clavicle
post
- ant boarder of trapezius muscle
1) Occiptal triangle Boundaries
ant.superior-post.border of
SCM
inferior-
omohyoid
post'ly
-ant .border of Trapezius
Occiptal Triangle content
Artery - branch of transverse
cervical Artery
Vein
- ext. jugular vein
-
transverse cervical vein
-
occipital vein
Nerve
- accessory nerve
five
cutaneous nerve
2) Subclavian Trianglen
Boundaries
ant. post. border of SCM
Inf.
- clavicle
post
inf.belly of omophyoid
Subclavian Triangle content
Artery- subclavian Artery
suprascapular
artery
Vein
- Ext. Jugular vein
-
Supra scapular vein
-
occipital vein
Nerve
- branch of brachial plexus
6 ansa
hypoglossi-supply omohyoid muscle
Ⅱ.
DORSUM OF NECK
1 Ligamentun nuchae - strong ligment from external occiptal
protuberance
to spinous process of
C1-C7
그림 7-4 From. Clinical oriented
Anatomy
by
Keith L. Moore P. 792에서 인용.
Supraspinous ligament- go down at the level of C7
2>
Greater occipital nerve & The 3rd occipital nerve 의 차이점
Greater
occiptal nerve |
The
3rd occipital nerve |
Larger
|
Smaller |
medial
branch from post
primary
rami of C2 |
medial
branch from post
primary
rami of C3 |
supply
of occipital area of scalp |
skin
of neck |
above
of superior nuchal line |
below
of the nuchal line |
3> Occipital Artery
- from ext. carotid artery
supply the skin, scalp anastomose
with
superficial temporal artery, post. auricular artery
-
give collateral branch
a)
muscular branch
b)
meningeal branch
c)
descending branch
d)
SCM branch
e)
Auricular branch
4> Transverse Cervical Artery
- Branch from thyro-cervical
artery which is branch
of
subclavian artery
Terminal
branch
a)
deep transverse cervical artery
b)
superficial transverse cervical artery
-
goes ant border of trapezius muscle
Ⅲ. BACK
1> Lumbodosal fascia
- thick wide tendinous sheath
cover the deep
muscle
of back (Lumbar, thoracic, sacral region)
a) Thoracic portion
- from ligamentum nuchae &
tip of spine of thoracic
vertbrae
continue with Serratus anterior, caudally
extended
into lumar region known as lumbar fascia
b) Lumbar portion
1) ant. lamella - attach transverse
process of lumbar
2)
middle lamella
3)
post.lamellae-extension of thoracicportion,
origin
of latissmus dorsi muscle
2> Muscles of Back -superifcial to deep
a)
1st layer- trapzius
Latissmus
dorsi
b)
2nd layer - Levator scapula, Rhomboid
그림7-5 first &second
layer of back muscles
From.
Basic And Clinical Anatomy of the SPINE,
SPINAL
CORD, AND ANS by Gregory D. Cramer
p.
74에서 인용.
c) 3rd layer - serratus superior
serratus
inferior
splenus
capitus
splenus
cervices
d)
4th layer - sacrospinalis or erector spinae
-
semispinalis
-
mutipidus
-
rotator
그림 7-6 3rd & 4th Layer of back Muscles
From.
Basic And Clinical Anatomy of the SPINE,
SPINAL
CORD, AND ANS by Gregory D. Cramer
p.
78에서 인용.
e) 5 th layer - interspinous
-
intertransverse
그림 7-7 5th Layer of Back Muscles From.
Basic And
Clinical
Anatomy of the SPINE, SPINAL
CORD,
AND ANS by Gregory D. Cramer
p.
83에서 인용.
3> Sacrospinalis의 3 column
a) Lateral group
-
iliocostalis lumborum
-
iliocostalis thoracis
-
iliocostalis cervicis
b)
midddle group or intermediated group
-
longissimus capitis
-
longissimus cervicis
-
longissimus thoracis
c)
medial group or spinalis group
-
spinalis capitus
-
spinalis cervicis
-
spinalis dorsi
Semispinalis
- most medial
a)
semispinalis capitus
b)
semispinalis cervicis
c)
semispinalis thoracis or dorsi
Mutipidus Muscls
- beneath the spinalis muscle
from level of C2 -sacrum
Rotator
Muscle
-
short fassiculi muscle. 12 pairs ,deep than the mutipus.muscle
4>
Vertebral Column
- male 71cm
-
female 61cm
Curvature
a) cervical curvature-from odontoid
process to the 2nd thoracic
b)
thoracic curvature- from T2-T12
c)
Lumbar curvature- from T12- lumbar Joint
d)
pelvic curvature - from lumbo-sacral to coccyx
* spina bifida - failure of fusion of 2 lamina
of the vertebra
which
result into a cleft
* vertebral canal - from foramen magnum to 2nd
sacral
A) Structure of vertebral
column
1)
ligament
a) Front of vertebral column
-
anterior longitudinal ligament---from foramen magnum
b)
behind of vertebral column
(1)
posterior longitudinal ligament
(2)
Intervertebral disc
(3)
Ligamentum flava - from anterior lower border
of
vertebral column to posterior border
of
next vertebral column
(4)
supra spinous ligament- continues ligamentum nuchae
(5)
interspinous ligament
(6)
intertransverse ligament
(7)
ligamentum nuchae
(8)
articular capsule
2) Blood vessel or spinal
artery
a) vertebral artery-continue
cervical region
b)
posterior intercostal artery-thoracic region
c)
lumbar artery-lumbar region
d)
lateral sacral artery- sacral region
3) Veins - starting at pia
mater
5> Subocciptal
1 muscle of Subocciptal
그림 7-8 sub occipital muscle
From.
Basic And Clinical Anatomy of the SPINE, SPINAL CORD,
AND
ANS by Gregory D. Cramer p. 90에서 인용.
Name |
origin |
insertion |
oblique capitus
superior |
transverse
of C1 |
sup. nuchaline
line |
oblique capitus
inferior |
spinous proces
of C2 |
transverse
of C1 |
Rectus capitus
post.minor |
spinous proces
of C2 |
above sup.
nuchaline line |
Rectus capitus
post.major |
post.tubercle
of C1 |
sup. nuchaline
line |
a) boundaries of sub occipital triangle
lateral , superiorly- oblique capitus superior
inferiorly-oblique capitus inferior
medially-Rectus capitus post.major
b) contents
of sub occipital triangle
1) vertebral artery
2)
post. ramus of 1st cervical nerve=subocciptal nerve
3)
subocciptal plexus of vein
* vertebral artery
origin - subclavian artery
commence-
between the interval of longus
cervics
& scalenius anterior
fermination-
inside the cranial cavity by meeting opposite
side
to form basilar artery
6>
Part of meninges of spinal cord & brain
a) epidural space - between duramater
& veretbral column
b) subdural space
- space between arcahnoid & duramater
c)
sub arachnoid space - space between arachnoid & pia mater,
here
CSF located
d) duramater - thick fibrous
tissue which enclose the spinal cord
e)
arachnoid - thin delecate non-vascular transparent membrane
f) pia mater - inner most thick vascular
closely adherent to the spinal cord
* 31 pair of spinal nerve
1) 8 cervical spinal nerve
2)
12 thoracic spinal nerve
3)
5 lumbar spinal nerve
4)
5 sacral spinal nerve
5)
1 coccyx spinal nerve
Ⅳ. CERVICAL SPINE
1 특징
그림7-9 TYPICAL CERVICAL
VERTEBRAE from p.185 Principles
of
Anatomy & physiology 8th edition by Bonnie Roesch
그림7-10 TYPICAL
CERVICAL VERTEBRAE from p.185
Principles
of Anatomy & physiology 8th edition
by
Bonnie Roesch
1.1 Cervical spine 은 우리 인체
중에서 가장 복잡한 관절 조직이다.
1989년
Dr.bland는 이곳에 37개의 뼈가 서로 다르게 작용한다고
했다.
1.2 이곳에는 수많은 신경, 혈관 , 님프노드,
ganglion이 지나가므로
인체에서
핵심부분이라고 할 수 있다.
1.3 옆에서 보면 cervical spine은
부분적으로 C1-C7까지 대칭을
이루고,
C5-C7지역은 약간의 급 curve을 이룬다.
2 Functional unit
2.1 우리가 흔히 말하는 Upper cervical spine은 occiput에서
C3 까지
말하는 사람도 있고 Occiput C1 C2라고 말하는
사람도
있다. Lower Cervical spine 은 C3- C7 까지를
말한다.
2.2 White & PanJabi에 의하면
cervical spine의 functional
unit은
Anterior column과 posterior column으로 나누는데
Anterior
column에는 vertebrae, longitudinal ligament, disc,
posterior
column에 는 neural osseous canal, posterior
ligament,
zygapophyseal joint, erector muscle of spine 이
포함되어
있다.
2.3 Neck 움직임은 flexion, extension,
lateral flexion, rotation 이
있다.
3 Lower
Cervical segment
- cervical vertebrae는 vertebral body와
posterior arch로 구성되며
vertebral
body은 위에서 보았을 때 약간 작고 rectangular shape
이며
옆에서 보았을때는 C2-C7까지는 직경이 증가한다.
이것은
우리가 움직일 때 lower vertebrae 를 지탱하는 조건이
된다.
3.1 Posterior longitudinal ligament
- 뒷cervical vertebrae의 superior
inferior margin에 부착된다.
3.2 Uncinate process
- typical vertebrae 의 superior
surface에 부착되며, posterior
component는
lower cervical에서 more prominent 하다.
3.3 Pedicles
- 아주 작고, vertebral body의
superior inferior margin 의
약간
중간지점에 위치한다.
3.4 Transverse
process
6 vertebral
body 의 양쪽에 위치하며 이 foramen으로
vertebral
artery 가 지나간다.
1.1 Intervertebral disc
1.1.1 Nucleus -
soft inner structure, 약 1mm두께로 12 lammellae로
둘러싸여
있고 80%가 water, proteoglycogen gel로 구성되어
있다.
1.1.2 Annulus
- sheet of parallel collagen fiber로 구성되어 있다.
-
circumferential annular fibers around central nucleus
pulposus
2 Upper
cervical segment
- 여기에 5 articulation이 있는데
2개의 Atlas Lateral mass 와
occiput
2개의 2개의 axis lateral mass 와 5번째는 posterior
arch와
odontoid process의 anterior surface,atlas의 transverse
ligament
사이의 articulation이다.
1 ATLAS
(C1)
6 머리를
받치는 중요한 뼈라고 해서, atlas라는 명칭이
붙었다고
할 정도로 아주 중요한 첫번째의 목 뼈이다.
이
뼈 하나만 잘 조절해도 많은 통증이 사라진다고 해서
Atlas
연구가 활발히 연구 중이다.
7 vertebral
body 가 없는 것이 특징이고 ,두개의 lateral
mass
가 anterior &posterior arch 에 의해서 연결되어
있다.
1.1 anterior arch - 두개의 lateral mass를 연결한다.
1.2 posterior arch - ligament nuchae 가 중앙에 연결되는
곳이며,또한
Rectus capitus posterior
minor가
origin되는 곳이다.
1.3 Lateral masses - anterior & poserior arch사이에 위치하며,
superior
articular procsess 와 inferior
articular
process 로 구성된다.
Lateral
mass의 anterior surface에 rectus
capitus
anterior muscles이 origin 된다.
1.4 Transverse process - foramen of TP가 cervical spine 중
가장
크며, 이곳을 지나는 구조물은
vertebral
artery, vein,sympathetic
nerve
plexus 이다.
1 AXIS
(C2)
- 이곳에는 특이한 구조물인 odontoid
prcess 가 존재한다.
치아에
걸리는 교합력이 이곳에 전달되기 때문에 교합과
긴밀히
연관이 된다.
- THE END-
상담안내(평생번호): 02-962-2828
|
