锁胸筋膜及其毗邻结构的临床解剖学结构

发布时间：2018-07-10 00:35

本文选题：腋静脉 + 胸肩峰动脉　；参考：《吉林大学》2012年硕士论文

【摘要】：目的：研究腋静脉的各段的长度，，外径；穿经锁胸筋膜各结构的主干长度，外径或者长度，宽度，及其与腋静脉穿刺处的毗邻关系，目的是为了检测出临床上穿刺时的一个相对的安全区域，而避免损伤到穿经锁胸筋膜处的这些结构。材料与方法： 60具福尔马林固定的成人尸体标本，尸体标本完整，胸部保留完好，年龄不详。观察记录穿经缩胸筋膜的结构，穿出结构的解剖学关系。测量定位各穿经结构以及缩胸筋膜下结构的管径，走形长度，以及距锁骨以及喙突的距离。结果： 1腋静脉第一段的长度为39.2±3.1mm，外径为7.7±1.7mm，第二段的长度为32.0±3.0mm，外径为9.6±2.4mm，第三段的长度为19.6±4.2，外径为12.4±2.8。 2胸肩峰动脉穿经锁胸筋膜处为其主干，主干的长度为11.98±3.40mm，外径为2.85±0.45mm，其分支肩峰支外径为1.6±0.3mm。 3胸外侧神经穿经锁胸筋膜处的主干的长度为40.54±3.13mm，厚度为0.86±0.06mm，宽度为1.84±0.09mm，且其在胸锁筋膜处的投影点为:其距离喙突的距离为38.38mm，距锁骨的距离为8.24mm,其在锁骨中线处的投影点为：若是在锁骨中线的外侧，则距离锁骨中线的距离为10.28mm，若是在锁骨中线的内侧，则距离锁骨中线的距离为11.55mm。 4胸肩峰动脉分支肩峰支与锁骨交点处至喙突距离为53.70mm。 5胸肩峰动脉在锁胸筋膜处距离锁骨距离为13.88mm，距离喙突距离为42.10mm；胸肩峰静脉位于其内侧,其距离锁骨距离为13.60mm,距离喙突距离为46.92mm。 6锁胸筋膜的上界长度为74.64mm，下外侧界长度为84.86mm，内侧界为28.24mm。 7头静脉在汇入腋静脉或锁骨下静脉处的外径平均为4.2±1.1mm，在喙突处的外径平均为2.9±1.1mm。头静脉距离喙突的距离为27.46mm，距离锁骨的距离为14.10mm。结论： 1腋静脉穿刺相较于锁骨下静脉，头静脉等的穿刺具有一定的优势，可以作为临床上进行置留穿刺的常用血管。 2.根据头静脉、胸肩峰动静脉、胸外侧神经穿经锁胸筋膜的分布情况中可以看出，胸肩峰静脉位于穿经锁胸筋膜各结构的最内侧，而上方最内侧为胸肩峰动脉的分支肩胛支，经测量，胸肩峰静脉与肩峰支均位于喙突内侧6cm范围以内，故临床上穿刺的进针点可位于喙突内侧6cm以上的腋静脉走形区域，即所谓的安全区。
[Abstract]:Objective: to study the length and outer diameter of the axillary vein, the length, the outer diameter or the length, the width of the main structure of the perforated thoracic fascia, and its adjacent relationship with the puncture place of the axillary vein. The aim is to detect a relatively safe area of clinical puncture without damaging these structures through the lock-in fascia. Materials and methods: 60 formalin fixed adult cadavers with intact chest and unknown age. The anatomical relationship between the structure of the perforating thoracic fascia and the perforating structure was observed. The diameter, length, distance from clavicle and coracoid were measured. Results: 1the length of the first segment of axillary vein was 39.2 卤3.1 mm, the external diameter was 7.7 卤1.7 mm, the length of the second segment was 32.0 卤3.0 mm, the external diameter was 9.6 卤2.4 mm, the length of the third segment was 19.6 卤4.2 mm, and the external diameter was 12.4 卤2.82 mm. The length of the main trunk is 11.98 卤3.40 mm, the external diameter is 2.85 卤0.45 mm, and the external diameter of the acromion branch is 1.6 卤0.3 mm 路3 the length of the main trunk through the latticulated fascia is 40.54 卤3.13 mm, the thickness is 0.86 卤0.06 mm, and the width is 1.84 卤0.09 mm. The distance from the coracoid process to the coracoid process is 38.38 mm, and the distance from the clavicle to the clavicle is 8.24 mm. The projection point at the midline of the clavicle is: if it is outside the midline of the clavicle, The distance from the midline of the clavicle is 10.28 mm, and if it is on the medial side of the midline of the clavicle, The distance from the central line of the clavicle was 11.55mm. 4 the distance from the point between the acromion branch and the clavicle to the coracoid process was 53.70 mm.5 the distance from the sternoacromian artery to the clavicle was 13.88 mm, and the distance from the coracoid process to the coracoid process was 42.10 mm. The thoracic and acromian veins are located on the medial side. The distance from the clavicle to the clavicle is 13.60 mm, the distance from the coracoid process to the coracoid process is 46.92 mm.6 the length of the upper bound of the latocapillary fascia is 74.64 mm, the length of the lower lateral boundary is 84.86 mm, and the medial boundary is 28.24 mm of the external diameter of the vein at the point where the vein flows into the axillary vein or the subclavian vein. The average diameter was 4.2 卤1.1 mm and 2.9 卤1.1 mm in the coracoid process. The distance from the cephalic vein to the coracoid process was 27.46 mm, and the distance from the clavicle to the clavicle was 14.10 mm. Conclusion: 1 axillary venipuncture is superior to subclavian vein and cephalic vein, and can be used as common blood vessel for indwelling puncture. 2. According to the distribution of the cephalic vein, the arteriovenous of the thoracic acromion and the lateral thoracolateral nerve, it can be seen that the thoracic and acromitic vein is located at the innermost side of the structure through the sternoclavicular fascia, and the upper most medial is the branch of the scapular branch of the thoracic acromion artery. The chest and acromion vein and acromion branch are located within the range of coracoid process medial 6cm, so the needle point can be located in the area of axillary vein which is above the coracoid process medial 6cm, that is, the so-called safe area.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322

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