人體解剖學(xué)椎管及其內(nèi)容物Vertebral canal and its contents

1、人體解剖學(xué)椎管及其內(nèi)容物Vertebral canal and its contentsVertebral canalSacrum & sacral canalNormal vertebral column and spinal cordSpinal cord in situ 2 enlargements medullary cone terminal filum cauda equina medullary cone cauda equina filum terminale Vertebra, intervertebral foramen, spinal cord, & spinal ner

2、ve The spinal segment31 segments of spinal cord The spinal cord is consisted of 31 segments in corresponding to the spinal nerves. 8 cervical segments, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal.Relationship of the spinal cord and spinal nervesEach of pair of spinal nerve leaves the spinal cana

3、l at the same number of the intervertebral foramen(corresponding intervertebral foramina)Each of pair of the spinal nerve is attached to spinal cord by anterior and posterior roots. Relationship between the segments of spinal cord and vertebral column Spinal cordVertebral columnC14CV1CV4C58CV4CV6T1T

4、4CV7TV3T5T8TV3TV6T9T12TV6TV9L15TV10TV12S15 and CoLV1Coverings of the spinal cord1. vertebral canal 2. meninges of spinal cord dura mater arachnoid mater pia materSpinal meningeal coveringsDura materArachnoid materPia materSpinal cord, spinal nerves, and spinal meningesSpaces Associated with the Spin

5、al MeningesEpidural space Subdural space Subarachnoid space denticulate ligaments dural root sheaths Inferior end of spinal dural sacEpidural Blocks & Spinal BlocksBlood supply of spinal cordVertebral arteryAscending cervical arteryIntercostal arteryLumbar artery Vertebral artery : SAArterial suppli

6、es of the spinal cord3 longitudinal vessels run the length of the spinal cord.An anterior spinal a. paired posterior spinal a. Segmental medullary a. & radicular a.Segmental medullary arteries and radicular arteries derived from segmental vessels, including the ascending cervical, intercostal and lu

7、mbar arteriesMajor anterior medullary a.Segmental medullary a. & radicular a.Arterial supply of spinal cordBlood supply of vertebraeVenous drainage of the spinal cordFollows a basically similar pattern to arteries supply Six longitudinal interconnecting venous channels exist. These consist of anteri

8、or and posterior veins which run in the midline. More irregular sometimes incomplete bilateral paired anteriolateral and posterolateral veins are situated near the lines of attachement of the dorsal and ventral nerve roots.Venous drainage of the spinal cord 6 longitudinal interconnecting venous chan

9、nels exist. Anterior, posterior veins, anteriolateral, and posteriolateral veins radicular veinsVein of spinal cord & vertebral venous plexusVertebral venous plexus Spinal veinsVenous drainage of the spinal cordAll of these vessels drain via anterior and posterior radicular veins into the internal v

10、ertebral venous plexus in epidural space The internal venous plexus communicates with an external venous plexus and hence with the ascending lumbar veins, the azygos and hemiazygos veins. Venous drainage of vertebral columnInnervation of periosteum and ligaments of vertebral column and of meningesOu

11、tline of vertebral canalclinical significanceNormal cervical vertebral column and spinal cord患者可能有顱內(nèi)出血，醫(yī)生擬進(jìn)行腰椎穿刺以確診。在何位置進(jìn)針？為何選取這些椎骨位置？此位置在嬰兒安全嗎？為什么在進(jìn)行腰椎穿刺的時(shí)候要病人的背部盡量屈曲？病例分析病例分析患者60歲，男性，主訴腹部脈搏搏動(dòng)顯著增強(qiáng)，感覺(jué)像是第二個(gè)心臟，并伴腹部、背部和腹股溝區(qū)疼痛。X線(xiàn)片發(fā)現(xiàn)患者腹主動(dòng)脈鈣質(zhì)沉積并伴有動(dòng)脈瘤表現(xiàn)。CT示直徑11cm的腹主動(dòng)脈瘤。住院治療前，患者在回家途中遭遇小型車(chē)禍。患者被立即送往醫(yī)院行破裂性動(dòng)脈瘤修復(fù)術(shù)。手術(shù)中患者的主動(dòng)脈多處被移位，并結(jié)扎了幾支節(jié)段性動(dòng)脈。雖然使用聚酯纖維對(duì)動(dòng)脈進(jìn)行了成功的修復(fù)，患者在術(shù)后仍發(fā)生了截癱和陽(yáng)痿，膀胱和直腸的功能也喪失了意識(shí)支配?；颊咝g(shù)后發(fā)生癥狀的解剖學(xué)基礎(chǔ)是什么？一18歲女性從馬上摔落，由于落地時(shí)頸部處于過(guò)伸位導(dǎo)致脊髓受