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1 Dept. of Human Anatomy, Si Chuan University Zhou hongying Vertebral canal & its contents OUTLINE spinal cord spinal cord & spinal nerve spinal cord & its coverings spinal cord & its blood vessels

2 Vertebral canal

3 Normal vertebral column and spinal cord

4 Spinal cord in situ cervical enlargement (C4 to T1 segments) lumbar enlargement (L2 to S3 segments)

5 Spinal cord in situ medullary cone cauda equina filum terminale

7 Vertebra, intervertebral foramen, spinal cord, & spinal nerve

8 Nerve Fibers of the Spinal Nerve spinal nerve (mixed) anterior root (motor) posterior root (sensory)

9 CLINICAL NOTE The Reffered Pain The Map of Reffered Pain

10 spinal segments & spinal nerve filament (rootlet) ventral root dorsal root spinal ganglion menigeal branch dorsal ramus ventral ramus rami communicants

11 31 segments of spinal cord 31 segments in corresponding to the spinal nerves: 8 cervical segments, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal.

12 Relationship of the spinal cord and spinal nerves Each spinal nerve leaves the vertebral canal at the same number of the intervertebral foramen

Relationship between the segments of spinal cord and vertebral column spinal segments upper cervical region (C1~C4) lower cervical and upper thoracic region (C5~T4) middle thoracic region (T5~T8)

13 Relationship between the segments of spinal cord and vertebral column spinal segments upper cervical region (C1~C4) lower cervical and upper thoracic region (C5~T4) middle thoracic region (T5~T8) lower thoracic region (T9~T12) lumber segments sacral and coccygeal segments vertebral levels (spines) = CV1 ~ CV4 1 = CV4 ~ TV3 2 = TV3 ~ TV6 3 = TV6 ~ TV9 = TV10 ~ TV12 = LV1 as a rule: cervical cord segments lie almost 1 spine higher than their corresponding vertebrae, thoracic segments lie almost 2 spines higher and lumbar segments 3-4 spines higher than their corresponding vertebrae

14 CLINICAL NOTES Herniation of Nucleus Pulposus in lumbar region

15 The Dermatomes an area of skin supplied by the dorsal (sensory) root of a spinal nerve. Each segment is horizontally disposed. there is considerable overlapping of adjacent dermatomes. each segmental nerve overlaps a part of area of its neighbors

17 Coverings of the spinal cord vertebral canal meninges of spinal cord dura mater arachnoid mater pia mater

18 Spaces Associated with the Spinal Meninges Epidural space Subdural space Subarachnoid space

19 Structures formed by spinal meninges Spinal cord, spinal nerves, and spinal meninges

20 Inferior end of spinal dural sac dural root sheaths filum terminale

21 dural root sheaths

22 denticulate ligaments

23 CLINICAL NOTE Epidural Blocks & Spinal Blocks The needle is inserted in the midline between the spinous processes of the LV3 and LV4 (or the LV4 and LV5). At these levels in adults, there is little danger of damaging the spinal cord.

24 CLINICAL NOTE Caudal Epidural Anesthesia

26 Blood Supply of the Spinal Cord vertebral artery ascending cervical artery intercostal arteries lumbar arteries

27 Arterial supply 3 longitudinal vessels run the length of the spinal cord. An anterior spinal a. paired posterior spinal a.

28 Originations of the Anterior & Posterior Spinal Arteries

29 Segmental Spinal Artery Central branches (Sulcal Artery) & Pial plexus

30 Segmental Spinal Artery segmental medullary artery radiculary artery

31 Major Anterior Segmental Medullary Artery (Artery of Adamkiewicz)

32 the artery of Adamkiewicz in a 78-year-old man with a true thoracoabdominal aortic aneurysm. MR angiography in a 74-year-old man with an aortic aneurysm. the oblique thin-slab maximum intensity projection images

33 Venous Drainage of the Spinal Cord 6 longitudinal interconnecting venous channels - anterior & posterior spinal veins - anterolateral & posterolateral veins radicular veins basically, follows a similar pattern to arterial supply

34 Venous Drainage of the Spinal Cord Pial Venous Plexus ant. & post. radicular / segmental veins drain back into internal vertebral venous plexus Internal & External vertebral Venous Plexuses

35 Veins of spinal cord & vertebral venous plexus vertebral venous plexus deep cervical vein in neck azygos venous system in thorax ascending lumbar veins in abdomen dural venous sinuses

36 Vertebral Canal & Its Contents

37 Normal cervical vertebral column and spinal cord

38 Guide to Dissection remove the muscles of vertebral column to exposure the boney structure open the vertebral canal by using a chisel, angled at 45 to the vertical cut open the meninges of spinal cord, then observe

39 Structures to Observe

40 CASE STUDY 患者 60 岁, 男性, 主诉腹部脉搏搏动显著增强, 感觉像是第二个心脏, 并伴腹部背部和腹股沟区疼痛 X 线片发现患者腹主动脉钙质沉积并伴有动脉瘤表现 CT 示直径 11cm 的腹主动脉瘤住院治疗前, 患者在回家途中遭遇小型车祸患者被立即送往医院行破裂性动脉瘤修复术手术中患者的主动脉多处被移位, 并结扎了几支节段性动脉虽然使用聚酯纤维对动脉进行了成功的修复, 患者在术后仍发生了截瘫和阳痿, 膀胱和直肠的功能也丧失了意识支配患者术后发生症状的解剖学基础是什么? 18 岁女性从马上摔落, 由于落地时颈部处于过伸位导致脊髓受损虽然患者通过正确的方式被迅速送往医院, 但仍在约 5 分钟后死亡尸检显示 : 数块颈椎发生骨折, 寰椎两侧椎动脉沟处发现骨折线,CV6 CV7 存在多发性骨折脊髓严重受损, 颈部软组织广泛出血上述哪些损伤可能由椎骨骨折引起? 脊柱的哪些相关结构也可能发生了破裂? 通常能够考虑到颈髓横断会导致四肢瘫痪, 但导致该患者死亡的原因是什么? 颈椎骨折通常会导致死亡吗?

校園常見內外科處置

校園常見內外科處置 1 2 校園常見傷病處置彰化縣急救教育推廣中心劉秀枝 liushu9@yahoo.com.tw 傷病定義傷病包含緊急與非緊急的學生傷害事件或疾病所引發身體不適等問題校園緊急傷病指發生在校園中的事故傷害與急症的處置措施, 幾乎每天都發