Anterior atlanto-occipital membrane: connective tissue membrane between the anterior superior arch of the atlas and the anterior border of the foramen magnum of the occipital.
Posterior atlanto-occipital membrane: located between the posterior arch of atlas and the posterior margin of the foramen magnum of occipital, it is located in the deep surface of the suboccipital triangle, and the vertebral artery and the first cervical nerve pass through the lateral part. The adult skin reaches the posterior membrane of atlanto-occipital approximately 4-5cm.
Transverse ligament of atlas: located behind the odontoid process, it is tough and has the function of restricting the motion of the odontoid process to the rear.
Atlas cruciate ligament: a longitudinal fiber bundle is sent up and down the middle of atlas transverse ligament, respectively attached to the anterior edge of the foramen magnum and the posterior part of the axial body, which has the effect of limiting the backward movement of the odontoid process. When the ligament is injured violently, the odontoid process is shifted backward, which may lead to fatal pressure on the spinal cord.
Apical odontoapical ligament: located in the deep surface of the transverse ligament of the atlas, between the apical odontoapical and the anterior edge of the foramen magnum of the occipital bone. Very thin. May limit axial downward displacement.
Laminating: it is the extension of posterior longitudinal ligament, covering behind the odontoid process and attaching to the occipital slope. It can prevent the odontoid process from moving back and protect the spinal cord.
Pterygium (pterygium pterygium) : located anteriorly above the transverse ligament of the atlas, between the odontoid process and the occipital condyle, it has the function of limiting the excessive forward and rotational movement of the head. Atlas transverse ligament and pterygium ligament are compound atlantoaxial ligament, which can stabilize atlantoaxial joint and atlantooccipital joint.
Nape ligament: nape ligament starts from the spinous process of all cervical vertebra and ends at the external occipital carina and the external occipital crest. Its superficial fibers are connected between the external occipital carina and the 7th cervical spinous process. It is deeply attached to the posterior atlas tubercle and all cervical spinous processes. There are multiple muscles attached to the side of the ligaments, such as capitis and collicularis cervicalis, which mainly limit excessive forward flexion of the neck.
Atlas – occipital joint: it is composed of occipital condyle and atlas supraarticular surface. Atlantooccipital anterior and posterior membranes enhance joint stability.
Atlantoaxial joint: consists of 3 joints. The lateral atlantoaxial joint is composed of the lower atlantoaxial articular surface and the upper axial articular surface on both sides, one on each side, which is equivalent to the facet joints between other vertebrae. The middle ring tooth joint is composed of the odontoid process of the axis and the odontoid concave behind the anterior arch of the atlas. The atlantoaxial central joint formed between the axial odontoid process and the transverse ligament of the atlas, which allows rotation of the head.
Articular dash forward joint: each articular capsule is loose differ, cervical flabby dislocation easily, bosom is more nervous, the waist is tight and thick. Anterior yellow ligament, posterior interspinous ligament strengthening, facet joints participate in the formation of the posterior wall of the intervertebral foramen, anterior and adjacent spinal nerve, cervical segment and vertebral artery through. Facet joints have spinal nerve back branch innervation, the nerve compression or pull, can cause back pain.
Cervical facet joints: cervical facet joints are synovial joints, composed of upper and lower facet joints. The articular process and vertebral body are about 40° ~ 45°, the articular surface is smooth, covered with hyaline cartilage, and the articular capsule is relatively loose. The intervertebral facet joints guide and limit the direction of motion of the motion segments. When be like cervical vertebra anterior flexion, the lower articular process of upper cervical vertebra slides forward on articular process of lower cervical vertebra, but articular capsule limits its excessive anterior flexion. Although the arrangement of cervical facet joints is conducive to flexion and extension, it is unstable and vulnerable to injury.
Hook joint, also known as luschka joint, consists of the hook of the 3-7 cervical vertebra and the lip margin of the upper vertebra. After 5 years of age, it develops gradually with the movement of the cervical spine, as a result of the differentiation from direct to indirect connections.
The important adjoint of uncinate vertebra is adjacent: the blood vessel of spinal cord, spinal membrane branch and vertebral body is posterior; The posterolateral part constitutes the anterior wall of the intervertebral foramen adjacent to the cervical nerve root. Lateral vertebral arteriovenous and sympathetic plexus. With age, vertebral hook bone hyperplasia may occur, compression of spinal nerves or vertebral vessels.
Hierarchical anatomy of spinal soft tissue
1. Deep fascia in the nape region
It is divided into shallow layer and deep layer. The superficial layer covers the surface of trapezius muscle and the deep layer is on the deep surface of the muscle, called the fascia. Position: deep surface of the trapezius, enclosing the clipping muscle, above the semiliacinous muscle: attached below the upper nape: transitional into the posterior layer of the thoracolumbar fascia medial side: attached to the anterior ligament
2. Thoracolumbar fascia
It is relatively weak in the thoracic and dorsal region, covering the surface of the vertical spinal muscle, and extending up the spine, with the medial side attached to the spinous process and supraspinous ligament of the thoracic vertebra, and the lateral side attached to the costal Angle, and thickening down to the lumbar region, and divided into three layers: anterior, middle and posterior.
3. Muscle layers
It is roughly divided into four layers from shallow to deep: the first layer contains the trapezius, latissimus dorsi and the posterior part of the external oblique; In the second layer, there are clamping muscles, levator scapulae, rhomboid muscles, serratus posteralis, serratus posteralis and posterior abdominal oblique muscles. The third layer has the erector spinal muscle and the posterior part of the transverse abdominis; The fourth layer has the suboccipital muscle, the transverse process spinous muscle and the transverse process between the muscle, the scalenus muscle and so on.
1. Superior trapezius muscle: arising from the upper nape line, the nape ligament and the spines of cervical vertebra 1-5; Intermediate trapezius muscle: from the spinous process of the 6th cervical vertebra to the spinous process of the 3rd thoracic vertebra; Just above the acromion of the scapula and the crest of the scapula. Inferior trapezius: arising from the spinous process of the 4th — 12th thoracic vertebra; It is inserted below the medial margin of the scapular crest at the levator scapulae junction. Function: to improve the scapula (together with levator scapulae); Rotate the shoulder blades upward (moving the pelvis upward); To draw back the shoulder blades; To depress the scapula; Extend head and neck (bilateral activity); Rotating head and neck (unilateral movement) blood supply: transverse carotid artery
Innervation: accessory nerve
Position: lower dorsum and lateral thorax subcutaneously.
Starting point: the spines of the lower 6 thoracic vertebrae, all lumbar vertebrae, sacral middle crest, and posterior iliac crest.
Terminus: humerus tuberculus crest.
Function: shoulder joint extension, adduction and rotation. Participate in pull-ups.
Innervation: thoracic and dorsal nerves (c6 — c8)
The second layer: 1. Hairpin muscle
Position: nape, deep surface of the trapezius.
Starting point: lower ligament, 7th cervical vertebra and 1-3 thoracic spinous process.
Terminal point: mastoid process, lateral occipital bone.
2. Cervical pinchpin muscle
Position: outside and below the capitis
Starting point: spinous process of the 3rd – 6th thoracic vertebra.
Insertion point: posterior tubercle of the transverse process of cervical vertebra 1-3.
Function: contract and extend the head at the same time on both sides; One side contracts to turn the head ipsilateral.
Blood supply: muscular branch of the aorta
Innervation: posterior ramus of the spinal nerve
Levator scapulae muscle
Position: on both sides of the nape, deep surface of the trapezius.
Starting point: posterior transverse tubercle of cervical vertebra 1-4.
Apex: upper Angle of shoulder blade and upper medial margin.
Function: lift shoulder blade. Scapula fixed, side contracted, neck bent ipsilateral. Contract both sides to extend the back of the neck.
Innervation: dorsal scapular nerve (c5 nerve root)
Position: deep surface of the middle of the trapezius, fibers obliquely downwards and outwards.
Starting point: cervical spines 6-7 (rhomboid), thoracic spines 1-4 (rhomboid).
Insertion: middle, lower medial margin of the shoulder blade.
Action: bring the shoulder blades closer to the spine and move them upward.
Innervation the dorsal scapular nerve.
5. Serratus supraposterior
Position: deep surface of the rhomboid muscle, fibers obliquely downwards and outwardly.
Starting point: the spinous process of the 6th and 7th cervical vertebra, the 6th and 7th cervical vertebra, and the 1st and 2nd thoracic vertebra, starting from the lower part of the acl. Dead center: outer surface of the rib Angle of the 2nd through 5th ribs, serrated. Effect: lift the ribs, help to inhale. Innervation: 1 — 4 intercostal nerves.
6. Serratus inferior posterior
Position: deep surface of the middle of latissimus dorsi, fibers obliquely upwards.
Starting point: the 11th – 12th thoracic vertebra and the 1st – 2nd lumbar spines.
Dead center: outer surface of the rib Angle of the 9th through 12th ribs, serrated.
Effect: lower ribs to aid exhalation.
Innervation: intercostal nerve
Layer 3: erector spinal muscle
Location: in the longitudinal groove on both sides of the spinous process of the spine. Composed of three muscle bundles, from the inside out is the iliocostal muscle, the longest muscle, spine muscle.
1. Iliocostal muscle: starting from the back of the sacrum, sacrotuberous ligament, posterior iliac crest, ending at the ribs.
The longest muscle can be divided into the head, neck, chest longest muscle starting point: the back of the sacrum, lumbar spine process, thoracic cervical transverse process. Insertion point: transverse process of thoracic vertebra, cervical vertebra, temporal mastoid process.
The spinous muscle can be divided into the head, neck, chest and lumbar spinous muscle starting point: the spine process of the lower vertebra.
Insertion: the spinous process of the upper vertebrae.
Function: to extend the spine and tilt the head back. Unilateral contraction is lateral flexion.
The fourth floor:
(1) the vertebra occipital muscle includes the following four muscles
1. Starting point of oblique upper oblique line of posterior rectus major fibers of the head: axial spinous process.
Insertion: lateral bone surface of the inferior occipital line.
Function: same as the clamping muscle
(2) posterior rectus minor fibers straight up
Starting point: posterior atlas tubercle.
Insertion: medial bone surface of the lower occipital line.
Function: make the head turn and backward.
(3) the oblique oblique oblique oblique above the oblique oblique oblique oblique oblique oblique oblique
Starting point: atlas transverse process.
Stop: occipital lower line.
Function: to tilt the head back.
(4) the head of the oblique muscle fibers outside the upper oblique line
Starting point: axial spinous process.
Terminal point: transverse process of atlas.
Function: one side makes the head turn to the same side, two side makes the head backward.
Innervation: suboccipital nerve
Scalenus anterior: arising from the anterior tubercle of the transverse process of the 3rd — 6th cervical vertebra; Stop at the inside of the upper margin of the 1st rib.
Scalenus medius arising from the retrotransverse tubercle of the 2nd — 7th cervical vertebra; Stop outside the upper margin of the first rib.
Posterior scalenus: arising from the retrotransverse tubercle of the 5th — 7th cervical vertebra; To the side of the 2nd rib, and sometimes to the 3rd rib.
Function: major muscles that cause lateral flexion of the cervical spine; Bilateral action of scalenus anterior helps the neck flex; The scalenus posterior stabilizes the neck, participates in breathing exercises, and elevates the chest when lifting and carrying objects.
Innervation: anterior ramus of spinal nerve c5-6
Medial upper bound: rectus magnus posterior to the head
Outer boundary: oblique muscle on the head
Outer lower boundary: inferior oblique muscle of the head
Floor: posterior atlanto occipital membrane and posterior arch of atlanto
Superficial side: clamp muscle, occipital nerve, half spine muscle
Contents: suboccipital nerve and vertebral artery
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