3 курс / Топографическая анатомия и оперативная хирургия / ТАиОХ голова
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ȽɅȺȼȺ IV
ȽɈɅɈȼȺ (CAPUT)
Ƚɨɥɨɜɚ ɨɬɝɪɚɧɢɱɢɜɚɟɬɫɹ ɨɬ ɲɟɢ ɥɢɧɢɟɣ ɤɨɬɨɪɚɹ ɧɚɱɢɧɚɟɬɫɹ ɧɚ ɜɨɡɜɵɲɟɧɢɢ ɩɨɞɛɨɪɨɞɤɚ protuberancia mentalis ɡɚɬɟɦ ɥɚɬɟɪɚɥɶɧɨ ɩɪɨɞɨɥɠɚɟɬɫɹ ɩɨ ɧɢɠɧɟɦɭ ɤɪɚɸ ɬɟɥɚ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɩɨ ɡɚɞɧɟɦɭ ɤɪɚɸ ɜɨɫɯɨɞɹɳɟɣ ɜɟɬɜɢ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɩɨ ɧɢɠɧɟɣ ɩɨɥɭɨɤɪɭɠɧɨɫɬɢ ɧɚɪɭɠɧɨɝɨ ɫɥɭɯɨɜɨɝɨ ɩɪɨɯɨɞɚ ɜɟɪɯɧɟɣ ɜɵɣɧɨɣ ɥɢ ɧɢɢ linea nuchae superior ɢ ɡɚɤɚɧɱɢɜɚɟɬɫɹ ɫ ɬɨɣ ɢ ɫ ɞɪɭɝɨɣ ɫɬɨɪɨɧɵ ɧɚ ɧɚɪɭɠɧɨɦ ɡɚɬɵɥɨɱɧɨɦ ɜɵɫɬɭɩɟ protuberancia occipitalis externae).
ɋɧɚɪɭɠɢ ɫɤɟɥɟɬ ɝɨɥɨɜɵ ɩɨɤɪɵɬ ɧɟɡɧɚɱɢɬɟɥɶɧɵɦ ɫɥɨɟɦ ɦɹɝɤɢɯ ɬɤɚɧɟɣ ɩɨ ɷɬɨɦɭ ɩɪɢ ɩɚɥɶɩɚɰɢɢ ɥɟɝɤɨ ɨɩɪɟɞɟɥɹɟɬɫɹ ɛɨɥɶɲɚɹ ɱɚɫɬɶ ɤɨɫɬɧɨɝɨ ɫɤɟɥɟɬɚ ɧɚɪɭɠ ɧɵɣ ɡɚɬɵɥɨɱɧɵɣ ɜɵɫɬɭɩ ɜɟɪɯɧɹɹ ɜɵɣɧɚɹ ɥɢɧɢɹ ɫɨɫɰɟɜɢɞɧɵɣ ɨɬɪɨɫɬɨɤ ɫɤɭɥɨɜɚɹ ɞɭɝɚ ɫɤɭɥɨɜɚɹ ɤɨɫɬɶ ɤɪɚɹ ɝɥɚɡɧɢɰɵ ɬɟɥɨ ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ ɢ ɞɪ ɇɢɠɧɹɹ ɩɨɜɟɪɯ ɧɨɫɬɶ ɨɫɧɨɜɚɧɢɹ ɱɟɪɟɩɚ ɜ ɛɨɥɶɲɟɣ ɫɜɨɟɣ ɱɚɫɬɢ ɧɟɞɨɫɬɭɩɧɚ ɩɪɹɦɨɦɭ ɩɚɥɶɩɚɬɨɪ ɧɨɦɭ ɢɫɫɥɟɞɨɜɚɧɢɸ
Ɋɚɡɥɢɱɚɸɬ ɦɨɡɝɨɜɨɣ ɢ ɥɢɰɟɜɨɣ ɨɬɞɟɥɵ ɝɨɥɨɜɵ ɝɪɚɧɢɰɚ ɦɟɠɞɭ ɤɨɬɨɪɵɦɢ ɩɪɨ ɯɨɞɢɬ ɩɨ ɜɟɪɯɧɟɝɥɚɡɧɢɱɧɨɦɭ ɤɪɚɸ ɫɤɭɥɨɜɨɣ ɤɨɫɬɢ ɢ ɫɤɭɥɨɜɨɣ ɞɭɝɟ ɞɨ ɧɚɪɭɠɧɨɝɨ ɫɥɭɯɨɜɨɝɨ ɩɪɨɯɨɞɚ ɪɢɫ 4.1).
Ɋɢɫ 4 Ƚɪɚɧɢɰɚ ɦɟɠɞɭ ɦɨɡɝɨɜɵɦ ɢ ɥɢɰɟɜɵɦ ɨɬɞɟɥɚɦɢ ɱɟɪɟɩɚ
ɆɈɁȽɈȼɈɃ ɈɌȾȿɅ ȽɈɅɈȼɕ
ȼ ɦɨɡɝɨɜɨɦ ɨɬɞɟɥɟ ɝɨɥɨɜɵ ɪɚɡɥɢɱɚɸɬ ɫɜɨɞ ɱɟɪɟɩɚ fornix cranii ɢ ɨɫɧɨɜɚɧɢɟ basis cranii ɋɜɨɞ ɢ ɨɫɧɨɜɚɧɢɟ ɨɬɝɪɚɧɢɱɟɧɵ ɞɪɭɝ ɨɬ ɞɪɭɝɚ ɧɨɫɨɥɨɛɧɵɦ ɲɜɨɦ ɧɚɞɝɥɚɡ ɧɢɱɧɵɦ ɤɪɚɟɦ ɜɟɪɯɧɢɦ ɤɪɚɟɦ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɨɫɧɨɜɚɧɢɟɦ ɫɨɫɰɟɜɢɞɧɨɝɨ ɨɬ ɪɨɫɬɤɚ ɞɚɥɟɟ ² ɜɟɪɯɧɟɣ ɜɵɣɧɨɣ ɥɢɧɢɟɣ ɢ protuberantia occipitalis externa.
ɋɜɨɞ ɱɟɪɟɩɚ ɨɬɝɪɚɧɢɱɢɜɚɟɬɫɹ ɨɬ ɨɫɧɨɜɚɧɢɹ ɱɟɪɟɩɚ ɩɥɨɫɤɨɫɬɶɸ ɩɪɨɜɟɞɟɧɧɨɣ ɱɟ ɪɟɡ ɧɚɞɝɥɚɡɧɢɱɧɵɣ ɤɪɚɣ margo supraorbitalis ɢ ɧɚɪɭɠɧɵɣ ɜɵɫɬɭɩ ɢɥɢ ɬɚɤɠɟ ɥɢ ɧɢɟɣ ɤɨɬɨɪɚɹ ɧɚɱɢɧɚɹɫɶ ɦɟɞɢɚɥɶɧɨ ɧɚ ɧɚɞɝɥɚɡɧɢɱɧɨɦ ɤɪɚɟ ɢɞɟɬ ɜɞɨɥɶ ɟɝɨ ɞɚɥɶ ɲɟ ɡɚɬɟɦ ɩɨ ɡɚɞɧɟɦɭ ɤɪɚɸ ɫɤɭɥɨɜɨɣ ɤɨɫɬɢ ɢ ɜɟɪɯɧɟɦɭ ɤɪɚɸ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɚ ɨɬ ɫɸɞɚ ɫɥɟɞɭɸɟɬ ɩɨɞ ɧɚɡɜɚɧɢɟɦ ɜɟɪɯɧɟɣ ɜɵɣɧɨɣ ɥɢɧɢɢ ɢ ɨɤɚɧɱɢɜɚɟɬɫɹ ɧɚ ɧɚɪɭɠ ɧɨɦ ɡɚɬɵɥɨɱɧɨɦ ɜɵɫɬɭɩɟ ɉɨɱɬɢ ɧɚ ɜɫɟɦ ɩɪɨɬɹɠɟɧɢɢ ɷɬɭ ɥɢɧɢɸ ɦɨɠɧɨ ɨɩɪɟɞɟ ɥɢɬɶ ɩɚɥɶɩɚɰɢɟɣ ɤɨɫɬɟɣ ɱɟɪɟɩɚ Ɋɚɡɥɢɱɚɸɬ ɧɚɪɭɠɧɨɟ basis cranii externa) ɢ ɜɧɭɬ ɪɟɧɧɟɟ basis cranii interna ɨɫɧɨɜɚɧɢɹ ɱɟɪɟɩɚ
ɋɜɨɞ ɱɟɪɟɩɚ (fornix capiti ɢɥɢ cranii ȼ ɩɪɟɞɟɥɚɯ ɫɜɨɞɚ ɱɟɪɟɩɚ ɜɵɞɟɥɹɸɬ ɫɥɟ ɞɭɸɳɢɟ ɨɛɥɚɫɬɢ ɥɨɛɧɨ-ɬɟɦɟɧɧɨ-ɡɚɬɵɥɨɱɧɭɸ ɜɢɫɨɱɧɭɸ ɢ ɫɨɫɰɟɜɢɞɧɭɸ ɉɨɫɥɟɞ ɧɹɹ ɨɬɧɨɫɢɬɫɹ ɤ ɨɫɧɨɜɚɧɢɸ ɱɟɪɟɩɚ ɧɨ ɜɤɥɸɱɟɧɚ ɜ ɨɛɥɚɫɬɶ ɫɜɨɞɚ ɬ ɤ ɩɨ ɯɚɪɚɤɬɟɪɭ ɢ ɫɬɪɨɟɧɢɸ ɫɥɨɟɜ ɦɚɥɨ ɱɟɦ ɨɬɥɢɱɚɟɬɫɹ ɨɬ ɧɟɝɨ
Ʌɨɛɧɨ-ɬɟɦɟɧɧɨ-ɡɚɬɵɥɨɱɧɚɹ ɨɛɥɚɫɬɶ (regio fronto-parieto-occipitalis)
Ƚɪɚɧɢɰɵ
ɫɩɟɪɟɞɢ ± ɧɚɞɝɥɚɡɧɢɱɧɵɣ ɤɪɚɣ; ɫɡɚɞɢ ± ɜɟɪɯɧɹɹ ɜɵɣɧɚɹ ɥɢɧɢɹ;
ɜ ɛɨɤɨɜɵɯ ɨɬɞɟɥɚɯ ± ɜɟɪɯɧɹɹ ɜɢɫɨɱɧɚɹ ɥɢɧɢɹ (linea temporalis superior).
ɋɥɨɢ
Ʉɨɠɚ ɨɬɥɢɱɚɟɬɫɹ ɡɧɚɱɢɬɟɥɶɧɨɣ ɬɨɥɳɢɧɨɣ ɨɫɨɛɟɧɧɨ ɜ ɡɚɬɵɥɨɱɧɨɣ ɢ ɬɟɦɟɧ ɧɨɣ ɨɛɥɚɫɬɹɯ ɛɨɥɶɲɟɣ ɱɚɫɬɢ ɩɨɤɪɵɬɚ ɜɨɥɨɫɚɦɢ ɦɚɥɨɩɨɞɜɢɠɧɚ ɢ ɩɪɨɱɧɨ ɫɪɚɳɟɧɚ ɫ ɩɨɞɥɟɠɚɳɢɦ ɫɭɯɨɠɢɥɶɧɵɦ ɪɚɫɬɹɠɟɧɢɟɦ galea aponeurotica ɫɨɞɟɪɠɢɬ ɛɨɥɶɲɨɟ ɤɨɥɢɱɟɫɬɜɨ ɩɨɬɨɜɵɯ ɢ ɫɚɥɶɧɵɯ ɠɟɥɟɡ ȼɵɜɨɞɧɵɟ ɩɪɨɬɨɤɢ ɫɚɥɶɧɵɯ ɠɟɥɟɡ ɢɧɨɝɞɚ ɡɚɤɭɩɨɪɢɜɚɸɬɫɹ ɱɬɨ ɜɟɞɟɬ ɤ ɨɛɪɚɡɨɜɚɧɢɸ ɪɟɬɟɧɰɢɨɧɧɵɯ ɤɢɫɬ ɷɬɢɯ ɠɟɥɟɡ ± ɚɬɟ ɪɨɦ
ɉɨɞɤɨɠɧɚɹ ɤɥɟɬɱɚɬɤɚ ɩɪɟɞɫɬɚɜɥɟɧɚ ɬɨɧɤɢɦ ɫɥɨɟɦ ɤɨɬɨɪɵɣ ɩɪɨɧɢɡɚɧ ɮɢɛ ɪɨɡɧɵɦɢ ɩɟɪɟɦɵɱɤɚɦɢ ɢɞɭɳɢɦɢ ɨɬ ɤɨɠɢ ɤ ɫɭɯɨɠɢɥɶɧɨɦɭ ɪɚɫɬɹɠɟɧɢɸ (ɫɭɯɨ ɠɢɥɶɧɨɝɨ ɲɥɟɦɚ galea aponeurotica) ɧɚɞɱɟɪɟɩɧɨɣ ɦɵɲɰɵ (m. epicranius) ɪɢɫ 4.2) ȼ ɪɟɡɭɥɶɬɚɬɟ ɷɬɨɝɨ ɨɛɪɚɡɭɸɬɫɹ ɹɱɟɣɤɢ ɩɥɨɬɧɨ ɡɚɩɨɥɧɟɧɧɵɟ ɠɢɪɨɜɨɣ ɬɤɚɧɶɸ Ʉɪɨɜɨɢɡɥɢɹɧɢɹ ɜ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɟ ɨɛɵɱɧɨ ɛɵɜɚɸɬ ɨɝɪɚɧɢɱɟɧɧɵɦɢ ɂɫɤɥɸ ɱɟɧɢɹ ɫɨɫɬɚɜɥɹɟɬ ɨɛɥɚɫɬɶ ɥɛɚ ɝɞɟ ɤɥɟɬɱɚɬɤɚ ɛɨɥɟɟ ɪɵɯɥɚɹ ɢ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɩɟ ɪɟɯɨɞɢɬ ɜ ɤɥɟɬɱɚɬɤɭ ɜɟɪɯɧɢɯ ɜɟɤ ɗɬɢɦ ɨɛɴɹɫɧɹɟɬɫɹ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɟ ɤɪɨɜɨɩɨɞɬɟ ɤɨɜ ɜ ɨɛɥɚɫɬɶ ɜɟɤ ɩɪɢ ɬɪɚɜɦɚɯ ɥɛɚ
ɋɭɯɨɠɢɥɶɧɵɣ ɲɥɟɦ ɨɬɞɟɥɟɧ ɨɬ ɧɚɞɤɨɫɬɧɢɰɵ ɪɵɯɥɵɦ ɫɥɨɟɦ ɤɥɟɬɱɚɬɤɢ ɱɬɨ ɨɛɟɫɩɟɱɢɜɚɟɬ ɟɦɭ ɩɨɞɜɢɠɧɨɫɬɶ ɋ ɤɨɠɟɣ ɢ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɨɣ ɫɭɯɨɠɢɥɶɧɵɣ ɲɥɟɦ ɢɦɟɟɬ ɩɪɨɱɧɭɸ ɫɜɹɡɶ ɚ ɩɨɷɬɨɦɭ ɜɦɟɫɬɟ ɫ ɧɢɦɢ ɩɪɢ ɬɪɚɜɦɚɯ ɨɧ ɦɨɠɟɬ ɨɬ ɫɥɚɢɜɚɬɶɫɹ ɨɬ ɤɨɫɬɟɣ ɫɜɨɞɚ ɱɟɪɟɩɚ ɧɚ ɡɧɚɱɢɬɟɥɶɧɨɦ ɩɪɨɬɹɠɟɧɢɢ ɨɛɭɫɥɚɜɥɢɜɚɹ ɫɤɚɥɶɩɢɪɨɜɚɧɧɵɣ ɯɚɪɚɤɬɟɪ ɪɚɧ
ȼ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɟ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɧɟɪɜɵ ɢ ɫɨɫɭɞɵ Ⱥɞɜɟɧɬɢɰɢɹ ɩɨɫɥɟɞ ɧɢɯ ɩɪɨɱɧɨ ɫɪɚɳɟɧɚ ɫ ɫɨɟɞɢɧɢɬɟɥɶɧɨɬɤɚɧɧɵɦɢ ɩɟɪɟɦɵɱɤɚɦɢ ɤɨɬɨɪɵɟ ɪɚɡɞɟɥɹɸɬ ɤɥɟɬɱɚɬɤɭ ɧɚ ɹɱɟɣɤɢ ɉɨɷɬɨɦɭ ɩɪɢ ɪɚɧɟɧɢɢ ɫɨɫɭɞɵ ɡɢɹɸɬ ɱɬɨ ɩɪɢɜɨɞɢɬ ɤ ɫɢɥɶ ɧɨɦɭ ɤɪɨɜɨɬɟɱɟɧɢɸ
ȼ ɥɨɛɧɨɣ ɨɛɥɚɫɬɢ ɩɪɨɯɨɞɢɬ ɧɚɞɛɥɨɤɨɜɚɹ ɢ ɧɚɞɝɥɚɡɧɢɱɧɚɹ ɚɪɬɟɪɢɢ aa. supratrochlearis et supraorbitalis ɂɯ ɫɨɩɪɨɜɨɠɞɚɸɬ ɨɞɧɨɢɦɟɧɧɵɟ ɜɟɧɵ ɢ ɧɟɪɜɵ ɗɬɢ ɫɨɫɭɞɵ ɢ ɧɟɪɜɵ ɜɵɯɨɞɹɬ ɢɡ ɩɨɥɨɫɬɢ ɝɥɚɡɧɢɰɵ ɱɟɪɟɡ ɨɞɧɨɢɦɟɧɧɵɟ ɨɬɜɟɪɫɬɢɹ Ɉɛɟ
2
ɚɪɬɟɪɢɢ ɹɜɥɹɸɬɫɹ ɜɟɬɜɹɦɢ ɝɥɚɡɧɨɣ ɚɪɬɟɪɢɢ a. ophthalmica ɢɡ ɫɢɫɬɟɦɵ ɜɧɭɬɪɟɧɧɟɣ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ
ɇɚɞɛɥɨɤɨɜɚɹ ɚɪɬɟɪɢɹ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɛɥɢɠɟ ɤ ɫɪɟɞɢɧɧɨɣ ɥɢɧɢɢ ɩɪɢɦɟɪɧɨ ɧɚ ɫɦ ɨɬɫɬɭɩɚɹ ɨɬ ɧɟɟ ɢ ɩɪɨɯɨɞɢɬ ɜɦɟɫɬɟ ɫ ɨɞɧɨɢɦɟɧɧɵɦ ɧɟɪɜɨɦ n. supratrochlearis). Ȼɨɥɟɟ ɦɨɳɧɚɹ ɧɚɞɝɥɚɡɧɢɱɧɚɹ ɚɪɬɟɪɢɹ ɫ ɨɞɧɨɢɦɟɧɧɵɦ ɧɟɪɜɨɦ n. supraorbitalis) ɩɪɨɯɨɞɢɬ ɧɚ ɫɦ ɤɧɚɪɭɠɢ ɨɬ ɩɟɪɜɨɣ
Ɉɛɚ ɧɟɪɜɚ ɹɜɥɹɸɬɫɹ ɜɟɬɜɹɦɢ ɥɨɛɧɨɝɨ ɧɟɪɜɚ n. frontalis) ɨɬɯɨɞɹɳɟɝɨ ɨɬ ɩɟɪ ɜɨɣ ɜɟɬɜɢ ɬɪɨɣɧɢɱɧɨɝɨ ɝɥɚɡɧɨɝɨ ɧɟɪɜɚ n. ophthalmicus).
Ɉɫɧɨɜɧɨɣ ɫɬɜɨɥ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɜɢɫɨɱɧɨɣ ɚɪɬɟɪɢɢ a. temporalis superficialis) ɜɦɟɫɬɟ ɫ ɭɲɧɨ-ɜɢɫɨɱɧɵɦ ɧɟɪɜɨɦ n. auriculatemporalis ɢɡ III ɜɟɬɜɢ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ ɩɪɨɟɰɢɪɭɟɬɫɹ ɩɨ ɜɟɪɬɢɤɚɥɢ ɤɩɟɪɟɞɢ ɨɬ ɤɨɡɟɥɤɚ tragus Ʉɨɧɟɱɧɵɦɢ ɜɟɬɜɹ ɦɢ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɜɢɫɨɱɧɨɣ ɚɪɬɟɪɢɢ ɹɜɥɹɸɬɫɹ ɥɨɛɧɚɹ ɢ ɬɟɦɟɧɧɚɹ ɜɟɬɜɢ rr. frontalis et parietalis).
Ɂɚɞɧɢɟ ɭɲɧɵɟ ɫɨɫɭɞɵ a. v. auricularis posterior ɢ ɡɚɞɧɢɣ ɭɲɧɨɣ ɧɟɪɜ n. auricularis posterior ɢɡ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ ɢɞɭɬ ɩɚɪɚɥɥɟɥɶɧɨ ɢ ɩɨɡɚɞɢ ɨɬ ɦɟɫɬɚ ɩɪɢɤɪɟɩɥɟɧɢɹ ɭɲɧɨɣ ɪɚɤɨɜɢɧɵ ɉɪɨɟɤɰɢɹ ɡɚɬɵɥɨɱɧɨɣ ɚɪɬɟɪɢɢ a. occipitalis ɧɚ ɫɜɨɞɟ ɱɟɪɟɩɚ ɧɚɯɨɞɢɬɫɹ ɧɚ ɫɟɪɟɞɢɧɟ ɦɟɠɞɭ ɫɨɫɰɟɜɢɞɧɵɦ ɨɬɪɨɫɬɤɨɦ ɢ ɧɚɪɭɠɧɵɦ ɡɚɬɵɥɨɱɧɵɦ ɜɵɫɬɭɩɨɦ Ȼɨɥɶɲɨɣ ɡɚɬɵɥɨɱɧɵɣ ɧɟɪɜ n. occipitalis major ɢɞɟɬ ɜɦɟ ɫɬɟ ɫ ɡɚɬɵɥɨɱɧɵɦɢ ɫɨɫɭɞɚɦɢ Ɉɧ ɹɜɥɹɟɬɫɹ ɡɚɞɧɟɣ ɜɟɬɜɶɸ ɜɬɨɪɨɝɨ ɲɟɣɧɨɝɨ ɧɟɪɜɚ Ɂɚɞɧɹɹ ɭɲɧɚɹ ɢ ɡɚɬɵɥɨɱɧɚɹ ɚɪɬɟɪɢɢ ɨɬɯɨɞɹɬ ɨɬ ɧɚɪɭɠɧɨɣ ɫɨɧɧɨɣ ɚɪɬɟɪɢɢ ɇɚ -ɫɦ ɤɡɚɞɢ ɨɬ ɜɟɪɯɧɟɝɨ ɤɨɧɰɚ ɩɪɢɤɪɟɩɥɟɧɢɹ ɭɲɧɨɣ ɪɚɤɨɜɢɧɵ ɩɪɨɯɨɞɢɬ ɩɪɨɟɤ ɰɢɹ ɦɚɥɨɝɨ ɡɚɬɵɥɨɱɧɨɝɨ ɧɟɪɜɚ n. occipitalis minor) ɹɜɥɹɸɳɟɝɨɫɹ ɱɭɜɫɬɜɢɬɟɥɶɧɨɣ ɜɟɬɜɶɸ ɢɡ ɲɟɣɧɨɝɨ ɫɩɥɟɬɟɧɢɹ
ɍɤɚɡɚɧɧɵɟ ɜɟɧɵ ɚɧɚɫɬɨɦɨɡɢɪɭɹ ɦɟɠɞɭ ɫɨɛɨɣ ɨɛɪɚɡɭɸɬ ɝɭɫɬɭɸ ɜɟɧɨɡɧɭɸ ɫɟɬɶ ɜ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɟ ɉɪɢ ɷɬɨɦ ɢɡ ɥɨɛɧɨɝɨ ɨɬɞɟɥɚ ɜɟɧɨɡɧɵɣ ɨɬɬɨɤ ɨɫɭ ɳɟɫɬɜɥɹɟɬɫɹ ɜ ɨɫɧɨɜɧɨɦ ɱɟɪɟɡ ɜɟɪɯɧɸɸ ɝɥɚɡɧɭɸ ɜɟɧɭ v. ophthalmica ɜ ɩɟɳɟɪɢ ɫɬɵɣ ɫɢɧɭɫ ɚ ɢɡ ɬɟɦɟɧɧɨɝɨ ɢ ɡɚɬɵɥɨɱɧɨɝɨ ɨɬɞɟɥɨɜ ± ɜ ɫɢɫɬɟɦɭ ɥɢɰɟɜɨɣ ɢ ɧɚɪɭɠ ɧɨɣ ɹɪɟɦɧɨɣ ɜɟɧ vv. facialis et jugularis ext.).
ɂɦɟɸɬɫɹ ɚɧɚɫɬɨɦɨɡɵ ɦɟɠɞɭ ɜɟɧɚɦɢ ɦɹɝɤɢɯ ɩɨɤɪɨɜɨɜ ɫɜɨɞɚ ɱɟɪɟɩɚ ɞɢɩɥɨ ɷɬɢɱɟɫɤɢɦɢ ɜɟɧɚɦɢ ɤɨɫɬɟɣ ɱɟɪɟɩɚ ɢ ɫɢɧɭɫɚɦɢ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ ɋɥɟɞɨ ɜɚɬɟɥɶɧɨ ɜɫɟ ɷɬɢ ɜɟɧɵ ɨɛɪɚɡɭɸɬ ɟɞɢɧɭɸ ɫɢɫɬɟɦɭ ɜ ɤɨɬɨɪɨɣ ɧɚɩɪɚɜɥɟɧɢɟ ɬɨɤɚ ɤɪɨɜɢ ɦɨɠɟɬ ɢɡɦɟɧɹɬɶɫɹ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɜɧɭɬɪɢɱɟɪɟɩɧɨɝɨ ɞɚɜɥɟɧɢɹ Ɉɬɫɭɬɫɬɜɢɟ ɤɥɚɩɚɧɨɜ ɜ ɜɟɧɚɯ ɫɩɨɫɨɛɫɬɜɭɟɬ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɸ ɢɧɮɟɤɰɢɢ ɧɚ ɤɨɫɬɢ ɱɟɪɟɩɚ ɬɜɟɪ ɞɭɸ ɦɨɡɝɨɜɭɸ ɨɛɨɥɨɱɤɭ ɫ ɨɛɪɚɡɨɜɚɧɢɟɦ ɬɪɨɦɛɨɫɢɧɭɫɢɬɨɜ ɦɟɧɢɧɝɢɬɚ ɢ ɚɛɫɰɟɫɫɨɜ ɦɨɡɝɚ
Ʌɢɦɮɨɨɬɬɨɤ ɩɪɨɢɫɯɨɞɢɬ ɤ ɥɢɦɮɚɬɢɱɟɫɤɢɦ ɭɡɥɚɦ ɬɪɟɯ ɝɪɭɩɩ ɜ ɩɨɜɟɪɯɧɨɫɬ ɧɵɟ ɢ ɝɥɭɛɨɤɢɟ ɨɤɨɥɨɭɲɧɵɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ nodi lymphatici parotidei superficialis et profundi ɢɡ ɥɨɛɧɨɣ ɨɛɥɚɫɬɢ ɜ ɫɨɫɰɟɜɢɞɧɵɟ nodi lymphatici mastoidei ɨɬ ɬɟɦɟɧɧɨɣ ɨɛɥɚɫɬɢ ɜ ɡɚɬɵɥɨɱɧɵɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ nodi lymphatici occipitales), ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɩɨɞ ɫɭɯɨɠɢɥɶɧɵɦ ɲɥɟɦɨɦ ɢɥɢ ɧɚɞ ɧɢɦ ɢɡ ɬɟɦɟɧɧɨɣ ɢ ɡɚɬɵɥɨɱ ɧɨɣ ɨɛɥɚɫɬɟɣ
3
Ɋɢɫ 4 ɋɥɨɢ ɫɜɨɞɚ ɱɟɪɟɩɚ ɧɚ ɮɪɨɧɬɚɥɶɧɨɦ ɪɚɡɪɟɡɟ, ɫɯɟɦɚ (ɩɨ Ⱦɟɥɢɰɢɧɭ ɫ ɢɡɦɟɧɟɧɢɹɦɢ
1 ² tela subcutanea; 2 ² galea aponeurotica; 3 ² v.v. diploicae; 4 ² ɩɨɞɚɩɨɧɟɜ-ɪɨɬɢɱɟɫɤɚɹ ɤɥɟɬɱɚɬɤɚ ² pericranium; 6 ² ɩɨɞɧɚɞɤɨɫɬɧɢɱɧɚɹ ɤɥɟɬɱɚɬɤɚ 7, 13 ² ɩɚɯɢɨɧɨɜɵ ɝɪɚɧɭɥɹ ɰɢɢ ² dura mater; 9 ² spatium subdurale; 10 ² arachnoidea mater; 11 ² spatium subarachnoidale; 12 ² encephalon; 14 ² falx cerebri; 15 ² sinus sagittalis; 16 ² w. cerebri;
17 ² v. subcutanea, v. emissaria.
Ɂɚ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɨɣ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɫɭɯɨɠɢɥɶɧɵɣ ɲɥɟɦ galea aponeurotica ɗɬɨ ɫɭɯɨɠɢɥɶɧɨɟ ɪɚɫɬɹɠɟɧɢɟ ɥɨɛɧɨɝɨ ɢ ɡɚɬɵɥɨɱɧɨɝɨ ɛɪɸɲɟɤ ɡɚɬɵɥɨɱɧɨɥɨɛɧɨɣ ɦɵɲɰɵ m. occipitofrontalis) ɉɨɞ ɫɭɯɨɠɢɥɶɧɵɦ ɲɥɟɦɨɦ ɪɚɫɩɨɥɨɠɟɧɨ ɩɨ ɞɚɩɨɧɟɜɪɨɬɢɱɟɫɤɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ Ɉɧɨ ɡɚɩɨɥɧɟɧɨ ɪɵɯɥɨɣ ɤɥɟɬɱɚɬɤɨɣ ɢ ɪɚɫɩɪɨ ɫɬɪɚɧɹɟɬɫɹ ɜ ɨɛɥɚɫɬɢ ɫɜɨɞɚ ɱɟɪɟɩɚ ɤɩɟɪɟɞɢ ± ɞɨ ɩɪɢɤɪɟɩɥɟɧɢɹ ɥɨɛɧɨɝɨ ɛɪɸɲɤɚ ɥɨɛɧɨɣ ɦɵɲɰɵ ɤ ɧɚɞɝɥɚɡɧɢɱɧɨɦɭ ɤɪɚɸ ɤɡɚɞɢ ± ɞɨ ɜɟɪɯɧɟɣ ɜɵɣɧɨɣ ɥɢɧɢɢ ɝɞɟ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɡɚɬɵɥɨɱɧɨɟ ɛɪɸɲɤɨ ɷɬɨɣ ɦɵɲɰɵ Ʌɢɫɬɤɢ ɫɭɯɨɠɢɥɶɧɨɝɨ ɲɥɟɦɚ ɩɟɪɟɯɨɞɹɬ ɜ ɩɨɜɟɪɯɧɨɫɬɧɭɸ ɮɚɫɰɢɸ ɜɢɫɨɱɧɨɣ ɨɛɥɚɫɬɢ ȼɦɟɫɬɟ ɫ ɬɟɦ ɝɥɭɛɨɤɢɣ ɥɢ ɫɬɨɤ ɫɭɯɨɠɢɥɶɧɨɝɨ ɲɥɟɦɚ ɩɪɨɱɧɨ ɫɪɚɫɬɚɟɬɫɹ ɫ ɧɚɞɤɨɫɬɧɢɰɟɣ ɩɨ ɥɢɧɢɢ ɩɪɢɤɪɟɩ ɥɟɧɢɹ ɜɢɫɨɱɧɨ-ɬɟɦɟɧɧɨɣ m. temporoparietalis ɦɵɲɰɵ ɨɝɪɚɧɢɱɢɜɚɹ ɩɨɫɬɚɩɨɧɟɜ ɪɨɬɢɱɟɫɤɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ ɩɨ ɫɬɨɪɨɧɚɦ ȼ ɪɵɯɥɨɣ ɤɥɟɬɱɚɬɤɟ ɩɨɫɥɟɞɧɟɝɨ ɩɪɨɯɨɞɹɬ ɬɟɦɟɧɧɵɟ ɷɦɢɫɫɚɪɧɵɟ ɜɟɧɵ ɫɜɹɡɵɜɚɸɳɢɟ ɩɨɞɤɨɠɧɵɟ ɜɟɧɵ ɫɜɨɞɚ ɱɟɪɟɩɚ ɫ ɜɟɪɯ ɧɢɦ ɫɚɝɢɬɬɚɥɶɧɵɦ ɫɢɧɭɫɨɦ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ
ɇɚɞɤɨɫɬɧɢɰɚ ɩɪɟɞɫɬɚɜɥɟɧɚ ɬɨɧɤɨɣ ɩɥɚɫɬɢɧɤɨɣ ɨɬɞɟɥɟɧɧɨɣ ɨɬ ɤɨɫɬɟɣ ɱɟɪɟɩɚ ɬɨɧɤɢɦ ɫɥɨɟɦ ɪɵɯɥɨɣ ɩɨɞɧɚɞɤɨɫɬɧɢɱɧɨɣ ɤɥɟɬɱɚɬɤɢ ȼ ɨɛɥɚɫɬɢ ɲɜɨɜ ɧɚɞɤɨɫɬɧɢɰɚ ɩɪɨɱɧɨ ɫɪɚɳɟɧɚ ɫ ɤɨɫɬɶɸ ɜ ɫɜɹɡɢ ɫ ɱɟɦ ɩɨɞɧɚɞɤɨɫɬɧɢɱɧɵɟ ɝɟɦɚɬɨɦɵ ɨɝɪɚɧɢɱɢ ɜɚɸɬɫɹ ɩɪɟɞɟɥɚɦɢ ɤɨɫɬɟɣ
4
Ʉɨɫɬɧɭɸ ɨɫɧɨɜɭ ɨɛɥɚɫɬɢ ɨɛɪɚɡɭɸɬ ɱɟɲɭɹ ɥɨɛɧɨɣ ɢ ɡɚɬɵɥɨɱɧɨɣ ɤɨɫɬɟɣ ɚ ɬɚɤɠɟ ɞɜɟ ɬɟɦɟɧɧɵɟ ɤɨɫɬɢ
Ʉɨɫɬɢ ɱɟɪɟɩɚ ɫɨɫɬɨɹɬ ɢɡ ɧɚɪɭɠɧɨɣ ɢ ɜɧɭɬɪɟɧɧɟɣ ɩɥɚɫɬɢɧɨɤ lamina externa et interna, s. vitrium ɤɨɦɩɚɤɬɧɨɝɨ ɜɟɳɟɫɬɜɚ ɦɟɠɞɭ ɤɨɬɨɪɵɦɢ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɝɭɛɱɚ ɬɨɟ ɜɟɳɟɫɬɜɨ diploe ɉɨɫɥɟɞɧɟɟ ɫɨɞɟɪɠɢɬ ɛɨɝɚɬɭɸ ɜɟɧɨɡɧɭɸ ɫɟɬɶ ɞɢɩɥɨɷɬɢɱɟ ɫɤɢɟ ɜɟɧɵ ɫɨɛɢɪɚɸɳɢɟ ɜɟɧɨɡɧɭɸ ɤɪɨɜɶ ɢɡ ɤɨɫɬɟɣ ɫɜɨɞɚ ɱɟɪɟɩɚ ɢ ɲɢɪɨɤɨ ɚɧɚ ɫɬɨɦɨɡɢɪɭɸɳɟɟ ɫ ɜɟɧɨɡɧɵɦɢ ɩɚɯɭɯɚɦɢ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ ɢ ɩɨɜɟɪɯɧɨɫɬ ɧɵɦɢ ɜɟɧɚɦɢ ɝɨɥɨɜɵ ɩɨɫɪɟɞɫɬɜɨɦ ɜɟɧɨɡɧɵɯ ɜɵɩɭɫɤɧɢɤɨɜ ɷɦɢɫɫɚɪɢɟɜ
ȼɧɭɬɪɟɧɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ ɱɟɪɟɩɚ ɥɢɲɟɧɚ ɧɚɞɤɨɫɬɧɢɰɵ Ʉ ɧɟɣ ɧɟɩɨɫɪɟɞɫɬɜɟɧ ɧɨ ɩɪɢɥɟɝɚɟɬ ɬɜɟɪɞɚɹ ɦɨɡɝɨɜɚɹ ɨɛɨɥɨɱɤɚ dura mater).
ȼ ɥɨɛɧɨɣ ɨɛɥɚɫɬɢ ɩɨɞ ɧɚɪɭɠɧɨɣ ɤɨɦɩɚɤɬɧɨɣ ɩɥɚɫɬɢɧɤɨɣ ɧɚɯɨɞɹɬɫɹ ɜɵɫɬɥɚɧ ɧɵɟ ɫɥɢɡɢɫɬɨɣ ɨɛɨɥɨɱɤɨɣ ɜɨɡɞɭɯɨɧɨɫɧɵɟ ɩɚɡɭɯɢ ɥɨɛɧɨɣ ɤɨɫɬɢ sinus frontalis).
ȼɢɫɨɱɧɚɹ ɨɛɥɚɫɬɶ regio temporalis)
Ƚɪɚɧɢɰɵ
ɫɜɟɪɯɭ ɢ ɫɡɚɞɢ ± ɜɟɪɯɧɹɹ ɜɢɫɨɱɧɚɹ ɥɢɧɢɹ linea temporalis superior);
ɫɩɟɪɟɞɢ ± ɫɤɭɥɨɜɨɣ ɨɬɪɨɫɬɨɤ ɥɨɛɧɨɣ ɤɨɫɬɢ ɢ ɥɨɛɧɵɣ ɨɬɪɨɫɬɨɤ ɫɤɭɥɨɜɨɣ ɤɨ
ɫɬɢ;
ɫɧɢɡɭ ± ɫɤɭɥɨɜɚɹ ɞɭɝɚ arcus zygomaticus) ɪɢɫ .
Ɋɢɫ Ɉɛɥɚɫɬɢ ɝɨɥɨɜɵ ɢ ɲɟɢ Ʉɨɠɚ ɜ ɷɬɨɣ ɨɛɥɚɫɬɢ ɜ ɜɟɪɯɧɟɦ ɨɬɞɟɥɟ ɩɨ ɫɬɪɨɟɧɢɸ ɫɯɨɞɧɚ ɫ ɤɨɠɟɣ ɥɨɛɧɨ-
ɬɟɦɟɧɧɨ-ɡɚɬɵɥɨɱɧɨɣ ɨɛɥɚɫɬɢ ɨɧɚ ɩɥɨɬɧɚɹ ɩɨɤɪɵɬɚ ɜɨɥɨɫɚɦɢ ɢ ɫɪɚɳɟɧɚ ɫ ɫɭɯɨ ɠɢɥɶɧɵɦ ɚɩɨɧɟɜɪɨɡɨɦ ɮɢɛɪɨɡɧɵɦɢ ɩɟɪɟɦɵɱɤɚɦɢ ȼ ɧɢɠɧɟɩɟɪɟɞɧɟɦ ɨɬɞɟɥɟ ɤɨɠɚ ɬɨɧɤɚɹ ɩɨɞɜɢɠɧɚɹ ɜɫɥɟɞɫɬɜɢɟ ɧɚɥɢɱɢɹ ɩɨɞ ɧɟɣ ɫɥɨɹ ɪɵɯɥɨɣ ɤɥɟɬɱɚɬɤɢ
5
ɉɨɞɤɨɠɧɚɹ ɤɥɟɬɱɚɬɤɚ ɪɚɡɜɢɬɚ ɫɥɚɛɨ ɩɪɢɱɟɦ ɜ ɜɟɪɯɧɟɦ ɨɬɞɟɥɟ ɨɧɚ ɩɥɨɬɧɚɹ ɜɧɢɡɭ ɢ ɫɩɟɪɟɞɢ ɪɵɯɥɚɹ ȼ ɷɬɨɦ ɫɥɨɟ ɪɚɡɜɢɜɚɟɬɫɹ ɩɨɜɟɪɯɧɨɫɬɧɚɹ ɜɢɫɨɱɧɚɹ ɚɪɬɟɪɢɹ
(a. temporalis superficialis ex a. carotis ext. ɪɢɫ 4.4) Ɉɧɚ ɫɨɩɪɨɜɨɠɞɚɟɬɫɹ ɨɞɧɨ ɢɦɟɧɧɨɣ ɜɟɧɨɣ ɢ ɭɲɧɨ-ɜɢɫɨɱɧɵɦ ɧɟɪɜɨɦ n. auriculotemporalis ɢɡ III ɜɟɬɜɢ ɬɪɨɣ ɧɢɱɧɨɝɨ ɧɟɪɜɚ Ɂɞɟɫɶ ɠɟ ɩɪɨɯɨɞɹɬ ɞɜɢɝɚɬɟɥɶɧɵɟ ɜɟɬɜɢ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ rr. temporales et zygomatici ȼ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɟ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɬɚɤɠɟ ɩɟɪɟɞɧɢɟ ɢ ɜɟɪɯɧɢɟ ɭɲɧɵɟ ɦɵɲɰɵ ɤ ɤɨɬɨɪɵɦ ɩɨɞɯɨɞɹɬ ɜɟɬɜɢ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ
ɉɨɜɟɪɯɧɨɫɬɧɵɟ ɜɢɫɨɱɧɵɟ ɫɨɫɭɞɵ ɢ ɭɲɧɨ-ɜɢɫɨɱɧɵɣ ɧɟɪɜ ɜɵɯɨɞɹɬ ɢɡ ɬɨɥ ɳɢ ɨɤɨɥɨɭɲɧɨɣ ɠɟɥɟɡɵ ɢ ɩɨɞɧɢɦɚɸɬɫɹ ɩɪɹɦɨ ɜɜɟɪɯ ɜɩɟɪɟɞɢ ɨɬ ɤɨɡɟɥɤɚ ɇɚ ɭɪɨɜɧɟ ɧɚɞɝɥɚɡɧɢɱɧɨɝɨ ɤɪɚɹ ɫɨɫɭɞɵ ɢ ɧɟɪɜ ɞɟɥɹɬɫɹ ɧɚ ɥɨɛɧɵɟ ɢ ɬɟɦɟɧɧɵɟ ɜɟɬɜɢ Ʌɨɛɧɚɹ ɜɟɬɜɶ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɜɢɫɨɱɧɨɣ ɚɪɬɟɪɢɢ ɢɡ ɧɚɪɭɠɧɨɣ ɫɨɧɧɨɣ ɚɧɚɫɬɨɦɨ ɡɢɪɭɟɬ ɫ ɧɚɞɝɥɚɡɧɢɱɧɨɣ ɚɪɬɟɪɢɟɣ ɢɡ ɜɧɭɬɪɟɧɧɟɣ ɫɨɧɧɨɣ ɚ ɬɟɦɟɧɧɚɹ ɜɟɬɜɶ ɷɬɨɣ ɚɪɬɟɪɢɢ ± ɫ ɡɚɬɵɥɨɱɧɨɣ ɚɪɬɟɪɢɟɣ ɢɡ ɧɚɪɭɠɧɨɣ ɫɨɧɧɨɣ Ʉɪɨɦɟ ɬɨɝɨ ɜɟɬɜɢ ɥɟɜɨɣ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɜɢɫɨɱɧɨɣ ɚɪɬɟɪɢɢ ɚɧɚɫɬɨɦɨɡɢɪɭɸɬ ɫ ɫɨɨɬɜɟɬɫɬɜɭɸɳɢɦɢ ɜɟɬɜɹɦɢ ɚɪɬɟɪɢɢ ɩɪɚɜɨɣ ɫɬɨɪɨɧɵ
ɑɭɜɫɬɜɢɬɟɥɶɧɚɹ ɢɧɧɟɪɜɚɰɢɹ ɜɢɫɨɱɧɨɣ ɨɛɥɚɫɬɢ ɤɪɨɦɟ ɭɲɧɨ-ɜɢɫɨɱɧɨɝɨ ɧɟɪɜɚ ɨɛɟɫɩɟɱɢɜɚɟɬɫɹ ɫɤɭɥɨ-ɜɢɫɨɱɧɨɣ ɜɟɬɜɶɸ r. zygomaticotemporalis ɨɬ II ɜɟɬɜɢ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ ɤɨɬɨɪɚɹ ɢɞɟɬ ɢɡ ɩɨɥɨɫɬɢ ɝɥɚɡɧɢɰɵ ɱɟɪɟɡ ɨɞɧɨɢɦɟɧɧɨɟ ɨɬɜɟɪ ɫɬɢɟ ɜ ɫɤɭɥɨɜɨɣ ɤɨɫɬɢ ɤ ɤɨɠɟ ɩɟɪɟɞɧɟɝɨ ɨɬɞɟɥɚ ɜɢɫɨɱɧɨɣ ɨɛɥɚɫɬɢ ɇɚɞ ɩɟɪɟɞɧɟɣ ɬɪɟɬɶɸ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɜ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɟ ɩɨɞɧɢɦɚɸɬɫɹ ɤ ɥɨɛɧɨɦɭ ɛɪɸɲɤɭ ɡɚɬɵɥɨɱɧɨ-ɥɨɛɧɨɣ ɦɵɲɰɵ m. occipitofrontalis) ± ɜɢɫɨɱɧɵɟ ɜɟɬɜɢ rr.temporales ɚ ɤ ɤɪɭɝɨɜɨɣ ɦɵɲɰɟ ɝɥɚɡɚ ± ɫɤɭɥɨɜɵɟ ɜɟɬɜɢ rr. zygomatici ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ
ɉɨɜɟɪɯɧɨɫɬɧɵɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɫɨɫɭɞɵ ɜɩɚɞɚɸɬ ɜ ɩɨɜɟɪɯɧɨɫɬɧɵɟ ɨɤɨɥɨ ɭɲɧɵɟ ɢ ɩɨɡɚɞɢɭɲɧɵɟ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ
ɉɨɜɟɪɯɧɨɫɬɧɚɹ ɮɚɫɰɢɹ ɹɜɥɹɟɬɫɹ ɩɪɨɞɨɥɠɟɧɢɟɦ ɫɭɯɨɠɢɥɶɧɨɝɨ ɲɥɟɦɚ ɢ ɬɟ ɪɹɟɬɫɹ ɜ ɩɨɞɤɨɠɧɨɣ ɤɥɟɬɱɚɬɤɟ ɛɨɤɨɜɨɣ ɩɨɜɟɪɯɧɨɫɬɢ ɥɢɰɚ ɋɨɛɫɬɜɟɧɧɚɹ ɮɚɫɰɢɹ (fascia temporalis ɢɦɟɟɬ ɞɜɚ ɥɢɫɬɤɚ ± ɝɥɭɛɨɤɢɣ ɢ ɩɨɜɟɪɯɧɨɫɬɧɵɣ Ɉɛɚ ɥɢɫɬɤɚ ɧɚɱɢɧɚɸɬɫɹ ɨɬ linea temporalis superior ɉɨɜɟɪɯɧɨɫɬɧɵɣ ɥɢɫɬɨɤ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɧɚɪɭɠɧɨɣ ɩɨɜɟɪɯɧɨɫɬɢ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɚ ɝɥɭɛɨɤɢɣ ± ɤ ɜɧɭɬɪɟɧɧɟɣ ɪɢɫ 4.5). ȼ ɪɟ ɡɭɥɶɬɚɬɟ ɷɬɨɝɨ ɦɟɠɞɭ ɚɩɨɧɟɜɪɨɬɢɱɟɫɤɢɦɢ ɥɢɫɬɤɚɦɢ ɢ ɫɤɭɥɨɜɨɣ ɞɭɝɨɣ ɨɛɪɚɡɭɟɬɫɹ ɡɚɦɤɧɭɬɨɟ ɩɪɨɫɬɪɚɧɫɬɜɨ ɤɨɬɨɪɨɟ ɡɚɩɨɥɧɟɧɨ ɦɟɠɚɩɨɧɟɜɪɨɬɢɱɟɫɤɨɣ ɠɢɪɨɜɨɣ ɤɥɟɬ ɱɚɬɤɨɣ ȼ ɧɟɣ ɩɪɨɯɨɞɢɬ ɫɪɟɞɧɹɹ ɜɢɫɨɱɧɚɹ ɚɪɬɟɪɢɹ a. temporalis media - ɜɟɬɜɶ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɜɢɫɨɱɧɨɣ ɜ ɫɨɩɪɨɜɨɠɞɟɧɢɢ ɨɞɧɨɢɦɟɧɧɨɣ ɜɟɧɵ Ƚɟɦɚɬɨɦɚ ɢɥɢ ɝɧɨɣɧɵɟ ɩɪɨɰɟɫɫɵ ɜ ɷɬɨɣ ɤɥɟɬɱɚɬɤɟ ɨɝɪɚɧɢɱɟɧɵ ɢ ɨɛɵɱɧɨ ɧɟ ɫɩɭɫɤɚɸɬɫɹ ɧɢɠɟ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɇɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɩɨɞ ɝɥɭɛɨɤɢɦ ɥɢɫɬɤɨɦ ɜɢɫɨɱɧɨɝɨ ɚɩɨɧɟɜɪɨɡɚ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɬɪɟɬɢɣ ɫɥɨɣ ɤɥɟɬɱɚɬɤɢ ± ɩɨɞɚɩɨɧɟɜɪɨɬɢɱɟɫɤɢɣ ɤɨɬɨɪɵɣ ɩɟɪɟɯɨɞɢɬ ɩɨɡɚɞɢ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɜ ɠɢɪɨɜɨɟ ɫɤɨɩɥɟɧɢɟ ɳɟɤɢ ɢ ɜ ɩɨɞɜɢɫɨɱɧɭɸ ɹɦɤɭ Ɂɚ ɩɨɞɚ ɩɨɧɟɜɪɨɬɢɱɟɫɤɨɣ ɠɢɪɨɜɨɣ ɤɥɟɬɱɚɬɤɨɣ ɫɥɟɞɭɟɬ ɜɢɫɨɱɧɚɹ ɦɵɲɰɚ ɉɨɫɥɟɞɧɹɹ ɧɚɱɢ ɧɚɟɬɫɹ ɨɬ ɧɚɞɤɨɫɬɧɢɰɵ ɜɢɫɨɱɧɨɣ ɹɦɤɢ ɤɧɢɡɭ ɜɨɥɨɤɧɚ ɜɟɟɪɨɨɛɪɚɡɧɨ ɫɯɨɞɹɬɫɹ ɢ ɡɚɤɚɧɱɢɜɚɸɬɫɹ ɦɨɳɧɵɦ ɫɭɯɨɠɢɥɢɟɦ ɤɨɬɨɪɨɟ ɩɪɨɯɨɞɢɬ ɩɨɡɚɞɢ ɫɤɭɥɨɜɨɣ ɞɭɝɢ ɢ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɜɟɧɟɱɧɨɦɭ ɨɬɪɨɫɬɤɭ processus coronoideus ɧɢɠɧɟɣ ɱɟɥɸɫɬɢ
Ʉ ɦɵɲɰɟ ɩɨɞɯɨɞɢɬ ɝɥɭɛɨɤɚɹ ɜɢɫɨɱɧɚɹ ɚɪɬɟɪɢɹ ɢ ɧɟɪɜɵ (a. temporalis profunda et nn. temporales profundi). Ⱥɪɬɟɪɢɹ ɨɬɯɨɞɢɬ ɨɬ ɱɟɥɸɫɬɧɨɣ ɚ ɧɟɪɜɵ ± ɨɬ III ɜɟɬɜɢ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ Ʌɢɦɮɚ ɨɬ ɷɬɨɣ ɨɛɥɚɫɬɢ ɨɬɬɟɤɚɟɬ ɜ ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ ɨɤɨ ɥɨɭɲɧɨɣ ɠɟɥɟɡɵ nodi lymphatici parotidei).
6
ɇɚɞɤɨɫɬɧɢɰɚ ɜ ɧɢɠɧɟɦ ɨɬɞɟɥɟ ɩɥɨɬɧɨ ɫɪɚɳɟɧɚ ɫ ɩɨɞɥɟɠɚɳɟɣ ɤɨɫɬɶɸ ɜ ɜɟɪɯ ɧɟɦ ɫɨɟɞɢɧɟɧɚ ɪɵɯɥɨ Ʉɨɫɬɧɭɸ ɨɫɧɨɜɭ ɨɛɪɚɡɭɟɬ ɛɨɥɶɲɨɟ ɤɪɵɥɨ ɨɫɧɨɜɧɨɣ ɤɨɫɬɢ ɱɟɲɭɹ ɜɢɫɨɱɧɨɣ ɚ ɬɚɤɠɟ ɱɚɫɬɢ ɥɨɛɧɨɣ ɢ ɬɟɦɟɧɧɨɣ ɤɨɫɬɟɣ Ƚɭɛɱɚɬɵɣ ɫɥɨɣ ɷɬɢɯ ɤɨɫɬɟɣ ɫɥɚɛɨ ɪɚɡɜɢɬ ɢɥɢ ɩɨɥɧɨɫɬɶɸ ɨɬɫɭɬɫɬɜɭɟɬ ɧɚɪɭɠɧɚɹ ɢ ɜɧɭɬɪɟɧɧɹɹ ɤɨɦɩɚɤɬ ɧɵɟ ɩɥɚɫɬɢɧɤɢ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɩɪɢɥɟɝɚɸɬ ɞɪɭɝ ɤ ɞɪɭɝɭ ɜ ɪɟɡɭɥɶɬɚɬɟ ɱɟɝɨ ɤɨɫɬɢ ɜ ɜɢɫɨɱɧɨɣ ɨɛɥɚɫɬɢ ɬɨɧɤɢɟ ɢ ɱɚɫɬɨ ɩɨɜɪɟɠɞɚɸɬɫɹ ɞɚɠɟ ɩɪɢ ɧɟɛɨɥɶɲɢɯ ɬɪɚɜɦɚɯ
ɇɚ ɜɧɭɬɪɟɧɧɟɣ ɩɨɜɟɪɯɧɨɫɬɢ ɤɨɫɬɟɣ ɜɢɫɨɱɧɨɣ ɨɛɥɚɫɬɢ ɩɪɨɯɨɞɢɬ ɫɪɟɞɧɹɹ ɦɟ ɧɢɧɝɟɚɥɶɧɚɹ ɚɪɬɟɪɢɹ a.meningea media ex a. maxillaris). Ⱥɪɬɟɪɢɹ ɨɛɪɚɡɭɟɬ ɜɞɚɜɥɟ ɧɢɟ ɧɚ ɤɨɫɬɢ ± ɛɨɪɨɡɞɭ sulcus arteriae meningea media ɂɧɨɝɞɚ ɚɪɬɟɪɢɹ ɩɪɨɯɨɞɢɬ ɜ ɤɨɫɬɧɨɦ ɤɚɧɚɥɟ Ɉɫɬɚɧɨɜɤɚ ɤɪɨɜɨɬɟɱɟɧɢɹ ɩɪɢ ɩɨɜɪɟɠɞɟɧɢɢ ɚɪɬɟɪɢɢ ɜ ɷɬɢɯ ɫɥɭ ɱɚɹɯ ɫɢɥɶɧɨ ɭɫɥɨɠɧɹɟɬɫɹ
Ɋɢɫ 4.4 ɉɨɜɟɪɯɧɨɫɬɧɵɟ ɫɨɫɭɞɵ ɢ ɧɟɪɜɵ ɜɢɫɨɱɧɨɣ ɨɛɥɚɫɬɢ
7
Ɋɢɫ 4.5 Ɏɪɨɧɬɚɥɶɧɵɣ ɫɪɟɡ ɱɟɪɟɡ ɜɢ ɫɨɱɧɭɸ ɨɛɥɚɫɬɶ
1 ² cutis; 2 ² tela subcutanea; 3 ² fascia superficialis; 4 ² fascia temporalis;
5 ² m. temporalis; 6 ² spatium interfasciale;
7 ² processus zygomaticus; 8 ² fascia parotideomasseterica; 9 ² a. et v. transversae faciei;
10 -ductus parotideus; 11 ² gl. Parotid ea; 12 ² m. masseter; 13 ² mandibula;
14 ² spatium subfasciale; 15 ² a. et v. maxillares; 16 ² spatium subtemporale;
17 ² ramus frontalis n. facialis.
ɋɨɫɰɟɜɢɞɧɚɹ ɨɛɥɚɫɬɶ regio mastoidea)
Ɋɚɫɩɨɥɚɝɚɟɬɫɹ ɩɨɡɚɞɢ ɭɲɧɨɣ ɪɚɤɨɜɢɧɵ ɢ ɨɝɪɚɧɢɱɟɧɚ ɩɪɟɞɟɥɚɦɢ ɫɨɫɰɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɤɨɬɨɪɵɣ ɩɚɥɶɩɢɪɭɟɬɫɹ ɧɚ ɜɫɟɦ ɩɪɨɬɹɠɟɧɢɢ ɍ ɡɚɞɧɟɣ ɝɪɚɧɢɰɵ ɨɛɥɚɫɬɢ ɨɩɪɟɞɟɥɹɟɬɫɹ ɩɭɥɶɫɚɰɢɹ ɡɚɬɵɥɨɱɧɨɣ ɚɪɬɟɪɢɢ Ⱦɥɹ ɩɪɨɟɤɰɢɢ ɜɧɭɬɪɢɤɨɫɬɧɵɯ ɨɛɪɚ ɡɨɜɚɧɢɣ ɨɬɪɨɫɬɤɨɦ ɟɝɨ ɧɚɪɭɠɧɚɹ ɩɨɜɟɪɯɧɨɫɬɶ ɞɜɭɦɹ ɥɢɧɢɹɦɢ ɞɟɥɢɬɫɹ ɧɚ ɱɟɬɵɪɟ ɤɜɚɞɪɚɧɬɚ ɜɟɪɬɢɤɚɥɶɧɨ ɩɪɨɜɨɞɢɬɫɹ ɩɨ ɜɵɫɨɬɟ ɨɬɪɨɫɬɤɚ ɨɬ ɜɟɪɲɢɧɵ ɤ ɫɟɪɟɞɢɧɟ ɨɫɧɨɜɚɧɢɹ Ƚɨɪɢɡɨɧɬɚɥɶɧɚɹ ɥɢɧɢɹ ɞɟɥɢɬ ɩɨɩɨɥɚɦ ɷɬɭ ɜɟɪɬɢɤɚɥɶ ɇɚ ɩɟɪɟɞɧɟɜɟɪɯ ɧɢɣ ɤɜɚɞɪɚɧɬ ɩɪɨɟɰɢɪɭɟɬɫɹ ɫɨɫɰɟɜɢɞɧɚɹ ɩɟɳɟɪɚ antrum mastoideum ɧɚ ɩɟɪɟɞɧɟ ɧɢɠɧɢɣ ± ɤɨɫɬɧɵɣ ɤɚɧɚɥ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ ɧɚ ɡɚɞɧɟɜɟɪɯɧɢɣ ± ɡɚɞɧɹɹ ɱɟɪɟɩɧɚɹ ɹɦ ɤɚ ɧɚ ɡɚɞɧɟɧɢɠɧɢɣ ± ɫɢɝɦɨɜɢɞɧɵɣ ɫɢɧɭɫ sinus sigmoideus).
Ʉɨɠɚ ɬɨɧɤɚɹ ɩɨɞɜɢɠɧɚɹ ɥɢɲɟɧɚ ɜɨɥɨɫ ɫ ɬɪɭɞɨɦ ɛɟɪɟɬɫɹ ɜ ɫɤɥɚɞɤɭ ɨɫɨɛɟɧ ɧɨ ɜ ɡɚɞɧɟɦ ɨɬɞɟɥɟ ɨɛɥɚɫɬɢ
ɉɨɞɤɨɠɧɚɹ ɠɢɪɨɜɚɹ ɤɥɟɬɱɚɬɤɚ ɪɵɯɥɚɹ ȼ ɧɟɣ ɪɚɫɩɨɥɨɠɟɧɵ ɡɚɞɧɹɹ ɭɲɧɚɹ ɦɵɲɰɚ m. auricularis posterior ɨɤɨɥɨɭɲɧɵɟ nodi lymphatici parotidei ɢ ɫɨɫɰɟ ɜɢɞɧɵɟ nodi lymphatici mastoidei ɥɢɦɮɚɬɢɱɟɫɤɢɟ ɭɡɥɵ Ʉɪɨɦɟ ɬɨɝɨ ɡɞɟɫɶ ɩɪɨɯɨ ɞɹɬ ɫɨɫɭɞɵ ɢ ɧɟɪɜɵ ɫɧɚɛɠɚɸɳɢɟ ɷɬɭ ɨɛɥɚɫɬɶ ɡɚɞɧɹɹ ɭɲɧɚɹ ɚɪɬɟɪɢɹ a. auricularis posterior ex a. carotis ext ɢ ɜɟɧɚ ɛɨɥɶɲɨɣ ɭɲɧɨɣ ɢ ɦɚɥɵɣ ɡɚɬɵɥɨɱɧɵɣ ɧɟɪɜɵ nn. auricularis magnus et occipitalis minor) ɢ ɡɚɞɧɹɹ ɜɟɬɜɶ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ ramus posterior n. facialis).
ɉɨɜɟɪɯɧɨɫɬɧɚɹ ɮɚɫɰɢɹ ɜ ɜɟɪɯɧɟɦ ɨɬɞɟɥɟ ɫɪɚɳɟɧɚ ɫ ɫɭɯɨɠɢɥɶɧɵɦ ɲɥɟɦɨɦ ɋɨɛɫɬɜɟɧɧɚɹ ɮɚɫɰɢɹ ɨɛɥɚɫɬɢ ɩɪɢɤɪɟɩɥɹɟɬɫɹ ɤ ɧɚɞɤɨɫɬɧɢɰɟ ɡɚɞɧɟɣ ɲɟɪɨɯɨɜɚ
ɬɨɣ ɱɚɫɬɢ ɫɨɫɰɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ crista mastoidea) ɢ ɩɟɪɟɯɨɞɢɬ ɧɚ ɩɪɢɤɪɟɩɥɹɸ
8
ɳɢɟɫɹ ɤ ɧɟɦɭ ɦɵɲɰɵ Ʉ ɫɨɫɰɟɜɢɞɧɨɦɭ ɨɬɪɨɫɬɤɭ ɩɪɢɤɪɟɩɥɹɸɬɫɹ mm. sternocleidomastoideus et splenius capitis ɢ ɡɚɞɧɟɟ ɛɪɸɲɤɨ ɞɜɭɛɪɸɲɧɨɣ ɦɵɲɰɵ m. digastricus ɉɨɞ ɷɬɢɦɢ ɦɵɲɰɵ ɩɚɪɚɥɥɟɥɶɧɨ ɢ ɤɧɭɬɪɢ ɨɬ ɫɨɫɰɟɜɢɞɧɨɣ ɜɵɪɟɡɤɢ ɜ ɛɨ ɪɨɡɞɟ ɩɪɨɯɨɞɢɬ ɡɚɬɵɥɨɱɧɚɹ ɚɪɬɟɪɢɹ a. occipitalis ɇɚɞɤɨɫɬɧɢɰɚ ɩɪɨɱɧɨ ɫɪɚɳɟɧɚ ɫ ɧɚɪɭɠɧɨɣ ɩɨɜɟɪɯɧɨɫɬɶɸ ɫɨɫɰɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɡɚ ɢɫɤɥɸɱɟɧɢɟɦ ɝɥɚɞɤɨɣ ɬɪɟ ɭɝɨɥɶɧɨɣ ɩɥɨɳɚɞɤɢ ɫɨɨɬɜɟɬɫɬɜɭɸɳɟɣ ɬɪɟɩɚɧɚɰɢɨɧɧɨɦɭ ɬɪɟɭɝɨɥɶɧɢɤɭ ɒɢɩɨ ɝɞɟ ɧɚɞɤɨɫɬɧɢɰɚ ɥɟɝɤɨ ɨɬɫɥɚɢɜɚɟɬɫɹ ȼ ɩɪɟɞɟɥɚɯ ɟɝɨ ɩɪɨɢɡɜɨɞɢɬɫɹ ɬɪɟɩɚɧɚɰɢɹ ɫɨɫɰɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɩɪɢ ɝɧɨɣɧɵɯ ɦɚɫɬɨɢɞɢɬɚɯ Ƚɪɚɧɢɰɚɦɢ ɬɪɟɭɝɨɥɶɧɢɤɚ ɒɢɩɨ ɹɜɥɹɸɬɫɹ ɫɩɟɪɟɞɢ ± ɡɚɞɧɢɣ ɤɪɚɣ ɧɚɪɭɠɧɨɝɨ ɫɥɭɯɨɜɨɝɨ ɩɪɨɯɨɞɚ ɫ ɧɚɯɨɞɹɳɟɣɫɹ ɧɚɞ ɧɢɦ ɨɫɬɶɸ spina suprameatica ɫɡɚɞɢ ± ɫɨɫɰɟɜɢɞɧɵɣ ɝɪɟɛɟɲɨɤ crista mastoidea ɫɜɟɪɯɭ ± ɝɨɪɢɡɨɧɬɚɥɶɧɚɹ ɥɢɧɢɹ ɩɪɨɜɟɞɟɧɧɚɹ ɤɡɚɞɢ ɨɬ ɫɤɭɥɨɜɨɝɨ ɨɬɪɨɫɬɤɚ
(processus zygomaticus ɜɢɫɨɱɧɨɣ ɤɨɫɬɢ ɪɢɫ 4.6).
ɋɨɫɰɟɜɢɞɧɵɣ ɨɬɪɨɫɬɨɤ ɫɨɞɟɪɠɢɬ ɹɱɟɣɤɢ cellulae mastoideae ɨɞɧɚ ɢɡ ɤɨɬɨ ɪɵɯ ɛɨɥɟɟ ɤɪɭɩɧɚɹ ± ɫɨɫɰɟɜɢɞɧɚɹ ɩɟɳɟɪɚ antrum mastoideum ɫɨɨɛɳɚɟɬɫɹ ɩɨ ɫɪɟɞɫɬɜɨɦ ɜɯɨɞɚ ɜ ɩɟɳɟɪɭ aditus ad antrum ɫ ɛɚɪɚɛɚɧɧɨɣ ɩɨɥɨɫɬɶɸ ȼɟɪɯɧɹɹ ɫɬɟɧɤɚ ɨɬɞɟɥɹɟɬ ɩɟɳɟɪɭ ɨɬ ɫɪɟɞɧɟɣ ɱɟɪɟɩɧɨɣ ɹɦɤɢ ɧɚ ɟɟ ɦɟɞɢɚɥɶɧɨɣ ɫɬɟɧɤɟ ɤɪɨ ɦɟ ɜɯɨɞɚ ɜ ɩɟɳɟɪɭ ɢɦɟɟɬɫɹ ɞɜɚ ɜɵɫɬɭɩɚ prominentia canalis semicircularis lateralis (ɜɵɫɬɭɩ ɥɚɬɟɪɚɥɶɧɨɝɨ ɩɨɥɭɤɪɭɠɧɨɝɨ ɤɚɧɚɥɚ ɢ prominentia canalis facialis ɜɵɫɬɭɩ ɥɢɰɟɜɨɝɨ ɤɚɧɚɥɚ Ʉ ɡɚɞɧɟɣ ɫɬɟɧɤɟ ɩɟɳɟɪɵ ɨɫɨɛɟɧɧɨ ɭ ɛɪɚɯɢɰɟɮɚɥɨɜ ɩɪɢ ɫɥɚɛɨɦ ɪɚɡɜɢɬɢɢ ɫɨɫɰɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɛɥɢɡɤɨ ɩɨɞɯɨɞɢɬ ɫɢɝɦɨɜɢɞɧɵɣ ɫɢɧɭɫ sinus sigmoideus ɩɪɨɟɰɢɪɭɸɳɢɣɫɹ ɧɚ ɫɨɫɰɟɜɢɞɧɵɣ ɝɪɟɛɟɲɨɤ Ɉɛɵɱɧɨ ɠɟ ɷɬɨɬ ɫɢɧɭɫ ɨɬ ɞɟɥɟɧ ɨɬ ɩɟɳɟɪɵ ɞɨɜɨɥɶɧɨ ɬɨɥɫɬɨɣ ɤɨɫɬɧɨɣ ɩɥɚɫɬɢɧɤɨɣ
ɋɨɫɰɟɜɢɞɧɚɹ ɩɟɳɟɪɚ ɞɥɢɧɨɣ ɜ ɫɪɟɞɧɟɦ ɦɦ ɲɢɪɢɧɨɣ ɦɦ ɧɚɯɨɞɢɬɫɹ ɧɚ ɝɥɭɛɢɧɟ - ɫɦ ɤɨɫɬɧɨɝɨ ɜɟɳɟɫɬɜɚ ɫɨɫɰɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ȼɨ ɢɡɛɟɠɚɧɢɟ ɩɨɜɪɟ ɠɞɟɧɢɣ ɬɪɟɩɚɧɚɰɢɹ ɫɨɫɰɟɜɢɞɧɨɝɨ ɨɬɪɨɫɬɤɚ ɜɟɞɟɬɫɹ ɜ ɩɪɟɞɟɥɚɯ ɬɪɟɭɝɨɥɶɧɢɤɚ ɒɢ ɩɨ
Ɋɢɫ 4.6. ɋɨɫɰɟɜɢɞɧɚɹ ɨɛɥɚɫɬɶ Ɍɪɟɭɝɨɥɶɧɢɤ ɒɢɩɨ ɋɯɟɦɚ
1 ² ɩɪɨɟɤɰɢɹ ɡɚɞɧɟɣ ɱɟɪɟɩɧɨɣ ɹɦɤɢ ² ɩɪɨɟɤɰɢɹ ɫɢɝɦɨɜɢɞɧɨɝɨ ɫɢɧɭɫɚ 3 ² ɬɪɟɭɝɨɥɶɧɢɤ ɒɢɩɨ
4 ² ɩɪɨɟɤɰɢɹ ɥɢɰɟɜɨɝɨ ɧɟɪɜɚ
5 ² ɧɚɪɭɠɧɨɟ ɫɥɭɯɨɜɨɟ ɨɬɜɟɪ ɫɬɢɟ 6 ² ɩɪɨɟɤɰɢɹ ɫɨɫɰɟɜɢɞɧɨɣ ɩɟ ɳɟɪɵ
Ɉɫɧɨɜɚɧɢɟ ɱɟɪɟɩɚ basis cranii)
ȼɧɭɬɪɟɧɧɟɟ ɨɫɧɨɜɚɧɢɟ ɱɟɪɟɩɚ basis cranii interna). Ɉɧɨ ɪɚɡɞɟɥɟɧɨ ɧɚ ɬɪɢ ɯɨɪɨɲɨ ɨɬɝɪɚɧɢɱɟɧɧɵɟ ɞɪɭɝ ɨɬ ɞɪɭɝɚ ɱɟɪɟɩɧɵɟ ɹɦɤɢ fossae ɩɟɪɟɞɧɸɸ ɫɪɟɞ ɧɸɸ ɢ ɡɚɞɧɸɸ
9
ɉɟɪɟɞɧɹɹ ɱɟɪɟɩɧɚɹ ɹɦɤɚ fossa cranii anterior) ɜɩɟɪɟɞɢ ɞɨɯɨɞɢɬ ɞɨ ɱɟɲɭɢ ɥɨɛɧɨɣ ɤɨɫɬɢ ɫɡɚɞɢ ɨɬɝɪɚɧɢɱɟɧɚ ɨɬ ɫɪɟɞɧɟɣ ɱɟɪɟɩɧɨɣ ɹɦɤɢ ɡɚɞɧɢɦ ɤɪɚɟɦ ɦɚɥɵɯ ɤɪɵɥɶɟɜ ɤɥɢɧɨɜɢɞɧɨɣ ɤɨɫɬɢ ala minor os sphenoidalis ɪɚɫɩɨɥɨɠɟɧɧɵɦ ɤɩɟɪɟɞɢ ɨɬ sulcus ɫhiasmaticus ȼ ɨɛɪɚɡɨɜɚɧɢɢ ɷɬɨɣ ɹɦɤɢ ɭɱɚɫɬɜɭɟɬ ɜɟɪɯɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ ɝɥɚɡɧɢɱɧɨɣ ɱɚɫɬɢ ɥɨɛɧɨɣ ɤɨɫɬɢ ɜ ɰɟɧɬɪɟ ± ɪɟɲɟɬɱɚɬɚɹ ɩɥɚɫɬɢɧɤɚ lamina cribrosa) ɪɟɲɟɬɱɚɬɨɣ ɤɨɫɬɢ ɩɨɡɚɞɢ ± ɩɟɪɟɞɧɢɣ ɨɬɞɟɥ ɢ ɦɚɥɵɟ ɤɪɵɥɶɹ ɤɥɢɧɨɜɢɞɧɨɣ ɤɨɫɬɢ ɉɨɫɪɟɞɢɧɟ ɹɦɤɢ ɜɵɫɬɭɩɚɟɬ ɩɟɬɭɲɢɧɵɣ ɝɪɟɛɟɧɶ crista galli ɨɬ ɤɨɬɨɪɨɝɨ ɧɚɱɢɧɚ ɟɬɫɹ ɫɟɪɩ ɛɨɥɶɲɨɝɨ ɦɨɡɝɚ falx cerebri ɨɛɪɚɡɨɜɚɧɧɵɣ ɥɢɫɬɤɚɦɢ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ ɉɨ ɜɟɪɯɧɟɦɭ ɤɪɚɸ ɩɨɫɥɟɞɧɟɝɨ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɜɟɪɯɧɢɣ ɫɚɝɢɬɬɚɥɶɧɵɣ ɫɢ ɧɭɫ sinus sagittalis superior) ɤɨɬɨɪɵɣ ɩɨɫɪɟɞɫɬɜɨɦ ɷɦɢɫɫɚɪɧɨɣ ɜɟɧɵ ɩɪɨɯɨɞɹɳɟɣ ɱɟɪɟɡ ɫɥɟɩɨɟ ɨɬɜɟɪɫɬɢɟ foramen caecum ɧɚɯɨɞɹɳɟɟɫɹ ɫɩɟɪɟɞɢ ɨɬ ɩɟɬɭɲɢɧɨɝɨ ɝɪɟɛɧɹ ɫɨɨɛɳɚɬɫɹ ɫ ɜɟɧɨɡɧɵɦɢ ɫɩɥɟɬɟɧɢɹɦɢ ɧɨɫɨɜɨɣ ɩɨɥɨɫɬɢ
ɉɨ ɫɬɨɪɨɧɚɦ ɨɬ ɩɟɬɭɲɢɧɨɝɨ ɝɪɟɛɧɹ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɨɬɜɟɪɫɬɢɹ ɪɟɲɟɬɱɚɬɨɣ ɩɥɚɫɬɢɧɤɢ ɪɟɲɟɬɱɚɬɨɣ ɤɨɫɬɢ ɱɟɪɟɡ ɤɨɬɨɪɵɟ ɩɪɨɯɨɞɹɬ ɜɟɬɨɱɤɢ ɨɛɨɧɹɬɟɥɶɧɨɝɨ ɧɟ ɪɜɚ ɨɤɨɥɨ ± nn. olfactorii, ɩɟɪɟɞɧɹɹ ɪɟɲɟɬɱɚɬɚɹ ɚɪɬɟɪɢɹ ɚ et v. ethmoidalis ant ɜɟɬɜɶ ɝɥɚɡɧɢɱɧɨɣ ɚɪɬɟɪɢɢ ɢ ɨɞɧɨɢɦɟɧɧɵɟ ɜɟɧɵ ɧɟɪɜ ɢɡ I ɜɟɬɜɢ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ Ɉɬ ɩɟɪɟɞɧɟɣ ɪɟɲɟɬɱɚɬɨɣ ɚɪɬɟɪɢɢ ɨɬɯɨɞɹɬ ɩɟɪɟɞɧɹɹ ɦɟɧɢɧɝɟɚɥɶɧɚɹ ɚɪɬɟɪɢɹ (a. meningea anterior ɩɢɬɚɸɳɚɹ ɩɟɪɟɞɧɢɣ ɨɬɞɟɥ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ ɉɨ ɫɬɨɪɨɧɚɦ ɨɬ ɩɟɬɭɲɢɧɨɝɨ ɝɪɟɛɧɹ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɨɛɨɧɹɬɟɥɶɧɵɟ ɥɭɤɨɜɢɰɵ ɫ ɧɚɱɢ ɧɚɸɳɢɦɢɫɹ ɨɬ ɧɢɯ ɨɛɨɧɹɬɟɥɶɧɵɦɢ ɬɪɚɤɬɚɦɢ ɢ ɥɨɛɧɵɟ ɞɨɥɢ ɝɨɥɨɜɧɨɝɨ ɦɨɡɝɚ Ɇɟ ɧɢɧɝɢɬ ɢ ɚɛɫɰɟɫɫɵ ɜ ɨɛɥɚɫɬɢ ɩɟɪɟɞɧɟɣ ɱɟɪɟɩɧɨɣ ɹɦɤɢ ɦɨɝɭɬ ɛɵɬɶ ɫɥɟɞɫɬɜɢɟɦ ɷɦ ɩɢɟɦɵ ɥɨɛɧɵɯ ɫɢɧɭɫɨɜ ɢɥɢ ɝɧɨɣɧɵɯ ɡɚɛɨɥɟɜɚɧɢɣ ɩɨɥɨɫɬɢ ɧɨɫɚ ɪɚɫɩɪɨɫɬɪɚɧɹɸ ɳɢɯɫɹ per continuitatem ɢɥɢ ɩɨ ɚɧɚɫɬɨɦɨɡɚɦ ɜɟɧ ɩɨɥɨɫɬɢ ɧɨɫɚ ɫ ɫɚɝɢɬɬɚɥɶɧɵɦ ɫɢɧɭɫɨɦ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ
ɋɪɟɞɧɹɹ ɱɟɪɟɩɧɚɹ ɹɦɤɚ fossa cranii media) ɨɬɝɪɚɧɢɱɟɧɚ ɫɩɟɪɟɞɢ ɤɪɚɹɦɢ ɦɚ ɥɵɯ ɤɪɵɥɶɟɜ ɤɥɢɧɨɜɢɞɧɨɣ ɤɨɫɬɢ ɫɡɚɞɢ ± ɜɟɪɯɧɢɦɢ ɝɪɚɧɹɦɢ ɩɢɪɚɦɢɞ ɜɢɫɨɱɧɵɯ ɤɨɫɬɟɣ ȼ ɰɟɧɬɪɚɥɶɧɨɣ ɱɚɫɬɢ ɦɟɠɞɭ ɨɛɟɢɦɢ ɫɪɟɞɧɢɦɢ ɱɟɪɟɩɧɵɦɢ ɹɦɤɚɦɢ ɧɚɯɨ ɞɢɬɫɹ ɬɭɪɟɰɤɨɟ ɫɟɞɥɨ sella turcica ɧɚ ɤɨɬɨɪɨɦ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɝɢɩɨɮɢɡ Ɍɭɪɟɰɤɨɟ ɫɟɞɥɨ ɡɚɬɹɧɭɬɨ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɨɣ ɨɛɪɚɡɭɸɳɟɣ ɞɢɚɮɪɚɝɦɭ ɫɟɞɥɚ diaphragma sellae). ȼ ɰɟɧɬɪɟ ɞɢɚɮɪɚɝɦɵ ɬɭɪɟɰɤɨɝɨ ɫɟɞɥɚ ɢɦɟɟɬɫɹ ɨɬɜɟɪɫɬɢɟ ɱɟɪɟɡ ɤɨɬɨɪɨɟ ɩɪɨɯɨɞɢɬ ɜɨɪɨɧɤɚ LQIXQGLEXOXP ɫɜɹɡɵɜɚɸɳɚɹ ɨɫɧɨɜɚɧɢɟ ɦɨɡɝɚ ɫ ɝɢɩɨ ɮɢɡɨɦ Ʉɨɫɬɧɚɹ ɨɫɧɨɜɚ ɛɨɤɨɜɵɯ ɨɬɞɟɥɨɜ ɫɪɟɞɧɟɣ ɱɟɪɟɩɧɨɣ ɹɦɤɢ ɨɛɪɚɡɭɟɬɫɹ ɛɨɥɶɲɢɦɢ ɤɪɵɥɶɹɦɢ ɤɥɢɧɨɜɢɞɧɨɣ ɤɨɫɬɢ ɩɟɪɟɞɧɟɜɟɪɯɧɢɦɢ ɩɨɜɟɪɯɧɨɫɬɹɦɢ ɩɢɪɚ ɦɢɞ ɢ ɱɟɲɭɣɱɚɬɨɣ ɱɚɫɬɶɸ pars squamosa ɜɢɫɨɱɧɵɯ ɤɨɫɬɟɣ ɉɟɪɟɤɪɟɫɬ ɡɪɢɬɟɥɶ ɧɵɯ ɧɟɪɜɨɜ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɤɩɟɪɟɞɢ ɨɬ ɬɭɪɟɰɤɨɝɨ ɫɟɞɥɚ ɜ ɨɞɧɨɢɦɟɧɧɨɣ ɛɨɪɨɡɞɟ ȼ ɛɨɤɨɜɵɯ ɨɬɞɟɥɚɯ ɫɪɟɞɧɟɣ ɱɟɪɟɩɧɨɣ ɹɦɤɢ ɧɚɯɨɞɹɬɫɹ ɜɢɫɨɱɧɵɟ ɞɨɥɢ ɝɨɥɨɜɧɨɝɨ ɦɨɡɝɚ ȼ ɜɟɪɯɭɲɤɟ ɤɚɦɟɧɢɫɬɨɣ ɱɚɫɬɢ ɜɢɫɨɱɧɨɣ ɤɨɫɬɢ ɫɩɟɪɟɞɢ ɜ ɬɪɨɣɧɢɱɧɨɦ ɜɞɚɜ ɥɟɧɢɢ impressio trigemini) ɪɚɫɩɨɥɨɠɟɧ ɩɨɥɭɥɭɧɧɵɣ ɭɡɟɥ ɬɪɨɣɧɢɱɧɨɝɨ ɧɟɪɜɚ V ɩɚɪɚ ɱɟɪɟɩɧɵɯ ɧɟɪɜɨɜ Ɉɧ ɥɟɠɢɬ ɜ ɪɚɫɳɟɩɥɟɧɢɢ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ ± cavum trigeminale ɚ ɤɧɚɪɭɠɢ ɨɬ ɧɟɝɨ ɩɪɨɟɰɢɪɭɟɬɫɹ ɤɪɵɲɚ ɛɚɪɚɛɚɧɧɨɣ ɩɨɥɨɫɬɢ (tegmen tympani ȼ ɨɤɪɭɠɧɨɫɬɢ ɬɭɪɟɰɤɨɝɨ ɫɟɞɥɚ ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ ɩɨ ɫɬɨɪɨɧɚɦ ɨɬ ɧɟɝɨ ɧɚɯɨɞɢɬɫɹ ɩɟɳɟɪɢɫɬɵɣ ɫɢɧɭɫ ɬɜɟɪɞɨɣ ɦɨɡɝɨɜɨɣ ɨɛɨɥɨɱɤɢ sinus cavernosus). ȼ ɩɟɳɟɪɢɫɬɵɣ ɫɢɧɭɫ ɜɩɚɞɚɸɬ ɜɟɪɯɧɹɹ ɢ ɧɢɠɧɹɹ ɝɥɚɡɧɵɟ ɜɟɧɵ ɚ ɱɟɪɟɡ ɧɟɝɨ ɩɪɨɯɨɞɹɬ ɜɧɭɬɪɟɧɧɹɹ ɫɨɧɧɚɹ ɚɪɬɟɪɢɹ ɋɪɟɞɧɹɹ ɱɟɪɟɩɧɚɹ ɹɦɤɚ ɫɨɨɛɳɚɟɬɫɹ ɫ ɞɪɭ ɝɢɦɢ ɨɛɥɚɫɬɹɦɢ ɝɨɥɨɜɵ ɩɨɫɪɟɞɫɬɜɨɦ ɤɚɧɚɥɨɜ ɳɟɥɟɣ ɢ ɨɬɜɟɪɫɬɢɣ
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