Fascial Layers of the Neck

頸筋膜層

Fascia is an internal connective tissue which forms bands or sheets that surround and support muscles, vessels and nerves in the body.

筋膜是一種內(nèi)部結(jié)締組織，它形成束狀或片狀包繞和支持體內(nèi)的肌肉、血管和神經(jīng)。

In the neck, these layers of fascia not only act to support internal structures, but also help to compartmentalise structures of the neck. There are two fascias in the neck – the superficial cervical fascia and the deep cervical fascia.

在頸部，這些筋膜層不僅支持內(nèi)部結(jié)構(gòu)，而且?guī)椭鷦澐诸i部結(jié)構(gòu)。頸部有兩層筋膜:頸淺筋膜和頸深筋膜。

In this article, we shall look at the anatomy of the fascial layers of the neck–their attachments, anatomical relationships and their clinical relevance.

在這篇文章中，我們將觀察頸筋膜層的解剖-它們的附著，解剖關(guān)系和臨床意義。

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Superficial Cervical Fascia

頸淺筋膜

The superficial cervical fascia lies between the dermis and the deep cervical fascia. It contains numerous structures:

頸淺筋膜位于真皮層和頸深筋膜之間。它包含許多結(jié)構(gòu):

Neurovascular supply to the skin

皮膚的神經(jīng)血管供應(yīng)

Superficial veins (e.g. the external jugular vein)

淺靜脈(如頸外靜脈)

Superficial lymph nodes

淺表淋巴結(jié)

Fat

脂肪

Platysma muscle

頸闊肌

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Platysma

頸闊肌

The superficial cervical fascia blends with the‘paper thin’platysma muscle. The platysma is a broad superficial muscle which lies anteriorly in the neck.

頸淺筋膜與“紙一樣薄”的頸闊肌附在一起。頸闊肌是一塊寬闊的淺表肌，位于頸前部。

It has two heads, which originate from the fascia of the pectoralis major and deltoid. The fibres from the two heads cross the clavicle, and meet in the midline, fusing with the muscles of the face. Superiorly, the platysma inserts into the inferior border of the mandible.

它有兩個起點，起源于胸大肌和三角肌表面的筋膜。來自兩個起點部位的纖維穿過鎖骨，在中線處交叉，與面部的肌肉融合，并向上伸入下頜骨的邊緣。

Innervation to the platysma is via the cervical branch of the facial nerve.

頸闊肌的神經(jīng)支配是面神經(jīng)的頸支。

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Deep Cervical Fascia

頸深筋膜

The deep cervical fascia lies, as its name suggests,‘deep’ to the superficial fascia and platysma muscle. This fascia is organised into several layers. These layers act like a shirt collar, supporting the structures and vessels of the neck.

頸深筋膜，顧名思義，位于淺筋膜和頸闊肌的“深處”。頸深筋膜被分為幾層。這些層次就像襯衫領(lǐng)子一樣，支撐著頸部的結(jié)構(gòu)和血管。

We shall now look at the layers of the deep cervical fascia in more detail (superficial to deep):

現(xiàn)在我們將更詳細(xì)地看一下頸深筋膜的各層(從淺到深):

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Investing Layer

封套筋膜層（頸深筋膜淺層）

The investing layer is the most superficial of the deep cervical fascia.

封套筋膜層是頸深筋膜的最淺層。

It surrounds all the structures in the neck. Where it meets the trapezius and sternocleidomastoid muscles, it splits into two, completely surrounding them.

它包圍了頸部的所有結(jié)構(gòu)。在與斜方肌和胸鎖乳突肌相匯處一分為二，完全包圍著它們。

The investing fascia can be thought of as a tube; with superior, inferior, anterior and posterior attachments:

封套筋膜可以被認(rèn)為是一個管狀結(jié)構(gòu);有上、下、前和后附著:

Superior – attaches to the external occipital protuberance and the superior nuchal line of the skull.

上-附著于枕外隆突和枕骨上項線。

Anteriorly – attaches to the hyoid bone.

前-與舌骨相連

Inferiorly – attaches to the spine and acromion of the scapula, the clavicle, and the manubrium of the sternum.

下-附著于脊柱和肩胛骨的肩峰，鎖骨和胸骨柄。

Posterior – attaches along the nuchal ligament of the vertebral column

后-附著于脊柱的頸韌帶?

Pretracheal Layer

氣管前層（頸深筋膜中層）

The pretracheal layer of fascia is situated in the anterior neck. It spans between the hyoid bone superiorly and the thorax inferiorly (where it fuses with the pericardium).

氣管前筋膜層位于頸前。向上跨越舌骨，向下跨越胸廓(與心包融合)。

The trachea, oesophagus, thyroid gland and infrahyoid muscles are enclosed by the pretracheal fascia. Anatomically, it can be divided into two parts:

氣管前筋膜包裹著氣管、食管、甲狀腺和舌骨下肌。解剖學(xué)上可分為兩部分:

Muscular part – encloses the infrahyoid muscles.

肌肉層/壁層-包括舌骨下肌群。

Visceral part – encloses the thyroid gland, trachea and oesophagus.

臟層-包繞甲狀腺，氣管和食管。

The posterior aspect of the visceral fascia is formed by contributions from the buccopharyngeal fascia (a fascial covering of the pharynx).

臟層的后部是由咽筋膜(覆蓋咽的筋膜)形成的。

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Prevertebral Layer

椎前筋膜層（頸深筋膜深層）

The prevertebral fascia surrounds the vertebral column and its associated muscles; scalene muscles, prevertebral muscles, and the deep muscles of the back.

椎前筋膜包繞著脊柱及其相關(guān)肌肉;斜角肌，椎前肌，以及背部的深層肌肉。

It has attachments along the antero-posterior and supero-inferior axes:

它在前后軸和上下軸上有附著物

Superior attachment – base of the skull.

上附著點-顱底。

Anterior attachment – transverse processes and vertebral bodies of the vertebral column.

前附著點-脊柱的橫突和椎體。

Posterior attachment – along the nuchal ligament of the vertebral column

后附著點-沿脊柱的頸后韌帶

Inferior attachment – fusion with the endothoracic fascia of the ribcage.

下附著點-與胸內(nèi)筋膜融合。

The anterolateral portion of prevertebral fascia forms the floor of the posterior triangle of the neck. It also surrounds the brachial plexus as it leaves the neck and subclavian artery as it passes through the lower neck region – in doing so, it forms the axillary sheath.

椎前筋膜的前外側(cè)部分構(gòu)成頸后三角的底。并向外下方伸展，包繞鎖骨下動、靜脈及臂叢延入腋窩，形成腋鞘。

Carotid Sheath

頸動脈鞘

The carotid sheaths are paired structures on either side of the neck, which enclose an important neurovascular bundle of the neck.

頸動脈鞘是位于頸部兩側(cè)的成對結(jié)構(gòu)，包裹著頸部重要的神經(jīng)血管束。

The contents of the carotid sheath are:

頸動脈鞘的內(nèi)容物有：

Common carotid artery

頸總動脈

Internal jugular vein.

頸內(nèi)靜脈

Vagus nerve.

迷走神經(jīng)

Accompanying cervical lymph nodes.

伴行的頸部淋巴結(jié)

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The fascia of the carotid sheath is formed by contributions from the pretracheal, prevertebral, and investing fascia layers. The carotid artery bifurcates within the sheath into the external and internal carotid arteries.

頸動脈鞘的筋膜是由氣管前筋膜層、椎前筋膜層和封套筋膜層組成的。頸總動脈在鞘內(nèi)分為頸外動脈和頸內(nèi)動脈。

The carotid fascia is organised into a column, which runs between the base of the skull to the thoracic mediastinum. This is of clinical importance as a pathway for the spread of infection.

頸動脈筋膜組織成一柱，在顱底和胸縱隔之間。作為感染擴散的途徑具有重要的臨床意義。

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Clinical Relevance: Fascial Spaces of the Neck

頸筋膜間隙的臨床意義

The neck fascia compartmentalises structures within the neck. These layers of tough fascia can limit the spread of infection (for example, a superficial skin abscess may be prevented from spreading deeper into the neck by the investing fascia).

頸筋膜將頸部內(nèi)的組織分隔開來。這些堅韌的筋膜層可以限制感染的擴散（例如，淺表皮膚膿腫可以通過封套筋膜阻止擴散到更深的頸部）。

However, infections that reach the potential spaces between the neck fascia have a well-defined spread:

然而，到達(dá)頸部筋膜之間潛在間隙的感染即有明確的擴散:

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Retropharyngeal space – located between the buccopharyngeal fascia (posterior aspect of the visceral pretracheal fascia) and the prevertebral fascia.

咽后間隙-位于頰咽筋膜（氣管前筋膜的后側(cè)）和椎前筋膜之間。

Extends from the base of the skull to the posterior mediastinum.

從顱底延伸到后縱隔。

Visceral space – enclosed by the visceral pretracheal fascia.

內(nèi)臟間隙-由氣管前筋膜包圍。

Extends from the hyoid bone to the superior mediastinum.

從舌骨延伸到上縱隔。

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除此之外，還有胸骨上間隙，椎前間隙，危險間隙（第四間隙）。

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