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1、CHAPTER58LUNG,CHESTWALL,PLEURA,ANDMEDIASTINUMJoeB.Putnam,Jr.external,internal,andtransverseorinnermostmuscles.Elevenanatomyintercostalspaces,eachassociatednumericallywiththeribsupe-selectionofpatientsforthoracicoperationsriortoit,containtheintercostalbundles(vein,ar
2、tery,andnerve)lungthattravelalongtheloweredgeofeachrib.Allintercostalspaceslungcancerarewideranteriorlyandeachintercostalbundlefallsawayfromtracheatheribposteriorlytobecomemorecentrallylocatedwithineachpulmonaryinfectionsspace.Theintercostalmusclelayersassistwithres
3、pirationandmassivehemoptysisprotectthethoracicstructures.Theextrinsicmusclesoftheemphysemaanddiffuselungdiseasechest,latissimusdorsimuscle,serratusanteriormuscle,pectora-pulmonarymetastaseslismajorandminormuscles,andcervicalmuscles(sternocleido-mastoid,scalenemuscle
4、s)attachtothebonythorax,protectthemiscellaneouslungtumorschestwallitself,andmayassistwithventilatoryeffortsinthosechestwallwithchronicobstructivepulmonarydisease(COPD).thoracicoutletsyndromeThesecondarymusclesconsistofthesternocleidomastoid,pleuraserratusposterior,a
5、ndlevatorescostarum.Thethirdmusclemediastinumgroupattachestheupperextremitytothebody.Thepectoralismajorandminormuscleslieanteriorlyandsuperficially.Poste-riorsuperficialmusculatureincludesthetrapeziusandlatissimusdorsi.Deepmusclesincludetheserratusanteriorandposteri
6、or,Thetermthoraxreferstotheareabetweentheneckandabdomenlevatores,andmajorandminorrhomboids.Thesesuperficialenclosedbytheribs,sternumandvertebraeradially,thethoracicanddeepmuscleshelpholdthescapulaetothechestwall.Ininletsuperiorly,andthediaphragminferiorly.Thechestor
7、respiratorydistress,thedeltoid,pectoralis,andlatissimusdorsithoraxsupportsandprotectstheinternalthoracicorgans,pro-musclesformatertiarysystemforventilatoryassistancethroughvidesforthenegativeinspiratoryforcethatinitiatesventilationfixationoftheupperextremities.andth
8、epositiveexpiratoryforceneededforvocalization,andThebonythoraxconsistsof12ribsperipherallyextendingcreatesaframefortheneck,upperextremitie
