系统解剖学周围神经.ppt

脊 神 经 Spinal Nerves,男，24岁，背部被刺伤，立刻跌倒，两下肢失去运动。数日右腿稍能活动。又过一周后右下肢几乎恢复了运动，但左下肢完全瘫痪。检查发现：左下肢无随意运动，腱反射亢进，Babinski征阳性。右侧躯干胸骨剑突水平以下和右下肢痛、温度觉丧失，但触觉、位置和运动觉正常。左侧躯干剑突以下和左下肢痛、温度觉完好，但触觉减弱，位置和运动觉丧失。,病例分析,腱反射亢进 Babinski征阳性,左下肢完全瘫痪 右下肢痛、温度觉丧失 左下肢位置觉、运动觉丧失,上运动神经元损伤,背部被刺伤,脊髓损伤,左侧皮质脊髓束受损 左侧脊髓丘系受损 左侧薄束受损,T4胸髓左侧半边横断右侧剑突以下痛温度觉丧失,提问 Answer questions,侧角 脊神经节,用模型说明 及英文名称,提问 Answer questions,侧角 脊神经节 纤维束 脊髓丘脑束,Nervous System,central N.S.,brain,spinal cord,peripheral N.S.,cranial n.,spinal n.,visceral n.,Spinal Cord,2 enlargements: cervical, lumbar,1 cone: conus medullaris,6 grooves and fissure,2 groups of nerve roots anterior, posterior,31 segments C8, T12, L5, S5, Co1,脊神经的区分 Classification,颈神经 cervical nerves 胸神经 thoracic nerves 腰神经 lumbar nerves 骶神经 sacral nerves 尾神经 coccygeal nerve,8对 12对 5对 5对 1对,脊神经的组成 formation,后根 posterior root,前根 anterior root,脊神经节 spinal ganglion,脊神经 spinal nerve,脊神经的纤维成分 Components,内脏感觉纤维 Visceral sensory fibers,躯体感觉纤维 Somatic sensory fibers,躯体运动纤维 Somatic motor fibers,内脏运动纤维 Visceral motor fibers,脊神经纤维成份,躯体感觉纤维 somatic sensory fibers 躯体运动纤维 somatic motor fibers 内脏感觉纤维 visceral sensory fibers 内脏运动纤维 visceral motor fibers,皮肤、骨骼肌和关节 skin,skeletal muscles, joints,心肌、平滑肌和腺体 cardiac muscles,smooth muscles,glands,脊神经的分支 branches,后支 posterior b.,前支 anterior b.,脊神经节 spinal ganglion,脊神经 spinal nerve,后根（感觉性） 前根（运动性）,前支 后支 脊膜支 交通支,椎间孔,脊神经（混合性）,Anterior branch,Communicating branch,Posterior branch,Posterior root,脊神经的分支 branches,Anterior root,Branches,后支 posterior branches,人体后正中线附近的皮肤和肌 具节段性,前支 anterior branch,躯干和前外侧的皮肤和肌 仅胸神经具节段性,颈丛 cervical plexus 臂丛 brachial plexus 胸神经 thoracic n. 腰丛 lumbar plexus 骶丛 sacral plexus,Spinal nerves,There are 31 pairs of spinal nerves, which leave the spinal cord and pass through intervertebral foramina. Each spinal nerve is connected to the spinal cord by the anterior root and the posterior root. The anterior root consists of (somatic, visceral) motor fibers. The posterior root consists of (somatic, visceral) sensory fibers. The cell bodies of those nerve fibers are situated in the spinal ganglion. So each spinal nerve is made up of a mixture of motor and sensory fibers.,Spinal nerves,After emerging through the intervertebral foramen, a typical spinal nerve immediately divides into four branches: the meningeal branch, communicating branch, posterior and anterior branches. Except in thoracic nerves T2 through T1, the anterior branches of the spinal nerves combine and then slit again to form four plexuses of spinal nerves which are the cervical, the brachial, the lumbar, and the sacral plexuses.,Composition: C14,Location： 胸锁乳突肌 上部的深面,Cervical plexus,颈丛,浅支：Superficial branches,枕小N.,耳大N.,颈横N.,锁骨上N.,深支 deep branches颈部大部分肌,膈神经( C3 5 )：phrenic n.,Composition：C58 + T1,C5,C6,C7,C8,T1,上干,下干,中干,根,支,束,股,干,臂 丛 brachial plexus,Location：,腋神经 axillary n.,后束穿四边孔 绕肱骨外科颈三角肌深面分布,三角肌、小圆肌，肩部和臂外侧上部皮肤,臂丛分支,肌皮神经 musculocutaneous n.,外侧束穿喙肱肌 肱二头肌深面至其外侧缘改名为前臂外侧皮神经（肘窝稍下方，穿深筋膜）,喙肱肌、肱二头肌、肱肌、前臂外侧皮肤,正中神经 median n.,外侧束、内侧束肱二头肌内侧穿过旋前圆肌（肘窝）指深、浅屈肌之间（前臂）腕管手掌,大部分前臂屈肌鱼际（拇收肌例外）、1，2蚓状肌,尺神经 ulnar n.,内侧束尺神经沟伴尺动脉下行（前臂）腕关节近侧5cm处分为手掌支、手背支,尺侧腕屈肌、指深屈肌尺侧半、小鱼际肌、骨间肌、3，4蚓状肌、拇收肌,桡神经 radial n.,后束腋动脉后方下行伴肱深动脉桡神经沟、肱肌与肱桡肌之间。,臂、前臂后群所有伸肌和肱桡肌; 臂、前臂后面皮肤。,手掌、背面神经分布示意图,正中神经,尺神经,桡神经,手部神经分布 手掌正中三指半，剩下尺侧一指半； 手背桡尺各一半，正中侵占三指半。,肋间神经 intercostal n.,肋下神经 subcostal n.,Thoracic Nerve,胸神经前支,12对,T2 胸骨角平面 T4 男性乳头平面 T6 剑突平面 T8 肋弓平面 T10 脐平面 T12-耻骨联合与脐 连线中点平面,腰丛,lumbar plexus,组成：部分T12 + L13+部分L4前支 位置：腹后壁，腰大肌深面,闭孔神经 obturator n.,股神经 femoral n. 髂肌与腰大肌之间下行 腹股沟韧带深面 股前部 隐神经（终支）,髌下、小腿内侧面、足内侧缘皮肤,隐神经 saphenous n.,大腿前群肌,股神经 femoral n.,闭孔神经 obturator n. 腰大肌内侧缘 循小骨盆侧壁 穿闭膜管 出小骨盆 （前、后支） 股内收肌群 肌支：闭孔外肌、股内侧肌群 皮支：大腿内侧面皮肤,骶丛,sacral plexus,组成：L4，5（腰骶干）+ S15 + Co1 位置：盆腔后壁，骶骨及梨状肌前方,臀上神经 superior gluteal n. 伴臀上动脉 梨状肌上孔 臀中、 小肌、阔筋膜张肌 臀下神经 inferior gluteal n. 伴臀下动脉 梨状肌下孔 臀大肌,骶丛分支, 阴部神经 pudendal n.,伴阴部内动脉 梨状肌下孔 坐骨小孔 坐骨直肠窝 肛门、会阴肌、皮肤,坐骨神经 sciatic n.,梨状肌下孔 坐骨结节、大转子之间大腿后面，股二头肌深面 腘窝上方 胫神经、腓总神经,胫神经 tibial n.,腘窝正中小腿后浅、深肌之间 内踝后方足底内、外侧神经,小腿后群肌、足底肌 小腿后面、足底皮肤,腓总神经 common peroneal n.,股二头肌内侧向外下 绕腓骨颈 穿腓骨长肌 腓浅神经、腓深神经,腓浅神经 superficial peroneal n. 腓骨长、短肌及趾长伸肌间下行,腓深神经 deep peroneal n. 伴胫前动脉 胫骨前肌、趾长 伸肌间 胫骨前肌、mu长伸肌 间 足背,Spinal nerves,Spinal nerves：connected with the spinal cord by two roots. Thirty-one pairs of spinal nerves：8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. The anterior （ventral） root ：motor (efferent) fibers from motor neurons in the ventral horn of the spinal cord. The posterior （dorsal）root ：sensory （afferent） fibers of cells in the spinal ganglion The anterior and posterior root： form a spinal nerve in the intervertebral foramen. The spinal nerve divides into four parts：anterior，posterior，communicating and meningeal branches.,Cervical plexus (C1 4) is located deep to the sternocleidomastoid muscle. The phrenic nerve is an important one. Brachial plexus (C5-T1) supplies nerves to the upper limb. Its five important branches: axillary, musculocutaneous, median, ulnar and radial nerve.,Thoracic nerves supply the skin of the thorax, the intercostal muscles, and the abdominal and back muscles. Lumbar plexuse (T12-L4) is behind the psoas major. We should pay attention to the following nerve: femoral, obturator nerve. Sacral plexuse (L4-Co) is located to the anterior surface of the pirifomis. We should pay attention to the following nerve: sciatic, common peroneal, tibial nerve.,The median nerve arises by two roots from the lateral and medial cord of the brachial plexus, which embrace the axillary artery and descend with the brachial artery to the cubital fossa. Then it descends in front of the forearm and passes beneath the flexor retinaculum into the palm of the hand. It supply the most of the muscles in front of the forearm except the brachioradialis, the flexor carpi ulnaris, the medial half of the flexor digitorum profundus，the thenar muscles except for the adductor pollicis and the first and second lumbrical muscles. Its cutaneous branches distribute to the skin of thenar, central part of the palm, the palmar aspect of the thumb, second, third and the lateral half of the fourth fingers, as well as the skin on the dorsum of the terminal phalanges.,The sciatic nerve leaves the pelvis through the greater sciatic foramen inferior to the piriformis. Then it descends along the posterior compartment of the thigh to enter the popliteal fossa, and terminates by dividing into the tibial and common peroneal nerves. The branches of the sciatic nerve supply the muscles of the foot, leg and the posterior compartment of the thigh. It also supplies the skin of the leg and foot.,小 结,上、下肢肌的神经支配,脊神经的四种纤维成分及与中枢的联系，脊 神经前根、后根、前支和后支的区别,颈、臂、腰、骶丛的组成、位置和重要分支， 各支的名称、起始、走行特点（穿肌、贴骨、 表浅）和分布,胸神经前支（肋间神经与肋下神经）行于肋下与胸腔穿刺的关系，胸神经前支皮肤分布呈明显的环带状节段性及其临床意义,学习脊神经时，注意联系中枢、骨骼肌和血 管，注意穿肌、贴骨、浅表部位,复习思考题,脊神经前根与后根、前支与后支的区别。 上、下肢主要神经干的走行特点、分布范围和易受损伤的部位。 膝关节运动肌的神经支配？,膝关节运动肌的神经支配,屈 肌：缝匠肌，股二头肌，半腱肌，半 膜肌，腘肌，腓肠肌 伸 肌：股四头肌 旋外肌：股二头肌 旋内肌：缝匠肌，半腱肌，半膜肌，腘肌,Cranial Nerves,脑 神 经,郑州大学解剖学教研室,脑神经概述,名称及序数,嗅、视、动眼； 滑、叉、外展； 面、听、舌咽； 迷、副、舌下神经全。,嗅N,视N,动眼N,滑车N,展N,三叉N,面N,前庭蜗N,舌咽N,迷走N,副N,舌下N,Cranial nerves,The 12 pairs of cranial nerves are attached to the brain and traverse openings in the skull. The cranial nerves : olfactory nerve (I), optic nerve (II), oculomotor nerve (III), trochlear nerve (IV), trigeminal nerve (V), abducent nerve (VI), facial nerve (VII), vestibulocochlear nerve (VIII), glossopharyngeal nerve (IX), vagus nerve (X), accessory nerve (XI), and hypoglossal nerve (XII).,纤维成分（七种）,一般内脏运动纤维,特殊内脏运动纤维,躯体运动纤维,内脏运动纤维,运动纤维,一般躯体感觉纤维,特殊躯体感觉纤维,一般内脏感觉纤维,特殊内脏感觉纤维,躯体感觉纤维,内脏感觉纤维,感觉纤维,（嗅器、味器）,（位听器、视器）,（咀嚼肌、面肌、咽喉肌）,脑神经分类,感觉神经：嗅神经、视神经、前庭蜗神经 运动神经：动眼神经、滑车神经、展神经、 副神经、舌下神经 混合神经：三叉神经、面神经、舌咽神经、 迷走神经,含副交感纤维的神经：动眼神经、面神经、舌咽神经、迷走神经,The cranial nerves provide input to the brain from (1) the special sense organs of smell (I), sight (II), hearing and balance (VIII), and taste (VII, IX and X); and (2) the general sensory receptors for pain and temperature, simple and fine touch, pressure, position sense, and vibration (V, VII, IX, and X). The cranial nerves convey output of the brain to the voluntary muscles concerned with movements of the head, eyes, mouth, face, tongue, pharynx, and larynx. The cranial nerves are also the major outlet for the parasympathetic nervous system.,Cranial N.,颅底内面观,脑 Encephalon, Brain,端脑 telencephalon 间脑 diencephalon 中脑 mesencephalon 后脑 metencephalon 脑桥 pons 小脑 cerebellum 延髓 medulla oblongata,感觉神经,名称、起源、入颅部位、连脑部位、传导冲动,上鼻甲上部、鼻中隔上部 粘膜内嗅细胞,筛孔 cribriform foramen,嗅球 olfactory bulb,嗅神经 olfactory n.,视神经 optic n.,视网膜中的节细胞,视神经盘optic disc,视神经,视神经管 optic canal,视交叉,前庭蜗神经 vestibulocochlear n.,壶腹嵴 球囊斑 椭圆囊斑,前庭神经节,前庭神经,螺旋器,蜗神经节,蜗神经,内耳门 internal acoustic pore,脑桥延髓沟,运动神经,名称、起源、连脑部位、 走行特点、出颅部位、分布,中脑脚间窝,海绵窦,眶上裂,眶,躯体运动纤维,内脏运动纤维,眼球外肌（上斜肌、外直肌除外）,睫状神经节,睫状肌、瞳孔括约肌,动眼神经 oculomotor n.,动眼神经 oculomotor n.,It enters the orbit through the superior orbital fissure and supplies the superior rectus, the levator palpebrae superioris, the inferior rectus, medial rectus and inferior obliquus.,From the nerve to the inferior obliquus a short thick branch is given to the ciliary ganglion. This branch contains the parasympathetic（副交感） preganglionic fibers, which pass in the short ciliary nerves to the sphincter pupillae.,The oculomotor nerve is a motor nerve.,滑车神经 trochlear n.,中脑背侧,绕大脑脚,海绵窦,眶上裂,眶,上斜肌,展神经 abducent n.,海绵窦,外直肌,眶上裂,眶,延髓脑桥沟,眼外肌神经支配,展神经,滑车神经,动眼神经,Oculomotor paralysis,Abducent nerve injury,副神经 accessory n.,延髓根纤维,颈静脉孔,延髓根、脊髓根,脊髓根纤维,迷走神经,咽喉肌,斜方肌 胸锁乳突肌,舌下神经 hypoglossal n.,延髓前外侧沟,舌下神经管,颈内动静脉之间,舌神经下方,穿颏舌肌,舌内、外肌,混合神经,名称、性质、走行、分支、分布,三叉神经 trigeminal n.,脑桥腹侧与脑桥臂交界处,三叉神经节,眼神经,上颌神经,下颌神经,V 三叉神经 trigeminal n.（混合性）,眼神经 ophthalmic n.,海绵窦,眶上裂 superior obital fissure,眶 orbit,泪腺N、鼻睫N、额N,泪腺、眼睑、眼球 、筛窦、鼻腔粘膜及鼻背、额部皮肤,眶内神经:,V 三叉神经 trigeminal n.（混合性）,上颌神经 maxillary n.,海绵窦,眼裂和口裂间皮肤、上颌牙及鼻、口腔粘膜,眶下N、颧N、 上牙槽N、翼腭N,圆孔foramen rotundum,翼腭窝,眶下裂,眶,下颌神经 mandibular n.,经卵圆孔,翼外肌深面,耳颞N,咀嚼肌N,舌N,下牙槽N,下颌孔,下颌管,颏孔,颏N,舌前2/3及口腔底粘膜,颊 N,耳 颞 区 皮 肤,下 颌 牙 、 牙 龈,颊部 皮 肤和粘膜,口裂以 下皮肤,三叉神经及其分支,VII 面神经 facial n. （混合性）,延髓内耳门internal acoustic pore内耳道meatus面N管茎乳孔stylomastoid foramen 穿腮腺面部,膝神经节, 面神经 facial n.,颅外的分支 （穿腮腺实质）,颞支,颧支,颊支,下颌缘支,颈支,Injury to the facial nerve,鼓索 chorda tympani,面神经管,副交感纤维 -下颌下神经节 下颌下腺、舌下腺,舌神经 lingual n.,颞下窝,鼓室tympanic cavity,VII 面神经 facial n. （混合性）,submandibular g.,味觉纤维 舌前2/3味蕾,岩鼓裂,岩大N （副交感纤维）,面N管,泪腺、腭及鼻 粘膜的腺体, 翼腭神经节,翼腭窝,岩大N裂孔,VII 面神经 facial n. （混合性）,pterygopalatine g.,破裂孔,颅底外,翼管,IX 舌咽神经 glossopharyngeal n.（混合性）,走行 延髓颈V孔颈内A、V之间弓形向前舌根,分支 舌支舌后1/3粘膜和味蕾 咽支咽肌 颈A窦支颈A窦、颈A小球 鼓室N tympanic n.,鼓室N 鼓室丛岩小N 耳N节耳颞N 腮腺 咽、咽鼓管、鼓室,鼓室N tympanic n.,鼓室N 鼓室丛岩小N 耳N节耳颞N 腮腺 咽、咽鼓管、鼓室,鼓室N tympanic n.,迷走神经vagus n.,颈内A.V. 之间后方,颈静脉孔,延髓,左迷走神经,右迷走神经,主动脉弓前方,左肺根后方,食管前丛,前干,锁骨下动脉前方,右肺根后方,食管后丛,后干,膈食管裂孔,膈食管裂孔,胃后支，腹腔支,胃前支，肝支,1.喉上神经环甲肌、声门裂 以上喉粘膜及会厌、舌根等 2.咽支咽腭肌、咽粘膜 3.颈心支心丛、主A神经 4.喉返 recurrent laryngeal N 右侧绕锁骨下A、左侧绕主A 弓颈部气管、食管间喉 肌、声门裂以下喉粘膜 5.支气管支和食管支 6.胃前支胃前半 7.肝支:随肝固有A 8.胃后支胃后半 9.腹腔支:随不成对脏支,X 迷走神经分支,左迷走神经,右迷走神经,喉返 N,1.喉上神经环甲肌、声门裂 以上喉粘膜及会厌、舌根等 2.咽支咽腭肌、咽粘膜 3.颈心支心丛、主A神经 4.喉返 recurrent laryngeal N 右侧绕锁骨下A、左侧绕主A 弓颈部气管、食管间喉 肌、声门裂以下喉粘膜 5.支气管支和食管支 6.胃前支胃前半 7.肝支:随肝固有A 8.胃后支胃后半 9.腹腔支:随不成对脏支,X 迷走神经分支,The vagus nerve is a mixed nerve. Its course is the longest and its distribution is the most extensive in the cranial nerves. It leaves the skull through the jugular foramen. The left vagus nerve forms the left pulmonary plexus, anterior part of the esophageal plexus and the anterior vagal trunk at the lower part of the esophagus. Th