系解脊神经

Nervous System,神经系统,第十六章 神经系统总论,系统解剖学P287295,一、神经系统的区分,一、神经系统的区分,中枢神经系统(CNS) central nervous system脑 brain脊髓 spinal cord周围神经系统(PNS) peripheral nervous system按连接部位脊神经 spinal nerves 脑神经 CN cranial nerves按分布对象躯体神经 somatic nerve内脏神经 visceral nerve,功能 Function,维持和调节其他系统的活动，使人体成为一个有机的整体。维持机体与外环境间的统一。The nervous system is a master system in the living body, it regulates and integrates the activities of all the other bodily systems for the benefit of the organism as a whole.,二、神经系统的组成,神经系统是由神经组织构成的。神经组织是由神经元和神经胶质构成的。,1. 神经元的结构 胞体 cell body突起树突 dendrite轴突 axon,（一） 神经元 Neuron,神经元是神经系统的形构和功能单位。,2A.神经元分类,根据神经元的形态和突起的数目,2B. 神经元分类,Sensory neuron,Association neuron,Motor neuron,A,B,C,根据神经元的功能和传导方向,联络神经元,感觉神经元,运动神经元,2. 神经纤维 Nerve fibers,具有神经膜细胞鞘的轴突无髓纤维（轴突+神经膜）薄髓纤维（轴突+神经膜+髓鞘）有髓纤维（轴突+神经膜+髓鞘）传入纤维afferent fibre 传出纤维efferent fibre,有髓纤维,突触,突触,突 触 Synapse,突 触 Synapse,(二)神经胶质或神经胶质细胞glial cell,作用：支持、营养、保护和修复等,三、神经系统的常用术语,灰质 gray matter皮质 cortex神经核 nucleus神经节 ganglion白质 white matter髓质 medulla纤维束 fasciculus神经 nerve,灰质 gray matter皮质 cortex神经核 nucleus白质 white matter髓质 medulla,灰质 gray matter,神经核 nucleus,白质 white matter纤维束 fasciculus,神经节 ganglion, 神经 nerve,神经系统的常用术语,灰质gray matter：即神经元胞体及其树突在中枢神经系统的集聚部位。皮质cortex：即配布在大、小脑表面的灰质。神经核nucleus：即在中枢部皮质以外，形态和功能相似的神经元胞体集聚成的团或柱。神经节ganglion：即神经元胞体在周围神经系统集聚的部位。白质white matter：即神经纤维在中枢神经系统集聚的部位。髓质medulla：即位于大、小脑皮质深部的白质。纤维束fasciculus：在白质中，起止、行程和功能基本相同的神经纤维集合在一起称为纤维束。神经nerve：神经纤维在周围神经系统集聚在一起称为神经。,四、神经系统的活动方式,反射反射弧,反射与反射弧,反射 ：是神经活动的基本方式，神经系统通过与它相连的各种感受器，接受内、外环境的各种刺激，经传入神经传导中枢（脊髓或脑）的不同部位，经过整合后发出相应的神经冲动，经传出神经传至相应的效应器，产生各种反应，称反射。反射弧 ：是反射的物质基础，由感受器、传入神经、中枢、传出神经和效应器构成。,第十八章 周围神经系统 Peripheral Nervous System,系统解剖学P358408,脊神经 spinal nerve脑神经 cranial nerve内脏神经 visceral nerve,第一节 脊神经 spinal nerve,系统解剖学P358375,概 述,脊神经构成脊神经分部脊神经纤维成分脊神经的分支,脊神经的构成、分部和纤维成分,颈神经8对cervical n.胸神经12对thoracic n.腰神经5对lumbar n. 骶神经5对sacral n. 尾神经1对coccygeal n.,脊神经的分部,脊神经的纤维成分 The component of the spinal nerves,The somatic afferent (sensory) fibers 躯体传入（感觉）纤维The visceral afferent (sensory) fibers 内脏传入（感觉）纤维The somatic efferent (motor) fibers 躯体传出（运动）纤维The visceral efferent (motor) fibers 内脏传出（运动）纤维,脊神经纤维成分,1.躯体传入（感觉）纤维：来自脊神经节的假单极神经元，其中枢突构成脊神经后根进入脊髓，周围突进入脊神经分布于皮肤、骨骼肌、肌腱和关节。将皮肤浅感觉（痛、温触觉）和肌、腱、关节的深感觉（运动觉、位置觉）中枢。,内脏传入（感觉）纤维,2.内脏传入（感觉）纤维：来自脊神经节的假单极神经元，其中枢突构成脊神经后根进入脊髓，周围分布于内脏、心血管和腺体，将这些结构的感觉冲动传入中枢。,躯体运动（传出）纤维,3.躯体运动（传出）纤维：发自脊髓前角，分布于骨骼肌、支配其随意运动。, 内脏运动（传出）纤维,4.内脏运动（传出）纤维：发自胸腰段脊髓侧角（交感中枢）或骶副交感核（副交感中枢），分布于内脏、心血管和腺体，支配心肌、平滑肌的运动，控制腺体的分泌。,脊神经的分支 branches of the spinal nerve,前支,后支,交通支,脊膜支,脊神经后支,分布于背部的皮肤和深层肌肉。, 脊神经前支,除胸神经前支保持原有的节段性走行和分布外，其余脊神经前支分别交织成脊神经丛，即 颈丛cervical plexus 臂丛brachial plexus 腰丛lumbar plexus 骶丛sacral plexus,分布于躯干前外侧和四肢的肌肉和皮肤。,一、颈 丛 Cervical Plexus,组成 formation位置 location分支及其分布浅支 superficial branches (cutaneous nerves)深支 deep branches (muscular branches),1.颈丛的组成,1.组成：颈丛由第14颈神经前支组成。,2.颈丛位置,2. 位置：位于肩胛提肌和中斜角肌的前方，胸锁乳突肌的深面。,胸锁乳突肌,中斜角肌,肩胛提肌,Lesser occipital n.,Great auricular n.,Transverse cervical n.,Intermidate supraclavicular n.,Lateral supraclavicular n.,Medial supraclavicular n.,颈前神经,内侧锁骨上神经,中间锁骨上神经,外侧锁骨上神经,耳大神经,枕小神经,3A.颈丛的皮支,胸锁乳突肌后缘中点称神经点“nervous point”，是颈丛皮支较集中浅出深筋膜处，为颈部浅层结构浸润麻醉的一个阻滞点。,3A.颈丛皮支的分布,Lesser occipital n.,Great auricular n.,Transverse cervical n.,Supraclavicular n.,3B.颈丛肌支,膈神经,3B.颈丛肌支：主要支配颈部深层肌、肩胛提肌、斜方肌、胸锁乳突肌、舌骨下肌群和膈。,3B.颈丛肌支,To infrahyoid muscles,To trapezius,Phrenic nerve膈神经,膈神经,膈神经,膈神经的分布,右膈神经的分布,膈 神 经,组成：由第35颈神经前支组成。行程：经前斜角肌前面锁骨下动、静脉之间肺根前方心包外侧膈。分布：其运动纤维支配膈肌，感觉纤维分布于胸膜和心包及膈下部分腹膜。右膈神经的感觉纤维尚分布到肝、胆囊和肝外胆道的浆膜。,膈神经phrenic nerve,组成：由第35颈神经前支组成。行程：经前斜角肌前面锁骨下动、静脉之间肺根前方心包外侧膈。分布：其运动纤维支配膈肌，感觉纤维分布于胸膜和心包及膈下部分腹膜。The motor fibres supply the diaphragm, the sensory fibres are distributed to the diaphragmatic peritoneum, the diaphragmatic and mediastinal pleurae and the pericardium.右膈神经的感觉纤维尚分布到肝、胆囊和肝外胆道的浆膜。The sensory fibres of the right phrenic nerve is also distributed to the liver, the gallbladder and the bile duct system.,二、臂 丛brachial plexus,组成 formation位置 location分支和分布 branches and distribution神经损伤 lesion of the nerve,1. 组成：臂丛由第58颈神经前支和第1胸神经前支大部分纤维组成。,C5C6C7C8T1,1A.臂丛的组成,1B.臂丛的根干股束,2.臂丛的位置,臂丛位于斜角肌间隙内锁骨中段后方腋窝内腋动脉周围。,Long thoracic nerve,Thoracodorsal nerve,Medial pectoral nerve,Lateral pectoral nerve,3.臂丛的分支及其分布,胸内侧神经,胸外侧神经,胸背神经,胸长神经,Branches and distribution of brachial plexus（1）,胸长神经：起自C57前支，支配前锯肌，损伤后前锯肌瘫痪，产生“翼状肩胛”。The long thoracic nerve supplies the serratus anterior muscle. Crushing or cutting the long thoracic nerve results in paralysis of the serratus anterior muscle and “winging of the scapula” . 。胸背神经：起自臂丛后束，支配背阔肌。 The thoracodorsal nerve arises from the posterior cord of the brachial plexus and supplies the latissimus dorsi muscle. 胸内侧神经：起自臂丛内侧束，支配胸大肌和胸小肌。 The medial pectoral nerve arises from the medial cord of the brachial plexus and supplies the pectoralis major and pectoralis minor muscle. 胸外侧神经：起自臂丛外侧束，支配胸大肌。 The lateral pectoral nerve arises from the lateral cord of the brachial plexus and supplies the pectoralis major and pectoralis minor muscle.,腋神经 axillary nerve,腋神经 axillary nerve,旋肱后动脉,腋神经,四边孔,腋神经axillary nerve,腋神经axillary nerve：起自臂丛的后束，伴旋肱后血管穿四边孔绕肱骨外科颈至三角肌深面，肌支支配三角肌和小圆肌，皮支布于肩部和臂外侧上部皮肤。,腋神经损伤：在肱骨外科颈骨折或肩关节脱位时易损伤，损伤后导致三角肌瘫痪，肩关节外展不能，小圆肌瘫痪肩关节外旋减弱，肩部和臂外侧上部皮肤感觉障碍。,腋 神 经,腋神经起自臂丛的后束，伴旋肱后血管穿四边孔绕肱骨外科颈至三角肌深面，肌支支配三角肌和小圆肌，皮支布于肩部和臂外侧上部皮肤。腋神经损伤：在肱骨外科颈骨折或肩关节脱位时易损伤，损伤后导致三角肌瘫痪，肩关节外展不能，三角肌萎缩，肩部失去圆隆的外形，肩峰突出，形成“方肩”畸形。,The axillary nerve,To arise from the posterior cord of the brachial plexus.To leave the axilla by passing backward with the posterior circumflex humeral vessels through the quadrilateral space and wind round the surgical neck of the humerus to reach the deltoid muscle.To supply the deltoid and teres minor muscles and the skin over the deltoid.To may be injured in fracture of the humeral neck or in dislocation of the shoulder joint.The axillary nerve injury results in deltoid paralysis (loss of shoulder abduction ), loss of sensation over the deltoid muscle, and teres minor paralysis ( weak external rotation).,(6)肌皮神经,臂丛外侧束,肌皮神经,喙肱肌,肱二头肌,前臂外侧皮神经,肱肌,肌皮神经：起自臂丛外侧束，肌支支配臂部前肌群（喙肱肌、肱肌和肱二头肌），终支为皮支称为前臂外侧皮神经，分支布于前臂外侧的皮肤。肌皮神经损伤：出现屈肘无力，前臂旋后力减弱，前臂外侧的皮肤障碍。,喙肱肌,肱二头肌,肱肌,肌皮神经,肌皮神经,起自臂丛外侧束；肌支支配臂部前肌群（喙肱肌、肱肌和肱二头肌）；终支：为皮支称为前臂外侧皮神经，分支布于前臂外侧的皮肤。,The musculocutaneous nerve,To arise from the lateral cord of the brachial plexus.To innervate the flexor muscles of the arm,including the coracobrachialis, biceps brachii, and brachialis muscles.To continue into the forearm as the lateral cutaneous nerve of the forearm, which supplies the lateral surface of the forearm.Injury to the musculocutaneous nerve in the axilla is usually inflicted by a knife or bullet. The wound results paralysis of the coracobrachialis, biceps, and brachii, consequently, lesion of the elbow and supination of the forearm are weakened. Loss of sensation may occur at the lateral surface of the forearm supplied by the lateral cutaneous nerve of the forearm.,正中神经,Median nerve,Median nerve,Median nerve,臂丛外侧束,臂丛内侧束,正中神经外侧根,正中神经内侧根,正中神经,正中神经,正中神经,组成行程,正中神经 median nerve,组成：由分别起自臂丛内、外侧束的内、外侧根汇合而成。行径：在腋窝两根夹持腋动脉，在臂部与肱动脉伴行在肱二头肌内侧沟内下行至肘窝，穿旋前圆肌及指浅屈肌腱弓至前臂，于前臂指浅、深屈肌间达腕部，穿腕管至手掌。,正中神经的分支分布,臂丛内侧束,臂丛外侧束,正中神经,正中神经的分支分布,在臂部无分支；在前臂发出分支支配除肱桡肌、尺侧腕屈肌、指深屈肌尺侧半之外的前臂屈肌群。,正中神经的分支分布,在手掌发出：正中神经返支，支配除拇收肌以外的鱼际肌；骨间总神经，支配第1、2蚓状肌和掌心、桡侧三个半手指掌面及其中节和远节指背的皮肤。,正中神经返支,骨间总神经,在肱骨髁上骨折、穿旋前圆肌及指浅屈肌腱弓、腕管时易损伤或压迫正中神经；表现为屈腕无力，拇指不能对掌，鱼际肌萎缩，手掌平坦，称 “ape-like hand 猿手”，拇指、食指、中指掌面皮肤感觉障碍。,正中神经损伤：,The median nerve,To be formed in the axilla by the union of medial and lateral root from the medial and lateral cords of the brachial plexus , respectively.To has no branches in the arm.To supply flexor and pronator muscles in the forearm, including both pronators and all of the flexor muscles except the brachioradialis, the flexor carpi ulnaris and the medial half of the flexor digitorum profundus.Supracondylar fracture of the humerus may injure the median nerve and the brachial artery.,An injury to the median nerve in the forearm can result in interfering with pronation of the forearm,with flexion of the phalanges of the second, the third digits and the distal phalanx of the thumb and with opposition of the thumb. Wrist flexion is less involved. The thenar muscles are paralysed,so that the thumb becomes to lie in the same plane as the other digits, it is just an “ape-like”hand. There is also a loss or weakness of sensation from the skin of the radial part of the palm and of the thumb, index and middle fingers and the radial half of the ring finger.,Ulnar nerve, 尺神经,臂丛内侧束,尺神经,Ulnar nerve,尺神经,组成行程,尺神经 ulnar nerve,组成：尺神经起自臂丛内侧束。行径：伴肱动脉行于肱二头肌内侧沟，在臂中份穿内侧肌间隔至臂后区内侧，经尺神经沟穿尺侧腕屈肌至前臂，在尺侧腕屈肌深面伴尺血管下行，经豌豆骨桡侧至手掌。, 尺神经,分支分布,分支分布,在臂部无分支。在前臂发出分支支配尺侧腕屈肌、指深屈肌尺侧半。,在腕部发出 尺神经的手背支：分布于手背尺侧半和小指、环指及中指尺侧半背面皮肤。,在手部发出尺神经的浅支：分布于小鱼际、小指和环指尺侧半掌面皮肤；尺神经的深支：分布于小鱼际肌、拇收肌、骨间肌及第3、4蚓状肌。,尺神经损伤,尺神经,尺侧腕屈肌,指深屈肌尺侧半,小鱼际肌,第34蚓状肌,拇收肌,骨间肌,尺神经损伤,尺神经损伤,内上髁骨折或尺神经沟，处损伤：可导致尺侧腕屈肌、指深屈肌尺侧半、拇收肌、骨间肌、第34蚓状肌、小鱼际肌瘫痪，出现屈腕力减弱、拇指不能内收，小指和环指远侧指骨间不能屈，夹纸实验阳性，呈“爪形手”，手背尺侧半、尺侧2个半指指背皮肤、尺侧1个半指掌侧和小鱼际等处皮肤感觉障碍。 豌豆骨远侧损伤：导致拇收肌、骨间肌、第34蚓状肌、小鱼际肌瘫痪瘫痪，出现拇指不能内收，小指和环指远侧指骨间不能屈，夹纸实验阳性，呈“爪形手”，尺侧2个半指指背皮肤、尺侧1个半指掌侧和小鱼际等处皮肤感觉障碍。,尺神经 The ulnar nerve,To arises from the medial cord of the brachial plexus.To pass along the groove between the medial epicondyle of the humerus and the olecranon.To has no branch in the arm.To supply the flexor carpi ulnaris, the medial half of the flexor digitorum profundus muscles, lumbricales 3ad 4,the adductor pollicis , andthird to fourth muscle ., 桡神经 radial nerve,桡神经,臂丛内侧束, 桡神经, 桡神经, 桡神经,桡神经,桡神经深支,骨间后神经,桡神经浅支,桡神经 radial nerve,起自臂丛后束;沿桡神经沟绕肱骨中段后面，在肱骨外上髁前方分为浅支和深支。桡神经浅支在肱桡肌深面伴桡血管下行，在前臂中、下1/3交界处经肱桡肌腱深面至前臂后区，尔后达手背；深支经桡骨颈外侧穿旋后肌至前臂后面，称为骨间后神经。,在腋窝，桡神经发出肌支支配肱三头肌；皮支为臂后皮神经，布于臂后区皮肤。在臂部，发出臂外侧下皮神经，布于臂外侧下皮肤；前臂后皮神经，布于前臂后区皮肤；肌支支配肱桡肌、肘肌和桡侧腕长伸肌。在肘窝，桡神经分为两个终末支： 桡神经深支，支配前臂伸肌群； 桡神经浅支，分支布于手背桡侧半和桡侧三个手指近节背面的皮肤和关节。,Wrist-drop “垂腕”虎口区皮肤感觉障碍,桡神经损伤,The lesion of the radial nerve桡神经损伤,在腋窝，损伤桡神经，导致臂伸肌、前臂伸肌瘫痪，出现不能伸肘、伸腕和伸指，当抬高前臂时呈“垂腕”状；臂后区、前臂后区、手背桡侧半（虎口区）、桡侧两个半指近节背面皮肤感觉障碍。肱骨中段骨折，伤及桡神经，导致前臂伸肌瘫痪，出现不能伸腕和伸指，当抬高前臂时呈“垂腕”状；前臂后区、手背桡侧半、桡侧两个半指近节背面皮肤感觉障碍。桡骨颈骨折伤及桡神经深支，导致前臂伸肌瘫痪，出现不能伸腕和伸指，当抬高前臂时呈“垂腕”状 。在前臂远侧伤及桡神经浅支，导致手背桡侧半、桡侧两个半指近节背面皮肤感觉障碍。,The distribution of the nerve in the hand,肱骨骨折,肱骨外科颈骨折肱骨中段骨折肱骨髁上骨折肱骨内上髁骨折,三、胸神经的前支,Subcostal nerve,intercostal nerve,肋间神经,肋下神经,肋间神经 Intercostal nerves,肋间神经,外侧皮支,前皮支,肋间神经,肋间神经 Intercostal nerves,肋间神经,外侧皮支,前皮支,Intercostal nerves,Lateral cutaneous branch,Anteriorl cutaneous branch,肋间神经的侧支,胸神经前支的分支分布,Intercostal nerve（T11）,胸骨角平面,乳头平面,剑突平面,肋弓平面,脐平面,脐与耻骨联合连线中点平面,T2,T4,T6,T8,T10,T12,胸神经前支在胸腹前壁的节段性分布,The Ventral Rami of the Thoracic Nerve胸神经的前支,有12对. They are twelve in number on each side第111胸神经前支称肋间神经 。第12胸神经前支称肋下神经。 The upper eleven lie between the ribs and are called the intercostal nerves . The twelfth lies below the last rib,so it is called the subcostal nerve. 其肌支支配肋间肌、腹直肌、腹外斜肌、腹内斜肌、腹横肌。皮支布于胸、腹前外侧壁皮肤。胸神经前支在胸腹前外侧壁的分布具有节段性。 The distribution of the anterior branches of the thoracic nerves is segmental on the anterior surface of the trunk, they present about the level of : T2-the sternal angle; T4-the nipple;T6-the xiphoid process; T8-the costal arch;T10-the umbilicus; T12-the anterior superior iliac spine,四、腰丛 Lumbar Plexus,组成 formation位置 location主要分支及其分布 The main branches and its distributions 神经损伤 lesion of nerve,1.腰丛的组成,1.腰丛的位置和分支,髂腹下神经,髂腹股沟神经,生殖股神经,股外侧皮神经,股神经,生殖股神经的生殖支,生殖股神经的股支,闭孔神经,腰大肌,T12,生殖股神经,腰丛 The Lumbar Plexus（1）,组成：由第12胸神经前支的一部分、第13腰神经前支和第4腰神经前支的一部分构成。The formation: it is formed by the ventral rami of the first three lumbar nerves, a part of the ventral rami of the last thoracic nerve and the fourth lumbar nerve.位置：位于腰大肌的深面。 The location:It is situated deep to the psoas major muscle,anterior to the transverse processes of the lumbar vertebrae.主要分支：有髂腹下神经、髂腹股沟神经、股外侧皮神经、股神经、闭孔神经、生殖股神经等。The branches: the iliohypogastric n., ilioinguinal n., lateral femoral cutaneous n., femoral n., obturator n., genitofemoral n.,髂腹下神经 iliohypogastric nerve、髂腹股沟神经 ilioinguinal nerve 、生殖股神经 genitofemoral nerve,腰丛 The Lumbar Plexus（2）,髂腹下神经iliohypogastric nerve：肌支支配腹前外侧壁肌，皮支布于臀外侧区、腹股沟区和下腹部的皮肤。Its muscular branch innervates the muscles of the lower part of the abdominal wall. Its cutaneous branch supply the skin of the hypogastric region , lateral area of the gluteal and medial area of the groin.髂腹股沟神经ilioinguinal n. ：肌支支配腹前外侧壁肌，皮支布于腹股沟部、阴囊或大阴唇皮肤。Its muscular branch innervates the muscles of lower abdominal wall.Its cutaneous branch supplies the scrotum(or the labium major) and the groin.生殖股神经：生殖支布于提睾肌和阴囊；股支布于股三角部的皮肤。Its genital branch supplies the cremaster muscle and the anterior scrotum or labia majora(the efferent limb of the cremaster reflex in men). Its femoral branch is distributed to inguinal triangle(the afferent limb of the cremaster reflex ).,临床意义：髂腹下神经、髂腹股沟神经、生殖股神经是位于腹股沟区的三条神经，在施行腹股沟区手术（如腹股沟斜疝或直疝修补术）和盲肠后位阑尾手术时，应注意勿损伤这些神经，以免造成所分布的肌瘫痪和皮肤感觉丧失。The iliohygastric, ilioinguinal and genitofemoral nerve must be protected carefully in the operation of the inguininal hernia.,股外侧皮神经lateral femoral cutaneous nerve,股外侧皮神经的分布,股外侧皮神经,股神经及其分支,股神经,缝匠肌,股四头肌,耻骨肌,隐神经,股神经的前皮支,股神经皮支的分布,股神经的前皮支,隐神经的小腿内侧支,隐神经的髌下支,股神经 Femoral Nerve,起自腰丛，由来自L2L4神经的前支组成；自腰大肌外缘穿出，在腰大肌与髂肌之间下行，经腹股沟韧带中点稍外侧的深面、股动脉外侧进入股三角，发出肌支和皮支。肌支：布于股前肌群(缝匠肌、股四头肌)和耻骨肌。Its muscular branches innervate the anterior femoral muscles（the quadriceps femoris, sartoris） and pectineus.皮支：股前皮神经，Its cutaneuos branches to the thigh are the anteiror femoral cutaneous nerves which are distributed to anterior and medial side of skin of the thigh. 隐神经，为最长的皮支，伴股动脉入内收肌管，穿出后至膝关节内侧，在小腿与大隐静脉伴行至足内侧缘，分支布于髌下、小腿内侧面和足内侧缘皮肤。 The longest one of them is the saphenous nerve which is distributed to the skin of the medial side of the leg and foot. 股神经是膝反射的传入和传出神经。The femoral nerve provides both afferent and efferent limbs of the knee-jerk reflex.,股神经损伤：,运动障碍：感觉障碍：,由于缝匠肌、股四头肌瘫痪，出现屈髋、内旋膝关节能力减弱，伸膝不能，髌反射消失。,大腿前、内侧、小腿前内侧、足内侧的皮肤感觉减弱或丧失。,闭孔神经及其分支,闭孔神经,至膝关节的关节支,股薄肌,闭孔神经的关节支,闭孔外肌,短收肌,长收肌,大收肌,闭孔神经的前支,闭孔神经的后支,cutaneous branches of obtrator nerve,闭孔神经的皮支,闭孔神经,cutaneous branches of obtrator nerve,闭孔神经的皮支,闭孔神经 obturator nerve,起自腰丛（L2L4）；自腰大肌内侧缘穿出，与闭孔血管伴行沿骨盆内侧壁前行，穿闭膜管出骨盆，分为前、后两支，分别位于短收肌的前面和深面；肌支：支配大腿内侧肌群和闭孔外肌。The muscular branches innervate the medial group of muscles.皮支：称股内侧皮神经，布于大腿内侧部皮肤。The cutaneous branches are distributed to the skin of the medial side of the thigh.关节支：分布于髋关节和膝关节。,闭孔神经损伤：,运动障碍：感觉障碍：,大腿内侧肌群瘫痪，出现髋关节内收不能，屈髋和髋外旋减弱。,大腿内侧上部感觉障碍。Injury to the obturator nerve results in impaired adduction of the thigh and a loss of the sensation in the skin of the medial aspect of the thigh.,临床应用：带闭孔血管神经蒂的股薄肌瓣替代肛门外括约肌手术。,四、The Sacral Plexus骶 丛,组成 formation位置 location主要分支及其分布 The main branches and its distribution 神经损伤 lesion nerve,1.骶 丛的组成,腰骶干,1.骶丛的位置,腰骶干,梨状肌,3.骶丛的分支分布,Quadratus femoris muscle,Posterior femoral cutaneous nerve,臀上神经,坐骨神经,臀下神经,阴部神经,股后皮神经,坐骨神经,股后皮神经,骶丛（1）,组成：由腰骶干（第4、5腰神经前支组成）、第15骶神经前支和尾神经前支构成。 It is formed by the lumbosacral trunk, the ventral rami of the sacral and coccygeal nerves.位置：位于盆腔内，骶骨和梨状肌的前面，髂血管的后方。It is closely related to the anterior surface of the piriformis muscle and sacrum.主要分支分布：有坐骨神经、臀上神经、臀下神经、股后皮神经、阴部神经等。,臀上神经Superior gluteal nerve ：伴臀上血管穿梨状肌上孔出盆腔,布于臀中肌、臀小肌和阔筋膜张肌。It leaves the pelvis through the greater sciatic foramen superior to the piriformis muscle in company with the superior gluteal vessels. it supplies the gluteus medius and minimus muscles and the tensor fascia latae muscle.臀下神经：伴臀下血管穿梨状肌下孔出盆腔,布于臀大肌。 The inferior gluteal nerve leaves the pelvis through the greater sciatic foramen inferior to the piriformis muscle with the inferior gluteal vessels. It supplies the gluteus maximus muscle. 髋关节后脱位可致臀下神经受损，臀大肌瘫痪，出现髋关节后伸无力，病人不能由坐位站立起来。,骶丛的分支、行径与分布,阴部神经,阴部神经,梨状肌,肛神经,会阴神经,阴部神经,阴部神经,肛神经,会阴神经,会阴浅神经,会阴深神经,阴囊后神经,阴茎背神经,阴部神经,阴部神经,肛神经,会阴神经,会阴浅神经,会阴神经的浅支,阴唇后神经,阴蒂背神经,阴部神经阻滞麻醉,坐骨棘,坐骨结节,阴部神经 pudendal nerve.,起自骶丛；经梨状肌下孔出盆腔,穿坐骨小孔入坐骨肛门窝,分支布于会阴部肌和会阴部皮肤。 The pudendal nerve exits the pelvis via the infrapiriform region of the greater sciatic foramen, then enters the ischiorectal fossa of the perineum via the lesser sciatic foramen. Its branches supply the perineum.分支分布：肛神经 anal nerve，布于肛门外括约肌和肛门部的皮肤；会阴神经perineal nerve，布于会阴诸肌和阴囊或大阴唇）；阴茎背神经或阴蒂背神经dorsal nerve of the penis or clitoris，布于阴茎或阴蒂海绵体和皮肤。,股后皮神经,股后皮神经,股后皮神经,股后皮神经,股后皮神经,坐骨神经,坐骨神经,胫神经,腓总神经,坐骨神经 sciatic nerve（1）,经梨状肌下孔出骨盆，在大转子和坐骨结节之间臀大肌深面下行至股后部，在腘窝上角分为胫神经和腓总神经。It leaves the pelvis through the greater sciatic foramen inferior to the piriformis muscle. Then it runs inferolaterally deep to the gluteus maximus muscle, and descends between the ischial tuberosity and the greater trochanter of the femur to enter the posterior compartment of the thigh. It divides into the tibial and common peroneal nerves at the superior angle of the popliteal fossa.在股后部发出肌支至股后肌群，包括股二头肌、半腱肌、半膜肌。 The braches of the sciatic nerve at the posterior region innervate the muscles of the posterior compartment of the thigh, including the biceps femoris, semimenbranosus, semitendinosus muscles.,(6)胫神经,胫神经,腓肠肌,比目鱼肌,行经,(6)胫神经,足底内侧神经,足底外侧神经,胫神经,行经,(6)胫神经,胫神经,腓肠内侧皮神经,关节支,跖肌,腓肠肌,比目鱼肌,至腘肌的神经,胫骨后肌,趾长屈肌,拇长屈肌,分支分布,(6)胫神经,足底内侧神经,足底内侧神经,胫神经,分支分布,(6)胫神经,腓肠内侧皮神经,分支分布,(6)胫神经,足底内侧神经,足底外侧神经,足跟内侧支,分支分布, 胫神经 tibial nerve,伴腘血管、胫后血管在小腿三头肌的深面下行，在内踝后方分为足底内、外侧神经。在小腿发出肌支布于小腿后肌群；皮支为腓肠内侧皮神经，布于小腿后面内侧上部皮肤。足底内、外侧神经medial and lateral plantar nerves:布于足底肌和足底皮肤。,胫神经损伤,胫神经损伤,胫神经损伤,运动障碍：小腿后肌群、足底肌瘫痪，导致踝关节不能跖屈，趾不能屈，足内翻力减弱，其拮抗肌小腿前肌群、外侧肌群收缩，出现足背屈外翻畸形（钩状足）。感觉障碍：小腿后面上部、足底皮肤感觉丧失