1、1,第十八章 周圍神經(jīng)系統(tǒng),神經(jīng)系統(tǒng),第一節(jié) 脊神經(jīng) 概 述 一、頸 叢 二、臂 叢 三、胸神經(jīng)前支 四、腰 叢 五、骶 叢 六、皮神經(jīng)分布的節(jié)段性和重疊性特點(diǎn) 第二節(jié) 腦 神 經(jīng) 第三節(jié) 內(nèi)臟神經(jīng)系統(tǒng),2,腦神經(jīng) 脊神經(jīng),周圍神經(jīng),周圍神經(jīng),軀體神經(jīng) 內(nèi)臟神經(jīng),周圍神經(jīng),感覺神經(jīng)（傳入神經(jīng)） 運(yùn)動(dòng)神經(jīng)（傳出神經(jīng)）,3,神經(jīng)外膜,神經(jīng)束膜,神經(jīng)束血管,神經(jīng),在周圍神經(jīng)系統(tǒng)中，神經(jīng)纖維聚集構(gòu)成神經(jīng)。,神經(jīng)外膜,神經(jīng)束,神經(jīng)束膜,髓鞘,施萬(wàn)細(xì)胞核,神經(jīng)纖維,神經(jīng)外膜血管,4,神經(jīng)節(jié),脊神經(jīng)節(jié) 腦神經(jīng)節(jié) 內(nèi)臟運(yùn)動(dòng)神經(jīng)節(jié),387 18-1,脊神經(jīng)節(jié),神經(jīng)節(jié)細(xì)胞,5,31對(duì),前根運(yùn)動(dòng) 后根感覺,C 8

2、T 12 L 5 S 5 Co 1,第一節(jié) 脊神經(jīng) 概 述,(一)脊神經(jīng)的構(gòu)成、分部和纖維分布,6,纖維成分,軀體感覺纖維 內(nèi)臟感覺纖維 軀體運(yùn)動(dòng)纖維 內(nèi)臟運(yùn)動(dòng)纖維,1.前支 2.后支 3.交通支：白交通支、灰交通支 4.脊膜支,(二)脊神經(jīng)的分支,脊神經(jīng)節(jié),后根,前根,灰交通支,白交通支,交感干神經(jīng)節(jié),腹腔神經(jīng)節(jié),內(nèi)臟,血管,骨胳肌,肌梭,皮膚,7,C1C4前支,皮支： 胸鎖乳突肌后緣中點(diǎn),二、頸叢,(一)頸叢的組成和位置：,(二)頸叢的分支：,1.枕小神經(jīng) (C2) 2.耳大神經(jīng) (C2，C3) 3.頸橫神經(jīng) (C2，C3) 4.鎖骨上神經(jīng) (C3，C4),耳大神經(jīng),枕小神經(jīng),頸橫神經(jīng),鎖

3、骨上神經(jīng),8,5.膈神經(jīng) (C3C5),肌支： 支配頸部深層肌、肩胛提肌、舌骨下肌群和膈,頸襻,耳大神經(jīng),頸橫神經(jīng),枕小神經(jīng),鎖骨上神經(jīng),膈神經(jīng),C1的前支,C2的前支,C3的前支,C4的前支,膈神經(jīng),9,C5C8，T1前支 斜角肌間隙,二、臂叢,(一)臂叢的組成和位置：,(二)臂叢的分支,1. 胸長(zhǎng)神經(jīng) (C5C7) 前鋸肌 翼狀肩 2. 胸背神經(jīng) (C6C8) 背闊肌 3. 腋神經(jīng) (C5C6) 4. 肌皮神經(jīng) (C5C7),肌皮神經(jīng),腋神經(jīng),胸長(zhǎng)神經(jīng),胸背神經(jīng),10,上干,中干,內(nèi)側(cè)束,下干,后束,外側(cè)束,C5的前支,C6的前支,C7的前支,C8的前支,T1的前支部分,肌皮神經(jīng),腋神經(jīng),

4、正中神經(jīng),尺神經(jīng),橈神經(jīng),胸長(zhǎng)神經(jīng),前臂內(nèi)側(cè)皮神經(jīng),肩胛下神經(jīng),臂內(nèi)側(cè)皮神經(jīng),11,5. 正中神經(jīng) (C6T1) 6. 尺神經(jīng) (C8,T) 7. 橈神經(jīng) (C5T),肌皮神經(jīng),橈神經(jīng),尺神經(jīng),正中神經(jīng),胸長(zhǎng)神經(jīng),肋間臂神經(jīng),正中神經(jīng),12,肩胛背神經(jīng) (C4C5) 肩胛上神經(jīng) (C5C6) 肩胛下神經(jīng) (C5C7) 胸內(nèi)側(cè)神經(jīng) (C8,T1) 胸外側(cè)神經(jīng) (C5C7) 臂內(nèi)側(cè)皮神經(jīng) (C8,T) 前臂內(nèi)側(cè)皮神經(jīng) (C8,T),肌皮神經(jīng),橈神經(jīng),尺神經(jīng),正中神經(jīng),胸長(zhǎng)神經(jīng),肋間臂神經(jīng),正中神經(jīng),13,肌皮神經(jīng),腋神經(jīng),正中神經(jīng),尺神經(jīng),臂內(nèi)側(cè)皮神經(jīng),前臂內(nèi)側(cè)皮神經(jīng),胸長(zhǎng)神經(jīng),胸內(nèi)側(cè)神經(jīng),肋間臂

5、神經(jīng),胸背神經(jīng),肩胛背神經(jīng),胸外側(cè)神經(jīng),肩胛上神經(jīng),14,橈神經(jīng),腋神經(jīng),正中神經(jīng),尺神經(jīng),臂內(nèi)側(cè)皮神經(jīng),前臂內(nèi)側(cè)皮神經(jīng),胸長(zhǎng)神經(jīng),肋間臂神經(jīng),胸背神經(jīng),肩胛背神經(jīng),肩胛上神經(jīng),15,腋神經(jīng),橈神經(jīng),三邊孔,四邊孔,16,尺神經(jīng),正中神經(jīng),前臂外側(cè)皮神經(jīng),肌皮神經(jīng),橈神經(jīng),尺神經(jīng),正中神經(jīng),17,尺神經(jīng),正中神經(jīng),肌皮神經(jīng),橈神經(jīng),尺神經(jīng),正中神經(jīng),18,橈神經(jīng),橈神經(jīng)淺支,尺神經(jīng)手背支,19,尺神經(jīng)深支,正中神經(jīng)返支,正中神經(jīng),橈神經(jīng)淺支,尺神經(jīng)手背支,指背神經(jīng),尺神經(jīng)淺支,指掌側(cè)總神經(jīng),指掌側(cè)固有神經(jīng),20,手部皮膚的神經(jīng)分布,正中神經(jīng),尺神經(jīng),橈神經(jīng),21,正中神經(jīng)損傷,橈神經(jīng)損傷垂腕,

6、尺神經(jīng)損傷爪形手,正中神經(jīng)與尺神經(jīng)損傷猿掌,22,12對(duì)： 第111 肋間神經(jīng) 第12 肋下神經(jīng),三、胸神經(jīng)前支,皮支： 外側(cè)皮支 前皮支,肋間神經(jīng),23,胸神經(jīng)前支節(jié)段性分布,T2分布區(qū)相當(dāng)于胸骨角平面 T4相當(dāng)于乳頭平面 T6相當(dāng)于劍突平面 T8相當(dāng)于兩側(cè)肋弓中點(diǎn)連線的平面 T10相當(dāng)于臍平面 T12相當(dāng)于臍與恥骨聯(lián)合連線中點(diǎn)的平面,24,T12部分，L1L3，L4部分,四、腰 叢,(一)腰叢的組成和位置：,(二)腰叢的分支,1. 髂腹下神經(jīng) (T12，L1) 2. 髂腹股溝神經(jīng) (L1) 3. 股外側(cè)皮神經(jīng) (L，L) 4. 股神經(jīng) (LL4) 5. 閉孔神經(jīng) (LL4) 6. 生殖股神

7、經(jīng)(L1，L),25,T12的前支 一部分,L1的前支,L3的前支,L2的前支,L4的前支 一部分,髂腹下神經(jīng),髂腹股溝神經(jīng),股外側(cè)皮神經(jīng),股神經(jīng),閉孔神經(jīng),生殖股神經(jīng),肋下神經(jīng),26,髂腹下神經(jīng),髂腹股溝神經(jīng),股外側(cè)皮神經(jīng),股神經(jīng),閉孔神經(jīng),生殖股神經(jīng),肋下神經(jīng),27,股神經(jīng),腹股溝韌帶,閉孔神經(jīng),隱神經(jīng),28,L4部分，L5，S1S5，Co,五、骶 叢,(一)骶叢的組成和位置：,(二)骶叢的分支,1. 臀上神經(jīng) (L4,L5,S1） 2. 臀下神經(jīng) (L5,S1,S2) 3. 股后皮神經(jīng) (S1S3) 4. 陰部神經(jīng) (S2S4),臀上神經(jīng),臀下神經(jīng),股后皮神經(jīng),陰部神經(jīng),29,腰骶干,L

8、5的前支,S的前支,L4的前支一部分,坐骨神經(jīng),陰部神經(jīng),30,臀上神經(jīng),臀中肌,臀下神經(jīng),臀大肌,股后皮神經(jīng),臀小肌,坐骨神經(jīng),陰部神經(jīng),31,陰部神經(jīng),會(huì)陰神經(jīng),肛神經(jīng),陰莖背神經(jīng),陰蒂背神經(jīng),肛神經(jīng),32,5. 坐骨神經(jīng) (L4, L5, S1S3) (1)脛神經(jīng)(L4,L5,S1S3) 足底內(nèi)側(cè)神經(jīng) 足底外側(cè)神經(jīng),足底內(nèi)側(cè)神經(jīng),足底外側(cè)神經(jīng),脛神經(jīng),坐骨神經(jīng),33,(2)腓總神經(jīng)(L4, L5, S1, S2) 腓淺神經(jīng) 腓深神經(jīng),腓深神經(jīng),腓淺神經(jīng),34,脛神經(jīng)損傷,“鉤狀足”,“馬蹄”內(nèi)翻足,腓總神經(jīng)損傷,35,六、皮神經(jīng)分布的節(jié)段性和重疊性特點(diǎn),36,相鄰兩條皮神經(jīng)的分布區(qū)域存在

9、一定程度的相互重疊。因此，當(dāng)一條皮神經(jīng)受損時(shí)，一般不會(huì)出現(xiàn)該皮神經(jīng)分布區(qū)的感覺喪失，而僅僅表現(xiàn)為感覺遲鈍。兩條以上相鄰的皮神經(jīng)受到損傷時(shí)，才會(huì)出現(xiàn)損傷神經(jīng)分布區(qū)的感覺完全消失的體征。,脊髓節(jié)段,脊神經(jīng)根,神經(jīng)干,皮神經(jīng)的節(jié)段性分布,A,B,C,A,B,C,37,練習(xí)題,簡(jiǎn)答： 1. 簡(jiǎn)述頸叢、臂叢、腰叢、骶叢的神經(jīng)組成。 2. 簡(jiǎn)述膈神經(jīng)、橈神經(jīng)、正中神經(jīng)、尺神經(jīng)、股神經(jīng)和坐骨神經(jīng)的起始、行程、分支、支配及損傷后的臨床表現(xiàn)。 3. 試述髂腹下神經(jīng)、髂腹股溝神經(jīng)、閉孔神經(jīng)、生殖股神經(jīng)的支配部位及損傷后癥狀。 4. 簡(jiǎn)述一些臨床癥狀的解剖機(jī)制：馬蹄內(nèi)翻足、鉤狀足、垂腕、爪形手、猿掌畸形。 名詞解釋： 脊神經(jīng)節(jié),38,重點(diǎn)和難點(diǎn),重點(diǎn)： 下列神經(jīng)的起始、走行、分支、分部及損傷后癥狀 ： （1）頸叢：膈神經(jīng)；（2）臂叢：橈