中枢神经系统

nullnull脊 神 经 Spinal Nerves许家军 第二军医大学解剖学教研室null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null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提问 Answer questions侧角 脊神经节用模型说明 及英文名称提问 Answer questions提问 Answer questions侧角 脊神经节 纤维束 脊髓丘脑束nullNervous Systemcentral N.S.brainspinal cordperipheral N.S.cranial n.spinal n.visceral n.nullSpinal 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, Co1null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 nerve8对 12对 5对 5对 1对null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 nervenull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 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,glandsnull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）nullAnterior branch Communicating branch Posterior branchPosterior root脊神经的分支 branchesAnterior rootBranchesnull后支 posterior branches人体后正中线附近的皮肤和肌 具节段性null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 plexusSpinal nervesSpinal nervesThere 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 nervesSpinal nervesAfter 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.nullComposition: C1~4Location： 胸锁乳突肌 上部的深面Cervical plexus 颈丛null浅支：Superficial branches枕小N.耳大N.颈横N.锁骨上N.null深支 deep branches→颈部大部分肌膈神经( C3 ~ 5 )：phrenic n.nullComposition：C5~8 + T1 C5C6C7C8T1上干下干中干根支束股干臂 丛 brachial plexusnullLocation：null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null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null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null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null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。null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。null肋间神经 intercostal n.肋下神经 subcostal n.Thoracic Nerve胸神经前支12对nullT2 – 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null腰丛lumbar plexus组成：部分T12 + L1~3+部分L4前支 位置：腹后壁，腰大肌深面null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）null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.null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null骶丛sacral plexus组成：L4，5（腰骶干）+ S1~5 + Co1 位置：盆腔后壁，骶骨及梨状肌前方 null 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null 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null 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null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null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 nervesSpinal nervesSpinal 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.nullCervical 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. nullThoracic 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.nullThe 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. nullThe 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、 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null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nullCranial Nerves脑 神 经许家军 第二军医大学解剖学教研室null脑神经概述名称及序数Ⅰ嗅、Ⅱ视、Ⅲ动眼； Ⅳ滑、Ⅴ叉、Ⅵ外展； Ⅶ面、Ⅷ听、Ⅸ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NCranial nervesCranial 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). null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）null脑神经分类感觉神经：Ⅰ嗅神经、Ⅱ视神经、Ⅷ前庭蜗神经 运动神经：Ⅲ动眼神经、Ⅳ滑车神经、Ⅵ展神经、 Ⅺ副神经、Ⅻ舌下神经 混合神经：Ⅴ三叉神经、Ⅶ面神经、Ⅸ舌咽神经、 Ⅹ迷走神经 含副交感纤维的神经：Ⅲ动眼神经、Ⅶ面神经、Ⅸ舌咽神经、Ⅹ迷走神经 null 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.nullCranial N.null颅底内面观脑 Encephalon, Brain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 null感觉神经名称、起源、入颅部位、连脑部位、传导冲动null上鼻甲上部、鼻中隔上部 粘膜内嗅细胞 筛孔 cribriform foramen嗅球 olfactory bulbⅠ嗅神经 olfactory n.nullⅡ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nullⅧ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nullnull运动神经名称、起源、连脑部位、 走行特点、出颅部位、分布null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 Ⅲ动眼神经 oculomotor n.null Ⅲ动眼神经 oculomotor n.nullIt 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.nullⅣ滑车神经 trochlear n.中脑背侧绕大脑脚海绵窦眶上裂眶上斜肌nullⅥ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眼外肌神经支配展神经滑车神经动眼神经nullOculomotor paralysisAbducent nerve injury nullⅪ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nullⅫ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null混合神经名称、性质、走行、分支、分布nullⅤ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）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:Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ眶内神经:Ⅱ,Ⅲ,Ⅳ,Ⅴ,ⅥV 三叉神经 trigeminal n.（混合性）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null 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null三叉神经及其分支三叉神经及其分支VII 面神经 facial n. （混合性）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nullⅦ 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nullInjury to the facial nervenull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 cavityVII 面神经 facial n. （混合性）submandibular g.味觉纤维 舌前2/3味蕾岩鼓裂null 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）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 tympanic n.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 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nullⅩ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null1.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null左迷走神经右迷走神经喉返 Nnull1.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nullnullThe 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. The right vagus nerve forms the posterior part of the esophageal plexus and the posterior vagal trunk at the inferior part of the esophagus.nullThe anterior and posterior vagal trunks enter the abdominal cavity through the esophageal hiatus of the diaphragm and are divided into their terminal branches near the cardia of the stomach. The fibers of the vagus nerve carry somatic motor impulses to pharynx and larynx and sensory fibers from same structure. The very large portion is composed of parasympathetic motor fibers, which supply heart muscles, smooth muscles and glands of abdominal visceral organs; transmits sensory impulses from viscera. nullThrough cavernous sinus and superior orbital fissure: Oculomotor n. Trochlear n. Abducent n. Ophthalmic n.Cranial N.nullThrough jugular foramen: glossopharyngeal n. vagus n. accessory n.Cranial N.null小 结脑神经的名称、顺序、性质、纤维成分、连脑部位、进出颅的部位及其他走行特点和分布概况。 连于端脑、间脑、中脑、脑桥、延髓的脑神经。 穿眶上裂、内耳道、颈静脉孔的脑神经。 面部的感觉和运动分别由哪些脑神经支配？如何分布？ 与眶、眼球、舌、喉、上、下颌牙及牙龈有关的脑神经有哪些？如何分布？ 四对副交感神经节的名称、位置null复习思考题某病人左眼睑下垂，经检查发现：两眼向前直视时，左眼有外斜视，左眼瞳孔扩大；两眼向右方运动时，右眼活动正常，左眼不能向右转动；两眼向下运动时，右眼运动正常，左眼不能向下转动。试分析损伤哪条神经？如何解释上述现象。 中耳鼓室手术不慎伤及面神经与腮腺肿瘤手术不慎伤及面神经时，临床表现有何不同？为什么？ 下列功能障碍，提示什么神经受损？为什么？（1）不能耸肩；（2）伸舌时舌尖偏向右侧；（3）声音嘶哑；（4）张口时口角偏向右侧。自学自学脑的位置、分部 脑干的位置、分部、外形null