周圍神經(jīng)系統(tǒng)課件

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

周圍神經(jīng)系統(tǒng)

PeripheralnervessystemJanuary,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

概述周圍神經(jīng)系統(tǒng)(peripheralnervoussystem)：一端連于中樞神經(jīng)系統(tǒng)的腦或脊髓，另一端連于身體各系統(tǒng)、器官。◆腦神經(jīng)(cranialnerves)-12對(duì)◆脊神經(jīng)(spinalnerves)-31對(duì)◆軀體神經(jīng)(somaticnerves)◆內(nèi)臟神經(jīng)(visceralnerves)◆傳出神經(jīng)(efferentnerves)◆傳入神經(jīng)(afferentnerves)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

自主神經(jīng)系統(tǒng)(autonomicnervoussystem)：指內(nèi)臟傳出神經(jīng)系統(tǒng)，又稱植物神經(jīng)系統(tǒng)，分為：◆交感神經(jīng)(sympatheticnerve)◆副交感神經(jīng)(parasympatheticnerve)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

一、神經(jīng)節(jié)神經(jīng)節(jié)(ganglion)：周圍神經(jīng)系統(tǒng)的神經(jīng)元胞體聚集構(gòu)成，包括：◆腦神經(jīng)節(jié)：連于腦神經(jīng)◆脊神經(jīng)節(jié)：連于脊神經(jīng)后根◆內(nèi)臟運(yùn)動(dòng)神經(jīng)節(jié)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

二、神經(jīng)神經(jīng)(nerve)：周圍神經(jīng)系統(tǒng)的神經(jīng)纖維聚集構(gòu)成。神經(jīng)纖維是由神經(jīng)元的長突起和在其外面的神經(jīng)膠質(zhì)細(xì)胞的一部分構(gòu)成。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

根據(jù)神經(jīng)纖維有否髓鞘將其分為兩種：◆有髓纖維——有髓鞘◆無髓纖維——神經(jīng)膜January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

神經(jīng)的結(jié)構(gòu)：◆神經(jīng)膜或髓鞘◆神經(jīng)內(nèi)膜

(endoneurium)◆神經(jīng)束膜

(perineurium)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

神經(jīng)的血管：◆外來系統(tǒng)：局部的營養(yǎng)血管和神經(jīng)外膜血管；◆內(nèi)在系統(tǒng)：神經(jīng)內(nèi)膜內(nèi)縱行走向的微血管網(wǎng)。

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

神經(jīng)的淋巴管：神經(jīng)束膜和神經(jīng)外膜內(nèi)有淋巴網(wǎng)，經(jīng)與動(dòng)脈伴行的淋巴管引流至局部淋巴結(jié)。血-神經(jīng)屏障(blood-nervebarrier)：存在于神經(jīng)內(nèi)膜毛細(xì)血管壁水平。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

三、周圍神經(jīng)再生神經(jīng)纖維潰變：也稱Weller變性，包括兩種情況：◆順行潰變：自損傷部位向神經(jīng)纖維遠(yuǎn)側(cè)部及其末梢發(fā)生的的潰變；◆逆行潰變：自損傷部位向神經(jīng)纖維近側(cè)部的潰變，一般僅出現(xiàn)一小段。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

神經(jīng)纖維的再生一般發(fā)生在損傷后的第2-3周。其過程如右圖：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

周圍神經(jīng)的再生受許多微環(huán)境因素的影響：◆施萬細(xì)胞的增生◆神經(jīng)營養(yǎng)因子：NGF、BDNF、CNTF、FGF等◆物理因素：交變磁場、氦氖激光、電場等◆某些中藥制劑◆斷端間的修復(fù)連接情況January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

第一節(jié)脊神經(jīng)

spinalnervesJanuary,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

一、概述（一）脊神經(jīng)的構(gòu)成、分布和纖維成分（1）構(gòu)成：

◆前根(anteriorroot)：運(yùn)動(dòng)性◆后根(posteriorroot)：感覺性◆脊神經(jīng)節(jié)(spinalganglion)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（2）分部：頸神經(jīng)(cervicalnerves)—８對(duì)胸神經(jīng)(thoracicnerves)—12對(duì)腰神經(jīng)(lumbernerves)—5對(duì)骶神經(jīng)(sacralnerves)—5對(duì)尾神經(jīng)(coccygealnerve)—1對(duì)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（3）纖維成分：

①軀體感覺纖維

②內(nèi)臟感覺纖維

③軀體運(yùn)動(dòng)纖維

④內(nèi)臟運(yùn)動(dòng)纖維January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（二）脊神經(jīng)的典型分支

◆脊膜支

◆交通支

◆后支

◆前支January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

其中：后支內(nèi)側(cè)支外側(cè)支皮支皮支肌支肌支分布于枕、項(xiàng)、背、腰、骶、臀部的皮膚分布于項(xiàng)、背、腰、骶部深層肌January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

第1頸神經(jīng)后支粗大—枕下神經(jīng)—椎枕肌第2頸神經(jīng)后支的皮支粗大—枕大神經(jīng)—枕項(xiàng)部皮膚第3頸神經(jīng)后支的內(nèi)側(cè)支—第3枕神經(jīng)—枕下區(qū)皮膚第1-3腰神經(jīng)后支的皮支—臀上皮神經(jīng)—臀上部皮膚第1-3骶神經(jīng)后支的皮支—臀中皮神經(jīng)—臀中區(qū)皮膚January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸叢臂叢腰叢骶叢前支形成4個(gè)脊神經(jīng)叢January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

二、頸叢（一）頸從的組成和位置組成：第1-4頸神經(jīng)前支位置：胸鎖乳突肌上部深面，中斜角肌和肩胛提肌起端的前方。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

◆皮支

◆肌支

◆膈神經(jīng)

◆交通支（二）頸叢的分支January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

主要的分支有：1.枕小神經(jīng)lesseroccipitalnerve2.耳大神經(jīng)greatauricularnerve3.頸橫神經(jīng)transversenerveofneck4.鎖骨上神經(jīng)supraclavicularnerve5.膈神經(jīng)phrenicnerveJanuary,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸袢(ansacervicalis)：也稱舌下神經(jīng)袢，是頸叢與舌下神經(jīng)之間的交通聯(lián)系。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,La