人體解剖學(xué)：脊神經(jīng)

脊神經(jīng)

TheSpinalNerves

脊神經(jīng)的概況前根后根前支后支脊神經(jīng)節(jié)交通支BranchesofspinalnervesAnteriorbranch:largest,innervatesanterolateralbodywallandlimbs，thegreatnerveplexus,e.g.thecervical,brachial,lumbar,andsacral,areformedbyanteriorramiPosteriorbranch:innervatesthebackofthetrunkCommunicatingbranch:connectthespinalnervetothesympathetictrunkMeningealbranch:re-entersvertebralcanalthroughintervertebralforamentoduramater31對C8、T12、L5、S5、Co1。前根(運(yùn)動(dòng))和后根(感覺)合成，脊神經(jīng)節(jié)前支后支混合性，脊神經(jīng)四種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)纖維后根（感覺性）前根（運(yùn)動(dòng)性）皮膚、運(yùn)動(dòng)系統(tǒng)內(nèi)臟心血管和腺體骨骼肌心肌平滑肌腺體脊神經(jīng)的構(gòu)成、分部和纖維成分前支粗大，混合性，胸神經(jīng)保持節(jié)段性，其余形成頸叢、臂叢，腰叢和骶叢。后支細(xì)，混合性，支配背側(cè)肌肉和皮膚。交通支連于脊神經(jīng)和交感干之間，有灰、白交通支之分。脊膜支來自交通支或胸交感干的分支，經(jīng)椎間孔返入椎管，布于被膜，血管，骨膜，韌帶等脊神經(jīng)的分支脊神經(jīng)的走行分布規(guī)律多與血管伴行形成血管神經(jīng)束分為皮支、肌支和關(guān)節(jié)支胸腹部分布有一定的節(jié)段性和重疊性神經(jīng)實(shí)心、白色，有一定韌性；借此可以與血管相鑒別。馬尾Cervicalplexus頸叢Formation:formedbyanteriorramiofC1-C4spinalnervesPosition:liesinfrontoftheoriginoflevatorscapulaeandscalenus

mediusanddeeptothesuperiorpartofthesternocleidomastoid

branchesBranches

Cutaneous

:LesseroccipitalGreatauricularTransversenerveofneckSupraclavicularnervesEmergearoundmiddleofposteriorborderofsternocleidomastoid,tosupplyskinofneckandscalpbetweenauricleandexternaloccipitalprotuberance眶上神經(jīng)滑車上神經(jīng)眶下神經(jīng)頸橫神經(jīng)鎖骨上神經(jīng)耳大神經(jīng)枕大神經(jīng)枕小神經(jīng)耳顳神經(jīng)膈神經(jīng)Phrenicn

膈肌運(yùn)動(dòng)，感覺頸叢肌支Muscularbranches

膈神經(jīng)

Brachialplexus臂叢Formation:FormedbyanteriorramiofC5-C8andT1spinalnervesPosition:Passesthroughthescalenefissuretoposterosuperiorofsubclavianartery,thenenterstheaxillatoformthreecordsMainbranche

前斜角肌臂叢中斜角肌

（1）胸長神經(jīng)（2）胸背神經(jīng)（3）肌皮神經(jīng)（4）正中神經(jīng)（5）尺神經(jīng)（6）橈神經(jīng)（7）腋神經(jīng)（8）胸外側(cè)神經(jīng)（9）胸內(nèi)側(cè)神經(jīng)（10）前臂內(nèi)側(cè)皮神經(jīng)（11）臂內(nèi)側(cè)神經(jīng)（12）肩胛下神經(jīng)

前鋸肌背闊肌C5C6C7C8T1上中下干外側(cè)束內(nèi)側(cè)束后束分支肌皮神經(jīng)

MusculocuteneousNerve自外側(cè)束穿喙肱肌肌支支配臂前群肌前臂外更名為前臂外側(cè)皮神經(jīng)損傷屈肘力弱肌皮神經(jīng)發(fā)自內(nèi)外側(cè)束行于前臂正中穿腕管達(dá)手掌肌支支配前臂6塊半肌拇收肌外的魚際肌皮支手掌橈側(cè)3個(gè)半手指皮膚感覺損傷－“猿掌”正中神經(jīng)MedianNerve正中神經(jīng)MedianNerve正中神經(jīng)損傷正中神經(jīng)尺神經(jīng)肌皮神經(jīng)肱骨內(nèi)上髁尺動(dòng)脈尺側(cè)腕屈肌指深屈肌自內(nèi)側(cè)束尺神經(jīng)溝不經(jīng)腕管肌支前臂尺側(cè)1塊半肌和拇收肌、骨間肌皮支掌尺側(cè)1個(gè)半、手背2個(gè)半手指感覺損傷－“爪形手”尺神經(jīng)尺神經(jīng)ulnarNerve爪形手橈神經(jīng)橈神經(jīng)淺支橈神經(jīng)深支起自后束經(jīng)橈神經(jīng)溝肌支臂部和前臂伸肌群皮支手背橈側(cè)2個(gè)半手指皮膚肱骨中段骨折可致該N損傷－垂腕。橈神經(jīng)RadialNerve橈神經(jīng)RadialNerve腋神經(jīng)

AxillaryNerve自后束穿四邊孔貼繞肱骨外科頸肌支－三角肌皮支－肩區(qū)外科頸骨折腋杖損傷－方肩

腋神經(jīng)尺神經(jīng)正中神經(jīng)橈神經(jīng)胸長神經(jīng)Longthoracicnerve胸背神經(jīng)自后束支配背闊肌乳癌清掃腋淋巴結(jié)注意保護(hù)起自神經(jīng)根支配前鋸肌損傷后出現(xiàn)翼狀肩

AnteriorbranchesofthoracicnervesIntercostalnerves(anteriorramiofT1-T11)

Subcostalnerve(anteriorramusofT12)Distribution:distributedtointercostalesandanterolateralabdominalmuscles,skinofthoracicandabdominalwall,parietalpleuraandperitoneum胸神經(jīng)前支特點(diǎn)節(jié)段性分布T2－胸骨角T4－乳頭T6－劍突T8－肋弓中點(diǎn)T10－肚臍T12－臍恥間中點(diǎn)重疊性一個(gè)肋間受相鄰兩條肋間神經(jīng)支配臨床一支肋間N傷無礙節(jié)段性和重疊性胸神經(jīng)前支前皮支外側(cè)皮支腰叢

LumberPlexus組成T12-L4前支位置腰大肌深面分支（1）髂腹下神經(jīng)（2）髂腹股溝神經(jīng)（3）股外側(cè)皮神經(jīng)（4）股神經(jīng)（5）閉孔神經(jīng)（6）生殖股神經(jīng)股神經(jīng)FemoralNerve起自L2-4前支。肌支髂肌和大腿前群肌。皮支大腿前面、小腿內(nèi)側(cè)面和足內(nèi)側(cè)緣感覺。隱神經(jīng)伴大隱靜脈尋找腰大肌外側(cè)緣

臨床內(nèi)靜中動(dòng)外神經(jīng)股神經(jīng)麻醉股動(dòng)脈穿刺股靜脈穿刺閉孔神經(jīng)ObturatorNerve

組成L2-4前支穿閉孔膜至大腿內(nèi)側(cè)肌支大腿內(nèi)側(cè)群肌皮支大腿內(nèi)側(cè)皮膚尋找腰大肌內(nèi)側(cè)緣股神經(jīng)股神經(jīng)股外側(cè)皮神經(jīng)隱神經(jīng)閉孔神經(jīng)Sacralplexus骶叢組成L4-S1-5-Co前支位置骶骨梨狀肌前面分支臀上神經(jīng)臀下神經(jīng)股后皮神經(jīng)陰部神經(jīng)坐骨神經(jīng)臀上神經(jīng)臀下神經(jīng)陰部神經(jīng)坐骨神經(jīng)股后皮神經(jīng)陰部神經(jīng)PudendalNerve起S2-S4前支出梨狀肌下孔（最內(nèi)側(cè)）穿坐骨小孔入陰部管布會陰部外生殖器臀上神經(jīng)出梨狀肌上孔支配臀中小肌臀下神經(jīng)出梨狀肌下孔支配臀大肌股后皮神經(jīng)出梨狀肌下孔臀上下神經(jīng)股后皮神經(jīng)坐骨神經(jīng)

SciaticNerve自L4-S3前支人體最粗大的N出梨狀肌下孔大腿后面下行在腘窩分為脛神經(jīng)腓總神經(jīng)肌支大腿后群肌皮支大腿后面坐骨神經(jīng)脛神經(jīng)TibialNerve坐骨神經(jīng)干延續(xù)

肌支小腿后群肌穿踝管至足底足底內(nèi)側(cè)神經(jīng)