神经系总论、周围神经系统概述课件.ppt

Introduction of the nervous system神经系统总论,郑州大学医学院解剖教研室,Functions,控制和调节其它系统的活动，使人体成为一个有机的整体。维持机体与外环境间的统一。不仅能适应环境，还能主观改造世界。,Divisions,Central nervous system(CNS)1.Brain（脑）2.Spinal cord（脊髓）Peripheral nervous system(PNS)Cranial n.（脑神经 12 pairs)Spinal n.(脊神经 31 pairs)Somatic n.（躯体神经）Visceral n.（内脏神经）,构造,神经组织,神经元 神经胶,胶质细胞比神经元多数十倍，具有支持保护营养绝缘和屏障等功能 少突胶质细胞-中枢 星形胶质细胞类型 施万细胞-周围 小胶质(巨噬)细胞 室管膜细胞,Neuron,胞体：3135um突起：树突：多个 轴突：1um1m,.2-20um 髓鞘Schwan C,Silver Stain,Nissl Stain,按形态分类双极神经元假单极神经元极神经元按功能分类感觉神经元运动神经元联络神经元按递质分类胆碱能神经元单胺能神经元氨基酸、肽能神经元,Classification,Synapses,Transmission Pattern,Chemical Electric,Neuron Region,AxodendriticDendrodendriticAxosomaticSomatosomatic,Axoplasmic Flow,Reflex Arc,机体接受内外界环境的刺激作出的应答性反应,常用术语,网状结构,脊神经节,神经,Spinal nerve general intyoduction脊神经总论,郑州大学医学院解剖教研室,General description,Functional components,1.Somatic efferent nerve fibers 躯体传出纤维(SE):fibers that transmit motor impulses from spinal cord to skeletal muscles.2.Visceral efferent nerve fibers内脏传出纤维(VE):fibers that transmit motor impulses from spinal cord to smooth muscles,cardiac muscle and glands.3.Somatic afferent nerve fibers躯体传入纤维(SA):fibers that transmit exteroceptive and proprioceptive impulses from body to spinal cord 4.Visceral afferent nerve fibers内脏传入纤维(VA):fibers that transmit interoceptive impulses from the viscera to spinal cord,Branches of spinal nerves,The Spinal Nerves,郑州大学医学院解剖教研室,一、Cervical plexus 颈丛,Formation:anterior rami of C1-C4 spinal nervesPosition:lies in front of the origin of levator scapulae and scalenus medius and deep to the superior part of the sternocleidomastoid 分支：1、皮支 2、肌支,Cutaneous branches,Emerge around middle of posterior border of sternocleidomastoid,to supply skin of neck and scalp枕小神经耳大神经颈横神经锁骨上神经,Muscular branches,supply the deep muscles of neckPhrenic nerve anterior rami of C3-C5 to diaphragm(motor and sensory)Descends over scalenus anterior to enter thorax Sensory fibers supply to pleurae,pericardium and peritoneum of diaphragm;usually right phrenic nerve may be distributed on live,gallbladder and biliary system.,Phrenic nerve,二、Brachial plexus 臂丛,Formation:Formed by anterior rami of C5-C8 and T1 spinal nervesPosition:Passes through the scalene fissure to posterosuperior of subclavian artery,then enters the axilla to form three cords,Main branche,正中神经内、外侧束发出伴肱动脉,沿肱二头肌内侧缘下行穿旋前圆肌指浅、深屈肌之间前臂前群 6 块半(除肱桡、尺侧腕屈、指深屈尺侧半)穿腕管进入手掌返支-鱼际肌(除拇收肌)1、2 蚓状肌指掌侧总N-桡侧手掌2/3 和3个半指,肌皮神经外侧束发出穿喙肱肌肱二头肌与肱肌之间下行臂肌前群肘关节外上方浅出前臂外侧皮下前臂外侧皮神经,尺神经内侧束发出向后穿臂内侧经尺神经沟肌间隔尺侧腕屈肌 和指深屈肌尺侧半经腕管表面入掌除正中支配外的手肌深支-拇收,3.4蚓状,骨间,小鱼际浅支-尺侧手掌1/3 和1个半指手背支-手背尺侧半 和尺侧 2半指,桡神经后束发出肱三头肌肱肌和肱二头肌之间进入肘窝深支前臂深肌+肱桡肌浅支绕至手背桡侧手背桡侧半和2个半指,腋神经后束发出伴旋肱后动脉穿四边孔三角肌深面三角和小圆肌三角肌后缘中点浅出肩、臂外上1/3 皮肤,1、Musculocutaneous nerve,2、Median nerve,除肱桡肌（桡神经）、尺侧腕屈肌、指深屈肌尺侧半（尺神经）以外所有前臂前群肌 鱼际肌（拇收肌尺神经）1、2蚓状肌旋前肌综合征腕管综合征损伤表现:猿掌,3、Ulnar nerve,尺侧腕屈肌 指深屈肌尺侧半拇收肌 小鱼际 骨间肌 3.4蚓状肌损伤表现:爪形手,4、Radial,C5-T1 后束肱三头肌 肱桡肌 前臂后群肌损伤表现:垂腕,5、Axillary,臂丛后束腋神经四边孔三角肌、小圆肌、肩和臂外侧皮肤损伤：肩不能外展 肩部骨突起-方肩 三角肌区皮肤感觉障碍,三、Thoracic nerves,Intercostal nerves(anterior rami of T1-T11)Subcostal nerve(anterior ramus of T12)Distribution:distributed to intercostales and anterolateral abdominal muscles,skin of thoracic and abdominal wall,parietal pleura and peritoneum,胸神经前支,T2 Sternal angle T4 Nipple T6 Xiphoid processT8 Costal archT10 UmbilicusT12 Midpoint between umbilicus and symphysis pubis,四、Lumbar plexus,Formation:formed by anterior rami of L1-L3,a part of anterior rami of T12and L4Position:lies within substance of psoas major,Branches,IliohypogastricIlioinguinal Lateral femoral cutaneousFemoral Obturator Genitofemoral,五、Sacral plexus 骶丛,Formation:formed by anterior rami of L4 and L5 spinal nerves(the lumbrosacral trunk)and anterior rami of sacral and coccygeal nervesPosition:lies in pelvic cavity,anterior to sacrum and piriformis,Branches,臀上神经 臀下神经股后皮神经阴部神经坐骨神经,Sciatic nerve,Leaves pelvis through infrapiriform foramen to enter gluteal regionruns inferiorly laterally deep to gluteus maximuspassing midway between the greater trochanter of femur and ischial tuberosity to back of thighlying deep to long head of biceps femorisnormally divided into tibial and common peroneal nerves just above popliteal fossa;innervates semitendinosussemimembranosus and biceps femoris and has articular branches to hip and knee joints,Tibial nerve,Decends through popliteal fossa and lies on popliteusthen runs inferiorly with posterior tibial vessels and terminates beneath flexor retinaculum by dividing into medial and lateral plantar nervessupplies posterior muscles of leg and knee joint,Common peroneal nerve,The Cranial Nerves,郑州大学医学院解剖教研室,学习方法,名称神经核性质连脑部位出入颅部位主要分支分支分布,Names of cranial nerves,Olfactory nerve Optic nerve Oculomotor nerve Trochlear nerve Trigeminal nerve Abducent nerve Facial nerve Vestibulocochlear nerve Glossopharyngeal nerve Vagus nerve Accessory nerve Hypoglossal nerve,连脑部位,Functional components,General somatic afferent fibers(GSA)Special somatic afferent fibers(SSA)General visceral afferent fibers(GVA)Special visceral afferent fibers(SVA)General somatic efferent fibers(GSE)Special visceral efferent fibers(SVE)General visceral efferent fibers(GVE),Classification of cranial nerves,Sensory cranial nervesMotor cranial nervesMixed nerves,Sensory cranial nerves,Olfactory nerve,Olfactory mucosa(SVA)Cribriform foramina Olfactory bulb,Optic nerve,Ganglion cell(SSA)Optic canal Lateral geniculate body,Vestibulocochlear nerve,Vestibular ganglion(SSA)Vestibular nuclei Internal acoustic meatus Cochlear ganglion(SSA)Cochlear nuclei,Motor cranial nerves,Oculomotor nerve,ComponentsGeneral somatic efferent fibers(GSE)General visceral efferent fibers(GVE)Main actionsupplies Superior,inferior and medial recti;inferior obliquus;levator palpebrae superiorisSphincter pupillea and ciliary muscleCiliary ganglion,出现患侧除外直肌、上斜肌外的全部眼外肌的瘫痪，上睑下垂、瞳孔斜向外下方、瞳孔散大、对光反射消失。,右侧动眼神经损伤,Abducent nerve,Abducent nerve injury,Accessory nerve,Hypoglossal nerve,Mixed cranial nerves,Trigeminal nerve,Ophthalmic nerve眼神经,Frontal nerve额神经:Supratrochlear nerve滑车上神经Supraorbital nerve眶上神经Lacrimal nerve泪腺神经Nasociliary nerve鼻睫神经,Maxillary nerve上颌神经,Leave skull through foramen rotundum BranchesInfraorbital nerve 眶下神经Zygomatic nerve 颧神经Superior alveolar nerve 上牙槽神经Pterygopalatine nerve 翼腭神经,Mandibular nerve 下颌神经,Auriculotemporal nerve 耳颞神经Buccal nerve 颊神经Lingual nerve 舌神经Inferior alveolar nerve下牙槽神经Nerve of masticatory muscles 咀嚼肌神经,Distribution,Sensation from cerebral dura mater Teeth and gum of lower jaw Mucosa of floor of mouthAnterior 2/3 of tongue Skin of auricular and temporal regions and below the mouth Motor to masticatory muscles,mylohyoid,and anterior belly of digastric,SVEGVESVAGSA,Facial nerve(),Branches within the facial canal,Chorda tympani 鼓索Greater petrosal nerve岩大神经Stapedial nerve 镫骨肌神经,Ganglion,Pterygopalatine ganglion 翼腭神经节Submandibular ganglion 下颌下神经节,Branches outside of facial canal,Temporal Zygomatic BuccalMarginal mandibular Cervical,Injury to the facial nerve,SVE GVESVAGVAGSA,Glossopharyngeal nerve(),Branches,Lingual branches 舌支Pharyngeal branches 咽支Tympanic nerve 鼓室神经Carotid sinus branch 颈动脉窦支OthersOtic ganglion 耳神经节,Vagus nerve(),GVESVEGVAGSA,Branches in neck,Superior laryngeal nerveCervical cardiac branchesOthers,Branches in thorax,Recurrent laryngeal nervesBronchial and esophageal branches,右,Branches in abdomen,Anterior and posterior gastric branchesHepatic branchesCeliac branches,总结,进出眶上裂的神经进出内耳门的神经进出颈静脉孔的神经舌的神经支配眼的神经支配,The Visceral Nervous System,郑州大学医学院解剖教研室,Composition,Visceral motor nerves,Main differences between somatic motor and visceral motor n.,Sympathetic part 交感部,Lower centerSympathetic ganglia,Paravertebral ganglia 椎旁节,Prevertebral ganglia 椎前节,Celiac ganglion 腹腔神经节Aorticorenal ganglion 主动脉肾节 Superior mesenteric ganglion 肠系膜上神经节Inferior mesenteric ganglion肠系膜下神经节,Preganglionic fibers,Greater splanchnic nerve内脏大神经 formed by preganglionic fibers from T5T9 ganglia,and relay in celiac ganglion.Lesser splanchnic nerve内脏小神经 formed by preganglionic fibers from T10T12 ganglia,and relay in aorticorenal ganglion.The postganglionic fibers supply the liver,spleen,kidney and alimentary tract as far as the left colic flexure.Lumbar splanchnic nerve腰内脏神经 Formed by preganglionic fibers from L1L4 ganglia,and relay in prevertebral ganglia.The postganglionic fibers supplydescending and sigmoid colon,rectum,pelvic viscera and lower limbs.,Postganglionic fibers,发自椎旁神经节的节后纤维，经灰交通支返回脊神经，随脊神经分布于全身血管、汗腺、立毛肌。攀附动脉走行形成丛随动脉分布到所支配器官。直接分布于器官,Distribution of sympathetic nerve,Parasympathetic part 副交感部,Lower center:located in four pairs parasympathetic nuclei in brain stem and in sacral parasympathetic nucleus of spinal cord segments S2S4Parasympathetic ganglia:terminal ganglia are near or within the wall of a visceral organ Para-organ ganglia 器官旁节：Ciliary ganglion 睫状神经节Pterygopalatine ganglion 翼腭神经节Submandibular ganglion 下颌下神经节 Otic ganglion 耳神经节Intramural ganglia 壁内节,Cranial portion颅部,ciliary ganglion,sphincter pupillae and ciliary muscles,pterygopalatine ganglion,lacrimal gland,submandibular ganglion,sublingual glandsubmandibular gland,otic ganglion,parotid gland,terminal ganglia,heart,lungs,liver,spleenkidneys,alimentary tractas far as left colic flexure,Sacral portion 骶部,Preganglionic fibers from sacral parasympathetic nucleus leave spinal cord with anterior roots of the spinal nerves S2S4,Then leave sacral nerves and form pelvic splanchnic nerve and travel by way of pelvic plexus to terminal ganglia in pelvic cavity Postganglionic fibers terminate in descending and sigmoid colon,rectum and pelvic viscera,Main differences between sympathetic and parasympathetic,Differences,Visceral plexuses,Cardiac plexuses Superficial,below aortic archDeep,anterior to bifurcation on tracheaPulmonary plexus Celiac plexus Abdominal aortic plexus Hypogastric plexus Superior hypogastric plexus Inferior hypogastric plexus(pelvic plexus),Visceral sensory nerves,Enteroceptors,，,Nucleus of solitary tract,Sympathetic nerve Pelvic splanchnic nerve,Posterior horn,Thalamus,Hypothalamus,Cerebral cortex,Somatic motor neurons visceral motor neuclei,Effectors,Referred pain 牵涉痛,