系統(tǒng)解剖學(xué)：神經(jīng)總論脊神經(jīng)

1、Nervous System,神經(jīng)系統(tǒng),Chapter 16 Introduction,一、神經(jīng)系統(tǒng)的區(qū)分,中樞神經(jīng)系統(tǒng)central nervous system (CNS) 腦 brain 脊髓 spinal cord 周圍神經(jīng)系統(tǒng)peripheral nervous system (PNS) 按連接的部位： 脊神經(jīng) spinal nerves 腦神經(jīng) cranial nerves,按分布的對象分為：,軀體神經(jīng)somatic nerve 分布于體表、骨、關(guān)節(jié)和骨骼肌 內(nèi)臟神經(jīng)Visceral nerve 分布于內(nèi)臟、心血管、平滑肌和腺體。,2.功能 Function,The nervous

2、 system is a master system in the living body, it regulates and integrates the activities of all the other bodily systems for the benefit of the organism as a whole. 維持和調(diào)節(jié)其他系統(tǒng)的活動，使人體成為一個有機(jī)的整體。 維持機(jī)體與外環(huán)境間的統(tǒng)一。,二、the composition of the nervous system,The nervous system is composed of nervous tissue. The

3、 nervous tissue consists of the neuron and neuroglia.,（一） The Neuron,Neurons are the structural and functional units of the nervous system. 1.Each neuron possesses a nucleated cell body and one or usually more branching processes.,The motor neuron The dendrite The axon The cell body The Schwann cell

4、 The oligodendrocyte,2.Classification:,Depending on the type and number of their processes, neurons are described as unipolar, bipolar and multipolar neuron.,Depending on their functions, neurons are described as sensory neuron, association neuron (interneurons) and motor neuron.,2.Nerve fibers,具有神經(jīng)

5、膜細(xì)胞鞘的軸突 無髓纖維（軸突+神經(jīng)膜）、薄髓纖維（軸突+神經(jīng)膜+髓鞘）、有髓纖維（軸突+神經(jīng)膜+髓鞘） 傳入纖維afferent fibre 傳出纖維efferent fibre,4. The Synapse,突觸：是神經(jīng)元與神經(jīng)元之間或神經(jīng)元與效應(yīng)器、感受器與神經(jīng)細(xì)胞之間特化的接觸區(qū)域，神經(jīng)元在接近其終末處常分成若干細(xì)支，細(xì)支的末端膨大形成突觸前末梢或終扣 terminal button，一個神經(jīng)元通過終扣與其他神經(jīng)元或效應(yīng)器細(xì)胞的表面接觸，稱突觸 synapse。 神經(jīng)元通過突觸把信息傳遞到另一個神經(jīng)元或效應(yīng)器。,自主神經(jīng)與平滑肌連接模式圖,(二)神經(jīng)膠質(zhì)或神經(jīng)膠質(zhì)細(xì)胞glial cel

6、l作用：支持、營養(yǎng)、保護(hù)和修復(fù)等,The macroglia The astrocyte The oligodendrocyte The Schwann cell The microglia The ependymal cell,反射弧：是反射的物質(zhì)基礎(chǔ)，由感受器、傳入神經(jīng)、中樞、傳出神經(jīng)和效應(yīng)器構(gòu)成。,Reflex Reflex arc,反射：是神經(jīng)活動的基本方式，神經(jīng)系統(tǒng)通過與它相連的各種感受器，接受內(nèi)、外環(huán)境的各種刺激，經(jīng)傳入神經(jīng)傳導(dǎo)中樞（脊髓或腦）的不同部位，經(jīng)過整合后發(fā)出相應(yīng)的神經(jīng)沖動，經(jīng)傳出神經(jīng)傳至相應(yīng)的效應(yīng)器，產(chǎn)生各種反應(yīng)，稱反射。,三、神經(jīng)系統(tǒng)的常用術(shù)語,灰質(zhì) gray mat

7、ter 皮質(zhì) cortex 神經(jīng)核 nucleus 白質(zhì) white matter 髓質(zhì) medulla 纖維束 fasciculus 神經(jīng)節(jié) ganglion 神經(jīng) nerve,灰質(zhì) gray matter皮質(zhì) cortex神經(jīng)核 nucleus白質(zhì) white matter髓質(zhì) medulla纖維束 fasciculus,灰質(zhì) gray matter,神經(jīng)核 nucleus,白質(zhì) white matter 纖維束 fasciculus,神經(jīng)節(jié) ganglion, 神經(jīng) nerve,Chapter 18 The Peripheral Nervous System,Introduction C

8、ervical plexus Brachial plexus Anterior branch of thoracic nerve Lumbar plexus Sacral plexus,Introduction,脊神經(jīng)構(gòu)成 脊神經(jīng)分部 脊神經(jīng)纖維成分 脊神經(jīng)的分支,脊神經(jīng)的構(gòu)成:由連于脊髓的脊神經(jīng)前根、后根在椎間孔處匯合形成。,頸神經(jīng)8對cervical n.胸神經(jīng)12對thoracic n.腰神經(jīng)5對lumbar n. 骶神經(jīng)5對sacral n. 尾神經(jīng)1對coccygeal n.,脊神經(jīng)的分部,The component of the spinal nerves,The somatic

9、afferent (sensory) fibers 軀體傳入（感覺）纖維 The visceral afferent (sensory) fibers 內(nèi)臟傳入（感覺）纖維 The somatic efferent (motor) fibers 軀體傳出（運(yùn)動）纖維 The visceral efferent (motor) fibers 內(nèi)臟傳出（運(yùn)動）纖維,脊神經(jīng)纖維成分,1.The somatic afferent (sensory) fibres convey pain,temperature,touch,and proprioception from the head, body w

10、all, and extremities to the CNS.,2.The visceral afferent (sensory) fibers convey sensory information from the visceral organs and cardiac vessels system to the CNS.,3.The somatic efferent (motor) fibers supply the muscles of the head, body wall, and extremities .,4.The somatic efferent (motor) fiber

11、s supply smooth muscles, cardiac muscle, and gland.,The branches of the spinal nerve：the anterior ramus, posterir ramus, meningeal ramus, and communicating branches.,1.The posterior rami of the spinal nerve innervate the skin and deep muscles of the back.脊神經(jīng)后支分布于背部的皮膚和深層肌肉。,2. The anterior rami of t

12、he spinal nerve innervate the skin and muscles of the ventral aspect of the body.Except for the ventral rami of thoracic nerves, the ventral rami of other spinal nerves form the cervical plexus, brachial plexus, lumbar plexus, and sacral plexus.,一、The Cervical Plexus,The formation The location The s

13、uperficial branches (cutaneous nerves) The deep branches (muscular branches),1. Formation,The cervical plexus is formed by the ventral rami of the four upper cervical nerves(C1C4). 頸叢由第14頸神經(jīng)前支組成。,1. Formation The cervical plexus is formed by the ventral rami of the four upper cervical nerves(C1C4)頸叢

14、由第14頸神經(jīng)前支組成。,2. Location位于肩胛提肌和中斜角肌的前方，胸鎖乳突肌的深面。,The middle of the posterior border of the sternocleidomastoid is termed “nervous point”.,3.The cutaneous branches 皮支 The nervous point 神經(jīng)點(diǎn),枕小神經(jīng) Lesser occipital n. 耳大神經(jīng)great auricular n.頸橫神經(jīng)transverse cervical n.鎖骨上神經(jīng)supraclavicular n.,Lesser occipita

15、l n.,Great auricular n.,Transverse cervical n.,Supraclavicular n.,The phrenic nerve arises from the third to the fifth cervical nerves膈神經(jīng)由第35頸神經(jīng)前支組成 .,3.The deep muscular branches supply the deeper muscles of the neck, as well as infrahyoid muscles, levator scapulae muscle, trapezius, sternocleidoma

16、stoid, and diaphragm.,The motor fibres supply the diaphragm, the sensory fibres are distributed to the diaphragmatic peritoneum, the diaphragmatic and mediastinal pleurae and the pericardium.,The sensory fibres of the right phrenic nerve is also distributed to the liver, the gallbladder and the bile

17、 duct system.,頸袢, to be formed by the union of the anterior branches of C1C3 . To innervates the infrahyoid muscles.,The ansa cervicalis 頸袢,二、The brachial Plexus,The formation The location The branches and distribution The lesion of the nerve,The brachial plexus is formed by the union of the ventral

18、 rami of the four lower cervical nerves(C5C8) and great part of the ventral ramus of the first thoracic nerve(T1).,The roots 根, trunks干, divisions股, cords束, and branches支 of the brachial plexus,臂叢的位置:位于斜角肌間隙內(nèi)鎖骨中段后方腋窩內(nèi)腋動脈周圍。,Long thoracic nerve 胸長神經(jīng),Thoracodorsal nerve 胸背神經(jīng),Medial pectoral nerve 胸內(nèi)側(cè)神

19、經(jīng),Lateral pectoral nerve 胸外側(cè)神經(jīng),臂叢的分支分布,Branches and distribution of brachial plexus,1. The long thoracic nerve supplies the serratus anterior muscle. Crushing or cutting the long thoracic nerve results in paralysis of the serratus anterior muscle and “winging of the scapula” .胸長神經(jīng)支配前鋸肌，損傷后前鋸肌癱瘓，產(chǎn)生“翼

20、狀肩胛”。 2. The thoracodorsal nerve arises from the poterior cord of the brachial plexus and supplies the latissimus dorsi muscle. 胸背神經(jīng)起自臂叢后束，支配背闊肌。 3. The medial pectoral nerve arises from the medial cord of the brachial plexus and supplies the pectoralis major and pectoralis minor muscle. 胸內(nèi)側(cè)神經(jīng)起自臂叢內(nèi)側(cè)

21、束，支配胸大肌和胸小肌。 4. The lateral pectoral nerve arises from the lateral cord of the brachial plexus and supplies the pectoralis major and pectoralis minor muscle. 胸外側(cè)神經(jīng)起自臂叢外側(cè)束，支配胸大肌。,6.腋神經(jīng)axillary nerve：起自臂叢的后束，伴旋肱后血管穿四邊孔繞肱骨外科頸至三角肌深面，肌支支配三角肌和小圓肌，皮支布于肩部和臂外側(cè)上部皮膚。,腋神經(jīng)損傷：在肱骨外科頸骨折或肩關(guān)節(jié)脫位時易損傷，損傷后導(dǎo)致三角肌癱瘓，肩關(guān)節(jié)外展不能

22、，小圓肌癱瘓肩關(guān)節(jié)外旋減弱，肩部和臂外側(cè)上部皮膚感覺障礙。,The axillary nerve,To arise from the posterior cord of the brachial plexus. To leave the axilla by passing backward with the posterior circumflex humeral vessels through the quadrilateral space and wind round the surgical neck of the humerus to reach the deltoid muscle.

23、 To supply the deltoid and teres minor muscles and the skin over the deltoid. To may be injured in fracture of the humeral neck or in dislocation of the shoulder joint. The axillary nerve injury results in deltoid paralysis (loss of shoulder abduction ), loss of sensation over the deltoid muscle, an

24、d teres minor paralysis ( weak external rotation).,6.肌皮神經(jīng),肌皮神經(jīng)：起自臂叢外側(cè)束，肌支支配臂部前肌群（喙肱肌、肱肌和肱二頭肌），終支為皮支稱為前臂外側(cè)皮神經(jīng)，分支布于前臂外側(cè)的皮膚。肌皮神經(jīng)損傷：出現(xiàn)屈肘無力，前臂旋后力減弱，前臂外側(cè)的皮膚障礙。,The musculocutaneous nerve,To arise from the lateral cord of the brachial plexus. To innervate the flexor muscles of the arm,including the coracob

25、rachialis, biceps brachii, and brachialis muscles. To continue into the forearm as the lateral cutaneous nerve of the forearm, which supplies the lateral surface of the forearm. Injury to the musculocutaneous nerve in the axilla is usually inflicted by a knife or bullet. The wound results paralysis

26、of the coracobrachialis, biceps, and brachii,consequently, flesion of the elbow and supination of the forearm are weakened. Loss of sensation may occur at the lateral surface of the forearm supplied by the lateral cutaneous nerve of the forearm.,7.正中神經(jīng),正中神經(jīng),組成：由分別起自臂叢內(nèi)、外側(cè)束的內(nèi)、外側(cè)根匯合而成。 行徑：在腋窩兩根夾持腋動脈，在

27、臂部與肱動脈伴行在肱二頭肌內(nèi)側(cè)溝內(nèi)下行至肘窩，穿旋前圓肌及指淺屈肌腱弓至前臂，于前臂指淺、深屈肌間達(dá)腕部，穿腕管至手掌。,正中神經(jīng)：在臂部無分支；在前臂發(fā)出分支支配旋前圓肌、旋前方肌和除肱橈肌、尺側(cè)腕屈肌、指深屈肌尺側(cè)半之外的前臂屈肌群。,在手掌發(fā)出：正中神經(jīng)返支，支配除拇收肌以外的魚際?。还情g總神經(jīng)，支配第1、2蚓狀肌和掌心、橈側(cè)三個半手指掌面及其中節(jié)和遠(yuǎn)節(jié)指背的皮膚。,正中神經(jīng)損傷：在肱骨髁上骨折、穿旋前圓肌及指淺屈肌腱弓、腕管時易損傷或壓迫正中神經(jīng)，表現(xiàn)為屈腕無力，拇指不能對掌，魚際肌萎縮，手掌平坦，稱“Hand of benediction 猿手”，拇指、食指、中指掌面皮膚感覺障礙。,

28、The median nerve,To be formed in the axilla by the union of medial and lateral root from the medial and lateral cords of the brachial plexus , respectively. To has no branches in the arm. To supply flexor and pronator muscles in the forearm, including both pronators and all of the flexor muscles exc

29、ept the brachioradialis, the flexor carpi ulnaris and the medial half of the flexor digitorum profundus. Supracondylar fracture of the humerus may injure the median nerve and the brachial artery.,An injury to the median nerve in the forearm can result in interfering with pronation of the forearm,wit

30、h flexion of the phalanges of the second, the third digits and the distal phalanx of the thumb and with opposition of the thumb. Wrist flexion is less involved. The thenar muscles are paralysed,so that the thumb becomes to lie in the same plane as the other digits, it is just an “ape-like”hand. Ther

31、e is also a loss or weakness of sensation from the skin of the radial part of the palm and of the thumb, index and middle fingers and the radial half of the ring finger.,Ulnar nerve,8. 尺神經(jīng),尺神經(jīng) ulnar nerve,組成：尺神經(jīng)起自臂叢內(nèi)側(cè)束。 行徑：伴肱動脈行于肱二頭肌內(nèi)側(cè)溝，在臂中份穿內(nèi)側(cè)肌間隔至臂后區(qū)內(nèi)側(cè)，經(jīng)尺神經(jīng)溝穿尺側(cè)腕屈肌至前臂，在尺側(cè)腕屈肌深面伴尺血管下行，經(jīng)豌豆骨橈側(cè)至手掌。,分支分布：

32、,在臂部無分支。 在前臂發(fā)出分支支配尺側(cè)腕屈肌、指深屈肌尺側(cè)半。,在腕部發(fā)出尺神經(jīng)的手背支：分布于手背尺側(cè)半和小指、環(huán)指及中指尺側(cè)半背面皮膚。,在手部發(fā)出尺神經(jīng)的淺支：分布于小魚際、小指和環(huán)指尺側(cè)半掌面皮膚；尺神經(jīng)的深支：分布于小魚際肌、拇收肌、骨間肌、及第1、2蚓狀肌。,尺神經(jīng)損傷：內(nèi)上髁骨折或尺神經(jīng)溝，處損傷：可導(dǎo)致尺側(cè)腕屈肌、指深屈肌尺側(cè)半、拇收肌、骨間肌、第34蚓狀肌小魚際肌癱瘓，出現(xiàn)屈腕力減弱、拇指不能內(nèi)收，小指和環(huán)指遠(yuǎn)側(cè)指骨間不能屈，夾紙實(shí)驗(yàn)陽性，呈“爪形手”，手背尺側(cè)半、尺側(cè)2個半指指背皮膚、尺側(cè)1個半指掌側(cè)和小魚際等處皮膚感覺障礙。 豌豆骨遠(yuǎn)側(cè)損傷：導(dǎo)致拇收肌、骨間肌、第34蚓

33、狀肌、小魚際癱瘓癱瘓，出現(xiàn)拇指不能內(nèi)收，小指和環(huán)指遠(yuǎn)側(cè)指骨間不能屈，夾紙實(shí)驗(yàn)陽性，呈“爪形手”，尺側(cè)2個半指指背皮膚、尺側(cè)1個半指掌側(cè)和小魚際等處皮膚感覺障礙。,The ulnar nerve,To arises from the medial cord of the brachial plexus. To pass along the groove between the medial epicondyle of the humerus and the olecranon. To has no branch in the arm. To supply the flexor carpi uln

34、aris, the medial half of the flexor digitorum profundus muscles, lumbricales 3ad 4,the adductor pollicis , andthird to fourth muscle .,9. 橈神經(jīng)radial nerve,橈神經(jīng)radial nerve,起自臂叢后束; 沿橈神經(jīng)溝繞肱骨中段后面，在肱骨外上髁前方分為淺支和深支。 橈神經(jīng)淺支在肱橈肌深面伴橈血管下行，在前臂中、下1/3交界處經(jīng)肱橈肌腱深面至前臂后區(qū)，爾后達(dá)手背； 深支經(jīng)橈骨頸外側(cè)穿旋后肌至前臂后面，稱為骨間后神經(jīng)。,在腋窩，橈神經(jīng)發(fā)出肌支支配肱三

35、頭?。黄ぶ楸酆笃ど窠?jīng)，布于臂后區(qū)皮膚。 在臂部，發(fā)出臂外側(cè)下皮神經(jīng)，布于臂外側(cè)下皮膚；前臂后皮神經(jīng)，布于前臂后區(qū)皮膚；肌支支配肱橈肌、肘肌和橈側(cè)腕長伸肌。 在肘窩，橈神經(jīng)分為兩個終末支： 橈神經(jīng)深支，支配前臂伸肌群； 橈神經(jīng)淺支，分支布于手背橈側(cè)半和橈側(cè)三個手指近節(jié)背面的皮膚和關(guān)節(jié)。,The lesion of the radial nerve橈神經(jīng)損傷,在腋窩，損傷橈神經(jīng)，導(dǎo)致臂伸肌、前臂伸肌癱瘓，出現(xiàn)不能伸肘、伸腕和伸指，當(dāng)抬高前臂時呈“垂腕”狀；臂后區(qū)、前臂后區(qū)、手背橈側(cè)半（虎口區(qū)）、橈側(cè)兩個半指近節(jié)背面皮膚感覺障礙。 肱骨中段骨折，傷及橈神經(jīng)，導(dǎo)致前臂伸肌癱瘓，出現(xiàn)不能伸腕和伸指，當(dāng)

36、抬高前臂時呈“垂腕”狀；前臂后區(qū)、手背橈側(cè)半、橈側(cè)兩個半指近節(jié)背面皮膚感覺障礙。 橈骨頸骨折傷及橈神經(jīng)深支，導(dǎo)致前臂伸肌癱瘓，出現(xiàn)不能伸腕和伸指，當(dāng)抬高前臂時呈“垂腕”狀 。 在前臂遠(yuǎn)側(cè)傷及橈神經(jīng)淺支，導(dǎo)致手背橈側(cè)半、橈側(cè)兩個半指近節(jié)背面皮膚感覺障礙。,橈神經(jīng)損傷： Wrist-drop “垂腕” 虎口區(qū)皮膚感覺障礙,The distribution of the nerve in the hand,肱骨骨折,肱骨外科頸骨折 肱骨中段骨折 肱骨髁上骨折 肱骨內(nèi)上髁骨折,三、The Ventral Rami of the Thoracic Nerve,They are twelve in num

37、ber on each side有12對. The upper eleven lie between the ribs and are called the intercostal nerves第111胸神經(jīng)前支稱肋間神經(jīng). The twelfth lies below the last rib,so it is called the subcostal nerve第12胸神經(jīng)前支稱肋下神經(jīng). The distribution of the anterior branches of the thoracic nerves is segmental胸神經(jīng)前支的分布具有節(jié)段性. On the an

38、terior surface of the trunk, they present about the level of : T2-the sternal angle; T4-the nipple;T6-the xiphoid process; T8-the costal arch;T10-the umbilicus; T12-the anterior superior iliac spine,Intercostal Nerves and Subcostal Nerve,胸神經(jīng)前支在胸、腹前外側(cè)壁的分布：肌支：支配肋間肌、腹直肌、腹外斜肌、腹內(nèi)斜肌、腹橫肌。外側(cè)皮支和前皮支：布于胸、腹前外側(cè)壁

39、皮膚。,the sternal angle,the nipple,the xiphoid process,the costal arch,the umbilicus,the anterior superior iliac spine,T2,T4,T6,T8,T10,T12,肋胸神經(jīng)前支在胸、腹前外側(cè)壁的分布特點(diǎn),三、The Lumbar Plexus 腰 叢,The formation 組成 The location 位置 The main branches and its distributions 分支及其分布 The lesion of nerve 神經(jīng)損傷,（一）組成：由第12胸神經(jīng)前

40、支的一部分、第13腰神經(jīng)前支和第4腰神經(jīng)前支的一部分構(gòu)成。,（二）位置：位于腰大肌的深面。,（三）分支：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)等。,The Lumbar Plexus,The formation: it is formed by the ventral rami of the first three lumbar nerves, a part of the ventral rami of the last thoracic nerve and the fourth lumbar nerve. The location:It is situated

41、deep to the psoas major muscle,anterior to the transverse processes of the lumbar vertebrae. The branches: the iliohypogastric n., ilioinguinal n., lateral femoral cutaneous n., femoral n., obturator n., genitofemoral n.,1.髂腹下神經(jīng)iliohypogastric n. ：肌支支配腹前外側(cè)壁肌，皮支布于臀外側(cè)區(qū)、腹股溝區(qū)和下腹部的皮膚。Its muscular branch

42、innervates the muscles of the lower part of the abdominal wall. Its cutaneous branch supply the skin of the hypogastric region , lateral area of the gluteal and medial area of the groin.,2.髂腹股溝神經(jīng)ilioinguinal n. ：肌支支配腹前外側(cè)壁肌，皮支布于腹股溝部、陰囊或大陰唇皮膚。Its muscular branch innervates the muscles of lower abdomin

43、al wall.Its cutaneous branch supplies the scrotum(or the labium major) and the groin.,3.生殖股神經(jīng)：生殖支布于提睪肌和陰囊；股支布于股三角部的皮膚。Its genital branch supplies the cremaster muscle and the anterior scrotum or labia majora(the efferent limb of the cremaster reflex in men). Its femoral branch is distributed to ingu

44、inal triangle(the afferent limb of the cremaster reflex ).,臨床意義：髂腹下神經(jīng)、髂腹股溝神經(jīng)、生殖股神經(jīng)是位于腹股溝區(qū)的三條神經(jīng)，在施行腹股溝區(qū)手術(shù)（如腹股溝斜疝或直疝修補(bǔ)術(shù)）和盲腸后位闌尾手術(shù)時，應(yīng)注意勿損傷這些神經(jīng)，以免造成所分布的肌癱瘓和皮膚感覺喪失。The iliohygastric, ilioinguinal and genitofemoral nerve must be protected carefully in the operation of the inguininal hernia.,4.股外側(cè)皮神經(jīng)latera

45、l femoral cutaneous nerve : It supplies the skin over the anterior and lateral part of the thigh.,5.股神經(jīng),股神經(jīng) femoral nerve,起自腰叢，由來自L2L4神經(jīng)的前支組成； 自腰大肌外緣穿出，在腰大肌與髂肌之間下行，經(jīng)腹股溝韌帶中點(diǎn)稍外側(cè)的深面、股動脈外側(cè)進(jìn)入股三角，發(fā)出肌支和皮支 肌支：布于股前肌群(縫匠肌、股四頭肌)。Its muscular branches innervate the anterior femoral muscles-the quaduriceps femor

46、is, sartoris and pectineus. 皮支：股前、內(nèi)側(cè)皮神經(jīng)，Its cutaneuos branches to the thigh are the anteiror and medial femoral cutaneous nerves which are distributed to anterior and medial side of skin of the thigh. 隱神經(jīng)，為最長的皮支，伴股動脈入內(nèi)收肌管，穿出后至膝關(guān)節(jié)內(nèi)側(cè)，在小腿與大隱靜脈伴行至足內(nèi)側(cè)緣，分支布于髕下、小腿內(nèi)側(cè)面和足內(nèi)側(cè)緣皮膚。 The longest one of them is the

47、saphenous nerve which is distributed to the skin of the medial side of the leg and foot. 是膝反射的傳入和傳出神經(jīng)。The femoral nerve provides both afferent and efferent limbs of the knee-jerk reflex.,股神經(jīng)損傷：運(yùn)動障礙：由于縫匠肌、股四頭肌癱瘓，出現(xiàn)屈髖、內(nèi)旋膝力減弱，伸膝不能，髕反射消失。感覺障礙：大腿前、內(nèi)側(cè)、小腿前內(nèi)側(cè)、足內(nèi)側(cè)的皮膚感覺減弱或喪失。,6.閉孔神經(jīng),閉孔神經(jīng)obturator n.,起自腰叢； 自腰大

48、肌內(nèi)側(cè)緣穿出，與閉孔血管伴行沿骨盆內(nèi)側(cè)壁前行，穿閉膜管出骨盆，分為前、后兩支，分別位于短收肌的前面和深面； 肌支：支配大腿內(nèi)側(cè)肌群和閉孔外肌。The muscular branches innervate the medial group of muscles. 皮支：稱股內(nèi)側(cè)皮神經(jīng)，布于大腿內(nèi)側(cè)部皮膚。The cutaneous branches are distributed to the skin of the medial side of the thigh.,閉孔神經(jīng)損傷：,運(yùn)動障礙：大腿內(nèi)側(cè)肌群癱瘓，出現(xiàn)髖關(guān)節(jié)內(nèi)收不能，屈髖和髖外旋減弱。 感覺障礙：大腿內(nèi)側(cè)上部感覺障礙。 Inju

49、ry to the obturator nerve results in impaired adduction of the thigh and a loss of the sensation in the skin of the medial aspect of the thigh. 臨床應(yīng)用：帶閉孔血管神經(jīng)蒂的股薄肌瓣替代肛門外括約肌手術(shù)。,四、The Sacral Plexus骶 叢,The formation 組成 The location 位置 The main branches and its distribution 主要分支及其分布 The lesion nerve神經(jīng)損傷,（

50、一）Formation：It is formed by the lumbosacral trunk, the ventral rami of the sacral and coccygeal nerves.由腰骶干（第4、5腰神經(jīng)前支組成）、第15骶神經(jīng)前支和尾神經(jīng)前支構(gòu)成。,（二）位置：位于盆腔內(nèi)，骶骨和梨狀肌的面，髂血管的后方。It is closely related to the anterior surface of the piriformis muscle and sacrum.,(三)分支分布,1.臀上神經(jīng)Superior gluteal nerve ：伴臀上血管穿梨狀肌上孔出

51、盆腔,布于臀中肌、臀小肌和闊筋膜張肌。It leaves the pelvis through the greater sciatic foramen superior to the piriformis muscle in company with the superior gluteal vessels. it supplies the gluteus medius and minimus muscles and the tensor fascia latae muscle. 2.臀下神經(jīng)：伴臀下血管穿梨狀肌下孔出盆腔,布于臀大肌。 The inferior gluteal nerve l

52、eaves the pelvis through the greater sciatic foramen inferior to the piriformis muscle with the inferior gluteal vessels. It supplies the gluteus maximus muscle. 髖關(guān)節(jié)后脫位可致臀下神經(jīng)受損，臀大肌癱瘓，出現(xiàn)髖關(guān)節(jié)后伸無力，病人不能由坐位站立起來。,骶叢的分支、行徑與分布,3.陰部神經(jīng),陰部神經(jīng) pudendal nerve.,起自骶叢； 經(jīng)梨狀肌下孔出盆腔,穿坐骨小孔入坐骨肛門窩,分支布于會陰部肌和會陰部皮膚。 The pudend

53、al nerve exits the pelvis via the infrapiriform region of the greater sciatic foramen, then enters the ischiorectal fossa of the perineum via the lesser sciatic foramen. Its branches supply the perineum. 分支分布：肛神經(jīng) anal nerve，布于肛門外括約肌和肛門部的皮膚；會陰神經(jīng)perineal nerve，布于會陰諸肌和陰囊或大陰唇）；陰莖背神經(jīng)或陰蒂背神經(jīng)dorsal nerve of

54、 the penis or clitoris，布于陰莖或陰蒂海綿體和皮膚。,4.股后皮神經(jīng)：出梨狀肌下孔,布于股后部的皮膚。The posterior femoral cutaneous nerve leaves the pelvis through the greater sciatic foramen inferior to the piriformis muscle and supplies the posterior region of the thigh.,5.坐骨神經(jīng),坐骨神經(jīng) sciatic nerve, 經(jīng)梨狀肌下孔出骨盆，在大轉(zhuǎn)子和坐骨結(jié)節(jié)之間臀大肌深面下行至股后部，在腘窩上

55、角分為脛神經(jīng)和腓總神經(jīng)。 It leaves the pelvis through the greater sciatic foramen inferior to the piriformis muscle. Then it runs inferolaterally deep to the gluteus maximus muscle, and descends between the ischial tuberosity and the greater trochanter of the femur to enter the posterior compartment of the thig

56、h. It divides into the tibial and common peroneal nerves at the superior angle of the popliteal fossa., 在股后部發(fā)出肌支至股后肌群，包括股二頭肌、半腱肌、半膜肌。The braches of the sciatic nerve at the posterior region innervate the muscles of the posterior compartment of the thigh, including the biceps femoris, semimenbranosus

57、, semitendinosus muscles.,脛神經(jīng), 脛神經(jīng) tibial nerve,伴腘血管、脛后血管在小腿三頭肌的深面下行，在內(nèi)踝后方分為足底內(nèi)、外側(cè)神經(jīng)。 在小腿發(fā)出肌支布于小腿后肌群；皮支為腓腸內(nèi)側(cè)皮神經(jīng)，布于小腿后面內(nèi)側(cè)上部皮膚。 足底內(nèi)、外側(cè)神經(jīng)medial and lateral plantar nerves:布于足底肌和足底皮膚。,脛神經(jīng)損傷：運(yùn)動障礙：小腿后肌群、足底肌癱瘓，導(dǎo)致踝關(guān)節(jié)不能跖屈，趾不能屈，足內(nèi)翻力減弱，其拮抗肌小腿前肌群、外側(cè)肌群收縮，出現(xiàn)足背屈外翻畸形（鉤狀足）。感覺障礙：小腿后面上部、足底皮膚感覺喪失或減弱。,Injury to the tibial nerve can result in paralysis of the flexor muscles in the leg and the intrinsic muscles of the