人體解剖學(xué)：脊髓

脊髓

spinalcord一、脊髓的位置和外形長約45cm占據(jù)椎管上2/3部分與脊柱的彎曲一致重約35g椎管內(nèi)上端－平枕骨大孔接延髓下端－新生兒L3

成人L1下緣Lumbarspinalpuncture(spinaltap)溝和裂

前正中裂

后正中溝

前外側(cè)溝脊神經(jīng)前根

后外側(cè)溝脊神經(jīng)后根

脊神經(jīng)節(jié)后根前根脊神經(jīng)后正中溝前正中裂前外側(cè)溝后外側(cè)溝脊髓每一對脊神經(jīng)前、后根的根絲附著的范圍即是一個(gè)脊髓節(jié)段segment脊髓全長可分31個(gè)節(jié)段cervical頸髓8thoracic胸髓12lumbar腰髓5sacral骶髓5

coccygeal

尾髓1Vertebrae椎骨頸膨大（C4～T1)腰骶膨大(L2～S3）頸髓第6節(jié)最粗腰髓第3節(jié)最粗兩個(gè)膨大脊神經(jīng)與脊髓膨大脊髓圓錐終絲馬尾脊髓圓錐終絲馬尾Relationshipofsegmentsofspinalcordtovertebrae

脊髓節(jié)段椎骨（脊柱）上頸髓(C1~C4)=C1~C4下頸髓和上胸髓(C5~T4)—1=C4~T3中胸髓(T5~T8)—2=T3~T6下胸髓(T9~T12)—3=T6~T9腰髓=T10~T12骶髓和尾髓=L1脊髓節(jié)段與椎骨的對應(yīng)關(guān)系每個(gè)脊髓節(jié)通過一對脊神經(jīng)，支配相應(yīng)一對體節(jié)。每一個(gè)脊髓節(jié)與相對應(yīng)節(jié)段的皮膚（皮節(jié)）和肌肉（肌節(jié)）等軀體性器官以及內(nèi)臟器官之間具有一定的神經(jīng)支配關(guān)系。軟脊膜蛛網(wǎng)膜硬脊膜椎體黃韌帶齒狀韌帶二、Themeningesofspinalcord

Spinalduramater硬脊膜硬膜外隙Spinalarachnoidmater脊髓蛛網(wǎng)膜

蛛網(wǎng)膜下隙終池硬膜下隙Spinalpiamater

軟脊膜終絲Spinalduramater硬脊膜

CharactersAbove,attachedtocircumferenceofforamenmagnumBelow,becomesthinneratlevelofS2,investsfilum

terminaletoattachatbackofcoccyxEpiduralspace

硬膜外隙Subduralspace硬膜下隙椎管內(nèi)面骨膜硬脊膜硬膜外隙蛛網(wǎng)膜硬膜下隙軟脊膜蛛網(wǎng)膜下隙Spinalarachnoidmater脊髓蛛網(wǎng)膜

CharactersAthin,delicate,tubularmembranlooselyinvestingspinalcordAbove,itiscontinuouswithcerebralarachnoidmaterSubarachnoidspace

蛛網(wǎng)膜下隙Position:liesbetweenpiaandarachnoidmaterscontainingcerebrospinalfluidTerminalcistern終池:thelargestpartofsubarachnoidspaceextendingfromterminationofspinalcordtolevelofS2,whereitisoccupiedbynervesofcauda

equina,soitisthebestsiteforalumbarpuncture

Spinalpiamater軟脊膜AdelicatevascularmembranethatcloselyinveststhespinalcordDenticulateligament齒狀韌帶:consistof21pairstriangularligamentsextendingfromspinalcordoneachsidebetweenanteriorandposteriorrootsofspinalnervestospinalduramate;theseligamentshelptofixpositionofspinalcord.Filum

terminale:anextensionofpiabeyondconus

medullaris

終池終絲硬脊膜蛛網(wǎng)膜軟脊膜StructureofSpinalCord

Graymatter灰質(zhì)角（柱）Whitematter白質(zhì)索Centralcanal中央管

三、脊髓的內(nèi)部結(jié)構(gòu)脊髓各節(jié)段的比較節(jié)段外形后角前角白質(zhì)其他C1-4C5-8T1-12L1-5S1-5CO圓形橫卵圓形卵圓圓形近乎圓形圓四邊形小圓形細(xì)長相對細(xì)細(xì)長短粗粗很短中等大寬大細(xì)小粗大粗、圓很短最多多較多少明顯減少最少網(wǎng)狀結(jié)構(gòu)明顯有后中間溝有側(cè)角有粗大神經(jīng)根出入的部位，脊髓增粗，灰質(zhì)量增加脊髓距腦越近的部位，白質(zhì)量越多(一)GrayMatterofSpinalCord

Anteriorhorn(column)前角（柱）Posteriorhorn(column)后角（柱）Lateralhorn(column)側(cè)角（柱）

ispresentinthethoracicandupperlumbersegmentsofthecord(T1-L3)

Intermediatezone中間帶Anteriorgraycommissures

灰質(zhì)前連合Posteriorgraycommissures

灰質(zhì)后連合

Anteriorhorn

(column):

前角containmotorneuronsThreekindsofneuronα-motorneuron:largermultipolarneuron,>37μmγ-motorneuron:smallerneuron,<37μmRenshaw’scell:negativefeedbackmechanismTwogroupsofnucleiMedialnucleargroup:presentinmostsegmentsofspinalcord,innervatingaxialmusclesLateralnucleargroup:presentonlyincervicalandlumbosacralenlargements,innervatinglimbmuscles新生兒頸膨大橫斷面前角外側(cè)核支配四肢肌支配軀干肌前角內(nèi)側(cè)核灰質(zhì)前角－Anteriorhorn前角損傷－骨骼肌癱瘓如；小兒麻痹癥含軀體運(yùn)動神經(jīng)元后內(nèi)側(cè)核前內(nèi)側(cè)核前角中央核膈神經(jīng)核（C3-5）Onuf核（S1-2）后外側(cè)后核手肌或足肌前核肩肌或髖肌前外側(cè)核臂肌或大腿肌后外側(cè)核前臂肌或小腿肌支配肢體伸肌和展肌的神經(jīng)元沿前角外周排列支配屈肌和收肌的神經(jīng)元排列在深部中間外側(cè)核T1-L3

含交感神經(jīng)元。S2-4

骶副交感核。新生兒胸髓橫斷面中間內(nèi)側(cè)核中間帶－Intermediatezone損傷：內(nèi)臟功能障礙含內(nèi)臟運(yùn)動神經(jīng)元灰質(zhì)后角－Posteriorhorn邊緣層后角固有核膠狀質(zhì)新生兒頸膨大橫斷面后角與感覺傳導(dǎo)有關(guān)胸核與軀干四肢疼溫覺有關(guān)含感覺和聯(lián)絡(luò)神經(jīng)元Rexed’s

lamina板層脊髓灰質(zhì)可分為10個(gè)板層,從后向前用Ⅰ～Ⅹ表示。后角邊緣層膠狀質(zhì)后角固有核前角運(yùn)動神經(jīng)核C6L3

Rexed’slamina板層posteriorhornisformedbylaminaⅠtoⅥ；IntermediatezonecorrespondingtolaminaⅦ；AnteriorhorniscomposedlaminaeⅧandⅨ；laminaⅩisthegraymattersurroundingthecentralcanal.脊髓的細(xì)胞構(gòu)筑分層C6L5（二）

WhiteMatterofSpinalCord

Whitemattercontainsthreekindsoffibers:ascending,descending,andfasciculuspropriusAnteriorfuniculus

前索Lateralfuniculus外側(cè)索Posteriorfuniculus后索Anteriorwhitecommissure白質(zhì)前連合脊髓內(nèi)部結(jié)構(gòu)－白質(zhì)纖維束在CNS內(nèi)，起止功能相同的纖維。只是相對集中區(qū)域，分界不清。胎兒時(shí)期相對集中上行纖維束將軀干四肢感覺沖動傳向腦下行纖維束

將運(yùn)動信息從腦傳向軀干四肢命名起止、形態(tài)、功能、綜合等固有束起止均在脊髓，緊靠脊髓灰質(zhì)，參與完成節(jié)段內(nèi)和節(jié)段間反射。AscendingTractsFasciculusgracilis（薄束）Fasciculuscuneatus

（楔束）

Posteriorspinocerebellartract（脊髓小腦后束）Anteriorspinocerebellartract（脊髓小腦前束）Spinothalamic

tract（脊髓丘腦束）薄束和楔束脊髓小腦后束脊髓小腦前束脊髓丘腦束Fasciculuscuneatus1.薄束和楔束Fasciculusgracilis起始走行功能同側(cè)軀干肢體深感覺和精細(xì)觸覺固有束皮質(zhì)脊髓束皮質(zhì)脊髓側(cè)束皮質(zhì)脊髓前束薄束和楔束脊髓丘腦束SLTCSpinothalamic

tract2.脊髓丘腦束起始走行功能對側(cè)1-2平面以下軀干肢體淺感覺脊髓小腦束脊髓小腦前束

整體運(yùn)動和姿勢脊髓小腦后束

肢體個(gè)別肌的精細(xì)運(yùn)動和姿勢協(xié)調(diào)脊髓小腦吻側(cè)束楔小腦束

Descendingtracts下行纖維束Lateralcorticospinaltract（皮質(zhì)脊髓側(cè)束）Anteriorcorticospinal

tract（皮質(zhì)脊髓前束）Rubrospinaltract（紅核脊髓束）Vestibulospinaltract（前庭脊髓束）Reticulospinaltract（網(wǎng)狀脊髓束）Mediallongitudinalfasciculus（內(nèi)側(cè)縱束）Tectospinaltract（頂蓋脊髓束）Fasciculusproprius

（固有束）皮質(zhì)脊髓束皮質(zhì)脊髓前束皮質(zhì)脊髓側(cè)束紅核脊髓束前庭脊髓束頂蓋脊髓束網(wǎng)狀脊髓束內(nèi)側(cè)縱束皮質(zhì)脊髓束上下運(yùn)動神經(jīng)元綜合征的比較癱瘓?zhí)攸c(diǎn)痙攣性癱（硬癱）遲緩性癱（軟癱）癱瘓范圍范圍廣泛范圍局限肌張力增高降低肌萎縮

無，晚期廢用性萎縮早期出現(xiàn)深反射亢進(jìn)減弱或消失淺反射減弱或消失減弱或消失病理反射有無皮質(zhì)脊髓束紅核脊髓束前庭脊髓束頂蓋脊髓束網(wǎng)狀脊髓束內(nèi)側(cè)縱束皮質(zhì)脊髓前束皮質(zhì)脊髓側(cè)束（三）網(wǎng)狀結(jié)構(gòu)－Reticularformation四、Bloodvesselsofspinalcord1.ArteriesofspinalcordTwosources

AnteriorandposteriorspinalarteriesBranchesofsegmentalarteries:ra