神经系总论、周围神经系统概述课件.ppt

1、Introduction of the nervous system神经系统总论神经系统总论郑州大学医学院解剖教研室郑州大学医学院解剖教研室Functions1. 控制和调节其它系统的活动，使人体成为一个控制和调节其它系统的活动，使人体成为一个有机的整体。有机的整体。2. 维持机体与外环境间的统一。维持机体与外环境间的统一。3. 不仅能适应环境，还能主观改造世界。不仅能适应环境，还能主观改造世界。DivisionsCentral nervous system (CNS) 1. Brain （脑）（脑） 2. Spinal cord （脊髓）（脊髓）Peripheral nervous syst

2、em (PNS)1.Cranial n. （脑神经（脑神经 12 pairs) 2.Spinal n. (脊神经脊神经 31 pairs) 3.Somatic n. （躯体神经）（躯体神经）4.Visceral n. （内脏神经）（内脏神经）构造神经组织神经组织神经元神经元 神经胶神经胶 胶质细胞比神经元多数十倍，具有具有支持保护营养绝缘和屏障等功能功能 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胞体胞体：3135um突起突起：树突：多个 轴突：1um1m,.2-20um 髓鞘Schwan C Silver StainNissl Sta

3、in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ClassificationSynapsesTransmission Pattern Chemical ElectricNeuron RegionAxodendriticDendrodendriticAxosomaticSomatosomaticAxoplasmic FlowReflex 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中枢部中枢部神经元胞体集聚神经元胞体集聚灰质灰质 皮质皮质 神经核神经核神经纤维集聚神经纤维集聚白质白质 髓质髓质 纤维

4、束纤维束神经元胞体集聚神经元胞体集聚神经节神经节神经纤维集聚神经纤维集聚神经神经周围部周围部网状结构网状结构脊神经节神经Spinal nerve general intyoduction脊神经总论脊神经总论郑州大学医学院解剖教研室郑州大学医学院解剖教研室 General description神经纤维运动感觉 内脏运动躯体运动内脏感觉躯体感觉前根后根31对8对颈神经12对胸神经5对腰神经5对骶神经1对尾神经Functional components1. Somatic efferent nerve fibers 躯体传出纤维躯体传出纤维(SE): fibers that transmit mo

5、tor impulses from spinal cord to skeletal muscles.2. Visceral efferent nerve fibers内脏传出纤维内脏传出纤维(VE): fibers that transmit motor impulses from spinal cord to smooth muscles, cardiac muscle and glands.3. Somatic afferent nerve fibers躯体传入纤维躯体传入纤维(SA): fibers that transmit exteroceptive and propriocepti

6、ve impulses from body to spinal cord 4. Visceral afferent nerve fibers内脏传入纤维内脏传入纤维(VA): fibers that transmit interoceptive impulses from the viscera to spinal cordBranches of spinal nerves脊膜支椎管脊髓被膜、韧带交通支白交通支灰交通支内脏、腺体、立毛肌后支躯干后部深层肌、皮肤前支胸神经：节段性分布颈丛： C1C4腰丛：骶丛：腰骶干：L4一部分，L5S15，Co1臂丛：C5 C8、T1 大部分The Spina

7、l Nerves郑州大学医学院解剖教研室郑州大学医学院解剖教研室一、一、Cervical plexus 颈丛颈丛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 branchesEmerge around middle of posteri

8、or 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 branchessupply the deep muscles of neckPhrenic nerve anterior rami of C3-C5 to diaphragm (motor and sensory) nDescends over scalenus anterior to enter thorax nSensory fibers supply to pleurae, pericardium and

9、 peritoneum of diaphragm; usually right phrenic nerve may be distributed on live, gallbladder and biliary system.Phrenic nerve二、二、Brachial plexus 臂丛臂丛Formation: Formed by anterior rami of C5-C8 and T1 spinal nervesPosition: Passes through the scalene fissure to posterosuperior of subclavian artery,

10、then enters the axilla to form three cordsMain branche 正中神经正中神经内、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

11、,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尺侧腕屈肌尺侧腕屈肌 指深屈肌尺侧半指深屈肌尺侧半拇收肌拇

12、收肌 小鱼际小鱼际 骨间肌骨间肌 3.4蚓状肌蚓状肌损伤表现:爪形手爪形手4、RadialC5-T1 后束后束肱三头肌肱三头肌 肱桡肌肱桡肌 前臂后群肌前臂后群肌损伤表现:垂腕垂腕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、三、Thoracic nervesIntercostal nerves (anterior rami of T1- T11) Subcostal nerve (anterior ramus of T12) Distribution: distributed to intercostal

13、es and anterolateral abdominal muscles, skin of thoracic and abdominal wall, parietal pleura and peritoneum胸神经前支胸神经前支nT2 Sternal angle nT4 Nipple nT6 Xiphoid processnT8 Costal archnT10 UmbilicusnT12 Midpoint between umbilicus and symphysis pubis四、四、Lumbar plexusFormation: formed by anterior rami of

14、L1-L3, a part of anterior rami of T12and L4Position: lies within substance of psoas majorBranchesnIliohypogastricnIlioinguinal nLateral femoral cutaneousnFemoral nObturator nGenitofemoral五、五、Sacral plexus 骶丛骶丛Formation: formed by anterior rami of L4 and L5 spinal nerves (the lumbrosacral trunk) and

15、anterior rami of sacral and coccygeal nervesPosition: lies in pelvic cavity, anterior to sacrum and piriformis Branches1. 臀上神经臀上神经 2. 臀下神经臀下神经3. 股后皮神经股后皮神经4. 阴部神经阴部神经5. 坐骨神经坐骨神经Sciatic nervevLeaves pelvis through infrapiriform foramen to enter gluteal regionvruns inferiorly laterally deep to gluteus

16、 maximusvpassing midway between the greater trochanter of femur and ischial tuberosity to back of thighvlying deep to long head of biceps femorisvnormally divided into tibial and common peroneal nerves just above popliteal fossa; innervates semitendinosusvsemimembranosus and biceps femoris and has a

17、rticular branches to hip and knee jointsTibial nerveDecends 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 jointComm

18、on peroneal nerveSuperficial peroneal nerveDeep peroneal nerveThe Cranial Nerves郑州大学医学院解剖教研室郑州大学医学院解剖教研室学习方法n名称n神经核性质n连脑部位n出入颅部位n主要分支n分支分布Names of cranial nerves Olfactory nerve Optic nerve Oculomotor nerve Trochlear nerve Trigeminal nerve Abducent nerve Facial nerve Vestibulocochlear nerve Glossoph

19、aryngeal nerve Vagus nerve Accessory nerve Hypoglossal nerve连脑部位Functional componentsGeneral 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 f

20、ibers (SVE)General visceral efferent fibers (GVE)Classification of cranial nervesSensory cranial nervesMotor cranial nervesMixed nervesSensory cranial nervesN.Location of cell body and axon categoriesCranial exitTerminal nucleiMain actionOlfactory cells (SVA)CribrifomforaminaOlfactory bulbSmell Gang

21、lion cells (SSA)Optic canalLateral geniculate bodyVision Vestibular ganglion(SSA)Internal acoustic meatusVestibular nucleiEquilibriumCochlear ganglion (SSA)Cochlear nucleiHearing Olfactory nerveOlfactory mucosa (SVA) Cribriform foramina Olfactory bulbOptic nerveGanglion cell (SSA) Optic canal Latera

22、l geniculate bodyVestibulocochlear nerveVestibular ganglion(SSA) Vestibular nuclei Internal acoustic meatus Cochlear ganglion (SSA) Cochlear nucleiMotor cranial nervesN. Nucleus of origin and axon categoriesCranial exitMain actionNucleus of oculomotor (GSE)Superior orbital fissureMotot to superior,

23、inferior and medial recti; inferior obliquus; levator palpebrae superiorisAccessory nucleus of oculomotor (GVE)Parasympathetic to sphincter pupillea and ciliary musclNucleus of trochlear nerve (GSE)Superior orbital fissureMotor to superior obliquusNucleus of abducent nerve (GSE)Superior orbital fiss

24、ureMotor to lateral rectus Nucleus of accessory nerve (SVE)Jugular foramen Motor to sternocleidomastoid and trapeziusNucleus of hypoglossal nerve( GSE)Hypoglossal canalMotot to muscles of tongueOculomotor nerveComponentsnGeneral somatic efferent fibers (GSE)nGeneral visceral efferent fibers (GVE)Mai

25、n actionsupplies nSuperior, inferior and medial recti; inferior obliquus; levator palpebrae superiorisnSphincter 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 nerveAbducent nerve injury Accessory nerveHypoglossal nerveMixed cranial nerves

26、Trigeminal nerveOphthalmic nerve眼神经眼神经Frontal nerve额神经额神经: wSupratrochlear nerve滑车上神经滑车上神经wSupraorbital nerve眶上神经眶上神经Lacrimal nerve泪腺神经泪腺神经Nasociliary nerve鼻睫神经鼻睫神经Maxillary nerve上颌神经上颌神经Leave skull through foramen rotundum BranchesnInfraorbital nerve 眶下神经眶下神经nZygomatic nerve 颧神经颧神经nSuperior alveola

27、r nerve 上牙槽神经上牙槽神经nPterygopalatine nerve 翼腭神经翼腭神经Mandibular nerve 下颌神经下颌神经Auriculotemporal nerve 耳颞神经耳颞神经Buccal nerve 颊神经颊神经Lingual nerve 舌神经舌神经Inferior alveolar nerve下下牙槽神经牙槽神经Nerve of masticatory muscles 咀嚼肌神经咀嚼肌神经DistributionSensation from cerebral dura mater Teeth and gum of lower jaw Mucosa of

28、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 digastricSVEGVESVAGSAFacial nerve ()Branches within the facial canalChorda tympani 鼓索鼓索Greater petrosal nerve岩大神经岩大神经Stapedial nerve 镫骨肌神经镫骨肌

29、神经GanglionPterygopalatine ganglion 翼腭神经节翼腭神经节Submandibular ganglion 下颌下神经节下颌下神经节Branches outside of facial canalTemporal Zygomatic BuccalMarginal mandibular CervicalInjury to the facial nerveSVE GVESVAGVAGSAGlossopharyngeal nerve ()BranchesLingual branches 舌支舌支Pharyngeal branches 咽支咽支Tympanic nerve

30、鼓室神经鼓室神经Carotid sinus branch 颈动脉窦支颈动脉窦支OthersOtic ganglion 耳神经节耳神经节Vagus nerve ()GVESVEGVAGSABranches in neckSuperior laryngeal nerveCervical cardiac branchesOthersBranches in thoraxRecurrent laryngeal nervesBronchial and esophageal branches右右Branches in abdomenAnterior and posterior gastric branche

31、sHepatic 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郑州大学医学院解剖教研室Composition分布于内脏、心血管、平滑肌和腺体。分布于内脏、心血管、平滑肌和腺体。内脏运动神经内脏运动神经周围部周围部副交感神经副交感神经内脏感觉神经内脏感觉神经交感神经交感神经包括包括中枢部中枢部周围部周围部内脏运动神经内脏运动神经又称自主神经系统或植物神经系统。又称自主神经系统或植物神经系统。Visceral motor nervesMain

32、 differences between somatic motor and visceral motor n.Somatic Visceral EffectorsSkeletal musclesCardiac, smooth muscles and glandsKind of fibersOne Two: sympathetic and parasympatheticFrom lower center to effect requireSingle neuronTwo neurons: preganglionic neuron (fiber) and postganglionic neuro

33、n (fiber)Fibers Thick myelinatedPreganglionic: thin myelinated postganglionic: unmyelinatedDistributive formNerve trunkNerve plexusesControl Voluntary (consciousness)Involuntary (unconsciousness )Sympathetic part 交感部交感部Lower centerSympathetic ganglia腹腔神经节、肠系膜上神经节腹腔神经节、肠系膜上神经节主动脉肾节、肠系膜下神经节主动脉肾节、肠系膜下神

34、经节椎旁神经节椎旁神经节交感干神经节交感干神经节 椎前神经节椎前神经节交感神经节交感神经节Paravertebral ganglia 椎旁节椎旁节颈神经节颈神经节颈上神经节颈上神经节颈中神经节颈中神经节颈下神经节颈下神经节胸神经节胸神经节 1012对对腰神经节腰神经节 4对对骶神经节骶神经节 23对对奇神经节奇神经节 1个个Prevertebral ganglia 椎前节椎前节Celiac ganglion 腹腔神经节腹腔神经节Aorticorenal ganglion 主动脉肾节主动脉肾节 Superior mesenteric ganglion 肠系膜上神经节肠系膜上神经节Inferior

35、 mesenteric ganglion肠系膜下神经节肠系膜下神经节Preganglionic fibers中间外侧核中间外侧核 前根前根 脊神经干脊神经干 白交通支白交通支 交感干交感干15 pairs white communicating branch (T1L3) 终于相应椎旁神经节交换神经元终于相应椎旁神经节交换神经元 在交感干内上或下行后终于上或下的椎旁节换元在交感干内上或下行后终于上或下的椎旁节换元 穿过椎旁神经节后终于椎前神经节交换神经元穿过椎旁神经节后终于椎前神经节交换神经元Greater splanchnic nerve内脏大神经内脏大神经 formed by pregan

36、glionic fibers from T5T9 ganglia, and relay in celiac ganglion.Lesser splanchnic nerve内脏小神经内脏小神经 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. L

37、umbar splanchnic nerve腰内脏神经腰内脏神经 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，发自椎旁神经节的节后纤维，经灰交通支返回脊神经，随脊经灰交通支返回脊神经，随脊神经分布于全身

38、血管、汗腺、神经分布于全身血管、汗腺、立毛肌。立毛肌。 攀附动脉走行形成丛随动脉分攀附动脉走行形成丛随动脉分布到所支配器官。布到所支配器官。 直接分布于器官直接分布于器官Distribution of sympathetic nervePreganglionic fibersPostganglionic fibersT1T5Head、neckupper limbthoracic visceraT5T12Abdominal visceraL1L3Pelvic visceralower limbParasympathetic part 副交感部副交感部Lower center: located i

39、n 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 nPara-organ ganglia 器官旁节器官旁节：wCiliary ganglion 睫状神经节睫状神经节wPterygopalatine ganglion 翼腭神经节翼腭神经节w

40、Submandibular ganglion 下颌下神经节下颌下神经节 wOtic ganglion 耳神经节耳神经节nIntramural ganglia 壁内节壁内节 Cranial portion颅部颅部ciliary ganglionsphincter pupillae and ciliary musclespterygopalatine ganglionlacrimal glandsubmandibular ganglionsublingual glandsubmandibular glandotic ganglionparotid glandterminal gangliahear

41、t, lungs, liver, spleenkidneys,alimentary tractas far as left colic flexure Sacral portion 骶部骶部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 pelv

42、ic plexus to terminal ganglia in pelvic cavity Postganglionic fibers terminate in descending and sigmoid colon, rectum and pelvic viscera Main differences between sympathetic and parasympatheticSympathetic Parasympathetic Lower centerLateral gray horn of spinal cord segments T1L3Four pairs parasympa

43、thetic nuclei and sacral parasympathetic nucleusGanglia Paravertebral, prevertebralTerminal Preganglionic f.Shorter LongerPostganglionic f.Longer Shorter Pre: Postganglionic1: many more 1: a fewDistributions Throughout the bodyLimited primarily to head and viscera of thorax, abdomen, and pelvisDiffe

44、rent actionPrepares for emergency situation (fight or flight)Conserve and restore body energy (rest and relaxation)Differences Visceral plexusesCardiac plexuses nSuperficial , below aortic archnDeep, anterior to bifurcation on tracheaPulmonary plexus Celiac plexus Abdominal aortic plexus Hypogastric

45、 plexus nSuperior hypogastric plexus nInferior hypogastric plexus (pelvic plexus) Visceral sensory nervesEnteroceptors ，, Nucleus of solitary tract Sympathetic nerve Pelvic splanchnic nerve Posterior horn Thalamus HypothalamusCerebral cortex Somatic motor neurons visceral motor neuclei Effectors Referred pain 牵涉痛牵涉痛