1、May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,三、臂 丛,（一）臂丛的组成和位置,组成：第5-8颈神经前支、第1胸神经前支大部分。 位置：经斜角肌间隙穿出，位于锁骨下动脉的后上方，继而经锁骨后方入 腋 窝，形成臂丛内侧束、后束和外侧束。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right
2、 reserved by YP HOU and YF SONG,5根3干6股3束5支，53635,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（二）臂丛的分支： 锁骨上分支
3、： 1.胸长神经(long thoracic nerve) 2.肩胛背神经（dorsal scapular never） 3.肩胛上神经（suprascapular never） 锁骨下分支 1.胸背神经(thoracodorsal nerve) 2.肩胛下神经（subscapular never ） 3.腋神经(axillary nere) 4.桡神经(radial nerve) 5.肌皮神经(musculocutaneous nerve)（外侧束发出） 5.尺神经(ulnar nerve)（内侧束发出） 6.正中神经(median nerve)（内、外侧束共同形成） 7.胸内侧神经（med
4、ial pectoral never） 8.胸外侧神经（lateral pectoral never）,后束分支,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,1.胸长神经(long thoracic nerve),分布于前锯肌和乳房。此神经损伤可出现“翼状肩”体征,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou Univer
5、sity. All right reserved by YP HOU and YF SONG,2.胸背神经(thoracodorsal nerve),分布于背阔肌，乳腺癌根治手术时注意勿伤此神经,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,3.腋神经,从后束发出,肌支支配三角肌和小圆肌，皮支分布于肩部和上臂后部的皮肤。损伤后出现“方肩”,May, 2009,Copyright Depart. Anatom
6、y, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,4.肌皮神经,发自外侧束，肌支支配喙肱肌、肱二头肌和肱肌。皮支分布于前臂外侧皮肤。,肌,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,5.正中神经,臂部分布： 由内、外侧束发出，臂部无分支，在前臂肌支支配除肱桡肌、尺侧腕屈肌、指深屈肌尺侧半以
7、外的前臂前群肌（6.5块肌肉）,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,正中神经的手区分布： 第1、2蚓状肌及鱼际肌（拇收肌除外）； 手掌桡侧2/3，桡侧3+1/2指掌面及其中节和远节指背面的皮肤。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP
8、HOU and YF SONG,正中神经损伤,正中神经与尺神经损伤（猿掌）,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,6.尺神经,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,尺神经的分支： 在臂部，无分支； 在前臂
9、上部，分支分布于尺侧腕屈肌、指深屈肌尺侧半深支手部分布于小鱼际肌、拇收肌、骨间肌、第3、4蚓状肌,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,尺神经的手区皮肤分布：,浅支分布于手背尺侧半和尺侧2个半手指背侧皮肤，手掌小鱼际、小指和环指尺侧半皮肤；,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All
10、 right reserved by YP HOU and YF SONG,尺神经损伤 （爪形手）,正中神经与尺神经损伤（猿掌）,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,前面观,后面观,7.桡神经,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP H
11、OU and YF SONG,桡神经浅支指背神经 桡神经深支骨间后神经,臂后皮神经 臂外侧下皮神经前臂后皮神经,分布于肱三头肌、肘肌、肱桡肌和桡侧腕长伸肌,在臂部,3个皮支肌支关节支,发出,分布于肘关节,桡神经的分支：,在前臂,发出,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,桡神经的手区皮肤分布：,May, 2009,Copyright Depart. Anatomy, School of Medici
12、ne, Lanzhou University. All right reserved by YP HOU and YF SONG,桡神经损伤（垂腕）,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（五）腰丛,组成：第12胸神经前支的一部分、第1-3腰神经前支和第4腰神经前支的一部分。 位置：腰大肌深面腰椎横突前方。,（一）腰丛的组成和位置,May, 2009,Copyright Depart. Anatom
13、y, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（二）腰丛的分支 1.髂腹下神经(iliohypogastric nerve) 2.髂腹股沟神经(ilioinguinal nerve) 3.股外侧皮神经(lateral femoral cutaneus nerve) 4.股神经(femoral nerve)肌支皮支隐神经 5.闭孔神经(obturator nerve) 6.生殖股神经(genitofemoral nerve),May, 2009,Copyright Depar
14、t. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,髂腹下神经：腰大肌外侧缘传出后走形于腹横肌、腹内斜肌、腹外斜肌之间，在腹股沟管浅环上方3 4 cm处穿出。分布于耻骨联合上方皮肤和腹壁下部的肌肉。阑尾手术麦氏切口强调钝性分离腹内外肌，以避免损伤。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU an
15、d YF SONG,髂腹股沟神经：在髂腹下神经的下方，进入腹股沟管，行于精索上方，出腹股沟管浅环。分布于阴囊或大阴唇皮肤，肌支支配腹壁下部的肌肉。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,是腰丛中最粗大的一个分支，股神经的分支有：肌支：支配股四头肌、耻骨肌和缝匠肌的运动。皮支：分布于股前面皮肤。最长的皮支为隐神经,3、股神经：,May, 2009,Copyright Depart. Anatomy,
16、School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,4、闭孔神经,在腰大肌内侧下行入小骨盆，穿过闭膜管至股部，主要支配股内收肌的运动和传导股内侧皮肤的感觉。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,5、生殖股神经 在髂总血管附近分为生殖支和股支。生殖支进入腹股沟管，随精索下行，分布于提睾肌和阴
17、囊（或大阴唇）。手术处理腹股沟管时应注意。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,（六）骶 丛,组成：第4腰神经前支余部和第5腰神经前支合成的腰骶干及全部骶神经和尾神经前支组成。 位置：位于盆腔内，骶骨和梨状肌的前面，髂血管后方，左侧骶丛前方有乙状结肠，右侧者前方有回肠袢。,（一） 骶丛的组成和位置,May, 2009,Copyright Depart. Anatomy, School of Med
18、icine, Lanzhou University. All right reserved by YP HOU and YF SONG,(二) 骶丛的分支 1.臀上神经(superior gluteal nerve) 2.臀下神经(inferior gluteal nerve) 3.股后皮神经(posterior femoral cutaneous nerve) 4.阴部神经(pudendal nerve) 5.坐骨神经(sciatic nerve),May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou Univers
19、ity. All right reserved by YP HOU and YF SONG,1、臀上神经和臀下神经,臀上神经由梨状肌上孔出盆腔，分布于臀中肌、臀小肌和阔筋膜张肌臀下神经由梨状肌下孔出盆腔，分布于臀大肌。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,2、阴部神经,从梨状肌下孔出盆腔，绕坐骨棘经坐骨小孔进入坐骨直肠窝，分布于会阴、外生殖器、肛门的肌肉和皮肤,May, 2009,Copyrigh
20、t Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,是全身最粗大、最长的神经。经梨状肌下孔出盆腔后走行于臀大肌深面，在坐骨结节与大转子之间下行至股后区，继而在股二头肌深面下行，分布于股后群肌。 在腘窝上方分为两大分支： 胫神经 腓总神经,3、坐骨神经,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by Y
21、P HOU and YF SONG,胫神经(tibial nerve) 分为两终支： 足底内侧神经 足底外侧神经 分布范围： 小腿后群和足底肌肉的运动及皮肤感觉,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,胫神经损伤（钩状足）,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right res
22、erved by YP HOU and YF SONG,腓总神经 分为两支：腓浅神经腓深神经 分布范围： 小腿前群、外侧群肌、足背肌的运动；小腿外侧、足背、趾背的皮肤感觉,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,腓总神经损伤马蹄内翻足畸形，行走时呈跨阈步态,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou Universi
23、ty. All right reserved by YP HOU and YF SONG,（七）脊神经损伤定位相关解剖基础,1. 脊神经分布的节段性规律 在躯干，颈神经和胸神经皮肤分布区阶段性明显，由上向下依顺序分阶段排列； 四肢的皮神经大致按肢芽长出的方向：在分布到肢体的神经顺序中，最上、最下者分布于肢体近侧；顺序居中的神经分布于肢体远侧部。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,May, 200
24、9,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,2. 皮神经分布的重叠性,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,3. 临床常用检测的肌运动及其节段神经支配,临床实践中，只需检测少数相关肌肉的运动，便可确定神经损伤的部位。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,
