1、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） Vis
2、ceral 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,Reflex Arc,机体接受内外界环境的刺激 作出的
3、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 trans
4、mit 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 impuls
5、es 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 nerves Position: lies in front of the origin of levator scapulae and scalenus medius and deep to the superior part of the sternocleidomastoid 分支：
6、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 neck Phrenic nerveanterior rami of C3-C5to diaphragm (motor and sensory) Descends over scalenus anterior to e
7、nter 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 nerves Position: Passes through t
8、he 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
9、 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
10、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
11、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 process T8 Costal arch T10 Umbilicus T12 Midpoint between umbilicus and symphysis pubis,四、Lumbar plex
12、us,Branches,Iliohypogastric Ilioinguinal Lateral femoral cutaneous Femoral 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 nerves Position: lies in pelvic cavity, anterior to s
13、acrum 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 region runs inferiorly laterally deep to gluteus maximus passing midway between the greater trochanter of femur and ischial tuberosity to back of thigh lying deep to lon
14、g head of biceps femoris normally divided into tibial and common peroneal nerves just above popliteal fossa; innervates semitendinosus semimembranosus and biceps femoris and has articular branches to hip and knee joints,Tibial nerve,Decends through popliteal fossa and lies on popliteus then runs inf
15、eriorly with posterior tibial vessels and terminates beneath flexor retinaculum by dividing into medial and lateral plantar nerves supplies 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, Olfact
16、ory 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) Gene
17、ral 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 nerves Motor cranial nerves Mixed nerves,Sensory cranial nerv
18、es,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 meatusCochlear ganglion (SSA) Cochlear nuclei,Motor cranial nerves,Ocu
19、lomotor nerve,Components General somatic efferent fibers (GSE) General visceral efferent fibers (GVE) Main actionsupplies Superior, inferior and medial recti; inferior obliquus; levator palpebrae superioris Sphincter pupillea and ciliary muscle Ciliary 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
20、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 for
21、amen rotundum Branches Infraorbital 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
22、 cerebral dura mater Teeth and gum of lower jaw Mucosa of floor of mouth Anterior 2/3 of tongue Skin of auricular and temporal regions and below the mouth Motor to masticatory muscles, mylohyoid, and anterior belly of digastric,SVE GVE SVA GSA,Facial nerve (),Branches within the facial canal,Chorda
23、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 Buccal Marginal mandibular Cervical,Injury to the facial nerve,SVE GVE SVA GVA GSA,Glossopharyngeal nerve (),Branches,
24、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 (),GVE SVE GVA GSA,Branches in neck,Superior laryngeal nerve Cervical cardiac branches Others,Branches in thorax,Recurrent laryngeal nerves Bronchial and esophageal branches
25、,右,Branches in abdomen,Anterior and posterior gastric branches Hepatic branches Celiac 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,Low
26、er center Sympathetic 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 gang
27、lia, 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 Forme
28、d 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 sympat
29、hetic 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 S2S4 Parasympathetic ganglia: terminal ganglia are near or within the wall of a visceral organ Para-organ ganglia 器官旁节： Ciliary
30、 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 gland submandibular gland,otic ga
31、nglion,parotid gland,terminal ganglia,heart, lungs, liver, spleen kidneys,alimentary tract as 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
32、 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 , b
33、elow aortic arch Deep, anterior to bifurcation on trachea Pulmonary 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,
