脊神经-双语-七年制.ppt

脊神经;脊髓内部结构;31 pairs spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal nerve. Formation: each spinal nerve is formed by union of anterior and posterior roots at intervertebral foramen 1.The anterior root 前根 Contains motor fibers for skeletal muscles. Those from T1 to L2 contain sympathetic fibers; S2 to S4 also contain parasympathetic fibers. 2. The posterior root 后根 Contains sensory fibers whose cell bodies are in the spinal ganglion. ;脊髓节段 （31个） Spinal segment;1. Anterior branch 前支: largest , innervates anterolateral body wall and limbs，the great nerve plexus, e.g. the cervical, brachial, lumbar, and sacral, are formed by anterior rami 2. Posterior branch 后支: innervates the back of the trunk 3. Communicating branch 交通支: connect the spinal nerve to the sympathetic trunk 4. Meningeal branch 脊膜支: re-enters vertebral canal through intervertebral foramen to dura mater;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 transmit 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 impulses from the viscera to spinal cord ;颈丛 臂丛 腰丛 骶丛;Cervical plexus 颈丛;3. 主要分支 (1)皮支 枕小神经 耳大神经 颈横神经 锁骨上神经;(2) 肌支: 膈神经 diaphragmatic nerve ;肩周炎？ 风湿性关节炎？ 软组织损伤？ 胆囊炎？;牵涉痛 referred pain;内脏器官疾病时的牵涉性痛区;引起牵涉痛的两种机制假说;(2)易化学说:此学说认为内脏传入纤维的侧支在脊髓与接受体表痛觉传入的同一后角神经元构成突触联系,从患痛内脏来的冲动可提高该神经元的兴奋性.从而对体表传入冲动产生易化作用,使微弱的体表刺激成为致痛刺激产生牵涉痛. ;牵涉痛机理——“经穴脏腑相关”理论的现代机制之一; Brachial plexus 臂丛; 5 - 3 – 6 - 3 - 5 根-干–股-束-支;锁骨上部的分支： 肩胛背N、胸长N、肩胛上N 锁骨下部的分支： 外侧束，内侧束，后束;臂丛;尺神经ulnar nerve;分支分布： 肌支——尺侧腕屈肌、指深屈肌尺侧半、手肌内侧大部分 皮支——手掌内侧1/3，内侧1个半指掌面 手背内侧1/2，内侧2个半指背面;?;典型损伤表现：;(2) 正中神经 median nerve;分支分布： 肌支——除