神经解剖学中山大学Spinal Nerves.pptVIP

第1颈神经干通过寰椎与枕骨之间出椎管，第2～7颈神经干都通过同序数颈椎上方的椎间孔穿出椎管，第8颈神经干通过第7颈椎下方的椎间孔穿出，12对胸神经干和5对腰神经干都通过同序数椎骨下方的椎间孔穿出，第1～4骶神经通过同序数的骶前、后孔穿出，第5骶神经和尾神经由骶管裂孔穿出。 上臂丛（臂丛上干）损害又称Duchenne-Erb麻痹。其临床特点为肩带肌和上肢近端肌群受累，表现为肩胛下肌、大圆肌、冈上肌、冈下肌、三角肌、胸大肌锁骨头、桡侧腕屈肌、旋前圆肌、肱桡肌和旋后肌无力、萎缩，肩关节外展、上举、屈肘和腕关节屈伸不能。感觉障碍不明显，有时上肢及手的桡侧面有感觉缺失。 DR. AUGUSTA MARIE DEJERINE-KLUMPKE(1859-1927) Born in America, she nevertheless studied medicine in Paris to become the first woman to be named interne des hopitaux. She carried on the bulk of his work in private practice and in research when her husband Joseph Jules Dejerine died in 1917. She is known as a clinician and a neuropathologist. In 1885 she described the symptomatology of lower brachial plexus lesions.下臂丛（臂丛下干）损害又称Klumpke-Dejerine麻痹。其临床特点为手的各项运动功能受累，尺侧腕屈肌、蚓状肌、大小鱼际肌和全部指屈肌麻痹，手肌萎缩明显，形成爪形手。手指和腕关节屈曲不能。指伸肌和肩肘关节的活动不受影响。 * Cranial Nerve II – Optic Cranial Nerve III – Oculomotor Oculomotor paralysis Cranial Nerve IV – Trochlear Cranial Nerve V – Trigeminal Trigeminal nerve Cranial Nerve VI – Abducens Cranial Nerve VII – Facial Bell’s palsy Bells palsy. Left: Weakness of all the muscles on the right side of the face becomes evident when the patient tries to smile. Notice the flattened nasolabial folds and widened palpebral fissure on the right. Right: Weakness of the muscles of the right side of the forehead when the patient attempts to furrow the brow. Cranial Nerve VIII – Vestibulocochlear Cranial Nerve IX – Glossopharyngeal Cranial Nerve X – Vagus Cranial Nerve XI – Accessory Cranial Nerve XII – Hypoglossal *** *** *** 阅读材料 1.《系统解剖学》柏树令、应大君主编。 （脊神经/脑神经） 在肘部和前臂，发支支配除肱桡肌、尺侧腕屈肌和指深屈肌尺侧半以外所有前臂屈肌及旋前肌。 在手掌支配鱼际肌(除拇收肌）, 第1、2 蚓状肌。皮支支配手掌桡 侧 2/3 的皮肤，桡侧三个半指的掌面以及其背面中、远指节的皮肤。 尺神经 ulnar nerve (C8～T1) 桡神经 radial nerve (C5～T1) 尺神经 桡神经 正中神经 尺神经 Injury of superior trunk of the brachial plexus Erb-Duchenne palsy Waiter(porter) tip position Injury of inferior trunk of the brachial plexus Klumpke palsy Claw hand Lumbar plexus L1 – L4 (+ L5) Less complex than brachial ple