神经系统总论PPT精品课件

1、Nervous System神经系统第十六章 神经系统总论一、神经系统的区分一、神经系统的区分中枢神经系统(CNS) central nervous system脑 brain脊髓 spinal cord周围神经系统(PNS) peripheral nervous system按连接部位脊神经 spinal nerves 脑神经 CN cranial nerves按分布对象躯体神经 somatic nerve内脏神经 visceral nerve功能 Function维持和调节其他系统的活动，使人体成为一个有机的整体。维持机体与外环境间的统一。The nervous system is a m

2、aster system in the living body, it regulates and integrates the activities of all the other bodily systems for the benefit of the organism as a whole.二、神经系统的组成神经系统是由神经组织构成的。神经组织是由神经元和神经胶质构成的。1. 神经元的结构 胞体 cell body突起树突 dendrite轴突 axon（一） 神经元 Neuron神经元是神经系统的形构和功能单位。2A.神经元分类根据神经元的形态和突起的数目2B. 神经元分类Sens

3、ory neuronAssociation neuronMotor neuronABC根据神经元的功能和传导方向联络神经元感觉神经元运动神经元2. 神经纤维 Nerve fibers具有神经膜细胞鞘的轴突无髓纤维（轴突+神经膜）薄髓纤维（轴突+神经膜+髓鞘）有髓纤维（轴突+神经膜+髓鞘）传入纤维afferent fibre 传出纤维efferent fibre有髓纤维突触突触突 触 Synapse突 触 Synapse(二)神经胶质或神经胶质细胞glial cell作用：支持、营养、保护和修复等三、神经系统的常用术语灰质 gray matter皮质 cortex神经核 nucleus神经节 g

4、anglion白质 white matter髓质 medulla纤维束 fasciculus神经 nerve灰质 gray matter皮质 cortex神经核 nucleus白质 white matter髓质 medulla灰质 gray matter,神经核 nucleus,白质 white matter纤维束 fasciculus,神经节 ganglion, 神经 nerve神经系统的常用术语灰质gray matter：即神经元胞体及其树突在中枢神经系统的集聚部位。皮质cortex：即配布在大、小脑表面的灰质。神经核nucleus：即在中枢部皮质以外，形态和功能相似的神经元胞体集聚成的团

5、或柱。神经节ganglion：即神经元胞体在周围神经系统集聚的部位。白质white matter：即神经纤维在中枢神经系统集聚的部位。髓质medulla：即位于大、小脑皮质深部的白质。纤维束fasciculus：在白质中，起止、行程和功能基本相同的神经纤维集合在一起称为纤维束。神经nerve：神经纤维在周围神经系统集聚在一起称为神经。四、反射与反射弧反射与反射弧反射 ：是神经活动的基本方式，神经系统通过与它相连的各种感受器，接受内、外环境的各种刺激，经传入神经传导中枢（脊髓或脑）的不同部位，经过整合后发出相应的神经冲动，经传出神经传至相应的效应器，产生各种反应，称反射。反射弧 ：是反射的物质基

6、础，由感受器、传入神经、中枢、传出神经和效应器构成。第十八章 周围神经系统The Peripheral Nervous System第一节 脊神经一、概 述脊神经构成脊神经分部脊神经纤维成分脊神经的分支（一）脊神经的构成、分部和纤维成分颈神经8对cervical n.胸神经12对thoracic n.腰神经5对lumbar n. 骶神经5对sacral n. 尾神经1对coccygeal n.脊神经的分部脊神经的纤维成分 The component of the spinal nervesThe somatic afferent (sensory) fibers 躯体传入（感觉）纤维The v

7、isceral afferent (sensory) fibers 内脏传入（感觉）纤维The somatic efferent (motor) fibers 躯体传出（运动）纤维The visceral efferent (motor) fibers 内脏传出（运动）纤维脊神经纤维成分1.躯体传入（感觉）纤维：来自脊神经节的假单极神经元，其中枢突构成脊神经后根进入脊髓，周围突进入脊神经分布于皮肤、骨骼肌、肌腱和关节。将皮肤浅感觉（痛、温触觉）和肌、腱、关节的深感觉（运动觉、位置觉）中枢。内脏传入（感觉）纤维2.内脏传入（感觉）纤维：来自脊神经节的假单极神经元，其中枢突构成脊神经后根进入脊髓，

8、周围分布于内脏、心血管和腺体，将这些结构的感觉冲动传入中枢。躯体运动（传出）纤维3.躯体运动（传出）纤维：发自脊髓前角，分布于骨骼肌、支配其随意运动。 内脏运动（传出）纤维4.内脏运动（传出）纤维：发自胸腰段脊髓侧角（交感中枢）或骶副交感核（副交感中枢），分布于内脏、心血管和腺体，支配心肌、平滑肌的运动，控制腺体的分泌。（二）脊神经的分支 branches of the spinal nerve前支后支交通支脊膜支脊神经后支分布于背部的皮肤和深层肌肉。 脊神经前支除胸神经前支保持原有的节段性走行和分布外，其余脊神经前支分别交织成脊神经丛，即 颈丛cervical plexus 臂丛brachi

9、al plexus 腰丛lumbar plexus 骶丛sacral plexus分布于躯干前外侧和四肢的肌肉和皮肤。一、颈 丛 Cervical Plexus组成 formation位置 location分支及其分布浅支 superficial branches (cutaneous nerves)深支 deep branches (muscular branches)1.颈丛的组成1.组成：颈丛由第14颈神经前支组成。2.颈丛位置 2. 位置：位于肩胛提肌和中斜角肌的前方，胸锁乳突肌的深面。胸锁乳突肌中斜角肌肩胛提肌Lesser occipital n.Great auricular n.

10、Transverse cervical n.Intermidate supraclavicular n.Lateral supraclavicular n.Medial supraclavicular n.颈前神经内侧锁骨上神经中间锁骨上神经外侧锁骨上神经耳大神经枕小神经 3A.颈丛的皮支胸锁乳突肌后缘中点称神经点“nervous point”，是颈丛皮支较集中浅出深筋膜处，为颈部浅层结构浸润麻醉的一个阻滞点。3A.颈丛皮支的分布Lesser occipital n.Great auricular n.Transverse cervical n.Supraclavicular n.3B.颈丛肌

11、支膈神经3B.颈丛肌支：主要支配颈部深层肌、肩胛提肌、斜方肌、胸锁乳突肌、舌骨下肌群和膈。3B.颈丛肌支To infrahyoid musclesTo trapeziusPhrenic nerve膈神经膈神经膈神经膈神经膈神经的分布右膈神经的分布膈神经phrenic nerve组成：由第35颈神经前支组成。行程：经前斜角肌前面锁骨下动、静脉之间肺根前方心包外侧膈。分布：其运动纤维支配膈肌，感觉纤维分布于胸膜和心包及膈下部分腹膜。The motor fibres supply the diaphragm, the sensory fibres are distributed to the dia

12、phragmatic peritoneum, the diaphragmatic and mediastinal pleurae and the pericardium.右膈神经的感觉纤维尚分布到肝、胆囊和肝外胆道的浆膜。The sensory fibres of the right phrenic nerve is also distributed to the liver, the gallbladder and the bile duct system.二、臂 丛The brachial Plexus组成 formation位置 location分支和分布 branches and di

13、stribution神经损伤 lesion of the nerve 1. 组成：臂丛由第58颈神经前支和第1胸神经前支大部分纤维组成。C5C6C7C8T11A.臂丛的组成1B.臂丛的根干股束2.臂丛的位置臂丛位于斜角肌间隙内锁骨中段后方腋窝内腋动脉周围。Long thoracic nerve Thoracodorsal nerve Medial pectoral nerveLateral pectoral nerve3.臂丛的分支及其分布胸内侧神经胸外侧神经胸背神经胸长神经Branches and distribution of brachial plexus（1）胸长神经：起自C57前支，

14、支配前锯肌，损伤后前锯肌瘫痪，产生“翼状肩胛”。The long thoracic nerve supplies the serratus anterior muscle. Crushing or cutting the long thoracic nerve results in paralysis of the serratus anterior muscle and “winging of the scapula” . 。胸背神经：起自臂丛后束，支配背阔肌。 The thoracodorsal nerve arises from the posterior cord of the bra

15、chial plexus and supplies the latissimus dorsi muscle. 胸内侧神经：起自臂丛内侧束，支配胸大肌和胸小肌。 The medial pectoral nerve arises from the medial cord of the brachial plexus and supplies the pectoralis major and pectoralis minor muscle. 胸外侧神经：起自臂丛外侧束，支配胸大肌。 The lateral pectoral nerve arises from the lateral cord of

16、the brachial plexus and supplies the pectoralis major and pectoralis minor muscle. 腋神经 axillary nerve腋神经 axillary nerve旋肱后动脉腋神经四边孔腋神经axillary nerve腋神经axillary nerve：起自臂丛的后束，伴旋肱后血管穿四边孔绕肱骨外科颈至三角肌深面，肌支支配三角肌和小圆肌，皮支布于肩部和臂外侧上部皮肤。腋神经损伤：在肱骨外科颈骨折或肩关节脱位时易损伤，损伤后导致三角肌瘫痪，肩关节外展不能，小圆肌瘫痪肩关节外旋减弱，肩部和臂外侧上部皮肤感觉障碍。The a

17、xillary nerveTo arise from the posterior cord of the brachial plexus.To leave the axilla by passing backward with the posterior circumflex humeral vessels through the quadrilateral space and wind round the surgical neck of the humerus to reach the deltoid muscle.To supply the deltoid and teres minor

18、 muscles and the skin over the deltoid.To may be injured in fracture of the humeral neck or in dislocation of the shoulder joint.The axillary nerve injury results in deltoid paralysis (loss of shoulder abduction ), loss of sensation over the deltoid muscle, and teres minor paralysis ( weak external

19、rotation).(6)肌皮神经臂丛外侧束肌皮神经喙肱肌肱二头肌前臂外侧皮神经肱肌肌皮神经：起自臂丛外侧束，肌支支配臂部前肌群（喙肱肌、肱肌和肱二头肌），终支为皮支称为前臂外侧皮神经，分支布于前臂外侧的皮肤。肌皮神经损伤：出现屈肘无力，前臂旋后力减弱，前臂外侧的皮肤障碍。喙肱肌肱二头肌肱肌肌皮神经The musculocutaneous nerveTo arise from the lateral cord of the brachial plexus.To innervate the flexor muscles of the arm,including the coracobrachia

20、lis, biceps brachii, and brachialis muscles.To continue into the forearm as the lateral cutaneous nerve of the forearm, which supplies the lateral surface of the forearm.Injury to the musculocutaneous nerve in the axilla is usually inflicted by a knife or bullet. The wound results paralysis of the c

21、oracobrachialis, biceps, and brachii, consequently, lesion of the elbow and supination of the forearm are weakened. Loss of sensation may occur at the lateral surface of the forearm supplied by the lateral cutaneous nerve of the forearm. 正中神经Median nerveMedian nerveMedian nerve臂丛外侧束臂丛内侧束正中神经外侧根正中神经内

22、侧根正中神经正中神经正中神经组成行程正中神经 median nerve组成：由分别起自臂丛内、外侧束的内、外侧根汇合而成。行径：在腋窝两根夹持腋动脉，在臂部与肱动脉伴行在肱二头肌内侧沟内下行至肘窝，穿旋前圆肌及指浅屈肌腱弓至前臂，于前臂指浅、深屈肌间达腕部，穿腕管至手掌。正中神经的分支分布臂丛内侧束臂丛外侧束正中神经正中神经的分支分布在臂部无分支；在前臂发出分支支配除肱桡肌、尺侧腕屈肌、指深屈肌尺侧半之外的前臂屈肌群。正中神经的分支分布在手掌发出：正中神经返支，支配除拇收肌以外的鱼际肌；骨间总神经，支配第1、2蚓状肌和掌心、桡侧三个半手指掌面及其中节和远节指背的皮肤。正中神经返支骨间总神经在肱

23、骨髁上骨折、穿旋前圆肌及指浅屈肌腱弓、腕管时易损伤或压迫正中神经；表现为屈腕无力，拇指不能对掌，鱼际肌萎缩，手掌平坦，称 “ape-like hand 猿手”，拇指、食指、中指掌面皮肤感觉障碍。正中神经损伤：The median nerveTo be formed in the axilla by the union of medial and lateral root from the medial and lateral cords of the brachial plexus , respectively.To has no branches in the arm.To supply f

24、lexor and pronator muscles in the forearm, including both pronators and all of the flexor muscles except the brachioradialis, the flexor carpi ulnaris and the medial half of the flexor digitorum profundus.Supracondylar fracture of the humerus may injure the median nerve and the brachial artery.An in

25、jury to the median nerve in the forearm can result in interfering with pronation of the forearm,with flexion of the phalanges of the second, the third digits and the distal phalanx of the thumb and with opposition of the thumb. Wrist flexion is less involved. The thenar muscles are paralysed,so that

26、 the thumb becomes to lie in the same plane as the other digits, it is just an “ape-like”hand. There is also a loss or weakness of sensation from the skin of the radial part of the palm and of the thumb, index and middle fingers and the radial half of the ring finger. Ulnar nerve 尺神经臂丛内侧束尺神经Ulnar ne

27、rve尺神经组成行程尺神经 ulnar nerve组成：尺神经起自臂丛内侧束。行径：伴肱动脉行于肱二头肌内侧沟，在臂中份穿内侧肌间隔至臂后区内侧，经尺神经沟穿尺侧腕屈肌至前臂，在尺侧腕屈肌深面伴尺血管下行，经豌豆骨桡侧至手掌。 尺神经分支分布分支分布在臂部无分支。在前臂发出分支支配尺侧腕屈肌、指深屈肌尺侧半。在腕部发出 尺神经的手背支：分布于手背尺侧半和小指、环指及中指尺侧半背面皮肤。在手部发出尺神经的浅支：分布于小鱼际、小指和环指尺侧半掌面皮肤；尺神经的深支：分布于小鱼际肌、拇收肌、骨间肌及第3、4蚓状肌。尺神经损伤尺神经尺侧腕屈肌指深屈肌尺侧半小鱼际肌第34蚓状肌拇收肌骨间肌尺神经损伤尺神

28、经损伤内上髁骨折或尺神经沟，处损伤：可导致尺侧腕屈肌、指深屈肌尺侧半、拇收肌、骨间肌、第34蚓状肌、小鱼际肌瘫痪，出现屈腕力减弱、拇指不能内收，小指和环指远侧指骨间不能屈，夹纸实验阳性，呈“爪形手”，手背尺侧半、尺侧2个半指指背皮肤、尺侧1个半指掌侧和小鱼际等处皮肤感觉障碍。 豌豆骨远侧损伤：导致拇收肌、骨间肌、第34蚓状肌、小鱼际肌瘫痪瘫痪，出现拇指不能内收，小指和环指远侧指骨间不能屈，夹纸实验阳性，呈“爪形手”，尺侧2个半指指背皮肤、尺侧1个半指掌侧和小鱼际等处皮肤感觉障碍。尺神经 The ulnar nerveTo arises from the medial cord of the b

29、rachial plexus.To pass along the groove between the medial epicondyle of the humerus and the olecranon.To has no branch in the arm.To supply the flexor carpi ulnaris, the medial half of the flexor digitorum profundus muscles, lumbricales 3ad 4,the adductor pollicis , andthird to fourth muscle . 桡神经

30、radial nerve桡神经臂丛内侧束 桡神经 桡神经 桡神经桡神经桡神经深支骨间后神经桡神经浅支桡神经 radial nerve起自臂丛后束;沿桡神经沟绕肱骨中段后面，在肱骨外上髁前方分为浅支和深支。桡神经浅支在肱桡肌深面伴桡血管下行，在前臂中、下1/3交界处经肱桡肌腱深面至前臂后区，尔后达手背；深支经桡骨颈外侧穿旋后肌至前臂后面，称为骨间后神经。在腋窝，桡神经发出肌支支配肱三头肌；皮支为臂后皮神经，布于臂后区皮肤。在臂部，发出臂外侧下皮神经，布于臂外侧下皮肤；前臂后皮神经，布于前臂后区皮肤；肌支支配肱桡肌、肘肌和桡侧腕长伸肌。在肘窝，桡神经分为两个终末支： 桡神经深支，支配前臂伸肌群；

31、桡神经浅支，分支布于手背桡侧半和桡侧三个手指近节背面的皮肤和关节。Wrist-drop “垂腕”虎口区皮肤感觉障碍桡神经损伤The lesion of the radial nerve桡神经损伤在腋窝，损伤桡神经，导致臂伸肌、前臂伸肌瘫痪，出现不能伸肘、伸腕和伸指，当抬高前臂时呈“垂腕”状；臂后区、前臂后区、手背桡侧半（虎口区）、桡侧两个半指近节背面皮肤感觉障碍。肱骨中段骨折，伤及桡神经，导致前臂伸肌瘫痪，出现不能伸腕和伸指，当抬高前臂时呈“垂腕”状；前臂后区、手背桡侧半、桡侧两个半指近节背面皮肤感觉障碍。桡骨颈骨折伤及桡神经深支，导致前臂伸肌瘫痪，出现不能伸腕和伸指，当抬高前臂时呈“垂腕”状

32、 。在前臂远侧伤及桡神经浅支，导致手背桡侧半、桡侧两个半指近节背面皮肤感觉障碍。The distribution of the nerve in the hand肱骨骨折肱骨外科颈骨折肱骨中段骨折肱骨髁上骨折肱骨内上髁骨折四、胸神经的前支Subcostal nerveintercostal nerve肋间神经肋下神经肋间神经 Intercostal nerves肋间神经外侧皮支前皮支肋间神经肋间神经 Intercostal nerves肋间神经外侧皮支前皮支Intercostal nervesLateral cutaneous branchAnteriorl cutaneous branch肋

33、间神经的侧支胸神经前支的分支分布Intercostal nerve（T11）胸骨角平面乳突平面剑突平面肋弓平面脐平面脐与耻骨联合连线中点平面T2T4T6T8T10T12胸神经前支在胸腹前壁的节段性分布The Ventral Rami of the Thoracic Nerve胸神经的前支有12对. They are twelve in number on each side第111胸神经前支称肋间神经 。第12胸神经前支称肋下神经。 The upper eleven lie between the ribs and are called the intercostal nerves . The

34、 twelfth lies below the last rib,so it is called the subcostal nerve. 其肌支支配肋间肌、腹直肌、腹外斜肌、腹内斜肌、腹横肌。皮支布于胸、腹前外侧壁皮肤。胸神经前支在胸腹前外侧壁的分布具有节段性。 The distribution of the anterior branches of the thoracic nerves is segmental on the anterior surface of the trunk, they present about the level of : T2-the sternal an

35、gle; T4-the nipple;T6-the xiphoid process; T8-the costal arch;T10-the umbilicus; T12-the anterior superior iliac spine五、The Lumbar Plexus 腰 丛组成 formation位置 location主要分支及其分布 The main branches and its distributions 神经损伤 lesion of nerve1.腰丛的组成1.腰丛的位置和分支髂腹下神经髂腹股沟神经生殖股神经股外侧皮神经股神经生殖股神经的生殖支生殖股神经的股支闭孔神经腰大肌T

36、12生殖股神经腰丛 The Lumbar Plexus（1）组成：由第12胸神经前支的一部分、第13腰神经前支和第4腰神经前支的一部分构成。The formation: it is formed by the ventral rami of the first three lumbar nerves, a part of the ventral rami of the last thoracic nerve and the fourth lumbar nerve.位置：位于腰大肌的深面。 The location:It is situated deep to the psoas major m

37、uscle,anterior to the transverse processes of the lumbar vertebrae.主要分支：有髂腹下神经、髂腹股沟神经、股外侧皮神经、股神经、闭孔神经、生殖股神经等。The branches: the iliohypogastric n., ilioinguinal n., lateral femoral cutaneous n., femoral n., obturator n., genitofemoral n.髂腹下神经 iliohypogastric nerve、髂腹股沟神经 ilioinguinal nerve 、生殖股神经 gen

38、itofemoral nerve腰丛 The Lumbar Plexus（2）髂腹下神经iliohypogastric nerve：肌支支配腹前外侧壁肌，皮支布于臀外侧区、腹股沟区和下腹部的皮肤。Its muscular branch innervates the muscles of the lower part of the abdominal wall. Its cutaneous branch supply the skin of the hypogastric region , lateral area of the gluteal and medial area of the gr

39、oin.髂腹股沟神经ilioinguinal n. ：肌支支配腹前外侧壁肌，皮支布于腹股沟部、阴囊或大阴唇皮肤。Its muscular branch innervates the muscles of lower abdominal wall.Its cutaneous branch supplies the scrotum(or the labium major) and the groin.生殖股神经：生殖支布于提睾肌和阴囊；股支布于股三角部的皮肤。Its genital branch supplies the cremaster muscle and the anterior scro

40、tum or labia majora(the efferent limb of the cremaster reflex in men). Its femoral branch is distributed to inguinal triangle(the afferent limb of the cremaster reflex ).临床意义：髂腹下神经、髂腹股沟神经、生殖股神经是位于腹股沟区的三条神经，在施行腹股沟区手术（如腹股沟斜疝或直疝修补术）和盲肠后位阑尾手术时，应注意勿损伤这些神经，以免造成所分布的肌瘫痪和皮肤感觉丧失。The iliohygastric, ilioinguina

41、l and genitofemoral nerve must be protected carefully in the operation of the inguininal hernia.股外侧皮神经lateral femoral cutaneous nerve股外侧皮神经的分布股外侧皮神经股神经及其分支股神经缝匠肌股四头肌耻骨肌隐神经股神经的前皮支股神经皮支的分布股神经的前皮支隐神经的小腿内侧支隐神经的髌下支股神经 Femoral Nerve起自腰丛，由来自L2L4神经的前支组成；自腰大肌外缘穿出，在腰大肌与髂肌之间下行，经腹股沟韧带中点稍外侧的深面、股动脉外侧进入股三角，发出肌支和皮支

42、。肌支：布于股前肌群(缝匠肌、股四头肌)和耻骨肌。Its muscular branches innervate the anterior femoral muscles（the quadriceps femoris, sartoris） and pectineus.皮支：股前皮神经，Its cutaneuos branches to the thigh are the anteiror femoral cutaneous nerves which are distributed to anterior and medial side of skin of the thigh. 隐神经，为最长

43、的皮支，伴股动脉入内收肌管，穿出后至膝关节内侧，在小腿与大隐静脉伴行至足内侧缘，分支布于髌下、小腿内侧面和足内侧缘皮肤。 The longest one of them is the saphenous nerve which is distributed to the skin of the medial side of the leg and foot. 股神经是膝反射的传入和传出神经。The femoral nerve provides both afferent and efferent limbs of the knee-jerk reflex.股神经损伤：运动障碍：感觉障碍：由于缝

44、匠肌、股四头肌瘫痪，出现屈髋、内旋膝关节能力减弱，伸膝不能，髌反射消失。大腿前、内侧、小腿前内侧、足内侧的皮肤感觉减弱或丧失。闭孔神经及其分支闭孔神经至膝关节的关节支股薄肌闭孔神经的关节支闭孔外肌短收肌长收肌大收肌闭孔神经的前支闭孔神经的后支cutaneous branches of obtrator nerve闭孔神经的皮支闭孔神经cutaneous branches of obtrator nerve闭孔神经的皮支闭孔神经 obturator nerve起自腰丛（L2L4）；自腰大肌内侧缘穿出，与闭孔血管伴行沿骨盆内侧壁前行，穿闭膜管出骨盆，分为前、后两支，分别位于短收肌的前面和深面；肌支

45、：支配大腿内侧肌群和闭孔外肌。The muscular branches innervate the medial group of muscles.皮支：称股内侧皮神经，布于大腿内侧部皮肤。The cutaneous branches are distributed to the skin of the medial side of the thigh.关节支：分布于髋关节和膝关节。闭孔神经损伤：运动障碍：感觉障碍：大腿内侧肌群瘫痪，出现髋关节内收不能，屈髋和髋外旋减弱。大腿内侧上部感觉障碍。Injury to the obturator nerve results in impaired

46、adduction of the thigh and a loss of the sensation in the skin of the medial aspect of the thigh.临床应用：带闭孔血管神经蒂的股薄肌瓣替代肛门外括约肌手术。四、The Sacral Plexus骶 丛组成 formation位置 location主要分支及其分布 The main branches and its distribution 神经损伤 lesion nerve1.骶 丛的组成腰骶干1.骶丛的位置腰骶干梨状肌3.骶丛的分支分布Quadratus femoris musclePosteri

47、or femoral cutaneous nerve臀上神经坐骨神经臀下神经阴部神经股后皮神经坐骨神经股后皮神经骶丛（1）组成：由腰骶干（第4、5腰神经前支组成）、第15骶神经前支和尾神经前支构成。 It is formed by the lumbosacral trunk, the ventral rami of the sacral and coccygeal nerves.位置：位于盆腔内，骶骨和梨状肌的前面，髂血管的后方。It is closely related to the anterior surface of the piriformis muscle and sacrum.主

48、要分支分布：有坐骨神经、臀上神经、臀下神经、股后皮神经、阴部神经等。臀上神经Superior gluteal nerve ：伴臀上血管穿梨状肌上孔出盆腔,布于臀中肌、臀小肌和阔筋膜张肌。It leaves the pelvis through the greater sciatic foramen superior to the piriformis muscle in company with the superior gluteal vessels. it supplies the gluteus medius and minimus muscles and the tensor fasc

49、ia latae muscle.臀下神经：伴臀下血管穿梨状肌下孔出盆腔,布于臀大肌。 The inferior gluteal nerve leaves the pelvis through the greater sciatic foramen inferior to the piriformis muscle with the inferior gluteal vessels. It supplies the gluteus maximus muscle. 髋关节后脱位可致臀下神经受损，臀大肌瘫痪，出现髋关节后伸无力，病人不能由坐位站立起来。骶丛的分支、行径与分布阴部神经阴部神经梨状肌肛神

50、经会阴神经阴部神经阴部神经肛神经会阴神经会阴浅神经会阴深神经阴囊后神经阴茎背神经阴部神经阴部神经肛神经会阴神经会阴浅神经会阴神经的浅支阴唇后神经阴蒂背神经阴部神经阻滞麻醉坐骨棘坐骨结节阴部神经 pudendal nerve.起自骶丛；经梨状肌下孔出盆腔,穿坐骨小孔入坐骨肛门窝,分支布于会阴部肌和会阴部皮肤。 The pudendal nerve exits the pelvis via the infrapiriform region of the greater sciatic foramen, then enters the ischiorectal fossa of the perine

51、um via the lesser sciatic foramen. Its branches supply the perineum.分支分布：肛神经 anal nerve，布于肛门外括约肌和肛门部的皮肤；会阴神经perineal nerve，布于会阴诸肌和阴囊或大阴唇）；阴茎背神经或阴蒂背神经dorsal nerve of the penis or clitoris，布于阴茎或阴蒂海绵体和皮肤。股后皮神经股后皮神经股后皮神经股后皮神经股后皮神经坐骨神经坐骨神经胫神经腓总神经坐骨神经 sciatic nerve（1）经梨状肌下孔出骨盆，在大转子和坐骨结节之间臀大肌深面下行至股后部，在腘窝上角

52、分为胫神经和腓总神经。It leaves the pelvis through the greater sciatic foramen inferior to the piriformis muscle. Then it runs inferolaterally deep to the gluteus maximus muscle, and descends between the ischial tuberosity and the greater trochanter of the femur to enter the posterior compartment of the thigh.

53、 It divides into the tibial and common peroneal nerves at the superior angle of the popliteal fossa.在股后部发出肌支至股后肌群，包括股二头肌、半腱肌、半膜肌。 The braches of the sciatic nerve at the posterior region innervate the muscles of the posterior compartment of the thigh, including the biceps femoris, semimenbranosus, s

54、emitendinosus muscles.(6)胫神经胫神经腓肠肌比目鱼肌行经(6)胫神经足底内侧神经足底外侧神经胫神经行经(6)胫神经胫神经腓肠内侧皮神经关节支跖肌腓肠肌比目鱼肌至腘肌的神经胫骨后肌趾长屈肌拇长屈肌分支分布(6)胫神经足底内侧神经足底外侧神经胫神经分支分布(6)胫神经腓肠内侧皮神经分支分布(6)胫神经足底内侧神经足底外侧神经足跟内侧支分支分布 胫神经 tibial nerve伴腘血管、胫后血管在小腿三头肌的深面下行，在内踝后方分为足底内、外侧神经。在小腿发出肌支布于小腿后肌群；皮支为腓肠内侧皮神经，布于小腿后面内侧上部皮肤。足底内、外侧神经medial and lateral plantar nerves:布于足底肌和足底皮肤。胫神经损伤胫神经损伤胫神经损伤运动障碍：小腿后肌群、足底肌瘫痪，导致踝关节不能跖屈，趾不能屈，足内翻力减弱，其拮抗肌小腿前肌群、外侧肌群收缩，出现足背屈外翻畸形（钩状足）。感觉障碍：小腿后面上部、足底皮肤感觉丧失或减弱。Injury to the tibial nerve can re