系统解剖学英文版教学课件：Peripheral Nervous System

PeripheralNervousSystemTheperipheralnervoussystem(PNS)

Accordingtotheoriginanddistribution,PNScanbedividedintothreeparts:spinalnerves:31pairscranialnerves:12pairsautonomicnervoussystem(visceralnervoussystemorvegetativenervoussystem)SectiononespinalnervesI.IntroductionThereare31pairsofspinalnerves,8pairsofcervical(C1-8)12pairsofthoracic(T1-12)5pairsoflumbar(L1-5)5pairsofsacral(S1-5)1pairofcoccygeal(Co1)1.

Spinalnerveroots

Eachspinalnerveconsistsofananterior(ventral)rootandaposterior(dorsal)root.Theanteriorrootcontainsmotorfibersarisingfromtheanteriorandlateralhornofthespinalcord.Theposteriorrootcontainssensoryfibersoriginatinginthepseudounipolarneuronsinthespinalganglionthatisinterposedinthecourseoftheposteriorroot.2.TypesofnervefibersinthespinalnerveSomaticafferent(sensory)fibers:distributedintheskin,sketetalmuscles,jointsandtendons;Visceralafferent(sensory)fibers:distributedinthevisceralorgans,cardiovascularsystemandglands;Somaticefferent(motor)fibers:innervatetheskeletalmuscles;(4)Visceralefferent(motor)fibers:innervatethesmoothmuscles,cardiovascularsystemandglands.3.

BranchesoftypicalspinalnervesDorsalbranch:isdistributedtothemusclesandskinoftheposteriorpartofthebody.CommunicatingbranchMeningealbranchAnteriorbranch:isdistributedtothelimbs,thelateralandventraltrunk.Theanteriorbranchesformthecervical,brachial,lumbarandsacralplexuseswithexceptionofthethoracicnerves(remainsegmental).

II.Thecervicalplexus1.Formation:C1-42.Location:deeplyinthesternocleiodmastoidmuscle.3.Branches:superficialanddeepbranches(1)Thesuperficial(cutaneous)branches:emergenearthemiddleoftheposteriorborderofthesternocleiodmastoidmuscle(NervepointofNevk).①Thelesseroccipitalnerve②Thegreaterauricularnerve③Thetransversenerveofneck④Thesupraclavicularnerve(2)Thedeepbranchesinnervatethedeepmusclesoftheneck,theinfrahyoidmusclesthelevatorscapulaeanddiaphragm.①phrenicnerveCourseDistribution:supplythediaphragm,thesensoryfiberssupplythepericardium,themediastinalpleuraeanddiaphragmaticperitoneum.Therightphrenicnerveisalsodistributedtotheliver,thegallbladderandthebiliarysytem.PhrenicnerveIII.Thebrachialplexus

1.Formation:C5-8andT1.C5C6C7C8T1SuperiortrunkMiddleInferiorLateralcordPosteriorMedialcord2.Branches(1)Thebranchesabovetheclavicle①LongthoracicN.:innervatestheserratusanterior.ThelesionoftheNcausesthe“wing”ofthescapula.②DorsalscapularN.:innervatesthelevatorscapulaeandrhomboideus③SuprascapularN.:innervatesthesupraspinatusandtheinfraspinatus.LongthoracicnerveWingofscapula

(ThelesionoflongthoracicN)

DorsalscapularNSuprascapularN(2)Thebranchesbelowtheclavicle①ThoracodorsalN:suppliesthelatissimusdorsi.②Lateralandmedialpectoralnerves(anteriorthoracicN):suppliesthepectoralismajorandpectoralisminor.③MusculocutaneousN:suppliesthecoracobrachialis,biceps,andbrachialismuscle.ItendsasthelateralantebrachialcutaneousN.

thoracodorsalnervemedialandlateralpectoralnerves

ThemusculocutaneousN④MedianNCourseBranches:forearm→muscularbranches,hand→arecurrentbranch,threecommonpalmardigitalnervesproperpalmardigitalnerves

ThemedianNerveDistributionofmediannerve:

Motorbranches:

intheforearm→thepronatorsandflexormusclesexceptthebrachioradialis,theflexorcarpiulnarisandthemedialhalfoftheflexordigitorumprofundus;

inthehand→thefirstandsecondlumbricalesandthethenarmusclesexcepttheadductorpollicis.

Sensorybranches:theskinofthepalmarsurfaceoftheradialhalfofthehandandthumbandthelateral21／2fingers,andthedorsalsurfaceofthemiddle,distalendsofthesamefingers.ClinicalfeaturesofthemedianN.lesion:

easilyinjuredatthewristandcauses“apehand”⑤UlnarNA.CourseB.Branches:forearm→muscularbranches,hand→superficialanddeepbranches,adorsalbranchTheulnarNTheulnarNC.Distributionofulnarnerve:Motorbranches:intheforearm→theflexorcarpiulnarisandthemedialhalfoftheflexordigitorumprofundus;inthehand→theadductorpollicis,thethirdandfourthlumbricales,interossei.Sensorybranches:hand→theskinoftheulnarhalfofthehand,andtheulnaroneandhalffingers.D.ClinicalfeaturesoftheulnarN.lesion:

easilyinjuredatthesulcusforunlarnerveorthewristandcauses“clawhand”

⑥RadialNA.CourseB.Branches:attheelbowjoint→thesuperficialanddeepbranchesC.Distribution:

Motorbranches:intheforearm→allextensors;thearm→allextensorsandthebrachioradialisSensorybranches:hand→thedorsalsurfaceoftheradialhalfofthehand,andtheproximaldigitsofthelateraltwoandhalffingers.

TheradialNerveD.ClinicalfeaturesoftheradialN.lesion:

easilyinjuredintheupperormiddlepartofthearmandcauses“Wristdrop”⑦AxillaryNA.CourseB.Distribution:supplythedeltoidandteresminorC.ClinicalfeaturesoftheN.lesion:easilyinjuredinfractureofthehumeralneckorindislocationoftheshoulderjointandcauses“quadrate”shoulder.IV.Theanteriorbranchesofthoracicnerves

1.Number:12pairs.Amongthem,11pairsaretheintercostalsnerves,1pairarethesubcostalnerves.2.Course3.Segmentaldistribution:T2→thesternalangleT4→thenippleT6→thexiphoidprocessT8→thecostalarchT10→theumbilicusT12→theanteriorsuperioriliacspineV.Thelumbarplexus

1.Formation:partofT12,L1-3andpartofL42.Location:behindinthepsoasmajor3.

Mainbranches(1)IliohypogastricN:supplytheskinofthehypogastricregionandinguinalregion.Itsmuscularbranchsuppliesthemusclesofthelowerpartoftheabdominalwall.(2)IlioinguinalN:supplytheskinoftheinguinalregion,thescrotum(orthegreaterlipofpudendum).Itsmuscularbranchsuppliesthemusclesofthelowerpartoftheabdominalwall.(3)LateralfemoralcutaneousTheiliohypogastricandilioinguinalN(4)FemoralN①Course:descendsbeneaththeinguinalligamenttoenterthefemoraltriangleonthelateralsideofthefemoralartery②Mainbranches:saphenousN(cutaneousN)③Distribution:suppiesthequadricepsfemoris,sartoriusandpectineus.Thesensorybranchessupplytheanteriorandmedialsurfacesofthethighandthesaphenousnervetothemedialsideofthelegandfoot.FemoralNFemoralN④ClinicalfeaturesofthefemoralN.lesion:impossibletoflexthethigh.Theextensionofthelegandthekneejerkarelost.(5)ObturatorN:

distributedtothemusclesandskinofthemedialsideofthethigh.(6)GenitofemoralN:distributedtothecresmaterandskinoverthescrotum(orthegreaterlipofpudendum).VI.Thesacralplexus1.Formation:L4-5(thelumbosacraltrunk),theanteriorbranchesofthesacralandcoccygealnerves.2.Location:situatedinfrontofthepiriformisontheposteriorwallofthepelvis.3.

Mainbranchesofthesacralplexus:(1)SuperiorglutealN:suppliesthegluteusmediusandminimusandthetensorfasciaelatae.(2)InferiorglutealN:suppliesthegluteusmaximus.(3)PosteriorfemoralcutaneousN(4)Pudendalnerve

①AnalN(inferiorrectalN)

②PerinealN

③DorsalNofpenisorclitoris

Thepudendalnerve(male)123

Thepudendalnerve(female)(5)SciaticN①Course:leavesthepelvisthroughthegreatersciaticforamenbelowthepiriformis,anddescendsbetweenthegreatertrochanterofthefemurandtheischialtuberosityalongtheposteriorsurfaceofthethightothepoplitealfossa,whereitterminatesbydividingintothetibialandcommonperonealnerves.

ThesciaticN②Distributionofsciaticnerve:suppliesthemusclesandskinoftheposteriorsideofthethigh.③Branchesofsciaticnerve:TibialNCourse:descendsbetweenthesuperficialanddeeplayersoftheposteriormusclesofthelegandenterstothesoleofthefoot.Branches:medialsuralcutaneousNinthebackoftheleg;medialandlateralplantarnervesinthesoleofthefoot

ThetibialnerveBranchesoftibialnerve:medialsuralcutaneousNinthebackofthe