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            【福建成人高考】2019年專升本醫學綜合之周圍神經系統(一)

            福建成人高考信息網www.laiwobuy.com 發布時間: 2018年11月13日

            周圍神經系統


              第一節 總論

              神經系統由腦、脊髓以及與它們相連并遍及全身各處的周圍神經組成,它在人體各器官、系統的功能中占有特殊重要的地位。它通過感受器接受機體內、外環境的各種刺激,經感覺神經傳至腦和脊髓的各級中樞,中樞將信息整合后,再把沖動經運動神經傳至效應器,控制和調節機體各系統的活動。

              神經系統的基本活動方式是反射。所謂反射就是神經系統對內、外環境的刺激作出適宜的反應。完成反射活動的形態結構基礎是反射弧。反射弧包括感受器→感覺神經(傳入神經) →中樞部→運動神經(傳出神經) →效應器。

              神經系統的組成

              神經系統可分為中樞神經和周圍神經。

              1.中樞神經包括腦和脊髓。

              2.周圍神經包括12對腦神經和31對脊神經。兩者都含有軀體神經和內臟神經。

              軀體神經分布到皮膚和運動系;內臟神經分布到內臟、心血管和腺體。兩種神經都有感覺和運動神經纖維。內臟運動纖維根據其作用不同,再分為交感神經和副交感神經。

              第二節 脊神經

              一、脊神經的組成

              脊神經主要分布至軀干和四肢,共31對,包括頸神經8對,胸神經12對,腰神經5對,骶神經5對。尾神經1對。每對脊神經都由與脊髓相連的前根和后根在近椎問孔處匯合而成。后根上有一膨大的脊神經節,內禽感覺神經元的胞體,其中樞突組成感覺性的后根,周圍突構成脊神經的感覺纖維成分。前根由運動纖維組成,其胞體位于脊髓灰質內。脊神經是混合性神經,禽有以下四種纖維成分。

              二、二肢的重要神經

              (一)組成

              臂從由第5—8頸神經的前支和第1胸神經前支的一部分組成。自頸根部斜角肌問隙,經鎖骨中點的后力方進入腋窩,嘲繞腋動脈排列。臂叢分支主要分布于上肢的肌和皮膚,臂叢的主要分支有:

              (二)肌皮神經

              起自外側束,支配臂部前群肌,終支在肘關節上方穿出深筋膜延續為前臂外側皮神經。分布于前臂外側的皮膚。

              (三)正中神經

              1.行徑 由內、外側兩根合成,發自內、外側束沿肱二頭肌內側溝,自肱動脈外側→前耐→舷動脈內側穿→旋前圓肌→指淺、指深屈肌之間→橈側腕屈肌腱與掌長肌腱之間→腕管→掌腱膜深面。

              2.分布 肌支→前臂屈肌(除肱橈肌、尺側腕屈肌和指深屈肌尺側半外)、第1、2蚓狀肌、魚際肌(除拇收肌);皮支→掌心、橈側3個半手指的掌面和魚際的皮膚。

              3.損傷

              (1)因魚際肌群萎縮而手掌雖平坦,呈現所謂的“猿手”。

              (2)運動障礙:屈腕能力減弱,前臂不能旋前,拇、食和中指不能屈曲,拇指不能作對掌運動。

              (3)感覺障礙:拇、食、中指末節皮膚最明顯。

              (四)尺神經

              沿臂內側下行,經肱骨內上髁后方的尺神經溝至前臂,伴尺動脈下行,經腕前面入手掌,分支分布于前臂尺側部分屈肌,手的小魚際肌和中間群肌及拇收肌,手掌尺側1/3和尺側一個半指的掌側皮膚,手背尺側半及尺側兩個半指的背側皮膚。

              尺神經損傷后,小魚際及部分中問群肌萎縮,第4、5指末節不能屈,拇指不能內收,其他指不能收、展,第4、5掌指關節伸直,指間關節屈曲,掌骨間隙深凹,形成“爪形手”。此外,尺側一個半指及相應手掌的皮膚感覺障礙。

              (五)橈神經

              1.行徑起自臂叢后束與肱深動脈伴行,經橈神經溝行向下.外,于肱肌與肱橈肌之間淺出,分淺、深兩支至前臂后面皮膚和后群肌。

              2.分布 肌支分布于肱三頭肌、肱橈肌及前臂伸肌;皮支分布于臂后面、前臂后面皮膚及手背橈側半2個半手指的皮膚。

              3.損傷肱骨中段骨折時常傷及此神經。

              肘關節屈曲,前臂呈旋前位,腕部呈“垂腕”狀態。

              運動障礙,不能伸肘、伸腕、仲指,前臂旋后力弱,呈“垂肘垂腕”畸形。

              感覺障礙,第1、2掌骨間隙背面(“虎口區”)的皮膚最明顯。

              (六)腋神經

              于腋動脈后方起于臂叢,經肱骨外科頸達三角肌深面,分支分布于三角肌、肩關節及臂部上1/3外側的皮膚。

              腋神經損傷后,主要表現為肩關節不能外展,由于三角肌的萎縮,呈現“方肩”征。


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