神经系统传导通路新.ppt

1、May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,神经系统的传导通路,兰州大学基础医学院 人体解剖学教研室,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,神经系统的传导通路,感觉传导通路运动传导通路神经系统的化学通路,May

2、, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,感觉传导通路sensory pathway,本体（深）感觉传导通路痛温觉、粗触觉和压觉（浅感觉）传导通路视觉传导通路和瞳孔对光反射通路听觉传导通路平衡觉传导通路内脏感觉传导通路,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved

3、by YP HOU and YF SONG,本体（深）感觉传导通路,定义：是指肌、腱、关节等运动器官在不同状态（运动或静止）时产生的感觉，又称深感觉，包括位置觉、运动觉和震动觉；该传导路还传导皮肤的精细触觉。此处主要述及躯干和四肢的本体感觉传导通路，有两条：一条传至大脑皮质，产生意识性感觉一条传至小脑，不产生意识性感觉,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,躯干和四肢意识性本体感觉和精细触觉传导通路

4、为：第1级神经元脊神经节中枢突脊神经后根内侧部脊神经后索升支、降支来自第5胸节以下经后索内侧部薄束薄束核来自第4胸节以上经后索外侧部楔束楔束核（经第2级神经元）,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,内侧丘系交叉（转折上行） 内侧丘系（第3级神经元）背侧丘脑腹后外侧核丘脑中央辐射内囊后肢 中央后回中、上部 投射到 中央旁小叶后部 中央前回,本体感觉精细触觉,传导路,起止,行程,交叉,损伤: 感觉性共

5、济失调,T45,脊神经节,周围突,中枢突,脊神经,后根,躯干四肢,上肢、躯干上部,下肢、躯干下部,肌、腱、关节,薄束,楔束、薄束,内侧丘系交叉,内侧丘系,中线旁下橄榄核之间,贯穿斜方体,红核背外侧,丘脑腹后外侧核,中央后回中上2/3 和中央旁小叶后部,内囊后肢,损伤症状,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,意识性深感觉传导通路由3级神经元组成：第1级神经元是脊神经节细胞第2级神经元的胞体在

6、薄、楔束核内第3级神经元的胞体在腹后外侧核，发出纤维称丘脑中央辐射,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,躯干和四肢非意识性本体感觉传导通路为： 脊神经节细胞中枢突脊神经后根内侧部脊髓终止于C8L2节段胸核和腰骶膨大（V 层外侧部）胸核同侧脊髓小脑后束小脑下脚小脑皮质腰骶膨大（V 层外侧部）对、同侧脊髓小脑前束小脑上脚小脑皮质传导躯干（除颈部）和下肢的本体感觉,May, 2009,Copyright

7、 Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,传导颈部和上肢的本体感觉其2级神经元位于：颈膨大部第、层延髓的楔束副核这两处神经元发出的第2级纤维也经小脑下脚进入小脑皮质。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,非意识性深感觉传导通路，由2级神经元组成

8、：第1级神经元是脊神经节细胞第2级神经元是胸核、腰骶膨大第 层外侧部、颈膨大第、层、楔束副核,传导躯干下肢本体感觉,同侧胸核（C8-L2）,脊髓小脑后束,旧小脑,楔束副核,部分纤维楔束,脊髓小脑前束,后角5-7层（腰骶膨大）,脊髓小脑前束,非意识性深感觉传导路,后角5-7层（颈膨大）,上肢颈部本体感觉,小脑上脚,小脑下脚,损伤: 反射性共济失调,同侧小脑投射,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,痛

9、温觉、粗触觉和压觉（浅感觉）传导通路,躯干和四肢痛温觉、粗触觉和压觉传导通路 头面部的痛温觉、触压觉传导通路,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,躯干和四肢痛温觉、粗触觉和压觉传导通路,传导通路为：第1级神经元脊神经节中枢突经后根脊髓传导痛温觉的纤维经后根外侧部脊髓背外侧束传导触压觉的纤维经后根内侧部脊髓后索终止于第2级神经元（、到层）,May, 2009,Copyright Depart. An

10、atomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,经白质前联合对侧外侧索和前索脊髓丘脑侧束（痛温觉）和脊髓丘脑前束（触压觉） 脊髓丘脑束（脊髓丘系）第3级神经元背侧丘脑腹后外侧核丘脑中央辐射内囊后肢 中央后回中、上部 投射到 中央旁小叶后部,痛温粗触觉传导路,起止,行程,交叉,损伤症状,脊神经节,周围突,中枢突,脊神经,后根,躯干四肢,皮肤,白质前连合交叉,脊髓丘脑束(前束)(侧束),后角-层,脊髓丘系,下橄榄核背外侧,内侧丘系的外侧,丘脑腹后外侧核,中央后回中上2/3

11、和中央旁小叶后部,内囊后肢,斜越白质前联合,上升12节段,痛温触压,损伤: 感觉障碍,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,该通路有3级神经元组成：第1级神经元是脊神经节细胞第2级神经元的胞体主要在脊髓第、到层第3级神经元的胞体在背侧丘脑的腹后外侧核，发出的纤维称丘脑中央辐射,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzh

12、ou University. All right reserved by YP HOU and YF SONG,头面部的痛温觉、触压觉传导通路,传导通路为：三叉神经节中枢突三叉神经感觉根脑桥三叉神经脊束（痛温觉）三叉神经脊束核三叉神经脑桥（触压觉）三叉神经脑桥核（交叉到对侧）三叉丘脑束（三叉丘系）背侧丘脑的腹后内侧核内囊后肢投射到中央后回下部,丘脑腹后内侧核,三叉神经脊束,三叉神经感觉核,中央后回下1/3,内囊后肢,内侧丘系背侧,头面部,浅感觉传导路,损伤: 感觉障碍,三叉丘系,三叉神经节,May, 2009,Copyright Depart. Anatomy, School of Medic

13、ine, Lanzhou University. All right reserved by YP HOU and YF SONG,该通路有3级神经元组成：第1级神经元是三叉神经节第2级神经元的胞体在三叉神经脊束核和脑桥核第3级神经元的胞体在背侧丘脑的腹后内侧核,躯干四肢浅、深感觉传导路对比总结,脊髓,脑干,前面观,脊髓后索内囊,脊髓侧索内囊,脑干内囊,完全交叉,延髓,脊髓,脑干,交叉以下损伤同侧感觉障碍,交叉以上损伤对侧感觉障碍,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All r

14、ight reserved by YP HOU and YF SONG,视觉传导通路和瞳孔对光反射通路,视觉传导通路如下：视锥、视杆细胞中层的双极细胞节细胞（经视神经轴突）视神经（经视神经管）颅腔 视交叉鼻侧半纤维交叉对侧视束颞侧半纤维不交叉同侧视束 外侧膝状体内（外侧膝状体核）视辐射内囊后肢视皮质区产生视觉,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,【视野】,视觉传导路及损伤,对光反射通路,单眼全盲,

15、双眼同向偏盲,双眼颞侧视野偏盲,双眼鼻侧视野偏盲,光线,视辐射,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,视觉传导通路有3级神经元：第1级神经元是视网膜中层的双极细胞第2级神经元是视网膜最内层的节细胞第3级神经元是外侧膝状体核,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right re

16、served by YP HOU and YF SONG,视野：指眼球固定向前平视时所能看到的空间范围。当视觉传导通路的不同部位受损时，可引起不同的视野缺损：视网膜损伤引起的视野缺损与损伤的位置和范围有关，若损伤在视神经盘则视野中出现较大暗点，若黄斑部受损则中央视野有暗点，,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,一侧视神经损伤可致该侧眼视野全盲视交叉中交叉纤维损伤可致双眼视野颞侧半偏盲一侧视交叉外侧

17、部的不交叉纤维损伤，则患侧眼视野的鼻侧半偏盲一侧视束及以上的视觉传导路受损，可致双眼病灶对侧半视野同向性偏盲,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,瞳孔对光反射通路如下：视网膜视神经视交叉两侧视束上丘臂顶盖前区两侧动眼神经副核动眼神经睫状神经节节后纤维瞳孔括约肌收缩两侧瞳孔缩小,距状沟上下的皮质,光,顶盖前区,动眼神经副核,对光反射,外侧膝状体,瞳孔括约肌睫状肌,感光细胞,双极细胞,节细胞,视束,视

18、交叉,视神经,双侧,内囊后肢,视辐射,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,不同部位损伤瞳孔对光反射表现,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,听觉传导通路,听觉传导通路如下：蜗神经节内的双极细胞中枢突，

19、组成蜗神经蜗腹侧核和背侧核（脑桥）斜方体（交叉至对侧）外侧丘系（经中脑被盖的背外侧部）下丘（经下丘臂）内侧膝状体听辐射内囊后肢大脑皮质的颞横回,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,听觉传导通路有4级神经元：第1级神经元是蜗神经节内的双极细胞第2级神经元胞体是在蜗腹侧核和蜗背侧核第3级神经元胞体在下丘第4级神经元胞体在内侧膝状体,May, 2009,Copyright Depart. Anatomy

20、, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,平衡觉传导通路,前庭神经节内的双极细胞中枢突，组成前庭神经（与蜗神经）脑前庭神经核群大脑皮质。前庭神经核群发出的纤维至中线两侧组成内侧纵束：,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,上升支动眼、滑车和展神经核眼肌前庭反射（眼球震颤）下降支

21、副神经脊髓核和颈髓前角细胞转眼、转头的协调运动前庭神经外侧核发出纤维组成前庭脊髓束完成躯干、 四肢的姿势反射（伸肌兴奋、屈肌抑制）,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,内脏感觉传导通路,一般内脏感觉传导通路特殊内脏感觉传导通路,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right

22、 reserved by YP HOU and YF SONG,一般内脏感觉传导通路,经脑神经：膝神经节、舌咽和迷走神经下节细胞中枢突 丘脑腹后内侧核或 岛叶 下丘脑外侧区换元经脊神经：脊神经节细胞中枢突,孤束核换元,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,脊髓中央管背外侧的后连合核换元臂旁核换元 丘脑大脑皮质后角灰质元 伴脊髓丘脑束 丘脑腹后外侧（内脏痛快痛） 核换元 皮质中央后回 大脑外侧沟上部脊

23、髓固有束内上行脊髓和脑干网状结构多次换元丘脑背侧核换元大脑边缘叶,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,特殊内脏感觉传导通路,嗅觉：嗅细胞 中枢突 嗅球换元 形成嗅丝经嗅束、嗅三角 梨状前区、杏仁周区、 和外侧嗅纹 杏仁体皮质内侧核,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All rig

24、ht reserved by YP HOU and YF SONG,味觉：膝、舌咽和迷走神经下节细胞中枢突孤束核上段 丘脑腹后内侧核额叶岛盖、岛叶,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,运动传导通路,定义：运动传导通路是指从大脑皮质至躯体运动和内脏活动效应器的神经联系。组成：上运动神经元（upper moter neurons）下运动神经元（lower moter neurons）躯体运动传导通路主

25、要为锥体系和锥体外系,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,锥体系,锥体系（pyramidal system）其上运动神经元位于：中央前回、中央旁小叶前部的巨型锥体细胞、其他类型的锥体细胞、位于额、顶叶部分的锥体细胞。这些神经元的轴突共同组成锥体束（ pyramidal tract ）。锥体束又可分为：皮质脊髓束皮质核束,May, 2009,Copyright Depart. Anatomy, Sc

26、hool of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,皮质脊髓束,皮质脊髓束（corticospinal tract）：中央前回上、中部，中央旁小叶前半部的锥体细胞轴突下行经内囊后肢的前部、大脑脚底中3/5的外侧部和脑桥基底部延髓锥体（在下端交叉至对侧）锥体交叉在脊髓侧索内下行皮质脊髓侧束逐节止于前角细胞，支配四肢肌（未交叉）在脊髓前索内下行皮质脊髓前束，支配躯干和四肢骨胳肌的运动,May, 2009,Copyright Depart. Anatomy, School of Medicine

27、, Lanzhou University. All right reserved by YP HOU and YF SONG,注意：一侧皮质脊髓束在锥体交叉前受损，导致对侧肢体瘫痪，躯干肌运动不受明显影响；在锥体交叉后受损，导致同侧肢体瘫痪,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,皮质脊髓束,锥体系,运动传导路,四肢肌,躯干肌,躯干肌,中央前回中上2/3中央旁小叶前部,内囊后肢,中脑：大脑脚底中3/5

28、外侧,脑桥基底部,延髓锥体,锥体交叉75纤维,皮质脊髓侧束,皮质脊髓前束,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,皮质核束,皮质核束（corticonuclear tract）中央前回下部的锥体细胞的轴突集合而成，下行经内囊膝至大脑脚底中3/5的内侧部，向下分出的纤维大部分止于双侧脑神经运动核。小部分纤维完全交叉到对侧止于面神经核下部、舌下神经核。支配对侧面下部的面肌和舌肌。,May, 2009,Co

29、pyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,锥体系：皮质核束,中央前回下1/3,内囊膝,中脑：大脑脚底中3/5内侧,脑桥基底部,延髓锥体,运动传导路,锥体系,皮质核束,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,由皮质核束的走行可知：面下部

30、肌的面神经核和舌下神经核只接受单侧（对侧）皮质核束支配外，其他脑神经运动核均接受双侧皮质核束的纤维。一侧上运动神经元受损，对侧眼裂以下的面肌和对侧舌肌瘫痪一侧面神经核的神经元受损，可致病灶侧所有的面肌瘫痪一侧舌下神经核的神经元受损，可致病灶侧全部舌肌瘫痪,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,面肌瘫痪：左：核下瘫 右：核上瘫,舌肌瘫痪：左：核下瘫 右：核上瘫,May, 2009,Copyright

31、Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,上下运动神经元损伤表现比较,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,锥体外系,锥体外系（extrapyramidal system）定义：是指锥体系以外的影响和控制躯体运动的所有传导路径，结构复杂。,调节肌张力机能 协调肌肉运动 维持体态姿势 习惯性动作,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,