一脊神經(jīng)后支卡壓綜合征診斷針”正秀砝5樂與針刀微創(chuàng)手術(shù)治療北京龐繼光針刀醫(yī)學(xué)研究院院長首席專家原中國中醫(yī)研究院長城醫(yī)院科研處主任原中國中醫(yī)研究院長城醫(yī)院三病區(qū)主任中國中醫(yī)藥學(xué)會(huì)針刀醫(yī)學(xué)會(huì)第三屆常務(wù)副秘書長龐繼光中國中醫(yī)藥學(xué)會(huì)針刀醫(yī)學(xué)分會(huì)資深專家組副組長海軍總醫(yī)院疼志疼痛中心特需專家外科主任醫(yī)師教授Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL一脊神經(jīng)后支卡壓綜合征診斷1第1部分脊神經(jīng)后支的概念由椎間管走出的神經(jīng)根,在出椎間管外口前分為兩支前支——走在橫突腹側(cè)面的神經(jīng)支后支—走在橫突背側(cè)面的神經(jīng)支;后內(nèi)側(cè)支——沿橫突根部下行,穿乳副突韌帶骨纖維管,至脊柱中央一側(cè)者;后外側(cè)支——沿橫突外側(cè)下行,再穿豎脊肌胸腰筋膜下,至臀部皮下者Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL第1部分2一相應(yīng)各器官段外側(cè)支皮支11因棒神經(jīng)漂高支接啟變能出m圖:翻脊神經(jīng)框架表預(yù)叢與劇神經(jīng)背上陽領(lǐng)青下群段一間神經(jīng)一1對肋間神是奔應(yīng)神是涼擁萍建年警星背內(nèi)側(cè)神經(jīng)Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL一相應(yīng)各器官312頸胸腰骶段脊神經(jīng)后支C1后支枕下神經(jīng)C2后支—枕大神經(jīng)(后內(nèi)側(cè)支-皮支)C3~8后支T1~10后支T11~L4后支(臀上皮神經(jīng)系統(tǒng))L5~S5后支(臀中皮神經(jīng)系統(tǒng))So1~5后支(臀下皮神經(jīng)系統(tǒng))Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL12頸胸腰骶段脊神經(jīng)后支41。3脊神經(jīng)后支的意義周圍神經(jīng)包括脊神經(jīng)前支與后支。目前書籍只寫脊神經(jīng)前支的卡壓綜合征,無脊神經(jīng)后支卡壓綜合征。似乎脊神經(jīng)后支神后的存在是毫無臨床意義的圖3-001是一個(gè)周圍神經(jīng)分布的示意圖第十勒聞神經(jīng)一斗內(nèi)側(cè)支圖中左側(cè)為脊神經(jīng)前支的分布情形圖中右側(cè)為脊神經(jīng)后支的分布情形旋下神經(jīng)脊神經(jīng)后支分布在頭后、項(xiàng)部、背部雪限取溝神經(jīng)臀上皮神經(jīng)外便皮神經(jīng)空腰部和臀部等廣大的區(qū)域,支配著具有十分2+…強(qiáng)大肌力的肌群豎脊肌。因此,脊神經(jīng)閉孔神經(jīng)臀下皮神經(jīng)后支卡壓綜合征的研究有著重要的臨床實(shí)用坐神經(jīng)價(jià)值。它在疼痛性疾病中占有重要地位Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL1。3脊神經(jīng)后支的意義514在神經(jīng)根管外口處脊神經(jīng)的分支(腰椎塑化標(biāo)本側(cè)面照片)頸椎椎間管的解剖:頸椎椎間管的截面呈橢園形高大于寬,國人測量高為脊御經(jīng)極79mm,寬為67mm,神神經(jīng)前支根貼管的下壁行走。各神經(jīng)根自上而下逐漸變粗,下位后太外女者神經(jīng)根矢狀徑可占椎間管截面積1/2,而橫徑則可占到葬向切帶全部(100%)。因此,神經(jīng)上切帶神經(jīng)管外根受壓的可能性很大神經(jīng)后支結(jié)構(gòu)圖《椎骨與脊神經(jīng)后支塑化標(biāo)本Evaluationonly.chAsposeslidesforNET4odientPalvetonoCreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePty14在神經(jīng)根管外口處脊神經(jīng)的分支6第之部分頸脊神經(jīng)后支分布的特點(diǎn)Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL第之部分721頸1脊神經(jīng)后支(枕下神經(jīng)分布特點(diǎn)斜方肌小直肌頭半棘肌又頭后大直肌為運(yùn)動(dòng)神經(jīng)支此神經(jīng)較前支為大。由寰椎后弓的椎動(dòng)脈溝內(nèi)的椎動(dòng)脈的下方自主干分出,向后行,進(jìn)入枕下三角,并支支配枕下三角諸肌頭上斜肌頭下斜肌頭最長肌頭后大直肌第1頸椎橫突頭下斜肌第2頸椎橫突頭后小直肌枕大神經(jīng)半棘肌第2頸后根節(jié)頸半棘肌上部皮膚頭半棘肌斜方肌肌支可穿頭下斜肌與枕大神經(jīng)相連3-007枕下結(jié)欄結(jié)。該神經(jīng)受卡壓者少Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL21頸1脊神經(jīng)后支(枕下神經(jīng)分布特點(diǎn)822枕大神經(jīng)解剖標(biāo)本與枕動(dòng)脈的關(guān)系枕外隆車神直肌頭的大項(xiàng)韌帶頭上斜肌C1橫突尖頭下斜肌頭半棘肌等(翻起)Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL22枕大神經(jīng)解剖標(biāo)本與枕動(dòng)脈的關(guān)系923枕大神經(jīng)的分布特點(diǎn)眼神經(jīng)研究證明枕大神經(jīng)(C2后支)腦干和脊髓在三叉神經(jīng)核與第2頸神經(jīng)之間,有神經(jīng)元連接,故太陽穴處與眶后處的疼痛,上頜神經(jīng)在進(jìn)行枕大神經(jīng)阻滯時(shí)下頜神經(jīng)耳核C4后支會(huì)解除其疼痛。3-008枕大神經(jīng)分布區(qū)及其與周圍聯(lián)系示意圖Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL23枕大神經(jīng)的分布特點(diǎn)10脊神經(jīng)后支卡壓綜合征的診斷與課件11脊神經(jīng)后支卡壓綜合征的診斷與課件12脊神經(jīng)后支卡壓綜合征的診斷與課件13脊神經(jīng)后支卡壓綜合征的診斷與課件14脊神經(jīng)后支卡壓綜合征的診斷與課件15脊神經(jīng)后支卡壓綜合征的診斷與課件16脊神經(jīng)后支卡壓綜合征的診斷與課件17脊神經(jīng)后支卡壓綜合征的診斷與課件18脊神經(jīng)后支卡壓綜合征的診斷與課件19脊神經(jīng)后支卡壓綜合征的診斷與課件20脊神經(jīng)后支卡壓綜合征的診斷與課件21脊神經(jīng)后支卡壓綜合征的診斷與課件22脊神經(jīng)后支卡壓綜合征的診斷與課件23脊神經(jīng)后支卡壓綜合征的診斷與課件24脊神經(jīng)后支卡壓綜合征的診斷與課件25脊神經(jīng)后支卡壓綜合征的診斷與課件26脊神經(jīng)后支卡壓綜合征的診斷與課件27脊神經(jīng)后支卡壓綜合征的診斷與課件28脊神經(jīng)后支卡壓綜合征的診斷與課件29脊神經(jīng)后支卡壓綜合征的診斷與課件30脊神經(jīng)后支卡壓綜合征的診斷與課件31脊神經(jīng)后支卡壓綜合征的診斷與課件32脊神經(jīng)后支卡壓綜合征的診斷與課件33脊神經(jīng)后支卡壓綜合征的診斷與課件34一脊神經(jīng)后支卡壓綜合征診斷針”正秀砝5樂與針刀微創(chuàng)手術(shù)治療北京龐繼光針刀醫(yī)學(xué)研究院院長首席專家原中國中醫(yī)研究院長城醫(yī)院科研處主任原中國中醫(yī)研究院長城醫(yī)院三病區(qū)主任中國中醫(yī)藥學(xué)會(huì)針刀醫(yī)學(xué)會(huì)第三屆常務(wù)副秘書長龐繼光中國中醫(yī)藥學(xué)會(huì)針刀醫(yī)學(xué)分會(huì)資深專家組副組長海軍總醫(yī)院疼志疼痛中心特需專家外科主任醫(yī)師教授Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL一脊神經(jīng)后支卡壓綜合征診斷35第1部分脊神經(jīng)后支的概念由椎間管走出的神經(jīng)根,在出椎間管外口前分為兩支前支——走在橫突腹側(cè)面的神經(jīng)支后支—走在橫突背側(cè)面的神經(jīng)支;后內(nèi)側(cè)支——沿橫突根部下行,穿乳副突韌帶骨纖維管,至脊柱中央一側(cè)者;后外側(cè)支——沿橫突外側(cè)下行,再穿豎脊肌胸腰筋膜下,至臀部皮下者Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL第1部分36一相應(yīng)各器官段外側(cè)支皮支11因棒神經(jīng)漂高支接啟變能出m圖:翻脊神經(jīng)框架表預(yù)叢與劇神經(jīng)背上陽領(lǐng)青下群段一間神經(jīng)一1對肋間神是奔應(yīng)神是涼擁萍建年警星背內(nèi)側(cè)神經(jīng)Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL一相應(yīng)各器官3712頸胸腰骶段脊神經(jīng)后支C1后支枕下神經(jīng)C2后支—枕大神經(jīng)(后內(nèi)側(cè)支-皮支)C3~8后支T1~10后支T11~L4后支(臀上皮神經(jīng)系統(tǒng))L5~S5后支(臀中皮神經(jīng)系統(tǒng))So1~5后支(臀下皮神經(jīng)系統(tǒng))Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL12頸胸腰骶段脊神經(jīng)后支381。3脊神經(jīng)后支的意義周圍神經(jīng)包括脊神經(jīng)前支與后支。目前書籍只寫脊神經(jīng)前支的卡壓綜合征,無脊神經(jīng)后支卡壓綜合征。似乎脊神經(jīng)后支神后的存在是毫無臨床意義的圖3-001是一個(gè)周圍神經(jīng)分布的示意圖第十勒聞神經(jīng)一斗內(nèi)側(cè)支圖中左側(cè)為脊神經(jīng)前支的分布情形圖中右側(cè)為脊神經(jīng)后支的分布情形旋下神經(jīng)脊神經(jīng)后支分布在頭后、項(xiàng)部、背部雪限取溝神經(jīng)臀上皮神經(jīng)外便皮神經(jīng)空腰部和臀部等廣大的區(qū)域,支配著具有十分2+…強(qiáng)大肌力的肌群豎脊肌。因此,脊神經(jīng)閉孔神經(jīng)臀下皮神經(jīng)后支卡壓綜合征的研究有著重要的臨床實(shí)用坐神經(jīng)價(jià)值。它在疼痛性疾病中占有重要地位Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL1。3脊神經(jīng)后支的意義3914在神經(jīng)根管外口處脊神經(jīng)的分支(腰椎塑化標(biāo)本側(cè)面照片)頸椎椎間管的解剖:頸椎椎間管的截面呈橢園形高大于寬,國人測量高為脊御經(jīng)極79mm,寬為67mm,神神經(jīng)前支根貼管的下壁行走。各神經(jīng)根自上而下逐漸變粗,下位后太外女者神經(jīng)根矢狀徑可占椎間管截面積1/2,而橫徑則可占到葬向切帶全部(100%)。因此,神經(jīng)上切帶神經(jīng)管外根受壓的可能性很大神經(jīng)后支結(jié)構(gòu)圖《椎骨與脊神經(jīng)后支塑化標(biāo)本Evaluationonly.chAsposeslidesforNET4odientPalvetonoCreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePty14在神經(jīng)根管外口處脊神經(jīng)的分支40第之部分頸脊神經(jīng)后支分布的特點(diǎn)Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL第之部分4121頸1脊神經(jīng)后支(枕下神經(jīng)分布特點(diǎn)斜方肌小直肌頭半棘肌又頭后大直肌為運(yùn)動(dòng)神經(jīng)支此神經(jīng)較前支為大。由寰椎后弓的椎動(dòng)脈溝內(nèi)的椎動(dòng)脈的下方自主干分出,向后行,進(jìn)入枕下三角,并支支配枕下三角諸肌頭上斜肌頭下斜肌頭最長肌頭后大直肌第1頸椎橫突頭下斜肌第2頸椎橫突頭后小直肌枕大神經(jīng)半棘肌第2頸后根節(jié)頸半棘肌上部皮膚頭半棘肌斜方肌肌支可穿頭下斜肌與枕大神經(jīng)相連3-007枕下結(jié)欄結(jié)。該神經(jīng)受卡壓者少Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL21頸1脊神經(jīng)后支(枕下神經(jīng)分布特點(diǎn)4222枕大神經(jīng)解剖標(biāo)本與枕動(dòng)脈的關(guān)系枕外隆車神直肌頭的大項(xiàng)韌帶頭上斜肌C1橫突尖頭下斜肌頭半棘肌等(翻起)Evaluationonly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL22枕大神經(jīng)解剖標(biāo)本與枕動(dòng)脈的關(guān)系4323枕大神經(jīng)的分布特點(diǎn)眼神經(jīng)研究證明枕大神經(jīng)(C2后支)腦干和脊髓在三叉神經(jīng)核與第2頸神經(jīng)之間,有神經(jīng)元連接,故太陽穴