脑和脊髓的被膜血管及脑脊液循环优质PPT.ppt

1、向上附于枕骨大孔边缘向下在第二骶椎水平逐渐变细，包裹终丝下端附于尾骨May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 硬膜外隙：硬脊膜与椎管内面的骨膜之间的间隙。间隙略呈负压，有脊神经根通过。临床上常在此进行硬膜外麻醉。硬膜下隙：硬脊膜和脊髓蛛网膜之间潜在的腔隙。May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right

2、reserved by YP HOU and YF SONG 2.脊髓蛛网膜（spinal arachnoid mater）为半透明的薄膜，在硬脊膜和软脊膜之间向上与脑蛛网膜相延续。蛛网膜下隙：脊髓蛛网膜和软脊膜之间较宽阔的间隙，内充满脑脊液。May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 终池：脊髓蛛网膜下隙的下部，自脊髓下端马尾神经根部至第2骶椎水平扩大的马尾神经周围的蛛网膜下隙。临床上常在第3、4或4、5腰椎间进行

3、腰穿，此处不易伤及脊髓。May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 3.软脊膜（spinal pia mater）薄而富有血管，紧贴在脊髓的表面，在脊髓下端移行为终丝。齿状韧带：脊神经前后跟之间形成的韧带，其尖端附于硬脊膜。作用：保护脊髓：和脊神经根一起使脊髓固定在椎管内，并浸泡于脑脊液中，加上硬膜外隙内的脂肪组织和椎内静脉丛的弹性垫作用，使脊髓不因外界的震荡而损伤。作为椎管内手术的标志。May,2009Copyri

4、ght Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2脑的被膜由外向内依次为：1.硬脑膜2.脑蛛网膜3.软脑膜May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 脑被膜模式图May,2009Copyright Depart.Anatomy,School of Medicine,Lan

5、zhou University.All right reserved by YP HOU and YF SONG 1.硬脑膜（cerebral dura mater）坚韧而有光泽，由两层合成，两层之间有血管和神经。硬脑膜与颅盖骨连接疏松，硬脑膜损伤时易在两者之间形成硬膜外血肿。硬脑膜在颅底处则与颅骨结合紧密，故颅底骨折时，易将硬脑膜与蛛网膜同时撕裂，导致脑脊液外漏。May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 1.由硬

6、脑膜形成的结构有：大脑镰（cerebral falx）：呈镰刀形伸入两侧大脑半球之间的大脑纵裂，前端连于鸡冠，后端连于小脑幕的顶，下缘游离于胼胝体的上方小脑幕（tentorium of cerebellum）：形似幕帐，伸入大、小脑之间。后外侧缘附于枕骨横窦沟和颞骨岩部上缘May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 前内侧缘游离形成幕切迹，与鞍背之间形成一环形孔，称小脑幕裂孔，内有中脑通过。小脑幕将颅腔不完全分成上、

7、下两部。小脑镰（cerebellr falx）：自小脑幕下面正中伸入两小脑半球之间鞍膈（diaphragma sellae）：位于蝶鞍上方，张于前床突、鞍结节和鞍背上缘之间，封闭垂体窝，中央有一小孔容垂体柄通过。May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2.硬脑膜窦（sinuses of dura mater）：定义：硬脑膜在某些部位两层分开，内面衬以内皮细胞，形成了硬脑膜窦特点：窦内含静脉血，窦壁无平滑肌，不能收

8、缩，损伤时易形成颅内血肿May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 主要的硬脑膜窦有：a）上、下矢状窦b）直窦c）横窦d）乙状窦e）海绵窦f）岩上窦和岩下窦May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 硬脑膜及硬脑膜静脉窦May,2009Co

9、pyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 海绵窦May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 硬脑膜窦内血液的流向 上矢状窦下矢状窦直窦窦汇横窦乙状窦 海绵窦岩上窦 岩下窦 颈内静脉May,2009Copyright Depart.Anatomy,School

10、 of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 2.脑蛛网膜（cerebral arachnoid mater）薄而透明，缺乏血管和神经，与硬脑膜之间有硬膜下隙，与软脑膜之间有蛛网膜下隙。脑蛛网膜下隙内充满着脑脊液l蛛网膜下池：蛛网膜下隙的大小不一，在有些部位扩大形成了蛛网膜下池May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG

11、 l小脑延髓池：小脑和延髓之间有，临床上常在此穿刺，进行脑脊液的检查l蛛网膜粒（arachnoid granulation）：脑蛛网膜紧贴硬脑膜，在上矢状窦处形成许多绒毛状突起，突入上矢状窦内May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 蛛网膜粒和硬脑膜窦May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right re

12、served by YP HOU and YF SONG 3.软脑膜（cerebral pia mater）：薄而富有血管和神经，覆盖于脑的表面并伸入沟裂内。在脑室的一定部位，软脑膜参与构成脉络组织，其血管反复分支成丛，连同其表面的软脑膜和室管膜上皮一起突入脑室，形成脉络丛，脉络丛是产生脑脊液的主要结构。May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 脑和脊髓的血管1脑的血管1.脑的动脉：颈内动脉、椎动脉、大脑动脉环2.

13、脑的静脉：有浅组和深组之分2脊髓的血管1.脊髓的动脉2.脊髓的静脉May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 1脑的血管1.脑的动脉：来源于颈内动脉和椎动脉。以顶枕沟为界：颈内动脉供应大脑半球的前2/3和部分间脑椎动脉供应大脑半球后1/3及部分间脑、脑干和小脑因此脑的动脉可分为颈内动脉系和椎动脉系。两动脉系在大脑的分支为皮质支和中央支。May,2009Copyright Depart.Anatomy,School o

14、f Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 脑底部的动脉May,2009Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG 颈内动脉（internal carotid artery）起自颈总动脉，穿出海绵窦后发出分支。按其行程可分为4部：颈部、岩部、海绵窦部和前床突上部。后两者是动脉硬化好发部位。颈内动脉的主要分支：大脑前动脉（arterior cerebral artery）大脑中动脉（m