感觉系统解剖生理 定位诊断,首都医科大学附属北京天坛医院 张在强,机械感受器（Mechanoreceptor）,Meissners end organ (RA, type I) responds best to light touch Pacinian corpuscles (RA, type II) responds best to vibration Merkels end organ (SA, type I) responds best to pressure Ruffinis end organs (SA, type II) respond best to pressure,纤维类型,A/A myelinated fibers (3072m/sec) convey light touch, proprioception, vibratory, and discriminative sensations Alightly myelinated fibers (430m/sec) convey sensation of pinprick and coldness C-unmyelinated fibers (0.42m/sec) convey the sensation of dull aching and warmth,与脊髓相连的脊神经前、后根汇合形成脊神经 C1 or Co1无后根 颈膨大位于 C5-T1 ，与上肢的神经支配有关。 腰骶膨大位于L1-S3，与下肢的神经支配有关。 腹侧根和背侧根在后根神经节远端汇合，形成混合型脊神经。 脊神经融合，在外周形成神经丛和神经干。,体表节段性及周围性感觉分布图,股神经,腓总神经,腓浅神经,腓深神经,胫神经,腓肠神经,胫神经,背根神经节,脊髓灰质板层结构,痛温觉传导通路,痛觉的中枢调节,Nociceptive specific (NS) cells：伤害感受特异细胞 wide dynamic ranges (WDRs)：动态区 parabrachial area (PB):臂旁区 periaqueductal grey (PAG)：中脑导水管周围灰质 rostral ventromedial medulla (RVM)：延髓头侧腹内侧区,后索 内侧丘系,感觉通路的纤维排列,Dorsolateral medullary syndrome (Wallenberg syndrome),Medial medullary syndrome (Dejerine syndrome),Syndrome of the caudal basis pontis (MillardGubler syndrome),Syndrome of the caudal pontine tegmentum,Syndrome of the oral pontine tegmentum,Syndrome of the red nucleus (Benedikt syndrome),Syndrome of the cerebral peduncle (Weber syndrome),上臂丛损伤： 三角肌、肱二头肌、冈上肌和冈下肌萎缩 上肢内旋 C5,6皮节分布区感觉障碍,下臂丛损伤： C8,T1损害 手肌萎缩 C7,C8,T1皮节感觉障碍 Horner综合症,