周围神经松动术蔡永裕

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1、Neuronsarethestructuralunitsofnervoustissue.CONTINUUMEssentiallytheentirenervoussystemisacontinuousstructureMechanically:Chemically:Electrically:PERIPHERALNEURODYNAMICS(PHYSICALHEALTHOFNERVOUSSYSTEM)蔡永裕,MS,PT美國西北大學物理治療研究所碩士臺灣台中澄清醫院復健治療部主任、臺灣大學醫學院物理治療臨床專家陽明大學兼任講師弘光科

2、技大學助理教授物理治療學會繼續教育主任委員前美國芝加哥ResurrectionMedicalCenter臨床專家前物理治療師公會全國聯合會理事長PERIPHERALNERVESPeripheralnervesusuallydon„tcontainnervecellbodies,dendritesorsynapses.Variations:PERIPHERALNERVEThestructuralorganizationofperipheralnervesallowsaxonstoconductimpulsesthatfacilit

3、ateanindividual‟sinteractionswiththeworldwhiledirectingandtoleratingthemyriadposturesofthetrunk,head,andlimbs.PERIPHERALNERVOUSSYSTEMPeripheralnerveshavethreecomponents:Axons(non-myelinatedandmyelinated)+Schwanncells(supportingcellsaroundtheaxons)Connectivetissues(wi

4、thbloodvessels)MechanicalInterfaceDIFFERENTCHARACTERISTICSOFAXONSnon-myelinatedaxons:veryslender,about0.2to1.5micrometresindiameter(0.3to1.6m/s).myelinatedaxons:1to20micrometresindiameter(3to100m/s).DIFFERENTAXONSCONNECTIVETISSUEOFPERIPHERALNERVEaxonsareinsulatedfro

5、meachother,bundledtogether,andprotectedby3connectivetissuelayers—theendoneurium,theperineurium,andtheepineurium.CONNECTIVETISSUESNeurovascularbundle(NV)Interfascicularepineurium(Ep)Perineurium(Pe)Endoneurium(En)Alargedepositionofendoneurialcollagen(＊)ENDONEURIUMva

6、scularlooseconnectivetissuethatsurroundsindividualSchwanncellsheaths,andtheirenclosedaxons,withinafascicle.PERINEURIUMBundlesofaxonsaregroupedintofasciclesbyadenseconnectivetissuecalledperineuriumformedby(upto15layersofflatperineurialcells.)Themostinternalperineurialc

7、ellsformaperineurialdiffusionbarrierthatfunctionswiththeblood-nervebarrierincontrollingtheendoneurialenvironment.Theselayersofcollagenandperineurialcellsmaketheperineuriumtheprimaryloadbearingportionofthenerve.EPINEURIUMNervefasciclesareheldtogetherandsurroundedbyacon

8、nectivetissuelayer,termedtheepineurium.Theepineurialconnectivetissueinnervesthatcontainmanyfascicles,andtheco