踝关节lecture翻译.ppt

Midtarsal joint跗关节 between calcaneus and cuboid on lateral side外侧为跟骨和骰骨之间 between talus and navicular on the medial side内侧为距骨和舟骨之间,Talocrural joint踝关节 inferior tibiofibular jnt. 下胫腓关节 tibiotalar jnt.胫距关节,Subtalar joint距下关节 aka talocalcaneal也就是距跟 between talus and calcaneus位于距骨和跟骨之间,medial内侧观,lateral外侧观,calcaneus,calcaneus,talus,fibula,tibia,cuboid,navicular,腓骨,跟骨,骰骨,胫骨,距骨,舟骨,跟骨,Talocrural Joint踝关节,Articulation between the tibia and fibula (inferior tibiofibular joint) and between the tibia and the talus (tibiotalar joint).位于胫骨和腓骨（下胫腓关节）之间，胫骨和距骨之间的关节（胫距关节） This joint is responsible for plantar flexion and dorsiflexion and some abduction/adduction. 该关节负责跖屈背屈以及一些外展/内收 The axis of rotation is a line between the two malleoli.沿两踝之间的连线扭转,Subtalar Joint距下关节,Allows pronation/supination and rotation.可以进行旋前/旋后和扭转 The talus articulates with the calcaneus anteriorly, posteriorly and medially.由距骨与跟骨前、中、后关节面构成 The axis of rotation runs diagonally from the posterior, lateral, plantar surface to the anterior, medial, dorsal surface.旋转轴方向为后侧、外侧、足底斜向前侧、内侧、足背。 The orientation of this axis makes pronation/supination triplanar with reference to the cardinal planes.该轴可做旋前/旋后三维动作,Pronation/Supination旋前/旋后,calcaneal eversion跟骨外翻 abduction外展 dorsiflexion背屈 calcaneal eversion跟骨外翻 talar adduction距骨内收 plantar flexion跖屈,calcaneal inversion跟骨内翻 adduction内收 plantar flexion跖屈,calcaneal inversion跟骨内翻 talar abduction距骨外展 dorsiflexion背屈,Pronation旋前,Supination旋后,Open Chain开链,闭链,Tibial Rotation胫骨扭转,The subtalar joint can be likened to the action of a mitered hinge (Inman and Mann, 1973).距下关节类似于斜铰动作 The orientation of the subtalar joint axis causes the tibia to internally rotate during pronation and externally rotate during supination.距下关节运动的轴向引起胫骨在旋前时内旋，旋后时外旋。 Thus, the tibia internally rotates with pronation or knee flexion and externally rotates with supination or knee extension.因此，旋前时胫骨内旋或膝关节屈曲内旋，旋后时胫骨外旋或膝关节伸展。,It is important that knee flexion and pronation occur in synchronization (as well as knee extension and supination).重要的是膝关节屈曲和旋前同时发生（膝关节伸展和旋后也是这样）,Midtarsal Joint跗关节,Actually consists of two joints: the calcaneocuboid on the lateral side and the talonavicular on the medial side.这两个关节实际组成：外侧的跟骰关节和内侧的距舟关节。,During pronation, the axes of these two joints are parallel, this unlocks the joint and creates a hypermobile foot that can absorb shock. 旋前时这两个关节之间的轴是平行的，未锁死的关节形成过度松弛的足部赖吸收震动 During supination the axes are not parallel and this joint becomes locked allowing efficient transmission of forces.旋后时，这两个轴不平行，此关节锁住，有效传递力量。,距骨,跟骰轴,跟骨,距舟轴,正常,旋前,Foot Orientation足部方向,前足外翻,后足外翻,正常,胫骨,距骨,跟骨,腓骨,跖骨头,前足内翻,胫骨外翻,后足内翻,A forefoot valgus exists when the forefoot is everted relative the rearfoot. This is not as common as forefoot varus. 前足外翻是相对于足跟外翻。这种情况不如前足内翻常见 A forefoot varus exists when the forefoot is inverted to the rearfoot. This is the most common cause of excessive pronation.前足内翻相对于足跟内翻，常见于过度旋前的情况。,A rearfoot valgus exists when the rearfoot is everted. 后足外翻出现在后足向外翻 A rearfoot varus exists when the rearfoot is inverted. This can increase maximum pronation. 后足内翻出现在后足向内翻时，导致过度旋前。,Ligaments韧带,Lateral side of ankle accounts for 85% of ankle sprains85%的踝关节扭伤多出现在外侧,Arches of the Foot足弓,There are 3 arches in the foot that contribute to support and shock absorption. These arches are maintained by the shape of the tarsal and metatarsal bones, ligaments and plantar fascia.足部有3个弓形结构，用来支撑和吸收震动。这些弓形结构由跗骨、跖骨、韧带和足底筋膜构成,Plantar surface,Fascia,Arch Types足弓种类,Feet are often classified according to the height of the medial arch.根据内侧足弓的高度，通常将足部分为： Normal正常 high-arched or pes cavus高弓足或弓形足 flat-footed or pes planus扁平足或平足 Arches can also be rigid or flexible.足弓也可以是刚性的或柔性的 High-arched, rigid feet make poor shock absorbers.高弓足，刚性足，吸震差 Flat-footed, flexible arches often allow excessive pronation.扁平足，柔性足，通常会过度旋前。,Plantar Flexors跖屈肌群,NOTE:注： 1) Soleus lies deep to gastrocnemius比目鱼肌 比腓肠肌更深 2) Both insert into the calcaneal tendon aka Achilles tendon都汇入到跟骨肌腱里也就是跟腱 里,Soleus比目鱼肌,Gastrocnemius腓肠肌,Posterior View后观,Assistant Plantar Flexors 跖屈肌肌群,Tibialis Posterior 胫骨后肌,Peroneus Brevis 腓骨短肌,Peroneus Longus 腓骨长肌,Flexor Digitorum Longus 胫骨后肌腱,Flexor Hallucis Longus 长屈肌肌腱,Plantaris 跖肌,Note: Their tendons pass posteriorly to the malleoli注：它们的肌腱 都经过足踝后方,Note: insertion is wrong!,Dorsiflexion背屈,peroneus tertius第三腓骨肌 (usually very close to extensor digitorum longus and often considered as part of this muscle)通常非常接近于趾长伸肌，通常也被认为属于这块肌肉,tibialis anterior胫骨前肌,extensor digitorum longus趾长伸肌,extensor hallucis longus拇长伸肌 (deep to ext. digitorum longus)比趾长伸肌 更深处,tibialis anterior 胫前肌,extensor hallucis longus 拇长伸肌,flexor digitorum longus 胫骨后肌腱,flexor hallucis longus 长屈肌肌腱,tibialis posterior 胫后肌,Invertors足内翻,primary基本,NOTE: Muscles pass to the medial side of the foot!注：肌肉延伸至 足内侧,peroneus brevis腓骨短肌,peroneus longus腓骨长肌,peroneus tertius第三腓骨肌,extensor digitorum longus 趾长伸肌,Evertors足外翻肌,primary基本,Causes of Excessive Pronation过度旋前的原因,Q-angle greater than 20 degreesQ角度大于20度 tibial varus greater than 5 degrees胫骨内翻大于5度 rearfoot varus greater than 2 degrees后足内翻大于2度 forefoot varus greater than 3 degrees前足内翻大于3度 plantar flexed first ray weak medial arch内部足弓弱 tight gastrocnemius and soleus or a short Achilles tendon 腓肠肌和比目鱼肌紧张或跟腱短,The Problem with Excessive Pronation过度旋前的问题,Excessive or prolonged pronation during the support phase will disrupt the normal tibial-femoral rotation relationship at the knee. The tibia continues to internally rotate with the prolonged pronation while the knee is extending. Knee extension is normally associated with external tibial rotation.,支撑时期，过度或长期旋前会导致损坏膝关节处正常的胫骨股骨扭转关系。长期旋前胫骨向内扭转而膝关节伸展。膝关节伸展通常伴随着胫骨内旋。,Orthopedic Evaluation骨科评估,Cassetto disegno,Drawer Test抽屉测试,patient supine患者仰卧位 Gripping the foot and exert a traction