膝关节解剖.ppt

KneeAnatomyTraining KneeAnatomy Introduction介绍Verylittlebonystability少的骨稳定Behavesmorelikearoundballonflatsurface运动主要是球在面上的滑动Ligamentsresponsibleforstability主要韧带稳定 KneeAnatomy Lookssimple butmostcomplex 看似简单 最复杂的关节Morelikelytobeinjuredthananyotherjointinthebody人体中更易受伤的关节Largestjointofthebody actuallyconsistingof4joints人体大关结 有4个关节组成Patellofemoral膑股关节 Lateraltibiofemoral外侧胫股关节 Medialtibiofemoral内侧胫股关节 Tibiofibular胫腓关节 KneeAnatomy BasicStructures基本组织Bones骨Femur股骨 Tibia胫骨 Fibula腓骨 Patella膑骨Muscles Tendons肌肉及肌腱Quadriceps四头肌 Hamstrings CalfmusclesLigaments韧带Medialcollateral内侧副韧带 Lateralcollateral外侧副韧带 Anteriorcruciate前交叉 Posteriorcruciate后交叉 Poplitealligament RetinaculumCartilage软骨Meniscus半月板 Articularcartilage关节软骨Bursae KneeBones BonesFemur股骨Large longboneofthethigh大长骨Tibia胫骨Largeboneofthelowerleg Fibula腓骨Smallboneofthelowerleg Patella膑骨 KneeCap KneeBones AnteriorView Femur Tibia Patella Patella NoPatella KneeBones Function Patella膑骨Patellofemoralgroove frontofthefemur Patellatrackingcanaffecttheoverallfunctionoftheknee 膑骨沟 膑骨轨迹影响膝的功能 PatellaPatellarGroove KneeBones Lat medViews Femur Tibia Fibula Patella Lateral Medial KneeBones PosteriorView Femur Tibia Fibula PrimaryKneeLigaments主要的膝韧带 MCLMedialCollateralLig LCLLateralCollateralLig KneeLigaments MedialandLateralCollateralLigamentshelpstabilizethekneebypreventingVarusandValgusforces内外侧副韧带防止内外翻 VarusTowardstheMidline Valgus外翻TowardstheOutside Valgus内翻TowardstheOutside KneeLigaments MCL LCL CruciateKneeLigaments cruciate cross 十字韧带 AnteriorCruciateLigament前交叉韧带Attachesanterioronthetibia posterolateralonthefemur附着于胫骨前部股骨后部Preventsanteriormovementofthetibiaonthefemur防止胫骨相对股骨的前移Checksexternalrotationofthetibiainflexion曲屈时防止胫骨外旋 Anterior ACL Inferior Superior Posterior Knee CruciateLigaments Knee ACL ACL Footprint前交叉胫骨附着点 Tibialattachment Anterior Posterior TibialPlateau TibialPlateau FemoralAttachment Footprint PosteriorCruciate后交叉韧带 AttachesPosterioronthetibia Antero medialonthefemur 附着于胫骨后股骨前内ThePCLisastrongfanshapedligamentthatisthestrongestinthebody后叉强大的扇形韧带Primarystabilizeragainstposteriormovementofthetibiaonthefemur防止胫骨后移Helpscheckthekneeinextension防止过伸 CruciateKneeLigaments Cruciate Cross PCL Knee Cruciates ACL PCL AnteriorView PosteriorView Knee Hingejoint flexion extension 铰链式关节 屈和伸Flexionisachievedbycontractingthehamstringmusclesinthebackoftheleg 通过收缩大腿后部肌肉屈曲关节TheExtensorMechanismsitsinfrontofthekneejoint 伸膝装置在膝关节前Theextensormechanismismadeupofthepatella thepatellartendon thequadricepstendonandthequadricepsmuscles 伸膝装置由膑骨 膑腱 股四头肌 股四头肌腱组成 KneeMuscles Muscles肌肉 Quadriceps股四头肌Vastuslateralis外侧束 Vastusintermedius中间束 Vastusmedialis内侧束HamstringsSartorius Gracilis Semimembranosus Semitendinosis Bicepsfemoralis缝匠肌 股薄肌 半腱肌肉 半膜肌 二头肌CalfMuscles小腿肌肉Gastrocnemius Soleus Popliteus PesAnserinemuscleattachmentisintothemedialtibia 腓肠肌 比目鱼肌 Knee Muscles Quadriceps股四头肌 VastusMedialis VastusLateralis VastusIntermedius Knee Muscles Quadriceps VastusMedialis股内侧肌 RectusFemoris股中间肌 VastusLateralis股外侧肌 Knee QuadricepsMechanism It sthemotorthatdrivesthekneejoint andallowsustowalk Composedofthepatellartendon thepatella andthequadricepsmusclesonthefrontofthethigh 走路的发动机由膑股 膑腱 股四头肌 股四头肌腱组成Thepatellaworkslikeafulcrum andincreasestheforceexertedbythequadricepsmusclesasthekneestraightens WhentheQuadricepsMusclescontract thekneestraightens Whentheyrelax thekneebends 膑骨为增加股四头肌肉力量的支点 收缩伸膝 放松屈膝 PatellarTendon QuadricepsTendon Femur Patella PatellarTracking 膑骨轨迹ThePatellarFacetstrackintheFemoralGroove Knee HamstringMuscles Sartorius缝匠肌Gracilis股薄肌Semimembranosis半腱肌Semitendonosis半膜肌 BicepsFemoris股二头肌 Knee HamstringMuscles PesAnserineAttachmentofthe鹅足Hamstringtendons SartoriusshownhereontheMedialTibialTuberosity MedialAttachments Knee HamstringMuscles LateralAttachment外侧附件BicepsFemorisAttachmenttotheFibula股二头肌肉腓骨附着点 KneeLigaments KneeLigaments Lateral MedialRetinaculum MedialRetinaculumMedialsupportforPatellarTracking LateralRetinaculumLateralsupportforPatellarTracking VastusMedialis VastusLateralis Knee Tendons TendonsQuadricepsTendonQuadricepsTendonconnectstheQuadricepsMusclestothePatella四头肌腱连接四头肌和膑骨PatellarTendonPatellarTendonconnectsthePatellatotheTibia 膑腱连接膑韧带和胫骨ThePatellaisaboneembeddedwithintheQuadricepsandPatellarTendonslyingovertheFemoralbone Alsoknownasa sesamoid bone 膑骨存在于股四头肌内 又成为籽骨 Knee Tendons QuadricepsTendon PatellarTendon Knee MeniscalCartilage Meniscus plural menisci 半月板Thearticularsurfacesbetweenthefemurandtibiaarenotcongruent Theyareclosestinfullextension Howeverthisspacemustbefilledbythemeniscus 股骨和胫骨关节面不是匹配的 在屈曲位是最接近的 空间被半月板填充Bothmenisciarethickerattheirperipheryandthinnertowardsthemiddle Theybothmoveinflexionandextension 两个半月板都是四周厚中间薄 在屈伸时都是运动的Thelateralmeniscusisnotfirmlyattachedtothecollateralligamentortothetibiaasisthemedialmeniscus Thus itislesspronetodistortionandinjury 外侧半月板不像内侧半月板那样同侧副韧带或胫骨紧密附着 Knee MeniscalCartilage Meniscus ACL PCLAttachmentsThelateralmeniscusis O shapedandgenerallyofequalthickness 外侧半月板o形 等厚 Themedialmeniscusis C shapedandisthickerposteriorlythananteriorly 内侧半月板c形 后侧比前侧厚 Lateral Medial Lateral Medial Knee Themenisciserveseveralfunctions半月板装置的几个功能A Lubrication润滑B Nutrition营养C Shockabsorbers震荡吸收D Spreadstress传导压力E Decreasearticularcartilagewear减少关节软骨磨损F Makejointspacesmorecongruent填充关节间隙G Preventhyperextension防止过伸Themeniscusactuallywrapsaroundtheupperbonetofillthespacebetweentheroundfemurandtheflattibia Knee Meniscus MeniscusCrescent shapedfibrocartilage半月形纤维软骨Collagenfibersarrangedlongitudinallyandradially胶原纤维成经向放射装Triangularincrosssection横截面呈三角形 Knee MeniscusThemenisciarerelativelyavasculartowardstheirinner1 3 somewhatvascularintheirmiddle1 3 vascularintheirouter1 3 Theyareheldinplacebythecoronaryligaments半月板内1 3为白区 中1 3为红白区 外1 3为红区 中间被冠状韧带连接 Themeniscipossessnonerves thusthereisnopainunlessacoronaryligament tibialattachment hasbeendamaged Thereisseldomabloodyeffusion however youmightfindsynovialswelling 半月板没有神经 因而没有疼痛直到冠状韧带损伤 很少有血液渗出 但是能看到关节液增长 Bloodsupplyperipherally Nobloodsupplyproximal ArticularKnee Cartilage关节软骨 Coversendsofbones joint 覆盖骨末端endsofthefemur thetopofthetibia topofthefibulaandthebackofthepatella股骨末端 胫骨及腓骨上端 膑骨背面White shinymaterial tough rubbery白色 有光泽 有弹性的 有硬度的Consistency thickFunctionabsorbshock吸收震荡providesmoothsurface facilitatemotion 提供表面的润滑 Knee ArticularCarti