(意大利整骨）膈肌中英文

1、( (意大利整骨膈肌中英意大利整骨膈肌中英文文2The diaphragm is a thin muscular and tendinous septum that separates thorax & abdominal cavities. It is pierced by the structures that pass between the chest and the abdomen.膈肌是别离胸腔和腹腔的肌肉肌腱薄组织膈膜。它被胸腔和腹腔之间的组织结构穿过。The diaphragm is the most important muscle of respiration. I

2、t is dome shaped and consists of a peripheral muscular part, which arises from the margins of the thoracic opening, and a centrally placed tendon. The origin of the diaphragm can be divided into three parts:Diaphragm膈肌膈肌膈肌是最重要的呼吸肌肉。它呈穹窿状，由胸腔开口边缘上升的肌肉组织构成其边部，而中心部为腱膜。膈肌的起源可以分为三局部。3ORIGIN OF THE DIAPHR

3、AGM膈肌的起源膈肌的起源A sternal part arising from the posterior surface of the xiphoid process胸骨部起源于剑突后骨面A costal part arising from the deep surfaces of the lower six ribs and their costal cartilages forms the right and left domes 肋部起源于下六对肋骨和肋软骨的内侧面，组成了左右的膈肌隆起A vertebral/lumbar part arising from upper three

4、lumbar vertebrae; forms the right and left crura and the arcuate ligaments脊柱/腰部起源于上3腰椎，组成左右膈脚和弓形韧带4SHAPE OF THE DIAPHRAGM膈肌形状膈肌形状It is studied as 可以被分为Central tendon中心腱Right & left crus 左右膈脚Right & left dome 左右膈肌隆起5 INSERTION OF THE DIAPHRAGM膈肌附着点膈肌附着点The diaphragm is inserted into a central

5、 tendon. The superior surface of the tendon is partially fused with the inferior surface of the fibrous pericardium. Some of the muscle fibers of the right crus pass up to the left and surround the esophageal orifice in a slinglike loop. These fibers appear to act as a sphincter and possibly assist

6、in the prevention of regurgitation of the stomach contents into the thoracic part of the esophagus.膈肌肌束止于中心腱。中心腱的上外表与纤维性心包膜局部膈肌肌束止于中心腱。中心腱的上外表与纤维性心包膜局部性地融合在一起。右膈脚的一些肌纤维越至左边，吊带似地性地融合在一起。右膈脚的一些肌纤维越至左边，吊带似地包围食管形成裂孔。这局部肌纤维起到了括约肌的作用，防包围食管形成裂孔。这局部肌纤维起到了括约肌的作用，防止胃部物体返流至胸腔食管。止胃部物体返流至胸腔食管。6The right crus ari

7、ses from the sides of the bodies of the L 1-3 & IV discs; the left crus arises from the sides of the bodies of the L 1-2 & IV disc.右膈脚起自于1-3腰椎和椎间盘侧部，左膈脚起自于1-2腰椎和椎间盘侧部Lateral to the crura the diaphragm arises from the medial & lateral arcuate ligament. 在膈脚的两侧，膈肌起自于中部和侧部的弓状韧带The medial arc

8、uate ligament extends from the side of the body of the second lumbar vertebra to the tip of the transverse process of the first lumbar vertebra. 中部的弓状韧带由第2腰椎体侧部延伸至第1腰椎横突末端The lateral arcuate ligament extends from the tip of the transverse process of the first lumbar vertebra to the lower border of t

9、he 12th rib. 侧部的弓状韧带由第1腰椎横突末端延伸至第12肋的下缘The medial borders of the two crura are connected by a median arcuate ligament which crosses over the anterior surface of the aorta两个膈脚的中部边缘由中部弓状韧带覆盖着主动脉前方连接着Pillars & Arcuate Ligaments柱形与弓形韧带柱形与弓形韧带7The caval opening lies at the level of the T 8 vertebra i

10、n the central tendon. 腔静脉裂孔位于T8水平的中心腱Inferior vena cava & branches of the right phrenic nerve.下腔静脉与右侧膈神经分支The esophageal opening lies at the level of the T 10 vertebra in a sling of muscle fibers derived from the right crus at the left of median plane.食管裂孔位于T10水平，由左中心平面的右膈脚发出的吊带肌纤维Esophagus, the

11、 right and left vagus nerves, the esophageal branches of the left gastric vessels, & the lymph vessels. 食管，右侧和左侧迷走神经，胃部左血管的食管分支和淋巴管The aortic opening lies anterior to the body of the T 12 vertebra between the crura. 主动脉裂孔位于T12椎体前方，两个膈脚之间Aorta, thoracic duct, & azygos vein.主动脉，胸导管与奇静脉The diap

12、hragm has three main openings:膈肌有膈肌有3个主要的裂孔：个主要的裂孔：8Nerve Supply of the Diaphragm膈肌的神经支配膈肌的神经支配Motor nerve supply:运动神经支配运动神经支配The right and left phrenic nerves (C3, 4, 5)右边和左边的膈神经右边和左边的膈神经C3,4,5Sensory nerve supply:感觉神经支配感觉神经支配The parietal pleura and peritoneum covering the central surfaces of the d

13、iaphragm are from the phrenic nerve and the periphery of the diaphragm is from the lower six intercostal nerves.覆盖于膈肌中心面的胸膜与腹膜由膈神经分出，膈肌的周覆盖于膈肌中心面的胸膜与腹膜由膈神经分出，膈肌的周围神经那么由下围神经那么由下6对肋神经分出对肋神经分出9Functions of the Diaphragm膈肌功能膈肌功能 Muscle of inspiration: On contraction the diaphragm pulls its central tendo

14、n down and increases the vertical diameter of the thorax. The diaphragm is the most important muscle used in inspiration.呼吸肌：收缩时膈肌下拉中心腱增加胸腔的垂直径长。呼吸肌：收缩时膈肌下拉中心腱增加胸腔的垂直径长。膈肌是最重要的吸气肌膈肌是最重要的吸气肌Muscle of abdominal straining: The contraction of the diaphragm assists the contraction of the muscles of the a

15、nterior abdominal wall in raising the intra-abdominal pressure for micturition, defecation, and parturition. 腹部紧张肌：膈肌收缩时帮助腹前部肌肉收缩，促进腹腹部紧张肌：膈肌收缩时帮助腹前部肌肉收缩，促进腹内排尿、通便及分娩活动内排尿、通便及分娩活动Weight lifting muscle: In a person taking a deep breath and holding it (fixing the diaphragm), the diaphragm assists the

16、muscles of the anterior abdominal wall in raising the intra-abdominal pressure. Before doing this make sure that a person have adequate sphincteric control of the bladder and anal canal under these circumstances.提举肌：当人深吸气抱住重物时固定膈肌，膈肌帮提举肌：当人深吸气抱住重物时固定膈肌，膈肌帮助腹前部肌肉收缩提升腹压在这个活动之前，需要确保助腹前部肌肉收缩提升腹压在这个活动之前，

17、需要确保人有在这种情况下控制膀胱和肛门括约肌的能力人有在这种情况下控制膀胱和肛门括约肌的能力10Functions of the Diaphragm膈肌功能膈肌功能 Thoraco-abdominal pump: The descent of the diaphragm decreases the intrathoracic pressure & increases the intra-abdominal pressure. This compresses the blood in the inferior vena cava and forces it upward into the

18、 right atrium of the heart. Within the abdominal lymph vessels is also compressed, and its passage upward within the thoracic duct is aided by the negative intrathoracic pressure. The presence of valves within the thoracic duct prevents backflow.胸腹泵：膈肌的下降减少胸内压，提高腹内压。这会挤胸腹泵：膈肌的下降减少胸内压，提高腹内压。这会挤压下腔静脉，

19、使血液泵回右心房。同时腹部淋巴管也受压下腔静脉，使血液泵回右心房。同时腹部淋巴管也受到挤压，它在胸导管处阀门阻止倒流的通行也受到到挤压，它在胸导管处阀门阻止倒流的通行也受到胸腔腹压的帮助胸腔腹压的帮助11 THORACIC DIAPHRAGM connections: 胸部膈肌的联系：胸部膈肌的联系：HEART by phrenic-pericardial ligament; also from the pericardium to the vertebrae we find vertebral-pericardial ligaments (from C6 to T4); from the p

20、ericardium to the sternum we have sternal- pericardial upper & lower ligaments.心脏，膈-膜心包韧带；同时从心包膜到椎骨我们可以看到脊椎-心包韧带；从心包到胸骨还有胸骨-心包上下韧带12 THORACIC DIAPHRAGM connections: 胸部膈肌联系：胸部膈肌联系： LUNGS, by phrenic-pleural ligaments; we also have costal-pleural (from K1-2 to pleura), vertebral-pleural and transv

21、erse-pleural (from C7 to pleura) ligaments that connect directly to the cervical spine.肺，膈肺，膈-胸膜韧带；同样还有肋胸膜韧带；同样还有肋-胸膜从肋胸膜从肋1、2到胸到胸膜，脊椎膜，脊椎-胸膜和横突胸膜和横突-胸膜从肋胸膜从肋7到胸膜韧带，直到胸膜韧带，直接联系着脊椎接联系着脊椎13 THORACIC DIAPHRAGM connections: 胸部膈肌联系：胸部膈肌联系： LIVER, by coronal ligament (under the right dome of the diaphragm

22、), triangular ligament under the left dome and falciform ligament.肝，由冠状韧带位于膈肌右圆顶下方，位于左圆顶下肝，由冠状韧带位于膈肌右圆顶下方，位于左圆顶下方的三角韧带和镰状韧带肝圆韧带方的三角韧带和镰状韧带肝圆韧带On the right side, we have also the right phrenic-colic ligament(between lower right part of liver and right colic corner).在右侧，同样有膈-结肠韧带位于肝右下部和右结肠角14THORACIC

23、DIAPHRAGM connections:胸部膈肌联系：胸部膈肌联系：On the right side, with the right colic flexure, we have also the right phrenic-colic ligament(between right dome and right colic flexure).在右侧，与右结肠屈曲，有右膈在右侧，与右结肠屈曲，有右膈-结肠韧带位于右圆顶和右结肠结肠韧带位于右圆顶和右结肠屈曲之间屈曲之间15 THORACIC DIAPHRAGM connections: 胸部膈肌联系：胸部膈肌联系： STOMACH (and

24、 esophagus), by gastro-phrenic ligament (under the left dome of the diaphragm), SMALL INTESTINE by Treitz muscle, SPLEEN by phrenic-spleen ligament, COLON by left phrenic-colic ligament.胃和食管，通过肠胃和食管，通过肠-膈膜韧带位于左圆顶下方，膈膜韧带位于左圆顶下方，通过韧带肌与小肠连接，通过膈通过韧带肌与小肠连接，通过膈-脾韧带与脾连接，通过脾韧带与脾连接，通过膈膈-结肠韧带与结肠连接结肠韧带与结肠连接16T

25、HORACIC DIAPHRAGMOsteopathic approch胸部膈肌整骨方法TakeCare Osteopathic AcademyMilano - Italy17THORACIC DIAPHRAGM dysfunction: 胸部膈肌的功能失常胸部膈肌的功能失常 The movement of the diaphragm is a compromise between its descent, its support visceral and the tension of the aponeurotic axis.膈肌的运动是在收缩下降、支撑内脏和维持腱膜轴张力的膈肌的运动是在收

26、缩下降、支撑内脏和维持腱膜轴张力的综合效果综合效果Malfunctions can be uni-bilateral, at level of the domes or of the pillars. Well talk then of dysfunction in inspiration low or high功能失常可以存在于单功能失常可以存在于单-双侧，位于隆起或者膈脚韧带水双侧，位于隆起或者膈脚韧带水平。我们以吸气高平。我们以吸气高/低来命名低来命名DYSFUNCTION OF LOW INSPIRATION: In this injury the diaphragm is contr

27、acted and keeps a relatively low position with respect to its neutral point, ie reduces the excursion epiratory.吸气低功能失常：这种情况中，膈肌在缩紧状态时保持相吸气低功能失常：这种情况中，膈肌在缩紧状态时保持相对于中立位较低的位置，减少了呼气时运动的程度更弱对于中立位较低的位置，减少了呼气时运动的程度更弱呼气呼气DYSFUNCTION OF HIGH INSPIRATION: In this dysfunction the diaphragm is contracted and m

28、aintains a relatively high position with respect to its neutral point, in other words reduces the inspiratory excursion. The lower ribs remain closed during the inspiratory time.吸气高功能失常：这种情况中，膈肌在缩紧状态时保持相吸气高功能失常：这种情况中，膈肌在缩紧状态时保持相对于中立位较高的位置，换句话说减少了吸气时运动的程对于中立位较高的位置，换句话说减少了吸气时运动的程度更弱吸气。而在吸气过程中下肋骨褒词闭合状态

29、度更弱吸气。而在吸气过程中下肋骨褒词闭合状态18How to name a dysfunction? 如何命名功能失常？如何命名功能失常？Hands covering rib cage, on the projections of the diaphragm:双手置于胸廓膈肌的突起处density test密度测试Which side is in trouble?哪一侧失常？If during breathe-in goes down, but during breathe-out doesnt go back, I have a dysfunction of “low inhalation.

30、 Also the rib cage on that side is first to open.如果在吸气时向下但呼气时没有回去，那么是有“低吸气功能失常。同样胸廓在这一侧是最开始翻开的。Opposite sensations for “high inpiration dysfunction“高吸气功能失常那么是相反的情况19 INSPIRATION DYSFUNCTION 吸气功能失常吸气功能失常Operator on the opposite side of the dysfunction. Patient supine.In the first phase, exaggerate dy

31、sfunction.Same side arm of the patient under the head.Caudal hand of the operator under the costal arch to be treated with the palm of the hand. Cranial hand on the costal ipsilateral rib cage.整骨师位于与功能失常相反一侧，患者仰整骨师位于与功能失常相反一侧，患者仰卧。首先进行的是将功能失常卧。首先进行的是将功能失常“扩大。患扩大。患者同侧手置于头下方。整骨师远端手置于肋者同侧手置于头下方。整骨师远端手置

32、于肋角下方，以手掌进行技术调整。近端手置于角下方，以手掌进行技术调整。近端手置于胸廓同侧肋骨处。胸廓同侧肋骨处。During inspiration, Move body weight to the top to exaggerate the parameter inspiratory. Hold rib cage opening during expiration and with the caudal hand vibrate.吸气时，将身体重量都移至顶部来扩大吸气吸气时，将身体重量都移至顶部来扩大吸气的运动程度。呼气时保持胸廓处于翻开状的运动程度。呼气时保持胸廓处于翻开状态，远端手作振动

33、手法态，远端手作振动手法Then fix the dysfunction: arm of the patient relaxed. Move body weight to the foot, keeping rib cage closing during inspiration and closing more during xpiration (also with vibrations).然后调整功能失常：患者手臂放松，将身体然后调整功能失常：患者手臂放松，将身体重量移向足部，保持胸廓在吸气时关闭，在重量移向足部，保持胸廓在吸气时关闭，在呼气时关闭更多同样配合振动手法呼气时关闭更多同样配合振动手法20 EXSPIRATION DYSFUNCTION 呼气功能失常呼气功能失常Operator in the same position as before.整骨师处于同样位置整骨师处于同样位置Start exaggerating dysfunction, by accompanying the grid rib in closing during exhalation and holding it during the inspiration phase s