米兰整骨-骰骨-课件

1Itislocatedontheouteredgeofthefoot,infrontoftheheelbone,behindthe4thand5thmetatarsal,withrespecttotheoutsidescaphoid.Ithastheshapeofatriangularprism-basedinterior.Ithas5facesand1margin.位于足部外侧缘，跟骨前，4、5跖骨后，相对舟状骨向外。内侧为三棱镜形，有5个面和1边缘Cuboid骰骨2Dysfunctionsofcuboid-navicular骰舟关节功能失常Duringtheinversionofthefootontheinsideofthecontractionoftheposteriortibialtubercleofthescaphoidintheleadupandback;thenthescaphoidwillmakeainternalrotation,ieitslowerfacewilllookinsideanditsoutsideedgewillslidedown.Thecuboidisalsoattractedtohimintheligamentousattachmentsthatconnectitwiththescaphoid.在足内翻中，收缩内面胫骨后结节，舟状骨先向上后；然后舟状骨内旋，底面向内外缘向下滑。骰骨也因为与舟状骨有韧带联系而被拉向它Duetotherostrumatthelevelofthecalcanealapophysislargeanditsarticularfacetwiththescaphoid,itwillresultinastopthatwillbringthecuboidboneinexternalrotation(hislowerfacelooksoutside).由于跟骨结节平面和与舟状骨切合的关节面，会使得骰骨停止而转向外旋（底面向外）Thismechanismissimilartoagearsprockets.此机制与链齿轮一样Thenavicularhasthentoascendthepredominanceinitsinternaltubercle,whilethecuboidwillhavethetendencytoraiseitsouteredge.舟状骨内侧结节上升，骰骨外缘上升3Duringtheeversionofthefootshortlateralperoneal,throughitsinsertionatthelevelofthestyloidprocessofthe5thmetatarsal,thecuboidwillattractoutsideandbackwardswhilethelongperonealsidewillraiseitsouteredge.在足外翻的过程中，腓骨短肌虽然附着在第5跖骨茎突，骰骨会向外后向，而腓骨长肌外缘上升Thecuboidwillmakealimitedexternalrotationfromtherostrumoftheheel.Similarly,thecuboidbone,thenaviculardrag,butevenhere,duetothesurgeoftheposteriortibialandthearticularfacetjoint,therewillbeagearsystemwhichwillresultinanascentoftheinternaltubercleofthescaphoidandadescentofitsouteredge.骰骨会做小幅度外旋从跟骨平面到足跟。同样地，骰骨，舟状骨拖拽，但是由于胫骨后缘运动和关节面，仍做链齿轮运动，最终是舟状骨内结节上升外缘下降Youthenexperienceanexternalrotationofthecuboidandinternalrotationofthescaphoid.会有骰骨外旋和舟状骨内旋Dysfunctionsofcuboid-navicular骰舟关节功能失常4Scaphoidininternalrotation:•MechanismManufacturer:flatfoot(ifarcislowered),distortionininversionandeversion•Symptoms:paintothescaphoidandelectivelikelypaininthesubtalarjointtothephysiologicallinkbetweenthenavicularandcuboid.•Palpation:morepronouncedinternaltubercleandhigher•Mobility:IncreasedinternalrotationCuboidinexternalrotation:•MechanismManufacturer:flatfeet,sprains•Symptoms:Painonelectivecuboid•Palpation:outeredgeraisedup•Mobility:increasedexternalrotation舟状骨内旋：•机制：平足（足弓低）足内外翻异常•

症状：舟状骨痛，可出现距下关节痛，舟骰之间的生理联系•

触诊：内侧结节易触，高•

运动性：内旋增加骰骨外旋：•

机制：平足，扭伤•

症状：可出现骰骨痛•

触诊：外缘上升•

运动性：外旋增加5Osteopathictestforcuboidandnavicular骰骨和舟状骨的整骨测试Thehandcephalicimpalmatheheelsoastodetermineafixedpoint近端的手触摸足跟来感觉受限点•Thedistalhandthroughthehypothenarisrestingontheheadofthe1stmetatarsalandthefootdoesmakeadorsiflexion远端手的小鱼际放置于第1跖骨，足踝做背屈•Thethumbofthehanddistalsettlesonthebottomofthetubercleofthescaphoid,becausetheindexisonthedorsal拇指放在舟状骨结节底部，食指在背部•Theosteopathdoesmakescaphoidmovementofinternalrotationwiththethumbrestandmovementsofexternalrotationwithindexsupport.操作者用拇指使舟状骨做内旋，食指帮助做外旋•Thetestiscomparative进行对比测试Thehandcephalicimpalmatheheel近端手置于足跟•Thehanddistaltothehypothenarontheheadofthe5thmetatarsalistoperformafootdorsiflexion远端手小鱼际置于第5跖骨，足踝做背屈•Thethumbandindexfingerdistalarearrangedrespectivelyonthedorsalandplantarsurfaceofthecuboid拇指和食指分别置于骰骨的足背和足底面•Osteopathsmovethecuboidinthesuperior-inferiordirectiontoevaluatethedysfunction.操作者在上下方向运动骰骨以评估功能失常•Thetestiscomparative进行对比测试6Correctiontechniquesofscaphoid舟状骨调整技术Theinnerhandthroughthethenarcomesintocontactwiththeupperpartofthenaviculartubercle内侧手通过大鱼际挤压舟状骨结节上部•Theexternalhandistoperformafootdorsiflexion外侧手背屈足踝•Theosteopathaftersearchingthetensionandtheequilibriumpoint,makesathrustwithhishandinsidetobringdownthetubercleandatthesametime,theexternalhandaccompaniestheinsidehandinmakingthisdescenttoperformamovementofthefoot‘subversionabduction操作者找到张力及平衡点，用内侧手施展thrust下压结节，同时外侧手配合使足外翻外展Samepointofcontactwiththeinsidehandonthetubercle内侧手放置于同样的结节处挤压•Theexternalhanddoesmakeadorsiflexionofthefoot外侧手背屈足踝•Theosteopathsearchthetensionandtheequilibriumpoint操作者找到张力及平衡点•Tryathrustwithhishandtolowertheinternaltuberclewhiletheexternalhandraisestheinsideedgeofthefoot,itisthereforedissociatethemovementofthescaphoidfromthatofthecuneiform施展thrust下压结节，同时外侧手将足内侧边缘上提，以此分离舟状骨和楔骨的运动•CarryoutapairinThrust.进行两次7Patientintheproneposition,theleg90°患者俯卧，屈膝90度•Theexternalhandpassesontopofthefootand,viathemetacarpal-phalangealjointofthe1°,takessupportontheupperedgeofthetubercle.外侧手置于足背顶部，通过第1掌跖关节，给予结节上缘支持•Thehandputsaplateontheinnerarchofthefoot,doesmakeadorsalflexion,abductionrealizestheinneredgeofthefootrialzandone另一手掌置于足内弓，使足踝背屈，外展至内边缘•Findingthebalance找到平衡点•Tensionandthrustupwards(elbowlow).至张力处向上施展thrust（肘弯在低位）8Patientsupinekneeflexion患者仰卧屈膝位Theinnerhandosteopathimpalmatheheelandstabilizes;thethenarofthehandisrestingontheoutersideedgeofthecuboid(fingersimpalmanothelowerface)andleadstowardstheinternalrotation,ietowardsthemidline.内侧手触摸稳定足跟，大鱼际放置于骰骨外侧缘（其他手指触摸底面），内旋足踝，使其朝向中线Itcallsforadorsiflexionofthefootbycontinuingtoleadtowardsthecorrection.继续引导至正确位置使得足踝背屈Onceinthebarrierwiththesametechniqueyoucandoathrustinthedirectionofinternalrotationofthecuboid.至障碍点时在骰骨内旋方向施展thrust技术Correctiontechniquesofcuboid骰骨调整技术9Technique“whip”“抽打”技术•Patientinprone患者俯卧位•Theosteopathisputatthefeetofthepatient,impalmafootfromthedorsalsurface,withthetwohands,twoincheswidepositioningoftheinneredgeofthecuboidbone,restingonthe操作者双手置于患者足部，托住足背，剩余两个拇指约2英寸宽置于骰骨两个内侧缘•Lightweighttractiontotheosteopathlowerlimb,leavinghangingthefoottothegroundtoformthehollowoftime(becarefulnottoputtoomuchplantarflexion!)使用较轻的力量，在足背置于治疗床面使向下推挤（注意不要造成过多跖屈）•Tensioningandthrustfromthebottomup.张力点处，从下往上施展thrust10Thecuneiformbonesarethree:1st,2ndand3rd.Theyarelocatedinfrontofthenavicular,cuboidinwardsandbackwardscomparedtothe1st,2nd,3rdmetatarsals.有3块，第1，第2和第3位于舟状骨前，骰骨内侧和第1、2、3跖骨后Directlyinfluencedbythescaphoidandsitesoverthecrosshaveatendencytobecomehollowtherebyadverselyaffectingthearcandfore-foot.受舟状骨的直接影响，位于足弓顶部，因此易形成空洞不利于足弓和前足Describedareessentiallytwotypesofdysfunction:•Cuneiformhigher•Cuneiformlower以下为主要的两种功能失常：高楔骨低楔骨Cuneiform楔骨11Osteopathictestforcuneiform楔骨的整骨测试Theosteopathmobilizescuneiformandheadmovementintheinferior-superiordirectionwithagripbetweenthethumbandindexfingeronthetopandbottomfaceofeachcuneiform操作者以拇指和食指抓住楔骨，在足背与足底方向上测试楔骨的运动性，每个楔骨单独测试•Theotherhandimmobilizesthecouplecuboid-navicular另一只手同时测试骰舟两骨的运动性•Thepatientissupineorprone患者可仰卧也可俯卧•ComparativeTest进行对比测试12Technicalsuperiorityincuneiformbones:高楔骨技术•The3rdcuneiformisthekeystone,thenthereductionsaremadeinthefollowingorder3rd-2nd-1st第3楔骨最重要，接着是第2，然后第1•Technique“bracelet”“手铐”技术•Patientsupine患者仰卧位•Theosteopathtakesarestatthelevelofthedistalphalanxofthemiddleonthedorsalsurfaceofthewedge-shaped,theotherhandissuperimposed操作者以第3指节置于楔骨足背面的中间，另一手叠上•Additionalsupportofthethumbsonthebasisofthecorrespondingmetatarsal拇指置于相应的跖骨底给予支持•Theosteopathmakesalongitudinaltractionandhaveperformedatafootdorsiflexion操作者施展纵向牵拉，同时使足背屈•Findingthebalancepointandthrustthelongitudinalaxisoftheleg找到平衡点，在足的纵向轴线上施展thrustCorrectiontechniqueforcuneiform楔骨的调整技术13Techniqueforcuneiformbonesininferiority:低楔骨技术•Technique“whip”“抽打”技术•Patientinprone患者俯卧•Sametechniqueforthecuboidwithsupportontheplantarsurfaceofthecuneiform与之前骰骨调整中同样，只是将手置于楔骨足底面予以支持•Tensioning增加张力•Findingthebalancepointandthrustfromthebottomtothetop找到平衡点，从底部向上施展thrust•2nd-1st-3rdcuneiform顺序为2、1、3楔骨14Hock-spacingofLisfranc趾跗关节的间隔ThespacingofLisfrancseparatesthetarsalfromthegoal.趾跗关节间隔将跗骨从goal分离出来Iam5;haveabase(proximal),abodyandahead(distal).跗骨有5块，一个底（近端），一个体和一个头（远端）The1stmetatarsalisthelargestandtheshortest,byinsertionoftheM.tibialisanteriorandM.peroneuslongusside.第1跖骨最大最短，有胫骨前肌和腓骨长肌的附着点The2ndmetatarsalisthelongest.第2跖骨最长The5thmetatarsal,theshortestandsmall,isarticulatedatthelevelofthebaseofthecuboidboneandisimportantforthepresenceofthestyloidwhereitfitsintotheshortperonealside.第5跖骨，最短最小，与骰骨底成关节，有一个重要的茎突是腓骨短肌的附着点Physiologicallyperformmovementsofflexion-extensionassociatedwithmovementsofabductionandadductionandaminimumofinternalandexternalrotation.Osteopathicdysfunctionsofthemetatarsalsareevaluatedbasedontheupperorlowerbase.生理学上存在屈伸，同时有外展内收和小幅度的内外旋。整骨中关注上下底的功能失常15Osteopathictestsformetatarsalbones跖骨的整骨测试Theosteopathmobilizesthebaseofeachmetatarsalheadandthemovementinthedirectionofinferior-superiorwithapinchbetweenyourthumbandforefinger.操作者用拇指和食指捏住每一个跖骨头的底部，在足背和足底方向（上下）上进行运动性测试•Theotherhandimmobilizesthemetatarsalsegmentprecedingthetest同时另一只手在每个跖骨测试前固定其他跖骨，防止其活动•Thepatientissupineorprone患者仰卧或者俯卧•ComparativeTest进行对比测试16Correctiontecniquesformetatarsalbones跖骨的调整技术TECHNIQUEFOR1st-2nd-3rdMETATARSUSBASEDTOP对于1、2、3跖骨底向上的技术•Patientsupine患者仰卧•Theosteopathgrabshisfoot,fingersarecrossedontheupperbaseofthemetatarsalinjuryin整骨师抓住患者足部，手指交叉置于跖骨足背面•Thethumbsarecontrappoggiothecorrespondingmetatarsalhead.拇指置于对应的跖骨头处•Thetechniqueiscarriedoutwithadownwardtractionandthrustwithhisfingersonthedorsalfacedown.拇指进行向下挤压施展thrust，同时其他手指在足背面给予支持TECHNIQUEFOR4th-5thMETATARSUSBASEDTOP对于4、5跖骨底向上的技术•Patientsupine患者仰卧•Theosteopathsittingbythesideofdysfunction操作者坐在功能失常一侧•Thelimbdysfunctionisrestingonherthigh功能失常肢置于大腿上•Withthehandthroughtheproximalpisiformcontactonthedorsalsurface,thebaseofthemetatarsal手掌豌豆骨处挤压跖骨底的足背面•Withthedistalhandthroughthepisiformcontactontheplantarsurface,theheadofthemetatarsal另一只手掌豌豆骨处挤压跖骨底的足底面•Researchofthebarrierandthrustapair,perpendiculartothelongitudinalaxisofthefoot.找到障碍点，在垂直于足部纵轴的方向上施展两次thrust技术17REDUCTION1st-2nd-3rdMETATARSUSBASEDBOTTOM1、2、3跖骨底向下的调整•Patientinprone患者俯卧•Theosteopathimpalmathefootwithhishands,thefingersarerestingonthedorsalsurface,thetwothumbscomeintocontactwiththebaseofthemetatarsalindysfunction操作者手托住足部，拇指顶在跖骨功能失常处，其他手指置于足背面给予支持•Correctionwithdownwardtractionandthrust向下挤压施展thrust技术REDUCTION4th-5thMETATARSUSBASEDBOTTOM4、5跖骨底向下的纠正•Patientindorsalrecumbency患者仰卧•Theosteopathissittingbythesideofthelegdysfunction操作者坐于功能失常肢一侧•Thelimbisrestingonhisthigh功能失常肢置于大腿•Withthepisiformdistalhand,makescontactontheplantarsurfaceofthebaseofthemetatarsalindysfunction远端手豌豆骨处置于跖骨底功能失常的足底面，进行挤压•Withtheproximalpisiformhand,makescontactonthebaseofthedorsalmetatarsalinjuryin近端手豌豆骨处置于跖骨底功能失常的足背面，进行挤压•Researchofthebarrierandthrustapair,perpendiculartothelongitudinalaxisofthefoot找到障碍点，在垂直于足部纵轴方向上施展两次thrust技术18Alsoknownasarticulationtibio-fibular也被称作胫腓接合

Articulationproximaltibialfibular.Artrodiabetweenthelateralcondyleofthetibiaandtheheadofthefibula.Ithasaverystrongjointcapsulereinforcedbythetwoligamentsinfrontandbackoftheheadofthefibula.胫腓近端关节。胫骨外侧髁与腓骨头之间的关节，依靠腓骨头前后的两条韧带形成了非常强大的关节。

Articulationdistaltibialfibular.Syndesmosisbetweenthelowerendofthetibiaandthelateralmalleolusofthefibula.Therearetwoligamentsatthislevelofthelateralmalleolusanteriorandposterior(slantingtothefibularmalleolusofthetibia).Duringdorsiflexion,thisjointisopenedtoallowtheslidingrearofthetrochleaofthetalus(largerthanbefore).胫腓远端关节。胫骨远端与腓骨外侧髁之间的韧带连结。在此外侧髁水平中也有前后两条韧带（斜向）。在背屈中，此关节打开以使距骨滑车（后部大于前部）向后滑动。Tibio-fibularjoint胫腓关节19Interosseousmembrane.Tesabytheinterosseouscrestofthetibiatothefibula.Basicallyconsistsoffibrousbundlesthatobliquelydownfromthetibiatothefibulaandviceversa.And'thistopalargeorificeforthepassageoftheanteriortibialvessels.Theanteriortibialarteryisthelesserbranchofthebifurcationofthepoplitealartery;theposteriortibialarteryisthelargerofthetwobranches,andgivesascollateralfibularorperonealarterythatbranchesoffthemuscle(nutritiziathearteryofthefibula,posteriormalleolararterylateraltothelateralmalleolarnetwork).Theanteriortibialarteryseparatestheanteriormalleolararteries,lateralandmedialtothemedialandlateralmalleolarnetworksaroundthetibiaandfibula.Youhavetothinkabouttheseifyouhaveproblemsorvascularstasis.Therefore,theinterosseousmembrane,inadditiontobeingamechanicalconnectionfascialchainsofpeculiarinterestinthefunctional(anddysfunctional)parentandchildofthefoot,playsanimportantroleinthehemodynamicsoftheleg.骨间膜胫腓骨间嵴之间的坚硬部分基本是由从胫骨到腓骨或者从腓骨到胫骨的斜向纤维束组成。在它顶端有胫骨前血管穿过，胫骨前动脉是胫骨动脉分支中较小的一支，而胫骨后动脉较大，且形成腓骨旁动脉或者腓动脉，从肌肉处分支，滋养腓骨动脉和踝血管网侧部。胫骨前动脉分支成前踝动脉群，侧部到中间和中间到侧部，分别滋养胫骨与腓骨。如果你有问题或血流淤滞，就必须考虑这些。因此，骨间膜除了是一个在功能特殊的兴趣方面正常（和不正常的）联系家长和孩子的机械连接筋膜链，对腿部的血流动力学也有重要作用。20Duringtheplantarflexion,thelowerendofthefibuladropsmakesaexternalrotationduetotheconvexityofthetalarfacetintheanteroposteriordirection;Astothemalleolarclamp,itclosesbecausethepulleytalariswiderforwardsandbackwards.在跖屈中，腓骨远端向下运动且因为距骨在前后轴向上的凸面而产生向外的旋转；踝部夹紧的过程中关闭，因为距骨滑车的前部要大于后部Duringdorsiflexion,theexternalmalleolusmovesawayfromtheinsidewheelliftsslightlyandinternally.在背屈中，外踝从内部移出且轻微向上Theuppertibial-fibularjointmovesaccordinglytotheexternalmalleolus:duringdorsiflexionoftheankletheheadofthefibulasalt.外踝背屈过程中，胫腓近端关节相应地移向内踝侧。Conversely,duringplantarflexion.跖屈相反Biomechanicsofthetibiaandfibula胫骨与腓骨的生物力学21AtthelevelofthefibularheadpassesthelateralpoplitealnerveinthepoplitealsciaticnervethatforminsidetheterminalbranchesofthesciaticBIGNERVE(lumbosacralplexusorsciaticnerve).在腓骨头水平为腘神经，是坐骨大神经的终支（腰骶丛或坐骨神经）22Theevaluationofthefibularheadorproximaltibiofibularorhigherisperformedwithmovementsintheanteroposteriordirection,butaftertheleginternallyrotated.评估腓骨头或者胫腓近端关节的方式为小腿内旋后前-后向的活动Dependingonthemovementisrestrictedappointthedysfunctionsofthefibularheadin:根据运动的受限点判断腓骨头的功能失常

anteriority向前

posteriority向后Theevaluationofthelateralmalleolusordistaltibialfibularisdonebyinducingmovementtowardtheanterior-afterwardness.评估外踝或者胫腓远端关节的方式为前后向活动Dependingonthemovementisrestrictedappointthemalfunctioningofthelateralmalleolusin:根据运动受限点判断外踝功能失常anteriority向前posteriority向后Assessmentoftibiofibular胫腓关节评估23Fibularheadinanteriority腓骨头向前（功能失常）ThrusttecniqueThrust技术Positionthepatientsupine.患者仰卧Withthehandcaudalintraruotathelowerlimb,thecranialhandinhispalmportion,isplacedabovethefibulararticulation.Withtheweightofthebodyisusedtostretchthejoint,thereyoudropbyperformingathrust.靠近足部的手固定下肢，靠近躯干的手掌心放置于腓骨头关节处。利用身体的重量牵伸关节，到障碍点时施展thrust。TECHNICALM.E.T.肌肉能量技术Patientissittingonthecouch.Itactsontheposteriortibialmuscle.患者坐于治疗床，主要是胫骨后部肌肉的活动BringthefootpositionSUBVERSIONANDEXTERNALROTATIONwiththecaudalhand.Withthehandplacedinfrontofthecranialfibulararticulationfosterstheposteriorizzazionefibula.操作者远端手使患者足外翻外旋，另一只手放在近端腓骨头前，意在使腓骨头向后回归正常位AskthepatienttomakeaFLEXFOOTANDREVERSALofthefoot,usingthetechniqueofcontraction-relaxation.Duringtherelaxationfosterposteriorizzazione.Repeatfor4-5times.要求患者做背屈-跖屈的动作，利用收缩放松技术。在放松时推动腓骨头向后。重复4-5次。24TECHNICALM.E.T.肌肉能量技术Patientissittingonthecouch.Actionistakenonthelongandshortperonealmuscles.患者坐于治疗床，主要是腓骨长肌和短肌的活动。BringthefootpositionINVERSIONANDINTERNALROTATIONwiththecaudalhand.Withthecranialhandwiththeindexfingerplacedbehindthefibulararticulationfosterstheanteriorizzazionefibula.治疗师用一只手使足部内翻内旋，另一只手食指放置于腓骨头关节后，调整向前Askthepatienttoperformadorsiflexionandeversionofthefoot,usingthetechniqueofcontraction-relaxation.Duringtherelaxationfosteranteriorizzazione.Repeatfor4-5times.要求患者踝背屈外翻，利用收缩放松技术。在放松时推动腓骨头向前。重复4-5次Fibularheadinposteriority后腓骨头25ThrusttechniqueThrust技术Placethemetatarsalphalangealjointofthehandcranialposteriortothefibularhead.一手放置于跖趾关节处，另一只手置于腓骨头后Graspthetailwithhishandthedistalpartoftheleg.Performaslightexternalrotationoftheleg,soastofacilitatetheanchorageoftheheadofthefibulaarticulationmetatarsal-phalangealjoint.Bringthekneeinflexiontowardsthebodyofthepatientwiththehandcranialthenwedgedagainstthebarriertoperformathrust使小腿轻微外旋，以锁定腓骨头和跖趾关节，向着患者躯干方向屈膝，然后朝着运动障碍点方向施展thrust26Dysfunctionslateralmalleolus外踝功能失常TECHNICALCORRECTIONOFAFRONTmalleolus前踝调整技术TECHNICALDIRECT直接技术Placethepatientinthesupineposition.患者仰卧Withthefingersofthehandpositionabovetheanklejoint.Tensionthejointandthenyoudroptheweightofthebodyperformingsuchathrusttowardstherear.手指置于踝关节处，活动关节至最大范围处（紧张），利用身体重力施展thrust垂直地面向下TECHNICALCORRECTIONOFAREARmalleolus后踝调整技术TECHNICALDIRECT直接技术Placethepatientintheproneposition.患者俯卧Withthefingersofthehandpositionabovetheanklejoint.Tensionarticulationbringingthethighwiththefootindorsiflexionandthenyoudroptheweightofthebodyperformingsuchathrustinthedirectionofthefront.手指放置于踝关节处，踝背屈至最大（关节紧张），利用身体重力施展thrust垂直于地面向下27Pathophysiologythroughclinicalcases

病理生理学临床例证

-LegandFoot–下肢

CLINICALCASE1

临床例证1TakeCareOsteopathicAcademyMilano-Italy28PatientPresentation

患者概况A38-year-oldmalecomplainsofnumbnessonthedorsumofhisrightfootanddifficultyliftingthefrontpartofthefoot.38岁男性，右足背部感到麻木，抬小腿困难。History

病史Thepreviousdayhewasstuckbyaca

前一天被汽车撞到Noseriousinjuries,butsubsequently:无严重外伤但随后：Numbnessoverthedorsumofhisrightfoot

整个右足背部麻木Havingtomakea“highstep”toavoiddragginghistoeswhenhewalks行走时需提腿防止脚趾划地Progressivelossoftheabilitytoraisehistoes逐渐失去提脚趾能力ClinicalCase

临床例证29PhysicalExamination身体检查Sensorydeprivationtotheentiredorsumoftherightfoot

整个右足背感觉缺失Dorsiflexionandeversionagainstresistanceweakerontherightsidecomparedtotheleftside与左足相比，右足抗阻力背屈与外翻能力较弱Rightfootdropandhighsteppageduringtheswingphaseofgait

右足下垂且摆动期高足Tenderness,edemaandhematomajustdistaltotheheadoftherightfibula右腓骨头末端压痛、肿胀、血肿Normaldeeptendonreflexesforthequadricepsandcalcanealtendons股四头肌与跟腱深反射正常Stablekneeandanklejoints膝关节与踝关节稳定LaboratoryTests实验室测试Nothingrelevant无明显症状ImagingStudies影像学Radiographicimaging:nondisplacedfractureoftheneckoftherightfibula放射影像学：右腓骨头非位移性骨折ClinicalCase

临床例证30injurytobothdeepandcommonfibularnervecanresultinfootdrop

深层腓神经和腓总神经受损都会导致足下垂differentialdiagnosisisrequired

需要进一步诊断ClinicalCase

临床例证ClinicalReasoning临床病因Thispatientpresentswithsignsandsymptomsindicatingaclinicalconditionoffootdrop症状显示为足下垂ClinicalProblemstoConsider临床需考虑的问题Anteriorcompartmentsyndrome前骨间症状Commonfibularnervetrauma腓总神经受损31RelevantAnatomy相关解剖Skeletalelementsthatcontributetothelateralaspectofkneeregion:膝关节侧面的骨骼结构Lateralcondyleofthefemur股骨侧髁Lateralcondyleofthetibia胫骨侧髁Proximalendofthefibula,articulatedwithlateralcondyleofthetibiaandprovidingdistalattachmentforthetendonofbicepsfemorisandthelateralcollateralligamentoftheknee腓骨近端与胫骨侧髁成关节，是股二头肌肌腱和膝侧副韧带的附着点ClinicalCase

临床例证3233RelevantAnatomy相关解剖Commonfibularnerve(L4-S2)palpableontheneckofthefibula腓总神经（L4-S2)可在腓骨颈处触及Nosensorydistribution无感觉神经分支Itinnervatestheshortheadofbicepsfemoris

支配股二头肌短头Thesubcutaneouspositionofthecommonfibularnerveonthefibularneckmakesitvulnerablewithtraumatothelateralkneeregion由于腓总神经在皮下的位置，使其在膝关节侧面区域创伤时易受损Ontheneckofthefibulacommonfibularnervedividesintoterminalbranches腓总神经在腓骨头处分成终末支ClinicalCase

临床例证34RelevantAnatomy相关解剖Ontheneckofthefibulacommonfibularnervedividesintoterminalbranches:腓总神经在腓骨头处分成终末支Superficialfibularnerve(L4-S1)腓表皮神经Itsuppliessensoryinnervationfromthedistalanterolaterallegandmostofthedorsumofthefoot受小腿前侧面和大部分足背的感觉神经支配Itinnervatesthemusclesofthelateralcompartmentoftheleg(fibularislongusandbrevis)支配小腿侧部肌肉（腓长神经和腓短神经）ClinicalCase

临床例证35ClinicalCase

临床例证RelevantAnatomy相关解剖Ontheneckofthefibulacommonfibularnervedividesintoterminalbranches:腓总神经在腓骨头处分成终末支：Deepfibularnerve(L4-L5)腓深神经Itsuppliessensoryinnervationfromtheadjacentsidesoftoes1and2受第1和2脚趾趾间部分的感觉神经支配Itinnervatesthemusclesoftheanteriorcompartmentoftheleg(tibialisanterior,extensorlongusdigitorumandhallucis,fibularistertius)and,onthefoot,extensorbrevisdigitorumandhallucis支配小腿前部肌肉（胫骨前肌、趾长伸肌、拇长伸肌、第3腓骨肌）和足部的趾短伸肌、拇短伸肌36RelevantAnatomy相关解剖Myofascialcompartmentsoftheleg:腿部肌筋膜Anterior前部Lateral侧部Deepandsuperficialposterior后部深浅ClinicalCase

临床例证37ClinicalCase

临床例证AnteriorCompartmentSyndrome

前骨间症状Seriousclinicalconditioninwhichexcessiveaccumulationofinterstitialfluidbecauseofedemaorsomedegreeofhemorrhageincreasethepressureinthecompartment由于水肿和出血引起的组织间液增多可导致骨间压力增加，是严重的临床症状。Asthebordersofthecompartmentareinelastic,theincreasedpressuremayresultinasufferingofallthemuscles,nervesandvesselsincluded,withischemiaandlaternecrosisofthesestructures由于骨间组织是无弹性的，压力的增加会导致区域内所有的肌肉、神经及血管受累，组织缺陷或坏死38SignsandSymptoms体征与症状SensoryDeficits感觉缺失Withacuteanteriorcompartmentsyndrome,anearlysignmaybethenumbnessfromtheadjacentsidesoftoes1and2(cutaneousdistributionofdeepfibularnerve)急性的前骨间症状，早期的体征是第1和2脚趾邻近部位（深腓神经的皮肤分布）麻木Increasingpaininanteriorlegcompartmentthatmayexceedthanthatoftheoriginalinjury

小腿骨间增加的疼痛可能会超过最初损伤的疼痛Severepainespeciallyduringplantarordorsi-flexion特别在跖屈与背屈时剧烈疼痛MotorDeficit运动缺失Weaknessofdorsiflexionofthefoot足踝背屈无力OtherDeficits其他伤害Visiblebulgingofanteriorcompartmentmuscles骨间前部肌肉可见的肿大Skinpalloroveranteriorcompartment骨间前部皮肤苍白Compartmentpressure>30mmHg骨间压力大于30mmHgLaboratoryevidenceofrhabdomyolysis研究中出现横纹肌溶解现象ClinicalCase

临床例证AnteriorCompartmentSyndrome

前骨间症状39Medicalemergencyrequiringimmediatesurgery(fasciotomy)torelieveincreasedcompartmentpressure紧急情况需要立即的手术（筋膜切开术）来减轻骨间膜增加的压力PredisposingFactors可能的原因Traumatoleg,includingfracturesandsurgeryorcastappliedtootightly(acutecompartmentsyndrome)腿部创伤，包括骨折、手术或者脱位时夹得太紧（急性骨间症状）ClinicalCase

临床例证AnteriorCompartmentSyndrome

前骨间症状40PredisposingFactors

发病诱因Athleticexertion,forexamplerunningordancing(chroniccompartmentsyndrome)运动员劳损，例如跑步或跳舞（慢性骨间症状）Rarelyamedicalemergency,signsandsymptomstendtobetransitoryandconservativetreatmentsasdecreasingintensityoftrainingandusingappropriatefootwearmayreduceoreliminatethesyndrome较少的紧急情况，体征与症状一般为慢性过渡性，通常保守治疗降低训练强度或应用足部绑件来减轻消除症状ClinicalCase

临床例证AnteriorCompartmentSyndrome

前骨间症状41ClinicalNote:临床说明AnteriorCompartmentSyndromevs“shinsplints”前骨间症状与“胫夹”“Shins