南中大推拿学课件：关节学

Arthrology

关节学

南京中医药大学基础医学院解剖学教研室

ClassificationTherearetwomajortypesofarticulationsorjoint.Continuousjoints

直接连结Fibrousjoints纤维连结:bonesareunitedbyfibrousconnectivetissueSyndesmosis

韧带连结Suture缝Cartilaginousjoints软骨连结:bonesareunitedbycartilageSynchondrosis

透明软骨结合:

bonesareunitedbyhyalinecartilageSymphysis

纤维软骨联合:bonesareunitedbyfibrocartilageSynosteosis

骨性结合Discontinuousjoints

间接连结－synovialjoints滑膜关节Synovialjoints

滑膜关节BasicstructuresArticularsurface关节面:coveredbyarticularcartilage关节软骨Articularcapsule关节囊Fibrousmembrane纤维膜Synovialmembrane

滑膜Articularcavity关节腔少量滑液，呈负压AccessorystructuresLigaments韧带(lig.):extra-andintracapsularligaments囊外(内)韧带Articulardisc关节盘

and

articularlabrum

关节唇:Synovialfold滑膜襞

andsynovialbursa滑膜囊Termsmovementsofjoints

关节运动术语Translation移动Flexionandextension屈和伸Adductionandabduction收和展Rotation旋转Medialandlateralrotation旋内和旋外Pronation

ans

supination旋前和旋后Inversionandeversion

足内翻和足外翻Circumduction

环转Classificationofsynovialjoints

关节的分类Uniaxialjoints单轴关节:hingejoints屈戍关节trochoid(pivot)joints车轴关节Biaxialjoints双轴关节:ellipsoidjoints椭圆关节saddlejoints鞍状关节Multiaxialjoints多轴关节:ball-and-socketjoint球窝关节planejoints平面关节ArticulationsofBonesofTrunk

躯干骨的连结脊柱由

24椎骨、1块骶骨、1块尾骨组成Jointsofthevertebralbodies

椎体间的连结Intervertebraldiscs

椎间盘

位于相邻的椎体之间Nucleuspulposus髓核,软而富于弹性、含水性较大的结构Annulusfibrosus纤维环

位于外周呈同心圆状，有弹性纤维组成Heminationofnucleuspulposus

髓核脱出（后外常见）Anteriorlongitudinalligament

前纵韧带宽厚，主要防止脊柱过分后伸Posteriorlongitudinalligament后纵韧带窄薄，主要防止脊柱过分前屈

Jointsofthevertebralarches

椎弓间的连结Ligamenta

flava

黄韧带―位于相邻的椎体之间Interspinalligament棘间韧带Supraspinalligament棘上韧带Ligamentum

nuchae项韧带

Intertansverseligament横突间韧带以上韧带主要防止脊柱过分前屈Zygapophysialjoint关节突关节Atlantooccipitaljoint

寰枕关节位于枕骨与寰椎之间点头、侧屈Atlantoaxialjoint

寰枢关节Threesynovialjointsbetweenatlasandaxis侧关节正中关节Supportedbyligamentsapicalligamentofdens齿突尖韧带alarligament翼状韧带transverseligamentofatlas寰椎横韧带tectorialmembrane覆膜旋转、支撑NormalCurvesofvertebralcolumnCervicalcurvature颈曲

convexforwardThoraciccurvature胸曲

convexbackwardLumbarcurvature腰曲

convexforwardSacralcurvature骶曲

convexbackward

Spinabifidacystica

脊柱裂Thoraciccage胸廓Composition―包括12对肋骨、12块胸椎、1块胸骨JointsCostovertebraljoints

肋椎关节Jointsofcostalhead肋头关节Costotransversejoints肋横突关节Sternocostaljoints胸肋关节Sternocostal

synchondrosisoffirstrib第一胸肋结合Sternocostaljoints胸肋关节:Interchondraljoints肋软骨连结:8,9,10肋软骨依次相连形成肋弓Generalfeaturesofthoraciccage前后径小于横径，前长后短胸廓上口:第1肋，胸骨柄上缘，第1胸椎胸廓下口:T12,12thand11th肋,肋弓胸骨下角:Function:

保护、容纳脏器参与呼吸运动InspirationExpirationJointsofskull颅骨的连结Continuousjoints:sutures,synchondrosisorsynosteosisTemporomandibularjoint颞下颌关节Articulatingsurfaces下颌窝下颌头外侧韧带联合关节上下、前后、侧方Jointsoflimbs肢体关节

基础医学院解剖教研室上肢关节

JointsofshouldergirdleSternoclavicularjoint胸锁关节Bones:锁骨胸骨头、胸骨柄、第1肋软骨内有关节盘.Movements:前后、上下Acromioclavicularjoint肩锁关节Bones:acromionandacromialendofclavicleMovement:rotationofscapulaonclavicle喙肩弓喙肩韧带coranoidprocessacromioncoracoacromial

ligamentJointsoffreeupperlimb★Shoulderjoint

肩关节

(ballandsocket)Bones:肱骨头、关节盂关节囊

薄而松弛，下部薄弱运动灵活，不稳定，容易发生前下脱位AccessorystructuresGlenoidlabrum盂唇:

fibrocartilaginousringonperipheryofglenoidcavityCoracohumeralligament喙肱韧带：runsfromcoracoidprocesstogreatertubercleMovements:flexion,extension,adduction,abduction,medialandlateralrotation,circumduction

★

Elbowjoint

肘关节Bones:lowerendofhumerus,upperendsofradiusandulnaHumeroulnarjoint肱尺关节:Humeroradialjoint肱桡关节:Proximalradioulnarjoint桡尺近侧关节:formedbyarticularcircumferenceofradiusandradialnotchofulnaCapsule关节囊:薄而松弛，后部松弛，两侧有韧带加强Ligaments:Radialcollacteralligament桡侧副韧带:attachedtolateralepicondyleandannularligamentofradiusUlnar

collacteralligament尺侧副韧带:attachedtomedialepicondyletomedialborderoftrochlearnotchAnnularligamentofradius桡骨环状韧带:attachedtoanteriorandposteriormarginsofradialnotchofulna,surroundstheheadofradiusMovements:前后运动Dislocation桡骨小头半脱位Jointsbetweenradiusandulna

Proximalradioulnarjoint

桡尺近侧关节Distalradioulnarjoint桡尺远侧关节:formedbyheadofulna,ulnarnotchofradiusandanarticulardiscInterosseousmembraneofforearm

前臂骨间膜:afibrousmembranebetweentheshaftofradiusandulnaJointsofhand★

Radiocarpaljoint桡腕关节

(ellipsoid)Bones桡、尺骨远端近侧列腕骨Movements:屈伸、收展、旋转IntercarpaljointsCarpometacarpaljoints:★

Carpometacarpaljointofthumb拇指腕掌关节Bones:trapeziumandbaseoffirstmetacarpalMovement:flexion,extension,adduction,abduction,andoppositionIntermetacarpaljointsMetacarpophalangealjointsInterphalangealjoints

JointsofLowerlimb

JointsofpelvicgirdleSacroiliacjoint骶髂关节Bones:auricularsurfaceofsacrumandiliumCapsule:verytightandstrengthenedbyligamentsVertebropelvicligaments髂腰韧带★

骶结节韧带:★

骶棘韧带:坐骨大、小孔

Pubicsymphysis

耻骨联合Articulation:symphysialsurfaceandinterpubicdisc(fibrocartilage)Ligaments:superiorpubicligamentandarcuatepubicligamentObturatormembrane

闭孔膜

obturatorcanal闭膜管Bonypelvis骨盆Composition:两侧髋骨、骶骨、尾骨Lesserpelvis

小骨盆pelvicinlet

骨盆上口(terminalline):Pelvicoutlet骨盆下口:尾骨尖、骶结节韧带、骶棘韧带、坐骨结节

Maindifferencebetweenmaleandfemalpelvis

MaindifferencebetweenmaleandfemalpelvisFemaleMalePelvicinletPelvicoutetPelviccavityPubicarch90~100070~750

Maindifferencebetweenmaleandfemalpelvis

男女形状窄长宽短倾斜度较小较大入口心性圆形耻骨下角70~75090~1000

出口小大Jointsoffreelowerlimb★

Hipjoint髋关节Bones:髋臼、股骨头关节囊厚韧AccessorystructuresAcetabulumlabrum髋臼唇;transverseacetebularligament髋臼横韧带LigamentsIliofemoral

lig.髂股韧带Ligamentofheadoffemur股骨头韧带Pubofemoral

lig.耻股韧带Ischiofemoralligament

坐股韧带Zona

orbicularis轮匝带

Movement:较肩关节幅度小、稳定Transverseacetebular

lig.LigamentofheadoffemurAcetabulumlabrumIliofemoral

lig.Ischiofemoral

lig.Pubofemoral

lig.Zona

orbicularis★Kneejoint膝关节Bones:股骨远端、胫骨近端、髌骨Articularcapsule:superapatellarbursa髌上囊,deepinfrapatellarbursa髌下深囊,alafolds翼状襞AccessorystructuresligamentsPatellarlig.髌韧带Fibularcollaterallig.腓侧副韧带Tibialcollaterallig.胫侧副韧带Patellarlig.Fibularcollaterallig.Tibialcollaterallig.Obliquepoplitealligament腘斜韧带Anteriorcruciate

ligment前交叉韧带Posteriorcruciateligament

后交叉韧带Medialmeniscus内侧半月板

(C-shaped)lateralmeniscus外侧半月板

(O-shaped)Movements:flexionandextension;flexedkneejointmaybepassivelyrotatedthrough700

lateralMedialTibiofibular

syndesmosis

胫腓连结Tibiofibularjoint胫腓关节Crural

interosseousmembrane小腿骨间膜Anteriorandposteriortibiofibularligaments

胫腓前、后韧带JointoffootTalocruraljoint距小腿关节(anklejoint)踝关节Bones:胫骨、腓骨远端和距骨LigmentsMediallig.内侧韧带，扇形、厚韧Laterallig.外侧韧带Anteriortalofibular

lig.

距腓前韧带Calcaneofibular

lig.跟腓韧带Posteriortalofibular

lig.

距腓后韧带Intertarsaljoints跗骨间关节Talocalcanealjoint距跟关节Talocalcaneonavicularjoint距跟舟关节Calcaneocuboidjoint

跟骰关节Tarsometatarsaljoints

跗跖关节Intermetatarsaljoints

跖骨间关节Metatarsophalangealjoints跖趾关节Interphalangealjoints

趾间关节transversetarsaljoint跗横关节Archesoffoot

足弓Mediallongitudinalarch内侧纵弓:formedbycalcaneus,navicular,threecuneiformsandfirsttothirdmetatarsalbones,headoftalusisthekeystoneofthisarchLaterallongitudinalarch外侧纵弓:

formedbycalcaneus,cuboid,fourthandfifthmetatars