踝关节生物力学优选ppt资料

踝关节生物力学第一页，共51页。AnkleAnatomicalStructuresTibiaFibularTalus第二页，共51页。Tibia胫骨(jìnggǔ)Thisisthestrongestlargestboneofthelowerleg.Itbearsweightandthebonecreatesthemedialmalleoli(thebumpontheinsideofyourankle)whichisthemedialaspectofthemortiseorthe(hole)thatthetaluslieswithin.这是最强壮(qiángzhuàng)的小腿骨。它具有承重和形成了内侧支撑面(组成脚踝的凹面)，能与距骨相契合第三页，共51页。TheTibiaisthemedialboneandlargestboneofthelowerleg.Tibia胫骨是小腿的最大和支撑(zhīchēng)骨的骨头。第四页，共51页。Fibula腓骨(féigǔ)Thisisasmallerlateralboneofthelowerleg.Itisnotvitalforweightbearingyetitcomprisesthelateral(outside)aspectofthemalleoliandmakesupthelateralaspectofthemortise.这是小腿的一根更小的外侧骨头(gǔtou)。它不承重，它是踝关节的外侧支撑面。第五页，共51页。Fibula--->Thefibulaislongerandnonweightbearing.Itmakesupthelateralaspectofthemortise.Thelateralmalleoliliesinferior(below)themedialmalleoli它比较(bǐjiào)长和不承重。并组成踝关节外侧面。并低于内侧面_______________________第六页，共51页。TalusThisbonetransmitstheforcesfromthecalcaneusupintothetibiaandalsoallowsthearticulationsofPlantarFlexion(pointingthefootdownward)DorsiflexionorpullingthefootupwardandInversion(rollingthefootinward)andEversion(rollingthefootoutward)第七页，共51页。------Talus第八页，共51页。TalocruralJointTheformationofthemortise(ahole)bythemedialmalleoli(Tibia)andlateralmalleoli(fibula)withthetaluslyinginbetweenthemmakesupthetalocruraljoint.Thisisahingejointandallowsmostofthemotionwithplantarflexionanddorsiflexion.第九页，共51页。________________________________TalocruralJt.第十页，共51页。SubtalarJointThearticulationbetweenthetalusandthecalcaneusisreferredtoasthesubtalarjoint.Motionallowedbythisjointisinversion(rollinward)/eversion(rolloutward)aswellasrearfootpronation(inwardtiltofthecalcaneus)andsupination(outwardtiltofthecalcaneus).第十一页，共51页。calcaneusTalus---SubtalarJointMedialaspectoffoot第十二页，共51页。AnkleLigamentsTherearethreelateralligamentspredominantlyresponsibleforthesupportandmaintenanceofboneapposition(bestpossiblefit).Theseligamentspreventinversionofthefoot.Theseligamentsare:AnteriortalofibularligamentCalcaneofibularligamentPosteriortalofibularligament第十三页，共51页。TalusFibulaTibiaAnt.TalofibularLigamentAnt.TibiofibularLig.第十四页，共51页。Post.TibiofibularLig.<-Fibula<-Ant.TalofibularLig<-TalusPeronealTendonsCalcaneofibularLigamentCalcaneusSubtalarJoint SpaceCuboid第十五页，共51页。calcaneus<-FibularheadPosteriortibiofibularLigamentAchillesTendonTalusPosteriortalofibularlig.Peronealtendons第十六页，共51页。ThedeltoidligamentThisislocatedonthemedialaspectofthefoot.Itisthelargestligamentbutisactuallycomprisedofseveralsectionsallfusedtogether.Thisligamentprevents(eversion)oftheankle.Thedeltoidligamentistriangularinshapeandhassuperficialanddeeplayers.Itisthemostdifficultligamentinthefoottosprain.第十七页，共51页。TibiaXXXNavicular-----TalusTibialisPosteriorTendonTibialisAnt.TendonDeltoidLigamentX第十八页，共51页。Musclesofthelowerleg/ankleThereare4compartmentsthatmakeupthelowerlegthatoperatethemotionsoftheankle.Injurycancauseswellinginsidethesecompartmentsthatcanleadtotissuedeathornervedamage.第十九页，共51页。第二十页，共51页。AnteriorCompartmentAnt.TibialisExt.HallicusLongusExtensorDigitorumLongusContainsAnt.TibialNerveContainsAnteriorTibialArteryDorsiflexorsofthefoot(liftsfootup)<-Ant.Comp第二十一页，共51页。LateralCompartmentEvertersofthefoot(turnsfootoutward)PeroneusLongusPeroneusBrevisPeroneusTertiusContainsthesuperficialperonealnerve<-Lat.Comp.第二十二页，共51页。PosteriorSuperficialGroupPlantarflexors(pushesfootdownwards)GastrocnemiusSoleusSuperficialPosterior第二十三页，共51页。PosteriorDeepAssistswithPlantarflexionTibialisPosteriorFlexorHallicusLongusFlexorDigitorumLongusPosteriortibialarteryPost.Deep---第二十四页，共51页。AssessingtheLowerLegandAnkleHistoryPasthistoryMechanismofinjuryWhendoesithurt?Typeof,qualityof,durationofpain?Soundsorfeelings?Howlongwereyoudisabled?Swelling?Previoustreatments?第二十五页，共51页。ObservationsPosturaldeviations?Istheredifficultywithwalking?Deformities,asymmetriesorswelling?Colorandtextureofskin,heat,redness?Patientinobviouspain?Israngeofmotionnormal?第二十六页，共51页。PercussionandcompressiontestsUsedwhenfractureissuspectedPercussiontestisablowtothetibia,fibulaorheeltocreatevibratoryforcethatresonatesw/infracturecausingpainCompressiontestinvolvescompressionoftibiaandfibulaeitheraboveorbelowsiteofconcernThompsontestSqueezecalfmuscle,whilefootisextendedofftabletotesttheintegrityoftheAchillestendonPositivetestsresultsinnomovementinthefootHoman’stestTestfordeepveinthrombophlebitisWithkneeextendedandfootofftable,ankleismovedintodorsiflexionPainincalfisapositivesignandshouldbereferred第二十七页，共51页。CompressionTestPercussionTestHoman’sTestThompsonTest第二十八页，共51页。AnkleStabilityTestsAnteriordrawertestUsedtodeterminedamagetoanteriortalofibularligamentprimarilyandotherlateralligamentsecondarilyApositivetestoccurswhenfootslidesforwardand/ormakesaclunkingsoundasitreachestheendpointTalartilttestPerformedtodetermineextentofinversionoreversioninjuriesWithfootat90degreescalcaneusisinvertedandexcessivemotionindicatesinjurytocalcaneofibularligamentandpossiblytheanteriorandposteriortalofibularligamentsIfthecalcaneusiseverted,thedeltoidligamentistested第二十九页，共51页。AnteriorDrawerTestTalarTiltTest第三十页，共51页。Kleiger’stestUsedprimarilytodetermineextentofdamagetothedeltoidligamentandmaybeusedtoevaluatedistalanklesyndesmosis,anterior/posteriortibiofibularligamentsandtheinterosseusmembraneWithlowerlegstabilized,footisrotatedlaterallytostressthedeltoidMedialSubtalarGlideTestPerformedtodeterminepresenceofexcessivemedialtranslationofthecalcaneusonthetalusTalusisstabilizedinsubtalarneutral,whileotherhandglidesthecalcaneus,mediallyApositivetestpresentswithexcessivemovement,indicatinginjurytothelateralligaments第三十一页，共51页。Kleiger’sTestMedialSubtalarGlideTest第三十二页，共51页。

FunctionalTestsWhileweightbearingthefollowingshouldbeperformedWalkontoes(plantarflexion)Walkonheels(dorsiflexion)Walkonlateralbordersoffeet(inversion)Walkonmedialbordersoffeet(eversion)HopsoninjuredanklePassive,activeandresistivemovementsshouldbemanuallyappliedtodeterminejointintegrityandmusclefunctionIfanyofthesearepainfultheyshouldbeavoided第三十三页，共51页。PreventionofInjurytotheAnkleStretchingoftheAchillestendonStrengtheningofthesurroundingmusclesProprioceptivetraining:balanceexercisesandagilityWearingproperfootwearandortapewhenappropriate第三十四页，共51页。SpecificInjuriesAnkleInjuries:SprainsSinglemostcommoninjuryinathleticscausedbysuddeninversionoreversionmomentsInversionSprainsMostcommonandresultininjurytothelateralligamentsAnteriortalofibularligamentisinjuredwithinversion,plantarflexionandinternalrotationOccasionallytheforceisgreatenoughforanavulsionfracturetooccurw/thelateralmalleolus第三十五页，共51页。Severityofsprainsisgraded(1-3)Withinversionsprainsthefootisforcefullyinvertedoroccurswhenthefootcomesintocontactw/unevensurfaces第三十六页，共51页。第三十七页，共51页。Grade1InversionAnkleSprainEtiologyOccurswithinversionplantarflexionandadductionCausesstretchingoftheanteriortalofibularligamentSignsandSymptomsMildpainanddisability;weightbearingisminimallyimpaired;pointtendernessoverligamentsandnolaxityManagementRICEfor1-2days;limitedweightbearinginitiallyandthenaggressiverehabTapemayprovidesomeadditionalsupportReturntoactivityin7-10days第三十八页，共51页。Grade2InversionAnkleSprainEtiologyModerateinversionforcecausinggreatdealofdisabilitywithmanydaysoflosttimeSignsandSymptomsFeelorhearpoporsnap;moderatepainw/difficultybearingweight;tendernessandedemaPositivetalartiltandanteriordrawertestsPossibletearingoftheanteriortalofibularandcalcaneofibularligamentsManagementRICEforatleastfirst72hours;X-rayexamtoruleoutfx;crutches5-10days,progressingtoweightbearing第三十九页，共51页。Management(continued)WillrequireprotectiveimmobilizationbutbeginROMexercisesearlytoaidinmaintenanceofmotionandproprioceptionTapingwillprovidesupportduringearlystagesofwalkingandrunningLongtermdisabilitywillincludechronicinstabilitywithinjuryrecurrencepotentiallyleadingtojointdegenerationMustcontinuetoengageinrehabtopreventagainstre-injury第四十页，共51页。Grade3InversionAnkleSprainEtiologyRelativelyuncommonbutisextremelydisablingCausedbysignificantforce(inversion)resultinginspontaneoussubluxationandreductionCausesdamagetotheanterior/posteriortalofibularandcalcaneofibularligamentsaswellasthecapsuleSignsandSymptomsSeverepain,swelling,hemarthrosis,discolorationUnabletobearweightPositivetalartiltandanteriordrawer第四十一页，共51页。ManagementRICE,X-ray(physicianmayapplydorsiflexionsplintfor3-6weeks)CrutchesareprovidedaftercastremovalIsometricsincast;ROM,PREandbalanceexerciseonceoutSurgerymaybewarrantedtostabilizeankleduetoincreasedlaxityandinstability第四十二页，共51页。EversionAnkleSprains

-(Represent5-10%ofallanklesprains)EtiologyBonyprotectionandligamentstrengthdecreaseslikelihoodofinjuryEversionforceresultsindamagetodeltoidligamentandpossiblyfxofthefibulaDeltoidcanalsobeimpingedandcontusedwithinversionsprains第四十三页，共51页。第四十四页，共51页。Pasthistory------TalusThereare4compartmentsthatmakeupthelowerlegthatoperatethemotionsoftheankle.PosteriorMostcommonlyduetolackofrehabilitation,butmoreimportantlylackofneuromusculartraining.AnatomicalStructuresFunctionalTestsTheTibiaisthemedialboneandlargestboneofthelowerleg.MedialaspectoffootThisislocatedonthemedialaspectofthefoot.PositivetestsresultsinnomovementinthefootAchillesTendonIstheredifficultywithwalking?TheTibiaisthemedialboneandlargestboneofthelowerleg.PosteriorWillrequireprotectiveimmobilizationbutbeginROMexercisesearlytoaidinmaintenanceofmotionandproprioception第四十五页，共51页。第四十六页，共51页。InjuryPreventionStrengthtrainingallowsthesupportingmusculaturetostabilizewhereligamentsmaynolongerbecapabl