膝关节评估-9-17课件

膝关节评估膝部韌帶拉傷内侧副轫带(MCL)/外侧副轫带(LCL)内翻压力测试(VarusStresstest)(圖右)外侧副轫带外翻压力测试ValgusStresstest(圖左)内侧副轫带Grade0:无松弛Grade1:<0.5cmGrade2:0.5~1cmGrade3:>1cm2膝部韌帶拉傷

前十字轫带(ACL),后十字轫带(PCL)前十字轫带:膝弯屈时放松(0~30度),伸直时紧张后十字轫带:膝弯屈时紧张(90度),伸直时放松3PCLACL.后十字轫带损伤胫骨下陷(sag

sign)

常见骑摩托车撞击前档板后损伤

5前十字轫带(ACL);后十字轫带(PCL)90°-前抽屉试验/后抽屉试验0~30°:前十字-紧张

90°:后十字-紧张前抽屉试验(+)表示胫骨被拉向前超過0.5cm，前十字轫带可能断裂后抽屉试验(+)表示胫骨被向後推離股骨超過0.5cm后十字轫带可能断裂6抽屉试验的盲点腘旁腱(腿后腱)肌(hamstring)太紧會拉不動

伪阴性当后十字轫带损伤时会使胫骨原先就处在后退的位置(sagsign)伪阳性7Lachmantest对前十字轫带损伤最敏感ACL膝弯屈25~30∘然后拉动胫骨远离股骨若轻易被拉开表示前十字轫带断裂8膝部KneeUnhappy

Triad膝盖扭伤合并内侧副韧带、前十字形韧带和半月软骨损伤的合并性严重损伤需碰撞的运动常见运动伤害机转:外侧碰撞力量在膝盖此时脚掌还紧贴在地面产生一个外转的扭力→前十字形韧带损伤可连带外側/內側结构的破坏10AFat-SuppressedProton-DensityweightedSagittalimage实心条状12MRI下正常前十字轫带T1-weightedMRI在应当出现前十字轫带的位置却看不到代表就是有损伤

Sagittalimageshowscomplete(ornear-complete)nonvisualizationoftheACLwithill-definededemaandhemorrhageintheusuallocationoftheACLintheintercondylarnotch.14MRIappearances

inACLtearT1-weightedMRIProton-densityweightedfat-suppressedsagittalimage

轫带边缘不规则部份断裂15Diagnosis:

PartialtearoftheproximalanteromedialbandoftheACL

半月軟骨损伤关节活动时卡住McMurraytest：平躺膝弯屈给与内转外转的力外转的力

外侧半月軟骨(Lat.Meniscus(左圖)内转的力内侧半月軟骨(Med.meniscus(右圖

)

检查有无杂音(clicksign)16meniscus半月軟骨Apley’stest：下压且旋转若有明显疼痛在膝盖处表示阳性17臏骨痛(PatellofemeralPain)宾骨碾磨测试(patellofemoralgrindtest)Apprehensiontest（恐懼）

宾骨被向外推时病病人会有恐慌表情18HamstingstrainQuadricepsstrain20宾骨股骨疼痛综合征股内斜肌(VMOvastusmedialisobliquemuscle)肌力不足:最重要的稳定肌肉股骨前倾造成股骨过於內转足旋前髋内转肌縮短;造成股骨過於內轉髋外转肌力不足;造成股骨過於內转:Iliopsoas,Glutealmuscles21宾骨肌腱炎(Patellartendonitis)近端:跳跃膝(Jumper’sknee)远端:Osgood-SchlatterDz23InfrapatellarbursitisPoplitealbursitis(Baker’scyst)24Osteoarthritis:grading

DepartmentofRheumatologyandMedicalIllustration,

UniversityofManchesterGrade0:NofeaturesGrade1:DoubtfulnarrowingofjointspaceandpossibleosteophyticlippingGrade2:DefiniteosteophytesandpossiblenarrowingofjointspaceGrade3:Moderatemultipleosteophytes,definitenarrowingofjointspace,andsomesclerosisandpossibledeformityofboneendsGrade4:Largeosteophytes,markednarrowingofjointspace,severesclerosis,anddefinitedeformityofboneends髂胫束综合症(Iliotibialbandsyndrome)Obertest27OpenandClosed-kineticChainExerciseClosed-kineticchainexerciseprovideamoresignificantcompressionforceacrossthekneewhileactivatingcocontractionofthequadricepsandhamstringmuscles.Open-chainexerciseatlowflexionanglesmayproduceanincreaseinanteriorshearforces,thatmaycauselaxityintheACL.28反覆宾骨不稳定的治疗目标:

减轻症状Increasequadricepsstrengthadendurance(VMO>lateralstructures).Useofpassiverestraints(Palumo-typebracing,McConnelltaping)toaugmentstabilityduringtransition.PatellarTapingCreateamechanicalmedialshiftofthepatellacentralizingitwithinthetrochleagrooveandimprovingpatellartracking.30TherapeuticExercisesHeelslides/Wallslides()Patellarmobilization31TherapeuticExercisesQuadricepssetsStraightlegraises(SLR)allplaneswithbraceinfullextensionuntilquadricepsstrengthissufficienttopreventextensionlag.Slowlyraiseit6to10inchesoffthefloor.Holdthispositionfor5secondsandthenrelax.Perform3setsof20repetitions,4to5daysaweek.32NonioerativetreatmentofRecurrentPatellarInstability(Lateral)HighEMGactivityoftheVMOLegpress.Lateralstep-up.Isometricquadricepssetting.Hipadductionexercise.33GeneralGuidelinesforNonioerativetreatmentofRecurrentPatellarInstability(Lateral)Gradualrestorationofflexibility(stretching)fornoteddeficits.IliotibialbandQuadriceps34Two-personOberstretchCross-overlateralfascialstretchSelfoberstretchLeaninglateralfascialstretchQuadricepsself-stretchGeneralGuidelinesforNonioerativetreatmentofRecurrentPatellarInstability(Lateral)Gradualrestorationofflexibility(stretching)fornoteddeficits.3.Hamstring4.Gastrocnemius35TherapeuticExercisesHamstringCurlsHoldthispositionfor5secondsandthenrelax.Perform3setsof20repetitions,4to5daysaweek,continuingfor3to4weeks.Straight–LegRaises(Prone)Tightenthehamstringsoftheinjuredlegandraisethelegtowardtheceilingasfarasyoucan.Holdthepositionfor5seconds.Perform3setsof20repetitions,4to5daysaweek.36TherapeuticExercisesNon-weightbearinggastrosoleus,HamstringstretchesProneextensionhangsforgravity–assistedkneeextensionSupineandlegelevationwithresistance37TherapeuticExercisesMinisquats0~30˚

Stationarybike(be