膝关节解剖 课件

KneeAnatomyTrainingKneeAnatomyIntroduction介绍Verylittlebonystability少的骨稳定Behavesmorelikearoundballonflatsurface运动主要是球在面上的滑动Ligamentsresponsibleforstability主要韧带稳定KneeAnatomyLookssimple,butmostcomplex.看似简单，最复杂的关节Morelikelytobeinjuredthananyotherjointinthebody人体中更易受伤的关节Largestjointofthebody,actuallyconsistingof4joints人体大关结，有4个关节组成Patellofemoral膑股关节,Lateraltibiofemoral外侧胫股关节,Medialtibiofemoral内侧胫股关节,Tibiofibular胫腓关节KneeBonesBonesFemur股骨Large/longboneofthethigh大长骨Tibia胫骨Largeboneofthelowerleg.Fibula腓骨Smallboneofthelowerleg.Patella膑骨“KneeCap”KneeBones:AnteriorViewFemur,Tibia,PatellaPatellaNoPatellaKneeBones:FunctionPatella膑骨Patellofemoralgroove(frontofthefemur).Patellatrackingcanaffecttheoverallfunctionoftheknee.膑骨沟，膑骨轨迹影响膝的功能PatellaPatellarGrooveKneeBones:PosteriorViewFemur,Tibia,FibulaPrimaryKneeLigaments主要的膝韧带MCLMedialCollateralLig.LCLLateralCollateralLig.KneeLigamentsMedialandLateralCollateralLigamentshelpstabilizethekneebypreventingVarusandValgusforces内外侧副韧带防止内外翻VarusTowardstheMidlineValgus外翻TowardstheOutsideValgus内翻TowardstheOutsideCruciateKneeLigaments(cruciate=cross)十字韧带AnteriorCruciateLigament前交叉韧带Attachesanterioronthetibia&posterolateralonthefemur附着于胫骨前部股骨后部Preventsanteriormovementofthetibiaonthefemur防止胫骨相对股骨的前移Checksexternalrotationofthetibiainflexion曲屈时防止胫骨外旋AnteriorACLInferiorSuperiorPosteriorKnee:CruciateLigamentsKnee:ACLACL“Footprint前交叉胫骨附着点”TibialattachmentAnteriorPosteriorTibialPlateauTibialPlateauFemoralAttachment(Footprint)Knee:CruciatesACLPCLAnteriorViewPosteriorViewKnee

Hingejoint-flexion&extension.铰链式关节-屈和伸

Flexionisachievedbycontractingthehamstringmusclesinthebackoftheleg.通过收缩大腿后部肌肉屈曲关节TheExtensorMechanismsitsinfrontofthekneejoint.伸膝装置在膝关节前Theextensormechanismismadeupofthepatella,thepatellartendon,thequadricepstendonandthequadricepsmuscles.伸膝装置由膑骨、膑腱、股四头肌、股四头肌腱组成Knee:MusclesQuadriceps股四头肌VastusMedialisVastusLateralisVastusIntermediusKnee:MusclesQuadricepsVastusMedialis股内侧肌RectusFemoris股中间肌VastusLateralis股外侧肌Knee:QuadricepsMechanism

It’sthemotor

thatdrivesthekneejoint,andallowsustowalk.Composedofthepatellartendon,thepatella,andthequadricepsmusclesonthefrontofthethigh.走路的发动机由膑股、膑腱、股四头肌、股四头肌腱组成Thepatellaworkslikeafulcrum,andincreasestheforceexertedbythequadricepsmusclesasthekneestraightens.WhentheQuadricepsMusclescontract,thekneestraightens.Whentheyrelax,thekneebends.

膑骨为增加股四头肌肉力量的支点，收缩伸膝，放松屈膝PatellarTendonQuadricepsTendonKnee:HamstringMusclesSartorius缝匠肌Gracilis股薄肌Semimembranosis半腱肌Semitendonosis半膜肌BicepsFemoris股二头肌Knee:HamstringMusclesPesAnserineAttachmentofthe鹅足Hamstringtendons(SartoriusshownhereontheMedialTibialTuberosity)MedialAttachmentsKneeLigamentsLateral&MedialRetinaculumMedialRetinaculumMedialsupportforPatellarTrackingLateralRetinaculumLateralsupportforPatellarTrackingVastusMedialisVastusLateralisKnee:TendonsTendonsQuadricepsTendonQuadricepsTendonconnectstheQuadricepsMusclestothePatella四头肌腱连接四头肌和膑骨PatellarTendonPatellarTendonconnectsthePatellatotheTibia.膑腱连接膑韧带和胫骨ThePatellaisaboneembeddedwithintheQuadricepsandPatellarTendonslyingovertheFemoralbone.Alsoknownasa“sesamoid”bone.膑骨存在于股四头肌内，又成为籽骨Knee:TendonsQuadricepsTendonPatellarTendonKnee:MeniscalCartilageMeniscus(plural=menisci)半月板Thearticularsurfacesbetweenthefemurandtibiaarenotcongruent.Theyareclosestinfullextension.Howeverthisspacemustbefilledbythemeniscus.股骨和胫骨关节面不是匹配的，在屈曲位是最接近的。空间被半月板填充Bothmenisciarethickerattheirperipheryandthinnertowardsthemiddle.Theybothmoveinflexionandextension.两个半月板都是四周厚中间薄，在屈伸时都是运动的Thelateralmeniscusisnotfirmlyattachedtothecollateralligamentortothetibiaasisthemedialmeniscus.Thus,itislesspronetodistortionandinjury.外侧半月板不像内侧半月板那样同侧副韧带或胫骨紧密附着Knee:MeniscalCartilageMeniscus,ACL/PCLAttachmentsThelateralmeniscusis”O“shapedandgenerallyofequalthickness.外侧半月板o形，等厚。Themedialmeniscusis”C“shapedandisthickerposteriorlythananteriorly.内侧半月板c形，后侧比前侧厚

LateralMedialLateralMedialKneeThemenisciserveseveralfunctions

半月板装置的几个功能A.Lubrication润滑B.Nutrition营养C.Shockabsorbers震荡吸收D.Spreadstress传导压力E.Decreasearticularcartilagewear减少关节软骨磨损F.Makejointspacesmorecongruent填充关节间隙G.Preventhyperextension防止过伸Themeniscusactuallywrapsaroundtheupperbonetofillthespacebetweentheroundfemurandtheflattibia.Knee:MeniscusMeniscusCrescent-shapedfibrocartilage半月形纤维软骨

Collagenfibersarrangedlongitudinallyandradially胶原纤维成经向放射装

Triangularincrosssection横截面呈三角形KneeMeniscusThemenisciarerelativelyavasculartowardstheirinner1/3,somewhatvascularintheirmiddle1\3,&vascularintheirouter1/3.Theyareheldinplacebythecoronaryligaments半月板内1/3为白区，中1/3为红白区，外1/3为红区。中间被冠状韧带连接。Themeniscipossessnonerves,thusthereisnopainunlessacoronaryligament(tibialattachment)hasbeendamaged.Thereisseldomabloodyeffusion,however,youmightfindsynovialswelling.半月板没有神经，因而没有疼痛直到冠状韧带损伤。很少有血液渗出，但是能看到关节液增长BloodsupplyperipherallyNobloodsupplyproximal.ArticularKnee:Cartilage关节软骨Coversendsofbones(joint)覆盖骨末端endsofthefemur,thetopofthetibia,top

ofthefibulaandthebackofthepatella股骨末端、胫骨及腓骨上端、膑骨背面White,shinymaterial,tough,rubbery白色、有光泽、有弹性的、有硬度的

Consistency.¼”thickFunctionabsorbshock吸收震荡providesmoothsurface(facilitatemotion)提供表面的润滑Knee:ArticularCartilageArticularcartilageproducesawonderfullubrication关节软骨产生关节液mechanismwithalmostzerofriction,whichhelpsusarticulateourjointsduringdailyactivi