《膝关节解剖》PPT课件.ppt

Knee Anatomy Training,Knee Anatomy,Introduction 介绍Very little bony stability 少的骨稳定Behaves more like a round ball on flat surface运动主要是球在面上的滑动Ligaments responsible for stability主要韧带稳定,Knee Anatomy,Looks simple,but most complex.看似简单，最复杂的关节More likely to be injured than any other joint in the body 人体中更易受伤的关节Largest joint of the body,actually consisting of 4 joints人体大关结，有4个关节组成Patellofemoral膑股关节,Lateral tibio femoral外侧胫股关节,Medial tibio femoral内侧胫股关节,Tibiofibular胫腓关节,Knee Anatomy,Basic Structures基本组织Bones骨Femur股骨,Tibia胫骨,Fibula腓骨,Patella 膑骨Muscles/Tendons 肌肉及肌腱Quadriceps四头肌,Hamstrings,Calf musclesLigaments 韧带Medial collateral内侧副韧带,Lateral collateral外侧副韧带,Anterior cruciate前交叉,Posterior cruciate后交叉,Popliteal ligament,RetinaculumCartilage软骨 Meniscus半月板,Articular cartilage 关节软骨Bursae,Knee Bones,BonesFemur股骨Large/long bone of the thigh 大长骨Tibia 胫骨Large bone of the lower leg.Fibula 腓骨Small bone of the lower leg.Patella膑骨“Knee Cap”,Knee Bones:Anterior View,Femur,Tibia,Patella,Patella,No Patella,Knee Bones:Function,Patella膑骨Patellofemoral groove(front of the femur).Patella tracking can affect the overall function of the knee.膑骨沟，膑骨轨迹影响膝的功能,PatellaPatellarGroove,Knee Bones:Lat/med Views,Femur,Tibia,Fibula,Patella,Lateral,Medial,Knee Bones:Posterior View,Femur,Tibia,Fibula,Primary Knee Ligaments主要的膝韧带,MCLMedial Collateral Lig.,LCLLateral Collateral Lig.,Knee Ligaments,Medial and Lateral Collateral Ligaments help stabilize the knee by preventing Varus and Valgus forces内外侧副韧带防止内外翻,VarusTowardsthe Midline,Valgus外翻Towardsthe Outside,Valgus内翻Towardsthe Outside,Knee Ligaments,MCL,LCL,Cruciate Knee Ligaments(cruciate=cross)十字韧带,Anterior Cruciate Ligament前交叉韧带Attaches anterior on the tibia&posterolateral on the femur附着于胫骨前部股骨后部Prevents anterior movement of the tibia on the femur防止胫骨相对股骨的前移Checks external rotation of the tibia in flexion曲屈时防止胫骨外旋,Anterior,ACL,Inferior,Superior,Posterior,Knee:Cruciate Ligaments,Knee:ACL,ACL“Footprint前交叉胫骨附着点”Tibial attachment,Anterior,Posterior,TibialPlateau,TibialPlateau,FemoralAttachment(Footprint),Posterior Cruciate后交叉韧带、Attaches Posterior on the tibia&Antero-medial on the femur.附着于胫骨后股骨前内The PCL is a strong fan shaped ligament that is the strongest in the body后叉强大的扇形韧带Primary stabilizer against posterior movement of the tibia on the femur防止胫骨后移Helps check the knee in extension防止过伸,Cruciate Knee Ligaments(Cruciate=Cross),PCL,Knee:Cruciates,ACL,PCL,Anterior View,Posterior View,Knee,Hinge joint-flexion&extension.铰链式关节-屈和伸 Flexion is achieved by contracting the hamstring muscles in the back of the leg.通过收缩大腿后部肌肉屈曲关节The Extensor Mechanism sits in front of the knee joint.伸膝装置在膝关节前 The extensor mechanism is made up of the patella,the patellar tendon,the quadriceps tendon and the quadriceps muscles.伸膝装置由膑骨、膑腱、股四头肌、股四头肌腱组成,Knee Muscles,Muscles肌肉、Quadriceps股四头肌Vastus lateralis外侧束,Vastus intermedius中间束,&Vastus medialis内侧束HamstringsSartorius,Gracilis,Semimembranosus,Semitendinosis,&Biceps femoralis缝匠肌、股薄肌、半腱肌肉、半膜肌、二头肌Calf Muscles小腿肌肉Gastrocnemius,Soleus,Popliteus,Pes Anserine muscle attachment is into the medial tibia.腓肠肌、比目鱼肌,Knee:Muscles,Quadriceps股四头肌,Vastus Medialis,Vastus Lateralis,Vastus Intermedius,Knee:Muscles,Quadriceps,Vastus Medialis股内侧肌,Rectus Femoris股中间肌,Vastus Lateralis股外侧肌,Knee:Quadriceps Mechanism,Its the motor that drives the knee joint,and allows us to walk.Composed of the patellar tendon,the patella,and the quadriceps muscles on the front of the thigh.走路的发动机由膑股、膑腱、股四头肌、股四头肌腱组成The patella works like a fulcrum,and increases the force exerted by the quadriceps muscles as the knee straightens.When the Quadriceps Muscles contract,the knee straightens.When they relax,the knee bends.膑骨为增加股四头肌肉力量的支点，收缩伸膝，放松屈膝,PatellarTendon,QuadricepsTendon,Femur,Patella,Patellar Tracking:膑骨轨迹 The Patellar Facets track in the Femoral Groove,Knee:Hamstring Muscles,Sartorius缝匠肌Gracilis股薄肌Semimembranosis半腱肌Semitendonosis半膜肌,Biceps Femoris股二头肌,Knee:Hamstring Muscles,Pes Anserine Attachmentof the鹅足Hamstring tendons(Sartorius shown hereon the Medial Tibial Tuberosity),Medial Attachments,Knee:Hamstring Muscles,Lateral Attachment外侧附件Biceps FemorisAttachment tothe Fibula股二头肌肉腓骨附着点,Knee Ligaments,Knee Ligaments,Lateral&Medial Retinaculum,Medial RetinaculumMedial supportfor Patellar Tracking,LateralRetinaculumLateral supportfor PatellarTracking,Vastus Medialis,Vastus Lateralis,Knee:Tendons,TendonsQuadriceps TendonQuadriceps Tendon connects the Quadriceps Muscles to the Patella四头肌腱连接四头肌和膑骨Patellar TendonPatellar Tendon connects the Patella to the Tibia.膑腱连接膑韧带和胫骨The Patella is a bone embedded within the Quadriceps and Patellar Tendons lying over the Femoral bone.Also known as a“sesamoid”bone.膑骨存在于股四头肌内，又成为籽骨,Knee:Tendons,QuadricepsTendon,Patellar Tendon,Knee:Meniscal Cartilage,Meniscus(plural=menisci)半月板The articular surfaces between the femur and tibia are not congruent.They are closest in full extension.However this space must be filled by the meniscus.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Both menisci are thicker at their periphery and thinner towards the middle.They both move in flexion and extension.两个半月板都是四周厚中间薄，在屈伸时都是运动的The lateral meniscus is not firmly attached to the collateral ligament or to the tibia as is the medial meniscus.Thus,it is less prone to distortion and injury.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:Meniscal Cartilage,Meniscus,ACL/PCL AttachmentsThe lateral meniscus is”O“shaped and generally of equal thickness.外侧半月板o形，等厚。The medial meniscus is”C“shaped and is thicker posteriorly than anteriorly.内侧半月板c形，后侧比前侧厚,Lateral,Medial,Lateral,Medial,Knee,The menisci serve several functions 半月板装置的几个功能A.Lubrication润滑B.Nutrition营养C.Shock absorbers震荡吸收D.Spread stress传导压力E.Decrease articular cartilage wear减少关节软骨磨损F.Make joint spaces more congruent填充关节间隙G.Prevent hyperextension防止过伸The meniscus actually wraps around the upper bone to fill the space between the round femur and the flat tibia.,Knee:Meniscus,MeniscusCrescent-shaped fibrocartilage半月形纤维软骨Collagen fibers arranged longitudinally and radially胶原纤维成经向放射装Triangular in cross section横截面呈三角形,Knee,MeniscusThe menisci are relatively avascular towards their inner 1/3,somewhat vascular in their middle 13,&vascular in their outer 1/3.They are held in place by the coronary ligaments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。The menisci possess no nerves,thus there is no pain unless a coronary ligament(tibial attachment)has been damaged.There is seldom a bloody effusion,however,you might find synovial swelling.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,Blood supplyperipherally,No blood supplyproximal.,Articular Knee:Cartilage关节软骨,Covers ends of bones(joint)覆盖骨末端ends of the femur,the top of the tibia,top of the fibula and the back of the patella股骨末端、胫骨及腓骨上端、膑骨背面White,shiny material,tough,rubbery白色、有光泽、有弹性的、有硬度的 Consistency.”thick Functionabsorb shock 吸收震荡provide smooth surface(facilitate motion)提供表面的润滑,Knee:Articular Cartilage,Articular cartilage produces a wonderful lubrication 关节软骨产生关节液mechanism with almost zero friction,which helps us articulate our joints during daily activities.关节液使日常运动零摩擦 Synovial fluid-thick viscous fluid layer inside the joint关节液粘稠的,Knee:Articular Cartilage,Hyaline Cartilage Composition透明软骨组成Cells细胞Chondrocytes(only one kind)Fluid80%Water by VolumeExtracelluar Matrix-The Framework provides form&stabilityCollagens胶原Proteoglycans蛋白多糖Non-collagenous proteins,Knee:Cartilage,Knee:Articular Cartilage,The interaction between water&framework gives cartilage mechanical properties of stiffness&resilience.交换水及矿物质,Knee:NeuroVascular Concerns,PeronealNerve腓总神经,PoplitealArtery腘动脉,PoplitealVein腘静脉,Popliteal/TibialNerve腘神经,Medial,Lateral,Knee,