Transcript 肌肉骨骼系统
肌肉骨骼系统
关节&软骨
Content
关节种类
软骨种类
主要四肢关节
椎间盘
关节置换&再生
Joints
Joints and their classification
bony joints
fibrous joints
cartilaginous joints
Synovial joints
Anatomy of selected diarthroses
humeroscapular joint 肱肩胛关节
elbow joint
coxal joint 髋关节
knee joint
9-3
Joints and Their Classification
Arthrology = study of the joints
Kinesiology = study of musculoskeletal movement
Classified by freedom of movement
diarthrosis (freely movable)
amphiarthrosis (slightly movable)微动关节
synarthrosis (little or no movement)不动关节
Classified how adjacent bones are joined
Fibrous
Cartilaginous
bony or synovial
9-4
Bony Joint (Synostosis)骨性结合
Gap between two bones ossifies
– frontal and mandibular bones in infants 额骨和下颌骨
– cranial sutures in elderly 颅缝
– attachment of first rib and sternum 胸骨
Can occur in either fibrous or cartilaginous joint
Fibrous Joints (Synarthrosis)
Collagen fibers span the space
between bones
Sutures
gomphoses 钉状关节
Syndesmoses 韧带联合
9-6
Fibrous Joint -- Sutures
Immovable fibrous joints
bind skull bones together
Serrate - interlocking lines(齿状联合)
Coronal(冠状缝), sagittal(矢状缝) and
lambdoid sutures(人字缝)
Lap - overlapping beveled edges
temporal and parietal bones(颞和颅顶骨)
Plane - straight, nonoverlapping
edges
palatine processes(腭突) of the maxillae
9-7
Types of Sutures
9-8
Fibrous Joint – Gomphoses钉状关节
Attachment of a tooth to its
socket
Held in place by fibrous
periodontal ligament(牙周韧带)
collagen fibers attach
tooth to jawbone(颚骨)
Some movement while
chewing
Fibrous Joint – Syndesmosis韧带联合
Two bones bound
by ligament only
interosseus membrane
Most movable of fibrous joints
Interosseus membranes unite
radius to ulna and tibia to
fibula
Cartilaginous Joint – Synchondrosis软骨结合
Bones are joined by
hyaline cartilage(透明软
骨)
rib attachment to
sternum(胸骨)
epiphyseal plate(骺板)
in children binds
epiphysis(骨骺) and
diaphysis(骨干)
9-11
Cartilaginous Joint – Symphysis骨联合
2 bones joined by
fibrocartilage(纤维软骨)
pubic symphysis(耻骨联
合) and intervertebral
discs
Only slight amount
of movement is
possible
Synovial Joint(滑膜关节)
Joint in which two bones are separated by a space called a
joint cavity
Most are freely movable
9-13
General Anatomy
Articular capsule encloses joint cavity
continuous with periosteum(骨膜)
lined by synovial membrane
Synovial fluid = slippery fluid; feeds cartilages
Articular cartilage = hyaline cartilage covering the joint surfaces
Articular discs and menisci(半月板)
jaw, wrist, sternoclavicular and knee joints
absorbs shock, guides bone movements and distributes forces
Tendon attaches muscle to bone
Ligament attaches bone to bone
9-14
Tendon Sheaths and Bursae
Bursa = saclike extension of joint capsule 滑囊
between nearby structures so slide more easily past each other
Tendon sheaths = cylinders of connective tissue lined with
synovial membrane and wrapped around a tendon
9-15
Components of a Lever
A lever is a rigid object that rotates around a fixed
point called a fulcrum(支点)
Rotation occurs when effort overcomes resistance
resistance arm and effort arm are described relative to
fulcrum
9-16
Mechanical Advantage of a Lever
Two kinds of levers
lever that helps increase output of force
human moving a heavy object with help of crowbar(撬棍)
lever move object further and faster
movement of row boat with paddle(桨)
Types of levers produce either increase in
speed or force
9-17
Mechanical Advantage
Mechanical advantage is calculated from the length of the
effort arm divided by the length of the resistance arm
Contraction of the biceps muscle (肱二头肌)causes the hand
to move fast and further (MA <1.0)
9-18
First-Class Lever
Has fulcrum in the middle between effort and resistance
Atlantooccipital joint(寰枕关节) lies between the muscles on the back
of the neck and the weight of the face
loss of muscle tone(肌张力) occurs when you nod off in class
9-19
Second-Class Lever
Resistance between fulcrum and effort
Resistance from the muscle tone of the temporalis(颞肌 )
muscle lies between the jaw joint(下颌关节) and the pull of
the diagastric muscle(二腹肌前腹) on the chin(下巴) as it opens
the mouth quickly
9-20
Third-Class Lever
Effort between the resistance and the fulcrum
most joints of the body
The effort applied by the biceps muscle is applied to the
forearm between the elbow joint and the weight of the
hand and the forearm
9-21
Range of Motion
Degrees through which a joint can move
Determined by
structure of the articular surfaces
strength and tautness of ligaments, tendons and
capsule
stretching of ligaments increases range of motion
double-jointed people have long or slack ligaments
action of the muscles and tendons
nervous system monitors joint position and muscle tone
9-22
Axes of Rotation
Shoulder joint has 3 degrees of freedom =
multiaxial joint多轴关节
Other joints – monoaxial or biaxial
9-23
Types of Synovial Joints
9-24
Ball-and-Socket Joints
Smooth hemispherical(半球) head fits within a
cuplike depression
head of humerus(肱骨) into glenoid cavity of scapula
head of femur into acetabulum(髋臼) of hip bone
Multiaxial joint
9-25
Condyloid (ellipsoid) Joints
Oval convex surface(椭圆凸面) on one bone fits
into a similarly shaped depression on the next
Radiocarpal joint(腕桡关节) of the wrist
metacarpophalangeal joints(掌指关节) at the bases of
the fingers
Biaxial joints
9-26
Saddle Joints
鞍状关节
Each articular surface is shaped like a saddle鞍,
concave(凹面) in one direction and convex(凸面) in the other
trapeziometacarpal joint(拇指腕关节) at the base of the thumb
Biaxial joint
more movable than
a condyloid or hinge joint(铰链关节)
forming the primate(灵长目)
opposable thumb
9-27
Gliding Joints(arthrodia) 滑动关节
Flat articular surfaces in which bones slide
over each other
Limited monoaxial joint
Considered amphiarthroses
9-28
Hinge Joints枢纽关节
One bone with convex surface that fits into a
concave depression on other bone
ulna and humerus at elbow joint
femur and tibia at knee joint
finger and toe joints
Monoaxial joint
9-29
Pivot Joints车轴关节
One bone has a projection that fits into a ringlike
ligament of another
First bone rotates on its longitudinal axis relative to
the other
atlantoaxial joint寰枢关节
(dens and atlas)
proximal radioulnar
joint allows the
radius during
pronation and supination
9-30
Flexion, Extension and Hyperextension
Flexion decreases the angle
of a joint
Extension straightens and
returns to the anatomical
position
Hyperextension = extension
beyond 180 degrees过伸
9-31
Flexion, Extension and Hyperextension
9-32
Abduction and Adduction
Abduction is movement of a part away from the midline
外展
hyperabduction – raise arm over back or front of head
Adduction is movement towards the midline
内收
hyperadduction – crossing fingers
9-33
Elevation and Depression
Elevation is a movement that raises a bone vertically垂直
Mandibles(下颌) are elevated during biting and clavicles(锁骨)
during a shrug
Depression is lowering the mandible or the shoulders
9-34
Protraction and Retraction
Protraction = movement
anteriorly on horizontal
plane 伸长
thrusting the jaw forward,
shoulders or pelvis forward
Retraction is movement
posteriorly 收回
9-35
Circumduction
Movement in which one end of
an appendage remains
stationary while the other end
makes a circular motion
Sequence of flexion, abduction,
extension and adduction
movements
baseball player winding up for a
pitch
9-36
Rotation
Movement on
longitudinal axis
rotation of trunk,
thigh, head or arm
Medial rotation
turns the bone
inwards
Lateral rotation
turns the bone
outwards
9-37
Supination and Pronation
In the forearm and foot
Supination 旋后
rotation of forearm so that the palm
faces forward
inversion and abduction of foot
(raising the medial edge of the foot)
Pronation
旋前
rotation of forearm so the palm faces
to the rear
Eversion外翻 and abduction外展 of foot
(raising the lateral edge of the foot)
9-38
Movements of Head and Trunk
屈曲
过伸
侧屈
Flexion, hyperextension and lateral flexion of vertebral
column
9-39
Rotation of Trunk and Head
Rotation of head
Right rotation of trunk
9-40
Movements of Mandible
下颌骨
Lateral excursion偏移 = sideways movement
Medial excursion = movement back to the midline
side-to-side grinding during chewing
Protraction – retraction缩进 of mandible
9-41
Movement of Hand and Digits
Radial and ulnar
flexion 桡偏尺偏
Abduction of fingers
and thumb 拇外展
Opposition is
movement of the
thumb to approach or
touch the fingertips对指
运动
Reposition is
movement back to the
anatomical position
9-42
Movements of the Foot
Dorsiflexion is raising of the toes as when you swing the foot
forward to take a step (heel strike) 背屈
Plantarflexion is extension of the foot so that the toes point
downward as in standing on tiptoe 跖屈
Inversion is a movement in which the soles are turned medially
Eversion is a turning of the soles to face laterally 外翻
9-43
Content
关节种类
软骨种类
主要四肢关节
椎间盘
关节置换&再生
PERICHONDRIUM 软骨膜
Dense irregularly
arranged connective
tissue (type I collagen)
Ensheaths the cartilage
Houses the blood
vessels that nourish滋养
chondrocytes
CHONDROBLAST成软骨细胞
Progenitor of
chondrocytes
Lines border between
perichondrium and
matrix
Secretes type II collagen
and other ECM
components
Chondroblasts build
CHONDROCYTE软骨细胞
Mature cartilage cell
Reside in a space
called the lacuna
Clear areas = Golgi
and lipid droplets
CHONDROCYTE软骨细胞
Chondrocytes
completely fill their
lacunae
RER(粗面内质网) and
euchromatic nuclei
Synthetically active,
secrete matrix
N
RER
Cartilage matrix
MATRIX
Provides the rigidity, elasticity, &
resilience回复力
FIBERS
Collagenous and elastic
GROUND SUBSTANCE
Glycosaminoglycans粘多糖 (chondroitin
sulfates, keratin sulfate, hyaluronic
acid)
Proteoglycans蛋白聚糖: GAGs + core
protein
Water
Basophilic嗜碱性
Territorial matrix - high [sulfated
proteoglycans ]
CARTILAGE GROWTH
Appositional
Increasing in WIDTH;
chondroblasts deposit
matrix on surface of
pre-existing cartilage
Interstitial
Increasing in LENGTH;
chondrocytes divide
and secrete new
matrix , expanding the
cartilage from within
(inside out)
TYPES OF CARTILAGE
HYALINE透明
ELASTIC弹性
FIBROUS纤维
HYALINE CARTILAGE
FUNCTION
Support tissue and organs
Model for bone
development
MATRIX
Type Ⅱ collagen (thin
fibrils)
Chondroitin sulfate, keratin
sulfate, hyaluronic acid
Water
LOCATION
Tracheal rings, nasal
septum, larynx, articular
surfaces of joints
ELASTIC CARTILAGE
FUNCTION
Support with flexibility
MATRIX
Normal components of hyaline
matrix plus ELASTIC fibers
LOCATION
External ear, external auditory
canal, epiglottis
STAINS
Elastic fibers stain BLACK with
Weigert stain
perichondrium
FIBROCARTILAGE
Orcein van Giesen Elastic stain - fibrocartilage - reddish brown
hyaline cartilage - yellow
FIBROCARTILAGE
FUNCTION
Support with great
tensile strength
MATRIX
Type Ⅰ collagen Oriented parallel to
stress plane
LOCATION
Intervertebral disks,
pubic symphysis
FIBROCARTILAGE
Chondrocytes align
between collagen fibers
软骨细胞在胶原纤维中成行排列
Collagen fibers lie
parallel to lines of stress
胶原纤维与受力方向平行
Content
关节种类
软骨种类
主要四肢关节
椎间盘
关节置换&再生
The Humeroscapular Joint肱肩胛关节
Most freely movable joint in the body
shallowness and looseness
deepened by glenoid labrum肩胛盂
Supported by ligaments and tendons
3 glenohumeral盂-肱, coracohumeral喙-肱,
transverse humeral and biceps tendon are
important joint stabilizer
Supported by rotator cuff 肩袖musculature
tendons fuse to joint capsule and
strengthens it
supraspinatus, infraspinatus, teres minor
and subscapularis (冈上肌、冈下肌、小圆肌、肩胛下肌)
4 Bursae associated with shoulder joint
9-58
Stabilizers of the Shoulder Joint
稳定肩关节的结构
9-59
Tendons of Rotator Cuff Muscles
肩袖的肌腱
9-60
Shoulder
Joint
Capsule,
Anterior
View
Dissection of Shoulder Joint
9-62
Shoulder Joint Capsule,
Posterior View
A. Acromion肩峰
B. Scapular spine肩胛冈
C. Coracohumeral ligament喙肱韧带
D. Supraspinatus muscle冈上肌
(cut away)
E. Infraspinatus muscle (cut away)冈下肌
F. Teres minor muscle (cut away)小圆肌
G. Triceps muscle (cut away)肱三头肌
H. Capsule
Shoulder Joint Capsule,
Lateral View
A. Acromion process
B. Coracoid process喙突
C. Coracoacromial ligament
D. Coracoclavicular ligament
E. Glenoid labrum盂唇
F. Triceps muscle (cut away)
G. Biceps muscle (cut away)
The Elbow Joint
Single joint capsule enclosing
the
humeroulnar and humeroradial
joints肱尺肱桡关节
Humeroulnar joint is supported
by collateral ligaments.
Radioulnar joint is head of
radius held in place by the
anular ligament 环形韧带
encircling the head
9-65
Elbow Joint
9-66
The Coaxal (hip) Joint
Head of femur articulates with acetabulum髋臼
Socket deepened by acetabular labrum髋臼唇
Blood supply to head of femur found in ligament of the
head of the femur Joint capsule strengthened by
ligaments
9-67
Hip Joint
Joint capsule strengthened
by ligaments
Pubofemoral耻骨-股骨
Ischiofemoral坐骨-股骨
Iliofemoral髂骨-股骨
9-68
Dissection of Hip Joint
9-69
The Knee Joint
Most complex diarthrosis 最复杂可动关节
patellofemoral = gliding joint(髌骨股骨关节滑动关节)
tibiofemoral = gliding with slight
rotation and gliding possible in
flexed position一定的选择和充分的屈曲
Joint capsule anteriorly consists
of patella and extensions of
quadriceps
femoris tendon股四头肌肌腱
Capsule strengthened by
extracapsular and intracapsular
ligaments囊内外韧带
9-70
Knee Joint – Sagittal Section矢状面
9-71
Knee Joint – Anterior and Posterior Views
Anterior and lateral cruciate ligaments limit anterior and
posterior sliding movements前交叉韧带和后交叉韧带限制前后滑动
Medial and lateral collateral ligaments prevent rotation of
extended knee侧副韧带限制旋转
9-72
Knee Joint – Superior View
Medial and lateral meniscus半月板 absorb shock and shape joint
9-73
Dissection of Knee Joint解剖图
9-74
Knee Joint Structures
Cruciate Ligaments- within the joint capsule, they cross. They
are intracapsular ligaments and named for their attachment
on the tibia.十字交叉韧带,命名根据胫骨位置
Knee Ligaments膝关节的韧带
Anterior Cruciate Ligament- It attaches to the anterior side of
the tibia just medial to the medial meniscus. It attaches to
the posterior side of the femur. It prevents anterior
translation of the tibia on the femur.前交叉韧带的位置,防止胫骨过度前移
Knee Ligaments
Posterior Cruciate Ligament- attaches to the
posterior side of the tibia. 胫骨后方 It attaches to the
anterior femur and prevents posterior translation of
the tibia on the femur.后交叉韧带,防止胫骨向后方的过度移动
Knee Ligaments
Medial Collateral
Ligament- Attached
to the tibia and femur
on the medial内侧 side
of the knee joint.
Also attached to the
medial meniscus, so
injury to one can
result in injury to
both.内侧副韧带
Knee Ligaments
Lateral Collateral Ligament- attached from the
femur to the fibula腓骨 on the lateral side of the knee.
Shorter and stronger than the MCL. 外侧副韧带
Knee Joint Structures半月板
Meniscus- medial and lateral meniscus are two
half moon, wedge shaped fibrocartilage纤维软骨
located on the superior tibia. They provide shock
absorption in the knee. Medial is more often torn.
Knee Structures
Pes Anserine muscle group- made up of Sartorius,
Gracilis and semiTendinosus. (SGT). They come from
posterior to medial anterior knee, there is a bursa 滑囊
under the insertion.
缝匠肌
半腱肌腱
鹅足滑囊
Content
关节种类
软骨种类
主要四肢关节
椎间盘
关节置换&再生
Intervertebral Disc椎间盘
Soft fibro-cartilaginous cushions垫
Between two vertebra椎体
Allows some motion
Serve as shock absorbers
Total – 23 discs
¼ th of the spinal column's length脊柱长度
Avascular 缺乏血管
Nutrients diffuse through end plates养分弥散
Intervertebral Disc Functions
Movement of fluid within the nucleus
Allows vertebrae to rock back and forth
Flexibility弹性
Act to pad and maintain the space between
the twenty-four movable vertebrae
Act as shock absorbers
Allow extension and flexion 伸展屈曲
Intervertebral Disc Anatomy解剖
Spongy center
Nucleus pulposus髓核
Surrounded by a tougher
outer fibrous ring
Anulus fibrosus纤维环
Anulus Fibrosus纤维环
Strong radial tire–like structure 放射样结构
Series of lamellae薄片
Concentric sheets of collagen fibers
Connected to end plates
Orientated定向 at various angles
Under compression
– Become horizontal水平的
Encloses nucleus pulposus髓核
Anulus 环
In Bending 弯曲
Increased tensile force posteriorly 拉力
Increased compressive force anteriorly压力
In Rotation 旋转
Reorientation of collagenous fibers
Tightening of fibers traveling in one direction
Loosening of fibers traveling in opposite direction
Nucleus Pulposus髓核
Has more water and PGs蛋白多糖
PG are macro-molecules
Attract and retain water
Hydrophilic gel–like matter 水凝胶样
• Resists compression
Amount of water
Activity related
Varies throughout the day
GLUCOSE
glucose
GLUT
glucose
glycogen
glucose-6-phosphate
OXYGEN
O2
pyruvate
2 ATP
lactate
36 ATP
V
H+
-
MCT
LACTATE
lactate
-
CO2 + H2O
H+
+
H
H+
H+
H+
NHE
H+-ATPase
LACTIC ACID 乳酸IS THE MAJOR METABOLITE
PRODUCED BY DISC CELLS
Metabolism of Disc cells
椎间盘细胞的代谢
Disc cells require glucose and oxygen to 糖和氧
maintain viability生存 and activity
They produce lactic acid as a metabolic
product.乳酸
Accumulation of lactic acid is detrimental有害
and can adversely affect viability and activity
•乳酸积累是有害可反过来影响细胞的存活和活性
Sections through human lumbar discs
椎间盘的两个截面
Cross section
Sagittal section
Blood supply to the avascular intervertebral disc
无血管的椎间盘的血供
Thin midsagittal section cut
from adjacent upper lumbar
vertebral bodies from a
young adult filled by arterial
injection
包括上下两个椎体的薄层矢状位切片图
adapted from: HV Crock and H Yoshizawa ‘Blood supply of the Vertebral column’
Schematic view of nutritional routes
into the intervertebral disc椎间盘营养路径示意图
Vertebral body
endplate终板
endplate
nucleus
Holm et al, 1981
From Holm et al, 1981
Details of blood vessels at disc-endplate junction
and of cartilaginous endplate椎间盘与终板连接处血管
bone
disc
blood vessels
From Crock, Goldwasser, Yoshizawa, 1991Roberts et al, 1989
Effects of cigarette smoke components on
blood supply to disc 吸烟对椎间盘血供影响
Holm and Nachemson, 1988
Stress-Strain Curve
应力应变曲线
Compressive Strength of Spine
脊柱不同节段压力图
Failure Strength of Spinal Ligaments
脊柱各韧带极限承重力
Types of motion
脊柱运动的类型
Motion Segment
活动节段
Theory of weight bearing
脊柱的承重原理
Nucleus pulpous imbibes water吸收水分
Develops internal pressure内部压力的升高
Pressure exerted in all directions各方向向外释放
Lateral forces
• Against annulus纤维环
Superiorly and inferiorly directed forces
• Against end plates终板
Increases stiffness
• Of end plate and annulus fibrosus
Theory of weight bearing (cont’d)
Disc Pressure And Positions
不同姿势椎间盘压力
Raymond Damadian, MD., President, Fonar Corporation Melville, N.Y., June 12, 2006
Herniated Disk
椎间盘突出
Can Occur when there is
enough pressure from
the vertebrae above and
below
This can force some or
all of the nucleus
pulposus through a
weakened or torn part of
the annulus fibrosus.
•
可导致部分或全部的髓核从纤维环薄
弱或破损处突出
Disc Herniation
The ruptured nucleus will
often come incontact with
and press on nerves near
the disc.突出髓核压迫神经
This can result in severe
pain严重疼痛
About 90% of herniated
discs occur in the lumbar
region. The discs in the
cervical region are affected
about 8%, those of the
thoracic region only about
1-2%大部分发生在腰椎
Herniated disks are one of
the most common causes of
back pain背部疼痛的原因
Disc Herniation
椎间盘突出
Content
关节种类
软骨种类
主要四肢关节
椎间盘
关节置换&再生
TJA: Indications
全关节置换适应症
Anatomy — Hip
髋的解剖
骨盆
髋臼
股骨头
股骨
股骨颈
大转子
THA Implants
全髋置换植入物
臼杯
聚乙烯膜(随时代发展而变化)
Technique: Total Hip Replacement
全髋置换术
• Femoral head
impaction股骨头嵌入
Final implant
最终植入物
Anatomy — Knee
膝关节解剖
Knee Replacement—Implants
全膝置换植入物
股骨处材料
髌骨处材料
Patellar
component
胫骨处材料
Knee Replacement—Implants
Knee Replacement—Implants
膝关节置换术
Causes of TJR Failure
全关节置换术失败原因
Wear of articular bearing surface关节承重面磨穿
Aseptic/mechanical loosening无菌性/机械性松动
Osteolysis骨质疏松
Infection感染
Instability关节不稳
Peri-prosthetic fracture假体周围骨折
Implant Failure植入物毁损
Wear of Articular Bearing Surface
关节承重面磨损
Aseptic/Mechanical Loosening
无菌性/机械性松动
Osteolysis
骨质疏松
Infection
感染
Dislocation/Instability
脱位/关节不稳
Peri-Prosthetic Fracture
假体周围骨折
Sri: PP fracture
Implant Failure
假体毁损
Take Home Message
知识点:
关节的种类、运动、力学模式
滑膜关节的结构组成、主要关节(肩关节、肘关节、髋关节、膝关
节)的结构
关节软骨的种类和组织学特点
椎间盘的结构、组织学、力学和代谢特点
思考题(面对疾苦和疑难,我们能做些什么?):
1) 骨关节炎功能失衡的解剖和组织学机制是什么?如何尽可能预防和
恢复?
2)椎间盘突出的解剖和组织学机制是什么?如何尽可能预防和恢复?