肌肉骨骼系统

1. 肌肉骨骼系统 关节&软骨

2. Take Home Message 知识点： 能够描述关节的主要种类 能够描述滑膜关节的结构组成 能够描述主要关节（肩关节、肘关节、髋关节、膝关节）的结构组成 能够描述透明软骨和纤维软骨的组织学特点 能够描述椎间盘的结构组成、组织学特点和代谢特点 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？如何从宏观（解剖结构）—中观（组织学）—微观（细胞行为调控）进行协同研究和治疗？ 2）椎间盘突出的解剖和组织学机制是什么？如何从宏观-中观-微观层面进行协同研究和治疗？

3. Content • 关节种类 • 主要四肢关节 • 椎间盘 • 软骨种类 • 关节修复

4. Joints Joints and their classification bony joints fibrous joints cartilaginous joints 9-4

5. 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

6. Fibrous Joints (Synarthrosis) Collagen fibers span the space between bones Sutures gomphoses 钉状关节 Syndesmoses韧带联合 9-6

7. 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 Fibrous Joint -- Sutures 9-7

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

9. Two bones bound by ligament only interosseus membrane Most movable of fibrous joints Interosseus membranes unite radius to ulna and tibia to fibula Fibrous Joint – Syndesmosis韧带联合

10. 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)

11. Cartilaginous Joint– Synchondrosis软骨结合 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

12. Synovial Joint(滑膜关节) Joint in which two bones are separated by a space called a joint cavity Most are freely movable

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, sternoclavicularand knee joints absorbs shock, guides bone movements and distributes forces Tendon attaches muscle to bone Ligament attaches bone to bone 9-13

14. Types of Synovial Joints 9-14

15. 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 9-15

16. 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 9-16

17. 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 9-17

18. Gliding Joints(arthrodia) 滑动关节 Flat articular surfaces in which bones slide over each other Limited monoaxial joint Considered amphiarthroses 9-18

19. 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 9-19

20. 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 9-20

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 9-21

22. Axes of Rotation Shoulder joint has 3 degrees of freedom = multiaxial joint多轴关节 Other joints – monoaxial or biaxial 9-22

23. 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 9-23

24. Flexion, Extension and Hyperextension 9-24

25. 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 9-25

26. 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 9-26

27. 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 9-27

28. 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 9-28

29. Rotation Movement on longitudinal axis rotation of trunk, thigh, head or arm Medial rotation turns the bone inwards Lateral rotation turns the bone outwards 9-29

30. 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) 9-30

31. Movements of Head and Trunk Flexion, hyperextension and lateral flexion of vertebral column 屈曲 过伸 侧屈 9-31

32. Rotation of Trunk and Head Right rotation of trunk Rotation of head 9-32

33. 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 9-33

34. 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 9-34

35. 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 9-35

36. Content • 主要四肢关节

37. 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 areimportant 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 9-37

38. Stabilizers of the Shoulder Joint稳定肩关节的结构 9-38

39. Tendons of Rotator Cuff Muscles肩袖的肌腱 9-39

40. Shoulder Joint Capsule, Anterior View

41. Dissection of Shoulder Joint 9-41

42. 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

43. 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)

44. 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 9-44

45. Elbow Joint 9-45

46. 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 9-46

47. Hip Joint Joint capsule strengthened by ligaments Pubofemoral耻骨-股骨 Ischiofemoral坐骨-股骨 Iliofemoral髂骨-股骨 9-47

48. Dissection of Hip Joint 9-48

49. 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 9-49

50. Knee Joint – Sagittal Section矢状面 9-50