膝關(guān)節(jié)解剖膝關(guān)節(jié)解剖(jipu)第一頁(yè)，共43頁(yè)。Knee AnatomyIntroduction 介紹Very little bony stability 少的骨穩(wěn)定Behaves more like a round ball on flat surface運(yùn)動(dòng)(yndng)主要是球在面上的滑動(dòng)Ligaments responsible for stability主要韌帶穩(wěn)定第二頁(yè)，共43頁(yè)。Knee AnatomyLooks simple,but most complex.看似簡(jiǎn)單，最復(fù)雜的關(guān)節(jié)看似簡(jiǎn)單，最復(fù)雜的關(guān)節(jié)More likely to be injured than any other joint in the body 人體人體中更易受傷的關(guān)節(jié)中更易受傷的關(guān)節(jié)Largest joint of the body,actually consisting of 4 joints人體人體大關(guān)結(jié)，有大關(guān)結(jié)，有4個(gè)關(guān)節(jié)組成個(gè)關(guān)節(jié)組成(z chn)Patellofemoral臏股關(guān)節(jié)臏股關(guān)節(jié),Lateral tibio femoral外側(cè)脛股關(guān)節(jié)外側(cè)脛股關(guān)節(jié),Medial tibio femoral內(nèi)側(cè)脛股關(guān)節(jié)內(nèi)側(cè)脛股關(guān)節(jié),Tibiofibular脛腓關(guān)節(jié)脛腓關(guān)節(jié)第三頁(yè)，共43頁(yè)。Knee AnatomyBasic Structures基本組織Bones骨Femur股骨,Tibia脛骨,Fibula腓骨(fig),Patella 臏骨Muscles/Tendons 肌肉及肌腱Quadriceps四頭肌,Hamstrings,Calf musclesLigaments 韌帶Medial collateral內(nèi)側(cè)副韌帶,Lateral collateral外側(cè)副韌帶,Anterior cruciate前交叉,Posterior cruciate后交叉,Popliteal ligament,RetinaculumCartilage軟骨 Meniscus半月板,Articular cartilage 關(guān)節(jié)軟骨Bursae 第四頁(yè)，共43頁(yè)。Knee BonesBonesFemur股骨Large/long bone of the thigh 大長(zhǎng)骨(chngg)Tibia 脛骨Large bone of the lower leg.Fibula 腓骨Small bone of the lower leg.Patella臏骨“Knee Cap”第五頁(yè)，共43頁(yè)。Knee Bones:Anterior ViewFemur,Tibia,PatellaPatellaNo Patella第六頁(yè)，共43頁(yè)。Knee Bones:FunctionPatella臏骨Patellofemoral groove(front of the femur).Patella tracking can affect the overall function of the knee.臏骨溝，臏骨軌跡影響(yngxing)膝的功能PatellaPatellarGroove第七頁(yè)，共43頁(yè)。Knee Bones:Lat/med ViewsFemur,Tibia,Fibula,PatellaLateralMedial第八頁(yè)，共43頁(yè)。Knee Bones:Posterior ViewFemur,Tibia,Fibula第九頁(yè)，共43頁(yè)。Primary Knee Ligaments主要(zhyo)的膝韌帶MCLMedial Collateral Lig.LCLLateral Collateral Lig.第十頁(yè)，共43頁(yè)。Knee LigamentsMedial and Lateral Collateral Ligaments help stabilize the knee by preventing Varus and Valgus forces內(nèi)外側(cè)副韌帶防止(fngzh)內(nèi)外翻VarusTowardsthe MidlineValgus外翻Towardsthe OutsideValgus內(nèi)翻Towardsthe Outside第十一頁(yè)，共43頁(yè)。Knee LigamentsMCLLCL第十二頁(yè)，共43頁(yè)。Cruciate Knee Ligaments(cruciate=cross)十字(sh z)韌帶Anterior Cruciate Ligament前交叉韌帶(rndi)Attaches anterior on the tibia&posterolateral on the femur附著于脛骨前部股骨后部Prevents anterior movement of the tibia on the femur防止脛骨相對(duì)股骨的前移Checks external rotation of the tibia in flexion曲屈時(shí)防止脛骨外旋AnteriorACLInferiorSuperiorPosterior第十三頁(yè)，共43頁(yè)。Knee:Cruciate Ligaments第十四頁(yè)，共43頁(yè)。Knee:ACLACL“Footprint前交叉(jioch)脛骨附著點(diǎn)”Tibial attachmentAnteriorPosteriorTibialPlateauTibialPlateauFemoralAttachment(Footprint)第十五頁(yè)，共43頁(yè)。Posterior Cruciate后交叉韌帶、Attaches Posterior on the tibia&Antero-medial on the femur.附著(fzhu)于脛骨后股骨前內(nèi)The PCL is a strong fan shaped ligament that is the strongest in the body后叉強(qiáng)大的扇形韌帶Primary stabilizer against posterior movement of the tibia on the femur防止脛骨后移Helps check the knee in extension防止過(guò)伸Cruciate Knee Ligaments(Cruciate=Cross)PCL第十六頁(yè)，共43頁(yè)。第十七頁(yè)，共43頁(yè)。Knee:CruciatesACLPCL第十八頁(yè)，共43頁(yè)。Knee Hinge joint-flexion&extension.鉸鏈?zhǔn)疥P(guān)節(jié)-屈和伸 Flexion is achieved by contracting the hamstring muscles in the back of the leg.通過(guò)收縮大腿(dtu)后部肌肉屈曲關(guān)節(jié)The Extensor Mechanism sits in front of the knee joint.伸膝裝置在膝關(guān)節(jié)前 The extensor mechanism is made up of the patella,the patellar tendon,the quadriceps tendon and the quadriceps muscles.伸膝裝置由臏骨、臏腱、股四頭肌、股四頭肌腱組成第十九頁(yè)，共43頁(yè)。Knee MusclesMuscles肌肉、Quadriceps股四頭肌Vastus lateralis外側(cè)束,Vastus intermedius中間(zhngjin)束,&Vastus medialis內(nèi)側(cè)束HamstringsSartorius,Gracilis,Semimembranosus,Semitendinosis,&Biceps femoralis縫匠肌、股薄肌、半腱肌肉、半膜肌、二頭肌Calf Muscles小腿肌肉Gastrocnemius,Soleus,Popliteus,Pes Anserine muscle attachment is into the medial tibia.腓腸肌、比目魚肌第二十頁(yè)，共43頁(yè)。Knee:MusclesQuadriceps股四頭肌Vastus MedialisVastus LateralisVastus Intermedius第二十一頁(yè)，共43頁(yè)。Knee:MusclesQuadricepsVastus Medialis股內(nèi)側(cè)肌Rectus Femoris股中間(zhngjin)肌Vastus Lateralis股外側(cè)(wi c)肌第二十二頁(yè)，共43頁(yè)。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.走路的發(fā)動(dòng)機(jī)由臏股、臏腱、股四頭肌、股四頭肌腱組成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.臏骨為增加(zngji)股四頭肌肉力量的支點(diǎn)，收縮伸膝，放松屈膝PatellarTendonQuadricepsTendon第二十三頁(yè)，共43頁(yè)。FemurPatellaPatellar Tracking:臏骨軌跡(guj)The Patellar Facets track in the Femoral Groove第二十四頁(yè)，共43頁(yè)。Knee:Hamstring MusclesSartorius縫匠肌Gracilis股薄肌Semimembranosis半腱肌Semitendonosis半膜肌Biceps Femoris股二頭肌第二十五頁(yè)，共43頁(yè)。Knee:Hamstring MusclesPes Anserine Attachmentof the鵝足Hamstring tendons(Sartorius shown hereon the Medial Tibial Tuberosity)Medial Attachments第二十六頁(yè)，共43頁(yè)。Knee:Hamstring MusclesLateral Attachment外側(cè)附件(fjin)Biceps FemorisAttachment tothe Fibula股二頭肌肉腓骨附著點(diǎn)第二十七頁(yè)，共43頁(yè)。Rectus FemorisGastrocnemius,Soleus,Popliteus,Pes Anserine muscle attachment is into the medial tibia.Knee:Muscles很少有血液滲出，但是(dnsh)能看到關(guān)節(jié)液增長(zhǎng)Behaves more like a round ball on flat surface運(yùn)動(dòng)(yndng)主要是球在面上的滑動(dòng)Prevent hyperextension防止過(guò)伸The medial meniscus is”C“shaped and is thicker posteriorly than anteriorly.Behaves more like a round ball on flat surface運(yùn)動(dòng)(yndng)主要是球在面上的滑動(dòng)Largest joint of the body,actually consisting of 4 joints人體大關(guān)結(jié)，有4個(gè)關(guān)節(jié)組成(z chn)Meniscus半月板,Articular cartilage 關(guān)節(jié)軟骨Rectus Femoris第四十一頁(yè)，共43頁(yè)。The meniscus actually wraps around the upper bone to fill the space between the round femur and the flat tibia.膝關(guān)節(jié)解剖(jipu)Quadriceps四頭肌,Hamstrings,Calf musclesAttaches anterior on the tibia&posterolateral on the femur附著于脛骨前部股骨后部Knee Ligaments第二十八頁(yè)，共43頁(yè)。Knee LigamentsLateral&Medial RetinaculumMedial RetinaculumMedial supportfor Patellar TrackingLateralRetinaculumLateral supportfor PatellarTrackingVastus MedialisVastus Lateralis第二十九頁(yè)，共43頁(yè)。Knee:TendonsTendonsQuadriceps TendonQuadriceps Tendon connects the Quadriceps Muscles to the Patella四頭肌腱(jjin)連接四頭肌和臏骨Patellar TendonPatellar Tendon connects the Patella to the Tibia.臏腱連接臏韌帶和脛骨The Patella is a bone embedded within the Quadriceps and Patellar Tendons lying over the Femoral bone.Also known as a“sesamoid”bone.臏骨存在于股四頭肌內(nèi)，又成為籽骨第三十頁(yè)，共43頁(yè)。Knee:TendonsQuadricepsTendonPatellar Tendon第三十一頁(yè)，共43頁(yè)。Knee:Meniscal CartilageMeniscus(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.股骨和脛骨關(guān)節(jié)面不是匹配的，在屈曲位是最接近的。空間(kngjin)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.兩個(gè)半月板都是四周厚中間薄，在屈伸時(shí)都是運(yùn)動(dòng)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.外側(cè)半月板不像內(nèi)側(cè)半月板那樣同側(cè)副韌帶或脛骨緊密附著第三十二頁(yè)，共43頁(yè)。Knee:Meniscal CartilageMeniscus,ACL/PCL AttachmentsThe lateral meniscus is”O(jiān)“shaped and generally of equal thickness.外側(cè)(wi c)半月板o形，等厚。The medial meniscus is”C“shaped and is thicker posteriorly than anteriorly.內(nèi)側(cè)半月板c形，后側(cè)比前側(cè)厚第三十三頁(yè)，共43頁(yè)。KneeThe menisci serve several functions 半月板裝置的幾個(gè)功能A.Lubrication潤(rùn)滑B.Nutrition營(yíng)養(yǎng)C.Shock absorbers震蕩吸收D.Spread stress傳導(dǎo)壓力E.Decrease articular cartilage wear減少關(guān)節(jié)軟骨磨損F.Make joint spaces more congruent填充關(guān)節(jié)間隙(jin x)G.Prevent hyperextension防止過(guò)伸The meniscus actually wraps around the upper bone to fill the space between the round femur and the flat tibia.第三十四頁(yè)，共43頁(yè)。Knee:MeniscusMeniscusCrescent-shaped fibrocartilage半月形纖維(xinwi)軟骨Collagen fibers arranged longitudinally and radially膠原纖維(xinwi)成經(jīng)向放射裝Triangular in cross section橫截面呈三角形第三十五頁(yè)，共43頁(yè)。KneeMeniscusThe 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半月板內(nèi)1/3為白區(qū)，中1/3為紅白區(qū)，外1/3為紅區(qū)。中間被冠狀韌帶連接。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.半月板沒(méi)有神經(jīng)，因而沒(méi)有疼痛直到冠狀韌帶損傷。很少有血液滲出，但是(dnsh)能看到關(guān)節(jié)液增長(zhǎng)Blood supplyperipherallyNo blood supplyproximal.第三十六頁(yè)，共43頁(yè)。Articular Knee:Cartilage關(guān)節(jié)(gunji)軟骨Covers ends of bones(joint)覆蓋骨末端ends of the femur,the top of the tibia,top of the fibula and the back of the patella股骨末端、脛骨及腓骨上端、臏骨背面White,shiny material,tough,rubbery白色(bis)、有光澤、有彈性的、有硬度的 Consistency.”thick Functionabsorb shock 吸收震蕩provide smooth surface(facilitate motion)提供表面的潤(rùn)滑第三十七頁(yè)，共43頁(yè)。Knee:Articular CartilageArticular cartilage produces a wonderful lubrication 關(guān)節(jié)軟骨產(chǎn)生關(guān)節(jié)液mechanism with almost zero friction,which helps us articulate our joints during daily activities.關(guān)節(jié)液使日常運(yùn)動(dòng)零摩擦(mc)Synovial fluid-thick viscous fluid layer inside the joint關(guān)節(jié)液粘稠的第三十八頁(yè)，共43頁(yè)。Knee:Articular CartilageHyaline Cartilage Composition透明(tumng)軟骨組成Cells細(xì)胞Chondrocytes(only one kind)Fluid80%Water by VolumeExtracelluar Matrix-The Framework provides form&stabilityCollagens膠原Proteoglycans蛋白多糖Non-collagenous proteins第三十九頁(yè)，共43頁(yè)。Knee:Cartilage第四十頁(yè)，共43頁(yè)。Knee:Articular CartilageChondral boneSubchondral boneJoint fluidForceThe interaction between water&framework gives cartilage mechanical properties of stiffness&resilience.交換(jiohun)水及礦物質(zhì)第四十一頁(yè)，共43頁(yè)。Knee:NeuroVascular ConcernsPeronealNerve腓總神經(jīng)(shnjng)PoplitealArtery腘動(dòng)脈(dngmi)PoplitealVein腘靜脈(jngmi)Popliteal/TibialNerve腘神經(jīng)MedialLateral第四十二頁(yè)，共43頁(yè)。Knee第四十三頁(yè)，共43頁(yè)。