脊柱內(nèi)在穩(wěn)定性肌群功能

Muscles-MusclesoftheBack(背部肌肉Superficiallaryer(moversofupperIntermediatelayer(musclesforDeeplayer(moversofSuperficialgroup(appendiculargroupmoversofupper6stabilizorsofscapula(6origin：脊柱、insertion：肩胛shoulderjointmoversorigin：肩胛骨、insertion：Intermediategroup(respiratorygroupmusclesforSerratusposteriorsuperior(Gray'sorigin：upperthoracicspineinsertion：2~5action：上提肋骨-->inspiration(innervation：ventralramusofT1~3intercostalSerratusposteriorinferiorO:lowerthoracic,lumbarspineI:8~12action：拉下肋骨-->expiration(innervation：ventralramusofT8~12intercostalLevatorcostarum(Gray'sO:C7~T10transverseI:action:elevatebrevis(提肋短肌)(連接相鄰肋骨)、innervation:dorsalramusofintercostalnerves(肋間神經(jīng)Deep最多的肌肉，移動(dòng)數(shù)量最多的骨骼、關(guān)節(jié)不可動(dòng)區(qū)：skull、pelvis、bony可動(dòng)區(qū)：neck(7cervicalvertebrae)、waist(5lumbarmoversofvertebralupper1/2forcervicallower1/2forlumbarmovementsofvertebralvertebraglidingjoints，動(dòng)作都是lineamovements但若視7C、5LA.angularmovements-->ErectorspinaeLateralbending(=B.Rotation-->TransversospinalesErectorspinaemuscles(豎脊肌群)(Gray'sposturemuscles(維持肌肉antigravity1~2minErectorspinaemm.sacrumspinousprocesscommontendonIliocostalisgroupiliocostalislumborum(腰髂肋肌)、iliocostalisthoracis(胸髂肋肌)、iliocostaliscervicis(頸髂肋位于最外側(cè)costalangle角)、transverseprocessoflowerCspine(低位Longissimusgrouplongissimusthoracis(胸最長肌)、longissimuscervicis(頸最長肌)、longissimuscapitis(頭最長transverseprocessofT,Cspine(胸、頸椎橫突)上。Spinalisgroupspinalisthoracis(胸棘肌)、spinaliscervicis(頸棘肌)、spinaliscapitis(頭棘肌)最靠近位置，起自棘突、終于棘突spinalistoracis到了頸部(spinaliscervicis)通常變得不明顯或缺少。再往上spinaliscapitissemispinalis相混合，可不必特別加以區(qū)lateraldorsalramusofC,TLspinaln.Transversospinalesmuscles(橫脊肌群你必須要移除豎棘肌群才能見到這些位于最的背部本體肌力-->rotation(旋轉(zhuǎn))力量-->轉(zhuǎn)spinous/tranverseSemispinalis由深而淺依序是rotators、multifidus、愈肌肉愈短、愈淺層肌肉愈壞處是長肌收縮時(shí)需要對(duì)側(cè)為數(shù)眾多短力矩，常造成對(duì)側(cè)肌不能放松，累積長Long&Shortrotators(1-->3)-這種最的短肌其實(shí)是最重要的posture[extendedRotators(旋轉(zhuǎn)肌fromtransverseprocesstosipinousprocessInterspinalisfromspinousprocesstospinous細(xì)分a.Interspinaliscervicis(頸棘間肌)、b.Interspinalislumborum(腰棘fromtransverseprocesstotransverseprocess這三種肌肉都在相鄰vertebrase3：extension,lateralbending、rotation伸直->側(cè)彎Multifidusm.(1--semispinalis，雙側(cè)同時(shí)收縮，伸直腰／Semispinalism.(半棘肌)(1--transverseprocess(O)、終止于頸椎spinousprocess(I)semipinalisthoracis(胸半棘肌)、semispinalis單側(cè)收縮轉(zhuǎn)對(duì)semispinalisfamilylowerhalfofback-->splenius,semispinalis-------(m.thatrotatetheCspine)-----Spleniusm.細(xì)分為：Spleniuscapitis(頭夾肌)、Spleniustrapezius(斜方肌)就可看見在頸部，如果切掉serratuspost.sup.(后上鋸肌)會(huì)更清楚。originspinousprocess(O)，insertion椎transverseprocess(I)、枕骨superiornuchal半棘肌的origin,insertiondorsalramusofC4~8cervicalspinaln.同semispinalisvs.splenius成頭部轉(zhuǎn)動(dòng)方向不同！(轉(zhuǎn)同側(cè)vs.轉(zhuǎn)對(duì)側(cè))總的來說，transversospinalesmm.和erectorspinaemm.這反映出vertebralcolumnbackmusclesposturesmuscles需求-->持續(xù)收縮伸直脊柱，抵消脊柱前方所以，backmm.是不能休息(posturesmm.基本特色)的(unlesssleeponthebed!)所以，上請坐好-->坐有坐相、站有站良好的才能避免脊柱變形-->產(chǎn)生左右不配平力量-->posturemm.不能放松-->頸、背痛[learningSpinalisfromspinousprocess(棘突)tospinousprocessSemispinalisfromtransversetospinousSpleniusorigin(O)insertion(I)semispinalis不同：轉(zhuǎn)同側(cè)vs.Suboccipitalregion內(nèi)容物：dorsalramusof1stcervicalspinalnerve(第一頸神經(jīng)背枝)、vertebralartery(椎動(dòng)脈)ObliquecapitisinferiorO:軸椎(axis；C2)棘突；I:寰椎(atlas；C1)ObliquecapitissuperiorO:C1；I:RectuscapitisposteriormajorO:C2；I:RectuscapitisposteriorminorO:C1(post.tubercle)；I:nerve1stcervicalspinalnerve[extended[recallspinalis是不是很像[recallsemispinalisoblique[recallspleniusoblique[Summary]musclesthatmovethesemispinaliscapitis、succipitaltriangleprevertebralsuperficalneck[learning起：背部本體肌肉(豎脊肌、橫脊肌合：神經(jīng)解剖的光反射、反射MusclesofthethoracicMusclesforrespirationCostalcage(肋架)上提／呼氣用肌肉能動(dòng)肋骨(e.g.：Pectoralisminor、前鋸肌Serratusanteior)Inspiration(吸氣用肌肉Diapharagm(橫膈(Nerveinnervation)：C3~C5Spinalnerve->phrenic橫膈是最重要吸氣肌，you'lldiewithoutitsintercostaln.支配，而是大老遠(yuǎn)由上方cervicaln.來支配？橫膈，因?yàn)閜hrenicnervemadeofC3~5Eercostal(ribcostaltubercle骨相接處，肌肉變?yōu)镋ercostalssternumcostalangle(肋角)肌肉變?yōu)镮ercostalsintercostalsvs.abdominalwallSternalis(胸骨肌)同InternalintercostalsinterchondralScalenes(斜角肌ant.、mid.scalenes1strib、post.scalenem.上提2ndribSternocleidomastoid(胸鎖乳突肌clavicle、1stribcostoclavicularligament(SCM1stribBack-->intermediatelayer-->respiratorySerratusposteriorsuperior(后上鋸肌)、Serratusposteriorinferior(后下鋸肌)serratusanterior運(yùn)動(dòng)用)vs.后鋸肌serratusposterior(-->呼吸用)Levatorcostarum(提肋肌costalpartofPectoralismajor(肋骨部Expiration(呼氣用肌肉Internalintercostalscostalpart(硬骨4Innercomplex(復(fù)合體Transversesthoracis將之下拉。由2~6Inermostintercostalsm.3~4Intercostalmm.(肋間肌Eercostalm.由后向前，腱膜(aponeurosis)('ercostalIercostalm.肌纖維和肋間外間呈"X"Innermostintercostalsm.Diaphragm(橫膈centraltendonportion(腱性部muscularportionSternalpartCostalpart(肋骨部)、后方Lumbarpart(腰部)diaphragmichiatusAorta、Esophagus、IVC[review]3)：3SternalpartCostalpart：胚胎期橫膈下降時(shí)被拉進(jìn)的腹壁肌肉，位于邊緣。與后方腰部間有Lumbocostal[clinicPhrenicherniapoststernalhernia(胸骨后疝thoracoabdominalpleuralLumbarLat.arcuateligament(外弓狀韌帶)(跨腰方肌)、Intarcuateligament(內(nèi)弓狀韌帶)(跨Rightcrus、Lefttcrushiatus(fromant.toInferiorvenaEsophagus、Vagusn.esophgealbranchofleftgastricartery(左胃動(dòng)脈食道Aorta、Thoracicduct(胸管)、Splanchnicn.ofsympatheticnerve(交感內(nèi)臟神經(jīng))、Azygosvein(奇神經(jīng)：Phrenicn.(膈神經(jīng))是直接進(jìn)入橫膈內(nèi)(右側(cè)入腱性部、左側(cè)入肌性部)。musculophrenica.(肌膈動(dòng)脈)、pericardiacalartery(心包膜動(dòng)脈)、superiorphrenicartery(膈上動(dòng)脈)inferiorphrenicartery(MusclesoftheabdominalAnteriorabdominal呼吸用、排便及排尿、腰部動(dòng)作中的Externalobliqueabdominis向上覆蓋住5~10ribs鋸肌(Serratusant.)、闊背肌(Latissimusdorsi)交錯(cuò)共9~12ribs。纖維方向是由外上方(腋下區(qū))斜向內(nèi)下方(近部郊-->手插進(jìn)長褲口袋時(shí)的方向Inguinalligament(韌帶)：(LigamentofASIS(Ant.sup.iliacspinePubictubercle(恥骨結(jié)節(jié))間Superficialinguinalring(淺環(huán)Spermaticcord(：男)／Roundlig.(圓Med.cruspubicsymphysis)、Lat.cruspubictubercle)，中間有Intercrurallig.(腳間韌帶)強(qiáng)化防止裂Reflectedligament(返折韌帶)：(LigamentofColles)方止于腹直肌鞘。位于淺環(huán)開口內(nèi)下方(Lacunarligament(陷窩韌帶)：(LigamentofGimbernat)(=LigamentofHesselbach)由靠近恥骨結(jié)節(jié)的韌帶纖維形成，它管內(nèi)緣)附著于pectinpubis(=pectinealPectinealligamentInternalobliqueabdominis向上附著于7~10ribs邊緣，下方附著于韌帶外2/3(內(nèi)1/3變?yōu)楸砻娴奶岵G肌)及iliaccrest，內(nèi)側(cè)10~12ribsThoracolumbarfascia。TransversusabdominisCremasterm.腹內(nèi)斜肌、腹橫肌下緣部份肌纖維跟隨進(jìn)入管，成為外的提睪肌。支配Genitabr.ofGenitofemoraln.(Inguinalfalx(鐮)=Conjointtendon(結(jié)合由上方跨過向內(nèi)、向后，附著于恥骨梳Inguinaltriangle肌肉的薄弱區(qū)(僅有Transveralisfascia腹橫筋膜)-->Directhernia(直接氙氣)Rectusabdominis向上附著于5~7ribspubictubercle4Tendinousintersections3Lineaalba(白線)，外側(cè)和三腹壁相接處形成縱向弧線稱Lineasemilunaris(半月9thribpubictubercle。出現(xiàn)肌肉內(nèi)的肌腱－Tendinousinscription脊柱運(yùn)動(dòng)中最重要的flexor(和脊柱后方背部本體肌肉互為拮抗肌(-->flexorvs.extensor)Rectussheath(aponeurosis)分為前后兩層，Ant.Layer橫肌腱膜形成，肚臍下方arcuateline(弓狀Endoabdominalfascia(淺)Transversalisfascia、Extraperitonealfacia(脂肪)、 Transversalisfascia

腹橫肌內(nèi)表面，屬腹腔內(nèi)筋膜，亦是前腹壁deep最的部分肚臍以下的post.layerofRectussheath進(jìn)入下肢大腿的Ant.wallofFemoralc 管前壁)(股管內(nèi)有femorala.,v.,lymphDeepinguinalring(深環(huán)位于Inguinaltriangle外，是穿出前入后成為Int.spermaticfascia(Interfoveolarligament位于前腹壁內(nèi)表面，緊鄰深環(huán)內(nèi)緣，橫筋膜延伸帶(Inf.epigastrica.v.緊貼其PyramidalisPosteriorabdominalquadratuslumborumPsoasmajor(腰大肌)、Psoasminor(腰小肌)、iliacus(髂hipjoint(髖關(guān)節(jié))前方通過，是髖關(guān)節(jié)強(qiáng)有力的形成共同肌腱(iliopsoaslessortrochanter([extendedpsoas、iliacuspelvicgirdle運(yùn)動(dòng)肌，影響到下肢近端的動(dòng)作，以及靜態(tài)平衡、動(dòng)參考m.ofplevicA.主要集中在ant.abdominal肌肌纖維字母的X在腹壁圍成一袋狀物，用以內(nèi)臟來輔助B.post.abdominalwall，lumbarHead,Thorax,PelvisNeck,WaistWaistFlexion/ExtensionLateralflexion：想象成發(fā)生在中軸上的Circumduction：由組合出的循序組合動(dòng)lumbarvertebraegliding(vertebraeglidingjoint)只有背部本體肌肉中的橫脊肌群(Transversospinalis之橫突、棘突)-->見背部肌肉(Semispinalis,Multifidus,Rotators)、脊神經(jīng)背枝(dorsalramus)Musclesofthe[learningobject]：Pelvic了解骨盆下口(pelvicoutlet)由于缺乏骨骼為底板，是故存在內(nèi) 形成隔膜的肌肉有內(nèi)、外兩層，外層是三角形在部官周圍，稱為隔膜。內(nèi)部在小骨盆內(nèi)形成，稱為骨盆[review]truetruepelvicPelvic即真骨盆，它是真、假骨盆的分界，稱為骨盆緣(pelvicbrim)它是橫向橢圓形(女性)或是心臟形()pelvicbrimPelvicbrimsacralpromontarymarginofala(骨氐翼緣)]＋弓狀線(Arcuatelineofilium)＋[恥骨梳(Pectenpubis)＋恥骨聯(lián)合(Symphysispubis)]Iliopectinealline線、恥骨梳合稱為髂恥骨梳線(Iliopectinealline)，它Iliopectinealline＝Arcuateline(iliacpart)＋Pectenpubic(pubicpart)(Gray'sLineaterminalis(終線)＝Arcuateline＋[Pectenpubis＋pubiccrest]真骨 邊緣＝骨氐骨岬＋骨盆緣＋恥骨聯(lián)pubiccrest(pecten真骨 邊緣＝骨氐骨岬＋骨盆緣＋恥骨聯(lián)Pelvic就是指小骨盆(lesserpelvis=truepelvis前：Pubicsymphysis后 A.Perinealdiaphragm(隔膜diaphragm(膈膜)，做為擋Pelvicoutlet前：Urogenitaltriangle無論男、女性，只有此層才有雙層膈膜-->位于泌尿生殖 后： 三角externalsphinctor(外括約肌Perinealdiaphragm(膈膜)=urogenitaldiaphragm(泌尿生殖隔o：Deeptransverseperineus(深橫肌)＋Externalurethralsphinctor(外括約肌) 深橫肌)(較不明顯)、外括約?。獵ompressor 壓肌)、Sphincterurethrovaginalis(括約深橫肌是三角形的肌肉，兩側(cè)穩(wěn)定附著于pubis(恥骨)，是隔膜中最的肌肉(-