系統(tǒng)解剖學(xué)：關(guān)節(jié)學(xué)-骨連結(jié)

Arthrology第二章關(guān)節(jié)學(xué)第一節(jié)總論

Introduction直接連結(jié)

thedirectjoint間接連結(jié)

theindirectjoint一、直接連結(jié)thedirectjoint纖維連結(jié)軟骨連結(jié)骨性結(jié)合1.纖維連結(jié)Fibrousjoints縫suture、韌帶ligament、膜membrane縫縫冠狀縫骨密質(zhì)板障1.纖維連結(jié)Fibrousjoints縫suture、韌帶ligament、膜membrane1.纖維連結(jié)Fibrousjoints縫suture、韌帶ligament、膜membrane小腿骨間膜脛腓遠(yuǎn)側(cè)連結(jié)脛腓近側(cè)關(guān)節(jié)2.

軟骨連結(jié)

cartilaginousjoints透明軟骨連結(jié)

hyalinecartilaginousjoint

synchondrosis

如：骺軟骨纖維軟骨連結(jié)

fibrocartilaginousjoint

symphysis

如：椎間盤椎間盤3.

骨性結(jié)合

Synostosis

Bonyunion骨性結(jié)合

SynostosisBonyUnionThebonesareunitedbytheossificationofthefibrousjointandsynchondrosisbetweenthem,e.g.,thesynostosesbetweentheilium,ischiumandpubisofthehipbone,thesynostosesbetweenthesacralvertebraeofthesacrum.二、間接連結(jié)

theindirectjoint1.基本結(jié)構(gòu)theessentialstructures2.輔助結(jié)構(gòu)theaccessorystructures3.關(guān)節(jié)的運(yùn)動(dòng)themovementofjoint

（關(guān)節(jié)articulation,滑膜關(guān)節(jié)

synovialjoint）

1.滑膜關(guān)節(jié)的基本結(jié)構(gòu)

TheessentialstructuresofsynovialjointArticularcapsule滑膜纖維膜關(guān)節(jié)腔關(guān)節(jié)軟骨關(guān)節(jié)囊關(guān)節(jié)面Articularsurface滑膜關(guān)節(jié)滑膜關(guān)節(jié)的基本結(jié)構(gòu)關(guān)節(jié)面即參與組成關(guān)節(jié)的各相關(guān)骨的接觸面，包括凸的關(guān)節(jié)頭和凹的關(guān)節(jié)窩。其表面覆有關(guān)節(jié)軟骨（多數(shù)為透明軟骨，少數(shù)為纖維軟骨），具有彈性，能承受負(fù)荷及吸收震蕩。關(guān)節(jié)囊是由纖維結(jié)締組織構(gòu)成的囊，附著于關(guān)節(jié)面周圍及附近的骨面上，與骨膜續(xù)連。由外層（纖維層）和內(nèi)層（清膜層）所組成?；げ桓采w關(guān)節(jié)軟骨。關(guān)節(jié)腔由關(guān)節(jié)軟骨和滑膜層所圍成的腔隙。內(nèi)含少量滑液，腔內(nèi)為負(fù)壓。TheessentialstructuresThearticularsurfaces（關(guān)節(jié)面）

arecoveredbythehyalinecartilageorthefibrouscartilage.Thejointcapsule（關(guān)節(jié)囊）isattachedtotheperipheryofthearticularsurfaceandadjacentbonesurface.Itiscomposedoftwolayers,thefibrouslayerandthesynoviallayer.Thejointcavity（關(guān)節(jié)腔）whichisaclosedcavityformedbythesynovialmembrane（滑膜）andthearticularcartilage（關(guān)節(jié)軟骨）.Itcontainsaproperamountofsynonialfluid（滑液）,andisnegativetotheatmospherepressure.2.滑膜關(guān)節(jié)的輔助結(jié)構(gòu)

Theaccessorystructuresofsynovialjoint韌帶theligaments囊內(nèi)韌帶theintracapsularligament.囊外韌帶theextracapsularligament.關(guān)節(jié)唇thearticularlabrum(lip)

關(guān)節(jié)盤thearticulardisc

半月板themeniscus滑膜皺襞thesynovialfold

滑膜囊thesynovialbursa髖關(guān)節(jié)

hipjoint膝關(guān)節(jié)

kneejoint膝關(guān)節(jié)

kneejoint滑膜關(guān)節(jié)的輔助結(jié)構(gòu)（1）韌帶：是連于相鄰兩骨之間的致密纖維結(jié)締組織束；有加強(qiáng)關(guān)節(jié)的穩(wěn)固或限制其過度運(yùn)動(dòng)的作用；有囊內(nèi)韌帶、囊外韌帶之分。關(guān)節(jié)盤位于兩關(guān)節(jié)面之間的纖維軟骨板，其周緣附于關(guān)節(jié)囊，并將關(guān)節(jié)腔分為兩部。使關(guān)節(jié)面更為適合，減少外力對關(guān)節(jié)的沖擊和震蕩，可增加關(guān)節(jié)的運(yùn)動(dòng)形式和范圍。例如：膝關(guān)節(jié)的半月板、胸鎖關(guān)節(jié)的關(guān)節(jié)盤、肩鎖關(guān)節(jié)的關(guān)節(jié)盤、顳下頜關(guān)節(jié)的關(guān)節(jié)盤等。關(guān)節(jié)唇附著于關(guān)節(jié)窩周緣的纖維軟骨環(huán)；可加深關(guān)節(jié)窩，增大關(guān)節(jié)的接觸面，增強(qiáng)關(guān)節(jié)的穩(wěn)定性。例如：髖關(guān)節(jié)的髖臼唇、肩關(guān)節(jié)的盂唇等?；りP(guān)節(jié)的輔助結(jié)構(gòu)（2）滑膜襞滑膜重疊卷折并突入關(guān)節(jié)腔內(nèi)形成的皺襞；在關(guān)節(jié)腔內(nèi)擴(kuò)大了滑膜的面積，有利于滑液的分泌和吸收?；つ一年P(guān)節(jié)囊纖維膜的薄弱或缺如處膨出而形成的囊狀結(jié)構(gòu)；擴(kuò)大了滑膜的面積，有利于滑液的分泌和吸收；位于肌腱與骨面之間的滑膜囊，可減少兩者之間的摩擦。3.關(guān)節(jié)運(yùn)動(dòng)背屈跖屈屈伸屈伸屈伸屈伸屈伸屈伸關(guān)節(jié)的屈、伸運(yùn)動(dòng)一般關(guān)節(jié)的屈伸運(yùn)動(dòng)：通常指沿（圍繞）冠狀軸所作的運(yùn)動(dòng)。運(yùn)動(dòng)時(shí)，相關(guān)節(jié)的兩骨之間的角度變小稱為屈，反之，角度變大稱為伸。踝關(guān)節(jié)的屈伸運(yùn)動(dòng)：其屈為足尖上抬，足背與小腿前面靠攏，又稱背屈；伸為足尖下垂，又稱跖屈。3.關(guān)節(jié)的運(yùn)動(dòng)展收內(nèi)旋外旋展收內(nèi)旋外旋收展運(yùn)動(dòng)

adduction&abduction是關(guān)節(jié)沿（圍繞）矢狀軸所作的運(yùn)動(dòng)。運(yùn)動(dòng)時(shí)，骨向正中矢狀面靠攏為收，反之，遠(yuǎn)離正中矢狀面為展。拇指腕掌關(guān)節(jié)的收展運(yùn)動(dòng)：其關(guān)節(jié)沿冠狀軸所作的運(yùn)動(dòng)為收展，拇指向示指靠攏為收，遠(yuǎn)離食指為展。內(nèi)旋和外旋

medialrotation&lateralrotation旋轉(zhuǎn)運(yùn)動(dòng)是關(guān)節(jié)沿垂直軸所作的運(yùn)動(dòng)。運(yùn)動(dòng)時(shí)，骨圍繞垂直軸向內(nèi)側(cè)旋轉(zhuǎn)稱為內(nèi)旋，反之，向外側(cè)旋轉(zhuǎn)稱為外旋。3.關(guān)節(jié)的運(yùn)動(dòng)環(huán)轉(zhuǎn)運(yùn)動(dòng)為屈、展、伸、收的連續(xù)運(yùn)動(dòng)。運(yùn)動(dòng)時(shí)，骨的上端在原位轉(zhuǎn)動(dòng)，下端作圓周運(yùn)動(dòng)，運(yùn)動(dòng)軌跡為圓錐形。環(huán)轉(zhuǎn)circumduction

3.關(guān)節(jié)的運(yùn)動(dòng)旋前旋后旋前、旋后

pronation&supination是前臂的橈骨對尺骨所作的運(yùn)動(dòng)。運(yùn)動(dòng)時(shí)，橈骨圍繞著橈骨頭中心到尺骨頭中心的軸線旋轉(zhuǎn)，橈骨與手向內(nèi)側(cè)旋轉(zhuǎn)，手掌朝后稱為旋前；反之，橈骨與手向外側(cè)旋轉(zhuǎn)，手掌朝前稱為旋后。3.關(guān)節(jié)的運(yùn)動(dòng)足內(nèi)翻足外翻足內(nèi)翻、足外翻

inversion&eversion足內(nèi)翻：足內(nèi)側(cè)緣上提，足底朝內(nèi)。足外翻：足外側(cè)緣上提，足底朝外。HingejointsPivotjointsEllipsoidjointsBall&socketsSaddlejoints關(guān)節(jié)的類型關(guān)節(jié)面形態(tài)運(yùn)動(dòng)軸數(shù)骨的數(shù)目運(yùn)動(dòng)方式TheTypesoftheSynovialJoints(1)Uniaxialjoint

單軸關(guān)節(jié)運(yùn)動(dòng)軸Theaxisofmovement關(guān)節(jié)面的形狀TheshapeofarticularsurfaceHingejoint滑車關(guān)節(jié)Pivotjoint車軸關(guān)節(jié)Ellipsoidjoint橢圓關(guān)節(jié)Saddlejoint鞍狀關(guān)節(jié)Ball&socketjoint球窩關(guān)節(jié)Planejoint平面關(guān)節(jié)Multiaxialjoint多軸或三軸關(guān)節(jié)Biaxialjoint雙軸關(guān)節(jié)TheTypesofSynovialJoints(2)

單關(guān)節(jié)simplejoint

復(fù)關(guān)節(jié)compositejoint骨的數(shù)目thenumberofbones運(yùn)動(dòng)形式thetypeofmovement單動(dòng)關(guān)節(jié)聯(lián)動(dòng)（聯(lián)合）關(guān)節(jié)單軸關(guān)節(jié)滑車關(guān)節(jié)尺骨肱骨滑車關(guān)節(jié)為單軸關(guān)節(jié)；關(guān)節(jié)頭呈滑車狀，關(guān)節(jié)窩呈相應(yīng)的凹狀；如肘關(guān)節(jié)、膝關(guān)節(jié)、踝關(guān)節(jié)、指（趾）骨間關(guān)節(jié)；圍繞冠狀軸作屈伸運(yùn)動(dòng)。單軸關(guān)節(jié)車軸關(guān)節(jié)樞椎寰椎齒突車軸關(guān)節(jié)為單軸關(guān)節(jié)；關(guān)節(jié)頭呈圓柱狀，關(guān)節(jié)窩與韌帶呈環(huán)狀;如寰樞正中關(guān)節(jié)和橈尺近側(cè)關(guān)節(jié)等；圍繞垂直軸作旋轉(zhuǎn)運(yùn)動(dòng)。鞍狀關(guān)節(jié)雙軸關(guān)節(jié)大多角骨第1掌骨鞍狀關(guān)節(jié)Saddlejoint為雙軸關(guān)節(jié)；關(guān)節(jié)面呈鞍狀；如拇指腕掌關(guān)節(jié)和小指腕掌關(guān)節(jié)；圍繞冠狀軸作收展運(yùn)動(dòng)，圍繞矢狀軸作屈伸運(yùn)動(dòng)，可作環(huán)轉(zhuǎn)運(yùn)動(dòng)。Ellipsoidjoint(condyloidjoint)雙軸關(guān)節(jié)橢圓關(guān)節(jié)近節(jié)指骨掌骨為雙軸關(guān)節(jié)；關(guān)節(jié)頭呈橢圓形凸面，關(guān)節(jié)窩呈橢圓形凹面;如腕關(guān)節(jié)。沿冠狀軸作屈伸運(yùn)動(dòng)，沿矢狀軸作收展運(yùn)動(dòng)，可作環(huán)轉(zhuǎn)運(yùn)動(dòng)。橢圓關(guān)節(jié)三軸關(guān)節(jié)球窩關(guān)節(jié)股骨頭髖臼球窩關(guān)節(jié)為三軸或多軸關(guān)節(jié)；關(guān)節(jié)頭呈球形，關(guān)節(jié)窩呈球形凹面；如髖關(guān)節(jié)、肩關(guān)節(jié)。沿冠狀軸作屈伸運(yùn)動(dòng)，沿矢狀軸作收展運(yùn)動(dòng)，沿垂直軸作旋轉(zhuǎn)運(yùn)動(dòng)，可作環(huán)轉(zhuǎn)運(yùn)動(dòng)。多軸關(guān)節(jié)平面關(guān)節(jié)肩胛骨肩峰鎖骨平面關(guān)節(jié)為多軸關(guān)節(jié)；關(guān)節(jié)面平坦；如腕骨間關(guān)節(jié)、肩鎖關(guān)節(jié)、跗跖關(guān)節(jié)等；可作移動(dòng)和旋轉(zhuǎn)運(yùn)動(dòng)。第二節(jié)中軸骨的連結(jié)一、軀干骨的連結(jié)

Thejointsofthebonesofthetrunk脊柱vertebralcolumn胸廓

thoraciccage（一）脊柱

Thevertebralcolumn組成和功能formation&

function椎骨間連結(jié)

The

jointsbetweenthevertebrae脊柱整體觀

Thevertebralcolumnasawhole脊柱的運(yùn)動(dòng)

Movementofvertebralcolumn組成和功能脊柱組成：成人脊柱由24塊椎骨、1塊骶骨和1塊尾骨籍骨連結(jié)而形成.Theadultvertebralcolumnconsistsof24vertebrae,1sacrum,1coccyxandtheconnectionsbetweenthem.功能：具有支撐、保護(hù)和運(yùn)動(dòng)。1、椎骨間連結(jié)

The

jointsbetweenthevertebrae椎體間連結(jié)

Thejointsofthevertebralbodies椎弓間連結(jié)

Thejointsofthevertebralarches（1）椎體間連結(jié)前縱韌帶anteriorlongitudinalligament后縱韌帶posteriorlongitudinalligament椎間盤Intervertebraldisc（1）椎體間連結(jié)前縱韌帶后縱韌帶1.椎體間連結(jié)前縱韌帶椎間盤椎間盤

intervertebraldiscs髓核纖維環(huán)后縱韌帶前縱韌帶椎

間

盤髓核纖維環(huán)椎間盤髓核纖維環(huán)椎間盤髓核纖維環(huán)后縱韌帶前縱韌帶椎間盤疝出椎間盤疝出椎間盤IntervertebralDisc形態(tài)結(jié)構(gòu)：椎間盤是連結(jié)相鄰兩個(gè)椎體的纖維軟骨盤；其形狀與椎體形狀一致，但各部厚度不一；由周圍部的纖維環(huán)和中央部的髓核構(gòu)成。髓核nucleuspulposus柔軟而富有彈性，為胚胎時(shí)脊索的殘留物;纖維環(huán)anulus

fibrosus

由多層纖維環(huán)按同心圓排列而成。功能：1）牢固連結(jié)相鄰的椎體；2）椎間盤堅(jiān)固而富有彈性，可承受壓力、減緩沖擊以保護(hù)腦；3）有利于脊柱向各個(gè)方向運(yùn)動(dòng)。臨床意義：纖維環(huán)的后份最簿，當(dāng)其破裂時(shí)，髓核可從后外側(cè)脫出，突入椎管或椎間孔，產(chǎn)生壓迫脊髓或神經(jīng)根引起放射痛或神經(jīng)痛,臨床稱為椎間盤脫出癥.棘上韌帶Supraspinousligament2.椎弓間連結(jié)黃韌帶Ligamenta

flava棘間韌帶Interspinousligament2.椎弓間連結(jié)項(xiàng)韌帶棘間韌帶項(xiàng)韌帶棘間韌帶2.椎弓間連結(jié)橫突間韌帶橫突間韌帶棘上韌帶黃韌帶黃韌帶yellowligament黃韌帶關(guān)節(jié)突關(guān)節(jié)zygapophysialjoint關(guān)節(jié)突關(guān)節(jié)關(guān)節(jié)突關(guān)節(jié)關(guān)節(jié)突關(guān)節(jié)關(guān)節(jié)突關(guān)節(jié)關(guān)節(jié)突關(guān)節(jié)寰枕關(guān)節(jié)寰枕關(guān)節(jié)寰枕關(guān)節(jié)囊寰樞關(guān)節(jié)十字韌帶翼狀韌帶齒突尖韌帶寰椎橫韌帶縱束寰樞外側(cè)關(guān)節(jié)關(guān)節(jié)囊寰樞關(guān)節(jié)十字韌帶翼狀韌帶齒突尖韌帶寰椎橫韌帶縱束寰樞外側(cè)關(guān)節(jié)寰樞正中關(guān)節(jié)寰椎橫韌帶齒突后關(guān)節(jié)面齒突前關(guān)節(jié)面寰椎前弓的齒突凹樞椎的齒突寰樞正中關(guān)節(jié)十字韌帶寰椎橫韌帶縱束齒突前關(guān)節(jié)面齒突后關(guān)節(jié)面寰椎前弓縱束脊柱腰段椎骨間連結(jié)

jointsbetweenthevertebrae椎體間連結(jié)

jointsofthevertebralbodies椎間盤

intervertebraldisc前縱韌帶

anteriorlongitudinalligament：各椎體前面后縱韌帶

posteriorlongitudinalligament：各椎體后面椎弓間連結(jié)

jointsofthevertebralarches關(guān)節(jié)突關(guān)節(jié)

jointsofarticularprocesses黃韌帶Ligamenta

flava(yellowligaments)：連于相鄰椎板之間棘間韌帶Interspinousligaments：連于相鄰棘突之間橫突間韌帶Intertransverseligaments：連于相鄰橫突之間棘上韌帶Supraspinousligaments：連于胸腰骶椎各棘突尖之間項(xiàng)韌帶Ligamentum

nuchae：連于頸椎各棘突尖之間寰樞關(guān)節(jié)Atlantoaxialjoint

（寰樞正中關(guān)節(jié)medianatlantoaxialjoint、寰樞外側(cè)關(guān)節(jié)lateralatlantoaxialjoint)3.脊柱整體觀

脊柱的生理性彎曲

頸曲胸曲腰曲骶曲

正常

駝背

脊柱前彎癥脊柱側(cè)凸脊柱的彎曲4.脊柱的運(yùn)動(dòng)屈伸、側(cè)屈、旋轉(zhuǎn)、環(huán)轉(zhuǎn)二、胸廓Thethoraciccage

組成和功能Formation&Function連結(jié)The

joints胸廓整體觀

Thethoraciccageasawhole胸廓的運(yùn)動(dòng)

Movementofthoraciccage組成和功能胸骨真肋假肋肋第12胸椎第1胸椎胸廓胸廓的組成及作用：由1塊胸骨、12對肋、12塊胸椎及其骨連結(jié)組成，有支持軀干、保護(hù)胸腹腔臟器、參與呼吸運(yùn)動(dòng)等作用。

Itisformedby12thoracicvertebrae,12pairsofribswiththeircostalcartilages,1sternumandtheconnectionsbetweenthem.功能：保護(hù)胸腔內(nèi)器官和運(yùn)動(dòng)作用。

Function：Protectsorgansinthethoraxandplaysthemovement.1.肋椎關(guān)節(jié)costovertebraljoint肋頭關(guān)節(jié)肋橫突關(guān)節(jié)2.胸肋連結(jié)軟骨結(jié)合胸肋關(guān)節(jié)軟骨間關(guān)節(jié)第1肋軟骨結(jié)合劍肋角

胸廓的連結(jié)1.肋椎連結(jié)肋頭關(guān)節(jié)Jointofheadofrib：由第1~12肋骨的肋頭與胸椎體肋凹構(gòu)成。肋橫突關(guān)節(jié)Costotransversejoint：由第1~10肋骨的肋結(jié)節(jié)與胸椎橫突肋凹構(gòu)成。2.胸肋連結(jié)Sternocostaljoints第1肋軟骨結(jié)合Firstcostalcartilaginousjoint胸肋關(guān)節(jié)(第2~7肋與胸骨)Sternocostaljoints軟骨間關(guān)節(jié)(第7~10肋軟骨之間)Interchondraljoints

肋弓Costalarch(第7~10肋軟骨）胸骨下角Infrasternalangle：左右肋弓之間的夾角劍肋角Xiphoid-costalangle

：劍突與肋弓之間的夾角肋間隙Intercostalspaces：相鄰兩肋之間的間隙

基本概念3.胸廓的整體觀頸靜脈切跡第1肋第1胸椎體劍突肋弓第11肋第12肋第12胸椎體胸廓的整體觀Thethoraciccageasawhole四壁fourwalls兩口twoopeningsThethoracicinlet(胸廓上口)isboundedbythe

—第1胸椎firstthoracicvertebrae

—第1對肋firstpairofribs

—頸靜脈切跡jugularnotchofsternumThethoracicoutlet(胸廓下口)isboundedbythe

—12ththoracicvertebrae第12胸椎

—第11、12對肋11thand12thpairsofribs

—左右肋弓leftandrightcostalarches

—?jiǎng)ν粁iphoid

process(劍胸聯(lián)合xiphisternaljoint)胸骨下角Infrasternalangle：左右肋弓之間的夾角劍肋角Xiphoid-costalangle

：劍突與肋弓之間的夾角肋間隙Intercostalspaces：相鄰兩肋之間的間隙胸廓的呼吸運(yùn)動(dòng)

Movementsofthethoracicwallduringinspiration二、顱的連結(jié)

TheJointsofSkull縫

sutures軟骨連結(jié)

synchondroses骨性結(jié)合synostoses滑膜關(guān)節(jié)

synovialjoint

(顳下頜關(guān)節(jié)

temporomandibularjoint)組成結(jié)構(gòu)特點(diǎn)顳下頜關(guān)節(jié)(TMJ)下頜頭關(guān)節(jié)盤下頜窩關(guān)節(jié)結(jié)節(jié)關(guān)節(jié)囊顳下頜關(guān)節(jié)(TMJ)組成結(jié)構(gòu)特點(diǎn)關(guān)節(jié)囊外側(cè)韌帶顳下頜關(guān)節(jié)的運(yùn)動(dòng)

下頜骨的上提、下降，發(fā)生在下關(guān)節(jié)腔。張大口是下頜骨下降并伴有向前的運(yùn)動(dòng)；閉口是下頜骨上提并伴有后退的運(yùn)動(dòng)。下頜骨的前進(jìn)、后退運(yùn)動(dòng)，發(fā)生在上關(guān)節(jié)腔。顳下頜關(guān)節(jié)的運(yùn)動(dòng)側(cè)方運(yùn)動(dòng)顳下頜關(guān)節(jié)的X線像顳下頜關(guān)節(jié)

(TMJ)

TheTemporomandibularJoint組成Formation由下頜頭和顳骨的下頜窩及關(guān)節(jié)結(jié)節(jié)構(gòu)成。

Itisformedbytheheadofthemandible,thearticulartubercleandthemandibular

fossaofthetemporalbone.關(guān)節(jié)類型Typeofjoint滑車關(guān)節(jié)或聯(lián)動(dòng)關(guān)節(jié)。Itisahingetypeofsynovialjointorlinkagejoint.結(jié)構(gòu)特點(diǎn)Characteristics關(guān)節(jié)面由纖維軟骨覆蓋。Itsarticularsurfacearecoveredbyfibrocartilage.含有關(guān)節(jié)盤，將關(guān)節(jié)腔分為兩部分。Ithasanarticulardiscwhichdividesthearticularcavityintotwoseparatesynovialcompartments.兩側(cè)有側(cè)韌帶加強(qiáng)。ThelateralligamentsstrengthentheTMJlaterally.前脫位較常見。TheanteriordislocationoftheTMJoccursoften.運(yùn)動(dòng)Movement有張口、閉口、前進(jìn)、后退和側(cè)方運(yùn)動(dòng)。Includestheopeningandclosingofthemouth,protrusionandretractionandlateralmovements.第三節(jié)附肢骨連結(jié)

Thejoinsofthelimbs上肢骨的連結(jié)

Thearticulationsoftheupperlimb下肢骨的連結(jié)

Thearticulationsofthelowerlimb一、上肢骨的連結(jié)上肢帶骨連結(jié)

Thearticulationsofthegirdleoftheupperlimb自由上肢骨連結(jié)

Thearticulationsofthefreeupperlimb（一）上肢帶骨連結(jié)

Thearticulationsofthegirdleoftheupperlimb1.胸鎖關(guān)節(jié)sternoclavicularjoint關(guān)節(jié)盤肋鎖韌帶鎖間韌帶鎖骨關(guān)節(jié)囊胸骨柄第1肋軟骨胸鎖前韌帶胸鎖關(guān)節(jié)TheSternoclavicularJoint組成Composition由鎖骨的內(nèi)側(cè)端、胸骨的鎖切跡和第1肋軟骨組成。Itisformedbythemedialendoftheclavicle,theclavicularnotchofsternum,andthefirstcostalcartilage.關(guān)節(jié)類型Typeofjoint為球窩關(guān)節(jié)。Itisaballandsocketjoint.結(jié)構(gòu)特點(diǎn)Characteristics是上肢與軀干間唯一的滑膜關(guān)節(jié)；Itistheonlysynovialjointbetween

theupperlimbandtrunk.關(guān)節(jié)腔內(nèi)有關(guān)節(jié)盤；Thereisanarticulardiscinthejointcavity.關(guān)節(jié)囊韌而厚，并有韌帶加強(qiáng)。Itscapsuleisstrongthickandstrengthenedbyligaments.運(yùn)動(dòng)Movements：幾乎可作任何方向的運(yùn)動(dòng)，如鎖骨外側(cè)端向上、向下、向前、向后、旋轉(zhuǎn)和環(huán)轉(zhuǎn)等。innearlyeverydirection.2.肩鎖關(guān)節(jié)

AcromioclavicularJoint肩鎖關(guān)節(jié)鎖骨肩峰2.肩鎖關(guān)節(jié)

AcromioclavicularJoint關(guān)節(jié)盤關(guān)節(jié)囊肩鎖關(guān)節(jié)

TheAcromioclavicularJoint由鎖骨的肩峰端和肩胛骨的肩峰構(gòu)成。Itisformeytheacromialendoftheclavicleandtheacromionofthescapula.關(guān)節(jié)面上有纖維軟骨覆蓋。Thearticularsurfaceiscoveredbyfibrocartilage.屬于平面關(guān)節(jié)。Itisanplanesynovialjoint.在關(guān)節(jié)腔的上部有關(guān)節(jié)盤。IthasanArticulardiscintheupperpartofjointcavity.3.喙鎖韌帶

coracoclavicuarligament

4.喙肩韌帶coracoacromialligament

5.喙肩弓

coracoacromialarch

喙肩韌帶喙突肩峰喙鎖韌帶3.喙鎖韌帶

coracoclavicuarligament

4.喙肩韌帶coracoacromialligament

5.喙肩弓

coracoacromialarch

喙肩韌帶喙突肩峰喙肩弓

CoracoacromialArch由肩胛骨的喙突和肩峰借喙肩弓連結(jié)而成。Itisformedbythecoracoidprocessandtheacromionofthescapula,andcoracoacromialligament.位于肱骨頭的上方，可防止肱骨頭向上脫位。Itoverliestheheadofthehumerus,preventingitssuperiordisplacementfromtheglenoidcavity.（二）自由上肢骨的連結(jié)TheArticulationsoftheFreeoftheUpperLimb⊙⊙GlenoidcavityHeadofhumerus1.肩關(guān)節(jié)（1）組成肱骨頭關(guān)節(jié)盂1.肩關(guān)節(jié)shoulderjoint（2）結(jié)構(gòu)特點(diǎn)關(guān)節(jié)囊喙肱韌帶1.肩關(guān)節(jié)（2）結(jié)構(gòu)特點(diǎn)盂唇肱二頭肌長頭腱喙肱韌帶肱二頭肌長頭腱1.肩關(guān)節(jié)（2）結(jié)構(gòu)特點(diǎn)（2）結(jié)構(gòu)特點(diǎn)1.肩關(guān)節(jié)shoulderjoint喙肱韌帶喙肩韌帶盂肱韌帶1.肩關(guān)節(jié)（2）結(jié)構(gòu)特點(diǎn)：肩袖肩胛下肌肌腱岡上肌肌腱岡下肌肌腱小圓肌肌腱（2）結(jié)構(gòu)特點(diǎn)1.肩關(guān)節(jié)shoulderjoint肩胛下肌肌腱岡上肌肌腱1.肩關(guān)節(jié)（2）結(jié)構(gòu)特點(diǎn)岡上肌肌腱岡下肌肌腱小圓肌肌腱肩關(guān)節(jié)脫位三、肩關(guān)節(jié)（3）運(yùn)動(dòng)方式伸屈三、肩關(guān)節(jié)（3）運(yùn)動(dòng)方式展收三、肩關(guān)節(jié)（3）運(yùn)動(dòng)方式環(huán)轉(zhuǎn)運(yùn)動(dòng)外旋三、肩關(guān)節(jié)（3）運(yùn)動(dòng)方式內(nèi)旋盂肱關(guān)節(jié)（肩關(guān)節(jié)）

Theglenohumeral(shoulder)joint(1)組成Composition由肩胛骨的關(guān)節(jié)盂和肱骨頭構(gòu)成。Itisformedbytheglenoidcavityofthescapulaandtheheadofthehumerus.關(guān)節(jié)類型Typeofjoint為典型的球窩關(guān)節(jié)。Itisatypicalballandsocketjoint.運(yùn)動(dòng)方式Movement可作屈伸、收展、旋轉(zhuǎn)和環(huán)轉(zhuǎn)運(yùn)動(dòng)。ItPermitstheflexion,extension,abduction,adduction,rotation,andcircumduction.肩關(guān)節(jié)Theshoulderjoint(2)結(jié)構(gòu)特點(diǎn)Characteristics關(guān)節(jié)窩小，關(guān)節(jié)頭大；Theglenoidcavityistherelativelyshallow,theheadofthehumerusisgreater.有纖維軟骨性的盂唇加深關(guān)節(jié)盂；Theglenoidcavityisdeepenedbythefibrocartilaginous

glenoidlabrum.Thearticularcapsuleisthinandloose（關(guān)節(jié)囊薄而松弛）.有肱二頭肌長頭腱穿過關(guān)節(jié)囊；Thelongheadofthebicepsbrachiipassesthroughthejointcapsule.

結(jié)構(gòu)特點(diǎn)Characteristics（）⑤關(guān)節(jié)囊的前壁有盂肱韌帶和肩胛下肌肌腱加強(qiáng)（上壁有喙肱韌帶、岡上肌肌腱和喙肩弓加強(qiáng)，后壁有岡下肌肌腱和小圓肌肌腱加強(qiáng)）；Thejointcapsuleisstrengthenedanteriorlybytheglenohumeralligamentandtheinfrascapularis

tendon(superiorlythecoracohumerusligament,thesupraspinatustendonandthecoracoacromialarch.posteriorlybytheinfraspinatusandterestendons.⑥下壁較薄弱，關(guān)節(jié)向前下方脫位最常見。itsinferiorpartisweaker,anteriorandinferiordislocationoccursthemostoften.2.肘關(guān)節(jié)（1）組成肱骨小頭肱骨滑車滑車切跡橈骨頭橈切跡headofradius肘關(guān)節(jié)冠狀面和X線影像片橈骨頭肱骨小頭冠突肱骨滑車肱骨外上髁內(nèi)上髁2.肘關(guān)節(jié)elbowjoint（2）結(jié)構(gòu)特點(diǎn)2.肘關(guān)節(jié)elbowjoint（2）結(jié)構(gòu)特點(diǎn)2.肘關(guān)節(jié)elbowjoint（2）結(jié)構(gòu)特點(diǎn)橈骨環(huán)狀韌帶橈尺骨近側(cè)關(guān)節(jié)2.肘關(guān)節(jié)elbowjoint（3）運(yùn)動(dòng)方式屈伸CarryingAngle

oftheElbowJoint“提攜角”165°～170°10°～15°肘內(nèi)翻＜10°肘外翻＞20°肘關(guān)節(jié)TheElbowJoint

組成Formation由肱骨的滑車、肱骨小頭與尺骨的滑車切跡和橈骨頭構(gòu)成Itisformedbythetrochleaandcapitulumofthehumerus,thetrochlearnotchoftheulna,andtheheadofradius.包括三個(gè)關(guān)節(jié)，即肱尺關(guān)節(jié)（屬滑車關(guān)節(jié),由肱骨滑車和尺骨的滑車切跡構(gòu)成）、肱橈關(guān)節(jié)（屬球窩關(guān)節(jié)，由肱骨小頭和橈骨頭關(guān)節(jié)面構(gòu)成）和橈尺近側(cè)關(guān)節(jié)（屬車軸關(guān)節(jié)，由橈骨頭環(huán)狀關(guān)節(jié)面和尺骨的橈切跡構(gòu)成）。Itincludesthreedistinctarticulations:thehumero-ulnarjoint(hinge)

,humero-radialjoint(ball-socket)andproximalradio-ulnar

joint(pivot).關(guān)節(jié)類型Typeofjoint為復(fù)關(guān)節(jié)或滑車關(guān)節(jié)。Itisacompositejointorhingesynovialjoint.運(yùn)動(dòng)

Movement可作屈、伸運(yùn)動(dòng)。itisforflexionandextension.

結(jié)構(gòu)特點(diǎn)Characteristics關(guān)節(jié)囊的前、后壁薄而松弛；Thejointcapsuleisthinandlooseanteriorlyandposteriorly關(guān)節(jié)囊兩側(cè)有橈側(cè)和尺側(cè)副韌帶；Thejointcapsuleisstronglythickenedoneithersidebyradialandulnarcollateralligaments.橈骨環(huán)狀韌帶容納橈骨頭，防止其脫出；Theannularligamentofrediusholdstheheadoftheradius.肘關(guān)節(jié)后脫位最為常見；Theposteriordislocationoftheelbowjointmaybemostoften.Onthearmofachildundertheageof8yearsmaysubluxate（半脫位）theradialheadthroughtheannularligament.橈尺骨的連結(jié)橈尺近側(cè)關(guān)節(jié)橈尺遠(yuǎn)側(cè)關(guān)節(jié)前臂骨間膜關(guān)節(jié)盤橈尺骨的連結(jié)

Thejointsoftheradiuswithulna組成：Itconsistsof:橈尺近側(cè)關(guān)節(jié)Theproximalradio-ulnarjoint橈尺遠(yuǎn)側(cè)關(guān)節(jié)Thedistalradio-ulnarjoint前臂骨間膜Theinterosseousmembranebetweentheshaftsoftheradiusandulna.運(yùn)動(dòng)：Itsmovementis旋前pronation旋后supination旋轉(zhuǎn)軸Theaxisofrotationis橈骨頭與尺骨頭的連線。Alineofheadofradiuswithheadofulna.前臂旋前和旋后運(yùn)動(dòng)旋后旋前旋后旋前前臂旋前和旋后的運(yùn)動(dòng)軸前臂旋前和旋后運(yùn)動(dòng)前臂作旋轉(zhuǎn)運(yùn)動(dòng)時(shí)，橈骨頭在原位自轉(zhuǎn)，而橈骨下端連同關(guān)節(jié)盤圍繞尺骨頭旋轉(zhuǎn)。當(dāng)橈骨轉(zhuǎn)至尺骨前方并與之交叉時(shí)，手背向前，稱為旋前pronation

。當(dāng)橈骨轉(zhuǎn)回到尺骨外側(cè)，手掌向前，稱為旋后supination。

3.腕關(guān)節(jié)（1）組成關(guān)節(jié)盤三角骨手舟骨月骨橈骨腕關(guān)節(jié)腕關(guān)節(jié)的關(guān)節(jié)窩的構(gòu)成腕關(guān)節(jié)面關(guān)節(jié)盤關(guān)節(jié)盤腕關(guān)節(jié)面

3.腕關(guān)節(jié)（2）結(jié)構(gòu)特點(diǎn)3.腕關(guān)節(jié)Flexion屈Extension

伸（3）運(yùn)動(dòng)方式展Abduction收

Adduction3.腕關(guān)節(jié)（3）運(yùn)動(dòng)方式腕關(guān)節(jié)Thewrist(radiocarpal)joint

組成Formation尺骨遠(yuǎn)側(cè)的關(guān)節(jié)盤、橈骨遠(yuǎn)側(cè)端與手舟骨、月骨、三角骨相關(guān)節(jié)。Thedistalendoftheradiusandthearticulardiscofthedistalulnaarticulatewiththescaphoid,lunateandtriquetrum.關(guān)節(jié)類型Type典型的橢圓關(guān)節(jié)或雙軸關(guān)節(jié)。Itisatypicalellipsoidsynovialjoint.結(jié)構(gòu)特點(diǎn)Characteristic關(guān)節(jié)囊松弛，周圍有韌帶加強(qiáng)。Thejointcapsuleislooseandstrengthenedbysurroundingligaments.運(yùn)動(dòng)形式Movement允許作屈伸、收展和環(huán)轉(zhuǎn)運(yùn)動(dòng)。Itallowsflexion-extension,abduction-adductionandcircumduction.4.手關(guān)節(jié)

（1）腕骨間關(guān)節(jié)

intercarpaljoints

（2）腕掌關(guān)節(jié)

carpo-metacarpal

（3）掌骨間關(guān)節(jié)

intermetacarpaljointintermetacarpaljoints腕中關(guān)節(jié)掌骨間關(guān)節(jié)腕掌關(guān)節(jié)（4）拇指腕掌關(guān)節(jié)

Thecarpo-metacarpaljointofthethumb大多角骨第Ⅰ掌骨底拇指腕掌關(guān)節(jié)圍繞矢狀軸在冠狀面上所作的運(yùn)動(dòng)拇指腕掌關(guān)節(jié)的屈、伸運(yùn)動(dòng)

屈伸拇指腕掌關(guān)節(jié)圍繞冠狀軸在矢狀面上所作的運(yùn)動(dòng)拇指腕掌關(guān)節(jié)的收

、展運(yùn)動(dòng).Adduction收Abduction

展拇指腕掌關(guān)節(jié)的對掌運(yùn)動(dòng)對掌復(fù)位由大多角骨和第Ⅰ掌骨底構(gòu)成。

Itismadeupofthetrapeziumandthebaseofthefirstmetacarpalbone.為鞍狀關(guān)節(jié)或雙軸關(guān)節(jié)。

Itisasaddlesynovialjoint.允許作屈伸、收展、環(huán)轉(zhuǎn)和對掌運(yùn)動(dòng)。

Itpermitsflexion-extension,adduction-abduction,circumductionandoppositionmovement..

拇指腕掌關(guān)節(jié)

Thecarpo-metacarpaljointofthethumb(5)掌指關(guān)節(jié)(6)指骨間關(guān)節(jié)（5）掌指關(guān)節(jié)（6）指骨間關(guān)節(jié)掌指關(guān)節(jié)的收展運(yùn)動(dòng)展收Extension伸屈掌指關(guān)節(jié)和指骨間關(guān)節(jié)的屈、伸運(yùn)動(dòng)手關(guān)節(jié)掌指關(guān)節(jié)metacarpo-phalangealjoints屬球窩關(guān)節(jié)，但由于側(cè)副韌帶的限制，可作屈伸、收展（其運(yùn)動(dòng)以中指的正中線為中軸，離開中線稱為展，靠攏中線稱為收）和環(huán)轉(zhuǎn)運(yùn)動(dòng)。指骨間關(guān)節(jié)

interphalangealjoints分為近、遠(yuǎn)側(cè)指骨間關(guān)節(jié)，屬滑車關(guān)節(jié)，可作屈伸運(yùn)動(dòng)。二、下肢骨的連結(jié)下肢帶骨連結(jié)

Thearticulationsofthegirdleoftheupperlimb自由下肢骨連結(jié)

Thearticulationsofthefreeupperlimb（一）下肢帶骨連結(jié)

Thearticulationsofthegirdleofthelowerlimb1.骶髂關(guān)節(jié)

sacro-iliacjoint骶髂關(guān)節(jié)1.骶髂關(guān)節(jié)

sacro-iliacjoint髂骨的耳狀面骶骨的耳狀面骶髂關(guān)節(jié)構(gòu)成：由骶骨和髂骨的耳狀面構(gòu)成特點(diǎn)：關(guān)節(jié)面凸凹不平，彼此結(jié)合緊密；關(guān)節(jié)囊緊張；有骶前韌帶、骶后韌帶、骶髂骨間韌帶加強(qiáng)。運(yùn)動(dòng)：活動(dòng)甚微；妊娠時(shí)活動(dòng)度可增大。2.閉孔膜

obturatormembrane閉膜管：由閉孔膜與閉孔溝圍成，有閉孔血管神經(jīng)通過。閉孔膜閉膜管

3.骶結(jié)節(jié)韌帶

sacrotuberous

lig.4.骶棘韌帶

sacrospinous

lig.

坐骨大孔

greatersciaticforamen

坐骨小孔

lessersciaticforamen骶結(jié)節(jié)韌帶骶棘韌帶坐骨大孔坐骨小孔5.恥骨聯(lián)合恥骨間盤恥骨上韌帶恥骨下韌帶恥骨聯(lián)合組成：由兩側(cè)恥骨聯(lián)合面借恥骨間盤連結(jié)構(gòu)成。結(jié)構(gòu)特點(diǎn)：恥骨間盤內(nèi)有一矢狀位的裂隙，有恥骨上韌帶和恥骨弓狀韌帶加強(qiáng)，運(yùn)動(dòng)：活動(dòng)甚微，但在妊娠分娩過程中，恥骨間盤中的裂隙增寬，擴(kuò)大骨盆的經(jīng)線。骨盆pelvis（1）組成（2）分部（3）界線岬弓狀線恥骨梳恥骨結(jié)節(jié)恥骨聯(lián)合上緣骨盆出口

pelvicoutlettipofcoccyxinferiormarginofpubicsymphysisinferiorramiofpubis尾骨尖骶結(jié)節(jié)韌帶坐骨結(jié)節(jié)恥骨聯(lián)合下緣坐骨支恥骨下支骨盆組成：由左、右髖骨和骶、尾骨及其骨連結(jié)構(gòu)成。功能：是連結(jié)軀干和下肢的橋梁，有效地傳遞重力和保護(hù)盆腔內(nèi)器官。分部：以界線（由骶骨岬、弓狀線、恥骨梳、恥骨結(jié)節(jié)和恥骨聯(lián)合上緣連成的環(huán)形線）為標(biāo)志，分為大骨盆和小骨盆。小骨盆：上口即骨盆界線，下口由尾骨尖、骶結(jié)節(jié)韌帶、坐骨結(jié)節(jié)、坐骨支、恥骨下支和恥骨聯(lián)合下緣圍成。骨盆的性別差異

Thesexualdifferencesinpelvis

骨盆男性女性

一般結(jié)構(gòu)厚、重薄、輕大骨盆深淺小骨盆窄、深寬、淺骨盆入口心形卵圓形、圓形骨盆出口較小較大恥骨弓和恥骨下角窄寬閉孔圓形卵圓形髖臼較大較小骨盆的性別差異骨盆Thepelvis（1）骨盆Thebonypelvisisformedby左右髖骨

twohipbones骶骨

sacrum尾骨

coccyx骨連結(jié)

joints骨盆借界線分為大骨盆和小骨盆。Itisdividedintoagreater(true)pelvisandalesser(false)pelvisbytheterminalline.界線Theterminallineisacircularline,formedby岬

sacralpromontory骶骨翼的前緣

anteriorborderofthesacralala髂骨的弓狀線earcuatelineoftheilium恥骨梳

pectenpubis恥骨嵴

pubiccrest恥骨聯(lián)合上緣

superiorborderofsymphysispubis骨盆

Thepelvis（2）骨盆出口Thepelvicoutletisboundedby恥骨聯(lián)合下緣theinferiormarginofpubicsymphysis

anteriorly,恥骨下支theinferiorramiofpubisandischial

tuberosities

anterolaterally,骶結(jié)節(jié)韌帶thesacrotuberorsligamentsposterolaterally,尾骨尖thetipofcoccyxposteriorly.（二）自由下肢骨的連結(jié)TheArticulationsoftheFreeofthelowerLimb1.髖關(guān)節(jié)

HipJoint（1）構(gòu)成（2）關(guān)節(jié)類型（3）結(jié)構(gòu)特點(diǎn)femoralhead髖臼acetabulum股骨頭髖關(guān)節(jié)

hipJoint組成：髖關(guān)節(jié)由股骨頭和髖骨的髖臼構(gòu)成Thehipjointisformedbythefemoralheadandtheacetabulumofhipbone.關(guān)節(jié)類型：屬于多軸的球窩關(guān)節(jié)Itisamultiaxialballandsocketjoint().結(jié)構(gòu)特點(diǎn)：Itscharacteristicisthat股骨頭的2/3容納在髖臼內(nèi)，或頭大窩大；About2/3theheadoffemuriscontainedwithintheacetabulum.1.髖關(guān)節(jié)

HipJoint（3）結(jié)構(gòu)特點(diǎn)1.髖關(guān)節(jié)

HipJoint（3）結(jié)構(gòu)特點(diǎn)恥股韌帶髂股韌帶1.髖關(guān)節(jié)

HipJoint（3）結(jié)構(gòu)特點(diǎn)坐股韌帶髂股韌帶3.Itscharacteristicisthat(2)關(guān)節(jié)囊厚而堅(jiān)韌；Thejointcapsuleisthickerandstrong,itattaches①近側(cè)附于髖臼周緣和髖臼橫韌帶；Proximallytothemarginsoftheacetabulumandtothetransverseacetabularligament.②遠(yuǎn)側(cè)附于股骨頸，前面達(dá)轉(zhuǎn)子間線，后面至轉(zhuǎn)子間嵴上方1cm的股骨頸處；Distallytothefemoralneck,anteriorlytothetrochantericlineposteriorlytotheneckabout1cmabovetheintertrochantericcrest.③股骨頸骨折可分為囊內(nèi)骨折、囊外骨折和混合性骨折；Thefractureofthefemoralneckmaybetheintracapsular,extracapsularormixedtype.髖關(guān)節(jié)

hipJoint(3)髖臼唇和髖臼橫韌帶加深了髖臼的深度；Thedepthoftheacetabulumisincreasedbythefibrocartilaginous

acetabularlabrum(lip)andthetransverseacetabularligament.(4)關(guān)節(jié)囊由周圍的韌帶加強(qiáng)；itsarticularcapsuleisstrengthenedbythesurroundingligaments.囊內(nèi)韌帶包括股骨頭韌帶。Theintracapsularligamentincludestheligamentofheadofthefemur.囊外韌帶包括髂股韌帶、恥股韌帶、坐股韌帶和輪匝帶。Theextracapsularligamentincludestheiliofemoralligament,pubofemoralligament,ischiofemoralligament,andorbicularzone.髖關(guān)節(jié)

hipJoint1.髖關(guān)節(jié)

hipJoint（4）運(yùn)動(dòng)方式伸屈1.髖關(guān)節(jié)

hipJoint（4）運(yùn)動(dòng)方式收展外旋內(nèi)旋1.髖關(guān)節(jié)

hipJoint（4）運(yùn)動(dòng)方式環(huán)轉(zhuǎn)髖關(guān)節(jié)

hipJoint運(yùn)動(dòng)方式：允許作屈伸、收展、旋轉(zhuǎn)和環(huán)轉(zhuǎn)運(yùn)動(dòng)Itpermitstheflexion,extension,adduction,abduction,rotationandcircumduction。髖關(guān)節(jié)脫位與骨折骨折脫位2.膝關(guān)節(jié)

KneeJoint（1）構(gòu)成（2）關(guān)節(jié)類型髕骨內(nèi)側(cè)髁外側(cè)髁內(nèi)、外側(cè)髁2.膝關(guān)節(jié)

KneeJoint（3）結(jié)構(gòu)特點(diǎn)2.膝關(guān)節(jié)（3）結(jié)構(gòu)特點(diǎn)（3）結(jié)構(gòu)特點(diǎn)2.膝關(guān)節(jié)

KneeJoint（3）結(jié)構(gòu)特點(diǎn)2.膝關(guān)節(jié)

KneeJoint脛側(cè)副韌帶tibialcollateralligament脛側(cè)副韌帶腓側(cè)副韌帶交叉韌帶前交叉韌帶后交叉韌帶交叉韌帶后交叉韌帶前交叉韌帶

前交叉韌帶在伸膝時(shí)最緊張，能防止脛骨前移。后交叉韌帶在屈膝時(shí)最緊張，能防止脛骨后移。交叉韌帶的作用膝關(guān)節(jié)半月板內(nèi)側(cè)半月板外側(cè)半月板膝關(guān)節(jié)半月板半月板的位置隨膝關(guān)節(jié)的運(yùn)動(dòng)而改變。(4)膝關(guān)節(jié)的運(yùn)動(dòng)伸屈膝關(guān)節(jié)

Thekneejoint