Chapter 2 The Arthrology Section 3 Joints of limbs主 講 人 馮 娜 【 目 的 與 要 求 】1. 掌握肩關(guān)節(jié)、肘關(guān)節(jié)、腕關(guān)節(jié)、髖關(guān)節(jié)、膝 關(guān)節(jié)和踝關(guān)節(jié)的構(gòu)成、特點(diǎn)及運(yùn)動(dòng)。 2. 掌握髖骨與脊柱間的韌帶連結(jié)，骨盆的組成與分部。3.了解胸鎖關(guān)節(jié)、肩鎖關(guān)節(jié)、骶髂關(guān)節(jié)的構(gòu)成，足弓的構(gòu)成及功能。 The General Description Owing to the erect standing of human being, the upper limb has been freed and more movable from weight bearing and become a laboring organ. The joints of the upper limb are chiefly for the mobility in action, whereas the joints of the lower limb are for the stability. . Joints of upper limb ) Joints of the girdle of the upper limb 1.Sternoclavicular joint胸鎖關(guān)節(jié) *Composition: clavicular notch of sternum, and the first costal cartilage, sternal end of clavicle. *Feature: Articular capsule: strong *Movements(poly-axial joint) Interclavicular lig. anterior sternoclavicular lig. costoclavicular lig. 2.Acromioclavicular joint 肩鎖關(guān)節(jié) ( plane joint)3.Coracoacromial ligament喙肩韌帶 Coracoacromial arch 喙肩弓 Coracoid process acromion )Joints of free upper limb1.Shoulder joint 肩關(guān)節(jié) (ball-and-socket) Composition: head of humerus and glenoid cavity of scapula Feature: Type of joint: Capsule: Thin and loose Accessory structures : Glenoid labrum盂唇 Coracohumeral ligament 喙肱韌帶 Movements of shoulder joint flexion and extension; adduction and abduction; medial and lateral rotation; circumduction. 頭大盂小囊松薄最易發(fā)生前下脫 2. Elbow joint 肘關(guān)節(jié)(compound joint) Composition: lower end of humerus, upper ends of radius and ulna1.Humeroulnar joint 肱尺關(guān)節(jié)2.Humeroradial joint肱橈關(guān)節(jié)3.Proximal radioulnar joint 橈尺近側(cè)關(guān)節(jié) Feature:Type of joint: compound joint Capsule: thin and loose anteriorly and posteriorly. Ligaments:1.Radial collacteral ligament 橈側(cè)副韌帶2. Ulnar collacteral ligament 尺側(cè)副韌帶3. Annular ligament of radius 橈骨環(huán)狀韌帶Movements: flexion and extension, pronation and supination Dislocation medial epicondyle of the humerus lateral epicondyle of the humerustip of the olecranon 3.Joints between radius and ulnar 1) Proximal radioulnar joint 橈尺近側(cè)關(guān)節(jié) 2) Distal radioulnar joint 橈尺遠(yuǎn)側(cè)關(guān)節(jié) 3) Interosseous membrane of forearm 前臂骨間膜 4.Joints of hand1) Radiocarpal joint橈腕關(guān)節(jié) (wrist joint) CompositionJoint formed by the distal end of radius ,articular disc below ulnar and scaphoid, lunate ,and triquetrum of carpus. FeatureType of joint: ellipsoid joint Capsule: lax , strengthened by surrounding ligaments Movements: flexion ,extension, adduction ,abduction,circumduction 2)Carpometacarpal joints Carpometacarpal joint of thumb 拇指腕掌關(guān)節(jié) Composition : trapezium and base of the first metacarpal Type of joint: saddle joint Movement: flexion, extension, adduction, abduction, and opposition3)The others:自學(xué) .Joints of Lower limb) Joints of pelvic girdle 1.Sacroiliac joint 骶髂關(guān)節(jié) Composition: auricular surface of sacrum and ilium Feature: Capsule: very tight and strengthened by ligaments 2.Vertebro-pelvic ligaments 1) Iliolumbar ligament髂腰韌帶 2) Sacrotuberous ligament 骶結(jié)節(jié)韌帶 3) Sacrospinous ligament 骶棘韌帶 These two ligaments convert the sciatic notches the greater and lesser sciatic foramen 坐骨大、小孔 3. Pubic symphysis 恥骨聯(lián)合4.Obturator membrane 閉孔膜 obturator canal 閉膜管 5. Pelvis骨 盆1)Composition:2)Terminal line界線:formed by promontory of sacrum, arcuate line, pecten pubis, pubis tuberosity and upper border of pubic symphysis .3)Two portions Greater pelvis Lesser pelvis 4)Lesser pelvis 小骨盆(1)pelvic inlet 骨盆上口(terminal line): (2)Pelvic outlet 骨盆下口: formed by tip of coccyx, sacrotuberous ligament, ischial tuberosity, ramus of ischium, inferior ramus of pubis, lower border of pubic symphysis(3)Pelvic cavity(4)Pubic arch, subpubic angle subpubic angle 骨盆的性差 男性 女性 骨盆形狀 窄而長(zhǎng) 寬而短 骨盆上口 呈心形 橢圓形 骨盆下口 狹小 寬大 骨盆腔 呈漏斗形 圓筒形 骶骨 窄長(zhǎng)， 寬短， 曲度大 曲度小 骶骨岬 突出 突出 明顯 不明顯 恥骨下角 70 75 90 100男性女性707590100 ) Joints of free lower limb1. Hip joint 髖關(guān)節(jié) Composition: acetabulum and femoral head Feature: (1) Articular capsule Strengthened and thick intra-capsular fracture extra-capsular fracture Acetabular labrum 髖臼唇 transverse acetabular ligament髖臼橫韌帶 Ligament of head of femur 股骨頭韌帶 Iliofemoral lig. 髂股韌帶 Pubofemoral lig. 恥股韌帶 Ischiofemoral ligament 坐股韌帶Zona orbicularis輪匝帶Ligament of head of femurAcetabular labrum Transverse acetebular lig.Ischiofemoral lig. (2) Accessory structures Iliofemoral lig.Pubofemoral lig. Movements of hip joint:flexion and extension adduction and abduction rotation and circumduction Clinical application 2.Knee joint 膝關(guān)節(jié)1)Composition: lower end of femur, upper end of tibia and patella2)Feature: Articular capsule: thin and loose 3)Accessory structures Patellar lig. 髕韌帶Patellar lig Tibial collaterallig. Fibular collateral ligment 腓側(cè)副韌帶 Tibial collateral ligment 脛側(cè)副韌帶 Anterior cruciate ligment 前交叉韌帶 Posterior cruciate ligment 后交叉韌帶 Posterior cruciate lig.Anterior cruciate lig. Suprapatellar bursa 髕上囊alar folds翼狀襞 Medial meniscus內(nèi)側(cè)半月板 (C-shaped) Lateral meniscus外側(cè)半月板 (O-shaped) 3)Movements: flexion and extension; flexed knee joint can do some rotated movements.lateralMedial 從 內(nèi) 向 外 ， 一 氧 化 碳 (CO) knee injury(three Cs,unhappy triad) Tibial collateral lig. Anterior cruciate lig. Medial meniscus 3)Tibiofibular syndesmosis 脛腓連結(jié) Tibiofibular joint 脛腓關(guān)節(jié) Crural interosseous membrane 小腿骨間膜 Anterior and posterior tibiofibular ligaments 脛腓前、后韌帶 4)Joints of foot: 1)Talocrural joint 距小腿關(guān)節(jié)(ankle joint) 踝關(guān)節(jié) Composition: lower ends of tibia and fibula, trochlea of talus Feature: Articular capsule: thin and loose in front and behind Movements(uniaxial joint) Dorsiflexion (extension) and plantar flexion (flexion)2)The others:自學(xué) Arches of foot 足弓 Composition : tarsals and metatarsals and ligaments between them. Normal arch Flatfoot 【Question】 1. Why is dislocation of the shoulder joint more commonly than dislocation of hip joint? 2What are the composition and accessory structures of the knee joint?