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Arthrology 关节学 山东大学医学院 解剖学教研室 李振华 Classification two major types Continuous joints 直接连结 Discontinuous joints 间接连结 -synovial joints 滑膜关节 Continuous joints 直接连结 Fibrous joints 纤维连结 Syndesmosis 韧带连结 Suture 缝 Cartilaginous joints 软骨连结 Synchondrosis 透明软骨结合 Symphysis 纤维软骨联合 Synosteosis 骨性结合 Synovial Joints 滑膜关节 Basic structures Articular surface 关节面: covered by articular cartilage 关节软骨 Articular capsule 关节囊 Fibrous membrane 纤维膜 Synovial membrane 滑膜 Articular cavity 关节腔: Containing a trace of synovial fluid Subatmospheric pressure in it Synovial Joints 滑膜关节 Accessory structures Ligaments 韧带 (lig.) Extracapsular ligaments 囊外韧带 intracapsular ligaments 囊内韧带 Articular disc 关节盘 and articular labrum 关节唇 Synovial fold 滑膜襞 and synovial bursa 滑膜囊 Joint Movement Terminology 关节运动术语 Translation 移动 Flexion and extension 屈和伸 Adduction and abduction 收和展 Rotation 旋转 Medial and lateral rotation 旋内和旋外 Pronation ans supination Inversion and eversion Circumduction 环转 旋前和旋后 足内翻和足外翻 flexion(屈)\ extension(伸) adduction(内收)\ abduction(外展) Rotation (旋转) Bone revolves around its own longitudinal axis medial rotation is turning of anterior surface in towards the midline lateral rotation is turning of anterior surface away from the midline Pronation 旋前 Supination 旋后 Inversion 足内翻 Eversion 足外翻 Circumduction(环转) Movement of a distal end of a body part in a circle Combination of flexion, extension, adduction and abduction Occurs at ball and socket, saddle and condyloid joints Classification of synovial joints 关节的分类 1. Uniaxial joints 单轴关节: hinge joints 屈戍关节: cylindrical end of 1 bone fits into trough shape of other angular movement-1 plane (eg) elbow, ankle, interphalangal trochoid (pivot) joints 车轴关节 round end fits into ring of bone + ligament rotation on long axis (eg) prox. radius/ulna, atlas/dens Classification of synovial joints 关节的分类 2. Biaxial joints 双轴关节: ellipsoid joints 椭圆关节 egg-shape articular surface + oval concavity side-to-side, back+forth movement (eg) metacarpophalangeal (knuckle) saddle joints 鞍状关节 articular surface both concave + convex side-to-side, back-forth movement (eg) carpometacarpal jt of thumb Classification of synovial joints 关节的分类 3. Multiaxial joints 多轴关节: ball-and-socket joint 球窝关节 spherical head + round socket multiaxial movement(eg) shoulder, femur plane joints 平面关节 articular surface in flat plane Short gliding movement (eg) intertarsal, articular processes of vertebrae Sprains • • • Torn or stretched ligaments. Spine, ankle & knee are common sites. Completely torn ligaments must be repaired. Edema associated with injury can further degrade the ligament. Dislocations Arthritis Joints of Bones of Trunk 躯干骨的连结 Vertebral column 脊柱 consists of 24 vertebrae, the sacrum, and the coccyx. Joints of the vertebral bodies 椎体间的连结 Intervertebral discs 椎间盘 Lie between bodies of adjacent vertebrae, composed of: Nucleus pulposus 髓核 an inner soft, pulpy, highly elastic structure (gelatinous core ) Annulus fibrosus 纤维环 an outer fibrous ring consisting of fibrocartilage Joints of the vertebral bodies 椎体间的连结 Anterior longitudinal ligament 前纵韧带 Strong band covering the anterior part of the vertebral bodies and intervertebral discs running from the anterior margin of foramen magnum to the S1~S2 Maintains stability of the intervertebral disc and prevents hyperextension of the vertebral column Joints of the vertebral bodies 椎体间的连结 Posterior longitudinal ligament 后纵韧带 Attached to the posterior aspect of the intervertebral discs and posterior edges of the vertebral bodies from C2 vertebra to sacrum Prevents hyperflexion of the vertebral column and posterior protrusion of the discs Hemination of nucleus pulposus 髓核脱出 Joints of the vertebral arches 椎弓间的连结 Ligamenta flava 黄韧带 ― elastic ligament, unite laminae of adjacent vertebrae, and complete the posterior wall of vertebral canal; tend to prevent hyperflexion of the vertebral column Interspinal ligament 棘间韧带 Supraspinal ligament 棘上韧带 Ligamentum nuchae 项韧带 Intertansverse ligament 横突间韧带 Zygapophysial joint 关节突关节 Atlantooccipital joint 寰枕关节 Between superior articulating surfaces of atlas and occipital condyles Supported by membrances and ligaments that join occipital bone and atlas Action ― nodding of head, lateral tilting of head Atlantoaxial joint 寰枢关节 Three synovial joints between atlas and axis Laterally, paired joints between articulating facets Median joint between dens of axis and anterior arch of atlas Supported by ligaments apical ligament of dens 齿突尖韧带 alar ligament 翼状韧带 transverse ligament of atlas 寰椎横韧带 tectorial membrane 覆膜 Action ― allow atlas (and head) to pivot on the axis and vertebral column The vertebral column as a whole Anterior aspect: the breadth of vertebral bodies increases from C2 to S2, then diminishes rapidly Dorsal aspect: the spinous processes of cervical vertebrae are short and bifid; the spinous processes of thoracic vertebrae are long, point obliquely downward and overlapped each other; the spinous processes of lumber vertebrae are nearly horizontally. Lateral aspect: shows four physiological curves The vertebral column as a whole Four physiological curves Cervical curvature convex forward Thoracic curvature Lumbar curvature Sacral curvature convex backward The vertebral column as a whole Movement of the vertebral column flexion extension lateral flexion rotation Lateral radiograph of the neck. The cervical curve of the vertebral column is well shown. Sagittal MRI of cervicothoracic spine. Sagittal MRI of thoracolumbosacral spine. Spina bifida cystica 脊柱裂 Thoracic cage 胸廓 Composition twelve thoracic vertebrae twelve pairs of ribs and costal cartilages sternum Thoracic cage 胸廓 Costovertebral joints 肋椎关节 Joints of costal head 肋头关节 Costotransverse joints 肋横突关节 Sternocostal joints 胸肋关节 Sternocostal synchondrosis of first rib 第一胸肋结合 Sternocostal joints 胸肋关节 Interchondral joints 肋软骨连结 between costal cartilages 8, 9, and 10 to form the costal arch 肋弓 General features of thoracic cage Roughly cone-shape, narrow above and broad below, flattened from beforebackwards, longer behind than in front Inlet of thorax 胸廓上口: bounded by upper border of manubrium, first rib, and vertebra T1 Outlet of thorax 胸廓下口: bounded by vertebra T12, 12th and 11th ribs, costal arch and xiphoid process Infrasternal angle 胸骨下角: formed by the costal arch of both side Intercostal spaces 肋间隙: lie between the ribs Thoracic cage 胸廓 Function: protects the organs in the thoracic cavity and upper abdominal cavity plays a vital role in the process of breathing Inspiration Expiration Joints of skull 颅骨的连结 Continuous joints: Sutures Synchondrosis or synosteosis Temporomandibular joint Temporomandibular joint 颞下颌关节 Aticulating surfaces Capsule: thin and lax in front and behind; strengthened by the lateral ligament 外侧韧带 Articular disc: Mandibular fossa and articular tubercle, above Head of mandibule, below separates surfaces forming upper and lower compartments within joint Movement: mandible may be elevated or depressed protruded or retracted rotation may also occurs as in chewing( a slight amount of side to side movement is also permitted)