系解重点Lower limb.docx
- 文档编号:17114660
- 上传时间:2023-07-22
- 格式:DOCX
- 页数:59
- 大小:44.85KB
系解重点Lower limb.docx
《系解重点Lower limb.docx》由会员分享,可在线阅读,更多相关《系解重点Lower limb.docx(59页珍藏版)》请在冰点文库上搜索。
系解重点Lowerlimb
LowerLimb
BonesandJoints
I.Hip(Coxal)Bone(Figures3-1and3-2)
∙Isformedbythefusionoftheilium,ischium,andpubisofthepelvis.
∙Articulateswiththesacrumatthesacroiliacjointtoformthepelvicgirdle.
A.Ilium
∙Formsthelateralpartofthehipboneandconsistsofthebody,whichjoinsthepubisandischiumtoformtheacetabulum,andthealaorwing,whichformstheiliaccrest.
∙Alsocomprisestheanterior-superioriliacspine,anterior-inferioriliacspine,posterioriliacspine,greatersciaticnotch,iliacfossa,andgluteallines.
B.Pubis
∙Formstheanteriorpartoftheacetabulumandtheanteromedialpartofthehipbone.
∙Comprisesthebody,whicharticulatesatthesymphysispubis;thesuperiorramus,whichenterstheformationoftheacetabulum;andtheinferiorramus,whichjoinstheramusoftheischium,apartoftheobturatorforamen(formedbyfusionoftheischiumandpubis).
C.Ischium
∙Formstheposteroinferiorpartoftheacetabulumandthelowerposteriorpartofthehipbone.
∙Consistsofthebody,whichjoinstheiliumandsuperiorramusofthepubistoformtheacetabulum,andtheramus,whichjoinstheinferiorpubicramustoformtheischiopubicramus.
∙Hastheischialspine,ischialtuberosity,andlessersciaticnotch.
D.Acetabulum
∙Isanincompletecup-shapedcavityonthelateralsideofthehipboneinwhichtheheadofthefemurfits.
∙Includestheacetabularnotch,whichisbridgedbythetransverseacetabularligament.
∙Isformedbytheiliumsuperiorly,theischiumposteroinferiorly,andthepubisanteromedially.
Figure3-1Coxal(hip)bone(lateralview).
II.BonesoftheThighandLeg(Figures3-2and3-3)
A.Femur
∙Isthelongestandstrongestboneofthebody.
1.Head
∙Formsabouttwothirdsofasphereandisdirectedmedially,upward,andslightlyforwardtofitintotheacetabulum.
∙Hasadepressioninitsarticularsurface,thefoveacapitisfemoris,towhichtheliga-mentumcapitisfemorisisattached.
ClinicalCorrelations
Dislocationofthefemoralhead:
isusuallyassociatedwithadvancedage(osteoporosis)andrequireshipreplacement.Itpresentsasashortenedlowerlimbwithmedialrotation.
Fractureoftheneckofthefemur:
resultsinischemicnecrosisoftheneckandheadbecauseofaninterruptionofbloodsupplyfromthemedialfemoralcircumflexartery,exceptforitssmallproximalpart.Itcausesapullofthedistalfragmentupwardbythequadricepsfemoris,adductors,andhamstringmusclessothattheaffectedlowerlimbisshortenedwithlateralrotation.
Pertrochantericfracture:
isafemoralfracturethroughthetrochantersandisaformoftheextracapsularhipfracture.Itismorecommoninelderlywomenthaninmenbecauseofanincreasedincidenceofosteoporosis.
2.Neck
∙Connectstheheadtothebody(shaft),formsanangleofabout125degreeswiththeshaft,andisacommonsiteoffractures.
∙Isseparatedfromtheshaftinfrontbytheintertrochantericline,towhichtheiliofemoralligamentisattached.
3.Greatertrochanter
∙Projectsupwardfromthejunctionoftheneckwiththeshaft.
∙Providesaninsertionforthegluteusmediusandminimus,piriformis,andobturatorinternusmuscles.
∙Receivestheobturatorexternustendononthemedialaspectofthetrochantericfossa.
Figure3-2Bonesofthelowerlimb.
Figure3-3Radiographofthehip,thigh,andpelvis.
4.Lessertrochanter
∙Liesintheanglebetweentheneckandtheshaft.
∙Projectsattheinferiorendoftheintertrochantericcrest.
∙Providesaninsertionfortheiliopsoastendon.
5.Lineaaspera
∙Istheroughlineorridgeonthebody(shaft)ofthefemur.
∙Exhibitslateralandmediallipsthatprovideattachmentsformanymusclesandthethreeintermuscularsepta.
6.Pectinealline
∙Runsfromthelessertrochantertothemediallipofthelineaaspera.
∙Providesaninsertionforthepectineusmuscle.
7.Adductortubercle
∙Isasmallprominenceattheuppermostpartofthemedialfemoralcondyle.
∙Providesaninsertionfortheadductormagnusmuscle.
ClinicalCorrelations
Adislocatedkneeorfractureddistalfemur:
mayinjurethepoplitealarterybecauseofitsdeeppositionadjacenttothefemurandthekneejointcapsule.
Transversepatellarfracture:
resultsfromablowtothekneeorfromsuddencontractionofthequadricepsmuscle.Theproximalfragmentofthepatellaispulledsuperiorlywiththequadricepstendon,andthedistalfragmentremainswiththepatellarligament.
Bumperfracture:
isafractureofthelateraltibialcondylethatiscausedbyanautomobilebumper,anditisusuallyassociatedwithacommonperonealnerveinjury.
B.Patella
∙Isthelargestsesamoidbonelocatedwithinthetendonofthequadricepsfemoris,whicharticulateswiththefemurbutnotwiththetibia.
∙Attachestothetibialtuberositybyacontinuationofthequadricepstendoncalledthepatellarligament.
∙Functionstoobviatewearandattritiononthequadricepstendonasitpassesacrossthetrochleargrooveandtoincreasetheangleofpullofthequadricepsfemoris,therebymagnifyingitspower.
C.Tibia
∙Istheweight-bearingmedialboneoftheleg.
∙Hasthetibialtuberosityintowhichthepatellarligamentinserts.
∙Hasmedialandlateralcondylesthatarticulatewiththecondylesofthefemur.
∙Hasaprojectioncalledthemedialmalleoluswithamalleolargrooveforthetendonsofthetibialisposteriorandflexordigitorumlongusmusclesandanothergroove(posterolateraltothemalleolusgroove)forthetendonoftheflexorhallucislongusmuscle.Italsoprovidesattachmentforthedeltoidligament.
D.Fibula
∙Haslittleornofunctioninweightbearingbutprovidesattachmentformuscles.
∙Hasahead(apex)thatprovidesattachmentforthefibularcollateralligamentofthekneejoint.
∙Hasaprojectioncalledthelateralmalleolusthatarticulateswiththetrochleaofthetalus;liesmoreinferiorandposteriorthanthemedialmalleolus;andprovidesattachmentfortheanteriortalofibular,posteriortalofibular,andcalcaneofibularligaments.Italsohasthesulcusfortheperoneuslongusandbrevismuscletendons.
ClinicalCorrelations
Pott'sfracture(Dupuytren'sfracture):
isafractureofthelowerendofthefibula,oftenaccompaniedbyfractureofthemedialmalleolusorruptureofthedeltoidligament.Itiscausedbyforcedeversionofthefoot.
Pillionfracture:
isaT-shapedfractureofthedistalfemurwithdisplacementofthecondyles.Itmaybecausedbyablowtotheflexedkneeofapersonridingpilliononamotorcycle.
Fractureofthefibularneck:
maycauseaninjurytothecommonperonealnerve,whichwindslaterallyaroundtheneckofthefibula.Thisinjuryresultsinparalysisofallmusclesintheanteriorandlateralcompartmentsoftheleg(dorsiflexorsandevertorsofthefoot),causingfootdrop.
III.BonesoftheAnkleandFoot(Figures3-2,3-4,3-5,and3-6)
A.Tarsus
∙Consistsofseventarsalbones:
talus,calcaneus,navicularbone,cuboidbone,andthreecuneiformbones.
1.Talus
∙Transmitstheweightofthebodyfromthetibiatothefootandistheonlytarsalbonewithoutmuscleattachments.
∙Hasaneckwithadeepgroove,thesulcustali,fortheinterosseousligamentsbetweenthetalusandthecalcaneus.
∙Hasabodywithagrooveonitsposteriorsurfacefortheflexorhallucislongustendon.
∙Hasahead,whichservesaskeystoneofthemediallongitudinalarchofthefoot.
2.Calcaneus
∙Isthelargestandstrongestboneofthefootandliesbelowthetalus.
∙Formstheheelofthefoot,articulateswiththetalussuperiorlyandthecuboidanteriorly,andprovidesanattachmentfortheAchillestendon.
∙Hasashelf-likemedialprojectioncalledthesustentaculumtali,whichsupportstheheadofthetalus(withthespringligament)andhasagrooveonitsinferiorsurfacefortheflexorhallucislongustendon(whichusesthesustentaculumtaliasapulley).
3.Navicularbone
∙Isaboat-shapedtarsalbonelyingbetweentheheadofthetalusandthethreecuneiformbones.
4.Cuboidbone
∙Isthemostlaterallyplacedtarsalboneandhasagroovefortheperoneuslongusmuscletendon.
∙Servesasthekeystoneofthelaterallongitudinalarchofthefoot.
5.Cuneiformbones
∙Arethreewedge-shapedbonesthatformapartofthemediallongitudinalandproximaltransversearches.
∙Articulatewiththenavicularboneposteriorlyandwiththreemetatarsalsanteriorly.
Figure3-4Anteroposteriorandlateralradiographsoftheknee.
Figure3-5Bonesofthefoot.
B.Metatarsus
∙Consistsoffivemetatarsalsandhasprominentmedialandlateralsesamoidbonesonthefirstmetatarsal.
ClinicalCorrelations
Marchfracture(stressfracture):
isafatiguefractureofoneofthemetatarsals,whichmayresultfromprolongedwalking.Metatarsalfracturesarealsocommoninfemaleballetdancerswhenthedancerslosebalanceandputtheirfullbodyweightonthemetatarsals.
Figure3-6Radiographoftheankleandfoot.
C.Phalanges
∙Consistsof14bones(twointhefirstdigitandthreeineachoftheothers).
JointsandLigaments
I.Hip(Coxal)Joint(Figures3-2,3-3,and3-7)
∙Isamultiaxialball-and-socketsynovialjointbetweentheacetabulumofthehipboneandtheheadofthefemurandallowsabductionandadduction,flexionandextension,andcircumductionandrotation.
∙Isstabilizedbytheacetabularlabrum;thefibrouscapsule;andcapsularligamentssuchastheiliofemoral,ischiofemoral,andpubofemoralligaments.
∙Hasacavitythatisdeepenedbythefibrocartilaginousacetabularlabrumandiscompletedbelowbythetransverseacetabularligament,whichbridgesan
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 系解重点Lower limb 重点 Lower