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1、关于踝关节lecture第一页，本课件共有31页Midtarsal joint跗关节跗关节between calcaneus and cuboid on lateral side外侧为跟骨和骰外侧为跟骨和骰骨之间骨之间between talus and navicular on the medial side内侧为距骨和舟内侧为距骨和舟骨之间骨之间Talocrural joint踝关节踝关节inferior tibiofibular jnt.下胫腓下胫腓关节关节tibiotalar jnt.胫距关节胫距关节Subtalar joint距下关节距下关节aka talocalcaneal也就是距跟
2、也就是距跟between talus and calcaneus位于位于距骨和跟骨之间距骨和跟骨之间medial内侧观lateral外侧观calcaneuscalcaneustalusfibulatibiacuboidnavicular腓骨跟骨骰骨胫骨距骨舟骨跟骨第二页，本课件共有31页Talocrural Joint踝关节Articulation between the tibia and fibula(inferior tibiofibular joint)and between the tibia and the talus(tibiotalar joint).位于胫骨和腓骨（下胫腓关节
3、）之间，胫骨和距骨之间的关节（胫距关节）This joint is responsible for plantar flexion and dorsiflexion and some abduction/adduction.该关节负责跖屈背屈以及一些外展/内收The axis of rotation is a line between the two malleoli.沿两踝之间的连线扭转第三页，本课件共有31页Subtalar Joint距下关节Allows pronation/supination and rotation.可以进行旋前/旋后和扭转The talus articulates
4、 with the calcaneus anteriorly,posteriorly and medially.由距骨与跟骨前、中、后关节面构成The axis of rotation runs diagonally from the posterior,lateral,plantar surface to the anterior,medial,dorsal surface.旋转轴方向为后侧、外侧、足底斜向前侧、内侧、足背。The orientation of this axis makes pronation/supination triplanar with reference to t
5、he cardinal planes.该轴可做旋前/旋后三维动作第四页，本课件共有31页Pronation/Supination旋前/旋后calcaneus moves on talus跟骨移动到距骨上talus moves on calcaneus距骨运动到跟骨上calcaneal eversion跟骨外翻abduction外展dorsiflexion背屈calcaneal eversion跟骨外翻talar adduction距骨内收plantar flexion跖屈calcaneal inversion跟骨内翻adduction内收plantar flexion跖屈calcaneal i
6、nversion跟骨内翻talar abduction距骨外展dorsiflexion背屈Pronation旋前Supination旋后Open Chain开链闭链第五页，本课件共有31页Tibial Rotation胫骨扭转The subtalar joint can be likened to the action of a mitered hinge(Inman and Mann,1973).距下关节类似于斜铰动作The orientation of the subtalar joint axis causes the tibia to internally rotate during
7、pronation and externally rotate during supination.距下关节运动的轴向引起胫骨在旋前时内旋，旋后时外旋。Thus,the tibia internally rotates with pronation or knee flexion and externally rotates with supination or knee extension.因此，旋前时胫骨内旋或膝关节屈曲内旋，旋后时胫骨外旋或膝关节伸展。It is important that knee flexion and pronation occur in synchronizat
8、ion(as well as knee extension and supination).重要的是膝关节屈曲和旋前同时发生（膝关节伸展和旋后也是这样）第六页，本课件共有31页Midtarsal Joint跗关节Actually consists of two joints:the calcaneocuboid on the lateral side and the talonavicular on the medial side.这两个关节实际组成：外侧的跟骰关节和内侧的距舟关节。During pronation,the axes of these two joints are parall
9、el,this unlocks the joint and creates a hypermobile foot that can absorb shock.旋前时这两个关节之间的轴是平行的，未锁死的关节形成过度松弛的足部赖吸收震动During supination the axes are not parallel and this joint becomes locked allowing efficient transmission of forces.旋后时，这两个轴不平行，此关节锁住，有效传递力量。距骨跟骰轴跟骨距舟轴正常旋前第七页，本课件共有31页Foot Orientation足
10、部方向前足外翻后足外翻正常胫骨距骨跟骨腓骨跖骨头前足内翻胫骨外翻后足内翻第八页，本课件共有31页A forefoot valgus exists when the forefoot is everted relative the rearfoot.This is not as common as forefoot varus.前足外翻是相对于足跟外翻。这种情况不如前足内翻常见A forefoot varus exists when the forefoot is inverted to the rearfoot.This is the most common cause of excessiv
11、e pronation.前足内翻相对于足跟内翻，常见于过度旋前的情况。第九页，本课件共有31页A rearfoot valgus exists when the rearfoot is everted.后足外翻出现在后足向外翻A rearfoot varus exists when the rearfoot is inverted.This can increase maximum pronation.后足内翻出现在后足向内翻时，导致过度旋前。第十页，本课件共有31页Ligaments韧带Lateral side of ankle accounts for 85%of ankle sprain
12、s85%的踝关节扭伤多出现在外侧第十一页，本课件共有31页Arches of the Foot足弓There are 3 arches in the foot that contribute to support and shock absorption.These arches are maintained by the shape of the tarsal and metatarsal bones,ligaments and plantar fascia.足部有3个弓形结构，用来支撑和吸收震动。这些弓形结构由跗骨、跖骨、韧带和足底筋膜构成Plantar surface Fascia第十二
13、页，本课件共有31页Arch Types足弓种类Feet are often classified according to the height of the medial arch.根据内侧足弓的高度，通常将足部分为：Normal正常high-arched or pes cavus高弓足或弓形足高弓足或弓形足flat-footed or pes planus扁平足或平足扁平足或平足Arches can also be rigid or flexible.足弓也可以是刚性的或柔性的High-arched,rigid feet make poor shock absorbers.高弓足，刚性足
14、，吸震差Flat-footed,flexible arches often allow excessive pronation.扁平足，柔性足，通常会过度旋前。第十三页，本课件共有31页Plantar Flexors跖屈肌群跖屈肌群NOTE:注：1)Soleus liesdeep togastrocnemius比目鱼肌比腓肠肌更深2)Both insert intothe calcanealtendon akaAchilles tendon都汇入到跟骨肌腱里也就是跟腱里Soleus比目鱼肌Gastrocnemius腓肠肌Posterior View后观第十四页，本课件共有31页Assistan
15、tPlantar Flexors跖屈肌肌群跖屈肌肌群Tibialis Posterior胫骨后肌PeroneusBrevis腓骨短肌PeroneusLongus腓骨长肌FlexorDigitorumLongus胫骨后肌腱FlexorHallucisLongus长屈肌肌腱Plantaris跖肌Note:Their tendons passposteriorly to the malleoli注：它们的肌腱都经过足踝后方Note:insertionis wrong!第十五页，本课件共有31页Dorsiflexion背屈peroneus tertius第三腓骨肌(usually very close
16、 to extensor digitorum longus and often considered as part of this muscle)通常非常接近于趾长伸肌，通常也被认为属于这块肌肉tibialisanterior胫骨前肌extensordigitorumlongus趾长伸肌extensorhallucislongus拇长伸肌(deep to ext.digitorumlongus)比趾长伸肌更深处第十六页，本课件共有31页tibialisanterior胫前肌extensorhallucislongus拇长伸肌flexordigitorumlongus胫骨后肌腱flexorha
17、llucislongus长屈肌肌腱tibialisposterior胫后肌Invertors足内翻足内翻primary基本NOTE:Muscles passto the medial side ofthe foot!注：肌肉延伸至足内侧第十七页，本课件共有31页peroneusbrevis腓骨短肌peroneuslongus腓骨长肌peroneustertius第三腓骨肌extensordigitorumlongus趾长伸肌Evertors足外翻肌足外翻肌primary基本第十八页，本课件共有31页Causes of Excessive Pronation过度旋前的原因Q-angle grea
18、ter than 20 degreesQ角度大于20度tibial varus greater than 5 degrees胫骨内翻大于5度rearfoot varus greater than 2 degrees后足内翻大于2度forefoot varus greater than 3 degrees前足内翻大于3度plantar flexed first rayweak medial arch内部足弓弱tight gastrocnemius and soleus or a short Achilles tendon腓肠肌和比目鱼肌紧张或跟腱短第十九页，本课件共有31页The Problem
19、 with Excessive Pronation过度旋前的问题Excessive or prolonged pronation during the support phase will disrupt the normal tibial-femoral rotation relationship at the knee.The tibia continues to internally rotate with the prolonged pronation while the knee is extending.Knee extension is normally associated w
20、ith external tibial rotation.支撑时期，过度或长期旋前会导致损坏膝关节处正常的胫骨股骨扭转关系。长期旋前胫骨向内扭转而膝关节伸展。膝关节伸展通常伴随着胫骨内旋。第二十页，本课件共有31页Orthopedic Evaluation骨科评估第二十一页，本课件共有31页Cassetto disegno第二十二页，本课件共有31页Drawer Test抽屉测试抽屉测试patient supine患者仰卧位患者仰卧位Gripping the foot and exert a traction on the tibia upward and a downward pressur
21、e.握住足部，在胫骨上施加向上向下的力握住足部，在胫骨上施加向上向下的力The presence of a forward movement of the talus relative to the tibia,indicates a lesion of the ligament PAA如果距骨相对于胫骨向前移动，如果距骨相对于胫骨向前移动，则表明则表明PAA韧带损伤韧带损伤The presence of a backward movement of the talus relative to the tibia indicates a lesion of the ligament PAP如果
22、距骨相对于胫骨向后移动，则表如果距骨相对于胫骨向后移动，则表明明PAP韧带损伤韧带损伤第二十三页，本课件共有31页Cassetto 第二十四页，本课件共有31页Stabilit laterale disegno第二十五页，本课件共有31页Lateral stability tests横向稳定性测试横向稳定性测试patient supine.患者仰卧位患者仰卧位Gripping the foot let them perform a reversal passively握住足部，将足部被握住足部，将足部被动翻转动翻转If you observe a side opening is possibl
23、e to suspect a ligament injury PAA and/or the peroneal-calcaneal如果发现一侧可以打开，如果发现一侧可以打开，可以怀疑是可以怀疑是PAA损伤或腓跟骨损伤。损伤或腓跟骨损伤。第二十六页，本课件共有31页Stabilit laterale第二十七页，本课件共有31页Stabilit mediale disegno第二十八页，本课件共有31页testing of medial stability内内侧稳定性测试侧稳定性测试patient supine患者仰卧位患者仰卧位Holding your foot,be followed passively eversion握住足部，被动外翻握住足部，被动外翻In case there is evidence of medial opening is possible to suspect a deltoid ligament injury如果证据表明内侧为打开，则有可能是三角韧带损伤。如果证据表明内侧为打开，则有可能是三角韧带损伤。第二十九页，本课件共有31页Stabilit mediale第三十页，本课件共有31页感感谢谢大大家家观观看看第三十一页，本课件共有31页