踝關(guān)節(jié)生物力學(xué)優(yōu)選ppt資料

踝關(guān)節(jié)生物力學(xué)第一頁(yè)，共51頁(yè)。AnkleAnatomicalStructuresTibiaFibularTalus第二頁(yè)，共51頁(yè)。Tibia脛骨(jìnggǔ)Thisisthestrongestlargestboneofthelowerleg.Itbearsweightandthebonecreatesthemedialmalleoli(thebumpontheinsideofyourankle)whichisthemedialaspectofthemortiseorthe(hole)thatthetaluslieswithin.這是最強(qiáng)壯(qiángzhuàng)的小腿骨。它具有承重和形成了內(nèi)側(cè)支撐面(組成腳踝的凹面)，能與距骨相契合第三頁(yè)，共51頁(yè)。TheTibiaisthemedialboneandlargestboneofthelowerleg.Tibia脛骨是小腿的最大和支撐(zhīchēng)骨的骨頭。第四頁(yè)，共51頁(yè)。Fibula腓骨(féigǔ)Thisisasmallerlateralboneofthelowerleg.Itisnotvitalforweightbearingyetitcomprisesthelateral(outside)aspectofthemalleoliandmakesupthelateralaspectofthemortise.這是小腿的一根更小的外側(cè)骨頭(gǔtou)。它不承重，它是踝關(guān)節(jié)的外側(cè)支撐面。第五頁(yè)，共51頁(yè)。Fibula--->Thefibulaislongerandnonweightbearing.Itmakesupthelateralaspectofthemortise.Thelateralmalleoliliesinferior(below)themedialmalleoli它比較(bǐjiào)長(zhǎng)和不承重。并組成踝關(guān)節(jié)外側(cè)面。并低于內(nèi)側(cè)面_______________________第六頁(yè)，共51頁(yè)。TalusThisbonetransmitstheforcesfromthecalcaneusupintothetibiaandalsoallowsthearticulationsofPlantarFlexion(pointingthefootdownward)DorsiflexionorpullingthefootupwardandInversion(rollingthefootinward)andEversion(rollingthefootoutward)第七頁(yè)，共51頁(yè)。------Talus第八頁(yè)，共51頁(yè)。TalocruralJointTheformationofthemortise(ahole)bythemedialmalleoli(Tibia)andlateralmalleoli(fibula)withthetaluslyinginbetweenthemmakesupthetalocruraljoint.Thisisahingejointandallowsmostofthemotionwithplantarflexionanddorsiflexion.第九頁(yè)，共51頁(yè)。________________________________TalocruralJt.第十頁(yè)，共51頁(yè)。SubtalarJointThearticulationbetweenthetalusandthecalcaneusisreferredtoasthesubtalarjoint.Motionallowedbythisjointisinversion(rollinward)/eversion(rolloutward)aswellasrearfootpronation(inwardtiltofthecalcaneus)andsupination(outwardtiltofthecalcaneus).第十一頁(yè)，共51頁(yè)。calcaneusTalus---SubtalarJointMedialaspectoffoot第十二頁(yè)，共51頁(yè)。AnkleLigamentsTherearethreelateralligamentspredominantlyresponsibleforthesupportandmaintenanceofboneapposition(bestpossiblefit).Theseligamentspreventinversionofthefoot.Theseligamentsare:AnteriortalofibularligamentCalcaneofibularligamentPosteriortalofibularligament第十三頁(yè)，共51頁(yè)。TalusFibulaTibiaAnt.TalofibularLigamentAnt.TibiofibularLig.第十四頁(yè)，共51頁(yè)。Post.TibiofibularLig.<-Fibula<-Ant.TalofibularLig<-TalusPeronealTendonsCalcaneofibularLigamentCalcaneusSubtalarJoint SpaceCuboid第十五頁(yè)，共51頁(yè)。calcaneus<-FibularheadPosteriortibiofibularLigamentAchillesTendonTalusPosteriortalofibularlig.Peronealtendons第十六頁(yè)，共51頁(yè)。ThedeltoidligamentThisislocatedonthemedialaspectofthefoot.Itisthelargestligamentbutisactuallycomprisedofseveralsectionsallfusedtogether.Thisligamentprevents(eversion)oftheankle.Thedeltoidligamentistriangularinshapeandhassuperficialanddeeplayers.Itisthemostdifficultligamentinthefoottosprain.第十七頁(yè)，共51頁(yè)。TibiaXXXNavicular-----TalusTibialisPosteriorTendonTibialisAnt.TendonDeltoidLigamentX第十八頁(yè)，共51頁(yè)。Musclesofthelowerleg/ankleThereare4compartmentsthatmakeupthelowerlegthatoperatethemotionsoftheankle.Injurycancauseswellinginsidethesecompartmentsthatcanleadtotissuedeathornervedamage.第十九頁(yè)，共51頁(yè)。第二十頁(yè)，共51頁(yè)。AnteriorCompartmentAnt.TibialisExt.HallicusLongusExtensorDigitorumLongusContainsAnt.TibialNerveContainsAnteriorTibialArteryDorsiflexorsofthefoot(liftsfootup)<-Ant.Comp第二十一頁(yè)，共51頁(yè)。LateralCompartmentEvertersofthefoot(turnsfootoutward)PeroneusLongusPeroneusBrevisPeroneusTertiusContainsthesuperficialperonealnerve<-Lat.Comp.第二十二頁(yè)，共51頁(yè)。PosteriorSuperficialGroupPlantarflexors(pushesfootdownwards)GastrocnemiusSoleusSuperficialPosterior第二十三頁(yè)，共51頁(yè)。PosteriorDeepAssistswithPlantarflexionTibialisPosteriorFlexorHallicusLongusFlexorDigitorumLongusPosteriortibialarteryPost.Deep---第二十四頁(yè)，共51頁(yè)。AssessingtheLowerLegandAnkleHistoryPasthistoryMechanismofinjuryWhendoesithurt?Typeof,qualityof,durationofpain?Soundsorfeelings?Howlongwereyoudisabled?Swelling?Previoustreatments?第二十五頁(yè)，共51頁(yè)。ObservationsPosturaldeviations?Istheredifficultywithwalking?Deformities,asymmetriesorswelling?Colorandtextureofskin,heat,redness?Patientinobviouspain?Israngeofmotionnormal?第二十六頁(yè)，共51頁(yè)。PercussionandcompressiontestsUsedwhenfractureissuspectedPercussiontestisablowtothetibia,fibulaorheeltocreatevibratoryforcethatresonatesw/infracturecausingpainCompressiontestinvolvescompressionoftibiaandfibulaeitheraboveorbelowsiteofconcernThompsontestSqueezecalfmuscle,whilefootisextendedofftabletotesttheintegrityoftheAchillestendonPositivetestsresultsinnomovementinthefootHoman’stestTestfordeepveinthrombophlebitisWithkneeextendedandfootofftable,ankleismovedintodorsiflexionPainincalfisapositivesignandshouldbereferred第二十七頁(yè)，共51頁(yè)。CompressionTestPercussionTestHoman’sTestThompsonTest第二十八頁(yè)，共51頁(yè)。AnkleStabilityTestsAnteriordrawertestUsedtodeterminedamagetoanteriortalofibularligamentprimarilyandotherlateralligamentsecondarilyApositivetestoccurswhenfootslidesforwardand/ormakesaclunkingsoundasitreachestheendpointTalartilttestPerformedtodetermineextentofinversionoreversioninjuriesWithfootat90degreescalcaneusisinvertedandexcessivemotionindicatesinjurytocalcaneofibularligamentandpossiblytheanteriorandposteriortalofibularligamentsIfthecalcaneusiseverted,thedeltoidligamentistested第二十九頁(yè)，共51頁(yè)。AnteriorDrawerTestTalarTiltTest第三十頁(yè)，共51頁(yè)。Kleiger’stestUsedprimarilytodetermineextentofdamagetothedeltoidligamentandmaybeusedtoevaluatedistalanklesyndesmosis,anterior/posteriortibiofibularligamentsandtheinterosseusmembraneWithlowerlegstabilized,footisrotatedlaterallytostressthedeltoidMedialSubtalarGlideTestPerformedtodeterminepresenceofexcessivemedialtranslationofthecalcaneusonthetalusTalusisstabilizedinsubtalarneutral,whileotherhandglidesthecalcaneus,mediallyApositivetestpresentswithexcessivemovement,indicatinginjurytothelateralligaments第三十一頁(yè)，共51頁(yè)。Kleiger’sTestMedialSubtalarGlideTest第三十二頁(yè)，共51頁(yè)。

FunctionalTestsWhileweightbearingthefollowingshouldbeperformedWalkontoes(plantarflexion)Walkonheels(dorsiflexion)Walkonlateralbordersoffeet(inversion)Walkonmedialbordersoffeet(eversion)HopsoninjuredanklePassive,activeandresistivemovementsshouldbemanuallyappliedtodeterminejointintegrityandmusclefunctionIfanyofthesearepainfultheyshouldbeavoided第三十三頁(yè)，共51頁(yè)。PreventionofInjurytotheAnkleStretchingoftheAchillestendonStrengtheningofthesurroundingmusclesProprioceptivetraining:balanceexercisesandagilityWearingproperfootwearandortapewhenappropriate第三十四頁(yè)，共51頁(yè)。SpecificInjuriesAnkleInjuries:SprainsSinglemostcommoninjuryinathleticscausedbysuddeninversionoreversionmomentsInversionSprainsMostcommonandresultininjurytothelateralligamentsAnteriortalofibularligamentisinjuredwithinversion,plantarflexionandinternalrotationOccasionallytheforceisgreatenoughforanavulsionfracturetooccurw/thelateralmalleolus第三十五頁(yè)，共51頁(yè)。Severityofsprainsisgraded(1-3)Withinversionsprainsthefootisforcefullyinvertedoroccurswhenthefootcomesintocontactw/unevensurfaces第三十六頁(yè)，共51頁(yè)。第三十七頁(yè)，共51頁(yè)。Grade1InversionAnkleSprainEtiologyOccurswithinversionplantarflexionandadductionCausesstretchingoftheanteriortalofibularligamentSignsandSymptomsMildpainanddisability;weightbearingisminimallyimpaired;pointtendernessoverligamentsandnolaxityManagementRICEfor1-2days;limitedweightbearinginitiallyandthenaggressiverehabTapemayprovidesomeadditionalsupportReturntoactivityin7-10days第三十八頁(yè)，共51頁(yè)。Grade2InversionAnkleSprainEtiologyModerateinversionforcecausinggreatdealofdisabilitywithmanydaysoflosttimeSignsandSymptomsFeelorhearpoporsnap;moderatepainw/difficultybearingweight;tendernessandedemaPositivetalartiltandanteriordrawertestsPossibletearingoftheanteriortalofibularandcalcaneofibularligamentsManagementRICEforatleastfirst72hours;X-rayexamtoruleoutfx;crutches5-10days,progressingtoweightbearing第三十九頁(yè)，共51頁(yè)。Management(continued)WillrequireprotectiveimmobilizationbutbeginROMexercisesearlytoaidinmaintenanceofmotionandproprioceptionTapingwillprovidesupportduringearlystagesofwalkingandrunningLongtermdisabilitywillincludechronicinstabilitywithinjuryrecurrencepotentiallyleadingtojointdegenerationMustcontinuetoengageinrehabtopreventagainstre-injury第四十頁(yè)，共51頁(yè)。Grade3InversionAnkleSprainEtiologyRelativelyuncommonbutisextremelydisablingCausedbysignificantforce(inversion)resultinginspontaneoussubluxationandreductionCausesdamagetotheanterior/posteriortalofibularandcalcaneofibularligamentsaswellasthecapsuleSignsandSymptomsSeverepain,swelling,hemarthrosis,discolorationUnabletobearweightPositivetalartiltandanteriordrawer第四十一頁(yè)，共51頁(yè)。ManagementRICE,X-ray(physicianmayapplydorsiflexionsplintfor3-6weeks)CrutchesareprovidedaftercastremovalIsometricsincast;ROM,PREandbalanceexerciseonceoutSurgerymaybewarrantedtostabilizeankleduetoincreasedlaxityandinstability第四十二頁(yè)，共51頁(yè)。EversionAnkleSprains

-(Represent5-10%ofallanklesprains)EtiologyBonyprotectionandligamentstrengthdecreaseslikelihoodofinjuryEversionforceresultsindamagetodeltoidligamentandpossiblyfxofthefibulaDeltoidcanalsobeimpingedandcontusedwithinversionsprains第四十三頁(yè)，共51頁(yè)。第四十四頁(yè)，共51頁(yè)。Pasthistory------TalusThereare4compartmentsthatmakeupthelowerlegthatoperatethemotionsoftheankle.PosteriorMostcommonlyduetolackofrehabilitation,butmoreimportantlylackofneuromusculartraining.AnatomicalStructuresFunctionalTestsTheTibiaisthemedialboneandlargestboneofthelowerleg.MedialaspectoffootThisislocatedonthemedialaspectofthefoot.PositivetestsresultsinnomovementinthefootAchillesTendonIstheredifficultywithwalking?TheTibiaisthemedialboneandlargestboneofthelowerleg.PosteriorWillrequireprotectiveimmobilizationbutbeginROMexercisesearlytoaidinmaintenanceofmotionandproprioception第四十五頁(yè)，共51頁(yè)。第四十六頁(yè)，共51頁(yè)。InjuryPreventionStrengthtrainingallowsthesupportingmusculaturetostabilizewhereligamentsmaynolongerbecapabl