【臨床骨骼肌肉學(xué)】半月板損傷課件

1、Meniscal Tears第1頁，共43頁。contentanatomical and functiontissues biomechanical characteristicsMeniscal TearsA study :Meniscal Tear Biomechanics:Loads Across Meniscal Tears in Human Cadaveric Knees第2頁，共43頁。ANATOMYanterior viewsuperior view第3頁，共43頁。Clark CR, Ogden JA. Development of the menisci of the hum

2、an knee joint. Morphological changes and their potential role in childhood meniscal injury. J Bone Jt Surg Am. 1983; 65:53847.which part of the meniscus is more likely to be injured?both :wedge-shaped and semi-lunar variety: size, shape, thickness, and mobility than medial menisci第4頁，共43頁。FUNCTIONS:

3、functioning as a shock absorberincreasing the passive stability of the knee,enhancing joint congruitydecreasing load transmission and tibiofemoral contact stressesassisting in joint lubricationaiding in knee joint proprioception.第5頁，共43頁。By spreading out the forces on the knee joint, the menisci pro

4、tect the articular cartilage from getting too much pressure on one small area on the surface of the joint. Without the menisci, the forces on the knee joint are concentrated onto a small area, leading to damage and degeneration of the articular cartilage, a condition called osteoarthritis.The menisc

5、i add stability to the knee joint. They convert the surface of the shinbone into a shallow socket, which is more stable than its otherwise flat surface. Without the menisci, the round femur would slide on top of the flat surface of the tibia.第6頁，共43頁。Not only does this tissue display complex anatomy

6、Regional variations in vascularization and cell populations of the meniscusbiomechanical characteristics第7頁，共43頁。Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982;10:905. PubMed: 7081532vascularizationfully vascularized10-30%10-25%10 years oldPrenatal to shortly a

7、fter birthMuturity which part of it is not easy toheal? (is directly related to blood circulation)第8頁，共43頁。Biochemical ContentCells in the outer, vascularized section of the meniscus (red-red region) are spindle-shaped, display cell processes, and are more fibroblast-like in appearance. are well-sui

8、ted to maintaining a fibrous extracellular matrix rich in collagen type I.cells in the middle section (white-red region) and inner section (white-white region) are more chondrocyte-like, though they are phenotypically distinct from chondrocytes. Cells in the superficial layer of the meniscus are sma

9、ll and round. inner meniscus cells produce both collagen types I and II, and glycosaminoglycans, giving rise to a hyaline-like inner portion of the tissue. 第9頁，共43頁。Herwig J, Egner E, Buddecke E. Chemical changes of human knee joint menisci in various stages of degeneration. Ann Rheum Dis. 1984; 43:

10、63540. PubMed: 6548109Proctor CS, Schmidt MB, Whipple RR, Kelly MA, Mow VC. Material properties of the normal medial bovine meniscus. J Orthop Res. 1989; 7:77182. PubMed: 2677284 red-red zone, collagen type I 80%other collagen variants (type II, III, IV, VI, and XVIII) present at less than 1%white-w

11、hite zone:70% of the tissue by dry weight collagen type II(60% ) collagen type I(40%) which type of the meniscal tear is more easier to happen?(transverse?vertical) 第10頁，共43頁。How force is transduced upon and throughout the knee meniscusFree body diagram of the forces acting on the knee meniscus duri

12、ng loading (for simplicity,only the lateral meniscus is shown). During everyday activity, the menisci are compressed by the downward force of the femur. Since the meniscus is a wedge, the femoral force is enacted at an angle, and thus a vertical component exists which is countered by the upwardforce

13、 of the tibia. Additionally, a horizontal component of the femoral force exists, which isexerted radially outward on each meniscus. This horizontal force is in turn countered by the anchoring force of the attachments at the posterior and anterior horns of the meniscus.Additionally, as this compressi

14、on occurs, circumferential stress is created along themeniscus. Therefore, the menisci function by converting compressive loads tocircumferential tensile loads. At the same time, shear forces are developed between thecollagen fibers within the meniscus while the meniscus is deformed radially.FfemFvF

15、hFtibFfem第11頁，共43頁。膝關(guān)節(jié)由股骨內(nèi)、外側(cè)髁和脛骨內(nèi)、外側(cè)髁以及髕骨構(gòu)成，為人體最大且構(gòu)造最復(fù)雜，損傷機(jī)會(huì)亦較多的關(guān)節(jié)。 第12頁，共43頁。結(jié)構(gòu)關(guān)節(jié)囊較薄而松弛，附著于各骨關(guān)節(jié)軟骨的周緣。關(guān)節(jié)囊的周圍有韌帶加固。前方的叫髕韌帶，在髕韌帶的兩側(cè)，有髕內(nèi)、外側(cè)支持帶 。后方有腘斜韌帶加強(qiáng)，內(nèi)側(cè)有脛側(cè)副韌帶，為扁帶狀，外側(cè)為腓側(cè)副韌帶關(guān)節(jié)囊的滑膜層廣闊，除關(guān)節(jié)軟骨及半月板的表面無滑膜覆蓋外，關(guān)節(jié)內(nèi)所有的結(jié)構(gòu)都被覆著一層滑膜。于髕下部的兩側(cè)，滑膜形成皺襞，突入關(guān)節(jié)腔內(nèi)，皺襞內(nèi)充填以脂肪和血管，叫做翼狀襞。兩側(cè)的翼狀襞向上方逐漸合成一條帶狀的皺襞，稱為髕滑膜襞，伸至股骨髁間窩的前緣。

16、第13頁，共43頁。結(jié)構(gòu)在關(guān)節(jié)內(nèi)，生有由纖維軟骨構(gòu)成的半月板 ，內(nèi)側(cè)半月板大而較薄，呈“C”形，外側(cè)半月板較小，成“o”型。半月板外緣厚，與關(guān)節(jié)囊相連內(nèi)緣薄而游離。半月板下面平坦，上面凹陷，分別與脛骨，股骨的關(guān)節(jié)面相適應(yīng)，增強(qiáng)了關(guān)節(jié)的穩(wěn)固性，還可起緩沖作用。第14頁，共43頁。輔助結(jié)構(gòu)半月板：由2個(gè)纖維軟骨板構(gòu)成，墊在脛骨內(nèi)、外側(cè)髁關(guān)節(jié)面上，半月板外緣厚內(nèi)緣薄。 翼狀襞：在關(guān)節(jié)腔內(nèi)，位于髕骨下方的兩側(cè)，含有脂肪的鄒襞，填充關(guān)節(jié)腔。 髕上囊和髕下深囊：位于股四頭肌腱與骨面之間 加固關(guān)節(jié)的韌帶 ：前后交叉韌帶 腓側(cè)副韌帶 脛側(cè)副韌帶 髕韌帶 第15頁，共43頁。第16頁，共43頁。第17頁，共43

17、頁。第18頁，共43頁?；具\(yùn)動(dòng)及特點(diǎn)當(dāng)膝關(guān)節(jié)完全伸直時(shí)，脛骨髁間隆起與股骨髁間窩嵌鎖，側(cè)副韌帶緊張，除屈伸運(yùn)動(dòng)外，股脛關(guān)節(jié)不能完成其他運(yùn)動(dòng) 當(dāng)膝關(guān)節(jié)屈時(shí)，股骨兩側(cè)髁后部進(jìn)入關(guān)節(jié)窩，嵌鎖因素解除，側(cè)副韌帶松弛，股脛關(guān)節(jié)才能繞垂直軸作輕度的旋轉(zhuǎn)運(yùn)動(dòng)。 膝關(guān)節(jié)運(yùn)動(dòng)時(shí)，半月板可發(fā)生位移，屈膝時(shí)向后移，伸膝時(shí)向前移；小腿旋轉(zhuǎn)時(shí)半月板隨股髁位移，一側(cè)滑向前，另一側(cè)滑向后 膝關(guān)節(jié)位于人體兩個(gè)最長的杠桿臂之間，在承受負(fù)荷和參與運(yùn)動(dòng)中易于損傷，股骨和脛骨以寬大的內(nèi)、外側(cè)髁關(guān)節(jié)面增大關(guān)節(jié)的接觸面積，可提高關(guān)節(jié)的穩(wěn)固性和減少壓強(qiáng) 膝關(guān)節(jié)基本運(yùn)動(dòng)是屈伸旋內(nèi)旋外第19頁，共43頁。與膝關(guān)節(jié)運(yùn)動(dòng)相關(guān)肌肉屈：半腱肌，半膜

18、肌，縫匠肌，股二頭肌，股薄肌和腓腸肌伸：股四頭肌旋內(nèi)：半腱肌，半膜肌，縫匠肌，股薄肌旋外：股二頭肌第20頁，共43頁。第21頁，共43頁。踝關(guān)節(jié)踝關(guān)節(jié)，又名距骨小腿關(guān)節(jié)。由脛、腓骨下端的關(guān)節(jié)面與距骨滑車構(gòu)成，踝關(guān)節(jié)屬滑車關(guān)節(jié)，可沿通過橫貫距骨體的冠狀軸做背屈及跖屈運(yùn)動(dòng)。 第22頁，共43頁。第23頁，共43頁。第24頁，共43頁。踝關(guān)節(jié)的運(yùn)動(dòng)足跖屈：小腿三頭肌，趾長屈肌，脛骨后肌，石母長屈肌，腓骨長肌和腓骨短肌足背屈：脛骨前肌，趾長伸肌和石母長伸肌足外翻：腓骨長肌和腓骨短肌足內(nèi)翻：脛骨前肌，脛骨后肌，石母長屈肌和趾長屈肌第25頁，共43頁。EricA cadavaric study709326

19、181第26頁，共43頁。ContentsTHEBackgroundMaterials and MethodsResultsDiscussion第27頁，共43頁。Part OneBackground01第28頁，共43頁。MAIN CONTENTImpact of Partial and complete rupture of anterior cruciate ligament on medial meniscusinvestigate the biomechanical impact of partial and complete ACL rupture on different par

20、ts of medial meniscus第29頁，共43頁。Part TwoMaterials and Metheds02第30頁，共43頁。ACL intact (ACL-I)anteromedial bundle transection (AMB-T)posterolateral bundle transection (PLB-T)ACL complete transection (ACL-T)第31頁，共43頁。Axial compressive3006090 Strain on the anterior horn, body part, and posterior horn of m

21、edial meniscus were measured under 200 N axial compressivetibial load 第32頁，共43頁。Specimen preparationPrior to experiments, the femur and tibia were cut to approximately 30 cm from the joint line, the proximal portion of the fibula was retained and secured to the tibia at its anatomic position using a

22、 cortical screw, and soft tissues were carefully removed except quadriceps muscle and joint capsule.第33頁，共43頁。第34頁，共43頁。Group of experiments and test proceduresthe specimens were positioned at 0, 30, 60, and 90 of flexion in sequence.During the whole test, the specimens were kept at a humidity of 60

23、80% and a temperature of 25C.第35頁，共43頁。Part ThreeResult03第36頁，共43頁。Resultresponses and changes in different areas of the medial meniscus toward strain resulting from ACL injury are also unclear.abnormal strains generated from anterior posterior translation and internal/external rotation of medial fe

24、moral condyle in this extent cause rupture of medial meniscus body more easily第37頁，共43頁。Part FourConclusions04第38頁，共43頁。Similar to complete rupture, partial rupture of ACL can also trigger strain concentration on medial meniscus,especially posterior horn, which may be a more critical reason for meni

25、scus injury associated with chronic ACL deficiency.第39頁，共43頁。ReferencesHenning CE. Current status of meniscus salvage. Clin Sports Med 1990;9:567-7 Yoon KH, Yoo JH, Kim KI. Bone contusion and associate meniscal and medial collateral ligament injury in patients with anterior cruciate ligament rupture

26、. J Bone Joint Surg Am 2011;93:1510-8.6.Papageorgiou CD, Gil JE, Kanamori A, Fenwick JA, Woo SL, Fu FH. The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med 2001;29:226-31.Tjoumakaris FP, Donegan DJ, Sekiya JK. Partial te

27、ars of the anterior cruciate ligament: Diagnosis and treatment. Am J Orthop (Belle Mead NJ) 2011;40:92-7.第40頁，共43頁。EricTHANK YOU第41頁，共43頁。 Ihn JC, Kim SJ, Park IH. In vitro study of contact area and pressure distribution in thehuman knee after partial and total meniscectomy. Int Orthop. 193; 17(4):2

28、14-218.Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repairon intraarticular contact areas and stress in the human knee: a preliminary report. Am JSports Med. 1986; 14(4):270-275.Wojtys EM, Chan DB. Meniscus structure and function. Instr Course Lect. 2005;54:323-330.

29、Kettelkamp DB, Jacobs AW. Tibiofemoral contact area: determination and implication. JBone Joint Surg Am. 1972; 54(2):349-356.Walker PS, Erkman MJ. The role of the menisci in the transmission across the knee. Clin Orthop Relat Res. 1975; (109):184-192.Alford JW, Lewis P, Kang RW, Cole BJ. Rapid progr

30、ession of chondral disease in thelateral compartment of the knee following meniscectomy. Arthroscopy. 2005;21(12):1505-1509.Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy onanterior-posterior motion of the knee. J Bone Joint Surg Am. 1982; 64(6):883-888.Fu FH, Thompson WO. Motion

31、 of the meniscus during knee flexion. In: Mow VC,Arnoczky SP, Jackson DW, eds. Knee Meniscus: Basic and Clinical Foundation. NewYork, NY: Raven Press; 1992:131-139.REFERENCE第42頁，共43頁。 Shoemaker SC, Markolf KL. The role of the meniscus in the anterior-posterior stability ofthe loaded anterior cruciat

32、e-deficient knee: effects of partial versus total excision. J BoneJoint Surg Am. 1986; 68(1):71-79.Arnoczky SP, Adams ME, DeHaven KE, Eyre DR, Mow VC. The meniscus. In: WooSL-Y, Buckwalter J, eds. Injury and Repair of the Musculoskeletal Soft Tissue. ParkRidge, IL: American Academy of Orthopaedic Surgeons; 1988:487-537. Mow VC, Ratcliffe A, Chern KY, Kelly MA. Structure and function relationships ofmenisci of the knee. In: Mo