Chapter 3 Bones and joints of the limbs

Section 1 Bones and joints of the upper limbs shoulder arm forearm hand carpus(wrist) metacarpus(palm) phalanx(fingers)

The bones of upper limbs 64 clavicle 锁骨 The shoulder girdle肩带2 scapula 肩胛骨 arm臂1-------humerus肱骨 The free bones radius桡骨 forearm前臂2 ulna尺骨 hand手 carpal bones 腕骨8 metacarpal bones掌骨5 phalanges指骨14

Bones and joints of the girdle 1 Bones and joints of the girdle 1. clavicle and scapula The Clavicle: ‘S’ – shape, short bone, shaft and 2 ends(sternal end and acromial end) The Scapula: triangular flat bone, 2 surfaces, 3 bordera and 3 angles (inferior angle) subscapular fossa, coracoid process, scapular spine → acromion, supraspinous & infraspinous fossa, scapular glenoid, supraglenoid & infraglenoid tubercle

2. The sternoclavicular joint 胸锁关节 The acromioclavicular jont 肩锁关节 igamentscoracoclavicular ligment ( 喙锁韧带,喙肩韧带 )

B. Bones and joints of the free upper limb 1 B. Bones and joints of the free upper limb 1. Bone of the arm --- the humerus superior end: head, anatomical neck, greater & lesser tubercle, surgical neck, shaft: deltoid tuberrosity, sulcus for radial nerve, nutrient foramen inferior end: medial & lateral epicondyle, trochlea, coronoid fossa, olecranon fossa, capitulum, radial fossa, sulcus for ulnar nrtve

2. bones of the forearm---radius & ulna The Radius: laterally, superior end: head, neck, articular circumference; shaft: radial tuberosity, nutrient foramen; inferior end: styloid process, carpal articular surface, ulnar notch; The Ulna: medially, superior end: olecranon, trochlear notch, coronoid process radial notch; shaft: ulnar tuberosity, nutrient forearm, interosseous border; inferior end: styloid process, head, articular circumference;

3. Bones of the hand Carpal bones(8): 2) metacarpal bones(5) 掌骨 The scaphoid 舟骨 The lunate 月骨 The triquetral 三角骨 The pisiform 豌豆骨 The trapezium 大多角骨 The trapezoid 小多角骨 The capitate 头状骨 The hamate 钩骨 2) metacarpal bones(5) 掌骨 3) Phalanges (14) 指骨

4. The joints of the free upper limb 1) The shoulder joint 肩关节 典型的球窝关节：肱骨头大，肩胛盂浅而小（4:1）； 关节囊松，关节腔大； 关节囊内有肱二头肌长头腱通过； 有关节唇； 韧带少，关节的稳定性取决于周围的肌； 易发生前脱位； 是全身活动最大的关节。

2）The elbow joint 肘关节： 为复关节，3组关节面包在1个共同的 关节囊内。3组关节面为： humeroulnar joint 肱尺关节 humeroradial joint 肱桡关节 proximal radioulnar joint 桡尺近侧关节 易发生后脱位，3点关系破坏。

3）The joints between ulnar and radius proximal radioulnar joint 桡尺近侧关节 interosseous membranes of forarm 前臂骨间膜 distal radioulnar joint 桡尺远侧关节 movement: supination & pronation

4) The joints of the hand *The radiocarpal (wrist) joint 桡腕关节 组成：关节窝：三角形关节盘下面 + 桡骨腕关节面；关节头：舟、月、三角骨的上面 5）intercarpal joints 腕骨间关节 6）carpometacarpal joints 腕掌关节 7）intermetacarpal joint 掌骨间关节 8）metacarpophalangeal joints 掌指关节 9）interphalangeal joints 指关节

Section 2 Bones and joints of lower limbs（62） ilium髂骨 The pelvic girdle 髋带1--hip bone髋骨 pubis耻骨 ischium坐骨 thigh大腿1--------femur股骨 ( knee膝1 -- patella髌骨) The free bones leg小腿2 ----tibia胫骨 , fibula腓骨 游离下肢骨 tarsal bones跗骨7 foot足 metatarsal bones柘骨 phalanges趾骨14

Pelvic girdle Bone — the hip bones irregular bone; Fetal hip bone develop as three separate bones: the ilium the ischium the pubis; in adults, these bones are fused together.

acetabulum 髋臼 obturator foramen 闭孔 iliac crest 髂嵴 anterior superior iliac spine 髂前上棘 greater sciatic notch 坐骨大切迹 arcuate line 弓状线 pubic tuberosity 耻骨结节 sciatic tuberosity坐骨结节 pubic pecten 耻骨梳 symphysial surface 耻骨联合

2. The joints of the pelvic girdle the pubic symphsis 耻骨联合 the sacroiliac joint 骶髂关节 the sacrotuberous lig. 骶结节韧带 and sacrospinous lig. 骶棘韧带 the greater sciatic foramen 坐骨大孔 the lesser sciatic foramen 坐骨小孔 the obturator membrane 闭孔膜 obturator canal 闭膜管 the pelvis 骨盆 greater pelvis 大骨盆 terminal line 界线 lesser pelvis 小骨盆

B. Free bones of the power limb Bone of the thigh the femur 股骨 superior end: femoral head 股骨头 femoral neck 股骨颈 greater trochanter 大转子 lesser trochanter 小转子 intertrochanteric line 转子间线 intertrochanteric crest 转子间嵴 shaft: gluteal tuberosity 臀肌粗隆 nutrient foramen 滋养孔 inferior end: lateral condyle 外侧髁 medial condyle 内侧髁 lateral epicondyle 外上髁 medial epicondyle 内上髁 intercondylar fossa 髁间窝 patellar surface 髌面

2. Bones of the leg the tibia 胫骨（内侧） superior end: condylus lateralis 外侧髁 condylus medialis 内侧髁 eminentia intercondylaris 髁间隆起 shaft: anterior margin 胫骨前嵴 tibial tuberosity 胫骨粗隆 nutrient foramen 滋养孔 inferior end: medial malleolus 内踝 2) the fibula 腓骨（外侧） fibular head 腓骨小头 malleolus lateralis 外踝 3) the patella 髌骨 底、尖、关节面 （内尺外橈、内胫外腓；向肘离膝 ）

3. Bones of the foot 1) tarsal bones 跗骨 talus 距骨 trochlea of talus 距骨滑车 calcaneus 跟骨 tuberosity of calcaneus 跟结节 navicular bone 舟骨 cuneiform bones (1~3) 楔骨 cuboid bone 骰骨 2) metatarsal bones(5)跖骨 3) phalanges 趾骨

c) The joints of the free lower limb 1 c) The joints of the free lower limb 1. The hip joint 髋关节 股骨头与髋臼组成（杵臼关节，2:1） 有关节唇（髋臼唇） 有囊内韧带（股骨头韧带和髋臼横韧带） 囊外有强大的髂股韧带（“Y”形 ） 与肩关节相比，活动性小，稳定性大 股骨颈骨折有囊内、囊外之分

2. The knee joint 膝关节 为人身上最复杂的关节 关节面：股骨的内、外侧髁，胫骨的内、外侧髁、髌骨。 韧带：囊外韧带： patellar lig. 髌韧带 tibial collateral lig. 胫侧副韧带 fibular collateral lig. 腓侧副韧带 poplitear oblique lig. 腘斜韧带 囊内韧带： anterior & posterior cruciate lig. 前、后交叉韧带 tranverse lig. of knee 膝横韧带 medial & lateral meniscus 内、外侧半月板 有滑液襞（ alar folds 翼状襞）和滑膜囊 （suprapatellar bursa 髌上囊和髌下囊） 以屈伸运动为主，在屈曲的状态下可作 轻微的旋转运动 易发生半月板和交叉韧带的损伤

3. The tibiofibular union 胫腓骨间连接 tibiofibular joint 胫腓关节 crural interosseous membrane 小腿骨间膜 tibiofibular syndesmosis 韧带 4. The joints of foot 1）talocrural joint or ankle jiont 距小腿关节 踝关节 组成：胫、腓骨下端；距骨滑车；韧带 韧带：跗内侧韧带（三角韧带）强大 跗外侧韧带较细小 故足内翻时易造成损伤 运动：内翻、外翻、背屈（伸）、跖屈（屈） 2）intertarsal joints 跗骨间关节 3）tarsometatarsal joints （Lisfranc) 跗跖关节 4） intermetatarsal joints 柘骨间关节 5）metatarsophalangeal joints 柘趾关节 6）interphalangeal joints of foot 趾关节 跗横关节（transverse tarsal joint, Chopart joint) 跟骰关节与距跟舟关节合称，呈”S”形； 临床上Chopart 关节和Lisfranc 关节可做为 截肢的部位。

5. The arches of foot 足弓 纵弓和横弓 3点着地：跟结节 第1柘骨头 第5柘骨头