Block6 PBL

2個月前跌倒，橈骨骨折，至兩週前疼痛腫脹，且手指無法彎曲

Disease of the skeletal system

1.發育異常

• Achondroplasia軟骨發育異常

2.與基質異常相關

• Osteogenesis imperfecta or Brittle bones
• Mucopolysaccharidoses
• Osteoporosis

3.噬骨細胞異常

• Osteopetrosis
• Paget Disease / Osteitis deformans

4.礦物質恆定異常

• Rickets / Osteomalacia
• Hyperparathyroidism
• renal osteodystrophy

5.骨折

6.骨壞死

7.感染

• Pyogenic osteomyelitis
• Tuberculous osteomyelitis
• Syphilis

8.Tumor/tumot-like lesions

Bone-forming tumors

• Osteoma
• Osteoid osteoma / osteoblastoma
• Osteosarcoma / osteogenic sarcoma

Cartilage-forming tumors

• Osteochondroma
• Chondroma
• Chondroblastoma
• Chondromyxoid fibroma
• Chondrosarcoma

Fibrous and fibro-osseous tumors

• Fibrous cortical defect(nonossifying fibroma)
• Fibrous dysplasia
• Fibrosarcoma and Malignant fibrous histiocytoma

Miscellaneous tumors

• Ewing sarcoma
• Giant cell tumor of bone
• Metastatic tumors to skeleton

Histology of Bone

1.功能及構造
2.Bone formation

Connective Tissue

1.connective tissue proper

• loose(areolar)
• dense--regular
• --irregular

2.connective tissue with special properities

• adipose tissue
• elastic tissue
• hematopoietic tissue
• mucous tissue

3.supporting connective tissues

• cartilage
• bone

Histology of Cartilage

3種軟骨組織

1.Hyaline cartilage
2.Elastic cartilage
3.Fibrocartilage

upper limb的joints

1.joints of the shoulder girdle & shoulder

• coracoacromial ligament
• superior transverse scapular ligament
• inferior transverse scapular ligament
• acromioclavicular joint
• acromioclavicular ligament
• coracoclavicular ligament=trapezoid ligament+conoid ligament
• glenoid lip
• coracohumeral ligament
• glenohumeral ligaments

2.臂關節

• elbow joint

upper limb的重要bone marking

1.scapula

• spine of scapula
• acromion
• acromial angle
• scapular notch
• infraglenoid tubercle
• supraglenoid tubercle
• neck of scapula
• coracoid process

2.Humerus

lower limb的關節

1.hip joint
2.knee joint
3.tibiofibular joint
4.ankle joint(tarsal joint)
5.subtalar joint

Lower limb的幾個重要區域

1.subinguinal space & femoral triangle--anterior thigh

• femoral triangle→邊界：inguinal ligament 、sartorius、adductorlongus；floor：pectineus、iliopsoas；roof：fascia lata、cribriform fascia、"part of sartorius"
• femoral artery穿過中間，頂點底下有deep femoral A&V
• 由外往內→NAV，其中A與V在femoral sheath內，神經沒被包起來
• femoral sheath包覆：femoral artery、femoral vein、femoral canal
• femoral→medial：lacunar ligament，lateral：femoral vein，anterior：inguinal ligament，posterior：pectineus
• subinguinal space被iliopectineal arch分成，前方：vascular lacuna，含A、V、淋巴；後方：muscular lacuna，含N、iliopsoas
• 股神經→分成saphenous nerve、nerve to vastus medialis
• 股三角的出口接到adductor cannal

2.adductor cannal & adductor hiatus

3.Tarsal tunnel

4.obturator cannal--medial thigh

5.greater sciatic foramen--gluteus

6.lesser sciatic foramen--perineum

Lower limb的Muscle

1.Anterior thigh muscle

• pectineus
• iliopsoas=iliacus+psoas major
• sartorius
• quadriceps femoris
• (1)rectus femoris
• (2)vastus lateralis
• (3)vastus medialis
• (4)vastus intermedius

2.Posterior thigh muscles(hamstrings)

• semitendinosus
• semimembranosus
• biceps femoris(long head)

3.Medial thigh muscles

• adductor longus
• adductor brevis
• adductor magnus
• gracilis
• obturator externus

4.Gluteal

淺層

• gluteus maximus
• gluteus minimus
• gluteus medius

深層

• piriformis
• obturator internus
• gemelli superior
• gemelli inferior
• quadratus femoris

5.Anterior compartment of the leg

• tibialis anterior
• extensor digitorum longus
• extensor hallucis longus
• fibularis(peroneus) tertius

6.Lateral compartmnt of the leg

• Fibularis longus
• fibularis brevis

7.Posterior compartment of the leg

淺層

• triceps surae=gastrocnemius+soleus
• plantaris

深層

• popliteus
• flexor digitorum longus
• flexor hallucis longus
• tibialis posterior

8.Foot

第一層

• abductor hallucis
• flexor digitorum brevis
• abductor digiti minimi

第二層

• quadratus plantae
• tendon of flexor hallucis longus
• tendon of flexor digitorum longus
• lumbrical muscles

第三層

• flexor hallucis brevis
• adductor hallucis

第四層

• interossei

Lower limb的重要Bone Markings

1.Hip Bone

• iliac crest
• tubercle of iliac crest
• anterior superior iliac spine
• anterior inferior iliac spine
• posterior superior iliac spine
• poserior inferior iliac spine
• greater sciatic notch
• ischial spine
• lesser sciatic noch
• ischial tuberosity
• iliac fossa
• gluteal surface
• sacropelvic surface
• auricular surface
• iliac tuberosity
• pubic tubercle
• iliopubic emincence
• pecten of the pubis
• obturator groove

2.Thigh Bone

• head of femur
• greater trochanter
• trochanteric fossa
• lesser trochanter
• intertrochanteric line
• intertrochanteric crest
• gluteal tuberosity
• linea aspera
• pectineal line
• popliteal surface
• intercondylar line
• intercondylar fossa
• medial condyle
• lateral condyle
• patellar surface

3.Leg

• anterior intercondylar area
• posterior intercondylar area
• intercondylar eminence
• medial intercondylar tubercle
• tuberculum intercondylare laterale
• tibial tuberosity
• soleal line of tibia
• interosseous margin
• medial malleolus
• malleolar groove

4.Foot

Block6 解剖學Learning Objects--Low limb

需要學習的是6個regions所對應出的6個項目
其中6個regions指的是
1.Femoral(thigh)
2.Gluteal (buttocks)
3.Knee joints
4.Leg
5.Ankle(talocrural)
6.Foot

所對應的6個項目分別是
1.Bone Marking
2.Vessels
3.Superficial--lymphatic drainage
--cutaneous nerves
4.Gait analysis步態分析
5.Muscle
6.重點區域--structures
--entrance