浙江大学医学院：神经精神与运动（PPT讲稿）运动系统慢性疾病、肩关节周围炎、腱鞘炎、股骨头坏死

浙江大学医学院八年制教学 胂经精神与运动1(模块2) 运动系统慢性疾病 肩关节周围炎、腱鞘炎 股骨头坏死 浙江大学医学院附属二院骨和 吴立东

浙江大学医学院八年制教学 神经精神与运动1（模块2） 运动系统慢性疾病 肩关节周围炎、腱鞘炎 股骨头坏死 浙江大学医学院附属二院骨科 吴立东

运动系统慢性损伤 Bursitis 滑囊炎

Bursitis 滑囊炎 运动系统慢性损伤

攪囊炎是指滑囊的急性或慢性炎症。滑囊是结缔组织中的 是由 有许漫液。少数写芙祖 附近 肌 腱立肌肉、皮肤之间。凡摩擦力豆压力较大的 都可 宾耐接转确期高的承动市或避兔 Bursae are sacs lined with a membrane similar to synovium; they usually are located about joints or where skin, tendon, or muscle moves over a bony prominence. u may or may not communicate with a joint Function: reduce friction, protect delicate structures from ressure

◼ 滑囊炎是指滑囊的急性或慢性炎症。滑囊是结缔组织中的 囊状间隙，是由内皮细胞组成的封闭性囊，内壁为滑膜， 有少许滑液。少数与关节相通，位于关节附近的骨突与肌 腱或肌肉、皮肤之间。凡摩擦力或压力较大的地方，都可 有滑囊存在，其作用主要是有利于滑动，从而减轻或避免 关节附近的骨隆突和软组织间的摩擦和压迫 ◼ Bursae are sacs lined with a membrane similar to synovium; they usually are located about joints or where skin, tendon, or muscle moves over a bony prominence. ◼ may or may not communicate with a joint. ◼ Function: reduce friction, protect delicate structures from pressure

Guadriceps Femur emons Bake musc Gastrocnemius st e uprag Semimembranosus ursa muscle Plantaris e prepatellar Pedicle Gastrocnemius bursa muscle (lateral head semimembranosus Superficial bursa nfrapatellar Synovial sacs Gastrocnemius musde Medial collateral (medial head ligament infrapatellar bursa Anserine bursa Tendons of gracilis sartorius, an semitendinosus muscles

Bursae are similar to tendon sheaths and the he synovial membranes of joints and are subject to the same disturbances:(1)acute or chronic trauma,(2) acute or chronic pyogenic化脓性 infection,and(3) low-grade inflammatory conditions such as gout, syphilis tuberculosis or rheumatoid arthritis Two types of bursae: normally present(as over the patella and olecranon) and adventitious ones(such as develop over a bunion 姆囊炎, an osteochondroma'骨 软骨瘤, or kyphosis背 of the spine). Adventitious bursae are produced by repeated trauma or constant friction摩擦 or pressure

◼ Bursae are similar to tendon sheaths and the synovial membranes of joints and are subject to the same disturbances: (1) acute or chronic trauma, (2) acute or chronic pyogenic化脓性 infection, and (3) low-grade inflammatory conditions such as gout, syphilis, tuberculosis, or rheumatoid arthritis. ◼ Two types of bursae: normally present (as over the patella and olecranon) and adventitious ones (such as develop over a bunion姆囊炎, an osteochondroma骨 软骨瘤, or kyphosis驼背 of the spine). Adventitious bursae are produced by repeated trauma or constant friction摩擦 or pressure

■急性滑囊炎:急性滑囊炎的治疗的特征是 疼痛,局限性压痛和活动受限。如为浅部 滑囊受累(髌前及鹰嘴),局部常红肿,化学 性(如结晶所致)或细菌性滑囊炎均有剧烈疼 痛,局部皮肤明显发红、温度升高,发作 可持续数日到数周,而且多次复发。异常 运动或用力过度之后能出现急性症状

◼ 急性滑囊炎：急性滑囊炎的治疗的特征是 疼痛，局限性压痛和活动受限。如为浅部 滑囊受累(髌前及鹰嘴)，局部常红肿，化学 性(如结晶所致)或细菌性滑囊炎均有剧烈疼 痛，局部皮肤明显发红、温度升高，发作 可持续数日到数周，而且多次复发。异常 运动或用力过度之后能出现急性症状

Treatment---the cause of the bursitis Systemic cause. such as gout痛风 or syphili梅每毒, and local trauma or irritants should be eliminated, and when necessary the patient's occupation or posture should be changed. One or more of the following local measures usuall are helpful: Rest, hot wet packs, elevation, and If necessary, immobilization of the affected part

Treatment---the cause of the bursitis Systemic causes, such as gout痛风 or syphilis梅毒, and local trauma or irritants should be eliminated, and, when necessary, the patient's occupation or posture should be changed. One or more of the following local measures usually are helpful: Rest, hot wet packs, elevation, and, if necessary, immobilization of the affected part

Surgical procedures useful in treating bursitis are Aspiration and injection of an appropriate drug, (2) incision and drainage when an acute suppurative化脓性 bursitis fails to respond to nonsurgical treatment, 3)excision of chronically infected and thickened bursae, and(4) removal of an underlying bony prominence

◼ Surgical procedures useful in treating bursitis are (1) aspiration and injection of an appropriate drug, (2) incision and drainage when an acute suppurative 化脓性bursitis fails to respond to nonsurgical treatment, (3) excision of chronically infected and thickened bursae, and (4) removal of an underlying bony prominence

Carpal Tunnel syndrome 腕管综合症 (another name: tardy median palsy) results from compression of the median nerve within the carpal tunnel The syndrome consists predominantly Incision of tingling刺痛 and numbness inthe Palmar branch of median ner typical median nerve distribution in the Flexor carpi radialis radial three and one-half digits(thumb, hals. Median nerve Palmaris longus index, long, radial side of ring). Pain occurs diffusely in the hand and radiates up the forearm. Thenar手掌 atrophy usually is seen later in the course of the nerve compression 横衫帮

Carpal Tunnel Syndrome 腕管综合症 (another name: tardy median palsy) results from compression of the median nerve within the carpal tunnel. The syndrome consists predominantly of tingling刺痛 and numbness in the typical median nerve distribution in the radial three and one-half digits (thumb, index, long, radial side of ring). Pain occurs diffusely in the hand and radiates up the forearm. Thenar手掌 atrophy usually is seen later in the course of the nerve compression. innervated

The syndrome frequently is associated with nonspecific tenosynovial edema and rheumatoid tenosynovitis, as are trigger finger and de Quervain disease. Some studies reported biopsy specimens of the flexor tendon synovium from 21 atients with " idiopathic特发性”capl tunnel syndrome. The findings were Similar in all and were typical of a connective tissue结缔组织 undergoing degeneration under repeated mechanical stress

◼ The syndrome frequently is associated with nonspecific tenosynovial edema and rheumatoid tenosynovitis, as are trigger finger and de Quervain disease. Some studies reported biopsy specimens of the flexor tendon synovium from 21 patients with “idiopathic特发性”carpal tunnel syndrome. The findings were similar in all and were typical of a connective tissue结缔组织 undergoing degeneration under repeated mechanical stress