人体结构与功能学 Human Anatomy and Physiology 运动系统 / 肌肉骨骼系统 Locomotor system/musculoskeletal system 骨学 Osteology 关节学 Arthrology 肌学 Skeletal muscle 1
人体结构与功能学 Human Anatomy and Physiology Skeletal Muscle Tissue 骨骼肌 陈晓 Chenxiao.610@gmail.com 浙江大学医学院干细胞与组织工程中心临床医学 运动医学博士 人类所有改造世界 改造自己的意 识活动都需要通过骨骼肌运动实现 2
骨骼肌常见疾病 : 难以治疗 肌肉创伤 : 肌肉损伤 肌腱损伤 ( 刘翔, 肩周炎 ), 一半以上的肌肉骨骼系统创伤 肌肉衰老 : 老年性变化的主要特征之一, 易摔倒导致骨折及其他损伤 骨骼肌常见疾病 : 难以治疗 神经原性肌萎缩 ( 霍金, 肌肉萎缩性侧索硬化症 ) 常见肌病 : 重症肌无力 进行性肌营养不良 周期性瘫痪 肌肉萎缩 3
课程设置 -- 骨骼肌理论课程内容,2.5 学时 课程目标 : 能分析大关节运动时肌肉力学模式 从肌肉 肌腱组织结构分析损伤时修复的策略 总论 : 人体的重要骨骼肌分布 分类和生物力学模型 一 肌肉的构造与各部分的功能 : 肌腹 肌腱 神经血管, 筋膜 二 肌肉的组织成分与功能 : 细胞 ( 肌肉细胞 / 肌纤维 卫星细胞 间质干细胞 血管内皮细胞, 肌腱细胞, 肌腱干细胞 ) 细胞外基质 ( 胶原, 多糖, 糖蛋白 ) 三 肌肉的收缩机制和功能 四 肌肉营养 生长 维持和愈合过程 课程设置 -- 骨骼肌课程内容 总论 : 人体的重要骨骼肌分布 分类和生物力学模型 一 肌肉的构造与各部分的功能 : 肌腹 肌腱 神经血管, 筋膜 二 肌肉的组织成分与功能 : 细胞 ( 肌肉细胞 / 肌纤维 卫星细胞 间质干细胞 血管内皮细胞, 肌腱细胞, 肌腱干细胞 ) 细胞外基质( 胶原, 多糖, 糖蛋白 ) 三 肌肉的收缩机制和功能 四 肌肉营养 生长 维持和愈合过程 4
思考题 - 课堂提问 周测及应用 周测 : 学习完后可应用知识分析日常生活 临床损伤 (1,2, 3) 及研究 (4)( 简答题 100 字左右描述, 也可自由发挥, 有不理解处请提问 ) 若想拥有施瓦辛格式的胸肌, 请从相关肌肉及关节的类型 功能做出肌肉运动的力学模型及实际动作 ( 从人体主要肌群的功能解释肌肉针对性训练的动作, 选一 : 股四头肌, 胸大肌, 肱二头肌等 ) 从肌肉 - 骨形成的力学杠杆特性简述各种关节的运动特征 ( 选一 ): 力学强度 运动速度, 灵活性及从关节所受力学分析其易损伤程度 ( 肩, 肘 膝, 踝关节 ) 根据弯腰时背部肌肉收缩对椎间盘的压力模式, 估计竖脊肌收缩时椎间盘所受的压力 ( 特别是搬重物, 坐车时颠簸等等常见不正确姿势 ), 如何避免生活中椎间盘急性及慢性损伤 ( 上两题为包括关节学内容, 关节课程有讨论, 主要为服务于是生活, 可只回答肌肉 - 关节力学杠杆模式 ) 简述肌肉 肌腱组织干细胞种类, 并简要分析及在损伤修复过程中应用 Pandect muscle system 1/3 OF HUMAN BODY Skeletal 骨骼肌 only voluntary muscle tissue ( 自主运动 ) Striated 横纹肌 Heart 心肌 Involuntary Striated Smooth 平滑肌 Involuntary Non-Striated 5
Pandect skeletal muscle system properties Contractible Extensible Excitable Function Action of body: Powerful contraction (100W/Kg) Joint stabilization Heat Do you know the magic power of your muscles? Cherish your health and bodies!! 衰老导致肌力 协调力下降是摔倒主因 :do exercise to delay aging!!! How and why you can anti-aging??? 1.Jonas Rantanen 深蹲 575 公斤 2.Donnie Thompson 深蹲 573 公斤 3 Vladislav Alhazov 深蹲 567 公斤 4 Mike Miller 深蹲 553 公斤 正常成年人肌肉的力量 : How about you,..100kg? 40N/cm2,10-20t/ person why don t you know? you are so strong? 人类不借外力和杠杆作用所能移动的最大重量 : 腿举 Jeff 1870 Lewis 公斤 ( 德国大力士台式腿举 Hermann 37.15 吨? Gorner) 6
Pandect classify of skeletal muscle type Size: vastus (huge); maximus (large); longus (long); minimus (small); brevis (short). Shape: deltoid (triangular 三角肌 ); rhomboid (like a rhombus with equal and parallel sides); latissimus (wide); teres (round); trapezius ( 斜方肌 like a trapezoid, a four-sided figure with two sides parallel). Direction of fibers: rectus (straight); transverse (across); oblique (diagonally); orbicularis (circular). Location: pectoralis (chest); gluteus (buttock or rump 臀肌 ); brachii (arm); supra- (above); infra- (below); sub- (under or beneath); lateralis (lateral). Number of origins: biceps (two heads); triceps (three heads); quadriceps (four heads). Origin and insertion:sternocleidomastoideus (origin on the sternum and clavicle, insertion on the mastoid process 胸锁乳突肌 ); brachioradialis (origin on the brachium or arm, insertion on the radius 肱桡肌 ). Action: abductor (to abduct a structure 展肌 ); adductor (to adduct a structure); flexor (to flex a structure); extensor (to extend a structure); levator (to lift or elevate a structure); masseter (a chewer). Pandect morphological skeletal muscle type 短肌长肌 轮匝肌 二腹肌 阔肌 羽状肌 Some skeletal muscles are broad in shape and some narrow. In some muscles the fibers are parallel to the long axis of the muscle; in some they converge to a narrow attachment; and in some they are oblique: 请举例 7
Pandect skeletal muscle mechanical model Muscle Muscle-tendon junction Tendon Tendon bone junction Typical skeletal muscle structure Force by muscle contraction 从重要关节分析重要肌肉的分布及功能 shoulder joint 肩关节 : pectoralis major 胸大肌, 三角肌, 斜方肌, 背阔肌, 肩袖相关肌肉 脊柱 : 竖脊肌 erector spinae ( 视频资料均来自互联网,30m) Elbow 肘关节 : 肱二头肌 biceps brachii, 肱三头肌, 前臂群 髋 膝 踝关节 : 臀大肌 内收肌群, 股四头肌 quadriceps femoris 小腿三头肌, ( 伸肌群 ) 8
Pandect skeletal muscle mechanical model muscle lever system First class lever: elbow( 肘关节 ) 动力点 阻力点分别在支点的两边 Pandect skeletal muscle mechanical model Second class lever: ankle joint( 踝关节 ) 省力杠杆 Third class lever: elbow ( 肘关节 ) 费力杠杆 9
肌肉的结构与功能 From single molecular to muscle tissue Structure of muscle : from whole muscles to myofilaments Macro- structure: Muscle tissue, nerve, vascular etc. Micro- structure Muscle cells, blood, ECM Ultra- structure: myosin 10
Structure of muscle tissue A whole skeletal muscle is considered an organ of the muscular system: 肌肉结构相关视频 ( 视频资料均来自互联网 ) skeletal muscle tissue: 肌腹 nerve tissue connective tissue blood or vascular tissue. 肌束膜 肌纤维 肌腱 肌外膜 肌内膜 筋膜 Function of muscle tissue Contract to create force: 肌纤维收缩视频 Move body Stable body 11
Structure and Function of Nerve tissue Nerve tissue: Neuromuscular spindle, neuromuscular junction Neuromuscular spindle 肌梭 1mmX 0.05-13mm Essential for controlling muscle contraction proprioceptive information http://baike.baidu.com/picview/821152/821152/0/574e9258d109b3deb341a6d 8ccbf6c81810a4c87.html#albumindex=0&picindex=0 Structure and Function of Nerve tissue: neuromuscular junction neuromuscular junction 神经肌肉接头, 终板 神经肌肉信号传递视频 Terminals of motor neurons Release neurotransmitter to control muscle contraction Nutrition 12
Function of nerve tissue on muscle determination: Innervate muscles 营养性作用 切断运动神经后, 肌肉因失去神经的营养性作用而出现萎缩 将支配慢肌和支配快肌的神经分别切断, 然后将支配快肌的中枢端与支配慢肌的神经的外周缝合, 待神经再生后, 慢肌就可转变成快肌 Question: 如何延缓肌肉衰老? 机体自己并不知道如何保持肌肉的修复功能 80 岁的男性平均损失 40% 的肌肉重量, 上了年纪的人容易摔倒或骨折并因此住院治疗 在医院他们又会失去更多的肌肉力量, 而且不会再恢复 50m Structure and Function of Nerve tissue Golgi tendon organs: 500X100um Losser collagen fibers Larger fibroblasts Near MTJ( 肌肉 - 肌腱连接 ) Activated by stretch of the tendon Providing proprioceptive information( 本体感觉, 位置 ) Very sensitive (much higher than muscles) No one knows its function on tendon regeneration and development Question : what is your opinion on Golgi tendon organs regeneration? 13
Blood supply of muscle Abundant Generally, an artery and at least one vein accompany each nerve that penetrates the epimysium of a skeletal muscle. Branches of the nerve and blood vessels follow the connective tissue components of the muscle of a nerve cell and with one or more minute blood vessels called capillaries Blood supply of muscle Classification of blood supply 14
Supplementary structures 1. Fascia Superficial fascia Deep fascia Intermuscular septa 肌间隔 Reti naculum 支持带 Osseofascial compartment 骨筋膜鞘 2. Tendinous sheath 腱鞘 3. Synovial bursa 滑液囊 4. Sesamoid bones 籽骨 Teninous sheath 腱鞘 Common flexor sheath 15
Connective tissue: Tendon Tendon: Dense fibrous connective tissue Connect muscle to bone Transmit the forces when movement Heterogeneous fibril diameter and crimp pattern Structure collagen molecules Cells tendon cells (tenocytes) chondrocytes synovial cells vascular cells smooth muscle cells capillary endothelial cells 2014 年 2 月 28 日星期五 4 时 35 31 分 43 秒 Structure of collagen 肌的分群 16
17 肌的分部肌的分部肌的分部肌的分部 1. 头颈肌头颈肌头颈肌头颈肌头肌头肌头肌头肌颈肌颈肌颈肌颈肌 2. 躯干肌躯干肌躯干肌躯干肌胸肌胸肌胸肌胸肌膈肌膈肌膈肌膈肌腹肌腹肌腹肌腹肌 3. 四肢肌四肢肌四肢肌四肢肌上肢肌上肢肌上肢肌上肢肌下肢肌下肢肌下肢肌下肢肌肌的分部肌的分部肌的分部肌的分部 1. 头颈肌头颈肌头颈肌头颈肌头肌头肌头肌头肌颈肌颈肌颈肌颈肌 2. 躯干肌躯干肌躯干肌躯干肌胸肌胸肌胸肌胸肌膈肌膈肌膈肌膈肌腹肌腹肌腹肌腹肌 3. 四肢肌四肢肌四肢肌四肢肌上肢肌上肢肌上肢肌上肢肌下肢肌下肢肌下肢肌下肢肌
Muscles of head 头肌 Craniofacial muscles 颅面肌 Epicranius 颅顶肌 Orbicularis oculi Muscles around mouth Masticatory muscles 咀嚼肌 Masseter 咬肌 Temporalis 颞肌 Medial pteryoid 翼内肌 Lateral pterygoid 翼外肌 Craniofacial muscles 颅面肌 Epicranius 颅顶肌 Orbicularis oculi 眼轮匝肌 Muscles around mouth 口周围肌 18
Masticatory muscles 咀嚼肌 1. Masseter 咬肌 2. Temporalis 颞肌 3. Medial pteryoid 翼内肌 4. Lateral pterygoid 翼外肌 2 1 4 3 19
Muscles of neck 颈肌 Superficial cervical muscles 颈浅层肌 Suprahyoid muscles 舌骨上肌群 Infrabyoid muscles 舌骨下肌群 Deep cervical muscles 颈深肌群 20
Superficial cervical muscles 颈浅层肌 颈浅层肌 1.Platysma 颈阔肌 2.Sternocleidomastoid 胸锁乳突肌 1 2 Suprahyoid muscles 舌骨上肌群 舌骨上肌群 1. Digastric 二腹肌 2. Mylohyoid 下颌舌骨肌 3. Stylohyoid 茎突舌骨肌 4. Geniohyoid 颏舌骨肌 3 1 2 21
Infrabyoid muscles 舌骨下肌群 舌骨下肌群 1. Sternohyoid 胸骨舌骨肌 2. Sternothyroid 胸骨甲状肌 3. Thyrohyoid 甲状舌骨肌 4. Omohyoid 肩胛舌骨肌 4 3 1 2 22
Deep cervical muscles 颈深肌群 颈深肌群 Anterior group Longus colli 颈长肌 Lateral group 1.Scalenus anterior 前斜角肌 2.Scalenus medius 中斜角肌 3.Scalenus posterior 后斜角肌 2 1 Scalene fissure 斜角肌间隙 23
Deep cervical muscles 颈深肌群 颈深肌群 Anterior group Longus colli 颈长肌 Lateral group 1.Scalenus anterior 前斜角肌 2.Scalenus medius 中斜角肌 3.Scalenus posterior 后斜角肌 2 1 Scalene fissure 斜角肌间隙 Scalene fissure 斜角肌间隙 24
Muscles of trunk 躯干肌 Muscles of back 背肌 Muscles of thorax 胸肌 Diaphragm 膈 Muscles of abdomen 腹肌 Muscles of back 背肌 1. Trapezius 斜方肌 2. Latissimus dorsi 背阔肌 3. Levator scapulae 肩胛提肌 4. Rhomboideus 菱形肌 5. Erector spinae 竖脊肌 6. Splenius 夹肌 Thoracolumbar fascia 胸腰筋膜 2 1 6 3 4 5 5 25
Muscles of thorax 胸肌 胸肌 Thoracico-upper-limb muscles 胸上肢肌 1. pectralis major 胸大肌 2. pectoralis minor 胸小肌 3. serratus anterior 前锯肌 前锯肌 Thoracico-intrinsic muscles 胸固有肌 : 1. Intercostales externi 肋间外肌 2. Intercostales interni 肋间内肌 3. Intercostales intimi 肋间最内肌 肋间最内肌 1 2 3 4 26
Diaphragm 膈 Location Dome-shape, central tendon Three parts: Sternal part 胸骨部 Costal part 肋部 Lumbar part 腰部 Three hiatus: Aortic hiatus 主动脉裂孔 Wsophageal hiatus 食管裂孔 Vena caval foramen 腔静脉孔 Two triangle Lumbocostal triangle 腰肋三角 Sternocostal triangle 胸肋三角 Actions 27
Muscles of abdomen 腹肌 Anteriolateral group Obliquus externus abdominis 腹外斜肌 Obliquus internus abdominis 腹内斜肌 Transversus abdominis 腹横肌 Rectus abdominis 腹直肌 Posterior group Psoas major 腰大肌 Quadratus lumborum 腰方肌 Sheath of rectus abdominis 腹直肌鞘 Linea alba 白线 Inguinal canal 腹股沟管 Inguinal triangle 腹股沟三角 Anteriolateral group Abliguus externus abdominis 腹外斜肌 28
Anteriolateral group Obliguus internus abdominis 腹内斜肌 Anteriolateral group Transversus abdominis 腹横肌 29
Anteriolateral group Rectus abdominis 腹直肌 Posterior group Quadratus lumborum 腰方肌 Psoas major 腰大肌 30
Sheath of rectus abdominis 腹直肌鞘 Linea alba 白线 Inguinal canal 腹股沟管 简述腹股沟管的位置 形态 四壁两口 ) 及通过内容 形态 ( 四壁两口 31
Muscles of upper limb 上肢肌 Muscles of scapula 肩带肌 Muscles of arm 臂肌 Muscles of forearm 前臂肌 Muscles of hand 手肌 Muscles of scapula 肩带肌 1.Deltoid 三角肌 2.Supraspinatus 冈上肌 3.Infraspinatus 冈下肌 冈下肌 4. Teres minor 小圆肌 5. Teres major 大圆肌 6. Sudscapularis 肩胛下肌 肩胛下肌 2 1 3 4 6 5 32
Muscles of arm 臂肌 Anterior group Biceps brachii 肱二头肌 Brachialis 肱肌 Coracobrachialis 喙肱肌 1 3 1 2 1 Muscles of arm 臂肌 Posterior group Triceps brachii 肱三头肌 1 33
Muscles of forearm 前臂肌 They consist of anterior and posterior groups. The anterior groups can be divided into four layers: The superficial layer: 1. Brachioradialis 肱桡肌 2. Pronator teres 旋前圆肌 3. Flexor carpi radialis 桡侧腕屈肌 4. Palmaris longus 掌长肌 1 2 5. Flexor carpi ulnaris 尺侧腕屈肌 3 4 The second layer 5 6. Flexor digitorum superficialis 指浅屈肌 The third layer 7. Flexor pollicis superficialis 拇长屈肌 8. Flexor digitorum profundus 指深屈肌 The fourth layer 9. Pronator quadratus 旋前方肌 6 7 8 9 Muscles of forearm 前臂肌 The posterior groups can be divided into two layers: Superficial layer: 1. Extensor carpi radialis longus 桡侧腕长伸 肌 2. Extensor carpi radialis brevis 桡侧腕短伸 肌 3. Extensor digitorum 指伸肌 4. Extensor digiti minimi 小指伸肌 5. Extensor carpi ulnaris 尺侧腕伸肌 Deep layer: 1. Supinator 旋后肌 2. Abductor pollicis longus 拇长展肌 3. Extensor pollicis brevis 拇短伸肌 4. Extensor pollicis longus 拇长伸肌 5. Extensor indicis 示指伸肌 5 4 3 1 2 10 6 7 9 8 34
Muscles of hand 手肌 Lateral Group 外侧群 ( 大鱼际 ) 1. Abductor pollicis brevis 拇短展肌 2. Flexor pollicis brevis 拇短屈肌 3. Opponens pollicis 拇对掌肌 4. Abductor pollicis 拇收肌 Medial Group 内侧群 ( 小鱼际 ) 1. Abductor digiti minimi 小指展肌 2. Flexor digiti minimi brevis 小指短屈肌 3. Opponens digiti minimi 小指对掌肌 Intermediate Group 中间群 1. Lumbricales 蚓状肌 2. Palmar interossei 骨间掌侧肌 3. Dorsal interossei 骨间背侧肌 1 8 2 6 5 Muscles of hand 手肌 Lateral Group 外侧群 ( 大鱼际 ) 1. Abductor pollicis brevis 拇短展肌 2. Flexor pollicis brevis 拇短屈肌 3. Opponens pollicis 拇对掌肌 4. Abductor pollicis 拇收肌 Medial Group 内侧群 ( 小鱼际 ) 1. Abductor digiti minimi 小指展肌 2. Flexor digiti minimi brevis 小指短屈 肌 小指短屈 3. Opponens digiti minimi 小指对掌肌 Intermediate Group 中间群 1. Lumbricales 蚓状肌 2. Palmar interossei 骨间掌侧肌 3. Dorsal interossei 骨间背侧肌 骨间背侧肌 3 9 7 35
Muscles of lower limb 下肢肌 Muscles of hip 髋肌 Muscles of thigh 大腿肌 Muscles of leg 小腿肌 Muscles of foot 足肌 Muscles of hip (pelvic girdle) 髋肌 Anterior group 1. Iliopsoas 髂腰肌 2. tensor fasciae latae 阔筋膜张肌 阔筋膜张肌 1. 2. 36
Muscles of hip (pelvic girdle) 髋肌 Anterior group 1. Iliopsoas 髂腰肌 2. tensor fasciae latae 阔筋膜张肌 阔筋膜张肌 Posterior group 1. gluteus maximus 臀大肌 2. gluteus medius 臀中肌 3. gluteus minimus 臀小肌 4. Piriformis 梨状肌 5. obturator internus 闭孔内肌 6. quadratus femoris 股方肌 7. obturator reternus 闭孔外肌 闭孔外肌 3 6 5 7 8 4 Muscles of thigh 大腿肌 Anterior group 1. Sartorius 股四头肌 2. Guadriceps femoris 缝匠肌 Medial group 1. Pectineus 耻骨肌 2. Adductor 长收肌 3. Gracilis 股薄肌 4. Adductor brevis 短收肌 5. Adductor magnus 大收肌 1 2 3 4 3 5 6 1 7 37
Muscles of thigh 大腿肌 Anterior group 1. Sartorius 股四头肌 2. Guadriceps femoris 缝匠肌 Medial group 1. Pectineus 耻骨肌 2. Adductor 长收肌 3. Gracilis 股薄肌 4. Adductor brevis 短收肌 5. Adductor magnus 大收肌 Posterior group 1. Biceps femoris 股二头肌 2. Semitendinosus 半腱肌 3. Semimembranosus 半膜肌 10 9 8 Muscles of leg 小腿肌 Anterior group 1. Tibialis anterior 胫骨前肌 2. Extensor digitorum 趾长伸肌 3. Extensor hallucis longus 踇长伸肌 Lateral group 1. Peroneus longus 腓骨长肌 2. Peroneus brevis 腓骨短肌 腓骨短肌 踇长伸肌 2 1 4 3 5 38
Muscles of leg 小腿肌 Anterior group 1. Tibialis anterior 胫骨前肌 2. Extensor digitorum 趾长伸肌 3. Extensor hallucis longus 踇长伸肌 Lateral group 1. Peroneus longus 腓骨长肌 2. Peroneus brevis 腓骨短肌 Posterior group Superficial layer: Triceps 小腿三头肌 Gastrocnemius 腓肠肌 Soleus 比目鱼肌 Deep layer 1. Popliteus 腘肌 2. Flexor digitorum longus 趾长屈肌 3. Flexor hallucis longus 踇长屈肌 4. Tibialis posterior 胫骨后肌 胫骨后肌 6 6 7 8 9 10 11 Muscles of foot 足肌 39
思考题 1. 了解骨骼肌的构造 形态 命名原则和配布规律 2. 肌的辅助结构有哪些? 3. 分别试述上 下肢肌群的配布及其功能 4. 试述头颈部肌的分群 5. 试述主要的呼吸肌有哪些? 40