「基礎醫學-解剖學」骨骼系統

腦顱 (Braincase):Cranium

面顱 (Facial skeleton):Viscerocranium

耳朵

三塊聽小骨位在顳骨之中。
The three auditory ossicles are located within the temporal bone.

甲狀軟骨




喉結(laryngeal prominence),又稱為 Adam's apple,主要是由喉部(larynx)的甲狀軟骨(thyroid cartilage)構成,是人類頸部前方突出的部位,其中男性又比女性更突出,原因為雄性激素會促進甲狀軟骨生長。
The thyroid prominence, also known as the Adam's apple, is a protrusion in the front of the neck that is mainly composed of the thyroid cartilage of the larynx. It is more prominent in men than in women due to the effects of testosterone on thyroid cartilage growth.
環甲肌(cricothyroid)的收縮可繃緊聲帶,而喉結主要是保護喉部內的聲帶、會厭等器官,還有改變聲帶的長度和張力,進而影響聲音的音高和音色。
Contraction of the cricothyroid muscle tenses the vocal cords, while the thyroid cartilage primarily serves to protect the vocal cords, epiglottis, and other laryngeal structures. It also plays a role in altering the length and tension of the vocal cords, thus affecting pitch and tone.
甲狀軟骨是人體最大的軟骨,呈蝶形,位於喉部中央。它由兩片甲狀軟骨板和一個甲狀軟骨角組成。
The thyroid cartilage is the largest cartilage in the body. It is butterfly-shaped and located in the center of the larynx. It is composed of two thyroid cartilage plates and one thyroid cartilage angle.

腭骨(palatine bone)是二塊的L形骨,形成硬腭的後面部份,鼻腔的側壁及底板的一部份,以及眼眶底板的一小部份。分隔鼻腔與口腔的硬腭後面部份是由腭骨的水平板所形成。參與鼻腔、眼眶、上顎的組成,但不參與顱腔的組成。


4.3.脊隨

4.3.1. 白質外側柱
側索位於脊髓的側方前外側溝和後側溝之間,有上行和下行傳導束。上行傳導束有脊髓丘腦束(痛覺、溫度覺和粗的觸覺纖維所組成)和脊髓小腦束(本體感受性衝動和無意識性協調運動)。下行傳導束有皮質脊髓側束亦稱錐體束(隨意運動)和紅核脊髓束(姿勢調節)。
4.3.2. 白質前柱
前索位於前外側溝的內側,主要為下行纖維束,如皮質脊髓(錐體)前束、頂蓋脊髓束(視聽反射)、內側縱束(聯絡眼肌諸神經核和項肌神經核以達成肌肉共濟活動)和前庭脊髓束(參與身體平衡反射)。兩側前索以白質前連合相互結合。
4.3.3. 灰質外側角
中央管前後的橫條灰質稱灰連合,將左右兩半灰質聯在一起。灰質的每一半由前角和後角組成。前角內含有大型運動細胞,其軸突貫穿白質,經前外側溝走出脊髓,組成前根。
4.3.4. 灰質前角
支配骨骼肌的運動神經元細胞體。


 
關於脊椎
脊髓通過頸椎、胸椎及腰椎一節,薦椎跟尾骨並無脊隨通過。
脊髓根(spinal root):使大腦傳送或接受資訊,並使神經系統得以保護。  

神經束膜(perineuriun)為神經中保護性結締組織的第二層,為一光滑透明的薄膜,將神經纖維分隔成束。神經束膜可輕易地與其包覆的神經纖維分離,以管狀外鞘的形式獨立出來。神經束膜外層為結締組織 

椎間盤位於椎體之間 

頸椎 (Cervical vertebrae)

頸椎共有7塊,其中C1(又稱寰椎)、C2(又稱軸. 椎)及C7為不典型頸椎;C1上與枕骨之枕髁形成. 寰枕關節,負責執行「點頭」動作,下與C2相連. 形成寰軸關節

頸椎、胸椎及腰椎皆有橫突 
橫突是由椎弓根後部向外側突出的一對突起。真正的橫突起,只在胸椎才能發現,最長的棘突也是在第五胸椎。位於頸椎的為肋橫突起,在腰椎的為肋骨突起。橫突起上、下有滑溜的關節面,是由上、下椎體與上、下關節所形成。

每個椎間孔皆有脊神經通過 

馬尾(cauda equina):是腰椎神經下段的神經根束簡稱,為腦的延伸,負責發送和接收骨盆器官及下肢的神經信息。當它受到壓迫,並發生馬尾症候群時,所有感覺和運動神經信息都會被阻斷,尤其是控制膀胱和腸道功能的神經,特別容易受到損傷。馬尾症候群屬於外科急症,需要及早醫治,以防止膀胱或排便控制機能受損,導致大小便失禁、性功能及感覺喪失、腿部運動功能受損、永久癱瘓等其他問題。 

從脊髓圓錐(conus medullaris)向下延伸,終絲(filum terminale)連結尾骨,用來幫忙固定脊髓

小孩和大人的骨頭相異之處
在青春期骨骺板(epiphyseal plate)對長骨的「縱向生長」最為重要,骨骺板也稱為生長板,是一種位於長骨各端骨骺中的透明軟骨盤。小孩與成人皆有生長板,但成人的生長板已停止生長,並被骺線取而代之。

肋骨

肋骨通常都是成對的,而安第斯熊是個例外,牠只有13對肋骨,其他的熊有14對肋骨,所以這也是一個屬於安第斯熊的特有特徵,有助於讓他生活在高海拔的地區。 
Ribs are usually in pairs, but the Andean bear is an exception. It has only 13 pairs of ribs, while other bears have 14 pairs. Therefore, this is also a unique feature of the Andean bear that helps it live in high-altitude areas.

安第斯熊是南美洲唯一的本土熊類,例如:委內瑞拉、哥倫比亞、厄瓜多、秘魯、玻利維亞和阿根廷;也因為牠們的眼睛周圍有金色和白色的光圈,所以也被稱為眼鏡熊
The andean bear is the only bear species native to South America, found in countries such as Venezuela, Colombia, Ecuador, Peru, Bolivia, and Argentina. They are also known as spectacled bears because they have golden and white rings around their eyes. 

骨盆骨骼

兩性骨盆的比較:骨盆入口寬度女>男;恥骨弓夾角女>男;骨盆出口寬度女>男;真骨盆深度男>女。

女性的骨盆會為了分娩做準備,由黃體和胎盤在懷孕期間分泌鬆弛素(relaxin)使骨盆韌帶鬆弛。
A woman's pelvis undergoes changes in preparation for childbirth. Relaxin, a hormone produced by the corpus luteum and placenta during pregnancy, causes the pelvic ligaments to soften and relax.

骨盆牽引是一種物理治療方法,常應用於治療下背痛、腰椎間盤突出等疾病,有助於緩解疼痛。
骨盆牽引的原理是利用牽引力拉伸脊柱,增加椎間隙,從而緩解神經根壓迫,減輕疼痛。
Pelvic traction is a physical therapy technique commonly used to treat low back pain, lumbar disc herniation, and other conditions. It helps to relieve pain by stretching the spine and increasing disc space, thereby decompressing the nerve roots and reducing pain.

在進行骨盆牽引時,通常會將病患置於牽引床上,保持仰臥位,雙腿伸直,膝、第二腳趾與滑輪在一直線位置,但這不是保持正確姿勢的唯一要求。並在病患的骨盆部位施加牽引力。
The patient is typically placed on a traction table in a supine position with legs extended, knees and second toes aligned with the pulleys,but this is not the only requirement for maintaining proper posture, and a traction force is applied to the patient's pelvis
牽引使用之拉力的具體大小應根據病患的具體情況進行調整,通常為病患體重的1/3-1/2
The specific amount of traction force used should be adjusted based on the individual patient's condition, typically ranging from 1/3 to 1/2 of the patient's body weight
為了增加牽引的效果,通常會將床尾抬高。
To enhance the traction effect, the foot end of the bed is often elevated

骨髓

是骨頭的結構之一,它是位於骨頭中心部位的軟性組織,包括紅骨髓和黃骨髓。

紅骨髓(Red Bone Marrow) 

紅骨髓存在於某些骨骼(如胸骨、肋骨、骨盆、脊椎骨等)的中心部位。紅骨髓是造血的主要地點,其中包含造血幹細胞,可以產生紅血球、白血球和血小板等血液成分。多發性骨髓瘤通常起源於紅骨髓中的浆细胞。

類澱粉來源的蛋白質前趨物質為免疫球蛋白輕鏈(immunoglobulin light chain),多發性骨髓瘤(Multiple Myeloma)會引起的類澱粉沉積症(Amyloidosis)。

而免疫球蛋白輕鏈(immunoglobulin light chain),是抗體分子的組成部分,輕鏈和重鏈是主要抗體組成的部分,用來識別和對抗外來病原體,如細菌和病毒。

多發性骨髓瘤是一種癌症,它通常起源於骨髓中的漿细胞,這些細胞產生免疫球蛋白的一種稱為輕鏈(light chain)。然而,在多發性骨髓瘤患者中,這些輕鏈有時會大量產生,並且可能沉積在不同的組織中,包括腎臟、心臟、神經系統等。這些輕鏈的沉積可以導致類澱粉沉積症,即免疫球蛋白輕鏈沉積在組織中,形成類似澱粉的沉積物,損害組織的功能。

"TNM" 是一種用於描述癌症分期的系統,通常稱為TNM分期系統。這個系統將癌症的分期細分為幾個不同的層次,以便描述腫瘤的大小、蔓延程度和轉移情況。這些字母代表著不同的詞語,以下是它們的詳細解釋:

T(Tumor,腫瘤):T代表腫瘤的大小和蔓延程度。T的數字和字母組合表示腫瘤的大小和侵犯程度,通常分為多個分級,例如T1、T2、T3等。在你提到的例子中,T3表示腫瘤相對較大或已經侵犯到周圍組織。

N(Nodes,淋巴結):N代表淋巴結的情況。N的數字表示受到影響的淋巴結的數量,通常也分為多個分級,例如N0、N1、N2等。在你提到的例子中,N1表示已經有1個淋巴結受到癌細胞的侵犯。

M(Metastasis,轉移):M代表轉移的情況。M0表示沒有遠端轉移,M1表示已經有遠端轉移到其他部位。

黃骨髓(Yellow Bone Marrow): 

黃骨髓主要存在於長骨的中心部分,如大腿骨和上臂骨。它主要是儲存脂肪細胞,並在需要時可以轉換為紅骨髓,參與造血。

骨髓不僅是造血的場所,也參與了免疫系統的調節和一些其他生理功能。多發性骨髓瘤等血液和骨髓相關的疾病可能會影響骨髓的功能,造成相關的健康問題。

踝關節骨骼


脛骨、腓骨上端與股骨相連接,下端與腓骨和距骨相連接;距骨的主要功能是連接脛骨和腓骨,一同組成踝關節(ankle joint),並在足踝關節中起到支撐和轉動的作用。
The tibia and fibula articulate with the femur at their proximal ends and with each other and the talus at their distal ends. The talus's primary function is to connect the tibia and fibula, forming the ankle joint, and provide support and rotation within the ankle joint.

骨骼疾病

骨性關節炎

骨性關節炎是一種退行性關節疾病,其特徵是關節軟骨的磨損和退化,是一種慢性退行性關節疾病,不是炎症性關節疾病,最先侵犯的是大關節,如膝關節、髖關節等,而周邊小關節通常在晚期才會受累。
Osteoarthritis (OA) is a degenerative joint disease characterized by the wear and tear of articular cartilage. It is a chronic degenerative joint disease, not an inflammatory joint disease. It first affects large joints, such as the knees and hips, and peripheral small joints are usually not affected until the late stage.

關節軟骨是一種覆蓋在關節末端的結締組織,可以緩衝骨骼之間的摩擦。隨著年齡的增長,關節軟骨會逐漸磨損和退化,導致關節面暴露,引起疼痛、僵硬和腫脹。
Articular cartilage is a connective tissue that covers the ends of bones and acts as a cushion to reduce friction between the bones. As we age, articular cartilage gradually wears and degenerates, exposing the joint surface and causing pain, stiffness, and swelling.

骨性關節炎的疼痛通常在活動後加劇,休息後緩減。
The pain of osteoarthritis is usually worse after activity and improves with rest.
這是因為在活動時,關節軟骨會受到更大的摩擦和磨損,從而引起疼痛。
This is because during activity, articular cartilage is subjected to greater friction and wear, which causes pain.
而休息時,關節軟骨可以得到休息和修復,疼痛就會減輕。
During rest, articular cartilage can rest and repair, and the pain will be relieved.

類風濕性關節炎(rheumatoid arthritis)


類風濕性關節炎是一種自身免疫性關節疾病,其特徵是關節滑膜的炎症。
Rheumatoid arthritis (RA) is an autoimmune joint disease characterized by inflammation of the synovial membrane.
類風濕性關節炎的疼痛通常在晨起時最為嚴重,經過活動後會有所緩解。
The pain of rheumatoid arthritis is typically most severe in the morning and improves with activity.
關節滑膜是一種覆蓋在關節內壁的組織,可以分泌潤滑液,滋養關節軟骨。
The synovial membrane is a tissue that lines the inside of joints and produces synovial fluid, which lubricates and nourishes the articular cartilage.
在類風濕性關節炎中,關節滑膜會發生炎症,導致關節疼痛、僵硬和腫脹。
In rheumatoid arthritis, the synovial membrane becomes inflamed, leading to joint pain, stiffness, and swelling.

最常發生非化膿性增殖性滑液膜炎(proliferative synovitis)。
滑液膜是包裹關節的薄膜,它分泌滑液,使關節能夠順利運動。在類風濕性關節炎中,滑液膜會發生發炎和增生,導致關節腫脹、疼痛和僵硬,及活動受限。
非化膿性增殖性滑液膜炎是指滑液膜發生非化膿性炎症,並伴有細胞增生。這種炎症是類風濕性關節炎的典型特徵。
滑液膜炎如果不及時治療,可能會導致關節軟骨和骨骼的破壞,最終導致關節畸形和功能障礙。
Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation of the synovium, the thin membrane that lines the joint and secretes synovial fluid. This inflammation, known as non-suppurative proliferative synovitis, leads to joint swelling, pain, stiffness, and limited range of motion. 
Non-suppurative proliferative synovitis is a type of inflammation that occurs in the synovium and is characterized by the growth of new cells. This inflammation is a hallmark of rheumatoid arthritis.
If left untreated, RA can cause joint damage and deformity.

類風溼性關節炎發炎活動期,可冷敷勿按摩關節,而Omega-3 脂肪酸具有抗發炎作用,可改善類風溼性關節炎症狀,抗腫瘤壞死因子藥物能讓關節紅腫熱痛在給藥後 1~2 週改善,而類固醇會抑制免疫系統,反而可能加重感染
uring a rheumatoid arthritis flare-up, cold compresses are recommended, but joint massage should be avoided. Omega-3 fatty acids have anti-inflammatory properties and can improve rheumatoid arthritis symptoms. Tumor necrosis factor inhibitors can reduce joint redness, swelling, heat, and pain within 1-2 weeks of treatment. Corticosteroids, on the other hand, can suppress the immune system and potentially increase the risk of infection.

脊柱側彎(scoliosis)

脊柱側彎會導致脊椎向一側彎曲,當身體前彎時,彎曲的部分會更明顯地凸起,形成高低差。
以至於雙側背部會出現高低不平的現象,而非對稱的突峰。這稱為亞當氏前彎測試,是診斷脊柱側彎的常見方法之一。
Scoliosis causes the spine to curve to one side. When a person bends forward, the curve becomes more pronounced, creating a visible hump. This results in an uneven appearance of the back, rather than symmetrical peaks. This is known as the Adam's forward bend test, and it is a common method for diagnosing scoliosis.   

脊柱側彎會導致身體兩側不對稱,肩膀、骨盆等部位的高度和位置也可能出現差異。
Scoliosis can lead to asymmetry on both sides of the body, with differences in the height and position of the shoulders, pelvis, and other areas.

Cobb 氏量角法是目前最常用的方法,透過X光片測量脊椎彎曲的角度,來評估側彎的嚴重程度。
The Cobb angle measurement is the most commonly used method to assess the severity of the curve. This involves measuring the angle of the spinal curve on an X-ray.   

脊柱側彎常伴隨骨盆傾斜、身體一側的肋骨突出、軀幹不對稱,導致身體重心偏移。
Scoliosis is often accompanied by pelvic tilt, a rib hump on one side of the body, and trunk asymmetry, leading to a shift in the body's center of gravity.

全髖關節置換術術後After total hip replacement

使用長柄輔助物或他人協助穿鞋襪,可以避免過度彎腰,保護髖關節,同樣的病人因車禍昏迷入院,仰臥期間,護理師於病人兩腿外側用粗隆捲軸從腰部到膝蓋加以固定與支托,兩者在髖關節的保護上卻有著共同的目標:預防髖關節外旋。
在雙腿間夾枕頭協助翻身及翻向健側,可以保持髖關節外展,採用了物理性的方式(粗隆捲軸、枕頭等)來固定和支撐髖關節,以減少外旋的風險,髖關節外旋若不加以控制,可能導致關節不穩定、疼痛,甚至脫位,因此預防髖關節外旋是兩種情況下的共同目標。
坐姿時髖關節屈曲不可大於90度,可以避免人工關節脫位。
全髖關節置換術後,在醫師評估下,患者通常在術後1-2天內即可在床上活動,並在護理人員協助下下床活動。
而骨泥是一種生物材料,用於填補骨缺損,促進骨癒合。它的存在並不會影響患者下床活動的時間
using a long-handled shoehorn or seeking assistance from others to put on socks and shoes can prevent excessive bending and protect the hip joint. Similarly, for a comatose patient due to a car accident, using a trochanter roll from the waist to the knee on both sides of the legs while supine can prevent external rotation of the hip joint. Both scenarios employ physical methods (such as trochanter rolls and pillows) to fix and support the hip joint, reducing the risk of external rotation. Uncontrolled external rotation can lead to joint instability, pain, and even dislocation. Therefore, preventing external rotation is a common goal in both situations. Placing a pillow between the legs during turning can maintain hip abduction and prevent dislocation. Hip flexion should not exceed 90 degrees when sitting to avoid dislocation of the artificial joint. Under the doctor's assessment, patients who have undergone total hip replacement can usually start bed activities 1-2 days post-surgery and get out of bed with the assistance of nursing staff. Bone cement, a biological material used to fill bone defects and promote bone healing, does not affect the timing of the patient's ambulation.

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