Sacral vertebrae type of connection. Connections of the bones of the body - vertebrae, ribs and sternum
The vertebrae are connected to each other using all types of connections: continuous (syndesmosis, synchondrosis and synostosis) and discontinuous (joints). There are connections between the vertebral bodies, their arches and processes.
CONNECTIONS OF VERTEBRAL BODIES
The vertebral bodies are connected to each other through continuous connections (synarthrosis, synarthroses) (Fig. 14) through:
1) fibrous tissue (syndesmosis): anterior longitudinal ligament (lig. longitudinale anterius) ( 1), which is located on the anterior surface of the vertebral bodies; posterior longitudinal ligament
(lig. longitudinale posterius) (2) - on the posterior surface of the vertebral bodies;
2) cartilage (synchondrosis): intervertebral discs (disci intervertebrales) ( 3) (after puberty). The intervertebral disc consists of a nucleus pulposus (nucleus pulposus) (4), located in the center and a fibrous ring (anulus fibrosus) (5) - on the periphery;
3) bone tissue (synostosis), which replaces the intervertebral discs between the sacral vertebrae (from 13 years of age).
UNION OF VERTEBRAL ARCHES AND PROCESSES
The vertebral arches and their processes are connected to each other continuously (synarthroses) and with the help of discontinuous connections - joints (diarthroses).
1. Continuous connections (Fig. 14, 15): between the vertebral arches - yellow ligaments
(ligamenta flava) (7); between the processes - interspinous ligaments (ligamenta interspinalia) (8),
supraspinous ligament (ligamenta supraspinalia) (in the cervical region called the nuchal ligament
(lig. nuchae)) (9), intertransverse ligaments (ligamenta intertransversaria) (10).
At the junction of the sacrum with the coccyx: sacrococcygeal ventral ligament (lig. sacrococcygeum ventrale); sacrococcygeal dorsal deep ligament (lig. sacrococcygeum dorsale profundum); sacrococcygeal dorsal superficial ligament (lig. sacrococcygeum dorsale superficiale).
2. Joints: facet joint (art. zygapophysialis) (11), which is formed by the upper and lower articular processes (processus articulares superiores et processus articulares inferiores) of adjacent vertebrae; lumbosacral joint (art. lumbosacralis);
sacrococcygeal joint (art. sacrococcygea). The facet joint is a combined joint, flat and inactive.
CONNECTION OF THE SPINAL COLUMN WITH THE SKULL
The discontinuous connection of the spinal column with the skull consists of a complex of 5 joints that allow movement of the head (skull) around three axes, as in a multi-axial (ball-and-socket) joint. Continuous connections are represented by membranes and ligaments (syndesmoses).
At the junction of the spinal column and the skull, the following joints are distinguished (Fig. 16):
1. The joint between the first cervical vertebra and the occipital bone - atlanto-zaty-
elbow joint (art. atlantooccipitalis).
2. Joints between the first and second cervical vertebrae - atlantoaxial joint
(art. atlantoaxialis).
Rice. 16. Connections of the spinal column with the skull: a, b, c - rear view; g - top view
The atlantooccipital joint (art. atlantooccipitalis) (1) is a combined joint. Formed by the occipital condyles (condyli occipitales) and the superior articular fossa -
mi Atlanta (foveae articulares superiores).
Syndesmoses: anterior atlanto-occipital membrane (membrana atlantooccipitalis anterior); posterior atlanto-occipital membrane (membrana atlantooccipitalis posterior).
The atlanto-occipital joint is a condylar (art. bicondylaris), biaxial joint. Movements: flexion (flexio) and extension (extensio) around the transverse axis; abduction (abductio) and adduction (adductio) around the sagittal axis and circular movement (circumductio).
The atlantoaxial joint (art. atlantoaxialis) consists of three joints: the median atlantoaxial joint (art. atlantoaxialis mediana) (2) - between the tooth of the second cervical vertebra (dens axis) and the tooth fossa (fovea dentis) of the atlas and two lateral atlanto-axial joints ( artt. atlantoaxiales laterales) (3) - between the lower articular fossae of the atlas and the upper articular surfaces of the second cervical vertebra (combined joint).
Syndesmoses: transverse ligament of the atlas (lig. transversum atlantis) (4); cruciate ligament of the atlas (lig. cruciforme atlantis) (5); pterygoid ligaments (ligamenta alaria) (6); ligament of the apex of the tooth (lig. apicis dentis) (7); cover membrane (membrana tectoria) (8).
Movements: rotation of the atlas, and with it rotation of the head left and right around a vertical axis, as in a cylindrical uniaxial joint.
SPINAL COLUMN AS A WHOLE
The spinal column (columna vertebralis) is formed by the vertebrae and their joints. Movement between two vertebrae is limited, but the entire spinal column performs a wide variety of movements due to the addition of movements of a large number of joints between the vertebrae. The following movements are possible in the spinal column:
1) flexion (flexio) and extension (extensio) around the frontal axis;
2) tilts to the side: abduction (abductio) and adduction (adductio) around the sagittal axis;
3) rotation (twisting) (rotatio): turning left and right around a vertical axis.
4) circular motion (circumductio).
The most mobile areas are the cervical and lumbar spine. The thoracic region is the least mobile, which is explained by the following factors:
1) the location of the articular processes is close to the frontal
2) thin intervertebral discs;
3) pronounced downward inclination of the vertebral arches and spinous processes.
The spinal column is a flexible and elastic formation and has physiological curves (Fig. 17), which serve for shock absorption, that is, to reduce shocks when walking and running on the brain and spinal cord, as well as on internal organs.
The bends are located in the sagittal plane: two forward lordoses (lordosis): cervical and lumbar (a, b); two back - kyphosis: thoracic and sacral (b, d).
The formative factor for the occurrence of bends is the action of muscles.
Cervical lordosis develops at 2–3 months, when the child begins to lift and hold his head.
Thoracic kyphosis appears in children due to the work of the muscles to maintain a sitting position at 5–7 months of life.
Lumbar lordosis and sacral kyphosis develop in connection with the function of the muscles that provide balance when a child stands and walks at 11–12 months.
In old age, there is a decrease in the flexibility and elasticity of the spinal column, a decrease in the thickness of the intervertebral discs, their calcification, progression
Rice. 17. Spinal column
thoracic kyphosis, decreased mobility.
JOINTS OF THE BONES OF THE CHEST
The joints of the bones of the chest include: 1 - joints of the chest (artt. thoracis); 2 - sternum connections; 3 - rib connections; 4 - vertebral connections.
FROM THE CHEST PARTS
The joints of the chest include:
1) costovertebrates joints (artt. costovertebrales), which include the joints of the head-
ki ribs (artt. capitis costae) and costotransverse joints (artt. costotransversariae) (Fig. 18, a);
2) sternocostal joints (artt. sternocostales) (Fig. 18, b);
3) intercartilaginous joints (artt. interchondrales).
Rib head joints(artt. capitis costae) (1) from the II to the X ribs are formed by the head of the rib and the costal fossae of the bodies of two adjacent vertebrae; the heads of the I, XI and XII ribs articulate with the complete fossae of the vertebrae of the same name).
Costal transverse joints (artt. costotransversariae) (Fig. 18, a) are formed by tubercles
lump of the rib and the costal fossa of the transverse process of the vertebra (2).
Rice. 18. Joints of the chest:
a - costovertebral joint; b - connections of the ribs with the sternum
The joints of the heads of the ribs and the costotransverse joints together form a combined, rotational joint, movements in which are carried out around one axis directed along the neck of the rib (3): when rotating from the outside inward, the cartilaginous ends of the ribs move down (exhalation), when rotating from the inside out, the cartilaginous ends the ribs and sternum rise up (inhale).
Ligaments of the costovertebral joints: radiate ligament of the rib head (lig. capitis costae radiatum) (4); intraarticular ligament of the rib head (lig. capitis costae intraarticulare) (5),
in the joints of the heads of the I, XI and XII pairs of ribs there are no these ligaments; costotransverse ligament (lig. costotransversarium) (6).
Sternocostal joints (artt. sternocostales) (7) are formed by the cartilage of the true ribs (from II to VII) and the costal notches of the sternum; less commonly, these connections are represented by symphyses. The cartilage of the first rib articulates with the manubrium of the sternum by cartilaginous fusion
(synchondrosis) (8).
Rice. 19. Whole chest
The cartilages of the VIII, IX and X ribs are connected at their ends through syndesmosis, and in the intercostal spaces between them intercartilaginous joints (artt. interchondrales) are formed (9).
Ligaments of the sternocostal joints: intra-articular sternocostal ligament (lig. sternocostale intraarticulare) (10) (for the joint of the second rib with the sternum); radiate sternal ligaments
(ligamenta sternocostalia radiata) (11); membrane of the sternum (membrana sterni) (12).
FROM THE STERMAL CONNECTION
The following connections of the sternum are found (Fig. 19): cartilaginous connections of the sternum: synchondrosis of the manubriosternalis (1), less often - symphysis of the sternum (symphysis manubriosternalis) (after 30 years it can be replaced by bone tissue -
new); synchondrosis of the xiphoid process (synchondrosis xiphosternalis) (2).
WITH RIB CONNECTION
The connections of adjacent ribs are represented by syndesmoses: the outer intercostal membrane (membrana intercostalis externa) - between the costal cartilages; internal intercostal membrane (membrana intercostalis interna) - between the posterior ends of the ribs.
The connections of the thoracic vertebrae are discussed above.
CHEST WHOLE
The chest (compages thoracis) (thorax) (Fig. 19) is formed by 12 pairs of ribs, the sternum and thoracic vertebrae, interconnected by various types of joints.
IN The chest contains: trachea, bronchi, lungs, heart and large vessels, esophagus, lymphatic vessels and nodes, nerves, thymus gland.
IN the chest is distinguished:
1) superior thoracic outlet
(apertura thoracis superior) (3), limited by the jugular notch of the sternum, the first pair of ribs, the first thoracic vertebra;
2) inferior thoracic outlet
(apertura thoracis inferior) (4), limited by the body of the XII thoracic vertebra, the XII pair of ribs, the anterior ends of the IX and X pairs of ribs, the edge of the cartilaginous costal arch, the edge of the xiphoid process;
3) costal arch (arcus costalis) ( 5 );
4) infrasternal angle (angulus infrasternalis) ( 6 );
5) intercostal space (spatia intercostalia) ( 7 );
6) pulmonary grooves (sulci pulmonales),
located on the sides of the pectoral bodies
vertebrae
There are 3 chest shapes:
conical (inspiratory); flat (expiratory); cylindrical - intermediate between flat and conical shapes.
In people brachymorphic type physique, a conical shape of the chest is observed: its lower part is wider than the upper, the substernal angle is obtuse, the ribs are slightly inclined downwards, the difference between the anteroposterior and transverse dimensions is small.
Skeleton of the body (spine, chest). Features of the structure of the cervical, thoracic, lumbar and sacral parts of the spinal column.
ANSWER: The skeleton of the body is formed by the spine and rib cage. The spine consists of 32-34 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 3-5 coccygeal. The vertebrae are located on top of each other and form the spinal column .
The vertebrae of different sections differ in shape and size. However, they all have common features. Each vertebra consists of a body located in front, and a vertebral arch located behind. The arch and posterior part of the vertebral body limit the wide vertebral foramen. The vertebral foramina of all vertebrae located above each other form a long spinal canal in which the spinal cord lies.
Several processes extend from the vertebral arch. The unpaired spinous process goes backwards. The apices of many spinous processes can be easily felt in a person along the midline of the back. To the sides of the arch extend transverse processes and two pairs of articular processes: upper and lower. On the upper and lower edges of the arch, near its origin from the body, there are vertebral notches on each side of the vertebra. The inferior notch of the overlying and superior notch of the underlying vertebrae form the intervertebral foramina. The spinal nerves pass through these openings.
Features of the cervical vertebrae. The cervical vertebrae are small in size compared to the rest. In each of their transverse processes there is a small round hole for the passage of the vertebral artery, which supplies blood to the brain. The bodies of the cervical vertebrae are low, the upper articular processes face upward, the lower ones face downward. The length of the spinous processes increases from the II to the VII vertebrae, their ends are bifurcated (except for the VII vertebra).
The I and II cervical vertebrae are significantly different from the rest. They articulate with the skull and bear the weight of the head. The first cervical vertebra, or atlas, lacks a spinous process. The middle part of the body of the atlas separated from it and grew onto the body of the second vertebra, forming it tooth. The atlas has lateral thickenings - lateral masses. Instead of articular processes of the atlas, there are articular fossae on the upper and lower surfaces of its lateral masses. The upper ones serve for articulation with the skull, the lower ones - with the II cervical vertebra.
The second cervical vertebra is called the axial vertebra. When the head turns, the atlas, together with the skull, rotates around the tooth. The tooth is a process that is located on the upper surface of the body of the second vertebra. On the sides of the tooth there are two upward-facing articular surfaces that articulate with the atlas. On the lower surface of the axial vertebra there are lower articular processes for articulation with the third cervical vertebra.
The VII cervical vertebra has a long spinous process, which can be felt under the skin at the lower border of the neck.
Thoracic vertebrae. The 12 thoracic vertebrae connect to the ribs. For this purpose, on both sides there are two pairs of costal fossae: on the lateral surfaces of the bodies for articulation with the heads of the ribs, as well as on the thickened ends of the transverse processes (only in the upper ten thoracic vertebrae) for articulation with the tubercles of the ribs corresponding to them. The spinous processes of the thoracic vertebrae are much longer than those of the cervical vertebrae and are directed sharply downward. This direction of the spinous processes prevents extension of the thoracic spine. The bodies of the thoracic vertebrae are larger than those of the cervical vertebrae and increase in size from top to bottom. The vertebral foramina have a rounded shape.
The five lumbar vertebrae are distinguished by the large size of their bodies and the absence of costal fossae. The transverse processes are relatively thin and long. The vertebral foramina are triangular in shape. The short spinous processes are located almost horizontally. The structure of the lumbar vertebrae ensures greater mobility of this part of the spine.
The five sacral vertebrae in an adult have fused to form a single sacral bone. The anterior surface of the sacrum is concave, showing two rows of round pelvic sacral foramina (four on each side). The posterior surface of the sacrum is convex, on it there are five longitudinal ridges formed due to the fusion of the spinous processes (median ridge), articular processes (right and left intermediate ridges) and transverse processes (lateral ridges). Inward from the lateral ridges there are four pairs of dorsal sacral foramina, which communicate with the pelvic foramina and the sacral canal. On the lateral parts of the sacrum there are ear-shaped surfaces for articulation with the pelvic bones. At the level of the auricular surfaces behind there is a sacral tuberosity, to which ligaments are attached. The sacral canal, which is the lower part of the spinal canal, contains the filum terminale of the spinal cord and the roots of the lumbar and sacral spinal nerves. The anterior branches of the sacral nerves and blood vessels pass through the pelvic (anterior) sacral foramen. The posterior branches of the same nerves emerge from the spinal canal through the dorsal sacral foramen.
The coccyx (coccyx bone) consists of 3-5 (usually 4) fused rudimentary vertebrae.
ANSWER: There are connections between the vertebral bodies, between their arches and between the processes. The bodies of two adjacent vertebrae are connected by intervertebral discs. Each intervertebral disc has the shape of a biconvex lens, in which a peripheral part is distinguished - the fibrous ring formed by fibrocartilage, and a central part - the nucleus pulposus. With the help of connective tissue fibers, the fibrous ring of adjacent vertebrae is firmly connected to each other. The elastic nucleus pulposus is located inside the annulus fibrosus and acts as a shock absorber between the two vertebrae. The diameter of the intervertebral discs is larger than the diameter of the bodies of the connected vertebrae, so the intervertebral discs act as ridges. The thickness of the intervertebral disc in the thoracic region is 3-4 mm, in the most mobile lumbar region - 10-12 mm.
Along the anterior and posterior surfaces of the vertebral bodies along the spinal column, respectively, pass the anterior and posterior longitudinal ligaments, firmly fused with the intervertebral discs. The arches of adjacent vertebrae are connected using yellow ligaments consisting of elastic connective tissue. Therefore, they have a yellow color, greater strength and elasticity. The articular processes of adjacent vertebrae form intervertebral joints reinforced by ligaments. The spinous processes are connected to each other by the interspinous ligaments and the supraspinous ligament. The supraspinous ligament, well developed in the cervical region, is called the nuchal ligament. Between the transverse processes are the intertransverse ligaments.
The connections of the sacrum with the coccyx are similar to the connections of the vertebral bodies. There is almost always a gap in the intervertebral disc of this joint, which often closes in people over 50 years of age.
Three bones take part in the connections of the spine with the skull: the occipital, the atlas and the axial vertebra. The joints formed between these bones allow greater freedom of movement of the head around three axes, like a ball-and-socket joint.
The atlanto-occipital joint consists of two separate joints (right and left), that is, it is combined. The articular surfaces (ellipsoidal) of each joint are formed by the condyle of the occipital bone and the superior articular fossa of the cervical vertebra. Each joint is enclosed in a separate articular capsule, and together they are strengthened by the anterior and posterior atlanto-occipital membranes. In the atlanto-occipital joint, movements around the frontal and sagittal axes are possible. Flexion and extension occur around the frontal axis (head tilts forward by 20° and backward movement by 30°). Around the sagittal axis, head tilts to the sides are possible by 15–20°.
The three joints between the atlas and the axial vertebra combine to form the combined atlanto-axial joint. This joint is cylindrical in shape and movements are only possible around a vertical axis (rotation). Rotations of the atlas around the tooth are performed together with the skull by 30-40° in each direction.
The anterior articular surface of the tooth of the axial vertebra is adjacent posteriorly to the articular surface on the fossa of the tooth of the anterior arch of the atlas. The posterior articular surface of the tooth is in contact with the transverse ligament of the atlas.
The paired lateral atlantoaxial joint (combined) is formed by the glenoid fossa on the lateral mass of the atlas and the superior articular surface on the body of the axial vertebra. These joints are strengthened by two pterygoid ligaments, the cruciate ligament of the atlas and a strong fibrous covering membrane, which is attached above to the occipital bone and below passes into the posterior longitudinal ligament. Movements in the right and left lateral atlantoaxial joints are performed together with movements in the medial atlantoaxial joint.
15. Chest, structure of the sternum and ribs. Connection of the ribs to the vertebrae and sternum. Specific structural features of the spinal column and sternum in connection with the vertical position.
ANSWER: The chest is formed by twelve pairs of ribs, the sternum, and the thoracic spinal column connected to each other.
The ribs are long, flat, curved plates located to the right and left of the thoracic vertebrae. In the posterolateral sections, the ribs consist of bone tissue, and in the anterior sections, they are made of cartilage. The upper seven ribs are called true ribs because each of them reaches the sternum through its own cartilage. The ribs from the eighth to the tenth are false, since their cartilages grow together and with the cartilages of the lower ribs, forming a costal arch. The eleventh and twelfth ribs are called fluctuating; their anterior ends do not reach the sternum and are lost in the upper parts of the anterior abdominal wall. The bony part of the rib consists of the head, on which there is an articular surface for articulation with the vertebral bodies, neck and body. On the body of the ten upper ribs there is a tubercle, also equipped with an articular surface for articulation with the transverse process of the vertebra. On the inner surface of each rib along its lower edge there is a groove to which the intercostal nerve, artery and veins are adjacent. In an adult, the ribs are directed from back to front and from top to bottom.
The sternum is a flat bone, in which three parts are distinguished: a wide manubrium at the top, an elongated body and the xiphoid process at the bottom. In the middle of the upper edge of the manubrium of the sternum there is a jugular notch, which is easily palpable in humans. On each side of the jugular notch are the clavicular notches for connection to the clavicles. On the lateral sides of the sternum there are costal notches for the attachment of the cartilage of the upper seven ribs. The xiphoid process has no notches, and the ribs are not attached to it.
Connections between the ribs and the vertebral column and sternum. The ribs are connected to the vertebrae by costovertebral joints. These include the joints of the rib heads and the costotransverse joints. Thus, the rib is attached to the vertebra at two points. The line connecting these points is the axis of rotation around which the rib rotates during breathing. As you inhale, the ribs rise and take a more horizontal position, due to which the chest increases in the frontal and sagittal planes. As you exhale, the ribs, on the contrary, descend and the chest shrinks.
The XI and XII ribs do not form costotransverse joints. The ribs articulate with the sternum using joints and cartilaginous joints. The cartilage of the first rib fuses with the sternum, forming synchondrosis. The cartilages of the II-VII ribs are connected to the sternum using the sternocostal joints, supported by ligaments. The anterior ends of the false ribs (VIII, IX, X) are not directly connected to the sternum; they are connected to the cartilage of the overlying ribs by intercartilaginous joints and form a costal arch.
The chest as a whole. The rib cage is an osteochondral formation consisting of the thoracic vertebrae, twelve pairs of ribs and the sternum, connected to each other. The chest has four walls (anterior, posterior and two lateral) and two openings (upper and lower apertures). The anterior wall is formed by the sternum and costal cartilages, the posterior wall by the thoracic vertebrae and posterior ends of the ribs, and the lateral walls by the ribs. The ribs are separated from each other by intercostal spaces.
The superior aperture is limited by the upper edge of the sternum, the first ribs and the anterior surface of the first thoracic vertebra. The anterolateral edge of the lower aperture, formed by the connection of the anterior ends of the VII-X ribs (false), is called the costal arch. The right and left costal arches limit the sides of the substernal angle, which is open downwards. On the sides behind, the lower aperture is limited by the twelfth ribs and the twelfth thoracic vertebra. The trachea, esophagus, vessels, and nerves pass through the upper aperture.
The inferior aperture is closed by a diaphragm, which has openings for the passage of the aorta, esophagus and inferior vena cava. The human chest is shaped like an irregular truncated cone. It is expanded in the transverse direction and flattened in the anteroposterior direction; it is shorter in front than in the back.
The joints of the body bones include connections of vertebrae, ribs and sternum.
In typical vertebrae, connections of bodies, arches and processes are distinguished.
I - vertebral body; 2 - intervertebral disc; 3 - anterior longitudinal ligament; 4 - radiate ligament of the rib head; 5 - joint of the rib head; 6 - superior articular process; 7 - transverse process; 8 - intertransverse ligament; 9 - spinous process; 10 - interspinous ligaments;
II - supraspinous ligament; 12 - lower articular process; 13 - intervertebral foramen
The bodies of two adjacent vertebrae are connected by intervertebral discs (disci intervertebrales). Their total number is 23. Such a disc is absent only between the I and II cervical vertebrae. The total height of all intervertebral discs is approximately a quarter of the length of the spinal column.
The disc is built primarily from fibrous cartilage and consists of two parts that gradually transform into each other. Along the periphery there is a fibrous ring consisting of concentric plates. The fiber bundles in the plates run obliquely, while in adjacent layers they are oriented in opposite directions. The central part of the disc is the nucleus pulposus. It consists of an amorphous substance of cartilage. The nucleus pulposus of the disc is displaced somewhat posteriorly, compressed by the bodies of two adjacent vertebrae and acts as a shock absorber, i.e., it plays the role of an elastic cushion.
The area of the disc is larger than the area of the adjacent vertebral bodies, therefore, normally, intervertebral discs protrude in the form of ridges beyond the edges of the vertebral bodies. Disc thickness (height) varies significantly along the spinal column. The greatest height of individual discs in the cervical region is 5-6 mm, in the thoracic region - 3-4 mm, in the lumbar region - 10-12 mm. The thickness of the disc changes in the anteroposterior direction: between the thoracic vertebrae the disc is thinner in the front, between the cervical and lumbar vertebrae, on the contrary, it is thinner in the back.
The vertebral bodies are connected anteriorly and posteriorly by two longitudinal ligaments. The anterior longitudinal ligament runs along the anterior surface of the vertebral bodies and intervertebral discs from the occipital bone to the first sacral vertebra. The ligament is firmly connected to the discs and periosteum of the vertebrae, preventing excessive extension of the spinal column.
The posterior longitudinal ligament runs along the posterior surface of the vertebral bodies from the clivus of the occipital bone and ends in the sacral canal. Compared to the anterior longitudinal ligament, it is narrower and widens in the area of the intervertebral discs. It loosely connects to the vertebral bodies and firmly fuses with the intervertebral discs. The posterior longitudinal ligament is an antagonist of the anterior one and prevents excessive flexion of the spinal column.
The vertebral arches are connected by the ligamentum flavum. Their color is due to the predominance of elastic fibers. They fill the gaps between the arches, leaving free the intervertebral foramina, limited by the upper and lower vertebral notches. The direction of elastic fibers in the ligaments is strictly regular: from the lower edge and inner surface of the arch of the overlying vertebra (starting from the second cervical) - to the upper edge and outer surface of the arch of the underlying vertebra. The yellow ligaments, like the intervertebral discs, have elasticity that helps strengthen the spinal column. Together with the bodies, vertebral arches and discs, they form the spinal canal, which contains the spinal cord with membranes and blood vessels.
Between the two adjacent spinous processes there are short interspinous ligaments, which are more developed in the lumbar region. Posteriorly, they directly pass into the unpaired supraspinous ligament, which ascends along the tops of all spinous processes in the form of a continuous cord.
In the cervical region, this ligament continues into the nuchal ligament, which stretches from the spinous process of the VII cervical vertebra to the external occipital protuberance. It has the appearance of a triangular plate located in the sagittal plane.
Between the transverse processes are the intertransverse ligaments. They are absent in the cervical region. When muscles contract, these ligaments limit the torso's sideways bending.
The only continuous connections between the vertebrae are the numerous intervertebral joints (articulationes intervertebrals). The inferior articular processes of each typical overlying vertebra articulate with the superior articular processes of the underlying vertebra. The articular surfaces on the articular processes of the vertebrae are flat, covered with hyaline cartilage, the articular capsule is attached along the edge of the articular surfaces. According to their function, articulationes intervertebrals are multiaxial combined joints. Thanks to them, the torso can be tilted forward and backward (flexion and extension), to the sides (adduction and abduction), circular movement (conical), torsional (twisting) and springing movement.
The fifth lumbar vertebra is connected to the sacrum using the same types of connections as free typical vertebrae.
Connection of the sacrum with the coccyx
Between the bodies of the V sacral and I coccygeal vertebrae there is also a discus intervertebral, inside of which in most cases there is a small cavity. This connection is called the symphysis. The sacral and coccygeal horns are connected by connective tissue - syndesmosis.
The lateral sacrococcygeal ligament is paired, it goes from the lower edge of the lateral sacral crest to the rudiment of the transverse process of the first coccygeal vertebra. It is analogous to the intertransverse ligaments.
The ventral sacrococcygeal ligament is located on the anterior surface of the sacrococcygeal joint and is a continuation of the anterior longitudinal ligament of the spinal column.
The deep dorsal sacrococcygeal ligament is located on the posterior surface of the body of the V sacral vertebra and the I coccygeal vertebra, i.e., it is a continuation of the posterior longitudinal ligament of the spinal column.
The superficial dorsal sacrococcygeal ligament begins from the edges of the sacral canal fissure and ends on the posterior surface of the coccyx. It almost completely covers the opening of the sacral fissure and corresponds to the supraspinous and yellow ligaments.
Connections of the 1st and 2nd cervical vertebrae to each other and to the skull
The atlantooccipital joint (articulatio atlantooccipitalis) is paired, ellipsoidal, biaxial, combined. Formed by the condyles of the occipital bone and the upper articular fossae of the first cervical vertebra. The articular surfaces are covered with hyaline cartilage, the capsule is free, attached along the edge of the articular surfaces. The atlanto-occipital joints are anatomically separate, but function together. Around the frontal axis, nodding movements are performed in them - tilting the head forward and backward. The range of movement reaches 45°. Around the sagittal axis, the head is tilted to the right and left in relation to the median plane. The volume of movement is 15-20°. Peripheral (conical) movement is also possible.
The anterior atlanto-occipital membrane is stretched between the main part of the occipital bone and the upper edge of the anterior arch of the atlas. The posterior atlanto-occipital membrane connects the posterior arch of the atlas to the posterior edge of the foramen magnum. These membranes close the wide gaps between the atlas and the occipital bone.
Between the I and II cervical vertebrae there are three joints: the median atlantoaxial joint (articulatio atlantoaxialis mediana), the right and left lateral atlantoaxial joints (articulationes atlantoaxiales laterales dextra et sinistra).
The median joint is formed by the anterior and posterior articular surfaces of the tooth of the axial vertebra, the articular fossa of the anterior arch of the atlas and the articular surface of the transverse ligament of the atlas. The anterior articular surface of the tooth articulates with the fossa of the tooth on the posterior surface of the anterior arch of the atlas. The posterior articular surface of the tooth articulates with the articular platform on the anterior surface of the transverse atlas ligament. This ligament is stretched behind the tooth of the axial vertebra between the medial surfaces of the lateral masses of the first cervical vertebra. It prevents the tooth from moving backward. From the central, slightly expanded part of the transverse ligament, the upper and lower longitudinal fascicles are directed up and down. The upper bundle ends on the anterior semicircle of the large (occipital) foramen, the lower bundle ends on the posterior surface of the body of the axial vertebra. These two bundles, together with the transverse atlas ligament, make up the cruciate ligament.
Thus, the tooth of the axial vertebra is located in an osteo-fibrous ring formed anteriorly by the anterior arch of the atlas, and posteriorly by the transverse ligament of the atlas.
The median atlantoaxial joint is cylindrical in shape, and movement in it is only possible around a vertical axis (rotation) passing through the tooth of the axial vertebra. The atlas rotates around the tooth along with the skull by 30-40° in each direction.
The lateral atlantoaxial joints (right and left) together make up the combination joints. Each is formed by the inferior articular fossa on the lateral mass of the atlas and the superior articular surface of the axial vertebra. The flat articular surfaces are covered with hyaline cartilage, the joint capsule is attached along the edge of the articular surfaces.
Movement in the right and left lateral atlantoaxial joints is carried out together with movement in the middle atlantoaxial joint. In these combined joints, only one type of movement is possible - rotation.
In total, 6 types of movements are performed in the atlanto-occipital and atlanto-axial joints - tilting the head forward and backward, tilting the head to the sides, circular (peripheral) movement and rotation. This equates to the maximum number of possible types of motion in a multi-axis ball and socket joint.
The medial and lateral atlantoaxial joints have additional ligamentous apparatus - the pterygoid ligaments and the ligament of the apex of the tooth. The pterygoid ligaments are two strong ligaments, each of which starts from the apex and lateral surface of the tooth, runs obliquely upward and attaches to the medial sides of the condyles. These ligaments are very strong and limit rotation at the medial atlantoaxial joint. The apical ligament is a thin band that runs upward from the apex of the tooth to the anterior edge of the foramen magnum.
At the back, from the side of the spinal canal, the median atlantoaxial and lateral atlantoaxial joints and their ligaments are covered with a wide, durable fibrous plate - the integumentary membrane. It comes from the clivus of the occipital bone down and continues into the posterior longitudinal ligament.
Spinal column
The spine, or spinal column (columna vertebralis), is represented by vertebrae and their joints. It includes the cervical, thoracic, lumbar and sacrococcygeal regions. Its functional significance is extremely great: it supports the head, serves as a flexible axis of the body, takes part in the formation of the walls of the chest and abdominal cavities and pelvis, supports the body, and protects the spinal cord located in the spinal canal.
The force of gravity perceived by the spinal column increases from top to bottom. The vertebral bodies are greatest in the sacral region; upward they gradually narrow to the level of the V thoracic vertebra, then widen again to the level of the lower cervical vertebrae and narrow again in the upper cervical region. The expansion of the spine in the upper part of the thoracic region is explained by the fact that the upper limb is fixed at this level.
When the vertebrae are connected to each other from the sides, 23 pairs of intervertebral foramina (foramina intervertebralia) are formed, through which the spinal nerves exit the spinal canal.
The length of the spinal column in an adult man of average height (170 cm) is approximately 73 cm, with the cervical region accounting for 13 cm, the thoracic region - 30 cm, the lumbar region - 18 cm, and the sacrococcygeal region - 12 cm. The average spinal column for a woman 3-5 cm shorter and amounts to 68-69 cm. In old age, the length of the spinal column decreases. In general, the length of the spinal column is about 2/5 of the total length of the body.
The spinal column does not occupy a strictly vertical position. It has bends in the sagittal plane. Curves facing convexly backward are called kyphosis, and curves facing forward are called lordosis. There are physiological lordoses - cervical and lumbar; physiological kyphosis - thoracic and sacral. At the junction of the fifth lumbar vertebra with the first sacral vertebra there is a significant protrusion, or promontory.
A - spinal column of a newborn; b — spinal column of an adult: I — cervical lordosis; II - thoracic kyphosis; III - lumbar lordosis; IV - sacral kyphosis; 1 - cervical vertebrae; 2 - thoracic vertebrae; 3 - lumbar vertebrae; 4 - sacrum and coccyx; 5 - thoracic vertebra
Kyphosis and lordosis are a characteristic feature of the human spinal column: they arose in connection with the vertical position of the body and are optimally expressed in an adult performing the command “at attention” (military posture). In this case, the perpendicular, lowered from the tuberculum anterius atlantis, crosses the bodies of the VI cervical, IX thoracic and III sacral vertebrae and exits through the apex of the coccyx. With sluggish posture, thoracic kyphosis increases, cervical and lumbar lordosis decreases.
Physiological lordosis and kyphosis are permanent formations. Thoracic kyphosis and lumbar lordosis are more pronounced in women than in men. The curves of the spinal column with a horizontal position of the body decrease somewhat, with a vertical position they stand out more sharply, and with increasing load (carrying heavy objects) they noticeably increase.
The formation of the curves of the spinal column occurs after birth. In a newborn, the spinal column looks like an arch, convexly facing backwards. At 2-3 months, the child begins to hold his head up, and cervical lordosis forms. At 5-6 months, when the child begins to sit up, thoracic kyphosis takes on a characteristic form. At 9-12 months, lumbar lordosis forms as a result of the human body adapting to an upright position when the child begins to walk. At the same time, an increase in thoracic and sacral kyphosis occurs. Thus, the curves of the spinal column are functional adaptations of the human body to maintain balance in an upright position.
Normally, the spinal column has no bends in the frontal plane. Its deviation from the median plane is called scoliosis.
The movements of the spinal column are the result of the functioning of numerous combined joints between the vertebrae. In the spinal column, when skeletal muscles act on it, the following types of movements are possible: bending forward and backward, i.e. flexion and extension; bending to the sides, i.e. abduction and adduction; torsion movements, i.e. twisting; circular (conical) movement.
The body bends forward and backward (flexion and extension) around the frontal axis. The amplitude of flexion and extension is 170-245°. When the body bends, the vertebrae bend forward, the spinous processes move away from each other. The anterior longitudinal ligament of the spinal column relaxes. Tension of the posterior longitudinal ligament, ligamentum flavum, interspinous and supraspinous ligaments inhibit this movement. At the moment of extension, the spinal column deviates posteriorly. At the same time, all its ligaments relax, except for the anterior longitudinal one, which becomes tense, limiting the extension of the spinal column. Intervertebral discs change their shape during flexion and extension. Their thickness decreases slightly on the inclined side and increases on the opposite side.
Tilts of the spinal column to the right and left (abduction and adduction) occur around the sagittal axis. The range of motion is 165°.
Torsion movement (twisting) of the spinal column occurs around a vertical axis. Its volume is 120°.
With a circular (conical) movement, the spinal column describes a cone, alternately around the sagittal and frontal axes. Springing movements (when walking, jumping) are performed due to the proximity and distance of neighboring vertebrae, while the intervertebral discs reduce shocks and tremors.
The volume and types of movements realized in each part of the spinal column are not the same. The cervical and lumbar regions are the most mobile due to the greater height of the intervertebral discs. The thoracic part of the spinal column is the least mobile, which is due to the lower height of the intervertebral discs, the strong downward inclination of the spinous processes of the vertebrae, as well as the frontal location of the articular surfaces in the intervertebral joints.
Rib connections
The ribs connect to the thoracic vertebrae, to the sternum and to each other.
The ribs are connected to the vertebrae using costovertebral joints (articulationes costovertebrales). These include the rib head joint and the costotransverse joint. The latter is absent from the XI and XII ribs.
The joint of the rib head (articulatio capitis costae) is formed by the articular surfaces of the upper and lower costal semi-fossae of two adjacent thoracic vertebrae (from II to X), the costal fossae of the I, XI, XII thoracic vertebrae and the articular surface of the rib head. In each of the joints of the rib head from II to X there is an intra-articular ligament of the rib head. It starts from the crest of the rib head and is attached to the intervertebral disc that separates the costal fossae of two adjacent vertebrae. The heads of the I, XI and XII ribs do not have a scallop. They articulate with the complete articular fossa located on the body of the corresponding vertebrae; therefore, these joints do not have an intraarticular ligament of the rib head. Externally, the joint capsule of the rib head is strengthened by the radiate ligament. Its bundles fan out and attach to the intervertebral disc and to the bodies of adjacent vertebrae.
The costotransverse joint (articulatio costotransversaria) is formed by the articulation of the articular surface of the tubercle of the rib with the costal fossa on the transverse process of the vertebra. The joint capsule is strengthened by the costotransverse ligament.
The ribs are connected to the sternum through joints and cartilaginous joints. Only the cartilage of the first rib directly fuses with the sternum, forming a permanent hyaline synchondrosis.
The cartilages of the II-VII ribs are connected to the sternum using the sternocostal joints (articulationes sternocostal). They are formed by the anterior ends of the costal cartilages and costal notches on the sternum. The articular capsules of these joints are a continuation of the perichondrium of the costal cartilages, which passes into the periosteum of the sternum. The radiate sternocostal ligaments strengthen the joint capsule on the anterior and posterior surfaces of the joints. Anteriorly, the radiate sternocostal ligaments fuse with the periosteum of the sternum, forming a dense membrane of the sternum.
The anterior ends of the false ribs (VIII, IX and X) are not directly connected to the sternum. Their cartilages are connected to each other, and sometimes there are modified intercartilaginous joints (articulationes interchondrales) between them. These cartilages form the costal arch on the right and left. The short cartilaginous ends of the XI and XII ribs end in the muscles of the abdominal wall.
The anterior ends of the ribs are connected to each other using the external intercostal membrane. The fibers of the outer membrane, filling the intercostal spaces, go obliquely down and forward. The opposite course of the fibers has an internal intercostal membrane, which is well expressed in the posterior sections of the intercostal spaces.
The joint of the rib head (I, XI, XII) is spherical in shape, and from II to X is saddle-shaped. The costotransverse joint is cylindrical in shape. Functionally, the joint of the rib head and the costotransverse joint are combined into a uniaxial rotational joint. The axis of movement passes through the centers of both joints and corresponds to the neck of the rib. The rear end of the rib rotates around the specified axis, while the front end rises or falls, since the rib is twisted. As a result of raising the anterior ends of the ribs, the volume of the chest increases, which, together with the lowering of the diaphragm, provides inhalation. When lowering the ribs, exhalation occurs due to the relaxation of the muscles and the elasticity of the costal cartilages. The elasticity of the chest in old age decreases, and the mobility of the ribs decreases significantly.
Whole chest
The chest (compages thoracis, thorax) is a bone-cartilaginous formation consisting of the sternum, 12 thoracic vertebrae, 12 pairs of ribs and their connections.
The rib cage forms the walls of the chest cavity, which contains the internal organs - the heart, lungs, trachea, esophagus, etc.
The shape of the chest is compared to a truncated cone, the base of which faces downwards. The anteroposterior size of the chest is smaller than the transverse size. The anterior wall is the shortest, formed by the sternum and costal cartilages. The lateral walls are the longest, they are formed by the bodies of twelve ribs. The posterior wall is represented by the thoracic spine and the ribs (up to their angles). The vertebral bodies protrude into the chest cavity, so on either side of them there are pulmonary grooves in which the posterior edges of the lungs are located.
At the top, the thoracic cavity opens with a wide opening - the upper aperture of the chest, which is limited by the manubrium of the sternum, the first rib and the body of the first thoracic vertebra. The plane of the superior aperture lies not horizontally, but obliquely: its anterior edge is lower, and therefore the jugular notch is projected at the level of the II-III thoracic vertebrae. The lower aperture of the chest is much wider than the upper one, it is limited by the body of the XII thoracic vertebra, the XII ribs, the ends of the XI ribs, the costal arches and the xiphoid process.
The spaces located between adjacent ribs, and in front between their cartilages, are called intercostal spaces. They are filled with intercostal muscles, ligaments and membranes.
Vessels, nerves, trachea and esophagus pass through the upper aperture of the chest. The lower aperture of the chest is closed by the thoraco-abdominal barrier - a thin muscle-tendon plate that separates the thoracic cavity from the abdominal cavity. Depending on the body type, there are three shapes of the chest: conical, cylindrical and flat. The conical shape of the chest is characteristic of the mesomorphic body type, cylindrical - dolichomorphic and flat - brachymorphic.
Joint diseases
IN AND. Mazurov
Vertebral column, or spine (columna vertebralis), formed from vertebrae located on top of each other, which are interconnected by various types of joints: intervertebral discs and symphysis, joints and ligaments (Fig. 101 and 102, table 23). The human spine has more than 122 joints, 365 ligaments and 26 cartilaginous joints. The spine performs a supporting function, is a flexible axis of the body, participates in the formation of the posterior wall of the chest and abdominal cavities, the pelvis, serves as a container and protection for the spinal cord, located in spinal canal (canalis vertebralis).
The vertebral foramina, overlapping one on one, form the spinal canal, the cross-sectional area of which in an adult is from 2.2 to 3.2 cm2. The canal is narrow in the thoracic spine, where it has a round shape, and it is wide in the lumbar spine, where its cross-section is close to a triangle in shape. The vertebral notches of adjacent vertebrae form symmetrical intervertebral foramina (foramina intervertebralia), in which the spinal nodes lie, the corresponding spinal nerves and blood vessels pass. Located in the spinal canal
Rice. 101. Connection of vertebrae(lumbar region, part of the vertebral structures has been removed, the spinal canal is visible)
Rice. 102. intervertebral disc(discus intervertebralis) and arcuate joints(articulationes zygapophysiales), horizontal cut between the II and IV lumbar vertebrae, top view
the spinal cord, covered with three Obolon, its anterior and posterior roots, venous plexuses and adipose tissue. Muscles attached to the vertebrae, contracting, change the position of the spinal column as a whole or its individual parts. The processes of the vertebrae are bony levers. The bodies, arches and processes of the vertebrae are connected to each other.
Connection of vertebral bodies. The vertebral bodies are connected by synchondrosis and syndesmosis. Between the vertebral bodies there are cartilaginous intervertebral discs (disci intervertebrales), the thickness of which ranges from 3-4 mm in the thoracic region, to 5-6 mm in the cervical region, and in the lumbar (most mobile) region reaches 10-12 mm. The first disc is located between the bodies of the II and III cervical vertebrae, the last - between the bodies of the V lumbar and I sacral vertebrae. Each disc has a biconvex shape. It consists of a centrally located nucleus pulposus (nucleus pulposus), surrounded fibrous ring (anulus fibrosus), formed by fibrous cartilage. There is often a horizontal fissure inside the nucleus pulposus, which gives rise to the name of such a connection intervertebral symphysis (symphysis intervertebralis). Since the diameter of the intervertebral disc is greater than the diameter of the vertebral bodies, the intervertebral discs protrude somewhat beyond the edges of the adjacent vertebral bodies.
Fibrous ring firmly fused with the bodies of two vertebrae. It consists of ordered circular plates formed predominantly by collagen
TABLE 23. Joints of the body
|
Name joint |
articular surfaces |
articular ligaments |
Type of joint, axis of movement |
function |
|
Atlanto-pothy-personal joint (paired - right and left) |
Right and left occipital condyles; superior articular surfaces of the atlas |
Anterior and posterior Atlas NTO-potile ichn and membranes |
Double-sided, ellipsoidal, combined, biaxial (frontal and arrow) |
Around the frontal axis - flexion up to 20 ° and extension up to 30 °, around the sagittal axis - tilt of the head to the side (abduction) up to 15-20 ° |
|
Median atlantoaxial joint |
Anterior part: tooth fossa on the anterior arch of the atlas and the anterior articular surface of the tooth of the II cervical vertebra. Posterior part: fossa on the transverse ligament of the atlas and posterior articular surface of the tooth of the II cervical vertebra |
Ligament of the apex of the tooth, two pterygoid ligaments, cruciate ligament of the atlas, roofing membrane |
cylindrical, uniaxial (Vertical) |
Rotation of the atlas around the tooth (vertical axis) by 30-40° in each direction |
|
Lateral atlanto-axial joint (paired) |
Lower articular surfaces of the atlas and upper articular surfaces of the II cervical vertebra |
Cruciate ligament of the atlas, roof membrane |
Flat combined, multi-axis |
Slips during rotation of the atlas in the median atlanto-axial joint |
|
Arc joints (paired) |
The superior and inferior articular processes of adjacent vertebrae |
Flat, multi-axial (arrow, frontal, vertical), combined, sedentary |
Flexion and extension of the spine, tilts to the right and left (up to 55 °), rotation (twisting) around a vertical axis when standing up to 90 °, sitting - up to 54 °) |
|
|
Lumbosacral joint |
The lower articular processes of the V lumbar vertebra and the upper articular processes of the sacral bone |
Flat, multi-axis, low-moving |
Sliding in different directions when moving the spine |
Types I and II. Thick collagen fibers (approximately 70 nm in diameter) of adjacent layers intersect each other at an angle of 60° and penetrate the hyalium cartilage and periosteum of the vertebrae. In addition to collagen, the main substance of the fibrous ring contains other macromolecules - elastin, proteoglycans, hyaluronic acid. These molecules are also clearly oriented in almost parallel rows like collagen, and non-collagenous proteins are oriented perpendicular to them. A few chondrocytes in the fibrous ring are located between bundles of collagen fibers in the form of isogeny groups. Ellipsoidal chondrocytes have a diameter of 15-20 microns and a spherical nucleus, the chromatin of which is partially condensed. Chondrocytes have a developed granular endoplasmic reticulum and Golgi complex; there are few mitochondria, but there are numerous proteoglycan granules.
nucleus pulposus, in which there are no blood vessels, formed by cartilage tissue, in which there are few chondrocytes. The number of collagen fibers in it (type II collagen) increases from the center to the periphery. In the center of the nucleus there are few collagen fibers and they do not have a clear orientation. At the periphery of the nucleus, collagen fibers are arranged in a circle, some of them pass directly into the tissue of the fibrous ring. Due to the large number of proteoglycains, which are in a non-aggregated state, the nucleus pulposus contains a lot of water, which determines its gelatinous consistency. In the center of the nucleus there are two types of cells. Some cells have processes and a small nucleus containing mainly decondensed chromatin, light cytoplasm, and a few organelles. Cells of the second type are round, large with a large nucleus, in which condensed chromatin is located along the periphery. In these cells, the granular endoplasmic reticulum and Golgi complex, many ribosomes and polyribosomes are well developed. It is these cells that synthesize proteins and proteoglycans. The nucleus pulposus is nourished by diffusion.
The structure of the intervertebral discs is ideally suited to perform the functions of mobility and shock absorption. The discs are elastic, and the vertebrae they connect have some mobility.
The vertebral bodies, connected to each other by cartilaginous discs, are further strengthened by strong connections - the anterior and posterior longitudinal connections, formed from dense fibrous connective tissue. Pe^judnya longitudinal ligament (lig. Longitudinale anterius) passes along the anterior surface of the bodies of all vertebrae, firmly fused with them and with the intervertebral discs. It starts from the pharyngeal tubercle of the occipital bone and the anterior tubercle of the anterior arch of the atlas and ends on the 2-3rd transverse lines of the pelvic surface of the sacrum. Between the Atlas and the occipital bone, the anterior longitudinal ligament is thickened and forms anterior atlantooccipitalis membrane (membrana atlantooccipitalis anterior), which is attached above to the anterior edge of the large foramen of the occipital bone, and below the anterior arch of the atlas. Posterior longitudinal ligament (lig. longitudinale posterius) runs along the posterior surface of the vertebral bodies in the spinal canal. From the lower edge of the slope of the occipital bone, it passes behind the articulation of the 1st and 2nd cervical vertebrae and further down to the 1st coccygeal vertebra. The connection is firmly fused to the intervertebral disc, but it is weakly connected to the vertebral bodies. At the level of the median atlanto-axial joint, the posterior longitudinal ligament expands and fuses with the bundles of the cruciate ligament of the atlas located in front of it, and upward it continues under the name - roofing membrane (membrana tectoria), which is attached to the lower edge of the occipital bone.
Connection of vertebral arches. The arches of the vertebrae are connected to each other by strong yellow connections (ligg. Flava), located in the spaces between the vertebral arches. These connections are formed from elastic connective tissue and have a yellowish color. The ligamentum flavum consists of parallel elastic fibers that intertwine with reticular and collagen fibers. These connections prevent excessive forward flexion of the spinal column. their elastic resistance resists the force that tends to tilt the torso forward and also promotes extension of the spinal column.
Connection of vertebral processes. Top and bottom articular processes adjacent vertebrae are connected to each other arcuate joints (articulationes zygapophysiales).
Flat articular surfaces of the articular processes, including the lower articular processes of the 5th lumbar and the upper articular processes of the 1st sacral vertebrae, covered with articular cartilage. The articular capsule is attached to the edges of the articular surfaces and is strengthened by thin bundles of connective tissue fibers. These joints are flat, multi-axial, combined, and inactive. They perform flexion and extension of the spine, its inclinations to the right and left, as well as rotation around a vertical axis.
The planes of the articular surfaces of the articular processes of the cervical vertebrae are located at almost an angle of 45° to the frontal plane. Gradually downward, these surfaces change direction, and in the lumbar spine they are already located almost parallel to the sagittal plane. This morphological feature of the orientation of the articular surfaces increases the biomechanical properties of the spine.
Spinous processes The vertebrae are connected to each other by interostovy and suprastovy connections. Mizhostovi connections (ligg. Inteispinalia) They connect the spinous processes of adjacent vertebrae; they are formed by densely formed connective tissue. In the cervical spine these connections are very thin and much thicker in the lumbar region. Supraspinale connections (lig. Supraspinale) It is represented by a long fibrous cord attached to the tops of the spinous processes of all vertebrae. The upper thickened part of the supraspinous connection, stretched between the external occipital crest and the spinous processes of the cervical vertebrae, is called cortical ligament (lig. Nuchae). This is a very strong connective tissue triangular plate that connects the occipital bone to the spine. Transverse processes with United with each other intertransverse connections (ligg. intertransversalia), that are stretched between the tips of the transverse processes of adjacent vertebrae. These connections are absent in the cervical spine.
Sacral bone connection called coccyx sacrococcygeal joint (articulatio sacrococcygea). The apex of the sacrum is connected to the first coccygeal vertebra by a cartilaginous intervertebral disc, as well as several ligaments. As a rule, a gap in the intervertebral discs closes in people over 50 years of age. There is a steam room located in the vicinity of Bokivtsiogozyednannya lateral sacrococcygeal ligament (lig. Sacrococcygeum laterale), starting on the lower edge of the lateral sacral crest and attached to the rudiment of the transverse process and coccygeal vertebra. This ligament in origin and location is analogous to the infratransverse ligament of the spinal column. Anterior sacrococcygeal ligament (lig. Sacrococcygeum anterius) located on the anterior surface of the apex of the sacrum and coccyx, it is a continuation of the anterior longitudinal ligament. Superficial posterior sacrococcygeal connection viscous (lig. sacrococcygeum posterius superficiale) starts from the edges of the sacral opening and attaches to the posterior surface of the coccyx. The structure of this ligament is similar to the supraspinous and yellow ligaments; it almost completely covers the sacral ligament. Deep posterior sacrococcygeal ligament (lig. Sacrococcygeum posterius profundum) located on the posterior surface of the bodies of both the coccygeal and V sacral vertebrae, is a continuation of the posterior longitudinal ligament. The sacrum and coccyx of the horn are connected to each other by syndesmoses. The coccyx at a young age is very mobile; in particular, in women during childbirth, it deviates significantly back.
Connection of the spinal column with the skull. The spinal column is connected to the skull by the atlanto-occipital, median and lateral atlanto-axial joints, which are strengthened by ligaments (Fig. 103).
Atlapto-occipital joint (articulatio atlantooccipitalis) paired, combined, double-grafted in shape. Formed by the articular surfaces of the occipital condyle and the superior articular surface of the atlas, covered with articular cartilage.
Each joint is surrounded by a wide articular capsule, which is attached to the edges of the articular surfaces. Both capsules are reinforced by the anterior and posterior atlanto-occipital membranes. Anterior atlanto-occipital membrane (membrana atlantooccipitalis anterior) stretched between the main part of the occipital bone and the upper edge of the anterior arch of the atlas. Posterior atlanto-occipital membrane (membrana atlantooccipitalis posterior) thinner, but wider than the front. It is stretched between the posterior semicircle of the foramen magnum and the upper edge of the posterior arch of the atlas. The spinal artery passes through this membrane into the spinal canal and goes into the cranial cavity to supply blood to the brain. The articular surface of each occipital condyle has an ellipsoidal shape.
Rice. 103. Connection of the atlas with the tooth of the axial vertebra. A - horizontal cut, top view. B - connections of the median atlanto-axial joint (posterior view, section in the frontal plane at the level of the posterior arch of the atlas)
m, therefore movements in this combined joint occur around the frontal (frontal) and sagittal (sagittal) axes: flexion up to 20 ° and extension up to 30 °, head tilts to the side up to 15-20 °.
Median Atlanta-axis joint (articulatio atlantoaxialis mediana) consists of two independent joints formed by the anterior and posterior articular surfaces of the tooth of the II cervical vertebra. The formation of the anterior of these joints involves the tooth fossa on the posterior surface of the anterior arch of the atlas. The posterior joint is formed by the posterior articular surface of the tooth and the fossa on the anterior surface transverse connection of the atlas (lig. Transversum atlantis). This ligament is stretched behind the tooth of the axial vertebra between the internal surfaces of the lateral masses of the atlas. The anterior and posterior articulations of the tooth have their own articular cavities and articular capsules.
The middle joint is still strengthened by several bonds that firmly hold the tooth. Odd thin ligament of the apex of the tooth (lig. Apicis dentis) stretched between the posterior edge of the anterior semicircle of the large foramen of the occipital bone and the apex of the tooth. Two strong wing-shaped connections (Bgg. Alaria) limit excessive rotation of the head to the right and left in the median atlanto-axial joint. Each ligament starts from the lateral surface of the tooth, follows obliquely upward and to the side, and is attached to the inner surface of the corresponding occipital condyle. The median atlanto-axial joint is cylindrical in shape and uniaxial. In it, the atlas rotates around the tooth (vertical axis) by 30-40 ° in each direction.
Paired combined flat in shape lateral atlantoaxial joint (articulatio atlantoaxialis lateralis) formed by the lower articular surfaces of the atlas and the upper articular surfaces of the axial vertebra. The right and left joints have separate joint capsules attached to the edges of the articular surfaces. All three joints are strengthened cruciate ligament of the atlas (lig. Cruciforme atlantis), created by the transverse ligament of the atlas and fibrous longitudinal fascicles (fasciculi longitudinales), which go up and down from the atlas cross-link. The superior fascicle is located behind the connection of the apex of the tooth and ends on the anterior semicircle of the large foramen of the occipital bone. The lower bundle is directed downward and attached to the posterior surface of the body of the axial vertebra. These two joints are inactive; only sliding occurs in them.
At the back, from the side of the spinal canal, the median and lateral atlanto-axial joints with their connections are covered with a wide and durable fibrous plate - roofing membrane (membrana tectoria).
This membrane from the body of the axial vertebra continues down into the posterior and posterior ligaments, and ends at the top at the edge of the inner surface of the slope along the tylic bone.
Sliding movements in the right and left lateral atlanto-axial joints are carried out simultaneously with the rotation of the atlas around the tooth of the axial vertebra in the median atlanto-axial joint.
Spinal column connection is supplied with blood in the cervical region by branches of the vertebral artery. In the thoracic region, the branches of the posterior intercostal arteries approach the spine, in the lumbar region - branches of the lumbar arteries, in the sacral region - branches of the lateral sacral arteries. Venous blood flows from the spine into the vertebral venous plexuses, and from them - respectively into the occipital, postauricular, deep cervical, posterior midribs, lumbar and sacral veins. Innervation connections of the spine are carried out by sensory fibers of the posterior branches of the corresponding spinal nerves.
Age-related features of the spine. The length of the spinal column in newborns is 40% of the length of the entire body. In the first 2 years of life, its length almost doubles. Up to 1.5 years, all parts of the spine grow rapidly, especially noticeable growth in width. From 1.5 to 3 years, vertebral growth slows down in the cervical and upper thoracic spine. At the age from 0 to 5 years, the lumbar and lower thoracic sections of the spinal column grow rapidly, and the growth of the cervical and upper thoracic spine slows down.
Between the ages of 5 and 10 years, the entire spine grows slowly but evenly in length and width. From 10 to 17 years, the entire spine grows rapidly, but mainly the lumbar and lower thoracic regions, and the thoracic vertebrae grow in width. Between the ages of 17 and 24 years, the growth of the cervical and thoracic spine slows down, and the growth of the lumbar and lower thoracic spine accelerates. Until the age of 16-17, the lumbar vertebrae grow primarily in width, and only after 17 years do they grow faster in length. The growth of the spine is completed approximately until 23-25 years.
In adults, the vertebral column is approximately 3.5 times longer than the spine of infants and reaches 60-75 cm in adult men, from 60 to 65 cm in women, which is approximately 2/5 of the body length of an adult. In old age, the length of the spinal column decreases by about 5 cm due to an increase in the curvature of the spine and a decrease in the thickness of the intervertebral discs. At the level of the sacral bone, the spine has the largest transverse dimensions - 10-12 cm. The VII cervical and I thoracic vertebrae are somewhat wider than the neighboring ones, because this is due to the attachment of the upper limbs at this level.
In newborns, compared to children and adults, intervertebral discs are relatively large in size, in particular thickness. The articular processes of the vertebrae are well defined, while the vertebral bodies, transverse and spinous processes are less developed. The fibrous ring of Liskov is well defined, clearly demarcated from the nucleus pulposus. Intervertebral discs in children bleed intensively. The arterioles interconnect with each other in the thickness of the disc, and on its periphery with the arterioles of the periosteum. Ossification of the marginal zone of the vertebrae in adolescents and young men leads to a decrease in the number of blood vessels in the intervertebral discs. With age, the thickness of the intervertebral discs, as well as the height of the vertebral bodies, decreases and they become less elastic. Until the age of 50, the nucleus pulposus gradually decreases. The inner part of the fibrous ring surrounding the nucleus pulposus never ossifies. The peripheral zones of the fibrous ring are partially replaced by cartilage and even ossification occurs. In old age and old age, the elasticity of the intervertebral discs decreases significantly, and pockets of calcification occur in the areas of fusion of the anterior longitudinal ligament with the anterior edge of the vertebra.
Curvatures of the spinal column. The human spine has several physiological curves. The forward bending of the spinal column is called lordosis, back bends- kyphosis, bends to the right or left - scoliosis. Cervical lordosis turns into thoracic kyphosis, lumbar lordosis changes, then sacrococcygeal kyphosis. Thoracic kyphosis and lumbar lordosis are more pronounced in women than in men. Physiological lordosis and kyphosis are permanent formations. Aortic scoliosis, expressed in 30% of people at the level of the III-V thoracic vertebrae in the form of a slight bend to the right, due to the location of the thoracic aorta at this level. The functional role of bends is very great. Thanks to them, shocks and shocks transmitted to the spine during various movements and falls are weakened - absorbed and protect the brain from unnecessary shocks. In a horizontal position of the body, the curves of the spine straighten slightly, in a vertical position they are more pronounced, and with increasing load they increase in proportion to its size. In the morning after a night's sleep, the curvature of the spine decreases, and the length of the spine increases accordingly. In the evening, on the contrary, the curvature of the bends increases, and the length of the spinal column decreases. Human posture affects the shape and magnitude of the curves of the spine. With a bent head and stoop, thoracic kyphosis increases, and cervical and lumbar lordosis decreases.
The spinal column of the human embryo and fetus has the shape of an arch, with a backward bend. In newborns, the spine does not have bends; they arise gradually and are caused by the growth of the spine, body position and muscle development. Cervical lordosis is formed at approximately 3 months of life, when the child begins to hold his head up, thoracic kyphosis - at 6 months, when the child begins to sit down, lumbar lordosis - at the end of the year, when the child begins to stand. In this case, the center of gravity of the body moves backward. Curves are finally formed by 6-7 years.
It is necessary to distinguish some of it from the physiological curves of the spinal column. pathological curvatures. These include primarily lateral curvature - scoliosis. Apart from the slight asymmetry of the spinal column inherent in all people, which turns out to be a barely noticeable right-sided scoliosis, caused by the greater development of the muscles of the upper limb girdle, then other types of scoliosis, which usually occur in childhood and early adolescence, are regarded as pathological and require the careful attention of a doctor. This is all the more important because with significant scoliosis, the position and, consequently, the function of most internal organs changes. The tilt of the pelvis also changes, which in women can lead to complications during childbirth. Among children and adolescents, school scoliosis most often develops due to habitual incorrect sitting at a desk. Scoliosis sometimes occurs due to shortening of the lower limb, which also requires early detection to prescribe orthopedic shoes. In old age, thoracic kyphosis (“senile hump”) increases, which is associated with age-related degenerative-dystrophic changes in the intervertebral discs and vertebral bodies and weakening of the tone of the back muscles. The final result of such snakes can be total kyphosis (the spine has an arched shape).
Spinal column in x-ray image. On radiographs in the anteroposterior projection, a narrowing - the “waist” - is visible in areas of the vertebral bodies. The upper and lower edges of the vertebral bodies have the shape of corners with rounded edges. The sacral foramina are visible against the background of the sacrum. At the sites of the intervertebral discs there are dark spaces. The pedicles of the vertebral arches have the shape of ovals and overlap the vertebral bodies. The vertebral arches are also superimposed on the image of the vertebral bodies. The spinous processes, located in the sagittal plane, have the appearance of a “falling drop” against the background of the vertebral bodies. Images of the inferior articular processes are superimposed on the contours of the superior processes. The head and neck of the corresponding rib are layered onto the transverse processes of the thoracic vertebrae.
On radiographs in the lateral projection, the arch of the cervical vertebra, the tooth of the axial vertebra, and the contours of the atlanto-occipital and atlanto-axial joints are visible. In other parts of the spinal column, vertebral arches, spinous and articular processes, joint spaces, and intervertebral foramina are determined.
Rice. 104. Magnetic resonance imaging (MRI) of the lower thoracic, lumbar and sacral spine of an adult (mid-arrow section) - from X thoracic (Τ X ) vertebra to the II sacral vertebra (S II )
The modern method of magnetic resonance imaging (MRI) is very informative, with the help of which you can study the structural features of not only bones, in particular the spine in three-dimensional coordinates, but also soft tissues and organs (Fig. 104).
Movements of the spinal column. The human spinal column is very mobile. This is facilitated by elastic thick intervertebral discs, the design of the vertebrae, in particular, the articular processes, ligaments and muscles. Although the movements between adjacent vertebrae are insignificant in volume, they “sum up”, which allows the vertebral column as a whole to make large-scale movements around 3 axes:
The spine is flexed forward around the frontal axis (flexio) and back extension (extensio). The amplitude of these movements reaches 170-245°. When the torso bends, the vertebral bodies bend forward, the spinous processes move away from each other. The anterior longitudinal ligament of the spinal column relaxes, and the posterior longitudinal ligament, yellow, mid-spinal and supraspinal ligaments, on the contrary, tighten and prevent this movement. When the spinal column is extended, all its connections, except the anterior longitudinal one, relax. The anterior longitudinal ligament, stretching, limits the extension of the spinal column. The thickness of the intervertebral discs during flexion and extension decreases on the side of the inclination of the spinal column and increases on the opposite side;
Around the sagittal axis, lateral flexion is performed on the right and left, the total range of movements reaches 165 °. These movements occur primarily in the lumbar spine. At the same time, the yellow and intertransverse ligaments, as well as the capsules of the arcuate joints located on the opposite side, are stretched and limit movement;
Rotational movements occur around the vertical axis (rotatio), with a total span of up to 120°. When rotating, the nucleus pulposus of the intervertebral discs acts as the articular head, the fibrous rings of the intervertebral discs and the yellow ligaments, stretching, limit this movement;
Circular rotation of the spinal column - the upper end of the spinal column moves freely in space, describing a cone, the apex of which is located at the level of the lumbosacral joint.
The volume and direction of movements in each part of the spinal column are not the same.
In the cervical and lumbar spine the range of movements is greatest. The range of motion in the cervical spine is 70-75° with flexion, 95-105° with extension, and 80-85° with rotation. In the thoracic spine, mobility is small, because movements are limited by the ribs and sternum, thin intervertebral discs and the spinous processes, which are partially directed obliquely downward; flexion - up to 35 °, extension - up to 50 °, rotation - 20 degrees. In the lumbar region, thick intervertebral discs promote greater mobility - flexion up to 60°, extension up to 45-50°. The special structure and location of the articular processes of the lumbar vertebrae limits the rotation and lateral movements of the spine.
Mobility in all parts of the spine is greatest in adolescents. After 50-60 years, the mobility of the spinal column decreases. So, the mobility of the spine depends primarily on the structure of the intervertebral discs. With age, the thickness and number of collagen bundles in fibrous rings increases. Their architecture is disrupted, the bundles are deformed, many collagen fibers are destroyed and hyalinized. At the same time, the elastic fibers also change - they become thicker, more tortuous, and fragmented. In the nucleus pulposus, starting from 5-6 years of age, the number of chondrocytes and collagen fibers increases. Until the age of 20-22, the nucleus pulposus is replaced by fibrous cartilage.
Normal human anatomy: lecture notes by M. V. Yakovlev
9. CONNECTION OF VERTEBRES
9. CONNECTION OF VERTEBRES
Vertebral connection(articulationes vertebrales) is carried out at the connection of the bodies, arches and processes of the vertebrae.
The vertebral bodies are connected by intervertebral discs (discus intervertebrales) and symphyses (symphysis intervertebrales). The intervertebral discs are located: the first is between the bodies of the II and III cervical vertebrae, and the last is between the bodies of the V lumbar and I sacral vertebrae.
In the center of the intervertebral disc is the nucleus pulposus (nucleus pulposus), along the periphery there is a fibrous ring (annulus fibrosus), formed by fibrous cartilage. There is a gap inside the nucleus pulposus, which turns this connection into a semi-joint - the intervertebral symphysis (symphysis intervertebralis). The thickness of the intervertebral discs depends on the level of location and mobility in a given section of the spinal column and ranges from 3 to 12 mm. The connections of the vertebral bodies through intervertebral discs are strengthened by the anterior (lig longitudinale anterius) and posterior (lig longitudinale posterius) longitudinal ligaments.
The vertebral arches are connected by the yellow ligaments (lig flava).
The articular processes form intervertebral joints (articulationes intervertebrales), related to flat joints. The most prominent articular processes are the lumbosacral joints (articulationes lumbosacrales).
The spinous processes are connected by the supraspinous ligament (lig supraspinale), which is especially pronounced in the cervical spine and is called the nuchal ligament (lig nuchae), and interspinous ligaments (lig interspinalia).
The transverse processes are connected by intertransverse ligaments (lig intertransversalia).
Atlanto-occipital joint (articulatio atlantooccipitalis) consists of two symmetrically located condylar joints, being a combined joint. This joint allows movement around the sagittal and frontal axes. The joint capsule is strengthened by the anterior (membrana atlantooccipitalis anterior) and posterior (membrana atlantooccipitalis posterior) atlantooccipital membranes.
Median atlantoaxial joint (articulatio atlantoaxialis mediana) is a cylindrical joint. It is formed by the anterior and posterior articular surfaces of the tooth of the axial vertebra, the articular surface of the transverse ligament of the atlas and the fossa of the atlas tooth. The transverse atlas ligament (lig transversum atlantis) is stretched between the inner surfaces of the lateral masses of the atlas.
Lateral atlantoaxial joint (articulatio atlantoaxialis lateralis) belongs to the combined joints, as it is formed by the articular fossa (fovea articularis inferior) on the right and left lateral masses of the atlas and the upper articular surface of the body of the axial vertebra. The paired lateral and median atlantoaxial joints are strengthened by paired pterygoid ligaments (lig alaria) and a ligament of the apex of the tooth (lig apices dentis). Behind the pterygoid ligaments there is a cruciate ligament of the atlas (lig cruciforme atlantis), which is formed by fibrous longitudinal bundles and the transverse ligament of the atlas. At the back, these joints are covered with a wide integumentary membrane (membrana tectoria).
Sacrococcygeal joint (articulatio sacrococcigea) is formed by the apex of the sacrum and the first coccygeal vertebra. The joint capsule is strengthened by the ventral (lig sacrococcigeum ventrale), superficial dorsal (lig sacrococcigeum dorsale superficiale), deep dorsal (lig sacrococcigeum dorsale profundum), paired lateral sacrococcygeal ligaments (lig sacrococcygeum laterale).
Spinal column (columna vertebralis) is represented by the totality of all vertebrae connected to each other. The spinal column is the container for the spinal cord, which is located in the spinal canal (canalis vertebralis).
The spine has five sections: cervical, thoracic, lumbar, sacral and coccygeal.
The spine has an S-shape due to the presence of physiological curves in the frontal and sagittal planes: thoracic and sacral kyphosis, cervical and lumbar lordosis, as well as pathological ones: thoracic scoliosis.
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