人体解剖生理学 - 骨骼系统

TheSkeletalSystem:Structure,Function,andDiseasesofthebonesandjointsIsthisthecorrectanatomicalposition?TheSkeletalSystemCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsPartsoftheskeletalsystemBones(skeleton)JointsCartilagesLigaments(bonetobone)(tendon=bonetomuscle)DividedintotwodivisionsAxialskeletonAppendicularskeleton–limbsandgirdleFunctionsofBonesCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsSupportofthebodyProtectionofsoftorgansMovementduetoattachedskeletalmusclesStorageofmineralsandfatsBloodcellformationBonesoftheHumanBodyCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsTheskeletonhas206bonesTwobasictypesofbonetissueCompactboneHomogeneousSpongyboneSmallneedle-like

piecesofboneManyopenspacesFigure5.2bMicroscopicAnatomyofBoneCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure5.3Bonesareclassifiedbytheirshape:

longshortflatirregular

ClassificationofBonesontheBasisofShapeCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure5.1ClassificationofBonesCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsLongbonesTypicallylongerthanwideHaveashaftwithheadsatbothendsContainmostlycompactboneExamples:Femur,humerusGrossAnatomyofaLongBoneCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsDiaphysisShaftComposedofcompactboneEpiphysis

EndsoftheboneComposedmostlyofspongyboneFigure5.2aStructuresofaLongBoneCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsPeriosteumOutsidecoveringofthediaphysisFibrousconnectivetissuemembraneSharpey’sfibersSecureperiosteumtounderlyingboneArteriesSupplybonecellswithnutrientsFigure5.2cClassificationofBonesCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsShortbonesGenerallycube-shapeContainmostlyspongyboneExamples:Carpals,tarsalsClassificationofBonesCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFlatbonesThinandflattenedUsuallycurvedThinlayersofcompactbonearoundalayerofspongyboneExamples:Skull,ribs,sternumClassificationofBonesCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsIrregularbonesIrregularshapeDonotfitintootherboneclassificationcategoriesExample:VertebraeandhipCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsSurfacefeaturesofbonesSitesofattachmentsformuscles,tendons,andligamentsPassagesfornervesandbloodvesselsCategoriesofbonemarkingsProjectionsandprocesses–growoutfromthebonesurfaceDepressionsorcavities–indentationsTypesofBoneCellsCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsOsteocytesMaturebonecellsOsteoblastsBone-formingcellsOsteoclastsBone-destroyingcellsBreakdownbonematrixforremodelingandreleaseofcalciumBoneremodelingisaprocessbybothosteoblastsandosteoclastsChangesintheHumanSkeletonCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsInembryos,theskeletonisprimarilyhyalinecartilageDuringdevelopment,muchofthiscartilageisreplacedbyboneCartilageremainsinisolatedareasBridgeofthenosePartsofribsJointsBoneGrowthCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsEpiphysealplatesallowforgrowthoflongboneduringchildhoodNewcartilageiscontinuouslyformedOldercartilagebecomesossifiedCartilageisbrokendownBonereplacescartilageBoneFracturesCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsAbreakinaboneTypesofbonefracturesClosed(simple)fracture–breakthatdoesnotpenetratetheskinOpen(compound)fracture–brokenbonepenetratesthroughtheskinBonefracturesaretreatedbyreductionandimmobilizationRealignmentoftheboneCommonTypesofFracturesSlide5.17Copyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsTable5.2StagesintheHealingofaBoneFractureSlide5.19Copyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure5.5Axialskeletonsupportsandprotectsorgansofhead,neckandtrunk

Axialskeleton: skull(craniumandfacialbones) hyoidbone(anchorstongueandmuscles associatedwithswallowing) vertebralcolumn(vertebraeanddisks) bonythorax(ribsandsternum)Appendicular

skeletonincludesbonesoflimbsand bonesthatanchorthemtotheaxialskeletonAppendicularskeleton: pectoralgirdle(claviclesandscapulae) upperlimbs(arms) pelvicgirdle(sacrum,coccyx) lowerlimbs(legs)Articulation-wherejointsmeet,connect,andareformed.22bonesinskull6inmiddleears1hyoidbone26invertebralcolumn25inthoraciccage4inpectoralgirdle60inupperlimbs60inlowerlimbs2inpelvicgirdle206bonesinallTheAxialSkeletonSlide5.20aCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFormsthelongitudinalpartofthebodyDividedintothreepartsSkullVertebralcolumnBonythoraxTheAxialSkeletonSlide5.20bCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure5.6Theskull8suturedbonesincraniumFacialbones:13suturedbones,1mandibleCranium encasesbrain attachmentsformuscles sinusesBonesoftheSkullCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure5.11AllowsforgrowthHumanSkull,SuperiorViewSlide5.23Copyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure5.8HumanSkull,InferiorViewSlide5.24Copyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure5.9ParanasalSinusesSlide5.25aCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsHollowportionsofbonessurroundingthenasalcavityFigure5.10TheHyoidBoneSlide5.26Copyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsTheonlybonethatdoesnotarticulatewithanotherboneServesasamoveablebaseforthetongueFigure5.12TheVertebralColumnSlide5.28Copyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsVertebraeseparatedbyintervertebraldiscsThespinehasanormalcurvatureEachvertebraeisgivenanameaccordingtoitslocationFigure5.14Vertebralcolumn7cervialvertebrae12thoracic5lumbar1sacrum(5fused1coccyx(4fused)VertebraevaryinsizeandmorphologyStructureofaTypicalVertebraeSlide5.29Copyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure5.16Thoraciccage ribs thoracicvertebrae sternum costalcartilagesTrueribsaredirectlyattachedtothesternum(firstsevenpairs)Threefalseribsarejoinedtothe7thribTwopairsoffloatingribsStructuresAssociatedwiththeSynovialJointSlide5.50Copyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsBursae–flattenedfibroussacsLinedwithsynovialmembranesFilledwithsynovialfluidNotactuallypartofthejointTendonsheathElongatedbursathatwrapsaroundatendonTheSynovialJointSlide5.51Copyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure5.28TypesofSynovialJointsBasedonShapeSlide5.52aCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure5.29a–cTypesofSynovialJointsBasedonShapeSlide5.52bCopyright©2003PearsonEducation,Inc.publishingasBenjaminCummingsFigure5.29d–fDiseasesandConditions

oftheSkeletalSystemArthritisBursitisInflammationoftheBursa(fluidfilledsacsurroundingthejoint).Abursacanbecomeinflamedfrominjury,infection(rareintheshoulder),orduetoanunderlyingrheumaticcondition.Bursitisistypicallyidentifiedbylocalizedpainorswelling,tenderness,andpainwithmotionofthetissuesintheaffectedarea.TendonitisSometimesthetendonsbecomeinflamedforavarietyofreasons,andtheactionofpullingthemusclebecomesirritating.Ifthenormalsmoothglidingmotionofyourtendonisimpaired,thetendonwillbecomeinflamedandmovementwillbecomepainful.Thisiscalledtendonitis,andliterallymeansinflammationofthetendon.Themostcommoncauseoftendonitisisoveruse.CarpalTunnelSyndromeAnyconditionthatcausesswellingorachangeinpositionofthetissuewithinthecarpaltunnelcansqueezeandirritatethemediannerve.Irritationofthemediannerveinthismannercausestinglingandnumbnessofthethumb,index,andthemiddlefingers,aconditionknownas"carpaltunnelsyndrome."OsteoporosisOsteoporosisisatermthatmeans"porousbones."Itisaskeletaldiseaseaffectingwomenandmen.Osteoporosisisaconditioninwhichboneshavelostminerals

especiallycalciumﾑmakingthemweaker,morebrittle,andsusceptibletofractures(brokenbones).Anyboneinthebodycanbeaffectedbyosteoporosis,butthemostcommonplaceswherefracturesoccuraretheback(spine),hips,andwrists.ScoliosisScoliosisisanabnormalcurvatureofthespine.Ifyourchildhasscoliosis,theviewfrombehindmayrevealoneormoreabnormalcurves.Scoliosisrunsinfamilies,butdoctorsoftendon'tknowthecause.Moregirlsthanboyshaveseverescoliosis.Adultscoliosismaybeaworseningofaconditionthatbeganinchildhood,butwasn'tdiagnosedortreated.Inothercases,scoliosismayresultfromadegenerativejointconditioninthespine.KyphosisWithkyphosis,yourspinemaylooknormaloryoumaydevelopahump.Kyphosiscanoccurasaresultofdevelopmentalproblems;degenerativediseases,suchasarthritisofthespine;osteoporosiswithcompressionfracturesofthevertebrae;ortraumatothespine.Itcanaffectchildren,adolescentsandadults.LordosisAnormalspine,whenviewedfrombehindappearsstraight.However,aspineaffectedbylordosisshowsevidenceofacurvatureofthebackbones(vertebrae)inthelowerbackarea,givingthechilda"swayback"appearance.TuberculosisoftheSpine-Pott’sDiseaseAsaformofextrapulmonarytuberculosisthatimpactsthespine,Pott’sdiseasehasaneffectthatissometimesdescribedasbeingasortofarthritisforthevertebraethatmakeupthespinalcolumn.Moreproperlyknownastuberculosisspondylitis,Pott’sdiseaseisnamedafterDr.PercivallPott,aneighteenthcenturysurgeonwhowasconsideredanauthorityinissuesrelatedtothebackandspine.Pott'sdiseaseisoftenexperiencedasalocalphenomenonthatbeginsinthethoracicsectionofthespinalcolumn.EarlysignsofthepresenceofPott’sdiseasegenerallybeginwithbackpainthatmayseemtobeduetosimplemusclestrain.However,inshortorder,thesymptomswillbegintomultiply.RicketsRicketsisthesofteningandweakeningofbonesinchildren,usuallybecauseofanextremeandprolongedvitaminDdeficiency.Someskeletaldeformitiescausedbyricketsmayneedcorrectivesurgery.ScurvyThehumanbodylackstheabilitytosynthesizeandmakevitaminCandthereforedependsonexogenousdietarysourcestomeetvitaminCneeds.ConsumptionoffruitsandvegetablesordietsfortifiedwithvitaminCareessentialtoavoidascorbicaciddeficiency.Eventhoughscurvyisuncommon,itstilloccursandcanaffectadultsandchildrenwhohavechronicdietaryvitaminCdeficiency.GoutGoutisadiseasethatresultsfromanoverloadofuricacidinthebody.Thisoverloadofuricacidleadstotheformationoftinycrystalsofuratethatdepositintissuesofthebody,especiallythejoints.Whencrystalsforminthejointsitcausesrecurringattacksofjointinflammation(arthritis).Chronicgoutcanalsoleadtodepositsofhardlumpsofuricacidinandaroundthejointsandmaycausejointdestruction,decreasedkidneyfunction,andkidneystones.AcromegalyAcromegalyisaseriousconditionthatoccurswhenthebodyproducestoomuchofthehormonesthatcontrolgrowth.･Thehormonemostoftenaffectediscalledgrowthhormone,orGH.Itﾊisproducedbythepituitarygland,atinyorganatthebaseofthebrain.･･Growthhormoneﾊpromotesgrowthofbone,cartilage,muscle,organs,andothertissues.･･Whenthereistoomuchgrowthhormoneinthebody,thesetissuesgrowlargerthannormal.Thisexcessivegrowthcancauseseriousdiseaseandevenprematuredeath.PoliomyelitisPoliomyelitis(polio)isahighlyinfectiousdiseasecausedbyavirus.Itinvadesthenervoussystem,andcancausetotalparalysisinamatterofhours.Itcanstrikeatanyage,butaffectsmainlychildrenunderthree(over50%ofallcases).Thevirusentersthebodythroughthemouthandmultipliesintheintestine.Initialsymptomsarefever,fatigue,headache,vomiting,stiffnessintheneckandpaininthelimbs.Onein200infectionsleadstoirreversibleparalysis(usuallyinthelegs).Amongstthoseparalysed,5%-10%diewhentheirbreathingmusclesbecomeimmobilized.Althoughpolioparalysisisthe