Анатомия человека = Human Anatomy

 АНАТОМИЯ
  ЧЕЛОВЕКА

   HUMAN
  ANATOMY
Допущено
Министерством образования Республики Беларусь в качестве учебного пособия для иностранных студентов учреждений высшего образования по специальности «Лечебное дело»







Минск «Вышэйшая школа» 2021

УДК 611(075.8)-054.6
ББК 28.706я73
    А64

    Авторы: Е.С. Околокулак, Ф.Г. Гаджиева, С.А. Сидорович, Д.А. Волчкевич

    Рецензенты: заведующий кафедрой анатомии человека с курсом оперативной хирургии и топографической анатомии УО «Гомельский государственный медицинский университет», кандидат медицинских наук, доцент В.Н. Жданович; доцент кафедры нормальной анатомии УО «Белорусский государственный медицинский университет», кандидат медицинских наук, доцент О.Л. Жарикова; доцент кафедры современных технологий перевода МГЛУ, кандидат филологических наук, доцент Т.И. Голикова

          Анатомия человека = Human Anatomy : учебное пособие / А64 Е.С. Околокулак [и др.]. — Минск : Вышэйшая школа, 2021. —
      416 с. : ил.
          ISBN 978-985-06-3304-0.

          Пособие освещает вопросы строения, классификации и функции всех систем и органов человека. В каждом разделе уделено внимание эмбриогенезу, описаны варианты и аномалии развития органов, указаны их кровоснабжение, иннервация и лимфоотток. Термины даны в соответствии с Международной анатомической номенклатурой. Пособие соответствует типовой учебной программе по дисциплине «Анатомия человека».
          Для иностранных студентов учреждений высшего образования по специальности «Лечебное дело».

УДК 611(075.8)-054.6
ББК 28.706я73


Учебное издание

Околокулак Евгений Станиславович
Гаджиева Фатима Гаджиахмедовна
Сидорович Сергей Александрович Волчкевич Дмитрий Александрович

АНАТОМИЯ ЧЕЛОВЕКА /HUMAN ANATOMY

Учебное пособие
На английском языке

Редактор Л.Д. Касьянова. Художественный редактор В.А. Ярошевич. Компьютерная верстка Н.В. Шабуни. Корректор Л.Д. Касьянова.
Подписано в печать 19.02.2021. Формат 70*100/16. Печать офсетная. Усл. печ. л. 33,8. Уч.-изд. л. 30,3. Тираж 400 экз. Заказ 522.
Республиканское унитарное предприятие «Издательство “Вышэйшая школа”». Свидетельство о государственной регистрации издателя, изготовителя, распространителя печатных изданий № 1/3 от 08.07.2013.
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Открытое акционерное общество «Типография “Победа”».Свидетельство о государственной регистрации издателя, изготовителя, распространителя печатных изданий № 2/38 от 29.01.2014. Ул. Тавлая, 11, 222310, Молодечно.

     Все права на данное издание защищены. Воспроизведение всей книги или любой ее части не может быть осуществлено без разрешения издательства.


ISBN 978-985-06-3304-0

                             © Оформление. УП «Издательство “Вышэйшая школа”», 2021

            PREFACE


     Human Anatomy is the science that studies the form and structure of a human organism, the organs and systems in relation with their functions, development and interactions with surrounding environment. It is a fundamental biomedical science which is a basic discipline for the medical education.
         The manual is a guide to an optimal student’s training for anatomical classes and an exam. Information is mostly explained in short separate entries. The entries that deal with the related topics are grouped in parts: osteology (about bones), arthrology (about joints), myology (about muscles), splanchnology (about internal organs), angiology (about the heart and vessels), neurology (about nervous system) and sense organs. Each part starts with the basic information followed by a more detailed explanation and discussion of the points. Entries are arranged according to the academic plan of Human Anatomy and are presented in sequence.
         The explanations are presented in the plain language. We generally preferred to use the traditional terms that are easy to understand, except for those which might be seriously misleading. The manual has a large number of illustrations and pictures.
         The book is intended for foreign students studying Human Anatomy in English. It is the first edition of this kind in Belarus. It will provide future physicians with the basic anatomy knowledge necessary for clinical practice. It will also be helpful for an instructor looking for a clear explanation of a difficult anatomical point.
         This manual may improve students’ background knowledge. We find it is useful for students in the preparation for missed classes and the exam.
         The textbook is a result of our many years’ experience in the work with the English-speaking students. The Department of Normal Anatomy of the EI “Grodno State Medical University” is very grateful to all who have helped us with the preparation of this edition.
         Suggestions and comments for correction and improvement of the manual are most welcome: they may be kindly sent to us by e-mail at anatomy@grsmu.by.
Authors

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FUNDAMENTALS
            OF OSTEOLOGY



         The skeleton consists of separate bones joined to each other by means of connective, cartilagenous or bony tissues. Bones and their connections form the passive locomotor apparatus (system).
             The importance of the skeleton. The bone system performs different functions either of predominantly mechanical or predominantly biological significance.
             The mechanical functions of the skeleton include protection, support, and the movement.
             Support (weight bearing) is provided by the attachment of soft tissues and organs to different parts of the skeleton. The movement is possible because bones have a lever structure (short or long). Bones form articulations and move with the help of muscles. Finally, protection is provided by the vertebral canal protecting the spinal cord; a bony case, the skull to protect the brain; the thoracic cage to protect the most important organs of the thoracic cavity (the heart, the lungs), and the pelvis to protect the reproductive organs.
             Biological functions of the bone system are associated with the participation of the skeleton in metabolism, mineral metabolism in particular (the skeleton is a reservoir of mineral salts, phosphorus, calcium, iron, etc). The skeleton participates in haemopoiesis due to the presence of bone marrows (medulla osseum) in bones.
             Development of the skeleton. The skeleton undergoes 3 stages of its development in human ontogenesis:
             1) connective-tissue (membranous);
             2) cartilaginous;
             3) bony.
             Almost all bones pass through these three developmental stages except for the bones of the skullcap, most bones of the face and several clavicle parts developing directly from the connective tissues without the cartilaginous stage. The bone passing through all (three) stages is called secondary and the bone undergoing only two stages (connective-tissue and bony) is called primary.
             There are four types of ossification (osteogenesis) (Latin os — bone): 1) intramembranous or endesmal; 2) perichondral; 3) periosteal; 4) enchondral.
             The bony compartments contain bone marrow (medulla ossium) which is the organ of haemopoiesis and biological protection of the organism. Bone marrow also takes part in supplying the bone with nutrition, thus

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         leading to the bone development and growth. In tubular bones, the medulla also fills the central canal, called cavitas medullaris. All the internal spaces of the bone are filled with marrow, an indispensable part of the bone as an organ.
     There are two types of bone marrow, red and yellow. Red bone marrow (medulla ossium rubra) is shown as a fine red mass of reticular tissues. The meshes of the red bone marrow contain cells directly involved in haemopoiesis and bone formation (cells forming bone, osteoblasts, and cells destroying bone, osteoclasts). The blood vessels and the blood elements give the marrow its red colour. Yellow bone marrow (medulla ossium flava) owes its colour to the fat cells, which it is mainly composed of.
     During the development and growth of the organism, when intensified haemopoietic and osteogenetic functions are necessary, red bone marrow is predominate (embryos and newborns have only red marrow). After birth red marrow is gradually replaced by yellow marrow filling the medullary cavities of the tubular bones in adults.
     > Bones classification.
     The skeleton consists of the following parts: bones of the trunk (vertebrae, ribs and sternum), bones of the skull (skull cap and facial skull), bones of the limb girdles or the shoulder girdle (scapula and clavicle) and the pelvic girdle (ilium, pubis and ischial bones), and bones of the free limbs: upper (humerus, bones of the forearm and hand) and lower (femur, bones of the shin and foot).
     Bones are classified according to their shape: long, short, flat, and mixed.
     Actually, it is more convenient to classify bones according to three principles (structure, function and development). The following bone classification was suggested by M.G. Prives:
     I. Tubular bones: 1) long, 2) short.
     II. Spongy bones: 1) long, 2) short, 3) sesamoid.
     III. Flat bones: 1) skull bones, 2) girdle bones.
     IV. Mixed bones.
     I.      Tubular bones. These bones are composed of spongy and compact substance forming a tube with a marrow cavity. Long tubular bones (forearm bones) are supporters as well as long the movement levers. Short tubular bones (metacarpal, metatarsal, phalanges) are short the movement levers.
     II.     Spongy bones. These bones consist mainly of spongy substance, covered with a thin layer of a compact substance. There are long (ribs and sternum) and short (vertebrae, carpal, and tarsal) spongy bones. The group of spongy bones also includes sesamoid bones, i.e. bones that resemble sesame seeds in shape (patella, pisiform bone). Sesamoid bones act as accessory devices in muscle work.
     III.     Flat bones: a) flat bones of the skull (frontal and parietal). Their structure contains diploe — spongy substance placed between the external and internal plates of the skull bones; b) flat bones ofthe girdles (scapula, pelvic bones).
     IV.     Mixed bones (bones of the skull base) consist of several parts that differ in function, structure, and development.

THE VERTEBRAL COLUMN.
                 A TYPICAL VERTEBRA. THE THORACIC VERTEBRAE



          The vertebral column (columna vertebralis) or the spine has a metameric structure consisting of separate bone segments, vertebrae — short spongy bones, placed one over another in a series.
              Function of the spine. The spine is the axial skeleton supporting the body. It protects the spinal cord enclosed in its canal and takes part in the head and trunk movement. The shape and position of the vertebral column are determined by the upright position of a man.
              Features of the vertebrae. According to the three functions of the spine, each vertebra (Greek spondylos) has the following features:
              1)      the body (corpus vertebrae) the anterior part, responsible for supporting and thickening the shape of the column;
              2)       the vertebral arch (arcus vertebrae) attached to the posterior surface of the body. It has a lamina (lamina arcus vertebrae) and a pair of pedicles (pediculi arcus vertebrae). The concavities above and below the pedicles are named the vertebral notches (incisurae vertebrales superiores et inferiors). When the vertebrae articulate with one another, the notches form the intervertebral foramen (foramen intervertebrale) permitting spinal nerves to pass. The vertebral arch and the body contributes to the formation of the vertebral foramen (foramen vertebrale). A series of these foramina forms the vertebral canal (canalis vertebralis) protecting the spinal cord. The primary function of the vertebral arch is a protective one.
              3)       the seven processes (processus), four articular, two transverse processes, one spinous process. The spinous process (the spine, processus spinosus) arises from the midline of the vertebral arch. The transverse process (processus transversus) projects laterally on each side of the vertebral arch. The paired superior articular process (processus articulares superiors) and paired inferior articular process (processus articulares inferiors) form articular pillars projecting upward and downward. The articular processes meet the corresponding pocesses of the adjoining vertebrae and form intervertebral joints. The transverse and spinous processes serve for the ligaments and muscles attachement.
              Some parts of the vertebrae in different regions of the spine have distinctive features. Accoding to these features the following vertebrae are distinguished: cervical (seven, CI—CVII), thoracic (twelve, TI—TXII), lumbar (five, LI—LV), sacral (five, SI—SV), and coccygeal (one to four, Col—ColV). The weight-bearing part of the cervical vertebrae (body) is relatively small (the first cervical vertebra has almost no body). As we go down from pars

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          cervicalis till pars lumbalis, the vertebral bodies gradually increase in size — the largest vertebrae has the lumbar segment. The sacral vertebrae carry the whole weight of the head, trunk, and upper limbs. In contrast, the coccygeal vertebrae are small bony structures without any arches. The vertebral arch forms a wider vertebral foramen where the spinal cord is thickened (lower cervical, upper thoracic, and upper lumbar vertebrae). Since the spinal cord terminates at the level of the second lumbar vertebra, the vertebral foramen of the lower lumbar and the sacral vertebrae

Fig. 1. The thoracic vertebra (vertebra thoracica, Th), lateral aspect:
1 — body; 2 — superior costal facet; 3 — superior articular process and facet; 4 — pedicle; 5 — transverse costal facet; 6 - transverse process; 7 - inferior articular process; 8 - spinous process; 9 - inferior vertebral notch; 10 - inferior costal facet

gradually narrows disappearing completely in the coccyx. The transverse and spinous processes — the sites of muscles and ligaments attachment — are more pronounced in parts that carry the most powerful musculatures (lumbar and thoracic segments).

     Thoracic vertebrae (vertebrae thoracicae) articulate with ribs. The presence of articular facets for ribs, fovea costales, on the body of each vertebra close to the base of the arch is the particular feature of all thoracic vertebrae (Fig. 1).
     Since ribs usually articulate with two adjoining vertebrae, most vertebral bodies have two incomplete (half) costal facets: one on the superior edge of the vertebra, the superior costal facet (fovea costalis superior) and the other on the inferior surface, the inferior costal facet (fovea costalis inferior). When one vertebra is placed on the other, two half-facets form a single complete articular facet. This is the place for the head of the rib attachment.

     The first thoracic vertebra is an exception: it has a complete articular facet (Fig. 2) on the superior edge where the first rib articulates and a half-facet on the inferior edge where the second rib articulates. The tenth vertebra has only one half-facet for articulating with the tenth rib. The eleventh and twelfth vertebrae have

Fig. 2. Features of the thoracic vertebrae

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a complete facet for articulating with the corresponding ribs. Therefore, these vertebrae (the first, tenth, eleventh, and twelfth) can be easily distinguished from the others. Because of the great weight they bear, the bodies of the thoracic vertebrae are larger than the bodies of the cervical vertebrae. The articular processes are positioned frontally. The transverse processes are directed laterally and to the back.
    The thoracic vertebrae have a transverse costal facet (fovea costalis processus transverses) to articulate with the costal tubercle (except the eleventh and twelfth vertebrae). The spinous processes of the thoracic vertebrae are long obliquely directed lying over each other like tiles. Such direction of the processes limits the spine extension being a protective accommodation for the the heart.


        2.1 THE CERVICAL, LUMBAR, SACRAL AND COCCYGEAL VERTEBRAE


The cervical vertebrae (vertebrae cervicales) are the smallest vertebrae in the column, as they support the least load, the head. The shape of the bodies is transverse-oval with upper and lower concave surfaces. The transverse processes are each pierced by the foramen transversarium (Fig. 3) giving the passage to the vertebral artery and vein as well as a plexus of sympathetic nerves in the upper six vertebrae.
    Each process consists of an anterior and posterior roots. The anterior portion is the homologue of the rib in the thoracic region, and, therefore, names the costal process (costotransverse bar) (processus costarius) or costal element: it arises from the side of the body and ends in a tubercle, the anterior tubercle. The posterior root, the true transverse process, springs from the vertebral arch behind the foramen, directed forward and lateralward; it ends in a flattened vertical tubercle, the posterior tubercle.
    The anterior tubercle of the sixth vertebra is the largest; it is called tuberculum
caroticum (the carotid artery can be

Fig. 3. The cervical vertebra (C), superior view:
1 — foramen transversarium; 2 — corpus vertebrae; 3 — anterior tubercle; 4 — posterior tubercle; 5 — pedicle; 6 — superior articular process; 7 — inferior articular process; 8 — arcus vertebrae; 9 — bifid spinous process; 10 — vertebral foramen

compressed against it to arrest bleeding). The spinous process of the first five cervical vertebrae is bifid. The seventh cervical vertebra has the largest spinous process, and for that reason it is called the vertebra prominens. This vertebra is easily located in a living person.
     The first (Fig. 4) and second cervical vertebrae have a specific shape since they form mobile articulations with the skull.
     The first cervical vertebra is called the atlas (atlas). It has no body and no spinous process. The atlas has two arches. The anterior arch is marked by the anterior tubercle (tuberculum anterius) on its anterior aspect, its posterior surface bears an oval facet articulating with the


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Fig. 4. The first cervical vertebra (atlas), superior view:
1 — tuberculum anterius; 2 — fovea dentis; 3 — processus transversus; 4 — facies articularis superior; 5 — arcus posterior; 6 — tuberculm posterius; 7 — sulcus a. vertebralis; 8 — foramen processus transversi; 9 — massa lateralis;
10 — arcus anterior

dens. The posterior arch is much longer than the anterior one, its posterior surface is also marked by the posterior tubercule (tuberculum posterius). The anterior and posterior arches of the atlas are connected by the lateral masses (massae laterales). The superior surface of each mass bears the superior articular facet (fovea articularis superior). This facet is concave articulating with the corresponding occipital condyle. The inferior articular facet (facies articularis inferior) is nearly circular and flat, articulating with the corresponding facet on the second cervical vertebra.
     The second cervical vertebra, the axis (axis) is identified by the presence of a tooth-like process, the dens or odontoid process. The dens projects upward from the body is believed to represent the body of the atlas which has fused with the body of the axis. The dens articulates anteriorly with the anterior arch of the atlas and posteriorly with the transverse ligament of the atlas. The pharyngeal and retrpharyngeal inflammations can cause decalcification of the atlas. This may lead to the loosing of the attachment of the transverse ligament which may eventually cause a sudden death from dislocation of the dens.
     The lumbar vertebrae (vertebrae lumbales) have massive bodies because they have to bear the greater part of the body weight. They have no costal facets on the body. The spinous processes are directed horizontally, to the back. The articular processes are in sagittal plane. The transverse process is a rudimentary rib fused completely with the true transverse process; a small part of it preserved as a small process on the posterior aspect of its root, is called the accessory process, processus accessorius.
     The sacral vertebrae (vertebrae sacrales) fuse in youth to form a single bone, the sacrum (os sacrum) (Fig. 5).
     The sacrum is triangular in shape, and its base (basis ossis sacri) faces upward, while the apex (apex ossis sacri) faces downward. The first sacral vertebra articulates with the body of the last lumbar vertebra. The projected anterior margin is called the sacral promontory (promontorium). The pelvic surface of the sacrum (facies pelvica) is concave. The median area is marked by four transverse ridges (lineae transversae) that indicate the

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lines of fusion of the vertebral bodies. These ridges end on either side at the pelvic sacral foramina (foramina sacralia pelvina). The dorsal surface has correspondingly the dorsal sacral foramina (foramina sacralia dorsalia). The dorsal surface is irregular and convex. There are five crests formed by the fusion of different parts of the vertebrae stretching lengthwise on the dorsal surface (Fig. 6): the unpaired median sacral crest (crista sacralis mediana) on the midline that represents the fused spinous processes of the sacral vertebrae; the intermediate sacral crests (cristae sacrales intermedianae) formed by the fusion of all articular processes of the sacral vertebrae and the lateral sacral crests (cristae sacrales laterales) that represent the fusion of the transverse processes.
     Laterally to the sacral foramina, the costal elements unite with each other and transverse processes to form lateral parts or masses (partes laterals). These parts have an ear-shaped surface, termed the auricular surface (facies auricularis). The posterior, roughed and pitted area is the sacral tuberosity (tuberositas sacralis) (the site of muscles and ligaments attachment).
     The sacral canal (canalis sacralis) passes through the sacrum. It is the continuation of the vertebral canal. The sacral canal is not closed in its distal part and opens with the gap, the sacral hiatus (hiatus sacralis). This gap is produced by the failure of the lamina of the fifth sacral vertebra to meet in the median plate, so the posterior surface of the body of that vertebra is exposed on the dorasal surface of the sacrum. Laterally to this hiatus there are the sacral cornua (cornua sacralia) — remnants of the inferior articular process of the last sacral vertebra — articulating with the similar cornua of the coccyx.
     In female the sacrum is shorter and wider than in the male, reflecting necessity for a wider pelvic cavity. The upper part of the bone is flattened, and the lower part




















Fig. 5. The sacrum, ventral view:
1 — foramina sacralia anteriora; 2 — ala ossis sacri; 3 — basis ossis sacri; 4 — processus articularis superior; 5 — pars lateralis; 6 — lineae transversae; 7 — apex ossis sacri

                                                                          Fig. 6. The sacrum, dorsal view:
1  — cornu sacrale; 2 — crista sacralis lateralis; 3 — facies au-ricularis; 4 — foramina sacralia posteriora; 5 — canalis sacra-lis; 6 — processus articularis superior; 7 — tuberositas ossis sac-ri; 8 — crista sacralis medialis; 9 — crista sacralis mediana;
                                                                                  10 — hiatus sacralis

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