Female pelvic bone. Features of the structure of the female pelvis and its differences from the male

Whenever there is any physical discomfort in the lower abdomen, most women associate it with dysfunction. genitourinary system. Having an idea about the pelvic organs, what is included in their composition, you can determine the area of ​​​​the lesion.

There are two systems in the pelvis: reproductive and excretory. Both systems, their constituent organs, are closely interconnected. Therefore, when any gynecological diseases excretory organs are often also affected.

reproductive system

The main role of the female reproductive organs is to provide the most favorable conditions for reproduction.

The female reproductive system includes the following organs:

• uterus (cervix and cervical canal);
• uterine (fallopian) tubes;

Entrance to reproductive system presented as an external opening into the vagina. It is hidden by the large and small labia. The area from the external opening to the cervical region of the uterus is called the vaginal canal. It ends with a vault, conditionally divided into 4 parts. The lower part of the vagina consists of the anterior and rear wall. Out of the uterus through its opening menstrual flow. The vagina plays an important role during labor.

If you go deep into the vagina with the help of a diagnostic tool (gynecological mirrors), you can see a protruding narrow part - the cervix. The section between the neck and the body itself is called cervical. There is also an entrance to the uterine cavity, it is presented in the form of an external and internal uterine os.

The uterus is one of the main organs of the reproductive sphere, the task of which is to create the most favorable conditions for bearing a fetus. Location: between bladder and rectum. Its size varies depending on age and individual characteristics.

In young girls, the size of the uterus ranges from 4-5 cm and weighs up to 50 grams. Among women reproductive age- about 7 cm and 50-80 grams. An increase in the body weight of the uterus is affected by hypertrophic structural changes observed during pregnancy, as well as the number of previous births.

The uterus is pear-shaped and slightly tilted forward (anteflexio position). A slight deviation of the uterus back (retroflexio) is allowed. With the exception of the vaginal part, it is hidden by the organs of the peritoneum. This body is quite mobile, so it can take any position.

The body of the uterus is made up of three layers:

1. Serous (Perimetry). It is characterized as a continuation of the parietal sheet of the peritoneum and a continuation of the cover of the bladder.
2. Muscular (myometrium). The thickest layer of the uterus, made up of muscles, fibers and connective tissue.
3. Mucosa (endometrium). It is presented in the form of superficial and deep cylindrical epithelium, penetrated by tubular glands.

Bartholin gland cyst

Timely diagnosis and competent approach contribute to early detection congenital anomalies and developing diseases. Regular preventive examinations at the gynecologist, compliance with his recommendations prevent the development of pathological changes in the pelvic organs.

Pelvic (innominate) bone ( oscoxae) up to 16–18 years old is represented by three separate bones connected by cartilage:

iliac,

sciatic

and pubic.

In the future, after ossification, the cartilages grow together and form an innominate bone.

Ilium woman's pelvis osilium) consists of two parts - the body and the wing. The body is represented by a short, thickened part of the ilium, it is involved in the formation of the acetabulum. The wing of the ilium is a fairly wide platinum with a concave inner and convex outer surfaces.

The most thickened and free upper edge of the wing forms the iliac crest ( cristailiaka).

In front, the crest begins with a protrusion - the anterior iliac spine ( spinailiakaanterior superior),

Below is the second protrusion - the anteroinferior spine ( spinailiakaanteriorinferior).

Under the anteroinferior spine, at the junction with the pubic bone, there is a third elevation - the iliopubic ( eminentiailiopubika).

The iliac crest itself ends behind the posterior superior iliac spine ( spinailia capoposterior),

Below which is the second protrusion - the posterior inferior iliac spine ( spinailiakaposteriorinferior).

In turn, under the posterior spine of the pelvis of the woman is the sciatic notch ( incisuraischiadicamajor).

Characteristic is the location of the ridge-like protrusion in the region of the transition of the wing to the body. This protrusion is called the arcuate line ( linearcuata). These lines of both iliac bones, together with the sacral cape, crests of the pubic bones and the upper edge of the symphysis, form the border (nameless) line ( line terminalis), which serves as the boundary between the large and small pelvis.

Ischium woman's pelvis osischii) is subdivided into the body involved in the formation of the acetabulum, and two branches (upper and lower). The upper branch goes from the body of the bone down and ends with the ischial tuberosity ( tuberischiadicum). On the back surface of the lower branch there is a protrusion - the ischial spine ( spinaischiadica). The lower branch goes anteriorly and upwards and connects with the lower branch of the pubic bone.

Pubic bone woman's pelvis ospubis), or pubic, forms the anterior wall of the pelvis. The pubic bone consists of a body and two branches: superior (horizontal) and inferior (descending). The body of the pubis is short and leaves part of the acetabulum, the lower branch joins with the corresponding branch of the ischium. On the upper edge of the upper branch of the pubic bone there is a sharp ridge, which ends in front with a pubic tubercle ( tuberculum pubis).

Between the upper and lower branches there is a sedentary joint in the form of cartilage, which is a semi-joint - the pubic symphysis ( symphysispubica). This joint has a slit-like cavity filled with liquid. During pregnancy, there is an increase in this gap. In turn, the lower branches of the pubic bones form an angle under the symphysis. The connecting branches of the pubic and ischial bones limit the extensive obturator foramen ( foramenobturatum).

The structure of the sacrum in the pelvis of a woman

The sacrum of the pelvis of a woman ( ossacrum) consists of five fused vertebrae. The dimensions of the vertebrae that make up the sacrum gradually decrease downwards, so the sacrum has the shape of a truncated cone. Its wide part (the base of the sacrum) is turned up, the narrow part (the top of the sacrum) is down. The back surface of the sacrum is convex, and the front is concave, it forms the sacral cavity. On the anterior surface of the sacrum (in the cavity), four transverse rough lines can be noted, corresponding to the ossified cartilaginous joints of the sacral vertebrae.

Directly the base of the sacrum of the pelvis of a woman (the surface of the first sacral vertebra) is connected to the fifth lumbar vertebra. Whereas in the middle of the anterior surface of the base of the sacrum a protrusion is formed - the sacral cape ( promantorium). On palpation between the spinous process of the fifth lumbar vertebra, you can feel the cavity - the supracacral fossa, which has a certain value when measuring the size of the pelvis.

The structure of the coccyx of a woman

Coccyx ( oscoccygis), as well as the sacrum, consists of fused 4-5 vertebrae and is a small bone, tapering downwards.

All the bones of the pelvis are connected primarily through the symphysis, and then the sacroiliac and sacrococcygeal connections follow.

Cartilaginous layers are located in all joints of the pelvic bones. The joints of the pelvic bones are strengthened with strong ligaments

What are the functions of the human pelvis?

In the anatomical structure human body The pelvis is of great importance, as it performs important functions for the body:

supporting - the spinal column is attached to it;

protective - human organs are placed inside the pelvic cavity ( bladder, colon, female and male reproductive organs);

The pelvis functions as the center of mass of the human skeleton;

hematopoietic - due to the high content of red bone marrow.

Right pelvic bone

Protective functions of the pelvis

One of the most important functions of the pelvis is protective. The anatomy of the human body is such that almost all reproductive organs, the bladder and some abdominal organs are located in the pelvic region.

All these organs are protected from mechanical damage and displacement by bone tissues of the pelvic cavity.

This is especially important for women when carrying a child. The bottom of the pelvis in the form of a junction of the sacrum and iliac bones is connected by ligaments and supports the uterus in the required position.

BONES OF THE SPINE COLUMN

The spinal column - the axis and support of our body - consists of 33-34 vertebrae, bone elements located one above the other. The vertebrae form the spinal canal where the spinal cord lies, have a central opening and small protrusions, processes to which muscles are attached.

The vertebrae are divided as follows:

7 cervical vertebrae, they are the least thick and the most mobile. The first cervical vertebra - the atlas - is incomplete, and the second - the axial vertebra - provides lateral rotation of the neck.

12 thoracic vertebrae are located in the back and are thicker and less mobile than the cervical vertebrae.

5 lumbar vertebrae are located in the lumbar region and are quite mobile.

5 sacral vertebrae, soldered together, form the sacrum, a very strong bone that serves as the basis for the spine.

4 or 5 coccygeal vertebrae, also tightly soldered, form coccyx.

Functions of the Spine The ligaments of the vertebrae and the connections of the spinal column act as buffers so that human movements do not wear out the spine. The functions of the spinal column are determined by its structure and the presence of a large number components, the most basic and main of them is the support of the human body. Other functions include: maintaining the human body in a vertical state; protection of the spinal cord and nerve endings; the rigidity of the human skeleton, the connecting node of other bones, muscles and joints; the basis and beginning of all human movements. The functioning of the spinal column and the harmonious coordinated work of all its constituent elements is largely possible precisely due to its structure. The anatomy of the spinal column simultaneously allows it to be flexible and plastic, while limiting mobility to avoid injury or injury.

Ribs Ribs are arcuate paired flat bones that connect the spine and sternum to form the chest. The thickness of the rib rarely exceeds 5 millimeters. The structure of the ribs The ribs are curved narrow plates, consisting of: Bones (long spongy bones with a head, neck and tubercle) - in its longest (back) part; Cartilage - in the shorter (front) part. The body of the rib has an inner (concave) and an outer (convex) surface, bounded by rounded and sharp edges. Vessels and nerves are located in the groove passing along the inner surface of the lower edge. A person has twelve ribs on each side, which are connected to the bodies of the thoracic vertebrae with their posterior ends. The ribs are divided into three groups according to the method of attachment: The seven upper ribs (true ribs) are connected directly to the sternum with their front ends; The next three, false ribs, are connected by their cartilage to the cartilage of the previous rib; The two lower ribs (oscillating ribs) lie freely with their front ends. The ribs are connected to the sternum and vertebrae using all types of connections: Synarthroses (syndesmosis and synchondrosis); Symphyses; Diarthrosis. The chest is lined from the inside with a connective tissue membrane, immediately below which is located, consisting of two smooth sheets of pleura. A thin layer of lubricant allows you to freely slide between the sheets while breathing. The function of the ribs The main functions of the ribs are: Protective function. The ribs, forming the ribcage, cover the heart, lungs and large vessels from injury and external influences; frame function. The chest, which helps to keep the organs in the chest cavity in the right position, does not allow the heart to move to the sides and fall off the lungs.

Several important functions for the normal functioning of the whole organism are performed by the spinal column. Therefore, maintaining it in a state of working capacity until the end of life should be the goal of those who care not only about the number of years lived, but also about their quality.

Functions of the spine

The human spinal column is a single system consisting of vertebrae, intervertebral discs, ligaments and joints, due to which it performs important functions. The first of these is holding on to the upper body and head. Performing this function, the spine withstands enormous loads, especially if its owner is overweight or spends a lot of time in an upright position.

The second function is provided by the intervertebral discs. They set in motion the spine itself and provide the possibility of movement of the entire upper part of the human body.

Another function of the spine is protective. It reliably covers the spinal cord with bone tissue, which, through the brain, ensures the movement of the limbs. The high-quality performance of all these functions is ensured by the coordinated work of all components of the human spinal column, so knowledge of the anatomy of the spine will help to avoid many health problems.

The structure of the spinal column

The spinal column as a whole consists of:

· vertebrae. They have the form of hollow rings, the openings of which form the spinal canal, a kind of protective zone for the spinal cord. Anatomy of all vertebrae similar, except for the first and second vertebrae cervical.

· Intervertebral discs. They are a closed cavity connecting the vertebrae, filled with a dense fluid and located between the vertebrae. The intervertebral discs account for approximately 5th of the entire length of the spinal column. The height of the intervertebral discs may differ in each case, and in a healthy person it is always more in the morning and less in the evening.

· Simple, complex and combined joints. These components of the spine provide a variety of back movements and comfortable functionality of the whole organism.

· Ligaments. They provide connection and strengthening of the joints, protect them from impacts.

· Muscles. They both protect the spine and help it move. The muscles of the spinal column differ in the direction of the fibers and their connection.

In general, the spine has an S-shape (the natural curves of the spine of a healthy person provide back cushioning and flexibility). Such a structure and functions of each of its individual components ensures the full functioning of the whole organism.

Departments and their functions

The human spine consists of 5 sections that smoothly pass one into another, are interconnected, differ in the number of vertebrae and mobility.

The cervical spine is the uppermost part of the spinal column, which accounts for the least degree of load. But this department is also the most mobile. It consists of 7 vertebrae interconnected in such a way that they provide head movement with a high amplitude. This is due to the structure of the first two vertebrae.

The first of them (atlas) does not communicate with the entire spine and has the form of two arches connected by lateral bone thickenings (lateral masses), which, through the condyle, attach it to the occipital region. The second (axis) is an odontoid process in the anterior part of the spinal column. This anatomy of the cervical region ensures its maximum mobility.

The transverse processes of the cervical vertebrae hide vertebral arteries. These are vessels that supply blood to the brainstem, cerebellum and occipital lobes of the cerebral hemispheres, which is very important for their full functioning.

The thoracic spine is curved back, thus forming a physiological kyphosis. Ribs emerge from the thoracic spine, so it is involved in protecting the heart and lungs from external damage. Unlike the cervical region, the thoracic is inactive, because the distance between the vertebrae in this part is the smallest, and the intervertebral discs are the narrowest.

The lumbar spine can withstand heavy loads, so it is the most massive and more fortified. Its vertebrae have a larger diameter and length of the intervertebral discs. The structure of the lower back forms a smooth bend forward, which allows you to evenly distribute the load on each individual vertebra.

The intervertebral discs in the lumbar region wear out faster due to the structure of the body and the influence of external factors (excess weight, physical activity, carrying weights, prolonged standing in an upright position).

The sacral spine consists of fused vertebrae and has a wedge-shaped shape, continues the lumbar region and ends with the coccyx. The coccygeal region completes the spinal column and fuses with the sacral region

The human chest is a shield that protects vital human organs from external influences - lungs, large blood vessels, a heart. In addition to protecting organs, the chest performs two more vital functions: respiratory and motor. Structure and functions chest The human thorax The thorax is the largest section of the spine. It consists of 12 thoracic vertebrae, ribs, sternum, muscles and part of the spinal column. The upper part of the sternum begins with the first thoracic vertebra, from which the first left and right rib connected by the handle of the sternum. The lower part of the chest is much wider than the upper. The end of the thoracic spine are the 11th and 12th ribs, the costal arch and the xiphoid process. Due to the costal arches and xiphoid process an infrasternal angle is formed. Anatomy of the thoracic spine and its functions The thoracic spine performs supporting functions, which are carried out by 12 semi-mobile vertebrae. The size of the vertebrae increases from top to bottom, taking into account the load of the human body weight. The vertebrae are connected by cartilage and muscles to 10 pairs of ribs. The vertebrae have processes located on both sides. The processes of the spine in humans serve to protect the spinal cord, which is located in spinal canal. Anatomy of the ribs and their functions The ribs are located in front of the thoracic region and are paired arches that consist of the body, head and cartilage. In internal cavity The ribs contain the bone marrow. Of the 12 thoracic ribs, 7 upper pairs are fixed between the spine and the manubrium of the sternum. The remaining 5 vertebrae are attached only to the vertebral steles. The eleventh and twelfth pair of ribs are hesitant, in some people they are absent. It is the ribs that perform the main protective function internal organs of the chest. Anatomy of the muscles of the thoracic region and their functions The main functions of the muscles of this region are: ensuring the movement of the arms and shoulder girdle; maintaining the rhythm of breathing. According to the anatomical structure, the pectoral muscles are divided into: Large - dense paired muscles located on the anterior wall of the chest. The function of a large muscle is to raise and move a person's arms. Small pectoral - flat muscles of a triangular shape, located under the large muscle. The main function of the small muscles is the movement of the scapula and its subsequent fixation at rest. Subclavian - flat muscles located between the rib and collarbone. The main function of this muscle group is to move the clavicle and lift the first rib. The serratus anterior is a flat muscle located on the lateral surface of the sternum. The main function is the movement of the scapula. Subcostal - flat muscles located on the inner surface of the 7-12 ribs. The main function of this muscle group is to helping the lungs person when exhaling. The diaphragm is a mobile muscle that includes a septum of tendons, which is located between the sternum and the abdominal cavity. The main function of the diaphragm is to inhale by expanding the cavity of the chest. Types of the chest Depending on the anatomical structure of the human body, the structure of the chest has 3 types: Asthenic. With this type of structure, the sternum is a narrow, elongated flat cone, on which the costal spaces, clavicles, and clavicular fossae are clearly visible. With an asthenic structure, the back muscles are very poorly developed. Normosthenic. The normosthenic structure is characterized by a conical truncated shape. The ribs with this structure of the cell are located at an angle, the shoulders reach an angle of 90% in relation to the neck. Hyperhypersthenic. This structure is characterized by a cylindrical shape. The diameters of the costal arches are almost equal. The anatomy of the spine and ribs is, with this structure, characterized by small gaps between the ribs and processes of the spine

Coma

Types of coma:

• uremic coma- kidney failure. Stages:

1. confusion;

2. disorientation;

3. skin smell of urea;

4. cerebral edema;

5. motor excitation;

6. respiratory depression;

7. approaching death.

 Hepatic coma occurs with liver damage, with hepatitis, with poisoning by mushrooms and other poisons, with cirrhosis of the liver. Stages:

1. confusion;

2. disorientation;

3. skin smell of urea;

4. putrid smell from the mouth;

5. skin itching;

6. cerebral edema;

7. motor excitation;

8. respiratory depression;

9. approaching death.

 diabetic coma :

1. hyperglycemic coma- starts gradually

1. weakness;

2. sharp headache;

3. intense thirst;

5. loss of consciousness;

6. smell of acetone from the mouth;

7. dry skin and mucous membranes;

8. softness of the eyeballs.

2. hypoglycemic coma

1. general weakness;

2. ringing in the ears;

3. dizziness;

4. trembling in the fingers;

5. cold sweat;

6. dilated pupils;

7. rapid loss of consciousness;

8. general convulsions.

Coma: general mechanisms of development and clinical and morphological manifestations of coma, significance for the body

Coma- an acutely developing severe pathological condition characterized by progressive depression of the central nervous system with loss of consciousness, impaired response to external stimuli and disorders of the vital functions of the body.

Causes of coma:

• exogenous:
• traumatic - brain damage;
• thermal - after overheating of the brain;
• toxic - mushrooms, alcohol, drugs;
• alimentary - long fasting;
• radiation;
• infectious;
• hypoxia;
• endogenous:
• violation cerebral circulation;
• anemic - low hemoglobin;
• endocrine - a disease of the pituitary gland.

Coma Development Mechanisms:

1. intoxication;

2. oxygen and energy starvation;

3. violation of acid and water balance

4. Complications caused by coma Other types of complications are disturbances in the regulatory function of the central nervous system. They can cause vomiting with the penetration of these masses into the respiratory organs, acute retention of urine outflow (up to rupture of the bladder), and the development of general peritonitis. Coma is also characterized by varying degrees of brain damage. Patients experience various disturbances in breathing (often - its stop), pulmonary edema, sudden changes in blood pressure, and even cardiac arrest. Such complications can lead to clinical and subsequently biological death of the patient. Consequences of a coma There is no direct answer to the question of how long a coma will last. Usually, a person is in a coma for no more than a few weeks. However, there are cases when the patient remains in this state for several months and even years. The record for the duration of stay in a coma is 37 years. It is impossible to unequivocally predict how the coma will end. Some people regain consciousness on their own when brain function is restored. For others, a course of serious therapeutic measures is required to get out of such a state. In some cases, when the brain suffers especially serious injuries, a person comes out of a coma, but his brain is able to restore only its most basic functions. After such a state, the patient can only breathe on his own, or sleep, and also take food with outside help. However, every cognitive part the brain, while losing its functions, and cannot respond to factors external environment. In this position, sometimes called "vegetative" in humans, all cognitive and neurological functions are lost. This state can last for years. Particularly difficult cases of patients in a coma Development of technology allows modern medicine to maintain (artificially) the vital functions of the human body in a coma for as long as necessary. The main question for doctors is the appropriateness of such procedures. A huge role in determining the possible prospects for the patient is played by the study of previous conditions and the specific causes that caused the coma. The issue of supporting functions often goes into the plane of moral and ethical concepts and even intersects with euthanasia. The patient's relatives categorically resist turning off the equipment, and doctors do not see the point of supporting such a patient's condition. The most important argument in favor of the latter would be brain death. This state of brain tissue has a special list clinical signs allowing us to state this fact. They give the conclusion that the patient's brain is dead.

1. There are 2 types of regulation: nervous and humoral. .

Nervous regulation extremely complex and wonderfully thought out. The sympathetic nervous system accelerates the contractions of the heart, increases strength, increases the excitability of the myocardium and enhances the conduction of an impulse through it, and the parasympathetic nervous system slows down, reduces, reduces, weakens.

The very first and elementary level of regulation is intracardiac. The processes of neurons that lie in the thickness of the heart wall form intracardiac plexuses, the endings of which are “stuffed” with every cubic millimeter of tissue. There are even ... intracardiac reflexes with their own sensitive, intercalary and motor neurons. It is at this level that the two most important conditions are solved. normal operation hearts. The first, discovered by the German O. Frank and the Englishman E. Starling. called the "Law of the Heart" and lies in the fact that the force of contraction of myocardial fibers is directly proportional to the magnitude of their stretching. This means that the more blood flows to the heart during diastole, the more it will contract, the more its volume stretches the heart chambers. The more active, the more intense their systole will be. The second level of regulation - the Anrep effect - provides an increase in cardiac contraction in response to an increase in peripheral vascular resistance, in other words, to a jump in blood pressure. Those. in both cases, the heart behaves adequately to the hemodynamic load. This is the first level nervous regulation. The second is the spinal cord. Motor (efferent or centrifugal) neurons are laid here, with their axons innervating the heart

The third level is the medulla oblongata. From it originates the main parasympathetic nerve– wandering with its "minus" effects on the heart. Secondly, it contains a sympathetic by nature vasomotor center. One part of which (pressor zone) stimulates the sympathetic action of spinal cord neurons, and the other (depressor zone) suppresses it.

The medulla oblongata is supervised by the fourth level - the nuclei of the hypothalamus. At this stage, something very important is carried out: the coordination of cardiac activity with other life processes.

The fifth level of regulation is the cerebral cortex, but when it is removed, failures in the work of the heart do not occur. Here's the highest level for you!

Humoral regulation associated with the influence of certain substances, such as hormones, electrolytes, dissolved gases, the stress hormone adrenaline. Hormones such as glucagon, thyroxine, glucocorticoids, angiotensin, serotonin, calcium salts cause increased and increased heart rate, as well as vasoconstriction. Against. Acetylcholine, potassium ions, lack of oxygen, acidification of the internal environment lead to a decrease in myocardial contractility, and prostaglandins, bradykinin, histamine, ATP have the opposite effect.

Simplified scheme of the nervous regulation of the functioning of the heart can be represented as follows: the cerebral cortex - the hypothalamic nuclei - the vasomotor center and nuclei vagus nerve in the medulla oblongata - the spinal cord - intracardiac plexuses. Thanks to this system, the heart experiences unconditioned reflex sympathetic and parasympathetic. As well as conditioned reflex influences. Through hormones, electrolytes, etc. humoral regulation of cardiac activity.

conduction system of the heart.
Regulation and coordination contractile function the heart is carried by its conducting system. These are atypical muscle fibers (cardiac conductive muscle fibers), consisting of cardiac conductive myocytes, richly innervated, with a small number of myofibrils and an abundance of sarcoplasm, which have the ability to conduct irritation from the nerves of the heart to the atrial and ventricular myocardium.
The centers of the conduction system of the heart are two nodes:
1) sinoatrial node located in the wall of the right atrium between the opening of the superior vena cava and the right ear and giving off branches to the atrial myocardium
2) atrioventricular node lying in the thickness of the lower part of the interatrial septum. From top to bottom, this node passes into atrioventricular bundle, which connects the atrial myocardium with the ventricular myocardium. In the muscular part of the interventricular septum, this bundle is divided into right and left leg, . The terminal branches of the fibers (Purkinje fibers) of the conduction system of the heart, into which these legs break up, end in the myocardium of the ventricles.

Scheme innervation heart can be represented as follows: sources of innervation of the heart - cardiac nerves and branches following to the heart; extraorganic cardiac plexuses (superficial and deep) located near the aortic arch and pulmonary trunk; intraorganic cardiac plexus, which is located in the walls of the heart and is distributed in all their layers.

cardiac nerves(upper, middle and lower cervical, as well as thoracic) start from the cervical and upper thoracic (II-V) nodes of the right and left sympathetic trunks. Cardiac branches originate from the right and left vagus nerves.

Superficial extraorganic cardiac plexus lies on the anterior surface of the pulmonary trunk and on the concave semicircle of the aortic arch; a deep extraorganic cardiac plexus is located behind the aortic arch (in front of the tracheal bifurcation). The upper left cervical cardiac nerve (from the left upper cervical sympathetic ganglion) and the upper left cardiac branch (from the left vagus nerve) enter the superficial extraorganic cardiac plexus. All other cardiac nerves and cardiac branches mentioned above enter the deep extraorganic cardiac plexus.

Branches of extraorganic cardiac plexuses pass into a single intraorganic cardiac plexus. It is conditionally subdivided into closely related subepicardial, intramuscular and subendocardial plexuses. The intraorganic cardiac plexus contains nerve cells and their accumulations, forming cardiac nodules, gangliacardiaca. There are six subepicardial cardiac plexuses: 1) right anterior and 2) left anterior. They are located in the thickness of the anterior and lateral walls of the right and left ventricles on both sides of the arterial cone; 3) anterior atrial plexus - in the anterior wall of the atria; 4) the right posterior plexus descends from the posterior wall of the right atrium to the posterior wall of the right ventricle; 5) the left posterior plexus from the lateral wall of the left atrium continues down to the posterior wall of the left ventricle; 6) the posterior plexus of the left atrium is located in the upper part of the posterior wall of the left atrium.

Hypothalamus- this is a small area located in the human diencephalon, consisting of many groups of cells that regulate the homeostasis of the body and the neuroendocrine function of the brain and includes more than 30 nuclei. The hypothalamus is part of the hypothalamic-pituitary system, which also includes the pituitary gland. The hypothalamus is located slightly below the thalamus and slightly above the brain stem.

The hypothalamus is connected through neural pathways almost all parts of the central nervous system. This connection includes the hippocampus, cerebral cortex, cerebellum, amygdala, spinal cord, and brainstem. The hypothalamus forms the ventral part of the diencephalon.

The hypothalamus connects the nervous system with endocrine system through the pituitary gland.

The hypothalamus is responsible for many activities of the autonomic nervous system, in particular for metabolic processes. Also in the hypothalamus is the synthesis and release of certain neurohormones that act on the pituitary gland, stimulating or inhibiting its secretion. Under the action of the hypothalamus, body temperature is controlled, as well as feelings of hunger, thirst, fatigue, sleep regulation.

The bone pelvis consists of a large and small pelvis. The border between them: behind - the sacral cape; from the sides - nameless lines, in front - the upper part of the pubic symphysis.

The bone base of the pelvis is made up of two pelvic bones: the sacrum and the coccyx.

The female pelvis is different from the male pelvis.

The large pelvis in obstetric practice is not important, but it is available for measurement. By its size judge the shape and size of the small pelvis. For measuring greater pelvis using an obstetric pelvis.

Main female pelvic dimensions:

In obstetric practice, the pelvis plays a fundamental role, which consists of 4 planes:

1. The plane of the entrance to the small pelvis.
2. The plane of the wide part of the small pelvis.
3. The plane of the narrow part of the pelvic cavity.
4. The plane of exit from the small pelvis.

The plane of the entrance to the small pelvis

Borders: behind - the sacral cape, in front - the upper edge of the pubic symphysis, on the sides - nameless lines.

The direct size is the distance from the sacral promontory to the upper edge of the false articulation 11 cm. The main size in obstetrics is coniugata vera.

The transverse dimension is 13 cm - the distance between the most distant points of the nameless lines.

Oblique dimensions - this is the distance from the sacroiliac joint on the left to the false ledge on the right and vice versa - 12 cm.

The plane of the wide part of the small pelvis

Borders: in front - the middle of the false articulation, behind - the junction of the 2nd and 3rd sacral vertebrae, on the sides - the middle of the acetabulum.

It has 2 sizes: straight and transverse, which are equal to each other - 12.5 cm.

The direct size is the distance between the gray hair of the pubic joint and the junctions of the 2nd and 3rd sacral vertebrae.

The transverse dimension is the distance between the midpoints of the acetabulum.

The plane of the narrow part of the pelvic cavity

Borders: in front - the lower edge of the pubic symphysis, behind - the sacrococcygeal joint, on the sides - ischial spines.

The direct size is the distance between the lower edge of the pubic joint and the sacrococcygeal joint - 11 cm.

The transverse dimension is the distance between the ischial spines - 10.5 cm.

The plane of exit from the small pelvis

Borders: in front - the lower edge of the pubic joint, behind - the tip of the coccyx, on the sides - the inner surface of the ischial tuberosities.

The direct size is the distance between the lower edge of the symphysis and the tip of the coccyx. During childbirth, the head of the fetus deviates the coccyx by 1.5-2 cm, increasing its size to 11.5 cm.

Transverse size - the distance between the ischial tubercles - 11 cm.

The angle of inclination of the pelvis is the angle formed between the horizontal plane and the plane of the entrance to the small pelvis, and is 55-60 degrees.

The wire axis of the pelvis is a line connecting the vertices of all direct dimensions of 4 planes. It has the shape of not a straight line, but concave and open in front. This is the line along which the fetus passes, being born through the birth canal.

Pelvis conjugates

External conjugate - 20 cm. Measured with a tazometer during external obstetric examination.

Diagonal conjugate - 13 cm. Measured by hand during internal obstetric examination. This is the distance from the lower edge of the symphysis (inner surface) to the sacral promontory.

The true conjugate is 11 cm. This is the distance from the upper edge of the symphysis to the sacral promontory. The measurement is not available. It is calculated by the size of the outer and diagonal conjugate.

According to the external conjugate:

9 is a constant number.

20 - external conjugate.

According to the diagonal conjugate:

1.5-2 cm is the Solovyov index.

The thickness of the bone is determined along the circumference of the wrist joint. If it is 14-16 cm, then 1.5 cm is subtracted.

If 17-18 cm - 2 cm is subtracted.

Rhombus Michaelis - the formation, which is located on the back, has a diamond shape.

It has dimensions: vertical - 11 cm and horizontal - 9 cm. In total (20 cm) giving the size of the outer conjugate. Normally, the vertical size corresponds to the size of the true conjugate. The shape of the rhombus and its size are judged on the state of the small pelvis.

The coordinated work of our nervous, muscular and circulatory systems, the structure of the skeleton will never cease to amaze, delight and raise questions. In search of answers to them, we are forced to remember biology lessons or look for information on the Internet. Today we will understand the structure of the human pelvis, learn about its functions and talk about the details and significant differences between the female and male pelvis.

The pelvis is created by two pelvic bones and the sacrum. They are connected by inactive joints, and strengthened by ligaments. Nerves and blood vessels pass through many holes in the skeleton. The anatomy of the pelvis is such that its bones limit it laterally and in front. Behind the limiter is the coccyx, which is the completion of the spine.

reference. The pelvic bones are also called nameless, and the pelvic bone in Latin sounds like "os coxae".

Gender specifics

The bones of the female pelvis are wider and denser, the bulge is less pronounced. The bones of the pubis are connected at right angles. The gluteal tubercles and iliac bone planes are 27 cm apart from each other. The lumen of the lower pelvis is wider and resembles an oval in appearance. The size of the pelvis is also larger than the male, and its inclined plane is about 60 °.

The male pelvis is more pronounced with a cape, characterized by an acute subpubic angle. The iliac planes and ischial tubercles are placed closer to each other. The lumen of the lower part of the pelvis looks like a long oval, its size is less than that of a woman, and the angle of inclination is approximately 50-55°.

blood supply

The following arteries are involved in the blood supply to the hip joint:

• ascending branch of the lateral artery;
• deep branch of the medial artery;
• round ligament artery;
• branches of the inferior and superior gluteal arteries;
• branches of the external iliac and inferior hypogastric arteries.

The significance of these vessels in the blood supply to the thigh is different. The main power supply of the femoral head is carried out due to the branches of the medial artery that surrounds the thigh.. A significantly smaller role in the blood supply is played by the external ascending branch of the circumflex artery of the thigh. The role of the branches of the superior and inferior gluteal, as well as the external iliac and inferior hypogastric arteries, is relatively small.

The outflow of blood from the area occurs through the veins that accompany the arterial vessels and then flow into the femoral, hypogastric and iliac veins.

Nerve plexuses

The hip joint has a rich nervous system. Innervation is carried out due to the nerves of the periosteum, periarticular neurovascular formations, as well as branches of large nerve trunks(femoral, sciatic, obturator, superior and inferior gluteal and pudendal nerves).

The posterior lower part of the joints is innervated by branches of the sciatic, superior gluteal, and pudendal nerves. The anterior part is the articular branch of the obturator nerve. The round ligament and the fat pad are the posterior branch of the obturator nerve. also in nervous system These structures involve the branches of the femoral and superior gluteal nerves.

Skeleton

The skeleton of the pelvic girdle begins to form during fetal development. After birth, the hip joint is presented as cartilage, which begins to gradually harden and then bulge out, forming a stronger bone structure.

The process continues until the adult organism is fully formed. After that, the growth of the bone stops, but the change in shape, localization and structure continues.

For clarity, pay attention to the photo of the skeleton of the human pelvis with a description of the bones.

pelvic bone (on Latin- os coxae) - this is the most big bone human and the most massive part of the musculoskeletal system. It consists of three sections: iliac, ischial and pubic. The fusion of these areas begins during puberty.

This happens just in those areas where the pressure on the pelvis is maximum. One of these areas is the acetabulum, in which the head is located. femur. After joining these parts, the hip joint is formed.
The iliac part consists of a wing (an extension at the top of the bone) and a body.

It is localized above the acetabulum. One edge of the wing is presented in the form of a comb, to which the abdominal muscles are attached. From the back of the ilium, its plane is combined with the sacroiliac joint.
The pubic bone is located under the acetabulum on the front side.

It is presented in the form of two branches, which are connected at an angle. Between them is a cartilaginous layer. All these elements form the pubic symphysis.

reference. The structure of the pelvic bones of a woman takes into account her ability to give birth to a child. When the fetus leaves the mother's womb, the cartilaginous tissues are susceptible to deformation, due to which the pelvic bones move apart. This makes the birth process easier.

The ischium is located on the back of the pelvis (at the same level as the pubis, only on the opposite side). The bone structure of this department has a bumpy surface, so that a person can take a sitting position.

In addition, the hip section consists of the coccyx and sacrum, creating an annular pelvic cavity.

Anatomically, the pelvis is divided into two sections: the large pelvis - the part of the innominate bone, which is located at the top, and the small pelvis - its narrow part, is located below. The bones of the small pelvis are conditionally separated by a border line that runs along the top of the sacrum, then to the arcuate contour of the ilium, it also captures the outer part of the pubic bone and the symphysis of the same name.

On both sides, numerous muscles of the abdominal cavity, back and spine are attached to these bones. Some leg muscles start from them. Thus, the muscular frame is formed.

Muscular structure

The muscular system is represented by visceral and parietal muscles. The muscles of the pelvis are located around the hip joint from all sides. Each group originates in the sacrum, spine, femur and pelvic bones.

Musculature plays a large role in the formation of the pelvic diaphragm. This includes paired muscles that lift anus, as well as unpaired. Here are the iliococcygeal, pubic-coccygeal muscles, as well as the powerful circular muscle of the rectum.

Functions

The hip joint has complex structure and performs the following functions:

1. support- to support the spine. It serves as the center of gravity of the musculoskeletal system.
2. Protective- warns the internal organs (bladder, intestines and reproductive organs) from external physical influences and damage. The value of the pelvic girdle is difficult to overestimate, as it protects the vital organs of the human body. Since the main function is protection, if it is damaged, there are risks of complications associated with damage to internal organs. Therefore, injuries of the hip joint most often entail serious consequences.

Conclusion

The male and female pelvic girdle performs the same vital functions, supports the spine and protects the internal organs from damage. However, the structure of the female pelvis is significantly different from the male. Nature assigned the female body the function of carrying and giving birth to a child, so her pelvis is formed in order to maximally secure and facilitate these processes.

It forms a generic the channel through which the fetus moves. Unfavorable conditions of intrauterine development, diseases transferred to childhood and inpuberty, can lead to disruption of the structure and developmentpelvis. The pelvis can be deformed as a result of trauma, tumors, various exostoses. Differences in the structure of the female and male pelvis begin to appear during puberty and become pronounced in adulthood. The bones of the female pelvis are thinner, smoother and less massive than those of the male. pelvis. The plane of the entrance to the small pelvis in women has a transverse-oval shape, while in men it has the shape of a card heart (due to the strong protrusion of the cape).

Anatomically, the female pelvis is lower, wider and larger in volume. The pubic symphysis in the female pelvis is shorter than the male. The sacrum in women is wider, the sacral cavity is moderately concave. The pelvic cavity in women approaches the cylinder in outline, while in men it narrows downwards in a funnel-shaped manner. The pubic angle is wider (90-100°) than in men (70-75°). The coccyx protrudes anteriorly less than in the male pelvis. The ischial bones in the female pelvis are parallel to each other, and converge in the male.

All of the above features are very great importance in the process of childbirth, the pelvis of an adult woman consists of 4 bones: two pelvic, one sacral and one coccygeal, firmly connected to each other,

Hip bone, or nameless (os coxae, os innominatum), consists up to 16— 18 years of 3 bones connected by cartilage in the area of ​​the acetabulum(acetabulum): iliac (os ileum), sciatic (os ischii) and pubic (os pubis ). After puberty, cartilage fuses together and a solid bone mass is formed - the pelvic bone.

On the ilium distinguish between the upper section - the wing and the lower - the body.At the place of their connection, an inflection is formed, called arcuate or be-zymyanny line ( linea arcuata, innominata ). On the ilium follows from-mark a series of protrusions having importance for an obstetrician. Upper thickenedwing edge - iliac crest ( Crista Iliaca ) - has an arcuatecurved shape, serves to attach the broad muscles of the abdomen. Spere-di it ends with the anterior superior iliac spine ( spina iliaca anterior superior ), and behind - the posterior superior iliac spine ( spina iliaca posterior superior ). These two spines are important in determining the size of the pelvis.Ischium forms the lower and posterior thirds of the pelvic bone. Sheconsists of a body involved in the formation of the acetabulum, and a branchischium. The body of the ischium with its branch makes an angle, openty anteriorly, in the region of the angle, the bone forms a thickening - the ischial tuberosity(tuber ischiadicum ). The branch goes anteriorly and upwards and connects with the lowerher branch of the pubic bone. On the back surface of the branch there is a protrusion - ischial spine (spina ischiadica). On the ischium, there are two clippings: large ischial notch ( incisura ischiadica major ), located below the posterior superior iliac spine, and a small sciatic notch ku (incisura ischiadica minor).

Pubic, or pubic, bone forms the anterior wall of the pelvis, consists of the bodyand two branches - the upper ( ramus superior ossis pubis) and lower (ramus inferior ossis pubis ). The body of the pubis forms part of the acetabulum. Togetherconnection of the ilium with the pubis is the iliopubic elevation ( eminentia iliopubica).

The upper and lower branches of the pubic bones are connected to each other in frontthrough cartilage, forming a sedentary joint, a half-joint ( symphysis ossis pubis ). The slot-like cavity in this connection is filled with liquid andincreases during pregnancy. The lower branches of the pubic bones formyut angle - pubic arch. Along the posterior edge of the superior ramus of the pubisthe pubic ridge stretches ( crista pubica ), passing backwards into linea arcuata of the ilium.

Sacrum(os sacrum ) consists of 5-6 vertebrae fixed to each other, the size of which decreases downwards. The sacrum has the shape of acone. The base of the sacrum is turned upward, the apex of the sacrum (narrowpart) - downwards. The anterior surface of the sacrum has a concave shape; on itthe junctions of the fused sacral vertebrae are visible in the form of transverserough lines. The posterior surface of the sacrum is convex. Along the midlinepass the spinous processes of the sacral vertebrae fused together.First sacral vertebra connected to V lumbar, has a protrusion - sacral cape (promontorium).

Coccyx (os coccygis ) consists of 4-5 fused vertebrae. He connectsusing the sacrococcygeal articulation with the sacrum. In braid connections the pelvis has cartilaginous layers.

female pelvis with obstetric point vision

There are two parts of the pelvis: the large pelvis and the small pelvis. border between them is the plane of entry into the small pelvis.

The large pelvis is bounded laterally by the wings of the ilium, behind -last lumbar vertebra. In front, it has no bony walls.

The pelvis is of the greatest importance in obstetrics. Through the small pelvisthe birth of the fetus is going on. Does not exist simple ways pelvic measurements.At the same time, the dimensions of the large pelvis are easy to determine, and based on them you can judge the shape and size of the small pelvis.

The small pelvis is the bony part of the birth canal. Form andthe size of the small pelvis is very important during childbirth and the definition of tactics for their management. With sharp degrees of narrowing of the pelvis and its deformationyah, childbirth through the natural birth canal becomes impossible, and women well, delivery by caesarean section.

The posterior wall of the small pelvis is made up of the sacrum and coccyx, the lateral ones arefarther bones, anterior - pubic bones with l circumferential symphysis. Top-The lower part of the pelvis is a solid bone ring. In the middle andlower thirds of the wall mscarlet pelvis is not continuous. In the lateral sections there are large and small sciatic foramen ( foramen ischiadicum majus etminus), limited respectively by large and small ischial notches (incisure ischiadica major et minor) and withviscous ( lig. sacrotuberale, lig. sacrospinale ). The branches of the pubic and ischial bones, merging, surroundobturator opening ( foramen obturatorium ) shaped like a triangle with rounded corners.

In the small pelvis, an entrance, a cavity and an exit are distinguished. In the pelvic cavity, excretelyayut wide and narrow parts. In accordance withthis in the pelvis distinguish four classical planes ( rice. one ).

The plane of the entrance to the small pelvis anteriorly bounded by the superior margin of the symphysis andthe upper inner edge of the pubic bones, from the sides - arcuate linesiliac bones and behind - sacral promontory. This plane is shapedtransversely located oval (or kidney-shaped). It distinguishes three size (rice. 2): straight, transverse and 2 oblique (right and left). Straight size is the distance from the upper inner edge of the symphysisto the sacral cape. This size is called the true or obstetric conjugates (conjugata vera) and equal 11 cm.

In the plane of the entrance to the small pelvis, tea still anatomical conjugate (conjugata anato - mica ) - the distance betweenthe upper edge of the symphysis andsacral cape.The value of the anatomical conjugate is11.5 cm. P about the pepper size - the distance between the most distant parts of the du-curved lines. He co-sets 13.0-13.5 cm. plane dimensions entrance to the small pelvisrepresent the distance betweendu sacroiliacarticulation of one sideny and the iliac-pubic eminence of the oppositefalse side. Rightthe oblique dimension is determinedfrom the right sacro-under-iliac joint, le-exit - from the left. These sizes Rs range from 12.0 to 12.5 cm .

The plane of the wide gas-ti cavity of the small pelvis from the front it is limited by the middle of the inner surface of the symphysis, from the sides - by the middle of the plates covering the acetabular cavities, from behind - by the junction of the II and III sacral vertebrae. In the wide part of the bands of the small pelvis, there are

2 sizes: straight and transverse. Straight size— distance between the junction of AND and III sacral vertebrae and the middle of the inner surface of the symphysis. It is equal to 12.5 cm. The transverse size is the distance between the midpoints of the inner surfaces of the plates covering the acetabulum. It is equal to 12.5 cm. Since the pelvis in the wide part of the cavity does not represent a continuous bone ring, oblique dimensions in this section are allowed only conditionally (13 cm each).

The plane of the narrow gasti of the pelvic cavity bounded in front by the lower edge of the symphysis, laterally by the awns of the ischial bones, and behind by the sacrococcygeal articulation.

In this plane, 2 sizes are also distinguished. Direct size - distance gap between bottom edgesymphysis and sacrococcygealjoint. He is equal 11.5cm. Cross dimension - the distance between thetyami ischial bones. He is 10.5 cm.

Plane of exit from the small pelvis( rice. 3 ) is limited in front by the lower edge of the pubic symphysis, from the sides - by the ischial tubercles, from behind - by the tip of the coccyx. Direct size - dis- standing between the bottom edgesymphysis and apex of the cop-chica. It is equal to 9.5 cm.the passage of the fetus through the birth canal (through the plane of exit from the small pelvis)due to protrusion of the coccyxposteriorly, this size is increasedshrinks by 1.5-2.0 cm and becomesnew equal to 11.0-11.5 cm. Cross dimension - the distance between the internal surfaces of the gray- personal bumps. It is equal to 11.0 cm.

When comparing the dimensions of the small pelvis in different planes, it turns out that in the plane of the entrance to the small pelvis, the transverse dimensions are maximum, in the wide part of the cavity of the small pelvis, the direct and transverse dimensions are equal, and in the narrow part of the cavity and in the plane of exit from the small pelvis, the direct dimensions are larger than the transverse ones.

In obstetrics, in some cases, a system is used parallel Goji planes( rice. 4 ). The first, or upper, plane (terminal) passes through the upper edge of the symphysis and the border (terminal) line. The second parallel plane is called the main one and passes through the lower edge of the symphysis parallel to the first. The fetal head, having passed through this plane, does not encounter significant obstacles in the future, since it has passed a solid bone ring. The third parallel plane is the spinal plane. It runs parallel to the previous two through the ischial spines. The fourth plane - the exit plane - runs parallel to the previous three through the top of the coccyx.

All classical planes of the small pelvis converge in the direction of the anterior (symphysis) and fan-shaped diverge backwards. If you connect the midpoints of all the direct dimensions of the small pelvis, you get a line curved in the form of a fishhook, which is called wire axis of the pelvis. It bends in the cavity of the small pelvis, corresponding to the concavity of the inner surface of the sacrum. The movement of the fetus birth canal occurs in the direction of the wire axis of the pelvis.

Angle of inclination of the pelvis - this is the angle formed by the plane of entry into the small pelvis and the horizon line. The value of the angle of inclination of the pelvis changes when the center of gravity of the body moves. In non-pregnant women, the angle of inclination of the pelvis is on average 45-46 °, and the lumbar lordosis is 4.6 cm (according to Sh. Ya. Mikeladze).

As pregnancy progresses, lumbar lordosis increases due to the displacement of the center of gravity from the region of the II sacral vertebra anteriorly, which leads to an increase in the angle of inclination of the pelvis. With a decrease in the lumbar lord dose, the angle of inclination of the pelvis decreases. Up to 16-20 weeks. pregnancy in the setting of the body, no changes are observed, and the angle of inclination of the pelvis does not change. By the gestational age of 32-34 weeks. lumbar lordosis reaches (according to I. I. Yakovlev) 6 cm, and
the angle of inclination of the pelvis increases by 3-4°, amounting to 48-50° ( rice. five ). The magnitude of the angle of inclination of the pelvis can be determined using special devices designed by Sh. Ya. Mikeladze, A. E. Mandelstam, as well as manually. When a woman is positioned on her back on a hard couch, the doctor holds her hand (palm) under the lumbosacral lordosis. If the hand passes freely, then the angle of inclination is large. If the hand does not pass, the angle of inclination of the pelvis is small. It is possible to judge the magnitude of the angle of inclination of the pelvis by the ratio of the external genitalia and thighs. With a large angle of inclination of the pelvis, the external genital organs and the genital gap are hidden between the closed thighs. With a small angle of inclination of the pelvis, the external genital organs are not covered by closed hips.

You can determine the value of the angle of inclination of the pelvis by the position of both iliac spines relative to the pubic joint. The angle of inclination of the pelvis will be normal (45-50°) if, in the horizontal position of the woman's body, the plane drawn through the symphysis and the superior anterior iliac spines is parallel to the plane of the horizon. If the symphysis is located below the plane drawn through these spines, the angle of inclination of the pelvis is less than normal.

A small angle of inclination of the pelvis does not prevent the fixation of the fetal head in the plane of the entrance to the small pelvis and the advancement of the fetus. Childbirth proceeds quickly, without damage to the soft tissues of the vagina and perineum. A large angle of inclination of the pelvis often presents an obstacle to fixing the head. Incorrect insertion of the head may occur. In childbirth, soft injuries are often observed. birth canal. By changing the position of the body of a woman in labor during childbirth, it is possible to change the angle of inclination of the pelvis, creating the most favorable conditions for the advancement of the fetus through the birth canal, which is especially important if a woman has a narrowing of the pelvis.

The angle of inclination of the pelvis can be reduced by lifting upper part the torso of a lying woman, or in the position of the body of the woman in labor on her back, lead to the stomach bent at the knees and hip joints legs, or put a polster under the sacrum. If the polster is under the lower back, the angle of inclination of the pelvis increases.