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The spine is anatomically and functionally complex department of the human musculoskeletal system. The full implementation of diverse functions (supporting, motor, protective for the spinal cord) is provided by a certain structure of the vertebrae, intervertebral discs and ligamentous apparatus developed in the process of phylogenesis. Deviations in the structure of these components of the spinal column are accompanied by more or less pronounced changes in the functionality of the latter and a decrease in the threshold of resistance to various damaging factors.

The formation of the spine in ontogenesis takes a significant time period, ending only by the age of 20-22, due to which the spine of a child differs significantly from the spine of an adult in a number of anatomical and functional indicators. These differences determine a number of features of the pathogenesis, clinical manifestations and course of injuries and diseases of the spine in children, and also require consideration in the differential diagnosis between the norm and pathology.

The main age feature of the anatomy of the bone part of the spinal column is the process of ossification of the cartilaginous elements of the vertebrae, which continues up to 15-16 years. By the time of the birth of a child, bone tissue is formed only in the central part of the vertebral bodies, the height of which is slightly more than half of their vertical size. The posterior sections of the vertebrae are ossified to a greater extent, cartilage tissue is preserved in the central part of the arches (at the location of the base of the spinous process), at the junction of the arches with the vertebral body, and at the tops of the articular and transverse processes. The tooth is also formed by cartilaginous tissue.

The structure of the ossified part of the vertebrae is undifferentiated, fine-meshed. The lines of force, which are clusters of closely spaced, equally oriented, more powerful bone plates, are absent. The lines of force are formed along the directions of compression and tension experienced by one or another area of ​​the bone under the influence of static and dynamic loads and tension of the muscle tendons at their attachment points, increasing the strength of the most loaded areas of the bone. The undifferentiated bone structure, which is characteristic of the bodies and arches of the vertebrae of children in the first years of life, has a lower mechanical resistance.

Ossification of cartilaginous models of the vertebral bodies is completed only by the age of 8. The rate of this process decreases in the cranial and caudal directions from the third thoracic vertebra. In other words, the ossification of the vertebral bodies of the upper thoracic region ends first of all, somewhat later - the mid-thoracic and cervical, then the lower thoracic, and the cartilaginous models of the bodies of the lumbar and sacral vertebrae are completely ossified last. The rates of ossification of different parts of the body of the same vertebra also differ from each other - in the thoracic spine, ossification of the anterior parts of the vertebral bodies, located in the region of the apex of physiological kyphosis, somewhat lags behind the ossification of their posterior parts, in the lumbar spine, inverse relationships are observed, t i.e., the posterior sections of the vertebral bodies are ossified at a slower pace. The difference in the rate of ossification of the anterior and posterior sections of the bodies of the thoracic and lumbar vertebrae is observed from the time of complete formation of the physiological curvature of the spine to the completion of the third phase of ossification of the cartilaginous limbus.

The gap between the right and left halves of the vertebral arches is filled with bone tissue by the age of 3, between the arches and bodies - by the age of 4-6 years. An exception to this rule is the II cervical vertebra, the ossification of the arch of which ends only by the age of 4-6 (Fiedlihg J., 1981), as well as the lower lumbar and sacral vertebrae, where the cartilaginous tissue in the area of ​​the base of the spinous process can remain normal until 11-12 years old. The last stage of the enchondral formation of the bone components of the spinal column is the ossification of the apophyses of the vertebral bodies, which begins at the age of 8–9 and continues until the age of 15–16.

Among the distinctive features of the anatomical structure of the vertebrae in children is also the preservation of central feeding arteries in their bodies, which vary over a wide age range, located in distinct channels that start from the ventral surface and sometimes continue to the posterior third of the sagittal size of the vertebral bodies. As the child grows, the canals are gradually obliterated from the center to the periphery.

An age-related feature, characteristic of only one cervical spine, is a more horizontal arrangement of the articular processes of the five lower cervical vertebrae than in adults. This creates, according to J. Fiedling (1981), the conditions for easier than in adults, the occurrence of violations of anatomical relationships in the intervertebral joints.

The main distinguishing feature of the intervertebral discs during the formation of the organism is a significantly higher water content in the gelatinous nucleus compared to adults. According to G. Jensen (1980), the water content in the intervertebral discs of children in the first year of life reaches 85-90%, and by the end of the growth of the spine it is only 55-70%. This feature of the chemical composition of the gelatinous nucleus also determines the features of the anatomical and functional state of the discs, namely: higher elasticity than in adults and, at the same time, a less perfect stabilizing function. J. Fielding (1981), in the study of the development of the cervical spine, found during head movements that children normally have displacements in the width of vertebra I relative to II and body II in relation to Body III up to 4 mm in flexion and 2 mm in extension.

The ligamentous apparatus of the spine in children also differs in its chemical composition and functional state, being both more elastic and more extensible than in adults. The increased elasticity of the intervertebral discs, combined with the increased elasticity of the ligamentous apparatus, causes increased mobility child's spine. According to our data (Sadofieva V.P., 1971), the volume of mobility of the thoracic and lumbar sections in any of the three planes (frontal, sagittal and horizontal) in children under the age of 8-9 years exceeds the volume of mobility of the same parts of the spine in an adult by 10° ± 1.1°, i.e. approximately 25%. At the same time, the weak stabilizing function of the intervertebral discs, combined with increased extensibility of the ligamentous apparatus, creates the prerequisites for the instability of the spinal segments.

The above anatomical and functional differences in the spine in children determine the features and its X-ray anatomy, without which it is impossible to distinguish between the norm and pathology and clarify the nature of the disease.

In an adult, the anatomical parameters of the spine are characterized by the following features. The median axis of the spine on the anteroposterior radiographs is rectilinear, on the lateral radiographs, three physiological bends are clearly identified (relatively slight lordosis of the cervical region, pronounced thoracic kyphosis, and pronounced lordosis of the lumbar region). The bodies of the thoracic and lumbar vertebrae in both standard projections are rectangular in shape with a slight concavity of all their contours. The only exception to this rule is the body of the fifth lumbar vertebra, which has a wedge-shaped shape with an anteriorly directed base on the lateral x-ray. The bodies of the cervical vertebrae, excluding I and II, on the posterior radiographs have two cranially facing small protrusions at the right and left edges, on the lateral radiographs - a distinct protrusion facing caudally. The posterior sections of the vertebrae are a single whole, the contour of the arches on the lateral radiographs passes into the posterior contour of the body without any diastasis. The lateral contours of the articular processes and the ends of the transverse processes are convex; in the lumbar region, on the upper articular processes, the image of the processus mamillaris is often revealed.

The architectonics of the bone structure of the vertebral bodies is characterized by the presence of two systems of force lines (vertical, occupying the entire diameter of the vertebral body, and horizontal, located only at the cranial and caudal surfaces). In the structure of the arches, two systems of lines of force ("arcades") are also revealed, with their apices facing each other and repeating the outlines of the upper and lower vertebral notches.

The intervertebral space resembles a biconvex lens in shape with the same height of paired marginal sections (right and left or anterior and posterior). The disc coefficient, i.e. the ratio of the height of the disc to the height of the body of the overlying vertebra, is 1/7 - 1/6 in the upper thoracic spine, 1/5 - 1/6 in the middle thoracic, 1/5 -1/4 in the lower thoracic and in the lumbar spine - approximately 1/3.

All linear dimensions of the vertebrae and intervertebral discs increase uniformly (by the same amount) in the caudal direction, starting from the third thoracic vertebra, corresponding to a segmental increase in body weight (D. G. Rokhlin, M. A. Finkelstein, 1956). The magnitude of this increase is individual and ranges from 1 to 2 mm.

According to the literature and the results of our research, the following four stages can be distinguished in the process of changing the normal X-ray anatomical picture of the spine in children.

Age up to 2.5 years. Physiological curves of the spine on radiographs made in the lateral projection are practically not expressed. The bodies of the thoracic and lumbar vertebrae have a mildly pronounced barrel-shaped shape due to the convexity of the cranial and caudal surfaces. The upper surface of the bodies of the cervical vertebrae is inclined downward and anteriorly, as a result of which they have a moderately pronounced wedge-shaped shape on the lateral radiographs. In the central parts of the bodies of most thoracic vertebrae, channels of the central feeding arteries are traced, which are displayed on the lateral radiograph as a narrow horizontal strip of enlightenment, delimited by clear end plates; on a radiograph made in the anteroposterior projection, in the form of a similar strip or, more often, a rounded enlightenment with a diameter of about 1 mm in the center of the vertebral body.

The intervertebral spaces are in the form of a biconcave (rather than biconvex, as in adults) lenses. Their height in the thoracic spine is about 1/3 of the height of the vertebral bodies, and in the lumbar - a little more than half. This is due to two reasons: firstly, greater than at an older age, the height of the intervertebral disc itself; secondly, by adding to the disk parts of the bodies of the higher and lower vertebrae that are not ossified and therefore invisible in the x-ray image. Intervertebral spaces are also detected between all sacral vertebrae, their height is relatively small and is approximately 1/5 of the height of the bodies of the corresponding vertebrae.

The vertebral arches on the anteroposterior radiographs consist of two halves, separated by a 1–1.5 mm wide translucent strip at the level of the base of the spinous process, the shadow of which is not detected. On the lateral radiographs, a band of enlightenment is visible between the posterior surface of the vertebral bodies and the image of the arches, the width of which is also approximately 1.5 mm. Atlas (I cervical vertebra) is represented by five separate parts (two halves of the anterior and posterior arches and the point of ossification of the anterior tubercle). Tooth Cn is short and does not reach the cranial contour of the anterior arch of the atlas with its upper end, its apex has V-shape. The base of the tooth either passes directly into the body of the second cervical vertebra, or is separated from the latter by a narrow strip of enlightenment. According to J. Fielding (1981), both variants of the X-ray anatomical picture, reflecting normal variants of tooth formation (either due to an independent core of ossification, or due to the body of CH), occur in an equal number of cases. The outer contours of the articular processes of the thoracic and lumbar vertebrae do not have bulges, the ends of the transverse processes are, as it were, chopped off.

The bone structure of the vertebrae is evenly fine-meshed without signs of the so-called lines of force. The increase in the caudal direction of the linear dimensions of the vertebrae and intervertebral discs is practically not expressed. So, for example, the difference in the heights of the bodies of two adjacent vertebrae, according to our data, is only 0.2-0.3 mm.

Anatomical structure of the spine of children from 2.5 to 4 years

On radiographs made in the lateral projection, physiological curves of the spine are outlined with a predominance of the severity of thoracic kyphosis. The vertebral bodies retain a barrel shape, the presence of channels of the central supplying arteries is a less typical phenomenon.

The arches of the cervical and thoracic vertebrae are continuous on the posterior radiographs, and the presence of diastasis between their halves can be considered as a sign of a lag in the development of the bone components of the spinal column or a violation of the integrity of the arches due to destruction or fracture. In the lumbar and sacral spine, the physiological spina bifida posterior is preserved. On radiographs made in the lateral projection, as well as in children of the previous age group, a strip of enlightenment is traced between the posterior contours of the vertebral bodies and images of the arches. In the deepening of the upper contour of the tooth of the II cervical vertebra, the core of the apex ossification can be traced. The base of the tooth is still separated from the body of Sn.

In the structure of the vertebral bodies, gentle vertical lines of force are revealed, in the structure of the arches - the beginnings of "arcades".

The size of the intervertebral spaces is large, the values ​​of the disc coefficient are similar to those in children of the previous age group. In the same way, the increase in the linear dimensions of the vertebrae and intervertebral discs in the caudal direction is practically not expressed.

Anatomical structure of the spine of children from 4 to 6 years

The physiological curves of the spine in the sagittal plane are quite distinct. The vertebral bodies have an almost rectangular shape with a slight convexity of the cranial and caudal contours. Canals of the central feeding arteries can be traced in single vertebrae, mainly in the midthoracic spine. During this age period, the bands of enlightenment between the images of the arches and bodies of the vertebrae on the lateral radiographs narrow more and more, and by the age of 6 they disappear completely. The band of enlightenment also disappears between the base of the tooth and the body of the second cervical vertebra. The apex of the tooth is also fully formed. Physiological spina bifida posterior is found only in the lower lumbar and sacral vertebrae. The formation of the architectonics of the bone structure of the bodies and arches of the vertebrae ends by the age of 5, and subsequently the absence of pronounced lines of force can already be considered as a sign of a violation of the functions of the bone tissue. The remaining X-ray anatomical parameters are identical to those described in children of the previous age group.

Anatomical structure of the spine of children from 7 to 11 years old

The vertebral bodies on anteroposterior radiographs are almost rectangular in shape. Their upper contour in children of 7-8 years old, as a rule, has wavy outlines, characteristic of the growth zones of any bone in the period preceding the appearance of ossification nuclei, in this case for the apophyses of the vertebral bodies. The first ossification points appear at the age of 8-9 years symmetrically near the right and left lateral contours. On radiographs made in the lateral projection, wedge-shaped vertebral bodies located in the region of the peaks of physiological kyphosis of the thoracic spine and physiological lordosis of the lumbar spine can be observed. The base of the wedge in the first case is turned backwards, in the second - anteriorly. The mentioned physiological wedging of the vertebral bodies differs from the pathological one, which occurs, for example, due to a compression fracture, by its insignificant severity, coincidence with the top of the physiological bend, and mainly by the smoothness of the decrease to the top of the bend and the subsequent normalization of the height of the anterior (in the thoracic region) or posterior (in the lumbar region). department) contours of the vertebral bodies. Reducing the height of one of the departments of the vertebral body with compression fracture or destruction is spasmodic.

The posterior sections of the vertebrae are continuous on radiographs, the disconnection of the right and left halves of the arches can be maintained normally only in the 5th lumbar and 1st sacral vertebrae. The sacral vertebrae are still separated, however, the diastasis between the bodies does not exceed 1.5 mm. The magnitude of the sequential increase in the linear dimensions of the vertebrae and intervertebral discs is relatively distinct and equals an average of 0.5 mm. The value of the disc coefficient in the upper and middle thoracic spine decreases to 1/4, but remains equal to 1/3 in the lower thoracic and 1/2 in the lumbar. Canals of the central feeding arteries in the vertebral bodies are among the rare X-ray findings.

Anatomical structure of the spine of children from 12 to 15 years old

The vertebral bodies in both planes (frontal and sagittal) have the shape of a rectangle with a slight concavity of all their surfaces and differ from the X-ray image of the vertebrae of adults only by displaying the process of synostosis of their apophyses. The first stage of synostosis (stage IV of the process of ossification of the apophyses), observed normally at the age of 13 years, is the filling of the gap between the shadow of the ossified apophysis and the contour of the vertebral body in the central part of the anterior surface of the latter. Then the synostosis spreads relatively quickly to the periphery, and by the end of this age period, only narrow wedge-shaped areas of enlightenment between the shadow of the apophysis and the lateral sections of the upper and lower surfaces of the vertebral bodies are revealed on the posterior radiographs.

The fusion of the right and left halves of the arches of the 5th lumbar and 1st sacral vertebrae, as well as the sacral vertebrae, ends normally by the age of 12. Preservation of segmentation of the sacrum, as well as radiographic separation of the halves of the arches of the vertebrae of any part of the spine after this period, is the basis for the conclusion of a developmental disorder. On radiographs of children aged 11-13, ossification points of the extra-articular part of the articular processes located at their tops can be traced. The value of the disc coefficient and the segmental increase in the linear dimensions of the vertebrae and intervertebral discs, starting from the age of 13, corresponds to those in adults.

Deviations from the normal formation of the spinal column are very diverse and, in general, are relatively common. Depending on the degree of severity and severity of the dysfunctions of the spine and other parts of the musculoskeletal system caused by them, these deviations are usually divided into developmental variants (if they are not accompanied by reliable functional disorders), developmental anomalies and deformities. The most common types of spinal developmental variants are the overexpression of processus mamillaris and processus accessorius of the transverse and articular processes of the lumbar vertebrae and spina bifida posterior occulta. According to a number of authors, as well as the results of our own studies, these variants occur with equal frequency both in spinal deformities and manifestations of myelodysplasia, and in practically healthy people.

Anomalies in the development of the components of the spinal column are more diverse and, depending on the area of ​​their maximum manifestation, can be divided into anomalies in the development of the vertebral bodies, their posterior sections, intervertebral discs, and anomalies in the number of vertebrae.

The development of the bone and joint system in preschool children

2.2 Development skeletal system in preschoolers

The process of ossification. The skeleton of a child is laid down in the early uterine period and consists mainly of cartilage tissue. Even in the uterine period, cartilage tissue begins to be replaced by bone tissue. The process of ossification proceeds gradually, and not all bones of the skeleton ossify at the same time.

After the birth of the child, the process of ossification continues. The timing of the appearance of ossification points and the end of ossification are different for different bones. For each bone, these terms are relatively constant, so these terms can be used to judge normal development skeleton in children and their age. The skeleton of a child differs from the skeleton of an adult in size, proportions, structure and chemical composition.

The development of the skeleton in children largely determines the development of the body, for example, the muscles develop more slowly than the skeleton grows.

There are two ways of bone development. Some bones develop directly from the mesenchyme (bones of the skull roof, face, and partly the clavicle, etc.) - this is primary ossification.

During primary ossification, skeletal mesenchymal syncytium is formed, in which osteoblast cells appear, turning into bone cells- osteocytes, and fibrils impregnated with lime salts and turning into bone plates. Therefore, bone develops from connective tissue. But most of the bones of the skeleton are first laid down in the form of dense mesenchymal formations, having approximately the outlines of future bones, which then turn into cartilaginous and are replaced by bones (bones of the base of the skull, trunk and limbs) - this is secondary ossification.

With secondary ossification, bone development occurs in place of cartilage outside and inside. Outside, the bone substance is formed by the osteoblasts of the periosteum. Inside the cartilage, an ossification nucleus arises, the cartilage resolves and is replaced by bone. The bone, as it grows, is resorbed from the inside by special cells called osteoclasts, and the bone substance is superimposed on the outside. The growth of the bone in length occurs due to the formation of bone substance in the cartilages, which are located between the epiphysis and the diaphysis, and these cartilages gradually shift towards the epiphysis. In humans, many bones are laid down in separate parts, which then merge into one bone, for example, the pelvic bone initially consists of three parts, which merge together by 14-16 years.

Tubular bones are also laid down in three main parts (not counting the ossification nuclei in the places of formation of bone protrusions), which then merge.

At the age of 4-5 years, bone beams appear in the upper epiphysis of the femur. After 7-8 years, bone trabeculae elongate and become homogeneous and compact. The thickness of the epiphyseal cartilage by the age of 17-18 reaches 2-2.5 mm. By the age of 24 growth upper end the bone ends and the upper epiphysis fuses with the diaphysis; the lower epiphysis grows to the diaphysis even earlier - by the age of 22.

By the end of puberty, the ossification of tubular bones is completed. With the end of ossification of tubular bones, their growth in length stops.

Lamellar bone develops from 5 months to 1.5 years, that is, when the child gets on his feet. During the 2nd year, most of the bone tissue has a lamellar structure, and by 2.5-3 years, the remnants of coarse fibrous tissue are no longer present.

Ossification is delayed with a decrease in the functions of the endocrine glands (anterior part of the adenohypophysis, thyroid, parathyroid, thymus, genital), lack of vitamins, especially D. Ossification is accelerated with precocious puberty, increased function of the anterior part of the adenohypophysis, thyroid gland and the adrenal cortex. The delay and acceleration of ossification are especially clearly manifested before the age of 17-18 and can reach a 5-10-year difference between the "bone" and passport ages. Sometimes ossification occurs faster or slower on one side of the body than on the other.

Age features of the chemical composition and structure of bones.

In children, the bones contain relatively more organic matter and less inorganic matter than those of adults. With age, the chemical composition of bones changes, the amount of salts of calcium, phosphorus, magnesium and other and other elements increases significantly, and the ratio between them changes. Calcium is retained in large quantities in the bones of young children, and phosphorus in older children.

With a change in the structure and chemical composition of bones, their physical properties change; in children they are more elastic and less brittle than in adults. Cartilage in children is also more plastic. Significant age-related differences are observed in the structure and composition of the bones, especially clearly in the number, location and structure of the Haversian canals. With age, their number decreases, and the location and structure change. How older child, the more dense the substance of the bone, and the younger, the more spongy. The structure of spongy bones by the age of 7 is similar to an adult. The younger the child, the more the periosteum is fused with the bone, and the older, the more it is limited from the dense substance of the bone and by the age of 7 it is already limited from it.

Peculiarities of the skull in children.

The skull is the skeleton of the head. In accordance with the features of development, structure and functions, two sections of the skull are distinguished: cerebral and facial (visceral). The brain part of the skull forms a cavity inside which the brain is located. The facial region forms the bone base of the respiratory apparatus and the alimentary canal.

The medulla of the skull consists of a roof (or vault of the skull) and a base. The parietal bone of the cranial vault is a quadrangular plate with four serrated edges. Two parietal bones connected by sutures form the parietal tubercle. In front of the parietal bones lies the frontal bone, most of which is represented by scales.

The convex part of the facial part of the skull is formed by the frontal tubercles, below which are the bones that form the walls of the orbits. Between the eye sockets is bow, adjacent to the nasal bones, below which are the cells of the ethmoid bone.

Behind the parietal bones is located occipital bone, due to which the base of the skull is formed and the skull is connected to the spine. On the sides of the roof of the skull are two temporal bones also involved in the formation of the base of the skull. Each of them contains the corresponding departments of the organ of hearing and vestibular apparatus. At the base of the skull is the sphenoid bone.

The bones of the base of the skull, developed from cartilage, are connected by cartilage tissue, which is replaced by bone tissue with age. The bones of the roof, developed from the connective tissue, are connected by connective tissue sutures, which become bony in old age. This also applies to the facial region of the skull.

The facial region of the skull is upper jaw, zygomatic, lacrimal, ethmoid, palatine, nasal bones, inferior nasal concha, vomer, mandible and hyoid bone.

Age features of the skull. The brain and facial parts of the skull are formed from the mesenchyme. The bones of the skull develop in a primary and secondary way. The skull of children differs significantly from the skull of adults in its size compared to the size of the body, the structure and proportions of individual parts of the body. In a newborn, the cerebral region of the skull is six times larger than the facial region, in an adult - 2.5 times. In other words, in a newborn, the facial region of the skull is relatively smaller than the brain region. With age, these differences disappear. Moreover, not only the shape of the skull and its constituent bones changes, but also the number of skull bones.

From birth to 7 years, the skull grows unevenly. Three waves of acceleration are established in the growth of the skull: 1) up to 3-4 years; 2) from 6 to 8 years; 3) from 11 to 15 years old.

At the age of 3 to 7 years, the base of the skull, together with the occipital bone, grows faster than the vault. At the age of 6-7 years, the frontal bone is completely fused. By the age of 7, the base of the skull and the foramen magnum reach a relatively constant value, and there is a sharp slowdown in the development of the skull.

Development mandible is directly related to work. chewing muscles and dental conditions. Two waves of acceleration are observed in its growth: 1) up to 3 years; 2) from 8 to 11 years old.

Head sizes in schoolchildren increase very slowly. At all ages, boys have a larger average head circumference than girls. The largest increase in the head is observed between the ages of 11 and 17, i.e., during puberty (for girls - by 13-14 years, and for boys - by 13-15).

The ratio of head circumference to height decreases with age. If at 9-10 years old the head circumference is on average 52 cm, then at 17-18 years old it is 55 cm. In men, the capacity of the cranial cavity is approximately 100 cubic meters. see more than women.

There are also individual features of the skull. These include two extreme forms of skull development: long-headed and short-headed.

Features of the child's spine.

The spine consists of 24 free vertebrae (7 cervical, 12 thoracic and 5 lumbar) and 9-10 non-free (5 sacral and 4-5 coccygeal). Free vertebrae, articulated among themselves, are connected by ligaments, between which there are elastic intervertebral discs made of fibrocartilage. The sacral and coccygeal vertebrae are fused to form the sacrum and coccyx. The vertebrae develop from cartilage tissue, the thickness of which decreases with age.

There are four stages in the development of the epiphyses of the vertebrae: up to 8 years - the cartilaginous epiphysis; from 9 to 13 years - calcification of the epiphysis; from 14 to 17 years old - bone epiphysis; after 17 years - the fusion of the epiphysis with the vertebral body.

From 3 to 15 years, the size of the lower lumbar vertebrae increases more than the upper thoracic. This is due to an increase in body weight, its pressure on the underlying vertebrae.

From the age of 3, the vertebrae grow equally in height and width; from 5-7 years old - more in height.

At 6-8 years old, ossification centers are formed in the upper and bottom surfaces vertebral bodies and at the ends of the spinous and transverse processes. Up to 5 years, the spinal canal develops especially rapidly. Since the vertebral bodies grow faster than the arches, the capacity of the canal decreases relatively, which corresponds to a decrease in the relative size of the spinal cord.

The length of the spine increases especially sharply during the first and second years of life, then the growth of the spine slows down and accelerates again from 7 to 9 years (more in girls than in boys).

The mobility of the spine depends on the height of the intervertebral cartilage discs and their elasticity, as well as on the frontal and sagittal size of the vertebral bodies. In an adult, the total height of the intervertebral discs is equal to one fourth of the height of the movable part of the spine. The higher the intervertebral discs, the greater the mobility of the spine. The height of the discs in the lumbar region is one third of the height of the body of the adjacent vertebra, in the upper and lower parts of the thoracic region - one fifth, in its middle part - one sixth, in the cervical region - one fourth, therefore, in the cervical and lumbar regions, the spine has the greatest mobility.

The flexion of the spine is greater than its extension. The greatest flexion of the spine occurs in the cervical region (70°), less in the lumbar, and the least in the thoracic region. Tilts to the side are greatest between the thoracic and lumbar regions (100°). The greatest circular motion is observed in the cervical spine (75°), it is almost impossible in the lumbar spine (5°). Thus, the cervical spine is the most mobile, the lumbar is less mobile, and the thoracic is the least mobile, because its movements are inhibited by the ribs.

The mobility of the spine in children, especially 7-9 years old, is much greater than in adults. It depends on the relatively larger size of the intervertebral discs and their greater elasticity.

Physiological curves of the spine. After birth, the spine acquires four physiological curves. At 6-7 weeks, when the baby's head is raised, an anterior bend (lordosis) occurs in the cervical region. At 6 months, as a result of sitting, backward bends (kyphosis) are formed in the thoracic and sacral regions. At 1 year old, with the onset of standing, lordosis is formed in the lumbar region. Initially, these physiological curves of the spine are held by the muscles, and then ligamentous apparatus, cartilage and bones of the vertebrae.

By the age of 3-4 years, the curves of the spine gradually increase as a result of standing, walking, gravity and muscle work. By the age of 7, cervical lordosis and thoracic kyphosis are finally formed.

Due to the spring movement of the spine, the magnitude of its bends can change. As a result of changes in the curvature of the spine and the height of the intervertebral discs, the length of the spine also changes: with age and during the day. During the day, a person's height varies within 1 cm, and sometimes 2-2.5 cm and even 4-6 cm. In the prone position, the length of the human body is 2-3 cm longer than in the standing position.

Peculiarities chest child.

The chest is made up of 12 pairs of ribs. The true ribs (the first - the seventh pair) are connected to the sternum with the help of cartilages, of the remaining five false ribs, the cartilaginous ends of the eighth, ninth and tenth pairs are connected to the cartilage of the overlying rib, and the eleventh and twelfth pairs do not have costal cartilages and have the greatest mobility, since end freely. The second - seventh pairs of ribs are connected to the sternum by small joints.

The ribs are connected to the vertebrae by joints, which, when the chest is raised, determine the movement of the upper ribs mainly forward, and the lower ribs to the sides.

The sternum is unpaired bone, in which three parts are distinguished: the handle, the body and the xiphoid process. The handle of the sternum articulates with the clavicle with the help of a joint containing an intracartilaginous disk (by the nature of the movements, it approaches the spherical joints).

The shape of the chest depends on age and gender. In addition, the shape of the chest changes due to the redistribution of the force of gravity of the body when standing and walking, depending on the development of the muscles of the shoulder girdle.

Age-related changes in the formation of the chest. The ribs develop from mesenchyme, which transforms into cartilage in the second month of uterine life. Their ossification begins in the fifth - eighth week, and the sternum - in the sixth month. The ossification nuclei in the head and tubercle appear in the upper ten ribs at the age of 5-6 years, and in the last two ribs - at the age of 15 years. The fusion of parts of the rib ends by the age of 18-25.

Up to 1-2 years, the rib consists of a spongy substance. From 3-4 years of age, a compact layer develops in the middle of the rib. From the age of 7, a compact layer grows along the entire rib

In the xiphoid process, the nucleus of ossification appears at the age of 6-12 years.

The shape of the chest. In humans, there are two extreme forms of the chest: long narrow and short wide. They also correspond to the shape of the sternum. Among the main forms of the chest, there are conical, cylindrical and flat shapes.

The shape of the chest changes significantly with age. After birth and for the first few years of life, the ribcage is cone-shaped with the base facing down. From the age of 2.5-3 years, the growth of the chest goes parallel to the growth of the body, in connection with this, its length corresponds to the thoracic spine. Then the growth of the body accelerates, and the chest becomes relatively shorter. In the first three years, there is an increase in the circumference of the chest, which leads to the predominance of the transverse diameter in the upper part of the chest.

Gradually, the chest changes its conical shape and approaches that of an adult, that is, it takes the form of a cone with the base turned upward. The chest acquires its final shape by the age of 12-13, but is smaller than in adults.

Gender differences are also observed in the growth of the circumference of the chest. In boys, the circumference of the chest from 8 to 10 years old increases by 1-2 cm per year, by puberty (from 11 years old) - by 2-5 cm. In girls up to 7-8 years old, the chest circumference exceeds half the size of their growth. In boys, this ratio is observed up to 9-10 years, from this age half of the height becomes larger than the size of the chest circumference.

Exceeding half of the height above the circumference of the chest depends on the growth rate of the body, which is greater than the growth rate of the circumference of the chest. The growth of the circumference of the chest is inferior to the addition of body weight, so the ratio of body weight to the circumference of the chest gradually decreases with age. The chest circumference grows most rapidly during puberty and in the summer-autumn period. Normal nutrition, good ones hygiene conditions and physical exercises have a dominant influence on the growth of the circumference of the chest.

The parameters of the development of the chest depend on the development of skeletal muscles: the more developed the skeletal muscles, the more developed the chest

Improper seating of children at a desk can lead to chest deformity and, as a result, a violation of the development of the heart, large vessels and lungs.

The development of the bones of the upper limbs.

The skeleton of the upper extremities includes the shoulder girdle and the skeleton of the arm. The shoulder girdle consists of the scapula and collarbone, the skeleton of the arm consists of the shoulder, forearm and hand. The hand is divided into the wrist, metacarpus and fingers.

The shoulder blade is a flat, triangular-shaped bone located on the back. The clavicle is a tubular bone, one end of which articulates with the sternum and ribs, and the other with the scapula. The costoclavicular joint appears in children from 11-12 years old; greatest development it reaches in adults.

The arm skeleton consists of the humerus (shoulder skeleton), the ulna and radius (forearm skeleton), and the bones of the hand.

The wrist consists of eight small bones arranged in two rows, forming a groove on the palm and a bulge on its back surface.

The metacarpus consists of five small tubular bones, of which the shortest and thickest is the thumb bone, the longest is the second bone, and each of the following bones is smaller than the previous one. The exception is the thumb (first) finger, which consists of two phalanges. The other four fingers have three phalanges. The largest phalanx is proximal, the smaller is the middle, and the smallest is the distal.

On the palmar surface, there are permanent sesamoid bones - inside the tendons between the metacarpal bone of the thumb and its proximal phalanx, and non-permanent - between the metacarpal bone and the proximal phalanx of the second and fifth fingers. The pisiform bone of the wrist is also a sesamoid bone.

The joints of the wrist, metacarpus and fingers are reinforced with a powerful ligamentous apparatus.

Age features of the development of the upper limbs. In a newborn, the clavicle is almost completely bone, the formation of a nucleus of ossification in its sternal region occurs at 16-18 years old, and merges with her body at 20-25 years old. Fusion of the nucleus of ossification of the coracoid process with the body of the scapula occurs at the age of 16-17 years. Synesthesia of the acromial process with her body ends at 18-25 years.

All long bones in a newborn, such as the humerus, radius, ulna, have cartilaginous epiphyses and bone diaphyses. There are no bones in the wrist, and cartilage ossification begins: in the first year of life - in the capitate and hamate bones; at 2-3 years old - in a trihedral bone; at 3-4 years - in the lunate bone; at 4-5 years old scaphoid; at 4-6 years old - in a large polygonal bone; at 7-15 years old - in the pisiform bone.

Sesamoid bones in the first metacarpophalangeal joint appear at 12-15 years of age. At the age of 15-18, the lower epiphysis of the humerus merges with its body, and the upper epiphyses merge with the bodies of the bones of the forearm. In the third year of life, ossification of the proximal and distal epiphyses of the phalanges occurs. "Bone age" determines the centers of ossification of the hand.

Ossification of the bones of the upper limbs ends: at 20-25 years old - in the collarbone, scapula and humerus; at 21-25 years old - in the radius; at 21-24 years old - in ulna; at 10-13 years old - in the bones of the wrist; at 12 years old - in the metacarpus; at 9-11 years old - in the phalanges of the fingers.

Ossification ends in men on average two years later than in women. The last centers of ossification can be found in the clavicle and scapula at 18-20 years old, in the humerus - at 12-14 years old, in the radius - at 5-7 years old, in the ulna - at 7-8 years old, in the metacarpal bones and phalanges fingers - in 2-3 years. Ossification of sesamoid bones usually begins during puberty: in boys - at 13-14 years old, in girls - at 12-13. The beginning of the merger of parts of the first metacarpal bone refers to the onset of puberty.

Features of the development of the pelvis and lower extremities. Skeleton of the lower extremities.

The pelvic girdle consists of the pubic, iliac and ischium, which are laid independently and merge with age, forming a pelvis connected behind with the sacral spine. The pelvis serves as a support for internal organs and legs. Due to the mobility of the lumbar spine, the pelvis increases the range of motion of the leg.

The leg skeleton consists of the femur (thigh skeleton), the tibia and fibula (tibia skeleton) and the bones of the foot.

The tarsus is made up of the talus, calcaneus, navicular, cuboid, and three cuneiform bones. Metatarsus is formed by five metatarsal bones. The toes consist of phalanges: two phalanges in the first toe and three phalanges in the remaining fingers. Sesamoid ossicles are located, as in the hand, but are much better expressed. The largest sesamoid bone of the leg skeleton is the patella, located inside the tendon of the quadriceps femoris. It increases the shoulder strength of this muscle and protects the knee joint from the front.

Development of the pelvic bones. The most intensive growth of the pelvic bones is observed in the first three years of life. In the process of fusion of the pelvic bones, several stages can be distinguished: 5-6 years (the beginning of fusion); 7-8 years (pubic and ischial bones grow together);

The size of the pelvis in men is smaller than in women. Distinguish between the upper (large) pelvis and the lower (small) pelvis. The transverse size of the entrance to the small pelvis in girls changes abruptly in several stages: at 8-10 years old (it increases very quickly); at 10-12 years old (there is some slowdown in its growth); from 12 to 14-15 years (growth increases again). The anteroposterior size increases more gradually; from the age of 9 it is less than the transverse. In boys, both sizes of the pelvis increase evenly.

The development of the bones of the lower extremities. By the time of birth, the femur consists of cartilage, only the diaphysis is bone. Synostosis in long bones ends at the age of 18 to 24 years. Kneecap acquires the form characteristic of an adult by the age of 10.

The development of the bones of the tarsus occurs much earlier than the bones of the wrist, the ossification nuclei in them (in the calcaneus, talus and cuboid bones) appear even in the uterine period. In the sphenoid bones, they occur at 1-3-4 years, in the scaphoid - at 4.5 years. At the age of 12-16, the ossification of the calcaneus ends.

The bones of the metatarsus ossify later than the bones of the tarsus, at the age of 3-6 years.

From the age of 7, the legs grow faster in boys. The greatest ratio of leg length to body is achieved in boys by the age of 15, in girls - by 13 years.

The human foot forms an arch that rests on the calcaneus and the anterior ends of the metatarsal bones. The general arch of the foot is made up of the longitudinal and transverse arches. The formation of the arch of the foot in humans occurred as a result of upright walking.

2.3 Formation of joints in children and their age characteristics

By the time of birth, the articular-ligamentous apparatus is anatomically formed. Newborns already have all the anatomical elements of the joints, but the epiphyses of the articulating bones consist of cartilage. The capsules of the joints of the newborn are tightly stretched, and most of the ligaments are characterized by insufficient differentiation of the fibers that form them, which determines their greater extensibility and lower strength than in adults. These features determine the possibility of subluxations, such as the head of the radius and humerus. The development of the joints most intensively occurs before the age of 3 years and is due to a significant increase in the motor activity of the child.

For the period from 3 to 8 years, the amplitude of movements in the joints gradually increases in children, the process of restructuring the fibrous membrane continues actively. joint capsule and ligaments, their strength increases.

At the age of 6-10 years, the structure of the joint capsule becomes more complicated, the number of villi and folds of the synovial membrane increases, vascular networks are formed and nerve endings synovial membrane.

Chapter 3. Diseases of the bone and joint systems in preschool children and their prevention

As the child grows, the proportions of his body change, the skeleton is aligned. This long process begins in the womb and ends by 20-25 years.

A great influence on the formation of the musculoskeletal system is exerted by congenital features, external conditions, daily routine, nutrition, physical overload during sports activities, past illnesses and everything that introduces an imbalance into the balanced state of the muscular-ligamentous frame and spine.

Pathologies of the musculoskeletal system in preschool children.

In children of the first years of life, congenital anomalies in the structure of the skeleton occur. Problems with the limbs are easily detected by a pediatrician during examination, but anomalies in the structure of the hip and spine are not always diagnosed in time, since in the first year of life they are still outwardly invisible.

About one in 60 newborns has some degree of hip instability. That's why great importance has screening for hip joints in newborns. Ideally, all children should be examined at birth, at 6–8 weeks, 6–8 months of age, and when the child begins to walk. This will reduce the number of late detections of hip dysplasia. Risk factors are family history, breech presentation.

If the hip is displaced enough for a long time, as a result, it is fixed in this position. Clinically, it looks like this: the leg is shortened, turned outward, the femoral and gluteal folds are asymmetrical. On examination, there is a limitation of hip abduction during leg flexion. When walking, the child limps painlessly.

Transient synovitis is an acquired, rapidly transient inflammatory disease. hip joint- occurs in children aged 3-8 years. Typically occurs due to viral infection and is the most common cause acute lameness in children of this age. More dangerous at this age (in 4-10-year-old children) is idiopathic aseptic necrosis of the epiphyseal part of the femoral head (Perthes' disease), in 10% of cases the lesion is bilateral. Boys get sick four times more often than girls. The child complains of pain in the hip or knee joints, lameness. Examination reveals flexion deformity of the joint and limited abduction. Diagnosis is confirmed radiographically, but early stages disease changes on radiographs may not be.

In children 4-11 years old, a painless cystic swelling sometimes occurs in the popliteal fossa, while the range of motion of the knee remains almost unchanged. The cystic formation is due to a semimembranous sac, often communicating with the knee joint. This benign cyst disappears on its own, although occasionally if it causes concern or reaches large sizes requiring surgical treatment.

Minor foot deformities may be associated with other congenital malformations, especially of the hip or spine. In one of the most common types of deformity (1:100), the front surface of the foot is in a varus position (adduction) with simultaneous supination (flexion). The sole of such a foot looks like a bean, but in this case there is no horse foot, in which the child focuses only on the toes while walking. The foot is flexible and lends itself to passive correction. Most children recover without treatment. For more severe deformities, traction or splinting is sometimes required. The need for surgical correction is rare.

Clubfoot occurs in one in a thousand newborns, and boys are predominantly affected. Half of the cases are bilateral lesions. A clumsy child needs early specialized treatment with traction and bandaging from a sticky plaster or plaster, and a course of physiotherapy. About half of the cases (mainly when there is no fixed deformity) are treatable, in the rest - children require surgical correction in the first year of life.

Flat feet. Up to three years, all children have a flattened medial arch of the foot. A painless, flexible foot at an older age is also regarded as a physiological norm. If flat feet are accompanied by pain, stiffness and spasm, especially of the peroneal muscles, a pathological cause of this condition should be sought. Congenital platypodia, as a rule, is expressed by a flat-valgus foot, subsequently a calcaneal foot may develop when the child, while walking, focuses on the calcaneus with a raised forefoot. This condition is determined even in the neonatal period, therefore, it requires the earliest possible correction. Acquired flat feet may be the result of rickets, sometimes combined with rachitic curvature of the lower extremities (valgus and varus deformities of the knee joints).

Posture disorders. By posture is understood the habitual posture of a person at rest and during movement. According to the classification of types of posture disorders (1962), there are: posture disorders in the frontal plane and posture disorders in the sagittal plane: flat back, flat-concave back, stooped back, round back, round-concave back.

Preschoolers often have a flaccid posture. One of the main reasons for the formation of a sluggish posture is the poor development of the child's muscles, his lack of physical activity, frequent or prolonged illness. A child with a sluggish posture can hardly maintain static postures, often changes the position of individual parts of the body. Such a child gives the impression of being tired, weak or ill. Signs of a sluggish posture: an increase in the cervical and thoracic curves of the spine; head slightly lowered; shoulders are lowered and moved forward; shoulder blades behind the back ("pterygoid" shoulder blades); the stomach sags; legs slightly bent at the knees.

For children of preschool age, normally developing, but poorly nourished, a somewhat increased roundness of the abdomen and shoulder blades slightly behind the back are also characteristic. Often, sluggish posture is combined with various defects in the lower extremities, which is explained by the general weakness of the entire musculo-ligamentous apparatus. In the absence of correction, flaccid posture leads to more stable forms of deformities of the musculoskeletal system.

Prevention of diseases in preschool children of the bone and articular systems.

For the correct formation musculoskeletal system great attention should be given to the overall physical development of the child. Moreover, from the first months of life, when the spine and its physiological curves are formed.

For the development of the muscular corset, a child over three years old should be accustomed to regular physical education: teach to swim, play football, jump rope, ski and skate. It is not recommended to send the child to sports sections early. As a rule, children over 5-6 years old are taken to sports, because at this age it is already possible to assess the level physical training child and the presence of pathologies.

State musculoskeletal system throughout a person's life depends to a large extent on adequate physical activity. It is known that the vibration of the bone, which occurs during movement, promotes the absorption of calcium by osteoblasts - bone-forming cells. Systematic exercise contributes to the growth and strengthening of bones, increases the elasticity of ligaments and muscle tendons, and increases joint flexibility. Hypodynamia or a lack of physical activity lead to a slowdown in bone metabolism, impair the absorption of calcium and phosphorus, bone growth slows down, its structure is disturbed, and conditions are created for shape distortion under the influence of static loads. The lack of sufficient physical activity also negatively affects the state of the joints: it leads to loosening of the articular cartilage and changes in the articular surfaces of the bones, a decrease in the amount synovial fluid, appearance pain when moving.

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The skeleton of the body is formed spinal column and chest. The spine in the sacral part is fixed motionless between the bones of the pelvis. The spinal column is not only a support for the head, shoulder girdle with upper limbs and all internal organs, but also a bone lever of movement. Both of these functions of the spine - static (support) and dynamic - determine its structure. There are several sections in the spine: cervical, consisting of 7 vertebrae; chest - out of 12; lumbar - from 5 vertebrae; sacral - from 5 fused vertebrae and coccygeal - from 4-5 fused vertebrae.

The structure of the spinal column. Each vertebra has a massive anterior part - the body, which passes into an arc at the back. The vertebrae overlap each other to form spinal canal in which the spinal cord is located. Several processes depart from the arch of the vertebra: articular upper and lower, transverse - heading to the sides and spinous, going backwards. The vertebrae of each department have their own structural features. For example, the spinous processes of the thoracic vertebrae are directed obliquely downward and thereby limit the movement of the vertebrae backward, the size of the vertebrae gradually increases from top to bottom, respectively. functional tasks support, reaching the greatest value in the lower lumbar and upper sacral regions.

A normally formed spine forms several physiological curves: cervical, convexly facing forward; chest - bulge back; lumbar - bulge forward; sacrococcygeal - bulge back.

Physiological curves help to maintain balance, soften shocks and tremors during movements. The curves of the spine are formed in the process of growth and development of the child. The cervical bend is formed when the child tries to raise his head and is fixed as it develops. neck muscles; chest - occurs during the period when the child begins to sit; lumbar - when he gets to his feet.

It is generally accepted that by the age of 6-7 years, the curves of the spine are already clearly expressed, by the age of 14-15 they become permanent, but they are finally formed only by the age of 20-25. In the process of age development, physiological curves change depending on the angle of the pelvis and the traction of the muscles that surround the spine. This allows you to influence the development of bends by appropriate selection of physical exercises.

The vertebral bodies are firmly connected to each other by fibrous cartilage tissue of the disc. Inside each disc has a nucleus pulposus. The discs are resilient, elastic, soften shocks and shocks when walking, running, jumping; displacement of the nucleus pulposus provides small movements between the vertebrae, movements around the vertical axis. As the body grows, the intervertebral discs gradually lose their elasticity and thicken. In children, the relative height of the intervertebral discs is greater than in adults. Interestingly, the length of the spine fluctuates even during the day. Under the influence of body weight, the intervertebral cartilages shrink, and by the evening the person becomes 1-3 cm lower. Therefore, you need to measure height at the same time, preferably in the morning.

Between the arches of the vertebrae are strong ligaments of elastic fibers, the so-called yellow ligaments. With movements of the spinal column, especially when flexed, these ligaments are stretched and tightened.

On the anterior and anterolateral surfaces of the vertebral bodies and intervertebral discs is the anterior longitudinal ligament, behind the vertebral bodies are covered with the posterior longitudinal ligament, which makes up the anterior wall of the spinal canal. Along the spinous processes are interspinous and supraspinous ligaments. Thus, the stability of the spine is provided by a powerful ligamentous apparatus.

The skeletal system is rebuilt throughout a person's life. At preschool and school age, ossification of the connective and cartilaginous elements of the vertebrae occurs.

During this period, incorrect postures, overwork, excessive overloads when performing physical exercises can cause severe posture disorders due to improper redistribution of the tone of the musculoskeletal system.

The greatest instability of the spine is observed at the age of 11-15 years. During this period of the so-called "secondary traction" preceding puberty, the body rapidly grows in length (intensive bone growth, increased ossification of the vertebrae), and the development of the muscular system is somewhat delayed. The growth of the spine in length is positively influenced by physical activity, various body movements and, in particular, rational physical exercises.

At the senior school (adolescent) age, although the processes of ossification in the skeleton are still not completed, the bones become stronger, the spine becomes more resistant to physical activity, increases muscle strength, body height prevails in width, body weight increases, posture formation ends.

Bone tissue, in particular the spine, is not only the main supporting mechanism, but also a reserve of calcium salts, from which the body receives the amount of lime it needs.

Hence the importance of ensuring the normal and correct development of the skeleton of children and especially the spine - a complex dynamic system. In addition, the spine performs protective function for the spinal cord.

Movement of the spinal column. Movements of the spine are possible in three mutually perpendicular planes: frontal - body tilts to the left and right, sagittal - flexion and extension of the body and horizontal ( vertical axis) - turns of the body. In addition, it is possible circular motions spine, which are a combination of rotations around different axes.

The greatest mobility is possible in the cervical and lumbar regions, while in the thoracic region, mobility is practically absent, it is limited by spinous processes that overlap each other.

Spinal mobility reaches its greatest development in childhood and adolescence. Physical exercises significantly improve the dynamic function of the spine. The main support of the spine is the pelvis, so the movements of the spine, especially its lumbar, for the most part are combined with changes in the ratios in the joints of the pelvis and hip joints.

Muscles of the spinal column. The movements of the spine are carried out big group muscles located mainly on the back of the neck and torso. These muscles belong to the type of strong muscles that perform predominantly static work. They are located under the muscles of the shoulder girdle and shoulder joint, under the trapezius, rhomboid, latissimus dorsi and under the serratus muscles related to respiratory movements. All the muscles that extensor the spinal column are combined into one complex muscle - the extensor of the body (rectifier of the spine according to the weight gain), etc. With the simultaneous contraction of these muscles, the spine is extended along its entire length. With their tone, the extensors of the back support the trunk in an upright position, helping to maintain the correct posture.

The muscles that straighten the spine include: iliocostal muscle - lower back, chest and neck; longissimus muscle - chest, neck and head; spinous muscle - chest, neck and head.

The iliopsoas muscle is involved in the flexion of the spine, which starts from 5 lumbar vertebrae and from the pelvic bone, goes down and is attached to the lesser trochanter of the femur. Thanks to the vertical position of a person, it has received significant development. In addition to flexion, the iliopsoas muscle takes part in the outward rotation of the thigh. It is of great importance for the formation lumbar lordosis. When it relaxes, the lordosis decreases, as it happens, for example, when sitting. On the contrary, in a standing position, the muscle tenses, the lordosis increases. If the contraction of this muscle coincides with a strong tension of the rectus abdominis muscle, then instead of lordosis, the formation of sternolumbar kyphosis is observed, as happens with the “angle” position when hanging on the gymnastic wall.

The rectus and oblique muscles of the abdomen, the transverse muscle, and the square muscle of the lower back also take part in the flexion of the torso. Rectus abdominis to the right and left of the midline of the abdomen. This muscle starts from the cartilage of the V, VI and VII ribs and from the xiphoid process and is attached to pubic bone. Its functions are varied: it is a flexor of the spine, with a unilateral contraction it contributes to its tilt to the side. With a fixed torso, she raises her legs along with the pelvis (exercise "angle").

The external oblique muscle of the abdomen starts from the 8 lower ribs and is attached to the iliac crest and pubic fusion. Function - contributes to the flexion of the spine, turning it in the opposite direction.

The internal oblique muscle of the abdomen originates from the anterior iliac spine and inserts on the 3 lower ribs. Function - promotes flexion of the spinal column and rotation of the body in its direction.

All listed muscles of the abdominal wall are located symmetrically on both sides.

Other functions of this muscle group are no less important. They support the insides in a normal position, contribute to the removal of their contents. Hence the name is clear - "abdominal press".

The abdominal press is closely related to the respiratory muscles. The abdominal muscles are antagonists of the diaphragm during breathing, and at the moment of straining they become synergists (ie, acting in one direction). When exhaling, they contract and push the abdominal organs up and back. The diaphragm is pushed into the chest cavity, and it decreases in the longitudinal direction.

In the practice of physical education, strengthening the abdominal muscles is of great importance. Muscle relaxation abdominals can lead to prolapse of the viscera, the formation of a hernia, congestion of blood in the abdominal cavity and lower extremities.

The structure and function of the chest. The chest consists of the thoracic spine, 12 pairs of ribs and the sternum. Within it are many important organs: lungs, heart, large blood vessels. Its anterior wall is formed by the sternum or sternum, the posterior - thoracic region spine, side walls - ribs. The shape of the chest is similar to a truncated cone, flattened in the direction from front to back. The smaller upper opening is limited by the 1st thoracic vertebra, the first two ribs, and the edge of the sternum. Through it pass the windpipe, or trachea, esophagus, blood vessels. The lower opening is limited by the last thoracic vertebra, the costal margin and the end of the sternum. From below, the chest is limited by the diaphragm.

The rib stands obliquely in relation to the spine: first it goes to the side and down, and then, forming a costal angle, it turns forward and down. Each rib is connected to a vertebra through joints. Such a structure gives certain character movement of the ribs and a change in the diameter of the chest.

When inhaling, under the influence of impulses from the central nervous system, the group of inhalatory muscles is reduced, and the chest expands in the anteroposterior and transverse directions; an increase in its volume forward occurs due to the divergence of the anterior ends of the upper ribs. Reducing the aperture provides an increase vertical size chest cavity. When exhaling, under the influence of impulses from the central nervous system, a group of expiratory muscles contracts. The muscles of the anterior wall of the abdominal cavity, actively contracting, push the abdominal organs upward and backward, which, in turn, push the diaphragm into the chest cavity; as a result, it decreases in the longitudinal direction.

Therefore, the mechanism of respiratory movements is reduced to the movement of the ribs and diaphragm.

Respiratory muscles are divided into actually respiratory and auxiliary. The respiratory muscles proper include the intercostal muscles, the transverse muscles of the chest, the upper and lower serratus and the main respiratory muscle - the diaphragm.

The accessory respiratory muscles during inhalation include the scalene muscles, pectoralis minor, pectoralis major, serratus anterior, and latissimus dorsi. The accessory expiratory muscles also include the abdominal muscles and the square muscle of the lower back. The abdominal muscles, when inhaled, are antagonists of the diaphragm, and when straining, they become synergists.

All auxiliary muscles with calm breathing almost do not take part and set the ribs in motion only with some certain conditions if they have support on the periphery (for example, on the shoulder blade - when performing intense arching on the gymnastic wall); in this case, they can assist in inhalation.

One of the most important structures human body is the spine. Its structure allows it to perform the functions of support and movement. The spinal column has an S-shaped appearance, which gives it elasticity, flexibility, and also softens any shaking that occurs when walking, running and other physical activities. The structure of the spine and its shape provide a person with the ability to walk upright, maintaining the balance of the center of gravity in the body.

Anatomy of the spinal column

The spinal column is made up of small bones called vertebrae. In total, there are 24 vertebrae connected in series to each other in a vertical position. The vertebrae are divided into separate categories: seven cervical, twelve thoracic and five lumbar. In the lower part of the spinal column, behind the lumbar region is the sacrum, consisting of five vertebrae fused into one bone. Below sacral department there is a coccyx, which is also based on fused vertebrae.

Between two adjacent vertebrae is intervertebral disc round shape, acting as a connecting seal. Its main purpose is to soften and absorb the loads that regularly appear during physical activity. In addition, discs connect the vertebral bodies to each other. Between the vertebrae there are formations called ligaments. They perform the function of connecting the bones to each other. The joints located between the vertebrae are called facet joints, which are similar in structure to the knee joint. Their presence provides mobility between the vertebrae. In the center of all vertebrae are openings through which the spinal cord passes. It contains nerve pathways that form a connection between the organs of the body and the brain. The spine is divided into five main sections: cervical, thoracic, lumbar, sacral and coccygeal. The cervical region has seven vertebrae, the thoracic region has twelve vertebrae, and the lumbar region has five. The bottom of the lumbar region is attached to the sacrum, which was formed from five vertebrae fused into a single whole. The lower part of the spinal column - the coccyx, has from three to five fused vertebrae in its composition.

Vertebrae

The bones involved in the formation of the spinal column are called vertebrae. The vertebral body has a cylindrical shape and is the most durable element that bears the main support load. Behind the body is the vertebral arch, which has the form of a semicircle with processes extending from it. The vertebral arch and its body form the vertebral foramen. The collection of holes in all the vertebrae, located exactly one above the other, forms the spinal canal. It serves as a receptacle for the spinal cord, nerve roots and blood vessels. Ligaments also participate in the formation of the spinal canal, among which the yellow and posterior longitudinal ligaments are the most important. The yellow ligament connects the proximal vertebral arches, and the posterior longitudinal connects the vertebral bodies behind. The vertebral arch has seven processes. Muscles and ligaments are attached to the spinous and transverse processes, and the superior and inferior articular processes appear in the creation of the facet joints.


The vertebrae are spongy bones, so they have a spongy substance inside, covered on the outside with a dense cortical layer. The spongy substance consists of bony crossbars that form cavities containing red bone marrow.

intervertebral disc

The intervertebral disc is located between two adjacent vertebrae and looks like a flat, rounded gasket. In the center of the intervertebral disc is the nucleus pulposus, which has good elasticity and performs the function of damping the vertical load. The nucleus pulposus is surrounded by a multilayer fibrous ring, which keeps the nucleus in a central position and blocks the possibility of displacement of the vertebrae to the side relative to each other. The fibrous ring consists of a large number of layers and strong fibers intersecting in three planes.

Facet joints

The articular processes (facets) that participate in the formation of facet joints depart from the vertebral plate. Two adjacent vertebrae are connected by two facet joints located on both sides of the arch symmetrically with respect to the midline of the body. The intervertebral processes of neighboring vertebrae are located towards each other, and their ends are covered with smooth articular cartilage. Thanks to the articular cartilage, friction between the bones that form the joint is greatly reduced. Facet joints allow for various movements between the vertebrae, giving the spine flexibility.

Foraminal (intervertebral) foramen

In the lateral parts of the spine, there are foraminal openings created with the help of the articular processes, pedicles, and bodies of two adjacent vertebrae. The foramina serve as the exit point for nerve roots and veins from the spinal canal. Arteries, on the contrary, enter the spinal canal providing blood supply to the nerve structures.

Paravertebral muscles

Muscles located next to the spinal column are called paravertebral. Their main function is to support the spine and provide a variety of movements in the form of tilts and turns of the body.

Spinal motion segment

The concept of the spinal motion segment is often used in vertebrology. It is a functional element of the spine, which is formed from two vertebrae connected to each other by an intervertebral disc, muscles and ligaments. Each spinal motion segment includes two intervertebral foramina, through which the nerve roots of the spinal cord, veins and arteries are removed.

cervical spine

The cervical region is located in the upper part of the spine, it consists of seven vertebrae. The cervical region has a forward convex bend, which is called lordosis. Its shape resembles the letter "C". The cervical region is one of the most mobile parts of the spine. Thanks to him, a person can perform tilts and turns of the head, as well as perform various neck movements.

Among the cervical vertebrae, it is worth highlighting the top two, bearing the name "atlas" and "axis". They received a special anatomical structure, unlike other vertebrae. The atlas (1st cervical vertebra) lacks a vertebral body. It is formed by the anterior and posterior arch, which are connected by bone thickenings. Axis (2nd cervical vertebra) has an odontoid process formed from a bony protrusion in the front. The odontoid process is fixed by ligaments in the vertebral foramen of the atlas, forming an axis of rotation for the first cervical vertebra. This structure makes it possible to carry out rotational movements of the head. The cervical region is the most vulnerable part of the spine in terms of the possibility of injury. This is due to the low mechanical strength of the vertebrae in this section, as well as a weak corset of the muscles located in the neck.

Thoracic spine

The thoracic spine contains twelve vertebrae. Its shape resembles the letter "C", located in a convex curve back (kyphosis). The thoracic region is directly connected to the posterior chest wall. The ribs are attached to the bodies and transverse processes of the thoracic vertebrae through the joints. With the help of the sternum, the anterior sections of the ribs are combined into a strong integral frame, forming the chest. The mobility of the thoracic spine is limited. This is due to the presence of the chest, low altitude intervertebral discs, as well as a significant long spinous processes of the vertebrae.

Lumbar spine

The lumbar region is formed from the five largest vertebrae, although in rare cases their number can reach six (lumbarization). The lumbar spine is characterized by a smooth forward curvature (lordosis) and is the link connecting the thoracic region and the sacrum. Lumbar you have to experience considerable stress, as it is under pressure from the upper body.

sacrum (sacral region)

The sacrum is a triangular bone formed by five fused vertebrae. The spine is connected to the two pelvic bones through the sacrum, located like a wedge between them.

Coccyx (coccygeal region)

Coccyx - lower section spine, which includes from three to five fused vertebrae. Its shape resembles an inverted curved pyramid. The anterior sections of the coccyx are designed to attach muscles and ligaments related to the activity of the organs of the genitourinary system, as well as remote sections of the large intestine. The coccyx is involved in the distribution of physical load on the anatomical structures of the pelvis, being important point supports.