Type of connection of the pelvic bones and the sacrum. Why do the pelvic bones in conjunction with the sacrum have little mobility? Pelvis as a functional unit

The anatomy of the hip joint, when carefully considered, is a rather complex structure. Moreover, the structure of the hip joint and pelvic bone can change greatly with age. For example, in infants, the structure of the hip joint changes as they mature and grow. Initially, the articulation of the pelvis and pelvic bone can be called immature, because. the ligamentous apparatus of the hip joint, which is part of it, is excessively flexible and elastic. In addition, researchers have found that in infants, the hollow of the hip joint is denser. This underdevelopment then disappears in a person. The articular area is located laterally in relation to the gluteal region, below the crest of the ischium.

The main function performed by the articulation of bones is to support the weight of the body when static and dynamic loads are applied to it. In addition to this function, the joint takes an active part in maintaining the balance of loads exerted on the body while maintaining balance in the body.

The structure of the pelvic apparatus

The anatomy of the human pelvis is quite complex. The pelvis includes two innominate bones. Conventionally, they are called right-handed and left-handed (located to the right and left relative to the axis).

The pelvis is classified according to size and shape. If there is a diagram of the structure of the hip joint and pelvis at different ages, then one can perfectly see on what principles the classification of the articular joint is carried out. Until the age of 15, the hip apparatus has three bones: the pubis, ischium and ilium. This underdevelopment in a person disappears over the years. These bone structures are conditionally called the innominate pelvic bone.

Bones and ligaments of the joint

The head of each hip bone of the pelvis is connected to adjacent bones by the human hip joint. The diagram shows that in the region of the acetabulum, three bones are articulated with the help of cartilage. The acetabulum is the junction of the femur and pelvic bones. When growing up, all three bones of the hip apparatus are connected. The head of the pelvic bone is carefully covered with elastic smooth connective tissue of the hip joint.

The narrowing of the joint space may indicate significant changes in the structure and shape of the cartilage. With arthrosis, a slight narrowing of the joint space will be visible on the x-ray. This is the first sign, because At this stage, limited movement is not yet observed.

As the diagram of the structure shows, the bone closest to the spine is the ilium. Its head is connected to the sacrum and to the other two bones of the hip apparatus. The bone itself has a rounded shape with two processes-protrusions.

The structure of the ischium in the design of the hip apparatus is as follows: the main body is connected from above with the ilium and separate processes. In addition, the ischium is connected to the pubic bone (its process, the horizontal lobe). Within this cavity, which is formed by these three bones, is the head of the femur.

The pubic bone of the hip apparatus consists of the main body and two processes-branches. The branches form a cavity, which is covered by a membrane.

Pelvic arteries

The artery of the hip apparatus is called the common iliac. It branches into two vessels. It does this by dividing the aorta. So, where the articulation of the sacrum and the hip apparatus is located, the branches of the artery give two more paired vessels that braid it.

Blood vessels supplying the pelvic joint

The external artery is the main vessel, it provides blood to the lower extremities. In the region of the hip joint, other branches of the vessels depart from it, which pass further into the joints, muscles of the legs, abdomen and to the genitals. Then the vessel passes into the femoral artery, from which the following branches pass:

1. The deep femoral artery is the largest artery and is divided into the lateral and medial arteries. They go around the thigh and conduct blood into the pelvis, thighs.
2. Epigastric superficial artery, which goes around the abdominal muscles in this place.
3. Artery near the ilium.
4. The genital arteries, which are external and supply the genitals with blood.
5. Inguinal arteries, which are responsible for the groin, skin and lymph nodes in the area.

The second (internal) artery is located in the small pelvis. The lumbar arteries, sacral, gluteal, umbilical, vas deferens, genital arteries and arteries of the rectum depart from it.

pelvic articulation

The pelvic joint has a very complex structure. The articulation is formed by the head of the femur and the socket formed by the pelvic bones (the acetabulum). The surface of the hip joint in the acetabulum is covered with a layer of cartilage tissue only in a certain area of ​​the hip joint. At the point of articulation, the femur is covered with a thin layer of cartilage. The joint of the hip apparatus connects the bones included in its composition into a single structure. Loose connective tissue is located inside the cavity. It is covered with a synovial bag. At the edges of the cavity are lips 5 mm in size. They are formed from collagen connective fibers. Due to this, there are no voids between the bones, and the head of the femur fits snugly. The hip joint is the largest articulation of bones in the human musculoskeletal system. The hip bone, which is part of the joint of the same name, is the largest bone in the body.

Hip injuries have always been difficult to treat, so it's best to know the basics and try not to injure yourself. The pelvic joints are quite fragile due to the specific structure and loads that are placed on the joint during life.

The hip joint capsule is characterized by a high level of strength in its design. The capsule is attached to the pelvic bone behind and in front of the lips of the hip joint. As a result of this design, it turns out that the neck is almost completely located in the capsule of the hip joint. The iliopsoas muscle joins the capsule. The capsule in this place becomes thinner, therefore, additional synovial fibers of the hip joint are most often formed.

This cavity contains the ligament of the femoral head. It consists of loose fibers, and on top is covered with synovial fibers of the connective tissue of the hip joint. In this ligament there are also vessels that lead to the femur. The ligament can stretch quite easily, so its mechanical and protective value is not very high for the hip joint. The main function of this ligament is to connect the bones that make up the hip apparatus.

The iliac femoral ligament is considered the strongest not only among the ligaments that make up the hip joint, but throughout the body as a whole. Its thickness can reach one centimeter. The ligament does not allow the hip to fully rotate inward or extend.

The ischial femoral ligament can be considered less developed. It is much weaker, this ligament is located behind the hip joint. The anatomical location of this ligament is due to the fact that it provides stability to the body's hip apparatus when the femur is displaced inward.

The pubic femoral ligament is located at the bottom of the hip apparatus. This is a very thin bundle of connective fibers that does not allow hip abduction.

Injuries to the hip apparatus mainly occur due to fractures and fractures of the bone in this area or due to problems with the ligaments or in general the entire hip joint. Cartilage wear and tear leads to many complications in movement.

Surgical intervention

Pelvic osteotomy is a surgical procedure for the treatment of hip dysplasia. This pathological change can be from birth and consists in the fact that the acetabulum of the hip joint is modified.

This can lead to the development of pelvic diseases, frequent subluxations, problems with femur and gait disturbance. Osteotomy is aimed at creating an additional bone structure of the hip joint, which will help to fix the femur more strongly. Then there will be no collateral damage.

If something hurts after surgery, then you need to re-examine. Osteotomy can only be performed after reaching the age of 10 years. But if there is a development of arthritis, then an operation such as osteotomy is prohibited.

Causes of pain

If the pelvis hurts, then you need to see a doctor, because. Violations can be of various kinds. Modern doctors list a large list possible causes pain in the hip joint and pelvic bones. Most often, pain is caused by injuries and systematic diseases of the hip apparatus.

Pain due to injury is the most common cause of hip and pelvic pain. If the pain has not subsided within a week after a blow or a fall, then you need to call a doctor. In this process, a neurologist and a chiropractor will help, who will prescribe a course of treatment. With falls and unsuccessful movements, a fracture of the bones of the hip apparatus, cracks, and dislocations of the joint may occur. With sharp and severe pain, it is necessary to protect the pelvis and lower limbs from movement, apply cold, drink an anesthetic until a full diagnosis of the problem of the hip joint is established.

In systemic diseases, inflammation of the connective fibers occurs. This means that an infection has begun to develop in the body or it may be a symptom of another disease. Such pain can cause osteoarthritis, infectious arthritis and osteoarthritis. In addition, pain can be caused by disorders in the blood vessels of the pelvic structure. Also, pain can be caused by neoplasms in the joint.

Better not to self-medicate. By the nature of the pain, it is difficult to make a diagnosis and prognosis, and some drugs, on the contrary, can only hurt. The pelvic complex is very complex, so you need to see a doctor.

In case of damage to the anatomical elements of the hip joint, an early appeal to medical specialist for the purpose of carrying out rehabilitation measures, since chronic injuries of this bone joint can cause a huge amount of trouble in the process of human life.

Pelvic bone (os coxae) in adults it looks like a whole bone. Until the age of 16, it consists of three separate bones: the ilium, ischium, and pubis. The bodies of these bones on the outer surface form the acetabulum, which serves as the junction of the pelvic bone with the femur.

Ilium (os ilium) the largest, occupies the upper posterior sections of the pelvic bone. It consists of two sections - the body and the wing of the ilium. Upper curved edge of the wing called iliac crest. In front of the iliac crest there are two protrusions - the superior and inferior anterior iliac spines, and below - the greater ischial notch. The inner concave surface of the wing forms the iliac fossa, and the outer convex surface forms the gluteal surface. On the inner surface of the wing there is an ear-shaped surface - the place of articulation of the pelvic bone with the sacrum.

Ischium (os ischii) consists of a body and a branch. Here are the ischial tuberosity and ischial spine, and so on. greater and lesser sciatic notches. The branch of the ischium, fused in front with the lower branch of the pubic bone, thus closes the obturator foramen of the pelvic bone.

Pubic bone (os pubis) has a body, upper and lower branches. At the junction of the bodies of the pubic and iliac bones is the iliac-pubic eminence. And along with the transition of the upper branch to the lower, in the region of the medial surface, there is a symphysial surface - the junction of the pelvic bones in front.

acetabulum formed by the fused bodies of the ilium, ischium and pubic bones. Its articular semilunar surface occupies the peripheral part of the cavity.

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1. sacroiliac joint- a tight joint formed by the ear-shaped articular surfaces of the sacrum and ilium. Blood supply from aa. lumbalis, iliolumbalis et sacrales laterales. Innervation: branches of the lumbar and sacral plexuses.

2. Pubic symphysis connects both pubic bones to each other. Between the surfaces of these bones facing each other, a fibrocartilaginous plate is laid, in which there is a synovial gap.

3.Sacrotuberous and sacrospinous ligaments-strong interosseous ligaments connecting the sacrum with the pelvic bone on each side: the first - with the ischial tuberosity, the second - with the adjacent spine. The described ligaments transform the greater and lesser sciatic notches into the greater and lesser sciatic foramen.

4. obturator membrane- fibrous plate covering the obturator foramen of the pelvis. Attached to the edges of the obturator groove of the pubic bone, it turns this groove into the obturator canal.

The pelvis as a whole

Both pelvic bones form the pelvis, which serves to connect the trunk with the free lower limbs. The bone ring of the pelvis is divided into two sections: the upper one - the large pelvis, and the lower, narrower one - the small pelvis. Below, the pelvic cavity ends with the lower aperture of the pelvis, ischial tubercles, and coccyx.

The bones of the female pelvis are generally thinner and smoother than those of men. The wings of the ilium in women are more deployed to the sides. The entrance to the female pelvis has a transverse-oval shape and is wider, the female sacrum is relatively wider and at the same time more flat. The coccyx protrudes less forward. The pelvic cavity in its outline approaches the cylinder. The female pelvis is low, but wider and more capacious.

The pelvic bones, connecting with each other and the sacrum, form the pelvis. At the junction of both pubic bones is the symphysis - a semi-movable joint. At the junction of the pelvic bones with the sacrum, a stiff joint is formed, where strength is combined with mobility. In connection with upright posture, the human pelvis is a support for the viscera and a place for transferring weight from the trunk to the lower limbs, as a result of which it experiences a huge load.

sacroiliac joint(articulation sacroiliaca) is formed by flat ear-shaped articular surfaces of the sacrum and ilium. It is strengthened by the anterior and posterior sacroiliac ligaments, as well as the interosseous ligaments, which are the strongest ligaments in the human body. As noted above, the joint is stiff, flat in shape, multiaxial in function, but there are practically no movements in it.

The sacrum is connected to the pelvic bone by two ligaments: the sacrotuberous - with the ischial tuberosity and the sacrospinous - with the ischial spine.

The described ligaments complement the bony walls of the pelvis in its posterior-lower section and turn the large and small ischial notches into the large and small openings of the same name.

Pubic symphysis(symphysis pubica) or semi-joint is formed between two pubic bones. The articular surfaces of the pubic bones are covered with hyaline cartilage. Between them there is a fibrocartilaginous plate, in which a narrow joint space is formed. The role of the articular capsule here is performed by the perichondrium. The pubic symphysis is supported by the superior and inferior pubic ligaments. Under the latter, a subpubic angle is formed. In this connection, small displacements of the bones relative to each other are possible due to the elasticity of the cartilage.

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5.5. Bone joints lower limb

Joints of the bones of the girdle of the lower limb. The pelvic bones are connected to each other and to the sacrum by means of discontinuous, continuous joints and a semi-joint.

sacroiliac joint, articulatio sacroiliaca, is formed by the ear-shaped surfaces of the sacrum and ilium. The articular surfaces are covered with fibrous cartilage. The sacroiliac joint is flat, strengthened by powerful sacroiliac ligaments, so there are no movements in it.

pubic symphysis, symphysis pubica, is located in the median plane, connects the pubic bones to each other and is a semi-joint (Fig. 5.10). Inside the cartilage (in its upper posterior section) there is a cavity in the form of a narrow gap, which develops on the 1st - 2nd year of life. Small movements in the pubic symphysis are possible only in women during childbirth. The pubic symphysis is strengthened by two ligaments: from above - by the superior pubic ligament, from below - by the inferior pubic ligament.

Continuous joints of the pelvic bone. The iliac-lumbar ligament descends from the transverse processes of the two lower lumbar vertebrae to the iliac crest.

sacrotuberous ligament connects the ischial tubercle with the lateral edge of the sacrum and coccyx.

sacrospinous ligament stretched from the ischial spine to the lateral edge of the sacrum.

Rice. 5.10. Bone connections and pelvic dimensions (diagram): a - top view: 7 - distantia intercristalis; 2 - distantia interspinosa; 3 - pubic symphysis; 4 - transverse size of the entrance to the small pelvis; 5 - true conjugate; 6 - border line; 7 - sacroiliac joint; b - side view: 7 - large sciatic foramen; 2 - small sciatic foramen; 3 - sacrospinous ligament; 4 - sacrotuberous ligament; 5 - output conjugate; 6 - angle of inclination of the pelvis; 7 - wire axis of the pelvis; 8 - true conjugate; 9 - anatomical conjugate; 10 - diagonal conjugate

obturator membrane closes the hole of the same name, leaving a small hole free at the obturator sulcus (see Fig. 5.11).

Taz in general. The pelvic bones, sacrum, coccyx and their ligamentous apparatus form the pelvis, pelvis. With the help of the pelvic bones, the trunk is also connected to the free section of the lower extremities.

Distinguish large pelvis, pelvis major, and small pelvis, pelvis minor. They are separated from each other by a border line, which is drawn on both sides from the cape through an arcuate line along the pubic crest to the pubic tubercle and further along the upper edge of the pubic symphysis.

The walls of the pelvic cavity form: behind - the sacrum and the anterior surface of the coccyx; in front - the anterior sections of the pubic bones and symphysis; from the sides - the inner surface of the pelvic bone below the border line. The obturator foramen located here is almost completely closed by the membrane of the same name, except for a small hole in the region of the obturator sulcus.

On the side wall of the small pelvis are the large and small sciatic foramen. The greater sciatic foramen is bounded by the sacrospinous ligament and the greater sciatic notch. The lesser sciatic foramen is limited by the sacrospinous and sacrotuberous ligaments, as well as the lesser sciatic notch. Vessels and nerves pass through these openings from the pelvic cavity to the gluteal region.

The pelvis in a vertical position of a person is tilted forward; the plane of the upper aperture of the pelvis forms an acute angle with the horizontal plane, forming the angle of inclination of the pelvis. In women, this angle is 55-60°, in men 50-55°.

Sex differences of the pelvis. In women, the pelvis is lower and wider. The distance between the spines and the iliac crests is greater, since the wings of these bones are deployed to the sides. The cape protrudes less forward, so the entrance to the male pelvis resembles a card heart in shape; in women, it is more rounded, sometimes even approaching an ellipse. The symphysis of the female pelvis is wider and shorter. The pelvic cavity is larger in women and narrower in men. The sacrum in women is wider and shorter, the ischial tubercles are turned to the sides, so the transverse size of the outlet is 1–2 cm larger. The angle between the lower branches of the pubic bones (subpubic angle) in women is 90-100°, in men 70-75°.

Of great importance in obstetrics for predicting the course of childbirth is knowledge of the average size of a woman's pelvis. The median anteroposterior dimensions of the small pelvis are collectively called conjugates. Typically, input and output conjugates are measured. The direct size of the entrance to the small pelvis - the distance between the cape and the upper edge of the pubic symphysis, is called the anatomical conjugate. It is equal to 11.5 cm. The distance between the cape and the most posterior point of the symphysis is called the true, or gynecological conjugate; it is equal to 10.5 - 11.0 cm. The diagonal conjugate is measured between the cape and the lower edge of the symphysis, it can be determined in a woman during a vaginal examination; its value is 12.5 -13.0 cm. To determine the size of the true conjugate, it is necessary to subtract 2 cm from the length of the diagonal conjugate.

Transverse diameter of the entrance to the small pelvis measured between the most distant points of the boundary line; it is equal to 13.5 cm. The oblique diameter of the entrance to the small pelvis is the distance between the sacroiliac joint on one side and the iliac-pubic eminence on the other; it is equal to 13 cm.

The direct size of the exit (exit conjugate) from the small pelvis in women is 9 cm and is determined between the tip of the coccyx and the lower edge of the pubic symphysis. During childbirth, the coccyx deviates back in the sacrococcygeal synchondrosis, and this distance increases by 2.0-2.5 cm.

Cross outlet dimension from the pelvic cavity is 11 cm. It is measured between the inner surfaces of the ischial tuberosities.

Wired pelvic axis, or guide line, is a curve connecting the midpoints of all conjugates. She goes almost parallel to the anterior surface of the sacrum and shows the path that the fetal head takes during childbirth.

Rice. 5.11. Hip joint: 1 - joint capsule; 2- iliac-femoral ligament; 3- obturator membrane; 4- pubic-femoral ligament; 5 - circular zone; 6- articular lip; 7 - acetabulum; 8- ligament of the femoral head

In obstetric practice great importance they also have some sizes of the large pelvis (see Fig. 5.10): the distance between the anterior superior iliac spines (distantia interspinosa), which is 25 - 27 cm; the distance between the most distant points of the iliac crests (distantia intercristalis), equal to 27 - 29 cm; the distance between the large trochanters of the femur (distantia intertrochanterica), equal to 31-32 cm. To assess the anteroposterior dimensions of the pelvis, the external conjugate is measured - the distance between the outer surface of the pubic symphysis and the spinous process of the V lumbar vertebra, which is 20 cm.

Joints of the free lower limb.

hip joint, articulatio coxae, is formed by the acetabulum of the pelvis and the head of the femur (Fig. 5.11). The central fossa of the acetabulum is filled with adipose tissue.

The articular capsule is attached along the edge of the acetabular lip and along the medial edge of the femoral neck. Thus, most of the femoral neck lies outside the joint cavity and the fracture of its lateral part is extra-articular, which greatly facilitates the treatment and prognosis of the injury.

In the thickness of the capsule is a ligament, called the circular zone, which covers the neck of the femur approximately in the middle. In the capsule of the joint, there are also fibers of three ligaments directed longitudinally: ilio-femoral, pubic-femoral and ischio-femoral, connecting the bones of the same name.

Auxiliary are the following elements of the joint: the acetabular lip, which complements the semilunar articular surface of the acetabulum; transverse ligament of the acetabulum, thrown over the notch of the acetabulum; ligament of the femoral head that connects the fossa of the acetabulum to the fossa of the femoral head and contains blood vessels that feed the femoral head.

The hip joint is a type of spherical joint - walnut, or cup-shaped. It allows movements around all axes: flexion and extension around the frontal axis, abduction and adduction around the sagittal axis, circular movement around the frontal and sagittal axes, rotation around the vertical axis.

Knee-joint, articulatio genus, is the largest joint of the human body. Three bones take part in its formation: the femur, tibia and patella (Fig. 5.12). The articular surfaces are: the lateral and medial condyles of the femur, the superior articular surface of the tibia and the articular surface of the patella.

The capsule of the knee joint is attached to the femur 1 cm above the edge of the articular cartilage and in front passes into the suprapatellar bursa, located above the patella between the femur and the tendon of the quadriceps femoris muscle. On the tibia, the capsule is attached along the edge of the articular surface.

The joint capsule is strengthened by the peroneal and tibial collateral ligaments located on both sides of the joint, as well as the patellar ligament. It is a tendon of the quadriceps femoris muscle, located below the patella.

Rice. 5.12. Knee-joint: 1 - femur; 2 - posterior cruciate ligament; 3 - anterior cruciate ligament; 4 - medial meniscus; 5 - transverse ligament of the knee; 6- collateral tibial ligament; 7- ligament of the patella; 8 - patella; 9 - tendon of the quadriceps femoris; 10 - interosseous membrane of the leg; eleven - tibia; 12 - fibula; 13 - tibiofibular joint; 14- collateral peroneal ligament; 15 - lateral meniscus; 16 - lateral condyle of the femur; 17 - patella surface

The joint has many accessory elements such as the patella, menisci, intraarticular ligaments, bursae, and folds.

The lateral and medial menisci partially eliminate the incongruence of the articular surfaces and perform a shock-absorbing role. The medial meniscus is narrow, crescent-shaped. The lateral meniscus is wider, oval. The menisci are connected to each other by the transverse ligament of the knee.

The anterior and posterior cruciate ligaments firmly connect the femur and tibia, crossing each other in the form of the letter "X".

The auxiliary elements of the knee joint also include pterygoid folds, which contain fatty tissue. They are

located below the patella on both sides. From the top of the patella to the anterior part of the tibia, an unpaired subpatellar synovial fold is directed.

The knee joint has several synovial bags, bursae synoviales, some of which communicate with the joint cavity:

1) suprapatellar bag, located between the femur and the tendon of the quadriceps femoris muscle; communicates with the joint cavity;

2) a deep subpatellar bag located between the patellar ligament and the tibia;

3) subcutaneous and subtendonal prepatellar bursae located in the tissue on the anterior surface of the knee joint;

4) muscle bags located at the place of attachment of the muscles of the lower leg and thigh in the area of ​​the knee joint.

Rice. 5.13. Joints of the bones of the lower leg: 1 - upper articular surface; 2 - tibia; 3 - interosseous membrane of the leg; 4 - medial malleolus; 5 - lower articular surface; b - lateral ankle; 7 - tibiofibular syndesmosis; 8 - fibula; 9 - tibiofibular joint

The knee joint is condylar in shape. Flexion and extension occur around the frontal axis. Around the vertical axis in a bent position, rotation of the leg in a small amount is possible.

Joints of the bones of the leg. The bones of the lower leg are connected to each other with the help of discontinuous and continuous connections.

The proximal ends of the bones of the lower leg are connected by a discontinuous connection - the tibiofibular joint, articulatio tibiofibularis (Fig. 5.13), - flat, inactive. The distal ends of the bones of the lower leg are connected by the tibiofibular syndesmosis, represented by short ligaments connecting the fibular notch of the tibia and the lateral malleolus of the fibula. A strong fibrous plate is an interosseous membrane that connects both bones almost throughout.

Joints of the bones of the foot. The joints of the bones of the foot can be divided into four groups:

1) connections of the bones of the foot with the bones of the lower leg - the ankle joint;

2) connections between the bones of the tarsus;

3) connections between the bones of the tarsus and metatarsus;

4) joints of the bones of the fingers.

Ankle (supratalar) joint, articulatio talocruralis, formed by both bones of the lower leg and the talus (Fig. 5.14). In this case, the block of the talus from the sides is covered by the lateral and medial ankles.

The joint capsule is attached along the edge of the articular surfaces. On the medial side, it is strengthened by the medial (deltoid) ligament. On the lateral side, the joint capsule is strengthened by three ligaments: anterior and posterior early-fibular, as well as calcaneal-fibular, which connect the corresponding bones.

Rice. 5.14. Joints of the bones of the foot: 1 - tibia; 2 - interosseous membrane of the leg; 3 - fibula; 4 - ankle joint; 5 - talocalcaneal-navicular joint; 6 - navicular bone; 7 - calcaneocuboid joint; 8 - tarsal-metatarsal joints; 9 - metatarsophalangeal joints; 10 - interphalangeal joints

The ankle joint is blocky in shape. It allows movements around the frontal axis: plantar flexion and dorsiflexion (extension). Due to the fact that the talus block is narrower behind, with maximum plantar flexion in the ankle joint, lateral rocking movements in a small amount are possible. Movements in the ankle joint are combined with movements in the subtalar and talocalcaneal-navicular joints.

Joints of the bones of the tarsus. Represented by the following joints: subtalar, talocalcaneal-navicular, calcaneocuboid, cuneiform.

subtalar joint, articulatio subtalaris, located between the talus and calcaneus. The joint is cylindrical, slight movements are possible in it only around the sagittal axis.

talocalcaneal-navicular joint, articulatio talocalcaneonavicularis, has a spherical shape, located between the bones of the same name. The articular cavity is supplemented by cartilage, which is formed along the plantar calcaneal-navicular ligament.

Ankle (nadtalar), the subtalar and talocalcaneal-navicular joints usually function together, forming a functionally unified joint of the foot, in which the talus plays the role of a bone disk.

Calcaneocuboid joint, articulatio calcaneocuboidea, located between the bones of the same name, saddle-shaped, inactive.

From a surgical point of view, the calcaneocuboid and talonavicular (part of the talocalcaneonavicular) joints are considered as one joint - the transverse tarsal joint (Chopard's joint). The articular space of these joints is located almost on the same line, along which it is possible to make an exarticulation (exarticulation) of the foot in case of severe injuries.

wedge-shaped joint, articulatio cuneonavicularis, is formed by the navicular and sphenoid bones and is practically immobile.

Tarsus-metatarsal joints, articulationes tarsometatarsales, are three flat joints located between the medial sphenoid and first metatarsal bones; between the intermediate, lateral sphenoid and II, III metatarsal bones; between the cuboid and IV, V metatarsal bones. All three joints from a surgical point of view are combined into one joint - the Lisfranc joint, which is also used to isolate the distal part of the foot.

metatarsophalangeal joints, articulationes metatarsophalangeae, formed by the heads of the metatarsal bones and the pits of the bases of the proximal phalanges. They are spherical in shape, strengthened by collateral (lateral) and plantar ligaments. They are fixed to each other by a deep transverse metatarsal ligament running transversely between the heads of the I-V metatarsal bones. This ligament plays an important role in the formation of the transverse metatarsal arch of the foot.

Two sesamoid bones are constantly enclosed in the plantar part of the capsule of the I metatarsophalangeal joint, so it functions as a block joint. The joints of the other four fingers function as ellipsoid. Flexion and extension around the frontal axis, abduction and adduction around the sagittal axis, and a small amount of circular motion are possible in them.

interphalangeal joints, articulationes interphalangeae, in form and function are similar to the same joints of the hand. They belong to block joints. They are strengthened by collateral and plantar ligaments. In the normal state, the proximal phalanges are in a state of dorsiflexion, and the middle ones are in plantar flexion.

As mentioned earlier, the foot forms longitudinal (five) and transverse (two) arches. A special role in the fixation of the transverse arches belongs to the deep transverse metatarsal ligament, which connects the metatarsophalangeal joints. The longitudinal arches are reinforced by a long plantar ligament that runs from the calcaneal tuber to the base of each metatarsal. The ligaments are the "passive" fixators of the arches of the foot.

test questions

1. What types of bone joints do you know?

2. Describe the continuous connections of the bones.

3. Name the main elements of the joint.

4. List the auxiliary elements of the joint.

5. How are joints classified according to shape? Describe the possible movements in them.

6. Give a classification of vertebral joints.

7. List the bends of the spinal column and name the timing of their appearance.

8. What rib connections do you know?

9. Describe the structural features of the temporomandibular joint.

10. List the joints of the upper limb. What movements are implemented in them?

11. What connections does the pelvic bone form?

12. What gender differences do you know of the pelvis?

13. List the dimensions of the female pelvis.

14. Describe the joints of the free lower limb.

On both sides of the sacrum are the pelvic bones. In fact, as physiologists point out to us, each pelvic bone is formed by three bones - the ilium (A), ischium (B) and pubis (C), which in children are connected by cartilage, and in adults form an fusion.

In the pelvic bone, two surfaces are distinguished: external and internal. Outside, the pelvic bone has a characteristic relief called the acetabulum (8). This is a spherical cavity covered with cartilage tissue and serving to connect with the head of the femur.

From the inside there are two articular surfaces, one, also covered with cartilaginous tissue (11), serves for articulation with the sacrum, and the other is part of the pubic fusion (12), with the help of which two pelvic bones are connected in front.

1. Iliac crest

2. Anterior superior iliac spine

3. Anterior inferior iliac spine

4. Posterior superior iliac spine

5. Posterior inferior iliac spine

6. Ischial notch is large

7. Ischial notch small

8. Acetabular cavity

9. Obturator foramen

10. Ischial tubercle

11. Articular surface of the sacrum

12. Articular surface of pubic fusion

1. Last lumbar vertebra (L5)

2. Intervertebral disc L5/S1

3. First sacral vertebra (S1)

4. Sacroiliac joints

5. Iliac crest

6. Anterior superior iliac spine

7. Anterior inferior iliac spine

8. Pubic fusion (pubic symphysis)

9. Obturator foramen

10. Ischial tubercle

11. Hip joint

12. Femoral head

13. Small skewer

14. Large skewer

15. Posterior superior iliac spine

16. Posterior inferior iliac spine

17. Large ischial notch

18. Lesser ischial notch

sacrum and coccyx

The sacrum has the shape of a triangle with its apex down and its base (1) up. The base is the superior surface of the S1 vertebral body. Adjacent to it is the last vertebral disc, and to its apex is the fifth and last lumbar vertebra (L5), forming the lumbosacral joint (L5/S1).

The sacrum consists of five vertebrae fused together, but retaining the structural elements of the described type of vertebra. In addition to the vertebral body, a less developed transverse process (2), arch (3), spinal canal (4), facet joints (5) (found only in the S1 vertebra), and spinous process (6) can be distinguished. The junction of the spinous processes of the sacral vertebrae is called the sacral crest (7). You can also note the presence of intervertebral holes, called sacral foramen (8). Nerve bundles pass through them, innervating the tissues of the perineum and lower extremities.

From the side, a wide articular surface (9) is easily visible, which serves to connect the sacrum with the pelvic bones.