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Catedra Anatomie
Oase
generaliti
Planul cursului
1. Sistemele funcionale ale corpului uman
2. Clasificarea regional i funcional
3. Sistemul locomotor
4. Clasificarea oaselor
5. Detalii anatomice particulare ale oaselor
6. Tipuri de esut osos
7. Histologia esutului osos
8. Vascularizaia oaselor
9. Osteogeneza
10. Creterea osoas
11. Modaliti de rspuns a osului la agresiune
12. Compoziia osului
3. Sistemul locomotor
partea pasiv: sistemele osos i
articular
dur
asigur rezistena i susinerea
topografie local profund i axial
partea activ: sistemul muscular
moale
asigur motilitatea
topografie periosoas,
interosteofascial, subcutanat sau
subseroas
c. Funciile oaselor
Shape - Shape develops over the growth of an individual and the skeletal system
will determine if they are tall or short, wide or narrow and other factors, such as the
size of hands and feet. According to the Student Nutrition (& Body Image) Action
Committee from UCLA, body shape or type is genetically inherited. Three types of
body shapes include ectomorphs (tall and thin), mesomorphs (shorter and
muscular) and endormorphs (apple or pear-shaped).
Support - The skeleton provides support to the body and holds internal organs in
their place.
Movement - The skeletal bones attach to each other by ligaments and further
attach to muscles by tendons.
Protection - The skeleton protects vital organs from damage by encasing them
within hard bones.
Blood Cell Production and Storage - The spongy tissue inside long bones, such
as the femur, or thigh bone, have two types of marrow responsible for blood cell
production.
99% din totalul de Ca2+ din organism
85% din totalul de fosfor
66% din totalul de magneziu
60% din totalul de sodiu
Structura macroscopic
lama (tblia) extern, mai groas,
format din esut osos lamelar
compact, (lamina densa)
lama (tblia) intern, mai subire,
format din esut osos lamelar
compact, (lamina vitreea)
stratul intermediar, de grosime
variabil, alctuit din esut osos
lamelar spongios, (diploe) i are
organizare particular, labirintic, cu
lamele osoase dispuse n jurul unei
reele de canale venoase, bogat
anastomozate care contribuie la
realizarea elasticitii bolii cutiei
craniene.
Os spongios
Structura macroscopic
diafiz (corp) format din:
periostul, structur conjunctiv vascular, care
prezint dou lame:
extern, fibroas, dens, ale crei fibre colagene
se continu cu cele ale capsulelor articulare,
ligamentelor, tendoanelor i fasciilor,
intern, osteogenetic, intens vascularizat, care
ader la planul subiacent prin fibrele colagene
perforante Sharpey i este responsabil de
creterea n grosime a oaselor
corticala, format din esut osos lamelar compact
cavitatea medular, mrginit de esut osos lamelar
ale crui trabecule se anastomozeaz formnd un
labirint n cavitile cruia se gsete mduva osoas
roie.
epifize (extremiti) alctuite din dou zone:
periferic, cortical, format dintr-o lamel subire
de os compact acoperit de cartilaj hialin articular
central, format din esut osos lamelar spongios
ale crui trabecule osoase se ordoneaz pe
direcia liniilor de for a solicitrilor mecanice
Structura macroscopic
metafiz, prezent n toat perioada de
cretere (pn la 25 ani) ntre diafiz i
epifiz i alctuit din dou segmente:
periferic, juxta-epifizar, cartilaginos,
avascular, numit
physis
(plac
epifizar, plac de cretere)
central, juxtadiafizar, vascularizat,
care formeaz metafiza propriu-zis,
unde avanseaz osificarea iniiat n
stratul profund al physis-ului.
Structura macroscopic
formate dintr-un strat cortical periferic, subire, de esut osos lamelar
compact i din esut osos lamelar spongios dispus central, ale crui
trabecule sunt orientate n sensul liniilor de for
Substantia corticalis
Substantia spongiosa
Caput femoris
Trochanter
major
Trochanter minor
Epicondylus
lateralis
Trochlea humeri
Epicondylus
medialis
Facies articularis
talaris
Maleolus
lateralis
Trochanter
major
Trochanter minor
Epicondylus
lateralis
Trochlea humeri
Epicondylus
medialis
Facies articularis
talaris
Maleolus
lateralis
a. Proeminene
linii - puin reliefate, care se definesc dup traiect (dreapt sau curb) i
localizare
linia muchiului solear
liniile nucale
liniile gluteale
vertebr
gt femural
Celulele osteoprogene
Celulele osteoprogenitoare () provin din celula mezenchimala primitiva si dau nastere
condroblastilor si osteoblastilor.
se gasesc la nivelul suprafetelor osoase libere (endost, periost, trabecule, cartilaj
calcifiat, metafiza osului in crestere).
Osteoblastele
Osteoblastele () depun osteoidul
(matricea osoasa)
celule columnare sau epiteloide aflate la
suprafata osului; cand sunt inactive au
aspect scuamos.
celule sintetizatoare de proteine, produc
factori de crestere care actioneaza
autocrin sau paracin, contin fosfataza
acida.
Se leaga de osteoblastele vecine prin
jonctiuni gap, prezinta receptori pentru
hormoni, vitamine, citokine.
Secreta procolagenoza din care rezzulta
colagenoza care lizeaza osteoidul
potentand activitatea osteoclastelor.
Au rol in resorbtia osoasa, resorbind o
portiune mica de osteoid, dupa care
intervin osteocitele.
Osteocitele
() se gasesc in lacune, prezinta
prelungiri care patrund in niste
canalicule si se anastomozeaza cu
prelungirile osteocitelor vecine prin
jonctiuni gap.
Aceste prelungiri formeaza un fel de
retea.
prezinta activitate redusa.
au organite in regresie.
provin
din
osteoblaste,
dar
transformarea osteocitelor inapoi in
osteoblaste este controversata.
Osteocitele
lacune cu i fr osteocite
Osteoclastele
diametru de 150 m, prezinta
cate 50 de nuclei in fiecare
celula, si se gasesc in niste
lacune
speciale,
numite
Howship.
Celulele sunt polarizate: nucleii
se afla la polul opus frontului
osos, iar spre frontul osos
prezinta o margine in perie
(margine dantelata) care in
repaus dispare.
Prezinta numerosi lizozomi
primari, cu diametrul de 0,5-3
m care contin fosfataza acida
rezistenta la tartrat si divarese
enzime proteolitice.
Osteoclastele
Originea osteoclastelor se
afla in precursori comuni cu
monocitele si granulocitele,
in maduva osoasa.
Osteoclastele se obtin prin
fuzionarea
precursorilor,
proces care este dependent
de un factor necunoscut.
Receptorii
pentru
calcitonina inhiba activitatea
osteoclastelor dar ele sunt
sensibile la factorul de
stimulare a osteoclastelor,
secretat de osteoblasti la
actiunea parathormonului.
lacun Howship
8. Vascularizaia oaselor
Osul primeste 10 din debitul cardiac.
asigurat de dou tipuri de vase nutritive:
vasele diafizare, reprezentate de artera nutritiv principal i venele comitante.
Artera nutritiv ptrunde prin foramenul nutritiv, strbate corticala i ajunge n canalul
central unde se mparte n ramuri terminale centrifuge direcionate spre metafize. n
acest traiect artera emite colaterale care formeaz urmtoarele plexuri:
plexul periostic, situat n stratul profund al periostului, alimentat de pediculi
accesori multipli provenii din arterele musculare ale regiunii care, la nivelul
metafizei, formeaz plexul metafizar superficial,
plexul stratului compact, situat n sistemul de canale Volkmann* i Havers
plexul medular, format din arteriole i capilare sinusoide,
plexul metafizar profund care vascularizeaz fa metafizar, osteogenetic, a
plcii cartilaginoase de creter
vasele epifizare, care provin din cele ale capsulei articulare. Arterele epifizare sunt
numeroase, ptrund prin orificii vasculare multiple i mici situate la periferia zonei
epifizare acoperit de cartilaj hialin i formeaz plexuri epifizare care au caracter
segmentar.
Plexurile venoase, abundente, colecteaz n canale venoase cu caracter comitant i,
datorit raporturilor importante cu areolele n care se gsete mduva osoas galben,
au potenial emboligen.
Inervatia are loc prin prelungiri nemielinizate ale nervilor in canalele haversiene.
Sinapsele sunt de tip adrenergic. Astfel sunt inervate: canalul haversian, periostul
si vasele medulare. In maduva se gasesc corpusculi Pacini.
9. Osificarea (osteogeneza)
Modelarea osoasa (organogeneza osoasa) consta in cresterea in lungime,
cresterea in grosime (in diametru) si asigurarea formei conice a epifizelor, prin
procese complexe, coordonate, neintelese inca pe deplin, si care mentin toata
viata forma oaselor.
Prin remodelare osoasa 10% din intreaga masa osoasa a organismului se
inlocuieste in fiecare an la individul tanar.
Remodelarea osoasa consta in inlocuirea osului primar, fibros, cu os secundar,
lamelar organizat in sisteme haversiene (osteoane secundare). Mai intai are loc
depunerea osteoidului si apoi mineralizarea acestuia. Un sistem haversian este
depus in 4-5 saptamani, in primele zile are loc mineralizarea in proportie de
70% iar apoi, in cateva luni, are loc mineralizarea completa. Mineralizarea este
influentata de factori locali sau generali si rezulta osul embrionar.
9. Osificarea (osteogeneza)
early development of the skeletal system begins in the third week after conception with the
formation of the notochord (a rod-like structure along the back of the embryo that later
becomes the spine, spinal cord, and brain), followed in the fourth week by the first signs of
arms and legs. Between the fifth and eighth weeks, the limbs (first the arms, hands, and
fingers, followed by the legs, feet, and toes) begin to extend and take on a definite shape.
By the end of the fifth week, the embryo has doubled in size and has grown a tail-like
structure that becomes the coccyx (lowermost tip of the backbone).
By the seventh week the embryo is about 2 cm (1 in) long and facial features are visible. At
this stage, the 206 bones of the human body are all set down, in surprisingly adult form.
However, the process of osteogenesis (development of bone) has not progressed to the
point where the bones are "bony." Ossification (the process whereby tissue becomes bone)
of most bony nuclei of the long bones and round bones does not complete until after birth.
Dezvoltarea oaselor continu i n timpul vieii adultului pentru vindecarea fracturilor sau
remodelarea osoas impus de diferite moduri de via.
3
4
9.1. Osificarea
intramembranoas
Fontanelele desmocraniului
fontanela anterioar (mare)
situat la intersecia suturilor coronal i sagital,
are form rombic, cm,
se nchide ntre 8-18 luni;
Aspecte particulare
deprimata deshidratare
bombata plns, ipat, hidrocefalie, meningit
ntrziere n nchiderea fontanelei anterioare rahitism
nchidere prematur craniostenoz
Osificarea encondral
Formation of bone collar
Cavitation of the hyaline cartilage
Invasion of internal cavities by the periosteal bud, and spongy bone
formation
Bone Deposition
Occurs where bone is injured or added strength is needed
Requires a diet rich in protein, vitamins C, D, and A, calcium, phosphorus,
magnesium, and manganese
Alkaline phosphatase is essential for mineralization of bone
Sites of new matrix deposition are revealed by the:
Osteoid seam unmineralized band of bone matrix
Calcification front abrupt transition zone between the osteoid seam and the older
mineralized bone
Bone Resorption
Accomplished by osteoclasts (giant, multinucleated cells that arise from the same
stem cells that produce macrophages)
Resorption bays grooves formed by osteoclasts as they break down bone
matrix
The osteoclast membrane seals off the bone that is to be broken down
Resorption involves osteoclast secretion of:
Lysosomal enzymes that digest organic matrix
Hydrochloric acid that converts calcium salts into soluble forms
The broken down products are endocytosed (transcytosed) and released into
the interstitial fluid and blood
Control of Remodeling
Two control loops regulate bone remodeling
Hormonal mechanism maintains calcium homeostasis in the blood (negative
feedback)
Rising blood Ca2+ levels trigger the thyroid to release calcitonin
Calcitonin inhibits bone resorption and stimulates calcium salt deposit in bone
Falling blood Ca2+ levels signal the parathyroid glands to release parathyroid
hormone (PTH)
PTH signals osteoclasts to degrade bone matrix and release Ca2+ into the
blood
Mechanical and gravitational forces acting on the skeleton
Picnodisostoza
oase fragile (fracturi ale celor dou
femururi la 13-14 ani)
brbie mic
fontanele care nu s-au nchis niciodat
degete foarte scurte
prini veri
Inflamaia
Formarea calusului moale
Formarea calusului dur
Remodelarea