Ko taw yog qhov feem ntau ntawm cov tib neeg qis qis. Qhov no txhais tau hais tias nws nyob deb tshaj plaws ntawm qhov nruab nrab ntawm lub cev. Nws yog nyob rau ntawm ko taw uas tag nrho cov load ntawm lub cev hnyav yog suav rau. Yog li ntawd, xws li, thaum xub thawj siab ib muag, ib feem me me ntawm lub cev muaj ib tug heev xav qauv. Cov ntsiab lus hais txog lub cev nqaij daim tawv, cov ntshav muab thiab innervation ntawm ko taw - tom qab hauv kab lus.
Topographic anatomy
Tus qauv ntawm txhua tus qauv ntawm tib neeg lub cev yuav tsum tau txiav txim siab maj mam. Yog li ntawd, ua ntej mus rau lub cev ntawm lub cev ntawm lub innervation ntawm ko taw, nws yog tsim nyog los disassemble nws lwm departments. Cov ko taw, zoo li lwm yam kev tsim cov pob txha hauv tib neeg lub cev, muaj cov hauv qab no:
- pob txha ncej;
- joints;
- striated leeg;
- vascular formations: veins, hlab ntsha, capillaries;
- nrawm.
pob txha ncej
Yuav kom nkag siab tag nrho cov innervation thiab ntshav mov ntawm ko taw, ib tug yuav tsum to taub dab tsi cov pob txha loj nws yog los ntawm.tsim. Tom qab tag nrho, cov hlab ntsha loj thiab cov hlab ntsha feem ntau nyob ntawm cov pob txha thiab muaj cov npe zoo sib xws.
Muaj peb ntu ntawm ko taw:
- tarsus;
- plus;
- phalanges of fingers.
Thaj chaw tarsal nyob ze tshaj plaws, uas yog, ncaj qha hauv qab pob taws pob taws. Txoj kab uas cais ob qho kev tsim no yog tib lub sijhawm ntawm ntug ntawm tib neeg ko taw. Cov kab no khiav raws ntug ntug ntawm lub calcaneus.
Lub tarsus muaj ob kab ntawm cov pob txha me. Thawj kab, uas nyob ze rau ntawm ntug ntawm ko taw, muaj talus thiab calcaneus. Lawv loj dua. Nyob rau hauv kab thib ob, uas yog nyob ze rau lub metatarsus, muaj tsib pob txha ib zaug, muab tso rau hauv ob kab ntxiv. Thawj yog sawv cev los ntawm plaub pob txha: peb cuneiform thiab ib tug scaphoid. Tsuas muaj ib lub cuboid nyob rau kab thib ob.
Qhov metatarsal ntawm ko taw yog nyob nruab nrab ntawm ob chav haujlwm. Nws muaj tsib pob txha ntawm kwv yees li tib cov duab thiab loj. Txhua yam ntawm lawv muaj peb ntu: lub taub hau, lub cev thiab lub hauv paus.
Cov phalanges ntawm cov ntiv tes muaj cov pob txha me tshaj plaws. Txhua phalanx suav nrog peb pob txha. Ib qho tshwj xeeb yog cov ntiv taw loj, uas tsuas muaj ob pob txha. Tus ntiv tes no tseem hu ua thawj zaug thiab txhais los ntawm Roman tus lej I. Tus ntiv tes me me, raws li, yog tus lej V.
Cov leeg nqaij
Lub luag haujlwm tseem ceeb ntawm cov hlab ntsha koom nrog hauv innervation ntawm ko taw yog tsom tshwj xeeb raukis ntawm impulses mus rau cov leeg nqaij. Tom qab tag nrho, nws yog precisely vim tau txais cov hlab ntsha impulses uas cov leeg nqaij contraction yog ua tau, thiab yog li ntawd, tib neeg taug kev.
Muaj tsib pawg leeg ntawm ko taw:
- lateral;
- rov;
- pem hauv ntej;
- txheej txheej;
- dub txheej.
Cov pab pawg sab nraud suav nrog cov leeg nqaij ntev thiab luv. Lawv qhov contraction muab kev abduction, sab nraud rotation (pronation), thiab flexion ntawm ko taw.
Pab pawg pem hauv ntej muaj cov leeg hauv qab no:
- ntev extensor ntawm tus ntiv tes xoo, vim tias nws tuaj yeem txuas ob tus ntiv taw thiab ko taw tag nrho los ntawm kev tsa nws sab saud;
- tibialis anterior, uas muab ko taw txuas ntxiv;
- ntev extensor ntawm cov ntiv tes, vim qhov kev ncua ntawm cov ntiv taw ntawm qhov thib ob mus rau plaub yog ua tau, nrog rau kev tsa lub ntug sab nraud thiab kev nyiag mus rau sab.
Cov leeg nqaij ntawm cov txheej sab saum toj yog koom nrog hauv kev tsim ntawm Achilles leeg, vim qhov kev txav ntawm pob taws pob taws tau muab.
Cov leeg sib sib zog nqus muaj qhov ntev flexor ntawm cov ntiv tes (muab kev sib hloov ntawm ko taw tawm sab nraud thiab flexes nws), ntev flexor ntawm thawj tus ntiv taw (ua haujlwm raws li lub npe), tus ncej tibialis cov leeg (flexes ko taw thiab adducts nws sab hauv).
Ntseeg cov ntshav
Lub innervation ntawm ko taw thiab chav kawm ntawm cov hlab ntsha nyob rau hauv nws yog inextricably txuas, txij li thaum feem ntau cov hlab ntsha, hlab ntsha thiab paj hlwb mus rau hauv ib tug.kev taw qhia. Yog li ntawd, koj yuav tsum paub lub ntsiab hlab ntsha ntawm lub distal extremities. Cov no suav nrog:
- posterior tibial artery;
- anterior tibial artery;
- lateral plantar artery;
- medial plantar artery;
- dorsal artery of ko taw.
Cov hlab ntsha tom qab thiab sab hauv tibial yog qhov txuas ntxiv ntawm cov hlab ntsha popliteal.
Cov hlab ntsha ntawm sab qaum thiab nruab nrab, raws li lawv lub npe qhia, nqa ntshav mus rau qhov chaw cog ntoo ntawm ko taw. Cov hlab ntsha nruab nrab muaj ob ceg: tob thiab qhov tob. Qhov sib sib zog nqus nqa ntshav mus rau cov leeg nqaij uas abducts tus ntiv taw loj thiab flexor digitorum brevis. Cov ceg tawv tawv tsuas muab cov ntshav rau cov leeg ntiv tes xoo xwb.
Lub lateral plantar artery muab ntshav rau feem ntau ntawm cov leeg. Nyob rau theem ntawm lub hauv paus ntawm metatarsus, nws tsim ib qho chaw cog qoob loo, los ntawm ntau cov ceg me me txuas mus rau ntau yam qauv ntawm ko taw. Los ntawm qhov arc no, cov hlab ntsha ntawm cov hlab ntsha ntawm cov hlab ntsha tuaj yeem tawm, uas, dhau los, muab cov ceg hu ua "perforating".
Los ntawm cov hlab ntsha ntawm cov hlab ntsha ntawm cov hlab ntsha ntawm cov phalanges ntawm cov ntiv tes, cov hlab ntsha ntawm cov leeg hlwb tau tsim, txhua tus uas tau muab faib ua ob txoj hlab ntsha.
Cov hlab ntsha ntawm ko taw nqa cov ntshav mus rau qhov chaw dorsal. Raws li qhov tshwm sim, nws tau muab faib ua ob ceg: thawj dorsal metatarsal hlab ntsha thiab cov ceg sib sib zog nqus plantar. Tsis tas li ntawd, tarsal hlab ntsha tawm ntawm nws: lateral thiab medial. Lawv nqa cov ntshav mus rau sab nraud thiab nruab nrab ntawm qhov chaw, feem.ko taw.
Lwm ceg ntawm dorsal ko taw hlab ntsha yog cov hlab ntsha arcuate. Los ntawm nws, los ntawm kev sib piv nrog cov hlab ntsha cog, cov hlab ntsha dorsal metatarsal tawm mus, uas tau muab faib ua cov hlab ntsha digital.
Ntshai ntawm ko taw dorsal
Cia peb pib qhov kev ntsuam xyuas ntawm cov hlab ntsha ntawm lub siab tshaj plaws ntawm lub siab nrog lub innervation ntawm dorsum ntawm ko taw. Tab sis ua ntej koj yuav tsum paub seb dab tsi yog qhov chaw sab nraud ntawm lub xaib no. Cov ntug sab hauv yog txwv los ntawm tuberosity ntawm cov ko taw navicular, nws yooj yim rau palpate, tshwj xeeb tshaj yog nyob rau hauv cov neeg nyias. Nws yog ib qho yooj yim kom pom tuberosity ntawm lub thib tsib metatarsal nyob rau sab ciam teb.
Innervation ntawm daim tawv nqaij ntawm ko taw, uas yog nws cov dorsal seem, yog ua los ntawm cov hlab ntsha hauv qab no:
- saphenous paj;
- medial cutaneous dorsal paj;
- nruab nrab cutaneous dorsal paj;
- lateral dorsal cutaneous paj.
thawj peb yog ceg ntawm cov hlab ntsha peroneal, cov ceg kawg ntawm tibial paj. Los ntawm cov hlab ntsha saphenous impulses mus rau nruab nrab ntawm lub pob taws thiab qhov nruab nrab ntawm tarsus. Hauv qee tus neeg, cov hlab ntsha no ntev dua thiab xaus rau ntawm lub hauv paus ntawm tus ntiv taw thawj.
Cov hlab ntsha nruab nrab ntawm dorsalis cutaneous hlab ntsha khiav raws thaj tsam nruab nrab ntawm ko taw thiab faib raws nws txoj kev mus rau hauv cov ceg uas mus rau ntawm daim tawv nqaij ntawm dorsum ntawm tus ntiv tes xoo thiab ib nrab mus rau cov ntiv taw thib ob thiab thib peb.
Cov paj hlwb dorsalis cutaneous paj hlwb faib rau hauv cov ceg digital uas txuas mus rau ntawm qhov ntsej muag ntawm peb thiab plaub, nrog rau cov ntiv taw thib plaub thiab thib tsib.
Lateral dorsal cutaneous pajnqa impulse mus rau sab nraud ntawm tus ntiv tes thib tsib.
Qhov tshwj xeeb ntawm innervation ntawm tib neeg ko taw, uas yog nws lub nraub qaum, yog nws qhov sib txawv tseem ceeb. Piv txwv li, qee tus neeg tsis muaj cov hlab ntsha ntawm lub dorsal cutaneous.
Ntshai ntawm ko taw
Innervation ntawm cov leeg ntawm ko taw ntawm qhov chaw cog qoob loo yog muab los ntawm cov paj hlwb: medial thiab lateral. Ob leeg ntawm cov hlab ntsha no tshwm sim los ntawm tibial paj hlwb.
Cov hlab ntsha nruab nrab khiav raws cov kwj dej nruab nrab nruab nrab thiab tsim cov arc me me. Qhov pib ntawm qhov arc sib raug rau lub hauv paus ntawm thawj metatarsal, thiab nws qhov kawg mus rau nruab nrab ntawm plaub metatarsal. Raws li cov paj hlwb nruab nrab, cov ceg ntoo calcaneal tawm ntawm nws. Lawv muab kev sib kis ntawm cov hlab ntsha impulses mus rau nruab nrab plantar ib feem ntawm pob taws.
Cov paj hlwb nruab nrab nqa cov impulses mus rau cov leeg uas rub tus ntiv tes xoo, nrog rau cov ntiv tes luv luv. Interestingly, nyob rau hauv cov me nyuam yaus, ob peb ceg mus rau lub superficial flexor ib zaug. Tom qab ntawd cov ceg tawm ntawm cov hlab ntsha medial plantar, uas innervate ntawm qhov chaw sib ntsib los ntawm thawj mus rau plaub ntiv tes. Cov ceg no yog hu ua thawj, thib ob thiab thib peb cov kab mob digital plantar qab haus huv. Lub innervation ntawm cov ntiv taw ntawm ib sab ntawm ko taw yog nqa tawm mus rau ntau dua precisely vim cov ceg no.
Cov hlab ntsha sab nraud yog nyob nruab nrab ntawm cov leeg nqaij square thiab luv flexor ntawm cov ntiv tes. Nws kuj muaj ob ceg: sab saum toj thiab tob. Lawv tawm ntawm cov hlab ntsha ntawm lub hauv paus ntawm cov pob txha metatarsal. Cov paj hlwb superficial muab tawm ob peb ceg: digitalcov paj hlwb ntawm sab ntug ntawm tus ntiv tes thib tsib, cov paj hlwb uas muaj ntau. Lawv innervate daim tawv nqaij ntawm qhov chaw ntawm tus ntiv tes thib plaub thiab thib tsib sib ntsib.
YNeb puas yog dab tsi?
Neuropathy ntawm qis extremities tsis yog ib qho kev kuaj mob, tab sis lub tswv yim sib sau ua ke rau cov kab mob uas lub paj hlwb puas tsuaj. Ua ntej ntawm tag nrho cov, lub distal qhov chaw ntawm lub caj dab raug kev txom nyem - lub innervation ntawm lub sab ceg thiab ko taw.
Qhov ua rau ntawm qhov teeb meem no muaj ntau heev, thiab cov tsos mob ntawm kev kho mob kuj sib txawv. Neuropathies yog tshwm sim los ntawm kev tsis sib haum xeeb ntawm kev txav mus los, kev hnov sphere, tawv nqaij thiab nqaij trophism.
Tej zaum yuav tsim muaj mononeuropathy (kev puas tsuaj rau ib leeg) lossis polyneuropathy (ntau qhov kev puas tsuaj rau ntau lub paj hlwb ib zaug).
Ua rau neuropathy
Muaj ntau yam uas ua rau muaj kev ua txhaum ntawm kev ua txhaum ntawm ko taw. Cov tseem ceeb muaj npe hauv qab no:
- kev quav cawv;
- siv tshuaj;
- ncua sij hawm raug tshuaj lom, tshwj xeeb tshaj yog ntsev ntawm cov hlau hnyav: txhuas, mercury, arsenic;
- kab mob endocrinological: ntshav qab zib mellitus, thyroid pathology;
- mob siab mob siab;
- ncua sijhawm vitamin thiab cov khoom noj tsis txaus;
- cov kev mob tshwm sim ntawm qee cov tshuaj: Amiodarone, Isoniazid, cytostatics;
- kab mob hnyav: kab mob diphtheria, kab mob HIV, kab mob sib kismumps;
- kab mob autoimmune uas cov tshuaj tiv thaiv tsim tawm tawm tsam lub cev cov hlwb: kab mob lupus erythematosus, dermatomyositis, mob caj dab rheumatoid;
- genetic predisposition.
Symptoms of neuropathy
kho mob tshwm sim ntawm neuropathy nyob ntawm seb qhov kev ua haujlwm ntawm lub paj hlwb puas: kev hnov, lub cev muaj zog lossis trophic (kev noj haus). Nws yog noteworthy tias feem ntau distal seem yog thawj tus raug kev txom nyem. Yog li ntawd, innervation ntawm cov ntiv taw yuav raug kev txom nyem nyob rau hauv thawj qhov chaw. Nrog rau kev txhim kho ntxiv ntawm tus kab mob, cov tsos mob yuav kis ntau dua.
Sensory disorders manifest as follows:
- Mob rhiab ntawm qhov rub lossis mob qhov xwm txheej uas sib haum rau thaj tsam ntawm qhov chaw ntawm lub paj hlwb cuam tshuam.
- Lub npe hu ua paresthesia - qhov kev xav ntawm kev nkag mus ntawm daim tawv nqaij, nruj, twisting ko taw. Qee lub sij hawm cov kev xav no tsis zoo siab uas cov neeg mob xav tau mob ceg rau lawv.
- Kev ua txhaum ntawm kev nkag siab. Ntxiv mus, muaj ib txhij poob ntawm tag nrho cov hom ntawm rhiab heev nyob rau hauv cheeb tsam ntawm innervation ntawm cov hlab ntsha cuam tshuam: mob, kub, tactile.
- Qee lub sij hawm hnov qab ataxia txhim kho. Qhov no yog ib qho mob uas ib tug neeg cuam tshuam los ntawm kev tsis khov thaum taug kev vim nws tsis hnov qhov chaw ntawm nws txhais taw. Qhov no yog vim kev ua txhaum ntawm kev nkag siab tob ntawm kev taw qhia ntawm lub cev hauv qhov chaw.
Kev tsis sib haum xeeb yog qhov tshwm sim hauv qab no:
- tshee thiab spasms hauvcov nqaij uas nws innervation yog impaired;
- nrog cov txheej txheem mus sij hawm ntev, cov leeg tsis muaj zog;
- flaccid paralysis - tus neeg mob poob lub peev xwm txav ko taw;
- txo qis hauv kev xav, uas tau kuaj pom thaum kuaj mob hlwb.
Vim yog ua txhaum ntawm cov leeg nqaij innervation, deformity ntawm ko taw tsim vim cov leeg nqaij atrophy. Atrophy tshwm sim ob qho tib si vim tsis ua haujlwm ntawm cov leeg nqaij thaum lub sijhawm tuag tes tuag taw, thiab vim kev puas tsuaj rau lub trophic kev ua haujlwm ntawm cov hlab ntsha sib thooj.
Txoj kev cuam tshuam ntawm kev tsis txaus ntseeg innervation
Kev mob ntev ntev ntawm cov ntiv taw innervation thiab lwm qhov ntawm cov qis qis tuaj yeem ua rau muaj qhov tshwm sim tsis zoo. Kev kho cov hlab ntsha ua haujlwm yog ib qho nyuaj heev thiab tsis yog ib txwm ua tau, tshwj xeeb tshaj yog nrog kev kho tsis raws sijhawm thiab tsis raug.
Atrophic hloov ntawm ko taw ua ntej ua rau tawv nqaij qhuav. Tom qab ntawd cov kab mob thiab kab nrib pleb tshwm, uas kho tau nyuaj heev. Yog tias koj tsis ua raws li cov cai ntawm kev nyiam huv ntawm tus kheej, kev kis kab mob tuaj yeem mus txog qhov ntawd.
Nrog rau lub sijhawm tsis ua haujlwm ntawm ko taw, kev kho dua tshiab ntawm nws txoj haujlwm nyuaj. Yog li, tuag tes tuag taw ntawm qis qis tuaj yeem nyob mus txog thaum kawg ntawm lub neej. Yog li ntawd, hauv kev kho mob neuropathy, kev saib xyuas tsis yog tsuas yog rau cov kev kho mob ntawm kev kho mob, tab sis kuj rau kev kho lub cev.
Mob thiab tsis kaj siab paresthesias tuaj yeem ua rau muaj teeb meem puas siab puas ntsws hauv tus neeg mob. Yog li ntawd, qee zaum yuav tsum tau noj tshuaj tiv thaiv kev nyuaj siab.
Zoo kawg
Taw yog ib feem tseem ceeb ntawm tib neeg lub cev. Yog li ntawd, tsis yog tsuas yog ib tug kws kho mob, tab sis kuj yog ib tug layman yuav tsum paub lub hauv paus ntsiab lus ntawm lub cev ntawm tus taw, cov yam ntxwv ntawm nws cov ntshav mov thiab innervation. Nws kuj tseem yuav tsum muaj lub tswv yim ntawm qhov neuropathy yog dab tsi thiab nws tshwm sim nws tus kheej li cas txhawm rau nrhiav kev pab kho mob hauv lub sijhawm.
