klinikuri

anatomia
(II nawili)
 zurgis midamo

z u r g i s m i d a m o

zurgi aris torsis ukana midamo, xerxemlis sveti RerZuli ConCxis

romelic moTavsebulia kisersa da mTavari nawilia da qmnis kisris da
dunduloebs Soris. igi erTmaneTTan zurgis ConCxs. mozrdilis xerxemlis
akavSirebs Tavs, kisersa da wels. svetis sigrZe 72-75 sm-ia. sigrZis 1/4 (by
zurgis SemadgenlobaSi Sedis: the IV discs) modis malTaSoris diskebze,
1. kani da kanqveSa qsovili; romlebic erTdroulad
2. kunTebi: zedapiruli da Rrma erTmaneTisagan gamoyofs da
kunTebi. zedapirulad ganlagebuli erTmaneTTan akavSirebs malebs.
kunTebiT xorcieldeba kidurebis xerxemlis svetis funqciebi:
moZraoba da wonasworobis SenarCuneba. 1. icavs zurgis tvins da
Rrma kunTebi (e.w. “zurgis namdvili zurgis tvinis nervebs;
kunTebi”) ganageben uSualod RerZuli 2. warmoadgens sxeulis
ConCxis moZraobas da wonasworobas; (simZimis?) sayrdens menjis zemoT;
3. xerxemlis sveti: malebi, 3. qmnis sxeulis mtkice da
malTaSua diskebi da maTTan moqnil RerZs; mas ukavSirdeba da
dakavSirebuli iogebi; masze moZraobs Tavi;
4. neknebi (gulmkerdis midamoSi) 4. mniSvnelovan rols
kerZod – maTi kuTxeebis medialurad TamaSobs sxeulis wonasworobisa
ganlagebuli nawilebi; SenarCunebasa da moZraobaSi
5. zurgis tvini da misi garsebi; (gadaadgileba sivrceSi).
6. sxvadasxva segmenturi nervi da
ZarRvi.

xerxemali

mozrdili adamianis xerxemali erTmaneTs da qmnian erT, mTlian

Sedgeba 24 malisa – vertebra, gavis Zvals; kudusuni Sedgeba 4-5 malisagan.
Zvlisa _ os sacrum da kudusunisagan _ xerxemlis Tavisufali malebi
os coccygis. iyofa sam jgufad: kisris, gulmkerdis
aRniSnuli 24 mala warmoadgens da welis malebad.
gancalkevebul, Tavisufal Zvlebs, amgvarad, mTel xerxemalSi
gava da kudusuni ki calke SeiZleba gavarCioT :
Zvlebisagan Sedgebian mxolod 1. kisris malebi _ vertebrae cervicales (7)
bavSvobis da yrmobis xanaSi; asakovan 2. gulmkerdis malebi _ vertebrae
xanaSi ki gavis malebi uerTdebian thoracicae (12)

klinikuri anatomia 65
 zurgis midamo

3. welis malebi _ vertebrae lumbales (5) firfitisagav: wina firfita

4. gavis malebi _ vertebrae sacrales (5) warmoadgens ganuviTarebel nekns da
5. kudusunis malebi _ vertebrae cocygeae amitom ewodeba neknovani morCi _
(4-5) processus costarius; ukana firfita ki
namdvil ganiv morCs warmoadgebs da
gulmkerdis yoveli mala neknovan morCTan SeerTebuli, ufro
warmoadgens xerxemlis tipur segments rTul saxels atarebs _ nekn-ganivi
da, amitom, saerTod malebis morCi _ processus costotransversarius.
SeswavlisaTvis saWiroa jer wina da ukana firfitebi
gulmkerdis malis nawilebis garCeva, SeerTebuli arian TavianTi gareTa
gulmkerdis malaSi, rogorc tipur boloebiT, ris gamo maT Soris rCeba
warmonaqmnSi, arCeven Semdeg nawilebs: xvreli, romelsac ganivi xvreli _
1. malis sxeuli _ corpus vertebrae foremen transversarium – ewodeba.
2. malis rkali _ arcus vertebrae amrigad, Cven vxvdebiT kisris
3. wvetiani morCi _ processus spinosus malebSi axal anatomiur warmonaqmns,
4. zeviTa sasaxsre morCi _ processus romelsac moklebulia zemoaRniSnuli
tipuri gulmkerdis mala.
articularis superior (ori)
kisris malebis Semdgomi
5. qveviTa sasaxsre morCi _
dakvirvebiTi Seswavla gviCvenebs, rom
processus artcularis inferior (ori)
kisris sxvadasxva malebs Soris sxva
6. ganivi morCi _ processus transverses
TvalsaCino gansxvavebac arsebobs.
(ori)
kisris pirveli mala, e.w. atlasi _
7. malis xvreli _ foramen vertebrae
atlas, yvelaze metad ganirCeva tipuri
8. malis zeviTa da qveviTa
malisagan. mas ara aqvs sxeuli, arc
naWdevebi _ incisura vertebralis superior et
wvetiani morCi, xolo sasaxsre
inferior (wyvil-wyvili). morCebi masze sustadaa gamoxatuli.
tipuri malis aRniSnuli niSnebi sxeulis magier mas aqvs wina rkali
moipoveba agreTve yvela danarCen
_arcus anterior; mis gverdebze
malaSi, zogierTi cvlilebebiT. es
mdebareoben momsxvilo gverdiTi
movlena damokidebulia im meqanikuri
masebi _ massa laterals. rkalis wina
pirobebisagan, romelTa zegavlenis
zedapirze aris wina xorkli _
qveS viTardeba da moqmedebs
tuberculum anterius, ukana zedapirze ki _
xerxemlis yvela midamos mala.
patara sasaxsre foso, romelsac
kisris malebi saerTod patarebia;
kbilis foso _ fovea dentis – ewodeba. mas
malis xvrelis forma samkuTxovania;
exeba meore malis kbili. atlasis
misi sxeulis simaRle sxva midamoebis
gverdiT masebze zemodan da qvemodan
malebTan SedarebiT ufro mcirea da
moTavsebulia sasaxsre zedapirebi,
mis horizontalur nakveTs elifsuri
romlebiTac atlasi, erTi mxriv,
moyvaniloba aqvs; wvetiani morCebi
qalas kefis Zvals enawevreba da meore
ukan arin gaSverili da maT TiTqmis
mxriv _ kisris meore malas. atlasis
horizontaluri mimarTuleba aqvT.
ganivi morCi Sedgeba ori Zvlovani ukana rkals _ arcus posterior – wvetiani

klinikuri anatomia 66
 zurgis midamo

morCis magier aqvs patara ukana tuberculum caroticum: masze SeiZleba

xorkli _ tuberculum posterius. atlasis saZile arteriis mibjena sisxlis
rkalis zeviTa zedapirze, gverdiTi denis dros.
masebis ukan, Zevs wvrili Rari kisris me-7 malas yvelaze grZeli
xerxemlis arteriisaTvis _ sulcus da gauyofeli momrgvali xorkliani
arteriae vertebralis. wvetiani morCi aqvs. es xorkli
atlasis xvreli sakmaod didia, advilad moipoveba kanis qveS da
masSi moTavsebulia meore malis amitom am malas warzidul malas _
kbili da zurgis tvini. aqve unda vertebra prominens – uwodeben.
aRiniSnos, rom am ori organos Sua, gulmkerdis malebis sxeuli
e.i. kbilsa da zurgis tvins Soris, TandaTan matulobs Tavisi sididiT da
mdebareobs mkvrivi atlasis ganivi sifarToviT, dawyebuli 1-dan me-12
iogi _ ligamentum transversum atlantis. es malamde. gulmkerdis malis xvreli
iogi gadaWimulia atlasis gverdiT momrgvalo moyvanilobisaa, wvetiani
masebs Soris. morCebi mimarTulia qveviT da
kisris meore malas ewodeba aqsisi kramitiseburad erTimeores faraven.
_ axis. mas is gansakuTrebuli niSani sasaxsre morCebi kargadaa gamoxatuli.
aqvs, rom sxeulis zeviTa zedapirze zeviTa sasaxsre morCebis sasaxsre
arsebobs kargad ganviTarebuli kbili zedapirebi mimarTulia ukan, qvemosi
_ dens, romlis garSemoc atlasi ki _ win. am malebis sxeulis
trialebs. es morCi cilindruli gverdebze moTavsebulia mTliani
formisaa, momrgvalo wvetiT davdeba sasaxsre zedapirebi (I, XI, XII) an
da winidan aqvs wina sasaxsre sasaxsre zedapirebis naxevari (II-dan
zedapiri _ facies articularis anterior, X-dis), romlebsac neknebis Tavebi
romliTac igi atlasis wina rkals enawevreba: neknis zeda foso _ fovea
enawevreba. costalis superior, neknis qveda foso _ fovea
rogorc ganviTarebis istoria costalis inferior. garda amisa, sasaxsre
gviCvenebs, atlasis sxeuli oTx zedapirebi moipoveba kidev malebis
nawilad iyofa. aqedan ori nawili ganiv morCebze _ fovea costalis transversalis,
ixarjeba atlasisi gverdiTi masebis romlebsac neknebis xorklebi
Sesadgenad, erTi nawili atlasis wina enawevreba. gulmkerdis XI da XII
rkalisTvis, xolo meoTxe nawili malebis ganivi morCebi moklebuli
gamoeyofa atlass, Seizrdeba aqsisis arian sasaxsre xedapirebs.
sxeulTan da, amrigad, Seqmnis mis amrigad, gulmkerdis zeviTa aTi
kbils. nekni saTanado malebTan ori
kisris me-2, me-3 da me-4 malebis wetiliTaa SeerTebuli: neknis TaviT _
wvetiani morCebi boloebSo oradaa sxeulTan da neknis xorkliT _ ganiv
gayofili. morCTan. ukanaskneli ori nekni
kisris me-6 malis neknovani morCis SeerTebulia saTanado malis
bolo kargadaa ganviTarebuli. igi sxeulTan mxolod erTi wertiliT _
cnobilia rogorc saZile xorkli _ neknis TaviT.

klinikuri anatomia 67
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welis malebi SedarebiT ufro aqvs e.w. ganivi xvreli _ foramen

msxvilia. maTi sxeulis horizontalur transversarium, romelSiac gaivlis
kveTs lobios moyvaniloba aqvs. xerxemlis arteria da vena (meSvide
malebis xvrelis forma samkuTxovania. malis gamoklebiT, romelSiac
sqeli da ganieri wvetiani morCi mxolod vena gadis).
pirdapir ukanaa mimarTuli. sasaxsre gulmkerdis midamos malebs
morCebi kargad aris gamoxatuli; maTi ekuTvnis yvela is mala, romelsac
sasaxsre zedapirebi dganan sagitalur sxeulis gverdebze darTuli aqvs
sibrtyeze, ganivi morCebis mwvervalebi sasaxsre fosoebi neknebTan
ukanaa mimarTuli. welis malebs kidev SesaerTeblad.
ori morCi aqvT: dvrilisebri morCi _ welis midamos malebi advilad
processus mamillaris, romelic zeviTa ganirCeva e.w. dadebiTi da uaryofiTi
sasaxsre morCis lateralur niSnebiT. uaryofiTi niSnebi: welis
zedapirzea moTavsebuli, da malebs ara aqvs ganivi xvrelebi da
damatebiTi morCi _ processus accessorius, arc sanekne zedapirebi. dadebiTi
romelic ekals gavs da moTavsebulia niSnebi: welis malebs 2 wyvili axali
ganivi morCis Zirze, ukanidan. morCi aqvT _ dvrilisebri da
amgvarad. imis Seucdomlad damatebiTi.
gamosarkvevad, Tu romel midamos
ekuTvnis esa Tu is mala, saWiroa
vixelmZRvaneloT Semdegi umTavresi
niSnebiT:
kisris midamos malebs ekuTvnis
yvela is mala, romelsac ganiv morCze

gavis Zvali _ os sacrumG

gavis Zvali Sedgeba 5 gavis dorsalis. mTlian ZvalSi sami nawili

malisagan _ vertebrae sacrales, romlebic ganirCeva : Sua _kenti da ori
yrmobis xanaSi (15-16 weli) uerTdebian gverdiTi _ partes laterals, romlebic
erTimeores da qmnian erT mTlian Sedgebian Sezrdili ganieri
Zvals. morCebisagan da ganuviTarebeli
gavis Zvali moxrili, samkuTxovani neknebisagan.
moyvanilobisaa, romlis ganieri wina zedapiri Sedrekili da
nawili _ fuZe _basis sacri zeviTaa SedarebiT sadaa, aqvs oTxi wyvili
miqceuli, mwvervali _ apex sacri – qveviT gavis menjismxrivi xvreli _ foramina
da win. gavis Zvalze or zedapirs sacralis pelvina, romlebSiac gavis Zvlis
arCeven : winas, anu menjisas _ facies arxidan zurgis tvinis nervebi
pelvina da ukanas, anu zurgisas _ facies gamodis. radgan gavis Zvali Seiqmneba

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5 malis SeerTebiT, amitom mis wina arxi Seiqmneba gavis malTa xvrelebis
edapirze aRniSnul xvrelebs Soris, SeerTebiT da Tavdeba gavis SesavaliT
naTlad Cans ganivi xazebi _ linea _ hiatus sacralis, romlis gverdebzec
transversae, romelTa mimarTulebiTac aRrniSneba e.w. gavis rqebi _ cornua
warmoebda malebis sxeulebis Sezrda. sacralia.
gavis Zvlis ukana zedapiri gavis arxi warmoadgens xerxemlis
xorkliania, gamodrekili da aqvs arxis gagrZelebas.
oTxi wyvili gavis zurgismxrivi gavis Zvlis gverdiT nawilebze
xvreli _ foramina sacralia dorsalia. am garedan Cans yurisebri zedapirebi _
zedapirze arCeven Zvlovan qedebs, facies auriculars – menjis ZvlebTan
malebis sxvadasxva morCebis SeerTebis SesaerTeblad. gavis qvemo bolo
Sedegs warmoadgenen: Seviwroebulia, aqvs sasaxsre
1. gavis Sua qedi _ crita sacralis zedapiri, romliTac igi uerTdeba
mediana (wvetiani morCebis SeerTebis kudusunis Zvals.
Sedegia). gavis Zvali iRebs monawileobas
2. gavis Suamdebare qedi _ crita menjis kedlis SeqmnaSi.
sacralis intermedia (wyvili, sasaxsre gavis Zvali garkveul sqesobriv
morCebis SeerTebis Sedegia). gansxvavebas gviCvenebs; qals es Zvali
3. gavis lateraluri qedi _ crita TvalsaCinod mokle, ganieri da
sacralis lateralis (wyvili, ganivi morCebis naklebad moxrili aqvs, mamakacs ki
_grZeli, viwro da mkveTrad
SeerTebis Sedegia).
modrekili.
gavis Zvlis fuZes uknidan
gamoxatuli aqvs gavis pirveli malis
zemo sasaxsre morCi _ processus
articularis superior, saidanac SeiZleba
gavis arxis naxva _ canalis sacralis; es

kudusunis Zvali _ os coccygis

adamianis kudusuni 4-5 ukanaskneli sustad aqvs gamoxatuli

ganuviTarebeli malisagan Sedgeba, agreTve me-2 malas., xolo rac Seexeba
romelic gugulis niskarts waagavs. me-3 da me-4 malas, maT aqvT
kudusunis malebs Soris mxolod momrgvalo forma da xSirad
pirvel malas SerCa ganuviTarebeli Sezrdilni arian.
sasaxsre morCebi, e.w. kudusunis rqebi kudusuni cxovelTa kuds
_ cornua coccygea da ganivi morCebis Seesabameba.
naSTebi gverdiTi wanazardebis saxiT.

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xerxemali mTlianad

xerxemali mTlianad warmoadgens yvelaze ganieri naprali

malTa svets, romelSic malebi aris kisris malasa da kefis Zvals
erTimeorezea dawyobili ise, rom Soris, danarCeni napralebi kisris
yoveli ori mezobeli mala Tavisi malebs Soris ufro viwroada
sxeuliT d sasaxsre morCebiT gulmkerdis malebis midamoSi TiTqmis
erTimeores exeba. aseT pirobebSi ar arsebobs. welis midmoSimalTaSua
malebis xvrelebi erTdebian da qmnian napralebi kvlav farTovdeba da
saerTo xerxemlis arxs _canalis yvelaze ganieria welis me-5 malasa da
vertebralis, romelic iwyeba kisris gavis Zvals Soris.
pirveli malidan da Tavdeba gavis am napralebis topografiis
SesavliT _hiatus sacralis. codna metad mniSvnelovania
naWdevebi, romlebic Cven samkurnalo nivTierebaTa Seyvanis
SeviswavleT malebis rkalebze, dros xerxemlis arxSi zurgis tvinis
mTlian xerxemalze sazRvraven anesTeziisaTvis da Tavzurgtvinis
malTaSua xvrelebs _ foramina siTxis aRebis dros.
intervertebralia. amisTana xvreli 23 xerxemali sagitalur
wyvilia da maTi saSualebiT sibrtyeze oTxjer idrikeba. kisris
xerxemlis arxidan zurgis tvinis pirveli nadreki naklebadaa
nervebi gamodian. gamoxatuli; misi gamidrekiloba winaa
malTa sxeulis odenoba mimarTuli da, amasTan, yvelaze Zlier
zevidan qveviT, gavis Zvlamde izrdeba, gamoweulia meoTxe da mexuTe mala.
aqedan ki xelaxla iwyeba misi gulmkerdis meore nadreki Tavisi
Semcireba da kudusunze TiTqmis gmodrekilobiT ukanaa mimarTuli; aq
uCinari xdeba. Tu xerxemals ukana yvelaze metad daSorebul malebs
mxridan SevxedavT, davinaxavT, rom ekuTvnian merve da mecxre mala; mesame
kisris midamos wvetian morCebs aqvT nadreki welisaa _ misi gamodrekiloba
odnav daxrili mimarTuleba. isev winaa mimarTuli, yvelaze metad
gulmkerdis midamoSi es morCebi gamodrekilia mesame mala; meoTxe
Zlier daxrili da erTimeores nadreki gavis Zvlisaa, sedrekilia
savsebiT faravs. welis midamoSi ukan ise, rom yvelaze daSorebuli
wvetiani morCebi horizontalur mesame malaa.
mimarTulebas iReben, xolo welis welis me-5 malasa dad avis
qveviTa ori malis wvetiani morCi Zvlis sazRvarze aRiniSneba mkveTrad
odnav zeviTaa aweuli. mezobeli winwamoweuli kuTxe, romelsac koncxs
malebis rkalebs Soris aris _ promontorium – uwodeben.
napralebi. es napralebi amovsebulia xerxemlis yvela
rkalebs Soris moTavsebuli e.w. aRniSnuli nadreki warmoadgens
yviTeli iogebiT. normalur movlenas, amitom isini

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cnobili arian rogorc Zlierdeba, wolis dros ki xerxemali

fiziologiuri nadrekebi. swordeba ise, rom misi sigrZe
fiziologiur nadreks, matulobs 2sm-mde.
Tavisi rkaliT win mimarTuls, axalSobilebs yvela aRniSnuli
uwodeben fiziologiur lordozs _ nadreki naklebad aqvT gamoxatuli;
lordosis. mxolod ConCxis TandaTanobiTi
fiziologiuri nadreki, romlis ganviTarebis mixedviT, kunTebis
rkali ukanaa mimarTuli, cnobilia muSaobis gavleniT da simZimis Zalis
rogorc fizioligiuri kifozi _ moqmedebiT xerxemali iRebs im
kyphosis. moxazulobas, romelic zemoT iyo
garda aRniSnuli nadrekebisa, aRniSnuli da romlis meoxebiTac
arCeven kidev gverdiT nadreks adamianis xerxemali mkveTrad
_skoliozs _ scoliosis. nadreki gansxvavdeba cxovelTa xerxemlisagan.
mimarTuli, Cveulebriv, marjvniv, anda, xerxemali sxeulisaTvis moqnil da
iSviaTad, marcxniv (caciebSi). am dros mtkice Zval-xrtilovan RerZs
wvetiani morCebi sxvadasxvanairad warmoadgens; igi iRebs monawileobas
aris daxrili qveviT, ris gamoc maT gulmkerdis, muclis da menjis
mier Seqmnili xazi ar aris swori. Rruebis ukana kedlebis SeqmnaSi.
samxedro dgomis dros wina da amasTan, xerxemlis arxi warmoadgens
ukana nadrekebi kargadaa gamoxatuli. saucxoo damcvel Rrus zurgis
am SemTxvevaSi xerxemlis xazi, tvinisa da misi nervuli
gatarebuli atlasis wina xorklidan, morCebisaTvis.
gaivlis me-6 malis, gulmkerdis me-9 mamakacis xerxemlis sigrZe udris
da gavis me-3 malis sxeulze da, saSualod 73 sm, qalis _ 69 sm.
bolos, kudusunis mwvervalze. axalSobilis _ 20 sm.
modunebuli dgomis dros kisrisa Rrma moxucebulobis dros
da welis lordozi swordeba, aRiniSneba xerxemlis sigrZis
gulmkerdis kifozi ki Zlierdeba. Semokleba 7 sm-mde.
ukanaskneli gansakuTrebiT xerxemlis sigrZe Seadgens sxeulis
gamoixateba Rrma moxucebulobaSi. sigrZis 2/5-s.
simZimiT datvirTvis dros nadreki

neknebi _ costae

miuxedavad imisa, rom neknebi arian xerxemlis svetTan da zurgis

miekuTvnebian gulmkerdis ConCxs, kunTebTan.
mainc mizanSewonilad CavTvaleT, maTi adamians 12 wyvili nekni
am TavSi Seswavla, radgan neknebis aqvs. tipuri nekni (6 an 7) Sedgeba ori
nawilebi zurgis midamoSic nawilisagan: umetesi ukana nawili
mdebareoben da isini dakavSirebuli Zvlovania _ os costale da mcire wina

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nawili xrtilovani _ cartilgo costalis. neknebs ki, meoredan meaTemde, sasaxsre

neknis ukana boloSi arCeven neknis zedapirebi gayofiliaqvT
Tavs _ caput costae – gamsxvilebuli, zemoaRniSnuli qediT. amrigad,
momrgvalebuli. darTuli sasaxsre aRniSnuli neknebi erTsa da imave
zedapiriT facies articularis capitis costae, dros or mezobel malas uerTdebian.
romelic an mTliania, an oradaa 1-li mekni TaviT uerTdeba
gayofili e.w. neknis Tavis qediT _ pirveli malis sxeuls, borcviT ki _
crista capitis costae, neknis Tavi malebis mis ganiv morCs.
sxeuls enawevreba. me-2 da me-10 neknebi TaviT
neknis Tavs moyveba Seviwroebuli uerTdebian ori mezobeli malis
nawili _neknis yeli _ collum costae, mis sxeulebs. xolo borcvebiT _
Sesatyvisi malis ganiv morCs.
Semdeg neknis borcvi _ tuberculum costae,
me-11 da me-12 nekns ara aqvT
romelsac ukana mxareze sasaxsre
kuTxeebi, borcvebi, Rarebi da, amasTan,
zedapiri facies articularis tuberculi costae
ar enawevrebian malebis ganiv morCebs
aqvs saTanado malis ganiv morCTan
da SeerTebuli arian mxolod
SesaerTeblad; xorklis ukan
Sesabamis malis sxeulTan.
mdebareobs neknis kuTxe _ angulus costae.
pirveli neknis zeviTa zedapirze,
am adgilas nekni mkveTrad uxvevs win
samkerde bolos siaxloviT,
da gadadis sxeulSi _ corpus costae.
mdebareobs xorkliani SemaRleba _
pirvel da meore neknze neknis
wina kibisebri kunTis xorkli _
kuTxe da neknis borcvi xvdeba
tuberculum m. scaleni anterior; am xorklis
erTmaneTs. Semdeg, qveviTa neknebSi
win moTavsebulia brtyeli laviwqveSa
borcvi da kuTxe TandaTan Sordebian
venis Rari _ sulcus venae subclaviae, ukan
erTimeores. meTerTmete nekns neknis
ki _ laviwqveSa arteries Rari _ sulcus
kuTxe odnav emCneva da meTormeteze ki
sruliad ar aRiniSneba. arteriae subclaviae.
neknis sxeulze arCeven neknebis sigrZe (I-VIII) TandaTan
gareTa da SigniTa zedapirebs da zemo matulobs, Semdeg ki (meTormetemde)
da qvemo kideebs, xolo pirvel neknze swrafad mcirdeba, pirveli nekni
_ zemo da qvemo zedapirebs da gareTa yvelaze ganieria, me-7 da me-8 _
da SigniTa kideebs. yvelaze grZeli, me-12 ki yvelaze
neknis SigniTa zedapirze, viwro da mokle.
qvemo kidis gaswvriv, neknis kuTxidan yoveli nekni modrekilia Tavisi
moyolebuli, miimarTeba neknis Rari _ radiusis, sibrTyisa da sigrZis RerZis
sulcus costae _ neknTaSua mimarT. modrekilobis umcirsi
radiusi aqvs pirvel nekns, udidesi _
sisxlZarRvebisa da nervebisaTvis.
ukanasknels; amisda mixedviT, wre,
pirveli, meTerTmete da
romelsac moxazavs neknTa pirveli
meTormete neknebis Tavebs aqvT
wyvili, yvelaze pataraa, xolo wre,
mxolod erTi mTliani sasaxsre
Semoxazuli ukanaskneli nekniT, iqneba
zedapiri, romliTac es neknebi erT
yvelaze didi. neknebis horizontalur
saTanado malas uerTdeba, danarCen

klinikuri anatomia 72
 zurgis midamo

sibrtyeze gamrudeba iwvevs im SeerTebuli mkerdis ZvalTan. qveviTa 5

garemoebas, rom neknebis ukana wyvili nekni cnobilia rogorc cru
boloebi, e.i. Tavebi, ufro maRla neknebi _ costae spuriae. maTgan me-8, me-9
dganan, vidre wina boloebi. neknebis da me-10 nekni xrtilovani nawiliT
gamrudeba maTi grZeli RerZis garSemo jer erTimeores uerTdebian da Semdeg
iwvevs imas, rom pirveli neknis zeviTa me-8 nekni me-7 neknis xrtils
zedapiri TandaTan iqceva gareTa ukavSirdeba. amis garda, ukanaskneli 2
zedapirad, qvemo zedapiri ki _ wyvili neknebis xrtilebi ar
SigniTa zedapirad. uerTdebian arc mkerdis Zvals, arc
neknebis pirvel weevils hqvia erTimeores da Tavisuflad meryeoben
namdvili neknebi _ costae verae, radgan muclis kunTebis sisqeSi (maT meryev
yvela es nekni sakuTari xrtiliT aris neknebs _ costae fluctuantes – uwodeben).

xerxemlis svetisa da qalas Senawevreba _

Juncturae columnae vertebralis et cranii

xerxemalSi Cven gvxvdeba ZvalTa 3) malTaSua diskoebi _ disci

yovelgvari Senawevreba: intervertebrales _ aerTebs malebis
1) saxsrebi gvxvdeba yoveli ori sxeulebs da warmoadgens
mezobeli malis wyvil sasaxsre sinqondrozis magaliTs; yoveli
morCTa Soris _ malTaSua saxsrebi _ malTaSua xrtili Sedgeba ori
articulationes intervertebrales. es saxsrebi nawilisagan: gareTa, fibrozuli
TavianTi moyvanilobiT ekuTvnian rgoli _ anulus fibrosus, romelic
brtyel saxsrebs _ articulatio plana. Sedgeba boWkovani xrtilisagan da
2) iogebi, romlebic gadaWimulia centraluri nawili _ moqnili,
malaTa ganiv morCTa Soris e.w. ganiv uformo, gamWirvale, romelsac rbil
morCTaSua iogebi _ liganemta birTvs _ nucleus pulposus _ uwodeben. es
intertransversaria, wvetian morCTa Soris _ ukanaskneli warmoadgens zurgis simis
wvetTaSua iogebi _ liganemta interspinalia, _ chorda dorsalis _ naSTs.
rkalTa Soris _ yviTeli iogebi kisris pirvel malas ara aqvs
(elastikuri boWkoebisagan) _ liganemta sxeuli, ris gamoc pirvelsa da meore
flava da iogi yaeTnis saxiT. gaWimuli malas Soris malTaSua diski ar
wvetian morCebze pirvelidan arsebobs.
ukanasknel malamde e.w. wvetzeda iogi 4). atlas-kefis saxsari _ articulatio
_ liganemtum supraspinale; es iogi kisris atlanto-occipitalis; am saxsarSi atlasi
midamoSi qmnis brtyel da sakmaod enawevreba kefis Zvals. igi
sqel qedis iogs _ liganemtum nuchae, kombinirebuli saxsaria, elifsoiduri
romelic kefis gareTa maRlobsa da moyvanilobisa; sasaxsre parki farTo
kisris malaTa wvetian morCebs Soris da Tavisufalia; atlasis tkalebsa da
aris gaWimuli. didi xvrelis napirebs Soris

klinikuri anatomia 73
 zurgis midamo

gadaWimulia atlas-kefis wina da iogis zeviT, kefis Zvlisaken da qveviT

ukana apki _ membrane atlanto-occipitalis _ aqsisis sxeulis ukana zedapirisaken
anterior et posterior. da atlasis ganiv iogTan erTad qmnis
5) atlas-aqsisis Sua da gverdiTi jvaredina iogs _ ligamentum cruciforme
saxsrebi _ articulatio atlanto-axialis mediana atlantis. zemodan yvela es iogi
et articulatio atlanto-axialis lateralis _ Sedgeba dafarulia mfaravi apkiT.
sami gancalkevebuli saxsrisagan; maT 6) gavis Zvali warmoadgens xuTi
Soris Sua saxsari warmoadgens calke malisagan Sezrdil Zvals.
aqsisis kbilis da atlasis wina xerxemlis svetis gaswvriv, malaTa
rkalis Senawevrebas; es saxsari Tavisi sxeulebis wina zedapirze, midis wina
moyvanilobiT mbrunvelia; amasTan gaswvrivi iogi _ ligamentum longitudinale
atlasi brunavs kbilisebri morCis anterius _ kefis Zvlis xaxis borcvidan
garSemo. danarCeni ori gverdiTi moyolebuli koncxamde, da ukana
saxsari warmoadgens malebis sasaxsre gaswvrivi iogi _ ligamentum longitudinale
morCebis Cveulabriv Senawevrebas. posterius, kisris me-2 malidan
zemoaRweril atlas-aqsisis moyolebuli kudusunis Zvlamde; es
saxsrebs aqvs Semdegi damxmare iogebi: iogi mdebareobs xerxemlis arxSi
frTisebri iogebi _ ligamenta alaria _ malaTa sxeulis ukana zedapirze.
gadaWimulia aqsisis kbilsa da kefis 7) gava-kudusunis Senawevreba _
rokebis SigniTa mxares Soris. kbilis junctura sacrococcygea. am SemTxvevaSi
mwvervalis iogi _ ligamentum apicis dentis kudusuni uerTdeba gavis Zvals yalbi
_ gadaWimulia aqsisis kbilis wvetsa saxsris saSualebiT. garedan igi
da didi xvrelis wina napirs Soris gamagrebulia damatebiTi iogebiT:
da Canasaxovani zurgis simis naSTs gava-kudusunis ventraluri,
warmoadgens; atlasis ganivi iogi _ dorsaluri da gverdiTi iogebiT
ligamentum transversum atlantis _ exveva _ligamenta sacrococcygea ventrale, dorsale et
aqsisis kbils uknidan da gadaWimulia laterale.
atlasis gverdiT masebs Soris; ori
fibrozuli morCi _ fasciculi
longitudinales, romlebic warizideba am

neknebis saxsrebi da SeerTebani _

articulationes costovertebrales

pirveli Svidi nekni wina Tavisuflad mdebareobs muclis

xrtilovani boloTi enawevreba kunTebis sisqeSi.
mkerdis Zvals, me-8, me-9 da me-10 ukana boloebiT neknebi
wyvili nekni uerTdeba erTmaneTs, da Senawevrebulia Semdegnairad: 1-li, me-
bolos, me-8 _7-s, me-11 da me-12 wv\yvili 11 da me-12 meknebisTavebi
nekni Tavisi wina boloebiT Senawevrebulia Sesatyvisi malis
sxeulTan. me-2 _10 neknebi ki _ or

klinikuri anatomia 74
 zurgis midamo

mezobel Sesatyvis da zemdebare CanTebi gamagrebulia winidan neknis

malasTan. am Senawevrebebs uwodeben Tavis sxivisebri iogiT _ ligamentum
neknis Tavis saxsrebs _ articulatuones cipitis costae radiatum.
capitis costae. b) nekn-ganivi saxsari _ articulatio
garda amisa, Senawevreba arsebobs costotransversarium. am saxsarSi neknis
zemo aTi wyvili neknis borcvsa da borcvi enawevreba saTanado malis
Sesatyvisi malebis ganiv morCebs ganivi morCis sasaxsre zedapirs.
Soris. am Senawevrebas uwodeben nekn- sasaxsre CanTa gamagrebulia
ganiv saxsrebs _ articulationes nekn-ganivi iogiT _ ligamentum
costotransversales. costotransversarium, romelic aerTebs
a) neknis Tavis saxsari _ articulatio neknis yelis dorsalur nawils
capitis costae. am saxsarSi neknis Tavi saTanado malis ganivi morCis
enawevreba malis sxeulis gverdze ventralur nawilTan, zemo nekn-ganivi
mdebare sasaxsre zedapirs. yoveli iogiT _ ligamentum costotransversarium
aRniSnuli saxsris Rru (gamonakliss superius da gverdiTi nekn-ganivi iogiT
Seadgens pirveli, me-11 da me-12 neknis _ ligamentum costotransversarium laterale.
Tavis saxsrebi) gayofilia neknis
Tavis saxsarSiga iogiT _ ligamentum
cipitis costae intraarticulare. am saxsrebis

zurgis kunTebi _ musculi dorsi

zurgis kunTebi or jgufad iyofa: Tu orive mxris kunTs erTad

erTi maTgani akavSirebs xerxemals
TavTan, zemo kiduris sartyelTan da
gulmkerdTan; meore jgufs
specialuri daniSnuleba aqvs TviT
xerxemlisaTvis. pirveli jgufis
kunTebi dawyobilia erTimeoris qveS
da maT Soris zedapiruli kunTebi
zurgid brtyelsa da ganier kunTebs
warmoadgenen.
pirveli zedapiruli Sre _ qveviT; sazogadod, trapeciuli kunTi
trapeciuli kunTi _ m. trapezius _iwyeba
kefis gareTa SemaRlebidan, kefis
zemo qedidan, kisrisa da gulmkerdis
yvela malebis wvetiani morCebidan da
umagrdeba laviwis akromionis bolos,
akromions da beWis qeds; am kunTs
trapeciis forma aqvs im SemTxvevaSi,
SevxedavT; yovel calkeul kunTs ki
samkuTxedis moyvaniloba aqvs, romlis
fuZe mdebareobs zurgis Sua xazze,
kefis borcvidan moyolebuli
gulmkerdis me-12 malamde, mwvervali
ki _ akromionze.
am kunTs SeuZlia aswios zemo
kiduris sartyeli zeviT, miuaxloos
beWi xerxemlis Sua xazs, daswios beWi
swevs mxris sartyels zeviT da, amave
dros, beWs abrunebs misi sagitaluri
RerZis garSemo, ise rom misi qveda
kuTxe gaiwevs gareT.
zurgis uganieresi kunTi _ m.
latissimus dorsi _ iwyeba gulmkerdis

klinikuri anatomia 75

qveviTa (VI-XII) malebis wvetiani
morCebidan, gulmkerdis fasciidan da
TeZos Zvlis qedidan; umagrdeba mxris
mcire borcvis qeds, am kunTs
samkuTxedis forma aqvs, sruliad
faravs torsis ukana da gverdiT
mxares, beWis qvemo kuTxidan
moyolebuli TviT kudusunamde.
am kunTs damatebiTi meSveli konebi
aqvs, romlebic iwyeba beWis qvemo
kuTxidan, es ukanaskneli kona
yovelvis kargad aris ganviTarebuli
da umagrdeba mxris imave mcire
borcvis qeds. igi cnobilia rogorc
gansakuTrebuli didi mrgvali kunTi _
m. teres major (ix. zeda kiduris kunTebi).
zurgis uganieresi kunTi abrunebs
mxars misi grZeli RerZis garSemo,
SigniTa mxrisaken, ise rom xelis
guli ukan brundeba da, amasTan, mxars
zurgze isvris.
meore Sre _ mcire da didi
rombisebri kunTebi _ m. rhomboideus
minor et major. maT Soris pirveli iwyeba
kisris qveviTa ori malis wvetiani
morCebidan da umagrdeba beWis SigniTa
kidis zemo nawils; meore _ didi _ ki
iwyeba gulmkerdis zeviTa oTxi malis
wvetiani morCebidan da umagrdeba
beWis SigniTa kidis qvemo nawils. es
kunTebi uaxlovebs beWs torsis Sua
xazs, anu xerxemals, da swevs mas
zeviT.
beWis amwevi kunTi _ m. levator
capulae. iwyeba oTxi myesovani kbiliT
kisris zeviTa oTxi malis ganivi
morCebidan da umagrdeba bewis zeda
kuTxes. igi swevs bews zeviT; Tu
ukanaskneli gamagrebulia , maSin xris
kisers.
klinikuri anatomia
zurgis midamo
mesame Sre _ ukana zeviTa
dakbiluli kunTi _ m. serrasus posterior
superior _ Zevs rombisebri kunTis qveS.
iwyeba kisris qveda ori malis da
gulmkerdis zeda ori malis wvetiani
morCebidan; umagrdeba zeviTa oTx
nekns da swevs maT zeviT (SesunTqvis
dros).
ukana qveviTa dakbiluli kunTi _
m. serratus posterior inferior (es kunTi meore
SreSia moqceuli) _ iwyeba gulmkerd-
welis fasciidan, gulmkerdis XI da XII
welis I da II malis wvetiani
morCebidan; umagrdeba qveviTa oTx
nekns da swevs maT qveviT (amosunTqvis
dros).
Tavisa da kisris salmunis kunTi _
m. splenius capitis et m. splenius cervicis _ Zevs
trapeciuli, rombisebri da ukana
zeviTa dakbiluli kunTebis qveS,
iwyeba qedis iogidan, kisris III-VI
malebis midamoSi da kisris VII malisa
da gulmkerdis zeviTa eqvsi malis
wvetiani morCebidan. Tavis nawili
umagrdeba kefis Zvlis zemo qedis
xazs da dvrilisebr morCs; kisris ki
_ zemo ori malis ganiv morCs.
es kunTi atrialebs Tavs gverdiTi
mxrisaken, xolo, rodesac orive kunTi
erTdroulad ikumSeba, Slis Tavs da
kisers ukan.
zurgis gammarTveli kunTi _ m.
erector spinae _ iwyeba iwyeba gavis Zvlis
dorsaluri xorkliani zedapiridan,
welis malis ganivi, dvrilisebri da
damatebiTi morCebidan, gulmkerd-
welis fasciidan da TeZos qedidan.
igi mdebareoba xerxemlis wvetian
morCebsa da neknTa kunTebs Soris
arsebul gaswvriv RarSi.
76
 zurgis midamo

es kunTi sam nawilad iyofa: gareTa kunTi _ m. multifidus, romelic

nawili, e.w. TeZo-neknebis kunTi _ m. xerxemlis mTel sigrZeze arsebobs
iliocostalis _umagrdeba myesovani gavis Zvlidan dawyebuli kisris meore
boloebiT neknTa kuTxeebs da kisris malamde. am kunTis calkeuli konebi
malebis ganiv morCebs (meoTxemde); Sua mWidrod arian erTmaneTSi gadabmuli.
nawili, e.w. ugrZesi kunTi _ m. yoveli mravalwilovani kunTi
longissimus dorsi _ umagrdeba gulmkerdisa gadabmulia or an sam mexobel malebs
da kisris ganiv morCebs da saboloo Soris ganivi morCebidan wvetian
zeviTa myesiT aRwevs dvrilisebr morCebamde.
morCs; SigniTa nawili, e.w. wvetiani mbrunveli kunTebi _ mm. rotatores _
kunTi _ m. spinalis _ umagrdeba zurgis es yRrmesi kunTebia. mdebareoben
da kisris malebis wvetian morCebs xerxemalze kisrisa, gulmkerdisa da
(meoremde). aRniSnuli kunTi Slis welis midamoSi, winamorbedi kunTis
wells, zurgs, kisers da Tavs. qveS _ mm. rotators cervicis, thoracis et
ganiv-wvetiani kunTi _ m. transverse- lumborum. maTi konebi gancalkevebulia
spinalis; am saxelwodebaSi da gawvdenilia ganov da wvetian
gaerTianebulia mravali mokle kunTi, morCTa Soris ori an sami mezobeli
romlebic gaWimulia ganiv da wvetian malis sigrZeze.
morCebs Soris, saxeldobr: neknebis amwevi kunTi _ mm. levatores
naxevradwvetiani, mravalwilovani da costarum; es kunTebi arseboben
mbrunveli kunTebi. gulmkerdis midamoSi; iwyebian
naxevradwvetiani kunTi _ m. gulmkerdis malebis ganivi morCebidan
semispinalis. es kunTi arsebobs da umagrdebian an saTanado, an kidev
gulmkerdis da kisris midamoebSi da mis qveviT mdebare neknebs.
qalaze Tavdeba. misi gulmkerdis mravalwilovani, mbrunveli da
nawili _ m. semispinalis thoracis neknebis amwevi kunTebi exmarebian
gulmkerdis qvemo eqvsi malis ganivi xerxemlis kunTebs maT mravalferovan
morCebidan iwyeba da umagrdeba kisris moZraobaSi.
qvemo ori da gulmkerdis zemo eqvsi kefis mokle kunTebs ekuTvnis: oTxi
malis wvetian morCebs. kunTis kisris wyvili kunTi, romelTac mniSvneloba
nawili _ m. semispinalis cervicis aqvT atlas-kefis da atlas-aqsisis
gulmkerdis zemo malis ganivi saxsrebis moZraobisaTvis.
morCebidan iwyeba da umagrdeba kisris Tavis didi ukana swori kunTi _ m.
malebis wvetian morCebs (II-dan V-mde). rectus capitis posterior major _ iwyeba
Tavis nawili _ m. semispinalis capitis aqsisis wvetiani morCidan da
iwyeba kisris qvemo oTxi malis ganivi umagrdeba kefis qedis zemo xazs.
morCebidan da umagrdeba kefis qicvis Tavis mcire ukana swori kunTi _ m.
foraks. SekumSvis dros Tavs Slis rectus capitis posterior minor _ iwyeba
ukan. atlasis ukana xorklidan da
zurgis yvelaze Rrma da mokle umagrdeba kefis qedis zemo xazs.
kunTebs ekuTvnian: mravalwilovani

klinikuri anatomia 77
 zurgis midamo

Tavis zemo iribi kunTi _ m. obliquus gverdiT, ris gamoc es kunTi isea
capitis superior _ gaWimulia atlasis moTavsebuli orive kalTas Soris,
ganiv morCsa sa kefis qicvs Soris. rogorc budeSi.
Tavis qvemo iribi kunTi _ m. obliquus gulmkerd-welis fascia
capitis inferior _ gaWimulia atlasis ganiv warmoadgens mkvriv da kargad
morCsa da aqsisis wvetian morCs gamagrebul warmonaqmns, romlidanac
Soris. iRebs dasawyiss bevri msxvili da
gulmkerd-welis fascia _ fascia Ronieri kunTi, saxeldobr: muclis
SigniTa iribi da ganivu kunTebi,
thoracolumbalis _Sedgeba orikalTisagan:
zurgis uganieresi kunTi, qveda ukana
wina da ukana. 1) wina, Rrma kalTa
dakbiluli kunTi da gava-wvetiani
iwyeba welis malebis ganivi
kunTi.
morCebidan, TeZos qedidan, TeZo-welis
welis oTxkuTxedi mdebareobs
iogidanm meTormete neknidan da
welis midamoSi uganieresi kunTis
mdebareos welis kvadratul da
qveS, XII neknis qveviT. es oTxkuTxedi
zurgis gammarTvel kunTebs Soris. am
zevidan mosazRvrulia ukana qvemo
kalTis zeviTa nawili, romelic
dakbiluli kunTis qveda napiriT,
welis malis ganiv morCsa XII nekns
garedan _ muclis gareTa da SigniTa
Soris aris gaWimuli, warmoadgens
iribi kunTis kidiT, Signidan _
mkriv da namgaliviT moxril iogebs,
zurgis gammarTveli kunTis gareTa
romelTac ewodebaT SigniTa da
napiriT. am oTxkuTxedis Ziri
gareTa rkalivani iogebi _ lig. arcuatum
warmodgenilia muclis ganivi kunTis
mediale et laterale.2) ukana, zedapiruli
myesovani nawiliT, romelic amave
kalTa iwyeba gulmkerdis qveviTa eqvsi
dros galmkerd-welis fasciis Rrma
malis, welis da gavis Zvlis wvetiani
furcels warmoadgens. es kedeli
morCebidan da TeZos qedidan.
metad Txeli da sustia da zogierT
umagrdeba neknebis kuTxeebs; welis
SemTxvevaSi Tiaqris mizezs
midamoSi gulmkerd-welis fasciis
warmoadgens.
wina da ukana kalTebi uerTdebian
erTmaneTs zurgis gammarTveli kunTis

xerxemlis arxis SigTavsi _ zurgis tvini

zurgis tvini _ medulla spinalis _ bolo konusis moyvanilobisaa da

warmoadgens grZel, cilindruli Tavdeba welis prveli malis qvemo
formis sxeuls, Sebrtyelebuls wina- napiris doneze zurgis tvinis konusiT
ukna mimarTulebiT da modrekils _ conus medullaris. konusis mwvervalidan
xerxemlis arxis modrekilobis qveviT miimarTeba dasasruli Zafi _
Sesaferisad. misi zemo sazRvari filum terminale, romelic mWidrod erTvis
atlasis rkalis donedan uSualod kudusunis meore malis sxeuls.
mogrZo tvinSi grZeldeba; misi qvemo

klinikuri anatomia 78
 zurgis midamo

zurgis tvini iyofa sam nawilad: larad _ funiculus, saxeldobr: wina,

kisris, gulmkerdis da welis lateralur da ukana _ funiculus anterior,
nawilebad; kisrisa da welis midamoSi lateralis et posterior.
zurgis tvini TiTistariviT zurgis tvinis masa ori
Semsxvilebulia da am nawilebs nivTierebisagan Sedgeba: ruxi
ewodeba kisris da welis nivTiereba _ substantia grisea, romelic
Semsxvilebani _ intumescentia cervicalis zurgis tvinis centrSia moTavsebuli
et intumescentia lumbalis. kisris da TeTri nivTiereba _ substantia alba,
Semsxvilebas ukavia xerxemlis arxSi romelsac ukavia zurgis tvinis
manZili kisris meore malidan periferia.
gulmkerdis meore malamde (yvelaze zurgis tvinis ruxi nivTiereba
msxvili adgili mexuTe malis nakveTze Tavisi formiT mogvagonebs
donezea); welis Semsxvilebas ki ukavia laTinur H-s, romlis yovel naxevarSi
manZili gulmkerdis meaTe malidan gamoiyofa Semdegi nawilebi: wina rqa
welis pirveli malis donemde _ cornu anterius, ukana rqa _ cornu
(yvelaze msxvili adgili meTormete posterius da gverdiTi rqa _ cornu laterale;
malis donezea).
gverdiTi rqebi gamoxatulia
mamakacebis zurgis tvinis sigrZe
gulmkerdis pirveli segmentidan
45sm-ia, qalebis _ 43sm.; misi wona
welis meore, mesame segmentamde.
aRwevs 30 grams.
zemoaRniSnuli rqebi gaerTianebuli
zurgis tvinis zemo sazRvari, e.i.
arian erTmaneTTan ruxi nivTierebiT,
sazRvari mogrZo tvinsa da zurgis
romelic cnobilia rogorc
tvins Soris aRiniSneba: atlasis
Suamdebare nivTiereba _ substantia
rkalis doneTi, an e.w. piramidTa
intermedia; es ukanaskneli aerTebs
jvarediniT, romelic mdebareobs wina
tvinis marjvena da marcxena nawilebs
medialur napralSi.
mis mTel sigrZeze.
zurgis tvini mTel sigrZeze ori
am SemaerTebeli nawilis centrSi
gaswvrivi RariT: wina Sua napraliT _
Zevs zurgis tvinis centraluri arxi
fissure mediana anterior da ukana Sua
_ canalis centralis.
RariT _ sulcus mediana posterior iyofa or
arxis ukan mdebare nawils hqvia
simetriul nawilad _ marjvena da
centraluri Suamdebare nivTiereba _
marcxena. ukana Sua Rari mTel
substantia intermedia centralis. xolo
sigrZeze amovsebulia gliuri
TeTrsa da viwro zonars, romelic
qsoviliT. amis garda, zurgis tvinis
Zevs win, hqvia TeTri SesarTavi _
yovel naxevarze zemodan qvemoT
comissura alba.
arsebobs sustad gamoxatuli kidev
zurgis tvinis ruxi nivTierebis
ori Rari: gverdiTi wina Rari _ sulcus
rqebi mdebareoben zurgis tvinis mTel
lateralis anterior da gverdiTi ukana Rari
sigrZeze uwyveti masis saxiT da qmnian
_ sulcus lateralis posterior. aRniSnuli ruxi nivTierebis wina, gvrdiTs da
RarebiT zurgis tvinis TeTri
ukana svetebs _ columna anterior, lateralis
nivTiereba yovel naxevarSi iyofa sam
et posterior.

klinikuri anatomia 79
 zurgis midamo

ruxi nivTierebis wina rqebi e.i Seicavs rogorc mgZnobiare, ise

SedarebiT mokle da ganieria da ver mamoZravebeli xasiaTis boWkoebs.
swvdebian zurgis tvinis periferias, zurgis tvinidan, rogorc iyo
samagierod ukana rqebi ufro viwro aRniSnuli, gamodis 31 wyvili nervi.
da grZelia da aRweven zurgis tvinis zurgis tvinis is naWeri, romelic
periferias. marjvniv da marcxniv dakavSirebulia
zurgis tvinidan gamodis 31 wyvili wyvil nervebTan, waroadgens zurgis
nervi. yoveli nervi Seiqmneba tvinis erT segments.
Semdegnairad: amrigad, zurgis tvinSi Sedis 31
zurgis tvinis orive mxareze wina segmenti: 8 segmenti kisris, 12 _
lateraluri Raridan gamodis gulmkerdis, 5 _ welis, 5 _ gavis da 1
ventraluri fesvi _ radix ventralis _ kudusunis segmenti, Sesatyvisi
(mamoZravebeli), xolo ukana spinaluri nervebiT.
lateraluri Raridan dorsaluri zurgis tvinis 31 segments ukavia
fesvi _ radix dorsalis. xerxemlis arxis zemo 2/3, xolo qvemo
zurgis tvinis gverdiT, Cveulebriv, 1/3-Si mdebareobs dasasruli Zafi _
malTaSua xvrelSi, ventraluri da filum terminale da mis garSemo zurgis
dorsaluri fesvebi uerTdebian tvinis nervebis grovebi dawyebuli
erTimeores xolo dorsaluri fesvi welis pirveli malis donedan;
SeerTebis win qmnis damaxasiaTebel aRniSnuli nervebis kompleqss ewodeba
gaganierebas, romelic Sedgeba raSis kudi _ cauda equina.
mgZnobiare fesvis ujredebisagan da kisris pirveli nervi xerxemlis
ewodeba zurgis tvinis kvanZi, anu xerxemlis arxidan gamodis kefis
spinaluri kvanZi _ ganglion spinale. Zvalsa da kisris I malas Soris, meore
spinaluri kvanZebi Seicaven cru nervi _ I da II malebs Soris da a.S.
erTmorCian (unipolarul) ujredebs, amgvrad, kisris areSi zurgis tvinis
romelTa erTiani morCi ujredTanve nervebi gamodis xerxemlis arxidan
iyofa aso T-s magvarad or morCad _ Sesabamisi malebis zemoT. gamonakliss
periferiuli, romelic kvanZSi modis Seadgens kisris VIII nervi, romelic
periferiidan da centraluri, xerxemlis arxs tovebs kisris VII da
romelic am ujredebidan midis gulmkerdis I malTaSua xvreliT.
centrisaken, e.i. zurgis tvinSi; danarCeni nervebi gamodis xerxemlis
centraluri morCebis grova qmnis arxidan Sesabamisi malebis qvemoT.
dorsalur fesvs _ radix dorsalis. kisris zeda 3-4 wyvilis nervis
amrigad, zurgis tvinidan gamosuli fesvebi daaxloebiT horizontalurad
ventraluri da dorsaluri fesvebis mdebareobs. momdevno nervebis fesvebi
boWkoebi erTiandebian, irevian ki ufro da ufro daxrili da
erTmaneTSi da qmnian zurgis tvinis, grZelia, vinaidan manZili maTi
anu spinalur nervs _ nervus spinalis, dasawyisidan Sesabamis malTaSua
romelsac ukve Sereuli xasiaTi aqvs, xvrelamde qvemoTken TandaTan
matulobs. gansakuTrebiT grZelia
welis qveda da gavis nervebis fesvebi,

klinikuri anatomia 80
 zurgis midamo

romlebic zurgis tvinidan welis I an dorsalis boWkoebi Sedian zurgis tvinSi

II malebis doneze gamodian da ukana lateraluri RariT.
xerxemlis arxs gavis xvrelebiT ukana rqis mwvervali Sexveulia e.w.
toveben. Jelatinisebur nivTierebaSi _
zurgis tvinis segmentebidan substantia gelatinosa, romlis wvrili
gamosuli mgZnobiare da mamoZravebeli ujredebis morCebi aerTeben
nervebis sainervacio areebi sxvadasxva doneze mdebare zurgis
(vl.tonkovi) ganawilebulia tvinis segmentebs. Jelatinisebr
Semdegnairad: nivTierebas umijnavdeba Rrublisebri
1. kisris I _ IV nervebi anerveben zona _ zona spongiosa, romelic Tavisi
kisris wina kunTebs, kisris kansa da ujredebis boWkoebiT aerTebs zurgis
SuasaZgids; tvinis uaxloes, mezoblad mdebare,
2. kisris V-VIII da gulmkerdis I da or-sam segments. Rrublisebr zonas
nawilobriv II nervebi anerveben zemo garedan faravs Txeli TeTri Sre _
kiduris kans da kunTebs; e.w. sanapiro zona _ zona terminalis.
3. gulmkerdis II _ XII nervebi gverdiT rqebSi mdebareobs wvrili
anerveben torsis kansa da kunTebs; ujredebis jgufi, romlebic ekuTvnis
4. welis I nervi _ anervebs simpaTikur sistemas. am ujredebis
sazardulis iogis mezoblad da neiritebi toveben zurgis tvins
zemoT mdebare kans. ventraluri fesvis boWkoebis
5. welis II da V nervebi da gavis I SemadgenlobaSi.
da II nervebi anerveben qvemo kiduris zurgis tvinis ruxi nivTierebis
kunTebs da kans. ukana rqis fuZesTan mdebareobs
6. gavis III da V da kudusunis msxvilujredovani gulmkerdis birTvi
nervebi anerveben qvemo kiduris _ nucleus thoracicus, romelic arsebobs
kunTebs da kans, gareTa sasqeso zurgis tvinis mTel sigrZeze, Tumca
organoebs, Soriss, dundulebis ufro mkveTrad aris gamoxatuli
medialur midamos. amave svetebSi gulmkerdis II segmentidan welis I
moTavsebulia moSardvis da segmentamde.
defekaciis refleqtoruli centrebi. ukana rqis Sua nawilSi mdebareobs
zurgis tvinis ruxi nivTierebis sustad gamoxatuli ukana rqis
wina rqebi Seicaven msxvil
sakuTari birTvi _ nucleus proprius cornu
mamoZravebel ujredebs, romelTa
posterioris.
aqsonebis kompleqsi e.w. fesvTa Zafebi
Suamdebare nawilSi gverdiTi rqis
_ fila articularia gamodian zurgis
garda, romelic Seadgens Sua
tvinidan wina gverdiTi RariT da
lateralur birTvs _ nucleus intermedio-
qmnian zemoaRniSnul ventralur
lateralis, mdebareobs Sua-medialuri
fesvebs _ radices ventrales.
birTvi _ nucleus intermedio-medialis.
zurgis tvinis ukana rqebi Seicaven
wina rqis ruxi nivTiereba Seicavs
gacilebiR ufro wvril ujredebs;
mamoZravebeli ujredebis jgufs: or _
maTTan dakavSirebuli mgZnobiare
medialurs, or _ lateralurs da erT
xasiaTis dorsaluri fesvis _ radix

klinikuri anatomia 81
 zurgis midamo

_ centralurs _ wina rqis sakuTari a) aRmavali:

birTvs _ nucleus proprius cornu anterioris. 1. zurgnaTxemis wina gza _ tractus
zurgis tvinis TeTri NnivTiereba spinocerebellaris anterior (tractus Growersi)
Sedgeba sami ZiriTadi e.w. larisagan _ 2. zurgnaTxemis ukana gza _ tractus
funiculi, romlebic gars ertymian rux spinocerebellaris posterior (tractus Flechsigi)
nivTierebas zurgis tvinis mTel 3. zurgTalamusis lateraluri gza
sigrZeze periferiidan da aerTianeben, _ tractus thalamicus lateralis
erTi mxriv, urTierT Soris zurgis b) daRmavali:
tvinis segmentebs, meore mxriv, zurgis 4. qerqzurgis (piramiduli)
tvinis segmentebs Tavis tvinis lateraluri gza _ tractus corticospinalis
birTvebTan da qerqTan. (pyramidalis) lateralis (tractus Monakowi)
arCeven wina, lateralur da ukana
5. rubrospinaluri gza _ tractus
larebs _ funiculus anterior, lateralis et
rubrospinalis
posterior, romlebic warmoadgenen III. wina laris SemadgenlobaSi
zurgis tvinis e.w. nervul gamtarebel Sedis:
gzebs, maT Soris: 1. qerqzurgis wina (piramiduli)
I. ukana lari Seicavs mgrZnobiare gza _ tractus corticospinalis (pyramidalis)
xasiaTis gamtarebel gzebs: nazi kona
anterior
_ funiculus gracilis (funiculus Golli) da
2. spinoTalamuri wina gza _ tractus
solebrivi kona _ funiculus cuneatus
spinothalamicus anterior
(funiculus Burdachi). 3. vestibulospinaluri gza _
II. lateraluri laris
tractus vestibulospinalis
SemadgenlobaSi Sedis rogorc
aRmavali, ise daRmavali gamtarebeli
gzebis sistema, saxeldobr _

zurgis tvinis garsebi

zurgis tvini Sexveulia sam garsSi, zedapiridan brtyeli epiTeliumiT. igi

romlebic kefis did xvrelSi uaRresad Txelia, nazi da gamWirvale.
ganuwyvetliv gadadian Tavis tvinis magari garsi Sedgeba mkvrivi da
garsebSi: sqeli SemaerTebeli qsovilisagan;
rbili garsi Sedgeba faSari xerxemlis arxSi igi Sedgeba ori
SemaerTebeli qsovilisagan, romelic firfitisagan, romelTa Soris rCeba
uxvad Seicavs sisxlis ZarRvebs, ris sakmao farTo sivrce.
gamo mas kidev uwodeben 1. zurgis tvinis rbili garsi _ pia
sisxlZarRvovan garss. mater spinalis mWidror ekvris zurgis
qselisebri garsi serozuli tvinis zedapirs, mdidaria sisxlis
xasiaTisaa da mofenilia orive ZarRvebis wvrili totebiT, romlebic

klinikuri anatomia 82
 zurgis midamo

SeiWrebian tvinis TeTr nivTierebaSi romlebic umagrdema qselisebr garss

garedan SigniT, xolo SedarebiT da masTan erTad magar garssac.
msxvili ZarRvebi SeiWreba rbil misamagrebeli kbilebis ricxvi
garsTan erTad wina Sua napralSi da meryeobs 19-25 Soris, dawyebuli kefis
ZiriTadad nawildeba zurgis tvinis didi xvrelidan welis pirveli malis
rux nivTierebaSi. Tavis tvinis donemde.
garkveul nawilebSi rbili garsi amrigad, zurgis tvini
qmnis or naoWs _ dublikaturebs, Camokidebulia dakbilul iogze da
romlebic Seizrdebian tvinis moTavsebulia Tavzurgis tvinis
parkuWebis SeTxelebul kedlebTan _ siTxeSi, rac erTsa da imave dros
ependimasTan da qmnian parkuWebis SesaniSnavi damcvelis rols asrulebs
sisxlZarRvovan sarqvelebs _ tela da amave dros xels uwyobs
chorioidea. maTTan aris dakavSirebuli yovelgvari moZraobis Sesrulebas
e.w. sisxlZarRvTa wnulebi _ plexus umtkivneulod da dauzianebliv.
chorioideus. gamoyofen tvinis parkuWebSi 3. zurgis tvinis magari garsi _
Tavzurgis tvinis siTxes _ liquor dura mater spinalis warmoadgens zurgis
cerebrospinalis. tvinis yvelaze magar da sqel garss.
2. zurgis tvinis qselisebri garsi mas aqvs vrceli CanTis forma,
romelSiac Sexveulia tvini; igi
_ arachniidea spinalis, warmoadgens metad
Sedgeb ori furclisagan: gareTa da
Txel serozul garss, romelic orive
SigniTa. gareTa furceli amofens
mxridan mofenilia brtyeli
uSualos xerxemlis arxis kedels
epiTeliumiT da daSorebulia rbili
Signidan, warmoadgens mis
garsisagan sakmaod vrceli qselqveSa
Zvlisazrdelas; SigniTa furceli. e.i.
sivrciT _ cavum subarachnoidale; es
namdvili magari garsi daSorebulia
sivrce amovsebulia Tavzurgis tvinis
pirvelisagan sivrciT, romelsac
siTxiT _ liquor cerebrospinalis; qvemo
ewodeba epiduruli Rru _ cavum
nawilSi qselqveSa sivrce mkveTrad
epidurale da romelSiac moipoveba uxvi
ganierdeba da qmnis saboloo
xerxemlis SigniTa venuri wnulebi _
cisternas _ cisterna terminalis, romelSic
plexus venosi vertebralis interni, limfuri
moTavsebulia raSis kudi. swored am
ZarRvebi da uxvad dagrovili cximi.
sivrcidan awarmoeben Tavzurgis
magari garsis SigniTa zedapiri
tvinis siTxis amoRebas.
mofenilia brtyeli epiTeliumiT.
zurgis tvini fiqsirebulia
magari garsis am zedapirsa da
xerxemlis arxSi, e.w. dakbiluli
qselisebri garsis gareTa zedapirs
iogiT _ ligamentum denticulatum.
Soris rCeba viwro naprali _
ukanskneli warmoadgens Txel, magram
subduruli Rru _ cavum subdurale. es
mkvriv firfitas, romelic mdebareobs
naprali amovsebulia limfismagvari
zurgis tvinis orive mxareze. igi
siTxiT. zurgis tvinis subduraluri
iwyeba zurgis tvinis gverdze rbili
Rru zemo nawilSi uerTdeba qalas
garsidan wina-ukana nervul fesvebs
Rrus aseTive sivrces, qvemo nawilSi
Soris, midis ganze da iyofa kbilebad,

klinikuri anatomia 83
 zurgis midamo

ki brmad Tavdeba gavis meore malis ventralur, ise dorsalur fesvebs da

doneze. SemdegSi mihyveba periferiul nervebs,
magari garsi uqmnis CanTas zurgis rogorc gareTa garsi.
tvinis yoveli nervis rogorc

zurgis tvinis sisxlZarRvebi

zurgis tvins kvebavs xerxemlis konusis bolimde; iseve, rogorc wina

arteriis _ arteria vertebralis totebi: SemTxvevaSi, mTeli xerxemlis
1. zurgis tvinis totebi _ rami sigrZeze mas uerTdeba xerxemlis,
spinales _ scildebian xerxemlis neknTaSua, welis da gavis arteriebis
arterias kisris midamoSi; amarageben totebi da amaragebs zurgis tvins dam
sisxlZarRvebiT rogorc xerxemlis is garsebs.
Rrma wvril kunTebs, ise TviT zurgis xerxemlis arxSi zurgis tvinis
tvins. magari garsis garSemo mdebareoben
2. magari garsis toti _ ramus xerxemlis SigniTa venuri wnulebi _
meningeus _ scildeba xerxemlis plexus venosi vertebralis interni, romlebic
arterias tvinis magar garsSi Sesvlis Rebuloben sisxls rogorc malebidan,
adgilas, Sedis did xvrelSi da ise zurgis tvinidan. aRniSnuli
totiandeba kefis midamos magar wnulebi Semdgaria wyvil-wyvili wina
garsSi da ukana venuri konebisagan, romlebic
3. zurgis tvinis ukana arteria _ a. gaSlilia mTeli xerxemlis sigrZeze.
wina msxvili venuri konebi
spinalis posterior _ ukavSirdeba
mWidrod arian mikruli da
mopirdapire Tanamosaxele arterias,
gadaxlarTuli erTimeoresTan, xolo
ris Semdegac Cayveba zurgis tvinis
kisrisa da gulmkerdis midamoSi
ukana gvrdiT gaswvriv Rars, ukana
gaerTianebulebic ki arian xerxemlis
fesvis win; am arterias anastomozuri
gaswvrivi sinusis saxiT.
totebi kisris midamoSi akavSireben
ukana, ufro wvrili konebi,
xerxemlis arteriis zurgis tvinis
mdebareoben malebis rkalebis wina
totebTan, gulmkerdis midamoSi _
zedapirze da yviTel iogebze,
neknTaSua arteriis totebTn, ufro
anastomozebis saSualebiT kavSiri
qvemoT _ welis da gavis arteriis
aqvT xerxemlis gareTa venur wnulTan.
totebTan da, amrigad, amarageben
rogorc wina, ise ukana konebi
sisxliT zurgis tvins dam is garsebs
gaerTianebuli arian malis sxeulis
xerxemlis arxis mTel manZilze.
zemo da qvemo napirTan ganivi
4. zurgis tvinis wina arteria _ a.
totebiT; venuri wnulebi arseboben
spinalis anterior iwyeba Tanamosaxele
agreTve xerxemlis malebis wina
mopirdapire arteriasTan erTad
zedapirzec, romlebsac beWdisebri
zurgis tvinis zemo sazRvris doneze
anastomozebi aerTianeben xerxemlis
da rogorc kenti arteria Cahyveba
zurgis tvinis wina Sua naprals

klinikuri anatomia 84
 zurgis midamo

venuri ZarRvebis erT mTlian kisris wina kunTebidan da kavSiri

sistemaSi. aqvT malTaSua venebTan; ukana wnulebi
xerxemlis wnulebis zemo bolo mdebareoben malebis rkalebze,
gars uvlis kefis Zvlis did xvrels sasaxsre da wvetian morCebze,
da uSualo kavSirSi imyofeba kefis malTaSua iogebze da zurgis mokle
sinusTan, ZiriTad venur wnulTan, kunTebze; maT kavSiri aqvT kefis,
enisqveSa nervis venur wnulTn da xerxemlis da kisris Rrma venebTan da
ixsneba xerxemlis venaSi. yviTeli iogebis xvrelebiT
xerxemlis wnulis qvemo bolo ukavSirdebian xerxemlis SigniTa
Sedgeba ufro wvrili venebisagan da wnulebs.
ixsneba gavis Zvlis venebSi. malTaSua venebi _ vv. intervertebralis _
xerxemlis gareTa wnulebi _ plexus xerxelis mTel sigrZeze mihyvebian
venosi vertebralis externi mdebareobs kisris zurgis tvinis nervebs badeebis saxiT;
midamoSi, xerxemlis gareTa zedapirze, maT ukavSirdeba zurgis tvinis venebi,
da Sedgebian wina da ukana xerxemlis SigniTa da gareTa venuri
wnulebisagan. maT Soris wina wnulebi wnulebi, gamoaqvT maTgan sisxli
kargad aris ganviTarebuli, agroveben Tavdebian xerxemlis venebSi,
sisvls malebis sxeulebidan da neknTaSua, welis da gavis wina venebSi.

zurgisa da xerxemlis topografiuli anatomia

(zogadi daxasiaTeba)

zurgis Sua xazis gverdebze rogorc zemoT iyo aRniSnuli,

aRiniSneba zurgis gammarTveli kunTebi ganlagebulia oTx Sred.
kunTebiT Seqmnili ori gaswvrivi pirvel Sres qmnian trapeciuli da
morgvi, romlebic SedarebiT ufro zurgis uganieresi kunTebi; meore Sres
kargadaa gamoxatuli qedisa da welis _ beWis amwevi, Tavisa da kisris
midamoebSi. kunTebs Soris mdebare salmuni kunTebi. beWsa da wvetian
RarSi isinjeba malTa wvetiani morCebs Soris mdebare areSi _ didi
morCebi. da mcire rombisebri kunTebi. amave
kani sqeli da mkvrivia, mWidrod Sres ekuTvnis wvetian morCebsa da
aris dakavSirebuli qveSmdebare neknebs Soris gadaWimuli ukana zeda
fasciebTan. dakbiluli da qveda dakbiluli
sakuTari fascia iwyeba malTa kunTebi; mesame kunTovani Sre
wvetiani morCebidan, qmnis budeebs mdebareobs RarSi, romelic
trapeciuli da zurgis uganieresi medialurad mosazRvrulia malTa
kunTebisaTvis da grZeldeba wvetiani morCebiT, xolo
mosazRvre midamoebis fasciebSi. lateralurad _ neknTa kuTxeebiT. am

klinikuri anatomia 85
 zurgis midamo

Sres ekuTvnis zurgis gammarTveli qedis iogSi (lig. nuchae), romelic

kunTi, romelic uknidan dafarulia
gulmkerd-welis fasciis ukana
furcliT. es ukanaskneli gulmkerdis
nawilSi SedarebiT sustad aris
ganviTarebuli, vidre welis nawilSi;
meoTxe Sres Seadgens zurgis Rrma
mokle kunTebi (mm. semispinalis, multifidus,
rotatores da sxv.)
malTa wvetiani morCebis areSi
kanqveSa qsovili ramdenadme ufro
naklebad aris ganviTarebuli. wvetian
morCebze gadaWimulia wvetzeda iogi
(lig. supraspinale). kiserSi igi grZeldeba
gaWimulia kefis gareTa SemaRlebasa
da kisris malTa wvetian morCebs
Soris. garda amisa, malebis wvetiani
morCebi erTmaneTTan dakavSirebulia
wvetTaSua iogebiT (ligg. interspinalia),
xolo malebis rkalebi _ yviTeli
iogebiT (ligg. flava).
zurgis rbil qsovilebs kvebavs
neknTaSua arteriebis ukana totebi,
agreTve kisris ganivi arteriis
daswvrivi toti.
inervacia xorcieldeba dorsaluri
nervebiT (gulmkerdis nervebis toti).

qedis midamo _ regio nuchae

zurgis zeda nawilSi calke iribi kunTiT (m. obliquus capitis inferior),
gamoiyofa qedis midamo, romelic Signidan _ Tavis didi swori kunTiT
topografiulad gansxvavdeba zurgid (m. rectus capitis major).
sxva nawilebisagan. igi zevidan samkuTxedis fskers qmnis atlasis
mosazRvrulia kefis gareTa rkali da atlas-kefis ukana apki
SemaRlebiTa da qedi zeda xaziT, (membrana atlantooccipitalis posterior). aqve
qvevidan _ kisris VII malis wvetian gaivlis xerxemlis arteria, romelic
morCsa da akromions Soris atlasis ganivi xvrelidan gamosvlis
gavlebuli xaziT, gverdebidan _ Semdeg medialurad ixreba da wveba
dvrilisebr morCsa da akromions atlasis ukana rkalze arsebul RarSi
Soris gavlebuli xazebiT. _ sulcus arteriae vertebralis. Semdeg atlas-
zedapiruli kunTebis qveS qedis kefis ukana apkSi gaivlis da didi
midamoSimdebareobs faSari xvreliT Sedis qalas RruSi. qedis
SemaerTebelqsovilovani Sre, midamoSi igi anastomozebiT
romelSic sisxlZarRvebi da nervebi ukavSirdeba kisris Rrma da kefis
gaivlis. am Srisa da misi momdevno arteriebs.
fasciuri furclis qveS mdebareobs kefis samkuTxedSi, garda amisa,
kefis mokle kunTebi. isini aq qmnian gaivlis kefqveSa, kefis didi da kefis
kefis samkuTxeds, romelic zevidan da mesame nervebi. kefqveSa nervi _ n.
garedan mosazRvrulia Tavis zeda
suboccipitalis kisris pirveli nervis
iribi kunTiT (m. obliquus capitis superior), ukana totia, gaivlis atlasis rkalsa
qvevidan da garedan _ Tavis qveda da xerxemlis arterias Soris.

klinikuri anatomia 86
 zurgis midamo

ainervirebs kefis mcire kunTebs. kefis
didi nervi _ n. occiptalis major gamoeyofa
kisris II nervis ukana tots, Tavis
qveda irib kunTs qvevidan gauvlis,
Tavis naxevrad wvetiani kunTis qveS
zeviT miemarTeba, qedis iogis
maxloblad xvrets naxevrad wvetian
kunTs da trapeciuli kunTis myesSi
arsebuli xvreliT kanqveS gamodis,
totiandeba kefisa da Txemis
midamoebSi. kefis mesame nervi _ n.
occipitalis tertius gamoeyofa kisris III
nervis ukana tots, xvrets naxevrad
wvetian kunTs da nawilobriv an
mTlianad ukavSirdeba kefis did
nervs. kefis mcire nervi _ n. occipitalis
minor gamoeyofa kisris II da III nervebs,
mkerd-laviw-dvrilisebri kunTis ukana
kidesTan kanqveS gamodis, dvrilisebri
morCis ukan zeviT miemarTeba da kefis
midamoSi gadadis.
Tavis naxevrad wvetiani kunTis qveS
mdebare SemaerTebel qsovilSi, garda
amisa, gaivlis kisris Rrma arteria _
a. cervicalis profunda (nekn-kisris Reros
toti), romelic kvebavs kunTebs da
anastomozebiT ukavSirdeba kefisa da
xerxemlis arteriebs. aqvea venuri
wnuli, romelsac qmnis kidris Rrma
da xerxemlis venebi, agreTve kefis
venebTan maTi damakavSirebeli totebi.
limfuri ZarRvebi ixsneba iRliis
kvanZebSi, agreTve kefis kvanZebSi,
romlebic trapeciuli da mkerd-laviw-
dvrilisebri kunTebis zeda boloebs
Soris mdebareoben.

xexemlis svetis “zedapiruli” anatomia

torsis ukana zedapiris (zurgis) kisris SeerTebis adgilze). C1 malas

daTvalierebisas (gansakuTrebiT wvetiani morCi ara aqvs, misi ukana
gverdidan) moCans svetis normaluri patara borcvi arc moCans, arc
nadrekebi. palpaciiT isinjeba wvetiani isinjeba. C3-C5 malebis mokle
morCebis umetesoba, gansakuTrebiT ki gaorkapebuli wvetiani morCebis
maSin, rodesac zurgi moxrilia. gasinjva SeiZleba qedis RarSi, kisris
msuqan individebSic kargad isinjeba kunTebs Soris, Tumca Znelad, kisris
wvetiani morCebi, vinaidan cximi, lordozis gamo, da imis gamoc, rom
Cveulebriv, ar lagdeba zurgis Sua kisris zedapirisagan gamoyofili
xazze. kisris malebs Soris yvelaze arian qedis iogiT. advilad isinjeba
kargad isinjeba C7 malis wvetiani C6 malis sakmaod grZeli,
morCi (warziduli mala). C2 malis gaorkapebuli wvetiani morCi C7 malis
wvetiani morCi aris pirveli Zvlovani wvetiani morCis zemoT (gansakuTrebiT
wertili, romelic moisinjeba kiseris kisris moxrisas). rodesac kiseri da
Sua xazze, Rrmad, kefis gareTa zurgi moxrilia moCans gulmkerdis
SemaRlebis qveS (Tavis yvelaze ukan pirveli malis wvetiani morCic. Tu
gaweuli nawilis qveS _ Tavisa da individi daxrilia, isinjeba wvetiani

klinikuri anatomia 87
 zurgis midamo

morCebis mwvervalebs Soris gaWimuli calmxrivi dislokaciis, an wvetiani

wvetTaSua iogi. C7 malis Semdeg morCis motexilobis Sedegi.
yvelaze grZelia Th1 malis wvetiani Th12 mokle neknis meSveobiT
morCi. gulmkerdis danarCeni malebis (romlis lateraluri bolo isinjeba
wvetiani morCebi kargad esinjebaT iRliis ukana xazze) SesaZlebelia Th12
gamxdar individebs. palpacias viwyebT malis wvetiani morCis amocnoba.
C7 malis qveS, zemodan qvemoT. vinaidan C1 malis ganivi morCis mosinjva
gulmkerdis wvetiani morCebi SesaZlebelia Rrma palpaciiT
erTmaneTs gadafaravs dvrilisebr morCsa da qvedaybis
(kramitiseburad), morCis mwvervalis kuTxes Soris. C6 malis ganivi morCis
done Tanxvdeba ara Sesabamisi morCis wina zedapirze palpaciiT
mwvervalis dones, aramed qveSmdebare SesaZlebelia sakmaod msxvili _
malis sxeulis dones. normaSi saZile borcvis amocnoba. am borcvis
wvetiani morCebis mwvervalebi erT win mdebareobs saZile arteria _
rigSi mdebareobs, maSinac ki rodesac individTa umetesobas gulmkerdis
es rigi Sua xazidan odnav gverZea malebis wvetiani morCebis orive
gaweuli. am rigidan erTi romelime mxares esinjeba ganivi morCebi; Tu
wvetiani morCis gadaadgileba individi moxrilia, esinjeba neknebic
SeiZleba iyos zigapofizuri saxsris _ neknis borcvidan kuTxemde.

zurgis kunTebis “zedapiruli” anatomia

zurgis Sua xazze, malebis zurgis Sua RarSi. isini moCans

wertiliani morCebis mwvervalebis moxril xerxemalze. zurgis Rari
gaswvriv, moCans ukana Sua Rari. mTavrdeba brtyeli samkuTxediT,
kiserze es Rari grZeldeba qedis romelic Seesabameba gavis Zvals.
RarSi. zurgis Rari gansakuTrebiT samkuTxedi qvemoT grZeldeba
Rrmaa gulmkerdis qvemo da welis dundulebSua napralSi.
midamoSi. zurgis gammarTveli kunTebi zemo kidurebis awevis dros beWi
(m. crector spinae) Raris gverdebze qmnian gadadgildeba lateralurad da
vertikalur morgvebs. es kunTebi gamoCndeba rombisebri da didi
kargad isinjeba welis midamoSi, maT mrgvali kunTebi, kargad moCans,
lateralur kideebTan. kanze agereTve, zurgis zedapiruli Sris
aRiniSneba odnav gamoxatuli kunTebic _ trapeciul da zurgis
CaRrmveba. uganieresi.
rodesac individi dgas, welis
malebis wvetiani morCebi Camalulia

klinikuri anatomia 88
 zurgis midamo

asakis gavlena malebze (asakobrivi cvlilebebi)

dabadebidan 5 wlamde welis malebis sxeulebis napirze (diskos

tipiuri malis simaRle 3-jer (5-6 mm- gareTa nawilis boWkoebis mimagrebis
dan 18 mm-de), xolo 5-13 wlis asakSi ki adgilas). gansakuTrebiT ki _ diskos
45-50 %-iT matulobs. simaRleSi zrda wina da ukana napirebTan. osteofitebi
grZeldeba mozardebSic (Wabukobis Cndeba, agreTve, zigapofizuri saxsris
xanaSi, Tumca zrdis tempi CanTis da damatebiTi iogebis
Senelebulia) da mTavrdeba 18-25 wlis mimagrebis adgilas, gansakuTrebiT
asakSi. Suaxnis da moxucebulobis zemo sasaxsre morCTan, maSin, rodesac
asakSi Zvlebis simkvrive da simtkice qvemo morCebis sasaxsre fasetebis
mcirdeba, kerZod _ malis centralur irgvliv aRiniSneba sasaxsre xrtilis
nawilSi, ris gamoc sasaxsre daWimuloba.
zedapirebi SigniT ixreba, amis gamo ki Zvlis an xrtilis aRniSnuli
malis zemo da qvemo zedapirebi cvlilebebi tradiciulad ganixileba
sagrZnoblad Rrmavdeba, xolo rogorc malebis daavadebebi _
malTaSua xrtili sagrZnoblad spondilozi da osteoarTrozi. ufro
amoizniqeba. Zvlis masis Semcireba da marTebulia, isini CavTvaloT
Sedegad malis sxeulis formis asakobriv cvlilebebad, romlebic
cvlileba SeiZleba iyos asakis Seesabamebian garkveuli asakisTvis
matebasTan erTad individis simaRlis damaxasiaTebeli malis normalur
daklebis erTerTi mizezi. malis anatomias, miT umetes, rom xSirad
zedapirebis CaRrmavebis gamo aseT cvlilebebs Tan ar sdevs
radiografiulad aRiniSneba malis tkivili, anu, zogi uCivis tkivils da
periferiuli malTaSua “sivrceebis” zogi _ ara. zogjer erTnairi
Seviwroeba. malTaSua diskos da siZlieris tkivili aqvs rogorc
malebis aseTi erTdrouli umniSvnelo, ise Zlieri
cvlilebebi iwvevs kompresiis morfologiuri cvlilebebis mqone
gaZlierebas malis sxeulis pacientebs. swored amitom, avtorTa
periferiaze _ diskebis erTmaneTTan rigi am, asakTan dakavSirebul
Sexebis adgilas. cvlilebebs ar miiCnevs paTologiad.
osteofitebi (Zvlovani
wanazardebi) Cveulebriv Cndeba

malebis anomaliebi

xandaxan ar xdeba ganivi morCis xerxemlis svetis Tandayolil

epifizis Serwyma da didi sifrTxilea anomaliebs Soris yvelaze xSiria
saWiro, rom ar SegveSalos malis Spina bifida occulta, rodesac ganviTarebis
motexilobaSi (radiografiuli normaluri procesis darRvevis
gamokvlevis an skanirebis dros). Sedegad malis firfitebi erTmaneTs

klinikuri anatomia 89
 zurgis midamo

ar uerTdeba da rCeba xerxemlis arxis an ramodenime malis rkalebis

defeqti (arxi ukanidan Riaa); aseTi defeqtTan erTad aRiniSneba zurgis
Zvlovani defeqtis sixSire Seadgens tvinis garsebis Tiaqari _ Meningocele
mosaxleobis 24%-ze mets da igi, an zurgis tvinis Tiaqari _
Cveulebriv, aRiniSneba welis pirveli Meningomyocele. Meningomyocele-s mZime
malis an gavis pirveli malis doneze. formebs, Cveulebriv, Tan axlavs
defeqti kaniT aris dafaruli, magram nevrologiuri simptomebi _ Sardis
mis lokalizaciaze mianiSnebs am buStis da nawlavebis kontrolis
adglze amosuli Tmebis grova. Spina moSla.
bifida-s mqone individTa umetesobas Spina bifida-s mZime formebi
zurgis problema ar awuxebs. nervuli lulis ganviTarebis
axalSobilis daTvalierebisas defeqtis Sedegia, rodesac
palpaciiT unda Semowmdes malebis embrionuli ganviTarebis pirveli 4
rkalebis intaqturoba xerxemlis kviris ganmavlobaSi ar xdeba nervuli
mTel sigrZeze. Spina bifida-s mZime lulis mTliani daxurva. (nervuli
formaa Spina bifida cystica, rodesac erT lulis qveda nawili rCeba Ria).

malebis variaciebi

adamianebis umetesobas 33 mala aqvs. problemebs da isini vlindeba

ganviTarebis darRvevisas es ricxvi SemTxveviT _ samedicino gamokvlevisas
SeiZleba Semcirdes (32 mala) an (sul sxva mizezis gamo) an gvamis
gadiddes (34 mala). malebis ricxvis seqciisa da autofsiis dros. maTi
variaciebis sixSire gavis Zvlis zemoT codna mainc saWiroa, dazianebis
meryeobs 5_12%-s Soris (normalurad (malis motexilobis) adgilis
24 malaa). malebis raodenobaze dazustebisaTvis. rogorc adamianis,
gavlenas axdens rasa, sqesi, ise sxva ZuZumwovrebis kisris malebis
genetikuri da garegani faqtorebi. raodenoba mudmivia (7), (Jirafis da
malebis raodenobiTi momateba ufro gvelisac). variaciebi ufro
damaxasiaTebelia mamakacebisaTvis, damaxasiaTebelia xerxemlis svetis
Semcireba _ qalebisaTvis; zogierTi welis da gulmkerdis midamoebisaTvis.
rasa gamoirCeva malebis raodenobis zogjer welis malebis ricxvi 5-ze
xSiri variaciebiT. malebis metia, aseT SemTxvevaSi aRiniSneba
raodenobis variaciebs mniSvneloba gulmkerdis malebis raodenobis
aqvs klinikisaTvis. xerxemlis svetis (kompensatoruli) Semcireba.
presakraluri nawilis sigrZis gavis malebis variacebs miekuTvneba
momatebis Sedegad xerxemlis welis e.w. gavis malebis “lumbalizacia”,
midamos qvemo nawili iWimeba, rac rodesac gavis malebis ricxvi
iwvevs misi samoZrao berketis Semcirebulia (4 mala), xolo welis
gadidebas. Tumca aRniSnuli xerxemlis nawili 5-is nacvlad 6
variaciebi xSirad ar qmnis zurgis malas Seicavs, da piriqiT SeiZleba

klinikuri anatomia 90
 zurgis midamo

iyos welis malebis sakralizacia ukavSirdeba rudimentuli kisris nekni.

(welis 4 da gavis 6 mala) aRsaniSnavia, igive unda iTqvas welis malis
rom kisris me-7 mala iwodeba kisris mimarTac.
malad im SemTxvevaSic rodesac mas

kisris neknebi

neknebis anomaliebs Soris aris gamsxvilebuli an TiTqmis

SedarebiT xSiria kisris neknebis pirveli neknis zomisaa. mosalodneli
arseboba (1-2%), es anomalia xSirad garTuleba: es zedmeti nekni
ormxrivia (SemTxvevaTa 60%). am dros (“eqstranekni”) SiZleba daawves
C7 malis neknganivi morCis wina nawili laviwqveSa arterias da mxris wnulis
(anu ganivi morCi) Cveulebrivze metad qveda nawils.

malTaSua diskoebis asakobrivi cvlilebebi

asakis matebasTan erTad adgili birTvi mSralia, marcvlovani da

aqvs rbili birTvis dehidratacias, sruliad waSlilia misTvis
elastinis da proteoglikanebis damaxasiaTebeli, normaluri
dakargvas da am fonze kolagenis struqtura. aseT SemTxvevaSi, simZimis
(proporciulad) momatebas. Sedegad Zalis vertikaluri zewolis dros,
malTaSua diskoebis turgori qreba, daWimulobis didi nawili modis
diskoebi xdeba myife da deformaciis fibrozul rgolze. asakis
mimarT ufro mdgradi. dehidrataciisa momatebasTan erTad rgolis
da kolagenis momatebis gamo diskos firfitebi sqeldeba da maTSi xSirad
or nawils Soris sazRvari iSleba. Cndeba napralebi da Rruebi.
moxucebSi malTaSua diskoebis rbili

klinikuri anatomia 91
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zurgis daavadebebi
zurgis tkivili ukana totebiT (sasaxsre da kunTovani
zurgis tkivili ar aris zurgis totebiT).
daavadebis aRmniSvneli termini. nervul qsovilSi aRmocenebuli
mosaxleobis daaxloebiT 10% tkivili, romelic gamowveulia
yovelwliurad mimarTavs spinaluri nervebis an nervuli
sakonsultaciod eqims CivilebiT fesvebis kompresiiT an gaRizianebiT,
zurgis tkivilis gamo. gamokvleuli vrceldeba maTi gavrcelebis
mosaxleobis 80%-ze meti uCivis segmentebSi _ dermatomebSi; Tumca
zurgis tkivils mTeli sicocxlis tkivili SeiZleba iyos misi
ganmavlobaSi, gansakuTrebiT ki xSiria warmoSobis adgilzec (lokaluri,
Civilebi welis tkivilis gamo, adgilobrivi tkivili).
romelic, Cveulebrivad, Cndeba 30-dan zurgis tvinis garsebis tkivili
70 wlamde asakSi. zurgis dazianeba SedarebiT iSviaTia da igi arc aris
(Back inywies) xSiria sportuli saerTod zurgis tkivilis gamomwvevi
Sejibrebis, industriuli da faqtori.
saavtomobilo katastrofis dros. zurgis lokalur tkivils
zurgis (zogadad) da, kerZod, ZiriTadad miekuTvneba: kunTebis,
welis tkivili janmrTelobis saxsrebis an fibrozuli ConCxis
TvalsazrisiT didi problemaa. Sromis tkivili.
unaris (SromadReebis) dakargvis kunTebis tkivili Cveulebriv aris
mixedviT igi meore adgilzea Tavis refleqsuri, krunCxviTi xasiaTis. is
tkivilis Semdeg. xSirad meoradia, rogorc damcavi
zurgis tkivilis wyaroa am midamos meqanizmi (kunTebis SekumSva tkivilis
5 kategoriis struqtura: molodinSi).
1. fibrozuli ConCxis struqturebi: zigapofizuri saxsris tkivilis
periosteumi, iogebi da malTaSua mizezi ZiriTadad aris an asakobrivi
diskoebis fibrozuli rgolebi osteoartriti an revmatuli arTriti.
2. zurgis tvinis garsebi; tkivili xerxemlis motexilobebis
3. sinovialuri SeerTebani: da dislokaciebis dros ar
zigapofizuri saxsrebis CanTebi; gansxvavdeba sxva Zvlebis analogiuri
4. kunTebi: zurgis sakuTari Rrma dazianebiT gamowveuli tkivilisagan.
kunTebi; mwvave, Zlieri tkivili, umetes
5. nervuli qsovili: malTaSua SemTxvevaSi, miuTiTebs periosteumis
xvrelebidan gamomavali spinaluri dazianebaze, maSin rodesac
nervebi an nervuli fesvebi. dislokaciebis dros aris iogebis
aqedan pirveli oris inervacia tkivili.
xdeba spinaluri nervebis malTaSua diskos Tiaqris dros
meningealuri (Sebrunebuli) totebiT; mwvave lokaluri tkivilis ueWveli
momdevno orisa _ spinaluri nervebis mizezia posterolatelaluri

klinikuri anatomia 92
 zurgis midamo

fibrozuli rgolis gaglejva da magnitur-rezonansuli gamokvleviT _

ukana gaswvrivi iogis dazianeba. MRI (Magnetic Resonance Imaging) _ iT.
zurgis dazianebebis dros saWiroa
pacientis Zalian frTxili gamokvleva atlasis motexiloba da
misi ufro meti dazianebis Tavidan dislokacia
asacileblad da swori mkurnalobis kisris pirveli mala warmoadgens
Casatareblad. magaliTad: Tu Zvlovan rgols, solis formis
avadmyofi zurgis tkivilTan erTad gverdiTi masebiT, romlebic
uCivis kidurebis uZraobas, erTmaneTTan SeerTebulia SedarebiT
SesaZlebelia saqme gvqondes Txeli wina da ukana rkalebiT da
xerxemlis motexilobasTan; amitom ganivi iogiT. imis gamo, rom gverdiTi
saWiroa avadmyofi gaisinjos masebis sqeli nawili gareT aris
mwoliare mdgomareobaSi, radgan mimarTuli, vertikaluri Zalis
mjdomiare an kiserdaxrili poziciis moqmedeba (magaliTad, CayvinTvis dros
dros pacientis gasinjvam SesaZloa auzis fskerze TaviT dacemisas) iwvevs
zurgis tvinis dazianeba gamoiwvios. gverdiTi masebis kompresias kefis
Zvlis rokebsa da aqsiss Soris da
kisris malebis dislokacia atlasis erTi an orive Zvlovani
kavSiri kisris malebs Soris, sxva rkalis motexilobas, xolo Tu qala
malebTan SedarebiT, ufro sustia, sakmarisad Zlieria _ ganivi iogis
maTi sasxsre fasetebis gawyvetasac (e.w. “jefersonis
horizontalurad ganlagebis gamo; motexiloba”_ burst fracture). am dros
amitom mcire Zalis zemoqmedebac mosalodnelia (Tumca ar aris
advilad iwvevs kisris malebis aucilebeli) zurgis tvinis dazianeba,
motexilobas da maT erTmaneTisagan radgan Zvlovani rgolis moculoba
dacilebas _ dislokacias. vinaidan (garSemoweriloba) faqtiurad
kisris midamoSi xerxemlis arxi momatebulia (ix. Tavi “atlasis ganivi
farTea, malebis msubuq dislokacias iogis gawyveta”). radiografiiT
ar sdevs Tan zurgis tvinis dazianeba. vlindeba farTed gadaSlili
igi SeiZleba daziandes malebis gverdiTi masebi. atlasis ganivi iogi
erTdrouli Zlieri dacilebisa da kisris meore malis kbilze ufro
motexilobebis dros (motexiloba- magaria.
dislokacia).
Tu dislokacias Tan ar sdevs aqsisis motexiloba da dislokacia
sasaxsre fasetebis mowyveta, sasaxsre kisris malebis motexilobebs
morCebis SeWmuxvna da gadaadgileba, Soris didi sixSiriT gamoirCeva
maSin SesaZlebelia kisris malebis aqsisis motexiloba (SemTxvevaTa 40 %-
TviTaRdgena (TviTgankurneba) ise, rom ze meti). Cveulebriv, xdeba im
rentgenologiurma gamokvlevam Zvlovani svetis motexiloba,
SeiZleba arc aCvenos zurgis tvinis romelsac qmnian aqsisis zemo da qvemo
dazianeba. rbili qsovilebis sasaxsre morCebi. am motexilobas
dazianebis gamovlena SesaZlebelia klinikaSi travmuli spondilozi

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 zurgis midamo

ewodeba. igi viTardeba Tavis, an atlasis ganivi iogis gawyveta

erTdroulad Tavisa da kisris, atlasis ganivi iogis gawyvetis
Zlieri gaSlis (hipereqstenziis) Sedegad aqsisis kbili Tavisufldeba,
Sedegad. rac iwvevs atlas-aqsisis Sua saxsris
Tavis aseTi hipereqstenzia RrZobas an nawilobriv dislokacias.
gamoiyeneboda sikvdilmisjilTa igive SeiZleba moxdes ganivi da
CamosaxrCobad (yulfi Tavsdeba nikapis mezobeli iogebis paTologiuri
qveS da xdeba sxeulis swrafi vardna darbilebis dros, rac Tavis mxriv
sigrZeze). amitom am motexilobas SemaerTebeli qsovilis dazianebis
“CamoxrCobilis” motexilobas Sedegia. daunis sindromiT daavadebul
uwodeben (hangmans fracture). adamianTa 20 %-s aReniSneba ganivi
dazianebaTa calkeul SemTxvevaSi, iogis moduneba da ganuviTarebloba.
rodesac adgili aqvs mesame malis zurgis tvinis kompresiis mizezi,
nawilobriv an srul gadanacvlebas ufro xSirad, SeiZleba iyos ganivi
meore malis win (nawilobrivi an iogis gawyveta an misi
sruli dislokacia), SeiZleba ganuviTarebloba da ara aqsisis
daziandes zurgis tvini da tvinis kbilis motexiloba. motexili kbilis
Rero, rasac moyveba kvadriplegia fragmenti ganiv iogTan erTad
(oTxive kiduris dambla) an sikvdili. gadainacvlebs atlasis wina rkalisken
aqsisis dazianebaTa Soris xSiria, da atlasi da kbili moZraobs rogorc
agreTve, misi kbilis motexiloba erTi mTliani, saTanado iogebis
(SemTxvevaTa 40-50 %), rac SeiZleba ararsebobis gamo. SesaZloa moxdes
iyos Tavze horizontalurad zurgis tvinis kisris midamos zeda
mimarTuli dartymis (a horizontal blou to nawilis kompresia atlasis ukana
the head) an osteopeniis (Zvlis masis rkalsa da aqsisis kbils Soris, rac
paTologiuri ganleva) Sedegi. gamoiwvevs oTxive kiduris damblas _
Cveulebriv, motexiloba xdeba kbilis kvadriplegias, an mogrZo tvinis
fuZesTan, anu malis sxeulisa da dazianebas da sikvdils.
kbilis SeerTebis adgilas. motexili atlasis rgolis daaxloebiT 1/3
nawilebi xSirad ar xorcdeba, uWiravs kbils, 1/3 zurgis tvins,
vinaidan am dros SesaZloa maT Soris darCenili 1/3 ki warmodgenilia
atlasis ganivi iogis SeWra, rac siTxis Semcveli sivrciT da
iwvevs fragmentebis sisxliT qsovilebiT, romlebic gars akravs
momaragebis Sewyvetas da usisxlo zurgis tvins (Steil Rule of Thirds). amiT
nekrozis ganviTarebas. aseve xSiria aixsneba is, rom zogierT pacients
malis sxeulis motexiloba kbilis (romelTa atlasi win aris
fuZis qveS. es motexiloba SedarebiT gadanacvlebuli) ara aqvs Civilebi
swrafad inkurneba, vinaidan motexil manamde, vidre ar gaakeTebs did
fragmentebs SenarCunebuli aqvT moZraobas (atlasis rgolis diametris
sisxliT momarageba. kbilis 1/3-ze ufro met moZraobas). zogjer
motexiloba SeiZleba iyos normaluri kraniovertebraluri midamoSi anTebac
osifikaciis darRvevis Sedegic. iwvevs kraniovertebraluri iogebis

klinikuri anatomia 94
 zurgis midamo

darbilebas da atlas-aqsisis saxsris ramodenime malis msxvrevad an

dislokacias. agreTve, pacientis kompresiul motexilobas. Tu malis
ucabedma moZraobam (mag. sawolidan metismetad (gadaWarbebul) win
skamze swrafad gadajdomam) SeiZleba moZraobas daemTxva kompresia, maSin es
gamoiwvios kbilis ukan gadanacvleba mala gadainacvlebs mis qveS mdebare
da zurgis tvinis dazianeba. malis win (mag. C6 an C7 malebis
dislokacia). am dros, Cveulebriv,
frTisebri iogebis gawyveta aRiniSneba ori mezobeli malis
frTisebri iogebi atlasis ganiv sasaxsre fasetebis motexiloba da
iogze ufro sustia, amitom dislokacia da wyvetTaSua iogebis
erTdroulad Tavis moxrisa da gawyveta. xerxemlis svetis dazianebas
brunvis Sedegad SeiZleba erTi an (misi Zlieri moxris dros) Tan sdevs
orive frTisebri iogis gawyveta. erTi zurgis tvinis gamousworebeli
iogis gawyvetisas moZraobis dazianeba.
amplituda sapirispiro mxares kisris ucabedma Zlierma gaSlamac
daaxloebiT 30 %-iT izrdeba. SeiZleba daazianos xerxemlis sveti
da zurgis tvini. hipereqstenziiT
spinaluri kvanZis kompresia kisris dazianeba mosalodnelia
Tumc iSviaTad, atlant-aqsisis burTis TaviT dartymisas (fexburTis
saxsarSi brunvam SeiZleba gamoiwvios TamaSis dros). aseTi Zlieri
zurgis tvinis C2 nervis kompresia. hipereqstenzia xSirad azianebs malis
kisris metismetad gaSlisas ukana nawilebs, iwvevs malebis
(hipereqstenzia) Tavis gverdze rkalebisaAda maTi morCebis msxvrevad
mobrunebis dros SesaZlebelia C2 da kompresiul motexilobas. kisris
nervis kompresia C1 da C2 malebs malebis motexilobis dros tkivili
Soris, rasac SeiZleba moyves Tavis aRiniSneba kisris dorsalur da beWis
xangrZlivi tkivili da kefa-kisris midamoSi, radganac mgrZnobiare
midamos Zlieri tkivili. kvanZebSi da zurgis tvinis (Sesabamis)
segmentebSi modis tkivilis impulsebi
xerxemlis svetis malebis aramarto malebidan, aramed kisris
motexilobebi da dislokaciebi kunTebidanac. kisris hipereqstenziis
ucabedi gadaWarbebuli, naZaladevi dros Zlier iWimeba xerxemlis wina
moZraoba, an xerxemlis ama Tu im gaswvrivi iogi da SesaZlebelia misi
regionisaTvis atipuri moZraoba gawyvetac. xerxemlis dazianeba
SeiZleba gaxdes xerxemlis svetis SeiZleba gamoiwvios, agreTve,
motexilobis an dislokaciis, an hipereqstenziis Semdeg Tavis uecarma
erTdroulad motexiloba- Zlierma moxram (hiperfleqsia) (Tavi
dislokaciis mizezi. ucabedi Zlieri ucbad, mkveTrad ecema mkerdze,
moxra, rasac adgili aqvs “rikoSetulad”). am dros
saavtomobilo katastrofis dros an mosalodnelia xerxemlis wina
Tavis Zlieri (naZaladevi) gadaxra gaswvrivi iogis gawyveta da mezobeli
gverdze xSirad iwvevs erTi an C2 an C3 malebis fibrozuli

klinikuri anatomia 95
 zurgis midamo

rgolebis dazianeba. aseT SemTxvevaSi Seviwroebas. igi SeiZleba iyos

Tavi (cranium), kisris pirveli mala da memekvidroebiTi anomalia. aseTi
meore malis wina nawili (kbili da individebi advilad eqvemdebarebian
sxeuli) scildeba Rerzul ConCxs da malebis asakobriv degeneraciul
ziandeba zurgis tvini. (ix. Tavi: cvlilebebs. Cveulebriv maqsimaluri
“aqsisis motexiloba da dislokacia). Seviwroeba aRiniSneba malTaSua
aseTi mZime dazianebisas adamiani diskos midamoSi. welis malebis
iSviaTad gadarCeba. fexburTi, yvinTva, Seviwroebam SeiZleba gamoiwvios
cxenidan gadmovardna, motokoliziebi xerxemlis arxis qvemo nawilSi
_ velosipediT an motocikletiT mdebare erTi an ramdenime nervuli
moZraobisas TaviT Sejaxeba iwvevs fesvis kompresia. eleqtromiografiiT
motexilobas upiratesad xerxemlis vlindeba im kunTebis inervaciis
svetis kisris nawilSi. simptomebi: yru moSla, romlebic inervirdeba wel-
tkivilebidan dawyebuli moZraobis da gavis nervebiT.
mgrZnobelobis TandaTanobiT mkurnaloba xdeba qirurgiulad _
moSlamde. lamineqtomiiT (ix. Tavi
gulmkerdisa da welis malebis “lamineqtomia”). Tu lumbaluri
dislokacia SedarebiT iSviaTia stenozis mqone pacients aReniSneba
sasaxsre morCebis erTmaneTTan mWidro malTaSua diskos gamobervac, es kidev
kavSiris gamo (naklebad moZravi ufro aviwroebs xerxemlis arxs,
saxsrebis gamo). xerxemlis svetis romelic isedac Semcirebulia
naklebad moqnili gulmkerdis arTrituli proliferaciisa da
midamodan bevrad ufro moZrav _ iogebis degeneraciis Sedegad.
welis midamoSi gadasvla xdeba
uecrad. amitom kisris malebis Semdeg rbili birTvis Tiaqari
xerxemlis sxva malebTan SedarebiT axalgazrda individebs Zlier
yvelaze xSiria _ gulmkerdis magari malTaSua diskoebi aqvT, amitom
meTerTmete da gansakuTrebiT dacemisas ufro xSiria malis
meTormete malis motexiloba (“broken motexiloba, vidre diskos gagleja.
neck”, broken back). L5 malis rkalis amasTan rbili birTvis turgori
saxsarSida nawilis uqonlobam an wylis didi Semcvelobis gamo
motexilobam (L5-s spondilozi) (daaxloebiT 90%) Zlier maRalia.
SeiZleba gamoiwvios am malis sxeulis miuxedavad amisa, xerxemlis svetis
gadanacvleba S1 malis win Zlierma moxram (hiperfleqsiam)
SesaZlebelia gamoiwvios diskos
(Spondylolisthesis), rasac moyveba (Tumca
gagleja da mezobeli malis
ar aris aucilebeli) gavis zeda
motexiloba. moxra winisken iwvevs
nawilSi raSis kudis nervebze zewola
xerxemlis kompresias da ukanidan mis
da zurgisa da qvemo kiduris tkivili.
daWimvas. am dros rbili birTvi
lumbaluri stenozi
Sesrialdeba ukan _ fibrozuli
lumbaluri stenozi ewodeba welis
rgolis Txel nawilSi. fibrozuli
erTi an ramodenime malis xvrelis
rgolis degeneraciis SemTxvevaSi

klinikuri anatomia 96
 zurgis midamo

rbili birTvis Tiaqari SeiZleba gamokvlevisas) da nervuli fesvis

SeiWres xerxemlis arxSi da daawves ufro met kompresias. miT umetes, Tu
zurgis tvins, an raSis kudis nervul amave dros malTaSua xvrelis irgvliv
fesvebs. diskos Tiaqris nacvlad aris Zvlis hipertrofia
xSirad ixmareba araswori (osteofitebi).
(Seuferebeli) gamoTqma “dacurebuli imis gamo, rom asakis momatebasTan
disko” (“Slipped disc”). sportis (daberebasTan) erTad adgili aqvs
mimomxilvelebi mas “gaglejil rbili birTvis normaluri
diskos”-ac (“ruptured disc”) uwodeben. struqturis SesamCnev moSlas (Zlieri
rbili birTvis Tiaqari Cndeba diskos dehidratacia, fibrozi, gamagreba,
ukana- gverdiT (posterolateralur) marcvlovaneba), Zalzed rTuldeba
nawilSi, sadac fibrozuli rgoli mwvave Tiaqris diagnozis dasma.
SedarebiT Txelia da ar aris mosalodnelia, rom aseT SemTxvevaSi
gamagrebuli xerxemlis wina da ukana nervuli fesvebis kompresia
gaswvrivi iogebiT. nervul fesvebTan gamoiwviosmalTaSua xvrelSi nervis
siaxlovis gamo posterolateralur irgvliv gaZlierebulma osifikaciam.
Tiaqars Tan axlavs tkivili. tkivili
aris ori saxis: mwvave (Cveulebriv, lumbago
lokaluria) da qronikuli. mwvave lumbago _ welis mwvave xasiaTis
tkivilis mizezia Tiaqris zemoqmedeba tkivilia, romelsac iwvevs L5-S1-is
gaswvriv iogebze da fibrozuli malTaSua diskos
rgolis periferiaze, agreTve qimiuri posterolateraluri Tiaqari,
gaRizianebis Sedegad ganviTarebuli rodesac igi awveba am midamos
adgilobrivi anTeba. qimiur tkivilis receptorebs, mag. ukana
gaRizianebas, Tavis mxriv, iwvevs gaswvriv iogSi. klinikuri suraTi
dazianebuli (gaglejili) rbili Zlier cvalebadia, magram misi
birTvidan warmoqmnili nivTierebebi. ZiriTadi simptomi aris welis mwvave,
qronikuli tkivili gamowveulia SeteviTi xasiaTis tkivili. welis
Tiaqris zemoqmedebiT nervul tkivili asocirebulia kunTebis
fesvebze. tkivili aRiniSneba fesvebis spazmTan. am dros aRiniSneba
Sesabamis sainervacio areSi xerxemlis svetis welis midamos
(dermatomaSi). daWimuloba da kunTebis iSemiis
yvelaze msxvili malTaSua diskoebi Sedegad gamowveuli krunCxvebi, ris
aris welisa da wel-gavis midamoSi, gamoc moZraoba am midamoSi xdeba
Sesabamisad moZraobac aq bevrad ufro mtkivneuli. mkurnalobis Sedegad
Tavisufalia. amitom am midamoSi lumbagos tipis welis tkivili
yvelaze ufro xSiria rbili birTvis Cveulebriv ramodenime dReSi Cacxreba,
posterolateruli Tiaqari. aqedan Tumca SeiZleba gadaizardos iSiazSi.
SemTxvevaTa daaxloebiT 90 % modis
L4-L5, L5-S1 malebis Tiaqrebze. mwvave iSiazi
Tiaqari iwvevs malTaSua xvrelis iSiazs xSirad iwvevs L5-S1 malTaSua
daviwroebasac (moCans radiografiuli diskos Tiaqari, romelic awveba

klinikuri anatomia 97
 zurgis midamo

sajdomi nervis L5-S1 komponentebs. malTaSua diskos Tiaqari kisris

iSiazis dros aRiniSneba welis da midamoSic iseve xSiria, rogorc
TeZos tkivili, romelic vrceldeba welis midamoSi. kisris ucabedi
qveviT _ barZayis ukana zedapirze da Zlieri moxra _ hiperfleqsia (mag.
kanWis midamoSi. welis midamos fexburTis TamaSis dros TavebiT
malTaSua xvrelebis zoma mcirdeba, Sejaxebisas) xSirad iwvevs malTaSua
welis nervebi ki msxvildeba, riTac diskos gaglejas malis motexilobis
unda aixsnas iSiazis didi sixSire. gareSe. kisris midamoSi malTaSua
asakis matebasTan erTad disko mdebareobs malTaSua xverelis
(daberebasTan erTad) zigapofizuri wina kideSi centralurad, amitom
saxsrebis an malTaSua xvrelebis diskos Tiaqari daawveba praqtikulad
posterolateruli kideebis irgvliv Tiaqris zemoT, da ara mis qvemoT,
Cndeba Zvlovani wanazardebi gamomaval nervs (gansxvavebiT welis
(osteofitebi), rac kidev ufro midamosagan). magram Tu gavixsenebT,
aviwroebs am xvrelebs da iwvevs mwvave rom kisris nervebi gamodian
tkivilis SegrZnebas qvemo kidurSi. Sesabamisi malis zemoT, maSin iseTive
nebismieri moZraoba, romelic Wimavs urTierToba rCeba diskos Tiaqarsa da
sajdom nervs, (magaliTad barZayis TiaqriT dazianebul nervs Soris,
moxra gaSlili muxlis dros) rogorc welis midamoSi. ase
aZlierebs diskos TiaqriT gamoWveuli magaliTad, C5-C6 malTaSua diskos
tkivils, Tumca zogierT invalids Tiaqari awveba C6 nervs, xolo C6 -C7
tkivili SeiZleba Seumsubuqdes kidec). diskos Tiaqari _ C7 nervs. kisris
malTaSua diskoebis dazianeba malTaSua diskos Tiaqari tkivils
SeiZleba gamoiwvios, agreTve, iwvevs kisris, beWis, mklavisa da
xerxemlis svetis Zlierma (mkveTrma, xelis midamoSi.
naZaladevma) brunvam an moxram. am kisris da welis midamoSi rbili
dros, rogorc wesi, xdeba diskos birTvis Tiaqris didi sixSire
qvemoT mdebare nervuli fesvis aRiniSneba sportis iseTi saxeebis
kompresia. ase, magaliTad, L4 - L5 diskos dros, rogorocaa CogburTi,
Tiaqris dros xdeba L5 nervis fexburTi, hokei, mZleosnoba (simZimis
kompresia, xolo L5-S1 diskos Tiaqris aweviT), tanvarjiSi, romelTa dros
dros _ S1 nervis kompresia. adgili aqvs am midamoebis grexiT
gavixsenoT, rom gulmkerdis da welis moZraobas da didi Zalis
midamoSi malTaSua disko qmnis zemowmedebas.
malTaSua xvrelis wina kidis qvemo
naxevars, xolo xvrelis zemoT zurgis tvinis vaskularizacia da
mdebare malis Zvali _ zemo naxevars. zurgis tvinis iSemia
zurgis tvinis nervi gaivlis xvrelis zurgis tvinis sisxliT
Zvlovan nawilTan. amiT aixsneba, rom momaragebisaTvis, garda zurgis tvinis
L4-L5, malTaSua diskos Tiaqari wina da ukana arteriebisa (xerxemlis
azianebs ara L4-s, aramed L5 nervs. arteriebisa da naTxemis ukana qvemo
arteriebis totebi) didi mniSvneloba

klinikuri anatomia 98
 zurgis midamo

aqvT segmentur (wina da ukana) qveda midamoebSi, yvela saxis

tvinovan arteriebsac (segmental mgrZnobelobis da nebiTi moZraobis
medullary arteries), romlebic gamoeyofa dakargvas (paraplegias) da, amave
xerxemlis, kisris gaswvriv, kisris dros, neironebis sikvdils zurgis
Rrma, nekTaSua, welis da gavis tvinis im nawilSi, romelsac sisxliT
lateralur arteriebs. segmentur amaragebs zurgis tvinis wina arteria.
arteriebs Soris yvelaze msxvilia _ paraplegiis mimdinareoba (misi
didi wina segmenturi tvinovani gaumjobeseba an gauareseba)
arteria (dwsta). individTa damokidebulia iseT faqtorebze,
daaxloebiT 65%-s aqvs kargad rogoricaa: pacientis asaki, dazianebis
gamoxatuli marcxena dwsta, igi simZime da aortis okluziis
aZlierebs (reinforces) zurgis tvinis 2/3- xangrZlivoba.
is cirkulacias, wel-gavis
Semsxvilebis CaTvliT. aRniSnuli zurgis tvinis dazianebebi
arteria, Cveulebriv, gamoeyofa xerxemlis arxis moculoba da
neknTaSua qvemo an welis zemo forma SesamCnevad icvleba xerxemlis
arterias da Sedis xerxemlis arxSi gaswvriv, mis sxvadasxva doneze.
gulmkerdis qvemo an welis zemo gansakuTrebiT es kargad Cans kisris
malTaSua xvrelidan. da welis nawilSi. kerZod, kisris
xerxemlis motexilobebis da nawilSi arxi viwroa, masSi zurgis
dislokaciebis dros irRveva zurgis tvini mWidrod exeba arxis kedlebs,
tvinis sisxlmomarageba rogorc rac potenciurad qmnis safrTxes,
zurgis tvinis arteriebidan, ise vinaidan kisris malebis mcire
segmenturi arteriebidanac. sisxlis motexilobis da dislokaciis drosac
miwodebis Semcireba (iSemia) iwvevs ki SeiZleba daziandes zurgis tvini.
kunTebis dasustebas da damblas. xerxemlis arxSi kisris malTaSua
zurgis tvinis sisxliT momaragebis diskos gamobervam SeiZleba
Semcireba SeiZleba gamoiwvios, gamoiwvios zurgis tvinis Soki (spinal
agreTve, segmenturi tvinovani cord shock) da dazianebuli diskos
arteriebis, kerZod ki, didi wina qveviT mdebare midamoebis dambla.
segmenturi tvinovani arteriis zogjer gamokvleviT arc ki vlindeba
Seviwroebamac. malis motexiloba an dislokacia, da
mxolod individis sikvdilis
aortis droebiTi okluzia (cross SemTxvevaSi, autofsiis dros dgindeba
clamped) gamoberili diskoTi zurgis tvinis
qirurgiuli operaciebis dros an darbileba _ welis midamoSi
anevrizmis Sedegad aortis kedlis malTaSua diskos SeWriT, yviTeli
dazianeba an didi wina segmenturi iogis SeSupebiT an zogoapofizuri
tvinovani arteriis okluzia iwvevs saxsris osteoarTritiT. xerxemlis
zurgis tvinis funqciis moSlas, arxis Seviwroebis dros xdeba raSis
sisxlis miwodebis darRvevas sxeulis kudis erTi an ramdenime nervul
fesvis kompresia, rac vlindeba

klinikuri anatomia 99
 zurgis midamo

dazianebuli nervebis gavrcelebis (orive qvemo koduris dambla).

midamoSi mgrZnobelobisa da pacientis mier sxeulis (torsis)
moZraobis moSliT. welis kontrolis unari damokidebulia
spondilizic (saxsris degeneraciuli dazianebis doneze.
dazianeba) iwvevs adgilobriv T10-L1 _ SenarCunebulia barZayis
(lokalur) tkivils da rigidobas. zogierTi kunTis funqcia.
zurgis tvinis ganivad gadakveTas L2-L3 _ SenarCunebulia kanWis
mosdevs mgrZnobelobis da nebiTi umetesi kunTebis funqcia.
moZraobebis dakargva dazianebuli
adgilis qvemoT. tvinis Reros sisxliT momaragebis
zurgis tvinis sxvadasxva doneze moSla
ganivad gadakveTis (transeqciis) tvinis Reros sisxliT momaragebis
Sedegebi: mTavari wyaroa xerxemlis arteriebi,
C1-C3 _ pacientis mdgomareoba amitom maTi dazianeba (mag. arteriis
mZimea, sasikvdiloa. skleroziT) iwvevs tvinis aRniSnuli
C4-C5 _ sunTqva SenarCunebulia, nawilis funqciis darRvevas. individi
magram aRiniSneba kvadriplegia uCivis Tavbusxvevas (Tavis
(oTxive kiduris funqciis moSla). xangrZlivad ukan mobrunebis dros);
C6-C8 _ gamoxatuli aqvs xelis da, vlindeba sxva klinikuri simptomebic,
saerTod. zemo kiduris sxvadasxva romlebic miuTiTeben tvinis Reros
funqciis moSla. SeuZlia TviTon sisxliT momaragebis Seferxebaze.
Wamos, ataros savarZeli.
T1-T9 (kisris da wel-gavis
Semsxvilebebs Soris) _ paraplegia

samkurnalo manipulaciebi
lumbaluri punqcia dazianebis SefasebisaTvis. punqcia
punqciiT iReben Tav-zurgis tvinis Cveulebriv keTdeba L3-L4 an L4-L5
siTxes. Tav-zurgis tvinis (Tzt) malebis wvetian morCebs Soris
siTxes didi mniSvneloba aqvs Tavisa arsebul sivrceSi aseptikis dacviT da
da zurgis tvinis trofikisaTvis. igi anezTeziis pirobebSi. (TeZos Zvlebis
icavs agreTve maT meqanikuri qedebis umaRlesi SemaerTebeli
biZgebisagan. centraluri nervuli sibrtye gadis L4 malis wvetian
sistemis (cns) sxvadasxva daavadebisa morCze).
da tvinis garsebis anTebis (meningitis) procedura: pacienti wevs gverdze.
dros icvleba siTxis ujreduli qvemo kidurebi moxrilia ise, rom
Semadgenloba, maTi koncentracia, muxlebi mibjenilia gulmkerdTan.
SesaZlebelia siTxeSi moxvdes aseT mdgomareobaSi izrdeba manZili
sisxlic. amitom Tzt-is siTxis wvetian morCebsa da malebis rkalebs
gasinjvas aqvs sadiagnostiko Soris, iWimeba yviTeli iogebi. nemsi
mniSvneloba cns-is sxvadasxva SehyavT 4-6 sm sigRrmeze (msuqan

klinikuri anatomia 100

 zurgis midamo

individebSi odnav ufro Rrmad). nemsi epiduruli blokada _ keTdeba an

xvdeba qselqveSa sivrceSi _ welis, lumbaluri punqciiT, an gavis arxis
anu saboloo cisternaSi. (amitom Sesavlidan (kaudaluri epiduruli
ewodeba punqcias lumbaluri). blokada).
cisternaSi moTavsebulia raSis kudi,
amitom lumbaluri punqciis dros lamineqtomia
safrTxe imisa, rom zurgis tvini lamineqtomia ewodeba xerxemlis
daziandes, ar aris. normalurad svetis romelime nawilSi erTi an
punqciis dros, nemsidan gamodis 1 ramdenime malis wvetiani morCis
wveTi 1 wamis ganmavlobaSi. Tu amokveTas Sesabamisi malis rkalis
qselqveSa sivrceSi wneva didia, siTxe firfitasTan erTad. (amave terminiT
gadmodis nakadis saxiT. aRiniSneba agreTve rkalebis amokveTa
punqciis gakeTeba ar SeiZleba rkalebis fexebis ganivad gadakveTis
intrakranialuri wnevis dros. es gziT).
ukanaskneli unda winaswar Semowmdes lamineqtomia arsebobs qirurgiuli
pacientis kompiuteruli da anatomiuri (saseqcio
topografiuli skanirebiT (kts), laboratoriaSi gvamis gakveTis dros).
Semowmeba SeiZleba Tvalis fskeris igi gamoiyeneba xerxemlis arxis
gasinjviTac _ oftalmoskopiiT. gasaxsnelad _ zurgis tvinTan da
punqcia keTdeba ara marto zurgis tvinis nervebis fesvebTan
diagnostikis mizniT, aramed cns-is (mgrZnobiare) ukanidan misdgomisaTvis.
daavadebis mkurnalobis mizniTac lamineqtomia Cveulebrivad keTdeba
(Tzt-is siTxeSi sxvadasxva welis II malis doneze. qirurgiul
samkurnalo preparatis Seyvana). lamineqtomias xSirad mimarTaven
zurgis tvinis an zurgis tvinis
zurgis tvinis blokada nervebis fesvebis simsivnis, xerxemlis
saanezTezio saSualeba SehyavT Tiaqris (malTaSua diskoebis Tiaqris),
Tzt-is siTxeSi (ix. “lumbaluri an Zvlis hipertrofiis (Warbi zrdis)
punqcia”), gautkivareba xdeba 1 wuTSi. dros.
blokadam SeiZleba gamoiwvios Tavis
tkivili lumbaluri punqciis dros
Tzt-is siTxis gadinebis gamo.

klinikuri anatomia 101

 zurgis midamo

zurgis midamos samedicino gamokvleva

kompiuteruli tomografia (kt) demineralizacias. radiografiuli

kt-iT SiZleba Tavisa da zurgis gamokvleviT am dros vlindeba malis
tvinis TeTri da ruxi nivTierebebis sxeulis Rrublisebri nivTierebis
erTmaneTisagan garCeva. mas iyeneben simkvrivis dakleba, ris gamoc
agreTve xerxemlis svetis ukeTesad moCans Txeli kompaqturi
motexilobebis, zurgis tvinis nivTiereba.
dazianebis (kompresiis) xarisxis da osteoporozis gvian stadiaze
Tandayolili anomaliebis dasadgenad. (daavadebis Sors wasuli SemTxveva)
malebis kompaqtur nivTierebaSi radiografiam SeiZleba gviCvenos
advilad gaivlis retgenis sxivebis malebis kolafsi (kompresiuli
umetesoba, amitom skanirebis dros motexiloba) da gulmkerdis
malebi moCans TeTrad. malTaSua gadidebuli kifozi.
diskoebi gamoirCevian ufro didi osteoporozi ZiriTadad
simkvriviT, vidre epidurul sivrceSi damaxasiaTebelia gulmkerdis
moTavsebuli cximovani qsovili da malebisaTvis, Tumca igi SeiZleba
Tav-zurgis tvinis siTxe. amitom kt-iT ganviTardes xerxemlis nebismier
SeiZleba malTaSua diskoebis Tiaqrisa malaSi.
da maTi gadaadgilebuli fragmentebis osteoporoziT ufro xSirad
amocnoba. avaddebian qalebi menopauzis Semdeg.

radiografia mielografia
xerxemlis svetis gadaReba xdeba mielografia aris zurgis tvinis
winidan, ukanidan da gverdebidan. es da nervuli fesvebis radiografiuli
aris Zlier warmatebuli kvlevis gamokvleva. lumbaluri punqciiT
meTodi iseTi maRali kontrastuli gamoaqvT Tav-zurgis tvinis siTxe
struqturis mqone qsovilis qselqveSa sivrceebidan da mis
gamosakvlevad, rogoricaa Zvali. nacvlad SehyavT sakontrasti
radiografiiT SesaZlebelia malebis nivTiereba. am meTodiT SeiZleba
sxeulebis osteoporozis dadgena. qselqveSa sivrcis daTvaliereba.
(osteoporozi aris Zvlebis daavadeba, kontrastuli nivTiereba vrceldeba,
romelic gamowveulia nivTierebaTa agreTve, nervuli fesvebis irgvliv,
cvlis moSliT). radiografiulad am magari garsis qveS.
dros aRiniSneba malebis sxeulebis
horizontaluri _sayrdeni firfitebis magnituri rezonansiT kvleva (mrk)
gaqroba. samagierod, kargad moCans magnituri rezonansiT gamokvleva
gamsxvilebuli vertikaluri xdeba kompiuteriT iseve, rogorc
firfitebi gaswvrivi zolebis saxiT. kompiuteruli tomografiis dros,
osteoporozis adreul stadiaze mxolod im gansxvavebiT, rom am dros
adgili aqvs Zvlebis ar gamoiyeneba X_ sxivebi. es meTodi

klinikuri anatomia 102

 zurgis midamo

idealuria xerxemlis svetis, zurgis kvlevis meTods mielografiasa da

tvinis da Tav-zurgis tvinis siTxis kompiuterul tomografiastan
gamosakvlevad, radgan igi saSualebas SedarebiT, radgan igi ufro
gvaZlevs naTlad davinaxoT malTaSua efeqturia zurgis tvinisa da nervuli
diskos komponentebi da maTi kavSiri fesvebis kompresiis da malTaSua
rogorc malebis sxeulebTan, aseve diskoebis degeneraciuli cvlilebebis
gaswvriv iogebTan; agreTve, rbili dasadgened. mrk aris, agreTve,
birTvis Tiaqari da misi zemoqmedeba idealuri damzogveli procedura
nervul fesvebze. zurgis tvinisa sa nervuli fesvebis
sul ufro da ufro xSirad struqturuli dazianebis
mimarTaven magnituri rezonansiT diferenciuli diagnozisaTvis

klinikuri anatomia 103

 zemo kiduri

zemo kiduri _ membrum superius

kiduris ConCxi _ sceleton membri

zemo kidurSi arCeven sartyels _ nawilad: maja _ carpus, nebi _

cingulum membri superioris da Tavisufal metacarpus da TiTebi _ digiti manus.
nawils _ pars libera membri superioris. zemo kiduri umagrdeba
sartyels ekuTvnis ori Zvali: torss sartyelis saSualebiT
laviwi _ clavicula da beWi _ scapula; Semdegnairad: laviwi Tavisi samkerde
Tavisufal nawilSi arCeven sam boloTi uerTdeba mkerdis tars,
nawils: mxars _ brachium, wina mxars _ akromionis boloTi ki _ beWis Zvlis
antebrachium da mtevans _ manus, akromions. beWi gulmkerdis ukana
romelic Tavis mxriv iyofa sam zedapirze mdebareobs da Tavis mxriv
enawevreba mxris Zvals.

zemo kiduris sartyeli _ cingulum membri superioris

laviwi _ clavicula laviwis iogis CanaWdevi _ impression lig.

laviwi warmoadgens grZel,
laTinuri aso S magvarad modrekil
Zvals, romelsac aqvs ori bolo:
samkerde bolo _ extremitas sternalis da
akromionis bolo _ extremitas acromialis.
laviwis SigniTa 2/3 qmnis nadreks
mimarTuls win, gareTa 1/3 nawili ki _
nadreks mimarTuls ukan.
laviwis samkerde bolo
momrgvalebulia, gasqelebulia da mas
darTuli aqvs sasaxsre zedapiri _
facies articularis sternalis, romliTac igi
mkerdis Zvals enawevreba. akromionis
bolo gabrtyelebulia zevidan qveviT
da aqvs sasaxsre zedapiri _ facies
articularis acromialis, romliTac igi
akromionis sasaxsre zedapirs
enawevreba; laviwis zeda zedapiri
sadaa, qveda ki xorkliania, sadac
ganirCeva medialurad mdebare nekn-
costo-clavicularis, lateralurad mdebare
konusisebri xorkli _ tuberculum
conoideum da trapeciuli xazi _ linea
trapezoidea.
beWi _ scapula
beWi warmoadgens samkuTxedis
moyvanilobis brtyel Zvals. masze
arCeven or zedapirs: saneknes _ facies
costalis da zurgisas _ facies dorsalis; sam
kides _ zedas _ margo superior, SigniTas
_ margo medialis da gareTas _ margo
lateralis da sam kuTxes _ zeviTa kuTxe _
angulus superior, gareTa kuTxe _ angulus
lateralis da qvemo kuTxe _ angulus inferior.
beWis sanekne zedapiri odnav
Sedrekilia da ewodeba beWqveSa foso
_ fossa subscapularis; masze gamoxatulia
ramdenime kunTovani xazi.
beWi mdebareobs gulmkerdis ukana
kedelze me-2 _7 neknebs Soris. misi

klinikuri anatomia 104


dorsaluri zedapiri odnav
gamodrekilia da beWis qediT _ spina
scapulae iyofa or fosod: zeviTa
patara qedzeda foso _ fossa supraspinata
da qveviTa didi qedqveSa foso _ fossa
infraspinata.
beWis qedis bolo miemarTeba gareT,
sqeldeba da qmnis did masiur morCs,
Sebrtyelebuls zevidan qveviT; es
morCi cnobilia akromionis _ acromion
_ saxelwodebiT. am morCs darTuli
aqvs sasaxsre zedapiri _ facies articularis
acromii laviwTan SesaerTeblad; beWis
zeviTa kides aqvs patara naWdevi _
incisura scapulae. am naWdevis gverdiT
beWis gareTa kuTxidan iwyeba
niskartisebri morCi _ processus
zemo kiduris Tavisufali nawilis ConCxi _
sceleton membri superioris liberi
mxris Zvali _ os humeri
mxris Zvali ekuTvnis grZel
lulisebr Zvlebs. aqvs diafizi _
mxris Zvlis sxeuli _ corpus humeri da
ori bolo, zemo da qvemo epifizi.
zemo boloze aris naxevarsferuli
moyvanilobis mxris Tavi _ caput humeri,
romliTac igi beWis sasaxsre fosos
enawevreba. Tavi mimarTulia SigniT da
Semofarglulia RariT, romelsac
ewodeba anatomiuri yeli _ collum
anatomicum. am yelis gareT mdebareobs
ori mozrdili borcvi: gareTa didi
borcvi _ tuberculum majus da SigniTa
mcire borcvi _ tuberculum minus . es
borcvebi qveviT viwrovdeba da qmnis
qedebs: didi borcvis qedi _ crista
klinikuri anatomia
zemo kiduri
coracoideus. es morCi miemarTeba jer win,
Semdeg ki mkveTrad uxvevs gareT da
Tavdeba momrgvalebuli boloTi. beWis
SigniTa kide yvelaze grZelia. beWis
gareTa kuTxe sakmarisad
gasqelebulia da misboloze arsebobs
sasaxsre foso _ cavitas glenoidalis _
elifsuri moyvanilobisa, romliTac
igi mxris Zvlis Tavs enawevreba. am
fosos zeviTa da qveviTa boloze
moTavsebulia ori xorkliani maRlobi
mxris kunTebis myesebis misamagreblad:
sasaxsre zeda borcvi _ tuberculum
supraglenoidale _ mxris orTava kunTis
myesisaTvis da sasaxsre qveda borcvi
_ tuberculum infraglenoidale _ mxris
samTava kunTis myesisaTvis.
tuberculi majoris da mcire borcvis qedi _
crista tuberculi minoris. am borcvebs Soris
gamoxatulia borcvTaSua Rari _ sulcus
intertubercularis, romelSic gaivlis mxris
orTava kunTis grZeli Tavis myesi.
borcvebis cota qveviT mxris Zvali
viwrovdeba da qmnis e.w. qirurgiul
yels _ collum chirurgicum.
mxris Zvlis sxeulis zemo nawili
cilindruli formisaa, qvemo nawili
ki _ samwaxnagovani prizmisa. sxeulis
Sua nawils gareTa mxareze
deltisebri kunTis misamagreblad
gamoxatuli aqvs Tanamosaxele
xorkli _ tuberositas deltoidea, xolo
ukana zedapirze Rari, romelSiac
Tavsdeba sxivis nervi da romelic
105
 zemo kiduri

cnobilia rogorc sxivis nervis Rari ZvalTaSua sivrce _ spatium interosseum

_ sulcus nervi radialis. antebrachii.
mxris Zvlis qveda bolo idayvis Zvlis zeviTa bolos
gaganierebulia da ewodeba roki _ darTuli aqvs Sedrekili sasaxsre
condylus humeri. mas darTuli aqvs ori zedapiri _ WaRisebri amonaWdevi _
sasaxsre zedapiri, romelTagan incisura trochlearis _ mxris WaRTan
gareTas aqvs sferuli moyvaniloba da SesaerTeblad. es sasaxsre zedapiri
hqvia capitulum humeri. xolo SigniTas ki mimarTulia win da mosazRvrulia
WaRis _ trochlea _ moyvaniloba aqvs. uknidan momsxvilo idayvis morCiT _
winidan WaRis zemoT moTavsebulia olecranon, xolo winidan _ mcire
ori foso: SigniTa gvirgvinovani foso gvirgvinovani morCiT _ processus
_ fossa coronoidea _ idayvis Zvlis coronoideus; idayvis Zvlis zemo bolos
gvirgvinovani morCisaTvis da gareTa gareTa mxareze aqvs sxivis naWdevi _
patara sxivis foso _ fossa radialis _ incisura radialis _ sxivis Zvlis TavTan
sxivis Zvlis TavisaTvis. ukanidan SenawevrebisaTvis.
WaRis zemoT arsebobs ufro idayvis sxeuls _ corpus ulnae aqvs
CaRrmavebuli idayvis foso _ fossa samwaxnagiani moyvaniloba da, amitom,
olecrani _ idayvis morCisaTvis. mxris masze arCeven sam zedapirs: winas,
Zvlis gverdiTi kideebi Tavdeba ori ukanas da SigniTas. wina da ukana
warzidulobiT, romelTac uwodeben zedapirebi xvdeba erTmaneTs gareTa
SigniTa da gareTa zedarokebs _ mxareze da qmnis Seviwroebul
epicondylus medialis et epicondylus lateralis. ZvalTaSua kides _ margo interossea.
SigniTa zedaroki sakmaod didia idayvis Zvlis qveda bolos
gareTaze. am zedarokebidan iwyeba cilindruli moyvaniloba aqvs
winamxris kunTebi. ewodeba idayvis Tavi _ caput ulnae,
romelsac SigniTa mxridan gaSverili
winamxris Zvlebi _ ossa antebrachii aqvs sadgisisebri morCi _ processus
winamxris SemadgenlobaSi Sedis styloideus ulnae, gareTa sxivisaken
ori Zvali: sxivi _ radius da idayvi _ mimarTuli mxare ki momrgvalebulia
ulna. es Zvlebi ekuTvnis lulisebr da darTulia sasaxsre zedapiriT,
Zvlebs. romelsac uwodeben idayvis
supinaciis mdgomareobaSi winamxris sabrunebel sasaxsre zedapirs _
Zvlebi paralelurad mdebareoben ise, circumferentia articularis ulnae.
rom sxivis Zvali Tavsdeba gareTa sxivis Zvlis zemo bolos hqvia
mxareze, ceris gaswvriv, xolo idayvis sxivis Tavi _caput radii, romlis zemo
Zvali _ SigniTa mxareze, nekis zedapirze aris sasaxsre foso _ mxris
gaswvriv. winamxris Zvlebi ise aris ZvalTan Sesanawevreblad. sxivis Zvlis
modrekili, rom exeba erTimeores Tavis qveviT aris Seviwroeba,
mxolod TavianTi boloebiT, danarCen romelsac ewodeba sxivis yeli _
manZilze ki maT Soris rCeba winamxris collum radii; sxivis Tavis garSemo
gamoxatulia momrgvalo sasaxsre

klinikuri anatomia 106

 zemo kiduri

zedapiri _ sxivis sabrunebeli meore distaluri rigis yvela

sasaxsre zedapiri _ circumferentia Zvals aqvs sasaxsre zedapirebi,
articularis radii, romliTac igi idayvis romlebiTac isini enawevrebian, erTi
Zvlis zemo bolos enawevreba. yelis mxriv, majis pirveli rigis Zvlebs,
qveviT sxivis Zvlis wina zedapirze meore mxriv, nebis Zvlebs da, bolos,
aris xorkliani borcvi, e.w. sxivis erTimeores.
xorkli _ tuberositas radii, mxris orTava majas ori zedapiri aqvs: wina
kunTis myesisaTvis, zedapiri _ facies anterior, romelic
sxivis sxuli gamodrekilia gareT warmoadgens Rrma majis Rars _ sulcus
da ukan, aqvs samwaxnagiani forma, ris carpi amovsebuls kunTebis myesebiT, da
gamo sami zedapiri ganirCeva: wina, ukana gamodrekili zedapiri _ facies
ukana da gareTa. wina da ukana posterior.
zedapirebi xvdebian erTmaneTs SigniTa wina zedapirze zemoxsenebuli
mxareze da qmnian maxvil sxivis majis Rari mosazRvrulia
ZvalTaSua kides _ margo interossea radii. SemaRlebebiT: Signidan cercvisebri
ZvliT da kaviani Zvlis kaviT _
mtevnis Zvlebi _ ossa manus hamulus os hamati, xolo garedan
navisebri ZvliT da trapeciuli Zvlis
majis Zvlebi _ ossa carpi xorkliT _ tuberculum os trapezii.

majis SemadgenlobaSi Sedis rva nebis Zvlebi _ ossa metacarpalia

Zvali, dawyobili or rigad. pirvel
proqsimalur rigs, dawyebuli ceris nebi xuTi Zvlisagan Sedgeba. es
mxridan, ekuTvnis: Zvlebi grZel Zvlebs ekuTvnis,
1. navisebri Zvali _ os scaphoideum romelTac aqvT diafizi _ sxeuli _
2. mTvarisebri Zvali _ os lunatum corpus da epifizebi.
3. samwaxnagiani Zvali _ os proqsimaluri bolo Tavisi
triquetrum brtyeli sasaxsre zedapiriT majis
4. cercvisebri Zvali _ os pisiforme meore rigis Zvlebs enawevreba da
meore distalur rigs ekuTvnis: saxelad fuZe _ basis ewodeba.
1. trapeciuli Zvali _ os trapezium distaluri bolo _ Tavi _ caput
2. trapecoiduli Zvali _ os _sferuli formisa da mas darTuli
trapezoideum aqvs sasaxsre zedapiri piveli rigis
falangebTan SenawevrebisaTvis.
3. Tavdida Zvali _ os capitatum
nebis Zvlebis sxeulebis ganiv
4. kaviani Zvali _ os hamatum
nakveTs samkuTxi forma aqvs; sxeulis
proqsimaluri rigis pirveli ori
ukana zedapiri odnav brtyeli da
Zvali _ navisebri da mTvarisebri _
kideebisaken momrgvalebulia, wina
enawevreba sxivis Zvals, cercvisebri
zeadpiri ki _ odnav Sezneqilia.
ki _ samwaxnagian Zvals.

klinikuri anatomia 107


nebis me-5 Zvals fuZesTan, ukana
mxareze aqvs nebis me-5 borcvi _
tuberositas ossis metacarpi quinti.
nebis pirveli Zvali, romelic cers
ekuTvnis, yvelaze mokle da ganieria,
saCvenebeli TiTis nebis Zvali ki
yvelaze grZelia.
mtevnis TiTebis Zvlebi _ ossa
digitorum manus
yoveli TiTi Sedgeba Zvlovani
nawilebisagan, romelTac falangebi _
phalanges _ hqvia. cers aqvs ori
falangi, danarCen TiTebs sam-sami
zemo kiduris kunTebi
zemo kiduris sartylis kunTebi
deltisebri kunTi _ m. deltoideus _
iwyeba laviwis samxre bolodan, beWis
akromionidan (acromion), beWis qedidan
da umagrdeba mxris Zvlis deltisebr
xorklian SemaRlebas. swevs mxars
zeviT _ horizontalur sibrtyemde.
qedzeviTa kunTi _ m. supraspinatus da
qedqveviTa kunTi _ m. infraspinatus. es
kunTebi iwyeba beWis dorsalur
zedapirze mdebare Tanamosaxele
fosoebidan da umagrdeba mxris Zvlis
did borcvs. atrialebs mxars gareT
da amagrebs mxris saxsars.
mcire mrgvali kunTi _ m. teres minor
_ iwyeba beWis qvemo kuTxidan da
umagrdeba mxris Zvlis did borcvs.
exmareba zemoT aRweril or kunTs.
didi mrgvali kunTi _ m. teres major _
iwyeba beWis qvemo kuTxidan da zurgis
uganieresi kunTis myesTan erTad.
umagrdeba mxris Zvlis mcire borcvis
klinikuri anatomia
zemo kiduri
falangi. yoveli TiTis falangs hqvia
distaluri frCxilis falangi, Sua da
proqsimaluri falangi. yvela falangs
aqvs fuZe _ basis, sxeuli _ corpus da
Tavi _ caput. amasTan, proqsimaluri da
Sua (garda cerisa) rigis falangTa
Tavebs aqvs WaRis moyvanilobis
sasaxsre zedapirebi.
frCxilebis falangebs fuZe aqvT
Sedrekili da orad gayofili, Tavi ki
_ ganieri, gabrtyelebuli, romelic
moyvanilobiT niCabs waagavs. falangTa
ukana zedapirebi gamodrekilia, wina
ki Sedrekili an brtyeli.
qeds. eweva mxars ukan, moizidavs mas
da atrialebs SigniT.
beWqveSa kunTi _ m. subscapularis _
iwyeba beWis wina zedapiridan da
umagrdeba mxris Zvlis mcire borcvs.
atrialebs mxars medialurad.
mxris kunTebi
mxris orTava kunTi _ m. biceps brachii
_ mxris wina zedapirze Zevs da iwyeba
ori TaviT: grZeli Tavi _ caput longum
_ myesovania, iwyeba sasaxsre fosos
zeda xorklidan, jer saxsris RruSi
gaivlis, Semdeg wveba borcvTaSua
RarSi; mokle Tavi _ caput breve _
iwyeba beWis niskartisebri morCidan,
niskart-mxris kunTTan erTad. orive
Tavi erTdeba, qmnis msxvil kunTovan
mucels da qvemo myesiT umagrdeba
sxivis Zvlis borcvs. am myess
scildeba TeTri, Txeli da ganieri
mxris orTava kunTis aponevrozi
_aponeurosis m. bicipitis brachii, romelic
108
 zemo kiduri

idayvis mxareze gadadis da Sewnulia samagierod, is kunTebi, romlebic

winamxris fasciaSi. orTava kunTi iwyeba mxris lateraluri
xris winamxars da exmareba mas zedarokidan da sxividan, Seadgens
supinaciaSi. meore jgufs, romelic mTeli Tavisi
niskart-mxris kunTi _ m. masiT mdebareobs winamxris
coracobrachialis _iwyeba beWis lateralur da ukana zedapirze. es
niskartisebri morCidan da umagrdeba kunTebi funqciis mxriv warmoadgenen
mxris Zvals Sua adgilas. am kunTis pirveli jgufis kunTebis
dasawyisi Sexorcebulia orTava antagonistebs, e.i. isini majis da
kunTis mokle TavTan. mxars swevs TiTebis gamSleli da supinatorebi
ZeviT. arian.
mxris kunTi _ m. brachialis _ iwyeba I. winamxris kunTebis pirveli
mxris Zvlis zemo nawilis wina jgufi mdebareobs xel-gulis
zedapiridan da umagrdeba idayvis zedapirze:
gvirgvinovan morCs. xris winamxars. 1. nebis grZeli kunTi _ m. palmaris
mxris samTava kunTi _ m. triceps longus _ iwyeba mxris Zvlis medialuri
brachii _ iwyeba sami TaviT: greZeli rokidan da umagrdeba xel-gulis
TaviT _ caput longum _ beWis sasaxsre aponevrozs _aponeurosis palmaris, sWimavs
fosos qveda xorklodan _ tuberculum mas da xris majas.
infraglenoidalis, SigniTa da gareTa TaviT 2. mrgvali pronatori _ m. pronator
_ caput mediale et laterale _ mxris Zvlis teres _ iwyeba ori TaviT medialuri
medialuri da lateraluri rokidan da idayvis gvirgvinovani
zedapirebidan; msxvili da magari morCidan, umagrdeba sxivs Sua
myesiT umagrdeba idayvis morCs _ adgilas. abrunebs winamxars
olekranons. Slis winamxars. medialurad (pronatio).
3. majis momxreli sxivisaken _
winamxris kunTebi m.flexor carpi radialis _ iwyeba madialuri
is kunTebi, romlebic iwyeba mxris rokidan da umagrdeba nebis meore da
orive zedarokidan da winamxris mesame Zvlebis fuZeebs. xris majas.
Zvlebidan, iwvevs xelis mtevnis da 4. majis momxreli idayvisaken_ m.
TiTebis sxvadasxva moZraobas. TiTqmis flexor carpi ulnaris _ iwyeba madialuri
yvela is kunTi, romelTa masa iwyeba rokidan da umagrdeba cercvisebr
medialuri zedarokidan, mdebareobs Zvals. xris majas.
winamxris SigniTa da wina zedapirze, 5. TiTebis zedapiruli momxreli
ugzavnis myesebs majis da TiTebis kunTi _ m. flexor digitorum superficialis _
xel-gulis mxares da Tavisi msxvili iwyeba madialuri rokidan da idayvis
xorciani nawiliT mdebareobs idayvze. Zvlidan da umagrdeba TiTebis Sua
es kunTebi funqciis mxriv falangebis fuZeebs (meore TiTidan
warmoadgenen majis da TiTebis moyolebuli mexuTemdis) ori
momxrelebs da winamxris da xelis gancalkevebuli fexiT _ orkapiT.
mtevnis pronatorebs. xris Sua falangebs.

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 zemo kiduri

6. TiTebis Rrma momxreli kunTi _ Sres da, dasasruls, merve kunTi

m. flexor digitorum profundus _ iwyeba meoTxe Sres warmoadgens.
idayvis wina zedapiridan da winamxris nebis xel-gulis zedapiri, kanis
ZvalTaSua apkidan; umagrdeba TiTebis garda, dafarulia mkvrivi,
distaluri falangebis fuZeebs (meore SemaerTebeli qsovilisagan Semdgari
TiTidan mexuTemdis). am kunTis myesebi xel-gulis aponevroziT _ aponeurosis
gaivlis TiTebze, zemoaRniSnuli palmaris.
zedapiruli momxreli kunTebis II. winamxris kunTebis meore jgufi
gaorkapebul myesovan fexebs Soris. mdebareobs dorsalur zedapirze:
xris TiTebis distalur falangebs 1. mxarsxivis kunTi _ m. brachioradialis
(meore TiTidan mexuTemde). _ iwyeba mxris gareTa napiridan da
xelis mtevnis midamoSi Rrma kunTTaSua Zgididan da Tavdeba sxivis
momxreli kunTi myesebidan iwyeba sadgisisebrmorCze. es kunTi sxivis
oTxi wvrili Wiayela kunTi _ mm. brunvis regulatoria.
lumbricales, romlebic umagrdeba 2. majis grZeli gamSleli
dorsaluri mxridan TiTebis sxivisaken _ m. extensor carpi radialis
proqsimaluri falangebis fuZeebs longus _ iwyeba mxris lateraluri zeda
(meoredan mexuTemdis). xris TiTebis rokidan da kunTTaSua Zgididan,
proqsimalur falangebs. umagrdeba nebis meore Zvlis fuZis
7. ceris grZeli momxreli kunTi _ zurgis zadapirs. Slis da ganzidavs
m. flexor policis longus _ iwyeba sxivis wina mtevans.
zedapiris Sua adgilas da umagrdeba 3. majis mokle gamSleli sxivisaken
ceris distaluri falangis fuZes. _ m. extensor carpi radialis brevis _ iwyeba
xris ceris distalur falangs. mxris gareTa zeda rokidan da
8. kvadratuli pronatori _ m. umagrdeba nebis mesame Zvlis fuZis
pronator quadratus _ winamxris kunTebs dorsalur zadapirs. Slis mtevans.
Soris yvelaze Rrmad mdebareobs, 4. TiTebis gamSleli kunTi _ m.
gadaWimulia idayvsa da sxivs Soris. extensot digitorum _ iwyeba lateraluri
mis funqcias Seadgens winamxris zeda rokidan da Tavisi myesebiT
pronacia. umagrdeba TiTebis Sua da distalur
aRniSnuli pirveli jgufis falangebs (meore TiTidan mexuTemdis).
kunTebis myesebi mdebareobs majis nebis Zvlebis Tavebis midamoSi es
midamoSi, Rrma majis RarSi _ canalis myesebi gadabmulia arTimeoresTan
carpi majis momxrelebis sabmelis iribi mimarTulebis myesovani
retinaculum flexorum _qveS. zemoaRniSnul anastomozebiT, romlebsac ewodeba
pirvel, more, msame da meoTxe kunTebs myesovani gadasabmelebi _ connexus
zedapiruli mdebareoba aqvT da intertendineus.
warmiadgenen kanqveS mdebare pirvekl 5. nekis gamSleli kunTi _ m. extensot
kunTovan Sres. mexuTe kunTI qmnis digiti minimi _ am kunTis dasawyisi da
meore Sres., meeqvse da meSvide _ mesame bolo sruliad iseTivea, rogorc

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 zemo kiduri

zemoaRniSnuli kunTis ukanaskneli eqvsi arxi. am arxebSi gadis yvela

TiTis myesisa. zemoaRniSnuli gamSleli kunTebis
6. majis gamSleli idayvisaken_ m. myesebi .
extensor carpi ulnaris _ iwyeba pirvel arxSi gadis ori myesi:
lateraluri zeda rokidan da ceris grZeli ganmzidveli da ceris
umagrdeba nebis mexuTe Zvlis fuZes mokle gamSleli kunTebis myesebi.
dorsaluri mxridan. Slis majas. me-2 arxSi gadis kunTebis myesebi _
7. idayvis kunTi _ m anconeus _ majis grZeli da mokle gamSlelebi
iwyeba mxris lateraluri zeda sxivisaken.
rokidan da umagrdeba idayvis zemo me-3 arxSi gadis: ceris grZeli
nawils ukanidan. Slis winamxars. gamSleli kunTis myesi.
8. ceris grZeli ganmzidveli kunTi me-4 arxSi gadis myesebi: TiTebis
_ m. abductor policis longus _ iwyeba gamSleli kunTisa da saCvenebeli
ZvalTaSua apkis dorsaluri TiTis gamSleli kunTisa.
zedapiridan, sxividan da idayvidan da me-5 arxSi gadis nekis sakuTari
umagrdeba ceris nebis Zvlis fuZes. gamSleli kunTis myesi.
9. ceris mokle gamSleli kunTi _ me-6 arxSi gadis idayvisaken majis
m. extensot policis brevis _ iwyeba sxivis gamSleli kunTis myesi.
dorsaluri zedapiridan da ZvalTaSua
apkidan, umagrdeba ceris
proqsimaluri falangis fuZes.
10. ceris grZeli gamSleli kunTi _ xelis mtevnis kunTebi
m. extensot policis longus _ iwyeba idayvis xelis mtevnis mokle kunTebi
dorsaluri zedapiridan da ZvalTaSua umTavresad Segroviliaxel-gulis
apkidan, umagrdeba ceris distaluri zedapirze. idayvis da sxivis mxareze
falangis fuZes. es kunTebi qmnis rbilkunTovan
11. saCvenebeli TiTis gamSleli maRlobebs: cerisas _thenar da nekisas
kunTi _ m. extensot indicis _ iwyeba _ hypothenar.
idayvis dorsaluri zedapiridan da ceris maRlobi _ thenar Semdgaria
erTvis am TiTis saerTo gamSleli oTxi mokle kunTisagan, romlebic
kunTis myess. dakavSirebuli arin cerTan:
12. supinatori _ m. supinator _ iwyeba 1. ceris mokle ganmzidveli kunTi _
mxris lateraluri zeda rokidan, m. abductor pilicis brevis _ zedapirulad
uvlis sxivis zemo nawils garSemo da Zevs. iwyeba momxrelebis sabmelidan
umagrdeba am Zvals winidan, garedan da navisebri Zvlis borcvidan;
da ukanidan. es kunTi abrunebs sxivs umagrdeba ceris proqsimaluri
gareTa mimarTulebiT (supinatio) . falangis fuZes.
majis dorsalur mxareze, winamxris 2. ceris mokle momxreli kunTi _
qvemo sazRvarze, mdebareobs majis m. flexor pilicis brevis _ iwyeba
gamSlelebis sabmeli _ retinaculi momxrelebis sabmelidan da
extensorum, romelSiac moTavsebulia trapeciuli da trapecoiduli

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Zvlebidan; umagrdeba ceris Sedgeba ganivi mimarTulebis

lateralur sesamoidur Zvals. konebisagan da gaWimulia momxrelebis
3. ceris momzidveli kunTi _ m. sabmelisa da nekis maRlobis
adductor pilicis _ iwyeba nebis mesame medialur napirs Soris. es kunTi
Zvlis xel-gulis zedapiridan da reducirebul kunTebs ekuTvnis,
umagrdeba ceris proqsimaluri Wmuxnis nekis maRlobis kans.
falangis fuZes. nebis ZvalTaSua sivrceSi
4. ceris pirispir damyenebeli kunTi moTavsebulia ZvalTaSua kunTebi _
_ m. opponens policis _ iwyeba mm. interossei. maTSi arCeven xel-gulisa
momxrelebis sabmelidan da da xel-zurgis ZvalTaSua kunTebs.
trapeciuli Zvlidan; umagrdeba nebis pirvels ekuTvnis sami kunTi, meores _
pirvel Zvals mis sigrZeze. oTxi; xel-gulis ZvalTaSua kunTebi _
nekis maRlobi _ hipothenar Sedgeba, mm. interossei palmares _ mdebareobs
Tavis mxriv, oTxi kunTisagan: ZvalTaSua sivrceSi, meore TiTidan
1. nekis ganmzidveli kunTi _ _ m. dawyebuli mexuTemdis; xel-zurgis
abductor digiti minimi _ iwyeba cercvisebri ZvalTaSua kunTebi _ mm. interossei
Zvlidan da umagrdeba nekis dorsales _ ki mdebareoben oTx
proqsimaluri falangis fuZes. ZvalTaSua sivrceSi, pirveli TiTidan
2. nekis mokle momxreli kunTi _ m. dawyebuli mexuTemdis. orive jgufis
flexor digiti minimi brevis _ iwyeba kaviani kunTebi iwyeba nebis Zvlebidan da
Zvlis kavidan da momxrelebis umagrdeba proqsimaluri falangis
sabmelidan da umagrdeba nekis fuZeebs dorsaluri da lateraluri
proqsimalur falangs. mxridan. xel-gulis ZvalTaSua
3. nekis pirispir damyenebeli kunTi kunTebi moizidaven meore, meoTxe da
_ m. opponens digiti minimi _ iwyeba nekis mexuTe TiTebs Sua TiTisaken, xel-
momxrel kunTTan erTad da umagrdeba zurgis ZvalTaSua kunTebi ki
nebis V Zvals idayvis mxareze. ganizidaven TiTebs xelis im Sua
xazidan, romelic Seesabameba Sua
4. nebis mokle kunTi _ m. palmaris
TiTis RerZs.
brevis, nekis maRlobis es ukanaskneli
kunTi mdebareobs kanis sisqeSi,

xelis mtevnis kunTTa myesebis sinoviuri budeebi

xelis mtevnis zemoaRweril garSemovlebulia sinoviuri budeebiT

mokle kunTTa or jgufs Soris (thenar _ vaginae synoviales digitorum manus. xel-
da hypothenar), im RarSi, romelic gulis mxareze, momxrelebis sabmekis
momxrelebis sabmelis qveS arsebobs, qveS, ori sinovialuri budea..
yvela grZeli kunTis myesi

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pirveli bude TiTebis zedapiruli ceris grZel ganmzidvels da

da Rrma momxreli kunTebis myesebisaa. ceris mokle gamSleli kunTebis
amasTan unda aRiniSnos, rom am budis myesebs saerTo bude aqvT.
zemo kide amoweulia momxrelebis saerTo bude aqvT agreTve sxivisken
sabmelis zeviT erTi santimetris majis gamSleli grZeli da mokle
manZilze, qveviTa kide ki aRwevs nebis kunTebis myesebs.
Sua nawils da mxolod nekis saerTo bude aqvT TiTebis saerTo
mimarTulebiT misdevs myess distalur gamSleli kunTis da saCvenebeli
falangamde. TiTis sakuTari gamSleli kunTis
meore bude arsebobs mxolod ceris myesebs.
grZeli momxreli kunTis myesisaTvis; sakuTari calke budeebi aqvT
amasTan, am budis proqsimaluri bolo Semdegi kunTebis myesebs: a) ceris
iwyeba zemoaRniSnuli budis imave grZel gamSlels, b) nekis sakuTar
doneze, qvemo bolo ki misdevs myess gamSlels da g) majis gamSlels
ceris distalur falangamde. idayvisaken.
amis garda, meore, mesame da meoTxe yvela an budis zemo kide
TiTebis myesebs samive falangis amoweulia gamSlelebis sabmelis zemo
sigrZeze aqvT Tavisi sakuTari da kidis zeviT erTi santimetriT, qvemo
gancalkevebuli sinovialuri budeebi. kideebi ki nebis Zvlebis Sua nawils
im myesebs, romlebic gaivlian aRwevs. yvelaze farTo da ganieri
gamSlelebis sabmelis eqvs arxSi, bude arsebobs mesame arxSi, yvelaze
xelis dorsalur mxareze aqvT Tavisi mokle _ meore arxSi da yvelaze
sinovialuri budeebi. grZeli _ mexuTeSi.

zemo kiduris topografiuli anatomia

zemo kidurze arCeven mxris sar- nawilSi iwyeba mkerdis didi kunTi,
tyelsa da Tavisufal nawils. mxris lateralur nawilSi—deltisebri
sartyeli, anu zemxari Sedgeba beWis, kunTi. am kunTebs Soris, uSualod
deltisebri, laviwqveda da iRliis laviwis qvemoT, kanze aRiniSneba
midamoebisgan, zemo kiduris CaRrmaveba (fossa infraclavicularis), romlis
Tavisufali nawili—deltisebri, siRrmeSi beWis niskartisebri morCi
mxris wina, mxris ukana, idayvis wina, isinjeba. ukana nawilSi kargad
idayvis ukana, winamxris wina, wina- isinjeba beWis qedi, gareTa
mxris ukana midamoebisa da xelis zedapirze—samxre morCi. am
mtevnisagan. ukanasknelis qveS SeiZleba movsinjoT
zemxari mxris Zvlis didi borcvi, mcire
zemxris reliefs qmnis mxris sar- borcvi da borcvTaSua Rari,
tyeli da masTan dakavSirebuli romelSic orTava kunTis grZeli
kunTebi. winidan kargad isinjeba Tavis myesi mdebareobs.
laviwi.. misi qveda kididan medialur

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beWis midamo, regio scapularis kisris ganivi arteriis Rrma tots

garegani orientirebia beWis qedi, ukavSirdeba.
akromioni, beWis kuTxe, beWis beWis Semomxvevi arteria (a. circum-
medialuri da lateraluri kideebi, flexa scapulae) gamoeyofa beWqveSa
romlebic xeliT, Cveulebriv kargad arterias (a. subscapularis) (iRliis
isinjebian. beWis dorsaluri zedapiri arteriis toti) da beWqveSa fosoSi
beWis qediT qedzeda da qedqveda gadadis samgverdiani xvreliT (foramen
fosoebad iyofa. trilaterum). es ukanaskneli zevidan
beWis midamo beWis mosazRvrulia mcire mrgvali kunTiT
kideebiT moisazRvreba. kani sqelia, (m. teres minor), qvevidan—didi mrgvali
kanqveSa qsovili SedarebiT mkvrivia, kunTiT (m. teres major), garedan—mxris
Seicavs didi raodenobiT fibrozul samTava kunTis grZeli TaviT. samgver-
konebsa da firfitebs, romlebic kans diani xvrelis gavlis Semdeg beWis
fasciasTan akavSireben. kanqveSa Semomxvevi arteria Sedis qedqveda
fasciac SedarebiT mkvrivia. sakuTari fosoSi, sadac beWzeda da kisris
fascia sustad ganviTarebulia. ganivi arteriis totebs ukavSirdeba.
kunTebi ganlagebulia or Sred. ze- es kavSiri did rols asrulebs
dapirul Sres qmnis trapeciuli, kolateraluri sisxlis mimoqcevis
zurgis uganieresi da deltisebri ganviTarebaSi, roca iRliis arteria
kunTebi, Rrma Sres—qedzeda, qedqveda, beWqveSa arteriis gamosvlis proqsima-
didi mrgvali da mcire mrgvali lurad ixSoba.
kunTebi. Rrma Sris kunTebi uSualod beWzeda nervi (n. suprascapularis) mxris
dafarulia beWis kideebTan da beWis wnulis totia, gaivlis beWis naWdevsa
qedTan Sezrdili aponevrozuli qed- da beWis ganiv iogs Soris arsebul
zeda da qedqveda fasciebiT, romlebic xvrelSi da beWzeda arteriasTan
ZvalTan erTad qmnian qedzeda da erTad jer qedzeda, Semdeg ki
qedqveda Zval-fasciur budeebs. qedqveda fosoSi gadadis. anervebs
qedzeda bude uWiravs qedzeda kunTs, qedzeda da qedqveda kunTebsa da mxris
qedqveda bude _ qedqveda da mcire sasaxsre CanTis ukana nawils. beWis
mrgval kunTebs. mcire mrgval kunTs midamos kans anervebs neknTaSua da
qvevidan didi mrgvali kunTi ekvris. laviwzeda nervebi.
qedzeda kunTsa da Zvals Soris beWis motexiloba. beWis motexilo-
SemaerTebel qsovilSi mdebareobs ba SedarebiT iSviaTad gvxvdeba,
beWzeda arteria, vena da nervi. radgan igi sakmaod moZravia da
beWzeda arteria far-kisris Reros dafarulia kunTebis sqeli feniT.
totia, Tanamgzavr venebTan erTad motexiloba gamowveulia Zalis
beWis zeda ganiv iogs (lig. transversum pirdapiri moqmedebiT (zurgze dacema,
scapulae superius) zevidan gadauvlis, cxenis floqvis Cartyma, avtomobilis
qedzeda fosoSi gaivlis da qedqveda ZariT zewola da a.S.). Zalze iSviaTia
fosoSi beWis Semomxvev arteriasa da arapirdapiri meqanizmi (dacema mxriT
gverdze an idayvze). motexiloba

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SeiZleba moxdes beWis nebismier sakuTari fascia deltisebri

adgilze. yvelaze xSiria beWis yelis kunTisTvis qmnis budes, romlidanac
motexiloba. sixSiris mixedviT meore kunTis sisqeSi Sedis fibrozuli
adgilzea beWis sxeulis motexiloba, morCebi. deltisebr da mkerdis did
mesameze—samxre morCis motexiloba. kunTebs Soris mdebareobs
am ukanasknelis garda SesaZlebelia deltisebr—mkerdis Rari, romelSic
niskartisebri morCis motexilobac. Sevardnis vena gaivlis. deltisebr
yvelaze iSviaTad aRiniSneba beWis kunTsa da mxris Zvals Soris Sema-
sasaxsre fosos motexiloba, agreTve erTebelqsovilovani sivrcea (spatium
beWis qveda kuTxis izolirebuli subdeltoideum), romelSic sinoviuri
motexiloba. abgebi, sisxlZarRvebi da nervebi
beWis yelis motexilobisas mxari mdebareobs. midamos mTavari
beWis sasaxsre fososTan erTad sisxlZarRvovan-nervuli kona Seicavs
CamoSvebulia qveviT da dazianebul iRliis nervs (n. axillaris) da mxris ukana
mxareze kiduri ufro grZelia, vidre Semomxvev arterias (a. circumflexa humeri
jansaRi kiduri. yelis motexilobisas posterior) Tanamgzavri venebiT. es kona
araiSviaTad aRiniSneba beWzeda iRliis fosodan deltisebrqveSa
arteriisa da beWzeda nervis dazi- sivrceSi gadadis oTxgverdiani
anebac. pirvels Sedegad mohyveba
xvreliT (foramen quadrilaterum),
sisxlCaqceva—hematoma, xolo
romelic zevidan mosazRvrulia mcire
meores—kontraqturis ganviTareba
mrgvali kunTiT, qvevidan—didi
mxris saxsarSi da mkveTri
mrgvali kunTiT, Signidan—mxris
mtkivneuloba mxris ganzidvisas.
samTava kunTis grZeli TaviT da
beWis sxeulis motexiloba uxSire-
garedan—mxris Zvlis qirurgiuli
sad xdeba qedqveda fosoSi.
yeliT. oTxgverdiani xvrelis gavlis
motexilobis xazis mimarTuleba
Semdeg iRliis nervi Tanamgzavr
ganivia.
sisxlZarRvebTan erTad uSualo
urTierTobaSia mxris Zvlis
deltisebri midamo
qirurgiul yelTan, ris gamoc am
deltisebri midamo zevidan moisaz-
doneze Zvlis motexilobis an mxris
Rvreba laviwiT, akromioniTa da beWis
saxsris amovardnilobis dros igi
qediT, qvevidan—deltisebri kunTis
SeiZleba daziandes. iRliis nervis
mimagrebis (deltisebri xorklis)
mxris ZvalTan urTierTobis adgili
doneze gavlebuli horizontaluri
midamos ukana zedapirze proecirdeba
xaziT, winidan da uknidan—
akromionidan daSvebuli vertikaluri
deltisebri kunTis kideebiT. del-
xazisa da deltisebri kunTis ukana
tisebri kunTi faravs mxris saxsars
kidis urTierTgadakveTis wertilSi.
da mimdebare kunTebs
iRliis nervi anervebs deltisebr
kani sqeli da SedarebiT nakleb
kunTs, mxris saxsars da deltisebri
moZravia. kanqveSa qsovilSi
midamos kans.
totiandeba laviwzeda da iRliis
nervebi. zedapiruli fascia Txelia.

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mxris ukana Semomxvevi arteria iribi kunTis mfarav fasciaSi, gareT—

ukavSirdeba mxris wina Semomxvev deltisebri kunTis mfarav da iRliis
arterias (a. circumflexa humeri anterior), fasciebSi, SigniT ezrdeba mkerdis
romelic iRliis fosodan Zvlisazrdelas. qalis mkerdis fascia
deltisebrqveSa sivrceSi mxris Zvlis ZuZus uqmnis budes.
qirurgiuli yelis winidan SemovliT mkerdis didi kunTi (m. pectoralis
gadadis. garda amisa, es arteriebi major) Sedgeba laviwis, mkerd-neknisa
anastomozebiT dakavSirebulia da muclis nawilebisgan. laviwis
gulmkerdakromionis arteriis nawili (pars clavicularis) iwyeba laviwis
deltisebr da akromionis totebTan. medialuri naxevridan, mkerd-neknis
es anastomozebi beWis midamos nawili (pars sternocostalis)—mkerdis
arteriul anastomozebTan erTad zemo Zvlisa da zeda 5_6 neknis
kiduris sisxliT momaragebis kolate- xrtilebidan, muclis nawili (pars
raluri gzaa. deltisebri kunTis qveS abdominalis)—muclis swori kunTis
mdebareobs sasaxsre CanTis mimdebare budidan. myesi umagrdeba mxris Zvlis
kunTebi, umagrdebian mxris Zvlis didi borcvis qeds.
proqsimalur bolos. mkerdis did kunTsa da deltisebr
kunTs Soris deltisebr-mkerdis Raria
laviwqveda midamo
(sulcus deltoideopectoralis), romelic zeviT
sazRvrebi: zevidan—laviwi,
gadadis deltisebr-mkerdis
qvevidan qalebSi—ZuZus zeda kide,
samkuTxedSi (trigonum deltoideopectoralis).
mamakacebSi—III neknis doneze
es ukanaskneli zevidan mosazRvrulia
gavlebuli horizontaluri xazi,
laviwiT, garedan—deltisebri
medialurad—mkerdis Zvali, latera-
kunTiT, Signidan—mkerdis didi
lurad—deltisebri kunTi.
kunTiT. deltisebr-mkerdis RarSi
kani Txelia, kanqveSa qsovilic
gaivlis Sevardnis vena (v. cephalica). igi
zeda nawilSi Txelia, qveviT TandaTan
deltisebr _ mkerdis samkuTxedSi
sqeldeba. kanqveSa qsovilSi
xvrets jer mkerdis fascias, Semdeg—
laviwzeda da neknTaSua nervebis
mkerd-laviwis fascias da erTvis
totebia.
iRliis venas.
zedapirul fasciaSi Caqsovilia
mkerd-laviwis fascia (f. clavipecto-
kisris kanqveSa kunTis konebi.
sakuTari fascia mkerdis didi kun- ralis) zeviT dakavSirebulia laviwsa da
Tis sisqeSi gzavnis morCebs. ufro niskartisebri morCis Zvlisazrdelas-
kargad aris gamoxatuli fasciis Tan, medialurad — neknebis
morCebi, romlebic yofen ZvlisazrdelasTan, qveviT da gareT
erTmaneTisgan am kunTis laviwis, mkerdis sakuTar da iRliis fasci-
mkerd-neknisa da muclis nawilebs. ze- ebTan. laviwsa da niskartisebri
viT sakuTari fascia ukavSirdeba morCis maxloblad igi sqeli da
laviws da grZeldeba kisris sakuTar mkvrivia. laviwqveSa da mkerdis mcire
fasciaSi, qveviT grZeldeba wina kunTebisTvis qmnis budeebs.
dakbiluli kunTisa da muclis gareTa

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laviwqveSa kunTi (m. subclavius) iwye- mcire kunTis zeda kidiT. samkuTxedis
ba I neknis zemo zedapiridan da umagr- fuZe miqceulia mkerdis Zvlisken.
deba laviwis samxre bolos qveda mkerdis samkuTxedi (trigonum pectorale)
zedapirs. mkerdis mcire kunTi (m. mosazRvrulia mkerdis mcire kunTis
pectoralis minor) iwyeba II_V neknebidan da zeda da qveda kideebiT, misi fuZec
umagrdeba niskartisebr morCs. mkerdis miqceulia mkerdis Zvlisken.
did kunTsa da mkerd-laviwis fascias mkerdqveSa samkuTxedi (trigonum
Soris zedapiruli mkerdqveSa subpectorale) zevidan mosazRvrulia
SemaerTebelqsovilovani sivrcea. mkerdis mcire kunTis qveda kidiT. am
mkerd-laviwis fascia mkerdis mcire samkuTxedis fuZe miqceulia gareT—
kunTis qveda kidesTan uerTdeba deltisebri kunTisken.
mkerdisa da iRliis fasciebs, ise, rom mkerd-laviwis samkuTxedSi mkerd-
zedapiruli mkerdqveSa sivrce qveviT laviwis fascia mkvrivia. masSi
daxSulia. mkerd-laviwis fascia iWers gaivlis Sevardnis vena, gulmkerd-
iRliis fascias aweul mdgomareobaSi, akromionis sisxlZarRvebi da mkerdis
rac iRliis fosos CaRrmavebas medialuri da lateraluri nervebi.
ganapirobebs. laviwqveda midamos qsovilebi ikve-
mkerdis mcire kunTis ukana zeda- beba neknTaSua arteriebis, gulmkerdis
pirsa da misi budis ukana firfitas SigniTa arteriis, gulmkerdis late-
Soris Rrma mkerdqveSa raluri arteriisa da gulmkerd-
SemaerTebelqsovilovani sivrcea. akromionis arteriis totebiT.
laviwis qveS niskartisebr morCTan laviwis motexiloba erT-erTi
mkerd-laviwis fasciaSi gaivlis uxSiresi dazianebaa, gansakuTrebiT
gulmkerd-akromionis arteria _ a. bavSvTa asakSi. uxSiresad motexiloba
thoracoacromialis (iRliis arteriis to- gamowveulia Zalis arapirdapiri
ti), romelsac mkerdis didi kunTis moqmedebiT gaSlil xelze an idayvze
qveS gamoeyofa mkerdis totebi (rami dacemiT. laviwi, ganicdis ra mkveTr
pectorales), deltisebri toti (r. zewolas sigrZis mimarTulebiT,
deltoideus) da akromionis toti (r. iRuneba da tydeba ori simrudis erTi
meoreSi gasvlis adgilze, sadac
acromialis). aqve totiandeba mkerdis
Zvali yvelaze wvrilia, e.i. Sua
medialuri da lateraluri nervebi
mesamedSi. Zvlis zedapiruli mdebare-
(mxris wnulis totebi), romlebic
obis gamo motexilobis gamowveva
mkerdis did da mcire kunTebs
SesaZloa agreTve Zalis uSualo
anerveben.
zemoqmedebiTac.
laviwqveda midamoSi laviwisa da
Cveulebriv, laviwis medialuri na-
mkerdis kunTebis urTierTobiT iqmneba
texi mkerd-laviw-dvrilisebri kunTis
mkerd-laviwis, mkerdisa da mkerdqveSa
moqmedebiT iwevs zemoT da ukan, late-
samkuTxedebi. mkerd-laviwis
raluri natexi ki kiduris simZimis
samkuTxedi (trigonum clavipectorale)
gamo dacildeba qvemoT, xolo mkerdis
zevidan mosazRvrulia laviwiTa da
didi kunTis gavleniT – ramdenadme
laviwqveSa kunTiT, qvevidan—mkerdis
win. garda amisa laviwqveSa kunTis

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 zemo kiduri

weviT erTi natexi meoris ukan ZarRvebiT. win grZeldeba mkerdis

moTavsdeba, rasac Sedegad laviwis fasciaSi, SigniT—wina dakbiluli
damokleba mohyveba. iSviaTia laviwis kunTis mfarav fasciaSi, gareT—mxris
motexiloba gareTa mesamedSi da ufro fasciaSi. igi gumbaTiviT zeviT aris
iSviaTia medialur mesamedSi. orive aweuli, rac imiT aixsneba, rom mker-
SemTxvevaSi motexili nawilebis dis didi kunTis ukan masTan
Secileba umniSvneloa. dakavSirebulia mkerd-laviwis fasciis
motexilobis xazi mozrdilebSi qveda nawili, romelsac iRliis sakid
ufro xSirad iribi mimarTulebisaa, iogs uwodeben.
bavSvebSi ki—ganivia. ukanasknelebSi iRliis foso amovsebulia
xSirad gvxvdeba ZvlisazrdelqveSa cximovani SemaerTebeli qsoviliT,
motexiloba. romelSic midamos sisxlZarRvebi,
msxvili sisxlZarRvebisa da mxris nervebi da limfuri kvanZebi
wnulis dazineba Zvlis natexebiT mdebareobs. iRliis SemaerTebeli
Zalian iSviaTad xdeba. zogierT qsovili dakavSirebulia mosazRvre
SemTxvevaSi mxris wnulis gaRizianebis midamoebis aseTsave qsovilTan, rac
movlenebi gamowveulia ara natexebis, iRliis anTebadi procesis am
aramed axlad ganviTarebuli korZis midamoebSi gavrcelebis SesaZ-
zewoliT. leblobas ganapirobebs.
iRliis foso mogvagonebs oTxwaxna-
iRliis midamo _ regio axillaris gian piramidas, romlis mwvervali
sazRvrebi: winidan_mkerdis didi mimarTulia zeviT. igi I neknsa da
kunTis qveda kide, uknidan—zurgis laviws Soris mdebareobs.
uganieresi da didi mrgvali kunTebis mwvervalidan iRliis fosoSi Sedis
qveda kideebi. sisxlZarRvovan-nervuli kona, rome-
iRliis midamo CaRrmavebulia, ris lic iRliis arterias, iRliis venasa
gamoc mas iRliis fososac uwodeben. da mxris wnuls Seicavs. iRliis
mis fskerze gareTa nawilSi xeliT fosos wina kedels qmnis laviwqveSa
isinjeba mxris Zvlis Tavi. kunTi, mkerdis didi da mcire kunTebi
kani Txelia, mdidaria oflisa da da mkerd-laviwis fascia, ukana
cximis jirkvlebiT, mozrdil adamians kedels—beWqveSa, zurgis uganieresi
dafaruli aqvs TmiT. kanqveSa qsovili da didi mrgvali kunTebi, medialur
sustad ganviTarebulia. zedapiruli kedels—wina dakbiluli kunTi,
fascia Txelia, morCebiT lateralur kedels—mxris Zvali, nis-
dakavSirebulia sakuTar fasciasTan. kart-mxris kunTi da mxris orTava
masSi iRliis zedapiruli limfuri kunTis mokle Tavi.
kvanZebi mdebareobs. iRliis fosos ukana kedelSi didsa
iRliis sakuTari fascia (fascia da mcire mrgval kunTebs Soris
axillaris) iRliis fosos kideebTan Seda- oTxgverdiani da samgverdiani
rebiT, sqeli da mkvrivia, centrSi xvrelebia.
Txelia da dacxrilulia kanqveSa iRliis fosos lateraluri kedlis
nervebiT, sisxlisa da limfuri gaswvriv, niskart-mxris kunTis (n.

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 zemo kiduri

coracobrachialis) gayolebiT mdebareobs dakbilul kunTSi), mkerdis medialuri

sisxlZarRvebisa da nervebis mTavari da lateraluri nervebi (nn. pectorales
kona, romelic iRliis arterias, medialis et lateralis) (anervebs mkerdis did
iRliis venas da mxris wnuls Seicavs. da mcire kunTebs), beWqveSa nervi (n.
iRliis vena mTel sigrZeze iRliis subscapularis) (anervebs beWqveSa kunTs)
arteriis win da medialurad da gulmkerd-zurgis nervi (n.
mdebareobs, mxris wnulis thoracodorsalis) (anervebs zurgis ugani-
komponentebis urTierToba iRliis eressa da did mrgval kunTebs).
arteriasTan ki sxvadasxva doneze iRliis arteria kanze proecirdeba
sxvadasxvanairia. mkerd-laviwis niskart-mxris kunTis gaswvriv
samkuTxedis farglebSi mxris wnuli gavlebul xazze anda iRliis fosos
mdebareobs iRliis arteriis ukan da lateraluri kedlis wina da Sua
lateralurad, mkerdis samkuTxedis mesamedebs Soris gavlebul
farglebSi mxris wnulis konebi vertikalur xazze. n. pirogovis mixed-
iRliis arterias exeba sami mxridan: viT, iRliis arteriis proeqcia See-
garedan—lateraluri kona (fasciculus sabameba iRliis fosos kanis Tmiani
lateralis), uknidan—ukana kona (fasciculus nawilis wina kides.
posterior) da Signidan—medialuri kona samkuTxedis doneze iRliis
(fasciculus medialis). mxris wnulis late- arterias gamoeyofa gulmkerdis ze-
raluri konidan aq yalibdeba kunT- mdebare arteria (a. thoracica suprema),
kanis nervi (n. musculocutaneus) da saSua- romelic zeda ori neknTaSua sivrcis
lo nervis (n. medianus) lateraluri Sesabamis areSi totiandeba, da
fesvi, medialuri konidan—saSualo gulmkerdakromionis arteria (a.
nervis medialuri fesvi, idayvis nervi thoracoacromialis), romelic mkerd-
(n. ulnaris), mxris kanis medialuri nervi laviwis fasciis gavliT laviwqveSa
(n. cutaneus brachii medialis) da winamxris midamoSi gadadis. mkerdis samkuTxedis
kanis medialuri nervi (n. cutaneus farglebSi iRliis arteriidan gamo-
antebrachii medialis), ukana konidan—sxivis dis gulmkerdis lateraluri arteria
nervi (n. radialis) da iRliis nervi (n. (a. thoracalis lateralis), romelic kvebavs
axillaris). mkerdqveSa samkuTxedis did dakbilul kunTs, mkerdis kunTs,
farglebSi saSualo nervi an misi limfur kvanZebsa da sarZeve jirkvals.
fesvebi mdebareobs iRliis arteriis mkerdqveSa samkuTxedis farglebSi
win; sxivisa da iRliis nervebi—ukan; iRliis arterias gamoeyofa beWqveSa
idayvis, mxris kanis medialuri da arteria da mxris wina da ukana
winamxris kanis medialuri nervebi— Semomxvevi arteriebi. beWqveSa arteria
medialurad; kunT-kanis nervi—late- (a. subscapularis) iRliis arteriis
ralurad. yvelaze msxvili totia. iyofa beWis
garda amisa, iRliis midamoSi Semomxvev arteriad (a. circumflexa
moTavsebulia mxris wnulis Semdegi scapulae) da gulmkerd-zurgis arteriad
totebi: gulmkerdis grZeli nervi (n. (a. thoracodorsalis). beWis Semomxvevi
thoracicus longus) (totiandeba wina arteria samgverdiani xvreliT

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 zemo kiduri

qedqveSa fosoSi gadadis, gulmkerd- mxris wina da ukana Semomxvevi arte-

zurgis arteria beWis kuTxesTan riebi.
saboloo totebad iyofa. mxris Semomxvevi arteriis qvemoT
mxris wina Semomxvevi arteria (a. zemo kiduris arteriuli magistralis
circumflexa humeri anterior) miemarTeba la- gadakvanZvis SemTxvevaSi
teralurad, mxris Zvlis qirurgiul kolateraluri sisxlis mimoqcevis
yels winidan Semouvlis da ganviTarebis pirobebi zogjer ar aris
deltisebrqveSa sivrceSi Sedis. mxris sakmarisi, radganac erTi mxriv, mxris
ukana Semomxvevi arteria (a. circumflexa wina da ukana Semomxvev arteriebsa da,
humeri posterior) iRliis nervTan erTad meore mxriv, mxris Rrma arterias
oTxgverdian xvrels gaivlis, mxris Soris anastomozebi sustad aris gamo-
Zvlis qirurgiul yels uknidan xatuli.
Semouvlis da deltisebrqveSa sivr- iRliis fosos cximovan
ceSi Sedis. SemaerTebel qsovilSi mdebareobs
beWqveSa kunTis wina zedapirze mde- erTmaneTTan dakavSirebuli limfuri
bareobs beWqveSa nervi (n. subscapularis), kvanZebis 5 jgufi: 1) nodi lymphatici
romelic beWqveSa kunTsa da did axillares laterales mdebareobs iRliis
mrgval kunTs anervebs da gulmkerd- fosos lateralur kedelTan sisxl-
zurgis nervi (n. thoracodorsalis) (zurgis ZarRvovan-nervuli konis medialur ze-
uganieres kunTs anervebs). dapirze, Rebulobs limfas zemo kidu-
iRliis arteria SedarebiT ufro ridan; 2) nodi lymphatici centrales yvelaze
meti anastomozebiT aris msxvili kvanZebia, mdebareobs iRliis
dakavSirebuli laviwqveSa fosos centrSi, iRliis sakuTari
arteriasTan, vidre mxris arteriasTan. fasciis qveS (nawili kanqveSa
kolateraluri sisxlis mimoqceva qsovilSi), limfas Rebulobs zemo
SedarebiT ufro advilad viTardeba, kiduridan, gulmkerdis kedlidan,
roca iRliis arteria ixSoba misgan zurgidan da ZuZudan; 3) nodi lymphatici
beWqveSa arteriis gamosvlis zemoT. posteriores (axillares mediales) mdebareobs
zemo kiduris sisxliT momarageba am wina dakbilul kunTze. gulmkerdis
SemTxvevaSi laviwqveSa arteriis lateraluri arteriis gaswvriv, lim-
mxridan xorcieldeba beWzeda fas Rebulobs gulmkerdis wina
arteriiTa da kisris ganivi arteriiT, gverdiTi kedlidan da muclis wina
xolo iRliis arteriis mxridan—beW- gverdiTi kedlis zeda nawilidan,
qveSa arteriiT, romelTa totebi beWis agreTve ZuZudan; erTi an ramdenime
midamoSi dakavSirebulia erTmaneTTan kvanZi moTavsebulia III neknze, mkerdis
mravalricxovani anastomozebiT. didi kunTis qveS (zorgiusis kvanZi);
garda amisa, deltisebr midamoSi es kvanZebi xSirad ziandeba ZuZus
anastomozebiT erTimeores kibos metastaziT; 4) nodi lymphatici
ukavSirdeba, erTi mxriv, gulmkerd- subscapulares (posteriores) mdebareobs
akromionis arteria da, meore mxriv, beWqveSa sisxlZarRvebis gaswvriv,
limfas Rebulobs zurgis zeda da

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 zemo kiduri

kisris ukana nawilebidan; 5) nodi mrgvali kunTebi. qvevidan sasaxsre

lymphatici axillares apicales mdebareobs CanTa ar aris dafaruli kunTebiT,
mkerd-laviwis samkuTxedSi, iRliis ris gamoc mxris saxsris qveda-
venis gaswvriv, limfas Rebulobs medialuri amovardniloba SedarebiT
iRliis yvela limfuri kvanZidan, ufro advilad viTardeba.
agreTve ZuZudan. mxris Zvlis didi borcvisa da
limfuri kvanZebis yvela aRniSnuli qedzeda kunTis myesis zemoT
jgufi dakavSirebulia erTmaneTTan mdebareobs bursa subdeltoidea,
limfuri ZarRvebiT, ris Sedegadac romelTanac xSirad SeerTebulia
iqmneba plexus lymphaticus axillaris et ufro zemoT mdebare bursa subacromialis.
subclavius. iRlis limfuri kvanZebidan beWis Zvlis yelsa da beWqveSa kunTis
limfa gamoaqvs laviwqveSa Reros myess Soris mdebareobs bursa m.
(truncus subclavius), romelic marcxena subscapularis. igi SeerTebulia mxris
mxareze erTvis gulmkerdis sadinars saxsris RrusTan da arcTu iSviaTad
an laviwqveSa venas, marjvena mxare- agreTve niskartqveSa abgasTan (bursa
ze—laviwqveSa venas an marjvena subcoracoidea), romelic niskartisebri
limfur sadinars. morCis fuZesTan mdebareobs.
iRliis limfuri kvanZebis sasaxsre parkis sinoviuri garsi
Cirqovani anTeba oTxgverdiani qmnis sam gamodrekilobas—iRliis,
xvreliT SeiZleba gavrceldes beWqveSa da borcvTaSua jibeebs.
deltisebri kunTis qveS mdebare iRliis jibe (recessus axillaris)
sivrceSi, samgverdiani xvreliT—beWis mdebareobs beWqveSa kunTsa da mxris
midamoSi, sisxlZarRvovan-nervuli samTava kunTis grZel Tavs Soris,
konis gayolebiT—mxarze an beWqveSa jibe (recessus subscapularis) —
laviwqveda midamoSi. beWqveSa kunTis myesis zeda nawilis
qveS, borcvTaSua jibe (recessus inter-
tubercularis)—borcvTaSua RarSi, orTava
mxris saxsari kunTis grZeli Tavis myesis gaswvriv.
mxris saxsari yvelaze farTo farg- orTava kunTis myesi mxris saxsarSi
lebSi moZravi sferuli saxsaria, rac dafarulia sinoviuri garsiT,
sasaxsre fosos farTobis simciriTa romelic miyveba mas borcvTaSua
da saxsris safiqsacio aparatis RarSi mxris Zvlis anatomiuri
gansakuTrebuli elastiurobiT yelidan 2_5sm manZilze, Semdeg zeviT
aixsneba. zevidan mas faravs beWis Sebrundeba da sasaxsre parkSi
samxre morCis, niskartisebri morCisa grZeldeba. amgvarad, borcvTaSua
da maT Soris gadaWimuli iogis (lig. RarSi orTava kunTis myesis irgvliv
coracoacrominale) mier Seqmnili TaRi, wi- Seqmnilia sinoviuri garsis
nidan—beWqveSa kunTi, niskart-mxris orkedliani gamodrekiloba.
kunTi da mxris orTava kunTis grZeli ukanaskneli ori jibe saxsris Cir-
Tavi, garedan—deltisebri kunTi, qovani anTebis dros nakleb winaaRmde-
uknidan—qedzeda, qedqveda da mcire gobas uwevs saxsarSi dagrovili

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 zemo kiduri

siTxis wnevas, SeiZleba gairRves da laviwqveSa (lux. subclavicularis) da

procesi mezobel midamoebSi niskartzeda (lux. supracoracoidea)
gavrceldes. Tu sinoviuri garsi amovardniloba. pirvel SemTxvevaSi
beWqveSa jibis areSi dairRva, Cirqo- Tavi gadanacvlebulia medialurad
vani anTeba vrceldeba beWqveSa Zval- laviwis qveS, meore SemTxvevaSi ki
fibrozul budeSi, sadac beWqveSa kun- amovardnilobas, rogorc wesi, Tan ax-
Ti mdebareobs, anda iRliis fosoSi. lavs niskartisebri morCis
roca sinoviuri garsi irRveva motexiloba.
borcvTaSua jibis areSi, Cirqi Tu motexilobis dros mxari mniSv-
gadadis mxris wina fasciur budeSi an nelovnadaa ganziduli, xolo Tavi
deltisebrqveSa sivrceSi. isinjeba iRliis fosoSi, maSin adgili
mxris saxsars kvebavs mxris wina da aqvs iRliis amovardnilobas (lux. axilla-
ukana Semomxvevi arteriebi da ris) (qveda amovardniloba).
gulmkerd-akromionis arteriis iSviaT amovarnilobas miekuTvneba
deltisebri da akromiuli totebi. iRliis amovardnilobis ukiduresi
limfuri ZarRvebi erTvis laviwzeda forma (lux. erecta), romlisTvisac
da iRliis kvanZebs. inervacia damaxasiaTebelia zemoT da gareT
xorcieldeba iRliisa da beWqveSa aweuli mxari.
nervebiT. iRliis nervi uSualod ukiduresad iSviaT amovardnilobas
saxsris qvemoT mxris Zvlis
warmoadgens akromionisqveSa (lux.
qirurgiul yels Signidan gadauvlis,
subacromialis) da qedqveSa (lux. infraspinatus)
ris gamoc saxsris amovardnilobis
amovardnilobebi, romlebic ukana
dros igi zogjer ziandeba.
amovardnilobebia. am formebis dros
mxris saxsris amovardniloba. mx-
mxris Tavi moTavsebulia sasaxsre
ris saxsris agebulebis zogierTi
fosos ukan uSualod akromionis qveS
Tavisebureba xels uwyobs mis
(akromionisqveSa amovardniloba) an
midrekilebas amovardnilobisadmi.
dacurebulia medialuri
amaT ekuTvnis: mniSvnelovani gans-
mimarTulebiT beWis qedis qveviT (lux.
xvaveba zomebSi mxris Tavsa da beWis
infraspinatus).
sasaxsre fosos Soris, farTo sasaxs-
mxris saxsris amovardnilobas xSi-
re CanTa, susti iogovani aparati da
rad Tan axlavs Zvlebisa da rbili
zeda kiduris xSiri travma.
qsovilebis dazianeba, qirurgiuli
amovardnili Tavis mdebareobis mi-
yelis motexiloba, didi borcvisa da
xedviT arCeven wina, qveda da ukana
sasaxsre fosos mogleja. kunTebis da
amovardnilobas.
myesebis dazianebis yvelaze meti
praqtikaSi upiratesad gvxvdeba wina
safrTxe emuqreba im kunTebs,
amovardnilobebi. maT Soris yvelaze
romlebic mxars atrialeben gareT,
xSiria niskartqveSa amovardniloba
agreTve mxris orTava kunTis myess.
(luxatio subcoracoidea). mxris Tavi am dros
mniSvnelovnad SeiZleba daziandes
isinjeba niskartisebri morCis qveS.
iRliis sisxlZarRvovan-nervuli kona.
mxari ganzidulia zomierad. wina
yvelaze xSirad ziandeba iRliis
amovardnilobebs miekuTvneba agreTve

klinikuri anatomia 122

 zemo kiduri

nervi, rac saSiSia deltisebri kunTis da mxris kanis qveda lateraluri

damblisa da atrofiis ganviTarebis nervi (n. cutaneus brachii lateralis inferior)
TvalsazrisiT. iRliis nervi SeiZleba (sxivis nervis toti); ukana mxareze—
daziandes mogvianebiTac—amovardnili mxris kanis ukana da winamxris kanis
mxris Cayenebisas qirurgis mier dorsaluri nervebi (n. cutaneus brachii
uxeSad Catarebuli manipulaciis Sede- posterior da n. cutaneus antebrachii posterior)
gad. (sxivis nervis totebi).
kanqveSa qsovili wina da SigniTa
mxareze Txeli da faSaria, ukana da
mxari gareTa—mxareze sqeli da SedarebiT
sazRvrebi: zevidan mkerdis didi mkvrivi.
kunTisa da zurgis uganieresi kunTis kanqveSa fascia Txeli firfitaa.
qveda kideebis SemaerTebeli xazi, sakuTari fascia orTava kunTis
qvevidan—mxris Zvlis zeda rokebidan medialuri da lateraluri Rarebis
ori TiTis zemoT gavlebuli xazi. gaswvriv mxris wina da ukana kunTebs
mxris medialur da lateralur Soris siRrmeSi uSvebs kunTTaSua
zedapirze gamoxatulia orTava kunTis Zgideebs (septum intermusculare mediale et
medialuri da lateraluri Rarebi laterale), romlebic mxris Zvals
(sulcus bicipitalis medialis et lateralis). umagrdebian. amis Sedegad mxarze iqm-
medialuri Rari zeviT iRliis fosoSi neba wina da ukana fasciuri budeebi.
gadadis, lateraluri Rari mxris zedarokebidan zeviT gatare-
deltisebri kunTis mimagrebis adgils buli vertikaluri xazebiT, romlebic
aRwevs da Semdeg deltisebr-mkerdis orTava kunTis medialur da
RarSi grZeldeba. qveviT orive Rari lateralur Rarebs Seesabamebian,
idayvis fosoSi gadadis. am RarebSi mxari wina da ukana midamoebad iyofa.
xeliT SeiZleba mxris Zvlis mosinjva.
igi ufro kargad isinjeba lateralur
RarSi—deltisebri kunTis mimagrebis mxris wina midamo _ regio brachii
adgilas.
anterior
kani mxris wina da medialur zeda-
kanqveSa qsovilSi ganlagebulia Se-
pirze SedarebiT Txeli, moZravi da
vardnisa da salmis venebi. Sevardnis
mgrZnobiarea, vidre ukana da
vena (v. cephalica) mxris orTava kunTis
lateralur zedapirebze. kans
lateralur kides miyveba da
anervebs: medialur mxareze, zeda na-
deltisebr-mkerdis RarSi gadadis.
wilSi—mxar-neknTaSua nervebi (nn.
salmis vena (v. basilica) midamos qveda
intercostobrachiales) (gamoeyofa II da III
mesamedSi kanqveS mdebareobs, zeviT
neknTaSua nervebs), qveda nawilSi—
mxris fasciis or furcels Soris
mxris kanis medialuri nervi;
gaivlis da mxris venas erTvis. salmis
lateralur mxareze—mxris kanis zeda
venasTan erTad winamxris kanis
lateraluri nervi (n. cutaneus brachii medialuri nervi mdebareobs.
lateralis superior) (iRliis nervis toti)

klinikuri anatomia 123


wina fasciuri bude winidan da
gverdebidan mosazRvrulia mxris
fasciiT, uknidan—mxris ZvliTa da
medialuri da lateraluri kunTTaSua
ZgideebiT. masSi mdebareobs mxris wina
kunTebi da mTavari sisxlZarRvovan-
nervuli kona. kunTebi ganlagebulia
or Sred: zedapirulad mdebareobs
mxris orTava kunTi (m. biceps brachii),
Rrmad, zeda naxevarSi —niskart-mxris
kunTi (m. coracobrachialis) da qveda or
mesamedSi—mxris kunTi (m. brachialis).
zedapiruli da Rrma kunTebi
gayofilia erTmaneTisgan mxris fasci-
is Rrma firfitiT.
mxris sisxlZarRvebisa da nervebis
mTavari kona mdebareobs orTava
kunTis medialur RarSi. fasciur
budes mas uqmnis medialuri kunTTaSua
Zgide. dasawyisSi igi Seicavs mxris
arterias, mxris venebs, saSualo,
sxivis, idayvis, mxris kanis medialur
da winamxris kanis medialur nervebs.
sxivisa da idayvis nervebi qvemoT
mxris ukana midamoSi gadadis. mxris
kanis medialuri nervi ki kanqveS
gamodis ise, rom orTava kunTis
medialuri Raris qveda naxevarSi
mxolod mxris arteria, mxris venebi,
saSualo da winamxris kanis medi-
aluri nervebi mdebareobs. isini kanze
proecirdebian iRliis fosos
lateralur kedelze gavlebuli
ganivi xazis wina da Sua mesamedebs
Soris mdebare wertilidan idayvis
naoWis Sua wertilamde gavlebul
xazze, romelic praqtikulad orTava
kunTis medialur Rars Seesabameba. aq
SeiZleba arteria TiTiT mxris Zvals
mivaWiroT da periferiaze sisxlis
dena SevaCeroT. mxris arterias mxris
zeda mesamedSi gamoeyofa mxris Rrma
klinikuri anatomia
zemo kiduri
arteria (a. profunda brachii), qveda
mesamedSi —idayvis gverdiTi zeda
arteria (a. colateralis ulnaris superior) da
idayvis gverdiTi qveda arteria (a.
collateralis ulnaris inferior).
saSualo nervi mxris zeda
mesamedSi mdebareobs mxris arteriis
lateralurad, Sua mesamedSi mas
iribad winidan gadauvlis da qveda
mesamedSi medialurad Tavsdeba. mxrisa
da winamxris kanis medialuri nervebi
mTel sigrZeze arteriis medialurad
mdebareobs. mxris zeda mesamedSi aseve
arteriis medialurad, magram
ramdenadme ufro Rrmad mdebareobs
idayvis nervi, romelic zeda da Sua
mesamedebis sazRvarze idayvis gverdiT
zeda arteriasTan erTad medialur
kunTTaSua ZgideSi gaivlis da ukana
fasciur budeSi gadadis. mxris Sua
mesamedSi igi kunTTaSua Zgidis ukan
mdebareobs, qveviT uknisken ixreba da
samTava kunTis medialuri Tavis
konebiT dafaruli mxris medialuri
zedarokisken miemarTeba.
idayvis nervi mxris qveda naxevarSi
proecirdeba xazze, romelic orTava
kunTis medialuri kidis Sua wertils
mxris medialur zedarokTan aerTebs.
sxivis nervi zeda kiduris yvelaze
msxvili nervia, mxris zeda mesamedSi
mxris arteriis ukan mdebareobs,
qveviT mxris Rrma arteriasTan erTad
ukana fasciur budeSi gadadis, samTava
kunTis medialur Tavsa da grZel Tavs
Soris gaivlis, mxris Zvals uknidan
spiralurad Semouvlis da midamos
qveda mesamedSi kvlav wina budeSi
brundeba. aq is jer samTava kunTis
lateralur Tavsa da mxris kunTs
Soris mdebareobs, xolo Semdeg—
124
 zemo kiduri

idayvis fosos sazRvarze—mxrisa da Seicavs. dasawyisSi es kona wina

mxar-sxivis kunTebs Soris Tavsdeba.
mxris qveda mesamedSi sxivis nervs
miyveba sxivis gverdiTi arteria (a.
collateralis radialis).
kunT-kanis nervi niskart-mxris kun-
Tis sisqeSi gavlis Semdeg mxris fas-
ciis Rrma furclis qveS qveviT da ga-
reT miemarTeba. mxris Sua da qveda
mesamedebSi igi mxris kunTze
mdebareobs. misi gagrZelebaa winamxris
kanis lateraluri nervi (n. cutaneus
antebrachii lateralis), romelic midamos
qveda sazRvarze orTava kunTis
lateralur kidesTan mxris sakuTari
fasciis qveS gamodis.
mxris ukana midamo _ regio brachii
posterior
kanqveSa qsovilSi totiandeba mxris
kanis zeda da qveda lateraluri ner-
vebi, mxris kanis ukana nervi da wi-
namxris kanis ukana nervi.
ukana fasciuri bude, romelSic
mxris samTava kunTi mdebareobs,
uknidan da gverdebidan mosazRvrulia
mxris fasciiT, winidan—mxris ZvliTa
da medialuri da lateraluri
kunTTaSua ZgideebiT. zeda nawilSi
mxris fascia samTava kunTis Tavebs
Soris agzavnis morCebs, qveda nawilSi
Txelia da Sezrdilia samTava kunTis
myesTan. samTava kunTsa da mxris Zvals
Soris kunT-mxris arxia (canalis
musculohumeralis), romelic zevidan
qveviT da Signidan gareT spiralurad
uvlis mxris Zvals. masSi mdebareobs
sisxlZarRvovan-nervuli kona, rome-
lic sxivis nervs, mxris Rrma arte-
riasa da mis Tanamgzavr venebs
fasciur budeSi mdebareobs, Semdeg
samTava kunTis grZel da medialur
Tavebs Soris arsebuli SualediT uka-
na fasciur budeSi gadadis da kunT-
mxris arxSi Tavsdeba, mxris Sua da
qveda mesamedebis sazRvarze late-
ralur kunTTaSua ZgideSi gaivlis da
wina fasciur budeSi brundeba. mxris
Sua mesamedSi sxivis nervi uSualod
Zvalze mdebareobs, ris gamoc am
Zvlis diafizis motexilobis dros
SeiZleba daziandes. mxris Rrma
arteria mxris Sua mesamedSi iyofa
sxivis gverdiT da gverdiT Sua arte-
riebad (a. collateralis radialis et a. collateralis
media). pirveli sxivis nervs miyveba da
idayvis fosoSi gadadis, meore ki
samTava kunTis medialuri Tavis sisqe-
Si totiandeba.
sxivis nervis proeqcia
zurgis uganieresi kunTis myesis qveda
kidesTan iwyeba da orTava kunTis
lateraluri Raris Sua da qveda
mesamedebis sazRvars aRwevs.
mxris diafizis motexiloba. mxris
diafizi tydeba an Zalis uSualo
zemoqmedebiT, an Zalis arapirdapiri
moqmedebiT: mtevniT an idayviT
dacemisas. motexilobis xazi
miimarTeba ganivad, iribad an
spiralurad. zogjer mxris diafizis
motexilobis mizezia mxris kunTebis
mkveTri SekumSva mZime sagnebis
gadasrolis dros.
natexTa Secilebis xasiaTi
damokidebulia motexilobis doneze:
Tu motexilobis xazi qirurgiuli
yelis maxloblad mdebareobs,
proqsimaluri natexi ganzidulia qed-
zeda kunTis mier, distaluri natexi
ki mozidulia mkerdis didi kunTis

klinikuri anatomia 125

 zemo kiduri

mier. rodesac motexilobis xazi idayvis morCis lateralurad mxris

deltisebri kunTis mimagrebis zemoT Zvlis gareTa zedarokidan 1sm-iT
mdebareobs, proqsimaluri natexi qvemoT kanze CaRrmavebaa, romelSic
mkerdis didi, zurgis uganieresi da isinjeba sxivis Zvlis Tavi (caput radii)
didi mrgvali kunTebis mier da mxris Zvlis mcire Tavi (capitulum
mozidulia SigniT da win. rodesac humeri). idayvis morCsa da mxris Zvlis
motexilobis xazi deltisebri kunTis medialur zedaroks Soris—idayvis
mimagrebis qvemoT mdebareobs, ukana medialur RarSi—isinjeba
proqsimaluri natexi deltisebri da idayvis nervi.
niskart-mxris kunTebis mier idayvis wina zedapirze SeimCneva
ganzidulia gareT da win, distaluri kanqveSa venebi, romlebic kargad
natexi ki mxris orTava da samTava gamoixateba mxarze laxtis zomierad
kunTebis mier aweulia zemoT da ukan. moWeriT.
kiduris mniSvnelovani damokleba ar mxris Zvlis zedarokebze
aRiniSneba. gavlebuli vertikaluri xazebiT
mxris diafizis motexilobis dros idayvi iyofa wina da ukana midamoebad.
SedarebiT xSirad ziandeba sxivis
nervi, romelic mxris Sua mesamedSi idayvis wina midamo _ regio cubiti
uSualod Zvalzea moTavsebuli. nervi anterior
SeiZleba daziandes an natexebiT an kani Txelia, kanqveSa qsovili fir-
ufro gvian axlad ganviTarebuli fitovani agebulebisaa. zedapiruli
korZis zewoliT. gamoricxuli ar fasciis sisqeSi gadis kanqveSa venebi
aris nervis moyola Zvlovani korZis da nervebi. lateralurad mdebareobs
sisqeSic. Sevardnis vena da winamxris kanis
mxris diafizis motexilobis dros lateraluri nervi, medialurad—
mxris deformacia mkveTradaa salmis vena da winamxris kanis
gamoxatuli. medialuri nervi. Sevardnisa da
salmis venebi erTmaneTTan dakavSire-
idayvi bulia idayvis Sua veniT (v. mediana
sazRvrebi: mxris zedarokebidan 2 cubiti), romelic Sevardnis venas
TiTis zeviT da 2 TiTis qveviT gamoeyofa, iribad zeviT da SigniT
gavlebuli horizontaluri xaziT. miemarTeba da salmis venas erTvis
garegani orientirebi: wina zedapir- (NN_isebri kavSiri). zogjer es kavSiri
ze aRiniSneba medialuri, Sua da
myardeba winamxris Sua venis (v. mediana
lateraluri SemaRlebebi, romelTa
antebrachii) medialuri da lateraluri
Soris idayvis wina medialuri da
totebiT. medialuri toti—v. mediana
lateraluri Rarebia. ukana zedapirze
basilica —erTvis salmis venas.
kargad isinjeba mxris medialuri da
lateraluri zedarokebi da idayvis lateraluri toti—v. mediana cephali-
morCi, xolo am ukanasknelis ca—Sevardnis venas (MM_isebri kavSi-
gverdebze—idayvis ukana medialuri ri). idayvis Sua vena dasawyisSi
da lateraluri Rarebi.

klinikuri anatomia 126

 zemo kiduri

(Sevardnis venis maxloblad) idayvis fosos kunTTaSua Zgideebi

dakavSirebulia idayvis Rrma venebTan. qmnis fibrozul budeebs amave fosos
mxris Zvlis medialuri zedarokis medialur da lateralur RarebSi
zemoT salmis venis medialurad mdebare sisxlZarRvovan da nervuli
mdebareobs idayvis zedapiruli konebisTvis.
limfuri kvanZebi. medialur RarSi, orTava kunTis
sakuTari fascia zeda nawilSi Txe- myesis medialur kidesTan mxris
lia, qveda-medialur nawilSi masSi kunTze mdebareobs mxris arteria
Caqsovilia orTava kunTis aponevrozi Tanamgzavri venebiT, xolo maTgan 0,5sm
(aponeurosis m. bicipitis). idayvis fosos SigniT—saSualo nervi. orTava kunTis
medialur da lateralur RarSi aponevrozis qveS mxris arteria iyofa
fascia uSvebs kunTTaSua Zgideebs da sxivisa da idayvis arteriebad.
yofs erTmaneTisgan kunTebs, romlebic sxivis arteria (a. radialis) mxar-sxivis
idayvis fosoSi SemaRlebebs qmnian. kunTsa da mrgval pronators Soris
medialur SemaRlebas qmnis mxris arsebul RarSi gadadis. idayvis
Zvlis medialuri zedarokidan dawye- arteria (a. ulnaris) mrgvali pronatoris
buli kunTebi—mrgvali pronatori (m. qveS gaivlis da TiTebis zedapirul
pronator teres), majis sxivisken momxreli da Rrma momxrel kunTebs Soris
kunTi (m. flexor carpi radialis), nebis grZeli Tavsdeba.
kunTi (m. palmaris longus), majis saSualo nervi mxris arteriis
idayvisken momxreli kunTi (m. flexor gayofis Semdeg idayvis arteriis
carpi ulnaris) da TiTebis zedapiruli gverdiT mdebareobs, mrgval
pronatorSi gaivlis da winamxarze
momxreli kunTi (m. flexor digitorum
gadadis.
superficialis).
idayvis fosos lateralur RarSi
Sua SemaRlebas qmnis orTava da
mxrisa da mxar-sxivis kunTebs Soris
mxris kunTebi, romlebic idayvis
zevidan Camodis sxivis nervi. igi aq
fosos fskerze eSvebian. orTava
iyofa zedapirul da Rrma totebad.
kunTis myesi umagrdeba sxivis xorkls
zedapiruli toti (r. superficialis) qveviT
(tuberositas radii), mxris kunTi—idayvis
sxivis arterias miyveba, Rrma toti (r.
xorkls (tuberositas ulnare). igi uSualod
profundus) supinatorSi gaivlis da
faravs winidan idayvis saxsars.
idayvis ukana midamoSi gadadis,
lateralur kunTovan SemaRlebas
anervebs majisa da TiTebis gamSlel
qmnis mxar-sxivis kunTi (m.
kunTebs da winamxris ukana midamos
brachioradialis), romelic mxris Zvlidan
kans.
da mxris lateraluri kunTTaSua
sxivis arteriidan idayvis fosoSi
Zgididan iwyeba, da supinatori (m.
gamodis sxivis Sebrunebuli arteria
supinator), romelic mxris lateraluri
(a. recurens radialis), romelic idayvis
zedarokidan, idayvis Zvlidan da
fosos lateraluri RariT zeviT
idayvis saxsris CanTidan iwyeba, sxivis
miemarTeba da sxivis gverdiT
Zvlis zeda bolos Semoexveva da masve
arterias (mxris Rrma arteriis toti)
umagrdeba.

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 zemo kiduri

anastomoziT ukavSirdeba. iqve idayvis idayvis kanqveSa abga _ bursa subcutanea

arteriidan gamodis idayvis olecrani.
Sebrunebuli arteria (a. recurens ulnaris) sakuTari fascia mimagrebulia
da ZvalTaSua saerTo arteria (a. mxris zedarokebsa da idayvis Zvlis
interossea communis). idayvis Sebrunebuli ukana kideze. lateraluri
arteria wina da ukana totebad iyofa. zedarokidan iwyeba majis sxivisken
wina toti idayvis fosos medialur gamSleli grZeli da mokle kunTebi
RarSi anastomoziT ukavSirdeba (mm. extensores carpi radialis longus et brevis),
idayvis gverdiT qveda arterias, ukana TiTebis saerTo gamSleli kunTi (m.
toti ki idayvis ukana midamoSi extensor digitorum communis), majis ida-
gadadis da ukavSirdeba idayvis yvisken gamSleli kunTi (m. extensor carpi
gverdiT zeda arterias. ZvalTaSua ulnaris) da idayvis kunTi (m. anconeus),
saerTo arteria dasawyisSive iyofa idayvis morCs umagrdeba mxris samTava
ZvalTaSua wina da ukana arteriebad, kunTis myesi, romlis qveS moTav-
romlebic winamxarze gadadian. ukana sebulia myesqveSa lorwovani abga _
ZvalTaSua arteria winamxris bursa mucosa subtendinea. medialur
ZvalTaSua apkSi gaivlis da gamoyofs zedaroksa da idayvis morCs Soris
ZvalTaSua Sebrunebul arterias, rom- sasaxsre CanTaze mdebareobs idayvis
elic idayvis ukana lateraluri nervi. igi majis idayvisken momxreli
RariT zeviT miemarTeba da kunTis or Tavs Soris gaivlis da
ukavSirdeba Sua gverdiT arterias. winamxarze gadadis.
amgvarad, erTi mxriv, idayvis, sxivisa
da Sua gverdiTi arteriebis, xolo, idayvis saxsari
meore mxriv, sxivis, idayvisa da Zva- idayvis saxsari Sedgeba mxar-
lTaSua Sebrunebuli arteriebis idayvis, mxar-sxivisa da sxiv-idayvis
urTierTkavSirebiT idayvis saxsris proqsimaluri saxsrisgan. mxar-idayvis
midamoSi Seqmnilia kolateraluri saxsars (articulatio humeroulnaris) qmnis
sisxlis mimoqcevisTvis mniSvnelovani
mxris Zvlis WaRi (trochlea humeri) da
arteriuli bade—rete articulare cubiti.
idayvis Zvlis WaRisebri naWdevi
mxris arteriis gamoyofis adgilas
(incisura trochlearis); mxar-sxivis saxsars
idayvis fosoSi mdebareobs nodi
(articulatio humeroradialis)—mxris Zvlis
lymphatici cubitales profundi, romlebic
mcire Tavi da sxivis Zvlis Tavis fo-
limfas Rebuloben kiduris
so, sxiv-idayvis proqsimalur saxsars
distaluri nawilebidan.
(articulatio radioulnaris proximalis)—idayvis
Zvlis sxivis naWdevi (incisura radialis) da
idayvis ukana midamo _ regio cubiti
sxivis Zvlis sabrunebeli sasaxsre
posterior
zedapiri (circumferentia articularis).
kani sqeli da moZravia: kanqveSa
saxsars winidan faravs mxris
qsovili sustad ganviTarebulia.
kunTi, winidan da gverdidan—
kanqveS idayvis morCze mdebareobs
supinatori, uknidan samTava kunTis
myesi da idayvis kunTi. mxar-sxivis

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 zemo kiduri

saxsris areSi mxris kunTis aRiniSneba winamxris orive Zvlis

lateralur kidesTan sasaxsre CanTaze ukana amovardniloba. am dros adgili
mdebareobs sxivis nervis Rrma toti. aqvs sasaxsre CanTis mniSvnelovnad
sxiv-idayvis saxsris areSi aRiniSneba dazianebas, xolo zogjer, mZime
sasaxsre CanTis parkisebri SemTxvevaSi adgili aqvs mxris kunTis
gamodrekiloba—recessus sacciformis, gaglejas da sisxlZarRvovan-nervuli
romelic saxsris susti adgilia. aseve konis dazianebasac. idayvis morCi da
sustia saxsris zeda nawili, romelic sxivis Zvlis Tavi mkveTrad
mxris Zvlis idayvis fosoSi (fossa warzidulebia ukan, idayvis fosoSi
olecranii) vrceldeba da zeviT samTava isinjeba mxris qveda bolo.
kunTis myess aRwevs. aRsaniSnavia mxrisa da winamxris
saxsris CxvletisTvis yvelaze xel- RerZebis uCveulo mdebareoba
sayrelia idayvis morCis mwvervalTan (winamxris RerZi gadanacvlebulia
mdebare wertili. gasinjvisTvis mxris RerZidan SigniT an gareT),
saxsari ufro misawvdomia idayvis saorientacio Zvlovani warmonaqmnebi
morCis mwvervalTan, agreTve ukana gadaadgilebulia, hunteris
medialuri da ukana lateraluri samkuTxedi darRveulia, moZraoba
Rarebis areSi. sasaxsre CanTas SeuZlebelia.
amagrebs: sxivis rgolisebri iogi (lig. sxivis Zvlis Tavis izolirebuli
annulare radii), romelic irgvliv exveva amovardniloba gvxvdeba upiratesad
sxivis Zvlis yels, idayvis gverdiTi bavSvebSi. araiSviaTia sxivis Zvlis
Tavis amovardniloba, gansakuTrebiT
iogi (lig. collaterale ulnare), romelic
mozrdilebSi, Serwymulia idayvis
gadaWimulia mxris Zvlis medialuri
Zvlis motexilobasTan zeda da Sua
zedarokidan idayvis Zvlis WaRisebri
mesamedis sazRvarze—montejis
naWdevis kidemde, da sxivis gverdiTi
motexiloba.
iogi (lig. collaterale radiale), romelic
gadaWimulia gareTa zedarokidan
sxivis Zvlis Tavis gareTa winamxari _ antebrachium
zedapiramde.
idayvis saxsari sisxliT maragdeba sazRvrebi: zevidan—mxris Zvlis
idayvis saxsris badisgan. limfuri zedarokebidan 2 TiTiT qveviT
ZarRvebi ixsneba idayvisa da iRliis gavlebuli xazi, qvevidan—sxivis
limfur kvanZebSi. inervacia Zvlis sadgisisebri morCis
xorcieldeba saSualo, sxivisa da mwvervalidan 2sm-iT zeviT gavlebuli
idayvis nervebiT. ganivi xazi.
idayvis saxsris amovardniloba. sakuTari fascia, sxivisa da idayvis
amovardniloba idayvis saxsarSi Zvlebi da winamxris ZvalTaSua apki
sasaxsre CanTisa da iogebis qmnis winamxris wina, ukana da gareTa
arasakmarisi simtkicis gamo sakmaod fasciur budeebs. wina budeSi
xSiria da upiratesad axalgazrda moTavsebulia majisa da TiTebis
asakSi gvxvdeba. yvelaze xSirad momxreli kunTebi, ukana budeSi—

klinikuri anatomia 129

 zemo kiduri

majisa da TiTebis gamSleli kunTebi, sxivis Zvals sadgisisebri morCis

gareTa budeSi—mxar-sxivisa da majis odnav zemoT), mrgvali pronatori
sxivisken gamSleli grZeli da mokle (iwyeba mxris Zvlis medialuri
kunTebi. zedarokidan da idayvis xorklidan,
zedapiris medialur nawilSi umagrdeba sxivis Zvlis gareTa
kargad isinjeba idayvis Zvali, late- zedapirs Sua mesamedSi), majis sxivis-
raluri zedapiris qveda or mesamed- ken momxreli kunTi (iwyeba mxris
Si—sxivis Zvali. Zvlis medialuri zedarokidan,
Tu muSts SevkravT da movxriT, wi- umagrdeba nebis II da III Zvlebis
namxris wina zedapirze qveda nawilSi fuZeebs), nebis grZeli kunTi (iwyeba
mkafiod gamoisaxeba majis sxivisken medialuri zedarokidan, ukavSirdeba
momxreli, nebis grZeli da TiTebis xelis gulis aponevrozs), majis
zedapiruli momxreli kunTebis idayvisken momxreli kunTi (iwyeba
myesebi, romlebic kargi orientiria medialuri zedarokidan, umagrdeba
winamxris qveda mesamedSi saSualo cercvisebr da kavian Zvlebs). meore
nervis blokadisa da masTan ope- Sres qmnis TiTebis zedapiruli momx-
raciuli midgomisTvis. reli kunTi (iwyeba medialuri zeda-
mxris Zvlis zedarokebidan sxivisa rokidan da winamxris Zvlebidan,
da idayvis sadgisisebr morCebamde umagrdeba II_V TiTebis Sua
gavlebuli gverdiTi xazebiT falangebis fuZeebs). mesame Sres qmnis
winamxari iyofa wina da ukana xelis ceris grZeli momxreli kunTi
midamoebad. (m. flexor policis longus) (iwyeba sxivis
Zvlis wina zedapiridan da ZvalTaSua
winamxris wina midamo _ regio apkidan, umagrdeba ceris distaluri
antebrachii anterior falangis fuZes) da TiTebis Rrma
kani Txeli da moZravia, kanqveSa momxreli kunTi (m. flexor digitorum profun-
qsovilSi lateralurad mdebareobs dus) (iwyeba idayvis Zvlis wina zeda-
Sevardnis vena, medialurad—salmis piridan da ZvalTaSua apkidan, umagr-
vena, SuaSi—winamxris Sua vena. deba II_V TiTebis distaluri
Sevardnisa da salmis venebi qveda falangebis fuZeebs). meoTxe Sres qmnis
mesamedSi winamxris ukana zedapirzea. kvadratuli pronatori (m. pronator
kanqveSa fascia sustad aris gamoxa- quadratus) (midamos qveda mesamedSia,
tuli. sakuTari fascia zeda nawilSi iwyeba idayvis Zvlis wina zedapiridan,
sqelia da aZlevs dasawyiss kunTovan umagrdeba sxivis Zvlis wina zedapirs).
konebs, qveda nawilSi SedarebiT meore da mesame kunTovani Sreebi
Txelia da kunTebisgan gayofilia gayofilia erTmaneTisgan winamxris
faSari qsoviliT, qmnis winamxris wina sakuTari fasciis Rrma firfitiT.
da gareTa fasciur budeebs, mesame da meoTxe kunTovan Sreebs
romlebSic kunTebi ganlagebulia oTx Soris winamxris qveda mesamedSi
Sred. pirvel SreSi mdebareobs mxar- pirogovis SemaerTebelqsovilovani
sxivis kunTi (iwyeba mxris Zvlis gare- sivrcea, romelic winidan mosazRv-
Ta kidis qveda mesamedidan, umagrdeba

klinikuri anatomia 130

 zemo kiduri

rulia TiTebis Rrma momxreli kun- idayvis sisxlZarRvovan-nervuli ko-

TiT, uknidan—kvadratuli pronatori- na mdebareobs idayvis RarSi (sulcus ulna-
Ta da ZvalTaSua apkiT. misi yvelaze ris), romelic Signidan moisazRvreba
farTo nawili majidan 5sm-iT zeviT majis idayvisken momxreli kunTiT da
mdebareobs. xelis gulis sinoviuri garedan—TiTebis zedapiruli
budeebis Cirqovani anTebis dros momxreli kunTiT. mis fskers qmnis
procesi zogjer am sivrceSi TiTebis Rrma momxreli kunTi. idayvis
vrceldeba. operaciuli midgoma sisxlZarRvovan-nervuli kona Seicavs
pirogovis sivrcesTan xorcieldeba idayvis arterias ori veniT da idayvis
sxivis an idayvis mxareze gavlebuli nervs. idayvis arteria dasawyisSi iri-
gaswvrivi ganakveTiT. bad—SigniT da qveviT miemarTeba,
winamxris wina budeSi kunTebs So- mrgvali pronatorisa da TiTebis
ris moTavsebulia sxivis, idayvis, Sua- zedapiruli momxreli kunTis qveS
mdebare da ZvalTaSua wina sisxlZar- gaivlis da idayvis RarSi gadadis. Ra-
Rvovan-nervuli konebi. sxivis ris zeda nawilSi igi kunTebiT aris
sisxlZarRvovan-nervuli kona dafaruli, Raris qveda nawilSi zeda-
mdebareobs sxivis RarSi (sulcus radialis), pirulad mdebareobs.
romelic garedan mosazRvrulia mxar- winamxris zeda sazRvarze idayvis
sxivis kunTiT, Signidan zeda arteriidan gamodis ZvalTaSua saerTo
mesamedSi—mrgvali pronatoriT da arteria, romelic iqve wina da ukana
qveda or mesamedSi—majis sxivisken ZvalTaSua arteriebad iyofa. midamos
momxreli kunTiT. sxivis kona Seicavs Sua da qveda mesamedebis sazRvarze
sxivis arterias Tanamgzavri venebiT idayvis arterias gamoeyofa
da sxivis nervis zedapirul tots. dorsaluri toti, romelic majis
sxivis arteria venebiTurT mdebareobs idayvisken momxreli kunTis qveS gaiv-
nervis medialurad. zeda nawilSi igi lis da majis kanqveSa qsovilSi toti-
dafarulia mezobeli kunTebis andeba.
kideebiT, qveda nawilSi ki zeda- winamxris zeda mesamedSi idayvis
pirulad, myesebs Soris mdebareobs. arteria kanze proecirdeba idayvis
sxivis arteria kanze proecirdeba fosos SuaSi mxris orTava kunTis
idayvis fosos SuaSi orTava kunTis myesis medialuri kididan winamxris
myesis medialuri kididan sxivis medialuri kidis zeda da Sua
sadgisisebri morCis medialur kidemde mesamedebis sazRvramde gavlebul
gavlebul xazze. sxivis nervis zeda- xazze, winamxris Sua da qveda mesame-
piruli toti winamxris zeda or debSi ki—mxris Zvlis medialuri
mesamedSi arteriis lateralurad zedarokidan cercvisebri Zvlis late-
mdebareobs. Sua da qveda mesamedebis ralur kidemde gavlebul xazze.
sazRvarze gareTken gadaixreba, mxar- idayvis nervi majis idayvisken
sxivis kunTis myessa da sxivis Zvals momxreli kunTis Tavebs Soris
Soris gaivlis da majis dorsalurad gaivlis da idayvis RarSi arteriis
kanqveSa qsovilSi gadadis. medialurad Tavsdeba. midamos Sua da
qveda mesamedebis sazRvarze mas

klinikuri anatomia 131


gamoeyofa dorsaluri toti, romelic
ise, rogorc idayvis arteriis
dorsaluri toti, majis idayvisken
momxrel kunTsa da idayvis Zvals
Soris gaivlis, xvrets fascias da
majis dorsalur mxareze kanqveSa
qsovilSi gadadis. idayvis nervi
proecirdeba mxris medialuri
zedarokis fuZidan cercvisebri Zvlis
lateralur kidemde gatarebul xazze.
Suamdebare sisxlZarRvovan-nervuli
kona Seicavs saSualo nervsa da
saSualo arterias (a. mediana) (wina
ZvalTaSua arteriis toti)
Tanamgzavri venebiT. saSualo nervi
idayvis fosodan mrgvali pronatoris
or Tavs Soris gaivlis, idayvis arte-
rias winidan gadauvlis da TiTebis
zedapirul da Rrma momxrel kunTebs
Soris Tavsdeba. midamos qveda
mesamedSi igi moTavsebulia saSualo
RarSi (sulcus medianus), romelic majis
sxivisken momxreli kunTisa da
TiTebis zedapiruli momxreli kunTis
myesebs Soris mdebareobs. winidan mas
faravs nebis grZeli kunTis myesi.
saSualo nervi kanze proecirdeba
mxris Zvlis medialur zedaroksa da
mxris orTava kunTis myess Soris
manZilis Sua wertilidan sxivisa da
idayvis Zvlebis sadgisisebr morCebs
Soris manZilis Sua wertilamde
gavlebul xazze.
winamxris wina fasciur budeSi
ZvalTaSua apkis wina zedapirze
TiTebis Rrma momxrel kunTsa da
ceris grZel momxrel kunTs Soris
mdebareobs ZvalTaSua wina arteria
Tanamgzavri venebiT da ZvalTaSua
nervi (saSualo nervis toti). arteria
kvadratuli kunTis zeda kidesTan
ZvalTaSua apkSi gaivlis, winamxris
klinikuri anatomia
zemo kiduri
ukana fasciur budeSi gadadis da
monawileobs majis dorsaluri
arteriuli badis SeqmnaSi.
winamxris ukana midamo _ regio
antebrachii posterior
kani SedarebiT ufro sqeli da
Tmiania, vidre winamxris wina midamoSi.
mas anervebs winamxris kanis ukana
nervi (sxivis nervis toti) da
winamxris kanis medialuri da
lateraluri nervebis totebi.
kanqveSa venebi ukavSirdeba Sevard-
nisa da salmis venebs. zedapiruli
fascia sustad aris gamoxatuli,
sakuTari fascia sqelia. misgan zeda
nawilSi iwyeba kunTovani konebi.
kunTebi qmnis or Sres. zedapirul
SreSi garedan SigniT ganlagebulia:
majis sxivisken gamSleli grZeli da
mokle kunTebi, TiTebis gamSleli
kunTi (m. extensor digitorum), nekis
gamSleli kunTi (m. extensor digiti minimi)
da majis idayvisken gamSleli kunTi
(m. extensor carpi ulnaris); Rrma SreSi—
xelis ceris grZeli ganmzidveli
kunTi (m. abductor policis longus), xelis
ceris grZeli da mokle gamSleli kun-
Tebi (mm. extensores policis longus et brevis)
da maCvenebeli TiTis gamSleli kunTi
(mm. extensor indicis).
zedapiruli Sris kunTebi iwyeba mx-
ris Zvlidan (upiratesad gareTa zeda-
rokidan), Rrma Sris kunTebi—
winamxris Zvlebidan da ZvalTaSua
apkidan. majis sxivisken gamSleli
grZeli da mokle kunTebi umagrdeba
Sesabamisad nebis II da III Zvlebis
fuZes, majis idayvisken gamSleli kun-
Ti—nebis V Zvlis fuZes, ceris
ganmzidveli kunTi—nebis I Zvlis fu-
132
 zemo kiduri

Zes. danarCeni kunTebi TiTebze motexilobis dros distaluri natexi

gadadis. winaa wamoweuli da idayvis ZvalTanaa
kunTebis zedapiruli da Rrma Sre- miaxlovebuli kvadratuli prona-
ebi gayofilia erTmaneTisgan fasciis toris mier; am garemoebas xels
Rrma furcliT. am furcelsa da uwyobs agreTve ceris mokle gamSle-
TiTebis gamSlel kunTs Soris li da grZeli ganmzidveli kunTebi.
moTavsebulia SemaerTebelqsovilovani idayvis Zvlis izolirebuli mote-
sivrce, romelSic ukana ZvalTaSua xilobis dros igi tydeba qveda an Sua
sisxlZarRvovan-nervuli kona mesamedSi. motexiloba uxSiresad gamo-
mdebareobs. igi Seicavs ukana ZvalTa- wveulia Zalis pirdapiri
Sua arterias, venebs da nervs. es zemoqmedebiT. natexTa dacilebas ara
ukanaskneli sxivis nervis Rrma totis aqvs adgili an metad sustadaa
gagrZelebaa. winamxris ukana gamoxatuli da umTavresad travmis
SemaerTebelqsovilovani sivrce moqmedebiTaa gamowveuli. Cveulebriv,
ZvalTaSua apkSi arsebuli xvreliT orive natexis bolo sxivs uaxlovdeba
dakavSirebulia winamxris wina (piro- da amasTan winaa wamoweuli.
goviseul) SemaerTebelqsovilovan winamxris orive Zvlis motexiloba
sivrcesTan. gamowveulia rogorc Zalis uSualo,
winamxris diafizuri motexiloba. ise arapirdapiri moqmedebiT (gaSlil
winamxris orive Zvlis erTdrouli xelze dacema). uxSiresad Zvlebi
motexiloba gacilebiT ufro xSirad tydeba qvemo an Sua mesamedSi. zemo
xdeba, vidre calkeuli Zvlis mesamedSi motexiloba iSviaTia. Zalis
motexiloba. pirdapiri moqmedebis dros
sxivis Zvlis izolirebuli motexi- motexilobis xazi orive Zvalze erT
loba SedarebiT ufro xSiria, vidre doneze gaivlis. Zalis arapirdapiri
idayvis Zvlis motexiloba. moqmedebis dros Zvlebi sxvadasxva
motexilobas iwvevs rogorc Zalis doneze tydeba.
uSualo, ise arapirdapiri moqmedeba rodesac orive Zvalia motexili,
gaSlil xelze dacemis dros. natexTa Secilebac ufro mkveTradaa
Cveulebriv, sxivis Zvali tydeba Sua gamoxatuli da ufro rTulicaa,
da qveda mesamedSi, iSviaTad, zemo vidre Zvlebis izolirebuli
mesamedSi. zemo mesamedSi motexilobis dros.
motexilobisas proqsimaluri natexi natexebis Secileba damokidebulia
moxrili da supinirebulia mxris rogorc travmis, agreTve kunTebis
orTava kunTis da supinatoris mier, moqmedebisgan da ZiriTadad iseTive
distaluri natexi ki pronacias ganic- xasiaTi aqvs, rogorc sxivis
dis. Sua mesamedSi motexilobis dros izolirebuli motexilobis dros aRi-
proqsimaluri natexi supinatorisa da niSneba. orive Zvlis motexilobisas
pronatoris erTdrouli moqmedebis sigrZiTi Secilebasac aqvs adgili
gamo saSualo mdebareobaSi imyofeba, natexTa erTimeoreze Securebis gamo.
distaluri natexi ki—pronaciis gvxvdeba kuTxiTi Secilebac. kuTxiTi
mdebareobaSi. qveda mesamedSi Secilebis dros kuTxis mwvervali

klinikuri anatomia 133

 zemo kiduri

ufro xSirad winaa mimarTuli, rasac xelis mtevnis nawilebia maja, nebi
adgili aqvs gaSlili kiduriT da TiTebi. TiToeul nawilSi arCeven
xelisgulze dacemis dros; xelis xelis gulis, anu palmarul da xelis
zurgze dacemisas ki kuTxis mwvervali zurgis, anu dorsalur zedapirebs.
ukanaa mimarTuli.
winamxris orive Zvlis erTdrouli maja _ carpus
motexilobis dros winamxris maja ganisazRvreba nebisgan cercvi-
deformacia mkveTradaa gamoxatuli. sebri Zvlis qvemoT gavlebuli ganivi
xaziT. palmarul zedapirze kani
xelis mtevani _ manus Txeli da moZravia, moklebulia Tmian
xelis mtevani ganisazRvreba wina- safarvels. kanqveSa venebi winamxris
mxrisgan sxivis Zvlis sadgisisebri Sua venas erTvis. kanis inervacia
morCis mwvervalidan 2sm-iT zemoT xorcieldeba winamxris kanis
gavlebuli ganivi xaziT—kanis medialuri da lateraluri nervebis
medialuri naoWiT. saboloo totebiT.
garegani orientirebi. majis areSi sakuTari fascia sqelia, dakavSire-
wina zedapirze sxivis mxareze bulia momxrelebis sabmelTan
isinjeba sxivis Zvlis sadgisisebri (retinaculum flexorum). es ukanaskneli
morCi da navisebri Zvlis borcvi (tuber Sedgeba zedapiruli da Rrma
ossis navicularis), idayvis mxareze— furclebisgan, romelTa Soris majis
cercvisebri Zvali (os pisiforme), odnav arxi (canalis carpi) gaivlis. iogiviT
qvemoT—kaviani Zvlis kavi (hamulus ossis sqeli zedapiruli furceli gadaWimu-
hamati). dorsalur zedapirze idayvis lia, erTi mxriv, navisebr da kavian
mxareze kargad isinjeba samwaxnagiani Zvlebsa da, meore mxriv, cercvisebr
Zvali (os triquetrum). sxivis Zvlis da kavian Zvlebs Soris. Rrma
sadgisisebri morCis distalurad, ce- furceli mofens majis ZvlebiT
ris ganzidvisas, SeimCneva samkuTxa Seqmnil Rars.
CaRrmaveba—e.w. anatomiuri saTuTune, majis palmarul zedapirze
romelSic sxivis arteriis pulsacia kunTebis myesebi ganlagebulia sam
isinjeba. nebis dorsalur zedapirze Sred. pirvel SreSi yvelaze
SesamCnevia kanqveSa venebi da TiTebis lateralurad mdebareobs majis
gamSleli kunTebis myesebi; kargad sxivisken momxreli kunTis myesi, rome-
isinjeba nebis Zvlebi; xelis gulze lic momxrelebis sabmelis or fur-
aRiniSneba nekisa da ceris maRlobebi cels Soris gaivlis da nebis II da III
(thenar da hypothenar), xolo maT Soris— Zvlebis fuZeebs umagrdeba. mis medi-
samkuTxa formis CaRrmaveba. roca alurad moTavsebulia nebis grZeli
ceri mozidulia, nebis I da II Zvlebs kunTis myesi, romelic dakavSirebulia
Soris dorsalur mxareze gamoxatuli momxrelebis sabmelTan da grZeldeba
I dorsaluri ZvalTaSua kunTis mier xelis gulis aponevrozSi. ufro
Seqmnili morgvi. medialurad mdebareobs majis ida-
yvisken momxreli kunTi, romelic
cercvisebr Zvals umagrdeba. meore

klinikuri anatomia 134

 zemo kiduri

Sres qmnis TiTebis zedapiruli momx- gadadis xelis gulze. nervi

reli kunTis myesebi, mesame Sres— sisxlZarRvebis medialurad mdebare-
ceris grZeli momxreli da TiTebis obs.
Rrma momxreli kunTebis myesebi, majis dorsalur zedapirze kani
romelTa Soris saSualo nervi SedarebiT ufro sqelia, vidre
mdebareobs. meore da mesame Sris palmarul zedapirze. kanqveSa
myesebi da saSualo nervi momxrelebis qsovilSi gaivlis Sevardnisa da
sabmelis qveS—majis arxSi gaivlis. salmis venebis Senakadebi, sxivis
aq myesebi mdebareobs or sinoviur nervis zedapiruli totisa da idayvis
parkSi, romelTagan lateraluri Sei- nervis dorsaluri totis ganStoebebi,
cavs ceris grZeli momxreli kunTis agreTve—winamxris kanis lateraluri
myess, xolo medialuri—danarCen nervis saboloo totebi.
myesebs. sinoviuri parkebi aq zogjer fascia qmnis gamSlelebis sabmels
SeerTebulia erTmaneTTan. maTi (retinaculum extensorum). misgan siRrmeSi
proqsimaluri boloebi winamxris miemarTeba da majis Zvlebs umagrdeba
pirogovis SemaerTebelqsovilovan fasciuri Zgideebi, ris Sedegadac
sivrceSi mdebareobs. iqmneba 6 Zval-fibrozuli arxi,
majis palmarul zedapirze gaivlis romlebSic sinoviuri budeebiT
agreTve sxivisa da idayvis garemoculi majisa da TiTebis
sisxlZarRvebi da idayvis nervi. gamSleli kunTebis myesebi gaivlis.
sxivis arteria Tanamgzavr venebTan sxivis Zvlis mxridan I arxSi gaivlis
erTad mdebareobs majis sxivisken ceris grZeli ganmzidveli da mokle
momxreli kunTis myesis lateralurad. gamSleli kunTebis myesebi, II arxSi—
aq igi iZleva xelis gulis zedapirul majis sxivisken gamSleli grZeli da
tots (ramus palmaris superficialis), Semdeg mokle kunTebis myesebi, III arxSi—ce-
ceris grZeli ganmzidveli da mokle ris grZeli gamSleli kunTis myesi, IV
gamSleli kunTebis myesebis qveS arxSi —TiTebis saerTo gamSleli da
gaivlis da gadadis am myesebsa da maCvenebeli TiTis sakuTari gamSleli
ceris grZeli gamSleli kunTis myess kunTis myesi, V arxSi—nekis sakuTari
Soris arsebul CaRrmavebaSi, gamSleli kunTis myesi da VI arxSi—
romelsac anatomiuri saTuTune ewo- majis idayvisken gamSleli kunTis mye-
deba. aqedan igi nebis I da II ZvalTa- si.
Sua sivrciT xelis gulze gadadis.
idayvis arteria Tanamgzavri vene- xelisguli _ palma manus
biT da idayvis nervi cercvisebri kani moklebulia Tmian safarvels,
Zvlis donemde majis idayvisken mkvrivi da naklebad moZravia,
momxrel kunTsa da TiTebis mdidaria oflis jirkvlebiT, rqovana
zedapirul momxrel kunTs Soris Sre kargad aris ganviTarebuli.
mdebareobs, qveviT gaivlis majis kanqveSa qsovili Seicavs mkvriv
fasciasa da momxrelebis sabmels fibrozul konebs, romlebic kans
Soris arsebul SualedSi, romelsac xelis gulis aponevrozTan
idayvis arxi (canalis ulnaris) ewodeba da akavSireben. sivrceebi fibrozul

klinikuri anatomia 135

 zemo kiduri

konebs Soris amovsebulia cximovani qsoviliT, romelic II_V TiTTaSua

qsovilis wilakebiT. kanqveSa qso- naoWebis proqsimalurad kanis bali-
vilSi wvrili venebi da saSualo da Sisebr SemaRlebebs qmnis. igi kanqveSa
idayvis nervebis totebia. amave SreSi SemaerTebel qsovils xelis gulis
nekis maRlobze ganivad mdebareobs Sua fasciuri budis SemaerTebel
nebis mcire kunTi (m. palmaris brevis). qsovilTan akavSirebs.
xelis gulze arCeven or fascias: komisuruli xvrelebis momsazRv-
zedapirulsa da Rrmas. zedapiruli reli xelis gulis aponevrozis
fascia faravs cerisa da nekis gaswvrivi konebidan nebis Zvlebis
maRlobTa kunTebs, TiTebis momxreli Tavebze mdebare nebis ganiv iogebamde
kunTebis myesebs, nebis palmarul miemarTeba Zgideebi, romlebic
mxareze mdebare sisxlZarRvebsa da xsenebul iogebTan erTad qmnian
nervebs, Rrma fascia ZvalTaSua kun- fibrozul arxebs Wiayela
Tebs. zedapiruli fasciis gverdiTi kunTebisTvis (mm. lumbricales).
nawilebi Txelia. Sua nawili ki komisuruli xvrelebiT nebis kanqveSA
gansakuTrebiT sqeli da mkvrivia, ris flegmona SeiZleba gavrceldes nebis
gamoc mas xelis gulis aponevrozi fasciur budeze, xolo aqedan, Wiayela
(aponeurosis palmaris) ewodeba. formiT igi kunTebis gaswvriv, xelis zurgze.
mogvagonebs samkuTxeds, romlis nebis aponevrozis gverdiTi
mwvervali miqceulia majisken, xolo kideebidan siRrmeSi miemarTeba
fuZe—TiTebisken. majis areSi igi da- medialuri da lateraluri kunTTaSua
kavSirebulia momxrelebis sabmelTan; Zgideebi. lateraluri kunTTaSua
aq aponevrozs umagrdeba nebis grZeli Zgide siRrmeSi medialurad ixreba da
kunTis myesi, romlis konebi mis ukavSirdeba nebis III Zvals, medialuri
sisqeSi maraosebr aris gaSlili. kunTTaSua Zgide umagrdeba nebis V
xelis gulis aponevrozi Seicavs Zvals. amgvarad xelis gulze Seqm-
zedapirul gaswvriv da Rrma ganiv nilia lateraluri, medialuri da Sua
fibrozul konebs. zedapiruli konebi fasciuri budeebi.
nebis grZeli kunTis myesis gagrZele- xelis gulis lateraluri bude
baa. aponevrozis distalur nawilSi Seicavs ceris maRlobis kunTebs,
isini iyofian 4 konad, romlebic II_V romlebic umTavresad iwyebian
TiTebis fuZeebs aRweven. gaswvriv momxrelebis sabmelidan da majis
konebs Soris moCans ganivi konebi, Zvlebidan. yvelaze zedapirulad da
romlebic ufro mkveTrad arian gareT mdebareobs ceris mokle
gamoxatuli aponevrozis distalur ganmzidveli kunTi (abductor policis brevis),
boloSi. aponevrozis gaswvriv da mis qveS, lateralurad moTavsebulia
ganiv konebs Soris TiTTaSua nao- ceris pirispir damyenebeli kunTi (m.
Webis proqsimalurad e.w. komisuruli opponens policis), medialurad—ceris
xvrelebia, romlebiTac kanqveS mokle momxreli kunTi (m. flexor policis
gamodis TiTebis sisxlZarRvebi da brevis), romlis zedapirul da Rrma
nervebi. komisuruli xvrelebi Tavebs Soris gaivlis sinoviuri
amovsebulia cximovani SemaerTebeli

klinikuri anatomia 136


budiT garemoculi ceris grZeli
momxreli kunTis myesi. ufro medi-
alurad ceris momzidveli kunTia (m.
adductor policis), romelic nebis II da III
Zvlebidan iwyeba.
ceris maRlobis kunTebze an kunTe-
bis sisqeSi gaivlis sxivis arteriis
xelis gulis zedapiruli toti (r.
palmaris superficialis), romelic aqedan Sua
fasciur budeSi gadadis da xelis
gulis zedapiruli rkalis SeqmnaSi
monawileobs.
xelis gulis medialuri fasciuri
bude Seicavs nekis ganmzidvel, nekis
momxrel da nekis pirispir damyenebel
kunTebs (m. abductor digiti minimi, m. flexor
digiti minimi et m. opponens digiti minimi), rom-
lebic umTavresad majis Zvlebidan da
momxrelebis sabmelidan iwyebian.
kunTebis lateralurad mdebareobs
idayvis nervisa da idayvis arteriis
totebi, romlebic nekis medialuri
zedapirisken miemarTebian.
medialur fasciur budeSi gavliT
Sua fasciur budeSi gadadis idayvis
arteriis Rrma toti (r. profundus a.
ulnaris) da idayvis nervis Rrma toti (r.
profundus n. ulnaris).
xelis gulis Sua fasciuri bude
Seicavs TiTebis momxreli kunTebis
myesebs, Wiayela kunTebs,
sisxlZarRvebsa da nervebs. xelis
gulis aponevrozis qveS yvelaze
zedapirulad mdebareobs xelis
gulis zedapiruli rkali (arcus
palmares superficialis), romelic Seqmnilia
idayvis arteriisa da sxivis arteriis
xelis guliseuli zedapiruli totis
SeerTebiT. misgan gamodis TiTebis
palmaruli saerTo arteriebi (aa.
digitales palmares communes), romlebic
klinikuri anatomia
zemo kiduri
iyofian TiTebis sakuTar palmarul
arteriebad (aa. digitales palmares
propriae). es arteriebi komisuruli
xvrelebiT tovebs Sua fasciur budes
da TiTebis kanqveSa qsovilSi gadadis.
xelis gulis zedapiruli rkalis
qveS gaivlis TiTebis oTxi saerTo
palmaruli nervi (n. digitales palmares
communes) romelTagan sami gamoeyofa
saSualo nervs, erTi ki—idayvis
nervis palmarul tots. TiToeuli
TiTis saerTo palmaruli nervi iyofa
TiTis or sakuTar palmarul nervad.
saSualo nervi, Cveulebriv, anervebs
I, II da III TiTebis palmarul zeda-
pirebs mTlianad da IV TiTis
palmaruli zedapiris lateralur
naxevars, idayvis nervi —V TiTis
palmarul zedapirs mTlianad da IV
TiTis palmaruli zedapiris medialur
naxevars. TiTebis nervebis msvleloba
Tanamosaxele arteriebis msvlelobas
Seesabameba.
TiTebis sisxlZarRvebisa da
nervebis qveS mdebareobs TiTebis
momxreli kunTebis myesebi da oTxi
Wiayela kunTi. TiToeuli Wiayela
kunTi iwyeba Sesabamisi TiTis Rrma
momxreli kunTis myesis lateraluri
zedapiridan da umagrdeba proqsi-
maluri falangis dorsalur zedapirs.
myesebis qveS xelis gulis Rrma
rkalia (arcus palmaris profundus),
romelsac sxivis arteria da idayvis
arteriis Rrma toti qmnis. sxivis
arteria Sua fasciur budeSi gadadis
anatomiuri saTuTunidan (nebis I da II
ZvalTaSua sivrceSi gavliT), xolo
idayvis arteriis Rrma toti idayvis
nervis totTan erTad—medialuri fas-
ciuri budidan.
137
 zemo kiduri

xelis gulis Rrma rkalidan gamo- Tebulia erTmaneTTan, rac maTi

dis nebis palmaruli arteriebi (aa. anTebis dros V-sebri anu jvaredini
metacarpales palmares), romlebic nebis tendovaginitis ganviTarebis
dorsalur arteriebs ukavSirdebian SesaZleblobas ganapirobebs (procesi
da komisurul xvrelebSi TiTebis I TiTis sinoviuri budidan gadadis V
saerTo arteriebs uerTdebian. TiTis sinoviur budeze an piriqiT).
idayvis nervis Rrma toti (r.
profundus n. ulnaris) xelis gulis Rrma xelisgulis AemaerTebelqsovilovani
rkalis qveS mdebareobs. igi anervebs sivrceebi
nekis maRlobis kunTebs, yvela fasciuri budeebis Sesabamisad xe-
ZvalTaSua kunTs, III da IV Wiayela lis gulze sami
kunTebs, ceris momzidvel kunTs da SemaerTebelqsovilovani sivrcea.
ceris mokle momxreli kunTis Rrma lateraluri, anu ceris maRlobis
konebs. ceris maRlobis danarCen SemaerTebelqsovilovani sivrce nebis
kunTebsa da I da II Wiayela kunTebs III Zvalsa da ceris grZeli momxreli
anervebs saSualo nervi. kunTis myesis sinoviur budes Soris
TiTebis momxreli kunTebis myesebi mdebareobs. I da II TiTTaSua naoWis
xelis mtevanze moTavsebulia areSi igi ukavSirdeba xelis zurgis
sinoviur budeebSi, romlebic kanqveSa qsovils.
distaluri mimarTulebiT bolo medialuri SemaerTebelqsovilovani
falangebamde vrceldebian. sivrce medialur fasciur budeSi
proqsimaluri mimarTulebiT ki II, III mdebareobs. igi SedarebiT ufro
da IV TiTebis myesTa sinoviuri izolirebulia.
budeebi vrceldeba neb-falangTa nebis Sua SemaerTebelqsovilovani
saxsrebamde, xolo I TiTis, anu sivrce TiTebis momxreli kunTebis
sxivismxrivi da V TiTis, anu myesebiT or nawilad iyofa.
idayvismxrivi sinoviuri budeebi nebze zedapirul nawilSi—uSualod xelis
gadadis da majis arxiT winamxris gulis aponevrozis qveS—mdebareobs
pirogoviseul sivrces aRwevs. xelis gulis zedapiruli rkali,
sxivismxrivi sinoviuri budis TiTebis palmaruli saerTo arteriebi
proqsimaluri bolo aq moTavsebulia da TiTebis palmaruli saerTo nerve-
sxivis Zvlis sadgisisebri morCis bi. aq arsebuli SemaerTebeli qsovili
mwvervalidan 2sm-iT zemoT, xolo nebis Zvlebis TavebTan komisuruli
idayvismxrivi sinoviuri budis proqsi- xvrelebiT kanqveSa SemaerTebel
maluri bolo—momxrelTa sabmelidan qsovils ukavSirdeba. am sivrcis Rrma
3_ 4sm-iT zemoT. idayvismxrivi nawilSi—TiTebis momxreli kunTebis
sinoviuri bude nebze da majis arxSi qveS—mdebareobs xelis gulis Rrma
II_IV TiTebis momxreli kunTebis rkali, idayvis nervis Rrma toti da
myesebsac moicavs. majis arxSi nebis palmaruli arteriebi.
sxivismxrivi da idayvismxrivi sinovi- aq arsebuli SemaerTebeli qsovili
uri budeebi SemTxvevaTa 10%-Si Seer- Wiayela kunTebis gayolebiT
ukavSirdeba III, IV da V TiTebis

klinikuri anatomia 138

 zemo kiduri

dorsalur SemaerTebel qsovils, gamSleli kunTis myesebi nebis Zvle-

xolo majis arxiT—winamxris pirogo- bis Tavebis doneze, Cveulebriv, dakav-
vis SemaerTebelqsovilovan sivrces. Sirebulia erTmaneTTan Txeli
amitom nebis Sua SemaerTebel- myesovani firfitebiT (connsexus
qsovilovani sivrcidan Cirqi SeiZleba tendineus). Rrma fascia nebis Zvlebsa
gavrceldes, erTi mxriv, nebis kanqveSa da ZvalTaSua dorsalur kunTebs
da TiTebis dorsalur SemaerTebel faravs. fasciis qveS mdebareobs nebis
qsovilze da, meore mxriv—winamxris ZvalTaSua dorsaluri arteriebi (aa.
Rrma SemaerTebelqsovilovan sivrceSi. interosseae dorsales), romlebic majis
dorsalur bades gamoeyofian.
xelis zurgi xelis zurgze Cirqovani procesi
kani Txeli da moZravia, Seicavs SeiZleba ganviTardes rogorc kanqveSa
cximis jirkvlebs da Tmis parkebs. qsovilSi, ise fasciis qveS.
kanqveSa qsovilSi nebis dorsaluri
venebi (vv. palmares dorsales) da kanis TiTebi
nervebia. venebi qmnis wnuls, kani xelis gulis mxareze sqeli da
romlidanac Sevardnisa da salmis mcired moZravia, Seicavs didi
venebi iwyeba. kans anervebs idayvis raodenobiT oflis jirkvlebs.
nervis dorsaluri da sxivis nervis kanqveSa qsovilSi cximovani
zedapiruli totebi, romlebic grovebi gayofilia erTmaneTisgan
Cveulebriv, Tanabrad nawildebian fibrozuli firfitebiT, romlebic
TiTebze ise, rom sxivis nervi anervebs umTavresad kanis perpendikularulad
I da II TiTebs mTlianad da III TiTis arian ganlagebuli, kanis dvrilovani
gareTa naxevars, idayvis nervi—III Sridan iwyebian da falangebis
TiTis SigniTa naxevars da IV_V Zvlisazrdelasa da momxreli kunTe-
TiTebs mTlianad. amasTanave, idayvisa bis myesebis fibrozul arxebs
da sxivis nervebis xsenebuli totebi ukavSirdebian. kanqveSa qsovilis
nebis areSi dakavSirebulia agebulebis aRniSnuli TaviseburebiT
erTmaneTTan SemaerTebeli konebiT aixsneba, rom anTebadi procesi am
ise, rom II, III da IV TiTebis SreSi vrceldeba ara gverdebze,
dorsalur kans SeiZleba anervebdes aramed siRrmeSi da SeiZleba
rogorc sxivis, ise idayvis nervi. gadavides Zvalze, myesTa budesa an
sakuTari fascia gamSlelebis sabme- saxsarze.
lis gagrZelebaa. gverdebze igi TiTebis dorsalur mxareze kani Se-
umagrdeba nebis II da V Zvlebs, nebis darebiT ufro Txeli da moZravia.
Zvlebis Tavebis areSi Sezrdilia proqsimaluri da Sua falangis areSi
gamSlelebis myesebTan. igi Cveulebriv Tmiania, ris gamoc aq
sakuTari fasciis qveS zogjer furunkuli viTardeba.
ganlagebulia xelis ceris grZeli da kanqveSa qsovili sustad aris
mokle gamSleli, maCvenebeli TiTis ganviTarebuli.
sakuTari gamSleli da nekis sakuTari
gamSleli kunTebis myesebi. TiTebis

klinikuri anatomia 139

 zemo kiduri

TiTebis kanisa da kanqveSa qsovilis TiTebis venebi arteriebs ar miyveba.

limfuri kapilarebis qselidan isini xelis gulidan dorsalur
dawyebuli wvrili ZarRvebi erTvis zedapirze gadadian da uerTdebian
TiTebis gverdebze gamtan Reroebs, xelis mtevnis dorsalur venur bades
romlebic TiTTaSua naoWebis areSi (rete venosum dorsale manus).
xelis zurgis kanqveSa faSar qsovil- TiTebis inervacia xelis gulis mxa-
Si gadadian. amiT aixsneba, rom TiTisa reze xorcieldeba saSualo da
da nebis xelis gulis mxareze gan-vi- idayvis nervebiT, xelis zurgis
Tarebuli Cirqovani anTebis dros, ro- mxareze—sxivisa da idayvis nervebiT.
gorc wesi, xelis zurgis SeSupeba yoveli TiTis gverdiT zedapirze
viTardeba. kanqveS mdebareobs TiTis sakuTari
TiTebis zedapiruli Sreebidan lim- palmaruli nervi (n. digitalis palmaris
fa miedineba iRliis kvanZebSi. marto proprius) da TiTis sakuTari
V da nawilobriv IV TiTebidan igi dorsaluri nervi (n. digitalis dorsalis
ikribeba idayvis kvanZebSi. amitom am proprius). TiTis sakuTari palmaruli
TiTebis Cirqovani procesebis dros nervi anervebs proqsimaluri da Sua
limfadeniti pirvelad SeiZleba falangebis palmaruli zedapirisa da
ganviTardes idayvis fosoSi da Semdeg distaluri falangis orive zedapiris
iRliaSi. I_III TiTebis safarvelebidan kans, TiTis dorsaluri nervi ki —
limfis gamomtani ZarRvebi Sevardnis mxolod proqsimaluri da Sua falan-
venas miyveba da laviwqveSa an gebis dorsaluri zedapiris kans.
laviwzeda limfur kvanZebSi ixsneba. yoveli TiTis palmaruli fascia
amitom am TiTebis panariciumis dros falangebis palmaruli zedapiris
SeiZleba iRliis limfuri kvanZebis gverdiT kideebs umagrdeba da
dazianebis gareSe laviwqveSa an falangebis ZvlisazrdelasTan erTad
laviwzeda limfadeniti ganviTardes. qmnis TiTebis momxreli myesebis
TiTebs sisxliT amaragebs sakuTari fibrozul arxs, romelic nebis Zvlis
palmaruli da dorsaluri arteriebi. Tavidan distaluri falangis fuZemde
TiTebis sakuTari palmaruli vrceldeba. arxebi gamagrebulia
arteriebi (aa. digitales palmares propriae) mkvrivi fibrozuli konebiT, romlebic
gamoeyofa TiTebis saerTo arteriebs, falangebze erTmaneTs ejvaredinebian,
ganlagebulia TiTebis gverdebze xolo saxsrebis areebSi rgolebiviT
kanqveSa qsovilSi palmaruli arian ganlagebuli. TiTebis moxrisas
zedapiris maxloblad, aRwevs dista- isini myesebs falangebTan iWeren.
lur falangebs. TiTebis dorsaluri ceris fibrozul arxSi gaivlis ce-
arteriebi (aa. digitales dorsales) SedarebiT ris grZeli momxreli kunTis myesi,
sustad aris ganviTarebuli, isini II_V TiTebis fibrozul arxebSi—
nebis dorsalur arteriebs TiTebis zedapiruli da Rrma
gamoeyofian da proqsimaluri da Sua momxreli kunTebis myesebi. ceris
falangebis dorsalur zedapirebze grZeli momxreli kunTis myesi umagr-
totiandebian. deba distaluri falangis fuZes.

klinikuri anatomia 140

 zemo kiduri

TiTebis zedapiruli momxreli kunTis diTi fexebi—distaluri falangis

myesi proqsimaluri falangis Tavis fuZes. proqsimaluri falangis areSi
doneze iyofa or fexad, romlebic gamSleli kunTis aponevrozisebr
pirveli falangTaSua saxsris doneze gabrtyelebul myess lateraluri
dorsalurad ixrebian, saxsars mxridan umagrdeba Wiayela kunTis
gverdebze iribad gadauvlian da Sua myesi, romelic nebze Rrma momxreli
falangis fuZes umagrdebian. Rrma mom- kunTis myesidan iwyeba.
xreli kunTis myesi zedapiruli mom-
xreli kunTis myesis fexebs Soris xelis mtevnis saxsrebi
gaivlis da distaluri falangis fu- majis midamoSi arsebuli sxiv-
Zes umagrdeba. majis, sxiv-idayvis distaluri, majis
Zval-fibrozul arxebSi myesebi ga- Sua da maja-nebis saxsrebi
xveulia sinoviur budeebSi, romlebic funqciurad erTimeoresTan aris
pariesuli da visceruli dakavSirebuli.
furclebisgan Sedgebian. pariesuli sxiv-majis saxsari (articulatio
furceli Signidan gamofens radiocarpea) Seqmnilia, erTi mxriv,
fibrozul arxs, visceruli furceli sxivis majiseuli sasaxsre zedapiriTa
ki irgvliv faravs myess, garda im da sasaxsre diskoTi, meore mxriv—
adgilisa, sadac myesTan navisebri (os naviculare), mTvarisebri (os
dakavSirebulia sinoviuri garsis lunatum) da samwaxnagiani (os triquetrum)
jorjlisebri viwro duplikaturi, anu ZvlebiT. cercvisebri Zvali am saxsris
myesis Tasmebi (vincula tendinum), SeqmnaSi ar monawileobs. igi
romlebSic Zvlisazrdeladan myesSi samwaxnagian ZvalTan qmnis calke
Semavali sisxlZarRvebi gaivlis. sino- saxsars.
viuri garsis jorjlisebri dupli- sxiv-majis saxsris naprali majis
katurebi gamoxatulia im ubnebSi, dorsalur zedapirze proecirdeba
sadac myesis bude Zvalze mdebareobs. sxivisa da idayvis Zvlebis
saxsrebis areebSi isini ar arseboben. sadgisisebr morCebs Soris
vinaidan myesis budis Rru viwroa, gatarebul rkalovan xazze, romlis
misi Cirqovani anTebis (Cirqovani Sua nawili amave morCebis
tendovaginiti) dros eqsudati awveba SemaerTebeli wrfis Sua wertilidan
xsenebul duplikaturebs da axSobs 1sm-iT zemoT mdebareobs.
maT sisqeSi gamaval sisxlZarRvebs. sasaxsre CanTa yoveli mxridan io-
garda amisa, igi toqsikuradac gebiT aris gamagrebuli. miuxedavad
moqmedebs da yovelive amis gamo amisa, masSi arcTu iSviaTad arsebobs
SeiZleba myesis nekrozi ganviTardes. susti adgilebi, romelTa saSualebiT
TiTebis dorsalur zedapirze saxsris Rru SeiZleba dauakvSirdes
TiToeuli gamSleli kunTis myesi saxsris areSi mdebare myesis sinoviur
gabrtyelebulia da qmnis TiTis budes.
dorsalur aponevrozs, romelic sam sxiv-majis saxsari SedarebiT
fexad aris gayofili. Sua fexi advili misadgomia dorsaluri
umagrdeba Sua falangis fuZes, gver-

klinikuri anatomia 141

 zemo kiduri

mxridan sxivis Zvlis distalur majis Zvlebis amovardnilobebi. ma-

bolosa da TiTebis gamSleli kunTis jis Zvlebis amovardnilobebi
myesis lateralur kides Soris. iSviaTad xdeba, ufro xSirad
sxiv-idayvis distaluri saxsari aRiniSneba mTvarisebri da navisebri
(articulatio radioulnaris distalis) ufro Zvlebis amovardnilobebi. majis sxva
xSirad gayofilia sxiv-majis Zvlebis amovardnilobebi ar gvxvdeba.
saxsrisgan, SedarebiT iSviaTad (40%- mTvarisebri Zvlis amovardnilobisas
Si) es saxsrebi SeerTebulia aRiniSneba Sesiveba da saxsarSi
erTmaneTTan maT Soris mdebare moZraobis SezRudva. mTvarisebri
sasaxsre diskoSi arsebuli napraliT. Zvlis mdebareobis Sesabamis adgilze
sxiv-idayvis distaluri saxsris palmarul zedapirze aRiniSneba
sinoviuri garsi proqsimalurad qmnis SemaRleba, xolo dorsalurze—
yuresmagvar gamodrekilobas, romelic CaRrmaveba. mklevarTa erTi nawili
winamxris Zvlebs Soris mdebareobs da mTvarisebri Zvlis amovardnilobas ar
winidan kvadratuli pronatoriT aris miiCnevs mxolod mTvarisebri Zvlis
dafaruli. dazianebad da ganixilavs mas rogorc
trapeciuli Zvali (os trapezium), tra- amovardnilobas sxiv-majis saxsarSi.
pecoiduli Zvali (os trapezoideum), navisebri Zvlis amovardniloba
Tavdida Zvali (os capitatum) da kaviani xdeba sxivis mxareze dorsalurad.
Zvali (os hamatum) majis proqsimaluri aRiniSneba Sesiveba, mtevani
rigis ZvlebTan qmnis majis Sua gadaxrilia sxivis mxareze, ceri
ramdenadme ganzidulia. anatomiuri
saxsars (articulatio intercarpea).
saTuTunes midamos maxloblad isinje-
maja-nebis saxsrebi (articulationes
ba mtkivneuli SemaRleba, moZraobebi
intercarpophalangeae) Seqmnilia majis
saxsarSi SezRudulia.
meore rigis ZvlebiTa da nebis
TiTebisa da falangebis amovardni-
Zvlebis fuZeebiT. saxsrebs majis
loba. xelis mtevnis midamoSi
Zvlebsa da nebis II_IV Zvlebs Soris
amovardnilobebidan praqtikuli
aqvT saerTo CanTa da saxsris Rru.
mniSvneloba aqvs amovardnilobas neb-
isini mcire farglebSi moZraobiT
falagisa da falangTaSua saxsarSi.
ganirCevian. ufro moZravia maja-nebis
amovardniloba neb-falangis
V saxsari. maja-nebis I saxsris CanTa
saxsrebSi. neb-falangis saxsris yvela
da Rru calkea, igi unagira saxsaria
amovardnilobidan sixSirisa da
da SedarebiT farTo farglebSi
praqtikuli mniSvnelobis mixedviT
moZraobiT xasiaTdeba.
pirveli adgili ceris amo-
neb-falangis saxsrebi (articulationes
vardnilobas ukavia. igi SeiZleba iyos
metacarpophalangeae) orRerZiani ukana (yvelaze xSiri forma) an wina.
saxsrebia da axasiaTebs SedarebiT ceris ukana amovardniloba arapirda-
farTo farglebSi moZraoba, piri travmis Sedegia, romelic iwvevs
falangTaSua saxsrebi (articulationes mis hipereqstenzias da ukan
interphalangeae) ki mxolod erTi (ganivi) gadanacvlebas. proqsimalurma
RerZis irgvlis moZraobs. falangma SeiZleba gadainacvlos

klinikuri anatomia 142


idayvis mxareze da moTavsdes nebis
Zvlis dorsalur zedapirze. igi mdeba-
reobs vertikalurad, nebis ZvalTan
qmnis swor kuTxes da gadaRunulia
idayvis mxareze. nebis Zvlis Tavi
palmarul zedapirze kanqveS qmnis
mrgvali formis SemaRlebas. saxsarSi
moZraoba gamoricxulia.
ceris wina amovardniloba Zalian
iSviaTia da Sedegia moRunul TiTze
dacemisa an dartymisa. sasaxsre parki
da gverdiTi iogebi iglijeba. saxsris
midamo mkveTrad deformirebulia,
aqtiuri moZraoba SeuZlebelia. nebis
Zvlis Tavi gamozneqilia dorsalur
zedapirze da isinjeba kanqveS.
danarCeni oTxi TiTis
amovardniloba neb-falangis saxsarSi
iSviaTad gvxvdeba. meore da mexuTe
TiTebis amovardniloba ufro xSiria,
vidre mesame da meoTxe TiTebisa.
amovardnilobebs Cveulebriv iwvevs
TiTebis hipereqstenzia palmarul
zedapirze dacemis an dartymis
Sedegad. amovardnilobis diagnozis
dasmisas yuradRebas iqcevs
damaxasiaTebeli deformacia: palma-
rul mxareze gamoSverilia nebis Zv-
lis Tavi. saeWvo SemTxvevebSi
gadamwyvetia rentgenis suraTi.
amovardniloba falangTaSua
saxsrebSi. amovardniloba
falangTaSua saxsrebSi uxSiresad
proqsimalur da Sua falangebs Soris
aRiniSneba. am dros saxsris formis
damaxasiaTebel cvlilebasTan erTad
kanqveS isinjeba falangis sasaxsre
boloebi.
distaluri falagis amovardnilo-
bas SeiZleba adgili eqnes yvela
klinikuri anatomia
zemo kiduri
TiTze, magram yvelaze ufro xSiria
cerze da umTavresad ukan. mas iwvevs
palmarul zedapirze dacema da
hipereqstenzia.
TiTebi damoklebulia, saxsari ode-
nobaSi momatebulia, aqtiuri moZraoba
SeuZlebelia.
nebis Zvlebisa da falangebis mote-
xilobebi. nebis Zvlebis motexiloba
Sedegia Zalis uSualo moqmedebisa
(simZimis dacema an dartyma krivis
dros). motexiloba yvelaze xSiria
nebis Zvlis Sua nawilSi. deformacia
sustadaa gamoxatuli natexTa umniSv-
nelo kuTxiT Secilebis gamo, rac
ganpirobebulia ZvalTaSua da Wiayela
kunTebis ZaliT. kuTxis mwvervali xe-
lis zurgiskenaa mimarTuli.
falangebi tydeba upiratesad Zalis
uSualo zemoqmedebiT. sxvebze xSirad
ziandeba distaluri falangebi. am
SemTxvevaSi natexebis Secilebas
Cveulebriv adgili ara aqvs.
proqsimaluri falangebis motexi-
lobis dros natexebi ZvalTaSua da
Wiayela kunTebis Zalis zegavleniT
Cveulebriv Secildebian xelis gulis
mimarTulebiT, adgili aqvs kuTxiT
Secilebas, kuTxe Riaa xelis
zurgisken.
Sua falangebis motexilobis dros
TiTebis zedapiruli momxreli kunTis
Zalis Sedegad natexebis Secileba
aseve xdeba kuTxis qveS, romelic Riaa
xelis zurgisken.
143
 zemo kiduri

klinikuri simptomebisa da sindromebis

topografiuli anatomia

“brWyalismagvari mtevnis simptomi” kunTs, yvela ZvalTaSua da ceris

(idayvis nervis dazianebis dros) ganmzidvel kunTebs.
xelisgulis toti anervebs idayvis-
klinikuri gamovlineba: SeuZlebe- mxridan 2,5 TiTs mtevnis zurgis
lia II_V TiTebis proqsimaluri mxares. “brWyalismagvari mtevnis
falangebis, agreTve III, IV, V TiTebis simptomi” adasturebs idayvis nervis
distaluri falangebis moxra da V dazianebas winamxris qveda mesamedSi.
TiTis mozidva. gamoxatulia
ZvalTaSua, Wiayela kunTebis da nekis “dakiduli mtevnis” simptomi
maRlobis kunTebis atrofia. kanis sim- (sxivis nervis dazianebis dros)
Srale, gaciveba da cianozi. IV_V Ti-
Tebis palmarul da III_IV_ V TiTebis klinikuri gamovlineba: sxivis ner-
dorsalur zedapirebze mgrZnobelobis vis dazianeba sxvadasxva doneze
ararseboba. iZleva gansxvavebul klinikur suraTs.
topografiul-anatomiuri safuZve- 1. mxris zeda mesamedSi—dakiduli
li: idayvis nervi winamxarze gadis mtevnis simptomi, SeuZlebelia idayvis
majis idayviskena momxreli kunTis or saxsarSi gaSla, moSlilia kanis
Tavs Soris. qveda mesamedSi mgrZnobeloba mxris da winamxris
mdebareobs idayvis RarSi. midamos ukana, agreTve xelis mtevnis
winamxris Sua mesamedSi idayvis dorsalur zedapirebze.
nervi iyofa 2 totad: dorsalur da 2. mxris Sua mesamedSi—dakiduli
palmarul totebad. zurgismxrivi mtevnis simptomi, amasTan
toti miemarTeba qveviT idayvis Zvalsa SenarCunebulia xelis gaSla idayvis
da majis idayvisaken momxrel kunTebs saxsarSi.
Soris arsebul SualedSi. Semouvlis 3. mxris qveda mesamedSi—dakiduli
ra idayvis Zvlis distalur bolos, mtevnis simptomi, amasTan
zurgis toti xvrets fascias da SenarCunebulia xelis gaSla idayvis
gadadis xelis mtevnis zurgze, sadac saxsarSi da supinacia.
iyofa saboloo totebad: TiTebis topograf-anatomiuri safuZveli:
dorsalur 5 totad. winamxarze iday- sxivis nervis dazianebis doneebi da
vis nervi gamoyofs kunTovan totebs misi klinikuri gamovlineba
majis idayviskena momxreli Seesabameba nervis 3 nawilis
kunTisaTvis da TiTebis Rrma topografiul-anatomiuri Tavisebu-
momxreli kunTis idayvismxrivi naxev- rebas.
risaTvis. 1. sxivis nervis pirveli nawili
Rrma toti aZlevs totebs V TiTis mdebareobs mxar-kunTovani arxis
maRlobis kunTebs da III da IV Wiayela kunTTaSua nawilSi, romelic
Seqmnilia mxris samTava kunTis

klinikuri anatomia 144

 zemo kiduri

grZeli da medialuri TavebiT. sxivis II, III da IV TiTebis distaluri falan-

nervi aq ar iZleva kunTovan totebs. gebis kanis mgrZnobeloba. viTardeba
2. sxivis nervis meore nawili trofikuli darRvevebi —kanis
mdebareobs mxar-kunTovani arxis gaciveba da simSrale, aqercvla,
ZvalkunTovan nawilSi, aq nervi cianozi. aRiniSneba winamxris wina
mdebareobs uSualod Zvalze zedapirisa da ceris maRlobis
spiralur RarSi. am doneze nervs kunTebis atrofia. SeuZlebelia muS-
gamoeyofa totebi mxris samTava kunTi- tis Sekvra—ceri da maCvenebeli
saTvis. TiTebi rCebian gaSlil mdgomareobaSi.
3. sxivis nervis mesame nawili TiTebis moxra falangTaSua saxsrebSi
miemarTeba winamxrisaken mxar-sxivis SezRudulia.
kunTis mxridan da jer kidev idayvis topograf-anatomiuri safuZveli. sa-
fosoSi iyofa 2 saboloo—zedapirul Sualo nervi gadadis ra winamxarze
da Rrma totebad. Rrma toti gaivlis jer gaivlis mrgvali pronatoris or
supinatoris arxSi da aRwevs Tavs Soris, Semdeg wveba TiTebis
winamxris ukana midamos. misi saboloo zedapirul da Rrma momxrel kunTebs
totia winamxris ukana ZvalTaSua Soris. mxris Zvlis medialuri
nervi. sxivis nervis Rrma toti iZleva zedarokis doneze saSualo nervi
totebs majisa da TiTebis yvela aZlevs totebs mrgval pronators, ma-
gamSleli, agreTve supinatorisa da jis sxiviskena momxrel kunTs, nebis
ceris grZeli ganmzidveli grZel kunTs, TiTebis zedapirul mom-
kunTisaTvis. amitom mxris qveda xrelsa da TiTebis Rrma momxrel
mesamedSi sxivis nervis dazianebis kunTs sxivis mxridan. winamxris
dros gamoxatulia dakiduli mtevnis distalur nawilSi yalibdeba toti
simptomi idayvis saxsarSi gaSlisa da kvadratuli pronatorisaTvis da
winamxris supinaciis SenarCunebiT. saSualo nervis xelisguliseuli
toti. saSualo nervi gaivlis majis
“maimunis mtevnis” simptomi arxSi da iyofa kanisa da kunTovan
(saSualo nervis dazianebis dros) totebad. kanis totebi anerveben xelis
gulis kans. kunTovani totebi
klinikuri gamovlineba: dakargulia miemarTebian ceris SemaRlebisa (ceris
mtevnis moxra, aseve I, II da momzidveli kunTis garda) da sxivis
nawilobriv III TiTebis proqsimalur mxridan mdebare or Wiayela
da distalur falangebSi moxra. kunTebisaken.
SeuZlebelia I TiTis pirispir saSualo nervi anervebs 3,5 TiTis
dayeneba. gamovardnilia mgrZnobeloba kans xelis gulis mxridan. aRniSnuli
I, II, III da IV TiTis lateralur naxe- kunTebis inervaciis moSla iwvevs
varSi. xelis zurgis mxares ar aris I, “maimunis mtevnis” simptoms.

klinikuri anatomia 145

 zemo kiduri

ganakveTebi zemo kiduris rbili qsovilebis Cirqovani

daavadebis dros

ganakveTebi xelis mtevanze gverdiT zedapirebze, sisxlZarRvebisa

xelis mtevnis Cirqovani daavadebe- da nervis konis win, saxsrebs Soris
bidan yvelaze xSirad gvxvdeba atareben gaswvriv ganakveTebs. kanis
TiTebis mwvave Cirqovani anTeba, anu kideebs mcire kavebiT gverdebze
panariciumi (sawereli). arCeven kanis, gadasweven da ganakveTebis mTel
kanqveSa, myesis (tendovaginiti), Zvlisa sigrZeze orive mxridan xsnian myesis
da saxsris panariciums. panariciumis sinoviur budes.
dros ganakveTebs avleben TiTis cerisa da nekis tendovaginitis
gverdebze da ara mis volarul dros xelisgulze, ceris SemaRlebis
(“muSa”) zedapirze. amasTan, ganakveTebi (thenar) medialuri kidisa da nekis
ar unda aRwevdes falangTaSua nao- SemaRlebis (hypothenar) lateraluri
Webs, raTa ar daziandes saxsrisa da kidis gaswvriv atareben damatebiT
myesis budis iogovani aparati. ganakveTebs, romelTa meSveobiT
distaluri falangis kanisa da kan- ixsneba myesTa budis nebis areSi mde-
qveSa panariciumis dros, Cveulebriv, bare nawili. ceris SemaRlebis medi-
iyeneben TiTis boloze frCxilis win alurad ganakveTis gatarebisas unda
gavlebul rkalovan ganakveTs im gavufrTxildeT saSualo nervis tots,
varaudiT, rom gadaikveTos kanidan romelic ceris pirispir damyenebel
Zvlisazrdelisaken mimavali kunTs (m. opponens policis) anervebs. ami-
SemaerTebelqsovilovani xarixebi. tom ganakveTi unda iwyebodes sxiv-
ganakveTi grZeldeba falangis majis saxsridan 1sm distalurad.
distaluri naxevris farglebSi, sinoviuri budeebis proqsimalur
vinaidan ufro proqsimalurad boloebs, romlebic winamxarze piro-
SeiZleba gadaikveTos TiTebis grZeli govis sivrceSi mdebareoben, xsnian
momxreli kunTis myesi. winamxris qveda mesamedSi gatarebuli
frCxilis budis anTebis (paroniqia) ganakveTebiT.
dros TiTis dorsalur zedapirze,
frCxilis Ziris proqsimalurad ganakveTebi winamxarze
avleben П-sebr ganakveTs. kanis winamxarze Rrma Cirqovani kerebi
nafleTs gadasweven zeviT da SeiZleba iyos rogorc wina an ukana,
frCxilis im nawils, romelic anTebis ise gverdiT fasciur budeSi.
Sedegad ganSorebulia budisagan, ganakveTebs atareben procesis
makratliT amokveTen. arcTu iSviaTad lokalizaciisa da gavrcelebis
saWiro xdeba frCxilis mTlianad Sesabamisad, Cirqis sruli evakuaciisa
mocla. da drenaJisaTvis optimaluri pirobis
myesis panariciums, anu TiTis Seqmnis gaTvaliswinebiT. unda
Cirqovani tendovaginitis dros veridoT sxivisa da idayvis nervebis
proqsimaluri da Sua falangebis wina- da sisxlZarRvebis dazianebas.

klinikuri anatomia 146

 zemo kiduri

winamxris qveda mesamedSi Rrma Sema-

erTebelqsovilovani, anu pirogovis ganakveTebi mxris zeda midamoSi
sivrcis gaxsnisaTvis sxivis Zvlis iRiliis fosos SemaerTebelqsovi-
sadgisisebri morCidan 2sm zemoT lovan sivrces xsnian kunTis wina da
sxivis Zvlis win atareben 8_10sm ukana kideebis gaswvriv gavlebuli
sigrZis ganakveTs. kanis, kanqveSa ganakveTebiT. zedapiruli Sreebis
qsovilisa da sakuTari fasciis gakveTis Semdeg naxuloben kunTis
gakveTis Semdeg sxivis Zvlis wina kideebs da romelime blagvi
zedapiridan kunTebis gaweviT xsnian xelsawyoTi xsnian kunTis qveS
pirogovis sivrces, romelic arsebul sivrces. ukana ganakveTis
kvadratul kunTsa da TiTebis gavlebis dros iRliis nervis dazi-
momxrel kunTebs Soris mdebareobs. am anebis asacileblad unda gvaxsovdes,
dros unda gavufrTxildeT sxivis rom nervi Sedis deltisebr kunTSi iq,
nervis zedapirul tots. drenaJis uke- sadac samxre morCis kuTxidan qveviT
Tesi pirobebis Seqmnis mizniT gatarebuli xazi gadakveTs am kunTis
sxenebul sivrces zogjer damatebiT ukana kides.
xsnian medialur mxareze, idayvis mxris saxsris irgvliv mdebare
Zvlis sadgisisebri morCidan 2sm Cirqovani keris farTod gaxsnisa da
zeviT gatarebuli ganakveTiT. am mxri- drenirebisaTvis iyeneben deltisebri
dan pirogovis sivrcis gaxsna SeiZ- midamos wina zedapirze gatarebul
leba idayvis Zvlis wina zedapirsa da vertikalur ganakveTs deltisebri
momxrel kunTebs Soris. kunTis boWkoebis gaTiSviT.
subpeqtorul flegmonas xsnian
ganakveTebi mxarze mkerdis didi kunTis qveda kidis
mxarze Rrma Cirqovani kera gaswvriv gatarebuli ganakveTiT. kanis,
SeiZleba iyos rogorc wina an ukana kanqveSa qsovilisa da sakuTari
fasciur budeSi, ise sisxlZarRvebisa fasciis gakveTis Semdeg mkerdis didi
da nervebis konis budeSi. wina kunTis qveda kides win da zeviT
fasciuri budis, ise rogorc ukana asweven da blagvi iaraRiT an TiTiT
fasciuri budis, gasaxsnelad, xsnian mkerdis did kunTsa da mkerd-
Cveulebriv, atareben or gaswvriv laviwis fascias Soris mdebare sivr-
ganakveTs Sesabamisi (orTava an ces. farTod gavrcelebuli
samTava) kunTebis medialuri da flegmonis SemTxvevaSi laviwis qveS
lateraluri kideebis gaswvriv. kanis, da mis gaswvriv damatebiT gaatareben
kanqveSa qsovilisa da fasciis gakve- ganiv ganakveTs (kontrapertura).
Tis Semdeg siRrmeSi aRweven saTanado zogjer saWiroa agreTve mkerdis
kunTis kidis SemovliT. dasaSvebia mcire kunTis fasciuri budis gaxsna,
agreTve kunTis gaTiSva. romelSic SeiZleba Cirqovani kera
sisxlZarRvovan-nervuli konis budes iyos.
xsnian orTava kunTis medialur RarSi iRliis fosos flegmonis gasaxs-
mxris arteriis proeqciidan 2sm win nelad ganakveTs atareben iRliis
gatarebuli ganakveTiT. fosos wina kidis gaswvriv. kanis,

klinikuri anatomia 147

 zemo kiduri

kanqveSa qsovilisa da sakuTari Sreebis gakveTis Semdeg kunTebs

fasciis gakveTis Semdeg iRliis TiSaven da xsnian Cirqovan keras.
fosos farTod xsnian. mosazRvre are- beWqveSa sivrceSi mdebare Cirqovan
Si procesis gavrcelebis SemTxvevaSi keras xsnian beWis saxerxemle kidis
saWiroa damatebiTi ganakveTebis gaswvriv gatarebuli 8sm sigrZis
gakeTeba. ganakveTiT. zedapiruli Sreebis
beWis midamoSi qedzeviTa da qedqve- Semdeg kveTen trapeciul, rombisebr
viTa sivrceebs xsnian beWis qedis da wina dakbilul kunTebs da xsnian
paralelurad gakeTebuli zeda da wina dakbilul kunTsa da gulmkerdis
qveda ganakveTebiT. zedapiruli kedels Soris mdebare sivrces.

operaciuli midgoma zemo kiduris arteriebTan

laviwqveSa arteriasTan midgoma qveviT uxvevs da deltisebr-mkerdis

laviwqveSa arteria laviwze proe- RarSi (sulcus
cirdeba am ukanasknelis Sua nawilSi. deltoideopectoralis) 5_8sm
operaciuli midgoma masTan manZilze grZeldeba. kanis, kanqveSa
SesaZlebelia rogorc laviwis zemoT qsovilisa da zedapiruli fasciis
an qvemoT gatarebuli ganakveTiT, ise gakveTis Semdeg laviws, gadaxerxvis
laviwis gadaxerxviT. laviwis zemoT adgilas, raspatoriT aTavisufleben
da qvemoT gatarebuli ganakveTebi, Zvlisazrdelasagan ise, rom am
Cveulebriv, ar iZleva farTod mid- ukanasknelis kavSiri garemomcvel
gomis SesaZleblobas. amitom maTi qsovilebTan SenarCunebuli darCes.
gamoyeneba SeiZleba mxolod im laviws gadaxerxaven jilis xerxiT da
SemTxvevaSi roca saWiroa xsenebuli mis boloebs maxvili kavebiT gverdze
sisxlZarRvebis gadakvanZva dazianebis gadasweven.
adgilis centralurad. laviwqveSa ufro farTo midgoma laviwqveSa
arteriis mopulsire hematomis, anev- arteriasTan xorcieldeba laviwis
rizmisa an garemomcveli qsovilebis subperiostuli rezeqciiT.
paTologiuri cvlilebebis SemTxve- Zvlisazrdelas aSrevebis Semdeg
vaSi mizanSewonilia midgoma laviwis laviws jilis xerxiT gadaxerxaven or
gadakveTis an rezeqciis gziT. ufro adgilas—niskartisebri morCis
xSirad iyeneben janeliZis an medialur kidesTan da mkerd-laviwis
petrovskis ganakveTs. saxsridan 2sm daSorebiT. Zvlis rezeq-
operaciuli midgoma janeliZis mi- ciis Semdeg kveTen Zvlisazrdelas
xedviT. avadmyofi wevs zurgze. kiduri ukana furcelsa da laviwqveSa kunTs.
ganziduli aqvs. ganakveTi iwyeba Wrilobis kideebis Clungi kavebiT
mkerd-laviwis saxsridan 1_2sm gareT, gverdebze gadawevis Semdeg gamoCndeba
laviwis zeda kidis gaswvriv laviwqveSa arteria, xolo am
miemarTeba, niskartisebr morCTan

klinikuri anatomia 148

 zemo kiduri

ukanasknelis ukan da zemoT—mxris marcxena laviwqveSa arteriis

wnuli. gadakvanZvisas unda gavufrTxildeT
laviwqveSa arteriis bolo mkerdis sadinars, romelic marcxena
nawilTan misadgomad saWiroa agreTve venur kuTxes erTvis.
mkerd-laviwis fasciis gakveTa da kolateraluri sisxlis mimoqceva
mkerdis mcire kunTis kaviT qveviT viTardeba Semdegi anastomozebiT: a.
gadaweva. arteriaze Carevis damTav- transversa colli, a. suprascapularis, a. circumflexa
rebis Semdeg keraven laviwqveSa kunT- scapulae, aa. circumflexa humeri ant. da post.,
sa da Zvlisazrdelas, romlis xarjze agreTve gulmkerdis kedlis arte-
SemdegSi laviwis amokveTili nawilis riebiT.
regeneracia xdeba.
rodesac arteriasTan midgoma gan- iRliis arteriasTan midgoma
xorcielebulia laviwis gadaxerxviT, iRliis arteriis saproeqcio xazi
sisxlZarRvze Carevis Semdeg Zvlis gaivlis iRliis fosos lateralur
boloebs erTimeores usworeben da kedelze, am ukanasknelis wina da Sua
afiqsireben mavTulis nakeriT an mesamedebs Soris. pirogovis mixedviT,
uJangavi foladis CxiriT. bolos igi iRliis fosos kanis Tmiani
keraven zedapirul Sreebs. laviwqveSa nawilis wina sazRvars Seesabameba.
arteriasTan midgoma janeliZis mixed- avadmyofi wevs zurgze, kiduri gan-
viT mosaxerxebelia sisxlZarRvis dis- ziduli aqvs swori kuTxis qveS da
talur nawilze Carevis SemTxvevaSi. misadgmel magidaze udevs.
petrovskis mixedviT midgoma xorci- ganakveTs atareben arteriis sapro-
eldeba T-sebri ganakveTiT, romlis eqcio xazis 1sm win, niskart-mxris
horizontalur nawils gaavleben kunTis mier Seqmnil SemaRlebaze
laviwis wina zedapirze 10_15sm iRliis fosos gumbaTidan mkerdis
sigrZeze, xolo vertikalur nawils— didi kunTis qveda kidemde. kanis,
qveviT 5sm sigrZeze. kveTen kans, kanqveSa qsovilisa da zedapiruli
kanqveSa qsovils, fascias da nawilob- fasciis gakveTis Semdeg xsnian nis-
riv mkerdis did kunTs. laviws kart-mxris kunTisa da orTava kunTis
gadaxerxaven jilis xerxiT da mis mokle Tavis fasciur budes. kunTebs
medialur naxevars subperiostulad blagvi kaviT gareTken gadasweven da
amokveTen. Zvlisazrdelas ukana kveTen maTi budis medialur kedels,
nawilisa da laviwqveSa kunTis romelic, amasTan, iRliis
gadakveTis Semdeg gamoCndeba laviwqve- sisxlZarRvebisa da nervebis konis
Sa sisxlZarRvebi. petrovskis wesis ga- budis lateraluri kedelicaa. am
moyeneba ufro mosaxerxebelia momentSi unda gavufrTxildeT iRliis
laviwqveSa arteriis proqsimalur venas, vinaidan mis dazianebam SeiZleba
nawilTan misadgomad. gamoiwvios haerovani embolia. Wrilo-
kolateraluri sisxlis mimoqcevis baSi pirvelad gamoCndeba saSualo
ganviTarebisaTvis laviwqveSa arteria nervi, romelic aq arteriis win da
umjobesia gadavkvanZoT misgan far- odnav lateralurad mdebareobs.
kisris Reros gamosvlis Semdeg. arteriis medialurad moTavsebulia n.

klinikuri anatomia 149

 zemo kiduri

cutaneus brachii medialis, n. cutaneus mxris arteriis gadakvanZva umjobesia

antebrachii medialis, n. medianus da n. misgan mxris Rrma arteriis gamosvlis
musculocutaneus, xolo arteriis ukan—n. Semdeg.
radialis da n. axillaris. saSualo kolateraluri sisxlis mimoqceva
nervs kaviT gadasweven lateralurad, viTardeba Semdegi arteriebiT: a.
xolo iRliis venas, idayvis nervs, profunda brachii, aa. colateralis ulnaris sup. da
mxrisa da winamxris kanis medialur inf., aa. recurens radialis da ulnaris da
nervebs—medialurad da iRliis kunTebis mkvebavi totebiT.
arterias mimdebare warmonaqmnebisagan mxris arteriasTan midgoma idayvis
gamoyofen. fosoSi. ganzidul kidurs misadgmel
iRliis arteriis gadakvanZvis magidaze aTavseben supinaciis
Semdeg kolateraluri sisxlis mdgomareobaSi. orTava kunTis
mimoqceva viTardeba laviwqveSa da medialuri Raris mimarTulebiT,
iRliis arteriis Semdegi totebiT: a. uSualod orTava kunTis myesis medi-
transversa colli, a. suprascapularis, a. circumflexa alurad atareben 6sm sigrZis
scapulae, aa. circumflexa humeri ant. da post. da ganakveTs ise, rom ganakveTis Sua
gulmkerdis kedlis arteriebiT. wertili idayvis naoWis Sua wertils
daemTxves. kanis gakveTis Semdeg
mxris arteriasTan midgoma salmis venas or ligaturas Soris
mxris arteriasTan midgoma mxris gadakveTen. kavebiT Wrilobis kideebis
Sua mesamedSi. arteriis proeqcia gadawevis Semdeg mxris fasciis sisqe-
Seesabameba orTava kunTis medialur Si SeimCneva mxris orTava kunTis apo-
Rars. avadmyofisa da kiduris nevrozis boWkoebi, romlebic iribad—
mdebareoba iseTivea, rogoric iRliis SigniT da qveviT miemarTebian.
arteriasTan midgomis dros. ganakveTs fasciasa da xsenebul aponevrozs
atareben arteriis saproeqcio xazis Rarian zondze kveTen, Wrilobis
paralelurad, misgan winisken 1sm kideebs blagvi kavebiT gverdebze
daSorebiT. ganakveTis sigrZea 6_8sm. gadasweven da orTava kunTis myesis
kanis, kanqveSa qsovilisa da medialurad, uSualod aponevrozis
zedapiruli fasciis gakveTis Semdeg qveS gamoCndeba arteria, romelsac
kveTen orTava kunTis budis wina Tan sdevs ori vena. arteriis
kedels, kunTs kaviT gareTken medialurad saSualo nervi
gadasweven da Rarian zondze kveTen mdebareobs.
kunTis fasciuri budis ukana kedels, kolateraluri sisxlis mimoqceva
romelic amave dros sisxlZarRvebisa viTardeba anastomozebiT, romlebic
da nervebis budis wina kedelia. e.w. idayvis saxsris bades (rete articularie
pirvelad gamoCndeba saSualo nervi, cubiti) qmnian.
romlis medialurad gadawevis Semdeg
mimdebare warmonaqmnebisagan gamoyofen sxivis arteriasTan midgoma
mxris arterias. kolateraluri sxivis arteriis saproeqcio xazi
sisxlis mimoqcevis ganviTarebisaTvis orTava kunTis myesis medialur

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kidesTan, anu idayvis fosos Sua Rars, romelic TiTebis zedapirul

wertilSi iwyeba da sxivis momxrelsa da majis idayvisken
sadgisisebri morCidan 0,5sm-iT medi- momxrel kunTs Soris mdebareobs.
alurad mdebare wertilSi Tavdeba. kunTebis gverdebze gadawevis Semdeg
kidurs afiqsireben supinaciis gamoCndeba idayvis arteria da venebi,
mdgomareobaSi. 5_6mm sigrZis ganakveTs romelTa medialurad idayvis nervi
avleben saproeqcio xazis mdebareobs.
mimarTulebiT, rac mxar-sxivis kunTis idayvis arteriasTan midgoma wina-
medialur kides Seesabameba. kveTen mxris qveda mesamedSi. ganakveTs
kans, kanqveSa qsovils, zedapirul atareben arteriis saproeqcio xazis
fasciasa da winamxris fascias. mxar- mimarTulebiT 6sm manZilze. majis
sxivis kunTs gadasweven late- idayvisken momxreli kunTis myess
ralurad, xolo majis sxivisaken Clungi kaviT medialurad gadasweven,
momxrel kunTs—medialurad da am ris Sedegadac am kunTsa da TiTebis
kunTebs Soris mdebare RarSi gamoCn- zedapirul momxrel kunTs Soris,
deba sxivis arteria Tanamgzavr veneb- TiTebis Rrma momxrel kunTze
Tan erTad. mis lateralurad mdebare- gamoCndeba idayvis arteria da misi
obs sxivis nervis zedapiruli toti, Tanamgzavri venebi, romelTa
romelic winamxris Sua da qveda mesa- medialurad idayvis nervi mdebareobs.
medebis sazRvarze mxar-sxivis kunTis idayvis an sxivis arteriis gadakvan-
qveS gaivlis da dorsalur mxareze Zvis Semdeg kolateraluri sisxlis
gadadis. mimoqceva viTardeba maT Soris
arsebuli uxvi anastomozebis xarjze,
idayvis arteriasTan midgoma romelTagan umTavresia xelisgulis
idayvis arteriis proeqcia zedapiruli da Rrma arteriuli
winamxris zeda mesamedSi iribi xazia, rkalebi.
romelic idayvis fosos Sua wertilSi
iwyeba da winamxris medialuri kidis xelisgulis zedapirul rkalTan
zeda da Sua mesamedebs Soris mdebare midgoma
wertilSi Tavdeba. qveda or mesamedSi xelisgulis zedapiruli rkalis
igi Seesabameba xazs, romelic mxris proeqcia Seesabameba cercvisebri
Zvlis medialur zedapirze iwyeba da Zvlidan nebsa da maCvenebel TiTs
cercvisebri Zvlis medialur kidesTan Soris arsebuli naoWis gareTa
Tavdeba. arterias ufro xSirad miud- bolomde gatarebuli xazis Sua
gebian winamxris Sua an qveda mesa- mesameds. arteriis proeqciis gaswvriv
medSi. gaatareben 3_4sm sigrZis ganakveTs.
winamxris Sua mesamedSi idayvis ar- xelisgulis aponevrozs, romelic
teriasTan misadgomad ganakveTs SemaerTebelqsovilovani xarixebiT
atareben sisxlZarRvis saproeqcio mWidrod aris dakavSirebuli kanTan,
xazis gaswvriv 7sm sigrZeze. kveTen Rarian zondze. xelisgulis
zedapiruli Sreebisa da sakuTari zedapiruli rkali mdebareobs
fasciis gakveTis Semdeg xsnian idayvis uSualod aponevrozis qveS.

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operaciuli midgoma zemo kiduris nervebTan

mxris wnulTan midgoma Semdeg miudgebian wina kibisebr kunTs,

mxris wnulis saproeqcio xazi, ro- romlis wina zedapirze SuasaZgidis
ca Tavi sawinaaRmdego mxarezea nervi mdebareobs, xolo qveviT, am
mobrunebuli, iwyeba mkerd-laviw- kunTsa da laviws Soris laviwqveSa
dvrilisebri kunTis ukana kidis Sua vena gaivlis. wina kibisebri kunTis
wertilSi, laviws SuaSi gadauvlis da gareTa kidesTan moCans kisris V, VI
mkerd-deltisebr RarSi grZeldeba. da VII nervebi da maT mier Seqmnili
dazianebis donisa da xasiaTis kisris wnulis Reroebi. Wrilobis
mixedviT mxris wnuls SeiZleba zeda nawilze afenen fiziologiur
mivudgeT rogorc laviwis zemoT— xsnarSi dasvelebul marlis safens da
kisris lateraluri samkuTxedis iwyeben wnulis gamoyofas laviwis
farglebSi, ise qvemoT—iRliis qvemoT.
midamoSi, magram wnulis farTod mkerd-deltisebri Raris gaswvriv
daTvalierebisa da masze Tavisufali kveTen mkerdis fascias, Sevardnis
Carevis saSualebas iZleva midgoma venas or ligaturas Soris gadakveTen
laviwis gadaxerxviT. anda deltisebr kunTTan erTad gareT
avadmyofi wevs zurgze, Tavi mibru- gadasweven, mkerdis kunTis laviwis
nebuli aqvs sawinaaRmdego mxareze, nawils 2_3sm farglebSi siganeze
ganziduli xeli misadgmel magidaze kveTen da SigniT gadasweven. kveTen
udevs. mkerd-laviwis fascias da miudgebian
ganakveTi iwyeba mkerd-laviw-dvri- iRliis sisxlZarRvebisa da nervebis
lisebri kunTis gareTa kidis Sua konas. mxris wnulis qveda nawilTan
mesamedSi, laviwis Sua wertils farTod midgomis saWiroebisas
aRwevs, laviwis wina zedapirze mkerdis mcire kunTs niskartisebr
gareTken uxvevs da mkerd-deltisebr morCze mimagrebis adgilas gadakveTen.
RarSi grZeldeba. kanis, kanqveSa yovelive amis Semdeg laviws Sua
qsovilis, zedapiruli fasciisa da nawilSi 1sm farglebSi irgvliv
kisris kanqveSa kunTis gakveTis Semdeg anTavisufleben Zvlisazrdelasagan,
Wrilobis zeda nawilSi Seqmnil wvrili burRiT or adgilas xvreten
rbili qsovilebis nafleTs laviwzeda da xvrelebs Soris jilis xerxiT
nervebTan erTad kaviT gareTken gadaxerxaven. gadaxerxili laviwis
gadasweven da kveTen kisris sakuTar nawilebs kavebiT gverdebze gadasweven
fascias. gareTa sauRle venas or da Zvlisazrdelas ukana furcels
ligaturas Soris gadakveTen an mkerd- laviwqveSa kunTTan erTad gadakveTen,
laviw-dvrilisebr kunTTan erTad Sig- ris Sedegadac farTod miudgebian
niT gadasweven; kveTen beW-laviwis mxris wnuls.
fascias, beW-inis kunTs gareTken nervuli Reroebis garemomcveli
gadasweven an gadakveTen da beW- warmonaqmnebisagan gamoyofis dros
laviwis fasciis qveS arsebuli unda gavufrTxildeT wnulis mokle
SemaerTebeli qsovilis gaTiSvis totebs. gansakuTrebul yuradRebas

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 zemo kiduri

saWiroebs nn. pectorales, romelTa fosos mxridanac. aq es nervi

dazianeba mkerdis kunTebis damblas mdebareobs mTavari sisxlZarRvebisa
iwvevs. frTxilad unda movepyraT da nervebis ukan—beWqveSa kunTze.
agreTve sisxlZarRvebs. marcxena
mxareze kisris areSi unda sxivis nervTan midgoma
gavufrTxildeT mkerdis sadinars, iRliis fosoSi sxivis nervTan mid-
romelic aq laviwqveSa da sauRle gomisaTvis avadmyofs awvenen zurgze,
venebis mier Seqmnil kuTxes erTvis. xolo mis xels aTavseben misadgmel
wnulze operaciuli Carevis Semdeg magidaze marT kuTxemde ganzidul
keraven laviwqveSa kunTs, laviwis mdgomareobaSi. ganakveTs atareben
boloebs maTSi winaswar Seqmnil iRliis fosos yvelaze Rrma
xvrelebSi gatarebuli mavTuliT an wertilidan qveviT, mxris medialur
abreSumis ZafiT erTimeores zedapirze, misi zeda mesamedis
ukavSireben. keraven mkerdis, kunTs, farglebSi. aq nervi iRliis mTavari
fasciasa da kans. sisxlZarRvebisa da nervebis konis
ukan mdebareobs, qveviT kidev ufro
iRliis nervTan midgoma uknisaken ixreba da kunT-mxris arxSi
avadmyofi wevs mucelsa an saR gve- (canalis musculohumeralis) gadadis.
rdze, mxari moziduli da odnav mxris midamoSi nervis distalur
SigniT mobrunebuli aqvs. monakveTTan midgomisaTvis
ganakveTs atareben beWis qedis Sua vsargeblobT saproeqcio xaziT,
wertilidan deltisebri kunTis ukana romelic deltisebri kunTis ukana
kidis gaswvriv am kunTis mimagrebis kidis Sua wertilidan iwyeba da
adgilamde. kanis, kanqveSa qsovilisa orTava kunTis lateraluri Raris qve-
da deltisebri fasciis gakveTis da boloSi Tavdeba.
Semdeg deltisebri kunTis ukana kides mxris Sua mesamedSi sxivis nervTan
gadsweven gareT da win, xolo samTava midgomisas avadmyofi mucelze wevs,
kunTis grZel Tavs—SigniT. xeli ganziduli aqvs da misadgmel
deltisebri fasciis Rrma furclis magidaze udevs. 10_12sm sigrZis
qveS gamoCndeba iRliis nervi, ganakveTs atareben nervis saproeqcio
romelic mxris Zvlis qirurgiul xazis gaswvriv. kanis, kanqveSa
yelze ganivad mdebareobs da mxris qsovilisa da fasciis gakveTis Semdeg
ukana Semomxvev arteriasTan erTad samTava kunTis lateralur da grZel
oTxkuTxa xvrelidan gamodis. del- Tavebs Soris mdebare napralSi, uSua-
tisebri kunTis dasawyisi nawilis lod mxris Zvalze gamoCndeba Txeli
nawilobrivi gadakveTiT da kunTebis fasciiT dafaruli sxivis nervi,
kidev ufro metad gadaweviT SeiZleba romelsac Tan sdevs mxris Rrma
oTxkuTxa xvreli gavaganieroT da arteria.
nervs iRliis fosos farglebSi idayvis midamoSi sxivis nervTan
mivudgeT. midgomisas avadmyofi wevs zurgze.
iRliis nervis dasawyisi nawilisad- ganakveTs atareben idayvis fosos wina
mi farTod midgoma SeiZleba iRliis lateralur Rarsa da sxivis RarSi.

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igi iwyeba orTava kunTis lateralur gakveTis Semdeg winamxris zeda

kidesTan, am kunTis myesSi gadasvlis mesamedSi erTmaneTisagan Clungad
doneze da sxivis RarSi 10_12sm ganaSoreben mrgval pronatorsa da ma-
grZeldeba. fasciis gakveTis Semdeg jis sxivisaken momxrel kunTs romel-
wina mxris kanis lateralur nervs Ta Soris saSualo nervi mdebareobs.
SigniT gadasweven da mxrisa da mxar- winamxris qveda mesamedSi fasciis
sxivis kunTebs Soris siRrmeSi gakveTis Semdeg majis sxivisaken
gamoaCenen sxivis nervis Reros, rome- momxreli kunTis myess gadasweven
lic aq zedapirul da Rrma totebad lateralurad, xolo nebis grZeli da
iyofa. TiTebis zedapiruli momxreli
kunTebis myesebs—medialurad, ris
saSualo nervTan midgoma mxarze Sedegadac gamoCndeba saSualo nervi,
mxarze saSualo nervi iseve proeq- romelic aq SedarebiT zereled mdeba-
cirdeba, rogorc mxris arteria. 5_6sm reobs.
sigrZis ganakveTs atareben saproeqcio
xazis win, misgan 1_2sm daSorebiT. idayvis nervTan midgoma mxris
mxris fasciis gakveTisa da orTava midamoSi
kunTis medialuri kidis gareT mxris zeda mesamedSi idayvis
gadawevis Semdeg gamoCndeba am kunTis nervTan midgoma amave doneze mxris
budis ukana firfita, romelic amave arteriasTan midgomis analogiurad
dros sisxlZarRvebisa da nervebis xdeba. nervi aq arteriis medialurad
konis budis wina firfitaa. am uka- mdebareobs.
nasknelis gakveTis Semdeg Clungad mxris qveda mesamedSi idayvis nervi
gamoyofen saSualo nervs, romelic proecirdeba orTava kunTis
mxris zeda mesamedSi mdebareobs mxris medialuri Raris Sua wertilidan
arteriis win da lateralurad, Sua mxris Zvlis medialur zedarokamde
mesamedSi—win, xolo qveda gatarebul xazze.
mesamedSi—medialurad. 8sm sigrZis ganakveTs atareben ner-
vis saproeqcio xazis gaswvriv, misgan
1sm ukan. kanis, kanqveSa qsovilisa da
saSualo nervTan midgoma fasciis gakveTisa da medialuri
winamxarze kunTTaSua Zgidis winisaken gadawevis
saSualo nervis saproeqcio xazi Semdeg gamoCndeba idayvis nervis Rero,
winamxarze iwyeba orTava kunTis romelic samTava kunTis medialuri
myesisa da mxris Zvlis medialuri Tavis konebis gaswvriv mdebareobs;
zedarokis SemaerTebeli xazis Sua zogjer igi kunTis konebiT aris
wertilSi da Tavdeba sxivisa da dafaruli. aq masTan erTad
idayvis Zvlebis sadgisisebr morCTa moTavsebulia a. collateralis ulnaris sup.
SemaerTebeli xazis Sua wertilSi.
ganakveTs atareben saproeqcio idayvis nervTan midgoma winamxarze
xazis gaswvriv 8sm manZilze. kanis, winamxarze idayvis nervis sapro-
kanqveSa qsovilisa da fasciis eqcio xazi iwyeba mxris Zvlis

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 zemo kiduri

medialuri zedarokidan da Tavdeba qveda mesamedebSi. kanis, kanqveSa

cercvisebri Zvlis lateralur qsovilisa da fasciis gakveTis Semdeg
kidesTan. ganakveTs atareben sapro- nervs monaxaven majis idayvisken
eqcio xazze. amasTan, winamxris zeda momxrelsa da TiTebis zedapirul
mesamedSi nervis SedarebiT Rrmad momxrel kunTebs Soris. aq mis late-
mdebareobis gamo ganakveTi ramdenadme ralurad idayvis arteria da venebi
ufro grZeli unda iyos, vidre Sua da mdebareobs.

operaciuli midgoma zemo kiduris grZel

lulisebr ZvlebTan
kidurebis ZvlebTan operaciuli movufrTxildeT idayvis nervis dorsa-
midgomisaTvis ganakveTs, Cveulebriv, lur tots, romelic winamxris qveda
akeTeben sisxlZarRvebisa da mesamedSi majis idayvisken momxrel
nervebisagan met-naklebi daSorebiT. kunTsa da idayvis Zvals Soris
operaciuli midgoma winamxris gaivlis da winamxris ukana zedapirze
ZvlebTan. sxivis ZvalTan gadadis.
midgomisaTvis ganakveTs atareben operaciuli midgoma mxris ZvalTan.
winamxris gareTa zedapirze. kanis, ganakveTs atareben orTava kunTis
kanqveSa qsovilisa da sakuTari lateralur RarSi. kanis, kanqveSa
fasciis gakveTis Semdeg mxar-sxivisa qsovilisa da sakuTari fasciis
da majis sxivisken grZel gamSlel gakveTis Semdeg mxrisa da orTava
kunTebs erTmaneTisagan daaSoreben da kunTs gadasweven win, xolo samTava da
Zvals miudgebian. winamxris qveda mxar-sxivis kunTs—ukan. ZvalTan
nawilSi unda veridoT sxivis nervis midgoma SedarebiT advili da usafr-
zedapiruli totis dazianebas, Txoa mxris Sua mesamedSi. zeda mesa-
romelic midamos Sua da qveda medSi unda movufrTxildeT iRliis
mesamedebis sazRvarze gareT uxvevs, nervs, romelic uSualod exeba mxris
mxar-sxivis kunTis myessa da Zvals Zvlis qirurgiul yels; qveda
Soris gaivlis da ukana zedapirze mesamedSi mxris kunTsa da mxar-sxivis
gadadis. kunTs Soris sxivis nervi mdebareobs.
operaciuli midgoma idayvis zeda mesamedSi ZvalTan midgoma uf-
ZvalTan xorcieldeba winamxris ro xelsayrelia deltisebri kunTis
medialuri zedapiridan—majis wina kidis gaswvriv gatarebuli
idayvisken momxrel da gamSlel ganakveTiT.
kunTebs Soris gavliT. aq saWiroa

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 zemo kiduri

zemo kiduris saxsrebis punqcia_Cxvleta

mxris saxsris punqcia_Cxvleta win da qveviT. am dros winamxari odnav

mxris saxsris Cxvleta gamonaJonis moxrili unda iyos. paTologiuri
lokalizaciis Sesabamisad procesis lokalizaciis Sesabamisad
xorcieldeba winidan an uknidan. Cxvleta dasaSvebia sxva
winidan nemsi SehyavT niskartisebr adgilebSic,magram ar SeiZleba idayvis
morCsa da mxris Zvlis Tavs Soris morCis medialurad, vinaidan aq
3_4sm siRrmeze. idayvis morCsa da mxris medialur ze-
uknidan Cxvletas axorcieleben sam- daroks Soris idayvis nervi
xre morCis mwvervalis ukana kidis qve- mdebareobs.
viT—deltisebri kunTis ukana kidesa
da qedzeda kunTis qveda kides Soris sxiv-majis saxsris Cxvleta
mdebare fosoSi. nemsi SeyavT beWis Cxvleta SeiZleba nebismier
niskartisebri morCis mimarTulebiT adgilas, magram, vinaidan sasaxsre
4_5sm siRrmeze. CanTa winidan dafarulia momxrel
kunTTa myesebis ori SriT, nemsis
idayvis saxsris punqcia_Cxvleta Seyvana ufro mizanSewonilia
nemsi SeyavT saxsarSi idayvis dorsaluri zedapiridan, sxivis
morCsa da mxris lateralur zedaroks mxareze—sxivisa da idayvis Zvlebis
Soris, uSualod sxivis Zvlis Tavis sadgisisebri morCebis SemaerTebeli
zemoT. am dros kiduri idayvis xazisa da nebis meore Zvlis gaswvriv
saxsarSi moxrili unda iyos swori gatarebuli xazis urTierTgadakveTis
kuTxiT. sasaxsre CanTis zeda TaRis wertilSi. nemsi gaivlis ceris grZeli
Cxvletisas nemsi SeyavT qsovilebSi gamSleli kunTisa da maCvenebeli
idayvis morCis mwvervalTan iribad — TiTis gamSleli kunTis myesebs Soris.

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 zemo kiduri

klinikuri mimoxilva

auskultaciis samkuTxedi mxolod horizontalur sibrtyemde

beWis qvemo kuTxesTan, zurgis (deltisebri da nawilobriv qedzeda
mravalSred ganlagebul kunTebSi, kunTebis wyalobiT).
zurgis uganieresi kunTis zemo-
horizontaluri, beWis medialuri da
trapeciuli kunTis qvemo-lateraluri
kideebiT mosazRvrulia patara gulmkerdis dorsaluri nervis
samkuTxedi, romelic aris xelsayreli dazianeba
adgili (“fanjara”) filtvis ukana iRliis fosos qvemo nawilSi
segmentebis mosasmenad. torsis qirurgiuli Carevis dros arsebobs am
moxrisa da gulxeldakrefili jdomis nervis (C6 –C8) dazianebis riski;
dros auskultaciis samkuTxedi vinaidan nervi miemarTeba fosos ukana
diddeba da kanqveS isinjeba meeqvse da kedlis qvemo nawilSi da Sedis
meSvide neknebi da meeqvse neknTaSua uganieres kunTSi medialuri mxridan,
sivrce. am kunTis myesovani da kunTovani
nawilebis sazRvarze. nervis
wina dakbiluli kunTis dambla dazianebis saSiSroebaa, agreTve, beWis
wina dakbiluli kunTis limfuri kvanZebis amokveTis dros,
damblas iwvevs guklmkerdis grZeli vinaidan nervis bolo monakveTi Zevs
nervis dazianeba. am kvanZebisa da beWqvesa arteries win.
gulmkerdis grZeli nervi wina zurgis uganieresi kunTi da mkerdis
dakbiluli kunTis wina zedapirze didi kunTis qvemo nawili qmnian wina-
Zevs, amitom dabla daSvebuli kiduris ukana kunTovan “Surduls” torssa da
dros igi daculia; samagirod, maRla zemo kidurs Soris. am “Surdulis”
aweuli kiduris dros advilia nervis Zlieri mawilia zurgis uganieresi
dazianeba (tyviiT, daniT). kunTi. kunTis damblis dros (
am dros beWis medialuri kide gulmkerdis dorsaluri nervis
gaweulia gverdze da ukan, frTis dazianebis Sedegad) individs ar
msgavsad, gansakuTrebiT maSin, SeuZlia cocva _ torsis
rodesac individi eyrdnoba xels, an gadaadgileba zemo kidurebTan ertad
zemo kiduriT ebjineba kedels. Tu (mag. kldeze, mTaze acoceba), ar
mklavi zeviT aris aweuli, beWi ufro SeuZlia yavarjnis xmareba.
metad Sordeba gulmkerdis ukana
kedels. beWis aseT mdgomareobas iRliis nervis dazianeba
“mfrinav beWs” uwodeben. SeuZlebelia mxris Zvlis qirurgiuli yelis
kiduris sruli ganzidva, misi maRla motexilobis dros, Cveulebriv<
aweva, radgan kunTi damblis gamo igi adgili aqvs iRliis nervis (C5- C6)
ver axerxebs kiduris zeviT brunvas. dazianebas, vinaidan nervi gaivlis
kiduris ganzidva SesaZlebelia mxris Zvlis Tavis qveS; yelis garSemo

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 zemo kiduri

nervis dazianeba mosalodnelia, kunTmyesovani “mbrunavi manJetis”

agreTve, mxris saxsris dislokaciis dazianeba iwvevs mxris saxsris
an yavarjniT nervis kompresiis stabilurobis darRvevas. travmis
Sedegad (yavarjnis arasworad Sedegad SesaZlebelia erTi an
xmarebisas). ramodenime kunTis (ufro xSirad
iRliis nervis mZime dazianeba qedzeda kunTis) myesis gawyveta.
iwvevs deltisebri kunTis atrofias. xSiria “mbrunavi manJetis” tendiniti
kunTi kargavs misTvis damaxasiaTebel (gansakuTrebiT moxucebSi).
simrgvales, brtyeldeba, Cndeba susti
CaRrmaveba akromionis qveS. kunTis mxris Zvlis proqsimaluri epifizis
atrofiasTan erTad SesaZlebelia motexiloba _ dislokacia
mgrZnobelobis dakargva mxris mxarze pirdapiri an arapirdapiri
proqsimaluri nawilis lateraluri dartyma iwvevs mxris Zvlis
midamos, romelic inervirdeba mxris motexiloba _ dislokacias
kanis lateraluri nerviT. (gansakuTrebiT, bavSvebSi da
deltisebur kunTSi xSirad keTdeba moxucebSi). vinaidan sasaxsre CanTa
wamlebis ineqcia. am dros (da “mbrunavi manJetis” kunTebis wyalobiT
saerTod mxarze qirurgiuli ufro gamagrebulia, vidre epifizuri
Carevisas) ar aris iRliis nervis firfita, mZime motexilobebis drosac
dazianebis saSiSroeba, radgan nervi mxris Zvlis Tavi rCeba sasaxsre
gaivlis kunTis wveS mxris Zvlis fosoSi da Zvlis diafizi scildeba
qirurgiuli yelis doneze. epifizs.

“mbrunavi manJetis” kunTebi iRliis arteriis kompresia

beWisa da mxris damakavSirebel iRliis arteria isinjeba iRliis
oTx kunTs, anu beWis sakuTar kunTebs fosos gareTa kedlis qvemo nawilSi.
“mbrunavi manJetis” kunTebs uwodeben. tyviiT an daniT miyenebuli Wrilobis
esenia: m. supraspinatus, m. infraspinatus, m. Sedegad profuzuli sisxldenis
teres minor, m. subscapularis (SITS). es kunTebi SesaCereblad mimarTaven iRliis
qmnian kunT-myesovan manJets mxris arteriis kompresias mxris Zvalze
saxsris irgvliv; maTi myesebi erTvian mkerdis mcire kunTis lateralur
mxris saxsris CanTis fibrozul Sres, kidesa da didi mrgvali kunTis
icaven saxsars da xels uwyoben mis medialur kides Soris (aq mdebareobs
stabilurobas. am kunTebis tonuri iRliis arteriis mesame, bolo
SekumSvis wyalobiT, mxris moZraobis monakveTi); zogjer saWiroa arteriis
dros, mxris Zvlis SedarebiT didi pirveli (proqsimaluri) monakveTis
Tavi ar vardeba beWis Zvlis odnav kompresia laviwsa da mkerd-laviw-
Sedrekili sasaxsre fosodan. dvrilisebri kunTis mimagrebis
qedzeda kunTi (garda imisa, rom is adgils Soris kuTxeSi.
“manJetis” SemadgenlobaSi Sedis)
exmareba deltisebr kunTs mxris
0
sawyis _ 15 -iT ganzidvaSi.

klinikuri anatomia 158

 zemo kiduri

iRliis arteriis anevrizma (mgrZnobelobis dakargvas). iRliis

iRliis arteriis pirveli arteriis anevrizma xSirad uCndeba
monakveTis anevrizma awveba mxris beisbolis moTamaSes _ burTis
wnulis Reros, rac iwvevs tkivils da momwodebels kiduris swrafi da
dazianebuli nervebis sainervacio Zlieri moZraobis gamo.
kanis midamos anesTezias

laviwqveSa venis punqcia (da iRliis limfuri kvanZebis gadideba

iRliis venis roli punqciis dros) zemo kudurSi infeqciis SeWras
laviwqveSa venis punqcias (da mis mosdevs iRliis limfuri kvanZebis
kaTeterizacias) klinikaSi mimarTaven gadideba da kiduris limfuri
sakvebi siTxis da medikamentebis ZarRvebis anTeba (limfangiti). pirvel
parenteraluri Seyvanis mizniT da rigSi diddeba mxarze ganlagebuli
centraluri venuri wnevis gasazomad. kvanZebi. limfangitis Sedegad kiduri
laviwqveSa venis punqciis dros gacxelebulia da kanze aRiniSneba
nemsi faqtiurad jer SehyavT iRliis mgZnobiare (mtkivneuli) zolebi
venaSi, iqidan ki gadian laviwqveSa (anTebadi ZarRvebis gaswvriv).
venaSi; amitom klinikuri iRliis kvanZebis gdidebas adgili
(usafrTxoebis) TvalsazrisiT metad aqvs gulmkerdis, ZuZus da muclis
mniSvnelovania, rom iRliis vena zemo midamos infeqciebis dros.
mdebareobs iRliis arteriisa da mis apikaluri jgufis metastazuri kibos
irgvliv mdebare mxris wnulis dros xSirad aRiniSneba limfuri
totebis win, zerapirulad (amis gamo kvanZebis Sexorceba iRliis venasTan,
maTi dazianebis riski naklebia). ris gamoc aucilebelia venis
procedura: marcxena xelis ceri garkveuli nawilis amokveTa.
Tavsdeba laviwis SuaSi, saCvenebeli gadodebulma apikalurma kvanZebma
TiTi ki _ mkerdis Zvlis taris SesaZlebelia gamoiwvion Sevardnis
sauRle amonaWdevSi; marjvena xeliT venis obstruqcia gulmkerdis mcire
nemsi SehyavT kanSi, ceris qveS. nemsi kunTis zemoT.
jer moxvdeba iRliis venaSi, Semdeg
maSinve medialurad _ laviwqveSa iRliis kvanZebis amokveTa
venaSi. nemsi frTxilad SehyvT iRliis limfuri kvanZebis amokveTa
saCvenebeli TiTis wveramde, anu da maTi paTologiuri analizi xSirad
marjvena venur kuTxemde (mkerd- aucilebelia ZuZus kibos stadiebis
laviwis saxsris ukan). procedura dadgenisa da Sesaferisi mkurnalobis
moiTxovs did sifrTxiles, rom ar daniSvnisaTvis. vinaidan iRliis
daziandes plevra da filtvi (da ar kvanZebi ganlagebulia garkveuli
garTuldes pnevmoToraqsiT) da TanmimdevrobiT da aseTive
iRliis arteria. TanmimdevrobiT moxvdeba maTSi
limfiT gadatanili simsivnuri
ujredebi; amitom friad

klinikuri anatomia 159

 zemo kiduri

mniSvnelovania kvanZebis imave advilia qirurgiuli Carevisas.nervis

TanmimdevrobiT rezeqcia, raTa dazianeba iwvevs kunTis damblas da
dadgindes kibos gavrcelebis farTobi e.w. “mfrinavi beWis” ganviTarebas.
da savaraudo metastazebi. gulmkerdis dorsaluri nervis
limfuri kvanZebis amokveTas xSirad (uneblie) gadaWras mosdevs zemo
mosdevs limfis drenaJis Seferxeba da kiduris mozidvisa da misi SigniT
misi dagroveba kanqveSa qsovilSi _ brunvis SezRudva _ zurgis uganieresi
limphedema (limfuri SeSupeba). kunTis damblis gamo. miuxedavad amisa,
iRliis kvanZebis amokveTis dros zogjer qirurgi iZulebulia gawiros
aris ori nervis dazianebis riski: nervi, Tu mis irgvliv ganlagebuli
gulmkerdis grZeli da gulmkerdis kvanZebi aSkarad avTvisebiania da
dorsaluri nervebis. aucilebelia maTi rezeqcia simsivnuri
gulmkerdis grZeli nervi wina ujredebis mosalodneli gavrcelebis
dakbiluli kunTis wina zedapirze (metastazebis) Tavidan acilebis
mdebareobs, amitom misi dazianeba mizniT.

klinikuri anatomia 160


qvemo kiduri _ membrum inferius
qvemo kidurSi arCeven sartyels _
cingulum membri inferioris da Tavisufal
nawils _ membrum inferius libera.
qvemo kiduris sartyels ekuTvnis
menjis Zvali _ is coxae; qvemo kiduris
Tavisufal nawilSi arCeven sam
nawils: proqsimalurs _ barZays _
femur, Sua nawils _ kanWs _ crus da
distalur nawils _ terfs _ pes.
qvemo kiduris sartyeli _ cingulum membri inferioris
menjis Zvali _ os coxae;
menjis Zvali Sedis menjis
SemadgenlobaSi, magram amave dros igi
warmoadgens qvemo kiduris sartylis
uZrav Zvals.
menjis Zvali 16 wlamde 3 gareTa da SigniTa bage _ labium
nawilisagan Sedgeba: TeZos Zvali _
ilium, boqvenis Zvali _ os pubis da
sajdomo Zvali _ os ischii. TiToeul
maTgans aqvs gasqelebuli nawili _
sxeuli _ corpus.
am sami nawilis sxeulebis Sezrda
warmoebs Zvlis gareTa zedapirze
arsebuli ganieri da Rrma fosos
midamoSi, romelsac tabuxis bude _
acetabulum _ ewodwba. ase rom, TeZos
Zvali Zevs am fosos zeviT, sajdomi
Zvali _ ukan da qveviT, xolo boqvenis
Zvali _ win da medialurad.
TeZos Zvals ori nawili aqvs:
momsxvilo TeZos Zvlis sxeuli _
corpus ossis ilii da misgan warziduli
brtyeli da ganieri TeZos Zvlis frTa
_ alla ossis ilii.
klinikuri anatomia
qvemo kiduri
muxlis midamoSi aRsaniSnavia
sesamoiduri Zvali _ kviristavi –
patella.
terfi Tavis mxriv sam nawilad
iyofa: ukana terfi _ tarsus, wina
terfi _ metatarsus da TiTebi _ digiti
pedis.
TeZos Zvalze aris Semdegi mTavari
warmonaqmnebi: TeZos Zvlis
Tavisufali gasqelebuli kide,
romelsac ewodeba TeZos qeli _ crista
iliaca; am qedis gaswvriv mdebareobs
externum et internum da Sumdebare xazi _
linea intermedia. TeZos Zvals brtyeli
forma aqvs.
TeZos Zvlis qedi winidan Tavdeba
TeZos wina zeda wvetiT _ spina iliaca
anterior superior. mis qvemoT, patara
naWdevis Semdeg, mdebareobs SedarebiT
naklebad gamoxatuli, TeZos wina
qveda wvetiT _ spina iliaca anterior inferior;
TeZos Zvlis qedi ukanidan Tavdeba,
agreTve, TeZos ukana zeda wvetiT _
spina iliaca posterior superior, romlis
qvemoT aris TeZos ukana qveda wveti _
spina iliaca anterior inferior. frTis SigniTa
zedapiri CaRrmavebulia da ewodeba
TeZos foso _ fossa iliaca.
TeZos Zvlis gareTa sadundule
zedapirze _ facies glutea aris sami
xorkliani xazi, romlebidanac
161
 qvemo kiduri

dundulia kunTebi iwyeba; mdebareobis sajdom ZvalSi arCeven sxeuls _

mixedviT maT wina, ukana da qvemo corpus ossis ischii, romelic gadadis
dunduluvani xazebs _ lineaglutea totSi _ ramus ossis ischii. am gadasvlis
anterior, posterior et inferior _uwodeben. midamoSi Seiqmneba msxvili Zvlovani
TeZos fosos qvemodan da Signidan warmonaqmni _ sajdomi borcvi _ tuber
mkveTrad SemisazRvrulia TeZos Zvlis ischiadicum. am borcvis ukan da zeviT
danarCeni nawilebisagan rkalovani mdebareobs sajdomi wveri _ spina
xaziT _ linea arcuata. im adgilas, sadac ischiadica, romelic gansazRvravs or
TeZos Zvlis sxeuli uerTdeba naWdevs: zemi did sajdom naWdevs _
boqvenis Zvlis sxeuls, aris incisura ischiadicum major da qvemo mcire
xorkliani TeZo_boqvenis maRlobi _ sajdom naWdevs _ incisura ischiadicum
eminentia iliopectinea, minor.
TeZos Zvlis frTis ukana kideze,
tabuxis bude _ acetabulum
medialuri mxridan, moTavsebulia
warmoadgens Rrma fosos gamoweuli
yurisebri zedapiri _ facies auricularis,
da Seviwroebuli napiriT _ supercilium
romliTac yoveli menjis Zvali gavis
acetabuli, romelic qveda nawilSi
Zvlis Tanamosaxele zedapirs
tabuxis budis naWdeviT _ incisura
enawevreba.
acetabuli _ wydeba.
boqvenis ZvalSi arCeven sxeuls _
tabuxis bude iyofa or nawilad:
corpus ossis pubis da or tots: zemo
periferiuli, sada, xrtiliT
horizontalurs _ ramus superior ossis
mofenili, mTvarisebri zedapiri _
pubis da qvemo, daswvrivs _ ramus inferior
facies lunata da centraluri, xorkliani
ossis pubis. zemo totis zeviTa napiris
_ tabuxis budis foso _ fossa acetabuli _
gaswvriv midis boqvenis Zvlis qedi _
barZavis mrgvali iogis misamagreblad.
pectin ossis pubis, romelic Tavdeba
boqvenis da sajdomi Zvlis totebi
boqvenis xorkliT _ tuberculum pubicum. uerTdebian erTimeores dsa sazRvraven
zemo totis qveda napiris mimarT,
mozrdil daxurul xvrels _ foramen
iribad, garedan SigniTa
obturatum.
mimarTulebiT, midis ganieri
daxuruli Rari _sulcus obturatorius.
boqvenis Zvlebis qvemo totebs Soris
iqmneba kuTxe, romelsac boqvenis
kuTxes _ angulus pubis uwodeben.

qvemo kiduris Tavisufali nawilis ConCxi _

sceleton membri inferioris liberi

barZayi _ femur sxeuls _ corpus femoris da or bolos _

barZayi ekuTvnis grZel lulisebr zemo da qvemo epifizs. zemo bolos
Zvlebs, romelSic arCeven diafizs _ aqvs sferuli moyvanilobis barZayis

klinikuri anatomia 162

 qvemo kiduri

Tavi _ caput femoris, romlis Sua da mosazRvraven samkuTxa

nawilSi aris momrgvalo, xorkliani moyvanilobis e.w. muxlqveSa zedapirs
Tavis foso _ fovea capitis femoris. _ facies poplitea.
barZayis Tavs mosdevs Seviwroebuli barZayis Zvlis qveda bolo
nawili _ barZayis yeli _ collum femoris. gasqelebulia da qmnis or did
yelis Semdeg, barZayis Zvlis sxeulze SigniTa da gareTa roks _ condylus
moTavsebulia ori borcvi, medialis et lateralis, romlebic mimarTulia
romelTaganac erTi mimarTulia gareT ukan. rokebis ukana nawilebi
da zeviT, ufro msxvilia da ewodeba gayofilia Rrma rokTaSua fosoTi _
didi cibruti _ trochanter major; meore fossa intercondylaris. yoveli rokis
mimarTulia SigniT da ukan, ufro gverdze aris e.w. SigniTa da gareTa
pataraa da ewodeba mcire cibruti _ zedarokebi _ epicondylus medialis et
trochanter minor. epicondylus lateralis. qvemo epifizze
barZayis Zvlis cibrutebi winidan ganirCeva sasaxsre zedapirebi didi
da ukanidan uerTdeba erTimeores wvivisaTvis da kviristavisaTvis _ fcies
kargad gamoxatuli xorkliani patellaris.
Zvlovani qedebiT; wina qeds, romelic
ufro naklebadaa ganviTarebuli, kviristavi _ patella
uwodeben cibrutTa Sua xazs _ linea kviristavi warmoadgens brtyel
intertrochanterika, xolo ukanas _ Zvals, romelzedac arCeven xorklian
cibrutTaSua qeds _ crista wina zedapirs _ facies anterior da ukana
intertrochanterica. sada sasaxsre zedapirs _ facies
didi cibrutis SigniTa mxareze articularis. ukanaskneli gayofilia
aris cibrutis foso _ fossa gaswvrivi morgviT or nawilad _
trochanterica. mcire cibrutis ukan da gareTa, SedarebiT did, da SigniTa
qveviT aris mniSvnelovani xorkliani mcire nawilad. zeviTa ganier bolos
xazi e.w. qedis xazi _ linea pectinea, ewodeba kviristavis fuZe _ basis
qedis kunTis misamagreblad. barZayis patellae, qvemo wvetian bolos ki _
Zvlis sxeuli gamrudebulia da kviristavis mwvervali _ apex patellae.
gamodrekili zedapiriT mimarTulia kviristavi ekuTvnis sesamoidur
win. Zvlebs. igi moTavsebulia barZayis
didi cibrutis ukan da qvemoT oTxTava kunTis myesis sisqeSi da
barZayis Zvlis sxeulze mdebareobs icavs muxlis saxsars.
sadundule xorkli _ tuberossitas glutaea.
barZayis Zvlis sxeuls ukanidan aqvs kanWis Zvlebi _ ossa cruris
gaswvrivi mimarTulebis xorkliani kanWis semadgenlobasi Sedis ori
xazi _ linea aspera ori bagiT: SigniTa Zvali: didi wvivi da mcire wvivi;
da gareTa _ labium mediale da labium pirveli mdebareobs mebialurad, tefis
laterale. barZayis sxeulis qvemo ceris mxareze, meore_ lateralurad,
nawilSi es bageebi Sordeba erTmaneTs, nekis mxareze.
miimarTeba barZayis zedarokebisaken

klinikuri anatomia 163


didi wvivis Zvali _ tibia
didi wvivi warmoadgens lulisebr
Zvals, romelSiac arCeven sxeuls _
corpus tibiae da or bolos; mis zemo
boloze arCeven SigniTa da gareTa
rokebs _ condylus medialis et condylus
lateralis. am rokebis nawili, mimarTuli
barZayis Zvlisaken, qmnis
sasaxsre zedapirs _ facies artikularis
superior; maT Soris SuaSi aRiniSneba
rokTaSua SemaRleba _ eminentia
intercondylaris, romelsac darTuli aqvs
wina da ukana rokTaSua are _ area
intercondylaris anterior et posterior.
didi wvivis wina qedis
boloze aris xorkliani Zvlovani
maRlobi _ didi wvivis borcvi _
tuberculum tibiae. gareTa
lateralur mxareze mdebareobs
patara, brtyeli mcire wvivis sasaxsre
zedapiri _ facies articularis fibularis,
romelsac mcire wvivis
enawevreba. didi wvivis
zedapirze iribi mimarTulebiT,
zevidan qveviT da garedan SigniT,
miemarTeba Zvlovani xorkliani xazi,
e.w. quslis kunTis xazi _ linea m. solei.
didi wvivis sxeuli samwaxnagiani
moyvanilobisaa da ganirCeva masze sami
_ SigniTa, gareTa da ukana zedapiri,
gansazRvruli erTmaneTisagan
maxvili wina, SigniTa da ZvalTaSua
kidiT _ margo anterior, medialis et
interossea. wina maxvili kide advilad
SeigrZnoba.
didi wvivis qvemo bolo ufro
wvrilia da mas medialur mxareze aqvs
sqeli Zvlovani morCi, mimarTuli
qveviT, romelsac uwodeben SigniTa
gojs _ malleolus medialis; mis ukana
zedapirze arsebobs gojis Rari _
klinikuri anatomia
qvemo kiduri
sulcus malleolaris didi wvivis kunTebis
myesebisaTvis. lateralur zedapirze
aris mcire wvivis naWdevi _ incisura
fibularis _ mcire wvivTan SesaerTeblad.
didi wvivis distaluri, anu qvemo
sasaxsre zedapiri _ facies articularis
inferior odnav Sedrekilia, oTxkuTxa
zemo formisaa da koWis Zvals enawevreba.
mcire wvivis Zvali _ fibula
mcire wvivi grZel lulisebr Zvals
ekuTvnis da didi wvivis gareTa
mxareze mdebareobs. arCeven sxeuls _
corpus fibulae da or bolos _ zemo da
zemo qvemo epifizebs.
zemo bolos, romelsac uwodeben
mcire wvivis Tavs _ caput fibulae, aqvs
rokis mwvervali _ apex capitis fibulae da Tavis
sasaxsre zedapiri _ facies articularis
capitis fibulae, romliTac igi didi wvivis
Zvals enawevreba.
Tavi mcire wvivis sxeuls samwaxnagovani
ukana prizmis moyvaniloba aqvs, romlis sami
zedapiri facies medialis, lateralis et posterior
gansazRvrulia mkveTri wvetiani wina,
ukana da ZvalTaSua kidiT _ margo
anterior, posterior et interossea.
qvemo bolo, saxeldobr, gareTa
goji _ malleolus lateralis, ganieri da
grZelia da SigniTa gojze ufro
sami qveviTaa daweuli. mis SigniTa mxareze
aris brtyeli, e.w. gareTa gojis
sasaxsre zedapiri _ facies articularis
malleoli koWis ZvalTan
SenawevrebisaTvis. ukana mxareze ki _
gareTa gojis foso _ fossa malleoli
lateralis, romelSiac mcire kunTebis
myesebi gaivlis.
wvivis Zvlebi Tanaswvrivad
mdebareoben da erTimeores erTvian
164
 qvemo kiduri

rogorc zemo, ise qvemo boloebiT ise, sasaxsre zedapirze aRiniSneba Rrma,
rom sxeulebs Soris rCeba e.w. kanWis e.w. koWis Rari _ sulcus tali.
ZvalTaSua sivrce _ spatium interosseum koWis Zvlis Tavi mimarTulia win
cruris. kanWis Zvlebis qvemo boloebi da qveviT da sasaxsre zedapiriT
qvemoT gaSverili gojebiT enawevreba navisebr Zvals _ facies
mogvagonebs Cangals, romelSic articularis navicularis. garda amisa,
Camjdaria koWis Zvali. ganirCeva koWis ukana morCi _ processus
posterior tali, romelzedac aRiniSneba
terfis Zvlebi _ ossa pedis terfis ceris grZeli momxreli
terfi sam nawilad iyofa: ukana kunTis myesis Rari _ sulcus tendo m. flex.
terfi _tarsus, wina terfi – metatarsus halluci longi; SigniTa xorkli _ tuberculum
da TiTebi _ digiti pedis. mediale da gareTa xorkli _ tuberculum
ukana terfi Svidi Zvlisagan laterale.
Sedgeba: qusls _ calcaneus aqv qveviT
1. koWis Zvali _ os talus gaSverili quslis borcvi _ tuber
2. quslis Zvali _ os calcaneus calcanei, romelzedac aRiniSneba quslis
3. navisebri Zvali _ os naviculare borcvis SigniTa da gareTa morCebi _
4. kuburi Zvali _ os cuboideum processus medialis et lateralis tuber calcanei.
5. SigniTa solisebri Zvali _ os quslis zemo mxareze sami sasaxsre
cuneiforme mediale zedapiria: wina, Sua da ukana. koWis
6. Suamdebare solisebri Zvali _ os sasaxsre zedapirebi _ koWis sasaxsre
cuneiforme intermedium zedapirebi _ facies articularis talaris anterior
7. gareTa solisebri Zvali _ os media et posterior, romlebiTac igi
cuneiforme laterale zemdebare koWs enawevreba. es
koWi sam nawilad iyofa: sxeuli _ zedapirebi gayofilia quslis RariT _
corpus tali, yeli _ collum tali da Tavi _ sulcus calcanei. koWisa da quslis Zvlis
caput tali. koWis sxeuli Tavisi WaRiT _ Rarebis SeerTeba qmnis farTo
trochlea tali kanWis Zvlebs enawevreba. fuRuros _ ukana terfis wiaRs _ sinus
WaRze ganirCeva: zemo zedapiri _ tarsi. qusli kuburi sasaxsre
facies anterior, SigniTa gojis zedapiri – zedapiriT _ facies articularis cuboidea _
facies malleolus medialis, gareTa gojis winidan enawevreba kubur Zvals.
zedapiri _ facies malleolus lateralis. quslis SigniTa zedapiris zemo
ukanasknel zedapirze aRiniSneba koWis napirTan arsebobs koWisaken
gareTa morCi _ processus lateralis tali. mimarTuli, kargad gamoxatuli
koWis sxeuli qvemo mxareze sami ganieri morCi _ koWis sabrjeni _
sasaxsre zedapiriT enawevreba qusls. suspentaculum talare. dgomis dros qusli
wina, Sua da ukana quslis sasaxsre Tavisi borcviT niadags eyrdnoba.
zedapirebi _ facies articularis calcanea navisebri Zvali _ os naviculare
anterior media et posterior. quslis ukana terfis medialur mxareze mdebareobs.
igi Tavisi Sedrekili ukana sasaxsre

klinikuri anatomia 165

 qvemo kiduri

zedapiriT koWis Zvlis Tavs enawevrba. romliTac isini ukana terfis Zvlebs (
wina mxareze aRsaniSnavia sami sami solisebri da kuburi)
sasaxsre zedapiri, romlebsac enawevrebian, sxeuli _ corpus da wina
solisebri Zvlebi enawevreba. SigniTa boloebi _ Tavebi _ caput, sferuli
mxareze navisebr Zvals sakmaod sasaxsre zedapiriT, romlebic
mozrdili da kanqveS advilad sapovn pirveli rigis falangebs enawevreba.
borcvi aqvs, romelsac navisebri wina terfis pirveli Zvlis Tavis qveS
Zvlis xorkls _ tuberositas ossis moTavsebulia ori sesamoiduri Zvali.
navicularis uwodeben. wina terfis pirveli da mexuTe
kuburi Zvali _ os cuboideum terfis Zvlis fuZes mniSvnelovani
gareTa mxris gaswvriv da quslis xorklianoba aqvs, mimarTuli ukan da
Zvlis win mdebareobs. mis wina mxareze gareT, da ewodeba wina terfis I da V
aris ori sasaxsre zedapiri, wina Zvlis xorklovanoba _ tuberositas ossia
terfis me-4 da me-5 ZvlebTan metatarsalis primi et quinti.
SenawevrebisaTvis. ukanidanigi
enawevreba quslis Zvals, xolo terfis TiTebis Zvlebi _ ossa
Signidan _ navisebr da gareta digitorum pedis
solisebr Zvlebs. masze aRiniSneba
sulcus tendo m. peronei longe _ mcire wvivis terfis yoveli TiTi Sedgeba e.w.
grZeli kunTis myesis Rari da kuburi falangebisagan. cers, iseve rogorc
Zvlis xorkli _ tubrositas ossis cuboidei xelis mtevanze, aqvs ori galangi. me-4
SigniTa, Sua da gareTa solisebri da me-5 TiTis Sua da distaluri
Zvlebi _ ossa cuneiforma mediale, falangebi mometebul SemTxvevaSi
intermedium et laterale ukanidan Sezrdilia.
enawevrebian navisebr Zvals, winidan _ mTlian terfze arCeven or
wina terfis 1-el, me-2 da me-3 Zvlebs zedapirs: mimarTuls qveviT,
da erTimeores. gareTa soliseburi dedamiwisken, ewodeba terf-Ziris
Zvali enawevreba kubur Zvals. zedapiri _ facies plantaris; igi
SigniTa solisebri Zvlis Sedrekilia rogorc gaswvrivi, ise
mwvervali mimarTulia terfis zurgis ganivi mimarTulebiT, ris gamoc terfi
mxrisaken, zeviT; Suamdebare da gareTa TaRis formas Rebulobs. terfi
Zvlis mwvervali ki terfis Zirisaken, eyrdnoba dedamiwas quslis Zvlis
qveviT. borcviT, wina terfis TavebiT da
ukanaskneli falangebiT. terfis meore
wina terfis Zvlebi _ ossa metatarsalia zedapiri mimarTulia zeviT,
I_V gamodrekilia da ewodeba zurgis
wina terfis Zvlebi xuTia. isini zedapiri _ facies dorsalis.
ekuTvnian grZel lulisebr Zvlebs da
aqvT gasqelebuli fuZeebi _ basis,
brtyeli sasaxsre zedapiriT,

klinikuri anatomia 166

 qvemo kiduri

qvemo kiduris sartylis Senawevrebani _

Juncturae cinguli membri inferioris

menjSi erTimeores enawevreba ori Zvlebi SeerTebuli aris boWkovani

menjis Zvali, gavisa da kudusunis SemaerTebelqsovilovani konebiT
Zvali. garda amisa, gavis Zvali (syndesmosis) da nawilobriv xrtiliTac
uerTdeba welis ukanasknel malas (synchondrosis).
sinqondrozis saSualebiT. gava-TeZos saxsari Zalian mtkiced
Senawevreba boqvenis ZvalTa Soris, aris gamagrebuli da masSi moZraoba
anu boqvenis simfizi _ symphisis pubica, mxolod tokvis saxiT gamoixateba
gamagrebulia ori iogiT: boqvenis milimetrebis farglebSi. saxsari
zemo da boqvenis rkalovani iogiT _ gamagrebulia winidan da ukanidan
ligamentum pubicum superius et ligamentum gava-TeZos ventralur da dorsaluri
arcuatum pubis. boqvenis simfizi iogebiT _ ligamenta sacroiliaca ventralia et
naxevrad saxsris _ hemiarthrosis dorsalia. amis garda, msxvili da sqeli,
magaliTs warmoadgens, radgan e.w. gava-TeZos ZvalTaSua iogebi _ lig.
SemarTebeli xrtilis sisqeSi sacroiliaca interossea, amagrebs am Zvlebs;
arsebobs Canasaxovani, daklaknili da igi gaWimulia TeZos da gavis Zvlebis
viwro sasaxsre naprali. xorklian zedapirebs Soris. gava-
gava_TeZos saxsari _ artoculatio TeZos saxsars didi mniSvneloba aqvs
sacroiliaca _ aris marjvena da marcxena; sxeulis meqanikis movlenebSi; igi
aq gavis Zvali enawevreba menjis TvalsaCino zegavlenas axdens
Zvlebs yurisebri zedapirebis siarulis xasiaTze da menjis
saSualebiT. sasaxsre Rru Zlier ganviTarebaze. Tavisi sasaxsre
viwro naprals warmoadgens. zedapirebis moyvanilobiT brtyel
TeZos Zvlis sasaxsre zedapiri saxsrebs ekuTvnis. amis garda, welis
cotaoden amobulculia, igi Casmulia ukanaskneli malis ganiv morCebs da
gavis Zvlis yurisebr zedapirSi, TeZos qedis ukana nawilebs Soris
romelic, samagierod, CaRrmavebas gadaWimulia kargad ganviTarebuli da
warmoadgens. gavis Zvalze yurisebri ganieri TeZo-welis iogi _ ligamentum
sasaxsre zedapiri vrceldeba, iliolumbale.
Cveulebriv, gavis I, II da III malebze. gavis Zvlis gverdT napirsa da
sasaxsre zedapiri bavSvebs am sajdomi Zvlis wvetsa da bircvs
saxsarSi sada aqvT, mozrdilebs ki _ Soris gadaWimulia ori friad
daklaknili. sasaxsre zedapirebi mniSvnelovani, msxvili, mkvrivi da
mofenilia boWkovani xrtiliT, magari iogi _ gava-wvetiani iogi _
romelic gavis Zvalze ufro sqelia ligamentum sacrospinale da gava-kukuxos
da zog adgilebSi Seicavs minisebr iogi _ ligamentum sacrotuberale; es iogebi
xrtilsac. sasaxsre Rru viTardeba im sazRvraven mcire menjis gverdiT or
droisTvis, rodesac bavSvs sarZeve mniSvnelovan xvrels: sajdom did
kbilebis Cvla ewyeba; manamdis ki xvrels _ foramen isciadicum majus da

klinikuri anatomia 167

 qvemo kiduri

sajdom mcire xvrels _ foramen nawilSi, boqvenis horizontaluri

ischiadicum minus. totis qveS, rCeba iribi arxi,
daxuruli xvreli menjis Zvlisa romelsac uwodeben daxurul arxs _
dafarulia boWkovani canalis obturatorius.
SemaerTebelqsovilovani damxurveli gava – kudusunis Senawevreba _
apkiT _ membrana obturatoria, xolo zemo junctura sacrococcygea ix. zemoT.

qvemo kiduris kunTebi

qvemo kiduris sartylis _ menjis _ kunTebi

TeZo-sukis kunTi _ m. iliopsoas _ xvrelis _ foramen ischiadicum major

Sedgeba ori nawilisagan: saSualebiT da umagrdeba ukanidan
a) sukis didi kunTi _ m. psoas major barZayis did cibruts. abrunebs
_ iwyeba gulmkerdis meTormete da barZays gareT.
welis xuTive malis ganivi morCebidan SigniTa damxurveli kunTi _ m.
da maTi sxeulebis lateraluri obturatorius internus _ iwyeba menjis
zedapirebidan. damxurveli apkis SigniTa zedapiridan
b) TeZos kunTi _ m. iliacus _ iwyeba da daxuruli xvrelis Zvlovani
TeZos Zvlis fosodan. napirebidan, stovebs mcire menjs
TeZos fosoSi es ori kunTi mcire sajdomi xvrelis _ foramen
erTimeores uerTdeba da erTad qmnis ischiadicum minor saSualebiT da
e.w. TeZo-sukis kunTs _ m. iliopsoas. es umagrdeba barZayis cibrutTa fosos.
ukanaskneli sazardulis iogis qveS, atrialebs barZays gareT.
kunTovani Sualedis _ lacuna musculorum didi dundula kunTi _ m. gluteus
saSualebiT, gadadis barZayze da maxumus _ iwyeba gavis Zvlis gareTa
msxvili myesiT umagrdeba barZayis zedapiridan da kudusunis ukana
mcire cibruts. am kunTis SekumSva zedapiridan da umagrdeba barZayis
iwvevs barZayis moxras, xolo Tu sadundule xorklian SemaRlebas.
barZayi gamagrebulia, xris wels. Slis barZays.
sukis mcire kunTi _ m. psoas minor Sua dundula kunTi _ m. gluteus
(aramudmivi) _ iwyeba gulmcerdis XII medius _ iwyeba TeZos Zvlis gareTa
da welis I malis sxeulebidan; zedapiridan da umagrdeba didi
umagrdeba TeZos fasciis im adgils, cibrutis wina zedapirs.
sadac es ukanaskneli mcire menjSi mcire dundula kunTi _ m. gluteus
gadaixreba. sWimavs menjis fascias. minimus _ iwyeba TeZos frTis gareTa
msxlisebri kunTi _ m. piriformis _ zedapiridan da umagrdeba did
iwyeba gavis Zvlis wina zedapirze. cibruts. exmareba Sua dundula kunTs.
gavis wina xvrelebis gverdiT, stovebs
mcire menjis Rrus didi sajdomi

klinikuri anatomia 168

 qvemo kiduri

zemo da qvemo tyupi kunTebi _ mm. umagrdeba cibrutTaSua qeds. abrunebs

gemelli superior et inferior _pirveli iwyeba barZays gareT.
sajdomi wvetidan, meore _ kukuxodan; gareTa damxurveli kunTi _ m.
orive erTvis SigniTa damxurveli obturatorius externus _ iwyeba damxurveli
kunTis myess da masTan erTad apkis gareTa zedapiridan da
umagrdeba cibrutTa fosos. exmareba umagrdeba cibrutTa fosos. abrunebs
SigniTa damxurvel kunTs. barZays gareT.
barZayis kvadratuli kunTi _ m.
quadratus femoris _ iwyeba kukuxodan da

barZayis kunTebi
barZayis kunTebi faravs am Zvals kunTi barZays xris TeZo-barZayis
yoveli mxridan da iyofa sam jgufad: saxsarSi, kanWs ki _ muxlis saxsarSi.
I jgufis kunTebi barZayis wina barZayis oTxTava kunTi _ m.
zedapirze mdebareobs. isini arian quadriceps femoris _ am kunTis grZeli
kanWis gamSlelni da, amave dros, Tavi, romelsac uwodeben barZayis
barZayis momxrelni. II jgufis kunTebi swor kunTs _ m. rectus femoris, iwyeba
barZayis ukana zedapirzea TeZos wina qvemo wvetidan, qvemo
moTavsebuli; isini arian kanWis boloTi gadadis kviristavze da
momxrelni da barZayis gamSlelni; III umagrdeba didi wvivis borcvs.
jgufis kunTebi barZayis medialur danarCen sam Tavs ewodeba ganieri
zedapirze arian Segrovili da kunTebi, maT Soris: gareTa ganieri
funqciurad barZayis momzidvelni kunTi _ m. vastus lateralis _ iwyeba didi
arian. cibrutidan da barZayis xorkliani
I jgufi: xazis gareTa bagidan; SigniTa ganieri
ganieri fasciis gamWimavi kunTi _ kunTi _ m. vastus medialis _ iwyeba
m. tensor fasciae latae _ iwyeba TeZos Zvlis barZayis xorkliani xazis SigniTa
wina zeda wvetidan, gadadis barZayis bagidan; Suamdebare ganieri kunTi _ m.
ganier fasciaSi, romelic exveva
vastus intermedius _ iwyeba barZayis wina
barZayis yvela kunTs, rogorc parki.
zedapiridan. samive kunTi, Tavisi qveda
am fasciis myesovani nawili,
boloebiT, muxlis sasaxsre parks
romelic kargad aris ganviTarebuli,
umagrdeba da Slis wvivs; grZeli
barZayis lateralur zedapirze aris
TaviT _ m. rectus femoris _ xris barZays.
gaWimuli, umagrdeba barZayis gareTa
II jgufi:
zedaroks da ewodeba TeZo_wvivis
barZayis ukana grZeli kunTebi
traqti _ tractus iliotibialis; sWimavs
iwyeba sajdomi borcvidan; maT Soris:
barZayis yvela kunTis saerTo parks _
barZayis orTava kunTi _ m. biceps
ganier fascias.
femoris. am kunTis grZeli Tavi _ caput
TerZis kunTi _ m. sartorius _ iwyeba
longum midis qveviT, uerTdeba meore
TeZos Zvlis wina wvetidan da
mokle Tavs _ caput breve, romelic
umagrdeba didi wvivis borcvs; es
iwyeba barZayis qveda mesamedSi, misi

klinikuri anatomia 169

 qvemo kiduri

xorkliani xazis gareTa bagidan; medialuri jgufis kunTebs

SeerTebis Semdeg orTava kunTi myesSi (mozidvaSi), ise ukana jgufis kunTebs
gadadis da umagrdeba mcire wvivis (wvivis moxraSi).
Tavs _ caput fibulae. grZeli momzidveli _ m. adductor
naxevradmyesovani kunTi _ m. longus, didi momzidveli _ m. adductor
semitendinosus _ iwyeba sajdomi magnus, mokle momzidveli kunTi _ m.
borcvidan, sadac es kunTi adductor brevis. yvela es CamoTvlili
Sexorcebulia orTava kunTis grZel oTxi kunTi iwyeba boqvenis Zvlis
TavTan; uvlis medialur roks da qvemo totidan, sajdomi Zvlis
umagrdeba didi wvivis borcvs _ totidan, sajdomi borcvidan da
tuberositas tibiae. umagrdeba barZayis xorkliani xazis
TiTistara kunTi_m. semimembranosus medialur bages; amasTan, didi
_ iwyeba sajdomi borcvidan da momzidveli kunTis magari da msxvili
umagrdeba Ddidi wvivis medialur myesi Tavdeba barZatis medialur
roks. zedarokze. funqcia _ barZayis
samive kunTi xris kanWs da Slis mozidva.
barZays. barZayis Sua da qvemo mesamedis
III jgufi: sazRvarze didi momzidveli kunTis
qedis kunTi _ m. pectineus _ iwyeba myesovani nawili Seicavs momzidvel
boqvenis Zvlis qedidan, umagrdeba arxs _ canalis adductorius (hunteris arxi),
barZayis qedis xazs. xris da romelSiac gadis barZayis msxvili
moizidavs barZays. sisxlZarRvebi _ barZayis arteria da
nazi kunTi _ m. gracilis _ iwyeba vena.
boqvenis Zvlis qveda totidan,
umagrdeba didi wvivis borcvs. es
kunTi exmareba rogorc barZayis

kanWis kunTebi

kanWis kunTebi Sedgeba sami pirveli Zvlis fuZes terfis Ziris

jgufisagan: wina, lateraluri da
ukana.
I jgufi:
wina jgufis kunTebi mdebareobs
didi wvivis wina kidis lateralur
mxareze, didi da mcire wvivis Zvlebs
Sua; iwyeba am Zvlebidan da maT Soris
gadaWimuli ZvalTaSua apkidan.
didi wvivis wina kunTi _ m. tibialis
anterior _ umagrdeba terfis medialur
solisebr Zvals da wina ferfis
mxridan. xris terfs dorsalurad da
abrunebs mas gareT (supinatio).
TiTebis grZeli gamSleli kunTi _
m extensor digitorum longus _ umagrdeba
fexis TiTebis Sua da distalur
falangebs, moyolebuli meore
TiTidan meoTxemde. am kunTis gareTa
zedapiridan warimarTeba
gansakuTrebuli kunTi, romlis myesic
umagrdeba wina terfis me-5 Zvlis

klinikuri anatomia 170


xorkls. am kunTs ewodeba mcire
wvivis mesame kunTi _ m. peroneus tertius.
ceris grZeli gamSleli kunTi _ m.
extensor hallucis longus _ umagrdeba ceris
distaluri falangis fuZes.
zemoaRwerili sami kunTis myesi,
romlebic moTavsebulia terfis
dorsalur zedapirze, koW-wvivis
saxsris midamoSi, gadis gamSlelebis
qvemo sabmelis _ Retinaculum mm.
extensorum inferus samTa arxSi: medialur
arxSi gadis didiwvivis wina kunTis
myesi, Sua arxSi _ ceris gamSleli
kunTis myesi, gareTa arxSi _ TiTebis
grZeli gamSleli kunTis myesi.
II jgufi:
lateralur jgufs ekuTvnis ori
kunTi:
mcire wvivis grZeli da mokle
kunTebi _ m. peroneus longus et m. peroneus
brevis. orive kunTi iwyeba mcire wvivis
Zvlidan mis zeda mesamed nawilSi da
misi Tavidan; maTi myesebi qveviT
ukanidan uvlian lateralur gojs da
gadadian terfze; Semdeg, mcire wvivis
mokle kunTi umagrdeba wina terfis
me-5 Zvlis borcvs, mcire wvivis
grZeli kunTi ki, terfisZiris mxareze,
umagrdeba medialur solisebr da wina
terfis pirvel Zvals. es kunTebi
xrian terfs terfis Ziris mxrisaken
da abruneben terfis lateralur
napirs zeviT (pronatio).
III jgufi:
wvivis ukana jgufis kunTebi iyofa
or nawilad: zedapiruli da Rrma.
zedapirul kunTebs ekuTvnis kanWis
samTava kunTi _ m. triceps surae, romelic
ganiyofeba Semdeg kunTebad: kanWis
tyupi kunTi _ m. gastrocnemius _ iwyeba
ori TaviT barZayis rokebis ukana
klinikuri anatomia
qvemo kiduri
zedapiridan. mis qveS mdebareobs
quslis kunTi _ m. soleus, romelic
iwyeba mcire wvivis Tavidan, didi
wvivis muxlqveSa xazidan da kanWis
ZvalTaSua apkidan. yvela es kunTi
kanWis Sua adgilas erTdeba, qmnis
msxvil da magar aqilesis quslis
myess _ tendo calcaneus (Achilli), romliTac
umagrdeba quslis borcvs. kanWis
samTava kunTi xris terfs terfis
Ziris mxrisaken.
terfis Ziris kunTi _ m. plantaris
(aramudmivi)_ iwyeba barZayis
lateraluri rokis ukana zedapiridan,
gadadis wvril da grZel myesSi,
uerTdeba aqilesis myess medialuri
mxridan da masTan erTad umagrdeba
quslis borcvs.
wvivis ukana Jgufis Rrma kunTebs
ekuTvnis:
muxlqveSa kunTi _ m. popliteus _
iwyeba barZayis gareTa rokidan da
umagrdeba didi wvivis muxlqveSa xazs.
atrialebs kanWs SigniT (pronatio).
wvivis ukana jgufis Rrma kunTebs
ekuTvnis:
didi wvivis ukana kunTi _ m. tibialis
posterior,
TiTebis grZeli momxreli kunTi _
m. flexor digitorum longus,
ceris grZeli momxreli kunTi _ m
flexor hallucis longus.
samive kunTi iwyeba kanWis Zvlebis
ukana zedapiridan da ZvalTaSua
apkidan; maTi myesebi uvlian medialur
gojs ukanidan, gadadian terfis Ziris
mxareze, amastan, pirveli _ wvivis
ukana kunTi umagrdeba navisebri Zvlis
xorkls da samive solisebr Zvals;
meore _ TiTebis grZeli momxreli _
itofa oTx myesad da umagrdeba
171
 qvemo kiduri

TiTebis distalur falangebs TviT saxeli gviCvenebs, rac Seexeba

(meoredan mexuTemde); mesame _ ceris didi wvivis ukana kunTs, igi xris
grZeli momxreli _ umagrdeba ceris terfs terfis Zirisaken da atrialebs
distalur falangs. am sam kunTSi mas SigniT (supinatio).
meore da mesame kunTebis funqcias

terfis kunTebi
terfis dorsalur zedapirze devs ceris momzidveli kunTi _ m.
mxolod erTi kunTi arsebobs _ adductor hallucis, romelic Sedgeba ori
TiTebis mokle gamSleli kunTi _ m. nawilisagan: iribi Tavi _ caput obliquum
extensor digitorum brevis. igi iwyeba quslis da ganivi Tavi _ caput transversum. maT
Zvlis zemo xorkliani zedapiridan da Soris pirveli iwyeba kuburi,
umagrdeba oTxi TiTis (ceris garda) lateraluri solisebri da wina
Sua da distalur falangebs. terfis me-2, me-3 da me-4 Zvlebidan,
ceris mokle gamSleli kunTi _ m. meore ki _ me-2 _5 winaterf-falangis
extensor hallucis brevis warmoadgens saxsrebis CanTebis qvemo zedapiridan
zemoxsenebuli kunTis medialur da da umagrdeba ceris proqsimaluri
umsxviles nawils da umagrdeba ceris falangis fuZes.
pirveli falangis fuZes. wina terfis ZvalTaSua sivrceebi
terfis Ziris kanqveS mdebareobs amovsebulia ZvalTaSua kunTebiT _
mkvrivi da magari terfZiris mm. intreossei.
aponevrizi _ aponeurosis plantaris, tefis kunTebis medialur jgufs
romelic kanTan mWidrod aris ekuTvnis:
SeerTebuli. am aponevrozis qveS ceris ganmzidveli kunTi _ m.
mdebareobs kunTebis sami jgufi: Sua, abductor hallucis iwyeba quslis da
medialuri da lateraluri. Sua navisebri Zvlis borcvebidan,
jgufs ekuTvnis: momxreli kunTebis sabmelidan _
TiTebis mokle momxreli _ m. flexor Retinaculum mm. flexorum da terf-Ziris
digitorum brevis; am kunTze ufro Rrmad, aponevrozidan; umagrdeba ceris
Semdeg SreSi, terfis kvadratuli proqsimaluri falangis fuZes.
kunTi mdebareobs _ m. quadratus plantae, ceris mokle momxreki kunTi _ m.
romelic quslis borcvidan iwyeba da flexor hallucis brevis _ iwyeba medialuri
uerTdeba TiTebis grZeli momxreli solisebri Zvlis qvemo zedapiridan;
kunTis myess. am grZeli momxrelis umagrdeba ceris sesamur Zvlebs da
myesebs darTuli aqvs oTxi Wia kunTi proqsimaluri falangis fuZes.
_ m-li lubricales, romlebic umagrdeba me-2 lateralur jgufs ekuTvnis:
-5 TiTis proqsimaluri falangebis nekis ganmzidveli kunTi _ m.
SigniTa kides da xris maT. abductor digiti minimi _ iwyeba quslis
kvadratul kunTze ufro Rrmad, Zvlis qvevTa zedapiridan da
TiTqmis pidapir wina terfis Zvlebze, umagrdeba wina terfis me-5 Zvlis da,

klinikuri anatomia 172

 qvemo kiduri

nawilobriv, nekis proqsimaluri terfis me-5 Zvlis fuZidan da

falangis fuZes. umagrdeba nekis proqsimaluri
nekis mokle momxreli kunTi _ m. falangis fuZes.
flexor digiti minimi brevis _ iwyeba wina

terfis kunTebis myesebis sinovialuri budeebi

terfze Semdegi sinovialuri momxreli da ceris grZeli momxreli
budeebi gvxvdeba: kunTebisaTvis. am budeebis zemo bolo
1. ori bude gamSleli kunTebis medialuri gojis doneze dgas, qvemo
qvemo sabmelis arxSi: bolo ki _ terfis Ziris mxareze,
a) wvivis wina kunTis navisebri Zvlis borcvis doneze.
myesisaTvis; es bude yvelaze grZelia 3. erTi saerTo bude _ mcire
da misi zemo bolo gamSleli wvivis kunTebis myesebisaTvis. amastan,
kunTebis zemosabmelis doneze dgas; b) aRniSnuli budis zemo bolo
ceris grZeli gamSleli kunTis lateraluri gojis zemoT 4 sm-iT
myesisaTvis. am budis qveviTa bolo aris amoweuli, qvemo bolo ki or
gamSlelebis qvemo sabmelis kididan nawilad ganiyofeba da mxolod mcire
gamoiyureba. wvivis grZel kunTs misdevs terfis
2. sami gancalkevebuli Zirze ( es bude sigrZeze iyofa or
sinovialuri bude, romlebic nawilad).
mdebareoben momxreli kunTebis 4. TiTebis momxreli kunTebis
sabmelis sisqeSi, saTanado sam arxSi, myesebi TiTebis midamoSi Sexveulia
Semdegi kunTebis myesebisaTvis: wvivis gancalkevebul sinovialur budeebSi
ukana kunTis, TiTebis grZeli iseve, rogorc es iyo xelis TiTebSi.

qvemo kiduris topografiuli anatomia

qveda kiduri zevidan mosazRvrulia dundulosa da barZayze ufro kargad

sazardulis naoWiT da TeZos qediT, aqvT gamoxatuli, vidre mamakacebs. qve-
uknidan—gavis ZvliTa da kudusuniT, mo kiduris Zval-saxsrovani da kunTo-
Signidan—Soris-barZayis naoWiT. vani sistemebi kargad aris ganviTare-
aRsaniSnavia qvemo kiduris asakobrivi buli, rac misi meqanikuri datvirTviT
da sqesobrivi Tavisebureba. aris ganpirobebuli.
axalSobilis qvemo kiduris Sefa- qvemo kidurze gamoiyofa Semdegi
rdebiTi sigrZe mcirea, SemdgomSi igi midamoebi: dundulis midamo, barZayis
zrdis damTavrebamde TandaTan wina da ukana, muxlis wina da ukana,
matulobs. sqesobrivi gansxvaveba wvivis wina da ukana, wviv-koWis
umTavresad damokidebulia cximovani saxsrisa da terfis.
qsovilis ganviTarebaze. igi qalebs

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 qvemo kiduri

dundulis midamo _ regio glutea gulmkerd-welis fasciaSi (f.

thoracolumbalis), didi dundula kunTs
sazRvrebi: zevidan TeZos qedi (crista uqmnis budes, romlis zedapiruli
furceli kunTSi agzavnis
iliaca), qvevidan—dundulovani Rari
mravalricxovan morCebs. amiT aixsneba,
(sulcus gluteus), medialurad—gavis Zvali
rom am kunTis anTeba, romelic
(os sacrum) da kudusuni (os coccigis),
zogjer dundulis midamoSi ineqciis
lateralurad—TeZos wina zeda
Semdeg viTardeba, SemosazRvruli
wvetidan daSvebuli vertikaluri xazi.
infiltratis xasiaTisaa, iwvevs
midamos Zval-iogovan safuZvels
qsovilebis mniSvnelovan daWimulobas
Seadgens: TeZos da sajdomi Zvlebi (os
da Zlier tkivils. didi dundula
ilium et os ishii), gava-wvetiani da gava- kunTis fasciuri budis Rrma
kukuxos iogebi (lig. sacrospinale et lig. sacro- furceli, zedapirul furcelTan Se-
tuberale), barZayis Zvlis yeli (collum darebiT, nakleb mkvrivia. kunTisgan
femoris), didi cibruti (trochanter major) igi ganSorebulia cximovani
da menj-barZayis saxsari. gava-wvetiani SemaerTebeli qsovilis feniT.
da gava-kukuxos iogebi did da mcire kunTebi ganlagebulia sam Sred.
sajdom naWdevebTan erTad pirvel Sres qmnis didi dundula
mosazRvravs did da mcire sajdom kunTi (m. gluteus maximus), romelic
xvrelebs. TeZos Zvlis gareTa zedapiris ukana
garegani orientirebia TeZos qedi, nawilidan, gavisa da kudusunis
TeZos wina zeda wveti, didi cibruti, gverdiTi kideebidan da gava-kukuxos
sajdomi borcvi da TeZos ukana zeda iogidan iwyeba, qveviT, gareT da win
wveti. miemarTeba, did cibruts gadauvlis
Sreebi. kani sqelia, Seicavs didi da brtyeli myesiT barZayis Zvlis
raodenobiT cximsa da oflis dundulovan xorkls (tuberositas glutea)
jirkvlebs. kanqveSa cximovani qsovili umagrdeba. misi myesi nawilobriv
kargad aris ganviTarebuli. zeda ganier fasciaSi grZeldeba da
ukana nawilSi igi gayofilia monawileobs TeZo-wvivis traqtis
zedapirul da Rrma Sreebad. Rrma Sre SeqmnaSi. did cibrutsa da didi dun-
grZeldeba welis midamoSi. dula kunTis myess Soris mdebareobs
kanqveSa qsovilSi totiandeba dun- bursa trochanterica m. glutei maximi. xolo
dulos zeda, Sua da qveda nervebi (nn. myessa da kanqveSa qsovils Soris—
glutei superior, medius et inferior) da zeda bursa trochanterica subcutanea.
dundulovani arteriis totebi. meore Sris kunTebi zevidan qveviT
sakuTari fascia zeviT dakavSire- ganlagebulia Semdegi TanmimdevrobiT:
bulia TeZos qedTan, qveviT da win Sua dundula kunTi (m. gluteus medius),
grZeldeba barZayis ganier fasciaSi.
msxlisebri kunTi (m. piriformis), SigniTa
midamos zeda gareTa nawilSi igi
damxuravi kunTi (m. obturatorius internus),
faravs Sua dundula kunTs (m. gluteus
zeda da qveda tyupi kunTebi (mm. gemeli
medius) zeviT da SigniT grZeldeba

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 qvemo kiduri

superior et inferior) da barZayis gareTa damxuravi kunTi (m. obturatorius

kvadratuli kunTi (m. quadratus femoris). externus) iwyeba damxuravi apkisa da
Sua dundula kunTi maraosebri daxuruli xvrelis kideebis wina
formisaa: iwyeba TeZos Zvlis gareTa zedapiridan, menj-barZayis saxsars
zedapiridan, umagrdeba didi cibrutis qvevidan gauvlis da cibrutis fosos
mwvervals. misi ukana nawili ar aris umagrdeba. dundulis midamoSi mas
dafaruli didi dundula kunTiT. barZayis kvadratuli kunTi faravs.
msxlisebri kunTi gavis Zvlis wina sisxlZarRvebi da nervebi dundu-
zedapirze iwyeba, did sajdom lis midamoSi gamodis zeda da qveda
xvrelSi gaivlis da didi cibrutis msxlisebri xvrelebiT. zeda
mwvervals umagrdeba. did sajdom msxlisebri xvreliT menjidan gamodis
xvrelSi sajdomi Zvlis qveda kidesa zeda dundulovani arteria (a. glutea
da msxlisebri kunTis zeda kides superior) da zeda dundulovani nervi (n.
Soris mdebareobs zeda msxlisebri gluteus superior), xolo menjis RruSi
xvreli (foramen suprapiriforme), xolo Sedis zeda dundulovani venebi (vv.
msxlisebri kunTis qveda kidesa da gluteae superiores) da limfuri ZarRvebi.
gava-wvetian iogs Soris—qveda qveda msxlisebri xvreliT menjidan
msxlisebri xvreli (foramen infrapirifor- gamodis qveda dundulovani arteria
me). SigniTa damxuravi kunTi iwyeba (a. glutea inferior), qveda dundulovani
damxuravi apkis (memebrana obturatoria) nervi (n. gluteus inferior), SigniTa sasir-
SigniTa zedapiridan da daxuruli cxo arteria, sasircxo nervi, barZayis
xvrelis (foramen obturatum) kideebidan, kanis ukana nervi (n. cutaneus femoris
menjis Rrus tovebs mcire sajdomi posterior) da sajdomi nervi (n. ishiadicus),
xvreliT da umagrdeba cibrutis xolo menjis RruSi Sedis arteriebis
fosos (fossa trochanterica). am kunTis Tanamgzavri venebi da limfuri
myesis zeda da qveda kideebis gaswvriv ZarRvebi.
mdebareobs zeda da qveda tyupi zeda dundulovani arteria menji-
kunTebi. zeda tyupi kunTi iwyeba dan gamosvlisTanave iyofa totebad
sajdomi wvetidan, qveda tyupi kunTi— ise, rom misi Reros is monakveTi,
kukuxodan. es kunTebic cibrutis fo- romelic zeda msxlisebri xvrelis
sos umagrdeba. qveda tyupi kunTis qve- gareT mdebareobs Zlier moklea
moT barZayis kvadratuli kunTia, (0,5_1sm). kvebavs dundulis midamos
romelic kukuxosa da cibrutTaSua kunTebs da anastomozebs amyarebs
qeds (crista intertrochanterica) Soris aris qveda dundulovan, TeZos Rrma
gadaWimuli. mesame Sres qmnis mcire Semomxvev da baZayis gareTa Semomxvev
dundula da gareTa damxuravi arteriebTan. zeda dundulovani
kunTebi. mcire dundula kunTi (m. arteriis menjis Rrudan gamosvlis
gluteus minimus) iwyeba TeZos Zvlis gare- adgili kanze proecirdeba TeZos ukana
Ta zedapiridan, umagrdeba didi zeda wvetsa da didi cibrutis
cibrutis wina kides. igi mTlianad mwvervals Soris gavlebuli xazis ze-
dafarulia Sua dundula kunTiT. da da Sua mesamedebis sazRvarze. zeda

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 qvemo kiduri

dundulovani venebi qmnis wnuls, (alkokis arxiT) Sorisisken

rimelic Tanamgzavr arterias faravs. miemarTebian. sasircxo nervi,
zeda dundulovani nervi zeda Cveulebriv, sasircxo sisxlZarRvebis
msxlisebr xvrelSi Tanamgzavri medialurad mdebareobs.
sisxlZarRvebis qveviT da ukan sajdomi nervi qveda msxlisebr
mdebareobs. igi anervebs Sua dundula xvrelSi danarCeni warmonaqmnebis
kunTs, mcire dundula kunTsa da lateralurad mdebareobs, qvemoT
ganieri fasciis gamWimav kunTs (m. barZayis kvadratul kunTs gadauvlis
tensor fasciae latae) da barZayis ukana midamoSi gadadis.
qveda dundulovani arteria zeda dundulis midamoSi sajdomi nervi
dundulovan arteriasTan SedarebiT proecirdeba vertikalur xazze, rome-
mcire kalibrisaa. menjidan misi lic sajdomi borcvis SigniTa kidesa
gamosvlis adgili kanze proeqcirdeba da didi cibrutis mwvervals Soris
TeZos ukana zeda wvetsa da sajdomi gatarebuli xazis Sua wertilSi
borcvis SigniTa kides Soris gav- gaivlis.
lebuli xazis Sua wertilis odnav did dundula kunTsa da dundulis
qvemoT da gareT. arteria sisxliT ama- midamos Sua kunTovan fenas Soris
ragebs did dundula kunTs, sajdom arsebuli SemaerTebeli qsovili
nervs da dundulis midamos kans; anas- sisxlZarRvebisa da nervebis
tomozebiT ukavSirdeba zeda gayolebiT mezobeli midamoebis
dundulovan arterias, barZayis SemaerTebel qsovils ukavSirdeba.
medialur Semomxvev arterias (a. sajdomi nervis gayolebiT igi dakav-
circumflexa femoris medialis) da damxurav Sirebulia barZayis ukana midamosTan,
arterias. Tanamgzavr venebsa da qveda mcire sajdomi xvreliT—kukuxo-
dundulovan nervTan erTad igi qmnis swori nawlavis fososTan, qveda
konas, romlis lateralurad msxlisebri xvreliT—menjis Rrus
mdebareobs sajdomi nervi, xolo gverdiT nawilSi mdebare SemaerTebel
medialurad—SigniTa sasircxo qsovilTan; zeda msxlisebri xvreliT
sisxlZarRvebi da sasircxo nervi. qve- aseTi kavSiri, Cveulebriv, ar
da dundulovani nervi did dundula arsebobs, vinaidan es xvreli. xSirad
kunTs anervebs. daxSulia mkvrivi SemaerTebelqsovi-
SigniTa sasircxo sisxlZarRvebi da lovani firfitiT, romelic zeda
sasixrcxo nervi qveda msxlisebr dundulovani sisxlZarRvovan-nervuli
xvrelSi danarCeni warmonaqmnebis konis budesTan aris dakavSirebuli.
medialurad mdebareobs. menjidan qveda msxlisebr da mcire sajdom
gamosvlis Semdeg isini gava-wvetian xvrelebSi SeiZleba Tiaqari
iogsa da sajdomi Zvlis wvetian morCs ganviTardes.
gadauvlian, Sorisis midamoSi
(sajdom-swornawlavis fosoSi) gada- barZayi
dian da SigniTa damxuravi kunTis mfa- kargad ganviTarebuli, masiuri kun-
rav fasciis or furcels Soris Tebi yoveli mxridan faravs barZayis

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 qvemo kiduri

Zvals, ris gamoc misi diafizi xeliT TeZosa da ganieri fasciis gamWimavi
Zneli gasasinjia. Zvlovani kunTebi ganieri fasciisgan Seqmnil
warmonaqmnebidan SedarebiT kargad budeebSi mdebareobs. barZayis wina
isinjeba didi cibruti, TeZos wina fasciuri bude kunTebTan erTad Sei-
zeda wveti da boqvenis simfizi. cavs barZayis sisxlZarRvebsa da
mniSvnelovani orientirebia sazardu- nervs, ukana bude-sajdom nervs,
lis naoWi, romelic sazardulis medialuri bude—damxurav sisxl-
(pupartis) iogis mdebareobas ZarRvovan-nervul konas. barZayi wina
Seesabameba, da barZayis wina Rari, da ukana midamoebad iyofa.
romelic barZayis wina zedapirze
gamSlel da momzidvel kunTebs Soris barZayis wina midamo
mdebareobs. sazRvrebi: zevidan—sazardulis
barZayis kunTebi sam jgufad iyofa. naoWi, qvevidan—kviristavidan 6sm
win gamSlelebia, ukan—momxrelebi, zemoT gavlebuli ganivi xazi,
medialurad—momzidvelebi. garedan—TeZos wina zeda wvetisa da
gamSlelebs ekuTvnis TerZis kunTi (m. barZayis lateraluri zedarokis
sartorius) da barZayis oTxTava kunTi (m. (epicondilus lateralis) SemaerTebeli xazi,
quadriceps femoris), momxrelebs— Signidan—boqvenis simfizisa da barZa-
TiTistara kunTi (m. semimembranasus) yis medialuri zedarokis (epicondilus
naxevrad myesovani kunTi (m. semi- medialis) SemaerTebeli xazi.
tendineus) da barZayis orTava kunTi (m. kani zeda nawilSi da SigniTa mxa-
biceps femoris), momzidvelebs—qedis kun- reze ufro Txeli da moZravia, vidre
Ti (m. pectineus), nazi kunTi (m. gracilis) qveda nawilSi da gareTa mxareze.
da barZayis grZeli, mokle da didi kanqveSa qsovili zedapiruli fasciiT
momzidveli kunTebi (mm. adductores or Sred aris gayofili. zedapiruli
femoris longus, brevis et magnus). garda fascia uqmnis budeebs zedapirul
amisa, barZayis lateralur mxareze, sisxlZarRvebs, nervebs, limfur
zeda nawilSi ganieri fasciis ZarRvebsa da limfur kvanZebs.
gamWimavi kunTia (m. tensor fasciae latae). zedapiruli arteriebi barZayis ar-
barZayis kunTebs gars ekvris sqeli terias gamoeyofa da saCino venis
da mkvrivi, aponevrozuli xasiaTis Sesavlis (hiatus saphenus), anu ovaluri
ganieri fascia (fascia lata). barZayis fosos (fossa ovalis) farglebSi anda mis
xsenebul kunTovan jgufebs Soris maxloblad kanqveS gamodis.
ganieri fa isgan siRrmeSi eSveba zedapiruli epigastruli arteria
Zgideebi, romlebic barZayis xorklian miemarTeba zeviT—Wipisken, TeZos
xazs ukavSirdebian da ganier zedapiruli Semomxvevi arteria—
fasciasTan erTad wina, ukana da me- gareT, sazardulis iogis paralelu-
dialur fasciur budeebs qmnian. garda rad TeZos wina zeda wvetisken. gareTa
amisa, TiToeuli kunTi gamoyofilia sasircxo arteria—SigniT, saTesle
mezobeli kunTebisgan faSari parkisken (qalebSi didi sasircxo
SemaerTebeli qsovilis feniT, xolo bagisken). arteriebis Tanamgzavri

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 qvemo kiduri

venebi did saCino da barZayis venebs sazardulis zedapiruli limfuri

erTvis. didi saCino vena (v. saphena kvanZebis erTi jgufi ganlagebulia
magna) barZayis wina midamos medialur uSualod sazardulis iogis
nawilSi mdebareobs, saCino venis medialuri nawilis gaswvriv. isini
SesavliT siRrmeSi eSveba da limfas agroveben muclis wina kedlis
sazardulis iogidan 3sm qvemoT qveda nawilis kanidan, dundulis
barZayis venas erTvis. kanze igi midamodan, Sorisidan, yiTadan da
proecirdeba barZayis medialuri gareTa sasqeso organoebidan. zedapi-
rokis ukana kididan sazardulis ruli limfuri kvanZebis meore jgufi
iogis Sua da medialuri mesamedebis mdebareobs saCino venis Sesavlis
sazRvramde gavlebul xazze. farglebSi saCino venis saboloo
kans anervebs welis wnulis Semdegi nawilis gverdebze. isini limfas
totebi: barZayis kanis lateraluri Rebuloben qvemo kiduris zedapiruli
nervi, romelic kanqveS gamodis TeZos nawilidan.
wina zeda wvetidan 1_2sm SigniT da sazardulis Rrma limfuri kvanZebi
qvemoT, amaragebs barZayis moTavsebulia TeZo-qedis SemaerTebel
lateraluri zedapiris kans; barZayis qsovilSi, barZayis sisxlZarRvebis
nervis kanis wina totebi (rami cutanei gaswvriv. erTi maTgani (rozenmiuler-
anteriores) kanqveS gamodis TeZos wina pirogovis limfuri kvanZi) mdebareobs
zeda wvetisa da wvivis medialuri barZayis rgolSi—barZayis venis
rokis SemaerTebel xazze, anervebs medialurad. sazardulis Rrma
barZayis wina da medialuri zeda- limfuri kvanZebi limfas Rebulobs
pirebis kans; sasqeso-barZayis nervis sazardulis zedapiruli kvanZebidan
barZayis toti (r. femoralis n. da barZayis Rrma Sreebidan. maTi
gamomtani ZarRvebi ixsneba TeZos
genitofemoralis) barZayze gamodis sisxl-
limfur kvanZebSi, romlebic menjSi
ZarRvTa SualediT, saCino venis Sesa-
TeZos gareTa sisxlZarRvebis gaswvriv
vals gaivlis da sazardulis iogis
mdebareoben.
qvemoT totiandeba. am nervis sasqeso
barZayis wina zedapiris kanqveSa
toti (r. genitalis n. genitofemoralis) anervebs
qsovilisa da zedapiruli fasciis
kans barZayis medialuri zedapiris
momdevno Sris—barZayis ganieri
zeda nawilSi. amave zedapiris qveda
fasciis aRweras mizanSewonilia
nawilSi (muxlis maxloblad) kans
warvumZRvaroT ufro Rrmad mdebare
anervebs damxuravi nervis toti.
warmonaqmnebis topografiis zogadi
limfuri kvanZebi ganlagebulia sa-
mimoxilva.
zardulis iogis qveS zedapirulad—
barZayis wina midamoSi subfasciuri
kanqveSa qsovilSi (nodi lymphatici
warmonaqmnebidan yvelaze zedapiru-
inguinales superficiales) da Rrmad—ganieri
lad mdebareobs TerZis kunTi. igi Te-
fasciis zedapiruli furclis qveS
Zos wina zeda wvetidan iwyeba, barZays
(nodi lymphatici inguinales profundae). maTi winidan iribad gadauvlis, barZayis
raodenoba da sidide individualurad Zvlis medialur roks uknidan
cvalebadia. Semouvlis da gabrtyelebuli myesiT

klinikuri anatomia 178

 qvemo kiduri

didi wvivis xorkls (tuberositas tibiae) medialuri da Sua mesamedebis

umagrdeba. mis qveS mdebareobs sazRvaridan barZayis medialuri
barZayis oTxTava kunTi (m. quadriceps rokisken miemarTeba.
femoris), romelic barZayis swori, barZayis (skarpas) samkuTxedi. barZa-
medialuri, lateraluri da Sua- yis samkuTxedi barZayis wina midamos
mdebare ganieri kunTebisgan Sedgeba. zeda mesamedSi mdebareobs. igi zevidan
barZayis swori kunTi (m. rectus femo- mosazRvrulia sazardulis iogiT,
ris) iwyeba TeZos wina qveda wvetidan garedan—TerZis kunTiT, Signidan—
da cibrutis fosos bagis zeda grZeli momzidveli kunTiT. mis
kididan, qveviT misi myesi kviristavis fskers qmnis TeZo-sukisa da qedis
fuZesa da wina zedapirs ukavSirdeba kunTebi.
da didi wvivis xorkls umagrdeba. TeZos wina zeda wvetsa da boqvenis
myesis im nawils, romelic kviristavsa borcvs Soris gadaWimuli sazar-
da didi wvivis xorkls Soris aris dulis iogi menjis ZvalTan qmnis
Sualeds, romelsac sazardulis iogsa
gadaWimuli, kviristavis iogi (lig.
da TeZo-boqvenis maRlobs (eminentia
patellae) ewodeba.
iliopectinea) Soris gadaWimuli TeZo-
medialuri ganieri kunTi (m. vastus
qedis rkali (arcus iliopectineus) yofs or
medialis) iwyeba barZayis xorkliani
nawilad. lateralur nawils ewodeba
xazis medialuri bagidan (labium mediale
kunTovani Sualedi (lacuna musculorum),
liniae asperae) lateraluri ganieri
medialur nawils—sisxlZarRvovani
kunTi (m. vastus lateralis)—didi
Sualedi (lacuna vasorum).
cibrutidan, cibrutTaSua xazidan da
kunTovani Sualedi ufro farToa.
xorkliani xazis lateraluri bagidan
igi winidan mosazRvrulia
(labium laterale liniae asperae), Suamdebare
sazardulis iogiT, uknidan da
ganieri kunTi (m. vastus intermedius)—
garedan—TeZos ZvliT, Signidan—
barZayis Zvlis wina zedapiridan.
TeZo-qedis rkaliT. masSi TeZo-sukis
oTxive am kunTis erTiani myesi
kunTi da barZayis nervi gaivlis.
umagrdeba kviristavs.
sisxlZarRvovani Sualedi winidan
barZayis wina kunTebs zeda nawilSi
mosazRvrulia sazardulis iogiT,
lateralurad ekvris ganieri fasciis
uknidan—qedis iogiT (lig. pectineale),
gamWimavi kunTi, romelic iwyeba TeZos
garedan—TeZo-qedis rkaliT,
wina zeda wvetidan da grZeldeba
Signidan—Sualedis iogiT (lig. lacunare).
TeZo-wvivis traqtSi. es ukanaskneli
sisxlZarRvovan SualedSi gaivlis
barZayis ganieri fasciis myesovani
barZayis sisxlZarRvebi, romelTagan
nawilia, umagrdeba didi wvivis
arteria mdebareobs lateralurad da
lateralur roks.
vena—medialurad. arteriasTan erTad
barZayis wina kunTebs Signidan
sisxlZarRvovan SualedSi gaivlis
esazRvreba barZayis momzidveli
sasircxo-barZayis nervis barZayis
kunTebi. am kunTovan jgufebs Soris
toti. venis medialu rad mdebareobs
aRiniSneba CaRrmaveba (barZayis wina
Rari), romelic sazardulis iogis

klinikuri anatomia 179

 qvemo kiduri

rozenmiuler-pirogovis limfuri kunTebs gadauvlis da barZayis ukana

kvanZi. midamoSi gadadis.
TeZo-sukis kunTi barZayze qveviT da barZayis samkuTxedSi, barZayis
SigniT miemarTeba da barZayis Zvlis arteriis lateralurad, ganieri
mcire cibruts (trochanter minor) fascia iyofa zedapirul da Rrma
umagrdeba. Signidan mas esazRvreba furclebad. Rrma furceli TeZo-
qedis kunTi, romelic boqvenis Zvlis sukisa da qedis kunTebis mfarav
qedidan iwyeba, qveviT da gareT fasciebs ukavSirdeba da barZayis ar-
miemarTeba da mcire cibrutis qvemoT teriisa da venis ukan SigniTken mie-
qedis xazs (linea pectinea) umagrdeba. Te- marTeba. zeviT igi umagrdeba TeZo-
Zo-sukisa da qedis kunTebis erTma- qedis rkals da qedis (kuperis) iogs.
neTisken miqceuli kideebi ramdenadme ganieri fasciis zedapiruli furceli
siRrmeSia Caweuli, ris gamoc am barZayis arteriasa da venas winidan
kunTebis farglebSi sazardulis gadauvlis da venis medialurad Rrma
iogis qvemoT Seqmnilia samkuTxa furcels uerTdeba. zeda kidiT igi
CaRrmaveba, romelsac TeZo-qedis foso sazardulis iogs ukavSirdeba. venis
(fossa iliopectinea), anu TeZo-qedis medialurad ganieri fasciis erTiani
samkuTxedi (trigonum iliopectineum) ewo- furceli momzidvel kunTebs gadauv-
deba. igi garedan mosazRvrulia TeZo- lis da barZayis ukana midamoSi
sukis kunTiT, Signidan—qedis kunTiT, gadadis.
zevidan—sazardulis iogiT. TeZo- amgvarad, barZayis arteria da vena
qedis fosoSi lateralurad mdeba- barZayis samkuTxedis farglebSi
reobs barZayis nervi, medialurad— ganieri fasciis zedapirul da Rrma
barZayis arteria, xolo am furclebs Soris arsebul
ukanasknelis medialurad—barZayis SemaerTebelqsovilovan sivrceSi
vena. mdebareobs. zedapiruli furceli
barZayis sakuTari, anu ganieri gareTa nawilSi—barZayis arteriis
fascia (f. lata). barZayis gareTa win—gansakuTrebiT sqeli da mkvrivia,
zedapirze ganieri fasciis gamWimavi xolo medialur nawilSi—barZyis
kunTis myesovani konebi, nawilobriv venis win—Txeli da faSari. maT
agreTve didi dundula kunTis Soris sazRvars qmnis fasciis
myesovani konebic gadadis ganier zedapiruli furclis gasqelebuli,
fasciaSi. aq igi gasqelebulia da gareTken gamodrekili namglisebri
qmnis TeZo-wvivis traqts, romelic Te- kide (margo falciformis), romlis zeda rqa
Zos wina zeda wvetidan didi wvivis (cornu superius) barZayis venas gadauvlis
lateralur rokamde vrceldeba. da sazardulis iogs an qedis fascias
barZayis wina zedapirze ganieri ukavSirdeba. qveda rqac (cornu inferius)
fascia uqmnis budes TerZis kunTs. am barZayis venas gadauvlis da ganieri
kunTis medialurad, barZayis qveda or fasciis Rrma furcels uerTdeba.
mesamedSi ganieri fascia momzidvel namglisebri kidis medialurad,
ganieri fasciis zedapirul furcelSi
gaivlis didi saCino vena, sxva kanqveSa

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 qvemo kiduri

sisxlZarRvebi, nervebi da limfuri wina kedels qmnis ganieri fasciis

ZarRvebi, romelTaTvis fasciaSi aq zedapiruli furceli (namglisebri
didi raodenobiT arsebobs xvrelebi kidis zeda rqa), ukana kedels—ganieri
da amitom mas dacxrilul fascias (f. fasciis Rrma furceli, gareTa
cribrosa) uwodeben. dacxriluli kedels—barZayis vena. barZayis arxis
fasciis aclis Semdeg mis adgilas sigrZe misi wina kedlis gayolebiT
rCeba CaRrmaveba, romelsac saCino ve- 1_2sm-s udris.
nis Sesavali (hiatus saphenus), anu ova- barZayis arxis gareTa rgoli
luri foso (fossa ovalis) ewodeba. normalurad ar arsebobs. igi
barZayis arxi (canalis femoralis). yalibdeba barZayis Tiaqris
sisxlZarRvovan SualedSi barZayis ganviTarebis procesSi—barZayis arxSi
venis medialurad mdebareobs barZayis Camosuli Tiaqris parki awveba namgli-
sebri kidis medialurad mdebare dac-
Rrma rgoli (annulus femoralis profundus).
xrilul fascias, TiSavs mas da
igi winidan mosazRvrulia
gamodis kanqveS, ris Sedegadac ova-
sazardulis iogiT, uknidan—qedis
luri fosos farglebSi iqmneba
(kuperis) iogiT, Signidan—Sualedis
barZayis arxis zedapiruli rgoli
(jimbernas) iogiT, garedan—barZayis
veniT. barZayis rgoli amovsebulia fa- (annulus femoralis superficialis). kanqveS
Sari SemaerTebeli qsoviliT, gamosuli Tiaqris parki dafarulia
romelSic rozenmiuler-pirogovis mxolod kaniT, kanqveSa qsoviliT,
limfuri kvanZia. muclis Rrus zedapiruli fasciiTa da eqstraperi-
mxridan barZayis Rrma rgoli toneuli cximovani SriT, ganivi
dafarulia muclis ganivi fasciiT, fasciisgan Seqmnili barZayis Zgide da
dacxriluli fascia ganleulia.
romelsac barZayis Zgide (septum
ganieri fasciis zedapirul da Rrma
femorale) ewodeba, eqstraperitoneuli
furclebs Soris arsebuli SemaerTe-
cximovani SriT da kedlis amyoli
beli qsovili sisxlZarRvovani
peritoneumiT. peritoneumi aq qmnis
SualediT ukavSirdeba menjis
barZayis fosos (fossa femoralis), rome-
subperitoneul sivrces, dacxriluli
lic sazardulis medialuri fosos
fasciis xvrelebiT—barZayis
qvemoT mdebareobs.
samkuTxedis kanqveSa SemaerTebel
qalis barZayis Rrma rgoli ufro
qsovils, barZayis Semomxvevi
ganieria (1,8sm) vidre mamakacis (1,2sm),
medialuri da lateraluri
rac imiT aixsneba, rom qalis menji,
arteriebis gayolebiT—menj-barZayis
mamakacis menjTan SedarebiT,
saxsris garSemo mdebare SemaerTebel
Cveulebriv, ufro ganieria. amitom
qsovils da momzidveli kunTebis
qalebSi barZayis Tiaqari gacilebiT
fasciur budes, gamxvreti arteriebis
ufro xSiria, vidre mamakacebSi.
gayolebiT—barZayis ukana midamos da
barZayis rgoli qveviT gadadis bar-
barZayis sisxlZarRvebis gaswvriv—
Zayis arxSi, romelic TeZo-qedis
momzidvel arxs.
fosoSi ganieri fasciis zedapirul da
barZayis sisxlZarRvebi midamos ze-
Rrma furclebs Soris mdebareobs. mis
da mesamedSi mdebareobs barZayis

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 qvemo kiduri

samkuTxedSi, Sua mesamedSi—barZayis cvalebadia. isini SeiZleba

wina RarSi, qveda mesamedSi— gamodiodnen sxvadasxva doneze
momzidvel arxSi. rogorc barZayis Rrma arteriidan, ise
barZayis arteria kanze proecirdeba TviT barZayis arteriidan.
sazardulis iogis Sua wertilidan barZayis medialuri Semomxvevi
barZayis Zvlis medialur zedarokamde arteria, Cveulebriv, gamodis barZayis
gavlebul xazze. Rrma arteriis dasawyisidan 1_1,5sm
dasawyisSi igi TeZo-boqvenis SemaR- daSorebiT; TeZo-sukis kunTis
lebis win mdebareobs. aq, sazardulis medialur kidesTan iyofa ganiv da
iogis qveda kidesTan, mis Sua Rrma totebad (ramus transversus et ramus
wertilis odnav medialurad TiTis profundus), romlebic sisxliT amara-
daWeriT SeiZleba barZayis arteria geben momzidvel kunTebs. Rrma toti
davaxSoT. Sedis napralSi qedisa da gareTa
barZayis samkuTxedis zeda nawil- damxurav kunTebs Soris da iyofa
Si—TeZo-qedis fosos farglebSi— aswvriv da daswvriv totebad,
barZayis arteria da vena ganieri romlebic barZayis ukana da dundulis
fasciis zedapirul da Rrma furcels midamoebSi gadadian. aswvrivi toti
Soris mdebareobs. barZayis vena ukavSirdeba dundulovan arteriebs,
medialuradaa, barZayis arteria— daswvrivi toti—damxurav da
lateralurad. qveviT vena TandaTan gamgmirav arteriebs.
ukan da gareT iwevs da sabolood ar- barZayis lateraluri Semomxvevi
teriis ukan Tavsdeba. arteria gamodis barZayis Rrma
barZayis arterias uSualod sazar- arteriis dasawyisidan 1,5_2sm
dulis iogis qveS gamoeyofa zeda- daSorebiT, TerZisa da barZayis swori
piruli epigastruli arteria, TeZos kunTis ukan gaivlis da didi
zedapiruli Semomxvevi arteria da cibrutisken miemarTeba. iyofa aswvriv
gareTa sasircxo arteriebi. isini da daswvriv totebad. aswvrivi toti
dacxriluli fasciis xvrelebiT ganieri fasciis gamWimavi kunTis qveS
kanqveSa qsovilSi gadadian. saza- ukavSirdeba zeda dundulovan
rdulis iogidan 4_6sm-iT qvemoT bar- arterias. daswvrivi toti swori
Zayis arteriis ukana-lateraluri, uka- kunTis qveS, lateralur da Sua
na an ukana-medialuri kedlidan ganier kunTebs Soris qveviT eSveba—
gamodis misi udidesi toti—barZayis kvebavs oTxTava kunTsa da kans, qveviT
Rrma arteria (a. profunda femoris), muxlqveSa arteriis totebs ukavSir-
romlis diametri zogjer TviT deba.
barZayis arteriis diametrs utoldeba. barZayis Rrma arterias qveviT gamo-
mas, Cveulebriv, dasawyisSive gamoe- eyofa sami gamgmiravi arteria. I
yofa barZayis medialuri da latera- gamgmiravi arteria gamodis qedis
luri Semomxvevi arteriebi (aa. circum- kunTis qveda kidis doneze, II
flexae femoris medialis et lateralis). gamgmiravi arteria—grZeli
barZayis Semomxvevi arteriebis momzidveli kunTis proqsimalur
gamosvlis adgili individualurad kidesTan, xolo III gamgmiravi arteria

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 qvemo kiduri

barZayis Rrma arteriis uSualo momzidveli arxi. barZayis sisxl-

gagrZelebaa. es arteriebi momzidveli ZarRvovan-nervuli kona barZayis qveda
kunTebis myesebSi arsebuli xvrelebiT mesamedSi gadadis momzidvel, anu
barZayis ukana midamoSi gadadis. barZay- muxlqveSa arxSi (canalis
garda amisa, barZayis arteriidan adductorius s. femoropopliteus). igi barZayis
sxvadasxva doneze gamodis 7_8 kunTo- wina Raris gagrZelebaa. mis
vani toti. qveda mesamedSi (momzidvel lateralur kedels qmnis barZayis
arxSi) barZayis arterias gamoeyofa medialuri ganieri kunTi, ukana _
muxlis daswvrivi arteria (a. genus medialur kedels — didi momzidveli
descendens), romelic kunTebsa da kunTi; wina kedels — ganier-
muxlis sasaxsre CanTas kvebavs. momzidveli firfita (membrana
barZayis Rrma arteriis gamosvlis qve- vastoadductoria). mis win, ganieri fasciis
moT barZayis arteriis gadakvanZvis or furcels Soris, TerZis kunTi
SemTxvevaSi kolateraluri sisxlis mdebareobs.
mimoqceva umTavresad xorcieldeba momzidvel arxSi gaivlis barZayis ar-
barZayis Rrma arteriiT, gamgmiravi teria, barZayis vena da saCino nervi.
arteriebiT da muxlqveSa arteriis vena mdebareobs arteriis ukan, saCino
totebiT. nervi—arteriis win da lateralurad.
barZayis arteriis totebis Tana- barZayis arterias aq gamoeyofa muxlis
mgzavri venebi barZayis venas erTvis. daswvrivi arteria (a. genus
garda amisa, barZayis venas descendens). arxs sami xvreli aqvs—
sazardulis iogTan 2_3sm qvemoT zeda, qveda da wina. zeda xvreliT
erTvis didi saCino vena. barZayis wina Raridan masSi Sedis bar-
barZayis nervi kunTovan SualedSi Zayis sisxlZarRvovan-nervuli kona,
TeZo-sukis kunTis TeZosa da sukis qveda xvreliT, romelic barZayis
nawilebs Soris ama Tu im siRrmeze Zvalsa da didi momzidveli kunTis
mdebareobs. zogjer igi kunTis myess Soris mdebareobs, barZayis
sisqeSia. dasawyisSi nervi gayofilia arteria da vena gadadis muxlqveSa
barZayis arteriisgan TeZo-qedis fosoSi. momzidveli arxis wina
rkaliT, TeZo-qedis fasciiTa da xvreli ganier-momzidvel firfitaSia.
ganieri fasciis Rrma furcliT. sa- am xvreliT arxidan TerZis kunTis
zardulis iogidan 2_3sm qvemoT igi qveS mdebare SemaerTebel qsovilSi
aRniSnul fasciur furclebSi gaiv- gamodis muxlis daswvrivi arteria da
lis, uSualod arteriis gverdiT saCino nervi.
Tavsdeba da iyofa totebad, romlebic uxlis daswvrivi arteria kvebavs
anerveben barZayis wina jgufis medialur ganier, TerZisa da naz
kunTebsa da kans. yvelaze medialurad kunTebs da ukavSirdeba muxlqveSa
mdebareobs barZayis nervis umsxvilesi arteriis totebs.
da ugrZesi toti—saCino nervi, saCino nervi did saCino venasTan
romelic barZayis arterias garedan erTad barZayis medialur roks
ekvris da masTan erTad momzidvel gadauvlis da wvivze gadadis.
arxSi Sedis.

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 qvemo kiduri

damxuravi arxi (canalis obturatorius). kunTebs. did momzidvel kunTs

damxuravi arxi barZayis wina midamos damxurav nervTan erTad anervebs
medialur nawilsa da momzidveli sajdomi nervi, xolo qedis kunTs—
kunTebis fasciur budes menjis barZayis nervi.
subperitoneul sarTulTan akavSirebs. barZayis medialuri kunTTaSua Zgi-
mis kedlebs qmnis boqvenis Zvlis zeda dis ukan medialur fasciur budeSi
totis qveda zedapirze mdebare barZayis momzidveli kunTebia. qedis,
damxuravi Rari, damxuravi apki da grZeli momzidveli da nazi kunTebi
damxuravi kunTebi. misi sigrZe 2_ 3sm-s mdebareobs zedapirulad, mokle
udris, miemarTeba iribad—uknidan win momzidveli kunTi—Rrmad. mokle da
da zevidan qveviT. grZeli momzidveli kunTebi winidan
damxuravi arxiT menjis Rrudan faravs did momzidvel kunTs.
barZayze gadadis damxuravi arteria momzidveli kunTebi iwyeba
Tanamgzavri venebiT da damxuravi boqvenisa da sajdomi Zvlebidan,
nervi. nervi, Cveulebriv, mdebareobs umagrdeba barZayis xorkliani xazis
win da medialurad, arteria—ukan da medialur bages. didi momzidveli
lateralurad, venebi—arteriis ukan kunTi, garda amisa, umagrdeba momzid-
da lateralurad. vel borcvs, romelic barZayis Zvlis
damxuravi arteria, Cveulebriv, medialur rokze mdebareobs. nazi kun-
gamoeyofa TeZos SigniTa arterias, Ti umagrdeba didi wvivis medialur
iSviaTad—qveda epigastrul arterias; roks didi wvivis xorklis
damxurav arxSi an arxidan gamosvlis maxloblad.
Semdeg iyofa wina da ukana totebad.
wina toti amaragebs momzidvel
kunTebs da anastomozebiT ukavSirdeba barZayis ukana midamo _ regio
dundulovan, barZayis medialur,
femoris posterior
Semomxvev da gamgmirav arteriebs.
sazRvrebi: zevidan—dundulovani
ukana toti amaragebs imave kunTebs da
naoWi, qvevidan—kviristavidan 6sm
TeZos Zvals. mas gamoeyofa tabuxis
zeviT gavlebuli ganivi xazi
budis toti (r. acetabularis), romelic
Signidan—boqvenis
barZayis Tavis iogiT barZayis Tavs
simfizisa da barZayis medialuri
aRwevs, igi anastomozebiT ukavSirdeba
zedarokis SemaerTebeli xazi,
qveda dundulovan da barZayis
garedan—TeZos wina zeda wvetisa da
medialur Semomxvev arteriebs.
barZayis gareTa zedarokis
damxurav nervs damxurav arxSi
SemaerTebeli xazi.
gamoeyofa toti gareTa damxuravi
kani barZayis ukana zedapirze Seda-
kunTisTvis da iqve anda arxidan
rebiT Txelia. kanqveSa qsovilSi
gamosvlisTanave iyofa wina da ukana
lateralurad gaivlis barZayis kanis
totebad. wina toti amaragebs mcire
lateraluri nervis totebi,
momzidvel kunTs da barZayis qveda
medialurad—sasqeso-barZayis,
naxevris medialuri zedapiris kans,
barZayisa da damxuravi nervebis
ukana toti—did momzidvel da qedis

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 qvemo kiduri

totebi. barZayis Sua xazze ganieri gamgmiravi arteriebi Tanamgzavri

fasciis or furcels Soris mdeba- venebiT.
reobs barZayis kanis ukana nervi, sajdomi nervi didi dundula kun-
romlis totebi gzadagza kanqveSa Tis qvemoT, mcire manZilze (1_2sm)
qsovilSi gamodis. mdebareobs uSualod ganieri fasciis
ganieri fascia barZayis ukana mida- qveS. barZayis Sua ori meoTxedis
moSi gamagrebulia ganivad farglebSi nervs faravs orTava
ganlagebuli fibrozuli konebiT. kunTis grZeli Tavi, romelic mas
misgan siRrmeSi miemarTeba da barZayis iribad gadauvlis. ufro distalurad
Zvlis xorkliani xazis gareT bages nervi mdebareobs barZayis ukana RarSi,
umagrdeba mkvrivi lateraluri romelic garedan mosazRvrulia
kunTTaSua Zgide, romelic yofs orTava kunTiT, Signidan ki—naxevrad
erTmaneTisgan barZayis wina da ukana myesovani da TiTistara kunTebiT.
jgufis kunTebs, da faSari ukana barZayis qveda sazRvarTan sajdomi
kunTTaSua Zgide, romelic didi nervi didi wvivisa da mcire wvivis
momzidveli kunTis ukana zedapirs saerTo nervebad iyofa. zogjer nervi
faravs da momzidvel kunTebs ukana ufro maRal doneze iyofa anda
jgufis kunTebisgan yofs. late- Tavidan gamoyofilia mTavar totebad
raluri da ukana kunTTaSua Zgideebi ise, rom barZayze sajdomi nervis
da ganieri fascia mosazRvravs adgilze erTis magier ori nervuli
barZayis ukana fasciur budes, Rero mdebareobs. sajdomi nervi bar-
romelSic barZayis orTava, naxevrad Zayze anervebs ukana jgufis kunTebs
myesovani da TiTistara kunTebi da nawilobriv—did momzidvel kunTs.
mdebareobs. isini kukuxodan iwyebian. misi proeqcia kanze Seesabameba
yvelaze lateralurad mdebareobs kukuxosa da did cibruts Soris
barZayis orTava kunTis grZeli Tavi. manZilis Sua wertilidan muxlqveSa
igi barZayis xorkliani xazidan fosos Sua wertilamde gavlebul
dawyebul mokle TavTan erTad qmnis xazs.
saerTo myess, romelic mcire wvivis sajdom nervs kvebavs Tanamgzavri
Tavs umagrdeba. mis medialurad arteria, romelic qveda dundulovan
mdebareobs naxevrad myesovani kunTi, arterias gamoeyofa da gamgmiravi
xolo am ukanasknelis medialurad— arteriebi. es arteriebi
TiTistara kunTi. TiTistara kunTi dakavSirebulia erTmaneTTan da mux-
umagrdeba didi wvivis medialur roks, lis arteriebTan anastomozebiT, ris
xolo naxevrad myesovani kunTi Sedegadac barZayis ukana midamoSi
TerZisa da naz kunTTan erTad—didi sajdomi nervis gaswvriv Seqmnilia
wvivis xorkls. erTiani anastomozuri kavSiri.
barZayis ukana kunTebs Soris faSar xsenebuli arteriebi kvebavs agreTve
SemaerTebel qsovilSi mdebareobs barZayis ukana kunTebs.
sajdomi nervi, barZayis SigniTa barZayis ukana fasciuri bude zeviT
Semomxvevi arteriis totebi da dakavSirebulia didi dundula kunTis
qveS mdebare sivrcesTan, qveviT—

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 qvemo kiduri

muxlqveSa fososTan, gamgmiravi barZayis Zvlis zeda mesamedSi mote-

arteriebis gaswvriv—barZayis wina xilobis dros natexebis Secileba
midamosTan. aseT suraTs iZleva: centraluri
barZayis diafizis motexiloba. bar- natexi gadanacvlebulia win da gareT,
Zayis diafizis motexiloba SedarebiT xolo periferiuli—SigniT da ukan.
xSiria. am dros yovelTvis aqvs adgi- centraluri natexis Secileba
li Zvlis irgvliv arsebuli rbili gamowveulia TeZo-sukisa da ganm-
qsovilebis ama Tu im xarisxiT zidveli (Sua da mcire dundula) kun-
gamoxatul dazianebas. ganasxvaveben Tebis ZaliT. periferiuli natexis Se-
garegani Zalis pirdapiri (motexilo- cileba ki gansazRvrulia momzidveli
bebi gamowveuli adamianis simaRlidan (cdoma SigniT) da kanWis tyupi kunTe-
CamovardniT, barZayis midamoSi bis moqmedebiT (cdoma ukan).
dartymiT) da arapirdapiri (barZayis barZayis Sua mesamedSi motexilobis
motexiloba terfisa da wvivis fiqsa- dros proqsimaluri natexi gadainacv-
ciis pirobebSi, rodesac tani tria- lebs win da ramdenadme gareT. im
lebs gaswvrivi RerZis irgvliv) moqme- SemTxvevebSi, rodesac motexiloba
debiT gamowveul dazianebebs. am miaxlovebulia distalur mesamedTan,
ukanasknel SemTxvevaSi viTardeba spi- proqsimaluri natexi ikavebs
raluri (xraxnisebri) motexiloba, ramdenadme mozidul mdebareobas (mom-
rbili qsovilebi ki Cveulebriv zidveli kunTebis Zala). distaluri
naklebadaa dazianebuli natexi gadanacvlebulia zeviT da
travmis meqanizmis mixedviT aRiniS- SigniT—momzidveli kunTebis
neba barZayis Zvlis diafizis moqmedeba.
sxvadasxva saxis motexiloba: ganivi, barZayis Zvlis qveda mesamedSi
iribi, msxvrevadi da spiraluri. motexilobisas centraluri natexi
barZayis motexilobis dros gadanacvlebulia win da SigniT
kunTebs azianebs rogorc Secilebuli (momzidveli kunTebis Zala), xolo
natexebis boloebi, aseve garegani periferiuli—ukan (kanWis tyupi
Zalis moqmedebac. kunTis Zala). barZayis motexiloba
barZayis kunTebi gansazRvraven (rokebis zeviT) saSiSia muxlqveSa
kiduris an misi calkeuli segmentebis sisxlZarRvebisa da didi wvivis nervis
mdebareobas, agreTve barZayis Zvlis dazianebis TvalsazrisiT. gansa-
natexebis Secilebis xasiaTs. maga- kuTrebiT didia muxlqveSa arteriis
liTad, barZayis nebismieri motexilo- dazianebis safrTxe, radganac igi
bisas kiduri damoklebulia. es ganpi- mdebareobs Rrmad, ZvalTan yvelaze
robebulia grZeli kunTebiT, romle- axlo.
bic iwyebian menjis Zvlebze, qveviT barZayis arteriisa da sajdomi ner-
umagrdebian wvivs da zeviT ewevian vis dazianeba barZayis motexilobisas
barZayis qveda bolos, wvivTan erTad. SesaZlebelia, magram iSviaTad
barZayis motexilobis dros qvemo gvxvdeba. wvrili sisxlZarRvebis
kiduri simZimis ZaliT rogorc wesi (umTavresad kunTebis mkvebavi totebis)
mobrunebulia gareTken.

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 qvemo kiduri

dazianeba iZleva mniSvnelovan barZayisa da dundulis midamoebSi

sisxldenas da hematomas. gavrceldes.
monacemebi natexebis Secilebis menj-barZayis saxsari gamagrebulia
xasiaTze gaTvaliswinebuli unda iyves agreTve kunTebiT, romlebic mas
qirurgebis mier motexili yoveli mxridan faraven: win
fragmentebis Casworebisa da swor moTavsebulia TeZo-sukis kunTi.
mdebareobaSi maTi fiqsaciis dros. barZayis swori kunTi da qedis kunTi,
gareT—mcire dundula kunTi, ukan—
menj-barZayis saxsari msxlisebri, SigniTa damxuravi, tyupi,
menj-barZayis saxsari formiT gareTa damxuravi da barZayis kvadra-
kaklisebria—tabuxis bude (acetabulum) tuli kunTebi, qveviT—gareTa
da misi bage (labium acetabulare) barZayis damxuravi kunTi.
Zvlis Tavis naxevarze mets faravs. sasaxsre CanTasa da TeZo-sukis kun-
sasaxsre CanTa dakavSirebulia menjisa Ts Soris, TeZo-boqvenis maRlobis
da barZayis ZvlebTan ise, rom, tabuxis ramdenadme qvemoT da gareT
budisa da barZayis Zvlis Tavis garda, mdebareobs TeZo-qedis abga (bursa
saxsris RruSi mdebareobs tabuxis iliopectinea). SemTxvevaTa daaxloebiT
budis bage, barZayis Zvlis yelis wina 10%-Si igi dakavSirebulia saxsris
zedapiri mTlianad da ukana zedapiris RrusTan.
2/3. sasaxsre CanTa winidan gamag- vinaidan menj-barZayis saxsari yove-
rebulia TeZo-barZayis iogiT (lig. ilio- li mxridan dafarulia kunTebiTa da
femorale), medialurad—boqven-barZayis cximovani qsovilis sqeli SriT, igi
iogiT (lig. pubofemorale) da uknidan— xeliT Zneli gasasinjia. kargad
sajdom-barZayis iogiT (lig. ishiofemorale). isinjeba didi cibruti, romlis
barZayis Zvlis yels maryuJisebr mwvervali, roca barZayi odnav
exveva yelTa iogi (zona orbicularis). moxrilia, TeZos wina zeda wvetisa da
garda amisa, saxsars amagrebs barZayis sajdomi borcvis SemaerTebel (rozen-
nelatonis) xazze mdebareobs. barZayis
Zvlis Tavis iogi (lig. capitis femoris).
amovardnilobis dros didi cibrutis
aRsaniSnavia sasaxsre CanTis susti
mwvervali dacilebulia am xazidan
adgilebi, romelTa farglebSi
qveviT, barZayis yelis motexilobis
barZayis amovardnilobis dros
dros—zeviT.
sasaxsre CanTa irRveva da barZayis
TeZos wina zeda wvetisa da
Zvlis Tavi tabuxis budidan gamodis.
boqvenis borcvis SemaerTebeli xazis
aseTi adgilebi win mdebareobs TeZo-
Sua wertilSi gavlebuli
barZayisa da boqven-barZayis iogebs
vertikaluri xazi barZayis Zvlis
Soris, ukan da qveviT—TeZo-barZayisa
Tavsa da tabuxis budes daaxloebiT
da sajdom-barZayis iogebs Soris,
or Tanabar nawilad yofs. aseve or
qveviT—boqven-barZayisa da sajdom-
Tanaswor nawilad yofs barZayis Tavs
barZayis iogebs Soris. sasaxsre CanTis
didi cibrutis mwvervalze gavlebuli
aRniSnuli susti adgilebidan
horizontaluri sibrtye.
SeiZleba saxsris Cirqovani anTeba

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 qvemo kiduri

menj-barZayis saxsars ainervirebs tabuxis fosos mimarT barZayis

barZayis, sajdomi da damxuravi Tavi mdebareobis mixedviT arCeven
nervebis totebi. sisxliT amaragebs barZayis wina da ukana
qveda dundulovani, barZayis amovardnilobas. wina amovardniloba
Semomxvevi da damxuravi arteriebi. Tavis mxriv iyofa luxatio suprapubica da
damxuravi arteria iZleva tabuxis luxatio opturatoria. radganac sasaxsre
budis arterias, romelic barZayis Ta- CanTis wina nawili gamagrebulia TeZo-
vis iogiT barZayis TavSi Sedis. barZayis mZlavri iogiT, amitom
menj-barZayis saxsrisa da misi amovardniloba uxSiresad xdeba ukan.
mezobeli midamoebis farglebSi amasTanave barZayis Tavi gadacurdeba
arsebuli arteriebi dakavSirebulia ukan da qveviT sajdom naWdevze (luxatio
erTmaneTTan mravalricxovani ischiadica) anda Secildeba zeviT (luxatio
anastomozebiT, romlebsac didi iliaca). ukana amovardnilobebis dros
mniSvneloba aqvT barZayis, TeZos gare- kiduri odnav damoklebulia, moxri-
Ta da TeZos SigniTa arteriis gamo- lia, mozidulia da Sebrunebulia Sig-
TiSvis SemTxvevaSi kolateraluri niTken; moZraobebi mkveTrad SezRudu-
sisxlis mimoqcevis ganviTarebisTvis. lia, barZayis Tavi isinjeba ukan da
gansakuTrebiT aRsaniSnavia didi cibrutis mwvervali 3_5sm-iT
anastomozebi, romlebiTac uSualod maRlaa rozernelatonis xazze.
arian erTmaneTTan dakavSirebuli: 1) wina amovardnilobisTvis damaxasi-
TeZos Rrma Semomxvevi da TeZo-welis aTebelia qvemo kiduris mkveTrad
arteriebi; 2) qvemo dundulovani, dam- ganzidva, rotacia gareTken, kiduri
xuravi da barZayis medialuri Semom- moCvenebiT dagrZelebulia menjis
xvevi arteriebi; 3) barZayis late- daxrilad mdebareobis gamo.
raluri Semomxvevi arteriis aswvrivi
toti da zemo dundulovani arteria.
muxli _ Genus
menj-barZayis saxsris
sazRvrebi: zevidan kviristavis ze-
amovardniloba. amovardniloba menj-
moT 6sm daSorebiT da qvevidan didi
barZayis saxsris midamoSi SeiZleba
wvivis xorklis doneze gavlebuli
iyos rogorc Tandayolili, ise
irgvlivi xazebi.
tramvuli. pirveli Sedegia intraute-
wina zedapirze xeliT kargad isin-
rinuli ganviTarebis periodSi
jeba kviristavi, didi wvivis xorkli
momxdari darRvevebisa. tramvuli
da maT Soris gadaWimuli kviristavis
amovardniloba sasaxsre CanTis simtki-
iogi, gverdebze, zeviT—barZayis Zvlis
cisa da saxsris irgvliv mdebare
medialuri da lateraluri rokebi da
mZlavri kunTebis gamo SedarebiT
zedarokebi, medialuri zedarokis
iSviaTad gvxvdeba. SemTxvevaTa did
zemoT—momzidveli borcvi da masze
nawilSi es amovardnilobebi
mimagrebuli didi momzidveli kunTis
viTardeba saxsarSi uxeSi
myesi, qveviT—didi wvivis medialuri
ZaldatanebiT gamowveuli
da lateraluri rokebi, lateraluri
gadametebuli moZraobiT.
rokis gareT—mcire wvivis Tavi, didi

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 qvemo kiduri

wvivis xorklsa da mcire wvivis Tavs barZayis zedarokebs umagrdebian,

Soris manZilis Sua wertilSi— dakavSirebuli arian sakuTar
SemaRleba (Jerdis borcvi) da masTan fasciasTan da amagreben sasaxsre
dakavSirebuli TeZo-wvivis traqti. CanTis wina nawils. barZayis oTxTava
ukana zedapirze SeimCneva muxlqveSa kunTis Rrma konebi qmnis
fosos momsazRvreli kunTebis damoukidebel muxlis saxsris kunTs
SemaRlebebi, romelTa Soris, muxlis (m. articularis genus), romelic sasaxsre
saxsris moxrisas, iqmneba CaRrmaveba, CanTas umagrdeba. oTxTava kunTis
lateralur mxareze isinjeba barZayis medialurad ganlagebulia TerZis,
orTava kunTis myesi, medialur nazi, naxevrad myesovani da TiTistara
mxareze—naxevrad myesovani da TiTis- kunTebis myesebi, romelTagan pirveli
tara kunTebis myesebi. sami umagrdeba didi wvivis medialuri
barZayis rokebis ukana kideze rokis wina medialur zedapirs da
gavlebuli vertikaluri xaziT muxli qmnis e.w. “batis fexs”. TiTistara
iyofa wina da ukana midamoebad, kunTis myesi ki iyofa sam nawilad,
romelTa Soris muxlis saxsari romelTagan ori umagrdeba didi wvi-
mdebareobs. vis medialur roks, xolo mesame
muxlqveSa irib iogSi Caeqsoveba.
muxlis wina midamo _ regio genus anterior muxlis wina midamos arteriebi
kani SedarebiT mkvrivi da moZravia, kviristavis areSi qmnis bades—rete arti-
kanqveSa qsovili sustad aris ganvi- culare, romelic muxlis saxsris arte-
Tarebuli, kanqveSa fasciac sustad riuli badis nawils Seadgens. venebi
aris gamoxatuli, sakuTari fascia erTvis did saCino venas. es
barZayis ganieri fasciis gagrZelebaa. ukanaskneli saCino nervTan erTad
igi dakavSirebulia barZayis midamos medialur kideSi mdebareobs.
zedarokebTan, didi wvivis rokebTan, saCino nervs aq gamoeyofa kviristavis
didi wvivis xorklsa da mcire wvivis qveda nervi (n. infrapatellaris).
TavTan. kviristavis win zedapiruli fasciis
fasciis qveS mdebareobs barZayis or furcels Soris mdebareobs bursa
oTxTava kunTis bolo nawili da misi synovialis patellaris subcutanea
myesi, romelic kviristavis fuZesa da (gvxvdeba sxva zedapirulad mdebare
zeda kides umagrdeba, Sua nawiliT muxlis abgebze ufro xSirad),
kviristavs winidan gadauvlis da zedapirul da sakuTar (ganier)
grZeldeba kviristavis iogSi, fasciebs Soris—bursa prepatellaris
romelic didi wvivis xorkls subfascialis, oTxTava kunTis myess da kvi-
umagrdeba. misi sigrZea 5sm, sigane—
ristavis Zvlisazrdelas Soris—bursa
2_2,5sm, sisqe—0,5sm. kviristavis
prepatellaris subtendinea. kviristavis wina
gverdiTi kideebidan iwyeba
sinoviuri abgebi zogjer
aponevrozuli agebulebis medialuri
dakavSirebulia erTmaneTTan.
da lateraluri sabmelebi (retinaculum
kviristavis qvemoT ori abgaa: kvi-
patellae mediale et laterale), romlebic didi ristavis iogis win kanqveSa
wvivis proqsimalur epifizs da

klinikuri anatomia 189

 qvemo kiduri

qsovilSi—bursa infrapatellaris subcutanea da fascia uqmnis budes agreTve muxl-

kviristavis iogis ukan—bursa qveSa fosos sisxlZarRvebsa da ner-
infrapatellaris profunda. barZayis medialuri vebs.
zedarokis doneze mdebareobs kanqveSa sakuTari fasciis aclis Semdeg
abga. arc erTi aRniSnuli abga ar aris ixsneba muxlqveSa foso, romelic
dakavSirebuli saxsris RrusTan. am formiT mogvagonebs rombs. igi
mxriv gamonakliss Seadgens zevidan da garedan mosazRvrulia
kviristavis zemoT oTxTava kunTis ormucela kunTiT, zevidan da
myesis qveS mdebare bursa suprapatellaris, Signidan—naxevrad myesovani da
romelic xSirad (85%) dakavSirebulia TiTistara kunTebiT, qvevidan da
saxsris RrusTan. misi wina kedeli garedan—tyupi kunTis lateraluri
ekvris oTxTava kunTis myess, ukana TaviT, qvevidan da Signidan—amave
kedeli gamoyofilia barZayis Zvlisgan kunTis medialuri TaviT, romelTanac
faSari SemaerTebeli qsoviliT. erTad terfZiris (aramudmivi) kunTi
(m. plantaris) mdebareobs. tyupi kunTis
muxlis ukana midamo _ regio genus Tavebi iwyeba barZayis rokebis ukana
posterior zedapirebidan da ramdenadme ufro
kani Txeli da moZravia. kanqveSa zeviT TviT barZayis Zvlidan,
qsovilSi zevidan Camodis barZayis terfZiris kunTi—lateraluri
kanis ukana nervis saboloo totebi. rokidan da muxlis sasaxsre CanTis
garda amisa, midamos medialur ukana kedlidan.
nawilSi mdebareobs saCino nervi, muxlqveSa fosos ukana kedels
lateralur nawilSi—kanWis kanis qmnis muxlqveSa fascia, wina kedels,
lateraluri nervis (n. cutaneus surae anu fskers—zevidan qveviT—barZayis
Zvlis muxlqveSa zedapiri (facies
lateralis) totebi. qveda nawilSi
sakuTari fasciis or furcels Soris popliteus), sasaxsre CanTis ukana nawili
gaivlis mcire saCino vena, romelic masTan dakavSirebuli muxlqveSa iribi
muxlqveSa venas erTvis. iogiT da muxlqveSa kunTi, romelic
sakuTari, anu muxlqveSa fascia barZayis lateraluri rokidan iwyeba
barZayis ganieri fasciis gagrZelebaa. da didi wvivis zeda epifizis ukana
igi fiqsirebulia barZayis zedapirs umagrdeba. muxlis ukana
zedarokebsa da mcire wvivis TavTan. midamos medialur zedapirze, zeda
muxlqveSa fascia siRrmeSi agzavnis nawilSi CaRrmavebaa, romelsac Jobe-
Zgideebs, romlebic barZayis ris fosos uwodeben. igi winidan
xorkliani xazis bageebs umagrdebian mosazRvrulia didi momzidveli
da qmnian budeebs lateralur mxareze kunTis myesiT, uknidan—naxevrad
orTava kunTis myesisTvis, medialur myesovani, TiTistara da nazi
mxareze—naxevrad myesovani da kunTebiT, zevidan—TerZis kunTiT,
TiTistara kunTebisTvis. qvevidan—tyupi kunTis medialuri
TaviTa da barZayis medialuri rokiT.
Joberis fosoSi SeiZleba mivudgeT
muxlqveSa arterias.

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 qvemo kiduri

muxlqveSa foso amovsebulia cximo- medialis), romelic mcire saCino

vani SemaerTebeli qsoviliT, romelic
zeviT sajdomi nervis garemomcvel
SemaerTebel qsovilSi grZeldeba da
ukavSirdeba didi dundula kunTis
qveS mdebare SemaerTebel qsovils.
momzidveli arxiT igi ukavSirdeba
barZayis samkuTxedis SemaerTebel qso-
vils, xolo qveviT, quslis kunTis
myesovani rkaliT mosazRvruli
xvreliT—wvivis ukana midamos Rrma
fasciuri budis SemaerTebel qsovils.
sisxlZarRvebi da nervebi
muxlqveSa fosoSi ganlagebulia
Semdegnairad: yvelaze zedapirulad,
uSualod sakuTari fasciis qveS
mdebareobs didi wvivisa da mcire
wvivis saerTo nervebi, didi wvivis
nervis win da medialurad (e.i. ufro
Rrmad)—muxlqveSa vena, xolo am uka-
nasknelis win da medialurad—
muxlqveSa arteria.
didi wvivis nervisa da barZayis
sisxlZarRvebis proeqcia kanze
Seesabameba xazs, romelic muxlqveSa
fosos zeda kuTxes qveda kuTxesTan
aerTebs.
sajdomi nervi muxlqveSa fosos ze-
da kuTxeSi anda ufro zeviT iyofa
didi wvivisa da mcire wvivis saerTo
nervebad, romlebic uSualod
muxlqveSa fasciis qveS mdebareoben.
didi wvivis nervi agrZelebs sajdomi
nervis msvlelobas—muxlqveSa fosos
zeda kuTxidan qveda kuTxeSi midis da
wvivis ukana sisxlZarRvebTan erTad
wvivis ukana midamoSi gadadis. muxl-
qveSa fosoSi mas gamoeyofa totebi
tyupi, terfZirisa da muxlqveSa
kunTebisTvis, xolo tyupi kunTis
Tavebs Soris mdebare RarSi—kanWis
kanis medialuri nervi (n. cutaneus surae
venasTan erTad wvivis ukana midamoSi
gadadis.
mcire wvivis saerTo nervi barZayis
orTava kunTis medialur kides miyveba.
am kunTis myessa da tyupi kunTis
lateralur Tavs Soris gaivlis,
mcire wvivis Tavs garedan Semouvlis
da mcire wvivis grZeli kunTis qveS
zedapirul da Rrma totebad iyofa.
muxlqveSa fosoSi misgan gamodis
kanWis kanis lateraluri nervi (n.
cutaneus surae lateralis), romelic wvivis
ukana midamos kanqveSa qsovilSi
gadadis. muxlqveSa arteria da vena
gaxveulia mkvriv
SemaerTebelqsovilovan budeSi, rome-
lic Sezrdilia am sisxlZarRvebis
kedlebTan da ZgidiT yofs mas
erTmaneTisgan. sisxlZarRvebi
muxlqveSa fosoSi Sedis momzidveli
arxiT. dasawyisSi isini moTavsebuli
arian didi wvivis nervis medialurad,
misgan 1_1,5sm daSorebiT, qveviT Tanda-
TanobiT uaxlovdebian nervs da masTan
erTad qmnian erTian konas. arteria
muxlqveSa fosoSi yvelaze Rrmad
mdebareobs—barZayis Zvlidan da
sasaxsre CanTidan igi gayofilia
1_1,5sm sisqis cximovani SriT.
muxlqveSa arterias gamoeyofa muxlis
zeda medialuri da zeda lateraluri
arteriebi (aa. genus superiores medialis et
lateralis), muxlis Sua arteria (a. genus
media), muxlis qveda medialuri da
lateraluri arteriebi (aa. genus inferio-
res medialis et lateralis), es arteriebi mux-
lis sasaxsre CanTis irgvliv qmnis
muxlis arteriul bades (rete genus),
romelsac uerTdeba muxlis daswvrivi
arteria (barZayis arteriis toti),

klinikuri anatomia 191

 qvemo kiduri

wvivis Sebrunebuli arteria (didi saxsris xazis mdebareoba Seesabameba

wvivis wina arteriis toti) da kanis ganiv naoWs.
kunTovani totebi. muxlis saxsari winidan ufro nak-
muxlis venebi raodenobiT bevrad lebad aris daculi meqanikuri zemoq-
aRemateba arteriebs da qmnis medebisgan, vidre uknidan. winidan mas
arteriul badesTan SedarebiT ufro faravs barZayis oTxTava kunTis myesis
rTul venur bades. muxlis venebi warmonaqmnebi: kviristavis zemoT—
erTvis muxlqveSa venas. TviT oTxTava kunTis myesi, qvemoT—
muxlqveSa kunTis qveda kidis done- kviristavis iogi, gverdebze—
ze muxlqveSa arteria Sedis wviv- kviristavebis sabmelebi (retinacula
muxlqveSa arxSi da iqve patellae medialis et lateralis), romlebic
(SesvlisTanave) iyofa didi wvivis wina kviristavis gverdiT kideebsa da didi
da ukana arteriebad. didi wvivis wina wvivis rokebs Soris arian gadaWimuli.
arteria (a. tibialis anterior) ZvalTaSua am warmonaqmnebs uSualod faravs
apkis xvreliT gadadis wvivis wina muxlis sakuTari fascia, romelic
midamoSi, didi wvivis ukana arteria (a. gareTa nawilSi gasqelebulia TeZo-
tibialis posterior) wviv-muxlqveSa arxiT— wvivis traqtiT, SigniTa nawilSi—
wvivis ukana midamoSi. TerZis kunTis myesovani konebiT.
muxlqveSa fosoSi arCeven limfuri uknidan saxsari dafarulia barZayis
kvanZebis 3 jgufs. Rrmad mdebare orTava, naxevrad myesovani, TiTistara,
kvanZebi sasaxsre CanTas ekvris, Sua muxlqveSa da tyupi kunTebiT, agreTve
jgufis kvanZebi ganlagebulia muxlqveSa fosoSi mdebare rbili qso-
sisxlZarRvebis gaswvriv, zedapiruli vilebis sqeli SriT.
kvanZebi—sakuTari fasciis qveS. saxsarSi barZayisa da didi wvivis
rokebs Soris medialuri da
muxlis saxsari lateraluri meniskebia, romlebic
muxlis saxsars qmnis barZayis qveda gareTa kideebiT mtkiced arian
epifizi, didi wvivis zeda epifizi da dakavSirebuli sasaxsre CanTasTan.
kviristavi. didi wvivis lateralur maTi wina da ukana nawilebi rokTaSua
roksa da mcire wvivs Soris arsebuli SemaRlebis win da ukan Sezrdilia
wvivTa saxsari (articulatio tibiofibularis), didi wvivis ZvalTan. meniskebis wina
Cveulebriv, ar aris dakavSirebuli kideebs Soris gadaWimulia muxlis
muxlis saxsarTan. kavSiri maT Soris ganivi iogi (lig. transversum genus).
SemTxvevaTa mxolod 20%-Si aRiniSneba. lateraluri meniski dakavSirebulia
roca muxlis saxsari moxrilia, ukana jvaredina iogTan da barZayis
kviristavis iogis gverdebze kargad lateralur rokTan menisk-barZayis
isinjeba saxsris xazi barZayis ukana iogiT (lig. meniscofemoralis posterior).
rokebsa da didi wvivis sasaxsre oTxTava kunTis myesisa da kviris-
zedapiris kides Soris mdebare tavis iogis garda, muxlis saxsars
CaRrmavebis saxiT. ukana zedapirze amagrebs didi da mcire wvivis

klinikuri anatomia 192

 qvemo kiduri

gverdiTi, muxlqveSa iribi, muxlqveSa gaswvriv. aseve kviristavsa da did

rkalovani da jvaredina iogebi. wvivsac sasaxsre CanTa umagrdeba
didi wvivisa da mcire wvivis gver- xrtilovani safarvelis kideebis
diTi iogebi (ligg. collateralia tibiale et gaswvriv.
fibulare) gadaWimulia barZayis muxlis sasaxsre CanTas aqvs gamod-
zedarokebsa da wvivis Zvlebs Soris. rekilobebi, anu abgebi, romlebic
muxlqveSa iribi iogi (lig. popliteum mniSvnelovanwilad adideben saxsris
obliquum) didi wvivis rokis doneze Rrus moculobas. 5 aseTi abga
gamoeyofa TiTistara kunTis myess da mdebareobs saxsris wina nawilSi,
iribad barZayis lateraluri rokisken 4_ukana nawilSi. yvelaze didi
miemarTeba. muxlqveSa rkalovani iogi moculobisaa wina Sua abga, romelic
(lig. popliteum arcuatum) iwyeba barZayis kviristavis zemoT oTxTava kunTis
lateraluri zedarokidan, umagrdeba myessa da barZayis Zvlis wina
muxlqveSa irib iogs. jvaredina iogebi zedapirs Soris mdebareobs. igi
xSirad (85%) SeerTebulia
(ligg. cruciata genus) mtkiced akavSirebs
kviristavzeda sinoviur abgasTan.
erTmaneTTan barZayisa da wvivis
saxsris wina nawilSi gverdebze
Zvlebs. wina jvaredina iogi iwyeba
moTavsebulia medialuri zeda,
barZayis lateraluri rokis SigniTa
medialuri qveda, lateraluri zeda
zedapirze. umagrdeba did wvivs
da lateraluri qveda abgebi. aseve
rokTaSua SemaRlebis win. ukana
saxsris ukana nawilSi mdebareobs
jvaredina iogi iwyeba medialuri ro-
medialuri zeda, medialuri qveda,
kis SigniTa zedapirze, umagrdeba didi
lateraluri zeda da lateraluri
wvivis Zvals rokTaSua SemaRlebis
qveda abgebi. garda amisa, gverdiT
ukan. jvaredina iogebi winidan da
nawilebSic aris zeda da qveda abgebi,
gverdebidan dafarulia sinoviuri
romelTa saSualebiT saxsris Rrus
garsiT.
wina da ukana nawilebi erTmaneTs
sasaxsre CanTa farToa, misi sino-
ukavSirdeba.
viuri garsiT SemosazRvruli Rru
muxlis saxsris amovardniloba.
vrcelia. kviristavis gverdebze CanTis
amovardniloba muxlis saxsris
fibrozul Sresa da sinoviur garss
midamoSi, misi iogovani aparatisa da
Soris moTavsebulia cximovani
irgvliv mdebare kunTebis siZlieris
qsovilis grovebi, ris Sedegadac
gamo, iSviaTi movlenaa. amisaTvis
sinoviuri garsi saxsarSi qmnis
aucilebelia didi Zaldataneba
frTisebr naoWebs (plicae alares),
urTierTSemxebi farTo sasaxsre zeda-
romlebic gadaWimulia kviristavis
pirebis SecilebisaTvis da Zlieri
fuZidan meniskebis wina kideebamde.
iogebis mTlianobis darRvevisTvis.
sasaxsre CanTa barZayis Zvlis wina
upiratesad aRiniSneba wina
zedapirs umagrdeba xrtilovani
amovardniloba. am dros didi wvivis
safarvelidan 4_5sm-iT zemoT, xolo
Zvali barZayis rokebis mimarT
rokebsa da ukana zedapirs—
Secilebulia win da zeviT. amo-
xrtilovani safarvelis kidis
vardnilobas SeiZleba Tan daerTos

klinikuri anatomia 193

 qvemo kiduri

barZayis rokebis motexilobac. wvivze qmnis wina, gareTa da ukana

gansakuTrebul saSiSroebas warmo- Zval-fasciur budeebs.
adgens muxlqveSa fosos sisxlZarRvo- didi wvivis Zvali winidan dafaru-
van-nervuli konis dazianeba, romelmac lia mxolod kaniT, kanqveSa qsovilis
SeiZleba kiduris dambla da gangrena Txeli feniT da fasciiT. amitom didi
gamoiwvios. aseve saxifaToa kanis wvivis xorkli, wina medialuri
dazianebac, rac daxurul amo- zedapiri, qedi (crista tibiae) da
vardnilobas gadaaqcevs Riad. medialuri goji (maleus medialis) xeliT
didi wvivis ukana amovardniloba kargad isinjeba. mcire wvivis umetesi
ufro iSviaTia, vidre wina. am dros nawili kunTebiTaa dafaruli da
sasaxsre parki iglijeba ukan da amitom xeliT isinjeba mxolod misi
rogorc wesi ziandeba iogebi. barZayis Tavi, qveda mesamedis gareTa zedapiri
rokebis ukana zedapiri mibjenilia da lateraluri goji (maleolus lateralis).
didi wvivis Zvlis wina zedapirze. wvivis ukana zedapirze qveda mesa-
xSiria muxlqveSa fosos medSi kargad isinjeba agreTve quslis
sisxlZarRvovan-nervuli konis (aqilevsis) myesi—tendo calcaneus (Achillis)
dazianebac. romlis gverdebze kanze, Cveulebriv,
aRiniSneba CaRrmaveba.
wvivi _ tibia
sazRvrebi: zevidan—didi wvivis
xorklze da qvevidan—gojebis fuZeze wvivis wina midamo _ regio cruris anterior
gavlebuli irgvlivi xazebi. wvivi kani SedarebiT Txeli da naklebad
iyofa wina da ukana midamoebad. maT moZravia. kanqveSa venebi erTvis did
Soris sazRvari wvivis SigniTa saCino venas, romelic wvivis qveda
zedapirze gaivlis didi wvivis nawilSi moTavsebulia didi wvivis
medialur kideze. gareTa zedapirze— wina-medialur zedapirze, xolo zeda
mcire wvivis kunTebsa da quslis nawilSi, Cveulebriv, wvivis ukana
kunTs Soris mdebare RarSi. midamoSi gadadis. masTan saCino nervi
sakuTari fascia mkvrivia, gareTa mdebareobs. kans medialur nawilSi
mxareze misgan siRrmeSi eSveba wina da anervebs saCino nervis totebi, late-
ukana kunTTaSua Zgideebi. wina ralur nawilSi—kanWis kanis latera-
kunTTaSua Zgide (septum intermusculare luri nervisa da mcire wvivis zeda-
anterius) ganaSorebs mcire wvivis piruli nervis totebi, romlebic kan-
kunTebs TiTebis grZeli gamSleli qveSa qsovilSi gamodian midamos Sua
kunTisgan da umagrdeba mcire wvivis da qveda mesamedebis sazRvarze.
wina kides. ukana kunTTaSua Zgide sakuTari fascia aponevrozuli
(septum intermusculare posterior) yofs erT- xasiaTisaa, zeda nawilSi mtkicedaa
maneTisgan mcire wvivisa da quslis Sezrdili wvivis wina, TiTebis grZel
kunTebs da umagrdeba mcire wvivis gamSlel da mcire wvivis kunTebTan,
ukana kides. wvivis Zvlebsa da romlebic nawilobriv misgan iwyebian.
ZvalTaSua apkTan erTad es Zgideebi qveda nawilSi igi qmnis gamSleli

klinikuri anatomia 194

 qvemo kiduri

kunTebis zeda sabmels (retinaculum mcire wvivis saerTo nervis saboloo

extensorum superius), romelic didi nawili da mcire wvivis zedapiruli
wvivis wina qedsa da mcire wvivis nervi gaivlis.
lateralur zedapirs Soris aris wina Zval-fasciur budeSi
gadaWimuli. wvivis wina midamo kunTebTan erTad mdebareobs
moicavs wvivis wina da gverdiT Zval- sisxlZarRvovan-nervuli kona,
fasciur budeebs. wina Zval-fasciuri romelic wvivis wina arterias, venasa
bude Seicavs terfisa da TiTebis da mcire wvivis Rrma nervs Seicavs.
gamSlelebs. medialurad mdebareobs wvivis wina arteria muxlqveSa ar-
didi wvivis wina kunTi (m. tibialis ante- teriidan gamoyofisTanave wvivis
rior), romelic didi wvivis late- ZvalTa-Sua apkSi arsebuli xvreliT
raluri rokidan, didi wvivis wina Zval-fasciur budeSi gadadis.
lateraluri zedapiridan da zeda naxevarSi igi mdebareobs
ZvalTaSua apkidan iwyeba. late- ZvalTaSua apkze wvivis wina da
ralurad mdebareobs TiTebis grZeli TiTebis grZel gamSlel kunTebs
gamSleli kunTi (m. extensor digitorum lon- Soris, qveda naxevarSi—didi wvivis
wina da fexis ceris grZel gamSlel
gus), romelic didi wvivis lateralu-
kunTebs Soris. didi wvivis wina
ri rokidan, mcire wvivis Tavidan,
arterias dasawyisSive gamoeyofa didi
mcire wvivis wina kididan da
ZvalTaSua apkidan iwyeba. midamos wvivis wina Sebrunebuli arteria (a.
qveda or mesamedSi am kunTebs Soris recurens tibialis anterior), romelic zeviT
fexis ceris grZeli gamSleli kunTia miemarTeba da muxlis saxsris badis
(m. extensor halucis longus), romelic mcire SeqmnaSi monawileobs. garda amisa, mas
wvividan da nawilobriv ZvalTaSua ap- gamoeyofa totebi TiTebis gamSleli
kidan iwyeba. da didi wvivis wina kunTebisTvis,
gareTa Zval-fasciuri bude Seicavs agreTve gojis wina medialuri da
mcire wvivis grZel da mokle kunTebs lateraluri arteriebi (aa. maleolares
(mm. peronei longus et brevis), romlebic anterior medialis et lateralis).
mcire wvivis Zvals garedan faraven. mcire wvivis Rrma nervi mcire wvi-
mcire wvivis grZeli kunTi erTi TaviT vis saerTo nervs gamoeyofa kunT-
iwyeba didi wvivis lateraluri mcire wvivis arxSi da mcire wvivis
rokidan, mcire wvivis Tavidan da Tavidan 6_7sm-iT qvemoT wina
wvivis fasciidan, meore TaviT—mcire kunTTaSua ZgideSi arsebuli xvreliT
wvivis gareTa zedapiridan. mcire wina Zval-fasciur budeSi gadadis.
wvivis mokle kunTi iwyeba mcire pirvelad igi wvivis wina sisxl-
wvivis gareTa zedapiridan, dafarulia ZarRvebis lateralurad mdebareobs,
mcire wvivis grZeli kunTiT. mcire Semdeg maT win Tavsdeba.
wvivis grZeli kunTis Tavebsa da wvivis wina sisxlZarRvovan-nervuli
mcire wvivis Zvals Soris wvivis zeda konis proeqcia kanze didi wvivis
1/3-Si mdebareobs kunT-mcire wvivis xorklsa da mcire wvivis Tavs Soris
arxi (canalis musculoperonealis), romelSic manZilis Sua wertilsa da gojTaSua

klinikuri anatomia 195


manZilis Sua wertils Soris
gavlebul xazs Seesabameba.
mcire wvivis zedapiruli nervi mci-
re wvivis grZeli kunTis Tavebs
Soris arsebuli Sualedidan gareTa
Zval-fasciur budeSi qveviT eSveba da
midamos Sua da qveda mesamedebis
sazRvarze kanqveS gamodis.
wvivis ukana midamo _ regio cruris posterior
kani SedarebiT ufro moZravia, vid-
re wvivis wina midamoSi. kanqveSa
qsovilSi didi da mcire saCino venebi
gaivlis. didi saCino vena saCino
nervTan erTad midamos zeda naxevarSi
didi wvivis medialur kidesTan
mdebareobs. igi aq wvivis wina
midamodan gadmodis. mcire saCino
venis Rero yalibdeba lateraluri
gojis ukan, wvivis qveda naxevarSi
zedapirul da sakuTar fasciebs
Soris mdebareobs. zeda naxevarSi
kanWis kanis medialur nervTan erTad
tyupi kunTis medialur da latera-
lur Tavebs Soris sakuTari fasciis
sisqeSi (pirogovis arxSi) gaivlis,
sabolood sakuTari fasciis qveS
Tavsdeba da muxlqveSa fosos qveda
kuTxeSi muxlqveSa venas erTvis.
kanis inervacia medialur nawilSi
xorcieldeba saCino nervis totebiT,
SuaSi—kanWis kanis medialuri nervis
totebiT da lateralur nawilSi—
kanWis kanis lateraluri nervis
totebiT. kanWis kanis medialuri nervi
midamos zeda naxevarSi mcire saCino
venasTan erTad sakuTari fasciis
sisqeSi mdebareobs, qveda naxevarSi ki
kanqveSa qsovilSia. kanWis kanis late-
raluri nervi kanqveS mdebareobs. qve-
viT kanWis kanis medialuri da late-
klinikuri anatomia
qvemo kiduri
raluri nervebis SeerTebiT iqmneba
kanWis nervi (n. suralis).
sakuTari fascia iyofa zedapirul
da Rrma furclebad. zedapiruli
furceli medialur mxareze didi
wvivis Zvals ukavSirdeba, lateralur
mxareze ki ukana kunTTaSua Zgidis
gamoyofis Semdeg wvivis wina midamoSi
gadadis. SedarebiT ufro sqeli Rrma
furceli wvivis Zvlebsa da ZvalTaSua
apkTan erTad qmnis Rrma fasciur
budes. zedapirul budeSi mdebareobs
tyupi kunTi (m. gastrocnemius),
terfZiris kunTi (m. plantaris) da
quslis kunTi (m. soleus). tyupi kunTis
medialuri da lateraluri Tavebi
iwyeba barZayis Zvlis rokebidan. tyupi
kunTis lateralur TavTan iwyeba mis
qveS mdebare terfZiris kunTi, romlis
wvrili da grZeli myesi tyupsa da
quslis kunTs Soris qveviT eSveba da
quslis myess ukavSirdeba. quslis
kunTi iwyeba didi da mcire wvivis
Zvlebidan da myesovani rkalidan,
romelic gadaWimulia mcire wvividan
quslis kunTis xazamde (linea m. solei).
zedapiruli Sris kunTebi wvivis qveda
mesamedSi erTdeba da qmnis quslis
(aqilevsis) myess, romelic quslis
borcvs umagrdeba.
Rrma fasciur budeSi ganlagebulia
TiTebis grZeli momxreli kunTi (m.
flexor digitorum longus), didi wvivis ukana
kunTi (m. tibialis posterior) da fexis ceris
grZeli momxreli kunTi (m. flexor halucis
longus). medialurad mdebareobs
TiTebis grZeli momxreli kunTi,
romelic didi wvividan iwyeba,
lateralurad—ceris grZeli momxre-
li kunTi, romelic mcire wvividan
iwyeba, SuaSi—didi wvivis ukana kunTi,
196
 qvemo kiduri

romelic wvivis orive Zvlidan da wviv-muxlqveSa arxSi didi wvivis

ZvalTaSua apkidan iwyeba. ukana arterias gamoeyofa mcire wvivis
TiTebis grZeli momxreli kunTis arteria (a. peronea), romelic gareTken
myesi midamos qveda mesamedSi uknisken ixreba, ceris grZel momxrel kunTze
iwevs da didi wvivis kunTis myesze gadadis da mcire wvivis gaswvriv
Tavsdeba ise, rom medialuri gojis lateraluri gojisken miemarTeba.
zemoT win mdebareobs didi wvivis qveda nawilSi arteria mdebareobs
ukana kunTis myesi, ukan—TiTebis mcire wvivis kunTebis ukan quslis
grZeli momxreli kunTis myesi, ufro myesis lateralurad wvivis fasciis
ukan da lateralurad—ceris grZeli Rrma furclis qveS; anastomoziT ukav-
momxreli kunTi. Sirdeba didi wvivis ukana arterias
kunTebis zedapirul da Rrma da grZeldeba gamgmirav totSi (r.
Sreebs Soris gaivlis: medialurad perforans), romelic ZvalTaSua apkSi
didi wvivis ukana arteria Tanamgzavri gaivlis, wina budeSi gadadis da
venebiT da didi wvivis nervi, xolo terfis dorsalur arterias
lateralurad—mcire wvivis arteria ukavSirdeba. garda amisa, mas gamoeyo-
Tanamgzavri venebiT. didi wvivis ukana fa totebi, romlebic monawileoben
sisxlZarRovan-nervuli konis budes lateraluri gojisa da quslis arte-
qmnis wvivis sakuTari fasciis Rrma riuli badis SeqmnaSi. mcire wvivis
furceli. arteria proecirdeba mcire wvivis
muxlqveSa arteria muxlqveSa kun- Tavidan 2sm SigniT mdebare
Tis qveda kidesTan iyofa didi wvivis wertilidan lateraluri gojis ukana
wina da ukana arteriebad. didi wvivis kidemde gavlebul xazze.
wina arteria ZvalTaSua apkis zeda didi wvivis nervi wviv-muxlqveSa
kideSi arsebuli xvreliT gadadis arxSi gasvlisas wvivis ukana arteriis
wvivis wina midamoSi. didi wvivis ukana lateralurad mdebareobs, mcire
arteria Tanamgzavr venebTan da didi wvivis arteriis dasawyiss uknidan
wvivis nervTan erTad gaivlis quslis gadauvlis, qveviT TandaTan
kunTis myesovan rkalsa da muxlqveSa medialurad iwevs da zogjer didi
kunTis qveda kides Soris da gadadis wvivis ukana arteriis ukan Tavsdeba.
wviv-muxlqveSa arxSi (canalis cruro- fasciuri budeebis Sesabamisad wvi-
popliteus), romlis wina kedels qmnis vis ukana midamoSi arsebobs
didi wvivis ukana kunTi, xolo ukana zedapiruli da Rrma
kedels—wvivis fasciis Rrma SemaerTebelqsovilovani sivrceebi,
furceli. arxis zeda xvrels uknidan saidanac Cirqovani procesi SeiZleba
mosazRvravs arcus tendineus m. solei, xolo sxvadasxva mimarTulebiT gavrceldes.
winidan —muxlqveSa kunTis qveda kide. zedapiruli SemaerTebelqsovilovani
qveda xvreli winidan mosazRvrulia sivrce qveviT gadadis quslis myesisa
didi wvivis ukana kidiT, uknidan—qus- da sinoviuri abgebis irgvliv
lis myesiT. didi wvivis ukana sisxl- arsebul SemaerTebelqsovilovan
ZarRvebi da didi wvivis nervi qveviT napralSi. Rrma SemaerTebelqso-
gadadis medialuri gojis arxSi. vilovani sivrce ZvalTaSua apkSi ar-

klinikuri anatomia 197

 qvemo kiduri

sebuli xvreliT dakavSirebulia wvi- Tan axlavs proqsimaluri natexebis

vis wina fasciur budesTan, wvivis Secileba win da SigniT (barZayis
ukana sisxlZarRvebis gaswvriv— oTxTava kunTisa da im kunTebis
terfis Sua SemaerTebelqsovilovan myesebis ZaliT, romlebic did wvivze
sivrcesTan, zeviT —muxlqveSa qmnian e.w. batis fexs), xolo
fososTan, xolo aqedan—sajdomi distaluri—ukan da gareT (kanWis
nervis gaswvriv—barZayis ukana Sema- samTava kunTis moqmedeba da terfis
erTebelqsovilovan sivrcesTan da simZimis gavlena). am motexilobis
barZayis sisxlZarRvebis gaswvriv— SemTxvevaSi terfi daSvebulia da
barZayis wina SemaerTebelqsovilovan mobrunebulia gareTken.
sivrcesTan. praqtikuli mniSvneloba aqvs imas,
wvivis Zvlebis motexiloba. wvivis rom wvivis Zvlebis motexilobis dros
Zvlebis motexilobaTa Soris pirveli mwvave periodSi erTi Zvlis natexebis
adgili, sixSiris mixedviT, wvivis sigrZivi dacileba SesaZlebelia
orive Zvlis erTdroul motexilobas mxolod maSin, rodesac motexilia an
uWiravs, meore adgilzea didi wvivis, amovardnilia wvivis meore Zvali. Tu
xolo mesameze—mcire wvivis motexilobis midamos rentgenograma
motexiloba. amas ar adasturebs, maSin
wvivis orive Zvlis motexiloba ga- aucilebelia motexilobis adgilidan
mowveulia umTavresad Zalis uSualo daSorebiT meore Zvlis motexilobis
zemoqmedebiT (dartyma, simZimis an amovardnilobis moZieba.
dacema). iSviaTad igi Sedegia Zalis mcire wvivis Zvlis izolirebuli
arapirdapiri zemoqmedebisa motexilobis dros natexTa dacileba
(simaRlidan terfebze dacema, umniSvneloa da umTavresad siganeSi
fiqsirebuli terfis pirobebSi ki- xdeba. Secileba sigrZeSi ar
duris motrialeba Tavisi RerZis irgv- aRiniSneba, radganac dauzianebeli
liv). wvivis orive Zvlis motexiloba didi wvivis Zvali TiTqos Sinagani
yvelaze xSiria wvivis Sua da qveda artaSnis rols asrulebs motexili
mesamedis sazRvarze, sadac didi mcire wvivis ZvlisTvis. mcire wvivis
wvivis Zvali ufro wvrilia. am Tavis motexilobis dros
adgilze igi yvelaze nakleb wina- SesaZlebelia mcire wvivis saerTo
aRmdegobas uwevs garegani Zalis ze- nervis dazianeba.
moqmedebas. sxva Zvlebis motexilobasTan Seda-
wvivis Zvlebis motexilobisas nate- rebiT gacilebiT xSiria wvivis
xebis Secilebis xasiaTs gansazRvravs Zvlebis Ria motexilobebi, rac
wvivis kunTebi. wvivis orive Zvlis ganpirobebulia misi anatomiuri
zeda mesamedSi motexilobis dros TaviseburebebiT. Zvlebis zedapiruli
proqsimaluri natexi barZayis oTxTava mdebareobisa da Zlieri kunTovani
kunTis SekumSvis gavleniT wamoweulia Sris ar arsebobis gamo didi wvivis
mkveTrad win, xolo distaluri natexi Zvlis maxvilwverian natexebs
dacilebulia ukan. wvivis Zvlebis SeuZliaT gaglijon rbili qsovilebi
motexilobas Sua da qveda mesamedebSi wvivis wina zedapirze. warmoiqmneba

klinikuri anatomia 198

 qvemo kiduri

Wriloba, romelSic gamoCrilia extrensorum inferius), romelic quslis

proqsimaluri natexis wvetiani bolo. Zvlis lateraluri zedapiridan erTi
zogjer ziandeba wvivis wina sisxl- nawiliT miemarTeba medialuri
ZarRvovan-nervuli kona. gojisken, xolo meore nawiliT—
navisebri Zvlis xorklisken (tuberositas
koW-wvivis saxsris midamo _ regio ossis navicularis). gamSlelTa sabmeli did
articularis talocruralis wvivsa da koW-wvivis saxsarTan erTad
sazRvrebi: zevidan—gojebis fuZeeb- qmnis sam Zval-fibrozul arxs,
ze da qvevidan—gojebis mwvervalebze romlebSic sinoviuri budeebiT
gavlebuli horizontaluri garemoculi myesebi gaivlis. medialur
sibrtyeebi. arxSi gaivlis wvivis wina kunTis
gverdebze isinjeba gojebi, romel- myesi, Sua arxSi—fexis ceris grZeli
Tagan lateraluri SedarebiT viwroa gamSleli kunTis myesi, lateralur
da 1,5_2sm-iT ufro dabla eSveba, arxSi—TiTebis grZeli gamSleli
vidre—medialuri. ukan kargad aris kunTis oTxi myesi da arcTu iSvi-
gamoxatuli quslis (aqilevsis) myesis aTad—mcire wvivis mesame kunTis myesi.
mier Seqmnili SemaRleba. terfis wvivis wina arteria Tanamgazvr ve-
dorsalurad moxrisas wina zedapirze nebsa da mcire wvivis Rrma nervTan er-
gojebs Soris isinjeba wvivis wina, Tad gaivlis Sua Zval-fibrozul
fexis ceris grZeli momxreli da zog- arxSi. aq igi ceris grZeli kunTis
jer TiTebis grZeli momxreli kunTe- myesis sinoviuri budis ukan da
bis myesebi. gojebis SemaerTebeli lateralurad mdebareobs.
xazis Sua wertilSi SeiZleba wvivis koW-wvivis saxsris midamos ukana
wina arteriis pulsaciis gasinjva. nawili gverdebidan moisazRvreba
koW-wvivis saxsris midamoSi wina, quslis myesis kideebiT.
ukana, medialuri da lateraluri kani SedarebiT sqelia. kanqveSa qso-
nawilebi gamoiyofa. vili ganviTarebulia sustad, Seicavs
koW-wvivis saxsris midamos wina arteriul anastomozebs, romlebsac
nawili gverdebidan mosazRvrulia didi wvivis arteriis quslis toti,
medialuri da lateraluri gojebiT. mcire wvivis arteriis quslis toti
kani Txeli da moZravia, kanqveSa da terfZiris arteriebis totebi
qsovili ganviTarebulia sustad. qmnis. xSirad kanze advili SesamCnevia
medialur gojze zedapiruli fasciis ganivad mimarTuli vena, romelic didi
sisqeSi gaivlis didi saCino vena, da mcire saCino venebis SenakadebTan
romelsac xSirad iyeneben intravenuri aris dakavSirebuli.
ineqciisTvis. masTan erTad saCino sakuTari fascia rogorc wvivis
nervi mdebareobs. medialuri gojis ukana midamoSi, aqac gayofilia
lateralurad aseve zedapiruli fas- zedapirul da Rrma furclebad,
ciis sisqeSi gaivlis mcire wvivis ze- romelTa Soris mdebareobs quslis
dapiruli nervis totebi. myesi da faSari cximovani qsovili.
sakuTari fascia qmnis gamSleli quslis myesis win quslis borcvze
kunTebis qveda sabmels (retinaculum mm. mdebareobs sinoviuri abga.

klinikuri anatomia 199


koW-wvivis saxsris midamos medi-
aluri nawili winidan moisazRvreba
medialuri gojiT, uknidan—quslis
myesis medialuri kidiT.
kani Txeli da mcired moZravia. kan-
qveSa venebi erTvis did saCino venas.
sakuTari fascia gamkvrivebulia da
qmnis momxrelebis sabmels, romelic
medialur gojsa da quslis Zvals
Soris aris gadaWimuli. medialur
gojsa da quslis ZvalTan erTad igi
mosazRvravs medialuri gojis arxs,
romelSic gaivlis fibrozuli da
sinoviuri budeebiT garemoculi momx-
reli kunTebis myesebi da wvivis ukana
sisxlZarRvovan-nervuli kona. igi
erTmaneTTan akavSirebs wvivis ukana
Rrma da terfZiris Rrma
SemaerTebelqsovilovan sivrceebs. ar-
xSi yvelaze win medialuri gojis
ukana zedapirze arsebul RarSi gaiv-
lis didi wvivis ukana kunTis myesi,
mis ukan—TiTebis grZeli momxreli
kunTis myesi da kidev ufro ukan—
ceris grZeli momxreli kunTis myesi,
romlis sinoviuri bude zogjer
dakavSirebulia koW-wvivis saxsris
RrusTan. momxrelebis sabmelis dista-
lurad TiTebis grZeli momxreli
kunTis myesi mqvemodan iribad gada-
uvlis ceris grZeli momxreli kunTis
myess.
sisxlZarRvovan-nervuli kona medi-
aluri gojis arxSi gaivlis TiTebis
grZeli momxreli da ceris grZeli
momxreli kunTebis myesebis fibrozul
budeebs Soris arsebul RarSi.
amasTan, nervi mdebareobs arteriis
ukan da lateralurad. arteria da
nervi gamoyofs totebs quslisTvis da
arxSi an arxidan gamosvlisas iyofa
mTavar totebad (terfZiris medialur
klinikuri anatomia
qvemo kiduri
da lateralur arteriebad da nerve-
bad), romlebic TiTebis grZeli momx-
reli da ceris grZeli momxreli
kunTebis myesebTan erTad terfze
quslis arxSi gadadian. es ukanaskneli
mosazRvrulia ceris ganmzidveli
kunTis dasawyisi nawiliTa da quslis
qveda medialuri zedapiriT.
sisxlZarRvovan-nervuli kona
myesebTan SedarebiT ufro
zedapirulad mdebareobs ise, rom aq
SeiZleba arteriis pulsaciis
gasinjva. arteriis proeqcia kanze See-
sabameba ukan da qvemoT gamodrekil
rkalovan xazs, romelic medialuri
gojidan 2sm-iT ukan gaivlis.
koW-wvivis saxsris midamos latera-
luri nawili lateralur gojsa da
quslis myess Soris mdebareobs.
kani moZravia. kanqveSa qsovilSi
arcTu iSviaTad mdebareobs sinoviuri
abga, agreTve mcire saCino vena da
kanWis nervi, romelTa proeqcia
Seesabameba lateralur gojsa da
quslis myess Soris manZilis Sua
wertilisa da wina terfis V Zvlis
borcvis SemaerTebel xazs. aqac
sakuTari fascia gasqelebulia da
qmnis mcire wvivis kunTebis zeda da
qveda sabmelebs (retinaculi mm.
pereneorum superius et inferius),
romlebic lateraluri gojidan
quslis Zvlamde arian gadaWimuli.
sabmelebis qveS myesebi aqac sinoviuri
budiT aris garemoculi da Zval-
fibrozul arxebSi mdebareobs. zeda
sabmelis qveS isini mdebareoben
saerTo sinoviur budeSi, qveda sabme-
lis qveS ki—cal-calke sinoviur
budeebSi. win mdebareobs mcire wvivis
mokle kunTis myesi, ukan—mcire wvivis
grZeli kunTis myesi.
200
 qvemo kiduri

mcire wvivis arteria gaivlis myese- mTlianobis darRvevisas. xSiria

bis ukan. aq mas gamoeyofa gamgmiravi garTuleba gojebis an didi wvivis
toti, wvivis ukana arteriasTan Zvlis ukana kidis motexilobiT.
SemaerTebeli toti da saboloo amovardnilobis gamosawvevad saWiroa
totebi. mniSvnelovani travma terfis motri-
alebiT. arCeven terfis amovardni-
koW-wvivis saxsari _ articulatio talocruralis lobas gareT, SigniT, win da ukan.
koW-wvivis saxsarSi wvivis Zvlebis iSviaTad gvxvdeba terfis Secileba
qveda boloebi esaxsreba quslis zeviT.
Zvlis zeda (WaRisebr) da gverdiT terfis amovardniloba gareT
zedapirebs. saxsris naprali winidan viTardeba terfis mkveTri pronaciis
proecirdeba gojebis fuZeebis momentSi da vertikaluri RerZis
SemaerTebel xazze. irgvliv misi Semotrialebisas. am
iogovani aparati sakmaod mZlavria. dros Cveulebriv adgili aqvs gareTa
igi Sedgeba deltisebri da sami gojis motexilobas. xSirad iglijeba
gareTa iogisgan. yvelaze Zlieria wvivTaSorisi sindesmozi.
deltisebri iogi (lig. deltoideum), terfis mkveTri supinaciisas tydeba
romelic iwyeba medialur gojze, SigniTa goji da mTeli terfi
qveviT maraosebr iSleba da umagrdeba Secildeba SigniT. miiReba terfis
koWis, quslisa da navisebr Zvlebs. amovardniloba SigniT.
lateraluri iogebi iwyeba late- terfis forsirebuli plantaruli
ralur gojze da umagrdeba koWis moxris dros viTardeba terfis ukana
Zvlis wina da ukana kideebsa da amovardniloba. am dros xSirad
quslis Zvals. winidan da uknidan aRiniSneba iogovani aparatis
saxsari moklebulia iogebs, magram mTlianobis darRveva, adgili aqvs
gamagrebulia myesebiT. win didi wvivis mcire wvivis Zvlisa da didi wvivis
wina, ceris grZeli gamSleli da Zvlis ukana kidis motexilobebs.
TiTebis saerTo gamSleli kunTebis terfis wina amovardniloba Sedare-
myesebia, ukan—ceris grZeli momxreli biT iSviaTia. igi viTardeba terfis
kunTis myesi. wvivis Zvlebis mkveTri eqstenziis momentSi da
sindesmozi gamagrebulia wvivTaSua terfze uknidan wina mimarTulebiT
wina da ukana iogebiT. dartymisas, anda fiqsirebuli terfis
sasaxsre CanTa farToa. igi Zvlebis pirobebSi didi wvivis Zvlis wina
sasaxsre zedapirebis kideebs zedapirze dartymis momentSi.
umagrdeba. dazianebis aseTi meqanizmis dros
saxsars sisxliT amaragebs didi sasaxsre CanTa iglijeba, Cveulebriv
wvivisa da mcire wvivis arteriebi. xdeba didi wvivis Zvlis sasaxsre
inervacia—kanWis, saCino da mcire zedapiris wina kidis motexiloba,
wvivis Rrma nervebiT. amasTan koWis Zvlis WaRi dacurdeba
amovardniloba koW-wvivis saxsarSi. win. terfi dagrZelebuli Cans. ukan
koW-wvivis saxsarSi amovardnilobebi isinjeba daWimuli aqilevsis myesi (Tu
xdeba Cveulebriv iogovani aparatis

klinikuri anatomia 201

 qvemo kiduri

igi gawyvetili araa) da didi wvivis romelic TiTTaSua naoWidan 2_ 2,5sm-

Zvlis ukana kide. iT proqsimalurad gaivlis.
simaRlidan fexebze dacemisas SeiZ-
leba moxdes quslis Zvlis terfis zurgi
motexiloba, gojebis saxsarSiga kani Txeli da moZravia, kanqveSa
motexiloba anda wvivTaSorisi qsovili ganviTarebulia SedarebiT
sindesmozis gagleja. koWis Zvali sustad da Raribia cximiT.
wvivis Zvlebs erTmaneTisgan gaTiSavs zedapiruli fasciis sisqeSi venuri
da mTeli terfi Secildeba zeviT. wnulia (rete venosum dorsalis pedis). misgan
medialur mxareze iwyeba didi saCino
terfis midamo _ regio pedis vena, romelic medialur gojze
terfze xeliT isinjeba quslis Zva- gadadis, xolo lateralur mxareze —
li, medialuri gojis qveS—koWis mcire saCino vena, romelic
sabjeni (sustentaculum tali), terfis lateraluri gojis ukan gaivlis.
medialur kideze, Sua adgilas, venuri wnuli distalurad
medialuri gojidan 4sm-iT win— dakavSirebulia terfis dorsalur
navisebri Zvlis xorkli (tuberositas ossis venur rkalTan (arcus venosus dorsalis pedis),
navicularis), am ukanasknelidan 3sm-iT romelic sisxls wina terfis
win—wina terfis I Zvlis fuZe da uf- dorsaluri venebidan Rebulobs.
ro win—misi Tavi. terfis gareTa venebis qveS gaivlis saCino, kanWis,
mxareze, lateraluri gojidan 2,5sm-iT mcire wvivis zedapiruli da Rrma
qvemoT SeiZleba mcire wvivis WaRis nervebis totebi. saCino nervi terfis
(trochlea peronealis) mosinjva. terfis medialuri kidis Sua nawils aRwevs.
lateralur kideze, Sua adgilas kanWis nervi terfze grZeldeba kanis
Sverilia, romelsac qmnis wina terfis dorsalur lateralur nervSi (n.
V Zvlis xorkli (tuberositas ossis metatarsi cutaneus dorsalis lateralis), amaragebs kans
V). dorsalurad moxril terfze, lateralur kideze da IV_V TiTebis
Cveulebriv, SeimCneva wvivis wina, erTmaneTisken miqceul zedapirebze.
ceris grZeli gamSleli da TiTebis mcire wvivis zedapiruli nervis tote-
grZeli gamSleli kunTebis myesebi. bia kanis dorsaluri medialuri nervi
ceris grZeli gamSleli kunTis myesis (n. cutaneus dorsalis medialis), romelic
lateralurad, gojTaSua wertilidan anervebs terfis medialuri naxevrisa
I da II TiTTaSua napralamde da ceris SigniTa zedapiris kans, da
gavlebul xazze isinjeba terfis kanis dorsaluri Suamdebare nervi (n.
dorsaluri arteriis pulsacia. cutaneus dorsalis intermedius), romelic
terfis zurgsa da terfis Zirs So- anervebs II da III TiTebis
ris sazRvari gaivlis terfis erTmaneTisken miqceuli zedapirebis
medialur da lateralur kideebze. kans. mcire wvivis Rrma nervi I da II
TiTebisgan terfi ganisazRvreba win TiTebis erTmaneTisken miqceuli
gamodrekili rkalovani xaziT, zedapirebis kans anervebs.

klinikuri anatomia 202

 qvemo kiduri

sakuTari fascia wvivis fasciis profundus), romelic wina terfis I

gagrZelebaa. mis furclebs Soris da II Zvlebs Soris gaivlis da terfis
gamSleli kunTebis myesebi mdebareobs. Ziris lateralur arterias
cerisa da TiTebis mokle gamSleli eanastomozeba.
kunTebi (m. extensor halucis brevis et m. wina terfis dorsaluri arteriebi
extensor digitorum brevis) iwyeba quslis (aa. metatarseae dorsales) wina terfis
Zvlidan, mdebareobs sakuTari fasciis Zvlebis Tavebis doneze TiTebis
qveS wina terfis Zvlebsa da dorsalur arteriebad iyofa. wina
ZvalTaSua kunTebze. terfis dorsaluri arteriebidan
grZeli gamSleli kunTebis myesebis gamodis wina da ukana gamgmiravi
medialurad mdebareobs didi wvivis totebi, romlebic wina terfis Zvlebs
wina kunTis myesi, romelic medialur Soris gaivlian da terfZiris arte-
solisebr Zvalsa da wina terfis I riebs ukavSirdebian.
Zvlis fuZes umagrdeba, SuaSi—ceris mcire wvivis Rrma nervi, romelic
grZeli gamSleli kunTis myesia, wvivze Tanamgzavri sisxlZarRvebis
lateralurad—TiTebis grZeli lateralurad mdebareobs, gojebis
gamSleli kunTis myesebia, ufro la- doneze maT ejvaredineba da terfis
teralurad—mcire wvivis aramudmivi zurgze medialurad Tavsdeba. anervebs
mesame kunTis myesi, romelic wina TiTebis mokle gamSlel kunTs da I_II
terfis V Zvlis xorkls umagrdeba. TiTebis erTmaneTisken miqceuli
sisxlZarRvovan-nervuli kona saku- zedapirebis kans.
Tari fasciis qveS mdebareobs. Seicavs
terfis dorsalur arterias terfis Ziri
Tanamgzavri venebiT da mcire wvivis kani mkvrivi, sqeli da mcired moZ-
Rrma nervs, gaivlis ceris grZeli ravia (gansakuTrebiT quslze da wina
gamSleli kunTis myesis la- terfis Zvlebis Tavebis areSi).
teralurad. distalur nawilSi mas kanqveSa qsovili ganviTarebulia
zevidan gadauvlis ceris mokle kargad, Seicavs didi raodenobiT
gamSleli kunTis myesi. fibrozul konebs, romlebic dakav-
ukana terfis areSi terfis dorsa- Sirebuli arian terfis Ziris aponev-
lur arterias gamoeyofa ukana terfis rozTan. I da V wina terf-falangis
lateraluri arteria (a. tarsea lateralis), saxsrebisa da quslis borcvis kanqveS
ukana terfis medialuri arteria (a. sinoviuri abgebia.
tarsea medialis) da rkalovani arteria (a. terfis Ziris aponevrozi (aponeurosis
arcuata), romelic TiTebis mokle plantaris) Zlier mkvrivi myesovani fir-
gamSleli kunTis qveS gaivlis da fitaa, romelic quslis borcvidan
gamoyofs wina terfis II_IV dorsalur iwyeba da wina terfis Zvlebis
arteriebs. wina terfze terfis Tavebamde vrceldeba. ukana nawilSi
dorsalur arterias gamoeyofa wina igi SedarebiT viwro da sqelia, vidre
terfis I dorsaluri arteria da wina nawilSi; wina terfze gayofilia
terfZiris Rrma toti (r. plantaris 4_5 nawilad, romlebic momxreli
kunTebis myesebs faraven. distalur

klinikuri anatomia 203

 qvemo kiduri

boloSi es nawilebi SeerTebulia TiTebis grZeli momxreli kunTis

erTmaneTTan ganivi fibrozuli myess calkeuli TiTebis myesebad
konebiT (fasciculi transversi) ris gamoc aq gayofamde umagrdeba terfZiris
aponevrozSi Seqmnilia komisuruli kvadratuli kunTi (m. quadratus plantae),
xvrelebi, romlebSic TiTebis sisxl- romelic quslis Zvlis qveda
ZarRvebi, nervebi da Wiayela kunTebi zedapiridan iwyeba. TiTebis grZeli
gaivlis. momxreli kunTis myesebidan iwyeba Wia-
aponevrozidan siRrmeSi eSveba yela kunTebi, romlebic II_V TiTebis
SigniTa da gareTa kunTTaSua Zgideebi, dorsalur aponevrozs umagrdebian.
romlebic terfZiris Rrma (ZvalTaSua) TiTebis grZeli momxreli kunTis
fascias uerTdebian. SigniTa Zgide myesebis qveS terfis Ziris ZvalTaSua
eSveba terfis Ziris medialur RarSi, fasciaze mdebareobs fexis ceris
romelic TiTebis mokle momxrel da momzidveli kunTis (m. adductor halucis)
ceris ganmzidvel kunTebs Soris iribi da ganivi Tavebi. iribi Tavi
mdebareobs, gareTa Zgide—terfis iwyeba kuburi Zvlidan, lateraluri
Ziris lateralur RarSi, romelic solisebri Zvlidan da wina terfis
TiTebis mokle momxrel kunTsa da II_IV Zvlebidan. ganivi Tavi iwyeba II_V
nekis momzidvel kunTs Soris terf-falangis sasaxsre CanTebidan da
mdebareobs. terfZiris iogebidan da irib TavTan
terfis Ziris aponevrozis qveS erTad umagrdeba fexis ceris
arsebul sivrces kunTTaSua Zgideebi lateralur sesamur Zvals. am kunTis
yofs sam fasciur buded, romelTagan iribi Tavis ukan terfZiris grZel
medialurSi moTavsebulia ceris iogSi gaivlis mcire wvivis grZeli
kunTebi, lateralurSi—nekis kunTebi, kunTis myesi, romelic medialur
SuaSi—danarCeni kunTebi. kunTTaSua solisebr da wina terfis pirvel
Zgideebi ufro mkveTrad aris Zvlebs umagrdeba.
gamoxatuli wina terfis wina nawilSi. medialuri fasciuri budis ukana
Sua budeSi zedapirulad, uSualod nawilSi mdebareobs fexis ceris ganm-
aponevrozis qveS mdebareobs TiTebis zidveli kunTi (m. abductor halucis), wina
mokle momxreli kunTi (m. flexor nawilSi—fexis ceris mokle
digitorum brevis), romelic terfZiris momxreli kunTi (m. flexor halucis brevis) da
aponevrozidan da quslis Zvlidan ceris grZeli momxreli kunTis myesi.
iwyeba. TiToeuli misi myesi Sesabamisi medialuri budis proqsimaluri
TiTis proqsimaluri falangebis areSi nawili igive quslis arxia, romelic
iyofa or fexad, romlebic Sua quslis Zvalsa da ceris ganmzidvel
falangebis fuZeebs umagrdebian. kunTs Soris mdebareobs. fibrozuli
TiTebis grZeli momxreli kunTis ZgidiT arxi iyofa wina da ukana
myesi mokle momxreli kunTis qveS nawilebad. wina nawilSi gaivlis fe-
iyofa 4 calkeul myesad, romlebic xis cerisa da TiTebis grZeli
TiTebis mokle momxreli kunTis momxreli kunTebis myesebi, ukana
fexebs Soris gaivlian da distaluri nawilSi—terfZiris kvadratuli
falangebis fuZeebs umagrdebian.

klinikuri anatomia 204

 qvemo kiduri

kunTi da terfis lateraluri momzidvel kunTebs Soris. Sua bude

sisxlZarRvovan-nervuli kona. medi- terfis dorsaluri da terfZiris
aluri kona mdebareobs terfZiris ar- lateraluri arteriebis
xis wina da ukana nawilebad gamyof urTierTdamakavSirebeli anastomozis
ZgideSi. gaswvriv ukavSirdeba terfis dorsa-
terfis Ziris lateraluri fasci- lur subfasciur sivrces, Wiayela
uri bude uWiravs nekis ganmzidvel da kunTebis gaswvriv—TiTTaSua
nekis mokle momxrel kunTebs (m. naoWebisa da TiTebis dorsalur
abductor digiti minimi et flexor digiti minimi). kanqveSa SemaerTebel qsovils, wina
lateraluri da medialuri budeebi terfisa da TiTebis plantaruli
ufro izolirebulia, vidre Sua bude, arteriebis gaswvriv—komisuruli
romelic wvivis ukana Rrma budesTan xvrelebiT—terfis Ziris kanqveSa qso-
dakavSirebulia terfis Ziris arxiT. vils, ceris grZeli momxreli kunTis
es ukanskneli proqsimaluri myesis gaswvriv—medialur fasciur
mimarTulebiT grZeldeba jer quslis budes, nekis momxreli kunTis myesisa
arxSi, xolo Semdeg medialuri gojis da terfZiris lateraluri
arxSi, romelic wvivis ukana midamos sisxlZarRvebis gaswvriv—lateralur
Rrma fasciur budeSi gadadis. budes, ceris grZeli momxreli kunTis
terfis Ziris arxi mdebareobs ukana myesisa da wvivis ukana sisxl-
terfis Rrma SreSi, terfis TaRis ZarRvovan-nervuli konis gaswvriv—
qveS. mis kedlebs qmnis: gverdebze wvivis ukana midamos Rrma fasciur
kunTTaSua fasciuri Zgideebi, zeviT— budes.
terfZiris grZeli iogi (lig. plantare terfis Ziris sisxlZarRvebi da
longum), qveviT—Rrma fascia, romelic nervebi. wvivis ukana arteria
TiTebis mokle gamSlel da terfis medialuri gojis ukan iyofa
Ziris kvadratul kunTs Soris terfZiris medialur da lateralur
mdebareobs. distalurad terfis Ziris arteriebad. terfZiris medialuri
arxi ukavSirdeba Sua fasciur budes. arteria Tanamgzavr venebTan da
terfis Ziris arxSi mdebareobs nervebTan erTad Sua da medialuri
terfis Ziris kvadratuli kunTi, fasciuri budeebis ZgideSi gaivlis,
TiTebisa da ceris grZeli momxreli awvdis totebs orive mosazRvre
kunTebis myesebi, terfis Ziris budeSi mdebare kunTebs da iyofa
medialuri da lateraluri sisxlZar- zedapirul da Rrma totebad.
Rvovan-nervuli konebi. zedapiruli toti amaragebs terfis
terfis Ziris Sua bude zedapirul medialur kides, Rrma toti—ceris
da Rrma SemaerTebelqsovilovan kunTebs da anastomoziT ukavSirdeba
sivrceebad iyofa. zedapiruli wina terfis I plantarul arterias
SemaerTebelqsovilovani sivrce (terfZiris lateraluri arteriis
mdebareobs TiTebis mokle da grZel toti).
momxrelebs Soris, Rrma sivrce—Ti- terfis lateraluri arteria Seda-
Tebis grZel momxrel da ceris rebiT ufro msxvilia. igi Tanamgzavr
venebTan da nervTan erTad gaivlis

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 qvemo kiduri

TiTebis mokle momxreli kunTis konebs. terf-TiTis naoWSi igi

myessa da terfZiris kvadratul kunTs SedarebiT Txelia.
Soris, wina terfze mdebareobs TiTebis dorsalur aponevrozTan
lateraluri kunTTaSua Zgidisa da dakavSirebulia gamSleli kunTebis
terfis Ziris Rrma fasciis SesayarSi. myesebi. fexis ceris grZeli da mokle
wina terfis Zvlebis fuZeebis areSi gamSleli kunTebis myesebi umagrdeba
terfZiris lateraluri arteria qmnis distaluri falangis fuZes, konebiT
rkals, romelic terfis Ziris ZvalTa- ukavSirdeba proqsimalur falangsac.
Sua aponevrozis sisqeSi mdebareobs. II_V TiTebis gamSleli kunTebis
wina terfis I da II ZvalTa Soris igi myesebi gverdiTi nawilebiT umagrdeba
anastomoziT ukavSirdeba terfis distaluri falangebis fuZeebs, Sua
dorsaluri arteriis terfZiris Rrma nawilebiT—Sua falangebis fuZeebs.
tots. proqsimaluri falangebis fuZeebTan
rkalis Seqmnamde terfis latera- myesi damagrebulia irgvlivi da
luri arteriidan gamodis IV da V jvaredini iogebiT.
TiTebis saerTo arteria. rkalidan momxreli kunTebis myesebi TiTebze
gamodis wina terfis plantaruli moTavsebulia Zval-fibrozul arxebSi,
arteriebi (aa. metatarsea plantares) II da maTi sinoviuri budeebi, terf-
III TiTebisTvis da totebi Rrma Sris falangTa saxsridan distalur
kunTebisTvis. falangTa fuZeebamde vrceldeba. II_V
terfZiris medialuri nervi TiTebis mokle momxreli kunTis
anervebs fexis ceris kunTebs, TiTebis myesebi boloSi or fexad iyofa da
mokle momxrel kunTs, I_III TiTebis Sua falangebis fuZeebs umagrdeba.
plantaruli zedapirisa da IV TiTis grZeli momxreli kunTis myesebi
medialuri zedapiris kans. mokle momxreli kunTis myesebis
terfZiris lateraluri nervi mTel fexebs Soris gaivlis da distaluri
sigrZeze mdebareobs arteriis falangebis fuZeebs umagrdeba. fexis
lateralurad. igi anervebs nekis ceris mokle moxreli kunTi umagrdeba
kunTebs, fexis ceris momzidvel Sesabamis terf-falangis saxsris
kunTs, terfis kvadratul kunTs, or sesamoidur Zvlebs, grZeli momxreli
lateralur Wiayela da ZvalTaSua kunTis myesi—distaluri falangis
kunTebs, IV TiTis lateraluri zeda- fuZes.
pirisa da V TiTis plantaruli sisxlZarRvebi da nervebi ganlage-
zedapiris kans. bulia TiTebis dorsalur da planta-
rul zedapirebze, maTi gverdiTi
fexis TiTebi kideebis maxloblad. TiTebis
dorsalur zedapirze kani Txeli dorsaluri arteriebi wina terfis
da moZravia, plantarul zedapirze dorsalur arteriebs gamoeyofa.
ufro sqeli da mkvrivia. kanqveSa dorsaluri nervebi I, II, III TiTe-
qsovili dorsalur mxareze sustadaa bisa da IV TiTis medialuri
ganviTarebuli, plantarul mxareze naxevrisTvis gamoeyofa mcire wvivis
mkvrivi da sqelia, Seicavs fibrozul zedapirul nervs, IV TiTis

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 qvemo kiduri

lateraluri naxevrisa da V TiTis- mdebareobs. es ori sxvadasxva saxsari

Tvis—kanWis nervs. pirveli ori TiTis (koW-navisebri da qusl-kuburi
erTmaneTisken miqceuli zedapirebi saxsrebi) moTavsebulia erT xazze da
Rebulobs totebs mcire wvivis Rrma qirurgiuli TvalsazrisiT gani-
nervisgan. xileba, rogorc ukana terfis ganivi,
TiTebis plantaruli arteriebi anu Soparis saxsari (articulatio tarsi
dorsalur arteriebTan SedarebiT transversa), romelic Sedgeba koW-
ufro ganviTarebulia, gamodis wina navisebr da qusl-kuburi saxsrebisgan
terfis plantaruli arteriebidan da (articulationes talonavicularis et
TiTebis boloebSi qmnis wnulebs. calcaneocuboidea). igi gamagrebulia
plantaruli nervebi I, II, III TiTebisa Zlieri orkapi iogiT (lig. bifurcatum)
da IV TiTis medialuri naxevrisTvis (Soparis gasaRebi), romelic quslis
gamodis terfZiris medialuri Zvals navisebr da kubur ZvlebTan
nervidan, IV TiTis lateraluri akavSirebs. garda amisa, koW-navisebri
naxevrisa da V TiTisTvis—terfis Zi- saxsari gamagrebulia didi wvivis wina
ris lateraluri nervidan. da ukana kunTebis myesebiT. garedan
mas esazRvreba qusl-kuburi saxsari
terfis saxsrebi da ukana terfis ube. Soparis saxsris
terfis ConCxs Seadgens ukana ter- meore nawils—qusl-kubur saxsars,
fis 7 Zvali, wina terfis—5 Zvali da garda amisa, amagrebs TiTebis mokle
14 falangi. ukana terfi iyofa ukana gamSleli kunTi da nekis ganmzidveli
da wina nawilebad. ukana nawils kunTi, terfis Ziris mxridan —grZeli
miekuTvneba quslisa da koWis Zvlebi, iogebi da terfis kvadratuli kunTi.
wina nawils—naviseburi, kuburi da saxsris xazi medialuri gojidan dis-
soliseburi Zvlebi. talurad daSorebulia 2,5_3sm-iT,
koWisa da quslis Zvlebi qmnis koW- lateraluri gojidan—4_4,5sm-iT.
qveSa saxsars (articulatio subtalaris). koWis saxsari gamagrebulia orkapi iogiT
Zvali, garda amisa, quslisa da navi- anu Soparis gasaRebiT, romelic qus-
sebur ZvlebTan qmnis koW-qusl- lis Zvals navisebr da kubur
navisebur saxsars (articulatio ZvlebTan akavSirebs. saxsars amagrebs
talocalcaneonavicularis). igi Sedgeba ori agreTve didi wvivis wina da ukana
nawilisgan, romelTa Soris ukana kunTebis myesebi.
terfis wiaRi (sinus tarsi) mdebareobs. navisebr da solisebr Zvlebs Soris
igi moTavsebulia koWis Zvals, quslis solisebr-navisebri saxsaria (articulatio
Zvalsa da koW-quslis ZvalTaSua iogs calcaneocuboidea), romelic dakavSirebu-
(lig. talocalcaneum) Soris. quslisa da lia solisebr, navisebr da kubur
kuburi Zvlebi qmnis qusl-kubur sax- Zvlebs Soris arsebul saxsrebTan.
sars (articulatio calcaneocuboidea), romelic saxsars iogebTan erTad amagrebs
koWisa da navisebr Zvlebs Soris arse- terfis zurgis mxareze didi wvivis
buli saxsris (koW-qusl-navisebri wina kunTis myesi, TiTebis grZeli
saxsris wina nawilis) xazze gamSleli kunTis myesebi da TiTebis

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 qvemo kiduri

mokle gamSleli kunTi, terfis Ziris saxsari SigniTa mxridan gamagrebulia

mxridan—didi wvivis ukana kunTisa da ceris momzidveli kunTiT, II_V
mcire wvivis grZeli kunTis myesebi. saxsrebi—Wiayela kunTebis myesebiT
erTi mxriv, kuburi da solisebri da terfis Ziris ZvalTaSua kunTebiT,
da, meore mxriv, wina terfis Zvlebi zemodan—dorsaluri ZvalTaSua
qmnis terfSoris (lisfrankis) kunTebiT. saxsrebis saerTo xazi ter-
saxsrebs (articulationes tarsometatarseae). fis dorsalur zedapirze proe-
saxsris iogebs Soris gamoirCeva cirdeba TiTTaSua naoWebidan 2_2,5sm-
solisebr-wina terfis ZvalTaSua iogi iT da plantarul zedapirebze 3sm-iT
(lig. cuneometatarseum interosseum), anu proqsimalurad gavlebul xazze.
lisfrankis gasaRebi, romelic terfi mTlianad SeiZleba Sevada-
medialur solisebr Zvals wina ter- roT naxevargumbaTs, romelsac ori
fis II ZvalTan akavSirebs. saxsars io- gaswvrivi da ori ganivi TaRi aqvs.
gebTan erTad dorsaluri mxridan gareTa gaswvriv, anu sayrden TaRs
amagrebs TiTebis grZeli da mokle Seadgenen quslis, kuburi da terfis
gamSleli kunTebisa da mcire wvivis IV_V Zvlebi, SigniTa gaswvriv, anu
mokle kunTis myesebi, terfis Ziris resorul TaRs—koWis, sami solisebri
mxridan—didi wvivis wina da ukana da I_III wina terfis Zvlebi.
kunTebis myesebi, romlebic gareTa gaswvrivi TaRi eyrdnoba
Sesabamisad navisebri Zvlis borcvs da quslis borcvs, terfis gareTa kides
wina terfis pirvel Zvals da wina terfis IV_V Zvlebis Tavebs,
umagrdebian. saxsris xazi terfis SigniTa gaswvrivi TaRi—koWis Zvals,
zurgze proeqcirdeba wina terfis V romelic quslis Zvalze mdebareobs,
Zvlis xorklis ukana kidesa da da wina terfis I_II Zvlebis Tavebs.
navisebri Zvlis xorklidan 2sm-iT win misi zambarisebri moqmedeba
mdebare wertils Soris gavlebul ganpirobebulia didi wvivis wina da
xazze. amasTan, saxsari Sua solisebr ukana kunTebis drekadobiT.
da wina terfis II Zvals Soris wina ganiv TaRs qmnis wina terfis
lisfrankis saxsris saerTo xazidan Zvlebi, ukana ganiv TaRs—ukana
ramdenadme ukan mdebareobs. terfis Zvlebi. wina TaRi
wina terf-falangis saxsrebi (articu- gamagrebulia ceris momzidveli
lationes metatarsophalangeae) dorsaluri kunTis ganivi TaviT, ukana TaRi—didi
mxridan dafarulia TiTebis grZeli wvivis ukana da mcire wvivis grZeli
da mokle gamSleli kunTebis myesebiT, kunTebis myesebiT, romlebic terfis
terfis Ziris mxridan—fibrozul Zirze erTmaneTs ejvaredinebian.
budeebSi mdebare TiTebis momxreli terfis saxsrebSi amovardniloba.
kunTebis myesebiT da ceris terfis saxsrebis amovardniloba
momzidveli kunTis mokle TaviT. SedarebiT iSviaTia. koWis Zvlis
saxsrebi gamagrebulia gverdiTi da amovardnilobas Tan axlavs kunTebisa
terfis Zirismxrivi iogebiT. garda da zogjer sisxlZarRvebisa da
amisa, pirveli wina terf-falangis nervebis mniSvnelovani dazianeba.
lisfrankis saxsarSi amovardniloba

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 qvemo kiduri

SeiZleba iyos sruli da nawilobrivi umTavresad simZimis terfze dacemiT.

(wina terfis calkeuli Zvlebisa navisebri Zvlis motexilobas SeiZleba
kuburi an solisebri Zvlebis mimarT). Tan axldes kuburi da solisebri
terfis Zvlebis motexiloba. ter- Zvlis motexiloba, agreTve
fis Zvlebis motexiloba sakmaod dorsaluri fragmentis amo-
xSiria. koWis Zvlis yelis motexiloba vardniloba. kuburi da solisebri
miiReba terfis forsirebuli Zvlebis motexiloba xSirad Serwy-
dorsaluri moxris dros. koWis yeli mulia ukana terfisa da wina terfis
miebjineba didi wvivis Zvlis qveda- Zvlebis motexilobasTan da amovardni-
wina kides da tydeba, warmoqmnis ra lobasTan.
or natexs. kuburi da solisebri Zvlebis mote-
terfis mkveTri plantaruli moxri- xilobas, rogorc wesi, Tan axlavs na-
sas SeiZleba motydes koWis ukana mor- texebis Secileba.
Ci. koWis Zvlis sxeulis kompresiuli wina terfis Zvlebi saerTod xSi-
motexiloba SesaZlebelia terfebze rad tydeba, umTavresad Zalis uSualo
simaRlidan dacemis dros. moqmedebiT (simZimis dacema terfis
ukana terfis ZvlebSi yvelaze xSi- zurgze). arCeven wina terfis Zvlebis
rad tydeba quslis Zvali, iSviaTad erTeul da mravlobiT motexilobebs.
Zalis pirdapiri zemoqmedebiT aRiniSneba agreTve wina terfis mexuTe
(dartyma, Tvlebis gadavla), Zvlis xorklis izolirebuli
umTavresad ki Zalis arapirdapiri mogleja, romelsac adgili aqvs
moqmedebiT—simaRlidan quslebze terfis forsirebuli mozidvisas. am
dacemis dros. koWis Zvali awveba ra dros terfis SigniTa kide aiwevs
zemodan quslis Zvals, iwvevs mis zemoT da mcire wvivis mokle kunTis
gabzarvas an SeiWreba masSi soliviT daWimuli myesi moglejs am xorkls.
da iwvevs quslis Zvlis damsxvrevas. terfis TiTebis falangebis motexi-
zogjer adgili aqvs medialur loba iSviaTi araa da gamowveulia
mxareze mdebare koWis sabjenis umTavresad maTze simZimis dacemiT an
motexilobas, aseve quslis borcvis SiSveli TiTebis raimeSi moyoliT.
medialuri morCis da amave borcvis motexiloba gvxvdeba motexili bolo-
zemo nawilis motexilobas. ebis rogorc SecilebiT, ise
navisebri, kuburi da solisebri Secilebis gareSe.
Zvlebis motexiloba gamowveulia

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 qvemo kiduri

ganakveTebi qvemo kiduris rbili qsovilebis

Cirqovani daavadebis dros

ganakveTebi terfze naT medialuri gojis areSi mdebare

gansakuTrebiT saxifaToa terfis Zval-fibrozuli arxebi. winaaRmdeg
Ziris Sua Zval-fasciuri budis SemTxvevaSi am areSi sinoviur
flegmona, vinaidan igi SeiZleba wvivis budeebSi mdebare myesebi SeiZleba
ukana Rrma SemaerTebelqsovilovan danekrozdes.
sivrceSi gavrceldes. am flegmonis
gasaxsnelad terfis Sua ganakveTis ganakveTebi wvivze
gamoyeneba ar aris gamarTlebuli, wvivis fasciur budeebs xsnian imave
radgan gakveTili terfZiris apo- gaswvrivi ganakveTebiT, romlebsac
nevrozis kideebi erTimeores Znelad wvivis wina da ukana arteriebTan
Sordeba da Cirqis evakuacia ferxdeba. misadgomad iyeneben. gansxvaveba is
amitom ganakveTis gavleba saWiroa aris, rom Rrmad mdebare Cirqovani
terfis medialuri an lateraluri kerebis drenaJis uzrunvelsayofad
kidis gaswvriv Semdegi sqemiT: terfis saWiroa SedarebiT ufro grZeli
Zirze, quslis ukana kididan 4_5sm win ganakveTebi. momxrelebis Rrma budis
ganivad gatarebuli xazis Sua gasaxsnelad ganakveTs atareben didi
wertilisa da IV_V TiTTaSua naoWis wvivis medialuri kidis gaswvriv,
SemaerTebel xazze atareben la- misgan 1_2sm ukan. wvivis sakuTari
teralur ganakveTs, xolo imave gani- fasciis gakveTis Semdeg tyup kunTs
vi xazis SigniTa naxevris Sua werti- ukan gadasweven, quslis kunTsac didi
lisa da I_II TiTTaSua naoWis wvividan misi nawilobrivi mokveTis
SemaerTebel xazze—medialur Semdeg ukan gadasweven da Rrma
ganakveTs. fasciur budes xsnian.
kanis, kanqveSa qsovilisa da terf- wvivis gverdiT fasciur budes xsni-
Ziris aponevrozis gakveTis Semdeg an wvivis lateralur zedapirze ga-
TiTebis mokle momxrel kunTs tarebuli gaswvrivi ganakveTiT.
gadasweven da xsnian mis qveS arsebul wvivze Cirqovani keris lokaliza-
Cirqovan keras. rodesac procesi ciisa da gavrcelebis Sesabamisad
gadasulia wvivis ukana Rrma sivrceSi, zogjer saWiroa ramdenime ganakveTis
am ukanasknels xsnian ganakveTiT, gatareba. Cirqovani keris gaxsnis
romelic gankuTvnilia wvivis qveda Semdeg WrilobaSi sisxlZarRvebidan
mesamedSi wvivis ukana arteriasTan daSorebiT SehyavT tamponi da drenaJi.
midgomisaTvis. amasTanave terfisa da
wvivis Cirqovan kerebs xsnian ara cal- ganakveTebi barZayze
calke, aramed erTiani grZeli barZayis Rrma Cirqovani kera SeiZ-
ganakveTiT, romelic wvividan leba iyos wina, medialur an ukana
medialuri gojis SemovliT terfis fasciur budeSi. wina budeSi Cirqovani
Zirze gadadis. amave dros unda gavxs- kera, Tavis mxriv, SeiZleba

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 qvemo kiduri

mdebareobdes rogorc zedapirulad— atareben erT an or ganakveTs.

barZayis ganier fasciasa da barZayis sisxlZarRvebis dazianebis
oTxTava kunTs Soris, ise swor asacileblad ganakveTs atareben maTi
kunTsa da Sua ganier kunTs Soris, an- proeqciidan odnav daSorebiT.
da barZayis oTxTava kunTsa da bar- barZayis momzidvel kunTTa (anu
Zayis Zvals Soris (barZayis Zvlis medialuri) fasciuri budis
irgvliv). gasaxsnelad barZayis medialur
wina budes xsnian barZayis wina da zedapirebze atareben gaswvriv
lateralur zedapirze gavlebuli ganakveTs. fasciis gakveTis Semdeg
gaswvrivi ganakveTiT. kanis, kanqveSa kunTebs TiTiT an romelime blagvi
qsovilisa da ganieri fasciis gakveTis iaraRiT TiSaven. grZeli momzidveli
Semdeg romelime blagvi iaraRiT xsni- kunTis qveS mdebare sivrces xsnian am
an barZayis swor kunTsa da kunTis medialuri kidis SemovliT.
lateralur ganier kunTs Soris barZayis ukana fasciur budesac
arsebul naprals. aseve xsnian gaswvrivi ganakveTiT,
barZayis Zvalsa da oTxTava kunTs romelsac atareben barZayis orTava da
Soris mdebare Cirqovani kera (para- naxevrad myesovan kunTebs Soris.
osaluri flegmona) ixneba barZayis SemaerTebelqsovilovan sivrces,
swori kunTis medialuri da romelSic sajdomi nervi mdebareobs,
lateraluri kideebis gaswvriv xsnian nervis proeqciis gverdiT
gavlebuli ganakveTebiT. swori kunTis gatarebuli gaswvrivi ganakveTiT.
qveS mdebare sivrcis gaxnis Semdeg
Sua ganieri kunTi Zvlamde iTiSeba.
sisxlZarRvTa budis, anu paravaza-
luri flegmonis gasaxsnelad TerZis
kunTis medialuri kidis gaswvriv

operaciuli midgoma qvemo kiduris arteriebTan

midgoma barZayis arteriasTan zurgze, barZayi odnav ganziduli da

menj-barZayisa da muxlis saxsrebSi gareTken mobrunebulia. ganakveTi
qveda kiduris odnav moxrili da tardeba arteriis saproeqcio xazze,
gareTken mobrunebul mdgomareobaSi sazardulis iogis 1_2sm zemoT
barZayis arteriis proeqcia Seesabameba mdebare wertilidan qveviT 10_12sm
xazs, romelic TeZos zeda wina wvetsa manZilze.
da boqvenis simfizs Soris Sua wer- kveTen kans, kanqveSa qsovils da ze-
tils aerTebs barZayis medialur dapirul fascias. Wrilobis kideebs
rokze mdebare momzidvel borcvTan blagvi kavebiT gadasweven. marlis
(kenis xazi). burTuliT cximovan SemaerTebeli
barZayis arteriasTan midgoma sa- qsovilisagan aTavisufleben
zardulis iogis qveS. avadmyofi wevs sazardulis iogsa da ovalur fosos.

klinikuri anatomia 211

 qvemo kiduri

Rarian zondze kveTen ganieri fasciis deSanis nemsiT medialuri mxridan.

zedapirul firfitas da miudgebian kolateraluri sisxlis mimoqceva
barZayis sisxlZarRvebs. ligaturas viTardeba barZayis Rrma arteriis to-
arteriis qveS gaatareben deSanis tebiT.
nemsiT venis mxridan. barZayis arteriasTan midgoma mom-
kolateraluri sisxlis mimoqcevis zidvel (hunteris) arxSi. kiduri
ganviTarebisaTvis barZayis arteria moxrilia muxlis saxsarSi da roti-
zeda mesamedSi umjobesia gadaikvanZos rebulia gareTken. sigrZiT 8_9sm gana-
misgan barZayis Rrma arteriis kveTs avleben arteriis saproeqcio
gamosvlis adgilis qvemoT, vinaidan am xazis mimarTulebiT ise, rom misi Sua
totis zemoT barZayis arteriis nawili Seesabamebodes momzidveli
gadakvanZva SedarebiT ufro xSirad arxis wina xvrels, romelic barZayis
iwvevs iSemiis movlenebs. medialuri rokidan 13_16sm-iT zemoT
anevrizmis SemTxvevaSi arteriasTan mdebareobs. kanis, kanqveSa qsovilisa
farTod midgomisaTvis iyeneben T-sebr da zedapiruli fasciis gakveTis Sem-
ganakveTs, romlis vertikalur nawils deg did saCino venas gverdze
avleben arteriis proeqciis mimar- gadasweven da Rarian zondze kveTen
TulebiT, xolo ganiv nawils— ganieri fasciis zedapirul furcels,
sazardulis iogis gaswvriv. am dros romlis qveS TerZis kunTi mdebareobs.
vertikaluri ganakveTiT zogjer am ukanasknels kaviT SigniT
kveTen agreTve sazardulis iogs, gadasweven da Wrilobis medialuri ki-
romelsac operaciis damTavrebis dis gaswvriv gamoCndeba barZayis didi
Semdeg keraven. momzidveli kunTis myesi, xolo late-
kolateraluri sisxlis mimoqceva raluri kidis gaswvriv—barZayis
viTardeba Semdegi arteriebiT: a. glutea medialuri ganieri kunTi, romelic
inf., a. obturatoria, a. pudenda inf. aa. circumflexa ganiermomzidveli firfitiT (membrana
femoris medialis et lateralis da sxv. vastoadductoria) dakavSirebulia
barZayis arteriasTan midgoma barZa- barZayis didi momzidveli kunTis
yis (skarpas) samkuTxedSi. ganakveTs myesTan da qmnis momzidveli (hunte-
avleben arteriis saproeqcio xazze ris) arxis wina-medialur kedels.
sazardulis iogidan 5_6sm masSi arsebuli xvreliT (momzidveli
daSorebuli wertilidan qveviT 8_9sm arxis wina xvreli) momzidveli
sigrZeze. kanis kanqveSa qsovilisa da arxidan gamodis muxlis daswvrivi
zedapiruli fasciis gakveTis Semdeg arteria da saCino nervi. am xvreliT
Rarian zondze kveTen barZayis ganier arxSi SeyavT Rariani zondi, romel-
fascias; TerZis kunTs kaviT gareTken zec kveTen ganier-momzidvel firfitas
gadasweven, misi budis ukana kalTas da xsnian momzidvel arxs. am uka-
aseve Rarian zondze kveTen da miudge- nasknelSi barZayis sisxlZarRvebi da
bian barZayis sisxlZarRvebs. aq saCino nervi mdebareobs. nervi
arteria venis win mdebareobs. arteriis win aris, vena ki—ukan.
ligaturas arteriis qveS atareben arteriis gadakvanZva ufro

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 qvemo kiduri

mizanSewonilia misgan muxlis daswv- sakuTar fascias. didi wvivis nervs

rivi arteriis gamosvlis qvemoT. gareTken gadasweven da gamoCndeba mis
kolateraluri sisxlis mimoqceva win medialurad mdebare muxlqveSa
viTardeba barZayis Rrma arteriis vena, romlis kidev ufro win da medi-
totebiT, romlebic dakavSirebuli alurad Tanamosaxele arteria mdeba-
arian muxlis arteriul badesTan (rete reobs. venas zedmiwevniT frTxilad
articulare genus). ganacalkeveben masTan mWidrod
dakavSirebuli arteriisagan da
midgoma muxlqveSa arteriasTan gareTken gadasweven. garemomcveli
muxlqveSa arteriasTan midgoma Jo- qsovilebisagan arteriis gamoyofisas
beris fosoSi. avadmyofi moTavsebulia gansakuTrebiT zogaven misgan gamo-
saoperacio magidaze iseve rogorc maval totebs.
barZayis arteriis gadakvanZvis dros. muxlqveSa arteriis gadakvanZvis
ganakveTs atareben didi momzidveli Semdeg kolateraluri sisxlis
kunTis myesis gaswvriv, barZayis mimoqceva viTardeba muxlis badis (rete
medialuri rokidan zeviT 7_8sm genus) saSualebiT.
manZilze. kanis, kanqveSa qsovilisa da
zedapiruli fasciis gakveTis Semdeg midgoma didi wvivis ukana
Rarian zondze kveTen barZayis ganier arteriasTan
fascias; barZayis grZeli momzidveli didi wvivis ukana arteriasTan
kunTis myess gadasweven win, xolo midgoma wvivis zeda mesamedSi.
naxevrad myesovani, TiTistara da nazi avadmyofi wevs mucelze, kiduri odnav
kunTebis myesebs—ukan, ris Semdegac moxrili aqvs muxlis saxsarSi.
Wrilobis zeda kuTxeSi gamoCndeba ganakveTs atareben muxlqveSa fosos
TerZis kunTi, xolo qveda kuTxeSi— Sua wertilidan qveviT 10_12sm
barZayis medialuri roki. aRniSnul manZilze. zedapiruli Sreebis gakve-
warmonaqmnebs Soris mdebare sivrciT, Tis Semdeg mcire saCino venas gverdze
romelsac Joberis foso ewodeba, gadasweven anda or ligaturas Soris
Sedian muxlqveSa fosoSi, sadac gadakveTen. tyupi kunTis Tavebs erTi-
uSualod barZayis Zvlis ukan meoresagan TiSaven, quslis kunTs
mdebareobs muxlqveSa arteria, xolo gaswvrivad kveTen, amave mimarTulebiT
arteriis ukan da lateralurad— kveTen kanWis kunTTaSua ukana Zgides
muxlqveSa vena. da xsnian kanW-muxlqveSa arxs,
muxlqveSa arteriasTan midgoma romelSic didi wvivis nervi da didi
muxlqveSa fosoSi. avadmyofi wevs wvivis ukana sisxlZarRvebi
mucelze; kiduri odnav moxrili aqvs mdebareobs. nervi moTavsebulia medi-
muxlis saxsarSi. muxlqveSa fosos alurad, arteria Tanamgzavri vene-
Sua xazis medialurad, misgan odnavi biT—lateralurad.
daSorebiT avleben 10_12sm sigrZis didi wvivis ukana arteriasTan mid-
gaswvriv ganakveTs. kanis, kanqveSa goma wvivis Sua mesamedSi. avadmyofi
qsovilisa da zedapiruli fasciis wevs gverdze, kiduri odnav moxrili
gakveTis Semdeg Rarian zondze kveTen aqvs menj-barZayisa da muxlis

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 qvemo kiduri

saxsrebSi. ganakveTs atareben wvivis myesi. arterias frTxilad gamoyofen

Sua mesamedSi xazze, romelic iwyeba garemomcveli warmonaqmnebidan da mis
didi wvivis medialuri rokis SigniTa qveS, nervis mxridan, deSanis nemsiT
kidis 2sm ukan da Tavdeba quslis atareben ligaturas.
myessa da medialur gojs Soris gata- kolateraluri sisxlis mimoqceva
rebuli xazis Sua wertilSi. zeda- viTardeba didi wvivis wina arteriisa
piruli Sreebisa da kanWis sakuTari da mcire wvivis arteriis totebiT.
fasciis gakveTis Semdeg tyupi kunTis
medialur Tavs kaviT ukan gadasweven, midgoma didi wvivis wina
didi wvivis Zvlidan 2_3sm ukan arteriasTan
quslis kunTs gaswvrivad kveTen da avadmyofi wevs zurgze, kiduri
aseve uknisken gadasweven, ris rotirebuli aqvs SigniT. arteriis
Sedegadac WrilobaSi gamoCndeba proeqcia iwyeba mcire wvivis Tavidan
kanWis kunTTaSua ukana Zgide. am didi wvivis xorklamde gatarebuli
ukanasknelis Rarian zondze gakveTis xazis Sua wertilidan da Tavdeba
Semdeg xsnian kanW-muxlqveSa arxs, gojebs Soris gatarebuli xazis Sua
romelSic moTavsebulia didi wvivis wertilSi.
ukana arteria Tanamgzavri venebiT da arteriis saproeqcio xazze atare-
didi wvivis nervi. arterias mezobeli ben 7_8sm sigrZis ganakveTs. kanis,
warmonaqmnebidan frTxilad gamoyofen kanqveSa qsovilisa da zedapiruli
da gadakvanZaven. fasciis gakveTis Semdeg kveTen kanWis
kolateraluri sisxlis mimoqceva fascias, romelic zeda nawilSi
viTardeba didi wvivis wina da mcire mWidrod aris dakavSirebuli
wvivis arteriebis totebiT. kunTebTan. wvivis zeda mesamedSi
didi wvivis ukana arteriasTan mid- arteria TiTebis grZel gamSlel
goma medialuri gojis ukan. medialur kunTsa da didi wvivis wina kunTs
gojsa da quslis (aqilevsis) myess Soris arsebul napralSi, ZvalTaSua
Soris atareben 6sm sigrZis ganakveTs, firfitazea. masTan erTad aq
romelic medialuri gojis kidis Tanamgzavri venebi da mcire wvivis
Sesabamisad odnav moxrilia. kanis, Rrma nervi mdebareobs.
kanqveSa qsovilisa da zedapiruli wvivis qveda mesamedSi arteria didi
fasciis gakveTis Semdeg Rarian wvivis wina kunTsa da fexis ceris
zondze kveTen momxreli kunTebis sab- grZel gamSlel kunTs Soris imyofeba.
mels da wvivis sakuTar fascias. didi wvivis wina arteriis gadakvan-
Wrilobis kideebis kavebiT gadawevis Zvis Semdeg kolateraluri sisxlis
Semdeg gamoCndeba didi wvivis ukana mimoqceva viTardeba mcire wvivis ukana
arteria Tanamgzavri venebiT, romelTa arteriis totebiT (a. peronea, a. plantaris
ukan didi wvivis nervi mdebareobs. aq, da sxv.).
sisxlZarRvovan-nervuli konis win,
fibrozul budeSi mdebareobs TiTebis
grZeli momxreli kunTis myesi, xolo
ukan—ceris grZeli momxreli kunTis

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 qvemo kiduri

midgoma terfis dorsalur gaswvriv, misgan 2mm daSorebiT, kveTen

arteriasTan terfis dorsalur fascias, fexis
arteria proecirdeba gojTaSua ceris mokle gamSlel kunTs gareT ga-
manZilis Sua wertilidan I da II dasweven da garemomcveli qsovi-
TiTTaSua naoWamde gatarebul xazze. lebidan gamoyofen terfis dorsalur
sigrZiT 5_6sm ganakveTs atareben arterias.
saproeqcio xazis mimarTulebiT. kolateraluri sisxlis mimoqceva
kanisa da kanqveSa qsovilis gakveTis viTardeba terfZiris medialuri da
Semdeg fexis ceris grZeli gamSleli lateraluri arteriebiT.
kunTis myesis lateraluri kidis

operaciuli midgoma qvemo kiduris nervebTan

midgoma barZayis nervTan aris rotirebuli. ganakveTs atareben

8_10sm sigrZis ganakveTi iwyeba barZayis arteriis saproeqcio xazis
sazardulis (pupartis) iogis Sua da medialurad, sazardulis iogidan
lateraluri mesamedebis sazRvarze, 10_12sm manZilze. zedapiruli Sreebis
misgan 2sm zemoT da miemarTeba TerZis gakveTis Semdeg ganiersa da qedis
kunTis medialuri kidis gaswvriv. fascias kveTen qedis kunTis boqvenis
kanis, kanqveSa qsovilisa da Zvlidan dawyebis xazis gaswvriv.
zedapiruli fasciis gakveTis Semdeg qedisa da grZel momzidvel kunTebs
kunTis medialur kidesTan kveTen kavebiT gverdebze gadasweven da qedis
ganier fascias da sazardulis iogis kunTs raspatoriT ganaSoreben boqve-
qveS TeZo-sukis kunTze gamoaCenen nis Zvlidan, ris Sedegadac siRrmeSi
barZayis nervis Reros, romelic aqve gamoCndeba gareTa damxurveli kunTi,
totebad iyofa. romlis fasciis qveS damxurveli
nervia, xolo nervis medialurad misi
midgoma saCino nervTan Tanamgzavri sisxlZarRvebi mdebareobs.
ganakveTs atareben barZayis qveda
mesamedSi ise, rogorc barZayis arte- midgoma sajdom nervTan
riasTan midgomis dros. zedapiruli sajdomi nervis saproeqcio xazi
Sreebis gakveTisa da TerZis kunTis kukuxosa da didi cibrutis
gareTken gadawevis Semdeg gamoCndeba SemaerTebeli xazis Sua wertilidan
membrana vastoadductoria, romelSic iwyeba da muxlqveSa fosos Sua
arsebuli xvreliT momzidveli wertilSi Tavdeba.
(hunteris) arxidan saCino nervi da sajdom nervTan midgoma dundulis
muxlis daswvrivi arteria gamodis. midamoSi. dundulis midamoSi sajdomi
nervis saproeqcio xazis
midgoma damxurvel nervTan mimarTulebiT gavlebuli ganakveTi
avadmyofi wevs zurgze, kiduri od- gansakuTrebiT travmulia, vinaidan igi
nav moxrili aqvs menj-barZayisa da gadauvlis did dundula kunTs.
muxlis saxsrebSi. barZayi gareTken amasTan, es ganakveTi yovelTvis ar

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 qvemo kiduri

iZleva nervTan sakmarisad farTod kunTebis gverdebze gadawevis Semdeg

midgomis SesaZleblobas. amitom ufro nervis monaxva advilia.
misaRebia gagen-torn-raZievskis rkalo- midgoma didi wvivis nervTan
vani ganakveTi. didi wvivis nervTan midgoma muxl-
avadmyofi wevs saR gverdsa an mu- qveSa fosoSi. kans kveTen gaswvrivad
celze. kanis ganakveTi iwyeba TeZos Zv- muxlqveSa fosos Sua xazze. fasciis
lis qedidan TeZos wina zeda wvetis gakveTis dros saWiroa
ukan, didi cibrutis win gaivlis, gavufrTxildeT did saCino venas,
uknisken uxvevs da barZayis ukana romelic aq zogjer didi wvivis nervs
zedapirze dundula naoWis odnav faravs. am SemTxvevaSi vena or
qveviT Tavdeba. zedapiruli Sreebis ligaturas Soris unda gadavkveToT.
gakveTis Semdeg ganivad kveTen didi didi wvivis nervi muxlqveSa fosos
dundula kunTis aponevrozs, nawilob- Sua xazis gaswvriv mdebareobs. ufro
riv—TviT kunTsac da dundula Rrmad da medialurad moTavsebulia
fasciis Rrma firfitas. am gziT jer muxlqveSa vena, xolo Semdeg—
Seqmnili kan-kunTis nafleTis muxlqveSa arteria.
medialurad gadawevis Semdeg didi wvivis nervTan midgoma wvivis
gamoCndeba dundulis midamos Sua midamoSi. operaciuli midgoma didi
kunTovani fena nervebiTa da sisxlZar- wvivis nervTan wvivis midamoSi didi
RvebiT. sajdom nervs, romelic qveda wvivis ukana arteriasTan midgomis
msxlisebri xvrelidan gamodis, analogiuria. aq nervi proecirdeba
monaxaven msxlisebri kunTis qveda xazze, romelic muxlqveSa fosos Sua
kidesTan. wertilidan iwyeba da medialuri
sajdom nervTan midgoma barZayis gojisa da quslis myesis SemaerTebeli
Sua mesamedSi. 10_12sm sigrZis xazis Sua wertilSi Tavdeba.
ganakveTs atareben nervis saproeqcio
xazis gaswvriv. ganieri fasciis midgoma mcire wvivis saerTo
gakveTis Semdeg WrilobaSi gamoCndeba nervTan
barZayis orTava kunTis grZeli Tavi, ganakveTs atareben muxlqveSa foso-
romelic am doneze sajdom nervs Si barZayis orTava kunTis myesis medi-
iribad gadauvlis. amitom Wrilobis aluri kidis gaswvriv. fasciis
zeda nawilSi mas kaviT gadasweven gakveTis Semdeg gamoCndeba nervis
SigniT, xolo Wrilobis qveda Rero, romelic orTava kunTis myessa
nawilSi—gareT. sajdomi nervi aq mde- da tyupi kunTis lateralur Tavs
bareobs, erTi mxriv, orTava kunTsa Soris mdebareobs. saWiroa movufr-
da, meore mxriv, TiTistara da TxildeT misgan gamomaval kanWis ka-
naxevrad myesovan kunTebs Soris. nis lateralur nervs.

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 qvemo kiduri

operaciuli midgoma qvemo kiduris grZel

lulisebr ZvlebTan

operaciuli midgoma wvivis Zvleb- mcire wvivis saerTo nervs, romelic

Tan. didi wvivis ZvalTan mcire wvivis Zvlis Tavis qvemoT
midgomisaTvis ganakveTs atareben kunTebSi mdebareobs.
wvivis wina medialur zedapirze, operaciuli midgoma barZayis Zval-
sadac Zvali mTel sigrZeze dafa- Tan. ganakveTs, Cveulebriv, atareben
rulia mxolod kaniTa da kanqveSa didi cibrutisa da gareTa zedarokis
qsoviliT. SemaerTebel xazze. kanis, kanqveSa
mcire wvivis ZvalTan midgoma xor- qsovilisa da zedapiruli fasciis
cieldeba wvivis gareTa zedapirze gakveTis Semdeg kveTen barZayis ganier
gavlebuli gaswvrivi ganakveTiT. zeda- fascias da ganieri fasciis gamWimav
piruli Sreebisa da sakuTari fasciis kunTs. lateralur ganier kunTs
gakveTis Semdeg wvivis lateralur da gadasweven win, barZayis orTava kunTis
ukana jgufis kunTebs erTmaneTisagan ukan. ZvalTan farTod midgomisaTvis
ganaSoreben, mcire wvivis grZelsa da lateralur ganier kunTs kveTen kone-
mokle kunTebs gadasweven win, samTava bis mimarTulebiT.
kunTs—ukan. unda movufrTxildeT

qvemo kiduris saxsrebis Cxvleta_punqcia

menj-barZayis saxsris Cxvleta Zvlis yels da, Tu ramdenadme zemoT-

menj-barZayis saxsris punqcia SeiZ- ken mivmarTavT, saxsarSi SeiWreba.
leba rogorc wina, ise gverdiTi
zedapiridan. winidan punqcia keTdeba muxlis saxsris Cxvleta_punqcia
didi cibrutis mwvervalidan kviristavis zeda abgis punqcias ake-
sazardulis (pupartis) iogis Sua da Teben kviristavis zeda bolos late-
medialur mesamedebs Soris ralur kidesTan. nemsi mimarTulia
gatarebuli xazis Sua wertilSi. barZayis gaswvrivi RerZis
Cxvletis siRrmea 4_5sm. nemsi mimar- perpendikularulad, gaivlis barZayis
Tulia ramdenadme medialurad. igi oTxTava kunTis myesis qveS da Sedis
saxsarSi Sedis uSualod barZayis abgaSi 3_4sm siRrmeze. amave
Zvlis yelis zemoT iq, sadac es wertilidan SeiZleba ganxorcieldes
ukanaskneli barZayis Zvlis TavSi TviT saxsris punqciac. am SemTxvevaSi
grZeldeba. nemsi gaivlis kviristavsa da barZayis
gverdiTi zedapiridan punqcias ake- qveda epifizs Soris. saxsris Cxvleta
Teben didi cibrutis mwvervalis SeiZleba agreTve kviristavis medi-
zemoT. nemsi mimarTulia barZayis aluri an lateraluri kidis Sua wer-
grZivi RerZis perpendikularulad, tilSi.
zustad frontalur sibrtyeSi.
pirvelad nemsi miebjineba barZayis

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 qvemo kiduri

koW-wvivis saxsris Cxvleta_punqcia zemoT. nemsi mimarTuli unda iyos

Cxvleta SeiZleba rogorc late- ukan da SigniT, kiduris RerZis
raluri, ise medialuri gojis perpendiku-larulad. saxsris
mxridan. wertili saxsris medialuri nawilis sapunqcio
lateraluri nawilis punqciisaTvis wertili medialur gojsa da ceris
mdebareobs saxsris wina zedapirze, grZeli gamSleli kunTis myess
lateralur gojsa da TiTebis grZeli Sorisaa. nemsi gaivlis koWis Zvalsa
momxreli kunTis myess Soris, gojis da medialur gojs Soris.
mwvervalidan erTi TiTis siganiT

klinikuri simptomebisa da sindromebis

topografiuli anatomia

msxlisebri kunTis sindromi msxlisebri kunTi abrunebs barZays

klinikuri gamovlineba: aRiniSneba gareT da nawilobriv ganzidavs,
tkivili qveda kidurSi, sajdomi amitom pasiuri mozidva da SigniT
nervis mimarTulebiT, romelic rotacia iwvevs tkivils dundulis
Zlierdeba barZayis mozidvisa da areSi, sajdom nervze zewolis
rotaciis dros, tkivili aRiniSneba gaZlierebis gamo.
agreTve didi cibrutis, gava-TeZos
saxsarsa da dundulis areSi. “mamlis nabijis” sindromi
topograf-anatomiuri safuZveli: (mcire wvivis saerTo nervis
sajdomi nervi mcire menjis Rrudan dazianebis dros)
gamodis msxlisebr kunTsa da gava- klinikuri gamovlineba: avadmyofi
wvetian iogs Soris. qveda msxlisebri maRla wevs fexs, Tavidan abijebs
xvrelidan nervi wveba tyup, SigniTa wveriT, Semdeg terfis gareTa kidiT
damxurav, barZayis kvadratul da bolos terfis ZiriT. SeuZlebelia
kunTebze da aZlevs maT kunTovan dorsaluri fleqsia, terfis
totebs. mobruneba gareT, TiTebis gaSla,
msxlisebri kunTis tramvis, spazmis agreTve quslebze dgoma da siaruli.
an SeSupebis dros adgili aqvs topograf-anatomiuri safuZveli:
sajdom nervze zewolas, rac iwvevs simptomi vlindeba mcire wvivis saer-
tkivils nervis datotianebis zonaSi. To nervis dazianebis dros muxlqveSa
msxlisebri kunTi iwyeba gavis Zvlis fosoSi an muxlis midamoSi, sadac
wina zedapiridan, 2_4 xvrelebis nervi gadis mcire wvivis zeda arxSi,
lateralurad, rac ganapirobebs romelic iqmneba grZeli mcire wvivis
tkivils nervis datotianebis zonaSi kunTiTa da mcire wvivis ZvliT. aq
palpaciis dros. vinaidan kunTi umagr- nervi iyofa Rrma da zedapirul
deba didi cibrutis medialuri zeda- totad. moZraobis moSla gamovlindeba
piris zeda nawils, amitom cibrutis terfisa da TiTebis gaSlis unaris
aris palpacia iwvevs tkivils. dakargviT (mm.tibialis anterior,

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 qvemo kiduri

extensores digitorium da hallucis “ukansvlis” simptomi

longus), aseve terfis gareTa da klinikuri gamovlineba: TeZos wina
SigniTa kideebis ganzidvisa da awevis zeda wvetis izolirebuli
darRveviT (mm. peronei longus da motexilobis dros win siaruli
brevis). terfi Camokidebulia, sustad SeuZlebelia mwvave Zlieri tkivilis
mobrunebulia SigniT, TiTebi gamo, xolo ukan svla gaadvilebulia.
ramdenadme moxrilia (“cxenis terfi”). topograf-anatomiuri safuZveli:
tkivili gamowveulia TerZis kunTis
“gamoweuli ujris” simptomi da barZayis ganieri fasciis damWimavi
klinikuri gamovlineba: kiduri mux- kunTis SekumSviT, romlebic iwyebian
lis saxsarSi swori kuTxiT aris TeZos wina zeda wvetidan da
moxrili. eqimi erTi xeliT ikavebs monawileoben kiduris moxraSi menj-
wvivs, xolo meoreTi afiqsirebs barZayisa da muxlis saxsrebSi.
barZays qveda mesamedSi. wvivs xeliT
winisken gamoswevs da warmoiqmneba barZayis deformacia “galifes”
kibiseburad win wamoweuli wvivsa da formiT
barZays Soris—“win gamoweuli klinikuri gamovlineba: barZayis
ujra”. Tu wvivze zewoliT adgili zeda mesamedSi motexilobis dros
aqvs mis ukan gadaadgilebas barZayis proqsimaluri bolo ganzidulia,
mimarT, am mdgomareobas “ukan gaweuli distaluri bolo ki mozidulia da
ujris” simptomi ewodeba. gareTaa rotirebuli.
topograf_anatomiuri safuZveli: topograf-anatomiuri safuZveli:
wina jvaredina iogi (lig. cruciatum TeZo-sukis kunTi, romelic umagrdeba
anterius) iwyeba barZayis lateraluri barZayis Zvlis mcire cibruts, proqsi-
rokis SigniTa zedapirze, umagrdeba malur bolos gadaanacvlebs win da
did wvivs rokTaSua SemaRlebis win. gareT. es cdoma Zlierdeba Sua da
iogis dazianebis dros adgili aqvs mcire dundula kunTebis gaweviT,
“win gamoweuli ujris” simptoms. romlebic umagrdebian did cibruts.
ukana jvaredina iogi (lig. periferiuli Zvlis natexi
cruciatum posterius) iwyeba barZayis gadaadgilebulia SigniT, vinaidan
medialuri rokis SigniTa zedapirze, ikumSeba momzidveli kunTebi, isini
umagrdeba didi wvivis Zvals rokTaSua iwyeba boqvenis Zvlis zeda totidan
SemaRlebis ukan. iogis dazianebis da umagrdeba barZayis Zvlis irib
dros viTardeba “ukan gaweuli ujris” xazs Sua da qveda mesamedSi. Zvlis
simptomi. natexis ukan cdoma xdeba kanWis tyupi
kunTis zegavleniT, romelic iwyeba
barZayis Zvlis rokebis zemoT da aseve
sasaxsre CanTidan.

klinikuri anatomia 219