Features of the subject of topographic anatomy and operative surgery. Topographic and anatomical research methods

The manual introduces the methodology for conducting basic operations, considers the relative position of organs and tissues in various parts of the body. For students of higher medical educational institutions.

LECTURE 1. INTRODUCTION TO TOPOGRAPHIC ANATOMY

Topographic anatomy ("local regional anatomy") - studies the structure of the body by region, - the relative position of organs and tissues in different areas of the body.

1. Tasks of topographic anatomy:

holotopy- areas of location of nerves, blood vessels, etc.

layered structure of the region

skeletopia- the ratio of organs, nerves, blood vessels to the bones of the skeleton.

siletopia- the relationship of blood vessels and nerves, muscles and bones, organs.

Typical anatomy- characteristic of a certain body type. Index The relative length of the body is equal to the length of the body (distantia jugulopubica) divided by height and multiplied by 100%:

31.5 and more - brachymorphic body type.

28.5 and less - dolichomorphic body type.

28.5 -31.5 - mesomorphic type of addition.

Age anatomy- the organisms of children and the elderly are different from people of mature age - all organs descend with age. Clinical Anatomy. Any operation consists of two parts:

Online access

Operational practices.

Online access- a method of exposure of a pathologically altered organ, depends on the patient's physique, his condition, the stage of the pathological process.

Criteria for evaluating online access (according to Shevkunenko-Sazon-Yaroshevich).

Alpha - operating action angle (should be neither large nor small)

Accessibility zone S (cm 2)

Axis of Operational Action (OS) - a line drawn from the surgeon's eye to the pathological organ

Beta - the angle of inclination of the axis of operational action - the closer beta is to 90 degrees, the better

OS - the depth of the wound. The relative depth of the wound is OC divided by AB - the smaller the better the cut.

O operative reception- depends on the stage of the process and the condition of the patient. Operative techniques are divided into radical and palliative. Radical operation- eliminates the cause of the disease (appendectomy). Palliative operation- eliminates some symptoms of the disease (liver metastases in cancer of the pyloric stomach - a new exit from the stomach is created - gastroenteroscopy). Operations differ in execution time. Emergency indications:

Bleeding, injury to the heart, large vessels, hollow organs;

Perforated stomach ulcer;

Strangulated hernia;

Appendicitis progressing to peritonitis.

Urgent- after 3-4 hours of observation in dynamics - acute appendicitis. Planned - Single-stage, multi-stage - with prostate adenoma and urinary retention - 1st stage - cystostomy, and after 2 weeks - removal of prostate adenoma.

2. The history of the development of topographic anatomy.

I period: 1764–1835 1764 - opening of the medical faculty of Moscow University. Mukhin - Head of the Department of Anatomy, Surgery and Midwifery. Buyalsky - published anatomical and surgical tables - director of the medical instrumental plant (Buyalsky's spatula). Pirogov- the founder of operative surgery and topographic anatomy. Years of life - 1810-1881. At the age of 14 he entered Moscow University. Then he studied in Dorpat with Moyer (the topic of his doctoral dissertation - "Ligation of the abdominal aorta in inguinal aneurysms" - defended at the age of 22). In 1837 - the atlas "Surgical anatomy of arterial trunks" and ... received the Demidov Prize. 1836 - Pirogov - professor of surgery at the University of Dorpat. 1841 - Pirogov returned to St. Petersburg to the Medical and Surgical Academy at the Department of Hospital Surgery. Founded 1 anatomical institute. New techniques invented Pirogov:

Layered preparation of a corpse

Crosscut, frozen cut method

Ice sculpture method.

The cuts were made taking into account the function: joints - in a bent and unbent state.

Pirogov is the creator of the Complete Course of Applied Anatomy. 1851 - atlas of 900 pages.

II period: 1835–1863 Separate departments of surgery and topographic anatomy are distinguished. III period: 1863-present: Bobrov, Salishchev, Shevkunenko (typical anatomy), Spasokukotsky and Razumovsky - founders of the Department of Topographic Anatomy; Klopov, Lopukhin.

3 Methods for studying topographic anatomy. On a corpse:

Layer preparation

Cross frozen cuts

"ice sculpture"

injection method

corrosion method.

On the living:

Palpation

Percussion

Auscultation

Radiography

CT scan.

4. Pirogov. Works that brought world fame:

"Surgical anatomy of arterial trunks and fascia" - the basis of topographic anatomy as a science

“Full course of applied anatomy of the human body with drawings. Anatomy descriptive-physiological and surgical”

"Topographic anatomy illustrated by cuts through the human body in 3 directions." The main rule is observed: the preservation of organs in their natural position.

Using the method of cuts to study not only the morphology, but also the function of organs, as well as differences in their topography associated with a change in the position of certain parts of the body and the state of neighboring organs

Used the method of cuts to develop the question of the most appropriate access to various organs and rational operational methods

Osteoplastic amputation of the lower leg

Animal experiments (abdominal aortic ligation)

Studying the action of ether vapor

For the first time he taught topographic anatomy of operative surgery.

MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS

GOMEL STATE MEDICAL INSTITUTE

Department of Normal Anatomy

course of operative surgery and

topographic anatomy

Approved at the meeting of the department protocol No. _____ from "__".

SUBJECT: SUBJECT AND OBJECTIVES OF TOPOGRAPHIC ANATOMY AND OPERATIONAL SURGERY

Teaching aid for students.

assistant E.Yu.

trainee teacher.

I.Relevance of the topic:

Operative surgery and topographic anatomy occupies an exceptionally important place in the system of doctor training, creating the basis for the transition from theoretical training of students to the practical application of the knowledge gained at the university.

Topographic anatomy gives an idea of the relative position and interconnection of organs among themselves, which is used by the doctor when developing a diagnosis or a plan for surgical treatment. Without knowledge of topographic anatomy, it is impossible to correctly perform surgical interventions, understand the mechanisms of development of certain pathological processes and topical diagnosis of diseases.

II.Purpose of the lesson:

The purpose of studying topographic anatomy and operative surgery, as a dual discipline, which is the most important part of the professional training of future doctors, is as follows: based on the study of the layered structure of areas of the human body, to form an idea of \u200b\u200bthe modern possibilities of surgical treatment and diagnosis of major surgical diseases and master the technique of providing the first surgical help.

III.Lesson objectives:

Based on its importance as a clinical and morphological discipline, the main tasks of topographic anatomy and operative surgery are:

1. study of the layered structure of areas of the human body, the characteristics of blood supply and innervation, the anatomical formations that make up them, regional lymphatic outflow;

2. study of the relative position and relationship of organs and systems in areas of the human body;

3. knowledge of the distinctive features of each layer of tissue;

4. to teach students to use the acquired anatomical knowledge to explain the clinical symptoms of various diseases and to choose rational methods of diagnosis and their surgical treatment;

5. study of the classification of surgical operations, based on the goals, purpose and time of execution;

6. study of the general principles and patterns of all surgical interventions / prompt access and prompt reception /;

7. study of surgical instruments, their significance and proper use in performing preparations and diagnostic surgical interventions;

IV.Key learning questions:

1. Subject and tasks of topographic anatomy and operative surgery.

2. Methods of topographic and anatomical studies.

3. Determination of the topographic and anatomical area, external landmark, projection.

4. Classification of surgical instruments and rules for using them.

v.Auxiliary material

CHAPTER 10. TOPOGRAPHICAL ANATOMY OF THE FACIAL SECTION OF THE HEAD

PART THREE. TOPOGRAPHIC ANATOMY AND OPERATIONAL SURGERY OF THE TRUNK AND LIMB. CHAPTER 14. TOPOGRAPHIC ANATOMY AND SURGERY OF THE BREAST

CHAPTER 15. TOPOGRAPHIC ANATOMY AND SURGERY OF THE ABDOMEN

CHAPTER 16. TOPOGRAPHIC ANATOMY AND PELVIC SURGERY

CHAPTER 17. OPERATIONAL SURGERY AND TOPOGRAPHIC ANATOMY OF THE LIMB

PART ONE. GENERAL QUESTIONS OF TOPOGRAPHIC ANATOMY AND OPERATIONAL SURGERY. CHAPTER 1. TOPOGRAPHIC ANATOMY AND OPERATIONAL SURGERY AS A TRAINING AND SCIENTIFIC DISCIPLINE

1.1. DEFINITION AND GENERAL CHARACTERISTICS

Topographic anatomy and operative surgery is a combined discipline consisting of two interrelated parts.

Topographic anatomy - Applied morphological science that studies the layered structure of body areas, the relative position of organs and anatomical structures in areas and parts of the body, their anatomical and functional relationships with other organs and areas.

Operative surgery - a part of surgery that studies the types, principles and techniques of surgical operations.

The main relationship between these two parts of a single academic discipline is that topographic anatomy constitutes the necessary anatomical basis, or anatomical rationale, for operative surgery.

Before each student embarking on the study of a new academic discipline, in this case, topographic anatomy and operative surgery, first of all, the questions arise: what is the purpose of studying this academic discipline, what place does it occupy in the system of academic disciplines of a medical university, how to study it?

The main goal of studying our academic discipline is the anatomical and surgical training of students, which is necessary for subsequent classes in clinical, primarily surgical, departments and in independent medical practice.

There are three components to this preparation.

Mastering the theoretical foundations of topographic anatomy and operative surgery.

The study of the topographic anatomy of specific areas and organs, the rationale, types and techniques of major surgical operations.

Obtaining practical skills in general operating technique.

An important task of modern topographic anatomy and operative surgery, along with the study of traditional sections of the academic discipline, is to familiarize students with new sections and areas of operative surgery (microsurgery, minimally invasive, endoscopic, laser surgery), topographic and anatomical foundations of diagnostic methods of intravital imaging (computer, magnetic resonance tomography, ultrasound scanning, endoscopy).

The subject to be studied is primarily significant for surgical specialties. At the Faculty of Dentistry, this is, of course, surgical dentistry and maxillofacial surgery. At the same time, we can also talk about the broader clinical significance of our discipline, for example, in terms of the study of clinical anatomy for many non-surgical clinical specialties (cardiology, gastroenterology, radiology, etc.).

Important in general clinical terms is the development by students of initial practical skills in general surgical technique.

This is the most general characteristic of topographic anatomy and operative surgery as an academic discipline.

The scientific content of topographic anatomy and operative surgery is the development, anatomical and experimental-surgical substantiation of new surgical operations and technologies, the development of modern areas of clinical anatomy, the strengthening and expansion of ties with clinical surgery and other clinical disciplines.

If we turn to the history of our academic discipline, it should first of all be noted that the idea of joint teaching of operative surgery and topographic anatomy on corpses belongs to the famous Russian surgeon, anatomist, scientist and public figure Nikolai Ivanovich Pirogov. Hence the need to provide basic information about his life, medical, scientific and social activities.

1.2. BASIC INFORMATION ABOUT THE LIFE AND ACTIVITIES OF N.I. PIROGOV

N.I. Pirogov was born in Moscow on November 13, 1810, died in the village. Cherry near Vinnitsa (Ukraine) November 23, 1881. In 1824, 14-year-old Nikolai Pirogov entered the medical faculty of Moscow University, from which he graduated in 1928 and was sent among the best graduates to the Professorial Institute of Derpt (now Tartu, Estonia) of the university to prepare for scientific and pedagogical activities. There he worked in a surgical clinic under the direction of Prof. Moyer, completed and defended his thesis for the degree of MD "Is ligation of the abdominal aorta an easy and safe intervention for inguinal aneurysms?".

After a 3-year trip abroad at the invitation of prof. Moyer N.I. Pirogov took the chair of surgery at the University of Dorpat. The activities of the young professor in Dorpat were very active and productive. He operated a lot, successfully engaged in topographic (surgical) anatomy, wrote and published the book Surgical Anatomy of Arterial Trunks and Fascia, which gained European fame and has not lost its scientific significance in our time.

In Dorpat, N.I. Pirogov proposed a project for the organization of departments of hospital surgery, which was adopted and implemented at the St. Petersburg Medical and Surgical Academy, and N.I. Pirogov received an invitation to take charge of this department and clinic.

In 1841 N.I. Pirogov moved to St. Petersburg, and the 15-year, most fruitful period of his activity began. It was there that he realized his idea of joint teaching of topographic anatomy and operative surgery by surgeons and not by anatomists. His department was called the department of hospital surgery, surgical and pathological anatomy.

N.I. Pirogov developed methods of topographic and anatomical research: saw cuts of frozen corpses, ice sculpture, performed major topographic and anatomical studies, the results of which he published in the atlas "Illustrated topographic anatomy of cuts made in three directions through a frozen human body", issues of the "Complete Course of Applied Anatomy" , manual "Topographic anatomy".

Rice. 1.1.N.I. Pirogov and V.I. Dal against the background of the surgical clinic of the University of Dorpat. Engraving thin. A.F. Presnova

To master the technique of surgical interventions on corpses and perform applied topographic and anatomical studies, N.I. Pirogov, together with professors Baer and Seidlitz, organized the Anatomical Institute as part of the Medico-Surgical Academy for practical exercises of students - the prototype of the departments of operative surgery and topographic anatomy.

The creation of methods for topographic and anatomical research, the publication of major scientific works and the organization of teaching topographic anatomy with operative surgery give every reason to consider N.I. Pirogov as the founder of Russian topographic anatomy.

N.I. Pirogov made a significant contribution to operative surgery. They were offered an alabaster (gypsum) bandage for fractures, osteoplastic amputation of the lower leg, a three-stage cone-circular amputation of the thigh, tenotomy of the Achilles tendon, serous-muscular-submucosal intestinal suture.

His works on surgery were published: “Osteoplastic elongation of the bones of the lower leg during exfoliation of the foot”, “Suspended alabaster bandage in the treatment of simple and complex fractures and for transporting the wounded on the battlefield”, “On the difficulties of recognizing surgical diseases and on happiness in surgery, explained by observations and case histories.

N.I. Pirogov was the founder of the anatomical and physiological direction of surgery, which largely determined the subsequent development of Russian surgery.

During the Petersburg period of life in 1847, N.I. Pirogov undertook a trip to the Caucasus, where, during the capture of the village of Salty, for the first time he performed an operation under ether anesthesia in military field conditions. In 1848 he worked on the cholera epidemic. The result of these works was the "Report on a trip to the Caucasus" and "Pathological anatomy of Asiatic cholera".

The activity of N.I. Pirogov in the besieged Sevastopol during the Crimean War of 1853 - 1856, where the talent of N.I. Pirogov not only as a surgeon, but also as an organizer of surgical care for the wounded. It was a real feat of Pirogov.

After leaving the Medical-Surgical Academy from 1858 to 1861, N.I. Pirogov served in the department of public education as a trustee of the Odessa, and then the Kyiv educational districts.

The last 20 years of N.I. Pirogov spent in his small estate in the village. Cherry of the Vinnitsa province in Ukraine (Fig. 1.2).

During this period in 1862-1866. he traveled abroad as a leader of a group of young Russians

Rice. 1.2.N.I. Pirogov in the last years of his life. Hood. N.F. Fomin (1999). Oil on canvas (80x60 cm). Surgical Museum of VmedA

Rice. 1.3.N.I. Pirogov. Engraving thin. A.F. Presnova

scientists (this group included a young, later famous microbiologist I.I. Mechnikov), and in 1977-1978. undertook an inspection trip to Bulgaria to the theater of the Russian-Turkish war.

He wrote the books "The Beginnings of General Military Field Surgery" and "Military Medical Practice and Private Assistance in the Theater of War in Bulgaria and in the Rear of the Army in 1877-1878", which played a large role in the formation and development of military field surgery. surgery.

In the last years of N.I. Pirogov wrote his memoirs, which were called “Questions of life. Diary of an old doctor. They remained unfinished, as he literally wrote until the last minute, while his hand could hold the pen.

Articles by N.I. Pirogov on social, pedagogical, medical topics were widely known in Russian society. N.I. Pirogov was a real patriot of Russia, he was one of the few people who were called and are called the conscience of the nation.

In May 1881, N.I. was honored in Moscow. Pirogov. I.E. Repin painted his portrait.

N.I. Pirogov lived a difficult, but extremely useful and happy life, during his lifetime he received national recognition as an outstanding surgeon, scientist and public figure.

Back in 1847, N.I. Pirogov was elected a corresponding member, and then an academician of the St. Petersburg Academy of Sciences, had a civil rank of the 3rd class according to the table of ranks - Privy Councilor, was awarded 8 Russian orders, 4 times received the Demidov Prizes of the St. Petersburg Academy of Sciences for his scientific works, was an honorary member of many medical societies, an honorary citizen of Moscow.

N.I. Pirogov, an outstanding figure in Russian medicine, stood at the origins of our dual discipline - topographic anatomy and operative surgery.

1.3. BRIEF OUTLINE OF THE HISTORY OF THE DEPARTMENTS

AND SCIENTIFIC SCHOOLS OF TOPOGRAPHIC

ANATOMY AND OPERATIONAL SURGERY

Organizationally, the idea of N.I. Pirogov about the joint teaching of operative surgery and topographic anatomy on corpses was implemented at the Medical and Surgical Academy (currently the St. Petersburg Military Medical Academy) by creating in 1865

independent department of operative surgery with topographic anatomy, i.e. 10 years after the departure of N.I. Pirogov from the Medical Surgical Academy.

In 1868, the same department was organized in Moscow at the medical faculty of Moscow University (now the Moscow Medical Academy named after I.M. Sechenov).

At these first two departments, the St. Petersburg and Moscow scientific schools of topographic anatomists and operative surgeons were formed, which played an outstanding role in the development of the departments of operative surgery and topographic anatomy, the development of modern topographic anatomy and major sections of operative surgery.

At various times, these departments were headed by such famous Russian surgeons as professors S.G. Kolomnin, I.I. Nasilov, E.G. Salishev in St. Petersburg, A.A. Bobrov, P.I. Dyakonov, P.A. Herzen, N.N. Burdenko in Moscow.

Of particular importance was the pedagogical, scientific and organizational activities of outstanding domestic surgeons-topographic anatomists acad. USSR Academy of Medical Sciences V.N. Shevkunenko (Fig. 1.4) in St. Petersburg and acad. USSR Academy of Medical Sciences V.V. Kovanov (Fig. 1.5) in Moscow.

Rice. 1.4. V.N. Shevkunenko

Rice. 1.5. V.V. Kovanov

The modern theory of anatomical variability, the surgical anatomy of fasciae and cellular spaces, a major contribution to operative, purulent, cardiovascular, plastic surgery, organ and tissue transplantation - this is not a complete list of the achievements of these scientific schools and their leaders. The most important result of the activity is the training of a whole galaxy of topographic anatomist surgeons who became heads of departments, who were active successors or founders of their own scientific schools. These are professors F.I. Valker, E.M. Margorin, A.M. Geselevich, A.N. Maksimenkov, M.A. Sreseli in St. Petersburg, A.A. Travin, I.D. Kirpatovsky, T.F. Lavrova, A.P. Sorokin in Moscow.

After the organization of the departments of operative surgery and topographic anatomy in all medical universities of the country, along with the first two departments, they quickly moved into the group of leaders of the department of the Russian Medical University (head of the department, Corresponding Member of the USSR Academy of Medical Sciences G.E. Ostroverkhov, then Academician of the Russian Academy of Medical Sciences Yu .M. Lopukhin), St. Petersburg Medical University (Head of the Department Prof. M.A. Sreseli, then Prof. O.P. Bolshakov), Kyiv Medical University (Head of the Department Prof. K.I. Kulchitsky), Moscow Medical Academy of Postgraduate Education (MAPO) (Head of the Department Corresponding Member of the USSR Academy of Medical Sciences B.V. Ognev, then Prof. Yu.E. Vyrenkov), St. Petersburg MAPE (Head of the Department Corresponding Member of RAMS S. A. Simbirtsev). Among the heads of the departments of operative surgery and topographic anatomy, much has been done to improve the educational process, develop scientific research, and introduce them into surgical practice, Professor S.S. Mikhailov (Orenburg, Moscow), I.F. Matyushin (Nizhny Novgorod), S.I. Elizarovsky (Arkhangelsk), B.I. Khubutia (Ryazan), D.B. Bekov (Lugansk), E.A. Zhukov, V.N. Perepelitsyn (Perm), A.Kh. Davletshin (Kazan), I.A. Ioffe, N.V. Ostrovsky (Saratov), F.F. Saks (Tomsk), T.V. Zolotareva (Kharkov), A.G. Konevsky (Volgograd), P.E. Tofilo (Tver), T.D. Nikitina (Novosibirsk), L.A. Tarasov (Barnaul). By citing many names of professors who headed different departments in different years of their long history, we want to show that in the medical universities of the country there was a circle of specialists in topographic anatomy surgeons who accepted and actively developed the Pirogovo traditions, ensured the pedagogical and scientific activities of the departments, and prepared their own scientific and pedagogical frames.

In scientific terms, the departments of operative surgery and topographic anatomy are research centers for the development of modern clinical anatomy, experimental bases for the further development of operative surgery, and the development of new surgical technologies. Their research work is based on close and varied collaboration with clinical departments.

Domestic topographic anatomist surgeons and entire departmental teams have made a significant contribution to the development of modern topographic anatomy. These include: further development of the doctrine of anatomical variability; clinical anatomy of the most important organs - heart, lungs, liver, pancreas, kidneys; creation of modern dental anatomy; development of topographic anatomy based on the use of in vivo imaging methods - computer, spiral, magnetic resonance imaging, endoscopy, ultrasound scanning.

One of the main directions in the research work of the departments of operative surgery and topographic anatomy is the development, anatomical and experimental justification of new surgical interventions. On this basis, a number of new operations have been proposed in abdominal, vascular, military field surgery, neurosurgery, and traumatology. Significant contribution to the development of surgical transplantation in the plastics and prosthetics of blood vessels, transplantation of endocrine glands and other areas.

Topographic anatomist surgeons take an active part in the development of such modern sections of operative surgery as microsurgery, minimally invasive, endoscopic, laser surgery.

1.4. GENERAL CONCEPTS AND TERMS

RESEARCH METHODS

If, as mentioned above, topographic anatomy is a morphological science that studies the layered structure of body regions, the topography of organs and anatomical structures and their anatomical and functional relationships with other organs and areas, then the currently widely used concept of “clinical (applied) anatomy" can be defined as a branch of anatomy that studies the structure and topography of organs in relation to the needs of clinical medicine. It contains sections related to various

clinical, especially surgical, specialties. Hence such areas of clinical anatomy as: surgical, microsurgical, neurosurgical, dental anatomy, sections of clinical anatomy for cardiology, gastroenterology, obstetrics and gynecology, etc.

Since in vivo imaging methods are used in clinical anatomy, X-ray, computed tomography, magnetic resonance imaging, ultrasound, and endoscopic anatomy are distinguished by the methods used. The data obtained using these methods are of great importance, on the one hand, for the development of modern anatomy and topographic anatomy, and on the other hand, as the anatomical basis of the corresponding diagnostic methods in pathology.

The systematization of modern anatomical disciplines and trends can be represented in the following classifications.

Classification of anatomical disciplines and directions

The main component of topographic anatomy is the topography of a region, organ or anatomical formation.

Topography is the location of organs and anatomical structures in a topographic-anatomical region or part of the body. It has the following components: holotopy, skeletopy, syntopy, projection onto the surface of the body.

Holotopy denotes the spatial position of an organ in a body part or topographic-anatomical region.

Skeletotopia determines the relationship of an organ or anatomical formation to parts of the skeleton.

Syntopy describes the relationship of an organ with surrounding organs and anatomical structures.

The projection of an organ is a place on the surface of the body corresponding to the position of an organ or part of it.

For the main blood vessels, nerves and other extended anatomical formations, there are projection lines that determine their position in parts of the body.

The projection line is a conditional line on the surface of the body, drawn between certain landmarks, corresponding to the position of a linear anatomical formation.

The main methodological principle of describing and studying topographic anatomy is regionality, i.e. description and study of anatomy and topography in parts of the body and topographic-anatomical areas.

According to the International Anatomical Nomenclature, the following parts of the body are distinguished: head, neck, torso (chest, abdomen, pelvis, back), upper limbs, lower limbs. Topographic and anatomical regions are distributed according to body parts as follows.

LECTURE 1. INTRODUCTION TO TOPOGRAPHIC ANATOMY

Topographic anatomy ("local regional anatomy") - studies the structure of the body by region, - the relative position of organs and tissues in different areas of the body.

1. Tasks of topographic anatomy:

holotopy- areas of location of nerves, blood vessels, etc.

layered structure of the region

skeletopia- the ratio of organs, nerves, blood vessels to the bones of the skeleton.

siletopia- the relationship of blood vessels and nerves, muscles and bones, organs.

Typical anatomy- characteristic of a certain body type. Index The relative length of the body is equal to the length of the body (distantia jugulopubica) divided by height and multiplied by 100%:

31.5 and more - brachymorphic body type.

28.5 and less - dolichomorphic body type.

28.5 -31.5 - mesomorphic type of addition.

Age anatomy- the organisms of children and the elderly are different from people of mature age - all organs descend with age. Clinical Anatomy. Any operation consists of two parts:

Online access

Operational practices.

Online access- a method of exposure of a pathologically altered organ, depends on the patient's physique, his condition, the stage of the pathological process.

Criteria for evaluating online access (according to Shevkunenko-Sazon-Yaroshevich).

Alpha - operating action angle (should be neither large nor small)

Accessibility zone S (cm 2)

Axis of Operational Action (OS) - a line drawn from the surgeon's eye to the pathological organ

Beta - the angle of inclination of the axis of operational action - the closer beta is to 90 degrees, the better

OS - the depth of the wound. The relative depth of the wound is OC divided by AB - the smaller the better the cut.

Bleeding, injury to the heart, large vessels, hollow organs;

Perforated stomach ulcer;

Strangulated hernia;

Appendicitis progressing to peritonitis.

2. The history of the development of topographic anatomy.

Layered preparation of a corpse

Crosscut, frozen cut method

Ice sculpture method.

The cuts were made taking into account the function: joints - in a bent and unbent state.

Pirogov is the creator of the Complete Course of Applied Anatomy. 1851 - atlas of 900 pages.

3 Methods for studying topographic anatomy. On a corpse:

Layer preparation

Cross frozen cuts

"ice sculpture"

injection method

corrosion method.

On the living:

Palpation

Percussion

Auscultation

Radiography

CT scan.

4. Pirogov. Works that brought world fame:

"Surgical anatomy of arterial trunks and fascia" - the basis of topographic anatomy as a science

“Full course of applied anatomy of the human body with drawings. Anatomy descriptive-physiological and surgical”

"Topographic anatomy illustrated by cuts through the human body in 3 directions." The main rule is observed: the preservation of organs in their natural position.

Used the method of cuts to develop the question of the most appropriate access to various organs and rational operational methods

Osteoplastic amputation of the lower leg

Animal experiments (abdominal aortic ligation)

Studying the action of ether vapor

For the first time he taught topographic anatomy of operative surgery.

LECTURE 2. TOPOGRAPHICAL AND ANATOMICAL JUSTIFICATION OF HEAD SURGERY

1. Border between the neck and head conditionally passes along the lower edge of the lower jaw, the apex of the mastoid process, the upper nuchal line, the external occipital protuberance and then passes symmetrically to the opposite side. Cephalic index equals the width divided by the length multiplied by 100. Width- distance between parietal tubercles . Length- from the bridge of the nose to the external occipital protuberance. Cephalic index:

74.9 and less - dolichocephalic (long-headed);

75–79.9 - mesocephals (medium head)

80 and more - brachycephalic (round-headed).

External differences- reflection of internal features. For example, access to the pituitary gland is through the pharyngeal fossa; in dolichocephals - it is elongated - access through the nasal cavity; in brachycephals, it is extended across - access through the oral cavity.

Scull divided into brain and facial sections. In the brain section, a vault and a base are distinguished. Within the arch, frontal, parietal, temporal and occipital regions are distinguished. The structure of the soft tissues of the frontal, parietal and occipital regions is the same - this is the fronto-parietal-occipital region. The structure of the temporal region is different.

2. In the fronto-parieto-occipital region- 6 layers of fabrics.

Leather- very thick, thicker in the occipital region than in the frontal region, contains many sebaceous glands, covered with hair for a large extent. The skin is firmly connected with the tendon helmet, the subcutaneous tissue connects the skin and the helmet into a single layer - the scalp.

Subcutaneous tissue- strong, rough, cellular, granular. Contains many strong dense fibers (vertical and oblique), many sweat glands. Vessels and nerves pass through this layer. Muscular-aponeurotic layer- consists of the frontal muscle in front, the occipital muscle in the back and the connecting tendon helmet (galea aponeuroxica). The tendinous helmet is tightly connected with the skin, and loosely with the periosteum, therefore, scalped wounds are frequent on the cranial vault (integumentary tissues exfoliate from the periosteum). Due to the good blood supply to the soft tissues of the skull, such wounds heal well with timely assistance. Subaponeurotic fiber- very loose. If hematomas and inflammatory processes occur in the subcutaneous tissue, they do not spread. The same processes in the subgaleal tissue are distributed throughout the head - behind - to the upper nuchal line (l. nuchae supperior), in front - to the superciliary arches, from the side - to the upper temporal line. Periosteum connects to the bones of the skull with the help of loose subperiosteal fiber. But in the area of the seams, the periosteum is tightly connected to the bone, there is no fiber there. Therefore, subperiosteal hematomas and inflammatory processes have sharply defined edges, corresponding to the line of bone sutures, and do not go beyond one bone (for example, birth hematomas). Bones The cranial vaults consist of outer and inner plates (lamina externa ex interna - it is also lamina vitrea - "glass"), between which there is a spongy substance - diploe. With injuries of the cranial vault, there is often a fracture of the inner plate with an intact outer one.

LECTURE 3. TOPOGRAPHY AND FEATURES OF THE STRUCTURE OF THE TEMPORAL REGION

1. Skin- in the posterior part of the region of its structure, it is similar to the skin of the fronto-temeeno-occipital region; in the anterior section - the skin is thin, the subcutaneous tissue is loose - the skin can be folded. AT subcutaneous tissue poorly developed muscles of the auricle, vessels and nerves are located. In the temporal region superficial fascia forms a thin sheet, which is gradually lost in the facial tissue. Part temporal aponeurosis the superficial and deep sheets enter, they diverge in the region of the zygomatic arch, and the surface sheet is attached to the outer surface of the zygomatic arch, and the deep one to the inner. Located between the leaves interaponeurotic layer of adipose tissue. The temporal aponeurosis in the region of the superior temporal line is tightly connected with the periosteum, therefore, the pathological accumulations formed under it do not go further to the cranial vault, but spread into the infratemporal fossa and onto the face.

Under the deep leaf of the temporal aponeurosis is located subaponeurotic fiber layer, which behind the zygomatic arch and zygomatic bone passes into Bish's fat lump. temporalis muscle located directly on the periosteum. The muscle starts from the lower temporal line, behind the zygomatic arch passes into a powerful tendon, which is attached to the coronoid process of the lower jaw. Periosteum in the lower part of the region is firmly connected with the underlying bone. In other departments, the connection with the bone was as loose as in the fronto-parietal-occipital region. Scales of the temporal bone very thin, contains almost no spongy substance, easily fractured. And since vessels are adjacent to the scales from the outside and from the inside, its fractures are accompanied by severe hemorrhages and compression of the brain. Between the temporal bone and the dura mater passes the middle artery of the dura mater (a. meningea media), the main artery that feeds the dura mater. This artery and its branches are tightly connected to the dura mater (dura mater), and form grooves on the bones - sulci meningei. Krenlein proposed a scheme of craniocerebral topography, thanks to which it is possible to determine the position of a. meningea media, its branches, and project the most important furrows of the cerebral hemispheres (Roland and Sylvian furrows) onto the integument of the skull.

2. Feature of blood supply soft tissues of the head is a rich arterial blood supply. Only 10 arteries supply blood to the soft tissues of the head. They make up 3 groups:

Front group - aa. supraorbitalis, supratrochlearis from the system a. carotica interna

Side group - a. temporalis and a. auricularis posterior from system a. carotica externa

Back group - a. occipitalis from a. carotica externa.

These arteries anastomose on both sides. As a result of abundant blood supply to the soft tissues of the head: very heavily bleeding wounds; wounds heal very quickly and are very resistant to infection. Vessels are characterized about the meridian direction (all vessels go to the crown), the nerves also go. This must be taken into account when cutting.

The main vessels are located in the subcutaneous tissue layer, closer to the aponeurosis, their sheath grows together with fibrous fibers - the vessels do not collapse on the cut.

Venous blood flow. Veins of the head are divided into 3 floors:

Extracranial system (veins run parallel to arteries)

Veins of the bones of the skull (v. diploae)

Intracranial system (sinuses of the dura mater).

All these systems are connected and the blood circulates in both directions (depending on the amount of intracranial pressure), which creates the risk of soft tissue phlegmon spreading to osteomyelitis, meningitis, meningoencephalitis.

Points for conduction anesthesia(location of the main nerves on the head)

The middle of the upper orbital edge - n. Supraorbitalis

The outer edge of the orbit - n. Zugomaticotemporalis

Ahead of the tragus - n. auriculotemporalis

Behind the auricle - n. auriculus magnus

The middle between the mastoid process and the external occipital protuberance - n. occipitalis major et minos.

3. Features of the structure of the mastoid process:

The trepanation triangle of Shipo is located in the anterior-upper region of the mastoid process. Here they perform trepanation of the mastoid part of the temporal bone with purulent mastoiditis and chronic otitis media. The boundaries of the Thorn triangle: in front - the posterior edge of the external auditory opening with the awn (spina supra meatum) located on it, behind - the mastoid scallop (crista mastoidea), above - the horizontal line - the continuation of the posterior zygomatic arch.

In the thickness of the mastoid process there are bone cavities - cellula mastoidea. They contain air and are lined with a mucous membrane. The largest cavity - the cave (antrum mastoideum) through aditusad antreem communicates with the tympanic cavity

The projection of the sigmoid sinus adjoins the posterior side of the trepanation triangle

Anterior to the Triangle of Shipo, in the thickness of the mastoid process, passes the lower section of the canal of the facial nerve.

When trepanation of the mastoid part of the bone, the sigmoid sinus, facial nerve, semicircular canals and the upper wall of the tympanic plane can be damaged.

LECTURE 4. TOPOGRAPHICAL ANATOMY OF THE BASE OF THE SKULL AND THE BRAIN

1. Cranial pits. On the inner base of the skull, there are three cranial fossae - anterior, middle, posterior (fossa cranii anterior, media et posterior). Anterior cranial fossa- delimited from the middle by the edges of the small wings of the sphenoid bone and the bone roller (limbus sphenoidalis), which lies anterior to the sulcus chiasmatis. The fossa cranii anterior is located above the nasal cavity and eye sockets. Within the fossa are the frontal lobes of the brain. On the sides of the crista gali are the olfactory bulbs (bulbi oltactorii), from which the olfactory tracts begin. Openings of the anterior cranial fossa: foramen caecum, openings of the lamina cribrosa of the ethmoid bone (missing n. olfactorii, a. ethmoidalis anterior, vein and nerve of the same name) . Middle cranial fossa- separated from the back wall of the Turkish saddle and the upper edges of the pyramids of the temporal bones. The central part of the middle cranial fossa has a depression - the fossa of the Turkish saddle, where the pituitary gland is located; anterior to the sella turcica in sulcus chiasmatis is the optic chiasm. The lateral sections of the middle cranial fossa are formed by the large wings of the sphenoid bones and the anterior surfaces of the pyramids of the temporal bones, contain the temporal lobes of the brain. At the top of the pyramid is the semilunar ganglion of the trigeminal nerve. On the sides of the Turkish saddle is the cavernous sinus. Openings of the middle cranial fossa: canalis opticus (misses n. opticus and n. ophtalmica); fissura orbitalis superior (skips vv. ophtalmicae; n. oculomotorius (III); n. trochlearis (IV); n. ophthalmicus; n. abducents (VI); foramen rotundum (skips n. maxillaris), foramen ovale (skips n. mandibularis ), foramen spinosos (skips a. meningea media), foramen lacerum (skips n. petrosus major).

Posterior cranial fossa- contains the bridge, medulla oblongata, cerebellum, transverse, sigmoid and occipital sinuses. Openings of the posterior cranial fossa: porus acusticus internus ((internal auditory opening) - skips a. labyrinthi, n. facialis (VII), n. statoacusticus (VIII), n. intermedius); foramen jugularis (skips n. glossopharyngeus (IX), n. vagas (X), n. accessorius willisii (XI), v. Jugularis interna); foramen magnum (passes the medulla oblongata with membranes, aa. Vertebralis, plexus venosi vertebrales interna, spinal roots n. accessorius); canalis hypoglossi (passes n. hypoglossus (XII)).

2. Shells of the brain

Dura mater(dura mater enencepnali) consists of two leaves and loose fiber between them. On the vault of the skull, the dura mater is loosely connected with the bones, between them there is a slit-like epidural space. At the base of the skull, the connection between the dura mater and the bones is very strong. In the sagittal direction from the crista gali to the protuberantia occipitalis interna, the superior sickle-shaped process of the dura mater extends, separating the cerebral hemispheres from each other. In the posterior part, the crescent brain connects with another process of the dura mater - the tent of the cerebellum, which separates the cerebellum from the cerebral hemispheres. The crescent process of the dura mater contains the superior sagittal venous sinus (sinus sagittalis superior), which is adjacent to the bones of the skull. The lower free edge of the cerebral sickle contains the lower sagittal sinus (sinus sagittalis inferior). The straight sinus (sinus rectus) is located along the line of connection between the crescent crescent and the tent of the cerebellum. The occipital sinus (sinus occipitalis) is contained in the thickness of the sickle of the cerebellum.

In the middle cranial fossa, on the sides of the Turkish saddle, there is a paired cavernous sinus (sinus cavernosus). Along the line of attachment of the tent of the cerebellum is the cavernous sinus (sinus transversus), which continues into the sigmoid sinus, located on the inner surface of the mastoid part of the temporal bone.

Spider and soft shell. Between the arachnoid (arachnoidea encephali) and dura mater is the subarachnoid space. The arachnoid membrane is thin, does not contain blood vessels, does not enter the furrows that limit the cerebral gyrus. The arachnoid membrane forms pachyon granulations (villi) that perforate the dura mater and penetrate into the venous sinuses. The pia mater (pia mater encephali) is rich in blood vessels, enters all the furrows, penetrating the cerebral ventricles, where its folds, together with the vessels, form the choroid plexuses.

3. Subarachnoid space, ventricles of the brain, cisterns

The space between the pia mater and arachnoid subarachnoid contains cerebrospinal fluid. Ventricles of the brain(there are four of them). IV ventricle - on the one hand, it communicates with the subarachnoid space, on the other hand, it passes into the central canal of the spinal cord; through the Sylvian aqueduct, the IV ventricle communicates with the III. The lateral ventricle of the brain has a central section (in the parietal lobe), an anterior horn (in the frontal lobe), a posterior horn (in the occipital lobe) and a lower horn (in the temporal lobe). Through 2 interventricular openings, the anterior horns of the lateral ventricles communicate with the third ventricle. cisterns- somewhat expanded sections of the subarachnoid space. The most important - cisterna cerebellomeolullaris - is limited from above by the cerebellum, in front - by the medulla oblongata. This cistern communicates with the latter through the middle opening of the 4th ventricle, below it passes into the subarachnoid space of the spinal cord.

4. Main furrows and convolutions of the brain

The central sulcus - sulcus elutralis (Rolando) - separates the frontal lobe from the parietal.

Lateral groove - sulcus lateralis - separates the frontal and parietal lobes from the temporal.

Parietal occipital sulcus - sulcus parietooccipitalis - separates the parietal lobe from the occipital lobe. In the precentral gyrus is the core of the motor analyzer, in the postcentral - the core of the skin analyzer. Both of these convolutions are connected to the opposite side of the body.

LECTURE 5. FACIAL DEPARTMENT OF THE HEAD

I. Facial skin - thin, mobile. Subcutaneous fat contains facial muscles, muscles, blood vessels, nerves. The duct of the parotid gland.

blood supply- from branches a. carotis externa: a. temporalu superficialis, a. facialis, a. maxillaris and a. Ophthalmica (from a. carotis interna). Vessels on the face form a network and anastomose well. On the face - 2 venous networks - superficial (consists of the facial and submandibular veins) and deep (represented by the pterygoid plexus). The pterygoid plexus is connected with the cavernous sinus dura mater through the emissaries and veins of the orbit, therefore purulent processes on the face are often complicated by inflammation of the meninges, phlebitis of the sinuses. motor nerves; the system of the facial nerve - innervates the facial muscles, the system of the third branch of the trigeminal nerve - innervates the masticatory muscles. The skin of the face is innervated by the branches of all three trunks of the trigeminal nerve and the branches of the cervical plexus. Projections of bone holes through which nerves pass. Foramen infraorbitale is projected 0.5 cm below the middle of the infraorbital margin. Foramen mentale - in the middle of the height of the body of the lower jaw between 1 and 2 small molars. Foramen manolibulare - from the side of the oral cavity - in the middle of the distance between the anterior and posterior edges of the lower jaw branch, 2.5–3 cm upwards from the lower edge.

2. Areas of the face

Eye socket area– 2 departments; superficial, located anterior to the orbital septum and constituting the region of the eyelids (regio palpebra)) and deep (located posterior to the orbital septum and constituting its own region of the orbit (regio orbitalis propria)), in which the eyeball with its muscles, nerves, fatty tissue and vessels.

own eye area. The upper wall of the orbit is the bottom of the anterior cranial fossa and frontal sinus; the lower wall is the roof of the maxillary sinus, the lateral wall of the orbit is the sphenoid and zygomatic bones; sinus and cells of the ethmoid labyrinth.

Holes in the walls of the eye socket:

In the medial wall - the anterior and posterior ethmoid openings

Between the lateral and superior walls, in the posterior section - the superior orbital fissure (connects the orbit to the superior cranial fossa)

Between the lateral and lower walls - the lower orbital fissure (connects the orbit with the temporal and infratemporal fossae, pterygoid sinus).

In the cavity of the orbit - 7 muscles: m. levator palpebrae superiores - refers to the upper eyelid; the remaining 6 muscles belong to the eyeball: 4 of them are straight (external, internal, upper, lower) and 2 oblique (upper and lower).

optic nerve occupies a central position in the orbit . Nose area-consists of the external nose and nasal cavity. nasal cavity. The septum divides the nasal cavity in two. On the side walls there are nasal conchas (3 on each side), delimiting 3 nasal passages (lower, middle, upper). The following are opened into the nasal cavity: above the upper concha - the sinus of the sphenoid bone, into the upper nasal passage - the posterior cells of the ethmoid labyrinth, into the middle nasal passage - the middle and anterior cells of the labyrinth of the ethmoid bone, the frontal and maxillary sinus, into the lower nasal passage - the lacrimal canal ( canalis nasolacrimalis). Additional cavities of the nose - frontal, maxillary, sphenoid and cells of the labyrinth of the ethmoid bone.

Mouth area- Oral cavity and lips. The oral cavity - with closed jaws, is divided into the actual oral cavity and the vestibule of the mouth.

Cheek area- the subcutaneous fat is most developed, Bish's fat lump adjoins it (lies between the buccal and chewing muscles). Mimic muscles of the buccal region: the lower part of m. orbitalis oculi, m. quadratus labii superiores, m. zugomaticus. Sensory nerves of the buccal region: branches n. trigeminus-n. infraorbitalis and nn. bucalis. Motor nerves - branches n. facialis.

Parotid chewing area- under the superficial fascia is its own fascia, which forms a capsule of the parotid gland. The parotid gland fills the muscular-fascial space (spatium parotideum) - the bed of the gland. At the top, the spatium parotideum adjoins the external auditory canal - here is a “weak spot” in the fascial cover of the gland, which undergoes a rupture with purulent parotitis, which often opens into the external auditory canal.

Deep area of the face- contains formations related to the chewing apparatus: upper and lower jaws, m. pterygoideus lateralis et medialis.

Read:

II. The period of scientific anatomy (starts from the time of Andrei Vesalius - the 16th century AD and continues to the present).
Anatomy and its place in a number of biological disciplines. The value of anatomy for medicine. Methods of anatomical research.
Anomalies of the skull bones, their significance in anatomy and practical medicine.
Certification and pedagogical measuring materials in pathological anatomy for the specialty "pediatrics"
Head Department of Human Anatomy named after Professor M.G. Prives,
Lesson number 1. Introduction to the discipline "Fundamentals of Clinical Anatomy with Manual Skills"

Topographic anatomy is studied on preserved and fresh corpses, as well as on a healthy and sick person. In the latter case, it is possible to determine the location, size, shape of the organ, etc. The need for such a study is due to the fact that after death changes occur in the location of organs and tissues. The study is carried out in anatomical areas, divided among themselves conditional boundaries. The latter are set according to external landmarks available for inspection and palpation. Landmarks are bony prominences, muscles, tendons, skin folds, arterial pulsation, etc.

The task of topographic anatomy includes determining the projection of organs on the skin, the relative position of the organs, their relationship to the bones of the skeleton. All this is reflected in the developed methods and schemes that allow you to find projection to the surface

bodies of deep-seated internal organs, vessels, nerves, furrows, convolutions, etc.

The study of individual areas of the human body is carried out by various methods both on a living person and on a corpse.

On a living person, using inspection and palpation, you can find external landmarks (bone protrusions, muscle elevations, intermuscular grooves, skin folds) and determine the boundaries of areas, projections of organs, vessels and nerves. Valuable data on topographic anatomy on a living person can be obtained using radiography, computed tomography and magnetic resonance imaging, ultrasound and ultrasound. on topographic anatomy with the study of the corpse.

Methods for studying topographic anatomy on a corpse.

The main one is the method layer-by-layer preparation (dissection) of tissues on a corpse.

Layered preparation of the area, i.e. pos
exploratory exposure of the layers of the region,
starting with the skin, - the main me
research method in both normal and
topographic anatomy. Via
scalpel, electro- or ultrasonic
tissue knife is sequentially dissected from
surface deep into (as during surgery). AT
this time the teacher pays attention
enrollment of students on topographic anatomical
features of the area that are needed
will take into account the doctor in his practice
which activity.

It is known that organs and tissues are displaced during preparation. So that they can be studied in a natural position, N.I. Pirogov. 1. Method "ice" anatomy includes cuts of frozen corpses or individual parts of the body, which are made in three directions perpendicular to each other, followed by the image of the ratio of tissues in the figure. The method of sawing a frozen corpse allows you to accurately determine the relative position of the organs of the study area. Study of Pirogov Sawing is an important stage in the training of specialists in ultrasound and computed tomography.

2. Method "anatomical sculpture". With the help of a chisel and a hammer on a frozen corpse, the studied internal organ, fixed in a natural position, is exposed. Both methods allow you to study the location of organs in pathology. For example, before freezing a corpse in any area of the human body, one can reproduce the mutual arrangement of organs, which is observed in various diseases. To this end N.I. Pirogov put anatomical experiments for the introduction of fluid into the chest or abdominal cavity, stomach, bladder, for the introduction of air into the intestines, etc. pouring and injection methods: gases, paints (one-, two- and multi-color), solutions, suspensions, suspensions are introduced, and contrast agents during x-ray examination.

The use of these methods with further preparation can be applied in topographic anatomy in the study of the circulatory and lymphatic systems, cellular spaces and the ways in which hematomas and pus spread in them. To study the architectonics of the vessels of parenchymal organs, corrosive method, in which dense coloring substances are introduced into tubular formations (vessels, bronchi, biliary tract, etc.). After hardening, the cast is washed from the remnants of the organ and they become available for research.

The study of topographic anatomy provides for the use of special methodological approaches and techniques in connection with its special tasks. To study topographic anatomy, the usual methods of layer-by-layer preparation of one or another vessel, nerve or muscle throughout its entire length or examination of a separate organ removed from the human body are not sufficient. To study the topography of the area, it is advisable to use the method of the so-called fenestrated preparation, when a window is limited with a scalpel within a relatively small area of any area of the human body (a rectangular flap is cut out),

within which all anatomical formations are strictly layered: vessels and nerves of the subcutaneous fatty tissue, muscles located under the sheet of their own fascia, neurovascular bundles lying under the muscles, etc. When considering all the detected formations, it is necessary not only to note their relationship with each other, but also to choose the most permanent and well-defined landmarks that help to find the necessary anatomical elements in the future.

As such landmarks, as a rule, well-palpable bony protrusions are used, drawn through constant points, longitudinal and transverse lines (for example, the median line of the body, the mid-clavicular line, tin. spinarum, tin. costarum and etc.). Finally, it is important to know with which neighboring organs (vessels, nerves, muscles) the desired anatomical object is in contact, on which, for example, side of the muscle visible in the wound, one or another neurovascular bundle is located, etc.

The position of organs in one or another area can be established in relation to the human body (holotopy), to the skeleton (skeletotopia), to surrounding organs and tissues (syntopia). In addition, they study the typical, age and surgical anatomy of the structure and location of organs. Holotopia of the organ, i.e. its position in relation to the human body as a whole. To determine the holotopy of organs, concepts are usually used that are well known in anatomy: the relationship to the sagittal (middle) and frontal (medial, lateral, dorsal, ventral, anterior, posterior position) planes of the body, the relationship to horizontal levels (high, low position, for the limbs proximal, distal). In some cases, for a more accurate characterization of the holotopy, a three-dimensional coordinate system is used, which is fixed relative to a chosen reference point (more often, according to bone landmarks). The liver, for example, is holotopically located in the right hypochondrium and proper epigastric regions of the abdominal cavity, the appendix in the inguinal region of the abdominal cavity, the heart in the anterior mediastinum of the chest cavity, etc.

Skeletotopia of the organ, i.e. its relation to the landmarks of the skeleton as the most constant and relatively accessible for visual observation, palpation and X-ray examination. The simplest example is the determination of the boundaries of the heart and its skeletotopia with respect to intercostal spaces, ribs and vertical lines, also drawn through bone landmarks, using percussion. (lin. parasternalis, lin. medioclavicularis). More accurate "skeletopia can be determined using radiography and fluoroscopy, if necessary, using radiocontrast preparations injected into the cavities of organs or into the lumen of blood vessels.

Syntopy of organs, i.e. the relation of an organ to neighboring anatomical formations directly adjacent to it. To study the syntopy of organs or their parts, there are special methods of research, which include cuts of the body in various planes (the method of "ice" anatomy), injections of various dyes (imprints of colored areas in places of contact with neighboring organs), X-ray examinations in different projections, Ultrasound I. Of particular interest are the most modern methods of computed radiography and NMR, which make it possible to obtain images of internal organs in any angle and planes with the possibility of their mathematical processing.

Use for the study of topographic relationships of such methods as X-ray, ultrasound. NMR, widely used in clinical practice, allows a deeper study of the clinical aspects of topographic anatomy, makes its connection with the clinic even more organic and inseparable, allowing, if necessary, direct clinical and anatomical comparisons and parallels.

typical anatomy, developed by the school of V.N. Shevkunenko, studies options for the structure and location of organs.

V.N. Shevkunenko with his students installed extreme and intermediate forms of anatomical variants, as well as level limits in the location of various organs (liver, spleen, kidneys, caecum, etc.).

The ratio of organs and tissues should always be studied both in normal and pathological conditions.

The structure and arrangement of organs in healthy people are subject to large fluctuations. By mathematical analysis of various options, it is possible to establish the frequency of both extreme types and transitional forms between them.

It is quite clear that it is important for the surgeon to know in each individual case, for example, the high or low location of the spleen in a given patient, whether the liver is tilted backwards or not. If it is thrown back, then the gallbladder is easily accessible, if the liver is tilted forward, the gallbladder is covered by it, it is more difficult to expose it in this case, etc.