klinikuri

anatomia
 Sesavali

anatomiis mokle istoria

fabrici (1537-1619 ww.) romelmac 1594 wels paduaSi
cnobili anatomiuri Teatri gaxsna. igi uiliam
anatomia Seiswavlis sxeulis struqturas. igi harveis erT-erTi maswavlebeli iyo. iTvleba, rom
medicinis erT-erTi yvelaze uZvelesi mecnierebaa, fabricis mier venebis sarqvelebis aRmoCenam miiyvana
romelsac jer kidev Zvel egvipteSi swavlobdnen harvei sisxlis mimoqvevis aRmoCenamde. 1628 wels
(Cvens welTaRricxvamde daaxloebiT 500 wliT adre). harveis mier gamoqveynebuli wigni “Exercitatio Anatomica
yvelaze adreuli anatomiuri aRweriloba, Cvens de Motu Cordis et Sanguinis in Animalibus”, cxovelebSi
eramde 3000, 2500 wliT adre, dawerili iyo papirusze, gulis muSaobisa da sisxlis mimoqcevis Sesaxeb,
(Persaud, 1984). mogvianebiT, Zvel saberZneT-Si medicinis istoriis qvakuTxedad iqca (Persaud, 1997).
adamianis anatomiis SeswavliT me-17 saukunis evropuli medicinis skolebisaTvis
dainteresdaHhipokrate (Cvens eramde 460-377 ww.), adamianis gvamis gakveTa mniSvnelovani da
romelic miCneulia medicinis mamad da anatomiis Cveulebrivi movlena gaxda da anatomiuri
mecnierebis fuZemdeblad. Hhipokrates ficis garda, muzeumebic bevr qalaqSi gaixsna.
man anatomiis ramdenime saxel-mZRvanelo dawera. erT- me-18 da me-19 saukuneebis ganmavlobaSi, anatomebma
erT wignSi hipokrate ambobs, rom “sxeulis buneba, gamoaqveynes mra-vali mSTambeWdavi wigni da atlasi,
misi agebuleba medicinis mecnierebis amosavali romlebic adamianis sxeulis aRweri-sTvis axal
wertilia”. aristotelem (Cvens eramde 384-322 ww.) standartebs amkvidrebdnen. gvamebis gakveTis
pirvelad gamoiyena termini “anatomia”, romelic danergvam ganapiroba adamianebis gvamebis mopovebis
berZnulad niSnavs nawilebad daWras, daSlas. ukanono xerxebis gavrceleba. saflavebis
laTinuri sityva “dissecare” igive mniSvnelobisaa. profesionali mZarcvelebi anatomiur skolebs
andre vezalis (Cvens eramde 1514-1664 ww.) Sedevri gvamebiT amaragebdnen da xSirad, mkvlelobasac ar
“adamianis sxeulis fabrika”, romelic 1543 wels eridebodnen. Aarc Tu iSvi-aTad, Ggvamebs iparavdnen
gamoqveynda, medicinis istoriaSi axali eris Mmedicinis skolis studentebi da maTi mas-
dasawyisad iTvleba. am droisTvis, moZRvreba wavleblebi (Persaud, 1997). 1832 wels did britaneTSi
anatomiaze iqca realur disciplinad, romelic parlamentma miiRo kanoni, romelic iTvaliswinebda
dafuZnebuli iyo rogorc uSualo dakvirvebebze, anatomiis SeswavlisaTvis medicinis skolebis
aseve mecnierul principebze. vezali anatomias legalur momaragebas upatrono da Semowiruli
ganixilavda rogorc medicinis mecnierebis gvamebiT. ingliss sxva qveynebmac mibaZes.
saZirkvels. andre vezalis Rirseuli mimdevari iyo

anatomiis Seswavlis xerxebi regionuli anatomia

regionuli (topografiuli) anatomia adamianis
sxeuls, misi formidan da masidan gamomdinare,
anatomia Seiswavlis struqturebs, sadac ganixilavs, rogorc mTavari nawilebisgan Seqmnil
mimdinareobs mniSvnelovani sasicocxlo procesebi erTian organisms (sur. I.1): sxeuli Sedgeba Tavisagan,
(funqciebi). miuxedavad imisa, rom istoriulad da kisrisgan da tanisagan (romelic Tavis mxriv iyofa:
pirdapiri mniSvnelobiT, anatomia upiratesad, gulmkerdi, muceli, zurgi da menji/Sorisi), aseve
sxeulis struqturuli organizaciis Semswavleli wyvili zeda kidurisa da wyvili qveda kidurisgan.
mecnierebaa, sagnis srulad gacnobiereba yvela es ZiriTadi nawili SeiZleba daiyos ubnebad
SesaZlebelia mxolod struqturebisa da maTi da zonebad. regionuli anatomia Seiswavlis sxeulis
Sesabamisi funqciebis erTdrouli ganxilvisas. struqturas da amasTanave, yuradRebas amaxvilebs
Tanamedrove anatomia funqciuri anatomiaa. mocemul calkeul nawilebze (mag., Tavze), ubanze (mag., saxe) an
wignSi aRwerilia adamianis makroskopuli anatomia qveubanze (mag., Tvalbude). ikvlevs agreTve,
anu adamianis sxeulis struqturuli organizaciis sxvadasxva sistemuri struqturebis (kunTebis,
Taviseburebani mikro-skopis gareSe. adamianis nervebis, arteriebis da a.S.) ganlagebasa da
anatomia Seiswavleba sam ZiriTad doneze—regi- urTierTkavSirs konkretul qveubanSi. amis Semdeg
onuli (topografiuli), sistemuri da klinikuri kvleva grZeldeba mimdebare ubnebSi. mocemul wignSi
(gamoyenebiTi),—rom-lebic asaxaven sxeulis swored aseTi meTodia gamoyenebuli da TiToeuli
struqturul organizacias; misi Seswavlis Tavi sxeulis ZiriTad nawilebs eZRvneba. aseTive
prioritetebsa da miznebs. midgoma gamoiyeneba Tanamedrove anatomiis kursSi,
romelic moicavs labo-ratorul komponentebs,

klinikuri anatomia 1
gakveTis CaTvliT. aseTi xerxiT anatomiis xulebis daxmarebiT. radiografiuli anatomia iZleva
Seswavlisas, mniSvnelovania TiToeuli ubnis mniSvnelovan informacias cocxali organizmis
anatomia regularulad davukavSiroT mezobel normalur struqturebze, romlebzec moqmedebs
ubnebsa da mTel organizms. kunTovani tonusi, organizmis siTxeebi, wneva da
regionuli anatomia ganixilavs agreTve, simZimis Zala; diagnostikuri radiologiis
sxeulis organizacias Sreebis mixedviT: kani, daxmarebiT, SesaZlebelia normalur struqturebSi
kanqveSa qsovili, zedapiruli da Rrma fasciebi; gamovlindes travmis efeqtebi, paTologia da
zogjer kanqveS ganlagebuli struqturebi dabereba. mocemul wignSi “samedicino gamosaxulebis
nawilobriv TvalsaCinoa da maTi Sewavla da kvleva paragrafebs” (mwvane foni) yoveli Tavis bolos, Tan
SesaZlebelia cocxal individebze, plastikuri erTvis radiografuli anatomia. miuxedavad amisa,
anatomiis saSualebiT. Rrmad ganlagebuli struqturebis samganzomilebiani
anatomiisa da maTi urTierTkavSirebis yovelmxrivi
plastikuri anatomia regionuli anatomiis da detaluri Seswavla SesaZ-lebelia gakveTis dros
umniSvnelovanesi nawilia. igi ganxilulia an sxeulis gare safarvelis mocilebis Semdeg,
mocemuli saxelmZRvanelos “plastikuri anatomiis pirdapir am struqturebis gakveTis procesSi.
paragrafebSi” (narinjisferi foni), sadac aRwerilia klinikur praqtikaSi gaerTiandeba plastikuri
kanqveS mdebare struqturebi, romelTa SegrZneba anatomia, radiografuli gamosaxulebebi da
cocxal organizmSi, rogorc mosve-nebul anatomiis SeswavliT miRebuli Tqveni codna, rac
mdgomareobaSi, ise moZraobisas, SeiZleba SexebiT saboloo jamSi, ganapirobebs TiToeuli pacientis
(palpaciiT). sxeulis garegani formis, zedapiris da anatomiis codnas.
aseve, zedapiris qveS mdebare struqturebis kompiuteri mniSvnelovani damatebiTi
daTvalierebiT an SegrZnebiT bevri mniSvnelovani saSualebaa regionuli anatomiis Sesaswavlad (Cahill
informaciis miReba SeiZleba. am meTodis mizania, and Leonard, 1997), radgan aadvilebs zogierT aspeqts.
erTi mxriv, im struqturebis vizualizacia kompiuteri kompleqsuri moqmedebebis saSualebas
(gonebrivi warmosaxviTi suraTis miReba), romelTa iZleva da agreTve, SesaZlebeli xdeba or da
moxazuloba Cans sxeulis zedapirze an sxeulis samganzomilebiani vizualuri anatomiuri
zedapiridan SesaZlebelia maTi palpacia, xolo, struqturebiT manipulireba, rac amartivebs kvlevis
meore mxriv, klinikur praqtikaSi—nebismieri process. magaliTad, seriuli anatomiuri anaTlebis
uCveulo an anomaluri struqturis amocnoba. sxva sibrtyiTi gamosaxulebebis Tanamimdev-ruli an
sityvebiT, rom vTqvaT, plastikuri anatomia miznad paraleluri Cveneba, kompiuteruli tomografia (CT)
isaxavs sxeulis zedapiris qveS ganlagebuli da magnituri rezonansis gamosaxulebebi (MRI);.
struqturebis yovelmxriv Seswavlas. magaliTad, swavleba Zalzed Sedegiania da damaxsovrebac
naCxvleti Wrilobis daTvalierebisas, eqimma unda efeqturia, roca instruqciuli swavleba kombini-
warmoidginos Rrmad mdebare struqturebi, romlebic rebulia realuri gakveTis gamocdilebasTan. es
SeiZleba dazianebuli iyos. plastikuri anato-miis niSnavs iswavlo gakveTebis gziT (Amadio, 1996, Mutyala
codna garkveulwilad, amcirebs didi faqtobrivi and Cahill, 1996). gakveTis dros Tqven xedavT, xeliT
masalis damax-sovrebis aucileblobas, radgan exebiT, miiwevT win da Tanmimdevrulad avlenT
sxeulis daTvaliereba da palpacia yovelTvis sxeulis nawilebs. 1970 wels cnobilma
SesaZlebelia. Sotlandielma meanma, uiliam hanterma, ganacxada:
plastikuri anatomia praqtikulad fizikaluri “mxolod gakveTa gvaswavlis sad unda gavWraT an
gasinjva-gamokvlevaa. palpacia (avadmyofis gasinjva rogor gavsinjoT cocxali organizmi Tavisuflad
xeliT) cocxali organizmis gasinjvis klinikuri da warmatebulad.”
meTodia. magaliTad, arteriuli pulsis palpacia
gamokvlevis fizikaluri meTodia. adamianis sistemuri anatomia ganixilavs sxeulis
gasinjvis gasaadvileblad, studentma unda iswavlos organizacias sistemebis mixedviT. ama Tu im sistemis
sxvadasxva instrumentis gamoyeneba. magaliTad, Semadgeneli organoebi erTad muSaoben rTuli
ofTalmo- skopis gamoyeneba Tvalis gamokvlevisTvis; funqciebis Sesasruleblad. organizmis yvela
steToskopisa da fonen-doskopis gamoyeneba gulisa sistemis mwyobri, urTierTSeTanxmebuli muSaobis
da filtvebis mosasmenad; nevrologiur CaquCs Sedegad, organizmi moqmedebs rogorc erTi mTliani.
iyeneben nervebisa da kunTebis funqciuri amrigad, sistemuri anatomia miznad isaxavs
mdgomareobis Sesa-mowmeblad. plastikuri organizmis funqciuri sistemebis Tanmimdevrul
anatomiisTvis gankuTvnili Tavebis wakiTxvisas Seswavlas. ZiriTadi sistemebi da maTi Sesabamisi
ecadeT, cocxali organizmis anatomia daukavSiroT Seswavlisa an mkurnalobis sferoebi (mocemulia
leqciebze da gakveTebze miRebul codnas. frCxilebSi) Semdegia:
cocxal organizmSi Rrmad mdebare
• sxeulis saerTo safarveli (dermatologia)
struqturebisa da maTi paTo-logiebis regionuli
Sedgeba kanis (integumen-ttum safarveli) da misi
Seswavla, SesaZlebelia radiologiuri gamosa-
danamatebisgan--Tmebi, frCxilebi da saofle

klinikuri anatomia 2
 jirkvlebi; aseve, kanqveSa qsovilisagan. kani buStisgan da Sardsadenisgan. am sis-temis
grZnobis eqstensiuri organoa. saSualebiT sisxli ifiltreba, xolo
• Zvlovani sistema (osteologia) Sedgeba Zvlebisa warmoqmnili Sardi transportirdeba, inaxeba da
da xrtilebisgan. es sistema gansazRvravs Cveni periodulad gamoiyofa (Txevadi narCenebi).
sxeulis ZiriTad formasa da sayrdens. kunTebis • reproduqciuli, sasqeso sistema (ginekologia
moqmedeba Zvlebze ganapirobebs moZraobas. Zvlebi qalebisaTvis da andrologia mamakacebisaTvis)
da masze mimagrebuli kunTebi anu sayrden- Sedgeba: 1.gonadebisagan (sakvercxeebi da
mamoZravebeli sistema saimedod icavs saTesleebi), romlebic gamoimuSaveben oocitebs
sasicocxlo mniSvnelobis organoebs. mag., guls, (kvercxebs) da spermas; 2. sadinarebisgan—
filtvebs, menjis organoebs da sxv. spermatozoidebisa da kvercxujredebis
• saxsrebi (arTrologia) Sedgeba saxsrebisagan da transportirebisTvis da 3. sasqeso organoebisgan,
maTTan asoci-rebuli iogebisgan, romlebic romlebic SesaZ-lebels xdian oocitebisa da
aerTebs ConCxis Zvlovan nawilebs da spermis Serwymas. kvercxujredis ganayofierebis
uzrunvelyofs moZraobas. Semdeg, qalis reproduqciuli sistema uzrun-
• kunTovani sistema (miologia) Sedgeba velyofs nayofis kvebas da mis dabadebas.
kunTebisagan, romlebic funqcionireben da • endokrinuli sistema (endokrinologia) Sedgeba
uzrunvelyofen sxeulis moZraobas. diskreciuli (TviTneburad, Tavisi
• nervuli sistema (nevrologia) Sedgeba Sexedulebisamebr moqmedi) Sinagani sekreciis
centraluri (Tavisa da zurgis tvini) da jirkvlebisgan (magaliTad, farisebri jirkvali);
periferiuli (Tavisa da zurgis tvinis nervebi) kuW-nawlavis traqtisa da sisxlZarRvTa kedlebis
nawilisagan. nervuli sistema aregulirebs da izolirebuli ujredebisagan da aseve,
koordinacias uwevs organoTa sistemebis specializebuli nervuli daboloebebisgan,
funqcionirebas da amavdroulad, uzrun-velyofs romlebic gankargaven hormonebis sekrecias.
organizmis adaptacias (Seguebas) gare samyaros hormonebi organuli moleku-lebia, romelTa
mudmivad cvalebad pirobebTan. gadatanas sxeulis nebismier nawilSi myof
• sisxlis mimoqcevis sistema (kardiologia, daSorebul efeqtorul ujredebamde emsaxureba
angiologia) Sedgeba gulisa da sisxlis mimoqcevis sistema. amrigad, endokrinuli
sisxlZarRvebisgan, romlebsac sisxli mTel sistemis zemoqmedeba, nervuli sistemis msgavsad,
organizmSi gadaaqvT da amarageben ujredebs mTel sxeulze vrceldeba. endokrinuli jir-
JangbadiT, sakvebi nivTierebebiTa da hormonebiT, kvlebi gavlenas axdenen metabolizmze da sxva
xolo ujredebidan gamoaqvT narCeni produqtebi. procesebze. magaliTad, menstruaciul ciklze.
• limfuri sistema warmoadgens limfuri ZarRvebis
ConCxisa da saxsrebis pasiuri sistemebisa da
bades, romelic sxeulis intersticiuli
aqtiuri kunTovani sistemis erToblioba qmnis e.w.
(Sidaujreduli) struqturebidan Warbi siTxis
supersistemas—sayrden-mamoZravebeli aparati anu
(limfis) gamodevnas axdens; es siTxe ifiltreba
sistema (orTopedia), radgan maTi SeTanxmebuli
limfur kvanZebSi da ubrundeba sisxlis
muSaoba lokomocias uzrunvelyofs. miuxedavad
mimoqcevis sistemas.
imisa, rom kunTebi, Zvlebi, saxsrebi da kidurebis
• saWmlis momnelebeli sistema
iogebi lokomociaze pirdapiri pasuxismgebeli
(gastroenterologia) Sedgeba orga-noebisa da
struqturebi arian, am procesSi sxva sistemebic
jirkvlebisagan, romlebic dakavSirebulia
arian CarTulni. mag., sisxlis mimoqcevis sistemis
sakvebis miRebasTan, ReWvasTan, ylapvasTan,
arteriebi da venebi sayrden-mamoZravebel sistemas
monelebasTan da absorbciasTan (Sewova), bolos
JangbadiTa da sakvebi nivTierebebiT amarageben da
ki, sakvebi nivTierebebis absorbciis Semdeg,
narCenebs gandevnian, xolo nervuli sistema
narCeni produqtebis (eqskrementebis) gamoyofasTan
moZraobis stimulacias ganapirobebs. faqtobrivad,
(myari narCenebi).
arcerTi sistema ar funqcionirebs izolirebulad.
• sasunTqi sistema (pulmonologia) Sedgeba
sistemuri anatomia, rogorc saswavlo kursi,
haergamtari gzebisagan da filtvebisgan,
ar moicavs gakveTas da mTeli kurikulumi
romlebic sisxls ujreduli sunTqvisTvis saWiro
Sedgenilia sistemuri TvalTaxedviT.
JangbadiT amarageben, xolo naxSirbadis dioqsids
sisxli-dan gandevnian. am sistemaSi, diafragma da
klinikuri anatomia
xorxi haeris nakads aregulirebs. amasTan, haeris
klinikur (gamoyenebiT) anatomiaSi
nakadi xorxSi qmnis garkveul tonuss, romelic
aqcentirebulia sxeulis struq-turisa da funqciis
SemdgomSi, enis, kbilebisa da tuCebis meSveobiT,
iseTi aspeqtebi, romlebic mniSvnelovania praqtikul
modificirdeba sametyvelo bgerebad.
medicinaSi, stomatologiaSi da momijnave
• Sardis gamomyofi sistema (urologia) Sedgeba:
samedicino-sanitarul discip-linebSi. klinikuri
Tirkmlebisgan, SardsawveTebisgan, Sardis
anatomia dafuZnebulia rogorc regionul, ise

klinikuri anatomia 3
sistemur anatomiaze. amasTanave, endoskopiisa da anatomiis codnis praqtikuli gamoyeneba. vfiqrobT,
gamosaxulebis miRebis meTodebis (magaliTad, kuWis TandarTul kompaqtdiskebze (CD) Cawerili klinikuri
SigniTa Sris daTvaliereba) gamoyenebiT SemTxvevebi ufro efeqturs gaxdis anatomiis
SesaZlebelia cocxali organizmis anatomiis Seswavlis process.
Seswavla.
klinikuri anatomia, regionuli da sistemuri Sejameba: amgvarad, anatomia aris adamianis
anatomiisgan gansxva-vebiT, kiTxvebs sxvagvarad svams. sxeulis struqturis Semswav-leli mecniereba;
magaliTad, sistemuri anatomia svams kiTxvas—“ra regionuli anatomia sxeuls ganixilavs, rogorc
aris am kunTis funqcia?“ klinikuri anatomiis segmentebisagan an ZiriTadi nawilebisagan Seqmnil
mixedviT, igive kiTxva ase formulirdeba _ “ras erTian organisms; plastikuri anatomia Seiswavlis
gamoiwvevs am kunTis funqciis moSla?” anda _ “nervi kanqveS mdebare struqturebs, romelTa daTvaliereba
uzrunvelyofs kanis mocemuli ubnis inervacias”; an gasinjva SesaZlebelia palpaciiT; radiografiuli
klinikuri anatomiis mixedviT - “romeli nervis anatomiis saSualebiT dgindeba kunTis tonusis,
dazianebaze migvaniSnebs am ubanis mgrZnobelobis sxeulis siTxeebisa da wnevis, aseve, simZimis Zalis
dakargva?”. klinikuri problemebis gadaWris zemoqmedeba da gavlena cocxali organizmis
TvalsazrisiT, klinikuri anatomiis safuZvliani struqturebze; klinikuri anatomia yuradRebas
Seswavla friad mniSvnelovani da amavdroulad, amaxvilebs praqtikul medicinaSi anatomiis codnis
sainteresoa. mocemuli wignis “klini-kasTan gamoyenebaze.
dakavSirebul CanarTebSi” (cisferi foni) aRwerilia

samedicino anatomiis terminologia termini teqstSi pirvelad gvxvdeba. magaliTad,

mkerdis kuTxe (luisis kuTxe). miaqcieT yuradReba:
eponimuri termini ar aRniS-navs, rom es kuTxe
dRes arsebobs anatomiisa da medicinis
SeimCneva gulmkerdis ConCxze.
saerTaSoriso leqsikoni. miuxedavad imisa, rom
samedicino terminologiis did nawils
TqvenTvis cnobilia sxeulis nawilebisa da ubnebis
anatomiuri terminologia Seadgens. imisaTvis, rom
zogadi terminebi, aucilebeli da mniSvnelovania
kargad gagigon, unda ecadoT gamoiyenoT zusti
zusti terminologiis damaxsovreba, rac xels
terminebi da sworad warmoTqvaT isini. terminebis
uwyobs mTeli msoflios profesionalebsa da
umetesoba dasabams iRebs laTinuri da berZnuli
mecnierebs Soris komunikacias. aseve, savaldebuloa
enidan. pirvelad samedicino ena SeiZleba rTulad
icodeT zogadi da sasubro terminologia, romelsac
mogeCvenoT, magram Tu terminis warmoSobas gaigebT,
pacienti iyenebs Tavisi daavadebis aRwerisas. garda
sityva ukve azriani gaxdeba TqvenTvis. magaliTad,
amisa, roca pacientebs vuxsniT maTi avadmyofobis
termini decidua - decidualuri garsi _ gamoiyeneba
problemebs, unda SegveZloT maTTvis gasageb enaze
orsulis saSvilosnos amomfeni garsis aRniSvni-
saubari.
saTvis, warmodgeba laTinuridan da niSnavs
mocemuli wignis terminologia Seesabameba
“Camovardnas”. es Sesatyvisi terminia, radgan
axal anatomiur termi-nologias: saerTasoriso
orsulobis bolos, bavSvis dabadebis Semdeg,
anatomiuri terminologia (Federative Committee on
endometriumi scildeba saSvilosnos kedels da
Anatomical Terminology, 1998) - anatomiuri terminologiis
gamoidevneba saSvi-losnodan; iseve, rogorc deciduous
avtoritetuli sacnobaro leqsikoni. “Terminologia
tree - foTlovan xes zafxulis bolos foTlebi
Anatomica”-Si (TA) aris laTinuri terminebi da maTi
scviva.
Sesabamisi inglisuri eqvivalentebi. samwuxarod,
SeTanxmebis safuZvelze, sxeulis zustad
zogjer terminologia SeiZleba gansxvavdebodes
aRwerisTvis da misi nawilebisa da organoebis
oficialuri terminologiisgan. xsenebuli
urTierTganlagebis miTiTebisaTvis, msoflios
gansxvavebebi SesaZloa gaugebrobis mizezi gaxdes da
anatomebi, sxvadasxva struqturis ganlagebisa da
amitom, frCxilebSi miTiTebulia araoficialuri
mimarTulebis aRsaniSnavad, erTi da igive terminebs
saxelwodeba. axali terminologiidan amoRebulia
iyeneben. igive terminebiT saubroben klinicistebic
eponimebi - terminebi, romlebic aRniSnaven adamianis
da amitom, anatomiuri terminologiis damax-sovreba
gvars, radgan aseTi aRniSvnebi ar miuTiTebs arc
saWiro da aucilebelia. swavlisa da gameorebis
struqturis tipze da arc mis mdebareobaze. garda
procesSi ivarjiSeT terminebis zustad gamoTqmaze
amisa, zogierTi eponimi istoriulad arazustia.
da Semdgom, Tqveni azri gasagebi iqneba rogorc
magaliTad, pirveli anatomi, romelmac aRwera
avadmyofobis istoriaSi sxeulis nawilebis
sazardulis iogi (pupartis iogi) ar iyo puparti.
aRwerisas, aseve pacientis daavadebis ganxilvisas
miuxedavad amisa, xSirad, eponimebi Setanilia
sxva klinicistebTan.
teqstSi da Casmulia frCxilebSi maSin, roca es

klinikuri anatomia 4
 sagitaluri iqneba. Tumca aqve unda aRiniSnos, rom
anatomiuri pozicia Sua sibrtyis paraleluri da masTan axlos mdebare
sibrtye SeiZleba movixsenioT, rogorc
anatomiuri aRwerilobebi yovelTvis keTdeba erT paramedialuri sibrtye.
Sesabamis anatomiur poziciaSi, rac gamoricxavs • frontaluri (koronaruli) sibrtye
orazrovnebas (sur. I.1 da I..2). adamianis anatomiis vertikaluri sibrtyea, rome-lic gadis sxeulis Sua
Seswavlis dros aucilebeli pirobaa, rom adamiani sibrtyis mimarT marTi kuTxiT da sxeuls wina da
warmovid-ginoT vertikalur mdebareobaSi: ukana asimetriul nawilebad yofs. aqac saWiroa
sawyisi wertili, sibrtyis poziciis miTiTebisTvis
• Tavi, mzera (Tvalebi) da fexis TiTebi (mag., qveda ybis morCebze gamavali frontaluri
mimarTulia win. sibrtye).
• xelebi CamoSvebulia tanis gaswvriv, • horizontaluri anu ganivi sibrtye gaivlis
xelisgulebiT win. Sua da frontaluri sibrtyis mimarT marTi kuTxiT
• qveda kidurebi da terfebi midgmulia da sxeuls yofs zeda da qveda asimetriul
erTmaneTze da moTavsebulia erTmaneTis nawilebad. sibrtyis donis misaTiTeblad, aqac
paralelurad, fexis TiTebi mimarTulia win. saWiroa sawyisi wertili, mag., “Wipze gamavali ganivi
sibrtye” an konkre-tul malaSi gamavali ganivi
aseTi anatomiuri pozicia sayovelTaod miRebulia sibrtye. radiologebi ganiv sibrtyes uwodeben
anatomiuri aRweri-lobisaTvis. am poziciisa da transaqsialur sibrtyes an ubralod aqsialur
Sesabamisi terminologiis gamoyenebiT, Tqven sibrtyes.
SegiZliaT zustad daukavSiroT erTmaneTs sxeulis sagitaluri, frontaluri da ganivi sibrtyeebis
sxvadasxva nawilebi. vertikaluri poziciis dros, ricxvi limitirebuli ar aris. anatomiuri
simZimis Zala iwvevs Sinagani organoebis qvemoT sibrtyeebis mTavari daniSnuleba sxeulze gakeTe-
wanacvlebas; eqims xSirad uxdeba mjdomare an buli ganakveTebis aRweraa. anatomebi sxeulis kveTas
mwoliare pacientis organoebis mdebareobis aRwera, praqtikulad axorcieleben (sur.1.3), xolo
radgan upiratesad, swored aseT poziciaSi sinjaven klinicistebi _ sibrtyeebis warmosaxvis meTodiT,
pacientebs. pacientis (an gvamis) aRwerisas, ra rogoricaa CT - ama Tu im struqturis aRwerisaTvis.
pozaSic unda iyos pacienti--gverdze, mucelze Tu zogjer saWiroa ara mTliani sibrtyis, aramed misi
zurgze mwoliare, an ugonod davardnili (saxiT Semadgeneli wrfeebis (sxeulis RerZebis warmodgena.
zemoT Tu qvemoT)--yovelTvis warmoidgineT
anatomiuri pozicia. • sigrZivi kveTi keTdeba sxeulis sigrZivi RerZis
an misi nebismieri nawilis paralelurad.
anatomiuri sibrtyeebi • ganivi kveTi keTdeba sxeulis sigrZivi RerZis an
misi nebismieri nawilis mimarT marTi kuTxiT;
anatomiuri aRweriloba emyareba oTx warmosaxviT radgan terfis sigrZivi RerZi horizontalur
sibrtyes (Sua anu medialuri, sagitaluri, sibrtyeSi mdebareobs, terfis ganivi kveTa
frontaluri, ganivi), romlebic gadakveTen anatomiur frontalur sibrtyeSi keTdeba (sur. I. 2. C).
poziciaSi warmodgenil sxeuls (sur. I..2): • iribi kveTi ar emTxveva arc erT anatomiur
sibrtyes. zogadad, samedicino praqtikaSi,
• Sua (medialuri) sibrtye vertikaluri
radiologiuri gamosaxulebebi da anato-miuri
sibrtyea, romelic gaivlis sxeulis sigrZivi
kveTebi zustad ar emTxveva sagitalur,
mimarTulebiT da sxeuls yofs marjvena da marcxena
frontalur an ganiv sibrtyes. xSirad isini
simetriul naxevrebad. xSirad, Sua xazs SecdomiT
iribad daxrilni arian.
iyeneben Sua (medialuri) sibrtyis sinonimad.
• sagitaluri sibrtyeebi vertikaluri urTierTdamokidebulebisa da mdebareobis amsaxveli
sibrtyeebia, romlebic Sua sibrtyis paralelurad terminebi
gadian. mkafio warmosaxvisTvis gonivrulia,
davasaxeloT sawyisi wertili da struqtura urTierTsawinaaRmdego zedsarTavi saxelebis
romelsac miTiTebuli sibrtye kveTs. magaliTad, meSveobiT SesaZlebelia sxeulis nawilebis
laviwis Sua wertilSi gamavali sagitaluri sibrtye. urTierdamokidebulebis aRwera anatomiur poziciaSi
arc Tu iSviaTad, amboben: “Sua sagitaluri sibrtye”. da ori struqturis mdebareobis erTmaneTTan
termini “sagitaluri” sruliad zedmetia Sua Sedareba (sur.I.4).
(medialuri) sibrtyis aRniSvnis dros (O’Rahilly, 1997). zedapiruli, medialuri da Rrma - am terminebiT
neiroanatomebi da nevro-logebi xSirad amboben _ aRweren sxeulis nawilebis mdebareobas an erTi
“parasagitaluri sibrtye”, rac aseve, arasworia, struqturis kavSirs mis zemoT an qvemoT mdebare
radgan nebismieri paraleluri sibrtye, Sua sibrtyis meore struqturasTan.
nebismieri mxridan, definiciis mixedviT, yovelTvis

klinikuri anatomia 5
 medialuri - am terminiT miuTiTeben, rom erT mxarezea (mag., RviZli), amboben, rom
(anatomiur poziciaSi) struqtura, mag., xelis mexuTe unilateralurad mdebareobs. termini--
TiTi (neki) ufro axlosaa sxeulis medi-alur ifsilateraluri gamoiyeneba maSin, roca gvinda
sibrtyesTan, vidre danarCeni TiTebi. amis aRvniSnoT, rom sxeulis ori sxvadasxva nawili erTi
sawinaaRmdegod, latera-luri gulisxmobs, rom da imave mxareze mdebareos. mag., marjvena ceri da
struqtura, mag., xelis pirveli TiTi (ceri) gaci- marjvena fexis didi TiTi. kontra-lateraluri
lebiT Sorsaa medialuri sibrtyidan. terminebi-- niSnavs sxeulis nawilebis ganlagebas
lateraluri da medi-aluri ar aris Sesabamisad, urTierTsawinaaR-mdego mxares mag., marjvena xeli
“gareTas” da SigniTas” _ sinonimebi. gareTa da marcxena xelis mimarT kontrla-teralurad
SigniTa niSnavs Sesabamisad, organos an Rrus mdebareobs.
centridan daSorebuls an masTan axlos mdebares,
mimarTulebisagan damoukideblad. moZraobasTan dakavSirebuli terminebi
ukana (dorsaluri) aRniSnavs sxeulis ukana
zedapirs an zurgTan axlos. wina (ventraluri) kidurebisa da sxeulis sxva nawilebis moZraobas
aRniSnavs sxeulis wina zedapirs. xSirad Tavis sxvadasxva termi-nebis daxmarebiT aRweren (sur. I.5).
tvinis nawilebis aRwerisas winas nacvlad moZraobaTa umetesoba xorcieldeba saxsrebis
rostralurs iyeneben, rac niSnavs niskartisebri saSualebiT. zorjer, moZraoba ar aris
Sverilisaken mimarTuls. adamianSi rostraluri dakavSirebuli ConCxTan. mag., enis, tuCebis,
aRniSnavs Tavis wina nawilTan axlos (mag., Tavis quTuToebis moZraoba.
tvinis Sublis wili naTxemis mimarT rostralurad fleqsia aRniSnavs moxras, moRunvas. saxsrebis
mdebareobs). umetesobisaTvis (mag., idayvis saxsari), fleqsia
qveda _ aRniSnavs fexis lanCasTan axlos niSnavs moZraobas wina mimarTulebiT, xolo muxlis
mdebares, xolo kaudaluri (L. cauda, kudi) saxsris fleqsia niSnavs moZraobas ukana
mimarTulebis aRmniSvneli terminia da niSnavs mimarTulebiT. dorsofleqsia aRniSnavs moxras koWis
kudisken mimarTuls; adamianis anatomiis aRweris saxsarSi. mag., aRmarTze asvla. plantarfleqsia
dros termini “kaudaluri” icvleba “kudusuniT”, niSnavs terfis an TiTebis brunvas terfis Ziris
romelic xerxemlis qveda boloze arsebuli mcire zedapirisken (mag., TiTis wverebze dgoma).
Zvalia. termini kaudaluri gamoiyeneba eqstenzia niSnavs gaSlas, gasworebas. Cveulebriv,
embriologiaSi, radgan adamianis embrions 8 kviris gaSla ukana mimarTulebiT xdeba, Tumca muxlis
Suamde aqvs kudismagvari, kaudaluri borcvi (Moore a. saxsarSi gaSla wina mimarTulebiT xdeba. zogjer,
Persaud, 2003). zeda _ niSnavs TxemTan (Tavis qalas normalur zRvarze metad gaSlam -- hipereqstenziam
yvelaze zeda wertilTan) axlos. termini SeiZleba travma gamoiwvios. mag., kisris
“kranialuri” aRniSnavs mimarTulebas da Tavisken hipereqstenzia, romelic aRiniSneba avtoavariis
mimarTuls niSnavs. dros (kisris maTraxisebri moZraoba). yuradRebiT
kombinirebuli terminebiT aRweren Sualedur daakvirdiT suraTs -- I.5: roca fexi iSleba koWis
mdebareobas: qveda medialuri niSnavs terfTan da saxsarSi, terfis Ziri moxrilia (mag., TiTis wverebze
Sua sibrtyesTan axlos, xolo zeda lateraluri dgomis dros). anatomiuri poziciidan gamomdinare,
niSnavs TavTan axlos da Sua sibrtyisgan Sors. didi TiTis garda, fleqsia da eqstensia aris
proqsimaluri da distaluri aRniSnavs moZraoba sagitalur sibrtyeSi.
urTierTsawinaaRmdego poziciebs Sesabamisad, axlos abduqcia niSnavs kiduris ganzidvas sxeulis Sua
da Sors kidurebis SeerTebis adgilidan. Cveulebriv, sibrtyidan; es aris moZraoba sxeulis Sua
zurgi aRniSnavs ukana zedapirs; aseve, aRniSnavs (medialuri) sibrtyidan frontalur sibrtyeSi (mag.,
sxeulis warziduli nawilebis zeda zedapirs. mag., sxeulis gverdidan xelis ganze gaweva). xelis
enis zurgi, cxviris zurgi. anatomebi amboben: xelis TiTebis abduqcia niSnavs Sua TiTis neitraluri
zurgi. imis gasagebad, Tu es zedapirebi ratom poziciidan sxva TiTebis ganzidvas an fexis TiTebis
iTvleba ukana zedapirebad, warmovidginoT ganzidvas meore TiTis neitraluri poziciidan.
oTxterfa, brtyelterfa cxoveli-daTvi, romelic xelis me-3 TiTi da fexis me-2 TiTi neitraluri
dadis fexis gulebiT. fexis guli aris terfis qveda poziciidan medialurad an lateralurad iweva
mxare-Ziri, romelic dgomis dros kontaqtSia ganze. marjvena da marcxena lateraluri fleqsia
miwasTan, xelis guli aRniSnavs xelis brtyel (lateraluri moxra) abduqciis specialuri formebia
zedapirs cerisa da sxva TiTebis gamoklebiT. xelis mxolod kisrisa da tanisTvis. saxe da tanis zeda
guli xelis zurgis mopirdapire mxarea. nawili mimarTulia win, roca Tavi da/an mxrebi
brundeba marjvena an marcxena mxares, rac iwvevs
lateraluris aRmniSvneli terminebi sxeulis Sua xazis moxras gverdisken. es
wyvil, marjvena da marcxena organoebze (mag., kombinirebuli moZraobaa, romelSic monawileobs
Tirkmlebi) amboben, rom isini bilateralurad bevri mimdebare mala.
mdebareoben, xolo kent organoze, romelic mxolod

klinikuri anatomia 6
 aduqcia niSnavs kiduris mozidvas sxeulis Sua protruzia aris moZraoba wina mimarTulebiT. mag.,
sibrtyesTan; es aris moZraoba frontalur qveda ybis (nikapis), tuCebis an enis gamoweva.
sibrtyeSi, medialuri sibrtyisken (magaliTad, roca retruzia aris moZraoba ukana mimarTulebiT. mag.,
zeda kidurebs vamoZravebT sxeulis mimarTulebiT). qveda ybis, tuCebis an enis Seweva. terminebi --
termini TiTebis aduqcia niSnavs, xelis an fexis protraqcia da retraqcia Cveulebriv, gamoiyeneba
gaSlili TiTebis xelaxla daaxlovebas an TiTebis mxrebis moZraobis aRsaniSnavad Sesabamisad, win da
mozidvas xelis me-3 an fexis me-2 TiTis neitraluri ukan.
poziciisken. medialurad an lateralurad elevacia -- moZraoba zemoT. mag., mxrebis aweva,
ganziduli xelis me-3 da fexis me-2 TiTebi moizideba mxrebis aCeCva, Tvalis gaxelis dros zeda quTuTos
ukan, neitralur poziciaSi. anatomiuri poziciis aweva an enis sasamde mitana. depresia niSnavs
mixedviT, ceris frCxili mimarTulia latera-lurad moZraobas qveda mimarTulebiT. mag., mxrebis Camoweva
da amitom, ceri brunavs 900 - iT, sxva TiTebTan Tavisuflad dgomis dros, Tvalis daxuWvis dros
mimarTebaSi. aqedan gamomdinare, ceri iRuneba da zeda quTuTos Camoweva an enis sasisgan mocileba.
iSleba frontalur sibrtyeSi, amitom misi abduqcia eversia aRniSnavs lanCis moZraobas medialuri
da aduqcia xorcieldeba sagitalur sibrtyeSi. sibrtyidan (lanCa mimarTulia lateralurad). roca
cirkumduqcia anu wriuli moZraoba aris terfi mTlianad eversirebulia, es gulisxmobs, rom
fleqsiis, eqstenziis, abduqciisa da aduqciis is dorsofleqsirebulia. inversia iseTi moZraobaa,
kombinacia, romlis drosac kiduris distaluri roca lanCa moZraobs medialuri sibrtyisken (lanCa
bolo moZraobs wreze. cirkumduqcia xorcieldeba mimarTulia medialurad). roca terfi mTlianad
nebismier saxsarSi, sadac yvela zemoaRniSnuli inversirebulia, es niSnavs, rom terfi
moZraoba SesaZlebelia (mag., barZayis saxsarSi). plantarfleqsirebulia.
rotacia--brunva, wrebrunva, triali sigrZivi
RerZis garSemo; sxeulis nawilis brunva sigrZivi anatomiuri terminebi
RerZis garSemo. mag., Tavis brunva. medialuri
rotaciis (Sida rotacia) dros, kiduris wina anatomia aRwerilobiTi mecnierebaa da amitom
zedapiri ufro axloa medialur sibrtyesTan, maSin adamianis sxeulis sxvadasxva organoebisa da maTi
roca lateraluri rotacia (gare rotacia) kiduris Sesabamisi funqciebis Seswavla saTanado terminebs
wina zedapirs aSorebs medialur sibrtyes. moiTxovs. studentebi, romlebic anatomiis Seswavlas
pronacia -- xelis brunviTi moZraoba, romelic iwyeben, uamravi axali anatomiuri terminis gamo,
radiuss Semowers (wina mxris lateraluri grZeli xSirad ibnevian. sabednierod, arsebobs mravali
Zvali) medialurad, sigrZivi RerZis garSemo ise, rom saSualeba, romelic dagexmarebaT am terminebis
xelisguli mimarTuli iqneba ukan, xolo xelis aTvisebaSi (Mehta et al., 1996; Stedman’s Medical Dictionery,
zurgi --win. roca idayvis saxsari moxrilia, 2005; Willis, 1995). bevri termini iZleva informacias ama
pronaciis dros xelisguli mimarTuli iqneba qvemoT Tu im struqturis formis, zomis, mdebareobis an
(mag., xelisgulis dadeba magidis zedapirze). funqciis Sesaxeb, anda erTi struqturis meoresTan
terfTan mimarTebaSi, pronacia gulisxmobs eversiisa msgavsebis Sesaxeb.
da abduqciis kombinacias. am dros terfis zogierT kunTs aqvs aRwerilobiTi saxeli,
medialuri kide mcirdeba. brtyelterfiani adamianis romelic mis mTavar maxasiaTebelze miuTiTebs. mag.,
terfi garkveulwilad, pronaciis mdgomareobaSia. deltisebr kunTs, romelic faravs mxars, samkuTxa
supinacia _ xelis brunviT moZraoba, romelic forma aqvs, rogorc berZnuli anbanis erTerTi asos
radiuss Semowers lateralurad, Tavisi sigrZivi “deltas” simbolos. sufiqsi “sebri” niSnavs msgavss.
RerZis garSemo ise, rom xelis zurgi mimarTuli
m. biceps niSnavs orTava kunTs, xolo m. triceps niSnavs
iqneba ukan, xolo xelisguli _ win (anatomiuri
samTava kunTs. zogierTi kunTis saxeli misi
pozicia). roca idayvis saxsari moxrilia, supinaciis
formidan gamomdinareobs. mag., m.piriformis niSnavs
dros xelis zurgi mimarTuli iqneba qvemoT, xolo
msxlisebr (msxlisebri formis) kunTs. zorjer,
xelis guli _ zemoT. (dasamaxsovreblad:
kunTis saxeli mis mdebareobas aRniSnavs. mag.,
xelisgulze dasxmuli supi ar daiRvreba Tu
m.temporalis--safeTqlis kunTi safeTqlis Zvalze
moxrili winamxari supinaciis mdgomareobaSia, magram
mdebareobs. zog SemTxve-vaSi kunTis saxeli
daiRvrebaMmaSin, roca winamxari pronaciis
moZraobas aRniSnavs. mag., m. levator scapulae beWis amwev
mdgomareobaSi gadava). rac Seexeba terfs, supinacia
kunTs niSnavs. amrigad, kunTebisa da sxeulis sxva
gulisxmobs terfis medialuri kidis gazrdas
nawilebis saxel-wodebebs logikuri axsna aqvs da
opozicia aris moZraoba, romlis drosac ceris
amitom, Tu Tqven daimaxsovrebT maT mniSvnelobas,
baliSi uaxlovdeba sxva TiTis baliSebs. am
romelsac gaimeorebT kiTxvis an gakveTis dros, am
moZraobis saSualebiT SegviZlia xeli movuWiroT
terminebis gaxseneba aRar gagiZneldebaT.
perangis Rils, aviRoT xelSi Wiqa. repozicia niSnavs
pirveli TiTis moZraobas opoziciuri moZraobis
sawinaaRmdegod -- Tavisi anato-miuri poziciisaken.

klinikuri anatomia 7
terminebis abreviatura SemTxveviT SerCeul adamianTa jgufSi individebi
erTmaneTisagan fizikurad gansxvavdebian. maTi
terminebis abreviatura (sityvebis pirobiTi ConCxis Zvlebi erTmaneTisagan gansxvav-deba ara
Semokleba) avadmyofobis istoriis SemoklebisTvis marto ZiriTadi formiT, aramed zedapiruli
gamoiyeneba. anatomiuri abreviaturebi SegxvdebaT struqturis umciresi detalebiT. variaciebi
nebismieri saxelmZRvanelos teqstSi maSin, rodesac aRiniSneba aseve, kunTebis mimagrebebis,
am abrevituris Sesabamisi termini pirvelad aris konfiguraciisaa da formis mxriv; garkveulwilad,
naxsenebi. klinikur abreviaturebs avadmyofobis venebis, arteriebisa da nervebis datotianebis
simptomebis ganxilvisa da aRweris dros iyeneben. am suraTic gansxvavebulia. yvelaze meti cvalebadoba
abreviaturebis gamoyenebis codna aseve venur ganStoebas axasiaTebs, yvelaze naklebi -
mniSvnelovania TqvenTvis. anatomiuri da klinikuri nervebs. fizikaluri gasinjvisas, diagnostirebisa da
abreviaturebi Tan axlavs agreTve, vrcel samedicino mkurnalobis procesSi, aucilebelia individualuri
leqsikonebs, zogadi samedicino abreviaturebis anatomiuri variaciebis gaTvaliswineba. mocemul
damatebiTi siis saxiT. saxelmZRvaneloSi anatomiuri struqturebis aRweris
dros ganixileba aseve, Sesabamisi variaciebi normis
Sejameba: anatomiuri terminebi, romlebic farglebSi. xSirad, variaciebis sixSire adamianTa
gamoyenebulia am wignSi aRebulia sacnobaro sxvadasxva jgufSi gasxvavebulia. erT populaciaSi
saxelmZRvanelodan - “Terminologia Anatomica (1998); Segrovili variaciebi, SeiZleba saerTod ar
zogadad, sasaubro samedicino terminologia da aRmoCndes meore populaciaSi. zogierTi variacia
gvaris Semcveli termi-nebi xSirad gamoiyeneba klinikurad mniSvnelovania, mag., naRvlis buStis
klinikur praqtikaSi. anatomiuri terminebis arteriis mdebareobis cvalebadoba misi dasawyisidan
umravlesoba dafuZnebulia sxeulis anatomiur naRvlis buStamde (ix. Tavi 2). qirurgs, romelmac ar
poziciaze. anatomiuri sibrtyeebi, kveTebi da icis am variaciis Sesaxeb, SeiZleba operaciis dros
anatomiuri terminebi gvexmareba adamianis problemebi Seeqmnas. mocemul wignSi klinikurad
struqturuli organizaciis Seswavlasa da sxeulis mniSvnelovani variaciebi mocemulia Sesabamis svetSi
sxvadasxva nawilebs Soris urTierdamokidebulebis (cisferi foni).
aRweraSi.
rasobrivi da seqsualuri gansxvavebebis garda,
adamianebSi vlindeba mniSvnelovani genetikuri
variaciebi. mag., polidaqtilia--zedmeti TiTebi;
anatomiuri variaciebi atrezia--bunebrivi xvrelis (saSos, swori nawlavis)
uqonloba da sxv. axalSobilTa 3%-s erTi an meti
anatomiuri saxelmZRvanelo aRwers adamianis mniSvnelovani Tandayolili anomalia aqvs. gvamis
sxeulis normalur agebulebas, romelic yvelaze gakveTisas variaciebisa da Tandayolili anomaliebis
xSirad gvxvdeba. zogjer, normis farglebSi, ama Tu aRmoCena saWiro informacias aZlevs studentebs
im struqturis imdennairi variacia arsebobs, rom variaciebis arsebobaze da maT sixSireze.
erTnairi struqtura TiTqmis naxevarze nakleb
SemTxvevaSi gvxdeba. axalbeda studentebi xSirad
gaocebulni rCebian, radgan sxeuli, romelsac isini
ikvleven an kveTen ar Seesabameba maT mier Sejameba: anatomiuri variaciebi xSiria da studentma
Seswavlil aRwerilobas da gamoyenebul atlass unda icodes, rom aseTi variaciebi Sexvdeba gakveTis
(Bergman et al., 1988). zogjer studentebi aseT dros. mniSvnelovania imis codna, Tu ra gavlenas
variaciebs yuradRebas ar aqceven an, roca axdens aseTi variaciebi fizikalur gasinjvaze,
cdiloben msgavseba ipovon maT mier naswavlTan, diagnos-tirebaze da mkurnalobaze.
SemTxveviT azianeben am struqturebs. amgvarad,
gakveTisa da preparirebuli sinjebis daTvali-erebis
dros unda moelodeT anatomiur variaciebs.

klinikuri anatomia 8
sxeulis safarveli sistema konkretul adgilze boWkoTa umetesobas erTnairi
mimarTuleba aqvs. man SeamCnia, rom gvamis kanze
wvetiani yinuliT miyenebuli naCxvleti Wriloba
kani sxeulis safarvelia da zogadad, napralis msgavsia, romelsac ara aqvs momrgvalebuli
janmrTelobis mdgomareobis sau-keTeso indikatoria. kideebi, radgan yinulis wvetma derma kolagenis
fizikaluri gasinjvis dros, mniSvnelovania misi boWkoebis mimarTulebiT gaWra da Wriloba Ria
guldasmiT daTvaliereba. kanis mdgomareobas darCa.
akvirdebian diferenci-aluri diagnostikis dros, kolagenis boWkoebis struqtura kanis gaWimvis
TiTqmis yvela daavadebis SemTxvevaSi. unars da kanis naoWebs --xazebs gansazRvravs.
kidurebSi kanis xazebs (langeris xazebi) sigrZivi
kanis daniSnulebaa: mimarTuleba aqvs, xolo kiserSi da tanSi ganivad
• sxeulis dacva siTxis dakargvisagan, garemos mavne miemarTeba (sur. 1.7). idayvebze, muxlebze, koWebze da
zemoqmede-bisgan (mag., meqanikuri dazinebisagan, majebze kanis Wimvadobis xazebi ganivi naoWis
ultraiisferi gamosxive-bisagan Tu sxva mavne paraleluria, romelic Cndeba kidurebis moxris
nivTierebebisagan. aseve, mikroorganizmebis dros. moxareT maja da Tqven kargad dainaxavT am
SeWrisagan). xazebs. dermis elastikuri boWkoebi asakTan erTad
• kani sxeulis struqturebsa (mag., qsovilebs, degradacias ganicdis da maTi aRdgena ar xdeba.
organoebs) da sasi-cocxlo nivTierebebs aqedan gamomdinare, elastikurobis dakargvis gamo,
(gansakuTrebiT eqstraujredul siTxeebs) xanSi Sesuli adamianis kani naoWdeba da ekideba.
akavebs, xels uSlis dehidratacias, romelic kani mraval specializebul struqturas Seicavs
sakmaod Zlieria kanis didi zedapiris (sur. I.6). dermis Rrmad ganlagebuli Sreebi Seicavs
dazianebisas (mag. damwvrobisas). Tmis folikulebs, romlebic dakavSirebulia gluv
• Tboregulacia, oflis aorTqlebiT da/an gammarTvel kunTebTan (mm.erector) da qonis jir-
zedapiruli sisxl-ZarRvebis dilataciiT an kvlebTan. Tmis gammarTveli kunTebis SekumSva iwvevs
SeviwrovebiT. Tmebis ‘wamowevas” (e.w. daxorklili kani). qonis
• mgrZnobeloba (mag., tkivilis), zedapiruli jirkvlebi dakavSirebulia Tmis budesTan. Tmis
nervebiTa da maTi mgrZnobiare daboloebebiT. gammarTveli kunTebis SekumSva Tmis “wamowevas”
• D vitaminis sinTezi da Senaxva. iwvevs, ikumSeba qonis jirkvlebi, rac xels uwyobs
kani, sxeulis yvelaze didi organo, Sedgeba cximovani produqtis kanis zedapirze gamotanas.
epidermisisgan--zedapi-ruli ujreduli fenisagan da kanis cximi anu qoni icavs Tmas da kans
dermisagan--SedarebiT Rrmad mdebare SemaerTebeli gamoSrobisagan. kanidan oflis jirkvlebis
qsovilis fenisagan (sur. 1.6). wyliani sekretis (oflis) aorTqleba, siTbos
epidermisi e.w. keratinizebuli epiTeliumia, rac dakargviT (gacivebiT), Termoregulacias
niSnavs, rom kans aqvs mtkice, garqovanebuli uzrunvelyofs. dermis mcire zomis arteriebi
zedapiruli Sre, romelic uzrunvelyofs gare (arteriolebi) CarTulia sxeulis mier siTbos
zedapiris dacvas. igi faravs regenerirebad da dakar-gvis an Sekavebis procesSi. maTi gafarToebis
pigmentur Rrma an bazalur Sres. epidermisSi Sedegad, zedapiruli kapi-larebi ivseba da siTbos
sisxlZarRvebi da limfuri ZarRvebi ar aris. (kani wiTldeba) asxivebs; zogjer ikumSeba, rac
avaskularuli epidermisis kveba xorcieldeba mis siTbos danakargs minimumamde amcirebs (kani,
qveS mdebare vaskularuli dermisagan, romelsac gansakuTrebiT tuCebze da TiTis wverebze
amaragebs masSi Semavali arteriebi. es arteriebi lurjdeba). kanidan viTardeba aseve, iseTi derivatebi
warmoqmnian kanis anastomozirebuli arteriebis (warmoebulebi), rogoricaa Tma, frCxilebi, sarZeve
wnuls. kani maragdeba agreTve, aferentuli nervuli jirkvlebi da kbilebis emali.
daboloebebiT, romlebic mgrZnobiarea Sexebis, kanqveSa qsovili (zedapiruli fascia)
gaRizianebis (tkivilis) da temperaturis mimarT. moTavsebulia zemoT mdebare kansa (derma) da Rrmad
umetesi nervuli daboloebebi ganTavsebulia dermaSi mdebare fascias Soris; igi Sedgeba ZiriTadad,
da mxolod ramdenime aRwevs epidermisSi. faSari SemaerTebeli qsovilisgan, sarezervo
derma kolagenuri da elastikuri boWkoebis cximisgan da Seicavs oflis jirkvlebs, zedapirul
monacvleobiT Seqmnili mkvrivi Srea. boWkoebi kans sisxlZarRvebs, limfur ZarRvebsa da nervebs (sur.
tonuss aZlevs da mis Zalasa da simtkices 1.6). am Sris neirovaskularuli struqturebis
uzrunvelyofs. cxovelebis derma moZravia; igi tyavs mxolod terminaluri ganStoebebi aRwevs kanSi.
warmoqmnis. avstrieli anatomi karl langeri kanqveSa qsovili sxeulis mniSvnelovani cximovani
ikvlevda aramumificirebuli cxovelebis gvamebis depoa da zogadad, misi sisqe damokidebulia
kans da aRmoaCina, rom kolagenis boWkoebis konebi miRebuli sakvebis raodenobaze. amasTan, kvebisagan
dermaSi yvela mimarTulebiT miemarTeba da mtkice damoukideblad, kanqveSa qsovilis ganawileba, anu
qeCismagvar qsovils warmoqmnis, Tumca yovel misi sisqe adamianis sxeulis sxva-dasxva nawilSi

klinikuri anatomia 9
sxvadasxvagvaria. mag., SeadareT erTmaneTs kanqveSa (keloidi) warmoqmniT. roca problemebi ar aris, mag.,
qsovilis sisqe welisa da barZayis midamoSi da nervis dazianeba xels ar uSlis, qirurgebi
fexis winamedialur zedapirze--didi wvivis wina cdiloben, kosmetikuri TvalsazrisiT, minimumamde
kideze an xelis zurgze, romlebic TiTqmis ar daiyvanon nawiburebi, risTvisac iyeneben qirurgiul
Seicavs aRniSnul qsovils. aseve, SeadareT gakveTas Wimvadobis xazebis paralelurad.
erTmaneTs kanqveSa qsovilisa da cximis ganawilebis
Tavisebureba sqesis mixedviT: zrdasrul qalebs kanis daWimvis niSnebi
cximis dagrovebis midrekileba aReniSnebaT sarZeve
jirkvlebSi da barZayebze, xolo mamakacebs -- dermaSi kolagenuri da elastikuri boWkoebi
muclis kedlis qveda nawilSi. kanqveSa qsovili mtkice, moqnil, badisebr qsovilovan struqturas
funqcionirebs, rogorc sxeulis maizoli-rebeli, qmnis. radgan arsebobs kanis gaWimvis SesaZlebloba,
siTbos Semakavebeli da amdenad, monawileobas iRebs qirurgiuli Carevis dros saWiroa gakeTdes
Termo-regulaciaSi. garda amisa, icavs kans Zvlis gacilebiT mcire ganakveTi, balzamirebuli gvamis
SemaRlebebis dawolisagan (mag., dundula kunTebi). (kans aRar aqvs elastikuroba) gakveTisas Catarebul
kanis iogebi (retinacula cutis), mravalricxovani analogiur procedurasTan SedarebiT. sxeulis
mcire zomis boWkovani konebia, romlebic kanqveSa zomebis momatebasTan erTad, kani nel-nela iWimeba
qsovilSi gadian da dermas akavSirebs Rrmad mdebare da izrdeba. kanis SesamCnevi da swrafi daWimva
fasciasTan (sur. I.6). am iogebis sigrZe da simkvrive SeiniSneba orsulobis dros da wonaSi mkveTri
gansazRvravs kanis mobilurobas. im adgilebSi, matebis dros. kanis Zlieri daWimva iwvevs dermis
sadac iogebi grZelia da gafantuli, kani ufro kolagenuri boWkoebis dazianebas (sur. BI.1). Txeli,
mobiluria. mag., xelis zurgi (sur. 1.8A da C). iq naoWiani kanis boWkoebi, jer wiTldeba, xolo Semdeg
sadac iogebi moklea da mWidrod arian mewamuli xdeba. orsulobis periodSi, mucelze,
ganlagebulni, kani mtkiced aris fiqsirebuli Rrmad dundulebze, barZayebze da sarZeve jirkvlebze
mdebare fasciasTan. mag., xelisguli da terfis Ziri Cndeba kanis gaWimvis niSnebi (striae gravidarum); striebi
(sur. I.8 B). kanis iogebi grZelia, magram sakmarisad (striae cutis distensae) Cndeba agreTve, msuqan individebSi,
kargad aris ganviTarebuli sarZeve jirkvlebSi, kanis daWimvis dros Rrmad mdebare fasciis
sadac iqmneba simZimis mqone suspenzoruli iogebi gafaSrebisa da kolagenis boWkoebis koheziurobis
(ix. sur. I. 20). Semcirebis gamo. orsulobis Sewyvetisa da wonis
daklebis Semdeg kanis daWimvis niSnebi Cveulebriv,
kanis Wrilobebi da nawiburebi uferuldeba, magram mTlianad arasodes qreba.

kani yovelTvis zemoqmedebis qveS imyofeba.

zogadad, gaglejili Wrilobebi an gakveTebi, Sejameba: sxeulis safarveli sistema (kani) Sedgeba
romlebic Wimvadobis xazebis paraleluria epidermisisagan, dermisagan da specializebuli
Cveulebriv, advilad xorcdeba, umniSvnelo struqturebisgan (Tmis folikulebi, qonisa da
nawiburiT, radgan boWkoebis dazianeba minimaluria. saofle jirkvlebi); kani mniSvnelovan rols
dauzianebeli boWkoebi gaWril kideebs adgilze asrulebs sxeulis dacvaSi, TboregulaciaSi da
akavebs. miuxedavad amisa, gaglejili an gakveTili SegrZnebaSi; kanSi sinTezirdeba da inaxeba D
Wriloba Wimvadobis xazebis ganivad azianebs vitamini; kanis Wimvadobis (langeris) xazebi
kolagenuri boWkoebis gacilebiT did ricxvs. ganapirobebs Wrilobis Sexorcebas. kanqveSa qsovili,
Wimvadobis xazebis gagleja tovebs sicarieles, romelic dermis qveS mdeba-reobs, organizmis
romelic SeiZleba Sexorcdes Warbi nawiburis cximovani depoa.

kanis dazianebebi da maTi klasifikacia mis qveS arsebul fenazec gavrceldes; Wrilobis
kideebi erTmaneTs Sordeba. nawiburis zomis
gaglejili Wrilobebi minimumamde dasayvanad, aucilebelia dermis
CamoWrili boloebis daaxloeba (nakeris dadebiT).
SemTxveviTi gaWra an kanis gagleja SeiZleba iyos
zedapiruli da Rrma. zedapiruli gaglejili damwvroba
Wriloba azianebs epidermiss da zogjer, dermis
zedapirul Sres. aseTi Wrilobidan sisxli modis, Termuli zemoqmedeba, ultraiisferi an
magram dermis mTlianoba ar irRveva. Rrma maionizirebeli gamosxiveba, aseve, qimiuri agentebi
gaglejili Wriloba dermis Rrmad mdebare Sres iwvevs kanis farTod gavrcelebul dazianebas-
azianebs; dazianeba SesaZloa kanqveSa qsovilze da damwvrobas. damwvrobis klasifikacia efuZneba

klinikuri anatomia 10
damwvrobis xarisxsa da kanis dazianebis siRrmes ar ziandeba. Sexorcebis procesi nela
(sur.BI.2): mimdinareobs (21 dRe an naklebi) da rCeba
nawiburi.
• I xarisxis (zedapiruli) damwvroba: dazianeba • III xarisxis (kanis sruli sisqis) damwvroba:
SemosazRvrulia epidermisiT; simptomebia: eriTema kanis mTeli sisqe ziandeba da SesaZlebelia qveS
(cxeli wiTeli kani), tkivili da edema (SeSupeba), mdebare kunTebis dazianebac. Sexorcebis procesi
zedapiruli Sris desqvamacia (aqercvla), romelic SeiZleba daiwyos mxolod kideebze; Ria,
Cveulebriv, ramdenime dRis Semdeg xdeba; dawylulebuli midamo saWiroebs kanis
aqerclili zedapiruli Sre swrafad ganaxldeba gadanergvas. mkvdar qsovils acileben da mas
bazaluri Sridan, mniSvnelovani nawi-buris cvlian sxva adgilebidan aRebuli kaniT.
warmoqmnis gareSe. mag., mzeze dawva. • pacientis zogadi mdgomareobis Sesafaseblad,
• II xarisxis (kanis sisqis nawilobrivi dazianeba) damwvrobis farTobi (mTeli sxeulis zedapiris
damwvroba: epider-misis da dermis zedapiruli dazianebis procenti) ufro mniSvnelovania, vidre
Sris dazianeba; buStukebis gaCena; nervis damwvrobis xarisxi (dazianebis siRrme).
daboloebebis dazianeba, rac am saxis dazianebas
metad mtkivneuls xdis; oflis jirkvlebi da Tmis
folikulebi, maTi zedapiruli nawilebis garda,

fasciebi, fasciuri budeebi, abgebi da kunTebis mfaravi Rrmad mdebare fascia da,
gansakuTrebiT, kidurebis fasciuri budeebis
potenciuri sivrceebi Semqmneli fasciebi, ConCxis kunTebis SekumSvisas,
kunTis muclis gareT mimarTul gafarToebas
gansazRvravs. aqedan gamomdinare, roca kunTebis
fascia sxeulis Rrmad mdebare struqturebis venebi da fasciuri gayofilebebi ikumSeba, sisxli
gasaxvevi, SesafuTi da maizolirebeli masalaa. gamoidevneba. venaSi ganlagebuli sarqvelebi
kanqveSa qsovilis (zedapiruli fascia) qveS saSualebas aZlevs sisxls mxolod erTi
arsebuli Sre (TiTqmis yvelgan) Rrmad mdebare mimarTulebiT (gulisken) imoZraos da kunTebis
fasciaa. (sur. I. 9). Rrmad mdebare fascia mkvrivi, modunebisas ukudinebas aferxebs. amrigad, sisxlis
organizebuli SemaerTebelqsovilovani Srea, gulSi dasabruleblad, Rrmad ganlagebuli fascia,
romelic cxims ar Seicavs da,Fkanisa da kanqveSa SekumSuli kunTebi, aseve venuri sarqvelebi
qsovilis paralelurad (magram ufro Rrmad), SeTanxmebulad funqcionirebs, rogorc kunT-venuri
sxeulis did nawils faravs. misi Sida zedapiri, tumbo, gansakuTrebiT qveda kidu-rebSi, sadac sisxli
romelic calkeul kunTebsa da neirovaskularul simZimis Zalis sawinaaRmdego mimarTulebiT moZraobs
konebs faravs, safari fasciaa (Garner a. Hiatt, 2001). misi (sur. I.25).
sisqe farTo farglebSi meryeobs; aRsaniSnavia, rom zogierTi saxsris siaxloves (mag., maja da koWi),
saxeze Rrmad mdebare fasciis mkafio Sreebi ar aris. Rrmad mdebare fascia SesamCnevad sqeldeba da qmnis
kidurebSi, msgavsi funqciis mqone kunTebi, e.w. sabmels anu damWers (retinaculum). mag., majis
romelTa inervacias erTi da igive nervebi dorsalur mxareze, winamxris qvemo sazRvarze
axorcielebs, moTavsebulni arian erT fasciur mdebareobs majis gamSlelebis sabmeli, romelSic
ganyofilebaSi-budeSi. fasciuri budeebi gadis gamSleli kunTebis myesebi (sur. I.19).
erTmaneTisagan gamoyofilni arian Rrmad mdebare subserozuli fascia sxvadasxva raodenobis
fasciis sqeli SriT, romelsac kunTTaSorisi Zgide cximovan qsovilTan erTad, moTavsebulia
ewodeba da romelic miemarTeba garSemoxveuli ZvalkunTovani kedlis Sida zedapirsa da sxeulis
fasciuri Sridan centrisaken, Zvlebze Rruebis amomfen serozul membranebs Soris. igi
misamagreblad. zogjer, Rrma fascia qveS mdebare iyofa endoTorakalur, endoabdominalur da
kunTebis mimagrebas (kunTis dasawyisi) ganapirobebs endopelvur fasciebad, aqedan ori ukanaskneli
(Tumca Cveulebriv es ar aris aRniSnuli kunTis miekuTvneba eqstraperitonealur fasciebs.
dasawyisis da mimagrebis CamonaTvalsa da abga (bursa) aris serozuli membranis Caketili
tabulebSi). upiratesad, kunTebi Tavisuflad Pparki anu garsi (SemaerTebeli qsovilis Txeli
ikumSeba da fasciis SigniT ufro Rrmad Cadis. membrana, romelic gamoimuSavebs sapox siTxes),
Rrmad mdebare fascia Zvalze Tavisuflad arasdros romelic sapoxi siTxis masekretirebeli Txeli Sris
gadadis; ZvalTan Sexebisas, Rrmad mdebare fascia garda, Cveulebriv dafuSuli an “carielia”. abga
periosteumTan (Zvlisazrdela) mtkiced erTiandeba. ZiriTadad, moTavsebulia iseT adgilebSi, romlebic

klinikuri anatomia 11
moxras eqvemdebareba da erT struqturas saSualebas aris garSemoxveuli, magram TviT am perangis SigniT
aZlevs Tavisuflad imoZravos meoreze. kanqveSa abga ar imyofeba. asevea filtvebic plevralur RruSi da
mdebareobs kanqveSa qsovilSi, kansa da Zvlis muclis Rrus organoebi peritonealur garsSi. am
SemaRlebas Soris. mag., idayvi da muxli. SemTxvevebSi, buStis an serozuli garsis Sida Sres
subfasciuri abga moTavsebulia Rrmad mdebare (romelic Semoxveulia muStze, organoze an
fasciis qveS. myesebis qveS arsebuli abga myesebis organoebze) visceruli Sre ewodeba; buStis gareTa
Zvlebze moZraobas aadvilebs. myesis sinoviuri Sres (an Sres, romelic sxeulis kedelTan aris
garsebi qmnian specializebul wagrZelebul abgebs, kontaqtSi) - pariesuli Sre. membranebis aseTi
romlebic Semoxveulia myesebze da axdens maT garSemoxveuli ormagi Sre erTmaneTTan
izolacias sabmelis (Zvalfibrozuli gvirabis) daaxloebuli sveli zedapirebiT, SigniT moqceul
gavlis dros (sur.I.10A). struqturas Caketil sivrceSi moZraobis
zogjer, abga saxsrebis sinovialur Rruebs Tavisuflebas aniWebs, mag., guli gulmkerdis ConCxSi
ukavSirdeba. radgan abga Txeli, gamWvirvale da myesi oseofibrozuli gvirabSi gavlisas.
serozuli membraniT aris warmoqmnili da amasTan,
“dafuSulia”, laboratoriaSi misi SemCneva an gaWra fasciuri sibrtyeebi
ar aris ioli. abgis gamovlena SesaZlebelia
Seferili siTxis inieqciiTa da gaberviT. atlasebze cocxal adamianSi arsebobs fasciuri sibrtyeebi
da saxelmZRvaneloebSi abga naCvenebia lateqsiT (interfasciuri da intrafasciuri), romlebic e.w.
inieqcirebul mdgomareobaSi (Cveulebriv lurjad), potenciuri sivrceebia momijnave fasciebsa da/an
romelic myardeba da amdenad, garemomcveli fasciebiT amofenil struqturebs Soris; potenciuri
qsovilebis moSorebis Semdeg, adgilze sivrceebi aris aseve, subserozuli fasciebis SigniT.
imobilizebuli rCeba. operaciis dros, aseTi interfasciuri sibrtyeebis
rogorc aRvniSneT, abga da myesebis sinovialuri arseboba qirurgisTvis metad xelsayrelia, radgan
garsebi carieli an potenciuri parkebi an maTi gancalkevebiT, SesaZlebelia realuri sivrcis
sivrceebia, romlebic Cveulebriv, serozuli an Seqmna, romelic Rrmad ganlagebul struqturebamde
sinovialuri membraniT aris amofenili (warmoqmnili) SeRwevis saSualebas iZleva. zogierTi proceduris
da anatomiis Seswavlisas aucileblad gvxvdeba. dros, qirurgi eqstraplevrul an
samganzomilebiani realuri sivrce-ebisgan eqstraperitonealur fasciur sibrtyeebs iyenebs, rac
gansxvavebiT, aRniSnuli sivrceebi dafuSul sxeulis Rruebis amomfeni membranebis gareT
mdgomareobaSia da amdenad, siRrme ara aqvs. maTi muSaobis saSualebas iZleva; es ki potenciuri
kedlebi mxolod maT Soris arsebuli sapoxi siTxiT dabinZurebisa da infeqciis gavrcelebis
erTdeba. im SemTxvevaSi, roca kedeli romelime SesaZleblobas minimumamde amcirebs. samwuxarod,
wertilSi ziandeba an roca siTxe Warbi raodenobiT balzamirebul gvamSi, es sibrtyeebi xSirad
sekretirdeba, isini realur sivrceebad iqceva; aseTi Serwymulia da Znelia maTi gansazRvra an Sefaseba.
mdgomareoba ki anomaluri an paTologiuria.
CafuSuli sinovialuri garsebi mraval Sejameba: Rrmad mdebare fasciebi organizebuli
mniSvnelovan organoze (mag. guli, filtvebi da SemaerTebeli qsovilia, romelic mTlianad
muclis Rrus organoebi) da struqturaze (mag., garSemoxveulia sxeulze, kanqveSa qsovilis qvemoT.
myesebis nawilebze) aris Semoxveuli. aseTi Rrma fasciuri furclebi (kunTTaSorisi Zgideebi)
konfiguracia Zalian hgavs did, magram cariel buSts kunTebs yofs jgufebad, faravs calkeul kunTs da
raime struqturis garSemo, mag., muStze neirovaskular konas (safari fascia). garkveul
garSemoxveuli buSti (sur. I.10B). carieli buStis adgilebSi Rrmad mdebare fascia sqeldeba da qmnis
orive Sre Semoxveulia obieqtze, magram muSti sabmels, romelic, saxsris moZraobis dros, myesebs
buStis SigniT ar imyofeba. TviT buSti carieli adgilze akavebs. abgebi serozuli membranebiT
rCeba. meti TvalsaCinoebisTvis, buSts winaswar warmoqmnili Caketili parkebia, romlebic
wyliT avseben, Semdeg clian. buSti SigniT sveli ganTavsebulia xaxunis adgilebSi. amis gamo,
rCeba; gulic zustad ase, perikardialuri perangiT advildeba erTi struqturis Tavisufali moZraoba
meore struqturaze.

klinikuri anatomia 12
Zvlovani sistema

Zvlovani sistema SeiZleba or funqciur nawilad periosteumi-Zvlissazrdela (sur. I.15), xolo

gaiyos (sur. I.11): xrtilis garSemo periqondriumi-xrtilis safari
garsi. periosteumi da periqondriumi Zvlovani
• RerZuli ConCxi Sedgeba Tavis Zvlebisgan qsovilis gareTa nawils kvebavs. periosteumi da
(Tavis qala), kiseri (enisqveSa Zvali da periqondriumi saWiroebis SemTxvevaSi,
kisris malebi) da tani (neknebi, mkerdis gansakuTrebiT, motexilobis Sexorcebisas,
Zvali, xerxemlis malebi da gavis Zvali). gamoimuSavebs met Zvlovan an xrtilovan ujredebs,
• apendikularuli ConCxi Sedgeba kidurebis aseve, uzrunvelyofs myesebisa da iogebis
Zvlebisgan da, maT Soris, mkerdis da menjis zedapirebis gamagrebas. Zvali ganakveTze Sedgeba
sartyelis warmomqmneli Zvlebisgan. ori erTmaneTisagan gansxvavebuli nivTierebisagan:
gareTa mkvrivi kompaqturi nivTierebisagan da
xrtili da Zvlebi SigniTa Rrublisebri nivTierebisagan. kompaqturi
nivTiereba mikroskopulad mTliani masaa da aris
ConCxi xrtilebisgan da Zvlebisgan Sedgeba. Zvlis magari da mtkice gareTa kedeli, romelsac
xrtili aris SemaerTe-beli qsovilis elastikuri, eyrdnoba SigniT mdebare Rrublisebri nivTierebis
naxevrad xisti warmonaqmni, romelic ConCxis im Zvlovani firfitebi. Zvlis Rru amovsebulia Zvlis
nawilebs qmnis, sadac meti moqniloba aris saWiro, tviniT, romelic orgvaria: wiTeli da yviTeli.
mag., neknebis xrtili neknebs mkerdis ZvalTan Zvlis wiTeli tvini sisxlis warmomSobi organoa.
akavSirebs. garda amisa, Zvlebis Sesasaxsrebeli ZvlebSi kompaqturi da Rrublisebri nivTierebis
zedapirebi sinovialuri SeerTebis adgilas Semcvelobis Tanafardoba maTi funqciebis
dafarulia sasaxsre xrtiliT da amdenad, Sesabamisad icvleba. meti kompaqturi nivTierebis
Tavisufali moZraobisTvis gvaqvs gluvi, dabali mqone Zvali uzrunvelyofs sxulis simZimis tarebas;
xaxunis mqone mosriale zedapirebi (sur. I.16). mag., grZel ZvlebSi, romlebic sxeulis simtkices
xrtilSi sisxl-ZarRvebi ar Sedis (anu xrtili ganapirobebs, kompaqturi nivTierebis raodenoba
avaskularulia); Jangbadi da sakvebi nivTierebebi yvelaze metia. kompaqturi nivTiereba aseve, didi
xrtilis ujredebSi difuziiT aRwevs. organizmis raodenobiTaa im adgilas, sadac moxra xorcieldeba.
zrdasTan erTad, ConCxSi Zvlisa da xrtilis grZel Zvlebs aqvs SemaRlebebi (mag., qedi,
Tanafardoba icvleba. rac ufro axalgazrdaa gamonazardi da borcvaki), romlebic sayrdenia didi
individi, miT metia ConCxSi xrtilis Semcveloba. zomis kunTebis misamagreblad. cocxal Zvals aqvs
axalSobilis Zvlebi rbili da moqnilia, radgan misi garkveuli elastikuroba (moqniloba) da amasTan
ConCxis umetesi nawili xrtilovania. maRali rigiduloba (simtkice).

Zvali maRalspecializebuli, SemaerTebel- Zvlebis klasifikacia

qsovilovani mtkice warmonaqmnia, romelic ConCxis
umetes nawils qmnis. Zvlebi sxeulis ZiriTadi Zvlebis klasifikacia maTi formis mixedviT.
sayrdenia. Zvlovani sistema uzrunvelyofs:
• grZeli Zvlebi Rruiania (mag., mxris Zvali);
• sxeulisa da misi mniSvnelovani Rruebis • mokle Zvlebi kuburi Zvlebia da maT miekuTvneba
sayrdenis Seqmnas;. koWisa (tarsus) da majis (carpus) Zvlebi;
• sasicocxlo mniSvnelobis struqturebis • brtyel Zvlebs Cveulebriv damcavi funqciebi aqvs
dacvas; (mag., qalas Semadgeneli Zvlebi, romlebic tvins
• moZraobis meqanikur safuZvels (berketebis icavs);
sistema); • uswormasworo formis Zvlebi (mag., saxis Zvlebi),
• marilebis depos (mag., kalciumi); romlebsac grZeli, mokle da brtyeli Zvlebisgan
• axali sisxlis ujredebiT ganuwyvetel gansxvavebuli forma aqvs.
momaragebas (sisxlis ujredebs gamoimuSavebs • sesamoiduri Zvlebi (mag., kviristavi) viTardeba
Zvlis tvini). zogierT myesSi maSin, roca myesi gadadis kidurebis
erTi grZeli Zvlidan meore grZel Zvalze. mag.,
boWkovani SemaerTebeli qsovilis safari, sasaxsre barZayis oTxTava kunTis myesis sisqeSi moTavsebuli
xrtilis garda, saxelosaviT aris Semoxveuli sesamoiduri Zvali--kviristavi, romelic icavs myess
ConCxis TiToeul elementze. Zvlis garSemo aris da muxlis saxsars zedmeti datvirTvisgan.

klinikuri anatomia 13
damatebiTi Zvlebi • naWdevi: Zvlis kidis CaRrmaveba (mag., sajdomi
damatebiTi (zedmeti) Zvlebi viTardeba im Zvlis didi naWdevi);
SemTxvevaSi, roca Cndeba gaZvalebis damatebiTi • SemaRleba: Zvlis Sverili (mag., kefis gare
centrebi. mTeli rigi Zvlebi gaZvalebis ramdenime borcvi);
centridan viTardeba da Cveulebriv, calkeuli • wveti: eklis magvari morCi (mag., TeZos Zvlis wina
nawilebi erTmaneTs erwymis. zogjer am centrebis zeda wveti);
Serwyma ar xdeba, ris gamoc warmoiqmneba damatebiTi • wvetiani wanazardi: mag., malis wvetiani morCi;
Zvali. kvlevam aCvena, rom es damatebiTi Zvali • cibruti: didi blagvi SemaRleba (mag., barZayis
faqtobrivad, mTavari Zvlis dakarguli nawilia. Zvlis didi cirbuti);
Zvlebis konturebiani ubnebi xSirad Cans Tavis qalas
• WaRi: mag., mxris Zvlis WaRi;
momijnave nakerebSi (ix. Tavi 7). es aris mcire zomis,
• xorkli: mag., deltisebri xorkli mxris Zvalze;
araswori formis, Wiisebri Zvlebi e.w. nakeris Zvlebi
• borcvi: didi momrgvalo SemaRleba (mag., sajdomi
(CanarTi Zvlebi). imisaTvis, rom rentgenogramaze
Zvlis borcvi).
damatebiTi Zvlebi ar avurioT Zvlis fragmentebSi,
aucilebelia vicodeT, rom damatebiTi Zvlebi aris
terfSic.
heterotopuli Zvlebi
Zvlis travma da Zvlis struqturis
zogjer, Zvlebis formireba xdeba rbil qsovilSi,
sadac Cveulebriv, Zvali ar unda iyos (mag., cvlilebebi
nawiburSi). cxenosnebs heterotopuli Zvlebi xSirad
Zvlebis dazianeba tkivils iwvevs, xolo Zvlebis
barZayebze uviTardebaT (cxenosnebis Zvlebi), kunTis
motexva - sisxl-denas. datvirTvis Sedegad da asakis
qronikuli daZabvis Sedegad: Tavdapirvelad mcire
matebasTan erTad, Zvlebi icvleba. sxva organoebis
zomis hemoragiuli ubnebi warmo-iqmneba, romlebic
msgavsad, Zvlebs aqvs sisxlZarRvebi, limfuri
jer kalcifikacias da Semdgom, gaZvalebas ganicdis.
ZarRvebi da nervebi. SesaZlebelia agreTve, ZvlebSi
raime daavadebis ganviTareba. Tu Zvlebi umoqmedodaa,
magaliTad, paralizebuli kiduris SemTxvevaSi,
orientirebi da warmonaqmnebi
Zvali atrofirdeba (mcirdeba zomaSi). SesaZloa,
moxdes Zvlis absorb-cia. mag., qveda ybis kbilebis
Zvlebze Taviseburi warmonaqmnebi Cndeba: 1.
amoRebis Semdeg; Zvlebi aseve, ganicdis
myesebis, iogebisa da fas-ciebis ZvalTan mimagrebis
hipertrofias (farTovdeba), roca xangrZlivi
adgilas, 2. sadac arteriebi ZvalTan axlosaa an
periodis manZilze Warb wonas atarebs.
Sedis ZvalSi. zogjer warmonaqmnebi Cndeba myesebis
Zvlis travmam (raime SemTxvevis Sedegad), SeiZleba
gzaze--xSirad, myesisTvis mimarTulebis misacemad,
misi motexva gamoiwvios. motexilobis kargad
myesis berketuli moqmedebis gasaumjobeseblad an
SexorcebisTvis, aucilebelia motexili Zvlis
saxsris moZraobis tipis kontrolisTvis. Zvlebis
boloebis zusti Tanxvedra, normalur poziciasTan
sxvadasxva orientirebi da Taviseburebebi Semdegia:
miaxloeba. am process Zvlis normaluri mdebareobis
(sur. I.13)
aRdgena ewodeba. Zvlis Sexorcebis procesSi,
• mcire zomis, mrgvali, sasaxsre Tavi-capitulum (mag., garSemo mdebare fibroblastebis (SemaerTebeli
mxris Zvlis mcire Tavi); qsovilis ujredebi) proliferacia xdeba da
gamomuSavdeba kolageni, romelic Zvlebis
• roki: momrgvalebuli, sasaxsre are, Cveulebriv
erTmaneTTan SesaerTeblad warmoqmnis koJris
warmodgenilia wyvilad (mag. barZayis
sayelos (sur. BI.3). motexvis ubanSi Zvlis
lateraluri rokebi);
rekonstruqcia mimdinareobs da koJrebi ganicdis
• qedi: Zvlis Sverili (mag., TeZos qedi);
kalcifikacias. droTa ganmavlobaSi, xdeba koJrebis
• zedaroki: borcvi rokis zemoT (mag., barZayis
rezorb-cia da maTi Canacvleba Zvlovani qsoviliT.
Zvlis lateraluri zedarokebi);
ramdenime Tvis Semdeg, motexilobis kvali qreba,
• xvreli: Zvlis xvreli (mag., mkvebavi xvreli); gansakuTrebiT axalgazrdebSi. motexiloba ufro
• foso: Rru an Cazneqili ubani (mag., beWis qedis xSiria bavSvebSi, maTi Zvlebis siTxelisa da
qvemoT arsebuli foso); gaufrTxilebeli moZraobebis gamo. sabednierod,
• Rari: mag., mxris Zvlis sxivisebri Rari; aseTi motexva upiratesad, “mwvane totis” motexvis
• Tavi-caput: didi, mrgvali sasaxsre bolo (mag., msgavsia (Zvlebis moRunviT gamowveuli arasruli
mxris Zvlis Tavi). motexva). mozardebis Zvlebis motexilobebi,
• xazi: mag., didi wvivis xazi; zrdasrulis Zvlebis motexilobasTan SedarebiT,
• goji: momrgvalebuli morCi (mag. mcire wvivis swrafad xorcdeba.
lateraluri goji);

klinikuri anatomia 14
osteoporozi Sejameba: Zvlovani sistema SeiZleba or nawilad
gaiyos - RerZuli nawili (Tavis, kisris da tanis
daberebis procesSi, Zvlis rogorc organuli, Zvlebi) da apendikularuli (kidurebis Zvlebi)
aseve araorganuli komponentebi mcirdeba, rac nawili. Zvlovani sistema, Tavis mxriv, Sedgeba
osteoporozs, Zvlovani qsovilis raodenobis xrtilovani qsovilisagan, naxevrad xisti
Semcirebas an Zvlovani qsovilis atrofias iwvevs SemaerTebeli qsovilisagan da Zvlovani
(sur. BI.4). aqedan gamomdinare, Zvlebi qsovilisagan, romelic warmoqmnilia mtkice
msxvrevadi xdeba, kargavs elastikurobas da advilad SemaerTebeli qsoviliT. Zvlovani qsovilis
tydeba. funqciebia: sayrdeni, dacvis, moZraobis, Senaxvisa
(zogierTi eleqtrolitis) da sisxlis ujredebis
sternaluri punqcia sinTezi. periosteumiT, dafarulia Zvlebi, xolo
periqondriumiT--xrtili. periosteumi da
Zvlis tvinis kvleva iZleva metad sasargeblo periqondriumi uzrunvelyofs Sesabamisad, Zvlisa da
informacias hemato-logiuri daavadebebis xrtilis zrda-ganviTarebas da kvebas. Zvali
Sefasebisas. radgan mkerdis Zvali moTavsebulia Seqmnilia ori saxis _ kompaqturi da Rrublisebri _
kanqveS da advili misawvdomia, amitom mas xSirad nivTierebisagan. Zvlebis klasifikacia ase
iyeneben Zvlis tvinis misaRebad. sternaluri gamoiyureba: grZeli, mokle, brtyeli, uswormasworo
punqciis dros, sinjis asaRebi didi diametris nemsi formis da sesamoiduri Zvlebi. calkeuli Zvlis
SehyavT mkerdis Zvlis Rrublisebur SreSi da struqturis aRwerisas iyeneben standartul
laboratoriuli kvlevisTvis gankuTvnili nemsiT terminebs, romlebic dafuZnebulia Zvlis
axdenen Zvlis wiTeli tvinis (Zvlis wiTel tvinSi orientirebze da Taviseburebebze.
warmoiqmneba sisxlis ujredebi) aspiracias.
zogjer, leikemiis mkurnalobisaTvis Zvlis tvinis
transplantacias mimarTaven.

Zvlis ganviTareba diferencirdeba qondroblastebad-gayofis unaris

mqone ujredebad mzard xrtilovan qsovilSi.
amrigad, warmoiqmneba xrtilovani Zvlis modeli,
mTeli rigi Zvlebis zrdas da momwifebas wlebi xrtili ganicdis kalcifikacias kalciumis
sWirdeba. magaliTad, mxris Zvlis gaZvaleba marilebiT. periostuli kapilarebi Caizrdeba
ebrionuli periodis (8 kvira) bolos iwyeba. kalcificirebul xrtilSi da uzrunvelyofs misi
miuxedavad amisa, gaZvalebis procesi arasrulia 20 Sida nawilis momragebas. es sisxlZarRvebi,
wlis asakamde. yvela Zvali warmodgeba mezenqimidan osteogenur (Zvlis warmomqmnel) ujredebTan erTad,
(embrionuli SemaerTebeli qsovili) ori warmoqmnis periosteul nergs (sur. I.14A). kapilarebi
gansxvavebuli procesis meSveobiT: intramembranuli astimulirebs gaZvalebis pirvelad centrs,
gaZvaleba (pirdapir mezenqimidan) da romelsac es saxeli imis gamo ewoda, rom Zvlis
endoqondrialuri gaZvaleba (mezenqimidan modelis ZiriTad nawilSi, misi warmomqmneli
warmoebuli xrtilisgan). Zvlis histologia Zvlovani qsovili enacvleba xrtilovan qsovils.
(mikroskopuli struqtura) orive SemTxvevaSi Zvlis RerZuli struqturis gaZvaleba mimdinareobs
erTnairia (Cormack, 2001; Moore a. Persaud, 2003). gaZvalebis pirveladi centridan, viTardeba Zvlis
• intramembranuli gaZvaleba (mezenqimidan mzardi diafizi.
warmoqmnili Zvali): Zvlebis mezenqimuri modeli gaZvalebis meoradi centrebis umravlesoba
warmoiqmneba embrionuli periodis ganmavlobaSi dabadebis Semdeg, ganviTarebadi Zvlis sxva
da pirdapiri gaZvaleba iwyeba muclad yofnis nawilebSi Cndeba. am centrebidan osifici-rebuli
periodSi. (gaZvalebuli) nawilebi qmnis epifizs. epifizis SuaSi
• endoqondrialuri gaZvaleba (Zvlis warmoqmna qondrocitebi ganicdis hipertrofias da maT Soris
xrtilidan): Zvlebis xrtilovani modeli arsebuli Zvlis matriqsis (eqstraujreduli
warmoiqmneba mezenqimidan muclad yofnis dros da nivTiereba) kalcifikacia xdeba. epifizuri arteriebi,
Semdgom, xrtilovan qsovils enacvleba Zvlovani asociirebul osteogenur ujredebTan erTad,
qsovili. ganviTarebad RruSi Caizrdeba. epifizTan axlos
endoqondrialuri gaZvalebis mokle aRwera mdebare diafizis gafarToebul nawils metafizi
dagvexmareba gavigoT, rogor izrdeba grZeli Zvlebi ewodeba. imisaTvis, rom zrda gagrZeldes, pirveladi
(sur. I.14). mezenqimuri ujredebi kondensirdeba da centridanN warmoqmnili Zvalovani struqtura ar

klinikuri anatomia 15
unda Seerwyas meoradi centridan warmoqmnil dros, magram xrti-lovani ujredebis distrofiuli
Zvalovan struqturas, sanam Zvali ar miaRwevs cvlilebebi Rerovan struqturebSi grZeldeba da
zrdasrul zomas. amrigad, grZeli Zvlis zrdis warmoiqmneba winaswari kalcifikaciis mkvrivi xazi.
procesSi xrtilovani epifizuri firfitebi diafizsa es xazebi--SeCerebuli zrdis xazebi, SemdgomSi
da epifizs Soris lagdeba (sur., I.14B). es zrdis gadaiqceva Zvlad, gaTxe-lebuli trabekulebiT.
firfitebi sabolood orive mxridan - diafizuri da
epifizuri mxridan _ Canacvldeba Zvlovani qsoviliT. epifizis gadanacvleba da gacalkeveba
amis Semdeg Zvlis zrda wydeba da diafizi epifizs
erwymis. Serwymis procesis (sinostozi) dros Zvlis zrdis kanonzomierebisa da sxvadasxva
warmoqmnili Serwymis xazi gansakuTrebiT mkvrivia asakis Zvlebis rentgeno-grafuli da sxva
da rentgenogramaze kargad Cans, rogorc epifizuri gamosaxulebebis codnis gareSe, gadanacvlebuli
xazi. Zvlebis epifizuri Serwyma xorcieldeba nel- epifizuri firfita SesaZlebelia CaTvaloT
nela pubertuli periodidan momwifebamde. mokle motexilobad, xolo epi-fizis gacalkeveba _
Zvlebis osifikacia, gaZvalebis pirveladi motexili Zvlis gadanacvlebul fragmentad.
centrebidan dawyebuli, grZeli Zvlebis pacientis asakisa da epifizis mdebareobis codna
osifikaciis procesis msgavsia da mxolod erTi agacilebT anatomiur Secdomas. epifizuri firfitis
mokle Zvali _ quslis Zvali viTardeba gaZvalebis ubanSi, diafizisa da epifizis kideebs gluvi safari
meoradi centridan. aqvs, xolo Zvlis motexilobisas Zvals wvetiani,
araswori formis kide aqvs. dazianeba, romelic
Zvlis zrda da Zvlis asakis Sefaseba motexilobas iwvevs zrdasrul individSi, bavSvebSi
klinikuri medicinisTvis, sasamarTlo epifizis wanacvlebas ganapirobebs.
medicinisTvis da anTropolo-giisTvis
mniSvnelovania im adgilebis codna, sadac gaZvalebis
centrebi yalibdeba; mniSvnelovania aseve, gaZvalebis
centrebis gaCenis dro, siCqare, romliTac isini
izrdeba da gaZvalebis wertilebis Serwymis dro
Zvlebis vaskularulizacia da inervacia
(sinostozis dawyebis dro). rentgenogramaze
gansazRvruli (rentgenofiris negativi) Zvlis asaki
Zvlebi uxvad maragdeba sisxlZarRvebiT. yvelaze
miuTuTebs adreul bavSvobis periodSi, bavSvobisas
advili SesamCnevia mkvebavi arteria (erTi an meti),
da pubertul periodSi mimdinare zrdis procesis
romelic periosteumis gareT gamavali mimdebare
saerTo maCvenebelze. axalgazrdis asaki SeiZleba
arteriis damoukidebeli totia. igi iribad Sedis
ganisazRvros Zvlebis osifikaciis centrebis
grZeli Zvlis RerZul kompaqtur SreSi mkvebavi
SeswavliT. (ix. mag., zeda kidurebis rentgeno-grafia
xvrelidan. mkvebavi arteria aRwevs Zvlis tvins da
me-6 TavSi). mTavari kriteriumebia: (1)
itoteba da qmnis kapilarul qsels. mkvebavi arteria
kalcificirebuli masalis gaCena diafizSi da/an
uzrunvelyofs Zvlis tvinis, Zvlis Rrublisebri
epifizSi da (2) epifizuri firfitis muqi xazis
Srisa da Zvlis kompaqturi Sris Rrma fenebis
gaqroba (am xazis ararseboba miuTiTebs, rom
sisxliT monaragebas (sur. I.15). amrigad,
epifizuri Serwyma ukve moxda; TiToeuli
Zvlisazrdelis arteriis bevri mcire toti
epifizisTvis Serwyma garkveul dros xdeba). epifizis
pasuxismgebelia Zvlis kompaqturi Sris kvebaze.
Serwyma diafizTan gogoebSi 1-2 wliT adre xdeba,
aqedan gamomdinare, Zvali, romelsac Zvlisazrdela
vidre biWebSi. adreul an gvian pubertul periodSi
mocilebuli aqvs, kvdeba. sisxli aRwevs Zvlis
Zvlis asakis gansazRvriT, SesaZlebelia zrdasrul
kompaqturi Sris osteocitebamde (Zvlis ujredebi)
asakSi simaRlis prognozireba (Behrman et al., 2004).
mikroskopuli arxebis sistemiT (haversis sistema an
sasamarTlo-samedicino eqspertizis dros Zvlis
osteonebi), romlebic mcire sisxlZarRvebs Seicavs.
asakis gansazRvra adamianis ConCxis mixedviT,
Zvlebis boloebi metafizuri da epifizuri
daaxloebiTi asakis dadgenis saSualebas iZleva.
arteriebiT maragdeba, romlebic gamoeyofa saxsrebis
mommaragebel arteriebs; kidurebSi es arteriebi
daavadebebisa da kvebis reJimis gavlena Zvlebis
ZiriTadad, periartikuluri arteriuli wnulis
zrdaze nawilia, romelic saxsarzea Semoxveuli da, saxsris
zogierTi daavadeba adreul epifizur Serwymas SesaZlo poziciisgan damoukideblad, sisxlis
(osifikaciis dro) ganapirobebs, individis nakadiT uzrunvelyofs saxsris distalur nawils.
qronologiur asakTan SedarebiT. sxva daava-debebi mkvebav xvrelebSi arteriebs Tan axlavs venebi.
piriqiT, Serwymis dayovnebas iwvevs. mzardi ConCxi mravali didi vena aseve gamodis xvrelidan Zvlis
metad mgrZnobiarea SedarebiT umniSvnelo da sasaxsre boloebis siaxloves. Zvlis wiTeli tvinis
tranzitoruli daavadebebisa da arasakmarisi, Semcvel Zvlebs mravali didi vena aqvs.
arasrulfasovani kvebis mimarT. metafizis xrtilis
pro-liferacia neldeba SimSilisa da avadmyofobis

klinikuri anatomia 16
ZvlisazrdelaSi uxvad aris agreTve limfuri avaskularuli nekrozi
ZarRvebi. epifizSi an Zvlis sxva nawilebSi arteriuli
Zvlebis mkvebav sisxlZarRvebs Tan axlavs nervebi. sisxliT momaragebis Sewyveta Zvlovani qsovilis
Zvlisazrdela uxvad maragdeba mgrZnobiare nervebiT sikvdils - avaskularul nekrozs (nekrosis- kvdoma)
- periostuli nervebi, romlebic tkivilis ganapirobebs. Zvlis motexvis Semdeg, Zvlis
boWkoebsac Seicavs. Zvlisazrdela gansakuTrebiT mimdebare mcire ubanSi mimdinareobs nekrozi.
mgrZnobiarea dazianebis an daWimvis mimarT, riTac zogierTi motexilobis SemTxvevaSi, SeiZ-leba Zvlis
aixsneba Zvlis motexilobis dros arsebuli mwvave didi fragmentis nekrozi ganviTardes. epifizis
tkivili. TviT Zvali mcired maragdeba mgrZnobiare mTeli rigi klinikuri darRveva bavSvebSi
daboloebebiT. Zvlebis vazomotoruli nervebi gaurkveveli etiologiis (mizezis) avasku-laruli
sisxlZarRvebis SekumSvas da gafarToebas nekroziT aris gamowveuli. am darRvevebs
ganapirobebs. amis gamo, Zvlis tvinSi sisxlis osteoqondrozi ewodeba (Salter, 1998).
nakadis miwodeba regulirdeba.
Sejameba: Zvlebis zrda ganpirobebulia
Sidamembranuli osifikaciis procesebiT, romlis
drosac embrionul da prenatalur periodebSi Zvlis
mezeqimuli modelebi formirdeba, xolo
endoqondruli osifi-kaciis dros nayofSi
warmoiqmneba xrtilovani modelebi, romelTa
umravlesoba, dabadebis Semdeg, Zvlovani qsoviliT
Canacvldeba.

saxsrebi

saxsari (SeerTeba) ori an meti Zvlis an ConCxis sasaxsre CanTa naCvenebia gaberil mdgomareobaSi.
rigiduli nawilebis SeerTebis adgilia. saxsrebs aqedan gamomdinare, potenciuri sasaxsre Rru Zlier
sxvadasxva forma da funqcia aqvs. zogierT saxsarSi gadidebulia. periosteumi, romelic faravs Zvlebs
moZraoba ar xorcieldeba, sxvebi umniSvnelod saxsris gareT, Sezrdilia sasaxsre kafsulis
moZraobs, xolo zogierTi saxsari Tavisufali boWkovan SresTan.
moZraobiT xasiaTdeba. mag., mxris saxsari. 2. fibrozuli saxsrebis Sesaxsrebuli Zvlebi
gaerTianebulia boWkovani SemaerTebeli qsoviliT.
saxsrebis klasifikacia fibrozul saxsrebSi ganxorcielebuli moZraoba
umravles SemTxvevaSi damokidebulia Sesasaxsrebeli
Zvlebis gamaerTianebeli boWkoebis sigrZeze.
arCeven sami tipis saxsars; aseTi dayofa
fibrozuli saxsris magaliTia qalas nakerebi (sur. I.
ZiriTadad, dafuZnebulia Zvlebis Sesaxsrebis
16B). es Zvlebi mWidrod ekvris erTmaneTs da
formaze.
talRovani xazis gaswvriv an mijrilia erTmaneTTan,
1. sinovialuri saxsrebis Sesaxsrebuli Zvlebi
an erTmaneTs gadafaravs. fibrozuli saxsris
gaerTianebulia sasaxsre kafsuliT anu CanTiT,
sindesmozuri tipi Zvlebs aerTianebs boWkovani
romelic Sedgeba SigniTa sinovialuri membrane-
SemaerTebeli qsovilis fenasTan, an iogTan an
sagan da gareTa, kolagenuri boWkoebis Semcveli,
boWkovani qsovilis membranasTan. aqedan gamomdinare,
mtkice fibrozuli Srisagan. sasaxsre CanTa
saxsris es tipi naxevrad moZravia. ZvalTaSorisi
gadaWimulia sasaxsre Rruze da kravs mas.
membrana wina mxarSi boWkovani SemaerTebeli
sinovialuri saxsris sasaxsre Rru (mag., muxlis
qsovilis fenaa, romelic aerTebs sxivis Zvals
saxsris Rru) warmoadgens potenciur sivrces,
romelic Seicavs, sinovialuri membranis mier idayvis ZvalTan. CaWdeuloba--gomphosis anu
sekretirebul, mcire raodenobis sapox sinovialur dentoalveoluri sindesmozi fibrozuli saxsaria,
siTxes. kafsulis SigniT, sasaxsre xrtili faravs romelSic Stiftis msgavsi wanazardi zustad ergeba
Zvlebis sasaxsre zedapirs (sayrdeni zedapirebi). saxsris CaRrmavebas _ kbilis fesvi da alveoluri
yvela danarCeni Sida zedapiri dafarulia bude. am saxsris mobiluroba (moryeuli kbili)
paTologiur mdgomareobaze, kbilis sayrdeni
sinovialuri membraniT. I.16A suraTze naCvenebi Zvlebi
qsovilebis darRvevaze miuTiTebs. am adgilebSi
Cveulebriv, mWidrod aris SeerTebuli da mxolod
arsebuli umniSvnelo moZraobebi migvaniSnebs
demonstrirebis mizniT aris gancalkevebuli; aseve,
(proprioceptuli aRqmiT) ramdenad normaluria

klinikuri anatomia 17
kbilebis wyoba an raime nawilakis arsebobaze sasaxsre zedapirebs unagiris forma aqvs
kbilebs Soris. (Sesabamisad, erTi Cazneqilia, xolo meore
3. xrtilovani saxsrebis sasaxsre struqturebi amozneqili). saxsari, rimelic pirveli TiTis (ceri)
gaerTianebulia hialinuri xrtiliT an fibrozuli fuZesTan iqmneba anu I maja-nebis saxsari
xrtiliT. pirvelad xrtilovan saxsrebSi anu unagirissebri saxsaria.
sinqondrozSi, Zvlebi gaerTianebulia hialinuri 3. rokisebri saxsrebi asrulebs moxras da gaSlas,
xrtiliT, romelic umniSvnelo daxris saSualebas aseve, abduqcias da aduqcias. amrigad, rokisebri
iZleva sicocxlis adreul etapze. pirveladi saxsrebi orRerZiania. miuxedavad amisa, moZraoba erT
xrtilovani saxsari Cveulebriv, droebiTi sibrtyeSi (sagitaluri) ufro Tavisuflad
gaerTianebaa, rogoricaa mag., grZeli Zvlis sruldeba, vidre meoreSi. rokisebri saxsris
ganviTarebis garkveul etapze arsebuli gaerTianeba magaliTia atlant-kefis an safeTqel-qveda ybis
(sur. I.14 da I. 16), sadac Zvlis epifizi da RerZi saxsari.
SeerTebulia epifizuri firfitiT. pirveladi 4. sferuli Sesaxsrebis saSualebiT xorcieldeba:
xrtilovani saxsari Zvlis sigrZeze gazrdis moxra da gaSla, abduqcia da aduqcia, medialuri da
saSualebas iZleva. roca zrda sruldeba, epifizuri lateraluri brunva. amrigad, sferuli saxsrebi
firfita gardaiqmneba Zvlad da epifizi erwymis mravalRerZiania. am metad moZrav saxsrebSi, erTi
diafizs. meoradi xrtilovani saxsrebi anu simfizi Zvlis sferuli zedapiri moZraobs meore Zvlis
mtkice, umniSvnelod moZravi saxsrebia, romlebic fosoSi. aseTi saxsris magaliTia barZayis saxsari,
gaerTianebulia fibrozuli xrtiliT. malebs Soris sadac barZayis Zvlis sferuli Tavi brunavs
fibrozul-xrtilovani malaTaSua diskoebi (sur. tabuxis fosoSi.
I.16C) Sedgeba Semkvreli SemaerTebeli qsovilisagan, 5. cilindruli saxsari vertikaluri RerZis garSemo
romelic malebs erTmaneTTan akavSirebs. kumulaciis brunvis saSualebas iZleva. amrigad, aseTi saxsrebi
Sedegad, saxsrebi uzrunvelyofs simtkices da erTRerZiania. am saxsarSi Zvlis momrgvalebuli
amortize-rebas, aseve xerxemlis mniSvnelovan wanazardi brunavs rgolSi. aseTi saxsris magaliTia
moqnilobas. atlant-aqsisis saxsari, sadac Tavis brunvis dros,
sinovialuri saxsrebi yvelaze gavrcelebuli atlasi (C1 mala) brunavs TiTisebri wanazardis,
saxsrebia, romlebic maT mier SeerTebuli Zvlebis RerZmalis (aqsisis) kbilisebri wanazardis (C2 mala)
Tavisufal moZraobas uzrunvelyofs. sinovialuri garSemo.
saxsrebi moZraobis saxsrebia da yvela kidurisTvis
aris damaxasiaTebeli. sinovialuri saxsrebi saxsris sisxlZarRvovani bade da inervacia
gamyarebulia damatebiTi iogebiT, romlebic an
gancalkevebulia (garegania) an qmnis sasaxsre
saxsrebi iRebs sisxls sasaxsre arteriidan,
kafsulis Sesqelebul nawils (Sinagania). im
romelic gamodis saxsris garSemo arsebuli
SemTxvevaSi, roca Zvlebis sasaxsre zedapirebi
sisxlZarRvebidan. arteriebi erTmaneTs
arakongruentulia, zogierT sinovialur saxsars
ukavSirdebian anastomozebis saSualebiT da qmnian
darTuli aqvs specialuri warmonaqmni, rogoricaa
kapilarul bades (pariartiku-laruli arteriuli
mag., fibrozul-xrtilovani sasaxsre diskoebi an
bade), romelic uzrunvelyofs saxsris sisxlmo-
meniskebi.
maragebas, saxsris poziciisagan damoukideblad.
gamoyofen sinovialuri saxsrebis 6 ZiriTad tips,
sasaxsre venebi Tan axlavs arteriebs. arteriebis
sasaxsre zedapirebis formisa da/an maTTvis
msgavsad, venebi aseve, mdebareobs sasaxsre
damaxasiaTebeli moZraobis saxis mixedviT (sur. I.17):
kafsulaSi upiratesad, sinovialur SreSi.
1. brtyeli saxsari, romelSic xdeba srialis msgavsi
saxsrebis uxvi nervuli daboloebebi
moZraoba, sasaxsre zedapirebis sibrtyis mimarT.
ganTavsebulia sasaxre kafsu-laSi. kidurebis (xelebi
saxsarSi monawile Zvlebis zedapirebi brtyelia an
da fexebi) distalur nawilebSi sasaxsre nervebi
TiTqmis brtyeli, romelTa moZraoba maTi mWidro
kanis nervebis ganStoebaa, romelic mis zemoT
sasaxsre kafsuliT aris limitirebuli. sxeulSi
mdebare kans anervebs. miuxedavad amisa, sasaxsre
mravalricxovani brtyeli saxsari arsebobs da maTi
nervebis umravlesoba kunTebTan mimavali nervebis
zoma TiTqmis yovelTvis mcirea. brtyeli saxsris
ganSroebaa, romelic saxsarsas anervebs. hiltonis
magaliTia laviw-akromionis saxsari, romelic
kanonis Tanaxmad, saxsris inervacia aseve, kunTis
iqmneba beWis Zvlis akromionsa da laviwis Zvals
inervacia, an kanis inervaciaa.
Soris.
saxsrebi aRiqvams proprioceptul mgrZnobelobas,
2. unagirisebri saxsari abduqciisa da aduqciis,
romelic uzrun-velyofs sxeulis nawilebis
moxrisa da gaSlis saSualebas iZleva. moZraoba
moZraobisa da poziciis gacnobierebas. sinovialuri
sruldeba ori RerZis garSemo; unagiri-sebri
membrana SedarebiT, moklebulia mgrZnobelobas.
saxsari orRerZiania da aseTi saxsris meSveobiT
fibro-zul SreSi da masTan dakavSirebul iogebSi
moZraoba xorcieldeba or sibrtyeSi - sagitalur da
tkivilis boWkoebi mraval-ricxovania da saxsris
frontalur sibrtyeSi. saxsarSi monawile Zvlebis
dazianebis SemTxvevaSi tkivilis Zlier SegrZnebas

klinikuri anatomia 18
iwvevs. mgrZnobiare nervebis daboloebebi reagirebs saxsari da muxlis saxsari). sisxlis nakadiT
daWimvaze, rac xSirad aRiniSneba sportuli nebismieri nivTiereba, rogorc normaluri, aseve
TamaSebis mag., kalaTburTis dros. arTritiT paTologiuri, advilad aRwevs sasaxsre Rrus. analo-
daavadebuli pacientebi dagvidastureben, rom giurad, saxsris travmatul infeqcias SeiZleba
saxsrebSi mravlad aris tkivilis nervuli mohyves arTriti--saxsris anTeba da septicemia--
daboloebebi. sisxlis mowamvla.

axalSobilis qalas saxsrebi arTroskopia

axalSobilis Tavis qalas sarqvelis Zvlebs sinovialuri saxsris Rrus kvleva SesaZlebelia
erTmaneTTan sruli kontaqti ara aqvs (sur. BI.5). aseT RruSi kanulis (Rru nemsi) SeyvaniT da
adgilebSi nakerebi boWkovani SemaerTebeli arTroskopiiT (mcire zomis teleskopi). qirurgiuli
qsovilis farTo ubnebs qmnis, romelsac yiflibandi procedura--arTroskopia qirurg--orTopeds
ewodeba. wina yiflibandi yvelaze metad aris saSualebas aZlevs daaTvali-eros saxsris
gamoweuli. araprofe-sionalebi mas bavSvis rbil paTologia, rogoricaa mag., sasaxsre diskoebis
adgils eZaxian. qalas Zvlebis urTierTgada-farvis gagleja. arTroskopiis dros SesaZlebelia
gamo, mSobiarobis dros yiflibandi axalSobilSi zogierTi qirurgiuli proceduris Catareba (mag.,
xSirad SemaRlebas warmoqmnis. Cveulebriv wina instrumentis Seyvana punqciis adgilis mcire
yiflibandi brtyelia. gamobe-rili yiflibandi ganakveTSi). radgan anTroskopis Sesayvanad sasaxsre
SeiZleba qalaSida wnevis momatebis Sedegi iyos. kafsulaSi gakeTebuli ganakveTi mcire zomisaa,
bavSvis tirilis dros, yiflibandi ibereba. aseTi proceduris Semdeg Sexorceba gacilebiT
yiflibandis pulsacia asaxavs pulss. Cazneqili swrafad mimdinareobs, vidre saxsris tradiciuli
yiflibandi ufro xSirad bavSvis dehidrataciaze qirurgiuli Carevis Semdeg.
miuTiTebs.

saxsrebis degeneraciuli daavadebebi

sinovialuri saxsrebi mudmiv datvirTvas uZlebs,
magram wlebis manZilze maTma gadametebulma
datvirTvam SeiZleba degeneraciuli cvlilebebi Sejameba:
gamoiwvios. zogierTi saxis destruqcia garduvalia
iseTi aqtiurobis dros, rogoricaa sirbili, saxsari ori an meti Zvlis an ConCxis mtkice
romelic droTa ganmavlobaSi cveTs sasaxsre nawilebis SeerTebis adgilia. gamoyofen sami tipis
xrtils. sasaxsre xrtilis dabereba, upiratesad, saxsars: fibrozuli, xrtilovani da sinovialuri.
barZayis, muxlis, xerxemlisa da xelebis saxsrebSi, sinovialuri saxsrebi, saxsrebis yvelaze
axalgazrdobidan iwyeba da nel-nela progresirebs. gavrcelebuli saxeobaa; saxsrebis klasifikacia ase
am Seuqcevadi degeneraciuli cvlilebebis Sedegad, gamoiyureba: brtyeli, unagirisebri, rokisebri,
sasaxsre xrtili nakleb efeqturi xdeba, rogorc sferuli da cilindruli. saxsrebi sisxliT
amortizatori da gapoxili zedapiri. aqedan maragdeba sasaxsre arteriebiT, romlebic xSirad
gamomdinare, saxsari moZraobis dros, sul ufro bades warmoqmnian. sasaxsre venebi Cveulebriv,
mgrZnobiare xdeba ganmeorebadi xaxunis mimarT. ganTavsebulia sinovialur membranaSi. saxsrebSi
zogierT individSi aseTi cvlilebebi mniSvnelovan uxvad aris nervuli daboloebebi, saxsrebi aRiqvamen
simptomebs ar iwvevs; sxvebSi ki - Zlier tkivils proprioreceptul SegrZnebebs, rac uzrunvelyofs
iwvevs. saxsrebis degeneraciul daava-debas-- sxeulis nawilebis moZraobisa da poziciis
osteoarTrits Tan axlavs rigiduloba, gacnobierebas.
diskomforti da tkivili. osteoarTriti xSiria
moxucebulebSi da Cveulebriv, azianebs im saxs-rebs,
romlebic sxeulis wonas atarebs (mag. menj-barZayis

klinikuri anatomia 19
kunTovani qsovili da kunTovani sistema

kunTovani sistema moicavs sxeulis yvela ConCxis kunTebi

kunTs. miuxedavad imisa, rom zogadad, kunTovani
sistemis kunTebi Sedgeba erTi konkretuli tipis
kunTovani qsovilisgan, sxvadasxva sistemebis forma, Taviseburebebi da kunTebis
organoebisaTvis damaxasia-Tebelia sxvadasxva tipis
saxelwodebebi
kunTovani qsovilis arseboba. mag., gulsisxl-
ZarRvTa, saWmlis momnelebeli, Sard-sasqeso da
sxeulis safarveli sistemebi maTTvis yvela ConCxis kunTi an ubralod kunTi, romelsac
damaxasiaTebeli kunTovani qsoviliT aris warmod- aqvs wiTelxorciani kumSvadi nawilebi (erTi an meti
genili. Tavi an muceli), ConCxis ganivzoliani kunTebia. zogi
kunTi mTlianad xorciania, magram umete-sobas
kolagenis mowesrigebuli konebisgan Semdgari
kunTovani qsovilis tipebi
TeTri, arakumSvadi nawilebi (myesebi) aqvs, romlebic
kunTovani ujredebi specializebuli kumSvadi
uzrunvelyofs maT mimagrebas (sur. I. 18A). roca
ujredebia, romlebsac kunTovan boWkoebsac
uTiTeben kunTis sigrZes, mxedvelobaSi iReben,
uwodeben, radgan modunebul mdgomareobaSi maT
rogorc kunTis mucels, aseve myesebs. sxva sityvebiT,
wagrZelebuli da viwro forma aqvs. ujredebi qmnis
rom vTqvaT, kunTis sigrZe ganisazRvreba manZiliT
qsovils, romelic sxeulis nawilebs amoZravebs da
mimagrebebis adgilebs Soris. kunTebis umetesoba
droebiT cvlis Sinagani organoebis (amcirebs mTeli
pirdapir an arapirdapir Zvlebze, xrtilebze,
organos an misi nawilis garSemowerilobas) formas.
iogebze an fasciebze an am struqturebis
SemaerTebeli qsovilis boWkoebi da kapilarebi
kombinaciebze aris mimagrebuli. zogi kunTi
wnulebad da konebad lagdeba kunTovan ujredebs
organosTan (mag., Tvalis kakali), kanTan
Soris. kunTebis mkafio Taviseburebebidan
(fascialuri kunTi) da lorwovan garsTan (sakuTriv
gamomdinare, gamoyofen kunTebis sam tips:
enis kunTebi) aris mimagrebuli. kunTebi lokomociis
• normaSi nebiTi kontrolis qveS imyofeba
(moZraobis) organoebia, magram garda amisa,
(nebiTi/uneblie).
uzrunvelyofs statikur sayrdens, sxeuls formas da
• mikroskopSi gasinjvis dros zoliani an gluvia siTbos regulacias.
(ganivzoliani/gluvi). I.19 suraTze naCvenebia kunTebi, romlebic
• ganlagebulia sxeulis kedelSi da kidurebSi an ganlagebulia zedapirulad. Rrmad ganlagebul
qmnis sxeulis Rrus Rru organoebs da kunTebs ganvixilavT, roca SeviswavliT calkeul
sisxlZarRvebs (somaturi/visceruli). ubnebs.
nervuli sistemis ganxilvis dros aRwerili iqneba kunTebis agebuleba da forma metad cvalebadia
somaturi da visceruli kunTebis gansxvaveba, maTi (sur., I. 18B). zogierTi kunTis myesebi qmnis brtyel
inervaciis TvalsazrisiT. firfitas--aponevrozs, romelic amagrebs kunTs
ConCxze, an Rrmad mdebare fasciaze (mag., zurgis
arsebobs sami tipis kunTi (cxrili I.1): uganieresi kunTi m. latissimus dorsi), an kunTis sxva
• ConCxis ganivzoliani kunTi somaturi nebiTi aponevrozze (sur. I.19). umravlesoba kunTebis
kunTia. kunTovani sistemis Semadgeneli ConCxis saxelwodeba dakavSirebulia maT funqciasTan an
didi kunTebi warmodgenilia soma-turi kunTebiT, ZvlebTan, romlebsac isini emagreba. mag., nekis
romlebic uzrunvelyofs moZraobas an Zvlebisa ganmzidveli kunTi ganizidavs neks; mkerd-laviw-
da sxva struqturebis (mag., Tvalis kakali) dvrilisebri kunTi emagreba qvemoT, mkerds da
stabilizacias. laviws, xolo zemoT - dvrilisebri morCiT qalas
• gulis ganivzoliani kunTi visceruli uneblie safeTqlis Zvals. zogierTi kunTis saxelwodeba
kunTia, romelic sisxls tumbavs da qmnis gulis emyareba maT ganlagebas (medialuri, wina, ukana) an
kedlis umetes nawils da didi sisxlZarRvebis sigrZes (brevis-mokle; longus-grZeli); kunTebis aRwera
momijnave nawilebs (mag., aorta) . da maTi klasifikacia SesaZlebelia maTi formis
• gluvi kunTi (araganivzoliani, dauxazavi) uneblie mixedviT da maTi saxelwodebac formidan
visceruli kunTia, romelic qmnis umetesi momdinareobs (sur. I.18 da I.19).
sisxlZarRvebis kedlebs da Rru organoebs • brtyel kunTebs aqvs paraleluri boWkoebi,
(viscera); gluvi kunTebi Tanmimdevruli xSirad aponevrozTan erTad, mag., gareTa iribi
SekumSvebis koordinaciis gziT (pulsaciebi an kunTi;
peristaltikuri SekumSvebi) gadaadgilebs • frTisebri kunTebi Tavisi konebis dalagebiT,
sisxlZarRvebsa da Rru organoenSi arsebul frTis msgavsia da SeiZleba iyos erTfrTiani,
substanciebs.

klinikuri anatomia 20
 orfrTiani an mravalfrTiani. magali-Tad, TiTebis regulirebac). nevrologiuri CaquCiT myesze
grZeli gamSleli kunTi erTfrTiania, xolo dakakunebis dros iwveva kunTis gaWimvis refleqsi,
deltisebri kunTi mravalfrTiani; romelic iwvevs moZraobas
• TiTistarisebr kunTs TiTistaras forma aqvs, tonuri SekumSva. “relaqsaciis” drosac
mrgvali sqeli mucliT (an muclebiT) da konusuri gonze myofi adamianis kunTebi TiTqmis yovelTvis
boloebiT, magaliTad, wina mxris orTava kunTi; umniSvnelod SekumSulia. aseTi SekumSva, romelsac
• kvadratul kunTebs oTxi toli gverdi aqvs mag., kunTis tonusi ewodeba, ar ganapirobebs moZraobas an
kvadratuli pronatori; aqtiur ukuqmedebas. tonuri SekumSva kunTs garkveul
simtkices aniWebs, xels uwyobs saxsrebis
• irgvlivi an sfinqteruli kunTebi ganlagebulia
stabilurobas, poziciis SenarCunebas da Sesabamis
sxeulis napralebis an xvrelebis garSemo da maTi
impulsze sapasuxod kunTi srul mzadyofnaSia.
SekumSva napralebs SemosazRvravs, magaliTadpiris
kunTis tonusi ikargeba mxolod ugono mdgomareobis
irgvlivi kunTi;
dros (Rrma Zilis, saerTo anesTeziis dros) an
• mravalTavian an mravalmuclian kunTebs
nervis dazianebis dros, romelic damblas iwvevs.
mimagrebisTvis erTze meti Tavi da erTze meti
fazuri SekumSva. gamoyofen kunTis fazuri
kumSvadi muceli aqvs, Sesabamisad, mag., orTava
SekumSvis or ZiriTad tips: izotonuri SekumSva,
kunTebs mimagrebis ori Tavi aqvs, samTava kunTebs -
romlis drosac kunTebis sigrZe icvleba
sami Tavi , ormuclian kunTebs ori muceli aqvs.
moZraobasTan kavSirSi da izometruli SekumSva,
roca kunTis sigrZe igive rCeba - moZraoba ar
sruldeba, magram Zala (kunTis daWimuloba) izrdeba
kunTebis SekumSva tonur doneebze maRla (sur. I. 20). SekumSvis aseTi
saxe mniSvnelovania vertikalurad dgomis dros,
ConCxis kunTi funqcionirebs SekumSviT. kunTebs roca kunTebi moqmedebs, rogorc fiqsatorebi.
SeuZlia daWimva, magram ara “miwola”. miuxedavad izotonuri SekumSvis ori tipi arsebobs.
amisa, iseTi fenomenis dros, rogoricaa yurebSi koncentruli SekumSvis dros moZraoba xorcieldeba
xmauri, wnevis gaTanabrebisTvis kunT-venuri tumbos kunTis damoklebis Sedegad. magaliTad, roca xeliT
(gv. 43) muSaobas safuZvlad udevs SekumSvis viRebT Wiqas, vubiZgebT kars an vaxorcielebT
procesSi kunTis muclis gafar-Toeba. roca kunTi dartymas. swored gansakuTrebuli Zalis gamoyenebis
ikumSeba da mokldeba, erT-erTi bolos mimagreba unari, koncentruli SekumSvis daxmarebiT,
fiqsirebuli rCeba, maSin roca meore bolos sportsmens moyvarulisgan ganasxvavebs. SekumSvis
mimagreba (ufro mobiluri) moizideba, rac moZraobas meore tipi eqscentruli SekumSvaa, romlis drosac
ganapirobebs. kunTebis mimagrebis adgilebs aRweren, SekumSuli kunTi grZeldeba anu ganicdis
rogorc dasawyiss da mimagrebas. dasawyisi regulirebul da gradualur relaqsacias da
Cveulebriv, kunTis proqsimalur boloa, romelic amasTan, agrZe-lebs Zal-Ronis daZabvas (romelic
fiqsirebuli rCeba kunTis SekumSvis dros, xolo nel-nela mcirdeba), mag., Tokis nel-nela gaSveba
mimagreba kunTis distaluri boloa, romelsac xelidan. eqscentruli SekumSva iseve mniSvnelovania
gadanac-vleba SeuZlia. miuxedavad amisa, kunTis koordinaciisTvis, funqciuri moZraobebisTvis,
SekumSva yovelTvis ase ar xdeba. sxva pirobebSi rogoricaa siaruli, sirbili da sagnebis Zirs
zogi kunTi moqmedebs orive mimarTulebiT. dadeba an Cajdoma ( koncentruli SekumSva).
magaliTad, zeda kiduris (xeli) gawevisas, misi xSirad, roca konkretuli moZraobis mTavari
distaluri bolo fiqsirebulia, xolo kiduris kunTi (mTavari mamoZravebeli) ganicdis koncentrul
proqsimaluri bolo da tani moZraobs. aqedan SekumSvas, misi antagonisti asrulebs
gamomdinare, mocemul saxelmZRvaneloSi, umetesi koordinirebul eqscentrul SekumSvas. siarulis
kunTebis mimagrebis aRwerisas, iyeneben terminebs dros, simZimis centris win gadanacvlebis mizniT,
proqsimaluri da distaluri an medialuri da kunTs vkumSavT koncentrulad, rac win uswrebs
lateraluri. aRsaniSnavia, rom roca kunTis kiduris gadaadgilebas da Semdeg, meore kidurze
mimagrebis adgili cnobilia, kunTis moZraobis simZimis Zalis gadatanis dros, gverdze gadaxris
dadgena SeiZleba logikuri gziT (codnis gareSe). asarideblad, vkumSavT eqscentrulad. erTnairi
refleqsuri SekumSva. miuxedavad imisa, rom datvirTvis dros eqscentruli SekumSvebi nakleb
ConCxis kunTebi nebiTi kunTebia, maTi moqmedebis metabolur energias saWiroebs da maqsimaluri
zogierTi aspeqti avtomaturia (refleqsuri) da SekumSvisas gacilebiT maRali daZabulobis doneebis
Sesabamisad, ar eqvemdebareba nebas. aseTi moqmedebis generirebis unari aqvs - 50% meti, vidre
magaliTia diaf-ragmis sunTqviTi moZraobebi, koncentruli SekumSvisas.
romlebic regulirdeba umTavresad, sisxlSi kunTis struqturul erTeulia ConCxis
Jangbadis da naxSirbadis dioqsidis doneebiT ganivzoliani kunTovani boWko, xolo mis funqciuri
stimulirebuli refleqsebis saSualebiT (miuxedavad erTeuli - motoruli erTeuli, romelic Sedgeba
amisa, garkveul sazRvrebSi, Cven SegviZlia nebiTi motoruli neironisa da mis mier kontrolirebuli

klinikuri anatomia 21
kunTovani boWko-ebisgan (sur. I.21). xerxemalSi TandaTanobiT dundeba da sabolood mwyobri
motoruli neironis stimulireba iwvevs impulsis moZraoba sruldeba.
warmoqmnas, romelic am motoruli erTeulis
kontrolis qveS myofi yvela kunTovani boWkos erTi da igive kunTi SeiZleba sxvadasxva
erTdroul SekumSvas ganapirobebs. motorul pirobebSi moqmedebdes rogorc agonisti,
erTeulSi kunTovani boWkoebis raodenoba erTidan antagonisti, sinergisti an fiqsatori. aRsaniSnavia,
ramdenime aseulamde cvalebadobs. boWkoebis ricxvi rom zogierT poziciaSi SesaZloa mTavari
damokidebulia kunTis zomaze da funqciaze. didi mamoZravebeli iyos simZimis Zala. aseT SemTxvevaSi,
motoruli erTeulebi, sadac erTi neironi ramdenime iqmneba paradoqsuli situacia: mTavari
aseul kunTovan boWkos amaragebs, mdebareobs tanSi mamoZravebeli, romelic moZraobaze pasuxismgeblad
da barZayis kunTebSi. TvalSi da xelis kunTebSi, iTvleba, inaqtiuria (pasiuria), xolo
sadac aucilebelia zusti moZraobebi, motoruli antigravitaciuli antagonistebis mier
erTeulebi mxolod ramdenime kunTovan boWkos regulirebuli relaqsacia (eqscentruli SekumSva)
moicavs. moZraoba (fazuri SekumSva) motoruli moZraobis aqtiuri (energiis moxmarebiT) komponentia.
erTeulebis mzardi ricxvis (romelic aWarbebs mag., sworad dgomis dros zeda kidurebis mozidva
tonusis SenarCunebisTvis saWiro dones) aqtivaciis (aduqcia) ganziduli poziciidan (tanis mimarT
Sedegia. lateralurad 900-iT ganziduli), _ am dros mTavari
mamoZravebeli (aduqtori) aris simZimis Zala;
kunTebi, romlebic am moZraobisaTvis mTavar mamoZra-
kunTebis funqciebi veblad iTvleba (mkerdis didi kunTi da zurgis
uganieresi kunTi), inaqtiuria (pasiuri). kunTi,
kunTebi asrulebs moZraobisa da sxeulis romelic am dros aqtiurad inervirdeba da
mdebareobis, poziciis specifikur funqcias. eqscentrulad ikumSeba _ deltisebri kunTia
• mTavari mamoZravebeli anu agonisti mTavari (abduqtori, romelic Cveulebriv, am moZraobis
kunTia, romelic pasuxismgebelia sxeulis antagonistad iTvleba).
garkveuli moZraobis Sesrulebaze. agonisti, kunTi, romlis gaWimva xdeba im Zvlebis RerZis
sasurveli moZraobis ganxorcielebisTvis, paralelurad, romel-sac is emagreba (mag., mxar-
koncentrulad ikumSeba, risTvisac asrulebs sxivis RerZi), araefeqtur moZraobas axorci-elebs, _
samuSaos did nawils (xarjavs did energias). kunTi moqmedebs kontaqtis SenarCunebisaTvis im
umravlesi moZraobebisTvis erTi mTavari saxsris mimarT, romelsac gadakveTs (anu
mamoZravebeli arsebobs, magram zogierTi ewinaaRmdegeba wamnacvlebel Zalebs); am tipis kunTi
moZraobebi saWiroebs or aseT mamoZra-vebels, maSuntirebeli kunTia. rac ufro iribia kunTis
romlebic Tanabrad muSaoben. gaWimvis xazi Zvlis mimarT, romelsac amoZravebs
(anu gaWimvis xazi ar aris Zvlis grZeli RerZis
• fiqsatorebi - kiduris mdgradi proqsimaluri
paraleluri. mag., mxris orTava kunTi idayvis moxris
nawilebia, romlebic izometrulad ikumSeba, roca
dros), miT ufro swrafi da efeqturia moZraoba. am
moZraoba distalur nawilebSi sruldeba.
tipis kunTi swraf, naxtomisebr moZraobas
• sinergistebi mTavari mamoZravebeli kunTis
asrulebs.
moqmedebas avseben. SesaZloa sinergisti uSualod,
pirdapir uwyobdes xels mTavar mamoZravebel
kunTs da amiT igive moZraobis ufro sust an
kunTebis nervebi da arteriebi
meqanikurad naklebad mniSvnelovan komponents
uzrunvelyofs, anda arapirdapir uwyobs xels: kunTebis inervaciis variaciebi naklebad gvxvdeba.
roca mTavari mamoZravebeli erTze met saxsars es aris TiTqmis mudmivi urTierTkavSiri. kidurSi,
moicavs, sinergisti fiqsatoris rols asrulebs. msgavsi moqmedebis kunTebi saerTo fasciur budeSia
arc Tu ise iSviaTia ramdenime sinergistis ganlagebuli da erTi da igive nervebiT inervirdeba;
monawileoba mTavari mamoZra-vebli kunTis mier amitom, Tqven unda iswavloT kiduris kunTebis
Sesrulebul konkretul moZraobaSi. inervacia, funqciuri jgufebis mixedviT da
• antagonisti kunTi meore kunTis sapirispiro daimaxsovroT mxolod gamonaklisebi. ConCxis
moqmedebas axorci-elebs. pirveladi antagonisti kunTebis nervebi (mamoZravebeli nervebi) kunTis
mTavari mamoZravlebelis sawinaaRm-degod xorcian nawilSi Sedis (myesebis sawinaaRmdegod) da
moqmedebs, magram SesaZloa sinergistebic meoradi TiTqmis yovelTvis Rrmad aris moTavsebuli (amdenad,
antago-nistebis sawinaaRmdegod moqmedebdes. roca daculia kunTiT, romlis inervaciasac axorcielebs).
moZraobis Sesasru-leblad aqtiuri ramdenime gamonaklisi miTiTebuli iqneba qvemoT.
mamoZraveblebi koncentrulad ikumSeba, antagonis- roca nervi gamWolad gaivlis kunTis xorcian
tebi SeTanxmebulad eqscentrulad ikumSeba, nawilSi an mimagrebis or Tavs Sua, es niSnavs, rom
nervi am kunTis inervacias axorcielebs.

klinikuri anatomia 22
gamonaklisia ukana (dorsaluri) totis kanis kunTis mimagreba zedmeti dagrZelebis saSualebas ar
ganStoebebi da zurgis zedapiruli kunTebi. iZleva. gamonaklisia barZayis ukana mxares mdebare
kunTebis sisxliT momarageba ar aris iseTive muxlqveSa kunTi. roca muxli gaWimulia, muxlqveSa
mudmivi, rogorc inervacia da Cveulebriv, kunTi maqsimalur sigrZes aRwevs, sanam barZayi
sxvadasxvagvaria. zogadad, arteriebi amaragebs im srulad ar moixreba. (anu moxra barZaySi
struqturebs, romelTanac kontaqts amyarebs. limitirebulia muxlqveSa kunTis dagrZelebis
amrigad, Tqven mogixdebaT moZraobis mimarTulebebis unariT). ueWvelia, rom, sxva kunTebTan SedarebiT,
swavla da logikurad mixvalT im daskvnamde, rom muxlqveSa kunTis xSiri “daWimva” (Tanmxlebi
kunTi sisxliT maragdeba mis siaxloves myofi yvela gaglejiT) ganpirobebulia rogorc zemoaRniS-nuliT,
arteriisgan. aseve eqscentruli SekumSvis ZaliT (sur. BI.6).

ConCxis kunTebis regeneracia da zrda

kunTis disfunqcia da dambla
klinikuri TvalsazrisiT, mxedvelobaSi misaRebia ConCxis ganivzoliani kunTis boWkoebi ar iyofa,
ara marto is, Tu normaSi ra funqcias asrulebs magram ConCxis kunTebis satelituri ujredebidan
kunTi, aramed romeli funqcia SeiZleba daikargos, warmoqmnili axali kunTovani boWkoebiT
Tu mocemuli kunTi ar ifunqcionirebs (dambla). SesaZlebelia maTi Canacvleba. es satelituri
rogor gamovlindeba mocemuli kunTis an kunTebis ujredebi moTavsebulia kunTovani boWkoebis
jgufis disfunqcia (romelia aSkara simptomi)? bazalur membranaze da mioblastebis (kunTovani
ujredebis winamorbedebis) potenciuri wyaroa.
kunTis tonusis dakargva saWiroebis SemTxvevaSi mioblastebs SeuZliaT
susti Zalis miuxedavad, kunTis tonuss didi erTmaneTTan Serwyma da ConCxis kunTebis axali
mniSvneloba aqvs. magaliTad, tuCebis kunTebis boWkoebis warmoqmna. warmoqmnili axali boWkoebis
tonusi kbilebs mwkrivSi akavebs. roca susti, magram raodenoba arasakmarisia kunTis mZime degeneraciis an
mudmivi wneva aRar aris (mag., damblis an mokle travmis kompensirebisTvis. efeqturi regeneraciis
tuCis dros kbilebi gaSiSvlebuli rCeba) kbilebi nacvlad, ConCxis axali kunTi Seicavs kunTovani
“migrirebs” da “gadmobrunebuli” xdeba. boWkoebis da nawiburovani qsovilis
ugono mdgomareobaSi (mag., saerTo anesTeziis dezorganizebul narevs. ConCxis kunTebi intensiuri
dros), roca kunTebis tonusi dakargulia, pacientis fizikuri datvirTvis Sedegad zomaSi matulobs.
awevam an mdgomareobis Secvlam SesaZle-belia aseTi zrda arsebuli boWkoebis hipertrofiis
saxsrebis dislokacia gamoiwvios. kunTis Sedegia, da ara axali kunTovani boWkoebis
denervaciis dros viTardeba kunTis dambla gamravlebis Sedegi. kunTovani boWkoebis
(modunebulia, ara aqvs arc tonusi da arc nebiTi an hipertrofia agrZelebs da zrdis miofibrilebs (sur.
refleqsuri fazuri SekumSvis unari). normaluri I.21), ris gamoc kunTs gacilebiT meti muSaobis
tonusis dakargvis SemTxvevaSi, sawinaaRmdego Sesruleba SeuZlia.
moqmedebis (antagonistebi) kunTebma SeiZleba kiduris
mosvenebis anormaluri pozicia ganapirobos. garda kunTis testireba
amisa, denervirebuli kunTi fibrozuli xdeba da
elastikurobas kargavs, rac aseve mosvenebis kunTis gamocdis saSualebiT eqims SeuZlia
uCveulo poziciis miRebas uwyobs xels. nervis dazianebis diagnostireba. arsebobs kunTis
kunTis tkivili da “daWimuli” kunTi gamocdis ori gavrcelebuli meTodi:
radgan eqscentruli SekumSvebis gamo SeiZleba • pacienti asrulebs moZraobebs, romlebic
moxdes ufro maRali daZabulobis generireba, Warbi ewinaaRmdegeba eqimis moZraobebs. magaliTad,
an axali amocanis SesrulebasTan dakavSirebuli pacienti xris winamxars, xolo eqimi
eqscentruli SekumSvebi kunTis tkivilis mizezi cdilobs gaaSlevinos igi. es xerxi
xdeba. magaliTad, grZel kibeze Camosvla, saSualebas aZlevs eqims gazomos pacientis
eqscentruli SekumSvebis gamo, iwvevs ufro met moZraobis Zala.
tkivils, vidre imave kibeze asvla. gagrZelebuli • eqimi asrulebs moZraobebs, romlebic
tipis eqscentruli SekumSvis dros kunTis daWimva ewinaaRmdegeba pacientis moZraobebs. wina
savaraudod, kunTSi iwvevs ufro mniSnelovan mxris moxris Sesamowmeblad, eqimi sTxovs
mikrogaglejas da/an Zvlisazrdelas gaRizianebas, pacients, moxaros winamxari da moxris
vidre Semoklebuli (koncentruli) SekumSva. procesSi eqimi ewinaaRm-degeba avadmyofis
ConCxis kunTebis dagrZelebis unari mcdelobas. Cveulebriv, Sesadareblad axdenen
limitirebulia. Cveulebriv, kunTebi mosvenebul kunTebis bilateraluri wyvilebis
mdgomareobaSi, Tanmxlebi dazianebis gareSe, Tavisi Semowmebas.
sigrZis erT mesamedze metad ar iWimeba. ConCxTan

klinikuri anatomia 23
eleqtromiografia (EMG) kunTebis Sejameba: kunTebi iyofa ConCxis ganivzolian, gulis
eleqtrostimulacia kunTis moqme-debis Semowmebis ganivzolian da gluv kunTebad. ConCxis kunTebi,
kidev erT meTodia. eqimi aTavsebs kanzeda formis mxriv, iyofa brtyel, frTisebr,
eleqtrodebs kunTze da sTxovs pacients, Seasrulos TiTistarisebr, kvadratul, irgvliv anu sfinqterul
garkveuli moZraobebi; Semdeg eqimi aZlierebs da sxva kunTebad. ConCxis kunTebi funqcionirebs
zemoqmedebas da kunTis moqmedebis SekumSviT, SesaZlebels xdis avtomatur (refleqsur)
eleqtropotencialebs Soris gansxvavebebs aRricxavs. moZraobebs, inarCunebs kunTebis tonuss (tonuri
normaSi, mosvenebuli kunTi aCvenebs mxolod sawyis SekumSva) da uzrunvelyofs fazur (aqtiur)
aqtiurobas (tonusi), romelic qreba mxolod Rrma SekumSvas, kunTis sigrZis cvlilebiT (izotonuri),
Zilis, damblis an anesTeziis dros. SekumSvis an cvlilebis gareSe (izometruli). izotonuri
procesSi kunTebi fazuri aqtiurobis sxvadasxva piks moZraobebi aris an koncentruli (moZraobis aRZvra
aCvenebs. EMG, sxvadasxva moZraobebis dros, damoklebiT) an eqscentruli (moZraoba SesaZlebelia
calkeuli kunTis aqtiurobis analizis saSualebas relaqsaciis regulirebiT). mTavari mamoZra-veblebi
iZleva. EMG SeiZleba kunTebis moqmedebis aRsadgenad anu agonistebi ZiriTadad, garkveul moZraobebzea
mimarTuli mkurnalobis programis SemuSavebaSic pasuxismebeli. fiqsatorebi kiduris erT nawils
dagvexmaros. “afiqsirebs”, roca kiduris meore nawili moZraobs.
sinergistebi mTavari mamoZravleblebis moqmedebas
aZliereben. antagonistebi sxva kunTis
sawinaaRmdegod moqmedeben.

• aRiniSneba CanarTi diskoebi - unikaluri,

gulis ganivzoliani kunTi specializebuli SeerTe-bebi bolo-bolosTan,
sadac isini jaWvad an baded aris SekavSirebuli
gulis ganivzoliani kunTi gulis kedels - gulis kunTis sxva ganStoebebTan.
miokardiums qmnis. zogjer miokardiumisTvis gulis uwyveti maRali aqtiurobis SenarCunebis
damaxasiaTebeli gulis gansakuTrebuli mizniT, gulis kunTi JangbadiT orjer ufro
ganivzoliani kunTi aortis kedelSi, filtvis venaSi mdidari sisxliT maragdeba, vidre ConCxis kunTi.
da zemo Rru venaSic aris. gulis ganivzoliani
kunTis SekumSva nebiT kontrols ar eqvemdebareba. gluvi kunTi
gulis SekumSvis sixSire regulirdeba Sida
peismeikeriT (ritmis wamyvani) - impulsis gamtari mikroskopSi gluv kunTs ara aqvs xazebi da
sistemiT, romelic specializebuli kunTovani swored aqedan momdinareobs misi saxelwodeba. gluvi
boWkoebisgan Sedgeba. gulis gamtar sistemaze, Tavis kunTi sisxlZarRvebis kedlebis Sua Sris (tunica media)
mxriv, gavlenas axdens antonomiuri nervuli sistema, did nawils qmnis (sur. I. .23 da cxrili I. 1). aqedan
romelic ganxilulia qvemoT. mikroskopSi gulis gamomdinare, gluvi kunTi warmodgenilia yvela
ganivzoliani kunTs mkafio xazebi etyoba. (cxrili vaskularul qsovilSi. gluvi kunTisgan Sedgeba
I.1). ganivzoliani kunTis orive tipi _ ConCxis kunTi agreTve, saWmlis momnelebeli traqtisa da
da gulis kunTi _ SekumSvis operatiulobiT, sadinarebis kedlebi. kanSi gluvi kunTi qmnis Tmis
siswrafiTa da ZaliT xasiaTdeba. marTalia, es gammarTvel kunTs, romelic dakavSirebulia Tmis
Taviseburebebi axasiaTebs rogorc ConCxis kunTs, folikulasTan (sur. I.6); gluvi kunTi Tvalis
aseve gulis kunTs, magram mainc, farTod kakalSi akontrolebs Tvalis brolis sisqes da
gamoyenebuli terminebi “zoliani” an “daxazuli” gugis zomas.
aRniSnavs ConCxis ganivzolian nebiT kunTs. gulis ganivzoliani kunTis msgavsad, gluvi kunTi
uneblie kunTia. miuxedavad amisa, pirdapir
gulis kunTi gansxvavdeba ConCxis kunTisgan inervirdeba avtonomiuri nervuli sistemiT. misi
rogorc moqmedebiT, aseve garegnuli formiT. ConCxis SekumSvis inicireba SesaZlebelia hormonaluri
kunTovani boWkoebisgan gansxvavebiT, gulis stimulaciiT an lokaluri stimuliT. gluvi kunTi
kunTovani boWkoebi: gaRizianebas gacilebiT nela pasuxobs _
Seyovnebulad da ufro neli SekumSviT. gluvi kunTi
• spontanurad da riTmulad ikumSeba (ar SeiZ-leba nawilobriv SekumSul mdgomareobaSi iyos
saWiroebs gareSe stimuls). xangrZlivi periodis manZilze da, ganivzolian
• ganStoebulia (gayofilia an datotvili) kunTTan SedarebiT, dazianebis gareSe, dagrZelebis
meti unari gaaCnia. orive es faqtori metad

klinikuri anatomia 24
mniSvnelovania sfinqterebis zomisa da tubularuli gulis kunTis hipertrofia da hiperplazia
(milakovani) struqturebis Sida sivrceebis
diametris regulaciisTvis. saWmlis momnelebel gazrdil moTxovnebs gluvkunTovani qsovilis
traqtSi, falopis lulaSi da SardsawveTSi, gluvi ujredebi hipertrofiiT pasuxobs. orsulobis dros,
kunTebi pasuxismgebelia peristaltikaze, riTmul saSvilosnos kedlis gluvkunTovani ujredebi ara
SekumSvebze, romlebic gadaadgilebs milako-vani marto zomaSi matulobs, aramed maTi ricxvic
struqturebis SigTavss. izrdeba (hiperplazia), radgan am ujredebs gayofis
unari SenarCunebuli aqvs. garda amisa, gluvi kunTis
axali ujredebi SeiZleba ganviTardes ujredebidan,
miokardiumis hipertrofia da miokardis romlebic bolomde ar aris diferencirebuli
infarqti (pericitebi) da ganlagebulia mcire zomis
sisxlZarRvebis gayolebiT (Cormark, 2001).
gazrdili moTxovnebis sapasuxod, miokardiumi
reagirebs kompensa-toruli hipertrofiiT - Sejameba: gulis kunTi gansakuTrebuli ganivzoliani
boWkoebis zomis matebiT. sisxliT momaragebis kunTia, romelic qmnis miokardiums da nawilobriv,
darRvevis dros ziandeba gulis ganivzoliani zogierT mTavar sisxlZarRvs. gulis kunTis SekumSva
kunTovani boWkoebi da qsovili nekrozdeba (kvdeba); nebas ar emorCileba; gulis riTmis wamyvani
viTardeba miokardiumis infarqti. nekro-zuli peismekeria, romelic avtonomiuri nervuli sistemiT
qsovils Caenacvleba fibrozuli nawiburovani regulirdeba. gluv kunTs ara aqvs xazebi. gluvi
qsovili. danekro-zebuli kunTovani ujredebis kunTi gvxvdeba yvela vaskularul qsovilSi, saWmlis
ganaxleba ar xdeba, radgan gulis kunTo-vani momnelebeli traqtisa da sxva Sinagani organoebis
ujredebi ar iyofa. garda amisa, gulis kunTSi ar kedlebSi. gluvi kunTi uSualod inervirdeba
aris ConCxis kunTisTvis damaxasiaTebeli avtonomiuri nervuli sistemiT da aqedan
satelituri ujredebis analogi, romelic gulis gamomdinare, nebas ar eqvemdebareba.
kunTis axali boWkoebis warmoqmnas SeZlebda.

gulsisxlZarRvTa sistema

mxriv ixsnebian did venebSi. udidesi venebia zeda da

organizmSi siTxis transports uzrunvelyofs qveda Rru venebi, romlebic abruneben JangbadiT
cirkulaciuri sistema. igi Sedgeba Rarib sisxls gulSi.
gulsisxlZarRvTa da limfuri sistemebisagan. guli cirkulaciuri sistemis sisxlZarRvebis
da sisxlZarRvebi warmoqmnian sisxlis satransporto umetesobas gaaCniaT sami garsi anu Sre (tunica)
qsels – gulsisxlZarRvTa sistemas. (sur 1.22). guli • tunica intima – SigniTa Sre, intima - igi
organizmSi sisxls gadatumbavs sisxlZarRvebis uxvi sisxlZarRvs amofens Signidan, Sedgeba erT Sred
qselis meSveobiT. sisxls ujredebTan miaqvs sakvebi ganlagebuli gabrtyelebuli ujredebisagan –
nivTierebebi, mineralebi, Jangbadi, da sxva endoTeliumisagan. endoTeliumi ganlagebulia Txel
substanciebi da gamoaqvs maTgan cxovelmyofelobis SemaerTebel qsovilovan firfitaze (bazaluri
produqtebi. arsebobs sisxlZarRvebis sami tipi: membrana). Kapilarebis kedeli Sedgeba mxolod am
arteriebi, venebi da kapilarebi. sisxli didi wneviT garsisagan. isini aseve Seicaven kargad gamoxatul
gamodis gulidan da sxeulSi nawildeba bazalur membranas.
sqelkedliani datotvili arteriebis meSveobiT. • Tunica media – Sua Sre, romelic ZiriTadad
saboloo gamanawilebeli sisxlZarRvebidan, Sedgeba gluvkunTovani ujredebisagan.
arteriolebidan, JangbadiT mdidari sisxli gadadis • Tunica adventitia – sisxlZarRvis gareTa
kapilarebSi. Kkapilarebi warmoqnian kapilarul SemaerTebelqsovilovani Sre anu garsi
qsels sadac xdeba ujredgare siTxesTan sxvadasxva yvelaze variabeluria Sua Sre. arteriebi,
nivTierebebis mimocvla (Jangbadi, mineralebi, sakvebi venebi da limfuri sadinrebi erTmaneTisagan
nivTierebebi, cxobelmyofelobis produqtebi da ganirCeva swored am Sris sisqis da organizaciis
sxva). kapilaebidan sisxli gadadis Txelkedlian mixedviT. arteriebis SemTxvevaSi Sua SreSi aseve
venulebSi, romlebic gavs ganier kapilarebs. gvxvdeba sxvadasxva raodenobiT elastiuri boWkoebi.
venulebi Caedineba mcire venebSi romlebic Tavis

klinikuri anatomia 25
 arteriebi mdgomareobis, paTologiis an qirurgiuli ligirebis
arteriebs gamoaqvT sisxli gulidan da Semdeg. Tu sisxlis mimoqcevis mTavari arxi
anawilebs mTel sxeulSi. sisxli miedineba klebadi daxSulia, maSin mcire alternatiuli sisxZarRvebi
diametris arteriebSi. sxvadasxva saxis arteriebi swrafad ganicdian zomaSi zrdas, es uzrunvelyofs
erTmeneTisagan ganirCeva zomiT, Sua SreSi kolateraluri sisxlis mimoqcevis ganviTarebas da
elastikuri boWkoebisa da gluvkunTovani ujredebis blokirebis adgilidan distalurad ganlagebuli
raodenobis da Tanafardobis mixedviT, kedlis struqturebis sisxlis mimoqcevis gaumjobesebas.
SefardebiTi sisqiT arteriis sanaTurTan, da Tumca adeqvaturi kolateraluri sisxlis mimoqcevis
funqciiT. arteriis zoma da tipi icvleba ganviTarebas sWirdeba gansazRvruli dro, amitom
TandaTanobiT – gulidan – periferiis mimarTulebiT. uecari okluziiis an ligirebis SemTxvevaSi igi
arsebobs sami tipis arteria arasakmarisia. aris ubnebi, sadac kolateraluri
sisxlis mimoqceva ar arsebobs, an igi arasakmarisia
• didi elastiuri arteriebi – (gamtari
mTavari, normaSi arsebuli sisxlZarRvebis
arteriebi) maT kedelSi gaaCniaT didi raodenobiT
Casanacvleblad. arteriebs, romelnic ar warmoqmnian
elastiuri boWkoebi. es arteriebi uSualod gamodian
anastomozebs mimdebare arteriebTan, ewodebaT
gulidan. elastiuroba maT saSualebas aZlevT
anatomiuri anu WeSmartad terminaluri anu saboloo
gafarTovdnen gulis SekumSvis dros (roca maTSi
arteriebi. aseTi arteriebis okluzia iwvevs sisxlis
gadadis gulidan gadmosrolili sisxli). es
miwodebis Sewyvetas organos im struqturaSi an
arteriebSi wnevis cvlilebis minimizaciis
segmentSi, romelsac isini kvebaven. magaliTisaTvis,
saSualebas iZleva. elastiuri arteriebi
WeSmaritad terminaluri arteria kvebavs baduras,
ubrundebian normalur zomas gulis modunebis dros
amitom misi okluzia iwvevs sibrmaves. araWeSmariti
da gadaisvrian sisxls saSualo zomis arteriebSi.
terminaluri arteriebi anu funqciuri terminaluri
es Tviseba saSualebas iZleva gulis SekumSvaTa
arteriebi (arasakmarisi kolateralebis mqone
Soris periodSi (roca parkuWebSi wneva nulamde
ateriebi) kvebaven tvinis segmentebs, RviZlsTirkmels,
ecema) arteriul sistemaSi SenarCundes wneva. didi
elenTas da nawlavebs. isini SesaZloa iyos aseve
elastiuri sisxlZarRvebis nimuSs warmoadgens
gulSi.
aorta, aortis rkalidan gamosuli arteriebi (mxar-
Tavis Rero, laviwqveSa da saZile arteriebi) da
filtvis Rero da misi arteriebi aTerosklerozi: iSemia da infarqti
• saSualo kunTovani arteriebi
(gamanawilebeli arteriebi) – maTi kedeli ZiriTadad ganviTarebad qveynebSi aTerosklerozi
Sedgeba cirkularulad ganlagebuli gluvkunTovani (arteriebis gamkvriveba) warmoadgens arteriebis
ujredebisagan. am arteriebs aqvT unari Seamciron yvelaze xSir daavadebas da aseve sisxlZarRvebis
TavianTi diametric (vazokonstriqcia). am unaris uxSires paTologiur process, romelsac vnaxulobT
meSveiobiT isini aregulireben sisxlis miwodebas gvamis gakveTis dros. aTerosklerozi warmoadgens
sxeulis sxvadasxva nawilebSi, maTi moTxovnis daavdebaTa jgufs, romlisaTvisac damaxasiaTebelia
mixedviT (mag. aqtioba, Termoregulacia). saxelebis arteriis kedlis gasqeleba da elastiurobis
mqone arteriebis umetesoba, maT Soris isini dakargva. aTerosklerozis dros uxSiresad arteriis
romelTa naxva SesaZlebelia gakveTis dros kedelSi grovdeba cximi (ZiriTadad qolesteroli).
(magaliTad. beWis, mxris arteria) warmoadgenen kalciumis Calageba iwvevs aTeromatozuli folaqis
saSualo zomis kunTovani tipis arteriebs (aTeromis) Camoyalibebas. igi warmoadgens kargad
• patara arteriebi da arteriolebi – maT SemosazRvrul, gamkvrivebul moyviTalo ubnebs an
gaaCniaT SedarebiT viwri sanaTuri da sqeli SeSupebebs arteriis SigniTa zedapirze. (sur BI.7A).
kunTovani kedeli. kapilarebis avsebis xarisxi da SemdgomSi viTardeba arteriebis Seviwroba da
arteriuli wneva ZiriTadad regulirdeba zedapiris dazianeba, rac iwvevs Trombozs
arteriolebis kedelSi arsebuli gluvkunTovani (lokaluri sisxlZarRvSida Sededeba). Trombozis
ujredebis tonusiT. Tu tonusi normaze maRalia, Sedegad SeiZleba daixSos arteriis sanaTuri an
maSin adgili aqvs hipertenzias. mcire sisxlZarRvebi Trombi gadavides sisxlis dinebaSi da distalurad
ZiriTadad ar atareben raime saxels da maTi ganlagebul wvril arteriebSi gamoiwvios okluzia
identifikacia gakveTis dros ar xdeba. (sur BI.7B).. aTerosklerozis Sedegad yalibdeba
arteriolebis danaxva SesaZlebelia mxolod iSemia (organoSi an regionSi sisxlis mimoqcevis
gadidebis pirobebSi. Semcireba) da infarqti (Semcirebuli sisxlis
anastomozebi (komunikacia, kavSiri) mimoqcevis Sedegad ganviTarebuli organos an
ganlagebulni arian arteriebis totebs Soris. isini qsovilis gansazrvruli farTobis nekrozi, anu
warmoadgenen potenciur SemovliT gzas sisxlis lokaluri sikvdili). es metad mniSvnelovania gulis
mimoqceviaTvis im SemTxvevebSi, roca normaSi (gulis iSemiuri daavadeba da miokardiumis
arsebuli sisxZarRvebi daxSulia kompresiis, saxsris infarqti), tvinis (insulti) da qveda kidurebis
distaluri nawilebis (gangrena) SemTxvevaSi.

klinikuri anatomia 26
 venebi
zogadad venebSi xdeba JangbadiT Raribi datotvili qselis saxiT (sur 1.24). aseTi ganlageba
sisxlis (venuri sisxlis) transportireba gulSi. xels uwyobs arteriebidan siTbos gadasvlas venebSi
amis Sedegd venebs aqvT muqi lurji Seferiloba. da civi kidurebidan gulisaken mimdinare SedarebiT
didi zomis filtvis venebi gamonakliss warmoadgens, dabali temperaturis mqone sisxlis gaTbobas.
radgan masSi gadis JangbadiT mdidari sisxli Tanmxlebi venebi ganlagebulia arteriis garSemo
(Cveulebriv mas ewodeba arteriuli sisxli), arsebul SedarebiT mkvirv (aradrekad) fasciaSi
romelic filtvidan Caedineba gulSi. radgan venur (vaskularul SaliTaSi), amitom gulis SekumSvis
sistemaSi wneva dabalia, amitom venebis kedeli dros arteriis gadabervis Sedegad isini
(gansakuTrebiT Sua Sre) ufro Txelia vidre misi brtyeldebian, rac iwvevs venebSi sisxlis moZraobas
Tanmxlebi arteriebis (sur 1.23). normaSi venebi ar periferiidan gulisaken – egreTwodebuli
pulsireben da dazianebis dros maTgan sisxli arteriovenuri tumbo.
Zlieri nakadiT ar moedineba. arsebobs sami saxis sistemuri venebi ufro variabeluria, vide
venebi: arteriebi. venozuri anastomozebi, rogorc
• venulebi warmoadgenen umciresi zomis venebs. pirdapiri, aseve arapirdapiri, maTSi ufro xSirad
venulebs sisxli gamoaqvT kapilarebidan da gvxvdeba. qveda kidurebis kunTebi, romelTa muclebi
erTmaneTTan SeerTebis Sedegad warmoqmnian wvril ganzidulia gareT da SemosazRvrulia Rrma fasciiT,
venebs. venulebi SeuiaraRebeli TvaliT ar Cans. iwveven venebis kompresias, ris Sedegadac maTSi xdeba
wvrili venebi SeerTebis Semdeg warmoqmnian ufro sisxlis gadaadgileba periferiidan gulisaken. es
msxvil venebs da venozur qselebs, iseTs rogoricaa efeqti kidev erT venur tumbos warmoadgens
magaliTad terfis venuri rkali (sur 1.22). mcire (kunTovan venuri) (sur 1.25). venebSi arsebuli
venebs saxeli ar aqvT. sarqvelebi sisxlis nakads yofen nawilebad da
• saSualo venebs sisxli gamoaqvT venuri aregulireben masSi wnevas, rac uzrunvelyofs
qselebidan. isini misdeven Tanmxleb arteriebs. qveda sisxlis mxolod erTi – periferiidan gulisaken –
kidurebze da zogierT sxva adgilebSi, sadac mimarTulebiT dinebas. venuri Segubeba, romelic
sisxlis dinebas gravitaciis sapirispiro qveda kidurebze gamoixateba simxurvalis da
mimarTuleba gaaCnia, saSualo venebs aqvT sarqvelebi, daRlilobis SegrZnebiT da rac didxans fexze
romlebic saSualebas iZleva sisxlma idinos gulis dgomis Sedegia, SeiZleba moixsnas sxeulis doneze
mimarTulebiT da ara piriqiT. saSualo venebis maRla fexebis aweviT. aseTi pozicia exmareba
magaliTs warmoadgens dasaxelebis mqone zedapiruli venebidan gulisaken sisxlis ukeT midinebas.
venebi da arteriis Tanmxlebi venebi, romelTa
saxelebic Sesabamisi arteriebis identuria. varikozuli venebi
• didi venebisaTvis damaxasiaTebelia roca venebis kedlebi kargaven Tavis
gluvkunTovani farTo, sigrZivi boWkoebis da kargad elastiurobas, isini sustdebian. venebis susti
ganviTarebuli adventiciis arseboba. magaliTs kedlebi ganicdis dilatacias sisxlis svetis
warmoadgens zeda Rru vena. gravitaciuli wnevis gamo. Sedegad yalibdeba
venebi ufro meti raodenobiTaa warmodgenili, varikozuli venebi – Sesiebuli, daklaknili venebi,
vidre arteriebi. venebis Txeli kedlebi maTi didi romlebic yvelaze xSirad gvxvdeba qveda kidurebze.
xarisxiT gafarToebis saSualebas iZleva, rac (sur b1.8). varikozuli venebis diametric normasTan
mniSvnelovania maSin, roca gulisken mimavali SedarebiT ufro didia. maTi sarqvlis sagdulebi
sisxlis dinebas xels uSlis garegani an Sinagani erTmaneTs ar xvdeba an dazianebulia anTebis
faqtori (zewola) (mag. Rrma CasunTqvis Semdeg Sedegad. aseT venebs gaaCniaT sarqvlebis ukmarisoba,
sunTqvis SeCerebis dros e.w valsalvis cda). radgan ris gamoc gulis mimarTulebiT mimdinare sisxlis
venebi da arteriebi warmoqmnian wres, amitom nakadi erTiania, rac iwvevs wnevis gazrdas venebSi
mosalodnelia vifiqroT, rom sisxlis mTeli da Sedegad sxvadasxva garTulebebis ganviTarebas.
moculobis naxevari ganlagebuli unda iyos varikozuli venebi aseve viTardeba Rrma fasciis
arteriebSi da naxevaric venebSi, magram radgan degeneraciis dros. gadagvarebuli fascia ver
venebis diametri ateriebTan SedarebiT ufro didia uzrunvelyofs kunTis SekumSvis dros venaze
da maT aqvT gafarToebis ufro meti SesaZlebloba, zewolis gadacemas da Sedegad kunTovan-venuri
amitom arteriebSi cirkulirebs sisxlis mxolod tumbo (kunTovanfasciuri) araefeqturia.
20%, danarCeni 80% ki - venebSi.
xSirad simartivisaTvis venebs gamosaxaven
erTi sisxlZarRvis saxiT, sinamdvileSi maTi sisxlis kapilarebi
umetesoba ori an mravlobiTia. isini romlebic Tan artriebSi sisxli mdidaria JangbadiT da
axlavs Rrma arteriebs - Tanmxlebi venebi (L.venae sakvebi nivTierebebiT, romlebic aucilebelia
comitantes) – SemosazRvraven maT araregularuli, ujredebis, qsovilebis da Sesabamisad organizmis

klinikuri anatomia 27
normaluri cxovelmyofelobisaTvis. Jangbadi da nawilSi xdeba ujredSorisi sivrcidan JangbadiT
sakvebi nivTierebebi sisxlZarRvidan unda gadavides Raribi da naxSirorJangiTa da cxovelmyofelobis
ujredSoris sivrceSi. swored kapilarebSi, produqtebT mdidari siTxis gadasvla ukan sisxlSi
romlebic warmoadgenen martiv endoTelialur (starlingis hipoTeza).
milakebs da erTmaneTTan aerTeben arteriebsa da zogierT midamoSi, magaliTad TiTebSi,
venebs, xdeba nivTierebaTa cvla sisxlsa da arsebobs pirdapiri kavSiri arteriolebsa da
ujredSoris nivTierebas Soris. kapilarebi qmnian venulebs Soris, maT mier momaragebuli kapilaruli
kapilarul kalapots, qsels, romelic aerTebs qselis proqsimalurad. aseTi saxis kavSirebs
venebsa da arteriebs. (sur 1.23). sisxli kaplarebSi ewodebaT arteriovenuri anastomozebi (Suntebi). maTi
gadadis arteriolebidan, romlebic aregulireben meSveobiT SesaZlebelia sisxlis moxvedra
wnevas da Semdgom Caedineba venebSi. arteriolebSi arteriidan pirdapir venaSi kapilarebis gverdis
arsebuli hidrostatikuri wneva aramarto gadadevnis avliT. arteriovenuri anastomozebi didi
sisxls kapilarebSi, aramed igive wnevis gradienti raodenobiT gvxvdeba kanSi, sadac isini mniSvnelovan
iwvevs JangbadiTa da sakvebi nivTierebebiT mdidari rols asruleben sxeulis siTbos SenarCunebaSi.
siTxis gadasvlas sisxlidan qsovilSi. es ZiriTadad zogierT situaciaSi sisxli gulSi
xdeba kapilarebis arteriul nawilSi. Tumca unda dabrunebamde gaivlis or kapilarul qsels (mag.
aRiniSnos, rom kapilaris kedeli SedarebiT portuli venis sistemaSi). sakvebi nivTierebebiT
gaumtaria plazmis cilebis mimarT. Sedegad mdidari sisxli gaivlis ra saWmlis momnelebeli
kapilaruli kalapotis bolos, venulebis siaxloves traqtis kapilarul qsels, karis venis meSveobiT
sisxlSi maRalia plazmis cilebis koncentracia da xvdeba RviZlis sinusoidur kapilarebis qselSi –
Sesabamisad osmosuri wnevac, amitom kapilarebis am RviZlis portul sistemaSi. (Tavi 2)

Sejameba: kardiovaskuluri sistema Sedgeba gulisa da sisxlZarRvebisagan “arteriebi, venebi da

kapilarebi”. maT aqvT garsebi – SigniTa Sre (intima), Sua Sre (media) da gareTa Sre (adventicia). arteriebis
kedelSi ari rogorc elastiuri, aseve kunTovani boWkoebi, romlebic mas sisxlis mimoqcevis funqciis
ganxorcielebis saSualebas aZleven. venebs gaaCniaT ufro Txeli kedeli, vidre arteriebs da ganirCevian
misgan sarqvlebiT, romlebic uzrunvelyofen sisxlis erTi mimarTulebiT dinebas. kapilarebi uwvrilesi
sisxlZarRvebia, romlebic erTmaneTTan akavSireben umcires arteriebs (arteriolebs) da venebs (venulebs).

limfuri sistema aseve uzrunvelyofs ujredebis daSlisa da

infeqciis Semdgom qsovilSi darCenili nawilakebis
eliminacias (moSorebas). limfuri sistemis
miuxedavad imisa rom limfuri sistema mniSvnelovan komponentebs warmoadgens (sur 1.26):
farTodaa ganawilebuli mTels organizmSi, gvamis • limfuri wnuli, limfuri kapilarebis qseli,
gakveTis dros mis umetesi nawilis naxva romlebic brmad iwyeba sxvadasxva qsovilis
SeuZlebelia. klinicistebisaTvis mniSvnelovania ujredSorisi sivrcidan. radganac limfuri
limfuri sistemis anatomiis codna. starlingis kapilarebi Sedgebian gaTxelebuli endoTeluri
hipoTeza xsnis Tu rogor brundeba kvlav sisxlis ujredebisagan da ar gaaCniaT bazaluri membrana,
mimoqcevaSi kapilarebidan gadasuli nivTierebebis amitom siTxes, plazmis maRalmolekulur cilebs,
umetesi nawili, Tumca yoveldRiurad daaxloebiT 3 baqteriebisa da ujrdebis nawilakebs da zogjer
litramde siTxis reabrsobcia ar xdeba. ufro metic, mTlianad ujredebsac (gansakuTrebiT limfocitebs)
zogierTi plazmis cila Jonavs ujredSoris Tavisuflad SeuZliaT maTSi gadasvla.
sivrceSi, aseve yoveldRiurad qsovilebSi grovdeba • limfuri ZarRvebi (Lymphatics) - isini
sxvadasxva makromelekula, romelTac ar SeuZliaT gavrcelebulia mTel organizmSi. limfuri ZarRvebi
gadalaxon kapilaruli barieri. Tu es nivTierebebi warmoadgenen Txelkedlian milebs, didi raodenobiT
dagrovdeboda ujredSoris sivceSi, maSin limfuri sarqvlebiT. cocxal organizmSi limfur
Seicvleboda osmosuri wnevis gradienti da ZarRvebs aqvT buStukovani agebuleba, rac maT
Camoyalibdeboda SeSupeba. nomalur pirobebSi daklaknil Sesaxedaobas aZlevs. limfuri kapilarebi
ujredSorisi sivrcis cilovani Semadgenloba da da ZarRvebi yvelganaa nanaxi iq sadac kapilarebi
osmosuri wneva ucvlelia, rasac uzrunvelyofs arsebobs, Tumca gamonaklisis saxiT isini ar
swored limfuri sistema. gvxvdeba kbilSi, ZvalSi, Zvlis tvinSi, da
limfuri sistema uzrunvelyofs ujredSorisi centralur nervul sistemaSi (cns-Si zedmeti
nivTierebidan narCeni cilebisa da siTxis gamotanas qsivilovani siTxe Cadis zurgtvinis siTxeSi).
da sisxlis mimoqcevaSi dabrunebas. limfuri sistema

klinikuri anatomia 28
 • limfa (laT. naTeli wyali) – aris mxolod droebiT aCerebs. limfis drenirebis axali
qsovilovani siTxe, romelic Cadis limfur gzebi maleve warmoiqmneba jer ufro periferiulad
kapilarebSi da gadaadgildeba limfuri ZarRvebis ganlagebul limfur-venuri, xolo Semdgom limfur
meSveobiT. Cveulebriv is aris gamWirvale, sadinrebs Soris arsebuli anastomozebis
wyliseburi da moyviTalo feris. SemadgenlobiT saSualebiT.
limfa sisxlis plazmis msgavsia.
• limfuri kvanZi – limfoiduri qsovilis limfuri sitemis sxva funqciebs miekuTvneba:
mcire masebi ganlagebulia limfuri sadinrebis • sakvebiT miRebuli cximis absorbcia da
gaswvriv. maTSi xdeba limfis filtracia transporti. specialur limfur kapilarebSi,
• limfocitebi imunuri sistemis mocirkulire romelTac ewoebaT laqtealebi, gadadis nawlavebis
ujredebia. isini reagireben ucxo sxeulebze mier absorbirebuli lipidebi da cximSi xsnadi
• limfoiduri qsovili warmoadgens adgils vitaminebi. visceraluri limfuri sadinrebiT
sadac xdeba limfocitebis produqcia. magaliTad rZiseburi siTxe, qilusi, gadadis gulmkerdis
isini moTavsebulia saWmlis momnelebeli traqtis sadinarSi da SemdgomSi Caedineba venaSi.
kedlebSi, elenTaSi, TimusSi da limfur kvanZebSi, • organizmis dacviTi meqanimis formireba.
aseve Zvlis wiTeli tvinis mieloidur qsovilSi. rodesac inficirebuli aridan ucxo cilebi gadadis
zedapiruli limfuri sadinrebi kanSi ufro limfaSi, am cilebis mimarT specifikuri
xSir qsels warmoqmnis, vidre venebi. maT Soris antisxeulebi warmoiqmneba imunokompetentur
arsebobs mravalricxovani anastomozebi. limfuri ujredebSi da/an limfocitebSi da gadaecema
sadinrebi miyveba venebs. es sadinrebi uerTdebian inficirebis adgils.
ufro didi zomis Rrma limfur sadinrebs, romlebic
miyvebian arteriebs. Rrma limfur sadinrebSi limfa kibos gavrceleba
aseve Cadis Sinagani organoebidan. sarwmunoa is kibo sxeulSi vrceldeba invaziis (mimdebare
mosazreba rom Rrma limfuri sadinrebi ganicdian qsovilSi Cazrda) da metastazirebis (simsivnuri
arteriebis zemoqmedebas adre aRwerili Tanmxlebi ujredebis diseminacia simsivnis pirveladi keridan
venebis msgavsad, rac uzrunvelyofs limfis dinebas. moSorebul adgilas) gziT. metastazebi warmoiqmneba
rogorc zedapiruli, aseve Rrma limfuri sadinrebi sami gziT:
ramdenime adgilas gaivlian limfur kvanZebs, • sxeulis Rruebis serozuli garsebis
uerTdebian mezobeli regionebis limfur sadinrebs (membranebis) pirdapiri moTesviT
da Sedegad qmnian ufro didi zomis sadinrebs. didi • limfogenuri gavrcelebiT (limfuri
zomis limfuri sadinrebi Cadian koleqtorul sadinrebis meSveobiT)
limfur ZarRvebSi, romelTac ewodeba limfuri
• hematogenuri gavrceleba (sisxlZarRvebis
Rero. limfuri Reroebis gaerTianebiT miiReba
meSveobiT)
rogorc marjvena aseve gulmkerdis limfuri
sadinrebi. (sur 1.26):
sakvirvelia, rom xSirad Txeli fascia an
• marjvena limfur sadinarSi limfa Cadis serozuli membrana xels uSlis simsivnis invazias,
sxeulis marjvena zeda kvadrantidan (Tavis, kisris magram Tu avTvisebiani simsivne penetrirebs invaziis
da gulmkerdis marjvena nawili, aseve marjvena zeda potenciur sivrceSi, xdeba Rruebis pirdapiri
kiduri). kiserSi isini Caedineba marjvena Sida moTesva. gavrcelebis limfogenuri gza yvelaze
sauRle da marjvena laviwqveSa venebis SeerTebis xSiria karcinomebis (epiTeluri simsivneebi, kibos
adgilze, romelsac ewodeba marvena venuri kuTxe. uxSiresi tipi) metastazuri diseminaciis dros.
• gulmkerdis sadinari krebs limfas sxeulis pirvelad simsivnes mowyvetili ujredebi Sedian da
danarCeni nawilebidan. limfuri Reroebi, romlebsac moZraoben limfuri sadinrebis saSualebiT. maTSi
limfa gamoaqvT sxeulis qveda nawilebidan, arsebuli ujredebis nawili ganicdis filtracias
erTmaneTs uerTdebian muclis RruSi, zogjer da rCeba limfur jirkvlebSi, ris Sedegadac
warmoqmnian dilatirebul CanTas, e.w. wrbolis warmoiqmneba kibos meoradi kerebi (metastazebi).
cisternas (L. cistern chyli). am CanTidan (Tu is arsebobs), limfuri jirkvlebis dazianebis kerebi miyveba
an gaerTianebuli Rerodan gulmkerdis sadinari limfuri drenaJis bunebriv gzas. amitom roca xdeba
gaivlis gulmkerds da Cadis marcxena venur kuTxeSi potenciurad metastazirebadi simsivnis amokveTa,
(marcxena Sida sauRle da marcxena laviwqveSa qirurgebi daavadebis stadiis dadgenas axdenen am
arteriis SeerTebis adgili). organodan an midamodan gamomavali limfuri
miuxedavad imisa rom limfis umetesi nawili sadinrebisa da kvanZebis amokveTis da gamokvlevis
sisxls ubrundeba zemoTmoyvanili gziT, limfuri Sedegebis safuZvelze. aqedan gamomdinare
sadinrebis garkveuli nawili Caedineba sxva venebSi. klinicistebisaTvis mniSvnelovania limfuri sistemis
aqedan gamomdinare limfuri Reros an TviT codna. es daexmareba praqtikos eqims daadginos
gulmkerdis sadinris ligireba limfis dinebas garkveuli organodan an regionidan limfur

klinikuri anatomia 29
kvanZebSi simsivnis metastazirebis SesaZlo gzebi an limfuri kvanZebi diddeba da xdeba ufro
limfur kvanZebSi nanaxi metastazebis meSveobiT mtkivneuli. es potenciurad saSiSia, radgan aseT
daadginos pirveladi keris lokalizacia. SemTxvevebSi SeiZleba ganviTardes septicemia
metastazirebuli limfuri kvanZebi (sisxlis mowamlva). limfedema (anu SeSupeba)
(kanceromatozuli kvanZebi) izrdeba zomaSi simsivnis warmoadgens intersticiuli siTxis lokalur
zrdasTan erTad, Tumca inficirebuli, SeSupebuli dagrovebas. igi warmoiSveba rodesac limfa ar
kvanZebisagan gansxvavebiT zewolis dros isini drenirebs sxeulis romelime nawilidan. magaliTad,
umtkivneuloa. Tu kanceromatozuli limfuri kvanZi qirurgiulad
metastazirebis hematogenuri gza ufro amoRebuli iqneba iRliis fosodan, maSin viTardeba
damaxasiaTebelia naklebad gavrcelebuli (magram zeda kiduris limfedema. ujredebis zrdam SeiZleba
ufro avTvisebiani) sismsivneebisaTvis – daazianos limfuri sadinrebi da warmoqmnas mcire
sarkomebisaTvis (SemaerTebeli qsovilis simsivne). zomis ujreduli emboliebi. isini SeiZleba mowydes
radgan venebi ufro meti raodenobiTaa da maT aqvT da gadavides regionul limfur kvanZebSi. am dros
ufro Txeli kedeli, metastazebis gavrceleba ufro simsivne SeiZleba gavrceldes sxva qsovilebsa da
xSiria venebis meSveobiT, vidre arteriebis gziT. organoebSi.
sisxlSi gadasuli simsivnuri ujredebi miyveba
venuri sisxlis dinebas, amitom sarkomebis dros
metastazirebis uxSires adgils warmoadgens
filtvebi da RviZli. zogadad sismsivnis pirveladi
kerebis amokveTa da mkurnaloba rTuli ar aris,
magram yvela dazianebuli limfuri kvaZis da
meoradi (metastazirebadi) simsivneebis sruli
mocileba TiTqmis SeuZlebelia. (Cotran et al. 1999). Sejameba
limfur sistemas gadaaqvs zedmeti
limfangiti, limfadeniti da limfedema ujredSorisi siTxe sisxlis mimoqcevaSi, igi aseve
asrulebs organizmis dacviT funqcias. limfuri
limfangiti da limfadeniti Sesabamisad sistemis mniSvnelovan komponentebs warmoadgens
warmoadgens limfuri sadinrebis da limfuri limfuri kapilarebis qseli, limfuri wnuli,
kvanZebis meorad anTebas. aRniSnuli paTologiuri limfuri sadinrebi, limfa, limfuri kvanZebi,
mdgomareoba viTardeba maSin, roca mwvave qimiuri an limfocitebi da limfoiduri qsovili. limfuri
baqteriuli anTebis Sedegad procesSi CaerTveba sistema warmoqmnis gansazRvruli tipis simsivnuri
limfuri sistema. aseT SemTxvevebSi limfuri ujredebis gavrcelebis da metastazirebis savaraudo
sadinrebi, romlebic normaSi TvaliT uxilavia, kanze gzas. limfuri sadinrebis anTeba warmoadgens
gamovlindebian wiTeli zolebis saxiT, xolo dazianebis an anTebis mniSvnelovan macnes.

nervuli sistema • nervuli sistemis struqturul da funqciur

erTeuls warmoadgens neironi (sur. I.27). neironi
Sedgeba ujredis sxeulisagan da morCebisagan
nervuli sitema saSualebas aZlevs organizms (wanazardebi). es ukanasknelni ori saxisaa – aqsonebi
upasuxos Sinagani da garegani garemos cvlilebebs. da dendritebi. maT gadaaqvT nervuli impulsi
igi aseve akontrolebs da aregulirebs sxeulis rogorc neironis sxeulis mimarTulebiT (aqsonebi)
sxvadasxva aqtiobas, magaliTad sisxlis mimoqcevas aseve piruku (dendritebi). mielini (lipiduri
da sunTqvas. aRwerilobis gaadvilebis mizniT nivTiereba) da sxvadasxva cila zogierTi aqsonis
nervul sistemas yofen: garSemo warmoqmnis mielinis garss. igi
• struqturulad – centraluri nervuli mniSvnelovnad zrdis aqsonSi nervuli impulsis
sistema (cns) da periferiuli nervuli sistema (pns) gadacemis siCqares. neironebs Soris komunikacia
• funqciurad – somaturi nervuli sistema (sns) (urTierToba) xdeba sinafsebis meSveobiT. sinafsebi
da autonomiuri nervuli sitema (ans) warmoadgens neironebs Soris arsebul wertilovan
nervuli sistema Sedgeba ujredebis ori kontaqtebs. komunikacia xorcieldeba neironebis
ZiriTadi tipisagan: neironi (nervuli ujredi) da mier sekretirebuli an gamoyofili qimiuri
neiroglia (gliis ujredebi) romlebic warmoadgenen agentebis, neirotransmiterebis, saSualebiT.
neironebis damxmare ujredebs. neirotransmiterebis zemoqmedebiT xdeba sxva
neironis aRgzneba an inhibireba (daTrgunva).

klinikuri anatomia 30
Sesabamisad es iwvevs nervuli impulsis romelic ganlagebulia TeTri nivTierebis matriqsSi.
gavrcelebas sxva neironebze an maT Sewyvetas. H fexebs ewodebaT rqebi, Sesabamisad arsebobs
• neiroglia (gliis ujredebi an glia) marjvena da marcxena ukana (dorsaluri) da wina
daaxloebiT 5 jer metia vidre neironebi. isini (ventraluri) ruxi rqebi.
araagznebadi ujredebia, romlebic warmoqmnian sami membranuli Sre – rbili garsi,
nervuli qsovilis mTavar sayrden komponents. glia qseliseburi garsi da magari garsi erToblivad
asrulebs neironis mkvebav da maizolirebel qmnian menings (Tavis tvinis garss). Tavis tvinis
funqcias. cns-Si neiroglia moicavs garsebi da Tavzurgtvinis siTxe gars akravs da
oligodendroglias, astrocitebs, ependimis icavs cns. Tavis da zurgis tvini gareTa zedapiri
ujredebs da mikroglias (patara gliis ujredebi). mWidrod aris dafaruli tvinis garsebs Soris
pns-Si neirogliis ujredebs miekuTvneba zurgis yvelaze SigniT ganlagebuli nazi, gamWvirvale
tvinis neironebis garSemo arsebuli satelituri rbili garsiT. Tavzurgis tvinis siTxe moTavsebulia
ujedebi da autonomiuri gangliuri da neirolemis rbil garssa da qselisebur garss Soris. rbil da
(Svanis) ujredebi. qselisebur garsebs gareT ganlagebulia sqeli da
mkvrivi magari garsi. Tavis tvinis mfaravi magari
centraluri nervuli sistema garsi mWidrod aris dakavSirebuli Tavis qalas
SigniTa zedapirTan. zurgis tvini gamoyofilia
garSemomyofi xerxemlis malis svetis Zvlisagan
centraluri nervuli sistema Sedgeba Tavisa
cximiT savse epiduruli sivrciT.
da zurgis tvinisagan (sur. I.28). cns mTavar
daniSnulebas warmoadgens Semomavali da gamavali
nervuli signalebis koordinacia da integracia.
aseve cns-Si xdeba iseTi umaRlesi fsiqikuri
(mentaluri, inteleqtualuri) funqciis cns dazianeba
ganxorcieleba, rogoricaa azrovneba da daswavla. rodesac Tavis an zurgis tvini dazianebulia,
cns nervuli ujredebis sxeulebis grovebs aqsonebis aRdgena umetes SemTxvevaSi ar xdeba.
ewodebaT birTvebi. nervuli boWkoebis (aqsonebis) regeneracia iwyeba dazianebidan proqsimalur
erTobliobas, romelic aerTebs mezobel an nawilSi. aqsoni agzavnis sacecebs (gamonazardebs)
urTierTdaSorebul birTvebs cns-Si ewodeba traqti. dazianebis midamoSi. Tumca es zrda iblokeba
Tavis da zurgis tvini Sedgeba ruxi da TeTri dazianebis areSi astrocitebis proliferaciiT da
novTieebisagan. nervuli ujredebis sxeulebi aqsonebis wanazardebi maleve ganicdian retraqcias.
ganlagebulia rux nivTierebaSi. TeTr nivTierebas Sedegad cns-Si xdeba traqtebis destruqcia, rasac
qmnis urTierT dakavSirebuli boWkoebis traqtebis moyveba mudmivi dainvalideba. cns-Si aqsonebis
sistemebi (sur. 1-29). zurgis tvinis ganivkveTze ruxi degeneraciisa da regeneraciis Sesaxeb ixileT
nivTierebas aqvs H (peplismagvari) magvari forma, Hutchins et al. (2002).

periferuli nervuli sistema Semoertymis aqsons, gamoyofs ra mas sxva

aqsonebisagan. pns-Si neirolema SeiZleba iyos 2
formis, Sesabamisad iqmneba nervuli boWkoebis 2
periferuli nervuli sistema (pns) Sedgeba cns klasi:
gareT mdebare nervululi boWkoebisa da ujredis 1. mielinizirebuli nervuli boWkoebis
sxeulebisagan. isini nervul impulss gadacemen neirolema Sedgeba individualuri aqsonis mimarT
rogorc centraluri nervuli sistemisaken aseve specifikuri neirolemis (Svanis) ujredebisagan.
sawinaaRmdego mimarTulebiT (sur. I.28). pns Svanis ujredebi Semoexvevian aqsons da qmnian
ZiriTadad Sedgeba nervebisagan, romlebic mielinis garss.
erTmaneTTan akavSirebs cns da periferiul 2. aramielinizirebuli nervuli boWkos
struqturebs. mniSvnelovania erTmaneTisagan nevrilemis ujredebi ar warmoqmnian zemoT aRniSnul
ganvasxvavoT nervuli boWkoebi da nervebi, specifikur garss. aseTi saxis nervul boWkoebSi
romlebsac zogjer diagramaze gamosaxaven rogorc ramdenime aqsoni gaxveulia erTi ujredis
erTidaigives. citiplazmaSi. es ujredebi ar warmoqnian mielinis
perifereuli nervuli boWko Sedgeba garss. kanis nervebSi boWkoebis umetesoba
aqsonisagan, misi nevrolemasagan (berZn. nervi +lema- aramielinuria.
garsi) da garSemomyofi endonevruli SemaerTebeli periferiuli nervi Sedgeba (1) periferiuli
qsovilisagan (sur. I.30). nevrilema Sedgeba neirolemis nervuli boWkoebis konebisagan (an “konebad Sekruli
(Svanis) ujredebisagan romelic uSualod gars boWkoebis konebisagan” an didi nervis SemTxvevaSi -
fascikulebisagan), (2) SemaerTebeli qsovili faravs

klinikuri anatomia 31
da erTad kravs nervul boWkoebs da fascikulebs da spinaluri (zurgis tvinis) nervebi
(3) sisxlRarRvebisagan (vasa nervorum), romelic kvebavs
nervul boWkoebs da maT safar qsovilebs (sur. I.31). spinaluri nervebi dasawyisSi gamodian zurgis
periferiuli nervuli boWkoebi mtkice da tvinidan fesvebis saxiT (xSirad simartivisTvis
elastiuria, radgan nervuli boWkoebi daculia sami diagramebze isini ar gamoisaxeba), romlebic
SemaerTebelqsovilovani safariT: ertiandebia da qmnian 2 nervul tots (sur. I.32):
• endonevriumi, Txeli SemaerTebeli qsovilia, • wina (ventraluri) fesvi. igi Sedgeba
romelic uSualod faravs aqsonebsa da nevrilemis motoruli (eferentuli) boWkoebisagan, romlebic
ujredebs. gamodian zurgis tvinis ruxi nivTierebis wina rqis
• perinevriumi, mkvrivi SemaerTebelqsovilovani nervuli ujredebis sxeulebidan da miemarTebian
Srea, romelic faravs periferiuli nervuli periferiulad ganlagebuli efeqtoruli
boWkoebis fascikulebs. igi qmnis efeqtur bariers organoebisaken.
ucxo nivTierebebis nervul boWkoebSi SeRwevis • ukana (dorsaluri) fesvi Sedgeba mgrZnobiare
sawinaaRmdegod. (aferentuli) boWkoebisagan, romelic iwyeba ukana
• epinevriumi, sqeli SemaerTebelqsovilovani (dorsaluri) totis anu zurgis tvinis sensorul
SaliTaa, romelic faravs fascikulebis konebs da gangliaSi ganlagebuli ujredebis sxeulebidan. es
qmnis nervis yvelaze gareTa safarvels. igi moicavs boWkoebi periferiulad miemarTeba mgrZnobiare
cximovan qsovils, sisxlis da limfur ZarRvebs. daboloebebamde. centralurad ki igi Sedis zurgis
periferiuli nervi agebulebiT gavs tvinis ruxi nivTierebis ukana rqaSi.
satelefono kabels: aqsonebi gavs calkeul mavTuls wina da ukana fesvebi erTiandebian malTaSua
romelic gaxveulia neirolemiTa da endonevriumiT; xvrelSi an cota proqsimalurad. Sedegad miiReba
isini Tavis mxriv Sekrulia perinevriumiT, xolo Sereuli spinaluri nervi romelic maleve iyofa 2
miRebuli konebi ki dafarulia epinevriumiT, pirvelad totad: ukana (dorsaluri) da wina
romelic qmnis “kabelis” gareTa safars. (ventraluri) toti. Sereuli spinaluri nervis
cns gareT myofi nervuli ujredebis sxeulebis totebi, rogorc maTi Semdgomi datotviT miRebuli
grovebs ewodeba ganglia. arsebobs motoruli nervebi, Seicavs rogorc motorul, aseve mgrZnobiare
(autonomiuri) da sensoruli gangliebi. boWkoebs. terminebi “motoruli” da “sensoruli”
nervi yovelTvis fardobiTi mcnebaa da aCvenebs Tu
periferiuli nervebis tipebi romeli tipis nervuli boWko ufro sWarbobs masSi.
tanis an kidurebis mainervirebeli nervebis
(motoruli nervebis) SemadgenlobaSi daaxloebiT
pns anatomiurad da funqciurad cns-is
40% sensoruli boWkoa, romlebic monawileoben
gagrZelebaa (sur. I.28). misi aferentuli (sensoruli,
tkivilis da proprioceptuli informaciis
mgrZnobiare) boWkoebi nervul impuls atarebs
gadacemaSi. kanis mgrZnobiare nervebi aseve Seicaven
grZnobis organoebidan (mag. Tvalidan) da sxeulis
motorul boWkoebs, romlebic monawileoben oflis
sxvadasxva nawilSi ganlagebuli mrZnobiare
jirkvlebis, sisxlZarRvebis gluvi kunTebis da Tmis
receptorebidan (mag. kani) cns mimarTulebiT.
folikulebis inervaciaSi.
eferentuli (motoruli, mamoZravebeli) boWkoebi
kanis unilateraluri are, romelsac
nervul impulss atarebs cns-dan efeqtoruli
ainervirebs erTi spinaluri nervi, ewodeba
organos mimarTulebiT (kunTebi da jirkvlebi).
dermatomi; kunTebis unilateralur jgufs,
romelsac ainervirebs erTi motoruli nervi -
periferiul nervebs miekuTvneba kranialuri da
ewodeba miotomi (sur. I.33A). spinaluri nervebis an
spinaluri nervebi.
ukana fesvebis dazianebis klinikuri kvlevebiT
• kranialuri nervi gamodis Tavis qalas
dadgenilia dermatomebis ruqa da
xvrelebidan da maT aRniSnaven sakuTari saxelebiT
identificirebulia maTi mainervirebeli specifikuri
(mag. trochlea) an romauli cifrebiT (mag. IV
spinaluri nervebi (sur. I.33B). Tumca calkeuli
kranialuri nervi). mxolod kranialuri nervebis 12
ukana fesvis an spinaluri nervis dazianeba iSviaTad
wyvilidan 11 gamodis uSualod Tavis tvinidan, CN XI
iwvevs aRniSnul ruqaze moyvanili dermatomebis
ki zurgis tvinis zeda nawilidan.
srul deinervacias, radgan mezobeli spinaluri
• spinaluri nervebi xerxemlis svetidan nervebi yovelTvis Seicaven boWkoebs, romlebic
gamodian malTaSua xvrelebis meSveobiT. yvela 31 gadafaraven mezobeli nervis sinervacio zonas.
wyvili gamodis zurgis tvinidan da maTi Sedegad miiReba ormagi “inervacia”. amitom
identifikacia xdeba asoTi da cifriT (mag T4). aso dermatomebis ruqaze maTi sazRvrebis gamosaxva
aRniSnavs zurgis tvinis segments (C –kisris, T – ufro mizanSewonilia gardamavali, gradaciuli
gulmkerdis, L-welis, S-gavis, Co –kudusunis), xolo ferebiT da aramkveTri konturebiT. zogadad,
cifri rigiTobas. aucilebelia 2 mezobeli spinaluri nervis (an ukana

klinikuri anatomia 32
fesvis) dazianeba raTa miviRoT Semcirebuli mainc) da zogic orive tipis boWkos. amasTan
mgrZnobelobis mqone ubani. arsebobs kavSirebi rogorc Tavis tvinis nervebs
ukana totebi erTmaneTisagan gancalkavebulebi Soris, aseve Tavis da zurgis tvinis (kisris zeda
rCebian. isini segmentebis mixedviT awvdian nervul segmentebis) nervebs Soris. amitom nervebi
boWkoebs xerxemlis svetis sinovialur saxsrebs, romlebSic dasawyisSi iyo mxolod motoruli
zurgis Rrma kunTebs da zedmdebare kans. wina boWkoebi, iReben sensorul boWkoebsac da piriqiT.
totebi awvdian nervul boWkoebs ufro didi pirveli ori nervis gamoklebiT (monawileoben
moculobis darCenil ubnebs, romlebic moicavs ynosvis da mxedvelobis SegrZnebaSi) kranialur
torsis wina da lateralur regionebs da zeda da nervebs, romlebic Seicaven sensorul boWkoebs,
qveda kidurebs. gaaCniaT sensoruli ganglia (zurgis tvinis
wina totebi ganawilebulia torsze sensoruli anu ukana fesvis gangliis msgavsad),
damoukideblad da ainervirebs kunTebs da kans sadac moTavsebulia aRniSnuli boWkoebis neironebis
segmenturad (sur. I.33C, I.34).. Tumca, upirveless sxeuli. miuxedavad imisa rom termini dermatomi
yovlisa kidurebis inervaciis SemTxvevaSi, wina gamoiyeneba mxolod spinaluri nervebis SemTxvevaSi,
totebis umetesi nawili erTiandeba mimdebare wina kranialuri nervebis Sesabamisi sainervacio zonebis
totebTan an maTi boWkoebis nawilTan da warmoqmnis gamoyofa SesaZlebelia. dermatomebisagan
wnulebs. aRniSnuli wnulebidan gamodis ukve axali gansxvavebiT, kranialuri nervebis mier inervirebul
mravasegmenturi periferiuli nervebi, romlebSic kanis ubnebs Soris arsebobs mxolod mcie
gaerTianebulia ramdenime spinaluri totis nervuli gadafarvebi.
boWko (sur. I.34 , I.35A & B).. wnulis formirebaSi
monawile segmenturi nervebis wina totebi aZleven somaturi da visceraluri boWkoebi
boWkoebs mravalricxovan periferiul nervebs,
romelic gamodis am wnulidan (sur. I.35A). aqedan kranialuri an spinaluri periferiuli
gamomdinare wnulidan gamosuli periferiuli nervi nervebis SemadgenlobaSi Sedis Semdegi tipis
Seicavs sxvadasxva spinaluri nervis boWkos (sur. boWkoebi (sur. I.36)::
I.35B). • somaturi boWkoebi
miuxedavad imisa, rom wnulSi gaerTianebis da o saerTo mgrZnobiare boWkoebi (saerTo
SemdgomSi gayofis Sedegad spinaluri nervebi somaturi aferentuli [ssa] boWkoebi) gadascemen
kargaven Tavis identurobas, zurgis tvinis SegrZnebas periferiidan cns-Si; es SeiZleba iyos
garkveuli segmentidan gamosuli da erT spinalur eqsteroceptuli (zerele) mgrZnobeloba kanidan
nervSi gaerTianebuli boWkoebi nawildeba erT (tkivili, temperatura, Sexeba da wneva) an tkivili da
garkveul dermatomSi. amasTan is SeiZleba moicavdes proprioceptuli (Rrma) mgrZnobeloba kunTebidan,
mezobeli dermatomebis mainervirebeli boWkoebis iogebidan da saxsrebidan. proprioceptuli
garkveul raodenobasac (sur. I.35C). mgrZnobeloba Cveulebriv qveSecneulia, iZleva
zemoTTqmulidan gamomdinare mniSvnelovania informacias saxsrebis mdgomareobis da iogebisa da
ganvasxvavoT spinalur nervSi (spinaluri nervis kunTebis daWimulobis Sesaxeb. es informacia Tavis
inervacia an segmenturi ganawileba, mag. dermatomebi tvins gadaecema SigniTa yuris vestibuluri aparatis
da miotomebi moniSnuli Sesabamisi asoeboT da impulsebTan erTad, rac mxedvelobis dauxmareblad
cifrebiT, mag. T4) da wnulidan gamomavali totebis saSualebas aZlevs Tavis tvis gaanalizos sxeulis
(periferiuli nervebis inervacia anu ganawileba, da kidurebis sivrculi orientacia.
romelTac saxelebi eniWeba periferiuli nervebis o somaturi motoruli boWkoebi (saerTo
mixedviT) boWkoebis ganawileba (sur. I.33B & C). somaturi eferentuli (sse) boWkoebi) gadascems
segmenturi inervaciis (klinikuri impuls ConCxis (nebiT) kunTebs
gamocdilebiT dadgenili dermatomebi) da • visceraluri boWkoebi
periferiuli nervebis ganawilebis (nervis o visceraluri sensoruli boWkoebi (saerTo
distaluri totebis gadaWriT dadgenili) gadatana visceraluri aferentuli [sva] boWkoebi) Rru
inervaciis ruqaze iZleva sruliad gansxvavebul organoebidan da sisxlZarRvebidan cns gadascemen
suraTs. gamonakliss warmoadgens torsis umetesi informacias tkivilis an qvecnobieri visceraluri
nawili, sadac segmenturi da periferiuli mgrZnobelobis (magaliTad, informacia romelic
ganawileba erTidaigivea. amis mizezs warmoadgens exeba gaWimvis, sisxlis airebs da sixlis wnevas)
nervuli wnulebis araseboba (Tumca aqac zonebis Sesaxeb.
gadafarva xdeba wnulidan gamomavali nervebis kanze o visceraluri motoruli boWkoebi (saerTo
ganawilebis SemTxvevaSi). visceraluri eferentuli (sve) boWkoebi) gadascems
impulss gluv (uneblie) kunTebs da jirkvlovan
kranialuri (Tavis tvinis) nervebi qsovils. boWkoebis ori tipi, presinafsuri da
zogierTi Tavis tvinis nervi Seicavs postsinafsuri, monawileobs cns-dan gluvkunTebsa
mgrZnobiare boWkoebs, zogi motoruls (dasawyisSi

klinikuri anatomia 33
da jirkvlebze impulsis gadacemaSi (aRwerilia mgrZnobiare boWkoebs, romlebic monawileoben
qvemoT). specialuri SegrZnebebis (ynosva, mxedveloba, smena,
orive tipis sensoruli boWkoebi – gemovneba da wonasworoba) aRqmaSi. (Tavis da kisris
visceraluri da saerTo sensoruli – warmoadgenen garkveuli kunTebis embriologiur-filogenezuri
fsevdounipolaruli neironebis morCebs, romelTa warmoSobis gaTvaliswinebiT kranialuri nervebis
sxeulebic ganlagebulia cns gareT, spinaluri da Semadgeneli zogierTi motoruli boWkoebi
kranialuri nervebis sensorul gangliebSi (sur. I.36 - tradiciulad klasificirdeba, rogorc
I.37). periferiuli nervebis motoruli boWkoebi visceraluri; Tumca aseTi saxelwodeba damabnevelia
warmoadgens multipolaruli neironebis aqsonebs. da klinikaSi ar gamoiyeneba da am terminis
somaturi motoruli da presinafsuri visceruli praqtikuloba kiTxviTi niSnis qveS dgas. amitom es
motoruli neironebis ujredis sxeulebi termini aq ar gamoiyneba. roca aucilebelia am
lokalizebulia zurgis tvinis rux nivTierebaSi. ukanasknelis gamoyeneba, boWkoebs vuwodebT –
postsinafsuri motoruli neironebis ujredis layuCis motoul boWkoebs, radgan sainervacio
sxeulebi ki – cns-is gareT - autonomiiur kunTis qsovili warmoiqmneba embrionis
gangliebSi. faringealuri (xaxis) rkalidan).
zemoTmoyvanili boWkoebis tipebTan erTad
zogierTi kranialuri nervi aseve Seicavs specialur

rizotomia SemaerTebelqsovilovani safari intaqturi rCeba.

ukana da wina fesvebi warmoadgens erTaderT nervis am tipis dazianebis dros qirurgiuli Careva
adgils, sadac spinaluri nervebis motoruli da saWiro ar aris, radgan intaqturi SemaerTebeli
sensoruli boWkoebi calk-calke mdebareobs. aqedan qsovilis safari warmarTavs aqsonis zrdas.
gamomdinare es adgili warmoadgens erTaderT ubans, periferiuli nervis gadaWris Semdeg regeneracia
sadac qirurgs SeuZlia seleqtiurad gadaWras nervi naklebad xdeba. wanazardebis gazrda xdeba aqsonis
(rizotomia), raTa Seamciros gansazRvruli tkivili proqsimalur boloze, magram mzardma aqsonma
an spastiuri paralizi. SeiZleba ver miaRwios mis samiznes. gadaWrili nervi
moiTxovs qirurgiul Carevas, radganac aqsonis
periferiuli nervis degeneracia da nervis regeneraciisaTvis saWiroa gadaWrili boloebis
mikereba epinerviumze nakeris dadebiT. saWiroa
iSemia
individualuri nervuli konebis SeZlebisdagvarad
zrdasruli adamianis nervul sistemaSi
zustad dalageba. neironis sxeuls mocilebuli
neironi ar ganicdis proliferacias. gamonakliss
aqsonis dgeneracias ewodeba anterograduli
warmoadgens ynosvis organos epiTeliumi. amitom,
(voleris) degeneracia. degeneraciuli procesi
daavadebis an tramvis Sedegad dazianebuli neironi
moicavs aqsons da mis mielinur garss.
ar Canacvldeba axliT. rodesac periferiuli nervi
nervis sisxlis momaragebis xangrZlivad
aris miWyletili, gadaWrili an sxvagvarad
Semcireba vasa vervorum-is kompresiis dros SeuZlia
dazianebuli, aqsonebi, ZiriTadad, degeneracias
gamoiwvios nervis degeneracia sur. 1-31. nervis
ganicdian dazianebis distalurad, radgan maTi
gaxangrZlivebulma iSemiam (araadekvaturi sisxlis
cxovelmyofeloba damokidebulia neironis sxeulze.
momarageba) SeiZleba gamoiwvios aranaklebi
Tu aqsonebi dazianda, magram ujredis sxeuli
dazianeba, vidre nervis miWyletam an gadaWram.
intaqturia, maSin regeneracia da funqciis aRdgena
SabaTis Ramis sindromi warmoadgens seriozul,
gansazRvrul pirobebSi SesaZlebelia. gadarCenis
xSirad, permanentuli paresTeziis magaliTs. es
Sansi yvelaze maRalia nervis kompresiis dros.
mdgomareoba aseve SeiZleba ganviTardes qirurgiuli
nervze zewola, ZiriTadad, iwvevs paresTeziebs.
procedurebis dros, laxtis xangrZlivi zewolis
magaliTad, es is grZnobaa, rodesac Tqven didi xnis
Sedegad. Tu iSemia arc ise xangrZlivia, viTardeba
ganmavlobaSi zixarT gadajvaredinebuli fexebiT
mxolod droebiTi mgrZnobelobis daqveiTeba an
(fexis fexze gadadeba) da viTardeba fexis dabuJeba.
paresTezia. gardamavali paresTezia albaT yvelas
nervis miWyletva azianebs an klavs aqsons dazianebis
gamoucdia stomatologiuri manipulaciebis dros.
adgilis distalurad, Tumca nervuli ujredis
sxeuli, Cveulebriv, gadarCeba da nervis

klinikuri anatomia 34
 somaturi nervuli sistema farmakologiuri mniSvneloba aqvs funqciur
gansxvavebas, radgan ans ori nawilis postsinafsuri
neironebi gamoyofen sxvadasxva neirotranmiterebs:
somaturi nervuli sistema Sedgeba vns da pns noradrenalins simpaTikuri nervuli sistema
somaturi nawilebisagan. igi uzrunvelyofs sxeulis (gamonaklisia oflis jirkvlebi) da acetilqolins –
yvela nawilis motorul da sensorul inervacias. parasimpaTikuri nervuli sistema.
garda organizmis Rruebis visceralur organoebs, ans-is simpaTikuri (Torakolumbaluri)
gluv kunTebs da jirkvlebs (sur. I.36 - I.37). somaturi ganyofileba
sensoruli sistema gadascems Sexebis, tkivilis, simpaTikuri nervulis sistemis presinafsuri
temperaturis da sxeulis mdebareobis mgrZnobiare neironebis sxeulebi nanaxia mxolod erT adgilas:
receptorebidan wamosul impulsebs. somaturi zurgis tvinis Sualateralur svetSi anu birTvSi
motoruli sistema ainervirebs mxolod ConCxis (sur. I.38).. es wyvili svetebi warmoadgens zurgis
kunTebs, astimulirebs kunTebis SekumSvas da
tvinis gulmkerdis (T1-T12) da zeda welis (T1 –L2an 3)
modunebas. magaliTad is monawileobas cxeli uTos
segmentebis ruxi nivTierebebis nawils. zurgis
Sexebis sapasuxo reaqciaSi.
tvinis am nawilebis ganiv ganakveTze isini
autonomiuri nervuli sistema lokalizebulia ruxi nivTierebis mcire
klasikurad, autonomiur nervul sistemas lateraluri rqebis saxiT, ukana da wina rqebs
uwodeben visceralur nervul sistemas an Soris. Sualateraluri sveti organizebulia
visceralur motorul sistemas (sur. I.33 - I.37). igi somatotopiurad (mag. ganlagebulia sxeulis
Sedgeba motoruli boWkoebisagan romlebic proeqciis mixedviT, Tavis nawilis Sesabamisi
astimulirebs gluv (aranebiT) kunTebs, segmenti moTavsebulia zemoT, xolo menjis da qveda
modificirebul kardiomiocitebs (gulis gamtar kidurebis – qvemoT). Sedegad SesaZlebelia
sistemas) da jirkvlovan (sekretorul) ujredebs. gamovicnoT sxeulis garkveuli nawilis
autonomiuri nervuli sistemis visceralur mainervirebeli presinafsuri simpaTikuri ujredebis
eferentul boWkoebs Tan axlavs aferentuli lokalizacia.
boWkoebic. radgan es boWkoebi monawileoben sns postsinafsuri neironis sxeuli
autoimunuri refleqsebis aferentuli komponentisa ganlagebulia or adgilas – paravertebrul da
da visceraluri tkivilis impulsebis gadacemaSi, prevertebrul gangliebSi (sur. I.39):
isini aregulireben viscerul funqciebs. aqedan • paravertebruli gangliebi dakavSirebulia
gamomdinare zogierTi autori visceralur erTmaneTTan da xerxemlis svetis orive mxares qmnian
aferentul boWkoebs ganixilavs rogorc ans nawils. marjvena da marcxena simpaTikur wvels (jaWvs),
yovel SemTxvevaSi es boWkoebi ganxilul unda iyos romlebic Cauyvebian xerxemals TiTqmis mTel
am sistemasTan erTad. sigrZeze. zeda paravertebruli ganglia (simpaTikuri
autonomiur nervul sistemis eferentuli wvelis kisris zeda ganglia) ganlagebulia Tavis
nervebis boWkoebi da gangliebi organizebulia or qalas fuZesTan. ukanaskneli ganglia kentia. igi
sistemaSi anu ganyofilebaSi: simpaTikuri ganlagebulia kudusunis doneze da miiReba marjvena
(Torakolumbaluri) da parasimpaTikuri da marcxena wvelis gaerTianebiT.
(kraniosakraluri) nawili. sensoruli da somaturi • prevertebruli ganglia ganlagebulia
motoruli inervaciiisagan gansxvavebiT, romelSic wnulSi, romelic gars evleba abdominaluri aortis
cns da efeqtoris mgrZnobiare daboloebebs Soris mTavari totebis gamosvlis adgils. aseTs mag.
impulsis gadacema xdeba erTi neironis meSveobiT, warmoadgens ori didi faSvis ganglia, romelic
ans orive ganyofilebaSi nervuli impulsis ganlagebulia faSvis RerosTan (aortidan gamomavali
gadacemaSi CarTulia ori multipolaruli erTerTi mTavari toti)
neironebis seria (sur. I.37). pirveli presinafsuri radgan masSi ganlagebulia motoruli
(pregangliuri) neironis sxeuli ganlagebulia cns boWkoebi, amitom presinafsuri neironebis aqsonebi
rux nivTierebaSi. misi boWko (aqsoni) sinafsiT zurgis tvins toveben wina totebis meSveobiT da
ukavSirdeba mxolod postsinafsuri (postgangliuri) Sedian Zurgis tvinis spinaluri nervebis (T1 –L2an 3)
neironis sxeuls, jaWvis meore neironi. meore wina fesvebSi (sur. I.40). presinafsuri simpaTikuri
neironis sxeuli moTavsebulia cns-is gareT boWkoebi maleve toveben spinaluri nervis wina
autonomiur gangliaSi, romlis boWkoebi bolovdeba fesvebs da gadadian simpaTikur wvelSi TeTri
efeqtorul organoSi (gluvi kunTebi, damakavSirebeli totebis meSveobiT (rami communicantes).
modificirebuli gulis kunTi an jirkvali). ans or simpaTikur wvelSi presinafsuri boWkoebi miyvebian
ganyofilebas Soris anatomiuri gansxvaveba efuZneba oTxidan erTerT SesaZlo mimarTulebas:
(1) presinafsuri ujredis sxeulis mdebareobas da (2)
cns-dan gamomaval nervTan dakavSirebuli
presinafsuri poWkoebis tips. samedicino praqtikaSi

klinikuri anatomia 35
 • simpaTikur wvelSi zemoT ganlagebul muclis da menjis Rrus visceraluri organoebis
paravertebruli gangliis postsinafsuri neironis inervaciaSi (mag. kuWi da nawlavebi) Sedian
mimarTulebiT, sadac igi qmnis sinafss prevertebralur gangliebSi muclisa da menjis Rrus
• simpaTikur wvelSi qvemoT ganlagebul nervebiT (didi, mcire, umciresi da lumbaluri
paravertebruli gangliis postsinafsuri neironis nervebi) (sur. I.40, I.41, - I.42). abdominaluri da menjis
mimarTulebiT, sadac igi qmnis sinafss nervebis yvela presinafsuri simpaTikuri boWko,
• simpaTikur wvelSi imave doneze ganlagebul Tirkmelzeda jirkvlis mainervirebeli nervebis
paravertebruli gangliis postsinafsuri neironis garda, sinafsebs am gangliebSi warmoqmnian.
mimarTulebiT, sadac igi qmnis sinafss prevertebraluri gangliebidan gamosuli
• gaivlis simpaTikur wvels sinafsis postsinafsuri boWkoebi qmnian periarteriul
warmoqmnis gareSe, grZeldeba Signeulobis nervSi wnulebs, romlebic miyvebian muclis aortis totebs.
zogierTi presinafsuri simpaTikuri boWko gaivlis
(wvelis toti romelic monawileobs muclis
prevertebrul (faSvis) ganglias sinafsebis
visceraluri organoebis inervaciaSi) da aRwevs
warmoqmnis gareSe da mTavrdeba pirdapir
prevertebrul ganglias.
Tirkmelzeda jirkvlis tvinovani Sris ujredebze
presinafsuri simpaTikuri boWkoebi, romlebic
(sur. I.42). Tirkmelzeda jirkvlis tvinovani Sris
ainervireben Tavs, kisers, sxeulis kedlebs, kidurebs
ujredebi funqcionireben rogorc postsinafsuri
da gulmkerdis Rrus miyvebian pirvel sam
neironebis specialuri tipi. isini specifikuri
mimarTulebas da sinafsebs warmoqmnian
efeqtoruli organos ujredebis magivrad
paravertebrul gangliaSi. presinafsuri simpaTikuri
neirotranmiterebs gamoyofen pirdapir sisxlis
boWkoebi, romlebic ainervireben viscerul
mimoqcevaSi. ris Sedegadac simpaTikuri moqmedebis
organoebs muclisa da menjis RruSi, miyvebian
qveS eqceva mTeli organizmi. ase rom am jirkvlis
meoTxe mimarTulebas.
simpaTikuri inervacia gamonakliss warmoadgens.
postsinafsuri simpaTikuri boWkoebi bevrad
rogorc adre iyo aRwerili, postsinafsuri
sWarbobs presinafsuri boWkoebis raodenobas;
simpaTikuri boWkoebi spinaluri nervebis yvela
yoveli presinafsuri simpaTikuri boWko sinafss
totis Semadgenel nawils warmoadgens. amitom
warmoqmnis 30-ze met postsinafsur boWkosTan.
periarteriuli wnulebis meSveobiT isini
ase rom postsinafsuri simpaTikuri boWkoebi,
gavrcelebulia mTels organizmSi da ainervireben
romlebic gankuTvnilia kisrisaTvis, sxeulis
rogorc yvela sisxlZarRvs (simpaTikuri sistemis
kedlebisa da kidurebisaTvis, gamodis simpaTikuri
upirvelesi funqcia), aseve oflis jirkvlebs, Tmis
wvelis paravertebruli gangliebidan da rami
gammarTvel kunTebs da visceralur struqturebs.
communicantes meSveobiT da Sedis mimdebare spinaluri
Sedegad simpaTikuri nervuli sistema aRwevs sxeulis
nervebis wina totebSi (sur. I.41). am gziT isini Sedian
yvela nawils, iseTi iSviaTi gamonaklisebis garda,
yvela 31 spinaluri nervis totebSi, maT Soris ukana
rogoricaa avaskularuli qsovilebi – xrtili da
totebSi, da astimulireben sisxlZarRvebis kedlis
frCxilebi. radgan simpaTikuri gangliebi
SekumSvas (vazomotorika), TmebTan dakavSirebuli
organizmSi ganlagebulia centralurad da axlosaa
gammarTvel kunTebs (pilomocia, romlis Sedegadac
mis SuaxazTan (gansakuTrebiT xerxemlis svetTan)
yalibdeba “batis kani”) da iwveven oflis gamoyofas.
presinafsuri boWkoebi SedarebiT moklea, xolo
yvela postsinafsuri simpaTikuri boWkos ujredis
postsinafsuri boWkoebi ki grZeli da
sxeuli, romlebic ainervireben Tavs (aseve feradi
gavrcelebulia sxeulis yvela nawilSi.
garsis dilatator “gamafarToebel” kunTs),
ganlagebulia simpaTikuri wvelis kisris zeda
gangliaSi. gangliidan gamosvlis Semdeg isini Tavis ans-is parasimpaTikuri
tvinis arteriis totebTan qmnian periarteriul (kraniosakraluri) nawili
nervul wnulebs, romlebic miyvebian saZile presinafsuri parasimpaTikuri neironebis
arteriis totebs, an uSualod uerTdebian sxeulebi ganlagebulia cns or ubanSi. maTi
axlosmdebare kranialur nervs, saidanac xvdebian boWkoebi ki or fesvSi. aseTi ganlageba ganapirobebs
Tavis gansazRvrul ubanSi (Maklad et al., 2001). parasimpaTikuri sistemis 2 alternatiul
muclis Rrus nervebi Seicavs visceralur dasaxelebas sur. 1-43:
eferentul (autonomiur) da aferentul boWkoebs, • tvinis Reros rux nivTierebaSi saidanac
romlebic gamodian sxeulis Rruebis visceraluri boWkoebi gamodis kranialuri nervebis saSualebiT
organoebidan. postsinafsuri simpaTikuri boWkoebi, (III, VII, IX, X), es boWkoebi Seadgenen kranialur
romlebic gankuTvnilia gulmkerdis RrusaTvis (mag. parasimpaTikur gamosavals.
guli, filtvi, da saylapavi) kardiopulmonaruli • zurgis tvinis gavis segmentis ruxi
nervebis meSveobiT Sedis gulis, filtvis da nivTierebidan (S 2-4) boWkoebi gamodian gavis
saylapavis wnulebSi (sur. I.40). presinafsuri Sesabamisi spinaluri nervebis wina totebiT da
simpaTikuri boWkoebi, romlebic monawileobs menjis nervebiT, romlebic warmoiqmnebian misi wina

klinikuri anatomia 36
totebisagan. es boWkoebi qmnian gavis parasimpaTikur simpaTikuri transmiterebi ainhibireben aqtiur
gamosavals. vazikonstriqcias, riTac sisxlZarRvebs pasiuri
ar aris gasakviri, rom kranialuri gamosavali gafarToebis saSualebas aZleven sisxlis wnevis
axorcielebs Tavis parasimfaTikur inervacias, xolo zemoqmedebiT). gulis gvirgvinovan sisxlZarRvebSi,
gavis ki menjis Rrus visceralur organoebis. Tumca ConCxis kunTis sisxlZarRvebSi da gareTa sasqeso
gulmkerdis da muclis Rrus visceruli organoebis organoebSi, simpaTikuri stimuli iwvevs
inervaciaSi dominant rols TamaSobs kranialuri vazodilatacias (Wilson-Pauwels et al., 1997).
gamosavali cTomili nervis meSveobiT (X wyvili). igi
axorcielebs gulmkerdis Rrus yvela visceraluri
organos da kuWnawlavis traqtis (dawyebuli visceruli mgrZnobeloba
saylapavidan msxvili nawlavis nawilis CaTvliT visceralur aferentul boWkoebs aqvT
[kolinjis marcxena kuTxemde]) umetesi nawilis mniSvnelovani urTierTdamokidebuleba ans-Tan,
inervacias. gavis gamosavali ainervirebs mxolod rogorc anatomiurad aseve funqciurad. am
daRmaval da sigmoidur kolinjs da swor nawlavs. boWkoebidan wamosuli nervuli impulsebi Tavis
kranialuri gamosavlis dominirebis gamo tvinis mier SeigrZnoba Cvengan gauTviTcnobiereblad.
parasimpaTikuri sistema simfaTikur sistemasTan isini iZlevian informacias organizmis Sinagani
SedarebiT ufro metad aris SezRuduli gavrcelebis garemos mdgomareobis Sesaxeb. es informacia
mxriv. parasimpaTikuri sistema vrceldeba mxolod gadamuSavdeba cns-Si, ris Sedegadac xdeba somaturi
TavSi, torsis visceralur RruebSi da gareTa da visceraluri refleqsebis ganxorcieleba.
genitaliebis ereqtilur qsovilSi. am ukanasknelidan visceraluri refleqsebi aregulireben sisxlis
gamonakliss warmoadgens is, rom igi ar aRwevs wnevas da qimiur Semadgenlobas iseTi funqciebis
sxeulis kedlebs da kidurebs. agreTve is, rom gavis meSveobiT, rogoricaa gulis cemis da sunTqvis
2-4 nervebis wina totebi ar aris spinaluri nervebis sixSire da sisxlZarRvebis rezistentoba.
nawili. visceraluri mgrZnobeloba, romelic
parasimfaTikuri gangliebis oTxi gamoxatuli SeigrZnoba Cvens mier (Cvens mier gacnobierebuli),
wyvili ganlagebulia TavSi (ix. 7-9 Tavi). ZiriTadad gamoixateba tkivilis saxiT. visceraluri
presinafsuri parasimfaTikuri boWkoebi warmoqmnian tkivili cudad lokalizebulia, zogjer atarebs
sinafsebs postsinafsuri ujredebis sxeulebTan, spastikur xasiaTs da SeiZleba Tan axldes SimSilis,
romlebic ganlagebulia samizne organos kedelze an simaZRris an gulis revis SegrZneba. qirurgebs,
siRrmeSi (garegani an Sinagani ganglia). aqedan romlebic operacias atareben lokaluri anesTeziis
gamomdinare presinafsuri boWkoebis umetesi nawili qveS, SeuZliaT gakveTon, daadon momWerebi, mowvan da
Zalian grZelia. igi miemarTeba cns-dan efeqtoruli Caataron sxva mtkivneuli manipulacia da pacientma
organoebisaken. postsinafsuri boWkoebi Zalia veraferi igrZnos. maSin roca sxva Sesabamisma
moklea, radgan igi gamodis gangliidan (romelic stimulaciam SeiZleba gamoiwvios tkivili, aseTebia
ganlagebulia organos siaxloves an uSualod mis magaliTad:
siRrmeSi) efeqtoruli organoebis mimarTulebiT.
• uecari gaWimva
• spazmi an Zlieri moWera
ans nawilebis funqcia
miuxedavad imisa, rom simpaTikuri da
• qimiuri gaRizianeba
parasimpaTikuri nervuli sitema ainervirebs aranebiT • meqanikuri stimulacia, gansakuTrebiT Tu
struqturebs (xSir SemTxvevaSi erTidaimaves), maT organo aqtiuria
aqvT sxvadasxva, ZiriTadad urTierTsawinaaRmdego • paTologiuri mdgomareobebi (gansakuTrebiT
efeqti (sur. I.41 - I.43). zogadad simpaTikuri sistema iSemia) romlebic normaSi arsebul stimulaciaze
aris kataboluri, romelic ganapirobebs organizmis dabalia
stresisadmi dacvis unars. parasimpaTikuri sistema normaluri aqtioba ZiriTadad ar iwvevs raime
ZiriTadad axorcielebs homeostazs an anabolizms. SegrZnebis Camoyalibebas. magram araadeqvaturi
cxrili 1.2 moyvanilia ans-is da misi nawilebis sisxlis momaragebis SemTxvevaSi (iSemia) SeiZleba
spacifikuri funqciebi. ganviTardes tkivili an sxva paTologiuri SegrZneba.
simpaTikuri sistemis upirveless funqcias visceraluri refleqsebis umetesoba da zogerTi
warmoadgens sisxlZarRvebis regulacia. es tkivili vrceldeba retrogradulad visceraluri
xorcieldeba sxvadasxva meqanizmiT. simpaTikuri aferentuli boWkoebis meSveobiT, romlebic Tan
nervuli sistema sisxlZarRvebze moqmedebs axlavs parasimpaTikur boWkoebs. visceraluri
tonogenurad (vazokonstriqcia). sisxlZarRvebis tkivilis impulsebis umetesoba (mag. gulidan da
umetesobaSi simpaTikuri signalis gaZliereba iwvevs peritineumis Rrus umetesi organodan) gadaecema
vazokonstriqcias, xolo misi Sesusteba ki centralurad simpaTikur boWkoebTan asocirebuli
vazodilatacias. Tumca sxeulis garkveul ubnebSi visceraluri aferentuli boWkoebis meSveobiT.
simpaTikuri signali iwvevs vazodilatacias (mag.

klinikuri anatomia 37
 cxrili I.2

avtonomiuri nervuli sistemis (ans) funqciebi

organo, traqti an sistema simpaTikuri stimulaciis efeqti parasimpaTikuri stimulaciis

efeqti

Tvalis guga afarToebs gugas (masSi Sedis meti aviwroebs gugas (icavs gugas gansakuTrebiT
kaklebi sinaTle da izrdeba mxedvelobis kaSkaSa sineTlisgan)
simaxvile)

wamwavoni sxeuli kumSavs wamwamovan sxeuls da aZlevs

saSualebas brols gafarTovdes axlos
xedvisTvis (akomodacia)

kani Tmis gammarTveli iwvevs Tmis yalyze dadgomas (batis kani) ara aqvs efeqti
kunTebi

periferiuli iwvevs sisxlZarRvebis Seviwroebas ara aqvs efeqti

sisxlZarRvebi (kanis, tuCebis gafermkTaleba da TiTis
boloebis galurjeba)

saofle jirkvlebi iwvevs oflianobas ara aqvs efeqti

sxva sacremle jirkvlebi odnav amcirebs sekrecias iwvevs sekreciis momatebas

jirkvlebi
sanerwyve jirkvlebi amcirebs sekrecias, nerwyvi xdeba ufro iwvevs uxvi, Txeli sekretis gamoyofas
sqeli da webovani

guli zrdis SekumSvebis sixSires da Zalas; amcirebs SekumSvebis sixSires da Zalas (

Trgunavs gvirgvinovan sisxlZarRvebze amcirebs energoxarjvas); aviwrovebs
parasimpaTikuri sistemis efeqts. gvirgvinovan sisxlZrRvebs, rac
afarToebs gvirgvinovan sisxlZarRvebs dakavSirebulia energoxarjvis daqveiTebul
moTxovnasTan

filtvebi Trgunavs parasimpaTikuri sistemis Aviwroebs bronqebs (amcirebs energoxarjvas

efeqts, ris Sedegadac xdeba bronqebis da aZlierebs bronqebis sekrecias)
gafarToeba da sekreciis Semcireba, rac
zrdis airTa cvlas.

saWmlis momnelebeli traqti Trgunavs peristaltikas da aviwrovebs aZlierebs peristaltikas da saWmlis

saWmlis momnelebeli traqtis momnelebeli wvenebis sekrecias; kumSavs
sisxlZzrRvebsise, rom sisxli swor nawlavs. Trgunavs SigniTaspinqteris
gadanawildeba ConCxis kunTebSi unars, rom gamoiwvios defekacia

RviZli da naRvlis buSti aZlierebs glikogenolizs glukozis iwvevs glikogenis warmoqmnasa da Senaxvas.
warmoqmniT (momatebuli
energoxarjvasTan dakavSirebiT) amcirebs naRvlis sekrecias

saSarde sistema Tirkmlis sisxlZarRvebis Seviwroeba Trgunavs Sardis buStis SigniTa spinqteris
amcirebs Sardis warmoqmnas; Sardis SekumSvas; kumSavs Sardis buSts da iwvevs
buStis SigniTa spinqteri ikumSeba, rom Sardvas.
Seakavos Sardi

sasqeso sistema iwvevs eiakulacias da sisxlZarRvTa iwvevs gareTa genitaliebis ereqtiluri

Seviwroebas, risi Sedegic aris ereqciis qsovilebis ereqcias
daqveiTeba

Tirkmelzeda jirkvlis tvinovani gamoamTavisuflebs adrenalins sisxlSi Ara aqvs efeqti (ar inervirdeba)
nivTiereba

klinikuri anatomia 38
 samedicino radiologia radiologiurad gaumWirvalea, xolo
naklebadmkvrivi gamWirvale.
Crdilis warmoqmnis bevri principi
radiologiuri anatomia Seiswavlis sxeulis gamoyenebulia rentgenologiaSi, rodesac Tqven
struqturasa da funqcias samedicino sxivuri akeTebT sakuTari xelis Crdils kedelze, Crdili
diagnostikis teqnikis gamoyenebiT. is nelnela xdeba ufro mkveTri xdeba Tu Tqveni xeli kedelTan
anatomiis mniSvnelovani nawili da warmoadgens axlosaa da piriqiT. radiografebi
radiologiis anatomiur safuZvlebs. igi warmoadgens rentgenografiuli kvlevisas pacientis sxeulis
samdicino mecnierebis nawils, romelic daavadebis gamosakvlev nawilebs aTavseben rac SeiZleba axlos
mkurnalobasa da diagnostikaSi iyenebs sxivur rentgenis firTan an deteqtorTan, raTa miRebuli
energias. Tu SevZlebT sxivuri diagnostikiT iqnas mkveTri suraTi da Tavidan iqnas acilebuli
miRebul suraTebze normaluri struqturebis artefaqtebi. rentgenologiur terminologiaSi ukana-
identificirebas, gagviadvileba daavadebiT an wina proeqcia ewodeba iseT rentgenogramas, rodesac
dazianebiT gamowveuli cvlilebebis gamocnobac. sxivi gaivlis pacientis uknidan wina mimarTulebiT.
samedicino praqtikaSi sxivuri diagnostikis teqnikis am dros rentgenis milaki moTavsebulia pacientis
codna gvexmareba davadginoT Tandayolili ukan, xolo firi ki win sur. 1-46a. wina-ukana
anomaliebi, simsivneebi da motexilobebi. yvelaze proeqciis SemTxvevaSi yvelaferi piriqiT xdeba.
xSirad iyeneben orive proeqciis dros rentgenogramebis
• rutinuli rentgenografia daTvaliereba xdeba TiTqos Tqven da pacienti
erTmaneTTan pirispir dgaxarT (am dros pacientis
• kompiuteruli tomografia (kt)
marjvena mxare Tqveni marcxena mxris sapirispirod
• ultrabgera dgas). es Seesabameba wina-ukana proeqcias (gulis da
• magnitur rezonansuli tomografia (mrt) filtvebis standartuli rentgenografia
• birTvuli energia (protonul emisiuri warmoadgens ukana-wina proeqciis wina-ukana xeds).
tomografia – scintiografia) lateraluri rentgenogramebisTvis gaumWirvale
miuxedavad imisa rom aRniSnuli meTodebi asoebi (R an L) gamoiyeneba marjvena an marcxena
erTmaneTisagan teqnikurad gansxvavdeba. maT saerTo mxaris aRsaniSnavad. igi edeba firs an deteqtors da
aqvT is rom isini iyeneben sxvadsxva energiis sxivs miRebuli gamosaxulebis daTvaliereba xdeba sxivis
da talRas, romelic sxeulSi gavlis an arekvlis proeqciis mimarTulebiT sur. 1-46b.
Semdeg iZleva mis gamosaxulebas. samedicino kontrastuli masebis gamoyeneba (iseTi
radiologia cocxali adamianis anatomiuri rentgenologiurad gaumWirvale siTxeebis,
struqturebis Seswavlis saSualebas iZleva. am rogoricaa iodis SenaerTebi an bariumi) saSualebas
meTodiT aseve SesaZlebelia gamokvleuli iqnas iZleva Seswavlil iqnas sxvadasxva Rruiani
amaTu im organos funqciuri mdgomareoba. organoebi, sisxlZarRvebi da sivrceebi, iseTebi
rogoricaa saWmlis momnelebeli sistema,
rentgenografia sisxlZarRvebi, Tirkmeli, sinovialuri Rruebi da
nobelis premiis laureatma. germanelma subaraqnoiduli sivrce, romlis vizualizacia
fizikosma vilhelm rentgenma 1895wels aRmoaCIna kontrastis gareSe SeuZlebelia (sur. 1-47).
rentgenis sxivebi. misma aRmoCenam saSualeba mogvca radiologiuri gamokvlevebis umetesoba tardeba
dagveTvalierebina cocxali adamianis ConCxi. minimum erTmaneTisagan marTi kuTxiT ganlagebul 2
miRebul suraTebs klinikaSi rentgenogramebs proeqciaSi. radgan, rentgenograma warmoadgens
uwodeben sur. 1-44. rentgenologiuri gamokvlevisas samganzomilebiani struqturis organzomilebian
maRalSeRwevadi rentgenis sxivis meSveobiT xdeba suraTs, amitom rentgenogramebze xdeba sxvadasxva
pacientis gaSuqeba, Sedegad rentgenologiur firze struqturis zeddeba. aqedan gamomdinare
an monitorze miiReba sxvadasxva gamWirvalobis mqone paTologiis swori lokalizaciis mizniT saWiro
suraTi, romelic Seesabameba sxeulis sxvadasxva xdeba erTze meti proeqciis gadaReba.
struqturas sur. 1-45. qsovili an organo, romelic
SedarebiT mkvrivia (magaliTad, kompaqturi Zvali) kompiuteruli tomografia (kt)
STanTqavs an aireklavs ufro meti raodenobiT kompiuteruli tomografia warmoadgens
rentgenis sxivebs, vidre naklebad mkvrivi qsovili sxeulis skanirebiT miRebul rentgenografiul
(magaliTad, Rrublovani Zvali). Sedegad mkvrivi suraTs, romelic Seesabameba ganiv anatomiur
qsovili an organo rentgenis firze warmoqmnis ganakveTs sur. 1-48. am teqnikis gamoyenebisas
gamWirvale ares, radgan firze an deteqtorze xvdeba rentgenis milaki da deteqtori brunavs sxeulis
naklebi raodenobis rentgenis sxivi. amitom, RerZis garSemo, izomeba, Caiwereba da kompiuterulad
SedarebiT naklebi vercxlis marcvlebi warmoiqmneba muSavdeba sxivuri energiis absorbciis maCveneblebi.
firze misi gamJRavnebis dros. mkvrivi qsovilebi Sedegad ganisazRvreba yoveli moculobiTi
elementis (voqselis) radiosimkvrive. yoveli

klinikuri anatomia 39
voqselis radiosimkvrive ganisazRvreba sxvadasxva ultrasonografiis gamoyeneba meanobaSi
faqtoriT, romelic moicavs am elementSi Semavali saSualebas iZleva arainvaziuri, usafrTxo meTodiT
gazebis, wylis, cximis an Zvlis Semcvelobas. gamokvleul iqnas nayofisa da dedis mdgomareoba.
kompiuteri gadaitans voqselebis mniSvnelobebs
monitorze an firze. kt suraTebze, martivi magnitur-rezonansuli tomografia
rentgenogramebis msgavsad, mkvrivi struqturebi
aisaxeba gamWirivaled da piriqiT sur. 1-48. kt-ze magniturrezonansuli tomografia iZleva kt
gamoisaxeba suraTi, TiTqosda damkvirvebeli idges magvar suraTebs, Tumca mrt meSveobiT miiRweva
pacientis fexebTan. qsovilebis ukeTesi diferencireba. mrt Sedegad
miRebuli gamosaxulebebi axlos dgas anatomiur
ultrasonografia gamosaxulebebTan sur. 1-50. sakvlevi piri Tavsdeba
ultrasonografia, anu eqografia, warmoadgens Zlieri magnituri velis mqone skanerSi.
ultrabgeriTi talRebis areklvis saSualebiT radiotalRebis areklvis Sedegad miRebuli
zedapiruli an Rrma struqturebis vizualizaciis infromacia muSavdeba kompiuteris meSveobiT da
meTods sur. 1-49. kt-sa da mrt-sTan SedarebiT miiReba gamosaxuleba.
ultrasonografia ufro iafi meTodia da qsovilSi arsebuli Tavisfali protonebi
Sesabamisad, aparatura ufro portatuli. gamokvleva lagdebian Zlier magnitur velSi da aigznebian
SeiZleba Catardes TiTqmis yvelgan – klinikis radiotalRebis impulsis zemoqmedebiT. protonebis
sakvlev kabinetSi, sawolTan an saoperacio sawyis mdgomareobaSi dabrunebisas mcire magram
magidasTan. xelsawyo warmoqmnis maRali sixSiris gazomvadi energia gamoiyofa, romelic fiqsirdeba
bgeriT talRebs, romlebic sxvadasxva struqturis mimRebSi. qsovili, romelic Seicavs didi
qsovilidan sxvadasxvagvarad airekleba. sxeulidan raodenobiT protonebs, mag. rogoricaa cximi da
miRebuli eqo Caiwereba mimRebze da gardaiqmneba wyali, gamoyofs meti raodenobiT energia, vidre sxva
gamosaxulebad. Sedegad miiReba ganivkveTis suraTi. qsovilebi. qsovilidan wamosuli signali efuZneba
aRniSnuli gamosaxuleba SeiZleba davaTvalieroT protonebis sam Tvisebas: T1 relaqsaciis, T2
realur droSi an moxdes misi Cawera. relaqsaciis da protonebis simkvrives. miuxedavad
ultrabgeriTi gamokvlevis mTavar imisa, rom siTxeSi didi raodenobiTaa Tavisufali
upiratesobas warmoadgens gamosaxulebis realur protonebi, moZrav siTxeSi agznebuli protonebi
droSi miRebis SesaZlebloba. Sesabamisad, Cven gadian velidan manam sanam isini moaswreben energiis
SegviZlia davakvirdeT sisxlZarRvebSi struqtuebis da Sesabamisad signalis gamocemas. amitom sisxli
moZraobas da sisxlis dinebas. dopleris mrt suraTze Cans Savad.
ultrabgeriT aparatSi STanTqmuli da areklili kompiuterebi, romlebic dakavSirebulia mrt
ultrabgeriTi talRebis sixSireebs Soris skanerTan, miRebuli monacemebis safuZvelze qmnian
gansxvavebis mixedviT SeiZleba ganisazRvros moZravi qsovilis rekonstruqciul suraTebs. maT SeuZliaT
obieqtis siCqare. es teqnika emyareba dopleris Seqmnan adamianis sxeulis ganivi, sagitaluri,
efeqtis princips. sisxlis dineba sisxlZarRvebSi frontaluri, medialuri da SedarebiT iribi
gamoisaxeba ferebSi, romelic zed edeba Wrilebis suraTebic ki. monacemebi SeiZleba
organzomilebian gamosaxulebas. gamoyenebuli iqnas samganzomilebiani
menjis visceraluri organoebis rekonstruqciebis miRebisaTvis. mrt saSualebiT
daTvaliereba SesaZlebeli xdeba savse Sardis miiReba rbili qsovilebis kargi gamosaxulebebi
buStis pirobebSi. Sardi am SemTxvevaSi asrulebs maionizebeli radiaciis gamoyenebis gareSe. pacientis
akustikuri fanjris rols, atarebs ra minimaluri moZraobebi problemas uqmnida pirveli Taobis
xarvezebiT bgeriT talRebs mis ukan ganlagebuli skanerebs, Tumca ukanasknel periodSi zeswrafi
menjis visceraluri organoebisaken da ukan. savse skanerebis Seqmnam moZravi struqturebis realur
Sardis buSti aseve gadaswevs airiT saves nawlavis droSi vizualizaciis saSualeba, mogvca (magaliTad,
maryuJebs menjis Rrudan. transvaginaluri gulis da sisxlis dinebis).
ultrabgeriTi gamokvleva saSualebas iZleva mimRebi
maqsimalurad axlos mivitanoT sakvlev organomde birTvuli medicina
(mag. sakvercxe), aseve igi Tavidan gvacilebs birTvuli medicinis gamosaxulebis teqnika
cximovani qsoviliTa da airebiT gamowveul iZleva informacias organizmSi Seyvanili
xarvezebs. Zvali airisagan gansxvavebiT aireklavs radiaqtiuli substanciebis umciresi raodenobis
TiTqmis yvela ultrabgeras. aqedan gamomdinare ganawilebis da koncentraciis Sesaxeb. birTvuli
zrdasruli adamianis cns-is da filtvebis skanirebis Sedegad miRebul suraTebze aisaxeba
gamokvleva eqoskopiurad SeuZlebelia. intravenurad Seyvanili radiaqtiuli nivTierebis
mcire dozebis lokalizacia. radionuklidebad
gamoyenebulia sxvadasxva elementis izotopi,

klinikuri anatomia 40
romelic SerCeviTad STainTqmeba sxvadasxva naxevraddaSlis periodi da gamoyofs pozitrons. pet
organosa da qsovilis mier (mag. technetium-99m skanireba gamoiyeneba organos funqciuri
methylene diphosphonate (99mTc-MDP), romelic gamoiyeneba mdgomareobis SefasebisaTvis, mag. Tavis tvinis. Tavis
Zvlebis skanirebis dros) sur. 1-51. tvinis gazrdili aqtivobis ubnebSi aRiniSneba
pozitronul-emisiuri tomografia (pet) izotopis seleqtiuri dagroveba. Sedegad SeiZleba
iyenebs ciklotroniT miRebul izotopebs, miviRoT mTliani organos an misi ganivkveTis suraTi.
romlebsac aqvT gansakuTrebiT xanmokle

Sejameba: samedicino radiologia saSualebas samedicino rdiologiis mtavar mizans warmoadgens

iZleva moxdes cocxali organizmis vizualizacias. paTologiuri mdgomareobis vizualizacia. amasTan,
am dros Cven vakvirdebiT struqturebs, romlebic radiologiuri anatomiis codna aucilebelia, raTa
imyofebian normaluri tonusis, moculobis, Sinagani SevZloT normaluri da paTologiuri mdgomareobis
wnevis das xv. pirobebSi. es SeuZlebelia gvamis diferencireba.
daTvalierebis dros. amasTan, raTqma unda

klinikuri anatomia 41