03/10/2011 SISTEM SKE K LE L TAL A L TU T LA L NG & & SE S N E D N I 1

SISTEM

SISTEM SKELETAL

SKELETAL

TULANG

Functions of the Bones

1. Support (penyokong)

2. Protection (pelindung)

3. Movement (gerakan)

4. Storage (deposit)

5. Hematopoiesis

2 Jenis Tulang

Tulang keras (Compacta)

KLASIFIKASI TULANG

•• Menurut strukturnya:Menurut strukturnya:

1. compact = masa solid; padat & keras = membentuk lapisan luar struktur tulang = unit fungsionil --- Sistem Havers 2. cancellous or spongy = berongga pada tulang bersumsum

CLASSIFICATION of BONES

•• Menurut BentukMenurut Bentuk

1.

1. Tulang panjang Tulang panjang = = ukuran panjang lebih besar ukuran panjang lebih besar dibanding lebarnya

dibanding lebarnya =

= Terdiri Terdiri ((diaphysisdiaphysis) & (epiphysis)) & (epiphysis)

diaphysis

diaphysis = = terisi sumsum kuningterisi sumsum kuning =

= cylindrical, large space or canal at the cylindrical, large space or canal at the centercenter =

= periosteumperiosteum

epiphysis

epiphysis = = dibangun oleh jaringan dibangun oleh jaringan cancellouscancellous e.g.: femur,

e.g.: femur, humerushumerus, tibia, fibula, radius, ulna, phalanges, tibia, fibula, radius, ulna, phalanges

Membranes

Membranes: : 1. 1. periosteumperiosteum 2.

2. endosteumendosteum

cont’n.

•• Menurut BentuknyaMenurut Bentuknya 2.

2. Tulang pendek Tulang pendek = = bentuk kuboidbentuk kuboid =

= tulang tulang spongy spongy dengan sedikit lapisan tulang dengan sedikit lapisan tulang keras

keras =

= tulang tulang sesamoidsesamoid ---- tulangnya pendek melekat di tulangnya pendek melekat di tendo

tendo e.g.: patellae.g.: patella

e.g.: carpals (wrist), tarsal (ankle) bones e.g.: carpals (wrist), tarsal (ankle) bones

3.

3. Tulang pipih Tulang pipih = = lebarlebar or or pipih panjangpipih panjang =

= proteksi proteksi & & perlekatan ototperlekatan otot Komposisi

Komposisi : 2 : 2 lapisan tipis tulang keras membungkus lapisan tipis tulang keras membungkus tulang

tulang spongyspongy

e.g.: bones of the skull, sternum, ribs, scapula e.g.: bones of the skull, sternum, ribs, scapula

cont’n.

•• Menurut bentukMenurut bentuk 4.

4. TulangTulangIrregular Irregular = = Yang tidak termasuk 3 Yang tidak termasuk 3 klasifikasi tulang sebelumnya

klasifikasi tulang sebelumnya e.g.:

e.g.: vertebraevertebrae pelvic bones pelvic bones

bones of the base of the skull bones of the base of the skull

KLASIFIKASI TULANG

cont’n.

•• Menurut perkembangannya:Menurut perkembangannya: 1. MembraMembraosaosa = = seperti membran seperti membran fibrofibrosasa,,

calcium gradually deposited until structure calcium gradually deposited until structure becomes ossified

becomes ossified

intramembranousintramembranous ossificationossification e.g.: bones of the skull, mandible

e.g.: bones of the skull, mandible 2.

2. CartilagenoCartilagenosasa = starts as cartilage, gradually ossified= starts as cartilage, gradually ossified enchondral

enchondral or or intracartilagenousintracartilagenous ossification.ossification. e.g.: long bones

CLASSIFICATION of BONES

cont’n. •• Menurut Lokasinya: Menurut Lokasinya:

A X I A L

A X I A L

skull skull 2222 hyoid hyoid 11 ossicles ossicles 66 vertebrae vertebrae 2626

ribs & sternum ribs & sternum 25_25_

80 80

cont’n.

•• Menurut lokasinya :Menurut lokasinya :

APPENDICULAR

APPENDICULAR

Upper Extremities

Upper Extremities Lower ExtremitiesLower Extremities

clavicle

clavicle 22 hip bonehip bone 22 scapulae

scapulae 22 femurfemur 22

humerus

humerus 22 patellapatella 22

radius

radius 22 tibiatibia 22

ulna

ulna 22 fibulafibula 22

carpals

carpals 1616 tarsalstarsals 1414 metacarpals 10

metacarpals 10 metatarsals metatarsals 1010 phalanges

phalanges 28__28__ phalanges phalanges 28__28__ 64

Fig. 6.10

Table. 6.2

KERANGKA AKSIAL

I.

I. TENGKORAKTENGKORAK

= skeleton

= skeleton --- kepalakepala & & wajahwajah =

= pipihpipih & irregular& irregular =

= gabungan berbagai sendigabungan berbagai sendi by joints (sutures)by joints (sutures) cranium

cranium ---- tengkorak non mandibularetengkorak non mandibulare

calvarium

calvarium ---- tengkorak termasuk tulang wajahtengkorak termasuk tulang wajah

cavities:

cavities: a. Cranial a. Cranial -- berisi otakberisi otak b. Orbital

b. Orbital -- berisi bola mataberisi bola mata & organ

& organ asesorisasesoris c. nasal

Fig. 6.14

PEMBAGIAN TULANG TENGKORAK

a.

a. Cerebral / cranial bones / brain case (8 bones)Cerebral / cranial bones / brain case (8 bones)

unpaired (4)

unpaired (4) paired (4)paired (4)

1. occipital

1. occipital 1. parietal1. parietal 2. frontal

2. frontal 2. temporal2. temporal 3. sphenoid

3. sphenoid 4.

4. ethmoidethmoid

b.

b. Facial or visceral craniumFacial or visceral cranium

paired (12)

paired (12) unpaired (2)unpaired (2)

a. Nasal

a. Nasal a. a. VomerVomer b.

b. LacrimalLacrimal b. Mandibleb. Mandible c. Maxilla

c. Maxilla d.

d. ZygomaticZygomatic / / malarmalar / cheek bones/ cheek bones e. Palatine

e. Palatine f. Inferior nasal

f. Inferior nasal conchaconcha or turbinateor turbinate

The uppermost portion of the human respiratory system, the nose is a The uppermost portion of the human respiratory system, the nose is a The uppermost portion of the human respiratory system, the nose is a The uppermost portion of the human respiratory system, the nose is a hollow air passage that functions in breathing and in the sense of hollow air passage that functions in breathing and in the sense of hollow air passage that functions in breathing and in the sense of hollow air passage that functions in breathing and in the sense of smell. The nasal cavity moistens and warms incoming air, while small smell. The nasal cavity moistens and warms incoming air, while small smell. The nasal cavity moistens and warms incoming air, while small smell. The nasal cavity moistens and warms incoming air, while small hairs and mucus filter out harmful particles and micro

hairs and mucus filter out harmful particles and micro hairs and mucus filter out harmful particles and micro

hairs and mucus filter out harmful particles and micro----organisms. This organisms. This organisms. This organisms. This illustration depicts the interior of the human nose.

illustration depicts the interior of the human nose. illustration depicts the interior of the human nose. illustration depicts the interior of the human nose.

Fig. 6.13

Fontanelle

=

= membran yang mengandung ruangmembran yang mengandung ruang terang untuk terang untuk newborn infants

newborn infants

e.g.:

e.g.: 1. 1. anterior anterior = largest= largest 2.

2. posterior posterior 3.

3. anterolateralanterolateral ((sphenoidalsphenoidal)) 4.

KERANGKA AXIAL

I.

I. HYOID BONE HYOID BONE

=

= berbentuk Uberbentuk U; ; terletak di bagian depan leherterletak di bagian depan leher =

= perlekatan dasar lidahperlekatan dasar lidah =

= ada diantara ada diantara mandibmandibuullaa & & kartilago kartilago thyroid thyroid

II.

II. OSSICLESOSSICLES

=

= tulang pada telingantulang pada telingan

a. Stapes (stirrup) a. Stapes (stirrup) 22 b.

b. IncusIncus (anvil)(anvil) 22 c.

c. MalleusMalleus (hammer)(hammer) 22

AXIAL SKELETON

I.

I. VERTEBRAL COLUMNVERTEBRAL COLUMN

=

= panjangpanjang, , kurvekurve, , gerakan sedikitgerakan sedikit =

= persatuan oleh persatuan oleh cartilage & ligamentscartilage & ligaments =

= panjang panjang 71 71 –– 75 cm.75 cm.

=

= dibentuk oleh tulangdibentuk oleh tulang----tulangtulang vertebraevertebrae

FUNCTION: FUNCTION:

1.1. penopang badanpenopang badan 2.

2. berisiberisi & & melindungi spinal kord melindungi spinal kord & & serabut saraf

VERTEBRAL COLUMN VERTEBRAL COLUMN

Ruas vertebra

Ruas vertebra youngyoung adultadult cervical cervical 77 77 Thoracic Thoracic 1212 1212 lumbar lumbar 55 55 sacral sacral 55 1 1 coccygeal coccygeal 4 4 1 1 33 33 2626 Diskusb

Diskusb IntervertebralIntervertebral= = pipih terdiri pipih terdiri atas

atas fibrocartilagefibrocartilage terletak terletak antara permukaan badan antara permukaan badan vertebrta

vertebrta Fungsi

Fungsi :: 1. 1. menyambung antar menyambung antar vertebta

vertebta 2.

2. bantalan (bantalan ( shock absorbershock absorber)) 3. flexibility & g

3. flexibility & gerakan erakan kolumna vertebra

kolumna vertebra

VERTEBRAL COLUMN VERTEBRAL COLUMN

General parts of vertebrae General parts of vertebrae

1. body

1. body 5. transverse process5. transverse process 2. arch

2. arch 6. 6. articulararticular processprocess 3. pedicle or root

3. pedicle or root 7. 7. spinousspinous processprocess 4. lamina

Ciri

Ciri--ciri bagian tulag vertebraciri bagian tulag vertebra

a. vertebrae

a. vertebrae servikalservikal (7)(7) = = membentuk kerangka lehermembentuk kerangka leher, , semua meimiliki semua meimiliki fotramen

fotramen

atypical vertebrae

atypical vertebrae servikalservikal: : 1. atlas

1. atlas ---- 11st st 2. axis or

2. axis or epistropheusepistropheus = 2= 2nd nd 3. 7

3. 7thth _{vertebraevertebrae servikalservikal = = spinousspinous process process sempit sempit , , foramen foramen} transversus kecil

transversus kecil

b. Thoracic vertebrae (12)

b. Thoracic vertebrae (12) = = selubung dadaselubung dada-- perlekatan igaperlekatan iga--igaiga = circular vertebral canal

= circular vertebral canal

Special characteristics of individual vertebrae Special characteristics of individual vertebrae cont’ncont’n

c. Lumbar vertebrae (5)

c. Lumbar vertebrae (5) = presence of = presence of mamillarymamillary & accessory processes& accessory processes = triangular vertebral foramen

= triangular vertebral foramen

d. Sacrum

d. Sacrum = = tulang tulang triangular triangular menghubungan tulang panggulmenghubungan tulang panggul

e.

e. CoccygealCoccygeal vertebrae (1)vertebrae (1) = 4 = 4 tulang tulang vertebraevertebrae inkomplit inkomplit bersatu membentuk ekor /

AXIAL SKELETON

I.

I. STERNUM (STERNUM (tulang dadatulang dada))

=

= tulang pipihtulang pipih, , dinding anterodinding antero--posterior posterior dinding toraks

dinding toraks =

= terdiri atas 2 tulang terdiri atas 2 tulang compact compact dengan lapisan dengan lapisan tulang

tulang spongy spongy mengandung sumsum merah mengandung sumsum merah

Bagian Bagian--bagiannyabagiannya:: a. a. ManubriumManubrium b. Corpus or body b. Corpus or body c.

AXIAL SKELETON

I.

I. IGAIGA--IGAIGA (12 pairs)(12 pairs)

=

= tulang pipih dengan lengkung dan 2 ujungtulang pipih dengan lengkung dan 2 ujung

1. vertebral

1. vertebral -- posterior; posterior; perlekatan perlekatan toratoraksks 2.

2. sternalsternal -- anterior; anterior; perlekatan perlekatan costal costal cartilagescartilages Classification of ribs:

Classification of ribs:

a.

a. SternalSternal or true ribs (1or true ribs (1stst_{to 7to 7}thth₎₎

-- ribs whose costal cartilages are directly ribs whose costal cartilages are directly attached to sternum

attached to sternum

b.

b. AsternalAsternal or false ribs (8or false ribs (8thth _{to 12to 12}thth₎₎

-- ribs whose costal cartilages are not attached ribs whose costal cartilages are not attached directly to the sternum but to 7

directly to the sternum but to 7thth

subdivisions:

subdivisions: 1. false rib proper 1. false rib proper -- 88thth_{, 9, 9}thth_{, 10, 10}thth_ribsribs

2. floating or hanging ribs

2. floating or hanging ribs –– 1111thth_{& 12& 12}thth

APPENDICULAR SKELETON

BONES of the UPPER BONES of the UPPER

EXTREMITY (UE EXTREMITY (UE))

1

1.. Clavicle (collar bone)Clavicle (collar bone) 2.

2. Scapula (shoulder Scapula (shoulder blade)

blade) –– articulates with articulates with humerus

humerus & clavicle& clavicle 3.

3. Humerus (arm bone) Humerus (arm bone) --longest & largest

longest & largest bone of UE bone of UE articulates with articulates with scapula (above) scapula (above) radius & ulna radius & ulna (below)

(below)

4.

4.

Radius

Radius -- lateral

lateral

bone of the

bone of the

forearm; cup

forearm;

cup--shaped head

shaped head

5.

5.

Ulna

Ulna -- principal

principal

bone of the

bone of the

forearm;

forearm;

longer & larger

longer & larger

than radius

BONES of the UPPER EXTREMITY BONES of the UPPER EXTREMITY

(UE)

(UE) cont’ncont’n

6.

6. Carpals (wrist bone) Carpals (wrist bone) -- 8 8 bones arranged into 2 rows bones arranged into 2 rows

-- proximal & distal rows proximal & distal rows 7.

7. Metacarpals (bones of the Metacarpals (bones of the hand)

hand) -- 5 long bones 5 long bones placed between carpals & placed between carpals & phalanges

phalanges

-- numbered from lateral numbered from lateral to medial

to medial 8.

8. Phalanges Phalanges (bones of the (bones of the fingers) = 14 long bones of fingers) = 14 long bones of the fingers

the fingers ---- 3 bones except 3 bones except thumb

thumb -- 2 bones2 bones

APPENDICULAR

SKELETON

BONES of the LOWER BONES of the LOWER

EXTREMITY (LE) EXTREMITY (LE)

1.

1. Tulang PANGGULTulang PANGGUL ((innominateinnominate bone)

bone)

Tulang panggul kanan & kiri Tulang panggul kanan & kiri + sacrum =

+ sacrum = lingkar panggullingkar panggul 3

3 bones: bones: 11. . iliumilium** 2

2. . ischiumischium** 3

3. pubis*. pubis*

Male Pelvic Girdle Female Pelvic Girdle

Fig. 6.32

2. Femur (

2. Femur (pahapaha) = ) = paling paling panjang

panjang, , kuatkuat, , terbesarterbesar 3. Tibia (

3. Tibia (tulang keringtulang kering) = ) = tulang panjang

tulang panjang; ; anterior, medial, & anterior, medial, & lebih besar dari fibula lebih besar dari fibula 4. Fibula (

4. Fibula (peronealperoneal bone) = bone) = panjang ramping sejajar panjang ramping sejajar tibia

Fig. 6.34

KERANGKA APPENDICULAR

TULANG EKSATREMITAS

TULANG EKSATREMITAS BAWAH

BAWAH cont’ncont’n

5.

5. TarsalsTarsals (ankle bone) = (ankle bone) = tulang pendek

tulang pendek; ;

2 2 barisbaris: : internal internal &

& externalexternal

6. Metatarsals (bones of 6. Metatarsals (bones of

foot) = 5

foot) = 5 tulang tulang panjang

panjang

dihitung dari dihitung dari medial

medial to lateralto lateral 7. Phalanges (bones of 7. Phalanges (bones of

toes) =

Fig. 6.35

Common Fractures greenstick

greenstick greenstick

greenstickfracturefracturefracturefracture

= the bone does not break = the bone does not break = the bone does not break = the bone does not break all of the way through. all of the way through. all of the way through. all of the way through. simple,

simple, simple,

simple,or or or or closedclosedclosedclosed =

= =

= when the bone breaks but when the bone breaks but when the bone breaks but when the bone breaks but the skin does not.

the skin does not. the skin does not. the skin does not.

compound, compound, compound,

compound,or or or or open open open open

= when the broken bone = when the broken bone = when the broken bone = when the broken bone tears through the skin, tears through the skin, tears through the skin, tears through the skin, introducing the dangerous introducing the dangerous introducing the dangerous introducing the dangerous possibility of infection. possibility of infection. possibility of infection. possibility of infection. The area around a break The area around a break The area around a break The area around a break swells and discolors, but swells and discolors, but swells and discolors, but swells and discolors, but some fractures can be some fractures can be some fractures can be some fractures can be detected only by X detected only by X detected only by X detected only by X----ray. ray. ray. ray. The weakened bones of the The weakened bones of the The weakened bones of the The weakened bones of the elderly are especially elderly are especially elderly are especially elderly are especially

Fig. 6B

Bone Deformation

Rickets Rickets Rickets

Rickets can result from can result from can result from can result from

insufficient vitamin D in the diet insufficient vitamin D in the diet insufficient vitamin D in the diet insufficient vitamin D in the diet or from insufficient amounts of or from insufficient amounts of or from insufficient amounts of or from insufficient amounts of ultraviolet radiation from the ultraviolet radiation from the ultraviolet radiation from the ultraviolet radiation from the sun.

sun. sun. sun.

It can lead to skeletal It can lead to skeletal It can lead to skeletal It can lead to skeletal

deformation, such as vertebral deformation, such as vertebral deformation, such as vertebral deformation, such as vertebral or leg curvature. or leg curvature. or leg curvature. or leg curvature.

Sendi

•

Persambungan/ artikulasio :

pertemuan antara dua atau lebih

dari tulang rangka.

•

Artrologi: ilmu yang mempelajari

65

3

Jenis Sendi Berdasarkan

strukturnya

• Fibrosa: hubungan antar sendi oleh jaringan fibrosa • Kartilago/tulang rawan: ruang antar sendinya berikatan

dengan tulang rawan.

• Sinovial/sinovial joint: ada ruang sendi dan ligament untuk mempertahankan persendian.

66

Sendi berdasarkan jenis

persambungannya

Sinartrosis

Sendi yang terdapat kesinambungan krn di antara kedua ujung tulang yang bersendi tdp suatu jaringan

Diartrosis

Sendi terdapat ketidak-sinambungan karena di antara tulang yg bersendi terdapat rongga (cavum

67

S

i

n

a

r

t

r

o

s

i

s

1. Syndesmosis: jaringan penghubungnya mrp

jaringan ikat

a

.

Sutura

: tepi-tepi tulang dihubungkan oleh

jaringan ikat yg tipis. Cth: di antara

tulang-tulang tengkorak

b.

Schindylesis

:

lempeng pd tulang yg satu

terjepit di dlm celah pada tulang lain. Cth

antara rostrum sphenoid & vomer

c.

Ghomphosis

: tulang yg 1 berbentuk kerucut

masuk ke dalam lekuk yg sesuai dgn bentuk

itu pd tlng lain.Cth: antara gigi dg rahang

d.

Syndesmosis elastica

: jar ikat

penghubungnya

mrp jar ikat elastin. Cth: di antara arc.

Vertebra oleh lig.flavum

e.

Syndesmosis fibrosa

: jar ikat

penghubungnya

mrp serat kolagen. Cth: antara ulna & radius

oleh membran interossa antebrachii

Sinartrosis

2.

Synchondrosis

: jaringan penghubungnya

jaringan tulang rawan. Cth:antara epifisis &

diafisis sebelum penulangan selesai, antara

kedua ossa pubica

3.

Synostosis

: jaringan penghubungnya

jaringan tulang. Cth: antara epifisis & diafisis

setelah penulangan selesai, antara os ilium,

os pubis, dan os ischium

69

Diartrosis

kepala sendi (caput articulare) & lekuk sendi (cavitas glenoidalis)

2. Simpai sendi (capsula articularis): stratum fibrosum (bgn luar) & stratum synoviale (bgn dlm)

3. Rongga sendi (cavum articulare) berisi cairan synovial

4. Alat-alat khusus:

- tendon: membatasi gerak sendi & sbg penyokong

mekanik

- kartilago & bantalan lemak (fat pads): discus &

meniscus articulares sbg alat menerima tumbukan,

penyangga, & untuk mengurangi diskongruen

- kandung sega (bursae mucosae) untuk memudahkan

gerakan sendi

- ligament (accessories, extracapsular, & intracapsular

ligaments)

71

Diartrosis bdskn kemungkinan gerak

1. Sendi kejur (amphiartrosis): kemampuan gerak sangat sedikit -Symphysis; dihubungkan oleh fibrokartilago. Cth: intervertebral

disc, pubic symphysis

2. Articulationes: kemampuan gerak luas a. Sendi sumbu 1

(1) sendi engsel/ hinge joint (ginglymus): sumbu gerak tegak lurus pd

arah panjang tulang. Cth: art.interphalangeae, humero-ulnaris

(2) sendi kisar/ pivot joint (art trochoidea): sumbu gerak kira-kira sesuai dgn arah panjang tulang. Cth:

art.radioulnaris,atlantodentalis

b. Sendi sumbu 2: kedua sumbu gerak berpotongan tegak lurus (1) Sendi telur/ ellipsoidal joint (art. Ellipsoidea): kepala sendi cekung

berbentuk ellipsoid dg sumbu panjang & sumbu pendek. Cth: art.radiocarpae

(2) Sendi pelana/saddle joint (art.sellaris): permukaan sendi berbentuk

pelana; arah sumbu yg 1 permukaannya cembung & arah sumbu yg lain cembung. Cth: art.carpo-metacarpea

Diartrosis bdskn kemungkinan gerak

c. Sendi sumbu 3 (arthroida): kemampuan gerak paling luas; kepala sendi berbentuk bola (1) Sendi peluru/ ball & socket joint (art.

Globoidea): lekuk sendi mencakup kurang dari setengah kepala sendi. Cth: art.humeri (2) Sendi buahpala (enarthrosis

spheroidea): lekuk sendi mencakup lebih dari setengah kepala sendi. Cth: art coxae

75

Penstabil sendi

1. Jaringan kolagen kapsula sendi &

ligamen.

2. Bentuk permukaan sendi →

menentukan gerakan spesifik sendi

3. Adanya tulang lain, otot rangka, &

bantalan lemak pd sendi

4. Tegangan pd tendon yg menempel pd

tulang yang bersendi

Gerakan Sendi

1. Gerakan lurus(linear motion) - gliding 2. Gerakan sudut(angular motion)

* fleksi-ekstensi-hiperekstensi * abduksi-adduksi

* sirkumduksi

3. Gerakan putar(rotation) * rotasi kanan-kiri * rotasi medial-lateral * pronasi-supinasi 4. Gerakan khusus * inversi-eversi * dorsofleksi-plantar fleksi * opposisi * protraksi-retraksi * elevasi-depresi * fleksi lateral

Fig. 6.41abcde