11.11
Der Thoraxkorb: Brustbein
Der thorakale oder Rippenkorb bildet den Thorax (Brust) des Körpers. Seine Hauptfunktion besteht darin, lebenswichtige Organe in der thorakalen Höhle,…
Das Brustbein ist ein T-förmiger flacher Knochen in der vorderen Mittellinie der Brustwand, der mit dem Brustkorb verbunden ist. Es schützt die Brustorgane und heftet sich an verschiedene Muskeln.
Er entsteht durch die Verschmelzung von drei Knochen: dem Manubrium, dem Körper und dem Xiphoid-Prozess.
Das Manubrium setzt an den Schlüsselbeinen an der Schlüsselbeinkerbe an und artikuliert mit den ersten beiden Rippenpaaren.
Der Körper verbindet sich mit dem Manubrium im sternalen Winkel. Seine gekerbten Seiten artikulieren mit den Rippenknorpeln des zweiten bis siebten Rippenpaares.
Der Xiphoid-Prozess verschmilzt mit dem Körper am Xiphisternalgelenk. Er ist in erster Linie knorpelig und wird nach dem vierzigsten Lebensjahr verknöchert. Er befindet sich auf der neunten Ebene des Brustwirbels, wo er an das Zwerchfell und den Musculus rectus abdominis anbindet. Unterhalb dieses Gelenks liegt das Herz.
Bei der Herz-Lungen-Wiederbelebung oder HLW werden die Hände in der Mitte des Brustbeins platziert, während der Brustkorb zusammengedrückt wird. Dadurch wird jeder physische Schub verhindert, der den Xiphoid-Prozess unterbrechen und in das Herz oder die Leber drücken kann, was zu schweren Blutungen führen kann.
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Q1: What are the three main parts of the sternum?
The sternum consists of three fused bones: the manubrium, body, and xiphoid process. The manubrium is the broader superior portion where the first rib pair attaches. The body is the elongated central section articulating with ribs 3–7. The xiphoid process is the inferior cartilaginous tip that gradually ossifies with age after forty.
Q2: Where does the sternum attach to the rib cage?
The sternum connects to the thoracic cage through multiple articulation points. The manubrium attaches to the first two rib pairs at the clavicular notch and sternal angle. The body articulates with costal cartilages of ribs 2–7 along its notched sides. The xiphoid process fuses with the body at the xiphisternal joint, located at the ninth thoracic vertebrae level.
Q3: What is the sternal angle and why is it anatomically important?
The sternal angle is the slightly bent junction where the manubrium and body meet. The second rib attaches at this landmark. Since the first rib is hidden behind the clavicle, the sternal angle and second rib serve as essential palpable landmarks for identifying and counting the lower ribs during physical examination.
Q4: What protective functions does the sternum provide?
The sternum protects vital thoracic organs including the heart and lungs as part of the thoracic cage structure. It forms the anterior midline of the thoracic wall and connects to muscles including the diaphragm and rectus abdominis. The heart lies directly below the xiphisternal joint, making proper sternum anatomy critical during medical procedures like CPR.
Q5: Why is xiphoid process fracture dangerous during CPR?
During cardiopulmonary resuscitation, hands are placed mid-sternum to avoid fracturing the xiphoid process. If broken, the xiphoid process can be thrust into the heart or liver, causing severe internal bleeding. Proper hand placement prevents this injury while allowing effective chest compression to circulate blood during cardiac emergencies.
Q6: How does the xiphoid process change with age?
The xiphoid process is primarily cartilaginous early in life, making it flexible and vulnerable to injury. Gradually with age, it undergoes ossification, becoming bone. This process is typically complete after age forty, transforming the xiphoid process from a soft cartilaginous structure into a rigid bony landmark.
Q7: What anatomical landmarks help identify the sternum during physical examination?
The jugular notch is a shallow U-shaped depression at the top of the manubrium, easily felt at the anterior base of the neck between the medial clavicle ends. The clavicular notches are shallow depressions on the manubrium's superior-lateral margins marking the sternoclavicular joints. These landmarks allow clinicians to locate and palpate the sternum accurately during examination.