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264 December 2005 1 CE Credit 14 The Surgical TechnologistTable 1: Human embryonic Development in weeks 1–8 Age (days) DECEMBER 2005 1 oocyte fertilization 2–3 morula (4–16 cells) 4 free blastocyst 5–6 attachment of blastocyst to endometrium 7–12 implantation • bilaminar embryo with primary yolk sac 13–15 trilaminar embryo with primitive streak • chorionic villi 16 gastrulation • formation of notochordal process 18 Hensen’s node and primitive pit • notochord and neurenteric canal • appearance of neural plate, neural folds and blood islands 20 appearance of first somites • deep neural groove • elevation of cranial neural folds • early heart tubes 22 beginning of fusion of neural folds • formation of optic sulci • presence of first two pharyngeal arches • beginning of heart beat • curving of embryo 24 closure of cranial neuropore • formation of optic vesicles • rupture of oropharyngeal membrane 26 closure of caudal neuropore • formation of pharyngeal arches 3 and 4 • appearance of upper limb buds and tail bud • formation of otic vesicle 28 appearance of lower limb buds • lens placode • separation of otic vesicle from surface ectoderm Table 1: Human embryonic Development in weeks 1–8 Age (days) 1 oocyte fertilization 2–3 morula (4–16 cells) 4 free blastocyst 5–6 attachment of blastocyst to endometrium 7–12 implantation • bilaminar embryo with primary Embryological Development yolk sac of 13–15 trilaminar embryo Bob Caruthers, with primitive streak • the chorionic villi n the first eight weeks of development, incred 16 gastrulation • formation I ible changes take place that define the struc cle will provide an overview of the development of notochordal process of the musculoskeletalture of the system.human embryo (Table 1). This arti cst Musculoskeletal System cells, originating in different regions of the Skeletal tissue derives from mesenchymal , 18 Hensen’s node and body, and may form connective tissue, blood, p bone and cartilage. One of the common features h d primitive pit • notochord of mesenchymal cells, precursors of skeletal for mation, is their tendency to be displaced some and neurenteric canal • distance from their point of origin. Mesenchy appearance of neural mal cells differentiate into osteoblasts and chon droblasts. Osteoblasts and chondroblasts pro plate, neural folds and duce different extracellular macromolecules. The end result of this process is bone and car blood islands tilage, two types of connective tissue that are related but significantly different. - - - Intraembryonic mesoderm The vast majority of the musculoskeletal system derives from intraembryonic mesoderm, which forms from the epiblast during the process of 20 appearance of first gastrulation. Gastrulation is the process by which the germ layers are formed through cell somites • deep neural movement. The three primary germ layers are groove • elevation of - the ectoderm (outer layer), mesoderm (middle layer), and endoderm (inner layer). 1,2,3,6 cranial neural folds • early - formation, the mesenchymal cells spread later - ally as a continuous layer between the ectoderm heart tubes - and endoderm, dividing into three regions: ● - 22 beginning of fusion of Paraxial mesoderm (somites)—paired seg ments (somitomeres) lying along the primitive neural folds • formation node. At approximately 20 days, somitomeres begin to transform into somites (solid masses of of optic sulci • presence paraxial mesoderm). These will further develop of first two pharyngeal into the vertebral column and muscles. arches • beginning of heart beat • curving of 6 embryo Shortly after 24 closure of cranial neuropore • formation of optic vesicles • rupture - of oropharyngeal membrane - 6 26 closure of caudal neuropore • formation of pharyngeal arches 3 and 4 • appearance of upper limb buds and tail bud • formation of otic vesicle 28 appearance of lower D ecember limb buds • lens placode • 2005 separation of otic The Surgical Technologist vesicle from surface ectoderm 15 264 DecemBER 2005 1 CE credIT ● Intermediate mesoderm—a small cord of but chondroblasts in the centers of chondrification cells lateral to the somites which forms about quickly begin to secrete an extracellular matrix day 22. These cells develop into the urogeni- that is characteristic of cartilage. The chondro- tal system and its related structures. blasts themselves are trapped in the matrix they ● Lateral mesoderm—differentiates into secrete. Once ensnared, they are called chondro- somatic (dorsal layer) and splanchnic (ven- cytes and begin to form cartilage.6 tral layer) mesoderm. The somatic meso- Mature cartilage growth occurs by two derm contributes to the musculature of the means: cell division within the cartilage and the body wall and the limbs. The splanchnic addition of newly differentiated cells onto the mesoderm develops into the mesentery and outer surface. The first type of growth is called walls of the digestive tract.1,3,6 interstitial growth, and it is essential to the growth in length and width of bones. The second Somites develop through a transformation pro- type is called appositional growth. cess in which blocks of segmented cells with mes- Osteogenesis occurs through a different enchymal morphology are changed into a sphere process. Mesenchymal cells differentiate into of epithelial cells. This sphere of epithelial cells osteoblasts. Osteoblasts secrete an extracellular remains within the paraxial mesoderm. This pro- organic matrix, called osteoid, that is later min- cess is initiated by a signal from the overlying eralized into bone. Osteoblasts, like chondro- ectoderm. The epithelial somites divide into two blasts, become entrapped in the secretion prod- structures. The ventral half becomes the sclero- ucts and are called osteocytes.6 tome and the dorsal half, the dermomyotome. The sclerotome forms the vertebral bodies and Intramembranous versus their associated connective tissue elements. The endochondral ossification dermomyotome further splits into two layers, the Bones are formed through two processes: Intra- myotome and the dermatome, which form the membranous ossification and endochondral dermis, connective tissues and skeletal muscles. A ossification. Intramembranous ossification is majority of the axial musculoskeletal system arises the process by which most of the flat bones of the from the sclerotomes, and the rest of the musculo- jaw and skull (excluding the base) are formed. skeletal system develops from the limb bud mes- Intramembranous ossification requires no pre- enchymal cells and lateral somatic mesoderm.6 existing cartilage. These bones form from and replace an embryonic membrane of connective Chondrogenesis and osteogenesis tissue. A periosteum develops in the surface of Chondrogenesis refers to the development of this bone, forming osteoblasts which continue cartilage, and osteogenesis to the development the ossification process. There is a close associa- of bone. Cartilage formation begins with the tion with blood vessels in this process.3,6,7,8 appearance of centers of chondrification of the While these bones are not commonly of con- axial skeleton and limb buds. The initial change cern in orthopedic surgery, a brief outline of the appears as an area of mesenchymal condensation process follows: - formationoptic of cup lens and vesicle,development nasal pitshand platesurogenital of • primaryprominent sinusevidence • nasalhemispheres of pits cerebral • development plates •pigment of visible footof retinal auricular• developmentformation hillocks of upper•appearance liprays • rapid ofment finger head • sixhillocks enlargeauricularnasolacrimal • formation appearanceofgroove and elbow ofbeginning toe regions raysof eyelids of • distinctformation • tipnipples of • presence nose of Age (days) 32 33 37 41 44 16 The Surgical Technologist DECEMBER 2005 m h j b e e e a a a g g k c c d d f f l c g b g a. Cartilage f. Medullary cavity j. Growth plate j b. Mesenchyme g. Proliferating chondrocytes k. Bone marrow h c. Hypertrophic chondrocytes h. Uncalcified cartilage l. Compact bone d. Osteoblasts (bone) i. Secondary ossification m. Epiphyseal cartilage e. Blood vessel center i ● Condensation of mesenchymal cells occur final size, at which time the osteoblasts revert FIGURE 1: 3,6,7,8 in close association with blood cells. Osteo- to osteoprogenitor cells. During progenitor cells differentiate into osteoblasts, and the osteoblasts secrete osteoid. Endochondral ossification requires the pres- endochrondal ● The osteoid is rapidly mineralized, and spic- ence of preexisting cartilage which is utilized as ossification, ules of bone begin to grow around the blood a temporary structure. The cartilage is partial- vessels. ly degraded prior to bone formation. This type existing cartilage ● The growing spicules merge creating large of ossification accounts for the formation of the provides a spongy networks of trabeculae which contain long bones of the extremities, vertebral column, bone lamellae and entrapped osteocytes. bones of the pelvis and the bones forming the framework for ● The trabeculae thicken with the addition of base of the skull. These bones are sometimes developing bone. new layers of bone on the outer surface. referred to as cartilage bones, because cartilagi- ● Osteoprogenitor cells on the outer surface nous models appear in the embryo. The process continue this cycle until the bone reaches its of endochondral ossification will be presented in - - formationoptic of cup lens and vesicle,development nasal pitshand platesurogenital of • primaryprominent sinusevidence • nasalhemispheres of pits
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