🔙 Quay lại trang tải sách pdf ebook Giải phẫu sinh lý Ebooks Nhóm Zalo BO Y TE VU KHOA HOC VA DAO TAO CIAIPHAU - SINH LY SACHDUNGCHOCACTRJONGTRUNGHOCYTE BO Y TE VU KHOA HOC VA DAO TAO GIAI PHAU - SIM I LY SACH DUNG CHO CAC TRUONG TRUNG HOC Y TE MA SO: T.10.W1, T.30.W1 NHA XUAT BAN Y HOC H A N O I -2007 CHi D AO BIEN SOAN VU KHOA HOC VA OAO TAO, B0 Y it' NHUTNG N G I/O I BIEN SOAN Phan giai phau TS. NGUYEN VAN HUY P h an sinh ly TS. L£ BA THUC THAM G IA TO CHLfC BAN TH AO THS. PHI' VAN THAM VA BAN THU KY HDTDSGK VA TLDH © Ban quyen thuoc Bo Y te (Vu khoa hoc va Oao tao) 2 LCft Gldl THIEU ThUc hien Nghi dinh 43/2000/ND-CP ngay 30/8/2000 cua Chmh phu quy dinh chi tiet va hudng dan trien khai luat Giao due, Bo Y te da phe duyet va ban hanh cac chUdng trinh khung cho giao due trung hoc chuyen nghiep nhom nganh siic khoe. Bo Y te to chutc bien soan bo tai lieu day - hoc cac mon cd sc! va chuyen mon theo chUdng trinh mdi nhfim ttfng budc xay dung bo sach chuan trong cong tac dao tao trung hoc nganh y te. Cuon Giai phau - S in k ly dUdc cac giang vien co kinh nghiem trong cong tac dao tao nhan lUc y te bien soan dUa tren chUdng trinh giao due cua nganh Dieu dUdng da khoa, Ho sinh he trung hoc. Tai lieu chia lam 2 phan: Giai phau hoc va Sinh ly hoc, moi phan co cac chUdng/muc vdi so" tiet hoc dUa tren quy dinh cua chUdng trinh. Moi chUdng/muc deu cau true gom: muc tieu, noi dung va tu lUdng gia. Day la tai lieu tot, lam cd sci bien soan giao trinh day - hoc phu hdp vdi cac doi tUdng dao tao trong trUdng Trung hoc va Cao dang y te. Nam 2005, cuon sach da dUdc Hoi dong chuyen mon tham dinh sach giao khoa va tai lieu day - hoc cua Bo Y te tham dinh, lam tai lieu day - hoc cua cac trUdng Trung hoc nganh y te trong giai doan hien nay. Vu Khoa hoc va Dao tao, Bo Y te xin chan thanh cam dn TS. Nguyen Van Huy, TrUdng Dai hoc Y Ha Noi (bien soan phan Giai p h lu hoc) va TS. Le Ba Thuc, Trung hoc y te Benh vien Bach Mai (bien soan phan Sinh ly hoc) da tich cUc tham gia hoan thanh tai lieu nay. Sach xuat ban lan dau chac chan con nhieu khiem khuyet, chung toi mong nhan dUdc y kien dong gop cua cac thay, co giao va dong nghiep de cuon sach ngay cang hoan thien. VU KHOA HOC VA DAO TAO BO Y TE 3 MUC LUC ■ ■ Ldi gidi thieu 3 Phan 1. GIAI PHAU HOC 7 Chuong 1. Gi6i thieu mon giai phau hoc ngi/di 9 Chuong 2. He xUdng 11 Chuong 3. He khdp 48 Chuong 4. He cd 71 Chuong 5. He tim mach 112 Chuong 6. He ho hap 139 Chuong 7. He tieu hoa 157 Chuong 8. He tiet nieu 185 Chuong 9. Cac he sinh due 196 Chuong 10. He than kinh 211 Chuong 11. Cac giac quan 248 Phan 2. SINH LY HOC 261 Chuong 1. Sinh ly dai cifdng 263 Gidi thieu mon sinh ly hoc 263 Dai ci/dng ve cd the song 263 Dai ci/dng ve te bao 266 Dich ngoai bao, dich noi bao va hang ti'nh noi moi 270 Sinh ly hoc chuyen hoa nSng lUdng 273 Sinh ly dieu hoa than nhiet 279 Chuong 2. Sinh ly mau 284 Sinh ly hoc hong cau 285 Sinh ly bach cau 289 Sinh hoc tieu cau 292 5 Chuong 3. Sinh ly tuan hoan 297 Sinh ly tim 297 Sinh ly tuan hoan dong mach 304 Sinh ly tuan hoan tTnh mach 307 Sinh ly tuan hoan mao mach 309 Chuong 4. Sinh ly ho hap 315 Chuong 5. Sinh ly tieu hoa 328 Chuong 6. Sinh ly tiet nieu 340 Chuong 7. Sinh ly noi tiet 347 Sinh ly vung di/6i doi 347 Sinh ly tuyen yen 348 Sinh ly tuyen giap 351 Sinh ly tuyen can giap 353 Sinh ly tuyen thUdng than 354 Sinh ly tuyen tuy noi tiet 356 Chuong 8. Sinh ly sinh san 362 Sinh ly sinh san nuf 362 Sinh ly sinh san nam 370 Chuong 9. Sinh ly than kinh 378 Chifc nang cam giac cua he than kinh 383 Chut nang van dong cua he than kinh 386 Vai tro van dong cua tieu nao 390 Chifc nang van dong cua vo nao 391 Sinh ly he than kinh thi/c vat 393 ChiTc nang cap cao cua he than kinh 394 Chuyen hoa cua nao 396 Tai lieu tham khao 402 6 P han 1 GIAI PHAU HOC C h ifc fn g 1 Gift THIEU MON GIAI PHAU HOC NGlflTI Giai phau hoc va cac phan mon cua giai phau hoc Gidi p h a u hoc ngiidi (hum an anatomy) la nganh khoa hoc nghien ctfu cau true cd the ngUdi. Tuy thuoc vao phUdng tien quan sat, giai ph au hoc dUdc chia thanh hai phan mon: gidi phau dai the (gross anatom y hay macroscopic ariatomy)^ nghien ctiu cac cau tru e co the q u an s a t b an g m a t thUOng va gidi p h a u vi the (microscopic anatom y hay histology) nghien ctiu cac cau true nho chi co the nhin thay qua kinh hien vi. Cac phi/ting thurc mo ta giai phau Tuy theo muc dich nghien ciiu, co nhieu each mo ta giai phau khac nhau. Ba each tiep can chlnh trong nghien ciiu giai phau la giai phau he thong, giai phau vung va giai phau be mat. G idi p h a u he th o n g (system ic anatom y) la cach mo ta m a d do cau tru e cua tulng he cd quan (thUc hien mot chtic nang nao do cua cd the) dUdc trin h bay rieng biet. Giai ph au he thong thlch hdp vdi muc dich giup ngUdi hoc hieu dUdc chiic n an g cua tiing he cd quan. Cac he cd q u an cua cd th e co: he da, he xUdng, he khdp, he cd, he th a n kinh, he tu a n hoan, he tieu hoa, he ho hap, he tie t nieu, he sinh due va he noi tiet. Cac giac quan la mot phan cua he than kinh. G idi p h a u vung (regional anatomy) hay g id i p h a u d in h k h u (topographical anatom y) la nghien ciiu va mo ta giai ph au cua ta t ca cac cau true (thuoc cac he cd quan khac nhau) trong mot vung, bao gom ca nhiing lien quan cua chung vdi nhau. Cd the dUdc chia th a n h nhiing vung ldn sau day: ngUc, bung, day chau va chau hong, chi dudi, chi tren, lung, dau va co. Moi v ung nay lai dUdc chia th a n h nhiing vung nho hdn. G idi p h a u be m a t (surface anatom y) la mo ta hinh dang be m at cd the ngUdi, dac biet la nhiing lien q u an cua be m a t cd th e vdi nhiing cau tru e d sau hdn nhif cac xUdng va cac cd. Muc dich chlnh cua giai p h a u be m a t la giup ngUdi hoc h in h d u n g ra nhiing cau tru e nSm du6i da. VI du, d n hiing ngUdi bi vet thUdng do dao dam, thay thuoc phai hinh dung ra nhiing cau true ben dudi vet thUdng co the bi ton thUdng. Vj tri cua mon giai phau hpc trong y hoc Trong y hoc, giai ph&u hoc dong vai tro cua mot mon hoc cd sd. Kien thiic giai ph^u hoc ngUdi la kien thiic nen tang, giup ta hieu dUdc hoat dong cua cd the ngUdi (sinh 11 hoc). Fernel noi rang "Giai p h lu hoc can cho sinh 11 hoc giong nhu mon dia 11 can cho mon lich si". Giai p h lu hoc cung la nen tang kien thiic can ban cua tat ca cac chuyen nganh lam sang. 9 Tir the giai phau T at ca cac mo ta giai ph au dUdc trin h bay trong moi lien quan vdi tu the giai p h a u de dam bao ra n g cac mo ta do dUdc ro ra n g va chi'nh xac. M ot ngUdi d tu th e giai phau la mot ngUdi diing th an g vdi: d lu , m&t va cac ngon chan hudng ra trUdc, cac got chan va cac ngon ch an ap s a t n h au , va hai tay buong thSng d h ai ben vdi cac gan ban tay hudng ra trUdc. Cac mat phang giai phau Nhiing mo ta giai phau dUdc dUa tren bon loai mat phing giai phau cat qua cd the d tu the giai phau. Co nhieu mat phang diing doc, diing ngang va na.m ngang nhUng chi co mot mat phang diing doc giiia. Tac dung chlnh cua cac mat phang giai phau la de mo ta cac m at cat va cac hinh anh cua cd the. M at p h a n g d iin g doc g iiia (medial sagittal plane) la m at phang th&ng diing di doc qua trung tam cua cd the, chia cd the th a n h cac niia phai va trai. 9 # t ■) •) Cac m a t p h a n g d iin g doc (sagittal planes) la nhiing m at phang thang * •> . * 9 diing di qua cd the song song vdi m a t p h an g diing doc giGa. Cac m a t p h a n g d iin g n g a n g (coronal/frontal planes) la nhiing m at phang thang diing di qua cd the vuong goc vdi m at phang diing doc giiia, chia cd the thanh cac phan trUdc va sau. Cac m a t p h a n g n a m n g a n g (horizontal planes) la cac mat phang di qua cd the vuong goc vdi cac m at phfing diing doc giiia va diing ngang. Mot mat phang n&m ngang chia cd the thanh cac phan tren va dudi. Cac tir chi moi quan he vj trl va so sanh Co nhieu tlnh tii dUdc s i dung de mo ta moi lien he ve vi trl cua cac p h a n cd the d tu the giai phau bang cach so sanh vi trl tUdng doi cua hai cau true vdi nhau, mot cau true ddn le vdi be m at hoac dUdng giiia, hay mot cau true vdi cac ciic cd the. Dudi day la nhiing tif thUdng dUdc s\i dung. Tren (superior/cranial/ cephalic) la n&m gan hdn ve phla dau; vl du noi "Tim n&m tren cd hoanh" nghla la noi tim n&m gan dau hdn cd hoanh, noi cai gi do di ve phla dau tiic la noi di ve phla tren. D iid i (inferior/caudal) la nSm gan hdn ve phla ban chan; vl du noi "Da day nam dudi tim" nghia la noi da day nSm gan ban chan hdn so vdi tim. Tritdc (anterior) la d gan m a t trUdc cd th e hdn. S a u (posterior) la nam gan m at sau cd the hdn. B en (lateral) va g iiia (medial). Ben la n&m xa m at phang doc giiia hdn, giiia thi ngUdc lai. G an (proximal) va x a (distal). G an nghla la n&m gan th a n hoac la diem nguyen uy (diem goc) cua mot m ach m au, th a n kinh, chi hoac cd quan.. hdn: x a co nghia ngUdc lai. N ong (superficial) la nam gan be m at hdn va sa u (deep) la nam xa be m at hdn. B en tro n g (internal) la d gan hdn ve p h la tr u n g ta m cua m ot cd q u a n hay khoang rong, ben n g o a i (external) thi ngUdc lai. C h tfd n g 2 HE XI/0NG (SKELETON SYSTEM) MUC TIEU 1. Trinh bay diicfc nhiCng kien thiic chung nhat ve he xiidng: sU phan chia, dac diem cau tao cua moi loai xiicfng, sit hinh thanh va phat trien cua cac xiicfng. 2. Mo ta diidc nhiing dac diem hinh the chinh cua cac xiicfng: cac mat khdp, cac cho bam cua cd, cac moc b i mat. 3. Goi dung diidc ten cua cac chi tiet chinh tren cac phiidng tien thiic hanh gidi phau he xiicfng. 1. Dai ci/dng Xifdng la nhiing cd quan dUdc cau tao chu yeu bang mo xiidng, mot loai mo lien ket ran. Bo xUdng dam nhiem cac chiic nang: nang dd cd the, bao ve va lam cho dUa cho cac cd quan, va van dong (cung he cd - khdp); bo xiidng cung la ndi san sinh cac te bao mau va la kho du truf c h at k h o an g va c h at beo (H 2.1). Dot song cd Xg don Xg vai Xg ltc Xg canh tay Xg si;dn Dot song that lung Xg quay Khoi xg cd tay - Cac xg dot ban tay tay Hinh 2.1. Bo xiidng -Cac xi/ong dot ngon Xg dui Xg banh che Xg chay Xg mac Khdi xg cd chan Cac xg dgt ban chan Cac xg dot ngon chan 11 1.1. Hinh the ngoai D ua vao hinh the ngoai va cau tao co the chia xUdng th a n h cac loai n h u xiidng dai (long bone), xiicfng ngan (short bone), xiidng det (flat bone), xiidng khong deu (irregular bone), xiidng co hoc kh i (pneumatized bone) va xiidng viing (sesamoid bone). Cac loai xUdng vdi nhiing hinh the khac nhau ke tren thich ling vdi cac chCfc n a n g rien g biet, vi du n h u xUdng dai co k h a n a n g van dong vdi dong tac rong rai, xUdng det thien ve chiic nang bao ve v.v... Cac xUdng dai co mot th an xUdng va hai dau xUdng. O xUdng chUa trUdng thanh, than va moi dau xUdng dai dUdc ngan cach n h a u bang mot sun dau xUdng. 1.2. Cau tao 1.2.1. Cau tao chung cCia cac loai xi/ong B at ky m ot xUdng nao cung dUdc cau tao bang cac p h an sau day, ke tii ngoai vao trong: m ang ngoai xUdng, mo xUdng dac, mo xUdng xop va o tuy. Mo xUdng thuoc loai mo lien ket, bao gom cac te bao bi vay quanh bdi chat can ban ran dac. C hat can ban cua xUdng bao gom 25% nUdc, 25% sdi protein va 50% muoi khoang. Cac loai te bao cua mo xUdng la tao cot bao, huy cot bao va te bao xUdng. M a n g n g o a i x iid n g (periosteum) la mot m ang mo lien ket dai giau mach m au boc quanh be m at xUdng (trif ndi co sun khdp). M ang nay gom hai ldp: ldp ngoai la mo sdi, ldp trong chiia cac te bao sinh xUdng (osteogenic cells). M ang ngoai xUdng giup xUdng phat trien ve chieu rong. No cung co tac dung bao ve va nuoi dUdng xUdng, giup lien xUdng gay va la ndi bam cho cac day chang va gan. Sun khdp la mot ldp sun trong bao phu m at khdp cua cac xUdng. No lam giam ma s a t va lam giam sU va cham tai nhiing khdp h o a t dich. X iid n g d a c (compact bone) la thanh phan dong vai tro chinh trong chiic n a n g bao ve, n a n g dd va k h a n g lai lUc n en ep cua tro n g luc h ay sU v an dong. Mo xUdng dac dUdc to chiic th a n h nhiing ddn vi dUdc goi la cac he thong Havers. Moi he thong Havers bao gom mot ong Havers b trung tam chiia cac m ach mau, mach bach huyet va than kinh. Bao quanh ong nay la cac la xiidng dong tam . Giiia cac la xUdng la nhiing khoang nho (goi la cac ho) chiia cac te bao xUdng va dich ngoai bao. Ong H avers va cac ho dUdc noi lien bang nhiing ken h nho goi la cac tieu quan xiidng. Vung n lm giiia cac he thong H avers chiia cac la xiidng ke. Cac la xUdng bao quanh xUdng b ngay dudi m ang xUdng la cac la chu vi ngoai. X iid n g xo p (spongy bone) do nhieu be xUdng bat cheo nhau chlng chit tao nen mot m ang ludi vay quanh cac khoang nho, trong n h u bot bien. K hoang nikm giiia cac be xUdng chiia tuy do (red bone marrow), ndi san xuat cac te bao mau. Moi be cua xUdng xop cung dUdc cau tao ban g cac la xUdng, cac ho chiia cac te bao xiidng va cac tieu q u a n nhUng k hong co cac he th o n g H a v ers thiic sU. A* . ~ O tu y (medullary cavity) la khoang rong ben trong than xUdng dai chiia tuy vang (yellow bone m arrow). T h an h o tuy dUdc lot bang noi cot mac (endosteum). Tuy vang chiia nhieu te bao md. 12I 1.2.2. Dac diem cau tao rieng cua mdi loai xi/ong (Hi2.2) Xiidng dai. 6 th a n xiicfng (diaphysis), ldp xiidng dac day d giiia va mong dan ve phia hai dau; ldp xUdng xop thi ngUdc lai. CJ h ai d a u x itd n g (epiphysis), ldp xUdng dac chi con la mot ldp mong, ben trong la khoi xUdng xop chiia tuy do. XUdng ngan co cau tao giong n h u dau xUdng dai. XUdng det gom hai ban xiidng dac kep d giiia la m ot ldp xiidng xop. 1.3. Cac mach mau cua xuong Xiidng diidc cap mau tot nhd hai loai dong mach: cac dong mach nuoi xiidng /a cac dong mach mach mang xiidng. Vdi mot xUdng dai, cac d o n g m a c h n u o i x itd n g thUdng gom mot dong mach dn chay chech qua xUdng dac qua mot lo nuoi xitdng (nutrient foramen) d gan giiia ;han xUdng den o tuy xUdng va mot so" dong m ach nhd di vao dau xUdng. Trong o uy xiidng dong mach ldn chia thanh cac nhanh gan va xa chay doc theo chieu dai :ua o tuy va p h a n chia th a n h cac n h a n h nhd dan di vao mo xUdng cua th a n xUdng, :ac dong m ach con lai nuoi dUdng cho mo xUdng va tuy do cua dau xUdng. Mo xg dac Mo xg xop Xi/dng det Mo xg dac Sun khdp Mo xg xop Xi/dng dai Xuong ngin Hinh 2.2. Cau true cua cac loai xi/dng 13 C ac d o n g m a c h m a n g x itd n g cap m au cho m ang ngoai xiidng (trvf cac m at khdp); mot so nhanh mach rat nho chui qua mang ngoai xUdng tdi phan ngoai xUdng dac va noi tiep vdi cac n h a n h cua dong m ach nuoi xiidng tu! p hla o tu y di ra. 1.4. Su hinh thanh va phat trien cua xirong XUdng dUdc hinh th a n h trong thdi ki phoi th ai (vao cuoi th a n g thii n h a t cua phoi) va tiep tuc p h at trien cho tdi tuoi trUcing thanh. Co hai giai doan hinh th a n h xUOng: o O g ia i d o a n th it n h a t, mo lien ket long leo cua phoi (thuoc trung mo, ma tru n g mo b a t nguon tu: tru n g bi) bien th a n h the dac dudi dang mot m ang dai; xUdng dUdc hinh th a n h tren m ang dai nay. G ia i d o a n th it h a i dien ra khi cac te bao cua the dac (mang dai) bien th a n h xUOng, theo hai cach: Mot so'it xitdng (gom cac xUdng vom so, xUdng ham dudi va xUdng don) dUdc hinh th a n h bang cach chuyen true tiep m ang th a n h xUdng. VI du, vom so cua phoi trUdc hai thang chi la mot mang; tti thang thii hai tren m ang nay xuat hien nhiing diem cot hoa lan rong dan ra tao nen nhiing xUdng det cua vom so. Q ua trin h bien m ang th a n h xUdng dUdc goi la mang cot hod va xUdng dUdc hinh th a n h theo cach nay la xitdng mang. Cac xitdng con lai (chiem hau het cac xUdng) dUdc hinh th a n h tii sun. TrUdc h e t the dac tru n g mo tao ra mo h in h xUdng b an g su n (d d a u th a n g thii hai). Tdi cuoi thang thii hai, khi sun phat trien, no bi mach m au xam lan. Cac te bao do mach m au m ang tdi pha huy sun va cho sun bi pha huy dUdc thay the bang mo xUdng. Q ua trin h nay dUdc goi la sun cot hod va xUdng dUdc h inh th a n h theo cach nay dUdc goi la xitdng sun. Vdi xUdng dai, thUdng thi mo hinh sun bi mach xam lan cJ tru n g ta m (ling vdi giiia th a n xUdng). Cac tao cot bao do m ach m a u m a n g tdi tao ra xUdng bang cach: te bao tao xUdng tiet ra chat cot giao; chat nay ngam muoi calci bien thanh xUdng; diem tao xUdng ban d lu nay la trung tam cot hod nguyen phat (primary ossification centre). Khi trung tam cot hoa nay p hat trien rong ra tdi dudi m ang ngoai xUdng, xUdng dUdc tiep tuc dUdc sinh ra bdi m ang ngoai xUdng. Su to ra ve dUdng kinh cua xUdng sun la do m ang ngoai xUdng xay dap them cac la xUdng dong tam ke tiep n h au (ve cd ban giong xUdng mang). Vdi xUdng sun ngfin va nho (xUdng co tay, co chan), sun dUdc th ay the d an chi bang mot tru n g tam cot hoa nguyen phat. XUdng cot song va xUdng dai cua chi dUdc hinh thanh tii nhieu trung tam cot hoa gom: trung tam cot hoa nguyen phat (chlnh) tao ra than xUdng va cac trung tam cot hod thii p h a t (secondary ossification centre) hay cac trung tam cot hod dau xitdng tao ra cac dau (epiphyses) hay mom xUdng. Cac trung tam cot hoa dau xUdng phan ldn xuat hien sau khi sinh. Trong qua trinh phat trien, cac trung tam cot hoa dau xUdng ngan cach v6i trung tam cot hoa chlnh bang mot tam sun dau xitdng (epiphysial cartilage).1" S u n nay giup xUdng p h a t trie n ve chieu dai. T am su n d a u xUdng ta n g sinh ve phla th an xUdng va phan tang sinh nay dUdc chuyen th a n h xUdng. Khi toe do cot hoa sun ldn hdn toe do tang sinh sun thi sun dan dUdc thay the h et bang xtfdng va xUdng ngiing tang trUdng ve chieu dai. 14 Su tan g trudng cua xUdng m ang ve cd ban la bang mot qua trin h boi dap them xUdng tren be m at va cac bd xUdng. Vi du nhu sii dong dan cua cac thdp (vung nam giiia cac bd va goc xUdng vom so): xUdng tien dan vao m ang thop bang cach boi dap them xUdng vao cac bd xUdng; dong thdi, m ang xiidng boi dap them xUdng len be m at xUdng. ThUc ra qua trinh cot hoa bao gom hai cong viec dien ra dong thdi: qua trinh kien thiet nhd cac tao cot bao va qua trinh pha huy nhd cac huy cot bao. Su pha huy xUdng giup tao nen cac hoc tuy d xUdng xop, o tuy d xUdng dai va cac ong H aver cua mo xUdng. 1.5. So Iirang va phan chia 206 xUdng cua bo xUdng ngUdi (H .2.1) dUdc sap xep th a n h phan: 80 xUdng cua bo xUdng true va 126 xUdng cua bo xUdng treo. Bo xitd n g tru e (axial skeleton) gom 22 xUdng so, 1 xUdng mong, 6 xUdng nho cua ta i va 51 xiidng th a n (gom 26 xUdng cot song, 24 xUOng sUdn va 1 xUdng tic). Bo xitd n g treo hay xitd n g c h i (appendicular skeleton) gom 64 xUdng chi tren va 62 xUdng chi dudi. 2. XiTdng so (bones o f cranium ) (cac H.2.3 - 2.8) XUdng so la m ot khoi gom 22 xUdng n l m d d au tre n cua cot song. Phan chia. So do hai nhom xUdng hdp thanh: cac xUdng hop so va cac xUdng mat. H op so la hop xUdng bao ve cho nao do tam xUdng tao nen: hai xitdng dinh, mot xitdng tran, mot xitdng cham , mot xitdng bitdm, mot xitdng sang va hai xitdng thdi ditdng. Cac xitd n g m a t tao nen khung xUdng cua mat, gom mUdi ba xUdng dinh th a n h mot khoi va dinh vdi hop so, va mot xUdng lien ket vdi khoi xUdng so bang khdp hoat dich. Mudi bon xUdng m at la: hai xitdng le, hai xiidng xoan m ui ditdi, hai xitdng m ui, hai xitdng ham tren , h ai xiidng kh&u cai, hai xitdng go ma, mot xiidng ham ditdi va mot xiidng la m ia. Nhiing dac diem chung. Ngoai viec tao nen hop so, cac xUdng so cung tao nen m ot so" k h o an g nhd khac, bao gom o m ui va cac o m at md ra phia trUdc. Mot so xUdng so chiia nhiing khoang dUdc lot bang niem mac va thong vdi mui; chung dUdc goi la nhiing xoang canh m ui. Trong xUdng thai dUdng cd nhiing khoang nhd chiia cac cau true lien quan tdi thinh giac va thang bang. Trong cac xUdng so, chi cd xUdng ham dudi la cd the chuyen dong dUdc, cac xUdng con lai dinh chat vdi nhau thanh mot khoi bang cac dudng khdp bat dong. so cd mot nen de nao nam tren va mot vom bao quanh va day tren nao. Cac xUdng cua vom so dUdc tao nen tii hai ban xUdng dac (ban ngoai va ban trong) n g a n cach n h a u ban g m ot ldp xUdng xop goi la loi xop. M at trong hop so dinh vdi m ang nao ciing, m at ngoai tao nen cho bam cho cac cd dau m at. Ngoai viec tao nen khung xUdng cua mat, cac xUdng m at con bao ve cho dudng vao cua cac he ho hap va tieu hoa. Ca khoi xUdng so bao ve va nang dd cho cac giac quan chuyen biet ve nhin, nem, ngiii, nghe va thang bang. 15 2.1. Cac x ifd n g hop so (brain box) X ito n g tr a n (frontal bone). Xiidng tran gom hai phan chinh: mot phjin tao nen tra n (phan trUdc cua hop so) la trai tran, mot p h a n n a m n g an g tao nen tr a n o m a t va h a u h e t p h a n trUdc cua nen so (ho" so trUdc). 6 m a t ngoai, h ai p h a n cua xUdng tran gap nhau tai bd tren o mat. Ngay tren bd nay, ben trong trai tra n co hai xoang tran. Cac x itd n g d in h (p arietal bone). H ai xUdng din h tao nen p h a n 16n cua cac m at ben va dinh so. Chung tiep khdp vdi nh au tai dudng khdp doc, vdi xUdng tra n tai dUdng khdp vanh, vdi xUdng cham tai dUdng khdp lambda va vdi cac xUdng th a i dUdng tai cac dUdng khdp trai. M at tro n g cua xiidng din h 15m va co nhiing ranh de cac mach mau di qua. Trai tr£n Xg tran Dudng khdp giura tran Loi tren goc mui Diem goc mui Khdp tran- mui Xuong mui Cung may 16 Xg dinh L6 tren o mat Xg sang Xg birdm O mat Mom go ma (xg tran) thai dircmg go ma-mat mui trade nanh ham tr6n huyetrang h^im dudi dinh ham dtrdi - l 6'i cam Cu cam Hinh 2.3. Xirong so: nhin tri/6c 16 Ho thai dirong Ong thj giac L6 dudi o mat Cung go ma Xg xoan difdi Mom chum Nganh xg ham dudi O mui Xg la mia Ho nanh Ho rang cira Lo cam Xg ham Cac xitd n g th d i d itdng (temporal bone). Moi xiidng thai dUdng tao nen mot mat dudi-ben cua hop so va mot phan cua nen so. No tiep khdp vdi cac xUdng dinh, cham, budm va go ma bing cac khdp bat dong. XUdng thai dudng do ba phan tao nen: phan da, phan trai va phan nhi. Phan da co hinh thap tam giac n&m ngang qua nen so, giiia xUdng budm va xUdng cham. Phan nay chiia tai giiia va tai trong, va nhiing ong cho dong mach canh trong va than kinh mat di qua. Ong dong mach canh co mot 16 ngoai md ra d mat dudi phan da va mot lo trong md ra d dinh phan da. Mom nhon tii mat dudi phan da nho xuong dudi la mom tram. Nen phan da hudng ra ngoai va ra sau. Mom loi tren nen phan da, d ngay sau lo tai ngoai, dUdc goi la mom chum. Trong mom chum co nhieu xoang nho. CJ giiia mom tram va mom chum cd lo tram-chum, ndi ra khoi so cua than kinh mat. Tren mat sau phan da co lo va ong tai trong, ndi cac than kinh so VII va VIII di qua. Bd sau p h ln da cung vdi xUdng cham gidi han nen lo tlnh mach canh, ndi di qua cua tinh mach canh trong. Trai xuong thai duong Diem thop . . . trade - ben 0 l^m thoP ig khdp budm-dinh nh Idn xuong budm Dudng khdp budm-tran Dudng khdp trai Diem thop sa Dudng khdp dinh-chum Xg cham Dudng khdp lambda U cham ngoai Diem thop sau- b6n Xg thai dudng Dudng khdp cham-chum Ong tai ngoai Mom chum Mom tram1 Loi cau xg ham dudi Gdc ham dudi Cu khdp Hinh 2.4 .Xi/ong so: nhin ben Dudng khdp budm-go ma Dudng khdp tran-go ma Diem gian may Xg gd ma Goc mui Xg mui V C % _ Xg sang Dudng khdp budm - trai Dudng khdp gd ma-thai duong 17 Phan trai la m anh xUdng mong hinh quat. Phan diidi cua trai thai dudng tach ra mom go md chay ra trUdc tiep khdp vdi mom thai dUdng cua xUdng go ma; mom cua hai xUdng cung nhau tao nen cung go md. Ho" 1dm n i m d m a t sau-dudi mom go ma la ho ham ditdi va cho loi tron b trUdc ho" nay la cu khdp. Ho va cu tiep khdp vdi chom xUdng ham dudi tao nen khdp thai dUdng-ham dudi. Phan nhl la m anh xUdng mong vay quanh 16 va ong tai ngoai. X itd n g c h a m (occipital bone). XUdng cham tao nen phan sau cua vom va nen so. XUdng cham gom ba ph&n vay quanh lo ldn xUdng cham. Lo l&n la ndi han h nao lien tiep vdi tuy song. TrUdc lo ldn la phan nen, hai ben la cac phan ben va d sau la trai cham. M at tren phan nen doc diing va dUdc goi la doc. Tren moi p han ben cd mot loi cau cham tiep khdp vdi m at tren cua khoi ben dot doi va mot ong than kinh ha thiet, ndi di qua cua than kinh so XII. M at sau trai cham cd u cham ngoai d giiia va cac ditdng gay d moi ben. Giiia m a t trUdc (hay m a t trong) trai cham cd u cham trong. Gd xUdng tii u nay di tdi lo cham la mao cham trong, con hai ranh ke tiep nhau tii u chay sang hai ben la ranh xoang ngang va ranh xoang sigma. R an h xoang n gang n g an cach h ai ho" d m a t tro n g tra i cham : ho dai nao b tren va ho tieu nao b dudi. X itd n g bitdm (sphenoid / sphenoidal bone). XUdng budm n a m d giiia n en so va tiep khdp vdi ta t ca cac xUdng khac cua hop so. Ngoai hop so, no con gop phan tao nen tr a n o m ui va cac th a n h o m at. Cac p h a n cua xUdng budm la th a n , c an h nho, canh ldn va cac mom chan budm. Than n&m giiia xUdng budm, tiep giap vdi xUdng san g d trUdc va xUdng cham d sau. M at tre n cua th a n xUdng budm cd ranh tritdc giao thoa va ho tuyen yen. Moi canh nho dinh vao phan trUdc than budm b&ng hai re va cung than budm gidi han nen ong thi giac, ndi di qua cua th&n kinh so II. 6 phia sau, moi canh ldn cung tii mot ben than budm chay sang ben, tao nen phan giiia cua nen so. Hai canh cung vdi th a n budm gidi h an nen khe o mat tren, ndi di qua cua cac than kinh Vl, III, IV va VI. T ren canh ldn cd 16 tron va lo bau due, lan lUdt la ndi di qua cua than kinh V2 va V3. Cac mom chan bitdm tii th a n chay xuong cac th a n h ben o mui. T rong th a n xUdng budm cd cac xoang bitdm thong vdi o mui. X itd n g s a n g (ethm oid/ethm oidal bone). XUdng san g n&m tre n dUdng giiia, d p h a n trUdc nen so. No con gop p h a n tao n en vach m ui, t r a n o m ui, th a n h ngoai o m ui va th a n h tro n g o m at. Cac p h a n cua xUdng san g gom m a n h sang, m a n h th&ng diing va cac me dao sang. M anh sang lap vao cho k h u y e t cua p h a n o m i t xUdng tra n , n g a n cach ho" so trUdc vdi o mui; giiia m a t tr e n cua m a n h sa n g nho len mot mom hinh tam giac goi la mao gd, hai ben mao cd cac lo sang. M anh thang diing chay vao vach mui. Moi me dao sang la m ot kho'i xUdng xo'p n&m giiia o m a t va o m ui. Khoi n ay chiia cac xoang sang th o n g vdi o m ui. H ai m a n h xUdng tii m ^ t tro n g moi me dao sa n g nhd vao o’ m u i dUdc goi la cac xoan m ui tren va ditdi. 18 2.2. Cac xi/Ong mat (facial skeleton) Dudng khdp doc Diem thop sau Xg cham Dudng khdp lambda Dudng khdp dinh-chum Diem thop sau-b6n Mat phang cham Dudng khdp cham-chum Lo chum Mom chum Khuyet chum Loi cau xg Dudng gay giura Dudng gay dudi thai duong Trai cham U cham ngoai Dudng gay tren phlng gay gay trgn cung Hinh 2.5. Xi/dng so: nhin tii sau X itd n g h a m tr e n (maxilla). Hai xUdng ham tren (da dinh lai) tao nen ham tren va tiep khdp vdi ta t ca cac xiidng m at khac, trti xiidng ham dudi. No tao nen mot p h a n cua s a n o m&t, m ot p h a n cua th a n h ben va s a n o mui, va h a u h e t k h a u cai ciing. XUdng ham tren gom than va cac mom. Than co cac m at hudng ve o m&t, o mui, ho" dudi th a i dUdng (dUdc goi lan liidt la m at o mat, m at m ui va m at ditdi thdi ditdng) va ve phla trUdc (m at tritdc). Nhiing chi tiet quan trong tren cac m at nay la: ranh ditdi o mat d m a t o milt, Id ditdi o m at va khuyet mui d m a t trtidc, cu ham d m at dudi th ai dUdng, ranh le va lo xoang ham tren d m at mui. T han xUdng chiia mot xoang ldn md vao o mui, xoang ham tren. Cd bon mom tii than xUdng nho ra: mom tran chay len tiep khdp vdi xUdng tran; mom go md tiep khdp vdi xUdng gd ma; mom huyet rang la mot cung m ang cac huyet rang cua cac rang ham tren; va mom khau cai tao nen 3/4 trUdc khau cai cting. Xtidng ham tren cung canh ldn xUdng budm gidi han nen khe o m at ditdi. 19 X iid n g h a m d iid i (mandibula). XUdng ham dudi gom mot than va hai nganh ham. Than xiicfng ham diidi cong hinh mong ngUa, gom mot nen day 0 dudi va phan huyet rang d tren. Giiia m at trUdc nen h a m diidi loi ra d th a n h loi cam va moi ben cd mot lo cam. Phan huyet rang cong thanh cung huyet rang va m ang cac lo huyet chan ra n g ham diidi. Moi nganh ham diidi lien tiep vdi than ham diidi tai goc ham diidi. Tu: day, n g an h h am chay len tre n gan n h u vuong goc vdi th a n ham . Dau tren cua nganh ham tach ra thanh mom vet d trUdc va mom loi cau d sau; giiia hai mom nay la khuyet ham diidi. Mom loi cau cd mot chom tiep khdp vdi ho ham dudi va cu khdp cua xUdng thai dudng. Tren m at trong cua nganh ham cd mot lo cho th a n k in h h u y et ra n g dudi di vao xUdng ham , lo ham diidi. Lo nay la ciia vao cua ong ham diidi. M ieng lo dUdc chan bang m ot m an h xUdng goi la liidi ham diidi. X iid n g m u i (nasal bone). Cac xUdng mui gap nhau tren dudng giiia va tao nen mot phan cua cau mui. X iid n g le (lacrim al bone). H ai xUdng le la nhQng xUdng nhd n am d sau va ngoai cac xUdng m ui va tao nen mot p h a n th a n h tro n g o m at. XUdng le cung vdi mom tra n xUdng h h a m tre n gidi h a n nen ho" le, ndi m a tu i le nam . X iid n g go m d (zygomatic bone). XUdng go m a lam cho gd ma loi len th a n h gd va tao nen mot p h a n cua th a n h ngoai va san o m at. No tiep khdp vdi cac xUdng tran, ham tren, budm va thai dUdng. Diem thop trifdc 20 X iid n g k h a u cai (palatine bone). Xiidng nay gom manh n&m ngang va manh th^ng dting hdp thanh hinh chti L. Manh n&m ngang cung vdi manh nam ngang cua xUdng ben do'i dien tao thanh phan sau cua khau cai cting. Manh thang diing nho len tren de tao nen mot phan cua thanh ngoai o mui va mot phan san o mat. X iid n g x o a n m u i d iid i (inferior nasal concha). Moi xUdng nay la mot xUdng mong cuon lai va nho vao o mui d dudi xUdng xoan mui gitia. X iid n g la m ia (vomer). Day la mot xUdng mong hinh tam giac tao nen mot phan vach mui. No tiep khdp d dudi vdi cac xUdng cua khau cai cting tai dUdng gitia va d tre n vdi m a n h th a n g dting cua xUdng san g va xUdng budm. X iid n g m o n g (hyoid bone). XUdng nay khdng thuoc xiidng so nhUng dUdc mo ta cung xUdng so cho tien. No la mot xUdng rdi hinh mong ngiia nam trong cac mo m em cua vung co, d ngay tre n th a n h q u an va dudi xUdng ham dudi. XUdng mong gom mot th an n&m ngang va hai sting d moi ben: sting ldn va sting nho. L6 rang cira Xg ham tren Mom thai dirong xg go ma Mom go ma xg thai duong Gai bLfdm Mom tram L6 tram chum Mom chum Xg thai duang M6m khau c^i xg ham trSn Mom huy6t rang xg hdm tren Phan ngang xg khau cai Gai mui sau Xg la mia Manh trong mom chan budm Phan nen xg cham Kh6i ben xg cham L6 cham ldn Trai xg cham U cham ngoeii Hinh 2.7. Mat ngo£i nen so 21 L6 sang Lo ong thi giac Mao tran Mao ga Manh sang va cac 16 sang Ong vo danh Ranh xoang TM sigma Ranh xoang TM ngang Hinh 2.8. Mat trong nen so 3. Xirdng than ^ Lo ong tai trong Lo TM canh Ong than kinh ha thiet Lo ldn xL/ong cham Xiidng cua than bao gom cot song va cac xUdng ngUc. 3.1. Cot song (vertebral column) (H.2.9) Cot song la mot cau tru e vtia m em deo vtia viing chac. No vCfa co th e van dong linh hoat vvia bao boc va bao ve tuy song, n an g dd cho dau, va tao cho bam cho cac xUdng sUdn, dai chau va cac cd liing. Cot song tao nen khoang 2/5 chieu cao cd the va do 26 xUdng tao nen, bao gom xiidng cung, xiidng cut va 24 dot song rdi. Cac dot song rdi gom 7 dot song co, 12 dot song ngUc va 5 dot song th a t liing. Xiidng cung do 5 dot song cung din h lien n h a u m a th a n h ; xUdng cut thUdng do 4 dot song cut dinh lai. Cot song san co h ai dUdng cong loi ra sa u ngay tu! luc sinh 22 9 3 ra va khong m a t di: corag ngw’c va cong cung. Khi tre ldn len va co the diing thang, cot song xuat hien them hai dudng cong mdi (ditdng cong thit phat). cong co va cong that litng (deu loi ra trUdc). B Hinh 2.9. Cot song nhin tri/dc (A) va ben (B) 3.1.1. Cac phan cua mot dot song dien hinh (H.2.10) Moi dot song (vertebra) gom co than dot song va cung dot song vay quanh 16 dot song. T h a n d o t so n g ( vertebral body) co hinh tru det, mat tren va mat diidi la cac mat gian dot song tiep khdp vdi dot song ke can qua dia gian dot song. C u n g d o t so n g (vertebral arch) d phia sau than dot song, cung vdi than dot song gidi han nen lo dot song. Cung gom m a n h cu n g d o t so n g (lamina of vertebral arch) rong va det, n&m d sau; cac cu o n g c u n g dot so n g (pedicle of vertebral arch) d triidc manh, dinh vdi than; va cac mom tu: cung moc ra. Cac bd tren va diidi cua cuong deu lom va diidc goi la cac khuyet song ( tren va ditdi). Khuyet song diidi cua dot song tren cung khuyet song tren cua dot song dudi lien ke gidi han nen lo gian dot song (intervertebral foramen), ndi ma cac day than kinh song va cac mach mau di qua. Cung dot song tach ra cac mom: 23 M ot mom gai (spinous process) tii giiia m at sau cua m anh cung dot song chay ra sau va xuong dudi, sd th ay dUdc d dudi da liing; Hai mom ngang (transverse process) tu: cho noi giiia cuong va m anh chay ngang ra hai ben; va 4 mom khdp, gom 2 mom khdp tren va 2 mom khdp di/di (superior and inferior articular process) mang cac mat khdp, cung tach ra tii khoang cho noi giiia cuong va manh; khi cac dot song tiep khdp vdi n h au thi 2 mom khdp dudi cua dot song tren tiep khdp vdi 2 mom khdp tren cua dot song dudi. ____________ Mom gai Manh cunq dot sonq Mom n g a n g __ Mom khdp tren Mom khdp dudi Cuong ----------------- L6 gian dot song Than OTa gian dot s6ng Hinh 2.10. Cac phan cua mot dot song dien hinh Lo d o t so n g (vertebral foramen) n&m giiia th a n dot song va cung dot song. Khi cac dot song chong len n h au tao th a n h cot song thi cac lo nay hdp th a n h ong song (vertebral canal) chiia tuy song. 3.1.2. Dac diem hinh the rieng cua dot song b tifng doan Cac dot song co (cervical vertebrae) (H.2.11) Hinh 2.11. Dot song co I (A) va II (B) 24 Cac dot song co co chung dac diem la: mom ngang dinh vao th a n va cuong cung dot song b an g 2 re, gidi h a n nen lo ngang (foram en tra n v e rsariu m ), ndi co cac m ach dot song di qua. Mot so" dot song co lai co them cac dac diem rieng. D ot co I hay dot doi (atlas) (H.2.11) khong co th a n m a co cung triidc, cung sau va hai khoi ben. Moi khoi ben co m at khdp tren tiep khdp loi cau xiidng cham va m at khdp ditdi tiep khdp vdi dot cd II. Dot co I I hay dot true (axis) (H.2.11) co mot mom tii m at tren cua th an nho len goi la rang dot true (dens of axis). Rang co mot dinh va hai mat khdp: m at khcfp triidc tiep khdp vdi cung trUdc dot doi, m at khdp sau tiep khdp vdi day chang ngang. D ot co V II hay dot loi (vertebra prom inens) co mom gai dai n h a t trong so cac mom gai dot song cd. Cac dot song ngtfc (thoracic vertebrae) (H.2.12) Dac diem cua cac dot song ngUc la chung cd hom siidn ngang tren mom ngang de tiep khdp vdi cu sUdn va cac hom siidn tren va diidi tren than dot de tiep khdp vdi chom sUdn. Hinh 2.12. Dot song ngi/c nhin tC/ tren (A) va nhin ben (B) Cac dot song th a t Ivfng (lum bar vertebrae) (H. 2.13) Dac diem giup phan biet cac dot song th a t lung la chung khong co lo ngang n h u dot song cd va khong cd cac hom siidn tren mom ngang va th a n n h u dot song ngUc. 25 Mom gai Xifcfng cung (sacrum) (H.2.14) Xiidng cung la mot khoi cua nam dot song cung dinh vdi nhau. No co hinh tam giac, gom mot nen, hai phan ben, mot mat liing va mot dinh. N en xiicfng cung hudng len tren, tiep khdp vdi dot song th at liing V tai khdp th&t lUng-cung. Bd triidc cua nen nho ra d giiia th a n h u nho, moi ben cua nen co mot canh va mot mom khdp tren. M oi p h a n ben xiidng cung co mot m at loa tai tiep khdp vdi xUdng chau, mot loi cu cung va mot m at chau hong hiidng ra trUdc. Tren m at chau hong lom va co bon ditdng ngang danh dau nhiing ndi dinh n h au giuta cac th a n xUdng cung; dau ngoai cua moi diidng ngang co m ot lo gian dot song thong vdi mot lo cung tritdc. M a t litn g loi, hiidng ra sau, co cac mao cung va bon lo cung sau. Cac mao ciing la ket qua cua sii dinh lai vdi nhau cua cac mom gai, mom khdp va mom ngang cua cac dot song ciing. Phan diidi cua mat sau co hai sitng cung n lm d hai ben lo ciing; lo nay la dau dudi cua ong cung. D in h xitd n g cu n g hiidng xuong diidi, khdp vdi xiidng cut. Xifcfng cu t (coccyx) (H.2.14) do 4 - 6 dot song cut dinh lien n h a u tao nen. 26 Hinh 2.14. Xi/ong cung va xirong cut y 3.2. Cac xuong nguc (thoracic skeleton) va long nguc (thoracic cage) ire Goc lie ire Mom mui kiem Hinh 2.15. Long ngire 27 , ac^xiidng nguc bao gom xUdng tic, cac xiidng siidn va cac dot song ngUc. ung tiep khdp vdi nhau tao nen long ngiic (H .2.15). Cac xUdng long nguc gidi f n n^ n kh°ang ngiic (thoracic cavity). K hoang nguc co 2 lo: lo ngiic tren thong vdi nen co, dUdc gidi h a n bdi m a t trUdc dot song ngUc I, xUdng sUdn I va k h u y e t tinh mach canh cua can xUdng tic; lo ngiic diidi dUdc gidi h an bdi th a n dot song ngUc XII, xUdng sUdn XII, cung si/dn va goc diidi lie. 12 xUdng sUdn d moi ben gidi h an nen 11 khoang gian siidn. R anh d gitia cot song nguc va xUdng sUdn d moi ben goi la ranh phoi. 3.2.1. Xuong ire (sternum) (H.2.16) XUdng tic la xUdng det, nam d gitia th a n h trUdc long ngUc va gom 3 ph an ti'nh tti tren xuong la: can tic, than tic va mom m ui kiem (mui tic). Gitia can tic va than tic la goc tic. Can tic co khuyet tinh m ach canh d bd tren va khuyet don d moi ben de tiep khdp vdi dau tic cua xUdng don. Moi bd ben cua can va th a n cd 7 khuyet siidn de tiep khdp vdi su n cua 7 xUdng sifdn tre n cung. Khuyet TM canh Hinh 2.16. Xifdng tic 28 3.2.2. Xitong sudn (ribs) (H.2.17) Co 12 doi xUdng sUdn, trong do cac doi I - VII tiep khdp vdi xiidng ilc bang mot sun sUdn rieng nen dUdc goi la cac xiicfng siidn that, cac doi VIII - XII khong cd sun sUdn rieng de tiep khdp vdi xUdng lie hoac khong tiep khdp (nhu cac doi XI - XII) nen dUdc goi la cac xiidng siidn g ia 4, rieng cac xUdng siidn XI - XII con diidc goi la cac xiidng siidn cut. Ve hinh the, moi xUdng siidn la mot xUdng dai, cong va det cd mot chom, mot cd va mot than. Chom siidn n&m d dau sau cua xiidng siidn va co mat khdp chom siidn de tiep khdp vdi than dot song ngUc. Co siidn la cho that lai giiia chom va than. Than siidn det va cong, co hai m a t va hai bd; m at ngoai cong loi, m a t trong cong lom; tren m at trong va doc theo bd dudi co ranh siidn de m ach - th a n kinh gian sUdn di qua. D au sau cua than co cu siidn, dau trUdc lien tiep vdi dau ngoai cua sun tUdng ting. Tren cu sudn cd mat khdp cu siidn de tiep khdp vdi mom ngang dot song ngUc. Cu sirdn Hinh 2.17. Xi/dng si/dn t 29 5. Cac xuung chi tren (bones of upper limb) (H.2.18) Hinh 2.18. Bo xifdng chi tren Moi chi tre n co 32 xiidng: 1 xiidng vai, 1 xiidng don, 1 xiidng c an h tay, 2 xiidng cfing tay (xiidng quay va xUdng tru) va 27 xiidng b an tay (gom 8 xUdng cd tay, 5 xiidng dot ban tay va 14 xUdng dot ngon tay). T rong cac xiidng ke tren , xiidng don va xiidng vai tao nen d a i c h i tr e n (shoulder girdle) hay d a i n g i/c (pectoral girdle) g&n cac xUdng cua obi tre n vdi bo xiidng true, cac xUdng con lai tao nen p h a n ttf do c u a c h i tr e n (free part of upper limb). 5.1. Xitong vai (scapula) (H.2.19) Xiidng vai la m ot xUdng det, h in h ta m giac n a m d p h a n tre n cua th a n h nguc sau. No cd hai m at, ba bd va ba goc. 30 An DC qua - cung vai Hinh 2.19. Xifdng vai ben phai, nhin tif trifdc va sau H a i m a t la m at triidc va mat sau. M at sa u co mot gd xifdng goi la gai vai tif bd trong chay chech len tren va ra ngoai roi tan cung bang mot mom rong, det goi la mom cung vai. Gai vai chia mat sau thanh hai ho: ho tren gai va ho'diidi gai. M at triidc lom sau va diidc goi la ho diidi vai. Ba bof la bd trong, bd ngoai va bd tren; b bd t r e n co khuyet vai va d ngoai khuyet vai la mom qua. B d tro n g cach cot song khoang 5 cm. B a goc la goc tren, goc diidi va goc ngoai. O goc ngo a i co o chao; o nay la mat tiep khdp vdi chom xiidng canh tay. 31 5.2. Xuong don (clavicle) (H.2.20) XUdng don la xUdng dai, cong hin h chut S n am d p h an trUdc-tren cua ngUc, ren xUdng sUdn thti nhat. XUdng don cong loi ra trUdc d ntia trong, cong lorn ra trUdc d n u a ngoai. No co mot th a n va hai dau. D au tro n g xUdng don co m at khdp vdi xUdng tic tao nen khdp tic-don. T h a n xiicfng don co ranh ccf diidi don d m at dudi. D au n g o a i co m at khdp tiep khdp vdi mom cung xUdng vai, tao nen khdp cting vai-don. XUdng don la xUdng duy n hat noi chi tren vdi bo xUdng true. Dai nguc khong tiep khdp vdi cot song ma dUdc giti tai cho bdi cac cd. Ducmg thang I Hinh 2.20. Xiidng don ben phai A. Nhin ttitren, B. Nhin tir diidi 5.3. Xuong canh tay (humerus) (H.2.21) Xtidng canh tay la xUdng dai va ldn n h a t chi tren co th an n lm gitia hai dau. D a u tren co chom xiicfng canh tay hinh 1/3 khoi cau hiidng len tren va vao trong. Diidng vien quanh chom diidc goi la co g id i p h a u . d lien ke vdi cd giai phau co hai cu xiidng nho len: cu be d trUdc va cu ldn d ben ngoai. H ai cu n g an cach nhau bang ranh gian cu. D au tre n th u hep dan va lien tiep vdi th a n xUdng tai co p h a u thuat. 32 T h a n xito n g gan co hinh lang tru tam giac nen co ba mat va ba bd: cac m at triidc-trong, triidc-ngoai va sa u ; cac bd trong, ngoai va triidc. C) khoang gitia mat tru6c-ngoai co loi cu delta. D au diidi do loi cau xiidng canh tay va cac mom tren loi cau tao nen: mom tren loi cau trong va mom tren loi cau ngoai. Loi cau xUdng canh tay la ten goi chung cua hai m at khdp: chom nho xiicfng canh tay ft ngoai tiep khdp vdi xUdng quay, rong roc xiicfng canh tay 6 trong tiep khdp vdi xUdng tru. be Hinh 2.21. Xirong canh tay ben phai, nhin tir triidc (A) va sau (B) 33 5.4. Xirong quay va xuong tru Day la hai xiidng cua ciing tay, deu la xUdng dai co mot th a n nam giiia hai dau. Khi ban tay d tu the giai ph&u, chung n&m song song vdi n h a u va xiidng quay nam ngoai xUdng tru. Hai xUdng nay tiep khdp vdi xUdng canh tay tai khdp khuyu, vdi cac xUdng cd tay tai khdp cd tay va vdi nhau tai cac khdp quay tru gan va xa. 5.4.1. XtfOng quay (radius) (H.2.22) D au tren xUdng quay nhd hdn dau dudi va dUdc goi la chom xiidng quay; chom bao gom mot vanh khdp d xung q u a n h tiep khdp vdi k h u y e t quay xUdng tru va mot hom khdp d m a t tre n tiep khdp vdi chom con xUdng canh tay. Chom noi vdi th a n qua mot co th a t hep. T h a n xitd n g gan co hinh lang tru tam giac nen cd ba m at la mat triidc, mat sau va mat ngoai; ba bd la bd triidc, bd sau va bd gian cot. C) p hla trUdc-trong goc noi giiia cd va th an co mot u loi goi la loi cu quay. D au ditdi la mot khoi to det co hai m a t khdp: mat khdp co tay hudng xuong dudi tiep khdp vdi cac xUdng cd tay hang tren; va khuyet tru hiidng vao trong tiep khdp vdi v an h khdp cua chom xUdng tru. Mom xUdng n am d ndi th a p n h a t cua m at ngoai (sd th ay dUdc dudi da) la mom tram quay. 5.4.2. Xuong tru (ulna) (H.2.22) D au tren cd mom khuyu va mom vet vay quanh khuyet rong roc. Khuyet rong roc khdp vdi rong roc xUdng canh tay con mom khuyu va mom vet lap vao cac ho" cung ten d dau dudi xUdng canh tay khi cang tay gap va ruoi. T ren m a t ngoai mom vet cd khuyet quay tiep khdp vdi vanh khdp cua chom xUdng quay. T h a n xitd n g gian cd h in h lang tr u ta m giac vdi ba m a t (m at triidc, m at sau va m at trong) va ba bd {bd triidc, bd sau va bd gian cot). D au ditdi tron va nhd, dUdc goi la chom xiidng tru. C hom bao gom mot vanh khdp tiep khdp vdi khuyet tru cua xUdng quay va mot mom chay xuong co ten la mom tram tru. 5.5. Cac xuong cua ban tay (bones of hand) (H.2.23) 5.5.1. Cac xUOng co tay (carpal bones) Cac xUdng cd tay la mot khoi gom tam xiidng ng&n xep thanh hai hang. H a n g tre n co bon xUdng, ke tu: ngoai vao trong, la: xiidng thuyen, xiidng nguyet, xiidng thap va xiidng dau\ h a n g diidi cung cd bon xUdng, ke tii ngoai vao la; xiidng thang, xiidng the, xiidng cd va xiidng moc. M at tren cua ba xUdng ben ngoai cua hang tren tiep khdp vdi xUdng quay (xUdng dau n&m trUdc xUdng thap), m at diidi cua chung tiep khdp vdi m at tren cua cac xUdng hang dudi. M at dudi cua cac xiidng hang dudi tiep khdp vdi cac xUdng dot ban tay. M at trUdc khoi xUdng cd tay hdp nen mot ra n h 15m goi la ranh co tay, ham gan gap b^c cau qua hai bd ranh va bien ranh thanh ong co tay. 34 Chom xg quay \ \ L6i cu quay _ Xg quay Mom khuyu Khuy6't rong roc Mom vet Loi cu tru Mao co ngua Thi/ng cheo Lo cua DM gian cot sau Mang gian cot Xg tru Lo cua DM gian cot tri/dc Mom khuyu ,.Chom xg quay Xg tru . — Xg quay B Mom \ Mom tram tru- \7 - - M o m tram quay Hinh 2.22. Xi/ong tru va xiidng quay ben phai A. Nhin tir triidc, B. Nhin tir sau 5.5.2. Cac xuong dot ban tay (metacarpals) Co nam xifdng dot ban tay, diidc danh so' theo thii ttf tijf ngoai vao trong la cac xiidng ban tay I, II, HI, IV va V. Moi xiidng nay la mot xiidng dai co than va hai dau. Dau tren (dau gan) la nen co cac mat khdp de tiep khdp vdi xiidng cd tay d hang diidi, tao nen cac khdp cd tay-dot ban tay, va vdi cac xUdng dot ban ke can; dau dudi (dau xa) la chom hinh ban cau tiep khdp vdi dot gan cua ngon tay tUdng ting, tao nen cac khdp dot ban tay-dot ngon tay. 35 Hinh 2.23. Cac xiidng cua ban tay ben phai, nhin ttr trirdc 5.5.3. Cac xuong ngon tay hay dd't ngon tay (phalanges) Moi ngon tay co ba dot la dot gan (proximal phalanx), dot giiia (middle phalanx) va dot xa (distal phalanx), rieng ngon cai khong co dot giiia. Nhu vay co tat ca 14 xiidng dot ngon tay d moi ban tay. Moi xiidng dot ngon tay deu co: than dot, nen dot d dau gan va chom dot d dau xa. Xiidng dot giiia moi ngon tay khdp vdi xiidng dot gan tai khdp gian dot ngon gan, vdi xiidng dot xa tai khdp gian dot ngon xa. 6. Cac xifdng cua chi dirdi (bones of lower limb) (H.2.24) M6i chi diidi cd 31 xUdng bao gom: 1 xiidng chau, 1 xiidng dui, 1 xUdng b a n h che, 1 xiidng chay, 1 xiidng mac, 7 xUdng cd chan, 5 xUdng dot b an ch an va 14 xUdng dot ngon chan. Xiidng chau d hai ben cung vdi xiidng cung tao nen dai chi ditdi (hay dai chau ■ pelvic girdle), cac xUdng con lai thuoc p h a n tit do cua chi ditdi (free part of lower limb). Dai chau lien ket cac xiidng thuoc phan tii do chi dudi vdi cot song va la cong cu chong dd cot song. Khoang do dai chau tao nen la chau hong, mot cau true cd vai tro nang dd cac tang chau hong. Hinh 2.24. Bo xi/ong chi di/6i 37 6.1. Xirong chau va chau hong 6.1.1. XifOng chau (hip/coxal bone) (cac H.2.25 va H.2.26) Moi xiidng chau cua tre mdi sinh bao gom ba xUdng ngan cach nhau bang sun: do la xitdng canh chau d phla tren, xiicfng m u d phia trudc-dudi, va xiicfng ngoi d phi'a sau-dudi. Ve sau, sun dUdc cot hoa va ba xUdng dinh lai vdi nhau d q uanh o coi. Nhiing cau true chung do ca ba phan xUdng chau hoac hai trong so ba phan tao nen la: (1) o coi la mot hom khdp sau d m at ngoai xUdng chau, tiep khdp vdi chom xiidng dui de tao nen khdp hong; (2) lo b it n&m giiia xUdng mu d trong va xUdng ngoi d ngoai; (3) n g a n h n g o i-m u do nganh xUdng ngoi va nganh dudi xiidng mu hdp nen; va (4) k h u y e t ngoi ldn la khuyet xUdng nam giiia gai ngoi va xiidng canh chau. X itd n g c a n h c h a u (ilium) la xUdng ldn nhat. Bd tren xUdng canh chau day len thanh mao chau. Cac dau trUdc va sau cua mao chau dUdc goi lan liidt la gai chau tritdc-tren va gai chau sau-tren. Bd trUdc xUdng canh chau cd gai chau tritdc ditdi nam ngay dudi gai chau trUdc-tren, bd sau cd gai chau sau-ditdi nam dudi gai chau sau-tren. M at trong xUdng canh chau co ho chau d tren va ditdng cung d dudi. C) sau ho' chau va dudng cung la loi cu chau va m at loa tai, ndi tiep khdp vdi xUdng cung. M at ngoai dUdc goi la m at mong, ndi cd cac dudng gd cho cac cd mong bam. Gai Hinh 2.25. Mat ngoai xifdng chau ben phai 38 Hinh 2.26. Mat trong xiidng chau ben phai X itd n g n g o i (ischium) gom than xUdng ngoi d tre n va nganh xUdng ngoi d dudi. Dau trong nganh xUdng ngoi lien tiep vdi nganh diidi xUdng mu, dau ngoai lien tiep vdi than va phinh to thanh cu ngoi. Bd sau than xUdng ngoi co gai ngoi va d diidi gai nay la khuyet ngoi be. X itd n g m u (pubis) gom co mot nganh tren, mot nganh ditdi va mot than d phia trong, giiia hai nganh. 6.1.2. Chau hong (pelvis) (H.2.27) C ha u h o n g (pelvis) diidc tao bdi sii tiep khdp gitia hai xiidng chau vdi xiidng cung va xiidng cut. Khoang do cac xUdng chau hong gidi han nen la khoang chau hong (pelvic cavity). Chau hong diidc eo chau tren (pelvic inlet) chia thanh chau hong ldn (greater pelvis) d tren va chau hong be (lesser pelvis) d diidi. Eo ch a u tre n nam tren mot m at phSng chech xuong dudi va ra trUdc. Moi mia cua eo chau tren di tii u nho xUdng cung tdi bd tren khdp mu va do cac dudng gd tre n xUdng cung va xUdng chau tao nen. C) nil, cac kich thudc cua eo ch au tre n la mot trong nhiing yeu to' quyet dinh sU lot cua dau th a i nhi tro n g luc de. Co ba kich thudc: dieting kinh triidc - sau dUdc do tii giiia u nho xUdng cung tdi giiia bd tren khdp mu; dildng kinh ngang la khoang cach toi da giiia hai diem tUdng tii d hai ben eo tren; va dildng kinh cheo dUdc do tii loi chau mu tdi khdp cung-chau. C hau h o n g ldn nam tren eo chau tren va la mot phan cua o bung C hau hong he dtidc gidi h a n bdi xUdng cung va xUdng cut d sau, xUdng ngoi va p h an dudi xUdng canh chau d hai ben, Va xUdng m u d trUdc. No thong d tre n vdi khoang bung qua eo chau tren, thong ra ngoai qua eo dudi (pelvic oulet). Chau hong be cd th a n h xUdng vay kin xung quanh. No dUdc day d dudi b&ng cac mo m em va chiia dung cac tan g chau hong. Cac dudng kin h cua khoang chau hong be dUdc do d miic giiia khoang nay, bao gom cac dudng kinh ngang, cheo va trUdc sau. Khdp cung-chau / Hinh 2.27. Chau hong Eo diidi co hinh tra m m a hai canh triidc la hai n g an h ngoi-m u gap n h a u tai goc diidi mu, hai can h sau la cac day ch&ng cung-cu vdi xUdng cu t d giGa. N h u vay, niia sau cua eo diidi khong phai la dudng vien ciing vi cac day ch&ng cd the gian dUdc va xtidng cut cung cd the dich chuyen. Eo dudi cung cd ba dudng kinh ngang, cheo va trUdc-sau. S u k h a c n h a u g iiia ch a u h o n g n a m va c h a u h o n g n il (H .2.28). C h au hong the hien dac diem gidi tinh ro ret: chau hong nil rong va ngan, cac dudng kinh eo chau tren ldn hdn nam. Cung mu va goc dudi mu cua nil rong hon nam , k hoang cach gian gai ngoi cua nO cung rong hdn. T rong khi dd xUOng chau hong cua nam day hdn va cac mom hay gd xUdng cung ro net hdn. 40 A B H.2.28. Chau hong nam (A) va chau hong nuf (B) 6.2. Xirang dui (femur/thigh bone) (H.2.29) La xiidng to, dai va khoe n h a t trong cd the, xiidng dui co mot th a n nam giiia hai dau. Chorp Ho mau chuyen \ _ x Mau chuyen ldn Mau chuyen ldn , Ch6rV ~ X Horn chom Mau chuyen be J ^ xuong dui Dudng luge Ml r Mep tro u g h \ 1 Hi i f f Dudn9 9ian Dudng rap | j j jIj^ mau til Mau chuydn be t— Than Mao tren loi cau trong Loi cu co mong B Mao tren loi cau ngoai Cu cdkhep Mat banh che Dien khoeo Ho gian loi cau <- Mom tren loi cau ngoai ' Cac loi cau \ \ Cu co khep i tren 101 m Mom tr6n I6i cau Mom tren loi cau trong Hinh 2.29. Xi/dng dui ben phai na°a' Mo . j L i ^ r n Loi cau ngoSi :an nnoAi ----------------- --- Loi i / " ' L6i cau trong A.Nhin tif tri/dc, B.Nhin tCr sau 41 TCf trong ra ngoai, d a u tren co chom xiidng dui, co xito n g dui, mau chuyen ldn va mau chuyen nho. Chom tiep khdp vdi o coi xiidng chau tao nen khdp hong. T h a n xito n g n h a n va gan tron nhUng d phia sau co mot dudng go ghe goi la ditdng rap. D au du d i to, tiep khdp vdi xUdng chay bang loi cau trong va loi cau ngoai. Hai loi cau noi vdi n h a u d trUdc bang mat banh che va dUdc n g an cach n h a u d phia sau bang ho gian loi cau. 6.3. Xirong banh che (patella) XUdng b an h che la mot xUdng nhd h in h tam giac n&m tro n g gan cd tut dau. No cd mot nen hudng len tren, mot dinh hudng xuong dudi va hai mat: mat khdp va mat tritdc. M at khdp hiidng ra sau tiep khdp vdi m at banh che cua xUdng dui. 6.4 Xirong chay (tibia) (H.2.30) Loi gian loi cau Loi cau ngoai Loi gian loi cau Loi cau trong s L6i cu chay - Xg chay Bd trade Loi cau trong \ Ranh gan cd gap ngon cai dai Ranh gan co gap -N \ J cac ngon dai / i Mat khdp tr6n ./C /S ^ / Ofnh chom xg mac Chom xg mac - Mao trong Mat ca trong- 1 ^ =1^1 x Mat ca ngoai Hinh 2.30. Xifdng chay va xiidng mac ben phai, nhin tCf triidc (A) va tCf sau (B) 42 Mat ca ngoai s Mat ca trong XUdng chay la xiidng ldn hdn, nSm d trong va la xiidng chiu trong liic trong so hai xiidng c^ng chan. No tiep khdp d d&u tre n vdi xiidng dui va xUdng mac, d dau dudi vdi xUdng mac va xUdng sen. D au tren la mot khoi xUdng to do loi cau trong va loi cau ngoai tao nen. Mat tren cua moi loi cau lom thanh mat khdp tren tiep khdp vdi mot loi cau xUdng dui. Tren mat sau-dudi loi cau ngoai co m at khdp mac tiep khdp vdi chom xUdng mac. T h a n xiid n g gan co hinh lang tru tam giac vdi ba m at (m at trong, m at ngoai va m at sau) va ba bd (bd triidc, bd trong va bd gian cot). T han xUdng cd loi cu chay nam d trUdc, dudi va giiia hai loi cau. P h an tre n cua m at sau th a n cd mot dudng gd chay chech xuong dudi va vao trong - ditdng cd dep . D au ditdi nhd hdn dau tren, co m at khdp ditdi hudng xuong dudi tiep khdp vdi xUdng sen, va khuyet mac hudng ra ngoai tiep khdp vdi dau dudi xUdng mac. Dau dudi keo dai xuong th an h mot mom d m at trong xUdng sen, tao nen m at cd trong. 6.5. Xirong mac (fibula) (H.2.30) XUdng mac la mot xUdng dai, m anh k hanh, d ngoai xUdng chay. D au tren phinh to goi la chom mac\ chom cd m at khdp tiep khdp vdi xUdng chay. T h a n xiid n g noi vdi chom mac qua mot cd va cung cd cac m at va cac bd gan giong n h u xUdng chay. D au d u d i h in h tam giac dUdc goi la m at cd ngoai. M at trong cua m at ca ngoai tiep khdp vdi xUdng sen. 6.6. Cac xirong cua ban chan (bones of foot) (cac H.2.31 va H.2.32) 2 8 - X a £ r ~ Xa 1 — Giura >- Cac) biua >~ xg dot ngon Gan J Xg dot ban I - Xg thuyen - Xg got-------- - - Xg dot ban V j f i j T - Trong "i i ~mM ~ Giura V Cacxgchem -Ngoai J _ Xg hop “ Ranh gan co mac dai -X g sen - Mat khdp mat ca trong h ~ Mat khdp mat ca ngoai Mat khdp tren Hinh 2.31. Cac xiidng ban chan ben phai, nhin tii tren 43 Cac xifdng cua ban chan gom 7 xifdng cd chan, 5 xifdng dot ban chan va 14 xifdng dot ngon chan. 6.6.1. Cac xuong co chan (tarsal bones) Bay xUdng cd chan xep th an h hai hang: hang sau co xicang sen va xiidng got\ hang trUdc co xiidng thuyin, xiidng hop va ba xiidng chem. X iid n g se n (talus) co hinh con sen vdi ba p h a n ke tii trUdc ra sau: chom sen, co sen va than sen. No nlim dudi xUdng chay, tren xUdng got va giiia cac m&t ca trong va ngoai. XUdng sen tiep giap vdi nhieu xUdng khac nen co nhieu m at khdp: m at trUdc chom sen co mat khdp thuyin tiep khdp vdi xUdng thuyen; cac m at tren va ben cua than sen co rong roc sen tiep khdp vdi m at khdp dudi cua xUdng chay va cac m at ca; m at dudi co cac mat khdp got triidc, giiia va sau tiep khdp vdi xUdng got. Hinh 2.32. Cac xi/dng ban chan ben phai, nhin tCrdi/di 44 X iidng g o t (calcaneus) la xifdng cd chan ldn nhat; no nam diidi xifdng sen va sau xUdng hop. XUdng gom sau mat. M at tren gom phan sau tu do va phan trifdc co cac mat khdp sen triidc, giiia va sau tiep khdp vdi xUdng sen. M at khdp sen giiia nam tren mot mom co ten la mom dd xitdng sen. Giiia cac m at khdp sen cua xifdng got va cac m a t khdp got cua xUdng sen deu co cac ra n h ngan cach: ra n h d xifdng sen la ranh sen, ra n h d xUdng got la ranh got . Cac ra n h d hai xUdng hdp nen xoang co chan. M at difdi co u got d sau va cu got d trUdc; u got do cac mom trong va ngoai (tiep dat) tao nen. M at ngoai cd rong roc mac d trUdc va ranh gan cd mac dai d sau. M at trong lom sau thanh ranh gan cd gap ngon cai dai. X itdng th u ye n (navicular) tiep khdp vdi chom sen d phia sau, vdi ba xifdng chem d p hia trUdc va vdi xUdng hop d phia ngoai; m a t trong cua no cd loi cu xitdng thuyen. Cac xiid n g chem trong, g iiia va n g oai (medial cuneiform, interm ediate cuneiform and la teral cuneiform) nam tre n mot h an g ngang d trUdc xifdng th u y en va sau cac xUdng dot ban I, II, va III. X itdng hop (cuboid) hinh khoi vuong nam giiia xifdng got va cac xUdng dot ban chan I V va V . Cac xiidng dot ban chan (m etatarsals) gom nam xUdng dUdc danh so' tii I - V, ke tii trong ra ngoai. Chung thuoc loai xifdng dai, moi xifdng cd than nam giiia nen va chom (dau xa). Nen co cac m at khdp tiep khdp vdi xUdng cd chan va vdi xUdng dot ban chan ben canh. Chom loi, tiep khdp vdi nen xUdng dot ngon chan gan. Cac xiid n g d o t ngon c h a n (phalanges) cd so" lifdng, h in h the va cach goi ten giong nhu xifdng dot ngon tay. TL/ LlfONG GIA A. XAC DINH Ll/A CHON DUNG NHAT CUA NHUNG CAU H6l NHI^U LlTA CHON SAU DAY 1. NhCrng mo ta sau day ve cau tao cua xufOng deu sai, trir: a. hoan toan b an g mo xUdng; i>. b an g mo xUdng, mo su n va m ang; c. hoan toan b an g xifdng dac; d. hoan toan b an g xifdng xop. 2. NhOmg xuong sau day deu khong thuoc loai xifdng dai, trir: a, xUdng dinh; b. xtidng vai; dot xUdng song; d xtidng don. 3. Cac xifdng dai difdc phat trien day du: a. ngay sau khi sinh;($. khi cac sun dau xtidng dtidc cot hoa hoan toan; c. nhd tru n g tam cot hoa nguyen p h at; d. tii m ot tr u n g ta m cot hoa. 45 4. Nhurng md ta sau day ve xifdng canh tay deu sai, trif: a. co ba m at tiep khdp vdi cac xiidng khac; b. tiep khdp vdi xiidng vai bang mot chom hiidng ra ngoai; c. khong sd th ay diidc qua da; d. co mot hom cho cd delta bam. 5. Nhurng mo ta sau day ve xifdng quay deu sai, trif: a. xoay q uanh xUdng tru tai hai khdp; b. co m ot loi cu cho cd canh tay bam ; c. co dau tren to hdn dau dudi; d. co khuyet rong roc khdp vdi xUdng canh tay. 6. Nhurng mo ta sau day ve xifdng vai deu sai, trif: a. lien ket vdi bo xUdng true qua xUdng don; b. co mot o chao d goc dudi; c. tiep khdp vdi xUdng don ban g mot khdp sdi; d. dUdc keo len nhd cd ngiic be. 7. Nhurng mo ta sau day ve mot dot song dien hinh deu sai, trif: a. co mot cung n am trUdc lo dot song: b. co mot mom gai nho ra tii giiia m a t sau than; c. co mot lo gian dot song n am giiia cuong va m a n h cua cung dot song; d. lien ket vdi cac dot song ke can bang ba loai khdp. 8. Nhurng mo ta sau day ve xifdng ham difdi deu sai, trif: a. la ndi bam cho dau di dong cua cac cd nhai; b. co mot xoang nam trong nganh ham dudi; c. tiep khdp vdi xUdng th a i diidng ta i m om vet; d. co mom loi cau nam giiia th a n va nganh ham diidi. 9. Nhurng md ta sau day ve xifdng dui deu sai, trif: a. la xiidng dai n h a t cd the; b. co mot chom tiep khdp vdi lo bit xUdng chau c. co mot th a n h in h lang tru ta m giac; d. co hai loi cau d dau diidi tiep khdp vdi xUdng chay va xUdng mac. 46 10. Nhurng mo ta sau day ve xi/dng chau deu sai, trir: a. la xUdng chi duy nhat tiep khdp vdi cot song; b. do xifdng mu va xUdng ngoi hdp lai tao nen; c. co hinh the giong n h au giiia nam va nii; d. tiep khdp vdi xUdng cung bang mot khdp sdi. B. XAC 0|NH NHQNG CAU SAU D U N G HAY SAI 11. T han xUdng sen co m a t tiep khdp d m at tren va hai m at ben. 12. Be xUdng cua xUdng xop cung co cac he thong Havers dien hinh. 13. XUdng dot song thuoc loai xUdng dUdc cot hoa tif sun. 14. Lo gian dot song nam giiia cac cuong cua cac cung dot song ke can nhau. 15. Chi co dot song cd mdi co lo tren mom ngang. 16. XUdng dai thUdng co mot dong m ach nuoi xUOng ldn di vao dau xUdng va cac dong m ach nho di vao th a n xUOng. 18. Ho' tuyen yen nam d m at tren p h an da xUdng th a i dudng. 19. O m at thong vdi hop so qua khe o m a t dudi va ong thi giac. 20. Horn nhi la hoc xUdng nam trong p h an tra i xUOng th ai dudng. 21. Cd the sd thay cac mom tren loi cau trong va ngoai cua dau dudi xUdng canh tay. 22. Mom tram quay d thap hdn mom tram tru. 23. O ngUdi nam liet giUdng, da p h u vung xUdng cung va m au chuyen 16n de bi loet. 24. Mat ca trong la moc xac dinh tinh mach hien ldn khi tiem truyen. 25. Gai chau trUdc tren va mao chau la nhiing mo'c giup xac dinh vi tri tiem mong. OAP AN: 1: b; 2: d; 3: b; 4: a; 5: a; 6: a; 7: d; 8: a; 9: a; 10: a; 11: D; 12: S; 13: D; 14: D; 15: D; 16: S; 18: S; 19: S; 20: S; 21: D; 22: D; 23: D; 24: D; 25: D 47 Chvtfofng 3 HE KHOTP (ARTICULAR SYSTEM) MUC TIEU 1. Trinh bay diidc sit khac biet v i cau tao va kha nang cii dong cua khdp sdi, khdp sun va khdp hoat dich. 2. Mo ta diidc cau tao chung cua khdp hoat dich va trinh bay diidc cach phan loai khdp hoat dich dtfa tren hinh the mat khdp va cac cii dong. 3. Md ta diidc mot sd khdp hoat dich ldn d cac chi va dau (khdp thdi ditdng-ham diidi, khdp vai, khdp khuyu, khdp hong va khdp goi). 1. Dai cudng ve he khdp Khdp (joint) la ndi lien ket giiia hai hoac nhieu xUdng, giiia xifdng va sun, hoac giiia xUdng va rang. Cac khdp dUdc phan loai theo cau tao va chiic nan g cua chung. Theo cau tao, cac khdp dUdc chia th a n h ba loai: khdp sdi, khdp su n va khdp hoat dich. Dua vao miic do hoat dong, cac khdp dUdc chia th a n h ba loai: khdp bat dong (synarthrosis), khdp ban dong (am phiarthrosis) va khdp dong (diarthrosis). 1.1. Khrfp sp i (fibrous joint) (H.3.1) Day la cac khdp khong co o khdp, cac xUdng dUdc giijf r a t c h a t vdi n h a u bang mo lien ket sdi, va co it hoac khong co cii dong giiia cac xUdng tiep khdp. Co ba loai khdp sdi la diidng khdp, khdp chang va khdp rang - huyet rang. Mot ditdng khdp (suture) la mot khdp sdi m a d do cac xUdng n am r a t s a t n h a u va chi co mot ldp mo sdi mong lien ket cac xUdng. Diidng khdp la kieu lien ket dien hinh giiia cac xiidng so va, ve chiic nang, d a y la kh d p b a t dong. Mot khdp chang (syndesmosis) la mot khdp sdi ma, neu so vdi dudng khdp, co mot khoang cach ldn hdn giiia cac xiidng tiep khdp va vi the co nhieu mo sdi hdn. Mo sdi cd the la mot m ang gian cot (chang han nhu giiia cac xUdng chay va mac) hoac day chang. Khdp chang cho phep mot miic cii dong han che giiia cac xUdng tiep khdp va diidc xep vao loai khdp ban dong. Mot khdp rang-huyet rang (gomphosis) la khdp sdi giiia mot chan ran g hinh non vdi huyet rang; mo lien ket sdi giiia chan ran g va huyet ra n g dUdc goi la day chang quanh rang. Khdp rang-huyet rang la khdp ba't dong. 48 Hinh 3.1. Cac loai khdp sdi a. Kh6p ch&ng chay- mac b. Oi/dng khdp d so c. Khdp rang-huyet rang 1.2. Khdp sun (cartilaginous joint) Khdp sun la khdp ma d dd cac xUOng tiep khdp diidc lien ket chat vdi nhau bang sun trong hoac sun-sdi. Giong nhii khdp sdi, khdp sun khong cd o khdp va chi cho phep mot miic cii dong han che hoac khong. Cd hai loai khdp sun: khdp sun trong va khdp sun-sdi. K hdp su n tro n g (synchondrosis) la cau tru e tam thdi chi cd d bo xiidng chiia trUdng th a n h . Day la khdp sun m a d dd v a t lieu lien k e t la sun trong. Cac vi du ve khdp sun trong la tam sun dau xitdng (epiphysial cartilage) ket noi dau xUdng va than xiidng cua mot xUdng dai dang phat trien, sun ndi xUdng siidn thii n hat va xUdng lie, nhiing sun lien ket xiidng canh chau, xUdng ngoi va xUdng mu. Khi xUdng ngiing ph at trien ve chieu dai, sun trong dUdc thay the bang xUdng va khdp sun bien thanh mot lien ket xitdng (bony union; synostosis). Ve chiic nang, kh d p s u n tro n g la khdp bat dong. K hdp sun-sdi (symphysis) la mot khdp sun m a d dd dau cua cac xiidng tiep khdp diidc phu bang sun trong, nhUng hai dau xUdng dUdc ph u sun nay dUdc ket noi bang mot dia sun-sdi. T at ca cac khdp sun-sdi n lm tren dudng giiia cua cd the. Khdp sun-sdi mu, khdp giiia can lie va th a n lie, va khdp giiia cac th a n dot song la nhiing khdp sun-sdi. Khdp sun-sdi thuoc loai kh d p ban dong. Kha nang cii dong h a n che m a khdp sun-sdi cd dUdc la nhd dia sun-sdi cd k h a n an g chiu dUdc sutc nen ep (hay dan hoi). 1.3. Khdp hoat dich (synovial joint) hay khop dong (diarthrosis) Khdp hoat dich la khdp cd mot khoang goi la o khdp (articular cavity) d giiia cac xiidng tiep khdp. O nay chiia chat hoat dich lam trdn khdp, cho phep khdp cii dong tii do. T a t cd cac kh d p h o a t d ich la n h iin g kh d p dong. Loai khdp nay cd m at pho bien d cac chi. 6 than, khdp doi - cham, cac khdp doi - true, cac khdp sitdn - dot song va cac khdp siidn - mom ngang cung la nhiing khdp hoat dich. 49 1.3.1. Cau tao cua khOp hoat dich (H.3.2) T at ca cac khdp h oat dich deu dUdc tao nen tu: nhiing th a n h p h an n h u sau: M a t k h d p (articular surface) la be m at tiep khdp cua cac xiidng tham gia cau tao khdp. M at khdp cd hinh the khac nhau tuy tting loai khdp va dUdc phu bang sun khdp (articular cartilage); sun khdp thuoc loai s u n tro n g (hyaline cartilage). Ldp sun nay lam cho m at khdp nhan va de trUdt. Nhiing m at khdp lom diidc goi la ho khdp (articular fossa). Khi cac m at khdp cd hinh the chiia th a t thich ling vdi nhau, co the cd them sun vien (labrum) de lam cho m at khdp lom sau them, hoac mot sun chem (meniscus) nam xen giiia phan ngoai vi cua hai m at khdp. Cung cd khi hai m at khdp khong tiep xuc triic tiep vdi nh au ma gian cach nhau bdi mot dia sun-sdi goi la dia khdp (articular discus). Dia khdp cd hai m at thich dng vdi cac m at khdp cua hai xUdng tiep khdp. Chang han, neu m at khdp cua hai xUdng deu loi thi dia khdp se cd hai m at lom. B a o k h d p (joint/articular capsule) la mot bao hinh ong boc quanh khdp va lien ket cac xUdng tiep khdp vdi nhau. Bao du long de khdp cd the cti dong tii do nhUng cung du chac de giii cho khdp khoi bi trat. Bao khdp do hai ldp tao nen, ldp hay mang xd (fibrous layer/m em brane) d ngoai va mang hoat dich (synovial m em brane/layer) d trong. Moi dau cua ldp xd bao khdp din h vao m an g xUdng d q u an h mot dau xUdng va dudng dinh nay it nhieu d cach xa mep (bd chu vi) sun khdp. Mang hoat dich la mot ldp te bao bieu mo lot m at trong ldp xd cua bao khdp cho tdi cho ldp nay dinh vao xUdng thi lat len boc phan dau xUdng trong bao khdp tdi tan ria sun khdp. Ngoai ra, mang hoat dich con bao boc nhiing cau true nam trong bao khdp m a khong chiu trong lUc (n h u su n vien, gan, day c h an g tro n g bao khdp). M ang hoat dich cung vdi cac m at khdp gidi han nen o khdp (articular cavity). No tiet ra mot dich dinh, dac nhu long trang trting goi la hoat dich (synovial fluid). Cac tac dung cua chat nay la bdi trdn cac m at khdp, cung cap cac c h at dinh dudng cho nhiing cau true ben trong o khdp va qua dd giup duy tri tin h ben viing cua khdp. C hat dich giii cho cac m at khdp khong tach rdi nhau, giong n h u khi giiia hai m at k in h cd mot it nUdc. O khdp doi khi bi p h a n chia m ot p h a n hoac hoan toan bdi mot dia khdp hoac sun chem. Nhiing tui nhd chtia hoat dich (hay cac tui thanh mac) cd m a t d m ot so' khdp. C hung cd tac dung nhu nhiing cai dem chong lai m a sat giiia mot xUdng va mot day chang hoac gan, hay gitia xUdng va da, ndi ma mot xUdng tham gia cau tao khdp d gan be m at da. C ac d a y c h a n g (ligaments) la phufdng tien giii cho khdp viing chac them. Cd ba loai day chang: day chang bao khdp (capsular ligaments) la cho day len cua bao khdp, day chang ngoai bao khdp (extracapsular ligamets) va day chang trong bao khdp (intracapsular ligaments). 50 Hinh 3.2. Sd do cau tao khdp hoat djch N hiing cd va gan di qua mot khdp khong nhiing cd chijfc n an g van dong khdp ma con cd vai tro giii khdp. T h a n k in h va m ach m au. Nhiing than kinh chi phoi cho mot khdp cung chinh la nhiing than kinh chi phoi cho nhiing cd van dong khdp dd. Nhiing dong mach n^m gan mot khdp hoat dich thUdng tach ra nhiing nhanh xuyen vao bao khdp va cac chang cua khdp. Rieng sun khdp dUdc nuoi dudng bang chat hoat dich. 1.3.2. Phan loai khdp hoat djch (H.3.3) Cac khdp hoat dich cd cau tao chung n h u nh au nhiing hinh the cua cac m at tiep khdp thi gom nhieu loai khac nhau. Diia vao hinh dang cua cac m at tiep khdp, khdp hoat dich dUdc chia th a n h sau loai (H.3.3): khdp phang, khdp ban le, khdp true, khdp chom, khdp loi cau va khdp yen. K hdp p h a n g (plane joint) hay kh d p triid t (H.3.3d). M at tiep khdp cua hai xifdng phang hoac hdi cong chi cho phep chung trUdt len nhau mot cach han che. Khdp tic-don, khdp cung vai-don, nhiing khdp giiia cac xifdng co tay va nhiing khdp giiia cac xifdng co chan la nhiing khdp phang. Khdp phang thuoc loai khdp khong true. K hdp ban le (hinge joint) hay kh d p ro n g roc (H.3.3c). 6 loai khdp nay, m at khdp cua mot xUdng loi hinh rong roc, m at khdp cua xifdng kia la mot khuyet lom de rong roc lap vao. N hiing cU dong cua khdp ban le chi khdp ga'p va ruoi giong nhif tai ban le cua mot canh cifa. Khdp khuyu, khdp goi, khdp co chan, khdp doi-cham va cac khdp gian dot ngon cua ngon tay va ngon chan la nhiing khdp ban le. Cac khdp ban le thuoc loai khdp ddn true. 51 K h d p tru e (pivot joint) (H .3.3e). C) mot khdp true, m at khdp tron hoac nhon cua mot xUdng tiep khdp vdi mot vong xUdng-sdi dUdc tao nen mot p h an do mot xUdng khac va mot phan do mot day chang. Khdp true thuoc loai khdp ddn true vi no chi cho phep c\i dong xoay tron quanh true doc cua no. Cac khdp quay-tru va khdp doi-truc giiia la nhiing khdp true. K h d p c h o m c a u (ball and socket joint; spheroidal joint) (H.3.3a,b). 0 loai khdp nay, m at khdp cua mot xUdng cd hinh cau (dUdc goi la chom), con m at khdp cua xUdng kia lom sau n h u mot o’ thich ling vdi chom. H in h d an g cua nhiing m a t tiep khdp cho phep khdp cd tam cti dong rong. N hiing cvf dong cd the cd cua loai khdp nay la: gap, ruoi, giang, khep, quay tron va xoay tron. Khdp vai va khdp hong la nhiing khdp chom. Nhiing khdp nay la khdp da true vi ch u n g cho phep cU dong quanh ba true. K h d p loi c a u (condylar joint) (H.3.3f.g) hay k h d p so a n (ellipsoid joint). 6 loai khdp nay, m at khdp loi hinh oval cua mot xUdng khdp vdi m at khdp lom hinh oval cua xUdng khac. Khdp co tay va cac khdp dot ban tay-dot ngon tay cua cac ngon tay II tdi V la nhiing vi du ve khdp loi cau. Khdp loi c&u cho phep cU dong quanh hai true va dUdc goi la khdp litdng true. Hinh 3.3. Cac loai khdp hoat djch chinh (xep theo hinh the) a,b. Khdp chom cau (khdp vai va khdp hong); c. Khdp ban le;d. Khdp phang (giGra hai xuong co tay); e. Khdp true (khdp Cl - CII); f,g. Khdp loi cau (khdp dot ban tay - ngon tay); h. Khdp yen 52 K hdp yen (saddle joint) (.H.3.3h). 6 mot khdp yen, mat khdp cua mot xiidng co hinh yen, con mat khdp cua xUdng kia thich iing vdi “yesn” nhii mong ngiidi ciidi ngUa khft vdi yen ngiia. Mot vi du ve khdp yen la khdp giiia xiidng thang vdi xUdng dot ban tay thii nhat. Khdp yen la mot bien the cua khdp loi cau va co cii dong tu do hdn khdp loi cau mac du no cung la khdp lUdng true. Diem khac cua khdp loi cau va khdp yen so vdi khdp chom cau la cac loai khdp nay khong thiic hien dUdc cii dong xoay tron nhu khdp chom c&u. Trong cac khdp cua cd the, khdp nao ma bao khdp chi vay quanh mot cap mat khdp thuoc mot trong sau loai tren la khdp ddn (simple joint), khdp nao co nhieu cap mat khdp la khdp phtic hdp (complex joint). Khdp true va khdp ban le la hai dang cua khdp tru (cylindrical joint). 1.3.3. Cac cCrdong cua khdp hoat djch Nhiing cii dong tai cac khdp hoat dich la trUdt, cac cii dong goc, xoay tron va cac cii dong dac biet. Cac cii dong goc la cac cii dong lam tang hoac giam goc giiia cac xUdng tiep khdp va bao gom gap, ruoi, giang, khep va quay tron. Gap (flexion) va ruoi (extention) la cac cii dong doi nh au thiidng xay ra d m at phang diing doc, gap lam giam goc giiia cac xUdng tiep khdp, ruoi thi ngUdc lai. G ia n g (abduction) la chuyen dong cua mot xiidng ra xa dudng giiia cd the, k h ep (adduction) la chuyen dong ngUdc lai. Rieng d ban tay va ban chan thi giang cac ngon co nghia la dua cac ngon ra xa ngon giiia. Q uay tro n (circumduction) la chuyen dong cua dau xa cua mot phan cd the trong mot vong tron do ket qua cua gap, ruoi, giang va khep. X oay tro n (rotation) la chuyen dong cua mot xUdng quanh true dai cua no. S a p (pronation) la cii dong xoay gan ban tay xuong dudi, ngiia (supination) la cii dong xoay gan ban tay len tren. Day la nhiing cii dong dac biet. 2. Cac khdp cua so (joints of skull) Khdp giiia cac xiidng so deu la cac kh6p sdi d dang cac diidng kh6p hoac cac k h 6 p s u n tro n g da hoa xUdng. So chi co mot khdp hoat dich la khdp thdi dtidng ham di/di. Khdp doi-cham, mot khdp lien k et xUdng so va cot song, dUdc mo ta d day cung cac khdp cua so cho tien. Khdp doi-cham (atlanto-occipital joint) la khdp hoat dich kieu loi cau giiia cac m at khdp tren cua dot doi va cac loi cau xUdng cham. Khdp nay cho phep gar>. ruoi va nghieng dau sang hai ben. Diidi day chi mo ta chi tiet khdp thai dUdng - ham dudi. Khdp thai difcfng-ham difdi (temporomandibular joint) (cac H.3.4 va H.3.5) Khdp thai diidng-ham dudi la khdp hoat dich, thuoc loai lUdng loi cau, noi xiidng thai diidng vdi xUdng ham dudi. 53 M at khdp. Mat khdp cua xiidng thai diidng nam d phan trai, gom cu khdp d triidc va ph&n triidc ho ham ditdi d sau. Ve phia xiidng ham diidi, mat khdp la chom xitdng ham ditdi. Xen giiia mat khdp cua hai xiidng la mot tam sun-sdi goi la dia khdp. Dia khdp co hai mat tren va diidi thich ting vdi mat khdp cua hai xiidng. B ao khdp dinh vao chu vi cac mat khdp cua hai xiidng va bam vao chu vi cua dia khdp; dia khdp chia o khdp thanh hai khoang: khoang thdi ditdng-dia khdp va khoang dia khdp-ham ditdi. Mang hoat dich cung bi chia doi thanh mang hoat dich tren lot mat trong ldp sdi cua bao khdp khdp thai dUdng-cfia khdp va mang hoat dich ditdi lot mat trong ldp sdi cua bao khdp khdp dia khdp-ham diidi. D ay chang. Bao khdp day len d cac m a t ngoai va trong th a n h day chang ngoai va day chang trong. Khdp con diidc giti bdi day chang bitdm-ham ditdi d mat trong cua khdp va day chang tram-ham ditdi d phia sau-trong cua khdp. Cac cd va nhU ng cii dong Ha xitdng ham ditdi. Khi ha mieng, chom xUdng ham diidi xday tren mat diidi cua dia khdp quanh mot true ngang. Co xiidng ham dudi va dia khdp cung diidc cd chan biidm ngoai keo ra triidc va dia khdp dich chuyen tdi diidi cu khdp. Chuyen dong ra triidc cua dia khdp diidc gidi han bdi stic cang cua mo xd-trun buoc dia khdp vao xiidng thai diidng. Xiidng ham diidi diidc ha thap nhd cd hai bung, cd cam-mong va cd ham-mong. Cd chan biidm ngoai dong vai tro quan trong trong viec keo xiidng ra triidc. Nang xitdng ham ditdi. Dong tac nay ngiidc vdi dong tac ha xiidng ham diidi. Dau tien chom xiidng ham diidi va dia khdp dich chuyen ra sau, tiep do chom xoay tren mat diidi dia khdp. Xiidng ham diidc nang len nhd cd thai diidng, cd can va cd chan biidm trong; cac sdi sau cua cd thai diidng keo chom xiidng ham diidi ra sau. Dia khdp diidc keo ra sau nhd mo xd-trun. Hinh 3.4. O khdp cua khdp thai difdng-ham diidi 54 Hinh 3.5. Khdp thai diidng - ham di/di nhin ben Diia ham diidi ra trUdc. Dia khdp diidc keo ra triidc tdi mat diidi cu khdp va chom xiidng ham diidi diidc keo theo cung dia khdp. Tat ca cti dong chi dien ra d khdp thai diidng-dla khdp. Ham diidi diia ra triidc lam cho cac rang ham diidi nam triidc rang ham tren. Dong tac nay xay ra khi cd chan biidm ngoai d ca hai ben cung co vdi sii ho trd cua hai cd chan biidm trong. Diia xiicfng ham diidi ra sau. Dia khdp va chom xiidng ham diidi diidc keo ra sau ve ho' ham diidi. Dong tac nay dien ra nhd cac sdi sau cua cd thai diidng. Cac cii dong nhai tiing ben. Cac cii dong nay bao gom viec luan phien diia ham diidi ra triidc va ra sau d moi ben. 3. Cac khdp cua cot song (vertebral joints) Ngoai trCi nhiing khdp hoat dich dac biet giiia dot doi vdi dot true thi cac dot song that liing, ngiic va co khac lien ket vdi nhau bang nhiing loai khdp giong nhau d tat ca cac vung. Do la nhiing khdp hoat dich giiia cac mom khdp, khdp sdi giiia cac cung dot song va khdp sun-sdi giiia cac than dot song. 3.1. Cac khdp hoat djch cua cot song (vertebral synovial joints) K hdp d o i-tru c g iiia (median atlanto-axial joint) (H.3.6) la khdp true g; .a mot ben la rang cua dot true vdi mot ben la cung triidc dot doi va day chdng ngang dot doi. Dong tac cua khdp nay la xoay dau. 55 Hinh 3.6. Kh6p dpi - true giOra (nhin tren) K hdp do i-tru c ben (lateral atlanto-axial joint) la khdp phang giiia mat khdp ditdi cua khoi ben dot doi vdi mat khdp tren cua dot true. Dong tac cua khdp nay cung la xoay dau. K hdp g iiia cac m om khdp (zygapophysial joints) (H.3.7a) cho phep cac mom khdp trifpt len nhau mot each ddn gian. Khdp that liing-cung va khdp ciing-cut. 3.2. Cac khdp chang cua cot song (syndesmoses of vertebral column) (H.3.7b) doc trudc DC tren gai DC gian gai Hinh 3.7. Cac kh6p va day chang cua cot song Day la loai khdp spi lien ket cac dot song. Mo sOi lien ket cac dot song duoc goi la cac day chang sau day: Day chang tren gai (supraspinous ligament) noi dinh cac mom gai; 56 Cac day chang gian gai (interspinous ligaments) nam giiia cac mom gai; Cac day chang gian ngang (intertransverse ligaments) noi cac mom ngang ke nhau; Cac day chang vang (ligamenta flava) cau tao hoan toan bang mo trun, chay giiia cac manh cung dot song ke nhau va gan nhii lap kin khoang lien manh; Day chang doc tritdc va day chang doc sau chay doc d mat triidc va mat sau than dot song. 3.3. Cac khdp sun-sori cua cot song (symphyses of vertebral column) Day la nhiing khdp sun ban dong giiia cac than dot song, diidc goi la khdp gian dot song. Cac mat tren va diidi cua than dot song deu lom d giiia, gd cao d xung quanh va diidc boc bang sun. Nhiing mat cua cac than dot song ke nhau diidc lien ket vdi nhau bang dia gian dot song. Dia co hinh thau kinh loi hai mat va gom hai phan: nhan tuy d giiia va vong sdi d xung quanh. Vong sdi cau tao bang mo xd-sun, dinh chat vdi be mat than dot song. Nhan tuy la mot khoi chat nhay co the dich chuyen trong vong sdi diidi liic ep giiia hai than dot song. Dia gian dot song cho phep mot miic cii dong nho giiia hai than dot song nhiing tam cii dong cong gop cua ca cot song hay doan cot song thi ldn hdn nhieu. Co hai day chang tang ciidng cho sii lien ket giiia cac than dot song (H.3.7b): day chang doc tritdc nam d mat triidc cac than dot song, di tii dot doi tdi phan tren mat triidc xiidng ciing; day chang doc sau nam d mat sau cac than dot song (trong ong song). 4. Cac khdp cua chi tren 4.1. Cac khop cua dai ngut (joints of pectoral girdle) Dai ngiic co hai khdp hoat dich thuoc loai khdp phang la khdp lic-don (H. 3.8) va khdp cung vai-don (H. 3.9). Hinh 3.8. Kh6p ire - don 57 Hinh 3.9. Khdp cung vai - don 4.2. Cac khdp cua chi tren tifdo (joints of free upper limb) Ngoai khdp chang quay-tru do mang gian cot cang tay va thitng cheo tao nen, cac khdp cua chi tren til do deu la khdp hoat dich, bao gom khdp o chao- canh tay hay khdp vai, khdp khuyu, khdp quay-tru xa va cac khdp cua ban tay. 4.2.1. Khdp o chao-canh tay hay khdp vai (glenohumeral joint; shoulder joint) (cac H.3.9 va 3.10) Khdp o chao-canh tay la mot khdp hoat dich kieu chom cau do chom xiidng canh tay va o chao xufdng vai tao nen (cac H.3.9 va 3.10) . Cac m at khdp la o chao xitdng vai va chom xitdng canh tay. Mot vanh sun sdi goi la sun vien o chao lam cho o chao sau va rong them. Bao k h d p nhu! mot tui rong boc toan bo khdp. No di til quanh o chao va sun vien tdi co giai phau xiidng canh tay. Phan diidi cua bao khdp rat long va day la viing yeu nhat cua no. Mang hoat dich tao nen mot ong bao quanh phan nam trong bao khdp cua dau dai gan cd nhi dau va bao phu sun vien o chao. Cac day chang. Day chang qua-canh tay til mom qua xiidng vai chay xuong bam vao cu 16n xiidng canh tay. Cac day chang o chao-canh tay tren, giita va ditdi la nhiing cho day len cua phan bao khdp boc mat triidc khdp vai. Dau dai cua gan cd nhi dau di qua o khdp trong ranh gian cu xiidng canh tay de tdi bam vao vanh tren o chao. 58 Xg don Co tr6n gai Sun vien 6 chao Co dudi gai Bao khdp Hinh 3.10. Thiet do dting ngang qua khdp canh tay Cac cuf dong. Khdp vai la khdp chom cau co cti dong rong rai hdn bat ki khdp nao khac cua cd the. Cac cti dong cua canh tay tai khdp vai la gap, ruoi, giang, khep, quay tron, xoay trong va xoay ngoai. 4.2.2. Khdp khuyu (elbowjoint) (H.3.11J Khdp khuyu la mot khdp phtic hdp ket noi dau difdi xiidng canh tay vdi dau tren xifdng quay va xifdng tru, dong thdi lien ket dau tren cua xifdng quay va xifdng tru vdi nhau. Theo so' cap mat khdp, khdp khuyu gom ba khdp: khdp canh tay-tru. khdp canh tay-quay va khdp quay- tru gan. Cac khdp canh tay-quay va canh tay-tru la khdp ban le cho phep gap - ruoi cang tay, khdp quay-tru gan la khdp true cho phep sap - ngtia cang tay. Cac m at khdp. Cap mat khdp cua khdp canh tay-quay la chom con xtidng canh tay va hom khdp cua chom quay, cua khdp canh tay-tru la rong roc xifdng canh tay va khuyet rong roc cua xifdng tru, va cua khdp quay-tru gan la vanh khdp cua chom xifdng quay va khuyet quay cua xifdng tru. Bao k h d p va day chang. Bao khdp boc ca ba cap mat khdp, di tti dau difdi xifdng canh tay den dau tren cac xifdng cang tay. K hdp ca n h tay - tru • q u a y difdc giti chac d cac mat trong va ngoai bdi hai day chang: day chdng ben tru (.H.3.12a) va day chdng ben quay (H.3.12b). K hdp q u a y - tru g a n difdc giti bdi hai day ch&ng: day chang vong xtidng quay noi bd trifdc va bd sau cua khuyet quay xifdng tru, va cung khuyet nay vay quanh chom xifdng quay; day chdng vuong chang tti co xifdng quay tdi bd difdi khuyet quay xifdng tru (H 3.11). 59 Hinh 3.11. Thiet do difng ngang khdp khuyu DC vong quay Bao khdp DC vuohg Cac c& dong. Dong tac cua khdp canh tay-tru-quay la gap (nhd cO canh tay va cd nhi dau canh tay) va ruoi (nhd cd tam dau canh tay). Dong tac cua khdp quay-tru gan la sap va ngiia cang tay quanh true doc c&ng tay. Ngiia la do co canh tay-quay va cd ngiia; sap la do cd sap tron va cd sap vuong. Cii dong sap - ngiia ban tay xay ra dong thdi d khdp canh tay-quay, khdp quay-tru gan va khdp quay tru xa. 60 4.2.3. Khdp quay-tru xa (distal radio-ulnar joint) (H.3.13) Khelp quay-tru xa la mot khdp true lien ket cac dau xa cua xifdng quay va xifdng tru. Cac m a t tiep khdp cua hai xifdng la vanh khdp chom xiicfng tru va khuyet tru cua xifdng quay. Ngoai bao xd, dau xa hai xifdng c&ng tay con difdc noi vdi nhau bdi dia khdp. Day la mot dia sun-sdi hinh tam giac ma dinh bam vao mat ngoai mom tram tru va nen bam vao bd difdi khuyet tru cua xifdng quay. Mat tren cua dia khdp tiep xuc vdi mat difdi cua chom xifdng tru con mat difdi cua no tiep khdp vdi xifdng thap. D ong tac cua khdp quay-tru xa la sap va ngiia ban tay. Hinh 3.13. Thiet do difng ngang qua cac khdp b dau difdi c8ng tay va ban tay 4.2.4. Cac khdp cua ban tay (joints of hand) (H.3.13) Cac khdp cua ban tay bao gom khdp quay-co tay, cac khdp gian co tay (giufa cac xifdng co tay), cac khdp co tay-dot ban tay, cac khdp gian dot ban tay (giiia nen cac xifdng dot ban tay), cac khdp dot ban tay-dot ngon tay (giiia chom cac xifdng dot ban vdi nen cac xifdng dot ngon gan) va cac khdp gian dot ngon tay. Khdp quay-co tay hay khdp co tay (wrist joint) (H.3.13). Khdp quay-co tay la mot khdp loi cau giiia dau xa xiicfng quay va dia khdp vdi cac xiidng thuyen, nguyet va thap cua co tay. Mat khdp d ca hai phia co hinh soan ho tifdng nhau, tren lom difdi loi. Dia khdp ngan cach chom xifdng tru vdi o khdp dong thdi ngan cach khdp quay-tru xa vdi khdp quay-co tay. Cac cuf dong cua khdp quay-co tay la gap, rudi, giang va khep . Stf phoi hdp cac dong tac tren cho phep lam difdc dong tac quay tron ban tay. Vi d iy la khdp loi cau nen ban tay khong xoay difdc khi c&ng tay co' dinh. 61 5. Cac khdp chi dudi 5.1. Cac khdp cua dai chau (joint of pelvic girdle) Dai chau co hai khdp: khdp cung-chau va khdp mu. K hdp cu n g -c h a u (H.3.14) la khdp hoat dich giiia dien loa tai cua xitong cung vdi dien loa tai cua xiidng chau. Tuy la khdp hoat dich nhiing cti dong cua khdp cung-chau rat han che vi cac mat khdp loi lom nhieu va cac day chang cua khdp rat khoe, dac biet la day chdng cung-chau gian cot. 6 cuoi thdi ky mang thai, cac day chlng cua khdp mem va gian ra nhd tac dung cua hormon, lam cho cti dong cua khdp tang len. K hdp m u la mot khdp sun-sdi. Mot dia sun-sdi goi la dia gian mu lien ket mat khdp cua hai than xiidng mu vdi nhau. 5.2. Cac khdp cua chi dirdi ti/d o (joints of free lower limb) 5.2.1. Khdp hong (hip joint) hay khdp chau-dui (H.3.15) Khdp hong la mot khdp hoat dich thuoc loai khdp chom cau do chom xiidng dui va o coi xiidng chau tao nen. Cac m at khdp bao gom chom xiidng dui va o coi xiidng chau. O coi diidc lam sau them nhd mot vong sun-sdi bam vao vanh o coi co ten la sun vien o coi. Bao k h d p va day c h an g . Bao khdp la mot cau true rat khoe di tti vanh o coi tdi co xiidng dui. No do cac sdi vong va cac sdi doc tao nen. Cac sdi vong, nam sau hdn, tao nen mot dai vong vay quanh co xiidng dui. Cac sdi doc d nong diidc tang ciidng bdi cac day chang chau-dtii, mu-dui va ngoi-dtii (H .3.16, a va b). Chom xiidng dui con diidc gan vdi o coi bang day chdng chom dui tti hom chom dtii chay xuong bam vao day ch&ng ngang va cac mep cua khuyet o coi (H 3.15). 62 Hinh 3.15. Thiet do ngang qua khdp hong Hinh 3.16. Cac day chang ngoai bao khdp cua khdp hong Cac cti dong. Khdp hong la khdp chom cau nhti khdp vai va co the thtfc hien dUdc cac cti dong gap, ruoi, giang, khep, xoay ngoai va xoay trong dui. Tuy vay, 63 khelp hong co cau tao vdng chic de co the chiu trong liic va t&m cii dong cua no khong rong nhil khdp vai. 5.2.2. Khdp goi (knee joint) (H.3.17) Khdp goi la khdp phde hdp ldn nhat cd the, bao gom khdp ban le gida xiidng dui vdi xiidng chay va khdp phang gida xiidng banh che vdi xiidng dui. Mat khdp. Cac m a t khdp cua khdp gida xiidng dui va xiidng chay la hai loi cau xiidng dui va hai mat khdp tren cua xiidng chay; d khdp gida xiidng dui va xufdng banh che, mat khdp xiidng banh che tiep khdp vdi m at banh che cua dau diidi xiidng dui. Hai dia sun-sdi, goi la cac sun chem trong va ngoai, n&m gida xiidng chay va cac loi cau xddng dui (H.3.18). Sun chem trong co hinh chd C, sun chem ngoai gan co hinh chd 0. Moi sun chem deu co mot sdng triidc va mot sdng sau lan liidt dinh vao cac dien gian loi cau triidc va sau cua xiidng chay. Bd chu vi cua moi sun chem thi day, loi va dinh vao bao khdp, con bd trong thi mong va lom. Mat tren cua sun chem khong phang nhil mat diidi ma lom de tiep xuc vdi loi cau xUdng dui. Bao khdp bam vao ria cac mat khdp cua xiidng chay va xiidng dui, vao cac bd xiidng banh che va vao bd chu vi cua cac sun chem. Cac day c h an g . Khdp goi co cac day chang b&t cheo nSm trong bao khdp, cac day chSng khac hoa lan v6i mat ngoai cua bao khdp va bao gom: day chdng f i4 banh che d phia triidc (H 3.17a)\ day chdng ben chay va day chang ben mac d hai ben (H 3.77b); day chdng khoeo cheo va day chdng khoeo cung d p hia sau (H.3.19). Cac c\i dong. Gap cang chan: cd bung chan va cac cd u ngoi - cang chan. Ruoi cang chan: cd tii dau dui. Hinh 3.17b. Thiet do difng ngang qua khdp goi DC bat cheo tardc DC ngang Hinh 3.18. Mat khdp tren xi/dng chay 65 5.2.3. Cac khdp giura xtfOng chay va xUdng mac Xiidng chay va xiidng mac lien ket vdi nhau bang hai loai khdp. Than va dau diidi cua chung lien ket vdi nhau bang khdp chang, bao gom mang gian cot noi than cua hai xiidng va mo sdi noi mat ca ngoai cua xiidng mac vdi khuyet mac cua dau diidi xiidng chay. Dau tren cua hai xiidng noi vdi nhau bang mot khdp hoat dich phang goi la khdp chay-mac tren. 5.2.4. Cac khdp cua ban chan (joints of foot) (H.3.20) Cac khdp cua ban chan bao gom khdp sen-c&ng chan, cac khdp giiia cac xiidng co chan, cac khdp co chan-dot ban chan, cac khdp gian dot ban chan, cac khdp dot ban chan-dot ngon chan va cac khdp gian dot ngon chan. Trong cac khdp gian xiidng co chan, khdp sen-got diidc goi la khdp diidi sen, khdp sen-got-thuyen va khdp got-hop diidc goi chung la khdp ngang co chan. Diidi day xin trinh bay ki ve khdp sen-cang chan. K hdp sen -ca n g ch a n h ay kh d p co c h a n (ankle joint) (H.3.20) la mot khdp hoat dich kieu ban le lien ket xiidng sen vdi dau diidi hai xiidng ckng chan. Xiidng sen co ba mat tiep khdp: mat tren khdp vdi m at khdp diidi cua dau diidi xiidng chay, mat trong khdp vdi mat cd trong xiidng chay va m at ngoai khdp vdi mat cd ngoai xiidng mac. Bao khdp diidc tang ciidng bdi day chdng ben ngoai d mat ngoai va day chdng ben trong (day chdng delta) d mat trong. Cac cii dong cua khdp co chan la: gap mu chan nhd cd chay triidc va cac cd duoi ngon chan: va gap gan chan nhd cd bung chan va cd dep vdi sii ho trd cua cac cd gap ngon chan. TL/LLTONG GIA A. TiM LL/A CHON DUNG NHAT COa NHCTNG CAU H6l NHI^U Ll/A CHON SAU 1. Nhurng mo ta sau day ve khdp sdi deu sai, trif: a. luon la khdp bat dong; b. gom cac diidng khdp, cac khdp ch&ng va cac khdp ban le; c. la loai khdp co o khdp; d. la khdp ma d do cac xiidng lien ket vdi nhau bang mo sdi. 2. Nhurng mo ta sau day ve khdp sun deu sai, trir: a. co kha nang cii dong han che neu la khdp sun trong; b. gom hai loai d bo xiidng dang phat trien; c. deu bien thanh lien ket xiidng khi bo xiidng ngiing phat trien; d. co mat pho bien d cac chi. 3. Nhurng mo ta sau day ve khdp hoat djch deu sai, trif: a. co the la khdp dong hoac khdp bat dong; b. la khdp ma cac mat xiidng tiep khdp khong dinh nhau; c. la khdp ma cac mat xiidng tiep khdp khong diidc boc bang sun khdp; d. la khdp lien ket cac xiidng vom so. 4. Nhurng mo ta sau day ve khdp vai deu sai, trir: a. la khelp ddn true; b. thuoc loai khdp phtic hdp; c. thuoc loai khdp soan (khdp loi ciu); d. linh hoat hdn khdp hong. 5. Nhurng mo ta sau day ve khdp khuyu deu sai, trir: a. la mot khdp phiic hdp; b. cho phep gap, ruoi, giang va khep ciing tay; c. co hai cap mat khdp; d. difdc van dong bdi cd delta va cd nhi dau. 6. Nhurng mo ta sau day ve khdp quay-co tay (khdp co tay) deu sai, trir: a. co nhieu true chuyen dong hdn khdp vai; b thuoc loai khdp chom cau; c. la khdp giiia dau difdi xifdng tru va cac xifdng co tay; 4- cho phep giang, khep, gap, ruoi va quay tron ban tay. 7. Nhurng mo ta sau day ve khdp hong deu sai, trir: a. la khdp giiia chom xiidng dui va o coi xifdng chau; b. thuoc loai khdp rong roc; c. co it true chuyen dong hdn khdp vai; d. khong co cii dong xoay tron. 8. Nhurng mo ta sau day ve khdp goi deu sai, trir: a. la khdp ban le; b. co day chling giii d ba phia; c. co sun vien quanh mat khdp tren xifdng chay; d. khong co day ch&ng n&m trong bao khdp. 9. Nhurng mo ta sau day ve loai khdp lien ket cac dot song deu sai, trir: a. khdp sun trong giiia cac than dot song; Id. cac day chang, cac khdp sun-sdi va cac khdp hoat dich; c. khdp sun-sdi giiia cac mom khdp dot song; d. mot khdp hoat dich kieu ban le giiia cac dot song co I va II. 10. Nhurng mo ta sau day ve khdp thai dUdng-ham dudi deu sai, trir: a. la mot trong cac khdp hoat dich cua so; \b. co hai o khdp va hai mang hoat dich; c. diidc van dong bdi cac cd mat; d. la khelp triic tiep giiia mat khdp cua hai xifdng. 6 8 11. Nhurng mo ta sau day ve s u lie n ket cua cot song deu sai, trCf: a. vdi xifdng so bang cac khdp chom cau; b. vdi cac xifdng chau bang cac khdp sun-sdi; c. vdi cac xifdng siidn bang cac khdp hoat dich; d. vdi cac xifdng vai bang nhiing khdp chang. B. TiM Ll/A CHON SAI CUA NHUNG CAU H6l NHI^U Ll/A CHON SAU 12. Cac thanh phan tao nen khdp hoat djch bao gom: a. cac mat khdp difdc phu sun khdp; b. mot bao khdp gom hai ldp; c. cac day chang luon nam ngoai bao khdp; d. sun vien, sun chem va dia khdp (d mot so' khdp). 13. Cac cur dong cua khdp duoc djnh nghla nhu sau: a. gap la cii dong lam giam goc giiia cac xiidng tiep khdp; b. giang la diia ra xa diidng giiia cd the; c. xoay tron la cii dong cua mot xiidng quanh true ngang cua no; d. sap la cii dong xoay gan ban tay xuong diidi. 14. Khdp o chao-canh tay: a. difdc che phu bdi cd delta; b. co the giang, gap va ruoi nhd cd delta; c. co bao khdp chat d moi phia; d. la mot trong cac khdp ma ho' khdp co sun vien. 15. Khdp nao sau day khong thuoc loai khdp khong true: a. khdp ban le; b. khdp chom cau; c. khdp soan; d. khdp p h an g (khdp triidt). 16. Cac than dot song duoc lien ket bdi: a. cac dia gian dot song; b. cac khdp sun-sdi (trif cac khdp doi-truc); c. cac day chang doc triidc va sau; d. cac khdp sun. C. XAC 0|NH NHCTNG CAU SAU D U N G HAY SAI 17. Dia gian dot song co the trat ra phia sau-ben de ep vao day than kinh so'ng. 18. Khong phai ta't ca cac khdp sdi deu la khdp bat dong. 19. Tat ca cac khdp sun la nhiing khdp ban dong. 20. Nhiing khdp hoat dich kieu triidt la nhiing khdp khong true. 21. Xifdng mong la xifdng duy nha't khong tiep khdp vdi cac xifdng khac. 69 22. Xiidng siidn chi tiep khdp vdi dot song ngiic tai than dot song. 23. Khdp sun va khdp sdi la nhiing khdp khong co o khdp. 24. Cac khdp co cau tao cang viing chac thi kha nang van dong cang han che. 25. Khdp ban le va khdp true diidc goi chung la khdp tru. 26. Nhiing cd va gan di qua khdp hoat dich khong co vai tro giii khdp. DAP AN: 1: d; 2: b; 3: b; 4: d; 5: a; 6: d; 7: a; 8: a; 9: b; 10: b; 11: c; 12: c; 13: c; 14: c; 15: d; 16: d; 17: D; 18: D; 19: S; 20: D; 21: D; 22: S; 23: D; 24: D; 25: D; 26: S Chu’cfng 4 HE C0 (MUSCULAR SYSTEM) MUC TliU 1. Mo td diidc d mite sd litdc cdc loai sdi cd va cdc loai mo cd. 2. Trinh bay diidc cau true cua cd bdm xtidng, cdc kieu sap xep sdi cd va cdc vai tro cua cd trong thiic hien mot dong tac nao do. 3. Mo td diidc cdc nhom cd chinh d ddu, co, than va cdc chi: cdch bdm, sit sap xep, dong tac va than kinh chi phoi cua moi nhom. 4. Goi dung ditdc ten cua cdc cd tren phiidng tien thiic hanh gidi phau he cd. 1. Dai circfng He cof difdc trinh bay d chiidng nay la he thong cua cac cd va nhom cd xifdng gay nen nhiing cii dong d cac khdp. Trong he nay, moi cd xiidng la mot cd quan do mo cd xifdng va mo lien ket tao nen. 1.1. Dai cuong ve mo co Cd the ta co ba loai mo cd khac nhau ve mo hoc, vi trl va sii chi phoi than kinh: cd xifdng, cd trdn va cd tim. 1.1.1. Md CO xuong (H.4.1). Loai cd nay con difdc goi la cd va n vi, khi nhin difdi kinh hien vi, te bao cd (sdi cd) cd nhiing dai sang va toi xen ke (van). Mo cd xifdng chu yeu la va n d o n g theo y m uon, tiic la triic tiep dap ling vdi sii kiem soat cua y muon. Hau het cd xifdng cung van dong khong theo y muon d chifng miic nao do. Vi du, ta thiidng khong biet ve cii dong co gian cua cd hoanh, ve tinh trang co thiidng xuyen cua cac cd giii tii the, hoac ve cac phan xa ruoi. 7.1.2. M6 CO trOn (H.4.2). Mo cd trdn co mat d thanh cua cac cau true rong, nhif cac mach mau, diidng d in khi va hau het cac cd quan trong o bung. No cung bam vao cac nang long d da. Difdi kinh hien vi, te bao cd trdn cd hinh thoi vdi duy nhat mot nhan d trung tam va khong cd van ngang. Cd trdn do than kinh tii chu chi phoi nen khong dap ling van dong theo y muon. 71 aCac nhan Hinh 4.2. Mo co tron 1.1.3. Md CO tim (H.4.3). Sdi cO tim cung co van ngang nhif sdi cd xifdng nhifng cac sdi cd nhanh noi vdi nhau lam cho cd tim trd thanh mot phien cO chif khong phai mot tap hdp cua cac sdi cd rieng re. Loai co nay cung do than kinh tii chu chi phoi va con co kha nang tii co bop khi khong cd xung dong tif than kinh trung ifOng di tdi. Hinh 4.3. Mo co tim 72 1.2. Cac loai ca xirong va cach goi ten ca Cac cd xiidng diidc chia thanh nhieu loai diia vao hinh dang, so dau nguyen uy, so' bung cd, cach sap xep bo sdi cd va chiic nang. * Cac loai th e o h in h d a n g va cdch sap xep bo sdi: cd hinh thoi, cO det, cO th^ng, cd tam giac, cd vuong, cd long vu (don, kep va da long vu), cd vong. * Cac loai theo so d d u nguyen uy: cd nhi dau, cd tam dau, cd tii dau. * Cac loai th eo so b u n g cd: cd hai bung. * Cac loai theo chiic nang: cd khep, cd giang, cd xoay, cd ga'p, cd ruoi, cO sap, cd ngiia, cd doi chieu, cO that, cd gian. Moi cd cu the diidc goi ten diia vao cach phan loai noi tren ket hdp vdi cac dac diem ve vi trl, kich thiidc va hiidng sdi cd. 1.3. Cau true cua co xirong Moi cd co phan bung cd (belly) nam giiia cac dau bdm (attachment) bang gan. Phan bung cd do cac sdi cd va thanh phan mo lien ket tao nen. Cac sdi cd xep thanh tiing bo sdi cd. Nhieu bd sdi cd hdp thanh mot cd. Cac sdi cd, cac bo sdi cd va toan bo cd deu diidc cac mang mo lien ket vay quanh: mang vay quanh moi sdi cd la m ang noi cd, mang vay quanh moi bo sdi cd la m ang chu cd va mang vay quanh toan bo cd la m ang ngoai cd. Cac mang mo lien ket cua bung cO keo dai ve cac dau cd va lien tiep vdi cac gan. Gan hoan toan do mo lien ket tao nen. No la phan khong co rut diidc ma chi truyen liic co cua bung cd tdi xiidng hoac cac cau true khac. Nhiing gan rong va det diidc goi la can. Ldp mo lien ket nam giiia cd va da diidc chia thanh hai phan: phan dac nam sau sat mang ngoai cd la mac boc cd hay mac sau, phan long leo (chiia md) 6 ngay diidi da goi la tam diidi da hay mac nong. Nhiing che mac ngan cach nhom cd nay vdi nhom cd kia diidc goi la vach gian cd. Cd mot so' cau true tao thuan ldi cho sii di chuyen cua cac gan co. Dd la cac bao xd cua gan, cac ham gan (retinacula), cac tui hoat dich (synovial bursa) va cac bao hoat dich (synovial sheath). 1.4. Cac dau bam cua co Hau het cac cd di qua It nhat mot khdp va thiidng bam vao cac xiidng tham gia tiep khdp tai khdp dd. Khi mot cd co, no keo mot trong cac xiidng tiep khdp ve phla xiidng kia. Hai xiidng tiep khdp thiidng khong dich chuyen ngang nhau khi cd co. Mot xiidng thiidng vSn ci vi trl ban dau hay dich chuyen It, hoac vi no diidc cac cd khac co' dinh bang cach keo ve hiidng ngiidc lai, hoac do vi trl va ca'u true cua no lam no khong dich chuyen diidc. Nhii vay, cac dau bam cua cd diidc phan biet thanh dau co dinh (fixed end) va dau di dong (mobile end). Dau co' dinh thiidng diidc goi la nguyen uy, dau di dong la bdm tan. d cac chi, dau co dinh (hay nguyen uy) thiidng la dau gan cua cd. 73 1.5. Cac kieu sap xep bd soi ca(R.4A) Cac sdi cd bam xifdng difdc sip xep trong cd thanh cac bo. Cac sdi cd trong moi bd thi n im song song nhau, nhiing sif sip xep cua cac bo so vdi cac gan cd the thuoc mot trong nam kieu dac trifng: song song, hinh thoi, vong, tam giac. hoac long vu. CJ cd song song, cac bd sdi chay song song vdi true doc cua cd va tan cung tai cac dau gan det. Cd hinh thoi co cac bd chay gan song song vdi true doc cua cd; bung cd thuon nho dan ve phia cac dau gan. Cac bo cua cd vong sap xep thanh cac vong trdn dong tam tao nen mot cd that vay quanh mot lo nao do. C) cd tam giac, cac bd cd nam tren mot vung rong hoi tu ve mot gan trung tam. Cac cd long vu cd bd sdi cd ngan neu so vdi tong chieu dai cd; gan cd trai ra tren hau nhif toan bo chieu dai cd. C) cd long vu ddn, cac bd sap xep chi d mot ben gan. Cd long vu kep, cac bd nam d ca hai ben gan. Cd da long vu do nhieu cd long vu kep gop lai. Hinh 4.4. Cac kieu cau true cua cd xifdng a,f. Cd vdi cac bo soi song song; b,g. Co hinh quat; c. Cd hinh long vu don; d. Cd hinh long vu kep; e. Co hinh thoi Kieu sap xep bd sdi cd anh hifdng tdi life co va tam van dong cua cd. Khi mot cd co, no ngan lai va chi cd chieu dai bang khoang 70% chieu dai luc nghi cua no. Nhif vay, cac sdi cd trong mot cO cang dai thi tam van dong ma no tao ra cang ldn. 74 Trai lai, s\ic co cua mot cd phu thuoc vao tong so sdi cd ma no chiia,^ vi mot sdi ngan co the co manh nhii mot sdi dai. Vi mot cd cho triidc nao do co the chiia hoac mot so liidng nhd sdi dai hoac mot so" liidng ldn sdi ngan, cach sap xep bo sdi cd the hien sii bu trif giiia liic co va tam van dong. Cac cd long vu co mot so liidng ldn bo sdi keo len cac gan cua chung, dem lai cho chung liic co ldn hdn nhiing mot tam van dong nhd hdn. Cac cd song song, trai lai, co tiidng doi it bo sdi chay doc theo chieu dai cd; nhii vay, chung co mot tim van dong ldn hdn nhiing liic co yeu hdn. 1.6. Si/phoi hop giura cac co va nhom co Mot dong tac bat ky nao do cung la ket qua cua sii hoat dong phoi hdp cua nhieu cd. Hau het cac cd xiidng diidc xep thanh nhiing cap doi khang nhau: cac cd gap-cac cd ruoi, cac cd giang-cac cd khep, va van van. Trong cac cap doi khang, mot cd, diidc goi la cd chu van (prime mover/agonist), co de gay nen cii dong mong muon trong khi cd kia, cd doi khang (antagonist), gian ra va tuan theo nhiing tac dong cua cd chu van. Vi du d cii dong gap c&ng tay tai khdp khuyu, cd nhi dau la cd chu van, cd tam dau la cd doi khang. Cd chu van va cd doi khang thiidng n im d hai phia doi ngufdc nhau cua mot xiidng hoac khdp. Cd chu van va cd doi khang hoan doi vai tro vdi nhau. Trong cii dong ruoi cang tay, cd tam dau la cd chu van, cd nhi dau la cd doi khang. Mot so cd, goi la ccf co dinh (fixators), co dong thdi vdi cd chu van de giii viing nguyen uy cua cd chu van, giup cho cd chu van hoat dong co hieu qua. Vi du, cac cd di tif than tdi dai vai co tac dung co dinh dai vai va cho phep cd den ta gay ra cii dong cua canh tay tren khdp vai. Co nhieu triidng hdp cd chu van di ngang qua mot so' khdp triidc khi viidt qua mot khdp ma tai do dong tac chinh cua no dien ra. De ngan can nhiing cii dong khong mong muon d mot khdp trung gian, mot so' cd goi la ccf hiep dong (synergists) se co va co' dinh khdp trung gian do. Vi du, cac cd gap va ruoi co tay co de co dinh khdp co tay, va dieu nay cho phep cac cd gap va rudi ngon tay hoat dong co hieu qua. Tuy thuoc vao dong tac can hoan thanh, nhieu cd co the dong vai tro nhii mot cd chu van, mot cd do'i khang, mot cd cd dinh hoac mot cd hiep dong. 1.7. Si/cung cap than kinh cho co Nhanh than kinh di tdi mot cd la than kinh hdn hdp gom ca sdi van dong (khoang 60%), sdi cam giac (khoang 40%) va mot so' sdi giao cam. Moi sdi van dong xuat phat tii mot neuron van dong cd than n im d nao hoac tuy song va tan cung bing cach chia ra nhieu nhanh di tdi mot nhom sdi cd. Mdi nhanh tiep xuc vdi mot sdi cd tai khdp than kinh-cd. Tai day, cac nhanh tan cung sdi true phinh to ra thanh bong tan ciing synap. Cac sdi cam giac xuat phat tii cac dau tan cung cam giac nim trong cd hoac gan, diidc goi ten lan liidt la thoi cd hoac thoi gan. Nhiing dau tan cung nay diidc kich thich bdi siic cang trong cd sinh ra trong luc co cd chu dong hoac gian cd thu dong. Chiic nang cua cac sdi cam giac la van chuyen tdi he than kinh trung lidng 75 thong tin ve do cang cd. Thong tin nay dong vai tro thiet yeu cho viec duy tri trifdng liic cd va tu the cd the va cho viec thiic hien cac dong tac phoi hdp theo y muon. Cac sdi giao cam phan phoi vao cd trdn cua thanh cac mach mau nuoi cd. Mot ndron van dong va tat ca cac sdi cd ma no chi phoi hdp nen mot ddn vi van dong. Trong luc nghi, cd van d trang thai co ban phan va trang thai nay goi la triidng liic cd. Vi cac sdi cd khong bao gid d trang thai trung gian gitia co va gian, triidng liic cd co difdc la nhd trong cd luon luon co mot it sdi cd co hoan toan, so dong con lai gian hoan toan. De tranh moi cd, cac nhom ddn vi van dong (cac nhom sdi cd) khac nhau luan phien nhau d vao trang thai hoat dong tai cac thdi gian khac nhau. Triidng life cd difdc duy tri nhd cung phan xa hai ndron. Ton thifdng mot hoac ca hai ndron nay dan tdi mat trifdng liic cd va cd se bi nheo. Khi co cd, so" cac ddn vi van dong di vao trang thai hoat dong ngay cang tang dong thdi mtic hoat dong cua cac ddn vi van dong cua cac cd doi khang giam di. Khi can co cd toi da, tat ca cac ddn vi van dong cua mot cd difdc difa vao trang thai hoat dong. 2. Cac cd cua dau (muscles of head) Cac cd cua dau bao gom cac cd mat, cac cd nhai, cac cd ngoai nhan cau, cac cd tieu cot tai, cac cd liidi, cac cd cua khau cai mem va eo hong. Chifdng nay chi trinh bay cac cd mat va cac cd nhai. 2.1. Cac ccf mat (facial muscles) (H.4.5) Cac cd mat dem lai cho loai ngifdi kha nang bieu hien nhieu loai cam xuc khac nhau tren net mat. Cac cd nay n&m gitia cac ldp cua mac nong. Chung thifdng co m ot d d u bdm vao m ac hoac cdc xU dng cu a so, m o t d a u b d m vao da. Do cach bam nhif vay nen khi co cac cd m at lam dich chuyen da chti khong phai mot khdp nhif cac cd khac. Trong so cac cd mat, co nhiing cd bao quanh cac lo vao cua cac hoc tii nhien cua dau nhif mat, mui va mieng. Cac cd nay co chiic nang nhif cac cd that va cac cd gian. Vi du, cd vong mat lam nh&m mat. Ve chi phoi than kinh, tat ca cac cd mat do than kinh m at van dong. Theo dinh khu va chtic nang, cac cd mat difdc xep thanh 5 nhom. Nhom ccf tren so. Phan chinh cua cac cd tren so la cd cham-tran (occipitofrontalis). Cd nay co hai bung cham va tran nam tren cac xifdng cung ten va difdc noi vdi nhau bdi can tren so. Nhom cd quanh tai gom cd tai tren (auricularis superior), cd tai triidc (auricularis anterior) va cd tai sau (auricularis posterior). Nhom cd quanh o mat va mi bao gom cd vong m at (orbicularis oculi), cd cau may (corrugator supercilii) va cd ha may (depressor s u p e r c i l i i ) . Nhom cd mui bao gom cd cao (procerus), cd m ui (nasalis) va cd ha vach m ui (depressor septi nasi). no. Bung tran co cham - tran - Co tai trade Co vdng mat Cac co go ma ldn va be Co nanq moi tren va canh mui C o c u d i------------- Cdvong mieng _ Co ha goc mieng - - -1 Co bam da cd Co mui (phan ngang) { Co nang goc mieng Co ha vach mui Cd thdi ken Co ha moi dudi Co cim mm ---------- fir ^------- Cd ire - ddn - chum wmm mmm Y M m i ' W m Hinh 4.5. Cac co bam da cd va mat (a) va dau (b) 77 Nhom cO quanh m ieng co sd lUdng nhieu nhat, bao gom cd vong mieng (orbicularis oris), ca nang moi tren (levator labii superioris), ccf nang moi tren canh mui (levator labii superioris alaeque nasi), ccf go md ldn (zygomaticus major), cd go md nho (zygomaticus minor), cd citdi (risorius), ccf nang goc mieng (levator anguli oris), cd ha moi ditdi (depressor labii inferioris), cd ha goc mieng (depressor anguli oris), cd thoi ken (buccinator) va cd cam (mentalis). 0 moi ben m at, phan ldn cac cd cua nhom cd quanh mieng tap tru n g lai va dan vdi n h a u tai mot diem d ngang ben ngoai goc m ieng tao nen mot tru xd-cd chic dac goi la modiolus. Tru nay giong nhu true cua mot banh xe ma cac cd tdi bam chung la nan hoa. 2.2. Cac CO nhai (masticatory muscles) Cac cd nhai la nhiing cd van dong xUdng ham dudi tai khdp thai dUdng-ham dudi. Nhom nay co bon cd la cd can, cd thdi ditdng va hai cd chan bitdm ngoai va trong. Ca bon cd deu do th an kinh ham dudi van dong. Cd c a n (masseter) (H .4.6a) gom phan nong va phan sau tii cung go ma chay xuong tdi goc va nganh xUdng ham dudi. Dong tac: keo xUdng ham dudi len tren; rieng phan sau keo xUdng ham dudi ra sau. Cd th d i d iid n g (temporalis) (H 4.6b) di tti ho" th a i dUdng tdi mom vet va bd trUdc cua nganh xUdng ham dudi. Dong tac: nang xUdng ham dudi ca khi cd co; rieng cac sdi sau co keo xUdng ham ra sau sau khi ham dudi dUdc keo ra trUdc. Cd c h a n biidm n g o a i (lateral pterygoid) (H.4.7) di tti xUdng biidm (dau tren bam vao canh ldn, dau dudi bam vao m at ngoai m anh ngoai mom chan budm) tdi co loi cau xUdng ham dudi va dia khdp thai dUdng-ham dudi. Dong tac: keo mom loi cau va dia khdp xUdng ham dudi ra trUdc, nhd do xUdng h am dudi dUdc keo ra trUdc va ha thap trong khi do chom cua no xoay tren dia khdp. Ket qua la m ieng dUdc ha ra. Hinh 4.6. Cd can va cd thai di/dng 78