a'

KM.008343 BO YTE

TA P

GIAI PHflU HOC DAI CITONG

CHI THEN - CHI DUtil - DAU - M AT - CO

Chu bien: GS. TS. BS. TRINH VAN MINH

NHA XUAT BAN GIAO DUC VI$T NAM

 GIAI PHAU NGUtn
i ap I

( ;i \ i i'll u h o c \)\\ c i o \( .
( HI I RKN - C H I 1)1 OI t) \ I M \ I CO
 "C on ngKi'ri d m n > \i7ng hang d o i ban chan
Y hoc h a t dan ti( g ia i p h d u h o c "

Trinh Van Minh

F ra n ce sco A n to m m a rc h i.

Cac mach cang chan. (In mau. theo ban khac dong cua P. Mascagni).
Tap tranh treo tucmg giai phi\u ca the nguoi \e theo kfch thiroc that.
Paris, Lasteyrie. 1823 -1826 (Paris. Thu Vien Truong Dai Hoc Y cu).
GIAI PHAU NGlffll
TAPI

G IA I P H A U H O C D A I C U O N G

CHI TREN - CHI D U 6 l - DAU - M A T - CO

M A SO: D01.Y01 W

TR L?G M G
CAOOANG a/
Y TE
PHU THO

NHA XUAT BAN GIAO DUC VIET NAM

 Chi d a o b ie n soan :

VU KHOA HOC VA DAO TAO - B0 Y TE

Chu bien:

GS.TS.BS. TRINH VAN MINH

Nguyen GS Bo mon Giai phau Tnidng Dai hoc Y Ha Noi

T h a m gia b ie n soan :

GS.TS.BS. TRINH VAN MINH

- Giai phau hoc dai ciidng
- Giai phau chi tren
- Giai phau chi dUdi
- Thiet ke, trd bien va hieu di'nh toan tap.

GVC.TS.BS. LE HUU HLfNG

- Giai phau dau mat co.

Sack co stf dung tranh cua cac tac gia trong va ngoai nUffc;
tranh cai bien va sang tac cua chu bien.

© Ban quyen thuoc Bo Y te (Vu Khoa hoc va Dao tao)

1134 - 2010/CXB/3 - 1931/GD Ma so: 7K879Y0 - DAI

 l o i g io i t h ie u

7 / , x . . A

De khong ngifng nang cao chat lu’dng dao tao nhan lire y te, ngoai viec to
chu’c bien soan va xuat ban cac sach va tai lieu dat chuan chuyen mon cua
nganh phuc vu dao tao Dai hoc, Cao dang, Trung cap, Bo Y te con quan tam
den cac sach chuyen de va tham khao O trinh do cao cho cong tac dao tao sau
dai hoc va dao tao lien tuc can bo nganh Y te.
Sach Giai phau ngtfdi tap 1 do GS.TS.BS. Trinh V5n Minh va cac nha giao
giau kinh nghiem thuoc chuyen nganh Giai phau cua tru’dng Dai hoc Y Ha Noi
bien soan, da thifc hien dung phuong cham cung cap : kien thuc cO ban, he
thong ; noi dung va thuat ngu chinh xac, khoa hoc ; cap nhat cac tien bo khoa
hoc, ky thuat hien dai va thuc tien Viet Nam.
Sach da duoc Hoi dong chuyen mon thanh lap theo q u y e t dinh so:
1937/QD-BY T, ngay 7 thang 6 nam 2010 cua Bo Y te tham dinh va danh gia
cao. Bo Y te quyet dinh la tai lieu dat chuan chuyen mon cua nganh Y te trong
giai doan hien nay.
Bo Y te xin chan thanh cam On GS. Nguyen Buu Trieu, Chu tich Hoi dong
tham dinh, PGS. N guyln V3n Huy, GS. Nguyen Hu”u Chinh, uy vien phan bien
va cac uy vien Hoi dong da doc, dong gop nhieu y kien quy bau cho quyet dinh
cua Bo Y te.

VU KHOA HOC VA DAO TAO - B0 Y TE

 LOI NOI DAU

Cuon Giai Phau Ngiidi dude bien soan chu yeu cho cac tru’dng Dai hoc Y
Viet Nam, nham sU dung lau dai theo moi thay doi chtfdng trinh, va phuc vu
cho nhic'u doi tUOng khac nhau.
Giai phau dude trinh bay theo quan diem ket hdp ca hai muc tieu:
- Giai phi]u m o ta va he thong nhung cau true giai phau cd ban theo tung
p h in ldn eua cd the, c3n thiet cho cac sinh vien Y nfim d lu va ca cac sinh vien
di6u dtfdng hoSc ngoai Y.
- G iaiph iu dinh khu theo tung vung nho vdi nhung chi tiet lien quan sau,
phuc vu rieng cho cac d6i ttfdng dai hoc Y, de thifc hanh phau rich va ap dung
ngoai khoa.
Sach cung nham phuc vu cho ca cac doi tUdng sau dai hoc, cac bac si
chuyen khoa khac nhau, cac nghien ciru sinh, va cac giang vien giang day giai
phau; nen co nhung phan tham khao sau hon va nhung chu thich vd thuat nguf
giai phau quoc te mdi. NgUdi giang va ngudi hoc tuy theo yeu clu, ma
chon loc.
Sach duOc bien soan theo 3 tap:

Tap I: G iai phau h oc dai citong. Giai phau chi tren, chi diidi, dau mat co
(mo ta he thong va dinh khu).

Tap II: Giai phau ngitc - bu ng (Thanh ngire - bung: xUOng, khdp, cd cua
than minh. Cac cd quan trong long ngUc: phoi va he ho hap, tim va he tu^n
hoan, trung that. Cac cd quan trong o’ bung: he tieu hoa, he tiet nieu -
sinh due).

Tap III: H e than kinh. H e n o i tiet (Trong cuon sach nay, phSn 16n cac
day th^n kinh ngoai bien da dude mo ta d tap I va tap II cung cac ph in khac
cua cd th§, nen tap III chi con lai chu yeu la "He TK trung Udng va cac day
thin kinh so").
Danh tir giai phiu dude su dung chu yeu theo “ Tirdieh Danh tir giai p h iu
qu oc te Viet hoa, co giai thich va ban luan, cua Trinh V3n Minh, NXB Y hoc
Ha N 61, 1999”, bien soan theo Nomina Anatomica thong qua tai London 1985,
(A/.A 1985, xuat ban 1989); va dircfc cap nhat bo sung them theo Terminologia
Anatomica th6ng qua tai Sao Paulo 1997 ( T.A. 1997, xuat ban 1998), nhtr m dt
m uc tiSu cua cuon sach nay.
 Ihuat ngu giai phau quoc te nidi co nhieu diem khac vo'i Danh tit giai
p h a u tien g Viet cu, duo’c xay dung tu tieng Phap cu bdi co GS. Do Xuan I lop,
va sua doi mot phan theo Nomina Anatomica thong qua tai Paris 1955 (PN A
1955), bdi tap the doi ngu can bo giang day Bo mon Giai phau H u on g Dai hoc
Y I la Noi tu 1959 — 1979, (“ Tit dien Giai ph au h o c 4 thif ticng Latin — A nh —
Phap — Viet, N X B Y H 1983 ”, do Nguyt'n Quang Quyen chu bien); nen chua
quen vdi cac can bo da dude dao tao tu nhung nam ve trUdc. Song no can dude
chinh thuc dua vao giang day de th oiig nhat ch o toan nganh Y V iet Nani,
trong mot tUdng lai gan nhat co the.
Di doi vdi viec gop phan xa y d u n g va cai to Danh tu g ia i phau Viet Nam
th eo Thuat n g u g ia ip lia u q u oc te nidi, cuon sach nay cung nham hien dai hoa
toi da ve m a t n o i dung. Khong theo mot trudng phai s3n co nao, ma co gang
ket h dp khai thac truyen thong sang tao cua Viet Nam, vdi viec chon loc co ban
luan nhu'ng kien thu'c co dien va hien dai cua ca 3 trifdng phai Pliap, Nga, A nh
M y, da ldn ludt tham nhap vao nude ta trong qua trinh !ich su phat trien nganh
Y Viet Nam.
Xuat phat tu yeu cau cua Bo Y te va Trudng Dai hoc Y Ha Noi sau khi Bo
Giao due va Dao tao ban hanh khung chuo'ng trinli dao tao dai hoc tlieo hai giai
doan tu 1995, cac tac gia dude giao nhiem vu da nliam co gang xay duiig cuon
sach nay thanh mot cuon sach giao khoa Giai ph au truyen thdhg va hien dai;
lam cd sd cd ban cho cac giang vien giai phau co the chon loc va rut gon, de
soan thao nliuiig bai giang theo moi yeu c iu tliay doi chu’dng trinli.
Xay dinig m6t cd sd giao khoa cd ban thong nhat, truyen thong va hien dai,
de? co the sii dim g lau dai cho nganh Y Viet Nam, la nhiem vu cua l'diung ngudi
di ti'u'dc. Tiep tuc bo sung ti'ong tUdng lai la trach nhiem cua cac the he tiep tl'ieo.
Bien soan lai lin nay da co cai bien, cap nliat va bo sung, m ong phuc vu
d oc gia dude t<3t hdn. Song cuon sach nao cung co nhung thieu sot va nhudc
diem nhat dinh cua no; m ong dude cac don g nghiep tich cUc gop y bo’ khuyet.
C hung toi xin chan thanh cam on.

Ha Noi, ngay 1 thang 10 nam 2010

GS.TS.BS. TRjNH VAN MINH

Nguyen Giang vien Cao cap Bo mon Giai p h iu

TRlfO NG DAI HOC Y HA NOI

 LOI c a m o n

Do dieu kien ve hu'u va su vi pham quyen tac gia cua cd sd in lau, Bo sach
Giao khoa Giai ph au Ngwd’i da lam vao tinh trang be tac, dd dang, tUdng nhu
khong the tiep tuc hoan thanh.
Song, nhan difdc thu mdi cua Bo TrUdng Bo Y Te va cua Chu Tich T ong
Hoi Y hoc, doi vdi cac Giao sir ch u yen gia ita n g h i hu’u (Quyet djnh so
1278/QD-BYT ngay 5-11-2008), cung nhu dude su quan tam cua Vu Khoa hoc -
Dao Tao, Bo Y te va Trudng Dai hoc Y Ha Noi, chung toi da co gang bien soan
lai, cap nhat va hoan chinh tron bo ca 3 tap.
Chung toi xin tran trong cam dn Bo Trudng Bo Y te Nguyen Q u o c Trieu,
Thu Trudng Nguyen Thi Kim Tien, Vu T ruong Vu Khoa hoc - Dao Tao
Truong Viet Dung va Chuyen vien cao cap Phi Van Tham (Vu Khoa hoc - Dao
tao) da thanh lap Hoi don g Giao su tham dinh, de con g nhan bo sach nay la
sach Giao khoa dai hoc va sau dai hoc chinh thuc cua Bo Y te Viet Nam.
Chung toi xin chan thanh cam dn GS. N guyen Buu Trieu - Chu tich Hoi
do n g va cac Giao su trong Hoi don g tham dinh, da doc, g o p y va danh gia cao
bo sach.
Nhan day, chung toi cung xin ghi nh6 con g sue cua nhung hoc tro va
d6ng nghiep cu : PGS.TS. Hoang Van Cue va BS.CK1I. N gu yen Due Cu1, tuy
khong co dieu kien tliam gia lin nay, song da co nhung d o n g g o p nhat djnh
trong giai doan khdi d i u bien soan tap 1 cu on sach tu nliung nam 1995 den
nam 1997.
Xin v o cung biet dn nliung ngucfi th iy dau tien cua nganh Giai Phliu Viet
Nam tai trudng Dai hoc Y Ha Noi: co GS. D6 Xuan H d p tu nhung nam 1932,
va c6' GS. Nguyen Hu’u tu nliung nam trudc 1945, da m d d u d n g cho nhufng
the he hoc tro chung toi ngay nay.

Ha Noi, thang 12 nam 2010

GS.TS. TRjNH VAN MINH

(Can bo giang day Giai p h iu Dai hoc Y Ha Noi 1956 - 2000)

 MUC LUC

Phan I. CIAI PIlAu HOC1 DAI CU'ONC

1 l);u cudng ve giai phau h o c ........................................... ........ 13
2, Dai cudng ve xu’dng. Ho x u d n g .................................................... ........................ 31
3. Dai cUdng ve khdp hav lien kct xudng. He khdp ..................... ........................ 11
4. Dai ctHing vc cd. He c d ..................................................................... .......................50

Phan II. CIAI P I l A u CHI TRKN

Giai phau he t h o n g chi t r e n .......................................................... .........................
5. Cac xudng chi t r e n ........................................................................... ...................... »;:»
(). Cac khdp chi tr e n.............................................................................. S2
7. Cac cd chi t r e n ................................................................................... ........................97
8. Mach chi tr en ..................................................................................... ..................... 130
9. Than kinh chi tren........................................................................ ....................... 139
Giai ph au d in h k h u ch i t r e n ......................................................... ..................... 175
10. Vai va n a ch .................................................................................. .................... 175
1 1. Canh t a v ........... ........................................................................... ...................... 191
12. K h u vu ............................................................................................ .................... 201
13. Cang t a v ....................................................................................... ......................208
1 1. Co tav............................................................................................. .................... 225
15. Ban t a v ......................................................................................... ......................230

P h an III. CIAI P I l A u CHI l ) U 6 l

Giai phau he thong chi dtfofi......................................................... ..................... 247
1(). Xudng chi clifdi................................ ...................................... ......................247
17. Khdp chi ihfdi.......................... ........... .................... 269
1S. Cac cd chi du'di.......................... .......................287
19. Dong mach chi du'di................... ..................... 318
20. Than kinh chi diidi.................... ......................335
Giai phau dinh khu chi dufefi.................. ...................... 347
21 . Vung mong................................

23. Cl61 ........................................................................................................................ 3 7 s

 25. Co chan hay vung sen cang chan..................................................................
26. Han chan............................................................................................................ 101

Phan I V . (MAI PHAU DAU - MAT - CO

Giai phau he; thong dau mat co 11 <
27. XUdng dau - mat............................................................................................... 11 ‘
28. Khdp cua dau - mat......................................................................................... 1;>8
29. Cac cd va mac cua dau mat co................................................................. 163
HO. Dong mach cua dau mat c o ...................................................................... 185
31. Than kinh d dau - mat - c o ............................................................................519
Giai phau dinh khu dau - mat - c o .................................................................. 526
32. Phan vung dau mat - c o .............................................................................. 526
33. Vung tic don c h u m ........................................................................................... 531
34. Vung co trUdc hav tam giac co trUdc............................................................. 537
35. Vung co hen hay tam giac co s a u ...................................................................546
Cac cd quan d dau - mat - c o ..............................................................................550
36. () mieng va cac cd quan phu th u o c .................... '..........................................550
37. Mui ...................................................................................................................... 572
38. H a u ...................................................................................................................... 583
39. Thanh q u a n ....................................................................................................... 593
40. Khi quan, tuven giap. tuyen can giap...........................................................609
41. Cd quan thj giac................................................................................................ 620
42. Cd quan tien dinh oc tai...................................................................................640
Phu lue............................................................................................................................ 671
 PHAN I

G I A I P H A U h o■ c o ami C l T O N G

- D a i circfng v e g ia i p h a u h o c .
- O a i c i/d n g v e c a c he x ird n g , k h d p , co.
- O a i c ir o n g v e c a c h e . tu a n h o a n , ho h a p , tie u h o a , tie t n ie u ,
s in h d u e , th a n k in h v a noi tiet, se d u d e trin h b a y tro n g c a c ta p
t ie p t h e o (T a p II: G ia i p h a u n g i/c - b u n g , T a p III: G ia i p h a u
h e th a n k in h t r u n g ird n g va he n o i tie t).
 DAI C a O N G VE GIAI PHAU HOC g]| 13

1. OAI
■ CUONG VE GIAI PHAU HOC
■

1. D IN H N G H IA - M U C T IE U , P H l/d N G P H A P V A D O I T l /d N G

Giai phau hoc (anatomia) la mon hoc nghien cUu ve hinh thai va cau tao cua
cd the.
Tir anatomia co nguon goc tu: tieng Hy Lap: “ana” co nghla la chia tach ra va
“tome” co nghia la cat. Vi phUdng phap cd ban de nghien ciiu giai phau la chia cat
ra de ma quan sat, nghia la phau tich (dissection).
Ta dich la “giai phau hoc” , vi “giai” cung co nghia la phan tach ra, va “phau”
cung co nghla la cat.

Cung co ngUdi dich theo doi tudng nghien cUu la "cd the hoc” song tit do khong
phan anh dung tu' goc “anatomia”, co y nghia ve phu'dng phap hdn la ve doi tUdng
nghien cUu. Hdn nua:

Cd the la doi tUdng nghien cUu chung cua nhieu mon hoc. ma khong neng cua
giai phau hoc.

Va “giai phau hoc” cung khong phai chi ap dung cho cd the ngUdi ma con cho
ca cay co, sau bo, sue vat v.v..., trong sinh hoc noi chung. cho nen cla co nhung mon
giai phau thuc vat va giai phau dong vat.

Cung co ngudi nham lan “giai phau" vdi "phau thuat", vi cung la mo xe tren
cd the. Song do lai la 2 mon hoc co doi tudng va muc tieu khac han nhau:
"Giai phau" la phau tich tren xac chet de nghien cUu, con "Phau thuat” la mo
xe tren ngudi song de chiia benh.
"Phau thuat” la dich tit chut “chirurgia” , cung bat nguon tit goc Hy Lap: "Kheir"
co nghia la ban tay, “ergon” la cong viec. Phau thuat la "mot phan cua nghe thuat
v hoc can den su can thiep cua ban tay, va la phtidng phap chiia benh bang can
thiep tu' ben ngoai vao, nen con goi la ngoai khoa. doi lap vdi noi khoa. dung thuoc
tac dong tu ben trong.
Vay “phau thuat” va “ngoai khoa” la hai tii dong nghia de dich chuf “chirurgia” ,
cung nhu "giai phau hoc” va “cd the hoc” la hai cach dich khac nhau cua chu
“anatomia” .

2. S i ; P H A t T R IE N V A P H A N C H IA , P H A N H O A C U A GLAI P H A U H O C

Vdi noi dung nghien ctiu la hinh the va cau tao cua cd the (con ngUdi hay sinh
vat trong thien nhien), mon giai phau hoc da phat trien theo nhieu htidng va da
phan hoa thanh rat nhieu nganh khac nhau:
14 I5S
L2*iJ GIAI PHAU NGJOI. TAP I

2.1. T h eo phufOng phap va mu’c do quan sat

2.1.1. Giai phau hoc quan sat bang mat thudng. goi la G ia i p h a u h o c d a i th e
(anatomie macroscopique/ gross anatomy), va nghien ciiu tren cd the binh thudng.
goi la g ia i p h a u th iib n g (anatomie normale). Do cung la pham vi nghien cUu chu
yeu cua “ Bo mon giai phau thudng", goi tat la "Bo mon giai phau" cua cac trUdng Y,
cloi vdi cd the con ngUdi.
’ [C hu thich tron g ngoSc don tieng Phap va tieng A nh],
7 a i ,
2 . 1 .2 . Giai phau hoc cat nho hdn nufa, de quan sat cac cau true cua cd the d rmic
do vi the, bang kinh hien vi quang hoc, goi la “ gicii p h a u vi th e " (anatomie
microscopique/microscopie anatomy), nay da tach ra thanh mot mon hoc rieng goi
la m o h o c (histologic/histology), nghien cUu cac cau true cd the d rniic do cac mo,
nghia la cac tap hdp te bao khac nhau.

2.1.3. Giai phau hoc quan sat bang kinh hien vi dien tu d mUc do vo cung nho hdn
nila. cho phep phan tich tdi muc 1 '1 angstrongs, de nghien cuu cac thanh phan
can tao d trong te bao va cac cau true phan tu cua chung, goi la g ia i p h a u sieu
vi th e (anatomie ultramicroscopique, ultramicroscopic anatomy), va g ia i p h a u
p h a n tit (anatomie moleculaire/molecular anatomy).
Nhd do da phat trien cae mon "T e b a o h o c " (cytologie/eytology) nghien cuu
cac loai te bao, voi cac cau true sieu vi cua chung, va nhung mon “ Dt tru y en h o c "
(genetique/genetic) nghien cuu cac cau true phan tu cua cae gen, nam trong cae
thanh phan cau true sieu vi dac biet d trong te bao.

2.1.4. Ngav nav, ngoai nhung phu’dng phap quan sat bang mat thudng va bang
kinh hien vi, su phat trien cua cac ky thuat vat lv da eho phep phat trien nhieu
phu'dng phap quan sat mdi trong gicii p h a u lam s a n g h a y h in h a n h y h oc
Giai. phau Xquang (Radiological anatomy): phat hien bAng soi hoac ehup tia X
Gun phau nhap nhay do (Scintigraphic, Scanning): phat hien bang chup dong vi
phong xa.
Gicii phciu noi soi (P^ndoscopy): Quan sat bang cach du'a ong soi vao cac khoang
o, hay cd quan rong ben trong co' the.
Sieu dm (Ultrasound, ultrasonography): phan anh cac hinh anh phan xa song
sieu am qua cac cau true khac nhau eua co the.
Giai phau X quang cat hip vi tinh (Computed tomography viet tat la C.T): the
hien cac hinh cat ldp khac nhau cua cac phan cd the. dinh vi bang vi tinh.
Giai phau cac hinh anh cong hifctng tit hat nhan (Imagerie par resonnance
magnetlque/Magnetic resonnance imaging, viet tdt la M.R.I): cung cho nhung
hinh cat ldp ro net cua cac phan cd the khac nhau. bang mot phu'dng phap vat lv
hien dai hdn.
 OAI C JO N G VE GIAI PHAU HOC [jjj| 15

Nhutng phUdng phap ngay cang hien dai nay da tao ra nhCing linh viic nghien
cUu giai phau mdi, khf'ic xa vdi phUdng phap co dien la phau tich. khong boc lo
hoan toan hinh thai cau true cua cd the trong khong gian ba chieu. ma chi phan
anh mot phan hinh chieu hay hinh cat cua cau true cd the tren mot hay nhCing
mat phang nhat dinh. Tat ca nhCing mon giai phau bang hinh anh do diidc gop
dudi mot ten chung la “ h in h a n h y h o c ” (imagerie medicale/medical imaging).

2.2. T h eo doi ttfdng va p h am vi n ghien cufu

2.2.1. Trong sinh hoc, ngoai giai phau ngu’efi con co nhieu doi tudng khac dUdc
nghien cUu bang phiidng phap giai phau nen da co cac mon g ia i p h a u th u c vat, g ia i
p h a u d o n g v a t, trong do dac biet co giai phau thu y nham phuc vu cho viec chiia
benh cho sue vat, gan vdi giai phau y hoc, nham phuc vu chiia benh cho con ngudi.

2.2.2. Mdi cau true cua cd the lai co luc lanh, luc benh, nen da hinh thanh hai linh
vUc nghien ciiu khac nhau: g ia i p h a u thitdng (anatomie normale/normal anatomy)
va g ia i p h a u b e n h (anatomie pathologique/patholgic anatomy).

2.2.3. Cac cau trite cua moi ca the cung bien doi theo cac giai doan phat trien khac
nhau cua doi song, nen cung co nhung phan mon neng de nghien cun su bien doi do.
- Nghien cuu su phat trien cua phoi tu' trong bung me den khi ra ddi goi la
p h o i th a i h o c (embryologie/embrvology).
- Sau khi ra ddi, cd the van con tiep tuc phat trien nen lai co gicii phau hoc
tre cm, giai phau hoc ngi/di Win, gicii phau hoc ngi/di gia.
Tat ca dude gop lai dudi mot ten chung la “gicii p h a u p h cit tr ie n cd th e

2.2.4. Nghien cuu so sanh giai phau cua cac loai dong vat khac nhau de tim ra quy
luat phat trien va tien hoa cua gidi dong vat va tu dong vat den ngudi goi la g ia i
p h a u so s a n h (antomie comparee/comparative anatomy) hay g ia i p h a u tien
h o a , va la mot phan cd ban cua nghien cuu p h a t tr ie n va p h a t sin h c h u n g loa i
(phylogenese/phylogenesis).

2.3. T h eo m u c d ich n g h ie n ctiu

Chi n en g gidi phau ngu’di cung da phuc vu cho nhieu muc dich khac nhau va
nhieu mon khoa hoc khac nhau:

2.3.1. G id i p h a u y h o c (medical anatomy): da hoi tu nhieu phan mon giai phau

ngifcii khac nhau: giai phau thudng, mo hoc, te bao hoc, phoi thai hoc, giai phAu
benh, giai phau Xquang, giai phau sieu am, giai phau nhan trac v.v...

2.3.2. Trong gidi phau sinh hoc, ngudi cung la mdt ddi tudng quan trong hang
dau trong gidi phau so sanh (comparative anatomy) hay gidi phau tien hoa
(evolutive anatomy) v.v... vi ngifdi la mile phat trien cao nhat cua dong vat.
16 g GIAI PHAU NGUOI. TAP I

2.3.3. G idi p h a u n h a n tr d c h o c (anthropometry) la mot phan mon eua giai

phau ngtfdi nghien cUu do dac kich thiidc cua cac doan va bo phan khac nhau cua
cd the con ngiidi, nham phuc vu cho nhieu muc dich va mon hoc khac nhau.
- Trong y hoc: de danh gia tinh trang the llie, dinh dtidng. va phat trien cua
cd the, d cac Ida tuoi, gidi tinh, va cac tinh trang lanh benh khac nhau v.v...
- Trong nhan chung hoc va co nhan hoc: de phan loai va nhan dang cac
chung toe loai ngiidi d cac thdi dai khac nhau.
- Trong cac nganh cong nghiep va kinh te khac: de thiet ke ra cac may moc
dung cu va trang thiet bi phu hop vdi tam voc va kich thifdc cd the cua moi nhom
ngiidi, hinh thanh mot mon hoc mdi goi la “Nghien ciiu thiet ke thfch nghi vdi
dieu kien lao dong” (ergonomy). Ngoai ra nhan trac hoc con la cd sd cho nhieu
viec khac: tuyen quan, tuyen sinh, tuyen nghe, tuyen sac dep (thi hoa hau) v.v...

2.3.4. G id i p h a u n h a n c h u n g h o c (anthropology)
Tim hieu, so sanh, va xep loai cac dac diem hinh thai va kich thiidc dac
trung cho cac chung toe hay quan the loai ngiidi khac nhau dang song tren trai
dat (nhan chung hoc hien dai); tim hieu va nhan dang cac dac diem hinh thai va
kich thiidc cua cac di cot co xiia, nham lam sang to qua trinh tien hoa va nguon
goc cua loai ngiidi, cung nhu cac cU dan moi vung tren trai dat (co nhan hoc,
khao co hoc).

2.3.5. G idi p h a u m y th u a t (artistic anatomy): quan tam den hinh thai, tiam voc.
ty le kich thufdc cua cd the ngUdi, d cac Ilia tuoi, gidi tinh, dan toe, nghe nghiep
khac nhau, cac ta the hoat dong trong lao dong va sinh hoat, cac trang thai bieu
hien net mat v.v..., de sang tac diidc cac tac pham hoi hoa va dieu khac phan anh
chan thifc, hien thitc thien nhien. phu hdp vdi tinh trang sinh dong cua cac cau
true giai phau be mat khac nhau. De lam dude viec do. Leonard de Vinci d Y. mot
nha hoi hoa danh tieng d the ky XVI. dong thdi cung da trd thanh mot nha
nghien ciiu giai phau cd ten tuoi.

2.3.6. G id i p h a u th e d u e th e th a o : quan tam den hinh the, cau true, chiic

nang, va phat trien cua cae cd quan van dong lien quan den cac dong tac the due.
the thao de co ke hoach tap luyen mot cach co khoa hoc.
Tat ca nhiing phan mon giai phau ngudi d cac nganh ke tren deu it nhieu co
lien quan den giai phau y hoc. va trong qua trinh lich svi phat trien dao tao dai
hoc d nitdc ta, luc khdi dau. chung da deu dude giang day va nghien ciiu tai
Trudng dai hoc Y Ha Noi. hoac do cac can bo giang day giai phau cua Trtfdng dai
hoe Y Ha Noi dam nhiem va tham gia xay diing.
Qua do chung ta cung thay giai phAu hoc khong chi phuc vu rieng cho nganh
Y, ma da phat huv tac dung cua no ra nhieu linh vUc khac trong khoa hoc va
cuoc song.
 DAI CUONG VE GIAI PHAU HOC gj 17

3. V| T il l C U A G IA I P H A U H O C T R O N G S IN H H O C

Gidi phau hoc nha ta viia thay la mot mon khoa hoc cd ban, md dau, va khai
sinh ra tat cd nhiing mon phan hoa va phat trien da neu tren cua no.
Tat ca nhflng mon nay van co mot doi tudng chung la hinh thai va cau true
cua cd the..., cho nen co the gop lai diidi mot cai ten chung la hinh thdi hoc
(morphologi e/morphology).
Hinh thai hoc la mot linh viic cd ban dau tien cua sinh hoc. va la cd sd cho
linh viic thii hai la sinh ly hoc (physiologie/physiology), nghien cUu ve chiic nang
va hoat dong cua cac cd quan, bo phan va cau true khac nhau cua cO the.
Hai linh vuc nay khong the tach rdi nhau diidc. Hinh thai luon di doi vdi chiic
nang, chufc nang tao hinh thai, va hinh thai nao thi phuc vu chiic nang do.
Cho nen gidi phau chiic nang (anatomie fonctionnelle/functional anatomy/
physiologic anatomy) da trd thanh mot quan diem va phiidng chain cd ban cua
nghien ciiu va mo ta giai phau.

4. T A M Q U A N T R O N G C U A G IA I P H A U H O C T R O N G Y H O C

Giai phau hoc luon luon la mon hoc nhap mon cua v hoc, va la mon y hoc cd sd
cd ban nhat.
- Trifdc het, gidi phau la cd sd cua tat cd cdc mon y hoc cd sd khac. Co hieu
diidc cau true dai the cua cac cd quan, bo phan cua cO the, mdi hoc du'o'c cau true
vi the va sieu vi the cua chung (mo hoc, te bao hoc v.v...) co hieu diidc cau tao cua
tung cd quan. bo phan mdi hieu dUdc chiic nang va hoat dong cua chung (sinh ly,
sinh hoa, diidc ly v.v...). Co hieu diidc giai phau thiidng mdi hieu dude giai phau
benh v.v...
- Gidi phau cung la cd sd cua cdc mon y hoc lam sang, vi co nam vufng diidc
chinh xac vi tri, hinh the, kich thiidc lien quan va cau tao cua cac cd quan, bo phan
cd the mdi co the tham kham, danh gia, va dieu tri diidc chung khi bi benh.
Dac biet doi vdi ngoai khoa, giai phau lai cang quan trong, vi moi ky thuat
phau thuat deu dUa tren cd sd nhiing hieu biet vung chac ve giai phau.
Vay co the khang dinh lai mot lan niia, giai phau hoc la cd sd cd ban nhat va
la mon hoc cd ban dau tien cua y hoc.

5. CAC Q U A N D IE M V A P H l/O N G P H A P T R t N f f i ^ J G d lA I P H A U HO C
[CAO DANG
Tuy muc dich va doi tUdng giang day, giai phau poc (}6 ^ e tr inh bay theo nhieu
cach khac nhau.

5.1. Giai p h au h oc he th on g (systematic anatomy u mo ta. (descriptive

anatomy): la cach mo ta giai phiu theo tting he th Sik&XMfyx uan, bo phan cung
2- GPN-T1
18 jjl GIAI PHAU N G JO I. TAP I

thuc hien mot clitic nang nhat dinh: he van dong, he tieu hoa. he tuan hoan. he
ho hap, he tiet nieu, sinh due. he than kinh. he 1101 tiet v.v...

5.2. Cach mo ta nay phu hop vdi quan diem g id i p h a u c h itc n a n g hon ca va co
the phuc vu cho nhieu doi tudng rong rai, ea trong va ngoai nganh ''l. Song khong
phai chi mo ta giai phau he thong mdi the hien duOc quan diem chtic nang Ma
trong moi each mo ta giai phau y hoe. moi chi tiet cau true deu can duOc gan lien
vdi quan diem "Hinh then luon luon di doi vdi chi/e nang'. Vi du: khi hoc ve moi bo
phan xufdng cd, khdp phai hieu ro moi bo phan do co tac dung gi hoat dong the nao
binh thudng va bat thudng (khi bi ton thudng) ra sao v.v... Tham chi, moi go mau.
loi, lom cua xudng cung deu cd tae dung neng cua no. Moi cau true, hinh the cua
moi cd quan, bo phan khac trong co the cung deu nham dap ting mot chtic nang
rieng cua no, cho nen cai cd ban khi hoe giai phau khong phai la nhd. ma la hieu.

5.3. Giai phau h oc dinh khu (topographic anatomy) h a v gnu phau titng vung
(regional anatomy): la each md ta cac cau true giai phau cua tting vting khu trti.
theo tting ldp tti nong vao sau. va dac biet chu y den cac chi tiet lien quan cua cac
thanh phan cau tao vdi nhau.
Cach mo ta nay phti hdp vdi quan diem “ G id i p h a u iin g d u n g ” hay "Gidi
phau ngoai khoa" (applied anatomy, surgical anatomy), nham phuc vu chu yeu
cho chan doan va dieu tri, va dac biet cho ung dung ngoai khoa. Tti nhting quan
diem cd ban da neu, cting co nhting cach trinh bay ket hdp khac nhau.

5.4. G iai phau hpc cat d oan tting p han : ket hdp mo ta cac cau trtic cd ban
cua tting vting cd the vdi giai phau dinh khu la mot cai tien rieng cua Viet Nam
(theo co GS. Do Xuan Hdp) trong thdi ky khang chien chong Phdp. Cd the dUdc
chia thanh cac phan ldn, hoc theo thti tti lan ludt: chi tren, chi difdi, dau, mat, co.
ngti quan, ngtic, bung, than kinh. Khi hoc moi phan lai chia thanh tting vung nho
hdn. vi du: chi tren gom: vai va nach, canh tay. cang tav, ban tay; moi vting nho
dtidc mo ta lan ltidt theo cac cau trtic cd ban. xudng, khdp, cd, mach. than kinh. co
chti y dac biet den cac lien quan chi tiet va ap dung ngoai khoa. Hoc xong vung
nao sinh vien nam vting ngay vting-ay, va co the len dtidng phuc vu mo xe ngay
tai cac chien trtidng, sau moi ddt hoc tap.
Cach giang nay tti sau 1954 den nay v ln dude ap dung lau dai cho sinh vien
cac Trtidng dai hoc Y d mien Bac Viet Nam. No co nhting tiu diem cua no, dac biet
ve lien quan va ajD dung thtic te phuc vu p h iu thuat. Song cung co nhiing nhtiOc
diem nhat dinh la'cac cd quan ctia cting mot he thong, nhti cac mach mau va than
kinh, da bi mo ta cat doan theo tting vting nho, lam mat tinh tong quan lien tuc
cua no. Nen can phai co nhting bai ngoai khoa tong ket he thong hoa lai toan cuc
sau khi hoc xong moi vung ldn.

5.5. Trong cuon sach nay, chung toi n h lm khac phuc nhtfdc diem do bang cach
 OAI CUONG VE GIAI PHAU HOC p 19

bat dau md td d a i ciiU ng va h e th o n g cdc cau true giai phau ccf ban (xudng.
khdp, cd, mach, than kinh) - theo titng phan ldn cua cd the rdi d in h k h u c h i tiet
th e o tiln g v u n g n h o.
Vi du: cho chi tren, se lan kfdt mo ta: xUdng chi tren, khdp chi tren, cd chi
tren, dong mach, tinh mach chi tren, than kinh chi tren. Giang cho cac sinh vien
nam dau (co the ap dung cho ca cac sinh vien dai hoc Y, Dieu diidng, hoac ngoai
nganh Y).
Roi sau do cung co va on tap lai, bang giai phau dinh khu tting vung nho co
bo sung nhiing chi tiet lien quan sau nham chu yeu phuc vu cho cac doi tiidng dai
hoc Y: co the hoc tiep ngay sau phan mo ta he thong, hoac de lai cho giai doan sau
tru'dc khi bu'dc vao giai phau thuat thuc hanh hoac khi di sau vao chuyen khoa
mo xe.

5.6 . G ia i p h a u be m a t ( surface anatomy): mo ta cac gidi han, cac moc, cac

hinh the hien ro dudi da, cac loi lom d be mat tUdng Ung vdi cac cau true ben
trong co the nhin thay hoac sd thav dude. Day la cach md td lien h e vdi th iic
te tren cd the song, giup cho sinh vien co the nhan dinh dtfOc de dang cac cau
true giai phau tren ngudi song khi hoe giai phau, khi tham kham benh nhan va
khi mo xe sau nay.
Quan diem lien he thuc te tren cO the song can difdc nhan manh trong moi bai
giang hay it nhat la trong khi thUc tap.

5.7. G iai p h a u X q u a n g (radiological anatomy): cung la mot cach lien he vdi

giai phau thuc te tren the song, can difa vao giang day giai phau, de sinh vien lam
quen vdi mot dai dien pho bien nhat trong cac mon uhinh anh y hoc" (imagerie
medicale/medical imaging).
Giai phau Xquang benh ly thuoc ve chuyen khoa Xquang, song giai phau
Xquang binh thifdng la mot cau noi giiia giai phau hoc binh thtidng va “hinh anh
y hoc” trong tham kham lam sang. Hdn nufa, khong rieng Xquang ma cac “hinh
anh y hoc” khac (giai phau sieu am, giai phau cat ldp bang vi tinh hay cong
hu'dng tu' hat nhan) cung can du'a dan vao giai phau hoc).

5.8. Giai phau chuyen khoa va chuyen de (special anatomy) la nhung chUdng
trinh giai phau rieng bo tuc cho cac sinh vien noi tru va cac bac si chuyen khoa sau
dai hoc, can co nhQng kien thiic giai phau sau hdn cho chuyen khoa cua minh.
Trong hoan canh hien tai d ta, cac chifdng trinh giai phau chuyen khoa, cung
nhu van de tu hoc con it nhieu han che.
Song 6 nhieu ntidc, m6i chuyen khoa deu co nhiing tai lieu giai ph!iu rieng di
sau vao lanh vUc cua minh: giai phliu than kinh, giai phau mat, giai phau tai mui
hong, giai phau rang ham mat, giai phiu Xquang, giai phiu sieu am v.v... va ngay
 GIAI PHAU NGLTOI. TAP I

nay, mot phan mon nghien cuu giai phau mdi cung da hinh thanh va phat tiien. do
la giai phau cac vat va cac manh ghep, phuc vu cho vi phau thuat tao hinh
Ngoai ra, ttiy theo yeu cau bo ttic rieng cua moi chuyen khoa, lai co nhQng bai
khoa giai phiu chuyen de rieng, di sau vao mot van de tap trung nhat dinh. Cac
khoa hoc chuyen de nhu vay 0 mot so nude, co the to chiic dinh ky. co hoc. co thi de
lav chiing chi (dao tao lien tuc), phuc vu cho viec phat trien chuyen khoa cua minh.

() ta, thuc hien soan thao mot chuyen de giai phau co lien quan den mot de
tai nghien ciiu khoa hoc, cung da trd thanh mot thu tuc can thiet cho mot luan an
tien si ve ngoai khoa, hoac cac chuyen khoa khac. Vi giai phau luon luon la cd sd
cd ban cho moi cai tien va phat trien cua phau thuat.

6. D A N H T V V A T H U A T NGLf G IA I P H A U

Mon khoa hoc nao cung co nhiing tti ngti rieng cua no. Tti ngti giai p h iu lai
cang co mot tam quan trong dac biet vi no la mon cd sd cd ban ctia tat ca cac
nganh co lien quan (trong sinh hoc, trong thti v, va nhat la trong y hoc).

6.1. T ren the gidi: rieng trong y hoc, tti ngti giai phau da co mot lich sit rat lau
ddi. Tti dau cong nguyen, tieng Hy Lap da dude dting de dat ten cho cac cau true
giai phau.
Den thdi ky trung co (the ky thti XV - XVI) ngtidi ta da bat dau sti dung tieng
Latin co lan mot so tti a Rap va co Hy Lap. Song cho tdi cuoi the ky XIX, moi ntiefe
van co nhting thuat ngti nen g ctia minh, nen moi cau trtic giai phau co nhieu ten
goi khac nhau, va ngudi ta udc chting co tdi 50.000 tti giai phau de chi khoang
5.000 chi tiet giai phau khac nhau ltic do.
De khac phuc tinh trang nay, nam 1895, mot so" cac nha giai phau chau Au, va
chau My (chti yeu: Dtic, Y, Anh. My) da hop nhau lai d Basle de thong qua mot ban
danh phap thong nhat bang tieng Latin lav ten la Basle Nomina Anatomica (BNA).
Nam 1933, BNA dtidc xet lai d Birmingham (Anh) bang tieng Latin va tieng Anh.
Nam 1936, Hoi nghi giai phau d Jena (Dtic) lai chd ra ddi mot ban danh phap
mdi, van b ln g tieng Latin, lay ten la Jena Nomina Anatomicia (JNA); vln chtia
co sti tham gia ctia Phap.
Nam 1950, Hoi nghi giai phau quoc te lan thti V tai Oxford (Anh) quyet dinh
thanh lap mot tiv ban danh phap giai p h iu quoc te, va 5 nam sau, nam 1955, Dai
hoi the gidi cac nha giai phau lan thti VI hop tai Paris da cho ra ddi ban danh tii
giai phau mang ten la “Parisiensa Nomina Anatom ica” (PNA. 1955), xuat ban lan
I nam 1956, la ban dau tien dtidc thong nhat cong nhan toan cau vdi sti tham gia
cua Phap.
PNA dtidc tiep tuc siia doi va bo sung d cac Hoi nghi giai phiu quoc te l&n VII
1960, d New York (t£ ban lan II nam 1961) va Hoi nghi giai phiu quoic te l&n
 DAI CUONG VE GIAI PHAU HOC [jl; 21

VIII nam 1965, d Wiesbaden (tai ban lan III nam 1966) deu lay ten chung la
Nomina Anatomica viet tat la N.A. Ten goi chung do da chting to ca the gidi chi
co mot ban danh tu giai phau chung thong nhat, ma khong can goi theo ten rieng
cua mot dia danh nao khac. Tti do N.A. van tiep tuc luon luon dtidc stia doi. bo
sung qua moi lan dai hoi thudng ky cua cac nha giai phau quoc te.
Cac dai hoi tiep thoo nam 1970 d Leningrad, nam 1975 6 Tokyo, nam 1980 0
Mexico, deu co stia doi, va dac biet bo sung them muc cac danh tti mo hoc va phoi
thai hoc.
Den nam 1985, Dai hoi the gidi cac nha giai phau hop 0 London da cho ra ddi
ban Danh tti giai phau quoc te lan VI (N.A. 1985). in nam 1989. gom 3 phan:
- Nomica Anatomica (xuat ban lan thti 6).
- Nomina Histologica (xuat ban lan thti 3).
- Nomina Embryologica (xuat ban lan thti 3).
Cuoi cting, Dai hoi cac nha giai phau quoc te hop tai Sao Paulo 1997 da thong
qua mot ban thuat ngti giai phau quoc te mdi gan day nhat, Terminologia
Anatomica (T.A. 1997), xuat ban nam 1998, ma chting ta dang ap dung hien nay.

6.2. O V ie t N a m : danh tti giai phau hoc cting da trai qua nhieu giai doan lich sti
khac nhau
- Tti triidc cach mang 1945 (1902 - 1945) va trong thdi ky tam chiem, tai
trtidng Dai hoc Y noi thanh Ha Noi (1948 - 1954), giai phau hoc noi rieng va y
hoc noi chung van dUdc giang va hoc hoan toan bang tieng Phap.
- Tdi nhting nam gan cuoi cua cuoc khang chien chong Phap, d vting khang
chien, co GS Do Xuan Help la ngtidi dau tien da dich cac tti giai phau tieng Phap
ra tieng Viet, dau tien viet sach giao khoa gidi phau bang tieng Viet (1951 - 1952)
va dau tien dtia tieng Viet vao giang day dai hoc tai Viet Nam.
- Tti sau 1954, viec giang day giai. phau d trtidng dai hdc Y Ha Noi va cac
trtidng mdi thanh lap khac, d mien Bac Viet Nam, van ap dung va phat trien danh
tii giai phau D o Xuan Hap dich theo tieng Phap. Cac sach giao khoa giai
phau va tti dien danh tti y hoc Phap Viet xuat ban lan dau d Ha Noi cung vay.
Nhting lan tai ban tiep theo, vdi sti dong gop ctia tap the cac can bo giang day
dau tien cua Bo mon Giai phau trtidng dai hoc Y Ha Noi, cac sach giao khoa giai
ph^u cu va Tti dien danh tti Y hoc Phap Viet do Bo Y te xuat ban (lan thti II, 1976),
da co it nhieu stia doi va bo sung theo danh tti giai phau quoc te cu thong qua tai
Paris (...), (PNA. 1955) (tham khao gian tiep qua cac sach Lien Xo cu).
Tuy vay, viec stia doi va bo sung theo DTGPQT ltic do van con rat han che, va
thtic te da so cac can bo nganh Y van quen dting cac tti giai phau dich tti tieng
Phap cu (tham chi cach dich tti tieng Phap doi khi con khong thong nhat gitia cac
chuyen khoa khac nhau). , t; .
22 [5j
LiaJ GIAI PHAU NGUCJI. TAP I

- Trong khi do. o mien Nam. tu nhung nam 1965 - 1968 giao su S g u y e n
lltiu va cac cong tac vien cung da lan ltidt cho xuat ban 6 tap “ D a n h tti c a th e
h o c ” ha th ti tie n g L a tin - P h a p - Viet, dich theo PNA. 1955. Song cac tu giai
phau ticng Viet d mien Nam (Sai Gon cu) khac xa rat nhieu cac tu quen dung d
mien Bfic, ke ca tti cti ctia GS. Do Xuan Hdp. lin tti mdi do tap the Bo mon Giai
phau Dai hoc Y Ha Noi dich theo PNA. 1955.
- Sau giai phong mien Nam (1975 - 1979). tap the can bo giang day Bo mon
Giai ph;\u trtidng dai hoc Y Ha Noi (gom cac BS. Nguyen Quang Quyen, Trinh
Van Minh, Nguyen Kim Loc, Le Quang Cat. Vti Duv San va Le Htiu Hung) da
cting nhau phan cong soan thao mot cuon "Tti dien danh tti gicii phau hoc 4 thti
tieng" (Latin, Anh, Phap, Viet), va mot cuon “Tti dien giai thich danh tti giai phau
hoc” . Danh tti giai phau tieng Viet dUOc bien soan lai thong nhat theo mot
nguyen tdc chung la dich theo danh tti gidi phau quoc te thong qua tcii Paris nam
1955, (PNA. 1955), diia tren cO sd stia doi va bo sung von tti giai phau san co cua
Viet Nam (tti 1951 - 1979).
Song do hoan canh thav doi dang tiec ve to chtic can bo trong noi bo Bo mon.
non Tu dien giai thich van con dd dang, va Tti d ien g id i p h a u h o c 4 th ti tie n g
den nam 1983 mdi xuat ban, dudi svJ chu bien cua GS. Nguyen Quang Quven Otic
do da chuyen sang Dai hoc Y-Dtidc Thanh pho Ho Chi Minh).
Tuy xuat ban lan dau trong hoan canh day ray kho khan, khong tranh khoi
nhting phan khiem khuyet, cuon sach da danh dau mot btiefe ngoat quan trong
trong viec cai to danh tti giai phau Viet Nam theo danh tti giai phliu quoc te.
Danh tti giai phau Viet Nam cai to budc dau theo PNA. 1955 da dtidc ap dung
mot cach tich ctic d mien Nam, trong cac cuon “Bai giang giai phliu hoc” cua Dai
hoc Y-Dtidc Thanh pho Ho Chi Minh xuat ban va tai ban tti 1985 den nay.
Mot sti cai to cd ban mdi co tinh cach mang da dude xtic tien manh me tti sau
nhting ldi kou goi doi mdi cua cac dai hoi 1992 va 1994 cua Hoi hinh thai hoc Viet
Nam va sti hinh thanh mot Tieu ban danh phap giai phau Viet Nam do GS. TS.
Trinh Van Minh lam Trudng ban. Do cung la mot trong nhting muc tieu quan trong
cua cuon sach nay, xuat ban lan I. 1998. dong thdi cting la tien de cho su ra ddi cua
cuon “ Tti d ien D a n h tti G idi p h a u Q u o c te V iet h o a c o g id i th ich va ban
lu a n " cua GS.TS. Trinh Van Minh. NXB Y hoc Ha Noi, 1999, dua tren cd sd Danh
tti giai phau quoc te mdi thong qua tai London 1985 (Nomina Anatomica 1985).

Tti PNA. 1955 den N.A. 1985 la 30 nam thav doi vdi 6 lan Dai hoi the gioi
cac nha giai phau quoc te. nen Tti dien DTGPQT Viet hoa 1999 cua Trinh Van
Minh (dtia theo N.A. 1985) cting co rat nhieu diem khac vdi Tti dien Giai phau 1
thti tieng 1983 cua tap the Bo mon Giai phau do Nguyen Quang Quyen chu bien
(dtia theo PNA. 1955). Tuy nhien ngay sau khi NA.1985 ra ddi, Tap doan Uy ban
danh phap Giai phau quoc te da lai tiep tuc nghien ctiu, stia doi, bo sung de hdn
 OAI C JO N G VE GIAI PHAU HOC gjl 23

10 nam sau cho ra ddi cuon Thuat ngu giai phau Quoc te mdi bang 2 thu tieng.
Latin va tieng Anh. thong qua tai Dai hoi The gidi cac nha Giai phau tai Sao
Paulo, 1997 (Terminologia Anatomica, T.A. 1997) xuat ban 1998. Cho nen, lien
tuc cap nhat va bo sung van la muc tieu khong ngu'ng cua cac lan tai ban tiep
theo cua cuon sach nay.

7. T ir T H E G IA I P H A U VA D IN H H l/O N G V I T R I GlAl P H A u
Giai phau hoc luon luon phai mo ta hinh the, vi tri, lien quan cua cac cau
true, co quan va bo phan doi chieu vdi toan cd the, va so sanh gitia chung vdi
nhau, nen can phai cd nhung quy tfdc dinh hudng thong nhat khi md ta, ma smh
\ icn nao ciing phai nam vung tru'dc khi hoc giai phau.

7.1. Tii the giai p hau : la tu' the ngudi diing thang. hai tay bu ong xuoi, mat va
hai ban tay hu'dng ve phia tru'dc (phia ngudi quan sat va md ta).
Cac vi tri tudng quan cua cac cau true giai phau dude xac dinh theo 3 mat
phang chinh trong khong gian.

7.2. Cac m at p h a n g giai phau (I linh 1).

7.2.1. M a t p h a n g d iin g d o c (planus sagittalis): la mat phang dung, theo chieu
doc tru'dc sau.
Cd nhieu mat phang dung doc song song vdi nhau. song chi co mot mat phang
dung doc giua (planus sagittalis medianus) nam chinh gnia co the va chia cd the
lam hai ntia doi xung. phai va trai. Ngoai ra. cho moi nUa cd the. mat phang diing
doc giua con la moc de so sanh 2 vi tri trong (medialis) va ngoai (lateralis) (gan
ho’n va xa hon so vdi mat phang do).

7.2.2. M a t p h a n g d iin g n g a n g hay m a t p h a n g trcin (planus frontalis): con goi

la m a t p h a n g v a n h (planus coronalis), la mat phang dung theo chieu ngang,
phai trai.
Cung cd nhieu mat phang dung ngang song song, song ngudi ta thudng lay
mot mat phang dung ngang tudng trung qua gitia chieu day tru'dc sau cua cd the
lam moc, chia co' the thanh: phia tru'dc (hay phia bung) (anterior/ventralis) va
phia sau (hay phia lung) (posterior/dorsalis).

7.2.3. M a t p h a n g n a m n g a n g (Planus horizontalis) la mat phang nam theo

chieu ngang (dudng chan trdi), thang goc vdi true dung thang cua cd the. hay
thang goc vdi 2 mat phang dung da neu tren.
Co nhieu mat phang nam ngang cao thap khac nhau. song song vdi cac chieu
nam ngang phai trai va tru'dc sau cua cd the. Seng cung cd the hinh dung mot
mat phang nam ngang tudng tnfng qua giila cd the. hay giua mot cd quan, bo
phan nao do. chia cd the hay cd quan, bo phan ra lam hai phan: tren, dudi.
24 GIAI PHAU NGUOI. TAP >

iinh 1. Cac mat phang cua cd the va cac tir djnh hi/dng

I Mat phang d iir >;,dng (Planus frontalis/coronaris); 2 Phia lung (sau) (Dorsalis/Posterior) 3 Phia
bung (trUdc) (Ventralis/A nterior); 4 Mat phang c^t ngang (Planus transversalis); 5 Tu the sap
(Pronatio), 6. Phia gan (gan goc chi) (Proxim alis), 7. Phia xa (xa goc chi) (Distalis). 8 Phia duoi
(du'di) (C audalis/lnferior), 9. Mat ph^ng d iin g doc (Planus sagittalis); 10. Tif the ngiia (Supmatio).
I I Mat phang nam ngang (P lanus horizontalis); 12 Mat ph4ng diing doc giufa (Planus sagittalis
m edianus): 13. Phia dau (tren) (C ram alis/Superior).
 OAI C U O N G VE GIAI P H A U HOC 25

7.2.1. Khong nen nham mat phang nam ngang vdi m at p h a n g ccit n g a n g (planus
ti ansveisalis) hay mat phang ngang, khong co y nghia quy u'dc djnh hudng trong
khong gian, ma chi la mot mat phang bat ky thang goc vdi true doc cua mot cO
(pian hay bo phan nao do cua cd the. X gan g (transvorsahs) chi co y nghia la
thang goc vdi doc (longitudinalis), doi khi co the trung hdp vdi nam ngang (doi vdi
cac chi d tu' the diing thang), song chu yeu lai khong nhif vay (vdi da so cac cO
quan, bo phan khong d tu the thang diing).

7.3. Cac vi tri va ch ieu hifcVng giai phau

Dude xac dinh mot cach doi lap nhau, theo 3 mat phang giai phau cd ban da neu:

7.3.1. 'Tren (superior) hay dau, phia dc'iu (cranialis), va Ditdi (inferior) hay (tuoi,
phia dudi (caudalis) la 2 vi tri, doi lap so vdi mat phang nam ngang.

7.3.2. Sau (posterior) hay phia IWng (dorsalis) va Triidc (anterior) hay phia bung
(ucntrali.fi) doi lap so vdi mat phang diing ngang.
Sd di co cac tu "phia dau”, "phia dudi”. "phia liing”, “phia bung" la de co the dung
chung cho ca giai phau so sanh (dong vat) va giai phau phat trien (phoi thai), vi
doi vdi clong vat 4 chan va thai nam trong bung me: dau, duoi khong phai la tren,
dudi, bung, lung khong phai la triidc, sau.

7.3.3. Phai (dexter) va trai (sinister) la hai phia doi lap so voi mat phang diing
doc giiia.

7.3.4. Trong (medialis) va ngoai (lateralis) la hai vi tri so sanh theo chieu ngang
d cung mot phia doi vdi mat phang diing doc giua:
Trong co nghia la d gan hdn va ngoai la d xa hdn so vdi diidng giOa, true giiia
hay mat phang dung doc giua cua cd the. (Medialis va lateralis dung ra phai dich
la phia giiia va phia ben, sat nghia vdi tu:’ Latin hdn, nhiing dai dong va kho goi
hdn so vdi trong va ngoai da rat quen dung).
Sdng “trong” va "ngoai” tieng Viet lai con mot y nghia khac, la trong sau, ngoai
nong, de so sanh hai vi tri: phia trong hay ben trong (internus), phia ngoai hay
ben ngoai (externus), d gan hdn va d xa hdn so vdi trung tam cua mot cd quan, bo
phan hay khoang o nao do cua cd the. y nghia nay it gap hdn trong cac ti* giai
phau. Song khi gap sinh vien can phai biet phan biet hai y nghla da neu d tren,
cua hai tu ddng am do. (Vi td Viet qua nghed nan sd vdi tir Latin, nen nhieu khi
buoc long phai dung mot tif Viet de dich nhieu tti Latin khac nhau).

7.3.5. Ngoai ra cdn mot so tu! dinh hitdng khac

G an, hay phia gan, dau gan (proximalis) va .ra hay phia xa. dau xa (distalis)
de se sanh 2 vi tri d gan hdn hay xa hdn so vdi goc chi, hay so vdi trung tam cua
mot cd quan hay mot he thdng.
26 [>X GIAI PHAU NGUOI. TAP I

- Quay hay phia quay (radialis) va tru hay phia tru (ulnaris) d chi tren cung
dong nghia vdi ngoai va trong.
Phia duty (tibialis) va phia mac (fibularis) d chi dudi cung dong nghia vdi trong
va ngoai.
Phia gan lay (palmaris) va phia mu tay (dorsalis) ttidng ting vdi trtfdc va
sau so vdi ban tay.
- Phia gan chan (plantaris) va phia mu chan (dorsalis) ttidng ting vdi dtfdi va
tren so vdi ban chan.

8. CAC P H L fd N G T IE N V A P H l /d N G P H A P H O C G IA I P H A U

Doi vdi sinh vien Y, giai phau luon dUdc coi la mot mon hoc kho, cho nen viec
hoc can cd phUdng tien va phUdng phap.
Doi vdi mot mon hinh thai hoc. phu’dng phap hoc tot nhat In trite quan: nhin
tan mat, sd tan tay. Vay phudng phap gan lien vdi phu'dng tien va thuc tap quan
trong hdn ly thuvet.

8.1. X a c va xtfofng la phu’dng tien titic qu an tot nhat

Hoc xudng thi phai true tiep cam lay xudng ma md ta, doi chieu vdi hinh ve
trong sach hoac tren bang. Hoc cac phan mem thi phai true tiep phau tich tren
xac ma quan sat, va tim hieu noi dung da neu trong bai giang hoac sach vo.
Trong hoan canh hien nay d Viet Nam, xac it. sinh vien nhieu. sd gid danh
cho thuc tap rat han che, nen sinh vien khong duo'c true tiep phau tich. ma chi
duoc hoc tren cac xac da phau tich san, do thav hu'dng dan. Song sinh vien phai
biet tranh thti, chain chu nhin va nghe roi sau do tu minh sd vao xac ma xem lai.
tim hieu them.
De khac phuc tinh trang thieu xac, da cd thdi ky Bo mon Giai phau Ha Noi da
co sang kien sti dung xac sd sinh. cho sinh vien phau tich. Song den nay dieu kien
do cting khong con thuc hien dude.
Mot sang kien bo sung khac la mb cho; gitip sinh vien co khai mem phan nao
ve giai phau tren cd the song: ve phuc mac. phe mac, cac phu tang, cac mach
mau, ke ca bach mach, ong ngtic v.v... vdi mau sac va hoat dong tu nhien tren co
the song. Song giai phau cho cd nhieu diem khac ngUdi can biet so sanh de hieu
cho dung.
Ngoai xac con nhieu loai hoc cu kh ac: cac bo xtidng va xtidng rdi, cac tieu ban
phau tich san, cac mo hinh, cac tranh ve. cac phim Xquang v.v...
Van de con ttiy thuoc vao dieu kien va cach to chtic ctia moi phong thi nghiem
giai phau. Song mot yeu cau cd ban doi vdi sinh vien la: y thtic bao quan dung cu va
ton trong noi quy; tranh mat mat, d6 vd. hti hong, thieu hut, sau moi ddt hoc tap.
 DAI ClfONG VE GIAI PHAU HOC OHM i

8.2. C ac xu’Ong rtfi

Cac xiidng rdi la hoc cu tic bj that lac nhat. Non d mot so phong thi nghiem co
nhiing gia treo: moi xifdng buoc chat vao mot fedi xich nho, dau tren xich gan vao
mot vong treo, long vao true ngang cua gia treo, xifdng co the di dong de dang khi
hoc, song khong dUdc tach khoi gia treo.
Trong hoan canh khong co gi<\ co dinh. van de la tti giac, hoc xong tra du.
Cam mang khoi phong thi nghiem.
Bo xudng lap san. khi hoc de tai cho, cam thao rdi.

8.3. Cac tieu ban phau tich san

Cac tieu ban phau tich san dude bao quan trong lo thuy tinh. trinh bay trong
phong musee. khi hoc cam vdt ra, cam choc quo vao trong lo.
Mot so thiet do mong (nao, chi...) dong kin, kep giua hai phien kinh. co the
cam tay, cung la nh un g sang kien rieng cua Bo mon Giai phau Ha Xoi trong qua
trinh giang day thuc tap. Can tranh rdi vd.
Ngay nay con mot kv thuat mdi la cac tieu ban giai phau nhiia hoa bang cach
cho ngam chat deo (plastination) theo phudng phap cua G.Von Hagens (mot nha giai
phau duong thoi ngUdi Due). Tieu ban that, nhung lai bao quan kho nhu nhung mo
hinh, su dung rat thuan tien trong thuc tap giai phau. Song phu'dng phap nav doi
hoi nhung phudng tien ky thuat rieng. chung toi da de nghi tim hieu. hoc tap va ap
dung (tu' nhung nam tru'dc khi ve huu), song, trong hoan canh luc do, van chita co
dieu kien thuc hien. Mong cac dong nghiep the he sau tiep tuc khai thac.
v ' •*
8.4. Cac loai m o h inh n h an tao ban g chat deo hay th ach cao
Tuy khong hoan toan giong thtic (tham chi doi khi co cho sai, khi hoc can
phat hien), song van gitip ich nhieu cho sinh vien ve hinh anh trong khong gian
hdn tranh ve va de tiep xtic hdn xac.
Mot so mo hinh do ta tti sang tao bang vai rat thuan loi cho viec tim hieu ve
phuc mac, cau tao cac ldp cd d thanh bung va ong ben v.v... ma cac loai mo hinh
khac khong mo ta diidc.

8.5. T ra n h ve
Tranh ve la phudng tien hoc tap rat tot va rat can thiet, lai de co va de hoc nhat,
b a tk y d dau.
Dtia vao cac tranh treo trong phong thi nghiem, sinh vien co the bo sung va
chinh ly nhung hinh ve, tti ghi chep trong bai giang ly thuyet, hoac tim hieu va
on tap ngay nhiing noi dung vtia hoc. Tai nha hay tai thii vien. sinh vien co the
gid cac tranh ve tren cac trang sach khac nhau ra ma quan sat. so sanh, suy luan
va tim hieu nhung noi dung chinh. Hoc tranh tot hdn hoc ldi vi hieu dtidc la nhd
28 g GIAI PHAU NGUOI. TAP I

cltide, tti hoc, nhap tam co suy luan va so sanh nhting dieu minh til quan sat va
kham pha vdi nhting dieu thay giang, sach viet. Do cting la cach hoc ma ban than
chting toi khi con la sinh vien da rat quan tam sti dung, trtidc va sau khi doc
phan ldi.
Cac tap tranh Atlas giai phau ngav cang phong phti d khap ndi cting nham
phuc vu cho muc tieu do, trong hoc tap va on tap giai phau.

8.6. T h e song
The song la mot hoc cu vo cting quan trong ma sinh vien de lang quen va lang
phi. Khong gi de hieu, de nhd. nhd lau, va de van dung vao thtic te bang cach
quan sat trtic tiep tren the song nhting cai co the quan sat diidc: tai ngoai, mat,
mtii, hong, mieng, rang, ltidi v.v... deu co the nhin thay dtidc bang cach soi gtidng
hay quan sat tron ban doner hoc Car man, gd. cua xtidng va cac chi tiet khac cua
giai phau be mat v.v... deu cu the va can lien he true tiep tren ban than minh. la
mot hoe cu thudng true dang quy

8.7. Hinh anh X q u a n g

Hinh anh X q u a n g cting la mot hoe cu true quan doi chieu vdi thuc te tren
the song.
Cac phong thtic tap giai phau 6 cac nude deu co trang bi cac den doc phim
Xquang (negatoscope) ma ta chua quan tam day du.
Co ndi con co mot phong n e n g danh cho giai phau Xquang. vdi day du cac bo
su'u tam cln loai phim Xq uang (nhu mot "musee" giai phau Xquang). sinh vien co
the den tham khao, tti hoc theo yeu cau.

8.8. Cac phu’dng tien nghe nhin (audio visuel)

Cac phu'dng tien nghe nhin da trd thanh mot phu'dng phap rat pho bien. vdi cac
trang bi day dti va hien dai. d cac nude phat trien. Trang bi d ta con qua ngheo nan.
va hau nhu ehtia dtidc khai thac. Phan "nhin” rat han che. tho sd. con phan "nghe”
chiia co. nen hoan toan phu thuoc vao thay. (Thtic te Viet Nam neu d dav la cho
den khi xuat ban lan dau cuon sach nay 1998. Song den nay dieu kien vat chat da
diidc cai thien hdn nhieu. Nhting phu'dng phap cu da lan ltidt lui ve di vang).

8.8.1. D en c h ie u tr u e ba n (epidiascope): cho phep cac thay chieu trtic tiep cac
hinh anh chon loc tti cac trang sach. hay tai lieu len mot man hinh de giai thich
cho sinh vien, song phudng tien nay ngay nay hau nhu khong con sti dung, vi qua
cong kenh va it tac dung.

8.8.2. D en ch ieu q u a d a u (overhead): de sti dung va pho bien hdn, de chieu cac
hinh ve, chu viet hoac tom tat noi dung bai giang v.v... chuan bi san tren giav trong.

8.8.3. M a y c h ie u dieting ba n (slides projector): cting rat pho bien va de sti dung
 OAI CUONG VE GIAI PHAU HOC [^ E 3

cho ly thuyet. thiic tap hay tii hoc ca nhan. Cac phim dUdng ban ve giai phau het
siic phong phu, va de lUu trC( gap boi so vdi cac tranh treo tudng. Co the xay dung
mot thu vien phim dUOng ban giai phau (diapotheque) vdi hang nghin phim, sap
xep mot cach khoa hoc. thanh nhieu bo khac nhau, treo trong mot tu kinh dac
biet, de khi can de chon va de lay. Hoac bao quan trong nhiing hop kin hay nhiing
ngan keo rieng.

8.8.4. M a y c h ie u d iid n g b a n c o lo n g tie n g n o i (diaposon): la mot phUdng phap

“nghe nhin” hien dai hdn, co the gidi thieu mot so bai giang hoac on tap bang
nhiing bo phim dUdng ban chuan bi san theo nhiing nguven tac su pham rat chat
che; chieu theo thu tu bdi mot may chieu tu dong, van hanh dong bo vdi mot may
phat am, thuyet minh giang giai noi dung hinh chieu. Bang cach nay cac nhom
sinh vien co the tii hoc hay on tap bat ky luc nao khong can co mat cua thay, ma
van viia xem hinh chieu viia nghe thuyet minh mot cach chuan nufc.

8.8.5. M a y c h ie u h a n g g h i h in h (video): cung co u'u the dac biet doi vdi giai
phau hoc, vi ghi lai nhung hinh anh thuc mot cach sinh dong. O cac nude co
dieu kien, cac man hinh video du'Oc mac trong cac giang du'dng, cac phong thuc
tap tii hoc va ca hai ben tudng phong phau tich ldn. Co the dung may phat bang
ghi hinh, va ca may viia thu viia phat, chieu trUc tiep hinh anh phau tich. mo xe
mau cua thay cho cac hoc vien diing ngay tai ban phau tich cua minh xem va
lam theo. Vi phong phau tich giai phau khong chi dao tao dai hoc ve giai phau,
ma con cho ca dao tao sau dai hoc ve cac ky thuat phau thuat khac nhau. thuc
tap mo xe tren xac.
8.8 . 6. M ay vi tin h (computer): la mot phudng tien mdi nhat da diidc diia vao ap
dung trong giai phau hoc, sinh vien va can bo nganh Y co the tim thay tren
nhiing dia vi tinh dac biet ca mot thu' vien giai phau hoc thu nho. vdi rat nhieu
chiidng trinh. nhieu hinh anh phong phu. nhieu cach hoc, cach tham khao. va
cach tii kiem tra rat sinh dong va co hieu qua.

0 mot phong thi nghiem giai phau hien dai (nhu d Tours, Phap ma toi co dip
tham quan tii' nam 1994), ngiidi ta da quan tam den hai khu dac biet, ma ta chu'a co:
- Mot khu "san xuat cac hinh anh giai phau" mang ten la icongraphie, vdi
day du cac trang bi may moc hien dai de san xuat cac tranh ve. anh chup. phim
du'dng ban, bang ghi hinh v.v..., phuc vu cho giang day. hoc tap, nghien ciiu khoa
hoc, va cho ca xuat ban, rieng ve giai phau hoc va hinh thai hoc.
- Mot khu mang ten la “Tin hoc, nghe - nhin, tii — hoc" (mformatique, audio -
visuel, auto enseignement) vdi nhieu phong hoc, trang bi khac nhau: vi tinh, video,
diaposon, Xquang, mo hinh v.v... Sinh vien co the den de tii hoc. tu tim hieu theo
you cau, nhu' den mot thit vien chuyen khoa rat phong phii va dav du.
Rieng ve vi tinh co mot phong ldn vdi hang chuc may vi tinh phuc vu cho sinh
ETTll'.l
■HH LriiJ GIAI PHAU NGUOI. TAP I

vien den tu hoc tap giai phau. va mot phong nho vdi may tinh va trami bi hien
dai hdn phuc vu cho viec nghien ciiu khoa hoc. chuan bi hum an v.v... cua cac
nghien ciiu sinh va bac si co lion quan.
Hoan canh nude ta. cho den thdi diem xuat ban cuon sach nay van chua co
dude nhung dieu kien nhu vay. song khong vi the ma ta khong hoc difdc tot mon
giai phau va khong lam dude tot nhung cong trinh nghien ciiu co gia tri. Yi xac
van luon luon Ja cd ban, va su quyet tam cua moi ngUdi lai cang cd ban hdn.
Trong cach hoc giai phau. ngoai phudng phap cd ban la "trifc quan" con nhieu
phudng phap, phudng chain va quan diem khac da dude it nhieu nhac tdi d cac
muc tren, va so rut kinh nghiem them trong qua trinh hoc tap.
Neu biet quan sat suy luan, so sanh, doi chieu,
* tim hieu va khai thac tat ca
nhiing phifdng phap, phudng cham, va quan diem da neu v6i nhiing phiJdng tien
ma hien tai minh co the co, thi hoc giai phau se khong kho, ma con la mot dieu
thu vi.
 OAI C JO N G VE XaO N G . HE X J O N G [jjj

2. DAI
■ Cl/ONG VE XIK3NG. HE
m XlfONG

(Ossa. Systoma skelctalc)

1. D IN H N G H IA - C H l/C N A N G

- Xifdng la nhiing bo phan ran bon trong tao thanh mot bo khung viing chac
nang dd tofin cd the, va lam cho diia cho cac thanh phan khac cua cd the.
- Mot so xifdng co tac dung cho chd va ban ve nhiing cd quan chiia dung ben
trong, nhu:: hop so, ong song, long ngiic, khung chau.
- Xudng lai la cho bam cua cac cd, hoat dong nhu nhiing don bay trong bo may
van dong gom co: xifdng. khdp, cd, va than kinh.
Tom lai xifdng co 3 nhiem vu chu yeu: nang dd. bao ve va van dong.
Ngoai ra xiidng con co nhiing chiic nang khac:
- Tuy xiidng la ndi tao huyet, san sinh ra cac huyet cau.
- Xiidng cung la kho dtf trii chat khoang (calci va phospho...) ma khi can cd the
co the huy dong lay ra.

* Mon hoc nghien cull ve xiidng goi la cot hoc (osfeologia), la phan giai p h iu hoc dau tien
can biet, tru’dc khi di vao cac phan khac cua co the.

2. T H A N H P H A N - S O L l /d N G

Bo xiidng ngiidi gom 206 xifdng, phan ldn la cac xifdng chan (doi xiing), chia lam
hai phan chinh (Hinh 2.1).

2.1. B o xiiofn g t r u e (skeleton axiale)

- Xudng so + xiidng mong va cac xudng nho cua tai 29

- Xudng than minh gom:

+ Col song 26
+ XiiOng siidn va xudng lie 25

2.2. B o x t i d n g t r e o h a y xitcfng c h i (skeleton appendiculare)

- Xuo'ng chi tren 6-1
Xudng chi dudi 62

Cong: 206
32 IliiiJ GIAI PHAU NGUOl. TAP I

3. H iN H T H E N G O A l

3.1. P han loai

Moi xiidng co mot hinh the khac nhau.
tuy theo chiic nang cua no d tting doan
cO the. Difa vao do, xUOng co the chia lam
4 loai chinh:
-X iid n g ddi (os longum): phan ldn d
cac chi (xiidng dtii, canh tay, cang tay.
cang chan) phu hdp vdi nhiing dong tac
van dong rong rai.
- Xiidng ngdn (os breve): gom nhiing
xiidng co tay, co chan v.v... phu hdp vdi
nhiing dong tac han che, nhiing mem deo
khi phoi hdp dong bo.
- Xiidng det (os planum): nhii cac
xiidng 6 vom so, xiidng ba vai, xUdng
chau, thich nghi vdi chiic nang bao ve.
- Xiidng khong deu (hay xiidng bat
dinh) (os irregulare): la nhiing xUOng
hinh the phiic tap, khong xep diidc vao
mot trong so" cac loai tren, nhii xiidng
ham tren, xiidng thai diidng, cac xiidng
d nen so.
- Ngoai ra con loai xiidng viing (ossa
sesamoidea) la nhiing xiidng nho nam
trong gan cd, va thtidng dem vao cac khdp,
de giam do ma sat cua gan, cd, gitip cho
cd hoat dong diidc tot hdn. Vi du xiidng
banh che la mot xiidng vting ldn nhat
cua cd the.

3.2. M o ta m ot xtidng
Moi xiidng dtidc mo ta mot cach
khac nhau, ttiy theo hinh the ngoai ctia
no. Vi du: mot xtidng dai bao gid cting
co mot than va 2 dau.
- Dau xtidng (epiphysis) co mat khdp.
nhting mom, mau, va cac co xtidng la ndi
tiep giap vdi mat khdp hay vdi than xtidng.
Hinh 2.1. Bo xiidng ngirdi (nhin tru'dc)
1. X iidng so: 2. Dot song co; 3. Xifdng don
4. X iidng vai; 5. X iidng Cfc; 6, X iid n g canh tay
7 Dot song that liing; 8. X iidng quay; 9 Xifdng
tru; 10. X iidng chau; 11. Xifdng cung. 12 Cac
xiidng co tay; 13. X iid n g dui; 14. X iid n g banh
che; 15. Xi/dng chay; 16. X ifdng mac. 17 Cac
xUdng co chan.
 OAI CUONG VE XlfClNG. HE X l/O N G (jj|| 33

- Than xUdng (diaphysis) thudng dude mo ta theo cac mat va cac bd.
- Cac dau, cac mat, cac bd xUdng thudng dUdc goi ten theo nhiing nguyen tac
dinh hudng chung cua giai phau hoc, va dude mo ta theo hinh the ngoai va y
nghla chiic nang cua chung.

3.3. Y n gh ia chCfc n a n g cua phat trien hinh the ngoai

Nhiing thay doi ve hinh the tren be mat xifdng deu co ten goi neng. Chung
phat trien do anh hiidng cua chiic nang va sii lien quan vdi cac cO quan d ben canh.
Noi mot cach khac, nhiing cho loi lom, go ghe. u. mom, khuyet, ho. ranh, lo v.v... la
do cd hay day chang bam. gan lifdt qua, mach mau than kinh chav tdi v.v...
Nhiing cho loi lom d cho bam cua gan co hay day chang, thiic chat la de tang
dien tich tiep xuc cho cd bam diidc viing chac hdn. Cd cang khoe thi xiidng cang
phat trien, va loi lom cang ro net. Cho nen xiidng d nam gidi thiidng to va tho, loi
lom ro ret hdn d nu gidi va tre em. Nhiing ngudi lao dong va tap luyen the due the
thao cung co nhung loi lom phat trien hdn ngudi ft lao dong.

4. C A U T A O B E N T R O N G C U A X l /d N G
Co the quan sat bang mat thudng (cau tao dai the) va bang kinh hien vi hay
kinh lup (cau tao vi the).

4.1. Cau tao dai the

Co nhung phan chung va phan rieng eho moi xudng hay moi loai xiidng.

4.1.1. Cau ta o c h u n g c u a xiid n g (Hinh 2.2).

Neu cua bat ky mot xudng nao ra ta cung thay co 2 phan chinh:
-X iid n g dac (substantia compaeta) d ngoai, ran, chac, min, vang nhat.
-X iid n g xop (substantia spongiosa) d trong, do nhieu be xudng bat eheo nhau
chang chit, de hd nhiing hoc nho trong nhu' bot bien.
Ngoai ra, tren mot xiidng tufdi con thay ro:
- 0 ngoai cung, boc ldp xifdng dac con mot ldp mang ngoai xudng hay ngoai
cot mac (periosteum) la mot mang lien ket mong du'di 2mm, chac. dinh chat vao
xifOng. Ldp trong cua cot mac mang nhieu mach mau va than kinh den nuoi
xifdng, va co nhieu te bao tre (cot bao) dong vai tro quan trong trong viec phat
trien xifdng ve chieu ngang.
- O trong cung, ben trong ldp xudng xop la tuy xiidiig (medulla ossiuni). Co hai
loai tuy xudng:
+ Tuy do (medulla ossium rubra) la ndi tao huyet. co d trong cac hoc xiidng
xop (d toan bo cac xifdng cua thai nhi va tre sd sinh. va d n e n g cac phan xudng
xop cua ngudi ldn).
+ Tuy vang (medulla ossium flava) chiia nhieu te bao md, chi co 0 trong cac
ong tuy d than xifo'ng dai ngifdi ldn, ben trong cung ldp xudng xop.
3- GPN-T1
 ijl GIAI P H A U N G U O I. T A P I

Hinh 2.2. Cau true

mot xudng dai dien hinh
1. Sun khdp.
2. Sun dau xudng
3 Xudng xop. Hinh 2.3. Cau true be xlto-' c
4. Xu'dng dac, (cua xu'dng xop): d cac xu'dng c~ ;
thich nghi vdi c h u t nang nang da ’ r
5. Ngoai cot mac.
ludng cd the Cac la be xu'dng chi^ f
6. O (ong) tuy. cac siic nen va sire cang
 DAI C JO N G VE XUONG HE XlfONG |JA 35

4.1.2. D a c d iem c a n ta o r ie n g cu a m oi lo a i xtid n g

- Xtidng da i :
+ O than xudng. ldp xu'dng dac d ngoai lam thanh mot ong xuong day d guia. va
mong dan d 2 dau; lop xUOng xop d trong. nguoc lai, mong d giua va day dan len d 2
dau; trong cung la mot ong tuy dai, chiia day tuy vang.
+ 0 2 dau xiidng, ldp xifdng dac chi con la mot ldp mong bao boc d ngoai. va
ben trong la ca khoi xifdng xop chiia day tuy do.
- Xtidng ngan: cau true cung tifdng tii nhu dau xifdng dai: gom mot khoi
xifdng xop d trong, boc bdi mot vo mong xudng dac d ngoai.
- Xtidng det: hdp bdi hai ban xifdng dac kep d gnia mot ldp xudng xop. Co cho
xifdng mong, hai ban xifdng dac dinh sat vao nhau va khong con ldp xifdng xop ntia.
- O’ cdc xtidng so: ban ngoai (lamina externa) rat chac, ban trong (lamina interma)
gion, va de vd, ldp xifdng xop d giiia (kep giiia 2 ban) mang ten rieng la loi xop (diploe).

4.1.3. Y n g h ia c a n ta o c u a cd c xtidng
Cau tao hinh ong cua xu’dng dac trong than .xuong dai, cimg nhu each sap xep
cac be xifdng trong xuong xop deu co tac dung lam nhe hot trong ludng. giam bdt
so lifdng vat chat can thiet cho cau true xuong, dong thdi lam tang sue chong dd
cua xu'dng doi vdi siie ep, sue keo va sue gay.
Cae be xiidng bao gid cung dude sap xep theo nhiing chieu hudng nhat dinh.
thich nghi vdi chiic nang cua moi xu'dng, nghia la theo chieu nhiing lue ma no phai
ehiu duiig.
Vi du: cac be cua xifdng chav ehiu dung sue nang cua eo the theo chieu doc. khi
xuong tdi xifdng sen va xifdng got da toa theo hai toan: mot hudng xuong dudi va ra
tru'dc. va mot hudng xuong du’di va ra sau. theo 2 diem tua chinh cua ban chan.
Tom lai, kien true cua xiidng phu hdp vdi chiic nang rieng cua no. va phu hdp
vdi nhiing quy luat chung cua kien true xay diing, theo mot nguyen tac chung la:
“Vdi mot trong luo'ng va so lifdng vat chat han che toi thieu. dam bao mot do vung
chac toi da” (Hinh 2.3).

4.2. Cau tao vi the

Xu'dng la mot mo lien ket, trong do cac te bao da bien thanh te bao xudng (cot
bao) sap xep theo nhiing khoang cach deu dan, va trong do co lang dong nhung
chat vo cd, chu yeu la muoi calei (du'di dang phiic hop phosphat calci va hydroxyd
calci) bao boc va che phu kin cac sdi keo.
Ve cd ban, mo xu'dng gom nhiing la mong dude tao nen bdi hon hop nhung
chat vo cd va hu'u cd. Va nhiing vung day hdn difdc tao thanh bdi sii hinh thanh
nhiing la cong them chong chat len nhung la tru'dc.
Khac vdi sun, xiidng co chiia cac mach mau phan bo mot cach deu dan. Trong
qua trinh phat trien, cac mach mau cua xu'dng bi vav quanh bdi cac la xifdng tan
tao. va tao thanh nhung ong xtidng hay ong Havers.
36 0 GIAI PHAU NGUOl. TAP I

Nhiing ong do chav chu yeu theo chieu doc trong mot xUOng dai. va cac la
xifdng dong tam bao quanh tao thanh mot he thong cac ong phan nhanh va noi
tiep vdi nhau, goi la he thong Havers.

5. CAC M A C H M A U C U A X U d N G
Gom 2 loai chinh: mach difdng cot va mach cot mac.

5.1. M ach nuoi xu’dng (mach difdng cot): chui vao xifdng qua lo nuoi (lo dUdng
cot), chay trong mot ong xien chech vao tdi ong tuy. Trong tuy xifdng dong mach
chia thanh 2 nganh ngifdc nhau, chay dqc theo chieu dai cua ong tuy va phan
chia thanh cac nganh nho dan nuoi xifdng. Cac nganh nay chui vao trong cac ong
Havers trong xifdng dac, va noi tiep vdi cac nhanh cua mach cot mac.

5.2. M ach m a n g xu’dng (mach cot mac): d quanh than xifdng va dau xUdng (trif
cac dien khdp) c6 nhieu mach rat nho qua cot mac tdi phan ngoai xifdng, va noi
tiep vdi cac nhanh cua dong mach nuoi xuong chinh tu trong ra.

6. T H A N H P H A N H O A H O C C U A X I/O N O

Thanh phan hoa hoc dam bao cho xuong co mot do chac dac biet vdi 2 tinh
chat: ran v?\ dan hoi. Tinh ran do cac chat vo cd va tinh dan hoi do cac chat him
cO. cu the nhu' sau:
6.1. Xu’dng tu’di (d ngudi ldn):
Chiia 50% mfdc; 15.75°o md: 12. 15°o chat hu'u co: 21,8% chat vo cd.

6.2. X ifdng kho (da lay md va nude):

C6n 2/3 la chat vo cd va 1/3 la chat hiiu cd.

- Chat hifu cd (33.30°o): chu yeu la chat cot giao (osseine), gom cac soi keo va
cac te bao xifo'ng.
- Chat vo cd (66.70°o): chu yeu la cac chat muoi voi.
Phosphat Ca: 51.04%
Carbonat Ca: 11.30%
Fluorur Ci : 2.00%
Phosphat Mg: 1.16%
Carbonat va chlorur Ca: l,2°o
Cac thanh phan hoa hoc cung thay doi theo chiic phan cua moi xudng. thee
tuoi. gidi, che do dinh du'dng va benh tat. Dac biet, mot so vitamin A, D. C, va mot
so benh noi tiet co the anh hudng den kien true va cau tao hoa hoc cua xuong
0 ngudi tre xu'dng it chat vo cd, nhieu chat hu'u cd nen mem deo. 0 ngudi gia.
xu'dng nhieu chat vo cd, it chat hu'u cd nen gion, de gay.
 DAI CUONG VE X JO N G . HE XUONG [jjj 37

7. SlT H i N H T H A N H V A P H A t T R I E N C U A X V O N G

7.1. Cac giai d oan hinh th an h va phat trien

7.1.1. T ron g p h o i th a i
Xiidng phat trien tCf ldp trung bi, va phat trien qua 3 giai doan: mang, sun
va xu'dng.
Tru1 mot so nhii vom so va mot vai xiiOng mat khong qua giai doan sun, va
xiidng siidn co mot phan cho den luc gia van 6 tinh trang sun.
Bo xiidng mang d ngiidi hinh thanh vao cuoi thang thu! nhat cua bao thai.
Den dau thang thii hai thi mang bien thanh sun, va tii cuoi thang thii hai thi
sun bat dau diidc thay the dan bang mo xiidng.

7.1.2. S au k h i d e
Qua trinh hoa xiidng van chiia chain diit, va con tiep tuc cho tdi ldn.
Tii luc mdi de cho den khi het ldn (khoang 25 tuoi) xu'dng ]>hat trien lam 2
giai (loan:
Tu luc mdi de den luc day thi (khoang 13, 11. 15 tuoi o mi. va 16. 17 tuoi d
nam) he xu'dng phat trien manh hdn he cd.
Tii day thi ve sau, he cd phat trien manh hdn he xu’dng.

7.2. Cd ch e hoa xtidng (cot hoa)

7.2.1. Ca c h e c h u n g
Mo xu'dng la mot mo lien ket dac biet (gom co chat can ban, cac te bao co
dinh, cac soi lien ket va cac sdi trun). Chat can ban cua xuong ran dac la do lang
dong muoi calci. Vay qua trinh cot hoa la qua trinh bien doi tu mo lien ket
thiiOng thanh mo ran dac ngam day muoi calci. trong do co 2 cong viec cung tien
hanh song song:
- Kien thiet: do cac te bao tao xiidng (tao cot bao — osteoblaste) tu mot so te
bao trung mo bien thanh; chat cot giao (osseine) xung quanh cac te bao nay phan
ting ket hop vdi cac muoi calci do mau mang tdi. tao nen xiidng.
- Pha huy: do cac te bao xiidng (hiiy cot bao - osteoclaste) tac dong vao xu'dng
nhii cac thuc bao. va cung do cac mach mau xoi vao. lam tieu huv xiidng. tao thanh
nhiing ong Havers, nhiing hoc tuv d xiidng xop va ong tuy 6 than xu'dng dai.

7.2.2. Cdc kien cot hoa

Xiidng phat trien tii mo lien ket cd the phai qua giai doan sun (sun cot hoa,
hay cot hoa gian tiep), hoac trtic tiep tii mang (soi cot hoa hay cot hoa true tiep).
a) Sun cot hoa va sit phat trien cua mot xi/dng ddi: khdi dau la mot mau hinh
bang sun, boc bdi mot mo lien ket. Cot hoa xay ra dong thdi tu' trong sun (cot hoa
trong sun) va tu ngoai mang (cot hoa ngoai sun hay cot hoa cot mac).
- Cot hoa noi sun (ossification enchondrale): tren mot mau hinh sun (phac
E H fin g ia i p h A u N G U O l. T A P I
■ ■ I -La.

hoa cua xtidng tudng lai). nay sinh mot diem cot hoa chinh (6 than xtidng) va cac
diem phu (d dau xuong).
Cot hoa bdi dau 6 ldp sau ctia sun: chat cot giao bao quanh cac te bao tao xudng
dtidc ngam muoi calci tao nen nhting la xtidng dong tam lan dan chat sun. Trong
khi dd chat sun v£n phat trien d be nong va chi ngting khi sun bi xam lan va thay
the hoan toan bdi chat xtidng.
Diem cot hoa d than tien dan den hai dau va con cach cac diem cot hoa d dau
xtidng bdi cac sun dau xtftfng, hay sun tiep. Khi con sun tiep thi xtidng van con
phat trien ve chieu dai; den khi sun tiep dtidc cot hoa hoan toan thi chieu dai xtidng
mdi ngting phat trien (Hinh 2.4).
- Cot hoa chu sjxn (ossification perichondrale) tti cot mac: ldp sau ctia cot mac
luon luon dtidc ngam vdi, lam cho xtidng phat trien theo chieu day.
Ngoai ra cot mac con cd chtic nang quan trong la lam cho xtidng tai sinh khi
xtidng bi gay.
O mot xtidng dai. b than xtidng: cot hoa trong sun va quanh sun cting xay ra
mot luc, lam xtidng phat trien theo chieu dai va chieu day. Ong tuy bat dau dude
tao nen do sti tieu buy ldp sau cua noi sun. lan dan ra 2 dau xtidng va gioi han
btidc tien cua nhting la xtidng tti cot mac lan vao.

Hinh 2.4. Sd do cot hoa va phat trien mot xu'dng dai

Phan trang la sun; cham la xu'dng xop (noi sun); den la xu'dng dac (chu sun).
A. Giai doan sun; B, C. Xuat hien ca xu’dng noi sun lan chu sun va phat trien tang dan, D. Xuat hien
cac trung tam cot hoa dau xu'dng; E, Cot hoa dau xu’dng da dat mtfc phat trien day du, song van con
ngan cach vdi than xu’dng bdi sun dau xu’dng F, Dau xu’dng da dinh lien vdi than xu’dng. O 2 giai doan
cuoi cung ong tuy (cham thua) da xuat hien va lan rong do qua trinh tieu huy xifdng xop.

O hai dau xtidng: cot hoa trong sun quan trong hdn tao nen ca khoi xtidng
xop; cot hoa cot mac chi cho mot ldp rat mong xtidng dac d ngoai.
Mat khdp khong bi cot hoa nen van con mot ldp sun day chting 2 - 3 cm
(sun khdp).
Diem cot hoa than xtidng cach diem cot hoa d dau xtidng bdi mot sun dau
xiAtng hay sun tiep, la thanh tri cuoi cting ctia cot hoa trong sun d than xtidng. va
lam cho xtidng tiep tuc phat trien ve chieu dai.
 DAI Cl/ONG VE XUONG. HE XlfONG []J! 39

b) M ang cot hoa hay sdi cot hoa va stf phat trien cua mot xiidng mcing: vom so
khi bat dau phat trien 6 phoi thai mot thang chi la mot mang. Mang nay co 2 la.
La trong sau nay bien thanh mang nao cting. Con la ngoai. khi phoi thai dtidc 2
thang, thav xuat hien nhung diem cot hoa. Nhting diem nay se dan dan lan toa
rong ra nhu giot dau, tao thanh nhting tam xtidng det 6 so. () nOi ma cac tam
xtidng lan toa gap nhau co mot vien sdi hep noi hai xtidng vdi nhau. tao thanh
nhting khdp khciu hay du’dng khdp (sutura), hoac con mot khoang mang rong
chtia hoa xtidng goi la thop (fontanella). Khi tre sinh ra, co thop tru’dc (bregma),
thop sau (lamda), thop sau ben (asterion) va thop tru’dc ben (pretion) (Hinh 2.5).
Thop trtidc co khi hdn mot nam mdi lap kin het.
Khi thop da lap kin het, so van tiep tuc ldn, cho den khi trtidng thanh.
Qua trinh pha htiy cting tiep dien song song vdi qua trinh xay dting tao thanh
ldp loi xop d gitia (diploe). Pha htiy manh me d mot so xtidng so va mat tao nen
cac xoang va cac hang xtidng.
15

Hinh 2.5. So tre sd sinh. Qua trinh cot hoa lan toa ti/c a c diem trung tam.
de lai nhCrng thop la nhCrng vung lien xu’dng muon.
1. Thop tru’dc; 2. Trung tam cot hoa d u tran; 3. Xu’dng tran; 4. O m^t; 5. Xu’dng ham tren 6. Lo c^m;
7. Xu'dng ham du’di; 8. Thop tru’d c ben; 9. Loi cau (xu'dng ham du’di); 10. Xu'dng thai du'dng. 11 Thop sau
ben; 12. Xu'dng cham; 13. Xu'dng dinh; 14. Trung tam cot hoa d u dinh. 15. Du'dng khdp khau (tran - dinh).

8. S U• T A I T A• O X lT d N G

Khi mot xtidng bi gay thi d dau va gitia hai doan gay se phat trien mot khoi
md lien ket. Md nay phan ldn la do cot mac sinh ra, phan nhd la tti can, cd, mach
mau, tuy xtidng. ong Havers. San it lau do muoi calci dong lai. md lien ket se bien
thanh xtidng (cot hoa trtic tiep) khong qua giai doan sun. Chi trong trtidng hdp
hai doan xtidng khong ghep lai gan nhau mdi cd mo sun. Mo nay khong bao gid
hoa xtidng nen d cho xtidng g^y co mot khdp gia.
40 jg| GIAI PHAU NGlfOl. TAP I

9. H IN H A N H X l /d N G T R E N P H IM X Q U A N G

Mo xtidng ngam muoi calci can quang nen xtidng la bo phan de quan sat bang
chieu hoac chup Xquang nhat. Qua dd cd the:
- Quan sat cac kien true ben trong cua xtiOng ngtidi song: thay ldp xtidng dac
d than xtidng day hdn d dau xtidng; thay be mat than xtidng nhdn hoac go ghe do
cd va day chang bam. thay cac mau, cac mom, tham chi cac ong mach dtidng cot
(htidng ve khdp khuyu d chi tren, chay xa khdp goi 6 chi dtidi).
Nghien ctiu cac diem cot hoa va qua trinh phat trien cua dau va than xtidng,
xac dinh thdi gian cot hoa cac sun tiep va danh gia ltia tuoi cua xtidng (Hinh 2.6).
- Nhan xet cac hien ttidng sinh ly va benh ly cua xtidng: nhting bieu hien gia
coi, loang xtidng (osteoporose), gai xtidng (osteophyte), nhting bien doi teo xtidng,
viem xtiOng, u xtidng, tai tao xtidng va lien xtidng khi gay.

Hinh 2.6. Hinh chup Xquang cac giai doan cot hoa cua xtidng. (Sun ft can quang nen khong nhin
thay Xuong do ngam chat khoang nen can quang vdi nhCrng do dam khac nhau).
O hinh a Khung chau, xu'dng dui va dau goi 6 mot tre 4 thang tuoi cac phan tao nen xuong chau con
duoc noi vdi nhau bdi, nhung sun, nen trong co ve rdi rac (chua lien thanh mot khoi). Dau tren xuong
dui cung van con hoan toan la sun. do do cung khong nhin thay. O dau goi co mot trung tam cot hoa
hinh bau due cho dau dudi xUdng dui va mot trung tam tUdng tu cho dau tren xuong chay Song dau
tren xUdng mac v£n con hoan toan la sun.

O hinh b Dau goi va cling chan cua mot tre 5 tuoi: dau dudi xUdng dui va ca 2 dau xuong chay va
xudng mac da phat trien day du thanh xUdng, song van con ngSn cach vdi than xtidng boi cac sun
dau xudng.
 DAI CI/ONG VE KHCJP HAY LIEN KET XLfONG. HE KHCJP [^j 41

3. OAI CUONG VE KHCJP

■

hay LIEN KET XLTONG. HE KHC5P

(Juncturae. Systema articulare)

1. D IN H N G H lA - X E P L O A I C H U N G

Sii lien ket giufa 2 hay nhieu xiidng tiep xtic vdi nhau goi la khdp (articulatio)
hay lien ket xu’dng (juncturae ossium). Phan giai phau hoc nghien ciiu ve khdp goi
la khdp hoc (arthrologia).
Tuy theo chiic nang cua moi khdp ma sU lien ket co khac nhau, va phan loai
khdp co the chia theo nhieu cach:
- T h eo d o n g ta c, co: khdp bat dong hay lien ket bat dong (synarthrosis),
khdp dong hay lien ket dong (diarthrosis) va khdp ban dong hay lien ket ban
dong (amphiarthrosis). Trong cac khdp dong, tuy theo miic do va pham vi hoat
dong cua khdp, ngudi ta lai chia ra cac khdp mot true, hai true, ba hay nhieu true.
- T h eo c a u ta o cd: khdp sdi hav lien ket dinh sdi (junctura fibrosea), khdp
sun hay lien ket dinh sun (junctura cartilaginea), khdp lien xudng, hay lien ket
dinh xu’dng (junctura ossea; synostosis) va khdp hoat dich hay lien ket dinh bao
hoat dich (junctura synovialis; Articulatio, Diarthrosis).
- T h eo h in h th e: cae dien khdp hay difdng khdp cua cac khdp bat dong cd the
co nhieu kieu hinh khac nhau (khdp rang cua, khdp vay, khdp phang, khdp mao).
Cac dien khdp cua eac khdp dong cung cd nhieu hinh thai khac nhau (khdp phang,
khdp cau, khdp xoan, kho'p true, khdp ban le, khdp yen, khdp ludng loi cau).
Thtic ra cau tao va hinh the khac nhau cung ehi la de thiie hien nhting chiic
nang khac nhau eiia moi khdp: cac khdp dinh bdi mo sdi hoac sun deu khong cii
dong hay cti dong rat it, va cac khdp hoat dich deu cti dong tti do mot cach it
nhieu rong rai. Vay phan loai theo cau tao va hinh the cung da phan anh dtidc
mot phan cd ban ve chiic nang ddng tac. Dtidi day chting ta se trinh bay theo cach
phan loai ctia Thuat ngti giai phau quoc te hien nay: lay cau tao va hinh the lam
cd ban, hdi khac vdi cach trinh bay trong cac tai lieu cti. lav chtic nang lam goc.
* [Ve ten goi cac khdp hay lien ket gitia cac xu’dng, cho den 1985 Danh tir giai phau quoc te,
N.A. 1985 van goi chung tat ca la khdp “articulatio. articulationes”. Song T.A. 1997 lai co xu
hi/dng doi lai, goi chung tat ca la “juncfura, juncturae" vdi nghla rong la lien ket xifdng noi
chung, v& chti "articulatio, articulationes" chi danh rieng cho cac khdp dong hay khdp hoat
dich ma thoi.
Tuy nhien trong Tieng Viet, chti “khdp” da qua quen dung va de goi, nen chung toi van bao
lull chti “khdp cho ca cac khdp dong, lan khdp bat dong. T ri/ mot so lien ket dac biet nhif cac
mang gian cot hay cac day chang noi gitia cac phan xuong d xa nhau: goi la “lien ket day
chang" cd ve phu hdp hon la “khdp day chang”].
e a i> X GIAI P H A U N G J O I. T A P I

2. CAC K H d P S d i H A Y L I E N K E T D I N H S d i (juncturae iibmsae)

Cac khdp sdi la loai khdp bat dong (synarthrosis) gom 2 loai chinh: khdp khau
va khdp day chang.
2.1. K h d p k h a u (Sutura) con goi la diidng khdp (theo co GS. Do Xucin Hdpj: la
loai lion ket sdi dien hinh giiia cac xUdng det d vom so, dinh chat vdi nhau mot
cach bat dong bdi mot ldp mo sOi noi giiia 2 bd xUdng vdi nhau va lien tiep vdi ldp
cot mac cua be mat cac xudng (Hinh 3.1b; 3.2a). Phat trien tii nhiing diem cot hoa
khac nhau cua xifdng mang, cac xu'dng nay tiep giap vdi nhau bdi nhiing bd co
hinh the khac nhau: khdp khau rang cUa (sutura serrata), khdp khau v£ty (sutura
squamosa), khdp khau phang (sutura plana).

Hinh 3.1. Cac loai khdp sdi

a. Khdp dinh sdi hay khdp day chang (syndesm osis) chay - mac,
b, Khdp khau (suture) d so; c. Khdp coc (gom phosis) cua rang,

Nhiing vung khdp ma xu'dng chiia lap kin han do xifdng mang chifa cot hoa het 0
tre mdi de goi la thop (fontanella). Binh thifdng thop se lap kin vao thang thd 18.
Su dinh lien cua cac xifdng qua dUdng khdp khau khi sdi da bien thanh xudng
goi la khdp dinh xiMng hay khdp lien xUctng (synostosis), bat dau d mat trong cua
so vao tuoi 20, va tien trien trong suot cuoc ddi. Song khong phai tat ca moi
difdng khdp khau deu difdc lap kin cho tdi gia.

2.2. Khdp d ay c h a n g (syndesmosis) hay lie n ket day chang: la dang lien ket
ma 2 xifdng d canh nhau hay xa nhau dUdc noi vdi nhau bdi mot mo xd trung
gian, tad thanh day chang (ligamenta) (Hinh 3.1a; 3.2b) hoac m ang lien cot
(membrana interossea). Vi du: khdp chay mac dudi. do day chang cot chat 2 xuong
vdi nhau; hay cac bd song song cua cac xifdng quay - tru va chav - mac dude ndi
vdi nhau bdi cac mang lien cot. Mo xd thudng nhieu hdn mo keo nen co the cu
dong dude chut it.
 OAI CUONG VE KHOP HAY LIEN KET XUONG. HE KHCJP |gj 43

’ [Su- giong nhau cua khdp khau va khdp day chang la cung thuoc loai khdp sdi hay lien ket
dinh sdi; sir khac nhau la sdi dinh cua khdp khau ngSn, lien tiep vdi cot m ac. g ^n lien vdi
cau tao m ang cua xUdng, cdn sdi dinh cua khdp day ch ^n g la cac sdi dai rong hdn. tao
thanh day cha ng hay m ang lien cot d ngoai xu’dng],

2.3. Mot kieu thii ba cua khdp sdi la kh dp d in h hav kh dp coc (gomphosis), nhif
mot cai coc cam vao mot lo, va difdc giti chat bdi mo lien ket giiia coc va thanh lo.
Vi du: khdp giiia chan rang va huyet rang (Hinh 3.1c).

Hinh 3.2. So do cau tao cac khdp soi (Juncturae fibrosae) (xem them Hinh 3.1c).
1. Ngoai cot mac; 2. Xuong; 3. Sdi dinh d khdp khau, 4. Day chang gian cot d khdp dinh day chang.

3. CAC KHOiP S U N H A Y L IE N K E T D IN H S U N (juncturae cartilagineae)

Cac khdp nav cung gom 2 loai: khdp dinh sun va khdp dinh sun sdi.

3.1. Cac khdp d in h sun hay khdp sun tron g (Synchondrosis): la mot giai
doan sun trung gian keo dai, sau nay se diidc cot hoa thanh xiidng lien.
Dien hinh la trong qua trinh cot hoa noi sun cua mot xifdng dai co mot sun
dau xiidng (cartilago epiphysialis) hay sun tiep giiia than xifdng va dau xifdng,
dam bao cho xifdng tiep tuc phat trien ve chieu dai (Hinh 2.4; 2.6). Den khi
trifdng thanh thi sun se bien thanh xifdng, do phat trien cot hoa tOf phia than
xifdng; va dau xifdng se lien vdi than xiidng (Hinh 2.4).
Phan ldn cac khdp dinh sun se bien mat khi bo xiidng da trifdng thanh, chi con
lai mot so' rat it d nen so va d xifdng lie.

Hinh 3.3. So do cau tao cac khdp soi (Juncturae fibrosae)

A. Khdp sun trong (synchondrosis); B. Khdp sun sdi (symphysis)
1 Ngoai cot mac; 2. Xuong; 3. Sun; 4. Ola (sun sdi); 5. Sun khdp.

Cac khdp dinh sun dien hinh deu bat dong (Hinh 3.3A). Khdp dinh sun can —
lie (synchondrosis manubrio—sternalis) giiia can va than xiidng lie la mot ngoai le,
E JS i GIAI PHAU NGL/Ol. TAP I

song thiic te khdp nay da trd thanh mot khdp dinh sun sdi (symphysis) bdi vi
phan ldn sun trong ban dau da bien thanh sun sdi.

3.2. Cac khdp d in h sun sdi hay khdp sun sort cung co the goi tat la khdp
d in h ” (symphysis): la nhQng khdp ma cac mat khdp cua 2 xUdng co phu sun trong
va diidc ndi vdi nhau bdi mo xd hdac sun sdi. Nhiing m6 n6i nay lam thanh nhiing
ldp dem co the nen ep hoac di dong, do do lam cho xiidng cung phan nao cii dong.
Cac dtia gian dot song (discus intervertebralis): la mot vi du ve nhiing mo noi
do, va cho mot hieu qua toan bo la sii mem deo cua cot song. O trung tam cua moi
dia gian dot song co mot “nhan mem'' hay "nhan keo (nucleus pulposus) (co ngiidi
dich la nhan tuy) la mot khoi niia long, mem deo va chac, khong nen ep diidc. lam
tang them siic dan hoi cua dia va cua cot song.
Khdp dinh mu cung la mot vi du khac tudng trung cho khdp sun soi
* [Chu thich ve TNG P "Nucleus pulposus'' trUdc day da dUdc dich it nhieu khac nhau la nhan
keo", "nhan tuy", hay "nhan thit" Vi theo DTGP Phap cu. “noyau gelatineux" la nhan keo pulpa
dentis" la tuy rang. Xet ve goc tir. chu "pulpa" tieng Latin lai co nghla la "phan thit mem cua mot
trai cay". Pulposus (Latin), pulpy (Anh). hay pulpeux (Phap) co nghla la 'm em nhao nhu phan
thit cua mot trai cay". Vay "nucleus pulposus ' dich la “nhan mem" (theo dung nghia cua tu goc).
hay “nhan keo" (theo ban chat cau tao sun sdi cua no) la de hieu hdn ca]

4. CAC KHCiP H O A T D IC H (juncturae syn o v ia le s; a rticu la tio n e s)

* [Thuat ngu" Giai phau quoc te T .A .1997 goi la “Junctura synovialis" hay “A rtic u la tio ' (so it),
vay “A rticulatio; D iarthrosis" duoc coi nhu dong nghia vdi “khdp hoat dich" hay "khdp dong’ ].

4.1. D inh nghla

Khdp hoat dich la loai khdp cu dong tu do co mot o khdp (cavitas articularis)
chiia mot chat hoat dich (synovia) lam trdn khdp.

4.2. Cau tao

4.2.1. M at kh d p cua cac dau xifdng difdc hoc mot ldp sun trong goi la sun khdp
(cartilago articularis), con goi la sun boc. Cac mat khdp co hinh the khac nhau.
tuv thu6c chiic nang cua mdi khdp. Sdng trdng mot khdp hai mat thudng co hinh
the doi lap vdi nhau: mot loi. mot lom. Khi mat lom qua be hoac chiia du sau. co
the co them mot vong mo sdi hdac sun sdi vien quanh, goi la sun vien hav vien
khdp (labrum articularis), hoac chem vao giua hai xifdng goi la sun chem hay
chem khdp (meniscus articularis), lam cho hom khdp rong them hoac sau them.
Khi hai mat khdp khong phu hdp vdi nhau hdac cung loi, thi co mot dia sun
S01- 89' la & a hay dia khdp (discus articularis) dem d giiia. lam chd 2 mat khdp
trd thanh phii hdp vdi dia. (Sun vien c6 dinh. con sun chem va dia khdp it nhieu
di dong, theo dong tac cua khdp).

4.2.2. C dc p h itd n g tie n n o i k h d p giii cho 2 dau xiidng ap chat vao nhau gom co
bao khdp va cac day chang.
 OAI CUONG VE KHOP HAY LIEN KET XUONG. HE KHOP 45

a) Bao khdp (capsula articularis): Theo Thuat ngu Giai phau quoc te (N.A.
1985 va T.A. 1997) cung nhu cac tac gia Anh. My, thi bao khdp clUdc coi nhu cau
tao dac trUng cua khdp hoat dich, tao thanh o khdp, g6m c6 2 ldp (Hinh 3.4).
— Ldp ngoai goi la m ang xd hay ldp xd cua bao khdp (mem brana fibrosa,
stratum fibrosum), la mot bao xd bao quanh khdp va ndi hai dau xUdng vdi nhau.
Ldp xd bam vad xung quanh moi dau xUOng 6 it nhieu cach xa mep sun khdp.
- Ldp trdng gqi la m ang hoat dich hay ldp hoat dich (membrana syndvialis,
stratum synoviale) la mot ldp thanh mac lot mat trong ldp xd cua bad khdp, chd
tdi chd bam cua ldp nay vad mdi dau xu’dng thi lat len phu tiep mot phan cdt mac
bao quanh dau xiidng, de bam vao tan sat mep sun khdp. Mang hoat djch tao
thanh mot tui kin bao quanh o khdp, trif d chd cd sun khdp che phu, va la ndi san
xuat va chiia diing chat hoat dich lam trdn va nudi sun khdp.

Hinh 3.4. So do cau tao mot khdp hoat dich (junctura synovialis; articulatio).
1. Mang xd bao khdp; 2. Mang hoat dich bao khdp; 3. Sun khdp; 4. O khdp; 5. Xudng; 6. Ngoai cdt mac.

Song theo cac sach giao khoa giai ph^u cu cua Viet Nam va Phap, thi 2 ldp
viia neu da diidc mo ta nhii hai thanh phan tach biet cua khdp, khac nhau ve cau
tao chiic nang, va chd bam:
- Ldp xd cua bao khdp diidc goi la bao khdp (capsule articulaire) va dUdc mo
td nhU mot phiidng tien giuE khdp, difdc tang ciidng bdi cac day chang.
- Con 16p hoat dich diidc goi la bao hoat dich (synoviale) la phiidng tien san
xuat va chiia diing hoat dich.
46 J>1
Ui) GIAI PHAU NGUCJl. TAP I

’ [Vay de thong nhat vdi D TG P Q T trong cac phan m o ta cu the tiep theo chung toi van
quan mem bao khop la bao chung gom 2 phan bao xo la ldp xa hay m ang xo cua bao
khdp. va bao hoat dich la lap hoat dich hay m ang hoat dich cua bao khop]

b) Cdc day chang (ligamenta): la nhQng phUdng tien tang cUdng cho bao xd hay
ldp x d cua bao khdp, de han che nhufng cQ dong khong dung hudng. Thudng la nhQng
day chcing bao khdp (ligamenta capsularia) do ban than ldp xd cua bao khdp day
len tao thanh. Song cung ro nhQng day chang rieng: ngoai bao khdp (ligamenta
extracapsularia), hoac hiem khi day chang trong bao khdp (ligamenta intracapsularia).
Doi khi mot so cd vUdt qua khdp cung c6 the dong vai tro tang cUdng giQ khdp. nhu
mot dav chang chu dong (Hinh 3.5).

H inh 3.5. K h d p Uc - don, m ot dai dien cua kh d p h o a t d ich

Trong trudng hop nay co mot dia khdp chia o khdp lam hai phan va co mot day chang phu kha chac 1
Bao khdp; 2. Dia khdp. 3. Sun khdp, 4. O khdp, 5. Day chang phu (day chang sUdn don).

4.3. X ep loai khdp hoat dich

Tuy theo so lu'ong cac xuong tham gia vao khdp la hai hoac nhieu hdn ma
khdp duoc goi la khdp dtfn (articulatio simplex) hay khdp kep (articulatio composita.
complexa).
Ngoai ra xep loai khdp co the chia theo 2 cach:
- Theo dong tac cua khop: khdp mot true, khdp hai true, khdp ba hay nhieu
true. Song true cung dude phan anh d U d c tinh nang phQc tap cua mdi khdp. Moi
loai true lai cd nhieu hinh the, chuc nang khac nhau. ChQc nang luon di doi vdi
hinh the, nen tot nhat van la xep loai.

- Theo hinh the cua mat khdp: hinh the vo cung bien ddi, da dang, nen thuc
ra khong cd cach xep loai nao la that day du. Danh phap giai phau mdi nhat gan
day thu gdn lai trong 7 loai chinh: khdp phang, khdp cau, khdp soan, khdp ban le.
khdp ludng loi cau, khdp true, khdp yen. Xep nhu vay cung chi la tUdng doi vi khi
nghien cuu tat ca cac khdp cua cd the, cd the se cd nhieu khdp phu hdp vdi mot
trong cac loai tren, song cung cd the cd mot vai khdp khong that phu hdp vdi mot
loai nao trong dd.
 D A I Cl/ONG VE KHOP HAY LIEN KET XlfONG. HE KHOP jjjj 47

4.3.1. Khdp ph d n g (articulatio plana) tieng Anh la "plane joint": giua hai mat
khdp gan phang hoac cong rat nhe, chi cho phep trUdt mot each han che. Vi du:
giua cac mom khdp cua cac dot song, giiia cac xudng co tay, co tay - ban tay. va
gian dot ban tay, cung nhu cac kh6p tUOng tu d ban chan.

Hinh 3.6. Cac loai khdp hoat dich chinh (xep theo hinh the)
a Khdp phang (giua 2 xu'dng co tay): b.c. Khdp cau (khdp vai - canh tay va khdp chau dui). e Khdp
soan (khdp quay co tay); d. Khdp loi cau (khdp dot ban tay ngon tay); f. Khdp true (giCra 2 dot song
co’ C1 - C2); g. Khdp yen (giua xu'dng thang va xu’dng dot ban tay I); h. Khdp ban le (giCra xi/dng
canh tay va xu’dng tru).

4.3.2. Khdp cau hay khdp o (articulatio spheroidea, cotyhca, enarthrosis), (tieng
Anh la ball and socket joint, spheroidal joint, cotyloid joint): tu Viet cu goi la
khdp chom: la khdp co mot dau tron lap vao mot o hay horn khdp: (Chu cotyhca
hay cotyloid co nghla la hom hay o, dUdc dung thay chd spheroid co nghia la cau.
de chi mot khdp “cau lap o” hay “cau lap hom” . De thong nhat vdi TNGPQT.
chung tdi xin dich la "khdp cau” ma khong goi la "khdp chom '. (vi chu “caput” da
dich la chom).
48 jj>J] GIAI PHAU NGlfOI. TAP I

Khdp cau cho phep nhung dong tac tU do rong rai nhat, theo moi hUdng. vay
la khdp nhieu true. Vi du: khdp canh tay (hay khdp vai), khdp chau dui (hay khdp
hong) (Hinh 3.7).

H inh 3.7. K h d p chau dui (khdp hong) mot khdp cau dien hinh
1. Xu'dng chau 2 Day chang chau dui, 3 Sun vien o coi 4 Cac be xu'dng cua xu'drg dui
5 Dai vong (zona orbicularis) 6 Bao khdp 7 Day chang tron 8. Sun khdp 9 O khdp

4.3.3. K hdp ellip , hay khdp loi ca u (articulatio ellipsoidea, condylaris. tieng
Anh la condylar joint, ellipsoid joint): la khdp cu dong theo hai hudng hay hai
true thang goc vdi nhau. Mat khdp hinh trai xoan hay bau due, ellip. co 2 dudng
cong, 1 dai, 1 ngan (Hinh 3.6).
Vi du: Khdp co tay (giua dau dudi cac xudng quay + tru va khoi xudng co tay).
chi co the gap - duoi va khep - giang ma khong xoay dude, do 2 chieu khong deu
nhau cua mat khdp hinh xoan: song van co the quay vong la dong tac phoi hop
gap, giang, duoi, khep.
Cac khdp ban tay. ngon lay hoac ban chan ngon chan cung la nhung khdp loi
cau hai true.

* [Mot so tac gia nhu Hollinshead. 1969. da tach rieng thanh hai loai: khdp loi cau va khop ellip
- Khdp loi cau la m ot bien the cua khdp cau. co mot hom khdp ndng hinh bau due va mot
loi khong tren han ma hoi rong sang hai ben xoay va khep - giang bi han che con cac
dong tac khac tu on g tu1n h u khdp cau
- K hdp ellip: ca hai m at loi va lom deu hinh ellip, co the gap duoi. khep - giang nhung
khong xoay.
Song theo N.A. 1985, “a rticula tio condylaris" (khdp loi cau) d uoc coi n h u dong nghia vdi
“articu latio ellip so id e a " (khdp ellip). Nay T A 1997 da bo han tu “co n d yla ris". de chi dung
thong nhat 1 tu1 “articu la tio e llip soidea ". ta co the dich la khdp ellip. hay hinh tu ong hca la
khop soan].
 DAI CUONG VE KHOP HAY LIEN KET XUONG. HE KHOP K ig E I

1.3.4. Khdp litdn.fi loi cau (articulatio bicondylaris, tieng Anh la "bicondylar
joint): la loai khdp co hai mat khdp deu loi hay co phan loi (nhu khdp thai du'Ong -
ham), non phai co mot dia khdp lom dem d giua. Khdp cu dong theo true ngang la
chinh (dong md mieng), song cung co the xoav nhe theo true doc, nhd dia khdp
dem d giiia (dUa ham sang hai ben).

4.3.5. Khdp hdn le (ginglymus, tieng Anh la ‘‘hinge joint): tu Viet cu goi la khdp
rong roc, vi cd mot dien khdp loi hinh rong roc, song cung co the phuc tap hon.
nen tii quoc te goi la ban le. Cac mat khdp sap xep phu hop vOi cii dong theo mot
true, giong nhu ban le cua mot canh cUa: va true dd nam ngang (thang goc vdi
true xUOng): khdp chi cd the gap va duoi. Vi du: khdp khuyu. khdp goi, khdp giua
cac dot ngon tay.

4.3.6. Khdp true (articulatio trochoidea), tieng Anh la “pivot joint” : td Viet cu goi
la khdp tru, tu Latin: trochoidea lai cd nghia la vong (nen cung cd the dich la khdp
vong (quanh true): gom mot mat khdp loi hinh tru tao thanh mot cai true, nam ap
vao mot mat khdp lom bao quanh bdi mot day chang tao thanh mot vong kin, nhu
mot true banh xe quay trong mot vong. Khdp chi cd mot dong tac xoay quanh mot
true doc. Vi du: Khdp quay tru tren va khdp gitia hai dot song cd I va II.

* [Theo T N G P Q T T.A.1997 ca hai loai khdp true (articulatio trochoidea) va khdp ban le (gynglinus)
da di/dc xep chung thanh mot loai khdp tru (articulatio cylindrica)].

4.3.7. Khdp yen (articulatio sellaris, tieng Anh la “saddle joint”): moi mat khdp
deu cd hai chieu cong, lom theo mot chieu va loi theo chieu kia. Hai mat khdp vdi
nhau nhu mot ngiidi ngoi tren yen ngiia. Khdp cd the gap - duoi va giang - khep
han che hdn ldai khdp cau, va dac biet xoay rat han che. Vi du: khdp co tay - dot
ban tay thti I cua ngon cai.
50 jgj GIAI PHAU NGUOI. TAP I

4. OAI
■ CUONG VE CO. HE
■ CO

(M u s c u li. S y s te m a m u s c u la r e )

1. CHLfC N A N G V A P H A N L O A I D A I C l /d N G

Van dong la dac tinh cua dong vat, tii cd the don bao cho tdi cd the phQc tap nhat.
Te bao co la nhiing te bao da dUdc biet hoa co tinh nang co rut de dam bao
chQc nang do. Do co rut ma cd van dong dUdc du la van dong va di chuyen theo y
muon, thuoc ddi song dong vat, hay van dong khong theo y muon, van chuyen cac
chat dinh dUdng va bai tiet, thuoc ddi song thuc vat.
Co the phan biet dude 3 loai cd trong cd the:
- C o va n hay cd xu’dng, van dong theo y muon chiem phan ldn nhat cua mo cd
trong cd the. Cac te bao cd la nhiing sdi hinh tru rat dai, co nhieu nhan. va co
nhung van ngang dac trUng, co the nhin thay dUOc dudi kinh hien vi. Cd van co
kha nang co rut nhanh, manh, nhUng trong mot thdi gian han che nhat dinh.
- Cd trd n hay cd van dong khong theo y m uon: tao nen ldp cd cua thanh cac
tang rong va cac mach mau. Cac te bao cd keo dai thanh hinh thoi, va moi te bao
chi co mot nhan ddn (khong co khia van ngang). Cac cd do co cham va yeu hdn cac
cd van, nhiing co the duy tri sQ co lau hOn.
- Cd tim : cung la cd van dong khong theo y muon, song te bao cd lai co nhQng
khia van ngang va thuoc loai hdp bao (syncitium). Cac th6 phan nhanh noi tiep
vdi nhau, va cac xung dong co lan toa qua do. Ve mat sinh ly hoc ngQdi ta goi hoat
dong cua tim la hoat dong cd sinh (myogenic), nghia la mot hoat dong co tQ dong,
phat sinh tQ trong cd, theo mot nhip co the dQdc bien doi, song khong phai dQdc
khdi dong bdi cac xung dong than kinh (Hinh 4.1).

1 2 3

Hinh 4.1. Ba loai mo cd

1. Co trdn; 2. Cd tim 3. Cd van
 OAI CUONG VE CO. HE CO 0 51

Cd xUdng chiem tdi 40% trong lUdng cd the d ngUdi. Tong so len tdi hdn 500 cd
(co tac gia ke tdi hdn 600 cd ke ca cd trdn va nhiing bo cd nho).

Trong cd co 74% nUdc, 25% cac chat lipid, protid. carbon hvdrat, cac muoi khoang
va chat dan hoi.

2. C A U T A O C U A C O

- Ddn vi mo hoc cua cd la sdi cd. Sdi cd van la mot te bao dai, hinh tru, da
nhan, co chieu day thay doi tti 10 - 40m, chieu dai tuy theo tac gia (co the co sdi dai
tdi 34cm, song da so sdi cd d ngUdi khong qua 10 — 15cm, va nhieu sdi ngan hdn).
Cac sdi xep song song vdi nhau tao thanh tting bo (fasciculi). Trong mot bd cd
the cd mot so sdi chay dai suot chieu doc cua bd. Song cting cd the cd nhieu sdi ngan,
cac dau thon cua sdi no xep chong len cac dau thon cua sdi kia, va dUdc boc chung bdi
md lien ket, lam cho nhieu sdi noi tiep vdi nhau cd the hoat dong nhu mot sdi dai.
- Moi sdi cd cd mot mang boc mong rieng goi la m a n g sdi cd (sarcolemma):
Bao hoc toan sdi cd va quanh nhung dau noi tiep cua sdi no chong len sdi kia
la mot mang ludi mong cac sdi keo chun gian goi la m a n g n o i cd (endomvsium).
Bao boc cac bd sdi co la mot bao mo lion ket day dac hdn goi la m a n g ch u cd
(perimysium) (Hinh 4.2).
2
3

Hinh 4.2. Cau tao cua mot cd. Cac bo sdi cd va cac bao. vach lien ket trong va ngoai cO

1. Mang ngoai co (epimysium); 2. Mang chu co (perimysium); 3 Mang noi co (endomysium);

4. Mach cap huyet
52 jfill
ILSiJ GIAI PHAU NGUOI. TAP I

Jiao hoc toan co la mot bao lien ket day hon ntia goi la mac (fascia). hay m a n g
n g o a i cd (epimysium).
Thuc Le cac bao mo lien ket ta tren la mot he thong lien tiep vdi nhau tu
ngoai vao trong va khi p h iu tich, hoc tach ldp mang ngoai co boc quanh mot cd. ta
co the thay no gtii vao trong long cO nhting vach mo lien ket mong hdn. chinh la
nhung mang chu cd ehia cd thanh nhting bd nhd hdn. Trong mang cd cac mach
mau, than kinh va mang phan chia nhd dan, de cuoi cting trd thanh lien tiep vdi
mang noi cd rat mong bao boc bdi mdi sdi cd.
Mot so cd dUdc cau tao tti dau den cuoi toan b&ng th it. Song da so cac cd cd
mot dau hoac ca hai dau la g a n . Gan dUdc cau tao toan bang sdi keo day dac nhu
cac day chang.

() chd noi tiep gitia cd va gan, cac mang sdi cd (sarcdlema) d dau cac sdi cd hoa
lan vdi cac sdi keo cua gan, cac bd keo cua cac bao noi cd va chu cd (endomysium,
perimysium) trite tiep lien tiep vdi nhting bd ciia gan. Nhif vav khong phai la sif
chuyen tiep true tiep giiia cac soi co va soi gan. ma la sii lien tiep giua md lien ket
cua cd va md lien ket tao thanh gan.
- Cung qua nhting mdi lien quan md lien ket nhii vay ma cd bam vao xudng
va cac phan di dong khac. Cac soi md lion ket day dac cua gan lain tiep vdi cac sdi
cua cot mac va tham nhap vao xu'dng. hoac hoa tron vdi cac soi cua ldp chan bi
ctia da (dermis), cua bao khdp. hoac cua cac cau trtic md lien ket khac.
Trong trudng hdp mot sd cd bam bang thit. chi cd nhting soi md lien ket ngan
gitia mot dien toa rong cua co va chd bam cua no.
Con trong loai cd bam bang gan, dau cd thon dan, va trong nhu lien tiep voi mot
gan trdn trang bong gom nhting sdi keo bd chat lai vdi nhau.

() mot sd cd, gan bam dan mong. dep nhu chiec la goi la c a n (aponeurosis).
Vi gan va can thudng diidc md ta nhu hai dau cua cd, nen phan thit d giua. hay
phan co rut cua cd thudng diidc goi la bung co (venter).

3. D A U B A M C U A CO

Hai dau bam cua cd thudng diidc goi la nguyen liy (origin) va bam tan (insertion).
Thuc ra dd chi la nhting tti tUOng doi. vi moi dau deu cd the di dong dude. Vay
nguyen uy la chd bam it di dong hdn va bam tan la chd bam di dong tii do hdn va
thudng thudng nguyen uy la chd bam d dau gan hdn, va bam tan la chd bam d dau
xa hdn. Sdng nhting dinh nghia dd doi khi lai trd thanh trai ngUdc, vi trong thuc
te. khi ta nang mot vat len thi dau xa cua chi tren la di dong, dau gan la co dinh.
Ngiidc lai, khi ta bam vao mot vat de nang ca than minh len thi dau xa lai la co
dinh va dau gan la di dong (Hinh 4.3).
 DAI CUONG VE CO HE CO 53

H inh 4.3. C ho bam cua co va anh h tfd n g d oi vd i d o n g tac. Vdi cung mot do co cd nao bam
gan khdp hdn thi chuyen dong don bay mot do ldn hdn, song vdi mot luc yeu hdn

' [C ho nen ngay nay T N G P Q T mdi T .A .1997 da khong dung cac tu nguyen uy (origin) va
bam tan (in se rtio n ) theo tieng Anh va tieng Phap cu. va chi dung chung m ot tu1 cho b a m '
(insertio, a tta c h m e n t) de chi moi cho bam cua mot cd bam vao xu'dng, (du la nguyen uy hay
bam tan). Tuy nhien de tien mo ta chung toi van tam theo cach goi cu van quen dung trong
cac sach giao khoa giai phau]

4. DO CO V A L U C CO C U A C O . L IE N Q U A N GILfA K IE N T R U C V A
c h u c n An g c u a cd
4.1. Do co va life co cu a c d
Chieu dai cua cac bo sdi cd va cach sap xep cua chung so vdi true doc (nghia la
true keo) cua co' la nhung nhan to quyet dinh den do dai va siic manh cua sU co
(do co va luc co cua cd).
Mot sdi cd khi co co the rut ngan qua
mi a chieu dai cua no liic thu' gian. Cac bd
cua mot cd, bat ke dude cau tao bdi nhung
sdi dai hay ngan. hoat dong nhu mot sdi cO
thong nhat. Vay do co cua mot cO phu
thuoc vao chieu dai cua phan thit nam
giua cac gan. Mot bo sdi cd khi co lai chi
con 43% chieu dai cua no (Hinh 4.4).
Giiia hai cd cung cd cac bd sdi song
Hinh 4.4. Cac thd cd khi co (b) rut ng£n
song vdi true keo. thi cd nao dai hdn se cd lai 1/3 - 1/2 chieu dai cua chung luc thu
gian (a) va phinh ra mot lUdng tUdng ung.
dai hdn.
54 [> ,(1
liijJ GIAI PHAU NGUOl. TAP I

Mat khac, luc co cua mot sdi cd ty le thuan vdi dUdng kinh cua no. Nen giiia
hai cd cung cd cac sdi song song vdi true keo thi co nao cd dien cat ldn hdn se cd
siic co manh hdn.

4.2. Tac d u n g cu a cac d an g k ien true k h ac nhau

- 0 dang kien true gian ddn, cac cd co cdc sen hay cdc ho sdi song song vdi true
keo thUdng det va mong (vi du nhu cd may), song cung co the tap trung hinh thoi
hoac toa rong hinh la, hinh quat. Nhiing cd dd thUdng cd do co toi da theo chieu
dai cua phan thit nam giiia 2 gan, song lai tUdng doi yeu ve liic co so vdi cac kieu
cd khac (Hinh 4.5).

Hinh 4.5. Cac kieu kien true khac nhau cua cac bo cd va phan phoi than kinh
a va f Cd vdi cac be sdi scng sang b va g Cd hinh quat; c. Cd hinh long vu don
d. Cd hinh long vu kep (2 ben), e Cd hinh thoi (theo Bardeen C.R: Am.J.Anat.6.259 1907)

- 0 dang kien true kieu long vu cdc bd scri bam chech theo mot g oc nhat dinh
vdi true keo, sudt doc chieu dai cua mot gan. Neu cac sdi chi bam vao mpt ben cua
gan, nhu mot niia long vu thi goi la kieu long vu mot ben hay kieu long vu ddn
(unipennate). Neu bam ca hai ben thi goi la kieu long vu hai ben hay long vu kep
 DAI CUCJNG VE CO. HE CO [jJi 55

(bipennate). Neu bam khAp xung quanh gan theo du moi hudng thi goi la kieu
long vu vong trdn (circumpennate). Cd cung cd the co kien true phuc tap hdn. gom
nhieu long vu hdp lai, goi la cd kieu da long vu (multipennate) nhit cd delta (Hinh
4.6 va 4.7).

Hinh 4.6. Sd do g id i th ie u kien tru e va cd che co cua cac cd h in h lo n g vu va hin h tam giac
Cac cd hinh long vu ro rang la nhCrng cd manh hdn

A. Cac kieu cd hinh long vu, 1. Long vu ddn (umpennate) 2. Long vu kep (bipennate). Long vu vong
tron (circumpennate), B. Cd hinh long vu khi thu" gian va luc co. a. Nhin thang b Nhin nghieng.
C. Cd hinh tam giac (luc co va chuyen dong cua xu'dng)

Hinh 4.7 Vi du ve kien true cd kieu long vu

1. Long vu ddn (um pennate) (cd gian cot gan tay); 2. Long vG kep (bipennate) (cd gian cot mu tay),
3. Da I6ng vu (m ultipennate) (cd delta). Nhin tren sd do. co the thay bo giC/a cd delta co 4 vach can
noi cd di xuong tu1 m om cung vai, va 3 vach can noi cd di len tu- xu'dng canh tay. vdi nhung sdi cd
bam chech vao do, nha nhufng long vu kep.

Neu d cae cd c6 cac sdi song song vdi true ked. luc cd ty le thuan vdi dien cat
cua toan cd, thi d kieu 16ng vu, dien cat cua cac bd soi ldn hdn nhieu sd vdi dien
cat cua tdan cd (vi la dien cat thang goc vdi true cua cac bo sdi ma khong phai vdi
56 [jj] GIAI PHAU NGlfOl. TAP I

true toan cd), do do luc co cung khoe hon nhieu so vdi mot cd co sdi song song cung
du'dng kinh.
NgUde lai, ve do eo thi cac bd sdi tac dong chech theo true keo cua cd lai cd
hieu qua di chuyen gan kem hdn so vdi chieu dai cua cd.
Ndi mot cach khac, kien true kieu nay Idi ve siic m an h , song lai thiet ve chieu
dai cua do cd.
n A % a
- Vi chieu ddi cua hung cd lien quan vdi do di chuyen cua xiidng, nen trii met
vai ngoai le, gan khong co khong chiem mot do dai thai qua giiia nguyen uy va
bam tan cua co.
Song sii tiet kiem cua cd the lai la lam sao thay the nhiing yeu to c o bdi nhrfng
yeu to sdi, d nhiing cho ma nhiing yeu to co khong cdn thiet cho dong tac ddi hdi.
Nguyen tie dd da diidc the hien d mot cd co nhieu dau nguyen uy, vi du nhii d
cd tam dau. Hai dau ngfin cua ed chi’ tac dong khi duoi khuyu. non co chieu dai
cac bo sdi cd bang nhau. phu hop vdi muc hoat dong cua khdp do. con dau dai cua
cd cd mot bung cd dai hdn, vi phai kiem them mot dong tac d vai.
Mot so cd khac lai cd nhieu gan bdm tan. nhu cac cd gap va duoi cac ngon tay.
ngon chan, va nhu vay de tiet kiem duoc cong cua no. Cung cd cd cd / hay nhieu
gan trung gian (nhu cd nhi than hay cd hai bung, cd thang bung).

5. D O N G T A C C U A CO

Tac dung co cua cd len mot khdp thifdng dUdc mo ta bang nhQng tQ thong nhat
cd the ap dung cho toan cd the. va cd lien quan vdi tii the giai phau. Tuy vay.
nhung tQ mo ta cung chi bieu hien difdc phan nao nhung cai phuc tap cua dong
tac. vi no chi thu gon dong tac trong mot binh dien nhat dinh ma thoi.
- Gap (flexion): cd nghia la be gap lai hay gap thanh goc d mot khdp, vi du nhu
gap khuyu, gap dau gdi.
- Dudi (extention): ngu'dc lai, cd nghia la lam thang ra. Trong tii the giai phau.
da phan cac chi deu d tu the duoi: tay, chan va lung deu th in g.
Doi vdi co chan cac tu gap — duoi cd the de bi lan 16n, tuv theo ngiidi ta hieu
theo nghia dan gian thQdng dung, hay theo nghia so sanh vdi ban tay. Vi vay,
chung ta cung can phai co mot quy Udc xac dinh lai cho ro: trong tii the dung
thang, co chan da luon luon 6 vi tri nQa gap. TQ vi tri do neu gap them nQa co
nghia la gap ve phia mu chan (dorsi-flexion). va dudi co nghla la gap ve phia gan
chan (plantar—flexion).
Doi vdi khdp vai, gap cd nghia la dQa canh tay ra trQdc va du6i la dQa canh
tay ra sau.
- Giang (abductidn) va khep (adductidn): co nghla la dQa ra xa va keo lai gan
 OAI C U O N G VE CO. HE CO

true cua cd the. Hai tu nav thudng khong gay nham lan. tru 6 ban tay va ban
chan, thi dong tac dang va khep doi vdi cac ngon cd nghla la dUa ra xa hay keo lai
gan true giua cua ban tay hay ban chan, ma khong phai cua cd the.
- X o a y vao trong (medial rotation) va .roay ra ngoai (lateral rotation): la nhQng
dong tac xoay mat trQdc cua mot chi ve phia mat phang dQng doc giQa cua cd the,
hay ra xa mat phang dd.
Doi vdi ban tay, cang tay va ban chan, thi dong tac xoay lai cd nhung ten goi neng:
— Sap (pronation): cd nghla la quay mat gan ban tay xuong dudi hoac ra sau.
Con ngita (supination) la quay mat gan ban tay len tren hoac ra trQdc.
Cac dong tac tudng tQ doi vdi ban chan d khdp cd chan rat han che. Xoay ban
chan vao trong hay Ion vao (inversion) la xoay mat gan ban chan vao trong. Xoay
ra ngoai, hay Ion ra (reversion) la dong tac ngUdc lai.
Mot dong tac xoay dac biet la dong tac doi chieu (opposition) cua ngon tav cai.
co nghia la xoay ngon cai tren ban Lay de ep chat vdi cac dau ngon lay khac. Dong
lac nhu vay bieu hien o' muc han che hdn nhieu, doi vdi ngon lay ul, cung nhu doi
vdi ngon cai va ngon lit d ban chan.
-- Quay vong (circumduction): la dong tac quay vong trdn, bao gom sU phoi
hdp lan ludt cac dong lac gap, giang, duoi, khep iheo moi ihQ tii nhat dinh.

Ngoai ra con mot so tu md La dong lac khac cung dude su dung tuy theo hoan
canh cu the: dita ra tru’dc (protrusion), keo ra sau (relraclion), nang len (elevation),
ha xuong (depression).

6. T O N G H O P D O N G t A C C U A Cti

Cac dong Lac cua cd the thudng la phUc hdp. Nen muon hieu ro ket qua tudng
Lac giQa cae cd can phan tich ro hdn vai trd cua moi cd hay moi nhdm cd trong cae
loai dong tac khac nhau.
Trong moi tinh huong, deu co mot so cd tac dong nhif nhung cd van dong chu
lu'c (prime movers hay agonists). Vf du: d cang tay. cd duoi cac ngon tay la cd chu
dong hay chu liic de duoi cac ngon tay, cung nhu cd gap cac ngon tay la cO chu luc
de gap cac ngon tay.
Cac cd hiep dong (synergists): la cac cd trd lQc hdac bd sung cho dong tac cua
cac cd van dong chu lQc. Vi du: trong khi cd dudi ngon tay la CO van dong chu life
cua dong tac duoi cac ngon tay, thi viec duoi hoan toan cac dot cuoi lai can co su
ho trd cua mot so cd nhd d ban tay la cac cd gian cdt va cd giun. Cac cd gian cdt
cdn co nhQng tac dung khac va khac nhau doi vdi cac ng6n tay. nhQng d6ng thdi
cung la cac cd hiep d6ng cho viec duoi hoan toan cac ngon tay.
Khi ta duoi cac ngon tay, thi cd du6i ngon tay dong thdi cung c6 xu hudng
58 [5j
'i iiu
GIAI PHAU NGl/CJl. TAP I

duoi ca ban tay. Song co tay cd the giQ bat dong de cho cac ngon duoi dUdc manh
hdn. Va su bat dong dd dude giQ bdi cac cd hoat dong nhu nhiing cd co dinh
(fixators).
Cdc cd doi khang (antagonists) la nhQng cO gav nhiing dong tac ngUdc lai doi
vdi cac cd khac. Vi du: cac cd duoi ngon tay la doi lap vdi cac cd gap ngon tay va
ngUdc lai. Song doi khang cung con mot tac dung rieng la kiem soat han che tii tii
liic co cua cd doi lap nhAm cung cap nhQng mQc do hoat dong chinh xac cua cd.
Vav nhQng dong tac rat tinh vi cua ngon tay tao nen mot phan cd ban cua ky
nang kheo leo khong phai chi do mot loai cd, ma con do ca cac cd doi lap.

7. T E N G O I C A C C d

Cac co trong cd the rat thay doi, theo hinh dang, cau tao, kich thQdc, vi tri, chd
bam. va dong tac. Moi mot tinh chat do. rieng re hoac phoi hdp, deu co the stf dung
de goi ten cac cd.
Nhii vay. cd cd the goi ten theo nhieu cach:
Theo hinh the: cd tam giac, co' vuong. cd trdn. cd tram, cd delta, cd thon. co rang
cua. cd hinh qua le. cd thap.
Theo vi tri: cd thai du'dng. cd tren gai. cd dudi gai, cd chay sau, cd gian cot. cd
gian sifdn.
- Theo chieu hudng cac thd cd: cd thang, cd cheo, cd ngang, cd vong.
Theo chd bam: cd Uc - ddn - chum, cd qua - canh tay.
- Theo sd dau nguyen uy: cd nhi dau. cd tam dau. cd tu' dau.
- Theo cau tao: cd ban gan. cd ban mac. cd hai bung (hay hai than).
- Theo chu'c nang (dong tac): cd gap ngon tay. cd duoi ngon tay, cd nang vai.
- Theo chiic nang va hinh the: cd sap tron. cd sap vuong.
- Theo kich thu'dc va vi tri: cd rong lung, cd dai dau.
- Theo chQc nang va vi tri: co gap nong ngon tay, cd gap sau ngdn tav. cd gap
cd tay tru, cd gap cd tay quay.
- Theo hinh the va kich thiidc: cd tron to. trdn be.
- Theo chu'c nang va kich thudc: cd khep ldn, cd khep be.
Nhii vav khi dec ten mot cO. ngiidi sinh vien da co mot khai niem cd ban ve
mot vai net mo ta dac trung cua cd. Va dieu dd cung tdi thieu hda dUdc dieu can
phai nhd.

8. C A C C A U T IIU C P H U C U A C d

Co hoat dong de dang va khong bi co sat khi co rut la nhd sii ho trd cua cac cd
quan phu thuoc.
 DAI C UO NG VE CO HE CO [jjl; 59

8.1. M a c (fascia): la 16p mo lion ket dUdc sap xep dac biet thanh nhung mang xo
khong chiia nn), trong mot he thong khung xo lien tuc cua cd the, lien quan mat
thiet vdi xudng, cd va cac day chang. Mac bpc c6 the d dUdi da, va cung c6 the hoc
cac cd hay cac nhom cd, ngan cach giiia cac ldp cd hay cac nhom cd. Mac boc
quanh co tac dung glut cho cac doan cd co duoc dung hudng khong bi di chuyen
sang 2 ben, va tao dieu kien cho moi cd co bop rieng re theo chiic nang cua no.
Mac thUdng kho phan biet va kho tach rdi ldp mang ngoai cd (epimysium) khi bae
boc mot cd, song biet hoa kha ro ret d cac ndi khac.
8.2. Ldp mac boc quanh cdc doan khac nhau cua cd t h e thudng goi la m a c sa u
(fascia profunda), (nhu' mac canh tay, mac cang tay, H. 4.8), vi no nam d du'di
ldp md va mo te bao dudi da chiia dung cac mach than kinh nong va dUdc gidi
han bdi mac nong (fascia superficialis). Mac sau hien ro hdn d cac chi va d co,
tao thanh nhiing bao xd hinh tru quan quanh cac phan d6, va bad bdc toan bo
cac cd, mach va than kinh sau cua cac vung do: vf du: mac canh tav, mac cang
tay (Hinh 4.8), mac rong dui, mac cang chan v.v... Quanh nguc va bung co mot
ldp mo lien ket. song khong co mot mac sau thuc su, cac co det khong co mac
bao phu, vi khong co chu'c nang can thiet. O mat cung vav. vi cac cd d mat la cac
cd bam da.

Hinh 4.8. Cac mac sau, cac vach gian cd va cac bao mach than kinh d canh tay (A) va cang tay (B)

A: 1. Xu’dng canh tay; 2. Vach gian cd ngdai; 3. Bad mach than kinh (ong canh tay); 4 Mac canh tay;
5. Vach gian cd trong; B: 6. Mac ciang tay; 7. Vach gian cd. 8, Mang gian cot, 9 Xu'dng quay,
10. Xu’dng tru.

8.3. V a c h gia n cd (septum intermuscularis): la nhiing che cua mac sau. di tu'
mac boc quanh chi tdi bam vao cot mac cua cac xu'dng d trong. ngan cach cac
nhom cd c6 tac dung khac nhau, va phan chia moi doan chi ra khong phai chi
thanh 2 vung dinh khu ldn (regio, regiones) trUdc sau, ma con thanh nhung ngan.
hay o cO nho hdn, co lap ve mat cau true va thong nhat ve mat chiic nang (o cd
gap, o cd duoi) (Hinh 4.8). Cac ngan hay 6 cd do nay diidc TN GPQT T.A. 1997 goi
la “compartimentum , la mot tii giai phau quoc te mdi dude chinh thiic cong nhan.
rm f> .{3 GIAI ph A u N GU Ol . t Ap I
M i f l lia J

dun theo tieng Anh la compartment. Tuy nifi "6 cd' co the trung hdp vdi "vung . hoac
co the Id nhu’ng ngan phan chia nho hdn cua viing).
- Neu trong mot vung (regio) trudc hay sau cua mot doan ehi. cac cd duoc sAp
xep lam nhieu ldp, thi d giiia cac ldp, cau true mac cung tach ra cac la (lamina) lam
thanh nhQng vach ngang ngan cach cac ldp: la nong, la gitia, Id sau (lamina
superficialis, media, profundus).
Caif true mac cung cd nhung cho day len, biet hoa dac biet, va cung vdi xiidng
tao thanh nhiing ong xUdng sdi de cho cac gan cd di qua: cu the la cac bao xd cua
gan va cac mac ham gan.

8.4. Cac bao x d cu a gan (vagina fibrosa tendinis) bao boc cac gan cd 6 cac
ngon tay, ngon chan bam vao hai bd cua cac xUdng dot ngon. lam thanh mot bao
xiidng sdi trong dd gan cd the triidt qua. va khong bi cang loi len khi gap ngon.

8.5. Cac h am gan h ay m ac h am (retinacula): tuf giai phau cu con goi la cdc
day chang vong co tay, co chan, la nhung chd day len cua mac sau. bam vao hai
ben bd xu'dng de giif cho gan khong xa rdi khoi xu'dng khi gap khdp cd tay. co chan
(Hinh 1.9).

8.6. Cac tui h oat dich (bursae synoviales): la nhung tui thanh mac. biet hoa tii
md lion ket, trong cd chiia mot thu nude nhdn nhu’ long trang tiling: la mot
phiidng tien lam trdn. giam bdt su co sat. giup cho cu dong diidc tu do. de dang:
. Tin hoat dich dem d giua nhiing cho ma gan hay cd ap vao va triidt tren mot
. cau true chac, nhii xUOng, sun. day chang, hoac cac gan khac v.v... goi la nhiing
t i i hoat dich du’di gan (b.s.subtendinea). hoac du’di cd (b.s submusculans). Cac
tui du'di gan thudng nam d ngay gan chd bam cua gan vao xUdng. Mot so tui khi d
gan bao khdp cd the thong vdi o khdp.
• Tui hoat dich du’di da (b.s. subcutanea) thudng cd d mat loi cua nhiing khdp
phai ehiu mot su' gap manh. vi da d chd dd phai tru'dt tren chd xiidng loi. Vi du: o
sau khdp khuyu, tru'dc khdp goi va ddi khi d phia mu cac khdp dot ban tay - ngon
tay hay khdp giiia cac dot ngon tay. Tui dudi da cung cd the cd. nhiing khong hang
dinh d nhung chd ma xiidng hoac day chang phai ehiu siic ep va co sat nhieu (do
nghe nghiep). Vf du: d mom ciing vai. d u loi (hay loi cu) xiidng chay, d cac mat ca. d
chd bam cua cae gan got va d dau xiidng dot ban chan I (mat trong).

8.7. B ao h o a t d ich (vagina synoviale): la mot bao hinh ong boc quanh mot gan
khi gan chui qua mac ham hay bao xd cua no. Thiic ra bao hoat dich gom 2 ong
mang long vao nhau: ong trong. hay la tang dinh chat vao gan, lien tiep vdi ong
ngoai hay Id thanh bao xung quanh: giua hai ong la mot khoang kin chiia nude
hoat dich bdi trdn hai mat tiep giap. 6 cho hai la lien tiep vdi nhau doc theo chieu
dai cua mat it ehiu siic ep nhat, la mot ncp mang goi la mac treo gan (mesotendon),
theo dd cd cae mach mau rat nho di vao nuoi gan (Hinh 4.9 va 4.10).
 OAI C l/O N G VE CO. HE CO [>X 61

() nhung cho gan co mUc hoat dong ldn. mac treo gan co the bien mat (nhu d
bao gan cac cd mac dai va ngan); hoac teo di chi’ con lai nhung di tich nhu nhQng
dai sdi lien ket noi mat lung cua gan vdi cac dot xu’dng, goi la cdc ncp ham hay
day chang gan (vincula) (d bao gan cac cd gap ngon tay).
* ["V inculum , v in c u la ’’ tieng Latin cung co nghla la ham, giuf (a frenum . frenulum ); song
“retinacula" da djch la "ham, m ac ham", nen “vincula" chung toi xin dich la "nep ham gan"
hay “day chan g g a n ”].

Hinh 4.9. Cac bao hoat djch va ham gan d co chan

I. Ham du'di gan duoi: 2. Ham tren gan mac, 3. Ham dUdi gan mac; 4 Bao hoat dich gan cd mac dai.
5. Bao hoat dich gan cd mac ngan, 6. Cd dudi ngan cac ngon chan. 7 Cd mac thu" ba. 8 Bao hoat
dich gan cd duoi dai cac ngon chan; 9. Cd dudi dai ngon cai va bao heat dich. 10. Ham tren gan duoi;
I I . Cd chay trUdc va bao hoat dich

Cac bao hoat dich d co tay, co chan, luon dudi cac ham gan, va bao gid cung
dai hdn cac ham gan 1 - 2cm, de cho gan co the tru'ot du chieu dai co rut cua cd.

Hinh 4.10. Sd do mot bao hoat djch gan cd

1. Gan cd. 2 M ach nuoi, 3 Bao hoat djch (a: la thanh. b la tang); 4. Mac treo gan (m esotendon).
 G IA I P h A u N G U O l . T A P I

* [Chu thich ve T N G P : "M ac” (fascia) va "Can" (aponeurosis):

- Chu1 fa s c ia " theo T N G P Q T . danh ti/ giai phau Phap cu van goi la: “a p o n e vro se ". ta dich
la "mac".
- Song TN G PQ T lai co tir “a p o n e u ro s is " danh tii giai phau Phap cu cung goi la "aponevrose".
nen Tir dien Giai phau hoc 4 thU tieng 1983 da djch lan Ion liic la 'can", luc la "mac"
Chung toi de nghi nen thong nhat djch " fa scia " la "m a c ” ; a p o n e u ro sis la "c a n ” Vi can hoi
khac vdi mac ve cau true va chu'c nang. Can gan vdi gan hdn la vdi m ac.
"Can" day hdn "m ac" co the la: m ot che gan toa rong cua 1 cd dai, hay m ot gan m ong toa
rong cua m ot cd rong. (n h if can co nhj dau canh tay, a p o n e u ro sis m .b icip ita lis brachii; can
cd cheo bung, can cd ngang bung...); “C an" cung co the la m ot la sdi m ong va c h ^ c lam
cho bam cho co. n h a can khau cai (aponeurosis palatinu s), can li/di, (a p o n e u ro sis linguae);
hoac la m ot phan day len dac biet cua m ot so m ac dupe tang c i/d n g bdi nhCmg dai spi doc
day chac, che phu va gop phan lam cho bam cho co hay gan cd: n h u can gan tay,
(aponeurosis palmaris); can gan chan, (aponeurosis plantaris), can mong, (aponeurosis glutea)].
 PHAN II

GIAI PH&U CHI TREN

- G ia i p h a u he th o n g ch i tre n
- G ia i p h a u d jn h k h u ch i tre n
 CAC X U O N G CHI TREN [jjj|

GIAI PHAU HEm THONG CHI TREN

5. CAC XUONG CHI TREN

(Ossa membri superioris)

Xudng chi tren bao gom:

—D a i c h i tr e n (cingulum membri
superioris) hay dai ngilc (cingulum
pectorale), con goi la dai vai, gom co 2
xu'dng: xUdng don d tru'dc, xUdng vai d
sau, tiep khdp vdi nhau d phia ngoai
bdi khdp cung vai - don (articulatio
acromioclavicularis). Dau trong cua
xu’dng don tiep khdp vdi bo xUdng true
(skeleton axiale) bdi khdp lie - don
(articulatio sternoclavicularis) la ndi
chi tren dinh vdi than minh (Hinh 5.1).
- P h a n tu d o c h i tren (pars libera
membri superioris) gom co:
+ C) canh tay: 1 xiidng canh tay.

+ C) cang tay: 2 xiidng, xu’dng tru d

trong, xUdng quay d ngoai.

+ 0 co tay: 8 xu'dng nho, xep thanh

2 hang, moi hang 4 xUdng.
o.
+ 0 ban tay: 5 xiidng ban tay, danh
so thii tu tii ngon cai den ngon lit.
+ 0 5 ngon tay: moi ngon co 3
xiidng dot ngon tay, goi ten theo thii
tii: dot gan hay dot I, dot giiia hay dot
II va dot xa hay dot III. Rieng ngon
cai chi co 2 dot (dot gan hay dot I, dot
xa hay dot II).

5- GPN-T1
66 fjD G IA I P H A U NGLfCJl. T A P I

XlTONG VAI
(S c a p u la )

Xiidng vai la mot xiidng det, mong, hinh tam giac up vao phia sau tren cua
long ngiic.

1. D IN H H l/C fN G
Khi mo ta, ta dat:
- Mat co gd noi len (gai vai) ra sau.
- Goc co hom khdp len tren va ra ngoai.

2. M O T A
Xu'dng vai co 2 mat, 3 bd, 3 goc.

2.1. C a c m a t

2.1.1. M a t siidn (facies costahs) hay mat tru’dc (F. anterior): lom thanh mot ho
goi la ho du’di vai (fossa subscapularis). cd cd dudi vai bam (Hinh 5.2).

Hinh 5.2. Xu’dng vai (mat sifdn)

1. Mom cung vai; 2. Cu tren o chao; 3. O chao. 4. Cu dudi o chao; 5. Bd ngoai. 6. Ho dubi v a
7. Goc du’di; 8. Bd trong; 9. Goc tren. 10. Khuyet vai; 11. Mom qua; 12. Dien khdp ddn.
 CAC XUONG CHI TREN fjX
LikJ 67

2.1.2. M at sa u (facies posterior): loi, co mot gd xudng noi len goi la gai vai (spina
scapulae), di tu 1/4 tren cua bd trong, hudng chech len tren ra ngoai, tan cung bdi
mot mom det, hudng ra trUdc goi la mom cung vai (acromion) (Hinh 5.3).
1

Hinh 5.3. Xu’dng vai (mat lung)

1. Mom cung vai; 2. Mom qua. 3. Gai vai, 4. Ho tren gai, 5 Bo trong, 6 Goc dudi 7 Bd ngoai,
8. Ho du’di gai; 9. Cd xu'dng vai.

Gai vai chia mat sau xUdng vai thanh 2 phan: phan tren la ho Iren gai (fossa
supraspinata) cd cd tren gai bam, phan dudi la ho di/di gai (fossa infraspinata) cd
cd du’di gai bam.
Mom cung vai (acromion), d dau ngoai cd mat khdp ddn (facies articularis
claviculans) tiep khdp vdi dau cung vai cua xu'dng don. Co xudng vai hdp vdi mom
cung vai mot goc goi la goc cung vai (angulus acromii).

2.2. C ac b d

2.2.1. B d tr o n g (margo medialis) 1/4 tren chech len tren va ra ngoai. 3/4 dudi
thang va song song vdi cot song; goc guJa phan chech va phan thang la cho bat
dau cua gai vai.
Mep trifdc cua bd trong co cd rang trudc bam. Mep sau bd trong cd cd goc bam
d tren, cd tram bam d dudi.

2.2.2. B d n g o a i (margo lateralis): phia tren day, phia ditdi d mat sau co cac gd
cheo de cd tron be va cd tron to bam.
68 0 G IA I P H A U N G U O I . T A P I

2.2.3. Bd tren (margo superior): mong, sac, phia ngoai co khuyet vai (incisura
scapulae) cho cac mach va than kinh vai tren di qua. Phia ngoai khuyet nho len
mot mom xUdng be gap ra trUdc va ra ngoai goi la mom quci (processus
coracoideus). Dau mom qua co cd nhi dau va cO qua canh tay bam. Mat tren mom
co day chang non va day chang thang bam. Bd trong mom cd ngUc be bam. bd
ngoai cd day chang cung vai qua bam.

2.3. Cac goc

Cd 3 goc.
2.3.1. G oc tren (angulus superior): gan vuong, cd cd nang vai bam.
2.3.2. G oc du di (angulus inferior): hoi trdn, cd cd dudi vai va cd rang trudc bam d
trUdc, cd trdn to va cO liing rong bam d sau.
2.3.3. G oc n g o a i (angulus lateralis): cd mot hdm khdp hinh bau due, tren be, dudi
to, 1dm hinh long chao goi la o chao (cavitas glenoidalis) de tiep khdp vdi chom
xuong canh tay. O chao tiep vdi than xu'dng bdi mot cho that hep goi la co xu'dng
vai (collum scapulae). O tren o chao cd mot loi nhd goi la cu tren 6 chao
(tuberculum supra glenoidale) cd dau dai cd nhi dau canh tay bam. O dudi o chao
cung cd mot loi nhd goi la cu ch/’cti o chao (tuberculum infraglenoidale), cd dau dai
cd tam dau canh tay bam.

X lfO N G D O N
( C la vicu lci)

Xu'dng ddn la mot xu'dng dai nam ngang d phia trUdc tren long ngUc. nhin va
so' thay dUdc. Xudng ddn cong hinh chu S. lom ra sau d trong. lom ra truoc 0
ngoai. dau trong khdp vdi xudng Uc, dau ngoai khdp vdi mom cung xudng vai.

1. D IN H H U d N G

Dat xudng nam ngang:

- Dau del ra ngoai.
- Bd lom cua dau nay ra trudc.
- Mat cd ranh xudng du'di.

2. M O T A

Xudng cd mot than va hai dau.

2.1. T h an xu’dng

Cong hinh chu S. cd hai mat. hai bd.

 C A C XLfONG C H I T R E N 69

- Mat tren: phing d ngoai, loi d trong. nhan d giQa. Phia trong co cd tic - don -
chum bam, phia ngoai co cd delta bam d triidc va cd thang bam d sau (Hinh 5.4).

Hinh 5.4. Xu'dng don (mat tren)

1. Dau cung vai; 2. Ch6 bam cd delta; 3. Dau Crc.

- Mat ditdi: go ghe, doc theo than xiidng co mot ranh de cd diidi don bam goi
la ranh cd ditdi don (sulcus musculi subclavii) (Hinh 5.5).

Hinh 5.5. Xudng don (mat dUdi)

1. Cu n6n; 2. Dien khdp cung vai; 3. Du’dng thang; 4. Ranh cd du'di don; 5. Dien khdp ire;
6. An day chang si/dn don.

- Bd tru'dc: mong va cong lom d ngoai. co cd delta bam; day va cong loi d
trong, co cd nguc to bam.

- Bd sau: loi va go ghe d ngoai, co cd thang bam lom o' trong co cd lie - don -
chum bam.

2.2. D au xiiofng
Co 2 dau: dau lie d trong, dau cung vai d ngoai.
- Dau lie (extremitas sternalis): to, day, co mat khdp i/c (facies articularis sternalis)
de tiep khdp voi xu'dng lie. O phia diidi co an day chang sitdn ddn (impressio ligamenti
costoclavicularis) de day chang siidn don bam.
- Dau cung vai (extremitas acromialis): det, rong. co ?7icit khdp cung vai (facies
articularis acromialis) de tiep khdp vdi mom cung xu'dng vai. 0 phia dudi co cu non
(tuberculum conoideum) de day chang non bam, co ditdng thang (linea trapezoidea)
•» v X x V
de day chang thang bam. O phia tren co u loi hay loi cu day chang qua - don
(tuberositas ligamenti coracoclavicularis) de day chang qua —don bam.
F T lfiH G IA I P H A U N G U O I . T A P I

* [ Chu thich ve T N G P : “ T u b e ro s ita s ” : tir chCr "tuber = u, u; "T u b e ro s u s ’ = day n hung cuc
loi go ghe khong deu: nen chung toi dich la “ u lo i” , (lay chCr tuber la u lam goc tu) Theo
tieng Phap “T u b e ro s ite ” la “T u m e ur en form e de tubercule", co GS D o X uan H op da dich la
"loi cu" vdi y nghla la loi tron, hinh cu. Song thirc te cac loi go ghe d cac xi/o n g khac nhau
kha da dang, nen goi chung la “u lo i” van phu hop han la “loi c u ” ].

3. A P D U N G

Xiidng don khdp vdi xiidng iic d trong, vdi xiidng vai d ngdai, xiidng vai lai
khdp vdi xiidng canh tay non khi nga chong khuyu hoac vai xuong, trong liidng
cua cd the se don vao xiiOng vai va xiiOng ddn, do xiidng ddn it di ddng nen thiidng
hay bi gay.
Neu gay d giQa thi doan ngoai bi cd delta va cd diidi ddn keo xuong, dean trdng
bi cd iic - ddn - chum keo len. Khi gky d ngdai thi it di lech hdn. Song diem yeu
nhat cua xiidng ddn la chd noi 1/3 ngoai vdi 2/3 trong, nen hay bi gay d day.

XlTONG CANH TAY

( H u m eru s)

Xu'dng canh tay la mot xiidng dai, khdp vdi xu'dng vai d tren va khdp vdi hai
xuong cang tay d diidi. Xu'dng cd mot than va hai dau.

1. D I N H H U O N G

Dat xu'dng diing thang; dau trdn len tren, va vao trong. Ranh cua dau nay
ra tru'dc.

2. M O T A

2.1. T h an xufdng
Cd 3 mat va hai bd.

2.1.1. Ccic m a t
- Mat tru’dc trong (facies anterior medialis): phang, nhan, d giQa cd Id nudi
xu'dng de cho mach mau vao xudng. 6 1/3 tren cd mot diidng gd, goi la m ao cu be
(crista tuberculi minoris). Phia dudi nu'a cd cd qua canh tay bam.
— Mat trtfdc ngoai (facies anteridr lateralis): gan giQa cd mot cho loi go ghe
hinh chQ V goi la u loi (lei cu) delta (tuberositas deltoidea) cho cd delta bam; nQa
dudi cd cd canh tay bam (Hinh 5.6 va 5.7).
 CAC X U O N G CHI TREN [g]| 71

* [Xem chu thich ve cach djch chir "tuberositas" o tren: u loi 0 day khong phai hinh cu ma
hinh chCr V nen con goi la V delta].

- Mat sau (facies posterior): co mot ranh xoan chech xuong dUdi va ra ngoai,
goi la ranh than kinh quay (sulcus nervi radialis), co day than kinh quay va dong
mach canh tay sau di qua, nen gay xUOng canh tay 6 khoang giuta xUOng thi than
kinh quay rat de bi ton thUOng.

Hinh 5.6. Xu'dng canh tay (nhin tru'dc) Hinh 5.7. Xudng canh tay (nhin sau)

1. Cu ldn: 2. Ranh gian cu: 3. Mao cu ldn; 4. U loi
(loi cu) delta; 5. Ho quay; 6. Mom tren loi cau
ngoai; 7. Chom nho; 8. Rong roc; 9. Mom tren loi
cau trong; 10. Ho vet; 11. L6 nuoi xu'dng; 12. Mao
cu be; 13. Co p h iu thuat; 14. Cu be; 15. Co giai
p h iu : 16. Chom.
1- Chom; 2. Co p h iu thuat. 3 Bd trong, 4 Mom
tren loi cau trong. 5. Rong roc, 6 Mom tren loi
cau ngoai 7 Ho khuyu. 8 Bd^ ngoai _9 Ranh
than kinh quay; 10. Cu to; 11. Co giai phau.

2.1.2. C d c bd
- Bd trong (margo medialis): d tren md, d dudi mong. sac, lien tiep vdi mom
tren lei cau trdng, gdi la mao tren loi cau trong (crista supracdndylaris medialis),
c6 vach gian cd trong bam.
E 3 i G IA I P H A U N G U d l . T A P I

- Bd ngoai (margo lateralis): cung md d tren, va ro net d dudi, phan dudi lien tiep
vdi mom tren loi cau ngoai, goi la mao tren loi cau ngoai (crista supracondylans
lateralis), cd vach gian c0 ngoai bam.
- Bd trudc b i t dau tQ mao cu ldn d tren, nhung rat md d giQa vi tron lai; va d
dudi bd dUdc keo dai bdi mot gd nho giQa cac ho vet va ho quay.

2.2. D au xifofng
Co 2 dau: dau gan hay dau tren, dau xa hay dau dQdi.

2.2.1. D a u tr e n g o m
- Chom xitdng canh tay (caput humeri): hinh 1/3 khoi cau hudng chech len
tren va vao trong, tiep khdp vdi o chao xQdng vai.
Chom tiep vdi phan con lai cua dau tren bdi mdt chd that hep gdi la cd giai phAu
(collum anatomicum).
- Nhin mat trUdc phia ngoai chom va co giai phau co:
+ Cu he (tuberculum minus) d trong. cho cd dudi vai bam.
+ Cu ldn (tuberculum majus) d ngoai, cho cac gan cd tren gai, dudi gai va tron
be bam.
+ GiQa 2 cu la rcinh gian cu (sulcus intertubercularis) co gan cua dau dai cd
nhi dau canh tay di qua.
- Dau tren noi vdi than xUdng bdi mot cho that hep, ranh gidi khong ro rang
goi la co phau thuat (collum chirurgicum), la mot diem yeu thQdng hay bi gay.
True cua dau tren hdp vdi true cua than xUdng mot goc khoang 130 .
- Ranh gian cu: chay dai tdi mat trudc trong cua than xUdng, va cd hai bd. -
+ 13d trong: la m a o cu be (crista tuberculi m m oris) di tQ cu be tdi mat
tru'dc trong xUdng canh tay, co cd tron to bam. TrUdc do, t r o n g ra n h co cd lung
ron g bam.
+ Bd ngoai: la m ao cu ldn (crista tuberculi majoris) di tQ cu ldn tdi bd trQdc
xifdng canh tay, co cd nguc td bam.

2.2.2. D a u dudi

Det va be ngang sang hai ben, dUdc cau tad chu yeu bdi m6t khdi cac dien
khdp va cac ho, cac mom di kern. Khoi cac dien khdp dQdc gdi la loi cau xiidng
canh tay (condylus humeri) gom co:
- Chom nho xiidng canh tay (capitulum humeri): d phia ngoai, hinh cau, tiep
khdp vdi hdm khdp cua chom xQdng quay.
- R on g roc xiidng canh tay (trdchlea humeri): d phia trong, hinh rong roc. tiep
khdp vdi khuyet rong roc cua dau tren xQdng tru. Phia tren chdm nho. d mat
trudc co mot ho lom nho, goi la ho quay (fossa radialis). Phia tren rong. 6 mat
tru'dc cd h o vet (fossa coronoidea), d mat sau co ho khuyu (fossa olecrani).
 CAC X U O N G CHI TREN [jjj 73

- 0 2 ben loi c&u xUdng canh tay co 2 mom tren loi cau: mom tren loi cau
ngoai (epicondylus lateralis) co cac cd duoi va ngiia cang tay, ban tay bam. Mom
tren loi cau trong (epicondylus medialis) co cac cd gap, sap ban tay va gap cac
ngon tay bam.
GiQa mom tren loi cau trong va mom khuyu cua xUdng tru cd mot ranh cho
than kinh tru di qua goi la ranh than kinh tru (sulcus nervi ulnaris).

XUONG QUAY
(Radius)

XQdng quay la mot trong hai xQdng cua cang tay, nam d phia ngoai c&ng tay.
Khi de ngQa cang tay, hai xUdng nam song song vdi nhau doc theo true cua cang
tay. Khi sap cang tay, xu'dng quay bat cheo phia trUde xUdng tru. Dau tren xUdng
tru cao hdn xQdng quay, nhung dau dUOi xUdng quay lai thap hdn dau dudi xUdng
tru nen khi nga chong ban tay xuong dat, trong lUdng cd the se don vao dau dudi
xQdng quay va lam gay dau nay (Hinh 5.8 va 5.9).

Hinh 5.8. Cac xudng cang tay (nhin trudc)

1. Vanh khdp chom quay; 2. Co xUOng quay; 3. U loi (loi cu) quay; 4. Bd trUdc xUOng quay; 5. Lo nuoi
xudng; 6. Bd trong xudng quay; 7. Mom tram quay; 8. Mom tram tru; 9. Lo nuoi xuong; 10. Bd trudc xifdng
tru; 11. Bd ngoai xi«ng tru; 12. Mom vet; 13. Khuyet rong roc; 14. Mom khuyu.
74 K j G IA I p h A u N G l / O l . T A P I

Hinh 5.9. Cac xtfcfng cang tay (nhin sau)

1 Mom khuyu, 2 Bd tru'dc xudng tru 3, Bd sau xu'dng tru, 4. Bd ngoai xUdng tru 5 Mom
tram tru, 6. Mom tram quay, 7 Bd trong xu'dng quay, 8 Bd sau xu'dng quay.

1. D I N H H l / d N G

Dat xiidng dung thang; dau to xuong dudi. mat co nhieu r anh cua dau nay ra
sau. mom tram ra ngoai.

2. M O T A

Xifdng quay la mot xudng dai, gom co 1 than va hai dau.

2.1. T h an xu’dng
Hinh lang tru tam giac va hdi cong ra phia ngoai. co 3 mat, 3 bd.

2.1.1. C dc m a t
+ Mat trade (facies anterior): phang, rong dan d dudi, d gitia co lo nuoi xUdng.
Phia tren co cd gap dai ngon cai bam. phia dudi co cd sap vuong bam.

+ Mat ngoai (facies lateralis): loi, tron, d tren co cd ngtia bam, d gitia co mot
cho go ghe co cd sap tron bam (Hinh 5.8).
+ M at sau (facies posterior): d tren tron, co cd ngiia bam, d dudi lom thanh
ranh co cd giang dai ngon cai va duoi ngdn ngon cai bam (Hinh 5.9).
 CAC X J O N G CHI TREN iU 75

2.1.2. C dc bd
Co 3 bd.
+ Be) trong hay bd gian cot (margo interosseus): mong, sac, hudng vao trong,
co mang gian cot cang tay bam.
+ Bd tritdc (margo anterior): di tQ u loi (hay loi cu) quay, hudng chech xuong
difdi va ra ngoai, cang xuong difdi cang md dan. Bd nay co CO gap nong cac ngon
tay bam.
+ Bd sau (margo posterior): md, khong co gi dac biet.

2.2. Cac dau xifdng

2.2.1. D a u tr e n
Nho, goi la chom xiidng quay (caput radii), co:
+ Mat tren lom goi la hom khdp (fovea
—4
articularis) tiep khdp vdi chom nhd xu’dng
canh tay.
+ Chu vi hinh vanh khan goi la vanh khdp
(circumferentia articularis), tiep khdp vdi khuyet
quay cua xUdng tru.
+ Co xtfdng quay (collum radii): la cho that
hep d du'di vanh khdp. dai khoang 10 - 12mm.

+ U loi (loi cu) xifttng quay (tuberositas

radii): la chd loi d goc gida cd va than xu'dng
m
quay, loi ve phia trong. cd gan cd nhi dau
canh tay bam.
Goc giua true cua cd va than xudng quay
goi la goc cd than, khoang 1601’, md ra ngoai, va
la mot veu td quan trong de xifdng quay quay Hinh 5.10. Xu’dng quay (nhin phia trong)
1. Mom tram quay; 2 Khuyet tru; 3. Bd
quanh xifdng tru. lam cho cang tay va ban tay
trong; 4. U loi (loi cu) xu’dng quay, 5. Co
cd the sap ngiia difdc. xu'dng quay; 6. Vanh khdp

2.2.2. D a u d u d i
Hinh mot khoi to va det, cd the ta cac mat nhu sau:
+ Mat trong: lom. hinh tam giac, cd dien khdp vdi xu'dng tru. goi la khuyet tru
(incisura ulnaris) cua xifdng quay.
+ Mat ngoai va mat sau co nhieu ranh cho cac gan duoi va dang ludt qua de
xudng ban tay.
+ Mat trudc: cd cd sap vuong bam.
76 |[jj} G IA I P H A U N G l f O l . T A P I

+ Mat du6i: la mat khdp vdi xiidng cd tay (facies articulare carpalis) gom 2 dien
nho: dien kh6p d ngoai hinh tam giac tiep khdp vdi xUdng thuyen. dien khdp d
trong hinh vuong tiep khdp vdi xUdng nguyet.
6 phia ngoai mat diicii, co mot mom xtfdng hiidng xuong dudi va ra ngoai, co
the sd thay dUdc dUdi da goi la mom tram quay (processus stvloideus radii). O
nen mom tram co cO canh tay quay bam. O dinh mom tram co day chang ngoai
cua kh6p co tay bam.

XlTONG TRU
(Ulna)

Xu'dng tru la mot xUdng dai, nam d phia trong cang tay.

1. D I N H H L f d N G
Dat xu'dng dung thang:
- Dau to len tren.
- Mat kh6p cua dau nay ra trUdc.
- Bd sac ra ngoai.

2. M O T A
Xu’dng co 1 than va 2 dau (Hinh 5.11).

2.1. T h an xiidng
Hinh lang tru tam giac co 3 mat. 3 bd.

2.1.1. C dc m a t
+ Mat triidc (facies anterior): lom d tren, co cd gap sau cac ngdn tay bam. phang
d dUdi, co cd sap vudng bam. 0 giUa co lo nuoi xUdng (Hinh 5.8).
+ Mat sau (facies pdsterior) hay sau ngoai (Hinh 5.9, 5.11): d tren ngay diidi
ngoai mom khuyu co mot dien nho, hinh tam giac cho cd khuyu bam: dudi dien
nay co mao cd ngiia (crista musculi supinatoris) chay chech tii mep sau khuyet
quay den bd sau xUdng tru. Dudi khuyet quay; ngoai mao cd ngiia la mot ho hep
cho cd ngiia bam. Diidi nua c6 mot gd thang diing chia mat sau thanh hai phan:
phan trong hep lom co cd duoi co tay tru bam, phan ngoai rong go ghe co 4 cd d
ldp sau cua vung cang tay sau bam (cd giang dai ngon cai, cd duoi ngan ngon cai.
cd duoi dai ngon cai va cd duoi ngon tro).
+ Mat trong (facies medialis): co cd gap sau cac ngon tay bam.
 C AC X lfO N G CHI TR EN 77

2.1.2. C dc bd
+ Bd ngoai hav bd gian cot (margo
interosseus): mong, sac, hudng ra ngoai,
co mang gian cot bam.
+ Bd tru’dc (margo anterior): ro d 1
tren, co cd gap sau cac ngon tay bam,
tron dudi cd cd sap vuong bam.
+ Bd sau (margo posterior): cong
hinh chut S, sd thay rd d ngay dudi da.

2.2. D au xifdng

2.2.1. D a u tr e n
To, gom co:
+ Mom khuyu (olecranon): nho len
cao nhat, mat tru’dc lom thanh khuyet
rong roc (mcisura trochlearis) khdp
vdi rong roc xu'dng canh tay, mat sau
Hinh 5.11. Xudng tru (nhin phia ngoai)
go ghe, cd cd tam dau bam, mat • tren . ... _ ... ,
b 1. Mao co ngifa; 2 Go thang duTig; 3 Vanh
nho ra trUdc, thanh mot "mo mom khuyu' khdp; 4. Bd gian cot (ngoai); 5. Ho cd ngUa.
v i , ’ ’ *- i .-,• .. 6. Khuyet quay; 7. Mom vet; 8 Khuyet rong roc;
lap vao ho khuyu cua dau dUdi xUdng _ ..■> , , , , 1 3
1 J ” 9. Mo mom khuyu.
canh tay khi duoi cang tay.
+ Mom vet (processus coronoideus): nhd ra trudc d dudi mom khuyu, va an
vao ho vet cua xudng canh tay khi gap cang tay. Mat tren mom vet lien tiep vdi
mat trUdc mom khuyu. tao nen khuyet rong roc (mcisura trochlearis), khdp vdi rong
roc xUdng canh tay - Mat dudi mom vet loi gd ghe goi la u loi (hay loi cu) xitcftig tru
(tuberositas ulnae) cd cd canh tay bam.
+ Phia ngoai mom vet lom thanh khuyet quay (mcisura radialis): tiep khdp vdi
vanh khdp cua xudng quay.

2.2.2. D a u d u d i
Trdn va loi goi la chom xiidng tru (caput ulnae), cd:
+ Vanh khdp xu’dng tru (circumferentia articularis ulnae) tiep khdp vdi khuyet
tru cua xu’dng quay.
+ Mom tram tru (processus styloideus ulnae) cua xUdng ti’u: nhd. hinh gan trdn
d phia sau trong cua chom. Sau mom cd mot ranh cho gan cd dudi cd tay tru qua.
Mom tram xitdng tru d cao hdn mom tram xu’dng quay.
+ Mat du’di cua chom lom, tiep khdp vdi xiidng co tay.
78 G IA I P H A U N G U O I . T A P I

CAC Xl/ONG CUA BAN TAY

(O ssa m an us)

Bam tay co 27 xiidng: 8 xiidng co tay (ossa carpi), 5 xifdng ban tay (ossa metacarpi),
1-1 xu'dng ngon tay (ossa digitorum).

1. CAC X l / d N G CO T A Y (ossa carpi)

Gom co 8 xifdng xep lam hai hang: khi gap ban tay vao cang tay, 4 xiidng
hang tren di lien vdi dau dudi cua cac xifdng cang tay, 4 xUdng hang diidi di lien
vdi cac xUdng cua ban tay, va gap vao hang tren.
Moi xUdng co tay deu cd 6 mat: mat trudc (mat gan tay) va mat sau (mat mu
tay) khong co dien khdp. Con 4 mat khac, tiep khdp vdi cac xiidng d tren, d dtfdi
va o hai bon. Rieng cac xuong d ngoai va trong cua moi hang chi co mot mat ben
tiep khdp, con mot mat tu do.

1.1. Bon xifdng h an g ti en

Xep thu tu tu ngoai vao trong (tii ngon cai den ngon ut) la xifdng thuyen.
xuong nguyet, xu'dng thap, xu'dng dau.
1.1.1. XiiOng th u y en (os scaphoideum): tiep khdp d tren vdi xifdng quay, d dudi
vdi xu'dng thang, xudng the. 6 trong vdi xifdng nguyet. Phia ngoai cd cu xudng
thuyen (tuberculum ossis scaphodei) de day chang cua khdp co tay bam. Khi nga
chong tay xuong dat, xUdng thuyen d ria ngoai ban tay bi trong lufdng cua cd the
don xuong nen de bi ton thudng hdn cac xudng khac.
1.1.2. XiiOng n g u y e t (os lunatum): hinh ban nguyet. Tiep khdp vdi xUdng quay d
tren, xUdng ca d difdi, xUdng thuyen d ngoai. xUdng thap d trong.

1.1.3. X iid n g th a p (os triquetrum): hinh thap tam giac, cd 3 mat. Mat tren tiep
khdp vdi xUdng tru, mat ngoai tiep khdi vdi xudng nguyet, mat dudi tiep khdp vdi
xudng moc.

1.1.4. X iidng d a u (os pisiforme): hinh hat dau. nam triidc xiidng thap, cd gan cd gap
co tay tru bam.

1.2. B on xifdng h a n g difdi

Ke tif ngoai vao trong la xUdng thang, xUdng the, xiidng ca, xifdng moc.

1.2.1. X iid n g th a n g (os trapezium): hinh thang, tiep khdp vdi xiidng thuyen d tren
xudng ban tay I d dudi, xUdng the d trong. Mat triidc xiidng thang co cu xiidng
thang (tuberculum ossis trapezii), de ham cac gan gap bam.

1.2.2. X iid n g th e (os trapezoideum): nho hdn, nSm giiia xiidng thang, xtfdng ca. va
khdp vdi xiidng ban tay II d diidi.
 CAC XUO NG CHI TREN /IF IH

1.2.3. XiiOng cd (os capitatum): la xUdng ldn nhat d co tay, nam chinh giua true cua
ban tay, giQa xUdng the va xu'dng moc va tiep khdp d du'di vdi xu’dng ban tay III.

1.2.4. X iid n g m o c (os ham atum ): mat trUdc co mot mom goi la mom moc hay moc
cua xifdng moc (ham ulus ossis hamati).
Nhin chung cac xUdng d co tay tao thanh mot khoi lom d giQa goi la ranh co tay
(sulcus carpi) va nho len d 2 bd:
Bd ngoai la cu xUdng thuyen va cu xUdng thang.
Bd trong la xUdng dau va moc cua xUdng moc.
Noi giQa hai bd co mot mac rong, chac, khoe, goi la ham cdc gan gap (retinaculum
musculorum flexorum) bien ranh co tay thanh ong co tay. de cac gan gap va cac
mach, than kinh tQ vung cang tay trQdc chui qua, di xuong gan tay.

2. CAC X l /d N G b A n T A Y H A Y D O T B A N T A Y fossa metacarpi)

* [Chu thich ve T N G P :
- “C a rp u s ” la t i i Latin m uon tu1tieng Hy Lap "karpos", co nghia la cd fay.
- “ M e ta c a rp u s ” tu" chu" "m eta + karpos" la phan chuyen tiep g iiia co tay va cac ngon tay.
dung ra phai goi la lo n g ban tay cfe khoi lan vdi ca ban tay (la "m anus"). Vay:
- “O ssa m e ta ca rp i hay ossa m etacarpalia" phai dich la cac x u o n g lo n g ban tay mdi that
ro nghia. S ong ta da qua quen goi tat theo co GS Do Xuan H op la cac x u o n g d o t ban
tay ” , vdi y nghia “ban tay" la phan giCfa cd tay va ngon tay. Tuy nhien, goi la "dot ban tay "
lai chi/a that phu hop. Vi ngon tay, m oi ngon cd 2 - 3 dot mdi goi la cac xudng dot ngon tay
(phalanges); con long ban tay. tudng ifng vdi moi ngon tay chi cd m ot xu'dng: nen theo
chung toi kho ng goi la cac xu'dng dot ban tay, ma chi la "cac x u o n g ban ta y” ma thoi]

Co 5 xUdng ban tay, tuong ung vdi 5 ngon tay, goi ten theo thQ tu tu ngoai
vao trong, la cac xu'dng ban tay I, II, III. IV va V. Cac xitdng nay deu thuoc loai
xtfdng dai nen cd mot than va hai dau (Hinh 5.12 va 5.13).

2.1. T h an xifd n g b a n tay (corp u s ossis m eta ca rp i)

Hoi cong lom ra trQdc, hinh lang tru tam giac. c6 3 mat: sau, trong va ngoai:
va 3 bd: trong. ngoai va trQdc.
Cac mat ben: cd cac cd gian cdt bam.

2.2. D au tren h a y d au gan la n e n x ii d n g b a n ta y 'basis ossis m eta ca rp i” .

Co 3 dien khdp:
— Dien khdp tren: tiep khdp vdi xQdng co tay.

- Hai dien khdp ben: tiep khdp vdi cac xQdng lan can. Rieng xQdng ban tay I
khong co dien khdp ben va xQdng ban tay II, V chi co 1 dien khdp ben.
Nen xQdng ban tay I co dien khdp hinh yen ngQa khdp vdi xQdng thang.
80 (HI G IA I P H A U N G U O I . T A P I

Hinh 5.12. Cac xu'dng ban tay (mat gan tay)

1. Xu'dng thuyen; 2. Xu'dng ca; 3. Xu'dng thang; 4. Xu'dng the; 5. Xu'dng ban tay th ii I; 6 Dot xa (dot III)
ngon tay; 7. Dot giCra (dot II); 8. Dot gan (dot I) ngon tay; 9. Xu'dng ban tay th iiV ; 10. Mom moc xu’dng
moc; 11. Xu'dng moc; 12. Xu'dng thap; 13. Xu'dng dau; 14. Xu'dng nguyet.

Nen xifdng ban tay III co mot mom ngan hoi nhon goi la mom tram xiidng ban
tay thii III (processus styloideus ossis metacarpi tertii).
Nen xiidng ban tay V nho len mot cu nho cho cd duoi co tay tru bam.

2.3. D au dufdi h ay d au xa la c h o m xutofng b a n ta y (caput ossis metacarpi),

hinh ban cau tiep khdp vdi dot gan cua ngon tay tUdng ling.

3. CAC X U d N G N G O N T A Y H A Y D O T N G O N T A Y (ossa digitorum; phalanges)

Moi ngon co 3 dot la:

- Dot gan (phalanx proximalis) hay dot I.
- Dot giQa (phalanx media) hay dot II.
- Dot xa (phalanx distalis) hay dot III.
Rieng ngon cai chi co 2 dot: dot I va II.
 CAC XU O N G CHI TREN g]| 81

1. Xu'dng nguyet; 2. Xu'dng dau; 3. Xu'dng thap; 4. Xu'dng moc. 5. Xudng thang; 6. Xtidng the.
7. Xu'dng ca; 8. Xu'dng thuyen.

Moi xiidng dot ngon tay deu co:

+ Than dot (corpus phalangis) cong lom ra trUdc, co hai mat. mat trudc phang,
mat sau loi va hdi tron.
+ Dau gan goi la nen dot (basis phalangis): tiep khdp vdi xUdng ban tay hoac
xUdng dot ngon tay d tren.
+ Dau xa la chom dot (caput phalangis): tiep khdp vdi xiidng dot d dQdi.
Rieng chom cua dot cuoi cung (dot xa) hinh mong ngifa, mat sau nhan, tiep
vdi mong tay. mat triidc go ghe goi la u loi (hay loi cu) dot ngon xa (tuberositas
phalangis distalis).

4 . C A C X l /O N G V U ’N G (ossa sesamoidea)

O ban tay. ngoai cac xQdng ke tren con co cac xiidng vQng, la nhiing xudng
nho, nam trong be day cua cac gan cd hoac d quanh cac khdp ban tay - ngon tay.
khdp giQa cac dot ngon tay, thQdng gap d mat gan tay, co tac dung lam tang them
do vQng chac cua cac khdp va lam tang them sQc manh cho cac gan cd.
8- GPN-T1
m E l G IA I P H A U N G l f b l . T A P I

6. CAC KHOP CHI TREN

(Juncturae membri superioris)*

Chi tren la bo phan van dong linh hoat nhat cua cd the nen hau het cac khdp
deu thuoc loai khdp hoat dich hay khdp dong.
Khdp chi tren gom co:
- Cac khdp thuoc dai ngUc.
- Cac khdp cua chi tren tii do.
* [T.A. 1997 dung chur “juncturae” de chi chung tat ca cac khdp hay lien ket xuong, du lei
dong hay bat dong, co hay khong co bao hoat djch; con Articulationes chi dung rieng cho
cac khdp hoat djch].

CAC KHOP CUA DAI NGUC

(J u n c t u r a e c in g u li p e c t o r a li s )

Cac khdp hay lien ket giiia cac xUdng cua dai ngUc noi chung (juncturae) bao
gom ca cac lien ket day chang (syndesmoses) nhii day chang qua cung vai (lig.
coraco acronnale), cac day chang ngang vai tren va dudi (lig. transversum scapulae
superius & inferius), lan cac khdp hoat dich. Khdp hoat dich gom 2 khdp chinh:
khdp cung vai - ddn va khdp uc - ddn.

1. KHCiP C U N G V A I D O N (articu latio acrom io c la v icu la ris)

La khdp giiia xu'dng vai va xu'dng ddn. cac mat khdp deu phftng.

1.1. C ac m a t k hdp
Gom cd:
- Mat khdp don d mom cung vai.
- Mat khdp cung vai d dau ngoai xUdng don.
Nam giiia hai mat khdp nay co 1 dia khdp (discus articularis).

1.2. Cac phtfdng tie n noi khdp

1.2.1. B a o kh d p (capsula articularis): dude cau tao bdi hai bao. hay 2 ldp co cau
tao va chiic nang khac nhau (Hinh 6.1).
 CAC KHO P CHI TREN fjj]| 83

- Bao xO: bam tu1chu vi mat khdp d dau mom cung xUdng vai den chu vi mat
khdp d dau cung vai xUdng don, noi 2 xifdng vdi nhau.

- Bao hoat dich hay mang hoat dich: lot d trong bao xd, san xuat va chifa nUdc
hoat dich lam giam ma sat giuta cac mat khdp.

1 2 3 4 5 6 7

H inh 6.1. Cac k h d p va day c h ln g cua dai ngUc hay dai ch i tre n (nhin tru'dc)
1. Day chang cung vai - qua; 2. Bao khdp cung vai - don, 3. Day chang thang. 4. Day
chang non; 5. Day chang qua - don; 6. Day chang sudn - don; 7 Day chang \Jc - don

1.2.2. C dc d a y c h a n g : la nhiing phan tang cudng cho bao xd cua khdp, gom co:
- Day chang cung vai —don (ligamentum acromio - claviculare): dinh vao mat
ngoai bao khop, la phan day len cua bao khdp.

- Day chang qua ddn (ligamentum coracoclaviculare). Gom co 2 phan:

+ Day chang thang (ligamentum trapezoideum).

+ Day chang non (ligamentum conoideum).
Lan lUdt di tu mom qua den difOng thang va cu non d mat dudi xifdng don.
Ngoai ra con co:
- Day chang qua - cung vai (ligamentum coraco—acromiale): di tu mom qua
den mom cung vai.

* [Cac day c h ln g qua don va qua cung vai thi/c ra khong tri/c tiep thuoc khdp cung vai don,
ma tao thanh mot loai khdp hay lien ket day ch^ng (syndesm oses) rieng giCra cac xu'dng do
(theo T .A .1997).

1.3. D o n g tac
Khdp cung vai - don thuoc loai khdp phang, chi co dong tac triidt. Bien do
hoat dong kem vi chi nhd vao tinh dan hoi cua sun khdp va cac day chang.
84 [EtJl
lik GIAI ph A u NGJOI. TAP I

2. K H d P tTC D O N (a rticu la tio s te rn o cla v icu la ris)

Lien ket giUa xUdng lie vdi xUdng don.

2.1. Cac m at khdp

Gom co: (Hinh 6.2).
- Mat khdp d dau Qc cua xUdng don: loi hinh yen.
- Mat khdp d khuyet don (mcisura clavicularis) cua xUdng vie; lom hinh yen.
- Dia khdp (discus articularis): dem vao giiia hai mat khdp.

Hinh 6.2. Khdp i/c sudn don va cac day chang

1. Day chang sudn don; 2. Day chang ifc don, 3, Day chang gian don.

2.2. Bao khdp

Gom 2 ldp:
- Bao xo': noi dau ifc xudng don vdi khuyet don cua xu'dng vie.
- Bao hoat dich: lot mat trong bao khdp.

2.3. Cac day ch a n g

Co 4 day:
- Day chang tic - ddn tru’dc (ligamentum sternoclaviculare anterius): dinh vao
mat trudc bao khdp.

- Day chang itc - ddn sau (ligamentum sternoclaviculare posterius): dinh vao
mat sau bac khdp.
- Day chang su’d/I - ddn (ligamentum costoclaviculare): di tii bd tren sun sudn I
tdi bd trudc dau lie xu'dng don.
- Day chang gian ddn (ligamentum interclaviculare): la nhiing thd sdi manh.
noi dau lie cua hai xu'dng don vdi nhau. vu'dt qua bd tren can xifdng lie.
Ngoai cae day chang tren. con co cd dudi don tang ciidng cho khdp.
 CAC KHOP CHI TREN [jj|i 85

2.4. D o n g tac
- Dua xifdng don ra trifdc, ra sau.
- Nang len, ha xuong.
- Quay vong.
Dong tac quay vong la sii ket hdp lien tuc cua cac dong tac tren. Trong dong
tac quay vong, dau cung vai cua xUdng don ve nen mot hinh bau due co chieu cao
khoang 10cm va chieu trudc sau khoang 12cm.

cAc k h 6 p c u a chi t r e n t u do
(J u n c t u r a e m em b ri s u p e r io r is lib e r i)

- Cac lien ket sdi (juncturae fibrosae) cua chi tren tii do gom: lien ket day
chang quay tru (syndesmosis radio ulnaris), tao bdi mang lien cot cang tay (membrana
mterossea antebrachi) va thifng cheo (chorda obliqua).
-- Cac khdp hoat dich (articulationes) cua chi tren tif do bao gom:
+ Khdp canh tay (articulatio humeri) hay khdp vai.
+ Khdp khuyu (articulatio cubitis).
+ Khdp quay - tru gan (art. radio ulnaris distalis).
+ Khdp quay - co tay (articulatio radio carpalis).
+ Cac khdp ban tay (articulationes manus).

1. K H O P C A N H T A Y (articulatio hum eri)

Khdp canh tay con goi la khdp vai hay khdp o chao —canh tay (glenohumeralis),
la mot kho'p hoat dich co dong tac rat linh hoat va rong rai.

1.1. Cac m a t k h d p (facies articularis)

- Chom xitcfng canh tay: tUdng Ung vdi 1/3 khoi cau. hudng len tren va
vao trong.

- O chcio xiidng vai: hinh bau due, lom long chao: cao 3,5cm; rong 2.5cm chi bang
1/3 hoac 1/4 dien tich cua chom cau xifdng canh tay.
- Sun vien o chao (labrum glenoidale): la mot vong sun bam quanh o chao
lam cho long o chao sau them de tang dien tiep khdp vdi chom xifdng canh tay.
Difdi sun vien co mot khuyet d bd trifdc o chao la mot khe hd. thong vdi mot tui
cung hoat dich.
86 III] G IA I P H A U N GlfCfl. T A P I

1.2. Bao khdp (capsula articularis)

- Bao xd mong va rong, 6 tren bam quanh o chao xUdng vai. O diidi bam quanh
d&u tren xUOng canh tay: phia tren bam vao co giai phau, phia dudi bam vao co
phiu thuat cach sun khdp khoang 1cm.
- Bao hoat dich: lot mat trong bao xd, co nhting dac diem sau:
Boc quanh dau dai cd nhi dau nen gan nay d trong bao khdp nhiing lai n&m
ngoai bao hoat dich.
Thong vdi mot so tui thanh mac dQdi cd cua cac bao quanh khdp: gan dai cd
dudi vai, cd nhi dau canh tay va cd delta.
Qua khe hd cua bao xd d gitia cac day chang o chao canh tay tren va gitia lien
quan vdi mat sau cd diidi vai.

1.3. C ac d ay ch a n g
Co 2 day (Hinh 6.3 va 6.4).

Hinh 6.3. Khdp vai (nhin phia tru'dc)

1. Bd tren day chang o’ chao - canh tay; 2. Day chang mom qua - canh tay; 3. Bd giCra day chang o chao -
canh tay; 4. Gan dau dai co nhi dau canh tay, 5. Bd du'di day chang o chao - canh tay; 6. Bao khdp (diem
yeu cua bao xd); K. Khe hd cua bao xd (Id thong cua bao hoat djch vdi tui hoat djch du'di vai).

- Day chang qua —canh tay (ligamentum coracohumerale): d tren bam vao mom
qua xUdng vai; d dudi che lam 2, 1 che bam vao cii be, 1 che bam vao cu ldn xUdng
canh tay. Gitia 2 che co gan dai cd nhi dau canh tay di qua.
- Cdc day chang o chao canh tay (ligament glenohumeralia): la phan day len
d mat triidc tren bao khdp, gom ba day ch&ng:
Day chang tren: di tti cu tren o chao xUdng vai den dau tren cu ldn xUdng
canh tay.
Day chang gitia: di tti cu tren o chao xUdng vai tdi nen cu be xUdng canh tay.
Day chang dudi: di tti vien trQdc o chao xQdng vai tdi co phau thuat xiidng
canh tay.
Ba day chang tren, giQa, dadi tao thanh 3 net cua chti Z, diem yeu giQa day
chang tren va giQa co gan cd dQdi vai tang cQdng.
 C AC K H O P CHI TREN [j|]| 87

Giiia day chang giiia va day chang diidi la diem yeu nhat cua bao khdp: chom
xUdng canh tay thudng trat qua do, loi ra trUdc va vao trong (trat khdp vai kieu
trudc trong).
4

Hinh 6.4. Khdp vai (nhin phia sau)

1. Bao khdp; 2 Cd tron be; 3. Cd du'di gai; 4 Cd tren gai

1.4. D o n g t a c
Khdp canh tay la mot khdp cau, hoat dong rat rong rai theo 3 true:
- Theo true triidc sau: co dong tac khep, giang.
- Theo true ngang: co dong tac dUa ra trudc, ra sau.
- Theo true thang diing: co dong tac xoay vao trong, xoay ra ngoai.
Dong tac xoay vong la ket qua phoi hdp cua cac dong tac neu tren.
Dong tac giang cua rieng khdp canh tay chi han che 6 mUc vuong goc vdi than
minh (giang 90°) vi phia tren khdp cd mom qua va khdp cting vai - ddn an ngO.
Song thuc te ta van dUa tay len cao hdn diidc vi cd sii di chuyen phoi hdp cua
xiidng vai, xiidng don va cua ca cot song nua. Cu the: khi diia mot tay len cao
(qua dau) thi goc dudi xUdng vai ben dd bi keo ra ngoai va cot song se nghieng ve
ben doi dien. Neu ca hai tay cung diia len cao thi cot song doan nguc dudi va doan
that liing bi gap ra triidc.
Khdp canh tay de bi trat hdn cac khdp khac vi bao khdp rong, mong, long leo,
day chang cd nhiing diem yeu va hoat dong cua khdp cd bien do ldn.

2. K H C fP K H U YTJ (a rticu la tio cu b iti)

Khdp khuyu lien ket dau diidi xifdng canh tay vdi dau tren cua hai xifdng
cang tay (xQdng quay, xufdng tru). Thufc chat la mot khdp kep bao gom 3 khdp
cung nam trong mot bao khdp chung do la:
88 (Uj GIAI PHAU NGtfOl. TAP I

- Khdp canh tay - tru (articulatio humero ulnaris).

- Khop canh tay - quay (articulatio humeroradialis).
- Khdp quay - tru tren hay khdp quay - tru gan (articulatio radio ulnaris
proximalis) (Hinh 6.5).

Hinh 6.5. Thiet do dung ngang qua khdp khuyu

1 Day chiang vong quay, 2, Tui bit hoat dich quay; 3. Tui bit hoat dich quay tru

2.1. C a c m a t khdp
- Dau dudi xtfdng canh tay co chom nho 6 ngoai. rong roc 6 trong.
- Dau tren xUdng tru cd hai khuyet; khuyet rong roc tiep khdp vdi rong roc
xUdng canh tav; khuyet quay khdp vdi vanh xUdng quay.
- Dau tren xUdng quay cd hom khdp tiep vdi chom nho xUdng canh tay va vanh
khdp tiep vdi khuyet quay xUdng tru.

2.2. B a o k hdp (ca p su la articularis)

- Bao xcf hoc chung ca 3 mat khdp;

0 tren bam quanh dau dudi xUdng canh tay, cach xa chu vi cac mat khdp.
O dtfdi bam quanh phia dudi mat khdp xUdng tru va co xiidng quay nen chom
xUdng quay xoay ttf do trong bao khdp.
- Bao hoat dich: lot mat trong bao xd.

2.3. C ac d ay ch a n g
Co the chia thanh 2 loai:
- Day chang cua khdp canh tay - tru - quay.
- Day chang cua khdp quay - tru tren.

2.3.1. Day chang cua kh&p canh ta y tru q u a y : dong tac chinh cua khdp la gap va
duoi nen day chang d hai ben chac, khoe hdn day chang trade v& day chang sau.
 CAC K HO P CHI TR EN [jj|| 89

- Day chang ben tru (ligamentum collaterale ulnare) (Hinh 6.6): di tit mom
tren loi cau trong xtfdng canh tay, toa hinh quat thanh 3 bd bam vao phi'a trong
dau tren xtfdng tru:
+ Bo trtfdc: bam vao bd trong mom vet.
+ Bo giiia: bam vao u loi xtfdng tru va keo dai xuong tan bd trong xUdng tru.
+ Bo sau: bam vao bd trong mom khuyu.

Hinh 6.6. Khdp khuyu (nhin phia trong)

1. Bo tru'dc day chang ben tru; 2. Bo giua day chang ben tru; 3. Bo sau day chang ben tru,
4. Day chang vong quay; 5. Day chang Cooper (Dai sdi cheo); 6. Loi cau trong xu'dng canh tay.

- Day chang ben quay (ligamentum collatterale radiale) (Hinh 6.7): di ttf
mom tren loi cau ngoai xtfdng canh tay, toa hinh quat thanh 3 bd bam vao phia
ngoai dau tren xtfOng tru.
+ Bd trtfdc: vong qua phia trUdc chom xtfdng quay, hoa lan vdi day chang vong
quay, va bam vao bd trtfdc khuyet quay xtfdng tru.
+ Bd giiia: vong qua phia sau chom xUOng quay, va cung hoa lan vdi day chang
vong quay, bam vao bd sau khuyet quay xtfdng tru.
+ Bo sau: bam vao bd ngoai mom khuyu.

Hinh 6.7. Khdp khuyu (nhin phia ngoai)

1. Bo sau day chang ben quay; 2. Bo gii/a dSy chang ben quay; 3. Bo trtfdc day chang ben
quay; 4. L6i cau ngo£i xtfdng canh tay.
90 H GIAI PHAU N G JO I. TAP I

- Day chang trUdc va day chang sau: 6 mat trifdc va mat sau cua khdp. mong,
yeu, gom cac sdi doc. di tif dau dudi xUOng canh tay tdi dau tren xudng quay va
xUdng tru. Rieng day chang sau con co cac sdi ngang de giif cho mom khuyu
^ i . 1
khong trat ra ngoai ho khuyu khi duoi cang tay.

2.3.2. Day chang cua khdp quay tru gan

Gom co:
- Day chdng vong quay (ligamentum anulare radii): om vong quanh vanh khdp
chom xUOng quay, hai dau bam vao bd trudc va bd sau khuyet quay cua xUdng
tru. Day chang nay rong d tren, hep d dudi, lai co sun boc d trong nen dUdc coi
nhu mot mat khdp vong va trong dong tac xoay cua chom, xUdng quay khong trat
ra ngoai dUdc (Hinh 6.8).
- Day chdng vuong (ligamentum quadratum): hinh vuong, di tti co xtfdng quay
tdi bd difdi khuyet quay xifdng tru.

Hinh 6.8. Day chang ben quay va day chang vong quay (nhin tru'dc)
1. Bo giCra day chang ben quay: 2 Bo tru’dc day chang ben quay; 3. Day chang vong quay

2.4. D o n g t a c

Dong tac cua khdp khuyu bao gom dong tac cua khdp canh tay - tru - quay va
dong tac cua khdp quay tru gan (hay khdp quay tru tren):
•K __
- 0 khdp canh tay - tru - quay: dong tac chu yeu la gap va duoi cang tay.

- O khdp quay - tru gan: dong tac chu veu la xoay quanh true thang diing. Con
dong tac sap ngtfa ban tay la hoat dong phoi hdp dong thdi cua ca 3 khdp:
+ Khdp canh tay - quay.
+ Khdp quay - tru gan (tren).
+ Khdp quay - tru xa (dudi).
 CAC KHO P CHI TREN [jjj 91

3. K H d P Q U A Y T R U X A (articulatio r a d io -u ln a r is distalis)

Khdp quay - tru xa hay khdp quay tru dudi lien ket hai dau dudi cua xtfdng
quay va xtfdng tru (Hinh 6.9 va 6.10).

3.1. M a t k h d p
- Chom xtfdng tru: co 2 mat khdp.
+ Mat ngoai: la vanh khdp, (circumferentia articularis) cua xtfdng tru, trdn,
chiem 2/3 ngoai cua chom, tiep khdp vdi khuyet tru cua xtfdng quay.
+ Mat dtfdi: tiep vdi mot dia khdp (discus articularis) hinh tam giac cua khdp
quay — cd tay. Dia khdp nay trudc day con goi la day chang tam giac xem phan
tiep d dtfdi: muc 3.3 (Hinh 6.10).
- Dau dtfdi xtfdng quay: mat trong co khuyet tru tiep khdp vdi chom xtfdng tru.

3.2. B a o k h d p
- Bao xd: bam vao bd trtfdc va bd sau cua dia khdp quay cd tay va vao xung
quanh cac mat khdp quay - tru. Bao xd difdc tang ctfdng bdi cac day chang quay -
tru trudc va sau (Hinh 6.9).

A B

Hinh 6.9. Cac khdp quay tru

A. Nhin trifdc; B. Nhin sau; 1. Day chang vong quay; 2. ThC/ng cheo.
3. Mang gian cot; 4. Day chang quay - tru tri/dc; 5. Day chang quay - tru sau.
92 H GIAI PHAU N G I/O I. TAP I

3.3. D a y c h a n g
Dia khdp hay day chang tam giac la mot tam sun sdi hinh tam giac, dinh
bam vao mat ngoai mom tram tru, nen bam vao bd dtfdi khuyet tru cua xtfdng
quay, vtfa co tac dung nhtf mot dia khdp dem gitfa xtfdng tru va cac xtfdng
nguyet, xtfdng thap; vtfa la mot day chang khoe, chac, noi dau dtfdi hai xtfdng
cang tay vdi nhau.

3.4. D o n g t a c
Dong tac chinh cua khdp quay - tru xa la sap va ngtfa ban tay. Dong tac nay
khong thtfc hien rieng re dtfdc ma phai phoi hdp d6ng thdi vdi khdp quay — tru
gan. Cu the la dau tren xtfdng quay, quay quanh chom nho xtfdng canh tay thi
dau dtfdi xtfdng quay lan quanh chom xtfdng tru.

Hinh 6.10. Khdp quay tru xa (Theo G regoire & O berlin, 4e.edit, 1953)
(Xu'dng tru keo xuong du'di de nhin ro day chang tam giac)
1. Xu'dng quay; 2. Khuyet tru; 3. Day ch ln g tam giac, hay dia khdp, 4. Xu'dng tru.

4. K H C fP Q U A Y - C O T A Y (a rticu la tio ra d io ca rp a lis)

Khdp quay — co tay lien ket dau dtfdi xtfdng quay vdi cac xtfdng co tav. Con
dau dtfdi xtfdng tru tham gia gian tiep qua day chang tam giac hay dia khdp
(discus articularis). Khi chdng ban tay xudng dat, trong ltfdng cd the truyen ttf
xtfdng quay xuong ban tay. dia khdp khong trtfc tiep an xuong cac'xtfdng co tay.

4.1. M a t k h d p
Gom co:
- Mat dtfdi dau dtfdi xtfdng quay: 16m, chia lam hai dien tiep khdp: dien ngoai
hinh tam giac tiep khdp vdi xtfdng thuyen, dien trong hinh td giac tiep khdp vdi
xtfdng nguyet.
 CAC KHOP CHI TREN 0 93

- Cac xu’dng co tay: xu'dng thuyen, xtfdng nguyet va xtfdng thap rang buoc
chat che vdi nhau bdi cac day chang gian cot lien co tay (ligamenta mtercapalia
intorossea); tao thanh mot khoi loi cjiu de tiep khdp vdi dau dtfdi xtfdng quay va
dia khdp. Con xtfdng dau khong thuoc khdp nay.
- Dia khdp (discus articularis) hay day chang tam giac, d day dong vai tro
nhu mot dia sun xd dem gifla cac mat khdp cua khdp quay co tay, nghia la giiia
dau dtfdi xtfdng tru va xtfdng thap.

4.2. B ao khdp
- Khdp quay co tay la mot khdp gap duoi la chinh nen bao xo chac khoe d hai
ben, mong d sau va d trudc (d sau mong hon d trtfdc).
- Bao hoat dich: lot d mat trong bao xd. Dang chu y la mat sau bao xd mong
nen mang dich co the chui qua de tao nen cac tui bit hoat dich.

4.3. Cac day ch a n g

Co 5 day chang d trtfdc, sau va hai ben cua bao khdp:
- D ay chdng ben cd lay - tru (ligamentum collaterate carpi ulnare): di ttf
mom tram xtfdng tru toi xudng thap va xtfdng dau.
- Day dicing bet ? cd tay quay (ligamentum collaterale carpi radiale): di ttf mom
tram xu'dng quay toi xu'dng thuyen.
- Day chdng qua y - cd tay - gan lay (ligamentum radiocarpate palmare).
- Day chd ng tru - cd tay - gan tay (ligamentum ulnocarpale palmare), hai
day nay d mat tru'dc bao khdp, di ttf dau dudi 2 xtfdng cang tay chum lai de bam
vao xtfdng ca, chi co mot phan nho bam vao xtfdng nguyet.

- D ay chd ng q u a y —cd tay - mu tay (ligamentum radiocarpale dorsale): d mat

sau bao khdp, di tii dau dtfdi xtfdng quay den xtfdng thap.

4.4. D o n g tac
Dong tac chinh cua khdp quay - co tay la gap 90u va duoi 60". Ngoai ra. khdp
con tham gia vao dong tac khep 45° giang 30° va mot phan nhd trong dong tac
sap ngtfa cang tay. Phoi hdp cac dong tac gap, giang, duoi, khep la dong tac xoay
vong (thtfc ra bien do hoat dong neu tren la do phoi hpp dong tac cua ca cac khdp
o' co tay).

5. C A C K H O P C U A b A n T A Y (a rticu la tio n e s m a n u s)

Cac khdp cua ban tay gom: (Hinh 6.11 va 6.12).

- Cac khdp d co tay (articulationes carpi) gom cac khdp gian xtfdng co tay
(articulationes intercapeae), khdp gitfa co tay (articulatio mediocarpeae), khdp
thap - dau (articulatio ossis pisiformis).
94 jj^j GIAI PHAU N G lfO I. TAP I

Hinh 6.11. Cac khdp d co tay va ban tay (mat gan tay)
1. Day chang quay - cd tay gan tay; 2. Day chang ben cd tay - quay; 3. Bao khdp; 4 Cac day chang
gian cot cd tay; 5. Cac day chang cd tay - ban tay - gan tay; 6. Cac day chang ben 7 Bao khdp
gian dot ngon tay; 8. Cac day chang ngang dot ban tay; 9. Cac day chang gan tay phu. 10 Cac day
chang gian dot ban tay - gan tay; 11 Day chang moc - ban tay; 12. Day chang dau - ban tay;
13 Day chang dau - moc; 14. Day chang ben cd tay - tru; 15. Day chang tru - cd tay - gan tay,
16. Bao khdp quay - tru du'di.

- Cac khdp co tay — ban tay (articulationes carpo metacarpales).

- Cac khdp gian cot ban tay (articulationes intermetacarpales).

- Cac khdp ban tay - ngon tay (articulationes metacarpo phalangeales).

- Cac khdp gian dot ngon tay (articulationes interphalangeales).

5.1. Khdp giufa co tay (articulatio m edio carpalis)

Khdp giiia cd tay lien ket giiia hai hang xu’dng cd tay vdi nhau.
Dien khdp phtic tap, hinh the khong deu thuoc nhieu xiidng giOa hai hang
co tay.
Dong tac chinh la gap, duoi. khep, giang. Cu the:
Gap ban tay: 85°
Duoi ban tay: 85"
Khep ban tay: 40u
Giang ban tay: 20°
 CAC KHO P CHI TREN [JJj 95

Hinh 6.12. Cac khdp d co tay va ban tay (mat mu tay)

1. Bao khdp quay - tru du'di; 2. Day chang ben co tay - tru; 3. Cac day chang gian dot ban tay mu
tay, 4. Bao khdp; 5 Day chang ben; 6. Cac day chang mu co’ tay - ban tay. 7 Bao khdp; 8 Cac day
chang gian cdt mu co’ tay; 9. Day chang ben co tay - quay; 10. Day chang quay co tay - mu tay.

5.2. C a c k h d p c o t a y - b a n t a y (articulationes carpom etacarp ales)

- Cac khdp co tay — ban tay (II —V) hen ket gitia cac xtfdng hang dudi co tay
vdi nen cac xtfdng ban tay, thuoc dang kh6p phang. Bien do hoat dong rat han
che, chi co dong tac trtfpt ve phia nav hay phia kia. khoang ttf 5 - 10".
- Rieng khdp co tay ban tay ngon cai hay khdp co tay - ban tay I (articulatio
carpo metacarpalia pollicis) lien ket xtfdng thang vdi nen xudng ban tay I. thuoc
dang khdp hinh yen co hai true quay vuong goc vo'i nhau.
Dong tac:
- Khep, giang: 45° - 60u.
- Doi chieu ngon cai va hoi vi: 35° - 40°.

5.3. C ac k h d p b a n tay - d ot n gon tay (articulationes metacarpophalangeales).

Cac khdp ban tay —dot ngon tay, goi tat la khdp ban - ngon tay, lien ket gitia
chom cac xtfdng ban tay vdi nen dot I cua cac ngon tay tu'dng ting. Cac khdp nay
thuoc loai khdp chom cau.
96 U] G IA I P H A U N G l f O l . T A P I

Dong tac:
- Gap duoi: 9 0 " - 100°.
- Khep giang: 40" - 45".
- Quay: han che.

5.4. Cac khdp gian dot ngon tay (articulationes interphalangeales).

Cac khdp gian dot ngon tay la nhQng khdp lien ket giQa cac xQdng dot ngon tay
vdi nhau. Co the chia thanh 2 loai:
- Cac khdp gian dot ngon tay gan: lien ket giQa dot gan vdi dot giQa cua cac
ngon tay.
- Cac khdp gian dot ngon tay xa: lien ket dot giQa vdi dot xa cac ngon tay.
Ca hai loai khdp nay deu co hinh rong roc va quay theo true ngang.
Dong tac: chi co gap va duoi.
Khdp gian clot ngon tay gan: 110' - 120".
Khdp gian dot ngon tay xa: 80 - 90".
 CAC CO CHI TREN [jX; 97

7. CAC CO CHI TREN

(Musculi membri superioris)

Van dong chi tren gom co:

- Cac cd d vai.
- Cac cd d canh tay.
- Cac cd d cang tay.
- Cac cd d ban tay.

c a c c o 6 VAI

Cac cd d vai quay xung quanh dai nguc va khdp canh tay. thuoc vung nguc o'
tru'dc vung ba vai 6 sau va vung delta d ngoai. Thuc ra cac cd nay gom hai loai
khac nhau ve vi tri nguyen uy va chu'c nang ctoi vdi chi tren:
- Cac cd ngoai lai: di ttf cot song hoac long nguc tdi dai nguc va xuong canh
tay chu yeu van dong dai ngtfc.
- Cac cd noi tai: di ttf dai ngtfc (hay tu xu'dng vai - xtfdng don) den xudng
canh lay. chu yeu van dong canh tay.
Theo Thuat ngu Giai phau Quoc te hien nay (X.A. 1985 va T.A. 1997) chi rieng
cac cd noi tai dupe xep vao cac co' cua chi tren. Con cac cd ngoai lai duoc tach
rieng de xep cung vdi vung ngtfc va lung; song chung toi van xin mo ta gop vao
day vi chung it nhieu tham gia van dong mot phan chi tren (dai ngtfc) dtfdc chi
phoi chu veu bdi dam roi than kinh canh tay, dong thdi tham gia vao giai phau
dinh khu vung vai va nach, la vung noi tiep chi tren vdi than minh.

1. CAC c d 6 V U N G N G U C
Deu la ngoai lai doi vdi chi tren va thuoc cac co' cua ngtfc. gom cac cd: ngtfc
ldn, ngtfc be va dtfdi don. tao nen thanh trudc cua nach; ngoai ra cung co the gop
them vao day cd rang trtfdc gidi han thanh trong cua nach.

1.1. Ccf n g t f c l d n (M. pectoralis major) (Hinh 7.3 va 7.4).

- Nguyen uy: co 3 phan:
Phan don (pars clavicularis): bam vao 2/3 trong bd trtfdc xtfdng don.
7- GPN-T1
 G IA I P H A U N G l / O l . T A P I
II

1 Co thang,
2. Co delta,
3 Cd du'di gai,
4. Cd trdn nhd,
5. Cd tron to,
6. Dau dai cd tam dau canh tay
7 Cd lung rong;
8 Dau ngoai cd tam dau canh tay
9. Cd canh tay,
10. Gan cd tam dau canh tay
11. Vach gian cd canh tay ngoai
12. Dau trong cd tam dau canh tay
13 Mom khuyu;
14. Cd khuyu;
15 Cd duoi cac ngon tay
16. Cd gian cot mu tay I;
17. Gan cd duoi dai ngon cai
18 M ac ham cac gan gap
19. Cd dudi nglin ngon cai
20. Cd giang dai ngon cai;
21 Cd gap co tay quay,
22. Cd dudi co’ tay quay ngan
23. Cd dudi co tay quay dai
24. Cd canh tay quay,
25. Cd nhi dau canh tay.
26. Cd rang tri/dc;
27. Cd cheo bung ngoai;
28. Cd ngi/c to.

Hinh 7.1. Cac cd chi tren. Nhin nghieng, ben phai (Theo Sinelnikov, M oskva. 1963;
 CAC CO CHI TREN [jjj 99

H in h 7.2. Cac cd cua vai. Nhin sau (Theo F.H Netter. 3rd edit, 2004)
I. Ca thang, 2. Cd delta, 3. M ac du'di gai; 4. Goc du'di vai; 5. Mom gai dot song N12, 6. Dau ngoai cd
tam dau canh tay; 7. Dau dai cd tam dau canh tay; 8. Cd lung rong; 9, Cd trdn to. 10. Cd tron nho,
I I . Cd du'di gai; 12. Gai vai; 13. Cd tren gai; 14. Mom cung vai; 15. Cd tram ldn; 16. Cd tram be;
17. Cd nang vai; 18, Mom gai dot song C7; 19. Cd goi dau; 20. Cd ban gai dau.

Phan lie — sudn (pars sternocostalis): bam vao xtidng lie va cac sun siidn tii
1 den 6.
Phan bung (pars abdominalis): bam vao bao cO thang bung.
- Bam tan: Ca 3 phan tren, chum hinh quat di tii nguc tdi xu'dng canh tay,
turn lai thanh mot gan tan bam vao mep ngoai cua ranh gian cu xuong canh tay.
theo hinh chti U (Phan ddn bam vao net ngoai, phan bung bam vao net trong,
phan lie siidn bam vao net diidi chti U).
- Dong tac: Neu ty vao long ngiic, cd cd tac dung khep canh tay va xoay vao
trong; neu ty vao xiidng canh tay thi cd nang ca than ngiidi va long nguc len (nhii
trong dong tac leo treo).
- Than kinh van dong cd: La cac nhanh ngiic tach ra tti bo trong va bd ngoai
cua dam roi canh tay.
CTTil'I G IA I P H A U N G U O I . T A P I

3 2 1

Hinh 7.3. Cac c0 vung nguc (lap nong)

1. Ca ngUc lan, 2 TTnh mach dau; 3, Ranh delta nguc. 4 Ca delta; 5. Ca thang bung

1.2. Cd ngtfc be (M. pectoralis

minor): nam 0 sau cO nguc ldn
(Hinh 7.5).
- Nguyen uy; bam vao cac
xtfOng sudn 3. 1, 5.
- Bam tan: cac thd turn lai
bam vao mom qua xtfdng vai.
- Dong tac: neu ty vao long
ngiic, cd keo xifdng vai xuong.
Neu ty vao mom qua co gop
phan lam nd long ngtfc trong
dong tac thd vao.
3
- Than kinh van dong: tach
Hinh 7.4. Bam tan cua cac co ngcrc ldn
ra ttf dam roi canh tay. Phan Cfc sifdn. 2. Phan don; 3. Phan bung
 CAC CO CHI TREN L*iU
101

2 1

H inh 7.5. C ac cd vu n g ngiTc (ldp sau)

1. Phan don co ngi/c ldn; 2. Co du’di don; 3. Co nguc ldn (bam tan). 4 Than kinh cd bi
5. Cd qua - canh tay; 6. Cd nguC be; 7. Phan sUdn c0 nguc ldn; 8. Phan ire cd ngifc ldn

1.3. Cd dtfdi d on (M. subclavius)

- Nguvcn liy: bam vao sun sifdn va xifdng sifdn 1. hudng ra ngoai va hoi Ion tron.
- Bum tan vao ranh difdi don cua xifdng don.
- Dong tac: keo xifdng don xuong, hoac nang xu'dng sudn 1 (tuy thuoc vao
diem ty).
- Than kinh vein dong: tach ra tif than tren dam roi canh tay.

1.4. Cd ra n g trtfdc (M. sorratus anterior)

-N g u y en liy: bam vao mat ngoai phan trifdc 10 xuong sifdn dau tien. chum lai
d phia sau, do
- Bam tan: vao mep trifdc bd trong xudng vai.
- Dong tae: Neu ty vao long ngifc, keo xifdng vai ra ngoai va ra trudc. ap sat
xifdng vai vao long ngifc. Neu ty vao xifdng vai. keo xudng sudn len. va la cd hit vao.
- Than kinh: do than kinh ngifc dai tach tii cac re C5, C6. C7 dam roi than
kinh canh tay.
Cd gop phan tao nen thanh trong cua nach, va duoc mot so tac gia xep vao
vung vai vi nam trifdc xifdng vai va gi\3 xudng vai ap vao long ngiic.
102 G IA I p h A u n g u c j i . T A P I

2. CAC c d d V U N G b A V A I V A L l/N G (vai sau)

Co the chia lam hai nhom: nong va sau.

2.1. N h om nong
Co 2 cO: cd thang va cd liing rong. deu la cd ngoai lai doi vdi chi tren. chu yeu
thuoc vung liing, di tu cot song den xiidng vai hoac xiidng canh tay va chi co mot
phan triim len ba vai (Hinh 7.2, 7.6, 7.7)

2.1.1. C o th a n g (M. trapezius): la mot cd det rong phu len king va gay. (Hinh 7.2).

- Nguyen uy:
Bam vao u nho cham ngoai, vao diidng gay tren cua xiidng cham va vao cac
mom gai cua cac dot song co va ngiic.
Cac thd cd d tren va diidi chum lai theo hinh thang ve phia dai ngiic, va:
Bam tan vao:
1/3 ngoai bd sau xiidng don: bd trong mat tren mom cung vai: mep tren. mep
du'di va dau trong gai vai.
- D ong tac: Nang va keo xiidng vai vao gan cot song. Neu ty vao xiiOng vai thi
nghieng dau ve ben doi dien.
Than kinh van dong: Tach ra tii day than kinh phu (XI) va tu dam roi co.

2.1.2. Cci liin g r o n g (M. latissimus dorsi): la mot cd rong, det phu phan duoi lung
(Hinh 7.2, 7.6).
-N g u y e n uy: Bam bdi mot ban gan dai va rong dan vao mom gai cac dot song
tu dot ngiic 6 den xiidng cung: vao bon xiidng siidn cuoi. va vao 1/3 sau mao chau.
Cac thd cd turn lai hudng chech len tren va ra ngoai, qua phia sau goc dudi
xiidng vai, roi xoan van om lay phia dudi cd tron to. de vong ra triidc.
- Bam tan: d day ranh gian cu xudng canh tay. giiia cd ngiic to d triidc va cd
tron to d sau) (Hinh 7.8).
- Dong tac: Khep va xoay canh tay vao trong. Neu ty vao xiidng canh tay thi
gop phan nang ca than minh len (khi leo treo).
- Than kinh van dong: Than kinh nguc lung la mot nganh ben cua bo sau
dam roi canh tay.

2.2. N h o m sau

Gom ca cac cd ngoai lai va cac cd noi tai doi vdi chi tren (Hinh 7.2, 7.7. 7.8).

2.2.1. C dc ca s a u n g o a i la i thuoc vung liing hdn la vung ba vai, gom 3 cd:

Cd nang vai.
Cac cd tram.
 C AC CO CHI TREN g j 103

Cd rang trUdc.
Cac cd nay deu di tti cot song hoac long nguc den xUdng vai va tac dong len
xUdng vai.

H inh 7.6. Cac cd v u n g vai (ldp nong)

(Da cat bo dau dai cd tam dau de boc lo tam giac cd tron)
1 Cd lung rong; 2. Cd tron to. 3. Co tron be; 4. Tam giac cd tron. 5. Cd du'di gai 6 Cd delta, 7. Co thang.

- Cd n a n g v a i (M. levator scapulae): la mot cO nho nam dudi cd thang.

Nguyen uy: Bam vao mom ngang cac dot song co.
Bam tan: vao bd trong xUdng vai, d phia tren gai vai.
Dong tac: Nang xudng vai, xoay xudng vai va nghieng co.
Than kinh van dong: Than kinh vai sau (N. dorsalis scapulae) tach tu1re C5
cua dam roi than kinh canh tay).
- C dc cd tra m (M. rhomboidei): gom 2 cd: cd tram ldn (M. rhomboideus
major) va cd tram be (M. rhomboideus minor), deu di tu cot song den bd trong
xifdng vai.
Nguyen uy: Bam vao mom gai cac dot song tu co 6 den nguc 5. day chang gay
(lig. nuchae) va day chang gian gai d doan cot song nay.
Du'dng di va bam tan: Cac thd cd di xuong dudi va ra ngoai de bam tan vao bd
trong xiidng vai. Cac thd bam tii dot song co goi la cd tram be. phan con lai goi la
cd tram ldn.
Dong tac: nang va keo xUdng vai vao trong.
Than kinh van dong: than kinh vai sau tach tii re C5 cua dam roi than kinh
canh tay.
C TTl ’l GIAI P HA U NGLfOl. T A P I

Cd ra n g triid c (M son atas anterior): da dupe mo ta cung vdi cac cd vung

nguc. Song cung co gop phan vao ldp sau cua vung ba vai vi nam trudc xudng vai
va giii xiidng vai ap vao long nguc.

H inh 7.7. Cac cd v u n g vai (ldp sau)

1. Cd du'di gai. 2. Cd tren gai. 3. Bao cd, 4 Cd lung rong. 5. Tam giac ba vai - tam dau
6. Cd tron to: 7. Dau dai cd tam dau. 8 Dau ngoai cd tam dau. 9. Lo tir giac, 10. Cd tron be

2.2.2. Cdc ca sdi/ n oi ta i cua vung ba vai: di tii xudng vai den xudng canh tay.
gom f> cd; 1 d phia sau xuong vai la cd tren vai. cd dudi gai, cd tron to. cd tron be
va 1 d phia tru'dc xiidng vai la cd diidi vai.
Ca tren g a i (M. supraspinatus) (Hinh 7.7).
Nguven uv: bam vao ho tren gai.
Ham tan: vao cu ldn xudng canh tay.
Dong tac: giang va xoay canh tay ra ngoai.
Than kinh van dong: than kinh ti en vai. tach ra tu than tren dam roi canh tay.
- Cd ditai g a i (M. infraspinatus):
Nguyen uy: bam vao ho dudi gai.
Bam tan vao: cu ldn xu'dng canh tay.
Dong tac: giang va xoay canh tay ra ngoai.
Than kinh van dong: than kinh tren vai. tach ra tu than tren dam roi canh tay.
- C o tron to (M. teres major):
Nguyen uy: 1/2 dudi bd ngoai xiidng vai.
Bam tan: mep trong ranh gian cu.
 CAC CO CHI TREN ja 105

Dong tac: tuy thuoc vao diem ly; Ty vao xudng vai: khep canh tay. Ty vao xuOng
canh tay: nang xUdng vai.
Than kinh van dong: than kinh cd tron to tach ra tu' bo sau dam roi canh tay.
Co tron be (M. tores minor):
Nguyen uy: 1/2 tren bd ngoai xUdng vai.
Bam tan: cu ldn xu'dng canh tay.
Dong tac: giang va xoay canh tay ra ngoai.
Than kinh van dong: than kinh nach, tach ra tQ bo sau dam roi canh tay.
- Co ditai va i: (M. subscapularis) (Hinh 7.8): nam d mat trudc xuong vai.
Nguyen uy: ho cludi vai.
Bam tan: cu nho xUdng canh tay.
Dong tac: xoay canh tav vao trong.
Than kinh van dong: cac than kinh du’di vai tren va dudi vai dudi tach ra tu
ho san dam roi canh tay.
2 1

Hinh 7.8. Cac cd d thanh sau cua nach

1. Cho bam cua cd rang tru'dc; 2. Cd du'di vai; 3. Lo tu1giac; 4 Tam giac ba vai - tam dau.
5. Tam giac canh tay - tam dau; 6. Dau dai cd tam dau; 7. Cd li/ng rong, 8 Cd tron to

3. CO’ V U N G D E L T A (vai ngoai)

Chi co 1 cd.
CO d e lt a (M. deltoideus) la mot cd ldn hinh chu delta (D) Ion nguoc. trum len
khdp vai, tao thanh u vai (Hinh 7.1, 7.2, 7.3, 7.6).
106 jjj] GIAI PHAU NGUOI. TAP I

- Nguyen uy: cd gom 3 bo bam d tren vao 3 ncti:

Bo sau hay bo gai vai (pars spinalis, bam vao mep dudi gai vai.
Bo giiia hay bo cimg vai (pars acromialis), bam vao bd ngoai mom cung vai
Bo tru’dc hay bo don (pars clavicularis) bam vao 1/3 ngoai bd trudc xuong ddn.
- Bam tan: cac bo turn lai thanh mot gan chung bam vao u loi (loi cu) delta
hinh chd V d mat ngoai xiidng canh tay.
- Ve cau lao: Cac bd trudc va sau gom nhiing bd sdi cd dai di xuong chay theo
chieu doc. Bd gitia hay bd cimg vai co cau true da long vu, gom 4 vach gan di
xuong tii mom cung vai, 3 vach gan di len tii loi cu delta, vdi cac sdi cd ngan, va
nhieu, bam chech giiia cac vach gan dd, tao thanh mot cd co liic co manh nhung
do co ngan (Hinh 4.7, bai Dai cUdng ve cd).
- Dong tac: giang canh tay, gap, duoi canh tay, xoay canh tay ra ngoai va vao
trong. Bd giiia co tac dung giang canh tay la chinh. Bo triidc gap (diia ra triidc) va
xoay canh tay vao trong. Bd sau duoi (diia ra sau) va xoay canh tay ra ngoai.
Than hinh run dong: Day than kinh nach la mot nganh ( img cua bo -an dam
rdi canh tay.
* [Ap dung thifc te: co dude cau tao dac biet, bo giiia dang da long vu, vdi 7 vach can noi co
tu' nguyen uy di xuong va tu1bam tan di len, cho cac thd cd bam chech 6 giua (Hinh 4 7).
Nen khi cac thd co bi ton thudng, hay bi het mot phan do tlem, gay ton thudng d a ; than kinh
nach n l m ngay du'di co, dac biet d tre nho: Ket qua co the dan den xd teo cd. dinh lien cac
vach can noi cd ke can thanh mot dai xd day, va gay co cdng cd delta. Vay quan diem
phong benh dat len hang dau: can tranh tiem vao co delta d tre nho].

CAC CO O CANH TAY

Ve mat giai phau dinh khu. canh tay dude chia thanh 2 vung: trudc va sau.
ngan cach nhau bdi xudng canh tay va hai vach gian cd trong. ngoai. Ve mat cau
tao va chiic nang, canh tay cd -1 cO dude xep thanh 2 nhom hav 2 o:
— O canh tay trudc hay o gap (compartimentum brachn anterius/flexorum).
gom 3 cO, va
—O canh tay sau hay c duoi (compartimentum brachii posterius/extensorum).
gom 1 cd.
Hai o cd canh tay d day cung tudng ting vdi 2 vung dinh khu da neu. Nen mo
ta cac cd canh tay theo vting hay theo o cung deu tudng dUdng.

i. cA c c d d V U N G c A n h TAY TRUdC
Co 3 cd xep thanh 2 ldp:
Ldp nong: co 1 cd: cd nhi dau canh tay.
Ldp sau: cd 2 cd: cd qua canh tay va cd canh tay.
 C AC CO CHI TREN [ j j 107

1.1. Cd nhi dau ca n h tay (M. biceps brachii) (Hinh 7.9).

La mot cd dai, hinh thoi, noi ro dtfdi da khi co.
Nguyen uy: co 2 dau.
Dau ngan (caput breve): bam vao mom qua xudng vai.
Dau dai (caput longum): bam vao cu tren o chao xtfdng vai. di xuong qua khdp
canh tay va ranh gian cu xUdng canh tay.
Bam tan: Gan chinh bam vao u loi (loi cu) xtfdng quay, va che can phu toa
chech xuong dtfdi va vao trong d trtfdc ranh nhi dau trong ctfa ho khuyu roi hoa
lan vdi mac cang tay.
D6ng tac: gap cang tay vao canh tay.

Hinh 7.9. Cac cd vung canh tay tru'dc (ldp nong)

1. Cd delta; 2. D au dai cd nhi dau; 3. Gan tan cd nhj dau, 4. Che can ca nhi dau 5 Cd
canh tay: 6 Cd nhj dau; 7. Dau ngan cd nhj dau; 8. Cd qua - canh tay,

1.2. Cd qua canh tay (M. coracobrachialis)

6 1/3 tren canh tay, phia trong (Hinh 7.9).

Nguyen uy: bam vao dinh mom qua xtfdng vai (cung dau ngan cd nhi dau).
c m ill G IA I P H A U N G l / O l . T A P I

Ham tan: cho noi 1/3 Iron vdi 1/3 piua mat trong xtfdng canh ta\
Dong tac: khep canh lay.
Than kinh van dong: day cd bi. mot nganh cung cua dam roi canh tav.

1.3. Cd canh tay (M brachialis) (Hinh 7.10).

Nam o' 2/3 dudi canh tay. dudi ldp cd nhi dau canh tay.
Nguyen uy: bam vao 2/3 dudi mat trtfdc xtfdng canh tav va hai vach gian cd
(trong va ngoai).
Ham tan: vao mom vet xtfdng tru.
Dong tac: gap cang tay vao canh tay.
Than kinh van dong: than kinh cd bi.

Hinh 7.10. Cac cd vung canh tay tri/dc (ldp sau)

1. Cd delta; 2. Dau ngoai cd tam dau. 3. Vach gian cd ngoai, 4. Cd canh tay quay: 5. Gan cd nhi dau (bi
cat); 6. Cd sap tron. 7 Mom vet, 8. Vach gian cd trong. 9. Cd canh tay: 10. Dau dai cd tam dau (d sau
vach gian cd trong); 11. Cd lung rong. 12 Cd qua - canh tay.

2. C A C CO 6 V U N G C A N H T A Y S A U

Vung canh tay sau chi co 1 cd.

 CAC CO CHI TREN X IC T H

C o ta m d a u c a n h ta y (IVl. triceps brachii) (Hinh 7.11 va 7.12).

Nguyen liy: co 3 dau:

Dau dai (caput longum): bam vao cu dtfdi o chao xtfdng vai.
Dau ngoai (caput lateralc): bam vao mat sau xiidng canh lay (d tren ngoai
ranh than kinh quay) va vao vach gian cd ngoai.
Dau trong (caput mediale): bam vao mat sau xudng canh tay (d dtfdi trong
ranh than kinh quay) va vao vach gian cd trong.
Ham tan: ca 3 dau chay xuong dtfdi turn lai thanh mot gan chung bam vao
mom khuyu xtfdng tru.
- Dong tac: duoi cang tay.
- Than kinh van dong: than kinh quay.

Hinh 7.11. Co vung canh tay sau (Cd tam dau canh tay)
1. Bd sau cd delta; 2. Cd tron be; 3. Cd tron to; 4 Dau dai cd tam dau, 5 Dau trong co
tam dau; 6 Cd khuyu; 7. Dau ngoai cd tam dau; 8. Bd ngoai cd delta
110OJ] G IA I P H A U N G U O l . T A P I

H inh 7.12. Sd do bam tan cua cd tam dau canh ta y

1. Che can trong, 2, Che can ngoai 3 Gan tan chinh bam vao mom khuyu, 4 Cd tam dau

CAC CO 6 c A n g t a y

Cang tay co 20 cd (ke ca cd khuyu), dude cac tac gia Phap va Xga chia lam 3
v u n g (regions, theo Testut & Latarjet). 3 o (loges. Theo Gregoire & Oberhni. hay
3 n h o m (groupes. theo Smelmkov): t r u ’dc (8 c0). s a u (8 cO) va n g o c ii (1 cd).
Thuat ngu' Giai phau Quoc te (T.A. 1997) va cac tac gia Anh My lai chi chia
cang tay lam 2 vung dinh khu: vung cang tay trifdc va vung cang tay sau (regio
antebrachh anterior/posterior), tuong Ung vdi 2 o cd: 6 cang tay tru’dc hay 6 gap
(compartimentum antebrachh anterius/flexorum) va o cang tay sau hay 6 duoi
(compartimentum antebrachh posterius/extensorum), ngan cach nhau bdi xudng
quay xu'dng tru. mang gian cot va hai vach gian cd trong va ngoai (Hinh 4.8).
Song cac vach gian cd khong hudng ngang sang hai ben; ma vach trong do
mac cang tay bam true tiep vao bd sau xiidng tru. hifdng ra sau; con vach ngoai
tach tu phan trudc mac cang tay. tdi bam vao bd triidc xiidng quay lai hiidng ra
 CAC CO CHI TREN [>Jj 111

triidc. Cho nen hai vung cang tav khong han la triidc - sau. ma la trudc trong va
sau ngoai.
Thiic te, 4 cd d phan ngoai cua vung cang tay sau da khong d sau ma lan ra
triidc kha nhieu (Hinh 7.13, 7.21, 7.22) tao thanh mot nhom rieng, phai goi la
nhom ngoai mdi dung vi tri tUdng doi cua no. Vav theo chung toi cac CO d cang tay
nen difdc chia thanh 3 nhom hay 3 o: trifdc, ngoai va sau nhu cac tac gia Phap va
Nga. Thuat nguf Giai phau Quoc te T.A.1997 tuy da gop o ngoai vao “o cang tay
sau” , song cung van phan biet d o cang tay sau mot phan dac biet la “phan ngoai,
hay phan quay” (pars lateralis; pars radialis).
Ve c h u ’c n d n g : Cac o cd cang tay trifdc va sau diidc goi la “o gap. o duoi” , cung
chi la ddn gian hoa theo ti'nh chat dac trifng nhat cua 2 nhom do la gap va duoi co
tay, ngon tay, song ngoai ra con co mot so cd lai co tac dung xoay cang tay (sap,
ngiia); va cd canh tay quay da khong tac dong len co tay ngon tay, ma gap cang
tay vao canh tay.
Ve c h i p h o i t h a n k i n h : Cac cd gap d mat trifdc cang tay duoc chi phoi bdi
than kinh giua va than kinh tru. Con co cac cd duoi 6 mat sau difdc chi phoi bdi
day quay.
Ve n g u y e n u y : cac cd ldp nong cua 2 nhom bam tap trung chu yeu 6 hai bon
khuyu: ldp ndng cac co cluoi bam vao mom tren loi cau ngoai; ldp nong cac cd gap
bam vao mom tren cua loi cau trong. Con cac cd ldp sau cua hai nhom bam vao
hai mat trudc/sau cua xifdng quay, xifdng tru va mang gian cot.

* [Chu thich ve T N G P Q T : Khai mem ve o co (co m p a rtim e n tu m ) la mot khai mem mdi cua
T.A. 1997 (diia theo tieng Anh “com partm ent"), de chi mot o. mot ngan hay 1 dia hat khu
tru difdc gidi han ro ret cua mot nhom cd co vj tri va c h iic nang tudng tii. O cd co the
trung hop vdi vung. hoac chi chiem 1 phan chia nho hdn cua vung Con v u n g (regio) la mot
khai niem dinh khu da co t i i lau, de chi mot khu v iic cau tao giai phau co gidi han nhat
dinh de phau tich va mo ta ap dung ngoai khoa. T heo T.A .1997. moi doan chi thudng
dude chia thanh 2 vung tru’dc sau. Moi vung co the tudng du’dng vdi mot o cd. hoac bao
gom mot so o cd khac nhau],

1. cAc c d o v u n g c A n g t a y TRl/CiC
Vung cang tay trudc tudng ung vdi o cd cang tay trudc, co 8 cd xep thanh 4 ldp:
- Ldp nong co 4 cd: cd sap tron; co’ gap co tay quay; cO gan tay dai; cd gap co
tay tru.
- Ldp giiia co 1 cd: cd gap nong cac ngon tay.
- Ldp sau co 2 cd: cd gap sau cac ngdn tay; cd gap dai ngon cai.
- Ldp sat xi/cfng co 1 cd: cd sap vuong.

1.1. Cd s a p tro n (M. pronator teres) (Hinh 7.13 va 7.14).

- Nguyen uy bam d 2 ndi.
112 ]Xl GIAI P H A U N G U O I TA P I

Dau canh tay (caput humeralo): bam vao mom tren loi cau trong xudng canh tay.
Dau tru (caput ulnare): bam vao mom vet xudng tru Gitfa hai dau co day
than kinh giua di qua.
- Bam tan: phan gitfa mat ngoai xtfdng quay.
Dong tac: sap va gap cang tay.
- ThAn kinh van dong: mot nhanh cua day than kinh giiia.

Hinh 7.13. Cac ca c in g tay nhin ttf tru'dc

1. Co canh tay; 2. Co canh tay quay; 3 Co duoi co tay quay dai; 4 Co gap dai ngon cai 5 Co gap
nong cac ngon tay; 6. Co gap co tay tru; 7. Co gan tay dai; 8. Co gap co tay quay. 9 Che can co nhi
dau; 10 Co sap tron; 11. Co nhi dau canh tay.
(Nhan xet: cac co 2, 3 la thuoc nhom ngoai cua cac cd vung c^ng tay sau (theo T.A. 1997). soog lan ra
tru'dc kha nhieu).

1.2. Cd gap co tay q u a y (M. flexor carpi radialis).

- Nguyen liy: mom tren loi cau trong xtfdng canh tay.
— Bam tan: gan tan keo dai di xuong co tay, luon dtfdi mac ham cac gan gap
trong mot che rieng cua mac. roi bam tan vao nen xtfdng dot ban tay II (hoac II
va 111) (Hinh 7.20).
 CAC CO CHI TREN

Hinh 7.14. Cac cd ldp nong vung cang tay tru'dc

1. Cd sap tron. 2 Cd gap co tay quay, 3. Mac ham cac gan gap 4 Co gan tay dai
5. Dau tru cd gap co tay tru: 6. Dau canh tay cd gap co tay tru.

- Dong tac: gap va sap ban tay.

- Than kinh van dong: mot nhanh cua than kinh giua.

1.3. C d g a n t a y d a i (M. palmaris longus)

- Nguyen uy: mom tren loi cau trong xifdng canh tay.
- Bam tan: Gan tan keo dai qua triidc co tay xuong gan tay. toa hinh quat
bam vao triidc mac ham cac gan gap va mac gan tay. gop phan tao thanh can gan
tay (Hinh 7.15).
- Dong tac: Gap ban tay va cang can gan tay.
- Than kinh van dong: Tach ra til than kinh giua.

1.4. Cd gap c o tay tru (M. flexor carpi ulnaris)

Chav doc bd trong cang tav.

8- GPN-T1
114 G IA I P H A U NGUCJl. T A P I

- Nguyen uy:
Dau canh tay (caput humerale): bam vao mom tren loi cau trong xtfdng
canh tay.
Dau tru (caput ulnare): bam vao mom khuyu va bd sau xtfdng tru.
- Bam tan: xuong co tay, gan tan bam vao xtfdng dau, xtfdng moc va nen
xtfdng ban tay 5 (Hinh 7.14).
- Dong tac: gap ban tay (ve phia trong).
- Than kinh van dong: tach ra ttf than kinh tru.

Hinh 7.15. Bam tan cua cd gan tay dai. Can gan tay va cd gan tay ngan
1. Can gan tay (Mac gan tay giCra. tang ci/dng bdi gan cd gan tay dai); 2. Mac gan tay ngoai (boc
mo cai); 3. Day chang ngang nong ban tay, 4 Mac gan tay trong (boc mo ut); 5 Co gan tay n g ln
6 Da gan tay.

1.5. Cd gap n o n g cac n gon tay (M. flexor digitorum superficialis) (Hinh 7.16)
- Nguyen uy: co 2 dau
Dau canh tay tru (caput humeroulnare): bam vao mom tren loi c^u trong
xtfdng canh tay va mom vet xtfdng tru.
 CAC CO CHI TREN Q 115

Hinh 7.16. Cac cd ldp giura vung cang tay tru'dc

1. Gan co nhi dau canh tay; 2 Cd ngifa; 3. Cd gap dai ngon cai; 4. Cd gap nong cac ngon tay;
5 Cho bam cua cd gap sau cac ngon tay; 6. Cd gap co tay tru; 7, Cho bam cua dau tru cd sap
tron, 8. Cho bam tan cua cd canh tay; 9. Xem tiep phan bam tan cua cac qan qap nqon tay (a
hinh 7,18, 7.19, 7.20. 7.29, 7.30).

Dau quay (caput radialis): bam vao 2/3 tren bd trudc xudng quay.
Not gitia hai dau la mot cung gan co dong mach tru va than kinh giua di qua.
- Bam tan; Cd di xuong tach thanh 2 ldp cho 4 gan tan; (ldp nong cho cac gan
ngon tay 111 va IV; ldp sau cho cac gan ngon II va V. Bon gan luon dudi mac ham
cac gan gap d co tay. roi toa ra d ban tay xuong cac ngon tay. Moi gan xuong tdi
ngon tay tudng Ung lai chia thanh 2 che de bam tan vao hai ben sUdn cua dot
giua ngon tay. goi la gan thung, vi gitia hai che co gan cd gap sau ngon tay xuyen
qua (Hinh 7 .IS. 7.19).

- Dong tac; gap dot II vao dot I d cac ngon tay tti II - V. va gap ban tay vao
cang tay.
- Than kinh van dong: tach ra tti than kinh gitia.
116 [U] G IA I P H A U N G l f O I . t a p I

Hinh 7.17. Cac cd ldp sau vung cang tay trifdc

1 Ca ngu'a; 2. Cho bam co gap nong cac ngon tay; 3. Ca sap tron; 4. Ca gap dai ngon cai. 5 Ca sap
vuong, 6. Mang gian cot, 7, Co gap sau cac ngon tay; 8 Co gap co tay tru; 9, Khoi co tren loi cau
(gom cac co sap tron. gap co tay quay, gan tay dai. va dau canh tay cua cd gap nong cac ngon tay)
10 Cd nhi dau; 11. Cd canh tay, 12 Xem tiep phan bam tan cua cac gan gap (d hinh 7 18. 7 19.
7.20, 7.31, 7.32).

1.6. Cd ga p sa u ca c n g o n ta y (M. flexor digitorum profundus (Hinh 7.17

va 7.18).
- Nguyen uv: bam vao mat trtfdc trong xudng tru, mom vet va mang gian cot
cang tay.
- Bam tan: xuong tdi phia dtfdi cang tay cd tach thanh 4 gan di xuong luon
dtfdi mac ham cac gan gap. d sau cac gan cd gap n6ng, roi toa xuong cac ngon tay
tii II - V: khi xuong tdi ngon tay. moi gan choc qua gan thung cua cd gap nong de
bam vao dot III cua ngon. va dude goi la gan xien (Hinh 7.19).
- Dong tac: gap dot III ngon tay vao dot II va gap ban tay vao cang tay.
- Than kinh van dong cac gan di vao ri£6n II, III: tach ra ttf than kmh giiia.
Than kinh van dong cac gan di vao ngon IV,"V: tach ra tti than kinh tru.
 CAC CO CHI TREN 117

Hinh 7.18. Bam tan cua cac gan gap nong va sau ngon tay (nhin tru'dc)
1. Gan gap nong ngon tay (gan thung); 2. Giao thoa gan, 3. Gan gap sau ngon tay (gan xien)

1.7. Co? gap d a i n gon c a i (M. flexor pollicis longus). (Hinh 17.17; 17.20)
- Nguyen uy: bam vao phan giQa mat trtfdc xtfdng quay va mang gian cot.
- Bam tan: gan tan di xuong luon dtfdi mac ham cac gan gap. d phia ngoai cac
gan gap sau ngon tay, de xuong bam vao dot II ngon cai.
- Dong tac: gap dot II ngon cai vao dot I va gap dot I vao ban tay.
- Than kinh van dong: mot nhanh cua than kinh giua.

9 2 3

Hinh 7.19. Bam tan cua cac gan gap nong va sau ngon tay (nhin nghieng)

1. Gan gap nong ngon tay, 2. Mac treo gan, 3. Gan gap sau ngon tay; 4 Bao hoat dich
ngon tay (bi cat. md)
 |(U] G IA I P H A U N G l f O l . T A P I

Hinh 7.20. Gan cd gap dai ngon cai va gan cd gap co tay quay, d co tay

1. Gan cd gap dai ngon I; 2. Gan cd gap co tay quay; 3. Nhanh mo cai cua day TK giCfa. 4. 5. Bo nong
va bo sau cua cd gap ngan ngon I. 6 Day than kinh giCfa.
A. Mac ham cac gan gap bi cat va lat ra ngoai de boc lo gan cd gap dai ngon cai d du'di gar ca gap co
tay quay nam trong ong mac rieng cua no (d cho che doi hinh chi/ Y cua mac ham cac gan gap bam
vao 2 mep ranh xu’dng thang) Hai bo cua cd gap ngan ngon I dude keo tach ra de lo gan ca gap dai
ngon I, chay d giiia.
B. Ong mac rieng cua gan cd gap co tay quay bi cat va keo vao trong. Gan cd gap dai ngon cai van
nam d du’di mac ham cac gan gap

1.8. C d s a p v u o n g (M. pronator quadratus) (Hinh 7.21)

Cd hinh vuong nam 0 1/4 dudi cang tay.
- Nguyen uy: 1/4 dudi mat trudc xudng quay.
- Bam tan: 1/4 dudi mat tru'dc xudng tru.
- Dong tac: sap ban tay va sap cang tay.

- Than kinh van dong: mot nhanh cua than kinh giua.

2. CAC c d d v u n g c An g t a y s a u

Vung cang tay sau theo TXGPQT co 12 cd xep thanh 2 ldp: ldp nong va lop sau:
- Ldp ndng co 7 cd. phan ldn di tu loi cau ngoai xu'dng canh tay xuong. chia
thanh 2 nhom:

Nhom ngoai hay phan ngoai (pars lateralis/radialis): gom 3 cd. di xuong doc
theo bd ngoai cang tay va lan ra tru'dc kha nhieu, dude cac tac gia Phap va Xga
xep thanh mot nhom hay o rieng la o cang tay ngoai (Hinh 7.13, 7.22, 7.23).
. Cd canh tay quay.
. Cd duoi co tay quay dai.
•Cd duoi co tay quay ngan.
 CAC CO CHI TREN g j| 119

Hinh 7.21. Cd canh tay quay va cd sap vuong

1. Than kinh quay; 2. Cd canh tay quay; 3. Ldp sau cd ngCfa. 4 Ldp nong cd ngiTa. 5. Ca
sap tron; 6. Cd sap vuong.

Nhom trong gom 4 cO thiic sii thuoc 6 cang tay sau (Hinh 7.23).
•Cd duoi cac ngon tay.
. Co duoi ngon lit.
. Cd duoi co tay tru.
. Cd khuyu.
- Ldp sau: co 5 cd, trong do 4 cd di chech xuong cac ngon tay I. II, thiic sii
thuoc 6 cang tay sau; va 1 cd ngrfa, d tren, vong quanh co xiidng quay ra ngdai va
ra triidc, diidc cac tac gia Phap xep vao 6 cang tay ngdai (cung 3 cd d nhdm ngdai
ldp n 6 ng) (Hinh 7.24).
120 jjlj G IA I P H A U N G U O I. T A P I

Hinh 7.22. Cac co khu ngoai vung cang tay sau

1. Cd canh tay quay. 2. Cd duoi co tay quay dai 3 Cd duoi co tay quay ngan 4 C a duoi
cac ngon tay; 5. Cd giang dai ngon cai. 6. Cd duoi ngan ngon cai; 7. Cd duoi dai ngon ca

•Cd giang dai ngon cai.

•Co duoi ngan ngon cai.
. Cd duoi dai ngon cai.
. Co duoi ngon tro.
•Co' ngii’a.
•»
2.1. Cac cd ldp n on g, n h o m ngoai v u n g ca n g tay sau

2.1.1. Cd c a n h ta y q u a y (M. brachioradialis): nam doc bd ngoai cang tay va i

ra tru'dc khd nhieu (tdi hdn 114 chieu rong cua cang tay (Hinh 7 .13, 7.21, 7.22).
Nguyen uy: mao tren loi cau ngoai xtfdng canh tay va vach gian cd ngoai.
 CAC CO CHI TREN []Jj 121

Bam Lan: cd rong d tren thu hep dan d dudi. bam tan d mom tram xudng quay.
Dong tac: gap cang tay vao canh tay va ngiia cang tay (khi dang de sap).
Than kinh van dong: Mot nhanh cua than kinh quay.

Hinh 7.23. Cac cd vung cang tay sau (ldp nong)

1. Mom khuyu: 2. Cd khuyu; 3. Cd gap cd tay tru; 4. Cd duoi cd tay tru; 5. Cd duoi ngon ut; 6 Mom tram
tru; 7. Cd duoi dai ngon cai; 8. Cd dudi ngan ngon cai; 9. Cd giang dai ngon cai; 10. Cd duoi cac ngon
tay; 11. Cd duoi cd tay quay ngan; 12. Cd duoi cd tay quay dai. 13. Cd canh tay quay

2.1.2. Ca d u oi c o ta y q u a y d a i (M. extensor carpi radialis longus (Hinh 7.22. 7.23):

Nguyen uy: phia tren mom tren loi cau ngoai xu'dng canh tay va vach gian cd
ngoai canh tay.
Bam tan: gan tan keo dai bi bat cheo d sau bdi cac cd giang dai ng 6 n I, dudi
ngan va dudi dai ng 6 n cai, va luon difdi mac ham cac gan dudi d c 6 tay, de xuong
mu tay bam tan vao nen xtfdng ban tay II.
Dong tac: duoi va giang ban tay.
Than kinh van dong: tach ra ttf than kinh quay.
122 HD GIAI PH A U N G U O I. TA P I

Hinh 7.24. Cac co vung cang tay sau (lap sau)

1. Gan duoi cac ngon tay; 2. Gan duoi co tay quay dai va n g in ; 3. Cd duoi ngon tro. 4 Cd duoi ngan
ngon cai; 5. Cd duoi dai ngon cai; 6. Cd giang dai ngon cai. 7. Cd ngifa. 7'. Mang gian cot 8 Bo
giC/a day chang ben quay (ben ngoai); 9. Cd khuyu.

2.1.3. Cd duoi co tay q u a y ngan (M. extensor carpi radialis brevis (Hinh 7.22. 7.23).
Nguven uv: Mom tren loi cau ngoai xudng canh tay.
Bam tan: Cd di song song d sau trong cd duoi co tay quay dai, xuong bam tan
vao nen xtfdng ban tay III.
Dong tac: duoi va giang ban tay.
Than kinh van dong: mot nhanh cua than kinh quay.
*>
2.2. Cac cd ldp n on g, n h o m tro n g v u n g ca n g tay sau
2.2.1. Cd d u o i c d c n g o n ta y (M. extensor digitorum) (Hinh 7.22 va 7.23):

Nguyen uy: mom tren loi cau ngoai xtfdng canh tay.
 C A C CO CHI T R E N fjj] 123

Bam tan: xuong dtfdi, cd chia thanh bon gan cho 4 ngon tay tu II den V. luon
dtfdi mac ham cac gan duoi d cd tay, toa xuong mu tay. Xuong tdi ngon tay, moi
gan lai chia thanh 3 che de bam vao nen cac dot II va III cua ngon tay tUdng ling
(Hinh 7.26, 7.27).
Dong tac: duoi cac ngon tay II - V va duoi ban tay.
Than kinh van dong: mot nhanh cua than kinh quay.

2.2.2. Cd d u o i n g o n ut (M. extensor digiti minimi) (Hinh 7.23).

Nguyen uy: mom tren loi cau ngoai xUdng canh tay, d sat trong cd duoi cac
ngon tay.
Bam tan: tdi nen ngon ut thi hoa lan vdi gan ngon ut cua cd duoi cac ngon tay.
Dong tac: duoi ngon lit.
Than kinh van dong: mot nhanh cua than kinh quay.

2.2.3. Ca d u o i c o t o y tru (M. extensor carpi ulnaris): nam doc bd sau xuong tru.
Nguyen uy: mom tren loi cau ngoai xtfdng canh tay va bd sau xu'dng tru.
Bam tan: nen xu'dng dot ban tay V.
Dong tac: duoi va khep co tay.
Than kinh van dong: Mot nhanh cua than kinh quay.

2.2.4. Ca k h u y u (M. anconeus): la mot cd nho. hinh thap, nam d sat phia trong
mom khuyu: duoc cac tac gia Nga (Sinelnikov. 1963) coi nhu mot phan tiep tuc cua
dau trong cd tam dau. va xep cung nhom co' cua vung canh tay sau.
Nguyen uy: bam vao mom tren loi cau ngoai xtfdng canh tay. va day chang ngoai
khdp khuyu.
Bam tan: vao mat sau trong mom khuyu va hoa lan vdi bao xd khdp khuyu.
Dong tac: duoi canh tay d khdp khuyu, dong thdi keo bao khdp len.
Than kinh van dong: mot nhanh cua than kinh quay, tiep tuc nhanh cua dau
trong cd tam dau canh tay di xuong.
*>
2.3. Cac c d ldp sau v u n g ca n g tay sau

2.3.1. Ca g i a n g d a i n g o n ta y c a i (M. abductor pollicis longus) (Hinh 7.23).

Nguyen uy: mat sau xtfdng tru, xtfdng quay va mang gian cot cang tay.
Bam tan: nen xtfdng dot ban tay I.
Dong tac: giang ngon tay cai.
Than kinh van dong: mot nhanh cua than kinh quay.
E l i GIAI PH A U NGUC3I. T A P I

2.3.2. Cd d u o i n g a n n g o n ta y c a i (M. extensor pollicis brevis):

Nguyen uv: mat sau xtfdng quay va mang gian cot cang tay.
Bam tan: nen xtfdng dot I ngon cai.
Dong tac: duoi va giang ngon cai.
Than kinh van dong: mot nhanh cua than kinh quay.

2.3.3. Cct d u o i dd i n g o n ta y c a i (M. extensor pollicis longus):

•I ' • °
Nguyen uy: phan giiia mat sau xtfdng tru va mang gian cdt cang tay.
Bam tan: nen dot II ngon cai.
Dong tac: duoi dot II ngon cai.
Than kinh van dong: mot nhanh cua than kinh quay.

2.3.4. Cd d u o i n g o n tr o (M. extensor indicis): d thap nhat trong cac cd 16p sau
(Hinh 7.24).
Nguyen uy: phia dtfdi mat sau xudng tru. mang gian cot cang tay.
Bam tan: tdi nen dot I ngon tro thi hoa lan vdi gan ngon tro cua co duoi cac
ngon tay.
Dong tac: duoi ngon tro.
Than kinh van dong: tach ra ttf than kinh quay.

Hinh 7.25. Cd ngura. Sd do nguyen uy va bam tan (Theo Gregoire va Oberlin)

1. Ldp nong; 2. Nganh sau day than kinh quay; 3. Thi/ng chech (day ch^ng Weitbrecht).
4. Ldp sau; 5. Bo giCra day chang ben quay (cua khdp khuyu).
 C A C CO CHI T R E N g|| 125

2.3.5. Ca ngita (M. supinator): Cd ngtfa co 2 ldp chong len nhau va quan xung
quanh co xUdng quay, giUfa hai ldp co nganh sau than kinh quay di qua (Hinh
7.24. 7.25):
Ldp nong: di ttf mom tren loi cau ngoai xtfOng canh tay va tif bo giua day
chang ben quay khdp khuyu di chech xuong dtfdi va ra ngoai vong quanh dau
tren xtfdng quay, tdi bam vao 1/3 tren mat ngoai xtfdng quay, d tren cho bam cua
cd sap tron, dtfdi u loi xtfdng quay.
Ldp sau: di ttf phia sau hom quay va mao cd ngtfa cua xtfdng tru. vong qua co
xtfdng quay de bam vao mat ngoai phan tren va co xtfdng quay.
•» ')
Dong tac: ngtfa cang tay va ban tay.
Than kinh van dong: mot nhanh cua than kinh quay.

CAC CO 6 BAN TAY

Ban tay gom co hai vung: vung gan tay va vung mu tay, ngan cach nhau bdi
cac xtfdng ban tay va cac khoang gian cdt ban tay. Trong cac khoang gian cdt co
cac cd gian cdt gan tav va mu tay.

1. Cac c d d m u tay

O mu tay chi co gan cua cac cd duoi ttf vung cang tay sau di xudng (va cac cd
gian cdt mu tay d ldp sau). Cac gan duoi cd the chia thanh ba nhom: trong, ngoai
va giiia (Hinh 7.26).

1.1. N h om ngoai

Co cac gan di ve phia ngon cai: gan co giang ngon cai, gan co duoi dai ngon
cai, gan cd duoi ngan ngon cai.

1.2. N h om tro n g

Cd cac gan di ve phia ngon ut: gan cd duoi ngon ut, gan cd duoi co tay tru.

1.3. N h o m giufa

Co cac gan di xuong cac ngon tay con lai: gan cd dudi cac ngon tay va gan cd
dudi ngon trd.

Xudng tdi ngon tay, mdi gan dudi con dtfpc tang ctfdng bdi cac dai bam
tan cua cac gan dudi phu trd, den ttf cac cd gian cot va cac cd giun. (Hinh
7.26, 7.27).
 GIAI P H A U N G U O l. T A P I

H inh 7.26. Cac gan cd du o i d m u tay

1. Gan cd dudi co tay tru; 2 Cd duoi ngon V. 3. Gan cd duoi cac ngon tay, 4 Cung dong mach mu
tay, 5. DM gian cot mu tay I (DM chinh ngon cai); 6. Gan cd duoi dai ngon I, 7 Dong mach quay
8. Gan cd duoi ngan ngon I, 9 Gan cd duoi co tay quay ngan, 10. Gan cd duoi co tay quay dai

0 co tay, khi qua mac ham cac gan duoi. cac gan cleu dtfdc hoc trong cac bao
hoat dich mu co tay cua chung (vaginae tendinum carpales dorsales). giup chung
hoat dong dupe de dang (Hinh 7.28).
1 2 3 4

Hinh 7.27. Sd do tan cung cac gan duoi chinh va phu ngon tay
(Theo Gregoire & Oberlm. 1953).

1 Gan cd duoi cac ngon tay; 2. Cac sdi xien; 3 Gan tan cd gian cot; 4. Gan tan toa rong cua cd gian
cot bam vao gan du6i ngon tay; 5 Cd gian cot; 6 Cd giun; 7. Gan cd gap sau ngon tay 8 Can gan
tay giCra; 9. Gan cd gap nong ngon tay.
(Nhan xet: Phan bam tan cua cac cd gian cot va cd giun vao gan duoi ngon tay cho phep lam dong
tac gap dot I ngon tay vao ban tay. trong khi van duoi cac dot II va III ngon tay).
 C A C CO CHI T R EN
m

Hinh 7.28. Cac bao hoat djch cua cac gan c0 duoi 6 mu tay (Theo Sinelm kov Moskva 1963)

1. Mac ham cac gan duoi; 2. Bao hoat dich gan duoi cd tay tru; 3. Bao hoat dich gan duoi cac ngon
tay va gan duoi ngon tro; 4. Bao hoat djch gan duoi ngon ut; 5. Cac can gian gan; 6. Bao hoat dich
gan duoi dai ngon cai. 7. Bao hoat dich cac gan giang dai va duoi ngan ngon cai 8. Bao hoat dich
cac gan duoi co tay quay dai va ngan.

2 . CAC c d 6 GAN TAY

Cac cd d gan tay chia lam 4 nhom:

- Nhom cd o mo cai: o' ngoai.
- Nhom cO o mo ut: d trong.
- Nhom cd o gan tay giQa: d giQa.
- Nhom cac cd o gian cot: d sau.

2.1. N h o m cd o m o c a i: Gom 4 cd (Hinh 7.29, 7.30. 7.31):

2.1.1. Cd giang ngan ngon cai (M. abductor pollicis brevis): nam d lia ngoai mo cai.
Nguyen uy: cu xQdng thuyen va xQdng thang.
128 (jj; GIAI ph A u N G l/O l. TA P I

Bam tan: nen xudng dot I ngon cai.

Dong tac: giang ngon cai.

2.1.2. Cd g a p n g a n n g o n c a i (M. flexor pollicis brevis):

Nguyen uy: co 1
‘ dau:
Dau nong (caput superficiale): bam vao cu xUdng thang
Dau sau (caput profondus): bam vao xUdng the, xtfdng ca.
Bam tan: hai bo turn lai bam vao nen dot 1 ngon cai.
Chu y: Giiia hai dau cua cd gap ngan co gan cua cd gap dai ngon cai chay qua.

Hinh 7.29. Cac cd d gan tay (ldp nong)

1 Gan cd canh tay quay. 2 Gan co gap co tay quay; 3. Gan cd gan tay dai; 4 Cd giang ngan ngon
cai; 5. Bo nong c0 gap ngan ngon cai. 6 Cd khep ngon cai; 7. Cd gian cot mu tay I. 8 Cac cd giun;
9. Cd gap ngan ngon ut. 10 Cd gan tay ngan (cat ch6 bam vao can gan tay va keo vao trong).
11. Cd giang ngon ut; 12 Gan gap nong cac ngon tay; 13. Gan cd gap co tay tru.
 C A C CO CHI T R E N [>Jj 129

2.1.3. C o d oi c h ie u n g o n c a i (M. opponens pollicis)

Nguyen uy: cu xUOng thang.

Bam tan: bd ngoai xUdng ban tay I.

Dong tac: doi chieu ngon cai vdi cac ngon khac.

2.1.4. C o k h e p n g o n c a i (M. adductor pollicis)

Nguyen uy: cd 2 dau:

Dau cheo (caput obliquum): bam vao xtfdng the, xtfdng ca va nen xtfdng ban
tay II, III.

Dau ngang (caput transversum): bam vao mat trtfdc xtfOng ban tay III
Bam tan: phia trong nen xtfdng dot I ngon cai.
Dong tac: khep ngon cai.
Than kinh van dong cac cd mo cai: la cac nhanh cua than kinh giua. trtf cd
khep va dau sau cd ngan gap la do than kinh tru van dong.

2.2. N hom cd o m o ut
(iom 1 cd: (Hinh 7.29. 7.30, 7.31).
1

Hinh 7.30. Cac cd mo cai va mo ut (ldp nong)

1 Gan cd gap co tay quay; 2. Gan cd giang dai ngon cai, 3. Co giang ngan ngon cai 4 Co doi chieu
ngon cai; 5. Dau nong ca gap ngan ngon cai; 6. Dau sau cd gap ngan ngon cai 7 Dau cheo cd khep
ngon cai; 8. Dau ngang cd khep ngon cai; 9. Cd doi chieu ngon ut 10. Cd gap ngan ngon ut 11. Cd
giang ngon ut, 12. Gan cd gap co tay tru.

2.2.1. C o g a n ta y n g a n (M. palmaris brevis): la mot cd bam da (Hinh 7.15: 7.29).

Nguyen uy: bam vao can gan tay va ham cac gan gap.

9- (iPN-TI
rPTnim g ia i p h a u n g u o i . t a p i

Bam tan: vao da 0 bd trong ban tay.

Dong tac: lam cang da phu tren mo lit.

2.2.2. Ca g i a n g n g o n ut (M. abductor digiti minimi):

Nguyen uy: xifdng dau.

Bam tan: phia trong nen dot I ngon lit.
Dong tac: giang ngon lit va gap dot I ngon lit.

2.2.3. Ca g a p n g d n n g o n ut (M. flexor digiti minimi brevis):

Nguyen uy: moc xiidng moc.

Bam tan: nen dot I, ngon lit.
Dong tac: gap dot I ngdn lit vao ban tay.

2.2.4. Ca d oi c h ie u n g o n ut (M opponent digiti minimi): nam sat xifdn? ro tav

va xudng ban tay.

Nguyen liy: moc xudng moc.

Bam tan: bd trong xuong ban tay V.

Dong tac: doi chieu ngdn lit vdi cac ngon khac. Khep va gap xUdng ban tav V.

Than kinh van dong cac cd md ut: deu tach ra tii' than kinh tru.

Hinh 7.31. Cac ccJ mo cai va mo ut (ldp sau)

1. Gan cd giang dai ngon cai: 2 Cd giang ngan ngon cai (bj cit); 3. Cd doi chieu ngon cai. 4 Dau
sau cd gap ngan ngon cai; 5. Dau nong cd gap ng§n ngon cai; 6. Dau cheo cd khep ngon cat 7 Dau
ngang cd khep ngon cai; 8 Cd doi chieu ngon ut; 9. Cd giang ngon ut; 10. Cd gap n g ln ngon ut (bi
cat); 11. Gan cd gap co tay tru.
 C A C CO CHI T R E N 0 131

2.3. N h om gan cd o gan tay giiia

Gom cac gan gap va cac cd giun (Hinh 7.29. Hinh 7.32, 7.33, 7.31) xep thanh
2 ldp:

2.3.1. Ldp n o n g : co 4 g a n g a p n o n g c d c n g on ta y (Hinh 7.29; 7.32).

Mdi gan khi xudng tdi dot gan ngdn tay tach thanh hai cho bam vao hai ben
sQdn dot giiia ngdn tay nen goi la gan thung.

Hinh 7.32. Cac cd d gan tay (O giCra da cat bo cac gan cd ldp nong)
1. Cd sap vuong, 2 Cd giang ngan ngon cai; 3. Cd doi chieu ngon cai 4 Gan cd gap dai ngon cai.
5. Gan cd gap nong ngon tay (gan thung); 6. Gan cd gap sau ngon tay (gan xien); 7 Cac cd giun.
8. Cd gap ngan ngon ut; 9. Cd doi chieu ngon ut; 10. Mac ham cac gan gap (bi cat); 11. Cd giang
ngon ut (bi cat); 12. Gan cd gap sau cac ngon tay; 13. Cd gap dai ngon cai.

2.3.2. Ldp g iiia : cd 4 g a n g a p s a u c d c ngdn tay i d 4 eel g iu n (Hinh 7.32, 7.34).

Khi xuong tdi cac dot ngon tay, mdi gan gap sau chui qua giuia hai che cua gan
gap ndng de bam vao mat triidc dot xa nen goi la gan xien.

O co tay, gan tay va cac ngdn tay cac gan gap ngdn tay va cd tay deu dude boc
bdi cac bao hoat dich chung hoac rieng cua chung d co tay gan tay (vaginae
132 |[j|j GIAI PH A U NGUCJI. TAP I

tendinum carpales palmares), va cac bao hoat dich ngon tay (vaginae synoviales
digitorum manus) (Hinh 7.33).
Cdc cd giun (Mm. lumbricales): diidc goi ten tii I - IV thd tu tu ngoai vao
trong, di td cac gan gap sau ngon tay den cac gan duoi ngon tay (Hinh 7.32,
7.34, 7.27).
- Nguyen uv:
Co giun I va II, bam vao phia ngoai gan gap sau cua ngon II va ngon III.
Co giun III va IV: moi cd bam vao ca 2 ben cac gan gap sau ke can. thuoc
ngon III, IV va V (Hinh 7.32).

Hinh 7.33 Cac bao hoat dich cac gan gap d gan tay phai
(Theo Sinelm kov. Atlas giai phau ngi/di. Moskva. 1963).
1 Bao hoat dich gan cd gap cd tay quay. 2 Bao hoat dich gan cd gap dai ngon cai. 3 Bao heat dich
gan cd gap dai ngon cai, 4 Bao hoat dich ngon tay V; 5. Bao hoat dich chung cac gan gap 6 Mac
ham cac gan gap (bi cat); 7 Gan cd gap nong cac ngon tay (keo ra); 8 Gan co gap sau cac ngon
tay, 9, Cd sap vuong.
 C A C CO CHI T R EN jjjj 133
Iicim tan: moi gan tan di xuong bam vao phia ngoai cac gan duoi ngon tay
tu ngon II den ngon V (Hinh 7.27).
- Dong tac: duoi dot II, III va gap dot I vao gan tay d cac ngon tay tu II den V.
*- Than kinh van dong:
Co giun I, II: do than kinh giufa van dong.
Co giun III, IV: do than kinh tru van dong.

2.4. N h om cac c d ldp sau (cac co gian cot)

Gom 8 cO gian cot 6 cac khoang gian cot ban tay, chia thanh 2 loai (Hinh 7.31
va 7.32): 4 co gian cot gan tay va 4 cO gian cot mu tay.

2.4.1. Cdc cd g i a n c o t g a n ta y (Mm. interossei palmares)

—Nguyen uv: gom 4 co bam vao ntfa trtfdc mat gan true giiia ban tay cua car
xudng ban tay I. II. IV. V. (Nghia la cd gian cot gan tay I va II bam vao 1/2 tru'dc
mat trong cac xu'dng ban tay I, II. Cd gan cot gan tay III, IV bam vao nua trudc
mat ngoai xu'dng ban tay IV, V).
— Bam tan: bdi mot gan nho bam vao nen dot gan ngon tay va mot can toa
long bam vao gan duoi cua cac ngon ttfOng ung, d phia cung ben vdi nguyen uy,
nghia la phia gan true giua ban tay.
- Dong tac: gap dot I. duoi dot II, III; khep cae ngon tay (phu).

Hinh 7.34. Cac gan gap sau va cac cd giun

1. Cac gan gap sau cac ngon tay; 2. Gan gap dai ngon tay cai; 3. Cac day chang vong
bao xd ngon tay (b| cat; ma ra); 4. Cac gan ca gian cot gan tay va mu tay; 5 Cac c0 giun
134 i GIAI P h A u NGI/CJI. T A P I

2.4.2. Cac c a g i a n c o t m u ta y (Mm interossei dorsales)

- Nguyen liy:
Cac cd gian cot mu tay I. II. Ill, IV: moi cd bam vao ca hai xiidng ban tay d 2
ben khoang gian cot (6 1/2 sau dien bam cua cac cd gian cot gan tay va d cac mat
xu'dng con lai ben doi dien).
Ham tan: vao nen dot I ngon tay va vao gan duoi cac ngon ttfdng Ung, d
phia doi dien vdi cho bam cua cac co gian cot gan tav, nghla la phia xa true giiia
ban tay.
- Dong tac: gap dot I. duoi dot II, III; giang cac ngon tay (phu).
- Than kinh van dong: Ca 8 cd gian cot deu do than kinh tru chi phoi.

Hinh 7.35. Cac co o gan tay (ldp sau)

1. Cd gap dai ngon cai; 2. Cd giang ngan ngon cai 3 Cd doi chieu ngon cai, 4. Cd giang ngan ngon
cai 5 Cd gap ngan ngon cai 6 Cd khep ngon cai 7 Gan cd gap dai ngon cai (chay giCra 2 t o co
gap ngan); 8 Gan co gap sau cac ngon tay (keo lat len de thay cac cd lOp sau), 9 Cac co giun (lat
len); 10. Cac c0 gian cot mu tay 11 Cac co gian cot gan tay. 12 Co gap ngan ngon ut 13 Co doi
chieu ngon ut; 14 Co giang ngon ut 15 Cac gan co gap sau cac ngon tay.
(Cac co gian cot 6 1/2 ngoai ban tay bi che khuat boi co khep ngon cai. Toan bo cac co gian cot va
co khep ngon cai tao nen o gian cot - khep thuoc lOp sau o gan tay giCra).
 C A C C O CHI T R EN 0 135

Hinh 7.36. Cac cd gian cot ban tay (nhin tru'dc). (Theo G regoire va Oberlin 1953)
1. Cd gian cot gan tay I; 2. Cd gian cot mu tay I, 3. Cd gian cot mu tay II 4 Cac cd
gian cot gan tay II va III; 5. True ban tay.

Hinh 7.37. Bam tan cua mot cd gian cot (gan tay hoac mu tay) (nhin sau)
(Theo Gregoire va Oberlin, 1953)
1. Gan tan bam vao nen dot gan ngon tay; 2. Can toa rong bam vao gan duoi; 3. Lung
ti/a gan duoi, 4. Gan du6i ngon tay (Xem them cac Hinh 7.26, 7.27, 7 28).
136 [>J] GIAI PH A U N G J O I. T A P I

8. MACH CHI TREN

■

Trong bai nav chung toi se lan ltfOt mo ta:

- Cac dong mach chi tren.
- Cac tinh mach chi tren.
- Cac mach bach huyet chi tren.

CAC DONG
■
MACH
■
CHI TREN
( A r t e r i a e m e m b r i s u p e r io r is )

Cac dong mach chi tren bat nguon tu dong mach du'di don.
Dong mach dudi don sau khi chui qua kho sudn don d dudi diem giua xuong
don thi doi ten thanh dong mach nach. nam trong ho nach. Toi bo duoi cd nguc to.
dong mach nach doi ten thanh dong mach canh tay. Dong mach canh tay chav
qua ong canh tay va qua vung khuyu trudc. xudng du'di nep gap khuyu khoang
3cm, thi chia thanh 2 nganh cung la dong mach quay va dong mach tru. Hai
mach nay di qua vung cang tay tru'dc xuong tdi ban tay thi tan het boi hai cung
dong mach: cung gan tay nong va cung gan tay sau. Tu cac c un g nay tach ra cac
nhanh cap mau cho ban tay va cac ngon tay.
Nhin chung dong mach chi tren co 2 dac diem:
- Ve du'dng di: Cac mach chinh deu nam d mat gap cua chi; d phia trong
(dong mach nach, dong mach canh tay) va phia trudc cua chi (phan dudi cua dong
mach canh tay, dong mach quay, dong mach tru. cac cung dong mach gan tay
nong va sau).
- Ve phan bo: Cac mach chinh lien quan mat thiet vdi cau tao cua bo xtfdng
chi. Canh tay co 1 xuong. chi co mot dong mach cung ten: dong mach canh tay.
Cang tay co 2 xtfdng thi cung co hai dong mach cung ten: dong mach quay va
dong mach tru. Ban tay co 5 xtfdng thi cung co 5 nhanh mach ttfdng tfng xuat
phat tu cac cung dong mach gan tay de di tdi cac ngon tay.

1. D O N G M A C H NtA C H (arteria axillaris)

1.1. N g u y en uy, tan cu n g

Dong mach nach tiep tuc dong mach dtfdi don, di ttf diem giiia mat dtfdi
xuong ddn tdi bd dudi cO ngtfc to thi doi ten thanh dong mach canh tay.
 M A C H CHI TR EN

Hinh 8.1. Dong mach chi tren

(Theo Trjnh Van Minh).

1. Dong mach vai sau;

2. Dong mach vai tren;
3 Dong mach cung vai - ngtfc;
4. Dong mach mu canh tay sau;
5. Dong mach mu canh tay tru’dc;
6. Nhanh cd delta;
7. Dong mach nuoi xu'dng canh tay;
8. Dong mach canh tay sau.
9. Dong mach quat ngtfdc quay;
10. Dong mach quat ngtfdc gian cot;
11. Dong mach gian cot sau;
12 Dong mach quay
13 Nhanh gan co tay quay
14 Mom tram quay
15 Nhanh gan tay nong
16. Dong mach chinh ngon cai.
17. Cac dong mach gan ban tay.
18. Cac dong mach gan ngon tay rieng,
19. Cac dong mach gan ngon tay chung,
20. Cung dong mach gan tay nong
21. Cung dong mach gan tay nong,
22. Nhanh gan tay sau
23. Xu'dng dau
24. Nhanh mu co tay tru
25. Nhanh gan co tay tru
26. Dong mach tru,
27. Dong mach gian cot tru'dc,
28. Dong mach gian cot chung,
29. Dong mach quat ngudc tru
30. Dong mach quat ngtfdc tru tru'dc;
31. Dong mach quat ngtfdc tru sau;
32. Dong mach ben tru dtfdi;
33. Dong mach bfen tru tren
34. Dong mach canh tay;
35. Dong mach vai dtfdi;
36. Cac nhanh sudn trtfdc;
37. Deng mach ngtfc ngoai,
38. Dong mach nach,
39 Dong m ach ngtfc tren,
40. Dong m ach ngtfc trong
41 Dong m ach dtfdi don;
42 Than giap co.
138 |[jjj GIAI PH A U N G U O l. T A P I

1.2. Du’dng di va dinh m oc

Khi tie xuoi tay doc theo than minh. dong mach nach chay chech xuong dudi.
ra ngoai va ra sau. tao thanh mot du'dng cong lom xuong dudi va vao trong.
(Hinh 8 . 1 ).
Khi dang tay vuong goc v6i than minh. ban tay de ngiia, dong mach nam tren
mot difdng vach tu diem giua xUdng don tdi diem gitia nep gap khuyu (dUdng
dinh moc cua dong mach).

1.3. Phan d oan, lien quan

Dong mach chav trong ho nach, lien quan vdi cac thanh cua nach va
cac thanh phan diing trong nach (tinh mach, than kinh...). Dac biet, dong
mach nach chav doc theo phia sau bd trong cO qua canh tay la cO tuy hanh cua
dong mach.
Tron difo'ng di. co' nguc be bat cheo qua tru'dc dong mach chia doiv_r mach
thanh 15 doan co lien quan khac vdi dam roi than kinh canh tay d nach doan iron
cd ngtic be, doan sau cO nguc be va doan dudi cd nguc be... (se dude mo ta ky hdn d
phan giai phau dinh khu vung nach) (Xem hinh 10.2).

1.4. N gan h ben

Dong mach nach tach ra o hoac 6 nganh ben. theo thu' tif tu' tren xuong duoi la:

1.4.1. D o n g m a c h n gtfc tren (A. thoraciea superior)

La mot nhanh nho. tach tii mat trudc dong mach, ngay difdi xu'dng don. choc
qua mac ddn - nguc de cap mau cho phan tren nguc va vu.

1.4.2. D o n g m a c h c u n g vai - ngtfc (A. thoraco-acronualis)

Tach tif mat triidc dong mach nach. ngang mile bd tren co ngiic be. xuyen qua
mac ddn - ngiic, chia thanh 1 nhanh goi ten theo vung cap mau nhii sau:
- Nhanh cung vai (ramus acromialis): phan nhanh cho mom cung vai va khdp
vai, tham gia vad mang mach cung vai (ndi tiep vdi cac nhanh cua ddng mach
tren vai, va ddng mach mu canh tay sau).
- Nhanh delta (ramus deltoideus): chay trong ranh delta - ngiic phan nhanh
cho cd delta.
- Nhanh don (ramus clavicularis): cap mau cho cd diidi don va khdp tic don.
- Cac nhanh ngiic (rami pectorales): di vao cd nguc ldn va cd ngiic be.

1.4.3. D o n g m a c h n g tfc n g o a i (A thoracica lateralis)

Tach tii’ mat trong cua dong mach nach, d doan sau cd ngiic be. chay doc theo
bd ngoai cd nguc be roi cho cac nhanh di vao cac cd ngiic, cd rang trUdc va cac cd
gian sudn.
 M A C H CHI T R E N (JQ 139

1.4.4. D o n g m u c h du’di vai (hay vai dudi) (A. subscapulans)

Xuat phat tii phia trong cua dong mach nach. chui qua lo tam giac ba vai tam
dau, ra sau, chia thanh hai dong mach:
Dong mach ngifc lUng (A. thoracodorsalis): phan nhanh vao cac cd lung rong.
rang triidc, gian siidn d thanh ben cua ngiic.
Dong mach mu vai (A. circumflexa scapulae): di ra mat sau xiidng vai roi 1161
vdi dong mach vai tren va vai sau cua dong mach diidi ddn.

1.4.5. D o n g m a c h m u c a n h tay triidc (A. circumflexa anterior humeri)

Thiidng tach tif mot than chung vdi dong mach mu - canh tay sau. vong ra
triidc co phau thuat xiidng canh tay, tdi ranh gian cu chia thanh hai nhanh:
nhanh len di vao khdp vai; nhanh ngoai di tdi cd delta va noi vdi dong mach mu
canh tay sau.

1.4.6. D o n g mcich m u c a n h tay s a u (A. circumflexa posterior humeri)

Tach tu' phia sau dong mach nach hoac tu 1 than chung da ke. roi cung day
than kmh nach, chui qua lo tif giac, vong ra phia sau co phau thuat xifdng canh
tay tdi vung delta nuoi cd delta va noi vdi dong mach mu - canh tay trifdc.

1.5. N ganh noi

Cac nganh ben cua dong mach nach tiep noi vdi cac nganh ben cua dong
mach du'di ddn va dong mach canh tay tao nen 3 vong noi.
- Vong noi quanh vai:
Do nganh dudi vai cua dong mach nach tiep noi vdi nganh vai tren va vai sau
cua dong mach dudi ddn (d mat sau xu'dng vai).
- V o n g n o i q u a n h n g u ’c:

Do nganh nguc ngoai va nhanh ngu'c cua dong mach ngiic — cimg vai (thuoc
dong mach nach) tiep 1101 vdi cac nhanh gian sudn cua dong mach ngifc trong
thuoc dong mach du'di don (d thanh trifdc ngu'c).
- V ong n o i q u a n h ca n h ta y:

Do hai dong mach mu - canh tay trifdc va mu - canh lay sau tiep noi vdi
nhau d quanh co phau thuat xu'dng canh tay va noi tiep vdi mot nganh delta di
len cua dong mach canh tay sau (thuoc dong mach canh tay).
Ngoai ra vong mach mu con co mot nhanh di len de tiep noi vdi mang mach
quanh mom cung vai.

1.6. A p d u n g thtfc te

Do co nhieu vong noi, dong mach nach co the that dude, trii d doan nguv
hiem: giiia nguyen uv cua dong mach difdi vai va dong mach mu. hay noi mot
each chung hdn, d du'di nguyen uy cua dong mach du'di vai.
140 i GIAI PH A U N G U O l. T A P I

2. D O N G M A C H C A N H T A Y (artena brachialis)

2.1. N guyen uy, tan cu n g

Dong mach canh tay la phan tiep theo cua dong mach nach bat dau tii bd
difdi cd ngu'c to tdi dudi nep gap khuyu khoang 3cm thi chia thanh 2 nganh cung
la dong mach quay va dong mach tru.

2.2. Du’dng di, d inh m oc va phan doan lien qu an

Dong mach canh tay tiep theo hifdng di cua dong mach nach va nam tren mot
difdng dinh moc vach tQ giQa xtfdng don tdi giQa nep khuyu.
Dong mach di qua 2 doan: doan canh tay va doan khuyu.
- Doan canh tay (tQ bd dQdi cd ngQc to den tren nep gap khuyu 3cm): dong
mach chay doc theo bd trong cd nhi dau canh tay la cd tuy hanh cua dong mach;
va cung vdi cac thanh phan khac (tTnh mach va than kinh) nhm t r o n ? mot on?
gidi ban bdi cac cd - mac phia trong canh tay. goi la ong canh tav (se duoc md ta
kv hdn d phan giai phan dinh khu).
Doan khuyu (tren va du'di nep gap khuyu khoang 3cm): dong mach nam
trong ranh nhi dau trong. cung vdi day than kinh giu'a, tdi du'di nep gap khuyu
khoang 2 - 3cm thi chia thanh 2 nganh cung la ddng mach quay va dong mach tru

2.3. N gan h ben

Cd 3 nganh chinh:
Dong mcich canh tay sau (A.profunda brachn):
La nganh ben ldn nhat cua dong mach canh tay, tach ra d difdi cac ddng mach
- mil canh tay, di cung day than kinh quay qua tam giac canh tay tam dau ra
vung canh tay sau. chay trong ranh than kinh quay cua xifdng canh tay. Dong
mach tach ra:
Cac nhanh ben gom:
+ Cac nhanh cho cd tam dau.

+ Cac dong mach nuoi xuong canh tay (Aa. nutnciae humeri): di vao cac lo
du'dng cdt ciia xifdng canh tay.
+ Nhanh delta (ramus deltoideus): di len cap mau cho phan difdi cd delta va
noi tiep vdi dong mach mu - canh tay sau.
Va 2 nganh cung:
+ Dong mach ben giua (A. collaterals media): chay xuong sau mom tren loi
cau ngoai, ndi vdi dong mach quat ngudc gian cot d phia sau.
+ Dong mach ben quay (A. collateralis radialis): chay xuong ranh nhi d^u
ngoai, ndi vdi dong mach quat ngudc quay d phia trQdc.
 M A C H CHI T R E N [jj| 141

* Dong mach ben tru tren (A. collaterals ulnaris superior): di cung vdi day
than kinh tru, choc qua vach gian cd trong ra vung canh tay sau, xuong noi vdi
dong mach quat ngtfdc tru sau d phia sau mom tren loi cau trong.
* Dong mach ben tru diidi (A. collaterals ulnaris inferior): Tach d thap hdn.
di xuong dtfdi chia 2 nganh: trtfdc noi vdi dong mach quat ngUdc tru trUdc d trong
ranh nhi dau trong, va sau noi vdi dong mach ben tru tren, roi dong mach quat
ngtfdc tru sau d phia sau mom tren loi cau trong.
* Ngoai ra dong mach canh tay con cho cac nhanh cd cho vung canh tay trtfdc.

2.4. N ganh noi

- Noi vdi dong mach nach:
Nhanh delta cua dong mach canh tay sau di len tiep noi vdi cac dong mach
mu - canh tay (cua dong mach nach) d phia sau co phau thuat xifdng canh tay.
- N d i vdi dong mach quay va dong mach tru:
Cac nhanh dong mach ben giiia va ben quay (cua dong mach canh tay sau).
va cac dong mach ben tru tren, ben tru du'di (cua dong mach canh tay) noi vdi cac
nhanh quat ngtfdc cua dong mach quay va dong mach tru, d quanh cac mom tren
loi cau, tao nen cac vong mach quanh khdp khuyu.

2.5. Ap d u n g thu’c te
- Dong mach canh tay co nhiing nganh ben dam bao noi tiep vdi cac dong
mach d du'di nen co the that difdc d difdi nguyen uy cua dong mach canh tay sau
va tot hdn d dudi nguyen uy cua dong mach ben tru tren. Doan nguy hiem la doan
tren nguyen uy dong mach canh tay sau (vi noi tiep d tren khong du dam bao).
Vay doan nguy hiem chung cua dong mach nach va dong mach canh tay la doan d
giua dong mach vai difdi va dong mach canh tay sau.
- Doan nong nhat cua dong mach canh tay la doan nam trong ranh nhi dau
trong; cung la ndi dat ong nghe khi do huyet ap d canh tay.

3. D O N G M A C H Q U A Y (artena radialis)

3.1. N g u y en uy, difdng di, tan cu n g

Dong mach quay la mot trong hai nganh cung cua dong mach canh tay. tach
ra d trong ranh nhi dau trong, dtfdi nep gap khuyu 3cm. chay chech theo hudng
cua dong mach canh tay. tdi bd ngoai xifdng quay, roi chay thang xuong doc theo
phia ngoai vung cang tay trtfdc. Den co tay, dong mach luon dudi mom tram quay
ra mu co tay, roi choc qua khoang gian cdt ban tay I de ra gan tay noi vdi nganh
gan tay sau cua dong mach tru tao nen cung dong mach gan tay sau.
142 ||[j GIAI PH A U N G U O I. T A P I

3.2. D inh m oc va phan doan lien quan

() c^ng tay, nhin chung dong mach nam tren mot difdng vach tu giua nep gap
khuyu den ranh mach.

0 1/3 tren cang tay: dong mach chech d tren cd sap tron. lan ltfdt bat cheo
trtfdc gan cd nhi dau canh tay, cd ngtfa, roi phan tan cd sap tron.

- 6 1/3 gitfa cang tay: mach chav thang xuong doc sau bd trong cd canh tav
quay, la cd tuy hanh cua dong mach.

- 6 1/3 dtfdi cang tay: dong mach nam trong ranh mach quay: gitfa gan cd
canh tay quay va gan cd gap co tay quay (goi la ranh mach, vi do la ndi dong
mach nam nong nhat de co the de dang bat mach d tren co tay).
•K ,, > * _

- O co tay va mu tay: dong mach vong dtfdi mom tram quay de ra sau roi
chav qua hom lao giai phau o' phia mu tay (hom lao difdc gidi han giua hai gan cd
duoi ngan va duoi dai ngon tay) (Hinh 7.20).

3.3. N hanh ben

Dong mach quat ngiMc quay (A. recurrens radialis):
Tach ra tu dong mach quay d 1/3 tren cang tay, di ngtfdc len ranh nhi dau
ngoai va noi vdi dong mach ben quay cua dong mach canh tay sau.
- Nhanh gan co tay (ramus carpalis palmans):

Tach ra d ngang mtfc phan tren dau dtfdi xudng quay va ndi vdi nhanh gan co
tay cua dong mach tru.

- N h a n h gan tay nong (ramus pa lm a ns superficialis):

Thifdng la mot nhanh rat nho tach ra trtfdc khi dong mach quay luon dtfdi
mom tram quay, di xuong gan tay. gop phan tao thanh cun g gan tay nong (arcus
palmaris superficialis).

- N h c i n h mu cd tay (ramus carpalis dorsalis):

Tach ra sau khi dong mach quay da luon dtfdi mom tram quay, xuong hom
lao giai phau. No vong qua mu co tay de noi vdi nhanh mu co tay cua dong mach
tru, tao nen mang hay cung mach mu co tay (rete carpale dorsalis). Ttf mang
mach nay tach ra cdc dong mach mu ban tay (Aa. metacarpales dorsales). phan
chia thanh cac dong mach mu ngon tay (Aa. digitales dorsales). (Hinh 8 .2 ). Tren
dtfdng di, moi dong mach mu ban tay cho 2 nhanh xien ra phia gan tay: nhanh
xien tren (qua dau gan khoang gian cdt. ndi vdi nhanh xien cua cung gan tay sau:
nhanh xien dtfdi (qua dau xa khdang gian cot), noi vdi nhanh xien ctia dong mach
gan ban tay ttfdng tfng (Hinh 8.3).
 M A C H CHI T R E N [>JJ| 143

H inh 8.2. V un g mu tay va cac d o n g m ach mu tay

(Theo R.T. W oodburne. Essentials of Human Anatom y. 1957).
1. Ham cac gan duoi; 2. Nhanh mu co tay cua DM tru; 3. Cung DM mu co tay, 4. Cac cd gian cot mu tay.
5. Cac DM xien du'di (noi vdi DM gan ban tay va gan ngon tay chung); 6. Cac nhanh mu dot 2, 3 cua cac
DM gan ngon tay rieng; 7. Cac DM mu ngon tay rieng; 8. Cac DM mu ban tay, 9. Cac DM xien tren (noi
vdi cac nhanh xien cua cung DM gan tay sau); 10. DM quay. 11. Nhanh mu co tay cua DM quay.

3.4. N G A N H C U N G

Dong mach quay chay qua hom lao giai phau (d giua cac gan cd duoi ngan va
duoi dai ngon cai). tach ra nhanh mu co tay, roi choc qua khoang gian cot I ra gan
tay de tcio thanh cung gan tay sau (arcus palmans profondus). Dong thdi tach ra
dong mach chinh ngon cai (A. pnnceps pollicis) va dong mach quay ngon tro
(A. radialis indicus). Hai dong mach nav thudng dude coi nhu nhung nhanh dau
tien tach ra tu cung gan tay sau (theo cac tac gia Phap): song cung cd the coi nhu
mot trong hai nganh cung cua dong mach quay: chia doi cho dong mach chinh
ngdn cai va cung gan tay sau (theo cac tac gia Anh. My). Chung se dude ta ky hdn
d phan sau (cac vong ndi cua cac ddng mach quay va tru).

3.5. N gan h noi

- Vdi dong mach canh tay: dong mach quat ngudc quay noi vdi dong mach ben
quay (cua dong mach canh tay sau) gop phan tao nen vong noi quanh khdp khuyu.
- Vdi dong mach tru: cac nhanh gan c 6 tay va mu co tay cua dong mach quay
noi vdi cac nhanh cung ten cua dong mach tru. Nhanh gan tay nong va nganh cung
cua dong mach quay noi vdi nganh cung va nhanh gan tay sau cua dong mach tru,
de tao nen cac cung dong mach gan tay nong va sau.
144 g l GIAI PH A U N G U O I. T A P I

3.6. Ap d u n g thife te
Do co nhieu vong noi phong phu nen dong mach quay co the that dtfdc khong
gay nguy hai.

4. D O N G M A C H T R U (arteria ulnaris)

4.1. N guyen uy, dtfOng di, tan cu n g

Dong mach tru cung la mot trong hai nganh cung cua dong mach canh tay,
bat dau tie dudi nep gap khuyu 3cm, chav chech xuong dtfdi va vao trong. tdi cho
noi 1/3 tren vdi 1/3 gitfa cAng tay thi chav thang xuong doc theo cd gap co tay tru
d phia trong vung cang tay trtfdc, va tan het d gan tay bang cach noi vdi nhanh
gan tay nong cua dong mach quay de tao nen cung gan tay nong.

4.2. D inh m oc va phan doan lien quan

Dong mach tru cung cd nhung doan lien quan nhu sau:
Doan chech: d 1/3 tren cang tay dong mach nam rat sau: d >au co -ap tron
va cd gap ndng cac ngdn tay. va d trudc co gap sau cac ngon tay.
Doan thang: d 12/3 dudi cang tay. ddng mach nam tren mot dudng vach tu mom
tren loi cau trong xu'dng canh tay tdi bd ngoai xtfdng dau va chay doc theo co gap
cd tay tru va la cd tuy hanh cua dong mach tru.
- 0 cd tay. dong mach tru chay tru'dc mac ham cac gan gap. d phia ngoai xudng
dau de xuong gan tay.

4.3. N gan h ben

Dong mach tru tach ra 5 nganh ben:

' Dong mach quat ngtfdc tru (A recurrens ulnaris):
Tach ra d dtfdi khdp canh tay - tru khoang 2 - 3 cm, chia thanh hai nganh:
+ Nganh trtfdc (ramus anterior): di ngudc len ranh nhi dau trong de noi vdi
nhanh ben tru dtfdi cua dong mach canh tay.
+ Nganh sau (ramus posterior): chay ra sau mom tren loi cau trong de noi vdi
dong mach ben tru tren.
Dong mach gian cot chung (A. interossea communis):
Tach ra d khoang giua 1/3 tren cang tay. chia thanh ba nganh:
+ Ddng mach gian cdt trudc (A. interossea anterior): di trtfdc mang gian cdt.
cap huyet cho cac cd d ldp sau vung cang tay trtfdc va mot nhanh nho eho day
than kinh gitfa: xuong tdi sau cd sap vuong thi chia 2 nganh cung: trtfdc (di xudng
khdp co tay) va sau (choc qua mang gian cdt de xuong mu tay).
 M A C H CHI T R E N [jjjj 145

+ Dong mach gian cot sau (A. interossea posterior): di qua bd tren mang gian
cot ra vung cang tay sau cap huyet cho cac cd d vung nay.
+ Dong mach quat ngtfdc gian cot (A. interossea recurrens): tach ra ttf dong
mach gian cot chung hoac ttf dong mach gian cot sau, chay ngudc len noi vdi dong
mach ben giiia (cua dong mach canh tay sau) d phia sau mom tren loi cau ngoai
xifdng canh tay.
* Nhanh mu co tay (ramus carpalis dorsalis): tach ra d ngang mtfc dau dtfdi
xtfdng tru, vong ra sau, noi vdi nhanh mu co tay cua dong mach quay.
* Nhanh gan co gay (ramus carpalis palmaris): tach ra d dtfdi do mot chut,
htfdng ra ngoai, noi vdi nhanh gan co tay cua dong mach quay.
* Nhanh gan tay sau (ramus palmaris profondus): tach ra d dtfdi mtfc xtfdng
dau, noi vdi nganh cung cua ddng mach quay tao nen cung gan tay sau (Arcus
palmaris profondus) (Hinh 8.3).

4.4. N ganh cu n g
Nganh cung cua dong mach tru noi vdi nhanh gan tay ndng cua dong mach
quay de tao thanh cu ng gan tay ndng (Arcus palmaris superficialis) d ban tay. Ttf
cung nay tach ra dong mach gan ngdn tay rieng cho bd tru ngdn II va cac dong
mach gan ngon tay chu ng (Aa. digitales palmares communes) nam tru'dc cac
khoang gian cot ban tay II, III, IV. Moi mach nay lai chia thanh 2 dong mach gan
ngon tay 7'ieng (Aa. digitales palmares propnae) di tdi cac ben ke can cua cac
ngdn tay ttfdng tfng.

4.5. N gan h noi

Dong mach tru noi tiep vdi dong mach canh tay va dong mach quay bdi cac
mang mach quanh khdp khuyu d tren, cac mang gan va mu co tay d dtfdi. va cac
cung gan tay d ban tay.
Do cd nhieu vong noi nen dong mach tru co the that dtfdc ma khong gay
nguy hai.

5. M A N G M A C H Q U A N H KHCiP K H U Y U

Mang mach quanh khdp khuyu (rete articulare cubiti), gom 2 vong noi:
- Vong noi quanh mom tren loi cau trdng.
- V 6 ng noi quanh mom tren loi cau ngoai.

5.1. V o n g noi q u a n h m o m tren loi cau tron g

Dtfdc tao nen bdi:
- Dong mach ben tru tren (cua ddng mach canh tay) ndi vdi nganh sau cua
10- GPN-T1
146 i GIAI P H A U NGlfCII. T A P I

dong mach quat ngtfdc tru (cua dong mach tru) va vdi nhanh sau cua dong mach
ben tru dtfdi: d sau mom tren loi cau trong xtfdng canh tay. Ngoai ra. dong mach
ben tru tren cung cho mot nhanh ra trtfdc noi vdi nganh trtfdc cua dong mach
quat ngtfdc tru va vdi dong mach ben tru dtfdi.
- Nganh trtfdc dong mach ben tru dtfdi (cua dong mach canh tay) noi vdi nganh
trtfdc cua dong mach quat ngtfdc tru (thuoc dong mach tru): d trtfdc mom tren loi
cau trong xtfdng canh tay.
- Nganh sau dong mach ben tru dtfdi di tdi phia sau mom tren loi cjiu trong
de cung vdi dong mach ben tru tren noi vdi nganh sau cua dong mach qu&t
ngtfdc tru.

5.2. V o n g noi q u a n h m o m tren loi cau ngoai

Dtfdc tao nen bdi:
D o n g mach ben quay cua d o ng mach canh tay sau ihm V-dt d o n e ma< h quat
ngtfdc quay (cua do ng mach quay): o phia trudc m o m tren loi can neoai xuong
c l u b tay.

Dong mach ben gitfa cua ddng mach canh tay sau ndi vdi clone mat h gian
cdt quat ngudc (thuoc dong mach gian cdt chung cua ddng mach tru): d phia sau
mom tren loi cau ngoai xtfdng canh tay,

6. C U N G G A N T A Y N O N G (a r c u s p a l m a r i s s u p e r f i c i a l i s )

Cung gan tay ndng duoc tao nen bdi su tiep ndi gitfa nganh cung cua dong
mach tru vdi nganh gan tay ndng cua dong mach quay (Hinh 8.3).

6.1. Difdng di va d in h m oc
Nganh cung cua dong mach tru ttf bd ngoai xtfdng dau chay chech xudn g diidi
va ra ngoai, tren cludng ke tu bd ngoai xuong dau den khe giua ngon II va ngon
III (phan chech). roi tat ngang ra ngoai. tren du'dng ng ang qua bd duoi neon cai
khi ngdn nay giang het mtfc (phan ngang) de tiep ndi vdi nganh gan tay n o n e cua
dong mach quay tii vung cd tav xuyen qua cac co md cai di xudng.

6.2. L ien quan

Cung dong mach gan tax' ndng nam ngay dtfdi ldp can gan tay va trudc cac gan
gap ndng ngdn tay.

6.3. P han n h an h

Cung tach ra 4 dong mach gan ngdn tay: nhanh thtf nhat di vao bo trong
ngon lit, 3 nhanh khac goi la cac dong mach gan ngon tay chung (Aa. digitales
 M A C H CHI T R EN [jjj| 147

palmares communes) di vao cac khoang gian cot ban tay II, III. IV. Moi nhanh lai
phan thanh hai dong mach gan ngon tay rieng (Aa. digitales palmares propnae)
de di tdi mat ben cac ngon tay V, IV, III va niia trong ngon tro.
Tom lai, cung gan tay nong cap mau cho ba ngon ritdi, ke tti ngon ut. qua cac
mach gan ngon tay chung va gan ngon tay rieng.

Hinh 8.3. Cac cung dong mach a gan tay

I. Dong mach gian cot tru'dc; 2. Dong mach quay; 3. Nhanh gan co tay quay 4. Nhanh gan tay nong.
5. Cung gan tay sau; 6. Dong mach chinh ngon cai; 7. Cac dong mach gan ban tay; 8 Dong mach
bd quay ngon tro; 9 Cac dong mach gan ngon tay rieng; 10. Cac dong mach gan ngon tay chung,
I I . Nhanh xien; 12, Cung gan tay ndng; 13. Nhanh gan tay sau cua dong mach tru; 14 Nhanh mu
cd tay cua dong mach tru; 15. Nhanh gan cd tay cua dong mach tru; 16 Dong mach tru.
(Chu thich: Dong m ach bd quay ngon tro (8) co the tach tri/c tiep tu" cung gan tay sau hay tu mot
than chung vdi dong m ach chinh ngon cai).

7. C U N G G A N T A Y S A U (arcus palmaris profundus)

7.1. N g u y e n u y

Cung gan tay sau dufdc tao nen bdi sii tiep ndi giiia nganh cung cua dong mach
quay vdi nhanh gan tay sau cua dong mach tru.
148 jfgj GIAI PH A U N G U O l. TA P I

Dong mach quay tii hom lao xuyen qua khoang gian cot I (gitfa xtfdng ban tay
I va II) chui qua giiia 2 ehiu cua cd khep ngon cai. tdi gan tay. htfdng vao trong noi
vdi nhanh gan tay sau cua dong mach tru. Nhanh gan tay sau cua dong mach
tru, cung vdi nhanh sau than kinh tru, choc qua cac cd mo ut, roi htfdng ra ngoai
noi vdi dong mach quay.

7.2. Lien quan

Cung gan tay sau nam trong o gian cot gan tay, sau mac sau gan tay, trtf6c
dau gan cac xudng ban tay II. Ill, IV va cac cd gian cot ban tay.
Nganh sau than kinh tru di cung vdi nhanh gan tay sau cua dong mach tru,
va chay song song vdi cung gan tay sau.

7.3. Phan nhanh

Cung Ian lu'ot tach ra cac nhanh:

Dong Dutch chinh ngon cat (A. princeps pollicis):

Xuat phat tu' dong mach quay d dau gan khoang gian dot ban tay I. (co the coi
nhu mot trong hai nhanh tan cua dong mach quay cho cung gan tay sau va dong
mach chmh ngon cai: hay nhu nhanh dau tien cua cung) chav xuong tdi dau xa
xu'dng dot ban tay I thi chia thanh hai nganh, chay theo hai ben ngon car
Dong mach quay ngon tro (A. radialis indicis) hay dong mach ben ngoai
ngon tro:
Tach ra ttf cung gan tay sau ngay dudi nguyen uy cua dong mach chinh ngon
cai hoac tii dong mach chinh ngon cai. di xuong doc bd ngoai ngon tro. Khi tdi dau
xa xiidng ban tay II. dong mach quay ngon tro con tach ra mot nhanh noi vdi
cung gan tav nong.

- Ba ddng mach gan ban tay (Aa. metacarpales palmares):

Di xuong tntOc cac khoang gian cot ban tay II, III, IV, tdi gan khdp ban tay -
ngon tay thi tach ra cac nhanh xien ra sau noi vdi cac dong mach mu ban tay. roi
tan het bang cach quat ra trudc noi vdi ba dong mach gan ngon tay chung cua
cung gan tay nong.

- Cdc nhanh xien (rami perforantes):

Com 3 nhanh \uat phat tii bd lom cua cung gan tay sau d phfa dau gan cac
xudng ban tay, choc qua cac khoang gian cot ban tay II, III, IV ra mu tay noi vdi
cac dong mach mu ban tay (cua cung dm mu co tay).
 M A C H CHI TR EN 0 1 149

CAC TINH MACH CHI TREN

(V e n a e m em b r i s u p e r io r is )

Chi tren gom 2 he thong tinh mach nong va sau.

1. CAC T IN H M A C H S A U C U A C H I T R E N (venae profundae membri

superioris)

Gom nhiing tinh mach di song song va bam sat cac dong mach cua chi tren.
Thong thtfdng moi dong mach (tii canh tay trd xuong) co 2 tinh mach di kern 2 ben.
Rieng dong mach nach chi co 1 tinh mach di kem.

1 .1 . 6 b a n tay

Phan ldn mau tinh mach dtfdc dan lUu theo cac tinh mach nong. Tuy nhien
cac cung dong mach gan tay cung co nhiing tinh mach rat nho di kem. Dac biet
cung tinh mach gan tay sau (arcus venosus palmaris profundus) di kem cung
dong mach cung ten cung nhan cac tinh mach gan ban tay (Vv. metacarpales
palmares).

1.2. O ca n g tay
Co 2 doi tinh mach quay va tinh mach tru di kem 2 dong mach quay va tru,
cung nhan cac nhanh ben ttfdng tfng vdi cac nhanh cua dong mach.

1.3. d canh tay

Cac tinh mach neu tren hdp lai de tao thanh 2 tinh mach canh tay di len theo
dong mach canh tay roi do vao tinh mach nach. Tinh mach nen tii nong tdi 1/3
giiia canh tay cung da choc qua mac canh tay de vao trong ong canh tay.

1.4. Cl nach
Tinh mach nach diidc tao nen d bd diidi cd tron to, do tinh mach nen va 2 tinh
mach canh tay chap lai. Tinh mach nach cung nhan cac nhanh tiidng ting vdi cac
nhanh cua dong mach nach, va dac biet con nhan mot tinh mach nong ldn nua la
tinh mach dau.
Khi qua khe giCfa xiidng don va xiidng stidn thti I thi no doi ten thanh tinh
mach diidi don.
l i n h mach dtfdi don se hdp vdi tinh mach canh trong thanh than tinh mach
canh tay dau, roi tiep tuc dtfa mau ve tim theo tinh mach chu tren.
150 H GIAI P h A u N G l/G l. T A P I

2. CAC T IN H M A C H N O N G C U A CHI T R E N (venae superficiales membri

superioris)
Gom nhung tinh mach n£m ngay dtfdi da va khong co dong mach di kem,
trong do co 2 tinh mach nong ldn nhat la tinh mach dau va tinh mach nen. Chung
deu bat nguon tif cac tinh mach d ngon tay va ban tay.

2.1. Cac tinh m ach gan ngon tay (Vv. digitales palm ares)
Chay doc 2 ben mat gan moi ngon tay, len tdi ke cac ngon tay thi chung noi
tiep vdi nhau, nhan them nhiing nhanh nho tti gan tay roi chay ra phia mu tay
qua gitfa cac chom xUdng dot ban tay de do vao cac tinh mach mu ngon tay.
Do vay cac nhanh cuoi nay thtfdng dtfdc goi la cdc tinh mach gian chom (Vv.
intercapitulares).

2 .2 . C a c t in h m a c h m u n g o n t a y (Vv.digitales dorsales)

La nhung tinh mach tudng ttf d phia mu ngdn tay: cac tinh mach d 2 ben moi
ngon noi tiep phong phu vdi nhau doc tren du'dng di; tdi ke gitfa cac ngon tay thi
tinh mach d moi ben 2 ngon giap nhau cung chap lai vdi nhau (va nhan them tinh
mach gian chom ttf phia gan tay tdi) de tao nen cdc tinh mach mu han tay (Vv.
metacarpales dorsales) (Hinh 8. 1).

Hinh 8.4. TTnh mach nong d mu ban tay

1. Nguyen uy tinh mach nen; 2. Cung tinh mach mu ban tay; 3. Cac tinh mach mu ngon tay
4. Cac tinh mach mu ban tay; 5 Nguyen uy tinh mach dau.
 MACH CHI TREN fjjj 151

2.3. Cac tinh m ach m u ban tay

Noi tiep vdi nhau d phia tren de tao thanh mot mang tinh mach mu ban tay
(Rete venosum dorsale manus) (co tac gia goi la cung tinh mach mu tay).

O phia ngoai (phia quay) mang

tinh mach mu tay lien tiep vdi tinh
mach dau thtfdng do tinh mach bd
ngoai mu ngon tro va cac tinh mach
mu ngon cai hdp lai.

O phia trong (phia tru) mang tinh

mach mu ban tay nhan tinh mach cua
bd trong mu ngon ut de tao nen tinh
mach nen.

2.4. Tinh m ach dau (V. cephalica)

Tiep tuc mang tinh mach mu tay d
phia ngoai, nhan cac tinh mach mu
ngon cai, di len d bd quay co tay.

0 cang tay no chay song song vdi

bd tru’dc cd canh tay quay, nhan cac
nhanh ben tif phia sau cang tay; len tdi
trifdc khuyu tinh mach dau thudng
tach ra mot nhanh noi chay chech len,
noi tiep vdi tinh mach nen goi la tinh
mach giiia khuyu (V. mediana cubiti).
Tinh mach nay cd mat trong 70%
trudng hop (theo Charles C.M., 1932,
Anat. Rec., 5-1:9), va thudng nhan them
mot (doi khi nhieu hdn) nhanh nong tu
phia trifdc cang tay (tinh mach giiia
cang tay) va mot nhanh thong, noi tif
cac tinh mach sau cua cang tay d difdi Hinh 8.5. TTnh mach va than kinh nong 0 chi tren
nep khuyu (Hinh 8 .6 ). Qua khoi nep (nhin tru’dc)

khuyu, tinh mach dau di len trong
ranh nhi dau ngoai, roi doc theo bd
ngoai cd nhi dau, va tiep theo chay
trong ranh delta ngvfc. Tinh mach di
vao sau, choc qua mac don - ngtfc de do
vao tinh mach nach. ngay difdi xifdng
don (Hinh 8.5).
1. TTnh mach dau; 2 Than kinh bi canh tay ngoai
tren cua T.K nach; 3. Than kinh bi canh tay ngoai
du'di cua T.K quay; 4 Than kinh bi cang tay ngoai
cua T.K co bi; 5. TTnh mach giCra dau; 6 Nhanh mo
cai T.K quay; 7. Nhanh bi gan tay T.K giua. 8 Nhanh
bi gan tay T.K tru; 9 Tinh mach giCfa cang tay. 10
Nhanh noi vdi T.M sau; 11. TTnh mach nen; 12. TTnh
mach giifa nen; 13. Than kinh bi cang tay trong.
14. TTnh m ach nen.
152|[>j[] GIAI PHAU NGUOl. TAP I

Doi khi co mot tinh mach dau phu (V. cephalica accessona) xuat phat ta mot
dam roi tinh mach 0 mat sau cang tay hoac tu phia tru cua mang tinh mach mu
tay, chay chech len tren bat cheo phia sau cang tay va do vao tinh mach dau d
dtfdi nep gap khuyu.

2.5. Tinh m ach nen (V. basilica)

Tiep tuc mang tinh mach mu tay d phia trong (phia tru), di len doc theo bd
tru cua cang tay, nhan cac nhanh ben tii ca 2 mat trtfdc va sau, roi len vung khuyu
trtfdc, d trtfdc mom tren loi cau trong.
Sau khi nhan tinh mach gitfa khuyu. tinh mach nen tiep tuc di len d trong ranh
nhi dau trong, roi choc qua mac canh tav d dtfdi diem gitfa canh tay mot chut. Tu'
do di len, tinh mach nen nam trong ong canh tay, d phia nong so vdi dong mach
canh tay. No van doc lap vdi cac thanh phan khac cho tdi khi len tdi nach mdi nhap
vdi hay nhan them cac tinh mach canh tay de trd thanh tinh mach nach.

2.6. Tinh m ach gitfa ca n g tay (V. m edia n s an tebrachh)

Hat nguon tu dam roi tinh mach gan tay nong, di len d gitfa mat trtfdc cang
tay va tan het 6 ho khuyu trtfdc bang cach do vao tinh mach giua khuyu hoac
tinh mach nen. Doi khi len tdi ho khuyu no chia doi thanh mot tinh mach giUa
nen (V. mediana basilica) thay the ve du'dng di va tan cung cho tinh mach giiia
khuyu, va mot tinh mach gii(a dau (V. mediana cephalica), di chech len doc bd
ngoai cd nhi dau de do vao tinh mach dau. Trong nhiing trtfdng hop nhu vav
(khoang 20% theo Charles. 1932, Anat. Rec. 51:9) ta co mot chti M tinh mach
dien hinh d trtfdc hd khuyu. Tinh mach gitia cang tay cd the ldn hoac khong co.
Khi co mat, no thtfdng noi tiep vdi cac tinh mach sau d cang tav bdi mot tinh
mach thong d du'di nep khuyu (Hinh 8. 6 va 8 .7 ).

Hinh 8.6. TTnh m ach nong d khuyu tay Hinh 8.7. TTnh m ach nong d khuyu
(dang thtfdng gap) (dang chtf M. tTnh mach)

1. TTnh mach dau; 2. TTnh m ach gitfa
khuyu; 3. TTnh m ach dau; 4 TTnh m ach
gitfa cang tay; 5. TTnh m ach noi vdi tTnh
mach sau; 6. TTnh m ach nen.
1. TTnh mach dau; 2. TTnh mach giijra <Jau:
3. TTnh mach dau; 4. TTnh mach giCfa c in g
tay; 5. TTnh mach nen; 6 Nhanh thong (noi
vdi TM sau); 7. TTnh mach gii/a nen. 8 TTnh
mach nen.
 MACH CHI TREN [g)| 153

BACH H U Y E T CHI T R E N

Cac mach bach huyet chi tren dan bach huyet tdi cac hach tan d nach. Thtfdng
co cac mach bach huyet nong di kem cac tinh mach nong va cac mach bach huyet
sau chay doc theo cac bo mach than kinh sau.

1. CAC H A C H B A C H H U Y E T 0 N A C H (nodi lymphoidei axillares)

* La nhting hach vung tap trung bach huyet cua chi tren va dai vai;
Gom ttf 20 den 30 hach. Co the chia thanh 5 toan ttf dtfdi len tren nhtf sau:

1.1. T oan can h tay, h ay toan ngoai (Nodi humerales/laterales)

Gom 4 - 6 hach nam 6 trong va sau tinh mach nach, nhan cac mach tdi dan
bach huyet cua gan toan bo chi tren, trtf phan dtfdc dan ltfu bdi cac mach di kem
tinh mach dau. Cac mach di dan bach huyet tdi cac toan trung tam va toan dinh
cua nach, mot phan tdi cac hach co sau du'di (Hinh 8 .8 ).
* Cac hach thu oc nhom canh tay cua cac hach bach huyet nach. tru'dc day N .A .1985 van
goi la "nodi b ra c h ia le s ” ; song T.A .1997 da doi lai la "nodi hum erales; nodi laterales", de khoi
lan vdi cac hach canh ta y ” (nodi brachiales) 6 thap hdn. trong ong canh tay].

1. Toan canh tay; 2. Toan di/di vai; 3. Toan ngi/c; 4. Toan trung tam; 5. Toan dinh; 6. TM dau.
154 i GIAI PHAU NGlfCJl. TAP I

1.2. T oan ngtfc hay toan trtfdc (nodi pectorales/antenores)

Gom 4 - 5 hach nSm doc theo bd dtfdi cd ngtfc be, lien quan vdi bo mach ngtfc
ngoai. Cac hach nay nhan cac mach tdi dan ltfu bach huyet cua thanh trtfdc ben
than minh ttf tren ron. Cac mach di chav den cac hach trung tam va hach dinh
cua nach.

1.3. T oan dtfdi vai (nodi subscapulares/posteriores) hay toan sau

Gom 6 - 7 hach, n&m doc theo bd dtfdi thanh sau cua nach. lien quan vdi bo
mach dtfdi vai. Cac hach nay nhan hach huyet cua da va cac cd d phan sau co va
phan ltfng cua than minh. Cac mach di dan bach huyet tdi toan dinh va toan
trung tam cua nach.

1.4. T oan tru n g ta m (nodi centrales)

Gom 3 — 4 hach nam d trong ldp md d nen nach. nhan bach huvet cua 3 toan
tren, sau do bach huyet theo cac mach di chay tdi cac hach d toan dinh.

1.5. T oan d inh (nodi apicales)

Gom tii 6 den 12 hach nam d phan sau doan tron cd ngtfc be. ttf bd tren cua cd
nay cho tdi dinh cua nach. doc theo bd trong cua tinh mach nach. Cac mach den
gom cac mach chay theo tinh mach dau. cac mach dan bach huyet tu phan ngoai
vi cua tuyen vu va cac mach di ttf cac hach thuoc 4 nhom tren d nach
Cac mach ttf cac hach d toan dinh hop thanh than bach huyet diti'ti don (truncus
subclavius); than d ben phai do true tiep vao hoi ltfu tinh mach phai hoac do vao
ong ddn bach huyet phai (ductus lymphaticus dexter); than d ben trai do vao ong
ngiic (ductus thoracicus).
* Nhtfng toan hach khac d cac doan thap hdn cua chi tren nam tren dudng di
cua cac mach chinh cua chi tren; gom: 1 ) cdc hach canh tay (nodi brachiales),
nam tren dtfdng di cua dm canh tay. 2 ) cdc hach tru (nodi cubitales). chu yeu nam
sau trong ho khuyu: mot so (1 — 3) d nong tren loi cau trong xuong canh tay. goi
la cac hach tren rong roc (nodi supratrocleares); 3) cdc hach cua cang tay. nam d
1/3 tren cang tay. doc theo dm tru.
Bach huyet cua chi tren dude chia thanh cac mach va cac hach nong (nodi
superficiales), va cac mach va hach sau (nodi profundi).

2. C A C M A C H B A C H H U Y E T N O N G C U A C H I T R E N

Bach huvet nong cua chi tren bat dau tti nhtfng dam roi bach huyet d
trong da.

2.1. O ban tay

Bat dau tti cac dam roi d ngon tay. Cac mach bach huyet chav theo 2 bd ben
 MACH CHI TREN 0 155

cac ngon tay tdi da gan tay, d day ph&n ldn cac mach cd xu htfdng chay ra sau de
tdi da mu tay. Phdn con lai cua ban tay mach bach huyet chay doc bd tru va bd
quay gan tay len tdi co tay. Nhieu mach gop ttf phan trung tam cua cac dam rdi
bach huyet gan tay hdp lai tao nen mot than bach huyet (Hinh 8.9).

Hinh 8.9. Bach huyet d ban tay

1. Bach huyet tii trung tam gan ban tay hudng tdi cac mach bach huyet sau 2 Hi/dng tdi
mu ngon tay. 3. Vong qua ke ngon hudng tdi mu ban tay. 4 Hudng tdi mu ban tay.

2.2. 0> can g tay va ca n h tay cac m ach bach h u yet n on g p h an ldn chay
theo cac tinh m a c h n on g
Cac mach nay tan het d toan hach ngoai cua nach. Cac mach d mat ngoai cua co
tay cung vdi cac mach d cang tay chay theo tinh mach dau. Con cac mach d phia
trong cua cd tay cung vdi mach d cang tay chay theo tinh mach nen, chay qua cac
hach tren loi cau trong roi chay len canh tay cung tinh mach nen. dd vao cac hach
toan ngoai cua nach (Hinh 8.10).
Cac mach bach huyet ttf mat trtfdc va sau cua vung delta chay vao nach do
vao cac hach d toan trtfdc (hay toan ngtfc) va toan sau (hay toan dtfdi vai).

Bach huyet tu vung ba vai do vao cac hach d toan dtfdi vai (hay toan sau)
cua nach.

3. C A C M A C H B A C H H U Y E T S A U C U A C H I T R E N

Cac mach bach huyet sau cua chi tren chu veu chay theo cac bd mach va than
kinh chinh cua chi tren (bd mach than kinh tru, quay, gian cot va canh tay) va
156 |[>|] GIAI PHAU NGUCJI. TAP I

tan het d cac hach thuoc toan ngoai cua nach. Cac mach bach huyet tQ cac cd
thuoc vung ba vai chay vao nach tan het d cac hach toan dtfdi vai. Bach huyet tQ
cd ngtfc do vao cac loan hach ngtfc, toan trung tam va toan dinh cua nach.

Hinh 8.10. Bach huyet chi tren

1. Hach delta ngtfc; 2 TTnh m ach dau; 3. TTnh mach gitfa khuyu; 4. TTnh m ach dau.
5. TTnh mach nen; 6. Cac hach tren rong roc; 7. TTnh m ach nen; 8. Cac hach nach.
9. TTnh m ach nach.

4. B A C H H U Y E T C U A V U

Tuyen vu thuoc cac cd quan sinh due nQ. se dQdc trinh bay d giai phau ngtfdi
tap II, sdng ve dan lQu bach huyet, chung tdi xin tam ghep vao day vi p h in ldn
bach huyet d vu do vao cac hach d nach.
Bach huyet cua tuyen vu bat ngucn tQ dam roi bach huyet trong mo lien ket
gian thuy trong thanh cua cac ong dlin sQa. Cac mach nay thong thQdng vdi dam
roi bach huyet dQdi da va dac biet quanh num vu vdi cac dam roi dQdi quang vu.
Ngoai ra con thong thQdng vdi cac dam roi trong mac sau cua vu, nhutng sQ tiep
noi nay dong vai tro trong sQ lan truyen sdrn cua ung thQ vu.
 MACH CHI TREN 0| 157

Hinh 8.11. Cac hach nach va bach huyet cua vu

1 Hach nach: 2. Hach canh tay (nach); 3. Hach vai tren; 4 Hach vai sau; 5, 6, 7 Cac hach ngu'c
nach tren, giua, dtfdi: 8. Hudng tdi hach gian sudn (sau), 9. Hudng tdi cac hach ben; 10 Hach canh
tfc; 11. Hach tfc; 12. Bach m ach sang ben doi dien; 13. Bach mach gian sudn trudc; 14. Hach Crc.
15. Hach canh Lfc; 16. Hach canh trong trudc dudi; 17. Cac hach dudi don; 18. Hach dinh nach

Hinh 8.12. Cac du’dng d in liru bach huyet vu

1. C6c hach ngtfc nach; 2. Cac hach dudi don; 3. Cac hach dinh nach; 4. Cac hach canh
(le (ngtfc trong); 5. Hudng sang b&n doi dien.

* [Cac so d6 n6u tren (Hinh 8.11, 8.12) chi co tinh chat tom tat giai-phim ifng dung lam sang.
Xin xem ti6p Hinh 8.13 cua Sinelnikov)].
158 0 GIAI PHAU NGUOI. TAP I

Hinh 8.13. Cac m ach va hach bach huyet d dau, co, nach va tuyen vu (nhin trifdc)
(da cat bo mot phan cac cd tfc don chum d co, va cac xu’dng cd d thanh trifdc dai ngtfc de boc lo cac
mach va hach bach huyet d sau). (Theo Sinelm kov, M oskva, 1963, tai ban tieng Anh. 3rd edit, 2003)
1. Tuyen mang tai; 2 Hach bach huyet cham; 3. Hach bach huyet sau tai; 4. Hach bach huyet canh
nhi than; 5. TM canh trong phai; 6. Hach bach huyet co nong; 7. Hach bach huyet canh - vai mong
8. Than bach huyet tren don 9. TM canh tay dau phai; 10. TM du’di don; 11. TM dau; 12 DM nach
13 TM nach; 14. Hach bach huyet trung tam; 15 Hach bach huyet dinh; 16 Hach bach huyet ngtfc.
17. Cd ngifc be; 18. Cd ngifc ldn; 19. Vu. 20. TM chu tren; 21. Hoi lifu TM canh tay dau. 22. ong dan
bach huyet phai; 23. Than bach huyet canh; 24. DM canh chung phai; 25. Hach bach huyet di/di
cam; 26. Cd ha goc m ieng; 27. Cac hach bach huyet di/6i ham; 28. Cd go ma ldn; 29 Cac hach
bach huyet mang tai; 30. Cd vong mi (vong o m§t); 31. Bung tran cd cham tran.
 T H A N K IN H CHI T R EN R U ffE I

9. THAN KINH CHI TREN

Chi tren cltfdc chi phoi (van dong va cam giac) bdi cac nganh ben va cac nganh
cung cua dam roi than kinh canh tay td vung co di xuong.

DAM ROI (THAN KINH) CANH TAY

(P le x u s b r a c h ia lis )

1. C A U T A O (Hinh 9.1)

Dam roi (than kinh) canh tav dude cau tao bdi nganh trifdc cua cac day than
kinh song co V, co VI, co VII, co VIII va nguc I goi la cac re (radices) cua dam roi.
Tru'dc het cac re nay hdp lai thanh ba than:
- Than tren (truncus superior): Do nganh trudc cua day than kinh co V, va co
VI (day co V da nhan them mot nhanh nhd cua day co IV) noi vdi nhau tao thanh.
- Than giita (truncus medius): do rieng nganh tru'dc cua day co VII tao nen.
- Than du'di (truncus inferior): do nganh tru'dc cua day than kinh co VIII hop
vdi nganh trudc cua day than kinh nguc 1 tao nen.
Moi than lai chia thanh 2 nganh triidc va sau. roi cac nganh nay lai hdp vdi
nhau thanh 3 bd. dude goi ten theo lien quan vdi dong mach nach, d cho dong
mach bat cheo sau cd ngu'c be:
- Bo ngoai (fasciculus lateralis): do nganh trudc cua than tren noi vdi nganh
trade cua than giua tao nen.
- Bo trong (fasciculus medialis); do rieng nganh tru'dc cua than dadi tao nen.
- Bo sau (fasciculus posterior): do nganh sau cua ca ba than hop lai.
Nhu' vay. ve cau tao nguyen uy va dia hat chi phoi:
- Bo sau mang nhung sdi than kinh cho phan sau chi tren. den ta cac day
than kinh song tu' co V den ngiic I (C5 - Nl).
- Bo ngoai gom nhiing sdi than kinh cho phan trudc chi tren. den tu cac day
than kinh song tu co V den co VII (C5 - C7).
- Bo trong mang nhiing sdi than kinh cho phan trudc chi tren. den tu cac day
than kinh song tii co VIII den ngiic I (C 8 - Nl).
Tii ba bo nav se tach ra mot so nganh ben va tat ca cac nganh cung cua dam
roi than kinh canh tay nha se mo ta dadi day:
160jjjj GIAI PH A U NGUC3I. T A P I

* [Ten cac thanh phan cau tao cua dam roi canh tay d day dUdc goi theo T N G P Q T NA.
1985 va T.A .1997. Song theo D TG P cua co GS. D o Xuan Hop va cac tac gia P hap cu Cac
than (truncus) than kinh, tru’dc day duoc goi la cac than nhat (troncs p rim a ire s) tren. giCra,
va dudi. C on cac bd (fascicu lus) trudc day goi la cac than nhi (tro n cs se co n d a ire s) trudc
ngoai, tru dc trong va sau].

Hinh 9.1. Dam roi than kinh canh tay

1. Than kinh Itfng vai; 2. Than kinh tren vai; 3 Bo ngoai; 4 Quai than kinh nguc; 5 D ong m ach nach.
6. Fte ngoai than kinh giua; 7. Than kinh cd bi; 8. Than kinh nach; 9. Than kinh quay; 10 Than kinh
giUa; 11. Than kinh tru; 12. R l trong than kinh gitfa. 13. Than kinh bi cSng tay trong. 14 Than kinh
dudi vai dudi (tach tir bd trong bi che khuat); 15. Than kinh bi canh tay trong, 16 Than kinh nguc
lung; 17. Than kinh dudi vai tren; 18 Bd trong; 19. Bd sau; 20. N.l; 21. C. VIII; 22. Than kinh nguc
dai, 23. C. VII; 24. Than kinh dudi dOn; 25. C. VI; 26. C. V; 27. C. IV.
 T H A N K IN H CHI T R E N g 161

2. VI T R I V A L IE N Q U A N

Cac than va bo cua clam roi canh tay phan ldn nam d co (phan tren don), va
phan nhd d nach (phan diidi ddn). Chi cd phan cuoi cua cac bd xudng tdi nach. va
phan chia thanh cac nganh cung d sau cd ngtfc be.
Lien quan chi tiet se dtfdc md ta d phan giai phau dinh khu (Hinh 10.1, 10.2,
10.3).

3. N G A N H C U N G

* B o n g o a i: tach ra hai nganh, ke ttf tren xuong dtfdi ttf ngoai vao trong la:
Than kinh ccj bi (nervus musculocutaneus).
Re ngoai than kinh gitia (radix medialis nervi mediani).
* B o tr o n g : Tach ra 4 nganh, lan ltfdt ttf tren xuong dtfdi ttf trong ra ngoai:
Than kinh hi canh tay trong (nervus cutaneus brachii medialis).
Than kinh hi cang tay trong (nervus cutaneus antebrachh medialis).
Than kinh tru (nervus ulnaris).
Re trong than kinh gitia (radix medialis nervi mediani).
* Bd sa u : tach ra 2 nganh:
Than kinh nach (nervus axillaris).
Than kinh quay (nervus radialis).
Trong so 7 nganh cung nay cd:
* 2 day hoan toan cam giac: than kinh bi - canh tay trong va than kinh bi -
cang tay trong.
* 5 day hdn hdp vtfa van dong, vtfa cam giac, gom cac day cd bi, nach. quay,
giua, tru.

4. N G A N H B E N (Hinh 9.1)

4.1. P h a n t r e n d o n (pars supraclavicularis) cd 4 nganh chinh. tach ra chu yeu

tif cac re va than tren cua dam roi:
- Than kinh vai sau hay li/ng vai (nervus dorsalis scapulae): tach tu day co 5,
cho hai cd tram ldn va tram be.
- Than kinh ngi/c dai (nervus thoracicus longus): tach tu cac day C5. C 6 . C7
cho cO rang trtfdc.
- Than kinh difdi don (nervus subclavius): tach tu than tren, che cd dtfdi ddn.
- Than kinh tren vai (nervus supra scapularis): tach ttf than tren. cho cac cd
tren gai, dudi gai.
11.GPN.T1
1620 GIAI PHAU NGUOI. TAP I

4.2. P h a n d ifd i d o n (pars infraclavicularis) co 5 nganh tach til cac bo cua dam
roi than kinh canh tay:
- Than kinh ngtfc trong (nervus pectoralis medialis): tach ttf bo trong, cho cd
ngtfc be, va mot phan cO ngtfc ldn.
- Than kinh ngtfc ngoai (nervus pectoralis lateralis): tach ttf bo ngoai. cho cd
nguc ldn. Cac than kinh ngtfc ngoai va ngtfc trong noi v 6 i nhau d trtfdc dong mach
nach tao thanh quai ngtfc.
- Cdc than kinh dtfdi vai tren va dtfdi (nervus subscapularis superior/ inferior):
gom 2 nhanh deu tach ttf bo sau cho phan tren va phan dtfdi cd dtfdi vai.
- Than kinh ngtfc Itfng (nervus thoracodorsalis): tach ttf bo sau. di cung dong
mach ngtfc ltfng cho cd ltfng rong.
* [Chu thich: T N G P Q T T.A. 1997 da xep hdi Ion 5 nganh ben n&y vao phan tr§n don. trong
khi cac bo ngoai - trong va sau cua dam roi than kinh canh tay lai thuoc phan dtfdi don],

Sau day la mo ta sO bo car nganh cung cua dam roi than kinh canh tay. lan
lu'dt theo thtf ttf nguyen uy tach ttf cac bo (ngoai. trong, sau) da ke tren:

THAN KINH CO BI
(N e r v u s m u s c u l o c u t a n e u s )

1. N G U Y E N U Y

Tach ra ttf bo ngoai dam roi canh tay; la nhanh tan thtf 1 cua bo ngoai. be
hdn va d phia ngoai nhanh thtf 2 la re ngoai than kinh gitfa.

2. D L fdN G D I V A L IE N Q U A N S d B O (Hinh 9.2)

Ttf nguyen uy chay chech xuong dtfdi va ra ngoai. xuven qua cd qua canh tay. roi
chay gitfa hai cd nhi dau canh tay d trudc va cd canh tay d sau. tdi ranh nhi djiu
ngoai. choc qua mac canh tay ra nong. chia thanh hai nganh cung di xuong cang tay.

3. P H A n N H A N H v A C H I P H O I (Hinh 9 2. 9.4)

O vung nach va canh tay trtfdc, than kmh cd bi tach ra cac nhanh cd (rami
musculares): van dong cho cd qua canh tay, cd canh tay va cd nhi dau canh tay.
Tu: ranh nhi dau ngoai nganh tan tiep tuc di xuong cang tay tao nen than kinh
bi cang tay ngoai (nervus cutaneus antebrachii lateralis) tach ra 2 nhanh trtfdc va
sau cam giac cho da d ntfa trtfdc ngoai va sau ngoai cang tay (Hinh 9.2, 9.4).
 THAN KINH CHI TREN [jjj 163

1. Bo ngoai DRCT;
2. Than kinh co bi;
3. Co qua canh tay:
4. Than kinh nach,
5. Than kinh quay:
6. Cd nhi dau canh tay,
7 Than kinh co bi;
8. Cd canh tay,
9 Cd sap tron
10. Cd gan tay dai.
11 Nganh tru'dc than kinh bi cang tay ngoai
cua T K cd bi:
12. Nganh sau than kinh bi cang tay ngoai cua
T.K cd bi;
13. Cd gap nong cac ngdn tay;
14. Cd gap dai ngon cai,
15. Cd sap vuong,
16. Cac cd mo cai (Cd giang ngan; - Cd doi
chieu. - Bo nong cd ngan gap),
17. Cac cd giun I. II,
18. Cac than kinh gan ngdn tay rieng.
19. Cac than kinh gan ngdn tay chung
20. Hai bd ngoai cd gap sau cac ngdn tay (cho
ngdn II; III);
21 Cd gap co tay quay;
22. Nganh sau than kinh bi c ln g tay trong;
23. Nganh trtfdc than kinh bi c ln g tay trong.
24 Than kinh giua;
25 Than kinh bi cang tay trong;
26. Than kinh tru;
27 Than kinh bi canh tay trong;
28. Bo trong (ORCT).

Hinh 9.2. Cac day than kinh giiira, co bi, bi cang tay trong, bi canh tay trong
(Theo Trjnh Vein Minh)
164 0 GIAI PHAU NGUOl. TAP I

THAN KINH Bi - CANH TAY TRONG

(N e r v u s c u t a n e u s b r a c h i i m e d ia lis )

1. N G U Y E N U Y

Tach ra tti bo trong dam roi canh tay nhu mot nhanh tan dau tien va be nhat,
tach ra d cao nhat va trong nhat ctia bo trong.

2. D l / d N G D I , L I E N Q U A N , C H I P H O I (H in h 9.2, 9 4)

0 nach, than kinh bi - canh tay trong chav sau tinh mach nach, di chech vao
trong. roi choc qua mac canh tav ra nong va phan nhanh cam giac cho Ha rf phan
tren mat trong canh tay va nen nach
() (lav nach. than kinh bi canh tay trong con nhan mot nhanh noi tu than
kinh gian sudn thti 11

THAN KINH BI - CANG TAY TRONG

(N e r v u s c u t a n e u s a n t e b r a c h i i m eclialis)

1. N G U Y E N U Y

Xuat phat tti bo trong dam 101 canh tay; la nhanh tan thti 2 cua bo trong.
tach ra d du'di va phia ngoai than kinh bi canh tay trong, 6 sat canh phia trong
day than kinh tru.

2 . D l / d N G D I , L I E N Q U A N T A N C U N G V A C H I P H O I (H in h 9 2 9 , 1 )

Luc dau, o' nach nam phia trong dong mach nach, gitia tinh mach va dong
mach; 101 xuong ong canh tay chay o trudc trong dong mach canh tay. tdi cho noi
1/3 gitia va 1/3 duoi canh tay thi choc qua mac canh tay cting tinh mach nen. de
ra nong.
Sau khi choc qua mac canh tay ra nong. than kinh bi - cang tay trong tiep
tuc di cting tinh mach nen den vting khuyu trudc thi chia thanh 2 nganh tan:
- Nganh tru’dc (ramus anterior): di xuong cam giac cho da vting trudc trong
cang tay.
 THAN KINH CHI TREN 0 165

- Nganh sau (ramus protenor): di xuong cam giac cho da vung sau trong
cang tav.
« .»
Ngoai ra, d canh tay, than kinh bi - cang tay trong con tach ra mot nhanh
nho cam giac cho da d phan dudi mat trong canh tay.

THAN KINH GlOA

(N e r v u s m e d ia n u s )

1. N G U Y E N U Y

Duoc tao nen Doi 2 re:

- Re ngocti (radix lateralis): tach ra tii bo ngoai dam roi canh tay.
- Re trong (radix medialis): tach ra tu bo trong dam roi canh tay.
Hai re hop lai theo hinh chu Y tao thanh than kinh giua nam 0 tru'dc ngoai
dong mach nach.

2. D l /d N G D I, L IE N Q U A N (Hinh 9.2)

Day than kinh giua la mot day than kinh ldn cua chi tren. chav dai tu nach
to'i tan cung ban tay.
- (3 nach: day giua chay chech xuong du'di va ra ngoai. d trudc ngoai dong
mach nach.
- Xuong canh tay: cung dong mach canh tay chay trong ong canh tay va bat
cheo tru'dc dong mach tu ngoai vao trong theo hinh chu X keo dai.
- Tdi vung khuyu tru'dc: day giua chay vao ranh nhi dau trong. d trdng ddng
mach.
- Xuong cang tay: khi dong mach canh ta\r chia thanh hai nganh cung, thi
day giua lach giua hai dau cd sap trdn bat cheo trifdc dong mach tru de chay vao
gnia true cang tay, chay sau cO gap ndng cac ngdn tay.
- Tdi co tay: khi cd thu lai thanh 4 gan gap. thi day giua chay tru'dc gan gap
ndng ngdn trd. ngoai gan gap nong ngdn giua, roi cung cac gan gap chui qua ong
cd tay, difdi ham cac gan gap, xudng gan tay.

3. N G A N H B E N (Hinh 9.2)

Khi qua vung nach va vung canh tay trifdc. day giQa khong cho mot nhanh
ben nao.
166 (gj G IA I P H A U N G l f O l . T A P I

(') vung khuyu trUdc (trong ranh nhi dau trong) va vung cang tav trudc tach ra:
- Cdc nhanh cd (rami musculares): di tdi cac cd d ldp nong va ldp giUa vung
cang tay trifdc: cd sap tron, cd gap co tay quay, cd gan tay dai. cd gap nong cac
ngon lay.
- Than kinh gian cot cdng tay tru’dc (nervus mterosseus antebrachh anterior):
di cung vdi dong mach gian cdt trUdc. van dong cho cac cd d ldp sau vung cang tay
tru'dc: cd gap dai ngdn cai, hai bd ngoai cO gap sau ngdn tay cho ngdn II. ngdn III,
va cO sap vuong.
- Nhanh gan tay cua than kinh giiia (ramus palmaris nervi mediani): la mot
nhanh nhd tach d tren ham cac gan gap, xudng cam giac cho da d giCfa phan tren
vung gan tay.

4. N G A N H C U N G (Hinh 9.2)

Sau khi qua ong cd tay day giua chia thanh d nhanh cung:
Nhanh ngoai hav n h a n h md car. chay vao md cai van d o n e c ho cac co
giang ngan ngon cai. ddi chieu ngon cai. dau nong cd gap ngan nsrdn cai. co
giun I va ll.
.'1 than kinh gan ngon tay chung (nervi digitales palmares commune.-): chav
(j trudc cac khoang gian cot ban tay I. II. Ill:
Than kinh gan ngon tay chung d khoang gian cdt ban tay I tach ra 3 than
hinh gan ngon tay n e n g (nervi digitales palmares proprn) di vao hai ben ngdn cai
va bd ngoai ngdn tro.
Moi than kinh ngdn tay chung d cac khoang gian cot II va III tach thanh hai
than kinh gan ngon tay n e n g di theo moi ben cac ngdn tudng ung.
- Nhanh trong cung la mot nhanh noi vdi than kinh tru (ramus commumcans
cum nervo ulnari).
Cac than kinh gan ngon tay rieng cua cac ngon trd. ngdn giua va nua ngoai
ngdn nhan con tach ra mot nhanh ben nho vong ra sau cam giac cho mu cac dot
II. Ill cua cac ngon tudng ling.

5. CH I P H O I

Day than kinh giua v i a van dong viia cam giac.

- Cam giac: cho hdn nua gan tay o phia ngoai (tru mot phan nho da d phia
ngoai md cai do day quay cam giac). mat gan tay cua 3 ngdn rudi d phia ngoai ke
tif ngdn cai va ca mat mu cac dot II - III cua cac ngdn dd (Hinh 9.4).
- Van dong: hau het cac cd d vung cang tay tru'dc: cd sap tron. co gap cd tay
quay, cd gan tay dai. cd gap ndng ngon tay. cO gap dai ngdn cai, hai bo ngoai cua
 T H A N K IN H C H I T R E N [g| 167

cd gap sau cac ngon tay, cd sap vudng. va d o mo cai vung gan tay: cd giang ngan
ngon cai, cd doi chieu ngon cai, dau nong c 0 ngan gap ngon cai, cd giun I va II.

6. A P D U N G T H U C TE

Khi day than kinh giufa bi ton thudng cac cd gap va sap bi het, ban tay bj cac
cd duoi keo ra sau, mo cai bi teo det va luon d tu the ngQa, goi la ban tay khi.

THAN KINH TRU

(N e r v u s u ln a r is )

1. N G U Y E N U Y

Tach ra tu' bo trong cua dam roi canh tay, 6 giua re trong day than kinh giua
0 ngoai va day than kinh bi - cang tay trong 6 trong.

2. DlfO’N G D I, L IE N Q U A N (Hinh 9.3)

Than kinh tru cung la mot day than kinh ldn cua chi tren di tu nach xuong
tan ban tay.
- O nach: day tru chay doc phia trong dong mach nach, trQdc khe giua dong
mach va tinh mach nach.
- 0 canh tay: 1/3 tren, day tru chay trong ong canh tay cung vdi ddng mach
canh tay; tdi 1/3 giQa canh tay thi choc qua vach gian cd trong (cung vdi dong
mach ben tru tren) de ra vung canh tay sau, roi di thang xuong vung khuyu sau.
- () vung khuyu sau: than kinh tru nam 6 ranh giua mom tren loi cau trong
va mom khuyu roi chui giQa hai dau nguyen uy cua cO gap co tay tru de theo cd
xuong vung cang tay trQdc.
- O vung cang tay tru'dc: day tru chay thed cd gap ec tay tru, va song song d phia
trong dong mach tru, theo mot du'dng vach tQ mom tren loi cau trong xu'dng canh tay
den bd ngoai xu'dng dau. Tdi c 6 tay day tru chay tru'dc mac ham cac gan gap. d phia
ngoai xQdng dau de xuong gan tay, chia thanh hai nganh cung: nong va sau.

3. N G A N H B E N (Hinh 9.3)

3.1. 6 n ach v a c a n h tay

Day tru khong tach ra mot nganh ben nao.

168 G IA I P H A U N G U O l . T A P I

3.2. d can g tay

Day tru tach ra:
- Cdc nhanh cd (rami musculares): van dong cho cO gap co tay tru va 2 bo
trong cO gap sau ngon tay (cho ngon IV va ngon V).
- Nhanh mu tay than kinh tru (ramus dorsalis nervi ulnaris): tach ra d 1/3
dudi cSng tay, di xuong mu tay phan ra cac than kinh mu ngon tay (nervi
digitales dorsales) cam giac cho nQa trong mu tay va mat mu 2 ngon rUdi ke tQ
ngon ut (trQ phan mu dot II - III cua 1/2 ngoai ngon nhan va nQa trong ngon
giQa la do day giQa cam giac).

3.3. d co tay
Than kinh tru cho mot nhanh gan tay than kinh tru (ramus palmaris nervi
ulnaris). roi tan ru n e hnne each chin 2 nhanh nong va sau

4. N G A N H T A N (Hinh 9.3)

Nhanh nong (ra m u s superficialis): di tru'dc cae cd mb u t . tach ra:

1 nhanh van done cho cd gan tay ngan.
1 nhanh ndi vdi than kinh giua.
2 nhanh than kinh gan ngon tay: than hinh gan ngon tay n e n g cho bo tru
ngon ut, va than kinh gan ngon tay chung (nervus digitalis palmaris communis)
cho khoang gian cot ban tay IV. Nhanh nay lai tach ra 2 than kinh ean neon tay
rieng cho 2 nQa ngon IV. V tuong ung.
- Nhanh sau (ramus profundus): laeh giua cac cd mo ut (cung nhanh ean tay
sau cua dong mach tru) roi choc qua mac sau gan tay vao o gian cot ean tay.
hudng ra ngoai theo cung mach gan tay sau. Nhanh sau day tru tach ra car
nhanh van don g cho cac cd mo ut (cd giang ngon ut. cd gap ngan ngon ut. co ddi
chieu ngdn ut), cac cO gian cdt. 2 cd giun III va IV. cd khep ngon cai. va dau -an co
gap ngan ngdn cai. va cac nhanh tdi cac khdp ban tay - ngdn tay.

5. CH I P H O I

Than kinh tru la niot day vua van dong, vua cam giac.
- Van dong:

O cang tay: cho cd gap cd tay tru va hai bd trong cd gap sau ngdn tay (ngon IV.
ngdn V).

0 ban tay: cho hau het cac co d ban tay. tru phan ldn cac cd md cai va cd giun
I. II do day giua van dong.
 T H A N K IN H C H I T R E N gj| 169

' ------27

. 26

1. Than kinh cd bi;

2. Co delta;
3 Than kinh nach;
4 Than kin h quay;
5. Than kinh bi canh tay ngoai tren
6 Dau dai va dau ngoai cd tam dau
7 Than kinh bi canh tay sau
7 \ Than kinh bi canh tay ngoai du'di
8. Than kinh bi c ln g tay sau,
9. Cd canh tay quay,
10. Cd duoi co tay quay dai va ngan
11. Nganh sau than kinh quay;
___ 22
12. Cd ngUa.
13. Cac cd vung cang tay sau,
14. Nganh nong than kinh quay;
15. Cac than kinh mu ngdn tay rieng,
16. Cac than kinh gan ngdn tay rieng;
17. Cac cd gian cot. cd giun 3.4 cd khep
ngdn cai. bd sau cd gap ngan ngdn cai,
18. Cac cd md ut; z
19. Nhanh sau than kinh tru.
--•■20
20. Nhanh ndng than kinh tru;
21. Nhanh bi mu tay than kinh tru.
22. Hai bd trong cd gap ndng cac ngdn tay.
23. Cd gap co tay tru;
17 24. Cd khuyu;
25. Dau trong cd tam dau;
26 Than kinh tru;
27. Than kinh bi canh tay trong;
28. Than kinh bi c ln g tay tay trong;
29. Than kinh giCra.

Hinh 9.3. Cac day than kinh nach, quay, tru

(Theo Trmh Van Minh)

170 j[j|j G IA I P H A U N G U O l . T A P I

- Cam giac (Hinh 9.4):

() gan tay: cho mot phan trong gan tay va mot ngon ri/di 0 phia trong ke tir
ngon lit.
- 6 mu tay: cho nua trong mu tay va hai ngon ri/di d phia trong ke tii ngon
ut (trijf cac phan mu dot II - III ngon giuia va niia ngon nhan do than kinh giQa
cam giac).

6. A P D U N G T H U C TE

Khi day tru bj ton thUOng. nhu 6 mot so benh nhan phong (hui). cac cd do day
tru van dong bi het, bieu hien ro nhat 0 ban tay la mo ut bi teo, ngon ut va ngon
nh£in luon d tu the dot I bi duoi, dot II, III bi gap, goi la ban tay vuot tru (do cac
co gian cot va cac cd giun 3 - 4 bi het, khong keo diidc phan cuoi cac gan duoi
tif ring u'ng) (Hinh 9.5).

THAN KINH NACH

(N. a x illa r is )

1. N G U Y E N U Y , D U 'd N G D I (Hinh 9.1. 9.3)

Day than kinh nach xuat phat nhu mot nhanh tan nho dau tien tu bo sau cua
dam roi than kinh canh tay, di cung vdi dong mach mu canh lay sau qua lo tu
giac, vong quanh co phau thuat xudng canh tay tdi vung delta (d duoi co delta),
rdi phan nhanh tan cho cO delta 0 khoang 6 cm dudi mom cung vai

2. PH AN N H AN H V A CHI PH OI

- Cdc nhanh cd (rann musculares): tren du'dng di qua lo tu giac day than
kinh nach tach ra mot nhanh van dong cho. cd tron be, roi tan het bang cach
phan nhanh chu yeu cho cd delta.

Trudc khi tan het. than kinh nach con tach ra:

- Than kinh hi canh tay ngoai tren (nervus cutaneus brachh lateralis
superior): cam giac cho da phu nua dudi vung delta va vung tren ngoai cua
canh tay.
 T H A N KIN H CHI T R EN 171

THAN KINH QUAY

(N e r v u s ra d ia lis )

1. N G U Y E N U Y

Tach ra tti bo sau dam roi canh tay va la nhanh tan chinh cua bo sau, sau khi
da tach ra day than kinh nach.

2. D l / d N G D I , L I E N Q U A N (H inh 9.3)

Day quay la mot trong 3 day than kinh ldn cua chi tren, keo dai tu1 nach
xuong tan cung d ban tay. No thudng chua clung cac sdi cua ca ~> re than kinh cau
tao cua dam rdi than kinh canh tay (song mot so trifdng hop khong co sdi cua Co
va Nl).

() nach: than kinh quay nam sau ddng mach nach: tru'dc cd difdi vai. roi
chui qua tam giac canh tay tam dau ra vung canh tay sau cung vdi dong mach
canh tay sau.

- O canh tay: chay chech xudng difdi va ra ngoai trong ranh than kinh quay d
mat sau phan ba giifa xudng canh lav, rdi choc qua vach gian co ngoai de ra trudc
tdi vung khuyu tru'dc.

- O vung khuyu trifdc: day quay nam trong ranh nhi dau ngoai, xudng tdi
ngang muc nep gap khuyu thi chia thanh hai nganh cung: nganh ndng va nganh
sau, tiep tuc di xudng cang tay va ban tay.

3. N G A N H B E N (H in h 9.3)

• 0 vung canh tay sau. day quay tach ra cac nhanh bi va cac nhanh co.

+ C dc n h a n h bi (rami cutaneus):

• Than kinh bi - canh tay sau (N. cutaneus brachii posterior): tach ra tif o
nach tru'dc gan cd lung rong, cam giac cho da d giua mat sau canh tay. du'di eo
delta.
• Than kinh bi - canh tay ngoai difdi (nervus cutaneus brachii lateralis
inferior) thudng difdc coi nhu mot nhanh tren cua than kinh bi cang tay sau, tach
ra tu ranh than kinh quay, choc qua dau ngoai cd tam dau, tdi cam giac cho da d
phan difdi mat ngoai canh tay.
172 [jj] GIAI P H A U N G U O I. TAP I

. Than kinh hi ca ng tay sau (nervus cutaneus antebrachn posterior): tach

ra tu' trong ranh than kinh quay, cho mot nhanh tren cam giac cho da 6 niia
dudi ngoai canh tay (than kinh bi canh tay ngoai dudi): roi choc qua mac canh
tay, di qua ldp ndng vung khuyu sau xudng cam giac cho da 0 phan giua mat
sau cang tav.
+ Cdc n h a n h cd (rami musculares): cd 3 nhanh cho cd tam dau canh tay;
nhanh cao nhat van dong cho dau dai cd tam dau tach cung vdi day bi - canh tay
sau. Cd nhanh thap nhat van dong cho dau trong cd tam dau. tiep tuc di xudng
van dong cho cd khuyu.

* 0 ranh nhi dau ngoai day quay tach ra cac nhanh van dong cd canh tay
quay, cd dudi cd tay quay dai, cd dudi cd tay quay ngan. Cac nhanh nay thQdng
tach ra d phan cuoi day quay, nhQng cung cd the tach ra tQ nganh sau cua than
kinh quay.

4. N G A N H C U N G ( Hi nh 9.3)

N g a n h n o n g 'r am us superficial ist: tu' ranh nhi dau ngoai chrr. thang
xu on g r un g ca ng tay theo cd canh tay </uay ca nam trong hao cd: tdi cho noi
1/3 giu'a va 1/3 du'di ca ng tay thi luon du'di gan cd canh tax (jua\ d< >~a u/ng
cang lay sau, roi di x u o n g mu han tay: tach ra cac nhanh than hinh mu ngon
tay (nervi digitales dorsales). cam giac cho nua ngoai mu ban tav va mu hai
ngdn rudi d nua ngoai (mu ngon cai. ngon tro va nua ngoai mu neon giua)
( Hi nh 9.3).

- N g a n h sa u (ramus profundus): tu' ranh nhi dau ngoai di xuong. lach giua 2
bd cua cd ngiia de ra vung cang tay sau. chay giua 2 ldp cd ndng va ,-au rua vung
nay. va phan nhanh van ddng cho cac cd cua vung. Phan du'di cd ngu a nganh sau
than kinh quay ch cung vdi dong mach gian cdt sau va ma ng ten la than kinh
gian cdt cang tay sau (nervus interosseus antebrachh posterior), tiep tuc d: xudng
tdi cac cd du'di cung d ldp sau va tan het d khdp cd tay.

5. C H I P H O I

Than kinh quay la mot day vua van dong, vua cam giac cho cac co va da o
plua sau chi tren. cu the la:

- Van dong: cac cd vung canh tay sau (cd tam dau canh tay va co khuyu thuoc
vung khuyu sau) cac cd o vung cang tay sau (cd canh tay quay, cd duoi cd tay
quay dai, co' duoi cd tay quay ngan. cd ngQa. cd duoi cac ngdn tay, cd dudi ngdn ut.
cd duoi cd tay- tru. cd giang dai ngdn cai. cd duoi ngan ngdn cai. cd duoi dai ngdn
 THAN KINH CHI TREN [jjj 173

cai, cd dudi ngdn tro). Vay day quay la day duoi va ngiia cang tay, ban tay. va
ngon tay.
- Cam giac: cho da d mat sau va niia du'di mat ngoai canh tay. mat sau cang
tav, niia ngoai mu tay va mu hai ngon rufdi ke tti ngdn cai (Hinh 9.4).

6. A p d u n g t h i / c t e

Khi day than kinh quay bi deft, tuy theo vi tri ton thtidng ma se gay nen it
nhieu cac bieu hien khac nhau: liet cac cd duoi cang tay; liet cac cd dudi va ngiia
ban tay, ngdn tay; ban tav bi keo rii xuong hinh co co, con goi la ban tay rdi.

SO DO TONG KET THAN KINH CHI TREN

Cuoi cung nguven uv. difdng di, chi phoi cam giac va van done cua th&n kinh
chi tren co the tom tat tro ng cac sd do sau day.

Hinh 9.4. Chi phoi cam giac chi tren

A. Mat tru’dc - B. Mat sau
1. Than kinh nach. 2. Than kinh quay; 3. Than kinh cd bi. 4 Than kinh giu’a 5 Than kinh tru
6 Than kinh bi cang tay trong; 7. Than kinh bi canh tay trong
GI A I P H A U N G U O I . T A P I

B&n tay rot

/ *

B a n tay v - V ‘ r -

Hinh 9.5. So do on tap tong hdp than kinh chi tren

(Sd do cau tao dam roi TK canh tay, sd do nguyen uy. ditfng di tan cung va chi pho.
cua cac nganh tan dam roi canh tay, sd do cam giac d ban tay (de hoc v.en tu chu thich)
 VAI VA NACH [jJi 175
LikJ

GIAI PHAU DINH KHU CHI TREN

■

Chi tren co the chia thanh 6 doan: vai, canh tay, khuyu, cang tav. co tay, ban
tay. Cac phan difdi day se trinh bay tong hdp dinh khu theo tifng vung nhd.
khong nhac lai chi tiet cac cau true giai phau da mo ta d tren (xin doi chieu vdi
phan giai phau he thong chi tren).

10. VAI VA NACH

Vai bao gom cac vung bao quanh dai nguc. hay dai chi tren la phan noi tiep
chi tren vdi than minh. bao quanh khdp vai va chiia dung mot vung quan trong la
nach: qua do co cac mach va than kinh di den chi tren.
Vai dude gidi han o' tren bdi xifdng ddn va bd tren xifdng vai. o' dudi bdi mot
binh dien ngang qua bd dudi co ngu'c to, d sau bdi bd trdng xudng vai, d trudc va
trong bdi vung vu (regio mammaria) va thanh nguc ben.
Vai bao gom: vung ngu'c ben, hay vung nach (regio pectoralis lateratis, regio
axillaris), vung ba vai (regio scapularis) va vung delta (regio deltoidea).
Theo each sap xep cua Thuat nguf Giai phau Quoc te hien nay (T.A.1997) chi
co vung delta la dude ke chinh thde vao cac vung cua chi tren (regiones membri
superioris). Con vung ba vai dude xep cung vdi cac vung cua lung (regiones dorsi);
vung ngu'c ben va nach difdc xep cung vdi cac vung ngifc trifdc va ben (regiones
thoracicae anteriores et laterales). Song d day chung toi van gop tat ca vao cung
mot bai, vi ly do da neu 6 tren, va coi vung nach la trong tam chinh cua bai nay.

VUNG NACH
(liegio axillaris)

Vung nach gom tat ca nhiing phan mem nam d trong khoang difdc gidi han
bdi xifdng canh tay, khdp vai va vung delta d ngoai. thanh ben long ngifc d trong,
xifdng vai, va vung ba vai d sau, vung ngifc ben (regio pectoralis lateralis) d trifdc.
Vay nach hinh thap cut co 4 thanh (trifdc, sau, trong. ngoai), 1 dinh d tren, 1 nen
hay ho nach (fossa axillaris) d difdi, vdi cac thanh phan quan trong (mach than
kinh) difng trong.
176 [$ GIAI p h A u NGlfCJl. t A p I

H inh 10.1. P hau tic h v u n g nach, nhin tru’dc (Theo Frank H Netter)

I. Cd bac thang tru’dc; 2 DM co ngang, 3, DM va TK vai sau; 4. Dm va tk vai tren 5 Cd thang,

6, Xu'dng ddn va cd du’di ddn (cat); 7 Dm nach; 8, Nhanh ngu'c; 9. Nhanh don; 10 Nhanh delta
I I . Nhanh cung vai; 12. DM cung vai ngu'c; 13. Gan cd ngu'c be (b| cat); 14. Mom qua 15 Mom
cung vai; 16. Tinh mach dau 17. TK cd bi. 18 Dm mu CT tru'dc: 19. TK nach va DM mu CT sau
20. Cd ngu'c ldn (bi cat); 21. Cd qua canh tay: 22 Cd delta 23. Cd nhi dau CT; 24 TK cd bi 25 Cd
canh tay; 26. DM canh tay sau. 27 TK quay; 28 Cd tam dau CT. 29 Cac Tm canh tay 30 TK tru
31. TK giCra; 32. DM canh tay. 33 TK bi cang tay trong 34 Tm nen; 35. TK tru 36 TK bi canh tay
trong, 37, TK gian sudn canh tay, 38 DM mu vai: 39. TK du’di vai du’di, 40. Cd tron to 41 DM du’di
vai, 42. Cd lu’ng rong; 43 TK va DM ngu’c ltfng; 44. TK dtfdi vai tren; 45. Cd rang trtfdc 45 TK ngtfc
dai va DM ngtfc ngoai; 47 Cd ngtfc be (bi cat); 48. TK ngtfc trong; 49. TK ngtfc ngoai, 50 DM ngtfc
tren; 51, Dam roi TK canh tay; 52. Xtfdng stfdn I; 53. DM va TM dtfdi don; 54. Cd vai mong (bi c it).
55. TK hoanh; 56. Cd tfc ddn chum
 VAI VA NAC H tj l 177

Hinh 10.2. Thiet do ngang qua nach

Cac thanh (tru’dc. sau. trong, ngoai) nach va cac mach than kinh dim g trong

1 Than kinh bi cang tay trong; 2. Than kinh giUa; 3. Than kinh cd bi, 4 Cd qua - nhi dau (Dau ngan
cd nhi dau va cd qua canh tay); 5. Tinh mach dau, 6 Dau dai cd nhi dau 7 Gan cd U ng rong
8 Gan cd tron to: 9 Xu’dng canh tay; 10. Cd delta: 11 Dong mach mu canh tay sau 12 Than kinh
nach. 13. Dau dai cd tam dau: 14. Cd tron be; 15. Xu’dng vai; 16. Cd du'di gai. 17 Cd du’di vai,
18. Cd rang tru'dc; 19 Than kinh quay; 20. Than kinh tru; 21. TTnh mach nach. 22 Than kinh bi canh
tay trong; 23. Cac cd gian stfdn; 24. Cd ngu'c to; 25. Cd ngu'c be; 26. Hach bach huyet.

1. CAC T H A N H C U A N A C H

1.1. T h an h trufdc la v u n g ngu?c n goai (regio pectoralis lateralis). (Hinh 7.3.

7.1. 7.5, 7.9, 10.1, 10.2, 10.4).

1.1.1. G idi h a n : d tren bdi xtidng don, d dtidi bdi bd dtidi cd nguc to, d ngoai bdi
ranh delta ngtic. d trong bdi mot dtidng thang dting di qua phia ngoai vting vu
(regio mammaria) (Hinh 7.3).

* [Pectoralis “tti chti pectus", co nghla la ngi/c (the thorax; the chest), chu yeu dung de chi
mat tri/dc. thanh tri/dc cua ngi/c, hay vung ngi/c tru’dc (the breast).
Vung ngtic (regio pectoralis) hay ngi/c tri/dc, tifdng ting vdi cd ngiic to, dupe chia lam 3
phan; vung vu (regio mammaria), vung ngi/c ben hay nguc ngoai (regio pectoralis lateralis)
va vung dudi vu (regio infra mammaria] (Theo T.A. 1997).

12- GPN-T1
178 [j|j GIAI P H A U N G l / O l . T AP I

1.1.2. H inh th e n g o a i (giai phau be mat)

- () tren. co xUOng don noi len thanh gd ngang cong nhe hinh chti S. loi
6 trong, lom d ngdai. Du'di xu'dng ddn la mot hd 16m gdi la h6 dudi don (fossa
mf'raclavicularis).
- Phia ngoai co mot ranh rong d tren, ngan gitia cd delta va cd ngiic (ranh
delta ngifc). Sd nan d phan tren day ranh hoac hdi lech vao trong chut it. co the
thay dinh cua mom qua xUdng vai.

1.1.3. Cau ta o: tif nong vao sau co (Hinh 10.4)

- Cac ldp nong gom co da, mong, mem; md dudi da it, chi ro d phan tren cua
vung. Trong ldp mo te bao nhao dudi da, co nhiing nhanh mach nong nho khong
quan trong va vai sdi cam giac tif cac than kinh gian sifdn va tif nhanh tren don
cua dam roi co nong.
- Mac ngi/c (fascia pectoralis): bao phu cd ngiic to, toa tif xifdng don, den bd
dudi cua cd Ihi 1ao nen mac ndng cua nen nach.
Cd nguc to: gom ba bo hinh quat tap trung ve phia mep truoc >ann gian cu
xu'dng canh tay. Bd tt en ngoai cua cd tUdng ung vdi ranh delta ngu< . 11 ong do co
tinh mach dau. mot nhanh cua dong mach cung vai nguc. va ddi kh; mot hoar
hai hach bach huyet nho. (Hinh 7.3. 7.-1: 10.1).
Ldp cd mac sau: gom cd cd dudi ddn nam dai dudi xu'dng don. co nguc be
toa hinh quat tif mom qua xudng cac xudng sudn 111. IV. V. va mac (ton ngu'c
(fascia clavi pectoralis) cang giua hai co. Mac bam vao 2 bo' ranh dudi don. boc lay
cd du'di ddn. toa xudng cd nguc be. tach lam ddi hoc lay cO ngiic be. O duoi co nguc
be hai la lai dinh vao nhau. xudng tdi day nach toa thanh day chang treo nach va
mac sau ciia nach.
Phan giua hai cd dudi ddn va nguc be cua mac ddn - nguc co tinh mach
dau, dong mach cung vai nguc va day than kinh nguc ngoai choc qua Ddng
mach va than kinh co the phan chia trudc hoac sau khi choc qua mac de tdi
mat sau cua cd.

1.2. T h a n h s a u la v u n g b a v a i (regio scapularis). (Hinh 7.6. 7.7. 7.8. 7.10. 10.1.

10.2. 10.3, 10.4)
La mot thanh xuong cd. gom cd:
- Xu'dng vai kep o giiia: cac cd tren gai. du'di gai, cd thang va cd delta phu
dang sau (Hinh 7.6. 7.7): co dudi vai dem dang tru'dc di tif mat trudc xuong vai
den cu nho xifdng canh tay (Hinh 7.8). O dudi khoi do con cd cac cd tron be va
tron to di tu mat sau bd ngoai xudng vai, tach ra 2 nga; cd trdn be tdi bam vao
mat sau cu ldn, cd trdn to tdi bam vao mep trong ranh gian cu; cd liing rone vong
quanh bd chidi cd tron to de ra phia tru'dc bam vao day ranh gian cu.
 VAI VA NAC H gj 179

Gitia hai cti tron de hd mot khoang hinh tam giac dUtic goi la tam gidc ba vai -
canh tay, hay tam giac cd trim.
Khoang nay co dau dai cua cd tam dau di qua, chia khoang lam hai phan: la
khpang tti giac hay tti giac canh tay tam dau d ngoai. va khoang tam giac hay
tam giac ba vai tam dau 6 trong (Hinh 10.3).
- Trong khoang tti giac canh tay tam dau co cac mach mu canh tay sau va
than kinh nach di qua. Than kinh nam tren dong mach va ngay dudi khdp vai.
- Trong khoang tam giac bd vai tam dau co nhanh ba vai cua dong mach dudi
vai di qua.
- Dudi cd litng rong va cd trdn to, con mot khoang xen gitia xUdng canh tay va
dau dai cd tam dau, goi la tam giac canh tay tam dau, di qua do co than kinh
quay va mach canh tay sau (se dUtic mo ta cung vdi canh tay).
(Thanh sau cua nach hay vung ba vai, di tii nong vao sau, tu phia lung, so dude
mo ta chi tiet them d phan sau).

Hinh 10.3 Sd do vung nach. Thanh sau va lien quan vdi cac mach than kinh (nhin tru’dc)
1. TTnh mach nach; 2. D ong mach nach; 3. Than kinh cd bi; 4. Than kinh nach, 5 Than kinh quay.
6. Than kinh cd lung rong; 7. Cd ngu’c be; 8. Than kinh cd tron to: 9 Cd du’di vai. 10 Dong mach
du’di vai; 11. Than kinh bi canh tay trong; 12. Than kinh bi cang tay trong 13 Than kinh tru:
14. Than kinh giCra
180 i GI AI P H A U N G U O l . T A P I

1.3. T h a n h t r o n g (Hinh 7.5. 10.1. 10.2)

La thanh bon long nguc, co cd rang trudc che phu. Doc thoo mat ngoai cua cd
co day than kinh ngiic dai chay thdng tit tren xuong diidi, phan nhanh cho cd. va
trUtic than kinh co dong mach ngiic ngoai.

1.4. T h a n h n g o a i (Hinh 10.1. 10.2. 10.3)

DUdc tao nen bdi dau tren xUdng canh Lav va khdp vai canh tay. cd nhi dau va
cd qua canh tay.
Dau dai cd nhi dau di tii cu tren o chao xiidng vai, chay qua khdp canh tay roi
doc theo ranh gian cu di xuong. Con dau ngan cd nhi dau va cd qua canh tay tii
dinh mom qua di xuong. Cd qua — canh tay co than kinh cd bi choc qua va la cd
tuy hanh cua dong mach nach (khi mo lat bd trong cd len se thay ro dong mach).
Bao phu d phia ngoai cung thanh ngoai cua nach la cd delta (se mo ta tiep d sau).

1.5. D in h n a c h (I Imh 7.5. 10.1. 10 2)

Dinh cut cua nach duoc gitii han o tru'dc bdi xuong don va co duoi dun. o siu
va trong bdi xuong Miiin thu 1. cd bo thu 1 cua cd rang tru'dc bam: o .-au va ngoai
boi bd tren xuong vai va m om qua.

Khe giua xuong sudn I va xuong don thuong dude goi la kho >uon don. qua do
co cac dong va tinh mach nach va cac bo cua dam roi than km h canh tay di qua
de xuong nach.

1.6. N o n h a y d a y n a c h (Hinh 10.1. 10.3. 10.1)

Tu o n g Ung vdi phan da hoc lom thanh mot ho. na m giua phan tren xu'dng
canh tay ti ngoai. thanh nguc ti trong. bd dudi cd ngiic td ti trudc va cd lung
rong ti sau.
Cau tao gom 1 lcip.
- Da: mong, mem mai. co long dai dac biet d ngQdi trUdng thanh va co tuven
mo hoi dac biet.
- Mo clif cii da: cti cac cuon md xen ke vdi nhung be xd.

Mac nong: mong lien tiep b trudc vtii mac nguc (fascia pectoralis) va o sau
vtii mac cti lung rong.

- Mac sau: o' tru’dc lien tiep vtii la sau cua day chang treo nach: ti sau phu
trudc co lung rong va cti tron to de bam vao bd ngoai xUdng vai.
Day chdng treo nach (lig. suspensorium axillae) la phan tiep tuc cua mac ddn
nguc (fascia elavi pectoralis) boc co dudi don va cd ngtic be, toa xuong bam vao
mac nach (fascia axillaris). 6 sau bti dudi cti ngiic to; va co tac dung keo hom nach
lom len tren, ti sau bti tru'dc cua nach. (Hinh 10.4).
 VAI VA NAC H [ g 181

Hinh 10.4. Thiet do dtrng doc qua nach

(Cau tao thanh tru'dc. thanh sau, nen nach, va cac mach than kinh dung trong)
1. Than kinh nach; 2. Dong mach nach; 3. Than kinh quay. 4. Ca delta, 5. Co du'di vai, 6 Co du'di gai,
7, Cd trdn be; 8 Cd trdn to; 9 Cd lifng rong; 10. Ldp da; 11. Mac sau; 12 Mac nong, 13. Day treo nach,
14. Cd ngu'c be. 15. Than kinh bi canh tay trong; 16. TTnh mach nach; 17. Than kinh bi c ln g tay trong,
18. Than kinh tru; 19. Than kinh giCra; 20. Than kinh cd bi; 21. Cd ngu'c to; 22 Mach mau va than kinh cac
cd ngu'c 23. Cd du'di don

2. CAC T H A N H P H A N D l /N G T R O N G N A C H

Trong ho nach hinh thap cut, gi6i han nhu tren, co chiia day mot
khoi te bao md qua do co cac bo mach than kinh quan trong va nhieu hach
bach huvet.
Cac mach than kinh di tif co va ngUc qua nach xuong chi tren chu yeu gom co
dong mach nach, tinh mach nach, cac bo cua dam roi than kinh canh tay va cac
nganh tan cua no.
182j[jj| G I A I P H A U NGUCJI T A P I

2.1. D ong m ach nach (Hinh 8.1. 10.2, 10.5. 10.6)

Dong mach chui vao o nach qua dinh nach d khe giiia xiidng siidn I va xiidng
don), hiidng chech xuong diidi ra ngdai va hdi ra sau. chav doc iheo phia sau bd
trong cd qua canh tay, va ra khoi day nach d phfa sau bd diidi cd ngiic ldn. Nhii
vav d tren, dong mach gan thanh triidc va trdng cua nach, 6 diidi dong mach lai
gan thanh ngoai
Tren diidng di, dong mach nach b it cheo d sau gan cd ngiic be. va co 3 doan
lien quan (la doan tren cO ngiic be, doan sau cd ngiic be va doan diidi cd ngiic be),
se diidc mo ta d phan sau, cung vdi dam roi than kinh canh tay.
Dong mach cho 6 nganh ben co the chia lam 4 nhom hiidng theo 4 phia: triidc,
sau, trong, ngoai (cho 4 thanh cua nach) (Hinh 8.1, 10.5, 10.6):

9
10

11
12

Hinh 10.5 Dong mach nach va cac nganh ben (nhin tru’dc)

(Theo F H Netter)

1. DM co ngang; 2 DM tren vai: 3. Mom cung vai va vong noi cung vai; 4. DM vai sau 5 Mom qua
6 DM mG CT tru’dc; 7. DM mu CT sau. 8 DM du'di vai: 9. DM mu vai; 10. DM canh tay 11 DM ngi/c
long; 12. DM ngu’c ngoai; 13. Nhanh ngu’c (DM cung vai ngi/c), 14. Nhanh delta, 15 Nhanh cung vai
16 Nhanh du'di ddn; 17. DM cung vai ngu'c: 18. DM ngu’c tren; 19. Xi/dng don (bi cit). 20 Co bac thang
trudc; 21. DM nach; 22. Than giap cd: 23 DM giap du’di; 24 DM cd len.
__ *
(Cac so 1, 2, 3 chu1dam (ghi tren ddng mach). chi cac doan tren, sau va di/di co ngi/c be cua DM nach)
 VAI VA NACH 183

+ Cac nhanh trUdc gom dong mach ngiic tren va dong much cung vai ngiic.
phan phoi cho cac cti ti thanh trUdc cua nach va thanh ngiic ben. Nhanh cung vai
cua dong mach cung vai ngUc cung gop phan cap mau cho cti delta, va noi tiep vtii
cac dong mach, mu canh tay ti mang mach cung vai.
+ Nhanh trong la dong mach ngiic ngoai phan nhanh cho thanh trong cua
nach, hay thanh ben cua long ngiic.
+ Nhanh sau la dong mach diidi vai, nhanh ldn nhat cua DM nach chui qua
tam giac ba vai tam dau noi tiep vdi cac dong mach vai tren, vai sau; cap huyet
cho cac cti ti thanh sau cua nach va vung ba vai, dac biet cho c0 liing rong.
+ Cac nhanh ngoai la cdc dong mach mu canh tay triidc va sau vong quanh
phia trudc va sau co phau thuat xUting canh tay; cap huyet cho cti delta, va cac cti,
xUting, khdp ti thanh ngoai nach; dong mach mu sau ldn hdn chui qua tii giac
canh tav tam dau.

Hinh 10.6 Cac noi tiep quanh vai cua dong mach nach (nhin sau)
(Theo F.H. Netter)
1. Cd nang vai; 2. DM vai sau; 3. Cd tren gai (bi cat); 4. Khuyet tren vai va day chang ngang tren
vai. 5. Gai vai; 6. Cd du'di gai (bi cat); 7. Cd trdn nho (bi cat); 7. Cd trdn nho (bi c£t); 8. Cd tron to;
9, 10. Dau ngoai va dau dai cd tam dau CT; 11. DM mu vai (nhanh sau cua DM difdi vai). 12 DM mu
sau CT (trdng tif giac canh tay tam dau) va cac nhanh len, xuong cua nd; 13. Nhanh du’di gai cua
DM tren vai; 14. M om cung vai; 15. Nhanh cung vai cua DM cung vai ngu’c; 16 DM tren vai.
17. Bung du’di cd vai m ong.
184 >X GI AI P h A u N G I / D I . TAP I

2.2. T i n h m a c h n a c h (Hinh 10.1. 10.2, 10.3)

( ’ hi co mot tinh mach ldn di thoo dong mach. O dudi, tinh mach nam trong
dong mach. cang len tren tinh mach cang chay ra trUdc va vao trong dong mach.
Tinh mach thifdng chi co 1, song cung khong hiem khi thay co 1 ong tinh
mach hen. nghla la mot nhanh noi tiep doc. kich cd rat thay doi. chay doc theo
tinh mach. d trudc tinh mach va dong mach.
- Tinh mach nach cung nhan nhCing nhanh ben di kem cac nhanh ben cua
dong mach va con nhan them tinh mach dau, la 1 tinh mach nong tii dUdi di len,
chay trong ranh delta nguc. roi choc qua mac don ngiic de do vao tinh mach nach d
ngay dudi xUdng don. Do vao tinh mach dau, d do con co tinh mach cung vai ngiic.

2.3. D am roi th a n k in h can h tay d n ach (Hinh 9.1, 9.5, 10.1, 10.2. 10.3)
Cau tao, vj tri va lien quan chung cua dam roi th&n kinh canh tay da diidc mo
t;i ti hai !) than kinh chi tren (muc 1. 2. 3. 1). O nach chi co cac bo va cac nganh
tan. nganh ben cua dam roi canh tay.

2 . 3 . 1 . L i e n q u a n v d i d o n g , t i n h m a c h n a e l i : co the mo ta theo 3 doan cua dong

mach nach:
D o a n I r e n cd n g i f c be: d dinh nach tinh mach d trong va lan ra trudc: dong
mach ti ngoai va lui ra sau: cac bo ngoai. sau. va trong cua dam roi canh tav nam
o' tren sau va ngoai dong mach. xep chong len nhau.
D o a n s a u c d n g u ’c be: cac bo quay xung quanh 3 mat sau. trong. ngoai dong
mach (nhu ten goi cua chung) va bat dau phan chia thanh cac nganh cung. Bo
ngoai di ra trudc ti ngoai dong mach, cho day cd bi va re ngoai than kinh giiia. Bo
trong lach giua dong mach va tinh mach. tach ra re trong day than kinh giUa.
day than kinh tru, day than kinh bi cang tay trong va day bi canh tay trong. Con
bo sau van nam sau dong mach, cho day than kinh quay va day than kinh nach
- Doan difdi cd ngi/c be: cac nganh cung cua dam roi canh tay tach xa d&n
dong mach de di theo cac hudng khac nhau. Chi co mot vai day van bam sat dong
mach qua day nach xuong tan canh tay. Cu the (Hinh 10.3):
• Day than kinh cd bi tu' bo ngoai: ti ngoai dong mach, da hudng xuong dudi va
ra ngoai de xien qua co qua canh tay.
• Day than kinh giua hop bdi 2 re (re ngoai tti bo ngoai, re trong tii bd trong)
chap lai d trudc dong mach, roi chay xuong ti trUtic ngoai dong mach.
• Day than kinh tru (tii bo trong) di xuong d sat mat trong dong mach doc
theo khe giiia dong mach va tinh mach.
• Day than kinh nach (tii bo sau) hudng xudng diidi, ra ngoai va ra sau, de
chui vao tu giac canh tay - tam dau cimg vdi dong mach mu - canh tay sau. Than
kinh chay d tren ddng mach. ngay sat dUdi bao kh6p canh tay.
 VAI VA NACH (>3 185

• Day than kinh quay tiep tuc di xuong d sau dong mach nach, triidc khi chui
qua tam giac canh tay tam dau, de xuong vung canh tay sau.

2.3.2. Dam roi canh tay tach ra cdc nganh ben 6 vung nach nhu sau:
• (.) triidc: co cac day than kinh ngifc ngoai. (tach tti bo ngoai) va ngu’c trong
(tach tu bo trong) tti 2 ben dong mach htfdng ra trudc, noi tiep vdi nhau tao thanh
quai than kinh ngiic d trtfdc dong mach ngay dtfdi nguyen liy ctia dong mach cung
vai ngtfc.
• 0 sau: tach ttf bo sau, co cdc day than kinh cho cac cd du’di vai, cd litng rong
va cd trim to.
• 0 trong: co day than kinh ngu’c ddi tach ttf cac day than kinh song co 5, 6, 7
di xuong cho cd rang trtfdc, ap vao mat ngoai cua cd.
Ngoai ra chav vao nach ttf tren xuong dtfdi va ttf trong ra ngoai con co cac
nhanh xien cua cac day than kinh gian stfdn dau tien, ndi tiep vdi day than kinh
bi canh tav trong. va cam giac cho da d day nach.

2.4. Cac hach b ach h u y et cf nach

Co 5 toan hach, trong do 3 toan lan ltfdt trai doc theo mat trong bo mach than
kinh nach, doc theo dong mach ngtfc ngoai va doc theo dong mach dtfdi vai. Cac
hach dtfdi cua chuoi theo doc cac mach nach con goi la chuoi canh tay nhan bach
huyet cua canh tay, cang tay va ban tay. Chuoi dtfdi vai nhan bach huyet d vung
vai. Chudi ngtfc nhan bach huyet d thanh ngtfc trtfdc ben.
Cac mach di ttf 3 toan hach do do ve cac hach cua cac toan trung tam va toan
dinh d cao hdn doc theo dong mach va tinh mach.
(Xin xem lai mo ta chi tiet hdn d bai 8: giai phau he thong cac mach chi tren).

VUNG BA VAI
(R e g io s c a p u la r is )

Vung ba vai hay vung vai sau gom tat ca cac phan mem nam sau xtfdng ba
vai va d thanh sau cua nach.

i. g i6 i h a n

Gidi han cua vung ba vai ttfdng ting vdi cac bd cua xtfdng vai: d tren len tdi
khoang gian stfdn I, d dtfdi xuong tdi xtfdng stfdn 8: d trong cach dtfdng gai song
khoang 6cm.
186 |[]J] G I AI P H A U N G U d l . T A P I

2. H IN H T H E N G O A l (giai phau be mat) (Hinh 7.2. 7.6)

• GiQa 1/4 tren va 3/4 dtfdi cua vung noi len mot go chech len tren va ra
ngoai: la do gai vai.
• () tren va dtfdi gai la 2 dien hdi lom, ttfdng tfng v6i cac ho tren gai va dtfdi gai.
• O phan tren ngoai cua ho dtfdi gai noi len bo sau cua cd delta.

3. C A U T A O

Ttf nong vao sau co:

3.1. C a c ld p n o n g
- Da: day, tho, di dong.
- Ldp md dadi da: co chieu day thay doi, gidi han d sau bdi mot ldp mac nong.
- Trong ldp md te bao diidi da: co cac nhanh cua cac dong mach va tinh mach
vai; rac mach hach huyet do vao cac hach tren gai va cac hach nach. cac nhanh
than kinh cam giac, ttf cac clay than kinh cua vung vai d phia ngoai va tu cac
nhanh ltfng cua cac day than kmh song nguc d phia trong.

3.2. L d p m a c s a u
O ho tren gai mac dinh vao cd thang; d ho dudi gai mac mong khi phu len cd
delta, cd thang va cd ltfng rong. day va trang bong khi phu len phan 16 cua cd dtfdi
gai (o' khe hd gitfa cac cd ldp nong).

3.3. C a c ld p c d d u ’di m a c (Hinh 7.2. 7.6. 7.7, 10.7)

3.3.1. (1 h o tr e n g a i
- Ldp nong: co cd thang bam vao gai vai.
- Ldp sau: co cd tren gai di ttf ho tren gai den cu ldn xtfdng canh tay va mac
tren gai, phu cd tren gai va ngan cach vdi cd thang bdi mot ldp mo md. trong do co
mot so hach bach huyet.

3.3.2. t i h o dtfdi g a i
- Ldp nong: co bo sau cd delta, mot phan cd thang va cd ltfng rong phu che phu.
- Ldp sau: co cac cd duoi gai. tron be. tron to va mac dtfdi gai nhu mot ldp mo
te bao che phu mat sau cac cd do.
Cd dtfdi gai chiem phan bam rong nhat cua ho. Cac cd tron bam doc bo ngoai
cua xu'dng vai. Cd ltfng rong chi di ngang qua goc dtfdi cua xtfdng. trtfdc khi vong
quanh bd dtfdi cua cd tron to de ra phia trtfdc cd do.
Ca 4 cd deu htfdng ra ngoai ve phia dau tren xtfdng canh tay va gop phan tao
nen thanh sau cua nach, vdi cac khdang tam giac ba vai canh tay (hay tam giac
co tron), ttf giac canh tay tam dau, va tam giac ba vai tam dau.
 VAI V A N A C H fi l 187

Hinh 10 7 V u n g ba vai va v u n g delta. Cac cc? ja cac mach than sa,.

(Sau khi da cat bo cac cd d nong va mot phan cac cd d sau)
(Theo Testut va Latarjet)
1. Gai vai, 2. DM tren vai, 3. TK tren vai, 4. Cd tren gai. 5. DM du'di vai. 6. Cd du'di gai. 7. Cd tron be.
8. Cd tron to; 9. Nhanh cho cd tron be, 10. Day than kinh quay. 11 Nhanh cho da vung vai Dau dai
va dau ngoai cd tam dau, 13. Cd delta; 14. Cac nhanh cho cd delta, 15. Dong mach mu sau 16 Day
than kinh nach; 17, Nhanh cho cd delta va khdp vai; 18 Mom cung vai.

3.4. C a c m a c h , t h a n k i n h s a u (Hinh 10.6, 10 7)

- O ho tron gai: co dong mach tren vai (A. suprascapularis) chui vao ho tren
gai o' tren day chang ngang khuyet vai, va day than kinh tren vai (X. supra,
scapularis), 6 duoi day chang ngang khuyet vai; ca hai chay sat xifdng, d mat sau
cd tren gai, tach ra cac nhanh cho cd, roi vong qua goc cung vai, (giuia gai vai va
co xu'dng vai) chui xuong ho dtfdi gai cho cd dtfdi gai.

- 0 ho du'di gai: cd 3 dong mach va 1 than kinh.

+ Nhanh vai eua dong mach diidi vai (A. subscapularis) ttf tam giac ba vai
tam dau di ra. phan phoi cho cac cd d ho dtfdi gai.
+ Nhanh tan cua dong mach tren vai ttf hd tren gai di xuong. vong qua bd
ngoai cua gai vai, cung gop phan cap huyet cho cac cd cua vtfng.
+ Dong mach vai sau (A. dorsalis scapulae) toi vung ba vai d goc tren trong
cua xtfdng vai, chav doc theo bd song cua xtfdng d trtfdc cd tram, phan nhanh chd
cac cd lan can (xem Hinh 10.6).
188 'A ik
G I AI P H A U N G U O I . T A P I

Cu 3 dong mach noi tiep vdi nhau mot cach phong phu tao nen mang mach
quanh vai; bao dam tuan hoan cho chi tien khi that dong mach nach d tren dong
mach dudi vai (lien he vdi Hinh 10.5).
+ Day than kinh tren vai di theo dong mach cung ten van dong cho cac cd tren
gai va dudi gai (Hinh 10.7).

VUNG DELTA
(R e g io d e lto id e a )

La vung chicm phan loi len d phia ngoai vai (thtfdng gdi la u vai). ttfdng ting
vdi cd delta, nam d phia ngoai vung nach va vting ba vai.

1. G i d i H A N

() tren la xUting don va mom cung vai; d dtfdi la cho bam cua cd delta vao
xudng canh tay; ti trtfdc la ranh dolta-nguc: d sau la dtfting thang dtfng di qua
du'dng khdp canh tay va bd sau cd delta.

2. H IN H T H E N G O A I (Giai p h au be mat)
Vung nho len hinh trdn deu do chom xtfdng canh tay doi cd len. Gidi han tren
sd thay dtfdc la dau ngoai xtfdng ddn. mom cung vai, va phan ngoai gai vai.

3. C A U T A O

3.1. Cac ldp non g

- Da; day, mem. nhtfng thd rap.
- Ldp md dtfdi da: day mong khac nhau tuv theo ngtfdi bed gay, gidi han bdi
mot ldp mac nong mong.
- Trong ldp mo lien ket dtfdi da: co cac mach. than kinh ndng, gdm nhting
nhanh mach nho khong quan trong, nhting nhanh than kinh tti nhanh cung vai
cua dam roi co nong d tren, va tti nhanh bi cua day than kinh nach d dtfdi.

3.2. Ldp m a c sau

M6ng va dinh vdi cd delta bdi nhting vach ngan xen vao gitia cac bo cd (la
nhting vach can noi co cua cd da long vti).

3.3. Ldp cd d elta

Gdm ba bo trtfdc, gitia, sau, lan ltfdt di tti xtidng don, mom cung vai va gai vai,
tap trung lai bam tan vao u loi chti V delta cua xtidng canh tay (Hinh 7.1, 7.2, 7.3).
 VAI VA N A C H jjjj 189

* [Dac biet bo giCra co delta la mot co da long vu. vdi 4 vach can noi co tCr nguyen uy di xuong va
3 vach can noi co ti/ bam tan di len. Bam chech giCfa cac vach can do gom rat nhieu nhCrng soi
co ngan: lam cho co co 1 IlTc co rat manh, va 1 do co ngan (Hinh 4.7). Song khi cac soi co bam
giCra cac vach bi ton thirong do tiem, hay do liet than kinh nach thi chung se bi thoai hoa xo va
dinh lien cac vach can noi co ke can vdi nhau thanh mot dai xo day, gay co ctfng co delta Dieu
da trd thanh 1 tai hoa cho qua nhieu tre em Viet Nam nhung nam gan day (2005 - 2006)]

3.4. Ldp m o te bao dtfdi cd va cac m ach than k inh sau

Dudi cd co mot ldp mo te bao xd, mat do va chieu day thay doi tuy cho.
0 phan tron cua khoang co mot tui hoat djch du'di delta nam ngay dtfdi vom
cung vai - qua va cd delta, tren cu ldn va cac gan cd quanh khdp (Hinh 10.815).
() phan dtfdi cua khoang te bao dtfdi cd delta nay co cac phan nhanh cua cac
mach va than kinh nach phan phoi cho cd delta (Hinh 8.1, 10.5, 10.7).
- Dong mach mu canh tay triidc: vong quanh trtfdc co phau thuat xtfdng canh
tay, bat cheo ngang qua ranh gian cu, chia thanh 2 nhanh: 1 nhanh di Ion thoo
ranh tdi khdp va mot nhanh tan het trong cd delta (Hinh 10.7).
- Dong mach mu canh tay sau ldn hdn: thoat ra ttf khoang ttf giac canh tay
tam dau, phan nhanh tdi mat sau cua cd delta.
- Than kinh nach di theo dong mach nay, la nhanh cua bo sau dam 101 than
kinh canh tay ti nach chui qua khe ttf giac ra sau, cho mot nhanh cho cd tron be
va mot nhanh bi cho vai. rdi chay vong quanh co xtfdng canh lay. khoang 5 - Gem
dtfdi mom ctfng vai. va phan nhanh tan het trong cd delta (Hinh 10.7).
- Dong mach cim g vai ngu'c cung cho mot nhanh cung vai chay difdi cd delta,
gan cac cho ham nguyen uy cua cd.
* [Ap dung thtfc te: Tiem vao co delta, neu dam qua sau, dac biet d tre nho, rat de xuyen
qua be day cua co, vao tdi khoang du'di co, va la m ot nguy co ldn gay ton thtfong den day
than kinh nach va dong m ach mu sau nam d do. Ton thtfong co the true tiep do kim tiem
dam, hay gian tiep do doc tinh bat thtfdng cua thuoc ngam day khoang. tham chi co the lan
xa hon len dam roi than kinh canh tay, gay Net TK co, do phan ung viem hay di ung doi vdi
thuoc tie m ... C ho nen co delta la co de bj co ctfng hon bat ky m ot co nao khac trong co the.
va cam tiem vao co delta d tre nho da thanh van de doi vdi y van quoc te, song van chtfa
dude quan tam d V ie t Nam - (Xem Trinh Van Minh. nhung dieu chtfa biet ve co ctfng co
delta, xay ra hang loat d tre em V iet Nam , NXB Ha Noi, 2007).
S tf lien quan cua co delta vdi cac cau true quanh khdp vai (H inh 10.8) cung cho phep giai
thich nhung ton th iro n g bien dang cua m ot so cau true (xtfdng, khdp, tui hoat djch) sau co
ci/ng co delta nang m an tinh, da dtfdc nhan m anh bdi 1 so cac nha phau thuat ntfdc ngoai],
Xin doi chieu vdi y van da ke trong tai lieu neu tren).

3.5. Ldp ca c cd va ga n cd q u a n h khdp vai

Dudi ldp mo te bao dtfdi cd delta va tui hoat dich dtfdi delta, ti phia tren con co
cac gan cd quanh khdp vai - canh lay, bam vao cac cu ldn va cu be cua dau tren
xtfdng canh tay: cd tren gai d tren, cd dtfdi gai va cd tron be d sau. cd dudi vai d
trtfdc (Hinh 10.8). Cd tron be cung vdi cac cd tron to, dau dai cd tam dau va xUdng
canh tay da gidi han ttf giac canh tay - tam dau. bi che phu hoan loan d phia sau
bdi cd delta. Cac mach than kinh ttf do thoat ra cung deu nam ngay dtfdi cO, trong
ldp mo te bao dtfdi delta (Hinh 10.5, 10.7).
190 m G I AI P H A U N G U O l . T A P I

A. Cac gan cd. xudng khdp vo day chang quanh khdp vai Nhin trtfdc
(Da cat bo cac cd va tui hoat dich du'di cd) (Theo F H Netter)

1. Bao khdp va day chang cung vai don. 2 . Mom cung vai. 3. Day chang qua cung j a t 4 Gan co
tren gai (bi cat); 5. Day chang qua canh tay, 6. Cu ldn 7. Cu be (xu'dng canh tay) 3 Day chang
ngang canh tay (qua ranh gian cu); 9 Bao hoat dich gan gian cu (thong vdi o khdp) 10 Gan c0
du'di vai (bi cat); 11. Gan dau dai cd nhi dau CT, 12. Cac day chang o chao canh tay 13 Difdng
vach chi vi tri cua tui hoat dich dudi gan cd dudi vai. 14. Ndi noi thong cua tui hoat dich du'di vai vdi o
khdp non, 15. Mom qua 16. Day chang ngang vai tren va khuyet tren vai, 17. Day chang non,
18. Day chang thang (cua day chang qua don); 19. Xu'dng don.

B. Cd dudi vai va tui hoat dich dudi cd delta. Nhfn tru'dc

(da cat bo xu'dng don va cac cd d trade va sau du’di khdp vai) (Theo F H N etter,
1 Cd delta (da cat dau bam vao xtfdng don va lat len); 2. Day chang bao khdp (o chao canh tay
dtfdi); 3. Cd dtfdi vai; 4. Tui hoat djch dtfdi cd delta, hoa lan vdi tui hoat dich dtfdi m om cung vai,
5. Cd tren gai.

Hinh 10.8. Cac cau true sau quanh khdp vai dtfdi cd delta

(Theo F.H. N etter, A tlas of Hum an Anatomy, 3rd edit, 2004, Plate 406).
 CANH TAY US) 191

11. CANH TA Y
(Brachium)

Vung canh tay la phan chi tren nam giiia vai va khuyu, dQ dc gidi han d tren
bdi mot dtfdng vong, di qua bd dtfdi gan cd ngtfc to, va d dtfdi bdi mot dtfdng vong d
tren nep gap khuyu 3cm.
Xtfdng canh tay va hai vach gian cd trong va ngoai chia canh tay lam 2 vung:
trtfdc va sau.
* [Cach phan cfoan va phan vung djnh khu chi tren, chi du’di noi chung it nhieu co tinh quy
ifdc de tien phau tich va mo ta lien quan trong ap dung ngoai khoa; nen cac gidi han, dac
biet gidi han tren du’di. chi la tudng ddi. Thuc te cac cau true mo ta khong khu tru trong mot
vung ma thudng di qua nhieu vung lien tiep].

VUNG CANH TAY TRLTOC

(R e g io b r a c h ii a n te r io r )

Gom tat ca phan mem d trtfdc xu'dng canh tay va cac vach gian cd canh tay
trong va ngoai.

1. G i d i H A N V A H iN H T H E N G O A l
Cac gidi han tren va du'di da ke d tren (chung cho canh tay). Cac gidi han ben
tudng ung vdi hai du'dng thang dtfng qua hai loi cau trong va ngoai.
Nhin chung vung canh tay trtfdc cd mot loi doc hinh thoi noi len d giua tudng
ling vdi cd nhi dau canh tay, va hai dtfdng ranh (trong va ngoai) d hai ben cd nhi
dau tuong ling vdi dtfdng bam cua cac vach gian cd vao mac canh tay. Doc theo
hai dtfdng nav cd tinh mach dau d ngoai va tinh mach nen d trong.

2. C A U T A O (H in h 11.1, 11.2, 11.3, 11.4)

Ttf ndng vao sau cd cac ldp nhtf sau:

2.1. C ac ldp n o n g
- Da: mem va mong.
— Md va m ac ndng: mac nong thtfc te chi la mot mang rat mong gidi han d
mat sau ldp md, nen cd the bo qua va gop lam mot vdi ldp md. Md canh tay day
mong tuy ngtfdi beo. gay. Nhin chung d ntf day hdn nam.
192 Ijgl GIAI p h A u N G J O I . T A P I

- Lap mo te bao diidi da: co cac mach va than kinh nong (Hinh 111)
+ Than kinh nong: phia Iren ngoai co nhanh bi - canh tay ngoai tron cua day
nach. phia tren trong co nhanh cua day bi - canh tay trong. phia dtfdi trong co
nhanh cua day bi c^ng - tay trong choc qua mac nong di xuong vung khuyu.
+ Tinh mach nong: phia ngoai co tinh mach dau tii vung khuyu trtf6c di len
ranh delta - ngtfc. Phia trong co tinh mach nen. ttf vung khuyu trtfdc di len den
g{ln gitfa mat trong canh tay thi choc qua mac canh tay (cung day bi - cang tay
trong) de vao ong canh tay.

H inh 11.1. TTnh mach va than kinh nong vung canh tay tri/dc

1. Than kinh bi canh tay ngoai tren (cua TK nach). 2 TTnh mach dau; 3. Than kinh bi cang tay sau ♦ bi
canh tay ngoai du’di (cua TK quay); 4. TTnh mach giua dau. 5. Than kinh bi cang tay ngoai (cua
TK cd bi). 6. TTnh m ach dau; 7 TTnh mach giCfa cang tay; 8. Than kinh bi cang tay trong
9 TTnh mach nen; 10 TTnh m ach noi sau; 11 TTnh mach giCfa nen;12. TTnh mach nen 13 Than kinh
bi canh tay trong.

2.2. M ac ca n h tay

Mong, chac, boc quanh canh tay, mac canh tay lien tiep 6 tren vdi mac
ngtfc, mac nach, va v6i mac cac cd delta va cd ltfng rong. 0 dtfdi mac bam vao
 CANH TAY [jj]| 193

cac mom tren loi cdu xtfdng canh tay, mom khuyu xudng tru, va lien tiep vdi mac
Ccing tay.
Mac canh tay tach ra 2 vach gian cO trong va ngoai toi bam vao 2 bd xu'dng
canh tay (tu’ cac mom tren loi cau trong va ngoai ngtfdc len tdi cho bam cua cd
delta d ngoai, va cd qua canh tay d trong, lien tiep d tren vdi mac cua cac cd dd).
- Cac vach gian cd va xtfdng canh tay chia canh tay thanh 2 d cd: o canh tay
trtfdc. hay o gap (compartimentum brachii antenus/flexorum) va o canh tay sau.
hay o dudi (compartimentum brachii posterius/extensorum). Hai o cd dong thdi
cung ttfdng dng vdi 2 vung dinh khu cua canh tay: vung canh tay trtfdc va sau
(regio brachialis anterior, regio brachialis posterior).

2.3. Cac ldp cd dtidi m a c

Vung canh tay trtfdc cd 3 cd xep thanh 2 ldp (Hinh 11.2):

H inh 11.2. V u n g c a n h ta y trtfd c (Cd mach, than kinh). Vach gian cd trong va mac canh tay
1. Cd qua canh tay. 2 Cd ngtfc to (dau bam tan); 3. Than kinh quay, 4 Dong mach canh tay 5. Than
kinh cd bi; 6. Cd nhi dau canh tay; 7. Cd canh tay; 8. Than kinh gitfa. 9. TTnh mach nen 10. Than kinh bi
canh tay trong; 11. Than kinh bi d in g tay trong; 12. Than kinh tru

13- GPN-T1
194 H GIAI P h A u N G U O l . T A P I

- Ldp nong: co cd nhi dau canh tay (M. biceps brachii). la mot cd dai hinh
thoi, co 2 dau nguyen uy: dtm ngan di tti mom qua va dau dai tti cu tren o chao
xtidng vai hdp lai thanh mot than cd di xuong bam vao u loi xUdng quay. Co
nhi dau la cd ttiy hanh cua dong mach canh tay, bd trong cua cd la moc de tim
.dong mach.
- Ldp sau: co 2 cd la cd qua canh tay d tren va cd canh tay d dtidi.
Cd qua canh tay (M. coracobrachialis): di tti mom qua xtidng vai den phan gitia
mat trong xtidng canh tay, phan 16n nam d thanh ngoai cua nach, phan nho chiem
phan tren trong cua vung canh tay.
Cd canh tay (M. brachialis): chiem gan het chieu rong cua ntia dtidi vung
canh tay d sau cd nhi dau, di tti xtidng canh tay va hai vach gian cd tdi mom vet
xtidng tru.

2.4. Cac m a c h th a n kin h sau (Hinh 11.2, 11.3, 11.4)

Com co bo mach than kinh canh tay nam trong ong canh tay va day than kinh
cd bi nam gitia 2 ldp cd nong va sau.

2.4.1. O n g c a n h ta y va bo m a ch th a n k in h c a n h ta y

• Vi tri, gidi han: ong canh tay la mot ong cd mac hinh lang tru tam giac nam
d phia trong vung canh tay trtfdc. dude gidi han bdi 3 thanh (Hinh 11.3. 13.1).
Thanh trtfdc: ntfa tren la co qua canh tay va cd nhi dau canh tay. Nua dtfdi la
co nhi dau canh tay.
Thanh sau: la vach gian cd trong va cd canh tay.
Thanh trong: la mac canh tay. mo dtfdi da va da.
• Cdc thanh phan diing trong ong canh tay: gom co cac dong tinh mach canh
tay va cac day than kinh giua. tru. bi cang tay trong.
+ Dong mach canh tay (A. brachialis): tiep theo dong mach nach tu bd dudi cd
ngtfc ldn chay vao ong canh tay doc sau bd trong cua cd qua - canh tay va cd nhi
dau canh tay (Hinh 11.2; 11.5).
Trong ong canh tay. dong mach tach ra 3 nhanh ben di theo 3 htfdng:
• Dong mach canh tay sau (A. profunda brachii): cung vdi than kinh quay qua
tam giac canh tay tam dau ra vung canh tay sau.
• Dong mach ben tru tren (A. collateralis ulnaris superior): Cung vdi day than
kinh tru xuven qua vach gian cd trong ra vung canh tay sau.
• Dong mach ben tru dtfdi (A. collateralis ulnaris inferior): di xuong vung
khuyu phan thanh 2 nhanh trudc va sau loi cau trong xtfdng canh tay.

+ Tinh m ach canh tay: c6 2 tinh mach canh tay (Vv. brachiales) di kem 2
 CANH TAY [gj 195

bon dong mach va nhan cac nhanh ben ttfdng tfng vdi cac nhanh ben cua dong
mach. Ngoai ra phan tren con co tinh mach nen (V. basilica), tu nong choc qua
mac canh tay de vao ong canh tay, hdp v6i cac tinh mach canh tay thanh tinh
mach nach.
+ Cdc day than kinh (Hinh 9.5, 11.2, 11.5): d ddan dau cua ong canh tay, dtfdi
nach quay xung quanh dong mach con co mot so nganh cung cua dam roi than
kinh canh tay: day gitfa d trtfdc, day tru va day bi cang tay trong d trong, day
quay d sau. Song cang xuong dtfdi thi cac day cang tach xa dan dong mach de ra
khoi ong canh tay theo cac htfdng khac nhau:

Hinh 11.3. Thiet do ngang qua 1/3 tren canh tay

1. Co canh tay; 2. Co nhj dau; 3. TTnh mach dau; 4. Than kinh bi canh tay ngoai tren (nhanh cua TK
nach); 5. Cd delta; 6. V ach gian cc) ngoai; 7. Than kinh bi canh tay ngoai tren; 8 Xu'dng canh tay,
9. Dong mach canh tay sau; 10. Than kinh quay; 11 Dau trong cd tam dau; 12 Dau ngoai cd tam
dau; 13. Dau dai cd tam dau; 14. Than kinh bi canh tay sau (nhanh cua TK quay), 15 Dong mach
ben tru tren; 16. Than kinh bi canh tay trong; 17. Vach gian cd trong; 18 Than kinh tru; 19. TTnh
mach nen; 20. Than kinh bi cSng tay trong; 21. Dong mach canh tay. 22. Than kinh gida. 23. Than
kinh bi canh tay trong; 24. Cd qua canh tay; 25. Than kinh cd bi.

• Day quay da s6m cung dong mach canh tay sau chui qua tam giac canh tav
tam dau de vao ranh quay d vung canh tay sau.
• Day tru den 1/3 giQa canh tay thi cung dong mach ben tru tren choc qua
vach gian cd trong ra vung canh tay sau (Hinh 11.2).
196 jg ] GIAI P H A U N G U O l. T A P I

• Day bi cang tay trong, den cho noi 1/3 giua va 1/3 dtfdi canh tay thi cung
choc qua mac canh tay ra ngoai nong cung vdi tinh mach nen.
• Chi con day gitia la trung thanh vdi dong mach canh tay va bat cheo hinh
chu X keo dai d trtfdc dong mach tu ngoai vao trong, xuong den tan khuyu.
2.4.2. D a y th a n h in h ca bi: Khong qua ong canh tay, ma xuyen qua cd qua
canh tay d vung nach, chay chech xuong dtfdi va ra ngoai, d gitfa 2 ldp cd: cd nhi
dau va cd canh tav, phan nhanh ben cho cac cd do. Khi tdi bd ngoai cd nhi dau 6
ranh nhi dau ngoai thi choc qua mac canh tay de thoat ra nong va trd thanh day
bi cang tay ngoai di xuong cam giac cho da d 1/2 ngoai cang tay.

Hinh 11.4. Thiet do ngang qua 1/3 du’di canh tay

1. TTnh mach dau: 2 Than kinh bi canh tay ngoai tren (nhanh cua than kinh nach), 3 Cd canh tay.
4 Than kinh bi canh tay ngoai tren: 5 Dong. tTnh mach canh tay sau; 6. Than kinh quay 7 Co canh
tay quay; 8. Vach gian cd ngoai; 9 Xu’dng canh tay; 10 Than kinh bi canh tay sau (nhanh cua th£n
kinh quay). 11. Cd tam dau canh tay. 12 dong mach tTnh mach ben tru tren; 13 Than kinh tru
14 Vach gian cd trong; 15 TTnh mach canh tay. 16. TTnh mach nen; 17. Than kinh bi c in g tay trong
18. Than kinh gitfa; 19 Dong m ach canh tay. 20. Than kinh bi canh tay trong; 21. Co nhi dau canh
tay; 22. Than kinh cd bi
 CANH TAY [ g 197

Hinh 11.5 Vung canh tay trudc. Co mach than kinh (Theo F.H Netter)

1 Mom qua, 2, Cd delta. 3, DM mu CT tru'dc; 4. Xu'dng canh tay 5 Gan cd ngu'c to (cat).
6.7. Dau dai va dau ngan cd nhi dau CT; 8. Cd qua canh tay; 9 DM canh tay 10 Nhanh cd.
11. TK giC/a; 12. N hanh cd; 13. Cd nhi dau CT; 14. Cd canh tay; 15 DM quat ngi/dc quay 16. Gan
cd nhi dau CT; 17. DM quay; 18. Cd canh tay quay; 19. Cd gap co tay quay. 20 DM tru 21 Cd sap
tron; 22. Can cd nhi dau; 23. Mom tren loi cau xu’dng canh tay; 24 DM ben tru du’di. 25 Vach gian
cd trong; 26. DM ben tru tren; 27, 28. Dau trong va dau dai cd tam dau CT 29 TK bi cang tay trong
30. TK tru; 31. TK bi canh tay trong; 32. DM canh tay sau; 33 Cd lung rong. 34 Cd tron to. 35 Cac
DM mu CT tri/d c va sau; 36. Cd du’di vai; 37. TK cd bi; 38. 39. Re trong va re ngoai TK giC/a
40. Cd ngu'c be; 41 DM nach.
198 |g j G I A I P H A U NGlfCJl. T A P I

VUNG CANH TAY SAU

(Regio brachii posterior)

1. GICII H A N

Vung canh tay sau n&m d phia sau xiidng canh tay va cac vach gian cd trong
va ngoai. Gidi han tren. dtfdi nhtf da neu d tren.

2. C A U T A O (Hinh 11.3, 11.4, 11.6)

Cac ldp ttf nong vao sau co:

2.1. Cac ldp non g

Da: day. thd hdn vung canh tay trtfdc.
Md, mac ndng va md te bao dtfdi da: cd mot sd mach ndng. nho va cac nhanh
bi cua than kinh nach d tren. cua than kinh quay d dtfdi.

2.2. Ldp m ac sau

Mac canh tay sau lion tiep vdi mac vung canh tay trtfdc nhtfng day va chac hdn,

2.3. Ldp cd du’di m ac

Vung canh tay sau chi cd 1 cd la cd tam dau canh tay, (M. triceps branchii):
dau dai di tu cu dtfdi d chao xudng vai. dau ngoai va dau trong di tu mat sau
xu'dng canh tay. d tren ngoai va 6 dudi trong ranh than kinh quay.
Ca 3 dau hdp thanh mot than cd dai. xudng dtfdi turn lai thanh mot gan tan
rong bam vao mom khuyu (Hinh 7.11, 11.6).

2.4. Cac m ach v a th a n kin h sau (Hinh 8.1. 9.3. 11.3, 11.4, 11.6)
Vung canh tay sau cd hai bd mach, than kinh.
2.4.1. B o m a ch th a n k in h tr e n : than kinh quay va cdc mach canh tay sau, sau
khi qua tam giac canh tay tam dau. chay chech xuong dudi va ra ngoai. trong
ranh than kinh quay d mat sau cua xudng canh tay, giiia chd bam cua 2 dau
trong va ngoai cua cd tam dau. Nam sau trong ranh dd, bd mach than kinh quay
bi dau dai va dau ngoai cua cd tam dau che phu d sau (Hinh 11.6, 11.7).

- 0 vung canh tay sau day than kinh quay tach ra cac nhanh ben:
• Cac nhanh bi - canh tay sau va bi canh tay ngoai ditdi: cam giac cho da d
mat sau va phan dtfdi mat ngoai canh tay.
• Than kinh bi cang tay sau di xudng qua vung khuyu sau, cam giac chd da d
mat sau cang tay.
 CANH TAY [jjj| 199

• Cdc nhanh ca, van dong cho cO tam dau canh tay va cO khuyu. Nhanh cho
dau dai cO tam dau va nhanh tren dau trong co tam dau thudng tach cao 6 tren
nach. Nhanh dtfdi dau trong cd tam dau, tach thap nhat va tiep tuc di xuong cho
cd khuyu (Hinh 9.3).
- Dong mach canh tay sau di kem d phia ngoai than kinh quay, cho:
• Nhanh nuoi xtfdng canh tay.
• Nhanh delta.
• Cac nhanh cd tam dau.
• Va tach ra 2 nh anh tan la dong mach ben quay va dong mach ben gitfa,
chay xuong trtfdc va sau loi cau ngoai xtfdng canh tay, noi tiep vdi cac dong mach
quat ngtfdc quay va quat ngtfdc gian cot.

2.4.2. Bo mach, th a n k in h dudi: than kinh tru va cdc dong, tinh mach ben trong
tren, sau khi choc qua vach gian cd trong d 1/3 giua canh tay, chay doc theo mat sau
vach. d trtfdc dau trong cd tam dau, xuong ranh than kinh tru d vung khuyu sau.

Hinh 11.6. Mach m au, than kinh vung canh tay sau
I. Cd lung rong; 2. Cd tron to; 3. Than kinh nach va dong mach mu canh tay sau; 4. Dau dai cd tam
dau; 5. Than kinh quay va dong mach canh tay sau; 6. Dau trong cd tam dau; 6 ’. Than kinh tru;
7. Cd khuyu; 8. Cd canh tay quay; 9. Dau trong cd tam dau; 10. Than kinh bi c in g tay sau:
I I . Cd canh tay; 12. V ach gian cd ngoai; 13. Dau ngoai cd tam dau; 14 Cd delta.
200H GIAI PHAU NGLfOl. TAP I

Hinh 11.7. Phau tich ccJ, mach, than kinh vung canh tay sau
(Theo F. H. Netter. Atlas of Human Anatom y, 3rd edit, 2003, plate 415)

1. Bao khdp vai; 2. Gan co tren gai; 3. Gan cd du'di gai; 4 Gan cd tron nho (bi cat) 5 Than kinh
nach; 6. DM mu CT sau; 7. TK bi canh tay ngoai tren; 8 DM canh tay sau; 9 Than kinh quay
10. DM ben giCra (A .collateralis m edia); 11 Dm ben quay (A .collateralis radialis), 12 TK bi canh tay
ngoai du'di; 13. Vach gian cd ngoai; 14. TK cd khuyu (thudng tach cung nhanh du'di dau trong cd tam
dau); 15. TK bi cang tay sau; 16 Mom tren loi cau ngoai xifdng canh tay; 17. Cd khuyu 18 Mom
khuyu xu'dng tru; 19. Than kinh tru; 20. Mom tren loi cau trong xi/dng canh tay; 21 Dau trong cd tam
dau canh tay; 22. Dau ngoai cd tam dau canh tay (bi cat); 23. Dau dai cd tam dau canh tay.
24. Cd trdn to.
 KHUYU 0| 201

12. KHUYU
(C u b itu s )

Khuyu la doan chi tren dupe gicii han d tren va dudi nep gap khuyu khoang 3cm.
Khuyu dtfdc cac xtfdng cua khdp khuyu chia lam 2 vung:
•Vung khuyu trtfdc.
•Vung khuyu sau. -

VUNG KHUYU TRUCiC

(R e g io cu b iti a n te r io r )

Vung khuyu trudc (con goi la vung ncp khuyu) d phia trtfdc khdp khuyu

1. HI NH T H E N G O A I

Nhin be mat vung khuyu tru'dc co 3 khoi loi hinh tam giac.
Loi gitfa: dinh t hu c xuong dtfdi, tudng ung vdi co nhi dau canh Lay.
Loi trong: dinh htfdng len tren va vao trong. tuong tfng vdi khoi cd bam vao
mom tren loi cau trong.
- Loi ngoai: dinh hudng len tren va ra ngoai. tudng Ung vdi khoi cd bam vao
mom tren loi cau ngoai.
Gitfa 3 khoi la hai ranh lom: ranh nhi dau ngoai va ranh nhi dau trong gap
nhau o' nep gap khuyu. tao thanh moi ho hinh chu V md len Lien, goi la ho khuyu
(fossa cubitalis).

2. C AU T A O

Tii' nong vao sau co:

2.1. Cac ldp n on g

Da: mong. min. mem mai di dong de dang.
- Md: gidi han bdi mac nong.
- Mo te bao dtfdi da: trong co cac tinh mach va than kinh nong.
+ 77nh mach ndng: ttf cang tay di len, phia ngoai co tinh mach dau (V. cephalica).
phia trong cd tinh mach nen (V. basilica); d gitfa cd the cd nhieu dang khac nhau:
202|jg] GIAI P H A U NG U O I. T A P I

• Thong thudng. noi giufa hai tinh mach nay la tinh mach gitia khuyu
(V. mediana cubiti) (nhu mot net chech chui N ngUdc) chech qua giiia khuyu
(Hinh 8.6); d giufa tinh mach giiia khuyu co nhan mot nhanh thong tu cac tinh
mach sau xien ra. Ngoai ra tii giiia cang tay di len con co tinh mach gitia cang tay
(V. mediana antebrachh). Tinh mach nay co the do vao tinh mach nen. hoac hdp
vdi tinh mach xien tii sau di ra va do vao tinh mach giCfa khuyu (Hinh 8.5).
• Doi khi (20% trUdng hdp, theo Charles) phan tan cua tinh mach giiia c&ng
tay cung co the thay the cho tinh mach giufa khuyu bang cach chia doi thanh tinh
mach gitia nen (V. mediana basilica) do vao tinh mach nen, va tinh mach gitia
dau (V. mediana cephalica) do vao tinh mach dau; tao thanh mot chQ M tinh
mach dien hinh d trUdc ho khuyu (Hinh 8.7, 12.1).

Hinh 12.1. Ldp nong vung khuyu trudc (tay phai) vdi cac tTnh m ach nong dang chCr M
(xem them m ot so dang khac cua cac tTnh mach nong d cac Hinh 8.5. va 8 9 1

1 Mac canh tay. 2. TTnh mach dau. 3 Than kinh bi cang tay sau (cua TK quay). 4 Than kinh bi cang
tay ngoai (cua TK cd bi); 5. TTnh mach giiia dau; 6. TTnh mach giCfa nen, 7. TTnh m ach giifa cang tay.
8 Mac c;ang tay; 9. Hach tren loi cau, 10 TTnh mach nen. 11 Than kinh bi c in g tay trong

+ Than kinh nong: d phia ngoai co than kinh bi - cang tay ngoai (nhanh tan
cua day cd bi) chdc qua mac canh tay d tren ranh nhi dau ngoai, roi chia thanh
hai nhanh cung, trUdc va sau. di tiep xuong cang tay (Hinh 9.2, 11.1. 12.1).

0 phia trong co day than kinh bi —cang tay trong, thoat ra nong (cung tinh
mach nen) d 1/3 giufa canh tay, chia thanh 2 nganh cung, triidc va sau. di xuong
cang tay. Nganh trudc phan thanh nhieu nhanh. thiidng di sau, nhung cung co
the co nhanh bat cheo tru'dc tinh mach giufa nen. (Hinh 9.2. 11.1, 11.2. 12.1).
 KHUYU g j 203

2.2. Ldp m ac sau

Lien tiep vdi mac canh tay, phu tren ba toan cd va cac ranh nhi dau. mong d
gitia, day d 2 ben; ben trong day hdn ben ngoai vi dUdc tang ctidng bdi che can cua
cd nhi dau canh tay.

2.3. Ldp cd
Gom 3 nhom cd tudng ting vdi 3 cho loi hinh tam giac da ta d giai phau be mat.
- Nhom giiia: gom 2 cd xep thanh 2 ldp: (Hinh 7.9, 7.13, 11.2, 12.2, 12.3).

6 nong co cd nhi dau canh tay, cho mot gan chinh dam xuong bam vao u loi
(loi cu) xifdng quay va mot tre can cd nhi dau CT (aponeurosis m. bicipitis
brachii) toa chech xuong dudi va vad trdng d trtidc ranh nhi dau trong va hoa vao
ldp mac sau.

0 sau co cd canh tay be reng, phu trtidc khdp khuyu, roi turn thanh gan bam
vao mat du'di mom vet.
- Nhom ngoai: gom 4 cd bam vao mom tren loi cau ngoai, lan lUdt tti nong vao
sau co cd canh tay quay, cd duoi co tay quay dai, cd duoi co tay quay ngan. cd
ngiia (Hinh 7.11).
- Nhom trong: gom 6 cd xep thanh 3 ldp (Hinh 7.13, 7.14, 7.17. 12.2. 12.3):
Ldp nong: Co 4 cd bam vao mom tren loi cau trong, lan lUdt tti ngoai vao
trong: cd sap tron, cd gap co tay quay, cd gan tay dai. cd gap co tay tru.
Ldp gitia: co dau canh tay tru cua cd gap nong cac ngon tay.
Ldp sau: co phan cao nhat cua cd gap sau cac ngdn tay bam vao mat trUdc
xitdng tru.

2.4. Cac ran h nhi• d au va cac m a• ch th a n k in h sau

3 tdan cd ke tren gidi han 2 ranh nhi dau, trong dd co cac mach than kinh quan
trong di qua.

2.4.1. R an h n h i d a u tr o n g (sulcus bicipitalis medialis): dtidc gidi han bdi 4 thanh:

Trong: la nhom cd tren loi cau trong.
Ngoai: la bd trdng cd nhi dau canh tay.
Trtidc: la ldp mac sau, tang ctidng bdi tre can cd nhi dau.
Sau (hay day ranh): la phan dtidi cd canh tay.
Trdng ranh cd: (Hinh 12.2)
+ Dong mach va tinh mach canh tay, d ngdai.
+ Day than kinh giiia, d trong.
+ Nhanh trtidc cua dong mach quat ngiicfc tru d day ranh, noi vdi nhanh trudc
cua dong mach ben tru dtidi.
204 |[|D GIAI PHAU NGUCfl. TAP I

0 phan du'di cua ranh: Dong mach canh tay da chia thanh 2 nganh tan:
dong mach quay tiep tuc di xuong, doc theo bd tren cd sap tron. dong mach tru
hudng chech xuong dudi va vao trong. bat cheo d sau cd sap trdn. Day than kinh
giQa da tach ra mot so nganh ben di tdi cac cd vung cang tay trade, lach gitia 2
dau cua cd sap trdn. bat cheo d trtidc dong mach tru. de tiep tuc di xuong theo
true gitia cang tay.

H inh 12.2. V u n g k h u y u tru d c (hen quan cua mach va than kinh d ranh nh i a . •.rc r'g i
1. Cd canh tay; 2. Cd nhi dau 3 Dong mach canh tay, 4 Than kinh giCra 5 Dor-g " -a c * tru 5 Co
sap tron. 7. Dong mach quay 8 Cd gap co tay quay 9 Cd gan tay dai. 10 Cd gac - 6 r'g cac ngon
tay, 11. Cd gap co tay tru, 12 Dau sau cd sap tron 13 Tre can cd nhi dau 14 Oa^ cd sap
tron, 15, Than kinh cd sap tron 16 Dong mach ben tru du'di 17 Than kinh tru

2.4.2. R a n h n h i d a u n g o a i <sulcus bicipitalis lateralis):

Cung dude gidi han bdi 4 thanh (Hinh 12.3):
Trong: la bd ngoai cd nhi dau canh tay.
Ngoai: la bd trong cua nhom eo tren loi cau ngoai.
Trtidc: la mac sau va cae thanh phan d ldp nong cua vun g khuyu truoe.
Sau (hay day ranh): la phan dtidi cd canh tay.
Trong ranh cd: (Hinh 12.3. 13.3. 13.5. 13.6. 12.3).
+ Day than kinh quay (X. radialis): tu vting canh tay sau choc qua vach gian
cd ngoai. roi theo cd canh tay quay di xuong trong ranh nhi dau ngoai. toi ngang
muc chom quay thi chia thanh 2 nganh cung: nong va sau.
() trong ranh. day quay va nganh sau cua no da tach ra cac nhanh ben cho cd
canh tay quay, cac cd duoi co tay quay dai va ngan. va cd ngtia.
 KHUYU 0 205

+ Di kem day than kinh quay, trong ranh nhi dau ngoai, con co dong mach
ben quay la nganh tan trtidc cua dong mach canh tay sau di xuong noi vdi dong
mach quat ngitac quay la nhanh cua dong mach quay tti dtidi di len.

H inh 12.3. T h ie t do ngang qua kh u yu

1 Gan cd nhi dau; 2 Than kinh bi c^ng tay ngoai cua TK cd bi. 3 TTnh mach dau 4 Dong mach
ben quay, noi tiep vdi DM quat ngtfdc quay; 5. Nganh nong than kinh quay. 6 Nganh sau than kinh
quay; 7. Cd canh tay quay; 8. Co duoi co tay quay dai; 9. Cd ngtfa; 10. Bao khdp 11. Co khuyu, 12.
Gan cd tam dau; 13, Mac boc khuyu; 14. Mom khuyu; 15. Dong mach ben tru tren. 16. Than kinh tru,
17, Than kinh bi cang tay sau cua TK quay; 18. Dau dtfdi xtfdng canh tay. 19. O khdp, 20, Cd sap
tron; 21. Co canh tay; 22. Dong mach quat ngtfdc tru trtfdc. 23. Than kinh gitfa. 24. Than kinh bi
cang tay trong; 25. Tinh mach nen; 26. Dong mach tinh mach canh tay.

VUNG KHUYU SAU

(R e g io c u b iti p o s te r io r )

1. G i d i H A N vA H IN H T H E N G O A l

Vung khuyu sau thudng goi la vung mom khuyu. nam d phia sau khdp
khuyu. O giua vung co mom khuyu loi len. Khi duoi cang tay thi d tren mom
khuyu co mot lom ngang, va hai ben la hai ranh doc: ranh ngoai rong va sau hdn
206i GIAI P H A U N G J O I . T A P I

ranh trong. Mom khuyu nftm tron cimg mot dtidng ngang di qua mom tron loi cau
trong va mom tron loi cau ngoai. Khi gap cang tay, mom khuyu 6 dudi dtidng ngang
qua hai mom tron loi cau.

2. C A U T A O

Tti nong vao sau:

2.1. Cac ldp n on g

- Da: day va tho rap.
- Md: hau nhu khong co.
- Ldp md te bao dtidi da: chi co mot vai mach nong khong quan trong va mot
vai nhanh than kinh cam giac di qua: nhanh cua than kinh bi canh tay ngoai dticli,
va than kinh bi cang tay sau cua than kinh quay d ngdai: than kinh bi - cSng tay
trong d trong.

2.2. Ldp m ac
Mong d mom khuyu va d gan cd tam dau. day hdn d cac khoi cd 2 ben, va hoa
nhap vdi ngoai cot mac cua mom xtidng cua vting.

2.3. Ldp cd

() vung khuyu sau cung gom 3 nhom:

- Nhom gitia: cd dau tan dtidi cua cd tam dau, bam vao mom khuyu. (Hinh 7.10).
- Nhom ngoai: cd 5 cd tren loi cau ngoai xep lam 2 ldp:
Ldp ndng: tti trong ra ngoai cd cd khuyu, cd duoi co tay tru, cd dudi neng ngon
tit va cd duoi cac ngdn tay (Hinh 7.23).
Ldp sau chi cd phan sau tren cua cd ngtia (Hinh 7.24).
Trong 1 cO nong chi cd cd khuyu di tti mom tren loi cau ngoai den mat ngoai
dau tren xtidng tru la nam hoan toan trong vung khuyu sau.
- Nhom trong: cd dau tren cua cd gap cd tay tru trum len dau tren cua cd gap
sau cac ngdn tay. Hai dau nguyen uy cua cd gap co tay tru bam vao mom tren loi
cau trong xtidng canh tay va mom khuyu xtidng tru. tad thanh mdt cung xd om
lay ranh khuyu, cho day than kinh tru chui qua (Hinh 7.23, 12.4).

2.4. C ac m a c h v a th a n k in h sau
- Cac mach: gom phan sau cua mang noi quanh khdp khuyu, nam d dtidi cac
cd, ap sat vad xtidng va khdp; d sau mom tren loi cau ngoai co dong mach quat
ngudc gian cdt noi vdi nhanh tan sau cua dong mach canh tay sau. 0 sau mom
tren loi cau trong cd nhanh sau dong mach quat ngiidc tru noi vdi nganh tan sau
cua ddng mach ben tru tren va ben tru diidi (Hinh 8.1).
 KHUYU 207

- Than kinh: co 2 than kinh d 2 ben mom khuyu.

Ben ngoai co than kinh cc) khuyu, la mot nhanh cua than kinh dtidi dau trong
cd tam dau. thuoc day quay, dam thang xuong bat cheo qua khe giua cd tam dau
va bd tren cd khuyu (Hinh 11.6, 11.7, 12.4).
Ben trong co than kinh tru, d tren ap sat mat sau vach gian cd trong va bi che
phu d sau bdi dau trong cd tam dau; xuong dtidi nam trong ranh than kinh tru
(ranh khuyu tren loi cau trong) va dtidc che phu bdi la mac cang tti dau trong cd
tam dau tdi dau tren cd gap co tay tru, roi chui qua cung xd cua cd nay, theo cd
xuong vung cang tay trtidc (Hinh 12.4).

* [Ap dung th tic te: D oan nSm trong ranh gitia m om khuyu va m om tren loi cau trong la doan
nong nhat cua day than kinh tru; co the so thay d tip c de tham kham khi day tru bj phi dai
trong benh phong.
Trong sinh hoat. khi vo y va dap vao vung nay. co the co cam giac te doc theo day than
kinh tru]

H inh 12.4 V u n g k h u y u sau (lOp sau)

1. Co tam dau; 2. Phan nguyen uy co canh tay quay; 3. Than kinh co khuyu; 4 Than kinh tru.
5. Co khuyu; 6. Cac co ldp nong vung c in g tay sau (bam vao mom tren loi cau ngoai); 7. Co gap cd
tay tru, 8 Nganh sau than kinh quay.
208 j>|] G I AI P H A U NGUCJI. T A P I

13. CANG TAY

Cang tay dtfOc gidi han:

- 6 tren: bdi mot dtfdng vong ngang qua dtfdi nep gap khuyu khoang 3cm.

- C) dtfdi: bdi mot dtfdng vong ngang qua tren chom xtfOng tru. Cang tay dtfdc
chia thanh 2 vung: trtfdc va sau. ngan cach nhau bdi xtfdng quay d ngoai. xtfdng
tru d trong va mang gian cot noi gitfa 2 xUdng d gitfa.

VUNG CANG TAY TRUCJC

(R e g io a n te b r a c h ii a n te r io r )

1. H iN H T H E N G O A I

Nhin chung vung cang tay tru'dc be to va loi d tren, thu nho va phang d dtfdi
vi cang xuong dudi. cac cd tieu thu nho trd thanh cac gan di xuong ban tay va cac
ngon.
Khi gap va nam chat ban tay thi nep gap co tay du'di cung han ro nhat. va noi
len hai gan la gan co' gap co tay quay 0 ngoai. gan cO gan tay dai d giua. giua hai
gan la mot ranh doc, la mot moc de dinh vi day than kinh gitfa nam d dudi.

2. C A U T A O

Ttf nong vao sau co:

2.1. C ac ldp n on g
- I)a: mong. min. di dong de dang.
- Md: mong 6 nam. day 6 ntf va tre em.
- Mo te bao dtfdi da: co cac than kinh va tinh mach nong.
+ T in h m a c h n o n g : ttf vung gan tay va 2 dau cung mach mu tay di len co
3 tinh mach (Hinh 13.1).
lin h mach gitia ccing tay d gitfa.
77nh mach nen d trong.
Tinh mach dau 6 ngoai.
 c A n g TAY 0 1 209

Hinh 13.1 Vung cang tay tru'dc (tinh mach va than kinh nong)
1. TTnh mach nen; 2. TTnh m ach dau; 3. TTnh mach giCra dau; 4. TTnh mach giua nen; 5. TTnh mach
thong (... noi sau); 6. TTnh mach dau, 7. TTnh mach gitfa cSng tay. 8. Than kinh bi cang tay trong
9, Than kinh bi c&ng tay ngoai (TK cd bi); 10. TTnh mach nen, 11. Nhanh gan tay cua than kinh tru;
12. Ca gan tay ngan; 13. Nhanh gan tay cua TK gitfa; 14. Nhanh bi c in g tay sau cua TK quay.

+ T h an k in h n d n g : co cac nhanh trtfdc cua:

TK bi cang tay trong: d trong.
TK bi cang tay ngoai (nhanh tan cua TK cd bi): d ngoai.

2.2. M ac ca n g tay
Ldp mac sau cua cang tay lien tiep d tren vdi mac canh tay, d dtfdi vdi mac
ban tay, va tao thanh mot bao xd boc quanh tat ca cac cd va cac cau true sau cua
cang tay.
- Theo T.A. 1997 va cac tac gia Anh - My: d phia sau trong cang tay, mac
bam vao mat sau mom khuyu va bd sau xtfdng tru, tad thanh mot tach gian cd
trong ngan cach giua hai vung hay hai o cang tay trudc va sau, d phia trong. 0
phia trtfdc ngdai cang tay, mac tach ra mot vach gian cd thtf hai; la vach gian cd

14- GPN-T1
210B G I AI P H A U N G U O l . T A P I

ngoai, tdi bam vao bd trtfdc xtfdng quay, ngan cach giiia hai vung hay hai o cang
tay trtfdc va sau, 6 phia ngoai; - (vach chi ro d 1/3 giiia cang tay, va md d 1/3 tren
va 1/3 dtfdi).
Nhu vay, hai vach gian cd goi la trong va ngoai khong htfdng ngang sang hai
ben, ma htfdng ra trtfdc va ra sau; nen hai vung cang tay triidc va sau...(regio
antebrachh anterior/posterior), dong thdi cung la hai o cang tay trtfdc va sau
(compartimentum antebrachii anterius, posterius) - thtfc te da khong la trtfdc va
sau, ma la trtfdc trong va sau ngoai (Hinh 13.2A).
- Song cac cd d phan ngoai cua o sau da lan ra trtfdc kha nhieu, nen cac tac
gia Phap va Nga da tach rieng thanh mot o ngoai, va chia cang tay thanh 3 o:
triidc, sau va ngoai. Gregoire & Oberlin con phan biet ro mot vach gian cd sau
ngoai ngan cach gitfa o sau va o ngoai di ttf bd sau xtfdng quay den mac cang tay,
(Hinh 13.2B).

Rouvierc lai coi vach nay la vach gian co' chinh ngan cach giua 1 vung cang
tay trtfdc va sau o phia ngoai. Nghia la da ghep d cang tay ngoai vao vung cang
tay trtfdc, trai ngudc vdi cac tac gia Anh My va T A. 1997.

Hinh 13.2 Mac cang tay va cac vach gian cd cf cang tay:
A. Theo W oodburne (My). B. Theo G regoire & O berlin (Phap).
1. Mac cang tay; 2. Vach gian ca ngoai. 2 Vach gian ca tru'dc ngoai, 2" Vach gian ca sau ngoai
3. Mang gian cot; 4. Xu'dng quay. 5 Xuang tru; 6. Vach gian ca trong.
T, S: Hai vung hay o c&ng tay tri/dc va sau (theo cac tac gia Anh My va T.A 1997)
T \ S', N Ba vung hay o c&ng tay tru'dc. sau va ngoai (theo cac tac gia Phap, Nga)

2.3. C ac ldp cd diidi m ac

Vung hay o cang tay trtfdc (theo T.A.1997) cd 8 cd xep thanh 4 ldp: dtfdc chia
lam 2 phan; phan ndng (pars superficialis) tao bdi cac cd ldp ndng va ldp gida:
phan sau (pars profunda) tao bdi cac cd ldp sau va ldp sat xtfdng.

Gitfa 2 phan ndng va sau cua vung hay o cang tay trtfdc co bd mach than kinh
 c A n g TAY 01 211

tru va day than kinh gitfa di qua. Gitfa phan nong cua vung hay o cang tay tru'dc
va phan ngoai cua vung cang tay sau (hay o cang tay ngoai) co bo mach than kinh
quay di qua (Hinh 13.7).
4 ldp cd cua vung cang tay trtfdc sap xep nhu sau:

2.3.1. Lap n on g : gom 1 cd, ke ttf ngoai vao trong la cd sap tron. co gap co tay quay,
cd gan tay dai va cd gap co tay tru (Hinh 13.3).
Tat ca deu bam v&o mom tren loi c&u trong xtfdng canh tay, toa hinh quat, di
xuong lan lUdt bam tan vao 1/3 gitfa mat ngoai xUdng quay, vao nen xtfdng dot
ban tay II, vao can gan tay, va vao mat trtfdc xtfdng dau.

Hinh 13.3. Vung cang tay tru’dc, cac cd Icfp nong va cac m ach m au, than kinh d khu ngoai

1. Than kinh quay; 2. Co canh tay quay; 3. Co ngtfa; 4. Nganh nong than kinh quay; 5. Dong mach
quay; 6. Cd dudi co tay quay dai va ngan; 7. Co canh tay quay; 8. Co sap vuong; 9 Co gap dai ngon
cai; 10. Than kinh giufa; 11. Than kinh tru; 12. Dong mach tru; 13. Co gap co tay tru; 14 Co gap
nong cac ngon tay; 15. Co gan tay dai; 16. Co gap cd tay quay; 17. Co sap tron; 18. Nganh sau than
kinh quay; 19. Than kinh giCra; 20. Dong mach canh tay; 21. Co canh tay.
212H GIAI P h A u NGUOI TAP I

Hinh 13.4 Co, m ach, than kinh Icfp giufa vung cang tay tru'dc
Da cat bo cac cd ldp nong (Theo F.H. Netter)
1. Cd nhi dau CT; 2. Cd canh tay; 3. Than kinh bi cling tay ngoai cua TK co bi (bi cat) 4 Than kinh
quay; 5. Nhanh sau TK quay; 6. Nhanh nong TK quay; 7. Gan cd nhi dau CT; 8 Dm quat ngifdc
quay; 9. DM quay; 10. Cd ngtfa; 11 Co canh tay quay; 12. Co sap tron (bi cat); 13 Co gap nong cac
ngon tay (dau quay); 14 Cd gap dai ngon cai; 15. Gan c0 gan tay dai va day chang gan co tay (cat
va lat ra ngoai); 16. Gan cd gap co tay quay; 17. Nhanh gan tay nong cua DM quay 18 Ham cac
gan gap; 19. Nhanh nong TK tru; 20 Nhanh gan tay sau DM tru va nhanh sau TK tru 21 Xtfong
dau; 22. Cac nhanh gan tay cua cac TK giufa va tru (bi cat); 23. Day TK gitfa; 24. Day TK tru va
nhanh mu tay; 25. DM tru; 26 Co gap nong cac ngon tay; 27. Co gap co tay tru; 28 DM gian cot
tru'dc. 29. Cd sap tron (dau tru bi cat). 30. DM gian cot chung; 31. DM tru; 32. Co gap nong cac ngon
tay (dau canh tay tru); 33. DM quat ngtfoc tru trtfdc. 34. Cac gan cd gap co tay quay, va cd gan tay
dai; 35. Mom tren foi cau trong; 36. Co sap tron (dau canh tay, bj cat va lat len); 37. Vach gian cd
trong canh tay; 38. DM canh tay, 39. TK giCfa; 40. TK tru.
 c A n g TAY 0 1 213

2.3.2. Lap g itfa : chi co mot cd la cd gap nong cac ngon tay bam bdi mot cung gan
rong cang giufa 2 dau canh tay - tru va dau quay. Cd rong va det 0 tren. thu hep d
dudi. chia thanh 4 gan xep lam 2 ldp, chui qua mac ham cac gan gap xuong ban
tav. cho cac ngon tti II - V. Cd nam trtfdc bo mach than kinh tru va than kinh
gitiaT nhtfng lai d sau va trong bo mach than kinh quay. (Hinh 13.4).
2.3.3. Lap s a u : co 2 cd gap (Hinh 13.5)

Hinh 13.5. Cac cd va mach than kinh sau vung cang tay tru’dc
(da cat bo 1 phan cac cd ldp nong va ldp giCra)
(Sd do tong hdp, ve lai cd siTa doi tranh cua G regoire & O berlin).
1. Dong m ach canh tay; 2. Cd nhi dau; 3. Dong mach quat ngtfdc quay. 4 Nganh sau than kinh
quay; 5. Cd ngtfa; 6. Cd canh tay quay; 7. Nganh ndng than kinh quay; 8. ddng m ach quay; 9. Cd
gap dai ngdn cai; 10. Gan gap co tay quay (cat); 11. Can gan tay (tan cung cua cd gan tay dai
da cat); 12. Gan gap ndng cac ngdn tay (cat); 13. Cd sap vuong; 14 Ddng mach va TK gian cot tru’dc
15. Than kinh gitfa; 16. Cd gap sau cac ngdn tay; 17. Dong m ach va than kinh tru; 18 Cung gan cd
gap ndng cac ngdn tay (cat); 19. dong mach quat ngtfdc tru; 20. Cac cd ldp ndng (da cat); 21. Ddng
m ach ben tru tren; 22. Than kinh tru; 23. Than kinh gitfa.
214 0 GIAI PHAU NGUOI. TAP I

•Cd gap sau cac ngon tay: d trong. ldn hdn. bam vao xtfdng tru va mang gian cot.
• Cd gap dai ngdn cai: d ngoai, nho hdn. bam vao xUOng quay.
Hai cd n£im giap nhau d gitia true cang tay, lam cho dtfa cho day than kinh
gitia d trudc va bo mach than kinh gian cot trtfdc d sau.

2.3.4. Lap s a t x ita n g : chi co 1 cd d 1/4 dtfdi c&ng tay la cd sap vuong. hinh 4
canh, bam vao mat trtfdc 1/4 dtfdi 2 xtfdng c£ng tay, cang ngang ttf bd trong
xtfdng tru den bd ngoai xtfdng quay. Sau cd chi co phan tan cua bo mach th4n
kinh gian cot trtfdc.

2.4. Cac m ach va th an k in h sau

Cac sach giai phau co dien cua Viet Nam va cua Phap thtfdng mo ta 4 bo
mach than kinh chinh d vung cang tay trtfdc va mot bd d vung cang tay sau.
Bon bo dtfdc coi la thuoc vung cang tay trtfdc nhtf sau: (Hinh 13.3).
() ngoai co bo t/i/av: gdm cae dong tinh mach quay va nhanh trade than
kinh quay nam d binh dien ndng nhat. di xudng d gitfa cae cd ldp none vunti cang
tay tru'dc va phan ngoai. vung cang tay sau.
() trong cd bo tru : gom cae dong - tinh mach tru va day than kinh tru. nam
sau hdn, di xudng d giua cae ed ldp giua va ldp sau vung cang tay trtfdc.
* O giua ed ho giu'ci: gdm day than kinh giua va dong mach cua no cung nam
sau ed ldp gitfa, va trtfdc giua cac ed ldp sau vung cang tay trtfdc.
- Bo gian cot tru’dc: gdm cae dong tinh mach gian cot trtfdc va than kinh gian
cot tru'dc, nam sau nhat, o sau gitfa cac cd ldp sau va ldp sat xudng. ngav trtfdc
mang gian cdt cang tay.
Viec ghep thanh 4 bd nhu vay cd loi la de nhd va khai quat hoa duoc 4 vi tri
lien quan chu yeu cua cac mach than kinh d cang tay, va hoan toan phu hop vdi
each chia vung cua Rouviere da neu 6 tren (ghep o cang tay ngoai vao vung cang
tay trtfdc).
Song xet chi tiet thi viec ghep thanh bd cac mach va than kinh kh o ne dong cd
va ddng nguon vdi nhau nhu vay cung cd phan chtfa that can doi ve cau tao. va
chinh xac ve dinh khu. so vdi quan diem ngay nay cua T.A. 1997 va cua cac tac
gia Anh My:
+ Bo gitfa chu yeu chi dtfo'c cau tao bdi day than kinh gitfa. vi ddng mach chi
la mot nhanh rat nho nuoi than kinh.
+ Bd quay d dung vi tri ranh gidi gitfa hai vung (trtfdc va sau cua T.A. 1997).
thuc chat la ghep giua hai thanh phan cau tae thuoc hai vung khac nhau: Neu
toan bo day quay cung tat ca cac cd ma no chi phoi dtfdc xep vao vung cang tay
sau, thi dong mach quay lai chu yeu thuoc vung cang tay trtfdc: tuy cung cap
huyet cho ca cac cd d nhom ngoai vung cang tay sau. va cd mot doan d 1'3 gitfa
cang tay lien quan chat che vdi nhanh trudc day than kinh quay.
 c A n g TAY 0 215

+ Chi co bo tru la hop bdi cac mach than kinh I6n cung nhau cii xuong tu 1/3
giQa cang tay den tan cung.
+ Va bo gian cot la bo mach - than kinh nho cung gan bo v6i nhau den cung.

2.4.1. lid m a ch th a n k in h q u a y
- Dong mach quay (A. radialis): la mot trong hai nganh cung cua dong mach
canh tay, tii ranh nhi dau trong, chay chech xuong cang tay, theo mot dtfdng vach
ttf giiia nep gap khuyu tdi ranh mach.
Tren dtfdng di dong mach co hai tinh mach di kem, lan ltfdt bat cheo d trtfdc:
gan tan cd nhi dau, cho bam tan cua cd ngiia va cd sap tron, dau quay cua cd gap
nong cac ngon tay, cd gap dai ngon cai va cd sap vuong. C) 2/3 tren cang tay dong
mach bi cd canh tay quay che phu d phia trtfdc, tdi 1/3 dtfdi cdng tay, dong mach
thoat khoi mat sau cua cd nay va xuong co tay thi chay trong ranh mach, giiia
gan cd canh tay quay d ngoai va gan cd gap cd tay quay d trong.
Phan nhanh bon: d 1/3 tron cang tay dong mach tach ra nhanh quat ngudc
quay cho cac cd lan can roi ngUo'c Ion ranh nhi dau ngoai. 0 1/3 gitfa cang tay tach
ra cac nhanh cd. O 1/3 du'di, tach ra nhanh gan co tay va nhanh gan tay nong.
N ganh nong than hinh qu a y: ttf ranh nhi dau ngoai di xudng. nam trong
bao cd canh tay quay, va chay doc theo bd ngoai dong mach d 1 '3 giua cang taw
nhtfng tdi 1/3 dudi cang tay lai tach xa dong mach. luon diidi gan cd nay de ra
sau. di xudng mu tay.

2.4.2. B o m a ch th a n k in h tru
Dong mach tru (A. ulnaris): la nganh cung ldn hdn cua dong mach canh
tay. Ttf cuoi ranh nhi dau trong (d gitfa hd khuyu). dong mach cung cd 2 tinh
mach di kem chay chech xudng du'di va vao trong. bat cheo sau cd sap tron. sau
than kinh gitfa. roi chui qua cung cd gap ndng cac ngdn tay. lach giua cd nay va
cd gap sau cac ngdn tay, tdi chd noi 1/3 tren vdi 1/3 gitfa cang tay thi dong mach
gap day than kinh tru va cd gap co tay tru ttf vtfng khuyu sau di xudng. Dong
mach chay doc phia ngoai than kinh tru, sau cO gap co tay tru (la co tuy hanh
cua dong mach), trtfdc co' gap sau cac ngdn tay, va sau trong co gap ndng cac
ngdn tay. Tdi 1/3 du'di cang tay, dong mach thoat khoi mat sau cd gap cd tay tru.
nhung van nam sau trong ranh gitfa gan cd gap sau cac ngdn tay va gan co gap
cd tay tru. Xudng cd tay dong mach di trtfdc mac ham cac gan gap d bd ngoai
xudng dau.
Phan nhanh ben: d 1/3 tren cang tay tach ra dong mach quat ngtfdc tru
(A. recurrens ulnaris) va dong mach gian cot chung (A. interossea communis).
Dong mach nay chia thanh 2 dong mach gian cdt tru'dc va gian cdt sau. Dong
mach gian cdt sau lach gitfa cd gap sau cac ngdn tay va cd gap dai ngdn I. roi vong
216| 0 GIAI PHAU NGlfCJl. TAP I

ldn tren mang gian cot de ra vung cang tay sau. Dong mach gian cot tiudc tach ra
mot nhanh nho cho day than kinh giua. roi chay thang xuong d trtfdc mang gian
cot, sau khe giua cd gap sau cac ngon tay va cd gap dai ngon I.

Hinh 13.6. Cac day than kinh sau d vung cang tay tru'dc
(Theo Gregoire & Oberlin).

1 Than kinh quay; 2 Nganh nong than kinh quay 3. Nganh sau than kinh qua,, 4 3c :a ^ h tay
quay. 5. Cd ngiia; 6. Cd gap nong cac ngon tay 7 Cd sap tron. 8 Co gap dai ngon ca 9 ~-ar' kinh
gian cot cang tay tru'dc, 10 Nhanh gan tay TK giCra 11 Cd sap vuong; 12. Nhanh r r ^ c a ' ta> than
kinh tru; 13, Cd gap co tay tru 14 Co gap sau cac ngon tay 15. Than kinh tru 16 C a - s a - ca sap
tron. 17. Cac cd bam vao mom tren loi cau (nguyen uy cac cd ldp nong vung cang ta, ’.rjcz t cat)
18 Than kinh giCfa. 19. Cd canh tay (cat)

O 1/3 dtfdi cang tay. dong mach tru tach ra hai nhanh: nhanh gan co tay (ramus
carpalis palmaris) va nhanh mu co tay (ramus carpalis dorsalis).
- Them kinh tru (X. ulnaris): ttf ranh than kinh tru d sau mom tren loi cau
 CANG TAY [jJ

trong xtfdng canh tay than kinh tru lach giufa hai dau nguyen uy cua cd gap co
tay tru roi theo cd do xuong vung cang tay trtfdc. gap dong mach tru d cho noi 1/3
tren vdi 1/3 gitfa cang tav. Than kinh tru chay doc phia trong dong mach tru va
nam trong bao cd gap co tay tru.
Xuong tdi co tay, than kinh tru cung dong mach nam sau trong ranh giCia gan
cd gap sau cac ngon tay va gan cd gap co tay tru. roi di trUdc ham cac gan gap d
sat bd ngoai xtfdng dau de xuong gan tay (Hinh 13.4).
Phan nhanh ben: d cang tay, than kinh tru tach ra cac nhanh van dong cho cd
gap co tav tru va hai bo trong cd gap sau cac ngon tay (cho cac ngon IV va ngdn V).
0 1/3 du'di cang tay than kinh tru con tach ra mot nhanh mu tay (ramus dorsalis
nervi ulnaris) vong ra sau de cam giac cho niia trong mu ban tay va mu 2 ngon
rtfdi d phia trong, (Nn. digitales dorsales). Ngoai ra no cung cho 1 nhanh gan tay
fR palmaris). di xuong gan tav, cam giac cho da d mo ut

3 2 1 29 28 2v

1(

16
17
Hinh 13.7. Thiet do ngang qua 1/3 gitfa cang tay

1 Than kinh gitfa, 2. Co gap co tay quay: 3. TTnh mach gitfa cang tay, 4 Co gap dai ngon cai 5 Co
canh tay quay; 6. Dong m ach quay; 7. TTnh mach dau, 8. Nhanh tru'dc than kinh quay S Co sap
tron, 10. Cd duoi co tay quay dai va ng^n, 11. Xtfdng quay, 12 Vach gian cd sau ngoai 13 Co
giang dai ngon cai. 14. Mach mau va than kinh gian cot tru'dc 15. Cd duoi ngan ngon cai 16. Co
duoi cac ngon tay. 17. Cd duoi ngon ut; 18. Cd duoi dai ngon cai. 19. Cd duoi co tay tru 20 Than
kinh bi c&ng tay sau cua TK quay, 21. Xtfdng tru; 22. Cd gap sau cac ngon tay. 23 Cd gap co tay
tru, 24, Than kinh tru 25 Than kinh bi cSng tay trong, 26. Dong tTnh mach tru 27 TTnh mach nen
28 Cd gap nong cac ngon tay; 29 Cd gan tay dai.

2.4.3. B o m a c h th a n k in h g iiia : gom day than kinh giua va mot dong mach nho
nuoi no.
218j[jjj G I AI P H A U N G U O I . T A P I

- Day than kinh gitia (N. medianus): tu1ranh nhi dau trong di xuong d phia
trong dong mach canh tay, lach gitia 2 dau cua cd sap tron. bat chco d trUdc dong
mach tru tif trong ra ngoai. roi chui dudi cung cd gap nong cac ngon tay. va chay
thang xuong dUdi d chinh gitia true cang tay. Than kinh nam sau cd gap nong cac
ngon tay va trong bao cd, trUdc khe gitia hai cd gap sau cac ngon tay d trong va
gap dai ngdn cai d ngoai. Xuong dudi, khi cac cd chuyen dan thanh gan. thi day
than kinh gitia thoat ra d phia ngoai cac gan gap nong de lo dan ra trtfdc. Tdi co
tay day than kinh gitia nam trtfdc gan gap nong ngon tro, ngoai gan gap nong
ngon gitia, va d sau khe gitia gan cd gap co tay quay d ngoai, gan cd gan tay dai d
trong (Hinh 13.3, 13.4, 13.6, 13.8).

Hinh 13.8. Thiet do ngang qua 1/3 du’di cang tay

1 Cd gan tay dai, 2. Than kinh giCfa 3 Gan cd gap co tay quay; 4 TTnh m ach nen 5 Than kinh bi
cang tay ngoai; 6. Dong m ach quay; 7. Cd gap dai ngon cai. 8. Cd sap vuong, 9 Cd canh tay quay.
10 Cd giang dai ngon cai, 11 Cd duoi ngan ngon cai. 12. Ca duoi co tay quay dai 13 Cd dudi co
tay quay ngan; 14. Xu’dng quay. 15 Cd duoi dai ngon cai; 16. Than kinh bi cang tay sau ic iia than
kinh quay); 17. Cd duoi ngon ut; 18 Cd duoi ngon tro; 19. Gan duoi cac ngon tay. 20 Gan dudi cd
tay tru; 21. Xu’dng tru, 22. Cd gap sau cac ngon tay; 23. Than kinh bi cling tay trong 24 Co gap co
tay tru; 25. Than kinh tru. 26 D ong m ach tru; 27. Than kinh bi cling tay trong. 28 TTnh mach dau.
29 Mac c ln g tay; 30. Cd gap nong cac ngon tay.
 c A n g TAY 0 219

Phan nhanh: d tren cung cd gap neng cac ngdn tay, day gitia da chd cac
nhanh van ddng chd cd sap trdn, cd gap cd tay quay, cd gan tay dai, cd gap ndng
ng6n tav.
0 dudi cung cd gap ndng, nd tach ra nhanh ldn nhat chd cang tay la than
kinh gian cot trtfdc cang lay (N. interosseus antebrachii anterior) di cung vdi
dong mach gian cot trudc va tach ra cac nhanh van ddng cac cd gap sau la cd gap
dai ngdn cai, hai bd ngdai cua cd gap sau cac ngdn tay (chd ngdn II va ngdn III) va
cd gap vudng, rdi tan het d khdp cd tay. O tren cd tay, day TK giufa cdn chd mot
nhanh nhd la nhanh gan tay (R. palmaris) di xudng phan giufa gan tay.
- Dong mach than kinh giiia (A. cdmitans nervi mediani): cd tac gia cdn gdi la
dong mach giufa (A. mediana), la mot nhanh nhd, xuat phat td dong mach gian
cdt trUdc (A. interossea anterior) chay doc theo day than kinh giufa, va cap mau
cho than kinh giOa. Song han htiu, dong mach nav co the phat trien ldn va di
cung than kinh xuong tan ban tay, noi vdi cung gan tay ndng.
2.4.4. B o m a ch th a n k in h g ia n c o t triidc: cd the tdm tat nhu sau:
- Dong mach gian cot triidc (A. interossea anterior): xuat phat tu dong mach
gian cdt chung, chay doc sau khe giufa gan cd gap dai ngdn cai va gan cd gap sau
ngon tay, kem thoo 2 tinh mach d hai ben va than kinh gian cdt trudc d phia
ngoai. Dong mach tach ra mot nhanh cho day than kinh giufa, va cac nhanh cd.
- Than kinh g ia n cot triidc cang tay (N. mterdsseus antebrachii anteridr): la
nhanh ldn nhat cua than kinh giua, di cung va nam ngoai ddng mach gian cdt
trudc, van ddng chd cac cd d ldp sau (trd 2 bd trdng cua cd gap sau cac ngdn tay),
va cam giac chd khdp cd tay.

VUNG CANG TAY SAU

(R e g io a n te b r a c h ii p o s te r io r )

Vung cang tay sau la vung d phia sau xudng tru. xtfdng quay, mang gian cdt
cang tav, va cac vach gian cd trdng va ngdai.

1. G i d i H A N V A H IN H T H E N G O A I

Thee cac tac gia Anh My va Thuat ngti giai phau qudc te hien nay. vung cang
tay sau bao gom ca vting hay o cang tay sau va o cang tay ngoai cua cac tac gia
Phap va Nga, nen lan ra trtidc kha nhieu (Hinh 13.2). Be rong lan ra trtfdc gidi
han khong ro ret ve phia quay bdi bd trtfdc cd canh tay quay, nhtfng lai han che
va lui ra sau ve phia tru. gidi han bdi bd sau xudng tru: cd the sd thay. d ndng
ngay dtfdi da, keo dai tti mom khuyu den mom tram tru: va nhin thay doc theo
220 (jji GIAI PHAU NGUC3I. TAP I

mot ranh h^n giiia 2 cd gap va duoi co tay tru khi duoi va nam chat ban tay.
Dong tac nay va dong tac cU dong cac ngdn tay. co tay cung lam noi ro va nhan
biet dtfdc cac cd d ldp ndng cua vung.
0 dtfdi, vung thu hep nen nhin va sd ro gidi han, d hai ben bd xudng. cac dau
xtfdng va cac mom tram quay va tru.

2. C A U T A O

2.1. Cac ldp n on g

- Da, mem, day hdn da vung cang tay trtfdc.
- Md du’di da: d nu day hdn d nam.
- Trong ldp mo te bao dtfdi da: co mot ltfdi tinh mach nong va cac nhanh than
kinh ndng: (Hinh 13.9 va 13.10).
Nhanh san cua day bi cang lay trong
(thuoc dam rdi canh tay). d trong.
Nhanh sau cua day bi cang tay ngoai
(thuoc day cd bi). d ngoai.
Nhanh bi cang tay sau cua day quay,
d giua.

2.2. Ldp m a c c a n g tay sau

Day, nhat la d tren va tach ra cac
tre hoc lay cac cd.

0 du'di mac day len thanh ham cac

gan dudi.

2.3. C ac ldp cd

Cac cd cua vung cang tay sau xep

thanh 2 ldp:

2.3.1. Ldp n d n g: gdm 6 ed bam vao

mao va mom tren loi cau trong. lan ltfo't
tu cao xuong thap. ttf tru'dc ra sau va ttf
ngoai vao trong cd cd canh tay quay, cd
duoi co tay quay dai, cd duoi co tay
quay ngan, cd duoi cac ngdn tay, cd duoi
ngdn ut, va cd duoi co tay tru, (khong
ke cd thtf 7 la cd khuyu da mo ta d vung
khuyu sau).
Hinh 13.9. TTnh m ach nong <3 vung
cang tay sau va mu tay
1. Mang tTnh mach cang tay sau 2 TTnh
mach nen: 3. Mang tTnh mach mu ban tay,
4. Cac tTnh mach mu ngon tay 5 TTnh
mach gian chom: 6 Cac tTnh mach mu
ban tay; 7. Tinh mach dau; 8 TTnh mach
dau d canh tay.
 c A n g TAY 0 221

Dac biet Lrong do co co canh tay quay cung hai cO duoi co tay quay dai va
ng;in tao thanh nhom ngocn hay phan ngoai (pars lateralis, p a rs ra d ia lis) eita o, hay
vung cdng tay sau, d tren lan nhirU >a triidc, nhiing d diidi lai hiidng ra sau ldn
liidt bam veto mom tram quay, va nen cdc xiidng ban tay II va. I ll (H 7.22, 7.23).
Con lai cac cO duoi cac ngon tay, duoi rieng ngon ut va duoi co tay tru, hop
thanh ldp nong cua phan trong vung cang tay sau, chav thang xuong dtfdi.
c h u y e n thanh gan, chui qua ham cac gan duoi xuong mu tay. (Hinh 7.23).

2.3.2. Ldp s a u : gom 5 cO, it nhieu hudng chech xuong dudi va ra ngoai. lan lUdt
ttf tren xuong dudi va ttf ngoai vao trong, co cd ngtfa, cd giang dai ngon I. cd duoi
ngdn ngon I. cd duoi dai ngon I, va cd duoi ngon tro. (Hinh 7.24, 13.11, 13.12).
Cd ngiia la mot cd mong, det,
gom 2 ldp ttf mom tren loi cau trong
xtfdng canh tay va mao cd ngtfa cua
xudng tru tii chech xudng. quan
quanh cd xu'dng quay va bam (ail vao
mat (rude ngoai cua xuting. (liua 2
ldp co nganh sau than kinh quay
lach qua. tu trdn xudng du'di ttf tru'dc
ra sau.
Cd ngiia bi cho phu hoan toan bdi
cac cd ldp ndng. va duoc ghep cung
cac cd nhom ngoai cua ldp ndng
thanh phan ngoai hay phan quay ciia
6 cang tay sau.
Ha cd tiep theo ciia ldp sau:
(giang dai, duoi ngan. va duoi dai
ngon cai) bam vao mat sau cua 1
hoac 2 xuong quay tru va vao mang
gian cdt, hudng chech xuong dtfdi va
ra ngoai; d tren bi che phu bdi cac cd
nhom trong ldp ndng. d du'di lan ludt
thoat ra ndng d bd ngoai cd duoi cac
ngon tay (Hinh 7.23). Roi cd giang
Hinh 13.10. Than kinh nong a vung cang tay
dai va duoi ngan ngdn cai bat cheo sau
sau va mu ban tay
cac gan cd duoi dai va duoi ngan co
1. Nhanh bi mu tay cua than kinh tru 2 Cac
tay quay d bd ngoai xu'dng quay, nhanh mu ngon tay. 3. Cac nhanh mu dot xa cua
trtfdc khi chui qua ham cac gan cac t/k gan ngon tay rieng thuoc than kinh giCra
dudi. Cd duoi dai ngdn cai bat cheo 4. Nhanh noi than kinh tru. 5. Nhanh nong than
kinh quay: 6. Than kinh bi cang tay ngoai cua
cac gan do d thap hdn. sau khi da than kinh cd bi 7 Than kinh bi cang tay trong
chui qua ham cac gan duoi (Hinh 8. Than kinh bi cang tay sau cua than kinh quay;
13.11, Hinh 13.12). 9. Nhanh bi canh tay ngoai du'di cua than kinh quay
222 G I AI P H A U N G U O I . T A P I

Cd du6i ngon tro d thap nhat va trong nhat, tti mat sau xtfdng tru chay d mat
sau cd va gan duoi cac ngon tay. xuong hoa vao gan ngon tro cua cd nay.

Hinh 13.11 Cd mach va than kinh ldp sau vung cang tay sau, da cat 1 phan sau lop co nong
(Theo G regoire & Oberlin, sCfa doi bdi Trinh Van Minh).
1. Cd khuyu, 2. Dong mach gian cot sau; 3. Cd duoi co tay tru; 4. Dong mach gian cot trudc (nhanh
tan), 5. Than kinh gian cot sau: 6. Cd duoi ngon tro, 7 Cd duoi dai ngon cai, 8 Cd duoi ngan ngon cai.
9. Cd giang dai ngon cai; 10 Cd sap tron. 11. Cd ngira. 12 Nganh sau than kinh quay 13 Cd du6i
chung cac ngon tay; 14. Cd duoi ngon tay ut, 15 Cd duoi co tay tru; 16. Cd duoi co tay quay ngan.
17. Cd duoi co tay quay dai, 18 Dong mach quat ngUdc gian cot; 19. Cd canh tay quay

2.4. Cac m a c h va th a n k in h sau

Co 2 nguon dong mach va mot nguon than kinh cho vting cang tay sau;
- Cac cd phan ngoai vting cang tay sau dtidc cap huyet bdi cac nhanh ben cua
dong mach quay, tach ra d vung cang tay trti6c, va van dong bdi cac nhanh ben
cua than than kinh quay, tach ra tti trong ranh nhi dau ngoai d vting khuyu.
- Cac cd phan trong vting cang tay sau dtidc cap huyet bdi dong mach gian cot
 c A n g TAY di] 223

sau. va van dong bdi nganh sau than kinh quay. (Hai yeu to nav thtfdng dtfdc ghep
vdi nhau dtfdi ten goi la bo mach than kinh gian cot sau).

2.4.1. C ac d o n g m a ch
- () phan ngoai vung cang tay sau (hay o cang tay ngoai cua cac tac gia
Phap): dong mach quat ngi/(fc quay la nhanh ben ldn nhat cua dong mach quay,
di ngtfdc len ranh nhi dau ngoai, phan nhanh cho cd canh tay quay va cac cO duoi
co tay quay, roi noi tiep vdi nhanh ben quay cua dong mach canh tay sau ttf sau
canh tav di xuong. (Hinh 13.5).
- O phan trong vung cang tay sau (hay o cang tay sau cua cac tac gia
Phap): dong mach gia n cot sau la nhanh cua dong mach gian cot chung thuoc
dong mach tru, chay d tren mang gian cot ra sau, thoat ra d bd dtfdi cd ngiia
(Hinh 13.11, 13.12)
•» ,
Tdi vung cang tay sau, ddng mach tach ra mot nhanh quat ngtfdc gian cot va
c ac nhanh khac cho cac cO duoi cua vung, roi di xuong 6 giua hai ldp cd nong va
sau. cung day than kinh gian cot sau, de tan het bang cach noi tiep vdi nhanh sau
cua dong mach gian col trudc.
(Nganh tan sau ciia dong mach gian cot trtfdc sau khi choc qua mang gian cot
d 1/3 dudi cang tay, tiep tuc di xudng d mat sau cua cac cd khu sau. phan nhanh
cho chung roi tiep noi vdi nganh tan cua dong mach gian cot sau. de xuong tham
gia vao mang mach mu cd tay).

2.4.2. T han k in h q u a y : la nguon duy nhat van dong cho tat ca cac cd d vung
cang tay sau va ca 2 nganh tan ciia no, (nganh ndng nganh sau) deu nam trong
2 phan ngoai va trong ciia vung do khi qua cang tay.
Tu ranh nhi dau ngoai di xudng, than kmh quay da phan nhanh cho cac cd
canh tay quay, duoi co lay quay dai va ngan rdi chia thanh 2 nganh tan: ndng va
sau (Hinh 13.3. 13.1. 13.5).
- Nganh ndng than kinh quay: di xuong cang tay theo cd canh tay quay va
nam trong bao cd dd; d 1/3 giufa cang tay no chay song song d phia ngoai dong mach
quay va xuong tdi chd noi 1/3 gitfa va 1/3 dtfdi cang tay thi luon dtfdi gan cd canh
tay quay de vong ra sau roi choc qua mac cang tay sau ra nong. di xudng mu tay.
- Nganh sau than kinh quay: htfdng tdi bd tren cd ngtfa d mat trtfdc cang tay
lach gitfa hai ldp ciia cd ngiia vong quanh co xtfdng quay ra sau. No tach ra cac
nhanh cho cd ngiia khi di qua cd do; va khi thoat khoi cd ngiia, ra sau, nd tach ra
mot so nhanh van dong cho cac cd d ldp ndng (cd dudi cac ngdn tay. cd duoi ngon
ut, va cd duoi co tay tru). Roi trd thanh than kinh gian cot cang tay sau
(N. interosseus antebrachii posterior), di xudng cung ddng mach gian cot sau (d
ben ngoai dong mach), tach ra cac nhanh cho cac cd d ldp sau vung cang tay sau
va tan het bdi mot nhanh di xuong khdp co tay. Tren dtfdng di, no di qua mat
ndng cac cd giang dai va dudi ngan ngdn I, mat sau cac cd dudi dai ngdn I va duoi
ngdn II. (Hinh 13.11, 13.12).
224 H G I AI P H A U N G U O l . T A P I

Hinh 13.12 Cd m ach than kinh ldp sau vung cang tay sau. Da cat bo 1 phan cac cd ldp nong
(Theo F.H Netter. Atlas of Human Anatom y, 3rd Edit, 2003, plate 428)

1. Nhanh sau DM ben tru tren; 2. Nhanh sau DM ben tru du'di (nhanh cua DM canh tay) 3 Vach
gian cd trong, 4. TK tru, 5. DM quat ngudc tru sau 6. Mom tren loi cau trong xifdng canh tay. 7 Gan
cd tam dau CT (bi cat); 8. Mom khuyu xu'dng tru; 9. Cd khuyu, 10. Cd gap co tay tru 11 DM quat
ngudc gian cot; 12. DM gian cot sau. 13 Xu'dng tru; 14 Cd dudi dai ngon cai. 15 Cd du6> ngon tro.
16. DM gian cot tru'dc (nhanh tan); 17. Gan cd duoi co tay tru (bi cat); 18. Gan cd duoi ngon ut (bi
cat); 19. Cac gan cd duoi cac ngon tay (bi cat), 20. Ham cac gan duoi; 21. Xu'dng ban tay V 22 Cd
gian cot mu tay I; 23. Xu’dng ban tay II; 24 Xu'dng ban tay I; 25. DM quay; 26. Gan cd dudi co tay
quay dai; 27. Gan cd duoi co tay quay ngan; 28. Cd dudi ngan ngon cai; 29. Cd giang dai ngon cai.
30. Than kinh gian cot sau. 31. Xu’dng quay; 32. Cd xap tron (dau bam tan); 33 Nhanh sau day than
kinh quay; 34. Cd ngiia, 35. Cd duoi co tay quay ng§n; 36. Gan chung cac cd dudi (du6t co tay tru.
duoi ngon ut, duoi cac ngon tay) (bi c^t); 37. Mom tren loi cau ngoai xifdng CT, 38 Cd du6i co tay
quay dai; 39. Cd canh tay quay; 40 Vach gian cd ngoai; 41. Nhanh ben giQa cua DM canh tay sau
 CO T A Y 01 225

14. CO TAY
(C a r p u s )

Co lay dUOc gidi han:

- O tren bdi mot dUdng vong ngang qua tren chom xtfdng tru.

- 0 dudi bdi mot dtfdng vong ngang qua dtfdi cu xtfdng thuyen va dau dtfdi
xtfdng dau.
Cac xtfdng cua khdp co tay chia co tay thanh hai vung: trtfdc va sau, gicii han
d ngoai bdi bd ngdai xtfdng quay va cac gan giang dai va duoi ngan I, 6 trong bdi
bd trong xtfdng tru va gan cd gap co tay tru.

VUNG CO TAY TRUC5C

(R e g io c a r p a lis a n te r io r )

1. H iN H T H E N G O A I

Gitfa vung cd 3 nep ngang. Nep dtfdi cung ro nhat goi la nep co tay, tudng ting
vdi du'dng khdp gitia co tay. Nghia la dau tren cua xtfdng ca nam tren du'dng cat
giua nep co tay vdi du'dng thang theo true ngdn gitia.

0 tren nep co tay co the nhin va sd thay noi len cac gan cd gap co tay tru.
ed gan tay dai. ed gap co tay quay va cd canh tay quay, giua hai gan ngoai
cung la phan dtfdi cua ranh mach. Gitia 2 gan d giua la du'dng chieu cua day
than kinh gitfa.
Dtfdi nep co tay la mot cho loi goi la got ban tay, tao nen bdi dau tren cac mo
cai va 1110 ut.

2. C A U T A O (tu' n o n g vao sau)

2.1. Cac ldp n on g

- Da: mem, mong, min d tren nep gap cd tay, day d dtfdi. ndi got ban tay
- Mo dtfdi da: gom mot ldp md rat mong va mot ldp mo te bao nhao. trong do
co cac nhanh than kinh cam giac cua cac day bi cang tay ngoai. bi - cang tay trong.
nhanh gan tay cua day gitia, va nhanh gan tay cua day tru.
15- GPkl T '
226 [jjj G I AI P H A U N G U O I . T A P I

2.2. L d p m a c
Mac cdng tay, day len d co tay de tao thanh day chang gan co tay. va ham cac
gan gap.
- Day chdng gan co tay (the palmar carpal ligament), theo cac tac gia Anh
My, (Woodburne, Netter), khong co ten trong T.A. 1997, la phan day len cua mac
cAng tay d mat trtfdc co tay; bam vao cac mom cham cua 2 xUdng quay, tru va che
phu d trtfdc cac gan gap nong, than kinh tru va cac bo mach d co tay.
Ham cdc gan gap (retinaculum musculorum flexorum): la mot dai sdi th6
day, chac, di tti cu xUdng thuyen va xUdng thang d ngoai tdi xUdng dau va mom
xtfdng moc d trong. Ham cang gitfa 2 bd cua ranh co tay va bien ranh thanh ong
> •» *■ . .
co tay cho cac gan gap d sau va day than kinh gitia chui qua. O phia ngoai, ham tach
thanh 1 che hinh chti Y bam vao 2 bd ranh xtfdng thang, tao thanh mot ong rieng
cho gan cd gap co tay quay cung bao hoat dich rieng cua no di qua (H 7 20: 7.30).
Ham cac gan gap nam d sau hdn va thap hdn day chang gan co tay. mac du bd
dudi cua day chang nay it nhieu lien tiep vdi mat trtfdc ham.

2.3. L d p d u ’di m a c
Di qua vung co tay trudc co cac gan cac cd gap va cac bao hoat dich. di kem,
dong mach quay, than kinh giua. va bo mach than kinh tru.
- C dc g a n ca: gom 3 ldp gan va mot ldp cd, thtf ttf nhtf sau:
+ Ldp 1 co 3 gan cd gap co tay quay, gan tay dai, va cd gap co tav iru. di xuong
d trtfdc ham cac gan gap. (Rieng gan gap co tay quay chui qua che bam d bd ngoai
mac ham cac gan gap).
+ Ldp 2 co 4 gan cua cd gap nong cac ngon tay xep thanh hai binh dien: gan
ngon giua va ngon nhan d trtfdc; gan ngon tro va ngon ut d sau.
+ Ldp 3 co 4 gan cua cd gap sau cac ngon tay va 1 gan cd gap dai ngon cai.
+ Tat ca cac gan gap nong va sau cac ngon tay (ldp 2 + 3) cung cac bao
hoat dich di kem va day than kinh gitia deu di d sau ham cac gan gap (trong
ong co tay).
+ Ldp 4 chi co d phan tren co tay la phan dtfdi cua cd sap vuong.
- H a i b a o h o a t d ic h : bao ngoai boc quanh gan gap ngon cai goi la bao quay.
Bao trong boc quanh cac gan gap cac ngon tay goi la bao tru.
- D o n g m a c h q u a y : chay trong ranh mach d trtfdc cd sap vuong. (gitia
gan cd canh tay quay va cd dang dai ngon cai d ngoai va gan cd gap co tay quay
d trong); tach ra nhanh gan tay nong roi vong qua dtidi mom tram quay de tdi
mu tay.

- T han k in h g iiia : nam trudc gan gap nong ngon tro va ngoai gan gap nong
 CO TAY [jli 227
LLaJ

ngon gitia. d sau khe giua gan cd duoi co tay quay va cd gan tay dai. roi luon dudi
ham cac gan gap de xuong gan tay.
- f)o n g tn a ch tru va th a n k in h tru (than kinh d trong dong mach) chay
doc theo bd ngoai gan cd gap co tay tru va sat bd ngoai xiidng dc\u, nam trifdc ham
cac gan gap, nhtfng sau mot tre cua mac ham cac gan gap phu len xudng dau va
lien tiep vdi gan cd gap co tay tru va ham cac gan duoi ttf sau di tdi.

VUNG CO TAY SAU

(R e g io c a r p a lis p o s te r io r )

1. HINH T H E N G O A I

Vung co tay sau cd 2 cho loi: phia trong la chom xtfdng tru. phia ngoai la dau
du’di xu'dng quay.

() du'di dau du'di xudng quay, phia ngoai co mot cho lom hinh tam giac gidi
han bdi cac gan cd giang dai va duoi ngan ngon cai d ngoai. va gan cd duoi dai
ngon cai o' trong, goi la hom lao gicii phau hay ho quay (fossa radialis). vi trong do
co dong mach quay di qua.

2. CAU T A O T U N O N G V A O S A U

2.1. Cac ldp n on g

- 13a: day hdn da d vung tru'dc co tay. Khi gap co tay, da phang va nhin ro cac
tinh mach nong. Khi duoi co tay, da co nhieu nep gap va noi len cac gan duoi cac
ngon tay (Hinh 14.1).
- Mo du'di da: chi co mot ldp mo te bao, khong md, khong mac nong. co cac tinh
mach nong va cac nhanh than kinh cam giac.
+ li n h mach nong: co cac phan tan cung cua cung tinh mach mu tay, phan
nguyen liy cua tinh mach dau va tinh mach nen.
+ Than kinh nong: co cac nhanh tan cua than kinh bi - cang tay trong d trong.
bi - cang tay ngoai d ngoai, va bi - cang tay sau cua day quay o' giua. Ngoai ra, d
ngoai con co phan tan cua nganh trtfdc day quay va d trong nhanh bi - mu tay
cua day tru di xuong mu tay.

2.2. Ldp m a c
Mac co tay sau d tren lien tiep vdi mac cang tay sau. d dtfdi day len thanh
228 [jj| G I AI P H A U N G U O I . T A P I

ham cac gan duoi (retinaculum musculorum extensorum): ham la mot dai thd sdi,
day va rong. bam 6 ngoai vao bd ngoai xUOng quay. trUdc ranh cua gan cd giang
dai ngon 1: d trong vao bd trong mom tram tru. xUdng thap. xudng dau va lien
tiej) vdi day chang gan co tay d trtfdc.

H inh 14.1. Ham cac gan du o i va bao h o a t d jc h cac gan d u o i

1. Bao gan duoi co tay tru, 2 Bao gan duoi ngon ut. 3 Bao gan duoi cac ngon tay 4 Bao gan duoi
dai ngon cai; 5. Bao gan duoi n g in ngon cai. 6 Bao gan giang dai ngon cai. 7 Bao gan duoi co tay
quay ngan, 8. Bao gan duoi co tay quay dai.

2.3. Cac ldp sau (dudi mac)

Gom cac gan cO va dong mach quay (Hinh 14.2).
- Cdc gan ca: ttf cang tay sau di xuong. chui qua ham cac gan duoi. nam
trong cac ranh d mat sau va mat ngoai dau dudi xu'dng quay. Ttf ham tach ra cac
tie vach ngan bam vao cac bd ranh. bien cac ranh thanh cac ong xuong sdi. Trong
moi ong cac gan dude boc trong cac bao hoat dich. cac bao nay keo dai it nhieu len
tren va xuong du'di ham.
Cac bao gan sap xep theo thtf ttf tu ngoai vao trong nhtf sau; bao gan cd dai
giang va duoi ngan ngdn cai. bao gan cac cd duoi co tay quay, bao gan cd duoi dai
ngdn cai, bao gan cd duoi cac ngdn tay va cd duoi ngdn trd, bao gan cd duoi ngon
ut, va trong cung la bao cd duoi co tay tru d sau ranh cua dau dtfdi xudng tru.
- Dong mach quay: tu trtfdc co tay vong dtfdi mom tram quay qua mat ngoai
khdp co tay ra sau. roi chay chech qua day "hom lao gidi phdu \ nam tren xtfdng
thang, bat cheo d dtfdi gan cd duoi dai ngon cai de tdi khoang gian cot thtf I (Hinh
1 1.2). Trong hom lao, dong mach tach ra dong mach chinh ngon cai va dong mach
mu co tay. Dong mach nay noi tiep vdi nhanh mu co tay tru cua dong mach tru
tao nen cung mqich mu co tay (xem Hinh 15.8).
 CO TA Y 0| 229

'[H o p hay hom lao giai phau ("tabatiere anatom ique" tieng Phap, hay "anatom ical s n u ff-b o x
tieng Anh) not dat bot thuoc la de hit, khong co ten trong thuat ngCr G PQ T, ma la mot ten goi
dan gian cua cac nha giai phau cu de chi m ot ho lom 6 phia ngoai mu cd tay, 6 giira 2 gan co
duoi dai va duoi ng£n ngon cai, noi ro khi duoi m anh ngon tay cai].

H inh 14.2 Ho d o n g m ach quay (hop lao giai phau)

1. Ho dong mach quay (hom lao giai phau); 2. Gan duoi co tay quay ngan. 3 Gan duoi co tay
quay dai, 4, Gan ccf duoi dai ngon cai. 5. Xu'dng thang. 6 Dong mach quay (khong ve cac
nhanh ben), 7. XUdng thuyen 8 Gan ca duoi ngan ngon cai, 9. Gan co giang dai ngon cai
230 g j GIAI P H A U N G lf O l. T A P I

15. BAN TA Y

Ban tay la phan cuoi cua chi tren, tiep theo co tay cho den tan cung cac ngon tay.
Ban tay gom 2 vung: gan tay va mu tay, ngan cach nhau bdi cac xUOng, khdp
va cac khoang gian cot ban tay.

VUNG GAN TAY

(R e g io p a lm a r is m a n u s)

Vung gan tay gom tat ca cac phan mem d tru'dc cac xu'dng. khdp va cac khoang
gian cdt ban tay.

1. O l d I H A N

- Gidi han tren: lien tiep vdi co tay. tudng ung vdi dtfdng vach tu phia dudi
xu'dng truyen tdi dau dtfdi xu'dng dau.
Hai ben: la bd trong va bd ngoai cua ban tay.

2. H I N H T H E N G O A I

Phan d tren cac ngdn tay goi la long ban tay hay gan ban tay (palma. vola). giUa
lom goi la hom gan tay. Phia ngoai loi gan trdn goi la mo cai (thenar), phia trong loi
thap hdn goi la mo ut (hypothenar).
Gan ban tay co 3 nep chinh. lam thanh mot chu M hoa thieu mot net:
- Nep tren dm lay md cai. dtfo'c tao nen do ddi chieu ngdn cai
- Hai nep khac la do gap cac ngdn II. III. IV, V.
Mat gan tay cua cac ngdn co cac nep hay ranh ngang. do gap cac ngdn va cac
dot ngon tay. Moi ngon II. III. IV. co 3 ranh: ranh tren (hay ranh ngon tay - ban
tay) d dtfdi khdp tudng tfng khoang 10 - 15mm. Ranh gitfa gan tudng tfng vdi
dtfdng khdp giua I va dot II ngdn tay. Ranh dtfdi d tren dtfdng khdp giua dot II va
dot 111 khoang 5mm.
Rieng ngdn cai chi cd 2 ranh ngang. Tren mat da d dtfdi dot cuoi cac ngdn co
van tay.
Hinh thai, chieu hudng cac nep gap d gan tay va cac van d dau ngon tay rat
da dang, vua mang tinh di truyen. vtfa la dac trtfng cua tting ca the.
 BAN TAY

3. CA U T A O

3.1. D a v a m o d iid i d a
Da gan tay day, tho va dinh chat vdi ldp mac bdi nhiing thd sdi day dac xen
giiia cac cuon md mong, tru1phan da phu tren mo cai mong va di dong, vi co mot
ldp mo te bao nhao dtfdi da. Da phu tren mo ut co mot cd bam da la cd gan tay
ngdn (m. palmaris brevis) di tti can gan tay tdi da d bd trong mo ut.
Trong ldp mo dudi da co cac tinh mach nong rat nho va nhieu nhanh than kinh
nong thuoc cac than kinh gitia, tru va quay.
Nhanh gan tay cua day than kinh gitia (Ramus palmaris n. mediani) tach ra
tti tren co tay, cam giac cho mot vting nho d gitia phan tren gan tay. Nhanh gan
tay cua day tru tach ra tti cang tay, cho mot vting nho hdn ve phia mo ut. Nhanh
nong cua than kinh quay cho mot nhanh cam giac cho bd ngoai mo cai.
Song cac nhanh chinh cho da d gan cac ngon tay la cac nhanh tan cua cac day
giua va day tru; vdi cac nhanh than kinh gan ngon tay chung va gan ngon tay
rieng, nam sau d dtfo’i can gan tay, xuong den gan ke cac ngon tay mdi thoat ra
nong; day gitia cho 3 ngdn rtfdi ke ttf ngoai vao va phan gan tay ttfdng tfng; day
tru cho 1 ngdn rtfdi ttf trong ra va phan gan tay con lai.

3.2. M A C G A N T A Y

Mac gan tay gom 3 phan khac nhau, day d giua va mong d 2 bon mo cai va mo
lit (xem Hinh 7.15).

3.2.1. P h a n g iiia : mac day len dac biet va dtfdc tang ctidng bdi nhting sdi gan toa
rong cua cd gan tay dai. non goi la c a n g a n t a y (aponeurosis palmaris). can la mot
manh sdi day, chac, hinh tam giac, dinh lion tiep vdi gan cd gan tay dai. day toa
tdi cac nep ban - ngdn tay cua 4 ngdn. ke tti ngdn lit. Can gan tay phu d trudc cac
gan gap ngdn tay. hai bon lien tiep vdi mac cua mo cai va mo ut.
Can dtfdc cau tao bdi cac thd sdi doc d ldp nong va cac thd soi ngang d ldp sau.
- Cac soi doc toa tti cac thd cua gan cd gan tay dai va tti mac ham cac gan gap
di xuong che thanh 4 dai doc htfdng tdi nen 4 ngdn tay.
- Cac sdi ngang: day len d 2 ndi, tao thanh:
Day chdng ngang nong ban tay (lig. metacarpale transversum superficiale,
tieng Anh la superficial transverse metacarpal ligament): vat ngang d trtidc va
noi cac dai doc vdi nhau d ngang mtic dau dudi cac xtfdng dot ban tay. chay ngang
tti bd ngoai xtfdng dot ban tay II tdi bd trong xtfdng dot ban tay V.
Cdc bo ngang (fasciculi tranversi): nam ngang d gitia cac dai doc va rang buoc
chung vdi nhau thanh mot mang ldn. Tdi gan nen cac ngdn tay thi bd ngang
232 | 0 G I AI P H A U N G U O I . T A P I

khong con, va giua cac dai doc de lo ra cac mach va than kinh gan ngon tay tu
sau thoat ra.

3.2.2. P h a n m a c p h u m o c a i: di tu bd ngoai can gan tay den bd ngoai xtidng dot

ban tay 1. 0 cho noi tiep vdi can gan tay. gan tay tach ra mot vach gian cd mo cai
tdi bam vao bd trtidc xtidng ban tay III.

3.2.3. P h a n m a c p h u m o ut: di tti bd trong can gan tay den bd trong xtidng dot
ban tay V. 6 cho noi tiep vdi can gan tay, tach ra mot vach gian cd mo ut tdi bam
vao bd trtidc xtidng dot ban tay V.
Nhti vav mac gan tay va cac vach gian cd phan chia gan tay thanh 3 o: o mo
cai d ngoai, o mo tit d trong, o gitia d gitia.
N&m dtidi 3 o la o gan tay sau hay o gian cot, che phu d trtidc. bdi mac sau gan
tay, hay mac gian cot gan tay.
O cac ngdn tay. mac tao thanh mot bao sdi hoc lay cac gan gap. va cung mat
trtidc cac xtidng dot ngdn tav tao thanh 1 ong xu'dng sdi.

3.3. C a c l d p d u ’di m a c v a c a c o g a n ta y
Cac cd, gan cd va cac mach than kinh o gan tay se dtidc mo ta lan ludt tu
ndng vao sau theo 4 o. gidi han bdi cac mac gan tay va cac vach gian co noi tron
(Hinh 15.1).
4

5 6

Hinh 15.1 Thiet do ngang qua ban tay

Cac mac va cac o gan tay (xem them hinh 7.15).
1. O mo ut; 2. 0 gan tay gitfa; 3. Can gan tay; 4. O mo cai; 5. O gian cot gan tay, 6 Mac sau gan tay
(mac gian cot gan tay).

- O gitfa: chtia hau het cac mach than kinh quan trong va cac gan gap tii
cang tay di xuong.
- O mo cai (hay o gan tay ngoai): co cac 16p cd o mo cai, va gan gap dai ngon
cai, cung nhanh gan tay nong ctia dong mach quay va nhanh mo cai cua than
kinh gitia.
 O mo ut (hay o gan tay trong): co cac cd o mo lit, dong mach gan tay sau
(A. palmaris profundus) thuoc dong mach tru va nganh sau cua than kinh tru.
- O gan tay sau: ndm dudi mac sau gan tay va gitia cac xudng ban tay, tao
thanh cac o gian cot, co cung dong mach gan tay sau, nganh sau than kinh tru va
cac cd gian cot.

3.3.1. O g a n ta y g iiia : dudi can gan tay, tu nong vao sau cd:
* Cung dong mach gan tay nong (arcus palmaris superficialis): tao non do sti
tiep noi cua dong mach tru vdi nhanh gan tay nong cua dong mach quay, cung
nong nam ngay dudi ldp mac nong gan tav, trtidc cac gan gap va trtidc cac nhanh
tan cua than kinh gitia va tru.
Tti phia loi cua cung tach ra dong mach ben trong ngon ut va 3 dong mach
gan ngon tay chung (aa. digitales palmares communes) di trtidc cac khoang gian
cot ban tay II, III, IV. Moi mach nay lai tach thanh hai dong mach gan ngon tay
rieng (Aa. digitales palmares proprii) di tdi cac ben ttidng ting cua cac ngdn II.
Ill, IV, V (Hinh 15.2).

Hinh 15.2. Vung gan ban tay (mach va than kinh lap nong)
1 Dong m ach quay: 2 Nhanh gan tay nong (cua dM quay): 3. Ca giang ngan ngon cai 4 Ca khep
ngon cai; 5. Cac dong m ach gan ngon tay chung; 6. Cung dong m ach gan tay nong; 7 Ca giang
ngon ut; 8. Ca gan tay ngan; 9. Nhanh gan tay sau (cua DM tru); 10. Dong mach va than kinh tru;
11. Than kinh giCfa.
234 [jjj G I AI P H A U N G U O I . T A P I

Tinh mach di kem cung dong mach chi co hai tinh mach rat nho. khong dang
ke (vi phan ldn tinh mach difdc dan lifu theo dtfdng mu tay).
* Cdc nhanh tan cua than kinh giiia va cua nhanh nong than kinh tru:
+ Than kinh giiia: sau khi di qua ong co tay (dtfdi mac ham cac gan gap), chia
thanh 5 nhanh:
* Nhanh ngoai: chay ngang vao mo cai, di qua mat trtfdc gan gap dai ngon cai
va tach ra cac nhanh van dong cac cd giang ngan ngdn cai, cd doi chieu ngon cai,
bo nong cd gap ngan ngon cai va cac cd giun 1 va 2.
* Cac nhanh con lai deu di phia sau cung dong mach gan tay nong va tach ra
cac than kinh gan ngon tay chung, roi than kinh gan ngon tay rieng cho 3 ngon
rtfdi, ke ttf ngon cai.
Ngoai ra, day giQa con tach ra 1 nhanh noi vdi than kinh tru.
+ Nhanh nong cua than kinh tru (ramus superficialis N.ulnaris): ttf than kinh
ti u o' tru'dc mac ham cac gan gap. ngoai xu'dng dau, di xuong d trudc: cac cd mo lit
tren cung mot binh dien vdi cac nhanh gan ngon tay cua than kinh giua, va cung
tach ra cac nhanh gan ngon tay chung va gan ngon tay n e n g de cam giac cho 1
ngon tav rtfdi. ke ttf ngon lit.
Cdc ldp gan gap: nam d sau cung dong mach gan tay sau va cac nhanh than
kinh gitfa va tru. xep thanh 2 binh clien:

+ O trtfdc co 4 gan gap nong cac ngon tay, khi xuong tdi cac ngon II. III. IV. V
moi gan che doi de bam tan vao 2 ben dot gitfa ngon tay, tao thanh cac gan thung
cho gan gap sau di qua (Hinh 7.8. 15.3).

1 2

Hinh 15.3 Cac gan gap va bao hoat djch d ngon tay
1. Gan gap nong cac ngon tay; 2. M ac treo gan; 3. Gan gap sau cac ngon tay 4 Bao
hoat dich ngon tay (da rach md)

+ 0 sau co 4 gan gap sau cac ngon tay: khi xuong tdi cac ngon ttfdng ling, chui
qua cac gan thung, tao thanh cac gan xien xuong bam tan d nen dot III ngon tay.
 BAN TAY [g| 235

Cung binh dien co 4 cd giun (mm. lummbricales) bam tu cac gan gap sau
vong qua mat ngoai cua cac khdp ban - ngon tay va tan het d cac gan duoi
tudng ling.
* Cdc bao hoat dich cdc gan gap (vaginae synoviales tendinum musculorum
flexorum): co 5 bao: 3 bao ngon tay & 2 bao ngon tay - co tay.
+ Cdc bao hoat dich ngon tay (vaginae synoviales digitorum manus) II, III,
IV: boc quanh cac gan gap cua cac ngon nay, di tu' khdp giCfa dot II va dot III
ngon tay tdi phia tren khdp ban ngon tay tUdng ling khoang 1cm (Hinh 15.4).

Hinh 15.4. Cac bao hoat djch 6 gan tay (Theo G regoire & Oberlin).
(Tri/dng hop ngoai le co them bao gan tay giufa sau. bao quanh gan gap ngon tro)

1. Bao gan tay giufa sau; 2. Bao hoat djch gan gap dai ngon cai; 3. Bao hoat djch ngon
tay III; 4. Bao hoat djch chung cac gan gap ngon tay.

+ Bao hoat dich chung cdc gdn gap ngon tay (vagina communis tendinum
musculorum flexorum) keo dai tif ngon ut len tren co tay, nen trifdc day cac tac
gia Phap con goi la hoat dich ngon tay - co tay trong (hay bao tru), di tu dot II - III
ngon ut len tdi tren mac ham gan gap khoang 4cm. 6 o gan tay gitia va ong co tay
236 |0 GIAI PHAU NGl/dl. TAP I

bao toa rong de boc ca cac gan gap nong va gap sau cua cac ngon khac. tao nen
cac tui cung d trudc gan gap nong. d sau gan gap sau va lach gnia cac gan gap
nong va gap sau (Hmh 15.4. 15.5).
*[Ooi khi bao chung cac gan gap d gan tay khong toa rong tdi gan gap ngon II. va mot so
tac gia con ke them 1 - 2 bao hoat djch gan tay rieng cho cac gan gap ngon II. goi la bao
hoat dich gan tay giCra. nong va sau (synoviale palm aire m o ye n n e superficiele/p rofonde)
(theo G regoire va O berlin ) (H inh 15.4. 15.7).

+ Bao hoat dich gan ca gap dai ngon cai

(vagina tendinis musculi flexoris pollicis longi)
cung keo dai len co tay goi la bao ngon tay - co
tay ngoai (hay bao quay); bao chay qua o mo
cai va ong co tay, tan het d tren mac ham cac
gan gap khoang 3cm (Hinh 15.4).

3.3.2. ( ) m o ca i (thenar) ha y o g a n tay ngoai

co 1 cd xep thanh 1 ldp. xen vao do co gan
gap dai ngdn cai va mot so mach than kinh
ch qua.
* Ldp thu nhat co cd giang ngan ngon cai
ill tii xuong thuyen den dau gan dot I ngon cai
Hinh 15.5 Cac tui cung cua bao hoat
(Hinh 15.2, 7.28). dich chung cac gan gap
Nhanh gan tay nong cua dong mach quay 1. Tui cung sau gan. 2 Tui cung gian
gan, 3. Tui cung tru'dc gan 4 Gan gap
co the bat cheo qua mat trudc. mat sau hoac sau cac ngon tay, 5. Gan gap nong cac
xuyen qua cd nay. ngon tay.

* Ldp thu' hai co 2 cd: cd doi chieu ngon cai ai tu xuong tnang toi do ngoai
xu'dng dot ban tay I. va dau nong cd gap ngan ngon cai di tii xiidng thang tdi dot 1
ngon cai (Hinh 7.29).

Giua hai ldp 1 va 2 co nhanh mo cai cua day than kinh giua tdi phan nhanh
van dong cho ba cd nay.

Ldp thu' ba co dau sau cd gap ngan ngon cai di tu xiidng the. xuong ca den
dot 1 ngon cai.

Giua hai dau nong va sau cua cd gap ngan co gan cd gap dai ngon cai va bao
hoat dich cua no di qua.

* Ldp thu tu co cd khep ngon cai vdi 2 dau: dau chech di tii xUdng the xUdng
ca: va dau ngang di tii than xu'dng ban tay III; Hai dau chum lai tdi bam vao nen
dot I ngon cai. Lach giua hai dau co dong mach quay tii khoang gian cot I d phia
mu tay chui qua de vao gan tay (Hinh 7.29).
 BAN TAY [jlj 237

3.3.3. O m o ut (hypothenar) hay o g a n ta y tr o n g

('6 3 cd xep thanh 2 ldp: co dong mach gan tay sau thuoc dong mach tru va
nhanh sau thdn kinh tru di qua de vao sau trong o gian cot. (Hinh 7.28. 7.29.
15.2, 15.6).
* Ldp cd thti nhat gom 2 cd:
Cd giang ngon lit d trong, di tti xtidng dau tdi dau gan dot I ngon tit.
Cd gap ngan ngon ut d ngoai, di tti xtidng moc den dau gan dot I ngon ut.
* Ldp thti hai chi co 1 cd la cd doi chieu ngon tit, di tti xtidng moc tdi phia
trong xtidng dot ban tay V.
* Nhanh gan tay sau (r. palmaris profundus) cua dong mach tru: tti phia
ngoai xtidng dau di gitia cd giang va gap ngan ngon tit roi bat cheo phia sau
hoac xien qua cd doi chieu ngon ut vao o gian cot, de noi tiep vdi cung dong
mach tay sau.
' N h a n h s a u t h a n h i n h t r u (ramus profundus. X. ulnaris): cung di cung nhanh
gan tay sau cua dong mach tru lach qua cac co mo ut. de vao 6 gian cot.
Khi di qua mo tit. nhanh gan tay sau cua dong mach tru va nhanh sau cua
lhan kinh tru deu tach ra cac nhanh cho cac co' mo ut.

3.3.1. O g ia n c o t h a y 6 g a n ta y sa u
Dude cau tao lan ludt tti' tru'dc ra sau hoi 3 ldp: mac. mach. than kinh va co.
Ldp mac: goi la m a c s a u g a n t a y (aponeurosis profundus) chi day va ro d
phan tru'dc cac khoang gian cot 111 va IV ngan cach o gian cot vdi o gan tay gitia:
con d phia ngoai. tru'dc cac khoang gian cot 1 va II chi co mot ldp mo te bao mong
ngan cach cac cO gian cot vdi cd khep ngdn cai.
- Cdc mach cd than kinh: ngay du'di mac sau cd cung dong mach gan tay sau
va nhanh sau than kinh tru, nam trong mot ldp te bao md mong.
Cung dong mach gan tay sau (arcus palmaris profundus) dtidc tao nen do
su tiep noi cua dong mach quay voi nhanh gan tay sau cua dong mach tru. Dong
mach quay tti phia mu tay chui qua khoang gian cdt I giua 2 dau cua cd gian cot
mu tay I, cho dong mach chinh ngdn cai va dong mach quay ngon tro. roi chui
qua khe gitia 2 dau cua cd khep ngdn cai chay ve phia mo ut de noi vdi nhanh sau
cua dong mach tru (Hinh 15.6).
Cung chay d trudc cac cd gian cot va cac xu'dng ban tay. tach ra cac dong
mach gan ban tay va cac dong mach xien; 3 dong mach gan han tay (Aa.
metacarpales palmares) II, III, IV, chay xuong duoi. d trtidc cac cd gian cot, tdi
gan khdp ban ta y-n gon tay thi tach ra cac nhanh xien ra mu tay. roi tan het
bang cach noi vdi 3 dong mach gan ngon tay chung cua cung gan tay nong.
238 i GIAI P H A U N G U O I. TA P I

Dong mach chinh ngon cai (A. pnnceps pollicis) cap mau cho ngon cai; va
dong mach quay ngon tro (A. radialis indicis) cap mau cho phia ngoai ngon tro.
Ngoai ra, cung gan tay sau con tach ra cac nhanh xien (rami perforantes). xuyen
qua cac khoang gian cot ban tay de tiep noi vdi cac mach mu ban tay.

H inh 15.6 V u n g gan ban tay (mach mau va than kinh ldp sau;
1. Dong mach quay. 2. Than kinh giUa 3. Cd giang ngan ngon cai. 4 Cd doi chieu ngon cai.
5. Cd gap ngan ngon cai, 6. Cd khep ngon cai, 7. Gan cd gap dai ngdn cai 8 Cac co giun,
9. Cac dong mach gan ban tay, 10. Cd gap ngan ngon ut, 11. Nhanh sau dong mach tru va cung
dong mach gan tay sau; 12. Nhanh sau than kinh tru; 13. Than kinh tru, 14. Dong mach tru

Nhanh sau cua than kinh tru: sau khi cung nhanh gan tay sau cua dong
mach tru qua cac cd mo ut vao o gian cot tiep tuc chay ra ngoai. song song vdi
cung mach gan tay sau. d trtidc cac cd gian cot va cac xtidng ban tay.
Tren dtidng di tach ra cac nhanh di tdi cac khdp ban tay - ngon tav va cac
nhanh van dong cac cd gian cot. hai cd giun III, IV, cd khep ngon cai va bo sau cd
gap ngan ngon cai.

- Ldp cd: gom 8 cd gian cot; 4 cd gian cot gan tay gap, duoi va khep cac ngon va
4 cd gian cot mu tay gap. duoi va giang cac ngon. so vdi true gitia ban tay. Do do:

* Cdc cd gian cot gan tay bam vao ntia trtidc mat ben phia gan true ban tay
cua cac xtidng dot ban tay I. II, IV. V va tan het d mat cting phia cua cac gan duoi
va nen dot I cac ngon ttidng ting.

* Cdc cd gian cot mu tay chiem phan con lai cua cac khoang gian cot ban
tay, bam vao ca 2 xtidng d 2 ben, de xuong bam tan vao mat xa true gitia ban
tay cua cac gan duoi va nen dot I cac ngon II, IV va 2 ben ngon III (Hinh 7.32,
33. 34; 15.7).
 BAN TAY Oil 239

4. CAC K H O A N G T E B A O C U A V U N G G A N T A Y

Xen ke gitia cac la mac, cac cd, gan va cac mach mau, than kinh d gan tay va
d cac ngon tay la mo te" bao, tao nen cac khoang te bao gan tay (Hinh 15.7).
Cd 4 khoang te bao chinh dtidi can:
- Khoang te bao o mo ut.
- Khoang te bao o mo cai (d giiia cd khep va cd ngan gap ngdn cai).
- Khoang te bao o gan tay gitia tru’dc gan, chiia cac mach va than kinh d
trtidc gan.
- Khoang te bao o gan tay giiia sau gan d giiia cac gan gap va mac sau.
Cac khoang te bao o gan tay gitia lien quan vdi dau tren cua cac bao hoat
dich ngdn tay va vdi bao hoat dich chung cac gan gap ngdn tay.
Khoang te bao o mo cai cd bao hoat dich gan gap dai ngdn cai.
Cac khoang te bao d o mo cai va d o gan tay giiia sau gan cdn thong vdi cac
khoang te bao cua vung mu tay qua cac ke ngdn tay. Do dd cac nhiem trung d gan
tay cd the gav sting vung mu tay.
Khoang te bao d o gan tay gitia cdn lien tiep vdi cac khoang te bao cua ngdn
tay tu' ngdn II den ngdn V bdi cac dai te bao di theo cac cd giun, nen day cung la
du'dng lan truyen nhiem khuan gitia gan tay va ngdn tay.

Hinh 15.7. Thiet do ngang qua ban tay

1. Gan gap dai ngon cai (va bao hoat djch cua no); 2. Cd giang ngan ngon cai; 3. Cd doi chieu ngon
cai, 4. Cd gap ngan ngon cai; 5. Cd khep ngon cai; 6. Gan duoi ng£n ngon cai; 7. Gan dudi dai ngon
cai; 8. Gan dudi cac ngon tay; 9. Co gian cot mu tay; 10. Cd gian cot gan tay; 11. Cd dudi ngon ut;
12. Cd giang ngon ut; 13. Cd gan tay ngan; 14. Cd gap ngan ngon ut; 15. Cd doi chieu ngon ut.
16. Bao hoat dich chung cac gan gap. 17. Cd giun; 18. Bao hoat dich gan tay giCra sau (bat thudng)
19. Bao hoat djch gan tay giufa nong (bait thudng).
240 [jjl GIAI P H A U NGlfCSI. T A P I

H inh 15.8 P hau tic h v u n g gan tay. Cd mach than kinh. ldp nong
(Theo F H. Netter. Atlas of Human Anatom y. 3rd edit, 2003, plate 449)
1, DM quay, 2. TK gitfa va nhanh gan tay, 3. Nhanh gan tay nong cua DM quay 4 C c g;ang ngan
ngon cai; 5. Ccf doi chieu ngon cai, 6. Cd gap ngan ngon cai; 7. N hanh van dong mo cai cua TK
giCra, 8. Cac TK va DM rieng ngon cai; 9, Cd khep ngon cai; 10. Cac nhanh cua TK gitfa cho cac cd
giun 1 va 2; 11. Cac bao xd va bao hoat dich cac gan gap, 12. Cac nhanh cho mu dot 2 3 cua cac
TK va DM gan ngon tay rieng 13 Cac DM va TK gan ngon tay rieng, 14. Nhanh noi cua TK gitfa vdi
TK tru. 15. Cac DM va TK gan ngon tay chung. 16. Cung DM gan tay nong; 17 Bao hoat dich chung
cac gan gap (bao tru); 18 Nhanh nong TK tru; 19. Nhanh gan tay sau DM tru va nhanh sau TK tru
20. Mac ham cac gan gap. 21 Day ch^ng gan co tay (lien tiep vdi m ac ham cac gan gapt 22 DM
va TK tru.
 ban tay

Hinh 15.9. V ung co ta y - gan ban tay (Mach than kinh ldp sau) Da cat bo phan ldn cac gan cd
mach than kinh ldp nong (Theo S inelnikov, tap III. Fig. 862. p. 198)

1 DM quay, 2. Mang gian cot, 3. DM gian cot tru’dc, 4. Cd canh tay quay, 5 Cd sap vuong: 6 Nhanh co
tay gan tay DM quay. 7. Nhanh gan tay nong DM quay; 8. Gan cd giang dai ngon cai 9 Gan cd duoi
ngan ngon cai, 10. Cd giang ngon cai, 11 Nhanh sau TK tru; 12. Cd gap ngan ngon cai 13. Cd khep ngon
cai (bi cat, nang len); 14. Cac cd gian cot gan tay; 15. Cac cd giun. 16 Cac gan cd gap nong va sau ngon
tay, 17. Cac nhanh tk cho cac cd giun; 18. Cac nhanh tk cho cac cd gian cot 19 Cd doi chieu ngon ut
20. Cac DM gan ban tay (bi cat); 21. Cung DM gan tay sau; 22. Nhanh (TK) cd mo ut 23 Cd giang ngon
ut, 24. Nhanh nong TK tru. 25. Nhanh gan tay TK tru; 26. Xu'dng dau. 27. Nhanh co tay gan tay DM tru
28. Nhanh mu tay TK tru; 29. Cd gap cd tay tru; 30. TK gian cdt triidc; 31. TK tru; 32 DM tru

16- GPN-T1
E E GIAI PH A U N G U O I T A P I

VUNG MU T A Y
(I ie g io d o r s a lis m a n u s)

1. G I ( ) I H A N

Vung mu tay gom cac phan mem d phia sau cac xu'dng. khdp ban tay. ('o cung
gidi han nhu vung gan lay.

2. H IN H T H E N G O A I

Nhin be mat. khi ban tav va cac ngon tav do duoi, thay hien ro cac gan duoi
tti co tay toa xuong va cac tinh mach nong. O vi tri cac khdp gian dot ngon tay
han Ion cac ncp ngang.
Khi gap cac ngon thay ro cac khdp ban tay - ngon tav nho len nhtf nhung mo hinh
chop, d tron muc cac kc ngon tay 1.5 - 2cm. Cac khdp gian dot ngon tav runs noi ro
() dau \a cua dot cuoi mdi ngdn cd mong tay hinh chu I ’ dinh ch.it d mat
trudc va d chu vi. chi hd mot bd tu do de mong phat trien chieu dai.

3. CA U T A O

Tit ndng vao sau lan ludt cd cac ldp nhu sau:

3.1. Cac ldp nong

l)a: mom. rat di cldng. khong co md.
Md te bao dtidi da: mong. nhao, cd nhieu tinh mach va than kinh ndng.
Tinh mach ndng: gdm cac tinh mach mu ban lay, noi tiep vdi nhau tao thanh
mot mang tinh mach mu tay (hay cung tinh mach mu tay) tan cung d hai dau bdi
tinh mach dau d phia ngoai va tinh mach nen d phia trong.
Than kinh nong: gdm cac nhanh bi - mu tay cua nhanh nong than kinh quay
va nhanh mu tay than kinh tru. Day quay cam giac cho ntia ngoai mu tay va mu
hai ngdn rtidi d phia ngoai, va day tru cam giac cho ntia trong mu tay va mu
2 ngdn rtidi d phia trong, qua cac than kinh mu ngon tay. Trti ph^n mu cua hai
dot cuoi cua cac ngdn tro, ngdn giua va ntia ngoai ngdn nh^n la do day TK giiia
cam giac (Hinh 15.8. 15.10).

3.2. M a c m u ta y
Mong nhting chac, d tren lien tiep vdi ham cac gan duoi, d dtidi phu va hoa
vao cac gan duoi, hai ben dinh vao cac xtidng ban tay I va V.

3.3. C a c g a n d u o i d tfd i m a c
Gdm cac gan cO tti vting cang tay sau di xuong qua ham cac gan duoi. Sap xep
lan ltidt tti ngoai vao trong nhti sau (Hinh 15.10):
- 3 gan ngon cai: gan cd giang dai ngon cai, duoi ngan ngon cai va duoi dai
ngdn cai.
- Gan cd dudi ngon tro va 4 gan cd duoi cac ngon tay.
 BAN TAY liX 243

(Ian cd duoi ngon lit va gan cd duoi co tay tru.

() day kho. giufa cac gan cd duoi ngan va duoi dai ngon cai con co phan cuoi
cua cac gan cd duoi cd tay quay dai va ngan. tdi bam vao dau tren cac xtfdng ban
lay II va III
Dudi ldp cac gan cd la cac mach chinh cua vung.

3.4. C a c d o n g m a c h O m u t a y (Hinh 15.10, 15.11)

Hinh 15.10. Vung mu tay (ldp neng)

1 Gan duoi cac ngon tay, 2. Mac ham cac gan duoi; 3. Nhanh mu ban tay than kinh tru, 4. Nhanh noi cua
than kinh tru; 5. Cac dong mach mu ban tay; 6. Cd gian cot mu tay I; 7 Gan cd duoi dai ngon tay cai,
8 Dong mach chinh ngon cai; 9. Gan cd duoi ngan ngon cai; 10 Dong mach quay, 11. Dong mach mu
co tay; 12. Nhanh nong cua than kinh quay.

D on g m a ch q u a y ttf phia tru'dc vong qua bd ngoai co tay. luon dtfdi cac gan
cd giang dai va duoi ngan ngon cai, chay qua ho dong mach quay (hay hom lao
giai phau) d giua dudi cac gan duoi ngan va duoi dai ngon cai. roi chui qua xoang
gian cot I de ra gan tay. Tren doan dtfdng ngan do, dong mach tach ra 1 hoac cac
nhanh mu co tay (ramus carpalis dorsalis): dong mach chinh ngon cai (A. princeps
pollicis), va dong mach bd ngoai ngon tro (A. radialis indicis).
Cac nhanh mu co tay cua dong mach quay noi vdi cac nhanh mu co tay cua
dong mach tru va vdi nganh tan sau cua dong mach gian cot trtfdc. tao thanh
m a n g m a ch m u c o ta y (rote carpale dorsale). Tu mang tach ra 3 dong mach mu
ban tay (Aa. metacarpales dorsales), chay sau cac cd gian cot mu tay II, III. IV.
Moi dong mach nhan them cac nhanh xien tu' cung gan tay sau va tti cac dong
mach gan ban tay roi chia doi d ngang mtic dau dtidi cac xtidng ban tay thanh hai
244 l[jj] GIAI PHAU NGUOI. TAP I

(tong mach mu ngon lay (Aa. digitales dorsales). Bong mach nay la nhung nhanh
tan nho. chi tdi lung chting 2 ben ngon tu'Ong Ung (Hinh 15.10. 15 1 1i.

3.5. M ac sau m u tay

Rat mong. phu sau cac cd gian cot mu tay.
Cac cd nay da dude ta cung vdi o gian cot d vung gan tay. Vay o dude gidi han
gitia hai la mac sau gan tay va mac sau mu tay. O cung vdi cac xUdng ban tay tao
nen mot vung trung gian gidi han gitia gan tay va mu tay.

Hinh 15.11 Phau tich vung mu tay. Ldp sau; da cat bo mot phan cac gan duoi va mac mu tay
(Theo F.H Netter)
1 Than kinh bi cang tay trong; 2 TK bi cling tay sau (nhanh cua TK quay); 3. Ham cac gan dud* 4 Nhanh
mu tay cua TK tru; 5 Nhanh mu co tay cua dm tru; 6. Gan cd duoi co tay tru; 7. Cung DM mu co tay 8 Cac
DM mu ban tay; 9. Cac TK mu ngon tay (cua nhanh mu tay TK tru); 10. Cac nhanh mu dot II. Ill ngon tay 4,
5 cua cac DM va TK gan ngon tay neng (cua day TK tru); 11. Cac nhanh mu dot 2, 3 cac ngon tay 2. 3. 4
cua cac DM va TK gan ngon tay neng (cua day TK giCte). 12. Cac TK mu ngon tay (cua nganh nong than
kinh quay); 13. Cac DM mu ngon tay; 14. Gan cd dudi co tay quay ngan; 15. Gan cd duoi cd tay quay dai.
16. Gan cd duoi dai ngon cai; 17 Gan cd duoi ngan ngon cai; 18. Gan cd giang dai ngon cai 19 DM quay
trong hom lao giai p h iu ; 20 Cac gan dudi ngon tay. gan dudi ngon lit va gan du6i ngon tro (tx cat).
21. Nganh nong TK quay; 22. TK bi cling tay ngoai (nganh tan cua TK cd bi).
 PHAN III

GIAI PHAU CHI Dirdfl

- G ia i p h a u he th o n g chi du'di
- G ia i p h a u d jn h k h u c h i d u d i
 X U O N G CHI DUOI ill

GIAI PHAU HE THONG CHI Dtfft

16. XUONG CHI DUC5I

(Ossa membri inforioris)

Xu’dng chau
Ttidng tif nhu chi tron, chi
dtidi ban gom dai chi du'di vh
chi dudi t ti do.
D ai ch i difdi (cingulum
nx'inbri inforioris) hay d m c h a u
(cingulum polvicum). duoc lao
non bdi hai xtidng chau. khdp
vdi nhau d phia trudc bdi khdp
dinh mu (symphysis pubica). va
khdp vdi xu'dng cting d phia sau
bdi khdp cung chau (articulatio
saeroiliaca).
Chi diidi tU d o (pars libora
mombri inforioris) gom:

+ O dui co xu'dng dui va xu'dng

banh cho.

+ O cang chan co xtidng chay

va xtidng mac.

+ O ban chan co: 7 xtidng co

chan xep thanh 2 hang, (sau 2
trtidc 5), 5 xtidng ban chan
danh sd thti tti tti 1 - V, tti
^ ----- Cac xu'dng co chan
trong ra ngoai, va 14 xtidng dot
Cac xu’dng ban chan
ngon chan, moi ngdn (II - V) co
3 dot. rieng ngon cai (I) chi co 2
dot (Hinh 16.1).
mm
' if J— Cac xu'dng ngon chan

Hinh 16.1. Cac xu’dng chi du’di

E2S] GIAI p h a u NGUOI. TAP I

XUONG CHAU
(O s c o x a e )

Xtfdng chau tiep khdp vdi xtfdng cung d phia sau, v6i xtfdng chau ben doi dien
d phia trtfdc va vdi xtfdng dui d dtfdi.
Xu'dng chau thuoc loai xtfdng det hinh dang phtfc tap hdi xoan van. co the vi
nhtf mot chong chdng 2 canh lech, canh nho co 1 lo thung rong. va d cho noi giiia
2 canh cd mot hom khdp sau (Hinh 16.3, 16.4).

1. D I N H H l/C fN G

Dat xudng theo chieu thang dung:

Mat cd hom khdp ra ngoai

Khuyet d vanh hom khdp (hay canh nho cd Id thung rong) xuong dudi.

- Bd co khuyet ldn ra sau.

2. C AU T A O

Ve mat p h o i th a i. xu'dng chau do ba xudng hop thanh: Xuong canh chau.

xu'dng mu va xtfdng ngoi. Yet tich ndi tiep giap giua ba xtfdng d tre em (cho den
16 - 17 tuoi) la dudng sun hinh chu Y o' day o coi (Hinh 16.2). Sau do sun hoa
xu'dng va khong con thay dudng noi tiep.
-X ifd n g canh chau (os ilium) o tren gom than xtfdng canh chau (corpus ossis
ilii). canh xtfdng canh chau (ala ossis llh). va mao chau (crista iliaca).

- Xifdng mu (os pubis) d trtfdc dtfdi gom co than xu'dng mu (corpus ossis
pubis), hai nganh tren va nganh dudi xudng mu ramus superior et ramus inferior
ossis pubis). Hai nganh xudng mu hop vdi nhau thanh mot goc htfdng ra trudc va
vao trong tiep khdp vdi xudng mu ben doi dien bdi mat khdp dinh mu (facies
symphysialis). O phia tren ngoai mat khdp dinh mu co cu mu (tuberculum
pubicum).

- Xu'dng ngoi (os ischil) d phia sau gom than (corpus) va nganh xi/(Pig ngoi
(ramus ossis ischn): Nganh nay uon cong ra trtfdc va noi lien vdi nganh dudi
xu'dng mu thanh nganh ngoi mu. 0 phia sau dudi ddan cong nganh xtfdng ngdi co
u ngoi (tuber ischiadicum) (Hinh 16.2).
 X l/O N G C H I D U O I [jjj| 249

H inh 16.2 Cau ta o xu'dng chau d g iai doan ph o i th a i (nhin mat ngoai)
1 0 coi (phan canh chau), 2. O coi (phan ngoi); 3. Lo bit. 4 Xu'dng ngoi. 5. Sun ngoi mu, 6. Xu’dng
mu. 7. O coi (phan mu): 8, Sun hinh Y (sun tiep giCfa ba phan): 9, Gai chau trade du'di 10, Xudng
canh chau, 11. Mao chau

3. M O T A ( x u o n g t r u d n g t h a n h )

Xu'dng chau dot. hinh chu' nhat, hdi xoan van non cd the md ta hai mat. bon
bd va bon goc.

3.1. M a t n g o a i x u ’d n g c h a u (Hinh 16.3):

0 giiia cd 6 coi (acetabulum) tiep khdp vdi chom xtiOng din. Day o coi cd hai
phan: dien nguyet hay mat nguyet (facies lunata) hinh ban nguyet. md xudng
du'di, la dien khdp tiep xtic vdi chom xu'dng dui, cd sun bao phu. Ho o coi (fossa
acetabuli) la phan lom 0 gitia khong tiep xtic vdi chom xtidng din.
Xung quanh o coi nhd len mot gd goi la vien o coi (limbus acetabuli). Phia
dtidi vien va dien nguyet cd mot khuyet goi la khuyet o coi (mcisura acetabuli).
Vat ngang qua khuyet o coi cd day chdng ngang 6 coi (ligamentum tranversum
acetabuli) (tao bdi sun vien o coi, bam quanh vien o coi).
- Tren o coi la mat ngoai xifcfng canh chau, cdn goi la mat mong (facies glutea),
co 3 cd mong to. mong nhd va mong be bam, ngan cach bdi ba dudng cong goi la
cac difdng mong trifdc, mong sau va mong difdi (linea glutea anterior, posterior et
inferior).
- Dtidi o coi la Id bit (foramen obturatum) tao nen boi vong cung xtiOng ngoi d
phia sau va vong cung xtiOng mu d phia trtidc, vdi nhting phan cu the nhti sau:
EE IJai g i a i P H A U NGlf Cf l. T A P I

Than x tfd n g n g o i gop phan tao non phan sau dtfdi o coi: 1m) sau than co gai
ngoi (spina ischiadica) va khuyet ngoi be (incisura ischiadica minor): phia dtidi
than lion tiep vdi nganh xu'dng ngoi. Nganh nay non cong xuong dtfdi va ra trtidc,
tiep noi vdi nganh du'di xu'dng mu. lid sau dudi doan cong day len go ghe goi la u
ngoi (tuber ischiadicum).
Than xiid n g m u tao non phan trtfdc dtfdi o coi. va lien tiep trtic tiep vdi
nganh tren xtfdng mu. Nganh nay hudng ra trudc, vao trong va hdi xuong dtidi.
Mat tren cd cd hide bam; bd sau tren sac. la Itfdc xtfdng mu (pecten ossis pubis); bd
trudc dtidi la mao bit (crista obturatoria): dau trtidc trong cd cu mu (tuberculum
pubicum).
Mat dudi cd ranh bit (sulcus obturatorium) cho cac mach than kinh bit di
qua. Nganh tren gap goc vdi nganh dtidi xtidng mu, tao nen d phia trtidc mot tlien
khdp mu. khdp vdi xtidng mu ben doi dien d difdng gitfa trtfrJc. Nganh dtfdi xtidng
mu hudng x u o n g dudi. ra ngoai va ra sau. tiep noi vdi n g a n h x u o n g ngoi. lao
thanh nganh ngoi mu. o dudi 1 6 hit.

Hinh 16.3. Xu’dng chau (mat ngoai)

1. Du’dng mong sau 2. Gai chau sau tren; 3. Gai chau sau dtidi; 4. Khuyet ngoi ldn 5. Gai ngoi;
6 Khuyet ngoi be; 7 U ngoi. 8. Lo bit 9. Nganh du’di xtidng mu; 10. Cu mu; 11. Nganh tren xifdng
mu; 12 Ho o coi; 13. Dien nguyet o coi; 14. Gai chau trtidc dtidi; 15. Dtidng mong dtidi. 16. Gai chau
sau tren; 17. Ho chau ngoai; 18. Du’dng mong trtidc.
 X l/O N G CHI D UO I i]X ij 251

3.2. M at tron g xu'dng ch au : co du’dng cung (linea arcuata). chav cheo tu sau
ra truck va tti tren xuong dUcfi, chia mat trong xudng chau lam hai phan:

() tren dudng cung la ho canh chau, hay ho chau (fossa iliaca) co co chau
(M. iliacus) bam. Phia sau ho chau co dien khdp vdi xiidng cung. goi la dien
nhi (fascies auricularis); tren va sau dien nhi co u loi (hay loi cu) canh chau
(tuberositas iliaca) go ghe, la nOi bam cua day dicing cung u (ligamentum
sacrotuberale).

O dudi dudng cung la mot dien vuong tUOng Ung vdi day o coi. dudi ntia la
lo bit.

Hinh 16.4. Xu’dng chau (mat trong)

1. Mao chau, 2 Ho chau (ho canh chau); 3. Gai chau tru’dc tren; 4. Gai chau tru'dc du’di. 5 Loi chau mu.
6. Ludc xu’dng mu: 7 Mat khdp dinh mu; 8. Bd du’di xu'dng chau (nganh ngoi mu). 9 U ngoi,
10 Khuyet ngoi be; 11. Gai ngoi; 12. Du’dng cung; 13. Khuyet ngoi ldn, 14 Dien nhi, 15 Gai chau
sau tren; 16. U loi canh chau

3.3. Bd tren xtfdng ch au : la bd tren cua phan canh chau, goi la mao chau
(crista iliaca), cong hinh chti S, bat dau tU gai chau tru’dc tren (spina iliaca
anterior superior) den ga i chau sau tren (spina iliaca posterior superior). 0 tu the
252 [jj| GIAI P H A U NG U O l. T A P I

citing gai chau trudc tren d ngang tam vdi dot song cung I. gai chau sau trdn
ngang vdi clot cung II. Ndi cao nhat cua mao chau ngang tam vdi dot that lung IV.

3.4. Bd dtiofi x ifd n g c h a u : la bd du'di cua nganh ngoi mu do nganh \Udng ngoi
(ramus ossis ischii) va nganh dudi xudng mu (ramus inferior ossis pubis) tao thanh
(Hinh 16.1).

3.5. Boi trtidc xtitfng c h a u : cd nhting cho loi lom, lan ludt tti tren xuong dudi
nhu sau:
Gai chau tru’dc tren (spina iliaca anterior superior).
Mot khuyet nong nho,
Gai chau tru’dc du’di (spina iliaca anterior inferior),
Loi chau mu (eminentia ihopubica), d cho tiep giai) gi^a than xUdng canh chau
va than xu’dng mu
Mot dien lUdc. hinh tam giac d mat tron nganh tren va than xudng mu ma
dinh la cii mu. canh trudc la mao hit (crista obturatoria). canh ,-au la lu'dc xtfdng
mu (pecten ossis pubis). Ludc xu'dng mu noi tiep vdi du'dng cung va la ndi bam
cua nhieu day chang quan trong d vung ben nhu' liem hen (fa 1x mguinahs), day
chdng hong (ligamentum lacunare). day chdng lu'dc (ligamentum pectineale), day
chdng phan hoi (ligamentum reflexum).
Cii mu (tuberculum })ubicum) co day chang ben bam.

3.6. Bd sau: bd sau cung cd nhieu cho loi lom. tti tren xuon g dudi cd:
Gai chau sau tren (spina iliaca posterior superior).
Gai chau sau du’di (spina iliaca posterior inferior).
Khuyet ngoi ldn (mcisura ischiadica major).
Gai ngoi (spina ischiadica).
Khuyet ngoi be (incisura ischiadica minor).

U ngoi (tuber ischiadicum).

3.7. B o n g o c xtiOng c h a u
- Goc tru'dc tren: gai chau trudc tren.
- Goc tru'dc du'di: cu mu.
- Goc sau tren: gai chau sau tren.
- Goc sau dudi: u ngoi.

4. K H U N G C H A U H A Y C H A U H O N G (pelvis)

Khung chau la mot dai xtidng khep kin 6 phan dtidi cua than minh. tao nen
bdi sti tiep khdp gitia hai xuong chau 6 trudc, xtiOng cung va xuong cut 6 sau.
 X U O N G C H I D u 'd i [jlj 253

Chau hong dtfdc chia thanh hai phan bdi mot dtfdng vong that hep d giua goi la eo
tren hay Id md chau tren (apertura pelvis superior).
- Phan tren loe rong goi la chau hong to hay chau ldn.
- Phan dtfdi thu hep goi la chau hong be hay chau nho.
Gidi han dtfdi cua chau hong be goi la eo du’di hay 16 md chau du’di (apertura
pelvis inferior)

4.1. Chau hong to hay chau lofn (pelvis major)

Chau hong to dtfdc tao nen bdi ho canh chau cua xu'dng chau va hai phan ben
cua nen xUdng ctfng, cd hinh mieng pheu loe len tren, lam gia dd cho cac tang
trong o bung va cho bam cua cac cd thanh bung.

4.2. Lo mo! chau tren (apertura pelvis superior)

Lo md chau tron la ranh gidi gitfa chau hong to va chau hong be. dtfrtc gidi
han bdi hai ben la hai dtfdng cung cua hai xudng chau, phia sau la bd trudc non
xu'dng ciing; phia tru'dc la lu'dc xUdng mu. Lo nam tren mot mat phang chech
xudng du'di va ra tru'dc.

4.3. Kich thtf(Vc khung chau

Ngudi ta thudng danh gia kha nang de kho hay de cua ngudi phu mi bang cach
do mot so kich thu'dc co lien quail nhu' sau (Hinh 16.5).

Hinh 16.5. Cac dtfdng kinh cua khung chau (nhin tir tru’dc tren)

1. Du’dng kinh lien mao; 2. Du'dng kinh lien gai chau tru'dc tren; 3. Du'dng kinh lien mau chuyen to.
4 Du'dng kinh tru'dc sau lo md chau tren (eo tren); 5. D i/dng kinh ngang lo md chau tren; 6 Du'dng
kinh cheo lo md chau tren.
2 54 jjj, GIAI PH A U N G l/0 1 . T A P I

Mot so kich thudc chau hong to cua niir ( I Im h 1(i 'u

V ie t N am P hap
K ic h th u d c (c m ) | -- — _ r -
D o tre n x u d n g D o tre n n g u d i D o tre n ngudi

Du'dng kinh lien gai

22.63 23.51 24
(giua 2 gai chau trud c tren)
D udng kinh lien gai 25.52 25.54 27
..... .......... .... _ —
D udng kinh lien m au chuyen 25.52 25,60 31

Mot so kich thirdc lo md chau tren cua nOr (Hinh 1(>.'>)

Kich th u d c (cm ) V iet N am Phap

D uong kinh trudc - sau (go nhd - bd tren xuong mu) 11 11

I
D uong kinh trUOc - sau (go nho - bo duoi xuong mu) 12 12
D udng kinh trUOc sau (go nhd sau mu) 10,86 11.60
D udng kinh ngang chinh giua 11.7 12
-
D uong kinh ngang Ion nhat 11.98 13.6
- --

D udng kinh cheo 11.6 13

. — •» - — ....... - . . . ,~

* [C ac kich th uo c neu tren chi co tinh chat vi du. (de co 1 khai niem dai cuong) Thuc te ket
qua thong ke it nhieu thay doi theo dia diem va thdi gian nghien cuu, dieu kien dinh du'dng.
chung toe va gidi tinh ]

Hinh the va kich thudc cua chau hong giUa nam va nil co khac nhau. Non
dua vao do, ngudi ta cd the phan biet dUdc gidi tinh cua bo xuong (Hinh 16.6 A
va I?)

Hinh 16.6 Khung chau A. Nam; B. Nur.

1. C hau be; 2. Lo md chau tren; 3. Chau ldn
 XU O NG CHI DUOI

XUONG DUI
( Fein ur)

Xifdng dui la mot xifdng to. dai va nang nhat trong cO the. noi giua xu'dng chau
va xifdng cang chan.

1. D IN H H l/C lN G
Hau co chom khdp tron ldn trdn.
- Chom hifdng vao trong.
- Bd noi thanh gd day (difdng rap) cua than xifdng hudng ra sau.

2. MO T A
Xifdng dni gdm mot than dai va hai dau

A. Nhin mat trifdc B. Nhin mat sau;

1. Mau chuyen to. 2 Dudng gian mau; 3. Dien banh che; 4. Mom tren loi cau ngoai; 5 Loi cau ngoai;
6. Loi cau trong; 7. Mom tren loi cau trong; 8. Cu cd khep; 9. Dien khoeo; 10. Mau chuyen be; 11. Co
xifdng dui (cd giai phiu); 12. Chom; 13. Ho day chang chom dui; 14. Hd mau chuyen ldn; 15. Mao gian
mau; 16. U loi (loi cu) mong; 17. Difdng luoc; 18. Dudng rap
256 [ I GIAI P H A U NG U O I. T A P I

2.1. T h a n x u ’d n g
'Phan xudng hoi cong lom ra sau, co ba mat. ba bd.
- Mat trifdc: nhan. hoi loi. co co rong giua bam.
- Mat ngoai va mat trong: tron. co cd rong ngoai va rong trong cho phu.
- Bd trong va bd ngoai: tron khong ro net.
- Bd sau: loi. go ghe, goi la difdng rap (linea aspera), co nhieu cO bam. Dtfdng
rap co hai mep: mep ngoai (labium laterale) va mep trong (labium mediale). Gitia
hai mep co lo nuoi xUOng.
6 phi'a tren hai mep tach xa dan dudng rap che thanh 3 nhanh: mep ngoai di
den mau chuyen ldn trd thanh u loi mong (tuberositas glutea) cho cO mong ldn
bam; mep gitfa di den bo sau mau chuyen nho tao thanh difdng lifOe (linea
pectinea) cho cO luOc bam; mep trong vong ra trtfdc 6 dtfdi mau chuyen nho, la cho
bam cua cd rong trnng
() phia dudi dudng rap cung che doi thanh 2 du'dng tren lot cau trong va ngxu
(linea supracondyiaris medialis lateralis): cluong trong di tdi mom tren loi can
trong va cu cd khep. du'dng ngoai tdi mom tren loi cau ngoai. Giua hai duong tren
loi cau trong va ngoai la mot dien hinh tam giac. goi la dien khoeo <lac les popliteal.

2.2. D a u t r e n
Dau tren gom co chom xuong dui. cd xudng dui, mau chuyen Ion va mau
chuyen nho.
- Chom xifdng di/i (caput fermons): hinh hai phan ba khoi cau hudng Ion
tren, vao trong va hoi ra tru'dc. tiep khdp vdi o coi xu'dng chau. Gan giua chom co
hom chom xu'dng di/i (fovea capitis femoris) de day chd ng chom dui <ligamentum
capitis femoris) bam.
- Cd xu’dng dui (collum femoris): con goi la cd giai phau noi chom xudng dui vdi
hai mau chuyen: co co hinh ong hoi det tru'dc sau. hudng xuong dudi va ra ngoai.
dai 30 - 10mm. True cua co hop vdi true cua than xuong mot goc 1300. goc nay tao
dieu kien cho xu'dng de hoat dong quanh khdp hong, nhtfng lai lam xuong kem
vung chac. Do vav. dau tren xuong dui phai co cau true cac be xuong thich hop de
khac phuc diem yeu do va nang dd trong ludng cua ca than minh (Hinh 2 3).
- Mau chuyen ldn (trochanter major): la mot loi ldn noi len 0 ngoai goc gap
giua cd va than xtfdng dui: mat ngoai loi cd the sd thay dtfdc du'di da. Mat trong
nhd ra sau cd xtfdng, cd 1 hd lom sau, goi la ho mau chuyen (fossa trochantenca).
- Mau chuyen nho (trochanter minor): la mot mau loi 0 chd noi giua cd xudng
va mat sau trong than xuong; cd cO that ltfng chau bam tan (Hinh 16.7).
Noi giua mau chuyen ldn vdi mau chuyen be, phia trtfdc co dtfcfng gian mau
(linea intertrochanteriea), phia sau cd m ao gian mau (crista intertrochanterica).
 X U O N G CHI DLfOl 0 257

2.3. D a u d u ’di
Dau du’di xtfdng dui tiep khdp vdi xtfdng chay bdi hai loi cau.
- Loi cau trong (condylus medialis) tiep khdp vdi dien khdp tren trong cua
xtfdng chay, mat trong cd mom tren loi cau trong (epicondylus medialis) va phia
tren cd cu cd khep (tuberculum adductorium).
- Loi cau ngoai (condylus lateralis) tiep khdp vdi dien khdp tren ngoai cua
xtfdng chay, mat ngoai cd mom tren loi cau ngoai (epicondylus lateralis).
C) phia trtfdc hai loi cau lien tiep vdi nhau bdi dien banh che (facies patellaris),
hdi lom hinh rong roc, tiep khdp vdi mat sau xtfdng banh che.
Phia sau gitia hai loi cau cd ho gian loi cau (fossa intercondylaris).
Dac biet noi bat cua xtfdng dui la to, khoe, ehiu dtfdc stic ep 1500 kg theo true
doc cua xtfdng.

XtfONG BANH CHE

(P a te lla )

Xu'dng banh che d chi dudi cd chtfc nang ttfdng ttf nhtf mom khuyu d chi tren.
song lai la 1 xtfdng rdi. di dong, cd the trtfdt de dang tren khdp goi; mat khac cd
the coi xtfdng banh che la mot xtfdng vtfng ldn nhat nam trong gan cd ttf dau. lam
diem ttfa cai thien goc tdi cua gan cd bam vao u xtfdng chay, va tang life cho cd
nay. Xu'dng banh che cd hinh tam giac nam trtfdc dau xtfdng dui va khdp goi. cd
tac dung bao ve khdp gdi.

1. D IN H H l/O iN G

- Dau nhon xudng dtfdi.

- Mat cd dien khdp ra sau.
- Phan rong hdn cua dien khdp ra ngoai (Hinh 16.8).

2. M O T A

Xiidng banh che gdm cd hai mat, hai bd, mot nen va mot dinh.
- Mat trtfdc (facies anterior): loi, gd ghe, la ndi bam cua cd ttf dau.
- Mat sau: cd mot gd ngang d mot phan ttf dtfdi, chia mat sau thanh hai phan:
Phan tren la dien khdp (facies articularis), tiep khdp vdi dien banh che cua
xtfdng dui. O gitfa cd mot gd doc chia lam hai phan, phim ngoai rong hon phan trong.
Phan dtfdi lien quan vdi khoi md cua khdp goi.
- Hai bd: bd trong va bd ngoai.
- N e n xifdng banh che (basis patellae) d tren.
- Dinh xtfcfng banh che (apex patellae) d dtfdi.
17- GPN-T1
258 [jjj GIAI P H A U N G U O I. T A P I

A B
Hinh 16.8. Xuong banh che
A. Mat trtfdc; B. Mat sau.
1. Nen; 2. Mat trudc; 3. dinh; 4. Phan ngoai dien khdp; 5. Phan trong dien khdp 6 Go doc dien khdp

XtfONG CHAY
( T ibia)

Xu'dng chay la mot xudng dai (khoang 33.6cm), chac. va la xudng chinh d phia
trong cua cang chan, ehiu phan ldn sue nang cua cd the.

1. D I N H H l / d N G

- Dau nhd xuong dudi.

- Mfiu cua dau nho (mat ca trong) vao trong.
- Bd sac cong chu' S cua than xuong ra tru'dc.

2. M O T A

Xu'dng gdm mot than va hai dau.

2.1. T h a n x i i d n g (corpus tibiae)

Nhin tii trudc xiidng chay thang. nhin ngang xiidng hdi cong loi ra trudc. nhin
tu' tren xudng thay dau tron xu'dng hdi van vao trong.
Than xiidng hinh lang tru tam giac. cd ba mat. ba bd.
- Mat trong (facies medialis) phang. nam ngay dudi da.
- Mat ngoai (facies lateralis) lom. d diidi van ra trtfdc.
- Mat sau (facies posterior); d tren cd dtfdng cd dep (linea m. solei) chay chech
xudng dtfdi va vao trong. cd cd dep bam.
- Bd trtfdc (margo anterior) sac. nam ngay dtfdi da do dd de bi chan thtfdng
khi va cham manh. Phan tren loi thanh u loi (loi cu) xtfOng chay (tuberositas
tibiae) de gan hanh che bam.
 X U O N G CHI D I/O I {jXi| 259

- H<) ngoai hay hd gian cot (margo interosseus) sac, co mang gian cot bam, d
phia dtfdi bd nay Lach lam hai che 6m lay mot khuyet hinh tam giac goi la khuyet
mac (mcisura f'ibularis) khdp vdi dau dudi xtfdng mac.
- Bd trong (margo medialis) khong ro rang lam (Hinh 16.9).

Hinh 16.9. Xu'dng chay va xu'dng mac phai

A. Nhin mat tru'dc; B. Nhin mat sau.

1. Loi cau ngoai, 2. U loi xu'dng chay (loi cu chay); 3. Mat ngoai xu’dng mac 4 Mat ngoai xUdng
chay, 5. Mat trong xu'dng mac; 6. Mat ca ngoai; 7. Mat ca trong; 8 Mat trong xu'dng chay, 9. bd gic'n
cot xu'dng chay; 10. Bd tru’dc xu'dng chay; 11. Du'dng cd dep; 12. Loi cau trong 13. Cu gian loi cau
trong; 14. Ho mat ca ngoai; 15. Dau du’di xu’dng mac; 16. Mat ca thu" ba: 17. Mat sau xu'dng mac,
18. Mat ngoai xu’dng mac; 19. Dinh chom mac; 20. Cu gian loi cau ngoai.

2.2. D au tren

Dau tren be rong d 2 ben thanh hai lot cau la loi cau trong (condylus medialis)
va loi cau ngocii (condylus latteralis).
- Mat tren hai loi cau la mat khdp tren (facies articularis superior) tiep khdp
vdi hai loi cau xifdng dui, bdi hai dien khdp co hinh o chao; dien trong dai va lom
hdn dien ngoai.
260|[jD G I AI P H A U N G U O l . T A P I

Gluta hai dien khdp noi len mot loi gian loi cau (eminentia intercondylaris),
hai hen loi nho len hai cu gian loi cau trong va ngoai (tuberculum intercondylare
mediale, tuberculum intercondylare laterale). Trtfdc cac cu la dien gian loi cau
tru’dc (area intercondylaris anterior): sau cac cu la dien gian loi cau sau (area
intercondylaris posterior. Cac dien nay la cho bam cua cac dau trtfdc. dau sau cac
sun chem va cua cac day chang bat cheo trtfdc va sau.
- (3 mat sau hai loi cau cach xa nhau. Nhtfng 0 mat trtfdc hai loi cau noi lien
nhau bdi mot dien hinh tam giac co nhieu lo mach, dtfdi do noi len mot u loi (hay
loi cu) xiidng chay (tuberositas tibiae), cho day chang banh che bam.
- Dtfdi va sau mat ngoai loi cau ngoai co dien khdp mac (facies articularis
fibularis) tiep khdp vdi dau tren xtfOng mac.

2.3. D au dUofi
Dau dtfdi xtfdng chay nho hdn dau tren. hinh mot khoi vuong.
Mat dudi tiep khdp vdi rong roc xtfdng son. gidi han d trtfdc va sau mat khdp
deu eo gd, gd sau xuong thap hdn khong cho xtfOng sen lui ra sau. n<’-n eon dtfdc
goi la mat ca thtf ba.
- Mat trtfdc loi va trdn. co gan cua cac cd duoi ngdn chan ltfdt qua.
Mat sau cung loi. co ranh gan cd gap rieng ngdn chan cai.
Mat ngoai co khuyet mac (mcisura fibularis) la mat khdp vdi dau dudi
xtfdng mac.
- Mat trong co mot mom to xuong thap goi la mat cd trong (malleolus medialis).
Mat ngoai mat ca trong co mat khdp mat ca (facies articularis malleoli) tiep khdp
vdi mat trong rong roc xu'dng sen. phia sau eo cae ranh de gan cd cane chan sau
va gan cd gap chung ngdn chan ltfdt qua.

XtfONG MAC
(F ib u la )

XtiOng mac la mot xtfOng dai. manh. d ngoai cang chan, dau dtfdi det. nhon nhtf
mui mac.

1. D IN H H l/C iN G

- Dau det co hinh tam giac (mui mac) xuong dtidi.

- Mat khdp cua dau nay vao trong.
- Ranh cua dau nay ra sau.
 X l/O N G CHI DUOI 0 261

2. MO TA

2.1. T h an xu'dng
Than xUdng hinh lang tru tam giac, co ba mat. ba bd.
- Mat ngoai (facies lateralis): d tren hudng ra ngoai, d dtfdi htfdng hdi ra sau.
lam xtfdng co ve hdi xoan van.
- Mat trong (facies medialis) co mot mao thang goi la mao trong (crista medialis),
mao nay chia mat trong lam hai khu: khu trtfdc va sau.
- Mat sau (facies posterior) hdi loi, go ghe. de cac co khu cAng chan sau bam.
- Bd tri/dc (margo anterior) mong, s^c, d dtfdi lien tiep vdi bd trtfdc cua mat
ca ngoai.
- Bd sau (margo posterior) trdn, nhan ro d mot phan tu dtfdi, ba ph&n ttf tren
chay ra phia ngoai, vi vay co tac gia con goi bd nay la bd ngoai.
- Bd gian cot (margo interosseus) co mang gian cot bam.

2.2. Dau tren

Dau tren phinh to. goi la chom xu’dng mac (caput fibulae), mat trong co dien
khdp chom mac (facies articularis capitis fibulae) tiep khdp vdi xudng chay. Dinh
chom mac (apex capitis fibulae) go ghe, co gan co nhi dau dui bam.

2.3. Dau dtfdi

Dau dudi tam giac tao nen mat cd ngoai (malleolus lateralis), thap hdn mat
ca trong do 1cm.
- Mat trong cd dien khdp mat cd (facies articularis malleoli) tiep khdp mat
khdp mat ca ngoai cua xtfdng sen.
- Mat ngoai cd da phu.
- Mat sau cd ranh mat ca (sulcus malleolaris) cho gan co mac ludt qua.
- Nen d tren dinh lien vdi than xtfdng.
- Dinh d dudi, phia trong cd mot ho mat ca ngoai cho day chang mac sen bam.

CAC XtfONG BAN CHAN

(O ssa p e d is )

Cac xtfdng ban chan gom cd: 7 xtfdng cd chan. 5 xtfdng ban chan va 14 xtfdng
dot ngdn chan. Cac xtfdng nav lien ket vdi nhau rat chat.
PTiflfH] G I AI P H A U N G U O I . T A P I

1. CAC X U O N G CO C H A N (ossa tarsis)

Co 7 xifdng xep lam hai hang:

- Hang sau co 2 xUdng: xUdng sen va xifdng got.
- Hang trudc co 5 xifOng: xifdng ghe. xifdng hop va 3 xifdng chem (Hinh 16.10).

Hinh 16.10 Cac xiidng ban chan (m at mu chan)

1. Chom xu'dng ban chan I; 2. Than xiidng ban chan I. 3 Nen xiidng ban chan I. 4 Cac xtfdng chem
5. Xu'dng ghe (thuyen); 6 X iid n g sen; 7. X iidng got; 8 Xtfdng hop, 9. Xtfdng ban chan V 10 Dot
gan (I) ngon chan V; 11. Dot gitfa (II) ngon chan V; 12. Dot xa (III) ngon chan V

1.1. Xtfdng sen (talus)

Xudng sen hinh con sen. co 3 phan: chom xtfOng sen (caput tali), co xtfOng sen
(collum tali) va than xuOng sen (corpus tali).
 XlTONG CHI D lftil [jl| 263

Xtfdng sen nam gitfa xtfdng chay d tren, xtfdng got d duoi va 2 ben kep gitfa
hai mat ca nhu d trong mot cai mong.

A
B
Hinh 16.11. Xu’dng sen
A Mat tren B Mat du'di
1 Mom sau 2. Dien mat ca ngoai (dien mac), 3. Mom ngoai 4 Chom 5 Co. 6 Dien mat ca trong
(dien chay); 7 Rong roc sen; 8 Than. 9. Ranh sen (xoang co chan) 10 Co 11 Chom 12 Dien
khdp ghe; 13. Dien khdp got tru'dc, 14 Dien khdp got giiTa 15. Dien khdp got sau

Vc hinh dang: xtfdng sen dtfdc xem nhii hinh hop 6 mat:
Mat tren va hai mat ben tao nen mot rong roc sen (trochlea tali) tiep khdp vdi
xiidng chay va xtfdng mac bdi 3 mat khdp:
Mat tren (facies superior): trtfdc rong hon sau. tiep khdp vdi dau du'di xu'dng chay.
- Mat trong: co dien mat ca trong (facies malleolaris medialis).
- Mat ngoai: co dien mat ca ngoai (facies malleolaris lateralis), khdp vdi cac
mat ca tudng ling.
- Mat du'di: khdp vdi xtfdng got bdi ba dien khdp g ot trtfdc, giua va sau (facies
articularis calcanea anterior, media et posterior). O giua cac dien khdp got trudc,
gitia va sau cd ranh sen (sulcus tali).
- Mat tru’dc: nhd ra mot chom xtfdng sen (caput tali), noi vdi than bdi cd xtfdng
sen (collum tali).
Chom xtfdng sen cd dien khdp g h e (hay thuyen) (facies articularis navicularis)
tiep khdp vdi xtfdng ghe (hay xiidng thuyen) d trtfdc.
- Mat sau: hep, cd mom sau xtfdng sen (processus posterior tali), tan het bdi
2 cu trong va ngoai, ngan cach nhau bdi ranh gan cd g a p ddi ngon cai (sulcus
tendinis musculi flexoris hallucis longi).

1.2. X tfcfn g g o t (calcaneus)

Xtfdng got la xtfdng to nhat d co chan, nam 0 dtfdi xtfOng sen, sau xtfOng hop.
XtfOng cd 6 mat:
 IK ] G I AI P H A U N G U O I . T A P I

- M at tren gom hai phan (Hinh 16.12):

• Hai phan ba trtfdc mat tren, tiep khdp
vdi xtfdng sen bdi ba dien khdp:
Dien khdp sen sau (facies articularis
talaris posterior), ldn nhat loi cong ttf sau
ra trtfdc dd lay than xtfdng sen.
Dien khdp sen giiia (facies articularis talaris
media), nam tren mot mom loi d phia trtfdc
tren mat trong xtfdng got dd lay phan trong
co xtfdng sen, goi la mom dd xu’dng sen hay
chan de sen (sustentaculum tali).
Dien khdp sen trvtdc (facies articularis talaris
anterior), d tren trong dau trtfdc xtfdng got, Hinh 16.12. Xtfdng g6t. mat tren
lien tiep vdi dien khdp sen giua. (Theo G regoire va O berlin;
1. Dien khdp sen tru'dc 2 D e n khdp sen
() giua cac dien khdp sen trudc - gitfa va gitfa. 3. Mom dd xudng sen imom nho)
4 Mat sau u got (loi Cu on; 5 Than
sau co ranh got (sulcus calcanei). Ranh got xUdng got, 6 Dien khdp se^ sau 7 Ranh
hdp vdi ranh sen cua xtfOng sen thanh mot got (xoang co chan) 8 Mom trudc (mom
ldn), 9 Dien khdp hop
dudng ong goi la xuong co chan (sinus tarsis). ’ [Mot so ten goi cu Than (5) loi cu Ion
(4), mom ldn (8), mom nho (3 j la theo cac
• Mot phan ba sau mat tren lom. keo tac gia Phap cu, nay khong dung trong
dai tdi tan dau sau xudng got. T.A.1997],

- M a t ditdi: lom t\J trifdc ra sau; dau tan dphia sau loi len thanh u got (tuber
calcanei): u got co hai mom tron tua len mat dat (Hinh 16.14):
Mom trong u got (processus medialis tubens calcanei).
Mom ngocii u got (processus lateralis tubens calcanei).
Gan dau tan phia trtfdc mat dtfdi xtfdng got. cung co mot loi nho. goi la cu xMng
got (tuberculum calcanei).
- M at n g o a i: gan giua co mot loi nhe goi la rong roc mac (trochlea peronealis):
ngan cach gitfa cac gan cd mac ngan va mac dai; phia sau va dtfdi do la ranh gan
cd mac ddi (sulcus tendinis m. peronei longi) (Hinh 16.1313).
- M a t tr o n g : 15m sau thanh mot mang rong chech ra trtfdc va xuong dtfdi; 6
phia trtfdc tren nho ra mot mom dd xifcfng sen (hay chan de sen) (sustentaculum
tali), dtfdi mom chan de sen la ranh gan cd gap dai ngon cai (Hinh 16.13.A)

* [Phan lom ldn d mat trong xu’dng got duoc cac tac gia Phap goi la “gouttiere calcaneenne'. co
the tam dich la "mang got", de khoi lan vdi ranh got (sulcus calcanei) d giua cac dien khdp 6
mat tren xu'dng. Song trong thuat nguf GP quoc te khong co ten mang got. ma chi cd ten
ranh gan cd gaip dai ngdn cai (sulcus tendinis musculi flexoris hallucis longi). la 1 ranh hep
d du'di mom dd xu'dng sen].
 X U O N G CHI DUOI ‘m

H inh 16.13. Xu'dng sen va xu’d ng g o t

A. Nhin mat trong, B. Nhin mat ngoai
1 Dien mat ca trong, 2 Co xu'dng sen; 3. Dien khdp ghe, 4 Dien khdp got trade, 5 Dien khdp hop
6 Mang got (mat trong). 7 U got, 8, Ranh gan cd gap dai ngon cai, 9. Mom dd xu'dng sen, 10 Mom
sau xu'dng sen, 11. Mat tren rong roc xu'dng sen. 12. Dien mat ca ngoai, 13 Co xuong sen.
14. Xoang co chan, 15. Dien khdp hop; 16. Rong roc mac 17. Mat ngoai than xu'dng got (cu bam
cua day chang mac got).

- M at trtfd c: co mat khdp hop (facies articularis cuboidea) tiep khdp v6i
xtfdng hop.
- M at sa u : phan tren hep nhan, lien quan v6i tui hoat dich. gan got, phan
gitfa rong, go ghe co gan got bam, phan dtfdi loi thanh u gut (tuber calcanei).

* [“U g o t” d tfdc m ot so tac gia goi la “cu got", “loi c u ” , “loi cu ldn” , dtfa theo tieng Anh, Phap
cu goi la “T u b e ro sity, T uberosite, grosse tu b e ro site ” . C hung toi dich theo T.A. 1997: T uber
la u, T ub ercu lu m m di la cu],

1.3. X ufdng g h e , h a y x i f d n g t h u y e n (os naviculare)

* ["Navicula” tieng Latin co nghla la thuyen, tau nho. Trtfdc day, cd GS. Do Xuan Hop da
djch “Os scaphoideum" d cd tay la "xtfong thuyen”, nen de nghj djch “Os navicular" 6 co
chan la “xtfong ghe" de khoi lan vdi cd tay. Thtfc te 0 day chi co tinh quy tfdc, vi ve hinh
ttfong goi la thuyen hay ghe deu dtfoc ca],

XtfOng ghe nam gitfa stfOng sen va ba xtfOng chem (Hinh 16.10, 16.14). Co 6 mat:
- Mat sau: lom, khdp vdi xtfOng sen.
- Mat trtfdc: loi ra trtfdc, cd ba dien khdp, khdp vdi ba xtfOng chem.
- Mat tren: loi len tren.
- Mat dtfdi: go ghe.
- Mat trong: loi ra thanh u loi (hay loi cu) xtfOng ghe (tuberositas ossis
navicularis).
- Mat ngoai: khdp vdi xtfOng hop.
266jjjjj GIAI P H A U N G U O l. T A P I

1.4. B a xu ’d n g c h e m t r o n g , t r u n g g i a n (hay gitfa) v a n g o a i (os cuneiforme

modiale. intermedium et latcrale) (Hinh 16.10. 16.11).
X tfdng ch em tr o n g : hinh chem. nhon d tren. mat sau tiep khop vdi xtfdng
ghe. mat trtfdc vdi xtfdng (dot) ban chan thtf nhat. mat ngoai vdi xtfdng (dot) ban
chan nhi va xtfdng chem trung gian.
X iid ng ch em tr u n g g ia n hay chem gitfa: be nhat. mat sau tiep khdp vdi
xtfdng ghe, mat trtfdc vdi xtfdng (dot) ban chan nhi va hai ben vdi xtfdng chem trong
va ngoai.
- X u o n g ch em n g o a i: mat sau tiep khdp vdi xtfdng ghe, mat trtfdc vdi xtfdng
(dot) ban chan ba, mat trong tiep khdp vdi xtfdng chem trung gian va xtfdng (dot)
ban chan nhi, mat ngoai tiep khdp vdi xtfdng hop.

1.5. X ifdng h op (os cuboideum )

Xu'dng hop hinh khoi vuong nam giua xudng got va xtfdng ban chan IV. V. Co
6 mat:
Mat trtfdc: co hai mat khdp. tiep khdp vdi xudng dot ban chan bon va nam.
- Mat sau: co mat khdp hinh tam giac. nen d tren, dinh d dtfdi. tiep khdp vdi
xudng got.
-- Mat trong: co mat khdp hinh bau due. tiep khdp vdi xtfdng chem ngoai va
doi khi vdi xudng ghe.
- Mat ngoai: nho va hep. la canh hen ngoai cua ban chan.
- Mat tren: trong len tren. co co mu chan, day chang va da phu.
- Mat dtfo'i: mat gan chan d gitfa co mot u to goi la u loi (loi cu) xtfdng hop
(tuberositas ossis cuboidei), trtfdc u co ranh gan cd mac ddi (sulcus tendinis musculi
peronei longi).

2. C A C X U O N G B A N C H A N (h ay d ot b a n c h a n ) (O ssa m e ta ta rsi)

Co 5 xtfdng long ban chan, danh so ttf I —V, ke ttf trong ra ngoai.

* [Chu thich: C ac xtfong long ban tay. ban chan van quen dtfdc goi (theo co GS Do Xu2n
Hop) la cac xtfong dot ban tay, dot ban chan. Song theo chung toi, cac ngon tay, ngon chan
moi ngon co 3 dot (hoac 2 dot cho ngon cai) nen mdi co cac xtfong dot ngon ttfong tfng.
Con long ban chan ban tay khong chia thanh dot nen chi goi lei cac xuong ban chSn, ban
tay I, II, III. IV, V; ma khong phai la “dot" ban chan, ban tay).

2.1. D a c d iem c h u n g

Cac xuong long ban chan thuoc loai xtfOng dai, moi xtfong co: 1 nen (basis),
1 than (corpus) va 1 chom (caput).
 X L f O N G C H I DL/Ol gj, 267

- Nen thtfdng co ba mat khdp: mot 6 gitfa de tiep khdp vdi xtfdng co chan, hai
d ben tiep vdi xtfdng ban chan ben canh.
Than xtfdng: cong len tren. hdi xoan, hinh tam giac, co mot mat tren va hai
miit hen.
- Chom: loi tiep khdp vdi xtfdng dot I ngon chan, hai ben cd hai mau nhd de
day chang bam.

2.2. D ac d iem rien g

- Xudng ban chan thtf nhat: nen chi cd 2 mat khdp, d sau vdi xtfdng chem trong.
d ngoai vdi xtfdng ban chan II, va d dtfdi cd mot mom de cd mac ben dai bam.
- Xtfdng ban chan nhi: la xtfdng dai nhat trong 5 xtfdng (dot) ban chan, tiep khdp
d sau vdi xUdng chem trung gian va d hai ben vdi xtfdng (dot) ban chan nhat va ba.
- Xtfdng ban chan ba: d sau tiep khdp vdi xtfdng chem ngoai, hai ben tiep khdp
vdi xu'dng (dot) ban chan hai va bon.
Xtfdng ban chan bon: co hai mat khdp, tiep khdp vdi xudng chem ngoai va
xu'dng hop.
Xu'dng ban chan nam: nen tiep khdp vdi xudng hop va co mot mom de co
mac ngan bam.

3. CAC X l /d N G D O T N G O N C H A N (ossa digitorum pedis)

Moi ngdn chan cd ba dot: gan, gitfa va xa (phalanx proximalis. media et distalis),
tiu ngdn cai chi cd hai.
Nhin chung giong xtfdng dot ngdn tay, nhtfng be va ngan hon, trtf xtfdng dot
ngon chan cai to hon (Hinh 16.14).

4. NHiN CH UNG VE CAU TAO V A CHUC N AN G CAC X l/d N G BAN CH A n

Cau tao xu'dng ban chan phu hop vdi hai ehtfc nang:
- Nang dd trong ltfdng cO the.
- Van chuyen.

Ung vdi hai chtfc nang nay cd the chia ban chan lam hai ntfa theo true doc
(tiep giap khac nhau vdi mat dat).

4.1. Niia n goa i b a n ch an

Ntfa ngoai gom cac xtfong ban chan IV, V, xtfong hop va mot phan xtfOng got.
Khi ta dting yen mot cho thi cac xtfOng cua ntfa ngoai nam tren mot mat phang,
ttfa len mat dat va de lai tren dat mot vet cong lien tuc lom vao trong. Nhtf vay
ntfa ngoai ban chan cd tac dung nhtf mot chan de ldn.
268 [jj GIA I P H A U N G lfO l. T A P I

H inh 16.14. Cac xu'dng ban chan (mat gan chan)

1. Ranh gan cd m ac dai, 2. Xu'dng hop: 3, Cu xtfdng got; 4. Mom ngoai u got 5 Mom
trong u got, 6. Mang got; 7. Xtfdng sen; 8. Xtfdng ghe (thuyen); 9. Ba xtfdng chem

4.2. Ntia tro n g b a n ch a n

Cac xu'dng tao thanh mot vom, mat loi hudng len tren, chi ttfa xuong mat dat
6 hai ndi la u got va cac chom xu'dng (dot) ban chan. Cac xtfOng cdn lai khong tiia
xuong mat dat ma cong thanh vom goi la cung doc phan trong ban chan (arcus
pedis longitudinalis pars medialis). Dinh cung ting vdi xtfOng sen. Cac phan khac
cua cung la mot phan xtfOng got, xtfdng ghe, cac xtfdng chem va phan ldn cac
xtfdng (dot) ban chan, trtf phan chom.
Do cau tao nhtf vay nen ntfa trong ban chan rat dan hoi nhtf mot lo xo, deo,
chac, co tac dung rat ldn den viec van chuyen.
Khi ta dtfng, gitf dtfdc thang bang la nhd;
- Thang bang ben: de hai m&t ca kep xtfdng sen 6 gitfa nhtf cai mong. khong
cho xu'dng sen tree ra ngoai hay vao trong.
- Thang bang trtfdc - sau: do m&t ca sau cua xtfdng chay ngan khong cho
xtfOng sen trtfOt ra sau.
 K H O P CHI D l / d l K rE E l

17. KHOP CHI Dlfdl

(.Juncturae membri inferioris)

Cac khdp hay lien ket xiidng chi difdi gom cac khdp cua dai chau va cac khdp
chi difdi tif do.

CAC KHdP CUA DAI CHAU ■

(Juncturae cinguli pelvici)

1. K H d P C U N G C H A U (articulatio sacro - iliaca)

Khdp cung chau la khdp gitfa dien nhi (facies auricularis) cua xifdng cung vdi
dien nhi cua xifdng chau.
Cdc m at kh d p: deu thuoc dang khdp phang va phu bdi sun sdi.
Hao kh dp: bam xung quanh bd cac mat khdp. va cang chat.

Hinh 17.1. Cac day c h ln g cua cac khdp dai chau (nhin tru'dc)
1. Day chang chau that lung trudc; 2. Day chang cung chau trudc; 3. Day chang cung gai.
4. Day chang cung u.

Cdc day chdng: chac, khde co d ca cac mat tru'dc sau cua khdp, va d xa khdp:
- Day chang cung - chau trtfdc (ligamentum sacrc —iliacum anterius).
270jjjj! G I AI P H A U N G U O l . T A P I

- Day chang cung - chau sau (ligamentum sacro - lliacum posterius).

- Day ch^ng chau that ltfng (ligamentum ilio - lumbale).
- Day chang cung - u (ligamentum sacrotuberale).
- Day ch^ng cung - gai (ligamentum sacrospinale) (Hinh 17. 1)-
l lai day chang cung - u va cung - gai khep kin cac khuyet ngoi ldn va nho tao
thanh 16 ngoi ldn (foramen ischiadicum majus) va lo ngoi nho (foramen ischiadicum
minus) (Hinh 17.2, 17.3).

Hinh 17.2. Cac day c h ln g cua cac khdp dai chau (nhin sau)
1. Khdp dinh mu; 2. Day chang cung u; 3. Day chang cung gai; 4. Day chang cung
chau sau; 5. Day chang chau that lung sau.

2. KHOiP D IN H M U (symphysis pubica)

Khdp dinh mu thuoc loai khdp sun sdi. la khdp giufa hai dien kh(fp dinh (facies
symphisialis) cua hai xtfdng mu. Hai mat khdp co phu sun trong 6 gitfa co dici gian
mu (discus interpubicus) la mot dia sun sdi (Hinh 17.2). Dia khdp dinh vdi hai mat
khdp cua 2 xtfdng mu. 0 gitfa dia co 1 o nhan mem, nam theo chieu dtfng doc.
C dc d a y c h d n g :
- D a y chdng mu tren (ligamentum pubicum superius).
- Day chang mu dtfdi (ligamentum pubicum inferius), trtfdc day con goi la day
chang cung mu (ligamentum arcuatum pubis).
Khdp mu co the co gian do ltfc nen va ltfc keo nen co nhieu tac dung trong viec
sinh de cua ntf.
 K H O P CHI DUOI |g| 271

3. KHCfP D A Y C H A N G C U A D A I C H A U (syndesmoses cinguli pelvici)

Ngoai 2 khdp da ke con co mot dang lien ket day chang la: m a n g bit (membrana
obturatoria), day va chac, day d mat ngoai lo bit. Mang bit gidi han cung ranh bit
d dtfdi nganh tren xifdng mu mot ong bit (canalis obturatorius) cho cac mach than
kinh bit di qua (Hinh 17.3).

9
10

Hinh 17.3. Cac day chang cua cua cac khdp dai chau (nhin trong)
(Theo Sinelm kov R.D, Atlas of Human Anatom y, Moskow. 2003, Fig 220, p 226)
1. Lo gian dot song. 2. Day chang vang: 3. Go nho; 4. Day chang cung chau trudc 5 Ong bit
6 Day chang mu tren, 7. Dia gian mu; 8. Day chang mu du'di (cung mu); 9 Mang bit 10 Mom liem
(cua day chang cung u). 11. Lo ngoi nho; 12. Lo ngoi ldn, 13 Day chang cung u 14 Day ch^ng
cung gai; 15. Ong cung; 16. Day chang tren gai (song); 17. Day c h in g gian gai
2721 0 GI AI p h A u N G U O l . t A p I

CAC k h O p CHI D tfO l T t f d o

(A r tic u la tio n e s m em b ri in fe r io r is lib e r i)

1. K H O P H O N G (articulatio coxae)
Khdp hong la khdp chom cau ldn nhat cO the, tiep noi xufOng dtfi v6i chau
hong. Khdp hong nSm sau 6 giufa ben va mong, co nhieu co che phu nen kho
phau thuat.

1.1. M at khdp

1.1.1. C hom xitd n g d u i (caput femoris)

Chiem hai phan ba hinh cau. G&n dinh chom co mot ho nho la ho chom dui
(fovea capitis femoris) de day chang chom dui bam. Chom dinh vao dau tren xtfdng
dui bdi co xtfdng dui (collum femoris), con goi la cb khdp.

1.1.2. () co i (acetabulum)
La mot o lom ldn d mat ngoai xtfdng chau, do ba phan cua xtfdng chau tao
thanh: canh chau, xuong mu va xudng ngoi; ltfc phoi thai gitfa ba phan co sun
hinh chtf Y. Phan tiep khdp vdi chom dui goi la dien nguyet (facies lunata). phan
lom con lai la ho o coi (fossa acetabuli) chtfa to chtfc md. Bd xtfdng d quanh 6 coi
nho Ion thanh vien o coi (limbus acetabuli) phia dtfdi vien co khuyet 6 coi (mcisura
acetabuli).

1.1.3. S un vien o c o i (labrum acetabulare)

La mot vong sun sOi bam vao vien o coi lam sau them o coi de om lay chom
dui. Phan sun vien vat ngang qua khuyet o coi goi la day chang ngang 6 coi
(ligamentum transversum acetabuli).

1.2. Phtfdng tien noi khdp

1.2.1. B a o kh d p (capsula articularis) gom 2 ldp:

- M ang xd hay bao xd: la mot bao sdi day, chac, boc quanh khdp va bam
(Hinh 17.3):
• Ve phia xtfdng chau: vao chu vi o coi va mat ngoai sun vien o coi.
• Ve phia xtfOng dui: d trtfdc vao dtfdng gian mau, 0 sau vao hai phan ba
trong co xtfOng dtfi, de hd mot phan ba ngoai: nen gay co xtfOng dui co the d trong
bao d phia trtfdc, va ngoai bao d phia sau.
- M ang hoat dich hay bao hoat dich (bursa svnovalis): la mot mang mong
phu mat trong bao xo' gom hai phan:
 K H O P C H I D u'di LV. r m

• Phan chinh: di ttf cho bam cua bao xd 6 quanh sun vien o coi. lot mat trong
bao xd. roi quat Ion toi chom xtfOng dui de dinh vao quanh sun hoc chom dui.
• Phan phu: hoc quanh day chang chom din. bam vao chu vi ho chom din va
ho o coi cua 2 xtfdng.
Nhtf vay day chang chom din d trong bao khdp nhtfng ngoai bao hoat dich.
Trong bao hoat dich chtfa chat nhdn gitfp cho khdp hoat dong de dang.

1.2.2. Cdc d a y c h d n g
Co hai loai:
- Cdc day chdng ngoai bao khdp: do bao khdp day len tao thanh, gom ba day
ch^ng (Hinh 17.4).

H inh 17.4. K h d p chau d u i (mat tru'dc)

1. Cd mong be; 2. Cd rong ngoai; 3. Gan cd that liing chau; 4. Mang bit. 5 Day chang mu dui,
6 Dai du'di mu; 7. Ong bit (ong du'di mu); 8. Day chang chau dui (bo chau trudc mau chuyen be).
9. Day chang chau dui (bo chau tru'dc mau chuyen to); 10. Gan cd thang dui.

• Day chdng chciu dui (ligamentum iliofemorale): di ttf gai chau trudc dtfdi. tdi
du'dng gian mau: day toa hinh tam giac, cac thd sdi day len d hai bd; nen eo tac gia
ta nhtf hai bo bam vao mau chuyen to va mau chuyen be.
• Day chdng mu di/i (ligamentum pubofemorale): dau tren bam vao nganh tren
xuong mu, dau dtfdi bam vao ho trtfdc mau chuyen be.
Day chang mu dui va hai bo cua day chang chau din hop thanh mot hinh chu Z.
Gitfa cac bd co cac khe hd, qua do bao thanh mac cua cO that lung chau cd the
thong vdi bao khdp.
1 8 -G P N -T i
274 U ) GIAI P H A U N G U O l. T A P I

• Day chdng ngoi dui (ligamentum ischiofemorale): d mat sau. di tir xiidng ngoi
tdi mau chuyen to.
• Dai vong (zona orbicularis): la nhiing sdi 0 ldp sau cua day chang ngoi dui,
vong quanh mat sau co xifdng din, nhif mot thifng quan quanh co xifdng dui.

H inh 17.4’. K h d p chau d u i (mat sau)

1. Lo ngoi ldn. 2 Day chang cung gai; 3. L6 ngoi be, 4, Day chang cung u, 5 Mom hem cua day
chang cung u 6 Dai vong; 7 Day chang ngoi dui; 8. Gan cd th in g dui (thuoc cd tu dau dui).

2
1

Hinh 17.5. Day ch&ng chom dui

1. Bo mu; 2 Bo giufa; 3. Bo ngoi; 4. Ho o coi; 5. Dien nguyet; 6. Sun vien o coi; 7. Day
chang chom dui; 8. Co xtfdng dui; 9. Chom cau xtfong dui.
 K H O P CHI D UO I (>JI| 275

- Day chdng trong hao khdp: nam trong o khdp va dude hoc bdi mang hoat dich,
la day chang chom dui (ligamentum capitis femoris) di ttf hom chom xu'dng dui
(fovea capitis femoris), vong xuong khuyet o coi, chia lam ba bo bam vao day chang
ngang va 2 ben khuyet o coi, cu the (Hinh 17.5):
- Bo mu bam vao xtfOng mu.
- Bo ngoi bam vao xtfdng ngoi.
- Bo gitfa bam vao day chang ngang.
Day chang nay co tac dung buoc chom xtfdng dui vao o coi va mang mach mau
tdi nuoi chom xtfdng dui.

1.3. D on g tac
Khdp hong co nhieu dong tac rong rai.
- Gap, duoi dui theo true ngang di ttf chom tdi bd tron man chuyen to.
- Khep va giang theo true trtfdc sau.
-- Xoay ra ngoai, xoay vao trong va xoav vong.

2. K H d P G O I (a rticu la tio genus)

Khdp goi la mot khdp phtfc hdp, co bao hoat dich rat rong, de bi sung va phong
to, lai d n6ng nen de bi va cham va ton thtfOng.
Khdp goi gdm 3 khdp thong nhau:
- Gitfa xtfdng din va xudng chay (la 2 khdp loi cau).
- Gitfa xu'dng dtfi va xu'dng banh che (la 1 khdp rong roc).

Ve mat chtfc nang no hoat dong nhtf 1 khdp ban le (ginglymus), song cung cho
phep xoay cang chan mot chtft, dac biet khi d ttf the gap goi.

2.1. M at khdp

2.1.1. D a u du di x tfd n g d u i
Dau dtfdi xu'dng dtfi cd hai mat khdp loi goi la loi cau trong va loi cau ngoai
khdp vdi 2 dien lom d mat khdp tren cua dau tren xtfdng chay; loi cau trong hep
hdn nhtfng dai hdn loi cau ngoai.

- 0 trtfdc: hai loi cau dfnh lien nhau tao thanh hai ma cua mot rong roc. htfdng
ra trtfdc goi la dien banh che (facies patellaris), khdp vdi xtfdng banh che

- 0 sau: hai loi cau tach xa nhau bdi ho gian loi cau (fossa intercondylaris).

2.1.2. D a u tr e n x tfd n g c h a y
Dau tren xtfdng chav cung loe rong thanh 2 loi cau de dd lay xtfdng din b^ng
hai dien 15m d m at khdp tren cua no (facies articularis superior). Dien ngoai rong
276 [>Ij
LillJ
GIAI PHAU NGLfOl. TAP I

va nong hon dien trong. O gitfa hai dien khdp co loi gian loi cau (eminentia
intercondylaris), chia khoang giua hai dien khdp thanh dien gian loi cau tri/dc va
dien gian loi cau sau.

2.1.3. Sun ch em (meniscus)

Co 2 sun chem nAm d tren phan chu vi 2 dien khdp tren cua 2 loi cau xtfdng
chay, lam cho 2 dien khdp nay sau them va rong them de khdp vdi 2 loi cau xtfdng
dtfi, sun chem ngoai (meniscus lateralis) hinh chtf O, sun chem trong (meniscus
medialis) hinh chtf C. Hai sun dinh vao xtfOng chav doc theo bd ngoai cac loi cau
xudng chay, va bdi cac dau tan trtfdc va sau cua chtfng: cac stfng trtfdc bam vao
dien gian loi cau trudc va cdc sifng sau vao dien gian loi cau sau. Hai bd trtfdc cua
2 sun chem lai dtfdc noi vdi nhau bdi day chdng ngang goi (ligamentum transversum
genus). Sun chem ngoai dinh long leo hdn vao xtfdng chay, nen co the trtfdt ra sau
khi ta duoi va ra trudc khi ta gap cang chan. Sun chem trong dinh chac hon. Neu
tac dong qua manh va dot ngot sun chem co the bi bong hoac rach va tro thanh
chtfdng ngai vat chen 0 giua khdp (Hinh 17.6).

2.1.4. X ifd n g hc'tnh c h e

Mat sau xtfdng banh che tiep khdp vdi rong roc xtfdng dui. Dinh xudng banh
che la moc de xac dinh khe khdp gitfa xtfdng dui va xtfdng chay.

Hinh 17.6. Cac sun chem khdp goi

1. Sun chem ngoai. 2. Sun chem trong.

 K H O P C H I DLf Ol [ii1277

2.2. Phu’dng tien noi khdp

2.2.1. B a o khdp
Mang x(f hay bao xd: bao quanh khdp. khong the tach rdi cac day chang d
xung quanh.
- Ve phia xifdng diii: bam vao mot difdng vien uon lifdn d tren dien rong roc,
tren hai loi cau va ho' gian loi cfiu.
- Ve phia xifdng chay: bam vao xung quanh 2 loi cau xifdng chav d phia du'di
hai dien khdp.
- () phia trudc bam vao cac bd cua xu’dng banh che.
- 0 giiia xifdng din va xifdng cKay: bao dinh vao sun chem, nen chia khdp lam
hai tang:
Tang tren sun chem rat rong
Tang dudi sun chem hep
Kin bi cham thudng manh sun chem cd the bong khoi xudng chaw chit mach
nuoi dudng va trd thanh chu'dng ngai vat d khdp gdi.
- Mang hay bao hoat dich: phu mat trong bao xd, nhtfng rat phuc tap.
- 0 tren bam vao quanh dien khdp xudng din; d dudi bam vao dien khdp xudng
chay, va d gitfa vao sun chem, chia d khdp thanh 2 tang, tren va du'di sun chem.

() sau, bao hoat dich phu trtfdc day chang bat cheo. nen tuy lach d gitfa khdp
nhung day chang lai d ngoai bao hoat dich.

- O trtfdc, bao hoat dich nhd len cao tao thanh mot tui cung hoat dich tren
hanh che, gitfa gan cd ttf dau va xtfdng din, cd the len cao tdi 8 - 10 cm tru'dc
xu'dng dtfi.

2.2.2. C ac d a y c h a n g
Khdp goi co nam he thong day chang.
- Cdc day chdng ben:
• Day chdng ben chay (ligamentum collaterale tibiale) di ttf cu tren loi cau
trong xu'dng din xudng dudi va ra trtfdc de bam vao mat trong dau tren xtfdng
chay (Hinh 17.7).
• Day chdng ben mac (ligamentum collaterale fibular) di chech ttf cu tren loi cau
ngoai xtfdng din xudng dtfdi va ra sau de bam vao chom xu'dng mac (Hinh 17.8).
- Cdc day chdng tru’dc:
• Day chdng banh che (ligamentum patellae).
- Mac ham banh che trong (retinaculum patellae mediale).
- Mac ham banh che ngoai (retinaculum patellae laterale).
Ngoai ra cdn gan cO ttf dau dui, co may, cO cang mac dtfi tang cudng.
278|{jU G I AI P H A U N G U O I . T A P I

- Cdc day chdng sau:

• Day chdng khoeo cheo (ligamentum
popliteum obliquum) la mot che quat
ngtfdc cua gan cd ban mac, di ttf trong
ra ngoai ttf dtfdi len tren, roi bam vao
vo loi cau ngoai xtfdng dtfi.
•Day chdng khoeo cung (ligamentum
popliteum arcuatum) di ttf chom xtfdng
mac toa thanh hai bo bam vao xtfOng
chay va xtfdng dtfi, tao thanh mot v&nh
cung co cd khoeo chui qua (Hinh 17.9).
- Cdc day chdng bat cheo d trong
hd gian loi can:
•Day chdng fxit cheo truW (ligamentum
cruciatum antenus) di tu mat trong H inh 17.7. K h d p g o i (day chang ben chay)
1 Gan cd tu1 dau dui 2 Mac ham banh che
loi cau ngoai xudng dui tdi dien gian
trong 3. Day chang ben chay 4 Day chang
loi cau trtfdc xtfdng chay. banh che.

Hinh 17.8. Khdp gdi

1. Day ch^ng ben mac.
 K H O P C H I D lfO l 0| 279

1. Gan cd ban mac. 2. Cd khoeo, 3. Day chang khoeo cung, 4 Bo trong day chang
khoeo cung; 5. Bo ngoai day chang khoeo cung; 6 Day chang khoeo cheo

• Day chdng hat cheo sau (ligamentum cruciatum posterius) di tu mat ngoai
loi cau trong xu’dng dui tdi dien gian loi cau sau xiiOng chay (Hinh 17.10).

Hinh 17.10. Khdp goi (cac day chang bat cheo)

1 Day chang bat cheo sau; 2. Day chang bat cheo tru'dc.
280 0 G I AI P H A U N G U O I . T A P I

Hai day chang nay bat cheo nhau thanh hinh chtf X. day trudc o phia ngoai,
day sau d phia trong. Hai day chang cheo rat chac gitf cho khdp goi khong trat
theo chieu trtfdc sau.
- Cdc day chdng sun chem :
• D ay chdng ngang goi (lig. transversum genus) noi hai bd trtfdc loi cua hai
sun chem vdi nhau.
• Day chdng chem dui trifdc (ligamentum meniscofemorale anterius) la mot so
sdi cua day chSng'bM cheo trtfdc, di ttf loi cau ngoai cua xtfdng dtfi den bam vao
stfng trtfdc cua sun chem trong.
• D ay chdng chem dui sau (ligamentum meniscofemorale posterius) la mot so
sdi sau cua day chhng bat cheo sau di ttf loi cau trong xtfdng dtfi tdi dau sau sun
chem ngoai.

2.3. D o n g tac
- Gap va duoi rang chan fthoo true ngnng).
- Xoav vao trong. xoay ra ngoai rat it (quanh true dung thantri

3. CAC K H d P c h A y m A c

Cac khdp hay lien ket gitfa 2 xudng chay va mac gom 3 phan:
- Khdp hoat dich chay mac (hay khdp chav mac tren) gitfa cac dau tren hai
xu'dng, la mot khdp hoat dich nho.
- Lien ket day chang gitfa hai than xu'dng noi vdi nhau bdi mang gian cot.
- Khdp dinh sdi chav mac: gitfa hai dau duoi cua hai xtfdng.

3.1. K hdp hoat d ich ch ay m ac (articulatio tibiofibularis)

Khdp hoat dich chay mac (hay khdp chay mac tren) la mot khop phang giua
mat khdp d mat trong chom mac vdi mat khdp mac d phia dtfdi mat sau ngoai loi
cau ngoai xtfong chay.
- Bao khdp: bam quanh dien khdp cua xudng mac va xtfdng chay. Bao khdp
day len tao thanh cac day chdng chom mac sau (ligamentum capitis fibulae jxjstenus)
va chom m ac trifdc (lig. capitis fibulae anterius).

3.2. M a n g gian cot ca n g ch a n

La mot dang lien ket day chang (hay khdp dinh sdi), noi gitfa cac bo gian cot
cua xtfdng chay va xtfdng mac.

3.3. Khcfp d in h scfi c h a y - m a c (syndesmosis tibiofibularis)

Khdp dinh sOi chay - mac (hay khdp chay mac dtfdi) la khdp lien ket gitfa mat
trong mat ca ngoai va khuyet mac 0 phia ngoai dau dtfdi xtfong chay. Hai dien
nay dtfOc gan chat che vdi nhau bdi:
 KHCfP C H I D l / d l gji 281

- D ay chdng chay - mac tru’dc (ligamentum tibiofibulare anterius).

- Day chdng chay - m ac sau (ligamentum tibiofibulare posterius).
Cac khdp nay rat l't hoat dong.

4. KHOiP G A P CO C H A N H A Y KHClP S E N C A iN G C h A n (articulation

talocruralis)
Khdp sen cang chan la khdp lien ket gitfa xUOng sen vdi dau du'di cac xu'Ong
chang chan.

4.1. Dien khdp

4.1.1. T han xiid n g s en

Co rong roc xu’dng sen (trochlea tali) tao nen bdi ba dien khdp:
- Dien tren.
Dien mat ca trong.
Dien mat ca ngoai.

4.1.2. D au du’di c d c xu ’d n g c a n g ch a n co
Dien khdp du'di xudng chay (facies articularis inferior) tiep khdp vdi then
tren cua rong roc xuo ng sen.
- Dien khdp mat ca trong (facies articularis malleoli medialis) d mat ngoai
mat ca trong xuong chay tiep khdp vdi dien mat ca trong cua xu'dng sen.
Dien khdp mat ca ngoai d mat trong mat ca ngoai xUdng mac tiep khdp vdi
dien mat ca ngoai ciia xudng sen.

4.2. Phu’dng tien noi khdp

B a o kh d p bam vao chu vi cac dien khdp. Bao xd bam cach xa sun khdp. va
d phia trudc bam vao co xu'dng sen. Bao yeu d phan trudc va sau. song o hai ben
day len thanh cac day chang.
- C dc d a y c h d n g gom co:
+ Cdc day chdng ben ngoai (lig. c o lla te r a ls laterales):
Day chdng m ac sen triidc (ligamentum talofibulare anterius).

Day chdng mac sen sau (ligamentum talofibulare posterius).

Day chdng mac got (ligamentum calcaneofibulare).
+ Cdc day chdng ben trong (ligamentum c o lla te r a ls mediales) con goi la day
chang delta (lig. deltoideum), gom 4 phan:
Phan chay - gh e (pars tibionavicularis) di tu xu'dng chay tdi xudng ghe.
Phan chdy —got (pars tibiocalcanea) di tu' xtfdng chay tdi xudng got.
282 |[jj|] G I A I P H A U NGUC5I. T A P I

Phan chay sen trade (pars tibiotalaris anterior) di tti xtfdng chay tdi phia trtfdc
xtfdng sen (Hinh 17.12).
Phan chay sen sau (pars tibiotalaris posterior) di ttf xtfdng chay den phia sau
xtfdng sen.

Hinh 17.11. Cac day ch^ng khdp co chan va khdp sen cang chan (mat ngoai)
1 Day chang chay m ac sau; 2 Day chang mac sen sau. 3. Day chang m ac got. 4 Day chang gian
cot sen got; 5. Day chang sen got ben, 6. Day chang mac sen trtfdc; 7. Day chang chay mac tri/dc.

Hinh 17.12. Cac day c h in g khdp co chan

(Khdp sen cin g chan nhin mat trong).
1 Day chang ghe got; 2. Day ch^ng sen got trong; 3. Day chang chay-ghe; 4. Day chang chay - got.
5 Day chang chay sen sau; 6. Day chang chay sen trtfdc.

4.3. D o n g tac

Gap va duoi ban chan 6 co chan.

 K H O P CHI D i r d l 283

CAC KHCSP CUA BAN CHAN

(A r tic u la tio n e s p e d is )

1. CAC KHCfP G IA N C O T CO C H A N (articulationes intertarseae)

Cac khdp gian cot co chan la cac khdp noi cac xiidng co chan vdi nhau.

1.1. Khdp dUdi sen (articulatio subtalaris) hay khdp sen g o t (articulatio talo
calcanea): la khdp giufa dien khdp lom rong d mat diidi than xu’dng sen vdi dien
khdp sau loi d mat tren xiidng got.
Bao khdp mong ndi gitia cac bd cua cac dien khdp dtidc tang ciidng bdi 3 day
chdng sen got trong, ngoai va sau (lig. talo calcaneum mediale, laterale, posterius).

1.2. K h d p s e n - g o t - g h e (articulatio talocalcaneo navicularis).

Khdp sen - got - ghe lien ket ba xu’dng vdi nhau, thuoc loai khdp chom.
Chom xu'dng sen tiep vdi o chao xiidng ghe. dien khdp tru'dc tren xu'dng got khdp
vdi phia sau trong xudng ghe.

1.3. Khdp got - h op (articulario calcaneocuboidea).

Khdp got hop la khdp hinh yen ngiia; dien khdp xtfdng got lom lap vao dien
khdp xu'dng hop loi yen ngtfa.
[Cac khdp sen ghe va got hop, tao thanh 1 dtfdng khdp khong deu ngang qua
co chan dtfOc goi chung la khdp ngang co chan (Articulatio tarsitransversa).

1.4. Khdp ch em - gh e (articulatio cuneonavicularis).

Ba dau sau ciia ba xtfdng chem khdp vdi mat trtfdc xtfdng ghe.
1.5. Cac khdp gia n c h e m (articulationes intercuneiformes).
La cac khdp do mat ben cac xtfdng chem khdp vdi nhau.
* [Cac khdp chem ghe, gian chem va chem hop hop thanh nhom cac khdp gian co chan xa,
co chung m ot o khdp bao quanh bdi m ot bao khdp chung],

1.6. Cac d a y c h a n g cu a ca c k h d p g ia n co t co ch a n , (ngoai khdp sen da

neu), gom cd:
* Cdc day chang mu co chan (ligamenta tarsi dorsalia):
- Day chang che doi (ligamentum bifurcatum): gom day chang got - hop (ligamentum
calcaneocuboideum) va day chang got - ghe (ligamentum calcaneonaviculare), di ttf
xtfdng got den xtfdng hop va xtfdng ghe.
- Day chang hop ghe mu chan (ligamentum cuboideonaviculare dorsale)
(Hinh 17.13).
284 | 0 g ia i PHAU NGUdl. TAP I

H inh 17.13. Cac day c h in g cua cac k h d p ban c h a n (phia mu cham

1. Cac day chang mu co chan - ban chan. 2 Cac day chang lien chem mu chan 3 Cac day chang
ghe - chem mu chan. 4 Day chang sen ghe mu chan 5. Day chang got ghe (d a / chang che doi)
6 Day ch&ng got hop (day chang che doi), 7 Day chang hop ghe mu chan 8 Da, chang hop chem
mu chan, 9. Cac day chang mu ban chan

- Day chang chem —hop - mu chan (ligamentum cuneocuboideum dorsale).

- Day chang sen —ghe (ligamentum talonaviculare).
- Cac day chang chem - ghe mu chan (ligamenta cuneonaviculana dorsalia).
- Cac day chang lien chem - mu chan (ligamenta intercunei-formia dorsalia).
Ten goi cua day chang la cho bam vao xiidng va lien ket cac xudng do
vdi nhau.
Ccic day chdnggcin cd chan (ligamenta tarsi plantaria):
- Day chang gan chan dai (ligamentum plantare longum) di td xudng got tdi
nen xiidng ban chan III. IV. V.
- Day chang got - hop gan chan (ligamentum calcaneocuboideum plantare)
di tu xifdng got tdi xiidng hop.
- Day chang got - ghe gan chan (lig. calcaneonaviculare plantare) di tir xifdng
got tdi xifdng thuyen.
 K H O P C H I DLf Ol 285

- Cac day chang chem - ghe gan chan (ligamenta cuneonavicularia plantana)
di ttf cac xtfdng chem tdi xtfdng thuyen.
- Day chang chem - hop gan chan (ligamentum cuneocuboideum plantare) ch
tir xtfdng chem ngoai den xtfdng hop.
- Cac day chang gian chem gan chan (ligamenta intercuneiformia plantana)
noi cac xtfdng chem vdi nhau.

1.7. D on g tac

0 cac khdp nay chi la nhtfng dong tac trtfdt nhe, gop phan vao stf mem deo va
linh hoat cua ban chan trong cac hoat dong:
- Gap va duoi.
- Giang va khep.
- Xoav trong va xoav ngoai

2. CAC K H O P CO C H A N B A N C H A N (articulationes tarsonu>-tatar*ale>).

Car khdp cd cha n ban ch an la nh u ng khdp noi nam xuting ban chan vtii ba
xudng chem va xuting hop. Ivhe khdp hinh vanh cung. n h u n g gap khuc loi lom
khong deu.
Car day c h a n g noi cac xuting vdi nhau gdm 3 loai:
Cac day chang mu cti chan han chan (ligamenta tarsometatarsalia dorsalia)
di tu' mat mu ba xuting chem va xu'dng hop tdi dau gan nam xu'dng ban chan.
Cdc day ch a n g gan co chdn - hdn chan (ligamenta tarsometatarsalia
plantana) th tii' mat gan cac xuo'ng chem v;i xu'dng hop tdi dau gan nam xudng
ban chan.
- Cdc day chdng gian cot chem - hdn chdn (ligamenta cuneometatarsalia interossea).

3. c A c K H O P G I A N C O T B A N C H A n (articulationes mtermetatarsales).
Ndi mat ben cua dau gan cac xtfdng ban chan vdi nhau.
Co 3 loai day chang:
- Cac day ch d n g mu hdn chdn (ligamenta metatarsaha dorsalia).
- C a c ddy ch d n g gan ban chdn (ligamenta metatarsaha plantana).
- Cac (lay ch d n g gian cdt - ban chdn (ligamenta metatarsaha - interossia).

4. CAC K H d P bAn C H A n - N G O N C H A n (articulationes metatar so

phalangeales)
Noi chom cac xu'Ong ban chan vdi dau gan cac xtfOng dot I ngdn chan.
Cac day chang gom co:
- Cac day chang gan ban chan —ngon chan (ligamenta plantana).
EETO G I AI P H A U N G l f d l . T A P I

- Day ch^ng ngang sau ban chan (ligamentum metatarsale transversum

profundum)
- Cac day ch&ng bon (lig. collateralia).

5. C A C K H C lP G I A N D O T N G O N C H A N (articulationes interphalangeales)

Noi cac dot ngon chan vdi nhau, gom co cac day chang gan dot ngon chan
(ligamenta plantana) va cac day chang ben (lig. collateralia).

Hinh 17.14. Cac day c h ln g cua cac khdp ban chan (phia gan chan)
1. Cac day chang ngang sau ban chan; 2. Cac day chang gan ban chan; 3. Cac day ch^ng gan co chan
ban chan; 4. Day chang got hop gan chan; 5 Day chang gan chan dai; 6. Day chijng got ghe gan chan
7. Day chang hop ghe gan chan; 8. Day chang chem ghe gan chan; 9. Day ch^ng chem hop gan chan
10. Day chang gian chem gan chan; 11. Cac day chang gan ngon chan.
 C AC CO CHI DUOI 287

18. CAC CO CHI DUCJI

(M u s c u li m e m b r i in fe r io r is )

Cac cd chi dtfdi (Hinh 18.1, 18.2) gom co:

- Cac cd 0 vung mong.
- Cac cd 0 dui.
- Cac cd 0 cang chan.
- Cac cd 0 ban chan.

CAC CO 6 VUNG MONG

Cac cd d vung mong dtfdc xep lam ba ldp.

1. L d p N O N G

Co 2 cd:

1.1. Cd m o n g to (M. gluteus maximus).

Cd mong to hinh vuong, rong va day. rat phat trien d ngtfdi do tu the dtfng
thang (Hinh 18.1. 18.3).
- Nguyen uv: bam vao phan sau mat ngoai canh chau, mat sau xUdng ctfng
va day chang ctfng u.
- Dtfdng di va bam tan: cd chay xuong dtfdi va ra trtfdc de bam vao u loi mong
6 che tren ngoai dtidng rap xtidng dtii.
- Dong tac: giang dtii va chu yeu la duoi dtii keo than minh ve tu' the dting
thang khi nga ve phia trtidc. Khi dting co dinh chau hong vdi than minh.
- Than kinh chi phoi: than kinh mong dtidi.

1.2. Cof c a n g m a c r o n g ( h a y m a c d u i ) (M. tensor fasciae latae).

* [F a s c ia la ta d u n g n g h la L a tin la "m a c rong", so n g d a n h ttf G P cu th e o co GS. D o X uan

Hop, va n q u e n g o i m a “ m a c d u i” , nen ch u n g toi xin tam de ca hai ca ch dich: de tien
doi ch ie u ].

La mot co det boc trong 2 la cua mac rong (hay mac dtii) 0 phia ngoai mong
va dtii, gitia cO may va cO mong nhd (Hinh 18.1, 18.2).
 1

I. Mao chau.
2 Cd mong nhd phu bd) can ong
3. Cd mong ldn
4. Dai chau chay
5. Dau
>au dai 1
Cd nhi dau d i
6 Dai.
)au ngan J
7. Cd gan chan.
8 Cd dep.
9. Cd m ac dai.
10. Cd mac ngan.
I I . Gan got (Achilles)
12 U got:
13. Cd gap dai cac ngon chan
14 Cd dep.
15. Cd bung chan,
16. Cd may.
17 Cd ban mac.
18 Cd ban gan
19. Cd khep ldn.
20. Cd thon.

Hinh 18.1. Cac co chi di/di (nhin sau)

 CAC CO CHI DUOI 0 289

1. Gai chau tru'dc tren,

2. Day chang ben;
3. Cd that ltfng chau,
4 Cd lu'dc,
5. Cd khep dai,
6. Cd thon,
7. Co may;
8. Day chang banh che,
9. Cd bung chan,
22
10. Xu'dng chay;
11, Cd dep. 21
12. Co dudi dai ngon I;
13. Co gian cot mu chan, 20

14. Gan co duoi dai cac ngon ch.an,

19
15. Cd dudi ngan cac ngon chan
16. Ham du'di cac gan duoi;
_ 18
17. Ham tren cac gan duoi;
17
18. Co duoi dai ngon cai;
19. Co mac ngan. 16
20. Cd duoi dai cac ngon chan;
15
21. Co chay trudc;
22. Co m ac dai, 14
23. Xu’dng banh che;
24. Cd rong ngoai;
25. Co th in g dui;
26. Dai chau chay;
27. Cd cang m ac rong.

Hinh 18.2. Cac cd chi du'di (nhin trudc)

19- GPN-T1
PETOm. g ia i p h Au ngucji. tap I

Nguyen uy: gai chau trudc ti en va phan trudc mep ngoai mao chau.
Bam lan: cac thd cd tan het d 1/3 tren dui bang 1 dai can long, hoa cung mac
long tao thanh ddi chau chay (tractus lliotibiahs). di xuong bam vao dau tren
xudng chav.
- Than kinh chi phoi: than kinh mong tren.
Dong tac: cang mac rong. va gop phan gap dui, giang dui duoi cang chan.
* [Co cang m ac rong d tfd c ca c tac gia Anh My (W o o d b u rn e 1957), xep va o vung mong,
song cac tac gia P hap (T estu t va Latarjet 1948) lai coi n h tf th u o c vung dui trtfd c ngoai).

2. LO P GILfA

Co mot cd.
Cd mong nhd (M. gluteus medius): hinh tam giac, mot phan d nong. mot ph&n
bi cd mong to che phu (Hinh 18.3).

Hinh 18.3. Cac cd vung m ong: ldp gitfa va I6p sau

1.Co mong nhd. 2. Can mong, 3 Co m ong to. 4. Day chang cung u, 5. Day chang cung gai.
6 Bd du'di co m ong to; 7 C ac cd ngoi cang; 8. Cho bam tan ciia cd fyong to. 9 Co vuong dui,
10 Gan co bit ngoai, 11. Co sinh doi dtfdi, 12. Gan cd bjt trong; 13. Cd sinh doi tren, 14 Cd hinh qua le
 C A C C O C H I DL/CJI ]X 291

- Nguyen uv: bam vao phan giufa mat ngoai canh chau, giua hai cludng mong
trtfdc: va sau.
Ham tan: mat sau ngoai mau chuyen to xtfOng dui.
- Than kinh chi phoi: nhanh cua than kinh mong tren.
- Dong tac: giang dui, cac bo trtfdc gap va xoay dui vao trong, cac bo sau xoay
dui ra ngoai: gop phan dtfng than minh d ttf the dtfng thang, khi nga ve phia trtfdc.
Khi ty vao xtfdng dtfi cd co se keo nghieng chau hong ve ctfng ben.

3. LCfP S A U
Co cd mong nho va 6 cO ch;)u hong - mau chuyen (Hinh 18.3).

Hinh 18.4. Cac cd vung m ong, ldp sau (cd mong be va cac cd chau hong mau chuyen)
1. Day chang cung u. 2. Cd vuong dui (cat); 3. Cd khep ldn; 4 Cd Itfdc, 5. Cd that ltfng chau. 6 Gan
cd bit ngoai; 7 Gan tan cd m ong nhd; 8. Gan cd bit trong va cac cd sinh doi 9 Cd hinh qua le
10. Cd mong be, 11. N guyen uy cd mong nhd.

3.1. Cof m o n g n h o (M. gluteus minimus)

- Nguyen uy: bam vao phan trtfdc dtfdi mat ngoai xtfdng canh chau (dudi dudng
mong dtfdi).
- Bam tan: bd trtfdc mau chuyen to xtfdng dtfi.
- Than kinh chi phoi: nhanh cua than kinh mong tren.
292 HJ) G I AI P H A U N G l f d l . T A P I

- Dong tac: giong cO mong nhd, giang dui, va gop phan keo than minh d tu the
ddng thang.

3.2. C d hinh qua le (M. piriformis)

- Nguyen uv: mat triidc ben xiidng cung.
- Diidng di va bam tan: tti trong chau hong be qua khuyet ngoi ldn ra vung
mong bam tan vao dinh mau chuyen to xiidng dtii.
- Than kinh chi phoi: nhanh cua dam roi cting tach d nhanh sau day cting II.
- Dong tac: xoay dtii ra ngoai va gop phan giang dtii.

3.3. C d sinh doi tren (M. gemellus superior) va c d sinh doi du’cfi (M. gemellus infenor)
- Nguyen tiy: cd tren bam vao gai ngoi, cd diidi bam vao u ngoi.
- Bam tan: vao mat trong mau chuyen to.
- Than kinh chi phoi: nhanh ben cua dam roi than kinh ctine.
Dong tac: xoav dm ra ngoai.

3 . 4 . C d b j t t r o n g ( M. o b t u r a t o r i u s i nt e r i ms ) <H i n h lS.->. i s . I. l ' v o i

Hinh 18.5. Cd bjt trong. Nhin tii mat trong chau (Theo G regoire va Oberlm

1. Ong bit (du’di mu). 2. Cho bam cua cd nang hau mon, 3. Mom liem cua day c -a ^ g
cung u; 4 Day chang cung u, 5 Day chang cung gai. 6. Cd hinh qua le. 7 Cd bit tro^g

- Nguyen uy: bam vao mat trong xuong chau d xung quanh lo bit va vao mat
trong mang bit
- Dtidng di va bam tan: tti trong chau hong be qua khuyet ngoi be. be gap lai
theo mot goc vuong. de bam tan vao ho mau chuyen to.
 C AC C O CHI DUOI

- Than kinh chi phoi: nhanh ben dam roi cung.

- Dong tac: xoay dui ra ngoai, gop phan duoi va giang khi dui 6 tu the gap.

3.5. Cd bit ngoai (M. obturatorius externus) (Hinh 18.6)

Hinh 18.6. Cd b jt n g o a i, nhin tii tru’dc, da cat cac cd that ltfng chau. cd Itfdc va cd khep dai
(Theo Gregoire & Oberlin).

1. Cd chau, 2. Cd that ltfng to (cat); 3. Cd Itfdc (cat va lat len); 4 Cd khep dai (cat va lat len) 5 Cd
bit ngoai; 6. Cd vuong dui. 7, Cd khep ldn; 8. Cd khep dai (cat), 9. Cd khep ngan 10 Cd that ltfng
chau (cat);

- Nguyen uy: bam vao mat ngoai mang bit va xung quanh lo bit.
- Duong di va bam tan: cac thd cO tap trung hinh quat thanh 1 gan chay
ngang ra sau co xuong dui bam vao ho mau chuyen to xu'dng dui. 6 du'di cd bit
trong va cac cd sinh doi.
- Than kinh chi phoi: nhanh ben cua dam roi cung.
- Dong tac: xoay dui ra ngoai.

3.6. C d v u o n g d u i (M. quadratus femoris) (Hinh 18.3, 18.4)

- Nguyen uy: u ngoi
- Bam tan: bam vao mot go d ngdai mao gian mau.
- Than kinh: nhanh chung vdi cd sinh doi.
- Dong tac: Xoay dui ra ngoai.
 G I AI P H A U N G U O I . T A P I

CAC CO 6 DUI

Vo mat giai phau djnh khu, dui dude chia thanh 2 vung ldn: vung din trudc
(regio femoris anterior) va vung dui sau (regio femoris posterior). Song cac cO cua dui
lai diidc chia thanh 3 nhom. mang tinh chiic nang khac nhau. va nam trong 3 o cd khu
tru hdn: O d u i tru th : hay 6 d u o i (compartimentum femoris antenus/extensorum), o
d u i sa u hay 6 g a p (compartimentum fermoris posterius/ flexorum) va 6 d u i trong,
hay 6 k h e p (compartimentum femoris mediale/ adductorum).

1. CAC c d d V U N G D U I T R lT d C

Gom 2 nhom hay 2 o dui trifdc va o dui trong.

1.1. O dui triftVc, hay o duoi

Co phan du'di cd that Iu'ng chau. cd may va cd hi dau din. N’ -j ra co canu
mac rong c u n g duoc cac tac gia Phap xep vao n h o m nay.

1.1 .1 . i ' d t h a t l u n g c h a u (M iliopsoas)

Co that lung chau do hai cd hop lai (la co that lung to va co chau chi co mot
phan nho di xuong lan het o dun
- Nguyen uy: c<f that /u'ng to (M. psoas major) ham vao mom nuang va than
cac dot song tu nguc Xll den that lung IV (Hinh 18.7).

Hinh 18.7. Co that lung chau

1. Co that lung be 2 Cd that lung to: 3. Co chau: 4. Gan eel that lung be
 C A C C O CHI D lfO I '■{ rrn

('ifc/uni (M. iliacus) ham vao mao chau va ho canh chau.

limn tan: hat co hop lai thanh mot. gan chung di xuong ham tan vao man « lnr.r:
nho \uong dui
'['han kinh chi phoi: nhanh cua dam roi that lung cho co that lunu to. nhanh cua
than kinh dm cho co chau.
Dong tac: gap dm vao than minh.
(j/thdl lu'n& hi; (M psoas minor) la mot co phu nho. o trudc co that lung lo. di tu
than dot song ngu'c XII den ham tan b loi chau - mu (eminontia lliopuhica).

/ V "

Hinh 18.8. Cac cd vung dui tru'dc (nhin ttf trtfdc)

1. Cd chau; 2. Cd may; 3. Cd cang mac rong; 4. Cd thing dui; 5. Cd rong ngoai, 6. Gan tan cd nhi dau
dui, 7. Day chang banh che; 8. Xtfdng banh che; 9. Gan cd ttf dau; 10 Cd rong trong. 11. Cd khep ldn
(bo dtfdi); 12. Cd thon; 13. Cd khep dai; 14. Cd khep ngan (d sau, nhin qua khe gitfa hai cd 13 - 15).
15. Cd Itfdc; 16. Day chang ben; 17. Cd that ltfng to.
2 96 GIAI P H A U N G U d l . T A P I

1.1.2. C o m a y (M. sartonus)

La cd dai nhat trong cd the (Hinh 18.8).
- Nguyen uy: bam tii gai chau trtfdc tren.
- Dtfdng di va bam tan: chay chech ttf tren xuong dtfdi, ttf ngoai vao trong de
bam tan vao phan tren mat trong xtfdng chay.
- Than kinh van dong: nhanh cua than kinh dtfi.
- Dong tac: gap din, giang va xoay dtfi ra ngoai, gap va xoay c&ng chan vao trong.

Hinh 18.9. Co turdau dui

1. Cd rong ngoai (moc keo ra ngoai); 2. Cd rong giQa; 3. Cd thing dui (phan tan cung). 4 Mat
trong xu'dng dui; 5. Cd rong trong (cat va moc vao trong); 6. Cd thdng dui (phan nguyen uy).
 C A C C O C H I DLfCfl |3| 297

1.1.3. Cd tit d a u d u i (M. quadricep femoris)

Cd tii dau dui la cd to nhat cd the, gom bon dau nguyen uy nhu sau:
- Nguyen uy:
Cd thang dui (M. rectus femoris) co mot dau thang (caput rectum) bam vao
gai chau trUdc dtfdi, va mot dau quat (caput reflexum) bam vao vien o coi.
Cd rong trong (M. vastus medialis) bam vao mep trong dtfdng rap xUdng dui.
Cct rong ngoai (M. vastus lateralis) bam vao mep ngoai dudng rap xtfdng dtfi.
Cd rong giiia (M. vastus intermedius) bam vao 3/4 tren mat trtfdc xtfdng dui
(Hinh 18.9).
- Bam tan: bon dau hop lai thanh mot gan chung cd ttf dau bam vao xtfdng banh
che theo 3 ldp gan tan.
Ldp nong: gan cd thang dtfi.
Ldp gitfa: gan cd rong trong va rong ngoai.
1.dp nau: gan cd rung gitfa.
Tii du'di xudng banh che cac sdi gan tan cua cd tu dau tao thanh day chdng hanh
chi’ (ligamentum patellae) xuong bam vao u loi (loi cu) xuong chaw
Mot vai ho gdi cua gan cd rong trong va rong ngoai di ttf canh hen xudng hanh
che den ham vao u loi xtfdng chay, tao thanh cae mac ham hanh che trong va
ngoai (retinacula patellae mediale et laterale).

* [Xu'dng banh che thuc te chi la mot xu'dng viing ldn nam trong gan ca tu dau Xu'dng ttfa len
cac loi cau xudng dui, co tac dung vi/a nhif mot don bay. viia nh ii mot rong roc cho gan co ttf
dau, lam tang goc keo cua gan len xudng chay],

- Than kinh chi phoi: nhanh ciia than kinh dtfi.

- Dong tac: gap dtfi. duoi cang chan (dong tac da bong).

1.2. O dui tron g, h a y o khep

Co cd Itfd c , 3 cO khep va cO thon (Hinh 18.8, 18.10).

1.2.1. Ca hide (M. pectineus).

- Nguyen uy: mao Itfdc xtfOng mu.
- Bam tan: chay xuong ham vao dtfdng Itfdc (linea pectinae) d phan tren dtfdng
rap xtfdng dtfi, ngay dudi mau chuyen be.
- Than kinh chi phoi: nhanh cd cua than kinh dtfi.
- Dong tac: gap. khep va hdi xoay dtfi ra ngoai (Hinh 18.9).

1.2.2. Cd k h e p d a i (M. adductor longus)

0 phia trong cO ltfOc.
- Nguyen uy: mat ngoai goc xtfong mu.
PT-THlIl G I AI P H A U NGUCJI. T A P I

Hinh 18.10. Cac cd khep dui

(cac cd bi c ^t bo phan giCra. chi de lai nguyen uy va bam tan)
1. Nguyen uy bo du'di cd khep ldn; 2. Cd lu'dc; 3. Cd khep dai; 4. Lo ha gan khep; 5 Gan tan bo di/di
cd khep ldn; 6. Bo giCfa cd khep ldn; 7. Hai bd cd khep ngan; 8. Bo tren cd khep ldn 9 Cd khep ng£n
(nguyen uy); 10. Cd khep dai (nguyen uy); 11 Cd Itfdc (nguyen uy).

- Bam tan; 1/3 giua dudng rap xudng dui 0 dtfdi cd Itfdc.
- Than kinh chi phoi: nhanh van dong cua than kinh bit va than kinh dui.
- Dong tac: khep, gap va hdi xoay dtfi ra ngoai.
1.2.3. Cd k h e p ngdn (M. adductor brevis)
Nam sau co' ltfOc va cd khep dai, trtfdc cO khep ldn.
- Nguyen uy: mat ngoai nganh dtfdi xtfOng mu.
- Bam tan: 1/3 tren dudng rap xtfOng dtfi.
- Than kinh chi phoi: nhanh cua than kinh bit.
- Dong tac: khep va xoay dui ra ngoai.
1.2.4. Cd k h e p ldn (M. adductor magnus).
Co khep dui manh nhat, day, rong, hinh tam giac, gom 3 bo:
- Nguyen uy: bam vao u ngoi (tuber ischiadicum) va 2/3 sau mat ngoai nganh
ngoi mu.
 C AC CO CHI DUOI fjlPEH

- Ham tan: hai bo tron ham vao difdng rap xuong dui. bo dudi thu lai thanh gan
trdn. chdc va ham vao cu cd khep (tuberculum adductonum) 6 mom tren loi cau
trong xudng dui. Ho giua va gan tan cua hd difdi gidi han cung xifdng dui mot lo hinh
tam giac. cd cac sdi hinh cung lam thanh vong trdn. goi la 16 hd gan khep (hiatus
tendinous adductorius) 6 phia tren loi cau trong xifOng dui (Hinh 18.10. 18.11).
- Thfin kinh chi phoi: than kinh ngoi va than kinh hit.
1

1 Bo tren cd khep ldn. 2. Bo giUa cd khep ldn; 3. Bo du'di cd khep ldn 4. Lo ha gan khep.
5. Nguyen uy dau ng^n cd nhi dau dui; 6. Cd rong ngoai; 7. Bam tan cd mong to; 8 Cd vuong dui.

1.2.5. C o th o n (M. gracilis)

Cd nho, thon va dai (Hinh 18.8).

- Nguyen uy: mat ngoai nganh xuong cua xifdng mu.
- Bam tan: gan cd chav ra phia sau loi cau trong xifdng dui xudng bam vao phia
dudi loi cau trong xifdng chay.
- Thdn kinh chi phoi: nhanh cua than kinh bit.
- Dong tac: gap va khep dui, gap va hdi xoay cang chan vao trong.
 GIAI PHAU NGUCJI. TAP I

Hinh 18.12. Cho bam cua cac cd d du’dng rap xu'dng dui

1. Cd lu’dc; 2. Cd khep ngan; 3. Cd khep dai, 4. Cd rong trong; 5. Cd khep ldn 5 Dau
ngan cd nhi dau dui; 7. Cd rong ngoai. 8 Cd mong to

2 . cAc c d d V U N G D U I SAU

Vung dui sau chi gom 1 o cd dui sau, hay o gap, co 3 cO toa tu u ngoi xtfdng
chau xuong dau tren 2 xudng chay. mac; cd nhi dau, cd bam gan va cd bam mac.
(Hinh 18.13, 18.14).

2.1. C d nh i d a u d u i (M. biceps femoris).

- Nguyen uy:
Dau dai (caput longum) bam vao u ngoi xtfdng chau.

Dau ngan (caput breve) bam vao phan dtfdi mep ngoai dtfdng rap xtfdng dui.
 C A C CO CHI DLTdl 0 301

- Bam tan: hai dau hdp nhat thanh mot gan chung bam vao chom xtfdng mac.
Than kinh chi phoi: nhanh cua than kinh ngoi.
Dong tac: duoi dui, gap va xoay cang chan ra ngoai.

H in h 18.13. Cac c d v u n g dui sau (ldp nong)

1. Cd khep ldn; 2. Cd ban mac; 3. Cd ban gan; 4. Cd thon; 5 Dau ngan cd nhi dau;
6. Dau dai cd nhi dau; 7. Cd rong ngoai; 8. Cd mong to.

2.2. Cd ban ga n (M. semitendinosus)

Ntfa tren la cd ntfa dtfdi la gan:
- Nguyen uy: bam vao u ngoi.
- Dtfdng di va bam tan: di xuong d sau cd ban mac ntfa dtfdi trd thanh 1 gan
rat dai xuong bam vao mat trong dau tren xtfdng chay, dtfdi chd bam cua cd thon.
- Than kinh chi phoi: nhanh cua than kinh ngoi.
- Dong tac: duoi dui, gap c&ng chan va hdi xday vao trong (Hinh 18.12).
302 [jjj G I AI P H A U N G l / d l . T A P I

2.3. C d ban m ac (M. semimembranosus)

- Nguyen uy: u ngoi.
Dtfdng di va bam tan: ntfa tren cua cd la mac, ntfa dtfdi la cd thu lai thanh
gan di xuong tdi ngang khdp goi thi chia lam ba bo:
Bo thtf nhat quat ngtfdc len tren va ra ngoai tao thanh day chang khoeo cheo
(gan quat ngrfOc).
Bo thtf hai di thang xuong bam vao mat sau loi cau trong xtfdng chay (gan thdng).
Bo thtf ba quat ngang ra trtfdc bam vao ranh ngang loi cau trong xtfdng chay
(gan quat ngang) (Hinh 18.13, 18.14).
- Than kinh chi phoi: nhanh cua than kinh ngoi.

Hinh 18.14. Cac cd vung dui sau (ldp sau)

1 Day chang cung u; 2. Cd khep ldn; 3 Cd ban mac; 4. Gan quSt ngtfdc cd ban mac. 5. Gan quat
ngang cd ban mac; 6. Gan th in g cd ban mac; 7. Gan tan cd nhj d5u dui; 8. Dau n g in co nhi dau dui;
9. Cd rong ngoai; 10. Ch6 bam tan cua cd mong to; 11. Cd vudng dui.
 C A C C O C H I DLf Ol |]X 303

CAC CO 6 CANG CHAN

Cae cd cua cang chan so ludng it hdn cd d cang tay vi khong co cac cd sap va
ngiia. Ve mat giai phau djnh khu, cang chan dtidc chia lam 2 vung ldn: vung cang
chan trifdc (regio cruris anterior) va vung cang chan sau (regio cruris posterior).
Song ve mat vj tri, va chiic nang, cac cd lai diidc chia lam 3 nhom, hay 3 o cd nho
hdn: O cang chan tru’dc hay o duoi (compartimentum cruris anterius/extensorum), o
cAng chan sau hay o gap (compartimentum cruris postenus/flexorum). va o cang
chan ngoai/hav o mac (compartimentum cruris laterale/fibularium/peroneum).

1. C A C c d V U N G C A N G C H A N T R l / d C
Vung cang chan triidc gom 2 nhom hay 2 o cd: o cang chan triidc va o cang
chan ngoai.

1.1. O cang ch an triidc hay o duoi

Co 1 cd: cd chav trudc (duoi ban chan) cd duoi dai cac ngon chan, cd duoi dai
ngon cai va cd mac ba (duoi va giang ban chan). (Hinh 18.15).
1.1.1. Cd c h a y trtfdc (M. tibialis anterior)
- Nguyen liy: 2/3 tren mat ngoai xu’dng chay, mang gian cot.
Bam tan: gan cd chui qua mac ham cac gan duoi d co chan, xuong bam vao
xudng chem trong va nen xudng dot ban chan I.
- Than kinh chi phoi: nhanh cua than kinh mac sau.
Dong tac: duoi ban chan va hdi nghieng vao trong.
1.1.2. Ca d u o i d d i c d c n g o n c h d n (M. extensor digitoruni longusj
- Nguyen uy: loi cau ngoai xiidng chay, 2/3 tren mat trong xiidng mac va mang
gian cot.
- Difdng di va bam tan: cd xuong 1/3 du'di cang chan chuyen thanh gan. roi
chia lam 4 gan nho chui qua mac ham cac gan duoi di tdi 4 ngon chan II, III. IV,
V. Phan tan moi gan chia lam 3 che:
Che gitfa bam vao d&u gan dot giufa ngon chan.
Hai che ben chap thanh mot gan bam vao dau gan dot xa ngdn chan.
- Than kinh chi phoi: nhanh cua than kinh mac sau.
- Dong tac: duoi cac ngon chan va duoi ban chan.
1.1.3. Ca duoi ddi n g o n chdn cai (M. extensor hallucis longus)
- Nguyen uv: 2/3 dufdi mat trong xiidng mac, mang gian cot.
- Bam tan: chui qua mac ham cac gan duoi, xuong bam vac nen dot xa ngon I.
- Than kinh chi phoi: than kinh mac sau.
- Dong tac: duoi ngon chan I.
304 [jj] G I AI P H A U N G U O I . T A P I

Hinh 18.15. Cac c 0 vung cang chan tru'dc

1. Gan cd nhi dau dui. 2. Dai chau chay. 3. Cd bung chan ngoai, 4. Cd mac da: 5 C r 3 j6 i dai cac
ngon chan, 6. Cd duoi dai ngon chan cai 7 Cd mac ba 8. Cd chay tru'dc, 9 Ca gac aa cac ngon
chan; 10. Cd bung chan trong 11 Gan ca may

1.1.4. Ca m a c ba (M. peroneus tertius)

- Nguyen uy: 1/3 cludi mat trong xudng mac va mang gian cot.
- Bam tan: nen xuong ban chan V.
- Than kinh chi phoi: nhanh cua than kinh mac sau.
- Dong tac: duoi ban chan, giang va xoay ban chan ra ngoai

1.2. O ca n g ch an n goai hay o m ac (Hinh 18.15. 18.16)

Co hai cd mac dai va mac ngan.

1.2.1. Cd m a c d a i (M. peroneus longus)

- Nguyen uy: bam vao chom xuong mac va vao 1/2 tren mat ngoai xuOng mac
- Bam tan: vong sau mat ca ngoai. qua ranh gan cd mac dai cua xudng got.
xuong gan chan, bam tan vao nen cac xudng ban chan I, II va xtfdng chem trong.
- Than kmh chi phoi: nhanh cua than kinh mac nong.
- Dong tac: gap ban chan va hdi xoay ra ngoai, dd vom gan chan.
 CA C CO CHI D UO I M

Hinh 18.16. Cac co d cang chan va ban chan (Nhin nghieng Mat ngoai)
(Theo Sinelnikov, Moskva)
1. Day chang ben m ac; 2 Gan cd nhi dau dui (cat); 3. Cd bung chan (*a u ngoai); 4 Cd mac dai,
5, Cd dep; 6. Cd m ac n g in ; 7. Ham tren cac cd mac; 8. Gan got (Achille). 9, Ham dtfdi cac cd mac,
10. Cd giang ngon ut. 11. Gan cd dudi dai cac ngon chan; 12. Gan cd m ac ba. 13. Gan cd mac
ngan; 14. Cd dudi ngan cac ngon chan; 15. Ham du'di cac gan duoi; 16. Ham tren cac gan dudi.
17. Cd duoi dai ngon chan cai; 18. Cd du6i dai cac ngon chan; 19. Cd chay tru’dc. 20 Day chang
banh che; 21. Sun chem ngoai; 22. Loi cau ngoai xtfdng dui; 23. Cd ttf dau dui.

20- GPN-T1
306 IfjT
I Uuk.
GIAI PHAU NGUOI. TAP I

1.2.2. Ca m a c n g d n (M. peroneus brevis)

- Nguyen uy: bam vao ntfa dtfdi mat ngoai xtfdng mac. va vao cac vach gian
cd trtfdc va ngoai.
- Bam tan: gan cO mac ngan chay trtfdc gan
cd mac dai. vong sau va cltfdi mat ca ngoai. roi
qua mat ngoai xUdng got tdi bam vao nen xu'Ong
ban chan V.
- Than kinh chi phoi: than kinh mac nong.
- Dong tac: nhtf cd mac dai.

2 . cAc c d v u n g cA n g chAn sau

Vung cang chan sau chi co 1 o cd: o cang

chan sau; song lai dude chia lam hai ldp hay 2
phan, ngan cach nhau bdi m o t c a c h h a y mac
ngang cang chan s a u .

- Ldp nong hay phan ndng (pars superficialis)

pars tricipitalis): eo cd tam dau cang chan va ed
gan chan.
- Ldp sau hay phan sdu, eo cd khoeo. cd gap
dai cac ngon chan, cd chay sau va cd gap dai
ngon cai.

2.1. Co? tam dau can g ch an (M. triceps surae)

Co tam dau dtfdc hop thanh bdi hai dau cua
cd bung chan (M. gastrocnemius) va ed dep (M.
soleus). (Hinh 18.16: 18.17).
Hinh 18.17. Cac cd cang chan ldp
+ Nguyen uy: nong, cd tam dau (nhin sau)

- Cd bung chdn: 6 nong nhat co hai dau: 1. Cd ban gan. 2 Gan cd ban mac
3. Cd dep, 4. Gan got 5 Cd mac dai
Dau ngoai (caput laterale) bam vao loi cau 6. Cd bung chan ngoai 7 Cd nhi dau dui
ngoai xUdng dui.
Dau trong (caput mediale) ldn hdn. bam vad loi cau trong xtfdng dui. Hai dau
chum lai roi barn vao mat sau gan cd dep.

- Cd dep: bam vao 1/3 tren mat sau xtfdng mac, vad dtfdng cd dep (linea m. solei)
d phan ba tren mat sau xudng chay. va cung gan cd dep cang gitfa 2 xtfdng (Hinh
18.16, 18.17, 18.18).

+ Bam tan: gan cd dep hdp vdi hai dau cua cd bung chan di xuong thu gon lai
thanh gan gdt (tendd calcaneus) bam vao phan gitfa mat sau xtfdng got.
 cac co chi duoi 0IETT3

+ Than kinh chi phoi: cac nhanh cua than kinh chav.
+ Dong tac: gap cang chan, gap ban chan, kieng chan, nen rat quan trong trong
dong tac chav nhav.

2.2. Cd gan ch a n (M. plantaris). (Hinh 18.18)

H inh 18.18. Cd gan chan va cd dep

Da cat bo cd bung chan
1. Cd gan chan, 2. Gan got, 3. Phan cuoi cd bung chan, 4, Cung gan cd dep

Cd rat manh de. nho, nen triidc day tieng Phap con gdi la cd gan chan gay (M.
plantaire grele).
- Nguyen uy: bam vao loi cau ngoai xifdng dui.
- Du'dng di va bam tan: nam giiia cd bung chan va cd dep roi chay xuong dudi
nhap vad bd trong gan gdt.
PTTflliH GI A I P H A U N G I / O I . T A P I

- Than kinh chi phoi: nhanh cua than kinh chay.

- Dong tac: phu cho cO dep.

2.3. C d k h o e o CV1. popliteus) (Hinh 18.19)

- Nguyen uy: bam vao loi cau ngoai xUOng dui.
- Bam tan: phan tren mat sau xtfdng chay, d tren dtfdng cd dep.
- Than kinh chi phoi: nhanh cua than kinh chay.
- Dong tac: gap cang chan.

2.4. Cd gap d ai ca c n g o n ch a n (M. flexor digitorum longus) (Hinh 18.20,

18 . 2 2 )
- Nguyen uv: 1/3 gitfa mat sau xtfdng chay.

H inh 18.19. Co k h o e o va lien quan m at sau k h d p g o i (Theo G regoire & O berlin;

1. Day chang khoeo cheo, 2. 2 . Day chang ben trong (khdp goi) va cac sdi chay - chay cua no 3 4, 5
Cac gan quat ngutfc, quat ngang va gan thang cua co bam mac; 6 Tui hoat dich du'di co khoeo 7 Mac
cd khoeo; 8. Cd khoeo (nguyen uy); 9. Day chiing ben ngoai (khdp goi); 10. Day chang khoeo cung
11 Dau ngoai cd bung chan (cat va lat len). (Lifu y: mac phu cd khoeo lien tiep vdi day chang cung, vay
vdi bao khdp,..).

- Dtfdng di va bam tan: cd bat cheo sau cd chay sau d 1/3 giiia dtfdi cang chan,
tdi co chan chay sau mat ca trong. gitfa gan cd chav sau va gan cd gap dai ngon
chan cai (Hinh 18.19). xuong gan chan, bat cheo dtfdi gan cd gap dai ngon cai. roi
 C AC CO CHI DUOI 0 309

chia thanh 4 gan bam vao nen dot xa cac ngon chan II, III, IV, V. Moi gan choc
qua hai che gan tan cua cO gap ngan cac ngon chan nen con goi la gan xien.
- Than kinh chi phoi: than kinh chay.
- Dong tac: gap cac ngon chan tu1II - V, gap ban chan va hoi xoay vao trong.
2.5. C d c h a y s a u (M. tibialis posterior)
- Nguyen uy: mang gian cot, va mat sau hai xtfOng cang chan.
- Dtfdng di va bam tan: gan cd chay xuong du6i hoi chech vao trong, di sau
mit ca trong xuong gan chan bam tan vao cu xtfdng thuyen, ba xtfOng chem, va nen
xtfdng dot ban II, III va IV.
- Than kinh chi phoi: nhanh cua than kinh chay.
- Dong tac: gap va xoay ban chan vao trong.

Hinh 18.20. Cac cd ldp sau vung cang chan sau (Da clit bo cac co ldp nong Moc keo vao trong
cd gap dai cac ngdn chan de boc lo cd chay sau d sau nhat)
1. Dien bam tan cua cd khoeo: 2. Cd gap dai cac ngon chan (bi keo vao trong); 3. Cd chay sau;
4. Gan cd chay sau; 5. Cd gap dai ngdn cai; 6. Cd mac dai; 7. Chd bam cua cd dep vao xtfdng mac;
7’. Dtfdng bam cua cd dep vao xtfdng chay.
310 [jjj GI AI P H A U N G U O I . T A P I

2.6. C d g a p d a i n g o n c a i (M. flexor hallucis longus) (Hinh 18.18).

- Nguyen uy: 2/3 dudi mat sau xtfdng mac va mang gian cot.
- Dtfdng di va bam tan: xuong gan chan bam vao dot xa ngon cai.
- Than kinh chi phoi: nhanh cua than kinh chav.
- Dong tac: gap ngon chan cai, gap va xoav ban chan vao trong.

Hinh 18.21. Cac gan cd gap khi qua mat tro n g co chan x u o n g gan chan
(Theo Gregoire & Oberlin)
1. Gan cd chay sau; 2 Gan cd gap dai cac ngon chan; 3. Gan cd gap dai ngcn c^an cai
4. Day chang delta (day chang ben trong khdp sen cang chan)

I—4

Hinh 18.22. Cac gan cd mac khi qua m at ngoai co chan, xudng gan chan
(Theo G regoire & O berlin)
1. Gan cd mac dai; 2. Gan cd m ac ngan; 3. Ham tren cac cd mac; 4. Bd giCfa day chang ben ngoai
khdp sen cang chan; 5 Ham du’di cac cd mac; 6 Bao hoat dich gan mac; 7 Ham dudi cac gan du6i
 CAC CO CHI DUOI g|j 311

Hinh 18.23. Cac cd ldp sau vung cang chan sau

Da clit bo ldp nong (Theo Sinelmkov. Moskva)
1. Dau trong cd bung chan (da cat); 2. Tui hoat dich dudi gan cd bung chan trong; 3 Gan tan cd ban
mac; 4. Cd khoeo; 5. Co gap dai cac ngon chan; 6. Cd gaip dai ngon cai. 7. Gan cd chay sau; 8. Gan
got (da cat bo phan tren); 9. Ham cac gan gap; 10. Ham tren cac gan cd mac; 11. Cd mac ngan;
12. Cd mac dai; 13. Cd chay sau; 14. Nguyen uy cd dep (da cat); 15. Chom xu'dng mac; 16 Gan tan
co nhj dau dui (da cat); 17. Dau ngoai cd bung chan (da cat); 18. Cd gan chan (da cat).
312 (gj G I AI P H A U NGUCJl. T A P I

CAC CO 6 BAN CHAN

(M u s c u li p e d is )

Cd d ban chan gom cac cd 6 mu chan va cac cd d gan chan.

1. C A C c d d M U C H A N

Ngoai cac gan duoi cua cac cd d o cang chan trtfdc di xuong nam d ldp nong,
chi co mot c0 la cd duoi ngdn cdc ngon chdn (M. extensor digitorum brevis) d ldp
sau. (Hinh 18.24).

Hinh 18.24. Cd duoi ngan cac ngon chan va ham cac gan duoi
(Theo Gregoire & Oberlin)
1. Co duoi ngan cac ngon chan; 2 Ham cac gan duoi.

- Nguyen uy: mat ngoai xtfdng got.

- Bam tan: cd chia thanh bon bo, cho bon gan tan. Ba gan ben ngoai bam vao
mat ngoai ba gan cd duoi dai ngon chan II, III va IV, rieng bo trong rat ldn dtfdc
 C A C CO CHI D U O I (jj|; 313

goi la erf duoi ngdn ngon cai (M. extensor digitorum brevis) bam tan vao nen dot
gan ngon I.
- Than kinh chi phoi: nhanh cua than kinh mac sau.
- Dong tac: duoi va hdi keo ra ngoai cac ngon chan I - IV.

2. c A c c d d GAN c h An

Gom 19 cd nam trong 4 o, tUdng ttf nhu d gan tay:

- O mo cai: co cd giang ngon cai, cd gap ngan cac ngon cai, va gan cd gap dai
ngon cai.
- O giiia: co cd gap ngan cac ngdn chan, gan cd gap dai cac ngon chan, kem
theo cd vuong gan chan, va bon cd giun.
- 0 gian cot khep: co cd khep ngon chan cai va bay cd gian cot gan chan va
nni chan.
- O mo ut: co cd dang ngon lit, cd gap ngan ngon lit va doi khi cd doi chieu
ngon lit.
Cac cd d gan chan co the xep chung lam bon ldp tu nong vao sail, lay o giua va
o gian cot khep lam chuan: (Cac cd d 2 ben chi la xep ldp tudng dudng):

2.1. L d p n o n g (Hinh 18.25)

Co cd gap ngan cac ngon chan d giufa va cac cd giang ngon cai va ngon ut d
hai ben:

2.1.1. Cd g i a n g n g o n c a i (M. abductor hallucis)

- Nguyen uy: bam vao mom trong u got, va vao mac ham cac gan gap (d
co chan).
- Dtfdng di va bam tan: cd di doc theo bd trong ban chan den bam vao mat
trong nen dot gan ngon chan cai.
- Than kinh chi phoi: nhanh cua than kinh gan chan trong.
- Dong tac: gap dot gan ngdn chan cai va giang ngon chan cai.

2.1.2. Cd g a p n g d n c d c n g o n c h d n (M. flexor digitorum brevis)

- Nguyen uy: mom trong u got va can gan chan.
- Bam tan: cd chia lam bon gan di vao bon ngon chan II, III, IV va V. Moi gan
lai chia lam hai che de bam vao nen dot gitfa cac ngdn nay.
- Dong tac: gap cac ngon chan II, III, IV va V.
- Than kinh chi phoi: nhanh cua than kinh gan chan trdng.

2.1.3. Ca g i a n g n g o n c h d n ut (M. abductdr digiti minimi)

- Nguyen uy: bam vao ca 2 mom trong va ngoai u got va vao mac gan chan ngoai.
314 ;[j|] GIAI P H A U N G U O l. T A P I

- Bam tan: vao mat ngoai nen dot gan ngon chan V.
- Than kinh chi phoi: nhanh cua than kinh gan chan ngoai.
Dong tac: giang va gap ngon chan ut.

H inh 18.25. Cac co a gan chan (ld p n o n g )

1. C d g i a n g n g o n V: 2. C d g a p n g a n c a c n g o n c h a n ; 3. M a c g a n c h a n 4 Ca giang
n g o n c h a n cai, 5. G a n g a p n g o n 2 c u a c d g a p dai c a c n g o n c h a n .

2.2. Lofp g i r i a (Hinh 18.26)

Chi co d o giiia - gian cot khep. gom eo gan cd gap dai cac ngdn chan, va cac cd
phu thuoc la:
2.2.1. Cd v u o n g g a n c h a n (M. quadratus plantae)
- Nguyen uy: bam vao mat dudi va mat trong phan sau xifdng got.
- Bam tan: vao bd ngoai gan cd gap dai cae ngdn chan. •
- Than kinh chi phoi: nhanh cua than kinh gan chan ngoai.
- Dong tac: tang cudng va chinh lai hudng cho gan cd gap dai ngdn chan.

2.2.2. C a c cO g i u n (M. lumbrieales)

- Nguyen uy: ba cd giun ngoai bam vao hai mat ben cac gan cd gap dai ngon
chan. Cd giun trong bam vao mat trong gan gap ngon II.
 C AC C O CHI D ifd i 0 315

- Bam tan: vao mat trong clot gan ngon chan ttfdng ting va vao cac che gan
duoi cua bon ngon chan ngoai.
- Than kinh: cd giun I do than kinh gan chan trong. cd giun II. III. IV do nhanh
cua thdn kinh gan chan ngoai chi phoi.
- Dong tac: gap dot gan, duoi dot xa.

H inh 18.26. Cac cd d gan chan (ldp giCra)

1. 4 cd giun, 2. Cd vuong gan chan; 3. Gan cd gap dai cac ngon chan; 4, Gan cd gap dai ngon cai

2.3. L d p s a u (Hinh 18.27)

Gom cd cd khep ngon cai d giua va cac cd gap ngan ngdn cai va gap ngan ngdn
ut d 2 ben (Hdi khac o' gan lay, cac cd doi chieu thudng khong cd. hay chi rat nho
non it dang ke). Ngoai ra gitia 2 bd cua cd gap ngan ngdn cai cdn cd gan cd gap dai
ngon cai di qua.

2.3.1. Cd g a p n g d n n g o n c h d n c a i (M. flexor hallucis brevis)

- Nguyen uv: bd dtidi hai xUdng chem ngoai va gitia. xtidng hop va day chang
got hop.
- Bam tan: gan cO tach lam hai bam vao 2 ben nen dot gan ngdn car. gitia hai
316 H G I AI P H A U N G U O I . T A P I

bo co gan cd gap dai ngdn chan cai chay qua. Bd trong bam tan cung gan cd giang
ngdn chan cai. Bd ngoai bam tan cung gan cd khep ngdn cai.
- Than kinh chi phoi: nhanh cua than kinh gan chan trong.
- Dong tac: gap dot gan ngdn chan cai.

2.3.2. Ca k h e p n g o n c h d n c a i (M. adductor hallucis)

- Nguyen uy: cd hai dau:
Dau chech (caput obliquum) bam vao xtfdng hop, xtfdng chem ngoai va nen xtfdng
ban chan III. IV.
Dau ngang (caput transversum) bam vao cac khdp ban chan ngdn chan III,
IV va V.
- Bam tan: hai dau chum lai bam tan d non xtfdng dot gan ngdn I.
- Than kinh chi phoi: nhanh cua than kinh gan chan ngoai
Dong lac: khep ngdn chan cai (Hinh 18.18).

Hinh 18.27. Cac co 6 gan chan (ldp sau)

1. Dau ngang cd khep ngon cai, 2. Cac cd gian cot gan chan; 3. Co gap ngan ngon
chan ut; 4 Gan cd m ac dai 5. Gan co chay sau; 6. Co gap ngan ngon chan cai. 7 Dau
chech cd khep ngon chan cai.
 C A C CO CHI DUOI 317

2.3.3. ( d g a p ngd n n g on chdn ut (M. flexor digit 1 minimi brevis)

Nguven uv: bam vao u loi xiidng hop, va nen xudng ban chan V.
Ham tan: vao nen dot gan ngon chan lit.
Than kinh chi phoi: nhanh cua than kinh gan chan ngoai.
Dong tac: gap dot gan ngon chan ut.

2.3.4. Cd doi c h ie u ngon ut (M. opponens digiti minimi): la 1 cd rat manh khong
ro ret. 0 ngoai cd gap ngan ngon Lit va thudng lan vdi cd nay, non it etude cong nhan
nhii 1 cd rieng:
- Nguven uy: bam vao u loi xu'dng hop, cung vdi cd gap ngan ngon lit.
- Ham tan: bd ngoai xifdng ban chan V.
- T h a n kinh chi phoi: nhanh cua than kinh gan chan ngoai.
- Dong tac: keo ngon lit vao gan true ban chan.

2.4. Lc/p gian cot

2.4.1. Cdc cd g i a n cot m u c h d n (M. interossei dorsales): cd bon cd

- Nguven uy: hai mat doi lap xu'dng ban chan d khoang gian cot I. II. Ill va IV.
- Ham tan:
Cd gian cot mu chan I bam vao mat trong nen dot gan ngon chan II.
Cd gian cot mu chan II. Ill, IV bam vao mat ngoai nen dot gan cac ngon II,
III va IV.
- Than kinh chi phoi: nhanh cua than kinh gan chan ngoai.
- Dong tac: giang ngon chan.

2.4.2. Cdc cd g i a n c o t g a n c h a n (M. interossei plantares): co ba cd

- Nguyen uy: mat trong cac xtfdng dot ban chan III. IV va V.
- Bam tan: mat trong nen dot gan cac ngon chan III. IV, V.
- Than kinh chi phoi: nhanh cua than kinh gan chan ngoai.
- Dong tac: khep ngon III, IV va V.
318 [gj GIAI P H A U N G l/ O l. T A P I

19. DONG
■ MACH
■ CHI DUOI
( A r t e r i a e m e m b r i in fe r io r is )

Chi dtfdi diidc cap mau bdi hai nguon dong mach:
- Tui dong mach chau trong (Arteria iliaca interna): co dong mach bjt c&’p
mau cho mot phan tren trong cua dui; - dong mach mong tren va dong mach
mong dudi cap mau cho vung mong va mot phan vung dui sau.
- Tii dong mach chau ngoai (Arteria iliaca externa) co: dong mach dui va cac
mach tiep theo cap mau cho vung dui triidc, vung dui sau, toan bo cang chan v&
ban chan.

CAC DONG MACH T ii DONG MACH CHAU TRONG

1. D O N G M A C H M O N G T R E N (A. glu tealis su p e rio r)

- Nguven uy: la nhanh ldn nhat cua than sau dong mach chau trong.
Du'dng di: di giua than that lung cung va day cung I cua dam roi than kinh
ciing cina khuyet ngoi ldn d tren cd hinh qua le ra vung mong.

- Phan nhanh va cap huyet: tdi vung mong chia lam hai nganh cung:
+ Nganh ndng (ramus superficialis) di tdi cd mong to. cap mau cho cd nay va
tie]) noi vdi dong mach mong dudi.
+ Nganh sau (ramus profundus) chia lam hai nhanh chay giua cd mong nhd
va cd mong be. phan nhanh cap mau cho hai cd nay (Hinh 19.1: 19.3: 21.2. 21.3.
22.14).

2. D O N G M A C H M O N G D lTO l (A. g lu tea lis in ferior)

- Nguyen liy: la mot trong nhung nhanh ldn cua than tnidc dong mach chau trong.
- Du'dng di: di giua nganh tru'dc cua day cung I va cung II. qua khuyet ngoi
ldn d du'di cd hinh qua le ra vung mong. O mong dong mach nam ngoai bd mach
than kinh then, nam trong day than kinh ngoi.
- Phan nhanh va cap huyet:

+ Nhanh cho cd mong to cap mau cho cd nay va tiep noi vdi dong mach mong tren.
 D O N G M A C H C H I DI/CJI j j l 319

+ Nhanh c ho cac cd u ngoi - mau chuyen cap mau cho nhom cd nay (gdm cac
cd bit trong, sinh doi, vuong dui va bit ngoai) va noi tiep vdi dong mach mu dui
ngoai. mu din trong va nhanh xier. \ ciia dong mach dui sau.
+ Nhanh di theo than kinh ngoi (A. comitans nervi ischiadici).

H inh 19.1. Cac n hanh cua d o n g m ach chau tro n g

1 Co that lung chau 2 Dong mach va tTnh mach chau ngoai; 3. Dong mach ron 4 Cac dong mach
bang quang tren. 5. Dong mach bit; 6. Dong mach true trang giC/a. 7 Dong mach bang quang du'di.
8. Dong mach ong tinh; 9. Dong mach then trong; 10. Dong mach mong du'di. 11 Dong mach mong
tren. 12 Dong mach cung ben. 13 Dong mach chau that lung.

3. D O N G M A C H T H E N T R O N G (A p u d en d a in terna)

Dong mach then trong cung vdi dong mach mong dudi diidc coi la hai nhanh
tan cua than trudc dong mach chau trong.
Tu' trong chau hong be qua khuyet ngoi ldn d dudi cd hinh qua le ra vung
mong, rdi vong quanh gai ngoi qua khuyet ngoi be lai vao chau hong cap huyet
cho vung day chau va cac cd quan sinh due ngoai.

4. D O N G M A C H B IT (A obturatoria)

- Nguyen uy: la mot nhanh cua than tntdc dong mach chau trong.
- Du'dng di: chay tu' tren xuong du'di va chech ra tru'dc. doc theo bd tren cd bit
trong, qua ranh bit (sulcus obturatorius) chia lam hai nhanh trUdc va sau. tiep
noi vdi nhau thanh mot vong quanh lo bjt, cap mau cho vung bit va mot phan di
xuong o dui trong.
- Phan nhanh: cho hai cd bit, mot phan cac cd khep d phia trdng dui, va 1
nhanh 6 c6i, di vao khdp hdng va ch6m xifdng dui, (xem mo ta chi tiet hdn d phan
giai ph^u dinh khu vung dui, bai 22, muc 3.4.3 vung bit va bd mach than kinh bit).
320 |[j|j G I AI P H A U N G U O I . T A P I

C A C D O■ N G M A■ C H T L / O O• N G M A■ C H C H A■ U NGOAI

1. D O N G M A C H D U I (A. femoralis) (Hinh 19.2; 22.9)

1.1. N g u y en uy tan cu n g
Dong mach dui tiep theo dong mach chau ngoai bat dau tti phia sau diem
gitia day chang ben xuong tdi lo ha gan khep thi doi ten thanh dong mach khoeo.

1.2. Dtidng di va lien q u a n ch in h

Tti diem gitia day chang ben dong mach di hdi chech xuong dtidi va vao trong
qua tam giac dtii, roi qua ong cd khep, tdi lo ha gan khep doi ten thanh dong
mach khoeo. Vav co 2 doan lien quan chinh:

() tron” turn giac din (trigonum femorale): dong mach nam ixiua. than kmh
din (> ngoai. linh mach dui d trung.

- () trong ong cd khop (oanalis adduotorius): dong mach bat cheo tru<x’ tinh mach
do vao t rong.
Duong dinh hudng: tti diem giua day chang ben den bd sau loi cau trong xudng
din. Cd the coi cd mav la cO tuy hanh ddng mach.

1.3. N gan h ben va noi tiep

1.3.1. D o n g m a c h th tfd n g vi n o n g (A. epigastnca superficialis): tach tti dong

mach dtii d cludi day chang ben 1 - 2cm. xien qua mac sang di ra ndng hudng ve
ron. noi tiep vdi dong mach thudng vi dudi (A. epigastrica inferior>. nhanh bon
cua dong mach chau ngoai. va vdi dong mach thudng vi tren (A. epigastrica
superior), nhanh tan cua dong mach ngtic trong (A. thoracica interna).

1.3.2. D o n g m a c h m u c h a u n o n g (A. circumflexa iliaca superficialis): thudng

tach ngang mtic vdi dong mach thudng vi ndng. di ve phia mao chau. phan nhanh
va tieji noi vdi dong mach mu chau sau (A. circumflexa iliaca profunda), nhanh
cua dong mach chau ngoai.

1.3.3. C dc d o n g m a c h th en n g o a i (arteriae pudendae externae): di ra ndng.

hudng ve vung sinh due ngoai. phan ra cac nhanh biu trddc (rami scrotales antenores)
neu la nam, cac nhanh moi trtidc (rami labiales antenores) neu la nti. va cac nhanh
ben (rami inguinales).

1.3.4. D o n g m a c h d u i s a u (A. profunda femoris): la dong mach chinh cua din.

tach difdi day chang ben do 4cm. di tdi bd tren cd khep dai, roi chay sau cd nay.
trtidc cd khep ngan va cd khep ldn.
 D O N G M A C H C H I Dl/ Cfl ;.k

1 Dong mach chu bung;

2 Dong mach chau chung;
3 Dong mach chau trong.
4. Dong mach chau ngoai,
5. Dong mach then ngoai.
6 Dong mach bit,
7. Dong mach mu dui trong,
8. Dong mach dui,
9. Dong mach goi xuong;
10. Dong mach goi tren trong;
11 Dong mach goi du'di trong;
12 Dong mach quat ngi/oc chay tru'dc
13. Dong mach chay tru'dc
14. Dong mach mat ca trong,
15 Dong mach mu chan,
16. Dong mach co chan trong.
17. Dong mach gan chan sau,
18 Dong mach mu ban chan I
(dong mach gian cot I).
19. Cac dong mach mu ngdn chan;
20 Cac dm mu ban chan;
21. Dm cung,
22. Dm co chan ngoai.
23. Dm mat ca ngoai.
24 Nhanh xien dm mac.
25. Dm goi du'di ngoai;
26. Dm goi tren ngoai.
27. Dm khoeo,
28. Nhanh xuong cua DM mu dui ngoai;
29. Cac DM xien;
30. DM mu dui ngoai;
31. DM dui sau;
32. DM mu chau ndng;
33. DM mu chau sau,
34 DM thudng vi ndng (DM dadi da bung),
35, DM thi/dng vi di/di.

Hinh 19.2. Cac dong mach chi du'di (nhin tru'dc)

(Theo Trjnh Van Minh).

21- GPN-T1
322 G I AI P H A U N G l f O l . T A P I

1. Nhanh ngang cua DM mu dui ngoai.

2. Cac DM xien,
3. DM goi tren ngoai,
4. DM khoeo;
5. DM goi du'di ngoai,
6. DM chay tru'dc,
7 DM mac.
8. Nhanh xien;
9 Nhanh thong (noi ngang cd chan)
10 Nhanh got ngoai,
11 Dm gan chan ngoai;
12 Cung gan chan;
13 Cac DM gan ban chan;
14. Cac DM gan ngon chan;
15. Nhanh gan chan sau cua DM mu chan,
16. DM gan chan trong,
17. Nhanh got trong,
18. U got;
19. DM chay sau;
20. DM goi difdi trong,
21. DM goi tren trong;
22. L6 ha gan khep;
23. DM dui;
24 DM dui sau;
25. DM mu dui trong;
26 DM mong difdi;
27 DM mong tren.

Hinh 19.3. Cac dong m ach chi dudi (nhin sau)

(Theo Trinh VSn Minh).
 D O N G M A C H CHI D ifd i [gj| 323

Phan nhanh: dong mach dui sau cap mau cho hau het cac cd d dui bdi cac
nhanh nhtf sau (Hinh 19.2; 19.3).
- Dong mach mu dui ngoai (A. circumflexa femoralis lateralis): di gitfa cd
th^ng dui va cd that ltfng chau, roi chia thanh 3 nhanh.
Nhanh len (ramus ascendens) di len d sau cd thang dui va cd cang mac rong.
tdi tan bd trtfdc cac cd mong, noi tiep v6i dong mach mong tren va phan nhanh
cho mat trtfdc dau tren xUdng dui.
Nhanh ngang (ramus transversus) chui qua cd rong ngoai, vong quanh co
phau thuat xUdng dtfi ra sau noi vdi dong mach mtf dui trong, dong mach mong
dtf6i va dong mach xien I.
Nhanh xuong (ramus descendens) di xuong trtfdc cd rong ngoai, phan nhanh
cho cd nay va cd rong gitfa roi noi tiep v6i dong mach goi xuong cua dong mach
dui, va nhanh goi tren ngoai cua dong mach khoeo, d mang mach banh che.
- Dong mach mu din trong (A. circumflexa femoralis medialis) lach gitfa cd
Itfdc va cd that ltfng chau ra sau, vong quanh co xtfdng dui. phan nhanh cho phan
tren cac cd khep va vung sau khdp hong bdi cac nhanh nong (ramus superficialis),
nhanh sau (ramus profundus), nhanh o coi (ramus acetabulans). Nhanh sau
phan chia d trtfdc cd vuong dui thanh cac nhanh len (ramus ascendens), nhanh
xuong (ramus descendens), cap mau cho chom va co xu'dng dui (collum femoris).
Nhanh nong di qua khe giua cd vuong dui va cd khep ldn, tiep noi vdi dong mach
mu dui ngoai, dong mach mong dtfdi va dong mach xien I.
- Cdc dong mach xien (Aa. perforantes): thtfdng cd ba dong mach xien, la
nhtfng nhanh ben va nhanh tan cua dong mach dui sau, xuyen qua cho bam cua
cd khep ngan va cd khep ldn ra khu dui sau. Moi dong mach lai chia nhanh len va
nhanh xuong ndi tiep vdi nhau. 0 tren nhanh len cua dong mach xien I tiep noi
vdi cac dong mach mu dui va dong mach ngoi. Phia dtfdi nhanh xuong cua dong
mach xien III noi vdi dong mach goi ben ngoai, nhanh cua dong mach khoeo.

1.3.5. D o n g m a c h g o i x u o n g (A. descendens genus): dong mach goi xuong la

nhanh ben cuoi cung cua dong mach dui, ttf ong cd khep xien ra nong, di xudng
roi chia lam hai loai nhanh:
+ Cac nhanh khdp (rami articulares) noi vdi mang khdp goi (rete articulare genus).
+ Nhanh hien (ramus saphenus) xudng cap mau cho da vtfng cd bung chan
(phia trong).

2. D O N G M A C H K H O E O (arteria poplitea) (Hinh 19.3, 19.4, 22.14, 23.1)

2.1. N g u y e n u y v a ta n cu n g

Dong mach khoeo tiep theo dong mach dtfi, bat dau ttf lo ha gan khep di
xuong tdi bd dtfdi cd khoeo thi chia lam hai nganh tan: dong mach chay trtfdc va
dong mach chay sau (Hinh 19.4).
F E E l’ ij GIAI P H A U N G U O l. T A P I

2.2. D u’d n g d i v a li e n q u a n c h i n h
Dong mach chay qua cham khooo. doan dau hdi chech tu tren xuong d tfd i. ta
trong ra ngoai. tdi giua khoeo chay thang xudng.
() khooo dong mach nam sau nhat va trong nhat, roi tdi tinh math khooo, roi
than kinh chav nam ndng nhat va ngoai nhat.

H inh 19.4. Sd do m an g m ach q u a n h banh ch e (Theo Trinh Van M inh;

1 Nhanh xuong cua dong mach mG dui ngoai; 2 Dong mach goi tren ngoai; 3. Dong mach goi dtfdi
ngoai; 4. Dong mach quat ngudc chay sau; 5. Dong m ach mu mac; 6. Dong mach quat ngifdc chay
tru'dc; 7. Dong mach chay tru'dc. 8. Dong mach chay sau; 9. Dong mach goi difdi trong 10. Dong
mach goi tren trong; 11. Dong mach goi xuong. 12 Dong mach dui.

2.3. N g an h ben va noi tiep

* Dong mach khoeo cho bay nhanh ben:
+ Dong mach goi tren ngoai (A. superior lateralis genus).
+ Dong mach goi tren trong (A. superior medialis genus).
+ Dong mach goi gitia (A. media genus).
+ Cdc dong mach cd bung chdn (A. surales), thtfdng co hai cho 2 dau trong va
ngoai cd bung chan.
 D O N G M A C H CHI DlfO! S ' 325

+ Dong mach goi du’di ngoai (A. inferior lateralis genus).

+ Dong mach gdi dtfdi trong (A. inferior medialis genus).
• Hon nhanh goi tren trong, tren ngoai, du'di trong, dudi ngoai, phan nhanh va
tiep noi vdi nhau tao thanh hai mang mach:
- Mang mach khdp goi (rete articulare genus).
- Mang banh che (rete patellare).
Cac mang mach nay cdn nhan:
• Nhanh khdp cua dong mach goi xuong.
• Nhanh xudng cua dong mach mu - dui ngoai.
• Dong mach quat ngtfdc chay trtfdc (A. recurrens tibialis anterior).
• Dong mach quat ngtfdc chay sau (A. recurrens tibialis posterior).
• Nhanh mu mac (ramus circumflexus fibularis).
Mac du co nhieu ndi tie]) nhtfng dong mach khoeo neu that van rat nguy hiem.
vi cac nhanh noi nho va kho phat trien trong md xo.

3. D O N G M A C H C H A Y T R U O C (A. tibialis anterior) (Hinh 19.2. 2 1.2)

3.1. N guyen uy, du’d ng di, tan cu n g

La mot trong hai nhanh tan cua mach khoeo. bat dau ttf bd dtfdi co khoeo di
qua bd tren mang gian cdt ra khu cang chan tru'dc. Tiep tuc di xudng theo dtfdng
dinh hudng ttf hom tru'dc dau tren xifdng mac tdi gitfa hai mat ca. roi chui qua
mac ham cac gan duoi d cd chan, ddi ten thanh dong mach mu chan.

3.2. N ganh ben va noi tiep

3.2.1. Dong mach quat ngtfdc chay sau (A. recurrens tibialis posterior) khong
hang dinh, tach ttf khi dong mach cdn d khu cang chan sau. di ngudc len tiep noi
vdi dong mach goi dudi ngoai.

3.2.2. Dong mach quat ngtfdc chay trtfdc (A. recurrens tibialis anterior) tach
ngay khi dong mach chay trtfdc qua mang gian cdt ra trtfdc cang chan, chay len
noi vdi dong mach gdi dudi ngoai, nhanh cua dong mach khoeo.

3.2.3. Dong mach mat cd trtfdc ngoai (A. malleolaris anterior lateralis): noi
vdi nhanh xien (ramus perforens) va cac nhanh mat ca ngoai cua dong mach mac,
va dong mach cd chan ngoai cua dong mach mu chan, tao thanh mang mach mat
ca ngoai (rete malleolare laterale).

3.2.4. Dong mach mat cd trtfdc trong (A. malleolaris anterior medialis): noi
vdi cac nhanh mat ca trong (rami malleolares mediales) cua dong mach chav sau.
cac dong mach co chan trong (Aa. tarsales mediales) cua dong mach mu chan, tao
thanh mang mach mat ca trong (rete malleolare mediale).
326 U G I AI P H A U NGUCJI. T A P I

o ■* » ,
3.2.5. C dc n h a n h n u o i CO k h u c a n g c h d n triidc va c a n g c h d n n g o a i
Do co nhieu nhanh noi nen dong mach chay trtfdc cd the that ma khong
nguy hiem.

4. D O N G M A C H M U C H A N (arteria dorsalis pedis) (Hinh 19.2. 26.1)

4.1. N g u y en uy, du’dng di, tan cu n g

Tiep theo dong mach chay trtfdc, bat dau ttf dtfdi mac ham cac gan duoi di xuong
mu chan theo mot dudng ttf gitfa hai mat ca. den dau gan khoang gian cot ban chan
1 thi chia thanh dong mach mu hdn chdn thd I va dong mach gan chdn sau.

Hinh 19.5. Cac dong mach d mu chan

1 Dong mach xien (nhanh cua DM mac), 2 Dong mach m it ca tru’dc ngoai; 3 Cac dong mach mu
ban chan; 4 Cac dong mach xien tru’dc: 5 Cac nhanh mu cua cac dong mach gan ngon chan neng I
6. Cac dong m ach mu ngon chan 7 Cac dong mach xien sau; 8 Dong m ach gan chan sau
9 Dong mach cung; 10. Dong m ach co chan trong. 11. Dong mach co chan ngoai 12 Gan cd chay
tru'dc; 13. Dong m ach mu chan, 14 Dong mach mat ca tru’dc trong; 15. Cd dudi dai ngdn cai,
16. Dong mach chay tru’dc.

4.2. N g a n h b en va noi tiep

4.2.1. Dong mach co chdn ngoai (A. tarsalis lateralis): di ra phia ngoai mu
chan, phan nhanh cho cd duoi ngan cac ngon chan va noi tiep vdi dong mach mat
 D O N G M A C H CHI D l/O l H 327

ca triidc ngoai cua dong mach chay tru’dc, nhanh xien cua dong mach mac, dong
mach cung cua dong mach mu chan, gop phan tao thanh mang mach quanh mat ca
ngoai (Hinh 19.5).
4.2.2. Cdc d on g m a c h co c h a n tr o n g (Aa. tarsales mediales): phan nhanh va tiep
no! vdi dong mach mdt ca trong tao thanh mang mach mat ca trong (rete malleolare
mediale).

4.2.3. D ong m ach c u n g (A. arcuata): la nhanh ldn nhat tach ttf dong mach mu
chan d nen xtfdng ban chan I, ttf do chay cong ra ngoai bat cheo dau gan cac
xtfdng dot ban chan, d dtfdi gan cd duoi dai va duoi ngan cac ngdn chan, tan het d
mat ngoai ban chan, noi tiep vdi cac dong mach co chan ngoai va gan chan ngoai.
Ttf dong mach cung tach ra cac dong mach mu ban chan (Aa. metatarsales
dorsales), chay trong cac khoang gian cdt ban chan II, III va IV. Mdi dong mach
tach ra c’> dau gan mot ulianh xien sau noi vdi cung mach gan chan sau (arcus
plantaris profundus), va d dau xa mot nhanh xien tru’dc noi vdi dong mach gan
ngon chan chung tudng tfng (A. digitale plantare commune), roi chia doi thanh
cac dong mach mu ngdn chan (A. digitales dorsales) di vao hai mat ben cac ngdn
chan III, IV, mat ngoai ngdn II va mat trong ngdn V.

1.2.4. D o n g m a c h g a n c h d n s a u (A. plantaris profundus): la nhanh tan cua

dong mach mu chan di xuong gan chan, qua khe gitfa 2 dau nguyen uy cua co
gian cdt mu chan I, xudng gan chan noi vdi dong mach gan chan ngoai.

4.2.5. D o n g m a c h m u ba n c h d n I: dong mach nay tach ra mot nhanh trong vao

mat trong ngdn chan cai. roi tiep tuc chay thang den ke ngdn chan I thi chia doi
thanh cac dong mach mu ngdn chan di vao mat ngoai ngdn chan cai va mat trong
ngon II.
Cd mot so trtfdng hdp dong mach chay trtfdc rat nhd. tan het 0 mot phan ba dudi
cang chan; Nhanh xien (ramus perforans) cua dong mach mach mac (A. fibularis;
peronea) rat to. phan nhanh va lam thay nhiem vu cua dong mach mu chan.

5. D O N G M A C H C H A Y S A U (arteria tibialis posterior) (Hinh 19.3, 24.6)

5.1. N g u y en uy, dufdng di, tan cu n g

Dong mach chay sau la nhanh tan chinh cua dong mach khoeo. Bat dau ttf
bd dtfdi cd khoeo. dong mach chay xuong ldp sau vtfng cang chan sau, d hai
phan ba tren theo dtfdng thang ttf gitfa nep gap khoeo tdi gitfa hai mat ca, tdi
mot phan ba dtfdi can g chan thi hdi chech vao trong, chay gitfa bd sau mat ca
trong va gan got, rdi vong qua mat trong xtfdng got, d dtfdi mac ham cac gan
gap rdi chia lam hai nganh tan la dong mach gan chan trong va dong mach
gan chan ngoai.
328 j f j l G I AI P H A U N G U O I TAP I

5.2. L ie n q u a n c h i n h
Dong mach nam giua hai ldp cd vung cang chan sau. dtfdi mac ngang sau
cang chan. Cung di co hai tinh mach chay sau. va than kinh chay nAm ngoai
dong mach.

5.3. N g a n h b o n

5.3.1. Cdc n h a n h cd: cap mau cho cdc cd vung cang chdn sau.

5.3.2. N h a n h m u m a c (ramus circumflexus fibularis): di vong qua chom xtfdng

mac len noi vdi nhanh goi dtfdi ngoai. gop phan vao mang mach khdp goi.

5.3.3. D o n g m a c h m a c (A. fibularis): tach ttf dong mach chay sau do 2 - 3cm
dudi cd khoeo. Ltfc dau nam gitfa cd chav sau va pd gap dai ngon cai. roi di sau
vao gitfa cd gap dai ngon cai va xtfdng mac, tdi co chan nam sau khdp chav mac
va tan hot cho cac nhanh tdi co chan va got.
Phan nhanh:
Cdc nhanh nuoi cd khu cang chan ngoai va xtfdng mac.
Nhanh xien (ramus porforans): choc qua phan duoi vach gian cot ra tru'dc.
Nhanh ndi (ramus communicans): noi vdi dong mach chay sau d ngang co chan.
Cdc nhanh mat cd ngoai (rami malleolares laterales): noi voi dong mach
mat ca tru'dc ngoai cua dong mach chay trudc.

5.3.4. Cdc n h a n h m at cd tr o n g (r a m i m a l l e o l a r e s m e d i a l e s ) cu a dong

m a c h c h a y s a u : Xoi vdi dong mach mat ca trUdc trong (A. malleolaris anterior
medialis) cua dong mach chay tru'dc va cac dong mach co chan trong (A. tarsales
mediales) cua dong mach mu chan, tao thanh mang mach mat ca trong (rete
malleolare mediale).

5.3.5. C dc n h a n h g o t (rami calcanei) cua dm chay sau: cap mau cho vung got
va noi tiep vdi cac nhanh got cua dong mach mac tao thanh mang mach got (rete
calcaneu m).

6. D O N G M A C H G A N C H A N T R O N G (A. plantaris medialis) (Hinh 19.3.

19.6, 26.4. 26.5)

6.1. N g u y en uy, difd ng di, tan cu n g

Dong mach gan chan trong la mot trong hai nganh tan cua dong mach chay
sau, bat dau ttf tang tren ranh cd gap dai ngon cai d m&t trong xtfdng got. di
xuong gan chan roi di thang ra trtfdc doc theo bd trong gan cd gap dai ngon cai,
den dau gan xtfdng ban chan I thi tan het bang cach chia 2 nhanh nong noi tiep
vdi nhanh bd trong ngon cai va vdi cac dong mach gan ban chan I, II, III.
 D O N G M A C H C H I D lT O l 329

6.2. Phan n h an h . Theo TNGPQT (N.A. 1985 va T.A. 1997) dong mach co 2 nhanh
nong va nhanh sau. Song thtfc te:
- Nhanh sau (ramus profundus): gom nhieu nhanh ben. tach tren dudng di
ciia dong mach, cap mau cho cd. xu’dng, khdp d phia trong gan chan.
- Nhanh ndng (ramus superficiales): la nhanh chinh tiep tuc di thang den
dau xu'dng ban chan 1. phan lam 2 nhanh tan, nhanh trong cap mau cho mat trong
ngon chan cai. Nhanh ngoai toa nhanh tiep noi vdi cac dong mach gan ban chan
I, 11, va 111 cua dong mach gan chan ngoai (Hinh 19.6).

Hinh 19.6. Cac dong mach cl gan chan

1. DM gan ngon chan chung; 2. DM gan ban chan; 3. DM gan chan ngoai (doan ngang); 4 DM gan
chan ngoai (doan chech); 5. Nhanh got; 6. Dong mach chay sau; 7. Dong m ach gan chan trong.
8. Nhanh sau; 9. N hanh nong; 10. Cac dong mach xien sau; 11. Dong mach gan chan sau; 12. Cac
dong mach xien trtfdc. 13. DM gan ngon chan rieng.

7. DONG MACH GAN CHAN NGOAl (arteria plantaris lateralis) (Hinh

19.3, 19.6, 26.4, 26.5)
330 igj G I AI P H A U N G l / O l . T A P I

7.1. N g u y en uy, dvfofng di, tan cu n g

Dong mach gan chan ngoai la nganh tan ldn hdn cua dong mach chav sau, di
qua tang dudi ranh cd gap dai ngdn cai d mat trong xUdng got roi chav chech ra
ngoai bat cheo gan chan, tdi nen xUdng ban chan V thi tat ngang vao trong, noi
tiep vdi nhanh gan chan sau cua dong mach mu chan d khoang gian cot I, tao
thanh cung gcin chdn sciu (arcus plantaris profundus).

7.2. P han nhan h

7.2.1. D o a n c h e c h , ttf nguyen uy den nen xtfdng ban chan thtf V. dong mach gan
chan ngoai tach ra cac nhanh cho cac cd lan can va cho da d phia ngoai gan chan.

7.2.2. D o a n n g a n g h a y c u n g g a n c h d n s a u t a c h ra
- Ba nhanh xien (rami perforantes): chui qua cac khoang gian cot ban chan noi
tiep vdi cac dong mach mu ban chan II. Ill va IV (cua dong mach cung d mu chan).
Bon dong mach gan ban chdn (A. metatarsales plantares): di ra trtfdc doc
thoo cac khoang gian dot ban chan I. II. Ill va IV, nhan cac nhanh xien (rami
perforantes) ciia cac dong mach mu ban chan, roi doi ten thanh cac dong mach
gan ngon chan ch u n g (Aa. digitales plantares communes), rat ngan. moi dong
mach nay lai chia doi thanh cdc dong mach gan ngon chdn rieng (Aa digitales
plantares propnae) di vao hai mat ben cua ngon chan II. Ill, IV. mat ngoai ngon I
va mat trong ngdn V.
(Ttfdng tu nhtf d ban tay, cac dong mach gan ngdn chan rieng ldn hdn cac
dong mach mu ngon chan, va cho nhtfng nhanh tan nho cti len cap huyet cho da d
mu clot xa ngon chan).
- Nhanh gan ngdn chan rieng cho mat ngoai ngdn V.

TINH MACH CHI Dtfdi

( V e n a e m e m b r i in fe r io r is )

Cung nhtf chi tren, chi du'di cd hai he tinh mach sau va nong.

1. C A C T IN H M A C H S A U C H I D l/C fl (venae profundae membri inferioris)

Cac tinh mach sau cua chi dtfdi di theo cac dong mach cung ten. dan mau
tinh mach ve tinh mach chau ngoai (vena iliaca externa). Mot phan nho di theo
cac dong mach ttf nguon chau trong. do ve tinh mach chau trong (vena iliaca
interna). Cac tinh mach ldn nhtf tinh mach khoeo, tinh mach dui chi co mot, con
cac tinh mach khac co hai. di kem dong mach.
 D O N G M A C H CHI D l/O l [jj|| 331

Hinh 19.7. TTnh mach nong d chi dudi

1. Cung tTnh mach mu chan; 2. Cac tTnh mach bd trong; 3. TTnh mach hien ldn (nguyen uy); 4. TTnh
mach hien ldn (d cSng chan); 5. TTnh mach hien ldn (d dui); 6. TTnh mach dui; 7. Co ban mac; 8. TTnh
mach hien be; 9. TTnh mach hien be; 10. Mat ca trong; 11. TTnh mach hien be. 12. TTnh mach khoeo;
13. Gan co nhi dau dui.
332j[g j GI A I P H A U NGUCJl. T A P I

- () ban chan: hai tinh mach mu chan cl 1 theo 2 ben dong mach mu chan len
tiep tuc do vao 2 tinh mach chav tru'dc. Cac tinh mach gan chan trong va gan
chan ngoai di theo cac dong mach cung ton tap trung do vao hai tinh mach chay
sau d phia trong co chan (Hinh 19.7).
- 0 cang chan: hai tinh mach chay trtfdc (Vv. tibiales antenores) di theo dong
mach chay trudc. Hai tinh mach chay sau (Vv. tibiales postenores) di theo dong
mach chay sau.
- 0 khoeo: cac doi tinh mach chav trtfdc va chav sau chap vao nhau thanh
mot tinh mach khoeo (V. poplitea). tinh mach khoeo qua lo ha gan cd khep doi ten
thanh tinh mach dui (V. femoralis).
- 6 dtfi: tinh mach dui nhan tinh mach dtfi sau (V. profundus femoralis) va tinh
mach hien ldn. roi chui dtfdi day ch£ng ben doi ten thanh tinh mach chau trong.

2. CAC T IN H M A C H N O N G CH I Dl/Cfl (venae superficiales membri inferioris)

Cac tinh mach nong chi dtfdi gom cac tinh mach nam ngay 0 lop mo te bao dtfdi
cla. khong cd dong mach di kem. bat dau ttf cac tinh mach d ngdn chan, ban chan.

2.1. d gan ch an
Cac tinh /nach gan ngon chdn (V. digitales plantares) di doc hai ben mat gan
ngdn chan, chap vao nhau 0 ke cac ngdn chan roi chu yeu thong qua cac tinh
mcich gian chom (V. mtercapitulares) do vao he thong cac tinh mach mu chan.
Cac tinh mach nay cung nhan them nhung nhanh nhd ttf phia gan chan, dan
ltfu mot phan mang tinh mach gan chdn (rete venosum plantare) ma mot sd tac
gia cdn goi la de tinh mach.
Ttf mang tinh mach gan chan cdn cd nhtfng nhanh do qua bd trong va bd
ngoai ban chan len phia mu chan, goi la tinh mach bd trong (V. marginalis medialis)
va tinh mach hd ngoai (V. marginalis lateralis).

2.2. d m u ch an

Cac tinh mach mu ngon chdn (V. digitales dorsales pedis) chap vao nhau tao
thanh cac tinh mach mu ban chdn (V. metatasales dorsales). Cac tinh mach nav
cdn nhan them cac tinh mach gian chom roi do vao cung tinh mach mu chdn.
Cung tinh mach mu chan (arcus venosus dorsalis pedis) nam d nong trong ldp md
dtfdi da, tren cac than kinh, chav ngang qua dau xa cac xtfdng ban chan. D&u
ngoai cua cung nhan them tinh mach mu trong ngdn cai, tao thanh tinh mach
hien l&n. Cdn nhieu tinh mach khong ten noi tiep gitfa cung mu chan va cac tinh
mach hien d gitfa mu chan, tao thanh mang tinh mach mu chan (rete venosum
dorsale pedis). Cac tinh mach hien cung con nhan cac tinh mach bd trong
(V. marginalis medialis) va bd ngoai (V. marginalis lateralis) ttf m ang tinh mach
gan chan di len.
 D O N G M A C H CHI Dl/01 [j i 333

2.3. Tinh m ach h ien ldn (V. saphena magna)

La tinh mach dai nhat cua cd the, tiep theo dau trong cung tinh mach mu chan
va tinh mach mu trong ngon cai, di len qua phia trtfdc mat ca trong, doc theo phia
trong cang chan, goi va dui, roi do vao tinh mach dui 6 3cm dtfdi day chang ben.
Tren dudng di tinh mach hien ldn nhan nhieu cac tinh mach nong nho:

- C) cang chan: cac nhanh tii mu chan, got chan, mat trifdc cang chan, goi,
nhanh ndi vdi tinh mach hien be.

- 0 dui: cac nhanh tu1mat trtfdc va mat ngoai dui, va 1 tinh mach hien phu
kha ldn (V. saphena accessoria) dan mau ttf mat trong va mat sau dui.
- 0 phan tren cua dui: trtfdc khi tinh mach chui vao lo ha tinh mach hien, no
con nhan:
+ Cac tinh mach then ngoai (Vv. pudendae externae).
+ Tinh mach mu chau nong (V. circumflexa iliaca superficialis).
+ Tinh mach thudng vj nong (V. epigastrica superficialis).

2.4. Tinh m ach h ien be (V. saphena parva)

Tinh mach hien be bat nguon tif dau ngoai cung tinh mach mu chan va tinh
mach mu ngoai ngon lit. Tif doc bd ngoai mu chan di len d sau mat ca ngoai. theo
bd ngoai cua gan got. roi di chech dan vao giua mat sau cang chan len vung
khoeo. choc qua mac khoeo do vao tinh mach khoeo.
Tren du'dng di. tinh mach hien be nhan nhieu linh mach nho. va co nhieu
nhanh ndi thong vdi he tinh mach sau.
(’ a hai tinh mach hien ldn va be deu co nhieu van. l i n h mach hien ldn cd tif
10 den 20 van. Tinh mach hien be cd ttf 4 den 10 van. Sd lifdng van thay doi theo
tuoi va gidi.
Cac tinh mach hien hay bi gian nhat la d phu nu de nhieu hoac do nghe nghiep
phai dtfng nhieu.

BACH HUYET 6 CHI Dtfdi

0 chi difdi co hai toan hach bach huyet chinh.

1. CAC H A C H B A C H H U Y E T K H O E O (nodi lymphatici popliteales)

Cac hach bach huvet khoeo co tif 3 - 6 hach:

- Mot hach nam d ndi tinh mach hien be do vao tinh mach khoeo. mot hach 6
334 B G I AI P H A U NGLTOI. T A P I

sau khdp goi, hach chay trtfdc (nodus tibialis anterior) nam d ndi tach ra dong
mach chay tru’dc, hach chay sau (nodus tibialis posterior) nam d dau tren dong
mach chay sau, hach mac (nodus fibularis) nam 6 cho tach ra dong mach mac.
- Cac hach bach huyet khoeo nhan bach huvet cua cac bach mach di theo
dong mach chav sau. dong mach chay tru'dc, dong mach mac.

2. C A C H A• C H B A• C H H U Y E T d B E• N

Com cac hach ben nong va ben sau.

2.1. Cac h ach b ach h u y et ben n on g (nodi lymphatici inguinales superficiales)

Co 8 den 12 hach, co khi nhieu hdn, nam ngoai mac rong d thanh trtfdc tam giac
dui, chia thanh 4 nhom:
- Cdc hach bach huyet ben ndng tren trong (nodi lymphatici inguinales superficiales
supero-mediales) nhan bach huyet ttf bo phan sinh due ngoai. day chau, phan
thanh bung trtfdc du'di ion.
- C d c hach bach huyet ben ndng tren ngoai (noch lymphatici inguinales superficiales
supero—laterales) nhan bach huyet 6 ben d vung mong.
- Cdc hach bach huyet ben ndng dtfdi (nodi lymphatici inguinales superficiales
inferiores) thtfdng co 4 - 5 hach. nam doc theo phan tan cua tinh mach hien ldn.
Nhan bach huvet nong cua chi du'di.

2.2. Cac h ach b ach h u y et ben sau (nodi lymphatici inguinales profundi)
Gom 2 — 3 hach nam dudi mac sang (fascia cribosa), trong ong din (canalis
femoralis). Hach thap nhat d dau dudi ong dui gan lo tinh mach hien (hiatus
saphenus), hach to nhat nam d dau tren ong dui co vong dui (anulus femoralis)
bao quanh. O day co the xay ra thoat vi dui. khoi thoat vi n^m trong ong dui.
Hach bach huyet ben sau nhan bach huyet d bo phan sinh due ngoai va ttf cac
hach ben nong.

3. B A C H M A C H

- Cac bach mach nong: co 3 dong chinh:

Dong trong va ngoai di theo tmh mach hien ldn, do vao cac hach ben nong.
Ddng sau di theo tinh mach hien be do vao cac hach bach huyet d khoeo.
- Cac bach mach sau: di theo cac dong mach chay sau, chay trtfdc va dong
mach mac do vao cac hach bach huyet d khoeo, roi ttf cac hach bach huyet khoeo.
cac mach di theo dong mach dui len do vao cac hach ben sau, hoac cac hach bach
huyet chau ngoai.
 T H A N KINH CHI DUOI [jlj 335

20. THAN KINH CHI DUC5I

Cac day than kinh chi phoi chi dtfdi deu tach ttf dam roi that ltfng va dam roi
cung, cdn dtfdc goi chung la dam roi that ltfng cung (plexus lumbosacralis).

1. d A M R O I T H A N K IN H T H A T L l/N G (p lexu s lu m b alis)

1.1. Cau tao

Dam roi than kinh that ltfng dtfdc tao bdi cac nganh trtfdc cua bon day song
that ltfng I, II, III, IV. Cac nganh nay lai chia ra cac nhanh trtfdc va sau.
- Cac nhanh sau tao thanh cac day than kinh chau ha vi, than kinh chau - ben,
than kinh dui bi ngoai va than kinh dui.
- Cac nhanh trtfdc tao thanh than kmh sinh due dui. than kinh bit Xganh
trtfdc cua that ltfng IV chap vdi nganh trtfdc that lung V tao thanh than that lung
cung (truncus lumbosacralis) (Hinh 20.1).

Hinh 20.1. Sd do cau tao dam roi than kinh that lung (cac day trang d trtfdc, cac day den d sau)
1. Than kinh chau ha vi; 2. Than kinh chau ben; 3. Than kinh dui bi ngoai; 4. Than kinh sinh due dui;
5. Than kinh dui; 6. Than kinh that ltfng cung; 7. Than kinh b|t.

1.2. Cac n h a n h ta n

1.2.1. D d y th a n k i n h c h a u - h a vi (nervus iliohypogastricus):

- Nguyen uy: nhanh sau cua nganh trtfdc than km h that ltfng I.
E S S GI A I P H A U N GL/ Ol . T A P

- Dtfdng di: thoo dtfdng vong ttf tren xuong dtfdi. tu sau ra trtfdc. ttf sau ra
nong. qua cac 16p cd cua thanh bung, d tren mao chau. va cung dui. tdi vung lo
ben nong.
- Chi phoi: than kinh chau ha vi cho hai nhanh tan la nhanh bi ngoai (ramus
cutaneus lateralis) cam giac da vung mu - chau. va nhanh bi trudc (R. cutaneus
anterior) cam giac da vung ben - bung. Ngoai ra co mot so nhanh vao van dong
cho cac co' l ong bung.

1.2.2. D ay th an hinh c h a u ben (N. ilioinguinalis)

- Nguyen uv: nhanh sau nganh trtfdc than kinh that ltfng I.
- Duong di: tudng tu day chau - ha vi. (di d dtfdi va gan song song vdi day
chau ha vi).
- Chi phoi: cam giac da ben va da bo phan sinh due ngoai. Mot so nhanh cho
phan dtfdi cac cd rong bung

1.2.3. Than hinh du i - hi n g o a i (X. cutaneus femoris lateralis)

Xguyen uv: hop bdi hai re thuoc cac nhanh sau cua nganh trudc cac day
than kmh that lung 11 va that lung 111
-- Dudng di: di ngang qua phan that lung cd that lung chau. thoat ra d bd
ngoai cd toi hd chau. chui du'di day chang ben 0 ngoai bao cd that ltfng chau. roi
chia lam hai nhanh di xudng mat ngoai dui.
Xhanh tru'dc cam giac cho da phia tru'dc ngoai cua dui. Xhanh sau cam giac
phia sau ngoai cua dui.
1.2.4. T han h in h d u i (X. lermoralis)
- Xguyen uy: hop boi cac nhanh sau cua nganh tru'dc cac day than kinh that
lung II. III. IV.
- Dudng di: di tu tren xudng dudi. luc dau giua hai bd cua cd that lung to. 101
theo doc bd ngoai co dd. chui dudi day chang ben. trong bao co that lung - chau.
xudng dui chia lam ba loai nhanh tan (Hinh 20.2).
+ Cdc nhanh cd (rami musculares): van dong cd ttf dau. cd ludc. cd may va
phan nho cd khep dai.
+ Cac nhanh bi tru’dc (rami cutanei anteriores): thtfdng choc qua cd may. cam
giac phia trtfdc cua dui.
+ Than kinh hien (X. saphenus): di qua tam giac dui vao ong cd khep roi ra
ndng chia lam hai nhanh:
Nhanh du’di banh che (R. infrapatellaris): cam giac da 6 mat trong khdp goi.
Cdc nhanh bi cang chdn trong (rami cutanei cruris mediales): di xuong cam
giac cho da mat trong cang chan va mot phan da got.
0 doan tren day chang ben. day than kinh dui con tach ra nhanh van dong cd
that ltfng - chau.
 TH A N K INH CHI D lfO l 337

1. Than kinh ha sudn 12;

2. Than kinh chau ha vi;
3. Than kinh chau ben;
4. Cd that ltfng chau;
5. Than kinh dui bi ngoai;
6. Than kinh dui;
7. Co Itfdc,
8. Co may;
9. Cd th§ng dui;
10. Ca rong ngoai;
11. Cd rong gitfa.
12. Cac nhanh bi trade;
13. Cd rong trong
14. Than kinh mac chung (hong khoeo ngoai),
15. Than kinh mac nong (cd bi);
16. Cd mac dai,
17. Cd mac ngan;
18. Than kinh bi mu chan gitfa,
19. Than kinh bi mu chan ngoai (nhanh tan cua
than kinh bung chan);
20. Cac than kinh mu ngon chan,
21. Cd duoi ngan ngon chan;
22. Than kmh bi mu chan trong.
23. Cd mac trtfdc;
24. Cd duoi dai ngon cai;
25. Cd duoi dai ngon chan;
26. Cd chay trtfdc;
27. Than kinh mac sau (chay tru'dc);
28. Nhanh bi c in g chan trong (cua than kinh hien);
29. Than kinh hien;
30. Nhanh bi dui trong (cua than kinh bit);
31. Cd khep ldn;
32. Cd khep dai;
33. Cd thon;
34. Cd khep ngan;
35. Cd bjt ngoai;
36. Cac nhanh sinh due,
37. Than kinh bit;
38. Than kinh sinh due dui;
39. Dam roi that ltfng.

Hinh 20.2. D am roi th a t lim g va chi phoi than kinh chi du’di (mat trtfdc) (Theo Tnnh Van Minh)

22- GDIU T1
FE TI 'I GIAI PH A U N G U O I T A P I

1.2.5. I)dy th an hinh sin h d u e d u i (X. genitofemorahs)

Xguven uy: nhanh tru'dc cua nganh trudc than kinh that lung I va mot
nhanh nhd tu day that lung 11
Dudng di va chi phoi: tu nguyen uy di chech xuong du'di va ra ngoai. roi
chay chech vao trong giufa 2 bo cua cd that lung to. thoat ra d bd trong cd. qua day
chang ben phan lam hai nhanh:
+ Nhanh dui (R. femoralis): cam giac da vung tam giac dui.
+ Nhanh sinh due (R. genitalis): cam giac da vung sinh due ngoai.

1.2.6. Ddy th a n hinh bit (N. obturatonus)

- Nguyen uy: hdp bdi cac nhanh triidc cua nganh triidc cac than kinh that
lung 11, III va IV.
- Dudng di: di xudng giufa 2 bo cua cd that liing to, thdat ra d bd trong cd,
xudng chau nho. tdi Id bit ( f o r ame n o b t u r a t u m) . chui qua r anh bit ( su Icum
o b t u r a t o n u s ) . x u d n g dui phan l am hai nhanh:
+ Nhanh tru'dc (R. anterior): phan nhanh van dong cac co bjt ngoai. cd khop
ngan, mot phan cd khep dai va co thon. rdi tan het bang mot nhanh bi (R
cutaneus) di thang xudng. cam giac da mat trong khdp goi.
+ Nhanh sau (R. posterior): di giua cac cd o dui trong. phan nhanh van dong
co' khep ldn va cam giac khdp hong.

2. DAM R O I C U N G (plexus sacralis)

Dam rdi cting nam sat thanh sau chau hong, ngay phia ben cua xudng cung
va trudc cd hinh qua le.

2.1. Cau tao va p h a n n h an h dai ctfcfng

Dam roi cung dude cau tao bdi than that lung cung (truncus lumbosacralis)
va nganh trudc cua cac day cung I. II. Ill va IV. (Than that lung cung do mot
phan nganh trudc day than kinh that lung IV va toan bo nganh trudc cua day
that lung V tao thanh (Hinh 20.3).
Cac nhanh nguyen uy ke tren gop phan tao thanh day than kinh ngoi va cac
nhanh khac ctia dam rdi cung bang cach cung chia thanh cac phan trudc va cac
phan sau tudng tti nhu cac nhanh trtfdc nhanh sau cua cdc than nguyen uy dam
roi canh tay, nhtfng khong tach rdi ro ret nhtf d dam roi cdnh tay.
- Cae phan hay cac sdi d sau tao thanh than kinh mong tren (ttf TL4 - 5. Cl);
than kinh mong dudi (tu TL5 va C l - 2): phdn mac chung cua than kmh ngoi (td
I'L l tdi C2); than kinh cd hinh qua le (ttf C2); than kinh xien bi (X. cutaneus
perforans) (ttf C2 - 3) v.v...
 T H A N KINH CHI D U O I [jl 339

TL4

H inh 20.3. Sd do cau tao dam roi cu n g (Theo Holinshead)

1. Than kinh mong tren. 2. Than kinh mong du'di. 3. Phan mac chung cua TK ngoi (than kinh mac
chung); 4. Phan chay cua TK ngoi (than kinh chay); 5. Than kinh cd vuong dui va co sinh doi dudi, 6
Than kinh cd bit trong va cd sinh doi tren; 7. Than kinh dui bi sau, 8. Than kinh xien bi 9 Than kinh
then: 10, Than kinh cd nang hau mon, 11, Than kinh cd ngoi cut, 12 Than kinh cd hau mon cut 13
Than kinh tang chau hong: 14. Than kinh cd hinh qua le
* [Cac phan trang den gidi thieu cac sdi tru'dc sau cua cac re than kinh tudng Ung thuc te khong tach rdi
ma van hoa lan thanh nhung than chung. Cac bo so 3 + 4 thuc te van hoa chung thanh 1 day TK ngoi],

- Cac phan hay cac sdi d trifdc tao thanh phan chay cua than kinh ngoi (tii
TL 1 tdi C3); than kinh then (tif C2 - 3.4); than kinh cd vuong din va cd sinh ddi
difdi tif (TL 4 - 5 - C l); than kinh cd sinh doi tron va co bit trong (tif TL5 + C l - 2);
than kinh cO nang hau mon va cd ngoi cut (tif C3 - 4); than kinh dui bi sau (do
cac sdi sau cua C l. 2 va cac sdi trifdc cua C2. 3).

2.2. M o ta cac n h a n h ch in h

2.2.1. T h a n k in h m o n g tr e n (N. glutous superidr)

- Nguyen uy: hdp bdi cac nhanh tach tif phan sau than that lung - cung va
day cung 1.
- Du'dng di va chi phoi: di cung dong mach va tinh mach mong tren qua
khuyet ngoi ldn d bd tren cd hinh qua le, roi chia lam hai nganh chay giua cd
mong nhd va cd mong be van dong cho hai cd nay va cd cang mac rong.
340 0 G I AI P H A U N G U O I . T A P I

2.2.2. Than hinh m o n g diidi (X. gluteus inferior)

- Nguyen uy: do cac nhanh tu phan sau cua day than kinh that lung V, cung
I, cung II tao thanh.
- Dudng di va chi phoi: tif trong chau hong qua khuyet ngoi ldn ra vung mong
d du'di cd hinh qua le roi phan nhanh cho cd mong to.

2.2.3. T han k in h d u i - bi s a u (Nervus cutaneus femoralis posterior)

- Nguyen uy: do hai phan hdp lai:
Phan ngoai: do cac sdi tii phan sau cua nganh trUdc cac day song cimg I, II.
Phan trong: do cac sdi tif phan trUdc cua nganh trifdc cac day song cung II V&
III (Hinh 20.3, 20.4).
- Dudng di: tif trong chau hong qua khuyet ngoi ldn d bd difdi cd hinh qua le
ra vung mong. nam giCfa cd mong ldn va cac cd chau hong — mau chuyen, roi tiep
tuc chay xuong khu dui sau.
- Phan nhanh va chi phoi:
Cac nhanh bi mong du'di (rami clunium mfenores): vong qua bo dudi cd mong
to ra nong, cam giac da o phan dudi ngoai cua mong.
Cac nhanh clay chau (rami perineales): cam giac cd quan sinh due ngoai.
Nhanh tan: chav xuong tdi khoeo. phan nhanh cam giac da khu dui sau va khoeo.

2.2.4. T han k in h th en (Nervus pudendus)

- Nguyen uy: do ba nhanh trudc cua nganh trudc cac day song cimg II. Ill va
IV tao thanh.
- Du'dng di va chi phoi than kinh then chui qua lo ngoi ldn d dudi day than
kinh ngoi. roi lai vong qua gai ngoi. de chui qua lo ngoi be vao trong chau nho. va
chay trong ong then (canalis pudendalis) cimg cac mach then. Ong then la mot
ong mac, tao nen do su che doi cua mac bit trong d thanh ngdai ho ngoi hau mon:
Qua ong dd cac mach than kmh then di tdi phan sau ngoai ciia hoanh nieu sinh
due. Than kmh then cho 2 nganh chinh la: than km h trvfc trang dudi. than kmh
day chau va than km h mu dudng vat (hay am vat).

2.2.5. T han k in h n g o i h a y th a n k in h h o n g (N. ischiadicus) con goi la than

kmh toa, hay than kmh hong ldn:

* [Chu thich ve T N G P : “Ischium tif chu" Hylap "iskion", co nghla la hong. “Nervus ischiadicus'
dung nghla T N G P Q T la "than kinh hong”. Song “Os ischii” tieng Viet da qua quen dich la
“xu'dng ngoi": nen tat ca nhCrng tif cd lien quan den “ischii, ischium, ischiadicus" deu dich la
"ngoi", hay “toa” theo chCr Han. Vay “Nervus ischiadicus’ da difpc dich theo 3 cach khac
nhau la: day than kinh ngoi. than kinh toa, hay than kinh hong ldn (T i/d ie n GPH 4 thif tieng,
1983); hay Viet hoa chinh xac hdn la: than kinh ngoi, hay than kinh hong (theo T i/ dien
D T G P Q T Viet fica. 1999)].
 T H A N K IN H CHI DlTdl [[p 341

1. Dam roi cung.

2. Than kinh then (trong);
3. Than kinh bi mong du'di;
4. Nhanh day chau;
5. Cd ban gan.
6. Co ban mac,
7. Co khep ldn;
8. Than kinh hien;
9. Than kinh chay (than kinh hong khoeo trong);
10. Co bung chan (co sinh doi);
11. Co khoeo,
12. Co dep;
13. Co chay sau
14. Cd gap dai cac ngon chan,
15. Nhanh got trong,
16. Than kinh gan chan trong
17. Co gap ngan cac ngon chan
18. Co giang ngon I;
19. Co gap ngan ngon I
20. Cac than kinh gan ngon chan chung.
21. Cac than kinh gan ngon chan rieng.
22. Cac co gian cot, cac co giun 2. 3, 4. co khep
ngon I, bo sau co gap ngan ngon I;
23. Co vuong gan chan.
24. Co gap ngan ngon ut,
25. Co giang ngon ut,
26. Than kinh gan chan ngoai
27. Cac nhanh got ngoai;
28. Than kinh bung chan,
29. Co gap dai ngon cai,
30. Nhanh thong mac;
31. Than kmh bi bung chan ngoai;
32. Than kinh bi bung chan trong.
33. Than kinh mac chung (than kinh hong khoeo ngoai),
34. Co nhi dau dui;
35. Than kinh ngoi (toa, hong Ion);
36. Than kinh bi dui sau (hong be);
37. Than kinh mong du’di;
38. Co mong to;
39. Co cang mac rong (dui);
40. Co mong be;
41. Co mong nhd;
42. Than kinh m ong tren.

Hinh 20.4. D am roi cung va chi phoi than kinh chi du’di (m at sau) (Theo Trinh Van Minh)
E T O ’I G I AI P H A U N G U O I . T A P I

Vc cau tao, la day than kmh Ion nhat khong nhung cua dam roi that lung
cung ma cua toan cd the. va la than tap hop cua gan tat ca cac re tan Ion cua dam
roi cung (TI., 1. TLo. ( ’ 1. C2. C3). Than kinh ngoi gom cac sdi nguven uy cua hai
day: than kmh chav (X. tibialis) va than kinh mac chung (X. fibularis communis)
hop nhat trong mot bao chung. di tii thanh ben chau hong be tdi dinh tram khoeo
roi mdi chia doi. Co khi hai day nay chia doi sdm hoac khong ( hap vao nhau;
trong trudng hdp nav thudng mot clay choc qua cd hinh qua le. mot day di dudi co
de ra vung mong.
- Nguyen uy:
Nguyen uv hdp nhat cua TK ngoi hay than kmh hong bao gom cac sdi cau tao
2 phan tan cung cua no:
Phan mac chung: do cac sdi tu' phan sau cua nganh trade cac day than kinh
that lifng IV, V, cung I va cung II tao thanh.
Phan chav: do car sdi tif phan tnfrlc curt nganh trifdc cac d ?v than kinh thSt
lung IV, V. ciing 1. cung 11 va cimg 111 tao thanh.
D u ’d n g d i ed h e n (/utm c h in h :

Tii trong chau hong be day TK ngoi qua khuyet ngoi ldn d dudi co hinh qua le.
ra viing mong. roi di xuong viing dui sau toi dinh tram khoeo thi chia doi thanh
than kinh chay va than kmh mac chung.
() mong: than kmh ngoi nam trudc cd mong ldn. sau cac cd chau hong - mau
chuyen, rdi qua ranh gnia u ngoi va mau chuyen lo xudng khu dui sau.
() khu dui s ;k i : than kmh nam sau co khep ldn, trudc cac cd ngoi - cang; bi
dau dai cd nhi dau dui bat cheo d sau tif trong ra ngoai.
- Nganh ben:
Khi qua dui than kinh ngoi tach ra cac nhanh van dong dau dai co nhi dau
dui. cd ban mac. cd ban gan va cd khep ldn (thuoc phan chay): nhanh van dong
dau ngan cd nhi dau dui va nhanh khop goi (thuoc phan mac chung).
N ganh tan:
Than kin h m d e c h u n g : tu dinh tram khoeo chay chech ra ngoai. doc theo bd
trong gan cd nhi dau dui. tdi dau tren xifdng mac. vong quanh co xudng mac phan
lam hai nhanh tan: than kmh mac nong va than kmh mac sau (Hinh 20 4. 20.2).
() khoeo than kmh mac chung cho 2 nhanh ben:
Than kinh bi b ung chdn ngoai (X. cutaneus surae lateralis), xuong cam giac
cho da d phan ngoai mat sau 2. 3 ti en cang chan.
Nhanh th on g m ac (ramus communicans fibularis), thudng tach tii than kmh
bi bung chan ngoai. di xuong nhap vdi than kinh bi bung chan trong cua than
kinh chay, de tao nen than kinh bu n g chdn (nervus suralis).
Xuong co xudng mac than kmh mac chung chia 2 nhanh tan:
+ Than kinh m ac ndng (X. fibularis superficialis): than kinh mac nong di
thang xuong giiia hai chd bam cua co mac ben dai vao mat ngoai xudng mac, roi
 T H A N KINH CHI D U O I T' 343

chay giufa cd mac dai va cd mac ngan tdi 1/3 dudi cang chan thi thoat ra o bo
trong cd mac dai. roi choc qua mac cang chan ra ndng. di xudng mu chan, o trudc
mac ham cac gan duoi.
Phan nhanh va chi phoi cua TK mac ndng:

() 2/3 tren cang chan than kinh mac nong tach ra cac nhanh cd (rami musculares)
van dong cac cd mac dai va mac ngan.
Xuong 1/3 dudi cang chan, than kinh mac nong da choc ra ndng va chia thanh
2 nhanh tan (Hinh 20.2):
• Than kinh bi mu chdn trong (N. cutaneus dorsalis medialis): cam giac mat
mu hai ngdn chan rudi ke tu ngdn cai (tru khoang gian cot I).
• Than kinh bi mu chdn giita (N. cutaneus dorsalis intermedins): cam giac
mat mu ntfa ngoai ngdn III va nua trong ngdn IV.
Cac nhanh tan cua cac day than kinh nav cho da mu cac ngdn chan tUdng
ung dude goi la cac than kinh mu ngon chdn (Xn digitales dorsale> pi'di>).
Tren du’dng di xudng mu chan, cac day than kinh nay cung da tach ra car
nhanh ben nho cho 1 phan da d cd chan va phan du'di cang chan.
+ Than kmh m ac sdu (N. fibularis profundus): than kinh mac sau di ngang
qua co xu'dng mac. xuyen qua vach gian cd tru’dc va dau tren cd duoi dai cac ngdn
chan vao khu cang chan tru'dc, rdi gap dong mach chav tru'dc, bat cheo trudc dong
mach, va cung dong mach di xudng tdi cd chan, chui dudi mac ham cac cd dudi
xudng mu chan.
Phan nhanh va chi phoi cua TK mac sau:
• Cac nhanh cd (rami musculares) van dong cac cd d o cang chan trudc va mu
chan: cd dudi dai cac ngdn chan, cd chay trudc. cd mac ba. cd duoi dai ngdn chan
cai va co' dudi ngan cac ngdn chan (6 mu chan).
• Nhanh cam giac la nhanh tan cua TK mac sau 6 mu chan: cam giac cho
khoang gian cot I va cac nua lifdng Ung cua mat mu cac ngdn chan I. II.
• T han k in h c h a y (Nervus tibialis): tach ra tu' than kinh ngoi d dinh tram
khoeo, di thang xuong theo true cua khoeo cung vdi dong mach va tinh mach
khoeo; roi xuong vung cang chan sau, chay giua hai ldp cd ndng va sau cua vung
cung dong mach chay sau. Tdi sau mat ca trong thi than kinh chia lam hai nhanh
cung: than kinh gan chan trong va than kinh gan chan ngoai. chui clu'di mac ham
cac gan gap de vong qua mat trong xifdng got xuong gan chan (Hinh 20.4).
- Cac nganh ben cua than kinh chay gdm:
+ Cac nhanh cam giac:
• Than kinh bi bung chan trong (N. cutaneus surae medialis) tach ra tu khoeo.
di tu' sau ra nong. o’ phia trong tinh mach hien be xuong tdi. 1/3 giuia bung chan
hdp vdi nhanh thong mac cua day bi bung chan ngoai (N. cutaneus surae lateralis)