BO YTE iiiiiiiiiiiiiii C I A I P H A U X O H P SACH DAO TAO ■ CU NHAN KY THUAT ■ Y HOC ■ (Chuyen nganh ky thuat hinh anh) U Chu bien: NGUYEN DOAN CUONG H nh A x u a t bA n y hoc U A N C H P H U 4* n* BO YTE ■ H P G IA IP H & UX-Q U A N G SACH DAO t a o cCr NHAN k y t h u A t y h o c Ma so: DK.05.Z.10 Chu bien: NGUYiN DOAN CUdNG U H NHA XUAT BAN Y HOC HA NOI - 2007 CHI D A O BIEN SOAN Vu Khoa hoc va Dao tao, Bo Y te CHU BIEN: Nguyin Doan Cudng H P N G U d l BIEN SOAN: Nguyen DoanCudng THAM GIA T O CHL/C BAN TH AO: ThS Phi VSn Tham TS Nguyln ManhPha U H © Ban quyen thuoc Bo Y te (Vu Khoa hoc va Dao tao) LCfl Gldl THIEU ThUc hien mot so" dieu cua Luat Giao due, Bo Giao due & Dao tao va Bo Y te da ban hanh chUdng trinh khung dao tao Cvf nhan ky thuat y hoc Bo Y te to chvfc bien soan tai lieu day- hoc cac mon cd scl, chuyen mon va cd ban chuyen nganh theo chUdng trinh tren nham tting bu6c xay dung bo sach chuan cong tac dao tao nhan liic y te Sach “Giai phau X quang” dUdc bien soan dUa tren chUdng trinh giao due cua Dai hoc Y dUdc Thanh pho" Ho Chi Minh tren cd sd chUdng trinh khung da dUdc phe duyet Sach dUdc bien soan dUa tren phUdng cham: kien thiic cd ban, he thong; noi dung chinh xac, khoa hoc; cap nhat cac tien bo khoa hoc, ky thuat hien dai va thuc tien Viet Nam H P Sach “Giai phlu X quang” da dtfdc bien soan bdi cac nha giao giau kinh nghiem va tarn huyet cua TrUdng dai hoc Y Dtfdc TP Ho Chi Minh Sach “Giai phiu X quang” da dvfdc Hoi dong chuyen mon tham dinh sach va tai lieu day- hoc chuyen nganh Cii nhan ky thuat y hoc cua Bo Y te tham dinh nam 2006 Bo Y te ban hanh lam tai lieu day-hoc dat chuan chuyen mon cua nganh y te giai doan 2006 - 2010 Trong qua trinh svi dung sach phai diidc chinh ly, bo sung va cap nhat U Bo Y te xin chan cam dn cac Nha giao, cac chuyen gia cua TrUdng dai hoc Y DUdc TP Ho Chi Minh da danh nhieu cong siic hoan cuon sach nay, cam dn TS Pham Ngoc Hoa, PGS.TS Nguyen Duy Hue, TS Hoang Minh Ldi, BS Ta Duy Chinh da doc phan bien de cuon sach difdc hoan chinh kip thdi phuc vu cho cong tac dao tao nhan liJc y te H Vi lan dau xuat ban nen co khiem khuyet, chung toi mong nhan difdc y kien dong gop cua dong nghiep, cac ban sinh vien va cac doc gia de lan xuat ban sau dUdc hoan thien hdn VU K H O A H O C V A O A O T A O BO Y TE f iiio ID j H P H U Ldl NOI OAU Cuon “Giai phau X quang” dUdc soan theo chUdng trinh chi tiet dao tao Cut nhan Ky thuat hinh anh da dtfdc Bo Giao due va Dao tao thong qua theo quyet dinh so 12/200l/QD-BGD&DT/DH, ky 26/4/2001 Sach dUdc sip xep tilng bai Moi bai deu co muc tieu d phan dau va cl cuoi moi bai co phan tu liidng gia de sinh vien co the ttf hoc va tii danh gia dufde Chung toi cung da difa them vao nhulng cau hoi suy luan de khuyen khich kha nang tu duy, tim toi hoc hoi cua sinh vien Chung toi tran cam dn: TS.BS Pham Ngoc Hoa - Chu nhiem bo mon Chan doan hinh anh Dai hoc Y DUdc pho' Ho chi Minh, kiem Trifdng Khoa Chan doan hinh anh benh vien Chd Rly pho" Ho Chi Minh, da hieu dinh cho cuon sach PGS.TS Nguyln Duy Hue - Chu nhiem Bo mon Chan doan hinh anh Dai hoc Y Ha Noi TS.BS Hoang Minh Ldi - Chu nhiem bo mon Chan doan hinh anh trifdng Dai hoc Hue, BS Ta Duy Chinh nguyen Trvfdng khoa Chan doan hinh anh Benh vien dai hoc Y DUdc TP Ho Chi Minh cd scf I, da dong gop nhieu y kien qui bau viec bien soan sach H P Cam dn CN Pham Cong Sach - Khoa X quang - Sieu am, Trung tam y te Q l l va to Nghe nhin khoa Dieu du5ng Ky thuat y hoc da giup dUa cac hinh anh vao quyen sach U Dac biet chung toi bay to long tran biet dn doi vdi GS Do Dinh Ho Khoa TrUcing khoa Dieu dUdng - Ky thuat y hoc thuoc dai hoc Y Diidc pho" Ho Chi Minh da nhiet tinh khuyen khich viec hoan cuon sach H Tuy nhien trinh co han, nen chic chan quyen sach nhieu thieu sot, kinh mong nhan diidc sU gop y cua cac doc gia Xin chan cam ta Nguyen Doan Cilbng H P H U MUC LUC ■ ■ Ldi gidi thieu Ldi noi dau Bai Giai phau X quang bo xtfOng tit chi I Cau true cua xiidng kh6p binh thUdng 9 II Khoang each binh thUdng cua cac khe kh6p cd the 11 III Tuoi xUdng va sii xuat hien cac diem cot hoa 11 IV Chi tren 16 V Chi dtfdi 22 H P Cau hoi liidng gia Bai Giai phau X quang cot song I Dai ciidng II Cac dot song co III Cac dot song ngiic IV Cac dot song that liing U V Xiidng cung VI XUdng cut H Cau hoi liidng gia Bai Giai phau X quang he tiet nieu I Than II Nieu quan 30 36 36 37 40 41 42 43 43 47 47 49 III Bang quang 50 IV Nieu dao 51 Cau hoi liidng gia 52 Bai Giai ph£u X quang he tieu hoa va gan mat 55 I He tieu hoa 55 II He gan mat 62 Cau hoi liidng gia 64 Bai Giai phau X quang so mat xoang I Dai ciidng II Cac chieu the cd ban chup so xoang III Giai phau X quang Cau hoi liidng gia H P Bai Giai phau X quang ngtfc I Thanh ngUc II Khi phe quan III Cac ranh lien thuy va stf phan chia thuy phoi IV Cac mach mau phoi, ron phoi U V Nhu mo phoi VI Cd hoanh VII Trung that H VIII Tim Cau hoi liidng gia Phan tra ldi cau hoi ltfOng gia Tai lieu tham khao Mau khdp dtfdi Mom ngang Manh cung song Mom gai Dia dem 10 Lo lien hdp 11 Khdp mau 12 Eo BAI GIAI PHAU X QUANG HE TIET NIEU Tra ldi phan dien vao cho tro'ng Cau 1: A Gan de B - cm C - cm H P D cm Cau 2: A Chieu cao L2 * 3,7 4,1 B Dai / C Ngang / U Cau 3: Vo than Tuy than Xoang than Cau 4: H A Diidng noi lien day chen cac dai than nho B Dtfdng bd ngoai than Cau 5: A True dai khoang cac dai than nho B True dai cua than Cau 6: A 90° B 60° 100 Tra ldi phan chon cau dung/sai Cau 1: Dung: A,B Sai: C> D Cau 2: Dung: A, D Sai: B, C Tra ldi phan dien chinh xac cac chi tiet vao cac hinh ve Hinh SO phim chup nieu tinh mach Than phai Than trai Nieu quan trai Cd that ltfng Bang quang H P Hinh Hinh vi tri cac cho hep sinh ly cua nieu quan Ch6 noi nieu quan va be than Ch6 nieu quan bit cheo vdi dong mach chau chung tieu khung Ch6 noi nieu quan va bang quang U BAI GIAI PHAu X QUANG HE TIEU HOA VA GAN MAT Tra ldi phan dien vao cho Cau 1: Cot song Khung chau Cau 2: H Cac xtfdng stfdn cuoi Hai khdp hang 1/ Co hinh dtfdng md canh cot song, keo dai ttf D 12 - LI den ho chau 2/ Bd ngoai thay rat rd tren phim X quang Cau 3: Vung mieng Killian ngang C6 Vung quai dong mach chu ngang D3 Vung phe quan goc trai ngang D6 Vung tam vi ngang D l l 101 Cau 4: Thtfc quan co ThUc quan ngtfc ThUc quan bung Cau 5: The tang ngtfdi Thi ho hap Tra lc/i phan chon cau dung nhat Cau 1: E Cau 2: A Cau 3: D Cau 4: C Cau 5: E Cau 6: E H P Tra ldi phan chon cau dung/ sai Cau 1: Dung: A,B Sai: C, D Cau 2: Dung: A, C U Sai: B, D Cau 3: Dung: A, B Cau 4: Dung: A Sai: C, D H Sai: B, C, D Tra ldi phan dien chinh xac chi tiet vao cac hinh ve: Hinh Bung khong chuan bi Gan Than phai Bang quang Bong hdi da day Lach Than trai Cd that ltfng Hinh Da day Hanh ta trang 102 Ta trang D2 Hang vi Thtfc quan bung Tam vi Bd cong nho Bd cong 16n Than da day Mon vi 10 Hong trang Hinh Dai trang Dai trang goc gan Dai trang len Manh trang Dai trang goc lach Dai trang xuong Dai trang sigma Dai trang ngang Trtfc trang Hinh Dtfdng mat H P Ong gan phai Ong tui mat Tui mat Ong gan trai Ong gan chung Ong mat chung A / Tra ldi phan cau hoi suy luan Cau 1: U Muon khao sat phan phinh vi da day, ta dung phim chup da day d ttf the' nam ngtfa, vi ci ttf the phinh vi nim vi tri thap hdn, thuoc can quang don het ve vung tao cho no co bd tron nhtf trai cam Cau 2: H Muon thay ro chi tiet goc bd cong nho, ta khao sat tren phim chup da day ci ttf the dtfng th&ng, vi ci ttf the goc bd cong nho khong bi cac phan khac cua da day va ta trang che khuat bA i G lA l PHAU X QUANG SO MAT XOANG Tra ldi phan dien vao cho Cau 1: Xtfdng tran Xtfdng dinh phai Xtfdng dinh trai Xtfdng cham 103 Cau 2: Xudng sang Xtfdng btfdm Xtfdng thai dtfdng phai Xtfdng thai dtfdng trai Tra ldi phan cau hoi dung/sai Sai: C va D Dung: A, B va E Tra lcfi phan chon cau dung nhat Cau 1: D Cau 2: C Cau 3: D Cau 4: D Cau 5: E Cau 6: B Cau 7: E Cau 8: E H P Cau 9: D Cau 10: B Cau 11: C Cau 12: B Cau 13: A Cau 14: D U Cau 15: D Cau 16: C Tra lcfi phan dien vao hinh ve H Hinh So thang: Khdp dinh cham ✓ Ong tai Kh6p vanh Mao ga Mom chum Ban xtfdng so Ban ngoai xtfdng so Xoang tran Bd tren xtfdng da 10 Xoang sang trtfdc 11 Cac cuon mui 12 Phan ben C l 13 Mom rang C2 Hinh So nghieng: 104 Ban xtfdng so Xoang tran Hoc m&t Xoang ham Chtf V go ma Ban ngoai xtfdng so Mau gitfdng trtfdc Mau gitfdng sau Ong tai ngoai 10 Ho yen 11 Cung go ma 12 Xoang btfdm 13 Cu trildc Cl 14 Cu sau Cl 15 Mom gai C2 Hinh Towne: Bd tren xUdng da Te bao chum Ong tai Lo cham Cung go ma Khdp dinh cham Xtfdng cham Mau gitfdng sau Loi cau xUdng ham dtfdi 10 Ltfng yen H P Hinh Hirtz: I Xoang ham Cung go ma Mom vet Xoang btfdm U Lo cham Mom rang C2 Cung rang ham tren Lo bau due a' II Ong tai ngoai Hinh Caldwell: H Xoang sang 10 Lo gai (lo tron nho) 12 Ho' yen Ban ngoai xtfdng so Khdp vanh Canh btfdm nho Khe hoc mat tren Ban xtfdng so Xtfdng tran Canh btfdm ldn Bd tren xtfdng da Cuon mui Hinh Xtfdng ham dtfdi the chech: Goc ham dtfdi phia xa phim Lo cam Khdp thai dtfdng ham Loi cau xtfdng ham dtfdi 105 Mom vet Goc ham dudi phia gan phim (ben can quan sat) Khuyet ham dudi Hinh Blondeau: Xoang tran Hoc mat Vach ngan mui Xudng go ma Cac cuon mui L6 rach sau Xoang sang trUdc Lo dudi hoc mat Xoang ham 10 Xoang budm Tra ldi phan cau hoi suy luan: H P Cau Phim chup so d the nghieng se giup ta khao sat ho yen tot nhat, vi d chieu the chung ta se thay dUdc mau giUdng trUdc, mau giUdng sau, lung yen va ho" yen Cau Phim Blondeau se giup ta thay dUdc gan het cac xoang mat tren cung mot phim Vi tren phim chung ta cd the thay dUdc xoang ham, xoang tran, xoang sang trUdc va xoang budm U Cau De khao sat canh budm ldn, canh budm nho va khe hoc mat tren ta dung phim chup d tU the Caldwell, vi d chieu the bd xUdng da bi day xuong bd dudi hai hoc mat, dd ta co the quan sat phan canh budm ldn, canh budm nho va khe hoc mat tren ro rang H BAI GIAI PHAU X QUANG N G l/C Tra ldi phan cau hoi dung/sai: Cau 1: Dung: B, D Sai: A, C Cau 2: Dung: A, C, D Sai: B Cau 3: Dung: C, D Sai: A, B Cau 4: Dung: A, B, D 106 Sai: C Tra ldi phan dien vao cho trong: Cau 1: A Hai nhanh phai va trai B NSm cao hdn C Trung that D Cung gitfa trai cua tim Cau 2: A Khoang lien stfdn sau hoac trtfdc B vi tri thap hdn H P C Cao hdn mot khoang lien stfdn D 1/3 trtfdc bdi bong tim Cau 3: A La mang phoi B Xtfdng tfc C Mat trtfdc cot song ngtfc U D Tren, gitfa, trtfdc va sau Tra ldi phan chon cau dung nhat: Cau 1: C Cau 3: B Cau 5: D Cau 7: D Cau 9: E H Cau 11: B Cau 2: C Cau 4: A Cau 6: D Cau 8: A Cau 10: A Cau 12: D Tra ldi phan dien vao hinh ve: Hinh Stf phan chia trung that: Xtfdng don Khi quan Trung that tren Trung that trtfdc Trung that gitfa Trung that sau 107 Hinh Ngtfc thang I Khi quan Phan len cua dong mach chu Bong tinh mach chu tren Dong mach phoi phai Nhi phai Bong tinh mach chu dtfdi XUdng don Bong hdi da day Quai dong mach chu 10 Phe quan trai II Than dong mach phoi 12 Tieu nhi trai 13 Phe quan phai 14 Dong mach chu xuong 15 That trai 16 Bong ngtfc 17 Goc stfdn hoanh H P Hinh Tim nghieng trai Dong mach chu len Than dong mach phoi That phai Nhi trai That trai Hinh Tim chech trtfdc trai U Thtfc quan I Xtfdng don Cung dong mach chu That trai Nhi trai H Dong mach chu len II Khi quan Dong mach chu xuong That phai Ctfa so dong mach 10 Goc phe quan Hinh Tim chech trtfdc phai Dong mach chu xuong Cung dong mach chu Dong mach chu len That phai Dinh that trai Tinh mach chu dtfdi Nhi phai Nhi trai Thtfc quan T r a ld i phan cau hoi s u y l u a n 108 Cau Stf khac biet giiia hinh phoi nghieng phai va nghieng trai la: + Tren phim nghieng phai, hai cd hoanh phai va trai song song Vi cd hoanh phai cl cao va gan phim, cd hoanh trai cl thap va xa phim nen dau den tia X chieu hinh cua chung len phim, lai cang lam cho chung xa hdn + phim nghieng trai, hai cd hoanh cat Vi cd hoanh phai cao va xa phim nen dau den tia X chieu hinh cua no len phim, se lam cho no cat cd hoanh trai Ngoai phia dtfdi cd hoanh trai ta co the thay bong hdi da day va 1/3 phia trtfdc cd hoanh trai bi xoa nhoa bong tim Cau Stf khac biet gitfa hinh chup phoi dtfng va nam la: De phan biet phim chup phoi dtfng hay nam ta can chu y: H P Than cac dot song co cuoi va dot song ngtfc dau tien co hinh : U Hinh chup dtfng Hinh chup nam Xtfdng ba vai nam chong len trtfdng phoi cl phim chup nam, tren phim chup dtfng xtfdng ba vai dtfdc tach khoi long ngtfc H Vom hoanh nam cao hdn va tim co ve to be hdn cl phim chup nam TAI LIEU THAM KHAO TS BS Pham Ngoc Hoa va BS Le V an Phtfdc Bo mon Chan doan Hinh anh Dai hoc Y Dtfdc Ho Chi Minh Bdi gidng chan doan X quang, 2002 Bo mon Chan doan Hinh anh Dai hoc Y Ha Noi Bdi giang chan doan hinh anh, 2001 Bo mon Chan doan Hinh anh D H oc Y Ha N oi Chan doan hinh anh bo may tiet nieu, 1999 • • • • H P Nguyen Van H oang, uy ban binh thtf va tiep va n Nhitng chieu the chup hinh tia X, 1972 Cue Quan Y, benh vien trung tfdng quan doi 10 Chan doan X quang xitcfng khdp, 1996 Jean Pierre M onnier va Jean M ichel T u bian er Chan doan X quang vd Hinh anh y hoc (ban dich), 1990 U M eschan Radiographic Positioning and Related Anatomy,1968 Andrea Gauthier Cornuelle and Radiographic Anatomy Positioning,1998 H 110 Diane H Gronefeld NHA XUAT BAN Y HOC GIAI PHAU X QUANG H P Chju trach nhiem xuat ban HOANG TRONG QUANG U H Bien tap: SCra ban in: Trinh bay bia: Ky thuat Vi tinh: B S N G U Y E N T | £ D 'n O N G N G U Y E N T | £ D n O N G C H U H U N G T R A N S A N H P U H In 0 c u o n , k h o 19 x c m tai X i/d n g in S6 Nha xuat ban Y hoc d S n g k y k e h o a c h x u a t b a n : 2 - 0 / C X B / - /Y H In x o n g v a n o p li/u c h ie u q u y II n m 0 H P H U H P U H NHA XUAT BAN Y HOC Dja chi: 352 Doi Can - Ba Dinh - Ha Noi Tel: 04.7.625922 - 7.625934 - 7.627819 - Fax: 04.7625923 E-maiil: Xuatbanyhoc@fpt.vn Website: www.cimsi.org.vn/nhaxuatbanyhoc GIA: 24.0000