Giản yếu giải phẫu người

GIAN YEU GIAI PHAU NGlftfl // • !( GIAN YEU GIAI PHAU NGl/CH CTai ban tan thvt sau c6sua chvta va bosung) GS Nguyen Quang Quyen TS B8 Pham Dang Dieu B8 Nguyen Ifan Dtic 8S Nguyen Yan Cuftng "irtS^ ^wg^ Ttt®^ NHA XUAT BAN Y HQC Chi nhanh Thanh Ho Chf Minh 2010 LOI NQI DAU Gidi phau ngUdi Id mot mon y hoc co sd khd hoc vd khd nhd nhung lai rat can thiet de lam ccf sd cho cdc mon y hoc khdc Chinh vi vay, viec hoc tap chucmg trinh ddo tao cung nhutu cm luyen thudng xuyen rat can thiet khong nhung cho doi twang cdc hoc vien cua TrUdng Dai hoc Y, cdc TrUdng Trung hoc Y te ma cung khong kern phdn bite thiet cho cdc nhdn vien y te Nham dap ting vdi nhu cau thvic te do, tren ccf sd rut kinh nghiem tti cuon Gidi Phau Hoc Gidn Yeu da dupe Nha Xuat Ban Y Hoc an hdnh vd tdi ban nhieu Ian, cung thvic tien gidng day tren 10 nam cho doi tupng Dai hoc vd Trung hoc Y te tai Trung Tarn Ddo Tao Boi Dudng CBYT Thanh Pho Ho Chi Minh, chung tdi Men soan cuon GIAN YEU GIAI PHAU NGlfdl Vdi y trinh bay thong tin mot each ngan gpn vd sue tich, chung tdi chon each hien soan cuon sdeh theo he thong cdc ca quan Nhu vay, cuon "Gidn Yeu Gidi Phau Ngitbi" co the dupe sti dung cho viec gidng day cdc doi tupng Trung cap Y, nhung cung cd the phuc vu cho viec he thong hoa kien thtic cho doi tupng sinh vien Dai hoc Y vd cdc nhdn vien y te cung cd the dung no nhu mot tdi lieu "giup tri nhd" ve gidi phau hoc Nham nhdn manh nhung kien thtic can thiet cung nhugiup ngUdi doc cd the tu ddnhgid, d moi.chucmg (mdi he thong), chung tdi cd hien soan cdc muc tieu vd phdn cau hoi trac nghiem Trong cuon sdch nay, chung tdi tie'p tuc sti dung cdc thudt ngti tieng Viet theo ban danh phdp gidi phau qudc te "Nomina anatomica" ma GS Nguyen Quang Quyen da ddt nen mdng tti nhting nam 80, cd mot so stia doi cho phii hpp vdi an ban mdi "Nomina anatomica" Ian thti nam 1985 Nhung khuon khd cua cuon, sdch, chung tdi khong them cdc tti bang tieng la-tinh tuong ting, mong quy ban doc thong cam Cdc hinh cuon sdch BS Phqm Dang Dieu, mot cdc tdc gid, sang tdc Nham tao dieu kien trUc quan tot hcfn cho ngUdi doc, chung tdi budc ddu dua them hinh mdu vdo an ban Hy vpng nhting Ian xud't ban tiep theo, chung tdi se dan dan thay the cdc hinh ve den trang bang cdc hinh mdu Vdi kinh nghiem it oi cua minh, chung tdi cd gang bien soan cuon sdch nay, nhung chac chan no nhieu thieu sdt Chung tdi chdn thdnh biet oil vd rat mong quy ban doc gdp y, phe hinh de cd the cdi tien mot tot hon cho nhting Ian in sau Du GS Nguyen Quang Quyen khong ntia, chung tdi van giti mot phdn nhting bdi viet tarn huyet cua Thay cuon Gidn \eu Gidi Phau NgUdi Vdi niem tudng nhd vd biet cm sau sac den ngUdi Thay cao cd da tan ddo tao vd vun dap cho chung tdi nen ngtidi, rat mong cuon sdch nhu mot thdnh qua tinh than ma chung tdi kinh dang Thay Chdn thdnh cam on Chi nhanh Nhd Xudt ban Y Hoc TP Ho Chi Minh da cho in cuon sdch TP Ho Chi Minh, 25 thdng nam 2000 Thay mat Ban bien soan, TS.BS PHAM DANG DIEU Chu nhiem BM Giai Phau TT Dao tao Boi dxidng CBYT TP HCM MUC LUC Trang Lo*i noi dau v Chu'o'ng I: MoT dau Muc tieu ly thuyet Dinh nghia, pham vi nghien cu\i va vai tro cua giai phau hoc Van de thuat ngff giai phau hoc 11 11 11 15 PhiTdng phap va phiTdng tien hoc giai phau 16 Cau hoi trac nghiem 16 | Chu'o'ng II: Te bao va mo 18 Muc tieu 18 Dai cifdng 18 Te bao 18 Mo 22 Cau hoi trac nghiem 40 y Chu'o'ng III: He xtftfng va kho^p Muc tieu ly thuye't 44 44 Muc tieu thi/c tap Dai cu'Cng XiTcfng dau mat Cot song Xirdngngtrc XiTOng chi tren XiTdng chi dirdi Dai ciTdng ve khdp Cau hoi trac nghiem 45 45 50 63 68 73 82 96 101 Chu'o'ng IV: He co* Muc tieu ly thuyet Muc tieu thiTc tap Dai ciTdng 113 113 114 115 Cac cd dau mat 117 Cac cd cd triTdc ben 122 Cac cd liTng gay Cac cd ngi/c bung 125 131 Cac cd chi tren 138 Cac cd chi diTdi 150 Day chau Cau hoi trac nghiem 165 171 Chu'o'ng V: He than kinh Muc tieu ly thuyet Muc tieu thifc tap DaiciTdng He than kinh trung iTdng 187 187 188 188 192 He than kinh tiT chu 213 Mang nao va su* lifu thong dich nao He than kinh ngoai bien Cau hoi trac nghiem 213 218 226 \ Chu'o'ng VI: He giac quan Muc tieu ly thuyet Muc tieu thiTc tap Dai ciTdng Cd quan thi giac Cd quan tien dinh - 6c tai 236 236 236 237 237 244 Da 254 Cau hoi trac nghiem 257 Chu'o'ng VII: He tieu hoa Muc tieu ly thuyet Muc tieu thirc tap Dai ciTdng Mieng Thirc quan Da day Ta trang va Ruot non Rupt gia Gan-diTdng mat Phiic mac Cau hoi trac nghiem 265 265 266 267 267 276 278 283 287 292 298 303 306 v Chu'o'ng VIII: He tim mach Muc tieu ly thuyet Muc tieu thirc tap Dai ciTdng Tim He thong mach mau Cau hoi trac nghiem 317 317 318 319 319 334 363 KChu'o'ng IX: He ho hap Muc tieu ly thuyet 373 373 Muc tieu thirc tap Dai ciTdng Miii Hau Thanh quan Khi quan 373 374 375 379 382 391 Phdi-mang phoi 391 Cau hoi trac nghiem 401 Chu'o'ng X: He noi tiet Muc tieu ly thuyet Muc tieu thirc tap Dai cUdng Tuyen yen Tuyen giap Tuyen can giap Tuyen thirdng than Nhtfng tuyen npi tiet khac Cau hoi trac nghiem , Chu'o'ng XI: He tiet nieu Muc tieu ly thuyet Muc tieu thirc tap Dai ciTdng 409 409 409 409 413 413 416 416 418 419 422 422 422 424 Than 424 Nieu quan Bang quang 432 435 Nieu dao 436 Cau hoi trac nghiem 439 , Chu'o'ng X£;He sinh due 445 Muc tieu ly thuyet Muc tieu thirc tap Cac cd quan sinh due nam Cac cd quan sinh due niT Cau hoi trac nghiem 445 445 446 454 471 CHUtfNG I MCI DAU GS Nguyen Quang Quyen BS Pham Dang Dieu MUC TIEU LY THUYET 1) Neu chinh xac dinh nghia, do'i tiTdng va npi dung nghien ctfu cua mon giai phau hoc 2) Thay diTdc vi tri va tarn quan cua mon giai phau hoc y hoc 3) Neu diTdc nhiTng nguyen tac chinh viec dat ten giai phau hoc 4) Mo ta mat phang giai phau qui chieu lien he vdi nhirng khai niem lien quan 5) Neu diTdc cac phiTdng tien va phiTdng phap hoc giai phau DINH NGHIA, PHAM VI NGHIEN CLfU VA VAI TRO CUA GIAI PHAU HOC Gidi phau hoc la mot mon hoc nghien ciTu cac hinh the va cau true cua co the, mo'i lien quan giiTa cac bo phdn ccf the va tuong quan cua toan cd the vdi nidi trudng Khac vdi cac mon sinh ly chuyen nghien ctfu ve cluTc nang, cd che va hoat dpng cua cac cd quan cua cd the, giai phau hoc la mot mon hinh thai hoc D6i vdi y hoc, Gidi phau hoc la mot mon co sd rat can thiet cho cdc mon y hoc co sd khac cung nhu cdc mon v hoc lam sang Pham vi nghien ctiu giai phEu hpc rat rang TriTdc kia, cac nganh khoa hpc cd ban, dac biet la vat ly hpc cluTa phat trien, ngiTdi ta chi mdi nghien ctfu cac hinh thai ngiTdi bang mat thiTdng va phau tich, mo xe tren xac Do la giai phau hpc dai the Nhd phat minh kinh hien vi quang hpc ngiTdi ta da nghien ctfu hinh the va cau tao cd the ngirdi d mtfc dp vi the (gidi phau hpc vi the gpi la mo hpc) va gan day 6" mtfc dp sieu vi va phan tu" nhd kinh hien vi dien tiT (gidi phau hpc sieu vi the) Tuy theo muc dich nghien ciTu cua tiTng chuyen nganh, ngirdi ta cung chia nhieu loai giai phau hpc nhiT gidi phau y hpc (phuc vu cho y hpc) (Hinh 1.1), giai phau nhdn chung hpc (phuc vu cho viec nghien ctfu dac diem cua cac chung tpc va quan the ngirdi), gidi phau my hpc (phuc vu cho linh viTc tao hinh my thuat), gidi phau the due the thao (phuc vu cho nghien ctfu va huan luyen the due the thao) Ngay vdi toe dp phat trien nhanh chong cua y hpc, cac nha nghien ctfu da phai phoi hdp nhieu linh viTc khac vdi nhiTng phiTdng phap tiep can khac nhiT gidi phau chtic nang, gidi phau phat trien, gidi phau so sdnh, giai phau dinh khu, gidi phau he thong Npi dung cuon sach trinh bay giai phau hpc y hpc d mtfc dp dai the va theo phirdng phap he thong, nghia la cac bp phan cd the diTdc mo ta theo he thong cac cd quan cung lam mot chtfc nang nhat dinh Ngirdi ta chia lam loai he thong chinh: He thong cdc co quan lien he bao gom: he cdc co quan chuyen dpng (he xiTdng - khdp, he cd), he than kinh va he gidc quan He thong cdc ccf quan dinh dudng bao gom: he tieu hoa, he tim mach, he ho hdp, he npi tiet va he tiet nieu He thong cdc ccf quan sinh sdn bao gom: he sinh due nam va he sinh due nti 12 (ttf cd ttf cung bang sang ben chau hdng) Mpt so cau trtfc khac nhtf am dao, trung tam gan day chau cung cd chtfc nang gitfp gitf ttf cung tai chd (Hinh 12.13) Ttf cung cd cau tao gdm cac ldp ttf ngoai vao la: a) ldp mac (phtfc mac phu ttf cung); b) ldp dudi mac; c) ldp ca day nha't d than va day ttf cung, tai day, cd mpt ldp cd dpc phia ngoai, gitfa la ldp cd rd'i quan Diy ching td cungcung /y Diy ching rdng Diy ching ngang co td cung Hinh 12.13: Sd cac day chang ttf cung (nhin tren) 463 quanh cac mach mau (nhd ma ttf cung cd the co de cam mau bong thai hoac kinh nguyet) va cung la ldp cd vdng Rieng d cd chi cd hai ldp cd dpc kep lay mpt ldp cd vdng; d) ldp niem mac day hay mdng theo thdi diem ciia chu ky kinh va ldp bong mpt phan d cud'i chu ky kem xuat huye't tao nen hien ttfdng kinh nguyet Long ttf cung rdng mpt khoang hinh tam giac gpi la budng tit cung vdi hai gdc tren nd'i thdng vdi vdi ttf cung va gdc dtfdi nd'i vdi ld dng cd td cung (Hinh 12.15) Chinh hinh dang ciia budng ttf cung cho phep dat cac vdng tranh thai Ttf cung dtfdc cung cap mau ttf dong mach td cung (Hinh 12.16) Dpng mach la mpt nhanh ciia dpng mach chau Khi chay d day ciia day chang rdng, dpng mach ttf cung bat cheo nieu quan each bd ben am dao khoang 1,5cm, sau nd chay ngoan ngoeo dpc bd ben than (cho phep keo dai nhanh chdng de theo kip stf phat trien cua ttf cung chtfa thai thai ky), de'n gdc ben thi chia hai nhanh tan la nhdnh vdi td cung va nhdnh budng trdng de nd'i vdi hai nhanh ttfdng tfng ciia dpng mach budng trtfng Mau tinh mach vao dam rd'i canh bd ben ttf cung rdi hdp tinh mach ttf cung va dan ltfu vao tinh mach chau Bach mach ttf cung vao hach bach huye't dpc dpng mach chau hoac hach canh ddng mach chii bung AM DAO: (Hinh 12.11, 12.12) la mpt d'ng cd mac rat dan hdi, dai khoang cm Dau tren bam quanh cd ttf cung tao vdm dm dqo, gidi han ben vdi cd ttf cung mpt tui bit chay vdng quanh (nhtfng thtfdng dtfdc phan tui bit trudc, hai tui bit ben va tui bit sau) Dac biet ltfu y la ttfi bit sau lien quan rat chat che 464 vdi ttfi cung ttf cung - trtfc trang Binh thtfdng thi am dao la mpt d'ng dep cd trtfdc va sau ap vao Thanh trudc lien quan vdi bang quang, nieu quan va nieu dao Thdnh sau lien quan vdi ttfi cung ttf cung - trtfc trang d tren va trtfc trang d dtfdi Bd ben lien quan vdi nieu quan, mach mau am dao va cac cau trtfc ciia day chau Dau dudi (Id) am dao md vao tien dinh am hd Binh thtfdng thi trtfdc Ian giao hdp Ian dau tien, dau dtfdi dtfdc day bang mpt mang khdng kin hoan toan gpi la mdng trinh Ben am dao cd nhtfng gd niem mac nam ngang gpi la gd dm dqo, d mat trtfdc va mat sau cd cot dm dqo chay dpc Am dap cd cau tao gdm ldp: a) ldp ca gdm cd dpc d ngoai va cd vdng d trong; b) ldp dudi niem mac cd nhieu mach mau nhtf mpt tang ctfdng va c) ldp niem mac nam cung Mip sau A Chita de idn ndo B De mot Idn C De nhieu Idn Hinh 12.14: Ld co ttf cung 465 BO PHAN SINH DUC NGOAI Bp phan sinh due ngoai ctfa ntf gdm am hd, am vat va vu 5.1 Am ho: (Hinh 12.17) la mpt cau trtfc dtfdc tao nen bdi nhieu phan nhtf go mu, moi Idn, mdi be va tien dinh am ho Buong tti cung Budng tu cung Cic nip ngang) Ong cd tti cung Nep Ii cq Nep dgc] Tui bit tren Ld tti cung