Bài giảng Giải phẫu học (Tập 1): Phần 1

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DAI HOC Y DOC THANH PHO HO CHI MINH BO MON GIAI PHAU HOC BAI GIANG PHAU C Chu bien: NGUYEN QUANG QUYEN NHA XUAT BAN Y HOC DAI HOC Y DLYC7C THANH PHO HO CHI MINH BO MON GIAI PHA1U HQC 62 fa'i„, Vitt' P lchot -eq,1 Xer TariJ BAI GIANG GIME PHAU HOC A T P1 CHI THEN - CHI - DIU M.Or C6 hi lin dui midi lam Co b6 sung at seta chaa NHA XUAT BAN Y HOC Chi nhanh Thanh phi") Ho Chi Minh 2013 F-.2014 _ott 6Altick f 52A CHU BIEN NGUYEN QUANG QUYEN BAN BIEN SOAN LE VAN CUING DU'ONG VAN HAI VO VAN HAI NGUYEN THitN HUNG TRAN HUNG NO TRI HUNG PHAN BAO KHANH NGUYEN QUANG QUYEN NGUYEN HOANG VAN LUVNG THI BACH VAN NGUYEN TRUNG VINH Lai not clan (Lein xuat bcin tha neim) Cuan 13ai gifing giai phAu hoc" &tor soan rat tinh gian theo chuong trinh hoc cda sinh vi'en he dai han cac Truing Dai hoc Y Khoa a Viet Nam Stich ditot sap xep lam hai tap Tap I gam cac chuong chi tren, chi duai va dau mat co Tap II gam cac chuong ngzie, bung, than kinh trung uong va gidi pilau hoc dai cueing Phan dai cuong trinh bay lai he thong cac ca quan de b6 sung cho nhang phan trade duce trinh bay theo yang Ccic danh tit va not dung cac danh tit ditqc sa dung hoan toan theo n danh tit gidi pha u quek to Nomina Anatomica (N.A) vet dich chai yeu theo cuan Tit dien gidi phew hoc (4 thd tieng : La tinh, Anh, Phap, Viet) cda Nguygn Quang Quyen (Nha Xueit Ban Y hoc, 1983) co sda dai dOi chat can thiet cho sat nghia vai nguy'en ban tang La tinh Ben canh mai tit tieng Viet deu có chd thick ngoac dein tit La tinh Wang ang Cuai mot tap setch có bcin chi dein tra cztu tang Viet va tang La tinh Sau lin tai bcin thd ba, theo y kien cua nhieu dung nghiep va ban doe, ngoeti viec saw chact nhang cho in sai, cluing toi da them phd n muc tieu trung gian cda mon giai phd u hoc vet muc tieu chuyen biet cd a tang bai gicing veto phdn ddu cua m5i beti va a cuai m6i beti, có cac eau hOi trdc nghiem theo clang cau tra Uri chon lua (MCQ) de sinh vi'en có the to hoc va to dcinh gici ditqc Ngoai de cuan scich hoan chinh thong to i da cho in truck mai bai mot hinh mau tong hap chop tren xcic (chd yeu lay theo Rouviere) va cac so lieu gidi phdu tren ngtteri Viet Nam nh'dm muc dich tham khcio Trong lam tai bcin this to va ilia nam nay, B I S Ngo Tri Hung dei Op sac viec chzi thich cac hinh mau vet PTS Le Van Cuing da cho cac so lieu ngitai Viet Nam trich cuan luan an PTS cua minh BS Pham De-mg Dieu vet BS Nguyen Van Dac (BO mon Gicii phau hoc TTDTBDCBYT thetnh pha Ha Chi Minh) del ba sung them nhieu cau trdc nghiem MCQ vet gop y sda nhdng sai sot ell a kin in trztoc Xin hoan nghenh vet chan cam on nhCtng clang gop quY bciu Chang toi cang bay to long bat on Nhet Xuat ban Y Hoc da cho tea kin lin thd neim cuan sach Thanh phd Ha Chi Minh, thcing 911995 Nguyen Quang Quygn Logi not au (Lein - xudt bcin thd natal lam) BO sach "Bai gifing Gieti phau hoc" co Pho Gicio stt Nguyen Quang Quyen chit bien vdi sit tham gia bien socin cda cac nhet gicii phau gietu kinh nghiem vet su gop sic ciia tap the can 14 nhein vien BO mon Gidi Phau Hoc Dai hoc Y Ditorc Thanh pla H6 Chi Minh BO sach du'orc xutit bdn Ian detu tien veto nam 1985, qua 13 Mn tea ban, bo sach la sach giao khoa gieti phau caa Dai hoc Y Dityc Thanh pita Ha Chi Minh va let mot tett lieu gicii phau quan trong, claw set dung tham khan tai cac tritemg dai hoc y khoa nude BO sach "Beti giang Giiii phial hoc" c6 hai tap cho doi tuong sinh vien dai hoc gam cac chuyen nganh bac si y khoa, bac si rang ham mat, bac si nganh y hoc co truyen, y to tong tong vet du'crc si Ngoai bO sach phut vu doto tao he cd nhan cac chuyen nganh y hoc va cac chuyen nganh khetc lien quan den khoa hoc sac kh6e Qua nhieu kin tai ban BO sach da &lac bO' sung sda chda de tang hoan thien hon Dcic biet Mn tai ban' nay, tap the can b62 gidng BO mon Gicii Phau Hoc, dO co nhieu can ba' gicing tre da tham gia tich cdc cong tcic sda chda cac loi va thi6u sot, có 1,6 sung chinh sita so/ beti gicing cho haul chinh han vet ye lai mot so hinh cluta rO, chuct dep de lam tang chat litang cda cac beti gicing nhu beti vang ben, trung that, runt non, runt gia Sap xe'p-lai thd tit, plain nhom so beti gidng cho phi hap horn -nhu' cac plain khai xuang so, khai xuang mat Vai sit phcit trien ctict khoa hoc, mot mein sach can phcii ducrc be sung, sda chda lien tuc de duqc cap nhat kien thdc mai Do cluing toi xin qujI theiy co, qa)i clang nghiep, cac hoc vien va cac em sinh vien clang g6p y kien de BO mon Gicii Phau Hoc seta chaa, sung cho tap sach ngety tang hoan thien han Mn tai bcin sau Chang tai xin cam on sit clang g6p qu3i bciu Chang toi cang reit cam on Nha xuat ban Y hoc, Chi nhcinh Thanh ph6 Ho Chi Minh let nori dot giap hieu dinh vet sda chaa qua nhieu Mn xueit bdn Thanh pile; H6 Chi Minh, ngety 27 thang nam 2013 Chu nhiem 130 mon PGS.TS Le Van Cutting MIX LUC Trang Ldi not &au Nhdp mon gidi pilau hoc (2 660 11 (4 tigt) (3 tigt) (2 tigt) (1 tigt) (2 tigt) (2 tigt) 28 54 68 83 90 106 (4 tigt) (2 tigt) (4 tigt) (1 tigt) (2 tigt) (2 tigt) 121 - 156 171 194 201 222 PHAN I - CHI TREN )(acing kherp chi teen Ndch Cdnh tay Khuku CAng tay Ban tay PHAN - CHI DWI 10 11 12 13 Xthing khop chi doh Ming Did Cl6i CAng than Ban than PHAN - DAU - MAT - Co Xuong kilo') dau mat 14 Car va mac (tau - mat - co 15 Cdc do, ng mach canh 16 DOng mach clued don 17 Tinh mach va bath mach dau mat c6 18 Dam reCi than kinh c6 19 a ming 20 Hau 21 Thanh quan 22 Khi quail, tuy6n gidp va tuy6n can gidp 23 Mai 24 Co quan thi gide 25 Car quan tiAn dinh - 6c tai 26 Cdc day than kinh so 27 Bing chi din tra cliu tigng ViOt Bang chi din tra cdu tie-ng La Tinh (4 tigt) (4 tigt) (3 tigt) (1 tigt) (2 tigt) (1 tigt) (2 tigt) (2 tigt) (3 tigt) (1 tigt) (1 tigt) (2 tigt) (3 tigt) (5 tigt) 238 238 301 319 329 346 354 366 380 397 405 416 430 453 486 512 MUC TIEU TRUNG GIAN COA BO MON GIAI PHAU HOC Sau hoc xong chaung trinh mon giai phAu hoc, ngutri sinh vien y khoa phai dat ducic cac muc tieu sau day : Neu durgc day du cac chi tiet giai pilau chinh cda tat ca cac be phan cc thg ngu6i MO to dttqc lien quan ctia tang 130 phan cac he thong, cac car quan ctia c6 the ngu6i Chi du cic tren xac, hinh ye, phim X quang, tren ngutri song, tren tieu ban cac chi tigt giai phau da dole hoc a phan ly thuygt Thay &Plc su th6ng nhat gala hinh the, cat' tao vdi chirc nang cilia cac be phan car the dg higu dutqc qua trinh den h6a cua sinh vat Neu dole tam quan cilia mon giai phau hoc co sa cilia tat ea cac mon co sa va cac mon lam sang cilia y hoc Hinh dung ddcfc pham vi va nei dung nghien tutu rat rang cilia mon giai phdu hoc Ling dung duvc cac hidu bigt ve giai phdu hoc cac mon y hoc khac va thyc t6 phong benh va dieu tri huang tai viec cham sOc sac khae ban dau 1.2 TINH MACH Tinh macho gan chan tao mot mang tinh mach gan chan (rete venosum plantaris) (H.12.3) Mang tinh mach nhan mau tit cac tinh mach gan nem chan (vv digitales plantares), cac tinh mach gan dot ban chan (vv ,netatarsae plantares) r6i not vdi mang tinh mach mu chan va tinh mach hidn lan, tinh mach hidn be 1.3 THAN KINH NONG Cam giac a gan chan du'ac chi ph6i bdi than kinh gan char' (n, plantaris medialis), than kinh gan chan ngoai (n plantaris lateralis), cac nhanh got (rami calcanei mediales) va cac nhanh got ngoai (rami calcanei lateralis) Tat ca cac nhanh tren d6u thu6c than kinh chay (H.9.1) (H.12.2) 1.4 CAN GAN CHAN (aponeurosis plantaris) Can gan chan g6m c6 ba phan: - Phan giCta: chac, chia nam tre tit gan got den nam nem char' - Phan trong: mong a sau, day a tru'ac - Phan ngoai: day a sau, mong trudc Can gan chan giita gop phan tao nen \Tom gan chan Tai nai n6i giita phan va phan Oita can gan chan ngoai va d6t ban chan I chan, c6 vach gian co di tit xucing got, ghe, chem den barn vao Tai noi not gi a phan ngoai va phan giita can gan chan co vach gian ca ngoai di tit gan ca mac dai va xoung &et ban V de-n barn vao LdP SAU Vach gian cd trong, vach gian co ngoai va can gan chair chia gan chan ba o co: cai: o trong, chda: ca dang ng6n cai, ca gap ngon cai ngan va gan co gap ngon cai dai - O giva: chda ca gap neon chan ngdn, ca vuong gan chan, cac co giun, gan ca gap cac ng6n chan dai, co khep ng6n chan cai va cac co gian cot - O m6 6t: a ngoai; c6 co' dang ng6n Lit va cd gap ngon lit ngdn Vi cac ca a ba o tren xep bon lap 1.6 ret nen khac vai o gan tay, ngoai to thoang to co a gan chan khong theo o ma theo lap 2.1 LOP CO NONG Gam ba co: dang ngon cai, gdp cac nein chan ngan va dang ngon lit (H.13.1) 2.1.1 Cd clang ngon cai (m abductor hallucis) Nguyen dy: tit mom cu )(acing got, cc( di doc theo canh cua co gap cac nen chan ngan va vach gian cd Barn tem: cling vdi gan co gap ng6n cai ngdn barn vao d6t gan nem cai M:ing tdc: gdp ngon cai, data ngon cai dang xa truc va g6p phan tao nen yam doc gan chan 223 Ca Op cac ngon chan nggn Cd dgng ngon Ot CO dgng ngon cai Gan cd gep cac ngon chan dal Hinh 13.1 : Ca gan chcin (lop nong) 2.1.2 01 ggp cac ng6n chan ngAn (m flexor digitorum brevis) Nguyen tiy : Barn vao cu g6t, can yang gan chan va hai vach gian co trong, ngoai Bcim tan : Co chia b6n gan d6n b6n ng6n chan ngoai Mei gan sau d6 chia hai tre (gan Wong tkr nha gan co ggp cac neon nong a chi tren de dgn nen cila d6t nem gin-a DOng tdc : Gap d6t gitia va gap d6t an 2.1.3 Car dang ng6n ut (m abductor digiti minimi) Nguyen ily : Barn vao cu g6t, can gan chan va vach gian co ngoai Bdm tan : Mat ngoai d6t an ng6n V .13Cing tcic : Gap ngon 5, dang ng6n va Op pilau tao nen Om doc ngoai gan chan 224 CO gap cac ngon chan ngan D6ng mach gan char? ngoai Co dang ng6n cal Than kinh gan chan ngoai Vach gian co ngoai Gan co' gap cac ng6n chan dai CO vuong gan chan Than kinh gan chan (nhanh ngoai) Nhanh n6ng TK gan chan ngoai Nhanh sau TK gan chan ngoai Vach gian co Co' gOp ngon cal ngan D6ng mach gan chan - CO clang ngon Gt Than kinh gan chan (nhanh trong) • Cd gap ngon cit ngan Co khop ng6n cal (dau che'ch) Nhanh ngon cal ciia DM Cac co' gian cot gan chan gan chan Cd khop ngon cai (dau ngang) Gan cod gap cac ng6n chan dai Gan cci gap cac ng6n chan ngan Anh X : Vzing gun chan (lap sdu) 225 Co (cd vuong gan chan gap Op) Gan cc gap cac ngon chan dai Gan cc Op ng6n cai dai Hinh 13.2 : Cu gan chdn (lop giaa) 2.2 LOP CO GILDA (H.13.2) Gdm cac co not tai ciia gan chan la co vuong gan chan, cac co giun va hai gan cc tit cang chan sau di xua-ng : gan co gap cac ngOn chan dai va gap nem cai dai Gan cc gap cac ngOn chan dai den d6t xa cua 136n ngon chan ngoai va nhm nang Ilan so vdi co gap ng6n cai dai 2.2.1 Cd vuong gan chan (m quadratus plantae) can du'oc goi la cc g6p phu (m flexor accessorius) 226 Nguyen ay : - Dau ngoai : MOm ngoai Cu g6t - Dau : Mat xu'cing got Barn tan : Hai b6 hap mat ca cign barn vao canh ngoai gan gdp cac ng6n chan dai DOng tcic : Chinh lai Inking tdc dung ctia ca gdp cac neon chan dai va g6p phan tao nen vom doc gan chan 2.2.2 Cac cd giun (mm lumbricales) Ba ca giun ngoai barn vao hai ben On co' gap cac ngon chan dai can ca giun barn vao canh gan gap ngon Sau d6 ca den barn tan mat d6t gan ngon chan Wang (mg va cho nhiing tre den tan gan Dang tcic : Gdp d6t gan b6n neon chan ngoai 2.3 LOP SAU (H.13.3) G6m hai phan : - Phan sau c6 day chang gan chan dai (ligamentum plantaris longus), gan co chay sau va gan ccr mac dai -Phan truck co cac co gdp nem cai nen, khep ng6n cai va gap ng6n Lit nen 2.3.1 Cd gap ng6n cai ngAn (m flexor hallucis brevis) Nguyen uy : Di tir xuang chem trong, gida, ngoai va day chang got hap - gan char' (lig calcaneocuboideum plantare) Barn tan : Vao hai xuang Wing va hai ben nen xuang d6t en ngon I D'ang tcic : Gap cl6t gdn ngon cai 2.3.2 Cd khep ng6n cai (m adductor hallucis) Nguyen uy : Ca c6 hai dau : + Dau cheo (caput obliquum) : Bam vao mil:mg hop, xuang chern ngoai, xuang dal ban II, III va day chang g6t - hop gan chan + Dau ngang (caput transversum) : Barn vao kh6p d6t ban - d6t neon chan III, IV, V Barn tan : Hai be) dgn barn tan 6r phia ngoai nen xurang cl6t neon gdn &la ngon DOng tcic : Khop ng6n 2.3.3 Cd gap ng6n ut ngAn (m flexor digiti minimi brevis) Nguyen ay : Cu xacing hap, nen xliang clot ban chan V Bdm tan : Vao nen clot en ng6n chan V DOng tcic : Gap d6t en ngon chan V 2.4 LOP CC GIAN COT (H.13.4, H.13.5) khoang giun cac 'axing d6t ban chan co cac co gian cot Ca gian cot gam hai loci : 227 Gan chay sau Cd ggp ngon cai nga'n Cd ggp ngon nggn Cd khop ng6n cal (dgu died) Cac co' gian gan chan cot Cd khop ngon cal (dgu ngang) Gan cd ggp ng6n cai dal Hinh 13.3 : Ca gan chdn (lap sdu) 2.4.1 Cac cd gian cot mu chan (mm interossei dorsales) CO b6n cc gian c6t mu chan lap b6n khoang gifta cac xurung difk ban chan Hai cc gian c6t mu ben den barn tan \Tao hai ben nen daft an ngon II, hai cc gian c6t ngodi dgn bam vac) mat ngoai xuang d6t ban III va IV (H.13.5) Cac cc dang ng6n chan 2.4.2 Cac cd gian cat gan chan (mm interossei plantares) CO ba cc gian c6t gan chan Cac cc barn tit mat cac xacrng d6t xuung ban III, IV, V den barn tan yao mat nen d6t nem an dm cac ngon turning Ling (H.13.4) 228 Cdc ca khep ngon III, IV, V vg gall true ctia ban than la ngon II Tdt ca cdc ca gan than (tit ca dang, ca gdp neon cdi ngon, cc gdp cdc ngon than ngan va ca giun I than kinh gan than trong) de'u than kinh gan than ngoai van dOng I Hinh 13.4 : Ca gian cot gan chdn Hinh 13.5 : Ca gian cot mu than 229 2.5 MACH MAU Wing mach chay sau cldn vimg got (regio calcanea) chia hai nhanh cling la Ong mach gan chan ngoai va Ong mach gan chan 2.5.1 DOng mach gan chan ngoai (a plantaris lateralis) (H.13.6) Nguyen dy, duang di: ding mach gan chan ngoai nhanh tan kin hun cua Ong mach chay sau acing mach di tit ngoai qua got chan ddn nen xu'ung d6t ban V Tai day Ong mach quat tra 14i vao ngang nen cac )(acing cl6t ban reii n6i vdi nhanh gan chan sau dia ding mach mu chan tao cung gan chan (arc us plantaris) Dutng di ciia ding mach có thd ve bang m6t, duUng di qua got chan tit didm gitira mat ca va mom cu got dgn nen xuang d6t ban V, re;i tit di ngang den nen xuang d6t ban I Duting kinh trung binh cua ding mach gan char' ngoai ngu'di Vidt Nam la 1,15 mm Cd clang ngon cal Dong mach gan chan ngoai EYO'ng mach gan chan Thin kinh gan chan ngoai Thin kinh gan chan Co vuong gan chan Cung gan chan DOng mach gan dot ban chan Cd khep ngon cal Gan gip ngon cal dai Hinh 13.6: Cdc dung mach gan chart 230 Lien quan : * Doan \rung got : DOng mach di gida )(dung g6t va co dang ng6n cdi * Doan che-ch : DOng mach di gilla co gap cac ng6n chan ngan va co vuong gan chan Than kinh gan chan ngoai luc dau a sau d6ng mach, sau di vao * Doan ngang la cung dOng mach gan chan, di cang luc cang sau, gida co gap cac ng6n chan dai, cac co giun vai co khep ngon cai va co gian cot Nhanh ben : DOng mach gan chan ngoai cho cac nhanh : — Cac nhanh Ong mach gan d6t ban chan (a metatarsae plantares) di a ke gida cac xdong d6t ban chan va cho nhanh (.16n cac nem — Cac nhanh xuyen (rami perforantes) n6i vdi Ong mach mu chan Than kinh gan chan ngoai Co clang ngon cal Cd clang ngon 01' Than kinh gan chan Co vuOng gan chan Cd khep ngon Gan co gap cac ngon chan dai cal Nhanh sau than kinh gan chan ngoai Gan co gap cat dai ngon Hinh 13.7: Cie thdn kinh a gan chdn 231 2.5.2 Bong mach gan chan (a plantaris medialis) Nho hon do, ng mach gan chan ngoai, do, ng mach gan chan di doc theo phia gan gap ngon cai dai, sau de n6i vai nhanh dOng mach gan d6t ban chan met Du'ong kinh trung binh cua &Mg mach gan chan a ngoai Viet Nam la mm 2.5.3 Tinh mach Di kern vai Ong mach va d6 vao cung tinh mach gan chan (arcus venosus plantaris) 2.6 THAN KINH (H.13.7) Ciing nhu dOng mach, gan chan co hai than kinh : than kinh gan chan ngoai va gan chan tach a than kinh chay, vOng got phia sau (lath ctia mat ca 2.6.1 Than kinh gan chan ngoai (n plantaris lateralis) Duac xem nhii day tru ar gan tay Than kinh di ding clueing Arai Ong mach gan chan ngoai va cho hai loai nhanh : —Nhanh Ming (ramus superficialis) : chia hai nhanh than kinh gan ngon chan chung (rt digitales plantares communes) M6i nhanh sau lai chia hai nhanh than kinh gan nem chan rieng (n digitales plantares proprii) dgn cam gide cho mot ng6n rudi ngoai —Nhanh sau (ramus profondus) di theo cling vai Ong mach gan chan va gi6ng nganh cling sau day than kinh tru den van deng cho cac ca a me lit, ba car giun ngoai, cac ca gian cot va ca khep nein cai 2.6.2 Than kinh gan chan (n plantaris medialis) Duac xem nhu' than kinh giaa a gan tay, than kinh di gida ca dang ngon cai va gal) cac neon chan ngan r6i cho cac nhanh : —Than kinh gan ngon chan rieng (n digitalis plantaris propri) dgn cam giac rieng cho canh nem —Ba than kinh gan ngon chan chung (nn digitalis plantaris communes) M6i nhanh sau de chia hai than kinh gan ngon chan rieng de chi ph6i cam gide cho ba ngon rueli ctia ngon chan Than kinh gan chan chi ph6i van &Ong cho ca dang ngon cai, ca gap nein cai ngan, ca gd.p cac ngon chan ngan va ca giun I Tom lai, ca a gan chan dirge chia ba o nhu' a gan tay, nhung xep lam Mn lap va chiIc nang caa ban chan khac ban tay nen thigu di ca d6i nein cai va neon lit Cac gan ca a gan chan da gop phan tao nen vom doc gan chan Mach mau a gan chan la Ong mach gan chan va gan chan ngoai Deng mach gan chan ngoai tao cung d'eng mach gan chan, cung tuang to cling &Ong mach gan tay sau Than kinh gan chan la than kinh gan chan Wang to nhu' than kinh tru va than kinh gan chan Wang tkr than kinh giCra ar gan tay 232 MU CHAN (dorsum pedis) LOP NONG 1.1 DA VA TO CHT3C1dI DA Da va to chart duai da a mu chan mong va de" di dOng Trong lap to chile dtfai da c6 chtla tinh mach va than kinh nong 1.2 TINH MACH VA THAN KINH NONG Tinh mach a mu chan tao mot mang tinh mach mu than (rete venosum dorsales pedis) Mang tinh mach n6i v6ri cung tinh mach mu chan (arcus venosus dorsalis pedis), sau de cung de vao tinh mach hien lan va hien be (v saphena magna, v saphena parva) (H.12.3) Cam gide a mu chan du'oc chi ph6i bai : * Than kinh bi mu chan (n cutaneus dorsalis medialis) thu6c than kinh mac nong chi ph6i cho hai ngon ruai * Than kinh N mu chan gifia (n cutaneus dorsalis intermedius) thu6c than kinh mac nong, chi ph6i cam giac cho canh ngoai ngon chan III, IV, va canh ng6n V * Than kinh bi mu chan ngoai (n cutaneus dorsalis lateralis) thuOc than kinh bi cang chan, chi ph6i cam giac cho canh ngoai ngon * Than kinh hien chi ph6i cho canh mu chan (H.12.2) * Than kinh mac sau chi ph6i cam giac cho ke gida nem I va II va not tie-p vai than kinh bi mu chan 1.3 MAC NONG : O tren mac lien tigp vdi mac gift gan dui ddai va a hai ben mac Binh vai can gan chan LOP SAU (H.13.8 va H.13.9) 2.1 CAC GAN CO Cdc gan car khu trade cang chan di duai mac gift gan du6i dgn barn vao mu chan g6m : —Gan car chay truac &roc boc bao gan car chay trurac (vagina tendinis m.tibialis anteriores) den barn vao xatong chem va nen xacing d6t ban I —Gan car du6i ng6n cdi dai dude boc bao hoat dich gan car du6i ng6n cdi dai (vagina tendinis m extensoris hallucis longi) Mil barn vao nen d6t xa ngon cai —Gan cd du6i cac ngon chan dai Mn barn vao nen cac d6t giUa va xa cua b6n nem ngoai cang — Gan car mac ba den barn vao nen 'axing d6t ban V Hai gan co trail dude boc mot bao hoat dich chung : bao hoat dich gan cU du6i cac ngon chan dai (vaginae tendinum m extensoris digitorum pedis longi) 2.2 CO DUOI CAC NGON CHAN NGAN (m extensor digitorum brevis) Nguyen ily : * Micmg got mdt tren va ngoai * Mac gift gan du6i du6i (retinaculum mm extensorium inferius) 233 Thin kinh bi mu char) DOng mach mu char? Gan co' mac ngan Cd chi)/ trudc Cd du& cac ng6n ngin Ca du'di ngon cal ngin Cac ddng mach mu ckit ban char? Thin kinh mac sau Gan ca du6i cac ngon chan dai CO du& ngon cai dai Hinh 13.8: Mu chtln Gan ca du6i cac ngon chan dai Cd duoi cac ngon chan ngan Co duoi ng6n car dai Ddng mach mu chan Gan ca chay sau Co clang ng6n Gt Gan ca mac dai Ca gip ng6n Of Ddng mach thin kinh gan chan ngoai Ca khep ngOn cal Ca gap cac ng6n chan dai Co gip ngon cal ngan Co' cac ng6n chan ngthn Ca clang ngon cai Gan ca gap ng6n car dai Ddng mach firth mach gan chan Hinh 13.9 : Thiet ngang ban chan qua cac xdong deft ban chan 234 Barn tan : Ca di dudi gan cu dui cac ngon chan dai va chia b6n bo de'n b6n nein chan * Bo Mil ng6n cdi lan nhal barn van d6t gdn nein cai, dadc goi la ca duinein cdi ngAn (m extensor hallucis brevis) * Ba bo 14i den dinh vao gan dui cac nein chan dai DOng tdc : Duibon nem chan ding Ca dui cac nein chan ngAn nam tren mac sau mu chan Mac non.g va mac sau chia mu chan hai khoang to bao : khoang doh da nam tren mac nong, khoang dudi mac nam gill-fa mac ming va mac sau Nhiem trUng a khoang nao se chi khu tru khoang ma khong lan sang khoang khdc 2.3 DONG MACH MU CHAN (a dorsalis pedis) acing mach chay trade dgn khdp c6 chan a dudi mac gift gan dui dudi thi d6i ten Ong mach mu chan Chie-u tren da, Ong mach mu chan di tit gala hai mat ca den ke gifia ngdn chan thd nhA va nen chan tha hai DOng mach di doc theo bd ngoai ca du6i ngon cai dai dgn nen xuang &it ban chan thd nligt thl cho nhdnh Tong mach cung (a arcuata) (H.13.8), va n6i vdi dOng mach gan chan ngoai DOng mach cung, sau chay tong ngoai a mdc nen mil:mg d6t ban chan, Judi cac gan co duidai va ca duingagn DUng mach cung chia cac nhanh : —Cac dimg mach mu d6t ban chan (aa metatarseae dorsales) di a ke giu'a cac xuang d6t ban Cdc dUng mach sau cho cac nhanh mu ngon chan (aa digitales dorsales) di gala ice mat lung cac nem chan Cdc dung mach mu d6t ban chan va mu ngon char' deu cho cac nhanh n6i vdi Ong mach gan chan — Nhanh gan chan sau (ramus plantaris profundus) di xu6ng gan chan a khoang gian cot I de n6i vdi dung mach gan chan ngoai (a plantaris lateralis) cung gan chan (arcus plantaris) Ngoai ra, a c6 chan dOng mach mu chan cho cac nhanh : —Dung mach c6 chan ngoai (a tarsea lateralis) —Cac dOng mach c6 chan (aa tarseae mediales) 2.4 THAN KINH MAC SAU chia nhanh ding a mu chan, di theo dOng mach mu char' va cam giac cho mot vUng rat nhO a ke giCta nein chan I va ng6n chan II (H.13.8) CAU HO1 TRAC NGHIEM Chun cau tra liri dung nh'dt 137 Ca nao KHONG co a gan chan : a) Ca gian cot gan chan b) Ca clang ngon chan d) Ca d6i ngon e) Ca gap cac ngon chan nga'n c) Ca giun 235 138 Cc; nao dudi day thuOc lap ca gitia ctia gan chan : a) Ca gap cac neon chan ngan d) Ca vuong gan chan b) Ca dang nein cai e) Ca gap ngan cai ngan c) Ca dang ngon 139 Chow), call thing : a) Xacing ban chan có cau tao hinh vom c16 thich nghi vai chic nang ch6ng dct va van chuyen ciia ban chan b) Neu mat Aram (ban chan bet) thi di lai kilo khan va dau clan c) Phan vom cao d IA ngoai han a bar ban chan d) a, b, c dung e) a, b dung (Xem them bed 8) 140 Ca dang nen chan cai than kinh nao van &Ong : a) Than kinh gan chan b) Nhanh 'long than kinh gan chan ngoai c) Nhanh sau than kinh gan chan ngoai d) Than kinh chay e) Mot than kinh khac Chon : a) N6u mOnh d6 (A) ching (B) dung va (A), (B) có lien quan nhan qua b) N6u (A) dung, (B) dung nIning kitting lien quan nhan qua c) Nati (A) dung, (B) sai d) Neu (A) sai, (B) clang e) Neu (A) sai, (B) sai 141 (A) Tiem tinh mach a mat ca thutIng chon tinh mach hi6n loin VI (B) Tinh mach hi6n Ian to d6 b0c 10 va nam trade mat ca 142 (A) Tiem tinh mach thaang chon tinh mach hign be Vi (B) Tinh mach hign be nam sau mat ca ngoai 143 DOng mach mu chan : a) Co the bat mach &Asc b) Di doc bar gan ca dui nem chan cai dai c) Do Ong mach chay trade d6i ten d) a, c dung e) a, b, c clang 236 144 Cung do, ng mach gan chan ducic tao nen bdi dOng mach gan chan (A) va dung mach gan chan ngodi (B) DOng mach gan chan la nhanh tan cua dOng mach chay sau (C) Deng mach gan chan ngoai la nhanh tan ciia dung mach mac (D) Cau tren SAI a ch6 nao ? (Ndu dung thi chon cau e) a) (A) d) (B) b) (A) va (D) e) Cau tren dting c) (C) Dung cac chi tigt sau cle tra Idi cau 145 va 146 a) Cac nhanh ding ctia than kinh gala a gan tay b) Cac nhanh ding dm than kinh tru a gan tay c) Nhanh ding sau dia than kinh tru d) Nhanh ding nong cila than kinh try e) Cac nhanh ding cila than kinh quay 145 W mat du' ng di va chi ph6i, than kinh gan chan gi6ng 146 W mat &Ong di va chi ph6i, than kinh gan chan ngoai gi6ng 147 Chi ph6i cam giac canh ngoai mu ban chan la met nhanh than kinh xuat phat tur : a) Than kinh chay d) Than kinh mac sau b) Than kinh bdp chan e) Than kinh hidn c) Than kinh mac ming 148 Khi so sanh gan chan va gan tay, cau nao sau day DUNG : a) Cac car gan chan ding chia o nhti cd gan tay nhung xdp ldp va kitting co cc d6i ng6n cai va co neat tit b) Cung &Ong mach gan chan ttrang tai nhu' cung dung mach gan tay c) Than kinh gan chan ngoai tu'o'ng tur nganh ding than kinh try d) a va c dung e) a, b va c dung 237 ... (2 tigt) (4 tigt) (1 tigt) (2 tigt) (2 tigt) 12 1 - 15 6 17 1 19 4 2 01 222 PHAN I - CHI TREN )(acing kherp chi teen Ndch Cdnh tay Khuku CAng tay Ban tay PHAN - CHI DWI 10 11 12 13 Xthing khop chi... tigt) (3 tigt) (1 tigt) (2 tigt) (1 tigt) (2 tigt) (2 tigt) (3 tigt) (1 tigt) (1 tigt) (2 tigt) (3 tigt) (5 tigt) 238 238 3 01 319 329 346 354 366 380 397 405 416 430 453 486 512 MUC TIEU TRUNG... va duai (11 .2.5) 2 .1 THAN XVONG 2 .1. 1 Mat trtiac ngoai (facies anterior lateralis) Khoang giiia c6 mOt vOng g6 gh6 hinh chit V goi la 16 1 c6 den ta (tub erositas deltoidea) (H.2.5A) 2 .1. 2 M4t