A. GIAI PHAU
Day than kinh gitfa phat sinh ttf than nhi trtfdc ngoai va trtfdc trong di xuong canh tay doc theo dong mach canh tay roi xuong cang tay, nam gitfa cac cd gap nong va sau. Khi den
1. Than nhi trtfdc ngoai va trtfdc trong trtfdng hop thanh day than trong trtfdng hop thanh day than kinh gitfa.
2. Cd sap tron3. Cd gan tay ldn 3. Cd gan tay ldn
4. Cd gap chung sau cac ngon tay5. Cd gap dai ngon cai 5. Cd gap dai ngon cai
6. Cd sap vuong
7. Cd giang n g ln ngon cai8. Cd doi chieu ngon cai 8. Cd doi chieu ngon cai
9. Cd gap ng§n ngon cai (bo nong)
Hinh 4.5: Day than kinh gitfa
cd tay, day than kinh gitfa chui giiia chui dtfdi day chang vong de xuong gan ban tay chia thanh nhieu nhanh tan ctfng. Day than kinh gitfa chi qua nach va canh tay ma khong chia nhanh nao d do.
- Day than kinh gitfa la mot moc de tim dong mach nach va dong mach canh tay (d ngay sau day than kinh gitfa).
- Day than kinh gitfa chi phoi dong tac gap ban tay va ngon tay (cd gan tay ldn, cd gap chung sau cac ngon tay, cd gap chung nong cac ngon tay), sap ban tay (cd sap tron, cd sap vuong), giang ngon cai (cd giang ngan ngon cai), doi chieu ngon cai (cd doi chieu ngon cai) (hinh 4.5).
Day than kinh gitfa cam giac 3 ngon tay rtfdi d gan tay (ngon cai, ngon tro, ngon gitfa va niia ngoai ngon nhan), d mu (dot 2,3 cua ngon tro va ngon gitfa, niia ngoai mu dot 2, 3 cua ngon nhan (hinh 4.2).
Day than kinh gitfa la day than kinh hon hdp. co nhieu sdi giao cam, nen khi bi thtfdng ton hay bj "chiing dau chay" (causalgia).
B. TRIEU CHLfNG
Van dong: ban tay co hinh dang "ban tay khi" (main de singe): do mo cai teo, ngon cai nam cung mat phang vdi cac ngon khac, ngon cai khong gap va khong doi chieu dtfdc (hinh 4.6)
Dong tac sap ban tay rat yeu. Dong tac gap ban tay vao cang tay khong bi mat hoan toan vi nhd co cd tru trtfdc va mot phan nhd cd ngtfa dai. Khi benh nhan nam tay lai thi co hinh dang dac biet "ban tay giang dao" (main de predicateur): Mat hoan toan dong tac gap ngon tro va ngon cai, dong tac gap ngon nhln va ngon ut v in binh thtfdng (hinh 4.6B).
Test kiem tra cd giang ngan ngon cai (do day than kinh giiia chi phoi): up sat hai long ban tay va cac ngon tay vao nhau hoac de sat hai ban tay cho dau ngon tro cham vao nhau, dang het stic ngon cai tao thanh goc vuong doi vdi cac ngon khac. Ngon tay cai ben liet d tren ngon tay cai ben lanh (hinh 4.7).
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H inh 4.7: Test kiem tra ca giang n g ln ngon cai
Hinh 4.8: Nguyen Cong L. Liet day than kinh giilfa Mat dong tac gap ngon tro va ngon cai Khong doi chieu dude ngon cai
Cam giac: giam hoac mat cam giac da khu viic day than kinh giiia phan bo" (hinh 4.2).
- Dinh diidng: teo cd mo cai, da thuoc khu vUc day than kinh gitia phan bo” co the bi kho, mong, cac ngon tay tai nhdt hoac tim, cac mong tay co khia va de gav, co khi tiet mo hoi, tang sting hoa, ram long, loet.
C. NGUYEN NHAN
*Trong thdi chien thtfdng gap thtfdng ton phoi hdp day than kinh gitfa vdi day than kinh khac (do vet thtfdng hay chan thtfdng canh tay, ft gap hdn do vet thtfdng hoac chan thtfdng c ln g tay).
*Trong thdi binh, day than kinh gitfa l't bi thtfdng ton, duy chi co hoi chtfng than kinh gitfa d ong cd tay la dang chu y nhtfng d ta ft gap hdn d chau Au.
*Hoi chtfng than kinh gitfa d cd tay (syndrome du nerf median au canal carpien) hay hoi chtfng ong cd tay (carpal tunnel syndrom):
- Trieu chtfng lam sang tap trung chu yeu d ban tay do than kinh gitfa va tuan hoan d ong cd tay bi chen ep gitfa xtfdng tu cot d co tay va day chang ngang co tay (transverse carpal ligament).
Day chang ngang co tay Day TK.giCra
X ifdng tu cot co tay
Hinh 4.9: Hoi chifng than kinh giifa d ong cd tay.
Nhtfng trieu chtfng chu yeu cua hoi chtfng nay bieu hien d khu vtfc cua day gitfa chi phoi la:
+ Di cam: cam giac te, kien bo, dau chay (causalgia) d dau ngon tro va ngon gitfa (hinh 4.2)
+ Liet dong tac gap va doi chieu ngon cai.
+ Dau tang len ve ban dem hoac khi benh nhan nam ban tay lai hoac xoe ban tay ra hoac khi gid tay len cao.
+ Trieu chilng lam sang am tinh quan trong la khong co roi loan cam giac chu quan va khach quan cua ngon ut.
+ Dau hieu gap ban tay vao cd tay: nhiing trieu chiing lam sang cua hoi chiing kinh giiia d ong cd tay tang len gap boi khi gap ban tay vao co tay.
- X quang: co the phat hien dtfdc nhtfng thay doi cua to chtfc xtfdng d cd tay.
- Nguyen nhan: do hep khe xtfdng tu cot cd tay va day ch&ng ngang cd tay do mot benh toan than (thoai hoa dang tinh bot amylose), phu niem (myxoedeme), benh tai cho (viem bao hoat dich - gan), benh htf khdp: arthrose). Cac vi chan thtfdng khdp cd tay. Benh nghe nghiep (rtfa, giat, mai, la quan ao...).
- Dieu tri:
Dieu tri bao ton la chu yeu: co" dinh bang bot (hoac nep bot ban dem) gitf cd tay d ttf the trung gian trong hai tuan le co the co ket qua trong mot so" it trtfdng hdp. Tiem cortison trtfc tiep vao ong cd tay hoac sieu am dieu tri nhtfng hau nhtf khong co ket qua.
Dieu tri phau thuat cat bo day ch&ng ngang cd tay: neu trieu chtfng ctf tai phat nhieu lan.