A. GIAI PHAU - SINH LY
- Giai phau: day than kinh tru xuat phat ttf than nhi trtfdc trong cua dam ro"i than kinh canh tay, di sau day than kinh gitfa de xuong canh tay, quat ra sau den ranh rong roc khuyu, vong quanh mom tren loi cau va xtfdng tru de ra phia
/ *> V . *> ,
nhanh cung: nhanh sau (deep branch) van dong cho tat ca cac cd mo ut, tat ca cac cd gian cot gan tay va mu tay, cd giun 3 va 4, cd khep ngon cai va cd gap ngan ngon cai (hinh 4.10); nhanh nong cho cam giac d gan tay va ngon tay (hinh 4.2).
Hinh 4.10: Day than kinh tru 1. Than nhat giCra 2. Cd tru trtfdc
3. Cd gap chung sau 4. Cd gan tay bi trong 5. Cd giang ngon ut 6. Cd doi chieu ngon ut 5. Cd giang ngon ut 6. Cd doi chieu ngon ut
7. Cd gap n g ln ngon ut 8. Cd gap ngan ngon cai (bo sau) 9. Cd khep ngon cai 9. Cd khep ngon cai
Nhanh hen: cho cd tru trtfdc, cd gap chung sau (hinh
4.1 0) va nhanh bi mu tay (dorsal cutanneous sensory branch) chi phoi cam giac cho da mu cd tay va mu ban tay, nhanh ben cho mu ngon ut, ngon n h ln va phan trong ngon gitfa (hinh 4.2).
- Sinh ly: day than kinh tru la mot day hon hop. Nhiem vu van dong dac biet quan trong doi vdi ban tay, bao gom cac dong tac:
+ Gap ban tay + Khep nhe ban tay
+ Gap dot 2 va 3 cua ngon ut va ngon nhan
B. TRIEU CHLTNG1. Van dong 1. Van dong
Liet day tru co nhtfng trieu chtfng chu yeu sau: - Vuot tru (griffe cubitale) (hinh 4.11A):
A b
Hinh 4.11:
+ Mo u t t e o n h o b e t x u o n g , c a c k h e g ia n dot lorn
x u o n g d e lo r o x U d n g b a n t a y v a b a n t a y n h tf c h a n c h im .
+ Dot 1 cac ngon tay (nhat la ngon 4 va 5) qua duoi va 2 dot khac gap, cac ngon tay luon luon d tu the giang (vi liet cac cd gian dot gan tay, mu tay va cd giun do giay tru chi phoi nen khong the gap dot 1 ngon tay, duoi dot 2 va 3 ngon ut va khong the khep dtfdc ngon tay (hinh 4.11 B).
+ Mat dong tac khep va giang cac ngon tay vi liet cac cd gian dot.
< ►
Hinh 4.12:
A. Dau hieu ngon cai cua Froment trong liet day tru trai) B. Test danh gia chirc nang ca khep ngon cai. B. Test danh gia chirc nang ca khep ngon cai.
+ Mat dong tac khep ngon cai: phat hien bang test danh gia chtic nang cd khep ngon cai (hinh 4.12B) hoac bang dau hieu ngon cai cua Froment (signe du pouce de Froment) (hinh 4.12A), benh nhan cam 1 td bia giiia ngon cai va ngon tro roi siet chat tay va keo mieng bia. 0
ben lanh, ngon cai siet chat dtfdc td bia (nhd co khep ngon cai do day tru chi phoi). Ben liet ngon cai khong khep dtfdc nen phai gap ngon cai (nhd cd gap dai ngon cai do day gitfa chi phoi) de bam td bia.
- Liet cac co gian dot gan tay, mu tay va cd giun, phat hien bSng test danh gia chtfc nang cd giun va cd gian cot (hinh 4.13A).
Liet cd gap ngon ut: phat hien bang test danh gia chtic nang cd gap ngan ngon ut (hinh 4.13B): Benh nhan up sat long ban tay tren mat ban roi gai ngon ut tren mat ban.
Hinh 4.13:
A. Test danh gia chirc nSng cd giun va cd gian cotB. Test danh gia c h u t nSng cd gap ngan ngon ut B. Test danh gia c h u t nSng cd gap ngan ngon ut
T r o n g thU c te la m s a n g (t r o n g trU dn g h d p ta y d a b o b o t) chi' c o th e c a n cU v a o v a n d o n g c u a n g o n ca i d e x a c d in h thU dng to n c a c d a y th a n k in h , th u d n g to n d a y q u a y : m a t d u o i v a g ia n g n g o n ca i, th u d n g to n d a y tru : m a t k h e p n g o n cai; thUOng to n d a y gitia: m a t g a p v a d o i c h ie u n g o n ca i).
2. Cam giac
Mat tat ca cac loai cam giac d ngon tay ut, mo tit va mot ntia ngon nhan (hinh 4.2).
3. Phan xa
Mat phan xa tru sap
C. NGUYEN NHAN
Day TK tru hay bi thudng ton trong benh phong (lepre), co the sd thay day TK tru noi ro trong ranh rong roc khuyu.
- Viem day than kinh tru do nhiem doc, nhiem khuan.
- T h U d n g to n th a n k in h t r u d o xU dn g sUdn cd (it g a p ).