- Loai C: Gay hoan toan cung sau, ton thtfdng m&'t viing ca chieu ngang va chieu doc.
Cau tao dau tren xitong du
Cac bd xUdng hinh vom cl phia ngoai
Cac bd xifdng hinh quat n&m d phia trong, hifdng di phu hdp vdi hifdng cua luc n6n. B6 hinh quat di tir cung Adam toa len chom xifdng dui.
,:V / / \ Hinh 22.2. Cau true cac be xuong cua cd xifdng dui
i ' ; / . ' 1 !
L
Co xtfdng dui va than xtfdng dui tao vdi nhau mot goc 130 do
Binh thUdng khi dting th in g : moi hang chiu 1/2 trong ltfc, khi btfdc di chan tru chiu 2,5 trong ltfc va khi chay thi chan cham d&'t chiu ltfc ty 5 l l n than trong.
• Cau tru e ba o khdp (hinh 22.3)
Bao khdp la mot cau true xd khoe bao boc het chom va g i n het cd
Phia trtfdc bao khdp bam vao dtfdng lien m&u chuyen, d phia sau bam nika ngoai cua xtfdng dui, mot phan cua cd xtfdng dui n im ngo&i khdp.
Khi gay, phan cd xtfdng dui n im noi khdp khong tao dtfdc can ngoai vi, stf li£n xtfdng chi con nhd vao m ang trong xtfdng.
Nude hoat dich khong tham gia vao qua trinh lien xUdng ma no con lam tieu mau tu, ngan cac te bao hinh thanh.
Mat trudc Mat sau
Hinh 22.3. Cau true bao kh6p cd xtfdng dui • M ach mau nuoi dudng co xUdng dui (hinh 22.4)
M ach mau nuoi dudng cd xtfdng dui rat ngheo nan, befi ba nguon:
Dong mach day chang tron: rat nho, nuoi 1/4 chom , m ot so ngtfdi lai khong c6 hoac bi xd viia.
Dong m ach mu: dtfdc chia ttf dong m ach dui sau, ttf bao khdp tdi nuoi chom . Dong m ach ttf than xtfdng dui-nen cd len nuoi.
Hinh 22.4. Mach mau nuoi chom xtfdng dui
• D u d n g g a y : dtfa vao vi tri dtfdng gay co xtfdng dui ma ngtfdi ta chia ra ba loai
(hinh 22.5)
Gay chom dtfdi Gay xuyen co Gay nen co
• D o c h e c h cu a d u d n g g a y : theo do ma Pauwels chia ra 3 loai, dtfa vao goc a la
goc tao bdi gitfa dien gay vdi mat phang n&m ngang. PI: a < 30°
Trong ltfc con ep nhieu vao dien gay, tien ltfdng tot P2: 30 a 70°C
Tap hdp ltfc rdi mot phan ra ngoai dien gay, tien ltfdng de dat. P3: a >70°
Dtfdng gay gan nhtf dting doc, rat kho lien
• L o a i g a y (dtfa vao stf di lech cua o gay) theo Garden co 4 loai (hinh 22.5)
Chu yeu dtfa vao X quang
G l: Gay m ot phan co-gay cai nhau. Cac be xtfdng phia dtfdi cua co con nguyen G2: Gay hoan toan, khong di lech
G3: Di lech nhieu nhtfng dien gay con dinh vao nhau G4: Chom khong con dinh vao co, chom quay ttf do
• Theo goc co- than (tren lam sang co 2 loai)
Gay cd xtfdng dui cai nhau: it gap (con goi la gay dang)
G ay cd xtfdng dui rdi nhau: gap ch u yeu tron g gay cd xtfdng du i (con goi la gay kh6p).
• Ton th u o n g p h a n m em : ton thtfdng day chang va bao khdp anh huong tdi nuoi dtfdng khdp. Dac biet la diit mach mau nuoi dtfdng chom, gay cang sat chom cang de bi tieu chom.
I
Hinh 22.5. Vj tri dtfdng gay
(1: gay dtfdi chom, 2: gay xuyen co, 3: gay nen cd)
' a < / v . V ■ > / \ L . j v ; . . r Gl G 3 G 4
Hinh 22.6. Phan loai theo Garden
2.3. Sinh ly benh
Gay cd xtfdng dui la mot gay xtfdng ldn trong cd the, lai hay gap d ngtfdi gia, nam lau, kho lien nen gay ra nhieu nguy hiem ca ve toan than, cung nhtf tai khdp.
• N gu y h iem tdi tin h m a n g : Benh nhan co the chet do cac biefn chtfng
— Nhiem trung tiet nieu — Nhiem trung phoi
- Loet do ty de vung cung - cut nhilm trung
• N gu y h iem tdi ch iic n a n g ch i (hinh 22.7)
- Tieu chom: cang gay sat chom cang de bi hoai ttf vi nguon nuoi chom con lai la dong mach day chang tron (binh thUdng nuoi 1/4 chom).
- Khdp gia: do mach nuoi kem, do loang xtfdng
- Thoai hoa khdp: ca chom xtfdng dui va ca o khdp meo mo, bien dang
- Can lech co xtfdng dui: co xtfdng dui guc, goc co - than khoang 90o lam cho hang khep, chan ngin.
- Voi hoa quanh khdp
Hinh 22.7. Tieu chom xtfdng dui
3. CHAN DOAN
3.1. Chan doan gay co xi/dng dui cai nhau, gay gang: ty le gap 30%
3.1.1. Lam sang: T rieu chting lam sang rat ngheo nan
— Sau tai nan benh nhan dau vung hang, dau rat md ho, rat kho xac dinh vi tri cu the.
— Cac dong tac cua khdp hang lam benh nhan dau it, nhUng van binh thtfdng.
A/
— A n dau nhe d vung tam giac Scarpa
— Neu kham ky co the thay chan gay ngan hdn chan lanh mot it, hang dang nhe va hdi xoay ngoai.
3.1.2. X quang: Rat quan trong de doan gay cai co xUdng dui
— Co mot vet dam d co xUdng dui vung cai nhau
— Thay doi cau true binh thifdng cua be xtfdng (d he quat)
3.2. Chan do£n gay co xifdng dui chinh danh (gay kh6p): Day la mot loai gay co
3.2.1. Lam sang
- Co the gap sau mot gay cai khong dtfdc ch&n doan va dieu tri - Dau: benh nhan rat dau sau tai nan
- Stfng ne vung tam giac Scarpa, an vung nay benh nhan rat dau - Mat cd nang cua khdp hang hoan toan
- Bien dang chi dien hinh: Chi n g ln , dui khep, cang ban chan xoay do ra
ngoai, nhtfng khong do sat mat gitfdng vi co bao khdp giti (khac vdi gay xtfdng dui). - Tran dich khdp goi muon