Giải phẫu sinh lý, dùng cho các trường trung học y tế

BO Y TE
VU KHOA HOC VA DAO TAO

CIAIPHAU - SINH LY
SACHDUNGCHOCACTRJONGTRUNGHOCYTE



BO Y TE
VU KHOA HOC VA DAO TAO

GIAI PHAU - SIM I LY
SACH DUNG CHO CAC TRUONG TRUNG HOC Y TE
MA SO: T.10.W1, T.30.W1

NHA XUAT BAN Y HOC
H A N O I -2 0 0 7


C H i D A O B IE N S O A N
VU KHOA HOC VA OAO TAO, B0 Y i t '
NHUTNG N G I/O I BIE N S O A N

P h a n g ia i p h a u
TS. N G U Y EN VAN HUY

P h a n s i n h ly
TS. L£ BA THUC
T H A M G IA TO CHLfC B A N T H A O
THS. PHI' VAN THAM VA
BAN TH U KY HDTDSGK VA TLDH

© Ban quyen thuoc Bo Y te (Vu khoa hoc va Oao tao)

2


LCft G ldl THIEU
ThUc hien Nghi dinh 43/2000/ND-CP ngay 30/8/2000 cua Chm h phu quy dinh
chi tiet va hudng dan trien khai luat Giao due, Bo Y te da phe duyet va ban h anh
cac chUdng trin h khung cho giao due trung hoc chuyen nghiep nhom nganh siic
khoe. Bo Y te to chutc bien soan bo tai lieu day - hoc cac mon cd sc! va chuyen mon
theo chUdng trin h mdi nhfim ttfng budc xay dung bo sach chuan trong cong tac dao
tao trung hoc nganh y te.
Cuon Giai p h a u - S in k ly dUdc cac giang vien co kinh nghiem trong cong tac
dao tao n h a n lUc y te bien soan dUa tren chUdng trinh giao due cua nganh Dieu
dUdng da khoa, Ho sinh he trung hoc. Tai lieu chia lam 2 phan: Giai phau hoc va
Sinh ly hoc, moi phan co cac chUdng/muc vdi so" tiet hoc dUa tren quy dinh cua
chUdng trinh. Moi chUdng/muc deu cau true gom: muc tieu, noi dung va tu lUdng
gia. Day la tai lieu tot, lam cd sci bien soan giao trinh day - hoc phu hdp vdi cac doi
tUdng dao tao trong trUdng Trung hoc va Cao dang y te. Nam 2005, cuon sach da
dUdc Hoi dong chuyen mon tham dinh sach giao khoa va tai lieu day - hoc cua Bo Y
te tham dinh, lam tai lieu day - hoc cua cac trUdng T rung hoc nganh y te trong giai
doan hien nay.
Vu Khoa hoc va Dao tao, Bo Y te xin chan th a n h cam dn TS. Nguyen Van
Huy, TrUdng Dai hoc Y Ha Noi (bien soan phan Giai p h l u hoc) va TS. Le Ba Thuc,
T rung hoc y te Benh vien Bach Mai (bien soan phan Sinh ly hoc) da tich cUc tham
gia hoan th a n h tai lieu nay. Sach xuat ban lan dau chac chan con nhieu khiem
khuyet, chung toi mong n han dUdc y kien dong gop cua cac thay, co giao va dong
nghiep de cuon sach ngay cang hoan thien.

VU KHOA HOC VA DAO TAO

BO Y TE

3



MUC
LUC
■
■
Ldi gidi thieu

3

Phan 1. GIAI PHAU HOC

7

Chuong 1. Gi6i thieu mon giai phau hoc ngi/di

9

Chuong 2. He xUdng

11

Chuong 3. He khdp

48

Chuong 4. He cd

71

Chuong 5. He tim mach

112

Chuong 6. He ho hap

139

Chuong 7. He tieu hoa

157

Chuong 8. He tiet nieu

185

Chuong 9. Cac he sinh due

196

Chuong 10. He than kinh

211

Chuong 11. Cac giac quan

248

Phan 2. SINH LY HOC

Chuong 1. Sinh ly dai cifdng

261
263

Gidi thieu mon sinh ly hoc

263

Dai ci/dng ve cd the song

263

Dai ci/dng ve te bao

266

Dich ngoai bao, dich noi bao va hang ti'nh noi moi

270

Sinh ly hoc chuyen hoa nSng lUdng

273

Sinh ly dieu hoa than nhiet

279

Chuong 2. Sinh ly mau

284

Sinh ly hoc hong cau

285

Sinh ly bach cau

289

Sinh

292

hoc tieu cau

5


Chuong 3. Sinh ly tuan hoan
Sinh ly tim

297

Sinh ly tuan hoan dong mach

304

Sinh ly tuan hoan tTnh mach

307

Sinh ly tuan hoan mao mach

309

Chuong 4. Sinh ly ho hap

315

Chuong 5. Sinh ly tieu hoa

328

Chuong 6. Sinh ly tiet nieu

340

Chuong 7. Sinh ly noi tiet

347

Sinh ly vung di/6i doi

347

Sinh ly tuyen yen

348

Sinh ly tuyen giap

351

Sinh ly tuyen can giap

353

Sinh ly tuyen thUdng than

354

Sinh ly tuyen tuy noi tiet

356

Chuong 8. Sinh ly sinh san

362

Sinh ly sinh san nuf

362

Sinh ly sinh san nam

370

Chuong 9. Sinh ly than kinh

378

Chifc nang cam giac cua he than kinh

383

C hu t nang van dong cua he than kinh

386

Vai tro van dong cua tieu nao

390

Chifc nang van dong cua vo nao

391

Sinh ly he than kinh thi/c vat

393

ChiTc nang cap cao cua he than kinh

394

Chuyen hoa cua nao

396

Tai lieu tham khao

6

297

402


Phan 1

GIAI PHAU HOC



C h ifc fn g 1

Gift THIEU MON GIAI PHAU HOC NGlflTI
Giai phau hoc va cac phan mon cua giai phau hoc

G idi p h a u hoc ngiidi (h u m a n a n a to m y ) la n g a n h k h o a hoc n g h ie n ctfu c au
tru e cd th e ngUdi. T u y th uo c vao phUdng tie n q u a n s a t, giai p h a u hoc dUdc ch ia
t h a n h h a i p h a n mon: g id i p h a u dai the (gross a n a to m y h a y m acroscopic ariatomy)^

n g h ie n ctiu cac c a u tr u e co th e q u a n s a t b a n g m a t thUOng va g id i p h a u vi the
(m icroscopic a n a to m y h a y histology) n g h ie n ctiu cac c au tr u e n h o chi co th e n h in
t h a y q u a k in h h ie n vi.
Cac p h i/tin g thurc mo ta giai phau

Tuy theo muc dich nghien ciiu, co nhieu each mo ta giai phau khac nhau. Ba
each tiep can chlnh trong nghien ciiu giai phau la giai phau he thong, giai phau
vung va giai phau be mat.
G id i p h a u he th o n g (sy stem ic a n a to m y ) la cach mo t a m a d do c a u t r u e c u a
tulng h e cd q u a n (thUc h ie n m o t chtic n a n g n a o do c u a cd th e) dUdc t r i n h b a y rie n g
biet. Giai p h a u h e th o n g th lc h hdp vdi m uc dich g iu p ngUdi hoc h ie u dUdc chiic
n a n g c u a tiin g he cd q u a n . Cac h e cd q u a n c u a cd th e co: h e da, he xUdng, h e k hd p,
h e cd, h e t h a n k in h , he t u a n h o a n , h e tie u hoa, he ho h a p , h e t i e t n ie u , h e s in h
due va h e noi tie t. Cac giac q u a n la m o t p h a n c u a h e t h a n k in h .

G idi p h a u v u n g (regional an atom y) h a y g id i p h a u d in h k h u (topographical
a n a to m y ) la n g h ie n ciiu va mo ta giai p h a u cu a t a t ca cac c a u tr u e (th uo c cac h e cd
q u a n k h a c n h a u ) tro n g m o t v un g, bao gom ca n h iin g lien q u a n c u a c h u n g vdi
n h a u . Cd th e dUdc c h ia t h a n h n h iin g v u n g ldn s a u day: ngUc, b u n g , d a y c h a u va
c h a u hong, chi dudi, chi tre n , lu ng , d a u v a co. Moi v u n g n a y lai dUdc c h ia t h a n h
n h iin g v u n g nh o hdn.

G id i p h a u be m a t (s u rfa c e a n a to m y ) la mo ta h in h d a n g be m a t cd th e
ngUdi, d ac b ie t la n h iin g lien q u a n c u a be m a t cd th e vdi n h iin g c a u t r u e d s a u h d n
nh if cac xUdng v a cac cd. M uc dich c h ln h c u a giai p h a u be m a t la g iup ngUdi hoc
h in h d u n g r a n h iin g c au tr u e nSm du6i da. VI du, d n h iin g ngUdi bi v e t th U dn g do
dao d a m , t h a y th u o c p h a i h in h d u n g r a n h iin g c a u tr u e b e n dudi v e t thU dng co t h e
bi to n thUdng.
Vj tri cua mon giai phau hpc tro n g y hoc

Trong y hoc, giai ph&u hoc dong vai tro cua mot mon hoc cd sd. Kien thiic
giai ph^u hoc ngUdi la kien thiic nen tang, giup ta hieu dUdc hoat dong cua cd the
ngUdi (sinh 11 hoc). Fernel noi rang "Giai p h l u hoc can cho sinh 11 hoc giong nhu
mon dia 11 can cho mon lich si". Giai p h l u hoc cung la nen tan g kien thiic can ban
cua ta t ca cac chuyen nganh lam sang.
9


Tir the giai phau
T a t ca cac mo ta giai p h a u dUdc t r i n h b a y tro n g moi lien q u a n vdi t u th e giai
p h a u de d a m bao r a n g cac mo ta do dUdc ro r a n g va chi'nh xac. M ot ngUdi d t u th e
giai p h a u la m ot ngUdi d iin g t h a n g vdi: d l u , m&t va cac ngon c h a n h u d n g r a trUdc,
cac got c h a n va cac ngon c h a n ap s a t n h a u , v a h a i ta y b u o n g th S n g d h a i b e n vdi
cac g a n b a n ta y h u d n g r a trUdc.
Cac mat phang giai phau

Nhiing mo ta giai phau dUdc dUa tren bon loai m at p h in g giai phau cat qua
cd the d tu the giai phau. Co nhieu m at phang diing doc, diing ngang va na.m
ngang nhUng chi co mot m at phang diing doc giiia. Tac dung chlnh cua cac m at
phang giai phau la de mo ta cac m at cat va cac hinh anh cua cd the.
M a t p h a n g d iin g doc g iiia (m e d ia l s a g it ta l p lan e) la m a t p h a n g th&ng
diing di doc q u a t r u n g ta m c u a cd th e , c h ia cd th e t h a n h cac n iia p h a i v a tra i.
9

#

t

■)

•)

Cac m a* t p h•>a n g d iin g doc
( s a g itta l p la n e s ) la n h iin g m a t p h a n g t h a n g
.*
9

diing di q u a cd th e song son g vdi m a t p h a n g d iin g doc giGa.

Cac m a t p h a n g d iin g n g a n g (c o ro n a l/fro n ta l p la n e s ) la n h iin g m a t p h a n g

t h a n g diin g di q u a cd th e v u o n g goc vdi m a t p h a n g diin g doc giiia, c h ia cd t h e
t h a n h cac p h a n trUdc va sau .

Cac m a t p h a n g n a m n g a n g (horizontal planes) la cac m at phang di qua
cd the vuong goc vdi cac m at phfing diing doc giiia va diing ngang. Mot m at phang
n&m ngang chia cd the th a n h cac phan tre n va dudi.
Cac tir chi m oi quan he vj trl va so sanh

Co n h ie u tln h tii dUdc s i d u n g de m o t a m oi lien h e ve vi t r l c u a cac p h a n cd
th e d tu th e giai p h a u b a n g c ach so s a n h vi t r l tUdng doi c u a h a i c a u tr u e vdi

n h a u , m o t c au tru e ddn le vdi be m a t h o ac dUdng giiia, h a y m o t c a u tr u e vdi cac
ciic cd th e. Dudi d a y la n h iin g tif thU dng dUdc s\i d u n g .

T ren (superior/cranial/ cephalic) la n&m gan hdn ve phla dau; vl du noi "Tim
n&m tren cd hoanh" nghla la noi tim n&m gan dau hdn cd hoanh, noi cai gi do di
ve phla dau tiic la noi di ve phla tren.

D iid i (inferior/caudal) la nSm gan hdn ve phla ban chan; vl du noi "Da day

nam dudi tim" nghia la noi da day nSm gan ban chan hdn so vdi tim.
T ritd c (a n te rio r) la d g a n m a t trUdc cd th e hdn.
S a u (po sterio r) la n a m g a n m a t s a u cd th e hdn.
B e n (la te ra l) v a g iiia (m edial). B en la n&m xa m a t p h a n g doc giiia hd n , giiia
th i ngUdc lai. G an (prox im al) v a x a (d istal). G a n n g h la la n&m g a n t h a n h o ac la
d ie m n g u y e n uy (diem goc) c u a m o t m a c h m a u , t h a n k in h , chi h o ac cd q u a n .. hdn:
x a co n g h ia ngUdc lai.
N o n g (superficial) la n a m g an be m a t hdn va s a u (deep) la n a m xa be m a t hdn.
B e n tro n g (in te rn a l) la d g a n hd n ve p h la t r u n g t a m c u a m o t cd q u a n h a y
k h o a n g rong, ben n g o a i (e x te rn a l) th i ngUdc lai.


C h tfd n g 2

HE XI/0NG (SKELETON SYSTEM)
MUC TIEU

1. Trinh bay diicfc nhiCng kien thiic chung nhat ve he xiidng: sU p h a n chia,
dac diem cau tao cua moi loai xiicfng, sit hinh thanh va p h a t trien cua
cac xiicfng.
2. Mo ta diidc nhiing dac diem hinh the chinh cua cac xiicfng: cac m at
khdp, cac cho bam cua cd, cac moc b i mat.
3. Goi dung diidc ten cua cac chi tiet chinh tren cac phiidng tien thiic
hanh gidi phau he xiicfng.
1. Dai ci/d n g
Xifdng la n h iin g cd q u a n dUdc c au ta o c h u y eu b a n g mo xiidng, m o t loai mo
lien k e t r a n . Bo xUdng d a m n h ie m cac chiic n a n g : n a n g dd cd th e , b ao ve va la m
cho dUa cho cac cd q u a n , va v a n do ng (cung he cd - khdp); bo xiidng c u n g la ndi
s a n s in h cac te b ao m a u va la k h o du truf c h a t k h o a n g va c h a t beo (H 2.1).

Dot song cd
Xg don
Xg vai
Xg LtC
Xg canh tay
Xg si;dn
Dot song that lung
Xg quay

Khoi xg cd tay
- Cac xg dot ban tay
-C ac xi/ong dot ngon tay
Xg dui

Xg banh che
Xg chay
Xg mac

Hinh 2.1. Bo xiidng
Khdi xg cd chan
Cac xg dgt ban chan
Cac xg dot ngon chan

11


1.1. Hinh the ngoai
D u a vao h in h th e ng o ai va c au ta o co th e ch ia xUdng t h a n h cac loai n h u

xiidng dai (long bone), xiicfng ngan (s h o rt bone), xiidng det (flat bone), xiidng

khong deu ( ir r e g u la r bone), xiidng co hoc k h i ( p n e u m a tiz e d bone) va xiidng viing
(s e sa m o id bone). Cac loai xUdng vdi n h iin g h in h th e k h a c n h a u ke t r e n th ic h ling
vdi cac chCfc n a n g r ie n g biet, vi d u n h u xUdng da i co k h a n a n g v a n d o n g vdi d o n g
tac ro n g ra i, xUdng d e t th ie n ve chiic n a n g bao ve v.v... Cac xUdng d a i co m o t t h a n
xUdng v a h a i d a u xUdng. O xUdng chUa trU dng t h a n h , t h a n va moi d a u xUdng da i
dUdc n g a n cach n h a u b a n g m ot s u n d a u xUdng.
1.2. Cau tao

1.2.1. Cau tao chung cCia cac loai xi/ong
B a t ky m o t xUdng nao c u n g dUdc c au ta o b a n g cac p h a n s a u day, ke tii n g o a i
vao tro ng : m a n g ngoai xUdng, mo xUdng dac, mo xUdng xop v a o tu y. Mo xUdng
th u o c loai mo lien ke t, bao gom cac te bao bi v ay q u a n h bdi c h a t c a n b a n r a n dac.
C h a t c a n b a n c u a xUdng bao gom 25% nUdc, 25% sdi p ro te in v a 50% m u o i k h o a n g .
Cac loai te bao c u a mo xUdng la ta o cot bao, h u y cot bao v a te b ao xUdng.

M a n g n g o a i x iid n g (p e rio ste u m ) la m o t m a n g mo lien k e t d a i g ia u m a c h
m a u boc q u a n h be m a t xUdng (trif ndi co s u n khdp). M a n g n a y gom h a i ldp: ldp
n g o ai la mo sdi, ldp tro n g ch iia cac te bao s in h xUdng (osteogenic cells). M a n g
n g o ai xUdng giup xUdng p h a t tr i e n ve c h ie u rong. No c u n g co ta c d u n g b ao ve v a
n u o i dUdng xUdng, giup lien xUdng gay v a la ndi b a m cho cac d a y c h a n g v a g an .
S u n k h d p la m o t ldp s u n tro n g bao p h u m a t k h d p c u a cac xUdng. No la m g ia m m a
s a t va la m gia m sU va c h a m ta i n h iin g k h d p h o a t dich.
X iid n g d a c (com pact bone) la t h a n h p h a n d on g v a i tro c h in h tr o n g chiic
n a n g bao ve, n a n g dd v a k h a n g lai lUc n e n ep c u a tr o n g luc h a y sU v a n dong. Mo
xUdng dac dUdc to chiic t h a n h n h iin g ddn vi dUdc goi la cac he thong H avers. Moi
h e th o n g H a v e rs bao gom m o t ong Havers b t r u n g ta m c h iia cac m a c h m a u , m a c h
b a c h h u y e t va t h a n k in h . Bao q u a n h o ng n a y la cac la xiidng d o n g ta m . G iiia cac
la xUdng la n h iin g k h o a n g n h o (goi la cac ho) c h iia cac te b a o xUdng v a d ich n g o a i
bao. O ng H a v e rs va cac ho dUdc noi lien b a n g n h iin g k e n h n h o goi la cac tieu quan
xiidng. V u n g n l m giiia cac h e th o n g H a v e r s c h iia cac la xiidng ke. C ac la xUdng

bao q u a n h xUdng b n g a y dudi m a n g xUdng la cac la c h u vi ngoai.
X iid n g x o p (spongy bone) do n h ie u be xUdng b a t cheo n h a u c h l n g c h it ta o
n e n m o t m a n g ludi v ay q u a n h cac k h o a n g nho, tr o n g n h u b o t bien. K h o a n g nikm
giiia cac be xUdng chiia tuy do (red b o n e m a rro w ), ndi s a n x u a t cac te b ao m a u .
Moi be c u a xUdng xop c u n g dUdc c a u ta o b a n g cac la xUdng, cac ho c h iia cac te b ao
xiidng v a cac tie u q u a n n h U ng k h o n g co cac h e th o n g H a v e r s thiic sU.
A*

.

~

O tu y ( m e d u lla ry cavity) la k h o a n g ro n g b e n tr o n g t h a n xUdng d a i c h iia tuy
vang (yellow bone m a rro w ). T h a n h o tu y dUdc lot b a n g noi cot mac (e n d o s te u m ).
T u y v a n g chiia n h ie u te bao md.

12

I


1.2.2. Dac diem cau tao rieng cua mdi loai xi/ong (Hi2.2)
Xiidng dai. 6 t h a n xiicfng (d ia p h y sis), ldp xiidng dac d a y d giiia v a m o ng
d a n ve p h ia h a i d a u ; ldp xUdng xop th i ngUdc lai. CJ h a i d a u x itd n g (e p ip h y s is),
ldp xUdng dac chi con la m o t ldp mong, b e n tro n g la k h oi xUdng xop chiia tu y do.
XUdng n g a n co c a u ta o giong n h u d a u xUdng dai. XUdng d e t gom h a i b a n
xiidng dac k e p d giiia la m o t ldp xiidng xop.
1.3. Cac mach mau cua xuong
Xiidng diidc cap m a u to t n h d h a i loai dong m ach: cac do ng m a c h n u o i xiidng
/a cac d on g m a c h m a c h m a n g xiidng.

Vdi m ot xUdng dai, c a c d o n g m a c h n u o i x itd n g thUdng gom m ot dong m a ch
dn ch ay chech q u a xUdng dac q u a m ot lo nuoi xitdng ( n u tr ie n t foram en) d g a n giiia
;han xUdng d en o tu y xUdng va m ot so" dong m a ch n hd di vao d a u xUdng. T ro n g o
uy xiidng dong m a ch ldn chia t h a n h cac n h a n h g a n va xa ch ay doc th eo ch ieu dai
:ua o tu y v a p h a n chia t h a n h cac n h a n h n h d d a n di vao mo xUdng cua t h a n xUdng,
:ac dong m a ch con lai nuoi dUdng cho mo xUdng v a tu y do c u a d a u xUdng.

Mo xg dac

Mo xg xop
Xi/dng det

Mo xg dac

Sun khdp
Xi/dng dai

Mo xg xop
Xuong n g in

Hinh 2.2. Cau true cua cac loai xi/dng

13


C ac d o n g m a c h m a n g x itd n g cap m a u cho m a n g n g o ai xiidng (trvf cac m a t
khdp); m o t so n h a n h m a c h r a t n h o c h u i q u a m a n g n g oai xUdng tdi p h a n ngoai
xUdng dac va noi tie p vdi cac n h a n h cua d on g m a c h n u o i xiidng tu! p h la o tu y di ra.
1.4. S u hinh thanh va phat trien cua xirong
XUdng dUdc h in h t h a n h tro n g thdi k i phoi th a i (vao cuoi t h a n g th ii n h a t

c u a phoi) v a tie p tu c p h a t tr i e n cho tdi tu o i trUcing t h a n h . Co h a i g iai d o a n h i n h
t h a n h xUOng:
o

O g i a i d o a n t h i t n h a t, mo lien k e t long leo c u a phoi (th u o c t r u n g mo, m a
t r u n g mo b a t n g u o n tu: t r u n g bi) b ie n t h a n h the dac dudi d a n g m o t m ang dai;
xUdng dUdc h in h t h a n h t r e n m a n g dai nay.
G ia i d o a n t h i t h a i d ie n r a k h i cac te bao c u a th e dac ( m a n g dai) b ie n
t h a n h xUOng, th e o h a i cach:

Mot so'it xitdng (gom cac xUdng vom so, xUdng h a m dudi v a xUdng don) dUdc

h i n h t h a n h b a n g cach c h u y e n tr u e tie p m a n g t h a n h xUdng. VI du, vom so c u a p h oi
trUdc h a i t h a n g chi la m o t m an g ; tti t h a n g th ii h a i t r e n m a n g n a y x u a t h ie n
n h iin g diem cot h o a la n ro n g d a n r a ta o n e n n h iin g xUdng d e t c u a vom so. Q u a
t r i n h b ie n m a n g t h a n h xUdng dUdc goi la m ang cot hod v a xUdng dUdc h i n h t h a n h
th e o cach n a y la xitdng mang.

Cac xitdng con lai (chiem h a u h e t cac xUdng) dUdc h i n h t h a n h tii s u n . TrUdc

h e t th e dac t r u n g mo ta o r a mo h in h xUdng b a n g s u n (d d a u t h a n g th ii h ai). Tdi
cuoi t h a n g th ii hai, k h i s u n p h a t trie n , no bi m a c h m a u x a m la n . Cac te b a o do
m a c h m a u m a n g tdi p h a h u y s u n va cho s u n bi p h a h u y dUdc t h a y t h e b a n g mo
xUdng. Q u a t r i n h n a y dUdc goi la sun cot hod v a xUdng dUdc h i n h t h a n h th e o c ach
n a y dUdc goi la xitdng sun. Vdi xUdng dai, thU dng th i mo h i n h s u n bi m a c h x a m
la n cJ t r u n g ta m (ling vdi giiia t h a n xUdng). Cac ta o cot b ao do m a c h m a u m a n g tdi
ta o r a xUdng b a n g cach: te bao ta o xUdng t i e t r a c h a t cot giao; c h a t n a y n g a m
m uo i calci b ie n t h a n h xUdng; d ie m ta o xUdng b a n d l u n a y la trung tam cot hod
nguyen p h a t (p r im a r y o ssifica tio n c e n tre ). K h i t r u n g t a m cot h o a n a y p h a t t r i e n
ro n g r a tdi dudi m a n g n goai xUdng, xUdng dUdc tie p tu c dUdc s in h r a bdi m a n g

ng oai xUdng. S u to r a ve dUdng k in h c u a xUdng s u n la do m a n g n g o a i xUdng xay
d a p th e m cac la xUdng do ng ta m ke tie p n h a u (ve cd b a n giong xUdng m a n g ). Vdi
xUdng s u n ngfin va n h o (xUdng co ta y , co c h an ), s u n dUdc t h a y t h e d a n chi b a n g
m o t t r u n g t a m cot h o a n g u y e n p h a t. XUdng cot so n g v a xUdng d a i c u a chi dUdc
h in h t h a n h tii n h ie u t r u n g ta m cot h o a gom: t r u n g t a m cot h o a n g u y e n p h a t
(chlnh) ta o r a t h a n xUdng va cac trung tam cot hod th ii p h a t (s e c o n d a ry
o ssific a tio n c e n tre ) h a y cac trung tam cot hod dau xitdng ta o r a cac d a u
(e p ip h y ses) h a y m om xUdng. Cac t r u n g t a m cot h o a d a u xUdng p h a n ldn x u a t h ie n
s a u k h i sin h . T ro n g q u a t r i n h p h a t trie n , cac t r u n g t a m cot h o a d a u xUdng n g a n
cach v6i t r u n g ta m cot h o a c h ln h b a n g m o t t a m sun dau xitdng (e p ip h y s ia l
cartila g e).1"S u n n a y g iu p xUdng p h a t tr i e n ve c h ie u dai. T a m s u n d a u xUdng t a n g
sin h ve p h la t h a n xUdng va p h a n t a n g s in h n a y dUdc c h u y e n t h a n h xUdng. K h i toe
do cot hoa s u n ldn h d n toe do t a n g s in h s u n th i s u n d a n dUdc t h a y th e h e t b a n g
xtfdng va xUdng n g iin g t a n g trU dn g ve c h ie u dai.

14


Su t a n g tr u d n g cua xUdng m a n g ve cd b a n la b a n g m o t q u a t r i n h boi d a p
th e m xUdng tr e n be m a t va cac bd xUdng. Vi d u n h u sii d o ng d a n c u a cac th d p
(v un g n a m giiia cac bd va goc xUdng vom so): xUdng tie n d a n vao m a n g th o p b a n g
cach boi d a p th e m xUdng vao cac bd xUdng; dong thdi, m a n g xiidng boi d a p th e m
xUdng len be m a t xUdng.
ThUc r a q u a t r i n h cot hoa bao gom h a i cong viec d ie n r a dong thdi: q u a t r i n h
k ie n t h i e t n h d cac ta o cot bao va q u a t r i n h p h a h u y nh d cac h u y cot bao. Su p h a
h u y xUdng giup ta o n e n cac hoc tu y d xUdng xop, o tu y d xUdng d a i va cac ong
H a v e r c u a mo xUdng.
1.5. So Iirang va phan chia
206 xUdng c u a bo xUdng ngUdi (H .2 .1 ) dUdc s a p xep t h a n h p h a n : 80 xUdng
c u a bo xUdng tr u e va 126 xUdng c u a bo xUdng treo. B o x itd n g tr u e (axial

sk ele to n ) gom 22 xUdng so, 1 xUdng mong, 6 xUdng nh o c u a ta i va 51 xiidng t h a n
(gom 26 xUdng cot song, 24 xUOng sUdn va 1 xUdng tic). B o x itd n g treo h a y
x itd n g c h i (a p p e n d ic u la r sk ele to n ) gom 64 xUdng chi tr e n v a 62 xUdng chi dudi.
2. XiTdng so (bones o f cranium ) (cac H.2.3 - 2.8)
XUdng so la m o t k ho i gom 22 xUdng n l m d d a u tr e n c u a cot song.
P h a n c h ia. So do h a i n h o m xUdng hdp th a n h : cac xUdng hop so v a cac xUdng
m a t. H op so la hop xUdng bao ve cho n ao do ta m xUdng ta o nen: h a i xitdng d inh,
m o t xitdng tra n , m o t xitdng cham , m o t xitdng bitdm, m o t xitdng sang v a h a i xitdng
th d i ditdng. C ac x itd n g m a t ta o n e n k h u n g xUdng c u a m a t, gom mUdi b a xUdng
d in h t h a n h m o t k h o i va d in h vdi hop so, va m o t xUdng lie n k e t vdi k h o i xUdng so
b a n g k h d p h o a t dich. M udi bon xUdng m a t la: h a i xitdng le, h a i xiidng xoan m u i
ditdi, h a i xitdng m ui, h a i xitdng h a m tren , h a i xiidng kh&u cai, h a i xitdng go m a,
m o t xiidng h a m ditdi v a m o t xiidng la m ia.
N h iin g dac d ie m c hu n g. N goai viec ta o n e n h op so, cac xUdng so c u n g ta o
n e n m o t so" k h o a n g n h d k h a c , bao gom o m u i v a cac o m a t md r a p h ia trUdc. M ot
so xUdng so c h iia n h iin g k h o a n g dUdc lot b a n g n ie m m a c va th o n g vdi m ui; c h u n g
dUdc goi la n h iin g xoang canh m u i. T ro n g xUdng t h a i dUdng cd n h iin g k h o a n g n h d
chiia cac c a u tr u e lien q u a n tdi t h i n h giac va t h a n g b a n g .
T r o n g cac xUdng so, chi cd xUdng h a m dudi la cd th e c h u y e n d on g dUdc, cac
xUdng con la i d in h c h a t vdi n h a u t h a n h m o t k ho i b a n g cac d u d n g k h d p b a t dong.
so cd m o t n e n de n a o n a m t r e n va m o t vom bao q u a n h va d a y t r e n nao.
Cac xUdng c u a vom so dUdc ta o n e n tii h a i b a n xUdng dac (ban ngoai v a ban
tro n g ) n g a n c ach n h a u b a n g m o t ldp xUdng xop goi la loi xop. M a t tr o n g h op so
d in h vdi m a n g n a o ciing, m a t n g oai ta o n e n cho b a m cho cac cd d a u m a t. N g oai
viec ta o n e n k h u n g xUdng c u a m a t, cac xUdng m a t con bao ve cho d u d n g vao c u a
cac h e ho h a p va tie u h oa. Ca khoi xUdng so b ao ve v a n a n g dd cho cac giac q u a n
c h u y e n b ie t ve n h in , n e m , ngiii, n g h e v a t h a n g b a n g .

15

2.1. Cac x ifd n g h o p s o (brain box)

X ito n g t r a n (fro n ta l bone). Xiidng t r a n gom h a i p h a n ch in h : m o t p h jin ta o
n e n t r a n (p h a n trUdc c u a h op so) la trai tra n , m o t p h a n n a m n g a n g ta o n e n t r a n o
m a t v a h a u h e t p h a n trUdc cu a n e n so (ho" so trUdc). 6 m a t ngoai, h a i p h a n c u a
xUdng t r a n g ap n h a u ta i bd tren o mat. N g ay tr e n bd nay, b e n tro n g t r a i t r a n co
h a i xoang tran.
C ac x itd n g d i n h ( p a rie ta l bone). H a i xUdng d in h ta o n e n p h a n 16n c u a cac
m a t b e n va d in h so. C h u n g tiep k hd p vdi n h a u ta i d u d n g k h d p doc, vdi xUdng t r a n
ta i dUdng k h d p v a n h , vdi xUdng c h a m ta i dUdng k h d p la m b d a v a vdi cac xUdng
th a i dUdng ta i cac dUdng k hd p tra i. M a t tro n g c u a xiidng d in h 15m v a co n h iin g
r a n h de cac m a c h m a u di qua.

Xg tran

Trai tr£n
Khdp tran- mui
Xuong mui

Dudng khdp giura tran
Loi tren goc mui

Cung may

Diem goc mui

16
Xg dinh
Xg sang

L6 tren o mat

Xg birdm
O mat
Mom go ma (xg tran)

Ho thai dirong

thai dircmg

Ong thj giac

go ma-mat

L6 dudi o mat
Cung go ma
Xg xoan difdi
Mom chum
Nganh xg ham dudi

mui trade

O mui

nanh

Xg la mia

ham tr6n

Ho nanh

huyetrang

Ho rang cira

h^im dudi

Lo cam
Xg ham

dinh ham dtrdi
- L 6'i cam
Cu cam

Hinh 2.3. Xirong so: nhin tri/6c

16


Cac x itd n g th d i d itd n g (temporal bone). Moi xiidng thai dUdng tao nen mot
m at dudi-ben cua hop so va mot phan cua nen so. No tiep khdp vdi cac xUdng
dinh, cham, budm va go ma b in g cac khdp bat dong. XUdng thai dudng do ba phan
tao nen: phan da, phan trai va phan nhi.
Phan da co hinh thap tam giac n&m ngang qua nen so, giiia xUdng budm va
xUdng cham. Phan nay chiia tai giiia va tai trong, va nhiing ong cho dong mach
canh trong va th an kinh m at di qua. Ong dong mach canh co mot 16 ngoai md ra d
m at dudi phan da va mot lo trong md ra d dinh phan da. Mom nhon tii m at dudi
phan da nho xuong dudi la mom tram . Nen phan da hudng ra ngoai va ra sau.

Mom loi tren nen phan da, d ngay sau lo tai ngoai, dUdc goi la mom chum . Trong
mom chum co nhieu xoang nho. CJ giiia mom tram va mom chum cd lo tram -chum ,
ndi ra khoi so cua th an kinh mat. Tren m at sau phan da co lo va ong tai trong, ndi
cac th an kinh so VII va VIII di qua. Bd sau p h ln da cung vdi xUdng cham gidi han
nen lo tlnh mach canh, ndi di qua cua tinh mach canh trong.
Trai xuong
thai duong

Diem thop
trade - ben

...
0 l^ m thoP

ig khdp budm-dinh
nh Idn xuong budm
Dudng khdp budm-tran
Dudng khdp budm-go ma

Dudng khdp trai

Dudng khdp tran-go ma
Diem gian may

Diem thop sa

Xg gd ma
Goc mui

Dudng khdp dinh-chum

Xg mui
Xg cham
V C % _ Xg sang
Dudng khdp lambda

Dudng khdp budm - trai
Dudng khdp gd ma-thai
duong

U cham ngoai

Diem thop sau- b6n
Xg thai dudng
Dudng khdp cham-chum
Ong tai ngoai
Mom chum
Mom tram1
Loi cau xg ham dudi
Gdc ham dudi
Cu khdp

Hinh 2.4 .Xi/ong so: nhin ben

17


Phan trai la m a n h xUdng m on g h i n h q u a t. P h a n diidi c u a t r a i t h a i d u d n g
ta c h r a mom go m d c h ay r a trUdc tiep k h d p vdi m om th a i dUdng c u a xUdng go m a;
m om c u a h a i xUdng c u n g n h a u ta o n e n cung go md. Ho" 1dm n i m d m a t s a u -d u d i

m om go m a la ho ham ditdi v a cho loi tr o n b trUdc ho" n a y la cu khdp. Ho v a cu tie p
k h d p vdi chom xUdng h a m dudi ta o n e n k h d p th a i dU dng-ham dudi.
Phan nh l la m a n h xUdng m ong vay q u a n h 16 va ong tai ngoai.
X itd n g c h a m (occipital bone). XUdng c h a m ta o n e n p h a n s a u c u a vom va
n e n so. XUdng c h a m gom b a ph&n v ay q u a n h lo ldn xUdng c h a m . Lo l&n la ndi
h a n h n a o lien tiep vdi tu y song. TrUdc lo ldn la phan nen, h a i b e n la cac p h a n ben
v a d s a u la trai cham. M a t t r e n p h a n n e n doc diing v a dUdc goi la doc. T r e n moi
p h a n b e n cd m o t loi cau cham tiep kh dp vdi m a t t r e n c u a k h o i b e n d o t doi v a m o t
ong than kinh ha thiet, ndi di q u a c u a t h a n k in h so XII. M a t s a u trai cham cd u
cham ngoai d giiia va cac ditdng gay d moi ben. G iiia m a t trUdc (h ay m a t tro n g )
tr a i c h a m cd u cham trong. Gd xUdng tii u n a y di tdi lo c h a m la mao cham trong,
con h a i r a n h ke tiep n h a u tii u ch ay s a n g h a i b e n la ranh xoang ngang v a ranh
xoang sigm a. R a n h x o an g n g a n g n g a n cach h a i ho" d m a t tr o n g t r a i c h am : ho dai
nao b tr e n va ho tieu nao b dudi.
X itd n g b itd m (sp h e n o id / s p h e n o id a l bone). XUdng b u d m n a m d giiia n e n so
va tie p kh dp vdi t a t ca cac xUdng k h a c c u a hop so. N goai hop so, no con gop p h a n
ta o n e n t r a n o m u i va cac t h a n h o m a t. Cac p h a n c u a xUdng b u d m la t h a n , c a n h
nho, c a n h ldn va cac m om c h a n budm . Than n&m giiia xUdng b u d m , tie p g ia p vdi
xUdng s a n g d trUdc v a xUdng c h a m d sau . M a t t r e n c u a t h a n xUdng b u d m cd ranh
tritdc giao thoa va ho tuyen yen. Moi canh nho d in h vao p h a n trUdc t h a n b u d m
b&ng h a i re v a c u n g t h a n bu d m gidi h a n n e n ong thi giac, ndi di q u a c u a th&n
k in h so II. 6 p h ia s a u , moi canh ldn c u n g tii m o t b e n t h a n b u d m c h a y s a n g b en ,
ta o n e n p h a n giiia c u a n e n so. H a i c a n h c u n g vdi t h a n b u d m gidi h a n n e n khe o
m at tren, ndi di q u a c u a cac t h a n k in h V l, III, IV va VI. T r e n c a n h ldn cd 16 tron
va lo bau due, la n lUdt la ndi di q u a c u a t h a n k in h V2 v a V3. Cac m om chan bitdm
tii t h a n c h a y x uo n g cac t h a n h b e n o m ui. T ro n g t h a n xUdng b u d m cd cac xoang
bitdm th o n g vdi o mui.
X itd n g s a n g (e th m o id /e th m o id a l bone). XUdng s a n g n&m t r e n dUdng giiia, d
p h a n trUdc n e n so. No con gop p h a n ta o n e n v a c h m u i, t r a n o m u i, t h a n h n g o a i o
m u i va t h a n h tro n g o m a t. Cac p h a n c u a xUdng s a n g gom m a n h s a n g , m a n h

th&ng diing va cac m e dao san g . M anh sang la p vao cho k h u y e t c u a p h a n o m i t
xUdng t r a n , n g a n c ach ho" so trUdc vdi o m ui; giiia m a t t r e n c u a m a n h s a n g n h o
le n m o t m om h in h ta m giac goi la mao gd, h a i b e n m a o cd cac lo sang. M anh
thang diing c h a y vao v a c h m u i. M oi me dao sang la m o t kho'i xUdng xo'p n&m
giiia o m a t va o m u i. K hoi n a y c h iia cac xoang sang t h o n g vdi o m u i. H a i m a n h
xUdng tii m ^ t t r o n g m oi m e d ao s a n g n h d v ao o’ m u i dUdc goi la cac xoan m u i
tren va ditdi.

18


2.2. Cac xi/Ong mat (facial skeleton)
Dudng khdp doc

Diem thop sau

Xg cham
Dudng khdp lambda

Dudng khdp dinh-chum

thai duong

Diem thop sau-b6n

Trai cham
U cham ngoai

Mat phang cham
Dudng khdp cham-chum

Lo chum

Dudng gay tren cung
phlng gay

Mom chum
gay trgn

Khuyet chum

Loi cau xg

Dudng gay dudi
Dudng gay giura

Hinh 2.5. Xi/dng so: nhin tii sau

X itd n g h a m tr e n (m axilla). H a i xUdng h a m t r e n (da d in h lai) ta o n e n h a m
t r e n va tie p k h d p vdi t a t ca cac xiidng m a t k h a c , trti xiidng h a m dudi. No ta o n e n
m ot p h a n c u a s a n o m&t, m o t p h a n c u a t h a n h b e n v a s a n o m ui, v a h a u h e t k h a u
cai ciing. XUdng h a m t r e n gom t h a n v a cac mom . Than co cac m a t h u d n g ve o m&t,
o m ui, ho" dudi t h a i dUdng (dUdc goi la n liidt la m at o mat, m at m ui v a m a t ditdi
thdi ditdng) v a ve p h la trUdc (m at tritdc). N h iin g chi t i e t q u a n tr o n g t r e n cac m a t
n a y la: ranh ditdi o m at d m a t o milt, Id ditdi o m at v a khuyet m ui d m a t trtidc, cu
ham d m a t dudi t h a i dUdng, ranh le v a lo xoang ham tren d m a t m u i. T h a n xUdng
chiia m o t x o a n g ldn md vao o m ui, xoang ham tren. Cd bon m o m tii t h a n xUdng
n ho ra: m om tran c h a y len tie p k h d p vdi xUdng tr a n ; m om go m d tie p k h d p vdi
xUdng gd m a; mom huyet rang la m o t c u n g m a n g cac huyet rang c u a cac r a n g h a m
tre n ; va m om khau cai ta o n e n 3/4 trUdc k h a u cai cting. Xtidng h a m t r e n c u n g
c a n h ldn xUdng b u d m gidi h a n n e n khe o m at ditdi.

19


X iid n g h a m d iid i (m a n d ib u la ). XUdng h a m dudi gom m o t t h a n va h a i
n g a n h h a m . Than xiicfng ham diidi cong h in h m o ng ngUa, gom m o t nen d a y 0 dudi
va p h a n huyet rang d tre n . Giiia m a t trUdc n e n h a m diidi loi r a d t h a n h loi cam va
moi b en cd m o t lo cam. P h a n h u y e t r a n g cong t h a n h cung huyet rang v a m a n g cac
lo h u y e t c h a n r a n g h a m diidi. Moi nganh ham diidi lien tie p vdi t h a n h a m diidi ta i
goc ham diidi. Tu: day, n g a n h h a m ch ay len tr e n g a n n h u v u o n g goc vdi t h a n h a m .
D a u tr e n cua n g a n h h a m ta c h r a t h a n h mom vet d trUdc va mom loi cau d sau ;
giiia h a i m om n a y la khuyet ham diidi. M om loi cau cd m ot chom tiep k h d p vdi ho
h a m dudi va cu k h d p cua xUdng th a i dudng. T r e n m a t tro n g c u a n g a n h h a m cd
m o t lo cho t h a n k in h h u y e t r a n g dudi di vao xUdng h a m , lo ham diidi. Lo n a y la
ciia vao c u a ong ham diidi. M ieng lo dUdc c h a n b a n g m o t m a n h xUdng goi la liidi
ham diidi.
X iid n g m u i (n a s a l bone). Cac xUdng m u i gap n h a u t r e n d u d n g giiia v a ta o
n e n m o t p h a n cu a c au mui.
X iid n g le (la c rim a l bone). H ai xUdng le la nhQ ng xUdng n h d n a m d s a u va
ngoai cac xUdng m u i v a ta o n e n m o t p h a n t h a n h tro n g o m a t. XUdng le c u n g vdi
m om t r a n xUdng h h a m tr e n gidi h a n n e n ho" le, ndi m a tu i le n a m .
X iid n g g o m d (zygom atic bone). XUdng go m a la m cho gd m a loi le n t h a n h
gd va ta o n e n m o t p h a n cu a t h a n h ngoai va s a n o m a t. No tie p k h d p vdi cac xUdng
tr a n , h a m tre n , b u d m va th a i dUdng.
Diem thop trifdc

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X iid n g k h a u c a i (palatine bone). Xiidng nay gom manh n&m ngang va manh

th^ng dting hdp thanh hinh chti L. Manh n&m ngang cung vdi manh nam ngang cua
xUdng ben do'i dien tao thanh phan sau cua khau cai cting. Manh thang diing nho len
tren de tao nen mot phan cua thanh ngoai o mui va mot phan san o mat.
X iid n g x o a n m u i d iid i (in ferior n a s a l concha). Moi xUdng n a y la m o t xUdng
m ong cuon lai va n h o vao o m ui d dudi xUdng xoan m u i gitia.
X iid n g la m ia (vomer). D ay la m ot xUdng m ong h in h ta m giac ta o n e n m o t
p h a n vach m ui. No tiep k hd p d dudi vdi cac xUdng cua k h a u cai cting ta i dUdng
gitia va d tr e n vdi m a n h th a n g dting cua xUdng s a n g va xUdng budm .
X iid n g m o n g (hyoid bone). XUdng n a y k h d n g th uo c xiidng so nhU ng dUdc mo
ta c u n g xUdng so cho tien . No la m ot xUdng rdi h in h m on g ng iia n a m tr o n g cac mo
m em cua v u n g co, d n g a y t r e n t h a n h q u a n v a dudi xUdng h a m dudi. XUdng m ong
gom m o t t h a n n&m n g a n g va h a i sting d moi ben: sting ldn v a sting nho.

L6 rang cira
M6m khau c^i xg
ham trSn

Xg ham tren

Mom huy6t rang xg
hdm tren

Mom thai dirong xg
go ma

Phan ngang xg
khau cai
Gai mui sau

Mom go ma xg

thai duong

Xg la mia

Gai bLfdm

Manh trong mom
chan budm
Phan nen xg cham

Mom tram
L6 tram chum

Kh6i ben xg cham

Mom chum
L6 cham ldn

Xg thai duang

Trai xg cham

U cham ngoeii

Hinh 2.7. Mat ngo£i nen so

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L6 sang

Lo ong thi giac

Mao tran

Mao ga
Manh sang
va cac 16 sang

Ong vo danh
Ranh xoang
TM sigma

^

Lo ong tai trong

Lo TM canh

Ranh xoang
TM ngang

Ong than kinh ha thiet

Hinh 2.8. Mat trong nen so

Lo ldn xL/ong cham

3. Xirdng than
Xiidng cu a th a n bao gom cot song v a cac xUdng ngUc.

3.1. Cot song (vertebral column) (H.2.9)
Cot song la m o t c au tr u e vtia m e m deo vtia v iin g chac. No vCfa co th e v a n
dong lin h h o a t vvia bao boc va bao ve tu y song, n a n g dd cho d a u , v a ta o cho b a m
cho cac xUdng sUdn, d a i c h a u va cac cd liing. Cot so n g ta o n e n k h o a n g 2/5 c h ie u
cao cd the va do 26 xUdng ta o n en , bao gom xiidng cu ng , xiidng c u t v a 24 dot song
rdi. Cac dot so ng rdi gom 7 do t song co, 12 d o t so n g ngUc va 5 dot song t h a t liing.
Xiidng cung do 5 do t so ng c u n g d in h lien n h a u m a th a n h ; xUdng c u t thU dng do 4
do t song cut d in h lai. Cot song s a n co h a i dUdng cong loi r a s a u n g a y tu! luc s in h

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9
3
ra va k h o n g m a t di: corag ngw’c v a cong cung. Khi tr e ldn le n v a co th e diing th a n g ,
cot song x u a t h ie n th e m h a i d u d ng cong mdi (ditdng cong th it phat). cong co va
cong that litng (deu loi r a trUdc).

B

Hinh 2.9. Cot song nhin tri/dc (A) va ben (B)

3.1.1. Cac phan cua mot dot song dien hinh (H.2.10)
Moi dot song (vertebra) gom co than dot song va cung dot song vay quanh 16
dot song.
T h a n d o t so n g ( vertebral body) co hinh tru det, m at tren va m at diidi la
cac m at gian dot song tiep khdp vdi dot song ke can qua dia gian dot song.
C u n g d o t so n g (vertebral arch) d phia sau th an dot song, cung vdi th an dot
song gidi han nen lo dot song. Cung gom m a n h c u n g d o t s o n g (lamina of
vertebral arch) rong va det, n&m d sau; cac c u o n g c u n g d o t so n g (pedicle of

vertebral arch) d triidc manh, dinh vdi than; va cac mom tu: cung moc ra. Cac bd
tren va diidi cua cuong deu lom va diidc goi la cac khuyet song ( tren va ditdi).
Khuyet song diidi cua dot song tren cung khuyet song tren cua dot song dudi lien
ke gidi han nen lo gian dot song (intervertebral foramen), ndi ma cac day th an
kinh song va cac mach m au di qua. Cung dot song tach ra cac mom:
23