BÀI GIẢNG GIẢI PHẪU HỌC T2 (y TP HCM) Nguyễn Quang Quyền

DAI HOC Y DI/0C THANH PHO HO CHI MINH

BO MOM GIAI l»II U HOC

BAIGIANG

GIAI PHAIT HOC
TAP 2

THAN MINH - NGUC - BUNG - THAN KINH TRUNG UONG GIAI PHAU HOC DAI CU0NG
In Ian thtf mufti bon

Co bo sung va stia chtfa

NHA XUAT BAN Y HQC
Chi nhanh Thanh pho Ho Chi Minh
2012


(Ill BIEN

NGUYEN QUANG QUYEN

BAN BIEN SO \\

LEVANClJOfNG

Dl/ONG VAN HAI

VO VAN HAI

NGUYEN THIEN HUNG

TRAN HUNG

NGO TRI HUNG

PHAN BAO KHANH

NGUYEN QUANG QUYEN

NGUYEN HOANG VAN

LtfCfNG THI BACH VAN

NGUYEN TRUNG VINH


Ldi noi data
(Ldn xudt ban thic nam)

Cuon "Bai giang giai phau hoc" dupe soon rat tinh gidn theo chuong
trinh hoc cua sinh vien he ddi han cdc Trudng Bai hoc YKlioa d Viet Nam.

Sack duocsdp xep lam hai tap. Tap I gdm cdc chuong chi tren, chi dudi vd

ddu mat co. Tap II gdm cdc chuong nguc, bung, than kinh trung Uongvd gidi
phdu hoc dai cudng. Phdn dai cUong trinh bay lai he thong cdc co quan de bo
sung cho nkungphdn trUdc dupe trinh bay theo vung.

Cdc danh tit vd noi dung cdc danh til dupe sit dung hodn todn theo

ban danh til gidi phdu qudc te Nomina Anatomica (N.A) vd dich chu yeu
theo cuon Til diin gidi phdu hoc (4 thic tieng : La tinh, Anh, Phdp, Viet)
cua Nguyin Quang Quyin (Nha Xudt Ban Yhoc, 1983) co sica d6i doi chut
khi can thiet cho sat nghia han vdi nguyen ban tieng La tinh. Ben canh

mdi^ tic tieng Viet deu co chu thick trong ngoac don tic La tinh tUong icng.
Cuoi mot tap sdch co ban chi ddn tra ciCu tieng Viet vd tieng La tinh.

Sau ldn tdi ban thii ba, theo y kien cua nhieu dong nghiep vd ban
doc,- ngodi viec siia ckUa nhUng did in sai, chung tdi da them phdn muc
tieu trung gian cua mon gidi phdu hoc vd muc tieu chuyen biet cua tiCng
bai giang vdo phdn ddu cua mdi bdi vd d cuoi mdi bai, co cdc cdu hoi
trdc nghiem tkeo dang cdu tra ldi chon lila (MCQ) de sinh vien co the tu

hoc vd tu dank gid duac. Ngodi ra de cuon sack hodn chink kon chung
tdi da cho in trUdc mdi bai mot hinh mdu tong hop chup tren xdc (chu
yeu lay theo Rouviere) vd cdc so lieu gidi phdu tren ngudi Viet Nam
nham muc dich tham khdo.

Trong ldn tdi ban tkU tu vd thd nam nay, B/S Ngo Tri Hung da
gop sue trong viec chu thick cdc hinh mdu vd PTS Le Van Cudng da cho
cdc so lieu ngudi Viet Nam trick trong cuon ludn an PTS cua minh. BS

Phqm Dang Dieu vd BS Nguyin Van Bite (Bo mon Gidi phdu hoc
TTBTBBCBYT thank phd Ho Chi Minh) da bo sung them nhieu cdu
trdc nghiem MCQ vd gop y stia nhUng sai sot cua ldn in trUdc. Xin hoan
nghenk vd chdn thank cam on nkUng ddng gop quy bdu do.
Chung tdi cung bay to long biet on Nha Xudt ban YHoc da cho tdi
ban ldn thic nam cuon sdch nay.

Thanh phdHo Chi Minh, thdng 9/1995

Nguyin Quang Quyen



Ldi noi dau
(Xudt ban ldn thic mudi ba)

Bo sdch Bai giang Gidi Phau Hoc do cdPho Gido suNguyen Quang Quyin chu
Men vdi su tham gia bien soan cua cdc nha gidi phau gidu kinh nghiem vd su
gop svtc cua tap the can bo nhdn vien Bo mon Gidi Phdu Hoc Dai hoc Y Duac

Thanh pho Ho Chi Minh. Bo sdch duoc xudt ban ldn ddu Hen vdo nam 1985,

qua 12 ldn tdi ban, bo sdch la sdch gido khoa gidi phau cua Dai hoc YDuac
Thanh phd Ho Chi Minh vd la mot tdi lieu gidi phdu quan trong, duoc svt dung
tham khdo tai cdc tnxdng dai hoc y khoa trong nude.

Bo sdch Bai giang Gidi Phdu Hoc co 2 tap cho ddi tUOng sinh vien dai hoc gom
cdc chuyen nganh bde si y khoa, bde si rang ham mat, bde si nganh y hoc cd
truyen, y te cdng cdng vd duac si. Ngodi ra bo sdch con phuc vu ddo tao he cic

nhdn cdc chuyen nganh y hoc vd cdc chuyen nganh khdc lien quan den khoa hoc
sue khoe.

Qua nhieu ldn tdi ban Bo sdch da duac bd sung sita chita de ngdy cdng hodn
thien han. Dae biet trong ldn tdi ban nay, tap the Can bo giang Bo mon Gidi

Phdu Hoc, trong do co nhieu can bo giang tre da tham gia tick cue trong cdng

tdc svCa chita cdc loi vd thieu sot, cd bd sung, chinh stia mot so bai giang cho
hodn chinh han vd ve lai mot so hinh chUa ro, chUa dep de lam tang chat luang
cua cdc bai giang nhu bai vilng ben, trung that, rudt non, rudt gia,... Sap xep lai
tM tu, phdn nhdm mot so bai giang cho phu hap han nhu cdc phdn khdi xuang
so, khdi xuang mat.

Vdi sUphdt trien cua khoa hoc, mot cuon sdch can phdi duac bdsung, svta chUa
lien tuc de cap nhat kien thvtc mdi Do do, chung tdi xin quy thdy cd, quy dong
nghiep, cdc hoc vien vd cdc em sinh vien ddng gop y kien de Bd mon Gidi Phau

Hoc stia chita, bd sung cho tap sdch ngdy cdng hodn thien han trong ldn tdi ban
sau. Chung tdi xin cam an su ddng gdp quy bdu do. Chung tdi cung rat cam an

Nha xudt ban Yhoc, chi nhdnh Thanh phd Ho Chi Minh, Id noi da giup hieu
dinh vd siCa chita qua nhieu ldn xudt ban.

Thanh phdHo Chi Minh, ngdy 16 thdng 5 nam 2011
Chu nhiem bo mon

PGS.TS. Le Van Cu^ng



MUC LUC
Trang
7

Lcfi noi dau
PHAN IV - THAN MINH

28
29
30

Xuang va khdp cua than
Cor cua than, cor hoanh
Ong ben

(3 tiet)

9

(4 tiet)

28

(1 tiet)

50

phanv-ngUc
31

Phoi

(2 tiet)

60

32

Tim

(3 tiet)

75

33

Trung that

(1 tiet)

93

PHAN VI - BUNG

34

Da day

(2 tiet)

102

35

Lach

(1 tiet)

114

119

36

Ta trang va tuy

(3 tiet)

37

Gan

(4 tiet)

133

38

Ruot non

(2 tiet)

154

39
40
41

42
43

Ruot gia
Than va tuyen thu"o/ng than
Nieu quan, bang quang, nieu dao
Co quan sinh due ntt
Co quan sinh due nam

(3 tiet)

168

(2 tiet)

183

(3 tiet)

201

(3 tiet)

222

(2 tiet)

242

44

Day chau

(1 tiet)

256

45

Phuc mac phan khu o bung

(4 tiet)

270

(2 tiet)

301

(3 tiet)

312

PHAN VII - THAN KINH TRUNG l/dNG

47

Tuy gai
Tram nao va trung nao

48

Gian nao

(2 tiet)

325

49

Doan nao

(4 tiet)

334

46

50

He than kinh tu" chu

(2 tiet)

355

51

Mang nao tuy
Mach nao tuy

(2 tiet)

363

(2 tiet)

376

52


PHAN VIII - GIAI PHAU DAI CtfdNG
Tuy gai
Tram nao va trung nao

(1 tiet)

387

(1 tiet)

402

55

Gian nao

(1 tiet)

412

56

Doan nao

(2 tiet)

419

57

He than kinh tu" chu

(1 tiet)

438

58

Mang nao tuy
Mach nao tuy

(1 tiet)

446

59

(1 tiet)

452

60

He than kinh tu" chu

(1 tiet)

460

61

Mang nao tuy
Mach nao tuy

(1 tiet)

465

(1 tiet)

485

53
54

62

Phu luc

492

Bang tra ldi cac cau trac nghiem

532

Bang chi dan tra cu*u tieng Vi£t

542

Bang chi dan tra cu*u tieng Latinh

568


PHAN IV - THAN MINH

28

CAC XUONG VA KH6P CUA THAN

MUC TIEU BAl GIANG
A. MUC TIEU LY THUYET

1. Mo ta dac diem chung cua cac dot song va dac diem rieng cua cac dot song d tUng doan

cd, nguc, that lung, cung nhu cua mot vai do't song dac biet.
2. Phan biet duoc dot song cd, do't song nguc va do't song that lung.
3. Mo ta cac doan cong cua cot song de gidi thich su phat trien cac doan cong do thich

nghi vdi tu the dung thang cua ngudi.

,

4. Neu cac dac diem cua tUng dot song va timg doan dot song thich nghi vdi chuc nang
cua chung.

5. Mo ta su" lien ket gitfa than cac do't song.
6. Mo ta vi tri, dac diem cua xuang Uc, xuang sUdn, sun sudn.
7. Ke ten cac khdp cua long nguc.
B. MUC TIEU THI/C TAP

1. Chi duoc tren xuang, phim Xquang cac dac diem chung cua cac dot song.
2. Nhan biet duac dot song d tung doan cot song cung nhu nhung dot song dac biet.
3. Chi duac tren xuang cac chi tiet giai phau cua xuang Uc.

4. Dat cac xuang sudn dung vi tri cua no va chi duac cac chi tiet giai phau quan trong.
5. Chi duac hinh anh binh thudng cua cot song va khdp giua cac than dot song tren phim Xquang.
6. Xac minh mom gai cua dot song cd VII va tUng xuang sudn tren ngudi song.

Xuang cua than ngudi gdm co : cot song nhu mot cai true chinh dd than minh. Xuang Uc
va cac xuang sudn hap vdi cac do't song nguc tao thanh ldng nguc. Ngoai ra con co 2 xuang

chau (da hoc dphan xuang chi dudi) hap vdi xuang cung thanh khung chau. Cac xuang do khdp
vdi nhau thanh cac khdp.


COT SONG

Cot song (columna vertebralis) la mot cot xuang dai uon eo tu" mat dudi xuang cham den

het xuang cut. Cot song bao boc va bao ve tuy gai.

Nhin nghieng cot song co 4 doan cong : doat cd ldi ra trUdc, doan ngUc ldi ra sau, doan
that lung ldi ra trUdc va doan cung ldi ra sau (H.28.1). Cau true 4 doan cong nay thich nghi vdi

tu the dung thang cua ngudi, trong khi d dong vat 4 chan thi chi co mot doan cong xuo'ng dudi.
Cot song cd tu 33 den 35 dot song (vertebra) xep chdng len nhau.

A. NHIN SAU

B. NHIN BEN

Hinh 28 1 : Cot song
10

C. NHIN TRUdC


24 do't tren thi rdi nhau tao thanh 7 do't song cd, 12 do't song ngUc va 5 do't song that
lung, 5 dot tiep dudi dinh lai lam mot tao thanh xuang cung va 4 hoac 6 dot cuoi cung rat nho
va can cdi cung dinh lai lam mot tao thanh xuang cut.

1. CAU TAO CHUNG CUA M0T DOT SONG
Mot dot song noi chung cd nhUng thanh phan sau day (H.28.2)

1.1. THAN DOT SONG (corpus vertebrae) hinh tru, cd 2 mat : tren va dudi, hoi lorn d giua
va mot vanh xuang dac d xung quanh.

Minh cung dot song

Mom ngang

Cudng cung
dot song

Lo dot song

Than dot song

A. NHIN TREN

Mom khdp
Ho sudn ngang

Mom gai

sUdn

Khuyet
Mom khdp dudi

song

B. NHIN BEN

Hinh 28.2 : Dot song ngUc
11


1.2. CUNG DOT SONG (arcus vertebrae) cung vdi than do't song tao thanh Id dot song

(foramen vertebralis). Cung do't song gdm 2 manh cung do't song (lamina arcus vertabrae) va 2
cuong cung dot song (pediculus arcus vertebrae). Hai bd tren va dudi cua moi cudng cd khuyet
song tren (incisura vertebralis superior) va khuyet song dudi (incisura vertebralis inferior). Khi

2 do't song khdp nhau thi cac khuyet do tao thanh 16 gian do't song (foramen intervertebrale) de
cho day than kinh gai song chui ra.

1.3. CAC MOM. TU cung dot song chdi ra cac mom nhu sau :
1.3.1. Mom gai (processus spinosus) tU giUa mat sau cua cung dot song chay ra sau va
xuo'ng dudi.

1.3.2. Mom ngang (processus transversus) tu cho noi gitfa cuong va manh di ngang ra
phia ngoai.

1.3.3. Mom khdp. Mdi dot song cd 4 mom : 2 mom khdp tren (processus articularis
superior) va 2 mom khdp dudi (processus articularis inferior).
Cac mom nay cung moc ra tu" cho noi giUa cuo'ng va manh cua cung dot song. Moi mom cd
mot dien khdp de khdp vdi dot song ke can.

1.4. LO DOT SONG (foramen vertebrate) duac gidi han phia trUdc bdi than dot song, d hai
ben va phia sau bdi cung dot song. Khi cac dot song ghep lai thanh cot song thi cac 16 dot song

tao thanh d'ng song (canalis vertebralis).
2. DAC DIEM RIENG CUA TtfNG LOAI DOT SONG.

Tuy theo chUc nang cua tUng doan cua cot sd'ng ma cac do't song cd nhUng dac diem rieng.
2.1. CAC DOT SONG CO (vertebrae cervicales) (H.28.3).

Dien khdp dudi

L6 mom ngang
Cu sau

dot song co

Cu trddc.
dot song co

Than dot song

Hinh 28.3 : Dot song co

2.1.1. Dac diem chung ciia cac dot song co.
Than det be ngang, day phia trUdc han phia sau.
Cudng tach ra tU phan sau ciia mat ben than dot song va khuyet song tren va dudi deu
sau bang nhau.
12


Manh hinh vudng va rdng han cao.
Dinh cua mom gai tach lam hai cu.

Mom ngang dinh vao than va cuo'ng bdi 2 rl gidi han n§n mot Id goi la Id ngang (foramen
transversarium) de cho mach dd't song chui qua. Dinh cua mom ngang tach lam 2 cu : cu trUdc

do't song cd (tuberculum anterius vertebrarum cervicalium) va cu sau do't song cd (tuberculum
posterius vertebrarum cervicalium). Mat tren cua mom ngang cd ranh than kinh gai song
(sulcus n. spinalis).

.

Mom khdp cd dien khdp phang nam ngang. Dien tren nhin len tren va ra sau. Dien dudi
nhin xud'ng dudi va ra trude.

L6 do't song hinh tarn giac va rdng han d cac 16 dd't song nguc va that lung de chUa doan
phinh cd cua tuy gai va thich Ung vdi bien do di dong ldn cua doan song cd.
Noi torn lai, dac trung quan trong nhat de xac dinh mot do't song cd la cd Id ngang.
2.1.2. Dac diem rieng cua mQt vai dot song co.

Bon dd't song cd cd mot vai dac trung rieng la dot song cd I, do't song cd II, dd't song cd VI
va do't song cd VII.

2.1.2.1. Dot song co I con goi la dot song doi (atlat) (H.28.4) cd dac diem la khdng cd than,
nen cd hinh nhu mot cai vdng vdi 2 khd'i ben (massa lateralis) cd ho' khdp tren (fovea
articularis superior) de khdp vdi ldi cau xuang cham va cd ho khdp dudi (fovea articularis
inferior) de khdp vdi do't song cd II.

Hai ben dUorc nd'i nhau d phia trude bdi cung trude (arcus anterior) va d phia sau bdi cung
sau (arcus posterior). Phia trUdc cung trUdc ldi ra thanh cu trUdc (tuberculum anterius) va phia
sau 1dm thanh ho' rang (fovea dentis) de khdp vdi rang (dentis) cua dd't cd II. 6 phia sau cung
sau loi ra thanh cu sau (tuberculum posterius) va phia tren sat vdi khd'i ben cd ranh ddng mach
dot sd'ng (sulcus arteriae vertebralis).

Ho rang

Ranh dong mach
dot song

Ho khdp tren
Cu trUdc

Khdi ben

Cung trUdc

Hinh 28.4 : Dot song cd I (dot song doi)
13


2.1.2.2. Ddt sdng cd II con goi Id ddt sdng true (axis) (H.28.5) la do't song day va khde
nhat trong cac ddt sd'ng cd. Dac diem cua do't nay la cd mot mom mgc len tren than ddt song

gci la rang (dentis). Rang duac coi nhu than cua dd't dpi dinh vao do't true de lam true cho do't
dpi quay. 6 phia trude rang cd dien khdp trUdc (fades articularis anterior) de khdp vdi ho' rang
cua ddt dpi va cd mot dien khdp sau (fades articularis posterior) de khdp vdi day chang ngang
cua dot dpi.

2.1.2.3. Ddt sdng cd VI cd dac diem la mom ngang ldi to ra thanh cu canh (tuberculum
caroticum vertebrae cervicalis VI). Cu nay neu to qua cd the chen vao ddng mach canh chung. No

cung la mdc gap gd cua ddng mach canh chung vdi ddng mach giap dudi va ddng mach dd't sd'ng.

Dien khdp trade

Dien khdp tren

Dien khdp dadi

Hinh 28.5 : Ddt sdng cd II (ddt sdng true).

2.1.2.4. Ddt sdng cd VII cd dac diem la mom gai khdng che doi va dai han ra, sd ngay

thay duac dudi da nen con goi la dd't sd'ng ldi (vertebra prominens). Ld ngang rat nho, cd khi
khdng cd. Dd't sd'ng cd VII nam d ranh gidi giua doan sd'ng cd va doan sd'ng ngUc nen cd nhieu
dac diem chuyen tiep giua dd't sd'ng cd va dd't sd'ng ngUc.
2.2 CAC DOT SONG NGUC (vertebrae thoraciae).

2.2.1. Dac diem chung ciia cac dot song ngtfc Cac dd't song nguc khdp vdi xuang sudn

va qua xuang sudn vdi xuang Uc de tao nen long ngUc do do mot dac diem quan trong cua dd't
sd'ng ngUc la d mdi ben than dd't sd'ng cd 2 ho' khdp la ho' sudn tren (fovea costalis superior) va
ho sudn dudi (fovea costalis inferior) de khdp vdi dau xuang sudn.

NhUng dac diem khac ciia dd't sd'ng ngUc la than day han cac dd't sd'ng cd, khuyet sd'ng
dudi sau han khuyet song tren (H.28.2).

Mom gai dai va chuc xuo'ng dudi vi doan sd'ng ngUc khong cu dong nhieu.

Mom ngang cd mot dien khdp goi la ho' sudn ngang (fovea costalis tranversalis) de khdp
vdi cu xuang sudn.

Mom khdp cd cac dien khdp ddng ngang nhin ra phia trUdc hoac phia''sau.
L6 dot song hinh gan trdn

Tom lai dac trUng quan trong nhat de xac dinh mot dd't sd'ng ngUc la cd ho' sudn d mat
ben than ddt sd'ng.
14


2.2.2. Dac diem rieng ciia mQt so' dot sd'ng ngu*c.

- Dd't song ngUc I la do't chuyen tiep tu doan cd sang doan nguc nen cd nhieu dac diem
gio'ng ddt cd VII. Ngoai ra cd cac dac diem rieng la hd' sudn tren la mot hd trpn ven de khdp
vdi chdm xuang sudn I trong khi hd' sudn dudi chi la mot nua hd' de khdp vdi mot phan chom
xuang sudn II.

- Dot sd'ng ngUc X khong cd hd' sudn dudi.

- Dd't song nguc XI va XII chi cd mot ho' sudn de khdp toan bo vdi cac xuang sudn tuang
Ung. Cac mom ngang khdng cd hd' sudn ngang.
2.3. CAC DOT SONG THAT LUNG (vertebrae lumbales).

2.3.1. Dac diem chung ciia cac dot song that lung (H.28.6). Do phai chd'ng dd toan
than va can chuyen dong nhieu nen cac do't song that lung cd cac dac diem sau day :
Than rat ldn va rdng be ngang.

Cuo'ng day va khuyet sd'ng dudi cung sau han khuyet sd'ng tren.
Mom gai cd hinh chU nhat va hudng ngang ra sau.

Mom ngang dai duac coi nhu mot xuang sudn thoai hda nen goi la mom sudn (processus
costarius). O phia sau chd mom sudn dinh vao cung dd't sd'ng cd mom phu (processus
accessorius).

Mom khdp tren det chieu ngang, cd dien khdp 1dm d mat trong va cd mom num. vii

(processus mamillaris) d mat ngoai. Mom khdp dudi cd dien khdp ldi hinh tru de thich Ung vdi
dien khdp ciia mom khdp tren.

L6 dot so'ng hinh tarn giac nho han Id dd't sd'ng cd va ldn han Id do't song nguc. Tom lai, vi
dd't sd'ng that lung khdng khdp vdi xuang sudn va khdng cd ddng mach dd't sd'ng chui qua Id
ngang nen dac trung de xac dinh mot do't so'ng that lung la khong cd hd' sudn d ben than va

khdng cd Id d mom ngang.

2.3.2. Dac diem rieng ciia mot so' dot sd'ng that ltfng
- Dot sd'ng that lung I cd mom sudn kem phat trien han cac dot khac.
- Dd't sd'ng that lung V thi cd than day d phia trude han phia sau, 2 mom khdp dudi each
xa nhau han d nhUng dd't that lung khac, mom gai nho nhat trong so' cac do't that lung.
2.4. XUONG CUNG

Xuang cung (os sacrum) do 5 do't song cung (vertebrae sacrales) dinh lai ma thanh.

Xuang cung khdp d tren vdi do't sd'ng that lung thu" nam tao thanh mot gdc ldi ra phia
trude goi la u nho (promontorium). Hai ben khdp vdi xuang chau tao thanh chau hdng. Xuang
cung hinh thap 4 mat, det trude sau, nen quay len tren, dinh xud'ng dudi, cd 2 mat la mat chau
hong va mat lung, mot nen, mot dinh va hai phan ben (H.28.7 va H.28.8).
15


Mom gai

Mom khdp tren

Mom khdp dudi

Mom num vu

Mom sudn

L6 ddt sdng
Than ddt sdng

A. NHIN TREN

Mom khdp tren

Mom num

Khuyet sdng tren
Wimuwiimiuiia

Mom sudn

I,

Mom gai

Khuyet sdng dudi

B. NHIN BEN

Hinh 28.6 : Ddt sdng that lung

2.4.1. Mat chau hong (fades pelvina). Mat nay quay ra phia trUdc (nen con goi la mat
trUdc) nhin vao chau hdng va 1dm. Cd 4 dudng ngang (lineae transversae) la vet tich ranh gidi

giua cac dd't sd'ng cung. (3 hai ben dau cac dudng ngang la 16 ciing chau hong (foramina sacralia
pelvina) de cho cac nhanh trude cua cac day than kinh gai sd'ng cung chui ra.
2.4.2. Mat lung (fades dorsalis) rat ldi va go ghe. Doc dudng giUa la mao cung giUa (crista
sacralis mediana). Mao nay la do cac mom gai cua 4 dd't sd'ng cung tren tao nen. O dau dudi
16

mao tre doi tao thanh 2 sting cung (cornu sacrale). GiUa 2 sting la mot khe hd goi la 16 cung

(hiatus sacralis) thong vdi 6'ng cung (canalis sacralis). (3 hai ben mao cung giua ia mao cung
trung gian (crista sacralis intermedia). Mao nay do cac mom khdp cua cac dd't so'ng cung tao
nen. Phia ngoai mao la cac 16 cung lung (foramina sacralia dorsalia) de cho nganh sau ciia cac
day than kinh gai sd'ng cung chui ra. Ngoai cac 16 cung lung la mao cung ben (crista sacralis
lateralis) do cac mom ngang cua cac do't so'ng cung tao nen.

Nen xUdng cung

Mom khdp tren

Phan sau

dudng tan cung

Dudng ngang

L6 cung
chau hong

Hinh 28.7 : Xuong cung (nhin trUdc)

GiUa mao cung giUa va hai mao cung trung gian la hai ranh cung do cac manh ciia cac do't
cung dinh lai.

2.4.3. Nen xuttng ciing (basis ossis sacri) (H.28.9) tuang ting vdi mat tren ciia dd't sd'ng
cung thti nhat. GiUa nen la dau tren ciia 6'ng cung.

Hai ben la mom khdp tren (processus articularis superior) de khdp vdi mom khdp dudi cua

dd't sd'ng that lung thti nam. Dudng gdc trdn lien tiep giua nen vdi mat chau hdng ciia xuang
cung tao nen phan sau ciia dudng cung (tinea arcuata) cua xuang chau, ranh gidi giUa chau ldn
va chau nho.

2.3.4. Phan ben (pars lateralis) hinh tarn giac ma nen d tren va dinh d dudi. (5 phan
trude nen cd dien tai hay dien nhi (fades auricularis) de khdp vdi dien tuang ting ciia xuang
chau. Phia sau dien nhi la ldi cu cung (tuberositas sacralis) (H.28.10).
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Ong cung

Mom khdp tren

Dien nhi

Mao cung ben

Mao cung trung gian

Mao cung giufa

Lo cung lung

Ranh cung

Lo cung

Sdng cung

XUdng cut

Sdng cut

Hinh 28.8 : Xuang cung (nhin sau)
Ong cung

Mao cung giOa
Mom khdp tren

Phan sau dudng tan cung

Hinh 28.9 : Nen xuong cung

2.4.5. Dinh xtfotag cung (apex ossis sacri) tiep khdp vdi nen xuang cut bang mot dien k

hinh soan cd dudng kinh ngang ldn. 6 nhUng ngudi ldn tudi, khdp nay eting lai bang md xuong.
2.4.6. Ong cung (canalis sacralis) lien tiep vdi d'lkg sd'ng va chtia cac nhanh cua dudi

ngua. Ong cung cd tiet dien hinh tam giac va thdng vdi cac 16 cung chau hong va cung lung bdi
4 Id gian dd't song (foramina intervertebralia).
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Goc nho

Dien nhi

Lo cung

Hinh 28.10 : Xuong cung (nhin ben)
2.5. XUdNG CUT

Xuang cut (os coccygis) duac tao nen bdi 4 den 6 dot sd'ng cut luc dau rdi nhau, sau dinh
lai lam mot (H.28.7 va H.28.8). Cac dd't sd'ng cut nay rat can cdi va dupe coi nhu la di tich ciia
cai dudi d cac loai vat. Xuang cut cung hinh thap 4 mat : mat chau hdng, mat lung, hai mat
ben, mot nen va mot dinh.

Mat chau hdng 1dm, mat lung ldi, nen quay len tren va khdp vdi dinh xuang cung. Cd hai
sting cut (cornu coccygeum) noi vdi hai sting cung bdi mot day chang.

XtfONG NGtfC
NgUc (thorax) dupe tao bdi mot khung xuang gdm 12 dot song ngUc, cac xuang sudn va
xuang tic, khung nay quay lay mot khoang goi la long ngUc (cavum thoracis) de chtia cac tang
quan trong nhu tim va phoi (H.28.11).
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L6 tren long ngdc

XUdng dc
Khoang
gian sudn

Ranh phdi
Cung sudn

Goc dudi dc

Mom
mui kiem

Lo dudi long ngUc

Hinh 28.11 : Long ngUc

Long ngUc gid'ng nhu mot thung rdng phihh d giua. Khac vdi ddng vat 4 chan ma long
nguc cd dudng kinh ngang be han dudng kinh trUdc sau, ldng nguc d ngudi cd dudng kinh
ngang ldn han dudng kinh trUdc sau de thich nghi vdi tu the dting thang. Ld tren ldng ngUc
(apertura thoracis superior) dupe gidi han bdi dd't sd'ng nguc thti nhat, xuang sudn thti nhat va
bd tren can xuang tic. Ld dudi ldng ngUc (apertura thoracis inferior) ldn han, duac gidi han bdi
dd't sd'ng ngUc thti mUdi hai va xuang sudn thti mudi hai d phia sau, sun sudn thti bay noi vdi
xuang tic d phia trUdc. O day hai sun sudn thti bay tao thanh gdc dudi tic (angulus
infrasternalis). Hai ben ldng nguc la cung sudn (arcus costalis). GiUa hai xuang sudn la khoang
gian sudn (spatium intercostale). Trong ldng ngUc doc hai ben cot sdng la ranh phdi (sulcus
pulmonalis) de chtia phan sau ciia phdi.

I. XLfCfNG StfCfN. Cac xuang sudn (costae) gdm 12 ddi la nhUng xuang dai, det, cong, d hai
ben ldng ngUc. Bay ddi tren nd'i true tiep vdi xuang tic bang sun rieng gpi la xuang sudn that
(costae verae). Nam ddi cud'i gdm 3 ddi VIII, IX, X nd'i vdi xuang tic nhd sun sudn thti bay va
hai ddi XI, XII khdng cd sun nd'i vdi xuang tic. Nam ddi cuoi nay dupe gpi la xuang sudn gia
(costae spuriae).
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1.1. DAC DIEM CHUNG CUA CAC XLfCfNG SLfCfN. Mdi xuang sUdn cd mot dau, mot cd
va mot than (H.28.12).

1.1.1. Dau suttn (caput costae) cd mot dien khdp (fades articularis capitis costae) gdm hai
mat chech ngan each nhau bdi mot mao gpi la mao dau sUdn (crista capitis costae). Dien nay
tiep khdp vdi hd' sudn d mat ben than hai dd't sd'ng ke nhau.

B. MAT NGOAI

Dau sUdn

Gdc sUdn

A. MAT TRONG

Hinh 28.12 : Xuong sUdn

1.1.2. Co stfcfn (collum costae) la phan that lai nd'i tti dau sUdn tdi cu sudn. Bd tren cd xu
xi gpi la mao cd sUdn (crista colli costae) de cho day chang sUdn ngang tren bam.

1.1.3. Cii stfcfn (tuberculum costae) nam d phan sau chd noi gitia cd va than. O phia dudi
trong ciia cii sUdn cd mot dien khdp (fades articularis tuberculi costae). Dien nay ldi, hinh soan
tiep khdp vdi hd' sudn ngang ciia mom ngang dd't sd'ng.
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1.1.4. Than su*dn (corpus costae) dai, det va rat cong. Phan nd'i gitia doan sau va doan
ben nhu gap lai tao thanh gdc sUdn (angulus costae). Tti chd gdc nay than xuang sudn nhu bi
van lam cho cac mat ciia than xuang d phia sau hudng theo 2 mat phang nam ngang va d phia
trUdc hudng theo hai mat phang chech.

Mat ngoai xuang sUdn thi nhdn va cd ca bam, con mat trong thi 1dm va doc theo phia bd
dudi cd mot ranh gpi la ranh sUdn (sulcus costae) trong cd mach gian sudn sau va nhanh trude

cua than kinh gian sudn.

1.2. DAC DIEM RIENG CUA M0T VAI XUCfNG SUCJN DAC BIET.
1.2.1. Xu'o'ng srfofn I : Rong nhat va ngan nhat, khdng bi xoan van va cd hai mat tren va
dUdi(H.28.13).

O mat tren cd hai ranh : ranh trUdc gpi la ranh tinh mach dudi don (sulcus v. subclaviae)
va ranh sau goi la ranh ddng mach dudi don (sulcus a. subclaviae). GiUa 2 ranh la cii ca bac

thang trude (tuberculum m. scaleni antericris) O phia sau ranh ddng mach dudi don la chd bam
ciia ca bac thang giua va ca rang trUdc.
Mat dudi khdng cd ranh sUdn

Cu sUdn

Xuong sudn II

XUdng sUdn I
Ranh dong mach dudi don

Ldi cu

cd rang trade

-

Cu co bac thang
Ranh tinh mach
dudi ddn

Hinh 28.13 : Xuong sudn I vd II
22


1.2.2. Xtfcfng su*d*n II : Cd hai mat chech tren ngoai va dudi trong. 6 phan giUa mat tren
ngoai cd ldi cii ca rang trUdc (tuberositas m. serrati anterioris) de cho ca cung ten bam vao
(H.28.13).

1.2.3. Xtfcfng su^n XI va XII : Dau sudn chi cd mot mat khdp. Khdng cd cd sudn, cii sUdn
va gdc sudn. Xuang sUdn thti mUdi hai cd dp dai rat thay ddi.

1.3. SUN SUON. Sun sudn (cartilago costalis) tiep nd'i vdi than sUdn d phia trude de khdp
vdi xuang tic. Cd hai mat trUdc va sau. Bay sun tren thi bam true tiep vao xuang tic con ba sun
sudn VIII, IX va X thi bam vao xuang tic gian tiep qua sun sudn VII. Hai xuang sudn XI va XII
khdng cd sun ma la lung nen con duac goi la xuang sudn cut.
Cac sun sUdn bam vao xuang tic d cac khuyet sudn.

Sun sUdn I bam vao xuang tic d can tic. Sun sUdn II d chd nd'i giUa can va than tic va sun
sudn VII d chd nd'i giUa than va mom mui kie'm.

Khuyet don
Khuyet don

Dien khdp vdi
sun sudn I
Can dc

Khuyet
tinh mach canh

Dien khdp vdi
sun sddn II

Cac khuyet sddn

Dien khdp vdi
Than dc

sun sddn III,
IV, V

Dien khdp vdi
sun sddn VI, VII

Mom mui kie'm
Mom mui kiem

Hinh 28.14 : Xuong 0,c (nhin trude)

Hinh 28.15 : Xuong itc (nhin ben)
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2. XLfdNG tfC Xuang tic (sternum) (H.28.14) la mot xuang det nam d thanh trUdc ciia ldng
nguc va gdm ba phan : can tic (manubrium sterni), than tic (corpus sterni) va mom mui kie'm
(processus xiphoideus). Can tic va than tic hap nhau thanh gdc tic (angulus sterni) ldi ra phia
trude (H.28.15).

Xuang tic cd hai mat : trUdc va sau, hai bd ben va hai dau : dau tren hay day va dau dudi
hay dinh.

Mat trude hai cong ldi ra trUdc, cd nhUng mao ngang la vet tich ciia chd nd'i 2 dd't tic vdi
nhau.

Mat sau nhdn va cong 1dm ra sau.

Bd ben cd bay khuyet sudn (incisurae costalis) de khdp vdi bay sun sudn.
Nen cd khuyet tinh mach canh (incisura jugularis) d giUa va khuyet don (incisura
clavicularis) d hai ben de khdp vdi dau tic ciia xuang don.

Dinh mdng va nhpn nhu mot mui kie'm nen gpi la mom mui kie'm. Ddi khi cd thung mot
Id gpi la ld mui kie'm. Thudng dupe cau tao bang sun.

CAC KHCJP CUA THAN
Cac xuang than duac lien ket vdi nhau bdi cac khdp. Cac dd't so'ng lien ket vdi nhau bang
cac khdp giUa than dd't sd'ng va cac khdp gitia cac mom khdp dd't sd'ng. Cac xuang sudn lien ket
vdi cac dd't sd'ng bang cac khdp sUdn dd't sd'ng (articulationes costovertebrales) va khdp sudn
ngang (articulatio costotransversaria). Cac xuang sUdn khdp vdi xuang tic bang cac khdp tic
(articulationes sternocostales). Xuang chau lien ket vdi nhau bang khdp ban ddng mu
(symphysis pubica) va vdi xuang cung bang khdp cung chau (articulatio sacroiliaca). Trong
pham vi gidi han ciia cud'n sach, chung ta chi xet qua ve khdp gitia than cac dd't sd'ng la khdp
quan trong va cd nhieu y nghia han ca.

KHCfP GlOA THAN CAC DOT SONG
Do la mot khdp ban ddng sun

1. DIEN KHCfP la mat tren va mat dudi ciia than hai dd't sd'ng ke nhau. Vi hai mat nay 1dm
nen gitia hai mat khdp cd dia gian dd't sd'ng.

2. DIA GIAN DOT SONG (disci intervertebrales) cau tao bang sa sun cd hinh tha'u kinh hai

mat ldi. Cd tat ca 23 dia nam chen gitia than cac dd't sd'ng tti dd't cd thti nhat tdi xuang cung.
Con cac dia gitia cac dd't sd'ng cung va dd't sd'ng cut thi da hda xuang va dinh lien lai thanh
mot xuang ciing va mot xuang cut... Rieng gitia xuang cung va xuang cut thi van tdn tai mot

khdp goi la khdp cung cut (junctura sacrococcygea), thudng la mot khdp sun hoac mot khdp
hoat dich (khdp ddng).

Mdi dia gdm cd hai phan : phan chu vi gpi la vdng sai (anulus fibrosus) duac cau tao bdi
24


cac vdng sa sun ddng tam rat dan hoi va phan trung tam gpi la nhan tuy (nucleus pulposus)
(H.28.16). Nhan tuy duac cau tao bdi mot chat rat dan hoi va cd the di chuyen trong vdng sai tuy
theo vi tri ciia cac dd't sd'ng. Thudng thi nhan nam gan bd sau han bd trutic ciia dia gian ddt, nen

khi gap manh than ngudi ra trUdc cd the gay thoat vi dia ra sau day ldi vao trong d'ng sd'ng.
Day chang vang

Day chang
doc sau

Day chang
tren gai

Dia gian ddt sdng
(nhan tuy)

Day chang.
gian gai

Vdng sdi

Day chang
dQC trade
Khdp lien
mom khdp

Dien khdp cua
mom khdp dudi

Ld gian ddt song

Hinh 28.16 : Khdp giUa than cdc ddt sdng

Dia gian dd't sd'ng day va ldn nhat d doan that lung. O doan cd va doan that lung dia day
d phia trUdc han phia sau va nguac lai d doan ngUc, vi vay doan cd'va that lung ldi ra trUdc va
ngUpc lai doan ngUc lai ldi ra sau.
3. DAY CHANG DOC TRtfCfC (tig. longitudinale anterius) bam tti nen xuang cham tdi tan

xuang cung, hep d tren, rdng d doan sd'ng ngUc rdi lai thu hep dan d doan that lung de sau
cung lien tiep vdi cd't mac ciia dd't sd'ng cung II. Day chang dinh vao than dot sd'ng va dia gian
dot song (H.28.16).

4. DAY CHANG DOC SAU (tig. longitudinale posterius) bam tti xtiang cham tdi tan xuang cut
d mat sau than cac dd't sd'ng ttic la thanh trUdc d'ng sd'ng.
CAU HOI TRAC NGHIEM

Chpn cau tra ldi dung nhat

323. Xuang nao dudi day KHONG thudc xuang than minh :
25