ATLAS - Giải Phẫu Người

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G S. B S. M IRCEA I FRIM v r¢N S f V I¢N H AN L AM Y K HOA R UMANI = , ? ATLAS GIAI PHAU NGIIO'I Ph;i'n ncji tl!Jng as. NguiJi d;ch: Nguyi}n Kim LQc ...~ .. ? N HA X UAT B AN Y H QC H A N (n - 2004
Mircea Ifrim Member of the Medical Science Academy Human Anatomy Atlas Viscera C oordinaitor: M ircea ! frim C olaborators: C hen F eng I frim, A drian M aghiar, T raian M aghiar, I Acad. Gh. N iculescu I R eviewers: P rof. D r. C ezar N iculescu, P rof. D r. D umilru D ragoi, P rof. D r. M ocanu G h. I llustrations b y E. P 5.1rascuta T ranslation i nto E nglish - L.M.Roller I frim, M ircea H uman A natomy A tlas/Mircea I frim - Arad: S ervo - Sal, 1 999. 3 v ol.; i1.; 3 4cm. I SBN 9 73 - 9442-03-X V aLlI - 1999 - 272 p. Bibliogr. - ISBN 9 73-9442-04-8 6 11 ( 081)
Loi l I!a e uon A tlas gia.i p hau n glidi r na c ae b:;m d ang d .m t ren t ay co nQi d ung de cl}p c hu y eu Wi c ae t~mg (cd q uan). T ac ph~m dUQc x uat b an b§.ng t ieng A nh v a 18. c ang t rinh dftu t ien t huQc th~ lo~i n ay c ua n ganh G iai p h a u hQc R umani. " Atlas g iai p h au n gudi" truClc h et l a slJ. k e t hua va p hat tri~n t tl t udng c ua nha gi3.i p h[m h9C VI d~i F rancisc J osef R ainer, c ha de c ua n ganh G iai p hfru hQc R umani. N en t ang t li h 1dng k haa hQc c ua R ainer b it n gu6n t it e ach o hio nh~n c{lu t rue t hea c hile n ang: mQi d lu t rue gi3.i p hftu d eu dl1Qc n ghien CUll v a g iai t hich d1;ta t ren C d sd c huc n ang c ua c hung. B en c~nh d6, " Atlas g iai p h a u ngl1di" c on d ang t hdi th~ hi~n mQt q uan ni~m C d b an k hitc e lla y hQc hi~n dlili. D 6 c hfnh l a q uan ni~m Him s ang.ICu6n s ach k h6ng d i v aa rno t 8 cae c au t rue g iai p hftu v oi n hung c hi t ie't n tdm r a v a b 6. NgU
LC:ii n 6idau C u6'n s ach A tlas gi:ii ph§.u hQc. x uat b an b ltng t ieng A nh 1:\ ffi9t t al li~u c6 119i d ung v tiqt q ua k huon k h6 e ua l;i.11 p hb.u hQc k inh di~n. M Qt m ;)t, c hung t oi n hun m~nh t oi n hling c hi t iet gi~li p hAu c6 t am q uan t rQng l am s ang, v a m~t k hac c hung Wi t rinh bi\y n hling u:ng cil,ll1g n~)i-ngo
LiJi l ita .............. ....................................................................................................................... 3 Lai noi d du .. ........................................................................................................... 5 C hu'dng 1. Duu v a Cd ......................................................................................................... 9 1\-10 dAu . .............................................................................................................................. 1 1 V ung mlii ............................................................................................................................. 1 2 Ctl..C hoc nllli ................................................................................................................ 1 5 N hung x oang c0-nh mili ............................................................................................. 2 1 1·lnc nli~ng ............................................................................................................................ 2 3 Ti('i'n d in h hoc mi~ng ................................................................................................... 24 l loc mi~ng c hinh thl1c ................................................................................................. 2 5 N hung v ung n ong c ua hOC mi~llg v a c ua m~t ........................................................... 28 Nen ( san) hoc mi$ng ................................................................................................... 31 lAiai v a v ung I uai ......................................................................................................... 3 2 ~ H ~ l h" ng t uyen nucIC Qt c ua oc mH;mg ................................................................. . 38 ' 'b ' h" " o Yom mi~ng ................................................................................................................... 41 Cac l ha n h p h a n p h 1,1 t h9c c ua hoc mWng ................................................................ . 49 " ' " u' ' " " , Y ung h iiu ............................................................................................................................ 55 H au (H9ng) .................................................................................................................. 55 V ung d uJi h am v a v ung m ang t ai .................................................................................... 6 5 V ung d110i h am ............................................................................................................. 6 5 V ung m ang t ai .............................................................................................................. 6 6 V ung t hanh q uan ............................................................................................................... 6 7 T hanh q uan .................................................................................................................. 6 7 V ung t uyen g iap· k hf q uan. t hvc q uan ......................................................................... 81 T uyen gi£tp .................................................................................................................... 81 K hi q uan do~n c 6 ......................................................................................................... 8 7 T h ' do~n co ....................................................................................................... 8 9 " J,iC q uan C hu'dng 2: N gtjc ................................................................................................................... 9 1 T hanh ngl,iC ........................................................................................................................ 93 V ung v u ( rung t uyen vu) ................................................................................................... 95 K hoang nb'Vc ....................................................................................................................... 97 M ang p h6i ..................................................................................................................... 97 P hc q uan gac .............................................................................................................. 101 P h6i ............................................................................................................................. 103 C ay p he q uan .................................................................................................................... 108 T rung t hat ......................................................................................................................... 1 16 T rung tha"t truOc .......................................................................................................... 1 16 V ung t im-mung n goai t im .......................................................................................... 1 27 T rung t hat s au ............................................................................................................ 146 C hu'dng 3 . B1;Ing ................................................................................................................. 1 55 Mb d."iu ............................................................................................................................... 1 57 G ioi h~n v a c ac th.3.nh c ua bl,lIlg ..................................................................................... 1 57 6 b1,111g ............................................................................................................................... 162 7
P huc m~IC (I'....l ang b1;l-ng) . .......................................................................................... 162 T fing t reo k ct m,:tc t rang n gang . .......................... . .. . ................. 179 V ung dq d ay ...... . 179 Vun~ t it trang-t1;l-Y t,:tng . ......................................................... . ............................. 1 89 \ lung g an .............................................................................................. . . .196 V ung Iflch . ................... .. . 216 T:'ing dLiai m~1.C t reo k et t rnng n gang ...................................................... .. . ..21S H ong t nlng v ii h 6i t.rang (Hong-h6i t rnng) . ............................................ .. .. ...... 219 D'.li t rang (RuQt. gift) ................................................................................................ 226 K hoang s au p hlic m~c ......... .. ......................................................................... 214 C IC t uyen tlni
9
e ua c an xut1ng ue, d d ay d liang n ay t rung M adau ¥oi gioi h~n dlioi e ua h o n nh mQ.eh c anh. P hhn t ren e ua t han ngl1di b ao g am h ai N hung C(1 q uan t~o n en p hftn dftu e lla t hanh p hiln: d au ( cephalaeum) v a co' ''b¢ m ay t hu n h(m c ae c hat" ( Rainer) t ue l a ( cervix). gioi h an p hau e ach g iua h ai p hau p hftn t ren e ung c lla h~ t ieu h oa v a h 6 h ap, n ay l il m qt dti~ng y ang, b rlt d au l it lJ c ham dliQe gQi t en k h6ng th~t c hinh x ae l a c ae n goai ( inioll). d lidng nay keo dai s ang h ai "tQ.ng" (ho~c "ct1 q uan")l, N hung n ha g iai h en dc t heo d ttdng ch~m t ren, t oi m om p hdu e6 gQi c ae t hanh p han e lla h~ t hong c hum, ch~y y ang q ua m om n ay t oi p hfa a dVdi o ng t ai n goai, r oi tOi bb s au e ua n ganh t ieu h oa v a h 6 h ap nAm t rong l ang ngl,tc l en xLtdng h am d voi t hl d 6i h uang d i t iep v a 6 bl,mg 1a "tf,tng", vi n hin tha'y c hung eo x u6ng d vai dQc bd n ay dtf tOi g oc x lidng h am ve b ong mliQt ( nhay n hot), Am Vat, v a nAm d u(ii ( gonion), r 6i Lien 1'a p hia trLloc qQc t rong m
v a v ung mi~ng 1a v ung cd d on, d l op n ong (gQi li:l d ua p hu t~l.llg r a n goai) c hi q ua mQt d uting r:~ch d dn g ian, d u s au d~ l am t hung c ua v ung n ay c6 m iu n h6 r a trl10c (mfru t rudc) e ua t uyen n udc b 9t m ang t ai c ung vOl to[l.ll bQ c hieu d ay CUD. c ac t hanh g ioi h:;m d iC 0 n 6i t ren. T hu*t n gu ''t~ng'' dl1Qc d ung O'ng b al x ua't e ua t uyen gQi 18. o'ng S tenon d 6 chi' c ac bQ p h*n c ua h~ t hong t ieu h oa v a (dQe t hea t ieng Vi~t 18. x te-nong). h6 h ap a p htin t ren c ua t han th~ ( dfiu v a c6) la k h6ng c hinh X{\C, vi c hung k h6ng n~m a t rong mQt 6 t hanh m~c, do d6 c hung k h6ng duCjc b aa bQc b al mQt m ang t hanh m~c b ong V ung m ui mliQt v a : lm, t uy n hien c ac "t~ng" n ay n hm (Regio nasalis) d n hung v i trio m a d~ t oi dUQc c hung t hi p hal phflU t ich, d t c hung r a k hoi v ung cd t.h§ c hua c hung. C ac "tq.ng" d ph
c ua c ac m~t t rlloc-ben c ua m ui d i d 9ng - cd n ang m oi t n!n v a c dnh m ili (m. dllQc, t~o t hnnh c anh m ui (alae nasi). T u l evator l abii s uperioris a laeque n asi) b am n guyen u y v an m{i t b en m om t ran c ua d inh m ai di r a p hia s all co m 9t n ep da. x lldng h am t ren v a v ao m om m lii c ua x lldng V ach m ili v a n hung b d tl.}' do c ua c ac c anh a m ili gioi h~n h ai l 6 m ui ( nares), p han b en t ran ( tuc m om {5 m M t rong c ua x lfdng t ran) a r ai t oa x uong b am t~n v ao l op s au c ua d a n goai n hat c ua 16 m ili gQi In n hung d iim c anh m ilL c anh m ili v a m oi t ren. - cd h(1 v ach m ili (m. m yrtiformis)3 x uat C hieu cao c ua m ili dllQc t fnh W d ilm g oc m iii ( nasion) t oi c tiim d udi m ili, v a p h a t t u h o cd l a c ua x udng h am t ren v a t u c hieu rQng c ua mG.i l a k hoang c ach g iua h ai h o n anh r ai d en b am t an v an l op s au c ua d a ctie'm ccinh maio T y s 6 g iua c hieu c ao v a a p han v ach m lii d i dQng ( hinh 5). chie'u rQng c ua m ili gQi l a c hi s 6' m ili. P han • K hung xUdng-s~n: V ung m lii dUQc b 6 c ua c hi s 6 m ili t ren to
H oc m iii: B e m~t b en n goai ella v ung d udng g iua v e p hfa s au, v om clla h ai x udng m lii d ca. h ai b eh s e t iep no'i v ao p hia t rong m lii tie'p k hdp vdi m onh d ung t hiing c lla v a r a s au vdi b e m~t b en t rong c lla ph.§.n x udng s ang, do do vom n ay t ang cUdng c ho n.§.m d p hia t ruoe e lla cac h6c mlii. B e m~t h e t hong n ang d a d g iua h ai ho'c m lii (Wc l a " ;anh d Ung t hiing xUdng s ang v a xUdng l a b en t rong c lla d09-n t ruoe-duoi c ac hoc m lii m ia 5). Bd t ruac c ua m am k hAu c ai c lla dUQc p hll b ai d a, c6 h inh mQt a ng vdi c hieu x udng h am t ren c6 t ac d vng n ang d a c ho b d d ai k hoang 1 5 m m (gQi l a tii/n d inh m ili). s au c lla c ae 10 m lii t rudc c lla ho'c m lii xUdng T hanh b en n goai c lla t ien d inh W ong u ng vil. v ach m lii c ling b am v ao g ai m lii clla voi c anh m lii v a t hanh b en t rong c hinh Ill. La xlMng h am t ren. u ach m ili ( septum n asi). d udi c lla t ien La d inh c hinh l a c ac 16 mlii. t ren c lla t ien * N ih b en d uai c lla k hung x udng S l:m d inh nAm d m u c dut;lc gQi l a t h€m m ili c lla m lii chi' h9P b ai c ac s \ln, b ao g am: c ac ( limen n asi), t uc l a m ue d do ldp d a p hu b e s1;in b en c ua m ili ( cartilago n asi l ateralis), m~t c lla t ien d inh t iep n oi vdi ldp n iem m
a Cae hoe m iii n oi v ung g6c t rong c ua m at voi t lnh mg,ch m at t ren, t Inh m~ch n ay s e d b v ao x oang (Cavum nasi) U nh mc;tch h ang i j t rong h 9P SQ, do d6 ne'u n;)n mt,m n h9t c on n on ( chua t hanh m u) d v ung m ili t hi e6 th~ d ftn toi h:).u q ua v iem H6c mlii h inh t hanh m ot h e t h6ng t inh mQ-ch h uyet k hoi d x oang t Inh ml;1ch d udng h .lm c6 n hieu n gach, ~~m' d p h.ln h ang, d ay 1a mi}t t inh t q.ng Him s ang n $ng. t rung t am c ua k hoi x udng m;)t, v a dUQC M qch b gch h uyet ( bgch m gch) c ua p han t hanh h ai nu:a bdi m(lt v ach d c hinh g iua ( xem t~p I ). v ung m ili dU9C p han t hanh c ac n h6m s au: n h6m t ren: t hu nh~n bl;1ch h uyet r 6i C ac hoc m ui t hong voi c ac h oc h di gQi l a a d b v ao c ac h~ch b~ch h uyet c ac x oang cg,nh m ui ( sinus p aranasales) v ung t ren t uyen m ang t ai v a c ac h~ch t ruac t ai; ho~c x oang h di e ua mi;it: d 6 l a c ac x oang t ran, x oang h am, x oang b udm, v a x oang . n h6m g iua: t hu nh$-n b~ch h uye't dt; db s ang. V e p hia t ruoc, c ac h oc m ili (xl1dng) v ao c ae hl;1ch bl;1ch h uyet d uai t uyen m ang md r a n goai b Ang h ai 16 gQi l a c ac zJ m ili t ai; t rude. V e p hia s au, c ac h oc m ili (xl1dng) n h6m d uai: t hu nh$-n b~ch h uyet d~ t hong vdi p h:in h(;mg-mili (con gQi l a ty- d5.n ve n h6m hl;1ch d udi h am. hau)7 b di h ai 10 gQi l a c ac l o m ili s au. C ac h6c m lii l a cd q uan d~ n glti; v i v i t ri c ao c ua T h,j,n k inh V/;in d 9ng dU9C t ach r a t U c hling, c ac h oc m ili l a p h.ln t ren c ung c ua c ac n hanh c ua d ay t h:ln k inh m at. d udng h a h ap. T han k inh c am g iac dUQc d am b aa M 6i h 6c m ui c6 b 6n t hanh, d6 l a: t hanh b qi d ay t han k inh t am t hoa, t hong q ua b en n goai k hong d eu d~n v a t hanh b en n hung n hanh: t rang, t hanh t ren v a t hanh d uoi; b a t hanh t hfrn k inh d uai-rong rQc ( mili n goai), s au n ay c6 cfi'u t ruc d dn g lan h dn. 1;\ mi}t n hanh t(i.n c ua d ay t h:ln k inh m ili- '" T hanh b en t rong c ua h ai h oc m lii l a mi, d ay t han k inh n ay 1l;1i 1;1 n hanh t~n c ua ca mQt k hung xUdng-Sl,ln c hung c ho h ai h 6c d ay t han k inh m
a l~ vili m ilimet. phcin d uoi c ua v ach mUl, c ua x ztdng c uon m ili dztdi; 0 p hia t rong b di c hinh xUClng c uon m ui d uoi; a ng mlii-l~ t rong lOp n iem m!;l.c co mQt ''vet m!;l.ch", l a mQt v ung r at g iau m~ch m au, v a t hudng l a I a dUdng t h6ng g iua hoc mAt voi h ac mlii, ndi x ay r a c hay m au c am ( chay m au mlii). q ua o ng n ay m toc mAt se d 6 v ao ngcich m ilt dztdi. * T himh t ren c ua moi hoc mlii c an g9i l a f ran h oc m ili, l a mQt m ang d ai t heo c hieu - Gng k hau c di l dn ho$.c o ng khii'u ceii t niac-sau, v a c ong 16m h uang x uong p hfa s au, nAm g iua x udng h am t ren v a x udng du'oi, c hi rQng k hoang v ai m ilimet. T rim k hftu c ai; 5 ng n ay n gan c ach h oan t oan voi h(rc m ili kf t u p hia t ruoc r a p hfa s au h9P h ac m lii v a c hi co 10 m d r a d vom kh~u c ai; bai: cac x ztdng m ili ( can g9i 1a xu'dng s ong - Lr5 b liJm-khdu c ai ( foramen s pheno- mlii), g ai m ili c ua x ztdng trein, m dnh n gang palatinum) g iai hf,ln bdi mi)t k huyet c ung c ua x ztdng s ang (can g9i l a m anh s ang: t en v a x ztdng bztam; q ua 16 n ay, h o' c han l amina c ribosa) v a t han x ztdng bztdm. T r:ln b ztdm-khdu c ai t h6ng vdi hoc mlii, va c ung hoc m lii n gan c ach hoc m ui v ai h9P S~J, v a Ia q ua 16 n ay r na bo m~ch-thtl.n k inh c hinh p han xu'dng d e g ay v a n hat c ua s o-mat, vi c lla hoc m ui d i v ao h6c m ui, do do 16 b uaro- m anh s ang r at mongo . . kh~u c ai d vqc coi l a " r6n" clla h6c m ili. 8 * Thil.nh dvdi c an g9i l a n~n (ho$.c s an) C ae x u'dng e llon r niii (ho~e x u'dng e ua hoc m ui, c ling co h inh th~ nhu' m i)t x oan): T hanh b en n goai c ua c ac hoc mlii m{mg, n hung m ang n ay r i)ng h dn v a n giin k h6ng ph~ng r na go g he do co cac x udng h dn so v ai trb.n c ua h5c m ui. Scm h oc m ili c u6n. T hvc r a d ay c hi l a cac l a x udng, c ong n gan e ach cae h ac m ui voi h oc mi~ng. B a 10i v e p hia l ong c ua h 6c rolii, v a co c hieu d ai phtl.n t v t ruoc e ua s an hoc roui h inh t himh t heo h Vdng t nioc-sau. boi m om k hdu c di c ua x ztdng h am t ren, c an mQt phtl.n t u s au l a m anh n gang c ua x ztdng X rtdng c ufIn m iU d rtai ho(ic xLtdng khti'u ceii. N iem mf,lC p hu n en hoc m ui c he x oan dztai ( concha n asalis i nferior) l a m 9t xUdng ri€mg bi~t, v a 13. xUdng d ai n ha't k in mQt a ng n ho g9i I a o ng r ang cUa ( ductus i ncisivus) ho$.c o ng k hdu c di trztac. t rong so' cac xVdng cuon; Xl1dng e u6n d uoi n§.m bAc n gang q ua 10 c lla x oang h am, c he * T hanh b en n goai c ua cae hoc m ui h9P k in p h:ln d voi e lla 10 n ay, v a t iep k hop voi t hanh bdi m$.t t rong c ua c ac xVdng h am gd c uon c lla c ac xVdng h am t ren v a xUdng t n2n v a c dnh t rong c ua m om c han b lidm, ca x udng l~. k h£u c ai, v a t iep k hop voi h ai xu'dng n ay t iep k hop 16.n I vqt voi: C ae x rtdng c uon ( xodn) t Ten v a g iiia l~ x ztdng (os l acrimale); ( concha n asalis s uperior e t m edia) k h6ng m dnh dz/ng t hdng c ua xztrlng k hdu cai; p hiii l a c ac x udng ri€mg rna 1ft c ac bQ ph~n c ua xUClng s ang. E d t ren c lla cac xUClng cac k hai b en c ua x ztdng s ang (con g ri c u6n n ay d inh va~ k hoi b en e ua xVdng s ang l a m e c ung x udng s ang); (ho~c m e c ung xUClng s ang). x ztdng c uon mUl dztdi ( concha X ztdng c uon g iita h inh t hanh n hv m i)t n asalis i nferior) c on g ri l a x lidng m om h inh v o-van n h6 v ao p hia t rong, Wi x oan dztdi. g:ln s at voi v aeh m ui, v a do do p han c hia Xztdng s ang I a y eu to' e hinh h inh t hanh hoc mlii r a t hanh h ai M ng: t:lng t ren, Ia n en t hanh b en n goai c ua h6c mlii, v i v *y v ung k hltu g idc (regio o lfactoria) v a t ang xu'dng n ay l a dUQ"c coi l a ' 'xvdng c hinh c ua d udi Ia v iing h 6 h ap (regio r espiratoria). mili" ( Guerran). C ac xVClng t ham g ia v an XVClng c u6n g iua k eo d ai r a t rVac va r a s au, t hanh b€m n goai c ua h6c mlii girli hl"m h ai 6 ng v a rnQt 10: - Gng m ili-l¢ ho$.c o ng l~-ty. ( canalis "R6n'·: Iii thu~t ngiJ chi nai cac m
V1.1Qt q ua d b en t ren c ac x oang s ang r a p hia xUdng s ang; d ay l a mQt "6ng t hong n h6 l en" t ru'dc v a r a p hia s au, d~ k hop v oi m ao s ang e ao t ren d6 h inh t hanh xu'dng c uon g iib_ (hoQ.c g(j c uon trEm) c ua xu'ong h am tn'3n v a N gach m ui d liiJi ( meatus n asi inferior): (j xu'ong khfru cai. X uong cuo'n t ren n ha h on, p han tru'oe c ua bd t ren c ua n gaeh n ay co 16 n hl.lng co h inh th~ g iong voi xu'dng e uon du'oi c ua o ng mlii-l~ md van ngach. g iua; eo th~ c on c6 mQt x uong c uon thu: t u L6 e ua x oang h am b i e he Hlp d p hia ha
h au, t di c ac h~ch c6 s au, v a m 9t p han n h6 d~ t ai g :ln o ng r ang crla t hi no'i t iep voi h dn t ai c ac h~ch b~ch h uyet d udi-ham. d 9ng mJ;lch khftu c ai xuo'ng, d 9ng mQ-ch n ay d i n gang q ua m an k hftu c ai (ho
XU'ong tr
~--_.r Dinh mOi mOi Sun canh mUi Ian (tru trong) ===::::::::::::::::::::::i Sun canh mOi Ian (Iry ngoai) Vaeh mOi (vaeh giDa mOil ~,,_ _- - - - - - - Canh mUi ------~~1t1 Sun vaeh rnaii (vach gii1a mOil LOng mOi Gai mOi \rude Hinh 4. Cac s~n clla mui (nhin t it ben dlfai) xuong mOi (wong 56ng mOil Xuong Iran Khemi H6c rnlt (6 rn't) _ ----:;7 Sun ml mal Mom I&n xuong _ _ _ _ _ __ ~ ~:::=~L.~~-_ Co nang mOi tr&n ham \r&n Xuong 1& _ _-----1;'---"'1~ va canh mOi ----~~;:_::-j]r Sun ben eua mUi _ _ .,....-.;;: - - - - - _ Co mOi, phan ngang (co ngang mOil - ------Tj Sun canh mOi Ian Co mOi, phan canh (Iru ngoai) mOi (ea no mOil Co ha vaeh mOi Sun canh mOi Ian (tnJ trong) Cav6ng mOi Sun vach mUi (v ach giDa mOil Hinh 5. Thap mui (khung xlfang·s~n va cac ca) 20
Mao ga xuang silng - - - - - -,!i Xoang tran Htmh khlru, cu6ng kh(tu, cae day tMn kinh khw g(ae, d¢ng m