ii THUONG COT SO ns CKEE VO VA * Mue tigu: 1. ¥thite durge tdm quan trong cha chén thuong cbt sng LUNE. That Lie 2. Biéi céch xée dinh c6 hay khéng c6 chin thong ct sGng (CTCS) 3, Nin dutge nhitng diéu nén lam vA nhitng 4igu kh6ng nén Ham khi so fp ote of dinh va vgn chuyén nan nhén. 4. Bit céch cffp citu, khdm bénh, chdn dodn va diéu tri CTCS NOI DUNG BAI GIANG: L Daicwdng: Cing véi sy phat trién eda x8 h6i CTCS ngiy cang xuat hign nhiéu, hing ném of Khodng 30 ca/ 1 trigu dan. ‘Chain thugng c6t s6ng 1a mét chén thugng nang, bdi vi phai do I¥c manh moi gay chin thuong, va thuding 1a da thuong, ma hu qud la ti vong hoge dé lai di ching nang né. Tuy nhién, néu biét cdch xi tri tht sé han ché duge tén thudng. Muén diéu trj CTCS tét ddi héi tai hién trong phai nhan dign tn thutdng chink x4c, so cttu nhanh chéng, cé dinh ding c4ch, van chuyén an toan, cp ctu hiéu qua va xi tri ding mifc ting trudng hdp. “iE. Gidi phlu hge chite ming: 1. Cétsiing: --=- 4 Gdm-32-33 d6t-x6p chéng-Hén nhau, n6i-v6i nhaw bing hé thong day-chitng vidi dém rit chfc, Chia lam 5 doan: 7 Aét sOng cé, 12 dét sing hing, 5 d6t sng that Ing, 5 dét cing, 3-4 d6t cut. ~ Bung cong sinh ly: cot sng (CS) khéng thang do ma bj vn ra truéc hodc cdng ra sau ty doan. Doan CS wn gitip chju lyc t6t, doan CS cong gitip tang dung tich. Cot sng c6 2 duténg cong sinh'ly, Udn ra truéc ting véi doan cé va doan'thAt Jung, Cong ra sau tng di doan lung va doan'ciing-cyt. Dudng cong sinh ly 1a dc trung cia sinh vat i bang 2 chan. 6 3 chite W fnh: nang 48 co thé, che ché thy s6ng, van d6ng than inh,CS that lung CS cang-cur Hinh 1: cdc doan va duéng cong sinh ly c6t song. 2 Détséng: — Than dét: 46 16n cia dot sOng ting dan tix trén xuGng dudi, su ting din dé 16n dap ting su chiu. Ic, Than dét phia truée c6 vd xuong méng bao ba xutong x6p bén trong vdi cdc be xudng day dic nhét la d ving chan cung tung sau (c6t gitla ctla Denis). Tudng sau quan trong khéng nhiing la than phan chju Ivc chi yéu ma con Ia “bite tudng” bao vé than kinh. - Ban song: ban song che ché phia sau mang cing, 1a thanh phan cia Ong chlng bam Vio. Ban sOng la m6t xuong det, c6 2 v6 xuong chée. Ban s6ng I: ni két hgp xuong kha tét. _ ‘Mom gal: indin gai Thanh phan sau ching cla xuong song, né hung ra san va xudng dudi. Mém gai la noi bam cia day ching trén gai, lién gai, chin; £6 téc dung chéng g4p qué mic rat hitu higu nha tay don dai. Cac lye t&: dng théng qua mom gai sé lam chuy€n déng cét sng. Dua vio Igi thé’ c hoc nay ma mém gai dugc chon lim ndi két hgp xuong hiéu qua. ~ Cu€ng cung: cuéng cung 1a thanh phan néi than dét phia tridc vdi céc than! phan phia sau. Mat 46 xuong cla cuéng cung nhiéu nhat, do dé cudng cane ding lam noi bat vit 16i sau ly twdng. Tuy nhién, vi cudng cung nhé va dé: hw6ng thy tig dét nén khi bat vit phai rat cn than va can d6 chinh xéc cao. 49 }—-——— . -sOng-va-la nén-cho. mém gai-Ban-séng 1a nai ving chéc dé cd va cdc day___ @3% Die diy Dia pitta 2 dot chung quanh, nhiém vi eta ching 1a 66 sy phan chia lc, nhfin nhay chéng lye cho phép cif dng nhung ch6ng lai cae van sun (end plate) trén va du6i, 6 tée dung chit Ive née? ¥ ~~ d€m vao thin d6t s6ng (schmorl's node). Vanh xo ngoai cing gbm vai Ip sgi doc dan ¢ tm sun goi 1a céc sgi trong va bam vao vO xufdng £0) Vanh xo chéng duge Iyc cing ding ké, nhutng chi dua v sy bi€n dang do téc d6ng cia ngoai lyc. Kha nang chong c4c Iyc sé gidm theo tubi. bén gay bién dang dia dém déng ké, c6 thé Am bé nl thodt vj nhan dia dém. ws ng, 62, gilt vita) ép, vanh x0 chi 1 dong qua misc. Dia d a ngan ng Sng, lye cing. Do 46, ita sig thodt nb héo nhau bam chat vao suo chia 1a si sharpey (sharpey’s fibers) go vanh xd thi khOng chéng néi Cac véc-td luc BaP, dudi va nghiéng han nbay, rach vanh xo va ri 4. Phiic hyp ede day ching: DAy ching (d/c) n6i lién c&c A6t s6ng va gidl ving cOt s6ng, bao gbm: = Day chang lign gai 18 loai dlc khfng lin tye, bam tit bd dutoi mém gai trén d&n bY trén mdm gai dudi. Mac dd d/c lién gei khOng khde 14m ahving abi ed tay ddn dai, nén né ch6ng luc gop manh hun die vang (chigu dai tay Gon duge tinh ti tryc xoay den day ching). — Déy ching vang rat khde nbytng-e6 tay dda ngdn nén chéng Ic cag yéu hgn d/c lign gai, Day ching ving cing [8 loai dic khong lién tue c6 m§t ti C6 2 — Cing 1, ving mat ¢ dudng gida, do v4: hinh thanh I khe doc gitta oft sOng. Day 1 noi dé vao dén mang citng midi cdch d& dang. Day chang vang chive céc qi dan h6i chié’m ti 16 phan trim cao nhdt so voi cc mé khéc trong cd thé nén khéng, bao gid bj léng leo, ciing khéng tao “nuit” khi dedi qué mio, nén trénh dude sy chén ép Ién bao mang ciing tly phia sau. - Déy chang doc iriéc tong 46; khde, bém khdng che vao bd tude cfc A6t —~—-— ~~ ing trai dai ty san So déh xuong cing. Vi dri pha {hide tryc Koay nén a6 66 téc dung chOng dudi qué mifc hit higu. — Déy chding dpc sau khéng khde bing d/c doc tnidc, bam vao bd sau cila mbi than d6t sng va vanh xd cla dia d@in, Xudt phat ty mang mdi (Tectorial) chay dai dén xuong cyt, 3 phia sau va cach truc xoay khéng xa (lay dn quad ngdn) nén tc dung ch6ng luc gap cia dic doc sau y€u nhft. Day ching doc sau bam chic vao giifa vanh xd phia sau nén han ch€ thoat vj dia dém trang tim, ma thudng thy thodt vi sau bén. — Déy ching Sao khép G6ng vai ve duy ti sif vitng chac cét sding hitu higu oho chin dAi tay @On trung binh va ban thin dle rét khde, 50 5 123