{"id":1228,"date":"2025-12-21T09:44:13","date_gmt":"2025-12-21T02:44:13","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=1228"},"modified":"2026-04-06T18:59:47","modified_gmt":"2026-04-06T11:59:47","slug":"sieu-am-khuyu-tay-phuong-phap-tiep-can-than-thien","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/sieu-am-khuyu-tay-phuong-phap-tiep-can-than-thien\/","title":{"rendered":"Si\u00eau \u00e2m kh\u1edbp khu\u1ef7u: ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn th\u00e2n thi\u1ec7n"},"content":{"rendered":"\n

1. Gi\u1edbi thi\u1ec7u<\/strong><\/p>\n\n\n\n

Si\u00eau \u00e2m (US) \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u1eeb nhi\u1ec1u th\u1eadp k\u1ef7 nay \u0111\u1ec3 t\u00ecm ki\u1ebfm c\u00e1c b\u1ea5t th\u01b0\u1eddng t\u1ea1i kh\u1edbp v\u00e0 quanh kh\u1edbp khu\u1ef7u. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y cho ph\u00e9p kh\u1ea3o s\u00e1t c\u00e1c kh\u1edbp, \u0111i\u1ec3m b\u00e1m g\u00e2n, d\u00e2y ch\u1eb1ng, g\u00e2n, c\u01a1, d\u00e2y th\u1ea7n kinh v\u00e0 b\u1ec1 m\u1eb7t x\u01b0\u01a1ng. Nh\u01b0 \u0111\u00e3 bi\u1ebft, si\u00eau \u00e2m l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh nhanh ch\u00f3ng, an to\u00e0n v\u00e0 d\u1ec5 ti\u1ebfp c\u1eadn, cho ph\u00e9p kh\u1ea3o s\u00e1t \u0111\u1ed9ng v\u00e0 so s\u00e1nh \u0111\u1ed1i b\u00ean, r\u1ea5t h\u1eefu \u00edch \u0111\u1ec3 ph\u00e1t hi\u1ec7n b\u1ec7nh l\u00fd. \u0110\u00e2y l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn an to\u00e0n cho c\u00e1c th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n nh\u1eb1m ch\u1ea9n \u0111o\u00e1n ho\u1eb7c \u0111i\u1ec1u tr\u1ecb, nh\u1eafm v\u00e0o c\u00e1c \u0111\u00edch trong kh\u1edbp ho\u1eb7c quanh kh\u1edbp.<\/p>\n\n\n\n

\u0110\u00e3 c\u00f3 m\u1ed9t s\u1ed1 t\u00e0i li\u1ec7u y v\u0103n t\u1eadp trung v\u00e0o kh\u1ea3o s\u00e1t si\u00eau \u00e2m kh\u1edbp khu\u1ef7u, t\u1ed5ng h\u1ee3p c\u00e1c m\u1eb7t c\u1eaft h\u00ecnh \u1ea3nh kh\u00e1c nhau \u0111\u01b0\u1ee3c coi l\u00e0 quan tr\u1ecdng \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh l\u00fd ph\u1ed5 bi\u1ebfn nh\u1ea5t. H\u1ea7u h\u1ebft c\u00e1c t\u00e0i li\u1ec7u n\u00e0y \u1edf d\u1ea1ng h\u01b0\u1edbng d\u1eabn ho\u1eb7c ph\u00e1c \u0111\u1ed3, ch\u1eb3ng h\u1ea1n nh\u01b0 “H\u01b0\u1edbng d\u1eabn K\u1ef9 thu\u1eadt Si\u00eau \u00e2m C\u01a1 x\u01b0\u01a1ng kh\u1edbp” c\u1ee7a H\u1ed9i Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh C\u01a1 x\u01b0\u01a1ng kh\u1edbp Ch\u00e2u \u00c2u (ESSR), h\u01b0\u1edbng d\u1eabn c\u1ee7a H\u1ed9i Si\u00eau \u00e2m trong Y h\u1ecdc Th\u1ee5y S\u0129 (SGUM), h\u01b0\u1edbng d\u1eabn c\u1ee7a H\u1ed9i Si\u00eau \u00e2m H\u1ec7 v\u1eadn \u0111\u1ed9ng \u0110\u1ee9c (DEGUM) v\u00e0 H\u01b0\u1edbng d\u1eabn Si\u00eau \u00e2m EULAR1<\/a><\/sup>. C\u00e1c t\u00e0i li\u1ec7u n\u00e0y ch\u1ee7 y\u1ebfu chia vi\u1ec7c th\u0103m kh\u00e1m th\u00e0nh c\u00e1c v\u00f9ng c\u1ee7a khu\u1ef7u tay (tr\u01b0\u1edbc, sau, trong v\u00e0 ngo\u00e0i) v\u00e0 t\u1eadp trung v\u00e0o c\u00e1c c\u1ea5u tr\u00fac c\u1ee5 th\u1ec3, nh\u01b0ng kh\u00f4ng khai th\u00e1c c\u00e1c chuy\u1ec3n \u0111\u1ed9ng tu\u1ea7n t\u1ef1 v\u00e0 k\u1ebft n\u1ed1i \u0111\u1ec3 li\u00ean k\u1ebft t\u1eebng b\u01b0\u1edbc. Ch\u00fang t\u00f4i coi s\u1ef1 k\u1ebft n\u1ed1i n\u00e0y l\u00e0 quan tr\u1ecdng t\u1eeb g\u00f3c \u0111\u1ed9 c\u1ee7a ng\u01b0\u1eddi th\u1ef1c h\u00e0nh, nh\u1eb1m \u0111\u1ea1t hi\u1ec7u qu\u1ea3 cao v\u00e0 t\u1eadn d\u1ee5ng t\u1ed1i \u0111a ti\u1ec1m n\u0103ng c\u1ee7a si\u00eau \u00e2m trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng th\u1ef1c t\u1ebf.<\/p>\n\n\n\n

Trong t\u00e0i li\u1ec7u n\u00e0y, ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t m\u1ed9t k\u1ef9 thu\u1eadt kh\u1ea3o s\u00e1t si\u00eau \u00e2m khu\u1ef7u tay theo tr\u00ecnh t\u1ef1, ti\u00eau ch\u00ed th\u00e2n thi\u1ec7n v\u1edbi ng\u01b0\u1eddi d\u00f9ng b\u1eb1ng c\u00e1ch tu\u00e2n theo tr\u00ecnh t\u1ef1 kh\u1ea3o s\u00e1t h\u1ee3p l\u00fd. Tr\u00ecnh t\u1ef1 m\u00e0 ch\u00fang t\u00f4i m\u00f4 t\u1ea3 l\u00e0 h\u1ee3p l\u00fd t\u1eeb g\u00f3c \u0111\u1ed9 c\u1ee7a ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n, bao ph\u1ee7 ph\u1ea7n l\u1edbn c\u00e1c c\u1ea5u tr\u00fac n\u01a1i th\u01b0\u1eddng t\u00ecm th\u1ea5y c\u00e1c thay \u0111\u1ed5i b\u1ec7nh l\u00fd, tu\u00e2n theo m\u1ed9t tr\u1eadt t\u1ef1 th\u1ef1c t\u1ebf v\u00e0 ti\u1ebft ki\u1ec7m th\u1eddi gian, \u0111\u1ed3ng th\u1eddi gi\u1ea3m thi\u1ec3u vi\u1ec7c ph\u1ea3i thay \u0111\u1ed5i t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n, t\u1eeb \u0111\u00f3 t\u1ed1i \u01b0u h\u00f3a to\u00e0n b\u1ed9 quy tr\u00ecnh. C\u00e1c ph\u00e1t hi\u1ec7n b\u1ec7nh l\u00fd s\u1ebd kh\u00f4ng \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong b\u00e0i n\u00e0y. Nh\u01b0 th\u01b0\u1eddng l\u1ec7, b\u00ean ph\u1ea3i c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0m m\u1eabu trong c\u00e1c h\u01b0\u1edbng d\u1eabn kh\u1ea3o s\u00e1t.<\/p>\n\n\n\n

2. K\u1ef9 thu\u1eadt kh\u1ea3o s\u00e1t<\/strong><\/p>\n\n\n\n

Trong ph\u1ea7n n\u00e0y, ch\u00fang t\u00f4i m\u00f4 t\u1ea3 k\u1ef9 thu\u1eadt c\u1ee7a m\u00ecnh d\u01b0\u1edbi d\u1ea1ng c\u00e1c b\u01b0\u1edbc kh\u00e1c nhau, \u0111\u01b0\u1ee3c ph\u00e2n b\u1ed5 qua n\u0103m t\u01b0 th\u1ebf c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n\n\n\n

C\u0103n c\u1ee9 theo “C\u00e1c quy tr\u00ecnh chu\u1ea9n h\u00f3a v\u1ec1 h\u00ecnh \u1ea3nh si\u00eau \u00e2m trong th\u1ea5p kh\u1edbp h\u1ecdc c\u1ee7a EULAR n\u0103m 2017”, si\u00eau \u00e2m khu\u1ef7u tay n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng \u0111\u1ea7u d\u00f2 ph\u1eb3ng (linear) \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao, v\u1edbi t\u1ea7n s\u1ed1 ch\u1ee7 y\u1ebfu tr\u00ean 9 MHz (v\u00e0 th\u1eadm ch\u00ed tr\u00ean 15 MHz \u0111\u1ed1i v\u1edbi c\u00e1c m\u00e1y si\u00eau \u00e2m \u0111\u1eddi m\u1edbi), s\u1eed d\u1ee5ng mode B v\u00e0 mode Doppler (n\u1ebfu c\u1ea7n), \u0111\u1ed3ng th\u1eddi li\u00ean t\u1ee5c t\u1ed1i \u01b0u h\u00f3a c\u00e1c c\u00e0i \u0111\u1eb7t.<\/p>\n\n\n\n

H\u00e3y \u0111\u1ea3m b\u1ea3o s\u1eed d\u1ee5ng l\u01b0\u1ee3ng gel d\u1ed3i d\u00e0o v\u00e0 lu\u00f4n th\u1ef1c hi\u1ec7n kh\u1ea3o s\u00e1t \u0111\u1ed9ng, di chuy\u1ec3n nh\u1eb9 nh\u00e0ng v\u00e0 s\u1eed d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt nh\u1ea5c \u0111\u1ea7u d\u00f2 (lift) v\u00e0 k\u1ef9 thu\u1eadt g\u00f3t-ng\u00f3n (heel-toe) khi th\u00edch h\u1ee3p.<\/p>\n\n\n\n

B\u1ea3ng 1 t\u00f3m t\u1eaft t\u1ea5t c\u1ea3 c\u00e1c t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n c\u00f9ng v\u1edbi c\u00e1c b\u01b0\u1edbc t\u01b0\u01a1ng \u1ee9ng.<\/p>\n\n\n\n

B\u1ea3ng 1: T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n v\u00e0 c\u00e1c b\u01b0\u1edbc kh\u1ea3o s\u00e1t si\u00eau \u00e2m<\/strong><\/td><\/tr><\/thead>
1. T\u01b0 th\u1ebf th\u1ee9 nh\u1ea5t:<\/strong> B\u1ec7nh nh\u00e2n ng\u1ed3i \u0111\u1ed1i di\u1ec7n b\u00e1c s\u0129, c\u1eb3ng tay \u0111\u1eb7t tr\u00ean b\u00e0n h\u1ed7 tr\u1ee3 v\u00e0 khu\u1ef7u tay g\u1ea5p nh\u1eb9.
1.1 C\u01a1 c\u00e1nh tay v\u00e0 m\u1eb7t kh\u1edbp tr\u01b0\u1edbc c\u1ee7a \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (m\u1eb7t c\u1eaft ngang)
1.2 C\u01a1 c\u00e1nh tay quay v\u00e0 th\u1ea7n kinh quay (m\u1eb7t c\u1eaft ngang)
1.3 Th\u1ea7n kinh gi\u1eefa v\u00e0 c\u01a1 s\u1ea5p tr\u00f2n (m\u1eb7t c\u1eaft ngang)
1.4 H\u1ed1 v\u1eb9t (m\u1eb7t c\u1eaft d\u1ecdc)
1.5 G\u00e2n nh\u1ecb \u0111\u1ea7u, m\u1eb7t c\u1eaft tr\u01b0\u1edbc kinh \u0111i\u1ec3n (m\u1eb7t c\u1eaft d\u1ecdc)
1.6 H\u1ed1 quay (m\u1eb7t c\u1eaft d\u1ecdc)<\/td><\/tr>
2. T\u01b0 th\u1ebf th\u1ee9 hai:<\/strong> B\u1ec7nh nh\u00e2n ng\u1ed3i \u0111\u1ed1i di\u1ec7n b\u00e1c s\u0129, c\u1eb3ng tay \u0111\u1eb7t tr\u00ean b\u00e0n h\u1ed7 tr\u1ee3 v\u00e0 khu\u1ef7u tay g\u1ea5p 90 \u0111\u1ed9 \u1edf t\u01b0 th\u1ebf s\u1ea5p, b\u1edd tr\u1ee5 c\u1ee7a c\u1eb3ng tay t\u1ef1a l\u00ean b\u00e0n.
2.1 M\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i (m\u1eb7t c\u1eaft d\u1ecdc)
2.2 M\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i (m\u1eb7t c\u1eaft ngang)<\/td><\/tr>
3. T\u01b0 th\u1ebf th\u1ee9 ba (\u201ct\u01b0 th\u1ebf con r\u1eafn\u201d):<\/strong> B\u1ec7nh nh\u00e2n ng\u1ed3i \u0111\u1ed1i di\u1ec7n b\u00e1c s\u0129 v\u1edbi m\u1ecfm khu\u1ef7u \u0111\u1eb7t tr\u00ean b\u00e0n, b\u00e0n tay h\u01b0\u1edbng l\u00ean tr\u00ean, khu\u1ef7u tay g\u1ea5p t\u1ed1i \u0111a v\u00e0 s\u1ea5p, gi\u1ed1ng h\u00ecnh con r\u1eafn.
3.1 \u201cT\u01b0 th\u1ebf con r\u1eafn\u201d \u2013 ba b\u01b0\u1edbc<\/td><\/tr>
4. T\u01b0 th\u1ebf th\u1ee9 t\u01b0:<\/strong> T\u01b0\u01a1ng t\u1ef1 nh\u01b0 t\u01b0 th\u1ebf th\u1ee9 nh\u1ea5t.
4.1 M\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong (m\u1eb7t c\u1eaft d\u1ecdc)
4.2 M\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong (m\u1eb7t c\u1eaft ngang)<\/td><\/tr>
5. T\u01b0 th\u1ebf th\u1ee9 n\u0103m (\u201ct\u01b0 th\u1ebf con cua\u201d):<\/strong> L\u00f2ng b\u00e0n tay \u0111\u1eb7t tr\u00ean b\u00e0n h\u1ed7 tr\u1ee3 v\u1edbi c\u1ed5 tay du\u1ed7i t\u1ed1i \u0111a, v\u00e0 khu\u1ef7u tay h\u01b0\u1edbng l\u00ean tr\u00ean, g\u1ea5p 90 \u0111\u1ed9, gi\u1ed1ng h\u00ecnh ch\u00e2n con cua.
5.1 G\u00e2n v\u00e0 c\u01a1 tam \u0111\u1ea7u (m\u1eb7t c\u1eaft d\u1ecdc)
5.2 G\u00e2n, c\u01a1 tam \u0111\u1ea7u v\u00e0 th\u1ea7n kinh tr\u1ee5 (m\u1eb7t c\u1eaft ngang)<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

C\u00e1c H\u00ecnh t\u1eeb 1 \u0111\u1ebfn 5 t\u00f3m t\u1eaft v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh theo tr\u00ecnh t\u1ef1 \u0111\u1ec1 xu\u1ea5t. L\u01b0u \u00fd r\u1eb1ng, v\u1edbi m\u1ed7i v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2, c\u00f3 th\u1ec3 thu \u0111\u01b0\u1ee3c nhi\u1ec1u h\u01a1n m\u1ed9t h\u00ecnh \u1ea3nh si\u00eau \u00e2m b\u1eb1ng c\u00e1ch th\u1ef1c hi\u1ec7n c\u00e1c \u0111i\u1ec1u ch\u1ec9nh nh\u1eb9, nh\u01b0 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 d\u01b0\u1edbi \u0111\u00e2y v\u00e0 \u0111\u01b0\u1ee3c minh h\u1ecda trong 47 h\u00ecnh \u1ea3nh si\u00eau \u00e2m \u0111i k\u00e8m.<\/p>\n\n\n\n

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2.1. T\u01b0 th\u1ebf th\u1ee9 nh\u1ea5t<\/strong><\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n ng\u1ed3i \u0111\u1ed1i di\u1ec7n v\u1edbi ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n, c\u1eb3ng tay \u0111\u1eb7t tr\u00ean b\u00e0n h\u1ed7 tr\u1ee3 v\u00e0 khu\u1ef7u tay g\u1ea5p nh\u1eb9 (H\u00ecnh 1). Thi\u1ebft l\u1eadp t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n \u0111\u1ea7u ti\u00ean n\u00e0y bao g\u1ed3m t\u1ed5ng c\u1ed9ng s\u00e1u b\u01b0\u1edbc kh\u1ea3o s\u00e1t ch\u00ednh (d\u01b0\u1edbi \u0111\u00e2y).<\/p>\n\n\n

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H\u00ecnh 1.<\/strong> V\u00ed d\u1ee5 v\u1ec1 t\u01b0 th\u1ebf th\u1ee9 nh\u1ea5t v\u00e0 v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 (c\u00e1c h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u xanh) \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c c\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m \u0111\u01b0\u1ee3c xem x\u00e9t cho v\u00f9ng<\/em> n\u00e0y, theo th\u1ee9 t\u1ef1 \u0111\u01b0\u1ee3c \u0111\u00e1nh s\u1ed1. L\u01b0u \u00fd r\u1eb1ng, \u0111\u1ed1i v\u1edbi m\u1ed7i v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2, c\u00f3 th\u1ec3 thu \u0111\u01b0\u1ee3c nhi\u1ec1u h\u01a1n m\u1ed9t h\u00ecnh \u1ea3nh si\u00eau \u00e2m, b\u1eb1ng c\u00e1ch th\u1ef1c hi\u1ec7n c\u00e1c \u0111i\u1ec1u ch\u1ec9nh nh\u1eb9.<\/em><\/p>\n\n\n

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H\u00ecnh 2.<\/strong> V\u00ed d\u1ee5 v\u1ec1 t\u01b0 th\u1ebf th\u1ee9 hai v\u00e0 v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 (c\u00e1c h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u xanh) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c c\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m \u0111\u01b0\u1ee3c xem x\u00e9t cho v\u00f9ng<\/em> n\u00e0y, theo th\u1ee9 t\u1ef1 \u0111\u01b0\u1ee3c \u0111\u00e1nh s\u1ed1. L\u01b0u \u00fd r\u1eb1ng, \u0111\u1ed1i v\u1edbi m\u1ed7i v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2, c\u00f3 th\u1ec3 thu \u0111\u01b0\u1ee3c nhi\u1ec1u h\u01a1n m\u1ed9t h\u00ecnh \u1ea3nh si\u00eau \u00e2m, b\u1eb1ng c\u00e1ch th\u1ef1c hi\u1ec7n c\u00e1c \u0111i\u1ec1u ch\u1ec9nh nh\u1eb9.<\/em><\/p>\n\n\n

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H\u00ecnh 3.<\/strong> V\u00ed d\u1ee5 v\u1ec1 t\u01b0 th\u1ebf th\u1ee9 ba v\u00e0 v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 (c\u00e1c h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u xanh) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c c\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf v\u00f9ng n\u00e0y, theo th\u1ee9 t\u1ef1 \u0111\u01b0\u1ee3c \u0111\u00e1nh s\u1ed1. L\u01b0u \u00fd r\u1eb1ng, v\u1edbi m\u1ed7i v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2, c\u00f3 th\u1ec3 thu \u0111\u01b0\u1ee3c nhi\u1ec1u h\u01a1n m\u1ed9t h\u00ecnh \u1ea3nh si\u00eau \u00e2m b\u1eb1ng c\u00e1ch th\u1ef1c hi\u1ec7n c\u00e1c \u0111i\u1ec1u ch\u1ec9nh nh\u1eb9.<\/em><\/p>\n\n\n

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H\u00ecnh 4.<\/strong> V\u00ed d\u1ee5 v\u1ec1 t\u01b0 th\u1ebf th\u1ee9 t\u01b0 v\u00e0 v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 (c\u00e1c h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u xanh) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c c\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m \u0111\u01b0\u1ee3c xem x\u00e9t cho ph\u00e2n \u0111o\u1ea1n n\u00e0y, theo th\u1ee9 t\u1ef1 \u0111\u01b0\u1ee3c \u0111\u00e1nh s\u1ed1. L\u01b0u \u00fd r\u1eb1ng, \u0111\u1ed1i v\u1edbi m\u1ed7i v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2, c\u00f3 th\u1ec3 thu \u0111\u01b0\u1ee3c nhi\u1ec1u h\u01a1n m\u1ed9t h\u00ecnh \u1ea3nh si\u00eau \u00e2m b\u1eb1ng c\u00e1ch th\u1ef1c hi\u1ec7n c\u00e1c \u0111i\u1ec1u ch\u1ec9nh nh\u1eb9.<\/em><\/p>\n\n\n

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H\u00ecnh 5.<\/strong> V\u00ed d\u1ee5 v\u1ec1 t\u01b0 th\u1ebf th\u1ee9 n\u0103m v\u00e0 v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 (c\u00e1c h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u xanh) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c c\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m \u0111\u01b0\u1ee3c xem x\u00e9t cho ph\u00e2n \u0111o\u1ea1n n\u00e0y, theo th\u1ee9 t\u1ef1 \u0111\u01b0\u1ee3c \u0111\u00e1nh s\u1ed1. L\u01b0u \u00fd r\u1eb1ng, \u0111\u1ed1i v\u1edbi m\u1ed7i v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2, c\u00f3 th\u1ec3 thu \u0111\u01b0\u1ee3c nhi\u1ec1u h\u01a1n m\u1ed9t h\u00ecnh \u1ea3nh si\u00eau \u00e2m b\u1eb1ng c\u00e1ch th\u1ef1c hi\u1ec7n c\u00e1c \u0111i\u1ec1u ch\u1ec9nh nh\u1eb9.<\/em><\/p>\n\n\n\n

2.1.1. C\u01a1 c\u00e1nh tay v\u00e0 m\u1eb7t kh\u1edbp tr\u01b0\u1edbc c\u1ee7a \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (m\u1eb7t c\u1eaft ngang)<\/strong><\/h3>\n\n\n\n

Ch\u00fang ta b\u1eaft \u0111\u1ea7u \u1edf m\u1eb7t tr\u01b0\u1edbc c\u00e1nh tay, x\u1ea5p x\u1ec9 t\u1ea1i m\u1ee9c ranh gi\u1edbi gi\u1eefa 1\/3 gi\u1eefa v\u00e0 1\/3 d\u01b0\u1edbi. \u0110\u1eb7t \u0111\u1ea7u d\u00f2 \u1edf m\u1eb7t c\u1eaft tr\u1ee5c ng\u1eafn (c\u1eaft ngang) \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u trong (internal\/ interior bicipital aponeurosis)2<\/a><\/sup>, \u0111\u00e2y l\u00e0 m\u1ed1c tham chi\u1ebfu \u0111\u1ea7u ti\u00ean c\u1ee7a ch\u00fang ta (H\u00ecnh 6).<\/p>\n\n\n

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H\u00ecnh 6.<\/strong> (a) V\u00ed d\u1ee5 v\u1ec1 t\u01b0 th\u1ebf th\u1ee9 nh\u1ea5t v\u00e0 v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) C\u00e2n (aponeurosis – c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 l\u00f5i g\u00e2n) c\u01a1 nh\u1ecb \u0111\u1ea7u trong tr\u00ean m\u1eb7t c\u1eaft ngang, t\u1ea1i v\u1ecb tr\u00ed n\u1ed1i gi\u1eefa 1\/3 gi\u1eefa v\u00e0 1\/3 d\u01b0\u1edbi c\u1ee7a c\u00e1nh tay, \u1edf m\u1eb7t tr\u01b0\u1edbc.<\/em><\/p>\n\n\n\n

T\u1eeb \u0111i\u1ec3m n\u00e0y di chuy\u1ec3n d\u1ea7n xu\u1ed1ng d\u01b0\u1edbi (v\u1ec1 ph\u00eda ng\u1ecdn chi), quan s\u00e1t c\u00e2n trong v\u00e0 c\u00e1c \u0111\u1ea7u c\u01a1 nh\u1ecb \u0111\u1ea7u h\u1ee3p nh\u1ea5t th\u00e0nh g\u00e2n nh\u1ecb \u0111\u1ea7u \u0111o\u1ea1n xa. G\u00e2n n\u00e0y b\u1eaft \u0111\u1ea7u n\u1eb1m th\u1eb3ng h\u00e0ng v\u1edbi \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay v\u00e0 th\u1ea7n kinh gi\u1eefa \u1edf ph\u00eda trong c\u1ee7a n\u00f3, t\u1ea1o th\u00e0nh b\u1ed9 ba BAM<\/strong> n\u1ed5i ti\u1ebfng (vi\u1ebft t\u1eaft c\u1ee7a B<\/strong>iceps – C\u01a1 nh\u1ecb \u0111\u1ea7u, A<\/strong>rtery – \u0110\u1ed9ng m\u1ea1ch c\u00e1nh tay v\u00e0 M<\/strong>edian nerve – Th\u1ea7n kinh gi\u1eefa, theo th\u1ee9 t\u1ef1 t\u1eeb ngo\u00e0i v\u00e0o trong) (H\u00ecnh 7).<\/p>\n\n\n

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H\u00ecnh 7.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc kh\u1edbp khu\u1ef7u, hi\u1ec3n th\u1ecb s\u1ef1 s\u1eafp x\u1ebfp c\u1ee7a b\u1ed9 ba BAM, bao g\u1ed3m g\u00e2n nh\u1ecb \u0111\u1ea7u, \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay v\u00e0 th\u1ea7n kinh gi\u1eefa, v\u00e0 c\u1ea3 tr\u1ebd c\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u (lacertus fibrosus).<\/em><\/p>\n\n\n\n

L\u01b0u \u00fd r\u1eb1ng ph\u00eda ngo\u00e0i c\u1ee7a BAM, b\u1ea1n c\u00f3 th\u1ec3 th\u1ea5y th\u1ea7n kinh b\u00ec c\u1eb3ng tay ngo\u00e0i<\/strong>, m\u1ed9t nh\u00e1nh c\u1ee7a th\u1ea7n kinh c\u01a1 b\u00ec (H\u00ecnh 8). Ph\u00eda tr\u00ean BAM, ch\u00fang ta c\u00f3 th\u1ec3 th\u1ea5y c\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u ngo\u00e0i (hay tr\u1ebd c\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u<\/strong> – lacertus fibrosus<\/strong>), b\u1eaft \u0111\u1ea7u t\u1eeb ph\u00eda trong c\u1ee7a \u0111i\u1ec3m n\u1ed1i g\u00e2n-c\u01a1 nh\u1ecb \u0111\u1ea7u v\u00e0 k\u1ebft th\u00fac t\u1ea1i m\u1ea1c s\u00e2u v\u00e0 bao m\u00f4 c\u01a1 c\u1ee7a c\u00e1c c\u01a1 v\u00f9ng khu\u1ef7u trong. Ch\u00fang ta c\u00f3 th\u1ec3 quan s\u00e1t c\u1ea5u tr\u00fac n\u00e0y d\u1ec5 d\u00e0ng h\u01a1n b\u1eb1ng c\u00e1ch y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n co c\u01a1 nh\u1ecb \u0111\u1ea7u \u0111\u1eb3ng tr\u01b0\u1eddng (g\u1ed3ng c\u01a1 nh\u01b0ng kh\u00f4ng c\u1eed \u0111\u1ed9ng). Tr\u1ebd c\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u (lacertus fibrosus) ng\u0103n c\u00e1ch t\u0129nh m\u1ea1ch n\u1ec1n \u1edf n\u00f4ng v\u1edbi \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay \u1edf s\u00e2u, t\u1ea1i ph\u1ea7n b\u00ean ngo\u00e0i h\u01a1n c\u1ee7a n\u00f3 (H\u00ecnh 9). D\u1eebng di chuy\u1ec3n \u0111\u1ea7u d\u00f2 khi b\u1ea1n ch\u1ea1m \u0111\u1ebfn r\u00f2ng r\u1ecdc v\u00e0 ch\u1ecfm con x\u01b0\u01a1ng c\u00e1nh tay, quan s\u00e1t bao kh\u1edbp bao ph\u1ee7 b\u1ec1 m\u1eb7t x\u01b0\u01a1ng (H\u00ecnh 10). Ph\u00eda tr\u00ean n\u00f3 l\u00e0 c\u01a1 c\u00e1nh tay, v\u1edbi c\u01a1 c\u00e1nh tay quay \u1edf ph\u00eda ngo\u00e0i v\u00e0 c\u01a1 s\u1ea5p tr\u00f2n \u1edf ph\u00eda trong.<\/p>\n\n\n

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H\u00ecnh 8.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc khu\u1ef7u tay, hi\u1ec3n th\u1ecb g\u00e2n nh\u1ecb \u0111\u1ea7u, tr\u1ebd c\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u v\u00e0 th\u1ea7n kinh b\u00ec c\u1eb3ng tay ngo\u00e0i.<\/em><\/p>\n\n\n

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H\u00ecnh 9.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc khu\u1ef7u tay, hi\u1ec3n th\u1ecb tr\u1ebd c\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u (Lacertus fibrosus \/l\u0259\u02c8s\u025c\u02d0rt\u0259s fa\u026a\u02c8bro\u028as\u0259s\/) \u0111i gi\u1eefa t\u0129nh m\u1ea1ch n\u1ec1n v\u00e0 \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay.<\/em><\/p>\n\n\n

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H\u00ecnh 10.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc kh\u1edbp khu\u1ef7u, hi\u1ec3n th\u1ecb ch\u1ecfm con (capitellum \/\u02cck\u00e6p\u026a\u02c8t\u025bl\u0259m\/ ) v\u00e0 r\u00f2ng r\u1ecdc x\u01b0\u01a1ng c\u00e1nh tay.<\/em><\/p>\n\n\n\n

2.1.2. C\u01a1 c\u00e1nh tay quay v\u00e0 th\u1ea7n kinh quay (m\u1eb7t c\u1eaft ngang)<\/strong><\/p>\n\n\n\n

T\u1eeb \u0111i\u1ec3m k\u1ebft th\u00fac c\u1ee7a b\u01b0\u1edbc 1.1, di chuy\u1ec3n v\u1ec1 ph\u00eda ngo\u00e0i cho \u0111\u1ebfn khi b\u1ea1n ch\u1ea1m v\u00e0o ch\u1ecfm con x\u01b0\u01a1ng c\u00e1nh tay. Ph\u00eda tr\u00ean n\u00f3, ch\u00fang ta c\u00f3 th\u1ec3 th\u1ea5y c\u01a1 c\u00e1nh tay (\u1edf ph\u00eda trong) v\u00e0 c\u01a1 c\u00e1nh tay quay (\u1edf ph\u00eda ngo\u00e0i) v\u1edbi th\u1ea7n kinh quay<\/strong> n\u1eb1m \u1edf gi\u1eefa (H\u00ecnh 11).<\/p>\n\n\n

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H\u00ecnh 11.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc v\u00e0 m\u1eb7t quay c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb th\u1ea7n kinh quay c\u00f9ng c\u00e1c c\u01a1 c\u00e1nh tay v\u00e0 c\u00e1nh tay quay<\/em><\/p>\n\n\n\n

Di chuy\u1ec3n xu\u1ed1ng d\u01b0\u1edbi, \u0111i theo th\u1ea7n kinh quay cho \u0111\u1ebfn khi n\u00f3 chia \u0111\u00f4i t\u1ea1i b\u1ec1 m\u1eb7t c\u01a1 ng\u1eeda, trong v\u00f2ng cung Frohse<\/strong> (Frohse\u2019s arcade), th\u00e0nh nh\u00e1nh c\u1ea3m gi\u00e1c v\u00e0 nh\u00e1nh v\u1eadn \u0111\u1ed9ng, nh\u00e1nh v\u1eadn \u0111\u1ed9ng ch\u00ednh l\u00e0 th\u1ea7n kinh gian c\u1ed1t sau (PIN)<\/strong> [17] (H\u00ecnh 12). Ngay sau v\u00f2ng cung Frohse, \u1edf s\u00e2u h\u01a1n, ch\u00fang ta c\u00f3 th\u1ec3 th\u1ea5y ch\u1ecfm quay \u0111\u01b0\u1ee3c bao quanh b\u1edfi d\u00e2y ch\u1eb1ng v\u00f2ng (H\u00ecnh 13). Th\u1ea7n kinh gian c\u1ed1t sau (PIN) chui v\u00e0o gi\u1eefa \u0111\u1ea7u n\u00f4ng v\u00e0 \u0111\u1ea7u s\u00e2u c\u1ee7a c\u01a1 ng\u1eeda khi ch\u00fang ta \u0111i xa h\u01a1n v\u1ec1 ph\u00eda d\u01b0\u1edbi. B\u1ea1n c\u1ea7n y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n s\u1ea5p c\u1eb3ng tay \u0111\u1ec3 c\u00f3 h\u00ecnh \u1ea3nh r\u00f5 h\u01a1n v\u1ec1 \u0111\u01b0\u1eddng \u0111i c\u1ee7a d\u00e2y th\u1ea7n kinh n\u00e0y (H\u00ecnh 14).<\/p>\n\n\n

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H\u00ecnh 12.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc v\u00e0 m\u1eb7t quay c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb nh\u00e1nh c\u1ea3m gi\u00e1c v\u00e0 nh\u00e1nh v\u1eadn \u0111\u1ed9ng c\u1ee7a th\u1ea7n kinh quay t\u1ea1i v\u00f2ng cung Frohse.<\/em><\/p>\n\n\n\n

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H\u00ecnh 13.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc v\u00e0 m\u1eb7t quay c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb d\u00e2y ch\u1eb1ng v\u00f2ng c\u1ee7a x\u01b0\u01a1ng quay.<\/em><\/p>\n\n\n

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H\u00ecnh 14.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc v\u00e0 m\u1eb7t quay c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb th\u1ea7n kinh gian c\u1ed1t sau c\u00f9ng c\u00e1c \u0111\u1ea7u n\u00f4ng v\u00e0 \u0111\u1ea7u s\u00e2u c\u1ee7a c\u01a1 ng\u1eeda.<\/em><\/p>\n\n\n\n

2.1.3. Th\u1ea7n kinh gi\u1eefa v\u00e0 c\u01a1 s\u1ea5p tr\u00f2n (m\u1eb7t c\u1eaft ngang)<\/strong><\/p>\n\n\n\n

Quay tr\u1edf l\u1ea1i ph\u00eda trong v\u00e0 l\u00ean tr\u00ean v\u1ec1 \u0111i\u1ec3m k\u1ebft th\u00fac c\u1ee7a b\u01b0\u1edbc 1.1, \u0111\u1ec3 b\u1ea1n c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y l\u1ea1i d\u1ea5u hi\u1ec7u BAM. Gi\u1eef th\u1ea7n kinh gi\u1eefa \u1edf gi\u1eefa h\u00ecnh \u1ea3nh, quan s\u00e1t tr\u1ebd c\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u \u1edf n\u00f4ng v\u00e0 \u0111\u1ea7u c\u00e1nh tay c\u1ee7a c\u01a1 s\u1ea5p tr\u00f2n \u1edf ph\u00eda trong (H\u00ecnh 15). Xa h\u01a1n v\u1ec1 ph\u00eda d\u01b0\u1edbi, th\u1ea7n kinh gi\u1eefa s\u1ebd \u0111i gi\u1eefa \u0111\u1ea7u c\u00e1nh tay (hay \u0111\u1ea7u n\u00f4ng) v\u00e0 \u0111\u1ea7u tr\u1ee5 (hay \u0111\u1ea7u s\u00e2u) c\u1ee7a c\u01a1 s\u1ea5p tr\u00f2n<\/strong> (H\u00ecnh 16).<\/p>\n\n\n

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H\u00ecnh 15.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc v\u00e0 m\u1eb7t tr\u1ee5 c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb th\u1ea7n kinh gi\u1eefa c\u00f9ng c\u00e1c c\u01a1 s\u1ea5p tr\u00f2n v\u00e0 c\u01a1 c\u00e1nh tay.<\/em><\/p>\n\n\n

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H\u00ecnh 16.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc v\u00e0 m\u1eb7t tr\u1ee5 c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb th\u1ea7n kinh gi\u1eefa n\u1eb1m gi\u1eefa hai \u0111\u1ea7u c\u1ee7a c\u01a1 s\u1ea5p tr\u00f2n.<\/em><\/p>\n\n\n\n

Quanh khu v\u1ef1c n\u00e0y, b\u1ea1n c\u00f3 th\u1ec3 t\u00ecm th\u1ea5y th\u1ea7n kinh gian c\u1ed1t tr\u01b0\u1edbc (AIN)<\/strong> t\u00e1ch ra t\u1eeb th\u1ea7n kinh gi\u1eefa, c\u00e1ch \u0111\u01b0\u1eddng n\u1ed1i hai m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u kho\u1ea3ng 5\u20136 cm v\u1ec1 ph\u00eda d\u01b0\u1edbi (H\u00ecnh 17), \u0111\u1ec3 ch\u1ea1y s\u00e2u h\u01a1n gi\u1eefa c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n s\u00e2u v\u00e0 c\u01a1 g\u1ea5p ng\u00f3n c\u00e1i d\u00e0i, s\u00e1t m\u00e0ng gian c\u1ed1t.<\/p>\n\n\n

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H\u00ecnh 17.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc khu\u1ef7u tay, hi\u1ec3n th\u1ecb th\u1ea7n kinh gi\u1eefa v\u00e0 th\u1ea7n kinh gian c\u1ed1t tr\u01b0\u1edbc.<\/em><\/p>\n\n\n\n

Sau khi r\u1eddi kh\u1ecfi m\u1ed1i li\u00ean quan m\u1eadt thi\u1ebft v\u1edbi c\u01a1 s\u1ea5p tr\u00f2n v\u00e0 t\u00e1ch ra th\u1ea7n kinh AIN, th\u1ea7n kinh gi\u1eefa li\u00ean quan \u0111\u1ebfn c\u1ea7u g\u00e2n c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n n\u00f4ng<\/strong> (sublimis bridge – m\u1ed9t cung m\u1ea1c n\u01a1i \u0111\u1ea7u c\u00e1nh tay-tr\u1ee5 v\u00e0 \u0111\u1ea7u quay c\u1ee7a c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n n\u00f4ng h\u1ee3p nh\u1ea5t t\u1ea1i gi\u1edbi h\u1ea1n g\u1ea7n c\u1ee7a n\u00f3) (H\u00ecnh 18).<\/p>\n\n\n

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H\u00ecnh 18.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang t\u1ea1i m\u1eb7t tr\u01b0\u1edbc \u0111o\u1ea1n g\u1ea7n c\u1eb3ng tay, hi\u1ec3n th\u1ecb th\u1ea7n kinh gi\u1eefa, c\u1ea7u g\u00e2n c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n n\u00f4ng (sublimis bridge) v\u00e0 c\u00e1c c\u01a1 xung quanh.<\/em><\/p>\n\n\n\n

V\u1ec1 ph\u00eda \u0111u\u00f4i (ph\u00eda d\u01b0\u1edbi) c\u1ee7a c\u1ea5u tr\u00fac n\u00e0y, ch\u00fang ta c\u00f3 th\u1ec3 th\u1ea5y c\u01a1 s\u1ea5p tr\u00f2n \u0111i ra ngo\u00e0i v\u1ec1 ph\u00eda ch\u1ed7 b\u00e1m t\u1eadn \u1edf x\u01b0\u01a1ng quay. T\u1eeb \u0111\u00f3, theo th\u1ee9 t\u1ef1 v\u00f2ng tr\u00f2n c\u00f9ng chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3, ch\u00fang ta c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c c\u01a1: g\u1ea5p c\u1ed5 tay quay, gan tay d\u00e0i, g\u1ea5p c\u00e1c ng\u00f3n n\u00f4ng, g\u1ea5p c\u1ed5 tay tr\u1ee5, g\u1ea5p c\u00e1c ng\u00f3n s\u00e2u v\u00e0 g\u1ea5p ng\u00f3n c\u00e1i d\u00e0i (H\u00ecnh 19). \u1ede g\u1ea7n \u0111\u00f3, ch\u00fang ta c\u00f3 th\u1ec3 kh\u1ea3o s\u00e1t ch\u1ed7 b\u00e1m t\u1eadn c\u1ee7a g\u00e2n nh\u1ecb \u0111\u1ea7u \u0111o\u1ea1n xa tr\u00ean x\u01b0\u01a1ng quay \u1edf m\u1eb7t c\u1eaft tr\u1ee5c ng\u1eafn. C\u00e1c s\u1ee3i t\u1eeb \u0111\u1ea7u ng\u1eafn c\u01a1 nh\u1ecb \u0111\u1ea7u n\u1eb1m n\u00f4ng h\u01a1n v\u00e0 b\u00e1m xa h\u01a1n tr\u00ean x\u01b0\u01a1ng quay so v\u1edbi c\u00e1c s\u1ee3i t\u1eeb \u0111\u1ea7u d\u00e0i, v\u1ed1n n\u1eb1m s\u00e2u h\u01a1n v\u00e0 b\u00e1m g\u1ea7n h\u01a1n (v\u1ec1 ph\u00eda g\u1ed1c chi) [16,18,19] (H\u00ecnh 20).<\/p>\n\n\n

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H\u00ecnh 19.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang hi\u1ec3n th\u1ecb c\u00e1c c\u01a1 t\u1ea1i m\u1eb7t tr\u01b0\u1edbc \u0111o\u1ea1n g\u1ea7n c\u1eb3ng tay. FCUM \u2013 c\u01a1 g\u1ea5p c\u1ed5 tay tr\u1ee5; FPLM \u2013 c\u01a1 g\u1ea5p ng\u00f3n c\u00e1i d\u00e0i.<\/em><\/p>\n\n\n

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H\u00ecnh 20.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang c\u1ee7a g\u00e2n nh\u1ecb \u0111\u1ea7u \u0111o\u1ea1n xa g\u1ea7n ch\u1ed7 b\u00e1m t\u1eadn, t\u1eeb g\u00f3c nh\u00ecn ph\u00eda tr\u01b0\u1edbc. C\u00e1c b\u00f3 s\u1ee3i \u0111\u00f3ng g\u00f3p c\u1ee7a \u0111\u1ea7u ng\u1eafn v\u00e0 \u0111\u1ea7u d\u00e0i c\u01a1 nh\u1ecb \u0111\u1ea7u c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c.<\/em><\/p>\n\n\n\n

2.1.4. H\u1ed1 v\u1eb9t (m\u1eb7t c\u1eaft d\u1ecdc)<\/strong><\/p>\n\n\n\n

B\u00e2y gi\u1edd, xoay \u0111\u1ea7u d\u00f2 90 \u0111\u1ed9, song song v\u1edbi tr\u1ee5c d\u00e0i c\u1ee7a c\u00e1nh tay. \u0110\u1eb7t \u0111\u1ea7u d\u00f2 th\u1eb3ng h\u00e0ng v\u1edbi r\u00f2ng r\u1ecdc x\u01b0\u01a1ng c\u00e1nh tay v\u00e0 m\u1ecfm v\u1eb9t x\u01b0\u01a1ng tr\u1ee5, \u1edf ph\u00eda trong c\u1ee7a m\u1eb7t tr\u01b0\u1edbc khu\u1ef7u tay. Quan s\u00e1t c\u01a1 c\u00e1nh tay (\u1edf s\u00e2u) v\u00e0 c\u01a1 s\u1ea5p tr\u00f2n (\u1edf n\u00f4ng) tr\u00ean m\u1eb7t c\u1eaft d\u1ecdc. C\u01a1 c\u00e1nh tay che ph\u1ee7 h\u1ed1 v\u1eb9t (ph\u00eda tr\u00ean) v\u00e0 m\u1ecfm v\u1eb9t (ph\u00eda d\u01b0\u1edbi), tr\u01b0\u1edbc khi \u0111i xu\u1ed1ng b\u00e1m v\u00e0o l\u1ed3i c\u1ee7 tr\u1ee5 (H\u00ecnh 21).<\/p>\n\n\n

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H\u00ecnh 21.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t tr\u01b0\u1edbc v\u00e0 m\u1eb7t tr\u1ee5 c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb h\u1ed1 v\u1eb9t x\u01b0\u01a1ng c\u00e1nh tay, r\u00f2ng r\u1ecdc, m\u1ecfm v\u1eb9t x\u01b0\u01a1ng tr\u1ee5, c\u00f9ng c\u01a1 c\u00e1nh tay v\u00e0 c\u01a1 s\u1ea5p tr\u00f2n.<\/em><\/p>\n\n\n\n

Sau \u0111\u00f3, h\u01b0\u1edbng v\u1ec1 ph\u00eda m\u1eb7t tr\u00ean c\u1ee7a m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong v\u00e0 \u0111\u1eb7t \u0111\u1ea7u d\u00f2 th\u1eb3ng h\u00e0ng v\u1edbi tr\u1ee5c d\u00e0i c\u1ee7a c\u01a1 s\u1ea5p tr\u00f2n<\/strong> (H\u00ecnh 22). Theo d\u00f5i c\u01a1 s\u1ea5p tr\u00f2n theo tr\u1ee5c d\u1ecdc cho \u0111\u1ebfn khi n\u00f3 b\u00e1m v\u00e0o x\u01b0\u01a1ng quay, t\u1ea1i \u0111i\u1ec3m n\u1ed1i gi\u1eefa 1\/3 tr\u00ean v\u00e0 1\/3 gi\u1eefa (H\u00ecnh 23). Sau \u0111\u00f3 \u0111\u01b0a \u0111\u1ea7u d\u00f2 l\u00ean tr\u00ean v\u1ec1 ph\u00eda trong c\u1ee7a m\u1ecfm v\u1eb9t \u0111\u1ec3 t\u00ecm nguy\u00ean \u1ee7y \u0111\u1ea7u tr\u1ee5 c\u1ee7a c\u01a1 s\u1ea5p tr\u00f2n [20] (H\u00ecnh 24).<\/p>\n\n\n

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H\u00ecnh 22.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc \u0111\u1ea7u c\u00e1nh tay c\u1ee7a c\u01a1 s\u1ea5p tr\u00f2n, xu\u1ea5t ph\u00e1t t\u1eeb m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong.<\/em><\/p>\n\n\n

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H\u00ecnh 23.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc ch\u1ed7 b\u00e1m t\u1eadn \u0111o\u1ea1n xa c\u1ee7a c\u01a1 s\u1ea5p tr\u00f2n v\u00e0o x\u01b0\u01a1ng quay.<\/em><\/p>\n\n\n\n

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H\u00ecnh 24.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc \u0111\u1ea7u tr\u1ee5 c\u1ee7a c\u01a1 s\u1ea5p tr\u00f2n.<\/p>\n\n\n\n

\u0110\u1ec3 c\u00f3 g\u00f3c nh\u00ecn t\u1eeb ph\u00eda trong v\u1ec1 g\u00e2n nh\u1ecb \u0111\u1ea7u \u0111o\u1ea1n xa<\/strong>, xoay c\u1ef1c d\u01b0\u1edbi c\u1ee7a \u0111\u1ea7u d\u00f2 ng\u01b0\u1ee3c chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3 v\u00e0 nghi\u00eang n\u00f3 \u0111\u1ec3 nh\u00ecn sang ph\u00eda ngo\u00e0i, t\u00ecm l\u1ed3i c\u1ee7 quay tr\u01b0\u1edbc, v\u00e0 sau \u0111\u00f3 l\u00e0 g\u00e2n nh\u1ecb \u0111\u1ea7u, th\u1ef1c hi\u1ec7n c\u00e1c \u0111i\u1ec1u ch\u1ec9nh tinh t\u1ebf \u0111\u1ec3 b\u1eaft \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh, lu\u00f4n \u0111\u1ec3 khu\u1ef7u tay \u1edf t\u01b0 th\u1ebf ng\u1eeda t\u1ed1i \u0111a [21] (H\u00ecnh 25). \u0110\u1eb7t l\u1ea1i \u0111\u1ea7u d\u00f2 \u1edf m\u1eb7t c\u1eaft d\u1ecdc c\u1eb3ng tay v\u00e0 di chuy\u1ec3n nh\u1eb9 ra ngo\u00e0i \u0111\u1ec3 b\u1ed9c l\u1ed9 th\u1ea7n kinh gi\u1eefa<\/strong> theo tr\u1ee5c d\u1ecdc, tr\u00ean \u0111\u01b0\u1eddng \u0111i c\u1ee7a n\u00f3 gi\u1eefa c\u01a1 c\u00e1nh tay v\u00e0 hai \u0111\u1ea7u c\u1ee7a c\u01a1 s\u1ea5p tr\u00f2n (H\u00ecnh 26).<\/p>\n\n\n\n

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H\u00ecnh 25.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t tr\u1ee5 c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb g\u00e2n nh\u1ecb \u0111\u1ea7u \u0111o\u1ea1n xa qua c\u1eeda s\u1ed5 \u00e2m \u0111\u01b0\u1ee3c t\u1ea1o b\u1edfi c\u01a1 s\u1ea5p tr\u00f2n.<\/em><\/p>\n\n\n\n

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H\u00ecnh 26.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc c\u1ee7a th\u1ea7n kinh gi\u1eefa n\u1eb1m gi\u1eefa hai \u0111\u1ea7u c\u1ee7a c\u01a1 s\u1ea5p tr\u00f2n, t\u1ea1i m\u1eb7t tr\u01b0\u1edbc \u0111o\u1ea1n g\u1ea7n c\u1eb3ng tay.<\/em><\/p>\n\n\n\n

2.1.5. G\u00e2n nh\u1ecb \u0111\u1ea7u, m\u1eb7t c\u1eaft tr\u01b0\u1edbc kinh \u0111i\u1ec3n (m\u1eb7t c\u1eaft d\u1ecdc) <\/em><\/p>\n\n\n\n

T\u1eeb \u0111i\u1ec3m k\u1ebft th\u00fac c\u1ee7a b\u01b0\u1edbc 1.4, di chuy\u1ec3n \u0111\u1ea7u d\u00f2 ra ngo\u00e0i v\u00e0 xu\u1ed1ng d\u01b0\u1edbi m\u1ed9t ch\u00fat \u0111\u1ec3 \u0111\u1eb7t \u0111\u1ea7u d\u00f2 th\u1eb3ng h\u00e0ng v\u1edbi g\u00e2n nh\u1ecb \u0111\u1ea7u \u0111o\u1ea1n xa, quan s\u00e1t ch\u1ed7 b\u00e1m t\u1eadn c\u1ee7a n\u00f3 t\u1ea1i l\u1ed3i c\u1ee7 quay. Th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt nghi\u00eang \u0111\u1ea7u d\u00f2 v\u1ec1 ph\u00eda d\u01b0\u1edbi (toe tilt) v\u00e0 \u0111\u1ec3 khu\u1ef7u tay ng\u1eeda t\u1ed1i \u0111a nh\u1eb1m kh\u1eafc ph\u1ee5c hi\u1ec7n t\u01b0\u1ee3ng b\u1ea5t \u0111\u1eb3ng h\u01b0\u1edbng (H\u00ecnh 27).<\/p>\n\n\n

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H\u00ecnh 27.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc g\u00e2n nh\u1ecb \u0111\u1ea7u \u0111o\u1ea1n xa theo m\u1eb7t c\u1eaft kinh \u0111i\u1ec3n, t\u1ea1i m\u1eb7t tr\u01b0\u1edbc khu\u1ef7u tay.<\/em><\/p>\n\n\n\n

2.1.6. H\u1ed1 quay (m\u1eb7t c\u1eaft d\u1ecdc) <\/em><\/p>\n\n\n\n

T\u1eeb b\u01b0\u1edbc 1.5, di chuy\u1ec3n ra ngo\u00e0i cho \u0111\u1ebfn khi b\u1ea1n th\u1ea5y th\u1ea7n kinh quay tr\u00ean m\u1eb7t c\u1eaft d\u1ecdc, n\u1eb1m gi\u1eefa c\u01a1 c\u00e1nh tay quay v\u00e0 c\u01a1 c\u00e1nh tay [22] (H\u00ecnh 28). Xa h\u01a1n m\u1ed9t ch\u00fat v\u1ec1 ph\u00eda ngo\u00e0i l\u00e0 h\u1ed1 quay x\u01b0\u01a1ng c\u00e1nh tay \u1edf ph\u00eda tr\u00ean (\u0111o\u1ea1n g\u1ea7n) v\u00e0 ch\u1ecfm quay \u1edf ph\u00eda d\u01b0\u1edbi (\u0111o\u1ea1n xa), n\u1eb1m th\u1eb3ng h\u00e0ng v\u1edbi nhau, v\u1edbi c\u01a1 c\u00e1nh tay quay n\u1eb1m ph\u00eda tr\u00ean v\u00e0 song song v\u1edbi b\u1ec1 m\u1eb7t (H\u00ecnh 29).<\/p>\n\n\n

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H\u00ecnh 28.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc th\u1ea7n kinh quay, n\u1eb1m gi\u1eefa c\u01a1 c\u00e1nh tay v\u00e0 c\u01a1 c\u00e1nh tay quay.<\/p>\n\n\n

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H\u00ecnh 29.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t tr\u01b0\u1edbc v\u00e0 m\u1eb7t quay c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb h\u1ed1 quay x\u01b0\u01a1ng c\u00e1nh tay, ch\u1ecfm con, ch\u1ecfm quay v\u00e0 c\u01a1 c\u00e1nh tay quay.<\/em><\/p>\n\n\n\n

2.2. T\u01b0 th\u1ebf th\u1ee9 hai<\/strong> <\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n ng\u1ed3i \u0111\u1ed1i di\u1ec7n b\u00e1c s\u0129 v\u1edbi c\u1eb3ng tay \u0111\u1eb7t tr\u00ean b\u00e0n kh\u00e1m, khu\u1ef7u tay g\u1ea5p 90 \u0111\u1ed9 v\u00e0 \u1edf t\u01b0 th\u1ebf s\u1ea5p. B\u1edd tr\u1ee5 c\u1ee7a c\u1eb3ng tay t\u1ef1a l\u00ean b\u00e0n (H\u00ecnh 2). Thi\u1ebft l\u1eadp t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n n\u00e0y bao g\u1ed3m t\u1ed5ng c\u1ed9ng hai b\u01b0\u1edbc kh\u1ea3o s\u00e1t ch\u00ednh.<\/p>\n\n\n\n

2.2.1. M\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i (m\u1eb7t c\u1eaft d\u1ecdc) <\/em><\/p>\n\n\n\n

\u0110\u1eb7t c\u1ef1c tr\u00ean (c\u1ef1c g\u1ea7n) c\u1ee7a \u0111\u1ea7u d\u00f2 l\u00ean m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i v\u00e0 ch\u1ec9nh n\u00f3 th\u1eb3ng h\u00e0ng v\u1edbi c\u00e1c s\u1ee3i c\u1ee7a g\u00e2n chung c\u00e1c c\u01a1 du\u1ed7i. S\u00e2u h\u01a1n, ch\u00fang ta c\u00f3 th\u1ec3 th\u1ea5y kh\u1edbp ch\u1ecfm con-quay v\u1edbi di\u1ec1m ho\u1ea1t d\u1ecbch c\u1ee7a n\u00f3 (H\u00ecnh 30), v\u00e0 ph\u1ee9c h\u1ee3p d\u00e2y ch\u1eb1ng n\u1eb1m gi\u1eefa kh\u1edbp v\u00e0 c\u00e1c s\u1ee3i g\u00e2n (H\u00ecnh 31).<\/p>\n\n\n

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H\u00ecnh 30.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t quay c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i v\u00e0 di\u1ec1m ho\u1ea1t d\u1ecbch.<\/em><\/p>\n\n\n

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H\u00ecnh 31.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t quay c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb g\u00e2n chung c\u00e1c c\u01a1 du\u1ed7i v\u00e0 ph\u1ee9c h\u1ee3p d\u00e2y ch\u1eb1ng b\u00ean ngo\u00e0i, bao g\u1ed3m c\u00e1c s\u1ee3i h\u1ee3p nh\u1ea5t c\u1ee7a d\u00e2y ch\u1eb1ng b\u00ean quay v\u00e0 d\u00e2y ch\u1eb1ng b\u00ean tr\u1ee5 ngo\u00e0i.<\/em><\/p>\n\n\n\n

Khi \u0111\u1ea7u d\u00f2 th\u1eb3ng h\u00e0ng v\u1edbi tr\u1ee5c d\u1ecdc c\u1eb3ng tay, kh\u00f4ng th\u1ec3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c c\u00e1c th\u00e0nh ph\u1ea7n d\u00e2y ch\u1eb1ng kh\u00e1c nhau. Tuy nhi\u00ean, b\u1eb1ng c\u00e1ch gi\u1eef c\u1ef1c tr\u00ean c\u1ee7a \u0111\u1ea7u d\u00f2 tr\u00ean m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u v\u00e0 ch\u1ec9 di chuy\u1ec3n c\u1ef1c d\u01b0\u1edbi ra ph\u00eda tr\u01b0\u1edbc, ch\u00fang ta c\u00f3 th\u1ec3 b\u1ed9c l\u1ed9 d\u00e2y ch\u1eb1ng b\u00ean quay ch\u1ea1y \u0111\u1ebfn d\u00e2y ch\u1eb1ng v\u00f2ng (H\u00ecnh 32). T\u01b0\u01a1ng t\u1ef1, gi\u1eef c\u1ea1nh tr\u00ean c\u1ee7a \u0111\u1ea7u d\u00f2 h\u01a1i th\u1ea5p h\u01a1n m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u m\u1ed9t ch\u00fat v\u00e0 di chuy\u1ec3n c\u1ef1c d\u01b0\u1edbi ra ph\u00eda sau, ch\u00fang ta c\u00f3 th\u1ec3 b\u1ed9c l\u1ed9 d\u00e2y ch\u1eb1ng b\u00ean tr\u1ee5 ngo\u00e0i, ch\u1ea1y \u0111\u1ebfn m\u00e0o c\u01a1 ng\u1eeda x\u01b0\u01a1ng tr\u1ee5 [23\u201325] (H\u00ecnh 33).<\/p>\n\n\n

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H\u00ecnh 32.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t quay c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb d\u00e2y ch\u1eb1ng b\u00ean quay v\u00e0 d\u00e2y ch\u1eb1ng v\u00f2ng.<\/em><\/p>\n\n\n

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H\u00ecnh 33.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc c\u1ee7a d\u00e2y ch\u1eb1ng b\u00ean tr\u1ee5 ngo\u00e0i, tr\u00ean g\u00f3c nh\u00ecn ch\u1ebfch t\u1ea1i ph\u00eda quay c\u1ee7a khu\u1ef7u tay, tr\u00ean \u0111\u01b0\u1eddng n\u1ed1i m\u00e0o c\u01a1 ng\u1eeda x\u01b0\u01a1ng tr\u1ee5 v\u1edbi m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i.<\/em><\/p>\n\n\n\n

Tr\u00ean si\u00eau \u00e2m kh\u00f4ng th\u1ec3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c c\u00e1c g\u00e2n ri\u00eang l\u1ebb t\u1ea1o n\u00ean g\u00e2n chung c\u00e1c c\u01a1 du\u1ed7i b\u00e1m v\u00e0o m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i, n\u01a1i nh\u1eadn c\u00e1c s\u1ee3i \u0111\u00f3ng g\u00f3p t\u1eeb c\u01a1 du\u1ed7i c\u1ed5 tay quay ng\u1eafn, c\u01a1 du\u1ed7i c\u00e1c ng\u00f3n, c\u01a1 du\u1ed7i ng\u00f3n \u00fat v\u00e0 c\u01a1 du\u1ed7i c\u1ed5 tay tr\u1ee5.<\/p>\n\n\n\n

Ngay ph\u00eda d\u01b0\u1edbi m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i, ch\u00fang ta c\u00f3 th\u1ec3 th\u1ea5y c\u01a1 du\u1ed7i c\u00e1c ng\u00f3n n\u1eb1m n\u00f4ng h\u01a1n so v\u1edbi g\u00e2n chung c\u00e1c c\u01a1 du\u1ed7i v\u00e0 c\u01a1 du\u1ed7i c\u1ed5 tay quay ng\u1eafn n\u1eb1m s\u00e2u, li\u00ean quan m\u1eadt thi\u1ebft v\u1edbi g\u00e2n n\u00e0y (H\u00ecnh 34). Di chuy\u1ec3n \u0111\u1ea7u d\u00f2 ra tr\u01b0\u1edbc nh\u01b0ng h\u01b0\u1edbng c\u1ef1c d\u01b0\u1edbi h\u01a1i ch\u1ebfch ra sau v\u1edbi khu\u1ef7u tay \u1edf t\u01b0 th\u1ebf s\u1ea5p, ch\u00fang ta c\u00f3 th\u1ec3 b\u1ed9c l\u1ed9 th\u1ea7n kinh gian c\u1ed1t sau (PIN), ch\u1ea1y xuy\u00ean qua c\u01a1 ng\u1eeda (H\u00ecnh 35). Di chuy\u1ec3n \u0111\u1ea7u d\u00f2 l\u00ean tr\u00ean v\u00e0 xoay nh\u1eb9 theo chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3, ch\u00fang ta c\u00f3 th\u1ec3 b\u1ed9c l\u1ed9 c\u01a1 v\u00e0 g\u00e2n du\u1ed7i c\u1ed5 tay quay d\u00e0i, b\u00e1m v\u00e0o m\u00e0o tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay. N\u1eb1m n\u00f4ng h\u01a1n n\u00f3, ch\u00fang ta c\u00f3 th\u1ec3 th\u1ea5y c\u01a1 c\u00e1nh tay quay (H\u00ecnh 36).<\/p>\n\n\n\n

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H\u00ecnh 34.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t quay c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb g\u00e2n chung c\u00e1c c\u01a1 du\u1ed7i c\u00f9ng c\u01a1 du\u1ed7i c\u00e1c ng\u00f3n v\u00e0 c\u01a1 du\u1ed7i c\u1ed5 tay quay ng\u1eafn.<\/em><\/p>\n\n\n

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H\u00ecnh 35.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t quay c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb th\u1ea7n kinh gian c\u1ed1t sau c\u00f9ng c\u01a1 c\u00e1nh tay quay v\u00e0 c\u01a1 ng\u1eeda.<\/em><\/p>\n\n\n

\n
\"\"\/<\/figure>\n<\/div>\n\n\n

H\u00ecnh 36.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc c\u01a1 v\u00e0 g\u00e2n du\u1ed7i c\u1ed5 tay quay d\u00e0i b\u00e1m v\u00e0o m\u00e0o tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay.<\/em><\/p>\n\n\n\n

2.2.2. M\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i (m\u1eb7t c\u1eaft ngang)<\/span><\/em> <\/p>\n\n\n\n

B\u00e2y gi\u1edd h\u00e3y kh\u1ea3o s\u00e1t g\u00e2n chung c\u00e1c c\u01a1 du\u1ed7i t\u1ea1i ch\u1ed7 b\u00e1m v\u00e0o m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u, b\u1eb1ng c\u00e1ch chuy\u1ec3n \u0111\u1ea7u d\u00f2 sang m\u1eb7t c\u1eaft tr\u1ee5c ng\u1eafn (H\u00ecnh 37). B\u1ea1n c\u0169ng c\u00f3 th\u1ec3 quan s\u00e1t g\u00e2n nh\u1ecb \u0111\u1ea7u \u0111o\u1ea1n xa theo tr\u1ee5c d\u1ecdc b\u1eb1ng c\u00e1ch di chuy\u1ec3n \u0111\u1ea7u d\u00f2 xu\u1ed1ng d\u01b0\u1edbi v\u00e0 ng\u1eeda c\u1eb3ng tay t\u1ed1i \u0111a (H\u00ecnh 38). Th\u1ef1c hi\u1ec7n nghi\u1ec7m ph\u00e1p \u0111\u1ed9ng ng\u1eeda\/s\u1ea5p \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed1t h\u01a1n ch\u1ed7 b\u00e1m v\u00e0o x\u01b0\u01a1ng quay v\u00e0 m\u1ed1i li\u00ean quan c\u1ee7a n\u00f3 v\u1edbi c\u01a1 c\u00e1nh tay quay v\u00e0 c\u01a1 ng\u1eeda.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

H\u00ecnh 37.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang g\u00e2n chung c\u00e1c c\u01a1 du\u1ed7i, g\u1ea7n ch\u1ed7 b\u00e1m t\u1eadn t\u1ea1i m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i.<\/em><\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

H\u00ecnh 38.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc g\u00e2n nh\u1ecb \u0111\u1ea7u \u0111o\u1ea1n xa g\u1ea7n ch\u1ed7 b\u00e1m t\u1eadn v\u00e0o x\u01b0\u01a1ng quay, t\u1eeb g\u00f3c nh\u00ecn ph\u00eda ngo\u00e0i.<\/em><\/p>\n\n\n\n

\u1ede ph\u00eda d\u01b0\u1edbi v\u1ecb tr\u00ed tr\u01b0\u1edbc \u0111\u00f3, ch\u00fang ta c\u00f3 th\u1ec3 b\u1ed9c l\u1ed9 c\u00e1ch c\u00e1c c\u01a1 c\u1eb3ng tay li\u00ean quan v\u1edbi nhau quanh b\u1edd g\u1ea7n c\u1ee7a x\u01b0\u01a1ng quay, v\u1edbi c\u01a1 ng\u1eeda n\u1eb1m g\u1ea7n x\u01b0\u01a1ng nh\u1ea5t. C\u00e1c c\u01a1 khu\u1ef7u, du\u1ed7i c\u1ed5 tay tr\u1ee5, du\u1ed7i ng\u00f3n \u00fat, du\u1ed7i c\u00e1c ng\u00f3n v\u00e0 du\u1ed7i c\u1ed5 tay quay ng\u1eafn \u0111\u01b0\u1ee3c s\u1eafp x\u1ebfp theo th\u1ee9 t\u1ef1 v\u00f2ng tr\u00f2n c\u00f9ng chi\u1ec1u kim \u0111\u1ed3ng h\u1ed3, nh\u01b0 trong H\u00ecnh 39b.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

H\u00ecnh 39.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang c\u00e1c c\u01a1 du\u1ed7i t\u1ea1i m\u1eb7t sau \u0111o\u1ea1n g\u1ea7n c\u1eb3ng tay. ECRBM \u2013 c\u01a1 du\u1ed7i c\u1ed5 tay quay ng\u1eafn; EDM \u2013 c\u01a1 du\u1ed7i c\u00e1c ng\u00f3n.<\/em><\/p>\n\n\n\n

2.3. T\u01b0 th\u1ebf th\u1ee9 ba (“t\u01b0 th\u1ebf con r\u1eafn”)<\/strong> <\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n ng\u1ed3i \u0111\u1ed1i di\u1ec7n b\u00e1c s\u0129 v\u1edbi m\u1ecfm khu\u1ef7u \u0111\u1eb7t tr\u00ean b\u00e0n, b\u00e0n tay h\u01b0\u1edbng l\u00ean tr\u00ean, v\u00e0 khu\u1ef7u tay g\u1ea5p t\u1ed1i \u0111a v\u00e0 s\u1ea5p, gi\u1ed1ng h\u00ecnh con r\u1eafn (H\u00ecnh 3). Ch\u1ec9 c\u00f3 m\u1ed9t b\u01b0\u1edbc ph\u1ee9c h\u1ee3p cho t\u01b0 th\u1ebf n\u00e0y.<\/p>\n\n\n\n

2.3.1. “T\u01b0 th\u1ebf con r\u1eafn” <\/em><\/p>\n\n\n\n

B\u1eaft \u0111\u1ea7u qu\u00e9t ngang ngay ph\u00eda d\u01b0\u1edbi m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u, t\u1ea1i ph\u1ea7n g\u1ea7n c\u1ee7a m\u00e0o c\u01a1 ng\u1eeda x\u01b0\u01a1ng tr\u1ee5, b\u1ed9c l\u1ed9 d\u00e2y ch\u1eb1ng v\u00f2ng xu\u1ea5t ph\u00e1t t\u1eeb \u0111\u00f3 (H\u00ecnh 40). Sau \u0111\u00f3, di chuy\u1ec3n c\u1ea1nh trong c\u1ee7a \u0111\u1ea7u d\u00f2 xu\u1ed1ng d\u01b0\u1edbi h\u01a1n, gi\u1eef c\u1ef1c ngo\u00e0i g\u1ea7n m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u, \u0111\u1ec3 b\u1ed9c l\u1ed9 d\u00e2y ch\u1eb1ng b\u00ean tr\u1ee5 ngo\u00e0i, b\u00e1m v\u00e0o \u0111i\u1ec3m xa h\u01a1n c\u1ee7a m\u00e0o c\u01a1 ng\u1eeda (H\u00ecnh 41).<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

H\u00ecnh 40.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc d\u00e2y ch\u1eb1ng v\u00f2ng quay b\u00e1m v\u00e0o m\u00e0o c\u01a1 ng\u1eeda \u0111o\u1ea1n g\u1ea7n, v\u00e0 c\u01a1 khu\u1ef7u n\u1eb1m ph\u00eda tr\u00ean.<\/em><\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

H\u00ecnh 41.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc d\u00e2y ch\u1eb1ng b\u00ean tr\u1ee5 ngo\u00e0i b\u00e1m v\u00e0o m\u00e0o c\u01a1 ng\u1eeda \u0111o\u1ea1n xa, v\u00e0 c\u01a1 khu\u1ef7u n\u1eb1m ph\u00eda tr\u00ean.<\/em><\/p>\n\n\n\n

Ti\u1ebfp theo, gi\u1eef c\u1ed1 \u0111\u1ecbnh c\u1ea1nh trong c\u1ee7a \u0111\u1ea7u d\u00f2, v\u00e0 \u0111\u01b0a c\u1ea1nh ngo\u00e0i xu\u1ed1ng d\u01b0\u1edbi, \u0111\u1ec3 tr\u1edf l\u1ea1i v\u1ecb tr\u00ed n\u1eb1m ngang. M\u1eb7t c\u1eaft cu\u1ed1i c\u00f9ng n\u00e0y cho ph\u00e9p nh\u00ecn th\u1ea5y ch\u1ed7 b\u00e1m v\u00e0o x\u01b0\u01a1ng quay c\u1ee7a g\u00e2n nh\u1ecb \u0111\u1ea7u \u0111o\u1ea1n xa. Th\u1ef1c hi\u1ec7n nghi\u1ec7m ph\u00e1p \u0111\u1ed9ng ng\u1eeda\/s\u1ea5p \u0111\u1ec3 kh\u1ea3o s\u00e1t s\u1ef1 to\u00e0n v\u1eb9n c\u1ee7a g\u00e2n n\u00e0y v\u00e0 m\u1ed1i li\u00ean quan c\u1ee7a n\u00f3 v\u1edbi c\u01a1 ng\u1eeda, c\u01a1 c\u00e1nh tay quay v\u00e0 c\u01a1 khu\u1ef7u (H\u00ecnh 42).<\/p>\n\n\n

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\"\"\/<\/figure>\n<\/div>\n\n\n

H\u00ecnh 42.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) Ch\u1ed7 b\u00e1m t\u1eadn \u0111o\u1ea1n xa c\u1ee7a g\u00e2n nh\u1ecb \u0111\u1ea7u t\u1ea1i l\u1ed3i c\u1ee7 quay t\u1eeb g\u00f3c nh\u00ecn ph\u00eda sau, c\u00f9ng c\u00e1c c\u01a1 ng\u1eeda, c\u01a1 du\u1ed7i ng\u00f3n \u00fat (EDM) v\u00e0 c\u01a1 khu\u1ef7u n\u1eb1m ph\u00eda tr\u00ean.<\/em><\/p>\n\n\n\n

2.4. T\u01b0 th\u1ebf th\u1ee9 t\u01b0 (t\u01b0\u01a1ng t\u1ef1 t\u01b0 th\u1ebf th\u1ee9 nh\u1ea5t)<\/strong> B\u1ec7nh nh\u00e2n ng\u1ed3i \u0111\u1ed1i di\u1ec7n b\u00e1c s\u0129, c\u1eb3ng tay \u0111\u1eb7t tr\u00ean b\u00e0n kh\u00e1m v\u00e0 khu\u1ef7u tay g\u1ea5p nh\u1eb9 (H\u00ecnh 4). Vi\u1ec7c quay l\u1ea1i t\u01b0 th\u1ebf n\u00e0y cho ph\u00e9p b\u1ec7nh nh\u00e2n ngh\u1ec9 ng\u01a1i.<\/p>\n\n\n\n

2.4.1. M\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong (m\u1eb7t c\u1eaft d\u1ecdc)<\/strong> Tr\u1edf l\u1ea1i t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n ban \u0111\u1ea7u (t\u01b0 th\u1ebf th\u1ee9 nh\u1ea5t). \u0110\u1eb7t \u0111\u1ea7u d\u00f2 d\u1ecdc theo c\u1eb3ng tay, v\u1edbi c\u1ef1c tr\u00ean \u0111\u1eb7t l\u00ean m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong, th\u1eb3ng h\u00e0ng v\u1edbi c\u00e1c s\u1ee3i c\u1ee7a g\u00e2n chung c\u00e1c c\u01a1 g\u1ea5p. V\u1edbi m\u1eb7t c\u1eaft n\u00e0y, ch\u00fang ta c\u00f3 th\u1ec3 b\u1ed9c l\u1ed9 m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong, r\u00f2ng r\u1ecdc, kh\u1edbp tr\u1ee5-r\u00f2ng r\u1ecdc v\u00e0 c\u1ee7 cao (sublime tubercle) c\u1ee7a m\u1ecfm v\u1eb9t, c\u0169ng nh\u01b0 \u0111i\u1ec3m b\u00e1m c\u1ee7a g\u00e2n v\u00e0 d\u00e2y ch\u1eb1ng (H\u00ecnh 43).<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

H\u00ecnh 43.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t tr\u1ee5 c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb b\u00f3 tr\u01b0\u1edbc c\u1ee7a d\u00e2y ch\u1eb1ng b\u00ean tr\u1ee5 trong v\u00e0 g\u00e2n chung c\u00e1c c\u01a1 g\u1ea5p.<\/em><\/p>\n\n\n\n

C\u00f3 m\u1ed9t s\u1ed1 c\u01a1 c\u00f3 nguy\u00ean \u1ee7y g\u00e2n t\u01b0\u01a1ng \u1ee9ng b\u00e1m v\u00e0o m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 g\u00e2n chung c\u00e1c c\u01a1 du\u1ed7i b\u00e1m v\u00e0o m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i (b\u01b0\u1edbc 2.1), tr\u00ean si\u00eau \u00e2m kh\u00f4ng th\u1ec3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c c\u00e1c g\u00e2n ri\u00eang l\u1ebb t\u1ea1o n\u00ean g\u00e2n chung c\u00e1c c\u01a1 g\u1ea5p b\u00e1m v\u00e0o m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong. G\u00e2n n\u00e0y nh\u1eadn c\u00e1c s\u1ee3i \u0111\u00f3ng g\u00f3p t\u1eeb c\u01a1 g\u1ea5p c\u1ed5 tay quay, gan tay d\u00e0i, g\u1ea5p c\u00e1c ng\u00f3n n\u00f4ng v\u00e0 c\u01a1 g\u1ea5p c\u1ed5 tay tr\u1ee5.<\/p>\n\n\n\n

N\u1eb1m s\u00e2u d\u01b0\u1edbi c\u00e1c c\u1ea5u tr\u00fac g\u00e2n n\u00e0y, h\u00e3y x\u00e1c \u0111\u1ecbnh c\u00e1c s\u1ee3i c\u1ee7a b\u00f3 tr\u01b0\u1edbc d\u00e2y ch\u1eb1ng b\u00ean tr\u1ee5 trong, v\u1edbi ch\u1ed7 b\u00e1m t\u1eadn c\u1ee7a n\u00f3 tr\u00ean c\u1ee7 cao, h\u00ecnh \u1ea3nh n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u1ed9c l\u1ed9 r\u00f5 h\u01a1n khi khu\u1ef7u tay g\u1ea5p 90 \u0111\u1ed9. N\u00f3 c\u00f3 hai d\u1ea3i, m\u1ed9t d\u1ea3i tr\u01b0\u1edbc hay d\u1ea3i n\u00f4ng v\u00e0 m\u1ed9t d\u1ea3i sau hay d\u1ea3i s\u00e2u (H\u00ecnh 44). \u1ede m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, c\u00f3 th\u00eam m\u1ed9t ch\u1ed7 b\u00e1m t\u1eadn \u0111o\u1ea1n xa c\u1ee7a b\u00f3 tr\u01b0\u1edbc, n\u1eb1m tr\u00ean th\u00e2n x\u01b0\u01a1ng tr\u1ee5 (H\u00ecnh 45).<\/p>\n\n\n

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\"\"\/<\/figure>\n<\/div>\n\n\n

H\u00ecnh 44.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t tr\u1ee5 c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb d\u1ea3i tr\u01b0\u1edbc v\u00e0 d\u1ea3i sau thu\u1ed9c b\u00f3 tr\u01b0\u1edbc c\u1ee7a d\u00e2y ch\u1eb1ng b\u00ean tr\u1ee5 trong (MUCL).<\/em><\/p>\n\n\n

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\"\"\/<\/figure>\n<\/div>\n\n\n

H\u00ecnh 45.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t tr\u1ee5 c\u1ee7a khu\u1ef7u tay, hi\u1ec3n th\u1ecb ch\u1ed7 b\u00e1m t\u1eadn \u0111o\u1ea1n xa c\u1ee7a b\u00f3 tr\u01b0\u1edbc d\u00e2y ch\u1eb1ng b\u00ean tr\u1ee5 trong (ABMUCL).<\/em><\/p>\n\n\n\n

2.4.2. M\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong (m\u1eb7t c\u1eaft ngang) <\/em><\/p>\n\n\n\n

Xoay \u0111\u1ea7u d\u00f2 90 \u0111\u1ed9 \u0111\u1ec3 quan s\u00e1t nguy\u00ean \u1ee7y c\u1ee7a g\u00e2n chung c\u00e1c c\u01a1 g\u1ea5p tr\u00ean tr\u1ee5c ng\u1eafn (H\u00ecnh 46). T\u1eeb \u0111i\u1ec3m n\u00e0y, b\u1ea1n c\u0169ng c\u00f3 th\u1ec3 t\u00ecm g\u00e2n nh\u1ecb \u0111\u1ea7u \u0111o\u1ea1n xa, \u1edf g\u00f3c nh\u00ecn c\u00f3 l\u1ebd l\u00e0 t\u1ed1t nh\u1ea5t \u0111\u1ec3 kh\u1ea3o s\u00e1t n\u00f3. Ch\u1ec9 c\u1ea7n di chuy\u1ec3n \u0111\u1ea7u d\u00f2 xu\u1ed1ng d\u01b0\u1edbi v\u00e0 ra tr\u01b0\u1edbc, \u0111\u1ec3 c\u1eb3ng tay \u1edf t\u01b0 th\u1ebf ng\u1eeda t\u1ed1i \u0111a (H\u00ecnh 47).<\/p>\n\n\n

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H\u00ecnh 46.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang g\u00e2n chung c\u00e1c c\u01a1 g\u1ea5p, g\u1ea7n ch\u1ed7 b\u00e1m t\u1eadn t\u1ea1i m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong.<\/em><\/p>\n\n\n

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H\u00ecnh 47.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc ch\u1ed7 b\u00e1m t\u1eadn \u0111o\u1ea1n xa g\u00e2n nh\u1ecb \u0111\u1ea7u t\u1ea1i l\u1ed3i c\u1ee7 quay, t\u1eeb g\u00f3c nh\u00ecn ph\u00eda trong.<\/em><\/p>\n\n\n\n

N\u1ebfu c\u1ea7n kh\u1ea3o s\u00e1t \u0111\u1ed9ng th\u1ea7n kinh tr\u1ee5 tr\u00ean tr\u1ee5c ng\u1eafn, h\u00e3y di chuy\u1ec3n ra sau v\u1ec1 ph\u00eda \u1ed1ng tr\u1ee5, \u0111\u1eb7t \u0111\u1ea7u d\u00f2 b\u1eafc c\u1ea7u gi\u1eefa m\u1ecfm khu\u1ef7u v\u00e0 m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong. T\u00ecm d\u1ea5u hi\u1ec7u b\u00e1n tr\u1eadt kh\u1edbp b\u1eb1ng c\u00e1ch g\u1ea5p khu\u1ef7u t\u1ed1i \u0111a trong khi \u1ea5n \u0111\u1ea7u d\u00f2 nh\u1eb9 nh\u1ea5t c\u00f3 th\u1ec3. Tuy nhi\u00ean, b\u1ea1n c\u00f3 th\u1ec3 gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1 n\u00e0y b\u1eb1ng b\u01b0\u1edbc ti\u1ebfp theo, t\u01b0 th\u1ebf con cua.<\/p>\n\n\n\n

2.5. T\u01b0 th\u1ebf th\u1ee9 n\u0103m (“t\u01b0 th\u1ebf con cua”) <\/strong><\/em><\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n t\u1ef3 tay l\u00ean b\u00e0n tr\u00ean c\u1ed5 tay du\u1ed7i t\u1ed1i \u0111a, khu\u1ef7u tay h\u01b0\u1edbng l\u00ean tr\u00ean v\u00e0 g\u1ea5p 90 \u0111\u1ed9, gi\u1ed1ng h\u00ecnh ch\u00e2n con cua (H\u00ecnh 5). T\u01b0 th\u1ebf n\u00e0y bao g\u1ed3m hai b\u01b0\u1edbc ch\u00ednh.<\/p>\n\n\n\n

2.5.1. G\u00e2n tam \u0111\u1ea7u (m\u1eb7t c\u1eaft d\u1ecdc)<\/strong> <\/p>\n\n\n\n

\u0110\u1eb7t m\u1ecfm khu\u1ef7u th\u1eb3ng h\u00e0ng v\u1edbi c\u00e1c s\u1ee3i g\u00e2n tam \u0111\u1ea7u tr\u00ean m\u00e0n h\u00ecnh, kh\u1ea3o s\u00e1t \u0111i\u1ec3m b\u00e1m g\u00e2n v\u00e0 s\u1ef1 to\u00e0n v\u1eb9n c\u1ee7a g\u00e2n. Quan s\u00e1t h\u1ed1 khu\u1ef7u, \u0111\u1ea1i di\u1ec7n cho ng\u00e1ch sau c\u1ee7a kh\u1edbp khu\u1ef7u, c\u0169ng nh\u01b0 \u0111\u1ea7u ng\u1eafn c\u01a1 tam \u0111\u1ea7u, r\u00f2ng r\u1ecdc v\u00e0 m\u1ecfm khu\u1ef7u (H\u00ecnh 48). Di chuy\u1ec3n v\u00e0o trong \u0111\u1ec3 kh\u1ea3o s\u00e1t thi\u1ebft di\u1ec7n d\u1ecdc c\u1ee7a th\u1ea7n kinh tr\u1ee5 trong \u0111\u01b0\u1eddng h\u1ea7m tr\u1ee5, v\u00e0 c\u1ea3 \u0111\u1ea7u d\u00e0i c\u01a1 tam \u0111\u1ea7u, du\u1ed7i khu\u1ef7u tay h\u1ebft m\u1ee9c c\u00f3 th\u1ec3 \u0111\u1ec3 th\u1ef1c hi\u1ec7n vi\u1ec7c n\u00e0y (H\u00ecnh 49).<\/p>\n\n\n

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H\u00ecnh 48.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc t\u1ea1i m\u1eb7t sau khu\u1ef7u tay, hi\u1ec3n th\u1ecb \u0111\u1ea7u ng\u1eafn c\u01a1 tam \u0111\u1ea7u, g\u00e2n tam \u0111\u1ea7u, m\u1ecfm khu\u1ef7u, r\u00f2ng r\u1ecdc v\u00e0 h\u1ed1 khu\u1ef7u.<\/em><\/p>\n\n\n

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H\u00ecnh 49.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft d\u1ecdc th\u1ea7n kinh tr\u1ee5 t\u1ea1i m\u1eb7t sau khu\u1ef7u tay.<\/em><\/p>\n\n\n\n

2.5.2. G\u00e2n tam \u0111\u1ea7u (m\u1eb7t c\u1eaft ngang)<\/strong> Xoay \u0111\u1ea7u d\u00f2 90 \u0111\u1ed9 \u0111\u1ec3 kh\u1ea3o s\u00e1t c\u1ea5u tr\u00fac g\u00e2n v\u00e0 h\u1ed1 khu\u1ef7u tr\u00ean tr\u1ee5c ng\u1eafn. X\u00e1c \u0111\u1ecbnh \u0111\u1ea7u d\u00e0i, \u0111\u1ea7u ng\u1eafn v\u00e0 \u0111\u1ea7u ngo\u00e0i c\u1ee7a c\u01a1 tam \u0111\u1ea7u, t\u1eeb trong ra ngo\u00e0i, t\u1ea1i m\u1ee9c h\u1ed1 khu\u1ef7u v\u00e0 m\u1eb7t sau c\u1ee7a r\u00f2ng r\u1ecdc x\u01b0\u01a1ng c\u00e1nh tay (H\u00ecnh 50).<\/p>\n\n\n

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H\u00ecnh 50.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang c\u00e1c \u0111\u1ea7u d\u00e0i, \u0111\u1ea7u ng\u1eafn v\u00e0 \u0111\u1ea7u ngo\u00e0i c\u1ee7a c\u01a1 tam \u0111\u1ea7u, t\u1ea1i m\u1eb7t sau khu\u1ef7u tay.<\/em><\/p>\n\n\n\n

Di chuy\u1ec3n v\u00e0o trong \u0111\u1ec3 kh\u1ea3o s\u00e1t k\u1ef9 th\u1ea7n kinh tr\u1ee5 tr\u00ean tr\u1ee5c ng\u1eafn, d\u1ecdc theo \u0111\u01b0\u1eddng h\u1ea7m tr\u1ee5 (\u0111\u01b0\u1ee3c t\u1ea1o b\u1edfi d\u00e2y ch\u1eb1ng Osborne \u1edf n\u00f4ng v\u00e0 b\u00f3 sau c\u1ee7a d\u00e2y ch\u1eb1ng b\u00ean tr\u1ee5 trong \u1edf s\u00e2u) (H\u00ecnh 51). T\u1ea1i \u0111\u00e2y, ch\u00fang ta c\u0169ng c\u00f3 th\u1ec3 t\u00ecm d\u1ea5u hi\u1ec7u b\u00e1n tr\u1eadt th\u1ea7n kinh tr\u1ee5, b\u1eb1ng c\u00e1ch y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n g\u1ea5p khu\u1ef7u tay t\u1eeb t\u1eeb \u0111\u1ec3 xem li\u1ec7u n\u00f3 c\u00f3 tr\u01b0\u1ee3t qua m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong hay kh\u00f4ng [30].<\/p>\n\n\n

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H\u00ecnh 51.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang th\u1ea7n kinh tr\u1ee5 n\u1eb1m gi\u1eefa d\u00e2y ch\u1eb1ng Osborne v\u00e0 b\u00f3 sau c\u1ee7a d\u00e2y ch\u1eb1ng b\u00ean tr\u1ee5 trong.<\/em><\/p>\n\n\n\n

Di chuy\u1ec3n \u0111\u1ea7u d\u00f2 xu\u1ed1ng d\u01b0\u1edbi, ch\u00fang ta c\u00f3 th\u1ec3 b\u1ed9c l\u1ed9 th\u1ea7n kinh tr\u1ee5 chui v\u00e0o gi\u1eefa c\u00e1c b\u1ee5ng c\u01a1 c\u1ee7a c\u01a1 g\u1ea5p c\u1ed5 tay tr\u1ee5, v\u1edbi d\u00e2y ch\u1eb1ng cung (arcuate ligament) \u1edf ph\u00eda tr\u00ean (H\u00ecnh 52).<\/p>\n\n\n

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H\u00ecnh 52.<\/strong> (a) V\u1ecb tr\u00ed \u0111\u1ea7u d\u00f2 (h\u00ecnh ch\u1eef nh\u1eadt m\u00e0u \u0111\u1ecf) \u0111\u1ec3 thu \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh \u1edf (b); (b) M\u1eb7t c\u1eaft ngang th\u1ea7n kinh tr\u1ee5, n\u1eb1m gi\u1eefa \u0111\u1ea7u tr\u1ee5 v\u00e0 \u0111\u1ea7u c\u00e1nh tay c\u1ee7a c\u01a1 g\u1ea5p c\u1ed5 tay tr\u1ee5 (FCUM).<\/em><\/p>\n\n\n\n

3. K\u1ebft lu\u1eadn<\/strong> Si\u00eau \u00e2m l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb m\u1ea1nh m\u1ebd cho kh\u1edbp khu\u1ef7u, v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng n\u00f3 \u0111ang gia t\u0103ng qua t\u1eebng n\u0103m khi ch\u00fang ta t\u1eadn d\u1ee5ng t\u1ed1i \u0111a ti\u1ec1m n\u0103ng c\u1ee7a c\u00e1c m\u00e1y si\u00eau \u00e2m m\u1edbi nh\u1ea5t. V\u1edbi nhu c\u1ea7u cao m\u00e0 ch\u00fang ta \u0111ang ph\u1ea3i \u0111\u1ed1i m\u1eb7t ng\u00e0y nay, k\u1ef9 thu\u1eadt kh\u1ea3o s\u00e1t hi\u1ec7u qu\u1ea3 v\u00e0 d\u1ec5 d\u00e0ng tr\u1edf n\u00ean c\u1ea5p thi\u1ebft \u0111\u1ec3 th\u1ef1c hi\u1ec7n m\u1ed9t cu\u1ed9c ki\u1ec3m tra ch\u1ea5t l\u01b0\u1ee3ng. H\u01a1n c\u1ea3 vi\u1ec7c li\u1ec7t k\u00ea c\u00e1c c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu c\u1ea7n qu\u00e9t, tr\u00ecnh t\u1ef1 \u0111\u1ec1 xu\u1ea5t c\u1ee7a ch\u00fang t\u00f4i \u0111\u01b0\u1ee3c t\u1ed5 ch\u1ee9c theo m\u1ed9t tr\u1eadt t\u1ef1 h\u1ee3p l\u00fd v\u00e0 ti\u1ebft ki\u1ec7m th\u1eddi gian, gi\u00fap vi\u1ec7c si\u00eau \u00e2m khu\u1ef7u tay tr\u1edf n\u00ean d\u1ec5 d\u00e0ng h\u01a1n trong khi v\u1eabn bao qu\u00e1t t\u1ea5t c\u1ea3 c\u00e1c ph\u1ea7n quan tr\u1ecdng c\u1ee7a kh\u1edbp ph\u1ee9c t\u1ea1p n\u00e0y.<\/p>\n\n\n\n

\u0110\u00f3ng g\u00f3p c\u1ee7a t\u00e1c gi\u1ea3<\/strong> TF v\u00e0 FS \u0111\u00f3ng g\u00f3p nh\u01b0 nhau v\u00e0o c\u00f4ng tr\u00ecnh n\u00e0y. TF v\u00e0 FS tham gia v\u00e0o vi\u1ec7c thi\u1ebft k\u1ebf nghi\u00ean c\u1ee9u. TF v\u00e0 FS thu th\u1eadp v\u00e0 ch\u1ec9nh s\u1eeda c\u00e1c h\u00ecnh \u1ea3nh si\u00eau \u00e2m. TF v\u00e0 FS r\u00e0 so\u00e1t n\u1ed9i dung k\u1ef9 thu\u1eadt c\u1ee7a b\u1ea3n th\u1ea3o. TF v\u00e0 FS chu\u1ea9n b\u1ecb b\u1ea3n th\u1ea3o.<\/p>\n\n\n\n

T\u00e0i tr\u1ee3<\/strong> Kh\u00f4ng c\u00f3 ngu\u1ed3n t\u00e0i tr\u1ee3 n\u00e0o \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00f4ng tr\u00ecnh n\u00e0y.<\/p>\n\n\n\n

S\u1ef1 tham gia c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 c\u1ed9ng \u0111\u1ed3ng<\/strong> B\u1ec7nh nh\u00e2n v\u00e0\/ho\u1eb7c c\u1ed9ng \u0111\u1ed3ng kh\u00f4ng tham gia v\u00e0o vi\u1ec7c thi\u1ebft k\u1ebf, th\u1ef1c hi\u1ec7n, b\u00e1o c\u00e1o ho\u1eb7c k\u1ebf ho\u1ea1ch ph\u1ed5 bi\u1ebfn c\u00f4ng tr\u00ecnh n\u00e0y.<\/p>\n\n\n\n

Tuy\u00ean b\u1ed1 xung \u0111\u1ed9t l\u1ee3i \u00edch<\/strong> C\u00e1c t\u00e1c gi\u1ea3 tuy\u00ean b\u1ed1 r\u1eb1ng h\u1ecd kh\u00f4ng c\u00f3 xung \u0111\u1ed9t l\u1ee3i \u00edch t\u00e0i ch\u00ednh ho\u1eb7c m\u1ed1i quan h\u1ec7 c\u00e1 nh\u00e2n n\u00e0o \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00f4ng tr\u00ecnh \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong b\u00e0i b\u00e1o n\u00e0y.<\/p>\n\n\n\n

L\u1eddi c\u1ea3m \u01a1n<\/strong> Ch\u00fang t\u00f4i c\u00f3 \u0111\u01b0\u1ee3c s\u1ef1 c\u1ee5 th\u1ec3 h\u00f3a c\u1ee7a d\u1ef1 \u00e1n n\u00e0y nh\u1edd v\u00e0o s\u1ef1 quan t\u00e2m, s\u1eb5n s\u00e0ng v\u00e0 h\u1ee3p t\u00e1c c\u1ee7a B\u00e1c s\u0129 Margarida Rocha v\u00e0 B\u00e1c s\u0129 Maria Rato, nh\u1eefng ng\u01b0\u1eddi \u0111\u00e3 t\u00ecnh nguy\u1ec7n l\u00e0m m\u1eabu t\u1ea1i Trung t\u00e2m Y h\u1ecdc H\u1ecdc thu\u1eadt Lisbon (CAML).<\/p>\n\n\n

  1. Li\u00ean \u0111o\u00e0n c\u00e1c Hi\u1ec7p h\u1ed9i Th\u1ea5p kh\u1edbp h\u1ecdc Ch\u00e2u \u00c2u European League Against Rheumatism – t\u00ean m\u1edbi: European Alliance of Associations for Rheumatology \u21a9\ufe0e<\/a><\/li>
  2. \u0110\u1ea7u d\u01b0\u1edbi c\u01a1 nh\u1ecb \u0111\u1ea7u c\u00f3 2 ph\u1ea7n, l\u00e0 g\u00e2n nh\u1ecb \u0111\u1ea7u v\u00e0 tr\u1ebd c\u00e2n nh\u1ecb \u0111\u1ea7u, tr\u1ebd c\u00e2n nh\u1ecb \u0111\u1ea7u ban \u0111\u1ea7u \u1edf ph\u00eda ngo\u00e0i sau \u0111\u00f3 \u0111i v\u00e0o ph\u00eda trong khu\u1ef7u tay. N\u00ean t\u00ean g\u1ecdi c\u1ee7a n\u00f3 m\u1eb7c d\u00f9 l\u00e0 external bicipital aponeurosis, nh\u01b0ng l\u1ea1i nh\u00ecn th\u1ea5y n\u00f3 r\u00f5 r\u00e0ng h\u01a1n \u1edf ph\u00eda trong. \u21a9\ufe0e<\/a><\/li><\/ol>","protected":false},"excerpt":{"rendered":"

    Trong t\u00e0i li\u1ec7u n\u00e0y, ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t m\u1ed9t k\u1ef9 thu\u1eadt kh\u1ea3o s\u00e1t si\u00eau \u00e2m khu\u1ef7u tay theo tr\u00ecnh t\u1ef1, ti\u00eau ch\u00ed th\u00e2n thi\u1ec7n v\u1edbi ng\u01b0\u1eddi d\u00f9ng b\u1eb1ng c\u00e1ch tu\u00e2n theo tr\u00ecnh t\u1ef1 kh\u1ea3o s\u00e1t h\u1ee3p l\u00fd, bao ph\u1ee7 ph\u1ea7n l\u1edbn c\u00e1c c\u1ea5u tr\u00fac n\u01a1i th\u01b0\u1eddng t\u00ecm th\u1ea5y c\u00e1c thay \u0111\u1ed5i b\u1ec7nh l\u00fd…<\/p>\n","protected":false},"author":1,"featured_media":1309,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":"[{\"content\":\"Li\u00ean \u0111o\u00e0n c\u00e1c Hi\u1ec7p h\u1ed9i Th\u1ea5p kh\u1edbp h\u1ecdc Ch\u00e2u \u00c2u European League Against Rheumatism - t\u00ean m\u1edbi: European Alliance of Associations for Rheumatology\",\"id\":\"379130d9-d01b-45e0-b747-d328c038be56\"},{\"content\":\"\u0110\u1ea7u d\u01b0\u1edbi c\u01a1 nh\u1ecb \u0111\u1ea7u c\u00f3 2 ph\u1ea7n, l\u00e0 g\u00e2n nh\u1ecb \u0111\u1ea7u v\u00e0 tr\u1ebd c\u00e2n nh\u1ecb \u0111\u1ea7u, tr\u1ebd c\u00e2n nh\u1ecb \u0111\u1ea7u ban \u0111\u1ea7u \u1edf ph\u00eda ngo\u00e0i sau \u0111\u00f3 \u0111i v\u00e0o ph\u00eda trong khu\u1ef7u tay. N\u00ean t\u00ean g\u1ecdi c\u1ee7a n\u00f3 m\u1eb7c d\u00f9 l\u00e0 external bicipital aponeurosis, nh\u01b0ng l\u1ea1i nh\u00ecn th\u1ea5y n\u00f3 r\u00f5 r\u00e0ng h\u01a1n \u1edf ph\u00eda trong. \",\"id\":\"7872c0e1-8f97-41c5-8fdc-aa45ccc87d6b\"}]"},"categories":[2,41,32,7,5],"tags":[92,91,90],"class_list":["post-1228","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-doc-sach-cho-vui","category-english-corner","category-hoc-sieu-am-tu-con-so-0","category-phan-mem-cxk","category-sieu-am","tag-elbow","tag-khuyu","tag-msk"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1228","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/comments?post=1228"}],"version-history":[{"count":19,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1228\/revisions"}],"predecessor-version":[{"id":1275,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/1228\/revisions\/1275"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media\/1309"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=1228"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=1228"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=1228"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}