Ebook Kỹ thuật chụp X-Quang - Kỹ thuật viên chuẩn đoán hình ảnh: Phần 1

Phần 1 cuốn Kỹ thuật chụp X-Quang - Kỹ thuật viên chuẩn đoán hình ảnh giới thiệu tới người đọc các kỹ thuật chụp X-Quang không chuẩn bị (thường quy) bao gồm: Kỹ thuật chụp X-Quang xương khớp chi trên, kỹ thuật chụp X-Quang xương khớp chi dưới, kỹ thuật chụp X-Quang phổi và khung xương lồng ngực,... Mời các bạn tham khảo.

K? THUAlO

CHyP X-QUAIM(G

Ky thuat vien chan doan hir

CAC SACH CUNG TAC GIA

S I E U Am T O N G QUAT, C h u b i e n N h a x u a t b a n Dai h o c H u e 2 0 1 1 6 0 4 t r a n g k h o

s acl i 1 9 x 2 7 c m

BAl GI AN G C H A N DOAN H I N H A N H , Viet c u n g c a c t a c gi a k h a c N h a x u a t b a n V

H o c , 2 0 0 7

PGS.TS PHAM MINH THONG

chu bien

KY THUAT

CHUP X-QUA

Ky thuat vien chan doan h

NHA XUAT BAN Y HOC

hA noi

CHU BIEN

Pg s.Ts Pham Minh Thong

BAN BIEN SOAN

Pg s.Ts Pham Minh Thong

Ts Pham Hong Due

Ths Le Thuy Lan

Cn Nguyen Tuan Dung

THU KY BAN BIEN SOAN

Ts Pham Hong Due

M y c L y c

Lofi noi dau

PHAN I KY THUAT CHUP X-QUANG KHONG CHUAN BI (THUCfNG QUY)

Chu’tfng 1 KY THUAT CHUP X-QUANG XUONG KHCJP CHI DUOl

Bai 1 Xuong d u i 4

Bai 2 Xao'ng c a n g c h a n 9

Bai 3 Khop h a n g 13

Bai 4 Khop g o i 21

Bai 5 Xtfo'ng b a n h c h e 26

Bai 6 Xuong klio'p co chan, xuo'ng g o t 29

Bai 7 Xuo'ng khop ban ngon c h a n 37

Chtfo’ng 2 KY THUAT CHUP X-QUANG XL^ONG KHOP CHI TREX Bai 8 Xuo'ng c an h t a y 44

Bai 9 Xuo'ng cang t a y 49

Bai 10 Kho'p v a i 53

Bai 11 Ivliuyu t a y 60

Bai 12 Co t ay (58

viii M u c luc

Bai 13 Xuong klidp ban t a y 74

Chtfdng 3 KY THUAT CHUP X-QUANG PHOI VA KHUNG XUONG LONG NGl/C Bai 14 P h o i S4 Bai 15 Xuo'ng s u o n 92

Bai 16 Xirong d o n 96

Bai 17 Khop Uc d o n 100

Bai 18 Xirong irc 102

Bai 19 Xirong ba v a i 105

Chtfdng 4 KY THUAT CHUP X-QUANG BUNG - TIET NIEU - KHUNG CHAU Bai 2 0 He tiet nieu (khong c h u a n bi) 110

Bai 2 1 Bung (khong c hu an b i ) 114

Bai 2 2 Kh ung c h a u 120

Chtfdng 5 KY THUAT CHUP X-QUANG COT SONG Bai 2 3 Cot s ong c o 127

Bai 2 4 Cot s ong l u n g 138

Bai 2 5 Cot song t ha t l u n g 145

ChUo’n g 6 KY THUAT CHUP X-QUANG XUCNG SO MAT Bai 2 6 Dai cuo'ng ve chup so m a t 158

Bai 2 7 So ( thang n g h i e n g ) 162

Bai 2 8: Xoang - B l o n d e a u 170

Bai 2 9 Nen so - H i r t z 175

Bai 3 0 Ta ng giua va sau n e n so - W o r ms B r e t t o n 182

Bai 3 1 Ho y e n 185

Bai 3 2 Ho m a t - xuo'ng go m a 189

Bai 3 3 Cu ng tiep xuo'ng go m a 192

Bai 3 4 Lo thi giac 194

Bai 3 5 Xuo'ng c h u m (tu the S c h u l l e r ) 197

Bai 3 6 Xuo'ng da (tu the S t e n v e r s ) 201

Bai 3 7 Tai xuo'ng c h u m (tu the M a y e r ) 206

Bai 38 Tai xuo'ng c h u m (tu the Chausse III) 209

Bai 3 9 Mom chain (tu the N a d e a u ) 212

Bai 40 Xuong c hi nh m u i 216

Bai 41 Loi cau xuong h a m du6i va khop thai duong h a m 219

Bai 4 2 H a m dudi c hech (ha m c h e c h ) 222

Bai 43 R a n g 227

PHAN II KY THUAT C H UP X-QUANG CO CHUAN BI Chu’d n g 7 THUOC CAN QUANG, TAI BIEN VA CACH XLT TRI Bai 44 Thuoc can quang, tai bien va cach xu t r i 238

Chtfdng 8 KY THUAT CHUP X-QUANG HE TIEU HOA Bai 4 5 Thuc q u a n 248

Bai 46 Da day - ta t r a n g 259

Bai 47 Ruot n o n 278

Bai 4 8 Dai t r a n g 287

Bai 49 Duong m a t - tui m a t 305

Chtfdng 9 KY THUAT CHUP X-QUANG HE TIET NIEU Bai 5 0 UIV (Urographie Intra Vei neus e) 322

Bai 51 He tiet nieu nguoc d o n g 344

Bai 5 2 Dan luu be t h a n 347

Chtftfng 10 KY THUAT CHUP X-QUANG HE SINH DUC Bai 53 Buong t u c ung - voi trUng 352

Bai 54 Tuven vu (ma mo gr ap hy ) 363

ChUdng 11 KY THUAT CHUP X-QUANG TUY SONG cAn QUANG (Myelography) Bai 55 Tuv s ong can quang (Myelography) 380

Chtfofng 12 KY THUAT CHUP X-QUANG TUYEN NU6C BOT (SIALOGRAPHY) Bai 5 6 Tuven nuo'c bot (Sialography) 392

ChUong 13 KY THUAT CHUP X-QUANG KHOP cAn QUANG Bai 57 Khop can q u a n g 402

T H l / M U C THAM KHAO 413

CHI MUC ( I N D E X ) 415

x Muc luc

Lfr n 6 i t>Au

C u n g vai sir phat tri en nhir vu bao cua khoa hoc cong

n gh e, n ganh B i e n q ua ng d u a c thira hirong cac tien bo d o, cac

tr a ng thiet bi t r o n g cac khoa Di en q ua ng t r u a c dav chi co X- qua ng thi g i a dav da co t h e m sieu a m, cat lop vi tinh, c on g hirong t u va X-qua ng m a ch ma u T u kv t huat analogue thi ngav nav tat ca cac mav m o c t r o n g khoa B i e n q ua ng d e u d u n g kv

t huat so (digital)

Voi n h ie u cac t ra n g thiet bi hien dai da giiip cac bac si

B i e n q ua ng co the chan doa n chinh xac lion va c h uv en sau hon

t r o n g n h ie u b e n h lv tuv nhi en kv t huat X-q ua ng kinh dien van dirac sir d u n g n hi eu nhat va la n h u n g t h a m k h a m ban dau t r o n g tat ca cac khoa Di en q u a ng t r e n the gicri C u n g c hinh vi lv do do

m a c h u ng toi bien soan c u on "Kv t h u a t c h up X - q u a n g " voi m u c dich lam tai lieu giang dav va t h a m khao t r o n g dao tao kv t hua t vien B i e n q ua ng t r o n g cac t r u o n g t r u n g cap, t r u o n g cao dang va dai hoc kv thuat; tai lieu t h a m khao cho cac bac si c h uv en n ganh

B i e n quang

Sach bao g o m hai phan:

xii Loi noi dau

Phan I la cac cac kv t huat chu p X-qua ng k h o n g chuan hi cac kv t hua t d u q c phan chia t h e o giai pha u bao g o m : cac kv thuat

ch up X-qua ng x u o n g k h o p chi du oi , cac kv t hua t c h up X -q u an g

x u o n g k h o p chi t r e n , kv t huat chu p phoi va long nguc , kv thuat

c hu p b u n g - tiet nieu - k hu n g chau; kv t huat c h up X -q ua ng cot song; kv t hua t ch up X -q ua ng so ma t

Phan II la cac kv t hu at c hup dac biet va kv t huat ch up co chuan bi bao g o m : T h u o c can quang; kv t huat c h up X-q ua ng he tieu hoa; kv t hu at c h up X-q ua ng he tiet nieu; kv t huat c h up X-

q uang he sinh due; kv t hu at chup tuv song can qua ng; kv thuat

c hu p t uve n nirac h ot; kv t huat chup k h o p can quang

Sach d u q c ke t hua cac an p h a m t r o n g va ngoai n u o c ve kv

t hu at c h up X -qu ang c u ng n h u dua vao kinh ngh ie m t r o n g thuc hanh lam sang cua cac bac sT, kv t hua t vien khoa Chan doa n hinh anh b e n h vien Bach Mai va bo m o n Chan do an hinh anh t r u o n g Cao dang v te Ha Noi T u v nhien chac chan c h u n g toi k ho ng

tr a nh khoi m o t so t hieu sot t r o n g qua t r i n h bien tap ve noi d u n g

c u ng n h u hinh t huc , kfnh m o n g cac quv d o n g nghiep d o n g gop v kien de c h un g toi co di eu kien bo sung va hoan th ie n, de noi

d u n g c u on sach cluoc t o t h o n va cap n ha t hon

P G S T S Ph a m Mi n h Th o n g

Ph o G i a m D o c Be nh Vi en Bach Mai

T r u o n g K ho a C h a n D o a n H i n h A n h Be nh Vi en Bach Mai

Ph o T r u o n g Bo M o n C h i n D o a n H i n h A n h Da i H o c Y Ha No i

L in G ift THlgU

N a m 1895, W C R on t g e n da tim ra tia X n h a thi n gh i e m

p h o n g dien qua m o t b o n g chan k ho n g va hinh chup X -q ua ng dau tien la anh x u o n g ban tav cua ba R o n t g e n H o n m o t the kv da

tr oi qua, n hieu p h u o n g phap tao anh mo i da d u q c p ha t m i n h va

u n g d u n g t r o n g v khoa n h u n g chieu, chup X -q ua ng van giu

n g uv e n gia tri va van luon l uon la k ha m xet c o ban dau tien cho hau het cac k h a m x e t b e n h lv cua m oi c h uv en khoa lam sang

N hi e u loai hinh kv t h ua t vien chan doa n hinh anh da d u q c dao tao qua cac t r u o n g t r u n g hoc, t r u o n g cao dang va dai hoc

t r o n g n u o c n h u n g c hu v en nganh chan d oa n hinh anh van rat can

m o t cuo n sach h u o n g dan t h uc hanh c h up X- qua ng, vi chi co the xac lap d u q c chan doan d u n g dua t r e n m o t p h i m X -q u a n g c h up

d u n g kv t hua t va dat veu cau Ben canh d o, kv t hua t \ i e n X-

q ua ng can n h o phai lam sao de d a m bao veu cau an to an buc xa cho b e n h nhan va n h u n g nguoi x un g q ua n h, dac biet la p h u n u

m a n g thai va t r e e m la hai doi t u o n g rat nhav c am voi b u c xa ion hoa

xiv Loi gioi thieu

C u o n kv t huat c h up X-quang cua tac gia Ph am Minh

T h o n g va C o n g su d u q c bien soan co ng p hu , ke thira n h u n g an

p h a m t r o n g n u o c va n u o c ngoai ne n co the coi la m o t giao tri nh

t u o n g doi hoan chinh hien nav va dap ung d u q c veu cau cua cac

d o n g nghiep cung n h u cua cac c o s o dao tao kv t huat X -q ua ng

t r o n g ca n ude

Toi tran t r o n g gioi t hieu c u o n sach nav toi doc gia

c huven nganh Chan doan hinh anh va nhiet liet c huc m u n g cac

t hanh \ ien Ban bien soan c u on sach da hoan t ha nh m o t cong viec rat co v nghia t h u c tien cho c h uv en nganh

GS TS Ho a n g D i r e Ki£tChii tich Hoi D i e n q u a n g va Y h o c hat nh an Viet N a m

Lfr nh A xu A t ban

Noi d u n g "Ky t h u a t c h up X-q ua n g, Ky t h u a t vien chan

d o a n hi nh anh" g o m hai pha n, kv thuat c h up X -q u an g k h o n g chuan hi ( t h u o n g quv) va kv t hu at c hu p X -q ua ng co chuan hi,

d u q c tri nh bav lan luqt qua 1 3 c h u o n g t r o n g 57 bai

Phan " T u l u o n g gia" d u q c soan cho t u n g bai T r o n g no luc nang cao chat lu qn g sach, c hung toi cho in sach bo n mau

t r e n giav t ot N h a m lam giam gia t ha nh cho c u on sach, t oa n bo

p han "Tur l u q n g gia" d u q c tach roi k h o n g in c un g t r o n g sach Phan nav se d u q c c u ng cap cho nguoi hoc bang m o t file PDF

D o c gia can d u n g phan " T u l u q n g gia" cua c u on "Kv t h u a t c h up X-q u an g , Ky t h u a t vien chan d oa n h inh anh" xin vui long gdi email veu cau ve dia chi: c a o t r a n _ i n c @ v a h o o c o m se d u o c nhan tile nav ( mi en phi)

Nha xuat ban Y H o c m o n g quv d oc gia \ u i long d o nnhan

N H A X U A T BAN Y H O C

xv

xvi Loi nha xuat ban

K? THUAT CHyP X-QUAWG

(thircmg qr

K? THUAT CHI j JP x - q uang

xirong khop chi duoi

Xirong dui

171 uc tidu hoc t$p

• N£u (JiiOc cac chi dinh chup xuong dui

•Trlnh bdy tfuoc ky thuat chup xutfng dui thing, nghieng.

Cac c d mdng khoe bam vao mau c huyen ldn lam dau tren dang, c d that ltfng

chau bam vao mau c huyen be lam dau tren gap ra trtfdc Dieu nay giai thich ga\ xtfdng dui rat hay di lech Khi ch up X-quang phai het stfc nhe nhang tranh iho bao Ttf the ch up xtfdng dui thang la can thiet khong dat van de c hu p nghieng neu nhtf thay tinh trang lam sang khong c ho phep

4

Ddi i Auuny uui j

2 G ay tren loi cau xtfdng dui

B Chup xuong dui phuc vu cho dieu trj

Gay xUOng dui co chi dinh dieu trj dong dinh noi tuy: Vai tro cua X-quang luc nay

la xac dinh vung tuy rong hay hep de chon dinh noi tuy phu hop

Danh gia tinh trang lien xtfefng sau dieu tri:

- Phtfdng phap dieu trj dong dinh noi tuy ngtfdc dong cho ket qua tot Sau mot thcJi gian (2-3 tuan), chup X-quang xUOng dui danh gia tinh trang lien

xtfdng de co htfdng dieu tri thich hdp

- Neu n h u gay xtfdng dui khong co chi dinh phau thuat, chi ho hot sau khi da

du thdi gian (khoang 6 tuan) Trtfdc khi thao hot tien hanh c hup lai xtfdng

dui, nhan djnh sd bo ve stf lien xtfdng, can xtfdng o gay

C Cac ton thuong khac

Chan doan viem xtfdng, u xtfdng, loang xtfdng

Mac du da dtfdc thay the chan doan bang chup cat ldp vi tinh nhtfng X-quang thtfdng quy van con nguyen gia tri vi re tien, de thuc hien, vtfa giup chan doan va theo ddi trong qua trinh dieu tri Trong nhtfng trtfdng hdp nay, tham kham X-qua ng

bat but)c phai chup 2 ttf the: thang va nghieng

III KY THUAT C H U P X UO N G DUI

- Benh nhan nam ngtfa tren ban X-quang Chan ben can c hup dudi thang, ban chan xoay nhe vao trong (neu gay khong hoan toan)

- Phim 30x40 cm, dat doc dtfdi dui, chinh diem giufa xtfdng dui vao gitfa phim khu tru c h um tia hoac che la chan chi theo chieu doc

- Tia trung tarn: chieu vuong goc ttf tren xuong qua diem gitfa dui vao trung

6 C h i Ky thuat chup X-quang xuong khop chi diroi

hang so chup (kV, mAs)

- Trong trtfdng hdp gay xtfdng dui dtfdc dieu tri bang dong dinh noi tuy can danh gia kich thtfdc that cua ong tuy, thi phai dat phim sat vao dui bong X- quang de khoang cach xa tir 1,5 den 2 m

- Phai lay dtfdc mot doan gay hoac mot khdp gan nhat neu c hup khu tru

B Ky thuat chup xirong dui nghieng

1 K y thuat chup nghieng ngoai (Hinh 1-2)

- Benh nhan nam nghieng hoan toan tren ban X-quang, ve phia ben can chup Chan ben khong chup co len dtfa ra trtfdc hoac dtfa ra sau toi da C o chan ke

Ddi 1 AUUliy UUI /

•> ° V • V —

- Phim 30x40 cm, dat doc dtfcfi dui, chinh diem gitfa xtfdng dui vao gitfa phim, khu tru c hum tia hoac che la chan chi theo chieu doc

(B), tia trung tarn chieu vuong goc qua di§m giu'a dui va vao trung tarn phim.

- Tia trung tarn: chieu vuong goc ttf tren xuong qua diem gitfa dui vao trung

tam phim

8 C h i Ky thuat chup X-quang xirong khop chi diroi

- T hong so chup: 60 kV 40 mAs, khoang cach 1(K) cm co the dung lUiM

chong mO

2 Ky thuat chup nghieng trong (Hinh 1-3)

- D u u c a p d u n g i r on g n h u n g triTOng h o p chan thifefng nang.

- Benh nhan nam ngUa hai chan duoi thang (hoac chan ben khong dau dua ra trifOc co het sUc len bong) Dui ben can chup dtfOc ke cao bang mot goi dem

- Phim 30x40 cm, dat thang dung doc dUOc co dinh boi kep giOfa hai dui (hoac dUOc co dinh bang bao cat neu chan ben khong c hup co) Bong X-

lay dtfdc 2/3dut(i dui).

- Tia trung tain: di n g a n g va v u o n g g o c q u a d i e m g i u a xUdng dui v a o t r u ng tarn p h i m

- T hong so chup: 60 kV 40 mAs khoang cach 100 cm co the dung luoi

chong m i l

Lifti y: T u the chup nay chi thay Jiroc 2/3 duoi xuong dui

Xirong ding chan

ITIuc tieu hoc tip

• Trinh bay dtfdc ky thuat chup xudng ding chan thing, nghieng.

I GlAl PHAU X U O N G CANG CHAN (Hinh 1-4)

II CAC CHI D!NH C H U P X UO N G CANG CHAN

- P h a t h i e n nht fng ton thiTcfng g a y xUdng c a n g c h an

- T he o doi danh gia lien xudng sau bo bot hoac phau thuat

o

- T i m n h u n g ton t hUdng b e n h ly: v i e m , u xUdng

III KY THUAT C H U P X U ON G CANG CHAN

- B e n h n h a n n a m ngUa tren b an X - q u a n g , c h a n c a n c h u p d u o i t h a n g , b a n

c h a n x o a y n h e v a o t r o n g (de t ac h dUOc toi da hai xUdng c h a y m a c )

- Phim 30x40 cm, dat doc duoi cang chan, chinh cang chan vao trung tarnphim, khu tru c hum tia hoac che la chan chi theo chieu doc

- Tia trun g tam : c h i e u t h a n g t u tren x u o n g v u o n g g o c v6i p h i m k h u tru v a o

d i e m gitfa xUOng c a n g c h a n , 0 p h i a n g o a i c a c h b d trUOc x u o n g c h a y k h o a n g

2 c m v a v a o t r u n g t a m p h i m

- T hong so chup: 50 kV, 20 mAs, 100 cm khong dung luoi c hong md.

- Benh nhan nam nghieng ve phia chan can chup, chan nay duoi thang, mat ngoai cang chan sat phim sao cho go trUOc cua xtfdng chav song sone vdi mat phim Chan ben ddi dien co len va dua ra phia trUdc

9

10 C h i Ky thuM chup X-quang xirong khop chi dutri

Vung gian

lot cau trade

Loi cau ngoai

Ranh cho cd chay sau

& co gap cac rg o n aai

Mat ca trong

Dien knop mat ca j Ct.-0I

Dien khop mat ca

Knuye- ~ a c Mat ca ^cca

He ma*

ca "cc a i

Bai 2 Xirong ding chan 11

chieu vuong goc tdi diem giu’a ding chan, 6 phia ngoai cach bd trudc xudng chay khoang 2 cm, vao trung tam phim.

- Phim 30x40 cm, dal doc dtfdi cang chan, chinh cang chan vao trung tam phim, khu tru c hum tia hoac che la chan chi theo chieu doc

- T ia trung tam : chieu vuong goc tdi diem giffa cang chan 0 mat sau xuong

c hay vao trung tam phim

- T h on g so chup: 45-48 kV, 20 mAs, 100 cm, khong dung ludi chong md Ltfu y: C h u p phai lay dude m ot k h6 p tuy theo vi tri ton t huon g ma ta l&y k h d p

gan do N eu co nep hoc kirn loai thi bo ra N eu bo bot thi tang thong so chup

12 C h i Ky thuat chup X-quang xirong khop chi diroi

chan d mat sau xudng chay.

Khop hang

ITIuc tieu hoc tip

•Trinh b&y dtfdc ky thuat chup khdp hang thing, nghidng.

i g iAi p hAu k h g p hAn g

Khdp hang dtfdc tao bdi chom xtfdng dui tiep khdp vdi o coi cua xudng chau C h om xtfdng dui hinh 2/3 khoi cau, htfdng len tren vao trong va ra trtfdc, c hom co sun che phu trir hdm c hom dui, la ndi bam cua day chang c hom dui

Dau tren x Udng dui co cau true dac biet:

- Ldp vo xudng dac d than xtfdng len den tan co khdp d phia trong

- Cac be xtfdng tu lai d phan vo xudng dac cua co xtfdng dui va tu do tiep noi vdi dtfdng giap

- Gitfa co va mau chuyen co mot he thong cung nhon ma c hom cua cung tua vao vo xUdng dac d than xUdng va dinh cung htfdng len tren Gitfa hai he thong nay cd mot c ho yeu d cd la ndi de gay, de bi trat khdp

II CAC CHI’ DINH C H U P K H O P HANG

A Trat khop hang

Da y la m ot ton thUdng k h d p t hu dn g gap d ngUdi ldn do c ha n thtfdng do mot

14 C h i Ky thuat chup X-quang xirong khop chi duoi

G a y c d xUOng d u i la loai h a y g a p d n gt fdi c a o t u o i p h a n l d n t u 6 0 t u o i t r d len

d o l o a n g xUOng D a y la l oa i g a y xUOng n a n g vi:

- D e t u v o n g c a o d o c a c b i e n ch tf ng sau g a y xUOng

- Rat kho lien xUdng nen thudng de lai cac tan phe nang ne

Tren phim chup thang va nghieng chung ta cd the thay cac hinh anh ton thuongsau:

- C d mot vet dam hdn d vung cd xUdng gay cai vao nhau Vet nay thtfdng d phia tren sat chom

- Doi khi thay mot dtfdng ran ntft nhe 0 bd dtfdi cd xtfdng dui

- Cac be thd xudng cua he quat bi gay khoa cho gay cai vao nhau

C Benh Perthes - Legg - Calve

B e n h n a y h a y g a p d tre e m 6- 8 tuoi T r e trai g a p n h i e u h d n tre gai N g u y e n n ha n:

- Khe khdp rong nhat la khe khdp phia trong

- ThUa vdi teo c ho m xudng dui

- Nhan c hom dac va nhd lai bieu hien bang dam vdi hdn binh thudng

- Ngoai chom xuat hien cac d sang hinh nang tren nen xtfdng dac

- C d xtfdng dui day va rong ra hdn binh thudng

D Khop hang ton thuong, viem khop hang

Khdp hang la mot khdp de bi ton thudng nen cd the qua cac giai doan (xem bai k\ thuat chup khung chau)

III KY THUAT C H U P K H Q P HANG

A Chup khop hang thing

1 C hup khdp hang thang nam ngiifa ( H i n h 1-7)

- Benh nhan nam ngtfa ngav ngan tren ban chup Tay dudi thang hoac dat

Bai 3 Khop hang 15

trtfdc ngtfc C o the dat dem goi dau va vung khdp goi giup benh nhan thoai mai d ttf the nam ngtfa

16 C h i Ky thuat chup X-quang xirong khop chi diroi

- Chan can c hup duoi thang, ban chan xoay nhe vao trong theo phUdng thang dung mot goc khoang 15°-20° T u the nay giup cd xuong dui ttf htfdng ra trtfdc dtfdc xoay theo htfdng na m ngang song song vdi phim.Chinh hai gai chau trtfdc tren song song vdi mat ban, neu benh nhan bj g&y co xUdng dui

thi de theo cd the cd nang

- Nen dat tam chan bao ve vung sinh due ngoai cua nam va vung budng trtfng cua ntf

- T i a t r u n g t a m

+ NSu c hup mot ben dat phim 24x30 cm dudi mo ng ben c hup sao cho khdp hang ben c hup vao trung tam phim, tia trung tam vuong goc vdi vdi phim

d diem gitfa nep ben

+ Neu c hup hai khdp tren cung mot phim phai dung phim 30x40 cm tia

thang dung mot goc khoang 55

- Phim 18x24 cm dat tren ban sao cho khdp hang vao giufa phim

- T i a t r u n g t a m : chech 15 len phia dau so vdi phUdng thang dung tdi tren

9

diem gitfa mong 5 c m vao phim

- T h o n g so c h u p : 70 kV, 45 mAs, 100 cm co ltfdi loc

B Ky thuat chup khop hang nghieng

Deii vdi benh nhan cur d ong dtfdc k h d p h ang, c o the c h u p tu the nieu d ao hoac

tu the chan ech C on ddi vdi be nh nha n k h o n g c u d o n g dUdc k h d p h a ng c d the

c h u p tu the tia X di n ga ng ttf trong ra

, - Phfrn 18x24 cm dat doc theo true cua \Udng dui sao cho khdp hang \ j.'• gitfa phim

Bai 3 Khop hang 17

T hong so chup: 70 kV, 45 mAs MX) cm co ludi chong md.

2 T if the chan ech (Hinh I -9)

Benh nhan nam ngufa ngay ngan tren ban Tay dudi thang hoac dat trtfdc ngtfc

+ Ddi vdi tu the chan ech hai ben:

• Ca khdp hang va khdp goi dtfdc gap khoang 90" Hai ban chan co len tdi da va long ban chan ap dtfa vao nhau Dang ca hai dui ra ngoai khoang 45° so vdi phuong thang dung giup cd xUOng dui dtfdc xoay theo hudng nam ngang song song vdi phim

I UNO TAO VOl MAT BAN t'cdCMOQ '

trung tam thang goc o' diem giua ben.

18 C h i Ky thuat chup X-quang xirong khop chi diroi

• Chinh hai gai chau trtfdc tren song song vdi mat ban T ia trung tam

thang goc vdi phim d diem gitfa dtfdng noi diem gitfa hai nep ben

+ Ddi vdi ttf the chan ech m ot ben:

• Nhtf ttf the tren hoac chan khong can chup dudi thang Ben can c hupgap khdp hang va khdp goi, roi xoay dui ra ngoai khoang 45" so vdi

phtfdng thang dtfng, ban chan dtfdc ap dtfa vao khdp goi ben ddi dien

• Tia trung tam chech len tren mot goc 10°-15° theo phtfdng thang

dtfng tdi cd xtfdng dui d diem gitfa nep ben

- T hong so chup: 70 kV, 45 mAs, 100 cm, cd ltfdi c hong md.

tren 10°-15° theo phudng thang dung tdi co xtfdng dui d diem giua nep ben.

Bai 3 Khop hang 19

3 Ttf the tia X di ngang (it dung) (Hinh 1-10)

- Tia trung tam : di ngang theo dUdng tao bdi hai mat phang dung doc gitfa

dui va nep ben vao phim

- T hong so chup: 70 kV, 45 mAs, 100 cm co lu6i chong md.

phim.

A Giai phlu phim khop hang thing (Hinh l - l l )

B.Giai phlu phim khop hang nghieng (Hinh 1-12)

2 0 C h i Ky thuat chup X-quang xirong khop chi diroi

1 Xudng canh chau 2 Gai chau trudc dudi 3 Gai chau 4 Tran khdp o coi 5 Khe khdp 6 Bd sau 7 Bd trudc 8 U X-quang (giot le X-quang) 9 Lo bit 10 Chom xudng dui 11 Ndi bam day chSng tron 12 Co giai phau 13 Mau chuyen ldn 14 Mau chuyen nho 15 Co phau thuat 16 Budng lien mau chuyen.

I Xudng mu 2 Xudng chau 3 Xudng ngoi 4 0 coi 5 Bd trudc 6 coi 6 Bd sau o coi 7 Chom xudng dui 8 Co giai phau 9 Mau chuyen ldn 10 Mau chuyen nho

I I Co phau thuat.

Khop goi

ffiu c tieu hoc tap

• Neu dude 3 chi dinh chup khdp goi.

• Trinh b&y dude ky thuat chup khdp goi thing, nghieng.

• Mo ta dude giai phau X-quang khdp goi thing, nghieng.

- Khdp goi la khdp phuc hop cua co the gom 2 khop

- K h d p gitfa xUdng dui va xUdng c h a y t h u o c loai k h d p loi cau

- Khdp giua xUdng dui va xUdng banh che thuoc loai khdp phang

Ph U d n g t ien ndi k h d p g o m b a o k h d p va d a y c h a n g

- B a o k h d p goi m o n g , ve p h i a xUdng dui b a o k h d p b a m tren d i en r o n g roc

t ren hai loi c a u va h d g i a n loi c a u ve p h i a \ U d n g c h a y b a o k h d p b a m d p h i a dUdi hai d i e n k h dp

- L a c a c d a y c h a n g ( k h d p goi c o 4 he t h o n g d a y c h a n g ) : d a y c h a n g trUdc, d a y

c h a n g sau d a y c h a n g b e n va d a y c h a n g c h eo

N h u v a y k h d p goi dtfdc coi n h u hai k h d p loi c a u c u a \ U d n g dui m o t d i e n k h d p c u a xUdng c h a y K h d p dtfdc g i u c h o k ho i trat s a n g b e n bdi da y c h a n g b e n v a k h oi trat ra trUdc bdi d a \ c h a n g c h e o

Trong mot so b e n h ly k h d p goi: ngoai vi ec c h a n d o a n b a n g c hup X-quang thudng qu \

v a c h u p cat ldp vi tinh, ngUdi ta con c h u p c o n g hUdng tu n g oa i ra c o the la m sicu a m

n e u nghi ngd tran d i c h k h d p goi

II CAC CHI D IN H C H U P KH Q P G O I

A Chan thuong khop goi

Khdp goi ldn nhat do do de bi c ham thudng C hu p khdp goi khong kho nhUnu doi

21

22 C h i Ky thuat chup X-quang xirong khop chi diroi

hoi ky t huat ti mi de xa c d i nh c o ton thtfOng h a y k h o n g Moi c h a n t h u o n g v u n g xUOng dui g a n h a y xa k h d p goi c u n g h a y g a p trim d i ch k h d p goi a n h htfdng toi c o nang

B Benh ly khop goi

C Tran dich khop goi

Tran d i ch k h d p goi la h a u q u a c u a c a c b e n h ly k h o p n h u c h a n thtfOng k h d p goi

khong phai de chan doan tran dich khdp ma djnh hUOng tim nguyen nhan tran

djch Mat khac c hup X-quang giup theo d5i va danh gia sau dieu trj.

III KY THUAT C H U P K H O P GOI

Muon c hup dung ky thuat, trudc het phai danh dau moc khe khdp:

- De dau goi hoi gap nhe Nan tu phia u trong xUOng chay len phia tren tha> mot ranh nho hoi lom (khe khdp) Danh dau bang but mUc m d tren da

- Trong th uc te k h e k h d p n g a n g vdi b d dudi xUOng b a n h c he

1 Ttf the ngtfa

- Benh nhan nam ngUa hoac ngdi tren ban X-quang chan ben cSn ch up duoi thang va ban chan xoay nhe vao trong

- Phim 18x24 cm dat dudi kheo dieu chinh khdp vao trung tam phim

- Tia trung tam : c h i e u t h a n g g o c vdi p h i m v a o k h e k h d p d a d a n h d ^u h o a c

b d d u di xUOng b a n h c h e tia ra t r u n g t a m p h i m

- T hong so chup: 50 k V 25 m A s 100 c m k h o n g ltfdi c h o n g m d

phim

Bai 4 Khop goi 2 3

banh che (khe khdp).

2 T if the sap

n / v 9 v /

- Benh nhan nam sap tren ban X-quang, cang chan co len va dUdc ty co djnh

vao goi dem sao cho true cua cang chan tao vdi mat ban mot goc 35-40

- Phim 18x24 c m dat dtfdi goi, dieu chinh khe khdp vao trung tam phim

- T ia trun g tam : chech xuong phia chan mot goc 40 so vdi phtfdng thang

dung, qua vung khe khdp da dtfdc danh dau, va vao trung tam phim

- T h ong so chup: 50 kV, 25 mAs, 100 cm khong ltfdi chong md.

T hu dn g ap dung ky thuat ch up khdp goi nghieng ngoai

- Benh nhan nam nghieng ve ben ton thudng Dau goi ben can ch up gap nhe,

hoac de theo tu the c d nang neu benh nhan dau hoac ctfng khdp Muon de

c ho khdp goi that nghieng, dat gd xtfdng chay song song vdi mat ban, cd chan dtfdc ke bang goi dem Chan ben khong chup dudi thang ra sau hoac

ra trudc

- Phim 18x24 cm dat dudi mat ngoai khdp goi dieu chinh khdp goi vao trune tam phim

2 4 C h i Ky thuat chup X-quang xirong khop chi diroi

Tia trung tam: chieu vao (lifting khe khdp da danh dau sau gan banh che I

cm nhifng chech nhe ve phia dau 5° (vi loi cau trong thap hdn loi cau ngoai nhir vay phim se cho hinh 2 loi cau xirdng dui chong len nhau)

T hong so chup: 50 kV, 25 mAs, 100 cm khong ltfdi chong md.

Li/u y: Ddi vdi benh nhan chan thtfdng nang hoac bd hot khong nam nghieng dtfdc thi cd the chup ttf the nghieng trong Benh nhan nam ngtfa dat phim phia trong va nang cao dau goi len tia trung tam di ngang ttf ngoai vao

nhau giu'a khe khdp da dude danh dau vdi bd sau gan banh che 1 cm

A Giai phiu phim chup khop goi th in g (Hinh 1-15)

B Giai phiu phim chup khop goi nghieng (Hinh 1-16)