giao trinh benh hoc ngoai phu y

8/12/2019 Giao Trinh Benh Hoc Ngoai Phu y

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Ch o bin son:V Khoa hc & o to, B Y t

Ch bin:

PGS. TS. Phm Vn Trnh

PGS. TS. L Th Hin

Nhng ngi bin son:

PGS. TS. T Vn Bnh

TS. L Lng ng

TS. L Th Hin

ThS. Thi Hong Oanh

PGS. TS. Phm Vn Trnh

ThS. Trn Hi Vn

Thk bin son

TS. L Th Hin

Tham gia t chc bn tho

ThS. Ph Vn Thm

TS. Nguyn Mnh Pha

Bn quyn thuc B Y t (V Khoa hc v o to)


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Li gii thiu

Thc hin mt s iu ca Lut Gio dc, B Gio dc & o to v B Y

t ban hnh chng trnh khung o to bc s chuyn khoa y hc c truyn,B Y t t chc bin son ti liu dy - hc cc mn c s, chuyn mn v c bnchuyn ngnh theo chng trnh trn nhm tng bc xy dng b sch chuntrong cng tc o to nhn lc y t.

SchBnh hc ngoi - ph y hc c truync bin son cho 2 mn hcBnh hc ngoi khoa Y hc c truyn v Bnh hc Sn ph khoa da trn chngtrnh gio dc i hc ca Trng i hc Y H Ni trn c s chng trnhkhung c ph duyt. Sch c cc nh gio giu kinh nghim v tmhuyt vi cng tc o to bin son theo phng chm: kin thc c bn, hthng; ni dung chnh xc, khoa hc, cp nht cc tin b khoa hc, k thut hin

i v thc tin Vit Nam.SchBnh hc ngoi - ph y hc c truyn c Hi ng chuyn mn

thm nh sch v ti liu dy - hc chuyn ngnh bc s a khoa ca B Y tthm nh vo nm 2007, l ti liu dy - hc t chun chuyn mn ca ngnhY t trong giai on hin nay. Trong qu trnh s dng sch phi c chnh l,b sung v cp nht.

B Y t xin chn thnh cm n cc nh gio, cc chuyn gia ca Khoa Yhc c truyn, Trng i hc Y H Ni dnh nhiu cng sc hon thnhcun sch ny; cm n GS. Hong Bo Chu c v phn bin cun schsm hon thnh, kp thi phc v cho cng tc o to nhn lc y t.

Ln u xut bn, chng ti mong nhn c kin ng gp ca ngnghip, cc bn sinh vin v cc c gi ln xut bn sau c hon thin hn.

khoa hc v o toB Y t


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Li ni u

Thc hin ngh quyt 226/CP ca Hi ng Chnh ph v vic pht trin y

hc c truyn Vit Nam, cn c cng vn s 7227/YT - K2T ca B Y t ngy27/9/2004 v vic thm nh sch v ti liu dy - hc h i hc v cao ngchnh quy, Khoa Y hc c truyn - Trng i hc Y H Ni bin son ti liuBi ging ngoi - ph y hc c truyn nhm cung cp cho sinh vin chuyn khoay hc c truyn c ti liu hc tp v tham kho v y hc c truyn theo chngtrnh ci cch.

Mc ch yu cu ca ti liu:

- V mt l thuyt: sinh vin nm c nhng c im c bn ca y hc ctruyn v bnh ngoi khoa v ph khoa.

- V mt thc hnh: nm c cc phng php chn on v iu tr mts bnh thng gp trong ngoi khoa v ph khoa phc v cho vic chm scsc kho ca nhn dn. Sch trnh by nhng im c bn c tnh cp nht, ckt hp gia y hc hin i v y hc c truyn.

Ch bin v cc tc gi bin son cun sch ny l nhng cn b gingdy y hc c truyn c nhiu kinh nghim v ngoi khoa v ph khoa ca KhoaY hc c truyn - Trng i hc Y H Ni son tho.

Trong qu trnh bin son v xut bn mc d c nhiu c gng nhngchc chn cn c thiu st, chng ti mong nhn c nhng kin ng gpca ng nghip v bn c.

PGS.TS. Nguyn Nhc Kim

Trng khoa Y hc c truyn

Trng i hc Y H Ni


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ch vit tt

BN Bnh nhn

TB Tim bp

TC T cung

TCBT T cung bnh thng

T/M Tnh mch

YHCT: Y hc c truyn

YHH: Y hc hin i


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Mc lc

Phn 1. Ngoi khoa 9Bin chng trong ngoi khoa y hc c truyn

Phm Vn Trinh 10S lc lch s iu tr chn thng trong y hc c truyn

L Lng ng 21

Bong gn (Nu thng)Phm Vn Trnh 24

To thng (ng gip phn mm)Phm Vn Trnh 27

Vt thng phn mm (Sang thng)Phm Vn Trnh 29

i cng v gy xng (C tit)L Lng ng 37

Nguyn tc iu tr gy xng kt hp Y hc c truynL Lng ng 42

Mt s loi gy xng (C tit)L Lng ng 65

Thuc y hc c truyn dng ngoi trong iu tr bnh da liu (Bnh b phu)T Vn Bnh 75

Chm (Phong chn)T Vn Bnh 82

Bnh my ay (n chn)T Vn Bnh 90

TrPhm Vn Trnh 97

R hu mn (Giang lu)Phm Vn Trnh 102

Mn nht (Tit inh)Trn Hi Vn 106

Si tit niu (Thch lm)Phm Vn Trnh 109

Phn 2. Sn ph khoa 117

Chng 1.i cng 118c im sinh l ca ph n

L Th Hin 118


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Bnh nguyn bnh sinh theo YHCT ca bnh ph khoaL Th Hin 121

c im v chn on bnh ph khoa (T chn)L Th Hin 123

Bt cngL Th Hin 126

Nguyn tc iu tr bnh ph khoaL Th Hin 130

Chng 2. iu tr mt s bnh ph khoa 134

Kinh nguyt khng uL Th Hin 134

Rong kinh (Kinh lu)L Th Hin 142

Rong huyt (Huyt lu)L Th Hin 146

au bng kinh (Thng kinh)L Th Hin 153

B kinh, v kinh (Trn huyt)L Th Hin 157

i hL Th Hin 162

Vim lot c t cung (m sang)Thi Hong Oanh 166

Vim m o (m dng)L Th Hin 169

Vim phn ph (Trng h)Thi Hong Oanh 173

Do sy thai (ng thai, thai lu)L Th Hin 177

Nn ma khi c thai (c tr)L Th Hin 182

Ph khi c thai (T thng)L Th Hin 186

Vim tc tia sa, vim tuyn v (Nh ung)L Th Hin 190

Thiu sa (Khuyt nh)L Th Hin 193

Sa sinh dc (m nh)L Th Hin 197


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Phn 1nh hc Ngoi khoay hc c truyn


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Bi 1

Bin chng trong ngoi khoay hc c truyn

Mc tiu1. Hiu v gii thch c cc nguyn nhn gy bnh ca ngoi khoa y hc c truyn.2. Thuc v trnh by c v bin chng bnh l ca ngoi khoa y hc c truyn.

1. Quan nim v phn loiBnh ngoi khoa thc ra c rt sm v c trc cc bnh ca cc khoakhc k c ni khoa, v con ngi sinh ra phi lao ng sinh tn cho nntrc tin phi xut hin cc kinh nghim iu tr: tai nn lao ng, cn trng,th cn Nhng t xa cc y vn li, nc ta cha xp ring ngoi khoa, Trung Quc thi nh Chu xp l dng khoa, thy thuc iu tr bnh dngkhoa gi l dng y.

Thi xa cho rng cc bnh sinh ra bn ngoi c th mt nhn thy, tay sthy c chng trng cc b u thuc phm vi ca ngoi khoa. V d: inh, ung,th, hu bi, tin bi, n c, loa lch, d, nham, bu c Sau ny do khoa hc

pht trin c s kt hp gia y hc c truyn (YHCT) vi y hc hin i (YHH)cho nn phm vi ngoi khoa rng hn, phong ph hn (v d: sa lm, chnthng, cn trng, th cn, cc bnh da liu, vim tc ng mch, tr).

Trong ngoi khoa y hc c truyn, da vo cc bnh tnh v nguyn nhnc th chia cc loi:

Loi nhit (thuc loi vim nhim theo y hc hin i): inh, ung, th,dng, n c, loa lch, d

Chn thng: trit thng, nu thng, toa thng, huyt , kh tr tngph do chn thng, trt .

Cc loi khc: nham, bng (ho sang), lnh cng (ng sang); trng, th cn. Ngoi ra cn chia ra cc bnh theo v tr tn thng, kt hp vi tnh cht

ca bnh.

+ Cc bnh vim nhim da, c, xng, khp, hch v tuyn v.+ Cc bnh cp tnh.


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+ Cc bnh hu mn trc trng.+ Cc bnh da liu.+ Cc bnh thuc chn thng.+ Cc bnh u.+ Cc bnh bang.+ Cc bnh b trng - th cn.+ Cc bnh ngoi khoa khc: si gan - mt - tit niu, vim tc ng

mch, tnh mch.

2. Khi qut v bin chng bnh ngoi khoa2.1. Bin chng nguyn nhn sinh bnh

Nguyn nhn gy bnh ngoi khoa l do cc nguyn nhn bn ngoi (lcdm), cc nguyn nhn bn trong (ni nhn) v cc nguyn nhn khc (bt,ngoi ni nhn) gy nn; nhng c c tnh gy bnh khc vi ni khoa.

2.1.1. Nguyn nhn bn ngoi

Lc dm t c cn gi l ngoi cm lc dm, tc l ngoi t gy nn, baogm: phong, hn, th, thp, to v ho xm nhp vo c th lm tn thng cth m pht bnh. Bnh c th pht ti ch (cc b), cng c th pht ra tonthn l tu thuc vo chnh kh (sc khng) ca c th. Chnh kh ton thnhgy bnh ton thn (mn, nht ton thn); chnh kh ti ch hgy bnh tich (nht, ung ti ch). Bnh cc b chim t l 70 - 80%.

Nguyn nhn gy bnh trong ngoi khoa thng do ho, 5 loi t kh khckt hp vi ho gy bnh, nhng bn thn chng cng bin thnh ho gybnh cn gi l ho c hoc nhit c. V vy Ni kinh c ni: Chnh kh cnbn trong, t kh khng lm g c.

Phong t: phong t l dng t, tnh ca phong l to nh v tn ln trnra ngoi, cho nn bnh da thng ri rc nhiu ni, c khi pht tonthn hoc tp trung u, mt, c, bnh nga v kh (hoc c vy mnghoc t b).

V d: phong xm nhp lm cho huyt to, b phu km nui dng m sinhbnh nhvim da thn kinh, vy nn

Phong thch hnh (di ng) m li bin ha nn pht bnh nhanh v thay

i, phn nhiu thuc dng chng (hoc xut hin sng, , au khng c vtr nht nh; hoc ln kinh git co rt).

V d: b vt thng cm phi phong t gy bnh ni phong c th gp phthng phong (ging nhun vn, nu l un vn cn phi phng v iu tr yhc hin i trc tin).


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Hn t: hn t l m t, tnh cht bnh su, thm, t b, cn xng...bnh phn nhiu thuc m chng. c im bnh ngoi khoa ca hn lsng m khng cng, mu sc da thm ta hoc mu da trc khi b bnhkhng , khng nng, au nhiu v tr nht nh, bnh m thm nng.

V d: nguyn nhn do hn lm cho kh huyt tr gy nn nhc u; chilnh but ti nht, thm ch thiu huyt nui dng, teo nh, rng t tay t

chn... gp trong thot th(ng mch); hoc nu do hn t xm nhp nhiu,lu, ngng tr kh huyt ton thn gy ton thn cng , lnh but, l bnhng thng (bnh lnh cng).

Ha t: ha t thuc dng t, cc triu chng chung l: nga, au, llot u do ha hoc phong, hn, th, thp t ho ha gy nn.

c im: pht bnh nhanh, cp tnh (sng, , nng v au). V d: nhitvo huyt c th gy n c ha nhit c nhbnh: inh, th, ung nht; tutheo v tr m gy chng bnh khc nhau nh: da l n c, c biu nh nhungnht kinh mch nhvim hch, trc ngc l tin bi sau lng l hu bi.

T v tr ca bnh c th bit cc nguyn nhn kt hp vi ha, c th: nupht bnh phn trn c th nh: u, mt, c, chi trn... l thng kt hp viphong; nu bnh pht ngc, sn, bng... l thng ha lu gi l ha ut vkh ho thng ut gia c th; nu pht bnh phn di c th nhhu mn,chi di, sinh dc, tit niu thng kt hp vi thp v tnh cht ca thp l hging. Tuy vy khi chn on nguyn nhn cn phi kt hp vi triu chng tonthn ti ch v v tr bnh trn c th iu tr mi li kt qu tt.

Thp t: thp t l m t, c tnh cht nht, dnh, bn c... Tu theo sthin lch ca hn nhit trong c th v ca qu tit kh tri m ha hn,ha nhit; m kt hp thnh thp hn, thp nhit.

c im: nu c nhc th da lot nt, chy nc hoc chy m; su thr, da m t.

V d: thp nhit gp tr lot nt, ung thng; thp hn gp chi di thgp cc lot mn, lot

To t: to l dng t, c im ca to l lm tn hi tn dch, huyt tosinh phong, phn nhiu bnh pht tay - chn v da (b phu)

Tnh cht ca to l: b phu kh, n, nga, mn, bong vy, nt k V d:nu nhit to xm nhp vo huyt sinh huyt to, huyt nhit... c th gp bnh vy nn; nu huyt to c th gp bnh thp mn tnh, da mn nga.

Th t: th l d

ng t, th

ng hip (bc), th thp b trng t lu hanhit phn nhiu pht ra c - da - u - mt.

c im l: sng , nung m, au, gp lnh au gim. V d: th thpnung t b phu thnh rm sy hoc cm phi th c thnh vt thng l lot,mn nc.


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2.1.2. Nguyn nhn bn trong

Nguyn nhn bn trong gi l ni thng tht tnh, l nhn t tinhthn, c th l: h (vui), n (gin), bi (bun), ai (lo), kinh (hi), khng (s), u(suy ngh)... b ri lon lm cho m dng khng iu ha, kh huyt khng hahp, cng nng ca cc tng ph v kinh lc b hn lon m gy bnh. Trongbnh ngoi khoa hay gp lo ngh, tc gin qu . V d: tnh ch khng thng,

tc gin qu lm cho can kh ut kt, kh tr m ngng... hay gp trn lmsng l bnh vim hch (loa lch), vim tuyn v, tc tia sa, u gip trng, cckhi u Ngoi ra cn gp cc bnh ngoi da nh: vim da thn kinh, bnh snnga cng do yu t tinh thn gy nn.

2.1.3. Cc nguyn nhn khc

n ung khng iu : theo Hi Thng Ln ng ni: n ung l bip nhng cht cho ch thiu, n ung qu mc th thng tn ti t vo trng, cho nn n ung khng iu cng l nguyn nhn gybnh ngoi khoa. V d: n nhiu th cay, nng, bo, ngt gy v trngtch nhit, ha c ni sinh gy nn bnh l lot, inh, nht, rm sy;hoc n ung qu nhiu gy nn thc tch, sinh bnh cp tnh bng, nthc n lnh hoc qu i gy nn cc bnh giun: tc rut do giun, giunchui ng mt

Phng dc: trong tp Ni kinh yu ch Hi Thng Ln ng ni r:Sinh hot l k cng ca hnh ng say m v sc gi l phng dc,tu sc ba bi gi l hao, say m sc dc qu mc th gi l tinh cn,ba bi th tinh kh tn mn. Nhvy nu phng dc qu gy thnkh tn thng, phong t, hn thp d xm nhp m sinh bnh (v d:vim tu xng, xng gy lu lin).

Ni : y cng l nhn t gy bnh v n c lin quan cht ch ti lc dmv cng l yu t sinh ra lc dm. V vy bnh ngoi khoa do ni gy nnchnh l do lc dm gy nn.

Cc nguyn nhn khc:+ Chn thng.+ Trng th cn.+ Ha thng v ng thng.Cc tn thng trn nu bnh nh th c da, gn, xng b tn thng; nu

bnh nng th cc tng ph b tn thng; nu bnh nghim trng hn th binbnh ton thn.

2.2. Bin chng v bnh l

Bnh l l mt tri thc hiu bit v bnh, gii thch c nguyn nhn gybnh trong c th v phn tch c s bin ha ca bnh, nh gi tin lngca bnh... cho nn n ht sc quan trng trn thc t lm sng, n c nghach o trng yu trong chn on, iu tr, phng v tin lng bnh.


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2.2.1. Bin chng v kh huyt

Kh huyt trong c th gip ln nhau m lu hnh, tun hon trongkinh mch... trong th nui dng tng ph, ngoi th nui dng c da duy tr s sng v c tc dng chng ngoi t. V vy kh huyt vng thnh,bo v bn ngoi s mnh th ngoi t khng d xm nhp; kh huyt hyu,bo v bn ngoi s km th cc nguyn nhn gy bnh rt d xm nhp c th

m gy nn bnh. Trong sch Ni kinh ni: Kh thng th au, hnh (huyt)thng th sng. Sng v au l phn ng bnh l khng ging nhau ca 2 loikh huyt b ngng tr. V vy pht sinh ra tn thng bnh l ngoi khoa nhtthit phi do kh huyt ngng tr gy nn. V d nhtrong ngoi khoa, chnthng kh huyt ngng tr l bnh l ch yu pht sinh v hnh thnh bnh(nhbnh l lot, inh, nht nu kh huyt xung thnh () thi k u ddng khi, thi k c m d thu nh v v m, thi k v m d thu nhming vt thng v sinh c (lin so).

V vy khi bin chng trong lm sng nht thit phi lm r quan h khhuyt vi bnh ni tn thng mi hiu c bn cht ca bnh m tin hnhnh ra phng hng iu tr. Cc biu hin ca tn thng kh huyt nhsau:

Kh tr: kh t th c hnh, kh tn th khng c vt tch, kh gy bnh thau, kh au th bt thng. Bnh thng gp nh: ngc sn y tc, khth do chn thng vng ngc sn (khng c triu chng gy xng, trnkh, trn dch mng phi, khng v gan lch) hoc li ko gy au; hocnh nhau vng bng gy tc bng, trng hi; hoc ln gy ct sng gychng bng, b i tiu tin; hoc cng c th do ni tng b ri lon gykh tr nhbnh kh hh hm (sa cc ph tng)

Kh ut: kh ut trong ngoi khoa c th sinh ra tch t hoc ut ho ho, tchy thnh dch m thnh m, m tch li thnh khi. Nu kh ut m tch

t th thnh s

ng, thnh khi mu sc da khng thay i, c th thay itheo tnh ch (v d: vim tuyn v, tc tia sa, u gip trng); nu kh utthnh m th thnh khi, sng nhng mm (v d: vim hch mn).

Kh h: kh htc l dng kh khng th khng t c biu vo bn trongc th c. Nu kh hton thn gy c ng kh khn, hay gp trong dichng ca cc chn thng thn kinh, c, xng, khp Nu kh htich th sc chng ti ch yu, c t d xm nhp gy ra l lot, inh,nhtgy cho cc ni b tn thng kh hi phc (v d: bnh kh hcatng ph, t kh hgy nn sa cc ph tng). Nu kh hti ch v tonthn th bnh sng m kh ph m, kh thu ming, th yu, n km, chtli nht, mch t.

Huyt : theo y hc c truyn, trong ngoi khoa thng kh tc kh tr,thng huyt tc huyt ngng. Kh tr khin huyt ngng, huyt ngngc th cn tr kh hnh, v vy huyt l gy ra bnh. Nu huyt ngng c nhc, b phu th sng, au, (v d: tn thng c, da, dy chng(tn thng phn mm)); nu cn tr dinh v th ut m sinh nhit, c


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triu chng bnh sng, nng, , au da, c (v d: bnh inh, nht,lot); nu huyt tch ngc sn th c triu chng y chng au tc,(v d: bnh vim ng mt, tn thng vng ngc do chn thng).

Huyt lu ut sinh nhit (ni phn di) huyt cng gy ra chymu (v d: tr chy mu).

Huyt nhit: huyt nhit do huyt lu, ut trong m sinh nhit; hocnhit c xm phm vo huyt phn. Nu da, c, khp th c triuchng cp tnh nh: sng, nng, , au m gp inh, n c, nht l do huyt lu ut thnh nhit gy nn. Nu c triu chng chy muth do nhit bc huyt lon hnh gy ra nh th huyt, nc huyt dosang chn

Huyt h: huyt hthng xut hin thi k sau ca bnh. Trong y hc ctruyn cho rng kh hbt dng, huyt hbt nhn. Cho nn cc ni tnthng m huyt hth khng nui dng c v ni tn thng khngth hi phc c (v d: cc vt thng m huyt h th rt kh thuming v lin c hoc trong cc trng hp gy xng nu huyt h

khng bao gi lin xng c).

2.2.2. Bin chng v cn xng

Cn lin quan ti can, xng lin quan ti thn, cn xng l ngn ca canthn, c kh huyt n m, can thn nhu dng. V vy cn xng m b tnthng th nht thit tn thng ti kh huyt v nh hng ti can thn.

Thanh nin c can thn kh thnh, cn xng pht trin chc cho nn cnxng b tn thng th rt d hi phc. Ngi gi th can thn kh suy, cn x-ng hyu; cho nn cn xng b tn thng th hi phc rt chm, thm chkhng hi phc. V vy iu tr bnh cn xng l iu tr bnh bn trong nn

cn ch n iu l ca kh huyt, can thn lm ch. V d: gy x

ng giaion u cn sng, nng, , au cn hot huyt hnh kh tiu lm ch;n giai on ht sng, nng, th phi tip lin xng, b can thn lm ch

2.2.3. Bin chng v tng ph

Trong ngoi khoa bnh c quan h cht ch vi tng ph. Bnh c th tbiu truyn vo tng ph (v d: cc bnh ngoi da, c, cn, xng tuy do ngoit gy bnh nhng nu khng iu tr tt s gy bnh tng ph nh inh,nht; nu ngi bnh chnh kh km s gy st cao, ho m ton thn v co gitdn n t vong ). Ngc li bnh thuc tng ph cng c th gy bnh ccb (v d: kh hch yu trung kh hgy ra nhtr).

Cc biu hin bnh tng ph thng gp l: Ho c cng tm:

+ Triu chng: st rt t, st nng cao, vt v, hn m, ni nhm, li ta, mch hng sc; c th ln cn git do chnh kh h, t kh thnh gyho c mnh xm phm tm bo gi l ho c cng tm.


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Cc bnh trong ngoi khoa hay gp do ho c cng tm l: l lot, mnnht ton thn

Can phong ni ng: bnh hay gp sau khi b vt thng cm phi phong tgy ng can kh, xut hin triu chng ming kh h, hm rng nghincht, ngi un cong, c th gy ph thng phong (lin h y hc hin igi l un vn, nu l un vn phi iu tr y hc hin i l ch yu).

Kh ca lc ph ri lon: kh ca lc ph phi lu thng m khng dng,thng ly thng ging lm ch, nu pht sinh ra bnh th kh s ngngtr. Tu theo v tr tn thng m gy bnh v tr khc nhau (v d: vng bng gy au bng, nn hoc bun nn, bng trng, i tin togp trong chn thng vng bng hoc ct sng tht lng v lng). Nhvy kh khng thng th au ph, kh khng ging th nn hoc bun nn,kh tr qu nhiu th gy bng trng, ph kh kt gy b i tin cngthng gp chng bnh cp tnh bng: giun chui ng mt, si gan, mt,si tit niu.

H tiu thp nhit: trong ngoi khoa hay gp thn hkhng kh ho cbng quang gy nn thp nhit v ngng kt h tiu v sinh chng tiutin , t i, i rt, i but, thm ch i ra mu (do nhit t xmphm huyt phn), i c hoc b i, c th gy au tht lng, bngdi tc, ru li vng, nht, mch huyn sc thng gp si tit niu, utin lit tuyn.

Ph kh bt c: bnh da c lin h vi ph, t v tm. Ph ch kh, linquan ti b mao; nu kh ph bt c th tu l khng ng m c, phonghn tha c m xm nhp v gy bnh ma chn, mn nga, mn m aymn tnh do lnh.

Ni tng tn thng: thng do ngoi lc tc ng lm tn thng nitng, tu theo cc v tr b ngoi lc tc ng khc nhau m gy cc tnthng khc nhau (v d: tn thng u c triu chng au u, chngmt, bun nn hoc lc tnh, lc m, hn m (y hc hin i gi l chnng no, chn thng s no gy xut huyt no); tn thng mi gysng au v chy mu mi; tn thng ngc th au ngc, kh th, ho ramu; tn thng bng c chng au bng, trng bng, b trung itin, nn ra mu, i tin ra mu).

Can thn h: can ch cn, nu can huyt h th khng th nui dngc cn gy nn khp au, c ng kh, t mi v yu khp. Hay gpcc tn thng khp v cc t chc phn mm nh: sai khp, tn thng

bao khp, dy chng khp sau chn thng, ng hoc cc c ng btthng.

Nu bnh lu ngy th m dch hao tn, nh hng ti thn m gy chngst v chiu, o hn, li , mch t sc, khp cng kh c ng (thoi hokhp).


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Bng biu hin cc triu chng c tn thng tng ph

Tng ph Triu chng

Tm Hn m, ni nhm, vt v, li kh, hoc ni khng r

Can Ton thn co cng, mt m trng trng, thng hay tc gin, hi hp

T Khng mun n, ung thuc thng nn ra, ngi gy tPh m nhiu, ho suyn - ngc au, ho c th m ln mu, th nhanh, ngt

mi hoc mi php phng

Thn Ming kht, hng kh, m nang co rt, lng gi mm yu

Tng ph u h Ton thn ph, nn nc, a chy, ming y m di

Kh huyt u h Th v ni yu, da xanh, li bu nht, chn tay lnh, ra m hi

2.2.4. Bin chng v h kinh lc

Kinh lc phn b khp c th, bt ngun t cc tng ph thng ra ngoi b

phu, mch, c, cn ct lm cho kh huyt lu thng v nui dng cc tngph, b phu, mch, c cn, xng hot ng. Cho nn bt lun nguyn nhn gybnh no, d trong (tc l tng ph), d ngoi (l b phu), mch, c xngu nh hng ti kinh lc, u lm cho kh huyt tc tr m pht sinh rabnh. V d: bnh l lot da, c (biu) c t c th theo kinh lc vo c quanni tng (l) gy bnh l lot tng ph; ngc li trong tng ph b bnh cth c t t tng ph theo ng kinh lc ra ngoi da, c, xng, khp m gybnh.

Cc bnh da, c, xng, khp d chn thng hay cc c t gy ra ulm kh huyt tc tr gy nn kinh lc ngng tr, cho nn trn lm sng phi

da vo b v ca ng kinh lc m bin chng. V d: bnh gy c (lot, l,nht) l thuc b v ca ng kinh bng quang; bnh vim tuyn v, tctia sa l thuc b v ca ng kinh v

Nh cc huyt nm trn ng kinh lc c lin quan cht ch vi cc tngph cho nn tng ph no b bnh s phn ng trn ng kinh lc (nht lphn ng ln cc huyt ca ng kinh). V d: bnh can m n huyt dnglng tuyn au, bnh ca h thng i tiu trng n tc tam l au cho nnda vo chn on tng ph b bnh (v d: chn on vim rut tha nhuyt lan v au).

Da vo lin quan ng kinh lc vi ng quan, v tr v ng ph (ni c

tr ca tng ph) chn on v iu tr, v d: Bnh nh u thuc kinh c Bnh tai thuc kinh thn. Bnh mi thuc kinh ph. Bnh lng bn tay thuc tm bo lc.


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Bnh lng bn chn thuc kinh thn. Bnh vng lng thuc ng kinh dng. Bnh trong cnh tay thuc th tam m kinh. Bnh pha trong i thuc tc tam m kinh. Bnh pha ngoi i thuc tc tam dng kinh.

Cc kinh lc lin quan cht ch vi kh huyt v cc c quan cho nn bnh kinh lc hoc c quan no cng c th gip cho chn on v iu tr theokh huyt.

+ Nhiu kh, t huyt:C th: bnh tam tiu kinh, tm kinh, m kinh, thn kinh.

+ t kh, nhiu huyt:C th: bnh tm bo lc, tiu trng, can kinh, bng quang.

+ t huyt, nhiu kh:C th: bnh ph kinh, t kinh.

+ Nhiu huyt, nhiu kh:C th: bnh i trng kinh, v kinh

Bnh ni nhiu huyt, nhiu kh hoc nhiu huyt, t kh d khi hnnhiu kh, t huyt hoc t kh, t huyt (v huyt l nui dng kh l thc ykh hot ng).

2.2.5. Bin chng v sng, au, m, nga

Trong qu trnh tin trin ca bnh ngoi khoa thng c du hiu sng,au, m v nga.

Sng: trong c th ngi ta kh huyt tun hnh khng ngng, khng nino khng n, khng ni no khng qua. Nu do nguyn nhn no lmkh huyt ng li hoc ngng tr th ti ni c sng au. Hnh thicng nhmu sc ch sng u khc nhau. Ch sng tn mn thuc h;ch sng cao, tp trung thuc thc; sng thuc phong th ch sng niphng m hay chy; sng thuc m th mm nhn nhbng hoc ngoicng trong mm khng , khng nng, mu da nh thng; v huytm sng th sc hi hng hoc bm tm; nu thnh m th mu sc bini, c th tm bm ln vng hoc mu xanh; sng do huyt khng chy,

sng do kh th chy. au: au chnh l do kh khng lu thng nhng kh l thng soi ca

huyt, huyt l m ca kh nn kh khng lu thng th huyt cng khnglu thng. Cho nn au l do kh huyt khng lu thng, tu theo nguynnhn m c tnh cht au khc nhau; nu au thuc h th a xoa bp,


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nu au thuc thc th xoa bp li au tng; au thuc hn th t li mtch, mu da khng thay i, gp nng th bt au; au thuc nhit thmu hng , gp lnh th au gim; v lm m m au th va au vasng to; v phong m au th au chy khp ngi rt nhanh, km theonga, t b hoc kin cn; v kh m au th au chy quanh khng nhtnh ch no.

Lm m: m l do kh huyt ho sinh ra. Nu kh huyt suy km thkhng th y c ra ngoi c, v th s bi nng ca cc chng ungnht, sang ungl do chnh kh y c ra ngoi lm cho c theo m rangoi cho nn bnh lm m nhung, nht, thng, c n giai onthnh hnh th phi khm xt k xem lm m cha, m su hay nng x l cho ng; ng thi khi c m th v cha v xem xt tnh chtmi mu ca m:

+ Phng php xem c m: ly hai ngn tay n nh ni sng, nu thybp bnh l c m, c nc. Ni ung nht n vo thy nng l c m,khng nng l khng c m; n vo thy cng rn l cha c m, mmnhn trong l c m chn; n nh thy au ngay l c m nng,

n nng mi thy au l m trong su; da phng mng l m nng,mu da khng thay i li khng co ln l m su.

+ Tnh cht ca m: do nguyn nhn khc nhau nn tnh cht m cngkhc nhau. Ngi kh huyt thnh vng th m ra c v vng, ngikh huyt hyu th m ra long v trng, nu m ra nhnc choc nc bt m thi th l chng cha c. Nu lc u ra mvng c, sau ra m nhmu hoa o, ri ra nc nht, l hintng bnh thng d thu ming ln da non. Nu sc m nhdu truhoc chy nc vng hoc nc trong thng nm trong chng cha luv kh.

Nga: nu mn nht trc khi v m pht nga l phong kt hp nhit.Sau khi v m m pht nga l bnh thng, l hin tng kh huyt dndn y , d ln da non nhng nga phi nhkin b mi l tt.

Nu bnh bin m pht nga, c th h, c m chy, cm phi phong msinh ra, l bnh nng kh khi. Mn nht li phnh nhbt go m nga,khi gi chy nc l thuc t kinh c thp, chy ra mu ti l t kinh to qu.

2.2.6. Phn bit bnh lnh - d v chng thun - nghch

Nm im lnh v by im d:Ngi xa tng kt kinh nghim lm sng lu di a ra:

+ Nm im lnh: Tinh thn tnh to khoan khoi, ting ni ho nh thng sut, li

nhun khng kh, n ng bnh thng.

C th nh nhng, yn vui khng bun bc, mng tay ti nhun, khinm khi dy yn tnh.


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Mi ti nhun; m c vng m khng hi thi. Ting ni rn ri, da d ti nhun, khng ho suyn, i tiu tin

bnh thng.

Khng pht nng, ming rng khng kh.+ By im d:

Thn tr bun bc khng yn, ming li kh ro, ni nng lu kh,ni tn thng ming rng thm en.

Thn th cng thng, mt nhn nghing, ming vt thng chy mu. Hnh dng gy cm, khng mun n, ch vt thng c m mm lm

su, khng bit au nhc, m trong t m hi thi.

Da kh rp, nhiu m, thanh m ngng, lu li, ho suyn, miphp phng.

Da en xm, c hng kh ro, bun bc, kht, bu di co ln. Tay chn mnh my ph thng, nn ma, nc, a chy, y bng. Ni tn thng lot nt nham nh nh t con ln, mu t nhin

chy ra, tay chn quyt lnh.

Chng thun, chng nghch:+ Chng thun l ni tn thng v cc chng trng ca bnh pht trin

bnh thng v tin lng tt.

+ Chng nghch l ni tn thng v cc chng trng th hin binchng, tin lng bnh xu.

T lng gi1. Anh (ch) hy trnh by v cho th d v cc nguyn nhn bn ngoi ca

ngoi khoa y hc c truyn.

2. Anh (ch) hy gii thch v cho th d v bin chng bnh l ca kh vhuyt trong ngoi khoa y hc c truyn.

3. Anh (ch) hy gii thch v cho th d v bin chng sng, au, m vnga theo y hc c truyn.

4. Anh (ch) hy phn bit bnh lnh - d v chng thun - nghch ca

bnh theo y hc c truyn.


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Bi 2

s lc lch s iu tr chn thngtrong y hc c truyn

mc tiu1. Hiu c qu trnh hnh thnh pht trin iu tr chn thng theo y hcc truyn.2. Hiu bit v tnh hnh kt hp y hc c truyn vi y hc hin i v iu trgy xng

1. S lc lch s iu tr chn thng theo YHCT n thunT khai thin lp a, y hc phng ng i u vi iu tr chn

thng ni chung v iu tr gy xng ni ring. Tri qua hng nghn nmkinh nghim, iu tr gy xng ngy cng c b sung v hon thin.

Ngi nguyn thu cn trong i sng hoang d, khi i kim n thngdng nhng v kh th s nhgy, ru chng c vi th d; hoc leo troln cy cao, chy nhy hi lm d b tai nn. Lc by gi ngi ta bit dngl cy hoc ru bi hoc xoa vo vt thng, l c s nguyn thu v

ngoi khoa chn thng.

1.1. Y hc c truyn Trung Quc

T i nh Chu (1066-255 TCN) n nh Tn (306-207 TCN) c chia rabn loi thy thuc l thc y, tt y, dng y (cha nht) v th y. Dng y cncha c m chm, ng gy xng...

n i nh Hn (206-25 TCN) v i nh Tn (265-420) c mt s schni v chn thng.

T i nh ng(608-917), ngi ta a khoa xng gp vo khoa xoa bp.

n i nh Thanh (1616-1911), v lun lun c chin tranh nn khoaxng c ch c bit. Nm Cn longth nht (1737) triu tp cc danh ybin son cun Chnh ct php trong c ni v nguyn nhn, triu chng,cch khm, cch iu tr gy xng, sai khp.

V thuc c chia ra thuc ung trong giao thng huyt mch v chngsng au; thuc dng ngoi b v c nh.


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Cc loi dng c b xng nh: trc lim (ci mnh mnh) c nhxng di; lam ly (ci git tha) c nh xng cng tay, cng chn; mcthng (ming g m vo lng) c nh xng sng; yu tr (ci m lng);bo tt (m bao) c nh u gi...

1.2. Y hc c truyn Vit NamXa kia, v cha c sch v ghi chp nn y hc dn tc ch c truyn

ming t ngi ny qua ngi khc. Ring nn b gy xng c tnh cht giatruyn v chuyn nghip.

n th k XIV Tu Tnh trong b Nam dc thn hiu ghi chpphng php iu tr thng khoa v dc vt ng dng nh: b mc t ra tro rc, rt; l cy thanh hao gi ra p; nha cy giao hng (cy thau) bi hn vt thng; cy t rng (ct toi b) c tc dng lm lnh vt thng vlin xng; r cy mng nc (phng hoa tin), v cy go (mc min) p chagy xng....

u th k th XVIII,Ln nggp thm trong quyn Bch gia trn tngc phng thuc cha gy xng, sai khp ca nc Lo truyn sang (cng thc

xin xem mc: thuc dng ngoi).Trong cc phng php c truyn cng c nhiu mn thuc n gin: nh

vp ng sng au th p b ch ti gi vi mui, p l cc tn gi vi mui,p nc g vang sc vi b ch...; chy mu th p lng culi, mng nhn, bhng, lng t ngc con c...; bong gn th chm, b l nng h nng, l ngitng qun, mo cau, b chui...

2. s lc lch s iu tr gy xng bng phng phpkt hp YHCT v YHH2.1. Trung Quc

Tt c cc bnh vin u c kt hp Trung - Ty y trong iu tr gy xngngoi tr v ni tr. nhm khoa hc ho Trung y, cc bc s Ty y hcphng php nn b c truyn ri ci tin, trc tip nn b, theo di v kim trabng X quang. Rt nhiu bnh nhn c nm vin theo di mt thi gian.

Trc khi nn bao gi cng phi tim t, tr em th phi gy m.

t chi tth trung bnh sinh l (c trng thi chng gin nht), dnglc ko v lc ko ngc li gii quyt di lch chng, di lch gp gc, di lchbn, di lch xoay....

Dng c b c khc nhau v cht liu mi bnh vin: np tre nh cho

ngn tay, ngn chn, np bt ngn (Bc Kinh); np g liu c dn mt lp dmng cho m (Thin Tn), nhng u di gi ton b xng hoc chm khp,cho php khp c th c ng c mt phn. Ngoi vic t np, m cng gimt vai tr quan trng nhm chng di lch th pht. m c lm bng giybn tt, c nhiu hnh dng khc nhau ph hp vi ni m. V tr t m tuthuc c ch di lch v nhim v c nh.


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tt c cc bnh vin kt hp iu tr, cc thy thuc u nhn nh:xng lin nhanh hn 1/3 thi gian so vi iu tr b bt, y l cha k n cnng chi gy phc hi nhanh hn, khng mt nhiu thi gian tp luyn vnng nhsau tho bt.

u im ca phng php l nh khng bt ng hon ton khp trn vdi gy, cc khp khc u c th c ng nh nhng ngay, ri cc ng tc

tng dn. V tp c ng c rt sm cho nn mu lu chuyn tt, xngkhng b mt cht vi (nht l ngi gi), c khng teo, do xng gy chnglin.

2.2. Vit Nam

Bt u t 1960, Khoa Chn thng Bnh vin Hu ngh Vit - c vBnh vin Xanh - Pn (Saint-Paul) phi hp vi Vin Nghin cu ng y (nay lBnh vin YHCT Trung ng) p dng phng php YHCT iu trnhng chn thng gy kn. Trong nhng nm u p dng cho mt s gyxng n gin ngi ln ri tr em. T thng 5 nm 1960 n cui 1963 iu tr 1841 trng hp chn thng kn, trong c 658 ca gy xng, 1183 cachm thng bong gn v trt khp.

Nm 1966; Khoa ngoi - Vin nghin cu ng y bc u ci tin np iu tr cc trng hp gy thn xng di nhcng chn, cng tay, xng ingi ln.

T 1977 Vin Y hc dn tc H Ni (Vin Nghin cu ng y trc y) tha k, pht huy u im ca c hai phng php YHCT v YHH, khc phcnhc im ca chng, xy dng phng php iu tr gy xng kt hpYHCT vi YHH nhchnh hnh bng dng c hoc bn chnh hnh, kim traX quang: sau khi v cm bng gy t, chm t hoc thu chm t th tin hnh

chnh hnh theo ph

ng php YHH, c nh x

ng gy bng np tre. Npkhng ngng c ci tin, t np g th s n np c vt iu chnh ngoi, cm bc lt, un cho n khun chi kt hp vi m lm bng giy bn gip chovic chnh phc thm hon thin, chng di lch th pht c nh xng gyngy mt tt hn. Cc bi sau y l ni dung ca phng php iu tr kt hpYHCT vi YHH.

T lng gi

1. Hy trnh by qu trnh pht trin YHCT Vit Nam

2. Hy trnh by tnh hnh iu tr kt hp YHCT v YHH trong gy xng.


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Bi 3

bong gn(Nu thng)

Mc tiu1. Hiu v trnh by c quan nim nguyn nhn, triu chng chn on nuthng, trng thng khoa ca ngoi khoa y hc c truyn.2. Bit v vn dng c phng php iu tr nu thng bng y hc c truyn.

1. Quan nim v nguyn nhnNu l xoay vn, thng l bnh, v xoay vn c khp lm tn thng kinh

lc cn c, kh c tc tr gy au yu nng, huyt tr gy sng nng . Theo yhc hin i l hin tng bong gn, gin dy chng hoc co tht c dy chnggy ra gi tt l bong gn, c th sinh ra cp tnh hoc mn tnh.

Nguyn nhn: do ng tc tri tth, t ngt qu mnh hoc ng tc gb ko di gy nn. V d: quay lng t ngt hoc mnh, hoc xch nng, quayc mnh, nm gi u cao, i guc cao gt hoc tro chn do bng Theo yhc c truyndo xoay vn qu mc, kh c tc tr gy au yu nng, huyt tr

gy sng nng .

2. Triu chng, chn onNu thng hay gp tht lng, c chn, c gy, c tay hoc khuu tay.

Ti ch: sau cc nguyn nhn r rng c th xut hin ngay cc triuchng: c th sau vi ting ng h hoc vi ngy.

Triu chng au ti ni tn thng: au tng dn nh hng ti vn ng,tu theo c tn thng phn mm hay khng m dn dn sng nng , cng ckhi au n thun (khng rch dy chng hoc bao khp), khng c du hiu

gy x

ng sai khp. Nu khng iu tr ngay s gy s

ng n, khng tm (nukhng tn thng mch mu); nng hn c th gy cng khp, long xng.

Theo y hc c truyn: do tc ng gin tip ca cc ng tc hoc ngoilc gy nn kh tr ti ch nn au; sau huyt gy sng nng , thp trgy n.


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3. iu tr3.1. Nguyn tc iu tr chung

Php iu tr: hot huyt, hnh kh, thcn, thng kinh, ch thng.

3.2. Thuc dng ngoi

3.2.1. Thuc pBi 1: p cao thng nht.

Bi 2:

Bt cc tn 8 phn Bt i hi 0,8 phn

Bt ngi cu 4 phn Sp ong 2 phn

Bt qu chi 1,6 phn Du ve 20 phn

Trn u, ng vo l dng dn. Khi dng tu theo v tr tn thng rnghay khng m p trc tip vo ni tn thng.

Bi 3:+ V cy go va gi nt sao vi ru, ngy p 1 ln.+ L nng h nng p vo ni tn thng.

3.2.2. Thuc xoa

Bi 1: Mt gu ha vi ru bi.

Bi 2: Trt tn

Nh hng 1 phn T mc 4 phn

Mt dc 1 phn Huyt gic 4 phnBng phin 1 phn Qu chi 1 phn

i hi 2 phn Nga trut 2 phn

Dy kim ngn 1 phn

Tn bt, mi ln dng ha vi ru va xoa ln ni tn thng, ngy 2 ln.

3.2. Thuc ung trong

Cao tiu vim

Ngi cu 12g T mc 10gHuyt gic 12g L mng tay 10g

Ngh vng 10g

Ngy ung 1 thang, hoc nu thnh cao ung, ngy ung 3 ln (sng, trav ti).


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3.4. Xoa nn, bm huyt

Phng php ny nhiu khi mang li kt qu rt tt.

Ko gin: ko t t theo hng sinh l, lc va phi, bnh nhn cm gicd chu, gi 1-2 pht, sau lm ng tc tr li (ngc li) hng ngtc gy tn thng.

Bt gn: dng ngn ci bt nh

kiu bt dy n, lm 2-3 ln vo ni c cotht c hoc dy chng vng au.

Bm, im huyt: dng cc huyt xa ni tn thng.3.5. Chm cu

Chm t cc huyt ti ch. Chm ton thn cc huyt:

au vng c gy : lc chm, hp cc, c du, kin tnh, phong tr.

au vng c chn : huyn chung, thi xung, tam m giao.

au vng tht lng : thn du, u trung, i trng du, th huyt.

au c tay : th tam l, hp cc, ngoi quan, dng tr.

au khuu tay : hp cc, trung ph, th tam l, th huyt, khc tr.

Thu chm: dng cc thuc gim au hoc gim au chng vim ca y hchin i tim vo cc huyt

vng c gy : c du, kin tnh.

vng c chn : huyn chung, tam m giao.

vng tht l

ng : thn du, i tr

ng du, th huyt.vng cng tay : th tam l.

Khng nn dng cc thuc du tim ni t c.

T lng gi1. Anh (ch) hy trnh by quan nim, nguyn nhn, triu chng v iu

tr nu thng theo y hc c truyn.

2. Anh (ch) hy trnh by phng php iu tr nu thng bng y hc ctruyn.


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Bi 4

Ta thng(ng gip phn mm)

Mc tiu1. Hiu v trnh by c quan nim, nguyn nhn, triu chng v chn on tathng trong thng khoa ca ngoi khoa y hc c truyn.2. Bit v vn dng c phng php iu tr ta thng bng y hc c truyn.

1. Quan nim v nguyn nhnTa thng l gip nt phn mm (ch yu l da, c, mch mu, thn

kinh), khng c rch da do ngoi lc trc tip gy nn.

Nguyn nhn: do cc vt cng p mnh vo vng da - c ca c th nhnh v, ng, th dc, va p.

Vng hay b tn thng l i, mng, lng, bng chn, cnh tay, cng tayv vai gy. Y hc hin i gi l chng ng gip.

2. Triu chng, chn on Vng da c sau khi b ngoi lc trc tip th nng, , au... tu mc

ngoi lc trc tip m vng tn thng to nh khc nhau.

Cng hay km theo gy xng hoc sai khp.3. iu tr

Tn thng ny theo y hc c truyn vn l kh tr huyt .

3.1. Php iu tr

Hot huyt, kh , hnh kh, th

cn. Nu n nhiu th li thu, thmthp; nu sng nng nhiu th thm lng huyt.

3.2. Thuc dng ngoi

p cao thng nht hoc cao song b tn (trc bch dip, i hong, bch, trch lan.


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Bi 5

Vt thng phn mm(Sang thng)

Mc tiu1. Hiu v trnh by c quan nim v bin chng ca vt thng phn mmtheo y hc c truyn.2. Nm c cc trnh t s dng cc bi thuc dng ngoi v dng trong ca yhc c truyn.3. Bit v ng dng tt phng php iu tr vt thng lu lin bng y hc c truyn.

1. Quan nim v bin chngCch y 770 nm trc Cng nguyn, do y hc c truyn pht trin

cho nn bit phn loi trong chn thng, hn na con ngi bit s dngkim kh cho nn khi cc loi kim kh ny gy rch da - c th gi l kim thng.

Sau ny do cc nguyn nhn gy ra vt thng c rt nhiu, ngoi kim khra cn nhiu loi sc nhn khc gy nn, cho nn ngi xa t tn chung lsang thng.

Sang thng l ch cc tn thng rch t da, c, mch mu c th to

nh hoc su nng tu thuc vo lc v vt rn sc nhn trc tip gy nn.1.1. c im tn thng ca vt thng

Y hc c truyn rt coi trng ti tn thng ti ch, c miu t theo mdng, kh huyt nhsau:

STT c im vt thng Dng - kh m - huyt

1 au nhiu + -

2 Chy mu - +

3 Sng khng + -

4 Sng c - +

5 Thm nt + -6 Sng khng thot m + (kh h) -

7 Vt thng chy nc vng - + (huyt h)

8 Vt thng khng lin hoc khng thu ming + (dng h) + (dng h)

9 Vt thng thm nt + (kit) + (kit)


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1.2. S lin quan gia vt thng vi tng ph, kh huyt

Theo quan im ca y hc c truyn: vt thng mau lnh hay khng cntu thuc chnh kh ca c th c th l

Kh: biu hin v au, thot m, vt thng sch. Do vy, nu kh hthvt thng au lin tc m , khng thot m, bn; nu kh cha h thvt thng au t, m thot d dng, vt thng ti sch.

Huyt: biu hin v sng nng, v lin vt thng. Nu huyt , huyt hu gy chy mu, chy nc vng vng tn thng; nu huyt khng hth ni tn thng c nui dng tt cho nn vt thng chng lin.

T: t lin quan ti c nhc, nhip huyt v sinh kh huyt ca hu thin.Trm bnh u do t gy nn v ngc li t nh hng tr li ti trm bnh.Do vy, nu t tt th vt thng chng lnh, t chy mu, d thot m.

Can: can tng huyt, can ch cn; nu can tt th vt thng lnhkhng nh hng ti vn ng.

Tm: ch thn minh, tm tt th huyt y , gic ng lnh, ngi bnhc ngh lc chu kh tp luyn khng li di chng.

Thn: ch ct tu, thn tt th vt thng khng nh hng ti xng.Nhvy vt thng phn mm khng nhng cn ch ti tn thng ti

ch m phi ch ti ton thn, phi bin chng chnh xc gia triu chng tich v ton thn mi c php iu tr tt, bnh s chng khi.

Trong iu tr vt thng phm mm phi kt hp gia y hc c truyn viy hc hin i, ch yu l cn tim phng un vn hoc ATT. Ngi xa c dngrau mung sng 120g ha vi nc si 25ml gn ly nc ung nhng cha cchng minh chc chn cha c nn vn ch vt thng mch mu ln v

dy thn kinh khu cm mu v ni thn kinh.

2. iu tr2.1. Thuc dng ngoi

2.1.1. Thuc cm mu phng nhim trng

Bi 1: Vi ti (vi n tru)

B hng bp ( long v)

Liu bng nhau, luyn thnh thi hoc ming p vo vt thng k c

a cn cng cm mu.Bi 2: L mn ti (hoc l ch rng ca)

Bt i hong

Gi nt l mn ti ho vi nc tiu tr em (ng tin) va gn lync ha vi bt i hong va p vo vt thng.


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Bi 3: L tru khng

L kim ngn

Liu bng nhau gi nt p vo vt thng

Bi 4: Nn chui tiu ln, ly cy non cao 60cm, b b ct tng khc gint p.

Bi 5: Mc cy cau (phn cau) 40g long v 20g

Trn u dng dn, p rc vo vt thng.

Bi 6: T kim an

T kim ng (ging hng) 200g Huyt kit 40g

Nh hng 40g Ng bi t 40g

Mt dc 40g Bng phin 1g

Cc v thuc tn nh trn u cng vi bng phin, cho vo l nt tht kn dng dn, cng lu cng tt.

Bi 7: Ht nhn (sao) 40g

Bng phin 8g

Tn nh cc v, trn u, ng trong l y kn dng dn.

2.1.2. Thuc ra vt thng

Dng cho cc vt thng bn hoc lot, nt c m hoc nc vng.

Bi 1: L tru khng 40g

Nc l 1 ltun si nc vi l tru khng 15 pht, ngui ly nc trong ha vi

bt phn phi, dng ra vt thng, ch dng trong 3 ngy.

Bi 2: Si t 1 phn T mc 1 phn

B cng anh 1 phn Nc 600ml

un si trong 2 gi cn 250ml gn nc cho vo chai dng dn, trong ngyc th p gc.

Bi 3: Tru khng 200g Phn phi 20g

B cng anh 200g Nc 2 lt

un si 2 lt nc vi tru khng, b cng anh cn 250ml ri ra vt thng.Bi 4: Cam thng tin

Cam tho 1 phn

Hnh ti 1 phn

Hai th un si ngui, ra vt thng.


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Bi 5: T hong

i hong 8g Hong lin 12g

Hong b 12g Hong cm 12g

Nu cao p hoc nc sc ra

2.1.3. Thuc lm sch vt thng

Dng cho cc vt thng lot, nt, chy nc vng, lu lin, lu thnh sov da non.

Bi 1: L m qu (thin chu sa)

Cch lm: ly l b cung, ra sch (c th ra thuc tm 1/1000) ronc, gi nt p vo vt thng, p hng ngy khi vt thng sch c ln danon th thi. C th nu thnh cao dng dn nhng khng hiu qu bng l ti.

Bi 2: Cao gii phng

M cy chai 1 phn

Du lc 1 phnun du lc vi m cy chai, khi no m cy chai chy ra th quy u

n khi thnh hn hp ng u ri pht ln ming vi kh, khi s dng dncao ln vt thng ra sch.

Tc dng: ht m xanh, lm sch t chc hoi t, lm vt thng chngkh v sch nht l i vi trc trng m xanh, d ln da non.

Bi 3: Len-t-uyn (cn gi l cy ui phng, dy sng rn, dy leo dcb ro hoc cy c th ven sui): ly 1kg, b l co ht r, ra sch len-t-uyn,bm nh. Ly 3 lt nc un si 3 gi, lc qua khn vi, ly nc sc c li cn700ml va ra va p, dng gc thm nc len-t-uyn p ln vt thng,sau bng li, cch 2-3 ngy thay bng 1 ln.

Dng cho vt thng rng nhbng.

Tc dng khng mong mun: xt, gy phn ng sng .

Bi 4: L sn thuyn (sn xm thuyn nhn dn dng v cy smthuyn, c ni dng l).

Dng 2 cch:

Dng p ti: lm ht m vt thng, t chc ht mc nhanh, da non lndn vo ngy th 2.

Dng bt: vt thng sch, kh, khng chy nc nhng khng tt bngdng ti.Bi 5: L vng nem

Bt l vng nem rc vo vt thng m ht nhanh v sch, au, dchu, chng khi.


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2.1.4. Thuc lm lin vt thng

Vt thng b lot su, sau khi ra sch th p loi thuc lm y vtthng t chc ht mc nhanh v y.

Bi 1: L m qu ti

L bng bong

Lng bng nhau, b cung, ra sch, gi nt, sau khi ra sch vt thngth p thuc, sau bng li, ngy thay bng 1 ln.

Bi 2: L sn thuyn

B cung, ra sch, gi nt, p ngy 1 ln, thuc lm sch vt thng vln da non nhanh.

2.1.5. Thuc lm chng ln da non hoc so

Bi 1: Bo sinh c

Thch cao 30g Xch thch 30g

Khinh phn 30g Nh hng 12g

Hng n 12g Mt dc 12g

Long ct 12g

Gi thnh bt mn, sau khi ra sch vt thng th rc thuc, nu kh thrc 1 ln.

Bi 2: Can khng sinh c tn

Can khng 40g

Nghin nh mn, rc vo vt thng thch hp vi vt thng c tnhcht hn.

2.1.6. Thuc lm tan tht thi, thu ming ln da non

Bi 1: Cu nht tn

Hng n 4g (1 phn)

Thch cao 36g (9 phn)

Tn thnh bt mn rc vo vt thng.

Bi 2: L m qu

L bng bongL nc si

Lng bng nhau, gi nh, sau khi ra sch vt thng th p thuc vo,p n khi no kn vt thng th thi.


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Bi 3: L m qu

L bng bong

Hn the

Lng bng nhau, gi nt p vo vt thng ngy 1 ln sau khi rasch vt thng, p n khi no vt thng y kn v ln da non th thi.

Khng nhng c th dng cho vt th

ng lu lin, su rng, kh y m dngcho c vt thng so li khng ln da non.

2.1.7. Vt thng lu lin, khng ln da non, so li, r nc vng

Bi 1: Phn cau (sao kh) 20g

Phn cy ch 16g

long v 8g

Phn phi 4g

Cc v tn nh, ry k, y kn, ng trong l dng dn; sau khi ra sch

vt thng rc thuc vo, ch rc 1 ln bt s thnh vy, khong 5-7 ngy saubong vy v khi.

Bi 2: Phn phi 55g

Bt hong ng 20g

Bt bng sa 55g

Hot thch 250g

Tn nh, ry k, ng vo l dng dn, khi dng phi ra vt thng vrc bt.

Bi 3: Sp ong 1 phnNha thng 3 phn

Lng trng g 3 phn

un si, quy u thnh hn hp, sau qut vo vi p ln vt thng ra sch, ngy p 1 ln.

Bi 4: M cy m u ( sn xut thnh kem balsino) dng iu tr vtthng lu lin, vim tu xng v vt thng mi khi. Thuc ny c tc dnggim au.

2.2. Thuc ungNgoi vic ch iu tr ti ch th cn ch ton thn, nhiu trng hp

sc khng ca ngi bnh tt ch cn iu tr ti ch. t kt qu iu trtt chng ta phi da vo c tnh ca vt thng v s hthnh ca tng ph,kh v huyt, tn dch iu tr.


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2.2.1. Vt thng th huyt (khng nhim trng)

Php iu tr:hot huyt thanh nhit, lng huyt, hnh kh, sinh c. Phng:

i hong 8g Hng hoa 10g

Phc tiu 6g Mc thng 8g

Ch xc 6g T mc 10g

Hu phc 6g Trn b 6g

ng quy 10g Cam tho 4g

2.2.2. Vt thng th nhit c (nhim trng thi k u)

Php iu tr: thanh nhit gii c, hot huyt, lng huyt, hnh kh,sinh c.

Phng:Bch ch 6g Sinh a 12gng quy 10g an b 12g

Xch thc 10g Xuyn khung 12g

Nh hng 6g Mt dc 10g

Bch trut 12g Cam tho 6g

C th sc ung hoc ngm ru ung.

2.2.3. Vt thng th thp nhit

Triu chng:vt thng lu lin, chy m hoc nc vng. Php iu tr:thanh nhit tr thp, gii c, bi m, hot huyt, sinh c. Bi thuc:Thc l bi nng thang

ng sm 12g Lin kiu 10g

Bch trut 10g Kim ngn hoa 12g

Bch thc (sao ru) 12g Xuyn bi mu 8g

Phc linh 12g Sinh hong k 10g

ng quy 10g Nhc qu 6g

Cam tho 6g Sinh khng 6g

Trn b 6g

Sc ung ngy 1 thang.


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2.2.4. Vt thng lu lin (kh huyt h)

Php iu tr:b kh huyt sinh c. Phng:

ng sm 12g Bch trut 12g

Bch linh 10g Xuyn khung 10g

ng quy 12g Bch thc 12g

Thc a 12g Cam tho 4g

Hong k 12g Ut kim 10g

Sc ung ngy 1 thang.

3. Kt lunKhi b cc vt thng cn phi ch tim phng un vn. i vi cc vt

thng mch mu ln v thn kinh th phi theo di st c ch nh phu

thut.Cc vt thng khc kt qu iu tr rt tt.

T lng gi1. Anh (ch) hy trnh by quan nim v bin chng ca vt thng phn

mm theo y hc c truyn.

2. Anh (ch) hy trnh by phng php iu tr vt thng lu lin bngthuc y hc c truyn.


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Bi 6

i cng v gy xng(C tit)

mc tiu1. Nu c nh ngha v nguyn nhn ca gy xng.2. M t c triu chng lm sng v bin chng ca gy xng.3. Nm c tin trin ca gy xng.

1. nh nghaGy xng l s ph hu t ngt cc cu trc bn trong ca xng do

nguyn nhn c hc, do gy ra s gin on v truyn lc qua xng. Hocni cch khc, xng mt tnh lin tc v hon chnh do ngoi lc gy nn.

2. Nguyn nhn v phn loiHu ht cc gy xng l do chn thng, do lc un b (hoc xon vn,

hoc c hai), trc tip hoc gin tip gy nn. Nu mt xng c bnh (vim,u...) b gy c gi l gy xng bnh l hay cn gi l gy xng t nhin.

Ngoi ra cc chn thng tuy nh, nhng lp i, lp li nhiu ln gy gyxng c gi l gy xng do stress.

Ngoi cc loi gy xng in hnh th tr em thng gp cc loi gycnh ti, gy xng cong tohnh, gy bong sn tip; ngi cao tui v phn mn kinh gy ln, gy c xng i, gy u di xng quay...

Xng c th gy khng hon ton, cong to hnh, phnh v xng, gycnh ti; gy hon ton lm hai hay nhiu on, nhiu mnh. Ngoi ra cn ccloi gy ci, gy ln, bong sn tip hp...

Cc loi di lch in hnh: bn - bn, chng, gin cch hai mt gy, gp gcv xoay.

3. Bin chng Chong do au. Mt mu (k c gy kn). Tc mch mu do m tu.


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Hi chng chn p khoang. Thng tn mch mu ln, thn kinh ngoi bin. Gy h v nhim trng. Hi chng ri lon dinh dng. Can xu. Ri lon chc nng vn ng.

4. Triu chng lm sng

4.1. Ba du hiu chc chn gy xng

Bin dng. C ng bt thng. Ting lo so (thng c nhn bit t cm gic ngn tay ngi khm).

4.2. Ba du hiu khng chc chn au. Hn ch hoc mt vn ng. Sng, vt bm tm.

Ngoi gy xng, cn ch bin chng v cc tn thng km theo (achn thng).

4.3. Cc du hiu gy xng bng hnh nh

Trn phim X quang chp theo hai bnh din (tth khc nu cn), ly c

hai khp ca mt thn xng; chp ct lp c in hoc cng hng t (t dng)vi cc gy phc tp... cho thy v tr gy, ng gy, cc di lch.

Cn ch n cc tn thng sn khp, m mm.

5. Tin trin ca gy xngLin xng gy l phn ng sinh hc t nhin ca c th sng. Cc thnh

tu v sinh hc lin xng n nay hay nu hai yu t chnh gip cho xnglin vng:

S phc hi giao thng mu gy xng: quan trng nht l phc hitun hon cng sm, cng phong ph, giao thng tt... th cng m bo snui dng vng xng gy, cho n khi h thng mch mu trong ng tum ng tr li chc nng nui dng chnh yu.

S bt ng gy: l yu t c - sinh hc m bo cho xng lin vng;khng c bt ng gy au n d di, gy co mch v lm gim giaothng mu vng gy. Cc u gy di ng c hi s ph hu cc mch


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mu tn to, cc mt gy khng p st vo nhau (iu kin xng lin).Vic bt ng khng tt cn gy ra di lch th pht, can lch...

Tm li, xng gy c th lin tt cn c cc iu kin sau:

+ Phc hi lu thng mu y vng gy.+ p st hai mt gy, khong cch khng vt qu mc cho php tu loi

gy, tu la tui.+ Bt ng vng vng gy, ng thi cho php vn ng sm c khp.+ Khng c cc yu t ngoi lai lm cn tr lin xng.C th tm tt qu trnh lin xng gy gm ba giai on lin tip, xen k

nhau:

Giai on sung huyt (hypermie): tiu sch m hoi t, lm sch gy. Giai on phc hi: m hn gn vng xng b gin on. Giai on to hnh xng: m ti to c thm cc cht v c tr thnh

m x

ng chnh thc.Tu theo cht lng bt ng m xng gy c lin theo ba hnh thc c

bn: lin xng trc tip, lin xng gin tip v lin xng theo phng phpcng gin.

5.1. Lin xng trc tip

Lin xng trc tip l s lin xng thng t m xng do mu to ra.M xng ch pht trin bn trong khe gia cc mt xng gy, khng c canbc cu. Trn film X quang: t c hnh nh cc ng can bn ngoi, ng gyhp dn v bin mt.

iu kin quan trng nht c lin xng trc tip l: Cc on gy phi c bt ng vng chcn mc gn nhkhng cn

mt di ng no gia 2 u gy (nht l nhng di ng c hi nhdi ngxon vn, un b, di lch ngang), ch cho php di lch nh theo trc t nn(di lch hu ch l tng s tip xc gia hai mt gy).

Cc iu kin khc nh: m bo lu thng mu nui dng y vng gy, 2 mt gy cng p st nhau cng tt.

Nhng kh khn trong qu trnh lin xng trc tip: qu trnh linxng trc tip ph thuc vo s nn chnh chnh xc v mt gii phu v cht

lng c nh. Gii hn giao ng cho php l rt nh. Trn thc nghim vtrn lm sng ngi ta chng minh l khe gia cc u gy khng nn qu0,5-1mm nu mun c s lp y khe gy bng xng trong 4-6 tun.

5.2. Lin xng gin tip

Hon cnh lin gin tip: bt ng khng hon ton vng chc.


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Hnh thc lin xng: can xng hnh thnh khng nhng khe gia ccmt gy vi nhau m cn bc cu c bn ngoi thn xng to thnh can xngto bao bc ly gy.

Theo Hunter (1837) qu trnh lin xng theo cc bc nhsau:

1. Vim ty.

2. Can x mm.3. Can sn cng.

4. To hnh can xng.

V din bin sinh hc, lin xng gin tip cng din bin tng t nhlin xng trc tip.

5.3. Lin xng bng phng php cng gin

Ilizarov t thp k 60 c cng xut dng phng php cng gin dndn cc on gy m to ra xng mi. iu kin lin xng theo phngthc ny l:

Khng ph hu tu xng:nhm bo ton v khng lm tn thng ccm sinh xng cng nhcc mch mu nui xng.

Cng gin chm, chnh xc: 1mm /24h chia lm nhiu ln, ( > 4 ln). Nhp cng gin khong 2mm c th lm ngng hn hin tng sinh xng dothiu nui dng; ngc li nhp ko cng gin chm (khong0,5mm/24h) c th dn n s lin xng sm, cn tr mc ch ko dixng.

Phi c nh vng chc, n hi:ch cho php mt kiu di ng xng duynht theo trc dc trong sut qu trnh iu tr.

T nn sm trn chi cng gin (i vi chi di).5.4. Ri lon ca lin xng

Cc ri lon ny bao gm: chm lin xng v khp gi.

Chm lin xng l mt khi nim quy c, khi mt xng gy phi bt ngdi hn thi gian bt ng trung bnh ca loi gy xng mi lin vng.

a s cc tc gi coi thi gian phi bt ng thm bng 1/2 thi gian btng trung bnh ni trn.

Khp gi: theo kinh in l s lin xng ngng giai on can sn, xkhng t c vng chc d c bt ng lu di.Nguyn nhn ph bin gy khp gi l xng gy khng c bt ng tt

hoc bt ng qu ngn khng thi gian.

Mt loi khp gi lng lo do mt nhiu xng, trn phim X quang c gincch > 1cm c gi l mt on xng.


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Nguyn nhn: a s nguyn nhn ton thn ch gy chm lin xng, cnnguyn nhn khp gi thng do thiu st trong iu tr, nht l bt ngkhng vng hoc khng thi gian c th gy nn chm lin xng hockhp gi.

V t iu chnh di chng bin dng: di chng bin dng sau gy xngthng thng c bn loi l ngn chi, bc thang (hnh li l), gp gc v xoay

ngoi hoc xoay trong. Phn ln cc bin dng u c sa cha theo xu hngtt hn theo thi gian (tui cng nh, kh nng t sa cha cng ln). Ringxng gy lin tth cn di lch xoay th trong qu trnh pht trin, c th tt iu chnh c di lch ny. Do vy trong khi nn chnh cn phi sa di lchny, i khi ngi ta phi phu thut c xng sa li.

Nhng nghin cu trn thc nghim cng nhnhng kinh nghim c rtra t lm sng, cn lm sng lm r quy lut chung ca qu trnh linxng, c hot ho v iu tit bi cc trm pht tn hiu khu vc v cctrung tm iu tit nm trong tng th mi lin h cc cng ng t bo, to racc hot ng ngn hn, phm vi hp. iu m bn nm chc thp k qua ccc nh chuyn mn coi l chn l trong iu tr gy xng l: sau khi phchi hnh th gii phu, cc on gy phi c bt ng tt, lin tc, thigian, m bo cung cp mu nui dng cho cc u gy v t chc phn mm,m bo khng lm ri lon qu trnh sinh hc t nhin ti gy, ng thi vnng sm h c khp phc hi c nng.

T lng gi1. Hy in cm t thch hp vo ch trng

Gy xng l.qua xng. Ba du hiu chc chn ca gy xng l.. Ba du hiu nghi ng gy xng l.

2. Hy in ch cho cu ng v ch S cho cu sai

* iu kin c xng lin trc tip l

Cc on xng gy phi c bt ng vng chc /S Mu nui dng y /S

* Di chng bin dng sau gy xng l Ngn chi /S Gp gc, xoay ngoi hoc xoay trong /S Tui cng ln kh nng sa cha xng cng ln /S


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Bi 7

Nguyn tc iu tr gy xngkt hp Y hc c truyn

Mc tiu1. Trnh by c cc nguyn tc iu tr gy xng theo YHCT.2. M t c 10 th thut nn chnh c bn.3. K c cc phng php ch to dng c nn b gy xng.

1. i cngiu tr gy xng theo YHCT, ngoi vic c nh xng gy cn ht sc

ch trng vn ng c khp trong thi gian c nh. Xng gy sau khi nnchnh, c c nh mt cch hp l, c th gi cho cc on xng gy v trtng i chnh xc l xng gy c th lin bnh thng; mt khc cn bt chigy v ton thn luyn tp vi cng v bin trong gii hn cho php gip cho thng tn chng lnh, xng gy chng lin v c nng chi sm bnhphc: trong tnh c ng, ng tnh kt hp.

Cc xng hot ng c nh t chc phn mm, ngc li b xng lil im bm ta cho cc c, gia chng c mi tc ng v nh hng ln nhau.Khi gy xng di lch, thng km theo thng tn phn mm; do vy, khi iutr gy xng, cn ch trng iu tr c xng gy ln t chc phn mm.Xng gy cn c nn chnh v c nh sm, t chc phn mm khi b tnthng thm.

Tuy nhin, khi t chc phn mm tn thng nghim trng, nguy cp titnh mng v tn hi chi b thng (v d nh t mch mu, ni tng tnthng...) th cn phi c x l trc, sau mi iu tr gy xng. Cp cutnh mng v phng nga tn ph, li hu qu nghim trng l nguyn tctrong iu tr bc u.

Quy trnh iu tr mt gy xng gm 4 nguyn tc c quan h hu ctun th theo nguyn l: kt hp ng - tnh v quan tm ti ch - tonthn.Bn nguyn tc l:

Nn chnh sm xng gy.


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C nh ngoi cc b mt cch hp l. Luyn tp cng nng. Dng thuc.

Ch nh iu tr theo y hc c truyn cho cc loi gy xng c ch nhb bt v gy xng sm khng do bnh l

2. Nn chnh sm xng gyCh dng cho gy xng c di lch

2.1. Thi gian nn chnh

Xng gy cng c nn chnh sm cng tt, tt nht l nn chnh trongvng 1- 4 gi sau khi b nn v lc ny ti ch cha sng n ln, th php thaotc d dng, c li cho vic lin xng. Khi chi gy sng n nghim trng th cth dng trong ung, ngoi p thuc, c nh np hoc ko lin tc; ng thigc cao chi, i cho sng n gim mi nn chnh. Tr em do xng gy chng lin

nn cng cn nn chnh sm, khng ch i n khi ht sng n mi tin hnh,m phi nn trong m. Chng hn, tr b gy trn li cu xng cnh tay, tich cho d sng n nhiu hay t u cn phi nn chnh sm. Khi nn c thdng hai tay p vng gy lm bt sng n gip cho vic nn chnh d hn.

2.2. V cm trc khi nn chnh

2.2.1. Phng php v cm

Trc y YHCT trong nhiu trng hp khng cn hoc khng c thucv cm th ng tc ca th thut nn chnh phi c thc hin nhanh, mc thch hp, ng tc dt khot. Hin nay hay dng gim au bng phng

php chm t hoc thu chm t bng novocain, lidocain.Mc ch v cm l lm cho bnh nhn ht hoc gim au v gin c

gip cho vic nn chnh c d dng. Ngy nay, v cm c p dng theo myphng thc di y:

Gy t gy: dng 5-20ml dung dch novocain hoc xylocain 1% timthng vo gy. K thut ny n gin, d lm, gim au tng i tt,thi gian ch i ngn (5-10 pht). Phng php i hi v trng tuyt i,v nu khng v trng tt th vic tim v tnh bin gy kn thnh gyh, c th c bin chng nghim trng l nhim trng gy. Mt s tc gicho rng a vo gy mt lng thuc lm thay i ni mi sinh hc t

nhin ti gy lm xng chm lin hn. Gy t cc b:i vi ngi ln, c th gy t vng nhgy chi trn c th

gy t m ri thn kinh cnh tay, gy chi di c th gy t ngoi mngcng (t lm)... u im ca phng php l gim au tng i tt, thigian v cm ko di v gim dn cho n 2 gi sau.


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Nhc im ca phng php l i hi k thut cao v kinh nghim.Trong mt s trng hp gy t m ri khng thnh cng v c th c tai bindo tim vo mch mu, kim tim gy tn thng ngoi mun, sc..

Thu chm t: thu chm t l phng php v cm kt hp YHH viYHCT. Dng 10-20ml thuc novocain hoc xylocain 1% tim vo cc huytnm ln cn hoc nm trn cc ng kinh i qua gy. Phng php n

gin, an ton, khng c nguy c nhim trng gy, khng lm thay i nimi gy nh tim t gy, gim au tng i tt, thi gian ch ikhong 15- 20 pht.

Nhc im ca phng php l v cm khng hon ton; ngi thuchm t cn bit huyt v tim.

Chm t:chm t cng cho kt qu gim au tng i tt. Hiu qu cnc ko di khong 30 pht sau khi ngng tc ng.

Tuy nhin thi gian i t di (t nht l 30 pht), khng gim au honton, phi ph thuc vo loi gy v bnh nhn thuc nhm p ng tt vichm t; ngi chm t cn phi chuyn su v phng tin chm t nhdyin i khi lm vng, cn tr th thut nn chnh xng gy.

Gy m: gy m l phng php v cm tuyt i, lm cho c mm toiu kin ht sc thun li cho nn chnh xng gy. Vi thnh tu cakhoa hc gy m ngy cng tin b cho php gy m ko di v ngy cngan ton hn. Phng php cn c u im gip tr em di 10 tui khi bkinh s.

Tuy vy, gy m i hi phi c cn b chuyn su, ch c th tin hnh nhng c s y t c y trang thit b chuyn ngnh. Thi gian ch i chophp gy m an ton l nhn n ung t nht l 6 gi, i khi chi gy sng nln hn. iu ny t nhiu nh hng xu cho vic nn chnh di lch ca xnggy. Mt s bnh nhn mc bnh mn tnh quan trng nh bnh gan, thn,bnh phi... chng ch nh gy m.

Nhvy, gy m c nhiu u im, nhng hin nay cn kh ph cp tronghon cnh nc ta.

2.2.2. X quang

X quang c vai tr ht sc quan trng, n cho php hiu r cc loi di lch ch nh th php nn chnh v ch tc cc np c nh, ng thi kim tras n nh ca cc on gy trong qu trnh iu tr.

Khi nn chnh:tu tng loi gy khc nhau m v tr cc khp hoc chigy c tth cho ph hp (v d: c nhc trong trng thi chng, thgin tin hnh nn chnh thun li hn).


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2.3. Cc th php nn chnh c bn

Thng dng 10 th php (ly gy xng cnh tay minh ha).

2.3.1. S

Trc v sau khi nn chnh, cn thit phi s nn r tnh hnh di lch caxng gy v kt qu sau nn chnh.

Dng hai tay s nn vng gy mt cch thn trng, xc nh tnh hnh ccon xng gy (v v tr, hng di lch), cng nhnhit v mch ca onngoi vi; cc tn thng khc v mch mu, t chc mm.

Khi nh nhng s khm hai on xng gy c th cm nhn c ting cxt ca hai u xng gy, ting c xt ny khi c kinh nghim s phn bitc l ting c ca hai v xng hay hai mt gy vi nhau, thng qua phnno xc nh c hng di lch sang bn ca cc on gy vi nhau, ting cxt vi nhau trong trng hp b gy vn nhiu mnh.

Phim X quang cho php chn on chnh xc xng gy v kiu di lch,trnh lm bnh nhn au n do thm khm gy nn. Tuy nhin cng cn

khm ton din nm c tnh trng chi gy cng nhngi bnh.

2.3.2. Ko

Dng bng vi c nh ngc vi chiu s ko, sau ko t t vi lc kotng dn cho ht di lch chng ri tin hnh cc th php nn chnh (hnh 7.1).Ko ch yu lm gin trng lc c (trng lc ny co ko gp phn lm ccon gy di lch, nht l di lch chng, di lch gp gc, di lch xon vn).

2.3.3. y

Dng lc y ngc vi chiu di lch gii quyt di lch bn (hnh 7.2).

Cn c vo v tr gy m cn s dng lc y nn mnh hay yu, tu sc khoca ngi nn m ch dng bn tay hay dng hai cng xit (sau khi an cicc ngn vo nhau) lc mnh hn.

Gy xng cnh tay

Hnh 7.1.Dng lc ko vko ngc li

Hnh 7.2.y v ysang bn

Hnh 7.3.p vo


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tay kia nm on ngoi vi dn vng v bn i din theo ngc ng c ch dilch a hai mt xng gy v v tr (hnh 7.6). Li dng th php p (mc2.3.4, hnh 7.3) hai mt gy p st nhau.

Hnh 7.5.Rung theo nhiu hng Hnh 7.6.Nn vng pha sau

Khi p dng th php ny cn ch : khi ko, khng c ko qu mnhv s lm thng tn c; ngc li nu ko qu yu cng lm tn thng c (doc ph ln cc mt gy) thm ch nghin nt phn mm m gia hai on gy.

Khi thao tc hai on gy cn da st vo nhau trnh thng tn thmphn mm xung quanh.

Khi tin hnh nn quay vng on gy, nu thy vng t chc phn mmth cn thay i phng hng, la ng i d v nh hn.

2.3.8. n ba im (tam im ni an php):p dng trong cc trng hp gycnh ti v ch n thun c di lch gp gc.

Mt im l nh gc di lch, hai im kia l hai u xng gy c nngc li vi im nh gc v nn ht di lch gp gc (hnh 7.3).

2.3.9. Tng tip xc (xc nh hp)

Dng trong cc trng hp cc on xng gy di lch xa nhau (v d gyxng cnh tay, do trng lng ca phn ngoi vi gy ko xung lm nhc vgin di c nh u v tam u cnh tay, on ngoi vi tch ri on trung tm).Tng tip xc l lm cho hai u gy ca xng p st nhau lm tng cng

thm tnh n nh. Vi gy ngang xng sau khi c nn chnh thng trc vdi lch xoay, ngi nn nm cht ly on gy trung tm, tay kia nm ly onngoi vi, tr th nh nhng n p hai on lm cho hai mt gy p st nhauthm (hnh 7.8). Khi nn chnh xng gy ngang cng c th dng php xc nh kim tra hiu qu. Nu nn chnh thnh cng, cc mt gy tip xc tt th khitr th n dn hai on gy vo nhau chi gy khng b ngn li.


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Hnh 7.7.Nn n ba im Hnh 7.8.Dn p hai mt gy

2.3.10. Tch

Dng trong cc trng hp gy hai xng cng tay, xng bn tay, xngsn, xng bn chn. Trong cc trng hp ny, cc on gy do s co ko camng lin ct hoc cc c gian t lm cho khe gia cc xng b hp li. Nginn dng hai ngn ci v cc ngn tr, gia, nhn bm phn tch gia ccxng, nn thng cc di lch gp gc, lm cho cc u gy v hp ng ch camnh l t mc ch nn chnh (hnh 7.9). Khi c nh, thng dng m hnha tch xng.

Trn y l 10 th php thng

dng. Cn cn c tnh hnh di lch vloi gy c th m dng mt hay phihp nhiu th php khi ng dng.

2.4. Tiu chun nn chnh

2.4.1. Phc hi gii phu

Xng gy sau khi nn chnh cnphi c phc hi v hnh th chi.Thng so snh vi chi bn lnh hocso snh cu trc tng ng thn th

ngi thng. Cc ch gy phi c tip xc nhau cng nhbnh thng cngtt tin lng c li cho lin xng v phc hi cng nng.

X quang cho php kim tra tt kt qu nn chnh.

Hnh 7.9.Phng php tch xng


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2.4.2. Phc hi cng nng

Sau khi xng gy c nn chnh, c nh, lin xng cn ch trngphc hi c nng chi gy. Mt s trng hp khng th phc hi v hnh th thcn cn c vo tui tc, ngh nghip, thi gian sau gy, v tr gy chn mctiu hi phc cng nng chi lm chnh; khng nn th bo hay c nn chnhnhiu ln lm thng tn thm cn, c, dy chng lm cho xng gy kh lin

v nh hng c nng chi gy v sau. Y hc hin i cng chng minh rngdo nn chnh th bo hay nhiu ln gy ct ho t chc phn mm lm cngc, khp, nh hng xu n chc nng chi gy. Hu qu ny cng thng gpi vi gy trn li cu xng cnh tay nhct ho ngoi khp, cng khuu...Mt s trng hp b vim xng mn tnh ko di.

3. C nh ngoi cc b hp lXng gy sau khi nn chnh cn c c nh mt cch hp l duy tr

tt v tr cc on gy.

Cn lu :

(1) Tnh cht, hng ca lc gy chn thng.

(2) Trng lng ca on ngoi vi gy.

(3) Lc co ko ca cc c.

(4) nh hng ca vn chuyn v phng php iu tr.

y l nhng nhn t dn ti pht sinh di lch th pht trong qu trnhiu tr v s lin xng. C nh ngoi hp l hon ton c th hn ch ti at l bin chng ny.

3.1. Cc nhn t gy di lch th pht sau khi nn chnh v c nhxng gy

3.1.1. Tnh cht v phng hng ca lc gy gy

Xng gy sau khi nn chnh v c nh, nu x l khng ph hp s gynn di lch th pht. Thng gp my loi sau y:

Phn mm nm trn ng di lch b tn thng to thnh ni yu. Lc tc ng khng theo hng trc xng do cn di lch: gp gc, bn - bn...

3.1.2.nh hng ca co c

Cc c lun lun duy tr trng lc c nht nh. trng thi bnh thng,h xng c phn b c ph tr chng gi mc qun bnh. S phi hp co ginca cc c to nn cc ng tc ht sc tinh vi. Do vy li dng tt s co ko vtrng lc cc c gp phn hon thin vic nn chnh v c nh xng gy.


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3.1.3.nh hng bi trng lng ca on gy ngoi vi

Sc nng ca on ngoi vi gy c th lm cho xng gy gp gc, di lchbn hoc to thnh di lch xa nhau. y cng l mt nhn t nh hng. Xngcnh tay thng hay b gy ngang, do vy sau khi nn chnh, c nh, trnglng on ngoi vi b ko xung gy gin cch gia hai mt gy v hu qu lchm hoc khng lin xng.

3.1.4.nh hng ca vn chuyn v phng php iu tr

Sau khi nn chnh v c nh xng gy, bnh nhn c a t bungth thut v phng bnh hoc t bnh vin v nh. Trong qu trnh vnchuyn, nu thiu cn trng c th lm xng gy di lch th pht. i vi trem cn c phng php vn chuyn ng, khng to nn lc gp dui qumc. Ngoi ra vic c nh khng chc chn hoc tho b phng tin qu smcng c th dn ti xng gy b di lch th pht.

3.2. Tc dng ca c nh ngoi

u im ca c nh np - dy buc l d dng iu chnh cht theotin trin ca sng. Sng cng gim bao nhiu, dy cng c buc cht tintheo n .

Vic s dng lt giang cho php iu chnh cht m i, nh nhng,khng nh hng n bt ng. Tuy nhin lt giang khng c n hi thchng cn thit cho din bin ca sng n, nht l trong thi gian u. S dngdy bng vi khc phc c nhc im ny, nhng vic tho m nt iuchnh cht kh khn hn.

Hin nay, ti Bnh vin Hu ngh Vit - c chng ti s dng dy dn(dy vencro) c n hi v cho php thao tc d dng, nng cao hn kh nng

v cht lng c nh.

3.2.1. Lc tc dng bn ngoi ca dy, np, m c nh

Khi dng np v dy qun buc to nn lc p nht nh. y l loi lcthng qua np, m c nh v tc dng ca t chc phn mm vng gy, lnhn t trng yu chng li di lch th pht ca xng gy. Chng hn dng 3m t vo xng gy phng ti di lch gp gc; dng hai m t c nh phng di lch bn - bn. i vi ngi ln khi b gy xng ln (nhxngi), do c dy, lc co ko ln c lc chng li gy nn di lch th phtcn phi phi hp ko lin tc bng bng keo dn da hoc inh xuyn qua li

cu x

ng.3.2.2. Tc ng ca lc co c

Cc khp v c ca chi gy c th phi hp hot ng co dui nh sc koqun bnh ca cc nhm c i lp c th gip v duy tr tc dng c nh.Do vy, cn phi cn c vo gy, loi gy, ni gy, la tui, sinh hc lin


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xng xc nh cng , bin tp luyn chi gy mt cch ph hp. Cc cti di vng c nh hot ng co gin (ln gn), c th tc dng ln xng gymt lc nht nh, mt mt to nn lc p dn hai u xng gy tip xc chthn, hai on gy nh vy n nh hn; mt khc khi c ln co gin, tun honkh huyt cng tng hn, m v np cng sn sinh lc gin tip tc ng lnxng gy, ngoi mc ch c nh v chng di lch th pht th vic t np vm hp l cn gip hon thin thm s nn chnh cha c hon ho, chuyn

nhng nhn t bt li thnh c li.

3.2.3. cc khp ca chi gy v tr ph hpSau khi nn chnh v c nh, chi gy c v tr ph hp c ngha

quan trng duy tr s n nh ca cc on gy. V d: gy xng cnh tay,on ngoi vi di lch vo trong v ra trc, on trung tm di lch ra ngoi vln trn to thnh gc m ra trc trong. T chc phn mm pha trc gycng b tn thng, to thnh ni xung yu. Sau khi nn chnh v c nh, cnphi a cnh tay ra ngoi, ln trn, khuu gp th mi c th duy tr tnh nnh ca xng gy. Gy trn li cu xng cnh tay kiu dui, cn c nh

khp khuu t

th khuu gp khin cho c tam u cnh tay ko cng gntam u to cho on ngoi vi c tnh n nh v tr nn chnh.

Nhvy, t cc khp ca chi gy nhng tth khc nhau c th iutit trng lc ca c nhm to nn nhng nh hng nht nh i vi tnh nnh ca cc on xng gy, duy tr s n nh ny trong 2-3 tun. Khi tpluyn, cn trnh cc ng tc bt li cho vic c nh xng gy, phng dilch th pht.

Tm li, xng gy sau khi c nn chnh v c nh, c nhiu nhn tc th dn ti vic pht sinh di lch th pht. Nu sau khi nn chnh ng dngc nh ngoi cc b mt cch uyn chuyn, hp l, phi hp tp luyn mt cchng n th c th phng trnh c di lch th pht, hon thin thm vic

nn chnh, c nh n, xng gy lin nhanh, cng nng chi phc hi tt... ktqu iu tr tt.

3.3. Ch nh c nh np dy buc

T chi gy kn: ring i vi gy xng i, do i c c ln, li c sc cmnh, cn dng phng php ko lin tc bng phng php YHH phihp c nh np.

T chi gy h: vt thng nh hoc c x l lin vt thng. Gy xng c cn nn chnh sa li.

3.4. Cc loi c nh ngoi cc b n thun dng np v dy vi c nh ngoi cc b: thch dng i vi

cc gy xng ng di (tr gy xng i).

C nh np vt khp: dng vi gy xng gn khp v gy ni khp.Nhgy li cu ngoi hoc li cu trong xng cnh tay, gy xng cnh


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tay 1/3 trn v 1/3 di, gy trn li cu xng cnh tay, gy mm khuu,gy xng chy on trn c chn...

C nh np kt hp khung c nh: thng dng cho gy xng i (gymt on).

Np kt hp ko lin tc: thch dng trong gy xng i (gy mt on),cc trng hp gy sng n ln, phng lon dng khng cho php nn b

mt th. Ngi ta thng ko lin tc trong giai on u, khi gim sngn th chuyn sang b np.

C nh np dy buc kt hp ngoi gi c nh: thch dng trong iutr gy xng cnh tay c di lch xa nhau lm xng gy chm hockhng lin.

Np kt hp gi c nh chi trn: thch dng cho trng hp gy xngcnh tay xoay trong v xoay theo trc phng on ngoi vi gp gcvo trong.

Np kt hp quang cao su: thch dng trong trng hp gy thn xngcnh tay c di lch xa nhau do trng lc ca on ngoi vi ko xung.

C nh vng my: thch dng khi b gy xng bnh ch tch hai mnh,di lch xa nhau.

Bn kim loi hoc kt hp np: thch dng trong cc trng hp gy xngbn v t ngn tay...

Mt s loi c nh c bit:+ C nh bng keo:dng trong trng hp gy xng sn v xng chu.+ Bng vi hnh ch s 8 kt hp bng keo: dng trong trng hp gy

xng n.

+ B bt trn keo, b bt trn keo kt hp vi np: dng trong trng hpgy xng bn chn.

Mt vi lng y gi trn thuc vi l khoai lang b.

3.5. Phng php ch to dng c

Nhng vt liu thng dng l np, bao vi bc np, mnh, m , dybuc, bng, bng keo, dng c ko, bn kim loi, quang cao su...

3.5.1. Np

Np l mt dng c quan trng dng c nh xng gy theo phng phpYHCT.

Nguyn liu: np c th lm t nhiu loi vt liu khc nhau nhg, v cy,ba cng, mo cau...v thng dng nht l lm bng tre hoc cy h tre.


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Tiu chun k thut:+ Np phi c rn lm gi cho xng gy, li cn c do v

n hi nht nh, thch hp cho p lc ni b vng b khi co c tpluyn sinh ra.

+ Hnh dng thch hp ni vng b.+ Kch thc di, rng tng ng theo yu cu c nh, sao cho sau khi b

khe gia cc np khong 1cm.

+ c bc hoc m m trnh thng tn do chn p ln da. Phng php ch to: tu loi nguyn vt liu khc nhau m c phng

php ch to khc nhau. Vit Nam, np ch yu c ch t np tre.

+ Chn tre: tre tt l loi tre bnh t (tre khng gi qu, cng khng nonqu), tui tre khong 1,5-2nm, ngoi v cn mu xanh, cc cnh ngang(thng gi l tay tre) phn gn gc trng thnh, khng cn tay treno di dng mng, v thn cy c bc lp phn ng, cc t tre di

chiu di ca np nh lm.Khi tre qu gi, l vng a, thn tre chuyn vng, ngoi ph phn nh

bn t l loi tre cng, chc, nhng kh nh hnh sau un.

Ch :khng dng tre ct ngn (tre b gi bo lm gy ngn khi ang cnl cy mng). Loi tre ny cht mm, gin, un d gy v tnh n hi km.

+ Cch lm: ch tre thnh phin mng 4 - 5mm, bn rng 3-5cm.Cho tre vo un si trong nc mui long 10 - 15 pht tr mi mt ri

a ra h nng, nc trong np si xo xo ri ht si, phin tre tr nn tngi do l c th cho vo khun hoc un th cng theo hnh dng yu cu. Sau

khi un xong, nhng phn un vo cn 70-90% hoc dung mi hu c (c thdng dm) nh hnh.

3.5.2. Mnh

c lm t cc nan tre, na. Nan c b rng t 5- 10mm, dy khong1mm c lin kt vi nhau bng lt giang. n sau ny Nguyn Quang Longci tin cho vo ti vi qun vo ni cn c nh.

3.5.3. m

m c nh cng l mt thnh phn quan trng cng vi np trong c

nh xng gy. Mc ch chnh ca m l phng di lch th pht v phn no gip cho s chnh phc thm hon thin.

Nguyn liu: m thng c lm bng giy bn gp xp nhiu ln. Tiu chun k thut:

+ m, ht m v khng kch thch da.


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+ Hnh dng kch thc ph hp ni vng m: m c nh to, nh, dy,mng, hnh dng u nhm tc dng lc ni vng m. m qu bhoc qu nh u nh hng khng tt cho vic n nh cc on xnggy. C th phn lm nhiu loi m v ng dng khc nhau.

Cc loi m+ m phng:hnh vung hoc hnh ch nht l loi m hay s dng

nht, ( rng nh hn np v ph thuc ni tip xc; di, cn c di ca chi gy v ni m, m c th di khong 5-15cm; dy cnc vo dy v mnh yu ca t chc phn mm ni m m nh,thng thng m dy khong 1,5-4cm). T chc phn mm mng, nhoth dng m tng i mng; t chc phn mm dy th dng m ckch thc dy.

ng dng:cn c vo hnh dng xng gy, tnh hnh di lch, nguyn lc lc hc t m cho ph hp. Thng dng phng php: dng 2 m, 3m v 4 m.

* Dng 2 m: thch dng cho xng gy c di lch bn. Sau khi nn

chnh, mi m c t pha i lp ca mi on gy (hnh 7.10).* Dng 3 m: thch dng trong trng hp xng gy di lch gp gc. Sau

khi nn chnh, 1 m t vo ni nh gc; 2 m cn li t hai u xng gy,i din vi m th nht. Ba m hnh thnh i lc phng xng gy ti dilch gp gc (hnh 7.11).

Hnh 7.10.C nh c 2 m Hnh 7.11.C nh c 3 m Hnh 7.12.C nh c 4 m

* Dng 4 m: thch dng trong trng hp xng gy va c di lch gpgc, va c di lch bn - bn. Sau khi xng gy c nn chnh, tu tnh hnhdi lch ca xng gy m s dng kt hp phng php dng hai m, ba m(hnh 7.12).

+ m tch xng:thng dng trong trng hp gy hai xng cng tay,gy xng bn tay hoc bn chn. Sau khi nn chnh, dng bng hay


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giy bn qun trn thnh m hnh a ng knh 1-1,5cm, di 6-10cm lm m tch hai xng phng gia cc xng (v d xngquay v xng tr) khng c khong cch thch hp lm nh hng nc nng ca ni gy. Khi t m cn phng s chn p lm tnthng, lon dng t chc phn mm (hnh 7.13).

Hnh 7.13.mtch xng

Hnh 7.14.mhp ct

Hnh 7.15.mtrng tm

Hnh 7.16.mnghing

Hnh 7.17.mhnh li Hnh 7.18.m

u ln

Hnh 7.19.Bng keodn dng ko lin tc

Hnh 7.20.Vng dy cnh gy xng bnh ch


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+ m hp ct:thch dng trong trng hp gy mm khuu v gy licu trong xng cnh tay. Sau khi nn chnh, dng m phng, ctkhuyt hnh bn nguyt t ln mnh gy phng di lch th pht(hnh 7.14).

+ m trng tm:dng trong gy li cu trong, ngoi hoc v mm chy,mt c chn. Sau khi xng gy c nn chnh, phn trng tm m

s c t ln phn li ca li cu hay mt c chn... phng s chnp cc b trn phn li ln ca xng gy (hnh 7.15).

+ m nghing hay m bc thang:dng m gn khp, ni phnh to caon hnh xng. m hnh nghing gip cho m ph hp khun chini cn m (hnh 7.16).

+ m hnh li:ng dng m cc u np. Cn c u np v cc b nitip xc m dng m hnh li mt cch ph hp (hnh 7.17).

+ m u ln:ng dng trong trng hp gy li cu ngoi m mnhgy tch ra. m u ln c t trm ln li cu, cn bn i din t

hai m bc thang (hnh 7.18).2.5.4. Bng keo

Lm bng vi pht nha dui hoc ngy nay dng bng dnh. i vi gyxng c c ln nhxng i, bng keo dnh da c ko lin tc kt hp vib np.

3.5.5. Vng dy

c s dng khi gy v xng bnh ch, vng dy c t m ly xngbnh ch v dng dy nt c nh ra sau.

3.5.6. Bng vi

c dng lm bng qun c nh hoc lm dy buc.

3.6. Phng php c nh (hnh7.21)

gy c bt ng tng i, hai khp trn v di gy c giiphng hon ton hoc b bt ng mt phn (gy gn khp).

Hnh 7.21.Phng php c nh


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3.7. Nhng im cn ch sau c nh np cc b

3.7.1. Gc cao chi gy

Phng php ny c tc dng lm gim sng n. C th dng chn, m,khung... lm gi .

3.7.2. Quan st theo di

Sau nn chnh, c nh, cn theo di cht ch 1- 4 ngy v mch, mu sc, m, cm gic, mc sng n v vn ng t ch ca phn chi thuc ngoivi vng b. Nu pht hin tun hon tr, cn ch theo di v iu chnh cht dy buc, trnh cc bin chng ri lon dinh dng do thiu mu nui.

3.7.3. Ch c nhng im au do c nh gy nn

Nu trong np ti vng chi b c im au chi (c th do m, c th docc u np gy nn) cn kp thi tho np kim tra phng bin chng lot,hoi t, nhim trng...

3.7.4. Thng xuyn ch iu chnh cht ca dy bucKhi chi gy gim sng, s pht sinh hin tng lng np, do vy hng

ngy cn phi kim tra cht dy buc kp thi iu chnh tng ln.

3.7.5. Theo di on xng gy di lch th pht

Xng gy sau khi nn chnh, c nh cn nh k kim tra tnh hnh dilch th pht ca cc on xng trong khong hai tun u. Nu c di lch thpht cn xem xt li cht ca dy buc v v tr cc np tm nguyn nhndi lch, nu qu mc cho php mi cn phi nn chnh li.

3.7.6. Hng dn ngi bnh tin hnh tp luyn (xem mc tp luyncng nng)

3.8. X l nhng bin c sau khi b np

3.8.1. Tun hon tr

Thng do buc cht qu hoc sng n trong giai on cng vim, chi thtm lnh, au but. Cn ni lng np, treo gc chi cao v theo di cht ch.

3.8.2. Lot do chn p

Cha nguyn nhn gy chn p, x l nhim trng. Nhn chung nu kim

tra ng ch v tin th him gp loi bin chng ny.3.8.3. Theo di thng tn kinh lc

B np c th gy tn thng kinh lc nhlit, ri lon cm gic

Trong trng hp nghi dy thn kinh b t hoc b chn p nng, cn canthip bng phu thut.


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3.9. Thi gian b np

Tu tng loi gy, thi gian c nh c khc nhau. YHCT thng cn ckhi trn lm sng c du hiu lin xng. C nhiu yu t nh hng n qutrnh lin xng bnh thng nhv tr gy, tui tc...

3.10. Tiu chun lin xng

3.10.1. Tiu chun tho np Ti ch n khng cn au. C ng chi gy v mi hng khng au. Ht c ng bt thng. Trong iu kin ngy nay X quang cho php khng nh lin xng bi

hnh nh can xng.

3.10.2. Tiu chun lin xng thc s (kt hp YHH)

C y tiu chun lin x

ng trn lm sng. X quang mt ng gy.

Lin xng thc s nhanh nht 6 thng sau gy. Tr s sinh c th sm hn.

4. Luyn tp cng nngLuyn tp c coi l bc quan trng trong iu tr gy xng theo YHCT

nhm t ti mc ch iu tr l phc chc nng chi gy. Nn chnh xnggy sm, c nh xng gy cc b mt cch hp l, ng thi tin hnh luyntp chnh xc theo tin , pht huy c tnh nng ng ch quan ca ngibnh c coi nhl nguyn tc iu tr.

Nguyn tc tp luyn: tp t nh n mnh, t bin nh n bin ln, t n gin n phc tp v khng c ng tc tp no gy au.

4.1. Th t tp luyn

4.1.1. Thi k u (thi k thay i c ho ti gy)

Thi k ny thng tin hnh 1-2 tun sau gy.

Ti ch sng, au, cc on xng gy cha n nh d di lch th pht, tchc phn mm cha bnh phc, do vy luyn tp trong thi k ny ch yu lco dui c ti ch, hay ni cch khc l ln gn ti ch. Cc khp trn v di

gy c bn l gi yn, cc khp khc ca thn th c th luyn cng nhm giaothng kh huyt gip cho tiu sng, phng c bp teo nho, hn ch chcnng khp v lm cho hai mt xng gy tip xc nhau.


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4.1.2. Thi k gia(thi k hnh thnh can xng)

Lin h vi YHH th thi k ny bao gm t bt u hnh thnh canxng n lin xng lm sng.

Thi k ny sng n gim, ti ch tng i ht au, tn thng tchc phn mm hi phc, xng gy c can dnh kt, cc on gy bt u ivo n nh. Hnh thc luyn cng trong thi k ny l tip tc tin hnh hot

ng co dui c ti chi tn thng, nh tr gip ca chi kho hoc cn b y ttng bc hot ng cc khp trn v di ni gy. ng tc phi chm, phmvi phi t nh n ln, v sau khi xng gy c can cng hn kiu lin xnglm sng th cn gia tng s ln hot ng, gia tng bin v cng .

4.1.3. Thi k cui (can xng cng)

Thi k ny hnh thc luyn cng ch yu l tng cng hot ng chng ca cc khp ca chi gy lm cho hi phc phm vi hot ng bnh thngca cc khp.

4.2. Nhng iu cn ch khi luyn tp cng nng Cn c vo s khc nhau gia cc giai on gy, ni gy, bn cht ca

thng tn phi hp ng dng cc phng php tp luyn khc nhau.Cc hot ng nht thit tin hnh di s ch o ca nhn vin y t.

Luyn cng phi tin dn tng bc. Ngay sau khi nn chnh c nh cnbt u luyn cng kin tr cho n lin xng. Cn c tin trnh linxng, phm vi luyn cng tng bc gia tng, tng dn s ln, nhng cnphi trnh khng ch gy b au v ton thn qu mt.

Luyn cng khng c nh hng n cht ca c nh xng gy,nht thit cm tuyt i mi hot ng bt li cho s lin xng.

5. dng ThucNgoi nguyn tc c nh xng gy: kt hp ng v tnh trn, nguyn

tc th hai trong iu tr gy xng theo YHCT l kt hp ti ch vi ton thncn th hin trong dng thuc xoa hoc p ngoi c tc dng ti ch v thucung trong c tc dng ton thn.

5.1. Thuc dng ngoi

Kinh nghim trong dn gian cng nh sch ghi chp li v thuc dng

ngoi p b gy x

ng rt phong ph. Th k XIV, Tu Tnh trong schNam dc thn hiu c phn dnh ring cho thng khoa v dc vt ng dng.u th k th XVIII Hi Thng Ln ng (L Hu Trc) trong quyn Bchgia trn tng c nu bi thuc t Lo truyn sang:


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Bi thuc p:G con 1 con (b lng v lng) Ba bt cm np

Tm gi, v go, qu chi tn bt 20g. u b v 3 cn

Tt c cc th gi nh ln nhau p vo vng gy sau khi ko nn.

C kh nhiu bi thuc p ngoi, tuy nhin nhc im ca phn ln ccbi thuc l nhiu v, phi thay thuc nhiu ln lm bnh nhn au v d gydi lch th pht.

Cc thuc dng ngoi c s dng tu thi k, hng theo cc php iutr nhung thuc trong. Hai php c ch trng: hot huyt tiu v b canthn, tip lin xng. Cc bi thuc c cu to t cc v thuc c tc dnghot huyt, li thu, lm n m gn ct, gim au, thc y lin xng v c tcdng st trng.

V sau cc thy thuc c xu hng ci tin theo hng gim s v v dngdng t dng th n dng bt ri n dng cao dn, cn xoa.

Di y l cng thc cao dn c sn xut ti khoa dc vin YHCTVit Nam:

+ Cng thc cao thng nht:Bt ngi cu 4 phn Bt i hi 0,8 phn

Bt cc tn 8 phn Bt qu chi 1,6 phn

Sp ong 2 phn Du thu du 20 phn

Tt c c trn u, p ln vi mng hoc giy dai dn vo vng gy(Lng y Phm Vn Su, Vin YHCT).

+ Cng thc bng vt thng gy h(Lng y Bi Xun Vn, Th Xun,Thanh Ho):Hng n 12g; Bng phin 4g; Bch cp 8g

Cng thc mt s ru v thuc dng ngoi c nghin cu ti vinYHCT Vit Nam xin xem phn tham kho.

Ngy nay di nh sng khoa hc, tc dng ca nhiu bi thuc clm sng t. Tuy nhin vic xoa bp, p thuc trong chn thng gy xngcng cn ng phng php tun theo c ch ca sinh hc lin xng.

5.2. Thuc ung trong

Da trn quan im iu tr ton din, kt hp ti ch v ton thn, saukhi xng gy c nn chnh v c nh, YHCT ch trng dng thuc tcng ti ch bng xoa, p v thuc ung trong c tc dng ton thn. iu nyc coi nhl mt nguyn tc iu tr. Thuc YHCT dng trong iu tr chnthng ni chung v trong gy xng ni ring rt phong ph v a dng. Di


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y xin ch trnh by thuc ng dng c th trong tn thng xng khp. Ccbi thuc c phng xin ch c nu tn, phn cng thc xin tham khoTuyn tp phng thang (NXB ng Nai 1995).

Tn thng gy xng ch yu l do ngoi thng. Sau khi tn thng ttyu kh huyt, tng ph cng nhkinh lc ton thn u bin ho. Ngi xani: Chi th tn thng bn ngoi tt kh huyt thng bn trong, phn v c

s bt n, tng ph do vy bt ho hoc Ngoi th

ng tn b phu gn x

ng,bn trong ng kinh lc, tng ph. iu ni ln cc b v chnh th linquan mt thit vi nhau. Vn dng bin chng lun tr, ung trong v dngngoi thuc YHCT c th iu chnh ni b c th, iu ng nhn t c li, xctin xng khp mau bnh phc. Qua kinh nghim c truyn v cc quan sttrn lm sng khng nh: thuc YHCT c tc dng thng hot kinh lc, tiuthng, ch thng, nhu dng kh huyt, ho dinh sinh tn.

Trong thc tin lm sng, da vo bin chng lun tr ng dng thucYHCT iu tr gy xng c th phn chia lm ba thi k: thi k u, thi kgia v thi k sau.

Thi k u dng theo php hnh , hot huyt, sinh tn; thi k giadng php b ch can thn tip lin xng; thi k sau dng php cng cn,cng ct phc nguyn.

5.2.1. Hot huyt ph

Gy xng trong thi k u (1-2 tun sau khi b thng) c th dngphp hnh hot huyt sinh tn. Ngi xa ni: Nht n th thng, khhuyt tc tr, dc tr k thng, tin hnh k , dc tiu k thng, tt hot khuyt, t thng khoa dng dc chi s d hnh hot huyt v bt nh phpmn gi, ngha l: Mt khi b thng, kh huyt vn hnh lp tc b tr trdn ti sng n. Mun tr au u tin phi hnh ; mun tiu sng tt phi

hot huyt. V vy, s d trong thng khoa khi dng thuc khng th khngdng hnh , hot huyt. Tuy nhin cn phi tu tnh hnh c th thng tnnng nh v bn cht ca tn thng s dng php tr thch ng.

5.2.2. Hnh kh hot huyt

Trng hp thng tn th cht t, chng trng nh c th dng php nyiu tr. Sch Ni kinh ni: Kt gi tn chi ngha l chng kt dng phngphp tn iu tr. C th dng cc bi thuc p ti ch, hoc Tht l tn (1) hoc dng ru T kimxoa ti ch. Ung trong c th dng Tht l tn hocTrt hon. Thuc sc c th dng bi Phc nguyn hot huyt thang, Hotdinh ch thng thang, Phc nguyn thng kh thang, Thun kh tn, Chnh ctmu n b thang, Nht bn chu thang.

5.2.3. Cng ph trNgi b nn kho mnh, tr tng i nghim trng, ti ch sng v

huyt lu tiu. Trong trng hp ny hot huyt c th thu kt qu. Sch Nikinh ni phng php: Kt gi tiu i.


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5.2.4. B can thn, tip lin xng

K gia ca gy xng (sau gy 1-2 tun n khi lin xng trn lmsng) c th dng php b ch can thn, tip lin xng. Can ch cn, Thn chct, do vy php b ch can thn l tc cn, tip ct. Thng dng cc bi nhTinh qu kt ct cao,Ni phc bt l tn vKt ct tn. Ngoi dng thuc nhtrn ni, bn trong c th dng thuc B thn trng cn thang hoc Tn

thng iu kinh thang, l b thuc cng hay cng b kim tr.5.2.5. Cng cn trng ct

K sau ca gy xng, sau khi xng gy lin lm sng dng phpcng cn trng ct php. C th dng cc dc vt nu trn. Khi chi gy bcng khp, c bp teo nho, gn c co qup, c th dng Thcn thang lmtng kh nng tp luyn, tng bc phc hi cng nng chi gy. Vi ngi thcht yu nhc, c th dng thuc b nhBt trn thang, Thp ton i bthang...

5.2.6. Thanh nhit hot huyt

Dng trong cc trng hp huyt ngng tr, huyt ho nhit, vtthng sng nng au. Dng cc thuc hnh hot huyt nu trn, giathm mt s v hn lng thanh nhit nhhong lin, hong cm, sinh a, nb, hong b... nhng cn ch phng hn lng thi qu ngn cn vic tiutan tr.

5.2.7. n kinh thng lc

Nhng thng tn lu nhim phong, hn, thp sng au nng ln c thdng php n kinh thng lc khu phong, tn hn, hot huyt tiu sng.Thng dng thuc ung trong nhThu ct an, Thcn hot huyt thang

v.v.. T chi th

ng tn lu, b phong, hn, thp xm nhp cng c th dng Th

cn thang. au vng lng hoc au lng cp, tn thng mn tnh kim phonghn c th ung nh thng hon.

Khong ba thp k li y, c nhiu bi thuc kinh nghim, bi thuc dngian c vin YHCT Vit Nam su tm, tha k. Di y l cng thc mts bi thuc c dng:

Ru (bi thuc gia truyn nhiu i ca lng y Bi Xun Vn ThXun - Thanh Ho)

Phng phong 8g Sa nhn 4g

Huyt gic 12g Thin nin kin 5gXuyn quy 8g c hot 8g

Tc on 2g i hong 8g

C 1 lt ru ngm 65g thuc, ngm 7 ngy ri lc ru ung.


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Tiu vim (thuc nam x)

L mng tay 10g Ngh 8g

Huyt gic 12g T mc 10g

Ngi cu 12g

Nu thnh cao lng, mi ngy ngi ln ung 30ml.

Thuc b gn xng(thuc nam x)Bt lc gic xng 10g Bt ct toi b 12g

Mu l 4g

Mt s bi thuc khc xin tham kho phn ph lc.

Tm li, mt trong nhng vn qu ca YHCT l iu tr gy xng. Kinhnghim v lnh vc ny c lu truyn qua nhiu th h mang tnh cht giatruyn. iu tr gy xng n thun theo YHCT trong nhiu trng hp hiuqu nn chnh cha tt, phng tin c nh n gin, d ph cp nhng chtlng c nh cha cao trong cc trng hp gy xng ln, c c co ko mnhnhxng i hoc mt s trng hp gy gn khp. iu tr gy xng theoYHCT hay theo YHH u c u im v nhc im nht nh. Vic kt hpYHCT vi YHH nhm pht huy u im v khc phc nhc im ca tngphng php cho php iu tr cht lng ngy mt cao hn, hon ho hn.

Phng php iu tr gy xng kt hp YHCT vi YHH l mt trongnhng phng php bt ng uyn chuyn mang tnh c nng, mt xu hngm ngnh chn thng chnh hnh v ang hng ti (Ilizarov G.A). Qutrnh lin xng ca phng php c nh sinh hc to lin xng gin tip (linxng k 2), kiu lin xng nhanh chng, cn lin xng trc tip (lin xngk 1) l mt qu trnh chm chp. Theo ng Kim Chu th iu tr gy xng

theo YHCT l mt trong nhng phng php iu tr ton din. Chng timong c nhiu nghin cu nhm hin i ho YHCT, xy dng phng phpiu tr gy xng vi cht lng cao, mang m bn sc YHCT dn tc VitNam.

T lng gi1. Hy in ch cho cu ng v ch S cho cu sai

C 4 nguyn tc iu tr gy xng /SC 8 th php c bn nn chnh gy xng /S

Tiu chun nn chnh gy xng tt l

phc hi gii phu v phc hi chc nng /S


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2. Hy in vo ch trng cm t thch hp

Sau khi xng c nn chnh v c nh cn lu :

Tnh cht chn thng.

Trng lng. gy

Lc co ko c

nh hng..iu tr

3. Nu 3 tc dng ca c nh ngoi.

4. M t 6 phng php ch to dng c nn b gy xng ?

5. Nu 2 tiu chun lin xng ?

6. Trnh by cc dng thuc YHCT dng kt hp trong iu tr gy xng ?


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Bi 8

Mt s loi gy xng(C trit)

Mc tiu1. M t c cc loi gy xng thng gp.2. Trnh by c phng php iu tr gy xng.

1. Gy u di xng quay1.1. c im

Gy u di xng quay chim khong 50% cc gy xng ni chung. Gp mi la tui, nhng thng gp nht tui 50-60, nht l ph n

mn kinh.

L loi gy gi, d chn on, d lin xng, nhng vic iu tr khng phil n gin.

1.2. Phn loi

Da vo c ch chia 2 loi chnh:+ Gy dui: do ng chng tay, c tay dui l thng gp nht. i din

cho nhm ny lPouteau- Colles;on gy xa di lch ln trn, ra sau vra ngoi.

+ Gy gp: do ng chng tay c tay gp, loi ny t gp hn. i din chonhm ny l Goyrand- Smith; on gy xa di lch ln trn, ra trc vra ngoi.

Ngoi ra cn chia theo v tr gy, gm c:+ Gy ngoi khp.+ Gy thu khp (trong c cc loi nhgy b khp trc, gy mm trm).Gy Pouteau - Colles v Goyrand - Smith l nhng gy xng ngoi khp,

ng gy n gin. Nu ng gy phc tp nhiu mnh v thu khp thkhng xp vo loi gy ny. Nu mt mnh ca b khp trc b gy di lch lntrn, lm trt khp c tay ra trc th c gi l kiu gyBarton.


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1.3. Chn on

Da vo:

Bnh s:ch nguyn nhn, c ch v tui. Triu chng lm sng. Phim X quang.

1.3.1. Triu chng lm sng

Triu chng c nng: au vng c tay, vn ng gp dui hoc sp ngahn ch.

Triu chng thc th:+ Sng vng c tay, t khi thy bm tm, nu gy thu khp s thy bao

khp cng phng.

+ n au nhi u di xng quay.+

Bin dng: Mm trm quay ln cao, c th ngang bng mm trm tr (du Laugier). Nhn thng: trc cng tay ko di khng qua ngn 3 m lch qua

ngn 4. Bin dng ny cn c gi l du hiu li

giao trinh benh hoc ngoai phu y

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