Tang Truong So Mat

8/7/2019 Tang Truong So Mat

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S TNG TRNG S MTwww.nhakhoanhungoc.com

TS. V Trng Nh Ngc


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Kin thc tng trng s mt c vai tr quan trng: chn on,lp k hoch iu tr, tin lng trong nn chnh rng hm.

Cha kha quan trng i vi s pht trin c th.

Enlow v Hanns (1996) cho rng m t chung hnh thi v mutng trng mt l mt lnh vc khoa hc hnh thi gip tr li3 cu hi:y (1) c s lin quan gia cc loi hnh mt khc nhau vi nhng thay

i pht trin ca hnh th u ton b hay khng?

y (2) Nhng khc bit trong pht trin ca mt gia 2 gii nh thno?

y (3) C s khc bit gia mt tr em v mt ngi ln hay khng?


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PHNG PHP NGHIN CU

Phng php vi th: t bo Phng php i th

y Nghin cu o trc tip: ngang, dc

y Nghin cu trn nh chp

y

Nghin cu trn phim XQ

Goldstein, Brodie (1941), Bjork (1955), Hunter (1966),Popovich v Thompson (1977), Coklica (1977),

Tanner v cng s (1966), Woodside (1979),Lundstrom v Woodside (1983), Farkas, Ngnim, Leev Farkas (1987), Broadbent Bolton, Brodie,Burlington, Nanda, Jorgensen (1991), Bishara(1995), Trn Thy Nga, Ng Th Qunh Lan (2000),L c Lnh (2002)


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NGUYN TC CHP NH CHUN HATTH U

Tth u tnhin theo Claman v cng s


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NGUYN TC CHPNH CHUN HA- TTH U -

nh b bin dng dou ng ra sau

Cm c v li do u

nghing sau

nh b bin dng do

u ci v pha trc

Cm c v li do

u ci v pha

trc


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NGUYN TC CHPNH CHUN HA- TTH XNG HM DI-

Tng quan KCtrung tm

Tng quan chm

mi ti a

Tng quan chm

mi ti a

Tng quan KCtrung tm


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NGUYN TC CHPNH CHUN HA- TTH XNG HM DI-

S thay i t th ca u che du t th caxng hm. A: XHD a ra trc qu mc,u ci v trc. B: Tng quan TT u

nga ra sau

S thay i t th u lm tng thay i tth xng. A: a hm ra trc qu mcvi u ng ra sau. B: Tng quan trung

tm vi u ci ra trc .


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NGUYN TC CHPNH CHUN HA- TTH U V NG KNH -

Tm ng knhcng cao

vi mt ngic chp

Mynh qu cao Mynh qu thp


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NGUYN TC CHPNH CHUN HA-TIU C, NG KNH, NH SNG-

Claman v cs; Bishara; Gavan v cs; Ferrario, William 1984; Reid PS

,Farkas,


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NGUYN TC CHPNH CHUN HA-TIU C, NG KNH, NH SNG-

ng knh wide tiu

c 35mm

nh chun: ng knh

tele tiu c 105mm,phim 35mm

ng knh tele tiu c

305mm


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NGUYN TC CHP NH CHUN HA-TIU C, NG KNH, NH SNG-

William (1984): Phng chp nn mu trng, nukhng n flash s phn chiu mu phng ln mtngi c chp, to ra mt bc nh c mu khngtrung thc

nh sng: t nhin hoc trong phng chp. Trongphng chp cn to ngun nh sng t nhin nht

William 1984; Reid PS, Farkas, Trn c Ti


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NGUYN TC CHP NH CHUN HA-TIU C, NG KNH, NH SNG-


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NGUYN TC CHP NH CHUN HA- KHONG CCH -

Ferrario v cng s: 2.55m

Reid PS v Farkas LG: tiu c 90-105mm,Kc 4feet (khong 1.22m)

Gavan v cs: kc t nht gp 10 ln chiu rngca u (trung bnh 1.53m) gim sai sxung cn di 1/100

Fabio Meneghini 2005: 1.5m

Ferrario va cs, Reid PS v Farkas LG, Gavan v cs, Claman; Bertrand

My nh dng phim 35


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NGUYN TC CHP NH CHUN HA- TIU C, KHONG CCH -

APS-C (1.6x) format, EF-S lenscompatibilityMn hnh: 2.5" LCD screenLy nt: H thng t ng ly nt

9 im nhy sng: ISO 100-1600Tc chp: 30-1/4000s shutterChp lin tc: 3 tm/giyChp lin tip: 27 tm Jpeg hay10 tm RAWH thng t ng lm sch cm

bit


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NGUYN TC CHP NH CHUN HA- THAM CHIU XC NH PHNG I -


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PHN TCH TRN PHIMS MT TXA


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.Is.Ii

.

.

.. ...

...

. .

SN

ANSPNS

.AGo

Me Pog.PogB Li

LsSn

Pn

.Gn

PHN TCH TRN PHIMS MT TXA


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CC YU T NH HNG N STNG TRNG

Yu t ti chy Yu t chc nng

Nut

ThNi

Yu t ton thn Yu t ni sinh

Yu t di truyn

Chng tc Ni tit

Yu t khc: tui, gii

Yu t ngoi sinh Ch dinh dng Kinh t x hi

Bnh l


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MT NGN TAY


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CN MI


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Y LI


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KHM LI

Mu sc

Hnh dng

Knh thc

C ng


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THMING


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CCH TNG TRNG XNG

Hnh Thnh Xng Mng


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CCH TNG TRNG XNG

Hnh

Hnh thnh xng t sn


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STNG TRNG XNG S-MT SAU SINH

3 hng: p xng b mt,m lin kt gia cc xngbin thnh xng, sn thnhxng.

3 hin tng: dch chuyn,xoay v s pht trin b rng.

4 vng: vm s, nn s, phchp mi-hm trn, hm di.


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DCH CHUYN

Dch chuyn tin pht dos ti to mi v qu trnhtiu xng trn mt b mtv p xng mt b mtkhc.

Dch chuyn th pht l kt qu cas tng trng khng ng u cacc xng k cn nhau, cc xngxung quanh tng trng nhiu hn,nhanh hn tc ng ln lm cho xngb dch chuyn th ng.


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STNG TRNG CA XNG VM S

S p xng b mt. S to xng cc

ng khp: Do ccng khp c 3 chiu

trong khng gian nns to xng gip spht trin theo tt ccc hng.

Tiu xng mt trongca vm s cng lc vis bi p xng mi mt ngoi lm thay ihnh dng trong cavm s khi tng trng.


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STNG TRNG NN S

Tri vi vm s, ccxng nn s cto thnh ban udi hnh thc snv sau bin i

thnh xng bi shnh thnh xngt sn. Nhng vngquan trng: ngkhp sn giaxng bm vx

ng ch

m, gi

a 2

phn ca xngbm v gia xngbm v xngsng.

1: Khp sn bm-sng2: Khp sn trong bm3: Khp sn bm-chm4: Khp sn ngoi trn chm5: Khp sn nn ngoi chm6: Khp sn trong chm


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STNG TRNG NN S

Ti to li phntrc ca nn stheo Enlow

Tng trng do tito li phn trcca nn s theoRakosi v Jonas


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STNG TRNG XNG MT

Nguyn tc b mt:M

t tng ng vi hng tng trng th bi xng vngc li mt khng tng ng vi hng tng trng th tiu xng

+: bi xng

-: tiu xng

Mt Y, A l tiu xng, X,B l bi

xng


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STNG TRNG XNG MT

Nguyn tc ch V ng vi cc xng s

mt hnh ch V, tiu xng mt ngoi

v bi xng mt trong, hng tng

trng theo hng m ca ch V

M hnh tng trng ca 2 mm vt. Hai

mm vt ln dn v di chuyn theo

hng ch V, tiu xng mt m, bi

xng mt li


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STNG TRNG XNG HM TRN

Do hin tng bi p v tiu xng, cu trc xng pht trin theohng ra sau v ln trn (di chuyn tin pht).. S di chuyn tinpht ngc vi hng ca tng trng, xng b tiu pha trc vbi p pha sau. Trong cng thi gian, phc hp mi-xng hmtrn di chuyn ra trc, theo cch ny gii phng v tr cn thit cho

s tng trng xng


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S di chuyn th pht ca phc hp mi-xng hm trn.Sdi chuyn thpht l kt qu ca stng trng ca hno gia v li c thi dng, xng hm trn tng trngra trc v xung di, xng c di chuyn v khngthay i cu trc ca n (theo Enlown nm 1962


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H chn bm hm nm gia mm chn bm v lic XHT (Enlow 1982)

Bi xng trn ngoi li cXHT v tiu xng mt tronglm XHT ko di ra sau. Do

vy, h v khe chn bm hmdi chuyn ra sau.


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Song song vi hintng ko di ra sau (dichuyn tin pht) XHTc hin tng trt ratrc.

Di chuyn th pht linquan n hin tng nongrng ca h s gia


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Cc ng khp pha sau cho php XHTdi chuyn xung di v ra trc


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Cui giai on tng trng,

hnh thnh s lin tc ca

xng (theo Enlow 1982)

Khong t do c to ra

do s di chuyn tin pht

cho php tng trng

xng ng khp

Theo Enlow, khi xng

mt c s di chuyn phn

ui do s nong rng ca

phn mm ln cn


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SPHT TRIN XNG HM

Thikbothai

10 thng

2 tui 5 tui 8 tui


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STNG TRNG XNG HM DI

XHD tri qua stng trng hu htsau khi sinh, l

xng c bin i adng nht v mthnh thi. ngkhp gia cm dndn mt i sau sinh

4-12

thng


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STNG TRNG XNG HM DI

Cc tiu n v gii phu XHD

1: Li cu

2:Mm vt

3: Gc hm

4: Xng rng

5: Li cm

6:Thn xng hm


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STNG TRNG XNG HM DI

Mi tn mu ch hng bi xng, mi tn mu xanh ch hng tiuxng (vng mu xanh l vng b tiu xng, mu hng l vng bi xng)


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STNG TRNG XNG HM DI

XHD tng trng theonguyn tc ch V

XHD tr em 5 tui v

ngi ln

Tng trng t xngmng v xng sn(li cu, mm vt, gchm). Sau khi sinh chc sn li cu cn tnti v hot ng choti 16 tui, c khi ti25 tui.


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STNG TRNG XNG HM DI


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STNG TRNG XNG HM DI

Bi p pha sau cnhln b tr s tiu xng mt trc v cho phpphc hi li rngcnh ln nh ban u

Song song vi s ko diXHD di chuyn ra trc


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STNG TRNG XNG HM DI

Di chuyn th pht do s nong rng ca h no gia, XHD di chuyn xung

di v ra trc. nh hng ny ch tc ng ln li cu, s di chuyn th pht

XHD b hn ch nhiu hn XHT. Ch vi iu kin s ko di ca 2 cu trc ging

nhau, tng quan gia XHT v XHD mi khng thay i cui giai on ny .


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STNG TRNG XNG HM DI

Tng trng theo chiu ngang cnh ln:cnh ln c cng mu tng trng vi hs gia, di chuyn ra sau. Song song vihin tng ny, tng trng chiu cao vra sau ca li cu to ra s di chuyn thpht XHD ra trc v xung di

Ton b hin tng s b tr s khcnhau theo chiu dc gia v t thgia XHT v XHD v to nn s dichuyn caudal mt phng cn


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STNG TRNG XNG HM DI

Ngc vi cc gi thuyt c, li cu khng phi chu trchnhim trong vic tng trng ton b ca XHD. N khng phi l trung tm kim sot cc vng tng trng m duy nht c chcnng ti ch


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SPHT TRIN XNG HM


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SXOAY CA XNG HM

Nghin cu s tng trng bngcch s dng implant xng hmca Bjork v cc cng s (1960) pht hin ra s xoay 2 xng hmtrong khi chng dch chuyn do tngtrng. Trc s xoay xng hm

khng c nhn thy v s xoay dinra vng trung tm xng hm, cth b che khut bi nhng thay i bmt v s mc rng.

Kiu xoay ca cc xng hm khitng trng nh hng r n cng

v hng mc rng.XHT thng xoay hng ra trc

vi (hng ng) nhng cng cth xoay nh v pha sau (hng m).

S xoay bnh thng XHD aphn trc XHD hng ln trn

(hng ng).


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STNG TRNG M MM

L

c mi tr c khun mtnghing li nhiu. Chm li t thngth 6 n 3 tui, gim gn 1/2 dotng tr-ng rt nhanh XHD. Lc 4 v8 tui nhng thay i t-ng ikhng c ngha ri li tng sau 8

tui ti lc tr-ng thnh. Nu tuitr-ng thnh khng c khc nhauno v gii ca t- th XHD, tr traiv gi chng ta nhn thy: nam volc 7 tui c 1/2 vu, n vo lc

7 tui c 3/4 vu.

D.Subtelny nhn thy mt trng nghing chung dt hn trai v hili gi.


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STNG TRNG CAMI

T 1 n 18 tui, tng trng un khng lc no chm li, chiu dimi trung bnh nam ln hn n vu ny ng mi la tui.

Chiu di mi tng t lc mi ntrng thnh. Gia 9 v 15 tui nh mitng v pha tr-c mt phng mt1mm/nm v nh dy th c th tng2mm/nm. C th -c l-ng s tng trngtrung bnh mi tui chnh nha 3-5mm/3nm. Traith-ng c nh mi tng lc dy th (13-15tui), gi s tng tr-ng u.

S tng tr-ng ca mi v pha d-i vtr-c vi 1 vect thng ng quan trng hnl vect ngang.


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TNG TRNG MI

Gii Chiu di lch chun Thay i tnh theo

mm

Nam Mi trn 23,8mm

Mi d-i 49,9mm

1,5

4,5

21,5 ti 26

42 ti 58

N Mi trn 20,1 mm

Mi d-i 46,4 mm

1,9

3,4

17 ti 23

38 n 52

Ging nhau mi trn v mi d-i nh-ng vi c-ng gn gpi vi mi d-i. Hai mi ngy cng li cng vi tui so vi -ngthm m. Trong mt nghin cu v t- th mi C.Burstone thy:

* Mi trn tng trng trung bnh 6,5 mm t lc ti lc tr-ngthnh v khng c khc bit v gii ch c n tng trng ngngli tui 14, mi tng tr-ng nhanh hn v chiu di so vi mi.

* Mi d-i tng trng trung bnh 8,2 mm t lc sinh ti tr-ngthnh mi d-i, ph khong 30% b mt cn li ca rng ca trn.


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STNG TRNG MT NGI TRNG THNH

Nm 1930 c nhng bo co c s tng trng nh ngitrung nin nhng mi ngi nhn chung vn cho rng s tng trng ccxng mt ngng li giai on cui tui thanh nin hoc nhng nm utui 20. Nc vo u nhng nm 80 cho thy s tng trng mt vn tip

tc din ra ngi trng thnh. Ni bt l nhng thay i chiu cao, ritheo chiu trc sau, nhng thay i theo chiu rng t xy ra nht, vnhng thay i quan st c h xng mt ngi ln c v nh tip tckiu tng trng trong thi k trng thnh.

Mt im c bit l s gim r mc tng trng n cui

nhng nm mi my tui c tip theo bng s tng trng tr li trongnhng nm 20 tui. Dng nh ph n ln u c thai to thm s tngtrng cho xng hm. Mc d nhng thay i do tng trng ngitrng thnh, nu nh gi bng mm/nm s rt nh nhng nu tnh tngcng qua hng chc nm th ln ng k


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M mm mt nhnnghing thay i nhiuhn h xng mt.Nhng thay i mmm gm c: mi di ra

(thng di ra ng k ngi trng thnh),hai mi phng hn vcm tr nn ni bthn.

Nhng thay i ngi trng thnh. A: thay i nam t 37 -77 tui,

xng hm trn v di u di ra trc, c bit l mi. B: thay i

tng trng n t 34 tui n 83 tui, xng di ra trc v hi xung

dui, mi m rng


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Nhng thay i tng trng ngi ln. A: nhng thay i kt trung bnh XHD

n, c cng kiu tng trng nh lc thiu nin. B: XHT xung di v ra trc,

c cng kiu tng trng nh trc .


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TIN LNG TNG TRNG


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KT LUN

XHT tng trng sau sinh bng s sinh xng mng, khngc s thay th sn nn tng trng bng cch bi xng bmt v cc ng khp ni XHT vi xng s v nn s.Tng trng ca mt l tng trng ngoi v di ca s,cu trc XHT pht trin theo hng ln trn v ra sau tuy nhin

XHT c xu hng dch chuyn xung di v ra trc nhiu.

XHD c xu hng tng trng ra trc v xung di. Tringc vi cc quan im trc y, li cu khng ng vai trquyt nh trong s tng trng ca XHD m ch c vai tr ti

ch. XHD tng trng theo nguyn tc hnh ch V (tngtrng t xng mng v xng sn).

S xoay ca XHT v di trong qu trnh tng trng nhhng nhiu n hin tng mc rng v kiu mt.


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Tng trng m mm cng rt quan trng khi phn tchkhun mt. Lc mi tr c khun mt trong nghing li

nhiu sau gim dn, tr gi thng li hn tr trai.S tng trng mt vn tip tc din ra ngi trngthnh. Nhng thay i chiu cao ngi trng thnh ni bthn nhng thay i theo chiu trc sau, nhng thay i theochiu rng th t xy ra nht, v nhng thay i quan st c

h xng mt ngi ln c v nh tip tc kiu tng trngtrong thi k trng thnh.

KT LUN


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