tang truong so mat
TRANSCRIPT
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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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STNG TRNG XNG HM TRN
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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STNG TRNG XNG HM TRN
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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STNG TRNG XNG HM TRN
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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STNG TRNG XNG HM TRN
Cc ng khp pha sau cho php XHTdi chuyn xung di v ra trc
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STNG TRNG XNG HM TRN
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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STNG TRNG MT NGI TRNG THNH
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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STNG TRNG MT NGI TRNG THNH
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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