{"id":17683,"date":"2023-04-10T17:13:49","date_gmt":"2023-04-10T10:13:49","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=17683"},"modified":"2023-04-11T13:16:32","modified_gmt":"2023-04-11T06:16:32","slug":"phuong-phap-phau-thuat-gay-tren-loi-cau-xuong-canh-tay-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/phuong-phap-phau-thuat-gay-tren-loi-cau-xuong-canh-tay-o-tre-em\/","title":{"rendered":"Ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay \u1edf tr\u1ebb em"},"content":{"rendered":"

G\u00e3y l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay l\u00e0 m\u1ed9t ch\u1ea5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em khi tham gia c\u00e1c ho\u1ea1t \u0111\u1ed9ng v\u1eadn \u0111\u1ed9ng. \u0110\u1ec3 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng v\u00e0 h\u1ea1n ch\u1ebf c\u00e1c bi\u1ebfn ch\u1ee9ng, ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3. Tuy nhi\u00ean, \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t, c\u00e1c b\u00e1c s\u0129 c\u1ea7n ph\u1ea3i \u00e1p d\u1ee5ng c\u00e1c ch\u1ec9 \u0111\u1ecbnh v\u00e0 k\u1ef9 thu\u1eadt m\u1ed5 ph\u00f9 h\u1ee3p. Trong ph\u1ea7n vi\u1ebft n\u00e0y, ch\u00fang ta s\u1ebd t\u00ecm hi\u1ec3u v\u1ec1 c\u00e1c ch\u1ec9 \u0111\u1ecbnh v\u00e0 k\u1ef9 thu\u1eadt m\u1ed5 g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay \u1edf tr\u1ebb em, t\u1eeb \u0111\u00f3 gi\u00fap c\u1ea3i thi\u1ec7n s\u1ee9c kh\u1ecfe v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a tr\u1ebb.<\/strong><\/p>\n

1. C\u00e1c ch\u1ec9 \u0111\u1ecbnh v\u00e0 k\u1ef9 thu\u1eadt ph\u1eabu th\u1eadt g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay \u1edf tr\u1ebb em<\/h2>\n

1.1 N\u1eafn k\u00edn b\u00f3 b\u1ed9t<\/h3>\n

N\u1eafn k\u00edn b\u00f3 b\u1ed9t th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho d\u1ea1ng g\u00e3y kh\u00f4ng di l\u1ec7ch v\u00e0 kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u, th\u1ea7n kinh, ch\u00e8n \u00e9p khoang.
\n\u01afu \u0111i\u1ec3m<\/strong>: chi ph\u00ed \u0111i\u1ec1u tr\u1ecb th\u1ea5p, \u0111\u01a1n gi\u1ea3n, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n t\u1ea1i tuy\u1ebfn c\u01a1 s\u1edf.
\nNh\u01b0\u1ee3c \u0111i\u1ec3m<\/strong>: d\u1ec5 b\u1ecb di l\u1ec7ch th\u1ee9 ph\u00e1t, ch\u00e8n \u00e9p khoang, ho\u1ea1i t\u1eed chi do ch\u00e8n \u00e9p b\u1ed9t, lo\u00e9t da, lo\u1ea1n d\u01b0\u1ee1ng da.
\nTh\u1eddi gian b\u1ea5t \u0111\u1ed9ng<\/strong>: trong kho\u1ea3ng t\u1eeb 4 \u0111\u1ebfn 6 tu\u1ea7n.
\nHi\u1ec7n nay, m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p k\u00e9o n\u1eafn b\u00f3 b\u1ed9t m\u1edbi \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 (n\u0103m 2008) trong m\u1ed9t nghi\u00ean c\u1ee9u c\u1ee7a nh\u00f3m t\u00e1c gi\u1ea3 t\u1ea1i Senegal (B\u1ec7nh vi\u1ec7n Aristide Le Dantec t\u1ea1i Dakar, Senegal) v\u1edbi t\u00ean g\u1ecdi Blount<\/p>\n

\"C\u00e1c
C\u00e1c b\u01b0\u1edbc ti\u1ebfn h\u00e0nh trong Blount trong \u0111i\u1ec1u tr\u1ecb g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay tr\u1ebb em<\/figcaption><\/figure>\n

Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p n\u1eafn k\u00edn v\u00e0 ki\u1ec3m tra m\u1ee9c \u0111\u1ed9 n\u1eafn ch\u1ec9nh ngay tr\u00ean m\u00e0n hu\u1ef3nh quang t\u0103ng s\u00e1ng C-arm, sau \u0111\u00f3 tay b\u00ean t\u1ed5n th\u01b0\u01a1ng s\u1ebd \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh ngay s\u00e1t c\u1ed5 b\u1ec7nh nh\u00e2n v\u1edbi m\u1ed9t \u0111ai c\u00f3 t\u00ean g\u1ecdi Collar and Cuff.
\nV\u1edbi ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u00f3 nhi\u1ec1u \u01b0u \u0111i\u1ec3m: th\u1eddi gian ti\u1ebfn h\u00e0nh ng\u1eafn, nhanh ch\u00f3ng, m\u1edf r\u1ed9ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec3u tr\u1ecb (k\u1ec3 c\u1ea3 Gartland III).<\/p>\n

\"H\u00ecnh
H\u00ecnh \u1ea3nh k\u1ebft qu\u1ea3 sau m\u1ed5 b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p Blount<\/figcaption><\/figure>\n

1.2 \u0110i\u1ec1u tr\u1ecb k\u00e9o li\u00ean t\u1ee5c<\/h3>\n

Ch\u1ec9 \u0111inh: trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng da b\u1ecb t\u1ed5n th\u01b0\u01a1ng tr\u1ea7y x\u01b0\u1edbc nhi\u1ec1u khi\u1ebfn cho ph\u1eabu thu\u1eadt tr\u1edf n\u00ean nguy hi\u1ec3m do nguy c\u01a1 nhi\u1ec5m khu\u1ea9n ho\u1eb7c cho nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f3 c\u1ed1 \u0111\u1ecbnh \u1ed5 g\u00e3y b\u1eb1ng ph\u1eabu thu\u1eadt v\u00ec t\u00ecnh tr\u1ea1ng g\u00e3y x\u01b0\u01a1ng c\u00e1c c\u1ed9t x\u01b0\u01a1ng tr\u00ean l\u1ed3i c\u1ea7u.
\n\u01afu \u0111i\u1ec3m<\/strong>: d\u1ec5 \u00e1p d\u1ee5ng.
\nNh\u01b0\u1ee3c \u0111i\u1ec3m<\/strong>: d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng da, b\u1ec7nh nh\u00e2n ph\u1ea3i n\u1eb1m t\u1ea1i gi\u01b0\u1eddng nhi\u1ec1u ng\u00e0y, c\u1ea7n c\u00f3 gi\u01b0\u1eddng v\u00e0 h\u1ec7 th\u1ed1ng k\u00e9o chuy\u00ean d\u1ee5ng. T\u1ef7 l\u1ec7 khu\u1ef7u v\u1eb9o trong t\u1eeb 9%-33%.
\nPh\u01b0\u01a1ng ph\u00e1p n\u00e0\u1ef5 hi\u1ec7n t\u1ea1i \u00edt khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng<\/p>\n

\"\u0110i\u1ebfu
\u0110i\u1ebfu tr\u1ecb k\u00e9o li\u00ean t\u1ee5c trong g\u00e3y tr\u00ean l\u1ed7i c\u1ea9u x\u01b0\u01a1ng c\u00e1nh tay tr\u1ebb em<\/figcaption><\/figure>\n

1.3 M\u1ed5 n\u1eafn ch\u1ec9nh k\u00edn v\u00e0 g\u0103m \u0111inh Kirschner<\/h3>\n

\u0110\u00e2y l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u1ed5 bi\u1ebfn nh\u1ea5t cho g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c g\u00e2y m\u00ea to\u00e0n th\u00e2n v\u00e0 n\u1eafn k\u00edn d\u01b0\u1edbi m\u00e0n t\u0103ng s\u00e1ng.<\/p>\n

\u01afu \u0111i\u1ec3m<\/strong>: b\u1ea3o t\u1ed5n m\u00f4 m\u1ec1m xung quanh \u1ed5 g\u00e3y gi\u00fap li\u1ec1n x\u01b0\u01a1ng nhanh, b\u1ea5t \u0111\u1ed9ng \u1ed5 g\u00e3y t\u1ed1t, h\u1eadu ph\u1eabu nh\u1eb9 nh\u00e0ng, th\u1eddi gian n\u1eb1m vi\u1ec7n ng\u1eafn, gi\u1ea3m bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng, s\u1eb9o x\u1ea5u.
\nC\u00e1ch n\u1eafn<\/strong>: tr\u01b0\u1edbc ti\u00ean k\u00e9o d\u1ecdc tr\u1ee5c c\u1eb3ng tay \u0111\u1ec3 ch\u1ec9nh di l\u1ec7ch ch\u1ed3ng. Sau \u0111\u00f3 n\u1eafn ch\u1ec9nh c\u00e1c di l\u00each sang b\u00ean v\u00e0 cu\u1ed1i c\u00f9ng g\u1ea5p \u0111o\u1ea1n g\u00e3y ngo\u1ea1i vi \u0111\u1ec3 n\u1eafn ch\u1ec9nh di l\u1ec7ch g\u1eadp g\u00f3c.<\/p>\n

\"C\u00e1ch
C\u00e1ch n\u1eafn ch\u1ec9nh \u0111i\u1ec3u tr\u1ecb g\u00e3y tr\u00ean l\u1ed1i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay<\/figcaption><\/figure>\n

\u0110\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 n\u1eafn ch\u1ec9nh<\/strong>
\nL\u00e2m s\u00e0ng: khu\u1ef7u ph\u1ea3i g\u1ea5p \u0111\u01b0\u1ee3c g\u1ea7n nh\u01b0 ho\u00e0n to\u00e0n. N\u1ebfu kh\u00f4ng g\u1ea5p t\u1ed1t, nguy\u00ean nh\u00e2n th\u01b0\u1eddng do ph\u1ea7n m\u1ec1m ch\u00e8n v\u00e0o b\u1edd tr\u01b0\u1edbc c\u1ee7a hai \u0111o\u1ea1n g\u00e3y. Khi \u1edf t\u01b0 th\u1ebf g\u1ea5p t\u1ed1i \u0111a, tr\u1ee5c c\u1ee7a c\u00e1nh tay v\u00e0 c\u1eb3ng tay song song v\u1edbi nhau.
\nX-quang: sau khi n\u1eafn k\u00edn, g\u1eadp khu\u1ef7u t\u1ed1i \u0111a, ch\u1ee5p X-quang theo t\u01b0 th\u1ebf Jones. N\u1eafn t\u1ed1t khi ph\u1ee5c h\u1ed3i \u0111\u01b0\u1ee3c g\u00f3c Baumann (b\u00ecnh th\u01b0\u1eddng > 10\u00b0) tr\u00ean phim th\u1eb3ng, \u0111\u01b0\u1eddng c\u00e1nh tay tr\u01b0\u1edbc \u0111i qua m\u1ed9t ph\u1ea7n ba gi\u1eefa c\u1ee7a ch\u1ecfm con tr\u00ean phim nghi\u00eang.<\/p>\n

\"G\u00f3c
G\u00f3c baumann v\u00e0 b\u1edd tr\u01b0\u1edbc x\u01b0\u01a1ng c\u00e1nh tay \u0111i qua ch\u1ecfm con<\/figcaption><\/figure>\n

L\u1ef1a ch\u1ecdn c\u1ed1 \u0111\u1ecbnh:<\/strong>
\n\u0110inh Kirschner 2.0mm n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p tr\u1ebb nh\u1ecf h\u01a1n 6 tu\u1ed5i. \u0110inh 1.6 mm n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho c\u00e1c tr\u1ebb nh\u1ecf h\u01a1n.
\nKhi g\u0103m \u0111inh n\u00ean khoan v\u1edbi t\u1ed1c \u0111\u1ed9 ch\u1eadm \u0111\u1ec3 tr\u00e1nh t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng do nhi\u1ec7t sinh ra t\u1eeb \u0111inh Kirschner.
\nC\u00e1c ph\u01b0\u01a1ng ph\u00e1p g\u0103m \u0111inh:<\/strong>
\nTrong c\u00e1c h\u00ecnh th\u1ee9c g\u0103m kim c\u1ed1 \u0111\u1ecbnh \u1ed5 g\u00e3y tr\u00ean l\u1ed3i c\u1ea9u, h\u00ecnh th\u1ee9c n\u00e0o l\u00e0 t\u1ed1t nh\u1ea5t v\u1eabn ch\u01b0a th\u1ed1ng nh\u1ea5t. C\u00e1ch xuy\u00ean \u0111inh \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh \u1ed5 g\u00e3y ch\u1eafc nh\u1ea5t tr\u00ean th\u1ef1c nghi\u1ec7m \u0111\u00e3 r\u00f5, nh\u01b0ng tr\u00ean l\u00e2m s\u00e0ng c\u00f2n li\u00ean quan \u0111\u1ebfn nguy c\u01a1 tai bi\u1ebfn, k\u1ef9 thu\u1eadt xuy\u00ean kim.
\nZionts v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 nghi\u00ean c\u1ee9u kh\u1ea3 n\u0103ng ch\u1ed1ng l\u1ea1i l\u1ef1c xoay tr\u00ean c\u00e1c m\u00f4 h\u00ecnh g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh b\u1eb1ng c\u00e1c c\u00e1ch xuy\u00ean \u0111inh Kirschner kh\u00e1c nhau. N\u1ebfu s\u1eed d\u1ee5ng kim Kirschner 18 mm, c\u1ea5u h\u00ecnh ch\u1ed5ng l\u1ea1i l\u1ef1c xoay t\u1ed1t nh\u1ea5t l\u00e0 c\u1ea5u h\u00ecnh xuy\u00ean kim b\u1eaft ch\u00e9o nhau ph\u00eda tr\u00ean \u1ed5 g\u00e3y. L\u1ef1c xoay ch\u1ec9 b\u1ecb gi\u1ea3m nh\u1eb9 n\u1ebfu s\u1eed d\u1ee5ng 3 kim ph\u00eda ngo\u00e0i, c\u1ea5u tr\u00fac v\u1eefng x\u1ebfp h\u00e0ng th\u1ee9 ba l\u00e0 c\u00e1c kim \u0111\u1eb7t ph\u00eda ngo\u00e0i v\u00e0 song song nhau, c\u1ea5u tr\u00fac y\u1ebfu nh\u1ea5t l\u00e0 hai kim \u0111\u1eb7t ph\u00eda ngo\u00e0i b\u1eaft ch\u00e9o nhau \u1edf ngay \u1ed5 g\u00e3y ho\u1eb7c g\u1ea7n \u0111\u01b0\u1eddng g\u00e3y.<\/p>\n

\"A.
A. Xuy\u00ean ch\u00e9o: m\u1ed9t b\u00ean trong v\u00e0 m\u1ed9t b\u00ean ngo\u00e0i
B. T\u1ecfa ra: hai \u0111inh xuy\u00ean t\u1eeb b\u00ean ngo\u00e0i
C. Song song: hai \u0111inh xuy\u00ean t\u1eeb b\u00ean ngo\u00e0i v\u00e0 song song v\u1edbi nhau<\/figcaption><\/figure>\n

Tuy nhi\u00ean v\u1edbi Skaggs v\u00e0 c\u1ed9ng s\u1ef1 cho r\u1eb1ng \u0111i\u1ec3m quan tr\u1ecdng trong vi\u1ec7c c\u1ed1 \u0111\u1ecbnh b\u1eb1ng xuy\u00ean \u0111inh b\u00ean ngo\u00e0i l\u00e0 t\u00e1ch hai \u0111inh t\u1ed1i \u0111a t\u1ea1i \u1ed3 g\u00e3y, c\u1ee5 th\u1ec3 l\u00e0 kho\u1ea3ng c\u00e1ch gi\u1eefa hai \u0111inh ph\u1ea3i l\u1edbn h\u01a1n 1\/3 chi\u1ec1u d\u00e0i li\u00ean l\u1ed3i c\u1ea9u x\u01b0\u01a1ng c\u00e1nh tay.
\nC\u00e1c ki\u1ec3u xuy\u00ean kim kh\u00e1c:<\/strong>
\nXuy\u00ean kim qua kh\u1edbp: g\u0103m kim qua m\u1ecfm khu\u1ef7u v\u00e0 \u0111i l\u00ean ph\u00eda th\u00e2n x\u01b0\u01a1ng c\u00e1nh tay \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p khu\u1ef7u qu\u00e1 s\u01b0ng. D\u00f9 \u0111\u01a1n gi\u1ea3n, ki\u1ec3u xuy\u00ean n\u00e0\u1ef5 kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn r\u1ed9ng r\u00e3i trong y v\u0103n. M\u1ed9t b\u1ea5t l\u1ee3i c\u1ee7a xuy\u00ean kim qua kh\u1edbp l\u00e0 l\u00e0m gia t\u0103ng nguy c\u01a1 c\u1ee9ng khu\u1ef7u v\u00e0 nhi\u1ec5m tr\u00f9ng kh\u1edbp.<\/p>\n

C\u1ed1 \u0111\u1ecbnh b\u1eb1ng kim Kirschner n\u1ed9i t\u1ee7y: m\u1ed9t k\u1ef9 thu\u1eadt kh\u00e1c \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh \u1ed5 g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u l\u00e0 s\u1eed d\u1ee5ng \u0111inh n\u1ed9i t\u1ee7y d\u1ebbo (\u0111inh Metaizeau) \u0111\u01b0\u1ee3c \u0111\u00f3ng xu\u00f4i d\u00f2ng. Tr\u00e1nh \u0111\u01b0\u1ee3c t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh tr\u1ee5 v\u00e0 kh\u00f4ng c\u1ea7n b\u00f3 b\u1ed9t l\u00e0 nh\u1eefng \u01b0u \u0111i\u1ec3m c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y.<\/p>\n

\"K\u1ef9
K\u1ef9 thu\u1eadt g\u0103m \u0111inh n\u1ed9i t\u1ee7y trong \u0111i\u1ec3u tr\u1ecb g\u00e3y tr\u00ean l\u00f3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay<\/figcaption><\/figure>\n

K\u1ef9 thu\u1eadt xuy\u00ean kim ch\u00e9o \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 b\u1edfi Dorgan (2010) v\u1edbi tr\u1ee5 trong \u0111\u01b0\u1ee3c xuy\u00ean kim theo h\u01b0\u1edbng t\u1eeb tr\u00ean xu\u1ed1ng d\u01b0\u1edbi, t\u1eeb ngo\u00e0i v\u00e0o trong. \u01afu \u0111i\u1ec3m c\u1ee7a c\u00e1ch xuy\u00ean kim n\u00e0y l\u00e0 tr\u00e1nh \u0111\u01b0\u1ee3c t\u1ed5n th\u01b0\u01a1ng th\u1ea9n kinh tr\u1ee5. Nh\u01b0ng nh\u01b0\u1ee3c \u0111i\u1ec3m c\u1ee7a k\u1ef9 thu\u1eadt n\u00e0y l\u00e0 c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh quay, k\u1ef9 thu\u1eadt xuy\u00ean kim kh\u00f3 h\u01a1n v\u00e0 t\u1ef7 !\u1ec7 nhi\u1ec5m tr\u00f9ng cao h\u01a1n c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c.<\/p>\n

\"K\u1ef9
K\u1ef9 thu\u1eadt g\u0103m \u0111inh ch\u00e9o trong \u0111i\u1ec3u tr\u1ecb g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay<\/figcaption><\/figure>\n

C\u00e1c bi\u00ean ch\u1ee9ng c\u1ee7a xuy\u00ean kim qua da:<\/strong>
\nT\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh tr\u1ee5: v\u00ec v\u1eady trong m\u1ed5 n\u00ean s\u1edd m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong v\u00e0 \u0111\u1eb7t kim ra ph\u00eda tr\u01b0\u1edbc \u0111\u1ec3 tr\u00e1nh th\u1ea7n kinh tr\u1ee5. Trong nh\u1eefng b\u00e1o c\u00e1o v\u1ec1 t\u1ed5n th\u01b0\u01a1ng th\u1ea9n kinh tr\u1ee5 x\u1ea3y ra sau khi xuy\u00ean kim, h\u1ea5u h\u1ebft c\u00e1c ca \u0111\u1ec1u t\u1ef1 ph\u1ee5c h\u1ed5i sau khi r\u00fat kim.
\nNhi\u1ec5m khu\u1ea9n: \u0111a ph\u1ea7n c\u00e1c nhi\u1ec5m tr\u00f9ng ch\u00e2n \u0111inh l\u00e0 nhi\u1ec5m tr\u00f9ng n\u00f4ng v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec3u tr\u1ecb b\u1eb1ng r\u00fat kim v\u00e0 kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed5ng.<\/p>\n

1.4 M\u1ed5 m\u1edf n\u1eafn ch\u1ec9nh \u1ed5 g\u00e3y <\/strong><\/h3>\n

Ch\u1ec9 \u0111\u1ecbnh: t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u, g\u00e3y h\u1edf \u0111\u1ed9 2, \u0111\u1ed9 3 (theo ph\u00e2n lo\u1ea1i c\u1ee7a Gustilo), c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ebfn mu\u1ed9n kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng n\u1eafn ch\u1ec9nh k\u00edn \u0111\u01b0\u1ee3c ho\u1eb7c n\u1eafn ch\u1ec9nh k\u00edn kh\u00f4ng \u0111\u1ea1t y\u00eau c\u1ea9u (\u00edt g\u1eb7p).<\/p>\n

T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n: C\u00f3 th\u1ec3 \u0111\u1eb7t b\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda ho\u1eb7c n\u1eb1m nghi\u00eang c\u00f3 gi\u00e1 \u0111\u1ee1 khu\u1ef7u, t\u00f9y v\u00e0o v\u1ecb tr\u00ed \u0111\u01b0\u1eddng m\u1ed5 PTV l\u1ef1a ch\u1ecdn.<\/p>\n

\"T\u01b0
T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n<\/figcaption><\/figure>\n

\u0110\u01b0\u1eddng m\u1ed5 cho m\u1edf n\u1eafn c\u00f3 th\u1ec3 l\u00e0 \u0111\u01b0\u1eddng ph\u00eda tr\u01b0\u1edbc, ph\u00eda sau ho\u1eb7c ph\u00eda b\u00ean. \u01afu \u0111i\u1ec3m c\u1ee7a \u0111\u01b0\u1eddng m\u1ed5 ph\u00eda tr\u01b0\u1edbc l\u00e0 cho ph\u00e9p quan s\u00e1t tr\u1ef1c ti\u1ebfp \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay v\u00e0 th\u1ea7n kinh gi\u1eefa c\u0169ng nh\u01b0 c\u00e1c m\u1ea3nh g\u00e3y. \u0110\u01b0\u1eddng m\u1ed5 ph\u00eda sau c\u00f3 nguy c\u01a1 l\u00e0m: m\u1ea5t v\u1eadn \u0111\u1ed9ng cao h\u01a1n, l\u00e0m \u1ed5 g\u00e3y m\u1ea5t v\u1eefng h\u01a1n do ph\u00e1 v\u1edd m\u00e0ng x\u01b0\u01a1ng nguy\u00ean v\u1eb9n ph\u00eda sau v\u00e0 nguy c\u01a1 ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch th\u1ee9 ph\u00e1t do ph\u00e1 v\u1ee1 ngu\u1ed3n cung c\u1ea5p m\u00e1u \u0111\u1ed9ng m\u1ea1ch cho r\u00f2ng r\u1ecdc x\u01b0\u01a1ng c\u00e1nh tay.<\/p>\n

\"C\u00e1c
C\u00e1c \u0111\u01b0\u1eddng m\u1ed5<\/figcaption><\/figure>\n

2. Bi\u1ebfn ch\u1ee9ng ph\u1eabu thu\u1eadt g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay \u1edf tr\u1ebb em<\/h2>\n

2.1 Bi\u1ebfn ch\u1ee9ng s\u1edbm<\/h3>\n

2.1.1 Bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u<\/h4>\n

C\u01a1 ch\u1ebf th\u01b0\u1eddng do \u0111\u1ed9ng m\u1ea1ch b\u1ecb th\u1eaft b\u1edfi m\u1ed9t d\u1ea3i c\u00e2n ho\u1eb7c ngo\u1ea1i m\u1ea1c c\u1ee7a \u0111\u1ed9ng m\u1ea1ch b\u1ecb d\u00ednh v\u00e0o \u0111\u1ea7u nh\u1ecdn c\u1ee7a \u0111\u1ea7u g\u00e3y trung t\u00e2m khi\u1ebfn \u0111\u1ed9ng m\u1ea1ch b\u1ecb k\u00e9o v\u00e0o b\u00ean trong \u1ed5 g\u00e2y. V\u1ecb tr\u00ed \u0111\u1ed9ng m\u1ea1ch b\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng \u1edf ngang m\u1ee9c \u0111\u1ed9ng m\u1ea1ch tr\u00ean r\u00f2ng r\u1ecdc khi\u1ebfn cho \u0111\u1ed9ng m\u1ea1ch d\u1ec5 b\u1ecb th\u1eaft \u1edf v\u1ecb tr\u00ed n\u00e0y.
\n2.1.2 T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh<\/p>\n

T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh quay:<\/strong><\/p>\n

Th\u01b0\u1eddng g\u1eb7p trong tr\u01b0\u1eddng h\u1ee3p di l\u1ec7ch sau trong.T\u1ed5n th\u01b0\u01a1ng th\u1ea9n kinh trong g\u00e3y tr\u00ean l\u1ed3i c\u1ea9u ki\u1ec3u du\u1ed7i th\u01b0\u1eddng l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ecb t\u1ea1m ng\u01b0ng d\u1eabn tru\u1ef5\u1ec3n th\u1ea9n kinh v\u00e0 s\u1ebd h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n. Ph\u1ee5c h\u1ed3i th\u1ea7n kinh th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n trong 2 – 3 th\u00e1ng \u0111\u1ea7u ti\u00ean, nh\u01b0ng m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 k\u00e9o d\u00e0i \u0111\u1ebfn 6 th\u00e1ng.<\/p>\n

T\u1ed5n th\u01b0\u01a1ng th\u1ea7n k\u1ec9nh gi\u1eefa:<\/strong><\/p>\n

T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh gi\u1eefa th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi ki\u1ec3u di l\u1ec7ch sau ngo\u00e0i. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, th\u01b0\u1eddng c\u00f3 t\u1ed3n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay k\u00e8m theo<\/p>\n

T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh gian c\u1ed1t tr\u01b0\u1edbc<\/strong><\/p>\n

T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh tr\u1ee5<\/strong><\/p>\n

2.2 Bi\u1ebfn ch\u1ee9ng mu\u1ed9n<\/h3>\n

2.2.1 C\u1ee9ng khu\u1ef7u<\/h4>\n

M\u1ea5t g\u1ea5p nhi\u1ec1u c\u00f3 th\u1ec3 do \u1ed5 g\u00e3y ch\u01b0a \u0111\u01b0\u1ee3c n\u1eafn ho\u00e0n ch\u1ec9nh<\/p>\n

2.2.2 Kh\u1edbp gi\u1ea3: th\u01b0\u1eddng \u00edt g\u1eb7p
\n2.2.3 Ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch<\/h4>\n

Ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch l\u1ed3i c\u1ea9u li\u00ean quan trong t\u1ea5t c\u1ea3 c\u00e1c lo\u1ea1i g\u00e3y \u1edf \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay do s\u1ef1 c\u1ea5p m\u00e1u nu\u00f4i cho c\u00e1c trung t\u00e2m c\u1ed1t h\u00f3a c\u1ee7a l\u1ed3i c\u1ea7u trong r\u1ea5t mong manh.<\/p>\n

\"S\u1ef1
S\u1ef1 c\u1ea5p m\u00e1u trong x\u01b0\u01a1ng c\u1ee7a \u0111\u1ea9u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay<\/figcaption><\/figure>\n

2.2.3 Khu\u1ef7u v\u1eb9o trong<\/h4>\n

2.2.4 Khu\u1ef7u v\u1eb9o ngo\u00e0i<\/h4>\n

3. K\u1ebft lu\u1eadn v\u1ec1 ph\u1eabu thu\u1eadt g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay \u1edf tr\u1ebb em<\/h2>\n

G\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay tr\u1ebb em l\u00e0 lo\u1ea1i g\u00e3y x\u01b0\u01a1ng th\u01b0\u1eddng r\u1ea5t hay g\u1eb7p. C\u1ea7n ph\u1ea9n bi\u1ec7t gi\u1eefa c\u01a1 ch\u1ebf du\u1ed7i v\u00e0 c\u01a1 ch\u1ebf g\u1ea5p, v\u00ec \u0111i\u1ec3u n\u00e0y quy\u1ebft \u0111\u1ecbnh \u0111\u1ebfn ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec3u tr\u1ecb, v\u1edbi g\u00e3y c\u01a1 ch\u1ebf g\u1ea5p s\u1ebd kh\u00f4ng th\u1ec3 n\u1eafn k\u00edn \u0111\u01b0\u1ee3c
\nPh\u1ee5c h\u1ed3i l\u1ea1i h\u00ecnh th\u1ec3 gi\u1ea3i ph\u1eabu \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay trong g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay tr\u1ebb em l\u00e0 \u0111i\u1ec1u h\u1ebft s\u1ee9c quan tr\u1ecdng \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 g\u00e2y v\u1eb9o khu\u1ef7u sau n\u00e0y. Ph\u01b0\u01a1ng ph\u00e1p m\u1ed5 n\u1eafn k\u00edn v\u00e0 g\u0103m \u0111inh v\u1eabn l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u01b0u vi\u1ec7t nh\u1ea5t hi\u1ec7n nay v\u1edbi hi\u1ec7u qu\u1ea3, k\u1ebft qu\u1ea3 sau m\u1ed5 tuy\u1ec7t v\u1eddi.
\nH\u01b0\u1edbng \u0111i m\u1edbi: k\u1ef9 thu\u1eadt Blount<\/p>\n

Xem th\u00eam: Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay<\/a><\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/p>\n

    \n
  1. Campbell’s Operative Orthopaedics. Canale ST, Beaty JH. Eleventh edition. Mosby Elsevier.<\/li>\n
  2. Rockwood & Green’s Fractures in Children, 7th<\/sup> Edition<\/li>\n
  3. Handbook of Fracture, 5E (2014), Pediatric Elbow<\/li>\n
  4. Practical Procedures in Orthopaedic Trauma Surgery<\/li>\n
  5. MasterTechniques in Orthopaedic Surgery Relevant Surgical Exposures<\/li>\n
  6. AO Principles of Fracture Management<\/li>\n
  7. OperativeTechniquesin Pediatric Orthopaedics, Chapter2:Open Reduction of Supracondylar Fractures of the Humerus<\/li>\n
  8. Tachdjian’s Pediatric Orthopaedics, 5th<\/sup> Edition, John A.Herring, Chapter 33: upper Extremity Injuries<\/li>\n
  9. Gray’s Anatomy, 40th<\/sup> Edition<\/li>\n
  10. Atlas gi\u1ea3i ph\u1eabu ng\u01b0\u1eddi, Frank H.Netter, 2013 Edition<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    G\u00e3y l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay l\u00e0 m\u1ed9t ch\u1ea5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em khi tham gia c\u00e1c ho\u1ea1t \u0111\u1ed9ng v\u1eadn \u0111\u1ed9ng. \u0110\u1ec3 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng v\u00e0 h\u1ea1n ch\u1ebf c\u00e1c bi\u1ebfn ch\u1ee9ng, ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3. Tuy nhi\u00ean, \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t, […]<\/p>\n","protected":false},"author":26,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[40],"tags":[3],"yoast_head":"\nPh\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay \u1edf tr\u1ebb em<\/title>\n<meta name=\"description\" content=\"Ph\u1ee5c h\u1ed3i l\u1ea1i h\u00ecnh th\u1ec3 gi\u1ea3i ph\u1eabu trong ph\u1eabu thu\u1eadt g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay \u1edf tr\u1ebb em l\u00e0 \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 g\u00e2y v\u1eb9o khu\u1ef7u sau n\u00e0y.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta 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