{"id":18008,"date":"2023-04-10T22:36:54","date_gmt":"2023-04-10T15:36:54","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18008"},"modified":"2023-04-11T11:27:58","modified_gmt":"2023-04-11T04:27:58","slug":"co-che-chan-doan-gay-chom-va-dau-tren-xuong-canh-tay","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/co-che-chan-doan-gay-chom-va-dau-tren-xuong-canh-tay\/","title":{"rendered":"C\u01a1 ch\u1ebf, ch\u1ea9n \u0111o\u00e1n g\u00e3y ch\u1ecfm v\u00e0 \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay"},"content":{"rendered":"

G\u00e3y \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay chi\u1ebfm 4-5% trong t\u1ea5t c\u1ea3 c\u00e1c lo\u1ea1i g\u00e3y x\u01b0\u01a1ng, v\u00e0 v\u1ecb tr\u00ed g\u00e3y hay g\u1eb7p nh\u1ea5t trong g\u00e3y x\u01b0\u01a1ng c\u00e1nh tay (45%). C\u00f3 th\u1ec3 g\u1eb7p \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i nh\u01b0ng \u0111a s\u1ed1 g\u1eb7p \u1edf ng\u01b0\u1eddi nhi\u1ec1u tu\u1ed5i do li\u00ean quan \u0111\u1ebfn t\u00ecnh tr\u1ea1ng lo\u00e3ng x\u01b0\u01a1ng, \u1edf ng\u01b0\u1eddi tr\u1ebb l\u00e0 li\u00ean quan \u0111\u1ebfn c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng m\u1ea1nh. N\u1eef g\u00e3y nhi\u1ec1u h\u01a1n nam v\u1edbi t\u1ec9 l\u1ec7 2:1<\/strong><\/p>\n

1. Gi\u1ea3i ph\u1eabu x\u01b0\u01a1ng c\u00e1nh tay<\/strong><\/h2>\n
\"H\u00ecnh
H\u00ecnh 6.1. Gi\u1ea3i ph\u1eabu x\u01b0\u01a1ng c\u00e1nh tay<\/figcaption><\/figure>\n

Kh\u1edbp vai c\u00f3 bi\u00ean \u0111\u1ed9 v\u1eadn \u0111\u1ed9ng l\u1edbn nh\u1ea5t c\u01a1 th\u1ec3 nh\u1edd c\u00f3 \u1ed5 ch\u1ea3o kh\u00e1 n\u00f4ng, di\u1ec7n kh\u1edbp ti\u1ebfp x\u00fac ch\u1ec9 chi\u1ebfm 25% ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay. Do v\u1eady, s\u1ef1 v\u1eefng ch\u1eafc c\u1ee7a kh\u1edbp vai ph\u1ee5 thu\u1ed9c ch\u1ee7 y\u1ebfu v\u00e0o d\u00e2y ch\u1eb1ng, bao kh\u1edbp v\u00e0 c\u00e1c g\u00e2n c\u01a1 bao quanh kh\u1edbp vai.<\/p>\n

C\u00f3 th\u1ec3 xem \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay l\u00e0 n\u01a1i h\u1ee3p nh\u1ea5t c\u1ee7a 4 th\u00e0nh ph\u1ea7n: ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay, m\u1ea5u \u0111\u1ed9ng l\u1edbn, m\u1ea5u \u0111\u1ed9ng b\u00e9 v\u00e0 th\u00e2n x\u01b0\u01a1ng c\u00e1nh tay<\/p>\n

\"H\u00ecnh
H\u00ecnh 6.2. Gi\u1ea3i ph\u1eabu \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay<\/figcaption><\/figure>\n

Tr\u1ee5c gi\u1eefa \u0111\u1ea7u v\u00e0 th\u00e2n x\u01b0\u01a1ng kho\u1ea3ng 130\u00b0, ng\u00e3 ra sau kho\u1ea3ng 20\u00b0 – 30\u00b0 so v\u1edbi m\u1eb7t ph\u1eb3ng ngang v\u00e0 m\u1eb7t ph\u1eb3ng d\u1ecdc kho\u1ea3ng 50\u00b0.<\/p>\n

M\u1eb7t ph\u1eb3ng x\u01b0\u01a1ng b\u1ea3 vai di \u0111\u1ed9ng trong bi\u00ean \u0111\u1ed9 t\u1eeb 30\u00b0 – 40\u00b0. \u0110i\u1ec1u n\u00e0y r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u1ee9ng d\u1ee5ng trong ch\u1ee5p XQ, trong ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1o v\u00e0 trong t\u1eadp luy\u1ec7n ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng sau ph\u1eabu thu\u1eadt.<\/p>\n

\"H\u00ecnh
H\u00ecnh 6.3. Bi\u00ean \u0111\u1ed9 v\u1eadn \u0111\u1ed9ng kh\u1edbp vai<\/figcaption><\/figure>\n

2. T\u1ea7m v\u1eadn \u0111\u1ed9ng kh\u1edbp vai:<\/strong><\/h2>\n

Ra sau 60\u00b0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0– Ra tr\u01b0\u1edbc 180\u00b0<\/p>\n

G\u1ea5p vai 135\u00b0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 – Du\u1ed7i vai 45\u00b0<\/p>\n

D\u1ea1ng vai 90\u00b0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 – Kh\u00e9p vai 30\u00b0<\/p>\n

Xoay ngo\u00e0i 30\u00b0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 – Xoay trong 90\u00b0<\/p>\n

\"H\u00ecnh
H\u00ecnh 6.4. Bi\u00ean \u0111\u1ed9 v\u1eadn \u0111\u1ed9ng kh\u1edbp vai<\/figcaption><\/figure>\n

M\u1ea1ch m\u00e1u ch\u00ednh nu\u00f4i ch\u1ecfm xu\u1ea5t ph\u00e1t t\u1eeb nh\u00e1nh xu\u1ed1ng c\u1ee7a \u0111\u1ed9ng m\u1ea1ch m\u0169 c\u00e1nh tay tr\u01b0\u1edbc v\u00e0 \u0111i v\u00e0o r\u00e3nh nh\u1ecb \u0111\u1ea7u. V\u00ec v\u1eady, g\u00e3y c\u1ed5 gi\u1ea3i ph\u1eabu c\u00f3 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u.<\/p>\n

\"H\u00ecnh
H\u00ecnh 6.5. M\u1ea1ch m\u00e1u nu\u00f4i ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay<\/figcaption><\/figure>\n

Th\u1ea7n kinh n\u00e1ch qua kho\u1ea3ng t\u1ee9 gi\u00e1c r\u1ed3i \u0111i ph\u00eda tr\u01b0\u1edbc v\u00e0 sau kh\u1edbp b\u1ea3 vai c\u00e1nh tay, c\u00f3 nguy c\u01a1 cao b\u1ecb t\u1ed5n th\u01b0\u01a1ng khi ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng vai.<\/p>\n

\"H\u00ecnh
H\u00ecnh 6.6. Th\u1ea7n kinh n\u00e1ch trong gi\u1ea3i ph\u1eabu \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay<\/figcaption><\/figure>\n

C\u00e1c c\u01a1 quanh kh\u1edbp vai co k\u00e9o t\u1ea1o bi\u1ebfn\u00a0d\u1ea1ng \u0111i\u1ec3n h\u00ecnh trong g\u00e3y x\u01b0\u01a1ng.<\/p>\n

M\u1ea5u \u0111\u1ed9ng l\u1edbn di l\u1ec7ch l\u00ean tr\u00ean v\u00e0 ra sau do c\u01a1 tr\u00ean gai v\u00e0 c\u00e1c c\u01a1 xoay ngo\u00e0i.<\/p>\n

M\u1ea5u \u0111\u1ed9ng b\u00e9 di l\u1ec7ch v\u00e0o trong do c\u01a1 d\u01b0\u1edbi vai.<\/p>\n

Th\u00e2n x\u01b0\u01a1ng c\u00e1nh tay b\u1ecb c\u01a1 ng\u1ef1c l\u1edbn k\u00e9o v\u00e0o trong.<\/p>\n

3. C\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng<\/strong><\/h2>\n

Ch\u1ee7 y\u1ebfu: ng\u00e3 t\u00e9 ch\u1ed1ng tay \u1edf ng\u01b0\u1eddi nhi\u1ec1u tu\u1ed5i, \u1edf ng\u01b0\u1eddi tr\u1ebb l\u1ef1c g\u00e2y g\u00e3y x\u01b0\u01a1ng t\u1eeb ch\u1ea5n th\u01b0\u01a1ng manh do \u0111\u00f3 m\u00f4 m\u1ec1m t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng v\u00e0 c\u00f3 th\u1ec3 c\u00f3 nhi\u1ec1u t\u1ed5n th\u01b0\u01a1ng ph\u1ed1i h\u1ee3p,<\/p>\n

\u00edt g\u1eb7p: ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp, d\u1ea1ng vai qu\u00e1 m\u1ee9c, \u0111i\u1ec7n gi\u1eadt, \u0111\u1ed9ng kinh, u x\u01b0\u01a1ng.<\/p>\n

4. Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng<\/strong><\/h2>\n

L\u00e2m s\u00e0ng kh\u00f3 ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c lo\u1ea1i g\u00e3y v\u00ec c\u00e1c d\u1ea5u hi\u1ec7u g\u00e3y x\u01b0\u01a1ng c\u00f3 th\u1ec3 gi\u1ed1ng nhau:<\/p>\n

–\u00a0\u00a0\u00a0 B\u1ec7nh nh\u00e2n \u0111\u1ebfn vi\u1ec7n trong t\u01b0 th\u1ebf chi tr\u00ean \u00e1p s\u00e1t th\u00e0nh ng\u1ef1c, tay l\u00e0nh n\u00e2ng \u0111\u1ee1 tay \u0111au.<\/p>\n

–\u00a0\u00a0\u00a0 V\u00f9ng vai \u0111au( s\u01b0ng n\u1ec1).<\/p>\n

–\u00a0\u00a0\u00a0 D\u1ea5u b\u1ea7m t\u00edm m\u1eb7t trong c\u00e1nh tay v\u00e0 th\u00e0nh ng\u1ef1c, lan xu\u1ed1ng v\u00f9ng h\u00f4ng l\u01b0ng (b\u1ea7m t\u00edm Hennequin).<\/p>\n

–\u00a0\u00a0\u00a0 \u0110au khi v\u1eadn \u0111\u1ed9ng.<\/p>\n

–\u00a0\u00a0\u00a0 C\u00f3 th\u1ec3 s\u1edd th\u1ea5y ti\u1ebfng l\u1ea1o x\u1ea1o x\u01b0\u01a1ng.<\/p>\n

–\u00a0\u00a0\u00a0 N\u1ebfu g\u00e3y x\u01b0\u01a1ng h\u1edf, ph\u00e2n lo\u1ea1i theo Gustilo.<\/p>\n

C\u1ea7n \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn t\u1ec9 m\u1ec9 t\u00ecnh tr\u1ea1ng m\u1ea1ch m\u00e1u, th\u1ea5n kinh. Th\u0103m kh\u00e1m k\u1ef9 \u0111\u00ea\u2019 ph\u00e1t hi\u1ec7n d\u1ea5u hi\u1ec7u b\u00e0n tay r\u1ee7, kh\u00e1m kh\u1ea3 n\u0103ng du\u1ed7i c\u1ed5 tay v\u00e0 c\u00e1c ng\u00f3n tay, kh\u1ea3 n\u0103ng d\u1ea1ng ng\u00f3n c\u00e1i, c\u1ea3m gi\u00e1c c\u1ee7a mu b\u00e0n tay, c\u1ea3m gi\u00e1c gan b\u00e0n ta\u1ef5, c\u1ea3m gi\u00e1c c\u00e1c \u00f4 m\u00f4 \u1edf b\u00e0n tay v\u00e0 c\u1ea3m gi\u00e1c c\u00e1c ng\u00f3n tay, \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00e0 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh n\u1ebfu c\u00f3. T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh n\u00e1ch d\u1ec5 b\u1ecb b\u1ecf qua do:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0110au l\u00e0m lu m\u1edd tri\u1ec7u ch\u1ee9ng t\u00ea, m\u1ea5t c\u1ea3m gi\u00e1c v\u00f9ng c\u01a1 Delta.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0110au l\u00e0m b\u1ec7nh nh\u00e2n t\u1eeb ch\u1ed1i co c\u01a1 Delta (test v\u1eadn \u0111\u1ed9ng).<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Di l\u1ec7ch x\u01b0\u01a1ng g\u00e3y l\u00e0m c\u01a1 Delta m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c.<\/p>\n

5. C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h2>\n

5.1. Ch\u1ee5p XQ<\/strong><\/h3>\n

V\u1edbi g\u00e3y \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay, c\u1ea7n thi\u1ebft ch\u1ee5p XQ v\u1edbi c\u00e1c t\u01b0 th\u1ebf: tr\u01b0\u1edbc sau theo m\u1eb7t ph\u1eb3ng c\u1ee7a x\u01b0\u01a1ng b\u1ea3 vai, m\u1eb7t b\u00ean x\u01b0\u01a1ng b\u1ea3 vai (Y-views) v\u00e0 ch\u1ee5p v\u1edbi t\u01b0 th\u1ebf n\u1eb1m d\u1ea1ng c\u00e1nh tay v\u00e0 h\u01b0\u1edbng tia v\u00e0o n\u00e1ch theo m\u1eb7t ph\u1eb3ng c\u00e1nh tay (axillary)<\/p>\n

N\u1ebfu ch\u1ee5p XQ thu \u0111\u01b0\u1ee3c nh\u1eefng h\u00ecnh \u1ea3nh v\u1edbi t\u1ed5n th\u01b0\u01a1ng g\u00e3y \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay<\/a> bao g\u1ed3m nhi\u1ec1u m\u1ea3nh r\u1eddi, c\u1ea7n thi\u1ebft ph\u1ea3i ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh t\u00e1i t\u1ea1o h\u00ecnh \u1ea3nh 3D \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng.<\/p>\n

Ch\u1ee5p kh\u1edbp vai b\u00ecnh di\u1ec7n m\u1eb7t, b\u00ecnh di\u1ec7n b\u00ean (h\u00ecnh \u1ea3nh n\u00e1ch) v\u00e0 x\u01b0\u01a1ng b\u1ea3 vai y\u1ebfp tuy\u1ebfn.<\/p>\n

Ch\u1ee5p kh\u1edbp vai b\u00ecnh di\u1ec7n b\u00ean Velpeau khi b\u00ecnh di\u1ec7n b\u00ean kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c.<\/p>\n

\"H\u00ecnh
H\u00ecnh 6.7. H\u00ecnh \u1ea3nh t\u01b0 th\u1ebf ch\u1ee5p kh\u1edbp vai th\u1eb3ng v\u00e0 t\u01b0 th\u1ebf ch\u1ee5p kh\u1edbp vai ch\u1ebfch b\u00ean<\/figcaption><\/figure>\n
\"H\u00ecnh
H\u00ecnh 6.8. H\u00ecnh \u1ea3nh ch\u1ee5p kh\u1edbp vai t\u01b0 th\u1ebf Velpeau<\/figcaption><\/figure>\n

5.2. CT scanner<\/strong><\/h3>\n

CT scanner \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e3y ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay, g\u00e3y l\u00fan, g\u00e3y ph\u1ee9c t\u1ea1p m\u1ea5u \u0111\u1ed9ng l\u1edbn, g\u00e3y ph\u1ea1m kh\u1edbp ph\u1ee9c t\u1ea1p<\/p>\n

Ng\u00e0y nay, ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p phim CT scanner, \u0111\u1eb7c bi\u1ec7t l\u00e0 CT 3D d\u1ef1ng h\u00ecnh, gi\u00fap x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c, ti\u00ean l\u01b0\u1ee3ng c\u0169ng nh\u01b0 c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb m\u1ed9t c\u00e1ch h\u1ee3p l\u00fd<\/p>\n

\"H\u00ecnh
H\u00ecnh 6.9. H\u00ecnh \u1ea3nh XQ v\u00e0 CT Scanner 3D d\u1ef1ng h\u00ecnh m\u1ed9t tr\u01b0\u1eddng h\u1ee3p g\u00e3y ph\u1ee9c t\u1ea1p \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay<\/figcaption><\/figure>\n

5.3.\u00a0\u00a0\u00a0\u00a0\u00a0 MRI<\/strong><\/h3>\n

MRI th\u01b0\u1eddng \u00edt \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ngay sau khi ch\u1ea5n th\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi c\u00f3 g\u00e3y x\u01b0\u01a1ng. Tuy nhi\u00ean, MR1 h\u1eefu \u00edch trong tr\u01b0\u1eddng h\u1ee3p x\u00e1c \u0111\u1ecbnh c\u00f3 t\u1ed5n th\u01b0\u01a1ng ch\u00f3p xoay hay kh\u00f4ng<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u00e3y \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay chi\u1ebfm 4-5% trong t\u1ea5t c\u1ea3 c\u00e1c lo\u1ea1i g\u00e3y x\u01b0\u01a1ng, v\u00e0 v\u1ecb tr\u00ed g\u00e3y hay g\u1eb7p nh\u1ea5t trong g\u00e3y x\u01b0\u01a1ng c\u00e1nh tay (45%). C\u00f3 th\u1ec3 g\u1eb7p \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i nh\u01b0ng \u0111a s\u1ed1 g\u1eb7p \u1edf ng\u01b0\u1eddi nhi\u1ec1u tu\u1ed5i do li\u00ean quan \u0111\u1ebfn t\u00ecnh tr\u1ea1ng lo\u00e3ng x\u01b0\u01a1ng, \u1edf ng\u01b0\u1eddi tr\u1ebb l\u00e0 […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[40],"tags":[3],"yoast_head":"\nC\u01a1 ch\u1ebf, ch\u1ea9n \u0111o\u00e1n g\u00e3y ch\u1ecfm v\u00e0 \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay<\/title>\n<meta name=\"description\" content=\"G\u00e3y \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay chi\u1ebfm 4-5% trong t\u1ea5t c\u1ea3 c\u00e1c lo\u1ea1i g\u00e3y x\u01b0\u01a1ng, v\u00e0 v\u1ecb tr\u00ed g\u00e3y hay g\u1eadp nh\u1ea5t trong g\u00e3y x\u01b0\u01a1ng c\u00e1nh tay (45%).\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, 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