{"id":18021,"date":"2023-04-10T23:20:38","date_gmt":"2023-04-10T16:20:38","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18021"},"modified":"2023-04-14T23:10:35","modified_gmt":"2023-04-14T16:10:35","slug":"cac-yeu-to-anh-huong-den-khop-dui-che","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/cac-yeu-to-anh-huong-den-khop-dui-che\/","title":{"rendered":"C\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1edbp \u0111\u00f9i – ch\u00e8"},"content":{"rendered":"

Kh\u1edbp \u0111\u00f9i-ch\u00e8 \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o n\u00ean b\u1edfi \u0111\u1eb1ng tr\u01b0\u1edbc l\u00e0 x\u01b0\u01a1ng b\u00e1nh ch\u00e8, \u0111\u1eb1ng sau l\u00e0 x\u01b0\u01a1ng \u0111\u00f9i, ph\u00eda d\u01b0\u1edbi l\u00e0 m\u1eb7t tr\u00ean m\u00e2m ch\u00e0y v\u00e0 xung quanh l\u00e0 h\u1ec7 th\u1ed1ng c\u01a1 v\u00e0 d\u00e2y ch\u1eb1ng. Ch\u00ednh v\u00ec th\u1ebf, b\u1ea5t k\u1ef3 s\u1ef1 thay \u0111\u1ed5i n\u00e0o c\u1ee7a b\u1ea5t c\u1ee9 m\u1ed9t trong b\u1ed1n th\u00e0nh ph\u1ea7n tr\u00ean s\u1ebd \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1edbp \u0111\u00f9i-ch\u00e8.<\/strong><\/p>\n

Nh\u00f3m t\u00e1c gi\u1ea3: PGS.TS. Tr\u1ea7n Trung D\u0169ng, BS. Nguy\u1ec5n Huy Ph\u01b0\u01a1ng<\/strong><\/p>\n

1. M\u1ed9t s\u1ed1 ch\u1ec9 s\u1ed1 v\u1ec1 h\u00ecnh \u1ea3nh h\u1ecdc \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u1ec1 kh\u1edbp \u0111\u00f9i – ch\u00e8 v\u00e0 c\u00e1ch \u0111\u00e1nh gi\u00e1<\/strong><\/h2>\n
\"H\u00ecnh
H\u00ecnh 1. C\u00e1c g\u00f3c \u0111\u00e1nh gi\u00e1 x\u01b0\u01a1ng b\u00e1nh ch\u00e8<\/figcaption><\/figure>\n

G\u00f3c r\u00f2ng r\u1ecdc l\u1ed3i c\u1ea7u \u0111\u00f9i (g\u00f3c Brattstrom) [37]: l\u00e0 g\u00f3c AOB c\u00f3 gi\u00e1 tr\u1ecb trung b\u00ecnh l\u00e0 142\u00b0 \u00b1 26\u00b0.<\/span><\/p>\n

G\u00f3c ch\u00e8 \u0111\u00f9i Merchant l\u00e0 DOC c\u00f3 gi\u00e1 tr\u1ecb tiling b\u00ecnh l\u00e0 -6\u00b0 v\u1edbi \u0111\u1ed9 l\u1ec7ch chu\u1ea9n l\u00e0 11\u00b0. G\u00f3c ch\u00e8 \u0111\u00f9i Merchant \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh nh\u01b0 sau: oc l\u00e0 tia ph\u00e2n gi\u00e1c c\u1ee7a g\u00f3c Brattstrom, \u0111\u01b0\u1eddng th\u1eafng OD l\u00e0 th\u1eb3ng n\u1ed1i t\u1eeb \u0111i\u1ec3m <\/span>o <\/span>\u0111\u1ebfn \u0111i\u1ec3m trung t\u00e2m cao nh\u1ea5t c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8. G\u00f3c DOC nghi\u00eang v\u1ec1 ph\u00eda l\u1ed3i c\u00e2u trong s\u1ebd c\u00f3 gi\u00e1 tr\u1ecb \u00e2m, nghi\u00eang v\u1ec1 ph\u00eda l\u1ed3i c\u1ea7u ngo\u00e0i s\u1ebd c\u00f3 gi\u00e1 tr\u1ecb d\u01b0\u01a1ng. Theo t\u00e1c gi\u1ea3 liioue v\u00e0 c\u1ed9ng s\u1ef1 (1988) [13] <\/span>g\u00f3c n\u00e0y c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed x\u01b0\u01a1ng b\u00e1nh ch\u00e8 nh\u01b0ng kh\u00f4ng chu\u1ea9n x\u00e1c nh\u01b0 g\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8. G\u00f3c ch\u00e8 \u0111\u00f9i Merchant c\u00e0ng \u00e2m ngh\u0129a l\u00e0 x\u01b0\u01a1ng b\u00e1nh ch\u00e8 c\u00e0ng l\u1ec7ch <\/span>1<\/span>‘i ngo\u00e0i, v\u00e0 g\u00f3c n\u00e0y c\u00e0ng d\u01b0\u01a1ng th\u00ec x\u01b0\u01a1ng b\u00e1nh ch\u00e8 c\u00e0ng l\u1ec7ch v\u00e0o trong.<\/span><\/p>\n

G\u00f3c ch\u00e8 \u0111\u00f9i ngo\u00e0i (g\u00f3c Laurin [14], g\u00f3c EPB) : \u0111\u01b0\u1eddng AB n\u1ed1i 2 \u0111\u1ec9nh l\u1ed3i c\u1ea7u \u0111\u00f9i v\u00e0 \u0111\u01b0\u1eddng PE n\u1ed1i m\u1eb7t kh\u1edbp ngo\u00e0i x\u01b0\u01a1ng b\u00e1nh ch\u00e8. G\u00f3c ch\u00e8 \u0111\u00f9i ngo\u00e0i l\u00e0 g\u00f3c t\u1ea1o b\u1edfi \u0111\u01b0\u1eddng AB giao v\u1edbi \u0111\u01b0\u1eddng PE. B\u00ecnh th\u01b0\u1eddng g\u00f3c n\u00e0y lu\u00f4n n\u1eb1m tr\u00ean \u0111\u01b0\u1eddng AB. G\u00f3c n\u00e0y ph\u1ee5 thu\u1ed9c nhi\u1ec1u v\u00e0o h\u00ecnh d\u1ea1ng x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u00e0 thay \u0111\u1ed5i theo t\u1eebng ng\u01b0\u1eddi. T\u00e1c gi\u1ea3 Wiberg (1941) [15] \u0111\u00e0 ph\u00e2n lo\u1ea1i x\u01b0\u01a1ng b\u00e1nh ch\u00e8 th\u00e0nh 6 d\u1ea1ng (h\u00ecnh v\u1ebd d\u01b0\u1edbi) v\u00e0 g\u00f3c Laurin thay \u0111\u1ed5i theo t\u1eebng d\u1ea1ng x\u01b0\u01a1ng b\u00e1nh ch\u00e8. \u0110\u00e1nh gi\u00e1 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng <\/span>kh\u1edbp g\u1ed1i theo thang \u0111i\u1ec3m Lysholm so s\u00e1nh gi\u1eefa tr\u01b0\u1edbc m\u1ed5 v\u00e0 sau m\u1ed5.<\/span>
\n<\/span><\/p>\n

\"H\u00ecnh
H\u00ecnh 2. C\u00e1c h\u00ecnh th\u00e1i x\u01b0\u01a1ng b\u00e1nh ch\u00e8 [15]<\/figcaption><\/figure>Patella tilt angle (g\u00f3c nghi\u00eang c\u1ee7a XBC): g\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 l\u00e0 g\u00f3c \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh gi\u1eefa \u0111\u01b0\u1eddng th\u1eb3ng \u0111i qua 2 \u0111i\u1ec3m c\u1ef1c trong v\u00e0 ngo\u00e0i x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u1edbi \u0111\u01b0\u1eddng th\u1eb3ng ti\u1ebfp tuy\u1ec3n ph\u00eda tr\u01b0\u1edbc 2 l\u1ed3i c\u1ea7u <\/span>\u0111\u00f9i (\u0111\u01b0\u1eddng ch\u00e2n tr\u1eddi) tr\u00ean phim X-quang ti\u1ebfp tuy\u1ebfn XBC. G\u00f3c n\u00e0y s\u1ebd kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o h\u00ecnh d\u1ea1ng x\u01b0\u01a1ng b\u00e1nh ch\u00e8 nh\u01b0 g\u00f3c Laurin v\u00e0 g\u00f3c n\u00e0y d\u1ec5 x\u00e1c \u0111\u1ecbnh tr\u00ean phim Xquang v\u00e0 phim ch\u1ee5p C\u1eaft l\u1edbp <\/span>vi t\u00ednh ho\u1eb7c C\u1ed9ng h\u01b0\u1edfng t\u1eeb.<\/span><\/p>\n

G\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 b\u00ecnh th\u01b0\u1eddng l\u00e0 < 5\u00b0, khi g\u00f3c n\u00e0y > 5\u00b0 t\u1ee9c l\u00e0 kh\u1edbp ch\u00e8 \u0111\u00f9i nhi\u1ec1u kh\u1ea3 n\u0103ng c\u00f3 v\u1ea5n \u0111\u1ec1. Theo t\u00e1c gi\u1ea3 Laurin v\u00e0 c\u1ed9ng s\u1ef1 (1978) [14] <\/span>qua nghi\u00ean c\u1ee9u b\u1ec7nh nh\u00e2n, t\u00e1c gi\u00e1 nh\u1eadn x\u00e9t l\u00e0 khi g\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 > 20\u00b0 th\u00ec ch\u1eafc ch\u1eafn kh\u1edbp ch\u00e8 \u0111\u00f9i c\u00f3 v\u1ea5n \u0111\u1ec1. Theo t\u00e1c gi\u1ea3 Ronald P.Gralsamer (1993) [12], khi nghi\u00ean c\u00edni 100 kh\u1edbp g\u1ed1i b\u1ea5t th\u01b0\u1eddng v\u1ec1 kh\u1edbp ch\u00e8 \u0111\u00f9i, t\u00e1c gi\u1ea3 th\u1ea5y c\u00f3 85% b\u1ec7nh nh\u00e2n c\u00f3 g\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 > 5\u00b0, nh\u01b0 v\u1eady t\u00e1c gi\u1ea3 nh\u1eadn x\u00e9t l\u00e0 g\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t ch\u1ec9 s\u1ed1 \u0111\u00e1nh gi\u00e1 tuy\u1ec7t \u0111\u1ed1i v\u1ec1 s\u1ef1 b\u1ea5t th\u01b0\u1eddng c\u1ee7a kh\u1edbp ch\u00e8 \u0111\u00f9i, nh\u01b0ng \u0111\u00f3 l\u00e0 m\u1ed9t ch\u1ec9 s\u1ed1 \u0111\u00e1ng tin c\u1eady \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 b\u1ea5t th\u01b0\u1eddng c\u1ee7a kh\u1edbp \u0111\u00f3. T\u00e1c gi\u1ea3 Aglietti (1983) [16] v\u00e0 t\u00e1c gi\u1ea3 Inoue (1988) [13] \u0111\u00e0 ti\u1ebfn h\u00e0nh nghi\u00ean c\u1ee9u \u0111\u1ed9c l\u1eadp nhau tr\u00ean c\u00e1c kh\u1edbp g\u1ed1i c\u00f3 b\u1ea5t th\u01b0\u1eddng kh\u1edbp ch\u00e8 \u0111\u00f9i th\u00ec c\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 \u0111\u01b0a ra k\u1ebft lu\u1eadn 85% b\u1ec7nh nh\u00e2n c\u00f3 kh\u1edbp nghi\u00eang b\u00e1nh ch\u00e8 \u0111\u1ea1t <\/span>y\u00eau c\u1ea7u th\u00ec l\u00e2m s\u00e0ng c\u1ea3i <\/b>thi\u1ec7n <\/span>h\u01a1n <\/b>\u0111\u00e1ng k\u1ec3 so v\u1edbi c\u00e1c nh\u00f3m \u0111\u1ed1i <\/span>t\u01b0\u1ee3ng <\/b>kh\u00e1c. Theo Koskinen (1991) [17] g\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 ngo\u00e0i ra c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u01b0\u1eddng ti\u1ebfp tuy\u1ebfn ph\u00eda tr\u01b0\u1edbc 2 l\u1ed3i c\u1ea7u \u0111\u00f9i (ch\u00ednh l\u00e0 \u0111\u01b0\u1eddng ch\u00e2n tr\u1eddi), trong l s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ea5t th\u01b0\u1eddng v\u1ec1 c\u00e1c l\u1ed3i c\u1ea7u \u0111\u00f9i (lo\u1ea1n s\u1ea3n ho\u1eb7c ph\u00ec \u0111\u1ea1i \u0111\u1ea7u xa x\u01b0\u01a1ng \u0111\u00f9i) s\u1ebd d\u1eabn \u0111\u1ebfn s\u1ed5 \u0111o g\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 s\u1ebd th\u1ea5p h\u01a1n ho\u1eb7c cao h\u01a1n gi\u00e1 tr\u1ecb th\u1ef1c t\u1ebf. S\u1ef1 xoay ra ngo\u00e0i c\u1ee7a \u0111\u1ea7u xa x\u01b0\u01a1ng \u0111\u00f9i c\u0169ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn g\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8, tuy nhi\u00ean g\u00f3c xoay ngo\u00e0i n\u00e0y ch\u1ec9 c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh tr\u00ean phim ch\u1ee5p CT ho\u1eb7c MRI. V\u00e0 theo t\u00e1c gi\u1ea3 Ronald p Grelsamer (1993) [12] th\u00ec g\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 c\u1ecf \u0111\u1ed9 tin c\u1eady cao h\u01a1n so v\u1edbi g\u00f3c Laurin khi \u0111\u00e1nh gi\u00e1 kh\u1edbp ch\u00e8-\u0111\u00f9i.<\/span><\/p>\n

2. M\u1ed1i t\u01b0\u01a1ng quan gi\u1eefa x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u00e0 l\u1ed3i c\u1ea7u \u0111\u00f9i. \u1ea2nh h\u01b0\u1edfng c\u1ee7a \u0111\u1ed9 xoay l\u1ed3i c\u1ea7u \u0111\u00f9i (femoral component rotated) \u0111\u1ebfn r\u00e3nh tr\u01b0\u1ee3t XBC (Patella femoral tracking)<\/strong><\/h2>\n

 <\/p>\n

\"H\u00ecnh
H\u00ecnh 3. \u1ea2nh h\u01b0\u1edfng c\u1ee7a m\u1ee9c \u0111\u1ed9 xoay l\u1ed3i c\u1ea7u \u0111\u00f9i \u0111\u1ebfn kho\u1ea3ng g\u1ea5p v\u00e0 g\u00f3c ch\u00e8 – \u0111\u00f9i<\/figcaption><\/figure>\n

R\u00e3nh tr\u01b0\u1ee3t x\u01b0\u01a1ng b\u00e1nh ch\u00e8 (hay ng\u01b0\u1eddi ta c\u00f2n l\u00e0 r\u00e3nh \u0111\u00f9i-ch\u00e8, ho\u1eb7c di\u1ec7n x\u01b0\u01a1ng b\u00e1nh ch\u00e8 c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i) nam \u1edf ph\u00eda tr\u01b0\u1edbc v\u00e0 gi\u1eefa hai l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i, \u0111\u00f3 l\u00e0 r\u00e3nh kh\u1edbp \u0111\u1ec3 x\u01b0\u01a1ng b\u00e1nh ch\u00e8 di \u0111\u1ed9ng tr\u01b0\u1ee3t tr\u00ean \u0111\u1ea7u xa x\u01b0\u01a1ng \u0111\u00f9i. B\u00ecnh th\u01b0\u1eddng, g\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 trong v\u00e0 ngo\u00e0i \u0111\u1ec1u nh\u1ecf h\u01a1n 5\u00b0, ngh\u0129a l\u00e0 tr\u1ee5c ngang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 n\u1eb1m song song v\u1edbi tr\u1ee5c ngang kh\u1edbp g\u1ed1i; b\u1ea5t k\u1ef3 m\u1ed9t nguy\u00ean nh\u00e2n n\u00e0o \u0111\u00f3 l\u00e0m cho g\u00f3c nghi\u00eang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 > 5\u00b0 th\u00ec s\u1ebd l\u00e0m cho kh\u1edbp ch\u00e8 \u0111\u00f9i c\u00f3 v\u1ea5n \u0111\u1ec1, g\u00e2y \u0111au ho\u1eb7c h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp g\u1ed1i v\u00e0 c\u00f3 th\u1ec3 g\u00e2y tr\u1eadt x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u00e0o trong ho\u1eb7c ra ngo\u00e0i kh\u1ecfi r\u00e3nh \u0111\u00f9i-ch\u00e8.<\/span>
\n<\/span><\/p>\n

Tr\u1ee5c ngang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 c\u00f9ng gi\u1ed1ng nh\u01b0 tr\u1ee5c ngang g\u1ed1i, kh\u00f4ng c\u1ed1 \u0111\u1ecbnh trong qu\u00e1 tr\u00ecnh ho\u1ea1t \u0111\u1ed9ng c\u1ee7a kh\u1edbp g\u1ed1i. Trong qu\u00e1 tr\u00ecnh g\u1ea5p du\u1ed7i g\u1ed1i, tr\u1ee5c ngang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 chuy\u1ec3n \u0111\u1ed9ng theo h\u00ecnh ch\u1eef J gi\u1ed1ng tr\u1ee5c ngang g\u1ed1i, \u0111\u1ea7u ch\u1eef J l\u00e0 khi g\u1ed1i du\u1ed7i t\u1ed1i \u0111a v\u00e0 \u0111u\u00f4i ch\u1eef J l\u00e0 khi g\u1ed1i g\u1ea5p t\u1ed1i \u0111a. Do x\u01b0\u01a1ng b\u00e1nh ch\u00e8 chuy\u1ec3n \u0111\u1ed9ng tr\u00ean r\u00e3nh ch\u00e8 \u0111\u00f9i-ch\u00e8 c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i n\u00ean trong qu\u00e1 tr\u00ecnh g\u1ea5p du\u1ed7i \u0111\u00f3, di\u1ec7n ti\u1ebfp x\u00fac gi\u1eefa x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 x\u01b0\u01a1ng b\u00e1nh ch\u00e8 thay \u0111\u1ed5i li\u00ean t\u1ee5c v\u00e0 t\u1ed5ng h\u1ee3p l\u1ef1c t\u00e1c \u0111\u1ed9ng l\u00ean x\u01b0\u01a1ng \u0111\u00f9i c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8 c\u0169ng li\u00ean t\u1ee5c thay \u0111\u1ed5i. Khi g\u1ed1i g\u1ea5p 60\u00b0, di\u1ec7n ti\u1ebfp x\u00fac gi\u1eefa x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 x\u01b0\u01a1ng b\u00e1nh ch\u00e8 l\u00e0 nhi\u1ec1u nh\u1ea5t, khi \u0111\u00f3 l\u1ef1c t\u00e1c d\u1ee5ng c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8 l\u00ean x\u01b0\u01a1ng \u0111\u00f9i l\u00e0 l\u1edbn nh\u1ea5t.<\/span><\/p>\n

B\u00ecnh th\u01b0\u1eddng, tr\u1ee5c ngang g\u1ed1i c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i kh\u00f4ng n\u1eb1m song song v\u1edbi \u0111\u01b0\u1eddng l\u1ed3i c\u1ea7u sau x\u01b0\u01a1ng \u0111\u00f9i m\u00e0 n\u1eb1m xoay ngo\u00e0i m\u1ed9t g\u00f3c 3\u00b0. Nh\u01b0 v\u1eady, khi \u0111\u1ea7u xa x\u01b0\u01a1ng \u0111\u00f9i xoay ngo\u00e0i m\u1ed9t g\u00f3c 3\u00b0 s\u1ebd \u0111\u1ea3m b\u1ea3o cho tr\u1ee5c ngang x\u01b0\u01a1ng b\u00e1nh ch\u00e8 nam song song v\u1edbi tr\u1ee5c ngang g\u1ed1i. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u1edbp g\u1ed1i b\u1ecb bi\u1ebfn d\u1ea1ng, l\u1ed3i c\u1ea7u \u0111\u00f9i b\u1ecb bi\u1ebfn d\u1ea1ng hay trong tr\u01b0\u1eddng h\u1ee3p sau thay kh\u1edbp g\u1ed1i to\u00e0n ph\u1ea7n, l\u00e0m cho g\u00f3c xoay ngo\u00e0i c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i l\u1edbn h\u01a1n nhi\u1ec1u ho\u1eb7c c\u00f3 khi b\u1ecb \u00e2m s\u1ebd l\u00e0 kh\u1edbp \u0111\u00f9i-ch\u00e8 b\u1ecb b\u1ea5t th\u01b0\u1eddng. Neu g\u00f3c xoay ngo\u00e0i x\u01b0\u01a1ng \u0111\u00f9i l\u1edbn h\u01a1n b\u00ecnh th\u01b0\u1eddng, l\u00fac \u0111\u1ecf g\u00f3c nghi\u00eang b\u00e1nh ch\u00e8 s\u1ebd > 5\u00b0, g\u00f3c Q x\u01b0\u01a1ng b\u00e1nh ch\u00e8 s\u1ebd t\u0103ng, s\u1ebd khi\u1ebfn cho x\u01b0\u01a1ng b\u00e1nh ch\u00e8 t\u1ef3 ch\u1ee7 y\u1ebfu v\u00e0o l\u1ed3i c\u1ea7u trong, l\u00e0m cho m\u1eb7t kh\u1edbp ph\u00eda xong x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u00e0 m\u1eb7t kh\u1edbp b\u00e1nh ch\u00e8 c\u1ee7a l\u1ed3i c\u1ea7u trong s\u00e8 ti\u1ebfp x\u00fac ch\u1ecbu l\u1ef1c ch\u1ee7 y\u1ebfu, l\u00e0m tho\u00e1i h\u00f3a nhanh kh\u1edbp \u0111\u00f9i-ch\u00e8 trong g\u00e2y \u0111au cho b\u1ec7nh nh\u00e2n. L\u00fac g\u00f3c <\/span>\u1ecd <\/span>qu\u00e1 20\u00b0 s\u1ebd t\u0103ng nguy c\u01a1 tr\u1eadt x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u00e0o ph\u00eda trong. Ng\u01b0\u1ee3c l\u1ea1i, n\u1ebfu g\u00f3c xoay ngo\u00e0i c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i < 3\u00b0, ho\u1eb7c kh\u00f4ng xoay ngo\u00e0i hay c\u00f3 khi l\u00e0 xoay trong, s\u00e8 khi\u1ebfn cho g\u00f3c nghi\u00eang trong c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8 > 5\u00b0, g\u00f3c Q nh\u1ecf ho\u1eb7c b\u1eb1ng 0\u00b0, nh\u01b0 v\u1eady x\u01b0\u01a1ng b\u00e1nh ch\u00e8 s\u00e8 t\u1ef3 l\u1ef1c ch\u1ee7 y\u1ebfu l\u00ean l\u1ed3i c\u1ea7u ngo\u00e0i, l\u00e0m kh\u1edbp \u0111\u00f9i-ch\u00e8 ngo\u00e0i tho\u00e1i h\u00f3a nhanh g\u00e2y \u0111au cho b\u1ec7nh nh\u00e2n, l\u00e0m t\u0103ng nguy c\u01a1 tr\u1eadt ra ngo\u00e0i c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8.<\/span>
\n<\/span><\/p>\n

\"H\u00ecnh
H\u00ecnh 4. T\u1ed5ng h\u1ee3p c\u00e1c l\u1ef1c t\u00e1c \u0111\u1ed9ng l\u00ean x\u01b0\u01a1ng b\u00e1nh ch\u00e8 [18]<\/figcaption><\/figure>\n

3. \u1ea2nh h\u01b0\u1edfng c\u1ee7a c\u00e1nh trong v\u00e0 c\u00e1nh ngo\u00e0i x\u01b0\u01a1ng b\u00e1nh ch\u00e8 \u0111\u1ebfn kh\u1edbp ch\u00e8-\u0111\u00f9i<\/b><\/h2>\n

H\u1ec7 th\u1ed1ng c\u00e1nh trong v\u00e0 c\u00e1nh ngo\u00e0i x\u01b0\u01a1ng b\u00e1nh ch\u00e8 (medial and lateral retinaculum patella) l\u00e0 h\u1ec7 th\u1ed1ng bao kh\u1edbp g\u1ed1i b\u00e1m v\u00e0o hai b\u00ean x\u01b0\u01a1ng b\u00e1nh ch\u00e8, \u0111\u01b0\u1ee3c t\u0103ng c\u01b0\u1eddng b\u1edfi h\u1ec7 th\u1ed1ng g\u00e2n c\u01a1 t\u1ee9 \u0111\u1ea7u \u0111\u00f9i, c\u01a1 may v\u00e0 c\u01a1 c\u0103ng m\u1ea1c \u0111\u00f9i. Ch\u1ee9c n\u0103ng c\u1ee7a h\u1ec7 th\u1ed1ng c\u00e1nh trong v\u00e0 ngo\u00e0i x\u01b0\u01a1ng b\u00e1nh ch\u00e8 l\u00ean kh\u1edbp ch\u00e8 \u0111\u00f9i l\u00e0 gi\u1eef cho x\u01b0\u01a1ng b\u00e1nh ch\u00e8 \u1ed5n \u0111\u1ecbnh v\u00e0 lu\u00f4n lu\u00f4n ch\u1ea1y trong r\u00e3nh r\u00f2ng r\u1ecdc c\u1ee7a l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i trong qu\u00e1 tr\u00ecnh g\u1ea5p du\u1ed7i g\u1ed1i.<\/span><\/p>\n

Theo t\u00e1c gi\u1ea3 Stefano Zaffagnini [19] <\/span>khi nghi\u00ean c\u1ee9u tr\u00ean m\u00f4 h\u00ecnh kh\u1edbp g\u1ed1i \u0111\u00e0 gi\u00e3 \u0111\u00f4ng, t\u00e1c gi\u1ea3 \u0111\u00e0 th\u1ea5y r\u1eb1ng khi g\u1ed1i g\u1ea5p t\u1eeb 0 \u0111\u1ebfn 20\u00b0, nh\u1edd c\u00f3 h\u1ec7 th\u1ed1ng c\u00e1nh trong v\u00e0 c\u00e1nh ngo\u00e0i x\u01b0\u01a1ng b\u00e1nh ch\u00e8 n\u00ean x\u01b0\u01a1ng b\u00e1nh ch\u00e8 gi\u1eef \u1ed5n \u0111\u1ecbnh \u1edf v\u1ecb tr\u00ed c\u0169 v\u00e0 b\u1eaft \u0111\u1ea7u t\u0103ng l\u1ef1c \u00e9p xu\u1ed1ng x\u01b0\u01a1ng \u0111\u00f9i. K!ii g\u1ed1i b\u1eaft \u0111\u1ea7u g\u1ea5p th\u00eam \u0111\u1ebfn t\u1ed1i \u0111a, x\u01b0\u01a1ng b\u00e1nh ch\u00e8 b\u00e1t \u0111\u1ea7u tr\u01b0\u1ee3t tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i trong r\u00e3nh r\u00f2ng r\u1ecdc l\u1ed3i c\u1ea7u \u0111\u00f9i cho \u0111\u1ebfn khi g\u1ed1i g\u1ea5p t\u1ed1i \u0111a th\u00ec d\u1eebng l\u1ea1i, khi \u0111\u00f3, h\u1ec7 th\u1ed1ng c\u00e1nh trong v\u00e0 ngo\u00e0i x\u01b0\u01a1ng b\u00e1nh ch\u00e8 c\u00e2n b\u1eb1ng v\u1ec1 l\u1ef1c, l\u00e0m cho x\u01b0\u01a1ng b\u00e1nh ch\u00e8 kh\u00f4ng tr\u1eadt ra ngo\u00e0i. H\u1ec7 th\u1ed1ng c\u00e1nh trong v\u00e0 ngo\u00e0i x\u01b0\u01a1ng b\u00e1nh ch\u00e8 \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o t\u1eeb c\u00e1c s\u1ee3i collagen v\u00e0 elastin gi\u00fap cho n\u00f3 c\u00f3 \u0111\u1ed9 \u0111\u00e0n h\u1ed3i v\u00e0 co d\u1eb1n nh\u1ea5t \u0111\u1ecbnh, khi g\u1ed1i g\u1ea5p, n\u00f3 v\u1eeba gi\u1eef x\u01b0\u01a1ng b\u00e1nh ch\u00e8 tr\u00ean r\u00e3nh r\u00f2ng r\u1ecdc, v\u1eeba l\u00e0m x\u01b0\u01a1ng b\u00e1nh ch\u00e8 \u00e9p m\u1ed9t l\u1ef1c nh\u1ecf l\u00ean kh\u1edbp ch\u00e8 \u0111\u00f9i, v\u00e0 khi g\u1ed1i g\u1ea5p 60\u00b0, l\u00fac n\u00e0y di\u1ec7n t\u00edch ti\u1ebfp x\u00fac c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u00e0 x\u01b0\u01a1ng \u0111\u00f9i l\u00e0 l\u1edbn nh\u1ea5t, v\u00e0 l\u1ef1c \u00e9p c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8 l\u00ean x\u01b0\u01a1ng \u0111\u00f9i l\u00e0 m\u1ea1nh nh\u1ea5t, t\u1eeb g\u1ed1i g\u1ea5p 60\u00b0 tr\u1edf \u0111i, h\u1ec7 th\u1ed1ng c\u00e1nh ch\u00e8 trong v\u00e0 <\/span>ngo\u00e0i <\/span>\u1ed5n \u0111\u1ecbnh gi\u1eef cho b\u00e1nh ch\u00e8 tr\u01b0\u1ee3t \u0111\u1ec1u tr\u00ean r\u00e3nh r\u00f2ng r\u1ecdc c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i [)8],[)9],[20]. Theo t\u00e1c gi\u1ea3 Stefano Zaffagnini v\u00e0 c\u00f4ng s\u1ef1[l 9] khi nghi\u00ean c\u1ee9u tr\u00ean kh\u1edbp ch\u00e8 \u0111\u00f9i v\u00e0 c\u00e1c th\u00e0nh ph\u1ea7n xung quanh, t\u00e1c gi\u1ea3 th\u1ea5y r\u1eb1ng vai tr\u00f2 c\u1ee7a c\u00e1nh b\u00e1nh ch\u00e8 b\u00ean trong v\u00e0 c\u00e1nh b\u00e1nh ch\u00e8 b\u00ean ngo\u00e0i vai tr\u00f2 kh\u00f4ng gi\u1ed1ng nhau khi t\u00e1c \u0111\u1ed9ng l\u00ean x\u01b0\u01a1ng b\u00e1nh ch\u00e8, c\u1ee5 th\u1ec3 l\u00e0 c\u00e1nh b\u00e1nh ch\u00e8 trong chi\u1ebfm 60% l\u1ef1c t\u00e1c d\u1ee5ng l\u00ean x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u00e0 khi t\u1ed5n th\u01b0\u01a1ng 50% c\u00e1nh b\u00e1nh ch\u00e8 trong !\u00e0 c\u00f3 nguy c\u01a1 g\u00e2y tr\u1eadt x\u01b0\u01a1ng b\u00e1nh ch\u00e8. V\u00ec v\u1eady, khi ph\u1eabu thu\u1eadt THKGTP, vi\u1ec7c kh\u00e2u ph\u1ee5c h\u1ed3i l\u1ea1i c\u00e1nh b\u00e1nh ch\u00e8 trong l\u00e0 r\u1ea5t quan tr\u1ecdng. Khi n\u00f3i v\u1ec1 c\u00e1nh b\u00e1nh ch\u00e8 ngo\u00e0i, Sven Ostermeier v\u00e0 c\u1ed9ng s\u1ef1 [21 ] nghi\u00ean c\u1ee9u tr\u00ean 8 g\u1ed1i t\u01b0\u01a1i gi\u00e3 \u0111\u00f4ng, t\u00e1c gi\u1ea3 nh\u1eadn x\u00e9t c\u00e1nh b\u00e1nh ch\u00e8 ngo\u00e0i kh\u00f4ng c\u00f3 vai tr\u00f2 quy\u1ebft \u0111\u1ecbnh t\u00ednh \u1ed5n \u0111\u1ecbnh c\u1ee7a kh\u1edbp ch\u00e8 \u0111\u00f9i, nh\u01b0ng n\u00f3 c\u00f3 vai tr\u00f2 l\u1edbn \u0111\u1ebfn vi\u1ec7c l\u00e0m gi\u1ea3m l\u1ef1c \u00e9p c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8 l\u00ean kh\u1edbp g\u1ed1i, <\/span>tuy nhi\u00ean t\u00e1c gi\u1ea3 c\u0169ng khuy\u1ec3n c\u00e1o n\u00ean ch\u00fa \u00fd c\u00e1nh b\u00e1nh ch\u00e8 ngo\u00e0i khi x\u01b0\u01a1ng b\u00e1nh ch\u00e8 m\u1ea5t s\u1ef1 \u1ed5n \u0111\u1ecbnh.<\/span><\/p>\n

4. G\u00f3c Q c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8<\/strong><\/h2>\n

G\u00f3c Q (Quadriceps angle – g\u00f3c c\u01a1 t\u1ee9 \u0111\u1ea7u \u0111\u00f9i) l\u00e0 m\u1ed9t trong c\u00e1c ch\u1ec9 s\u1ed1 quan tr\u1ecdng nh\u1ea5t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 \u1ed5n \u0111\u1ecbnh c\u1ee7a kh\u1edbp ch\u00e8 \u0111\u00f9i. G\u00f3c Q \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u0111\u1ea7u ti\u00ean b\u1edfi t\u00e1c gi\u1ea3 Brattstrom v\u00e0o n\u0103m 1970 [22], n\u00f3 th\u1ec3 hi\u1ec7n l\u1ef1c k\u00e9o c\u1ee7a c\u01a1 t\u1ee9 \u0111\u1ea7u l\u00ean x\u01b0\u01a1ng b\u00e1nh ch\u00e8. C\u00e1c ph\u1eabu thu\u1eadt vi\u00ean th\u01b0\u1eddng \u0111o g\u00f3c Q tr\u00ean l\u00e2m s\u00e0ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng kh\u1edbp ch\u00e8 – <\/span>\u0111\u00f9i ho\u1eb7c \u1edf c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng d\u1ec5 b\u1ecb ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp n\u00e0y, nh\u01b0 c\u00e1c v\u1eadn \u0111\u1ed9ng vi\u00ean tr\u1ebb ch\u01a1i th\u1ec3 thao. Nh\u01b0ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111o g\u00f3c Q tr\u00ean l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u01b0\u1ee3c chu\u1ea9n h\u00f3a, v\u00e0 gi\u00e1 tr\u1ecb c\u1ee7a n\u00f3 thay \u0111\u1ed5i ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111o kh\u00e1c nhau. V\u00ec th\u1ebf, \u0111o g\u00f3c Q d\u1ef1a v\u00e0o X-quang \u0111\u01b0\u1ee3c nhi\u1ec1u t\u00e1c gi\u1ea3 nh\u1eadn \u0111\u1ecbnh l\u00e0 ch\u00ednh x\u00e1c h\u01a1n. Tr\u1eadt kh\u1edbp g\u1ed1i v\u00e0 \u0111au kh\u1edbp ch\u00e8 – \u0111\u00f9i \u0111\u00e3 tr\u1edf th\u00e0nh v\u1ea5n \u0111\u1ec1 r\u1ea5t ph\u1ed5 bi\u1ebfn hi\u1ec7n nay. Trong tr\u01b0\u1eddng h\u1ee3p g\u1ed1i b\u1ecb v\u1eb9o ngo\u00e0i, t\u0103ng s\u1ea3n \u0111\u1ea7u xa x\u01b0\u01a1ng \u0111\u00f9i, x\u01b0\u01a1ng ch\u00e0y xoay ra ngo\u00e0i, l\u1ed3i c\u1ee7 x\u01b0\u01a1ng ch\u00e0y b\u1ecb bi\u1ec3n d\u1ea1ng ra ngo\u00e0i,… c\u00f3 th\u1ec3 l\u00e0m t\u0103ng g\u00f3c Q, V\u00e0 s\u1ef1 t\u0103ng g\u00f3c Q l\u00e0 m\u1ed9t trong c\u00e1c y\u1ebfu t\u1ed5 c\u00f3 th\u1ec3 g\u00e2y tr\u1eadt kh\u1edbp b\u00e1nh ch\u00e8.<\/span><\/p>\n

G\u00f3c Q l\u00e0 g\u00f3c \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh theo 2 <\/span>c\u00e1ch:<\/span><\/p>\n

+ Tr\u00ean l\u00e2m s\u00e0ng: l\u00e0 g\u00f3c \u0111\u01b0\u1ee3c t\u1ea1o b\u1edfi 2 \u0111\u01b0\u1eddng th\u1eb3ng: \u0111\u01b0\u1eddng th\u1eb3ng th\u1ee9 nh\u1ea5t l\u00e0 vector l\u1ef1c c\u1ee7a c\u01a1 t\u1ee9 \u0111\u1ea7u \u0111\u00f9i khi c\u01a1 n\u00e0y co, hay ch\u00ednh l\u00e0 \u0111\u01b0\u1eddng th\u1eb3ng \u0111i t\u1eeb t\u00e2m b\u00e1nh ch\u00e8 l\u00ean tr\u1ee5c c\u1ee7a g\u00e2n c\u01a1 t\u1ee9 \u0111\u1ea7u \u0111\u00f9i. \u0110\u01b0\u1eddng th\u1eb3ng th\u1ee9 hai l\u00e0 \u0111\u01b0\u1eddng th\u1eb3ng \u0111i qua t\u00e2m b\u00e1nh ch\u00e8 \u0111\u1ebfn l\u1ed3i c\u1ee7 x\u01b0\u01a1ng ch\u00e0y.<\/p>\n

+<\/span><\/i> Tr\u00ean phim X-quang: l\u00e0 g\u00f3c t\u1ea1o b\u1edfi 2 \u0111\u01b0\u1eddng th\u1eb3ng: \u0111\u01b0\u1eddng th\u1ee9 nh\u1ea5t \u0111i t\u1eeb t\u00e2m b\u00e1nh ch\u00e8 \u0111\u1ebfn gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean, \u0111\u01b0\u1eddng th\u1eb3ng th\u1ee9 hai \u0111i t\u1eeb t\u00e2m b\u00e1nh ch\u00e8 \u0111\u1ebfn l\u1ed3i c\u1ee7 x\u01b0\u01a1ng ch\u00e0y.<\/span><\/p>\n

Tr\u1ecb s\u1ed1 c\u1ee7a g\u00f3c Q b\u00ecnh th\u01b0\u1eddng l\u00e0 t\u1eeb 8 <\/span>– 10\u00b0 \u1edf nam gi\u1edbi, 10 – 20\u00b0 \u1edf n\u1eef gi\u1edbi, nh\u01b0ng tr\u1ecb s\u1ed5 n\u00e0y c\u00f3 th\u1ec3 b\u1ecb thay \u0111\u1ed5i ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1c th\u00e0nh ph\u1ea7n c\u1ea5u t\u1ea1o n\u00ean n\u00f3 \u0111o nh\u00e2n tr\u00e1c h\u1ecdc. G\u00f3c Q th\u1ec3 hi\u1ec7n l\u1ef1c \u00e9p c\u1ee7a b\u00e1nh ch\u00e8 l\u00ean kh\u1edbp g\u1ed1i, n\u1ebfu l\u1ef1c \u00e9p n\u00e0y qu\u00e1 l\u1edbn s\u1ebd g\u00e2y \u0111au kh\u1edbp ch\u00e8 \u0111\u00f9i, N\u1ebfu g\u00f3c Q qu\u00e1 l\u1edbn (g\u00f3c Q > 20\u00b0) l\u00e0m ch\u00e2n b\u1ecb v\u1eb9o ngo\u00e0i, s\u1ebd g\u00e2y tr\u1eadt x\u01b0\u01a1ng b\u00e1nh ch\u00e8 ra ngo\u00e0i r\u00e3nh ch\u00e8 \u0111\u00f9i. N\u1ebfu g\u00f3c Q \u00e2m s\u1ebd l\u00e0 ch\u00e2n v\u1eb9o\u00a0<\/span>trong, g\u00e2y tr\u1eadt b\u00e1nh ch\u00e8 v\u00e0o trong r\u00e3nh ch\u00e8 \u0111\u00f9i. G\u00f3c Q \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c s\u1ef1 t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u01a1 t\u1ee9\u00a0 \u0111\u1ea7u \u0111\u00f9i l\u00ean x\u01b0\u01a1ng b\u00e1nh ch\u00e8. Khi \u0111\u01b0\u1ee3c \u0111o \u0111\u1ea1c ch\u00ednh x\u00e1c, n\u00f3 cung c\u1ea5p th\u00f4ng tin r\u1ea5t h\u1eefu \u00edch li\u00ean quan \u0111\u1ebfn chi d\u01b0\u1edbi, \u0111\u1ecf l\u00e0 m\u1ed1i li\u00ean h\u1ec7 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 x\u01b0\u01a1ng ch\u00e0y, c\u0169ng nh\u01b0 s\u1ef1 t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u01a1 t\u1ee9 \u0111\u1ea7u l\u00ean c\u00e1c tr\u1ef1c c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 x\u01b0\u01a1ng <\/span>ch\u00e0y.<\/span><\/p>\n

Theo Maytreyee Nandi v\u00e0 c\u1ed9ng s\u1ef1 [23] khi nghi\u00ean c\u1ee9u 93 kh\u1edbp g\u1ed1i \u1edf ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng tr\u01b0\u1eddng th\u00e0nh, t\u00e1c gi\u1ea3 \u0111\u00e0 \u0111o g\u00f3c Q \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh theo c\u1ea3 2 c\u00e1ch v\u00e0 so s\u00e1nh nhau, t\u00e1c gi\u1ea3 th\u1ea5y r\u00e0ng tr\u1ecb s\u1ed12 <\/span>g\u00f3c n\u00e0y t\u1ec9 l\u1ec7 thu\u1eadn v\u1edbi nhau theo h\u00e0m b\u1eadc nh\u1ea5t, v\u00e0 t\u00e1c gi\u1ea3 \u0111\u01b0a ra c\u00f4ng th\u1ee9c t\u00ednh g\u00f3c 0 tr\u00ean phim X-quang d\u1ef1a v\u00e0o \u0111o X-quang l\u00e2m s\u00e0ng:<\/span>
\n<\/span><\/p>\n

\"\"<\/p>\n

G\u00f3c Q c\u0169ng ph\u1ee5 thu\u1ed9c nhi\u1ec1u v\u00e0o t\u01b0 th\u1ec3 c\u1ee7a b\u1ec7nh nh\u00e2n khi \u0111\u00e1nh gi\u00e1 g\u00f3c Q. C\u00f3 3 t\u01b0 th\u1ebf \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 g\u00f3c <\/span>\u1ecd <\/span>tr\u00ean l\u00e2m s\u00e0ng: m\u1ed9t !\u00e0 \u0111\u1ec3 ch\u00e2n \u1edf t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda kh\u00f4ng ch\u1ecbu l\u1ee5c; hai l\u00e0 \u0111\u1ec3 b\u1ec7nh nh\u00e2n \u0111\u1ee9ng v\u1edbi c\u00e1c c\u01a1 th\u1ea3 l\u1ecfng; ba l\u00e0 b\u1ec7nh nh\u00e2n \u0111\u1ee9ng v\u00e0 c\u01a1 t\u1ee9 \u0111\u1ea7u co t\u1ed1i \u0111a. T\u1ea5t c\u1ea3 c\u00e1c c\u00e1ch \u0111o tr\u00ean \u0111\u1ec1u c\u00f3 \u01b0u \u0111i\u1ec3m v\u00e0 nh\u01b0\u1ee3c \u0111i\u1ec3m ri\u00eang c\u1ee7a ch\u00fang. Tuy nhi\u00ean \u0111o \u1edf t\u01b0 th\u1ebf th\u1ee9 nh\u1ea5t l\u00e0 \u0111\u01a1n gi\u1ea3n nh\u1ea5t v\u00e0 chu\u1ea9n x\u00e1c nh\u1ea5t v\u00e0 hay \u0111\u01b0\u1ee3c c\u00e1c gi\u1ea3 s\u1eed d\u1ee5ng \u0111o \u0111\u1ea1c nhi\u1ec1u nh\u1ea5t tr\u00ean l\u00e2m s\u00e0ng [22],<\/span><\/p>\n

5. \u1ea2nh h\u01b0\u1edfng c\u1ee7a h\u00ecnh th\u00e1i x\u01b0\u01a1ng \u0111\u00f9i, x\u01b0\u01a1ng ch\u00e0y \u0111\u1ebfn x\u01b0\u01a1ng b\u00e1nh ch\u00e8<\/b><\/h2>\n
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    X\u01b0\u01a1ng \u0111\u00f9i<\/i><\/b><\/h3>\n<\/li>\n<\/ul>\n

    Nhi\u1ec1u t\u00e1c gi\u1ea3 \u0111\u00e3 nghi\u00ean c\u1ee9u \u1ea3nh h\u01b0\u1edfng c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i l\u00ean kh\u1edbp \u0111\u00f9i- ch\u00e8, Ngo\u00e0i g\u00f3c xoay c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1edbp \u0111\u00f9i-ch\u00e8 \u0111\u00e3 ph\u00e2n t\u00edch \u1edf m\u1ee5c tr\u00ean, th\u00ec \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1edbp \u0111\u00f9i-ch\u00e8 c\u00f2n c\u00f3 kh\u1edbp h\u00e1ng v\u00e0 khung ch\u1eadu. Theo t\u00e1c gi\u1ea3 Lee v\u00e0 c\u1ed9ng s\u1ef1, t\u00e1c gi\u00e1 nh\u1eadn \u0111\u1ecbnh r\u1eb1ng s\u1ef1 xoay c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i v\u00e0o trong l\u00e0m m\u1eb7t kh\u1edbp c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8 quay trong v\u00e0 \u0111\u1ea9y x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u00e0o gi\u1eefa tr\u01b0ng t\u00e2m c\u1ee7a kh\u1edbp \u0111\u00f9i-ch\u00e8, ngo\u00e0i ra t\u00e1c gi\u1ea3 c\u00f2n nh\u1ea5n m\u1ea1nh s\u1ef1 xoay c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i l\u00e0m cho t\u0103ng l\u1ef1c \u00e9p c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u00e0o l\u1ed3i c\u1ea7u \u0111\u00f9i, nh\u1ea5t l\u00e0 khi x\u01b0\u01a1ng \u0111\u00f9i xoay ngo\u00e0i > 20\u00b0. Do v\u1eady, t\u00e1c gi\u1ea3 k\u1ebft lu\u1eadn r\u1eb1ng c\u00f3 m\u1ed1i li\u00ean h\u1ec7 gi\u1eefa kh\u1edbp \u0111\u00f9i-ch\u00e8 v\u00e0 s\u1ef1 xoay trong ho\u1eb7c xoay ngo\u00e0i c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i, c\u1ee5 th\u1ec3 l\u00e0 c\u1ee7a kh\u1edbp h\u00e1ng v\u00e0 khung ch\u1eadu. Theo t\u00e1c gi\u1ea3 Wilson v\u00e0 c\u1ed9ng s\u1ef1, khi nghi\u00ean <\/span>c\u1ee9u tr\u00ean 20 kh\u1edbp g\u1ed1i b\u00ecnh th\u01b0\u1eddng v\u00e0 20 kh\u1edbp g\u1ed1i \u0111au khi ho\u1ea1t \u0111\u1ed9ng ng\u1ed3i x\u1ed5m, \u0111i l\u1ea1i v\u00e0 xoay ngo\u00e0i kh\u1edbp h\u00e1ng, t\u00e1c gi\u1ea3 k\u1ebft lu\u1eadn s\u1ef1 \u0111au \u1edf kh\u1edbp \u0111\u00f9i-ch\u00e8 c\u00f3 li\u00ean quan v\u1edbi s\u1ef1 xoay kh\u1edbp h\u00e1ng v\u00e0 c\u1ee7a khung ch\u1eadu. T\u00e1c gi\u1ea3 Souza c\u00f9ng c\u00f3 k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 khi nghi\u00ean c\u1ee9u tr\u00ean nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m nghi\u00ean c\u1ee9u t\u01b0\u01a1ng t\u1ef1, tuy nhi\u00ean t\u00e1c gi\u1ea3 c\u0169ng ch\u00fa \u00fd l\u00e0 c\u00f3 vai tr\u00f2 c\u1ee7a s\u1ee9c c\u01a1 \u0111\u00f9i tham gia c\u00f9ng. Khi nghi\u00ean c\u1ee9u tr\u00ean 6 kh\u1edbp g\u1ed1i c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111au c\u1ee7a ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i t\u1eeb 15-39 tu\u1ed5i, t\u00e1c gi\u1ea3 Powel \u0111\u00e3 ch\u1ee5p C\u1ed9ng h\u01b0\u1edfng t\u1eeb kh\u1edbp \u0111\u00f9i-ch\u00e8 trong qu\u00e1 tr\u00ecnh ho\u1ea1t \u0111\u1ed9ng g\u1ed1i du\u1ed7i t\u1ed1i \u0111a kh\u00f4ng ch\u1ecbu tr\u1ecdng l\u1ef1c v\u00e0 kh\u1edbp g\u1ed1i \u1edf t\u01b0 th\u1ebf ng\u1ed3i x\u1ed5m. T\u00e1c gi\u1ea3 \u0111\u00e3 nh\u1eadn th\u1ea5y s\u1ef1 b\u1ea5t th\u01b0\u1eddng c\u1ee7a kh\u1edbp \u0111\u00f9i-ch\u1ec7 khi k\u1ebft th\u00fac qu\u00e1 tr\u00ecnh du\u1ed7i trong c\u1ea3 hai tr\u01b0\u1eddng h\u1ee3p, \u0111\u1ed3ng th\u1eddi th\u00eam v\u00e0o \u0111\u00f3 l\u00e0 s\u1ef1 chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8 tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i r\u00f5 r\u1ec7t h\u01a1n trong tr\u01b0\u1eddng h\u1ee3p g\u1ed1i du\u1ed7i t\u1ed1i \u0111a kh\u00f4ng ph\u1ea3i ch\u1ecbu tr\u1ecdng l\u1ef1c. Nghi\u00ean c\u1ee9u n\u00e0y ch\u1ee9ng minh r\u1eb1ng khi kh\u00f4ng ch\u1ecbu t\u00e1c d\u1ee5ng c\u1ee7a tr\u1ecdng l\u1ef1c, x\u01b0\u01a1ng b\u00e1nh ch\u00e8 quay xung quanh x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 khi ch\u1ecbu tr\u1ecdng l\u1ef1c, x\u01b0\u01a1ng \u0111\u00f9i quay d\u01b0\u1edbi so v\u1edbi x\u01b0\u01a1ng b\u00e1nh ch\u00e8, \u0111i\u1ec1u \u0111\u00f3 th\u1ec3 hi\u1ec7n vai tr\u00f2 c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i \u0111\u1ed1i v\u1edbi s\u1ef1 b\u1ea5t th\u01b0\u1eddng c\u1ee7a kh\u1edbp \u0111\u00f9i-ch\u00e8.<\/span><\/p>\n

    T\u00f3m l\u1ea1i, s\u1ef1 xoay b\u1ea5t th\u01b0\u1eddng c\u1ee7a kh\u1edbp h\u00e1ng hay h\u00ecnh d\u1ea1ng b\u1ea5t th\u01b0\u1eddng c\u1ee7a khung ch\u1eadu \u0111\u1ec1u \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1edbp \u0111\u00f9i-ch\u00e8.<\/span><\/p>\n

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    • \n

      X\u01b0\u01a1ng ch\u00e0y<\/i><\/strong><\/h3>\n<\/li>\n<\/ul>\n

      S\u1ef1 b\u1ea5t th\u01b0\u1eddng \u1edf kh\u1edbp \u0111\u00f9i-ch\u00e8 c\u0169ng c\u00f3 nguy\u00ean nh\u00e2n t\u1eeb x\u01b0\u01a1ng ch\u00e0y. S\u1ef1 xoay trong hay xoay ngo\u00e0i c\u1ee7a x\u01b0\u01a1ng ch\u00e0y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn v\u1ecb tr\u00ed c\u1ee7a l\u1ed3i c\u1ee7 x\u01b0\u01a1ng ch\u00e0y, l\u00e0m t\u0103ng g\u00f3c Q khi m\u00e2m ch\u00e0y xoay ngo\u00e0i, l\u00e0m gi\u1ea3m g\u00f3c Q khi m\u00e2m ch\u00e0y xoay trong, khi\u1ebfn cho kh\u1edbp \u0111\u00f9i-ch\u00e8 b\u1ea5t th\u01b0\u1eddng v\u00e0 g\u00e2y \u0111au, l\u00e0m t\u0103ng nguy c\u01a1 tr\u1eadt x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u00e0 tho\u00e1i h\u00f3a kh\u1edbp \u0111\u00f9i-ch\u00e8 [24], Trong tr\u01b0\u1eddng h\u1ee3p thay kh\u1edbp g\u1ed1i to\u00e0n ph\u1ea7n, l\u00e1t c\u1eaft x\u01b0\u01a1ng ch\u00e0y h\u1ebft s\u1ee9c quan tr\u1ecdng trong vi\u1ec7c \u1ed5n \u0111\u1ecbnh kh\u1edbp \u0111\u00f9i-ch\u00e8. G\u00e2n c\u01a1 t\u1ee9 \u0111\u1ea7u \u0111\u00f9i th\u00f4ng qua x\u01b0\u01a1ng b\u00e1nh ch\u00e8 b\u00e1m v\u00e0o l\u1ed3i c\u1ee7 ch\u00e0y, trong tr\u01b0\u1eddng h\u1ee3p c\u1eaft kh\u00f4ng chu\u1ea9n, l\u00e1t c\u1eaft kh\u00f4ng vu\u00f4ng g\u00f3c v\u1edbi tr\u1ee5c x\u01b0\u01a1ng ch\u00e0y, trong qu\u00e1 tr\u00ecnh ho\u1ea1t \u0111\u1ed9ng g\u1ea5p du\u1ed7i c\u1ee7a g\u1ed1i, l\u1ed3i c\u1ee7 ch\u00e0y s\u1ebd di chuy\u1ec3n t\u1ecbnh ti\u1ebfn v\u00e0o trong ho\u1eb7c ra ph\u00eda ngo\u00e0i so v\u1edbi l\u1ed3i c\u1ea7u \u0111\u00f9i, l\u00e0m cho g\u00f3c Q thay \u0111\u1ed5i li\u00ean t\u1ee5c theo chu k\u1ef3 g\u1ea5p du\u1ed7i g\u1ed1i. T\u00f9 d\u00f3 s\u00e8 l\u00e0m x\u01b0\u01a1ng b\u00e1nh ch\u00e8 kh\u00f4ng tr\u01b0\u1ee3t c\u00e2n x\u1ee9ng theo r\u00e3nh \u0111\u00f9i-ch\u00f2 n\u1eefa m\u00e0 s\u1ebd li\u00ean t\u1ee5c \u0111i chuy\u1ebfn ra ngo\u00e0i ho\u1eb7c v\u00e0o trong tr\u00ean r\u00e3nh \u0111\u00f9i-ch\u00e8, g\u00e2y b\u1ea5t th\u01b0\u1eddng kh\u1edbp n\u00e0y. \u0110i\u1ec1u n\u00e0y c\u0169ng di\u1ec5n ra t\u01b0\u01a1ng t\u1ef1 khi \u0111\u1eb7t m\u1ee9c \u0111\u1ed9 xoay c\u1ee7a ph\u1ea7n ch\u00e0y nh\u00e2n t\u1ea1o kh\u00f4ng ch\u00ednh x\u00e1c.<\/span><\/p>\n

      V\u00ec v\u1eady, s\u1ef1 xoay c\u1ee7a m\u00e2m ch\u00e0y v\u00e0 l\u00e1t c\u1eaft m\u00e2m ch\u00e0y trong thay kh\u1edbp g\u1ed1i to\u00e0n ph\u1ea7n c\u00f9ng \u1ea3nh h\u01b0\u1edfng r\u1ea5t l\u1edbn \u0111\u1ebfn kh\u1edbp \u0111\u00f9i-ch\u00e8.<\/span><\/p>\n

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

        \n
      1. K\u00f6nig C., Sharenkov A., Matziolis G., et al. (2009). Joint line elevation in revision TKA leads to increased patellofemoral contact forces. <\/span>J Orthop Res<\/span><\/i><\/li>\n
      2. Bellemans J., Colyn <\/span>w., <\/span>VandenneuckerH., et al, (2012). The Chitranjan Ranawat Award: Is Neutral Mechanical Alignment Normal for All Patients?: The Concept of Constitutional Varus. <\/span>Clin Orthop Relat Res,<\/span><\/i> 470( I ), 45-53.<\/span><\/li>\n
      3. Kwang Kwon <\/span>s., <\/span>Prakash Jain N., Yeal Kang J., et al. (2015). Influence of Posterior Condylar Offset on Maximal Flexion and Outcome Scales Following TKA in Asian Patients. <\/span>Reconstr Rev,<\/span><\/i> 4(4). 15-21.<\/span><\/li>\n
      4. Kim J.-H.<\/span> (2013). Effect of posterior femoral condylar offset and posterior<\/span>tibial slope on maximal flexion angle of the knee in posterior cruciate ligament sacrificing total knee arthroplasty. Knee Slirg Relat Res,<\/i> 25(2), 54-59.<\/li>\n
      5. Soda Y., Oishi J., Nakasa T., et al. (2007). New parameter of flexion after posterior stabilized total knee arthroplasty: posterior condylar offset ratio on X-ray photographs. <\/span>Atvh Ofthop Trauma Surg,<\/span><\/i> 127(3), 167 -170.<\/span><\/li>\n
      6. Bellemans<\/span> .1., Banks <\/span>s., <\/span>Victor J., et al. (2002). Fluoroscopic analysis of the <\/span>kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br,<\/i> 84(1), 50-53.<\/li>\n
      7. Goldstein W.M., Raab D.J., Gleason T.F., et al. (2006). Why posterior cmciate- rctaining and substituting total knee replacements have similar ranges of motion. The importance of posterior condylar offset and cleanout of posterior condylar space. <\/span>J Bone Joint SurgAm,<\/span><\/i> 88 Suppl 4, ! 82-188.<\/span><\/li>\n
      8. Hanratty B.M., Thompson N.W., Wilson R.K., et al. (2007). The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate- sacrificing mobile-bearing implant. <\/span>J Bone Joint Slirg Br,<\/span><\/i> 89-B(7), 915-918.<\/span><\/li>\n
      9. Bauer T., Biau D., Colmar M., ct al, (2010). Influence of posterior condylar offset on knee flexion after cruciate-sacrificing mobile-bearing total knee replacement: a prospective analysis of 410 consecutive cases. <\/span>The Knee,<\/span><\/i> 17(6), 375-380.<\/span><\/li>\n
      10. Arabori M., Matsui N., Kuroda R., et al. (2008). Posterior condylar offset and flexion in posterior cruciate-retaining and posterior stabilized TKA. <\/span>J Orthop Sei OffJJpn Orthop Assoc,<\/span><\/i> 13(1), 46 50.<\/span><\/li>\n
      11. Grclsamer R., Bazos A., and Proctor C. (1993). Radiographic analysis of patellar lilt. J Bone Joint Surg Br,<\/i> 75-B(5), 822-824.<\/li>\n
      12. Inoue M., Sliino K., Hirose 11., ct al. (1988). Subluxation of the patella. Computed tomography analysis of patellofemora! congruence. J Bone Joint Sing Am,<\/i> 70(9), 1331-1337.<\/li>\n
      13. Laurin C.A., Levesque H.P., Dussault R., et al. (1978). The abnormal lateral patellofemoral angle: a diagnostic roentgenographic sign of recurrent patellar subluxation. J Bone Joint Surg Ain,<\/i> 60(1), 55-60.<\/li>\n
      14. Wiberg G (1941). Roentgenographic and anatomic studies on the femoropatellar joint: with special reference to chondromalacia patellae. Acta Orthop Scanci,<\/i> 12, 319-410.<\/li>\n
      15. Aglietti P., lnsall J.N., and Cerulli G. (1983). Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop,<\/i> (176), 217-224.<\/li>\n
      16. Koskinen SK (1991). Restoration of patellofemoral congruity by combined lateral release and tibial tuberosity transposition as assessed by MRI analysis. Mt Orthop, <\/i>(15), 363 366.<\/li>\n
      17. Canale ST., Beaty J.H., and Campbell W.C. (2012), Campbell\u2019s operative orthopaedics,<\/i> Mosby, St. Louis, Mo. ; London,<\/li>\n
      18. Zaffagnini S., Colie F., Lopomo N., et al. (2013). The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc,<\/i> 21 (9), 2164-2171.<\/li>\n
      19. Thay Q, Lee, PhD; Bruce Y. Yang, BS; Matthew D. Sandusky, BS; Patrick J. McMahon, MD (2001). The effects of tibial rotation on the patellofemoral joint: Assessment of the changes in in situ strain in the peripatellar retinaculum and the patellofemoral contact pressures and areas. J Rehabil Res Dev,<\/i> 38(5), 463^-69.<\/li>\n
      20. Sven Ostermeier (2007), Dynamic measurement of patellofemoral kinematics and contact pressure after lateral retinacular release: an in vitro study, Knee Surgery, Sports Traumatology, Arthroscopy.<\/i><\/li>\n
      21. Brattstrom H. (1970). Patella Alta in Non-Dislocating Knee Joints. Acta Orthop Scand,<\/i> 41(5), 578-588.<\/li>\n
      22. Nandi (Kar) M., Deb S., Pal J.N., et al. (2013). The \u201cquadriceps angle\u201d: correlation between clinical and radiographic measurements from a study in North Bengal. J Anat Soc India,<\/i> 62( I), 68-72.<\/li>\n
      23. Alberto Gobbi (2014), The patellofemoral joint: state of the art in evaluation and management, Springer Berlin Heidelberg, New York, NY.<\/i><\/li>\n<\/ol>\n

         <\/p>\n","protected":false},"excerpt":{"rendered":"

        Kh\u1edbp \u0111\u00f9i-ch\u00e8 \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o n\u00ean b\u1edfi \u0111\u1eb1ng tr\u01b0\u1edbc l\u00e0 x\u01b0\u01a1ng b\u00e1nh ch\u00e8, \u0111\u1eb1ng sau l\u00e0 x\u01b0\u01a1ng \u0111\u00f9i, ph\u00eda d\u01b0\u1edbi l\u00e0 m\u1eb7t tr\u00ean m\u00e2m ch\u00e0y v\u00e0 xung quanh l\u00e0 h\u1ec7 th\u1ed1ng c\u01a1 v\u00e0 d\u00e2y ch\u1eb1ng. 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