{"id":19179,"date":"2023-04-12T20:36:54","date_gmt":"2023-04-12T13:36:54","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19179"},"modified":"2023-04-14T18:23:21","modified_gmt":"2023-04-14T11:23:21","slug":"can-lam-sang-va-phau-thuat-trat-khop-vai-tai-dien","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/can-lam-sang-va-phau-thuat-trat-khop-vai-tai-dien\/","title":{"rendered":"Tr\u1eadt kh\u1edbp vai t\u00e1i di\u1ec5n: C\u1eadn l\u00e2m s\u00e0ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt"},"content":{"rendered":"<p><strong>Tr\u1eadt kh\u1edbp vai l\u00e0 s\u1ef1 m\u1ea5t ti\u1ebfp x\u00fac c\u1ee7a di\u1ec7n kh\u1edbp \u1ed5 ch\u1ea3o v\u00e0 ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay. Tr\u1eadt kh\u1edbp vai t\u00e1i di\u1ec5n l\u00e0 t\u00ecnh tr\u1ea1ng tr\u1eadt kh\u1edbp vai t\u1eeb l\u1ea7n 2 tr\u1edf l\u00ean (th\u01b0\u1eddng tr\u00ean 10 l\u1ea7n), sau b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u1ef1 n\u1eafn \u0111\u01b0\u1ee3c. Th\u00f4ng qua b\u00e0i vi\u1ebft, ch\u00fang t\u00f4i s\u1ebd gi\u1edbi thi\u1ec7u v\u1ec1 c\u1eadn l\u00e2m s\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu th\u1eadt trong tr\u1eadt kh\u1edbp vai t\u00e1i di\u1ec5n.<\/strong><\/p>\n<p><strong>Nh\u00f3m t\u00e1c gi\u1ea3:<\/strong> PGS. TS \u0110inh Ng\u1ecdc S\u01a1n, BS CKII V\u0169 Tr\u01b0\u1eddng Th\u1ecbnh<\/p>\n<p><strong>Ng\u00e0y ph\u00e1t h\u00e0nh<\/strong>: 30\/03\/2022<\/p>\n<h2>1. C\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n tr\u1eadt kh\u1edbp vai t\u00e1i di\u1ec5n<\/h2>\n<p><strong>1.1 X quang\u00a0tr\u01b0\u1edbc &#8211; sau (anteroposterior: AP)<\/strong><\/p>\n<figure id=\"attachment_19320\" aria-describedby=\"caption-attachment-19320\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-19320\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-18.29.39-300x129.png\" alt=\"Minh ho\u1ea1 t\u01b0 th\u1ebf ch\u1ee5p X quang\u00a0tr\u01b0\u1edbc - sau (anteroposterior: AP)\" width=\"300\" height=\"129\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-18.29.39-300x129.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-18.29.39-1024x439.png 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-18.29.39-768x329.png 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-18.29.39.png 1302w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-19320\" class=\"wp-caption-text\">Minh ho\u1ea1 t\u01b0 th\u1ebf ch\u1ee5p X quang\u00a0tr\u01b0\u1edbc &#8211; sau (anteroposterior: AP)<\/figcaption><\/figure>\n<p><span style=\"font-weight: 400;\">\u0110\u00e1nh gi\u00e1 tr\u00ean phim AP: \u0111\u1ed1i v\u1edbi kh\u1edbp vai b\u00ecnh th\u01b0\u1eddng, \u0111\u01b0\u1eddng vi\u1ec1n l\u00f5m c\u1ee7a b\u1ec1 m\u1eb7t \u1ed5 ch\u1ea3o tr\u00ean phim ph\u1ea3i ph\u00f9 h\u1ee3p v\u1edbi b\u1ec1 m\u1eb7t l\u1ed3i c\u1ee7a ch\u00f2m x\u01b0\u01a1ng c\u00e1nh tay. N\u1ebfu c\u1ecf b\u1ea5t k\u1ef3 s\u1ef1 ch\u1ed3ng ch\u00e9o n\u00e0o \u0111\u01b0\u1ee3c th\u1ea5y gi\u1eefa \u1ed5 ch\u00e0o v\u00e0 <\/span><span style=\"font-weight: 400;\">\u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay th\u00ec c\u00f3 th\u1ec3 nghi ng\u1edd tr\u1eadt kh\u1edbp vai.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Ngo\u00e0i ra c\u00f2n c\u00e1c c\u00f3 t\u01b0 th\u1ebf trong tr\u1eadt kh\u1edbp vai: West Point \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 Bankart x\u01b0\u01a1ng, Stryker Notch \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u1ecfm x\u01b0\u01a1ng c\u1ea3nh tay (t\u1ed5n th\u01b0\u01a1ng Hill &#8211; Sach).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u0110\u00e1nh gi\u00e1 tr\u00ean phim Y-view (h\u01b0\u1edbng tia X song song v\u1edbi gai vai): kh\u1edbp vai b\u00ecnh th\u01b0\u1eddng, b\u00f3ng X-quang v\u1ea1ch ra d\u1ea1ng ch\u1eef \u201cY&#8217; hai n\u00e9t tr\u00ean c\u1ee7a ch\u1eef \u201cY\u201d l\u00e0 \u0111\u1ea1i di\u1ec7n cho gai vai v\u1ea3 m\u1ecfm c\u1ee7ng vai, trong khi n\u00e9t d\u01b0\u1edbi c\u1ee7a ch\u1eef \u201cY\u201d l\u00e0 th\u00e2n x\u01b0\u01a1ng vai. \u00d4 ch\u1ea3o v\u00e0 ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay \u1edf v\u1ecb tr\u00ed trung t\u00e2m ch\u1eef \u201cY\u201d.<\/span><\/p>\n<p><strong>1.2\u00a0 Ch\u1ee5p CT-Scan kh\u1edbp vai sau<\/strong><\/p>\n<ul>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">Ch\u1ee5p CT r\u1ea5t h\u1eefu \u00edch trong tr\u01b0\u1eddng h\u1ee3p tr\u1eadt kh\u1edbp vai c\u1ea5p t\u00ednh khi h\u00ecnh \u1ea3nh phim X-quang ch\u1ea5t l\u01b0\u1ee3ng k\u00e9m ho\u1eb7c c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ee9ng minh kh\u00f4ng r\u00f5 r\u00e0ng b\u1ec7nh l\u00fd kh\u1edbp vai.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">Phim CT trong tr\u1eadt kh\u1edbp vai r\u1ea5t c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u00edch th\u01b0\u1edbc v\u00e0 s\u1ef1 di l\u1ec7ch c\u1ee7a m\u1ea3nh g\u00e3y x\u01b0\u01a1ng \u1ed5 ch\u1ea3o ho\u1eb7c m\u1ea3nh g\u00e3y \u0111\u1ea7u g\u1ea7n x\u01b0\u01a1ng c\u00e1nh tay.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">Phim CT Scan tr\u1eadt kh\u1edbp vai d\u1ef1ng h\u00ecnh 3 chi\u1ec1u gi\u00fap x\u00e1c \u0111\u1ecbnh r\u00f5 t\u1ed5n th\u01b0\u01a1ng b\u1ec7nh l\u00fd c\u1ee7a x\u01b0\u01a1ng: g\u00e3y x\u01b0\u01a1ng c\u1ea5p t\u00ednh, Bankart x\u01b0\u01a1ng, Hill &#8211; Sach. Ngo\u00e0i ra CT Scan c\u00f3 ti\u00eam thu\u1ed1c c\u1ea3n quang gi\u00fap x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng r\u00e1ch ch\u00f3p xoay, t\u1ed5n th\u01b0\u01a1ng bao kh\u1edbp.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u1ed9 nh\u1ea1y trong ch\u1ea9n \u0111o\u00e1n r\u00e1ch s\u1ee5n vi\u1ec1n c\u1ee7a CT Scan c\u00f3 ti\u00eam thu\u1ed1c c\u1ea3n quang kho\u1ea3ng 80 &#8211; 90% v\u1edbi \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 90%.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u00e1nh gi\u00e1 m\u1ea5t x\u01b0\u01a1ng \u1ed5 ch\u1ea3o tr\u00ean phim CT Scan d\u1ef1ng h\u00ecnh 3 chi\u1ec1u, v\u1edbi nh\u1eefng l\u1ea7n ch\u1ee5p CT Scan v\u00e0 h\u00ecnh \u1ea3nh c\u1ee7a vai \u0111\u1ed5i b\u00ean, m\u1ed9t v\u00f2ng tr\u00f2n ph\u00f9 h\u1ee3p nh\u1ea5t c\u1ee7a 2\/3 d\u01b0\u1edbi \u1ed5 ch\u1ea3o x\u01b0\u01a1ng vai b\u00ecnh th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ed3ng l\u00ean b\u00ean \u1ed5 ch\u1ea3o vai t\u1ed5n th\u01b0\u01a1ng \u0111\u1ec3 \u01b0\u1edbc t\u00ednh s\u1ed1 l\u01b0\u1ee3ng m\u1ea5t x\u01b0\u01a1ng<\/span><\/li>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">Theo Lo v\u00e0 c\u1ed9ng s\u1ef1, m\u1ea5t x\u01b0\u01a1ng b\u1edd tr\u01b0\u1edbc \u1ed5 ch\u00e0o l\u00e0 7,5 mm t\u01b0\u01a1ng \u1ee9ng v\u1edbi kho\u1ea3ng 25% m\u1ea5t x\u01b0\u01a1ng.<\/span><\/li>\n<\/ul>\n<p><strong>1.3\u00a0 Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI)<\/strong><\/p>\n<ul>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">N\u00eau x\u00e9t \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt th\u00ec MRI \u0111\u01b0\u1ee3c xem l\u00e0 chu\u1ea9n tham chi\u1ebfu \u0111\u1ebf x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu b\u1ec7nh v\u00ec ph\u1ea7n l\u1edbn c\u00e1c ch\u1ea5n th\u01b0\u01a1ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng &#8211; bao kh\u1edbp.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">MRI gi\u00fap \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n bao <\/span><\/span><span style=\"font-weight: 400;\">g\u1ed3m: s\u1ee5n vi\u1ec1n, d\u00e2y ch\u1eb1ng \u1ed5<\/span><span style=\"font-weight: 400;\"> ch\u00e1o, <\/span>c\u00e1nh tay, g\u00e2n c\u01a1 ch\u00f3p xoay, d\u00e2y ch\u1eb3ng kh\u1edbp c\u00f9ng \u0111\u00f2n, bao ho\u1ea1t d\u1ecbch kh\u1edbp, s\u1ee5n kh\u1edbp&#8230;<\/li>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">MRI c\u00f3 ti\u00eam thu\u1ed1c c\u1ea3n quang c\u00f3 \u0111\u1ed9 nh\u1ea1y cao h\u01a1n trong ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu b\u1ec7nh v\u1ec1 t\u1ed5n th\u01b0\u01a1ng r\u00e1ch s\u1ee5n vi\u1ec1n, r\u00e1ch bao kh\u1edbp, r\u00e1ch g\u00e2n c\u01a1 ch\u00f3p xoay. MRI ti\u00eam c\u1ea3n quang c\u00f3 \u0111\u1ed9 nh\u1ea1y tr\u00ean 95%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 100% trong khi MRI th\u00f4ng th\u01b0\u1eddng th\u00ec \u0111\u1ed9 nh\u1ea1y khoang 80 &#8211; 90%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u g\u1ea7n 100<b>%.<\/b><\/span><\/li>\n<\/ul>\n<p><strong>1.4 N\u1ed9i soi ch\u1ea9n \u0111o\u00e1n<\/strong><\/p>\n<ul>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">N\u1ed9i soi ch\u1ea9n \u0111o\u00e1n l\u00e0 m\u1ed9t trong nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p l\u00fd t\u01b0\u1edfng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n t\u1ed5n th\u01b0\u01a1ng r\u00e1ch s\u1ee5n vi\u1ec1n, Bankart x\u01b0\u01a1ng, t\u1ed5n th\u01b0\u01a1ng Hill &#8211; Sach&#8230;<\/span><\/li>\n<\/ul>\n<h2><strong>2. Gi\u1edbi thi\u1ec7u m\u1ed9t s\u1ed1 ph\u1eabu thu\u1eadt trong \u0111i\u1ec1u tr\u1ecb\u00a0<\/strong><\/h2>\n<p><strong>2.1 Gi\u1edbi thi\u1ec7u m\u1ed9t s\u1ed1 ph\u1eabu thu\u1eadt<\/strong><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt m\u1edf s\u1eeda ch\u1eefa bong \u0111i\u1ec3m b\u00e1m c\u1ee7a to\u00e0n b\u1ed9 d\u00e2y ch\u1eb1ng \u1ed5 ch\u1ea3o c\u00e1nh tay d\u01b0\u1edbi t\u1ea1i \u0111i\u1ec3m b\u00e1m \u1edf \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay (t\u1ed5n th\u01b0\u01a1ng HAGL): c\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u00e0ng b\u1eb1ng m\u1ed9t m\u0169i neo ho\u1eb7c c\u1ed1 \u0111\u1ecbnh b\u1eb1ng khoan l\u1ed7 xuy\u00ean qua x\u01b0\u01a1ng.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt Davi P HLiberty: gh\u00e9p x\u01b0\u01a1ng b\u1edd tr\u01b0\u1edbc \u1ed5 ch\u1ea3o b\u1eb1ng x\u01b0\u01a1ng t\u1ef1 th\u00e2n (autograft) ho\u1eb7c x\u01b0\u01a1ng \u0111\u1ed3ng lo\u1ea1i (Allograft): th\u01b0\u1eddng s\u1eed d\u1ee5ng x\u01b0\u01a1ng m\u00e0o ch\u1eadu, m\u1ea3nh gh\u00e9p d\u00e0i kho\u1ea3ng 3 cm v\u00e0 d\u00e0y kho\u1ea3ng 2 cm.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt Stephen S.Burkart: chuy\u1ec3n m\u1ecfm qu\u1ea1 xu\u1ed1ng gh\u00e9p v\u00e0o b\u1edd tr\u01b0\u1edbc \u1ed5 ch\u1ea3o b\u1ecb khuy\u1ebft, m\u1ea3nh gh\u00e9p n\u1eb1m ngo\u00e0i kh\u1edbp (b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng c\u00e1c m\u0169i kh\u00e2u neo)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt Da vi P Huberty &#8211; Stephen <\/span>S.Burkart: chuy\u00ean \u0111i\u1ec3m b\u00e1m g\u00e2n c\u01a1 d\u01b0\u1edbi vai v\u00e0o ch\u1ed7 khuy\u1ebft Hill Sach. K\u1ef9 thu\u1eadt n\u00e0y \u00e1p d\u1ee5ng khi ph\u1eabu thu\u1eadt n\u1ed9i soi th\u1ea5t b\u1ea1i.<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt m\u1edf s\u1eeda ch\u1eefa t\u1ed5n th\u01b0\u01a1ng Hill &#8211; Sach b\u1eb1ng m\u1ea3nh gh\u00e9p \u0111\u1ed3ng lo\u1ea1i (allograft): m\u1ea3nh gh\u00e9p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng c\u00f3 th\u1ec3 l\u00e0 ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay ho\u1eb7c ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i.<\/span><\/li>\n<\/ul>\n<figure id=\"attachment_19406\" aria-describedby=\"caption-attachment-19406\" style=\"width: 285px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-19406\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.03.46-285x300.png\" alt=\"H\u00ecnh \u1ea3nh ph\u1eabu thu\u1eadt s\u1eeda ch\u1eefa t\u1ed5n th\u01b0\u01a1ng Hi\u1ec9l - Sach b\u1eb1ng m\u1ea3nh gh\u00e9p \u0111\u1ed3ng lo\u1ea1i \" width=\"285\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.03.46-285x300.png 285w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.03.46.png 414w\" sizes=\"(max-width: 285px) 100vw, 285px\" \/><figcaption id=\"caption-attachment-19406\" class=\"wp-caption-text\">H\u00ecnh \u1ea3nh ph\u1eabu thu\u1eadt s\u1eeda ch\u1eefa t\u1ed5n th\u01b0\u01a1ng Hi\u1ec9l &#8211; Sach b\u1eb1ng m\u1ea3nh gh\u00e9p \u0111\u1ed3ng lo\u1ea1i<\/figcaption><\/figure>\n<p><strong>2.2 Ph\u1eabu thu\u1eadt n\u1ed9i soi<\/strong><\/p>\n<p><strong>2.2.1<\/strong> <b>Ph\u1eabu thu\u1eadt Bankart<\/b><\/p>\n<p><strong>Chu\u1ea9n b\u1ecb d\u1ee5ng c\u1ee5 v\u00e0 b\u1ec7nh nh\u00e2n<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c g\u00e2y m\u00ea n\u1ed9i kh\u00ed<\/span> <span style=\"font-weight: 400;\">kho\u1ea3ng t\u1eeb 95-105 mmHg th\u00ec l\u00e0<\/span> <span style=\"font-weight: 400;\">l\u00fd t\u01b0\u1edfng nh\u1ea5t cho cu\u1ed9c ph\u1eabu thu\u1eadt.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u00c1p l\u1ef1c m\u00e1y b\u01a1m n\u01b0\u1edbc t\u1eeb 40-50 mmHg th\u01b0\u1eddng l\u00e0 \u0111\u1ee7 (v\u1edbi \u0111i\u1ec1u ki\u1ec7n huy\u1ebft \u00e1p t\u00e2m thu trong kho\u1ea3ng l\u00fd t\u01b0\u1edfng)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">B\u1ed9 d\u1ee5ng c\u1ee5 n\u1ed9i soi kh\u1edbp vai ti\u00eau chu\u1ea9n, \u1ed1ng k\u00ednh 70 \u0111\u1ed9, cannulas 5mm v\u00e0 8mm v\u00e0 m\u1ed9t s\u1ed1 d\u1ee5ng c\u1ee5 \u0111\u1eb7c bi\u1ec7t kh\u00e1c<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">C\u00e1c lo\u1ea1i m\u0169i kh\u00e2u neo \u0111\u1ec3 s\u1eeda ch\u1eefa bao kh\u1edbp v\u00e0 s\u1ee5n vi\u1ec1n<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u00c1o c\u1ed1 \u0111\u1ecbnh kh\u1edbp vai sau ph\u1ea7n thu\u1eadt.<\/span><\/li>\n<\/ul>\n<p><b>Ng\u00f5 v\u00e0o<\/b><\/p>\n<p><span style=\"font-weight: 400;\">C\u00e1nh tay kh\u00e9p, x\u00e1c \u0111\u1ecbnh, \u0111\u00e1nh d\u1ea5u c\u00e1c m\u1ed1c gi\u1ea3i ph\u1eabu v\u00e0 x\u00e1c \u0111\u1ecbnh c\u00e1c ng\u00f5 v\u00e0o, t\u00f9y theo th\u00f3i quen l\u00e0m vi\u1ec7c c\u1ee7a ph\u1eabu thu\u1eadt vi\u00ean m\u00e0 s\u1ed1 l\u01b0\u1ee3ng c\u00f9ng nh\u01b0 ng\u00f5 v\u00e0o kh\u1edbp vai c\u00f3 th\u1ec3 t\u00f9y bi\u1ebfn, ch\u00fang t\u00f4i xin gi\u1edbi thi\u1ec7u m\u1ed9t s\u1ed1 ng\u00f5 v\u00e0o ph\u1ed5 bi\u1ebfn hay \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><strong>Ng\u00f5 sau<\/strong>: Th\u01b0\u1eddng \u1edf v\u1ecb tr\u00ed 2 cm\u00a0<\/span><span style=\"font-weight: 400;\">xu\u1ed1ng d\u01b0\u1edbi v\u00e0 1 cm v\u00e0o trong so v\u1edbi g\u00f3c sau ngo\u00e0i m\u1ecfm c\u00f9ng vai, ng\u00f5 v\u00e0o n\u00e0y c\u00f3 th\u1ec3 thay \u0111\u1ed5i ph\u1ee5 thu\u1ed9c v\u00e0o k\u00edch th\u01b0\u1edbc v\u00e0 th\u1ec3 tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n, khi quan s\u00e1t v\u00e0 d\u00f9ng ng\u00f3n tay c\u00e1i \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u00e2y l\u00e0 \u0111i\u1ec3m l\u00f5m m\u1ec1m s\u00e2u nh\u1ea5t v\u00f9ng sau kh\u1edbp vai \u201csoft spot\u201d.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Ng\u00f5 sau ngo\u00e0i<\/strong><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Ng\u00f5 sau d\u01b0\u1edbi<\/strong><\/li>\n<\/ul>\n<figure id=\"attachment_19414\" aria-describedby=\"caption-attachment-19414\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-19414\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.08.47-300x113.png\" alt=\"Ng\u00f5 v\u00e0o ph\u00eda sau v\u00e0 x\u00e1c \u0111\u1ecbnh \u0111i\u1ebfm \u201csoft spot \" width=\"300\" height=\"113\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.08.47-300x113.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.08.47-1024x385.png 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.08.47-768x288.png 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.08.47.png 1326w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-19414\" class=\"wp-caption-text\">Ng\u00f5 v\u00e0o ph\u00eda sau v\u00e0 x\u00e1c \u0111\u1ecbnh \u0111i\u1ebfm \u201csoft spot<\/figcaption><\/figure>\n<ul>\n<li><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\"><strong>Ng\u00f5 tr\u01b0\u1edbc<\/strong>: ng\u00f5 n\u00e0y \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt t\u1eeb ngo\u00e0i v\u00e0o trong (outside-in): ng\u00f5 ph\u00eda tr\u01b0\u1edbc \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp sau khi \u0111\u00e0 quan s\u00e1t to\u00e0n b\u1ed9 kh\u1edbp vai t\u1eeb ng\u00f5 v\u00e0o ti\u00eau chu\u1ea9n ph\u00eda sau. V\u1edbi k\u1ef9 thu\u1eadt outside-in, m\u1ed9t \u201ccannula\u201d # 8 mm s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1eb7t \u0111i qua <\/span><\/span><span style=\"font-weight: 400;\">\u0111i\u1ec3m \u201csoft spot\u201d ph\u00eda tr\u01b0\u1edbc, \u0111i\u1ec3m n\u00e0y t\u01b0\u01a1ng \u1ee9ng v\u1edbi m\u1ed9t tam gi\u00e1c n\u1ed9i kh\u1edbp \u0111\u01b0\u1ee3c gi\u1edbi h\u1ea1n b\u1edfi: ph\u00eda tr\u00ean l\u00e0 \u0111\u1ea7u d\u00e0i g\u00e2n nh\u1ecb \u0111\u1ea7u trong kh\u1edbp, ph\u00eda d\u01b0\u1edbi l\u00e0 ph\u1ea7n tr\u00ean trong kh\u1edbp c\u1ee7a g\u00e2n c\u01a1 d\u01b0\u1edbi vai v\u00e0 c\u1ea1nh tr\u01b0\u1edbc c\u1ee7a \u0111\u00e1y \u00f4 ch\u1ea3o. Ng\u00f5 v\u00e0o ph\u00eda tr\u01b0\u1edbc t\u00f9y v\u00e0o v\u1ecb tr\u00ed \u0111\u1eb7t kh\u00e1c nhau \u0111\u01b0\u1ee3c chia th\u00e0nh 2 ng\u1ee1 v\u00e0o ph\u1ee5:<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ng\u00f5 v\u00e0o tr\u01b0\u1edbc &#8211; d\u01b0\u1edbi<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ng\u00f5 tr\u01b0\u1edbc &#8211; tr\u00ean<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<figure id=\"attachment_19416\" aria-describedby=\"caption-attachment-19416\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-19416\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.10.57-300x90.png\" alt=\"Ng\u00f5 v\u00e0o ph\u00eda tr\u01b0\u1edbc d\u01b0\u1edbi v\u00e0 ph\u00eda tr\u01b0\u1edbc tr\u00ean\" width=\"300\" height=\"90\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.10.57-300x90.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.10.57-1024x307.png 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.10.57-768x230.png 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.10.57.png 1342w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-19416\" class=\"wp-caption-text\">Ng\u00f5 v\u00e0o ph\u00eda tr\u01b0\u1edbc d\u01b0\u1edbi v\u00e0 ph\u00eda tr\u01b0\u1edbc tr\u00ean<\/figcaption><\/figure>\n<p><strong>N\u1ed9i soi kh\u1edbp ch\u1ea9n \u0111o\u00e1n:<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">M\u1ed9t ch\u1ea5n \u0111o\u00e1n l\u00e2m s\u00e0ng to\u00e0n di\u1ec7n th\u1ef1c hi\u1ec7n bang n\u1ed9i soi kh\u1edbp vai t\u1eeb ng\u00f5 v\u00e0o ph\u00eda sau \u0111\u1ec3 x\u00e1c nh\u1eadn ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc mo v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u1ed3ng th\u1eddi c\u00e1c t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu b\u1ec7nh. <\/span>Bao g\u1ed3m:<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">B\u1ec1 m\u1eb7t kh\u1edbp c\u1ee7a \u1ed5<\/span><span style=\"font-weight: 400;\">\u00a0ch\u1ea3o v\u00e0 ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">B\u1ec1 m\u1eb7t b\u00ean d\u01b0\u1edbi c\u1ee7a ch\u00f3p xoay<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chu vi s\u1ee5n vi\u1ec1n<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u1ea7u d\u00e0i g\u00e2n nh\u1ecb \u0111\u1ea7u<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">G\u00e2n c\u01a1 d\u01b0\u1edbi vai<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u00e1nh gi\u00e1 c\u00e1c d\u00e2y ch\u1eb1ng bao kh\u1edbp<\/span><\/li>\n<\/ul>\n<p><b>2.2.2 Ph\u1eabu thu\u1eadt g\u00f5 d\u00ednh ph\u1ee9c h\u1ee3p bao kh\u1edbp s\u1ee5n vi\u1ec1n &#8211; chu\u1ea9n b\u1ecb \u1ed5 ch\u1ea3o<\/b><\/p>\n<p><span style=\"font-weight: 400;\">B\u01b0\u1edbc n\u00e0y r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c \u0111<\/span><span style=\"font-weight: 400;\">\u00e1nh gi\u00e1 t\u00ednh to\u00e0n v\u1eb9n c\u1ee7a m\u00f4 m\u1ec1m (s\u1ee5n vi\u1ec3n bao kh\u1edbp) v\u00e0 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho vi\u1ec7c kh\u00f4i ph\u1ee5c t\u1ed5n th\u01b0\u01a1ng giai ph\u1eabu c\u1ee7a \u1ed5 ch\u1ea3o.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">S\u1ee5n vi\u1ec1n v\u00e0 ph\u1ee9c h\u1ee3p bao kh\u1edbp s\u1ee5n vi\u1ec1n ph\u1ea3i \u0111\u01b0\u1ee3c g\u1ee1 d\u00ednh \u0111\u1ea3m b\u1ea3o t\u00e1ch kh\u00f3i ho\u00e0n to\u00e0n c\u1ed5 v\u00e0 b\u1edd tr\u01b0\u1edbc d\u01b0\u1edbi c\u1ee7a \u1ed5 ch\u1ea3o \u0111\u1ebfn \u0111\u1ec9nh c\u1ee7a v\u1ecb tr\u00ed r\u00e1ch, d\u1ec3 d\u00e0ng k\u00e9o s\u1ee5n vi\u1ec1n bao kh\u1edbp v\u1ec1 x\u1ea5p xi v\u1edbi b\u1edd tr\u01b0\u1edbc \u1ed5<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">ch\u1ea3o (th\u1ef1c hi\u1ec7n bang \u201cShaver\u201d qua ng\u00f5 ph\u00eda tr\u01b0\u1edbc)<\/span><\/p>\n<p><span style=\"font-weight: 400;\">V\u1edbi \u1ed1ng k\u00ednh \u0111\u1eb7t \u1edf ng\u00f5 sau, d\u1ee5ng c\u1ee5 n\u1ed9i soi \u201cRasp\u201d \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o kh\u1edbp t\u1eeb ng\u00f5 tr\u01b0\u1edbc \u0111\u1ebf lo\u1ea1i b\u1ecf m\u00f4 m\u1ec1m (t\u1ed5 ch\u1ee9c x\u01a1 d\u00ednh) v\u00e0 m\u00e0i m\u00f2n c\u1ed5 v\u00e0 b\u1edd tr\u01b0\u1edbc \u1ed5 ch\u1ea3o t\u1ea1o gi\u01b0\u1eddng \u0111\u1ec3 kh\u00e2u s\u1ee5n vi\u1ec1n. Ch\u00fa \u00fd c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p c\u00f9ng v\u1edbi \u201cShaver\u201d m\u00e0i \u0111\u1ebfn khi b\u1ec1 m\u1eb7t x\u01b0\u01a1ng r\u1ec9 m\u00e1u v\u00e0 tr\u00e1nh l\u00e0m t\u1ed5n th\u01b0\u01a1ng ph\u1ee9c h\u1ee3p s\u1ee5n vi\u1ec1n bao kh\u1edbp.<\/span><\/p>\n<p><strong>K\u1ef9 thu\u1eadt kh\u00e2u neo<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">V\u1edbi \u1ed1ng k\u00ednh \u1edb ng\u00f5 v\u00e0o ph\u00eda sau, \u0111\u1eb7t neo th\u00f4ng qua \u201ccannulas\u201d \u1edf ng\u00f5 v\u00e0o ph\u00eda tr\u01b0\u1edbc.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">\u0110\u1eb7t m\u0169i neo \u0111\u1ea7u ti\u00ean l\u00ean v\u00e0nh \u1ed1 ch\u1ea3o k\u1ec1 v\u1edbi b\u1ec1 m\u1eb7t kh\u1edbp (neo n\u00e0y c\u00f3 th\u1ec3 \u0111\u1eb7t l\u00ean b\u1ec1 m\u1eb7t \u1ed5 ch\u1ea3o m\u1ed9t <\/span><\/span>v\u00e0i milimet \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o neo \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh ch\u1eafc ch\u1eafn trong x\u01b0\u01a1ng \u1ed5 ch\u1ea3o v\u00e0 t\u1ea1o di\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i khi kh\u00e2u s\u1ee5n vi\u1ec1n bao kh\u1edbp v\u00e0o \u1ed5\u00a0ch\u1ea3o). Th\u00f4ng th\u01b0\u1eddng v\u1ecb tr\u00ed neo n\u00e0y c\u00e0ng g\u1ea7n v\u1ecb tr\u00ed 6 gi\u1edd c\u00e0ng t\u1ed1t.<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Sau khi neo \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh v\u00e0o b\u1edd tr\u01b0\u1edbc d\u01b0\u1edbi <\/span><span style=\"font-weight: 400;\">0<\/span><span style=\"font-weight: 400;\"> ch\u1ea3o, k\u00e9o hai \u0111\u1ea9u chi kh\u00e2u qua ng\u00f5 ph\u00eda tr\u01b0\u1edbc. \u0110\u00e1nh gi\u00e1 m\u0169i neo \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh ch\u1eafc ch\u1eafn b\u1eb1ng c\u00e1ch gi\u1eadt c\u1ea3 hai \u0111\u1ea7u ch\u1ec9 kh\u00e2u l\u00ean.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Qua ng\u00f5 ph\u00eda trir\u1edbc, s\u1eed d\u1ee5ng m\u1ed9t d\u1ee5ng c\u1ee5 m\u00f3c n\u1ed9i soi (m\u1ecf chim <\/span>BirdBeak ho\u1eb7c c\u00e2y m\u00f3c chi ki\u1ec3u con thoi Suture Lasso) kh\u00e2u xuy\u00ean qua m\u00f4 d\u01b0\u1edbi s\u1ee5n vi\u1ec1n, \u1edf d\u01b0\u1edbi v\u00e0 ngo\u00e0i m\u0169i neo. Sau \u0111\u00f3 m\u00f3c m\u1ed9t s\u1ee3i ch\u1ec9 kh\u00e2u k\u00e9o xuy\u00ean qua m\u00f4 s\u1ee5n vi\u1ec1n n\u00e0y. L\u01b0\u1ee3ng bao kh\u1edbp s\u1ee5n vi\u1ec1n \u0111\u01b0\u1ee3c l\u1ea5y n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1ed9 l\u1ecfng l\u1ebbo c\u1ee7a d\u00e2y ch\u1eb1ng bao kh\u1edbp.<\/li>\n<li><span style=\"font-weight: 400;\">Ti\u1ebfn h\u00e0nh bu\u1ed9c th\u1eaft n\u00fat m\u00f9i neo n\u00e0y b\u1eb1ng d\u1ee5ng c\u1ee5 th\u1eaft n\u00fat n\u1ed9i soi. Sau \u0111\u00f3 ki\u1ec3m tra \u0111\u1ed9 v\u1eefng ch\u1eafc c\u1ee7a n\u00fat bu\u1ed9c b\u1ea3ng m\u00f3c n\u1ed9i soi, c\u1eaft ch\u1ec9 kh\u00e2u \u0111\u1ec3 k\u1ebft th\u00fac n\u00fat bu\u1ed9c.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u1eb7t t\u1ea5t c\u1ea3 c\u00e1c neo t\u1ea1i m\u1ed9t th\u1eddi \u0111i\u1ec3m c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn th\u1ea5t b\u1ea1i c\u1ee7a m\u0169i kh\u00e2u. Do \u0111\u00f3, ch\u00fang t\u00f4i mu\u1ed1n l\u1eb7p l\u1ea1i t\u1eebng b\u01b0\u1edbc trong s\u1ed1 \u0111\u00f3 (c\u1ed1 \u0111\u1ecbnh neo, kh\u00e2u s\u1ee5n vi\u1ec1n bao kh\u1edbp, th\u1eaft n\u00fat) cho m\u1ed7i neo.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">V\u1ecb tr\u00ed neo ti\u1ebfp theo \u00edt \u0111\u00f2i h\u1ecfi k\u1ef9 thu\u1eadt h\u01a1n. Ch\u00fang t\u00f4i th\u01b0\u1eddng b\u1ed5 tr\u00ed m\u1ed7i neo c\u00e1ch nhau 4 \u0111\u1ebfn 5 mm v\u00e0 s\u1eed d\u1ee5ng trung b\u00ecnh ba neo. Tuy nhi\u00ean, s\u1ed1 l\u01b0\u1ee3ng neo \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u00f9y thu\u1ed9c v\u00e0o \u0111\u1ed9 d\u00e0i c\u1ee7a r\u00e1ch s\u1ee5n vi\u1ec1n, do \u0111\u00f3 x\u00e1c \u0111\u1ecbnh n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n\u00a0<\/span><span style=\"font-weight: 400;\">trong ph\u1eabu thu\u1eadt. C\u00e1c neo ti\u1ebfp theo th\u01b0\u1eddng \u0111\u1eb7t \u1edf c\u00e1c v\u1ecb tr\u00ed 2 gi\u1edd v\u00e0 4 gi\u1edd.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Ph\u1eabu thu\u1eadt n\u1ed9i soi l\u00e0m v\u1eefng kh\u1edbp vai \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u00e0ng c\u00e1ch l\u00e0m theo c\u00e1c b\u01b0\u1edbc n\u00eau tr\u00ean. Nh\u01b0ng \u0111\u1ec3 ho\u00e0n th\u00e0nh m\u1ed9t c\u00e1ch c\u00f3 hi\u1ec7u qu\u1ea3 th\u00ec ph\u00e1i l\u00e0m ch\u1ee7 m\u1ed9t s\u1ed1 chi ti\u1ebft tinh t\u1ebf h\u01a1n v\u1ec1 m\u0169i kh\u00e2u. M\u1ed9t s\u1ed1 l\u01b0u \u00fd c\u1ee5 th\u1ec3 \u0111\u1ec3 c\u00f3 m\u0169i kh\u00e2u neo \u0111\u1ea3m b\u1ea3o:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tr\u00e1nh l\u00e0m ch\u00e9o ch\u1ec9 kh\u00e2u t\u1eeb c\u00f9ng m\u1ed9t neo. Khi chu\u1ea9n b\u1ecb m\u1ed9t ch\u1ec9 kh\u00e2u \u0111\u1ebf kh\u00e2u xuy\u00ean qua s\u1ee5n vi\u1ec1n bao kh\u1edbp, ch\u1ecdn ch\u1ec9 g\u1ea7n v\u1edbi s\u1ee5n vi\u1ec1n c\u1ea7n kh\u00e2u.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ph\u1ea3i lu\u00f4n quan s\u00e1t neo kh\u00e2u khi r\u00fat ch\u1ec9 tr\u00e1nh l\u00e0m ch\u1ec9 kh\u00e2u b\u1ecb tu\u1ed9t kh\u1ecfi neo<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Khi bu\u1ed9c ch\u1ec9 ch\u00fa \u00fd gi\u1eef cho n\u00fat th\u1eaft n\u01a1 ra kh\u1ecfi b\u1ec1 m\u1eb7t kh\u1edbp, tr\u00e1nh g\u00e2y ra tri\u1ec7u ch\u1ee9ng c\u01a1 h\u1ecdc.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u1ea3m b\u1ea3o \u0111\u00e1nh gi\u00e1 vi\u1ec7c s\u1eeda ch\u1eefa b\u1eb1ng c\u00e1ch ki\u1ec3m tra m\u1ee9c \u0111\u1ed9 ch\u1eafc ch\u1eafn c\u1ee7a c\u00e1c m\u0169i neo b\u1eb1ng d\u1ee5ng c\u1ee5 que th\u0103m n\u1ed9i soi.<\/span><\/li>\n<\/ul>\n<p><b><i>2.2.3 Rentplissage (\u201cl\u1ea5p \u0111\u1ea7y\u201d)<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">L\u00e0 k\u1ef9 thu\u1eadt c\u1ed1 \u0111\u1ecbnh g\u00e2n c\u01a1 d\u01b0\u1edbi gai v\u00e0 bao kh\u1edbp ph\u00eda sau v\u00e0o v\u00f9ng khuy\u1ebft x\u01b0\u01a1ng c\u1ee7a t\u1ed1n th\u01b0\u01a1ng Hill <\/span><span style=\"font-weight: 400;\">Sach b\u1eb1ng m\u0169i kh\u00e2u neo.<\/span><\/li>\n<\/ul>\n<p><b>\u00a0Chu\u1ea9n b\u1ecb b\u1ec7nh nh\u00e2n <\/b><b>v\u00e0 <\/b><b>d\u1ee5ng c\u1ee5<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">T\u01b0\u01a1ng t\u1ef1 ph\u1eabu thu\u1eadt Bankart<\/span><\/li>\n<\/ul>\n<p><b>Ng\u00f5 v\u00e0o v\u00e0 c\u00e1ch th\u1ee9c ph\u1eabu thu\u1eadt<\/b><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">V\u00e0o kh\u1edbp vai qua ng\u00f5 v\u00e0o ph\u00eda sau, d\u1ea1ng v\u00e0 xoay ngo\u00e0i c\u1ea3nh tay \u0111\u1ec3 c\u00f3 th\u1ec3 quan s\u00e1t \u0111\u01b0\u1ee3c to\u00e0n b\u1ed9 t\u1ed5n th\u01b0\u01a1ng Hill &#8211; Sach.<\/span><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-19422\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.22.17-300x143.png\" alt=\"T\u1ed5n th\u01b0\u01a1ng Hill - Sach. V\u1ecb tr\u00ed \u0111\u1eb7t neo\" width=\"300\" height=\"143\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.22.17-300x143.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.22.17-768x365.png 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.22.17.png 1002w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/>\n<p>&nbsp;<\/p>\n<p>T\u1ed5n th\u01b0\u01a1ng Hill &#8211; Sach. V\u1ecb tr\u00ed \u0111\u1eb7t neo<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Thi\u1ebft l\u1eadp ng\u00f5 v\u00e0o tr\u01b0\u1edbc &#8211; tr\u00ean, chuy\u1ec3n \u1ed5ng k\u00ednh qua ng\u00f5 tr\u01b0\u1edbc tr\u00ean v\u00e0 \u0111\u1eb7t m\u1ed9t \u201ccannulas\u201d v\u00e0o ng\u00f5 ph\u00eda sau.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">\u0110\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng Hill &#8211; Sach, Bankart&#8230; qua ng\u00f5 tr\u01b0\u1edbc tr\u00ean. V\u1ecb tr\u00ed ng\u00f5 sau l\u00e0 ch\u00ednh x\u00e1c n\u1ebfu n\u00f3 \u0111\u01b0\u1ee3c \u0111\u1eb7t \u0111\u1ed1i \u0111i\u1ec7n v\u1edbi t\u1ed1n th\u01b0\u01a1ng Hill &#8211; Sach v\u00e0 \u1edf m\u1ed9t g\u00f3c cho ph\u00e9p \u0111\u1eb7t \u0111\u01b0\u1ee3c kho\u1ea3ng hai neo. N\u1ebfu ng\u00f5 sau l\u00e0 kh\u00f4ng \u0111\u00fang v\u1ecb tr\u00ed, t\u1ed1i \u01b0u h\u00f3a v\u1ecb tr\u00ed c\u1ee7a n\u00f3 v\u1edbi h\u1ed7 tr\u1ee3 c\u1ee7a m\u1ed9t kim ti\u00eam\u00a0<\/span><span style=\"font-weight: 400;\">c\u1ed9t s\u1ed1ng t\u1ea1i th\u1eddi \u0111i\u1ec3m n\u00e0y.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nh\u1eb9 nh\u00e0ng l\u00e0m s\u1ea1ch b\u1ec1 m\u1eb7t c\u1ee7a t\u1ed5n th\u01b0\u01a1ng \u201cengaging Hill-Sachs\u201d v\u1edbi m\u1ed9t d\u1ee5ng c\u1ee5 m\u00e0i x\u01b0\u01a1ng, c\u1ea9n th\u1eadn m\u00e0i lo\u1ea1i b\u1ecf m\u1ed9t l\u01b0\u1ee3ng x\u01b0\u01a1ng t\u1ed1i thi\u1ec3u tr\u00ean b\u00e8 m\u1eb7t. C\u0169ng c\u1ea7n l\u00e0m\u00a0<\/span>s\u1ea1ch b\u1ec1 m\u1eb7t to\u00e0n b\u1ed9 khoang ph\u00eda sau v\u00e0 bao kh\u1edbp b\u1eb1ng d\u1ee5ng c\u1ee5 \u201cShaver\u201d. V\u1edbi d\u1ef1 \u0111o\u00e1n s\u1eeda ch\u1eefa ton th\u01b0\u01a1ng Bankart, c\u1ed5 \u1ed5 ch\u1ea3o ph\u1ea3i \u0111\u01b0\u1ee3c chu\u1ea9n b\u1ecb tr\u01b0\u1edbc khi m\u1ed9t ti\u1ebfn h\u00e0nh k\u1ef9 thu\u1eadt \u201cremplissage\u201d.<\/li>\n<\/ul>\n<ul>\n<li><span style=\"font-weight: 400;\">Gi\u1eef \u1ed1ng k\u00ednh b\u1edd ng\u00f5 v\u00e0o tr\u01b0\u1edbc &#8211; tr\u00ean, c\u1ea9n th\u1eadn r\u00fat \u201ccannulas\u201d \u1edf v\u1ecb tr\u00ed ng\u00f5 ph\u00eda sau t\u1eeb bao kh\u1edbp ph\u00eda sau v\u00e0 g\u00e2n c\u01a1 d\u01b0\u1edbi gai v\u00e0o <\/span>khoang d\u01b0\u1edbi c\u01a1 Delta (\u201ccannulas\u201d kh\u00f4ng \u0111\u01b0\u1ee3c v\u01b0\u1ee3t qua c\u01a1 Delta v\u00e0 ph\u1ea3i n\u1eb1m trong khoang gi\u1eefa c\u01a1 Delta v\u00e0 c\u01a1 d\u01b0\u1edbi gai). V\u1edbi v\u1ecb tr\u00ed \u201ccannulas\u201d n\u00e0y, ti\u1ebfn h\u00e0nh \u0111\u1eb7t neo qua \u201ccannulas\u201d xuy\u00ean qua g\u00e2n c\u01a1 d\u01b0\u1edbi gai v\u00e0 bao kh\u1edbp ph\u00eda sau<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">C\u1ed1 \u0111\u1ecbnh neo \u0111\u1ea7u ti\u00ean v\u00e0o ph\u00eda d\u01b0\u1edbi c\u1ee7a t\u1ed5n th\u01b0\u01a1ng Hill &#8211; Sach<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><\/li>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">Ti\u1ebfp theo hai \u0111\u1ea7u ch\u1ec9 kh\u00e2u c\u1ee7a neo \u0111\u1ea7u ti\u00ean l\u1ea7n l\u01b0\u1ee3t \u0111\u01b0\u1ee3c xuy\u00ean qua bao kh\u1edbp ph\u00eda sau v\u00e0 g\u00e2n c\u01a1 d\u01b0\u1edbi gai, h\u01b0\u1edbng t\u1eeb trong kh\u1edbp v\u00e0o khoang d\u01b0\u1edbi c\u01a1 Delta (kh\u00f4ng xuy\u00ean qua c\u01a1 Delta), kho\u1ea3ng c\u00e1ch <\/span><span style=\"font-weight: 400;\">2 m\u0169i kh\u00e2u kho\u1ea3ng 1 cm.<\/span><\/li>\n<li aria-level=\"1\">\u0110\u1eb7i neo th\u1ee9 hai \u1edf ph\u00eda tr\u00ean c\u1ee7a t\u1ed5n th\u01b0\u01a1ng Hill &#8211; Sach. Ti\u1ebfn h\u00e0nh xuy\u00ean hai \u0111\u1ea7u ch\u1ec9 kh\u00e2u c\u1ee7a neo xuy\u00ean qua bao kh\u1edbp sau v\u00e0 g\u00e2n c\u01a1 d\u01b0\u1edbi gai t\u01b0\u01a1ng t\u1ef1 nh\u01b0 tr\u00ean<\/li>\n<li><span style=\"font-weight: 400;\">Bu\u1ed9c th\u1eaft n\u00fat l\u1ea7n l\u01b0\u1ee3t hai neo (bu\u1ed9c neo ph\u00eda d\u01b0\u1edbi tr\u01b0\u1edbc), n\u01a1 c\u1ee7a n\u00fat th\u1eaft n\u1eb1m ph\u00eda ngo\u00e0i kh\u1edbp v\u00e0 n\u1eb1m trong khoang d\u01b0\u1edbi c\u01a1 Delta (c\u00f3 th\u1ec3 xem n\u01a1 c\u1ee7a c\u00e1c n\u00fat th\u1eaft bang c\u00e1ch \u0111\u1eb7t \u1ed5ng k\u00ednh t\u1eeb ng\u00f5 sau l\u00ean khoang d\u01b0\u1edbi m\u1ecfm c\u00f9ng vai),<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ph\u1ea7n bao kh\u1edbp sau v\u00e0 g\u00e2n c\u01a1 d\u01b0\u1edbi gai s\u1ebd l\u1ea5p \u0111\u1ea7y t\u1ed5n th\u01b0\u01a1ng Hill &#8211; Sach.<\/span><\/li>\n<\/ul>\n<figure id=\"attachment_19425\" aria-describedby=\"caption-attachment-19425\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-19425\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.26.16-300x298.png\" alt=\"T\u1ed5n th\u01b0\u01a1ng Hill - Sach \u0111\u01b0\u1ee3c l\u1ea5p \u0111\u1ea7y\" width=\"300\" height=\"298\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.26.16-300x298.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.26.16-150x150.png 150w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Anh-chup-Man-hinh-2023-04-12-luc-20.26.16.png 492w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-19425\" class=\"wp-caption-text\">T\u1ed5n th\u01b0\u01a1ng Hill &#8211; Sach \u0111\u01b0\u1ee3c l\u1ea5p \u0111\u1ea7y<\/figcaption><\/figure>\n<p><span style=\"font-weight: 400;\">\u0110\u1ec3 \u0111\u0103ng k\u00fd kh\u00e1m v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u1ea1i B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec, Qu\u00fd Kh\u00e1ch c\u00f3 th\u1ec3 li\u00ean h\u1ec7 \u0111\u1ebfn\u00a0<b class=\"link-in-body\">Hotline<\/b>\u00a0H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec tr\u00ean to\u00e0n qu\u1ed1c, ho\u1eb7c \u0111\u0103ng k\u00fd kh\u00e1m tr\u1ef1c tuy\u1ebfn\u00a0<a class=\"link-in-body\" href=\"https:\/\/www.vinmec.com\/vi\/dat-kham\/\"><b class=\"link-in-body\">T\u1ea0I \u0110\u00c2Y<\/b><\/a><b>.<\/b><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tr\u1eadt kh\u1edbp vai l\u00e0 s\u1ef1 m\u1ea5t ti\u1ebfp x\u00fac c\u1ee7a di\u1ec7n kh\u1edbp \u1ed5 ch\u1ea3o v\u00e0 ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay. Tr\u1eadt kh\u1edbp vai t\u00e1i di\u1ec5n l\u00e0 t\u00ecnh tr\u1ea1ng tr\u1eadt kh\u1edbp vai t\u1eeb l\u1ea7n 2 tr\u1edf l\u00ean (th\u01b0\u1eddng tr\u00ean 10 l\u1ea7n), sau b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u1ef1 n\u1eafn \u0111\u01b0\u1ee3c. Th\u00f4ng qua b\u00e0i vi\u1ebft, ch\u00fang t\u00f4i s\u1ebd gi\u1edbi thi\u1ec7u [&hellip;]<\/p>\n","protected":false},"author":49,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[75,40],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Tr\u1eadt kh\u1edbp vai t\u00e1i di\u1ec5n: C\u1eadn l\u00e2m s\u00e0ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt<\/title>\n<meta name=\"description\" content=\"C\u00e1c c\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n trong tr\u1eadt kh\u1edbp vai t\u00e1i di\u1ec5n bao g\u1ed3m X quang\u00a0tr\u01b0\u1edbc - sau, Ch\u1ee5p CT-Scan kh\u1edbp vai sau\" \/>\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 property=\"og:title\" content=\"Tr\u1eadt kh\u1edbp vai t\u00e1i di\u1ec5n: C\u1eadn l\u00e2m s\u00e0ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt\" \/>\n<meta property=\"og:description\" content=\"C\u00e1c c\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n trong tr\u1eadt kh\u1edbp vai t\u00e1i di\u1ec5n bao g\u1ed3m X quang\u00a0tr\u01b0\u1edbc - 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