{"id":21199,"date":"2023-04-16T11:52:18","date_gmt":"2023-04-16T04:52:18","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21199"},"modified":"2023-05-02T14:38:13","modified_gmt":"2023-05-02T07:38:13","slug":"khop-thai-duong-ham-tmj-giai-phau-chuc-nang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/khop-thai-duong-ham-tmj-giai-phau-chuc-nang\/","title":{"rendered":"Kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m – Gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng l\u1ed3i c\u1ea7u v\u00e0 di\u1ec7n kh\u1edbp."},"content":{"rendered":"

Hai kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m l\u00e0 nh\u1eefng kh\u1edbp \u0111\u1ed9ng duy nh\u1ea5t c\u1ee7a s\u1ecd. C\u00e1c m\u00f4 t\u1ea3 v\u1ec1 kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m \u0111\u00e3 \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong nhi\u1ec1u s\u00e1ch gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng. B\u00e0i vi\u1ebft n\u00e0y n\u00f3i v\u1ec1 gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng c\u1ee7a kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m v\u00e0 t\u01b0\u01a1ng quan c\u1ee7a n\u00f3 \u0111\u1ed1i v\u1edbi h\u1ec7 th\u1ed1ng nhai. C\u00f9ng t\u00ecm hi\u1ec3u th\u00eam.<\/strong><\/p>\n

1. L\u1ed3i c\u1ea7u x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi – T\u1ed5ng quan gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng<\/h2>\n

L\u1ed3i c\u1ea7u c\u00f9ng v\u1edbi m\u1ecfm qu\u1ea1 l\u00e0 hai m\u1ecfm t\u1eadn h\u1ebft c\u1ee7a c\u00e0nh l\u00ean x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi. L\u1ed3i c\u1ea7u \u1edf ph\u00eda sau, m\u1ecfm qu\u1ea1 \u1edf ph\u00eda tr\u01b0\u1edbc, gi\u1eefa hai m\u1ecfm \u0111\u00f3 l\u00e0 khuy\u1ebft Sigma.<\/span><\/p>\n

L\u1ed3i c\u1ea7u thu\u00f4n, k\u00edch th\u01b0\u1edbc theo chi\u1ec1u ngang (ngo\u00e0i – trong) t\u1eeb 15 – 20 mm, theo chi\u1ec1u tr\u01b0\u1edbc sau l\u00e0 8 – 10 mm. \u0110\u1ea7u ngo\u00e0i v\u00e0 \u0111\u1ea7u trong c\u1ee7a l\u1ed3i c\u1ea7u t\u1eadn h\u1ebft b\u1edfi c\u00e1c c\u1ef1c: c\u1ef1c ngo\u00e0i v\u00e0 c\u1ef1c trong (H\u00ecnh 1). \u0110\u01b0\u1eddng n\u1ed1i hai c\u1ef1c l\u1ed3i c\u1ea7u k\u00e9o d\u00e0i s\u1ebd \u0111i v\u1ec1 ph\u00eda trong v\u00e0 ph\u00eda sau, g\u1eb7p nhau \u1edf v\u00f9ng b\u1edd tr\u01b0\u1edbc l\u1ed7 ch\u1ea9m, t\u1ea1o th\u00e0nh m\u1ed9t g\u00f3c kho\u1ea3ng 145-160\u00b0 (H\u00ecnh 2). \u0110\u01b0\u1eddng n\u1ed1i hai c\u1ef1c c\u1ee7a l\u1ed3i c\u1ea7u nh\u01b0 v\u1eeba m\u00f4 t\u1ea3 c\u0169ng c\u00f3 h\u01b0\u1edbng song song v\u1edbi \u0111\u01b0\u1eddng n\u1ed1i c\u00e1c m\u00fai ngo\u00e0i v\u00e0 trong t\u01b0\u01a1ng \u1ee9ng c\u1ee7a c\u00e1c r\u0103ng sau. C\u1ef1c ngo\u00e0i ng\u1eafn (n\u00ean \u1edf g\u1ea7n c\u1ed5 l\u1ed3i c\u1ea7u h\u01a1n c\u1ef1c trong), kh\u00e1 t\u00f9 v\u00e0 th\u01b0\u1eddng g\u1ed3 gh\u1ec1 \u1edf n\u01a1i b\u00e1m c\u1ee7a \u0111\u0129a kh\u1edbp, d\u00e2y ch\u1eb1ng th\u00e1i d\u01b0\u01a1ng h\u00e0m b\u00e1m v\u00e0o m\u1ed9t c\u1ee7 nh\u1ecf (c\u1ee7 d\u01b0\u1edbi l\u1ed3i c\u1ea7u ngo\u00e0i). C\u1ef1c trong d\u00e0i n\u00ean \u1edf xa c\u1ed5 l\u1ed3i c\u1ea7u v\u00e0 c\u0169ng g\u1ed3 gh\u1ec1 \u1edf n\u01a1i b\u00e1m c\u1ee7a \u0111\u0129a kh\u1edbp v\u00e0 bao kh\u1edbp.<\/span><\/p>\n

\"giai-phau-chuc-nang-1\"
H\u00ecnh 1: L\u1ed3i c\u1ea7u – Nh\u00ecn t\u1eeb ph\u00eda tr\u01b0\u1edbc<\/figcaption><\/figure>\n
\"giai-phau-chuc-nang-2\"
H\u00ecnh 2: \u0110\u01b0\u1eddng n\u1ed1i hai c\u1ef1c l\u1ed3i c\u1ea7u k\u00e9o d\u00e0i \u0111i v\u1ec1 ph\u00eda trong v\u00e0 ph\u00eda sau, g\u1eb7p nhau \u1edf v\u00f9ng b\u1edd tr\u01b0\u1edbc l\u1ed7 ch\u1ea9m.<\/figcaption><\/figure>\n

Di\u1ec7n kh\u1edbp c\u1ee7a l\u1ed3i c\u1ea7u h\u01a1i l\u1ed3i theo chi\u1ec1u tr\u01b0\u1edbc sau, th\u1eb3ng ho\u1eb7c l\u1ed3i nh\u1eb9 theo chi\u1ec1u ngo\u00e0i trong. \u0110\u00f4i khi di\u1ec7n kh\u1edbp \u1edf l\u1ed3i c\u1ea7u b\u1ecb ph\u00e2n chia b\u1edfi m\u1ed9t g\u1edd ho\u1eb7c m\u1ed9t r\u00e3nh c\u1ea1n th\u00e0nh hai ph\u1ea7n, ph\u1ea7n ngo\u00e0i th\u01b0\u1eddng ng\u1eafn h\u01a1n ph\u1ea7n trong. Di\u1ec7n l\u00e0m vi\u1ec7c c\u1ee7a l\u1ed3i c\u1ea7u \u1edf v\u1ec1 ph\u00eda tr\u01b0\u1edbc v\u00e0 tr\u00ean. B\u1edd tr\u01b0\u1edbc c\u1ee7a di\u1ec7n kh\u1edbp th\u01b0\u1eddng c\u00f3 m\u1ed9t g\u1edd x\u01b0\u01a1ng, b\u1edd sau c\u1ee7a di\u1ec7n l\u00e0m vi\u1ec7c \u1edf l\u1ed3i c\u1ea7u th\u01b0\u1eddng l\u00e0 \u0111i\u1ec3m cao nh\u1ea5t c\u1ee7a x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi, \u1edf \u0111\u00e2y th\u01b0\u1eddng c\u00f3 m\u1ed9t g\u1edd (g\u1edd tr\u00ean l\u1ed3i c\u1ea7u) v\u00e0 m\u1eb7t sau c\u1ee7a l\u1ed3i c\u1ea7u thu\u1ed9c kh\u1edbp nh\u01b0ng kh\u00f4ng ph\u1ea3i l\u00e0 di\u1ec7n l\u00e0m vi\u1ec7c.<\/p>\n

Di\u1ec7n kh\u1edbp c\u1ee7a c\u1ea3 l\u1ed3i c\u1ea7u v\u00e0 c\u1ee7a x\u01b0\u01a1ng th\u00e1i d\u01b0\u01a1ng \u0111\u01b0\u1ee3c ph\u1ee7 b\u1edfi m\u00f4 s\u1ee3i kh\u00f4ng c\u00f3 m\u1ea1ch m\u00e1u s\u0103n ch\u1eafc, ch\u1ee9a \u00edt t\u1ebf b\u00e0o s\u1ee5n v\u00e0 proteoglycan d\u1ea1ng s\u1ee5n (CPGs), c\u00e1c s\u1ee3i chun v\u00e0 s\u1ee3i kh\u00e1ng acid (s\u1ee3i oxytalan). \u0110\u00f3 l\u00e0 kh\u1edbp \u0111\u1ed9ng duy nh\u1ea5t c\u1ee7a c\u01a1 th\u1ec3 m\u00e0 c\u00e1c di\u1ec7n kh\u1edbp kh\u00f4ng \u0111\u01b0\u1ee3c bao b\u1ecdc b\u1edfi s\u1ee5n trong. Nh\u01b0 v\u1eady, kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m kh\u00f4ng ph\u1ea3i ch\u1ec9 l\u00e0 m\u1ed9t c\u1ea5u tr\u00fac n\u00e2ng \u0111\u1ee1 kh\u1ed1i l\u01b0\u1ee3ng t\u0129nh m\u00e0 l\u00e0 m\u1ed9t kh\u1edbp bi\u1ec7t h\u00f3a cao \u0111\u1ec3 th\u00edch \u1ee9ng v\u1edbi nh\u1eefng vect\u01a1 thay \u0111\u1ed5i v\u1ec1 l\u1ef1c nh\u01b0 trong ho\u1ea1t \u0111\u1ed9ng nhai.<\/p>\n

Trong \u0111\u1eddi s\u1ed1ng, h\u00ecnh d\u00e1ng c\u1ee7a l\u1ed3i c\u1ea7u c\u00f3 th\u1ec3 di\u1ec5n ra nh\u1eefng thay \u0111\u1ed5i, trong \u0111\u00f3 c\u00f3 nh\u1eefng thay \u0111\u1ed5i l\u00e0 \u0111\u1ec3 th\u00edch \u1ee9ng v\u1edbi gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng v\u00e0 t\u00ecnh tr\u1ea1ng kh\u1edbp c\u1eafn.<\/p>\n

2. Di\u1ec7n kh\u1edbp \u1edf s\u1ecd – Gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng<\/h2>\n

Ph\u1ea7n di\u1ec7n kh\u1edbp \u1edf s\u1ecd c\u1ee7a kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m thu\u1ed9c ph\u1ea7n d\u01b0\u1edbi x\u01b0\u01a1ng th\u00e1i d\u01b0\u01a1ng, ngay tr\u01b0\u1edbc b\u1edd tr\u01b0\u1edbc x\u01b0\u01a1ng \u1ed1ng tai v\u00e0 sau m\u1ecfm g\u00f2 m\u00e1 x\u01b0\u01a1ng th\u00e1i d\u01b0\u01a1ng. Di\u1ec7n kh\u1edbp g\u1ed3m m\u1ed9t l\u1ed3i \u1edf ph\u00eda tr\u01b0\u1edbc (l\u1ed3i kh\u1edbp) v\u00e0 m\u1ed9t l\u00f5m \u1edf ph\u00eda sau (h\u00f5m kh\u1edbp) (H\u00ecnh 3), gi\u1edbi h\u1ea1n c\u1ee7a di\u1ec7n kh\u1edbp l\u00e0 n\u01a1i b\u00e1m c\u1ee7a bao kh\u1edbp (xem ph\u1ea7n bao kh\u1edbp d\u01b0\u1edbi \u0111\u00e2y).<\/p>\n

L\u1ed3i kh\u1edbp l\u00e0 m\u1ed9t cu\u1ed9n x\u01b0\u01a1ng, l\u1ed3i ch\u1ebfch v\u00e0o trong v\u00e0 ra sau nh\u01b0ng h\u01a1i l\u00f5m theo chi\u1ec1u ngo\u00e0i trong. T\u1eeb m\u00e0o l\u1ed3i kh\u1edbp, s\u01b0\u1eddn sau c\u1ee7a l\u1ed3i kh\u1edbp tho\u1ea3i h\u01a1n s\u01b0\u1eddn tr\u01b0\u1edbc. S\u01b0\u1eddn sau c\u1ee7a l\u1ed3i kh\u1edbp di\u1ec7n ho\u1ea1t \u0111\u1ed9ng (di\u1ec7n l\u00e0m vi\u1ec7c) c\u1ee7a di\u1ec7n kh\u1edbp \u1edf s\u1ecd. (Do c\u00f3 l\u1ed3i kh\u1edbp \u1edf x\u01b0\u01a1ng th\u00e1i d\u01b0\u01a1ng, kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m c\u00f2n \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u00e0 m\u1ed9t kh\u1edbp l\u01b0\u1ee1ng l\u1ed3i c\u1ea7u).<\/p>\n

H\u00f5m kh\u1edbp l\u00e0 m\u1ed9t v\u00f2m, l\u00f5m c\u1ea3 theo chi\u1ec1u g\u1ea7n xa l\u1eabn theo chi\u1ec1u ngo\u00e0i trong, h\u00f5m c\u00f3 tr\u1ee5c d\u00e0i theo chi\u1ec1u ngo\u00e0i trong v\u00e0 c\u00f9ng h\u01b0\u1edbng v\u1edbi tr\u1ee5c d\u00e0i c\u1ee7a l\u1ed3i c\u1ea7u nh\u01b0 \u0111\u00e3 m\u00f4 t\u1ea3 tr\u00ean. Tr\u1ea7n c\u1ee7a h\u00f5m kh\u1edbp m\u1ecfng, li\u00ean h\u1ec7 v\u1edbi n\u1ec1n s\u1ecd gi\u1eefa, n\u01a1i m\u1ecfng nh\u1ea5t c\u00f3 \u0111\u1ed9 d\u00e0y kho\u1ea3ng 2 mm. Ph\u1ea7n sau c\u1ee7a h\u00f5m kh\u1edbp l\u00e0 x\u01b0\u01a1ng \u0111\u00e1, ph\u00e2n c\u00e1ch v\u1edbi ph\u1ea7n tr\u01b0\u1edbc c\u1ee7a h\u00f5m kh\u1edbp b\u1eb1ng m\u1ed9t khe (khe nh\u0129 trai), ph\u1ea7n sau kh\u00f4ng thu\u1ed9c kh\u1edbp.<\/p>\n

C\u00e1c di\u1ec7n kh\u1edbp c\u1ee7a kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m kh\u00f4ng kh\u00edt s\u00e1t v\u1edbi nhau, (ch\u00ednh v\u00ec v\u1eady, vi\u1ec7c so s\u00e1nh c\u01a1 ch\u1ebf \u0111\u00f2n b\u1ea9y trong ho\u1ea1t \u0111\u1ed9ng c\u1ee7a kh\u1edbp l\u00e0 kh\u00f4ng ho\u00e0n to\u00e0n th\u1ecfa \u0111\u00e1ng). C\u00e1c di\u1ec7n kh\u1edbp kh\u00f4ng ti\u1ebfp x\u00fac v\u1edbi nhau ngay c\u1ea3 khi h\u00e0m d\u01b0\u1edbi c\u1eafn l\u1ea1i. Kho\u1ea3ng c\u00e1ch gi\u1eefa hai di\u1ec7n kh\u1edbp \u1edf ph\u00eda trong l\u1edbn h\u01a1n so v\u1edbi ph\u00eda ngo\u00e0i, ph\u00eda sau l\u1edbn h\u01a1n ph\u00eda tr\u01b0\u1edbc, kho\u1ea3ng c\u00e1ch \u0111\u00f3 \u0111\u01b0\u1ee3c l\u1ea5p \u0111\u1ea7y b\u1edfi \u0111\u0129a kh\u1edbp v\u00e0 c\u00e1c m\u00f4 li\u00ean k\u1ebft quanh \u0111\u0129a.<\/p>\n

C\u1ea3 l\u1ed3i kh\u1edbp v\u00e0 h\u00f5m kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m \u0111\u1ec1u thu\u1ed9c \u0111\u1ea7u sau cung ti\u1ebfp c\u1ee7a ph\u1ea7n trai x\u01b0\u01a1ng th\u00e1i d\u01b0\u01a1ng, l\u1ed3i kh\u1edbp l\u00e0 r\u1ec5 ngang, h\u00f5m kh\u1edbp l\u00e0 ph\u1ea7n l\u00f5m gi\u1eefa r\u1ec5 ngang v\u00e0 r\u1ec5 th\u1eb3ng<\/p>\n

\"giai-phau-chuc-nang-3\"
H\u00ecnh 3: C\u1ea5u tr\u00fac x\u01b0\u01a1ng c\u1ee7a kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m: A. Nh\u00ecn t\u1eeb ph\u00eda b\u00ean, B. Nh\u00ecn t\u1eeb ph\u00eda d\u01b0\u1edbi<\/figcaption><\/figure>\n

3. Gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng \u0111\u0129a kh\u1edbp<\/h2>\n

\u0110\u00f2i h\u1ecfi v\u1ec1gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng quan tr\u1ecdng nh\u1ea5t c\u1ee7a \u0111\u0129a kh\u1edbp l\u00e0 n\u00f3 ph\u1ea3i thay \u0111\u1ed5i v\u1ec1 v\u1ecb tr\u00ed v\u00e0 h\u00ecnh d\u00e1ng sao cho n\u00f3, c\u00f9ng v\u1edbi m\u00f4 sau \u0111\u0129a c\u00f3 th\u1ec3 l\u1ea5p \u0111\u1ea7y kho\u1ea3ng gi\u1eefa c\u00e1c di\u1ec7n kh\u1edbp b\u1eb1ng x\u01b0\u01a1ng v\u00e0 \u1ed5n \u0111\u1ecbnh x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi trong b\u1ea5t k\u1ef3 pha n\u00e0o c\u1ee7a v\u1eadn \u0111\u1ed9ng.<\/p>\n

3.1. \u0110\u1eb7c \u0111i\u1ec3m h\u00ecnh th\u1ec3 v\u00e0 c\u1ea5u t\u1ea1o<\/h3>\n

Nh\u00ecn t\u1eeb ph\u00eda tr\u00ean, \u0111\u0129a c\u00f3 h\u00ecnh oval ho\u1eb7c h\u00ecnh ch\u1eef nh\u1eadt v\u1edbi c\u00e1c v\u1ea1t (flaps) tam gi\u00e1c \u1edf ph\u00eda trong v\u00e0 ngo\u00e0i. C\u00e1c v\u1ea1t n\u00e0y g\u1ea5p xu\u1ed1ng v\u00e0 \u0111\u00ednh c\u00e1c \u0111\u1ea7u c\u1ee7a n\u00f3 v\u00e0o ngay d\u01b0\u1edbi c\u00e1c c\u1ef1c ngo\u00e0i v\u00e0 c\u1ef1c trong c\u1ee7a l\u1ed3i c\u1ea7u.<\/p>\n

Nh\u00ecn chung, \u0111\u0129a kh\u1edbp c\u00f3 h\u00ecnh m\u1ed9t th\u1ea5u k\u00ednh l\u00f5m hai m\u1eb7t. N\u1eeda sau c\u1ee7a \u0111\u0129a d\u00e0y h\u01a1n n\u1eeda tr\u01b0\u1edbc, ph\u1ea7n trong d\u00e0y h\u01a1n ph\u1ea7n ngo\u00e0i, ph\u1ea7n gi\u1eefa c\u1ee7a \u0111\u0129a m\u1ecfng, ph\u00f9 h\u1ee3p v\u1edbi kho\u1ea3ng c\u00e1ch gi\u1eefa hai di\u1ec7n kh\u1edbp. C\u00e1c ph\u1ea7n d\u00e0y h\u01a1n c\u1ee7a \u0111\u0129a \u1edf tr\u01b0\u1edbc v\u00e0 sau \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 d\u1ea3i tr\u01b0\u1edbc v\u00e0 d\u1ea3i sau, ph\u1ea7n m\u1ecfng c\u1ee7a \u0111\u0129a l\u00e0 v\u00f9ng trung gian. M\u1eb7t tr\u00ean c\u1ee7a \u0111\u0129a h\u01a1i l\u1ed3i \u1edf ph\u1ea7n sau v\u00e0 h\u01a1i l\u00f5m \u1edf ph\u1ea7n tr\u01b0\u1edbc, ph\u00f9 h\u1ee3p v\u1edbi h\u00ecnh th\u1ec3 c\u1ee7a di\u1ec7n kh\u1edbp \u1edf s\u1ecd. M\u1eb7t d\u01b0\u1edbi c\u1ee7a \u0111\u0129a l\u00f5m. Ph\u1ea7n d\u00e0y nh\u1ea5t c\u1ee7a \u0111\u0129a kh\u1edbp l\u00e0 ph\u1ea7n sau, \u1ee9ng v\u1edbi h\u00f5m kh\u1edbp. Khi hai h\u00e0m \u1edf v\u1ecb tr\u00ed \u0111\u00f3ng, d\u1ea3i sau th\u01b0\u1eddng \u1edf tr\u00ean ho\u1eb7c h\u01a1i tr\u01b0\u1edbc so v\u1edbi m\u00e0o tr\u00ean l\u1ed3i c\u1ea7u. \u0110\u0129a kh\u1edbp \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o t\u1eeb m\u00f4 s\u1ee3i keo s\u0103n ch\u1eafc ch\u1ee9 kh\u00f4ng ph\u1ea3i l\u00e0 m\u00f4 s\u1ee5n (tr\u01b0\u1edbc \u0111\u00e2y, \u0111\u0129a kh\u1edbp \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u201cs\u1ee5n ch\u00eam\u201d, t\u00ean n\u00e0y ng\u00e0y nay kh\u00f4ng c\u00f2n d\u00f9ng). C\u00e1c m\u1eb7t c\u1ee7a \u0111\u0129a \u0111\u01b0\u1ee3c ph\u1ee7 b\u1edfi m\u00f4 ho\u1ea1t d\u1ecbch (H\u00ecnh 4, 5).<\/p>\n

\"giai-phau-chuc-nang-4\"
H\u00ecnh 4: Thi\u1ebft \u0111\u1ed3 \u0111\u1ee9ng d\u1ecdc qua kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m<\/figcaption><\/figure>\n
\"\"
H\u00ecnh 5: Thi\u1ebft \u0111\u1ed3 \u0111\u1ee9ng ngang qua kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m<\/figcaption><\/figure>\n

Th\u00e0nh ph\u1ea7n c\u1ea5u tr\u00fac \u0111\u0129a kh\u1edbp l\u00e0 c\u00e1c s\u1ee3i collagen \u0111\u1ecbnh h\u01b0\u1edbng m\u1eadt \u0111\u1ed9 cao, CPGs, s\u1ee3i chun. C\u00e1c s\u1ee3i collagen c\u1ee7a v\u00f9ng trung gian c\u00f3 h\u01b0\u1edbng \u00edt nhi\u1ec1u vu\u00f4ng g\u00f3c v\u1edbi tr\u1ee5c ngang c\u1ee7a \u0111\u0129a, tr\u00ean \u0111\u01b0\u1eddng \u0111i, c\u00f3 nh\u1eefng nh\u00e1nh k\u1ebft n\u1ed1i theo chi\u1ec1u ngo\u00e0i trong v\u00e0 tr\u00ean d\u01b0\u1edbi. Khi \u0111\u1ebfn g\u1ea7n v\u00f9ng c\u00e1c d\u1ea3i tr\u01b0\u1edbc v\u00e0 d\u1ea3i sau, ch\u00fang t\u1ecfa ra theo c\u1ea3 hai chi\u1ec1u tr\u00ean d\u01b0\u1edbi v\u00e0 ngo\u00e0i trong \u0111\u1ec3 b\u1ec7n v\u00e0o ho\u1eb7c li\u00ean t\u1ee5c v\u1edbi c\u00e1c s\u1ee3i \u1edf v\u00f9ng n\u00e0y. C\u00e1c s\u1ee3i theo h\u01b0\u1edbng ngo\u00e0i trong chi\u1ebfm \u01b0u th\u1ebf \u1edf d\u1ea3i sau \u0111\u0129a. M\u00f4 c\u1ee7a \u0111\u0129a kh\u1edbp kh\u00f4ng th\u1ec3 hi\u1ec7n kh\u1ea3 n\u0103ng t\u00e2n t\u1ea1o v\u00e0 \u0111\u1ed5i m\u1edbi, v\u00ec v\u1eady, c\u00e1c th\u01b0\u01a1ng t\u1ed5n \u1edf \u0111\u0129a kh\u1edbp th\u01b0\u1eddng l\u00e0 v\u0129nh vi\u1ec5n v\u00e0 kh\u00f4ng h\u1ed3i ph\u1ee5c (v\u1ec1 v\u1ea5n \u0111\u1ec1 n\u00e0y, c\u00f3 t\u00e0i li\u1ec7u cho r\u1eb1ng \u0111\u0129a kh\u1edbp \u00edt di\u1ec5n ra nh\u1eefng thay \u0111\u1ed5i trong qu\u00e1 tr\u00ecnh t\u00edch tu\u1ed5i nh\u01b0ng c\u00f3 kh\u1ea3 n\u0103ng s\u1eeda ch\u1eefa cao).<\/p>\n

C\u00e1ch b\u00e1m c\u1ee7a c\u00e1c \u0111\u0129a kh\u1edbp b\u1eb1ng c\u00e1c v\u1ea1t v\u00e0o l\u1ed3i c\u1ea7u nh\u01b0 v\u1eeba m\u00f4 t\u1ea3 cho ph\u00e9p \u0111\u0129a d\u1ecbch chuy\u1ec3n tr\u01b0\u1ee3t v\u1ec1 ph\u00eda tr\u01b0\u1edbc v\u00e0 ph\u00eda sau nh\u01b0 m\u1ed9t c\u00e1i m\u0169 c\u00f3 th\u1ec3 tr\u01b0\u1ee3t t\u1edbi tr\u01b0\u1edbc v\u00e0 ra sau tr\u00ean \u0111\u1ea7u l\u1ed3i c\u1ea7u. C\u00e1c v\u1ea1t c\u1ee7a \u0111\u0129a kh\u1edbp kh\u00e1 d\u00e0i, v\u00ec v\u1eady \u0111\u0129a c\u0169ng c\u00f3 th\u1ec3 tr\u01b0\u1ee3t xoay tr\u00ean l\u1ed3i c\u1ea7u. Nh\u1eefng d\u1ecbch chuy\u1ec3n nh\u1ecf \u0111\u00f3 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u0129a kh\u1edbp c\u00f3 kh\u1ea3 n\u0103ng tr\u01b0\u1ee3t v\u00e0 ti\u1ebfp x\u00fac v\u1edbi c\u00e1c di\u1ec7n kh\u1edbp c\u1ee7a x\u01b0\u01a1ng th\u00e1i d\u01b0\u01a1ng v\u00e0 x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi \u1edf m\u1ecdi t\u01b0 th\u1ebf.<\/p>\n

To\u00e0n b\u1ed9 chu vi c\u1ee7a \u0111\u0129a li\u00ean t\u1ee5c v\u1edbi m\u00f4 li\u00ean k\u1ebft quanh \u0111\u0129a, chia khoang kh\u1edbp th\u00e0nh hai bu\u1ed3ng (xem ph\u1ea7n bao kh\u1edbp). C\u00e1c m\u1eb7t c\u1ee7a \u0111\u0129a r\u1ea5t tr\u01a1n nh\u1eb5n, \u0111\u01b0\u1ee3c ph\u1ee7 b\u1edfi d\u1ecbch c\u1ee7a m\u00f4 ho\u1ea1t d\u1ecbch, l\u00e0m gi\u1ea3m thi\u1ec3u t\u1ed1i \u0111a ma s\u00e1t gi\u1eefa \u0111\u0129a v\u00e0 c\u00e1c di\u1ec7n kh\u1edbp. T\u00ednh \u0111\u00e0n h\u1ed3i c\u1ee7a \u0111\u0129a l\u00e0 do n\u00f3 \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o t\u1eeb m\u00f4 s\u1ee3i v\u00e0 do ch\u00ednh h\u00ecnh d\u00e1ng c\u1ee7a n\u00f3. Trong khe kh\u1edbp, \u0111\u0129a c\u00f3 th\u1ec3 thay \u0111\u1ed5i h\u00ecnh d\u00e1ng \u0111\u00f4i ch\u00fat, v\u00f9ng m\u1ecfng h\u01a1n c\u1ee7a \u0111\u0129a c\u00f3 th\u1ec3 d\u1ecbch chuy\u1ec3n theo chi\u1ec1u ngo\u00e0i trong ho\u1eb7c \u0111\u0129a c\u00f3 th\u1ec3 xoay trong c\u00e1c v\u1eadn \u0111\u1ed9ng kh\u00f4ng \u0111\u1ed1i x\u1ee9ng c\u1ee7a h\u00e0m d\u01b0\u1edbi, l\u00e0m cho n\u00f3 l\u1ea5p \u0111\u1ea7y khe kh\u1edbp.<\/p>\n

3.2. \u0110\u1eb7c \u0111i\u1ec3m gi\u1ea3i ph\u1eabu<\/h3>\n

C\u00e1c v\u1eadn \u0111\u1ed9ng gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng c\u1ee7a \u0111\u0129a trong khe kh\u1edbp n\u00f3i chung l\u00e0 b\u1ecb \u0111\u1ed9ng, ngh\u0129a l\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 can thi\u1ec7p tr\u1ef1c ti\u1ebfp c\u1ee7a c\u00e1c c\u01a1. Do c\u00e1c m\u1eb7t tr\u01a1n v\u00e0 c\u00f3 t\u00ednh \u0111\u00e0n h\u1ed3i, \u0111\u0129a kh\u1edbp d\u1ecbch chuy\u1ec3n m\u1ed9t c\u00e1ch b\u1ecb \u0111\u1ed9ng \u0111\u1ec3 chui v\u00e0o ch\u1ed7 v\u1eeba v\u1edbi n\u00f3 nh\u1ea5t khi c\u00f3 v\u1eadn \u0111\u1ed9ng c\u1ee7a h\u00e0m d\u01b0\u1edbi, ngh\u0129a l\u00e0 khi h\u00ecnh d\u1ea1ng c\u1ee7a khe kh\u1edbp thay \u0111\u1ed5i. \u0110\u00f3 l\u00e0 n\u01a1i c\u00f3 s\u1ef1 ti\u1ebfp x\u00fac t\u1ed1i \u0111a gi\u1eefa \u0111\u0129a kh\u1edbp v\u00e0 c\u00e1c di\u1ec7n kh\u1edbp v\u00e0 l\u00e0 n\u01a1i \u0111\u0129a kh\u1edbp \u0111\u00e1p \u1ee9ng t\u1ed1t nh\u1ea5t vi\u1ec7c n\u00e2ng \u0111\u1ee1 l\u1ed3i c\u1ea7u.<\/p>\n

V\u1eadn \u0111\u1ed9ng c\u1ee7a \u0111\u0129a kh\u1edbp v\u00e0 l\u1ed3i c\u1ea7u: Khi h\u00e0m d\u01b0\u1edbi m\u1edf v\u00e0 \u0111\u00f3ng, l\u1ed3i c\u1ea7u xoay v\u00e0 tr\u01b0\u1ee3t v\u1ec1 ph\u00eda tr\u01b0\u1edbc. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o cho th\u1ea5y l\u1ed3i c\u1ea7u c\u00f3 v\u1eadn \u0111\u1ed9ng xoay t\u1ef1 do quanh tr\u1ee5c \u0111i ngang qua hai l\u1ed3i c\u1ea7u (Berry, D. C., 1959; Gibb, C.H., Lundeen, H.C., 1982; Salaorni, C., Palla, S., 1994). Khi h\u00e0m d\u01b0\u1edbi m\u1edf t\u1eeb v\u1ecb tr\u00ed kh\u1edbp c\u1eafn trung t\u00e2m, l\u1ed3i c\u1ea7u c\u00f3 th\u1ec3 xoay v\u00e0 l\u1eadp t\u1ee9c d\u1ecbch chuy\u1ec3n ra tr\u01b0\u1edbc ho\u1eb7c xu\u1ed1ng d\u01b0\u1edbi tr\u00ean m\u1ed9t \u0111o\u1ea1n ng\u1eafn, sau \u0111\u00f3, d\u1ecbch chuy\u1ec3n v\u1ec1 ph\u00eda tr\u01b0\u1edbc. To\u00e0n b\u1ed9 \u0111o\u1ea1n v\u1eadn \u0111\u1ed9ng c\u1ee7a l\u1ed3i c\u1ea7u khi h\u00e1 (t\u1ed1i \u0111a) l\u00e0 13-15 mm, trong khi \u0111\u00f3, \u0111\u0129a kh\u1edbp d\u1ecbch chuy\u1ec3n v\u1ec1ph\u00eda tr\u01b0\u1edbc 5-9 mm (Finlay, I.A., 1965). Do s\u1ef1 ho\u1ea1t \u0111\u1ed9ng ph\u1ed1i h\u1ee3p gi\u1eefa l\u1ed3i c\u1ea7u v\u00e0 \u0111\u0129a kh\u1edbp, ng\u01b0\u1eddi ta coi ch\u00fang l\u00e0 m\u1ed9t ph\u1ee9c h\u1ee3p, ph\u1ee9c h\u1ee3p l\u1ed3i c\u1ea7u- \u0111\u0129a kh\u1edbp.<\/p>\n

Khi l\u1ed3i c\u1ea7u r\u1eddi kh\u1ecfi h\u00f5m kh\u1edbp v\u00e0 d\u1ecbch chuy\u1ec3n v\u1ec1 ph\u00eda tr\u01b0\u1edbc, m\u1ed9t \u00e1p l\u1ef1c \u00e2m \u0111\u01b0\u1ee3c t\u1ea1o th\u00e0nh \u1edf v\u00f9ng b\u00e1m d\u00ednh ph\u00eda sau. \u1ede \u0111i\u1ec3m h\u00e1 t\u1ed1i \u0111a, b\u00e1m d\u00ednh sau d\u00e3n l\u1edbn g\u1ea5p b\u1ed1n \u0111\u1ebfn n\u0103m l\u1ea7n so v\u1edbi khi c\u1eafn \u1edf kh\u1edbp c\u1eafn trung t\u00e2m. (B\u00e1m d\u00ednh ph\u00eda sau g\u1ed3m ba ph\u1ea7n: ph\u1ea7n th\u00e1i d\u01b0\u01a1ng (TPA), ph\u1ea7n l\u1ed3i c\u1ea7u (CPA) v\u00e0 ph\u1ea7n trung gian (IPA)). Ph\u1ea7n th\u00e1i d\u01b0\u01a1ng b\u1ecb \u00e9p gi\u1eefa th\u00e0nh c\u1ee7a h\u00f5m kh\u1edbp v\u00e0 s\u01b0\u1eddn sau c\u1ee7a l\u1ed3i kh\u1edbp, ph\u1ea7n l\u1ed3i c\u1ea7u b\u1ecb g\u1ea5p d\u01b0\u1edbi d\u1ea3i sau. S\u1ef1 d\u00e3n c\u1ee7a d\u1ea3i sau l\u00e0 do gi\u00e3n m\u1ea1ch c\u1ee7a \u0111\u00e1m r\u1ed1i t\u0129nh m\u1ea1ch \u1edf ph\u1ea7n trung gian v\u00e0 d\u00e3n ho\u1ea1t d\u1ecbch \u1edf ph\u00eda sau khoang kh\u1edbp (H\u00ecnh 6)<\/p>\n

\"\"
H\u00ecnh 6: \u1ede \u0111i\u1ec3m h\u1ea3 t\u1ed1i \u0111a, b\u00e1m d\u00ednh sau d\u00e3n l\u1edbn g\u1ea5p b\u1ed1n \u0111\u1ebfn n\u0103m l\u1ea7n so v\u1edbi khi c\u1eafn \u1edf kh\u1edbp c\u1eafn trung t\u00e2m.<\/figcaption><\/figure>\n

B\u1edd sau c\u1ee7a \u0111\u0129a kh\u1edbp d\u00ednh v\u00e0o m\u1ed9t m\u00f4 li\u00ean k\u1ebft l\u1ecfng l\u1ebbo d\u1ea1ng \u0111\u1ec7m gi\u00e0u m\u1ea1ch m\u00e1u, m\u00f4 s\u1ee3i \u0111\u00e0n h\u1ed3i v\u00e0 c\u00e1c s\u1ee3i th\u1ea7n kinh tai th\u00e1i d\u01b0\u01a1ng. M\u00f4 n\u00e0y (m\u00f4 sau \u0111\u0129a) c\u0169ng \u0111\u01b0\u1ee3c ph\u1ee7 b\u1edfi m\u00f4 ho\u1ea1t d\u1ecbch \u1edf c\u1ea3 m\u1eb7t tr\u00ean v\u00e0 m\u1eb7t d\u01b0\u1edbi (l\u00e1 sau \u0111\u0129a tr\u00ean v\u00e0 l\u00e1 sau \u0111\u0129a d\u01b0\u1edbi), t\u1ea1o n\u00ean v\u00f9ng l\u00e1 k\u00e9p. Do b\u1ecb d\u00ednh v\u00e0o \u0111\u0129a, m\u00f4 sau \u0111\u0129a \u0111i theo v\u1eadn \u0111\u1ed9ng c\u1ee7a \u0111\u0129a v\u00e0 l\u1ea5p \u0111\u1ea7y kho\u1ea3ng tr\u1ed1ng do s\u1ef1 di chuy\u1ec3n c\u1ee7a l\u1ed3i c\u1ea7u trong c\u00e1c v\u1eadn \u0111\u1ed9ng c\u1ee7a h\u00e0m d\u01b0\u1edbi.<\/p>\n

M\u00f4 sau \u0111\u0129a l\u00e0 ngu\u1ed3n cung c\u1ea5p d\u1ecbch kh\u1edbp cho c\u1ea3 hai bu\u1ed3ng kh\u1edbp, c\u00f3 t\u00e1c d\u1ee5ng b\u00f4i tr\u01a1n v\u00e0 dinh d\u01b0\u1ee1ng c\u00e1c th\u00e0nh ph\u1ea7n trong kh\u1edbp. C\u1ea5u tr\u00fac \u0111\u00e0n h\u1ed3i c\u1ee7a m\u00f4 sau \u0111\u0129a cho ph\u00e9p n\u00f3 \u0111i theo v\u1eadn \u0111\u1ed9ng c\u1ee7a l\u1ed3i c\u1ea7u v\u00e0 tr\u1edf l\u1ea1i v\u1ecb tr\u00ed c\u0169. V\u00ec v\u1eady, m\u00f4 sau \u0111\u0129a v\u1eeba c\u00f3 ch\u1ee9c n\u0103ng dinh d\u01b0\u1ee1ng v\u00e0 chuy\u1ec3n h\u00f3a n\u1ed9i kh\u1edbp, v\u1eeba cho ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp. Trong ho\u1ea1t \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng c\u1ee7a kh\u1edbp, m\u00f4 sau \u0111\u0129a kh\u00f4ng ph\u1ea3i ch\u1ecbu t\u1ea3i.<\/p>\n

L\u00e1 sau \u0111\u0129a tr\u00ean \u0111i t\u1eeb d\u1ea3i sau \u0111\u0129a \u0111\u1ebfn khe nh\u0129-trai, c\u00f3 c\u1ea5u t\u1ea1o t\u1eeb m\u00f4 s\u1ee3i \u0111\u00e0n h\u1ed3i. Gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng ch\u00ednh c\u1ee7a l\u00e1 sau \u0111\u0129a tr\u00ean l\u00e0 kh\u00e1ng l\u1ea1i l\u1ef1c k\u00e9o \u0111\u0129a kh\u1edbp ra tr\u01b0\u1edbc c\u1ee7a b\u00f3 tr\u00ean c\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i, gi\u00fap \u1ed5n \u0111\u1ecbnh \u0111\u0129a kh\u1edbp trong t\u01b0 th\u1ebf h\u00e1 t\u1ed1i \u0111a (l\u1ed3i c\u1ea7u \u1edf tr\u01b0\u1edbc d\u01b0\u1edbi l\u1ed3i kh\u1edbp).
\nKhi h\u00e1 t\u1ed1i \u0111a, m\u00f4 sau \u0111\u0129a c\u0103ng v\u00e0 c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o v\u00e0 xoay \u0111\u0129a kh\u1edbp v\u1ec1 ph\u00eda sau, \u0111\u1ec3 tr\u00e1nh s\u1ef1 sai v\u1ecb tr\u00ed ra tr\u01b0\u1edbc c\u1ee7a \u0111\u0129a kh\u1edbp v\u00e0 \u0111\u1ec3 v\u00f9ng m\u1ecfng \u1edf trung t\u00e2m \u0111\u0129a kh\u1edbp n\u1eb1m gi\u1eefa l\u1ed3i c\u1ea7u v\u00e0 l\u1ed3i kh\u1edbp.<\/p>\n

\u1ede t\u01b0 th\u1ebf ngh\u1ec9, \u0111\u0129a kh\u1edbp n\u1eb1m \u1edf v\u1ecb tr\u00ed xoay ra tr\u01b0\u1edbc nh\u1ea5t \u0111\u1ec3 ph\u00f9 h\u1ee3p v\u1edbi kho\u1ea3ng c\u00e1ch c\u00e1c di\u1ec7n kh\u1edbp.<\/p>\n

Trong giai \u0111o\u1ea1n sau c\u1ee7a s\u1ef1 d\u1ecbch chuy\u1ec3n ra tr\u01b0\u1edbc c\u1ee7a \u0111\u0129a kh\u1edbp trong \u0111\u1ed9ng t\u00e1c h\u00e1, l\u1ef1c co c\u1ee7a c\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i th\u1eafng l\u1ef1c k\u00e9o ra sau c\u1ee7a m\u00f4 sau \u0111\u0129a v\u00e0 t\u1ea1o t\u00e1c \u0111\u1ed9ng l\u1edbn h\u01a1n \u0111\u1ed1i v\u1edbi \u0111\u0129a kh\u1edbp (H\u00ecnh 7 v\u00e0 8).<\/p>\n

L\u00e1 sau \u0111\u0129a d\u01b0\u1edbi \u0111i t\u1eeb d\u1ea3i sau \u0111\u0129a \u0111\u1ebfn b\u00e1m v\u00e0o b\u1edd d\u01b0\u1edbi di\u1ec7n kh\u1edbp sau l\u1ed3i c\u1ea7u, c\u00f3 c\u1ea5u t\u1ea1o ch\u1ee7 y\u1ebfu t\u1eeb m\u00f4 s\u1ee3i collagen, ch\u1ec9 c\u00f3 \u00edt s\u1ee3i \u0111\u00e0n h\u1ed3i. L\u00e1 sau \u0111\u0129a d\u01b0\u1edbi kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng c\u0103ng d\u00e3n nh\u01b0 l\u00e1 sau \u0111\u0129a tr\u00ean. N\u00f3 c\u00f3 t\u00e1c d\u1ee5ng gi\u1eef \u1ed5n \u0111\u1ecbnh \u0111\u0129a kh\u1edbp tr\u00ean \u0111\u1ea7u l\u1ed3i c\u1ea7u. Khi l\u1ed3i c\u1ea7u d\u1ecbch chuy\u1ec3n ra tr\u01b0\u1edbc, \u0111\u0129a kh\u1edbp d\u1eddi v\u1ec1 ph\u00eda sau \u0111\u1ec3 duy tr\u00ec ti\u1ebfp x\u00fac gi\u1eefa ph\u1ea7n trung t\u00e2m c\u1ee7a \u0111\u0129a v\u1edbi di\u1ec7n kh\u1edbp \u1edf l\u1ed3i c\u1ea7u, l\u00e0m l\u00e1 sau \u0111\u0129a d\u01b0\u1edbi kh\u00f4ng b\u1ecb k\u00e9o c\u0103ng.<\/p>\n

\"giai-phau-chuc-nang-7\"
H\u00ecnh 7: Qu\u00e1 tr\u00ecnh h\u00e1
A. Khi l\u1ed3i c\u1ea7u \u1edf \u1edf v\u1ecb tr\u00ed cao nh\u1ea5t \u1edf s\u01b0\u1eddn sau l\u1ed3i kh\u1edbp, \u0111\u0129a kh\u1edbp \u1edf ph\u00eda tr\u01b0\u1edbc l\u1ed3i c\u1ea7u, th\u1eb3ng h\u00e0ng v\u1edbi h\u01b0\u1edbng c\u1ee7a l\u1ef1c t\u00e1c \u0111\u1ed9ng. Khi c\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i b\u00f3 d\u01b0\u1edbi co (+), c\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i b\u00f3 tr\u00ean d\u00e3n (-), l\u1ed3i c\u1ea7u b\u1ecb k\u00e9o ra tr\u01b0\u1edbc. \u0110i\u1ec1u n\u00e0y l\u00e0 do c\u00e1c s\u1ee3i \u0111\u00e0n h\u1ed3i b\u00e1m ph\u00eda sau \u0111\u0129a kh\u1edbp xoay \u0111\u0129a t\u1edbi \u0111\u1ec9nh l\u1ed3i c\u1ea7u khi l\u1ed3i c\u1ea7u di chuy\u1ec3n xu\u1ed1ng d\u01b0\u1edbi tr\u00ean s\u01b0\u1eddn sau l\u1ed3i kh\u1edbp.
B. Khi l\u1ed3i c\u1ea7u b\u1ecb k\u00e9o \u0111i xu\u1ed1ng d\u01b0\u1edbi, c\u00e1c s\u1ee3i \u0111\u00e0n h\u1ed3i c\u1ee7a m\u00f4 sau \u0111\u0129a c\u0103ng h\u01a1n, l\u00e0m xoay \u0111\u0129a kh\u1edbp h\u01b0\u1edbng v\u1ec1 ph\u00eda \u0111\u1ec9nh l\u1ed3i c\u1ea7u v\u00e0 gi\u1eef \u0111\u0129a kh\u1edbp \u1edf v\u1ecb tr\u00ed th\u1eb3ng v\u1edbi s\u1ef1 thay \u0111\u1ed5i h\u01b0\u1edbng c\u1ee7a l\u1ef1c. C\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i b\u00f3 tr\u00ean d\u00e3n (-) \u0111\u1ec3 cho ph\u00e9p c\u00e1c s\u1ee3i \u0111\u00e0n h\u1ed3i k\u00e9o \u0111\u0129a kh\u1edbp v\u1ec1 ph\u00eda sau. Ch\u00fa \u00fd s\u1ef1 ch\u00f9ng t\u1eeb t\u1eeb c\u1ee7a d\u00e2y ch\u1eb1ng sau \u0111\u0129a.
C. Khi l\u1ed3i c\u1ea7u di chuy\u1ec3n \u0111\u1ebfn \u0111\u1ec9nh l\u1ed3i kh\u1edbp, h\u01b0\u1edbng l\u1ef1c t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c c\u01a1 n\u00e2ng h\u00e0m th\u1eb3ng \u0111\u1ee9ng qua \u0111\u1ec9nh l\u1ed3i c\u1ea7u. C\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i b\u00f3 tr\u00ean d\u00e3n trong su\u1ed1t qu\u00e1 tr\u00ecnh v\u1eadn \u0111\u1ed9ng ra tr\u01b0\u1edbc c\u1ee7a l\u1ed3i c\u1ea7u cho ph\u00e9p c\u00e1c s\u1ee3i \u0111\u00e0n h\u1ed3i c\u1ee7a m\u00f4 sau \u0111\u0129a ki\u1ec3m so\u00e1t v\u1ecb tr\u00ed \u0111\u0129a kh\u1edbp khi h\u00e1. Ch\u00fa \u00fd c\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i b\u00f3 tr\u00ean b\u00e1m v\u00e0o c\u1ea3 \u0111\u0129a kh\u1edbp v\u00e0 l\u1ed3i c\u1ea7u, ng\u0103n c\u1ea3n \u0111\u0129a kh\u1edbp kh\u00f4ng b\u1ecb k\u00e9o ra sau qu\u00e1 m\u1ee9c.<\/figcaption><\/figure>\n
\"giai-phau-chuc-nang-8\"
H\u00ecnh 8: Qu\u00e1 tr\u00ecnh \u0111\u00f3ng
A. Ngay khi qu\u00e1 tr\u00ecnh \u0111\u00f3ng h\u00e0m b\u1eaft \u0111\u1ea7u, c\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i b\u1ecf d\u01b0\u1edbi d\u00e3n ra (-) cho ph\u00e9p l\u1ed3i c\u1ea7u b\u1ecb k\u00e9o l\u00ean tr\u00ean v\u00e0 ra sau b\u1edfi t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c c\u01a1 n\u00e2ng h\u00e0m. \u0110\u1ed3ng th\u1eddi c\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i c\u1ee7a b\u00f3 tr\u00ean co k\u00e9o \u0111\u0129a kh\u1edbp ra tr\u01b0\u1edbc khi l\u1ed3i c\u1ea7u b\u1eaft \u0111\u1ea7u di chuy\u1ec3n v\u1ec1 ph\u00eda sau.
B. Khi l\u1ed3i c\u1ea7u tr\u1edf l\u1ea1i tr\u00ean s\u01b0\u1eddn d\u1ed1c c\u1ee7a l\u1ed3i kh\u1edbp, s\u1ef1 co c\u1ee7a c\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i b\u00f3 tr\u00ean (+) ki\u1ec3m so\u00e1t v\u1ecb tr\u00ed c\u1ee7a \u0111\u0129a kh\u1edbp, xoay \u0111\u0129a kh\u1edbp ra ph\u00eda tr\u01b0\u1edbc l\u1ed3i c\u1ea7u. C\u00e1c s\u1ee3i \u0111\u00e0n h\u1ed3i c\u1ee7a m\u00f4 sau \u0111\u0129a duy tr\u00ec m\u1ed9t l\u1ef1c k\u00e9o v\u1ec1 ph\u00eda sau \u0111\u1ec3 ch\u1ed1ng l\u1ea1i s\u1ef1 k\u00e9o ra tr\u01b0\u1edbc c\u1ee7a c\u01a1.
C. C\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i b\u00f3 d\u01b0\u1edbi d\u1eabn trong su\u1ed1t v\u1eadn \u0111\u1ed9ng \u0111\u00f3ng cho ph\u00e9p l\u1ed3i c\u1ea7u tr\u01b0\u1ee3t tr\u1edf l\u1ea1i tr\u00ean s\u01b0\u1eddn sau l\u1ed3i kh\u1edbp. C\u01a1 ch\u00e2n b\u01b0\u1edbm ngo\u00e0i b\u00f3 tr\u00ean co (+) \u0111\u1ec3 gi\u1eef \u0111\u0129a kh\u1edbp \u1edf ph\u00eda tr\u01b0\u1edbc; khi l\u1ed3i c\u1ea7u tr\u1edf v\u1ec1 t\u01b0\u01a1ng quan trung t\u00e2m, \u0111\u0129a kh\u1edbp t\u1ef1 \u0111\u1ed9ng xoay ra sau tr\u1edf v\u1ec1 v\u1ecb tr\u00ed \u0111\u00fang c\u1ee7a n\u00f3 t\u1ea1i t\u01b0\u01a1ng quan trung t\u00e2m. \u0110\u1ebfn th\u1eddi \u0111i\u1ec3m n\u00e0y, d\u00e2y ch\u1eb1ng sau \u0111\u0129a c\u0103ng, ng\u0103n kh\u00f4ng cho \u0111\u0129a kh\u1edbp xoay ra ph\u00eda tr\u01b0\u1edbc qu\u00e1 m\u1ee9c.<\/figcaption><\/figure>\n

Ngu\u1ed3n: T\u1ed5ng h\u1ee3p<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Hai kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m l\u00e0 nh\u1eefng kh\u1edbp \u0111\u1ed9ng duy nh\u1ea5t c\u1ee7a s\u1ecd. C\u00e1c m\u00f4 t\u1ea3 v\u1ec1 kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m \u0111\u00e3 \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong nhi\u1ec1u s\u00e1ch gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng. B\u00e0i vi\u1ebft n\u00e0y n\u00f3i v\u1ec1 gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng c\u1ee7a kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m v\u00e0 t\u01b0\u01a1ng quan c\u1ee7a n\u00f3 \u0111\u1ed1i v\u1edbi h\u1ec7 th\u1ed1ng […]<\/p>\n","protected":false},"author":21,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[28,33],"tags":[3],"yoast_head":"\nKh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m - Gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng l\u1ed3i c\u1ea7u v\u00e0 di\u1ec7n kh\u1edbp.<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft n\u00e0y n\u00f3i v\u1ec1 gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng c\u1ee7a kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m v\u00e0 t\u01b0\u01a1ng quan c\u1ee7a n\u00f3 \u0111\u1ed1i v\u1edbi h\u1ec7 th\u1ed1ng nhai. 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