{"id":2654,"date":"2023-04-09T18:30:31","date_gmt":"2023-04-09T11:30:31","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2654"},"modified":"2023-04-14T14:44:17","modified_gmt":"2023-04-14T07:44:17","slug":"ton-thuong-sun-vien-tren","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ton-thuong-sun-vien-tren\/","title":{"rendered":"\u0110\u1ea1i c\u01b0\u01a1ng t\u1ed5n th\u01b0\u01a1ng s\u1ee5n vi\u1ec1n tr\u00ean SLAP"},"content":{"rendered":"

SLAP (superior labrum anterior to posterior) l\u00e0 c\u1ea5u tr\u00fac s\u1ee5n vi\u1ec1n v\u00e0 g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea9u \u1edf ch\u1ed7 b\u00e1m v\u00e0o b\u1edd tr\u00ean \u1ed5 ch\u1ea3o x\u01b0\u01a1ng vai.\u00a0 C\u1ea5u tr\u00fac n\u00e0y d\u1ec5 b\u1ecb th\u01b0\u01a1ng t\u1ed5n khi d\u01b0 l\u1ef1c c\u1ee7a c\u01a1 nh\u1ecb \u0111\u1ea7u t\u00e1c \u0111\u1ed9ng v\u00e0o ch\u1ed3 b\u00e1m \u1edf b\u1edd tr\u00ean \u00f4 ch\u1ea3o g\u00e2y n\u00ean th\u01b0\u01a1ng t\u00f4n. T\u1ed5n th\u01b0\u01a1ng SLAP<\/a> l\u00e0 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n vi\u1ec1n tr\u00ean t\u1eeb tr\u01b0\u1edbc ra sau, th\u01b0\u1eddng g\u00e2y \u0111au kh\u1edbp vai v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c ho\u1ea1t \u0111\u1ed9ng sinh ho\u1ea1t h\u1eb1ng ng\u00e0y, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi ch\u01a1i th\u1ec3 thao.\u00a0<\/strong><\/p>\n

Nh\u00f3m t\u00e1c gi\u1ea3:<\/strong> PGS.TS. Tr\u1ea7n Trung D\u0169ng, TS. \u0110\u1ed7 V\u0103n Minh, ThS. L\u00ea Kh\u00e1nh Tr\u00ecnh, ThS. Nguy\u1ec5n Anh \u0110\u1ee9c, ThS. Nguy\u1ec5n Trung V\u00e3n, ThS. Tr\u1ea7n \u0110\u1ee9c Tu\u1ea5n, BsCKII. V\u0169 Quang Ngh\u0129a<\/span><\/p>\n

1.D\u1ecbch t\u1ec5 h\u1ecdc<\/b><\/h2>\n
    \n
  • Trong khi t\u1ef7 l\u1ec7 m\u1eafc ph\u1ea3i th\u1ef1c s\u1ef1 c\u1ee7a t\u1ed5n th\u01b0\u01a1ng SLAP v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft, t\u00fd l\u1ec7 m\u1eafc b\u1ec7nh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ea3i qua n\u1ed9i soi kh\u1edbp vai \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o t\u1eeb 6% \u0111\u1ebfn 26%.<\/span><\/li>\n
  • T\u1ea1i Hoa K\u1ef3, Snydet v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 b\u00e1o c\u00e1o k\u1ebft qu\u00e1 c\u1ee7a h\u01a1n 140 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt cho t\u1ed5n th\u01b0\u01a1ng SLAP. C\u00e1c t\u00e1c gi\u1ea3 ghi nh\u1eadn t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh c\u1ee7a t\u1ed5n th\u01b0\u01a1ng SLAP l\u00e0 6% \u1edf nh\u1eefng ng\u01b0\u1eddi tr\u1ea3i qua soi kh\u1edbp vai trong th\u1eddi gian 8 n\u0103m. T\u1ed5n th\u01b0\u01a1ng li\u00ean quan bao g\u1ed3m t\u1ed5n th\u01b0\u01a1ng Bankart (22%) v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u1ee7a r\u00e1ch ch\u00f3p xoay (11%). Chi c\u00f3 28% t\u1ed5n th\u01b0\u01a1ng SLAP \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y m\u00e0 kh\u00f4ng c\u00f3 b\u1ec7nh l\u00fd li\u00ean quan.<\/span><\/li>\n
  • T\u1ed5n th\u01b0\u01a1ng SLAP th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng v\u1eadn \u0111\u1ed9ng vi\u00ean ch\u01a1i th\u1ec3 thao, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c m\u00f4n th\u1ec3 thao th\u01b0\u1eddng ph\u1ea3i s\u1eed d\u1ee5ng tay qua \u0111\u1ea7u nh\u01b0 v\u1eadn \u0111\u1ed9ng vi\u00ean n\u00e9m b\u1ecfng, tennis, c\u1ea7u l\u00f4ng, b\u00f3ng r\u1ed5… v\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n h\u01a1n 40 tu\u1ed5i th\u01b0\u1eddng c\u00f3 nh\u1eefng thay \u0111\u1ed5i tho\u00e1i h\u00f3a t\u1ef1 nhi\u00ean m\u00e0 c\u00f3 th\u1ec3 gi\u1ed1ng nh\u01b0 m\u1ed9t t\u1ed5n th\u01b0\u01a1ng SLAP.<\/span><\/li>\n<\/ul>\n

    2.Gi\u1ea3i ph\u1eabu v\u00e0 ch\u1ee9c n\u0103ng s\u1ee5n vi\u1ec1n tr\u00ean<\/b><\/b><\/h3>\n

    S\u1ee5n vi\u1ec1n c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m t\u0103ng \u0111\u1ed9 s\u00e2u c\u1ee7a \u1ed5 ch\u1ea3o th\u00eam 50%, l\u00e0m t\u0103ng di\u1ec7n t\u00edch ti\u1ebfp x\u00fac c\u1ee7a b\u1ec1 m\u1eb7t \u1ed5 <\/span><\/b>ch\u1ea3o v\u1edbi ch\u00f2m x\u01b0\u01a1ng c\u00e1nh tay 75% theo chi\u1ec1u d\u1ecdc l\u00ean\u00a0 v\u00e0 57% theo chi\u1ec1u ngang.<\/span><\/p>\n

    S\u1ee5n vi\u1ec1n b\u00e1m quanh v\u00e0nh \u1ed5<\/span>\u00a0ch\u00e1o, c\u00f3 ti\u1ebft di\u1ec7n h\u00ecnh tam gi\u00e1c v\u00e0 \u0111\u01b0\u1ee3c chia l\u00e0m 6 khu v\u1ef1c:<\/span><\/p>\n

      \n
    • S\u1ee5n vi\u1ec1n tr\u00ean (I)\"s\u1ee5n<\/span><\/li>\n
    • S\u1ee5n vi\u1ec1n tr\u01b0\u1edbc tr\u00ean (II)<\/li>\n
    • S\u1ee5n vi\u1ec1n tr\u01b0\u1edbc d\u01b0\u1edbi (III)<\/li>\n
    • S\u1ee5n vi\u1ec1n d\u01b0\u1edbi (IV)<\/li>\n
    • S\u1ee5n vi\u1ec3n sau d\u01b0\u1edbi (V) <\/span><\/li>\n
    • S\u1ee5n vi\u1ec1n sau tr\u00ean (VI)<\/span><\/li>\n<\/ul>\n

       <\/p>\n

      S\u1ee5n kh\u1edbp che ph\u1ee7 v\u01b0\u1ee3t qua v\u00e0nh tr\u00ean c\u1ee7a \u1ed5 ch\u1ea3o, s\u1ee5n vi\u1ec1n tr\u00ean c\u00f3 th\u1ec3 g\u1eafn v\u00e0o v\u00e0nh \u1ed5 ch\u1ea3o, nh\u01b0ng th\u00f4ng th\u01b0\u1eddng n\u00f3 g\u1eafn v\u00e0o ph\u00eda trong c\u1ee7a v\u00e0nh \u1ed5 ch\u1ea3o. V\u1edbi s\u1ee5n vi\u1ec1n tr\u00ean b\u00e1m v\u00e0o ph\u00eda trong v\u00e0nh \u1ed5 ch\u1ea3o v\u00e0 g\u00e2n nh\u1ecb \u0111\u1ea7u b\u00e1m ch\u1eb7t v\u00e0o c\u1ee7 tr\u00ean \u1ed5 ch\u1ea3o t\u1ea1o ra m\u1ed9t ngh\u00e1ch d\u01b0\u1edbi s\u1ee5n vi\u1ec1n (Sublabral recess) s\u00e2u kho\u1ea3ng v\u00e0i milimet t\u1eeb v\u00e0nh tr\u00ean \u1ed5 ch\u1ea3o \u1edf v\u1ecb tr\u00ed 12 gi\u1edd (c\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi t\u1ed5n th\u01b0\u01a1ng SLAP).<\/p>\n

       <\/p>\n

      \"s\u1ee5n<\/p>\n

      Kho\u1ea3ng 40- 60% g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u b\u1eaft ngu\u1ed3n t\u1eeb c\u1ee7 tr\u00ean \u1ed5 ch\u1ea3o, c\u00e1c s\u1ee3i c\u00f2n l\u1ea1i b\u00e1m tr\u1ef1c ti\u1ebfp v\u00e0o ph\u00eda trong c\u1ee7a s\u1ee5n vi\u1ec1n tr\u00ean. Theo ph\u00e2n lo\u1ea1i c\u1ee7a Vangsness c\u00f3 4 type trong s\u1ef1 ph\u00e2n b\u1ed5ph\u00eda tr\u01b0\u1edbc sau c\u1ee7a \u0111i\u1ec3m b\u00e1m g\u00e2n nh\u1ecb \u0111\u1ea7u trong kh\u1edbp vai:<\/p>\n

        \n
      • Type I: b\u00e1m ho\u00e0n to\u00e0n \u1edd ph\u00eda\u00a0 (22%)<\/li>\n
      • Type II: b\u00e1m ch\u1ee7 y\u1ebfu \u1edd ph\u00eda sau (33%)<\/li>\n
      • Type III: b\u00e1m \u0111\u1ed3ng \u0111\u1ec1u \u1edf c\u1ea3 ph\u00eda tr\u01b0\u1edbc v\u00e0 ph\u00eda sau\u00a0 (37%)<\/li>\n
      • Type IV: B\u00e1m ch\u1ee7 y\u1ebfu \u1edf ph\u00eda tr\u01b0\u1edbc v\u00e0 m\u1ed9t \u00edt \u1edf ph\u00eda sau\u00a0 (8%)<\/li>\n<\/ul>\n

         <\/p>\n

        \"diem<\/p>\n

        C\u00e1c d\u1ea1ng bi\u1ebfn \u0111\u1ed5i gi\u1ea3i ph\u1eabu b\u00ecnh th\u01b0\u1eddng c\u1ee7a s\u1ee5n vi\u1ec1n tr\u01b0\u1edbc tr\u00ean, bao g\u1ed3m:<\/p>\n

          \n
        • L\u1ed7 b\u00ean d\u01b0\u1edbi s\u1ee5n vi\u1ec1n tr\u01b0\u1edbc tr\u00ean (Sublabral foramen), c\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi t\u1ed5n th\u01b0\u01a1ng r\u00e1ch s\u1ee5n vi\u1ec1n ho\u1eb7c r\u00e1ch SLAP<\/li>\n
        • Kh\u00f4ng c\u00f3 s\u1ee5n vi\u1ec1n tr\u01b0\u1edbc tr\u00ean, d\u00e2y ch\u1eb1ng \u1ed5 ch\u1ea3o c\u00e1nh tay gi\u1eefa d\u00e0y l\u00ean \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ph\u1ee9c h\u1ee3p Buford (Buford complex).<\/li>\n<\/ul>\n

          3. Sinh b\u1ec7nh h\u1ecdc<\/h4>\n

          M\u1ed9t lo\u1ea1t c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t cho t\u1ed5n th\u01b0\u01a1ng SLAP, trong \u0111\u1ed1 c\u00e1c c\u01a1 ch\u1ebf ph\u1ed5 bi\u1ec3n nh\u1ea5t bao g\u1ed3m:<\/p>\n

            \n
          • C\u01a1 ch\u1ebf \u0111\u1ea7u ti\u00ean l\u00e0 do nguy\u00ean nh\u00e2n b\u00ean ngo\u00e0i (th\u1ee9 c\u1ea5p) l\u1ef1c k\u00e9o qu\u00e1 m\u1ee9c l\u00ean c\u00e1nh tay v\u00e0 nguy\u00ean nh\u00e2n b\u00ean trong l\u00e0 h\u01b0\u1edbng c\u1ee7a l\u1ef1c t\u1ea3i v\u00e0 ho\u1ea1t \u0111\u1ed9ng l\u1eb7p \u0111i l\u1eb7p l\u1ea1i \u1edf t\u1ea7m cao h\u01a1n \u0111\u1ea7u. C\u1ea3 hai nguy\u00ean nh\u00e2n n\u00e0y t\u1ea1o ra m\u1ed9t l\u1ef1c k\u00e9o l\u00ean \u0111i\u1ec3m b\u00e1m c\u1ee7a g\u00e2n nh\u1ecb \u0111\u1ea7u.<\/li>\n
          • C\u01a1 ch\u1ebf th\u1eed hai do Burkhart v\u1ea3 c\u1ed9ng s\u1ef1 m\u00f4 t\u1ea3: t\u1ed3n t\u1ea1i m\u1ed9t c\u01a1 sinh h\u1ecdc \u1edf v\u1eadn \u0111\u1ed9ng vi\u00ean c\u00f3 tay t\u1ea7m cao h\u01a1n \u0111\u1ea7u (v\u1eadn \u0111\u1ed9ng vi\u00ean n\u00e9m b\u00f3ng, b\u01a1i l\u1ed9i, tennis…) k\u1ebft qu\u1ea3 d\u1eabn \u0111\u1ebfn \u201cb\u00f3c v\u1ecf ng\u01b0\u1ee3c\u201d (peel-back SLAP).<\/li>\n<\/ul>\n
            4. Ph\u00e2n lo\u1ea1i Snyder\u2019s<\/h5>\n

            -Ph\u00e2n lo\u1ea1i ban \u0111\u1ea7u c\u1ee7a Snyder v\u1ec1 t\u1ed5n th\u01b0\u01a1ng SLAP v\u1eabn \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn ph\u1ed5 bi\u1ebfn nh\u1ea5t. G\u1ed3m c\u00f3 4 lo\u1ea1i:<\/p>\n

              \n
            • Typ I: R\u00e1ch \u1edf b\u1edd h\u01b0\u1edbng v\u1ec1 trung t\u00e2m \u1ed5 ch\u1ea3o v\u00e0 tho\u00e1i h\u00f3a t\u1ea1i ch\u1ed7. S\u1ee5n vi\u1ec1n tr\u00ean v\u00e0 \u0111i\u1ec3m b\u00e1m g\u00e2n nh\u1ecb \u0111\u1ea7u c\u00f2n nguy\u00ean v\u1eb9n. Nh\u1eefng t\u1ed5n th\u01b0\u01a1ng n\u00e0y th\u01b0\u1eddng g\u1eb7p ph\u1ed5 bi\u1ebfn \u1edd ng\u01b0\u1eddi trung ni\u00ean v\u00e0 th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/li>\n<\/ul>\n

               <\/p>\n

              \"typ<\/p>\n

                \n
              • Type II: l\u00e0 t\u1ed5n th\u01b0\u01a1ng l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. Ph\u1ea7n s\u1ee5n vi\u1ec1n tr\u00ean (ph\u1ea7n c\u00f3 g\u00e2n nh\u1ecb \u0111\u1ea7u b\u00e1m v\u00e0o) t\u00e1ch ra kh\u1ecfi c\u1ee7 tr\u00ean \u1edf ch\u1ea3o. T\u1ed5n th\u01b0\u01a1ng type II th\u1ec3 hi\u1ec7n s\u1ef1 di \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng c\u1ee7a s\u1ee5n vi\u1ec1n v\u00e0 g\u00e2n nh\u1ecb \u0111\u1ea7u.\"\"<\/li>\n
              • Type III:\u00a0 t\u1ed5n th\u01b0\u01a1ng r\u00e1ch ki\u1ec3u \u201cquai x\u00e1ch\u201d c\u1ee7a s\u1ee5n vi\u1ec1n tr\u00ean, v\u1edbi \u0111i\u1ec3m b\u00e1m c\u1ee7a g\u00e2n nh\u1ecb \u0111\u1ea7u c\u00f2n nguy\u00ean v\u1eb9n. T\u00f9y thu\u1ed9c v\u00e0o k\u00edch th\u01b0\u1edbc c\u1ee7a r\u00e1ch, m\u1ee9c \u0111\u1ed9 di \u0111\u1ed9ng c\u1ee7a s\u1ee5n vi\u1ec1n m\u00e0 c\u00f3 th\u1ec3 di chuy\u1ec3n v\u00e0o kh\u1edbp t\u1ea1o ra c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 h\u1ecdc. \"s\u1ee5n<\/li>\n
              • Type IV: S\u1ee5n vi\u1ec1n tr\u00ean r\u00e1ch ki\u1ec3u \u201cquai x\u00e1ch\u201d v\u1edbi t\u1ed5n th\u01b0\u01a1ng m\u1edf r\u1ed9ng l\u00ean \u0111\u1ebfn g\u00e2n nh\u1ecb \u0111\u1ea7u, t\u1ea1o ra m\u1ed9t h\u00ecnh d\u1ea1ng r\u00e1ch c\u1ee7a g\u00e2n nh\u1ecb \u0111\u1ea7u. M\u1ed9t ph\u1ea7n \u0111\u00e1ng k\u1ec3 c\u1ee7a g\u00e2n nh\u1ecb \u0111\u1ea7u b\u00e1m v\u00e0o \u1ed5 ch\u1ea3o th\u01b0\u1eddng v\u1eabn c\u00f2n nguy\u00ean v\u1eb9n.\"s\u1ee5n<\/li>\n<\/ul>\n

                 <\/p>\n

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

                SLAP (superior labrum anterior to posterior) l\u00e0 c\u1ea5u tr\u00fac s\u1ee5n vi\u1ec1n v\u00e0 g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea9u \u1edf ch\u1ed7 b\u00e1m v\u00e0o b\u1edd tr\u00ean \u1ed5 ch\u1ea3o x\u01b0\u01a1ng vai.\u00a0 C\u1ea5u tr\u00fac n\u00e0y d\u1ec5 b\u1ecb th\u01b0\u01a1ng t\u1ed5n khi d\u01b0 l\u1ef1c c\u1ee7a c\u01a1 nh\u1ecb \u0111\u1ea7u t\u00e1c \u0111\u1ed9ng v\u00e0o ch\u1ed3 b\u00e1m \u1edf b\u1edd tr\u00ean \u00f4 ch\u1ea3o g\u00e2y n\u00ean th\u01b0\u01a1ng t\u00f4n. T\u1ed5n […]<\/p>\n","protected":false},"author":36,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[75,40],"tags":[3],"yoast_head":"\n\u0110\u1ea1i c\u01b0\u01a1ng t\u1ed5n th\u01b0\u01a1ng s\u1ee5n vi\u1ec1n tr\u00ean SLAP - Vinmec<\/title>\n<meta name=\"description\" content=\"T\u1ed5n th\u01b0\u01a1ng s\u1ee5n vi\u1ec1n tr\u00ean, ch\u1ed7 b\u00e1m c\u1ee7a \u0111\u1ea7u d\u00e0i g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u\u00a0 (SLAP), m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y \u0111au kh\u1edbp vai d\u1ec5 b\u1ecf s\u00f3t khi th\u0103m kh\u00e1m v\u00e0 ch\u1ea9n \u0111o\u00e1n. \u0110au trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y th\u01b0\u1eddng dai d\u1eb3ng, t\u0103ng l\u00ean khi th\u1ef1c hi\u1ec7n c\u00e1c \u0111\u1ed9ng t\u00e1c \u0111\u01b0a tay qua \u0111\u1ea7u v\u00e0 l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng c\u1ee7a tay b\u1ecb ch\u1ea5n th\u01b0\u01a1ng.\" \/>\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=\"\u0110\u1ea1i c\u01b0\u01a1ng t\u1ed5n th\u01b0\u01a1ng s\u1ee5n vi\u1ec1n tr\u00ean SLAP - 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