{"id":2665,"date":"2023-04-09T16:14:28","date_gmt":"2023-04-09T09:14:28","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2665"},"modified":"2023-04-11T08:44:32","modified_gmt":"2023-04-11T01:44:32","slug":"ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/","title":{"rendered":"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i"},"content":{"rendered":"

K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng (gap balancing technique)\u00a0 trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i d\u1ef1a tr\u00ean vi\u1ec7c gi\u1ea3i ph\u00f3ng c\u00e1c d\u00e2y ch\u1eb1ng v\u00e0 c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m sau khi c\u1eaft m\u00e2m ch\u00e0y v\u00e0 tr\u01b0\u1edbc khi c\u1eaft x\u01b0\u01a1ng \u0111\u00f9i.<\/strong><\/p>\n

C\u00e1c b\u1ec7nh t\u1ed5n th\u01b0\u01a1ng kh\u1edbp g\u1ed1i nh\u01b0 tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i<\/a> c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c ho\u1eb7c s\u1eed d\u1ee5ng thu\u1ed1c. <\/span>Ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i<\/b> l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn khi c\u00e1c can thi\u1ec7p kh\u00f4ng ph\u1eabu thu\u1eadt nh\u01b0 d\u00f9ng thu\u1ed1c, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 s\u1eed d\u1ee5ng n\u1ea1ng tr\u1ee3 \u0111\u1ee1 ho\u1eb7c c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n \u0111i b\u1ed9 kh\u00e1c kh\u00f4ng c\u00f2n gi\u00fap gi\u1ea3m \u0111au. B\u00e0i vi\u1ebft sau \u0111\u00e2y s\u1ebd cung c\u1ea5p th\u00eam th\u00f4ng tin v\u1ec1 k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng<\/strong> trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i.<\/p>\n

T\u00e1c gi\u1ea3: PGS. TS. Tr\u1ea7n Trung D\u0169ng<\/p>\n

Ng\u00e0y ph\u00e1t h\u00e0nh:<\/p>\n

1. T\u1ed5ng quan k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i<\/h2>\n

K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng (gap balancing technique)\u00a0 trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i d\u1ef1a tr\u00ean vi\u1ec7c gi\u1ea3i ph\u00f3ng c\u00e1c d\u00e2y ch\u1eb1ng v\u00e0 c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m sau khi c\u1eaft m\u00e2m ch\u00e0y v\u00e0 tr\u01b0\u1edbc khi c\u1eaft x\u01b0\u01a1ng \u0111\u00f9i.<\/p>\n

K\u1ef9 thu\u1eadt n\u00e0y v\u1ec1 l\u00fd thuy\u1ebft c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n \u0111\u1ecbnh tr\u01b0\u1edbc \u0111\u1ed9 xoay ngo\u00e0i x\u01b0\u01a1ng \u0111\u00f9i m\u00e0 v\u1eabn \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1ee3c l\u00e0 kho\u1ea3ng g\u1ea5p\/du\u1ed7i \u0111\u1ed1i x\u1ee9ng v\u00e0 b\u1eb1ng nhau, gi\u1ea3m thi\u1ec3u \u0111\u01b0\u1ee3c s\u1ef1 m\u1ea5t v\u1eefng c\u1ee7a kh\u1edbp g\u1ed1i khi g\u1ea5p; tuy nhi\u00ean nh\u01b0\u1ee3c \u0111i\u1ec3m l\u00e0 c\u00e1c l\u00e1t c\u1eaft x\u01b0\u01a1ng ph\u1ea7n \u0111\u00f9i l\u1ea1i ph\u1ee5 thu\u1ed9c ho\u00e0n to\u00e0n v\u00e0o l\u00e1t c\u1eaft m\u00e2m ch\u00e0y v\u00e0 gi\u1ea3i ph\u00f3ng ph\u1ea7n m\u1ec1m[7]. Tuy nhi\u00ean vi\u1ec7c c\u1eaft m\u00e2m ch\u00e0y v\u00e0 l\u01b0\u1ee3ng gi\u00e1 ph\u1ea7n m\u1ec1m, d\u00e2y ch\u1eb1ng hai b\u00ean kh\u1edbp g\u1ed1i kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u00f9ng d\u1ec1 d\u00e0ng v\u00e0 ch\u00ednh x\u00e1c. V\u00ec v\u1eady k\u1ef9 thu\u1eadt n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u00e1c ph\u1eabu thu\u1eadt vi\u00ean c\u00f3 kinh nghi\u1ec7m \u00e1p d\u1ee5ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p tho\u00e1i ho\u00e1 g\u00e2y bi\u1ebfn d\u1ea1ng l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i n\u1eb7ng ho\u1eb7c g\u00e3y x\u01b0\u01a1ng l\u1ed3i c\u1ea7u \u0111\u00f9i tr\u01b0\u1edbc \u0111\u00f3, kh\u00f3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c c\u00e1c tr\u1ee5c gi\u1ea3i ph\u1eabu c\u1ee7a l\u1ed3i c\u1ea7u trong m\u1ed5.<\/p>\n

C\u00f3 02 k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng c\u01a1 b\u1ea3n. M\u1ed9t l\u00e0 c\u00e2n b\u1eb1ng kho\u1ea3ng g\u1ea5p tr\u01b0\u1edbc. Hai l\u00e0 c\u00e2n b\u1eb1ng kho\u1ea3ng du\u1ed7i tr\u01b0\u1edbc sau \u0111\u00f3 c\u00e2n b\u1eb1ng kho\u1ea3ng g\u1ea5p sao cho b\u1eb1ng v\u1edbi kho\u1ea3ng du\u1ed7i. C\u1ea3 2 k\u1ef9 thu\u1eadt n\u00e0y \u0111\u1ec1u c\u00f3 nh\u1eefng thu\u1eadn l\u1ee3i v\u00e0 kh\u00f3 kh\u0103n ri\u00eang.<\/p>\n

2. C\u00e2n b\u1eb1ng kho\u1ea3ng g\u1ea5p tr\u01b0\u1edbc trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i<\/h2>\n

R\u1ea5t nhi\u1ec1u ph\u1eabu thu\u1eadt vi\u00ean ti\u1ebfn h\u00e0nh c\u00e2n b\u1eb1ng kho\u1ea3ng g\u1ea5p tr\u01b0\u1edbc khi c\u00e2n b\u1eb1ng kho\u1ea3ng du\u1ed7i. \u0110\u1ea7u ti\u00ean s\u1ebd l\u00e0 l\u00e1t c\u1eaft \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng ch\u00e0y \u0111\u1ea3m b\u1ea3o vu\u00f4ng g\u00f3c v\u1edbi tr\u1ee5c c\u1ee7a x\u01b0\u01a1ng ch\u00e0y. L\u00e1t c\u1eaft n\u00e0y r\u1ea5t quan tr\u1ecdng v\u00e0 l\u00e0 ti\u1ec1n \u0111\u1ec1 cho c\u00e1c l\u00e1t c\u1eaft x\u01b0\u01a1ng \u0111\u00f9i ti\u1ebfp theo. S\u1ef1 c\u1eaft nghi\u00eang v\u00e0o trong (varus cut) c\u1ee7a x\u01b0\u01a1ng ch\u00e0y s\u1ebd d\u1eabn \u0111\u1ebfn s\u1ef1 xoay trong c\u1ee7a ph\u1ea7n \u0111\u00f9i khi m\u00e0 kho\u1ea3ng g\u1ea5p h\u00ecnh ch\u1eef nh\u1eadt \u0111\u01b0\u1ee3c t\u1ea1o ra [l]. Ng\u01b0\u1ee3c l\u1ea1i, s\u1ef1 c\u1eaft nghi\u00eang ra ngo\u00e0i (valgus cut) c\u1ee7a x\u01b0\u01a1ng ch\u00e0y s\u1ebd d\u1eabn \u0111\u1ebfn xoay ngo\u00e0i qu\u00e1 m\u1ee9c c\u1ee7a ph\u1ea7n \u0111\u00f9i. M\u1ed9t vi\u1ec7c quan tr\u1ecdng c\u1ea7n ph\u1ea3i l\u01b0u \u00fd l\u00e0 ph\u1ea3i lo\u1ea1i b\u1ecf t\u1ea5t c\u1ea3 c\u00e1c ch\u1ed3i x\u01b0\u01a1ng \u1edf kh\u1edbp g\u1ed1i tr\u01b0\u1edbc khi gi\u1ea3i ph\u00f3ng ph\u1ea7n m\u1ec1m v\u00e0 c\u1eaft x\u01b0\u01a1ng. Khi kh\u1edbp g\u1ed1i \u0111\u01b0\u1ee3c c\u0103ng \u0111\u1ec1u m\u1ed9t c\u00e1ch ch\u00ednh x\u00e1c \u1edf t\u01b0 th\u1ebf g\u1ea5p, l\u00e1t c\u1eaft x\u01b0\u01a1ng ch\u00e0y n\u00ean song song v\u1edbi tr\u1ee5c sTEA v\u00e0 vu\u00f4ng g\u00f3c v\u1edbi tr\u1ee5c APA (H\u00ecnh 4.1). C\u00e1c ph\u1ea7n m\u1ec1m c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng th\u00eam n\u1ebfu c\u00e1c tr\u1ee5c n\u00e0y kh\u00f4ng ph\u00f9 h\u1ee3p nhau. Khi kh\u1edbp g\u1ed1i \u0111\u1ea1t \u0111\u01b0\u1ee3c kho\u1ea3ng g\u1ea5p c\u00e2n x\u1ee9ng, c\u00e1c l\u00e1t c\u1eaft b\u1edd tr\u01b0\u1edbc v\u00e0 b\u1edd sau l\u1ed3i c\u1ea7u \u0111\u00f9i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n theo t\u1ea5m khu\u00f4n c\u1eaft tr\u01b0\u1edbc sau (AP cutting block). Sau \u0111\u00f3 t\u1ea5m \u0111\u1ec7m (t\u1ea5m \u201cGap\u201d) h\u00ecnh h\u1ed9p ch\u1eef nh\u1eadt c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o th\u1eed \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o kho\u1ea3ng g\u1ea5p n\u00e0y l\u00e0 \u0111\u1ed1i x\u1ee9ng.<\/p>\n

\"hinh-4.1-dat-dinh-vi-cat-bo-truoc-sau-loi-cau-dui-song-song-voi-lat-cat-xuong-chay-trong-ky-thuat-can-bang-khoang-phau-thuat-thay-khop-goi\"
H\u00ecnh 4.1. \u0110\u1eb7t \u0111\u1ecbnh v\u1ecb c\u1eaft b\u1edd tr\u01b0\u1edbc – sau l\u1ed3i c\u1ea7u \u0111\u00f9i song song v\u1edbi l\u00e1t c\u1eaft x\u01b0\u01a1ng ch\u00e0y [1]<\/figcaption><\/figure>Sau khi c\u00e2n b\u1eb1ng \u0111\u01b0\u1ee3c kho\u1ea3ng g\u1ea5p ch\u00ednh x\u00e1c, ti\u1ebfn h\u00e0nh c\u00e2n b\u1eb1ng kho\u1ea3ng du\u1ed7i. \u0110\u1ec3 g\u1ed1i du\u1ed7i th\u1eb3ng, \u0111\u1eb7t thi\u1ebft b\u1ecb k\u00e9o c\u0103ng kh\u1edbp g\u1ed1i, m\u1ee9c \u0111\u1ed9 c\u0103ng nh\u01b0 v\u1edbi kho\u1ea3ng g\u1ea5p (h\u00ecnh 4.2). \u0110\u1eb7t 1 n\u00f2ng n\u1ed9i t\u1ee7y ho\u1eb7c ngo\u00e0i \u1ed1ng tu\u1ef7 x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m xung quanh sao cho n\u00f2ng n\u00e0y tr\u00f9ng v\u1edbi tr\u1ee5c c\u01a1 h\u1ecdc c\u1ee7a chi d\u01b0\u1edbi. Khi kho\u1ea3ng g\u1ea5p v\u00e0 kho\u1ea3ng du\u1ed7i \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c, ti\u1ebfn h\u00e0nh c\u1eaft l\u00e1t \u0111\u1ea7u xa l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i. Sau khi c\u1eaft x\u01b0\u01a1ng l\u1ea1i ti\u1ebfp t\u1ee5c \u0111\u01b0a t\u1ea5m \u0111\u1ec7m v\u00e0o \u0111\u1ec3 ki\u1ec3m tra kho\u1ea3ng du\u1ed7i xem c\u00f3 c\u00e2n x\u1ee9ng v\u00e0 b\u1eb1ng v\u1edbi kho\u1ea3ng g\u1ea5p kh\u00f4ng.<\/p>\n
\"hinh-4.2-xac-dinh-vi-tri-va-chieu-day-cua-lat-cat-dau-xa-xuong-dui-dua-vao-khoang-duoi\"
H\u00ecnh 4.2. X\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed v\u00e0 chi\u1ec1u d\u00e0y c\u1ee7a l\u00e1t c\u1eaft \u0111\u1ea7u xa x\u01b0\u01a1ng \u0111\u00f9i d\u1ef1a v\u00e0o kho\u1ea3ng du\u1ed7i [1]<\/figcaption><\/figure>\n

3. C\u00e2n b\u1eb1ng kho\u1ea3ng du\u1ed7i tr\u01b0\u1edbc<\/h2>\n

C\u00e1c ph\u1eabu thu\u1eadt vi\u00ean c\u0169ng c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh c\u00e2n b\u1eb1ng kho\u1ea3ng du\u1ed7i tr\u01b0\u1edbc. Hi\u1ec7n nay m\u1ed9t s\u1ed1 ph\u1eabu thu\u1eadt vi\u00ean th\u00edch c\u00e1ch n\u00e0y h\u01a1n v\u00ec gi\u1ea3i ph\u00f3ng ph\u1ea7n m\u1ec1m khi g\u1ed1i du\u1ed7i s\u1ebd ch\u00ednh x\u00e1c h\u01a1n v\u00e0 \u0111\u1ea1t \u0111\u01b0\u1ee3c c\u00e2n b\u1eb1ng kho\u1ea3ng t\u1ed1t h\u01a1n. V\u1edbi k\u1ef9 thu\u1eadt n\u00e0y, \u0111\u1ea7u xa x\u01b0\u01a1ng \u0111\u00f9i \u0111\u01b0\u1ee3c c\u1eaft d\u1ef1a tr\u00ean m\u1ed9t n\u00f2ng n\u1ed9i t\u1ee7y \u0111\u1eb7t vu\u00f4ng g\u00f3c v\u1edbi l\u00e1t c\u1eaft \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng ch\u00e0y, t\u1ee9c l\u00e0 song song v\u1edbi tr\u1ee5c x\u01b0\u01a1ng ch\u00e0y (h\u00ecnh 4.2). Do s\u1ef1 c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi c\u00e1c c\u1ea5u tr\u00fac c\u1ea1nh d\u00e2y ch\u1eb1ng, n\u00ean t\u1ea5t c\u1ea3 c\u00e1c gai x\u01b0\u01a1ng, bao g\u1ed3m gai x\u01b0\u01a1ng \u1edf ph\u00eda sau c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i v\u00e0 xung quanh m\u00e2m ch\u00e0y ph\u1ea3i \u0111\u01b0\u1ee3c c\u1eaft b\u1ecf tr\u01b0\u1edbc khi gi\u1ea3i ph\u00f3ng ph\u1ea7n m\u1ec1m. N\u1ebfu l\u1ea5y b\u1ecf c\u00e1c ch\u1ed3i x\u01b0\u01a1ng ph\u00eda sau l\u1ed3i c\u1ea7u \u0111\u00f9i v\u00e0 m\u00e2m ch\u00e0y sau khi c\u1eaft b\u1edd sau c\u1ee7a l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i c\u00f3 th\u1ec3 g\u00e2y ra kho\u1ea3ng c\u00e1ch kh\u00f4ng c\u00e2n \u0111\u1ed1i d\u1eabn \u0111\u1ebfn s\u1ef1 sai l\u1ec7ch v\u1ec1 \u0111\u1ed9 c\u1ee7a ph\u1ea7n \u0111\u00f9i. Th\u00f4ng th\u01b0\u1eddng r\u1ea5t kh\u00f3 \u0111\u1ebf c\u1eaft b\u1ecf c\u00e1c ch\u1ed3i x\u01b0\u01a1ng ph\u00eda sau v\u00ec c\u00e1c d\u1ee5ng c\u1ee5 \u0111i v\u00e0o ph\u00eda sau r\u1ea5t kh\u00f3. C\u00e1c t\u00e1c gi\u1ea3 g\u1ee3i \u00fd r\u1eb1ng c\u00f3 th\u1ec3 c\u1eaft m\u1ed9t ph\u1ea7n l\u1ed3i c\u1ea7u sau x\u01b0\u01a1ng \u0111\u00f9i (kho\u1ea3ng 4mm) c\u1ee7a m\u1ed9t ho\u1eb7c c\u1ea3 hai l\u1ed3i c\u1ea7u \u0111\u00f9i khi g\u1ed1i g\u1ea5p 90 \u0111\u1ed9. Sau \u0111\u00f3, d\u00f9ng tr\u1ee3 c\u1ee5 c\u0103ng gi\u00e3n khe kh\u1edbp (Laminar Spreader) \u0111\u1ec3 l\u00e0m \u0111i\u1ec3m t\u1ef1a \u1edf gi\u1eefa r\u1ed3i \u0111\u1ee5c b\u1ecf c\u00e1c ch\u1ed3i x\u01b0\u01a1ng ph\u00eda sau b\u1eb1ng \u0111\u1ee5c x\u01b0\u01a1ng lo\u1ea1i u\u1ed1n cong (H\u00ecnh 4.3).<\/p>\n

\"hinh-4.3-lay-bo-cac-choi-xuong-phia-sau-loi-cau-xuong-dui-trong-phau-thuat-thay-khop-goi\"
H\u00ecnh 4.3. L\u1ea5y b\u1ecf c\u00e1c ch\u1ed3i x\u01b0\u01a1ng ph\u00eda sau l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i<\/figcaption><\/figure>\n

Sau khi c\u1eaft x\u01b0\u01a1ng t\u1ea1o kho\u1ea3ng du\u1ed7i v\u00e0 c\u1eaft b\u1ecf c\u00e1c ch\u1ed3i x\u01b0\u01a1ng, \u0111\u01b0a 1 t\u1ea5m \u0111\u1ec7m v\u00e0o kho\u1ea3ng du\u1ed7i, ti\u1ebfn h\u00e0nh c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m sao cho tr\u1ee5c c\u01a1 h\u1ecdc chi d\u01b0\u1edbi v\u1ec1 0 \u0111\u1ed9 (h\u00ecnh 4.4). N\u1ebfu d\u00e2y ch\u1eb1ng ch\u01b0a c\u00e2n b\u1eb1ng th\u00ec ph\u1ea3i gi\u1ea3i ph\u00f3ng c\u00e1c c\u1ea5u tr\u00fac d\u00e2y ch\u1eb1ng b\u1ecb c\u0103ng cho \u0111\u1ebfn khi tr\u1ee5c chi d\u01b0\u1edbi v\u1ec1 sinh l\u00fd v\u00e0 kho\u1ea3ng du\u1ed7i l\u00e0 \u0111\u1ed1i x\u1ee9ng [2].<\/p>\n

\"hinh-4.4\"
H\u00ecnh 4.4. C\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m \u1edf t\u01b0 th\u1ebf du\u1ed7i<\/figcaption><\/figure>\n

M\u1ed9t khi kho\u1ea3ng du\u1ed7i \u0111\u01b0\u1ee3c c\u00e2n b\u1eb1ng v\u00e0 \u0111\u1ed1i x\u1ee9ng, m\u1ee5c ti\u00eau l\u00e0 c\u1eaft x\u01b0\u01a1ng t\u1ea1o kho\u1ea3ng g\u1ea5p c\u0169ng \u0111\u1ed1i x\u1ee9ng v\u00e0 b\u1eb1ng v\u1edbi kho\u1ea3ng du\u1ed7i. D\u00f9ng d\u1ee5ng c\u1ee5 l\u00e0m c\u0103ng \u0111\u1ec1u c\u00e1c d\u00e2y ch\u1eb1ng b\u00ean khi g\u1ed1i g\u1ea5p 90 \u0111\u1ed9. Tr\u1ee5c li\u00ean m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u \u0111\u00f9i TEA v\u00e0 tr\u1ee5c tr\u01b0\u1edbc – sau l\u1ed3i c\u1ea7u \u0111\u00f9i APA \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 tr\u1ee5c tham chi\u1ebfu \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh g\u00f3c xoay c\u1ee7a ph\u1ea7n \u0111\u00f9i. Th\u00f4ng th\u01b0\u1eddng, khi kh\u1edbp g\u1ed1i \u0111\u01b0\u1ee3c c\u00e2n b\u1eb1ng \u1edf kho\u1ea3ng du\u1ed7i v\u00e0 c\u1eaft x\u01b0\u01a1ng ch\u00e0y ch\u00ednh x\u00e1c th\u00ec l\u00e1t c\u1eaft x\u01b0\u01a1ng ch\u00e0y s\u1ebd song song v\u1edbi sTEA v\u00e0 vu\u00f4ng g\u00f3c v\u1edbi APA (h\u00ecnh 4.5).<\/p>\n

\"hinh-4.5\"
H\u00ecnh 4.5. So s\u00e1nh l\u00e1t c\u1eaft m\u00e2m ch\u00e0y v\u00e0 c\u00e1c tr\u1ee5c sTEA, APA [1]<\/figcaption><\/figure>N\u1ebfu tr\u1ee5c sTEA v\u00e0 l\u00e1t c\u1eaft \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng ch\u00e0y kh\u00f4ng song song v\u1edbi nhau, c\u00f3 th\u1ec3 x\u1ea3y ra 1 trong c\u00e1c \u0111i\u1ec1u sau: (1) l\u00e1t c\u1eaft \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng ch\u00e0y kh\u00f4ng ch\u00ednh x\u00e1c, (2) x\u00e1c \u0111\u1ecbnh ch\u01b0a ch\u00ednh x\u00e1c tr\u1ee5c sTEA, (3) c\u1ea5u tr\u00fac d\u00e2y ch\u1eb1ng b\u00ean c\u1ee7a kh\u1edbp g\u1ed1i (bao g\u1ed3m b\u00f3 n\u00f4ng c\u1ee7a d\u00e2y ch\u1eb1ng b\u00ean trong v\u00e0 ph\u1ee9c h\u1ee3p d\u00e2y ch\u1eb1ng b\u00ean ngo\u00e0i – g\u00e2n c\u01a1 khoeo) kh\u00f4ng \u0111\u1ea3m b\u1ea3o c\u00e2n b\u1eb1ng nhau khi g\u1ed1i g\u1ea5p 90 \u0111\u1ed9. N\u1ebfu c\u00e1c c\u1ea5u tr\u00fac d\u00e2y ch\u1eb1ng n\u00e0y c\u00f3 kh\u1ea3 n\u0103ng ph\u1ea3i gi\u1ea3i ph\u00f3ng th\u00ec c\u00e1c t\u00e1c gi\u1ea3 s\u1ebd \u0111\u1eb7t khu\u00f4n c\u1eaft b\u1edd tr\u01b0\u1edbc sau l\u1ed3i c\u1ea7u \u0111\u00f9i song song v\u1edbi tr\u1ee5c sTEA. Khu\u00f4n n\u00e0y c\u00f3 k\u00edch th\u01b0\u1edbc th\u00edch h\u1ee3p v\u1edbi k\u00edch th\u01b0\u1edbc c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh cho \u0111\u1ebfn khi song song v\u1edbi l\u00e1t c\u1eaft \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng ch\u00e0y. B\u1eb1ng c\u00e1ch \u0111i\u1ec1u ch\u1ec9nh khu\u00f4n c\u1eaft tr\u01b0\u1edbc – sau \u0111\u00f9i n\u00e0y theo chi\u1ec1u tr\u01b0\u1edbc sau, s\u1ebd t\u1ea1o ra kho\u1ea3ng g\u1ea5p b\u1eb1ng v\u1edbi kho\u1ea3ng du\u1ed7i tr\u01b0\u1edbc \u0111\u00f3<\/p>\n

\"hinh-4.6\"
H\u00ecnh 4.6. \u0110\u1eb7t khu\u00f4n c\u1eaft tr\u01b0\u1edbc-sau l\u1ed3i c\u1ea7u \u0111\u00f9i [1]<\/figcaption><\/figure>
\n\u0110\u1ec3 \u0111\u1ea3m b\u1ea3o c\u1ee7a s\u1ef1 b\u1eb1ng nhau kho\u1ea3ng g\u1ea5p – du\u1ed7i, m\u1ed9t t\u1ea5m \u0111\u1ec7m tr\u01b0\u1edbc \u0111\u00f3 \u0111\u00e3 d\u00f9ng \u0111\u1ebf thi\u1ebft l\u1eadp kho\u1ea3ng du\u1ed7i \u0111\u01b0\u1ee3c \u0111\u1eb7t v\u00e0o b\u00ean d\u01b0\u1edbi khu\u00f4n c\u1eaft tr\u01b0\u1edbc – sau l\u1ed3i c\u1ea7u \u0111\u00f9i v\u00e0 s\u00e1t tr\u00ean b\u1ec1 m\u1eb7t l\u00e1t c\u1eaft \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng ch\u00e0y v\u00e0 kho\u1ea3ng g\u1ea5p \u0111\u01b0\u1ee3c \u0111\u00e1nh d\u1ea5u tr\u01b0\u1edbc khi c\u1eaft b\u1edd sau l\u1ed3i c\u1ea7u \u0111\u00f9i (h\u00ecnh 4.7).<\/p>\n
\"hinh-4.7-tam-dem-cua-khoang-duoi-duoc-dat-vao-khoang-gap-trong-phau-thuat-thay-khop-goi\"
H\u00ecnh 4.7. T\u1ea5m \u0111\u1ec7m c\u1ee7a kho\u1ea3ng du\u1ed7i \u0111\u01b0\u1ee3c \u0111\u1eb7t v\u00e0o kho\u1ea3ng g\u1ea5p [1]<\/figcaption><\/figure>\n

4. Nh\u1eefng thu\u1eadn l\u1ee3i v\u00e0 kh\u00f3 kh\u0103n c\u1ee7a k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng<\/h2>\n

M\u1ee9c \u0111\u1ed9 v\u1eefng c\u1ee7a kho\u1ea3ng g\u1ea5p c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c khi s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng \u0111\u1ec3 t\u1ea1o ra kho\u1ea3ng g\u1ea5p h\u00ecnh ch\u1eef nh\u1eadt [4],[5]. Katz v\u00e0 c\u1ed9ng s\u1ef1 nghi\u00ean c\u1ee9u c\u00e1c kh\u1edbp g\u1ed1i c\u1ee7a 8 x\u00e1c ch\u1ebft, so s\u00e1nh s\u1ef1 ch\u00ednh x\u00e1c khi s\u1eed d\u1ee5ng tr\u1ee5c sTEA, APA v\u00e0 k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u1ed9 xoay c\u1ee7a ph\u1ea7n \u0111\u00f9i [12]. T\u00e1c gi\u1ea3 nh\u1eadn th\u1ea5y r\u1eb1ng tr\u1ee5c sTEA kh\u00f3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c v\u00e0 xoay ngo\u00e0i h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi tr\u1ee5c APA (p < 0,005) v\u00e0 k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng (p < 0,00001). Do c\u00e1c m\u1ed1c x\u01b0\u01a1ng b\u1ecb che khu\u1ea5t ho\u1eb7c kh\u00f3 x\u00e1c \u0111\u1ecbnh trong m\u1ed5, t\u00e1c gi\u00e0 cho r\u1eb1ng k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng c\u00f3 th\u1ec3 mang l\u1ea1i \u0111\u1ed9 tin c\u1eady cao h\u01a1n khi so s\u00e1nh v\u1edbi sTEA v\u00e0 APA. Trong nghi\u00ean c\u1ee9u c\u1ee7a Griffin v\u00e0 c\u1ed9ng s\u1ef1 \u1edf 84 kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng, nh\u1eadn th\u1ea5y kh\u00f4ng c\u00f3 kh\u1edbp g\u1ed1i n\u00e0o c\u00f3 kho\u1ea3ng g\u1ea5p v\u00e0 kho\u1ea3ng du\u1ed7i b\u1ecb ch\u00eanh l\u1ec7ch nhau qu\u00e1 3mm [13]. Trong nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean \u1edf 38 kh\u1edbp g\u1ed1i \u0111\u01b0\u1ee3c thay kh\u1edbp c\u00f3 m\u00e2m ch\u00e0y xoay, s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng, Bolt v\u00e0 c\u1ed9ng s\u1ef1 nh\u1eadn th\u1ea5y 90% c\u00e1c tr\u01b0\u1eddng h\u1ee3p, g\u00f3c gi\u1eefa b\u1edd sau l\u1ed3i c\u1ea7u \u0111\u00f9i nh\u00e2n t\u1ea1o v\u00e0 tr\u1ee5c sTEA l\u00e0 nh\u1ecf h\u01a1n 3 \u0111\u1ed9 tr\u00ean phim ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh sau m\u1ed5 [6].<\/p>\n

Dennis v\u00e0 c\u1ed9ng s\u1ef1 so s\u00e1nh m\u1ee9c \u0111\u1ed9 v\u1eefng c\u1ee7a 40 kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt c\u1eaft x\u01b0\u01a1ng chu\u1ea9n v\u00e0 20 kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng [15]. S\u1ef1 xu\u1ea5t hi\u1ec7n v\u00e0 m\u1ee9c \u0111\u1ed9 ch\u00eanh l\u00ean cao c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i (femoral condylar lift-off) \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 cho t\u1eebng k\u1ef9 thu\u1eadt m\u1ed5 \u1edf c\u00e1c kho\u1ea3ng g\u1ea5p 0, 30, 60, 90 \u0111\u1ed9, s\u1eed d\u1ee5ng ch\u01b0\u01a1ng tr\u00ecnh ph\u00e2n t\u00edch \u0111\u1ed9ng h\u1ecdc 3 chi\u1ec1u t\u1ef1 \u0111\u1ed9ng. K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng cho th\u1ea5y t\u1ef7 l\u1ec7 ch\u00eanh l\u00ean cao c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i tr\u00ean lmm \u00edt h\u01a1n nhi\u1ec1u so v\u1edbi k\u1ef9 thu\u1eadt c\u1eaft x\u01b0\u01a1ng chu\u1ea9n (p < 0,0001). S\u1eed \u0111\u1ee5ng k\u0129 thu\u1eadt c\u1eaft x\u01b0\u01a1ng chu\u1ea9n, s\u1ef1 ch\u00eanh l\u00ean cao c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i l\u1edbn h\u01a1n 1mm g\u1eb7p \u1edf 12\/20 kh\u1edbp g\u1ed1i (chi\u1ebfm 60%) lo\u1ea1i b\u1ea3o t\u1ed3n d\u00e2y ch\u1eb1ng ch\u00e9o sau (posterior cruciate retaining – PCR) v\u00e0 9\/20 kh\u1edbp g\u1ed1i (chi\u1ebfm 45%) lo\u1ea1i c\u1eaft b\u1ecf d\u00e2y ch\u1eb1ng ch\u00e9o sau (posterior stabilized – PS). Kh\u00f4ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p n\u00e0o ch\u00eanh l\u00ean cao c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i > 1mm khi s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng. K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng c\u0169ng c\u00f3 m\u1ee9c \u0111\u1ed9 ch\u00eanh l\u00ean cao c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i t\u1ed1i \u0111a ch\u1ec9 0,9 mm, th\u1ea5p h\u01a1n nhi\u1ec1u so v\u1edbi k\u1ef9 thu\u1eadt c\u1eaft x\u01b0\u01a1ng chu\u1ea9n (\u1edf nh\u00f3m b\u1ea3o t\u1ed3n DCCS l\u00e0 3,l mm, nh\u00f3m c\u1eaft b\u1ecf DCCS l\u00e0 2,5mm, v\u1edbi p = 0,0002).<\/p>\n

L\u00e1t c\u1eaft \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng ch\u00e0y l\u00e0 r\u1ea5t quan tr\u1ecdng khi s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng. Vi\u1ec7c c\u1eaft x\u01b0\u01a1ng ch\u00e0y b\u1ecb nghi\u00eang v\u00e0o trong (vams) s\u1ebd d\u1eabn \u0111\u1ebfn s\u1ef1 xoay trong c\u1ee7a ph\u1ea7n \u0111\u00f9i khi l\u00e1t c\u1eaft b\u1edd sau l\u1ed3i c\u1ea7u \u0111\u00f9i song song l\u00e1t c\u1eaft \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng ch\u00e0y. T\u01b0\u01a1ng t\u1ef1, khi c\u1eaft x\u01b0\u01a1ng ch\u00e0y nghi\u00eang ra ngo\u00e0i (valgus) s\u1ebd d\u1eabn \u0111\u1ebfn ph\u1ea7n \u0111\u00f9i b\u1ecb xoay ngo\u00e0i qu\u00e1 m\u1ee9c. Vi\u1ec7c c\u1eaft b\u1ecf \u00edt qu\u00e1 hay nhi\u1ec1u qu\u00e1 x\u01b0\u01a1ng ch\u00e0y hay x\u01b0\u01a1ng \u0111\u00f9i \u0111\u1ec1u d\u1eabn \u0111\u1ebfn s\u1ef1 kh\u00f4ng ph\u00f9 h\u1ee3p v\u1ec1 k\u00edch th\u01b0\u1edbc c\u1ee7a kho\u1ea3ng g\u1ea5p v\u00e0 kho\u1ea3ng du\u1ed7i. C\u00e1c t\u00e1c gi\u1ea3 khuy\u1ebfn c\u00e1o n\u00ean c\u1eaft \u0111\u1ea7u xa x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng ch\u00e0y ph\u00f9 h\u1ee3p v\u1edbi \u0111\u1ed9 d\u00e0y c\u1ee7a kh\u1edbp nh\u00e2n t\u1ea1o. C\u1eaft qu\u00e1 nhi\u1ec1u \u0111\u1ea7u xa x\u01b0\u01a1ng \u0111\u00f9i s\u1ebd d\u1eabn \u0111\u1ebfn l\u00e0m r\u1ed9ng kho\u1ea3ng du\u1ed7i, k\u00e9o theo mi\u1ebfng \u0111\u1ec7m Insert c\u1ee7a ph\u1ea7n ch\u00e0y s\u1ebd ph\u1ea3i d\u00e0y h\u01a1n \u0111\u1ec3 b\u00f9 l\u1ea1i kho\u1ea3ng du\u1ed7i \u0111\u00f3. L\u00fac n\u00e0y \u0111\u1ec3 tr\u00e1nh vi\u1ec7c qu\u00e1 c\u0103ng c\u1ee7a kho\u1ea3ng g\u1ea5p, th\u00ec l\u00e1t c\u1eaft b\u1edd sau l\u1ed3i c\u1ea7u \u0111\u00f9i l\u1ea1i ph\u1ea3i d\u00e0y h\u01a1n, d\u1eabn \u0111\u1ebfn s\u1ef1 gi\u1ea3m b\u1edbt offset ph\u00eda sau c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i. N\u1ebfu c\u1eaft qu\u00e1 \u00edt \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng ch\u00e0y c\u0169ng s\u1ebd d\u1eabn \u0111\u1ebfn ph\u1ea3i t\u0103ng c\u1eaft b\u1edd sau LC\u0110 \u0111\u1ec3 tr\u00e1nh s\u1ef1 qu\u00e1 c\u0103ng c\u1ee7a kho\u1ea3ng g\u1ea5p.<\/p>\n

T\u00ednh to\u00e0n v\u1eb9n c\u1ee7a h\u1ec7 th\u1ed1ng d\u00e2y ch\u1eb1ng b\u00ean v\u00e0 c\u00e2n b\u1eb1ng ch\u00ednh x\u00e1c c\u00e1c d\u00e2y ch\u1eb1ng c\u0169ng r\u1ea5t quan tr\u1ecdng trong k\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng. D\u00e2y ch\u1eb1ng b\u00ean trong quy\u1ebft \u0111\u1ecbnh \u0111\u1ed9 v\u1eefng m\u1eb7t trong c\u1ee7a kho\u1ea3ng g\u1ea5p. \u0110\u1ed9 v\u1eefng m\u1eb7t ngo\u00e0i c\u1ee7a kho\u1ea3ng g\u1ea5p l\u1ea1i ph\u1ee5 thu\u1ed9c v\u00e0o h\u1ec7 th\u1ed1ng d\u00e2y ch\u1eb1ng b\u00ean ngo\u00e0i v\u00e0 g\u00e2n c\u01a1 khoeo. Khi d\u00e2y ch\u1eb1ng b\u00ean trong b\u1ecb thi\u1ebfu h\u1ee5t do gi\u00e3n ho\u1eb7c gi\u1ea3i ph\u00f3ng qu\u00e1 m\u1ee9c s\u1ebd d\u1eabn \u0111\u1ebfn s\u1ef1 t\u0103ng c\u1ee7a kho\u1ea3ng g\u1ea5p \u1edf khoang trong. \u0110i\u1ec1u n\u00e0y s\u1ebd d\u1eabn \u0111\u1ebfn s\u1ef1 xoay trong c\u1ee7a ph\u1ea7n \u0111\u00f9i khi \u0111\u01b0\u1ee3c \u0111\u1eb7t song song v\u1edbi l\u00e1t c\u1eaft x\u01b0\u01a1ng ch\u00e0y. V\u00e0 ng\u01b0\u1ee3c l\u1ea1i, khi d\u00e2y ch\u1eb1ng b\u00ean ngo\u00e0i b\u1ecb thi\u1ebfu h\u1ee5t s\u1ebd d\u1eabn \u0111\u1ebfn xoay ngo\u00e0i qu\u00e1 m\u1ee9c c\u1ee7a ph\u1ea7n \u0111\u00f9i.<\/p>\n

 <\/p>\n

T\u1ea2I LI\u1ec6U THAM KH\u1ea2O<\/p>\n

    \n
  • Brian Daines, Douglas A. Dennis. Gap Balancing vs. Measured Resection Technique in Total Knee Arthroplasty. Clinics in Orthopedic Surgery2014;6:l-8.<\/li>\n
  • Heesterbeek PJ, Jacobs wc, Wymenga AB. Effects of the balanced gap technique on femoral component rotation in Clin Orthop Relat Res. 2009;467(4): 1015-22.<\/li>\n
  • Dennis DA. Measured resection: an outdated technique in total knee Orthopedics. 2008;31(9):940, 943-4.<\/li>\n
  • Fehring TK. Rotational malalignment of the femoral com- ponent in total knee arthroplasty. Clin Orthop Relat 20OO;(38O):72-9.<\/li>\n
  • Katz MA, Beck TD, Silbcr JS, Seldes Rrfy, Lotke Deter- mining femoral rotational alignment in total knee arthro- plasty: reliability of techniques. J Arthroplasty. 2001; 16(3): 301-5.<\/li>\n
  • Bolclt JG, Stiehl JB, Munzinger u, Beveriand D, Keblish PA. Femoral component rotation in mobile-bearing total knee Knee. 2006;13(4):284-9.<\/li>\n<\/ul>\n

     <\/p>\n

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

    K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng (gap balancing technique)\u00a0 trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i d\u1ef1a tr\u00ean vi\u1ec7c gi\u1ea3i ph\u00f3ng c\u00e1c d\u00e2y ch\u1eb1ng v\u00e0 c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m sau khi c\u1eaft m\u00e2m ch\u00e0y v\u00e0 tr\u01b0\u1edbc khi c\u1eaft x\u01b0\u01a1ng \u0111\u00f9i. C\u00e1c b\u1ec7nh t\u1ed5n th\u01b0\u01a1ng kh\u1edbp g\u1ed1i nh\u01b0 tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng […]<\/p>\n","protected":false},"author":33,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[40],"tags":[3],"yoast_head":"\nK\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i - Vinmec<\/title>\n<meta name=\"description\" content=\"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng l\u00e0 1 k\u1ef9 thu\u1eadt c\u1ee7a ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i, d\u1ef1a tr\u00ean vi\u1ec7c gi\u1ea3i ph\u00f3ng c\u00e1c d\u00e2y ch\u1eb1ng v\u00e0 c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m sau khi c\u1eaft m\u00e2m ch\u00e0y v\u00e0 tr\u01b0\u1edbc khi c\u1eaft x\u01b0\u01a1ng \u0111\u00f9i.\" \/>\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=\"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i - Vinmec\" \/>\n<meta property=\"og:description\" content=\"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng l\u00e0 1 k\u1ef9 thu\u1eadt c\u1ee7a ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i, d\u1ef1a tr\u00ean vi\u1ec7c gi\u1ea3i ph\u00f3ng c\u00e1c d\u00e2y ch\u1eb1ng v\u00e0 c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m sau khi c\u1eaft m\u00e2m ch\u00e0y v\u00e0 tr\u01b0\u1edbc khi c\u1eaft x\u01b0\u01a1ng \u0111\u00f9i.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-09T09:14:28+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-11T01:44:32+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/hinh-4.1-300x206.jpg\" \/>\n<meta name=\"author\" content=\"Trang Tran\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Trang Tran\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"13 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/\",\"name\":\"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i - Vinmec\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-09T09:14:28+00:00\",\"dateModified\":\"2023-04-11T01:44:32+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/72cd991fbdbb1fb2d60ba15ea1686e3f\"},\"description\":\"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng l\u00e0 1 k\u1ef9 thu\u1eadt c\u1ee7a ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i, d\u1ef1a tr\u00ean vi\u1ec7c gi\u1ea3i ph\u00f3ng c\u00e1c d\u00e2y ch\u1eb1ng v\u00e0 c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m sau khi c\u1eaft m\u00e2m ch\u00e0y v\u00e0 tr\u01b0\u1edbc khi c\u1eaft x\u01b0\u01a1ng \u0111\u00f9i.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/72cd991fbdbb1fb2d60ba15ea1686e3f\",\"name\":\"Trang Tran\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/0.gravatar.com\/avatar\/34008fd382f52248f5f72c0f1ec1547b?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/0.gravatar.com\/avatar\/34008fd382f52248f5f72c0f1ec1547b?s=96&d=mm&r=g\",\"caption\":\"Trang Tran\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/trantrang0225gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i - Vinmec","description":"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng l\u00e0 1 k\u1ef9 thu\u1eadt c\u1ee7a ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i, d\u1ef1a tr\u00ean vi\u1ec7c gi\u1ea3i ph\u00f3ng c\u00e1c d\u00e2y ch\u1eb1ng v\u00e0 c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m sau khi c\u1eaft m\u00e2m ch\u00e0y v\u00e0 tr\u01b0\u1edbc khi c\u1eaft x\u01b0\u01a1ng \u0111\u00f9i.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i - Vinmec","og_description":"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng l\u00e0 1 k\u1ef9 thu\u1eadt c\u1ee7a ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i, d\u1ef1a tr\u00ean vi\u1ec7c gi\u1ea3i ph\u00f3ng c\u00e1c d\u00e2y ch\u1eb1ng v\u00e0 c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m sau khi c\u1eaft m\u00e2m ch\u00e0y v\u00e0 tr\u01b0\u1edbc khi c\u1eaft x\u01b0\u01a1ng \u0111\u00f9i.","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/","og_site_name":"Vinmec","article_published_time":"2023-04-09T09:14:28+00:00","article_modified_time":"2023-04-11T01:44:32+00:00","og_image":[{"url":"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/hinh-4.1-300x206.jpg"}],"author":"Trang Tran","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Trang Tran","Est. reading time":"13 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/","name":"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i - Vinmec","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-09T09:14:28+00:00","dateModified":"2023-04-11T01:44:32+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/72cd991fbdbb1fb2d60ba15ea1686e3f"},"description":"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng l\u00e0 1 k\u1ef9 thu\u1eadt c\u1ee7a ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i, d\u1ef1a tr\u00ean vi\u1ec7c gi\u1ea3i ph\u00f3ng c\u00e1c d\u00e2y ch\u1eb1ng v\u00e0 c\u00e2n b\u1eb1ng ph\u1ea7n m\u1ec1m sau khi c\u1eaft m\u00e2m ch\u00e0y v\u00e0 tr\u01b0\u1edbc khi c\u1eaft x\u01b0\u01a1ng \u0111\u00f9i.","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/ky-thuat-can-bang-khoang-trong-phau-thuat-thay-khop-goi\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"K\u1ef9 thu\u1eadt c\u00e2n b\u1eb1ng kho\u1ea3ng trong ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i"}]},{"@type":"WebSite","@id":"http:\/\/noithathoaphat.in\/ctv\/#website","url":"http:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/72cd991fbdbb1fb2d60ba15ea1686e3f","name":"Trang Tran","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/0.gravatar.com\/avatar\/34008fd382f52248f5f72c0f1ec1547b?s=96&d=mm&r=g","contentUrl":"http:\/\/0.gravatar.com\/avatar\/34008fd382f52248f5f72c0f1ec1547b?s=96&d=mm&r=g","caption":"Trang Tran"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/trantrang0225gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/2665"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/33"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=2665"}],"version-history":[{"count":14,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/2665\/revisions"}],"predecessor-version":[{"id":3052,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/2665\/revisions\/3052"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=2665"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=2665"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=2665"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}