{"id":2713,"date":"2023-04-09T17:45:57","date_gmt":"2023-04-09T10:45:57","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2713"},"modified":"2023-04-11T11:27:39","modified_gmt":"2023-04-11T04:27:39","slug":"co-che-benh-sinh-cua-hc-ong-co-tay","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/co-che-benh-sinh-cua-hc-ong-co-tay\/","title":{"rendered":"C\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay: nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft"},"content":{"rendered":"<p><strong>H\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay (Carpal Tunnel Syndrome) \u0111\u01b0\u1ee3c Sir James Paget m\u00f4 t\u1ea3 \u0111\u1ea7u ti\u00ean t\u1eeb n\u0103m 1854, l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd ch\u00e8n \u00e9p d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean hay g\u1eb7p nh\u1ea5t, h\u1ed9i ch\u1ee9ng n\u00e0y x\u1ea3y ra khi th\u1ea7n kinh gi\u1eefa b\u1ecb ch\u00e8n \u00e9p khi n\u00f3 \u0111i ngang qua \u1ed1ng c\u1ed5 tay. H\u1eadu qu\u1ea3 c\u1ee7a vi\u1ec7c ch\u00e8n \u00e9p l\u00e0 g\u00e2y ra \u0111au, t\u00ea, gi\u1ea3m ho\u1eb7c m\u1ea5t c\u1ea3m gi\u00e1c v\u00f9ng da b\u00e0n tay thu\u1ed9c chi ph\u1ed1i c\u1ee7a th\u1ea7n kinh gi\u1eefa, t\u1ea1o c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu cho ng\u01b0\u1eddi b\u1ec7nh, m\u1ea5t ng\u1ee7. Th\u00f4ng qua b\u00e0i vi\u1ebft, nh\u00f3m t\u00e1c gi\u1ea3 ch\u00fang t\u00f4i tr\u00ecnh b\u00e0y v\u1ec1 c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay.<\/strong><\/p>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_2744\" aria-describedby=\"caption-attachment-2744\" style=\"width: 412px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-2744\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/download-4.jpg\" alt=\"hinh-anh-mo-ta-HC-OCT\" width=\"412\" height=\"276\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/download-4.jpg 412w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/download-4-300x201.jpg 300w\" sizes=\"(max-width: 412px) 100vw, 412px\" \/><figcaption id=\"caption-attachment-2744\" class=\"wp-caption-text\">H\u00ecnh \u1ea3nh m\u00f4 t\u1ea3 HC OCT<\/figcaption><\/figure>\n<p>Nh\u00f3m t\u00e1c gi\u1ea3:<\/p>\n<p>PGS. TS. Tr\u1ea7n Trung D\u0169ng, BS Ma Ng\u1ecdc Th\u00e0nh, TS. Nguy\u1ec5n Th\u1ecb Li\u1ec5u, BS. Tr\u1ea7n Quy\u1ebft<\/p>\n<p>Ng\u00e0y ph\u00e1t h\u00e0nh: 9\/4\/2023<\/p>\n<ol>\n<li>\n<h2><strong>L\u1ecbch s\u1eed nghi\u00ean c\u1ee9u HC \u1ed1ng c\u1ed5 tay<\/strong><\/h2>\n<\/li>\n<\/ol>\n<p>T\u1ef7 l\u1ec7 m\u1eafc h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay (HC OCT) ng\u00e0y c\u00e0ng t\u0103ng l\u00ean do nhu c\u1ea7u c\u00f4ng vi\u1ec7c c\u00f3 s\u1eed d\u1ee5ng nhi\u1ec1u \u1edf c\u1ed5 tay, c\u00e1c \u0111\u1ed9ng t\u00e1c t\u1ec9 m\u1ec9, l\u1eb7p \u0111i l\u1eb7p l\u1ea1i, k\u1ebft h\u1ee3p v\u1edbi s\u1ef1 hi\u1ec3u bi\u1ebft c\u1ee7a th\u1ea7y thu\u1ed1c v\u00e0 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c n\u00e2ng cao, s\u1ef1 ra \u0111\u1eddi c\u1ee7a c\u00e1c ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7n \u0111\u1ea1i nh\u01b0 \u0111i\u1ec7n sinh l\u00fd th\u1ea7n kinh, si\u00eau \u00e2m gi\u00fap cho vi\u1ec7c ph\u00e1t hi\u1ec7n b\u1ec7nh \u0111\u01b0\u1ee3c s\u1edbm h\u01a1n.<\/p>\n<p>\u1ede n\u01b0\u1edbc ta ch\u01b0a c\u00f3 th\u1ed1ng k\u00ea ch\u00ednh th\u1ee9c n\u00e0o v\u1ec1 HC OCT. Nh\u1eefng th\u1ed1ng k\u00ea \u1edf M\u1ef9 cho th\u1ea5y t\u1ef7 l\u1ec7 m\u1eafc h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay h\u00e0ng n\u0103m kho\u1ea3ng 50\/1000 ng\u01b0\u1eddi, \u1edd nh\u00f3m nguy c\u01a1 cao t\u1ef7 l\u1ec7 n\u00e0y c\u00f3 th\u1ec3 l\u00ean t\u1edbi 500\/1000 ng\u01b0\u1eddi .<\/p>\n<p>H\u1ed9i ch\u1ee9ng n\u00e0y hay g\u1eb7p \u1edf ph\u1ee5 n\u1eef trung ni\u00ean. H\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n m\u1eafc HC OCT l\u00e0 v\u00f4 c\u0103n (chi\u1ebfm 70%), s\u1ed1 c\u00f2n l\u1ea1i c\u00f3 th\u1ec3 do c\u00e1c nguy\u00ean nh\u00e2n n\u1ed9i sinh ho\u1eb7c ngo\u1ea1i sinh. Nguy\u00ean nh\u00e2n n\u1ed9i sinh t\u1eeb c\u00e1c y\u1ebfu t\u1ed1 l\u00e0m gia t\u0103ng th\u1ec3 t\u00edch c\u00e1c th\u00e0nh ph\u1ea7n trong OCT nh\u01b0 thai k\u1ef3, ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, gout, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, vi\u00eam bao ho\u1ea1t d\u1ecbch&#8230; C\u00e1c nguy\u00ean nh\u00e2n ngo\u1ea1i sinh nh\u01b0 ch\u1ea5n th\u01b0\u01a1ng, kh\u1ed1i u&#8230; g\u00e2y ch\u00e8n \u00e9p l\u00e0m thay \u0111\u1ed5i k\u00edch th\u01b0\u1edbc \u1ed1ng c\u1ed5 tay t\u1eeb \u0111\u00f3 l\u00e0m gia t\u0103ng \u00e1p l\u1ef1c k\u1ebd d\u00f9 th\u1ec3 t\u00edch c\u00e1c th\u00e0nh ph\u1ea7n trong OCT kh\u00f4ng thay \u0111\u1ed5i.<\/p>\n<p>Khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi th\u00ec b\u1ec7nh c\u00f3 th\u1ec3 kh\u1ecfi ho\u00e0n to\u00e0n, ng\u01b0\u1ee3c l\u1ea1i n\u1ebfu \u0111\u1ec3 mu\u1ed9n th\u00ec s\u1ebd g\u00e2y ra nh\u1eefng t\u1ed5n th\u01b0\u01a1ng v\u00e0 di ch\u1ee9ng k\u00e9o d\u00e0i l\u00e0m \u1ea3nh h\u01b0\u1edfng l\u1edbn \u0111\u1ebfn sinh ho\u1ea1t v\u00e0 c\u00f4ng vi\u1ec7c. Theo th\u1ed1ng k\u00ea \u1edf M\u1ef9, h\u00e0ng n\u0103m c\u00f3 kho\u1ea3ng 200.000 ca ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb HC OCT, do \u0111\u00f3 ng\u01b0\u1eddi lao \u0111\u1ed9ng ph\u1ea3i ngh\u1ec9 vi\u1ec7c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u1eddi s\u1ed1ng kinh t\u1ebf, k\u00e8m theo \u0111\u00f3 l\u00e0 m\u1ed9t kho\u1ea3n chi ph\u00ed t\u01b0\u01a1ng \u0111\u1ed1i l\u1edbn cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ebfn trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a b\u1ec7nh, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c u\u1ed1ng thu\u1ed1c ch\u1ed1ng vi\u00eam ho\u1eb7c ti\u00eam corticoid t\u1ea1i \u1ed1ng c\u1ed5 tay k\u1ebft h\u1ee3p s\u1eed d\u1ee5ng n\u1eb9p c\u1ed5 tay l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng nhanh, tuy nhi\u00ean t\u1ef7 l\u1ec7 tri\u1ec7u ch\u1ee9ng t\u00e1i ph\u00e1t s\u1edbm kh\u00e1 cao.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt c\u1eaft d\u00e2y ch\u1eb1ng ngang c\u1ed5 tay l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 nh\u1ea5t, ch\u1ec9 \u0111\u1ecbnh khi b\u1ec7nh nh\u00e2n \u0111\u1ebfn trong giai \u0111o\u1ea1n trung b\u00ecnh tr\u1edf l\u00ean, ho\u1eb7c \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa th\u1ea5t b\u1ea1i, C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng nh\u01b0: m\u1ed5 h\u1edf truy\u1ec1n th\u1ed1ng, m\u1ed5 h\u1edf \u00edt x\u00e2m l\u1ea5n, ph\u1eabu thu\u1eadt n\u1ed9i soi, ph\u1eabu thu\u1eadt x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m. Th\u00f4ng qua b\u00e0i vi\u1ebft, nh\u00f3m t\u00e1c gi\u1ea3 ch\u00fang t\u00f4i tr\u00ecnh b\u00e0y v\u1ec1 c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a HC \u1ed1ng c\u1ed5 tay.<\/p>\n<ul>\n<li>N\u0103m 1854 Paget m\u00f4 t\u1ea3 2 tr\u01b0\u1eddng h\u1ee3p c\u00f3 b\u1ec7nh l\u00fd th\u1ea7n kinh gi\u1eefa sau g\u1eaby \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng quay.<\/li>\n<li>Bouilly (1884) m\u00f4 t\u1ea3 m\u1ed9t tr\u01b0\u1eddng h\u1ee3p 17 tu\u1ed5i, can l\u1ec7ch sau g\u00e3y Colles c\u00f3 ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt \u0111\u1ee5c ch\u1ed3i x\u01b0ong. M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 kh\u00e1c: Blencher, Kirschheim, Dickson, c\u00f9ng m\u00f4 t\u1ea3 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa sau g\u00e3y Colles.<\/li>\n<\/ul>\n<p>Abbott v\u00e0 Saunders (1933) nghi\u00ean c\u1ee9u tr\u00ean x\u00e1c b\u1eb1ng c\u00e1ch ti\u00eam thu\u1ed1c\u00a0 nhu\u1ed9m v\u00e0o \u1ed1ng c\u1ed5 tay, quan s\u00e1t khi g\u1ea5p c\u1ed5 tay th\u00ec thu\u1ed1c nhu\u1ed9m b\u1ecb \u0111\u1ea9y ng\u01b0\u1ee3c l\u1ea1i, t\u1eeb \u0111\u00f3 h\u1ecd cho r\u1eb1ng nguy\u00ean nh\u00e2n g\u00e2y n\u00ean ch\u00e8n \u00e9p l\u00e0 do t\u01b0 th\u1ebf Cotton-Loder ( g\u1eadp c\u1ed5 tay) khi b\u1ea5t \u0111\u1ed9ng \u0111i\u1ec1u tr\u1ecb g\u00e3y Colles.<\/p>\n<p>\u0110\u00e2y l\u00e0 t\u01b0 th\u1ebf th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng t\u1ea1i th\u1eddi \u0111i\u1ec3m b\u1ea5y gi\u1edd, Leviss D, Miller EM (1922) m\u00f4 t\u1ea3 3 tr\u01b0\u1eddng h\u1ee3p ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa sau tr\u1eadt x\u01b0\u01a1ng nguy\u1ec7t, c\u1ea3i thi\u1ec7n sau m\u1ed5 l\u1ea5y b\u1ecf x\u01b0\u01a1ng nguy\u1ec7t. Watson-Jones, Mcyerding (1927) \u0111\u00e3 b\u00e1o c\u00e1o s\u1ef1 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng th\u1ea7n kinh gi\u1eefa sau \u0111i\u1ec1u tr\u1ecb tr\u1eadt x\u01b0\u01a1ng nguy\u1ec7t, v\u1ea5n \u0111\u1ec1 tr\u1eadt c\u0169 x\u01b0\u01a1ng nguy\u1ec7t v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1ch l\u1ea5y b\u1ecf x\u01b0\u01a1ng nguy\u1ec7t c\u00f2n \u00e1p d\u1ee5ng cho \u0111\u1ebfn ng\u00e0y nay,<\/p>\n<p>M\u1ed9t v\u1ea5n \u0111\u1ec1 n\u1eefa c\u0169ng \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u0111\u00f3 l\u00e0 r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c th\u1ea7n kinh gi\u1eefa kh\u00f4ng li\u00ean quan \u0111\u1ebfn ch\u1ea5n th\u01b0\u01a1ng. Raynaud (1862) c\u00f4ng nh\u1eadn s\u1ef1 r\u1ed1i lo\u1ea1n n\u00e0y li\u00ean quan \u0111\u1ebfn v\u1eadn m\u1ea1ch, d\u00f9 sao \u00f4ng c\u0169ng nh\u1eadn th\u1ea5y m\u1ed9t tri\u1ec7u ch\u1ee9ng: s\u1ef1 t\u00ea b\u00ec c\u00e1c ng\u00f3n tay v\u00e0 s\u1ef1 kh\u00f3 kh\u0103n trong vi\u1ec7c gi\u1eef c\u00e1c \u0111\u1ed3 v\u1eadt. N\u0103m 1880 Putnam \u0111\u00e3 b\u00e1o c\u00e1o 37 tr\u01b0\u1eddng h\u1ee3p, ch\u1ee7 y\u1ebfu l\u00e0 b\u1ec7nh nh\u00e2n n\u1eef c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng r\u1ed1i\u00a0 lo\u1ea1n c\u1ea3m gi\u00e1c, t\u00ea b\u00ec v\u1ec1 \u0111\u00eam, \u00f4ng cho r\u1eb1ng th\u1ee7 ph\u1ea1m l\u00e0 s\u1ef1 gi\u1ea3m c\u1ea5p m\u00e1u th\u1ea7n kinh gi\u1eefa.<\/p>\n<ul>\n<li>N\u0103m 1933, Learmonth b\u00e1o c\u00e1o 2 tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt c\u1eaft d\u00e2y ch\u1eb1ng ngang, gi\u1ea3i ph\u00f3ng ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa. Ca th\u1ee9 nh\u1ea5t \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n n\u0103m 1929 c\u1eaft d\u00e2y ch\u1eb1ng ngang cho b\u1ec7nh nh\u00e2n b\u1ecb kh\u1edbp gi\u1ea3 x\u01b0\u01a1ng thuy\u1ec1n, ch\u00e8n \u00e9p th\u1ea7n kinh. Ca th\u1ee9 hai do vi\u00eam kh\u1edbp \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt n\u0103m 1930. \u00d4ng \u0111\u01b0\u1ee3c coi l\u00e0 ng\u01b0\u1eddi \u0111\u1ea7u ti\u00ean th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt n\u00e0y, m\u1edf ra h\u01b0\u1edbng m\u1edbi \u0111i\u1ec1u tr\u1ecb ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa J. Cannon v\u00e0 Love (1946) c\u00f4ng b\u1ed1 38 tr\u01b0\u1eddng h\u1ee3p ph\u1eabu thu\u1eadt c\u1eaft d\u00e2y ch\u1eb1ng ngang, b\u00e0i b\u00e1o n\u00e0y c\u0169ng m\u00f4 t\u1ea3 r\u00f5 k\u1ef9 thu\u1eadt m\u1ed5.<\/li>\n<li>Pha &#8211; len b\u00e1o c\u00e1o h\u00e0ng tr\u0103m ca v\u00e0o c\u00e1c n\u0103m 1950, 1951, 1957 . \u00d4ng c\u0169ng m\u00f4 t\u1ea3 c\u01a1 ch\u1ebf b\u1ec7nh sinh li\u00ean quan \u0111\u1ebfn vi\u00eam m\u00e0ng ho\u1ea1t d\u1ecbch v\u00e0 t\u0103ng \u00e1p l\u1ef1c trong \u1ed1ng c\u1ed5 tay. M\u1ed9t test l\u00e2m s\u00e0ng c\u0169ng \u0111\u01b0\u1ee3c mang t\u00ean \u00f4ng.<\/li>\n<\/ul>\n<p>Ti\u00eam steroid v\u00e0o \u1ed1ng c\u1ed5 tay c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng, nh\u1eefng t\u00e0i li\u1ec7u c\u1ee7a Mayo clinic c\u0169ng \u0111\u00e3 n\u00f3i v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p n\u00e0y (1954). Phalen, \u00bfendlich (1957) l\u00e0 nh\u1eefng ng\u01b0\u1eddi \u0111\u1ea7u ti\u00ean c\u00f4ng b\u1ed1 kinh nghi\u1ec7m trong \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ti\u00eam Steroid. C\u00e1ch \u0111i\u1ec1u tr\u1ecb n\u00e0y c\u00f2n \u00e1p d\u1ee5ng cho \u0111\u1ebfn ng\u00e0y nay cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb m\u1ee9c \u0111\u1ed9 nh\u1eb9, do c\u01a1 ch\u1ebf vi\u00eam, t\u0103ng \u00e1p l\u1ef1c trong \u1ed1ng c\u1ed5 tay.<\/p>\n<p>Simpson (1956) \u0111\u00e3 nghi\u00ean c\u1ee9u \u1ee9ng d\u1ee5ng c\u1ee7a ch\u1ea9n \u0111o\u00e1n \u0111i\u1ec7n trong ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay. Sau \u0111\u00f3 ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u r\u1ed9ng, c\u00f3 nhi\u1ec1u c\u1ea3i ti\u1ebfn, ti\u1ebfn b\u1ed9. Ng\u00e0y nay n\u00f3 l\u00e0 c\u1eadn l\u00e2m s\u00e0ng \u0111\u1ea7u tay \u0111\u1ec3 s\u1eed d\u1ee5ng ch\u1ea9n \u0111o\u00e1n, ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb, c\u0169ng nh\u01b0 theo d\u00f5i sau \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u sau n\u00e0y \u0111\u00e3 l\u00e0m r\u00f5 h\u01a1n v\u1ec1 c\u01a1 ch\u1ebf b\u1ec7nh sinh, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p c\u1eadn l\u00e2m s\u00e0ng kh\u00e1c c\u0169ng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng (si\u00eau \u00e2m, MRI), c\u00f9ng v\u1edbi \u0111\u00f3 l\u00e0 c\u00e1c s\u1ef1 ra \u0111\u1eddi c\u1ee7a c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt : \u00edt x\u00e2m l\u1ea5n, n\u1ed9i soi, ph\u1eabu thu\u1eadt x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m, \u0111\u00e3 mang l\u1ea1i nh\u1eefng ti\u1ebfn b\u1ed9 trong \u0111i\u1ec1u tr\u1ecb HC OCT.<\/p>\n<h2><strong>2. Gi\u1ea3i ph\u1eabu b\u1ec7nh v\u00e0 c\u01a1 ch\u1ebf b\u1ec7nh sinh HC \u1ed1ng c\u1ed5 tay<\/strong><\/h2>\n<p>\u1ede b\u00e0n tay b\u00ecnh th\u01b0\u1eddng, \u00e1p l\u1ef1c k\u1ebd trung b\u00ecnh b\u00ean trong OCT l\u00e0 2,5 mmHg, \u00c1p l\u1ef1c t\u0103ng t\u1ed1i \u0111a khi du\u1ed7i hay g\u1ea5p h\u1ebft t\u1ea7m v\u1eadn \u0111\u1ed9ng c\u1ed5 tay, nh\u1ecf h\u01a1n \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y mao m\u1ea1ch trung b\u00ecnh l\u00e0 31 mmHg. Khi c\u00f3 s\u1ef1 t\u0103ng \u00e1p l\u1ef1c b\u00ean trong OCT c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ef1 bi\u1ebfn d\u1ea1ng c\u01a1 h\u1ecdc c\u1ee7a bao myelin ho\u1eb7c g\u00e2y thi\u1ebfu m\u00e1u th\u1ea7n kinh gi\u1eefa.<\/p>\n<p>M\u1ed9t trong nh\u1eefng d\u1ea5u hi\u1ec7u nh\u1eadn bi\u1ebft b\u1ec7nh ch\u00e8n \u00e9p th\u1ea7n kinh m\u1ea1n t\u00ednh nh\u01b0 HC\u00a0 OCT l\u00e0 s\u1ef1 tho\u00e1i h\u00f3a myelin, s\u1ef1 m\u1ea5t myelin b\u1eaft ngu\u1ed3n t\u1eeb s\u1ef1 ph\u00e1 v\u1ee1 c\u01a1 ch\u1ebf c\u00e1c \u0111o\u1ea1n gian h\u1ea1ch c\u1ee7a th\u1ea7n kinh. C\u00e1c \u0111o\u1ea1n myelin h\u00ecnh tr\u1ee9ng b\u1ecb ph\u00e1 v\u1ee1 v\u00e0 b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u1edf hai \u0111\u1ea7u c\u1ee7a n\u01a1i b\u1ecb ch\u00e8n \u00e9p. N\u1ebfu\u00a0 t\u1ed5n th\u01b0\u01a1ng do ch\u00e8n \u00e9p n\u00e0y \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng thi c\u00e1c t\u1ebf b\u00e0o Schwann s\u1ebd t\u1ea1o l\u1ea1i myelin cho s\u1ee3i tr\u1ee5c v\u00e0 c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i l\u1ea1i d\u1eabn truy\u1ec1n g\u1ea7n nh\u01b0 b\u00ecnh th\u01b0\u1eddng. N\u1ebfu s\u1ef1 ch\u00e8n \u00e9p k\u00e9o d\u00e0i v\u00e0 s\u1ef1 tho\u00e1i h\u00f3a myelin lan r\u1ed9ng s\u1ebd d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp s\u1ee3i tr\u1ee5c v\u00e0 tho\u00e1i h\u00f3a \u1edb ph\u1ea7n xa v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng, Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, s\u1ef1 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng \u0111\u00f2i h\u1ecfi nhi\u1ec1u th\u1eddi gian v\u00e0 ph\u1ee9c t\u1ea1p h\u01a1n \u0111\u1ebf t\u00e1i sinh s\u1ee3i tr\u1ee5c.<\/p>\n<p>S\u1ef1 t\u1eafc ngh\u1ebdn l\u01b0u th\u00f4ng t\u0129nh m\u1ea1ch c\u1ee7a m\u1ea1ng m\u1ea1ch xung quanh hay bao ngo\u00e0i th\u1ea7n kinh d\u1eabn t\u1edbi s\u1ef1 thi\u1ebfu oxy v\u00e0 ph\u00f9 n\u1ec1 trong th\u1ea7n kinh. M\u1ee9c \u0111\u1ed9 c\u1ee7a s\u1ef1 ph\u00f9 n\u1ec1 v\u00e0 s\u1ef1 t\u1eafc ngh\u1ebdn d\u1eabn truy\u1ec1n th\u1ea7n kinh c\u00f3 li\u00ean quan v\u1edbi m\u1ee9c \u0111\u1ed9 v\u00e0 th\u1eddi gian ch\u00e8n \u00e9p. \u0110\u1ed3ng th\u1eddi n\u00f3 c\u0169ng g\u00e2y ra xung huy\u1ebft t\u0129nh m\u1ea1ch v\u00e0 l\u00e0m ch\u1eadm tu\u1ea7n ho\u00e0n.<\/p>\n<p>Khi \u00e1p l\u1ef1c tr\u1edf n\u00ean cao h\u01a1n hay ch\u00e8n \u00e9p k\u00e9o d\u00e0i s\u1ebd g\u00e2y ra s\u1ef1 s\u01b0ng n\u1ec1 ch\u00e8n \u00e9p k\u00e9o d\u00e0i s\u1ebd g\u00e2y ra s\u1ef1 s\u01b0ng n\u1ec1 c\u1ee7a c\u00e1c b\u00f3 th\u1ea7n kinh b\u00ean trong bao th\u1ea7n kinh do s\u1ef1 tho\u00e1t d\u1ecbch v\u00e0 ph\u00f9 n\u1ec1. S\u1ef1 ph\u00f9 n\u1ec1 trong th\u1ea7n kinh l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng do s\u1ef1 thay \u0111\u1ed5i m\u00f4i tr\u01b0\u1eddng ion t\u1ea1i ch\u1ed7 c\u1ee7a s\u1ee3i tr\u1ee5c. C\u0169ng c\u00f3 t\u00e0i li\u1ec7u cho r\u1eb1ng s\u1ef1 t\u0103ng \u00e1p l\u1ef1c k\u1ebd c\u1ee7a \u1ed1ng g\u00e2y \u1ea3nh h\u01b0\u1edfng c\u01a1 h\u1ecdc tr\u1ef1c ti\u1ebfp l\u00ean d\u1eabn truy\u1ec1n s\u1ee3i tr\u1ee5c.<\/p>\n<p>C\u00e1c k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u cho th\u1ea5y s\u1ef1 ch\u00e8n \u00e9p k\u00e9o d\u00e0i \u1edf \u00e1p l\u1ef1c 20 mmHg s\u1ebd d\u1eabn \u0111\u1ebfn s\u1ef1 gi\u1ea3m d\u1eabn truy\u1ec1n th\u1eb3ng nhanh c\u1ee7a s\u1ee3i tr\u1ee5c, c\u00f2n d\u1eabn truy\u1ec1n th\u1eb3ng ch\u1eadm gi\u1ea3m \u1edd \u00e1p l\u1ef1c 30 mmHg. S\u1ef1 t\u0103ng \u00e1p l\u1ef1c c\u00e0ng k\u00e9o d\u00e0i, c\u00e0ng l\u00e0m x\u00e1o tr\u1ed9n l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0 d\u1eabn truy\u1ec1n s\u1ee3i tr\u1ee5c, d\u1eabn t\u1edbi s\u1ef1 thay \u0111\u1ed5i v\u0129nh vi\u1ec5n. K\u1ebft qu\u1ea3 cu\u1ed1i c\u00f9ng c\u1ee7a s\u1ef1 ch\u00e8n \u00e9p th\u1ea7n kinh k\u00e9o d\u00e0i l\u00e0 s\u1ef1 ph\u00e1 h\u1ee7y c\u1ea5u tr\u00fac b\u00ean trong v\u00e0 b\u00ean ngo\u00e0i th\u1ea7n kinh, thay b\u1eb1ng m\u00f4 x\u01a1 s\u1eb9o d\u00e0y \u0111\u1eb7c.<\/p>\n<p>V\u1ec1 m\u1eb7t sinh l\u00fd b\u1ec7nh chia 3 giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n c\u1ee7a HC OCT :<\/p>\n<p><strong>Giai \u0111o\u1ea1n 1<\/strong>: trong giai \u0111o\u1ea1n n\u00e0y c\u00f3 s\u1ef1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 t\u1ea1m th\u1eddi bao th\u1ea7n kinh \u1edb v\u00f9ng b\u1ecb ch\u00e8n \u00e9p g\u00e2y \u0111au v\u00e0 d\u1ecb c\u1ea3m t\u1eebng \u0111\u1ee3t \u1edf da b\u00e0n tay do th\u1ea7n kinh gi\u1eefa chi ph\u1ed1i. C\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y x\u1ea3y ra \u0111i\u1ec3n h\u00ecnh v\u00e0o bu\u1ed5i t\u1ed1i ho\u1eb7c sau nh\u1eefng ho\u1ea1t \u0111\u1ed9ng nh\u01b0 l\u00e1i xe, c\u1ea7m m\u1ed9t quy\u1ec3n s\u00e1ch, t\u1edd b\u00e1o, nghe \u0111i\u1ec7n tho\u1ea1i l\u00e2u,&#8230; nh\u1eefng \u0111i\u1ec1u n\u00e0y cho th\u1ea5y c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n th\u1ea7n kinh.<\/p>\n<p><strong>Giai \u0111o\u1ea1n 2<\/strong>: c\u00e1c d\u1ecb c\u1ea3m, ch\u00e2m tr\u00edch \u1edf b\u00e0n tay tr\u1edf n\u00ean h\u1eb1ng \u0111\u1ecbnh, th\u01b0\u1eddng xuy\u00ean h\u01a1n, t\u01b0\u01a1ng \u1ee9ng v\u1edbi s\u1ef1 r\u1ed1i lo\u1ea1n vi m\u1ea1ch m\u00e1u \u1edf bao ngo\u00e0i v\u00e0 b\u00ean trong th\u1ea7n kinh k\u00e9o theo ph\u00f9 n\u1ec1 b\u00ean trong b\u00f3 th\u1ea7n kinh. \u0110i\u1ec7n c\u01a1 th\u01b0\u1eddng cho th\u1ea5y b\u1ea5t th\u01b0\u1eddng d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c.<\/p>\n<p><strong>Giai \u0111o\u1ea1n 3<\/strong>: ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c b\u1ecb t\u1ed5n th\u01b0\u01a1ng v\u0129nh vi\u1ec1n, xu\u1ea5t hi\u1ec7n teo c\u01a1 \u1edf m\u00f4 c\u00e1i. \u0110i\u1ec7n c\u01a1 cho th\u1ea5y s\u1ef1 tho\u00e1i h\u00f3a myelin v\u00e0 s\u1ee3i tr\u1ee5c th\u1ee9 ph\u00e1t sau m\u1ed9t th\u1eddi gian d\u00e0i ph\u00f9 n\u1ec1 b\u00ean trong th\u1ea7n kinh.<\/p>\n<p>T\u1eeb c\u01a1 ch\u1ebf b\u1ec7nh sinh ta nh\u1eadn th\u1ea5y r\u1eb1ng: vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm b\u1ec7nh ngay \u1edf giai \u0111o\u1ea1n 1 v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi s\u1ebd \u1ea3nh h\u01b0\u1edfng t\u1ed1t \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u0169ng nh\u01b0 th\u1eddi gian h\u1ed3i ph\u1ee5c c\u1ee7a th\u1ea7n kinh gi\u1eefa. Ng\u01b0\u1ee3c l\u1ea1i, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u1edf giai \u0111o\u1ea1n mu\u1ed9n khi th\u1ea7n kinh gi\u1eefa \u0111\u00e3 b\u1ecb tho\u00e1i h\u00f3a n\u01b0\u1edbc \u0111\u00f2i h\u1ecfi ph\u1ea3i m\u1ea5t nhi\u1ec1u th\u1eddi gian m\u00e0 s\u1ef1 h\u1ed3i ph\u1ee5c th\u1ea7n kinh l\u1ea1i kh\u00f4ng kh\u00f4ng ho\u00e0n to\u00e0n.<\/p>\n<h2><strong>3. Nguy\u00ean nh\u00e2n g\u00e2y HC \u1ed1ng c\u1ed5 tay<\/strong><\/h2>\n<p>Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm b\u1ec7nh ngay \u1edf giai \u0111o\u1ea1n 1 v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi s\u1ebd \u1ea3nh h\u01b0\u1edfng t\u1ed1t \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u0169ng nh\u01b0 th\u1eddi gian h\u1ed3i ph\u1ee5c c\u1ee7a th\u1ea7n kinh gi\u1eefa. Ng\u01b0\u1ee3c l\u1ea1i, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u1edf giai \u0111o\u1ea1n mu\u1ed9n khi th\u1ea7n kinh gi\u1eefa \u0111\u00e3 b\u1ecb tho\u00e1i h\u00f3a n\u01b0\u1edbc \u0111\u00f2i h\u1ecfi ph\u1ea3i m\u1ea5t nhi\u1ec1u th\u1eddi gian m\u00e0 s\u1ef1 h\u1ed3i ph\u1ee5c th\u1ea7n kinh l\u1ea1i kh\u00f4ng ho\u00e0n to\u00e0n<\/p>\n<p><strong>3.1. HC OCT v\u00f4 c\u0103n<\/strong><\/p>\n<p>Kho\u1ea3ng 70% c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 HCOCT kh\u00f4ng t\u00ecm \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n r\u00f5 r\u00e0ng. C\u00f3 th\u1ec3 c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng vi\u00eam bao ho\u1ea1t d\u1ecbch, t\u0103ng \u00e1p l\u1ef1c kho\u1ea3ng gian b\u00e0o trong \u1ed1ng c\u1ed5 tay g\u00e2y n\u00ean ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa. Th\u1ef1c t\u1ebf th\u1ea5y c\u00e1c tri\u1ec7u ch\u1ee9ng gi\u1ea3m \u0111i khi d\u00f9ng thu\u1ed1c ch\u1ed1ng vi\u00eam u\u1ed1ng ho\u1eb7c ti\u00eam v\u00e0o \u1ed1ng c\u1ed5 tay<\/p>\n<p><strong>3.2 C\u00e1c nguy\u00ean nh\u00e2n ngo\u1ea1i sinh<\/strong><\/p>\n<p>Theo Kerwin, c\u00e1c nguy\u00ean nh\u00e2n l\u00e0m thay \u0111\u1ed5i k\u00edch th\u01b0\u1edbc cung c\u1ed5 tay hay OCT c\u00f3 th\u1ec3 l\u00e0m gia t\u0103ng \u00e1p l\u1ef1c k\u1ebd d\u00f9 th\u1ec3 t\u00edch c\u00e1c th\u00e0nh ph\u1ea7n ch\u1ee9a kh\u00f4ng \u0111\u1ed5i.<\/p>\n<ul>\n<li>Bi\u1ebfn d\u1ea1ng kh\u1edbp v\u00e0 c\u00e1c ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng c\u1ed5 tay:<\/li>\n<\/ul>\n<p>G\u00e3y \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng quay, g\u00e3y x\u01b0\u01a1ng c\u1ed5 tay, kh\u1edbp gi\u1ea3 x\u01b0\u01a1ng thuy\u1ec1n, b\u00e1n tr\u1eadt xoay x\u01b0\u01a1ng thuy\u1ec1n, tr\u1eadt x\u01b0\u01a1ng nguy\u1ec7t, vi\u00eam kh\u1edbp c\u1ed5 tay g\u00e2y ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa trong \u1ed1ng c\u1ed1 tay.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/nhi\/benh-hemophilia-la-benh-gi\/\">Hemophilia<\/a>, <a href=\"https:\/\/www.vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/benh-da-u-tuy-la-gi-va-tien-trien-nhu-nao\/\">b\u1ec7nh u t\u1ee7y<\/a>.<\/li>\n<\/ul>\n<p>Nguy\u00ean nh\u00e2n c\u1ee7a s\u1ef1 gia t\u0103ng HC OCT \u1edf b\u1ec7nh nh\u00e2n Hemophilia c\u0169ng ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5. S\u1ef1 ch\u00e8n \u00e9p th\u1ea7n kinh do m\u00e1u t\u1ee5 xung quanh hay xu\u1ea5t huy\u1ebft trong c\u01a1 hay thi\u1ebfu m\u00e1u do xu\u1ea5t huy\u1ebft trong th\u1ea7n kinh \u0111\u01b0\u1ee3c cho l\u00e0 c\u00e1c nguy\u00ean nh\u00e2n.<\/p>\n<ul>\n<li>C\u00e1c lo\u1ea1i u<\/li>\n<\/ul>\n<p>U t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 x\u01b0\u01a1ng v\u00e0 bao g\u00e2n, u m\u1ee1, u m\u00e1u, nang ho\u1ea1t d\u1ecbch, u h\u1ea1t tophy&#8230; g\u00e2y cho\u00e1n ch\u1ed5 trong l\u00f2ng OCT v\u00e0 d\u1eabn \u0111\u1ebfn ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa.<\/p>\n<p><strong>3.3. C\u00e1c nguy\u00ean nh\u00e2n n\u1ed9i sinh<\/strong><\/p>\n<p>Kerwin \u0111\u00e3 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n n\u1ed9i sinh t\u1eeb c\u00e1c y\u1ebfu t\u1ed1 l\u00e0m gia t\u0103ng th\u1ec3 t\u00edch c\u00e1c th\u00e0nh ph\u1ea7n trong \u1ed1ng nh\u01b0:<\/p>\n<ul>\n<li>Thai k\u1ef3:Trong su\u1ed1t thai k\u1ef3 s\u1ef1 \u1ee9 \u0111\u1ecdng d\u1ecbch l\u00e0m t\u0103ng l\u01b0\u1ee3ng d\u1ecbch trong OCT, d\u1eabn \u0111\u1ebfn t\u0103ng \u00e1p l\u1ef1c k\u1ebd trong OCT g\u00e2y ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa. H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n (kho\u1ea3ng 62%) \u0111\u1ec1u c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0o giai \u0111o\u1ea1n th\u1ee9 3 trong qu\u00e1 tr\u00ecnh mang thai v\u00e0 th\u01b0\u1eddng bi\u1ebfn m\u1ea5t t\u1ef1 nhi\u00ean sau khi sinh.<\/li>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/chay-than-nhan-tao-nhung-dieu-can-biet\/\">Ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o \u0111\u1ecbnh k\u1ef3<\/a>:Nguy\u00ean nh\u00e2n do nhi\u1ec1u y\u1ebfu t\u1ed1, b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn m\u1ea1n c\u00f3 li\u00ean quan v\u1edbi t\u0103ng ure m\u00e1u. K\u1ebft qu\u1ea3 l\u00e0 c\u00e1c th\u1ea7n kinh ngo\u1ea1i bi\u00ean \u0111\u1ec1u b\u1ecb ch\u1ea5n th\u01b0\u01a1ng nh\u1ecf v\u00e0 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9. Ure huy\u1ebft t\u0103ng c\u0169ng li\u00ean quan \u0111\u1ebfn s\u1ef1 t\u0103ng th\u1ec3 t\u00edch d\u1ecbch ngo\u1ea1i b\u00e0o m\u00e0 c\u00f3 th\u1ec3 g\u00e2y t\u0103ng \u00e1p l\u1ef1c trong OCT. C\u00e1c t\u00e1c \u0111\u1ed9ng n\u00e0y c\u1ee7a ure huy\u1ebft t\u0103ng c\u00f3 th\u1ec3 tr\u1edf n\u00ean n\u1eb7ng h\u01a1n b\u1edfi th\u00f4ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch khi b\u1ec7nh nh\u00e2n ph\u1ea3i ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/li>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/benh\/suy-giap-3245\/\">Suy gi\u00e1p:<\/a><\/li>\n<\/ul>\n<p>Nguy\u00ean nh\u00e2n \u0111\u01b0\u1ee3c cho l\u00e0 do s\u1ef1 t\u00edch t\u1ee5 Zyxedemateous m\u00f4 trong d\u00e2y ch\u1eb1ng ngang c\u1ed5 tay.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/benh\/gout-gut-3052\/\">B\u1ec7nh G\u00fat<\/a>:<\/li>\n<\/ul>\n<p>Do s\u1ef1 l\u1eafng \u0111\u1ecdng tinh th\u1ec3 urat trong g\u00e2n g\u1ea5p g\u00e2y ph\u00ec \u0111\u1ea1i g\u00e2n, ho\u1eb7c c\u00e1c h\u1ea1t tophy trong \u1ed1ng c\u1ed5 tay ph\u00e1t tri\u1ec3n t\u1eeb bao kh\u1edbp, bao ho\u1ea1t d\u1ecbch , t\u00ecnh tr\u1ea1ng vi\u00eam ph\u00ec \u0111\u1ea1i bao ho\u1ea1t d\u1ecbch g\u00e2n g\u1ea5p do g\u00fat c\u0169ng g\u00e2y ra ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa<\/p>\n<ul>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/co-xuong-khop\/cac-benh-thuong-gap\/viem-khop-dang-thap-nguyen-nhan-trieu-chung-chan-doan-va-dieu-tri\/\">Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/a>:<\/li>\n<\/ul>\n<p>G\u00e2y ra vi\u00eam bao g\u00e2n d\u1eabn \u0111\u1ebfn ph\u00f9 n\u1ec1 v\u00e0 \u1ee9 d\u1ecbch trong bao g\u00e2n g\u1ea5p.<\/p>\n<ul>\n<li>B\u1ec7nh \u0111a d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: Do t\u00ednh ch\u1ea5t d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng c\u1ee7a th\u1ea7n kinh v\u1edbi s\u1ef1 ch\u00e8n \u00e9p n\u00ean d\u1ec5 b\u1ecb HC OCT<\/li>\n<li>Thi\u1ebfu h\u1ee5t vitamin: Theo nghi\u00ean c\u1ee9u c\u1ee7a Folkers v\u00e0 c\u1ed9ng s\u1ef1 c\u00f3 m\u1ed1i quan h\u1ec7 gi\u1eefa thi\u1ebfu h\u1ee5t vitamin B6, B2 v\u00e0 s\u1ef1 n\u1eb7ng l\u00ean c\u1ee7a HC OCT.<\/li>\n<\/ul>\n<p><strong>Nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i v\u1ec1 \u0111o \u00e1p l\u1ef1c trong \u1ed1ng c\u1ed5 tay<\/strong><\/p>\n<p>V\u1edbi gi\u1ea3 thuy\u1ebft t\u0103ng \u00e1p l\u1ef1c kho\u1ea3ng k\u1ebd l\u00e0 y\u1ebfu t\u1ed1 d\u1eabn \u0111\u1ebfn ch\u00e8n \u00e9p th\u1ea7n kinh, ch\u00fang t\u00f4i ti\u1ebfn h\u00e0nh nghi\u00ean c\u1ee9u vi\u1ec7c \u0111o \u00e1p l\u1ef1c trong \u1ed1ng c\u1ed5 tay.<\/p>\n<p>K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i tr\u00ean 33 b\u1ec7nh nh\u00e2n b\u1ecb h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt cho th\u1ea5y \u1edf t\u01b0 th\u1ebf trung gian, \u00e1p l\u1ef1c \u1ed1ng c\u1ed7 tay l\u00e0 13,87 \u00b1 1,56 mmHg, \u1eda t\u01b0 th\u1ebf g\u1ea5p c\u1ed5 tay 90\u00b0 v\u00e0 du\u1ed7i c\u1ed5 tay 90&#8243;, \u00e1p l\u1ef1c trong \u1ed1ng c\u1ed5 tay t\u0103ng l\u00ean cao t\u01b0\u01a1ng \u1ee9ng l\u00e0 27,60 \u00b1 2,53 mmHg and 34,76 \u00b1 3,25 mmHg.<\/p>\n<p>C\u00e1c k\u1ebft qu\u1ea3 c\u1ee7a ch\u00fang t\u00f4i c\u0169ng c\u1ecf kh\u00e1c bi\u1ec7t so v\u1edbi 2 t\u00e1c gi\u1ea3 c\u00f4ng b\u1ed5 tr\u01b0\u1edbc ch\u00fang t\u00f4i l\u00e0 Gelbemian v\u00e0 Rojviroj. C\u00e1c t\u00e1c gi\u1ea3 c\u00f9ng cho r\u1eb1ng s\u1ef1 kh\u00e1c bi\u1ec7t l\u00e0 do ph\u01b0\u01a1ng ti\u1ec7n v\u00e0 c\u00e1ch th\u1ee9c \u0111o \u0111\u1ea1c kh\u00e1c nhau.<\/p>\n<figure id=\"attachment_2734\" aria-describedby=\"caption-attachment-2734\" style=\"width: 697px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-2734\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Screenshot-543.png\" alt=\"ket-qua-do-ap-luc-ong-co-tay-o-cac-tu-the-khac-nhau-cua-chung-toi-v\u00e0-cac-tac-gia-khac\" width=\"697\" height=\"223\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Screenshot-543.png 697w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Screenshot-543-300x96.png 300w\" sizes=\"(max-width: 697px) 100vw, 697px\" \/><figcaption id=\"caption-attachment-2734\" class=\"wp-caption-text\">K\u1ebft qu\u1ea3 \u0111o \u00e1p l\u1ef1c \u1ed1ng c\u1ed5 tay \u1edf c\u00e1c t\u01b0 li\u1ec7u kh\u00e1c nhau cu\u1ea3 ch\u00fang t\u00f4i v\u00e0 c\u00e1c t\u00e1c gi\u1ea3 kh\u00e1c<\/figcaption><\/figure>\n<p>Trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i, vi\u1ec7c th\u1ef1c hi\u1ec7n tr\u00ean nh\u00f3m ch\u1ee9ng ch\u01b0a ti\u1ebfn h\u00e0nh \u0111\u01b0\u1ee3c do li\u00ean quan \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 \u0111\u1ea1o \u0111\u1ee9c nghi\u00ean c\u1ee9u. Tuy nhi\u00ean, k\u1ebft qu\u1ea3 c\u1ee7a Gelberman v\u00e0 Rojviroj tr\u00ean nh\u00f3m ch\u1ee9ng c\u0169ng kh\u00f4ng gi\u1ed1ng nhau cho th\u1ea5y v\u1ea5n \u0111\u1ec1 ph\u01b0\u01a1ng ti\u1ec7n v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111o \u0111\u1ea1c r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c l\u01b0\u1ee3ng gi\u00e1 ch\u00ednh x\u00e1c k\u1ebft qu\u1ea3.<\/p>\n<figure id=\"attachment_2741\" aria-describedby=\"caption-attachment-2741\" style=\"width: 789px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-2741\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Screenshot-544.png\" alt=\"Ket-qua-nghien-cuu-tren-nhom-chung-cua-2-tac-gia\" width=\"789\" height=\"484\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Screenshot-544.png 789w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Screenshot-544-300x184.png 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Screenshot-544-768x471.png 768w\" sizes=\"(max-width: 789px) 100vw, 789px\" \/><figcaption id=\"caption-attachment-2741\" class=\"wp-caption-text\">K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u tr\u00ean 2 nh\u00f3m ch\u1ee9ng c\u1ee7a 2 t\u00e1c gi\u1ea3<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong><\/p>\n<ol>\n<li>Leti Acciaro A. Landi, N. Della Rosa, A. Pellacani, (2007), Carpal Tunnel Syndrome: Rare Causes. Carpal Tunnel Syndrome. Vol. 13.: Springer,<\/li>\n<li>Ashworth Nl (2014). Carpal Tunnel Syndrome, BMJ clinical evidence<\/li>\n<li>Gelfman (2009), Long-term trends in carpal tunnel syndrome. Neurology,. 72(1): p. 33-41.<\/li>\n<li>Luchetti. (2007), Btiopathogenesis, in Carpal tunnel syndrome, springer, p. 21-27.<\/li>\n<li>David Bozeutka, Barry Katzman (2002), Open carpal tunnel release. Atlas of the Hand Clinics p i 81 \u2014 189<\/li>\n<li>Atroshi I, Flondell M, HoferM, Ranstam (\u00a3013). Methylprednisolone injections for the carpal tunnel syndrome: a randomized, placebo-controlled trial. Ann Intern Med.<\/li>\n<li>w. Keith (2010), American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of carpal tunnel syndrome. J Bone Joint Slirg Am,. 92(1): p. 218-9.<\/li>\n<li>c. Amadio (2007). History of Carpal Tunnel Syndrome. Carpal Tunnel Syndrome. Vol. 2. p 3-8<\/li>\n<li>Cannon BW, Love JG (1946), Tardy median palsy; median neuritis; median thenar neuritisamen able to surgery. Surgery 20:210-216<\/li>\n<li>Phalen GS (1951), Spontaneous compression of the median nerve at the wrist. JAMA 145:1128-1132<\/li>\n<li>Phalen GS, Gardner WJ, La Londe AA (1950), Neuropathy of the median nerve due to compression beneath the transverse carpal ligament. J Bone Joint Siirg 32A: 109-112 31.<\/li>\n<li>Phalen GS,Kendrick JI (1957), Compression neuropathy of the median nerve in the carpal tunnel. JAMA 164:524-530<\/li>\n<li>Amadio PC (1992) The Mayo Clinic and carpal tunnel syndrome. Mayo Clin Proc 67:42-48<\/li>\n<li>Simpson JA (1956), Electrical signs in the diagnosis of carpal tunnel and related syndromes. J Neurol Neurosurg Psychiatry 19:275-280<\/li>\n<\/ol>\n<table>\n<tbody>\n<tr>\n<td><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<ol start=\"15\">\n<li>A. Berger p. Yugucros (2007), Anatomy of the Carpal Tunnel. Carpal tunnel syndrome. Vol. 2.: springer, p. 10-12<\/li>\n<li>-M. Schmidt (2007), Normal Anatomy and Variations of the Median Nerve in the Carpal Tunnel. Carpal tunnel syndrome. Vol. 3.: Springer, p 13-19<\/li>\n<li>Tr\u1ecbnh V\u0103n Minh (2004), Gi\u1ea3i ph\u1eabu ng\u01b0\u1eddi.: NXB Y h\u1ecdc.<\/li>\n<li>Michael Forseth, Peter Stem (2002), Management of complications of carpal tunnel release. Atlas of the Hand Clinics p 309-3 ] 6<\/li>\n<li>Bedeschi (2007), Carpal Tunnel Syndrome Surgical Complications. Carpal tunnel syndrome. Vol. 37.: Springer. 266-289.<\/li>\n<li>Luchetti (2007), The Pathophysiology of Median Nerve Compression. Carpal tunnel syndrome. Vol. 5.: Springer, p 28-44<\/li>\n<li>Bruce Conolly (1984), Treatment of carpal tunnel syndrome. A Colour Atias of Treatment of carpal tunnel syndrome..<\/li>\n<li>Agnes Beng-Hoi Tan, Jacqueline Siau Woon Tan (2012), Outcomes of open carpal tunnel releases and its predictors. A prospective study. HandSlirg,. 17(3): p. 341-345.<\/li>\n<li>Kerwin, c. s. Williams, J. G. Seiler (1996), The pathophysiology of carpal tunnel syndrome. Hand Clin, 12(2): p. 243-5 ].<\/li>\n<li>Folkers and J. Ellis (1990) , Successful therapy with vitamin B6 and vitamin B2 of the carpal tunnel syndrome and need for determination of the RDAs for vitamins B6 and B2 for disease states. Ann N YAcadSci,. 585: p. 295-301.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>H\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay (Carpal Tunnel Syndrome) \u0111\u01b0\u1ee3c Sir James Paget m\u00f4 t\u1ea3 \u0111\u1ea7u ti\u00ean t\u1eeb n\u0103m 1854, l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd ch\u00e8n \u00e9p d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean hay g\u1eb7p nh\u1ea5t, h\u1ed9i ch\u1ee9ng n\u00e0y x\u1ea3y ra khi th\u1ea7n kinh gi\u1eefa b\u1ecb ch\u00e8n \u00e9p khi n\u00f3 \u0111i ngang qua \u1ed1ng c\u1ed5 tay. 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