{"id":2767,"date":"2023-04-09T19:26:52","date_gmt":"2023-04-09T12:26:52","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2767"},"modified":"2023-04-14T23:11:12","modified_gmt":"2023-04-14T16:11:12","slug":"thoai-hoa-khop-goi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/thoai-hoa-khop-goi\/","title":{"rendered":"Tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i: T\u1eeb c\u01a1 ch\u1ebf b\u1ec7nh sinh \u0111\u1ebfn bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng"},"content":{"rendered":"

Tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 ph\u1ed5 bi\u1ebfn trong d\u00e2n s\u1ed1 hi\u1ec7n nay, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf c\u00e1c ng\u01b0\u1eddi trung ni\u00ean v\u00e0 cao tu\u1ed5i. \u0110\u00e2y l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 tho\u00e1i h\u00f3a v\u00e0 m\u00f2n c\u1ee7a c\u00e1c kh\u1edbp, d\u1eabn \u0111\u1ebfn gi\u1ea3m t\u00ednh linh ho\u1ea1t v\u00e0 \u0111\u1ed9 b\u1ec1n c\u1ee7a kh\u1edbp g\u1ed1i. Nh\u1eefng tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p c\u1ee7a tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i bao g\u1ed3m \u0111au v\u00e0 kh\u00f3 kh\u0103n trong vi\u1ec7c di chuy\u1ec3n.<\/strong><\/p>\n

1. \u0110\u1ecbnh ngh\u0129a tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i<\/b><\/h2>\n

Tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i (THKG) l\u00e0 t\u1ed5n th\u01b0\u01a1ng tho\u00e1i h\u00f3a c\u1ee7a s\u1ee5n kh\u1edbp do c\u00f3 s\u1ef1 b\u1ea5t th\u01b0\u1eddng trong qu\u00e1 tr\u00ecnh sinh t\u1ed5ng h\u1ee3p ch\u1ea5t c\u0103n b\u1ea3n c\u1ee7a c\u00e1c t\u1ebf b\u00e0o s\u1ee5n. \u0110\u1eb7c tr\u01b0ng c\u1ee7a b\u1ec7nh l\u00e0 qu\u00e1 tr\u00ecnh m\u1ea5t s\u1ee5n kh\u1edbp v\u00e0 h\u00ecnh th\u00e0nh c\u00e1c gai x\u01b0\u01a1ng c\u1ea1nh kh\u1edbp [1], [2],<\/span><\/p>\n

2. Ph\u00e2n lo\u1ea1i b\u1ec7nh tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i<\/strong><\/h2>\n
    \n
  • Tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i nguy\u00ean ph\u00e1t<\/i><\/b><\/li>\n<\/ul>\n

    S\u1ef1 l\u00e3o h\u00f3a l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh c\u1ee7a THKG. B\u1ec7nh th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n mu\u1ed9n \u1edf ng\u01b0\u1eddi tr\u00ean 50 tu\u1ed5i. C\u00f9ng v\u1edbi s\u1ef1 thay \u0111\u1ed5i tu\u1ed5i t\u00e1c, s\u1ef1 th\u00edch \u1ee9ng c\u1ee7a s\u1ee5n kh\u1edbp v\u1edbi c\u00e1c t\u00e1c nh\u00e2n t\u00e1c \u0111\u1ed9ng l\u00ean kh\u1edbp ng\u00e0y c\u00e0ng gi\u1ea3m. Nguy\u00ean nh\u00e2n c\u1ee7a s\u1ef1 thay \u0111\u1ed5i n\u00e0y c\u00f3 th\u1ec3 l\u00e0 s\u1ed1 l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn nu\u00f4i d\u01b0\u1ee1ng v\u00f9ng kh\u1edbp b\u1ecb gi\u1ea3m s\u00fat, \u1ea3nh h\u01b0\u1edfng t\u1edbi vi\u1ec7c nu\u00f4i d\u01b0\u1ee1ng s\u1ee5n; s\u1ef1 ph\u00e2n b\u1ed1 ch\u1ecbu l\u1ef1c c\u1ee7a kh\u1edbp b\u1ecb thay \u0111\u1ed5i th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh tho\u00e1i h\u1ecfa. THKG nguy\u00ean ph\u00e1t hi\u1ec7n nay, theo nhi\u1ec1u k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u, \u0111ang c\u00f3 xu h\u01b0\u1edbng tr\u1ebb h\u00f3a[l],[3].<\/span><\/p>\n

      \n
    • Tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i th\u1ee9 ph\u00e1t<\/i><\/b><\/li>\n<\/ul>\n

      Th\u01b0\u1eddng l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a c\u00e1c qu\u00e1 tr\u00ecnh sau:<\/span><\/p>\n

        \n
      • Ch\u1ea5n th\u01b0\u01a1ng: g\u00e3y x\u01b0\u01a1ng n\u1ed9i kh\u1edbp, c\u1eafn l\u1ec7ch, t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam, sau c\u1eaft s\u1ee5n ch\u00eam, vi ch\u1ea9n th\u01b0\u01a1ng li\u00ean ti\u1ebfp, v\u1eb9o tr\u1ee5c chi.<\/span><\/li>\n
      • Sau c\u00e1c b\u1ec7nh l\u00fd x\u01b0\u01a1ng s\u1ee5n: ho\u1ea1i t\u1eed x\u01b0\u01a1ng, h\u00fay ho\u1ea1i s\u1ee5n do vi\u00eam, vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, vi\u00eam kh\u1edbp nhi\u1ec5m khu\u1ea9n, b\u1ec7nh Paget<\/span><\/li>\n
      • \u00a0B\u1ec7nh kh\u1edbp vi tinh th\u1ec3: G\u00fat m\u1ea1n t\u00ednh, calci h\u00f3a s\u1ee5n kh\u1edbp<\/span><\/li>\n
      • B\u1ec7nh Hemophilia<\/span><\/li>\n
      • B\u1ec7nh n\u1ed9i ti\u1ebft: \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, to vi\u1ec1n c\u1ef1c, c\u01b0\u1eddng gi\u00e1p tr\u1ea1ng, c\u01b0\u1eddng c\u1eadn gi\u00e1p, m\u00e3n kinh[l],[3].<\/span><\/li>\n<\/ul>\n

        3. C\u01a1 ch\u1ebf b\u1ec7nh sinh tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i<\/b><\/h2>\n

        Nhi\u1ec1u thuy\u1ebft gi\u1ea3i th\u00edch s\u1ef1 tho\u00e1i ho\u00e1 s\u1ee5n trong b\u1ec7nh tho\u00e1i ho\u00e1 kh\u1edbp, nh\u01b0ng ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch theo thuy\u1ebft c\u01a1 h\u1ecdc l\u00e0 khi c\u00f3 s\u1ef1 qu\u00e1 t\u1ea3i c\u01a1 h\u1ecdc l\u00e0m thay \u0111\u1ed5i chuy\u1ec3n ho\u00e1 c\u1ee7a c\u00e1c<\/span>t\u1ebf b\u00e0o s\u1ee5n, h\u00ecnh th\u00e0nh c\u00e1c men ph\u00e2n h\u1ee7y protein (proteolytic) g\u00e2y ph\u00e1 v\u1ee1 c\u00e1c ch\u1ea5t c\u0103n b\u1ea3n c\u1ee7a s\u1ee5n. Hi\u1ec7n t\u01b0\u1ee3ng b\u1ec7nh l\u00fd \u0111\u1ea7u ti\u00ean l\u00e0 nh\u1eefng m\u1ea3nh g\u00e3y nh\u1ecf nhi\u1ec1u c\u1ee1 kh\u00e1c nhau, sau \u0111\u00f3 g\u00e2y tho\u00e1i ho\u00e1 v\u00e0 m\u1ea5t d\u1ea7n s\u1ee5n kh\u1edbp, bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac c\u1ee7a kh\u1edbp v\u00e0 h\u00ecnh th\u00e0nh gai x\u01b0\u01a1ng [1],[2].<\/span><\/p>\n

        Giai \u0111o\u1ea1n s\u1edbm c\u00e1c t\u1ebf b\u00e0o s\u1ee5n c\u00f3 bi\u1ec3u hi\u1ec7n ph\u00ec \u0111\u1ea1i, t\u0103ng ti\u1ebft c\u00e1c cytokin nh\u01b0 Interleukin I (IL-1); y\u1ebfu t\u1ed1 ho\u1ea1i t\u1eed u (TNFa) v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng kh\u00e1c, c\u00e1c men l\u00e0m ti\u00eau c\u00e1c ch\u1ea5t c\u0103n b\u1ea3n nh\u01b0: c\u00e1c collagenase, gelatinase, stromolysin, c\u00e1c men kh\u00e1c nh\u01b0 lysosyme v\u00e0 cathepsin, TL-1 v\u00e0 TNF g\u00e2y tho\u00e1i ho\u00e1 s\u1ee5n b\u1eb1ng c\u00e1ch k\u00edch th\u00edch ti\u1ebft c\u00e1c men g\u00e2y ph\u00e1 h\u1ee7y collagen v\u00e0 proteoglycan, \u0111\u1ed3ng th\u1eddi \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p c\u00e1c protein c\u1ee7a ch\u1ea5t c\u0103n b\u1ea3n c\u1ee7a s\u1ee5n.<\/span><\/p>\n

        C\u00e1c men k\u1ec3 tr\u00ean b\u1ecb \u1ee9c ch\u1ebf b\u1edfi m\u1ed9t protein c\u00f3 tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed nh\u1ecf, g\u1ecdi l\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf t\u1ed5 ch\u1ee9c c\u1ee7a metalloproteinase. S\u1ef1 c\u00e2n b\u1eb1ng gi\u1eefa c\u00e1c ch\u1ea5t k\u00edch th\u00edch v\u00e0 \u1ee9c ch\u1ebf ho\u1ea1t t\u00ednh c\u1ee7a c\u00e1c men \u0111\u1ea3m b\u1ea3o s\u1ef1 chuy\u00ean ho\u00e1 s\u1ee5n b\u00ecnh th\u01b0\u1eddng. Khi t\u0103ng y\u1ebfu t\u1ed1 k\u00edch th\u00edch ho\u1ea1t t\u00ednh men d\u1eabn \u0111\u1ebfn tho\u00e1i ho\u00e1 s\u1ee5n kh\u1edbp. Qu\u00e1 tr\u00ecnh tho\u00e1i ho\u00e1 kh\u1edbp kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c, v\u00ec khi c\u00f3 bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac s\u1ee5n th\u00ec t\u00e1c \u0111\u1ed9ng c\u01a1 h\u1ecdc l\u00ean kh\u1edbp c\u0169ng thay \u0111\u1ed5i, d\u1eabn \u0111\u1ebfn nh\u1eefng qu\u00e1 t\u00e0i n\u1eb7ng h\u01a1n, l\u00e0m gi\u1ea3i ph\u00f3ng nhi\u1ec1u men g\u00e2y tho\u00e1i ho\u00e1 h\u01a1n v\u00e0 ti\u1ebfp t\u1ee5c nh\u01b0 v\u1eady qu\u00e1 tr\u00ecnh tho\u00e1i ho\u00e1 li\u00ean t\u1ee5c x\u1ea3y ra[l],[2],<\/span><\/p>\n

        4. M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nguy c\u01a1 li\u00ean quan v\u1edbi tho\u00e1i ho\u00e1 kh\u1edbp\u00a0<\/b><\/h2>\n
          \n
        • Ch\u1ea5n th\u01b0\u01a1ng v\u00e0 vi ch\u1ea5n th\u01b0\u01a1ng c\u00f3 vai tr\u00f2 quan tr\u1ecdng l\u00e0m thay \u0111\u1ed5i b\u1ec1 m\u1eb7t s\u1ee5n, nh\u1eefng ch\u1ea5n th\u01b0\u01a1ng l\u1edbn g\u00e2y g\u00e3y x\u01b0\u01a1ng, tr\u1eadt kh\u1edbp k\u00e8m theo t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ho\u1eb7c ph\u00e2n b\u1ed1 l\u1ea1i \u00e1p l\u1ef1c tr\u00ean b\u1ec1 m\u1eb7t s\u1ee5n kh\u1edbp.<\/span><\/li>\n
        • Y\u1ebfu t\u1ed1 n\u1ed9i ti\u1ebft v\u00e0 chuy\u1ec3n ho\u00e1: b\u1ec7nh to \u0111\u1ea7u chi, suy ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p, ph\u1ee5 n\u1eef sau m\u00e3n kinh.<\/span><\/li>\n
        • C\u00e1c d\u1ecb t\u1eadt b\u1ea9m sinh, kh\u1edbp l\u1ecfng l\u1ebbo.<\/span><\/li>\n
        • Vi\u00eam kh\u1edbp nhi\u1ec5m khu\u1ea9n c\u1ea5p t\u00ednh, ho\u1eb7c m\u00e3n t\u00ednh (vi\u00eam m\u1ee7 kh\u1edbp, lao kh\u1edbp).<\/span><\/li>\n
        • Vi\u00eam kh\u1edbp do c\u00e1c b\u1ec7nh kh\u1edbp m\u1ea1n t\u00ednh (vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p).<\/span><\/li>\n
        • Thi\u1ebfu m\u00e1u, ho\u1ea1i t\u1eed x\u01b0\u01a1ng.<\/span><\/li>\n
        • Lo\u1ea1n d\u01b0\u1ee1ng x\u01b0\u01a1ng.<\/span><\/li>\n
        • R\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng sau c\u00e1c b\u1ec7nh th\u1ea7n kinh.<\/span><\/li>\n
        • B\u1ec7nh r\u1ed1i lo\u1ea1n \u0111\u00f4ng ch\u1ea3y m\u00e1u (Hemophilia), u m\u00e1u[4],[5].<\/span><\/li>\n<\/ul>\n

          5. S\u1ef1 thay \u0111\u1ed5i c\u1ee7a s\u1ee5n kh\u1edbp trong b\u1ec7nh tho\u00e1i h\u00f3a kh\u1edbp\u00a0<\/b><\/h2>\n

          \u0110\u1ea1i th\u1ec3:<\/span><\/i> th\u1ea5y m\u1eb7t s\u1ee5n kh\u00f4ng tr\u01a1n nh\u1eb5n, m\u1ea5t b\u00f3ng, c\u00f3 c\u00e1c v\u1ebft n\u1ee9t, c\u00e1c v\u1ebft lo\u00e9t tr\u00ean b\u1ec1 m\u1eb7t s\u1ee5n, l\u00e0m l\u1ed9 ph\u1ea7n x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n, d\u00e0y l\u1edbp x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n v\u00e0 c\u00f3 c\u00e1c gai x\u01b0\u01a1ng \u1edf ph\u1ea7n r\u00eca s\u1ee5n kh\u1edbp. G<\/span>iai \u0111o\u1ea1n r\u1ea5t s\u1edbm c\u00f3 th\u1ec3 th\u1ea5y xu\u1ea5t hi\u1ec7n c\u00e1c t\u1ebf b\u00e0o vi\u00eam nh\u01b0ng ch\u1ec9 trong th\u1eddi gian ng\u00e1n, h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng vi\u00eam \u00edt g\u1eb7p trong tho\u00e1i ho\u00e1 kh\u1edbp.<\/span><\/p>\n

          T\u1ed5n th\u01b0\u01a1ng m\u00e0ng ho\u1ea1t d\u1ecbch l\u00e0 bi\u1ec3u hi\u1ec7n th\u1ee9 ph\u00e1t v\u00e0 mu\u1ed9n h\u01a1n th\u01b0\u1eddng bi\u1ebfn \u0111\u1ed5i x\u01a1 h\u00f3a m\u00e0ng ho\u1ea1t d\u1ecbch v\u00e0 bao kh\u1edbp, \u0111\u00f4i khi c\u00f3 vi\u00eam tr\u00e0n d\u1ecbch 0 kh\u1edbp th\u1ee9 ph\u00e1t do c\u00e1c m\u00e1nh s\u1ee5n nh\u1ecf b\u1ecb bong tr\u1edf th\u00e0nh c\u00e1c di v\u1eadt nh\u1ecf trong \u00f4 kh\u1edbp k\u00edch th\u00edch gi\u1ed1ng nh\u01b0 vi\u00eam kh\u1edbp do vi tinh th\u1ec3.<\/span><\/p>\n

          Shucket cho r\u1eb1ng c\u00f3 s\u1ef1 (thay \u0111\u1ed5i r\u00f5 r\u1ec7t v\u1ec1 sinh h\u00f3a trong s\u1ee5n kh\u1edbp b\u1ecb tho\u00e1i h\u00f3a l\u00e0 nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ebfn s\u1ee5n b\u1ecb suy y\u1ebfu khi ch\u1ecbu t\u1ea3i v\u00e0 sau \u0111\u00f3 l\u00e0 c\u00e1c bi\u1ec3u hi\u1ec7n kh\u00e1c c\u1ee7a tho\u00e1i h\u00f3a kh\u1edbp. S\u1ef1 suy y\u1ebfu v\u1ec1 s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o s\u1ee5n c\u00f3 th\u1ec3 t\u1edbi 50% n\u1ebfu so s\u00e1nh gi\u1eefa nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh tr\u00ean 80 tu\u1ed5i v\u1edbi nh\u1eefng ng\u01b0\u1eddi d\u01b0\u1edbi 40 tu\u1ed5i. Nh\u1eefng thay \u0111\u1ed5i trong c\u1ea5u t\u1ea1o h\u00f3a h\u1ecdc c\u1ee7a s\u1ee5n kh\u1edbp \u0111\u00e3 x\u1ea3y ra tr\u01b0\u1edbc tu\u1ed5i d\u1eady th\u00ec v\u00e0 ti\u1ebfp t\u1ee5c di\u1ec5n ra ng\u00e0y c\u00e0ng r\u00f5 r\u1ec7t \u1edf tu\u1ed5i trung ni\u00ean. So v\u1edbi c\u00e1c t\u1ebf b\u00e0o tr\u1ebb, c\u00e1c t\u1ebf b\u00e0o gi\u00e0 t\u1ed5ng h\u1ee3p r\u1ea5t \u00edt protein v\u00e0 collagen. \u0110i\u1ec1u n\u00e0y d\u1eabn t\u1edbi suy gi\u1ea3m \u0111\u1ed9 b\u1ec1n s\u1ee5n kh\u1edbp v\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng t\u00e1i t\u1ea1o. Nh\u01b0 v\u1eady, khi c\u00e1c t\u1ebf b\u00e0o s\u1ee5n gi\u00e0 kh\u00f4ng kh\u00f4i ph\u1ee5c l\u1ea1i \u0111\u01b0\u1ee3c m\u1ed9t c\u00e1ch nhanh ch\u00f3ng, v\u00e0 v\u1ebft n\u1ee9t c\u1ef1c nh\u1ecf s\u1ebd xu\u1ea5t hi\u1ec7n \u1edf v\u00f9ng \u0111\u00e1y s\u1ee5n, th\u01b0\u01a1ng t\u1ed5n ban \u0111\u1ea7u xu\u1ea5t hi\u1ec7n v\u00e0 d\u1ea7n d\u1ea7n chuy\u1ec3n th\u00e0nh tho\u00e1i h\u00f3a kh\u1edbp.<\/span><\/p>\n

          \u0110\u1ed9 I: m\u1eb7t s\u1ee5n kh\u1edbp c\u00f2n nguy\u00ean v\u1eb9n, bang phang, t\u1ebf b\u00e0o c\u00f2n sinh s\u1ea3n, x\u01a1 h\u00f3a \u00edt, v\u00f9ng gi\u1eefa v\u00e0 v\u00f9ng s\u00e2u c\u1ee7a s\u1ee5n kh\u1edbp kh\u00f4ng \u1ea3nh h\u01b0\u1edfng. <\/span><\/p>\n

          \u0110\u1ed9 2: b\u1ec1 m\u1eb7t di\u1ec7n kh\u1edbp b\u1ecb gi\u00e1n \u0111o\u1ea1n, x\u01a1 h\u00f3a k\u00e8m theo t\u0103ng sinh t\u1ebf b\u00e0o, ch\u1ea5t c\u01a1 b\u1ea3n c\u1ee7a m\u00f4 s\u1ee5n t\u0103ng kh\u1ea3 n\u0103ng b\u1eaft m\u00e0u thu\u1ed1c nhu\u1ed9m v\u00e0 t\u1ebf b\u00e0o ho\u1ea1i t\u1eed \u1edf v\u00f9ng gi\u1eefa c\u1ee7a s\u1ee5n kh\u1edbp. <\/span><\/p>\n

          \u0110\u1ed9 3: c\u00f3 v\u1ebft n\u1ee9t \u0111\u1ee9ng d\u1ecdc k\u00e9o d\u00e0i v\u00e0o v\u00f9ng gi\u1eefa c\u1ee7a s\u1ee5n kh\u1edbp.X\u01a1 h\u00f3a c\u1ee7a ch\u1ea5t c\u01a1 b\u1ea3n lan v\u00e0o v\u00f9ng gi\u1eefa c\u1ee7a s\u1ee5n kh\u1edbp.Tho\u00e1i h\u00f3a kh\u1edbp ti\u1ebfn tri\u1ec3n c\u00e1c v\u1ebft n\u1ee9t c\u00f3 th\u1ebf t\u00e1ch ra c\u00e1c nh\u00e1nh v\u00e0 k\u00e9o d\u00e0i v\u00e0o v\u00f9ng s\u00e2u c\u1ee7a s\u1ee5n kh\u1edbp, c\u00f3 c\u00e1c t\u1ebf b\u00e0o ch\u1ebft \u1edf c\u00e1c v\u00f9ng gi\u00e1p v\u1edbi c\u00e1c v\u1ebft n\u1ee9t,<\/span><\/p>\n

          \u0110\u1ed9 4: s\u1ee5n kh\u1edbp b\u1ecb ch\u1ee3t lo\u00e9t, m\u1ea5t ch\u1ea5t c\u01a1 b\u1ea3n c\u1ee7a m\u00f4 s\u1ee5n \u1edf giai \u0111o\u1ea1n s\u1edbm bi\u1ec3u hi\u1ec7n b\u1eb1ng bong l\u00e1 s\u1ee5n m\u1ecfng kh\u1ecfi v\u00f9ng n\u00f4ng c\u1ee7a s\u1ee5n kh\u1edbp, khi c\u00e1c v\u1ebft ch\u1ee3t r\u1ed9ng h\u01a1n d\u1eabn t\u1edbi h\u00ecnh th\u00e0nh h\u1ed1, n\u1ee9t v\u00e0 t\u1ea1i \u0111\u00f3 m\u1ea5t ch\u1ea5t c\u01a1 b\u1ea3n.<\/span><\/p>\n

          \u0110\u1ed9 5: di\u1ec7n kh\u1edbp m\u1ea5t h\u1ebft m\u00f4 s\u1ee5n trong bao ph\u1ee7, s\u1ee5n trong kh\u00f4ng l\u1eafng \u0111\u1ecdng kho\u00e1ng ch\u1ea5t b\u1ecb lo\u00e9t tr\u1ee3t ho\u00e0n to\u00e0n.<\/span><\/p>\n

          \u0110\u1ed9 6: bi\u1ebfn d\u1ea1ng kh\u1edbp, g\u00e3y x\u01b0\u01a1ng vi th\u1ec3, bi\u1ebfn \u0111\u1ed5i d\u01b0\u1eddng vi\u1ec1n c\u1ee7a di\u1ec7n kh\u1edbp, m\u00f4 s\u1ee5n b\u1ecb ch\u1ee3t lo\u00e9t ho\u1eb7c m\u1ea5t, c\u00e1c gai x\u01b0\u01a1ng h\u00ecnh th\u00e0nh \u1edf b\u1edd v\u00e0 trong v\u00f9ng trung t\u00e2m di\u1ec7n kh\u1edbp.<\/span><\/p>\n

          Bi\u1ebfn \u0111\u1ed5i m\u00f4 x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n: <\/span><\/i>m\u00f4 x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n \u0111\u1ea9y l\u00ean tr\u1edf’ n\u00ean x\u01a1 c\u1ee9ng v\u00e0 k\u00e9m ng\u1ea5m kho\u00e1ng ch\u1ea5t, x\u01b0\u01a1ng c\u00f3 ch\u1ea5t l\u01b0\u1ee3ng k\u00e9m h\u01a1n.Thi\u1ebfu h\u1ee5t c\u00e1c t\u1ea1o c\u1ed1t b\u00e0o c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t ph\u1ea7n c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a tho\u00e1i h\u00f3a kh\u1edbp. C\u00e1c kh\u1edbp ch\u1ecbu l\u1ef1c c\u00f3 th\u1ec3 b\u1ecb g\u00e3y x\u01b0\u01a1ng vi th\u1ec3 \u1edf l\u1edbp x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n v\u00e0 ph\u1ee7 l\u00ean l\u1edbp s\u1ee5n. S\u1ef1 h\u00ecnh th\u00e0nh gai x\u01b0\u01a1ng c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t c\u01a1 ch\u1ebf b\u00f9 tr\u1eeb b\u1ea3o v\u1ec7 s\u1ee5n kh\u1edbp khi c\u00f3 t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c l\u1ef1c l\u00ean kh\u1edbp[1],[6-8].<\/span><\/p>\n

          6. Nguy\u00ean nh\u00e2n g\u00e2y \u0111au trong b\u1ec7nh tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i<\/b><\/h2>\n

          \u0110au trong THKG ch\u1ee7 y\u1ebfu do k\u00edch th\u00edch t\u1ea1i v\u00f9ng t\u1ed5n th\u01b0\u01a1ng s\u1ee5n kh\u1edbp. Ngo\u00e0i ra \u0111au c\u00f2n do c\u00e1c y\u1ebfu t\u1ed1 th\u1eed ph\u00e1t sau t\u1ed5n th\u01b0\u01a1ng s\u1ee5n g\u00e2y ra nh\u01b0[l],[4];<\/span><\/p>\n

            \n
          • Gai x\u01b0\u01a1ng l\u00e0m c\u0103ng \u0111\u1ea7u m\u00fat th\u1ea7n kinh \u1edf m\u00e0ng x\u01b0\u01a1ng<\/span><\/li>\n
          • Co kco c\u1ee7a c\u00e1c d\u00e2y ch\u1eb1ng trong kh\u1edbp<\/span><\/li>\n
          • Vi\u00eam bao ho\u1ea1t d\u1ecbch<\/span><\/li>\n
          • Vi\u00eam ho\u1eb7c do c\u0103ng bao kh\u1edbp do ph\u00f9 n\u1ec1<\/span><\/li>\n
          • Co c\u01a1 v\u00f9ng g\u1ed1i<\/span><\/li>\n<\/ul>\n

            7. Ph\u00e2n \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n kh\u1edbp<\/b><\/h2>\n

            7.1. M\u1ed9t s\u1ed1 ph\u00e2n \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n kh\u1edbp theo gi\u1ea3i ph\u1eabu b\u1ec7nh<\/i><\/b><\/p>\n

              \n
            • Ph\u00e2n lo\u1ea1i theo Outerbridge [9]<\/span><\/li>\n<\/ul>\n

              + \u0110\u1ed9 0: S\u1ee5n kh\u1edbp b\u00ecnh th\u01b0\u1eddng<\/span><\/p>\n

              + \u0110\u1ed9 l: S\u1ee5n kh\u1edbp v\u00f9ng tho\u00e1i h\u00f3a tr\u1edf n\u00ean m\u1ec1m h\u01a1n, ph\u00f9 n\u1ec1 v\u00e0 c\u00f3 th\u1ec3 \u0111\u1ed5i m\u00e0u v\u00e0ng<\/span><\/p>\n

              + \u0110\u1ed9 2: Khuy\u1ebft m\u1ed9t ph\u1ea7n b\u1ec1 d\u00e0y c\u1ee7a s\u1ee5n ho\u1eb7c xu\u1ea5t hi\u1ec7n c\u00e1c v\u1ebft n\u1ee9t tr\u00ean b\u1ec1 m\u1eb7t s\u1ee5n kh\u1edbp<\/span><\/p>\n

              + \u0110\u1ed9 3: <\/span>v\u1ebft <\/span>n\u1ee9t c\u1ee7a s\u1ee5n s\u00e2u h\u01a1n nh\u01b0ng ngang m\u1ee9c d\u01b0\u1edbi s\u1ee5n<\/span><\/p>\n

              + \u0110\u1ed9 4: M\u1ea5t ho\u00e0n to\u00e0n b\u1ec1 d\u00e0y c\u1ee7a s\u1ee5n, l\u1ed9 x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n<\/span><\/p>\n

                \n
              • Ph\u00e2n \u0111\u1ed9 theo <\/span>ICRS <\/b>(International Cartilage Repair Society classification) [ 10],<\/span><\/li>\n<\/ul>\n

                \u0110\u1ed9 0: S\u1ee5n kh\u1edbp b\u00ecnh th\u01b0\u1eddng<\/span><\/p>\n

                \u0110\u1ed9 X: S\u1ee5n g\u1ea7n nh\u01b0 b\u00ecnh th\u01b0\u1eddng. S\u1ee5n tr\u1edf n\u00ean m\u1ec1m h\u01a1n <\/span>v\u00e0 m\u1eb7t s\u1ee5n l\u00f5m<\/span>
                \n<\/span><\/p>\n

                h\u01a1n so v\u1edbi b\u00ecnh th\u01b0\u1eddng, xu\u1ea5t hi\u1ec7n v\u1ebft n\u1ee9t, g\u00e3y \u1edf n\u00f4ng<\/span><\/p>\n

                \u0110\u1ed9 3: S\u1ee5n t\u1ed5n th\u01b0\u01a1ng > 50% b\u1ec1 d\u00e0y s\u1ee5n nh\u01b0ng ch\u01b0a qua l\u1edbp x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n. S\u1ee5n \u0111ang bong, r\u1ed9p kh\u1ecfi x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n thu\u1ed9c giai \u0111o\u1ea1n n\u00e0y.<\/span><\/p>\n

                \u0110\u1ed9 4: T\u1ed5n th\u01b0\u01a1ng \u0111\u00e3 qua l\u1edbp x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n<\/span><\/p>\n

                7.2. Ph\u00e2n \u0111\u1ed9 theo Kellgren V\u00c0\u00ab Lawrence (198 7)<\/i><\/b><\/p>\n

                Tr\u00ean phim X-quang ch\u1ee5p g\u1ed1i th\u1eb3ng, c\u00f3 \u0111\u1ed3n tr\u1ecdng l\u01b0\u1ee3ng (b\u1ec7nh nh\u00e2n \u0111\u1ee9ng)[ll],[12]:<\/span><\/p>\n

                + \u0110\u1ed9 1: khe kh\u1edbp g\u1ea7n nh\u01b0 b\u00ecnh th\u01b0\u1eddng, c\u00f3 th\u1ebf c\u00f3 gai x\u01b0\u01a1ng nh\u1ecf.<\/span><\/p>\n

                + \u0110\u1ed9 2: khe kh\u1edbp h\u1eb9p nh\u1eb9, c\u00f3 gai x\u01b0\u01a1ng nh\u1ecf.<\/span><\/p>\n

                + \u0110\u1ed9 3: khe kh\u1edbp h\u1eb9p r\u00f5, c\u1ecf nhi\u1ec1u gai x\u01b0\u01a1ng k\u00edch th\u01b0\u1edbc v\u1eeba, v\u00e0i ch\u1ed7 \u0111\u1eb7c x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n, c\u00f3 th\u1ec3 c\u00f3 bi\u1ebfn d\u1ea1ng \u0111\u1ea7u x\u01b0\u01a1ng.<\/span><\/p>\n

                + \u0110\u1ed9 4: khe kh\u1edbp h\u1eb9p nhi\u1ec1u, gai x\u01b0\u01a1ng k\u00edch th\u01b0\u1edbc l\u1edbn, \u0111\u1eb7c x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n, bi\u1ebfn d\u1ea1ng r\u00f5 \u0111\u1ea7u x\u01b0\u01a1ng.<\/span><\/p>\n

                7.3 Ph\u00e2n \u0111\u1ed9 tr\u00ean h\u00ecnh \u1ea3nh c\u1ed9ng h\u01b0\u1edfng t\u1eeb (CHT)<\/i><\/b><\/p>\n

                + \u0110\u1ed9 0: b\u1edd s\u1ee5n kh\u1edbp b\u00ecnh th\u01b0\u1eddng<\/span><\/p>\n

                + \u0110\u1ed9 1: \u0111\u01b0\u1eddng vi\u1ec1n c\u1ee7a s\u1ee5n b\u00ecnh th\u01b0\u1eddng nh\u01b0ng s\u1ee5n t\u1ed5n th\u01b0\u01a1ng t\u0103ng t\u00edn hi\u1ec7u.<\/span><\/p>\n

                + \u0110\u1ed9 2: m\u1eb7t s\u1ee5n m\u00f2n ho\u1eb7c lo\u00e9t < 50% b\u1ec1 d\u00e0y s\u1ee5n <\/span><\/p>\n

                + \u0110\u1ed9 3: t\u1ed5n th\u01b0\u01a1ng ph\u1ea7n l\u1edbn bc d\u00e0y s\u1ee5n, > 50% nh\u01b0ng < 100%<\/span><\/p>\n

                + \u0110\u1ed9 4: t\u1ed5n th\u01b0\u01a1ng to\u00e0n b\u1ed9 b\u1ec1 d\u00e0y s\u1ee5n[20]<\/span><\/p>\n

                8. L\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng c\u1ee7a tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i<\/b><\/h2>\n

                8.1. \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng<\/i><\/b><\/p>\n

                  \n
                • \u0110au kh\u1edbp g\u1ed1i m\u1ed9t b\u00ean ho\u1eb7c hai b\u00ean (khi ngh\u1ec9 ng\u01a1i v\u00e0 ban \u0111\u00eam)<\/span><\/li>\n
                • C\u1ee9ng kh\u1edbp khi kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng (bu\u1ed5i s\u00e1ng d\u01b0\u1edbi 30 ph\u00fat)<\/span><\/li>\n
                • Gi\u1ea3m kh\u1ea3 n\u0103ng <\/span>v\u1eadn <\/b>\u0111\u1ed9ng (kh\u00f3 kh\u0103n v\u1edbi m\u1ed9t v\u00e0i \u0111\u1ed9ng t\u00e1c)<\/span><\/li>\n
                • C\u00f3 ti\u1ebfng l\u1ee5c c\u1ee5c trong g\u1ed1i khi c\u1eed \u0111\u1ed9ng<\/span><\/li>\n
                • T\u0103ng c\u1ea3m gi\u00e1c <\/span>\u0111au <\/b>x\u01b0\u01a1ng<\/span><\/li>\n
                • S\u1edd th\u1ea5y \u1ee5 x\u01b0\u01a1ng<\/span><\/li>\n
                • Nhi\u1ec7t \u0111\u1ed9 da v\u00f9ng kh\u1edbp b\u00ecnh th\u01b0\u1eddng ho\u1eb7c t\u0103ng nhi\u1ec7t \u0111\u1ed9 kh\u00f4ng \u0111\u00e1ng k\u1ec3. <\/span><\/li>\n<\/ul>\n

                  Trong c\u00e1c tri\u1ec7u ch\u1ee9ng tr\u00ean, \u0111au<\/span>kh\u1edbp g\u1ed1i l\u00e0 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng ch\u00ednh. <\/span>\u0110au t\u0103ng khi v\u1eadn \u0111\u1ed9ng, \u0111\u1ee1 \u0111au khi ngh\u1ec9 ng\u01a1i[l],[4].<\/span><\/p>\n

                  8.2. \u0110\u1eb7c \u0111i\u1ec3m c\u1eadn l\u00e2m s\u00e0ng<\/i><\/b><\/p>\n

                    \n
                  • X-quang (XQ) th\u01b0\u1eddng quy, 3 t\u01b0 th\u1ebf: <\/span><\/i><\/li>\n<\/ul>\n

                    +<\/span><\/i> T\u01b0 th\u1ebf th\u1eb3ng, ch\u00e2n ch\u1ecbu tr\u1ecdng l\u1ef1c: \u0111\u00e1nh gi\u00e1 khe kh\u1edbp m\u00e2m ch\u00e0y-l\u1ed3i c\u1ea7u ngo\u00e0i v\u00e0 m\u00e2m ch\u00e0y-l\u1ed3i c\u1ea7u trong <\/span><\/p>\n

                    + T\u01b0 th\u1ebf nghi\u00eang, g\u1ed1i g\u1ea5p 30\u00b0: \u0111\u00e1nh gi\u00e1 di\u1ec7n kh\u1edbp l\u1ed3i c\u1ea7u \u0111\u00f9i v\u00e0 m\u00e2m ch\u00e0y<\/span><\/p>\n

                    + Ch\u1ee5p ti\u1ebfp tuy\u1ebfn b\u00e1nh ch\u00e8, g\u1ed1i g\u1ea5p 45\u00b0: \u0111\u00e1nh gi\u00e1 khe kh\u1edbp ch\u00e8-\u0111\u00f9i<\/span>
                    \n<\/span><\/p>\n

                    \"\"
                    H\u00ecnh 1.1. C\u00e1c h\u00ecnh \u1ea3nh x-quang ch\u1ee5p g\u1ed1i theo c\u00e1c t\u01b0 th\u1ebf, t\u01b0 th\u1ebf th\u1eb3ng (A), nghi\u00eang(B) v\u00e0 ti\u1ebfp tuy\u1ebfn x\u01b0\u01a1ng b\u00e1nh ch\u00e8 (C) [12]<\/figcaption><\/figure>\n

                    C\u00f3 3 d\u1ea5u hi\u1ec7u c\u01a1 b\u1ea3n trong THKG tr\u00ean x-quang:<\/span><\/p>\n

                    + H\u1eb9p khe kh\u1edbp kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u, kh\u00f4ng ho\u00e0n to\u00e0n<\/span><\/p>\n

                    + M\u1ecdc gai x\u01b0\u01a1ng \u1edf ph\u1ea7n ti\u1ebfp gi\u00e1p gi\u1eefa x\u01b0\u01a1ng v\u00e0 s\u1ee5n<\/span><\/p>\n

                    + \u0110\u1eb7c x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n<\/span><\/p>\n

                      \n
                    • Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT-Scanner): <\/span><\/i>Ch\u1ee5p CT c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng s\u1edbm c\u1ee7a s\u1ee5n v\u00e0 x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n<\/li>\n<\/ul>\n
                        \n
                      • Ch\u1ee5p b\u01a1m thu\u1ed1c c\u1ea3n quang v\u00e0o \u1ed5 kh\u1edbp.<\/span><\/i><\/li>\n
                      • Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb kh\u1edbp g\u1ed1i (CHT): <\/span><\/i>Ch\u1ee5p CHT cho th\u1ea5y h\u00ecnh \u1ea3nh v\u00e0 nh\u1eefng bi\u1ebfn \u0111\u1ed5i c\u1ee7a c\u00e1c c\u1ea5u tr\u00fac v\u00e0 t\u1ed5 ch\u1ee9c m\u00f4 m\u1ec1m r\u1ea5t ch\u00ednh x\u00e1c. CHT cung c\u1ea5p nh\u1eefng h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp \u0111a chi\u1ec1u n\u00ean gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1 ch\u1ed3ng \u1ea3nh c\u1ee7a c\u00e1c c\u1ea5u tr\u00fac ch\u1ed3ng l\u1ea5n. S\u1ef1 \u00e1p d\u1ee5ng CHT trong THKG cho ph\u00e9p \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 nh\u1ea1y, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a XQ th\u00f4ng th\u01b0\u1eddng b\u1eb1ng c\u00e1ch x\u00e1c \u0111\u1ecbnh c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m XQ ri\u00eang r\u1ebd c\u1ee7a THKG v\u00e0 ch\u1ea9n \u0111o\u00e1n THKG. T\u1ed5n th\u01b0\u01a1ng \u0111i\u1ec3n h\u00ecnh c\u1ee7a THKG tr\u00ean CHT:<\/li>\n<\/ul>\n

                        + S\u1ee5n kh\u1edbp m\u1ecfng ho\u1eb7c m\u1ea5t<\/span><\/p>\n

                        + Gai x\u01b0\u01a1ng r\u00eca kh\u1edbp<\/span><\/p>\n

                        + S\u1ee5n ch\u00eam m\u1ea5t ho\u00e0n to\u00e0n ho\u1eb7c h\u1ee7y ho\u1ea1i r\u00f5 r\u1ec7t<\/span><\/p>\n

                        + T\u1ed5n th\u01b0\u01a1ng m\u1ed9t ph\u1ea7n ho\u1eb7c ho\u00e0n to\u00e0n d\u00e2y ch\u1eb1ng ch\u00e9o<\/span><\/p>\n

                        + C\u1ed1c d\u1ecb v\u1eadt trong kh\u1edbp c\u00f3 xu h\u01b0\u1edbng t\u1ee5 t\u1eadp th\u00e0nh \u0111\u00e1m \u1edf t\u00fai c\u00f9ng tr\u00ean x\u01b0\u01a1ng b\u00e1nh ch\u00e8 ho\u1eb7c k\u00e9n Baker<\/span><\/p>\n

                        \u00a0+ Tr\u00e0n d\u1ecbch kh\u1edbp g\u1ed1i th\u01b0\u1eddng g\u1eb7p<\/span><\/p>\n

                        + C\u00e1c<\/span> k\u00e9n d\u01b0\u1edbi<\/span> s\u1ee5n<\/b> ho\u1eb7c<\/span> c\u00e1c h\u1ed1c <\/span>d\u01b0\u1edbi<\/span> s\u1ee5n bi\u1ebfu<\/span> hi\u1ec7n<\/span> l\u00e0 v\u00f9ng t\u0103ng <\/span>t\u00edn hi\u1ec7u bao b\u1ecdc b\u1edfi v\u00f9ng v\u1ecf m\u1ecfng gi\u1ea3m t\u00edn hi\u1ec7u. C\u00e1c g\u00e3y x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n, \u0111\u1eb7c bi\u1ec7t c\u00e1c g\u00e3y x\u01b0\u01a1ng m\u00e3n t\u00ednh th\u1ea5y d\u01b0\u1edbi d\u1ea1ng nh\u1eefng h\u1ed1c d\u01b0\u1edbi s\u1ee5n gi\u1ea3m t\u00edn hi\u1ec7u c\u1ea3 hai ph\u00eda<\/span><\/p>\n

                        + Ph\u00f9<\/span> x\u01b0\u01a1ng l\u00e0<\/span> h\u00ecnh<\/span> \u1ea3nh<\/span> t\u0103ng t\u00edn <\/span>hi\u1ec7u<\/span> tr\u00ean T2<\/span> x\u00f3a<\/span> m\u1ee1,<\/span> c\u00f3 vi\u1ec1n <\/span>kh\u00f4ng r\u00f5 n\u00e9t.<\/span><\/p>\n

                        + Qu\u00e1 ph\u00e1t ho\u1eb7c d\u00e0y m\u00e0ng ho\u1ea1t d\u1ecbch c\u0169ng th\u01b0\u1eddng g\u1eb7p trong THKG<\/span><\/p>\n

                        + \u0110o \u0111\u01b0\u1ee3c th\u1ec3 t\u00edch v\u00f9ng khuy\u1ebft s\u1ee5n do tho\u00e1i h\u00f3a.<\/span><\/p>\n

                          \n
                        • N\u1ed9i soi kh\u1edbp g\u1ed1i (NSK) [16].<\/span><\/i><\/li>\n<\/ul>\n

                          NSK l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c nh\u1ea5t, c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y tr\u1ef1c ti\u1ebfp v\u1ecb tr\u00ed v\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng c\u1ee7a s\u1ee5n \u1edf c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau. Theo Curl v\u00e0 c\u1ed9ng s\u1ef1, c\u00f3 66% s\u00f4 tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng s\u1ee5n kh\u1edbp \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n trong c\u00e1c ph\u1eabu thu\u1eadt li\u00ean quan n\u1ed9i soi kh\u1edbp. NSK c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p sinh thi\u1ebft m\u00e0ng ho\u1ea1t d\u1ecbch l\u00e0m x\u00e9t nghi\u1ec7m t\u1ebf b\u00e0o ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c b\u1ec7nh kh\u00e1c ho\u1eb7c nghi\u00ean c\u1ee9u \u0111\u1ecbnh l\u01b0\u1ee3ng m\u1ed9t s\u1ed1 cytokin d\u1eabn t\u1edbi t\u00ecnh tr\u1ea1ng tho\u00e1i h\u00f3a c\u1ee7a s\u1ee5n. Ngo\u00e0i ra, NSK c\u00f2n c\u00f3 vai tr\u00f2 h\u1ed7 tr\u1ee3 \u0111i\u1ec1u tr\u1ecb THK.<\/span><\/p>\n

                          \u00a0<\/b><\/p>\n

                          T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/b><\/p>\n

                            \n
                          1. Tr\u1ea7n Ng\u1ecdc \u00c2n (1995). H\u01b0 kh\u1edbp v\u00e0 h\u01b0 c\u1ed9t s\u1ed1ng, b\u1ec7nh th\u1ea5p kh\u1edbp. <\/span>NXB Y h\u1ecdc:<\/span><\/i> tr.<\/span>I93-209<\/li>\n
                          2. Mankin, H.B.J. (1974). The reaction of articular cartilage to injury and osteoarthritis Part II. <\/span>New England Journal of Medicine;<\/span><\/i> 291, 1335\u201440.<\/span><\/li>\n
                          3. David J. Samson, M.S. Mark D. (2007), Treatment of Primary and Secondary Osteoarthritis of the Knee. <\/span>Evidence Report\/Technology Assessment,<\/span><\/i> Number 157.<\/span><\/li>\n
                          4. Felson DT, Lawrence RC, Dieppe PA, et al (2000). Osteoarthritis: new insights. Part 1: the disease and its risk factors. <\/span>Ann Intern Med.<\/span><\/i> \u1ec833(8):635\u201c46<\/span><\/li>\n
                          5. Creamer p, Lethbridge Cejku M. Factors associated with functional impairment in symptomatic knee osteoarthritis. <\/span>Rheumatology,<\/span><\/i> 39(5), 490-496<\/span><\/li>\n
                          6. Coventry, M.B. (1965). Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee: a preliminary report. <\/span>Journal of Bone and Joint Surgery, American Volume,<\/span><\/i> 47A, 984-90.p. 1124.<\/span><\/li>\n
                          7. Linda J Sandell, Thomas Aigner. (2001). Articular cartilage and changes in arthritis An introduction: Cell biology of osteoarthritis. <\/span>Arthritis Res,<\/span><\/i> 3:107 -113.<\/span><\/li>\n
                          8. Horton W.E, Bennion Jr. p, Yang L (2006). Cellular, molecular, and matrix changes in cartilage during aging and osteoarthritis. <\/span>J Musculoskelet Neuronal Interact; <\/span><\/i>6(4):379-381.<\/span><\/li>\n
                          9. Radrigo Campos (2011). Assessment of reproducibility of the Outerbridge and FSA classifications for chondral lesions of the knee. <\/span>Rev Bras Ortop<\/span><\/i> 46(3):266-69.<\/span><\/li>\n
                          10. Mainil-Varletl T, Aigner A, Brittberg M, (2002). The International Cartilage Repair Society (ICRS) ‘Histological Visual Scale. <\/span>European Cells and Materials; <\/span><\/i>4(1), 10.<\/span><\/li>\n
                          11. Hart D. J, Spector T. D (2003). Kellgren & Lawrence grade 1 osteophytes in the knee\u2014doubtful or definite?. <\/span>Osteoarthritis and Cartilage;<\/span><\/i> 11, 149-150.<\/span><\/li>\n
                          12. KellgrenJ. H, Lawrence J. S(1957). Radiologic assessment of osteoarthritis, <\/span>Ann. Rheum Dis\\<\/span><\/i> vol. 16, pp. 494-501.<\/span><\/li>\n
                          13. Bruno c, Vande Berg (2002). Assessment of Knee Cartilage in Cadavers with Dual-Detector Spiral CT Arthrography and MR Imaging. <\/span>Radiology, 222(2):<\/span><\/i> tr. 430-435.<\/span><\/li>\n
                          14. Colton CL (1988). Magnetic Imaging of the knee. (Book review). <\/span>J Bone Joint Surg;10-B\\<\/span><\/i> 859.<\/span><\/li>\n
                          15. Recht MP, Resnick D (1994). MR imaging of articular cartilage: current status and future directions. <\/span>AJR;<\/span><\/i> 163: 283-290<\/span><\/li>\n
                          16. D\u01b0\u01a1ng \u0110\u00ecnh To\u00e0n, Nguy\u1ec5n Xu\u00e2n Th\u00f9y (2014), \u201c\u0110i\u1ec1u tr\u1ecb tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i b\u1eb1ng ph\u1eabu thu\u1eadt n\u1ed9i soi\u201d, <\/span>Ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp g\u1ed1i,<\/span><\/i> NX l\u00ec Y h\u1ecdc, tr. 212-227,<\/span><\/li>\n
                          17. Livesley, P.J., Doherty, M., Needoff, M., and Moulton, A. (1991). Arthroscopic lavage of osteoarthritic knees. <\/span>Journal of Bone and Joint Surgery, British Volume; <\/span><\/i>73B, 922-6.<\/span><\/li>\n
                          18. Dieuwke Schiphof, Mark de Niet (2011). Identifying Knee Osteoarthritis. <\/span>The Netherlands Organization for Scientific Research,<\/span><\/i> ISBN: 978-94-6169-194.<\/span><\/li>\n
                          19. Belo J. N, Berger M. Y.(2009). The prognostic value of the clinical ACR classification criteria of knee osteoarthritis for persisting knee complaints and increase of disability in general practice. <\/span>Osteoarthritis Research Society International;<\/span><\/i> 17, 1288-1292.<\/span><\/li>\n
                          20. Brett Levine, MD. Treatment Options for Osteoarthritis of the Knee. <\/span>Clinician s Guide, AHRQ Pub.<\/span><\/i> No. 09-EHC010-3.<\/span><\/li>\n
                          21. Robert T. Bashaw, PT (2005). Rehabilitation of the Osteoarthritic Patient: Focus on the Knee. <\/span>Clin Sports Med;<\/span><\/i> 24, 101 – 131.<\/span><\/li>\n
                          22. Choosing Pain Medicine for Osteoarthritis: A Guide for Consumers Agency for Healthcare Research and Quality, January 2007<\/span><\/li>\n
                          23. Yuanyuan Wang, Louise F (2004). The Effect of Nutritional Supplements on Osteoarthritis. <\/span>Alternative Medicine Review;<\/span><\/i> 9 (3), 275-291.<\/span><\/li>\n
                          24. Viscosupplementation for Osteoarthritis of the Knee, <\/span>Rapid Review: Public March <\/span><\/i>17,2010<\/span><\/li>\n
                          25. Agency for Healthcare Research and Quality. Three treatments for osteoarthritis of the knee: <\/span>Evidence shows lack of benefit.<\/span><\/i> April 2009.<\/span><\/li>\n
                          26. Burnouf, T., Goubran, H. A.et al (2013). Blood-derived biomaterials and platelet growth factors ill regenerative medicine. <\/span>Blood Reviews;<\/span><\/i> 27 (2), 77-89.<\/span><\/li>\n
                          27. Tinsley, B. A., Ferreira, J. v.et al (2012). Platelet-Rich Plasma Nonoperative Injection Therapy-A Review of Indications and Evidence. <\/span>Operative Techniques in Sports Medicine;<\/span><\/i> 20 (2), 192-200.<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

                            Tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 ph\u1ed5 bi\u1ebfn trong d\u00e2n s\u1ed1 hi\u1ec7n nay, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf c\u00e1c ng\u01b0\u1eddi trung ni\u00ean v\u00e0 cao tu\u1ed5i. \u0110\u00e2y l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 tho\u00e1i h\u00f3a v\u00e0 m\u00f2n c\u1ee7a c\u00e1c kh\u1edbp, d\u1eabn \u0111\u1ebfn gi\u1ea3m t\u00ednh linh ho\u1ea1t v\u00e0 \u0111\u1ed9 b\u1ec1n c\u1ee7a kh\u1edbp g\u1ed1i. Nh\u1eefng tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng […]<\/p>\n","protected":false},"author":28,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[75,40],"tags":[3],"yoast_head":"\nTho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i: T\u1eeb c\u01a1 ch\u1ebf b\u1ec7nh sinh \u0111\u1ebfn bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/title>\n<meta name=\"description\" content=\"B\u00e0i b\u00e1o n\u00e0y cung c\u1ea5p m\u1ed9t c\u00e1ch t\u1ed5ng quan v\u1ec1 tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i. \u0110\u1ecdc gi\u1ea3 s\u1ebd \u0111\u01b0\u1ee3c t\u00ecm hi\u1ec3u v\u1ec1 c\u01a1 ch\u1ebf b\u1ec7nh sinh, d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng.\" \/>\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 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