{"id":28056,"date":"2023-05-03T22:29:41","date_gmt":"2023-05-03T15:29:41","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28056"},"modified":"2023-05-03T22:29:41","modified_gmt":"2023-05-03T15:29:41","slug":"trat-khop-hang-cac-phuong-phap-nan-kin-phan-2","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/trat-khop-hang-cac-phuong-phap-nan-kin-phan-2\/","title":{"rendered":"Tr\u1eadt kh\u1edbp h\u00e1ng: c\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u1eafn k\u00edn (ph\u1ea7n 2)"},"content":{"rendered":"

Tr\u1eadt kh\u1edbp h\u00e1ng l\u00e0 t\u00ecnh tr\u1ea1ng khi ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 \u1ed5 c\u1ed1i b\u1ecb l\u1ec7ch kh\u1ecfi v\u1ecb tr\u00ed b\u00ecnh th\u01b0\u1eddng, c\u00f3 th\u1ec3 ho\u00e0n to\u00e0n ho\u1eb7c m\u1ed9t ph\u1ea7n. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 do ch\u1ea5n th\u01b0\u01a1ng. N\u1eafn k\u00edn l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u, th\u01b0\u1eddng th\u1ef1c hi\u1ec7n trong ph\u00f2ng c\u1ea5p c\u1ee9u. \u1ede ph\u1ea7n 1 ch\u00fang ta \u0111\u00e3 n\u00f3i \u0111\u1ebfn c\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u1eafn k\u00edn th\u01b0\u1eddng d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tr\u1eadt kh\u1edbp h\u00e1ng. \u1ede ph\u1ea7n n\u00e0y, ch\u00fang ta s\u1ebd ti\u1ebfp t\u1ee5c b\u00e0n lu\u1eadn v\u1ec1 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u1eafn k\u00edn kh\u00e1c.
\n<\/span><\/span><\/span><\/strong><\/p>\n

1. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u1eafn k\u00edn trong tr\u1eadt kh\u1edbp h\u00e1ng ra sau (ti\u1ebfp)<\/h2>\n

1.1. Ph\u01b0\u01a1ng ph\u00e1p Howard<\/h3>\n

B\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda, c\u1ea3 b\u00e1c s\u0129 ch\u00ednh v\u00e0 ng\u01b0\u1eddi ph\u1ee5 \u0111\u1ee9ng \u1edf b\u00ean b\u1ecb tr\u1eadt kh\u1edbp. \u0110\u01b0a \u0111\u00f9i vu\u00f4ng g\u00f3c v\u1edbi th\u00e2n m\u00ecnh ph\u01b0\u01a1ng th\u1eb3ng \u0111\u1ee9ng. Ng\u01b0\u1eddi ph\u1ee5 n\u1eafm \u0111\u00f9i v\u00e0 k\u00e9o ngang. Ng\u01b0\u1eddi ph\u1ee5 th\u1ee9 hai gi\u1eef x\u01b0\u01a1ng ch\u1eadu trong khi n\u1eafn. N\u1ebfu kh\u00f4ng c\u00f3 ng\u01b0\u1eddi ph\u1ee5 th\u1ee9 hai, ng\u01b0\u1eddi ph\u1ee5 th\u1ee9 nh\u1ea5t s\u1ebd c\u1ed1 \u0111\u1ecbnh x\u01b0\u01a1ng ch\u1eadu khi b\u00e1c s\u0129 ch\u00ednh gi\u1eef \u0111\u1ea7u g\u1ed1i c\u1ee7a c\u1eb3ng ch\u00e2n c\u00f9ng b\u00ean. B\u00e1c s\u0129 ch\u00ednh k\u00e9o theo h\u01b0\u1edbng tr\u00ean – d\u01b0\u1edbi, \u0111\u1ed3ng th\u1eddi xoay trong v\u00e0 ngo\u00e0i cho \u0111\u1ebfn khi n\u1eafn th\u00e0nh c\u00f4ng.<\/p>\n

\"\"<\/a>
Ph\u01b0\u01a1ng ph\u00e1p Howard<\/figcaption><\/figure>\n

1.2. Ph\u01b0\u01a1ng ph\u00e1p Piggyback<\/h3>\n

B\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda \u1edf m\u00e9p d\u01b0\u1edbi c\u1ee7a gi\u01b0\u1eddng. \u0110\u00f9i c\u00f9ng b\u00ean t\u1ea1o g\u00f3c 90\u00b0 v\u1edbi th\u00e2n theo chi\u1ec1u th\u1eb3ng \u0111\u1ee9ng.<\/span><\/span> B\u00e1c s\u0129 \u0111\u1eb7t \u0111\u1ea7u g\u1ed1i c\u1ee7a b\u1ec7nh nh\u00e2n l\u00ean vai c\u1ee7a m\u00ecnh v\u00e0 d\u00f9ng vai l\u00e0m \u0111i\u1ec3m t\u1ef1a, t\u00e1c d\u1ee5ng m\u1ed9t l\u1ef1c h\u01b0\u1edbng xu\u1ed1ng x\u01b0\u01a1ng ch\u00e0y \u0111\u1ec3 t\u1ea1o ra m\u1ed9t l\u1ef1c h\u01b0\u1edbng ra tr\u01b0\u1edbc \u1edf h\u00f4ng cho \u0111\u1ebfn khi kh\u1edbp h\u00e1ng \u0111\u01b0\u1ee3c n\u1eafn v\u1ec1 v\u1ecb tr\u00ed.
\n<\/span><\/span><\/span><\/p>\n

\"\"<\/a>
Ph\u01b0\u01a1ng ph\u00e1p Piggyback<\/figcaption><\/figure>\n

1.2. Ph\u01b0\u01a1ng ph\u00e1p Tulsa\/Rochester\/Whistler<\/h3>\n

B\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda, b\u00e1c s\u0129 \u0111\u1ee9ng \u1edf b\u00ean b\u1ecb tr\u1eadt kh\u1edbp h\u00e1ng. \u0110\u1ea7u g\u1ed1i b\u00ean \u0111\u1ed1i di\u1ec7n g\u1eadp 130\u00b0.<\/span><\/span> B\u00e1c s\u0129 \u0111\u1eb7t c\u00e1nh tay c\u1ee7a m\u00ecnh d\u01b0\u1edbi \u0111\u1ea7u g\u1ed1i c\u00f9ng b\u00ean sao cho ch\u00e2n g\u1eadp tr\u00ean c\u1eb3ng tay v\u00e0 d\u00f9ng ch\u00ednh b\u00e0n tay \u0111\u00f3 \u0111\u1ec3 n\u1eafm l\u1ea5y \u0111\u1ea7u g\u1ed1i b\u00ean \u0111\u1ed1i di\u1ec7n.<\/span><\/span> V\u1edbi b\u00e0n tay c\u00f2n l\u1ea1i, b\u00e1c s\u0129 c\u1ed1 \u0111\u1ecbnh m\u1eaft c\u00e1 ch\u00e2n c\u00f9ng b\u00ean v\u00e0o c\u00e1ng v\u00e0 t\u1ea1o l\u1ef1c k\u00e9o xu\u1ed1ng d\u01b0\u1edbi b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng m\u1eaft c\u00e1 ch\u00e2n c\u00f9ng v\u1edbi xoay trong v\u00e0 ngo\u00e0i cho \u0111\u1ebfn khi kh\u1edbp h\u00e1ng \u0111\u01b0\u1ee3c n\u1eafn v\u1ec1 v\u1ecb tr\u00ed c\u0169.
\n<\/span><\/span><\/span><\/p>\n

\"\"<\/a>
Ph\u01b0\u01a1ng ph\u00e1p Tulsa\/Rochester\/Whistler<\/figcaption><\/figure>\n

1.4. Ph\u01b0\u01a1ng ph\u00e1p Skoff<\/h3>\n

B\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf n\u1eb1m nghi\u00eang v\u1edbi ch\u00e2n b\u00ean b\u1ecb tr\u1eadt h\u01b0\u1edbng l\u00ean tr\u00ean. B\u00e1c s\u0129 ch\u00ednh \u0111\u1ee9ng b\u00ean \u0111\u1ed1i di\u1ec7n m\u1eb7t b\u1ec7nh nh\u00e2n. Ch\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1edf t\u01b0 th\u1ebf g\u1eadp h\u00f4ng 90\u00b0, xoay trong 45\u00b0, kh\u00e9p 45\u00b0 v\u00e0 g\u1eadp \u0111\u1ea7u g\u1ed1i 90\u00b0. B\u00e1c s\u0129 ch\u00ednh k\u00e9o sang ngang trong khi khi ng\u01b0\u1eddi ph\u1ee5 k\u00e9o theo ph\u01b0\u01a1ng trung v\u1edbi ph\u01b0\u01a1ng c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i. Sau \u0111\u00f3, b\u00e1c s\u0129 ch\u00ednh s\u1ebd n\u1eafn ph\u1ea7n l\u1ed3i ra \u1edf v\u00f9ng m\u00f4ng v\u00e0 \u0111\u1ea9y ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i b\u1ecb tr\u1eadt cho \u0111\u1ebfn khi kh\u1edbp h\u00e1ng \u0111\u01b0\u1ee3c n\u1eafn l\u1ea1i \u0111\u00fang v\u1ecb tr\u00ed.<\/p>\n

\"\"<\/a>
Ph\u01b0\u01a1ng ph\u00e1p Skoff<\/figcaption><\/figure>\n

1.5. Ph\u01b0\u01a1ng ph\u00e1p Stimson Gravity<\/h3>\n

B\u1ec7nh nh\u00e2n n\u1eb1m s\u1ea5p, H\u00f4ng v\u00e0 \u0111\u1ea7u g\u1ed1i t\u1ea1o g\u00f3c 90\u00b0 t\u1ea1i m\u00e9p gi\u01b0\u1eddng. V\u1edbi m\u1ed9t ng\u01b0\u1eddi ph\u1ee5 c\u1ed1 \u0111\u1ecbnh x\u01b0\u01a1ng ch\u1eadu, b\u00e1c s\u0129 ch\u00ednh gi\u1eef \u0111\u1ea7u g\u1ed1i v\u00e0 m\u1eaft c\u00e1 ch\u00e2n c\u00f9ng b\u00ean v\u00e0 t\u00e1c d\u1ee5ng l\u1ef1c xu\u1ed1ng ph\u1ea7n xa \u0111\u1ea7u g\u1ed1i cho \u0111\u1ebfn khi ph\u1ea7n chi \u0111\u00f3 \u0111\u01b0\u1ee3c h\u1ea1 xu\u1ed1ng. B\u00e1c s\u0129 c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng xoay trong v\u00e0 ngo\u00e0i \u0111\u1ec3 h\u1ed7 tr\u1ee3 gi\u1ea3m b\u1edbt. Ph\u1ea3i th\u1eadn tr\u1ecdng v\u1edbi k\u1ef9 thu\u1eadt n\u00e0y, v\u00ec b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c an th\u1ea7n \u1edf t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i li\u00ean t\u1ee5c \u0111\u01b0\u1eddng th\u1edf c\u1ee7a h\u1ecd. Ngo\u00e0i ra, ph\u1ea3i th\u1eadn tr\u1ecdng \u0111\u1ec3 tr\u00e1nh b\u1ec7nh nh\u00e2n r\u01a1i ra kh\u1ecfi gi\u01b0\u1eddng.<\/p>\n

\"\"<\/a>
Ph\u01b0\u01a1ng ph\u00e1p Stimson Gravity<\/figcaption><\/figure>\n

1.6. Ph\u01b0\u01a1ng ph\u00e1p k\u00e9o – ph\u1ea3n l\u1ef1c<\/h3>\n

Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y l\u00e0 m\u1ed9t bi\u1ebfn th\u1ec3 c\u1ee7a Ph\u01b0\u01a1ng ph\u00e1p Skoff.<\/span><\/span> B\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf n\u1eb1m nghi\u00eang v\u1edbi chi c\u00f9ng b\u00ean h\u01b0\u1edbng l\u00ean tr\u00ean.<\/span><\/span> Ng\u01b0\u1eddi ph\u1ee5 di chuy\u1ec3n b\u00ean b\u1ecb \u1ea3nh h\u01b0\u1edfng theo h\u01b0\u1edbng g\u1eadp h\u00f4ng 90\u00b0, xoay trong 45\u00b0, kh\u00e9p 45\u00b0 v\u00e0 g\u1eadp \u0111\u1ea7u g\u1ed1i 90\u00b0.<\/span><\/span> S\u1eed d\u1ee5ng kh\u0103n v\u1ea3i th\u1eaft n\u00fat \u0111\u1ec3 t\u1ea1o 2 v\u00f2ng. Ng\u01b0\u1eddi ph\u1ee5 \u0111\u1ee9ng trong v\u00f2ng th\u1ee9 nh\u1ea5t v\u00e0 lu\u1ed3n qua h\u00e1ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 \u0111\u1ebfn m\u00e0o ch\u1eadu. B\u00e1c s\u0129 \u0111\u1ee9ng trong<\/span><\/span> v\u00f2ng th\u1ee9 hai \u0111\u1eb7t ph\u00eda sau \u0111\u1ea7u g\u1ed1i c\u00f9ng b\u00ean.<\/span><\/span> B\u00e1c s\u0129 ch\u00ednh k\u00e9o ph\u01b0\u01a1ng ngang\u00a0 b\u1eb1ng c\u00e1ch ng\u1ea3 ng\u01b0\u1eddi ra sau trong khi s\u1eed d\u1ee5ng tay c\u00f2n l\u1ea1i \u0111\u1ec3 \u0111i\u1ec1u khi\u1ec3n ch\u00e2n.<\/span><\/span> \u0110\u1ed3ng th\u1eddi, ng\u01b0\u1eddi ph\u1ee5 ng\u1ea3 ng\u01b0\u1eddi ra h\u01b0\u1edbng ng\u01b0\u1ee3c l\u1ea1i, \u0111\u1ed3ng th\u1eddi s\u1eed d\u1ee5ng g\u00f3t b\u00e0n tay \u0111\u1ec3 \u1ea5n v\u00e0o v\u00f9ng bi\u1ebfn d\u1ea1ng \u1edf v\u00f9ng m\u00f4ng cho \u0111\u1ebfn khi th\u00e0nh c\u00f4ng.
\n<\/span><\/span><\/span><\/p>\n

\"\"<\/a>
Ph\u01b0\u01a1ng ph\u00e1p k\u00e9o – ph\u1ea3n l\u1ef1c<\/figcaption><\/figure>\n

1.7. K\u1ef9 thu\u1eadt Waddell<\/h3>\n

Ng\u01b0\u1eddi ph\u1ee5 c\u1ed1 \u0111\u1ecbnh x\u01b0\u01a1ng ch\u1eadu c\u1ee7a b\u1ec7nh nh\u00e2n d\u1ef1a v\u00e0o c\u00e1ng, b\u00e1c s\u0129 ch\u00ednh tr\u00e8o l\u00ean c\u00e1ng.<\/span><\/span> B\u00e1c s\u0129 ch\u00ednh \u0111\u1eb7t ch\u00e2n b\u1ec7nh nh\u00e2n v\u00e0o gi\u1eefa hai ch\u00e2n c\u1ee7a b\u00e1c s\u0129 v\u00e0 \u0111\u1eb7t c\u1eb3ng tay b\u00ean d\u01b0\u1edbi \u0111\u1ea7u g\u1ed1i b\u1ec7nh nh\u00e2n.<\/span><\/span> \u0110\u1ec3 c\u1ed1 \u0111\u1ecbnh ch\u00e2n b\u1ec7nh nh\u00e2n, b\u00e1c s\u0129 \u0111\u1eb7t c\u1eb3ng tay c\u1ee7a m\u00ecnh ngang \u0111\u1ea7u g\u1ed1i, sao cho khu\u1ef7u tay \u1edf tr\u00ean m\u1ed9t \u0111\u1ea7u g\u1ed1i v\u00e0 b\u00e0n tay b\u00e1m v\u00e0o \u0111\u1ea7u g\u1ed1i b\u00ean kia.<\/span><\/span> V\u1edbi \u0111\u1ea7u g\u1ed1i c\u00f9ng b\u00ean g\u1ea7n v\u1edbi ng\u1ef1c c\u1ee7a b\u00e1c s\u0129, b\u00e1c s\u0129 ch\u00ednh ch\u1ec9nh \u0111\u00f9i v\u00e0 h\u00f4ng g\u00f3c 60\u00b0-90\u00b0 v\u00e0 \u0111\u1ea7u g\u1ed1i g\u1eadp 90\u00b0.<\/span><\/span> B\u00e1c s\u0129 ch\u00ednh k\u00e9o x\u01b0\u01a1ng \u0111\u00f9i b\u1eb1ng c\u00e1ch nghi\u00eang ng\u01b0\u1eddi v\u1ec1 ph\u00eda sau, s\u1eed d\u1ee5ng b\u00e0n ch\u00e2n c\u1ee7a m\u00ecnh l\u00e0m tr\u1ee5 v\u00e0 ti\u1ebfp t\u1ee5c cho \u0111\u1ebfn khi kh\u1edbp h\u00e1ng v\u1ec1 v\u1ecb tr\u00ed.<\/span><\/span><\/span><\/p>\n

\"\"<\/a>
Ph\u01b0\u01a1ng ph\u00e1p Waddell x\u1eed tr\u00ed tr\u1eadt kh\u1edbp h\u00e1ng<\/figcaption><\/figure>\n

2. T\u1ed5ng k\u1ebft c\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u1eafn k\u00edn \u0111i\u1ec1u tr\u1ecb tr\u1eadt kh\u1edbp h\u00e1ng<\/h2>\n

V\u1edbi t\u1ef7 l\u1ec7 ch\u1ea5n th\u01b0\u01a1ng m\u1ea1nh c\u00e0ng t\u0103ng v\u00e0 s\u1ed1 ca thay kh\u1edbp h\u00e1ng to\u00e0n ph\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n, s\u1ed1 ca tr\u1eadt kh\u1edbp h\u00e1ng t\u1ef1 nhi\u00ean v\u00e0 sau thay kh\u1edbp h\u00e1ng c\u00f3 th\u1ec3 s\u1ebd t\u0103ng l\u00ean.<\/span><\/span> Nh\u00e2n vi\u00ean y t\u1ebf ph\u1ea3i l\u00e0m quen v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p t\u1ed1t nh\u1ea5t \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y.<\/span><\/span> B\u1ec7nh nh\u00e2n b\u1ecb tr\u1eadt kh\u1edbp h\u00e1ng ph\u1ea3i \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n c\u1ea9n th\u1eadn v\u00e0 b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb ph\u1ea3i th\u00f4ng th\u1ea1o c\u00e1c c\u00e1ch kh\u00e1c nhau \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ch\u1ea5n th\u01b0\u01a1ng v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea3y ra.<\/span><\/span> \u0110\u00e1nh gi\u00e1 v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, bao g\u1ed3m nh\u1eadn bi\u1ebft c\u00e1c bi\u1ebfn ch\u1ee9ng ti\u1ec1m \u1ea9n, l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 mang l\u1ea1i k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t cho b\u1ec7nh nh\u00e2n.<\/span><\/span><\/span><\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/h3>\n

1. Dwyer AJ, John B, Singh SA, Mam MK. Complications after posterior dislocation of the hip<\/span>. Int Orthop<\/span>. 2006. August;30<\/span>(4<\/span>):224-227. doi: 10.1007\/s00264-005-0056-9<\/span><\/p>\n

2. Dreinh\u00f6fer KE, Schwarzkopf SR, Haas NP, Tscherne H. Isolated traumatic dislocation of the hip. Long-term results in 50 patients<\/span>. J Bone Joint Surg Br<\/span>. 1994. January;76<\/span>(1<\/span>):6-12. <\/span><\/p>\n

3. Waddell BS, Mohamed S, Glomset JT, Meyer MS. A detailed review of hip reduction maneuvers: a focus on physician safety and introduction of the Waddell technique<\/span>. Orthop Rev (Pavia)<\/span>. 2016. March 21;8<\/span>(1<\/span>):6253. doi: 10.4081\/or.2016.6253.<\/span><\/p>\n

4. Dawson I, van Rijn AB. Traumatic anterior dislocation of the hip<\/span>. Arch Orthop Trauma Surg<\/span>. 1989;108<\/span>(1<\/span>):55-57. doi: 10.1007\/BF00934160.<\/span><\/p>\n

5. Clegg TE, Roberts CS, Greene JW, Prather BA. Hip dislocations\u2014epidemiology, treatment, and outcomes<\/span>. Injury<\/span>. 2010. April;41<\/span>(4<\/span>):329-334. doi: 10.1016\/j.injury.2009.08.007.<\/span><\/p>\n

6. Sanders S, Tejwani N, Egol KA. Traumatic hip dislocation\u2014a review<\/span>. Bull NYU Hosp Jt Dis<\/span>. 2010;68<\/span>(2<\/span>):91-96. <\/span><\/p>\n

7. Dawson-Amoah K, Raszewski J, Duplantier N, Waddell BS. Dislocation of the Hip: A Review of Types, Causes, and Treatment. Ochsner J. 2018 Fall;18(3):242-252. doi: 10.31486\/toj.17.0079. PMID: 30275789; PMCID: PMC6162140.<\/p>\n","protected":false},"excerpt":{"rendered":"

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