{"id":2851,"date":"2023-04-09T20:56:22","date_gmt":"2023-04-09T13:56:22","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2851"},"modified":"2023-04-14T23:10:54","modified_gmt":"2023-04-14T16:10:54","slug":"phau-thuat-dieu-tri-thoai-hoa-khop-goi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/phau-thuat-dieu-tri-thoai-hoa-khop-goi\/","title":{"rendered":"Ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i"},"content":{"rendered":"

Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c \u0111\u1eb7t ra khi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa k\u1ebft h\u1ee3p v\u1eadt l\u00fd tr\u1ecb li\u1ec7u kh\u00f4ng c\u00f2n hi\u1ec7u qu\u1ea3. Nh\u1eefng ph\u1eabu thu\u1eadt can thi\u1ec7p t\u1ed1i thi\u1ec3u \u0111\u01b0\u1ee3c quan t\u00e2m v\u00e0 \u01b0u ti\u00ean th\u1ef1c hi\u1ec7n khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh, \u0111\u1eb7c bi\u1ec7t tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i. \u0110\u1ed1i v\u1edbi ph\u1eabu thu\u1eadt x\u00e2m l\u1ea5n, thay kh\u1edbp g\u1ed1i l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng ph\u1ed1 bi\u1ebfn. T\u1ea1i M\u1ef9, h\u1eb1ng n\u0103m c\u00f3 tr\u00ean 300 ngh\u00ecn kh\u1edbp g\u1ed1i \u0111\u01b0\u1ee3c thay, v\u00e0 con s\u1ed1 n\u00e0y ng\u00e0y c\u00e0ng t\u0103ng l\u00ean \u0111\u1ed3ng th\u1eddi v\u1edbi m\u1ee9c \u0111\u1ed9 gi\u00e0 h\u00f3a c\u1ee7a d\u00e2n s\u1ed1 M\u1ef9 [28],[29]<\/strong><\/p>\n

1. N\u1ed9i soi l\u00e0m s\u1ea1ch (Arthroscopic lavage and debridement)<\/i><\/b><\/h2>\n

R\u1eeda kh\u1edbp g\u1ed1i l\u00e0 ph\u01b0\u01a1ng ph\u00e1p d\u00f9ng dung d\u1ecbch n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd \u0111\u1ebf b\u01a1m r\u1eeda kh\u1edbp g\u1ed1i qua \u1ed1ng trocart. R\u1eeda kh\u1edbp g\u1ed1i \u0111\u01b0\u1ee3c Burman th\u1ef1c hi\u1ec7n \u0111\u1ea7u ti\u00ean n\u0103m 1934 [30], <\/span>v\u1ec1 <\/span>l\u00fd thuy\u1ebft, r\u1eeda kh\u1edbp c\u00f3 th\u1ec3 c\u00e0i thi\u1ec7n l\u00e2m s\u00e0ng nh\u1edd lo\u1ea1i b\u1ecf \u0111\u01b0\u1ee3c c\u00e1c m\u1ea3nh d\u1ecb v\u1eadt nh\u1ecf do qu\u00e1 tr\u00ecnh b\u00e0o m\u00f2n c\u1ee7a s\u1ee5n kh\u1edbp g\u00e2y ra, lo\u1ea1i b\u1ecf c\u00e1c cytokines g\u00e2y vi\u00eam\u00a0<\/span>m\u00e0ng ho\u1ea1t d\u1ecbch. Tuy nhi\u00ean, t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng ch\u1ec9 c\u1ea3i thi\u1ec7n trong th\u1eddi gian r\u1ea5t ng\u1eafn, v\u00ec b\u1ea3n th\u00e2n t\u1ed5n th\u01b0\u01a1ng s\u1ee5n kh\u00f4ng \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft [31], \u0110\u1ebfn n\u0103m 1941, Magnusoti th\u1ef1c hi\u1ec7n n\u1ed9i soi l\u00e0m s\u1ea1ch, ngh\u0129a l\u00e0 qua n\u1ed9i soi, \u0111\u1ed3ng th\u1eddi v\u1edbi r\u1eeda kh\u1edbp, d\u00f9ng d\u1ee5ng c\u1ee5 c\u1eaft l\u1ecdc t\u1ed5 ch\u1ee9c vi\u00eam bao ho\u1ea1t d\u1ecbch, l\u1ea5y b\u1ecf c\u00e1c d\u1ecb v\u1eadt kh\u1edbp g\u1ed1i do m\u1ea3nh s\u1ee5n v\u1ee1 bong ra (loose bodies), c\u1eaft b\u00f2 c\u00e1c gai x\u01b0\u01a1ng r\u00eca kh\u1edbp (osteophytes) v\u00e0 c\u00e1c k\u00e9n kh\u1edbp (k\u00e9n Baker) [32], \u0110\u1ed1i v\u1edbi nh\u1eefng m\u1ea3nh s\u1ee5n kh\u1edbp c\u00f2n b\u00e1m nh\u01b0ng m\u1ea5t v\u1eebng, c\u00f3 nguy c\u01a1 bong g\u00e3y g\u00e2y d\u1ecb v\u1eadt v\u1ec1 sau c\u0169ng \u0111\u01b0\u1ee3c l\u1ea5y b\u1ecf. S\u1ee5n ch\u00eam r\u00e1ch do tho\u00e1i h\u00f3a \u0111\u01b0\u1ee3c x\u1eed l\u00fd. Nh\u1eefng kh\u1edbp g\u1ed1i tho\u00e1i h\u00f3a n\u1eb7ng, t\u1ed5 ch\u1ee9c x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n g\u1ed3 gh\u1ec1, \u0111\u01b0\u1ee3c m\u00e0i nh\u1eb5n. N\u1ed9i soi l\u00e0m s\u1ea1ch gi\u00fap b\u1ec7nh nh\u00e2n tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i c\u1ea3i thi\u1ec7n \u0111\u01b0\u1ee3c l\u00e2m s\u00e0ng trong m\u1ed9t th\u1eddi gian nh\u1ea5t \u0111\u1ecbnh, \u0111\u1eb7c bi\u1ec7t l\u00e0 d\u1ea5u hi\u1ec7u k\u1eb9t kh\u1edbp, ti\u1ebfng l\u1ee5c c\u1ee5c kh\u1edbp c\u01a1 b\u1ea3n \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft. N\u1ed9i soi l\u00e0m s\u1ea1ch kh\u1edbp \u0111\u01b0\u1ee3c chi \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n tho\u00e1i h\u00f3a g\u1ed1i giai \u0111o\u1ea1n 2, 3, \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa kh\u00f4ng k\u1ebft qu\u1ea3 nh\u01b0ng ch\u01b0a c\u00f3 ch\u1ec9 \u0111\u1ecbnh ho\u1eb7c ch\u01b0a th\u1ec3 ph\u1eabu thu\u1eadt thay kh\u1edbp [47]. Tuy nhi\u00ean, \u0111\u1ebfn nay v\u1eabn c\u00f2n nhi\u1ec1u tranh lu\u1eadn v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a n\u1ed9i soi l\u00e0m s\u1ea1ch kh\u1edbp, ph\u1ea7n l\u1edbn t\u00e1c gi\u1ea3 \u0111\u1ec1u nh\u1eadn \u0111\u1ecbnh, hi\u1ec7u qu\u1ea3 c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y l\u00e0 kh\u00f4ng r\u00f5 r\u00e0ng. Moseley ch\u1ee9ng minh r\u1eb1ng, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng c\u1ee7a nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u00e0ng r\u1eeda kh\u1edbp \u0111\u01a1n thu\u1ea7n ho\u1eb7c r\u1eeda kh\u1edbp k\u1ebft h\u1ee3p c\u1eaft l\u1ecdc l\u00e0m s\u1ea1ch kh\u1edbp khi so s\u00e1nh v\u1edbi nh\u00f3m ch\u1eedng[33]. Livesley (1991) v\u00e0 h\u1ea7u h\u1ebft c\u00e1c t\u00e1c gi\u1ea3 c\u00f9ng kh\u1eb3ng \u0111\u1ecbnh n\u1ed9i soi r\u1eeda, l\u00e0m s\u1ea1ch kh\u1edbp trong \u0111i\u1ec1u tr\u1ecb tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i h\u1ea7u nh\u01b0 kh\u00f4ng mang l\u1ea1i hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au l\u00e2u d\u00e0i [34].<\/span><\/p>\n

2. K\u00edch th\u00edch t\u1ee7y x\u01b0\u01a1ng qua n\u1ed9i soi (Arthroscopic bone marrow stimulation)<\/i><\/b><\/h2>\n

K\u00edch th\u00edch t\u1ee7y x\u01b0\u01a1ng qua n\u1ed9i soi b\u1eb1ng c\u00e1ch g\u00e2y t\u1ed5n th\u01b0\u01a1ng ch\u1ea3y m\u00e1u v\u00f9ng x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n nh\u1eb1m m\u1ee5c \u0111\u00edch t\u1ea1o ra c\u00e1c s\u1ee3i fibrin b\u00e1m d\u00ednh tr\u00ean b\u1ec1 m\u1eb7t v\u00f9ng khuy\u1ebft s\u1ee5n. C\u00e1c t\u1ebf b\u00e0o ch\u01b0a bi\u1ec7t h\u00f3a t\u1eeb d\u1ecbch t\u1ee7y x\u01b0\u01a1ng (trong \u0111\u00f3 c\u00f3 nguy\u00ean b\u00e0o s\u1ee5n) tr\u00f4i ra, b\u00e1m d\u00ednh v\u00e0o c\u00e1c s\u1ee3i fibrin, c\u00f9ng v\u1edbi s\u1ef1 tham gia c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng t\u1ea1i ch\u1ed7 (Growth Factors), tr\u1ea3i qua qu\u00e1 tr\u00ecnh s\u1eb9o h\u00f3a, l\u1edbp s\u1ee5n x\u01a1 (fibrocartilage) \u0111\u01b0\u1ee3c t\u1ea1o th\u00e0nh, che ph\u1ee7 v\u00f9ng khuy\u1ebft s\u1ee5n. Qu\u00e1 tr\u00ecnh n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh do vai tr\u00f2 c\u1ee7a TBG v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 ph\u00e1t tri\u1ec3n c\u00f3 m\u1eb7t trong d\u1ecbch t\u1ee7y x\u01b0\u01a1ng sau k\u00edch th\u00edch v\u00e0 \u0111\u01b0\u1ee3c g\u1ecdi chung l\u00e0 <\/span>ph\u01b0\u01a1ng ph\u00e1p k\u00edch th\u00edch t\u1ee7y x\u01b0\u01a1ng <\/b>{Bone Marrow Stimulation) [35]. Tuy nhi\u00ean, qua nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt th\u1ef1c nghi\u1ec7m, l\u1edbp s\u1ee5n x\u01a1 t\u1ea1o ra sau k\u00edch th\u00edch t\u1ee7y x\u01b0\u01a1ng, v\u1ec1 c\u1ea5u tr\u00fac vi th\u1ec3 kh\u00f4ng gi\u1ed1ng nh\u01b0 l\u1edbp s\u1ee5n trong b\u00ecnh th\u01b0\u1eddng (hyaline cartilage) \u1edf ch\u1ed7 k\u00e9m b\u1ec1n v\u1eefng, d\u1ec5 b\u1ecb bong g\u00e0y. Khi soi<\/span>tr\u00ean k\u00ednh hi\u1ec3n vi quang h\u1ecdc th\u1ea5y trong c\u1ea5u tr\u00fac c\u1ee7a s\u1ee5n x\u01a1 c\u00f3 s\u1ed5 l\u01b0\u1ee3ng t\u1ebf b\u00e0o s\u1ee5n (chondrocyte) nam r\u1ea3i r\u00e1c, th\u01b0a th\u1edbt, t\u1eadp trung ch\u1ee7 y\u1ebfu l\u00e0 m\u00f4 \u0111\u1ec7m gi\u00e0u s\u1ee3i x\u01a1. Trong khi \u0111\u00f3, tr\u00ean ti\u00eau b\u1ea3n s\u1ee5n trong, s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o s\u1ee5n t\u1eadp trung v\u1edbi m\u1eadt \u0111\u1ed9 cao h\u01a1n, m\u00f4 \u0111\u1ec7m gi\u00e0u s\u1ee3i collagen type II [35],<\/span>
\n<\/span><\/p>\n

\"\"
H\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng di\u1ec7n b\u00e1nh ch\u00e8 kh\u1edbp g\u1ed1i ph\u1ea3i qua NSK tr\u01b0\u1edbc m\u1ed5 (A) v\u00e0 sau khi m\u1ed5 k\u00edch th\u00edch t\u1ee7y x\u01b0\u01a1ng 18 th\u00e1ng – xu\u1ea5t hi\u1ec7n nhi\u1ec1u s\u1ee5n x\u01a1 (B) [35]<\/figcaption><\/figure>\n

3. N\u1ed9i soi k\u00edch th\u00edch t\u1ea1o t\u1ed5n th\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n (Microfractures-MF)<\/i><\/b><\/h2>\n

\u0110\u00e2y l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt k\u00edch th\u00edch t\u1ee7y x\u01b0\u01a1ng, d\u01b0\u1ee3c Steadman v\u00e0 c\u1ed9ng s\u1ef1 m\u00f4 t\u1ea3 n\u0103m 1997 [36]. Qua n\u1ed9i soi g\u1ed1i, c\u00e1c v\u00f9ng khuy\u1ebft s\u1ee5n \u0111\u01b0\u1ee3c l\u00e0m s\u1ea1ch, \u0111\u1ec3 l\u1ed9 x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n. Nh\u1eefng ph\u1ea7n s\u1ee5n c\u00f2n b\u00e1m nh\u01b0ng m\u1ea5t v\u1eefng \u0111\u01b0\u1ee3c l\u1ea5y b\u1edf \u0111\u1ebfn v\u00f9ng s\u1ee5n l\u00e0nh, d\u00f9ng d\u00f9i \u0111\u1ea7u nh\u1ecdn ho\u1eb7c khoan t\u1ea1o nhi\u1ec1u l\u1ed7 tr\u00ean n\u1ec1n x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n cho \u0111\u1ebfn ch\u1ea3y m\u00e1u v\u00e0 d\u1ecbch t\u1ee7y x\u01b0\u01a1ng (H\u00ecnh 2.5-A,B). C\u00e1c l\u1ed7 n\u00e0y c\u00e1ch nhau 3-4 mm (3-4 l\u1ed3 tr\u00ean m\u1ed9t em<\/span>2<\/span>), s\u00e2u kho\u1ea3ng 4 mm. Sau m\u1ed5, g\u1ed1i c\u00f3 th\u1ec3 t\u1eadp g\u1ea5p du\u1ed7i b\u00ecnh th\u01b0\u1eddng, nh\u01b0ng kh\u00f4ng t\u1ef3 trong v\u00f2ng 4-6 tu\u1ea7n. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 ti\u1ebfn h\u00e0nh n\u1ed9i soi ki\u1ec3m tra (second look) sau 8-12 th\u00e1ng (H\u00ecnh 2.5-C), qua \u0111\u00f3 sinh thi\u1ebft l\u00e0m m\u00f4 b\u1ec7nh h\u1ecdc th\u1ea5y rang v\u00f9ng s\u1ee5n m\u1edbi h\u00ecnh th\u00e0nh ch\u1ee7 y\u1ebfu l\u00e0 s\u1ee5n x\u01a1 (fibrocartilage) [37].<\/span><\/p>\n

MF l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt \u0111i\u1ec1u tr\u1ecb tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i kh\u00f4ng qu\u00e1 ph\u1ee9c t\u1ea1p, d\u1ec5 th\u1ef1c hi\u1ec7n, chi ph\u00ed th\u1ea5p, \u00e1p d\u1ee5ng ch\u1ee7 y\u1ebfu cho nh\u1eefng tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i th\u1ee9 ph\u00e1t sau ch\u1ea5n th\u01b0\u01a1ng, c\u00f3 v\u00f9ng khuy\u1ebft s\u1ee5n nho (< 4cm<\/span>2<\/span>), th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi tr\u1ebb. Steadman (2003) th\u00f4ng b\u00e1o c\u00f3 80% c\u1ee7a 70 kh\u1edbp g\u1ed1i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt n\u00e0y c\u00f3 c\u1ea3i thi\u1ec7n \u0111\u01b0\u1ee3c l\u00e2m s\u00e0ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 tri\u1ec7u ch\u1ee9ng \u0111au v\u00e0 bi\u00ean \u0111\u1ed9 v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp [38], Kreuz (2006) v\u00e0 c\u1ed9ng s\u1ef1 l\u1ea1i th\u1ea5y r\u1eb1ng, trong s\u1ed1 85 b\u1ec7nh nh\u00e2n sau mo MF, s\u1ef1 c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng chi k\u00e9o d\u00e0i \u0111\u01b0\u1ee3c 1 <\/span>th\u00e1ng. \u0110\u1ed1i v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n tr\u1ebb d\u01b0\u1edbi 40 tu\u1ed5i, t\u00ecnh tr\u1ea1ng c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng t\u1ed1t h\u01a1n [39]. \u0110\u1ed3ng th\u1eddi v\u1edbi MF th\u00ec ph\u01b0\u01a1ng ph\u00e1p c\u1ea5y gh\u00e9p t\u1ebf b\u00e0o s\u1ee5n \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 \u1ee9ng d\u1ee5ng. M\u1ed9t th\u1ed1ng k\u00ea \u0111\u01b0\u1ee3c Harris th\u1ef1c hi\u1ec7n n\u0103m 2010 d\u1ef1a tr\u00ean 7 k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u t\u00f9\u2019 n\u0103m 2004-2010 c\u1ee7a c\u00e1c t\u00e1c gi\u1ea3 Basad, Kunutsen, Saris, Kohti khi so s\u00e1nh MF v\u1edbi gh\u00e9p t\u1ebf b\u00e0o s\u1ee5n t\u1ef1 th\u00e2n th\u1ea5y k\u1ebft qu\u1ea3 l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n c\u00f3 xu h\u01b0\u1edbng nghi\u00eang v\u1ec1 gh\u00e9p t\u1ebf b\u00e0o s\u1ee5n t\u1ef1 th\u00e2n [39].<\/span><\/p>\n

4. G<\/i><\/b>h\u00e9p t\u1ebf b\u00e0o s\u1ee5n t\u1ef1 th\u00e2n (Autologous<\/i><\/b> Chondrocyte <\/i><\/b>Implantation-ACI)<\/i><\/b><\/h2>\n

Ph\u01b0\u01a1ng ph\u00e1p ACI \u0111\u01b0\u1ee3c Brittberg m\u00f4 t\u1ea3 \u0111\u1ea7u ti\u00ean v\u00e0o n\u0103m 1994 [40], Theo \u0111\u00f3, t\u1ebf b\u00e0o s\u1ee5n sau khi \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb <\/span>m\u00f4 <\/span>s\u1ee5n c\u1ee7a ch\u00ednh b\u1ec7nh nh\u00e2n qua n\u1ed9i soi kh\u1edbp, \u0111\u01b0\u1ee3c nu\u00f4i c\u1ea5y trong m\u00f4i tr\u01b0\u1eddng nh\u00e2n t\u1ea1o gi\u00e0u dinh d\u01b0\u1ee1ng v\u00e0 gi\u00e0u c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng, trong th\u1eddi gian 3-4 tu\u1ea7n \u0111\u1ec3 \u0111\u01b0\u1ee3c t\u0103ng sinh. Kh\u1ed1i t\u1ebf b\u00e0o s\u1ee5n sau khi t\u0103ng sinh (kho\u1ea3ng<\/span><\/p>\n

tri\u1ec7u t\u1ebf b\u00e0o) \u0111\u01b0\u1ee3c tr\u1ed9n l\u1eabn trong huy\u1ec5n d\u1ecbch trung t\u00ednh ho\u1eb7c huy\u1ec1n d\u1ecbch ch\u1ee9a nhi\u1ec1u collagen, \u0111\u01b0\u1ee3c gh\u00e9p tr\u1edf l\u1ea1i v\u00e0o v\u00f9ng khuy\u1ebft s\u1ee5n qua m\u1edb kh\u1edbp g\u1ed1i [41]. Kh\u1ed1i t\u1ebf b\u00e0o \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh b\u1eb1ng m\u00e0ng x\u01b0\u01a1ng l\u1ea5y t\u1eeb x\u01b0\u01a1ng ch\u00e0y c\u1ee7a b\u1ec7nh nh\u00e2n.<\/span><\/p>\n

Qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt n\u00e0y \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft th\u00e0nh 5 b\u01b0\u1edbc nh\u01b0 sau:<\/span><\/p>\n

    \n
  • B\u01b0\u1edbc 1: N\u1ed9i soi kh\u1edbp, l\u1ea5y m\u00f4 s\u1ee5n l\u00e0nh t\u1ea1i v\u1ecb tr\u00ed kh\u00f4ng t\u1ef3 \u0111\u00e8<\/span><\/li>\n
  • B\u01b0\u1edbc 2: Nu\u00f4i c\u1ea5y \u0111\u1ec3 t\u0103ng sinh<\/span><\/li>\n
  • B\u01b0\u1edbc 3: M\u1edf kh\u1edbp g\u1ed1i l\u00e0m s\u1ea1ch v\u00f9ng khuy\u1ebft s\u1ee5n<\/span><\/li>\n
  • B\u01b0\u1edbc 4: L\u1ea5y m\u00e0ng x\u01b0\u01a1ng t\u1eeb x\u01b0\u01a1ng ch\u00e0y, kh\u00e2u ph\u1ee7 b\u1ec1 m\u1eb7t v\u00f9ng khuy\u1ebft s\u1ee5n.<\/span><\/li>\n
  • B\u01b0\u1edbc 5: B\u01a1m huy\u1ec5n d\u1ecbch ch\u1ee9a t\u1ebf b\u00e0o s\u1ee5n sau nu\u00f4i c\u1ea5y v\u00e0o d\u01b0\u1edbi m\u00e0ng x\u01b0\u01a1ng.<\/span><\/li>\n<\/ul>\n

    Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y ch\u1ec9 n\u00ean \u00e1p d\u1ee5ng cho nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i, c\u00f3 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n m\u1edbi v\u00e0 m\u1ed9t v\u1ecb tr\u00ed v\u1edbi di\u1ec7n t\u00edch v\u00f9ng khuy\u1ebft s\u1ee5n v\u1eeba [41].<\/span><\/p>\n

    \u01afu \u0111i\u1ec3m c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p: ph\u1ee5c h\u1ed3i \u0111\u01b0\u1ee3c l\u1edbp s\u1ee5n m\u1edbi c\u00f3 b\u1ea3n ch\u1ea5t l\u00e0 s\u1ee5n trong (hyaline cartilage), c\u00f3 t\u00ednh \u0111\u00e0n h\u1ed3i, t\u00ednh b\u1ec1n v\u1eefng cao, gi\u1ed1ng s\u1ee5n b\u00ecnh th\u01b0\u1eddng<\/span><\/p>\n

    Nh\u01b0\u1ee3c \u0111i\u1ec3m c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p; b\u1ec7nh nh\u00e2n ph\u1ea3i tr\u1ea3i qua hai l\u1ea7n ph\u1eabu thu\u1eadt, \u0111\u1eb7c bi\u1ec7t l\u1ea7n gh\u00e9p t\u1ebf b\u00e0o s\u1ee5n ph\u1ea3i m\u1edf kh\u1edbp g\u1ed1i. M\u1eb7t kh\u00e1c t\u1ebf b\u00e0o s\u1ee5n ph\u1ea3i nu\u00f4i c\u1ea5y trong m\u00f4i tr\u01b0\u1eddng \u0111\u1eb7c bi\u1ec7t v\u1edbi gi\u00e1 th\u00e0nh cao, l\u00e0m t\u0103ng chi ph\u00ed \u0111i\u1ec1u tr\u1ecb. Kh\u1ed1i t\u1ebf b\u00e0o s\u1ee5n \u0111\u01b0\u1ee3c nh\u00e2n l\u00ean t\u1eeb c\u00e1c t\u1ebf b\u00e0o s\u1ee5n tr\u01b0\u1edfng th\u00e0nh n\u00ean nhanh l\u00e3o h\u00f3a, thi\u1ebfu \u1ed5n \u0111\u1ecbnh. Ngay sau gh\u00e9p, m\u1ea3nh gh\u00e9p d\u1ec5 b\u1ecb bong kh\u1ecfi v\u1ecb tr\u00ed gh\u00e9p, d\u1eabn \u0111\u1ebfn th\u1ea5t b\u1ea1i[42]. Gh\u00e9p x\u01b0\u01a1ng s\u1ee5n ho\u1eb7c gh\u00e9p t\u1ebf b\u00e0o s\u1ee5n \u0111\u1ec1u ph\u1ea3i l\u1ea5y m\u1ed9t ph\u1ea7n s\u1ee5n l\u00e0nh, g\u00e2y v\u00f9ng t\u1ed5n th\u01b0\u01a1ng m\u1edbi trong kh\u1edbp. Ngo\u00e0i ra b\u1ea3n th\u00e2n s\u1ee5n gh\u00e9p kh\u00f4ng gi\u1eef \u0111\u01b0\u1ee3c c\u1ea5u tr\u00fac nguy\u00ean th\u1ee7y ban \u0111\u1ea7u, s\u1ef1 ph\u1ea3n \u1ee9ng t\u1ea1i v\u00f9ng gi\u00e1p ranh gi\u1eefa s\u1ee5n gh\u00e9p (cho) v\u00e0 l\u00e0nh (nh\u1eadn) v\u1eabn \u0111ang l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c.<\/span><\/p>\n

    5. Ph\u1eabu thu\u1eadt gh\u00e9p x\u01b0\u01a1ng s\u1ee5n t\u1ef1 th\u00e2n ho\u1eb7c \u0111\u1ed3ng lo\u1ea1i (Osteochondral Autograft\/ Autograft Transplantation – OAT)<\/i><\/b><\/h2>\n

    N\u1ebfu gh\u00e9p ph\u1ea7n s\u1ee5n (hyaline cartilage) \u0111\u01a1n thu\u1ea7n s\u1ebd kh\u00f4ng t\u1ea1o \u0111\u01b0\u1ee3c s\u1ef1 li\u1ec1n s\u1ee5n t\u1ea1i v\u1ecb tr\u00ed gi\u00e1p ranh gi\u1eefa m\u1ea3nh gh\u00e9p v\u00e0 s\u1ee5n l\u00e0nh (do s\u1ee5n kh\u00f4ng c\u00f3 m\u1ea1ch nu\u00f4i). \u0110\u1ec3 kh\u1eafc ph\u1ee5c nh\u01b0\u1ee3c \u0111i\u1ec3m \u0111\u00f3, gh\u00e9p x\u01b0\u01a1ng s\u1ee5n- m\u1ea3nh gh\u00e9p bao g\u1ed3m ph\u1ea7n x\u01b0\u01a1ng li\u1ec1n s\u1ee5n, s\u1ebd t\u1ea1o \u0111\u01b0\u1ee3c s\u1ef1 li\u1ec1n x\u01b0\u01a1ng t\u1ea1i v\u1ecb tr\u00ed gh\u00e9p, nh\u1edd \u0111\u00f3 s\u1ee5n gh\u00e9p s\u1ed1ng v\u00e0 v\u1ea7n \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1ee3c ch\u1ee9c n\u0103ng c\u1ee7a s\u1ee5n. OAT \u0111\u01b0\u1ee3c Matsusue m\u00f4 t\u1ea3 \u0111\u1ea7u ti\u00ean n\u0103m 1993. OAT \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho\u00a0<\/span>nh\u1eefng t\u1ed5n th\u01b0\u01a1ng s\u1ee5n c\u00f3 di\u1ec7n t\u00edch nh\u1ecf v\u00e0 v\u1eeba (1 -4cm<\/span>2<\/span>), \u0111\u01a1n \u1ed5. S\u1ee5n gh\u00e9p \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb s\u1ee5n l\u00e0nh \u1edf v\u1ecb tr\u00ed kh\u00f4ng t\u1ef3 \u0111\u00e8 c\u1ee7a ch\u00ednh b\u1ec7nh nh\u00e2n (t\u1ef1 th\u00e2n) ho\u1eb7c c\u1ee7a ng\u01b0\u1eddi cho (\u0111\u1ed3ng lo\u1ea1i) [43]. M\u00e1nh glico h\u00ecnh tr\u1ee5, bao g\u1ed3m ph\u1ea7n x\u01b0\u01a1ng li\u1ec1n s\u1ee5n, \u0111\u01b0\u1ee3c n\u00eam ch\u1eb7t v\u00e0o v\u1ecb tr\u00ed khuy\u1ebft s\u1ee5n, t\u1ea1o ra b\u1ec1 m\u1eb7t s\u1ee5n gi\u1ed1ng s\u1ee5n l\u00e0nh (H\u00ecnh 2.7). OAT c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh qua n\u1ed9i soi ho\u1eb7c m\u1ed5 m\u1edf. Nh\u01b0\u1ee3c \u0111i\u1ec3m ch\u00ednh c\u1ee7a OAT l\u00e0 t\u1ea1o t\u1ed5n th\u01b0\u01a1ng m\u1edbi t\u1ea1i v\u1ecb tr\u00ed l\u1ea5y s\u1ee5n \u0111\u1ed1i v\u1edbi gh\u00e9p t\u1ef1 th\u00e2n. Neu gh\u00e9p \u0111\u1ed3ng lo\u1ea1i, li\u00ean quan \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 x\u1eed l\u00fd m\u1ea3nh gh\u00e9p v\u00e0 th\u1ea3i gh\u00e9p. Trong th\u1eddi gian ch\u01b0a li\u1ec1n x\u01b0\u01a1ng, m\u1ea3nh gh\u00e9p d\u1ec5 r\u01a1i v\u00e0o kh\u1edbp g\u00e2y k\u1eb9t kh\u1edbp khi b\u1ec7nh nh\u00e2n v\u1eadn \u0111\u1ed9ng.<\/span>
    \n<\/span><\/p>\n

     <\/p>\n

    \"\"
    M\u00f4 ph\u1ecfng c\u00e1c b\u01b0\u1edbc gh\u00e9p x\u01b0\u01a1ng s\u1ee5n t\u1ef1 th\u00e2n qua n\u1ed9i soi kh\u1edbp [43].<\/figcaption><\/figure>Outerbridge (1995) ch\u1ee9ng minh r\u1eb1ng, b\u1ec7nh nh\u00e2n sau OAT \u0111i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng s\u1ee5n v\u1ecb tr\u00ed l\u1ed3i c\u1ea7u \u0111\u00f9i, t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng v\u00e0 ch\u1ee9c n\u0103ng kh\u1edbp g\u1ed1i \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n m\u1ed9t c\u00e1ch r\u00f5 r\u1ec7t sau th\u1eddi gian theo d\u00f5i trung b\u00ecnh 6,5 n\u0103m. T\u1ea1i v\u1ecb tr\u00ed gh\u00e9p c\u00f3 s\u1ef1 li\u1ec1n x\u01b0\u01a1ng \u1edf ph\u1ea7n x\u01b0\u01a1ng. Ph\u1ea7n s\u1ee5n \u0111\u01b0\u1ee3c ph\u1ee5c h\u1ed3i b\u1eb1ng l\u1edbp s\u1ee5n x\u01a1 (\u00edibrocart\u00ec\u1ec9age) [44],<\/span><\/p>\n

    N\u0103m 2003, Handy b\u00e1o c\u00e1o v\u1edbi s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n l\u1edbn h\u01a1n, g\u1ed3m 597 l\u1ed3i c\u1ea7u \u0111\u00f9i, 76 m\u00e2m ch\u00e0y v\u00e0 118 di\u1ec7n kh\u1edbp ch\u00e8 \u0111\u00f9i \u0111\u01b0\u1ee3c gh\u00e9p x\u01b0\u01a1ng s\u1ee5n, th\u1eddi gian theo d\u00f5i sau m\u1ed5 g\u1ea7n 10 n\u0103m, t\u1ef7 l\u1ec7 t\u1ed1t v\u00e0 r\u1ea5t t\u1ed1t chi\u1ebfm l\u1ea7n l\u01b0\u1ee3t 92%, 87% v\u00e0 79% [45].<\/span><\/p>\n

    M\u1eb7c d\u00f9 k\u1ebft qu\u1ea3 c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c kh\u1eb3ng \u0111\u1ecbnh, tuy nhi\u00ean c\u1ea3 ba ph\u01b0\u01a1ng ph\u00e1p MF, AC1 v\u00e0 OAT \u0111\u1ec1u ch\u1ec9 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng tr\u00ean b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i, ch\u1ee7 y\u1ebfu l\u00e0 tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i th\u1ee9 ph\u00e1t sau ch\u1ea5n th\u01b0\u01a1ng, di\u1ec7n t\u00edch v\u00f9ng khuy\u1ebft s\u1ee5n nh\u1ecf v\u00e0 \u0111\u01a1n \u1ed5 [45],<\/span><\/p>\n

    6. Gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c (TBG)<\/i><\/b><\/h2>\n

    M\u1ed9t s\u1ed1 ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e3 \u0111\u1ec1 c\u1eadp \u01af tr\u00ean nh\u01b0 gh\u00e9p t\u1ebf b\u00e0o s\u1ee5n t\u1ef1 th\u00e2n (ACI), gh\u00e9p x\u01b0\u01a1ng s\u1ee5n t\u1ef1 th\u00e2n ho\u1eb7c \u0111\u1ed3ng lo\u1ea1i (OAT), Micro\u1eefacture (MF) \u0111\u1ec1u ch\u1ec9 \u00e1p d\u1ee5ng cho THKG th\u1ee9 ph\u00e1t sau ch\u1ea5n th\u01b0\u01a1ng, c\u00f3 t\u1ed5n th\u01b0\u01a1ng khuy\u1ebft s\u1ee5n tr\u00ean di\u1ec7n t\u00edch h\u1eb9p, m\u1ed9t v\u1ecb tr\u00ed, \u1edf ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i. \u0110\u1ed1i v\u1edbi THKG nguy\u00ean ph\u00e1t, t\u1ed5n th\u01b0\u01a1ng s\u1ee5n kh\u1edbp th\u01b0\u1eddng x\u1ea3y ra tr\u00ean di\u1ec7n t\u00edch r\u1ed9ng, c\u00f3 th\u1ec3 \u1edf nhi\u1ec1u v\u1ecb tr\u00ed, \u1edf ng\u01b0\u1eddi c\u00f3 tu\u1ed5i. Ph\u01b0\u01a1ng ph\u00e1p n\u1ed9i soi kh\u1edbp \u0111e r\u1eeda, c\u1eaft l\u1ecdc v\u00e0 l\u00e0m s\u1ea1ch c\u00e1c khoang kh\u1edbp g\u1ed1i \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng. Tuy nhi\u00ean, theo k\u1ebft qu\u1ea3 c\u1ee7a nhi\u1ec1u nghi\u00ean c\u1ee9u cho th\u1ea5y, n\u1ed9i soi l\u00e0m s\u1ea1ch kh\u1edbp \u0111\u01a1n thu\u1ea7n kh\u00f4ng mang l\u1ea1i hi\u1ec7u qu\u1ea3 \u0111\u00e1ng k\u1ec3 [3 1 ],[33]. H\u01b0\u1edbng nghi\u00ean c\u1ee9u d\u00f9ng TBG \u0111\u1ec3 s\u1eeda ch\u1eefa, t\u00e1i t\u1ea1o s\u1ee5n kh\u1edbp b\u1ecb t\u1ed5n th\u01b0\u01a1ng do tho\u00e1i h\u00f3a, \u0111\u00e0 \u0111\u01b0\u1ee3c ti\u1ebfp c\u1eadn t\u1eeb nh\u1eefng n\u0103m \u0111\u1ea7u c\u1ee7a th\u1eadp ni\u00ean 90 [46].<\/span><\/p>\n

    V\u1edbi \u0111\u1eb7c t\u00ednh c\u00f3 kh\u1ea3 n\u0103ng t\u1ef1 t\u00e1i t\u1ea1o v\u00e0 bi\u1ec7t h\u00f3a th\u00e0nh nh\u1eefng t\u1ebf b\u00e0o chuy\u00ean bi\u1ec7t, \u0111a d\u00f2ng trong nh\u1eefng \u0111i\u1ec1u ki\u1ec7n nh\u1ea5t \u0111\u1ecbnh, TBG \u0111\u01b0\u1ee3c xem nh\u01b0 l\u00e0 ngu\u1ed3n \u201cnguy\u00ean li\u1ec7u d\u1ef1 tr\u1eef\u201d, gi\u00fap c\u01a1 th\u1ebf s\u1eeda ch\u1eefa, t\u00e1i t\u1ea1o, thay th\u1ebf nh\u1eefng m\u00f4, t\u1ed5 ch\u1ee9c b\u1ecb t\u1ed5n th\u01b0\u01a1ng hay gi\u00e0 h\u00f3a, trong \u0111\u00f3 c\u00f3 s\u1ee5n kh\u1edbp [46],[47], H\u01b0\u1edbng \u1ee9ng d\u1ee5ng, gh\u00e9p TBG th\u00e0nh c\u00f4ng, s\u1ed5 m\u1edf ra m\u1ed9t tri\u1ec3n v\u1ecdng m\u1edbi trong \u0111i\u1ec1u tr\u1ecb THKG c\u1ea3 nguy\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t, gi\u00fap ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ea9y l\u00f9i \u0111\u01b0\u1ee3c th\u1eddi gian ph\u1ea3i thay kh\u1edbp ho\u1eb7c tr\u00e1nh \u0111\u01b0\u1ee3c cu\u1ed9c ph\u1eabu thu\u1eadt thay kh\u1edbp v\u1ed1n nhi\u1ec1u r\u1ee7i ro v\u00e0 t\u1ed1n k\u00e9m.<\/span><\/p>\n

    7. <\/i><\/b>Ph\u1eabu thu\u1eadt \u0111<\/i><\/b>\u1ee5c x\u01b0\u01a1ng ch\u1ec9nh tr\u1ee5c (Osteotomy)<\/i><\/b><\/h2>\n

    M\u1ee5c \u0111\u00edch c\u1ee7a \u0111\u1ee5c x\u01b0\u01a1ng s\u1eeda tr\u1ee5c l\u00e0 l\u00e0m thay \u0111\u1ed5i tr\u1ee5c c\u01a1 h\u1ecdc hay tr\u1ee5c ch\u1ecbu l\u1ef1c c\u1ee7a chi d\u01b0\u1edbi, chuy\u1ec3n tr\u1ecdng t\u00e2m ch\u1ecbu l\u1ef1c c\u1ee7a kh\u1edbp g\u1ed1i t\u1eeb khoang tho\u00e1i h\u1ecfa sang khoang l\u00e0nh theo tr\u1ee5c sinh l\u00fd, l\u00e0m gi\u1ea3m t\u1ea3i l\u00ean b\u1ec1 m\u1eb7t kh\u1edbp \u0111\u00e3 tho\u00e1i ho\u00e1, gi\u00fap b\u1ec7nh nh\u00e2n gi\u1ea3m \u0111au cho t\u1edbi khi v\u00f9ng s\u1ee5n m\u1edbi b\u1ecb m\u00f2n [48], \u0110\u1ee5c x\u01b0\u01a1ng s\u1eeda tr\u1ee5c th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ebf \u0111i\u1ec1u tr\u1ecb nh\u1eefng tho\u00e1i ho\u00e1 kh\u1edbp g\u1ed1i s\u1edbm, m\u1ed9t khoang (khoang trong ho\u1eb7c khoang ngo\u00e0i c\u1ee7a kh\u1edbp), th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3n d\u1ea1ng ch\u00e2n ki\u1ec3u v\u1eb9o trong (ch\u00e2n ch\u1eef O) hay v\u1eb9o ngo\u00e0i (ch\u00e2n ch\u1eef X-hai b\u00ean, ch\u1eef K-m\u1ed9t b\u00ean). V\u1ecb tr\u00ed \u0111\u1ee5c x\u01b0\u01a1ng c\u00f3 th\u1ec3 \u1edf m\u00e2m ch\u00e0y ho\u1eb7c tr\u00ean l\u1ed3i c\u1ea7u \u0111\u00f9i, \u0111\u1ee5c theo h\u00ecnh th\u1ee9c \u201cV \u0111\u00f3ng\u201d ho\u1eb7c \u201cV m\u1edf\u201d. \u0110\u1ed1i v\u1edbi ch\u00e2n v\u1eb9o trong (tho\u00e1i h\u00f3a khoang trong), c\u00f3 th\u1ec3 \u0111\u1ee5c x\u01b0\u01a1ng ki\u1ec3u \u201cV \u0111\u1ecfng\u201d \u1edf ph\u00eda ngo\u00e0i <\/span>ho\u1eb7c <\/b>ki\u1ec3u \u201cV m\u1edf\u201d \u1edf ph\u00eda trong m\u00e2m ch\u00e0y. Theo kinh \u0111i\u1ec3n, th\u01b0\u1eddng \u0111\u1ee5c ki\u1ec3u \u201cV \u0111\u00f3ng\u201d ph\u00eda ngo\u00e0i m\u00e2m ch\u00e0y, \u0111\u1ed3ng th\u1eddi \u0111\u1ee5c c\u1ea3 x\u01b0\u01a1ng m\u00e1c ho\u1eb7c t\u1ea1o h\u00ecnh l\u1ea1i kh\u1edbp ch\u00e0y m\u00e1c tr\u00ean c\u00f9ng b\u00ean. Tuy nhi\u00ean nh\u01b0\u1ee3c \u0111i\u1ec3m c\u1ee7a k\u1ef9 thu\u1eadt n\u00e0y l\u00e0 d\u1ec5 g\u1eb7p tai bi\u1ebfn li\u1ec7t th\u1ea7n kinh m\u00e1c chung do t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng m\u00e1c. Theo Staubli (2003), t\u1ef7 l\u1ec7 g\u1eb7p tai bi\u1ebfn n\u00e0y l\u00e0 11%. <\/span>M\u1ed8T m\u1ed1i quan t\u00e2m n\u1eefa \u0111\u00f3<\/span>!\u00e0 s\u1ef1 thay \u0111\u1ed5i tr\u1ee5c khi \u0111\u1ee5c x\u01b0\u01a1ng ki\u1ec3u V \u0111\u00f3ng ph\u00eda ngo\u00e0i c\u00f3 th\u1ec3 l\u00e0m thay \u0111\u1ed5i b\u00ecnh di\u1ec7n kh\u1edbp ch\u00e8 \u0111\u00f9i. S\u1ef1 m\u1ea5t x\u01b0\u01a1ng c\u0169ng g\u00e2y ra m\u1ed9t th\u00e1ch th\u1ee9c cho v\u1ea5n \u0111\u1ec1 thay kh\u1edbp v\u1ec1 sau. Tr\u01b0\u1edbc nh\u1eefng nh\u01b0\u1ee3c \u0111i\u1ec3m n\u00e0y, \u0111\u1ee5c x\u01b0\u01a1ng ph\u00eda trong m\u00e2m ch\u00e0y kicu V m\u1edf ng\u00e0y nay \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn ph\u1ed5 bi\u1ebfn h\u01a1n khi \u0111i\u1ec1u tr\u1ecb tho\u00e1i h\u00f3a khoang trong do tr\u1ee5c chi v\u1eb9o trong [49].<\/span><\/p>\n

    T\u1eeb n\u0103m 1961, Jackson v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 ch\u1ee9ng minh \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au sau khi thay \u0111\u1ed5i tr\u1ee5c c\u01a1 h\u1ecdc c\u1ee7a kh\u1edbp \u1edf b\u1ec7nh nh\u00e2n v\u1eb9o tr\u1ee5c chi. Tuy nhi\u00ean nhi\u1ec1u t\u00e1c gi\u1ea3 kh\u00e1c (Harris 1970) nghi ng\u1edd k\u1ebft qu\u1ea3 n\u00e0y v\u00e0 cho r\u1eb1ng, nguy\u00ean nh\u00e2n g\u00e2y \u0111au trong v\u1eb9o tr\u1ee5c chi kh\u00f4ng ho\u00e0n to\u00e0n do thay \u0111\u1ed5i tr\u1ee5c c\u01a1 h\u1ecdc [50], Ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ee5c x\u01b0\u01a1ng s\u1eeda tr\u1ee5c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh r\u1ed9ng r\u00e3i cho \u0111i\u1ec1u tr\u1ecb tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i t\u1eeb nh\u1eefng n\u0103m 1960 \u0111\u1ebfn nh\u1eefng n\u0103m 1970. Khi theo d\u00f5i l\u00e2u d\u00e0i tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c thay kh\u1edbp g\u1ed1i v\u1edbi t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng cao, ph\u01b0\u01a1ng ph\u00e1p n\u00e0y sau \u0111\u00f3 \u00edt \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ph\u1ed5 bi\u1ebfn. M\u1ed9t \u01b0u \u0111i\u1ec3m c\u1ee7a \u0111\u1ee5c x\u01b0\u01a1ng s\u1eeda tr\u1ee5c v\u01b0\u1ee3t tr\u1ed9i h\u01a1n so v\u1edbi thay kh\u1edbp l\u00e0 b\u1ea3o t\u1ed3n \u0111\u01b0\u1ee3c x\u01b0\u01a1ng quanh g\u1ed1i, gi\u1eef \u0111\u01b0\u1ee3c c\u1ea5u tr\u00fac b\u00ean trong c\u0169ng nh\u01b0 h\u1ec7 th\u1ed1ng d\u00e2y ch\u1eb1ng b\u00ean ngo\u00e0i c\u1ee7a kh\u1edbp. Do v\u1eady, v\u1edbi b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i, tho\u00e1i h\u00f3a kh\u1edbp m\u1ed9t khoang c\u00f3 li\u00ean quan \u0111\u1ebfn l\u1ec7ch tr\u1ee5c chi, \u0111\u1ee5c x\u01b0\u01a1ng s\u1eeda tr\u1ee5c v\u1eabn l\u00e0 m\u1ed9t ch\u1ec9 \u0111\u1ecbnh ph\u00f9 h\u1ee3p [49],[50].<\/span><\/p>\n

    8. Ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i<\/i><\/b><\/h2>\n

    Thay kh\u1edbp l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3, b\u1ec7nh nh\u00e2n s\u1edbm l\u1ea5y l\u1ea1i \u0111\u01b0\u1ee3c ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp g\u1ed1i sau m\u1ed5. Tuy nhi\u00ean, ihay kh\u1edbp l\u00e0 m\u1ed9t ph\u1eabu thu\u1eadt l\u1edbn, ti\u1ec1m \u1ea9n nhi\u1ec1u r\u1ee7i ro h\u01a1n, gi\u00e1 th\u00e0nh cao, kh\u00f4ng ph\u1ea3i b\u1ec7nh nh\u00e2n n\u00e0o c\u0169ng \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u ki\u1ec7n thay kh\u1edbp. H\u01a1n n\u1eefa tu\u1ed5i th\u1ecd c\u1ee7a kh\u1edbp nh\u00e2n t\u1ea1o ch\u1ec9 c\u00f3 th\u1eddi h\u1ea1n nh\u1ea5t \u0111\u1ecbnh, n\u00ean \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n thu\u1ed9c nh\u1ecfm tr\u1ebb tu\u1ed5i (< 55) ph\u1ea3i \u0111\u1ee9ng tr\u01b0\u1edbc nguy c\u01a1 thay l\u1ea1i kh\u1edbp (revision) nhi\u1ec1u l\u1ea7n, nh\u1ea5t l\u00e0 tu\u1ed5i th\u1ecd trung b\u00ecnh c\u1ee7a con ng\u01b0\u1eddi ng\u00e0y c\u00e0ng t\u0103ng. V\u00ec v\u1eady, ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i ph\u1ea3i x\u00e9t tr\u00ean nhi\u1ec1u kh\u00eda c\u1ea1nh, nh\u01b0 m\u1ee9c \u0111\u1ed9 tho\u00e1i h\u00f3a, tu\u1ed5i, kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c…[51]. Thay kh\u1edbp g\u1ed1i c\u00f3 th\u1ec3 thay 1 khoang trong ho\u1eb7c khoang ngo\u00e0i ho\u1eb7c thay kh\u1edbp g\u1ed1i to\u00e0n b\u1ed9.<\/span>
    \n<\/span><\/p>\n

     <\/p>\n

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

      \n
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    51. Insall, J.N. (1996). Knee arthroplasty, then, now and tomorrow. In <\/span>Current concepts in primary and revision total knee arthroplasty<\/span><\/i> (ed. J.N. Insall, W.N. Scott, and G.R. Scuderi), pp. 1 <\/span>-2.<\/span><\/i> Lippincott-Raven, Philadelphia, PA<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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