{"id":2999,"date":"2023-04-09T23:07:10","date_gmt":"2023-04-09T16:07:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2999"},"modified":"2023-04-10T14:47:26","modified_gmt":"2023-04-10T07:47:26","slug":"tao-hinh-day-chang-cheo-sau-tao-duong-ham-va-phuong-tien-co-dinh-day-chang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/tao-hinh-day-chang-cheo-sau-tao-duong-ham-va-phuong-tien-co-dinh-day-chang\/","title":{"rendered":"T\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00e9o sau t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m v\u00e0 ph\u01b0\u01a1ng ti\u1ec7n c\u1ed1 \u0111\u1ecbnh"},"content":{"rendered":"

C\u01a1 s\u1edd \u0111\u1ec3 ph\u00e2n lo\u1ea1i c\u00e1c k\u1ef9 thu\u1eadt t\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00e9o sau (DCCS) v\u1edbi \u0111\u01b0\u1eddng h\u1ea7m xuy\u00ean ch\u00e0y d\u1ef1a theo c\u00e1ch th\u1ee9c t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m d\u1ef1a tr\u00ean c\u00e1ch th\u1ee9c khoan \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i, c\u00e1ch th\u1ee9c \u0111\u01b0a m\u1ea3nh gh\u00e9p v\u00e0o \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i c\u00f9ng nh\u01b0 ph\u01b0\u01a1ng ti\u1ec7n c\u1ed1 \u0111\u1ecbnh m\u1ea3nh gh\u00e9p v\u00e0o \u0111\u01b0\u1eddng h\u1ea7m x\u01b0ong \u0111\u00f9i t\u1eeb ngo\u00e0i v\u00e0o (outside in) hay t\u1eeb trong ra (inside out). C\u1ea3 hai k\u1ef9 thu\u1eadt n\u00e0y khi t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u00e0y \u0111\u1ec1u ph\u1ea3i khoan t\u1eeb ngo\u00e0i v\u00e0o. Sau n\u00e0y, v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n c\u00f9a c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n v\u00e0 d\u1ee5ng c\u1ee5 ph\u1eabu thu\u1eadt n\u1ed9i soi, vi\u1ec7c khoan \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 x\u01b0\u01a1ng ch\u00e0y ho\u00e0n to\u00e0n c\u00f3 th\u1ebf \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u1ea5t c\u1ea3 t\u1eeb b\u00ean trong kh\u1edbp g\u1ed1i ra ngo\u00e0i n\u00ean h\u00ecnh th\u00e0nh k\u1ef9 thu\u1eadt t\u1ea5t c\u1ea3 b\u00ean trong (all inside).<\/p>\n

Nh\u1eefng nghi\u00ean c\u1ee9u th\u1ef1c nhi\u1ec7m v\u00e0 l\u00e2m s\u00e0ng cho th\u1ea5y v\u1ecb tr\u00ed y\u1ebfu nh\u1ea5t c\u1ee7a m\u1ea3nh gh\u00e9p khi t\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00ednh l\u00e0 v\u1ecb tr\u00ed c\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb1ng trong \u0111\u01b0\u1eddng h\u1ea7m. Nh\u1eefng nghi\u00ean c\u1ee9u, c\u1ea3i ti\u1ebfn c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n c\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb1ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u1eb1m gi\u00fap ph\u1eabu thu\u1eadt vi\u00ean ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt m\u1ed9t c\u00e1c \u0111\u01a1n gi\u1ea3n m\u00e0 \u0111\u1ea1t k\u1ebft qu\u1ea3 cao h\u01a1n. \u0110\u1ec3 c\u1ed1 \u0111\u1ecbnh m\u1ea3nh gh\u00e9p trong \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng c\u00f3 th\u1ec3 l\u00e0 v\u00edt kh\u00f4ng ti\u00eau ho\u1eb7c v\u00edt sinh h\u1ecdc t\u1ef1 ti\u00eau, c\u1ea5u t\u1ea1o c\u1ee7a v\u00edt ch\u1eb9n c\u00f9ng kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o lo\u1ea1i v\u00edt ch\u1eb9n b\u1eaft ti\u1ebfn (antegrade) hay b\u1eaft l\u00f9i (retrogreade).<\/p>\n

1. C\u00e1c k\u1ef9 thu\u1eadt t\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00e9o sau v\u1edbi \u0111\u01b0\u1eddng h\u1ea7m xuy\u00ean ch\u00e0y d\u1ef1a theo c\u00e1ch th\u1ee9c t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m<\/h2>\n

1.1 K\u1ef9 thu\u1eadt t\u1eeb ngo\u00e0i v\u00e0o (outside in)<\/strong><\/h3>\n

\u0110\u1eb7c tr\u01b0ng c\u1ee7a k\u1ef9 thu\u1eadt n\u00e0y l\u00e0 s\u1eed d\u1ee5ng hai \u0111\u01b0\u1eddng r\u1ea1ch da: m\u1ed9t \u0111\u01b0\u1eddng r\u1ea1ch da \u1edf ph\u00eda tr\u01b0\u1edbc trong c\u1ee7a m\u00e2m ch\u00e0y \u0111\u1ec3 t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u00e0y v\u00e0 m\u1ed9t \u0111\u01b0\u1eddng r\u1ea1ch da ph\u00eda tr\u01b0\u1edbc trong c\u00f9a x\u01b0\u01a1ng \u0111\u00f9i \u0111\u1ec3 t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i. C\u1ea3 hai \u0111\u01b0\u1eddng h\u1ea7m n\u00e0y \u0111\u1ec1u \u0111\u01b0\u1ee3c khoan t\u1eeb ngo\u00e0i v\u00e0o.<\/p>\n

\"Khoan
Khoan \u0111\u01b0\u1eddng h\u1ea7m \u0111\u00f9i t\u1eeb ngo\u00e0i v\u00e0o cho BTN (T) v\u00e0 BST (P)<\/figcaption><\/figure>\n

1.2 K\u1ef9 thu\u1eadt t\u1eeb trong ra (inside out)<\/strong><\/h3>\n

\u0110\u1eb7c tr\u01b0ng c\u1ee7a k\u1ef9 thu\u1eadt n\u00e0y l\u00e0 s\u1eed d\u1ee5ng m\u1ed9t \u0111\u01b0\u1eddng r\u1ea1ch da ph\u00eda tr\u01b0\u1edbc trong c\u1ee7a m\u00e2m ch\u00e0y \u0111\u1ec3 t\u1ea1o \u0111\u01b0\u1eddng\u00a0\u00a0\u00a0\u00a0 h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i b\u1eb1ng c\u00e1ch khoan t\u1eeb ngo\u00e0i v\u00e0o c\u00f2n \u0111\u01b0\u1eddng h\u1ea7m \u0111\u00f9i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch khoan t\u1eeb trong ra qua l\u1ed7 v\u00e0o tr\u01b0\u1edbc ngo\u00e0i d\u01b0\u1edbi s\u1ef1 h\u00f4 tr\u1ee3 c\u1ee7a n\u1ed9i soi.<\/p>\n

\"Khoan
Khoan \u0111\u01b0\u1eddng h\u1ea7m \u0111\u00f9i t\u1eeb trong ra cho b\u00f3 sau trong (A) v\u00e0 b\u00f3 tr\u01b0\u1edbc ngo\u00e0i (B)<\/figcaption><\/figure>\n

1.3 K\u1ef9 thu\u1eadt t\u1ea5t c\u1ea3 b\u00ean trong (all inside)<\/h3>\n

K\u1ef9 thu\u1eadt n\u00e0y \u0111\u00f2i h\u1ecfi c\u00f3 m\u0169i khoan ng\u01b0\u1ee3c chuy\u00ean d\u1ee5ng. \u0110\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u00e0y v\u00e0 \u0111\u01b0\u1eddng h\u1ea9m x\u01b0\u01a1ng \u0111\u00f9i \u0111\u1ec1u \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1c m\u0169i khoan t\u1eeb trong kh\u1edbp ra ngo\u00e0i. Ch\u1ec9 c\u1ea7n r\u1ea1ch da r\u1ea5t nh\u1ecf \u0111\u1ec3 \u0111\u01b0a kim d\u1eabn \u0111\u01b0\u1eddng, \u0111\u1ed3ng th\u1eddi c\u0169ng ch\u00ednh l\u00e0 m\u0169i khoan ng\u01b0\u1ee3c v\u00e0o trong kh\u1edbp n\u00ean k\u1ef9 thu\u1eadt n\u00e0y c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 k\u1ef9 thu\u1eadt kh\u00f4ng \u0111\u01b0\u1eddng r\u1ea1ch da.<\/p>\n

\"Khoan
Khoan \u0111\u01b0\u1eddng h\u1ea7m ch\u00e0y t\u1ea5t c\u1ea3 b\u00ean trong d\u00f9ng m\u0169i khoan ng\u01b0\u1ee3c Flip Culter<\/figcaption><\/figure>\n

2. C\u00e1c k\u1ef9 thu\u1eadt d\u1ef1a theo ph\u01b0\u01a1ng ti\u1ec7n c\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb1ng ch\u00e9o sau<\/h2>\n

2.1 C\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb1ng ch\u00e9o sau b\u1eb1ng v\u00edt ch\u1eb9n<\/h3>\n

Trong s\u1ed1 c\u00e1c k\u1ef9 thu\u1eadt c\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb1ng, c\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb1ng b\u1eb1ng v\u00edt ch\u1eb9n l\u00e0 k\u1ef9 thu\u1eadt ph\u1ed5 bi\u1ebfn nh\u1ea5t. K\u1ef9 thu\u1eadt n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch b\u1eaft m\u1ed9t v\u00edt ch\u1eb9n song song v\u1edbi d\u00e2y ch\u1eb1ng \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb1ng trong \u0111\u01b0\u1eddng h\u1ea7m. Khi ti\u1ebfn h\u00e0nh b\u1eaft v\u00edt ch\u1eb9n ph\u1ea3i k\u00e9o c\u0103ng d\u00e2y ch\u1eb1ng \u0111\u1ebf d\u00e2y ch\u1eb1ng kh\u00f4ng b\u1ecb th\u01b0\u01a1ng t\u1ed5n do v\u00edt ch\u1eb9n g\u00e2y n\u00ean, l\u00e0m y\u1ebfu ho\u1eb7c \u0111\u1ee9t d\u00e2y ch\u1eb1ng. V\u00edt ch\u1eb9n d\u00f9ng \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh m\u1ea3nh gh\u00e9p trong \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng c\u00f3 th\u1ec3 l\u00e0 v\u00edt kh\u00f4ng ti\u00eau ho\u1eb7c v\u00edt sinh h\u1ecdc t\u1ef1 ti\u00eau, c\u1ea5u t\u1ea1o c\u1ee7a v\u00edt ch\u1eb9n c\u00f9ng kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o lo\u1ea1i v\u00edt ch\u1eb9n b\u1eaft ti\u1ebfn.<\/p>\n

\"C\u1ed1
C\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb1ng ch\u00e9o sau b\u1eb1ng v\u00edt ch\u1eb9n<\/figcaption><\/figure>\n

2.2 C\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb1ng ch\u00e9o sau b\u1eb1ng n\u00fat treo<\/h3>\n

K\u1ef9 thu\u1eadt n\u00e0y kh\u1eafc ph\u1ee5c \u0111\u01b0\u1ee3c nh\u01b0\u1ee3c \u0111i\u1ec3m c\u1ee7a k\u1ef3 thu\u1eadt c\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb3ng b\u1eb1ng v\u00edt ch\u1eb9n l\u00e0 \u0111\u00f2i h\u1ecfi ph\u1eabu thu\u1eadt vi\u00ean c\u00f3 kinh nghi\u1ec7m \u0111\u1ec3 b\u1eb3t v\u00edt ch\u1eb9n n\u1ebfu kh\u00f4ng s\u1ebd l\u00e0m t\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb3ng khi c\u1ed1 \u0111\u1ecbnh. K\u1ef9 thu\u1eadt n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi m\u1ea3nh gh\u00e9p g\u00e2n c\u01a1 Hamstring, g\u00e2n c\u01a1 ch\u00e0y tr\u01b0\u1edbc, g\u00e2n c\u01a1 m\u00e1c b\u00ean d\u00e0i… C\u00f3 nhi\u1ec1u th\u1ebf h\u1ec7 n\u00fat treo kh\u00e1c nhau \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n v\u00e0 \u1ee9ng \u0111\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n

\"c\u1ed1
C\u1ed1 \u0111\u1ecbnh m\u1ea3nh gh\u00e9p d\u00e2y ch\u1eb1ng ch\u00e9o sau \u1edf \u0111\u01b0\u1eddng h\u1ea7m ch\u00e0y b\u1eb1ng n\u00fat treo v\u00e0 c\u1ed1 \u0111\u1ecbnh m\u1ea3nh gh\u00e9p \u1edf \u0111\u01b0\u1eddng h\u1ea7m \u0111\u00f9i c\u1ee7a BTN b\u1eb1ng v\u00edt ch\u1eb9n v\u00e0 BST b\u1eb1ng n\u00fat treo<\/figcaption><\/figure>\n

2.3 C\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb1ng b\u1eb1ng ch\u00e9o sau c\u00e1c d\u1ee5ng c\u1ee5 kh\u00e1c<\/h3>\n

C\u00e1c d\u1ee5ng c\u1ee5 kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh d\u00e2y ch\u1eb1ng bao g\u1ed3m Stabler, Graftlink, Cross pin, Intrafix, Transfix…T\u00f9y v\u00e0o th\u00f3i quen c\u1ee7a ph\u1eabu thu\u1eadt vi\u00ean kinh nghi\u1ec7m ph\u1eabu thu\u1eadt m\u00e0 m\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 hay s\u1eed d\u1ee5ng m\u1ed9t s\u1ed1 lo\u1ea1i ph\u01b0\u01a1ng ti\u1ec7n c\u1ed1 \u0111\u1ecbnh nh\u1ea5t \u0111\u1ecbnh. M\u1ed9t s\u1ed5 t\u00e1c gi\u1ea3 \u0111\u1ec1 xu\u1ea5t vi\u1ec7c s\u1eed d\u1ee5ng hai ph\u01b0\u01a1ng ti\u1ec7n c\u1ed1 \u0111\u1ecbnh m\u1ea3nh gh\u00e9p \u1edf m\u1ed3i \u0111\u1ea7u c\u1ee7a m\u1ea3nh gh\u00e9p.<\/p>\n

\"H\u00ecnh
H\u00ecnh \u1ea3nh d\u00e2y ch\u1eb1ng ch\u00e9o sau sau ph\u1eabu thu\u1eadt t\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng v\u00e0 c\u1ed1 \u0111\u1ecbnh m\u1ea3nh gh\u00e9p \u1edf \u0111\u01b0\u1eddng h\u1ea7m \u0111\u00f9i b\u1eb1ng Transfix v\u00e0 \u0111\u01b0\u1eddng h\u1ea7m ch\u00e0y b\u1eb1ng Intrafix<\/figcaption><\/figure>\n

Xem th\u00eam: \u0110\u1ee9t d\u00e2y ch\u1eb1ng ch\u00e9o sau, khi n\u00e0o c\u1ea7n ph\u1eabu thu\u1eadt?<\/a><\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/p>\n

    \n
  1. Clancy W.G.J., Shelboume K.D., Zoellner G.B., et al. (1983). Treatment of knee joint instability secondary to rupture of t|ie posterior cruciate ligament. Report of a new procedure. JBJS, 65(3), 310.<\/li>\n
  2. Fanelli G.c. (2004). Transtibial tunel posterior cruciate ligament reconstruction, Textbook of Arthroscopy, Saunders, An Imprint of Elsevier, 893- 925.<\/li>\n
  3. Ahn J,-H, and Ha c.w. (2000). Posterior trans-septal portal for arthroscopic surgery of the knee joint. Arthrose J Arthrose Relat Surg, 16(7), 774\u2014779.<\/li>\n
  4. Ahn J,H. (2006). Arthroscopic Transtibial Posterior Cruciate Ligament Reconstruction With Preservation of Posterior Cruciate Ligament Fibers: Clinical Results of Minimum 2-Year Follow-up. Am J Sports Med, 34(2), 194-204.<\/li>\n
  5. Berg E.E. Posterior cruciate ligament tibial inlay reconstruction. Arthroscopy. 1995;11: 69-76.<\/li>\n
  6. Rauh M.A., Bergfeld G.A., Wind W.M., Parker R.D (2008). Inlay posterior cruciate ligament reconstruction, Reconstructive Knee Surgery, 3rd edition, Lippincotl Williams & Wilkins, 254- 263.<\/li>\n
  7. Adler G.G. (2013). AlUInside Posterior Cruciate Ligament Reconstruction With a GraftLink. Arthrose Tech, 2(2), ell 1-el 15.<\/li>\n
  8. Slullitel D., Galan H., Ojeda v., et al. (2012). Double-Bundle \u201cAll-Inside\u201d Posterior Cruciate Ligament Reconstruction. Arthrose Tech. 1(2), e 141 e 148.<\/li>\n
  9. Stannard J.p, and Cook J.L. (2015). Tibial Iniay Posterior Cruciate Ligament Reconstruction: Advances to a New Technique. Oper Tech Spoits Med, 23(4), 298-301.<\/li>\n<\/ol>\n
    \n

    <\/p>\n

    kh\u00f4ng<\/p>\n<\/div>\n

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    C\u01a1 s\u1edd \u0111\u1ec3 ph\u00e2n lo\u1ea1i c\u00e1c k\u1ef9 thu\u1eadt t\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00e9o sau (DCCS) v\u1edbi \u0111\u01b0\u1eddng h\u1ea7m xuy\u00ean ch\u00e0y d\u1ef1a theo c\u00e1ch th\u1ee9c t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m d\u1ef1a tr\u00ean c\u00e1ch th\u1ee9c khoan \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i, c\u00e1ch th\u1ee9c \u0111\u01b0a m\u1ea3nh gh\u00e9p v\u00e0o \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i c\u00f9ng nh\u01b0 ph\u01b0\u01a1ng ti\u1ec7n c\u1ed1 \u0111\u1ecbnh m\u1ea3nh gh\u00e9p v\u00e0o […]<\/p>\n","protected":false},"author":26,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[40],"tags":[3],"yoast_head":"\nT\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00e9o sau t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m v\u00e0 ph\u01b0\u01a1ng ti\u1ec7n c\u1ed1 \u0111\u1ecbnh<\/title>\n<meta name=\"description\" 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