{"id":33838,"date":"2023-05-15T23:20:06","date_gmt":"2023-05-15T16:20:06","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=33838"},"modified":"2023-05-15T23:20:06","modified_gmt":"2023-05-15T16:20:06","slug":"thay-toan-bo-xuong-dui-dieu-tri-ung-thu-xuong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/15\/thay-toan-bo-xuong-dui-dieu-tri-ung-thu-xuong\/","title":{"rendered":"Thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i \u0111i\u1ec1u tr\u1ecb ung th\u01b0 x\u01b0\u01a1ng"},"content":{"rendered":"

Thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i<\/a> c\u00f3 th\u1ec3 coi l\u00e0 1 trong nh\u1eefng \u0111\u1ea1i ph\u1eabu thu\u1eadt. Ph\u1eabu thu\u1eadt n\u00e0y c\u00f3 th\u1ec3 coi l\u00e0 ph\u1eabu thu\u1eadt c\u00f3 \u0111\u01b0\u1eddng m\u1ed5 l\u1edbn nh\u1ea5t c\u01a1 th\u1ec3, \u0111\u1ea3m b\u1ea3o b\u1ed9c l\u1ed9 \u0111\u01b0\u1ee3c c\u1ea3 kh\u1edbp h\u00e1ng, kh\u1edbp g\u1ed1i v\u1edbi chi\u1ec1u d\u00e0i trung b\u00ecnh \u0111\u01b0\u1eddng m\u1ed5 cho 1 ng\u01b0\u1eddi c\u00f3 th\u1ec3 h\u00ecnh b\u00ecnh th\u01b0\u1eddng v\u00e0o kho\u1ea3ng 50-60 cm. Ph\u1eabu thu\u1eadt n\u00e0y c\u00f3 th\u1ec3 coi l\u00e0 bao g\u1ed3m c\u1ea3 ph\u1eabu thu\u1eadt thay kh\u1edbp h\u00e1ng v\u00e0 thay kh\u1edbp g\u1ed1i n\u00ean m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a ph\u1eabu thu\u1eadt h\u01a1n r\u1ea5t nhi\u1ec1u l\u1ea7n 2 ph\u1eabu thu\u1eadt tr\u00ean c\u1ed9ng l\u1ea1i.<\/strong><\/p>\n

<\/b>1. T\u1ed5ng quan thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0 x\u01b0\u01a1ng<\/b><\/h2>\n

Nh\u01b0 \u0111\u00e3 n\u00f3i, Ph\u1eabu thu\u1eadt n\u00e0y c\u00f3 th\u1ec3 coi l\u00e0 bao g\u1ed3m c\u1ea3 ph\u1eabu thu\u1eadt thay kh\u1edbp h\u00e1ng v\u00e0 thay kh\u1edbp g\u1ed1i n\u00ean m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a ph\u1eabu thu\u1eadt h\u01a1n r\u1ea5t nhi\u1ec1u l\u1ea7n 2 ph\u1eabu thu\u1eadt tr\u00ean c\u1ed9ng l\u1ea1i. C\u00e1c nguy c\u01a1 bi\u1ebfn ch\u1ee9ng th\u00ec t\u0103ng l\u00ean g\u1ea5p nhi\u1ec1u l\u1ea7n. V\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a khoa h\u1ecdc k\u1ef9 thu\u1eadt c\u0169ng nh\u01b0 quan \u0111i\u1ec3m \u0111i\u1ec1u tr\u1ecb, vi\u1ec7c thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i c\u00f3 xu h\u01b0\u1edbng t\u0103ng l\u00ean v\u00e0 ch\u1ee7 y\u1ebfu ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 x\u01b0\u01a1ng \u0111\u00f9i l\u00e0 ch\u00ednh. Tuy v\u1eady, \u00edt ai bi\u1ebft r\u1eb1ng, nh\u1eefng ca thay x\u01b0\u01a1ng \u0111\u00f9i \u0111\u1ea7u ti\u00ean l\u1ea1i ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh l\u00fd l\u00e0nh t\u00ednh.<\/span><\/p>\n

Buchman \u0111\u01b0\u1ee3c coi l\u00e0 ng\u01b0\u1eddi \u0111\u1ea7u ti\u00ean th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i nh\u00e2n t\u1ea1o cho b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh Paget v\u00e0o n\u0103m 1965. Ch\u1ec9 nh\u1eafc \u0111\u1ebfn thay th\u1ebf to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i th\u00ec n\u0103m 1966, Ottolenghi th\u00f4ng b\u00e1o tr\u01b0\u1eddng h\u1ee3p thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i b\u1eb1ng x\u01b0\u01a1ng \u0111\u1ed3ng lo\u1ea1i cho 1 b\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec5m tr\u00f9ng. Nh\u1eefng n\u0103m 70 c\u1ee7a th\u1ebf k\u1ef7 20, t\u1ea1i Mayo Clinic, trung t\u00e2m y khoa h\u00e0ng \u0111\u1ea7u n\u01b0\u1edbc M\u1ef9, ch\u1ec9 \u0111\u1ecbnh ch\u00ednh cho ung th\u01b0 x\u01b0\u01a1ng v\u1eabn l\u00e0 c\u1eaft c\u1ee5t sau \u0111\u00f3 l\u00e0 ph\u1ed1i h\u1ee3p c\u00e1c \u0111i\u1ec1u tr\u1ecb kh\u00e1c nh\u01b0 ho\u00e1 ch\u1ea5t. Marcove \u0111\u01b0\u1ee3c coi l\u00e0 1 trong nh\u1eefng ng\u01b0\u1eddi ti\u00ean phong trong vi\u1ec7c ti\u1ebfn h\u00e0nh thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i \u0111i\u1ec1u tr\u1ecb ung th\u01b0 cho b\u1ec7nh nh\u00e2n v\u1edbi c\u00e1c k\u1ebft qu\u1ea3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u00e0o n\u0103m 1974 v\u00e0 1977 trong \u0111\u00f3 \u00f4ng c\u0169ng ch\u1ec9 ra nh\u1eefng h\u1ea1n ch\u1ebf c\u1ee7a c\u00e1c thi\u1ebft k\u1ebf hi\u1ec7n c\u00f3 trong vi\u1ec7c ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng kh\u1edbp h\u00e1ng v\u00e0 kh\u1edbp g\u1ed1i c\u1ee7a b\u1ec7nh nh\u00e2n trong \u0111\u00f3 nh\u1ea5n m\u1ea1nh \u0111\u1ebfn c\u00e1c thi\u1ebft k\u1ebf kh\u1edbp g\u1ed1i ki\u1ec3u b\u1ea3n l\u1ec1 \u1edf giai \u0111o\u1ea1n \u0111\u00f3, tuy c\u00f3 \u01b0u \u0111i\u1ec3m l\u00e0m v\u1eefng \u0111\u01b0\u1ee3c kh\u1edbp g\u1ed1i do c\u00e1c d\u00e2y ch\u1eb1ng \u0111\u00e3 b\u1ecb c\u1eaft b\u1ecf tuy nhi\u00ean v\u1eabn c\u00f2n h\u1ea1n ch\u1ebf do bi\u00ean \u0111\u1ed9 g\u1ea5p t\u1ed1i \u0111a c\u1ee7a c\u00e1c b\u1ec7nh nh\u00e2n ch\u1ec9 \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u1ed1i \u0111a 90 \u0111\u1ed9.<\/span><\/p>\n

Ph\u1eabu thu\u1eadt thay th\u1ebf to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i th\u1ef1c hi\u1ec7n v\u00e0o n\u0103m 1952 b\u1edfi Buchman, b\u00e1o c\u00e1o k\u1ebft qu\u1ea3 t\u1ed1t sau 6 th\u00e1ng. Tuy v\u1eady, t\u1eeb \u0111\u00f3 \u0111\u1ebfn nay, \u0111\u00e2y v\u1eabn l\u00e0 ph\u1eabu thu\u1eadt \u00edt g\u1eb7p, ph\u1ee9c t\u1ea1p, \u00edt trung t\u00e2m y t\u1ebf tr\u00ean th\u1ebf gi\u1edbi th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c n\u00ean kh\u00f4ng c\u00f3 nhi\u1ec1u b\u00e1o c\u00e1o \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n. H\u1ea7u h\u1ebft c\u00e1c b\u00e1o c\u00e1o d\u01b0\u1edbi d\u1ea1ng ca l\u00e2m s\u00e0ng, ho\u1eb7c v\u1edbi s\u1ed1 l\u01b0\u1ee3ng \u00edt trong nhi\u1ec1u n\u0103m. Ph\u1eabu thu\u1eadt thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 kh\u1ed1i u x\u01b0\u01a1ng \u00e1c t\u00ednh ho\u1eb7c l\u00e0 ph\u1eabu thu\u1eadt thay th\u1ebf th\u00ec 2 tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3i b\u1ec7nh l\u00fd \u00e1c t\u00ednh kh\u00e1c. Toepfer so s\u00e1nh k\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i c\u1ee7a 22 b\u1ec7nh nh\u00e2n chia l\u00e0m 2 nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd ung th\u01b0 v\u00e0 kh\u00f4ng ph\u1ea3i ung th\u01b0 cho k\u1ebft qu\u1ea3 kh\u00e1 th\u00fa v\u1ecb khi \u0111i\u1ec3m ch\u1ee9c n\u0103ng trung b\u00ecnh c\u1ee7a nh\u00f3m b\u1ec7nh nh\u00e2n ung th\u01b0 cao h\u01a1n c\u00f3 \u00fd ngh\u0129a v\u1edbi 19\/30 \u0111i\u1ec3m so v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3i ung th\u01b0 l\u00e0 9\/30 \u0111i\u1ec3m. M\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng g\u1eb7p ph\u1ea3i l\u00e0 bi\u1ebfn ch\u1ee9ng v\u1ec1 ph\u1ea7n m\u1ec1m (c\u1ee9ng kh\u1edbp, tr\u1eadt kh\u1edbp) chi\u1ebfm 59%, nhi\u1ec5m tr\u00f9ng 22%, g\u00e3y d\u1ee5ng c\u1ee5 kh\u1edbp 9%.<\/span><\/p>\n

<\/b>2. Nh\u1eefng \u0111i\u1ec3m l\u01b0u \u00fd<\/b><\/h2>\n

2.1\u00a0 Ch\u1ec9 \u0111\u1ecbnh thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i:<\/strong><\/h3>\n

Ch\u1ec9 \u0111\u1ecbnh thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc th\u1eadn tr\u1ecdng v\u00e0 th\u01b0\u1eddng cho nh\u1eefng l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb khi ph\u1ea3i c\u00e2n nh\u1eafc kh\u1ea3 n\u0103ng th\u00e1o kh\u1edbp h\u00e1ng ho\u1eb7c c\u1eaft c\u1ee5t cao cho b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, vi\u1ec7c \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n c\u0169ng c\u1ea7n k\u1ef9 l\u01b0\u1ee1ng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 th\u00e0nh c\u00f4ng cao c\u1ee7a ph\u1eabu thu\u1eadt.<\/span><\/p>\n

0 \u0110\u1ed1i v\u1edbi b\u1ec7nh l\u00fd u x\u01b0\u01a1ng, x\u01b0\u01a1ng \u0111\u00f9i l\u00e0 x\u01b0\u01a1ng th\u01b0\u1eddng b\u1ecb t\u1ed5n th\u01b0\u01a1ng nh\u1ea5t, c\u1ea3 u nguy\u00ean ph\u00e1t ho\u1eb7c di c\u0103n. \u0110\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng u x\u01b0\u01a1ng \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f9i, 1 s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 ph\u1eabu thu\u1eadt c\u1eaft c\u1ee5t ho\u1eb7c gi\u1eef l\u1ea1i ph\u1ea7n c\u1eb3ng ch\u00e2n v\u00e0 t\u1ea1o h\u00ecnh b\u1eb1ng k\u1ef9 thu\u1eadt c\u1ee7a van Nes (van Nes rotationplasty) \u0111\u1ec3 t\u1ea1o thu\u1eadn l\u1ee3i cho vi\u1ec7c s\u1eed d\u1ee5ng ch\u00e2n gi\u1ea3 c\u1ee7a b\u1ec7nh nh\u00e2n. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 ch\u1ec9 \u0111\u1ecbnh nh\u01b0 tr\u00ean, vi\u1ec7c thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i \u0111em l\u1ea1i nh\u1eefng l\u1ee3i \u00edch h\u01a1n cho b\u1ec7nh nh\u00e2n.<\/span><\/p>\n

o C\u00f9ng v\u1edbi s\u1ed1 l\u01b0\u1ee3ng ph\u1eabu thu\u1eadt thay kh\u1edbp h\u00e1ng t\u0103ng l\u00ean l\u00e0 s\u1ed1 l\u01b0\u1ee3ng c\u00e1c tr\u01b0\u1eddng h\u1ee3p ph\u1ea3i thay l\u1ea1i kh\u1edbp c\u0169ng t\u0103ng theo. M\u1ed9t trong nh\u1eefng v\u1ea5n \u0111\u1ec1 kh\u00f3 kh\u0103n trong vi\u1ec7c thay l\u1ea1i kh\u1edbp \u0111\u00f3 l\u00e0 s\u1ef1 m\u1ea5t .th\u1ec3 t\u00edch x\u01b0\u01a1ng \u0111\u00f9i do ti\u00eau x\u01b0\u01a1ng, c\u00f3 th\u1ec3 nhi\u1ec5m tr\u00f9ng ho\u1eb7c kh\u00f4ng. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, ti\u00eau x\u01b0\u01a1ng nhi\u1ec1u, vi\u1ec7c t\u1ea1o h\u00ecnh l\u1ea1i x\u01b0\u01a1ng \u0111\u00f9i b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p truy\u1ec1n th\u1ed1ng l\u00e0 kh\u00f4ng kh\u1ea3 thi v\u00e0 do \u0111\u00f3, ch\u1ec9 \u0111\u1ecbnh thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c \u0111\u1eb7t ra. \u0110\u00f4i khi vi\u1ec7c thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i \u0111\u1ed3ng th\u1eddi gi\u1ea3i quy\u1ebft c\u1ea3 nh\u1eefng v\u1ea5n \u0111\u1ec1 c\u1ee7a kh\u1edbp g\u1ed1i ho\u1eb7c kh\u1edbp h\u00e1ng l\u00e2n c\u1eadn c\u00f9ng b\u00ean do th\u01b0\u1eddng c\u00e1c kh\u1edbp n\u00e0y c\u0169ng xu\u1ea5t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng tho\u00e1i ho\u00e1.<\/span><\/p>\n

0 M\u1ed9t s\u1ed1 t\u00f4n th\u01b0\u01a1ng kh\u00e1c c\u0169ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng x\u01b0\u01a1ng \u0111\u00f9i, c\u00f3 th\u1ebf g\u00e2y g\u00e3y b\u1ec7nh l\u00fd ho\u1eb7c c\u00e1c bi\u1ebfn d\u1ea1ng s\u1edbm c\u1ee7a x\u01b0\u01a1ng nh\u01b0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng trong b\u1ec7nh Paget, tr\u01b0\u1eddng h\u1ecdp \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i b\u1edfi Buchman n\u0103m 1965. T\u01b0\u01a1ng t\u1ef1’ nh\u01b0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng th\u1ec3 gi\u1ea3 u v\u00e0 t\u1ed5n th\u01b0\u01a1ng kh\u1edbp trong b\u1ec7nh Hemophilia c\u0169ng l\u00e0 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc thay x\u01b0\u01a1ng \u0111\u00f9i to\u00e0n b\u1ed9.<\/span><\/p>\n

2.2\u00a0 K\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt:<\/strong><\/h3>\n

o C\u00f3 2 thi\u1ebft k\u1ebf ch\u00ednh cho thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i, \u0111\u00f3 l\u00e0 thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i ki\u1ebfu n\u1ed9i tu\u1ef7 (intramedullary total femur replacement IM-TFR) v\u00e0 thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i d\u00f9ng cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p u (\u201ctumortype\u201d TFR). Thi\u1ebft k\u1ebf c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i nh\u00e2n t\u1ea1o ki\u1ec3u IM-TFR d\u1ef1a tr\u00ean nguy\u00ean t\u1eafc l\u00e0 t\u1ea1o k\u1ebft n\u1ed1i gi\u1eefa 2 kh\u1edbp h\u00e1ng v\u00e0 kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o tr\u01b0\u1edbc \u0111\u00f3, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n theo 2 c\u00e1ch: 1 l\u00e0 s\u1eed d\u1ee5ng 1 kh\u00fac n\u1ed1i n\u1ed9i tu\u1ef7 \u0111\u1ec3 li\u00ean k\u1ebft 2 kh\u1edbp h\u00e1ng v\u00e0 kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o tr\u01b0\u1edbc \u0111\u00f3 m\u00e0 c\u1ea3 2 kh\u1edbp nh\u00e2n t\u1ea1o v\u1eabn c\u00f2n \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh ch\u1eafc v\u00e0o x\u01b0\u01a1ng,\u00a0 2 l\u00e0 s\u1eed d\u1ee5ng 1 kh\u00fac n\u1ed1i li\u00ean k\u1ebft v\u1edbi kh\u1edbp h\u00e1ng v\u00e0 kh\u1edbp g\u1ed1i thay l\u1ea1i qua kh\u1edbp n\u1ed1i khi ph\u1ea3i thay l\u1ea1i \u0111\u1ed3ng th\u1eddi c\u1ea3 kh\u1edbp h\u00e1ng v\u00e0 kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o. Thi\u1ebft k\u1ebf c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i to\u00e0n b\u1ed9 ki\u1ec3u IM-TFR c\u00f3 thu\u1eadn l\u1ee3i l\u00e0 h\u1ea1n ch\u1ebf \u0111\u01b0\u1ee3c vi\u1ec7c m\u1edf r\u1ed9ng \u0111\u01b0\u1eddng m\u1ed5 \u1edf v\u00f9ng gi\u1eefa x\u01b0\u01a1ng \u0111\u00f9i tuy nhi\u00ean c\u0169ng c\u00f3 h\u1ea1n ch\u1ebf l\u00e0 ph\u1ea3i c\u00f3 \u0111\u1ea7y \u0111\u1ee7 c\u00e1c l\u1ef1a ch\u1ecdn cho kh\u00fac n\u1ed1i n\u1ed9i tu\u1ef7 \u0111\u1ec3 ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c kh\u1edbp h\u00e1ng v\u00e0 kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o s\u1eb5n c\u00f3 trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng ph\u1ea3i thay l\u1ea1i kh\u1edbp h\u00e1ng v\u00e0 kh\u1edbp g\u1ed1i nh\u00e2n t\u1ea1o do c\u00f2n c\u1ed1 \u0111\u1ecbnh v\u1eefng ch\u1eafc v\u00e0o x\u01b0\u01a1ng.<\/span><\/p>\n

o \u0110\u01b0\u1eddng m\u1ed5 th\u01b0\u1eddng l\u00e0 \u0111\u01b0\u1eddng ngo\u00e0i v\u00e0o x\u01b0\u01a1ng \u0111\u00f9i, ph\u00eda tr\u00ean kh\u1edbp h\u00e1ng th\u01b0\u1eddng s\u1ebd v\u00e0o kh\u1edbp h\u00e1ng qua \u0111\u01b0\u1eddng tr\u01b0\u1edbc. \u1ede ph\u1ea7n kh\u1edbp g\u1ed1i, c\u00f3 th\u1ec3 l\u00e0 \u0111\u01b0\u1eddng c\u1ea1nh ngo\u00e0i b\u00e1nh ch\u00e8 n\u1ebfu c\u00f3 th\u1ef1c hi\u1ec7n thay kh\u1edbp g\u1ed1i v\u1edbi kh\u1edbp b\u1ea3n l\u1ec1. Ph\u1ea7n l\u1edbn c\u00e1c thi\u1ebft k\u1ebf x\u01b0\u01a1ng \u0111\u00f9i nh\u00e2n t\u1ea1o c\u00f3 thi\u1ebft k\u1ebf c\u1ed1 \u0111\u1ecbnh g\u00f3c c\u1ee7a c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i c\u0169ng nh\u01b0 \u0111\u1ed9 xoay ngo\u00e0i c\u1ee7a kh\u1ed1i l\u1ed3i c\u1ea7u, \u0111i\u1ec1u n\u00e0y h\u1ea1n ch\u1ebf kh\u1ea3 n\u0103ng t\u00f9y ch\u1ec9nh trong ph\u1eabu thu\u1eadt c\u1ee7a ph\u1eabu thu\u1eadt vi\u00ean v\u00e0 l\u00e0m t\u0103ng nguy c\u01a1 tr\u1eadt kh\u1edbp h\u00e1ng v\u00e0 tr\u01b0\u1ee3t c\u1ee7a x\u01b0\u01a1ng b\u00e1nh ch\u00e8 \u1edf’ r\u00e3nh l\u1ed3i c\u1ea7u c\u00f3 th\u1ebf g\u00e2y \u0111au m\u1eb7t tr\u01b0\u1edbc kh\u1edbp g\u1ed1i sau m\u1ed5. Do \u0111\u00f3 thi\u1ebft k\u1ebf kh\u1edbp h\u00e1ng th\u01b0\u1eddng s\u1ebd l\u00e0 d\u1ea1ng b\u00e1n ph\u1ea7n ho\u1eb7c to\u00e0n b\u1ed9 ki\u1ec3u kho\u00e1 (constrained) \u0111\u1ebf ch\u1ed1ng tr\u1eadt kh\u1edbp h\u00e1ng. \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i do ung th\u01b0, 0 c\u1ed1i th\u01b0\u1eddng kh\u00f4ng can thi\u1ec7p, kh\u1edbp h\u00e1ng s\u1eed d\u1ee5ng d\u1ea1ng b\u00e1n ph\u1ea7n v\u00e0 bao kh\u1edbp \u0111\u01b0\u1ee3c kh\u00e2u k\u1ef9 \u0111\u1ec3 tr\u00e1nh tr\u1eadt kh\u1edbp h\u00e1ng. T\u00ecnh tr\u1ea1ng tr\u01b0\u1ee3t c\u1ee7a b\u00e1nh ch\u00e8 tr\u00ean r\u00e3nh l\u1ed3i c\u1ea7u c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 k\u1ef9 tr\u01b0\u1edbc khi c\u1ed1 \u0111\u1ecbnh kh\u1edbp. Vi\u1ec7c ph\u1ee5c h\u1ed3i \u0111i\u1ec3m b\u00e1m c\u00e1c kh\u1ed1i c\u01a1, \u0111\u1eb7c bi\u1ec7t c\u00e1c c\u01a1 d\u1ea1ng kh\u1edbp h\u00e1ng r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o v\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng \u0111\u01b0\u1ee3c t\u01b0\u01a1ng \u0111\u1ed1i b\u00ecnh th\u01b0\u1eddng. M\u1eb7c d\u00f9 tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i nh\u00e2n t\u1ea1o c\u00f3 c\u00e1c l\u1ed7 \u0111\u1ec3 kh\u00e2u ph\u1ee5c h\u1ed3i \u0111i\u1ec3m b\u00e1m tuy nhi\u00ean, vi\u1ec7c ph\u1ee5c h\u1ed3i \u0111i\u1ec3m b\u00e1m c\u00e1c c\u01a1 v\u00e0o x\u01b0\u01a1ng \u0111\u00f9i nh\u00e2n t\u1ea1o l\u00e0 1 ph\u1ea7n, ph\u1ea7n c\u00f2n l\u1ea1i l\u00e0 vi\u1ec7c kh\u00e2u t\u1ea1o \u0111i\u1ec3m k\u1ebft d\u00ednh \u0111\u1ecbnh h\u01b0\u1edbng gi\u1eefa ‘c\u00e1c g\u00e2n \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1ee3c ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng sau m\u1ed5. Vi\u1ec7c kh\u00e2u \u0111\u00ednh c\u00e1c \u0111i\u1ec3m b\u00e1m g\u00e2n v\u00e0o x\u01b0\u01a1ng \u0111\u00f9i nh\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c thu\u1eadn l\u1ee3i h\u01a1n nh\u1edd c\u00e1c l\u01b0\u1edbi c\u1ed1 \u0111\u1ecbnh quanh x\u01b0\u01a1ng nh\u00e2n t\u1ea1o. Nh\u1eefng c\u1ea3i ti\u1ebfn v\u1ec1 v\u1eadt li\u1ec7u nh\u1eb1m l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng b\u00e1m d\u00ednh c\u1ee7a m\u00f4 v\u00e0o v\u1eadt li\u1ec7u nh\u00e2n t\u1ea1o.<\/span><\/p>\n

Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng: S\u1ef1 kh\u00f3 kh\u0103n cho vi\u1ec7c t\u1eadp ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng ch\u1ee7 y\u1ebfu cho c\u00e1c \u0111\u1ed9ng t\u00e1c c\u1ee7a kh\u1edbp h\u00e1ng do c\u00e1c \u0111i\u1ec3m b\u00e1m c\u1ee7a kh\u1ed1i c\u01a1 m\u00f4ng, c\u00e1c c\u01a1 ch\u1eadu h\u00f4ng m\u1ea5u chuy\u1ec3n, c\u01a1 t\u1ee9 \u0111\u1ea7u \u0111\u00f9i, c\u01a1 th\u1eaft l\u01b0ng ch\u1eadu c\u1ea7n c\u00f3 th\u1eddi gian \u0111\u1ebf t\u1ea1o li\u00ean k\u1ebft v\u1eefng ch\u1eafc. V\u00ec v\u1eady, giai \u0111o\u1ea1n \u0111\u1ea7u, trong kho\u1ea3ng 3-4 tu\u1ea7n \u0111\u1ea7u, c\u00e1c \u0111\u1ed9ng t\u00e1c c\u1ee7a kh\u1edbp h\u00e1ng chi th\u1ef1c hi\u1ec7n th\u1ee5 \u0111\u1ed9ng v\u00e0 h\u1ea1n ch\u1ebf. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u1eadp \u0111\u1ee9ng, t\u1ef3 ch\u00e2n ch\u1ecbu l\u1ef1c t\u0103ng d\u1ea7n t\u00f9y theo kh\u1ea3 n\u0103ng v\u00e0 \u0111i l\u1ea1i v\u1edbi d\u1ee5ng c\u1ee5 tr\u1ee3 \u0111\u1ee1. Vi\u1ec7c t\u1eadp kh\u1edbp g\u1ed1i v\u00e0 kh\u1edbp h\u00e1ng ch\u1ec9 t\u00edch c\u1ef1c d\u1ea7n sau 3 tu\u1ea7n \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o c\u00e1c k\u1ebft n\u1ed1i m\u00f4 m\u1ec1m t\u01b0\u01a1ng \u0111\u1ed1i v\u1eefng ch\u1eafc.\u00a0<\/span><\/p>\n

\"thay-toan-bo-xuong-dui\"
Thi\u1ebft k\u1ebf x\u01b0\u01a1ng \u0111\u00f9i nh\u00e2n t\u1ea1o ki\u1ebfu IM-TFR<\/figcaption><\/figure>\n

2.3 Tai bi\u1ebfn, bi\u1ebfn ch\u1ee9ng:<\/strong><\/h3>\n

o Bi\u1ebfn ch\u1ee9ng h\u00e0ng \u0111\u1ea7u \u0111\u00e1ng lo ng\u1ea1i nh\u1ea5t l\u00e0 nhi\u1ec5m tr\u00f9ng. Nhi\u1ec1u b\u00e1o c\u00e1o c\u1ee7a c\u00e1c t\u00e1c gi\u1ea3 cho th\u1ea5y t\u1ef7 l\u1ec7 nhi\u1ec5m tr\u00f9ng c\u1ee7a ph\u1eabu thu\u1eadt thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i cao h\u01a1n h\u1eb3n so v\u1edbi c\u00e1c ph\u1eabu thu\u1eadt kh\u00e1c. Y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i cho v\u1ea5n \u0111\u1ec1 nhi\u1ec5m tr\u00f9ng l\u00e0 c\u01a1 \u0111\u1ecba b\u1ec7nh nh\u00e2n ung th\u01b0 mi\u1ec5n d\u1ecbch kh\u00f4ng t\u1ed1t nh\u01b0 ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng v\u00e0 \u0111\u01b0\u1eddng m\u1ed5 l\u1edbn, b\u00f3c t\u00e1ch ph\u1ea7n m\u1ec1m nhi\u1ec1u.<\/span>
\n<\/span> Tr\u1eadt kh\u1edbp h\u00e1ng l\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ea7n quan t\u00e2m. Nguy\u00ean nh\u00e2n ch\u00ednh l\u00e0 do vi\u1ec7c ph\u1ee5c h\u1ed3i bao kh\u1edbp v\u00e0 ph\u1ea7n m\u1ec1m kh\u00f4ng \u0111\u1ea3m b\u1ea3o \u0111\u1ec3 l\u00e0m v\u1eefng kh\u1edbp nh\u00e2n t\u1ea1o do \u0111\u00f3 c\u1ea7n l\u01b0u \u00fd trong vi\u1ec7c ph\u1ee5c h\u1ed3i ph\u1ea7n m\u1ec1m v\u00e0 vi\u1ec7c t\u1eadp luy\u1ec7n sau ph\u1eabu thu\u1eadt.<\/span><\/p>\n

T\u00e1c gi\u1ea3:<\/b> PGS.TS. Tr\u1ea7n Trung D\u0169ng (ch\u1ee7 bi\u00ean) v\u00e0 c\u1ed9ng s\u1ef1, <\/span>Trung t\u00e2m Ch\u1ea5n th\u01b0\u01a1ng Ch\u1ec9nh h\u00ecnh v\u00e0 Y h\u1ecdc th\u1ec3 thao<\/span>, <\/span>B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec Times City .<\/span><\/p>\n

HASHTAG: #Ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh, #Ung th\u01b0 x\u01b0\u01a1ng, #Thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i, #Ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt chi d\u01b0\u1edbi\u00a0<\/b><\/p>\n

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

    \n
  1. WHO Classification of Tumours of Soft Tissue and Bone. Fourth Edition – WHO<\/span><\/li>\n<\/ol>\n

    –\u00a0 OMS accessed: 05\/04\/2020.<\/span><\/p>\n

      \n
    1. \u00a0 \u00a0 Anderson M.E. (2016). Update on Survival in Osteosarcoma. Orthop Clin North Am, 47(1), 283-292.<\/span><\/li>\n
    2. \u00a0 \u00a0 Biermann J.S., Chow w., Adkins D.R. v\u00e0 c\u1ed9ng s\u1ef1. (2019). NCCN Guidelines Index Table of Contents Discussion. Bone Cancer, 96.<\/span><\/li>\n
    3. \u00a0 \u00a0 Malawer M.M., Wittig J.C., Bickels J. v\u00e0 c\u1ed9ng s\u1ef1. (2015), Operative Techniques in Orthopaedic Surgical Oncology, Lippincott Williams & Wilkins.<\/span><\/li>\n
    4. \u00a0 \u00a0 Ernest u. Conrad. Book Orthopeadic Oncology 2010. Page 117<\/span><\/li>\n
    5. \u00a0 \u00a0 Buchman J. (1965). TOTAL FEMUR AND KNEE JOINT REPLACEMENT WITH A VITALLIUM ENDOPROSTHESIS. Bull Hosp Joint Dis, 26, 21-34.<\/span><\/li>\n
    6. \u00a0 \u00a0 Ahmed A.R. (2009). Total femur replacement. Arch Orthop Trauma Surg, 130(2), 171.<\/span><\/li>\n
    7. \u00a0 \u00a0 Toepfer A., Ha\u01b0asser N., Petzschner I. v\u00e0 c\u1ed9ng s\u1ef1. (2018). Is total femoral replacement for non-oncologic and oncologic indications a safe procedure in limb preservation surgery? A single center experience of 22 cases. Eur J Med Res, 23.<\/span><\/li>\n
    8. \u00a0 \u00a0 Reddy K.B. (2017). Total Femoral Prosthesis in Malignant Bone Tumours: A Case Series. CTOIJ, 3(3).<\/span><\/li>\n
    9. \u00a0 Kakimoto T., Matsumine A., Asanuma K. v\u00e0 c\u1ed9ng s\u1ef1. The clinical outcomes of total femur prosthesis in patients with musculoskeletal tumors. SICOT J, 5.<\/span><\/li>\n
    10. \u00a0 Sewell M.D., Spiegelberg B.G.I., Hanna S.A. v\u00e0 c\u1ed9ng s\u1ef1. (2009). Total femoral endoprosthetic replacement following excision of bone tumours. J Bone Joint SurgBr, 91(11), 1513-1520.<\/span><\/li>\n
    11. \u00a0 Kalra s., Abudu A., Murata H. v\u00e0 c\u1ed9ng s\u1ef1. (2010). Total femur replacement: primary procedure for treatment of malignant tumours of the femur. Eur J Surg Oncol, 36(4), 378-383.<\/span><\/li>\n<\/ol>\n

      13. Puri A., Gulia A., v\u00e0 Chan W.H. (2012). Functional and oncologic outcomes after excision of the total femur in primary bone tumors: Results with a low cost total femur prosthesis. Indian J Orthop, 46(4), 470-474.<\/span><\/p>\n

      \u00a0<\/span><\/p>\n

      \u00a0<\/span><\/p>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

      Thay to\u00e0n b\u1ed9 x\u01b0\u01a1ng \u0111\u00f9i c\u00f3 th\u1ec3 coi l\u00e0 1 trong nh\u1eefng \u0111\u1ea1i ph\u1eabu thu\u1eadt. 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