{"id":33946,"date":"2023-05-15T23:21:16","date_gmt":"2023-05-15T16:21:16","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=33946"},"modified":"2023-05-15T23:21:16","modified_gmt":"2023-05-15T16:21:16","slug":"tao-hinh-day-chang-cheo-truoc","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/15\/tao-hinh-day-chang-cheo-truoc\/","title":{"rendered":"\u1ee8ng d\u1ee5ng gi\u1ea3i ph\u1eabu t\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc : k\u1ef9 thu\u1eadt m\u1ed9t b\u00f3"},"content":{"rendered":"

T\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc (DCCT) v\u1edbi k\u1ef9 thu\u1eadt m\u1ed9t b\u00f3 l\u00e0 k\u1ef9 thu\u1eadt ra \u0111\u1eddi s\u1edbm nh\u1ea5t v\u00e0 \u0111\u1ebfn t\u1eadn ng\u00e0y nay v\u1eabn l\u00e0 ph\u1ed5 bi\u1ebfn nh\u1ea5t. K\u1ef9 thu\u1eadt n\u00e0y kh\u00f4ng kh\u00f3 \u0111\u1ec3 th\u1ef1c hi\u1ec7n nh\u01b0ng r\u1ea5t d\u1ec5 l\u00e0m sai. \u0110i\u1ec1u n\u00e0y xu\u1ea5t ph\u00e1t t\u1eeb nhi\u1ec1u l\u00fd do nh\u01b0:<\/strong><\/p>\n

+ \u0110\u01b0\u1eddng k\u00ednh \u0111\u01b0\u1eddng h\u1ea7m th\u01b0\u1eddng nh\u1ecf h\u01a1n di\u1ec7n b\u00e1m c\u1ee7a DCCT<\/strong><\/p>\n

+ K\u1ef9 thu\u1eadt th\u1ef1c hi\u1ec7n ng\u00e0y nay ch\u1ee7 y\u1ebfu qua n\u1ed9i soi, vi\u1ec7c quan s\u00e1t qua n\u1ed9i soi kh\u00f4ng th\u1ef1c s\u1ef1 gi\u1ed1ng nh\u01b0 quan s\u00e1t ph\u1eabu tr\u01b0\u1eddng th\u00f4ng th\u01b0\u1eddng.<\/strong><\/p>\n

Nh\u01b0 v\u1eady, vi\u1ec7c x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c v\u1ecb tr\u00ed l\u00fd t\u01b0\u1edfng c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m v\u00e0 c\u00e1c m\u1ed1c \u0111\u1ec3 c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c v\u1ecb tr\u00ed \u0111\u00f3 khi th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt khoan t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m l\u00e0 r\u1ea5t quan tr\u1ecdng. Gi\u1ea3i ph\u1eabu \u1ee9ng d\u1ee5ng c\u00f3 vai tr\u00f2 quan tr\u1ecdng v\u00e0 mang t\u00ednh quy\u1ebft \u0111\u1ecbnh cho s\u1ef1 th\u00e0nh c\u00f4ng c\u1ee7a ph\u1eabu thu\u1eadt n\u00e0y.<\/span><\/p>\n

\u00a0 \u00a01.\u00a0 <\/strong><\/span>T\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u1ea7y t\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc<\/strong><\/h2>\n

1.1 V\u1ecb tr\u00ed l\u00fd t\u01b0\u1edfng c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u1ea7y<\/strong><\/h3>\n

D\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc c\u00f3 vai tr\u00f2 ch\u00ednh trong vi\u1ec7c gi\u1eef cho m\u00e2m ch\u1ea7y kh\u00f4ng tr\u01b0\u1ee3t ra tr\u01b0\u1edbc so v\u1edbi l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i do \u0111\u00f3, v\u1ec1 m\u1eb7t l\u00fd thuy\u1ebft v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u1ea7y c\u00e0ng ra tr\u01b0\u1edbc th\u00ec c\u00e0ng t\u1ed1t v\u00ec khi \u0111\u00f3 th\u00ec g\u00f3c t\u1ea1o b\u1edfi d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc v\u00e0 m\u00e2m ch\u1ea7y l\u00e0 nh\u1ecf nh\u1ea5t do \u0111\u00f3 ph\u1ea7n l\u1edbn c\u00e1c b\u00f3 c\u1ee7a d\u00e2y ch\u1eb1ng s\u1ebd tham gia v\u00e0o l\u1ef1c c\u0103ng c\u1ee7a d\u00e2y ch\u1eb1ng ch\u1ed1ng l\u1ea1i s\u1ef1 tr\u01b0\u1ee3t ra tr\u01b0\u1edbc c\u1ee7a m\u00e2m ch\u1ea7y. Ng\u01b0\u1ee3c l\u1ea1i, n\u1ebfu v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u1ea7y c\u00e0ng v\u1ec1 ph\u00eda sau th\u00ec g\u00f3c c\u1ee7a d\u00e2y ch\u1eb1ng so v\u1edbi m\u00e2m ch\u1ea7y c\u00e0ng l\u1edbn th\u00ec ch\u1ec9 c\u00f3 m\u1ed9t ph\u1ea7n c\u00e1c b\u00f3 c\u1ee7a d\u00e2y ch\u1eb1ng s\u1ebd tham gia v\u00e0o l\u1ef1c c\u0103ng c\u1ee7a d\u00e2y ch\u1eb1ng ch\u1ed1ng l\u1ea1i s\u1ef1 tr\u01b0\u1ee3t c\u1ee7a m\u00e2m ch\u1ea7y do \u0111\u00f3 hi\u1ec7u qu\u1ea3 l\u00e0m v\u1eefng g\u1ed1i tr\u01b0\u1edbc sau s\u1ebd gi\u1ea3m \u0111i.<\/span><\/p>\n

Tuy nhi\u00ean, n\u1ebfu v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m ra tr\u01b0\u1edbc qu\u00e1, m\u1ea3nh gh\u00e9p s\u1ebd b\u1ecb k\u1eb9t v\u00e0o khe li\u00ean l\u1ed3i c\u1ea7u v\u00e0 do \u0111\u00f3 c\u00f3 th\u1ec3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng v\u00e0 \u0111\u1ee9t (Notch impingement). Hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y \u1edf d\u00e2y ch\u1eb1ng b\u00ecnh th\u01b0\u1eddng c\u0169ng c\u00f3 do ch\u1ed7 b\u00e1m c\u1ee7a d\u00e2y ch\u1eb1ng v\u00e0o m\u00e2m ch\u1ea7y r\u1ed9ng v\u00e0 lan ra s\u00e1t ph\u00eda tr\u01b0\u1edbc c\u1ee7a m\u00e2m ch\u1ea7y v\u00e0 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng k\u1eb9t sinh l\u00fd (physical impingement). Do hi\u1ec7n t\u01b0\u1ee3ng k\u1eb9t sinh l\u00fd n\u00e0y m\u00e0 d\u00e2y ch\u1eb1ng c\u00f3 t\u00ecnh tr\u1ea1ng bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac v\u1ec1 m\u00f4 h\u1ecdc \u0111\u1ec3 th\u00edch nghi<\/span><\/p>\n

Nh\u01b0 v\u1eady v\u1ecb tr\u00ed l\u00fd t\u01b0\u1edfng c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u1ea7y l\u00e0 c\u00e0ng ra ph\u00eda tr\u01b0\u1edbc c\u00e0ng t\u1ed1t mi\u1ec5n l\u00e0 kh\u00f4ng b\u1ecb k\u1eb9t v\u00e0o khe li\u00ean l\u1ed3i c\u1ea7u. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, ph\u1eabu thu\u1eadt vi\u00ean ph\u1ea3i t\u1ea1o h\u00ecnh khe li\u00ean l\u1ed3i c\u1ea7u(Notch plasty) \u0111\u1ec3 tr\u00e1nh x\u1ea3y ra hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y.<\/span><\/p>\n

1.2 C\u00e1c m\u1ed1c gi\u1ea3i ph\u1eabu<\/strong><\/h3>\n

\u0110\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u1ea7y \u0111\u01b0\u1ee3c t\u1ea1o ra ph\u1ea3i n\u1eb1m trong v\u1ecb tr\u00ed b\u00e1m nguy\u00ean th\u1ee7y c\u1ee7a DCCT v\u00e0 g\u1ea7n v\u1ec1 ph\u00eda tr\u01b0\u1edbc nh\u01b0ng ph\u1ea3i \u0111\u1ea3m b\u1ea3o kh\u00f4ng b\u1ecb k\u1eb9t v\u00e0o khe li\u00ean l\u1ed3i c\u1ea7u khi du\u1ed7i g\u1ed1i. V\u1ecb tr\u00ed nguy\u00ean th\u1ee7y c\u1ee7a DCCT n\u1eb1m gi\u1eefa c\u00e1c m\u1ed1c gi\u1ea3i ph\u1eabu l\u00e0:<\/span><\/p>\n

+ S\u1eebng tr\u01b0\u1edbc s\u1ee5n ch\u00eam ngo\u00e0i \u1edf ph\u00eda ngo\u00e0i (t\u01b0\u01a1ng \u1ee9ng v\u1edbi t\u00e2m c\u1ee7a b\u00f3 tr\u01b0\u1edbc trong)<\/span><\/p>\n

+ Gai ch\u1ea7y trong \u1edf ph\u00eda trong (t\u01b0\u01a1ng \u1ee9ng v\u1edbi t\u00e2m c\u1ee7a b\u00f3 sau ngo\u00e0i)<\/span><\/p>\n

+ B\u1edd tr\u01b0\u1edbc c\u1ee7a PCL hay ch\u00ednh x\u00e1c h\u01a1n l\u00e0 g\u1edd RER + Di t\u00edch c\u1ee7a ACL<\/span><\/p>\n

V\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m kh\u00f4ng \u0111\u01b0\u1ee3c ra qu\u00e1 ph\u00eda tr\u01b0\u1edbc v\u00ec s\u1ebd c\u00f3 nguy c\u01a1 k\u1eb9t v\u00e0o khe li\u00ean l\u1ed3i c\u1ea7u. B\u00ecnh th\u01b0\u1eddng, DCCT \u0111\u00e3 c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng “k\u1eb9t sinh l\u00fd” do \u0111\u00f3 v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m ph\u1ea3i n\u1eb1m v\u1ec1 ph\u00eda sau c\u1ee7a di t\u00edch DCCT. Tuy nhi\u00ean, v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m kh\u00f4ng \u0111\u01b0\u1ee3c ra ph\u00eda sau qu\u00e1, v\u1eeba kh\u00f4ng \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1ee3c ch\u1ee9c n\u0103ng c\u1ee7a d\u00e2y ch\u1eb1ng, v\u1eeba c\u00f3 nguy c\u01a1 k\u1eb9t (impingement) v\u00e0o DCCS .<\/span><\/p>\n

\"tao-hinh-day-chang-cheo-truoc\"
Minh h\u1ecda \u0111\u1ecbnh v\u1ecb v\u1ecb tr\u00ed khoan t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m tr\u00ean Xquang theo \u0111\u01b0\u1eddng Blumensat<\/figcaption><\/figure>\n

VI hi\u1ec7n t\u01b0\u1ee3ng “k\u1eb9t sinh l\u00fd” c\u1ee7a DCCT ch\u1ee7 y\u1ebfu do b\u00f3 tr\u01b0\u1edbc trong n\u00ean v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u1ea7y th\u01b0\u1eddng l\u1ec7ch v\u1ec1 ph\u00eda b\u00f3 sau ngo\u00e0i. T\u1ee9c l\u00e0 v\u1ecb tr\u00ed khoan t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m n\u1eb1m v\u1ec1 ph\u00eda ngo\u00e0i c\u1ee7a gai ch\u1ea7y trong v\u00e0 ph\u00eda tr\u01b0\u1edbc c\u1ee7a b\u1edd tr\u01b0\u1edbc d\u00e2y ch\u1eb1ng ch\u00e9o sau kho\u1ea3ng 7mm (t\u01b0\u01a1ng \u1ee9ng v\u1edbi g\u1edd RER) khi quan s\u00e1t qua n\u1ed9i soi. N\u1ebfu c\u00f3 Xquang trong m\u1ed5 th\u00ec v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u1ea7y c\u00f3 th\u1ec3 t\u00ednh to\u00e1n ch\u00ednh x\u00e1c h\u01a1n, t\u01b0\u01a1ng \u1ee9ng v\u1edbi v\u00f9ng 2 tr\u00ean \u0111\u01b0\u1eddng Amis Jacob tr\u00ean phim ch\u1ee5p kh\u1edbp g\u1ed1i nghi\u00eang v\u00e0 n\u1eb1m ph\u00eda ngo\u00e0i c\u1ee7a gai ch\u1ea7y trong tr\u00ean phim ch\u1ee5p kh\u1edbp g\u1ed1i th\u1eb3ng. V\u1ecb tr\u00ed n\u00e0y \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1ee3c d\u00e2y ch\u1eb1ng kh\u00f4ng b\u1ecb k\u1eb9t v\u00e0o khe li\u00ean l\u1ed3i c\u1ea7u \u0111\u1ed3ng th\u1eddi \u1edf xa nh\u1ea5t v\u1ec1 ph\u00eda tr\u01b0\u1edbc.<\/span><\/p>\n

Nh\u01b0 v\u1eady, c\u00f3 th\u1ec3 th\u1ea5y, \u0111\u1ed1i v\u1edbi v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u1ea7y c\u1ea7n \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1ee3c c\u00e1c y\u00eau c\u1ea7u:<\/span><\/p>\n

+ N\u1eb1m \u1edf n\u1eeda sau c\u1ee7a di t\u00edch DCCT<\/span><\/p>\n

+ N\u1eb1m v\u1ec1 ph\u00eda ngo\u00e0i c\u1ee7a gai ch\u1ea7y trong<\/span><\/p>\n

+ C\u00e1ch g\u1edd RER (ho\u1eb7c b\u1edd tr\u01b0\u1edbc DCCS kho\u1ea3ng 7 mm)<\/span><\/p>\n

2. T\u1ea1o \u0111\u01b0\u1eddng h\u1ea9m x\u01b0\u01a1ng \u0111\u00f9i<\/strong><\/h2>\n

2.1 V\u1ecb tr\u00ed l\u00fd t\u01b0\u1edfng c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i trong t\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc<\/strong><\/h3>\n

Kh\u00e1i ni\u1ec7m “\u0111\u1eb3ng tr\u01b0\u1eddng” (isometricity):<\/span><\/p>\n

Trong \u0111\u1ed9ng h\u1ecdc c\u1ee7a kh\u1edbp g\u1ed1i, l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i \u0111\u00f3ng vai tr\u00f2 chuy\u1ec3n \u0111\u1ed9ng tr\u00ean m\u1eb7t ph\u1eb3ng m\u00e2m ch\u1ea7y. Chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i kh\u00e1c nhau gi\u1eefa l\u1ed3i c\u1ea7u trong v\u00e0 l\u1ed3i c\u1ea7u ngo\u00e0i. L\u1ed3i c\u1ea7u trong x\u01b0\u01a1ng \u0111\u00f9i ch\u1ec9 c\u00f3 chuy\u1ec3n \u0111\u1ed9ng xoay m\u00e0 h\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3 chuy\u1ec3n \u0111\u1ed9ng tr\u01b0\u1ee3t theo chi\u1ec1u tr\u01b0\u1edbc sau. L\u1ed3i c\u1ea7u ngo\u00e0i x\u01b0\u01a1ng \u0111\u00f9i, ngo\u00e0i chuy\u1ec3n \u0111\u1ed9ng xoay c\u00f2n c\u00f3 chuy\u1ec3n \u0111\u1ed9ng tr\u01b0\u1edbc sau m\u00e0 kho\u1ea3ng c\u00e1ch t\u1eeb t\u01b0 th\u1ebf du\u1ed7i th\u1eb3ng (g\u1ea5p 5\u00b0) \u0111\u1ebfn t\u01b0 th\u1ebf g\u1ea5p 120<\/span>o<\/span> l\u00e0 18mm.<\/span><\/p>\n

“\u0110\u1eb3ng tr\u01b0\u1eddng” l\u00e0 kh\u00e1i ni\u1ec7m trong \u0111\u00f3 kho\u1ea3ng c\u00e1ch t\u1eeb \u0111i\u1ec3m b\u00e1m c\u1ee7a d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc v\u00e0o x\u01b0\u01a1ng \u0111\u00f9i \u0111\u1ebfn \u0111i\u1ec3m b\u00e1m v\u00e0o m\u00e2m ch\u1ea7y kh\u00f4ng thay \u0111\u1ed5i khi kh\u1edbp g\u1ed1i chuy\u1ec3n \u0111\u1ed9ng g\u1ea5p du\u1ed7i, ngh\u0129a l\u00e0 \u0111i\u1ec3m b\u00e1m v\u00e0o l\u1ed3i c\u1ea7u c\u1ee7a d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc ch\u1ea1y tr\u00ean 1 \u0111\u01b0\u1eddng tr\u00f2n c\u00f3 t\u00e2m l\u00e0 \u0111i\u1ec3m b\u00e1m v\u00e0o m\u00e2m ch\u1ea7y. Tuy nhi\u00ean, v\u1edbi nh\u1eefng hi\u1ec3u bi\u1ebft v\u1ec1 gi\u1ea3i ph\u1eabu, DCCT c\u00f3 c\u1ea5u tr\u00fac hai b\u00f3 th\u00ec kh\u00e1i ni\u1ec7m “\u0111\u1eb3ng tr\u01b0\u1eddng” \u0111\u1ed1i v\u1edbi d\u00e2y ch\u1eb1ng b\u00ecnh th\u01b0\u1eddng ch\u1ec9 c\u00f3 \u00fd ngh\u0129a t\u01b0\u01a1ng \u0111\u1ed1i. \u0110\u1ed1i v\u1edbi d\u00e2y ch\u1eb1ng m\u1edbi \u0111\u01b0\u1ee3c t\u1ea1o h\u00ecnh v\u1edbi c\u1ea5u tr\u00fac m\u1ed9t b\u00f3, kh\u00e1i ni\u1ec7m n\u00e0y c\u0169ng ch\u1ec9 kh\u00f4ng c\u00f3 \u00fd ngh\u0129a tuy\u1ec7t \u0111\u1ed1i v\u00ec c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u1ea7y. Nh\u01b0ng, v\u1ec1 m\u1eb7t ph\u1eabu thu\u1eadt, kho\u1ea3ng c\u00e1ch gi\u1eefa hai \u0111i\u1ec3m b\u00e1m c\u00e0ng g\u1ea7n “\u0111\u1eb3ng tr\u01b0\u1eddng” th\u00ec k\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt c\u00e0ng t\u1ed1t do d\u00e2y ch\u1eb1ng \u00edt b\u1ecb thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i nh\u1ea5t(t\u1eeb c\u0103ng sang ch\u00f9ng v\u00e0 ng\u01b0\u1ee3c l\u1ea1i). M\u1eb7c d\u00f9 kh\u00f4ng t\u1ed3n t\u1ea1i m\u1ed9t v\u1ecb tr\u00ed \u0111\u1eb3ng tr\u01b0\u1eddng tuy\u1ec7t \u0111\u1ed1i nh\u01b0ng c\u00e1c t\u00e1c gi\u1ea3 \u0111\u1ec3u th\u1ed1ng nh\u1ea5t l\u00e0 \u0111\u1ed1i v\u1edbi k\u1ef9 thu\u1eadt t\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng m\u1ed9t b\u00f3, v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m c\u00e0ng \u1edf v\u1ec1 ph\u00eda sau c\u1ee7a di t\u00edch DCCT th\u00ec ch\u1ee9c n\u0103ng c\u00e0ng t\u1ed1t.<\/span><\/p>\n

V\u1ecb tr\u00ed l\u00fd t\u01b0\u1edfng c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i:<\/span><\/p>\n

V\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i n\u1ebfu ra tr\u01b0\u1edbc qu\u00e1 th\u00ec khi du\u1ed7i g\u1ed1i c\u00f3 th\u1ec3 b\u1ecb ch\u00f9ng c\u00f2n khi g\u1ea5p g\u1ed1i c\u00f3 th\u1ec3 c\u0103ng qu\u00e1, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn h\u1ea1n ch\u1ebf g\u1ea5p g\u1ed1i. V\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m n\u1ebfu \u1edf sau qu\u00e1 th\u00ec d\u00e2y ch\u1eb1ng s\u1ebd b\u1ecb l\u1ecfng khi g\u1ea5p g\u1ed1i v\u00e0 c\u0103ng qu\u00e1 khi du\u1ed7i g\u1ed1i, c\u00f3 th\u1ec3 s\u1ebd h\u1ea1n ch\u1ebf du\u1ed7i g\u1ed1i.<\/span><\/p>\n

2.2 C\u00e1c m\u1ed1c gi\u1ea3i ph\u1eabu<\/strong><\/h3>\n

Kh\u00e1c v\u1edbi \u0111\u01b0\u1eddng h\u1ea7m m\u00e2m ch\u1ea7y, c\u00e1c m\u1ed1c gi\u1ea3i ph\u1eabu t\u01b0\u01a1ng \u0111\u1ed1i r\u00f5 r\u00e0ng v\u00e0 d\u1ec5 quan s\u00e1t, vi\u1ec7c t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i kh\u00f3 kh\u0103n h\u01a1n do v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m n\u1eb1m s\u00e2u h\u01a1n n\u00ean kh\u00f3 quan s\u00e1t qua n\u1ed9i soi. H\u01a1n n\u1eefa, c\u00e1c m\u1ed1c gi\u1ea3i ph\u1eabu c\u0169ng kh\u00f4ng d\u1ec5 d\u00e0ng x\u00e1c \u0111\u1ecbnh v\u00e0 d\u1ec5 quan s\u00e1t nh\u01b0 c\u1ee7a m\u00e2m ch\u1ea7y n\u00ean ph\u1ea7n l\u1edbn c\u00e1c sai s\u00f3t v\u1ec1 m\u1eb7t k\u1ef9 thu\u1eadt l\u00e0 do vi\u1ec7c t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i. M\u1eb7t trong c\u1ee7a l\u1ed3i c\u1ea7u ngo\u00e0i x\u01b0\u01a1ng \u0111\u00f9i t\u01b0\u01a1ng \u0111\u1ed1i ph\u1eb3ng, do \u0111\u00f3 vi\u1ec7c \u0111\u1ecbnh v\u1ecb v\u1ecb tr\u00ed \u0111\u01b0\u1eddng h\u1ea7m ch\u1ee7 y\u1ebfu l\u00e0 \u0111\u1ecbnh v\u1ecb theo hai chi\u1ec1u kh\u00f4ng gian l\u00e0 tr\u00ean – d\u01b0\u1edbi v\u00e0 tr\u01b0\u1edbc – sau.<\/span><\/p>\n

C\u00e1c m\u1ed1c gi\u1ea3i ph\u1eabu th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong vi\u1ec7c t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i l\u00e0:<\/span><\/p>\n

+ V\u1ecb tr\u00ed r\u00e3nh li\u00ean l\u1ed3i c\u1ea7u v\u00e0 s\u01a1 \u0111\u1ed3 “\u0111\u1ed3ng h\u1ed3”<\/span><\/p>\n

+ B\u1edd ph\u00eda sau c\u1ee7a l\u1ed3i c\u1ea7u ngo\u00e0i<\/span><\/p>\n

+ G\u1edd “Resident\u2019s rigde”<\/span><\/p>\n

+ \u0110\u1ecbnh v\u1ecb b\u1eb1ng Xquang trong m\u1ed5<\/span><\/p>\n

Ngo\u00e0i ra, m\u1ed9t s\u1ed1 m\u1ed1c gi\u1ea3i ph\u1eabu kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0ng th\u01b0\u1eddng \u1ee9ng d\u1ee5ng trong k\u1ef9 thu\u1eadt t\u1ea1o h\u00ecnh hai b\u00f3 nh\u01b0 g\u1edd li\u00ean l\u1ed3i c\u1ea7u ph\u00eda ngo\u00e0i (lateral intercondylar rigde) hay g\u1edd li\u00ean b\u00f3 (lateral bifurcate rigde),…<\/span><\/p>\n

V\u1ecb tr\u00ed r\u00e3nh li\u00ean l\u1ed3i c\u1ea7u v\u00e0 s\u01a1 \u0111\u1ed3 “\u0111\u1ed3ng h\u1ed3”<\/span><\/p>\n

\u0110\u1ecbnh v\u1ecb v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i theo chi\u1ec1u tr\u00ean d\u01b0\u1edbi d\u1ef1a tr\u00ean \u00fd t\u01b0\u1edfng s\u01a1 \u0111\u1ed3 “\u0111\u1ed5ng h\u1ed3” trong \u0111\u00f3 v\u1ecb tr\u00ed cao nh\u1ea5t c\u1ee7a khe li\u00ean l\u1ed3i c\u1ea7u t\u01b0\u01a1ng \u1ee9ng v\u1edbi 12h v\u00e0 v\u1ecb tr\u00ed \u1edf m\u00e2m ch\u1ea7y t\u01b0\u01a1ng \u1ee9ng 6h. D\u1ef1a tr\u00ean kh\u00e1i ni\u1ec7m n\u00e0y \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m, t\u01b0\u01a1ng \u1ee9ng \u1edf b\u00ean ph\u1ea3i l\u00e0 v\u1ecb tr\u00ed 10h30, \u1edf b\u00ean tr\u00e1i l\u00e0 lh30. M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 kh\u00e1c m\u00f4 t\u1ea3 nh\u1eefng v\u1ecb tr\u00ed kh\u00e1c nhau ch\u00fat \u00edt (9h30, 10h00, 11h00) \u0111\u1ed1i v\u1edbi b\u00ean ph\u1ea3i v\u00e0 1h00, 2h00, 2h30 \u0111\u1ed1i v\u1edbi b\u00ean tr\u00e1i). S\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y l\u00e0 do di t\u00edch di\u1ec7n b\u00e1m v\u00e0o l\u1ed3i c\u1ea7u c\u1ee7a DCCT r\u1ed9ng h\u01a1n di\u1ec7n t\u00edch c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m.<\/span><\/p>\n

B\u1edd ph\u00eda sau c\u1ee7a l\u1ed3i c\u1ea7u ngo\u00e0i<\/span><\/p>\n

B\u1edd ph\u00eda sau c\u1ee7a l\u1ed3i c\u1ea7u l\u00e0 1 m\u1ed1c quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ecbnh v\u1ecb v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m theo chi\u1ec1u tr\u01b0\u1edbc sau. Do \u0111\u00f3 g\u1ea7n nh\u01b0 l\u00e0 b\u1eaft bu\u1ed9c khi t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i ph\u1ea3i x\u00e1c \u0111\u1ecbnh r\u00f5 b\u1edd ph\u00eda sau c\u1ee7a l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i. Kho\u1ea3ng c\u00e1ch t\u1eeb b\u1edd sau c\u1ee7a di t\u00edch ch\u1ed7 b\u00e1m c\u1ee7a DCCT \u0111\u1ebfn vi\u1ec1n s\u1ee5n l\u1ed3i c\u1ea7u l\u00e0 2-3 mm do \u0111\u00f3 l\u00fd t\u01b0\u1edfng l\u00e0 b\u1edd<\/span><\/p>\n

sau c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m c\u00e1ch b\u1edd sau c\u1ee7a l\u1ed3i c\u1ea7u ngo\u00e0i m\u1ed9t kho\u1ea3ng c\u00e1ch t\u01b0\u01a1ng t\u1ef1 l\u00e0 2-3mm. \u0110\u00e1nh gi\u00e1 tr\u00ean Xquang trong m\u1ed5, v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m n\u1eb1m \u1edf v\u00f9ng 4 c\u1ee7a \u0111\u01b0\u1eddng Blumensat .<\/span><\/p>\n

G\u1edd “Resident\u2019s rigde”<\/span><\/p>\n

“Resident\u2019s rigde” l\u00e0 m\u1ed9t g\u1edd x\u01b0\u01a1ng c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i \u0111\u01b0\u1ee3c William G Clancy Jr m\u00f4 t\u1ea3. \u00d4ng n\u00f3i: “… khi m\u1ed9t b\u00e1c s\u0129 n\u1ed9i tr\u00fa b\u1eaft \u0111\u1ea7u h\u1ecdc k\u1ef9 thu\u1eadt t\u1ea1o h\u00ecnh ACL, th\u01b0\u1eddng th\u00ec vi\u1ec7c gi\u1ea3i ph\u00f3ng t\u1ed5 ch\u1ee9c ph\u1ea7n m\u1ec1m ph\u00eda sau kh\u00f4ng \u0111\u1ee7, ph\u1ea7n g\u1edd x\u01b0\u01a1ng \u1edf sau nh\u1ea5t m\u00e0 h\u1ecd nh\u00ecn th\u1ea5y l\u00e0 g\u1edd Resident\u2019s rigde” (tr\u00edch d\u1eabn t\u1eeb 25). Khi \u0111\u00e1nh gi\u00e1 tr\u00ean 10 b\u1ec7nh ph\u1ea9m g\u1ed1i, Mark R Hutchinson th\u1ea5y r\u1eb1ng c\u00f3 g\u1edd n\u00e0y th\u1ea5y \u1edf 9\/10 b\u1ec7nh ph\u1ea9m. G\u1edd Resident\u2019s rigde l\u00e0 ch\u1ed7 nh\u00f4 l\u00ean hay v\u1ecb tr\u00ed thay \u0111\u1ed5i chi\u1ec1u cong c\u1ee7a khe li\u00ean l\u1ed3i c\u1ea7u, n\u1eb1m ngay tr\u01b0\u1edbc v\u1ecb tr\u00ed b\u00e1m c\u1ee7a DCCT v\u00e0 tr\u01b0\u1edbc b\u1edd ph\u00eda sau c\u1ee7a khe li\u00ean l\u1ed3i c\u1ea7u. N\u1ebfu nh\u1ea7m l\u1eabn g\u1edd n\u00e0y v\u00e0 b\u1edd sau c\u1ee7a khe li\u00ean l\u1ed3i c\u1ea7u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng \u0111\u00f9i ra tr\u01b0\u1edbc do \u0111\u00f3 d\u1ec5 d\u1eabn \u0111\u1ebfn th\u1ea5t b\u1ea1i c\u1ee7a ph\u1eabu thu\u1eadt.<\/span><\/p>\n

\u0110\u1ecbnh v\u1ecb b\u1eb1ng Xquang trong m\u1ed5<\/span><\/p>\n

V\u1edbi nh\u1eefng nghi\u00ean c\u1ee9u s\u00e2u v\u1ec1 gi\u1ea3i ph\u1eabu v\u00e0 nh\u1ea5t l\u00e0 \u0111\u1ecbnh v\u1ecb v\u1ecb tr\u00ed c\u1ee7a ch\u1ed7 b\u00e1m DCCT v\u00e0o l\u1ed3i c\u1ea7u theo \u0111\u01b0\u1eddng Blumensat, vi\u1ec7c s\u1eed d\u1ee5ng Xquang trong m\u1ed5 s\u1ebd \u0111em l\u1ea1i \u0111\u1ed9 ch\u00ednh x\u00e1c r\u1ea5t cao cho vi\u1ec7c t\u1ea1o \u0111\u01b0\u1eddng h\u1ea7m. Tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng Xquang trong m\u1ed5 c\u0169ng ph\u1ea3i d\u1ef1a tr\u00ean c\u00e1c m\u1ed1c gi\u1ea3i ph\u1eabu nh\u1ea5t \u0111\u1ecbnh, \u0111\u00f3 l\u00e0 c\u00e1c gai ch\u1ea7y \u1edf m\u00e2m “‘ch\u1ea7y, \u0111\u01b0\u1eddng li\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i, \u0111\u01b0\u1eddng Blumensat c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 m\u00e2m ch\u1ea7y .<\/span><\/p>\n

\u00a0<\/span>T\u00e1c gi\u1ea3:<\/strong> PGS.TS. Tr\u1ea7n Trung D\u0169ng, ” T\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc kh\u1edbp g\u1ed1i qua n\u1ed9i soi” , Trung t\u00e2m Ch\u1ea5n th\u01b0\u01a1ng Ch\u1ec9nh h\u00ecnh v\u00e0 Y h\u1ecdc th\u1ec3 thao, B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec Times City.<\/p>\n

Xem th\u00eam: Gi\u1ea3i ph\u1eabu d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc<\/a><\/p>\n

(ch\u00e8n link n\u00e0y sau khi xu\u1ea5t b\u1ea3n).<\/p>\n","protected":false},"excerpt":{"rendered":"

T\u1ea1o h\u00ecnh d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc (DCCT) v\u1edbi k\u1ef9 thu\u1eadt m\u1ed9t b\u00f3 l\u00e0 k\u1ef9 thu\u1eadt ra \u0111\u1eddi s\u1edbm nh\u1ea5t v\u00e0 \u0111\u1ebfn t\u1eadn ng\u00e0y nay v\u1eabn l\u00e0 ph\u1ed5 bi\u1ebfn nh\u1ea5t. 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