{"id":1885,"date":"2023-05-29T19:00:07","date_gmt":"2023-05-29T12:00:07","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=1885"},"modified":"2023-07-31T17:44:37","modified_gmt":"2023-07-31T10:44:37","slug":"co-rut-khop","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/co-rut-khop\/","title":{"rendered":"Joint contracture"},"content":{"rendered":"

1. OVERVIEW<\/h2>\n

Thu\u1eadt ng\u1eef \u201cco r\u00fat kh\u1edbp\u201d \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 m\u00f4 t\u1ea3 s\u1ef1 m\u1ea5t \u0111i ph\u1ea1m vi chuy\u1ec3n \u0111\u1ed9ng th\u1ee5 \u0111\u1ed9ng c\u1ee7a c\u00e1c kh\u1edbp di \u0111\u1ed9ng, lo\u1ea1i kh\u1edbp ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 th\u1ec3 chuy\u1ec3n \u0111\u1ed9ng \u0111\u01b0\u1ee3c.<\/p>\n

Joint contracture<\/a> l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng \u0111\u00e1ng k\u1ec3 v\u1edbi qu\u00e1 tr\u00ecnh suy y\u1ebfu ti\u1ebfn tri\u1ec3n v\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t s\u1edbm. Kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp c\u00f3 th\u1ec3 gi\u1ea3m m\u1ed9t ph\u1ea7n ho\u1eb7c ho\u00e0n to\u00e0n. Co r\u00fat kh\u1edbp c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i l\u00e0 b\u1ec7nh l\u00fd kh\u00f4ng vi\u00eam c\u1ee7a h\u1ec7 c\u01a1 x\u01b0\u01a1ng. Co r\u00fat kh\u1edbp th\u01b0\u1eddng x\u1ea3y ra trong ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp, arthritis<\/a> ho\u1eb7c b\u1ec7nh h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, nh\u01b0ng nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u1eabn l\u00e0 do motionless<\/a> kh\u1edbp. Nh\u01b0 ch\u00fang ta \u0111\u00e3 bi\u1ebft, b\u1ea5t \u0111\u1ed9ng kh\u1edbp th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb quan tr\u1ecdng \u0111\u1ed1i v\u1edbi fracture<\/a>, tr\u1eadt kh\u1edbp v\u00e0 t\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng. Tuy nhi\u00ean, sau m\u1ed9t th\u1eddi gian d\u00e0i b\u1ea5t \u0111\u1ed9ng m\u1edbi h\u00ecnh th\u00e0nh co r\u00fat kh\u1edbp th\u00ec vi\u1ec7c \u0111i\u1ec1u tr\u1ecb ph\u1ee5c h\u1ed3i r\u1ea5t kh\u00f3 kh\u0103n, ngay c\u1ea3 \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt nh\u01b0 arthroscopy<\/a> v\u1eabn kh\u00f3 kh\u00f4i ph\u1ee5c l\u1ea1i t\u1ea7m v\u1eadn \u0111\u1ed9ng nh\u01b0 c\u0169.<\/p>\n

Co r\u00fat kh\u1edbp c\u0169ng g\u1eb7p \u1edf ng\u01b0\u1eddi cao tu\u1ed5i trong c\u00e1c c\u01a1 s\u1edf ch\u0103m s\u00f3c l\u00e3o khoa. V\u1eadn \u0111\u1ed9ng t\u1ee9 chi m\u1ed9t c\u00e1ch tho\u1ea3i m\u00e1i l\u00e0 \u0111i\u1ec1u ki\u1ec7n ti\u00ean quy\u1ebft cho v\u1eadn \u0111\u1ed9ng v\u00e0 t\u1ef1 ch\u1ee7 khi v\u1ec1 gi\u00e0. C\u00e1c nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 h\u1ecdc cho th\u1ea5y t\u1ec9 l\u1ec7 m\u1eafc co r\u00fat kh\u1edbp \u1edf ng\u01b0\u1eddi cao tu\u1ed5i t\u1eeb 20% \u0111\u1ebfn 80%. \u1ede ng\u01b0\u1eddi cao tu\u1ed5i, co r\u00fat c\u00f3 th\u1ec3 do nhi\u1ec1u t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd v\u00e0 v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe g\u00e2y ra, nh\u01b0ng b\u1ea5t \u0111\u1ed9ng do ch\u1ea5n th\u01b0\u01a1ng c\u1ea5p t\u00ednh ho\u1eb7c b\u1ec7nh t\u1eadt d\u01b0\u1eddng nh\u01b0 l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh.<\/p>\n

M\u1eb7c d\u00f9 m\u1ea5t 15\u00b0 g\u1eadp c\u1ee7a khu\u1ef7u tay s\u1ebd \u1ea3nh h\u01b0\u1edfng \u00edt \u0111\u1ebfn ho\u1ea1t \u0111\u1ed9ng c\u00e1 nh\u00e2n, nh\u01b0ng n\u1ebfu m\u1ea5t kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng c\u1ee7a knee joint<\/a> s\u1ebd khi\u1ebfn b\u1ecb kh\u1eadp khi\u1ec5ng v\u0129nh vi\u1ec5n. Co r\u00fat kh\u1edbp \u1edf chi tr\u00ean c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u1ea5t kh\u1ea3 n\u0103ng m\u1eb7c qu\u1ea7n \u00e1o ho\u1eb7c \u0103n u\u1ed1ng \u0111\u1ed9c l\u1eadp trong khi co r\u00fat kh\u1edbp \u1edf chi d\u01b0\u1edbi c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u1ea5t v\u1eefng v\u00e0 kh\u00f4ng th\u1ec3 \u0111i l\u1ea1i \u0111\u1ed9c l\u1eadp v\u00e0 nguy c\u01a1 n\u1eb1m li\u1ec7t gi\u01b0\u1eddng cao h\u01a1n. Khi co r\u00fat kh\u1edbp \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh, c\u00e1c n\u1ed7 l\u1ef1c \u0111\u1ec3 k\u00e9o gi\u00e3n kh\u1edbp v\u1ec1 t\u1ea7m v\u1eadn \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 g\u00e2y \u0111au \u0111\u1edbn, nhi\u1ec1u khi kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c do s\u1ef1 co r\u00fat c\u1ee7a c\u00e1c m\u00f4 m\u1ec1m v\u00e0 c\u0169ng c\u00f3 th\u1ec3 do kh\u1edbp kh\u00f4ng c\u00f2n t\u01b0\u01a1ng \u0111\u1ed3ng. V\u00e0o th\u1eddi \u0111i\u1ec3m \u0111\u00f3, c\u00e1c co r\u00fat kh\u00f4ng th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c v\u00e0 b\u1ec7nh nh\u00e2n s\u1ebd b\u1ecb m\u1ea5t ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng \u0111\u00e1ng k\u1ec3 v\u00e0 v\u0129nh vi\u1ec5n.<\/p>\n

Co r\u00fat kh\u1edbp l\u00e0m t\u0103ng nguy c\u01a1 d\u1eabn \u0111\u1ebfn c\u00e1c h\u1eadu qu\u1ea3 x\u1ea5u cho b\u1ec7nh nh\u00e2n nh\u01b0 \u0111au, lo\u00e9t t\u00ec \u0111\u00e8 v\u00e0 nguy c\u01a1 t\u00e9 ng\u00e3. V\u00ec v\u1eady, co r\u00fat kh\u1edbp l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y ra t\u00ecnh tr\u1ea1ng khuy\u1ebft t\u1eadt qu\u00e1 m\u1ee9c \u1edf ng\u01b0\u1eddi cao tu\u1ed5i v\u1edbi t\u00e1c \u0111\u1ed9ng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00e0 ho\u1ea1t \u0111\u1ed9ng x\u00e3 h\u1ed9i.<\/p>\n

Co r\u00fat kh\u1edbp \u0111\u00e1p \u1ee9ng r\u1ea5t k\u00e9m v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7n c\u00f3, ch\u1ee7 y\u1ebfu li\u00ean quan \u0111\u1ebfn v\u1eadt l\u00fd tr\u1ecb li\u1ec7u. Kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i m\u1ed9t ph\u1ea7n c\u1ee7a co r\u00fat kh\u1edbp g\u1ed1i s\u1ebd c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng nh\u01b0ng b\u1ec7nh nh\u00e2n v\u1eabn c\u1ea7n \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 \u0111\u1ec3 v\u1eadn \u0111\u1ed9ng v\u00ec s\u1ef1 thi\u1ebfu du\u1ed7i c\u1ee7a kh\u1edbp g\u1ed1i ch\u1ec9 5\u00b0 s\u1ebd d\u1eabn \u0111\u1ebfn kh\u1eadp khi\u1ec5ng v\u00e0 d\u00e1ng \u0111i s\u1ebd kh\u00f4ng b\u00ecnh th\u01b0\u1eddng. C\u00e1c can thi\u1ec7p d\u1ef1 ph\u00f2ng v\u00e0 Rehabilitation<\/a> nh\u1eafm v\u00e0o c\u00e1c co r\u00fat kh\u1edbp c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 m\u1eafc b\u1ec7nh, t\u0103ng c\u01b0\u1eddng ch\u1ee9c n\u0103ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00e0 cu\u1ed1i c\u00f9ng, ng\u0103n ng\u1eeba t\u00e0n t\u1eadt v\u1ec1 l\u00e2u d\u00e0i.<\/p>\n

2. NGUY\u00caN NH\u00c2N V\u00c0 T\u1ec8 L\u1ec6 CO R\u00daT KH\u1edaP<\/strong><\/h2>\n

2.1 T\u1ed5n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng<\/strong><\/h3>\n

Vogel v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 b\u00e1o c\u00e1o t\u1ec9 l\u1ec7 bi\u1ebfn ch\u1ee9ng c\u01a1 x\u01b0\u01a1ng v\u00e0 th\u1ea7n kinh (bao g\u1ed3m nhi\u1ec1u d\u1ea1ng co r\u00fat kh\u00e1c nhau) \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh c\u00f3 ch\u1ea5n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng t\u1eeb khi c\u00f2n nh\u1ecf. 23% b\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat h\u00e1ng, 16% b\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat c\u1ed5 ch\u00e2n v\u00e0 7% b\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat khu\u1ef7u tay. Co r\u00fat khu\u1ef7u ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb li\u1ec7t n\u1eeda ng\u01b0\u1eddi.<\/p>\n

2.2 B\u1ecfng<\/strong><\/h3>\n

Huang v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a n\u1eb9p v\u00e0 k\u00e9o gi\u00e3n li\u00ean t\u1ee5c qua c\u00e1c kh\u1edbp \u1edf 625 b\u1ec7nh nh\u00e2n b\u1ecb s\u1eb9o burn<\/a>. C\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb b\u1ecfng \u1edf n\u00e1ch, khu\u1ef7u tay, c\u1ed5 tay v\u00e0 g\u1ed1i. T\u1ec9 l\u1ec7 co r\u00fat s\u1eb9o b\u1ecfng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb kh\u00f4ng d\u00f9ng n\u1eb9p v\u00e0 k\u00e9o gi\u00e3n t\u01b0\u01a1ng \u1ee9ng l\u00e0 94,8%; 81,5%; 62,9% v\u00e0 74,6% \u0111\u1ed1i v\u1edbi v\u00f9ng n\u00e1ch, khu\u1ef7u tay, c\u1ed5 tay v\u00e0 g\u1ed1i. Ng\u01b0\u1ee3c l\u1ea1i, t\u1ec9 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng n\u1eb9p v\u00e0 k\u00e9o gi\u00e3n d\u01b0\u1edbi 6 th\u00e1ng l\u00e0 89,9%; 70%, 68;8% v\u00e0 50%; t\u1ec9 l\u1ec7 n\u00e0y gi\u1ea3m h\u01a1n \u1edf b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb tr\u00ean 6 th\u00e1ng.<\/p>\n

2.3 T\u1ed5n th\u01b0\u01a1ng n\u00e3o\/\u0110\u1ed9t qu\u1ef5<\/strong><\/h3>\n

Singer v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 b\u00e1o c\u00e1o t\u1ec9 l\u1ec7 m\u1eafc v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a co r\u00fat c\u1ed5 ch\u00e2n \u1edf 105 b\u1ec7nh nh\u00e2n \u1edf \u0111\u01a1n v\u1ecb ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng ph\u1eabu thu\u1eadt th\u1ea7n kinh v\u00ec ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o m\u1ee9c \u0111\u1ed9 v\u1eeba \u0111\u1ebfn n\u1eb7ng trong th\u1eddi gian 1 n\u0103m. T\u00e1c gi\u1ea3 \u0111\u00e3 \u0111\u1ecbnh ngh\u0129a co r\u00fat l\u00e0 t\u1ea7m v\u1eadn \u0111\u1ed9ng th\u1ee5 \u0111\u1ed9ng t\u1ed1i \u0111a d\u01b0\u1edbi 0\u00b0 g\u1eadp l\u01b0ng v\u1edbi g\u1ed1i du\u1ed7i. C\u00f3 16,2% b\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat c\u1ed5 ch\u00e2n, v\u1edbi m\u1ed1i li\u00ean quan k\u00e9m gi\u1eefa m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o v\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n co r\u00fat c\u1ed5 ch\u00e2n.<\/p>\n

Pohl v\u00e0 Mehrholz kh\u1ea3o s\u00e1t co r\u00fat vai \u1edf 50 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i trung t\u00e2m ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng c\u1ee7a \u0110\u1ee9c do b\u1ecb t\u1ed5n th\u01b0\u01a1ng n\u00e3o nghi\u00eam tr\u1ecdng. T\u1ea7m v\u1eadn \u0111\u1ed9ng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng kho\u1ea3ng c\u00e1ch t\u0103ng l\u00ean gi\u1eefa m\u1ecfm khu\u1ef7u v\u00e0 gh\u1ebf trong khi b\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda tr\u00ean gh\u1ebf tr\u1ecb li\u1ec7u v\u00e0 tay c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c di chuy\u1ec3n th\u1ee5 \u0111\u1ed9ng, g\u1ea5p v\u00e0 gi\u1eef sau g\u00e1y. Co r\u00fat \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 kho\u1ea3ng c\u00e1ch trung b\u00ecnh gi\u1eefa m\u1ecfm khu\u1ef7u v\u00e0 gh\u1ebf cao h\u01a1n gi\u00e1 tr\u1ecb tham chi\u1ebfu c\u1ee7a nh\u00f3m \u0111\u1ed1i ch\u1ee9ng. 28 b\u1ec7nh nh\u00e2n (56%) b\u1ecb co r\u00fat \u1edf \u00edt nh\u1ea5t m\u1ed9t b\u00ean vai. M\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh v\u00e0 th\u1eddi gian h\u00f4n m\u00ea l\u00e0m t\u0103ng nguy c\u01a1 co r\u00fat.<\/p>\n

Yarkony v\u00e0 Sahgal b\u00e1o c\u00e1o t\u1ec9 l\u1ec7 co r\u00fat t\u1ed5ng th\u1ec3 l\u00e0 84% \u1edf c\u00e1c b\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o theo d\u00f5i 1 n\u0103m. 81% b\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat h\u00e1ng, 76% b\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat vai, 76% b\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat c\u1ed5 ch\u00e2n v\u00e0 44% b\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat khu\u1ef7u. Th\u1eddi gian h\u00f4n m\u00ea k\u00e9o d\u00e0i l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 ph\u00e1t tri\u1ec3n co r\u00fat kh\u1edbp. Pinedo v\u00e0 Villa \u0111\u00e1nh gi\u00e1 c\u00e1c bi\u1ebfn ch\u1ee9ng \u1edf b\u1ec7nh nh\u00e2n sau \u0111\u1ed9t qu\u1ef5 li\u1ec7t n\u1eeda ng\u01b0\u1eddi. Trong s\u1ed1 73 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i m\u1ed9t b\u1ec7nh vi\u1ec7n ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng \u1edf T\u00e2y Ban Nha, 23% b\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat kh\u1edbp.<\/p>\n

2.4 \u0110\u1ed1i v\u1edbi tr\u1ebb em<\/strong><\/h3>\n

T\u1ec9 l\u1ec7 co r\u00fat g\u1ed1i \u1edf tr\u1ebb em Hoa K\u1ef3 v\u00e0 \u00dac m\u1eafc b\u1ec7nh tho\u00e1t v\u1ecb t\u1ee7y \u2013 m\u00e0ng t\u1ee7y \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 32% v\u1edbi co r\u00fat kh\u1edbp g\u1ed1i tr\u00ean 10\u00b0. Lawrence v\u00e0 c\u1ed9ng s\u1ef1 b\u00e1o c\u00e1o t\u1ec9 l\u1ec7 co r\u00fat l\u00e0 51% g\u1eb7p trong Muscular dystrophy<\/a> gi\u1ea3 ph\u00ec \u0111\u1ea1i. Thomas v\u00e0 c\u1ed9ng s\u1ef1 b\u00e1o c\u00e1o t\u1ec9 l\u1ec7 co r\u00fat kh\u1edbp g\u1ed1i, m\u1ea5t v\u1eefng g\u1ed1i l\u00e0 71% trong b\u1ec7nh \u0111a co r\u00fat b\u1ea9m sinh.<\/p>\n

2.5 \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi cao tu\u1ed5i<\/strong><\/h3>\n

Co r\u00fat kh\u1edbp th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5, Parkinson<\/a> v\u00e0 sa s\u00fat tr\u00ed tu\u1ec7. C\u00e1c y\u1ebfu t\u1ed1 kh\u00f4ng li\u00ean quan \u0111\u1ebfn co r\u00fat kh\u1edbp l\u00e0 gi\u1ea3m th\u1ecb l\u1ef1c, t\u0103ng c\u00e2n n\u1eb7ng, tr\u1ea7m c\u1ea3m, osteoarthritis<\/a> v\u00e0 ti\u1ec1n s\u1eed c\u00f3 g\u00e3y x\u01b0\u01a1ng v\u00f9ng h\u00e1ng ho\u1eb7c chi d\u01b0\u1edbi. Resnick trong m\u1ed9t nghi\u00ean c\u1ee9u t\u1ea1i c\u01a1 s\u1edf ch\u0103m s\u00f3c l\u00e3o khoa cho th\u1ea5y 31% co r\u00fat \u1edf chi tr\u00ean v\u00e0 26% c\u00f3 co r\u00fat \u1edf chi d\u01b0\u1edbi. T\u1ec9 l\u1ec7 co r\u00fat kh\u1edbp g\u1ed1i c\u00f3 th\u1ec3 chi\u1ebfm t\u1edbi 75% \u1edf ng\u01b0\u1eddi cao tu\u1ed5i v\u1edbi co r\u00fat tr\u00ean 5\u00ba.<\/p>\n

2.6 B\u1ec7nh \u01b0a ch\u1ea3y m\u00e1u<\/strong><\/h3>\n

Trong m\u1ed9t nghi\u00ean c\u1ee9u \u1edf Th\u1ee5y \u0110i\u1ec3n n\u0103m 1964 b\u00e1o c\u00e1o c\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh \u01b0a ch\u1ea3y m\u00e1u, t\u1ec9 l\u1ec7 b\u1ec7nh l\u00fd hip joint<\/a> l\u00e0 7,6%; kh\u1edbp g\u1ed1i l\u00e0 63,7%; kh\u1edbp c\u1ed5 ch\u00e2n l\u00e0 36,9%; shoulder<\/a> l\u00e0 13,4%; elbow joint<\/a> l\u00e0 54,8%; kh\u1edbp c\u1ed5 tay l\u00e0 8,3%. B\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u01b0a ch\u1ea3y m\u00e1u n\u1eb7ng c\u00f3 t\u1ec9 l\u1ec7 m\u1eafc b\u1ec7nh kh\u1edbp cao h\u01a1n nhi\u1ec1u so v\u1edbi b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh v\u1eeba \u0111\u1ebfn nh\u1eb9.<\/p>\n

2.7 Ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh<\/strong><\/h3>\n

Tanzer v\u00e0 Miller kh\u1ea3o s\u00e1t bi\u1ebfn d\u1ea1ng g\u1eadp h\u1eb1ng \u0111\u1ecbnh tr\u01b0\u1edbc v\u00e0 sau ph\u1eabu thu\u1eadt \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt thay to\u00e0n b\u1ed9 kh\u1edbp g\u1ed1i. \u0110\u1ed9 co r\u00fat g\u1ed1i trung b\u00ecnh sau ph\u1eabu thu\u1eadt l\u00e0 14,8\u00b0 v\u00e0 c\u1ea3i thi\u1ec7n th\u00e0nh 2,9\u00b0 \u1edf l\u1ea7n t\u00e1i kh\u00e1m cu\u1ed1i c\u00f9ng sau 1 n\u0103m.<\/p>\n

3. SINH L\u00dd B\u1ec6NH<\/strong><\/h2>\n

3.1 C\u01a1 ch\u1ebf b\u1ec7nh sinh<\/strong><\/h3>\n

Sinh l\u00fd b\u1ec7nh co r\u00fat kh\u1edbp ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5 r\u00e0ng; th\u00f4ng tin h\u1ea1n ch\u1ebf v\u1ec1 c\u00e1c y\u1ebfu t\u1ed1 nguy\u00ean nh\u00e2n, s\u1ef1 ti\u1ebfn tri\u1ec3n, sinh l\u00fd b\u1ec7nh li\u00ean quan v\u00e0 d\u1ef1 \u0111o\u00e1n \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb. S\u1ef1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng c\u1ee7a co r\u00fat kh\u1edbp k\u1ebft h\u1ee3p v\u1edbi s\u1ef1 \u0111\u00f3ng g\u00f3p kh\u00f4ng t\u01b0\u01a1ng \u0111\u1ed3ng c\u1ee7a c\u00e1c m\u00f4 li\u00ean k\u1ebft kh\u1edbp v\u00e0o kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp \u0111\u1eb7t ra nh\u1eefng th\u00e1ch th\u1ee9c \u0111\u1ed1i v\u1edbi vi\u1ec7c nghi\u00ean c\u1ee9u co r\u00fat kh\u1edbp. H\u01a1n n\u1eefa, co r\u00fat th\u01b0\u1eddng l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a m\u1ed9t lo\u1ea1t c\u00e1c r\u1ed1i lo\u1ea1n ph\u1ee9c t\u1ea1p m\u00e0 trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p l\u00e0 \u0111a y\u1ebfu t\u1ed1.<\/p>\n

Co r\u00fat kh\u1edbp th\u01b0\u1eddng l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a t\u00ecnh tr\u1ea1ng vi\u00eam m\u1ea1n t\u00ednh (vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p), nhi\u1ec5m tr\u00f9ng, tho\u00e1i h\u00f3a kh\u1edbp ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng l\u1eb7p \u0111i l\u1eb7p l\u1ea1i. \u0110au do tr\u00e0n d\u1ecbch kh\u1edbp, c\u00f3 li\u00ean quan \u0111\u1ebfn ph\u1ea3n \u1ee9ng vi\u00eam c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m vi\u00eam kh\u1edbp, th\u01b0\u1eddng l\u00ean \u0111\u1ebfn \u0111\u1ec9nh \u0111i\u1ec3m khi kh\u1edbp b\u1ecb n\u1eb9p v\u00e0 b\u1ea5t \u0111\u1ed9ng. Khi c\u1eed \u0111\u1ed9ng kh\u1edbp b\u1ecb h\u1ea1n ch\u1ebf, co r\u00fat c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n. Tho\u00e1i h\u00f3a kh\u1edbp d\u1eabn \u0111\u1ebfn bi\u1ebfn d\u1ea1ng v\u00e0 t\u00e1i t\u1ea1o l\u1ea1i b\u1ec1 m\u1eb7t kh\u1edbp v\u00e0 c\u00e1c qu\u00e1 tr\u00ecnh vi\u00eam kh\u1edbp d\u1eabn \u0111\u1ebfn s\u1eb9o bao ho\u1ea1t d\u1ecbch, \u0111i\u1ec1u n\u00e0y kh\u00f4ng ch\u1ec9 g\u00f3p ph\u1ea7n g\u00e2y co c\u1ee9ng trong kh\u1edbp m\u00e0 c\u00f2n g\u00e2y co r\u00fat quanh kh\u1edbp. B\u1ecfng th\u01b0\u1eddng g\u00e2y h\u1ea1n ch\u1ebf s\u1ef1 di \u0111\u1ed9ng c\u1ee7a m\u00f4 m\u1ec1m xung quanh kh\u1edbp, do \u0111\u00f3, d\u1eabn \u0111\u1ebfn co r\u00fat kh\u1edbp.<\/p>\n

R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh c\u01a1 d\u01b0\u1eddng nh\u01b0 l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y h\u1ea1n ch\u1ebf kh\u1edbp sinh l\u00fd ngo\u00e0i kh\u1edbp, c\u00f3 th\u1ec3 l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a \u0111o\u1ea1n c\u1ed9t s\u1ed1ng v\u00e0 ph\u1ea7n tr\u00ean c\u1ed9t s\u1ed1ng d\u1eabn \u0111\u1ebfn r\u00fat ng\u1eafn chi\u1ec1u d\u00e0i c\u1ee7a c\u00e1c s\u1ee3i c\u01a1 khi ngh\u1ec9. \u0110\u1ed9 l\u1ec7ch tr\u1ee5c c\u01a1 c\u0169ng c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1. C\u00e1c b\u1ec7nh l\u00fd nh\u01b0 \u0111\u1ed9t qu\u1ef5, sa s\u00fat tr\u00ed tu\u1ec7 \u0111a nh\u1ed3i m\u00e1u v\u00e0 c\u00e1c b\u1ec7nh g\u00e2y ra thay \u0111\u1ed5i d\u1eabn truy\u1ec1n th\u1ea7n kinh (ch\u1eb3ng h\u1ea1n nh\u01b0 b\u1ec7nh Parkinson) c\u00f3 th\u1ec3 g\u00e2y ra ch\u1ee9ng co c\u1ee9ng. T\u01b0 th\u1ebf co c\u1ee9ng th\u1ec3 hi\u1ec7n v\u1edbi s\u1ef1 m\u1ea5t c\u00e2n b\u1eb1ng n\u0103ng \u0111\u1ed9ng ki\u1ec3m so\u00e1t c\u01a1 \u1edf c\u00e1c chi li\u00ean quan v\u00e0 d\u1eabn \u0111\u1ebfn co r\u00fat c\u01a1. C\u00e1c lo\u1ea1i thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 ngo\u1ea1i th\u00e1p nh\u01b0 thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n c\u0169ng c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o ch\u1ee9ng co r\u00fat c\u01a1.<\/p>\n

3.2 M\u00f4 b\u1ec7nh h\u1ecdc<\/strong><\/h3>\n

Lo\u1ea1i m\u00f4 h\u1ea1n ch\u1ebf t\u1ea7m v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n lo\u1ea1i co r\u00fat. C\u00e1c m\u00f4 c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn s\u1ef1 m\u1ea5t t\u1ea7m v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp bao g\u1ed3m c\u01a1, bao kh\u1edbp, g\u00e2n, d\u00e2y ch\u1eb1ng, s\u1ee5n, da v\u00e0 x\u01b0\u01a1ng. Th\u01b0\u1eddng c\u00f3 s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a nhi\u1ec1u lo\u1ea1i m\u00f4 li\u00ean quan v\u00e0 r\u1ea5t kh\u00f3 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh s\u1ef1 \u0111\u00f3ng g\u00f3p c\u1ee7a c\u00e1c c\u1ea5u tr\u00fac kh\u1edbp ri\u00eang l\u1ebb v\u00e0o gi\u1edbi h\u1ea1n c\u1ee7a t\u1ea7m v\u1eadn \u0111\u1ed9ng. Co r\u00fat kh\u1edbp ph\u00e1t sinh t\u1eeb c\u00e1c m\u00f4 b\u1ea3n ch\u1ea5t c\u01a1 (v\u00ed d\u1ee5, c\u01a1 v\u00e0 c\u00e2n m\u1ea1c) c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc c\u00e1c b\u1ec7nh l\u00fd th\u1ea7n kinh trong \u0111\u00f3 c\u00e1c t\u1ebf b\u00e0o th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng b\u1ecb l\u1ed7i g\u00e2y ra co c\u1ee9ng c\u01a1. Trong b\u1ec7nh Dupuytren<\/a>, m\u1ed9t d\u1ea3i x\u01a1 \u1edf gan b\u00e0n tay t\u1ea1o ra s\u1ef1 co r\u00fat c\u1ee7a c\u00e1c kh\u1edbp ng\u00f3n tay<\/a>. C\u00e1c co r\u00fat c\u0169ng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf l\u1edbp b\u00ec v\u1edbi da g\u00e2y h\u1ea1n ch\u1ebf t\u1ea7m v\u1eadn \u0111\u1ed9ng \u1edf b\u1ec7nh nh\u00e2n b\u1ecfng ho\u1eb7c x\u01a1 c\u1ee9ng b\u00ec. Co r\u00fat c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 b\u1ec7nh l\u00fd kh\u1edbp. S\u1ef1 ph\u00e1t tri\u1ec3n x\u01b0\u01a1ng d\u01b0\u1edbi d\u1ea1ng t\u1ea1o c\u1ed1t b\u00e0o ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng nh\u01b0 g\u00e3y x\u01b0\u01a1ng trong kh\u1edbp \u0111\u01b0\u1ee3c bi\u1ebft l\u00e0 d\u1eabn \u0111\u1ebfn co r\u00fat kh\u1edbp. T\u1ed5n th\u01b0\u01a1ng c\u00e1c m\u00f4 li\u00ean k\u1ebft, ch\u1eb3ng h\u1ea1n nh\u01b0 tr\u01b0\u1eddng h\u1ee3p s\u1ee5n b\u1ecb vi\u00eam s\u1ee5n x\u01b0\u01a1ng t\u00e1ch r\u1eddi ho\u1eb7c r\u00e1ch meniscus<\/a>, c\u00f3 th\u1ec3 g\u00e2y ra co r\u00fat kh\u1edbp. Trong c\u00e1c co r\u00fat kh\u1edbp do b\u1ea5t \u0111\u1ed9ng g\u00e2y ra, bao kh\u1edbp \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 g\u00f3p ph\u1ea7n v\u00e0o h\u1ea1n ch\u1ebf kh\u00f4ng th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c c\u1ee7a t\u1ea7m v\u1eadn \u0111\u1ed9ng kh\u1edbp th\u00f4ng qua c\u01a1 ch\u1ebf bao kh\u1edbp ng\u1eafn l\u1ea1i, vi\u00eam d\u00ednh bao kh\u1edbp v\u00e0\/ho\u1eb7c x\u01a1 h\u00f3a kh\u1edbp. C\u00f3 th\u1ec3 c\u00f3 nhi\u1ec1u h\u01a1n m\u1ed9t lo\u1ea1i m\u00f4 li\u00ean quan \u0111\u1ebfn s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a co r\u00fat kh\u1edbp (v\u00ed d\u1ee5 b\u1ea5t \u0111\u1ed9ng d\u1eabn \u0111\u1ebfn teo c\u01a1 v\u00e0 nh\u1eefng thay \u0111\u1ed5i trong bao kh\u1edbp \u0111\u1ec1u g\u00f3p ph\u1ea7n l\u00e0m m\u1ea5t t\u1ea7m v\u1eadn \u0111\u1ed9ng). T\u00ednh ch\u1ea5t kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t c\u1ee7a b\u1ec7nh d\u1eabn \u0111\u1ebfn kh\u00f3 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 li\u00ean quan c\u1ee7a t\u1eebng m\u00f4 v\u00e0 c\u00e1c ti\u1ec1m n\u0103ng cho \u0111i\u1ec1u tr\u1ecb \u0111\u00e1nh tr\u00fang \u0111\u00edch \u0111\u1ed1i v\u1edbi b\u1ec7nh l\u00fd co r\u00fat kh\u1edbp.<\/p>\n

3.3 T\u1ebf b\u00e0o v\u00e0 ph\u00e2n t\u1eed c\u1ee7a s\u1ef1 ph\u00e1t tri\u1ec3n co r\u00fat kh\u1edbp<\/strong><\/h3>\n

Co r\u00fat kh\u1edbp c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn ph\u1ea3n \u1ee9ng vi\u00eam do ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp \u0111\u1ebfn kh\u1edbp (r\u00e1ch, g\u00e3y x\u01b0\u01a1ng,\u2026), ngo\u00e0i ra, c\u0169ng c\u00f3 th\u1ec3 ph\u00e1t sinh m\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u vi\u00eam c\u1ed5 \u0111i\u1ec3n. H\u01a1n 400 t\u00ecnh tr\u1ea1ng kh\u00e1c nhau \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i l\u00e0 b\u1ec7nh \u0111a co r\u00fat kh\u1edbp b\u1ea9m sinh. N\u00f3i chung, c\u0103n nguy\u00ean c\u1ee7a b\u1ec7nh d\u1eabn \u0111\u1ebfn gi\u1ea3m c\u1eed \u0111\u1ed9ng c\u1ee7a thai nhi (lo\u1ea1n v\u1eadn \u0111\u1ed9ng b\u00e0o thai) v\u00e0 kh\u1edfi ph\u00e1t c\u00e0ng s\u1edbm, co r\u00fat c\u00e0ng n\u1eb7ng. R\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng \u1edf thai nhi c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u00edch t\u1ee5 m\u00f4 li\u00ean k\u1ebft xung quanh kh\u1edbp, teo c\u01a1 do kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng ho\u1eb7c b\u1ec1 m\u1eb7t kh\u1edbp b\u1ea5t th\u01b0\u1eddng. C\u00e1c b\u1ec7nh th\u1ea7n kinh c\u01a1 v\u00e0 s\u1ef1 h\u00ecnh th\u00e0nh b\u1ea5t th\u01b0\u1eddng c\u1ee7a c\u01a1 ho\u1eb7c th\u1ea7n kinh g\u00e2y ra y\u1ebfu c\u01a1 v\u00e0 gi\u1ea3m chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a thai nhi d\u1eabn \u0111\u1ebfn co r\u00fat. C\u00e1c \u0111\u1ed9t bi\u1ebfn trong c\u00e1c gen c\u1ee5 th\u1ec3 c\u00f3 li\u00ean quan \u0111\u1ebfn b\u1ec7nh. C\u00e1c gen \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a con \u0111\u01b0\u1eddng b\u1ec7nh l\u00fd c\u01a1 v\u00e0 con \u0111\u01b0\u1eddng b\u1ec7nh l\u00fd th\u1ea7n kinh v\u00e0\/ho\u1eb7c c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c m\u00f4 li\u00ean k\u1ebft.<\/p>\n

B\u1ec7nh sinh c\u1ee7a s\u1ef1 ph\u00e1t tri\u1ec3n co r\u00fat kh\u1edbp do b\u1ea5t \u0111\u1ed9ng \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u trong nhi\u1ec1u th\u1eadp k\u1ef7 v\u00e0 \u0111\u00e3 cho ra nhi\u1ec1u k\u1ebft qu\u1ea3 kh\u00e1c nhau. S\u1ef1 t\u0103ng sinh c\u1ee7a m\u00f4 trong kh\u1edbp v\u00e0 k\u1ebft d\u00ednh ho\u1ea1t d\u1ecbch v\u1edbi s\u1ee5n kh\u1edbp sau \u0111\u00f3 l\u00e0 s\u1ef1 tho\u00e1i h\u00f3a \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3. Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y kh\u00f4ng gi\u1ed1ng v\u1edbi c\u00e1c b\u00e1o c\u00e1o kh\u00e1c m\u00f4 t\u1ea3 kh\u00f4ng t\u0103ng sinh m\u00f4 h\u1ea1t trong kh\u1edbp c\u0169ng nh\u01b0 kh\u00f4ng b\u00e1m d\u00ednh v\u00e0o s\u1ee5n. Nh\u1eefng k\u1ebft qu\u1ea3 kh\u00e1c bi\u1ec7t n\u00e0y c\u00f3 th\u1ec3 l\u00e0 do c\u00e1c kh\u1edbp v\u00e0 ph\u01b0\u01a1ng ph\u00e1p c\u1ed1 \u0111\u1ecbnh kh\u00e1c nhau \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, m\u1ed9t trong s\u1ed1 \u0111\u00f3 bao g\u1ed3m ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp v\u00e0o kh\u1edbp. S\u1eed d\u1ee5ng m\u00f4 h\u00ecnh chu\u1ed9t, vi\u1ec7c gi\u1ea3m chi\u1ec1u d\u00e0i n\u1ed9i m\u1ea1c ho\u1ea1t d\u1ecbch sau khi b\u1ea5t \u0111\u1ed9ng cho th\u1ea5y r\u1eb1ng s\u1ef1 k\u1ebft d\u00ednh c\u1ee7a bao ho\u1ea1t d\u1ecbch x\u1ea3y ra trong c\u00e1c co r\u00fat kh\u1edbp h\u01a1n l\u00e0 t\u0103ng sinh m\u00f4 h\u1ea1t.<\/p>\n

Co r\u00fat kh\u1edbp do b\u1ea5t \u0111\u1ed9ng c\u00f3 c\u1ea3 th\u00e0nh ph\u1ea7n b\u1ec7nh l\u00fd c\u01a1 v\u00e0 kh\u1edbp. Trong m\u00f4 h\u00ecnh chu\u1ed9t, th\u1eddi gian b\u1ea5t \u0111\u1ed9ng d\u01b0\u1edbi hai tu\u1ea7n g\u00e2y ra co r\u00fat ch\u1ee7 y\u1ebfu l\u00e0 do h\u1ea1n ch\u1ebf v\u1ec1 c\u01a1 v\u00e0 co r\u00fat c\u00f3 th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c v\u1edbi s\u1ef1 c\u1ed1 \u0111\u1ecbnh t\u1ef1 nhi\u00ean. Khi b\u1ea5t \u0111\u1ed9ng trong b\u1ed1n tu\u1ea7n ho\u1eb7c h\u01a1n, c\u00e1c c\u1ea5u tr\u00fac kh\u1edbp \u0111\u00f3ng g\u00f3p nhi\u1ec1u h\u01a1n v\u00e0o s\u1ef1 h\u1ea1n ch\u1ebf c\u1ee7a t\u1ea7m v\u1eadn \u0111\u1ed9ng v\u00e0 k\u1ebft qu\u1ea3 l\u00e0 c\u00e1c co r\u00fat kh\u00f4ng th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c. Th\u00e0nh ph\u1ea7n kh\u1edbp b\u1ec7nh l\u00fd ch\u00ednh h\u1ea1n ch\u1ebf ph\u1ea1m vi v\u1eadn \u0111\u1ed9ng l\u00e0 bao kh\u1edbp sau. Bao kh\u1edbp t\u1ea1o th\u00e0nh m\u1ed9t \u1ed1ng bao quanh c\u00e1c kh\u1edbp ho\u1ea1t d\u1ecbch v\u00e0 \u0111\u01b0\u1ee3c c\u1ea5u th\u00e0nh t\u1eeb c\u00e1c m\u00f4 s\u1ee3i d\u00e0y \u0111\u1eb7c v\u00e0 \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o ch\u1ee7 y\u1ebfu t\u1eeb s\u1ee3i collagen protein. Nhi\u1ec1u nh\u00f3m c\u00f3 c\u00e1c co r\u00fat kh\u1edbp li\u00ean quan v\u1edbi s\u1ef1 gi\u00e1n \u0111o\u1ea1n trong t\u1ed5ng h\u1ee3p collagen, t\u1ed5 ch\u1ee9c v\u00e0 c\u00e1c thay \u0111\u1ed5i sau qu\u00e1 tr\u00ecnh chuy\u1ec3n \u0111\u1ed5i. T\u1eeb n\u0103m 1966, m\u1ed9t nghi\u00ean c\u1ee9u tr\u00ean chu\u1ed9t v\u00e0 ch\u00f3 \u0111\u00e3 cung c\u1ea5p b\u1eb1ng ch\u1ee9ng v\u1ec1 s\u1ef1 gia t\u0103ng t\u1ed5ng h\u1ee3p collagen trong kh\u1edbp sau khi b\u1ea5t \u0111\u1ed9ng. Tr\u00ean m\u00f4 h\u00ecnh chu\u1ed9t, c\u00e1c th\u00ed nghi\u1ec7m \u0111\u00e3 cho th\u1ea5y l\u01b0\u1ee3ng collagen lo\u1ea1i I cao h\u01a1n v\u00e0 l\u01b0\u1ee3ng collagen lo\u1ea1i III th\u1ea5p h\u01a1n trong c\u00e1c t\u1ebf b\u00e0o bao kh\u1edbp c\u1ee7a ch\u00e2n b\u1ea5t \u0111\u1ed9ng so v\u1edbi ch\u00e2n \u0111\u01b0\u1ee3c gi\u1ea3 ph\u1eabu thu\u1eadt, cho th\u1ea5y r\u1eb1ng s\u1ef1 co r\u00fat l\u00e0 do x\u01a1 h\u00f3a. Trong m\u1ed9t m\u00f4 h\u00ecnh chu\u1ed9t kh\u00e1c, \u0111\u00e3 c\u00f3 s\u1ef1 gia t\u0103ng \u0111\u00e1ng k\u1ec3 trong vi\u1ec7c gi\u1ea3m li\u00ean k\u1ebft ch\u00e9o c\u1ee7a collagen d\u01b0\u1edbi d\u1ea1ng c\u00e1c s\u1ea3n ph\u1ea9m glycat h\u00f3a b\u1ec1n v\u1eefng (AGEs). Nh\u1eefng thay \u0111\u1ed5i sau chuy\u1ec3n \u0111\u1ed5i n\u00e0y \u0111\u01b0\u1ee3c bi\u1ebft l\u00e0 l\u00e0m t\u0103ng \u0111\u1ed9 c\u1ee9ng c\u1ee7a m\u00f4 li\u00ean k\u1ebft. Vai tr\u00f2 c\u1ee7a AGEs \u0111\u01b0\u1ee3c nh\u1ea5n m\u1ea1nh b\u1edfi s\u1ef1 ph\u1ed5 bi\u1ebfn c\u1ee7a m\u1ed9t s\u1ed1 t\u00ecnh tr\u1ea1ng vi\u00eam kh\u1edbp n\u1eb7ng \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/a> g\u00e2y ra b\u1edfi s\u1ef1 d\u01b0 th\u1eeba AGEs do gia t\u0103ng s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a glucose. S\u1ef1 m\u1ea5t t\u1ed5 ch\u1ee9c c\u1ee7a c\u00e1c s\u1ee3i collagen \u1edf bao kh\u1edbp sau so v\u1edbi kh\u1edbp kh\u00f4ng b\u1ecb c\u1ed1 \u0111\u1ecbnh v\u00e0 s\u1ef1 gi\u1ea3m glycosaminoglycans c\u0169ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong bao kh\u1edbp b\u1ecb b\u1ea5t \u0111\u1ed9ng. Glycosaminoglycans l\u00e0 chu\u1ed7i polysaccharid d\u00e0i gi\u1eef n\u01b0\u1edbc v\u00e0 s\u1ef1 m\u1ea5t \u0111i c\u1ee7a ch\u00fang c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn li\u00ean k\u1ebft ch\u00e9o collagen. Nh\u1eefng thay \u0111\u1ed5i kh\u00e1c \u1edf bao kh\u1edbp sau bao g\u1ed3m \u00edt t\u1ebf b\u00e0o ho\u1ea1t d\u1ecbch t\u0103ng sinh h\u01a1n v\u00e0 gi\u1ea3m chi\u1ec1u d\u00e0i bao ho\u1ea1t d\u1ecbch. C\u00e1c m\u1eabu bao kh\u1edbp sau c\u1ee7a ng\u01b0\u1eddi thu \u0111\u01b0\u1ee3c t\u1eeb b\u1ec7nh nh\u00e2n tho\u00e1i h\u00f3a kh\u1edbp \u0111\u01b0\u1ee3c thay kh\u1edbp g\u1ed1i to\u00e0n ph\u1ea7n cho th\u1ea5y s\u1ef1 gia t\u0103ng m\u00f4 collagen v\u00e0 s\u1ef1 gi\u1ea3m m\u00f4 ho\u1ea1t d\u1ecbch \u1edf nh\u00f3m co r\u00fat kh\u1edbp so v\u1edbi nh\u00f3m kh\u00f4ng co r\u00fat kh\u1edbp. M\u1eb7c d\u00f9 c\u00e1c k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u n\u00e0y ch\u01b0a c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea, nh\u01b0ng ch\u00fang tr\u00f9ng kh\u1edbp v\u1edbi c\u00e1c k\u1ebft qu\u1ea3 tr\u01b0\u1edbc \u0111\u00f3 l\u00e0 t\u0103ng x\u01a1 h\u00f3a, gi\u1ea3m t\u0103ng sinh t\u1ebf b\u00e0o ho\u1ea1t d\u1ecbch v\u00e0 co ng\u1eafn chi\u1ec1u d\u00e0i bao ho\u1ea1t d\u1ecbch. S\u1ef1 co ng\u1eafn c\u1ee7a bao kh\u1edbp sau k\u1ebft h\u1ee3p v\u1edbi x\u01a1 h\u00f3a c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n g\u00e2y ra co r\u00fat kh\u1edbp g\u1ed1i kh\u00f4ng h\u1ed3i ph\u1ee5c. S\u1ef1 thay \u0111\u1ed5i bi\u1ec3u hi\u1ec7n gen \u1edf bao kh\u1edbp sau c\u1ee7a kh\u1edbp g\u1ed1i b\u1ea5t \u0111\u1ed9ng c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u. Ph\u00e2n t\u00edch bi\u1ec3u hi\u1ec7n gen tr\u00ean to\u00e0n b\u1ed9 gen c\u1ee7a bao kh\u1edbp sau \u1edf b\u1ec7nh nh\u00e2n tho\u00e1i h\u00f3a kh\u1edbp v\u00e0 co r\u00fat cho th\u1ea5y gi\u1ea3m mRNA casein v\u00e0 t\u0103ng chondroadherin, ch\u1ea5t c\u1ea3m \u1ee9ng t\u1ea1o m\u1ea1ch CYR61 v\u00e0 SRY-box 9, 4 gen c\u00f3 li\u00ean quan \u0111\u1ebfn x\u01a1 h\u00f3a m\u00f4.<\/p>\n

C\u00e1c con \u0111\u01b0\u1eddng ly gi\u1ea3i protein li\u00ean quan \u0111\u1ebfn teo c\u01a1 kh\u00f4ng s\u1eed d\u1ee5ng bao g\u1ed3m: con \u0111\u01b0\u1eddng ph\u1ee5 thu\u1ed9c ubiquitin-proteasome, con \u0111\u01b0\u1eddng h\u1ec7 th\u1ed1ng caspase, con \u0111\u01b0\u1eddng ma tr\u1eadn metalloproteinase, con \u0111\u01b0\u1eddng ph\u1ee5 thu\u1ed9c Ca2+<\/sup> v\u00e0 con \u0111\u01b0\u1eddng autophagy-lysosome. C\u00e1c qu\u00e1 tr\u00ecnh sinh h\u1ecdc quan tr\u1ecdng li\u00ean quan \u0111\u1ebfn qu\u00e1 tr\u00ecnh x\u01a1 h\u00f3a c\u01a1 x\u01b0\u01a1ng bao g\u1ed3m s\u1ef1 d\u00e0y l\u00ean c\u1ee7a m\u00f4 li\u00ean k\u1ebft gi\u1eefa c\u00e1c c\u01a1 do bi\u1ebfn \u0111\u1ed5i y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng-\u03b21 v\u00e0 m\u00f4i tr\u01b0\u1eddng y\u1ebfm kh\u00ed trong c\u01a1 x\u01b0\u01a1ng d\u1eabn \u0111\u1ebfn s\u1ef1 h\u00ecnh th\u00e0nh y\u1ebfu t\u1ed1 g\u00e2y thi\u1ebfu oxy-1\u03b1.<\/p>\n

4. TRI\u1ec6U CH\u1ee8NG L\u00c2M S\u00c0NG<\/strong><\/h2>\n

Co r\u00fat kh\u1edbp ph\u00e1t tri\u1ec3n \u00e2m th\u1ea7m v\u00e0 c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. Ng\u01b0\u1eddi b\u1ec7nh th\u01b0\u1eddng ch\u1ec9 \u0111au khi c\u1ed1 g\u1eafng v\u1eadn \u0111\u1ed9ng kh\u1edbp h\u1ebft t\u1ea7m v\u1eadn \u0111\u1ed9ng v\u01b0\u1ee3t qu\u00e1 gi\u1edbi h\u1ea1n. Nhi\u1ec1u ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y kh\u00f4ng y\u00eau c\u1ea7u kh\u1edbp ph\u1ea3i chuy\u1ec3n \u0111\u1ed9ng trong to\u00e0n b\u1ed9 ph\u1ea1m vi ho\u1ea1t \u0111\u1ed9ng c\u1ee7a n\u00f3. Do \u0111\u00f3, co r\u00fat c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n do kh\u00f4ng \u0111\u01b0\u1ee3c ch\u00fa \u00fd trong th\u1eddi gian d\u00e0i cho \u0111\u1ebfn khi h\u1ea1n ch\u1ebf kh\u1edbp x\u1ea3y ra c\u1ea3n tr\u1edf ho\u1ea1t \u0111\u1ed9ng ch\u1ee9c n\u0103ng. Khi th\u0103m kh\u00e1m ngo\u1ea1i tr\u00fa, b\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat kh\u1edbp b\u00e0n tay v\u00e0 ng\u00f3n tay c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n v\u1edbi ph\u00e0n n\u00e0n v\u1ec1 vi\u1ec7c c\u1ea7m n\u1eafm y\u1ebfu ho\u1eb7c kh\u00f4ng hi\u1ec7u qu\u1ea3. B\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat kh\u1edbp g\u1ed1i c\u00f3 th\u1ec3 than phi\u1ec1n \u0111i l\u1ea1i kh\u1eadp khi\u1ec5ng ho\u1eb7c \u0111au v\u00f9ng h\u00e1ng ho\u1eb7c th\u1eaft l\u01b0ng. Nh\u1eefng ng\u01b0\u1eddi b\u1ecb ch\u1ea5n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng c\u00f3 nguy c\u01a1 b\u1ecb \u0111au vai cao h\u01a1n 2,5 l\u1ea7n n\u1ebfu b\u1ecb co r\u00fat vai v\u00e0 nh\u1eefng ng\u01b0\u1eddi b\u1ecb teo c\u01a1 t\u1ee7y s\u1ed1ng ho\u1eb7c b\u1ec7nh c\u01a1 b\u1ea9m sinh c\u00f3 nguy c\u01a1 b\u1ecb \u0111au khu\u1ef7u tay cao h\u01a1n 8 l\u1ea7n n\u1ebfu h\u1ecd b\u1ecb co r\u00fat khu\u1ef7u tay.<\/p>\n

Th\u0103m kh\u00e1m \u0111o t\u1ea7m v\u1eadn \u0111\u1ed9ng th\u1ee5 \u0111\u1ed9ng ho\u1eb7c ch\u1ee7 \u0111\u1ed9ng c\u1ee7a kh\u1edbp b\u1ecb co r\u00fat l\u00e0 ch\u00eca kh\u00f3a \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 nghi\u00eam tr\u1ecdng c\u1ee7a co r\u00fat kh\u1edbp. T\u00e1c \u0111\u1ed9ng l\u1ef1c b\u00ean ngo\u00e0i, ch\u1eb3ng h\u1ea1n nh\u01b0 ng\u01b0\u1eddi kh\u00e1m ho\u1eb7c thi\u1ebft b\u1ecb v\u1eadt l\u00fd tr\u1ecb li\u1ec7u, \u0111o t\u1ea7m v\u1eadn \u0111\u1ed9ng th\u1ee5 \u0111\u1ed9ng b\u1eb1ng c\u00e1ch di chuy\u1ec3n kh\u1edbp trong su\u1ed1t ph\u1ea1m vi chuy\u1ec3n \u0111\u1ed9ng th\u00f4ng th\u01b0\u1eddng c\u1ee7a n\u00f3 m\u00e0 kh\u00f4ng c\u1ea7n n\u1ed7 l\u1ef1c v\u1eadn \u0111\u1ed9ng t\u1eeb b\u1ec7nh nh\u00e2n. Th\u01b0\u1edbc \u0111o g\u00f3c d\u00f9ng \u0111o \u01b0\u1edbc l\u01b0\u1ee3ng kho\u1ea3ng c\u00e1ch g\u00f3c c\u1ee7a chuy\u1ec3n \u0111\u1ed9ng kh\u1edbp v\u00e0 s\u1ef1 m\u1ea5t t\u1ea7m v\u1eadn \u0111\u1ed9ng trong co r\u00fat th\u01b0\u1eddng \u0111\u01b0\u1ee3c ghi l\u1ea1i th\u00f4ng qua vi\u1ec7c so s\u00e1nh v\u1edbi kh\u1edbp b\u00ean c\u1ea1nh ho\u1eb7c c\u00e1c gi\u00e1 tr\u1ecb quy chu\u1ea9n. Th\u00f4ng th\u01b0\u1eddng, co r\u00fat kh\u1edbp \u0111\u01b0\u1ee3c \u0111\u1eb7t t\u00ean theo kh\u1edbp c\u00f3 li\u00ean quan v\u00e0 h\u01b0\u1edbng \u0111\u1ed1i di\u1ec7n v\u1edbi vi\u1ec7c thi\u1ebfu t\u1ea7m v\u1eadn \u0111\u1ed9ng. \u0110\u1ed1i v\u1edbi kh\u1edbp g\u1ed1i, t\u1ea7m v\u1eadn \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng t\u1eeb du\u1ed7i ho\u00e0n to\u00e0n \u1edf 180\u00b0 \u0111\u1ebfn g\u1ea5p ho\u00e0n to\u00e0n \u1edf kho\u1ea3ng 40\u00b0 l\u00e0 kho\u1ea3ng 140\u00b0. M\u1ea5t t\u1ea7m v\u1eadn \u0111\u1ed9ng kh\u1edbp g\u1ed1i khi du\u1ed7i \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 co r\u00fat g\u1ea5p kh\u1edbp g\u1ed1i, so v\u1edbi s\u1ef1 m\u1ea5t bi\u00ean \u0111\u1ed9 g\u1ea5p b\u00ecnh th\u01b0\u1eddng c\u1ee7a kh\u1edbp g\u1ed1i, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 co r\u00fat du\u1ed7i kh\u1edbp g\u1ed1i. C\u1ea3 hai kh\u1edbp b\u1ecb \u1ea3nh h\u01b0\u1edfng v\u00e0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a co r\u00fat kh\u1edbp s\u1ebd g\u00e2y ra t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn b\u1ec7nh nh\u00e2n. Co r\u00fat kh\u1edbp g\u1ed1i \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn d\u00e1ng \u0111i v\u00e0 s\u1ef1 \u0111i l\u1ea1i, trong khi co r\u00fat kh\u1edbp khu\u1ef7u ch\u1ec9 h\u1ea1n ch\u1ebf m\u1ed9t s\u1ed1 chuy\u1ec3n \u0111\u1ed9ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi c\u00e1nh tay, t\u1ee9c l\u00e0 nh\u1eefng \u0111\u1ed9ng t\u00e1c \u0111\u00f2i h\u1ecfi ph\u1ea3i g\u1eadp khu\u1ef7u tay.<\/p>\n

5. \u0110I\u1ec0U TR\u1eca<\/strong><\/h2>\n

Co c\u1ee9ng c\u01a1 v\u00e0 teo c\u01a1 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, nh\u01b0ng vi\u1ec7c kh\u00f4ng s\u1eed d\u1ee5ng g\u00e2y ra nh\u1eefng thay \u0111\u1ed5i trong c\u1ea5u tr\u00fac t\u1ed5 ch\u1ee9c kh\u1edbp m\u00e0 kh\u00f4ng th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c. Co r\u00fat kh\u00f4ng th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c g\u00e2y ra b\u1edfi bao kh\u1edbp c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1edfi m\u1ed9t \u201c\u0111i\u1ec3m cu\u1ed1i c\u1ee9ng\u201d khi \u0111o t\u1ea7m v\u1eadn \u0111\u1ed9ng th\u1ee5 \u0111\u1ed9ng, tr\u00e1i ng\u01b0\u1ee3c v\u1edbi \u201c\u0111i\u1ec3m cu\u1ed1i x\u1ed1p\u201d x\u00e1c \u0111\u1ecbnh m\u1ed9t co r\u00fat s\u1ebd \u0111\u00e1p \u1ee9ng hi\u1ec7u qu\u1ea3 v\u1edbi c\u00e1c li\u1ec7u ph\u00e1p v\u1eadt l\u00fd tr\u1ecb li\u1ec7u. Co r\u00fat kh\u1edbp c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 b\u1eb1ng k\u00e9o gi\u00e3n v\u00e0 n\u1eb9p; tuy nhi\u00ean, h\u1ea7u h\u1ebft c\u00e1c co r\u00fat ch\u1ec9 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n khi ch\u00fang tr\u1edf th\u00e0nh m\u1ea1n t\u00ednh v\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng. K\u00e9o gi\u00e3n ph\u1ea7n l\u1edbn c\u0169ng kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi m\u1eafc c\u00e1c b\u1ec7nh l\u00fd th\u1ea7n kinh nh\u01b0 \u0111\u1ed9t qu\u1ef5, t\u1ee7y s\u1ed1ng, ch\u1ea5n th\u01b0\u01a1ng n\u00e3o ho\u1eb7c b\u1ea1i n\u00e3o.<\/p>\n

Th\u00f4ng th\u01b0\u1eddng, co r\u00fat nhi\u1ec1u ban \u0111\u1ea7u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n b\u1eb1ng c\u00e1ch ki\u00ean tr\u00ec k\u00e9o gi\u00e3n nh\u01b0ng c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i ph\u1eabu thu\u1eadt t\u1eeb khi c\u00f2n nh\u1ecf \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c s\u1ef1 \u0111i\u1ec1u ch\u1ec9nh ho\u00e0n to\u00e0n. N\u1ebfu t\u00ecnh tr\u1ea1ng co r\u00fat nghi\u00eam tr\u1ecdng v\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng, ph\u1eabu thu\u1eadt gi\u1ea3i ph\u00f3ng bao kh\u1edbp l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn. C\u00e1c co r\u00fat t\u1eeb 15\u00b0 \u0111\u1ebfn 50\u00b0 th\u01b0\u1eddng c\u00f3 k\u1ebft qu\u1ea3 th\u1ecfa m\u00e3n. Ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 c\u00f3 hi\u1ec7u qu\u1ea3, nh\u01b0ng \u0111\u00f2i h\u1ecfi k\u1ef9 thu\u1eadt cao v\u00e0 c\u00f3 nguy c\u01a1 t\u1ea1o ra s\u1ef1 m\u1ea5t v\u1eefng trong kh\u1edbp ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch th\u1ea7n kinh quan tr\u1ecdng. Ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh v\u00e0 thanh thi\u1ebfu ni\u00ean b\u1ecb co r\u00fat h\u01a1n 70\u00b0 khi g\u1eadp trong th\u1eddi gian d\u00e0i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p h\u00e0n kh\u1edbp<\/a> cho k\u1ebft qu\u1ea3 t\u1ed1t. K\u1ebft qu\u1ea3 gi\u1ea3i ph\u00f3ng m\u00f4 m\u1ec1m t\u1ec9 l\u1ec7 ngh\u1ecbch v\u1edbi m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a co r\u00fat.<\/p>\n

L\u01b0u \u00fd r\u1eb1ng c\u1ea7n ph\u1ea3i ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 t\u00ecnh tr\u1ea1ng co r\u00fat kh\u1edbp v\u00e0 co r\u00fat ng\u1eafn \u0111\u01a1n v\u1ecb g\u00e2n c\u01a1 ngo\u00e0i kh\u1edbp tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt. \u0110i\u1ec1u n\u00e0y \u0111\u1eb7c bi\u1ec7t \u0111\u00fang khi c\u00f3 k\u00e8m theo s\u1ef1 co r\u00fat ch\u1eb7t c\u00e1c \u0111\u01a1n v\u1ecb g\u00e2n c\u01a1. Khi v\u1eadn \u0111\u1ed9ng th\u00ec g\u00e2n c\u01a1 ph\u1ea3i ho\u1ea1t \u0111\u1ed9ng ch\u1ed1ng l\u1ea1i s\u1ef1 chuy\u1ec3n \u0111\u1ed9ng do c\u1ee9ng kh\u1edbp v\u00e0 co r\u00fat m\u00f4 m\u1ec1m, do \u0111\u00f3 ch\u00fang kh\u00f4ng th\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 nh\u01b0 mong mu\u1ed1n. Tuy nhi\u00ean, m\u1eb7c d\u00f9 kh\u00f3 h\u01a1n, nh\u01b0ng sau ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 \u0111eo th\u00eam n\u1eb9p ch\u1ec9nh h\u00ecnh \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n v\u00e0 \u0111\u00f4i khi k\u1ef9 thu\u1eadt n\u00e0y l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 c\u1ea3i thi\u1ec7n h\u01a1n n\u1eefa v\u00e0 t\u0103ng c\u01b0\u1eddng k\u1ebft qu\u1ea3 \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u1eb1ng ph\u1eabu thu\u1eadt.<\/p>\n

Nh\u00ecn chung, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7n t\u1ea1i kh\u00f4ng hi\u1ec7u qu\u1ea3 v\u00e0 c\u0103n b\u1ec7nh n\u00e0y v\u0129nh vi\u1ec5n l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ec3 ch\u1ea5t c\u1ee7a c\u00e1c c\u00e1 nh\u00e2n. C\u00f3 m\u1ed9t s\u1ed1 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng d\u01b0\u1ee3c l\u00fd c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m t\u0103ng ph\u1ea1m vi chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a co r\u00fat kh\u1edbp. Enzyme collagenase tinh khi\u1ebft, hi\u1ec7n \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb co r\u00fat b\u00e0n tay Dupuytren v\u00e0 ch\u1ee9ng co r\u00fat d\u01b0\u01a1ng v\u1eadt Peyronie, c\u00f3 ti\u1ec1m n\u0103ng nh\u1eafm v\u00e0o s\u1ef1 gia t\u0103ng x\u01a1 h\u00f3a c\u1ee7a bao kh\u1edbp sau. Vi\u1ec7c ti\u00eam decorin v\u00e0o kh\u1edbp trong m\u00f4 h\u00ecnh th\u1ecf \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 l\u00e0m thay \u0111\u1ed5i s\u1ef1 bi\u1ec3u hi\u1ec7n c\u1ee7a c\u00e1c gen s\u1ee3i v\u00e0 c\u00f3 th\u1ec3 c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m gi\u1ea3m m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a co r\u00fat kh\u1edbp. Ti\u00eam acid hyaluronic n\u1ed9i kh\u1edbp \u0111\u00e3 c\u1ea3i thi\u1ec7n c\u01a1n \u0111au v\u00e0 bi\u00ean \u0111\u1ed9 chuy\u1ec3n \u0111\u1ed9ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam d\u00ednh bao kh\u1edbp \u1edf vai. C\u00e1c can thi\u1ec7p d\u01b0\u1ee3c l\u00fd b\u1eb1ng ti\u00eam n\u1ed9i kh\u1edbp c\u00f3 kh\u1ea3 n\u0103ng tr\u1edf th\u00e0nh m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb co r\u00fat kh\u1edbp trong t\u01b0\u01a1ng lai.<\/p>\n

6. PH\u1ee4C H\u1ed2I CH\u1ee8C N\u0102NG<\/strong><\/h2>\n

Co r\u00fat kh\u1edbp l\u00e0 h\u1eadu qu\u1ea3 ch\u00ednh c\u1ee7a vi\u1ec7c b\u1ea5t \u0111\u1ed9ng, gi\u1ea3m ch\u1ed1ng ch\u00e2n v\u00e0 m\u1ea5t c\u00e2n b\u1eb1ng c\u01a1. \u0110\u1eb7c bi\u1ec7t, vi\u1ec7c th\u01b0\u1eddng xuy\u00ean s\u1eed d\u1ee5ng xe l\u0103n c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c co r\u00fat \u1edf h\u00e1ng, g\u1ed1i, c\u1ed5 ch\u00e2n v\u00e0 khu\u1ef7u tay, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf c\u00e1c c\u01a1 c\u00f3 s\u1ee9c ch\u1ecbu l\u1ef1c k\u00e9m h\u01a1n. B\u1edfi v\u00ec co r\u00fat c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf kh\u1ea3 n\u0103ng di chuy\u1ec3n, \u0111\u1ecbnh v\u1ecb, v\u1ec7 sinh v\u00e0 s\u1ef1 tho\u1ea3i m\u00e1i, ph\u00f2ng ng\u1eeba co r\u00fat v\u1eabn l\u00e0 m\u1ed9t th\u00e0nh ph\u1ea7n quan tr\u1ecdng c\u1ee7a qu\u1ea3n l\u00fd ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng.<\/p>\n

N\u1ec1n t\u1ea3ng c\u1ee7a vi\u1ec7c ph\u00f2ng ng\u1eeba co r\u00fat l\u00e0 s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng th\u1ee9c v\u1eadt l\u00fd. Ch\u00fang bao g\u1ed3m ch\u1ecbu tr\u1ecdng l\u01b0\u1ee3ng khi \u0111\u1ee9ng v\u1edbi s\u1ef1 ph\u00e2n b\u1ed5 tr\u1ecdng l\u01b0\u1ee3ng \u0111\u1ed3ng \u0111\u1ec1u, c\u0103ng gi\u00e3n ch\u1ee7 \u0111\u1ed9ng v\u00e0 th\u1ee5 \u0111\u1ed9ng, \u0111\u1ed3ng th\u1eddi s\u1eed d\u1ee5ng n\u1eb9p \u0111\u1ec3 h\u1ed7 tr\u1ee3 k\u00e9o gi\u00e3n. \u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n k\u00e9o gi\u00e3n ch\u1ee7 \u0111\u1ed9ng c\u00e1c nh\u00f3m c\u01a1 \u0111a kh\u1edbp, vi\u1ec7c k\u00e9o gi\u00e3n th\u1ee5 \u0111\u1ed9ng l\u00e0 \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng, b\u1edfi v\u00ec c\u00e1c t\u01b0 th\u1ebf th\u00f4ng th\u01b0\u1eddng h\u00e0ng ng\u00e0y kh\u00f4ng \u0111\u1eb7t c\u00e1c c\u01a1 quan tr\u1ecdng \u2013 c\u01a1 b\u1ee5ng ch\u00e2n, c\u01a1 khoeo, c\u01a1 th\u1eb3ng \u0111\u00f9i, c\u01a1 c\u0103ng m\u1ea1c \u0111\u00f9i v\u00e0 c\u01a1 th\u1eaft l\u01b0ng ch\u1eadu \u2013 \u1edf m\u1ee9c c\u0103ng t\u1ed1i \u0111a. Nhi\u1ec7t v\u00e0 si\u00eau \u00e2m c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a vi\u1ec7c k\u00e9o gi\u00e3n v\u00e0 \u0111\u1ecbnh v\u1ecb. C\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 ph\u00e1t sinh t\u1eeb c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0y, v\u1edbi nguy c\u01a1 b\u1ecb r\u00e1ch da, ch\u1ea3y m\u00e1u, h\u00ecnh th\u00e0nh v\u1ebft lo\u00e9t, tr\u1eadt kh\u1edbp v\u00e0 \u0111au.<\/p>\n

Ch\u01b0\u01a1ng tr\u00ecnh ph\u00f2ng ng\u1eeba co r\u00fat ph\u00f9 h\u1ee3p c\u00e1 th\u1ec3 n\u00ean \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t. Ch\u01b0\u01a1ng tr\u00ecnh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n b\u1edfi m\u1ed9t nh\u00e0 tr\u1ecb li\u1ec7u v\u1eadt l\u00fd ho\u1eb7c ngh\u1ec1 nghi\u1ec7p v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u1ea1y cho c\u00e1c th\u00e0nh vi\u00ean trong gia \u0111\u00ecnh ho\u1eb7c nh\u1eefng ng\u01b0\u1eddi ch\u0103m s\u00f3c kh\u00e1c \u0111\u1ec3 th\u1ef1c hi\u1ec7n \u00edt nh\u1ea5t l\u00e0 h\u00e0ng ng\u00e0y. Ngo\u00e0i ra, ch\u01b0\u01a1ng tr\u00ecnh n\u00ean t\u1eadp trung v\u00e0o c\u00e1c nh\u00f3m c\u01a1 b\u1ecb \u1ea3nh h\u01b0\u1edfng \u0111\u1eb7c bi\u1ec7t trong m\u1ed9t \u0111i\u1ec1u ki\u1ec7n nh\u1ea5t \u0111\u1ecbnh. Tuy nhi\u00ean, c\u00e1c ph\u00e1c \u0111\u1ed3 k\u00e9o gi\u00e3n ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 h\u00f3a. S\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a vi\u1ec7c k\u00e9o gi\u00e3n v\u00e0 s\u1eed d\u1ee5ng d\u1ee5ng c\u1ee5 ch\u1ec9nh h\u00ecnh \u0111\u1ec3 ng\u0103n ng\u1eeba co r\u00fat c\u00f2n nhi\u1ec1u tranh c\u00e3i. V\u1ec1 l\u00e2u d\u00e0i n\u00ean c\u00f3 c\u00e1c nghi\u00ean c\u1ee9u chuy\u00ean s\u00e2u h\u01a1n trong l\u0129nh v\u1ef1c n\u00e0y. \u0110\u1eb7c bi\u1ec7t \u1edf nh\u1eefng c\u00e1 nh\u00e2n s\u1eed d\u1ee5ng xe l\u0103n l\u00e0m ph\u01b0\u01a1ng ti\u1ec7n di chuy\u1ec3n ch\u00ednh, c\u00e1c co r\u00fat v\u1eabn c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n m\u1eb7c d\u00f9 k\u00e9o gi\u00e3n, \u0111\u1ecbnh v\u1ecb v\u00e0 n\u1eb9p. Can thi\u1ec7p ph\u1eabu thu\u1eadt cho c\u00e1c bi\u1ebfn d\u1ea1ng c\u1ee9ng nh\u1eafc c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng d\u1ec5 \u0111\u1ecbnh v\u1ecb, k\u00e9o d\u00e0i kh\u1ea3 n\u0103ng ch\u1ecbu tr\u1ecdng l\u01b0\u1ee3ng khi \u0111\u1ee9ng v\u00e0, trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, k\u00e9o d\u00e0i th\u1eddi gian \u0111i l\u1ea1i b\u1eb1ng n\u1eb9p. V\u00ec m\u1ea5t kh\u1ea3 n\u0103ng \u0111i l\u1ea1i c\u00f3 li\u00ean quan \u0111\u1ebfn y\u1ebfu c\u01a1 h\u01a1n l\u00e0 co r\u00fat, tuy nhi\u00ean, can thi\u1ec7p ph\u1eabu thu\u1eadt \u0111\u1ed1i v\u1edbi c\u00e1c co r\u00fat th\u01b0\u1eddng s\u1ebd kh\u00f4ng cho ph\u00e9p ph\u1ee5c h\u1ed3i ho\u1ea1t \u0111\u1ed9ng \u0111\u1ed9c l\u1eadp \u0111\u00e3 m\u1ea5t tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n

7. K\u1ebeT LU\u1eacN<\/strong><\/h2>\n

Ng\u0103n ng\u1eeba s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u00e1c co r\u00fat kh\u1edbp s\u1ebd l\u00e0 c\u00e1ch h\u00e0nh \u0111\u1ed9ng t\u1ed1t nh\u1ea5t; tuy nhi\u00ean, co r\u00fat th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n khi tr\u1edf th\u00e0nh m\u1ea1n t\u00ednh v\u00e0 kh\u00f4ng th\u1ec3 ph\u1ee5c h\u1ed3i. V\u00ec c\u00e1c co r\u00fat ph\u00e1t tri\u1ec3n ch\u1eadm n\u00ean r\u1ea5t kh\u00f3 x\u00e1c \u0111\u1ecbnh trong c\u00e1c giai \u0111o\u1ea1n s\u1edbm. Ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n s\u1ebd kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi v\u1eadt l\u00fd tr\u1ecb li\u1ec7u ti\u00eau chu\u1ea9n l\u00e0 ch\u00eca kh\u00f3a \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 v\u00e0 th\u00e0nh c\u00f4ng. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n tho\u00e1i h\u00f3a kh\u1edbp \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i, gi\u1ea3m bi\u00ean \u0111\u1ed9 g\u1ea5p g\u1ed1i sau ph\u1eabu thu\u1eadt v\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng du\u1ed7i g\u1ed1i m\u1ed9t b\u00ean c\u00f3 li\u00ean quan \u0111\u1ebfn co r\u00fat. Vi\u1ec7c quan s\u00e1t th\u1ea5y gi\u1ea3m t\u1ea7m v\u1eadn \u0111\u1ed9ng kh\u1edbp g\u1ed1i hai b\u00ean c\u00f3 th\u1ec3 cho ph\u00e9p can thi\u1ec7p s\u1edbm. Ph\u00f2ng ng\u1eeba c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng b\u1eb1ng c\u00e1ch x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n d\u1ec5 b\u1ecb co r\u00fat kh\u1edbp v\u00e0 \u0111\u1ea3m b\u1ea3o k\u00edch th\u00edch kh\u1edbp th\u00f4ng qua vi\u1ec7c ch\u1ecbu t\u1ea3i v\u00e0 c\u00e1c b\u00e0i t\u1eadp t\u0103ng t\u1ea7m v\u1eadn \u0111\u1ed9ng. Khi ph\u00f2ng ng\u1eeba kh\u00f4ng c\u00f2n l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn, vi\u1ec7c x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi v\u1eadt l\u00fd tr\u1ecb li\u1ec7u so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n s\u1ebd kh\u00f4ng \u0111\u00e1p \u1ee9ng (c\u1ea3m gi\u00e1c m\u1ec1m so v\u1edbi c\u1ea3m gi\u00e1c c\u1ee9ng) s\u1ebd l\u00e0 m\u1ed9t c\u00e1ch s\u1eed d\u1ee5ng hi\u1ec7u qu\u1ea3 c\u00e1c ngu\u1ed3n l\u1ef1c. Nh\u1eefng b\u1ec7nh nh\u00e2n co r\u00fat kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn c\u00e1c \u0111i\u1ec1u tr\u1ecb kh\u00e1c (ph\u1eabu thu\u1eadt v\u00e0 can thi\u1ec7p d\u01b0\u1ee3c l\u00fd) ho\u1eb7c, t\u00f9y theo m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u1ea1y c\u00e1c k\u1ef9 thu\u1eadt t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho m\u1ed9t l\u1ed1i s\u1ed1ng \u0111\u1ed9c l\u1eadp v\u1edbi s\u1ef1 co r\u00fat. C\u1ea7n nh\u1ea5n m\u1ea1nh vi\u1ec7c ph\u00f2ng ng\u1eeba b\u1eb1ng c\u00e1ch \u01b0u ti\u00ean ch\u1ea9n \u0111o\u00e1n s\u1edbm b\u1ec7nh nh\u00e2n co r\u00fat kh\u1edbp m\u1edbi xu\u1ea5t hi\u1ec7n, v\u00ec ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p co r\u00fat \u00edt nghi\u00eam tr\u1ecdng l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh hi\u1ec7u qu\u1ea3 v\u00e0 d\u1ec5 qu\u1ea3n l\u00fd h\u01a1n. Nh\u00ecn chung, co r\u00fat kh\u1edbp l\u00e0 m\u1ed9t b\u1ec7nh ph\u1ee9c t\u1ea1p, kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u00e0 \u0111a y\u1ebfu t\u1ed1 m\u00e0 v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7n \u0111\u1ea1i, r\u1ea5t kh\u00f3 \u0111\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c.<\/p>\n

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