{"id":1901,"date":"2023-06-04T22:10:50","date_gmt":"2023-06-04T15:10:50","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&#038;p=1901"},"modified":"2025-04-12T12:02:07","modified_gmt":"2025-04-12T05:02:07","slug":"vat-li-tri-lieu-trong-chan-thuong-chinh-hinh","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/vat-li-tri-lieu-trong-chan-thuong-chinh-hinh\/","title":{"rendered":"V\u1eadt l\u00ed tr\u1ecb li\u1ec7u trong ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh"},"content":{"rendered":"<h2>1. T\u1ed4NG QUAN<\/h2>\n<p>V\u1eadt l\u00fd tr\u1ecb li\u1ec7u (<em>Physical Therapy\/Medicine<\/em>) \u2013 Ph\u1ee5c h\u1ed3i Ch\u1ee9c n\u0103ng (<em>Rehabilitation<\/em>) l\u00e0 m\u1ed9t chuy\u00ean ng\u00e0nh y khoa t\u1eadp trung v\u00e0o vi\u1ec7c ph\u1ee5c h\u1ed3i s\u1ee9c kh\u1ecfe, ch\u1ee9c n\u0103ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, gi\u00fap h\u1ecd h\u00f2a nh\u1eadp tr\u1edf l\u1ea1i v\u1edbi c\u1ed9ng \u0111\u1ed3ng [1].<\/p>\n<p>\u1ee8ng d\u1ee5ng trong b\u1ec7nh l\u00fd ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u g\u1ea7n nh\u01b0 l\u00e0 m\u1ed9t m\u1ea3nh gh\u00e9p kh\u00f4ng th\u1ec3 t\u00e1ch r\u1eddi. Th\u1ef1c t\u1ebf \u0111\u00e3 c\u00f3 r\u1ea5t nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p sau khi \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt kh\u00e2u n\u1ed1i g\u00e2n, hay t\u00e1i t\u1ea1o d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc, b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn t\u1eadp luy\u1ec7n k\u1ef9 c\u00e0ng, s\u00e2u s\u00e1t, d\u1eabn t\u1edbi k\u1ebft c\u1ee5c l\u00e0 m\u1ea3nh gh\u00e9p \u0111\u1ee9t l\u1ea1i, hay g\u00e2y x\u01a1 d\u00ednh, khi\u1ebfn cho b\u1ec7nh nh\u00e2n h\u1ea1n ch\u1ebf ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng, kh\u00f4ng ph\u1ee5c h\u1ed3i l\u1ea1i \u0111\u01b0\u1ee3c nh\u01b0 l\u00fac tr\u01b0\u1edbc m\u1ed5. V\u1edbi t\u00ecnh h\u00ecnh c\u1ee7a n\u01b0\u1edbc ta hi\u1ec7n nay, nhu c\u1ea7u v\u00e0 k\u1ef3 v\u1ecdng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh ng\u00e0y c\u00e0ng n\u00e2ng cao, sau m\u1ed5 b\u1ec7nh nh\u00e2n kh\u00f4ng ch\u1ec9 y\u00eau c\u1ea7u v\u1ec1 vi\u1ec7c \u201ct\u00f4i c\u00f3 th\u1ec3 \u0111i l\u1ea1i \u0111\u01b0\u1ee3c\u201d, m\u00e0 th\u1eadm ch\u00ed l\u00e0 \u201ct\u00f4i mu\u1ed1n ch\u1ea1y nhanh h\u01a1n, kh\u1ecfe h\u01a1n, m\u1ea1nh h\u01a1n\u201d. Do \u0111\u00f3, vai tr\u00f2 c\u1ee7a v\u1eadt l\u00fd tr\u1ecb li\u1ec7u trong \u0111i\u1ec1u tr\u1ecb Ch\u1ea5n th\u01b0\u01a1ng Ch\u1ec9nh h\u00ecnh c\u00e0ng tr\u1edf n\u00ean quan tr\u1ecdng. Ph\u1eabu thu\u1eadt vi\u00ean l\u00e0 ng\u01b0\u1eddi tr\u1ef1c ti\u1ebfp ti\u1ebfp c\u1eadn v\u00e0 ch\u1eefa tr\u1ecb cho th\u01b0\u01a1ng t\u1ed5n c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, n\u00ean c\u00e0ng ph\u1ea3i n\u1eafm r\u00f5 h\u01a1n ai h\u1ebft v\u1ec1 ch\u01b0\u01a1ng tr\u00ecnh t\u1eadp luy\u1ec7n tr\u01b0\u1edbc m\u1ed5, sau m\u1ed5 ph\u00f9 h\u1ee3p v\u00e0 t\u1ed1i \u01b0u nh\u1ea5t cho t\u1eebng ng\u01b0\u1eddi b\u1ec7nh, ph\u1ed1i h\u1ee3p c\u00f9ng v\u1edbi c\u00e1c b\u00e1c s\u0129, nh\u00e2n vi\u00ean v\u1eadt l\u00fd tr\u1ecb li\u1ec7u s\u1ebd \u0111em l\u1ea1i k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed1t nh\u1ea5t. Hay nh\u01b0 m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt, ch\u1ec9 c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n, ph\u1ed1i h\u1ee3p gi\u1eefa thu\u1ed1c men, thay \u0111\u1ed5i th\u00f3i quen v\u00e0 t\u1eadp v\u1eadt l\u00fd tr\u1ecb li\u1ec7u. C\u0169ng gi\u1ed1ng nh\u01b0 thu\u1ed1c men, vi\u1ec7c n\u1eafm r\u00f5 c\u00e1c nguy\u00ean l\u00fd, ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a c\u00e1c ph\u01b0\u01a1ng ph\u00e1p v\u1eadt l\u00fd tr\u1ecb li\u1ec7u, s\u1ebd gi\u00fap cho b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb c\u00f3 nhi\u1ec1u l\u1ef1a ch\u1ecdn h\u01a1n \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a \u0111i\u1ec1u tr\u1ecb \u0111a m\u00f4 th\u1ee9c.<\/p>\n<ol>\n<li><strong>L\u1ecaCH S\u1eec<\/strong><\/li>\n<\/ol>\n<p>Hippocrates \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 ng\u01b0\u1eddi \u0111\u1eb7t n\u1ec1n m\u00f3ng cho ng\u00e0nh v\u1eadt l\u00fd tr\u1ecb li\u1ec7u khi \u00f4ng c\u00f3 nh\u1eefng ghi ch\u00e9p \u0111\u1ea7u ti\u00ean v\u1ec1 nh\u1eefng k\u1ef9 thu\u1eadt n\u1eafn ch\u1ec9nh x\u01b0\u01a1ng kh\u1edbp, \u0111\u1eb7c bi\u1ec7t l\u00e0 kh\u1edbp vai v\u00e0 \u0111\u1ed1t s\u1ed1ng. \u0110\u1ebfn n\u0103m 1543, c\u00f4ng tr\u00ecnh mi\u00eau t\u1ea3 chi ti\u1ebft gi\u1ea3i ph\u1eabu ng\u01b0\u1eddi do Andreas Versallius x\u00e2y d\u1ef1ng \u0111\u00e3 g\u00f3p ph\u1ea7n v\u00e0o s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ng\u00e0nh ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng n\u00f3i chung c\u0169ng nh\u01b0 ng\u00e0nh v\u1eadn \u0111\u1ed9ng tr\u1ecb li\u1ec7u n\u00f3i ri\u00eang.<\/p>\n<p>75<\/p>\n<p>\u0110\u1ebfn th\u1ebf k\u1ef7 XVII \u2013 XVIII, vi\u1ec7c n\u1eafn ch\u1ec9nh x\u01b0\u01a1ng kh\u1edbp \u0111\u01b0\u1ee3c ph\u1ed5 bi\u1ebfn r\u1ed9ng r\u00e3i t\u1ea1i Anh v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0 m\u1ed9t trong nh\u1eefng c\u00e1ch \u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u1eddi b\u1ea5y gi\u1edd. M\u1eb7c d\u00f9 v\u1eabn c\u00f2n nh\u1eefng sai l\u1ea7m v\u1ec1 c\u01a1 s\u1edf khoa h\u1ecdc, nh\u1eefng k\u1ef9 thu\u1eadt s\u01a1 kh\u1edfi n\u00e0y \u0111\u00e3 t\u1ea1o ti\u1ec1n \u0111\u1ec1 cho s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ng\u00e0nh v\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 osteopathy sau n\u00e0y. \u0110\u1ebfn th\u1ebf k\u1ef7 XIX, Mary McMillan \u0111\u01b0\u1ee3c xem l\u00e0 ng\u01b0\u1eddi ti\u00ean phong trong v\u1eadt l\u00fd tr\u1ecb li\u1ec7u t\u1ea1i M\u1ef9. B\u00e0 \u0111\u00e3 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn b\u1ed1n chuy\u00ean ng\u00e0nh, bao g\u1ed3m n\u1eafn ch\u1ec9nh c\u01a1 kh\u1edbp, v\u1eadn \u0111\u1ed9ng tr\u1ecb li\u1ec7u, \u0111i\u1ec7n tr\u1ecb li\u1ec7u v\u00e0 th\u1ee7y tr\u1ecb li\u1ec7u. N\u0103m 1921, Hi\u1ec7p h\u1ed9i V\u1eadt l\u00fd tr\u1ecb li\u1ec7u Ph\u1ee5 n\u1eef Hoa K\u1ef3 (<em>American Women\u2019s Physical Therapeutic Association<\/em>) l\u00e0 t\u1ed5 ch\u1ee9c ng\u00e0nh \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c th\u00e0nh l\u1eadp v\u00e0 Mary McMillan l\u00e0 h\u1ed9i tr\u01b0\u1edfng. \u0110\u1ebfn n\u0103m 1923, h\u1ed9i \u0111\u01b0\u1ee3c \u0111\u1ed5i t\u00ean th\u00e0nh Hi\u1ec7p h\u1ed9i Sinh l\u00fd tr\u1ecb li\u1ec7u Hoa K\u1ef3 (<em>American Physiotherapy Association<\/em>). Trong v\u00f2ng tr\u00ean 30 n\u0103m, nhi\u1ec1u nghi\u00ean c\u1ee9u c\u0169ng nh\u01b0 s\u00e1ch b\u00e1o v\u1ec1 \u1ee9ng d\u1ee5ng c\u1ee7a c\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u1eafn ch\u1ec9nh, \u0111\u1eb7c bi\u1ec7t \u00e1p d\u1ee5ng trong \u0111au c\u1ed9t s\u1ed1ng, c\u0169ng nh\u01b0 s\u1ef1 hi\u1ec3u bi\u1ebft con \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c \u0111au \u0111\u00e3 g\u00f3p ph\u1ea7n v\u00e0o n\u1ec1n t\u1ea3ng khoa h\u1ecdc cho s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ng\u00e0nh v\u1eadt l\u00fd tr\u1ecb li\u1ec7u. T\u1ea7m \u1ea3nh h\u01b0\u1edfng c\u1ee7a ng\u00e0nh c\u0169ng ng\u00e0y c\u00e0ng nh\u00e2n r\u1ed9ng v\u00e0 c\u00e1c t\u1ed5 ch\u1ee9c qu\u1ed1c t\u1ebf b\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh. N\u0103m 1966, t\u1ea1i Anh, Li\u00ean minh V\u1eadt l\u00fd tr\u1ecb li\u1ec7u To\u00e0n c\u1ea7u (<em>World Federation of Physical Therapy<\/em>) \u0111\u01b0\u1ee3c<\/p>\n<p>V\u1eadt l\u00fd tr\u1ecb li\u1ec7u (<em>Physical Therapy\/Medicine<\/em>) \u2013 Ph\u1ee5c h\u1ed3i Ch\u1ee9c n\u0103ng (<em>Rehabilitation<\/em>) l\u00e0 m\u1ed9t chuy\u00ean ng\u00e0nh y khoa t\u1eadp trung v\u00e0o vi\u1ec7c ph\u1ee5c h\u1ed3i s\u1ee9c kh\u1ecfe, ch\u1ee9c n\u0103ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, gi\u00fap h\u1ecd h\u00f2a nh\u1eadp tr\u1edf l\u1ea1i v\u1edbi c\u1ed9ng \u0111\u1ed3ng [1].<\/p>\n<p>\u1ee8ng d\u1ee5ng trong b\u1ec7nh l\u00fd ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u g\u1ea7n nh\u01b0 l\u00e0 m\u1ed9t m\u1ea3nh gh\u00e9p kh\u00f4ng th\u1ec3 t\u00e1ch r\u1eddi. Th\u1ef1c t\u1ebf \u0111\u00e3 c\u00f3 r\u1ea5t nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p sau khi \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt kh\u00e2u n\u1ed1i g\u00e2n, hay t\u00e1i t\u1ea1o d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc, b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn t\u1eadp luy\u1ec7n k\u1ef9 c\u00e0ng, s\u00e2u s\u00e1t, d\u1eabn t\u1edbi k\u1ebft c\u1ee5c l\u00e0 m\u1ea3nh gh\u00e9p \u0111\u1ee9t l\u1ea1i, hay g\u00e2y x\u01a1 d\u00ednh, khi\u1ebfn cho b\u1ec7nh nh\u00e2n h\u1ea1n ch\u1ebf ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng, kh\u00f4ng ph\u1ee5c h\u1ed3i l\u1ea1i \u0111\u01b0\u1ee3c nh\u01b0 l\u00fac tr\u01b0\u1edbc m\u1ed5. V\u1edbi t\u00ecnh h\u00ecnh c\u1ee7a n\u01b0\u1edbc ta hi\u1ec7n nay, nhu c\u1ea7u v\u00e0 k\u1ef3 v\u1ecdng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh ng\u00e0y c\u00e0ng n\u00e2ng cao, sau m\u1ed5 b\u1ec7nh nh\u00e2n kh\u00f4ng ch\u1ec9 y\u00eau c\u1ea7u v\u1ec1 vi\u1ec7c \u201ct\u00f4i c\u00f3 th\u1ec3 \u0111i l\u1ea1i \u0111\u01b0\u1ee3c\u201d, m\u00e0 th\u1eadm ch\u00ed l\u00e0 \u201ct\u00f4i mu\u1ed1n ch\u1ea1y nhanh h\u01a1n, kh\u1ecfe h\u01a1n, m\u1ea1nh h\u01a1n\u201d. Do \u0111\u00f3, vai tr\u00f2 c\u1ee7a v\u1eadt l\u00fd tr\u1ecb li\u1ec7u trong \u0111i\u1ec1u tr\u1ecb Ch\u1ea5n th\u01b0\u01a1ng Ch\u1ec9nh h\u00ecnh c\u00e0ng tr\u1edf n\u00ean quan tr\u1ecdng. Ph\u1eabu thu\u1eadt vi\u00ean l\u00e0 ng\u01b0\u1eddi tr\u1ef1c ti\u1ebfp ti\u1ebfp c\u1eadn v\u00e0 ch\u1eefa tr\u1ecb cho th\u01b0\u01a1ng t\u1ed5n c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, n\u00ean c\u00e0ng ph\u1ea3i n\u1eafm r\u00f5 h\u01a1n ai h\u1ebft v\u1ec1 ch\u01b0\u01a1ng tr\u00ecnh t\u1eadp luy\u1ec7n tr\u01b0\u1edbc m\u1ed5, sau m\u1ed5 ph\u00f9 h\u1ee3p v\u00e0 t\u1ed1i \u01b0u nh\u1ea5t cho t\u1eebng ng\u01b0\u1eddi b\u1ec7nh, ph\u1ed1i h\u1ee3p c\u00f9ng v\u1edbi c\u00e1c b\u00e1c s\u0129, nh\u00e2n vi\u00ean v\u1eadt l\u00fd tr\u1ecb li\u1ec7u s\u1ebd \u0111em l\u1ea1i k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed1t nh\u1ea5t. Hay nh\u01b0 m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt, ch\u1ec9 c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n, ph\u1ed1i h\u1ee3p gi\u1eefa thu\u1ed1c men, thay \u0111\u1ed5i th\u00f3i quen v\u00e0 t\u1eadp v\u1eadt l\u00fd tr\u1ecb li\u1ec7u. C\u0169ng gi\u1ed1ng nh\u01b0 thu\u1ed1c men, vi\u1ec7c n\u1eafm r\u00f5 c\u00e1c nguy\u00ean l\u00fd, ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a c\u00e1c ph\u01b0\u01a1ng ph\u00e1p v\u1eadt l\u00fd tr\u1ecb li\u1ec7u, s\u1ebd gi\u00fap cho b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb c\u00f3 nhi\u1ec1u l\u1ef1a ch\u1ecdn h\u01a1n \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a \u0111i\u1ec1u tr\u1ecb \u0111a m\u00f4 th\u1ee9c.<\/p>\n<h2><strong>2. L\u1ecaCH S\u1eec<\/strong><\/h2>\n<p>Hippocrates \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 ng\u01b0\u1eddi \u0111\u1eb7t n\u1ec1n m\u00f3ng cho ng\u00e0nh v\u1eadt l\u00fd tr\u1ecb li\u1ec7u khi \u00f4ng c\u00f3 nh\u1eefng ghi ch\u00e9p \u0111\u1ea7u ti\u00ean v\u1ec1 nh\u1eefng k\u1ef9 thu\u1eadt n\u1eafn ch\u1ec9nh x\u01b0\u01a1ng kh\u1edbp, \u0111\u1eb7c bi\u1ec7t l\u00e0 kh\u1edbp vai v\u00e0 \u0111\u1ed1t s\u1ed1ng. \u0110\u1ebfn n\u0103m 1543, c\u00f4ng tr\u00ecnh mi\u00eau t\u1ea3 chi ti\u1ebft gi\u1ea3i ph\u1eabu ng\u01b0\u1eddi do <a href=\"https:\/\/en.wikipedia.org\/wiki\/Andreas_Vesalius\" target=\"_blank\" rel=\"noopener\">Andreas Versallius<\/a> x\u00e2y d\u1ef1ng \u0111\u00e3 g\u00f3p ph\u1ea7n v\u00e0o s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ng\u00e0nh ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng n\u00f3i chung c\u0169ng nh\u01b0 ng\u00e0nh v\u1eadn \u0111\u1ed9ng tr\u1ecb li\u1ec7u n\u00f3i ri\u00eang.<\/p>\n<p>\u0110\u1ebfn th\u1ebf k\u1ef7 XVII \u2013 XVIII, vi\u1ec7c n\u1eafn ch\u1ec9nh x\u01b0\u01a1ng kh\u1edbp \u0111\u01b0\u1ee3c ph\u1ed5 bi\u1ebfn r\u1ed9ng r\u00e3i t\u1ea1i Anh v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0 m\u1ed9t trong nh\u1eefng c\u00e1ch \u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u1eddi b\u1ea5y gi\u1edd. M\u1eb7c d\u00f9 v\u1eabn c\u00f2n nh\u1eefng sai l\u1ea7m v\u1ec1 c\u01a1 s\u1edf khoa h\u1ecdc, nh\u1eefng k\u1ef9 thu\u1eadt s\u01a1 kh\u1edfi n\u00e0y \u0111\u00e3 t\u1ea1o ti\u1ec1n \u0111\u1ec1 cho s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ng\u00e0nh v\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 osteopathy sau n\u00e0y. \u0110\u1ebfn th\u1ebf k\u1ef7 XIX, Mary McMillan \u0111\u01b0\u1ee3c xem l\u00e0 ng\u01b0\u1eddi ti\u00ean phong trong v\u1eadt l\u00fd tr\u1ecb li\u1ec7u t\u1ea1i M\u1ef9. B\u00e0 \u0111\u00e3 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn b\u1ed1n chuy\u00ean ng\u00e0nh, bao g\u1ed3m n\u1eafn ch\u1ec9nh c\u01a1 kh\u1edbp, v\u1eadn \u0111\u1ed9ng tr\u1ecb li\u1ec7u, \u0111i\u1ec7n tr\u1ecb li\u1ec7u v\u00e0 th\u1ee7y tr\u1ecb li\u1ec7u. N\u0103m 1921, Hi\u1ec7p h\u1ed9i V\u1eadt l\u00fd tr\u1ecb li\u1ec7u Ph\u1ee5 n\u1eef Hoa K\u1ef3 (<em>American Women\u2019s Physical Therapeutic Association<\/em>) l\u00e0 t\u1ed5 ch\u1ee9c ng\u00e0nh \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c th\u00e0nh l\u1eadp v\u00e0 Mary McMillan l\u00e0 h\u1ed9i tr\u01b0\u1edfng. \u0110\u1ebfn n\u0103m 1923, h\u1ed9i \u0111\u01b0\u1ee3c \u0111\u1ed5i t\u00ean th\u00e0nh Hi\u1ec7p h\u1ed9i Sinh l\u00fd tr\u1ecb li\u1ec7u Hoa K\u1ef3 (<em>American Physiotherapy Association<\/em>). Trong v\u00f2ng tr\u00ean 30 n\u0103m, nhi\u1ec1u nghi\u00ean c\u1ee9u c\u0169ng nh\u01b0 s\u00e1ch b\u00e1o v\u1ec1 \u1ee9ng d\u1ee5ng c\u1ee7a c\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u1eafn ch\u1ec9nh, \u0111\u1eb7c bi\u1ec7t \u00e1p d\u1ee5ng trong \u0111au c\u1ed9t s\u1ed1ng, c\u0169ng nh\u01b0 s\u1ef1 hi\u1ec3u bi\u1ebft con \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c \u0111au \u0111\u00e3 g\u00f3p ph\u1ea7n v\u00e0o n\u1ec1n t\u1ea3ng khoa h\u1ecdc cho s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ng\u00e0nh v\u1eadt l\u00fd tr\u1ecb li\u1ec7u. T\u1ea7m \u1ea3nh h\u01b0\u1edfng c\u1ee7a ng\u00e0nh c\u0169ng ng\u00e0y c\u00e0ng nh\u00e2n r\u1ed9ng v\u00e0 c\u00e1c t\u1ed5 ch\u1ee9c qu\u1ed1c t\u1ebf b\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh. N\u0103m 1966, t\u1ea1i Anh, Li\u00ean minh V\u1eadt l\u00fd tr\u1ecb li\u1ec7u To\u00e0n c\u1ea7u (<em>World Federation of Physical Therapy<\/em>) \u0111\u01b0\u1ee3c th\u00e0nh l\u1eadp. N\u0103m 1974, T\u1ed5 ch\u1ee9c Li\u00ean bang Qu\u1ed1c t\u1ebf c\u00e1c nh\u00e0 v\u1eadt l\u00fd tr\u1ecb li\u1ec7u (<em>International Federation of Physical Therapist<\/em>) ra \u0111\u1eddi v\u00e0 l\u00e0 n\u01a1i trao \u0111\u1ed5i kinh nghi\u1ec7m c\u0169ng nh\u01b0 ph\u00e1t tri\u1ec3n nh\u1eefng nguy\u00ean t\u1eafc v\u00e0 h\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh chuy\u00ean m\u00f4n. M\u00e3i \u0111\u1ebfn nh\u1eefng n\u0103m 90 c\u1ee7a th\u1ebf k\u1ef7 XX, H\u1ecdc vi\u1ec7n V\u1eadt l\u00fd tr\u1ecb li\u1ec7u trong Ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh Hoa K\u1ef3 \u0111\u01b0\u1ee3c th\u00e0nh l\u1eadp, ch\u1ecbu tr\u00e1ch nhi\u1ec7m x\u00e2y d\u1ef1ng ch\u01b0\u01a1ng tr\u00ecnh \u0111\u00e0o t\u1ea1o n\u1ed9i tr\u00fa chuy\u00ean ng\u00e0nh v\u1eadt l\u00fd tr\u1ecb li\u1ec7u c\u0169ng nh\u01b0 quy chu\u1ea9n h\u00f3a vi\u1ec7c c\u1ea5p ch\u1ee9ng ch\u1ec9 h\u00e0nh ngh\u1ec1. Hi\u1ec7n nay, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u \u0111\u00e3 tr\u1edf th\u00e0nh m\u1ed9t ng\u00e0nh ngh\u1ec1 \u0111\u1ed9c l\u1eadp v\u1edbi \u0111\u1ed1i t\u01b0\u1ee3ng l\u00e0 s\u1ef1 suy gi\u1ea3m ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng v\u00e0 ph\u01b0\u01a1ng th\u1ee9c l\u00e0 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p v\u1eadt l\u00fd [2].<\/p>\n<p>\u1ede ph\u01b0\u01a1ng \u0110\u00f4ng, t\u1eeb l\u00e2u c\u00e1c th\u1ea7y thu\u1ed1c \u0111\u00e3 bi\u1ebft \u0111\u1ebfn nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p \u1ee9ng d\u1ee5ng y h\u1ecdc c\u1ed5 truy\u1ec1n, b\u00e0i thu\u1ed1c d\u00e2n gian trong \u0111i\u1ec1u tr\u1ecb, ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng, ch\u1eb3ng h\u1ea1n nh\u01b0 ph\u01a1i n\u1eafng, ng\u00e2m b\u00f9n, xoa b\u00f3p, b\u1ea5m huy\u1ec7t, ch\u00e2m c\u1ee9u, ch\u01b0\u1eddm n\u00f3ng, \u0111\u1eafp l\u1ea1nh, kh\u00ed c\u00f4ng, d\u01b0\u1ee1ng sinh. Nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p v\u1eabn \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng cho \u0111\u1ebfn ng\u00e0y nay, cho th\u1ea5y nh\u1eefng hi\u1ec7u qu\u1ea3 t\u00edch c\u1ef1c trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd c\u01a1 x\u01b0\u01a1ng kh\u1edbp, Ch\u1ea5n th\u01b0\u01a1ng Ch\u1ec9nh h\u00ecnh.<\/p>\n<h2><strong>3. T\u1ed4NG QUAN V\u1ec0 V\u1eacT L\u00dd TR\u1eca LI\u1ec6U TRONG CH\u1ea4N TH\u01af\u01a0NG CH\u1ec8NH H\u00ccNH<\/strong><\/h2>\n<h3><strong>3.1 Kh\u00e1i ni\u1ec7m v\u1eadt l\u00fd tr\u1ecb li\u1ec7u <\/strong><\/h3>\n<p>V\u1eadt l\u00fd tr\u1ecb li\u1ec7u, hay t\u00e1c nh\u00e2n v\u1eadt l\u00fd (<em>Physical agents<\/em>) l\u00e0 c\u00e1c d\u1ea1ng n\u0103ng l\u01b0\u1ee3ng hay v\u1eadt ch\u1ea5t \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng \u0111\u1ec3 h\u1ed7 tr\u1ee3 ng\u01b0\u1eddi b\u1ec7nh trong tr\u1ecb li\u1ec7u, ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng. C\u00e1c t\u00e1c nh\u00e2n n\u00e0y bao g\u1ed3m nhi\u1ec7t, l\u1ea1nh, n\u01b0\u1edbc, \u00e1p l\u1ef1c, s\u00f3ng \u00e2m, t\u1eeb tr\u01b0\u1eddng, \u0111i\u1ec7n t\u1eeb. Thu\u1eadt ng\u1eef \u201ct\u00e1c nh\u00e2n v\u1eadt l\u00fd\u201d c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 ch\u1ec9 m\u1ed9t d\u1ea1ng n\u0103ng l\u01b0\u1ee3ng nh\u1ea5t \u0111\u1ecbnh n\u00f3i chung, v\u00ed d\u1ee5 nh\u01b0 t\u1eeb tr\u01b0\u1eddng hay s\u00f3ng \u00e2m, hay \u0111\u1ec3 ch\u1ec9 m\u1ed9t ph\u1ed5 n\u0103ng l\u01b0\u1ee3ng c\u1ee5 th\u1ec3, nh\u01b0 l\u00e0 tia UV hay si\u00eau \u00e2m; hay \u0111\u1ec3 ch\u1ec9 m\u1ed9t ph\u01b0\u01a1ng ti\u1ec7n\/m\u00e1y m\u00f3c c\u1ee5 th\u1ec3, v\u00ed d\u1ee5 nh\u01b0 \u0111\u00e8n h\u1ed3ng ngo\u1ea1i hay m\u00e1y si\u00eau \u00e2m tr\u1ecb li\u1ec7u. Thi tho\u1ea3ng nh\u1eefng thu\u1eadt ng\u1eef t\u01b0\u01a1ng t\u1ef1 nh\u01b0 ph\u01b0\u01a1ng ti\u1ec7n v\u1eadt l\u00fd (<em>physical modality\/physical agent modality<\/em>), t\u00e1c nh\u00e2n l\u00fd sinh (<em>biophysical agent<\/em>), t\u00e1c nh\u00e2n l\u00fd \u0111i\u1ec7n (<em>electrophysical agent<\/em>) c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng mang h\u00e0m ngh\u0129a t\u01b0\u01a1ng t\u1ef1 nh\u01b0 t\u00e1c nh\u00e2n v\u1eadt l\u00fd \u2013 <em>physical agent. <\/em>Trong ph\u1ea1m vi ch\u01b0\u01a1ng s\u00e1ch n\u00e0y, \u0111\u1ec3 thu\u1eadn ti\u1ec7n v\u00e0 th\u1ed1ng nh\u1ea5t trong vi\u1ec7c g\u1ecdi t\u00ean, t\u00e1c gi\u1ea3 xin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u1eeb \u201ct\u00e1c nh\u00e2n v\u1eadt l\u00fd tr\u1ecb li\u1ec7u\u201d ho\u1eb7c \u201cv\u1eadt l\u00fd tr\u1ecb li\u1ec7u\u201d \u0111\u1ec3 ch\u1ec9 chung c\u00e1c thu\u1eadt ng\u1eef tr\u00ean [3].<\/p>\n<p><strong>3.2 Ph\u00e2n lo\u1ea1i v\u1eadt l\u00fd tr\u1ecb li\u1ec7u <\/strong><\/p>\n<p>V\u1eadt l\u00fd tr\u1ecb li\u1ec7u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo t\u00e1c nh\u00e2n: nhi\u1ec7t (<em>thermal)<\/em>, c\u01a1 (<em>mechanical)<\/em> v\u00e0 \u0111i\u1ec7n t\u1eeb (<em>electromagnetic)<\/em> (<strong>B\u1ea3ng 8.1<\/strong>). T\u00e1c nh\u00e2n nhi\u1ec7t bao g\u1ed3m nhi\u1ec7t n\u00f4ng (<em>superficial-heating)<\/em>, nhi\u1ec7t s\u00e2u (<em>deep-heating)<\/em>, nhi\u1ec7t l\u1ea1nh n\u00f4ng (<em>superfical-cooling)<\/em>. T\u00e1c nh\u00e2n c\u01a1 h\u1ecdc bao g\u1ed3m k\u00e9o n\u1eafn, n\u00e9n \u00e9p, n\u01b0\u1edbc v\u00e0 s\u00f3ng \u00e2m. T\u00e1c nh\u00e2n \u0111i\u1ec7n t\u1eeb bao g\u1ed3m c\u00e1c d\u1ea1ng v\u1eadt ch\u1ea5t \u0111i\u1ec7n t\u1eeb v\u00e0 \u0111i\u1ec7n. M\u1ed9t s\u1ed1 t\u00e1c nh\u00e2n c\u00f3 th\u1ec3 thu\u1ed9c nhi\u1ec1u ph\u00e2n lo\u1ea1i. Ch\u1eb3ng h\u1ea1n nh\u01b0 n\u01b0\u1edbc, s\u00f3ng \u00e2m c\u00f3 t\u00e1c d\u1ee5ng v\u1eeba c\u01a1 h\u1ecdc, v\u1eeba nhi\u1ec7t h\u1ecdc [3].<\/p>\n<p><strong>B\u1ea3ng 8.1. <\/strong>Ph\u00e2n lo\u1ea1i c\u00e1c t\u00e1c nh\u00e2n v\u1eadt l\u00fd tr\u1ecb li\u1ec7u<\/p>\n<table width=\"592\">\n<tbody>\n<tr>\n<td width=\"81\">\n<p><strong>Ph\u00e2n lo\u1ea1i<\/strong><\/p>\n<\/td>\n<td width=\"105\">\n<p><strong>T\u00e1c nh\u00e2n<\/strong><\/p>\n<\/td>\n<td width=\"406\">\n<p><strong>Ph\u01b0\u01a1ng ti\u1ec7n l\u00e2m s\u00e0ng<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"81\">\n<p>Nhi\u1ec7t h\u1ecdc<\/p>\n<\/td>\n<td width=\"105\">\n<p>Nhi\u1ec7t s\u00e2u<\/p>\n<p>Nhi\u1ec7t n\u00f4ng<\/p>\n<\/td>\n<td width=\"406\">\n<p>Si\u00eau \u00e2m, th\u1ea5u nhi\u1ec7t (diathermy)<\/p>\n<p>T\u00fai ch\u01b0\u1eddm n\u00f3ng<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"81\">\n<p>&nbsp;<\/p>\n<\/td>\n<td width=\"105\">\n<p>Nhi\u1ec7t l\u1ea1nh<\/p>\n<\/td>\n<td width=\"406\">\n<p>T\u00fai ch\u01b0\u1eddm l\u1ea1nh<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"81\">\n<p>C\u01a1 h\u1ecdc<\/p>\n<\/td>\n<td width=\"105\">\n<p>K\u00e9o n\u1eafn<\/p>\n<p>N\u1eafn \u00e9p<\/p>\n<\/td>\n<td width=\"406\">\n<p>K\u00e9o n\u1eafn c\u01a1 h\u1ecdc<\/p>\n<p>B\u0103ng thun, v\u1edb \u00e1p l\u1ef1c<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"81\">\n<p>&nbsp;<\/p>\n<\/td>\n<td width=\"105\">\n<p>N\u01b0\u1edbc<\/p>\n<\/td>\n<td width=\"406\">\n<p>Xo\u00e1y n\u01b0\u1edbc (Whirlpool)<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"81\">\n<p>&nbsp;<\/p>\n<\/td>\n<td width=\"105\">\n<p>S\u00f3ng \u00e2m<\/p>\n<\/td>\n<td width=\"406\">\n<p>Si\u00eau \u00e2m<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"81\">\n<p>\u0110i\u1ec7n t\u1eeb<\/p>\n<\/td>\n<td width=\"105\">\n<p>D\u1ea3i \u0111i\u1ec7n t\u1eeb<\/p>\n<p>D\u00f2ng \u0111i\u1ec7n<\/p>\n<\/td>\n<td width=\"406\">\n<p>Tia UV, laser<\/p>\n<p>M\u00e1y TENS (Transcutaneous Electrical Nerve Stimulation \u2013 k\u00edch th\u00edch th\u1ea7n kinh b\u1eb1ng xung \u0111i\u1ec7n qua da)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><strong>3.3 T\u00e1c d\u1ee5ng c\u1ee7a v\u1eadt l\u00fd tr\u1ecb li\u1ec7u<\/strong><\/h3>\n<p>C\u00e1c t\u00e1c nh\u00e2n v\u1eadt l\u00fd \u0111em l\u1ea1i nh\u1eefng t\u00e1c d\u1ee5ng trong tr\u1ecb li\u1ec7u nh\u01b0 [3]:<\/p>\n<ul>\n<li>Kh\u00e1ng vi\u00eam, t\u0103ng c\u01b0\u1eddng h\u1ed3i ph\u1ee5c m\u00f4 (<strong>B\u1ea3ng 8.2<\/strong>)<\/li>\n<li>Gi\u1ea3m \u0111au (\u0111i\u1ec1u ch\u1ec9nh con \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n, ti\u1ebfp nh\u1eadn \u0111au) (<strong>B\u1ea3ng 8.3<\/strong>)<\/li>\n<li>C\u1ea3i thi\u1ec7n trong h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng, thay \u0111\u1ed5i t\u00ednh chun gi\u00e3n c\u1ee7a collagen (<strong>B\u1ea3ng 8.4<\/strong>) &#8211; \u0110i\u1ec1u ch\u1ec9nh tr\u01b0\u01a1ng l\u1ef1c c\u01a1 (<strong>B\u1ea3ng 8.5<\/strong>).<\/li>\n<\/ul>\n<p><strong>B\u1ea3ng 8.2.<\/strong> \u1ee8ng d\u1ee5ng c\u1ee7a v\u1eadt l\u00fd tr\u1ecb li\u1ec7u trong l\u00e0nh v\u1ebft th\u01b0\u01a1ng, h\u1ed3i ph\u1ee5c m\u00f4<\/p>\n<table style=\"width: 29.5029%; height: 170px;\" width=\"593\">\n<tbody>\n<tr>\n<td style=\"width: 69.2604px;\">\u00a0<\/td>\n<td style=\"width: 118.594px;\">\u00a0<\/td>\n<td style=\"width: 245.917px;\">\u00a0<\/td>\n<td style=\"width: 134.562px;\">\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>3.4. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh chung c\u1ee7a v\u1eadt l\u00fd tr\u1ecb li\u1ec7u <\/strong><\/p>\n<p>Nh\u00ecn chung, m\u1ed9t s\u1ed1 \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u1eb7c bi\u1ec7t c\u1ea7n c\u00e2n nh\u1eafc v\u00e0 th\u1eadn tr\u1ecdng khi ch\u1ec9 \u0111\u1ecbnh c\u00e1c t\u00e1c nh\u00e2n v\u1eadt l\u00fd tr\u1ecb li\u1ec7u, c\u1ee5 th\u1ec3:<\/p>\n<ul>\n<li>Ph\u1ee5 n\u1eef mang thai: v\u00ec nguy c\u01a1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn thai nhi do b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u00e1c \u0111\u1ed9ng c\u1ee7a v\u1eadt l\u00fd tr\u1ecb li\u1ec7u tr\u00ean thai nhi c\u00f2n h\u1ea1n ch\u1ebf<\/li>\n<li>B\u1ec7nh l\u00fd \u00e1c t\u00ednh: v\u00ec nguy c\u01a1 khi n\u0103ng l\u01b0\u1ee3ng c\u1ee7a c\u00e1c t\u00e1c nh\u00e2n v\u1eadt l\u00fd g\u00e2y bi\u1ebfn \u0111\u1ed5i\/\u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a m\u00f4 \u00e1c t\u00ednh, ung th\u01b0<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 m\u00e1y t\u1ea1o nh\u1ecbp hay c\u1ea5y gh\u00e9p c\u00e1c thi\u1ebft b\u1ecb \u0111i\u1ec7n t\u1eed kh\u00e1c: do nguy c\u01a1 n\u0103ng l\u01b0\u1ee3ng c\u1ee7a t\u00e1c nh\u00e2n v\u1eadt l\u00fd \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng, ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c thi\u1ebft b\u1ecb \u0111i\u1ec7n t\u1eed<\/li>\n<li>B\u1ec7nh nh\u00e2n khi\u1ebfm khuy\u1ebft v\u1ec1 x\u00fac gi\u00e1c hay t\u00e2m th\u1ea7n: \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n n\u00e0y th\u01b0\u1eddng kh\u00f3 kh\u0103n, h\u1ea1n ch\u1ebf trong vi\u1ec7c c\u1ea3m nh\u1eadn v\u00e0 ti\u1ebfp nh\u1eadn c\u00e1c gi\u00e1c quan, d\u1eabn \u0111\u1ebfn kh\u00f4ng th\u1ec3 ph\u1ea3n h\u1ed3i ch\u00ednh x\u00e1c v\u1ec1 hi\u1ec7u qu\u1ea3, t\u00e1c \u0111\u1ed9ng c\u1ee7a v\u1eadt l\u00fd tr\u1ecb li\u1ec7u \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh<\/li>\n<\/ul>\n<h3>4. NHI\u1ec6T TR\u1eca LI\u1ec6U<\/h3>\n<p><strong>4.1. Nhi\u1ec7t n\u00f4ng (<em>Superficial heat<\/em>)<\/strong><\/p>\n<p><strong>\u0110\u1ecbnh ngh\u0129a:<\/strong> l\u00e0 bi\u1ec7n ph\u00e1p n\u00e2ng nhi\u1ec7t \u0111\u1ed9 tr\u00ean b\u1ec1 m\u1eb7t da cho \u0111\u1ebfn l\u1edbp m\u00f4 1 cm d\u01b0\u1edbi da nh\u1eb1m l\u00e0m t\u0103ng tu\u1ea7n ho\u00e0n n\u00f4ng, gi\u1ea3m \u0111au v\u00e0 gi\u00e3n c\u01a1. Ph\u01b0\u01a1ng ph\u00e1p nhi\u1ec7t n\u00f4ng \u0111\u01b0\u1ee3c chia l\u00e0m ba lo\u1ea1i t\u00f9y theo ph\u01b0\u01a1ng th\u1ee9c th\u1ef1c hi\u1ec7n, bao g\u1ed3m d\u1eabn truy\u1ec1n nhi\u1ec7t (<em>conduction<\/em>), \u0111\u1ed1i l\u01b0u (<em>convection<\/em>) v\u00e0 b\u1ee9c x\u1ea1 (<em>radiation<\/em>). Ph\u01b0\u01a1ng th\u1ee9c d\u1eabn truy\u1ec1n nhi\u1ec7t c\u00f3 th\u1ec3 l\u00e0 ch\u01b0\u1eddm n\u00f3ng ho\u1eb7c ng\u00e2m paraffin <strong>(H\u00ecnh 8.1)<\/strong>. Nhi\u1ec7t \u0111\u01b0\u1ee3c truy\u1ec1n t\u1eeb t\u00fai ch\u01b0\u1eddm <strong>(H\u00ecnh 8.2B)<\/strong> ho\u1eb7c l\u1edbp paraffin v\u00e0o c\u01a1 th\u1ec3. Ph\u01b0\u01a1ng th\u1ee9c \u0111\u1ed1i l\u01b0u c\u00f3 th\u1ec3 l\u00e0 t\u1eafm xo\u00e1y n\u00f3ng ho\u1eb7c th\u1ed5i d\u00f2ng h\u01a1i n\u00f3ng qua v\u00f9ng c\u1ea7n t\u00e1c \u0111\u1ed9ng. Ph\u01b0\u01a1ng th\u1ee9c b\u1ee9c x\u1ea1 <strong>(H\u00ecnh 8.2A)<\/strong> s\u1eed d\u1ee5ng \u00e1nh s\u00e1ng c\u00f3 b\u01b0\u1edbc s\u00f3ng 5.500 \u2013 7.000 Angstrong ho\u1eb7c tia h\u1ed3ng ngo\u1ea1i. Khi photon t\u00e1c \u0111\u1ed9ng t\u1edbi m\u00f4, ch\u00fang b\u1ecb h\u1ea5p th\u1ee5 v\u00e0 chuy\u1ec3n th\u00e0nh nhi\u1ec7t. V\u00ec \u0111\u00e8n h\u1ed3ng ngo\u1ea1i c\u00f3 th\u1ec3 n\u00e2ng nhi\u1ec7t \u0111\u1ed9 m\u00f4 m\u00e0 kh\u00f4ng c\u1ea7n ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u00e0o da b\u1ec7nh nh\u00e2n, ph\u01b0\u01a1ng ph\u00e1p n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ecdn cho nh\u1eefng v\u1ebft th\u01b0\u01a1ng sau ph\u1eabu thu\u1eadt ho\u1eb7c nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 sang th\u01b0\u01a1ng da.<\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-1931\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture1.jpg\" alt=\"Picture1\" width=\"275\" height=\"177\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture1.jpg 275w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture1-18x12.jpg 18w\" sizes=\"(max-width: 275px) 100vw, 275px\" \/><\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-1932\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture2.jpg\" alt=\"Picture2\" width=\"237\" height=\"177\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture2.jpg 237w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture2-16x12.jpg 16w\" sizes=\"(max-width: 237px) 100vw, 237px\" \/><\/p>\n<p><strong>H\u00ecnh 8.1. (A)<\/strong> Tay b\u1ec7nh nh\u00e2n nh\u00fang v\u00e0o b\u1ed3n paraffin n\u00f3ng ch\u1ea3y. <strong>(B)<\/strong> Tay b\u1ec7nh nh\u00e2n r\u00fat ra kh\u1ecfi b\u1ed3n paraffin v\u00e0 l\u01b0\u1ee3ng nhi\u1ec7t t\u1eeb l\u01b0\u1ee3ng paraffin b\u00e1m tr\u00ean tay l\u00e0 t\u00e1c nh\u00e2n nhi\u1ec7t n\u00f4ng [4]<\/p>\n<figure id=\"attachment_1933\" aria-describedby=\"caption-attachment-1933\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img decoding=\"async\" class=\"size-medium wp-image-1933\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture3-300x151.jpg\" alt=\"Picture3\" width=\"300\" height=\"151\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture3-300x151.jpg 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture3-18x9.jpg 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture3.jpg 593w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1933\" class=\"wp-caption-text\"><strong>H\u00ecnh 8.2. (A)<\/strong> \u0110\u00e8n chi\u1ebfu trong ph\u01b0\u01a1ng ph\u00e1p b\u1ee9c x\u1ea1. <strong>(B)<\/strong> T\u00fai ch\u01b0\u1eddm n\u00f3ng qu\u1ea5n quanh v\u00f9ng t\u1ed5n th\u01b0\u01a1ng [4]<\/figcaption><\/figure>\n<p><strong><a href=\"https:\/\/bsvothanhtoan.com\/\">C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng<\/a>:<\/strong> vi\u1ec7c t\u0103ng nhi\u1ec7t \u0111\u1ed9 k\u00edch th\u00edch gi\u00e3n m\u1ea1ch v\u00e0 t\u0103ng t\u01b0\u1edbi m\u00e1u t\u1ea1i da nh\u1eb1m th\u00fac \u0111\u1ea9y vi\u1ec7c l\u00e0nh v\u1ebft th\u01b0\u01a1ng. C\u00f3 hai c\u01a1 ch\u1ebf \u0111\u01b0\u1ee3c cho l\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c gi\u00e3n c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u d\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng nhi\u1ec7t. M\u1ed9t l\u00e0 ph\u1ea3n x\u1ea1 gi\u00e3n m\u1ea1ch khi c\u00e1c th\u1ee5 th\u1ec3 nhi\u1ec7t \u1edf da b\u1ecb k\u00edch th\u00edch. Hai l\u00e0 s\u1ef1 k\u00edch th\u00edch s\u1ea3n xu\u1ea5t c\u1ee7a nh\u1eefng ch\u1ea5t g\u00e2y gi\u00e3n m\u1ea1ch nh\u01b0 bradykinin v\u00e0 nitric oxide. Hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au c\u1ee7a vi\u1ec7c \u00e1p d\u1ee5ng nhi\u1ec7t \u0111\u1ed9 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch b\u1eb1ng thuy\u1ebft ki\u1ec3m so\u00e1t c\u1ed5ng (<em>gate control theory<\/em>). T\u00edn hi\u1ec7u t\u1eeb th\u1ee5 th\u1ec3 nhi\u1ec7t \u0111\u1ed9 trong kho\u1ea3ng 37 \u2013 40<sup>o<\/sup>C c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c \u0111au qua s\u1ee3i th\u1ea7n kinh A\u03b4 v\u00e0 C t\u1ea1i s\u1eebng sau t\u1ee7y s\u1ed1ng. Tuy nhi\u00ean, khi nhi\u1ec7t \u0111\u1ed9 t\u0103ng l\u00ean qu\u00e1 45<sup>o<\/sup>C, t\u00edn hi\u1ec7u \u0111au s\u1ebd \u0111\u01b0\u1ee3c k\u00edch th\u00edch tr\u1edf l\u1ea1i. Nhi\u1ec7t \u0111\u1ed9 c\u00f2n c\u00f3 th\u1ec3 gi\u00fap gi\u00e3n c\u01a1 b\u1eb1ng c\u00e1ch gi\u1ea3m k\u00edch th\u00edch s\u1ee3i th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng gamma. Ngo\u00e0i ra, nhi\u1ec7t n\u00f4ng c\u00f2n cho th\u1ea5y c\u00f4ng d\u1ee5ng l\u00e0m t\u0103ng t\u00ednh k\u00e9o gi\u00e3n c\u1ee7a m\u00f4 m\u1ec1m, qua \u0111\u00f3 g\u00f3p ph\u1ea7n l\u00e0m gi\u1ea3m x\u01a1 d\u00ednh v\u00e0 h\u1ed7 tr\u1ee3 t\u1eadp luy\u1ec7n bi\u00ean \u0111\u1ed9 dao \u0111\u1ed9ng c\u1ee7a kh\u1edbp.<\/p>\n<p><strong>Ch\u1ec9 \u0111\u1ecbnh:<\/strong> nh\u1eefng t\u00ecnh tr\u1ea1ng \u0111au b\u00e1n c\u1ea5p v\u00e0 m\u1ea1n t\u00ednh, c\u0103ng c\u01a1, tho\u00e1i h\u00f3a kh\u1edbp, vi\u00eam bao ho\u1ea1t d\u1ecbch, bong g\u00e2n, gi\u1ea3m t\u1ea7m v\u1eadn \u0111\u1ed9ng.<\/p>\n<p><strong>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: <\/strong>v\u1ebft th\u01b0\u01a1ng h\u1edf, nhi\u1ec5m tr\u00f9ng da ho\u1eb7c v\u1ebft th\u01b0\u01a1ng, r\u1ed1i lo\u1ea1n v\u1eadn m\u1ea1ch, b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean ho\u1eb7c huy\u1ebft kh\u1ed1i. Nhi\u1ec7t n\u00f4ng c\u0169ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong \u0111i\u1ec1u tr\u1ecb \u0111au do t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ea5p, v\u1ed1n \u0111i \u0111\u00e3 bi\u1ec3u hi\u1ec7n s\u01b0ng, n\u00f3ng, \u0111\u1ecf.<\/p>\n<h5>4.2. L\u1ea1nh tr\u1ecb li\u1ec7u (Therapeutic cold ho\u1eb7c Cryotherapy)<\/h5>\n<p><strong>\u0110\u1ecbnh ngh\u0129a:<\/strong> l\u00e0 bi\u1ec7n ph\u00e1p l\u00e0m h\u1ea1 nhi\u1ec7t \u0111\u1ed9 m\u00f4 t\u1ea1i ch\u1ed7 v\u00e0 l\u1ee3i d\u1ee5ng nh\u1eefng thay \u0111\u1ed5i sinh l\u00fd t\u01b0\u01a1ng \u1ee9ng \u0111\u1ec3 gi\u1ea3m \u0111au, ki\u1ec3m so\u00e1t ph\u00f9 n\u1ec1 v\u00e0 ch\u1ea3y m\u00e1u.<\/p>\n<figure id=\"attachment_1935\" aria-describedby=\"caption-attachment-1935\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture4-1-300x111.jpg\" alt=\"Picture4\" width=\"300\" height=\"111\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture4-1-300x111.jpg 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture4-1-18x7.jpg 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture4-1.jpg 578w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1935\" class=\"wp-caption-text\"><strong>H\u00ecnh 8.3. (A)<\/strong> Ch\u01b0\u1eddm l\u1ea1nh. <strong>(B)<\/strong> Ch\u01b0\u1eddm \u0111\u00e1 [4]<\/figcaption><\/figure>\n<p><strong>C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng: <\/strong>nhi\u1ec7t \u0111\u1ed9 th\u1ea5p l\u00e0m gi\u1ea3m k\u00edch th\u00edch c\u00e1c \u0111\u1ea7u m\u00fat th\u1ea7n kinh t\u1ea1i v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng, do \u0111\u00f3 gi\u1ea3m d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c \u0111au. Ngo\u00e0i ra, vi\u1ec7c gi\u1ea3m d\u1eabn truy\u1ec1n tr\u00ean nh\u1eefng s\u1ee3i th\u1ea7n kinh h\u01b0\u1edbng t\u00e2m t\u1eeb thoi c\u01a1 (s\u1ee3i Ia) v\u00e0 s\u1ee3i th\u1ea7n kinh li t\u00e2m (s\u1ee3i alpha v\u00e0 gamma) gi\u00fap c\u1ea3i thi\u1ec7n hi\u1ec7n t\u01b0\u1ee3ng c\u0103ng c\u01a1 (<em>muscle spasm<\/em>). L\u1ea1nh tr\u1ecb li\u1ec7u k\u00edch th\u00edch co m\u1ea1ch, nh\u1edd \u0111\u00f3 ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u v\u00e0 vi\u1ec7c gi\u1ea3m t\u01b0\u1edbi m\u00e1u c\u0169ng gi\u00fap ki\u1ec3m so\u00e1t s\u1ef1 ph\u00f9 n\u1ec1 t\u1ea1i v\u1ebft th\u01b0\u01a1ng. S\u1ef1 co m\u1ea1ch l\u00e0 m\u1ed9t ph\u1ea3n \u1ee9ng sinh l\u00fd nh\u1eb1m h\u1ea1n ch\u1ebf m\u1ea5t nhi\u1ec7t c\u01a1 th\u1ec3 v\u00e0 m\u1ea1ch m\u00e1u co t\u1ed1i \u0111a khi nhi\u1ec7t \u0111\u1ed9 \u00e1p d\u1ee5ng h\u1ea1 t\u1edbi 10<sup>o<\/sup>C. Nh\u01b0 v\u1eady, l\u1ea1nh tr\u1ecb li\u1ec7u t\u00e1c \u0111\u1ed9ng qua vi\u1ec7c l\u00e0m ch\u1eadm d\u1eabn truy\u1ec1n th\u1ea7n kinh v\u00e0 l\u1ee3i d\u1ee5ng hi\u1ec7u \u1ee9ng co m\u1ea1ch c\u1ee7a c\u01a1 th\u1ec3 \u0111\u1ec3 \u0111\u1ed1i kh\u00e1ng v\u1edbi \u0111\u00e1p \u1ee9ng vi\u00eam c\u1ea5p t\u1ea1i v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng.<\/p>\n<p><strong>Ch\u1ec9 \u0111\u1ecbnh: <\/strong>l\u1ea1nh tr\u1ecb li\u1ec7u th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho v\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m c\u1ea5p t\u00ednh ho\u1eb7c sau ph\u1eabu thu\u1eadt. Nh\u1eefng t\u00ecnh tr\u1ea1ng kh\u00e1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh bao g\u1ed3m nh\u1eefng \u0111\u1ee3t vi\u00eam c\u1ea5p c\u1ee7a c\u00e1c b\u1ec7nh l\u00fd m\u1ea1n t\u00ednh nh\u01b0 vi\u00eam bao ho\u1ea1t d\u1ecbch, vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, \u0111\u1ee3t c\u1ea5p tho\u00e1i h\u00f3a kh\u1edbp,\u2026 Ngo\u00e0i ra l\u1ea1nh tr\u1ecb li\u1ec7u c\u00f2n \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng \u0111au m\u1ea1n t\u00ednh, \u0111i\u1ec3n h\u00ecnh l\u00e0 h\u1ed9i ch\u1ee9ng \u0111au c\u00e2n c\u01a1 (<em>myofascial pain syndrome<\/em>) v\u00ec kh\u1ea3 n\u0103ng c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng c\u0103ng c\u01a1 nh\u01b0 \u0111\u00e3 tr\u00ecnh b\u00e0y.<\/p>\n<p><strong>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: <\/strong>b\u1ec7nh nh\u00e2n nh\u1ea1y c\u1ea3m v\u1edbi l\u1ea1nh, c\u00f3 r\u1ed1i lo\u1ea1n v\u1eadn m\u1ea1ch (h\u1ed9i ch\u1ee9ng Reynauld, b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean,\u2026) ho\u1eb7c nhi\u1ec5m tr\u00f9ng da \u2013 v\u1ebft th\u01b0\u01a1ng.<\/p>\n<p><strong>4.3. Nhi\u1ec7t s\u00e2u (Deep heat ho\u1eb7c Diathermy)<\/strong><\/p>\n<p><strong>\u0110\u1ecbnh ngh\u0129a:<\/strong> l\u00e0 ph\u01b0\u01a1ng ph\u00e1p s\u1eed d\u1ee5ng chuy\u1ec3n \u0111\u1ed5i n\u0103ng l\u01b0\u1ee3ng c\u1ee7a c\u00e1c tia s\u00f3ng th\u00e0nh nhi\u1ec7t l\u01b0\u1ee3ng t\u1ea1i c\u00e1c m\u00f4 s\u00e2u nh\u01b0 d\u00e2y ch\u1eb1ng, g\u00e2n, bao kh\u1edbp, c\u01a1 m\u00e0 kh\u00f4ng l\u00e0m t\u0103ng nhi\u1ec7t \u0111\u1ed9 c\u1ee7a l\u1edbp b\u00ec \u2013 th\u01b0\u1ee3ng b\u00ec v\u00e0 l\u1edbp m\u1ee1 d\u01b0\u1edbi da. \u0110\u00e2y th\u1ef1c ch\u1ea5t l\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p chuy\u1ec3n \u0111\u1ed5i n\u0103ng l\u01b0\u1ee3ng (<em>conversion<\/em>). C\u00e1c tia s\u1eed d\u1ee5ng trong nhi\u1ec7t s\u00e2u bao g\u1ed3m s\u00f3ng si\u00eau \u00e2m (<em>ultrasound<\/em>), s\u00f3ng ng\u1eafn (<em>shortwave<\/em>) v\u00e0 vi s\u00f3ng (<em>microwave<\/em>). Hai lo\u1ea1i s\u00f3ng sau thu\u1ed9c v\u1ec1 s\u00f3ng \u0111i\u1ec7n t\u1eeb v\u00e0 do \u0111\u00f3, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u0111i\u1ec7n nhi\u1ec7t (<em>diathermy<\/em>). L\u1ee3i \u0111i\u1ec3m c\u1ee7a hai s\u00f3ng \u0111i\u1ec7n t\u1eeb so v\u1edbi si\u00eau \u00e2m l\u00e0 t\u00e1c \u0111\u1ed9ng nhi\u1ec7t tr\u00ean m\u1ed9t di\u1ec7n t\u00edch m\u00f4 r\u1ed9ng h\u01a1n. S\u00f3ng si\u00eau \u00e2m l\u00e0 s\u00f3ng \u00e2m v\u1edbi t\u1ea7n s\u1ed1 tr\u00ean 20 kHz (xem m\u1ee5c \u201cSi\u00eau \u00e2m\u201d). S\u00f3ng ng\u1eafn c\u00f3 t\u1ea7n s\u1ed1 v\u00e0o kho\u1ea3ng 1,8 \u2013 30 MHz v\u1edbi b\u01b0\u1edbc s\u00f3ng kho\u1ea3ng 3 \u2013 200 m (trong kho\u1ea3ng c\u1ee7a s\u00f3ng radio). C\u00e1c \u1ee9ng d\u1ee5ng hi\u1ec7n nay cho ph\u00e9p s\u1eed d\u1ee5ng s\u00f3ng ng\u1eafn v\u1edbi ba gi\u00e1 tr\u1ecb t\u1ea7n s\u1ed1 13.56 MHz (\u03bb 22 m), 27,12 MHz (\u03bb 11 m) v\u00e0 40,68 MHz (\u03bb = 7,5 m). Vi s\u00f3ng c\u00f3 t\u1ea7n s\u1ed1 v\u00e0o kho\u1ea3ng 300 MHz \u2013 300 GHz v\u1edbi b\u01b0\u1edbc s\u00f3ng kho\u1ea3ng 1 mm \u2013 1 m. Hi\u1ec7n nay, t\u1ea7n s\u1ed1 vi s\u00f3ng \u0111\u01b0\u1ee3c d\u00f9ng trong y khoa l\u00e0 2.450 MHz.<\/p>\n<p><strong>C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng: <\/strong>c\u1ea3 s\u00f3ng ng\u1eafn v\u00e0 vi s\u00f3ng \u0111\u1ec1u c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p ph\u00e1t x\u1ea1 li\u00ean t\u1ee5c ho\u1eb7c ng\u1eaft qu\u00e3ng. Trong \u0111\u00f3, vi\u1ec7c ph\u00e1t x\u1ea1 li\u00ean t\u1ee5c cho t\u00e1c \u0111\u1ed9ng v\u1ec1 nhi\u1ec7t gi\u1ed1ng nh\u01b0 s\u00f3ng si\u00eau \u00e2m. Khi \u00e1p d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p ph\u00e1t x\u1ea1 ng\u1eaft qu\u00e3ng, l\u01b0\u1ee3ng nhi\u1ec7t t\u1ecfa ra m\u1ed7i xung b\u1ecb ph\u00e2n t\u00e1n b\u1edbt v\u00e0 kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u00e1ng k\u1ec3, nh\u01b0ng nh\u1eefng t\u00e1c \u0111\u1ed9ng l\u00ean ho\u1ea1t \u0111\u1ed9ng t\u1ebf b\u00e0o v\u00e0 t\u01b0\u1edbi m\u00e1u v\u1eabn \u0111\u01b0\u1ee3c mi\u00eau t\u1ea3 qua c\u00e1c th\u1ef1c nghi\u1ec7m. Nh\u01b0 v\u1eady, ngo\u00e0i t\u00e1c \u0111\u1ed9ng v\u1ec1 nhi\u1ec7t, c\u00e1c tia x\u1ea1 c\u00f2n \u1ea3nh h\u01b0\u1edfng l\u00ean ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ebf b\u00e0o qua vi\u1ec7c thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 ion calcium trong b\u00e0o t\u01b0\u01a1ng, t\u00e1c \u0111\u1ed9ng l\u00ean ch\u1ee9c n\u0103ng chuy\u1ec3n h\u00f3a c\u1ee7a t\u1ebf b\u00e0o theo h\u01b0\u1edbng t\u0103ng t\u1ed5ng h\u1ee3p c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng t\u1eeb nguy\u00ean b\u00e0o s\u1ee3i, t\u1ebf b\u00e0o s\u1ee5n v\u00e0 k\u00edch ho\u1ea1t \u0111\u1ea1i th\u1ef1c b\u00e0o. Ngo\u00e0i ra, c\u00e1c tia x\u1ea1 c\u00f2n gi\u00fap t\u0103ng t\u01b0\u1edbi m\u00e1u t\u1edbi c\u00e1c vi m\u1ea1ch, h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh l\u00e0nh v\u1ebft th\u01b0\u01a1ng. Tuy nhi\u00ean, c\u01a1 ch\u1ebf c\u1ee5 th\u1ec3 c\u1ee7a c\u00e1c t\u00e1c \u0111\u1ed9ng n\u00e0y v\u1eabn c\u00f2n ch\u01b0a r\u00f5.<\/p>\n<p><strong>Ch\u1ec9 \u0111\u1ecbnh: <\/strong>s\u00f3ng ng\u1eafn th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho nh\u1eefng t\u1ed5n th\u01b0\u01a1ng s\u00e2u t\u1ea1i c\u00e1c kh\u1edbp l\u1edbn nh\u01b0 kh\u1edbp g\u1ed1i, kh\u1edbp h\u00e1ng v\u00ec t\u00ednh xuy\u00ean th\u1ea5u c\u0169ng nh\u01b0 di\u1ec7n t\u00edch m\u00f4 t\u00e1c \u0111\u1ed9ng l\u1edbn h\u01a1n si\u00eau \u00e2m. S\u00f3ng ng\u1eafn c\u00f2n \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 gi\u1ea3m \u0111au, gi\u1ea3m c\u0103ng c\u01a1, gi\u1ea3m vi\u00eam, t\u0103ng \u0111\u1ed9 \u0111\u00e0n h\u1ed3i cho c\u00e1c m\u00f4 li\u00ean k\u1ebft. M\u1ed9t s\u1ed1 c\u00e1ch \u00e1p d\u1ee5ng s\u00f3ng ng\u1eafn v\u00e0 vi s\u00f3ng \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong <strong>(H\u00ecnh 8.4).<\/strong><\/p>\n<figure id=\"attachment_1936\" aria-describedby=\"caption-attachment-1936\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1936\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture5-300x100.jpg\" alt=\"Picture5\" width=\"300\" height=\"100\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture5-300x100.jpg 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture5-18x6.jpg 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture5.jpg 593w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1936\" class=\"wp-caption-text\"><strong>H\u00ecnh 8.4. <\/strong>C\u00e1c h\u00ecnh th\u1ee9c chi\u1ebfu s\u00f3ng ng\u1eafn v\u00e0 vi s\u00f3ng v\u00e0o v\u00f9ng t\u1ed5n th\u01b0\u01a1ng [3]<\/figcaption><\/figure>\n<p><strong>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: <\/strong>b\u1ec7nh nh\u00e2n \u0111ang \u0111\u1eb7t thi\u1ebft b\u1ecb t\u1ea1o nh\u1ecbp tim, nh\u1eefng d\u1ee5ng c\u1ee5 b\u1eb1ng kim lo\u1ea1i \u0111\u01b0\u1ee3c c\u1ea5y v\u00e0o c\u01a1 th\u1ec3, ph\u1ee5 n\u1eef mang thai, kh\u00f4ng s\u1eed d\u1ee5ng cho m\u1eaft v\u00e0 c\u00e1c c\u01a1 quan sinh d\u1ee5c, \u0111\u1ea7u x\u01b0\u01a1ng thanh thi\u1ebfu ni\u00ean.<\/p>\n<p><strong>4.4. Si\u00eau \u00e2m<\/strong><\/p>\n<p><strong>\u0110\u1ecbnh ngh\u0129a:<\/strong> l\u00e0 m\u1ed9t trong nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p nhi\u1ec7t s\u00e2u, s\u1eed d\u1ee5ng s\u00f3ng \u00e2m v\u1edbi t\u1ea7n s\u1ed1 tr\u00ean 20 kHz \u0111\u1ec3 t\u0103ng nhi\u1ec7t \u0111\u1ed9 m\u00f4 \u1edf \u0111\u1ed9 s\u00e2u 3 \u2013 5 cm d\u01b0\u1edbi da m\u00e0 kh\u00f4ng t\u0103ng nhi\u1ec7t \u0111\u1ed9 ngo\u00e0i da. Li\u1ec1u l\u01b0\u1ee3ng si\u00eau \u00e2m \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh nh\u01b0 sau:<\/p>\n<ul>\n<li>Li\u1ec1u nh\u1eb9: &lt; 0, 5 W\/cm<sup>2<\/sup><\/li>\n<li>Li\u1ec1u trung b\u00ecnh: 0,5 \u2013 1,2 W\/cm<sup>2 <\/sup>&#8211; Li\u1ec1u m\u1ea1nh: 1,2 \u2013 3 W\/cm<sup>2<\/sup>.<\/li>\n<\/ul>\n<p><strong>C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng:<\/strong> s\u00f3ng \u00e2m c\u00f3 t\u00e1c \u0111\u1ed9ng v\u1ec1 nhi\u1ec7t v\u00e0 c\u01a1 h\u1ecdc l\u00ean v\u00f9ng m\u00f4 t\u1ed5n th\u01b0\u01a1ng. S\u1ef1 h\u1ea5p th\u1ee5 s\u00f3ng \u00e2m b\u1edfi m\u00f4 s\u1ea3n sinh ra nhi\u1ec7t. M\u1ed7i lo\u1ea1i m\u00f4 trong c\u01a1 th\u1ec3 c\u00f3 m\u1ed9t h\u1ec7 s\u1ed1 suy gi\u1ea3m kh\u00e1c nhau <strong>(B\u1ea3ng 8.7)<\/strong>, bi\u1ec3u hi\u1ec7n cho s\u1ef1 suy gi\u1ea3m c\u1ee7a s\u00f3ng si\u00eau \u00e2m khi \u0111i qua m\u00f4i tr\u01b0\u1eddng \u0111\u00f3. H\u1ec7 s\u1ed1 suy gi\u1ea3m c\u00e0ng l\u1edbn, s\u1ef1 h\u1ea5p th\u1ee5 t\u1ea1i m\u00f4 c\u00e0ng nhi\u1ec1u d\u1eabn \u0111\u1ebfn hi\u1ec7u \u1ee9ng nhi\u1ec7t c\u00e0ng cao. M\u00f4i tr\u01b0\u1eddng ch\u1ee9a nhi\u1ec1u collagen h\u1ea5p th\u1ee5 s\u00f3ng nhi\u1ec1u nh\u1ea5t, v\u00ec v\u1eady x\u01b0\u01a1ng, c\u01a1 v\u00e0 m\u00f4 li\u00ean k\u1ebft quanh kh\u1edbp c\u00f3 th\u1ec3 s\u1ea3n sinh m\u1ed9t hi\u1ec7u \u1ee9ng nhi\u1ec7t \u0111\u1ee7 \u0111\u1ec3 l\u00e0m t\u0103ng t\u00ednh k\u00e9o gi\u00e3n c\u1ee7a d\u00e2y ch\u1eb1ng, g\u00e2n c\u01a1 v\u00e0 bao kh\u1edbp. Ngo\u00e0i t\u00e1c \u0111\u1ed9ng v\u1ec1 nhi\u1ec7t \u0111\u1ed9 c\u00f2n gi\u00fap gi\u1ea3m \u0111au, gi\u1ea3m c\u0103ng c\u01a1, t\u0103ng t\u01b0\u1edbi m\u00e1u v\u00e0 t\u0103ng t\u1ed1c \u0111\u1ed9 chuy\u1ec3n h\u00f3a. Tuy nhi\u00ean, s\u00f3ng si\u00eau \u00e2m v\u1edbi t\u1ea7n s\u1ed1 c\u00e0ng cao th\u00ec \u0111\u1ed9 xuy\u00ean th\u1ea5u c\u00e0ng k\u00e9m v\u00e0 hi\u1ec7u \u1ee9ng nhi\u1ec7t m\u1eb7c d\u00f9 cao nh\u01b0ng b\u1ecb gi\u1edbi h\u1ea1n \u1edf v\u00f9ng m\u00f4 n\u00f4ng. Th\u1ef1c nghi\u1ec7m cho th\u1ea5y s\u00f3ng v\u1edbi t\u1ea7n s\u1ed1 1 MHz l\u00e0 t\u1ed1i \u01b0u nh\u1ea5t v\u1edbi m\u00f4 \u1edf \u0111\u1ed9 s\u00e2u 5 cm d\u01b0\u1edbi da v\u00e0 s\u00f3ng v\u1edbi t\u1ea7n s\u1ed1 3 MHz th\u00edch h\u1ee3p cho m\u00f4 \u1edf \u0111\u1ed9 s\u00e2u 1 \u2013 2 cm d\u01b0\u1edbi da.<\/p>\n<p><strong>B\u1ea3ng 8.7.<\/strong> H\u1ec7 s\u1ed1 suy gi\u1ea3m c\u1ee7a m\u00f4<\/p>\n<table width=\"592\">\n<tbody>\n<tr>\n<td width=\"197\">\n<p><strong>M\u00f4<\/strong><\/p>\n<\/td>\n<td width=\"219\">\n<p><strong>H\u1ec7 s\u1ed1 suy gi\u1ea3m (dB\/cm)<\/strong><\/p>\n<\/td>\n<td width=\"176\">\n<p><strong>H\u1ec7 s\u1ed1 suy gi\u1ea3m (%\/cm)<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"197\">\n<p>M\u00e1u<\/p>\n<\/td>\n<td width=\"219\">\n<p>0,12<\/p>\n<\/td>\n<td width=\"176\">\n<p>3<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"197\">\n<p>M\u1ee1<\/p>\n<\/td>\n<td width=\"219\">\n<p>0,61<\/p>\n<\/td>\n<td width=\"176\">\n<p>13<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"197\">\n<p>Th\u1ea7n kinh<\/p>\n<\/td>\n<td width=\"219\">\n<p>0,88<\/p>\n<\/td>\n<td width=\"176\">\n<p>0<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"197\">\n<p>C\u01a1<\/p>\n<\/td>\n<td width=\"219\">\n<p>1,2<\/p>\n<\/td>\n<td width=\"176\">\n<p>24<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"197\">\n<p>M\u1ea1ch m\u00e1u<\/p>\n<\/td>\n<td width=\"219\">\n<p>1,7<\/p>\n<\/td>\n<td width=\"176\">\n<p>32<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"197\">\n<p>Da<\/p>\n<\/td>\n<td width=\"219\">\n<p>2,7<\/p>\n<\/td>\n<td width=\"176\">\n<p>39<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"197\">\n<p>G\u00e2n<\/p>\n<\/td>\n<td width=\"219\">\n<p>4,9<\/p>\n<\/td>\n<td width=\"176\">\n<p>59<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"197\">\n<p>S\u1ee5n<\/p>\n<\/td>\n<td width=\"219\">\n<p>5,0<\/p>\n<\/td>\n<td width=\"176\">\n<p>68<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"197\">\n<p>X\u01b0\u01a1ng<\/p>\n<\/td>\n<td width=\"219\">\n<p>13,9<\/p>\n<\/td>\n<td width=\"176\">\n<p>96<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>T\u00e1c d\u1ee5ng c\u01a1 h\u1ecdc c\u1ee7a s\u00f3ng si\u00eau \u00e2m ch\u1ee7 y\u1ebfu c\u00f3 \u0111\u01b0\u1ee3c t\u1eeb ph\u01b0\u01a1ng ph\u00e1p ph\u00e1t x\u1ea1 gi\u00e1n \u0111o\u1ea1n v\u1edbi xung c\u00f3 c\u01b0\u1eddng \u0111\u1ed9 th\u1ea5p (<em>low <\/em>\u2013 <em>intensity pulsed ultrasound<\/em>). V\u1edbi ph\u01b0\u01a1ng ph\u00e1p n\u00e0y, s\u1ef1 t\u0103ng nhi\u1ec7t \u0111\u1ed9 x\u1ea3y ra kh\u00f4ng \u0111\u00e1ng k\u1ec3 v\u00ec l\u01b0\u1ee3ng nhi\u1ec7t sinh ra \u1edf m\u1ed7i xung b\u1ecb ph\u00e2n t\u00e1n m\u1ea5t trong kho\u1ea3ng th\u1eddi gian gi\u00e1n \u0111o\u1ea1n gi\u1eefa hai xung. Nh\u1eefng nghi\u00ean c\u1ee9u v\u1ec1 t\u00e1c \u0111\u1ed9ng c\u01a1 h\u1ecdc cho th\u1ea5y c\u1ea3i thi\u1ec7n trong t\u00e1i c\u1ea5u tr\u00fac m\u00f4, kh\u00e1ng vi\u00eam, t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch v\u00e0 m\u00e0ng t\u1ebf b\u00e0o. Nh\u1eefng h\u1ec7 qu\u1ea3 n\u00e0y xu\u1ea5t ph\u00e1t t\u1eeb ba hi\u1ec7n t\u01b0\u1ee3ng: (1) t\u1ea1o hang (<em>cavitation<\/em>), (2) vi d\u00f2ng (<em>microstream<\/em>) v\u00e0 (3) d\u00f2ng s\u00f3ng \u00e2m (<em>acoustic streaming<\/em>). Hi\u1ec7n t\u01b0\u1ee3ng (2) v\u00e0 (3) l\u00e0 nh\u1eefng dao \u0111\u1ed9ng c\u1ee7a m\u00f4i tr\u01b0\u1eddng khi c\u00f3 s\u00f3ng si\u00eau \u00e2m di chuy\u1ec3n qua. C\u00e1c ph\u1ea7n t\u1eed trong m\u00f4i tr\u01b0\u1eddng dao \u0111\u1ed9ng t\u1ea1o n\u00ean c\u00e1c pha n\u00e9n v\u00e0 pha gi\u00e3n. S\u1ef1 dao \u0111\u1ed9ng c\u1ee7a c\u00e1c ph\u1ea7n t\u1eed v\u00e0 s\u1ef1 thay \u0111\u1ed5i \u00e1p su\u1ea5t l\u00e0m t\u0103ng t\u00ednh th\u1ea5m qua c\u00e1c m\u00e0ng c\u1ee7a c\u00e1c t\u1ed5 ch\u1ee9c, t\u0103ng t\u00ednh khu\u1ebfch t\u00e1n v\u00e0 th\u1ea9m th\u1ea5u c\u1ee7a t\u1ed5 ch\u1ee9c, t\u1eeb \u0111\u00f3 l\u00e0m t\u0103ng c\u00e1c qu\u00e1 tr\u00ecnh sinh h\u1ecdc c\u1ee7a t\u1ed5 ch\u1ee9c, bao g\u1ed3m ho\u1ea1t \u0111\u1ed9ng c\u1ee7a \u0111\u1ea1i th\u1ef1c b\u00e0o, s\u1ef1 t\u1ed5ng h\u1ee3p protein c\u1ee7a nguy\u00ean b\u00e0o s\u1ee3i, t\u0103ng s\u1ea3n xu\u1ea5t nitric oxid gi\u00fap gi\u00e3n m\u1ea1ch v\u00e0 k\u00edch ho\u1ea1t t\u1ebf b\u00e0o t\u0103ng tr\u01b0\u1edfng bi\u1ec7t h\u00f3a th\u00e0nh t\u1ebf b\u00e0o c\u01a1 m\u1edbi. S\u1ef1 t\u1ea1o l\u1ed7 th\u1ef1c ch\u1ea5t l\u00e0 dao \u0111\u1ed9ng c\u1ee7a nh\u1eefng b\u00f3ng kh\u00ed t\u1ef1 nhi\u00ean trong m\u00f4. C\u00e1c b\u00f3ng kh\u00ed n\u00e0y c\u00f3 th\u1ec3 v\u1ee1 v\u00e0 t\u1ea1o ra m\u1ed9t \u00e1p l\u1ef1c l\u00ean m\u00f4i tr\u01b0\u1eddng xung quanh. C\u00e1c ph\u00e2n t\u1eed c\u00f3 th\u1ec3 b\u1ecb k\u00edch th\u00edch d\u1eabn \u0111\u1ebfn t\u0103ng t\u1ed1c \u0111\u1ed9 ph\u1ea3n \u1ee9ng sinh h\u1ecdc.<\/p>\n<p><strong>Ch\u1ec9 \u0111\u1ecbnh:<\/strong> si\u00eau \u00e2m tr\u1ecb li\u1ec7u th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 gi\u1ea3m \u0111au (\u0111au do th\u1ea7n kinh, co th\u1eaft c\u01a1,\u2026) tr\u01b0\u1edbc c\u00e1c b\u00e0i t\u1eadp k\u00e9o gi\u00e3n m\u00f4 m\u1ec1m (m\u00f4 li\u00ean k\u1ebft quanh kh\u1edbp) v\u00e0 nh\u1eefng t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m, d\u00e2y ch\u1eb1ng, g\u00e2n c\u01a1 v\u00ec s\u00f3ng si\u00eau \u00e2m th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh l\u00e0nh v\u1ebft th\u01b0\u01a1ng v\u00e0 t\u00e1i t\u1ea1o m\u00f4. Ph\u01b0\u01a1ng ph\u00e1p ph\u00e1t xung gi\u00e1n \u0111o\u1ea1n c\u01b0\u1eddng \u0111\u1ed9 th\u1ea5p hi\u1ec7n nay c\u00f2n \u0111\u01b0\u1ee3c khuy\u1ebft c\u00e1o s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb g\u00e3y x\u01b0\u01a1ng gi\u00fap gi\u1ea3m th\u1eddi gian li\u1ec1n x\u01b0\u01a1ng; s\u00f3ng si\u00eau \u00e2m c\u01b0\u1eddng \u0111\u1ed9 l\u1edbn c\u00f3 th\u1ec3 g\u00e2y \u0111au v\u00e0 ch\u1eadm l\u00e0nh. S\u1ef1 t\u1ed5n th\u01b0\u01a1ng, th\u1eddi gian b\u1ea5t \u0111\u1ed9ng l\u00e2u ng\u00e0y v\u00e0 s\u1ef1 t\u1ea1o s\u1eb9o c\u00f3 th\u1ec3 g\u00e2y co r\u00fat c\u00e1c m\u00f4 li\u00ean k\u1ebft v\u00e0 l\u00e0m gi\u1ea3m t\u1ea7m v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp. V\u00ec v\u1eady, t\u00e1c \u0111\u1ed9ng nhi\u1ec7t c\u1ee7a s\u00f3ng si\u00eau \u00e2m v\u00e0o s\u00e2u \u0111\u1ebfn c\u00e1c c\u1ea5u tr\u00fac n\u00e0y \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong v\u1eadt l\u00fd tr\u1ecb li\u1ec7u. S\u00f3ng si\u00eau \u00e2m c\u00f2n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng \u0111\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 truy\u1ec1n t\u1ea3i thu\u1ed1c qua da qua t\u00e1c \u0111\u1ed9ng c\u01a1 h\u1ecdc khi s\u00f3ng di chuy\u1ec3n qua v\u00f9ng th\u01b0\u1ee3ng b\u00ec c\u0169ng nh\u01b0 kh\u1ea3 n\u0103ng t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch v\u00e0 m\u00e0ng t\u1ebf b\u00e0o.<\/p>\n<figure id=\"attachment_1937\" aria-describedby=\"caption-attachment-1937\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1937\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture6-300x71.jpg\" alt=\"Picture6\" width=\"300\" height=\"71\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture6-300x71.jpg 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture6-18x4.jpg 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture6.jpg 592w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1937\" class=\"wp-caption-text\"><strong>H\u00ecnh 8.5. (A) <\/strong>D\u1ee5ng c\u1ee5 si\u00eau \u00e2m. <strong>(B)<\/strong> \u00c1p d\u1ee5ng si\u00eau \u00e2m li\u1ec7u ph\u00e1p tr\u00ean t\u1ed5n th\u01b0\u01a1ng h\u1edf.<strong> (C)<\/strong> \u00c1p d\u1ee5ng si\u00eau \u00e2m li\u1ec7u ph\u00e1p tr\u00ean t\u1ed5n th\u01b0\u01a1ng k\u00edn [3]<\/figcaption><\/figure>\n<p>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/p>\n<p>C\u00e1c v\u00f9ng nh\u01b0 n\u00e3o, t\u1ee7y s\u1ed1ng, c\u01a1 quan sinh d\u1ee5c, thai nhi.<\/p>\n<p>V\u00f9ng \u0111i\u1ec1u tr\u1ecb c\u00f3 mang c\u00e1c v\u1eadt kim lo\u1ea1i ho\u1eb7c v\u1eadt r\u1eafn (\u0111inh, n\u1eb9p v\u00edt,&#8230;).<\/p>\n<p>C\u00e1c kh\u1ed1i u (c\u1ea3 u l\u00e0nh v\u00e0 u \u00e1c t\u00ednh).<\/p>\n<p>Gi\u00e3n t\u0129nh m\u1ea1ch v\u00e0 vi\u00eam t\u1eafc \u0111\u1ed9ng m\u1ea1ch, vi\u00eam t\u1eafc t\u0129nh m\u1ea1ch.<\/p>\n<p>C\u00e1c v\u00f9ng \u0111ang ch\u1ea3y m\u00e1u v\u00e0 c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u nh\u01b0 t\u1eed cung th\u1eddi k\u1ef3 kinh nguy\u1ec7t, ch\u1ea3y m\u00e1u d\u1ea1 d\u00e0y, c\u00e1c v\u1ebft th\u01b0\u01a1ng m\u1edbi, c\u00e1c ch\u1ea5n th\u01b0\u01a1ng c\u00f3 t\u1ee5 m\u00e1u,&#8230;<\/p>\n<p>C\u00e1c \u1ed5 vi\u00eam nhi\u1ec5m khu\u1ea9n v\u00ec c\u00f3 th\u1ec3 l\u00e0m vi khu\u1ea9n lan r\u1ed9ng.<\/p>\n<p>C\u00e1c ch\u1ea5n th\u01b0\u01a1ng m\u1edbi trong 3 ng\u00e0y \u0111\u1ea7u.<\/p>\n<ol start=\"5\">\n<li><strong>C\u00c1C T\u00c1C NH\u00c2N \u0110I\u1ec6N T\u1eea KH\u00c1C<\/strong><\/li>\n<\/ol>\n<p>S\u00f3ng \u0111i\u1ec7n t\u1eeb bao g\u1ed3m m\u1ed9t chu\u1ed7i c\u00e1c b\u01b0\u1edbc s\u00f3ng t\u1eeb 10<sup>-15<\/sup> \u0111\u1ebfn 10<sup>5<\/sup> m <strong>(H\u00ecnh 8.6)<\/strong>. B\u01b0\u1edbc s\u00f3ng c\u00e0ng ng\u1eafn, n\u0103ng l\u01b0\u1ee3ng c\u00e0ng cao v\u00e0 ng\u01b0\u1ee3c l\u1ea1i. Trong ph\u1ea7n n\u00e0y, 2 s\u00f3ng \u0111i\u1ec7n t\u1eeb \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp, l\u00e0 \u00e1nh s\u00e1ng th\u1ea5y \u0111\u01b0\u1ee3c (<em>visible light<\/em>) v\u00e0 tia c\u1ef1c t\u00edm (<em>ultraviolet<\/em>). Tia h\u1ed3ng ngo\u1ea1i (infrared light) \u0111\u00e3 \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y \u1edf ph\u1ea7n nhi\u1ec7t n\u00f4ng. Vi s\u00f3ng (microwave) v\u00e0 s\u00f3ng ng\u1eafn (<em>shortwave<\/em> hay <em>radiowave<\/em>) l\u00e0 nh\u1eefng t\u00e1c nh\u00e2n nhi\u1ec7t s\u00e2u.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1938\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture7-300x128.png\" alt=\"Picture7\" width=\"300\" height=\"128\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture7-300x128.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture7-1024x437.png 1024w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture7-768x328.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture7-1536x656.png 1536w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture7-18x8.png 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture7.png 1871w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<p><strong>5.1. Laser v\u00e0 \u00e1nh s\u00e1ng<\/strong><\/p>\n<p><strong>\u0110\u1ecbnh ngh\u0129a: <\/strong>\u00e1nh s\u00e1ng th\u1ea5y \u0111\u01b0\u1ee3c l\u00e0 m\u1ed9t d\u1ea1ng s\u00f3ng \u0111i\u1ec7n t\u1eeb c\u00f3 b\u01b0\u1edbc s\u00f3ng t\u1eeb 400 \u2013 700 nm. Kh\u00e1i ni\u1ec7m s\u00f3ng \u00e1nh s\u00e1ng d\u00f9ng trong tr\u1ecb li\u1ec7u l\u00e0 c\u00e1c b\u01b0\u1edbc s\u00f3ng g\u1ea7n ho\u1eb7c trong v\u00f9ng nh\u00ecn th\u1ea5y, t\u1eeb 500 \u2013 1.100 nm. M\u1ed9t ch\u00f9m \u00e1nh s\u00e1ng t\u1eeb ngu\u1ed3n s\u00e1ng (v\u00ed d\u1ee5 \u0111\u00e8n LED, \u0111\u00e8n d\u00e2y t\u00f3c,\u2026) c\u00f3 th\u1ec3 bao g\u1ed3m nhi\u1ec1u s\u00f3ng v\u1edbi c\u00e1c b\u01b0\u1edbc s\u00f3ng kh\u00e1c nhau v\u00e0 \u0111\u01b0\u1ee3c mi\u00eau t\u1ea3 l\u00e0 \u0111a m\u00e0u (<em>polychromic<\/em>). Ng\u01b0\u1ee3c l\u1ea1i, laser c\u0169ng l\u00e0 m\u1ed9t tia \u00e1nh s\u00e1ng, nh\u01b0ng \u0111\u01a1n m\u00e0u (<em>monochromic<\/em>) v\u00ec ch\u1ec9 bao g\u1ed3m m\u1ed9t lo\u1ea1i s\u00f3ng. Khi \u00e1nh s\u00e1ng \u0111\u01b0\u1ee3c chi\u1ebfu v\u00e0o m\u00f4, ch\u00fang s\u1ebd b\u1ecb h\u1ea5p th\u1ee5 v\u00e0 t\u1eeb \u0111\u00f3 g\u00e2y ra nh\u1eefng hi\u1ec7u \u1ee9ng h\u00f3a \u2013 sinh h\u1ecdc l\u00ean t\u1ebf b\u00e0o.<\/p>\n<p>Laser (<em>Light Amplification by Stimulated Emission of Radiation<\/em>) ch\u1ec9 v\u1ec1 s\u1ef1 khu\u1ebfch \u0111\u1ea1i \u00e1nh s\u00e1ng b\u1eb1ng s\u1ef1 ph\u00e1t x\u1ea1 k\u00edch th\u00edch. Laser l\u00e0 m\u1ed9t ph\u01b0\u01a1ng th\u1ee9c t\u1ea1o ra \u00e1nh s\u00e1ng c\u00f3 t\u00ednh \u0111\u1ecbnh h\u01b0\u1edbng v\u00e0 c\u01b0\u1eddng \u0111\u1ed9 cao. V\u1eadt li\u1ec7u \u0111\u1ec3 t\u1ea1o laser c\u00f3 th\u1ec3 l\u00e0 kh\u00ed (He, Ne) ho\u1eb7c ch\u1ea5t r\u1eafn (Al, Ga, As). Hi\u1ec7n nay, c\u00f3 hai lo\u1ea1i laser \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ch\u00ednh trong y h\u1ecdc l\u00e0 laser \u0111\u1ecf d\u1ea1ng kh\u00ed (HeNe; 632,8 nm) v\u00e0 diod b\u00e1n d\u1eabn h\u1ed3ng ngo\u1ea1i nh\u01b0 (GaAs, 904 nm) ho\u1eb7c (AlGaAs, 808 nm).<\/p>\n<p><strong>C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng:<\/strong> m\u00f4 sau khi h\u1ea5p th\u1ee5 c\u00e1c s\u00f3ng \u00e1nh s\u00e1ng, s\u1ebd \u0111\u01b0\u1ee3c k\u00edch th\u00edch t\u1ea1o nhi\u1ec1u ATP, qua nh\u1eefng t\u00e1c \u0111\u1ed9ng l\u00ean men cytochrome-c-oxidase trong chu\u1ed7i truy\u1ec1n electron t\u1ea1i ti th\u1ec3 v\u00e0 t\u0103ng ho\u1ea1t qu\u00e1 tr\u00ecnh phi\u00ean m\u00e3. Vi\u1ec7c t\u0103ng t\u1ed5ng h\u1ee3p nh\u1eefng RNA quy \u0111\u1ecbnh cho protein ti\u1ec1n collagen t\u1ea1o nhi\u1ec1u collagen lo\u1ea1i I h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh l\u00e0nh. Ngo\u00e0i ra, s\u00f3ng \u00e1nh s\u00e1ng c\u00f2n th\u00fac \u0111\u1ea9y t\u0103ng sinh nguy\u00ean b\u00e0o s\u1ee3i v\u00e0 n\u1ed9i m\u1ea1ch, g\u00f3p ph\u1ea7n v\u00e0o vi\u1ec7c t\u00e1i t\u1ea1o m\u1ea1ng l\u01b0\u1edbi vi m\u1ea1ch t\u1ea1i n\u01a1i t\u1ed5n th\u01b0\u01a1ng. Li\u1ec7u ph\u00e1p \u00e1nh s\u00e1ng c\u00f2n l\u00e0m thay \u0111\u1ed5i nhi\u1ec7t \u0111\u1ed9 c\u1ee7a m\u00f4 t\u1ed5n th\u01b0\u01a1ng, gi\u00fap gi\u1ea3m \u0111au, gi\u1ea3m vi\u00eam. M\u1eb7c d\u00f9 c\u01a1 ch\u1ebf cho t\u1eebng t\u00e1c \u0111\u1ed9ng ch\u01b0a \u0111\u01b0\u1ee3c r\u00f5 r\u00e0ng, nhi\u1ec1u th\u00ed nghi\u1ec7m cho th\u1ea5y laser c\u00f3 th\u1ec3 g\u00e2y gi\u00e3n m\u1ea1ch, qua \u0111\u00f3 t\u0103ng t\u01b0\u1edbi m\u00e1u, t\u0103ng cung c\u1ea5p oxygen v\u00e0 d\u01b0\u1ee1ng ch\u1ea5t, c\u0169ng nh\u01b0 lo\u1ea1i b\u1ecf ch\u1ea5t th\u1ea3i chuy\u1ec3n h\u00f3a, h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh l\u00e0nh v\u1ebft th\u01b0\u01a1ng. L\u1ee3i \u00edch kh\u00e1ng khu\u1ea9n c\u1ee7a s\u00f3ng \u00e1nh s\u00e1ng th\u1ea5y \u0111\u01b0\u1ee3c qua s\u1ef1 \u1ee9c ch\u1ebf s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a vi sinh v\u1eadt, bao g\u1ed3m <em>Staphylococcus aureus, Pseudomonas aeruginosa<\/em> v\u00e0 <em>Escherichia coli<\/em>, c\u0169ng nh\u01b0 c\u00e1c lo\u1ea1i n\u1ea5m.<\/p>\n<p><strong>Ch\u1ec9 \u0111\u1ecbnh:<\/strong> v\u1edbi nh\u1eefng l\u1ee3i \u00edch trong vi\u1ec7c gi\u1ea3m \u0111au, kh\u00e1ng vi\u00eam, gi\u1ea3m th\u1eddi gian l\u00e0nh v\u1ebft th\u01b0\u01a1ng, li\u1ec7u ph\u00e1p \u00e1nh s\u00e1ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong nh\u1eefng t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m, g\u00e3y x\u01b0\u01a1ng, tho\u00e1i h\u00f3a kh\u1edbp, vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, \u0111i\u1ec1u tr\u1ecb \u0111au. Li\u1ec1u \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong <strong>(B\u1ea3ng 8.8).<\/strong><\/p>\n<p><strong>B\u1ea3ng 8.8.<\/strong> Li\u1ec1u laser \u0111i\u1ec1u tr\u1ecb trong m\u1ed9t s\u1ed1 ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng<\/p>\n<table width=\"594\">\n<tbody>\n<tr>\n<td width=\"304\">\n<p><strong>Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n<\/td>\n<td width=\"290\">\n<p><strong>Li\u1ec1u (J\/cm<\/strong><strong><sup>2<\/sup><\/strong><strong>)<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"304\">\n<p>M\u00f4 m\u1ec1m \u0111ang l\u00e0nh<\/p>\n<\/td>\n<td width=\"290\">\n<p>1,8 \u2013 40 (th\u01b0\u1eddng l\u00e0 5 \u2013 24)<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"304\">\n<p>X\u01b0\u01a1ng \u0111ang l\u00e0nh<\/p>\n<\/td>\n<td width=\"290\">\n<p>T\u1ed1i \u0111a 120<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"304\">\n<p>Vi\u00eam kh\u1edbp<\/p>\n<\/td>\n<td width=\"290\">\n<p>0,5 \u2013 2700<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"304\">\n<p>Vi\u00eam h\u1ea1ch<\/p>\n<\/td>\n<td width=\"290\">\n<p>1 \u2013 2<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"304\">\n<p>H\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay<\/p>\n<\/td>\n<td width=\"290\">\n<p>3 \u2013 9 (t\u1ed1i \u0111a 32)<\/p>\n<p>&nbsp;<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>C\u00e1ch \u1ee9ng d\u1ee5ng li\u1ec7u ph\u00e1p \u00e1nh s\u00e1ng ho\u1eb7c laser trong v\u1eadt l\u00fd tr\u1ecb li\u1ec7u<strong> (H\u00ecnh 8.7)<\/strong>: ngu\u1ed3n s\u00e1ng c\u00f3 th\u1ec3 ph\u00e1t \u00e1nh s\u00e1ng \u0111\u1ecf (600 \u2013 700 nm) ho\u1eb7c s\u00f3ng d\u00e0i h\u01a1n ho\u1eb7c tia laser. Ngu\u1ed3n s\u00e1ng n\u00e0y \u0111\u01b0\u1ee3c \u00e1p v\u00e0o v\u00f9ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb tr\u00ean c\u01a1 th\u1ec3 b\u1ec7nh nh\u00e2n. Ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n \u0111\u01b0\u1ee3c \u0111eo k\u00ednh b\u1ea3o h\u1ed9 m\u1eaft trong qu\u00e1 tr\u00ecnh s\u1eed d\u1ee5ng tia laser.<\/p>\n<figure id=\"attachment_1939\" aria-describedby=\"caption-attachment-1939\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1939\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture8-300x203.jpg\" alt=\"Picture8\" width=\"300\" height=\"203\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture8-300x203.jpg 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture8-18x12.jpg 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture8.jpg 421w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1939\" class=\"wp-caption-text\"><strong>H\u00ecnh 8.7. (A) <\/strong>Ngu\u1ed3n ph\u00e1t laser. <strong>(B) v\u00e0 (C)<\/strong> \u00c1p d\u1ee5ng tia laser v\u00e0o nh\u1eefng v\u00f9ng t\u1ed5n th\u01b0\u01a1ng kh\u00e1c nhau [3]<\/figcaption><\/figure>\n<p><strong>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: <\/strong>ung th\u01b0, chi\u1ebfu laser tr\u1ef1c ti\u1ebfp v\u00e0o m\u1eaft, b\u1ec7nh nh\u00e2n v\u1eeba ho\u00e0n th\u00e0nh x\u1ea1 tr\u1ecb trong v\u00f2ng 4 \u2013 6 th\u00e1ng, chi\u1ebfu l\u00ean tuy\u1ebfn gi\u00e1p ho\u1eb7c c\u00e1c tuy\u1ebfn n\u1ed9i ti\u1ebft, v\u00f9ng t\u1ed5n th\u01b0\u01a1ng \u0111ang ch\u1ea3y m\u00e1u, \u0111\u0129a s\u1ee5n \u0111ang ph\u00e1t tri\u1ec3n \u1edf tr\u1ebb em v\u00e0 ph\u1ee5 n\u1eef mang thai.<\/p>\n<p><strong>5.2. Ultraviolet (UV)<\/strong><\/p>\n<p><strong>\u0110\u1ecbnh ngh\u0129a:<\/strong> l\u00e0 tia \u0111i\u1ec7n t\u1eeb c\u00f3 t\u1ea7n s\u1ed1 7,5\u00d710<sup>4<\/sup> \u0111\u1ebfn tr\u00ean 10<sup>5<\/sup> Hz v\u00e0 c\u00f3 b\u01b0\u1edbc s\u00f3ng t\u1eeb 400 \u0111\u1ebfn nh\u1ecf h\u01a1n 290 nm. Tia UV d\u00f9ng trong v\u1eadt l\u00fd tr\u1ecb li\u1ec7u \u0111\u01b0\u1ee3c chia l\u00e0m ba lo\u1ea1i theo ba kho\u1ea3ng b\u01b0\u1edbc s\u00f3ng kh\u00e1c nhau.<\/p>\n<p>UV-A ho\u1eb7c tia UV c\u00f3 b\u01b0\u1edbc s\u00f3ng d\u00e0i (320 \u2013 400 nm) c\u00f3 t\u00e1c d\u1ee5ng \u0111\u1ed5i m\u00e0u da (tanning) do k\u00edch th\u00edch s\u1ef1 t\u00edch t\u1ee5 c\u1ee7a melanin \u1edf t\u1ea7ng \u0111\u00e1y l\u1edbp th\u01b0\u1ee3ng b\u00ec.<\/p>\n<p>UV-B ho\u1eb7c tia UV c\u00f3 b\u01b0\u1edbc s\u00f3ng v\u1eeba (290 \u2013 320 nm) c\u00f3 t\u00e1c d\u1ee5ng g\u00e2y \u0111\u1ecf da v\u00e0 ph\u1ecfng (ch\u00e1y n\u1eafng) v\u00e0 \u0111\u01b0\u1ee3c d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb psoriasis.<\/p>\n<p>UV-C ho\u1eb7c tia UV c\u00f3 b\u01b0\u1edbc s\u00f3ng ng\u1eafn (&lt; 290 nm) c\u00f3 t\u00e1c d\u1ee5ng di\u1ec7t khu\u1ea9n v\u00e0 \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb n\u1ea5m ho\u1eb7c lo\u00e9t da.<\/p>\n<p>Ph\u01b0\u01a1ng th\u1ee9c \u00e1p d\u1ee5ng tia UV trong \u0111i\u1ec1u tr\u1ecb l\u00e0 d\u00f9ng \u0111\u00e8n chi\u1ebfu m\u1ed9t lo\u1ea1i tia UV v\u00e0o v\u00f9ng da t\u1ed5n th\u01b0\u01a1ng c\u1ee7a b\u1ec7nh nh\u00e2n. T\u00e1c \u0111\u1ed9ng c\u1ee7a tia UV l\u00ean c\u01a1 th\u1ec3, ngo\u00e0i lo\u1ea1i tia, c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 c\u1ee7a ngu\u1ed3n \u0111\u00e8n, kho\u1ea3ng c\u00e1ch, di\u1ec7n t\u00edch da ti\u1ebfp x\u00fac v\u00e0 g\u00f3c chi\u1ebfu. Tia UV-A c\u00f3 \u0111\u1ed9 xuy\u00ean th\u1ea5u cao nh\u1ea5t v\u00e0 khi chi\u1ebfu \u1edf g\u00f3c 90<sup>o<\/sup> so v\u1edbi b\u1ec1 m\u1eb7t da, s\u1ebd c\u00f3 t\u00e1c \u0111\u1ed9ng l\u1edbn nh\u1ea5t.<\/p>\n<p><strong>C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng:<\/strong> tia UV t\u1ea1o ra nh\u1eefng ph\u1ea3n \u1ee9ng quang h\u00f3a h\u1ecdc khi ti\u1ebfp x\u00fac v\u1edbi m\u00f4 c\u01a1 th\u1ec3, qua \u0111\u00f3 t\u1ed5ng h\u1ee3p ch\u1ea5t h\u00f3a h\u1ecdc (vitamin D3), \u1ea3nh h\u01b0\u1edfng ho\u1ea1t \u0111\u1ed9ng t\u1ebf b\u00e0o, g\u00e2y \u0111\u1ecf da, s\u1eabm m\u00e0u da, di\u1ec7t khu\u1ea9n, c\u0169ng nh\u01b0 \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a h\u1ec7 mi\u1ec5n d\u1ecbch. Hi\u1ec7n t\u01b0\u1ee3ng \u0111\u1ecf da x\u1ea3y ra do s\u1ef1 ti\u1ebft histamin v\u00e0 prostaglandin t\u1eeb l\u1edbp th\u01b0\u1ee3ng b\u00ec g\u00e2y gi\u00e3n m\u1ea1ch m\u00e1u. Tuy nhi\u00ean, c\u01a1 ch\u1ebf th\u1ef1c s\u1ef1 c\u1ee7a t\u00e1c \u0111\u1ed9ng n\u00e0y c\u1ee7a tia UV v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch r\u00f5. Li\u1ec1u l\u01b0\u1ee3ng tia UV \u0111\u01b0\u1ee3c t\u00ednh to\u00e1n d\u1ef1a v\u00e0o li\u1ec1u t\u1ed1i thi\u1ec3u \u0111\u1ec3 hi\u1ec7n t\u01b0\u1ee3ng \u0111\u1ecf da x\u1ea3y ra. Ph\u1ea7n l\u1edbn \u1ee9ng d\u1ee5ng c\u1ee7a tia UV ch\u00fa tr\u1ecdng v\u00e0o c\u00e1c b\u1ec7nh da li\u1ec5u ho\u1eb7c t\u1ef1 mi\u1ec5n. D\u00f9 v\u1eady, c\u00e1c t\u00e1c \u0111\u1ed9ng g\u00e2y gi\u00e3n m\u1ea1ch m\u00e1u, kh\u00e1ng khu\u1ea9n ho\u1eb7c sinh t\u1ed5ng h\u1ee3p vitamin D3 v\u1eabn c\u00f3 nh\u1eefng l\u1ee3i \u00edch nh\u1ea5t \u0111\u1ecbnh l\u00ean h\u1ec7 c\u01a1 x\u01b0\u01a1ng.<\/p>\n<ol start=\"6\">\n<li><strong>\u0110I\u1ec6N TR\u1eca LI\u1ec6U<\/strong> (<strong><em>Electrotherapy<\/em>)<\/strong><\/li>\n<\/ol>\n<p><strong>6.1. \u0110\u1ecbnh ngh\u0129a<\/strong><\/p>\n<p>\u00a0D\u00f2ng \u0111i\u1ec7n l\u00e0 d\u00f2ng c\u1ee7a c\u00e1c h\u1ea1t mang \u0111i\u1ec7n t\u00edch (ion d\u01b0\u01a1ng ho\u1eb7c \u00e2m). C\u00f3 ba lo\u1ea1i d\u00f2ng \u0111i\u1ec7n (1) m\u1ed9t chi\u1ec1u, (2) xoay chi\u1ec1u v\u00e0 (3) d\u00f2ng \u0111i\u1ec7n theo xung (pulsed current). V\u00ec c\u00e1c t\u1ebf b\u00e0o trong c\u01a1 th\u1ec3, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1ebf b\u00e0o c\u01a1 v\u00e0 th\u1ea7n kinh, lu\u00f4n \u0111\u01b0\u1ee3c \u0111i\u1ec1u khi\u1ec3n b\u1edfi tin hi\u1ec7u \u0111i\u1ec7n \u2013 s\u1ef1 kh\u1eed c\u1ef1c m\u00e0ng t\u1ebf b\u00e0o v\u00e0 t\u00edn hi\u1ec7u th\u1ea7n kinh, d\u00f2ng \u0111i\u1ec7n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 g\u00e2y ra c\u00e1c \u0111\u00e1p \u1ee9ng sinh l\u00fd, nh\u1ea5t l\u00e0 trong ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng, \u0111\u1ec3 h\u1ed7 tr\u1ee3 b\u1ec7nh nh\u00e2n l\u1ea5y l\u1ea1i ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng s\u1edbm nh\u1ea5t c\u00f3 th\u1ec3. \u0110\u1ec3 \u00e1p d\u1ee5ng \u0111i\u1ec7n tr\u1ecb li\u1ec7u, m\u1ed9t b\u1ed9 (hay \u0111\u01a1n v\u1ecb) k\u00edch th\u00edch \u0111i\u1ec7n \u0111\u01b0\u1ee3c chu\u1ea9n b\u1ecb <strong>(H\u00ecnh 8.8)<\/strong>. C\u00e1c ch\u1ec9 s\u1ed1 v\u1ec1 d\u00f2ng \u0111i\u1ec7n s\u1ebd \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh sao cho ph\u00f9 h\u1ee3p v\u1edbi m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111i\u1ec7n c\u1ef1c \u0111\u01b0\u1ee3c \u0111\u1eb7t tr\u00ean da c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110i\u1ec7n c\u1ef1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf th\u00e0nh nh\u1eefng mi\u1ebfng d\u00e1n ho\u1eb7c g\u0103ng tay ho\u1eb7c b\u1ed3n n\u01b0\u1edbc m\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 ng\u00e2m chi v\u00e0o <strong>(H\u00ecnh 8.9).<\/strong><\/p>\n<p><figure id=\"attachment_1940\" aria-describedby=\"caption-attachment-1940\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1940\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture9-300x104.png\" alt=\"Picture9\" width=\"300\" height=\"104\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture9-300x104.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture9-1024x355.png 1024w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture9-768x266.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture9-1536x532.png 1536w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture9-18x6.png 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture9.png 1784w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1940\" class=\"wp-caption-text\"><strong>H\u00ecnh 8.8. <\/strong>M\u1ed9t b\u1ed9 d\u1ee5ng c\u1ee5 \u0111i\u1ec7n tr\u1ecb li\u1ec7u bao g\u1ed3m<strong> (1) <\/strong>B\u1ed9 \u0111i\u1ec1u khi\u1ec3n nh\u1eefng th\u00f4ng s\u1ed1 c\u1ee7a d\u00f2ng \u0111i\u1ec7n \u0111i\u1ec1u tr\u1ecb.<strong> (2) <\/strong>L\u1ed7 c\u1eafm cho c\u00e1c \u0111i\u1ec7n c\u1ef1c. <strong>(3) <\/strong>Ngu\u1ed3n \u0111i\u1ec7n c\u00f3 th\u1ec3 l\u00e0 pin 9V ho\u1eb7c \u0111i\u1ec7n t\u01b0\u1eddng [3]<\/figcaption><\/figure> <figure id=\"attachment_1941\" aria-describedby=\"caption-attachment-1941\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1941\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture10-300x107.png\" alt=\"Picture10\" width=\"300\" height=\"107\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture10-300x107.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture10-1024x365.png 1024w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture10-768x274.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture10-1536x547.png 1536w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture10-18x6.png 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture10.png 1864w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1941\" class=\"wp-caption-text\"><strong>H\u00ecnh 8.9. (A) <\/strong>\u0110i\u1ec7n c\u1ef1c d\u1ea1ng mi\u1ebfn d\u00e1n.<strong> (B) <\/strong>\u0110i\u1ec7n c\u1ef1c g\u0103ng tay (<em>garment electrode<\/em>). <strong>(C) <\/strong>\u0110i\u1ec7n c\u1ef1c l\u00e0 n\u01b0\u1edbc [3]<\/figcaption><\/figure><\/p>\n<p><strong>C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng: <\/strong>d\u00f2ng \u0111i\u1ec7n c\u00f3 th\u1ec3 t\u1ea1o ra m\u1ed9t \u0111i\u1ec7n th\u1ebf \u0111\u1ed9ng tr\u00ean m\u00e0ng t\u1ebf b\u00e0o, gi\u00fap d\u1eabn truy\u1ec1n th\u1ea7n kinh v\u00e0 k\u00edch th\u00edch co c\u01a1. K\u00edch th\u00edch t\u1eeb d\u00f2ng \u0111i\u1ec7n c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c nh\u1eefng k\u1ebft qu\u1ea3 sinh l\u00fd nh\u01b0 t\u0103ng s\u1ee9c c\u01a1, ng\u0103n ng\u1eeba teo c\u01a1 v\u00e0 gi\u1ea3m co c\u1ee9ng. Tuy nhi\u00ean, co c\u01a1 do k\u00edch \u1ee9ng \u0111i\u1ec7n t\u00e1c \u0111\u1ed9ng tr\u01b0\u1edbc ti\u00ean v\u00e0 ch\u1ee7 y\u1ebfu \u0111\u1ebfn c\u00e1c s\u1ee3i c\u01a1 nh\u00f3m II (co r\u00fat nhanh), kh\u00e1c v\u1edbi k\u00edch \u1ee9ng sinh l\u00fd t\u00e1c \u0111\u1ed9ng tr\u01b0\u1edbc ti\u00ean l\u00ean c\u00e1c s\u1ee3i c\u01a1 nh\u00f3m I (co r\u00fat ch\u1eadm) (xem ch\u01b0\u01a1ng <em>Sinh l\u00fd co c\u01a1 v\u00e0 thay \u0111\u1ed5i c\u1ee7a c\u01a1 sau ch\u1ea5n th\u01b0\u01a1ng<\/em>). V\u00ec th\u1ebf, th\u1eddi gian ngh\u1ec9 gi\u1eefa c\u00e1c \u0111\u1ee3t \u0111i\u1ec7n tr\u1ecb li\u1ec7u c\u1ea7n \u0111\u01b0\u1ee3c t\u00ednh to\u00e1n ph\u00f9 h\u1ee3p sao cho c\u01a1 b\u1eafp c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ngh\u1ec9 ng\u01a1i v\u00e0 s\u1eb5n s\u00e0ng \u0111\u00e1p \u1ee9ng v\u1edbi nh\u1eefng tr\u1ecb li\u1ec7u ti\u1ebfp theo. Ngo\u00e0i ra, s\u1ef1 ph\u1ed1i h\u1ee3p gi\u1eefa co c\u01a1 sinh l\u00fd (c\u00e1c b\u00e0i t\u1eadp v\u1eadn \u0111\u1ed9ng tr\u1ecb li\u1ec7u) v\u00e0 co c\u01a1 do k\u00edch \u1ee9ng \u0111i\u1ec7n l\u00e0 c\u1ea7n thi\u1ebft cho s\u1ef1 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng c\u1ee7a c\u1ea3 hai nh\u00f3m s\u1ee3i c\u01a1. \u0110\u1ed1i v\u1edbi t\u00ecnh tr\u1ea1ng li\u1ec7t c\u01a1 do t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh, \u00e1p d\u1ee5ng d\u00f2ng \u0111i\u1ec7n m\u1ed9t chi\u1ec1u \u00edt nh\u1ea5t 10 ms c\u00f3 th\u1ec3 k\u00edch th\u00edch co c\u01a1. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ea5t \u0111\u1ed9ng sau ph\u1eabu thu\u1eadt ho\u1eb7c do ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c c\u00f3 b\u1ec7nh l\u00fd v\u1ec1 c\u01a1, \u0111i\u1ec7n tr\u1ecb li\u1ec7u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng s\u1edbm nh\u1eb1m h\u1ed7 tr\u1ee3 t\u00e1i t\u1ea1o s\u1ee9c c\u01a1.<\/p>\n<p>K\u00edch th\u00edch c\u1ee7a d\u00f2ng \u0111i\u1ec7n theo xung t\u1eeb 100 \u2013 150\/gi\u00e2y trong kho\u1ea3ng 50 \u2013 80 us v\u1edbi c\u01b0\u1eddng \u0111\u1ed9 kh\u00f4ng g\u00e2y co c\u01a1, nh\u01b0ng v\u1eabn \u0111\u1ee7 \u0111\u1ec3 k\u00edch th\u00edch c\u1ea3m gi\u00e1c d\u1eabn truy\u1ec1n b\u1eb1ng th\u1ea7n kinh A beta. \u0110i\u1ec1u n\u00e0y gi\u00fap gi\u1ea3m \u0111au do \u1ee9c ch\u1ebf d\u1eabn truy\u1ec1n \u0111au (s\u1ee3i A delta v\u00e0 C) t\u1ea1i s\u1eebng sau t\u1ee7y s\u1ed1ng.<\/p>\n<p>D\u00f2ng \u0111i\u1ec7n c\u00f2n c\u00f3 th\u1ec3 k\u00edch th\u00edch c\u01a1 th\u1ec3 t\u1ed5ng h\u1ee3p opioid n\u1ed9i sinh gi\u00fap \u0111i\u1ec1u bi\u1ebfn d\u1eabn truy\u1ec1n c\u1ea3m gi\u00e1c \u0111au.<\/p>\n<p>D\u00f2ng \u0111i\u1ec7n c\u00f2n h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh l\u00e0nh b\u1eb1ng vi\u1ec7c thu h\u00fat c\u00e1c nguy\u00ean b\u00e0o s\u1ee3i, \u0111\u1ea1i th\u1ef1c b\u00e0o \u0111\u1ebfn v\u00f9ng t\u1ed5n th\u01b0\u01a1ng v\u00e0 k\u00edch th\u00edch s\u1ef1 t\u1ed5ng h\u1ee3p collagen cho qu\u00e1 tr\u00ecnh x\u01a1 h\u00f3a v\u00e0 t\u0103ng t\u1ed5ng h\u1ee3p y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng m\u1ea1ch (<em>vascular endothelial growth factor<\/em>) cho qu\u00e1 tr\u00ecnh t\u0103ng sinh m\u1ea1ch m\u00e1u. C\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o, t\u1ebf b\u00e0o bi\u1ec3u b\u00ec v\u00e0 b\u1ea1ch c\u1ea7u trung t\u00ednh kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng b\u1ecb thu h\u00fat v\u00e0o c\u1ef1c d\u01b0\u01a1ng, trong khi t\u1ebf b\u00e0o lympho, ti\u1ec3u c\u1ea7u, t\u1ebf b\u00e0o mast, t\u1ebf b\u00e0o keratin (<em>keratinocytes<\/em>), t\u1ebf b\u00e0o g\u1ed1c th\u1ea7n kinh (<em>neural progenitor cells<\/em>), nguy\u00ean b\u00e0o s\u1ee3i v\u00e0 b\u1ea1ch c\u1ea7u trung t\u00ednh ho\u1ea1t h\u00f3a b\u1ecb thu h\u00fat b\u1edfi c\u1ef1c \u00e2m. \u0110\u1ec3 thu h\u00fat c\u00e1c lo\u1ea1i t\u1ebf b\u00e0o th\u00edch h\u1ee3p nh\u1ea5t cho giai \u0111o\u1ea1n ch\u1eefa l\u00e0nh m\u00f4, \u0111i\u1ec7n c\u1ef1c \u00e2m \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb v\u1ebft th\u01b0\u01a1ng b\u1ecb nhi\u1ec5m tr\u00f9ng ho\u1eb7c vi\u00eam v\u00e0 \u0111i\u1ec7n c\u1ef1c d\u01b0\u01a1ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng n\u1ebfu c\u00f3 ho\u1ea1i t\u1eed m\u00e0 kh\u00f4ng b\u1ecb vi\u00eam v\u00e0 khi v\u1ebft th\u01b0\u01a1ng \u0111ang trong giai \u0111o\u1ea1n t\u0103ng sinh c\u1ee7a qu\u00e1 tr\u00ecnh ch\u1eefa l\u00e0nh.<\/p>\n<p><strong>6.2. Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n<p>B\u1ec7nh nh\u00e2n b\u1ecb b\u1ea5t \u0111\u1ed9ng sau ph\u1eabu thu\u1eadt (knee athroplasty, ph\u1ee5c h\u1ed3i d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc) ho\u1eb7c do t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh \u2013 c\u01a1, t\u00ecnh tr\u1ea1ng \u0111au c\u1ea5p v\u00e0 m\u1ea1n sau t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c do b\u1ec7nh l\u00fd, b\u1ec7nh nh\u00e2n \u0111ang h\u1ed3i ph\u1ee5c sau ch\u1ea5n th\u01b0\u01a1ng (lo\u00e9t), t\u00ecnh tr\u1ea1ng ph\u00f9 do thi\u1ebfu v\u1eadn \u0111\u1ed9ng c\u01a1.<\/p>\n<p><strong>6.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n<ul>\n<li>B\u1ec7nh nh\u00e2n \u0111ang b\u1ecb r\u1ed1i lo\u1ea1n nh\u1ecbp tim ho\u1eb7c \u0111ang s\u1eed d\u1ee5ng c\u00e1c thi\u1ebft b\u1ecb t\u1ea1o nh\u1ecbp<\/li>\n<li>Ph\u1ee5 n\u1eef mang thai<\/li>\n<li>B\u1ec7nh nh\u00e2n \u1edf giai \u0111o\u1ea1n \u0111\u1ea7u (\u0111\u00e1p \u1ee9ng vi\u00eam c\u1ea5p) c\u1ee7a t\u1ed5n th\u01b0\u01a1ng c\u01a1 \u2013 ph\u1ea7n m\u1ec1m quanh c\u01a1. S\u1ef1 co c\u01a1 do k\u00edch \u1ee9ng \u0111i\u1ec7n c\u00f3 th\u1ec3 l\u00e0m t\u1ed5n th\u01b0\u01a1ng th\u00eam c\u00e1c c\u1ea5u tr\u00fac v\u00e0 \u1ea3nh h\u01b0\u1edfng qu\u00e1 tr\u00ecnh l\u00e0nh<\/li>\n<li>\u0110i\u1ec7n c\u1ef1c kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1eb7t tr\u00ean v\u00f9ng xoang \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh ho\u1eb7c nh\u1eefng v\u00f9ng c\u00f3 kh\u1ea3 n\u0103ng t\u1ea1o huy\u1ebft kh\u1ed1i<\/li>\n<li>\u0110i\u1ec7n tr\u1ecb li\u1ec7u c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n c\u1ea9n tr\u1ecdng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c v\u00ec kh\u00f3 bi\u1ebft \u0111\u01b0\u1ee3c c\u01b0\u1eddng \u0111\u1ed9 ho\u1eb7c th\u1eddi gian \u00e1p d\u1ee5ng n\u00e0o l\u00e0 \u0111\u1ea1t ng\u01b0\u1ee1ng an to\u00e0n.<\/li>\n<\/ul>\n<ol start=\"7\">\n<li><strong>C\u01a0 H\u1eccC TR\u1eca LI\u1ec6U (<em>Mechanical Agents<\/em>)<\/strong>\n<ul>\n<li><strong>Th\u1ee7y tr\u1ecb li\u1ec7u<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><strong>\u0110\u1ecbnh ngh\u0129a:<\/strong> l\u00e0 ph\u01b0\u01a1ng ph\u00e1p s\u1eed d\u1ee5ng n\u01b0\u1edbc t\u00e1c \u0111\u1ed9ng l\u00ean b\u1ec1 m\u1eb7t c\u01a1 th\u1ec3 nh\u1eb1m \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng. Th\u1ee7y tr\u1ecb li\u1ec7u c\u00f3 th\u1ec3 chia th\u00e0nh ng\u00e2m ho\u1eb7c kh\u00f4ng c\u1ea7n ng\u00e2m (x\u1ecbt hay \u0111\u1ed5 n\u01b0\u1edbc) m\u1ed9t ph\u1ea7n ho\u1eb7c to\u00e0n b\u1ed9 c\u01a1 th\u1ec3.<\/p>\n<p><strong>C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng: <\/strong>th\u1ee7y tr\u1ecb li\u1ec7u t\u1ea1o \u00e1p l\u1ef1c r\u1eeda tr\u00f4i m\u00f4 ho\u1ea1i t\u1eed v\u00e0 h\u00f2a tan surfactants v\u00e0 c\u00e1c ch\u1ea5t kh\u00e1ng khu\u1ea9n (kh\u00e1ng sinh) gi\u00fap l\u00e0nh v\u1ebft th\u01b0\u01a1ng; v\u00ec th\u1ebf, ph\u01b0\u01a1ng ph\u00e1p n\u00e0y th\u01b0\u1eddng \u00e1p d\u1ee5ng<\/p>\n<p>trong ch\u0103m s\u00f3c v\u1ebft th\u01b0\u01a1ng, ch\u1ec9 \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi c\u00e1c v\u1ebft th\u01b0\u01a1ng l\u1ed9 m\u00f4 d\u01b0\u1edbi da, c\u00f3 m\u00f4 ho\u1ea1i t\u1eed ho\u1eb7c d\u1ecb v\u1eadt d\u00ednh v\u00e0o. Ngo\u00e0i ra, th\u1ee7y tr\u1ecb li\u1ec7u c\u00f2n c\u00f3 nh\u1eefng t\u00e1c \u0111\u1ed9ng l\u00ean h\u1ec7 c\u01a1 x\u01b0\u01a1ng kh\u1edbp. Khi ng\u00e2m m\u00ecnh trong n\u01b0\u1edbc, d\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a l\u1ef1c Archimedes, t\u1ea3i tr\u1ecdng m\u00e0 c\u00e1c kh\u1edbp ph\u1ea3i ch\u1ecbu \u0111\u01b0\u1ee3c gi\u1ea3m b\u1edbt c\u00f3 th\u1ec3 l\u00ean \u0111\u1ebfn 75%, do \u0111\u00f3 c\u00f3 th\u1ec3 gi\u00fap t\u1eadp v\u1eadn \u0111\u1ed9ng c\u00e1c kh\u1edbp m\u1ed9t c\u00e1ch an to\u00e0n tr\u00e1nh ch\u1ea5n th\u01b0\u01a1ng v\u00e0 g\u00e2y \u0111au. \u0110\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n vi\u00eam kh\u1edbp, b\u00e9o ph\u00ec, tho\u00e1i h\u00f3a kh\u1edbp, m\u1ea5t v\u1eefng d\u00e2y ch\u1eb1ng th\u00ec ph\u01b0\u01a1ng ph\u00e1p n\u00e0y t\u1ecf ra kh\u00e1 hi\u1ec7u qu\u1ea3. Ngo\u00e0i ra, s\u1ee9c c\u1ea3n c\u1ee7a n\u01b0\u1edbc khi v\u1eadn \u0111\u1ed9ng c\u0169ng c\u00f3 th\u1ec3 gi\u00fap t\u1eadp t\u0103ng s\u1ee9c m\u1ea1nh cho c\u01a1 \u1edf chi, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi 1 s\u1ed1 b\u1ec7nh nh\u01b0 h\u1ed9i ch\u1ee9ng \u0111au c\u01a1 x\u01a1 h\u00f3a, vi\u00eam kh\u1edbp, suy tim, x\u01a1 c\u1ee9ng r\u1ea3i r\u00e1c.<\/p>\n<ul>\n<li><strong>K\u00e9o n\u1eafn<\/strong><\/li>\n<\/ul>\n<p><strong>\u0110\u1ecbnh ngh\u0129a:<\/strong> l\u00e0 ph\u01b0\u01a1ng ph\u00e1p d\u00f9ng l\u1ef1c k\u00e9o l\u00e0m t\u00e1ch r\u1eddi c\u00e1c m\u1eb7t kh\u1edbp v\u00e0 l\u00e0m t\u0103ng chi\u1ec1u d\u00e0i c\u1ee7a c\u00e1c m\u00f4 m\u1ec1m xung quanh kh\u1edbp (g\u00e2n, c\u01a1, d\u00e2y ch\u1eb1ng). Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho c\u00e1c kh\u1edbp c\u1ed9t s\u1ed1ng v\u00e0 ngo\u1ea1i bi\u00ean. Ph\u1ea7n n\u00e0y ch\u1ee7 y\u1ebfu ch\u1ec9 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn ph\u01b0\u01a1ng ph\u00e1p k\u00e9o n\u1eafn d\u00e0nh cho c\u00e1c kh\u1edbp c\u1ed9t s\u1ed1ng.<\/p>\n<p><strong>C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng:<\/strong> \u0111\u1ec3 d\u1ec5 hi\u1ec3u, ta c\u1ea7n ph\u1ea3i nh\u1edb l\u1ea1i m\u1ed9t v\u00e0i chi ti\u1ebft gi\u1ea3i ph\u1eabu c\u1ee7a c\u1ed9t s\u1ed1ng. C\u1ed9t s\u1ed1ng g\u1ed3m 24 \u0111\u1ed1t s\u1ed1ng x\u1ebfp \u0111\u00e8 l\u00ean nhau v\u00e0 li\u00ean k\u1ebft v\u1edbi nhau b\u1eb1ng c\u00e1c d\u00e2y ch\u1eb1ng. Gi\u1eefa c\u00e1c \u0111\u1ed1t s\u1ed1ng c\u00f3 c\u00e1c \u0111\u0129a \u0111\u1ec7m li\u00ean k\u1ebft t\u1eeb \u0111\u1ed1t s\u1ed1ng tr\u00ean \u0111\u1ebfn \u0111\u1ed9t s\u1ed1ng d\u01b0\u1edbi v\u00e0 \u0111\u00f3ng vai tr\u00f2 nh\u01b0 m\u1ed9t \u0111\u1ec7m gi\u1ea3m x\u00f3c. T\u1ee7y s\u1ed1ng n\u1eb1m ph\u00eda sau th\u00e2n s\u1ed1ng v\u00e0 \u0111\u0129a \u0111\u1ec7m, ch\u1ea1y xuy\u00ean su\u1ed1t \u1ed1ng s\u1ed1ng v\u00e0 cho c\u00e1c r\u1ec5 th\u1ea7n kinh tho\u00e1t ra ngo\u00e0i qua c\u00e1c l\u1ed7 li\u00ean h\u1ee3p (\u0111\u01b0\u1ee3c t\u1ea1o ra t\u1eeb c\u00e1c m\u1eb7t kh\u1edbp ph\u1ea7n sau gi\u1eefa hai \u0111\u1ed1t s\u1ed1ng li\u00ean ti\u1ebfp). Vi\u1ec7c k\u00e9o n\u1eafn ch\u1ee7 y\u1ebfu s\u1ebd gi\u00fap k\u00e9o gi\u00e3n c\u1ed9t s\u1ed1ng, t\u1eeb \u0111\u00f3 gi\u00fap gi\u1ea3m \u00e1p l\u1ef1c t\u00e1c d\u1ee5ng l\u00ean \u0111\u0129a \u0111\u1ec7m v\u00e0 c\u00e1c m\u1eb7t kh\u1edbp, gi\u00fap l\u1ed7 li\u00ean \u0111\u1ed1t s\u1ed1ng r\u1ed9ng h\u01a1n b\u1edbt ch\u00e8n \u00e9p v\u00e0o c\u00e1c r\u1ec5 th\u1ea7n kinh v\u00e0 k\u00e9o d\u00e0i c\u1ea3 c\u00e1c c\u1ea5u tr\u00fac m\u00f4 m\u1ec1m xung quanh.<\/p>\n<p><strong>Ch\u1ec9 \u0111\u1ecbnh trong m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd c\u01a1 x\u01b0\u01a1ng kh\u1edbp: <\/strong><\/p>\n<p>Tho\u00e1t v\u1ecb \u0111\u0129a \u0111\u1ec7m: ch\u1ee7 y\u1ebfu \u00e1p d\u1ee5ng v\u1edbi tho\u00e1t v\u1ecb \u0111\u0129a \u0111\u1ec7m c\u1ed9t s\u1ed1ng c\u1ed5, v\u1edbi c\u1ed9t s\u1ed1ng th\u1eaft l\u01b0ng hi\u1ec7n c\u00f2n \u0111ang b\u00e0n c\u00e3i. K\u00e9o n\u1eafn c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m k\u00edch th\u01b0\u1edbc c\u1ee7a \u0111\u0129a \u0111\u1ec7m tho\u00e1t v\u1ecb (do k\u00e9o gi\u00e3n c\u00e1c th\u00e2n s\u1ed1ng \u0111\u01b0\u1ee3c minh h\u1ecda nh\u01b0 h\u00ecnh d\u01b0\u1edbi), t\u1eeb \u0111\u00f3 gi\u00fap gi\u1ea3m ch\u00e8n \u00e9p v\u00e0o r\u1ec5 th\u1ea7n kinh. L\u1ef1c k\u00e9o t\u1ed1i thi\u1ec3u \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u00e1c d\u1ee5ng l\u00e0 t\u1eeb 7 \u2013 13 kg.<\/p>\n<p>Ch\u00e8n \u00e9p th\u1ea7n kinh gai s\u1ed1ng (<em>Spinal Nerve Root Impingement<\/em>): s\u1ef1 ch\u00e8n \u00e9p c\u00f3 th\u1ec3 x\u1ea3y ra tho\u00e1t v\u1ecb \u0111\u0129a \u0111\u1ec7m, do s\u1ef1 m\u1ea5t \u0111\u00e0n h\u1ed3i c\u1ee7a d\u00e2y ch\u1eb1ng (ligament encroachment), h\u1eb9p l\u1ed7 li\u00ean \u0111\u1ed1t s\u1ed1ng, gai c\u1ed9t s\u1ed1ng, vi\u00eam r\u1ec5 th\u1ea7n kinh ho\u1eb7c tr\u01b0\u1ee3t \u0111\u1ed1t s\u1ed1ng. Nh\u00ecn chung, b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n \u0111au t\u0103ng khi c\u00f3 s\u1ef1 gia t\u0103ng \u00e1p l\u1ef1c l\u00ean \u0111\u1ed1t s\u1ed1ng (ch\u1eb3ng h\u1ea1n nh\u01b0 \u0111au tay tr\u00e1i t\u0103ng khi nghi\u00eang \u0111\u1ea7u v\u1ec1 c\u00f9ng b\u00ean l\u00e0m h\u1eb9p l\u1ed7 li\u00ean \u0111\u1ed1t s\u1ed1ng tr\u00e1i) v\u00e0 gi\u1ea3m khi c\u00f3 \u0111\u1ed9ng t\u00e1c l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ed1t s\u1ed1ng th\u00ec c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi k\u00e9o n\u1eafn.<\/p>\n<p><strong>7.3. B\u0103ng \u00e9p (<em>Compression<\/em>)<\/strong><\/p>\n<p><strong>\u0110\u1ecbnh ngh\u0129a:<\/strong> l\u00e0 ph\u01b0\u01a1ng th\u1ee9c d\u00f9ng l\u1ef1c c\u01a1 h\u1ecdc h\u01b0\u1edbng v\u00e0o trrung t\u00e2m \u0111\u1ec3 gia t\u0103ng \u00e1p l\u1ef1c ngo\u1ea1i vi \u0111\u1ed1i v\u1edbi c\u01a1 th\u1ec3 hay m\u1ed9t b\u1ed9 ph\u1eadn c\u01a1 th\u1ec3. B\u0103ng \u00e9p th\u01b0\u1eddng d\u00f9ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n c\u00e2n b\u1eb1ng d\u1ecbch v\u00e0 tu\u1ea7n ho\u00e0n hay gi\u00fap h\u1ea1n ch\u1ebf h\u00ecnh th\u00e0nh s\u1eb9o. C\u00e2n b\u1eb1ng d\u1ecbch \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n b\u1eb1ng vi\u1ec7c gia t\u0103ng \u00e1p su\u1ea5t th\u1ee7y t\u0129nh \u1edf m\u00f4 k\u1ebd, tr\u1edf n\u00ean l\u1edbn h\u01a1n \u00e1p l\u1ef1c trong m\u1ea1ch m\u00e1u. Qua \u0111\u00f3 h\u1ea1n ch\u1ebf hay \u0111\u1ea3o ngh\u1ecbch d\u00f2ng ch\u1ea3y ng\u01b0\u1ee3c c\u1ee7a d\u1ecbch t\u1eeb m\u1ea1ch m\u00e1u hay h\u1ec7 b\u1ea1ch huy\u1ebft [3].<\/p>\n<p><strong>\u1ee8ng d\u1ee5ng trong b\u1ec7nh l\u00fd c\u01a1 x\u01b0\u01a1ng kh\u1edbp \u2013 Ch\u1ea5n th\u01b0\u01a1ng Ch\u1ec9nh h\u00ecnh:<\/strong><\/p>\n<ul>\n<li>Ph\u00f9 chi trong suy van t\u0129nh m\u1ea1ch (mang v\u1edb gi\u00e3n t\u0129nh m\u1ea1ch) hay ph\u00f9 m\u1ea1ch b\u1ea1ch huy\u1ebft<\/li>\n<li>D\u1ef1 ph\u00f2ng thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i (h\u1ec7 th\u1ed1ng b\u01a1m h\u01a1i \u00e1p l\u1ef1c ng\u1eaft qu\u00e3ng) <strong>(H\u00ecnh 8.10)<\/strong><\/li>\n<li>H\u1ed7 tr\u1ee3 \u0111\u1ecbnh h\u00ecnh m\u1ecfm c\u1ee5t sau c\u1eaft c\u1ee5t <strong>(H\u00ecnh 8.10)<\/strong><\/li>\n<li>H\u1ea1n ch\u1ebf s\u1eb9o ph\u00ec \u0111\u1ea1i: nh\u1edd c\u01a1 ch\u1ebf nh\u01b0 m\u1ed9t b\u1ea3n l\u1ec1 \u0111\u1ed1i v\u1edbi m\u00f4 m\u1edbi t\u0103ng sinh, gi\u1ea3m ph\u00f9 n\u1ec1 t\u1ea1i ch\u1ed7 v\u00e0 \u0111\u1ecbnh h\u00ecnh collagen, b\u0103ng \u00e9p \u00edt nh\u1ea5t 23 ti\u1ebfng\/ng\u00e0y v\u1edbi \u00e1p l\u1ef1c 20 \u0111\u1ebfn 30 mm gi\u00fap gi\u1ea3m \u0111\u1ed9 d\u00e0y s\u1eb9o v\u00e0 h\u1ed3ng ban. C\u00e1c ph\u01b0\u01a1ng ti\u1ec7n \u0111\u00e8 \u00e9p c\u00f3 th\u1ec3 d\u00f9ng nh\u01b0: b\u0103ng thun, b\u0103ng \u00e9p s\u01b0\u1eddn <strong>(H\u00ecnh 8.11).<\/strong><\/li>\n<\/ul>\n<figure id=\"attachment_1942\" aria-describedby=\"caption-attachment-1942\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1942\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture11-300x154.png\" alt=\"Picture11\" width=\"300\" height=\"154\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture11-300x154.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture11-1024x526.png 1024w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture11-768x395.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture11-1536x789.png 1536w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture11-18x9.png 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture11.png 2018w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1942\" class=\"wp-caption-text\"><strong>H\u00ecnh 8.10.<\/strong> B\u0103ng \u00e9p trong \u0111\u1ecbnh h\u00ecnh m\u1ecfm c\u1ee5t <strong>H\u00ecnh 8.11.<\/strong> M\u1ed9t s\u1ed1 d\u1ea1ng b\u0103ng v\u1edbi \u00e1p l\u1ef1c ph\u00f9 h\u1ee3p \u0111\u1ec3 h\u1ea1n ch\u1ebf s\u1eb9o l\u1ed3i<\/figcaption><\/figure>\n","protected":false},"featured_media":1365,"comment_status":"open","ping_status":"closed","template":"","tags":[164],"chuyen-muc":[58],"class_list":["post-1901","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","tag-vat-li-tri-lieu","chuyen-muc-dieu-tri-co-ban-trong-chan-thuong-chinh-hinh"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/1901","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang"}],"about":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/types\/bai-giang"}],"replies":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/comments?post=1901"}],"version-history":[{"count":1,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/1901\/revisions"}],"predecessor-version":[{"id":4509,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/1901\/revisions\/4509"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/1365"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=1901"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=1901"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=1901"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}