{"id":1953,"date":"2023-06-28T12:00:43","date_gmt":"2023-06-28T05:00:43","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=1953"},"modified":"2025-05-16T21:46:42","modified_gmt":"2025-05-16T14:46:42","slug":"phau-thuat-thay-khop-nhan-tao","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/phau-thuat-thay-khop-nhan-tao\/","title":{"rendered":"Artificial joint replacement surgery"},"content":{"rendered":"

1. T\u1ed4NG QUAN<\/strong><\/h2>\n

Ph\u1eabu thu\u1eadt thay kh\u1edbp l\u00e0 ph\u1eabu thu\u1eadt lo\u1ea1i b\u1ecf c\u00e1c b\u1ed9 ph\u1eadn b\u1ecb h\u01b0 h\u1ecfng ho\u1eb7c b\u1ecb b\u1ec7nh c\u1ee7a kh\u1edbp v\u00e0 t\u00e1i t\u1ea1o b\u1ec1 m\u1eb7t kh\u1edbp b\u1eb1ng c\u1ea5y gh\u00e9p thay th\u1ebf s\u1eed d\u1ee5ng kh\u1edbp nh\u00e2n t\u1ea1o c\u00f3 ch\u1ee9c n\u0103ng g\u1ea7n gi\u1ed1ng nh\u01b0 kh\u1edbp b\u00ecnh th\u01b0\u1eddng. Ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb c\u00e1c t\u1ed5n th\u01b0\u01a1ng b\u1ec7nh l\u00fd kh\u1edbp nh\u01b0 tho\u00e1i h\u00f3a kh\u1edbp<\/a> ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng c\u00e1c kh\u1edbp, \u0111\u1ea7u ti\u00ean l\u00e0 kh\u1edbp h\u00e1ng<\/a>, sau \u0111\u00f3 l\u00e0 kh\u1edbp g\u1ed1i<\/a> v\u00e0 hi\u1ec7n nay \u0111\u00e3 xu\u1ea5t hi\u1ec7n kh\u1edbp vai<\/a>, kh\u1edbp khu\u1ef7u<\/a>, kh\u1edbp \u0111\u1ed1t ng\u00f3n tay<\/a>,\u2026 Vi\u1ec7c thay th\u1ebf c\u00e1c kh\u1edbp b\u1ecb h\u01b0 h\u1ecfng n\u00e0y c\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng cho b\u1ec7nh nh\u00e2n.<\/p>\n

Kh\u1edbp nh\u00e2n t\u1ea1o c\u00f3 th\u1ec3 b\u1eb1ng: kim lo\u1ea1i, g\u1ed1m ho\u1eb7c nh\u1ef1a ch\u1ecbu l\u1ef1c,\u2026 Vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt, kh\u1edbp nh\u00e2n t\u1ea1o, to\u00e0n ph\u1ea7n hay b\u00e1n ph\u1ea7n, th\u1eddi gian h\u1ed3i ph\u1ee5c c\u00f2n t\u00f9y thu\u1ed9c v\u00e0o t\u1eebng ng\u01b0\u1eddi b\u1ec7nh c\u1ee5 th\u1ec3, tu\u1ed5i t\u00e1c, l\u1ed1i s\u1ed1ng, c\u00e1c b\u1ec7nh l\u00fd n\u1ec1n,\u2026<\/p>\n

Trong b\u00e0i n\u00e0y, t\u00e1c gi\u1ea3 ch\u1ee7 y\u1ebfu \u0111\u1ec1 c\u1eadp v\u1ec1 thay kh\u1edbp h\u00e1ng v\u00e0 kh\u1edbp g\u1ed1i.<\/p>\n

2. L\u1ecaCH S\u1eec PH\u00c1T TRI\u1ec2N<\/strong><\/h2>\n

M\u1eb7c d\u00f9 c\u00e1c ph\u1eabu thu\u1eadt thay kh\u1edb<\/a>p \u0111\u00e3 xu\u1ea5t hi\u1ec7n t\u1eeb r\u1ea5t s\u1edbm, kho\u1ea3ng nh\u1eefng n\u0103m 1800. Tuy nhi\u00ean, ch\u1ec9 khi lo\u00e0i ng\u01b0\u1eddi th\u1eadt s\u1ef1 hi\u1ec3u \u0111\u01b0\u1ee3c t\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c r\u1eeda tay tr\u01b0\u1edbc m\u1ed5 v\u00e0 s\u1ef1 v\u00f4 tr\u00f9ng, kh\u00e1ng sinh sau m\u1ed5, g\u00e2y m\u00ea ti\u1ebfn b\u1ed9 v\u00e0o n\u1eeda cu\u1ed1i th\u1ebf k\u1ef7 XIX, th\u00ec l\u00fac n\u00e0y ph\u1eabu thu\u1eadt thay kh\u1edbp m\u1edbi th\u1eadt s\u1ef1 ph\u00e1t tri\u1ec3n r\u1ed9ng r\u00e3i. Thi\u00ean ni\u00ean k\u1ef7 tr\u01b0\u1edbc k\u1ebft th\u00fac b\u1eb1ng th\u1ebf k\u1ef7 XX, c\u00f3 ba ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn nh\u01b0 s\u1ef1 th\u00e0nh c\u00f4ng l\u1edbn nh\u1ea5t c\u1ee7a y h\u1ecdc v\u00e0 l\u00e0m thay \u0111\u1ed5i cu\u1ed9c s\u1ed1ng l\u00e0: ph\u1eabu thu\u1eadt \u0111\u1ee5c th\u1ee7y tinh th\u1ec3, b\u1eafc c\u1ea7u \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 thay kh\u1edbp.<\/p>\n

Ngay t\u1eeb nh\u1eefng n\u0103m 1930, thay th\u1ebf kh\u1edbp h\u00e1ng b\u1eb1ng acrylic (H\u00ecnh 12.1<\/strong>) \u0111\u00e3 \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf v\u00e0 th\u1ef1c hi\u1ec7n. M\u1eb7c d\u00f9 \u201cAcrylic hip\u201d l\u00e0 thi\u1ebft k\u1ebf \u0111\u1ea7u ti\u00ean, nh\u01b0ng nh\u1eefng thi\u1ebft k\u1ebf n\u00e0y kh\u00f4ng th\u00e0nh c\u00f4ng. Th\u1ea5t b\u1ea1i l\u00e0 v\u00ec nhi\u1ec1u l\u00fd do; h\u1ea7u h\u1ebft c\u00e1c v\u1eadt li\u1ec7u n\u00e0y kh\u00f4ng t\u01b0\u01a1ng th\u00edch v\u1edbi c\u01a1 th\u1ec3 ng\u01b0\u1eddi, ch\u00fang kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng ch\u1ed1ng m\u00e0i m\u00f2n, do \u0111\u00f3 nhanh h\u1ecfng, th\u1ee7y tinh b\u1ecb gi\u00f2n v\u00e0 cu\u1ed1i c\u00f9ng s\u1ebd v\u1ee1 ho\u1eb7c kh\u1edbp gi\u1ea3 s\u1ebd kh\u00f4ng b\u00e1m ch\u1eb7t v\u00e0o x\u01b0\u01a1ng d\u1eabn \u0111\u1ebfn l\u1ecfng l\u1ebbo, c\u01a1 th\u1ec3 th\u1ea3i gh\u00e9p. M\u1eb7c d\u00f9 t\u1ea5t c\u1ea3 c\u00e1c v\u1eadt li\u1ec7u n\u00e0y \u0111\u1ec1u th\u1ea5t b\u1ea1i, \u201cacrylic hip\u201d \u0111\u00e3 \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c trong nhi\u1ec1u th\u1eadp k\u1ef7 v\u00e0 c\u00e1c kh\u1edbp n\u1ed1i t\u01b0\u01a1ng t\u1ef1 v\u1eabn ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi anh em nh\u00e0 Judet.<\/p>\n

\"Picture1\"
H\u00ecnh 12.1.<\/strong> Kh\u1edbp h\u00e1ng t\u1ee7y tinh \u0111\u1eddi \u0111\u1ea7u. (A) X-quang<\/a> sau thay kh\u1edbp h\u00e1ng 2 n\u0103m. (B) H\u00ecnh \u1ea3nh c\u00fap nh\u00e2n t\u1ea1o b\u1eb1ng th\u1ee7y tinh [1]<\/figcaption><\/figure>\n

S\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a k\u1ef9 thu\u1eadt t\u1ea1o h\u00ecnh kh\u1edbp g\u1ed1i t\u1ed5ng th\u1ec3 b\u1eaft \u0111\u1ea7u t\u1eeb n\u0103m 1860, khi b\u00e1c s\u0129 ph\u1eabu thu\u1eadt ng\u01b0\u1eddi \u0110\u1ee9c, Themistocles Gluck, ph\u1eabu thu\u1eadt c\u1ea5y gh\u00e9p c\u00e1c kh\u1edbp b\u1ea3n l\u1ec1 nguy\u00ean th\u1ee7y \u0111\u1ea7u ti\u00ean l\u00e0m b\u1eb1ng ng\u00e0 voi.<\/p>\n

B\u01b0\u1edbc \u0111\u1ed9t ph\u00e1 \u0111\u1ea7u ti\u00ean \u0111\u1ebfn sau s\u1ef1 ra \u0111\u1eddi c\u1ee7a h\u1ee3p kim chrom-coban trong c\u00e1c thi\u1ebft b\u1ecb y t\u1ebf. Chrom-coban m\u1ecbn; d\u00f9ng \u0111\u1ec3 l\u00e0m g\u01b0\u01a1ng; r\u1ea5t c\u1ee9ng \u2013 do \u0111\u00f3 ch\u1ed1ng m\u00e0i m\u00f2n. N\u00f3 r\u1ea5t c\u1ee9ng, t\u1ed3n t\u1ea1i l\u00e2u d\u00e0i nh\u01b0ng tr\u01a1 v\u1edbi c\u01a1 th\u1ec3 ng\u01b0\u1eddi. Ti\u1ebfn s\u0129 Austin T. Moore t\u1eeb B\u1eafc Carolina v\u00e0 ti\u1ebfn s\u0129 Thompson t\u1eeb New York \u0111\u00e3 thi\u1ebft k\u1ebf ri\u00eang c\u00e1c s\u1ea3n ph\u1ea9m thay th\u1ebf kh\u1edbp h\u00e1ng b\u1eb1ng chrom-coban l\u00e0 nh\u1eefng s\u1ea3n ph\u1ea9m \u0111\u1ea7u ti\u00ean th\u00e0nh c\u00f4ng (H\u00ecnh 12.2<\/strong>). C\u00e1c kh\u1edbp kh\u00e1c nh\u01b0 kh\u1edbp g\u1ed1i c\u0169ng \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng b\u1eb1ng ch\u1ea5t li\u1ec7u n\u00e0y. Ng\u00e0y nay, c\u00e1c thi\u1ebft k\u1ebf t\u01b0\u01a1ng t\u1ef1 v\u1eabn \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. M\u1eb7c d\u00f9 c\u00e1c b\u1ed9 ph\u1eadn gi\u1ea3 \u201cAustin Moore\u201d v\u00e0 \u201cThompson\u201d l\u00e0 nh\u1eefng thi\u1ebft k\u1ebf ti\u00ean phong, tuy nhi\u00ean, tu\u1ed5i th\u1ecd c\u1ee7a c\u00e1c kh\u1edbp n\u00e0y kh\u00f4ng cao.<\/p>\n

C\u00f9ng th\u1eddi gian n\u00e0y t\u1ea1i Anh, b\u00e1c s\u0129 John Charnley<\/a> nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n th\u00e0nh c\u00f4ng xi m\u0103ng acrylic, sau khi tr\u1ed9n h\u1ed7n h\u1ee3p b\u1ed9t v\u00e0 dung d\u1ecbch v\u1edbi nhau, s\u1ebd t\u1ea1o n\u00ean xi m\u0103ng c\u1ee9ng ch\u1eafc trong v\u00f2ng 15 ph\u00fat. M\u1edf ra m\u1ed9t b\u01b0\u1edbc ti\u1ebfn l\u1edbn trong k\u1ef9 thu\u1eadt thay kh\u1edbp nh\u00e2n t\u1ea1o c\u00f3 xi m\u0103ng. Ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh thay to\u00e0n b\u1ed9 kh\u1edbp h\u00e1ng b\u1eb1ng kim lo\u1ea1i tr\u00ean polyethylen c\u1ee7a John Charnley \u0111\u00e3 truy\u1ec1n c\u1ea3m h\u1ee9ng cho s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf to\u00e0n b\u1ed9 kh\u1edbp g\u1ed1i hi\u1ec7n \u0111\u1ea1i. Frank Gunston, c\u00f9ng b\u1ec7nh vi\u1ec7n v\u1edbi Charnley, \u0111\u00e3 ti\u1ebfp t\u1ee5c thi\u1ebft k\u1ebf m\u1ed9t kh\u1edbp g\u1ed1i kh\u00f4ng b\u1ecb tr\u1ea7y x\u01b0\u1edbc thay th\u1ebf c\u1ea3 m\u1eb7t trong v\u00e0 ngo\u00e0i c\u1ee7a kh\u1edbp b\u1eb1ng c\u00e1c th\u00e0nh ph\u1ea7n \u1ed1ng d\u1eabn ri\u00eang bi\u1ec7t (H\u00ecnh 12.3<\/strong>). C\u01a1 sinh h\u1ecdc \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a vi\u1ec7c b\u1ea3o t\u1ed3n nguy\u00ean v\u1eb9n d\u00e2y ch\u1eb1ng ch\u00e9o<\/a> v\u00e0 d\u00e2y ch\u1eb1ng ph\u1ee5, gi\u00fap duy tr\u00ec s\u1ef1 \u1ed5n \u0111\u1ecbnh c\u1ee7a c\u00e1c th\u00e0nh ph\u1ea7n x\u01b0\u01a1ng \u0111\u00f9i, x\u01b0\u01a1ng ch\u00e0y v\u00e0 thi\u1ebft k\u1ebf cho ph\u00e9p tr\u1ecdng t\u00e2m quay thay \u0111\u1ed5i khi g\u1eadp \u0111\u1ea7u g\u1ed1i. Cho \u0111\u1ebfn nay, kh\u1edbp nh\u00e2n t\u1ea1o ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n hi\u1ec7n \u0111\u1ea1i h\u01a1n, t\u01b0\u01a1ng th\u00edch v\u1edbi c\u01a1 th\u1ec3 ng\u01b0\u1eddi, c\u00f3 tu\u1ed5i th\u1ecd cao h\u01a1n, \u0111em l\u1ea1i t\u1ea7m v\u1eadn \u0111\u1ed9ng ph\u1ee5c h\u1ed3i g\u1ea7n nh\u01b0 kh\u1edbp b\u00ecnh th\u01b0\u1eddng.<\/p>\n

 <\/p>\n

\"Picture2\"
H\u00ecnh 12.2.<\/strong> Ch\u1ecfm Moore. Thi\u1ebft k\u1ebf \u0111\u1eddi \u0111\u1ea7u \u0111\u01b0\u1ee3c l\u1ea5y ra sau 2,5 n\u0103m (h\u00ecnh b\u00ean tr\u00e1i) v\u00e0 c\u00e1c thi\u1ebft k\u1ebf \u0111\u1eddi sau (c\u00e1c h\u00ecnh b\u00ean ph\u1ea3i) [10]<\/figcaption><\/figure>
\"Picture3\"
H\u00ecnh 12.3.<\/strong> Thi\u1ebft k\u1ebf kh\u1edbp g\u1ed1i to\u00e0n ph\u1ea7n \u0111\u1eddi \u0111\u1ea7u c\u1ee7a Gunston [1]<\/figcaption><\/figure><\/p>\n

3. CH\u1ec8 \u0110\u1ecaNH<\/strong><\/h2>\n

\u0110au kh\u1edbp kh\u00f4ng thuy\u00ean gi\u1ea3m v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00f4ng ph\u1eabu thu\u1eadt nh\u01b0 v\u1eadt l\u00fd tr\u1ecb li\u1ec7u, thu\u1ed1c, n\u1eb9p, ti\u00eam kh\u1edbp, thi\u1ebft b\u1ecb tr\u1ee3 gi\u00fap \u0111i b\u1ed9 v\u00e0 ngh\u1ec9 ng\u01a1i.<\/p>\n

C\u1ee9ng kh\u1edbp v\u00e0 h\u1ea1n ch\u1ebf kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng khi\u1ebfn b\u1ec7nh nh\u00e2n kh\u00f3 ho\u1eb7c kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n c\u00e1c ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y.<\/p>\n

S\u01b0ng (vi\u00eam) kh\u00f4ng c\u1ea3i thi\u1ec7n khi d\u00f9ng thu\u1ed1c ho\u1eb7c thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng.<\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y x\u1ea3y ra do c\u00e1c b\u1ec7nh l\u00fd sau:<\/p>\n