{"id":2002,"date":"2023-07-01T07:00:26","date_gmt":"2023-07-01T00:00:26","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=2002"},"modified":"2023-07-31T18:07:44","modified_gmt":"2023-07-31T11:07:44","slug":"viem-gan-calci-hoa-khop-vai","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/viem-gan-calci-hoa-khop-vai\/","title":{"rendered":"Vi\u00eam g\u00e2n Calci h\u00f3a kh\u1edbp vai"},"content":{"rendered":"

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

B\u1ec7nh l\u00fd quanh ch\u00f3p xoay<\/a> kh\u1edbp vai<\/a> bao g\u1ed3m nhi\u1ec1u b\u1ec7nh l\u00fd kh\u00e1c nhau, trong \u0111\u00f3 vi\u00eam g\u00e2n calci h\u00f3a th\u01b0\u1eddng hay b\u1ecb b\u1ecf s\u00f3t, v\u1edbi t\u1ec9 l\u1ec7 m\u1eafc 2,7% theo Bosworth, b\u1ec7nh th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n sau c\u00f9ng sau khi lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c ho\u1eb7c \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa th\u1ea5t b\u1ea1i [7]. M\u1eb7c d\u00f9 vi\u00eam g\u00e2n calci h\u00f3a \u0111\u01b0\u1ee3c quan s\u00e1t ch\u1ee7 y\u1ebfu \u1edf kh\u1edbp vai, nh\u01b0ng n\u00f3 c\u00f3 th\u1ec3 x\u1ea3y ra kh\u1eafp c\u01a1 th\u1ec3 [1]. Vi\u00eam g\u00e2n calci h\u00f3a kh\u1edbp vai l\u00e0 b\u1ec7nh l\u00fd \u0111au th\u01b0\u1eddng g\u1eb7p \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 calci h\u00f3a \u1edf c\u1ea3 d\u00e2y ch\u1eb1ng v\u00e0 \u0111i\u1ec3m b\u00e1m d\u00e2y ch\u1eb1ng c\u1ee7a c\u00e1c d\u00e2y ch\u1eb1ng kh\u1edbp vai, trong c\u00e1c bao ho\u1ea1t d\u1ecbch, bao g\u1ed3m c\u1ea3 bao ho\u1ea1t d\u1ecbch d\u01b0\u1edbi m\u1ecfm c\u00f9ng vai. S\u1ef1 calci h\u00f3a bao g\u1ed3m c\u00e1c c\u1ee5m calci hydroxyapatit \u1edf d\u1ea1ng tinh th\u1ec3 ho\u1eb7c \u1edf d\u1ea1ng v\u00f4 \u0111\u1ecbnh h\u00ecnh [4]. \u0110au li\u00ean quan \u0111\u1ebfn c\u00e1c ho\u1ea1t \u0111\u1ed9ng l\u1eb7p \u0111i l\u1eb7p l\u1ea1i, \u0111au \u00e2m \u1ec9, ph\u00f9 n\u1ec1 khu tr\u00fa v\u00e0 gi\u1ea3m t\u1ea7m v\u1eadn \u0111\u1ed9ng kh\u1edbp l\u00e0 nh\u1eefng tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p. M\u1eb7c d\u00f9 b\u1ec7nh t\u1ef1 kh\u1ecfi trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, nh\u01b0ng v\u1eabn c\u00f3 m\u1ed9t l\u01b0\u1ee3ng \u0111\u00e1ng k\u1ec3 b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n tri\u1ec7u ch\u1ee9ng v\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 c\u1ea3i thi\u1ec7n v\u1ec1 h\u00ecnh \u1ea3nh h\u1ecdc. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, quy tr\u00ecnh t\u1ef1 nhi\u00ean c\u1ee7a qu\u00e1 tr\u00ecnh l\u1eafng \u0111\u1ecdng calci, qu\u00e1 tr\u00ecnh v\u00f4i h\u00f3a trong c\u00e1c g\u00e2n, ti\u1ebfp theo \u0111\u00f3 l\u00e0 qu\u00e1 tr\u00ecnh h\u1ea5p thu l\u1ea1i calci l\u1eafng \u0111\u1ecdng b\u1eb1ng c\u00e1ch n\u00e0o \u0111\u00f3 \u0111\u00e3 b\u1ecb d\u1eebng l\u1ea1i. M\u1ed9t s\u1ed1 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7n \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, m\u1eb7c d\u00f9 \u0111\u1ec3 xem \u0111\u00f3 l\u00e0 s\u1ef1 l\u1ef1a ch\u1ecdn t\u1ed1t nh\u1ea5t th\u00ec v\u1eabn c\u00f2n g\u00e2y tranh c\u00e3i [1]. Tuy nhi\u00ean, c\u00f3 s\u1ef1 \u0111\u1ed3ng thu\u1eadn kh\u00e1 l\u1edbn trong vi\u1ec7c b\u1eaft \u0111\u1ea7u v\u1edbi ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n b\u1eb1ng c\u00e1ch ngh\u1ec9 ng\u01a1i, s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAID), v\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 \u0111\u1ed1i v\u1edbi c\u00e1c giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n xa h\u01a1n c\u1ee7a b\u1ec7nh l\u00e0 ti\u00eam corticosteroid v\u00e0o bao ho\u1ea1t d\u1ecbch d\u01b0\u1edbi m\u1ecfm c\u00f9ng vai. Ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o ch\u1ec9 khi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n kh\u00f4ng th\u00e0nh c\u00f4ng.<\/p>\n

2. D\u1ecaCH T\u1ec4 H\u1eccC<\/strong><\/h2>\n

T\u1ec9 l\u1ec7 m\u1eafc ph\u1ea3i vi\u00eam g\u00e2n calci h\u00f3a<\/a> \u1edf ng\u01b0\u1eddi l\u1edbn \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u00e0o kho\u1ea3ng 2,7 \u2013 10,3%; trong s\u1ed1 b\u1ec7nh nh\u00e2n n\u00e0y, 50% c\u00f3 tri\u1ec7u ch\u1ee9ng. B\u1ec7nh th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf n\u1eef v\u1edbi t\u1ec9 l\u1ec7 nam:n\u1eef l\u00e0 1:2 [7].<\/p>\n

B\u1ec7nh th\u01b0\u1eddng g\u1eb7p \u1edf \u0111\u1ed9 tu\u1ed5i t\u1eeb 30 \u2013 60 tu\u1ed5i v\u00e0 x\u1ea3y ra \u1edf hai b\u00ean trong 10 \u2013 25% tr\u01b0\u1eddng h\u1ee3p [5,13]. Th\u00f4ng th\u01b0\u1eddng vi\u00eam g\u00e2n calci h\u00f3a s\u1ebd \u1ea3nh h\u01b0\u1edfng n\u1eb7ng h\u01a1n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n m\u00e0 c\u00f4ng vi\u1ec7c \u0111\u00f2i h\u1ecfi ph\u1ea3i s\u1eed d\u1ee5ng c\u00e1nh tay trong th\u1eddi gian d\u00e0i \u1edf t\u01b0 th\u1ebf xoay trong v\u00e0 d\u1ea1ng nh\u1eb9, v\u00ed d\u1ee5 nh\u01b0 nh\u00e2n vi\u00ean v\u0103n ph\u00f2ng, thu ng\u00e2n, th\u1ee3 may v\u00e0 c\u00e1c c\u00f4ng nh\u00e2n l\u00e0m vi\u1ec7c theo d\u00e2y chuy\u1ec1n [5,8]. Khi c\u00e1nh tay xoay trong v\u00e0 d\u1ea1ng nh\u1eb9, c\u00e1c c\u01a1 ch\u00f3p xoay s\u1ebd co, l\u00e0m c\u00e1c v\u00f9ng nh\u1ea1y c\u1ea3m nh\u1ea5t d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng h\u01a1n do t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u nu\u00f4i. V\u00f9ng n\u00e0y t\u01b0\u01a1ng \u1ee9ng v\u1edbi v\u00f9ng \u00edt m\u00e1u nu\u00f4i c\u1ee7a g\u00e2n c\u01a1 tr\u00ean gai, ngay ph\u00eda trong \u0111i\u1ec3m b\u00e1m v\u00e0o m\u1ea5u \u0111\u1ed9ng l\u1edbn. C\u01a1 ch\u1ebf vi\u00eam g\u00e2n kh\u1edbp vai n\u00e0y<\/p>\n

kh\u00e1c v\u1edbi c\u01a1 ch\u1ebf b\u1ec7nh l\u00fd tho\u00e1i h\u00f3a g\u00e2n \u1edf c\u00e1c v\u00f9ng kh\u00e1c c\u1ee7a c\u01a1 th\u1ec3 (g\u00e2n g\u00f3t, l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay, x\u01b0\u01a1ng \u0111\u00f9i) [10].<\/p>\n

V\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n v\u01b0\u1ee3t b\u1eadc hi\u1ec7n nay c\u1ee7a si\u00eau \u00e2m v\u00e0 c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI), \u0111\u1ed9 ch\u00ednh x\u00e1c v\u00e0 \u0111\u1ed9 chi ti\u1ebft khi m\u00f4 t\u1ea3 c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu \u0111\u00e3 \u0111\u01b0\u1ee3c n\u00e2ng cao. Do \u0111\u00f3, t\u1ec9 l\u1ec7 m\u1eafc c\u1ee7a b\u1ec7nh s\u1ebd cao h\u01a1n so v\u1edbi tr\u01b0\u1edbc \u0111\u00e2y.<\/p>\n

3. SINH B\u1ec6NH H\u1eccC<\/strong><\/h2>\n

Theo Uhthoff v\u00e0 Loehr, vi\u00eam g\u00e2n calci h\u00f3a x\u1ea3y ra \u1edf nhi\u1ec1u giai \u0111o\u1ea1n, t\u1eeb vi\u1ec7c h\u00ecnh th\u00e0nh tinh th\u1ec3 calci, t\u00edch t\u1ee5 trong m\u00f4, cho \u0111\u1ebfn qu\u00e1 tr\u00ecnh h\u1ea5p th\u1ee5 t\u1ef1 nhi\u00ean c\u1ee7a calci. Qu\u00e1 tr\u00ecnh n\u00e0y do s\u1ef1 \u0111\u00ecnh tr\u1ec7 c\u1ee7a ho\u1ea1t \u0111\u1ed9ng t\u1ebf b\u00e0o, \u1ea3nh h\u01b0\u1edfng c\u1ea3 s\u1ef1 h\u00ecnh th\u00e0nh v\u00e0 lo\u1ea1i b\u1ecf tinh th\u1ec3 calci trong m\u00f4. Theo hai t\u00e1c gi\u1ea3, s\u1ef1 t\u00edch t\u1ee5 calci x\u1ea3y ra theo 3 giai \u0111o\u1ea1n: ti\u1ec1n calci h\u00f3a, calci h\u00f3a v\u00e0 h\u1eadu calci h\u00f3a. Giai \u0111o\u1ea1n \u0111\u1ea7u bao g\u1ed3m s\u1ef1 chuy\u1ec3n s\u1ea3n c\u1ee7a c\u00e1c t\u1ebf b\u00e0o s\u1ee3i s\u1ee5n, d\u1eabn \u0111\u1ebfn c\u00e1c ph\u1ea3n \u1ee9ng l\u00e0m thay \u0111\u1ed5i n\u1ed9i m\u00f4i v\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 h\u1ecdc c\u1ee7a c\u00e1c g\u00e2n. Giai \u0111o\u1ea1n calci h\u00f3a sau \u0111\u00f3 \u0111\u01b0\u1ee3c chia th\u00e0nh ba giai \u0111o\u1ea1n nh\u1ecf: th\u00e0nh l\u1eadp, ngh\u1ec9 ng\u01a1i v\u00e0 t\u00e1i h\u1ea5p thu, cu\u1ed1i c\u00f9ng k\u1ebft th\u00fac b\u1edfi h\u1eadu calci h\u00f3a. Chu tr\u00ecnh n\u00e0y c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng \u1edf b\u1ea5t c\u1ee9 \u0111i\u1ec3m n\u00e0o do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau (\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/a>, \u0111\u1ed9t bi\u1ebfn gen,\u2026). S\u1ef1 k\u00e9m t\u01b0\u1edbi m\u00e1u c\u1ee7a g\u00e2n c\u00f3 th\u1ec3 kh\u00f4ng g\u00e2y tho\u00e1i h\u00f3a, nh\u01b0ng n\u00f3 c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n l\u00e0m gi\u1ea3m c\u01a1 ch\u1ebf t\u1ef1 ph\u00fac h\u1ed3i c\u1ee7a c\u01a1 th\u1ec3 \u1edf nh\u1eefng \u0111o\u1ea1n g\u00e2n t\u1ed5n th\u01b0\u01a1ng [9].<\/p>\n

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

Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p l\u00e0 \u0111au kh\u1edbp vai, c\u1ea5p t\u00ednh ho\u1eb7c m\u1ea1n t\u00ednh, c\u00f3 th\u1ec3 \u0111i k\u00e8m v\u1edbi gi\u1ea3m bi\u00ean \u0111\u1ed9 v\u1eadn \u0111\u1ed9ng kh\u1edbp vai c\u1ea5p t\u00ednh ho\u1eb7c gi\u1ea3m d\u1ea7n theo th\u1eddi gian. Theo Uhthoff v\u00e0 Loehr, \u0111au th\u01b0\u1eddng x\u1ea3y ra \u1edf giai \u0111o\u1ea1n t\u00e1i h\u1ea5p thu, do ph\u1ea3n \u1ee9ng vi\u00eam nh\u1eb1m m\u1ee5c \u0111\u00edch lo\u1ea1i b\u1ecf tinh th\u1ec3 calci l\u1eafng \u0111\u1ecdng. Vi\u1ec7c t\u00ecm th\u1ea5y b\u1eb1ng ch\u1ee9ng c\u1ee7a l\u1eafng \u0111\u1ecdng calci tr\u00ean si\u00eau \u00e2m l\u00e0 m\u1ed9t trong nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m li\u00ean quan \u0111\u1ebfn \u0111au v\u00e0 vi\u1ec7c n\u00e0y cung c\u1ea5p b\u1eb1ng ch\u1ee9ng cho th\u1ea5y tri\u1ec7u ch\u1ee9ng \u0111au s\u1ebd t\u1ef1 gi\u1ea3m khi qu\u00e1 tr\u00ecnh t\u00e1i h\u1ea5p thu calci x\u1ea3y ra th\u00e0nh c\u00f4ng [9].<\/p>\n

Do \u0111\u00f3, c\u00f3 s\u1ef1 li\u00ean quan gi\u1eefa tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 k\u00edch th\u01b0\u1edbc c\u1ee7a v\u00f9ng calci ho\u00e1. M\u1ed9t t\u00e1c gi\u1ea3 kh\u00e1c l\u00e0 Bosworth nh\u1eadn th\u1ea5y c\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n khi \u0111\u01b0\u1eddng k\u00ednh v\u00f9ng calci h\u00f3a tr\u00ean 1,5 cm [5]. M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 kh\u00e1c kh\u00f4ng c\u00f4ng nh\u1eadn \u0111i\u1ec1u n\u00e0y, h\u1ecd ch\u1ec9 k\u1ebft lu\u1eadn \u0111\u01b0\u1eddng k\u00ednh v\u00f9ng calci h\u00f3a nh\u1ecf h\u01a1n 1 cm s\u1ebd kh\u00f4ng g\u00e2y tri\u1ec7u ch\u1ee9ng v\u00e0 v\u1ecb tr\u00ed calci h\u00f3a \u1edf g\u00e2n s\u1ebd g\u00e2y ra tri\u1ec7u ch\u1ee9ng t\u01b0\u01a1ng \u1ee9ng. Vi\u00eam g\u00e2n calci h\u00f3a x\u1ea3y ra \u1edf g\u00e2n c\u01a1 tr\u00ean gai th\u01b0\u1eddng g\u00e2y ra \u0111au nhi\u1ec1u nh\u1ea5t [11].<\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng k\u00e8m theo c\u00f3 th\u1ec3 l\u00e0 co c\u1ee9ng c\u01a1, vi\u00eam bao ho\u1ea1t d\u1ecbch d\u01b0\u1edbi m\u1ecfm c\u00f9ng vai, vi\u00eam \u0111\u1ea7u d\u00e0i g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u, r\u00e1ch ch\u00f3p xoay<\/a>, vi\u00eam m\u1ea5u \u0111\u1ed9ng l\u1edbn x\u01b0\u01a1ng c\u00e1nh tay,\u2026<\/p>\n

5. H\u00ccNH \u1ea2NH H\u1eccC<\/strong><\/h2>\n

5.1 X-quang<\/strong><\/h3>\n

L\u00e0 ph\u01b0\u01a1ng ph\u00e1p h\u00ecnh \u1ea3nh h\u1ecdc \u0111\u1ea7u ti\u00ean \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n vi\u00eam g\u00e2n calci h\u00f3a v\u00e0 \u0111\u01b0\u1ee3c xem l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean b\u1ec7nh nh\u00e2n \u0111au kh\u1edbp vai. X-quang<\/a> ti\u00eau chu\u1ea9n s\u1ebd bao g\u1ed3m phim ch\u1ee5p tr\u01b0\u1edbc sau t\u01b0 th\u1ebf trung t\u00ednh, xoay trong, xoay ngo\u00e0i. H\u00ecnh \u1ea3nh v\u00f4i h\u00f3a th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n tr\u00ean X-quang l\u00e0 \u0111\u00e1m m\u1edd kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u00e0 kh\u00f4ng c\u00f3 h\u00ecnh d\u1ea1ng nh\u1ea5t \u0111\u1ecbnh v\u1edbi b\u1edd kh\u00f4ng r\u00f5 r\u00e0ng [11,12].<\/p>\n

\"Picture12\"
H\u00ecnh 16.1.<\/strong> V\u00f4i h\u00f3a m\u1eadt \u0111\u1ed9 d\u00e0y, d\u1ea1ng \u0111\u00e1m tr\u00ean ngo\u00e0i \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay, d\u1ecdc theo g\u00e2n c\u01a1 tr\u00ean gai. https:\/\/radiopaedia.org\/cases\/calcific-tendinopathy-of-the-rotator-cuff?lang=us<\/em><\/figcaption><\/figure>\n

5.2 Si\u00eau \u00e2m<\/strong><\/h3>\n

Si\u00eau \u00e2m \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c cho vi\u1ec7c nh\u1eadn di\u1ec7n, x\u00e1c \u0111\u1ecbnh \u0111i\u1ec3m v\u00f4i h\u00f3a trong g\u00e2n c\u01a1 ch\u00f3p xoay. \u0110\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a si\u00eau \u00e2m g\u1ea7n nh\u01b0 b\u1eb1ng ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI). V\u00f4i h\u00f3a \u0111\u01b0\u1ee3c x\u00e1c \u0111inh b\u1edfi kh\u1ed1i echo d\u00e0y c\u00f3 ho\u1eb7c kh\u00f4ng \u0111u\u00f4i t\u0103ng \u00e2m ph\u00eda sau [6]. Si\u00eau \u00e2m c\u00f3 \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao cho ph\u00e9p ph\u00e1t hi\u1ec7n c\u00e1c c\u1eb7n v\u00f4i h\u00f3a r\u1ea5t nh\u1ecf, l\u00e0m thay \u0111\u1ed5i ki\u1ebfn th\u1ee9c tr\u01b0\u1edbc \u0111\u00e2y v\u1ec1 d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 s\u1ef1 ph\u00e2n b\u1ed1 c\u1ee7a c\u00e1c \u1ed5 v\u00f4i h\u00f3a \u1edf vai. Ngo\u00e0i ra, si\u00eau \u00e2m c\u00f2n gi\u00fap ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c, v\u00ed d\u1ee5 nh\u01b0 r\u00e1ch ch\u00f3p xoay, b\u1ec7nh l\u00fd \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay, b\u1ec7nh l\u00fd \u0111\u1ea7u d\u00e0i g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u,\u2026 v\u00e0 c\u00f3 th\u1ec3 qua h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m d\u00f9ng c\u00e1c bi\u1ec7n ph\u00e1p \u0111\u1ec3 can thi\u1ec7p v\u00e0o c\u00e1c bao ho\u1ea1t d\u1ecbch [11].<\/p>\n

\"Picture13\"
H\u00ecnh 16.2.<\/strong> Vi\u00eam g\u00e2n calci h\u00f3a g\u00e2n c\u01a1 tr\u00ean gai ph\u1ea3i: bi\u1ec3u hi\u1ec7n b\u1edfi kh\u1ed1i echo d\u00e0y, kh\u00f4ng c\u00f3 \u0111u\u00f4i t\u0103ng \u00e2m ph\u00eda sau. https:\/\/radiopaedia.org\/cases\/calcific-tendinopathy-supraspinatus-4?lang=us<\/em><\/figcaption><\/figure>\n

5.3 C\u1ed9ng h\u01b0\u1edfng t\u1eeb<\/strong><\/h3>\n

MRI hi\u1ec7n kh\u00f4ng c\u00f2n khuy\u1ebfn c\u00e1o l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n c\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n vi\u00eam g\u00e2n calci h\u00f3a. MRI cung c\u1ea5p \u0111\u1ed9 t\u01b0\u01a1ng ph\u1ea3n c\u1ee7a m\u00f4 m\u1ec1m ch\u00ednh x\u00e1c v\u00e0 d\u01b0\u1edbi d\u1ea1ng nhi\u1ec1u l\u1edbp v\u1edbi \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao, nh\u01b0ng tinh th\u1ec3 calci l\u1eafng \u0111\u1ecdng l\u1ea1i bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi h\u00ecnh \u1ea3nh gi\u1ea3m t\u00edn hi\u1ec7u tr\u00ean T2, do \u0111\u00f3, kh\u00f3 ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c \u1ea3nh gi\u1ea3 t\u1ea1o b\u1edfi m\u00f4 m\u1ec1m hay m\u00e1u t\u1ee5. MRI v\u1eabn l\u00e0 c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n m\u1eafc ti\u1ec1n h\u01a1n si\u00eau \u00e2m v\u00e0 kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng s\u1eb5n c\u00f3. Do \u0111\u00f3, MRI d\u00e0nh c\u00f3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ph\u1ee9c t\u1ea1p nh\u01b0 r\u00e1ch ch\u00f3p xoay, nghi ng\u1edd ho\u1ea1i t\u1eed<\/a> ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay [11,14].<\/p>\n

\"Picture14\"
H\u00ecnh 16.3. <\/strong>C\u00f9ng b\u1ec7nh nh\u00e2n trong \u1ea3nh B, h\u00ecnh \u1ea3nh v\u00f4i h\u00f3a l\u00e0 kh\u1ed1i gi\u1ea3m t\u00edn hi\u1ec7u tr\u00ean T2. https:\/\/radiopaedia.org\/cases\/calcific-tendinopathy-supraspinatus-4?lang=us<\/em><\/figcaption><\/figure>\n

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

\u0110i\u1ec1u tr\u1ecb vi\u00eam g\u00e2n calci h\u00f3a bao g\u1ed3m \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n v\u00e0 ph\u1eabu thu\u1eadt. S\u1eed d\u1ee5ng NSAIDs \u0111\u00f3ng vai tr\u00f2 ch\u00ednh, hi\u1ec7u qu\u1ea3 trong vi\u1ec7c gi\u1ea3m \u0111au \u1edf giai \u0111o\u1ea1n c\u1ea5p t\u00ednh, \u0111i k\u00e8m v\u1edbi v\u1eadt l\u00fd tr\u1ecb li\u1ec7u \u0111\u1ec3 tr\u00e1nh c\u1ee9ng kh\u1edbp, ti\u00eam corticosteroid t\u1ea1i ch\u1ed7. Ph\u1eabu thu\u1eadt m\u1edf ho\u1eb7c n\u1ed9i soi lo\u1ea1i b\u1ecf v\u00f4i h\u00f3a th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc sau khi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n th\u1ea5t b\u1ea1i [11,13].<\/p>\n

6.1 \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n<\/strong><\/h3>\n

Hi\u1ec7n nay c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n, \u00edt x\u00e2m l\u1ea5n, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi, ph\u1ed1i h\u1ee3p v\u1edbi nhau \u0111\u1ec3 \u0111\u1ea1t k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t. B\u1ec7nh nh\u00e2n sau khi \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n t\u00edch c\u1ef1c, n\u1ebfu tri\u1ec7u ch\u1ee9ng v\u1eabn c\u00f2n sau 6 th\u00e1ng, b\u1ea3o t\u1ed3n xem nh\u01b0 th\u1ea5t b\u1ea1i [11].<\/p>\n

Trong giai \u0111o\u1ea1n c\u1ea5p c\u1ee7a b\u1ec7nh, gi\u1ea3m \u0111au l\u00e0 m\u1ee5c ti\u00eau \u0111\u1ea7u ti\u00ean v\u00e0 h\u00e0ng \u0111\u1ea7u l\u00e0 s\u1eed d\u1ee5ng NSAIDs. C\u1ea7n c\u1ea9n tr\u1ecdng \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed lo\u00e9t d\u1ea1 d\u00e0y, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a hay nguy c\u01a1 tim m\u1ea1ch cao. S\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng vi\u00eam, gi\u1ea3m \u0111au \u0111i k\u00e8m v\u1edbi v\u1eadt l\u00fd tr\u1ecb li\u1ec7u mang l\u1ea1i k\u1ebft qu\u1ea3 t\u1ed1t, chi ph\u00ed th\u1ea5p v\u00e0 d\u1ec5 dung n\u1ea1p. \u0110\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng vi\u00eam bao<\/p>\n

ho\u1ea1t d\u1ecbch k\u00e8m theo c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng corticosteroid ti\u00eam t\u1ea1i ch\u1ed7. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y v\u1eabn c\u00f2n \u0111ang tranh c\u00e3i do c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ho\u1eb7c th\u1eadm ch\u00ed l\u00e0m x\u1ea5u \u0111i t\u00ecnh tr\u1ea1ng b\u1ec7nh do \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh t\u00e1i h\u1ea5p thu c\u1eb7n l\u1eafng calci h\u00f3a [11,14].<\/p>\n

C\u00e1c ph\u01b0\u01a1ng ph\u00e1p m\u1edbi nh\u01b0 s\u1eed d\u1ee5ng s\u00f3ng cao t\u1ea7n, ch\u1ecdc h\u00fat d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m, ti\u00eam huy\u1ebft t\u01b0\u01a1ng gi\u00e0u ti\u1ec3u c\u1ea7u \u0111ang l\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p m\u1edbi, \u00edt x\u00e2m l\u1ea5n, hi\u1ec7u qu\u1ea3 cao, mang l\u1ea1i h\u01b0\u1edbng \u0111i m\u1edbi cho \u0111i\u1ec1u tr\u1ecb vi\u00eam g\u00e2n calci h\u00f3a kh\u00f4ng c\u1ea7n ph\u1eabu thu\u1eadt [11,14,15].<\/p>\n

6.2 \u0110i\u1ec1u tr\u1ecb b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt<\/strong><\/h3>\n

H\u1ea7u h\u1ebft c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111\u1ec1u khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt cho c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n sau 6 th\u00e1ng [11]. Hi\u1ec7n nay, ph\u1eabu thu\u1eadt n\u1ed9i soi l\u00e0 ph\u01b0\u01a1ng ph\u00e1p l\u1ef1a ch\u1ecdn \u01b0u ti\u00ean do t\u1ec9 l\u1ec7 t\u1eed vong \u00edt h\u01a1n, nh\u01b0ng mang l\u1ea1i k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 ph\u1eabu thu\u1eadt m\u1edf.<\/p>\n

V\u1ea5n \u0111\u1ec1 \u0111\u1eb7t ra khi ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt l\u00e0 c\u00f3 n\u00ean l\u1ea5y h\u1ebft v\u00f4i h\u00f3a hay kh\u00f4ng, sau khi l\u1ea5y v\u00f4i h\u00f3a c\u00f3 c\u1ea7n kh\u00e2u ph\u1ee5c h\u1ed3i g\u00e2n t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng, c\u00f3 t\u00e1i t\u1ea1o bao ho\u1ea1t d\u1ecbch sau ph\u1eabu thu\u1eadt kh\u00f4ng? C\u00e1c v\u1ea5n \u0111\u1ec1 n\u00e0y c\u00f2n \u0111ang tranh c\u00e3i [11].<\/p>\n

C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y v\u1eadn \u0111\u1ed9ng kh\u1edbp vai sau m\u1ed5 kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi k\u00edch th\u01b0\u1edbc v\u00f4i ho\u00e1. Sau khi ti\u1ebfn h\u00e0nh t\u00e1c \u0111\u1ed9ng v\u00e0o g\u00e2n v\u00f4i h\u00f3a, qu\u00e1 tr\u00ecnh t\u00e1i h\u1ea5p thu c\u0169ng \u0111\u01b0\u1ee3c t\u1ef1 kh\u1edfi \u0111\u1ed9ng l\u1ea1i, do \u0111\u00f3, nhi\u1ec1u t\u00e1c gi\u1ea3 khuy\u1ebfn cao kh\u00f4ng c\u1ea7n can thi\u1ec7p \u0111\u1ec3 lo\u1ea1i b\u1ecf tri\u1ec7t \u0111\u1ec3 v\u00f4i h\u00f3a, qu\u00e1 tr\u00ecnh t\u00e1i h\u1ea5p thu s\u1ebd t\u1ef1 tri\u1ec7t ti\u00eau c\u00e1c tinh th\u1ec3 calci c\u00f2n l\u1ea1i [9,11,14].<\/p>\n

Sinh b\u1ec7nh h\u1ecdc c\u1ee7a vi\u00eam g\u00e2n calci h\u00f3a l\u00e0 t\u1ef1 ch\u1eefa l\u00e0nh, do \u0111\u00f3 sau khi l\u1ea5y v\u00f4i h\u00f3a, vi\u1ec7c kh\u00e2u kh\u00e9p t\u1ed5n th\u01b0\u01a1ng g\u00e2n l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft. Tuy nhi\u00ean, n\u1ebfu t\u1ed5n th\u01b0\u01a1ng sau ph\u1eabu thu\u1eadt qu\u00e1 l\u1edbn ph\u1ea3i kh\u00e2u kh\u00e9p l\u1ea1i, vi\u1ec7c n\u00e0y \u0111\u1ed3ng th\u1eddi c\u0169ng gi\u00fap b\u1ec7nh nh\u00e2n v\u1eadn \u0111\u1ed9ng \u0111\u01b0\u1ee3c s\u1edbm sau m\u1ed5 [11].<\/p>\n

Ph\u1eabu thu\u1eadt n\u1ed9i soi \u0111i\u1ec1u tr\u1ecb vi\u00eam g\u00e2n calci h\u00f3a \u0111ang l\u00e0 h\u01b0\u1edbng \u0111i tri\u1ec3n v\u1ecdng trong vi\u1ec7c ch\u1ecdn l\u1ef1a ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3, \u00edt x\u00e2m l\u1ea5n v\u00e0 ph\u1ee5c h\u1ed3i t\u1ed1t sau m\u1ed5, mang l\u1ea1i ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng t\u1ed1t h\u01a1n.<\/p>\n

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

Vi\u00eam g\u00e2n calci h\u00f3a l\u00e0 b\u1ec7nh do s\u1ef1 ng\u01b0ng tr\u1ec7 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ebf b\u00e0o<\/a>, ng\u01b0ng \u0111\u1ecdng c\u1ee7a c\u00e1c c\u1eb7n l\u1eafng tinh th\u1ec3 calci, th\u01b0\u1eddng x\u1ea3y ra qu\u00e1 tr\u00ecnh t\u1ef1 h\u1ea5p thu sau \u0111\u00f3. Do \u0111\u00f3, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n s\u1ebd t\u1ef1 kh\u1ecfi m\u00e0 kh\u00f4ng c\u1ea7n s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u n\u00e0o.<\/p>\n

Nguy\u00ean nh\u00e2n c\u1ee7a b\u1ec7nh ch\u01b0a r\u00f5 r\u00e0ng, k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u0169ng kh\u00f4ng ho\u00e0n to\u00e0n ho\u00e0n h\u1ea3o, ch\u01b0a c\u00f3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ti\u00eau chu\u1ea9n. Do \u0111\u00f3 \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh, ph\u1eabu thu\u1eadt n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc l\u00e0 ph\u01b0\u01a1ng ph\u00e1p cu\u1ed1i c\u00f9ng.<\/p>\n

C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb m\u1edbi \u0111\u00e1nh tr\u00fang \u0111\u00edch, nghi\u00ean c\u1ee9u gen mang l\u1ea1i hi\u1ec7u qu\u1ea3 l\u00e2u d\u00e0i, song song v\u1edbi \u0111\u00f3 l\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n, \u00edt x\u00e2m l\u1ea5n h\u1ee9a h\u1eb9n mang l\u1ea1i hi\u1ec7u qu\u1ea3 cao, c\u1ea7n \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u th\u00eam nh\u01b0 s\u1eed d\u1ee5ng s\u00f3ng cao t\u1ea7n, ch\u1ecdc h\u00fat d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn si\u00eau \u00e2m,\u2026<\/p>\n","protected":false},"featured_media":2268,"comment_status":"open","ping_status":"closed","template":"","tags":[88,223,172],"chuyen-muc":[61],"class_list":["post-2002","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","tag-khop-vai","tag-viem-gan","tag-viem-gan-calci-hoa-khop-vai","chuyen-muc-benh-ly"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2002","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=2002"}],"version-history":[{"count":0,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2002\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/2268"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=2002"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=2002"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=2002"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}