{"id":2008,"date":"2023-07-01T12:00:38","date_gmt":"2023-07-01T05:00:38","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&#038;p=2008"},"modified":"2023-07-31T18:09:50","modified_gmt":"2023-07-31T11:09:50","slug":"gay-xuong-thuyen","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-thuyen\/","title":{"rendered":"G\u00e3y x\u01b0\u01a1ng thuy\u1ec1n"},"content":{"rendered":"<h2>1. T\u1ed4NG QUAN<\/h2>\n<p>X\u01b0\u01a1ng thuy\u1ec1n l\u00e0 m\u1ed9t x\u01b0\u01a1ng \u0111\u1ecbnh h\u01b0\u1edbng xi\u00ean n\u1eb1m \u1edf m\u1eb7t quay c\u1ee7a c\u1ed5 tay. L\u00e0 m\u1ed9t x\u01b0\u01a1ng c\u1ed5 tay quan tr\u1ecdng, c\u00f3 ch\u1ee9c n\u0103ng l\u00e0m c\u1ea7u n\u1ed1i li\u00ean k\u1ebft gi\u1eefa c\u00e1c h\u00e0ng x\u01b0\u01a1ng c\u1ed5 tay g\u1ea7n v\u00e0 xa. X\u01b0\u01a1ng thuy\u1ec1n \u0111\u00f3ng g\u00f3p \u0111\u00e1ng k\u1ec3 v\u00e0o s\u1ef1 \u1ed5n \u0111\u1ecbnh c\u1ee7a c\u1ed5 tay v\u00e0 ch\u1ee9c n\u0103ng c\u01a1 sinh h\u1ecdc, b\u1edfi v\u00ec chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a n\u00f3 c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a x\u01b0\u01a1ng nguy\u1ec7t (th\u00f4ng qua s\u1ef1 g\u1eafn k\u1ebft c\u1ee7a <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/ton-thuong-day-chang-cheo\/\">d\u00e2y ch\u1eb1ng ch\u00e9o<\/a> thuy\u1ec1n nguy\u1ec7t) v\u00e0 chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a h\u00e0ng xa x\u01b0\u01a1ng c\u1ed5 tay. X\u01b0\u01a1ng thuy\u1ec1n n\u1eb1m ho\u00e0n to\u00e0n trong kh\u1edbp v\u00e0 80% x\u01b0\u01a1ng \u0111\u01b0\u1ee3c bao ph\u1ee7 b\u1edfi s\u1ee5n t\u1ea1o th\u00e0nh b\u1ec1 m\u1eb7t kh\u1edbp. G\u1ea7n m\u1ed9t n\u1eeda x\u01b0\u01a1ng thuy\u1ec1n \u0111\u01b0\u1ee3c bao ph\u1ee7 b\u1edfi s\u1ee5n kh\u1edbp, \u0111i\u1ec1u n\u00e0y l\u00e0m cho di\u1ec7n t\u00edch b\u1ec1 m\u1eb7t x\u01b0\u01a1ng \u0111\u01b0\u1ee3c nu\u00f4i d\u01b0\u1ee1ng b\u1edfi m\u1ea1ch m\u00e1u h\u1ea1n ch\u1ebf. C\u00e1c \u0111\u1ed9ng m\u1ea1ch nu\u00f4i x\u01b0\u01a1ng thuy\u1ec1n tr\u1ea3i d\u00e0i \u1edf m\u1eb7t g\u1ea7n v\u00e0 m\u1eb7t l\u01b0ng c\u1ee7a x\u01b0\u01a1ng v\u1ecb tr\u00ed kh\u00f4ng c\u00f3 di\u1ec7n kh\u1edbp. C\u00e1c nghi\u00ean c\u1ee9u c\u1ee7a Gelberman v\u00e0 Menon \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng trong 75% m\u1eabu x\u01b0\u01a1ng thuy\u1ec1n, t\u00e1c gi\u1ea3 nh\u1eadn th\u1ea5y c\u00f3 hai nh\u00e1nh t\u1eadn t\u00e1ch ra t\u1eeb \u0111\u1ed9ng m\u1ea1ch quay cung c\u1ea5p m\u00e1u cho x\u01b0\u01a1ng thuy\u1ec1n \u1edf m\u1eb7t l\u01b0ng v\u00e0 m\u1eb7t g\u1ea7n; c\u00e1c nh\u00e1nh n\u00e0y l\u1ea7n l\u01b0\u1ee3t l\u00e0 nh\u00e1nh c\u1ed5 tay \u1edf l\u01b0ng v\u00e0 nh\u00e1nh \u1edf l\u00f2ng b\u00e0n tay [1]. Trong 20% x\u01b0\u01a1ng thuy\u1ec1n, h\u1ea7u h\u1ebft c\u00e1c nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch k\u1ebft th\u00fac \u1edf \u0111o\u1ea1n eo. Do c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu c\u00e1c \u0111\u1ed9ng m\u1ea1ch n\u00e0y, \u0111o\u1ea1n g\u1ea7n kh\u1edbp c\u1ee7a x\u01b0\u01a1ng thuy\u1ec1n \u0111\u01b0\u1ee3c nu\u00f4i d\u01b0\u1ee1ng theo ki\u1ec3u ng\u01b0\u1ee3c d\u00f2ng, do \u0111\u00f3, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch t\u1ec9 l\u1ec7 cao c\u1ee7a <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/hoai-tu-vo-mach-chom-xuong-dui\/\">ho\u1ea1i t\u1eed<\/a> v\u00f4 m\u1ea1ch c\u1ef1c g\u1ea7n v\u00e0 kh\u00f4ng <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/cham-lanh-xuong-va-khong-lanh-xuong\/\">li\u1ec1n x\u01b0\u01a1ng<\/a> trong <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-kin\/\">g\u00e3y x\u01b0\u01a1ng<\/a> thuy\u1ec1n kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n [2,3] (<strong>H\u00ecnh 17.1<\/strong>).<\/p>\n<p>Trong s\u1ed1 c\u00e1c ch\u1ea5n th\u01b0\u01a1ng x\u01b0\u01a1ng c\u1ed5 tay, g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n \u0111\u01b0\u1ee3c coi l\u00e0 ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u1edbi t\u1ec9 l\u1ec7 \u01b0\u1edbc t\u00ednh dao \u0111\u1ed9ng t\u1eeb 50% \u0111\u1ebfn 70% c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng c\u1ed5 tay v\u00e0 l\u00ean \u0111\u1ebfn 11% trong t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-ban-ngon-tay-gay-xuong-ban-tay\/\">g\u00e3y x\u01b0\u01a1ng b\u00e0n tay<\/a>. G\u00e3y x\u01b0\u01a1ng thuy\u1ec1n x\u1ea3y ra ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf nam gi\u1edbi tr\u1ebb tu\u1ed5i [4,5]. Van Tassel v\u00e0 c\u1ed9ng s\u1ef1, s\u1eed d\u1ee5ng c\u01a1 s\u1edf d\u1eef li\u1ec7u H\u1ec7 th\u1ed1ng gi\u00e1m s\u00e1t th\u01b0\u01a1ng t\u1eadt \u0111i\u1ec7n t\u1eed Qu\u1ed1c gia, cho th\u1ea5y t\u1ec9 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng l\u00e0 1,47\/100.000 ng\u01b0\u1eddi\/n\u0103m [5]. T\u1ec9 l\u1ec7 g\u00e3y x\u01b0\u01a1ng n\u00e0y c\u00f3 th\u1ec3 cao h\u01a1n \u1edf c\u00e1c v\u1eadn \u0111\u1ed9ng vi\u00ean v\u00e0 qu\u00e2n nh\u00e2n [6,7]. \u1ede tr\u1ebb em, g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n \u00edt g\u1eb7p h\u01a1n, ch\u1ec9 chi\u1ebfm 3% t\u1ed5ng s\u1ed1 g\u00e3y x\u01b0\u01a1ng b\u00e0n tay v\u00e0 c\u1ed5 tay tr\u1ebb em [8,9]. L\u1edbp s\u1ee5n ngo\u1ea1i vi d\u00e0y bao ph\u1ee7 v\u00e0 b\u1ea3o v\u1ec7 x\u01b0\u01a1ng thuy\u1ec1n c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch cho t\u1ec9 l\u1ec7 g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n \u1edf tr\u1ebb em th\u1ea5p h\u01a1n. B\u1ea5t ch\u1ea5p t\u1ea7n su\u1ea5t x\u1ea3y ra, g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n ho\u1eb7c b\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 \u201c<a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/bong-gan\/\">bong g\u00e2n<\/a>\u201d \u1edf c\u1ed5 tay.<\/p>\n<figure id=\"attachment_2011\" aria-describedby=\"caption-attachment-2011\" style=\"width: 292px\" class=\"wp-caption aligncenter\"><img fetchpriority=\"high\" decoding=\"async\" class=\"size-medium wp-image-2011\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture15-1-292x300.png\" alt=\"Picture15\" width=\"292\" height=\"300\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture15-1-292x300.png 292w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture15-1-996x1024.png 996w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture15-1-768x789.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture15-1-12x12.png 12w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture15-1.png 1469w\" sizes=\"(max-width: 292px) 100vw, 292px\" \/><figcaption id=\"caption-attachment-2011\" class=\"wp-caption-text\"><strong>H\u00ecnh 17.1. A<\/strong>: M\u1ea1ch m\u00e1u x\u01b0\u01a1ng thuy\u1ec1n. <strong>B<\/strong>: H\u00ecnh \u1ea3nh 3 chi\u1ec1u (ch\u1ee5p MSCT) m\u1ea1ch m\u00e1u nu\u00f4i x\u01b0\u01a1ng thuy\u1ec1n [26] \u0110M: \u0111\u1ed9ng m\u1ea1ch<\/figcaption><\/figure>\n<p>Bi\u1ec3u hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 r\u1ea5t \u00edt v\u00e0 ch\u1ee5p <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/x-quang-trong-chan-thuong-chinh-hinh\/\">X-quang<\/a> ban \u0111\u1ea7u c\u00f3 th\u1ec3 kh\u00f4ng ph\u00e1t hi\u1ec7n g\u00e3y x\u01b0\u01a1ng. Ch\u1eadm tr\u1ec5 trong \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng ch\u1eadm li\u1ec1n x\u01b0\u01a1ng, kh\u1edbp gi\u1ea3 ho\u1eb7c ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch [10,11]. C\u00e1c bi\u1ebfn ch\u1ee9ng n\u00e0y \u0111\u1ec1u ph\u1ee9c t\u1ea1p cho vi\u1ec7c ph\u1eabu thu\u1eadt ph\u1ee5c h\u1ed3i l\u1ea1i gi\u1ea3i ph\u1eabu x\u01b0\u01a1ng thuy\u1ec1n. G\u00e3y x\u01b0\u01a1ng thuy\u1ec1n ph\u00e1t hi\u1ec7n tr\u1ec5 s\u1ebd ti\u1ebfn tri\u1ec3n th\u00e0nh m\u1ed9t d\u1ea1ng <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/viem-xuong-tuy\/\">vi\u00eam kh\u1edbp<\/a> c\u1ed5 tay tho\u00e1i h\u00f3a \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 kh\u1edbp gi\u1ea3 x\u01b0\u01a1ng thuy\u1ec1n ti\u1ebfn tri\u1ec3n s\u1eadp l\u00fan (SNAC) (<strong>H\u00ecnh 17.2<\/strong>). Do \u0111\u00f3, ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 x\u1eed tr\u00ed th\u00edch h\u1ee3p l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o b\u1ea3o t\u1ed3n ch\u1ee9c n\u0103ng c\u1ed5 tay v\u00e0 <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/dai-cuong-co-the-dong-hoc\/\">\u0111\u1ed9ng h\u1ecdc<\/a> [12,13].<\/p>\n<figure id=\"attachment_2012\" aria-describedby=\"caption-attachment-2012\" style=\"width: 285px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" class=\"size-medium wp-image-2012\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture16-1-285x300.png\" alt=\"Picture16\" width=\"285\" height=\"300\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture16-1-285x300.png 285w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture16-1-974x1024.png 974w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture16-1-768x807.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture16-1-11x12.png 11w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture16-1.png 1038w\" sizes=\"(max-width: 285px) 100vw, 285px\" \/><figcaption id=\"caption-attachment-2012\" class=\"wp-caption-text\"><strong>H\u00ecnh 17.2.<\/strong> X-quang tr\u01b0\u1edbc sau x\u01b0\u01a1ng b\u00e0n tay cho h\u00ecnh \u1ea3nh vi\u00eam kh\u1edbp tho\u00e1i h\u00f3a x\u01b0\u01a1ng thuy\u1ec1n, kh\u1edbp gi\u1ea3 x\u01b0\u01a1ng thuy\u1ec1n ti\u1ebfn tri\u1ec3n s\u1eadp l\u00fan (SNAC) [26]<\/figcaption><\/figure>\n<h2><strong>2. C\u01a0 CH\u1ebe CH\u1ea4N TH\u01af\u01a0NG<\/strong><\/h2>\n<p>G\u00e3y x\u01b0\u01a1ng thuy\u1ec1n th\u01b0\u1eddng do t\u00e9 ch\u1ed1ng b\u00e0n tay v\u1edbi c\u1ed5 tay du\u1ed7i v\u00e0 nghi\u00eang quay. Todd l\u00e0 ng\u01b0\u1eddi \u0111\u1ea7u ti\u00ean nghi\u00ean c\u1ee9u c\u01a1 ch\u1ebf c\u1ee7a g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n v\u00e0 \u00f4ng tin r\u1eb1ng ch\u00fang x\u1ea3y ra do \u00e1p l\u1ef1c qu\u00e1 m\u1ee9c [14], trong khi Cobey v\u00e0 White l\u1eadp lu\u1eadn r\u1eb1ng g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 n\u00e9n \u00e9p qu\u00e1 m\u1ee9c d\u1ecdc theo b\u1ec1 m\u1eb7t kh\u1edbp n\u1ed1i gi\u1eefa x\u01b0\u01a1ng thuy\u1ec1n v\u00e0 x\u01b0\u01a1ng c\u1ea3 [15]. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n x\u1ea3y ra v\u1edbi s\u1ef1 n\u00e9n \u00e9p c\u1ed5 tay g\u00f3c l\u1ec7ch quay, Weber v\u00e0 Chao x\u00e1c nh\u1eadn th\u00eam nh\u1eefng ph\u00e1t hi\u1ec7n n\u00f3i tr\u00ean v\u00e0 c\u00f3 th\u1ec3 t\u1ea1o ra g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n b\u1eb1ng c\u00e1ch t\u00e1c \u0111\u1ed9ng m\u1ed9t l\u1ef1c l\u00ean ph\u1ea7n quay c\u1ee7a l\u00f2ng b\u00e0n tay t\u01b0 th\u1ebf c\u1ed5 tay nghi\u00eang quay t\u1eeb 95<sup>o<\/sup> \u0111\u1ebfn 100<sup>o<\/sup> [16,17].<\/p>\n<p>G\u00e3y x\u01b0\u01a1ng thuy\u1ec1n c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c ch\u1ea5n th\u01b0\u01a1ng kh\u00e1c v\u00e0 ng\u01b0\u1eddi ta th\u01b0\u1eddng nghi ng\u1edd \u0111\u1ed1i v\u1edbi g\u00e3y \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng quay hay c\u00e1c d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng quanh x\u01b0\u01a1ng nguy\u1ec7t k\u00e8m theo trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ea5n th\u01b0\u01a1ng v\u1eadn t\u1ed1c cao h\u01a1n. S\u1ef1 li\u00ean quan d\u00e2y ch\u1eb1ng quanh x\u01b0\u01a1ng nguy\u1ec7t khi x\u1ea3y ra ch\u1ea5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn g\u00e3y x\u01b0\u01a1ng c\u1ed5 tay li\u00ean quan. C\u00e1c v\u1ecb tr\u00ed c\u00f3 kh\u1ea3 n\u0103ng b\u1ecb g\u00e3y bao g\u1ed3m \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng quay, x\u01b0\u01a1ng thuy\u1ec1n, x\u01b0\u01a1ng thang, x\u01b0\u01a1ng c\u1ea3, x\u01b0\u01a1ng m\u00f3c v\u00e0 x\u01b0\u01a1ng th\u00e1p, m\u1eb7c d\u00f9 g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n l\u00e0 ph\u1ed5 bi\u1ebfn nh\u1ea5t.<\/p>\n<h2><strong>3. L\u00c2M S\u00c0NG \u2013 C\u1eacN L\u00c2M S\u00c0NG<\/strong><\/h2>\n<h3><strong>3.1 L\u00e2m s\u00e0ng<\/strong><\/h3>\n<p>C\u1ea7n \u0111\u1eb7t nghi ng\u1edd l\u00e2m s\u00e0ng cao trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ea5n th\u01b0\u01a1ng c\u1ed5 tay r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 tr\u00e1nh b\u1ecf s\u00f3t m\u1ed9t v\u1ebft g\u00e3y di l\u1ec7ch t\u1ed1i thi\u1ec3u. N\u00ean nghi ng\u1edd g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n \u1edf b\u1ea5t k\u1ef3 b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i n\u00e0o b\u1ecb ng\u00e3 ch\u1ed1ng c\u1ed5 tay khi d\u1ea1ng ho\u1eb7c c\u1ed5 tay nghi\u00eang quay. B\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n \u0111au c\u1ed5 tay, nh\u01b0ng c\u01a1n \u0111au c\u00f3 th\u1ec3 r\u1ea5t \u00edt. C\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m:<\/p>\n<ul>\n<li>\u0110au khi s\u1edd v\u00e0o h\u1ed1 l\u00e0o c\u1ed5 tay, hay \u0111au t\u1ea1i l\u1ed3i c\u1ee7 x\u01b0\u01a1ng thuy\u1ec1n khi \u1ea5n t\u1ea1i ch\u1ed7 ho\u1eb7c d\u1ed3n d\u1ecdc tr\u1ee5c <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-ban-ngon-tay-gay-xuong-ban-tay\/\">ng\u00f3n tay<\/a> I<\/li>\n<li>\u0110au t\u0103ng khi nghi\u00eang quay t\u1ed1i \u0111a, du\u1ed7i c\u1ed5 tay t\u1ed1i \u0111a<\/li>\n<li>\u0110au nhi\u1ec1u c\u1ed5 tay sau ch\u1ea5n th\u01b0\u01a1ng, gi\u1ea3m d\u1ea7n khi b\u00f3 n\u1eb9p, b\u00f3 thu\u1ed1c ho\u1eb7c u\u1ed1ng thu\u1ed1c gi\u1ea3m \u0111au. Sau 7 \u2013 14 ng\u00e0y, ng\u01b0\u1eddi b\u1ec7nh c\u1ea3m th\u1ea5y b\u1edbt \u0111au nhi\u1ec1u nh\u01b0ng kh\u00f4ng h\u1ebft \u0111au ho\u00e0n to\u00e0n, n\u00ean l\u1ea7m t\u01b0\u1edfng b\u1ecb \u201cch\u1ea5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng, bong g\u00e2n\u201d<\/li>\n<li>S\u01b0ng nh\u1eb9 v\u00f9ng h\u1ed1 l\u00e0o c\u1ed5 tay<\/li>\n<li>H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng c\u1ed5 tay. S\u1ee9c c\u1ea7m n\u1eafm b\u00e0n tay gi\u1ea3m<\/li>\n<li>Nghi\u1ec7m ph\u00e1p Watson d\u00f9ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1ef1 m\u1ea5t v\u1eefng x\u01b0\u01a1ng thuy\u1ec1n. B\u1ec7nh nh\u00e2n ng\u1eeda b\u00e0n tay, th\u1ea3 l\u1ecfng. Ng\u01b0\u1eddi kh\u00e1m nghi\u00eang tr\u1ee5 v\u00e0 du\u1ed7i nh\u1eb9 c\u1ed5 tay, \u1ea5n gi\u1eef ng\u00f3n c\u00e1i v\u00e0o l\u1ed3i c\u1ee7 x\u01b0\u01a1ng thuy\u1ec1n, sau \u0111\u00f3 cho b\u00e0n tay nghi\u00eang sang b\u00ean quay t\u1eeb t\u1eeb v\u00e0 h\u01a1i g\u1ea5p d\u1ea7n. N\u1ebfu x\u01b0\u01a1ng thuy\u1ec1n b\u1ecb m\u1ea5t v\u1eefng, \u0111\u1ea7u g\u1ea7n s\u1ebd b\u1ecb \u0111\u1ea9y ra kh\u1ecfi di\u1ec7n kh\u1edbp x\u01b0\u01a1ng quay v\u1ec1 ph\u00eda mu tay, nghi\u1ec7m ph\u00e1p d\u01b0\u01a1ng t\u00ednh khi b\u1ec7nh nh\u00e2n \u0111au v\u00e0 c\u00f3 th\u1ec3 c\u00f3 ti\u1ebfng \u201ckh\u1ee5c\u201d t\u1ea1i kh\u1edbp c\u1ed5 tay. Khi ng\u01b0\u1eddi kh\u00e1m th\u1ea3 l\u1ecfng ng\u00f3n c\u00e1i, c\u00f3 th\u1ec3 c\u1ea3m nh\u1eadn \u0111\u01b0\u1ee3c x\u01b0\u01a1ng thuy\u1ec1n tr\u01b0\u1ee3t v\u1ec1 l\u1ea1i v\u1ecb tr\u00ed ban \u0111\u1ea7u (<strong>H\u00ecnh 17.3<\/strong>).<\/li>\n<\/ul>\n<figure id=\"attachment_2013\" aria-describedby=\"caption-attachment-2013\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" class=\"size-medium wp-image-2013\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture17-1-300x208.png\" alt=\"Picture17\" width=\"300\" height=\"208\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture17-1-300x208.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture17-1-1024x710.png 1024w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture17-1-768x533.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture17-1-18x12.png 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture17-1.png 1426w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-2013\" class=\"wp-caption-text\"><strong>H\u00ecnh 17.3.<\/strong> Nghi\u1ec7m ph\u00e1p Watson [27]<\/figcaption><\/figure>\n<h3><strong>3.2 C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h3>\n<p>C\u00e1c h\u00ecnh chi\u1ebfu c\u1ee7a x\u01b0\u01a1ng c\u1ed5 tay \u0111\u01b0\u1ee3c coi l\u00e0 ti\u00eau chu\u1ea9n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n g\u1ed3m X-quang b\u00ecnh di\u1ec7n sau \u2013 tr\u01b0\u1edbc, b\u00ecnh di\u1ec7n sau \u2013 tr\u01b0\u1edbc nghi\u00eang tr\u1ee5 t\u1ed1i \u0111a, b\u00ecnh di\u1ec7n th\u1eb3ng \u2013 nghi\u00eang ch\u1ebfch 45<sup>o<\/sup> ho\u1eb7c ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb, ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh d\u1ef1ng h\u00ecnh.<\/p>\n<p>X-quang ban \u0111\u1ea7u \u0111\u1ea7y \u0111\u1ee7 ph\u00e1t hi\u1ec7n g\u00e3y x\u01b0\u01a1ng trong 85% \u0111\u1ebfn 90% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. Tuy nhi\u00ean, phim X-quang ban \u0111\u1ea7u c\u00f3 th\u1ec3 \u00e2m t\u00ednh. T\u1ec9 l\u1ec7 ch\u1ee5p X-quang \u00e2m t\u00ednh gi\u1ea3 \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 cao t\u1edbi 25% [10]. V\u00ec v\u1eady, m\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed ph\u00f9 h\u1ee3p v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng d\u01b0\u01a1ng t\u00ednh v\u1edbi phim ch\u1ee5p X-quang m\u00e0 kh\u00f4ng b\u1ecb g\u00e3y x\u01b0\u01a1ng th\u00ec \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n tr\u00ean l\u00e2m s\u00e0ng v\u00e0 c\u1ea7n ch\u1ee5p th\u00eam c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh r\u00f5 h\u01a1n.<\/p>\n<p><a href=\"https:\/\/bsvothanhtoan.com\/\"><strong>C\u00e1c t\u01b0 th\u1ebf ch\u1ee5p X-quang x\u01b0\u01a1ng thuy\u1ec1n:<\/strong><\/a><\/p>\n<ul>\n<li>Ch\u1ee5p th\u1eb3ng b\u00ecnh di\u1ec7n sau \u2013 tr\u01b0\u1edbc ho\u1eb7c k\u1ebft h\u1ee3p c\u1ed5 tay th\u1eb3ng v\u00e0 nghi\u00eang tr\u1ee5 t\u1ed1i \u0111a<\/li>\n<li>Ch\u1ee5p th\u1eb3ng c\u1ed5 tay du\u1ed7i m\u1eb7t l\u01b0ng 20\u00b0, tia ch\u1ee5p t\u1eeb sau ra tr\u01b0\u1edbc, t\u1eadp trung v\u00e0o n\u1ec1n x\u01b0\u01a1ng b\u00e0n II<\/li>\n<li>Ch\u1ee5p t\u01b0 th\u1ebf b\u00e0n tay c\u1ea7m vi\u1ebft. B\u00e0n tay nghi\u00eang 45\u00b0, ng\u00f3n I \u1edf t\u01b0 th\u1ebf \u0111\u1ed1i chi\u1ebfu. Tia ch\u1ee5p t\u1eadp trung v\u00e0o h\u1ed1 l\u00e0o t\u1eeb sau ra tr\u01b0\u1edbc.<\/li>\n<\/ul>\n<figure id=\"attachment_2014\" aria-describedby=\"caption-attachment-2014\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-2014\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture18-1-300x265.png\" alt=\"Picture18\" width=\"300\" height=\"265\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture18-1-300x265.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture18-1-1024x904.png 1024w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture18-1-768x678.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture18-1-14x12.png 14w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture18-1.png 1217w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-2014\" class=\"wp-caption-text\"><strong>H\u00ecnh 17.4 <\/strong>X-quang x\u01b0\u01a1ng thuy\u1ec1n [30]<\/figcaption><\/figure>\n<p>Khi ch\u01b0a c\u00f3 c\u00e1c c\u00f4ng c\u1ee5 kh\u00e1c ngo\u00e0i X-quang, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng \u0111\u01b0\u1ee3c <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/so-cuu-bat-dong-gay-xuong\/\">b\u1ea5t \u0111\u1ed9ng<\/a> v\u00e0 ch\u1ee5p li\u00ean t\u1ee5c trong 3 tu\u1ea7n. Ng\u00e0y nay, nh\u1edd c\u00f3 c\u00e1c c\u00f4ng c\u1ee5 \u0111\u00e1ng tin c\u1eady h\u01a1n nh\u01b0 ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT-scan), MRI, si\u00eau \u00e2m. Trong \u0111\u00f3, si\u00eau \u00e2m \u0111\u00e1nh gi\u00e1 g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n l\u00e0 m\u1ed9t gi\u1ea3i ph\u00e1p thay th\u1ebf an to\u00e0n so v\u1edbi CT v\u00e0 X-quang, si\u00eau \u00e2m th\u00f4ng d\u1ee5ng trong c\u00e1c c\u01a1 s\u1edf y t\u1ebf v\u00e0 nh\u1edd vi\u1ec7c tr\u00e1nh tia b\u1ee9c x\u1ea1 n\u00ean c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n t\u1ea1i m\u1ecdi n\u01a1i m\u1ed9t c\u00e1ch nhanh ch\u00f3ng. G\u1ea7n \u0111\u00e2y, Jain v\u00e0 c\u1ed9ng s\u1ef1 [20] \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng, trong m\u1ed9t nghi\u00ean c\u1ee9u ti\u1ec1n c\u1ee9u tr\u00ean 114 b\u1ec7nh nh\u00e2n, \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a vi\u1ec7c ph\u00e1t hi\u1ec7n g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n b\u1eb1ng si\u00eau \u00e2m l\u00ean \u0111\u1ebfn 98% so v\u1edbi ch\u1ee5p X-quang ch\u1ec9 d\u01b0\u01a1ng t\u00ednh v\u1edbi 20%. M\u1eb7c d\u00f9 c\u00e1c gi\u00e1 tr\u1ecb n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ee9ng th\u1ef1c v\u1edbi c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c, nh\u01b0ng \u0111i\u1ec1u n\u00e0y \u0111\u00e3 ch\u1ec9 ra m\u1ed9t ph\u01b0\u01a1ng ti\u1ec7n d\u1ec5 d\u00e0ng \u0111\u1ec3 s\u00e0ng l\u1ecdc g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n<p><figure id=\"attachment_2015\" aria-describedby=\"caption-attachment-2015\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-2015\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture19-300x153.jpg\" alt=\"Picture19\" width=\"300\" height=\"153\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture19-300x153.jpg 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture19-18x9.jpg 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture19.jpg 564w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-2015\" class=\"wp-caption-text\"><strong>H\u00ecnh 17.5.<\/strong> Ch\u1ee5p MRI pha T2 (tr\u00e1i) pha T1 (ph\u1ea3i) cho th\u1ea5y c\u00f3 g\u00e3y eo x\u01b0\u01a1ng thuy\u1ec1n [32]<\/figcaption><\/figure> <figure id=\"attachment_2016\" aria-describedby=\"caption-attachment-2016\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-2016\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture20-300x113.png\" alt=\"Picture20\" width=\"300\" height=\"113\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture20-300x113.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture20-1024x385.png 1024w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture20-768x289.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture20-1536x578.png 1536w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture20-18x7.png 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture20.png 1772w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-2016\" class=\"wp-caption-text\"><strong>H\u00ecnh 17.6<\/strong>. Ch\u1ee5p CT-scan b\u00ecnh di\u1ec7n coronal (A), d\u1ef1ng h\u00ecnh 3D (B) v\u00e0 b\u00ecnh di\u1ec7n sagital (C) c\u00f3 g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n [31]<\/figcaption><\/figure><\/p>\n<p>M\u1eb7c d\u00f9 c\u00f3 nhi\u1ec1u c\u00f4ng c\u1ee5 h\u1eefu \u00edch h\u1ed7 tr\u1ee3 cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n c\u1ea5p t\u00ednh, MRI v\u1eabn h\u1eefu \u00edch nh\u1ea5t trong vi\u1ec7c ph\u00e1t hi\u1ec7n g\u00e3y x\u01b0\u01a1ng \u1ea9n (<strong>H\u00ecnh 17.5<\/strong>). M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng k\u00e8m ph\u00f9 n\u1ec1 nhi\u1ec1u v\u1eabn c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng MRI \u0111\u1ec3 ph\u00e1t hi\u1ec7n x\u01b0\u01a1ng g\u00e3y trong v\u00e0i gi\u1edd g\u00e3y x\u01b0\u01a1ng [20]. M\u1ed9t \u01b0u \u0111i\u1ec3m kh\u00e1c c\u1ee7a MRI c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng c\u1ed5 tay c\u00f9ng c\u00e1c ch\u1ea5n th\u01b0\u01a1ng kh\u00e1c. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng MRI l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n v\u1edbi \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00ean t\u1edbi 100% [21,22].<\/p>\n<p>B\u00ean c\u1ea1nh \u0111\u00f3, ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao k\u00e8m d\u1ef1ng h\u00ecnh (<strong>H\u00ecnh 17.6<\/strong>) c\u0169ng l\u00e0 ph\u01b0\u01a1ng ph\u00e1p h\u1eefu \u00edch trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ch\u1ee5p MRI \u0111\u01b0\u1ee3c. Ch\u1ee5p CT x\u01b0\u01a1ng thuy\u1ec1n c\u00f3 \u0111\u1ed9 nh\u1ea1y 72%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 99%. \u0110i\u1ec1u \u0111\u00e1ng l\u01b0u \u00fd l\u00e0 ch\u1ee5p CT m\u1eb7c d\u00f9 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh t\u1ed1t nh\u01b0ng l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n g\u00e2y ph\u01a1i nhi\u1ec5m b\u1ee9c x\u1ea1 [18].<\/p>\n<h2><strong>4. \u0110I\u1ec0U TR\u1eca<\/strong><\/h2>\n<p>\u0110i\u1ec1u tr\u1ecb g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n ph\u1ee5 thu\u1ed9c v\u00e0o th\u1eddi \u0111i\u1ec3m (ph\u00e1t hi\u1ec7n s\u1edbm hay mu\u1ed9n), ch\u1ea9n \u0111o\u00e1n th\u00edch h\u1ee3p v\u00e0 lo\u1ea1i g\u00e3y x\u01b0\u01a1ng. S\u1ef1 ch\u1eadm tr\u1ec5 trong \u0111i\u1ec1u tr\u1ecb l\u00e0m t\u0103ng nguy c\u01a1 kh\u00f4ng li\u1ec1n x\u01b0\u01a1ng v\u00e0 ph\u1ea3i x\u1eed tr\u00ed ph\u1eabu thu\u1eadt. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng khi \u0111i\u1ec1u tr\u1ecb tr\u1ec5 4 tu\u1ea7n, nguy c\u01a1 kh\u00f4ng li\u1ec1n x\u01b0\u01a1ng c\u00f3 th\u1ec3 l\u00ean t\u1edbi 40%. Ngay c\u1ea3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p g\u00e3y c\u1ef1c g\u1ea7n \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 c\u00f3 t\u1ec9 l\u1ec7 <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/cham-lanh-xuong-va-khong-lanh-xuong\/\">l\u00e0nh x\u01b0\u01a1ng<\/a> ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c n\u1ebfu \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb h\u1ee3p l\u00fd trong v\u00f2ng 4 tu\u1ea7n sau khi ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n<p>Trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb, m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 kh\u00e1c g\u00f3p ph\u1ea7n g\u00e2y kh\u00f4ng li\u1ec1n x\u01b0\u01a1ng v\u00e0 bi\u1ebfn ch\u1ee9ng; nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0y bao g\u1ed3m m\u1ee9c \u0111\u1ed9 di l\u1ec7ch c\u1ee7a \u1ed5 g\u00e3y, v\u1ecb tr\u00ed c\u1ee7a \u1ed5 g\u00e3y v\u00e0 \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh c\u1ee7a \u1ed5 g\u00e3y. G\u00e3y x\u01b0\u01a1ng thuy\u1ec1n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo v\u1ecb tr\u00ed gi\u1ea3i ph\u1eabu v\u00e0 \u0111\u1ed9 di l\u1ec7ch. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Herbert\" target=\"_blank\" rel=\"noopener\">Herbert<\/a> v\u00e0 Fisher \u0111\u00e3 m\u00f4 t\u1ea3 v\u00e0 \u0111\u1ec1 xu\u1ea5t m\u1ed9t h\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i k\u1ebft h\u1ee3p gi\u1ea3i ph\u1eabu, \u0111\u1ed9 di l\u1ec7ch v\u00e0 <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/khai-thac-benh-su-va-tien-can-benh-ly-ngoai-chan-thuong\/\">b\u1ec7nh s\u1eed<\/a> g\u00e3y x\u01b0\u01a1ng (<strong>H\u00ecnh 17.7<\/strong>). H\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i Herbert cung c\u1ea5p c\u00f3 \u00fd ngh\u0129a ti\u00ean l\u01b0\u1ee3ng [23]. Ngo\u00e0i ph\u00e2n lo\u1ea1i Herbert c\u00f2n c\u00f3 ph\u00e2n lo\u1ea1i Mayo (<strong>H\u00ecnh 17.8<\/strong>), ph\u00e2n lo\u1ea1i Russe (<strong>H\u00ecnh 17.9<\/strong>) ho\u1eb7c ph\u00e2n lo\u1ea1i \u0111\u01a1n gi\u1ea3n (g\u00e3y \u0111\u1ea7u xa, g\u00e3y ngang eo v\u00e0 g\u00e3y \u0111\u1ea7u g\u1ea7n). Oka v\u00e0 Morimoto \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n t\u1eeb c\u1ef1c xa \u0111\u1ebfn l\u1ed3i c\u1ee7 x\u01b0\u01a1ng thuy\u1ec1n (Herbert B2) c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng d\u1eabn \u0111\u1ebfn x\u1eb9p v\u00e0 bi\u1ebfn d\u1ea1ng g\u1eadp do m\u1ea5t s\u1ef1 \u1ed5n \u0111\u1ecbnh do d\u00e2y ch\u1eb1ng \u1edf c\u1ef1c xa x\u01b0\u01a1ng thuy\u1ec1n [24]. Kh\u1ea3 n\u0103ng ph\u00e2n bi\u1ec7t g\u00e3y x\u01b0\u01a1ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u1edbi g\u00e3y x\u01b0\u01a1ng \u1ed5n \u0111\u1ecbnh l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft, v\u00ec gi\u00fap b\u00e1c s\u0129 x\u00e1c \u0111\u1ecbnh c\u00f3 c\u1ea7n \u0111\u01b0\u1ee3c x\u1eed tr\u00ed ph\u1eabu thu\u1eadt hay kh\u00f4ng.<\/p>\n<p><figure id=\"attachment_2018\" aria-describedby=\"caption-attachment-2018\" style=\"width: 273px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-2018\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture21-273x300.png\" alt=\"Picture21\" width=\"273\" height=\"300\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture21-273x300.png 273w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture21-930x1024.png 930w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture21-768x845.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture21-11x12.png 11w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture21.png 1343w\" sizes=\"(max-width: 273px) 100vw, 273px\" \/><figcaption id=\"caption-attachment-2018\" class=\"wp-caption-text\"><strong>H\u00ecnh 17.7.<\/strong> Ph\u00e2n lo\u1ea1i g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n theo Herbert [26]<\/figcaption><\/figure> <figure id=\"attachment_2019\" aria-describedby=\"caption-attachment-2019\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-2019\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture22-300x172.png\" alt=\"Picture22\" width=\"300\" height=\"172\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture22-300x172.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture22-1024x586.png 1024w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture22-768x439.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture22-18x10.png 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture22.png 1236w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-2019\" class=\"wp-caption-text\"><strong>H\u00ecnh 17.8.<\/strong> Ph\u00e2n lo\u1ea1i g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n theo Mayo [28]<\/figcaption><\/figure> <figure id=\"attachment_2020\" aria-describedby=\"caption-attachment-2020\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-2020\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture23-300x106.png\" alt=\"Picture23\" width=\"300\" height=\"106\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture23-300x106.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture23-1024x363.png 1024w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture23-768x272.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture23-1536x544.png 1536w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture23-18x6.png 18w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture23.png 1596w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-2020\" class=\"wp-caption-text\"><strong>H\u00ecnh 17.9.<\/strong> Ph\u00e2n lo\u1ea1i theo Russe v\u1edbi ba d\u1ea1ng g\u00e3y ch\u00e9o, g\u00e3y ngang v\u00e0 g\u00e3y d\u1ecdc [29]<\/figcaption><\/figure><\/p>\n<h3><strong>4.1. \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n<\/strong><\/h3>\n<p>B\u1ea5t \u0111\u1ed9ng v\u1eabn l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn c\u00f3 th\u1ec3 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c \u0111\u1ec3 x\u1eed tr\u00ed g\u00e3y x\u01b0\u01a1ng \u1ed5n \u0111\u1ecbnh, kh\u00f4ng di l\u1ec7ch; bao g\u1ed3m g\u00e3y eo v\u00e0 g\u00e3y c\u1ef1c xa kh\u00f4ng b\u1ecb l\u1ec7ch, di l\u1ec7ch khi kho\u1ea3ng c\u00e1ch g\u00e3y t\u1eeb 1 mm tr\u1edf xu\u1ed1ng tr\u00ean phim X-quang tr\u01b0\u1edbc v\u00e0 sau xi\u00ean; g\u00f3c nguy\u1ec7t \u2013 c\u1ea3 nh\u1ecf h\u01a1n 15<sup>o<\/sup> v\u00e0 g\u00f3c thuy\u1ec1n \u2013 nguy\u1ec7t kh\u00f4ng l\u1edbn h\u01a1n 60<sup>o<\/sup> \u1edf b\u00ecnh di\u1ec7n b\u00ean. \u0110\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c s\u1ef1 di l\u1ec7ch, n\u00ean ch\u1ee5p CT cho t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng; h\u01a1n n\u1eefa, b\u1eb1ng ch\u1ee9ng g\u1ea7n \u0111\u00e2y cho th\u1ea5y r\u1eb1ng ch\u1ee5p CT d\u1ef1ng h\u00ecnh ba chi\u1ec1u c\u00f3 th\u1ec3 l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n t\u1ed1t nh\u1ea5t \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh lo\u1ea1i g\u00e3y v\u00e0 \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh.<\/p>\n<p>N\u1ebfu g\u00e3y \u1edf v\u1ecb tr\u00ed ngang eo ho\u1eb7c c\u1ef1c xa x\u01b0\u01a1ng thuy\u1ec1n, th\u00ec vi\u1ec7c b\u1ea5t \u0111\u1ed9ng b\u1eb1ng <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/bo-bot\/\">b\u00f3 b\u1ed9t<\/a> l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p; tuy nhi\u00ean, vi\u1ec7c b\u1ea5t \u0111\u1ed9ng s\u1ebd l\u00e0m h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp (ng\u00f3n tay c\u00e1i, c\u1ed5 tay v\u00e0\/ho\u1eb7c c\u1eb3ng tay) nh\u01b0ng mang l\u1ea1i kh\u1ea3 n\u0103ng li\u1ec1n x\u01b0\u01a1ng v\u00e0 lu\u00f4n \u0111\u01b0\u1ee3c tranh lu\u1eadn. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra b\u1eb1ng ch\u1ee9ng v\u1ec1 s\u1ef1 d\u1ecbch chuy\u1ec3n c\u1ee7a c\u1ef1c g\u1ea7n v\u00e0 c\u1ef1c xa x\u01b0\u01a1ng thuy\u1ec1n trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p khi c\u1eed \u0111\u1ed9ng c\u00e1nh tay di chuy\u1ec3n gi\u1eefa t\u01b0 th\u1ebf s\u1ea5p v\u00e0 ng\u1eeda. Do \u0111\u00f3, b\u1ea5t \u0111\u1ed9ng n\u1eb9p b\u1ed9t c\u1ea7n c\u1ed1 \u0111\u1ecbnh t\u1eeb b\u00e0n tay \u0111\u1ebfn khu\u1ef7u tay v\u1edbi c\u1ed5 tay \u1edf v\u1ecb tr\u00ed trung t\u00ednh.<\/p>\n<p>Tr\u01b0\u1eddng h\u1ee3p b\u1ea5t \u0111\u1ed9ng b\u1ed9t g\u00e3y ngang eo kh\u00f4ng di l\u1ec7ch c\u00f3 th\u1ec3 l\u00e0nh trong 8 tu\u1ea7n v\u1edbi 90% tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c b\u1ea5t \u0111\u1ed9ng th\u00edch h\u1ee3p. T\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng n\u00e0y l\u1eadp lu\u1eadn cho vi\u1ec7c x\u1eed tr\u00ed kh\u00f4ng ph\u1eabu thu\u1eadt \u1edf h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e3y eo \u1ed5n \u0111\u1ecbnh kh\u00f4ng di l\u1ec7ch; tuy nhi\u00ean, vi\u1ec7c can thi\u1ec7p ph\u1eabu thu\u1eadt s\u1edbm \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 l\u00e0m gi\u1ea3m chi ph\u00ed \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m th\u1eddi gian b\u1ea5t \u0111\u1ed9ng. Vi\u1ec7c ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p x\u01b0\u01a1ng c\u00f3 th\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n v\u1eadn \u0111\u1ed9ng s\u1edbm h\u01a1n, gi\u1ea3m t\u1ec9 l\u1ec7 \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p x\u01b0\u01a1ng tr\u1ec5 v\u00e0 gi\u1ea3m th\u1eddi gian ngh\u1ec9 vi\u1ec7c [25]. B\u1ea5t ch\u1ea5p nh\u1eefng l\u1ee3i \u00edch n\u00e0y, c\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u0169ng nh\u01b0 ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt c\u0169ng c\u00f3 th\u1ec3 mang \u0111\u1ebfn nhi\u1ec1u r\u1ee7i ro v\u00e0 bi\u1ebfn ch\u1ee9ng h\u01a1n. Ch\u00ednh v\u00ec th\u1ebf, c\u1ea7n c\u00e2n nh\u1eafc nh\u1eefng r\u1ee7i ro v\u00e0 l\u1ee3i \u00edch l\u00e2u d\u00e0i khi ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p x\u01b0\u01a1ng thuy\u1ec1n.<\/p>\n<h3><strong>4.2. \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/strong><\/h3>\n<p>Ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p:<\/p>\n<ul>\n<li>G\u00e3y x\u01b0\u01a1ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh<\/li>\n<li>G\u00e3y x\u01b0\u01a1ng c\u1ef1c g\u1ea7n<\/li>\n<li>G\u00e3y ngang eo di l\u1ec7ch<\/li>\n<li>G\u00e3y x\u01b0\u01a1ng c\u00f3 kho\u1ea3ng c\u00e1ch di l\u1ec7ch h\u01a1n 1 mm<\/li>\n<li>Kh\u00f4ng l\u00e0nh x\u01b0\u01a1ng, kh\u1edbp gi\u1ea3<\/li>\n<li>M\u1ea5t v\u1eefng kh\u1edbp c\u1ed5 tay v\u00e0 t\u1ed5n th\u01b0\u01a1ng kh\u1edbp quay c\u1ed5 tay.<\/li>\n<\/ul>\n<p>Nh\u01b0 \u0111\u00e3 \u0111\u1ec1 c\u1eadp tr\u01b0\u1edbc \u0111\u00f3, c\u1ef1c g\u1ea7n c\u00f3 ngu\u1ed3n cung c\u1ea5p m\u00e1u h\u1ea1n ch\u1ebf, \u0111i\u1ec1u n\u00e0y gi\u1ea3i th\u00edch cho t\u1ec9 l\u1ec7 cao kh\u00f4ng li\u1ec1n x\u01b0\u01a1ng v\u00e0 s\u1ef1 c\u1ea7n thi\u1ebft khi ph\u1eabu thu\u1eadt. Trong tr\u01b0\u1eddng h\u1ee3p c\u00e1c m\u1ea3nh v\u1ee1 l\u1edbn, v\u00edt n\u00e9n kh\u00f4ng m\u0169 l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n c\u1ed1 \u0111\u1ecbnh ph\u1ed5 bi\u1ebfn nh\u1ea5t. Trong tr\u01b0\u1eddng h\u1ee3p \u0111o\u1ea1n g\u1ea7n qu\u00e1 nh\u1ecf \u0111\u1ec3 c\u00f3 th\u1ec3 ti\u1ebfp nh\u1eadn v\u00edt, kim Kirschner (kim K) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh \u1ed5 g\u00e3y. C\u00e1c k\u1ebft qu\u1ea3 tr\u01b0\u1edbc \u0111\u00e2y \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u0111\u1ed1i v\u1edbi ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt m\u1edf s\u1eed d\u1ee5ng v\u00edt n\u00e9n, \u0111\u1ec1u b\u00e1o c\u00e1o t\u1ec9 l\u1ec7 l\u00e0nh x\u01b0\u01a1ng l\u00e0 r\u1ea5t cao.<\/p>\n<p>Ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 l\u00e0m t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u nu\u00f4i x\u01b0\u01a1ng tr\u00ean b\u1ec7nh nh\u00e2n g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n \u0111\u1ed3ng th\u1eddi c\u00f3 th\u1ec3 l\u00e0m h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng sau ph\u1eabu thu\u1eadt. Ch\u00ednh v\u00ec c\u00e1c t\u1ed5n th\u01b0\u01a1ng li\u00ean quan \u0111\u1ebfn ph\u1eabu thu\u1eadt n\u00ean h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng thuy\u1ec1n ph\u00e1t hi\u1ec7n s\u1edbm ng\u00e0y nay c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb th\u00f4ng qua ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt qua da ho\u1eb7c <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/noi-soi-khop-co-ban\/\">n\u1ed9i soi kh\u1edbp<\/a>, ngay c\u1ea3 khi c\u1ea7n gh\u00e9p x\u01b0\u01a1ng \u0111\u1ec3 l\u00e0m h\u1ea1n ch\u1ebf t\u1ed5n th\u01b0\u01a1ng \u1edf m\u1ee9c t\u1ed1i thi\u1ec3u. M\u1eb7c d\u00f9 ph\u1eabu thu\u1eadt qua da th\u00e0nh c\u00f4ng hay kh\u00f4ng th\u00ec b\u1ec7nh nh\u00e2n n\u00ean l\u01b0u \u00fd r\u1eb1ng trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng k\u1ebft h\u1ee3p x\u01b0\u01a1ng \u0111\u01b0\u1ee3c qua da ho\u1eb7c kh\u00f4ng \u0111\u1ee7 kh\u1ea3 n\u0103ng c\u1ed1 \u0111\u1ecbnh m\u1ea3nh g\u00e3y, ph\u1eabu thu\u1eadt vi\u00ean s\u1ebd chuy\u1ec3n sang ph\u1eabu thu\u1eadt m\u1edf khi c\u1ea7n thi\u1ebft.<\/p>\n<p>B\u1ea5t k\u1ec3 c\u00e1ch ti\u1ebfp c\u1eadn x\u01b0\u01a1ng g\u00e3y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0 g\u00ec, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111i\u1ec3m v\u00e0o h\u1ee3p l\u00fd th\u00f4ng qua m\u1ea3nh g\u1ea7n ho\u1eb7c xa trong qu\u00e1 tr\u00ecnh \u0111\u1eb7t v\u00edt. M\u1ed9t s\u1ed1 nghi\u00ean \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng m\u1ed9t v\u00edt \u0111\u1eb7t t\u1ea1i v\u1ecb tr\u00ed trung t\u00e2m s\u1ebd gi\u00fap x\u01b0\u01a1ng \u0111\u1ea1t \u0111\u1ed9 c\u1ee9ng l\u1edbn h\u01a1n v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng ch\u1ecbu t\u1ea3i khi so s\u00e1nh v\u1edbi v\u00edt \u0111\u1eb7t l\u1ec7ch t\u00e2m. Ngo\u00e0i ra, v\u00edt ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u1ecbnh v\u1ecb \u1edf m\u1ed9t g\u00f3c vu\u00f4ng v\u1edbi \u0111\u01b0\u1eddng \u0111\u1ee9t g\u00e3y \u0111\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 cao nh\u1ea5t. Do \u0111\u00f3, lo\u1ea1i g\u00e3y v\u00e0 v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng g\u00e3y quy\u1ebft \u0111\u1ecbnh s\u1ef1 \u01b0u ti\u00ean s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn x\u01b0\u01a1ng g\u00e3y b\u1eb1ng h\u01b0\u1edbng n\u00e0o. H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng lo\u1ea1i B1 v\u00e0 B2 theo Herbert c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt ti\u1ebfp c\u1eadn t\u1eeb m\u1eb7t l\u01b0ng, trong khi vi\u1ec7c n\u1eafn ch\u1ec9nh bi\u1ebfn d\u1ea1ng g\u1eadp g\u00f3c th\u01b0\u1eddng y\u00eau c\u1ea7u ti\u1ebfp c\u1eadn m\u1eb7t l\u00f2ng. M\u1eb7c d\u00f9 kh\u00f4ng c\u00f3 l\u1ee3i \u00edch n\u00e0o \u0111\u01b0\u1ee3c ch\u1ec9 ra r\u00f5 r\u00e0ng cho n\u00ean b\u00e1c s\u0129 ph\u1eabu thu\u1eadt c\u1ea7n l\u00e0m quen v\u1edbi t\u1eebng c\u00e1ch ti\u1ebfp c\u1eadn x\u01b0\u01a1ng thuy\u1ec1n.<\/p>\n<h3><strong>4.3. \u0110\u01b0\u1eddng m\u1ed5 v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p k\u1ebft h\u1ee3p x\u01b0\u01a1ng<\/strong><\/h3>\n<p>Ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn t\u1ed1i thi\u1ec3u qua da th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u00e1c ph\u1eabu thu\u1eadt vi\u00ean \u01b0u ti\u00ean th\u1ef1c hi\u1ec7n, nh\u1ea5t l\u00e0 \u0111\u1ed1i v\u1edbi c\u00e1c lo\u1ea1i g\u00e3y Herbert B1 v\u00e0 B2. C\u00e1c \u0111\u01b0\u1eddng m\u1ed5 th\u01b0\u1eddng d\u00f9ng nh\u01b0 \u0111\u01b0\u1eddng m\u1ed5 m\u1eb7t tr\u01b0\u1edbc c\u1ed5 tay (Russe): theo \u0111\u01b0\u1eddng \u0111i \u0111\u1ed9ng m\u1ea1ch quay, b\u1edd ngo\u00e0i g\u00e2n g\u1eadp c\u1ed5 tay quay hay \u0111\u01b0\u1eddng m\u1ed5 m\u1eb7t sau c\u1ed5 tay: d\u1ecdc m\u1eb7t l\u01b0ng c\u1ed5 tay, gi\u1eefa g\u00e2n du\u1ed7i d\u00e0i ng\u00f3n I v\u00e0 g\u00e2n du\u1ed7i chung ng\u00f3n tay. C\u1ea7n x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed x\u01b0\u01a1ng thuy\u1ec1n h\u1ee3p l\u00fd n\u1eafm r\u00f5 c\u00e1c c\u1ea5u tr\u00fac li\u00ean quan \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh (<strong>H\u00ecnh 10<\/strong>).<\/p>\n<p>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p k\u1ebft h\u1ee3p x\u01b0\u01a1ng th\u01b0\u1eddng d\u00f9ng:<\/p>\n<ul>\n<li>Kim Kirschner: d\u1ec5 th\u1ef1c hi\u1ec7n thao t\u00e1c, chi ph\u00ed th\u1ea5p, \u0111\u1eb7c bi\u1ec7t d\u00f9ng trong tr\u01b0\u1eddng h\u1ee3p m\u1ea3nh g\u00e3y c\u1ef1c g\u1ea7n qu\u00e1 nh\u1ecf kh\u00f4ng \u0111\u1ee7 \u0111\u1eb7t v\u00edt, \u0111\u01b0\u1eddng m\u1ed5 kh\u00f4ng qu\u00e1 d\u00e0i kh\u00f4ng g\u00e2y t\u1ed5n th\u01b0\u01a1ng kh\u1edbp thang \u2013 thuy\u1ec1n. Nh\u01b0\u1ee3c \u0111i\u1ec3m: kh\u00f4ng gi\u1eef v\u1eefng \u1ed5 g\u00e3y so v\u1edbi k\u1ebft h\u1ee3p x\u01b0\u01a1ng b\u1eb1ng v\u00edt.<\/li>\n<li>V\u00edt n\u00e9n \u00e9p AO, Herbert, Acutrack: c\u1ed1 \u0111\u1ecbnh v\u1eefng ch\u1eafc \u1ed5 g\u00e3y x\u01b0\u01a1ng, d\u1ec5 \u0111\u1ea1t l\u00e0nh x\u01b0\u01a1ng. \u0110\u00f2i h\u1ecfi ph\u1eabu thu\u1eadt vi\u00ean c\u00f3 kinh nghi\u1ec7m, d\u1ec5 t\u1ed5n th\u01b0\u01a1ng kh\u1edbp thang thuy\u1ec1n. &#8211; Kim m\u00f3c (Staple, Agraffe), n\u1eb9p Ender.<\/li>\n<\/ul>\n<figure id=\"attachment_2021\" aria-describedby=\"caption-attachment-2021\" style=\"width: 263px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-2021\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture24-263x300.png\" alt=\"Picture24\" width=\"263\" height=\"300\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture24-263x300.png 263w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture24-896x1024.png 896w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture24-768x878.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture24-11x12.png 11w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/06\/Picture24.png 1276w\" sizes=\"(max-width: 263px) 100vw, 263px\" \/><figcaption id=\"caption-attachment-2021\" class=\"wp-caption-text\"><strong>H\u00ecnh 17.10.<\/strong> V\u1ecb tr\u00ed x\u01b0\u01a1ng thuy\u1ec1n v\u1edbi c\u00e1c c\u1ea5u tr\u00fac li\u00ean quan [33]<\/figcaption><\/figure>\n<p><strong>4.4. Gh\u00e9p x\u01b0\u01a1ng<\/strong><\/p>\n<p>C\u00f3 nhi\u1ec1u lo\u1ea1i x\u01b0\u01a1ng gh\u00e9p v\u1edbi m\u1ee5c \u0111\u00edch ph\u1ee5c h\u1ed3i chi\u1ec1u d\u00e0i x\u01b0\u01a1ng thuy\u1ec1n, t\u00e1i l\u1eadp chi\u1ec1u d\u00e0i c\u1ed5 tay.<\/p>\n<ul>\n<li>Gh\u00e9p x\u01b0\u01a1ng ch\u1eadu Matti (1937) \u2013 Russe (1951)<\/li>\n<li>Gh\u00e9p x\u01b0\u01a1ng ch\u1eadu Fernandez (1984)<\/li>\n<li>Gh\u00e9p x\u01b0\u01a1ng c\u00f3 cu\u1ed1ng m\u1ea1ch Zaidemberg (1991): t\u1eeb nh\u00e1nh qu\u1eb7t ng\u01b0\u1ee3c khoang 1,2 c\u1ee7a \u0111\u1ed9ng m\u1ea1ch quay: th\u1ef1c hi\u1ec7n trong tr\u01b0\u1eddng h\u1ee3p kh\u1edbp gi\u1ea3 k\u00e8m ho\u1ea1i t\u1eed c\u1ef1c g\u1ea7n x\u01b0\u01a1ng thuy\u1ec1n.<\/li>\n<\/ul>\n<p>Ngo\u00e0i ra, c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p gh\u00e9p x\u01b0\u01a1ng c\u00f3 cu\u1ed1ng kh\u00e1c nh\u01b0 t\u1eeb l\u1ed3i c\u1ee7 x\u01b0\u01a1ng thuy\u1ec1n (Judet), c\u01a1 s\u1ea5p vu\u00f4ng (Braun, 1983), \u0111\u1ed9ng m\u1ea1ch tr\u1ee5 (Guimberteau, 1990), n\u1ec1n x\u01b0\u01a1ng b\u00e0n II (Brunelli, 1992), cu\u1ed9n m\u1ea1ch m\u00e1u \u0111\u1eb7t v\u00e0o \u1ed5 g\u00e3y g\u1ea7n (Fernandez, Eggli, 1995), x\u01b0\u01a1ng b\u00e0n I (Yuccerturk, 1997).<\/p>\n","protected":false},"featured_media":2269,"comment_status":"open","ping_status":"closed","template":"","tags":[173,174],"chuyen-muc":[61],"class_list":["post-2008","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","tag-gay-xuong-thuyen","tag-xuong-thuyen","chuyen-muc-benh-ly"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2008","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=2008"}],"version-history":[{"count":0,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2008\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/2269"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=2008"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=2008"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=2008"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}