{"id":2075,"date":"2023-07-11T07:00:25","date_gmt":"2023-07-11T00:00:25","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=2075"},"modified":"2023-07-31T18:30:17","modified_gmt":"2023-07-31T11:30:17","slug":"benh-co-rut-dupuytren","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/benh-co-rut-dupuytren\/","title":{"rendered":"B\u1ec7nh co r\u00fat Dupuytren"},"content":{"rendered":"

OUTLINE<\/strong><\/h2>\n

Define<\/strong><\/h3>\n

B\u1ec7nh Dupuytren l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n t\u0103ng sinh s\u1ee3i x\u01a1 kh\u00f4ng \u00e1c t\u00ednh, ti\u1ebfn tri\u1ec3n ch\u1eadm g\u00e2y d\u00e0y v\u00e0 co r\u00fat ng\u1eafn d\u1ea7n c\u00e2n (fascia) gan tay d\u1eabn \u0111\u1ebfn co r\u00fat ng\u00f3n tay<\/a> k\u00e9o d\u00e0i g\u00e2y suy gi\u1ea3m ch\u1ee9c n\u0103ng.<\/p>\n

Co r\u00fat g\u1eadp ng\u00f3n th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u v\u1edbi ng\u00f3n 5 v\u00e0 ng\u00f3n 4 v\u00e0 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c kh\u1edbp b\u00e0n ng\u00f3n tay (MCP) ho\u1eb7c kh\u1edbp li\u00ean ng\u00f3n g\u1ea7n (PIP).<\/p>\n

Co r\u00fat Dupuytren thu\u1ed9c nh\u00f3m b\u1ec7nh x\u01a1 h\u00f3a (fibromatoses) bao g\u1ed3m b\u1ec7nh x\u01a1 h\u00f3a g\u00e2n (b\u1ec7nh Ledderhose), x\u01a1 h\u00f3a d\u01b0\u01a1ng v\u1eadt (b\u1ec7nh Peyronie) v\u00e0 x\u01a1 h\u00f3a m\u1eb7t l\u01b0ng kh\u1edbp li\u00ean \u0111\u1ed1t ng\u00f3n g\u1ea7n (c\u00e1c h\u1ea1t Garod).<\/p>\n

B\u1ec7nh \u0111\u1eb7t t\u00ean theo b\u00e1c s\u0129 Guillaume Dutruytren, ng\u01b0\u1eddi m\u00f4 t\u1ea3 c\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng v\u00e0 th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt th\u00e0nh c\u00f4ng \u0111\u1ea7u ti\u00ean v\u00e0o n\u0103m 1831 v\u00e0 c\u00f4ng b\u1ed1 c\u00e1c k\u1ebft qu\u1ea3 tr\u00ean The Lancet v\u00e0o n\u0103m 1834.<\/p>\n

B\u1ec7nh sinh<\/strong><\/h3>\n

T\u1ed5n th\u01b0\u01a1ng ch\u00ednh l\u00e0 m\u1ed9t n\u1ed1t (nodule) b\u1eaft \u0111\u1ea7u \u1edf l\u00f2ng b\u00e0n tay, ban \u0111\u1ea7u l\u00e0 m\u1ed9t kh\u1ed1i m\u00f4 li\u00ean k\u1ebft ch\u1eafc \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh v\u00e0o da v\u00e0 c\u00e2n m\u1ea1c s\u00e2u h\u01a1n. V\u1ec1 m\u00f4 h\u1ecdc, n\u00f3 \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi m\u00f4 t\u1ebf b\u00e0o h\u1ed7n lo\u1ea1n, d\u00e0y \u0111\u1eb7c, kh\u00f4ng vi\u00eam \u1edf m\u1eb7t tr\u01b0\u1edbc c\u00e2n gan tay.<\/p>\n

Ph\u1ea3n \u1ee9ng t\u1ebf b\u00e0o ch\u00ednh \u0111\u1ed1i v\u1edbi s\u1ef1 co r\u00fat m\u00f4 trong b\u1ec7nh Dupuytren \u0111\u01b0\u1ee3c cho l\u00e0 do nguy\u00ean b\u00e0o s\u1ee3i v\u00e0 bi\u1ec7t h\u00f3a c\u1ee7a n\u00f3 nguy\u00ean b\u00e0o s\u1ee3i c\u01a1. S\u1ef1 ho\u1ea1t h\u00f3a v\u00f4 c\u0103n n\u00e0y x\u1ea3y ra \u0111\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c cytokine nguy\u00ean b\u00e0o s\u1ee3i interleukin-1, prostaglandin F2, prostaglandin E2, y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb ti\u1ec3u c\u1ea7u, y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb m\u00f4 li\u00ean k\u1ebft v\u00e0 quan tr\u1ecdng nh\u1ea5t l\u00e0 y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng.<\/p>\n

Chuy\u1ec3n d\u1ea1ng y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng beta (transforming growth factor-beta) v\u00e0 y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng nguy\u00ean b\u00e0o s\u1ee3i (fibroblast growth factor). Ngo\u00e0i ra, c\u00e1c microRNA (mRNA) \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh trong c\u00e1c m\u1eabu m\u00f4 co r\u00fat Dupuytren, nh\u01b0 miR-29c, miR130b v\u00e0 miR-140-3p, c\u00f3 vai tr\u00f2 \u0111i\u1ec1u h\u00f2a c\u00e1c gen quan tr\u1ecdng li\u00ean quan \u0111\u1ebfn con \u0111\u01b0\u1eddng chuy\u1ec3n h\u00f3a beta-catenin: WNT5A, ZIC1 v\u00e0 TGFB1.<\/p>\n

D\u1ea7n d\u1ea7n n\u1ed1t n\u00e0y lan r\u1ed9ng, g\u00e2y ra r\u00fat ng\u1eafn l\u1ea1i v\u00e0 c\u0103ng tr\u00ean c\u00e1c d\u1ea3i c\u00e2n d\u1ecdc c\u1ee7a c\u00e2n gan tay, t\u1ea1o th\u00e0nh c\u00e1c d\u1ea3i m\u00f4 ph\u00ec \u0111\u1ea1i nh\u01b0 d\u00e2y th\u1eebng (cords). Kh\u00f4ng gi\u1ed1ng nh\u01b0 n\u1ed1t, d\u1ea3i d\u00e2y n\u00e0y c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m m\u00f4 h\u1ecdc r\u1ea5t kh\u00e1c bi\u1ec7t; n\u00f3 ch\u1ee9a \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 nguy\u00ean b\u00e0o s\u1ee3i c\u01a1 v\u00e0 \u00edt nguy\u00ean b\u00e0o s\u1ee3i trong m\u1ed9t c\u01a1 ch\u1ea5t collagen<\/a> d\u00e0y \u0111\u1eb7c v\u1edbi \u00edt m\u1ea1ch m\u00e1u. Nh\u1eefng thay \u0111\u1ed5i tr\u00ean da l\u00e0 nh\u1eefng d\u1ea5u hi\u1ec7u s\u1edbm nh\u1ea5t c\u1ee7a B\u1ec7nh Dutruytren, l\u00e0m d\u00e0y da v\u00e0 m\u00f4 d\u01b0\u1edbi da l\u00f2ng b\u00e0n tay. C\u00e1c n\u1ebfp g\u1ee3n s\u00f3ng \u1edf gan tay c\u00f3 th\u1ec3 x\u1ea3y ra tr\u01b0\u1edbc khi h\u00ecnh th\u00e0nh co r\u00fat (contracture) g\u1eadp ng\u00f3n tay.<\/p>\n

Tuy nhi\u00ean b\u1ec7nh Dupuytren kh\u00f4ng ph\u1ea3i lu\u00f4n lu\u00f4n ti\u1ebfn tri\u1ec3n. M\u1ed9t nghi\u00ean c\u1ee9u tr\u00ean 247 ng\u01b0\u1eddi tham gia v\u1edbi b\u1ec7nh Dupuytren nguy\u00ean ph\u00e1t theo d\u00f5i m\u1ed7i 3 \u2013 6 th\u00e1ng th\u1ea5y r\u1eb1ng \u0111\u1ebfn 75% b\u1ec7nh nh\u00e2n b\u1ec7nh \u1ed5n \u0111\u1ecbnh th\u1eadm ch\u00ed tho\u00e1i tri\u1ec3n.<\/p>\n

D\u1ecbch t\u1ec5, y\u1ebfu t\u1ed1 nguy c\u01a1<\/strong><\/h3>\n

T\u1ec9 l\u1ec7 hi\u1ec7n m\u1eafc b\u1ec7nh<\/a> tr\u00ean to\u00e0n c\u1ea7u l\u00e0 3% \u0111\u1ebfn 6% ng\u01b0\u1eddi da tr\u1eafng. T\u1ec9 l\u1ec7 hi\u1ec7n m\u1eafc \u1edf ch\u00e2u \u00c1 l\u00e0 kho\u1ea3ng 3% v\u00e0 \u00edt g\u1eb7p h\u01a1n \u1edf ng\u01b0\u1eddi \u1ea4n \u0110\u1ed9 (< 1%).<\/p>\n

B\u1ec7nh Dupuytren x\u1ea3y ra ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i (> 50%), hi\u1ebfm g\u1eb7p \u1edf tr\u1ebb nh\u1ecf h\u01a1n 10 tu\u1ed5i.<\/p>\n

Nam g\u1eb7p nhi\u1ec1u h\u01a1n n\u1eef (80%) v\u00e0 di\u1ec5n ti\u1ebfn nhanh v\u00e0 n\u1eb7ng h\u01a1n.<\/p>\n

Kh\u00f4ng c\u00f3 li\u00ean quan v\u1edbi s\u1ef1 thu\u1eadn tay.<\/p>\n

– Y\u1ebfu t\u1ed1 nguy c\u01a1:<\/strong><\/p>\n

+ Y\u1ebfu t\u1ed1 di truy\u1ec1n: m\u1eb7c d\u00f9 nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p d\u01b0\u1eddng nh\u01b0 l\u00e0 v\u00f4 c\u0103n, c\u00e1c th\u00e0nh ph\u1ea7n di truy\u1ec1n v\u00e0 y\u1ebfu t\u1ed1 ngh\u1ec1 nghi\u1ec7p \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o<\/p>\n

+ Li\u00ean h\u1ec7 v\u1edbi ch\u1ea5n th\u01b0\u01a1ng: c\u00f3 m\u1ed1i li\u00ean quan ph\u1ea7n n\u00e0o v\u1edbi vi ch\u1ea5n th\u01b0\u01a1ng, rung \u0111\u1ed9ng v\u00e0 ch\u1ea5n th\u01b0\u01a1ng<\/p>\n

+ C\u00e1c m\u1ed1i li\u00ean quan v\u1edbi \u0111\u1ed9ng kinh c\u00f2n ch\u01b0a r\u00f5, thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh kh\u00f4ng l\u00e0m t\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh.<\/p>\n

DIAGNOSE<\/strong><\/h2>\n

Clinical symptoms<\/strong><\/h3>\n

Co r\u00fat Dupuytren th\u01b0\u1eddng kh\u1edfi ph\u00e1t v\u00e0 ti\u1ebfn tri\u1ec3n kh\u00f4ng \u0111au. C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e0m b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m b\u1ec7nh l\u00e0 gi\u1ea3m t\u1ea7m v\u1eadn \u0111\u1ed9ng, gi\u1ea3m kh\u00e9o l\u00e9o b\u00e0n tay v\u00e0 b\u00e0n tay b\u1ecb \u201cm\u1eafc k\u1eb9t\u201d khi \u0111\u01b0a tay v\u00e0o t\u00fai qu\u1ea7n.<\/p>\n

B\u1ec7nh nh\u00e2n th\u1ea5y c\u1ea3m gi\u00e1c n\u1ed5i c\u1ed9m ho\u1eb7c d\u00e0y l\u00ean \u1edf gan tay v\u00e0 \u0111\u00f4i khi \u1edf ng\u00f3n tay. Th\u01b0\u1eddng s\u1ef1 d\u00e0y l\u00ean n\u00e0y xu\u1ea5t hi\u1ec7n \u0111\u00e3 nhi\u1ec1u n\u0103m v\u00e0 c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n ch\u1eadm.<\/p>\n

Kh\u00e1m th\u1ea5y:<\/p>\n

+ C\u00e1c n\u1ed1t c\u1ee9ng \u1edf l\u00f2ng b\u00e0n tay, c\u00f3 th\u1ec3 \u0111au khi s\u1edd: c\u00e1c n\u1ed1t d\u00ednh s\u00e1t v\u1edbi da, v\u1eadn \u0111\u1ed9ng c\u1ee7a c\u00e1c n\u1ed1t khi v\u1eadn \u0111\u1ed9ng ng\u00f3n tay g\u1ee3i \u00fd m\u1ed9t s\u1ef1 ph\u1ed1i h\u1ee3p v\u1edbi g\u00e2n v\u00e0 kh\u00f4ng ph\u1ea3i co r\u00fat Dutruytren.<\/p>\n

+ D\u1ea3i d\u00e2y kh\u00f4ng \u0111au g\u1ea7n v\u1edbi c\u00e1c n\u1ed1t<\/p>\n

+ Da gan tay tr\u1eafng khi du\u1ed7i ng\u00f3n tay<\/p>\n

+ Joint contracture<\/a> b\u00e0n ng\u00f3n tay v\u00e0 li\u00ean \u0111\u1ed1t ng\u00f3n g\u1ea7n (th\u01b0\u1eddng l\u00e0 ng\u00f3n 4, ng\u00f3n 5, ng\u00f3n c\u00e1i v\u00e0 ng\u00f3n tr\u1ecf \u00edt b\u1ecb nh\u1ea5t): \u0111o v\u00e0 ghi l\u1ea1i t\u1ea7m v\u1eadn \u0111\u1ed9ng co r\u00fat g\u1eadp ng\u00f3n v\u00e0 \u0111\u00e1nh gi\u00e1 qu\u00e1 du\u1ed7i b\u00f9 tr\u1eeb ho\u1eb7c co r\u00fat c\u1ee7a kh\u1edbp li\u00ean ng\u00f3n xa<\/p>\n

+ Test m\u1eb7t b\u00e0n (table top) Hueston: y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n \u0111\u1eb7t b\u00e0n tay l\u00ean m\u1eb7t b\u00e0n, n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 \u0111\u1eb7t l\u00f2ng b\u00e0n tay s\u00e1t m\u1eb7t b\u00e0n l\u00e0 d\u01b0\u01a1ng t\u00ednh.<\/p>\n

Grading<\/strong><\/h3>\n