{"id":2314,"date":"2023-09-22T16:54:33","date_gmt":"2023-09-22T09:54:33","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&#038;p=2314"},"modified":"2024-12-24T15:04:59","modified_gmt":"2024-12-24T08:04:59","slug":"tong-quan-kien-thuc-ve-sun-chem","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/tong-quan-kien-thuc-ve-sun-chem\/","title":{"rendered":"T\u1ed5ng quan s\u1ee5n ch\u00eam"},"content":{"rendered":"<h2><span class=\"fontstyle0\">1. \u0110\u1eb6C \u0110I\u1ec2M GI\u1ea2I PH\u1eaaU H\u1eccC C\u1ee6A S\u1ee4N CH\u00caM<\/span><\/h2>\n<h3><span class=\"fontstyle0\">1.1. S\u1ee5n ch\u00eam trong<\/span><\/h3>\n<ul>\n<li><span class=\"fontstyle2\">S\u1ee5n ch\u00eam trong c\u00f3 h\u00ecnh ch\u1eef C, d\u00e0i kho\u1ea3ng 5 \u2013 6 cm, \u0111i t\u1eeb di\u1ec7n tr\u01b0\u1edbc gai ch\u1ea1y v\u00f2ng theo m\u00e2m ch\u00e0y trong ra ph\u00eda sau v\u00e0 b\u00e1m v\u00e0o di\u1ec7n sau gai, b\u1edd ngo\u1ea1i vi d\u00ednh ch\u1eb7t v\u00e0o bao kh\u1edbp trong.<\/span><\/li>\n<li><span class=\"fontstyle2\">S\u1eebng sau (16 \u2013 20 mm) r\u1ed9ng h\u01a1n s\u1eebng tr\u01b0\u1edbc (8 \u2013 10 mm), s\u1eebng tr\u01b0\u1edbc b\u00e1m ch\u1eafc v\u00e0o m\u00e2m ch\u00e0y ngay ph\u00eda tr\u01b0\u1edbc gai ch\u00e0y tr\u01b0\u1edbc v\u00e0 d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc. S\u1eebng sau b\u00e1m v\u00e0o m\u00e2m ch\u00e0y sau ngay ph\u00eda tr\u01b0\u1edbc n\u01a1i b\u00e1m d\u00e2y ch\u1eb1ng ch\u00e9o sau, li\u00ean quan ch\u1eb7t ch\u1ebd v\u1edbi d\u00e2y ch\u1eb1ng b\u00ean trong sau v\u00e0 g\u00e2n c\u01a1 b\u00e1n m\u1ea1c,\u2026 Ch\u00ednh m\u1ed1i quan h\u1ec7 gi\u1ea3i ph\u1eabu v\u1edbi c\u00e1c th\u00e0nh ph\u1ea7n xung quanh \u0111\u00e3 l\u00e0m h\u1ea1n ch\u1ebf s\u1ef1 di chuy\u1ec3n c\u1ee7a s\u1ee5n ch\u00eam trong khi v\u1eadn \u0111\u1ed9ng g\u1ea5p du\u1ed7i g\u1ed1i, \u0111i\u1ec1u n\u00e0y gi\u1ea3i th\u00edch v\u00ec sao th\u01b0\u01a1ng t\u1ed5n s\u1ee5n ch\u00eam trong hay g\u1eb7p trong ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp g\u1ed1i <\/span><span class=\"fontstyle2\">[53]<\/span><span class=\"fontstyle2\">.<\/span><\/li>\n<\/ul>\n<h3><span class=\"fontstyle0\">1.2. S\u1ee5n ch\u00eam ngo\u00e0i<\/span><\/h3>\n<figure id=\"attachment_2316\" aria-describedby=\"caption-attachment-2316\" style=\"width: 439px\" class=\"wp-caption aligncenter\"><img fetchpriority=\"high\" decoding=\"async\" class=\"wp-image-2316 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/hinh-1.2.png\" alt=\"H\u00ecnh 1.2\" width=\"439\" height=\"330\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/hinh-1.2.png 439w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/hinh-1.2-300x226.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/hinh-1.2-16x12.png 16w\" sizes=\"(max-width: 439px) 100vw, 439px\" \/><figcaption id=\"caption-attachment-2316\" class=\"wp-caption-text\">H\u00ecnh 1.1. S\u1ee5n ch\u00eam li\u00ean quan v\u1edbi c\u00e1c th\u00e0nh ph\u1ea7n trong kh\u1edbp (Ngu\u1ed3n: Functional anatomy and biomechanics of the meniscus &#8211; Caldwell G.L. 1994) [53]<\/figcaption><\/figure>\n<p><span class=\"fontstyle0\">1. S\u1eebng sau s\u1ee5n ch\u00eam trong<\/span><\/p>\n<p><span class=\"fontstyle0\">2. D\u00e2y ch\u1eb1ng b\u00ean trong<\/span><\/p>\n<p><span class=\"fontstyle0\">3. S\u1eebng tr\u01b0\u1edbc s\u1ee5n ch\u00eam trong<\/span><\/p>\n<p><span class=\"fontstyle0\">4. D\u00e2y ch\u1eb1ng ngang<\/span><\/p>\n<p><span class=\"fontstyle0\">5. D\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc<\/span><\/p>\n<p><span class=\"fontstyle0\">6. S\u1eebng tr\u01b0\u1edbc s\u1ee5n ch\u00eam ngo\u00e0i<\/span><\/p>\n<p><span class=\"fontstyle0\">7. D\u00e2y ch\u1eb1ng b\u00ean ngo\u00e0i<\/span><\/p>\n<p><span class=\"fontstyle0\">8. C\u01a1 khoeo<\/span><\/p>\n<p><span class=\"fontstyle0\">9. S\u1eebng sau s\u1ee5n ch\u00eam ngo\u00e0i<\/span><\/p>\n<p><span class=\"fontstyle0\">10. D\u00e2y ch\u1eb1ng s\u1ee5n ch\u00eam <\/span><span class=\"fontstyle0\">\u2013 <\/span><span class=\"fontstyle0\">\u0111\u00f9i<\/span><\/p>\n<p><span class=\"fontstyle0\">11. D\u00e2y ch\u1eb1ng ch\u00e9o sau<\/span><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><span class=\"fontstyle0\">S\u1ee5n ch\u00eam ngo\u00e0i c\u00f3 h\u00ecnh ch\u1eef O m\u1edf v\u00e0o trong, ph\u1ee7 b\u1ec1 m\u1eb7t kh\u1edbp m\u00e2m ch\u00e0y v\u00e0 r\u1ed9ng h\u01a1n s\u1ee5n ch\u00eam trong, xu\u1ea5t ph\u00e1t t\u1eeb di\u1ec7n tr\u01b0\u1edbc gai, h\u01a1i ra ph\u00eda ngo\u00e0i m\u1ed9t ch\u00fat so v\u1edbi \u0111i\u1ec3m b\u00e1m c\u1ee7a d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc \u1edf m\u00e2m ch\u00e0y.<\/span><\/li>\n<li><span class=\"fontstyle0\">S\u1eebng tr\u01b0\u1edbc v\u00e0 s\u1eebng sau c\u1ee7a s\u1ee5n ch\u00eam ngo\u00e0i r\u1ed9ng b\u1eb1ng nhau, k\u00edch th\u01b0\u1edbc kho\u1ea3ng 12 \u2013 13 mm. <\/span><span class=\"fontstyle0\">S\u1ee5n ch\u00eam ngo\u00e0i ch\u1ea1y v\u00f2ng ra sau theo b\u1edd m\u00e2m ch\u00e0y ngo\u00e0i v\u00e0 b\u00e1m v\u00e0o di\u1ec7n sau gai c\u00f9ng v\u1edbi d\u00e2y ch\u1eb1ng \u0111\u00f9i \u2013 s\u1ee5n ch\u00eam v\u00e0 d\u00e2y ch\u1eb1ng ch\u00e9o sau [53].\u00a0<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3><span class=\"fontstyle0\">1.3. Th\u1ea7n kinh v\u00e0 m\u1ea1ch m\u00e1u nu\u00f4i s\u1ee5n ch\u00eam<\/span><\/h3>\n<p><strong><span class=\"fontstyle0\">* M\u1ea1ch m\u00e1u nu\u00f4i s\u1ee5n ch\u00eam<\/span><\/strong><\/p>\n<figure id=\"attachment_2322\" aria-describedby=\"caption-attachment-2322\" style=\"width: 313px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" class=\"wp-image-2322 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.2.png\" alt=\"Ch\u01b0\u01a1ng 1.2\" width=\"313\" height=\"153\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.2.png 313w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.2-300x147.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.2-18x9.png 18w\" sizes=\"(max-width: 313px) 100vw, 313px\" \/><figcaption id=\"caption-attachment-2322\" class=\"wp-caption-text\">H\u00ecnh 1.2. S\u01a1 \u0111\u1ed3 c\u1ea5p m\u00e1u cho s\u1ee5n ch\u00eam (Ngu\u1ed3n: Direct real time measurement of meniscal blood flow &#8211; Swiontkowski M. F. 1988) [111]<\/figcaption><\/figure>\n<p><span class=\"fontstyle0\">M\u1ea1ch m\u00e1u nu\u00f4i d\u01b0\u1ee1ng<a href=\"https:\/\/bsvothanhtoan.com\/\"> s\u1ee5n ch\u00eam<\/a> \u0111\u1ec1u \u0111\u01b0\u1ee3c t\u00e1ch ra t\u1eeb c\u00e1c nh\u00e1nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch khoeo. \u1ede khoeo, \u0111\u1ed9ng m\u1ea1ch khoeo chia ra n\u0103m nh\u00e1nh b\u00ean: <\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; Hai nh\u00e1nh trung t\u00e2m \u0111i v\u00e0o bao kh\u1edbp ph\u00eda sau v\u00e0 t\u1ea1o th\u00e0nh m\u1ea1ng m\u1ea1ch nu\u00f4i d\u01b0\u1ee1ng bao kh\u1edbp<\/span><\/p>\n<p><span class=\"fontstyle0\"> &#8211; Sau \u0111\u00f3, \u0111\u1ed9ng m\u1ea1ch khoeo chia th\u00e0nh nh\u1eefng nh\u00e1nh nh\u1ecf l\u00e0 \u0111\u1ed9ng m\u1ea1ch g\u1ed1i tr\u00ean, g\u1ed1i gi\u1eefa v\u00e0 g\u1ed1i d\u01b0\u1edbi: <\/span><\/p>\n<p style=\"padding-left: 40px;\"><span class=\"fontstyle2\">+ <\/span><span class=\"fontstyle0\">\u0110\u1ed9ng m\u1ea1ch g\u1ed1i gi\u1eefa ch\u1ea1y xuy\u00ean qua bao kh\u1edbp ph\u00eda sau v\u00e0 chia th\u00e0nh ba nh\u00e1nh c\u1ea5p m\u00e1u cho <\/span>d\u00e2y ch\u1eb1ng ch\u00e9o sau, v\u00f9ng c\u1ea1nh s\u1ee5n ch\u00eam trong v\u00e0 v\u00f9ng c\u1ea1nh s\u1ee5n ch\u00eam ngo\u00e0i.<\/p>\n<p style=\"padding-left: 40px;\"><span class=\"fontstyle2\">+ <\/span><span class=\"fontstyle0\">\u0110\u1ed9ng m\u1ea1ch g\u1ed1i d\u01b0\u1edbi g\u1ed3m nh\u00e1nh b\u00ean trong v\u00e0 <\/span><span class=\"fontstyle0\">b\u00ean ngo\u00e0i xuy\u00ean qua bao kh\u1edbp \u1edf m\u1eb7t tr\u01b0\u1edbc t\u1ea1o <\/span><span class=\"fontstyle0\">th\u00e0nh m\u1ea1ng m\u1ea1ch d\u01b0\u1edbi g\u00e2n b\u00e1nh ch\u00e8. T\u1eeb m\u1ea1ng <\/span><span class=\"fontstyle0\">m\u1ea1ch n\u00e0y c\u00f3 c\u00e1c nh\u00e1nh nh\u1ecf \u0111i v\u00e0o v\u00f9ng c\u1ea1nh hai <\/span><span class=\"fontstyle0\">s\u1ee5n ch\u00eam \u1edf ph\u00eda tr\u01b0\u1edbc.<\/span><\/p>\n<p><span class=\"fontstyle0\">Nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch g\u1ed1i ngo\u00e0i v\u00e0 trong c\u1ea5p m\u00e1u cho s\u1ee5n ch\u00eam ngo\u00e0i v\u00e0 s\u1ee5n ch\u00eam trong, c\u00e1c nh\u00e1nh t\u00e1ch ra t\u1eeb \u0111\u1ed9ng m\u1ea1ch n\u00e0y c\u1ea5p m\u00e1u cho hai s\u1ee5n ch\u00eam gi\u1ea3m d\u1ea7n t\u1eeb b\u1edd ngo\u1ea1i vi n\u01a1i s\u1ee5n ch\u00eam ti\u1ebfp gi\u00e1p v\u1edbi bao kh\u1edbp \u0111\u1ebfn b\u1edd t\u1ef1 do. S\u1ef1 ph\u00e2n b\u1ed1 m\u1ea1ch m\u00e1u nu\u00f4i s\u1ee5n ch\u00eam \u0111\u01b0\u1ee3c nhi\u1ec1u c\u00f4ng tr\u00ecnh nghi\u00ean c\u1ee9u ch\u1ec9 ra r\u1eb1ng, s\u1ef1 c\u1ea5p m\u00e1u nu\u00f4i chia l\u00e0m ba v\u00f9ng, \u0111\u1eb7c bi\u1ec7t n\u1ed5i b\u1eadt v\u00f9ng s\u1eebng tr\u01b0\u1edbc v\u00e0 s\u1eebng sau, c\u00f2n \u1edf s\u1eebng gi\u1eefa ch\u1ec9 c\u00f3 ph\u1ea7n n\u1ec1n c\u1ee7a s\u1ee5n ch\u00eam \u0111\u01b0\u1ee3c c\u1ea5p m\u00e1u <\/span><span class=\"fontstyle0\">[125],[130]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<figure id=\"attachment_2323\" aria-describedby=\"caption-attachment-2323\" style=\"width: 223px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" class=\"wp-image-2323 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.3.png\" alt=\"Ch\u01b0\u01a1ng 1.3\" width=\"223\" height=\"174\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.3.png 223w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.3-15x12.png 15w\" sizes=\"(max-width: 223px) 100vw, 223px\" \/><figcaption id=\"caption-attachment-2323\" class=\"wp-caption-text\">H\u00ecnh 1.3. H\u00ecnh \u1ea3nh c\u1ed9ng h\u01b0\u1edfng t\u1eeb v\u1ec1 c\u1ea5p m\u00e1u cho s\u1ee5n ch\u00eam (Ngu\u1ed3n: Direct real time measurement of meniscal blood flow &#8211; Swiontkowski M. F. 1988) [111]<\/figcaption><\/figure>\n<p><span class=\"fontstyle0\">Nh\u1eefng c\u00f4ng tr\u00ecnh nghi\u00ean c\u1ee9u c\u1ee7a Arnoczky S.P. n\u0103m 1983 v\u00e0 Benedetto K.P. n\u0103m 1985 cho th\u1ea5y s\u1ef1 c\u1ea5p m\u00e1u \u1edf v\u00f9ng s\u1eebng tr\u01b0\u1edbc v\u00e0 s\u1eebng sau v\u00e0 ph\u1ea7n r\u00eca s\u1ee5n ch\u00eam r\u1ea5t phong ph\u00fa v\u00e0 gi\u1ea3m \u0111i r\u00f5 r\u1ec7t \u1edf b\u1edd t\u1ef1 do <\/span><span class=\"fontstyle0\">[43],[47]<\/span><span class=\"fontstyle0\">. N\u0103m 1988, nghi\u00ean c\u1ee9u c\u1ee7a Swiontkowski M.F. \u0111o l\u01b0\u1ee3ng c\u1ea5p m\u00e1u cho s\u1ee5n ch\u00eam b\u1eb1ng laser Doppler c\u0169ng cho k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 v\u00e0 ngay t\u1ea1i v\u00f9ng \u0111\u01b0\u1ee3c c\u1ea5p m\u00e1u, v\u00f2ng n\u1ed1i gi\u1eefa c\u00e1c mao m\u1ea1ch l\u00e0 r\u1ea5t hi\u1ebfm <\/span><span class=\"fontstyle0\">[111]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; V\u00f9ng gi\u00e0u m\u1ea1ch m\u00e1u nu\u00f4i (v\u00f9ng \u0111\u1ecf \u2013 \u0111\u1ecf): chi\u1ebfm 1\/3 ngo\u00e0i, v\u00f9ng n\u00e0y c\u00f3 \u0111\u1ea7y \u0111\u1ee7 m\u1ea1ch m\u00e1u nu\u00f4i, r\u00e1ch v\u00f9ng n\u00e0y d\u1ec5 ph\u1ee5c h\u1ed3i n\u1ebfu ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; V\u00f9ng trung gian (v\u00f9ng \u0111\u1ecf \u2013 tr\u1eafng): \u1edf 1\/3 gi\u1eefa m\u1ea1ch m\u00e1u nu\u00f4i, m\u1ea1ch m\u00e1u b\u1eaft \u0111\u1ea7u gi\u1ea3m d\u1ea7n, t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 l\u00e0nh khi \u0111i\u1ec1u tr\u1ecb \u0111\u00fang nh\u01b0ng k\u1ebft qu\u1ea3 \u0111em l\u1ea1i v\u1edbi t\u1ef7 l\u1ec7 th\u1ea5p h\u01a1n.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; V\u00f9ng v\u00f4 m\u1ea1ch (v\u00f9ng tr\u1eafng \u2013 tr\u1eafng): 1\/3 trong kh\u00f4ng c\u00f3 m\u1ea1ch m\u00e1u nu\u00f4i, r\u00e1ch \u1edf \u0111\u00e2y kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i n\u00ean th\u01b0\u1eddng \u0111i\u1ec1u tr\u1ecb c\u1eaft b\u1ecf \u0111i ph\u1ea7n r\u00e1ch.<\/span><\/p>\n<p><strong><span class=\"fontstyle2\">\u0110\u00e2y l\u00e0 c\u01a1 s\u1edf quan tr\u1ecdng cho vi\u1ec7c ch\u1ec9 \u0111\u1ecbnh kh\u00e2u s\u1ee5n ch\u00eam b\u1ecb r\u00e1ch do ch\u1ea5n th\u01b0\u01a1ng<\/span><\/strong><\/p>\n<figure id=\"attachment_2324\" aria-describedby=\"caption-attachment-2324\" style=\"width: 225px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-2324 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.4.png\" alt=\"Ch\u01b0\u01a1ng 1.4\" width=\"225\" height=\"193\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.4.png 225w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.4-14x12.png 14w\" sizes=\"(max-width: 225px) 100vw, 225px\" \/><figcaption id=\"caption-attachment-2324\" class=\"wp-caption-text\">H\u00ecnh 1.4. Ph\u00e2n v\u00f9ng s\u1ee5n ch\u00eam theo c\u1ea5p m\u00e1u (Ngu\u1ed3n: Direct real time measurement of meniscal blood flow &#8211; Swiontkowski M.F. 1988) [111]<\/figcaption><\/figure>\n<p><strong><span class=\"fontstyle0\">*<\/span><span class=\"fontstyle1\">Th\u1ea7n kinh<\/span><\/strong><\/p>\n<p><span class=\"fontstyle3\">Th\u1ea7n kinh \u0111i theo c\u00f9ng m\u1ea1ch m\u00e1u, n\u1eb1m trong l\u1edbp \u00e1o ngo\u00e0i c\u1ee7a m\u1ea1ch m\u00e1u v\u00e0 \u0111i v\u00e0o s\u1ee5n ch\u00eam ph\u00e2n nh\u00e1nh c\u00f9ng c\u00e1c b\u00f3 s\u1ee3i collagen t\u1ea1o th\u00e0nh m\u1ea1ng l\u01b0\u1edbi. C\u00e1c s\u1ee3i th\u1ea7n kinh t\u1eadp trung ch\u1ee7 y\u1ebfu \u1edf m\u1ed9t ph\u1ea7n ba r\u00eca ngo\u00e0i c\u1ee7a <\/span><span class=\"fontstyle3\">s\u1ee5n ch\u00eam <\/span><span class=\"fontstyle3\">v\u00e0 \u0111\u00f3ng vai tr\u00f2 b\u1ea3o v\u1ec7 kh\u1edbp ch\u1ed1ng l\u1ea1i nh\u1eefng c\u1eed \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng <\/span><span class=\"fontstyle3\">[110]<\/span><span class=\"fontstyle3\">.<\/span><\/p>\n<h3><span class=\"fontstyle4\">2. M\u00d4 H\u1eccC C\u1ee6A S\u1ee4N CH\u00caM<\/span><\/h3>\n<p><span class=\"fontstyle3\">&#8211; N\u0103m 1958, t\u00e1c gi\u1ea3 Viernstein K. \u0111\u00e3 n\u00eau s\u1ee5n ch\u00eam \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o b\u1edfi 65% s\u1ee3i collagen, 16% chondrotinsulfat, 19% l\u00e0 n\u01b0\u1edbc v\u00e0 c\u00e1c th\u00e0nh ph\u1ea7n kh\u00e1c. Khi s\u1ee5n ch\u00eam b\u1ecb tho\u00e1i h\u00f3a, l\u01b0\u1ee3ng chondrotinsulfat s\u1ebd gi\u1ea3m \u0111i c\u00f2n kho\u1ea3ng 5%, thay th\u1ebf v\u00e0o \u0111\u00f3 s\u1ebd l\u00e0 c\u00e1c t\u1ed5 ch\u1ee9c x\u01a1, c\u00f2n th\u00e0nh ph\u1ea7n collagen g\u1ea7n nh\u01b0 kh\u00f4ng thay \u0111\u1ed5i. Th\u00e0nh ph\u1ea7n x\u01a1 s\u1ee5n c\u1ee7a s\u1ee5n ch\u00eam ch\u1ee7 <span class=\"fontstyle0\">y\u1ebfu l\u00e0 collagen type I (chi\u1ebfm 90%), g\u1ea7n gi\u1ed1ng nh\u01b0 g\u00e2n v\u00e0 <\/span><\/span><span class=\"fontstyle3\"><span class=\"fontstyle0\">s\u1ee5n <\/span><span class=\"fontstyle0\">[114]<\/span><span class=\"fontstyle0\">.<\/span><\/span><\/p>\n<p><span class=\"fontstyle3\"><span class=\"fontstyle0\">&#8211; Theo nghi\u00ean c\u1ee9u c\u1ee7a Adam M.E. v\u00e0 Muir H. n\u0103m 1981; McNicol D. v\u00e0 Roughley P.J. n\u0103m 1980 cho th\u1ea5y c\u00f3 s\u1ef1 kh\u00e1c nhau v\u1ec1 t\u1ef7 l\u1ec7 c\u1ee7a proteoglycan v\u00e0 glycosaminglycan trong c\u1ea5u tr\u00fac c\u1ee7a s\u1ee5n ch\u00eam v\u00e0 s\u1ee5n kh\u1edbp <\/span><span class=\"fontstyle0\">[39],[88]<\/span><span class=\"fontstyle0\">. Ngo\u00e0i ra, theo <\/span><span class=\"fontstyle0\">Mc Nicol D. v\u00e0 Roughley P.J. cho r\u1eb1ng t\u1ef7 l\u1ec7 proteoglycan trong s\u1ee5n ch\u00eam c\u1ee7a ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh ch\u1ec9 b\u1eb1ng 1\/8 s\u1ee5n kh\u1edbp v\u00e0 trong th\u00e0nh ph\u1ea7n s\u1ee5n ch\u00eam c\u00f2n c\u00f3 dermaltalsuifat v\u1edbi h\u00e0m l\u01b0\u1ee3ng kho\u1ea3ng 29%, \u0111\u00e2y l\u00e0 th\u00e0nh ph\u1ea7n kh\u00f4ng c\u00f3 trong s\u1ee5n kh\u1edbp.<\/span><\/span><\/p>\n<p><span class=\"fontstyle3\"><span class=\"fontstyle0\">&#8211; N\u0103m 1984, Insall J.N. nh\u1eadn th\u1ea5y trong c\u1ea5u tr\u00fac s\u1ee5n c\u00f2n c\u00f3 m\u1ed9t c\u1ea5u tr\u00fac quan tr\u1ecdng l\u00e0 proteoglycan. C\u1ea5u tr\u00fac n\u00e0y \u0111\u01b0\u1ee3c t\u1ea1o t\u1eeb glycosaminoglycan v\u00e0 protein. S\u1ef1 s\u1eafp x\u1ebfp c\u00e1c ph\u00e2n t\u1eed proteinglycan gi\u1eefa c\u00e1c b\u00f3 s\u1ee3i collagen \u0111\u00e3 t\u1ea1o cho s\u1ee5n ch\u00eam c\u00f3 kh\u1ea3 n\u0103ng \u0111\u00e0n h\u1ed3i ch\u1ed1ng \u0111\u1ee1 l\u1ea1i l\u1ef1c k\u00e9o v\u00e0 l\u1ef1c \u0111\u1ea9y c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i khi g\u1ea5p, du\u1ed7i <\/span><span class=\"fontstyle0\">g\u1ed1i <\/span><span class=\"fontstyle0\">[77]<\/span><span class=\"fontstyle0\">. <\/span><span class=\"fontstyle0\">C\u00e1c s\u1ee3i n\u00e0y s\u1eafp x\u1ebfp v\u1edbi nhau theo kh\u00f4ng gian ba chi\u1ec1u v\u00e0 \u0111an ch\u00e9o nhau r\u1ea5t ch\u1eafc: lo\u1ea1i ngang chi\u1ebfm 2\/3 trong, x\u1ebfp nhi\u1ec1u t\u1eeb trong ra ngo\u00e0i ch\u1ecbu s\u1ee9c t\u1ea3i \u00e9p, lo\u1ea1i d\u1ecdc \u0111i v\u00f2ng quanh chi\u1ebfm 1\/3 ngo\u00e0i ch\u1ecbu s\u1ee9c c\u0103ng, lo\u1ea1i \u0111\u1ee9ng d\u1ecdc \u1edf v\u00f9ng trung gian n\u1ed1i k\u1ebft c\u00e1c s\u1ee3i tr\u00ean. Nh\u1edd c\u1ea5u tr\u00fac m\u00f4 h\u1ecdc n\u00e0y gi\u00fap s\u1ee5n ch\u00eam c\u00f3 t\u00e1c d\u1ee5ng truy\u1ec1n t\u1ea3i <\/span><span class=\"fontstyle0\">l\u1ef1c <\/span><span class=\"fontstyle0\">[67],[125],[127],[130]<\/span><span class=\"fontstyle0\">.<\/span><\/span><\/p>\n<p><span class=\"fontstyle3\"><span class=\"fontstyle0\">&#8211; Theo Walker P.S., c\u00e1c b\u00f3 s\u1ee3i collagen ch\u1ea1y v\u00f2ng cung v\u00e0 \u0111an ch\u00e9o l\u1eabn nhau \u1edf ph\u1ea7n r\u00eca v\u00e0 ph\u1ea7n gi\u1eefa s\u1ee5n ch\u00eam c\u00f3 t\u00e1c d\u1ee5ng trong vai tr\u00f2 h\u1ea5p ph\u1ee5 l\u1ef1c c\u1ee7a v\u00f9ng n\u00e0y khi kh\u1edbp g\u1ed1i du\u1ed7i th\u1eb3ng \u1edf t\u01b0 th\u1ebf \u0111\u1ee9ng <\/span><span class=\"fontstyle0\">[119]<\/span>\u00a0<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; \u1ede v\u00f9ng ngo\u1ea1i vi s\u00e1t bao kh\u1edbp, c\u00e1c b\u00f3 s\u1ee3i <a href=\"https:\/\/bsvothanhtoan.com\/\">collagen<\/a> ch\u1ea1y song song c\u00f3 vai tr\u00f2 ch\u1ecbu l\u1ef1c k\u00e9o v\u00e0 l\u1ef1c \u0111\u1ea9y c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i tr\u00ean m\u00e2m ch\u00e0y khi g\u1ea5p du\u1ed7i g\u1ed1i <\/span><span class=\"fontstyle0\">[119]<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-2325 size-full aligncenter\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.5.png\" alt=\"Ch\u01b0\u01a1ng 1.5\" width=\"272\" height=\"204\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.5.png 272w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.5-16x12.png 16w\" sizes=\"(max-width: 272px) 100vw, 272px\" \/><\/p>\n<figure id=\"attachment_2326\" aria-describedby=\"caption-attachment-2326\" style=\"width: 235px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-2326 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/1.5.png\" alt=\"1.5\" width=\"235\" height=\"193\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/1.5.png 235w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/1.5-15x12.png 15w\" sizes=\"(max-width: 235px) 100vw, 235px\" \/><figcaption id=\"caption-attachment-2326\" class=\"wp-caption-text\">H\u00ecnh 1.5. C\u1ea5u tr\u00fac m\u00f4 h\u1ecdc v\u00e0 ph\u00e2n t\u1eed s\u1ee5n ch\u00eam (Ngu\u1ed3n: The meniscus: review of basic principles with application to Surgery and Rehabilitation &#8211; Timothy Brindle 2001) [114]<\/figcaption><\/figure>\n<p><span class=\"fontstyle0\">&#8211; Do c\u00f3 s\u1ef1 s\u1eafp x\u1ebfp kh\u00e1c nhau c\u1ee7a c\u00e1c b\u00f3 s\u1ee3i collagen \u1edf trong c\u00e1c v\u1ecb tr\u00ed kh\u00e1c nhau c\u1ee7a s\u1ee5n ch\u00eam, d\u1eabn \u0111\u1ebfn c\u00e1c h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu b\u1ec7nh kh\u00e1c nhau, v\u00ed d\u1ee5 nh\u01b0 t\u1ed5n th\u01b0\u01a1ng \u1edf ph\u1ea7n r\u00eca s\u1ee5n ch\u00eam s\u00e1t bao kh\u1edbp th\u01b0\u1eddng l\u00e0 \u0111\u01b0\u1eddng r\u00e1ch d\u1ecdc, t\u1ed5n th\u01b0\u01a1ng t\u1ea1i ph\u1ea7n t\u1ef1 do th\u01b0\u1eddng l\u00e0 t\u1ed5n th\u01b0\u01a1ng r\u00e1ch ngang ho\u1eb7c r\u00e1ch h\u00ecnh v\u1ea1t.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; N\u0103m 1911, Fick R. nghi\u00ean c\u1ee9u c\u1ea5u tr\u00fac s\u1ee5n ch\u00eam \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh \u0111\u00e3 nh\u1eadn th\u1ea5y nh\u1eefng b\u00f3 s\u1ee3i chun bao quanh t\u1ed5 ch\u1ee9c x\u01a1 s\u1ee5n th\u00e0nh m\u1ed9t l\u1edbp m\u1ecfng v\u00e0 n\u1eb1m trong l\u1edbp t\u1ed5 ch\u1ee9c li\u00ean k\u1ebft. C\u00e1c b\u00f3 s\u1ee3i n\u00e0y s\u1eafp x\u1ebfp theo h\u00ecnh v\u00f2ng cung ch\u1ea1y t\u1eeb ph\u1ea7n n\u1ec1n s\u1ee5n ch\u00eam ra \u0111\u1ebfn ph\u1ea7n r\u00eca <\/span><span class=\"fontstyle0\">[67]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; Nghi\u00ean c\u1ee9u c\u1ee7a Tobler T. v\u00e0o n\u0103m 1936 c\u0169ng cho th\u1ea5y c\u1ea5u tr\u00fac s\u1ee5n ch\u00eam c\u1ee7a tr\u1ebb s\u01a1 sinh l\u00e0 nh\u1eefng m\u00f4 li\u00ean k\u1ebft s\u1eafp x\u1ebfp d\u1ea1ng l\u01b0\u1ee3n s\u00f3ng xen k\u1ebd v\u1edbi nh\u1eefng b\u00f3 s\u1ee3i chun <\/span><span class=\"fontstyle0\">[116]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; Theo c\u00f4ng tr\u00ecnh nghi\u00ean c\u1ee9u c\u1ee7a Reinbach W. n\u0103m 1954 <\/span><span class=\"fontstyle0\">[127]<\/span><span class=\"fontstyle0\">, Bullough P.G. n\u0103m 1970 <\/span><span class=\"fontstyle0\">[50] <\/span><span class=\"fontstyle0\">v\u00e0 Walker P.S. n\u0103m 1975 <\/span><span class=\"fontstyle0\">[119] <\/span><span class=\"fontstyle0\">cho th\u1ea5y r\u1eb1ng s\u1ef1 s\u1eafp x\u1ebfp c\u1ee7a c\u00e1c b\u00f3 s\u1ee3i chun v\u00e0 t\u1ed5 ch\u1ee9c x\u01a1 s\u1ee5n theo c\u1ea5u tr\u00fac kh\u00f4ng gian ba chi\u1ec1u \u0111\u00e3 \u0111\u1ea3m b\u1ea3o cho s\u1ee5n ch\u00eam th\u1ef1c hi\u1ec7n vai tr\u00f2 h\u1ea5p thu l\u1ef1c, ph\u00e2n ph\u1ed1i v\u00e0 d\u00e0n \u0111\u1ec1u l\u1ef1c.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; N\u0103m 1986, Beaupre A.R. quan s\u00e1t tr\u00ean k\u00ednh hi\u1ec3n vi \u0111i\u1ec7n t\u1eed nh\u1eadn th\u1ea5y c\u00e1c b\u00f3 s\u1ee3i n\u1eb1m ngang \u1edf b\u1edd t\u1ef1 do gi\u00fap cho s\u1ee5n ch\u00eam c\u00f3 kh\u1ea3 n\u0103ng h\u1ea5p thu l\u1ef1c, c\u00e1c b\u00f3 s\u1ee3i ch\u1ea1y song song \u1edf ph\u1ea7n n\u1ec1n s\u00e1t bao kh\u1edbp gi\u00fap cho s\u1ee5n ch\u00eam ch\u1ecbu l\u1ef1c c\u0103ng, k\u00e9o v\u00e0 c\u00e1c b\u00f3 s\u1ee3i \u0111an ch\u00e9o gi\u00fap cho s\u1ee5n ch\u00eam c\u00f3 kh\u1ea3 n\u0103ng thay \u0111\u1ed5i h\u00ecnh d\u1ea1ng, qua \u0111\u00f3 t\u0103ng di\u1ec7n t\u00edch ti\u1ebfp x\u00fac c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i v\u1edbi m\u00e2m ch\u00e0y khi g\u1ea5p, du\u1ed7i g\u1ed1i <\/span><span class=\"fontstyle0\">[46]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<h3><span class=\"fontstyle4\">3. C\u01a0 SINH H\u1eccC C\u1ee6A S\u1ee4N CH\u00caM<\/span><\/h3>\n<p><span class=\"fontstyle0\">&#8211; <\/span><span class=\"fontstyle0\">Theo k\u1ebft qu\u1ea3 c\u1ee7a nhi\u1ec1u c\u00f4ng tr\u00ecnh nghi\u00ean c\u1ee9u, trong tr\u1ea1ng th\u00e1i \u0111i kh\u1edbp g\u1ed1i ch\u1ecbu 4,5 \u2013 6,2 l\u1ea7n tr\u1ecdng l\u01b0\u1ee3ng c\u1ee7a c\u01a1 th\u1ec3, ri\u00eang m\u00e2m ch\u00e0y ch\u1ecbu n\u1eb7ng \u0111\u1ebfn 72,2% tr\u1ecdng l\u01b0\u1ee3ng, l\u1ef1c t\u00e1c \u0111\u1ed9ng qua s\u1ee5n ch\u00eam \u1edf t\u01b0 th\u1ebf g\u1ed1i g\u1ea5p v\u00e0 du\u1ed7i kh\u00e1c nhau. Theo Burke v\u00e0 Ahmed th\u00ec c\u00f3 50% l\u1ef1c ch\u1ecbu n\u1eb7ng s\u1ebd truy\u1ec1n qua s\u1ee5n ch\u00eam trong t\u01b0 th\u1ebf g\u1ed1i du\u1ed7i th\u1eb3ng, 85% l\u1ef1c ch\u1ecbu n\u1eb7ng s\u1ebd truy\u1ec1n qua s\u1ee5n ch\u00eam \u1edf t\u01b0 th\u1ebf g\u1ea5p g\u1ed1i <\/span><span class=\"fontstyle0\">[51]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; Voloshin v\u00e0 Wosk so s\u00e1nh th\u1ea5y \u1edf nh\u1eefng kh\u1edbp g\u1ed1i c\u00f2n s\u1ee5n ch\u00eam c\u00f3 kh\u1ea3 n\u0103ng h\u1ea5p thu l\u1ef1c v\u00e0 gi\u1ea3m s\u1ed1c cao h\u01a1n 20% so nh\u1eefng kh\u1edbp g\u1ed1i \u0111\u00e3 b\u1ecb c\u1eaft s\u1ee5n ch\u00eam. Khi c\u1eaft m\u1ed9t ph\u1ea7n s\u1ee5n ch\u00eam th\u00ec di\u1ec7n t\u00edch ti\u1ebfp x\u00fac m\u00e2m ch\u00e0y v\u1edbi l\u1ed3i c\u1ea7u \u0111\u00f9i s\u1ebd gi\u1ea3m 10% v\u00e0 t\u0103ng \u0111i\u1ec3m ch\u1ecbu l\u1ef1c l\u00ean 65%. <\/span><span class=\"fontstyle0\">S<\/span><span class=\"fontstyle0\">au khi c\u1eaft b\u1ecf to\u00e0n b\u1ed9 s\u1ee5n ch\u00eam, m\u1eb7t ti\u1ebfp x\u00fac n\u00e0y gi\u1ea3m 75% v\u00e0 t\u0103ng \u0111i\u1ec3m ch\u1ecbu l\u1ef1c l\u00ean t\u1eeb 235 \u0111\u1ebfn 700% so v\u1edbi b\u00ecnh th\u01b0\u1eddng <\/span><span class=\"fontstyle0\">[110]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; C\u01a1 ch\u1ebf g\u00e2y <a href=\"https:\/\/bsvothanhtoan.com\/\">th\u01b0\u01a1ng t\u1ed5n s\u1ee5n ch\u00eam<\/a> \u0111\u01b0\u1ee3c Smile <\/span><span class=\"fontstyle0\">[109] <\/span><span class=\"fontstyle0\">ph\u00e2n t\u00edch v\u00e0 chia th\u00e0nh b\u1ed1n l\u1ef1c ch\u00ednh: l\u1ef1c \u00e9p t\u1eeb tr\u00ean xu\u1ed1ng, l\u1ef1c xoay, d\u1ea1ng hay kh\u00e9p v\u00e0 g\u1ea5p hay du\u1ed7i. Tuy nhi\u00ean, c\u00e1c l\u1ef1c tr\u00ean th\u00f4ng th\u01b0\u1eddng ph\u1ed1i h\u1ee3p v\u1edbi nhau t\u00f9y \u01b0u th\u1ebf c\u1ee7a l\u1ef1c n\u00e0o m\u1ea1nh m\u00e0 khi g\u00e2y th\u01b0\u01a1ng t\u1ed5n s\u1ee5n ch\u00eam s\u1ebd cho ra h\u00ecnh th\u00e1i th\u01b0\u01a1ng t\u1ed5n kh\u00e1c nhau.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-2327 size-full aligncenter\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.6.png\" alt=\"Ch\u01b0\u01a1ng 1.6\" width=\"274\" height=\"266\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.6.png 274w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/chuong-1.6-12x12.png 12w\" sizes=\"(max-width: 274px) 100vw, 274px\" \/><\/p>\n<figure id=\"attachment_2328\" aria-describedby=\"caption-attachment-2328\" style=\"width: 252px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-2328 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/1.6.png\" alt=\"1.6\" width=\"252\" height=\"262\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/1.6.png 252w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/09\/1.6-12x12.png 12w\" sizes=\"(max-width: 252px) 100vw, 252px\" \/><figcaption id=\"caption-attachment-2328\" class=\"wp-caption-text\">H\u00ecnh 1.6. C\u01a1 ch\u1ebf g\u00e2y t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam c\u1ee7a g\u1ed1i (Ngu\u1ed3n: La pathalogie m\u00e9canisque du Genou &#8211; Saragaglia 2003) [139]<\/figcaption><\/figure>\n<p><span class=\"fontstyle0\">&#8211; \u1ede c\u00e1c \u0111\u1ed9 tu\u1ed5i kh\u00e1c nhau th\u00ec \u0111\u1ed9 d\u00e0y, \u0111\u1ed9 ch\u1eafc v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng l\u1edbp s\u1ee5n c\u1ee7a m\u1eb7t kh\u1edbp c\u0169ng kh\u00e1c nhau. Ch\u00ednh v\u00ec v\u1eady, khi b\u1ecb ch\u1ea5n th\u01b0\u01a1ng s\u1ebd g\u00e2y ra nh\u1eefng ki\u1ec3u th\u01b0\u01a1ng t\u1ed5n kh\u00e1c nhau. \u1ede ng\u01b0\u1eddi tr\u1ebb, m\u1eb7t s\u1ee5n kh\u1edbp d\u00e0y, kh\u1ea3 n\u0103ng \u0111\u00e0n h\u1ed3i v\u00e0 h\u1ea5p thu l\u1ef1c c\u00f2n t\u1ed1t n\u00ean th\u01b0\u1eddng th\u1ea5y \u0111\u01b0\u1eddng r\u00e1ch d\u1ecdc. Ng\u01b0\u1ee3c l\u1ea1i, \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh tr\u00ean 30 tu\u1ed5i, ch\u1ea5t l\u01b0\u1ee3ng s\u1ee5n th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u suy gi\u1ea3m, kh\u1ea3 n\u0103ng h\u1ea5p thu \u0111\u01b0\u1ee3c c\u00e1c l\u1ef1c xoay k\u00e9m h\u01a1n n\u00ean hay g\u1eb7p \u0111\u01b0\u1eddng r\u00e1ch ngang ho\u1eb7c r\u00e1ch ch\u00e9o. \u1ede ng\u01b0\u1eddi gi\u00e0, s\u1ee5n kh\u1edbp tho\u00e1i h\u00f3a nhi\u1ec1u, l\u1edbp s\u1ee5n m\u1ea5t \u0111i, khe kh\u1edbp g\u1ed1i h\u1eb9p l\u1ea1i, c\u1eed \u0111\u1ed9ng l\u0103n c\u1ee7a l\u1ed3i c\u1ea7u tr\u00ean m\u00e2m ch\u00e0y b\u1ecb ma s\u00e1t nhi\u1ec1u, n\u00ean th\u01b0\u1eddng th\u1ea5y nh\u1eefng \u0111\u01b0\u1eddng r\u00e1ch nham nh\u1edf <\/span><span class=\"fontstyle0\">[139]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; Ki\u1ec3u r\u00e1ch d\u1ecdc th\u01b0\u1eddng g\u1eb7p khi m\u1ee9c \u0111\u1ed9 ch\u1ea5n th\u01b0\u01a1ng qu\u00e1 l\u1edbn \u1edf t\u01b0 th\u1ebf g\u1ed1i du\u1ed7i t\u1ed1i \u0111a, l\u00e0m cho m\u00e2m ch\u00e0y xoay ngo\u00e0i qu\u00e1 m\u1ee9c. Khi m\u1ea3nh r\u00e1ch d\u1ecdc s\u1ee5n ch\u00eam qu\u00e1 l\u1edbn v\u00e0 c\u00f3 d\u1ea1ng h\u00ecnh quai x\u00e1ch, quai n\u00e0y di chuy\u1ec3n v\u00e0o trong khuy\u1ebft l\u1ed3i c\u1ea7u v\u00e0 g\u00e2y k\u1eb9t kh\u1edbp [109],[110].<\/span><\/p>\n<h3><span class=\"fontstyle0\"><span class=\"fontstyle2\">4. VAI TR\u00d2 C\u1ee6A S\u1ee4N CH\u00caM<\/span><\/span><\/h3>\n<h3><span class=\"fontstyle0\"><span class=\"fontstyle2\">4.1. Ph\u00e2n ph\u1ed1i v\u00e0 d\u00e0n \u0111\u1ec1u tr\u1ecdng l\u1ef1c c\u01a1 th\u1ec3 t\u00e1c \u0111\u1ed9ng xu\u1ed1ng m\u00e2m ch\u00e0y<\/span><\/span><\/h3>\n<p><span class=\"fontstyle0\">&#8211; S\u1ee5n ch\u00eam ch\u1ecbu \u0111\u1ef1ng kho\u1ea3ng 45% tr\u1ecdng l\u01b0\u1ee3ng c\u1ee7a c\u01a1 th\u1ec3 v\u00e0 di \u0111\u1ed9ng tr\u00ean b\u1ec1 m\u1eb7t m\u00e2m ch\u00e0y song song v\u1edbi vi\u1ec7c g\u1ea5p du\u1ed7i g\u1ed1i. M\u1eb7t cong c\u1ee7a s\u1ee5n ch\u00eam c\u00f3 t\u00e1c d\u1ee5ng ph\u00e2n ph\u1ed1i l\u1ef1c v\u00e0 chuy\u1ec3n b\u1edbt t\u1eeb 30 \u2013 55% l\u1ef1c sang ngang, khi c\u00f3 \u0111\u1ee7 s\u1ee5n ch\u00eam th\u00ec di\u1ec7n ti\u1ebfp x\u00fac t\u0103ng l\u00ean 2,5 l\u1ea7n, khi kh\u00f4ng c\u00f3 s\u1ee5n ch\u00eam s\u1ee9c \u00e9p t\u1eeb tr\u00ean l\u1ed3i c\u1ea7u xu\u1ed1ng m\u00e2m ch\u00e0y s\u1ebd t\u1eadp trung v\u00e0o m\u1ed9t di\u1ec7n t\u00edch nh\u1ecf h\u01a1n, l\u00e2u ng\u00e0y d\u1eabn \u0111\u1ebfn h\u01b0 m\u1eb7t kh\u1edbp \u1ea3nh h\u01b0\u1edfng ch\u1ee9c n\u0103ng c\u1ee7a g\u1ed1i.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; C\u00e1c t\u00e1c gi\u1ea3 nh\u01b0: Burke D.L. v\u00e0 Kurosawa H.T. ch\u1ec9 ra r\u1eb1ng s\u1ee5n ch\u00eam ngo\u00e0i ch\u1ecbu t\u00e1c \u0111\u1ed9ng tr\u1ecdng l\u1ef1c c\u01a1 th\u1ec3 h\u01a1n s\u1ee5n ch\u00eam trong (71% so v\u1edbi 29%) [51]. \u0110\u00e2y c\u0169ng l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam trong nhi\u1ec1u h\u01a1n s\u1ee5n ch\u00eam ngo\u00e0i trong ch\u1ea5n th\u01b0\u01a1ng g\u1ed1i.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; Theo Kummer B. h\u00ecnh d\u1ea1ng gi\u1ea3i ph\u1eabu s\u1ee5n ch\u00eam c\u00f3 vai tr\u00f2 trong vi\u1ec7c ph\u00e2n ph\u1ed1i l\u1ef1c, d\u00e0n \u0111\u1ec1u l\u1ef1c t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u01a1 th\u1ec3 xu\u1ed1ng kh\u1edbp g\u1ed1i. Khi kh\u1edbp g\u1ed1i \u1edf t\u01b0 th\u1ebf du\u1ed7i th\u1eb3ng, tr\u1ecdng l\u1ef1c c\u01a1 th\u1ec3 s\u1ebd d\u1ed3n v\u00e0o v\u1ecb tr\u00ed th\u1ea5p nh\u1ea5t c\u1ee7a l\u1ed3i c\u1ea7u v\u00e0 m\u00e2m ch\u00e0y. T\u1ea1i v\u1ecb tr\u00ed m\u00e2m ch\u00e0y \u0111\u01b0\u1ee3c s\u1ee5n ch\u00eam che ph\u1ee7, c\u0169ng s\u1ebd c\u00f3 m\u1ed9t ph\u1ea3n l\u1ef1c th\u1eb3ng g\u00f3c v\u1edbi b\u1ec1 m\u1eb7t s\u1ee5n ch\u00eam. Tuy nhi\u00ean, nh\u1edd h\u00ecnh d\u1ea1ng l\u00e0 m\u1ed9t h\u00ecnh ch\u00eam n\u00ean t\u1ed5ng h\u1ee3p l\u1ef1c s\u1ebd l\u00e0 l\u1ef1c \u0111\u1ea9y <\/span><span class=\"fontstyle0\">ngang v\u1ec1 ph\u00eda r\u00eca c\u1ee7a m\u00e2m ch\u00e0y. Nh\u1edd v\u1eady, tr\u1ecdng l\u1ef1c c\u01a1 th\u1ec3 t\u00e1c \u0111\u1ed9ng l\u00ean m\u00e2m ch\u00e0y \u0111\u01b0\u1ee3c d\u00e0n \u0111\u1ec1u <\/span><span class=\"fontstyle0\">[125]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<h3><span class=\"fontstyle2\">4.2. Vai tr\u00f2 h\u1ea5p ph\u1ee5 l\u1ef1c t\u00e1c \u0111\u1ed9ng xu\u1ed1ng m\u00e2m ch\u00e0y<\/span><\/h3>\n<p><span class=\"fontstyle0\">&#8211; Fairbank l\u00e0 ng\u01b0\u1eddi \u0111\u1ea7u ti\u00ean \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng ch\u1ecbu l\u1ef1c c\u1ee7a s\u1ee5n ch\u00eam. \u00d4ng \u0111\u00e3 quan s\u00e1t v\u00e0 theo d\u00f5i trong m\u1ed9t th\u1eddi gian d\u00e0i sau khi c\u1eaft to\u00e0n b\u1ed9 s\u1ee5n ch\u00eam c\u1ee7a kh\u1edbp g\u1ed1i th\u00ec th\u1ea5y c\u00f3 s\u1ef1 thay \u0111\u1ed5i l\u1ef1c t\u00e1c \u0111\u1ed9ng l\u00ean m\u1eb7t kh\u1edbp v\u00e0 s\u1ef1 thay \u0111\u1ed5i n\u00e0y l\u00e0m t\u0103ng tho\u00e1i h\u00f3a kh\u1edbp. Baratz M.E. v\u00e0 Mengator sau m\u1ed9t qu\u00e1 tr\u00ecnh nghi\u00ean c\u1ee9u c\u0169ng th\u1eeba nh\u1eadn \u0111i\u1ec1u n\u00e0y <\/span><span class=\"fontstyle0\">[44]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; N\u0103m 1911, khi n\u00f3i v\u1ec1 vai tr\u00f2 c\u1ee7a s\u1ee5n ch\u00eam, Fick R. xem s\u1ee5n ch\u00eam nh\u01b0 m\u1ed9t mi\u1ebfng \u0111\u1ec7m c\u00f3 vai tr\u00f2 gi\u1ea3m s\u1ef1 va \u0111\u1eadp v\u00e0 ch\u1ea5n \u0111\u1ed9ng c\u1ee7a l\u1ed3i c\u1ea7u \u0111\u00f9i v\u1edbi m\u00e2m ch\u00e0y khi g\u1ea5p du\u1ed7i g\u1ed1i <\/span><span class=\"fontstyle0\">[67]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<p><span class=\"fontstyle0\">&#8211; S\u1ef1 chuy\u1ec3n \u0111\u1ed9ng v\u00e0 thay \u0111\u1ed5i h\u00ecnh d\u1ea1ng c\u1ee7a s\u1ee5n ch\u00eam trong qu\u00e1 tr\u00ecnh g\u1ea5p du\u1ed7i g\u1ed1i c\u0169ng nh\u01b0 c\u00e1c \u0111\u1ed9ng t\u00e1c xoay trong, xoay ngo\u00e0i c\u1ee7a kh\u1edbp \u0111\u1ea3m b\u1ea3o vai tr\u00f2 h\u1ea5p ph\u1ee5 l\u1ef1c c\u1ee7a s\u1ee5n ch\u00eam. Khi g\u1ea5p g\u1ed1i, c\u1ea3 hai s\u1ee5n ch\u00eam c\u00f9ng tr\u01b0\u1ee3t d\u1ea7n tr\u00ean m\u00e2m ch\u00e0y ra ph\u00eda sau v\u00e0 ng\u01b0\u1ee3c l\u1ea1i khi du\u1ed7i g\u1ed1i c\u1ea3 hai s\u1ee5n ch\u00eam c\u00f9ng tr\u01b0\u1ee3t d\u1ea7n tr\u00ean m\u00e2m ch\u00e0y ra ph\u00eda tr\u01b0\u1edbc. Qua \u0111\u00f3, di\u1ec7n ti\u1ebfp x\u00fac gi\u1eefa l\u1ed3i c\u1ea7u \u0111\u00f9i v\u00e0 m\u00e2m ch\u00e0y t\u0103ng l\u00ean, l\u1ef1c t\u00e1c \u0111\u1ed9ng gi\u1eefa l\u1ed3i c\u1ea7u \u0111\u00f9i v\u00e0 m\u00e2m ch\u00e0y gi\u1ea3m \u0111i.<\/span><\/p>\n<h3><span class=\"fontstyle2\">4.3. Ch\u1ee9c n\u0103ng t\u0103ng di\u1ec7n ti\u1ebfp x\u00fac gi\u1eefa l\u1ed3i c\u1ea7u \u0111\u00f9i v\u1edbi m\u00e2m ch\u00e0y<\/span><\/h3>\n<p><span class=\"fontstyle0\">Nh\u1edd c\u00f3 s\u1ee5n ch\u00eam m\u00e0 di\u1ec7n t\u00edch ti\u1ebfp x\u00fac gi\u1eefa l\u1ed3i c\u1ea7u \u0111\u00f9i v\u00e0 m\u00e2m ch\u00e0y t\u0103ng l\u00ean. C\u00e1c nghi\u00ean c\u1ee9u c\u00f3 s\u1eed d\u1ee5ng c\u1ea3m \u1ee9ng l\u1ef1c c\u1ee7a Helne H. J. n\u0103m <\/span><span class=\"fontstyle0\">1981 <\/span><span class=\"fontstyle0\">[72]<\/span><span class=\"fontstyle0\">, <\/span><span class=\"fontstyle0\">c\u1ee7a Baratz M. E. n\u0103m <\/span><span class=\"fontstyle0\">1986 <\/span><span class=\"fontstyle0\">[44] <\/span><span class=\"fontstyle0\">cho th\u1ea5y sau khi c\u1eaft b\u1ecf s\u1ee5n ch\u00eam l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 <\/span><span class=\"fontstyle0\">di\u1ec7n ti\u1ebfp x\u00fac gi\u1eefa l\u1ed3i c\u1ea7u v\u00e0 m\u00e2m ch\u00e0y.<\/span><\/p>\n<h3><span class=\"fontstyle2\">4.4. Ch\u1ee9c n\u0103ng d\u00e0n \u0111\u1ec1u d\u1ecbch kh\u1edbp<\/span><\/h3>\n<p><span class=\"fontstyle0\">S\u1ee5n ch\u00eam t\u1ea1o s\u1ef1 t\u01b0\u01a1ng h\u1ee3p gi\u1eefa hai m\u1eb7t ti\u1ebfp x\u00fac gi\u1eefa l\u1ed3i c\u1ea7u \u0111\u00f9i v\u00e0 m\u00e2m ch\u00e0y, qua \u0111\u00f3 ph\u00e2n b\u1ed1 \u0111\u1ec1u ho\u1ea1t d\u1ecbch b\u00f4i tr\u01a1n gi\u00fap dinh d\u01b0\u1ee1ng s\u1ee5n kh\u1edbp.<\/span><\/p>\n<h3><span class=\"fontstyle2\">4.5. C\u00e1c vai tr\u00f2 kh\u00e1c<\/span><\/h3>\n<p><span class=\"fontstyle0\">S\u1ee5n ch\u00eam g\u00f3p ph\u1ea7n cho s\u1ef1 v\u1eefng ch\u1eafc c\u1ee7a kh\u1edbp g\u1ed1i. B\u00ean c\u1ea1nh \u0111\u00f3, v\u1edbi c\u1ea5u tr\u00fac m\u1eadt \u0111\u1ed9 d\u00e0y c\u00e1c c\u1ea3m th\u1ee5 b\u1ea3n th\u1ec3 t\u1eadp trung \u1edf s\u1eebng sau s\u1ee5n ch\u00eam \u0111\u00e3 gi\u00fap cho ch\u00fang c\u00f3 vai tr\u00f2 b\u1ea3o v\u1ec7 kh\u1edbp g\u1ed1i ch\u1ed1ng l\u1ea1i c\u00e1c c\u1eed \u0111\u1ed9ng xoay v\u00e0 du\u1ed7i g\u1ed1i qu\u00e1 m\u1ee9c. Ngo\u00e0i ra, s\u1ee5n ch\u00eam c\u00f2n c\u00f3 t\u00e1c d\u1ee5ng l\u1ea5p \u0111\u1ea7y khe kh\u1edbp g\u1ed1i, tr\u00e1nh cho bao kh\u1edbp v\u00e0 ho\u1ea1t m\u1ea1c kh\u00f4ng b\u1ecb k\u1eb9t v\u00e0o khe kh\u1edbp <\/span><span class=\"fontstyle0\">[130]<\/span><span class=\"fontstyle0\">.<\/span><\/p>\n<p><span class=\"fontstyle0\">T\u00f3m l\u1ea1i, qua gi\u1ea3i ph\u1eabu, c\u1ea5u t\u1ea1o m\u00f4 h\u1ecdc, c\u01a1 sinh h\u1ecdc v\u00e0 vai tr\u00f2 c\u1ee7a s\u1ee5n ch\u00eam ta th\u1ea5y r\u1eb1ng trong ch\u1ea5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam trong d\u1ec5 t\u1ed5n th\u01b0\u01a1ng h\u01a1n s\u1ee5n ch\u00eam ngo\u00e0i. B\u00ean c\u1ea1nh \u0111\u00f3, tu\u1ed5i tr\u1ebb s\u1ee5n ch\u00eam th\u01b0\u1eddng r\u00e1ch d\u1ecdc. N\u1ebfu c\u1eaft b\u1ecf s\u1ee5n ch\u00eam s\u1ebd l\u00e0m t\u0103ng nguy c\u01a1 tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i, do \u0111\u00f3, r\u00e1ch s\u1ee5n ch\u00eam \u1edf v\u00f9ng \u0111\u1ecf \u2013 \u0111\u1ecf, \u0111\u1ecf \u2013 tr\u1eafng c\u1ea7n kh\u00e2u b\u1ea3o t\u1ed3n \u0111\u1ec3 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng n\u00e0y<\/span><\/p>\n","protected":false},"featured_media":4413,"comment_status":"open","ping_status":"closed","template":"","tags":[227],"chuyen-muc":[58],"class_list":["post-2314","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","tag-tong-quan-sun-chem","chuyen-muc-dieu-tri-co-ban-trong-chan-thuong-chinh-hinh"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2314","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=2314"}],"version-history":[{"count":1,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2314\/revisions"}],"predecessor-version":[{"id":4414,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2314\/revisions\/4414"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/4413"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=2314"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=2314"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=2314"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}