{"id":2331,"date":"2023-09-23T07:00:14","date_gmt":"2023-09-23T00:00:14","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=2331"},"modified":"2024-12-24T15:07:28","modified_gmt":"2024-12-24T08:07:28","slug":"hinh-thai-ton-thuong-rach-sun-chem","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/hinh-thai-ton-thuong-rach-sun-chem\/","title":{"rendered":"H\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng r\u00e1ch s\u1ee5n ch\u00eam"},"content":{"rendered":"

T\u00f9y theo v\u1ecb tr\u00ed, t\u00ednh ch\u1ea5t v\u00e0 h\u00ecnh th\u00e1i \u0111\u01b0\u1eddng r\u00e1ch m\u00e0 ph\u00e2n chia th\u00e0nh nhi\u1ec1u lo\u1ea1i h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng r\u00e1ch s\u1ee5n ch\u00eam<\/a> kh\u00e1c nhau.<\/span><\/p>\n

1. THEO V\u1eca TR\u00cd<\/span><\/h3>\n

Cooper D.E. c\u0103n c\u1ee9 v\u00e0o s\u1ef1 s\u1eafp x\u1ebfp c\u00e1c b\u00f3 s\u1ee3i collagen v\u00e0 ph\u00e2n b\u1ed1 m\u1ea1ch m\u00e1u, \u0111\u00e3 ph\u00e2n lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng\u00a0 theo c\u00e1c v\u1ecb tr\u00ed kh\u00e1c nhau <\/span>[100]<\/span>:<\/span><\/p>\n

– Theo chi\u1ec1u d\u1ecdc g\u1ed3m ba ph\u1ea7n:<\/span><\/p>\n

+ <\/span>R\u00e1ch s\u1eebng tr\u01b0\u1edbc s\u1ee5n ch\u00eam<\/span><\/p>\n

+ <\/span>R\u00e1ch s\u1eebng sau s\u1ee5n ch\u00eam<\/span><\/p>\n

+ <\/span>R\u00e1ch t\u1ea1i 1\/3 gi\u1eefa th\u00e2n s\u1ee5n ch\u00eam.<\/span><\/p>\n

– Theo b\u1ec1 r\u1ed9ng g\u1ed3m b\u1ed1n ph\u1ea7n:<\/span><\/p>\n

+ <\/span>Ph\u1ea7n c\u1ea1nh: l\u00e0 n\u01a1i s\u1ee5n ch\u00eam d\u00ednh v\u1edbi bao <\/span>kh\u1edbp b\u1eb1ng t\u1ed5 ch\u1ee9c li\u00ean k\u1ebft l\u1ecfng l\u1ebbo. \u0110\u00e2y l\u00e0 n\u01a1i t\u1eadp <\/span>trung c\u00e1c nh\u00e1nh m\u1ea1ch xu\u1ea5t ph\u00e1t t\u1eeb bao kh\u1edbp \u0111i v\u00e0o <\/span>nu\u00f4i d\u01b0\u1ee1ng s\u1ee5n ch\u00eam.<\/span><\/p>\n

+ <\/span>Ph\u1ea7n r\u00eca: t\u01b0\u01a1ng \u1ee9ng 1\/3 ngo\u1ea1i vi c\u1ee7a s\u1ee5n ch\u00eam, s\u00e1t <\/span>v\u1edbi bao kh\u1edbp. \u0110\u00e2y l\u00e0 ph\u1ea7n s\u1ee5n ch\u00eam \u0111\u01b0\u1ee3c c\u1ea5p m\u00e1u <\/span>b\u1edfi c\u00e1c nh\u00e1nh m\u1ea1ch t\u1eeb bao kh\u1edbp.<\/span><\/p>\n

+ <\/span>Ph\u1ea7n trung gian: t\u01b0\u01a1ng \u1ee9ng 1\/3 gi\u1eefa b\u1ec1 m\u1eb7t s\u1ee5n <\/span>ch\u00eam, l\u00e0 ranh gi\u1edbi gi\u1eefa ph\u1ea7n s\u1ee5n ch\u00eam \u0111\u01b0\u1ee3c c\u1ea5p <\/span>m\u00e1u nu\u00f4i d\u01b0\u1ee1ng v\u00e0 ph\u1ea7n v\u00f4 m\u1ea1ch.<\/span><\/p>\n

+ <\/span>Ph\u1ea7n trung t\u00e2m: l\u00e0 ph\u1ea7n c\u00f2n l\u1ea1i c\u1ee7a b\u1edd t\u1ef1 do s\u1ee5n ch\u00eam, ph\u00eda trung t\u00e2m bu\u1ed3ng kh\u1edbp. \u0110\u00e2y l\u00e0 ph\u1ea7n v\u00f4 m\u1ea1ch, s\u1ee5n ch\u00eam \u0111\u01b0\u1ee3c nu\u00f4i d\u01b0\u1ee1ng b\u1eb1ng th\u1ea9m th\u1ea5u t\u1eeb d\u1ecbch kh\u1edbp. Ph\u00e2n v\u00f9ng t\u1ed5n th\u01b0\u01a1ng theo ph\u00e2n lo\u1ea1i c\u1ee7a Cooper \u0111\u01b0\u1ee3c h\u1ea7u h\u1ebft c\u00e1c t\u00e1c gi\u1ea3 \u00e1p d\u1ee5ng v\u00ec c\u00f3 th\u1ec3 ti\u00ean l\u01b0\u1ee3ng \u0111\u01b0\u1ee3c h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng v\u00e0 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p t\u01b0\u01a1ng \u1ee9ng v\u1edbi t\u1eebng v\u1ecb tr\u00ed.<\/span><\/p>\n

\"Ch\u01b0\u01a1ng
H\u00ecnh 2.1. Ph\u00e2n v\u00f9ng s\u1ee5n ch\u00eam theo Cooper. A, F: s\u1eebng sau; B, E: th\u00e2n; C, D: s\u1eebng tr\u01b0\u1edbc 0: ph\u1ea7n c\u1ea1nh trung t\u00e2m; 1: ph\u1ea7n r\u00eca; 2: ph\u1ea7n trung gian; 3: ph\u1ea7n trung t\u00e2m (Ngu\u1ed3n theo AJ Rao 2015) [100]<\/figcaption><\/figure>\n

Trong nghi\u00ean c\u1ee9u c\u1ee7a t\u00e1c gi\u1ea3 V\u00f5 Th\u00e0nh To\u00e0n<\/a> v\u00e0 c\u1ed9ng s\u1ef1, t\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu n\u1eb1m \u1edf s\u1eebng sau s\u1ee5n ch\u00eam (c\u00f3 36\/72 b\u1ec7nh nh\u00e2n chi\u1ebfm t\u1ef7 l\u1ec7 50%), ti\u1ebfp theo l\u00e0 r\u00e1ch \u1edf v\u00f9ng gi\u1eefa (c\u00f3 20\/72 b\u1ec7nh nh\u00e2n chi\u1ebfm t\u1ef7 l\u1ec7 27,78%). R\u00e1ch \u1edf s\u1eebng <\/span>tr\u01b0\u1edbc l\u00e0 16\/72 b\u1ec7nh nh\u00e2n (chi\u1ebfm t\u1ef7 l\u1ec7 22,22%). K\u1ebft qu\u1ea3 n\u00e0y c\u0169ng ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c t\u00e1c gi\u1ea3 trong v\u00e0 ngo\u00e0i n\u01b0\u1edbc nh\u01b0 Nguy\u1ec5n M\u1ea1nh Kh\u00e1nh <\/span>[5]<\/span>, Nguy\u1ec5n Qu\u1ed1c D\u0169ng <\/span>[2]<\/span>, Choi <\/span>[55]<\/span>, Hoffelner T. <\/span>[73]<\/span>.<\/span><\/p>\n

S\u1ee5n ch\u00eam di chuy\u1ec3n c\u00f9ng l\u1ed3i c\u1ea7u khi kh\u1edbp chuy\u1ec3n \u0111\u1ed9ng g\u1ea5p du\u1ed7i tr\u01b0\u1ee3t ra tr\u01b0\u1edbc khi du\u1ed7i g\u1ed1i v\u00e0 l\u00f9i ra sau khi g\u1ea5p g\u1ed1i. Khi ch\u1ea5n th\u01b0\u01a1ng x\u1ea3y ra \u0111\u1ed9t ng\u1ed9t \u1edf t\u01b0 th\u1ebf xoay v\u00e0 g\u1ed1i g\u1ea5p qu\u00e1 m\u1ee9c, s\u1ef1 d\u1ecbch chuy\u1ec3n c\u1ee7a s\u1ee5n ch\u00eam ra tr\u01b0\u1edbc ho\u1eb7c ng\u01b0\u1ee3c l\u1ea1i kh\u00f4ng theo k\u1ecbp v\u1edbi chuy\u1ec3n \u0111\u1ed9ng, c\u00f3 th\u1ec3 b\u1ecb \u0111\u1ea9y d\u1ed3n, k\u1eb9t k\u1eb9t l\u1ea1i \u1edf m\u1ed9t v\u1ecb tr\u00ed d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng.<\/span><\/p>\n

Bullough P.G. m\u00f4 t\u1ea3 c\u1ea5u t\u1ea1o m\u00f4 h\u1ecdc: c\u00e1c s\u1ee3i collagen s\u1eafp x\u1ebfp nhau theo kh\u00f4ng gian ba chi\u1ec1u. C\u00e1c s\u1ee3i n\u00e0y \u0111an ch\u00e9o v\u00e0 xo\u1eafn v\u1edbi nhau, c\u00f3 nh\u1eefng s\u1ee3i ch\u1ea1y ngang theo chi\u1ec1u r\u1ed9ng, c\u00f3 nh\u1eefng b\u00f3 s\u1ee3i ch\u1ea1y theo chi\u1ec1u d\u1ecdc. T\u1ea1i th\u00e2n s\u1ee5n ch\u00eam ch\u1ec9 c\u00f3 nh\u1eefng s\u1ee3i ngang v\u00e0 d\u1ecdc \u0111an xen nhau, c\u00f2n \u1edf s\u1eebng sau \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o b\u1edfi c\u00e1c s\u1ee3i collagen kh\u00f4ng li\u00ean k\u1ebft v\u1edbi nhau gi\u1eefa chi\u1ec1u ngang v\u00e0 chi\u1ec1u d\u1ecdc. Do \u0111\u00f3, khi ch\u1ea5n th\u01b0\u01a1ng nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng s\u1eebng sau cao h\u01a1n so v\u1edbi th\u00e2n s\u1ee5n v\u00e0 s\u1eebng tr\u01b0\u1edbc s\u1ee5n ch\u00eam <\/span>[49],[50]<\/span>.<\/span><\/p>\n

2. THEO T\u00cdNH CH\u1ea4T TH\u1edcI GIAN<\/span><\/h3>\n

– R\u00e1ch m\u1edbi: trong v\u00f2ng ba tu\u1ea7n \u0111\u1ea7u ti\u00ean k\u1ec3 t\u1eeb khi ch\u1ea5n th\u01b0\u01a1ng<\/span><\/p>\n

– R\u00e1ch c\u0169: ngo\u00e0i th\u1eddi gian ba tu\u1ea7n sau ch\u1ea5n th\u01b0\u01a1ng.<\/span><\/p>\n

3. THEO PH\u00c2N V\u00d9NG C\u1ea4P M\u00c1U S\u1ee4N CH\u00caM<\/span><\/h3>\n
\"2.2\"
H\u00ecnh 2.2. Ph\u00e2n v\u00f9ng s\u1ee5n ch\u00eam theo c\u1ea5p m\u00e1u (Ngu\u1ed3n: Direct real time measurement of meniscal blood flow – Swiontkowski M. F. 1988) [111]<\/figcaption><\/figure>\n

– <\/span>V\u00f9ng \u0111\u1ecf \u2013 \u0111\u1ecf (v\u00f9ng gi\u00e0u m\u1ea1ch m\u00e1u nu\u00f4i)<\/span>: 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 li\u1ec1n n\u1ebfu ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 kh\u00e2u ph\u1ee5c h\u1ed3i.<\/span><\/p>\n

– <\/span>V\u00f9ng \u0111\u1ecf \u2013 tr\u1eafng (v\u00f9ng trung gian): <\/span>\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 li\u1ec1n 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

– <\/span>V\u00f9ng tr\u1eafng \u2013 tr\u1eafng (v\u00f9ng v\u00f4 m\u1ea1ch): <\/span>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 li\u1ec1n l\u1ea1i n\u00ean th\u01b0\u1eddng \u0111i\u1ec1u tr\u1ecb c\u1eaft b\u1ecf \u0111i ph\u1ea7n r\u00e1ch <\/span><\/p>\n

Tr\u00ean th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng vi\u1ec7c x\u00e1c \u0111\u1ecbnh ranh gi\u1edbi c\u00e1c v\u00f9ng n\u00e0y d\u1ef1a v\u00e0o m\u00e0u s\u1eafc r\u1ea5t kh\u00f3 kh\u0103n. N\u0103m 1990, de Haven K. E. \u0111\u00e3 nghi\u00ean c\u1ee9u gi\u1ea3i ph\u1eabu v\u00e0 ch\u1ec9 ra r\u1eb1ng v\u00f9ng s\u1ee5n ch\u00eam t\u1eeb s\u00e1t bao kh\u1edbp ra 3 mm v\u1ec1 ph\u00eda b\u1edd t\u1ef1 do l\u00e0 v\u00f9ng \u0111\u1ecf \u2013 \u0111\u1ecf, ti\u1ebfp theo v\u00f9ng s\u1ee5n ch\u00eam c\u00e1ch bao kh\u1edbp t\u1eeb 3 \u0111\u1ebfn 5 mm l\u00e0 v\u00f9ng \u0111\u1ecf \u2013 tr\u1eafng, c\u00f2n l\u1ea1i l\u00e0 v\u00f9ng tr\u1eafng \u2013 tr\u1eafng [60].<\/span><\/p>\n

4. THEO H\u00ccNH TH\u00c1I \u0110\u01af\u1edcNG R\u00c1CH<\/span><\/span><\/h3>\n

Ph\u00e2n lo\u1ea1i h\u00ecnh \u1ea3nh th\u01b0\u01a1ng t\u1ed5n \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp nhi\u1ec1u v\u00ec c\u1ea7n thi\u1ebft cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n

4.1. Theo c\u00e1ch ph\u00e2n lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng kinh \u0111i\u1ec3n c\u1ee7a Trillat chia l\u00e0m ba \u0111\u1ed9 v\u00e0 \u00e1p d\u1ee5ng cho s\u1ee5n ch\u00eam trong <\/span>[114]<\/span><\/span><\/h3>\n