{"id":2372,"date":"2023-09-24T07:00:20","date_gmt":"2023-09-24T00:00:20","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=2372"},"modified":"2024-12-24T15:11:59","modified_gmt":"2024-12-24T08:11:59","slug":"cac-phuong-phap-dieu-tri-rach-sun-chem","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/cac-phuong-phap-dieu-tri-rach-sun-chem\/","title":{"rendered":"C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam"},"content":{"rendered":"

\u0110i\u1ec1u tr\u1ecb r\u00e1ch s\u1ee5n ch\u00eam<\/a> kh\u1edbp g\u1ed1i<\/a> do ch\u1ea5n th\u01b0\u01a1ng nh\u01b0 \u201cn\u1eafn l\u1ea1i\u201d s\u1ee5n b\u1ecb r\u00e1ch ho\u1eb7c b\u1ea5t \u0111\u1ed9ng<\/a> kh\u1edbp g\u1ed1i sau ch\u1ea5n th\u01b0\u01a1ng \u0111\u00e3 c\u00f3 nh\u1eefng k\u1ebft qu\u1ea3 nh\u1ea5t \u0111\u1ecbnh. K\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ednh ch\u1ea5t, h\u00ecnh th\u00e1i v\u00e0 v\u1ecb tr\u00ed c\u1ee7a \u0111\u01b0\u1eddng r\u00e1ch, tuy nhi\u00ean, c\u00f3 nh\u01b0\u1ee3c \u0111i\u1ec3m l\u00e0 th\u1eddi gian b\u1ea5t \u0111\u1ed9ng k\u00e9o d\u00e0i sau ch\u1ea5n th\u01b0\u01a1ng, do \u0111\u00f3 c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf.<\/span><\/p>\n

Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt m\u1edf kh\u1edbp g\u1ed1i \u0111\u1ec3 c\u1eaft s\u1ee5n ch\u00eam b\u00e1n ph\u1ea7n hay to\u00e0n ph\u1ea7n \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng trong m\u1ed9t th\u1eddi gian d\u00e0i v\u1edbi \u01b0u \u0111i\u1ec3m x\u1eed tr\u00ed tri\u1ec7t \u0111\u1ec3 th\u01b0\u01a1ng t\u1ed5n nh\u01b0ng c\u0169ng ph\u1ea3i b\u1ea5t \u0111\u1ed9ng sau m\u1ed5, th\u1eddi gian \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i, nguy c\u01a1 nhi\u1ec5m tr\u00f9ng kh\u1edbp.<\/span><\/p>\n

Ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp<\/a> g\u1ed1i l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh tr\u00ean th\u1ebf gi\u1edbi v\u00e0o ng\u00e0y 09 th\u00e1ng 3 n\u0103m 1955 do Watanabe.M th\u1ef1c hi\u1ec7n. T\u1eeb \u0111\u00f3, ph\u1eabu thu\u1eadt n\u1ed9i soi \u0111\u00e3 ph\u00e1t tri\u1ec3n nhanh ch\u00f3ng, t\u1eebng b\u01b0\u1edbc ho\u00e0n thi\u1ec7n v\u00e0 \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng r\u1ed9ng r\u00e3i nh\u01b0 hi\u1ec7n nay nh\u1edd v\u00e0o nhi\u1ec1u \u01b0u \u0111i\u1ec3m: kh\u00f4ng nh\u1eefng ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c c\u00e1c th\u01b0\u01a1ng t\u1ed5n b\u00ean trong kh\u1edbp g\u1ed1i, m\u00e0 c\u00f2n x\u1eed tr\u00ed c\u00e1c th\u01b0\u01a1ng t\u1ed5n \u0111\u00f3.<\/span><\/p>\n

1. \u0110I\u1ec0U TR\u1eca B\u1ea2O T\u1ed2N<\/span><\/h3>\n

S\u1ee5n ch\u00eam v\u00e0 nh\u1eefng th\u01b0\u01a1ng t\u1ed5n c\u1ee7a s\u1ee5n ch\u00eam \u0111\u00e3 \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn t\u1eeb th\u1eddi Hippocrates. L\u00fac \u0111\u00f3 ng\u01b0\u1eddi ta cho r\u1eb1ng, \u0111\u00f3 <\/span>l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a sai kh\u1edbp v\u00e0 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n thu\u1ea7n l\u00e0 n\u1eafn l\u1ea1i cho \u0111\u00fang.<\/span><\/p>\n

– N\u0103m 1731, Bass J. \u0111\u00e3 m\u00f4 t\u1ea3 hai tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c n\u1eafn l\u1ea1i s\u1ee5n ch\u00eam ngo\u00e0i b\u1eb1ng c\u00e1ch d\u00f9ng ng\u00f3n tay<\/a> \u1ea5n v\u00e0o khe kh\u1edbp b\u00ean ngo\u00e0i.<\/span><\/p>\n

– N\u0103m 1773, William Bronfield c\u0169ng \u0111\u00e3 m\u00f4 t\u1ea3 c\u00e1ch n\u1eafn s\u1ee5n ch\u00eam b\u1eb1ng c\u00e1ch n\u1eafm l\u1ea5y c\u1ed5 ch\u00e2n b\u1ec7nh nh\u00e2n t\u1eeb t\u1eeb k\u00e9o v\u00e0 g\u1ea5p d\u1ea7n g\u1ed1i l\u1ea1i. S\u1ee5n ch\u00eam s\u1ebd tr\u1edf v\u1ec1 v\u1ecb tr\u00ed gi\u1ea3i ph\u1eabu.<\/span><\/p>\n

– N\u0103m 1803, VonHey c\u0169ng \u0111\u01b0a ra ph\u01b0\u01a1ng ph\u00e1p n\u1eafn l\u1ea1i s\u1ee5n ch\u00eam kh\u1edbp g\u1ed1i khi b\u1ecb k\u1eb9t kh\u1edbp b\u1eb1ng c\u00e1ch du\u1ed7i m\u1ea1nh kh\u1edbp g\u1ed1i sau \u0111\u00f3 t\u1eeb t\u1eeb g\u1ea5p l\u1ea1i.<\/span><\/p>\n

Tuy nhi\u00ean, khi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n th\u00ec th\u1eddi gian b\u1ea5t \u0111\u1ed9ng b\u1ed9t k\u00e9o d\u00e0i. B\u00ean c\u1ea1nh \u0111\u00f3, ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u0169ng c\u00f3 nh\u01b0\u1ee3c \u0111i\u1ec3m l\u00e0 kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c ch\u00ednh x\u00e1c \u0111\u01b0\u1eddng r\u00e1ch nh\u1ecf hay l\u1edbn, r\u00e1ch d\u1ecdc theo th\u00e2n s\u1ee5n ch\u00eam hay r\u00e1ch ph\u1ee9c t\u1ea1p, r\u00e1ch v\u00f9ng r\u00eca n\u01a1i c\u1ea5p m\u00e1u t\u1ed1t hay l\u00e0 v\u00f9ng v\u00f4 m\u1ea1ch d\u1eabn \u0111\u1ebfn t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng th\u1ea5p. Theo Dehaven K.E. t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng l\u00e0 38% <\/span>[56]<\/span>. Do \u0111\u00f3, ng\u00e0y nay c\u00e1c t\u00e1c gi\u1ea3 tr\u00ean th\u1ebf gi\u1edbi g\u1ea7n nh\u01b0 ch\u1ecdn bi\u1ec7n ph\u00e1p can thi\u1ec7p t\u00edch c\u1ef1c l\u00e0 can thi\u1ec7p ph\u1eabu thu\u1eadt tr\u1eeb c\u00e1c tr\u01b0\u1eddng h\u1ee3p: \u0111\u01b0\u1eddng r\u00e1ch d\u1ecdc th\u00e2n nh\u01b0ng kh\u00f4ng h\u1ebft chi\u1ec1u d\u00e0y ho\u1eb7c \u0111\u01b0\u1eddng r\u00e1ch d\u1ecdc h\u1ebft chi\u1ec1u d\u00e0y d\u01b0\u1edbi 10 mm v\u00e0 ph\u1ea7n s\u1ee5n ch\u00eam r\u00e1ch di l\u1ec7ch \u00edt h\u01a1n 3 mm khi d\u00f9ng que th\u0103m d\u00f2 ho\u1eb7c \u0111\u01b0\u1eddng r\u00e1ch ngang d\u01b0\u1edbi 5 mm.<\/span><\/p>\n

2. \u0110I\u1ec0U TR\u1eca B\u1eb0NG PH\u1eaaU THU\u1eacT<\/span><\/h3>\n

2.1. Ph\u1eabu thu\u1eadt m\u1edf<\/span><\/h3>\n

N\u0103m 1867, Bradhurst W. \u0111\u00e3 th\u1ef1c hi\u1ec7n th\u00e0nh c\u00f4ng ca ph\u1eabu thu\u1eadt s\u1ee5n ch\u00eam b\u1eb1ng c\u00e1ch ph\u1eabu thu\u1eadt m\u1edf v\u00e0 \u0111\u00e3 l\u1ea5y ra to\u00e0n b\u1ed9 s\u1ee5n ch\u00eam r\u00e1ch. Tuy nhi\u00ean, k\u1ebft qu\u1ea3 mang l\u1ea1i ch\u01b0a cao, hay g\u1eb7p nhi\u1ec5m khu\u1ea9n kh\u1edbp v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn v\u1eadn \u0111\u1ed9ng kh\u1edbp.<\/span><\/p>\n

Thomas Annandale <\/span>[122] <\/span>v\u00e0o gi\u1eefa th\u1ebf k\u1ef7 XIX \u0111\u00e3 \u0111\u01b0a ra kh\u00e1i ni\u1ec7m v\u1ec1 th\u01b0\u01a1ng t\u1ed5n s\u1ee5n ch\u00eam. N\u0103m 1885, trong chuy\u00ean lu\u1eadn \u201cK\u1ebft qu\u1ea3 c\u1eaft b\u1ecf s\u1ee5n h\u00ecnh b\u00e1n nguy\u1ec7t trong vi\u1ec7c b\u1ea3o t\u1ed3n ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng kh\u1edbp g\u1ed1i\u201d, t\u00e1c gi\u1ea3 \u0111\u1ec1 c\u1eadp t\u1edbi vi\u1ec7c l\u1ea5y b\u1ecf \u0111i ph\u1ea7n s\u1ee5n ch\u00eam t\u1ed5n th\u01b0\u01a1ng b\u1eb1ng m\u1edf kh\u1edbp.<\/span><\/p>\n

2.2. Ph\u1eabu thu\u1eadt n\u1ed9i soi<\/span><\/h3>\n

Ca ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi Watanabe M. v\u00e0o ng\u00e0y 09 th\u00e1ng 3 n\u0103m 1955. Qua n\u1ed9i soi \u00f4ng \u0111\u00e3 l\u1ea5y ra \u0111\u01b0\u1ee3c m\u1ed9t kh\u1ed1i u t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 v\u00e0ng \u1edf t\u00fai b\u1ecbt c\u01a1 t\u1ee9 \u0111\u1ea7u. \u0110\u1ebfn ng\u00e0y 04 th\u00e1ng 5 n\u0103m 1962, \u00f4ng \u0111\u00e3 th\u1ef1c hi\u1ec7n ca ph\u1eabu thu\u1eadt \u0111\u1ea7u ti\u00ean c\u1eaft s\u1ee5n ch\u00eam kh\u1edbp g\u1ed1i qua n\u1ed9i soi.<\/span><\/p>\n

Sau th\u00e0nh c\u00f4ng c\u1ee7a Watanabe M. ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp g\u1ed1i \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n m\u1ea1nh m\u1ebd. N\u0103m 1974, O\u2019Connor B. \u0111\u00e3 th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt c\u1eaft s\u1ee5n ch\u00eam kh\u1edbp g\u1ed1i qua n\u1ed9i soi t\u1ea1i M\u1ef9 v\u00e0 \u0111\u1ea1t k\u1ebft qu\u1ea3 t\u1ed1<\/span>t. McGinty J.B. \u0111\u00e3 \u1ee9ng d\u1ee5ng k\u1ef9 thu\u1eadt \u0111i\u1ec7n t\u1eed \u0111\u1ec3 truy\u1ec1n h\u00ecnh \u1ea3nh trong kh\u1edbp l\u00ean m\u00e0n h\u00ecnh gi\u00fap cho vi\u1ec7c quan s\u00e1t, \u0111\u00e1nh gi\u00e1 v\u00e0 x\u1eed l\u00fd c\u00e1c t\u1ed5n th\u01b0\u01a1ng ch\u00ednh x\u00e1c v\u00e0 thu\u1eadn l\u1ee3i h\u01a1n.<\/span><\/p>\n

T\u1eeb \u0111\u00f3 \u0111\u1ebfn nay, ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng r\u1ed9ng r\u00e3i, Bergstrom (1983), nghi\u00ean c\u1ee9u 58 ca c\u1eaft b\u00e1n ph\u1ea7n s\u1ee5n ch\u00eam, so s\u00e1nh gi\u1eefa ph\u1eabu thu\u1eadt n\u1ed9i soi v\u00e0 ph\u1eabu thu\u1eadt m\u1edf kh\u1edbp, t\u00e1c gi\u1ea3 \u0111i \u0111\u1ebfn k\u1ebft lu\u1eadn: ph\u1eabu thu\u1eadt n\u1ed9i soi c\u00f3 nhi\u1ec1u \u01b0u \u0111i\u1ec3m h\u01a1n so ph\u1eabu thu\u1eadt ph\u1eabu thu\u1eadt m\u1edf <\/span>[122]<\/span>.<\/span><\/p>\n

C\u00e1c t\u00e1c gi\u1ea3 nh\u01b0 Pettrone F.A.(1982), Martens M.A. (1986), Simpson D.A. (1986) v\u00e0 Lohnert J. (1986) \u0111\u1ec1u \u0111i \u0111\u1ebfn k\u1ebft lu\u1eadn: ph\u1eabu thu\u1eadt c\u1eaft s\u1ee5n ch\u00eam kh\u1edbp g\u1ed1i qua n\u1ed9i soi cho k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n, th\u1eddi gian ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng<\/a> v\u1eadn \u0111\u1ed9ng kh\u1edbp nhanh h\u01a1n, r\u00fat ng\u1eafn th\u1eddi gian n\u1eb1m vi\u1ec7n, nhanh ch\u00f3ng \u0111\u01b0a b\u1ec7nh nh\u00e2n tr\u1edf l\u1ea1i cu\u1ed9c s\u1ed1ng lao \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng so v\u1edbi ph\u1eabu thu\u1eadt ph\u1eabu thu\u1eadt m\u1edf <\/span>[78],[86]<\/span>.<\/span><\/p>\n

Ph\u1ea3i \u0111\u1ebfn th\u1ebf k\u1ef7 XX, khi s\u1ef1 hi\u1ec3u bi\u1ebft v\u1ec1 gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng c\u0169ng nh\u01b0 vai tr\u00f2 c\u01a1 sinh h\u1ecdc c\u1ee7a s\u1ee5n ch\u00eam trong v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp g\u1ed1i \u0111\u01b0\u1ee3c \u0111\u1ea7y \u0111\u1ee7, c\u00e1c nh\u00e0 khoa h\u1ecdc ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh \u0111\u00e3 t\u00ecm c\u00e1ch \u0111\u1ec3 c\u00f3 th\u1ec3 x\u1eed l\u00fd ch\u00ednh x\u00e1c c\u00e1c th\u01b0\u01a1ng t\u1ed5n s\u1ee5n ch\u00eam tr\u00ean nguy\u00ean t\u1eafc b\u1ea3o v\u1ec7 t\u1ed1i \u0111a ph\u1ea7n s\u1ee5n ch\u00eam c\u00f2n l\u00e0nh. Ph\u1eabu thu\u1eadt n\u1ed9i soi ra \u0111\u1eddi \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u \u0111\u00f3.<\/span><\/p>\n

2.2.1. <\/span>Ph\u1eabu thu\u1eadt c\u1eaft s\u1ee5n ch\u00eam<\/span><\/h3>\n

N\u0103m 1867, Bradhurst W. \u0111\u00e3 th\u1ef1c hi\u1ec7n th\u00e0nh c\u00f4ng ca ph\u1eabu thu\u1eadt c\u1eaft s\u1ee5n ch\u00eam \u0111\u1ea7u ti\u00ean b\u1eb1ng c\u00e1ch m\u1edf kh\u1edbp, l\u1ea5y \u0111i to\u00e0n b\u1ed9 s\u1ee5n ch\u00eam r\u00e1ch. N\u0103m 1885, Annadale T. th\u00f4ng b\u00e1o s\u1eed d\u1ee5ng ch\u1ec9 chromcatgut kh\u00e2u ph\u1ee5c h\u1ed3i l\u1ea1i th\u00e2n s\u1ee5n ch\u00eam cho k\u1ebft qu\u1ea3 t\u1ed1t.<\/span><\/p>\n

Ph\u1ea3i \u0111\u1ebfn n\u0103m 1892 m\u1edbi c\u00f3 m\u1ed9t b\u00e1o c\u00e1o v\u1edbi s\u1ed1 l\u01b0\u1ee3ng l\u1edbn g\u1ed3m 24 tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf s\u1ee5n ch\u00eam do<\/span>Bruns P. th\u1ef1c hi\u1ec7n. C\u00e1c ph\u1eabu thu\u1ead th\u1eddi b\u1ea5y gi\u1edd ch\u1ec9 \u0111\u01a1n gi\u1ea3n l\u00e0 l\u1ea5y b\u1ecf \u0111i s\u1ee5n ch\u00eam. Tuy nhi\u00ean, v\u1eabn t\u1ed3n t\u1ea1i tranh c\u00e3i gi\u1eefa vi\u1ec7c ch\u1ec9 c\u1eaft b\u1ecf ph\u1ea7n b\u1ecb th\u01b0\u01a1ng t\u1ed5n hay n\u00ean c\u1eaft b\u1ecf to\u00e0n b\u1ed9 s\u1ee5n ch\u00eam\u00a0 <\/span>[106]<\/span>.<\/span><\/p>\n

– <\/span>C\u1eaft to\u00e0n ph\u1ea7n: <\/span>l\u00e0 s\u1ee5n ch\u00eam b\u1ecb c\u1eaft b\u1ecf ho\u00e0n to\u00e0n \u0111\u1ebfn t\u1eadn bao kh\u1edbp.<\/span><\/p>\n

M\u1eb7c d\u00f9 sau khi b\u1ecb c\u1eaft b\u1ecf, \u0111\u1eb7t bi\u1ec7t l\u00e0 \u1edf s\u1eebng sau, n\u01a1i gi\u00e0u m\u1ea1ch m\u00e1u nu\u00f4i d\u01b0\u1ee1ng v\u1eabn c\u00f3 s\u1ef1 t\u00e1i sinh tr\u1edf l\u1ea1i, nh\u01b0ng ph\u1ea7n s\u1ee5n t\u00e1i sinh n\u00e0y th\u01b0\u1eddng nh\u1ecf, m\u1ec1m v\u00e0 m\u1ecfng h\u01a1n s\u1ee5n ch\u00eam b\u00ecnh th\u01b0\u1eddng. C\u1ea5u tr\u00fac vi th\u1ec3 c\u1ee7a ph\u1ea7n s\u1ee5n ch\u00eam t\u00e1i sinh ch\u1ee7 y\u1ebfu l\u00e0 t\u1ed5 ch\u1ee9c li\u00ean k\u1ebft v\u00e0 kh\u00f4ng c\u00f3 t\u1ebf b\u00e0o s\u1ee5n. Do v\u1eady, ch\u1ee9c n\u0103ng sinh c\u01a1 h\u1ecdc c\u1ee7a ph\u1ea7n s\u1ee5n t\u00e1i sinh c\u0169ng b\u1ecb h\u1ea1n ch\u1ebf.<\/span><\/p>\n

\u0110a s\u1ed1 c\u00e1c t\u00e1c gi\u1ea3 nh\u1eadn th\u1ea5y c\u00f3 s\u1ef1 thay \u0111\u1ed5i tr\u00ean X-quang<\/a> \u1edf 70% b\u1ec7nh nh\u00e2n sau c\u1eaft b\u1ecf s\u1ee5n ch\u00eam, trong \u0111\u00f3 c\u00f3 20% l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a tho\u00e1i h\u00f3a kh\u1edbp<\/a> <\/span>[103],[104],[107]<\/span>. Tr\u00ean quan s\u00e1t l\u00e2m s\u00e0ng c\u0169ng v\u1eady, t\u1ef7 l\u1ec7 tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n sau c\u1eaft b\u1ecf s\u1ee5n ch\u00eam t\u0103ng d\u1ea7n theo th\u1eddi gian sau ph\u1eabu thu\u1eadt: 40% sau 10 n\u0103m, 56% sau 20 n\u0103m v\u00e0 l\u00e0 100% \u1edf th\u1eddi gian sau \u0111\u00f3 <\/span>[63],[69],[74],[79]<\/span>.<\/span><\/p>\n

– <\/span>C\u1eaft b\u00e1n ph\u1ea7n: <\/span>l\u00e0 c\u1eaft b\u1ecf ph\u1ea7n r\u00e1ch \u0111\u1ebfn ph\u1ea7n ranh gi\u1edbi gi\u1eefa v\u00f9ng \u0111\u01b0\u1ee3c c\u1ea5p m\u00e1u v\u00e0 v\u00f9ng v\u00f4 m\u1ea1ch, \u0111\u1ec3 l\u1ea1i ph\u1ea7n r\u00eca c\u1ee7a s\u1ee5n ch\u00eam.<\/span><\/p>\n

– <\/span>C\u1eaft m\u1ed9t ph\u1ea7n s\u1ee5n ch\u00eam: <\/span>l\u00e0 ph\u1eabu thu\u1eadt ch\u1ec9 c\u1eaft b\u1ecf ph\u1ea7n s\u1ee5n ch\u00eam b\u1ecb th\u01b0\u01a1ng t\u1ed5n t\u00f9y theo k\u00edch th\u01b0\u1edbc ph\u1ea7n th\u01b0\u01a1ng t\u1ed5n l\u1edbn hay nh\u1ecf.<\/span><\/p>\n

Nh\u1eefng ng\u01b0\u1eddi \u0111i ti\u00ean phong v\u00e0 \u1ee7ng h\u1ed9 cho vi\u1ec7c c\u1eaft m\u1ed9t ph\u1ea7n s\u1ee5n ch\u00eam ph\u1ea3i k\u1ec3 \u0111\u1ebfn Robert Jones n\u0103m 1909 v\u00e0 Don King n\u0103m 1936. V\u00ec ch\u01b0a c\u00f3 k\u1ef9 thu\u1eadt n\u1ed9i soi n\u00ean c\u00e1c t\u00e1c gi\u1ea3 nh\u1eadn th\u1ea5y c\u1eaft m\u1ed9t ph\u1ea7n s\u1ee5n ch\u00eam c\u0169ng c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf nh\u1ea5t \u0111\u1ecbnh. Bergstrom R., Dandy D.J., Hamberg P. nh\u1eadn th\u1ea5y ph\u1eabu thu\u1eadt m\u1edf kh\u1edbp d\u1ec5 b\u1ecf s\u00f3t c\u00e1c th\u01b0\u01a1ng t\u1ed5n \u1edf s\u1eebng sau ho\u1eb7c nh\u1eefng th\u01b0\u01a1ng t\u1ed5n \u1edf m\u1eb7t d\u01b0\u1edbi s\u1ee5n ch\u00eam do kh\u00f4ng quan s\u00e1t \u0111\u01b0\u1ee3c <\/span>[45],[58],[71]<\/span>. Theo nh\u1eefng nghi\u00ean c\u1ee9u c\u1ee7a Du Troit G.T. v\u00e0 Enslin T.B. n\u0103m 1945, Smillie J.S. n\u0103m 1978, Andrews J.L. v\u00e0 c\u1ed9ng s\u1ef1 n\u0103m 1975, c\u00e1c th\u01b0\u01a1ng t\u1ed5n n\u1ebfu b\u1ecb b\u1ecf s\u00f3t s\u1ebd ti\u1ebfp t\u1ee5c ti\u1ebfn tri\u1ec3n th\u00e0nh nh\u1eefng \u0111\u01b0\u1eddng r\u00e1ch m\u1edbi v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n \u1ea3nh h\u01b0\u1edfng t\u1edbi ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng kh\u1edbp g\u1ed1i sau ph\u1eabu thu\u1eadt (tr\u00edch t\u1eeb <\/span>[129]<\/span>). Gillqquist J. n\u0103m 1982, Martens M.A. n\u0103m 1986 nh\u1eadn th\u1ea5y c\u1eaft s\u1ee5n ch\u00eam m\u1ed9t ph\u1ea7n c\u00f3 nh\u1eefng \u01b0u \u0111i\u1ec3m l\u00e0 \u00edt g\u00e2y ch\u1ea5n th\u01b0\u01a1ng trong ph\u1eabu thu\u1eadt, gi\u1eef \u0111\u01b0\u1ee3c t\u1ed1i \u0111a ph\u1ea7n l\u00e0nh \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp, gi\u1ea3m t\u1ef7 l\u1ec7 tho\u00e1i h\u00f3a kh\u1edbp sau ph\u1eabu thu\u1eadt <\/span>[68],[87]<\/span>.<\/span><\/p>\n

C\u00e1c c\u00f4ng tr\u00ecnh nghi\u00ean c\u1ee9u tr\u00ean l\u00e2m s\u00e0ng c\u1ee7a Dandy D.J. n\u0103m 1978, Northmore-Ball M.D., Fauno P. n\u0103m 1992 v\u00e0 Molina H.E. n\u0103m 2002 \u0111\u1ec1u cho th\u1ea5y k\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt sau c\u1eaft m\u1ed9t ph\u1ea7n s\u1ee5n ch\u00eam t\u1ed1t h\u01a1n, t\u1ef7 l\u1ec7 tho\u00e1i h\u00f3a kh\u1edbp sau ph\u1eabu thu\u1eadt c\u0169ng gi\u1ea3m \u0111\u00e1ng k\u1ec3 so v\u1edbi ph\u1eabu thu\u1eadt c\u1eaft to\u00e0n b\u1ed9 s\u1ee5n ch\u00eam <\/span>[57],[64],[90],[93]<\/span>.<\/span><\/p>\n

Ph\u1eabu thu\u1eadt<\/a> n\u1ed9i soi kh\u1edbp g\u1ed1i ra \u0111\u1eddi \u0111\u00e3 kh\u1eafc ph\u1ee5c ho\u00e0n to\u00e0n nh\u1eefng nh\u01b0\u1ee3c \u0111i\u1ec3m tr\u00ean v\u00e0 ng\u00e0y c\u00e0ng ho\u00e0n thi\u1ec7n gi\u00fap cho ph\u1eabu thu\u1eadt c\u1eaft m\u1ed9t ph\u1ea7n s\u1ee5n ch\u00eam tr\u1edf th\u00e0nh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u.<\/span><\/p>\n

Nh\u1eefng nghi\u00ean c\u1ee9u c\u1ee7a c\u00e1c t\u00e1c gi\u1ea3 nh\u01b0 Dandy D. n\u0103m 1978, Lysholm J. v\u00e0 Gillquist J. n\u0103m 1981, Ferkel R.D. n\u0103m 1985 \u0111\u1ec1u cho th\u1ea5y nh\u1eefng \u01b0u \u0111i\u1ec3m v\u01b0\u1ee3t tr\u1ed9i c\u1ee7a n\u1ed9i soi so v\u1edbi ph\u1eabu thu\u1eadt m\u1edf kh\u1edbp nh\u01b0 sau <\/span>[57],[66],[83]<\/span>.<\/span><\/p>\n

Th\u1eddi gian h\u1ed3i ph\u1ee5c ng\u1eafn h\u01a1n: 10,5 ng\u00e0y v\u1edbi ph\u1eabu thu\u1eadt qua n\u1ed9i soi so v\u1edbi 32,7 ng\u00e0y v\u1edbi ph\u1eabu thu\u1eadt m\u1edf kh\u1edbp <\/span>[57]<\/span>.<\/span><\/p>\n

– Gi\u1ea3m thi\u1ec3u t\u1ed1i \u0111a ch\u1ea5n th\u01b0\u01a1ng<\/a> trong ph\u1eabu thu\u1eadt. Gi\u1ea3m th\u1eddi gian n\u1eb1m vi\u1ec7n. Nhanh ch\u00f3ng tr\u1edf l\u1ea1i lao \u0111\u1ed9ng v\u00e0 luy\u1ec7n t\u1eadp th\u1ec3 thao<\/span><\/p>\n

– Gi\u1ea3m tri\u1ec7u ch\u1ee9ng \u0111au sau ph\u1eabu thu\u1eadt<\/span><\/p>\n

– Gi\u1ea3m thi\u1ec3u nguy c\u01a1\u00a0 v\u00e0 c\u1ee9ng kh\u1edbp sau ph\u1eabu thu\u1eadt.<\/span><\/span><\/p>\n

C\u00e1c t\u00e1c gi\u1ea3 nh\u1eadn th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c \u1ed1ng k\u00ednh c\u00f3 \u0111\u01b0\u1eddng k\u00ednh nh\u1ecf cho ph\u00e9p quan s\u00e1t to\u00e0n b\u1ed9 c\u00e1c th\u00e0nh ph\u1ea7n trong kh\u1edbp, x\u1eed l\u00fd ch\u00ednh x\u00e1c, kh\u00f4ng b\u1ecf s\u00f3t t\u1ed5n th\u01b0\u01a1ng v\u00e0 b\u1ea3o v\u1ec7 t\u1ed1i \u0111a c\u00e1c th\u00e0nh ph\u1ea7n l\u00e0nh trong kh\u1edbp <\/span>[54],[62]<\/span>\u00a0<\/span><\/p>\n

\"4.1\"
H\u00ecnh 4.1. H\u00ecnh \u1ea3nh n\u1ed9i soi r\u00e1ch s\u1ee5n ch\u00eam<\/a> v\u00e0 sau khi c\u1eaft s\u1ee5n ch\u00eam m\u1ed9t ph\u1ea7n (Ngu\u1ed3n: Meniscal repair – Wirth C. R. 1981) [121<\/figcaption><\/figure>\n

2.2.2. <\/span>Ph\u1eabu thu\u1eadt kh\u00e2u l\u1ea1i s\u1ee5n ch\u00eam<\/span><\/h3>\n

\u0110\u1ed1i v\u1edbi nh\u1eefng s\u1ee5n ch\u00eam r\u00e1ch do nguy\u00ean nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng, nguy\u00ean t\u1eafc b\u1ea3o v\u1ec7 \u0111\u01b0\u1ee3c t\u1ed1i \u0111a l\u00e0 t\u1ed1t nh\u1ea5t. Ng\u01b0\u1eddi ta t\u00ecm c\u00e1ch kh\u00e2u l\u1ea1i nh\u1eefng \u0111\u01b0\u1eddng r\u00e1ch m\u1edbi, \u1edf nh\u1eefng s\u1ee5n ch\u00eam b\u00ecnh th\u01b0\u1eddng. Ph\u1eabu thu\u1eadt kh\u00e2u s\u1ee5n ch\u00eam \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ea7u ti\u00ean b\u1edfi t\u00e1c gi\u1ea3 Thomas Annandale (1885) b\u1eb1ng ph\u1eabu thu\u1eadt m\u1edf kh\u1edbp. Sau \u0111\u00f3, c\u00e1c t\u00e1c gi\u1ea3 nh\u01b0 Lexer E. (1931), Jonasch (1964) th\u1ef1c hi\u1ec7n v\u00e0 k\u1ebft qu\u1ea3 mang l\u1ea1i c\u0169ng ch\u01b0a r\u00f5 r\u1ec7t <\/span>[135]<\/span>.<\/span><\/p>\n

N\u0103m 1969, t\u00e1c gi\u1ea3 Ikeuchi l\u00e0 ng\u01b0\u1eddi \u1ee9ng d\u1ee5ng \u0111\u1ea7u ti\u00ean ph\u1eabu thu\u1eadt n\u1ed9i soi \u0111\u1ec3 kh\u00e2u s\u1ee5n ch\u00eam. \u0110\u1ebfn n\u0103m 1976, \u00f4ng b\u00e1o c\u00e1o k\u1ebft qu\u1ea3 kh\u00e2u b\u1ed1n tr\u01b0\u1eddng h\u1ee3p \u0111\u1ea7u ti\u00ean, c\u00f3 ba tr\u01b0\u1eddng h\u1ee3p th\u00e0nh c\u00f4ng. N\u0103m 1978, t\u00e1c gi\u1ea3 Price C. T. v\u00e0 Allen W. C. b\u00e1o c\u00e1o 36 tr\u01b0\u1eddng h\u1ee3p r\u00e1ch d\u1ecdc s\u1ee5n ch\u00eam \u1edf ph\u1ea7n r\u00eca, k\u1ebft qu\u1ea3 c\u00f3 30 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f2n c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh c\u1ee7a th\u01b0\u01a1ng t\u1ed5n l\u00e0 k\u1eb9t kh\u1edbp, \u201cl\u1ee5c kh\u1ee5c\u201d trong kh\u1edbp v\u00e0 khu\u1ef5u g\u1ed1i <\/span>[101]<\/span>.<\/span><\/p>\n

Nh\u1edd nh\u1eefng hi\u1ec3u bi\u1ebft ng\u00e0y c\u00e0ng r\u00f5 h\u01a1n v\u1ec1 ngu\u1ed3n c\u1ea5p m\u00e1u, m\u00f4 b\u1ec7nh h\u1ecdc, ng\u01b0\u1eddi ta th\u1ea5y r\u1eb1ng c\u00f3 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam c\u00f3 th\u1ec3 kh\u00e2u ph\u1ee5c h\u1ed3i, b\u00ean c\u1ea1nh \u0111\u00f3, v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ph\u1eabu thu\u1eadt n\u1ed9i soi \u0111\u00e3 \u0111em l\u1ea1i k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n.<\/span><\/p>\n

Ph\u1ea3i \u0111\u1ebfn th\u1eadp ni\u00ean 80 c\u1ee7a th\u1ebf k\u1ef7 XX, qu\u00e1 tr\u00ecnh kh\u00e2u s\u1ee5n ch\u00eam m\u1edbi \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng r\u1ed9ng r\u00e3i tr\u00ean th\u1ebf gi\u1edbi nh\u01b0: Henning (1980), Wirth (1981), Marshall D.J. (1982),… C\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 \u0111\u01b0a ra ch\u1ec9 \u0111\u1ecbnh v\u00e0 k\u1ef9 thu\u1eadt c\u1ee5 th\u1ec3 cho qu\u00e1 tr\u00ecnh kh\u00e2u s\u1ee5n ch\u00eam <\/span>[88],[115],[121]<\/span>.<\/span><\/p>\n

* <\/span>Ch\u1ec9 \u0111\u1ecbnh: <\/span>hi\u1ec7n nay, h\u1ea7u h\u1ebft c\u00e1c t\u00e1c gi\u1ea3 \u0111\u1ec1u th\u1ed1ng nh\u1ea5t v\u1edbi ch\u1ec9 \u0111\u1ecbnh c\u1ee7a Timmy P.<\/span><\/strong><\/p>\n

– V\u1ecb tr\u00ed r\u00e1ch v\u00f9ng gi\u00e0u m\u1ea1ch m\u00e1u n\u01a1i ti\u1ebfp gi\u00e1p v\u1edbi bao kh\u1edbp (v\u00f9ng \u0111\u1ecf \u2013 \u0111\u1ecf v\u00e0 v\u00f9ng \u0111\u1ecf \u2013 tr\u1eafng), \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i c\u1ea7n c\u00e2n nh\u1eafc kh\u00e2u c\u1ea3 v\u00f9ng tr\u1eafng \u2013 tr\u1eafng.<\/span><\/p>\n

– T\u1ed1t nh\u1ea5t l\u00e0 r\u00e1ch m\u1edbi kh\u00f4ng qu\u00e1 8 tu\u1ea7n<\/span><\/p>\n

– T\u1ed1t nh\u1ea5t l\u00e0 kh\u00e2u \u1edf b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 45 tu\u1ed5i, tuy nhi\u00ean, c\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y th\u1ea5y r\u1eb1ng k\u1ebft qu\u1ea3 c\u0169ng t\u1ed1t \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i.<\/span><\/p>\n

– Kh\u1edbp g\u1ed1i \u0111\u01b0\u1ee3c kh\u00e2u s\u1ee5n ph\u1ea3i v\u1eefng, k\u1ebft qu\u1ea3 s\u1ebd kh\u00f4ng t\u1ed1t n\u1ebfu kh\u1edbp g\u1ed1i m\u1ea5t v\u1eefng <\/span>[115]<\/span>.<\/span><\/p>\n

* <\/span>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e2u s\u1ee5n ch\u00eam qua n\u1ed9i soi:<\/span><\/strong><\/p>\n