{"id":751,"date":"2023-03-14T18:20:09","date_gmt":"2023-03-14T11:20:09","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&#038;p=751"},"modified":"2023-05-16T07:26:15","modified_gmt":"2023-05-16T00:26:15","slug":"gay-khung-chau","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-khung-chau\/","title":{"rendered":"Pelvic Fracture"},"content":{"rendered":"<h2>\u0110\u1ea0I C\u01af\u01a0NG<\/h2>\n<p>Khung ch\u1eadu (<a href=\"https:\/\/dictionary.cambridge.org\/dictionary\/english\/pelvis\" target=\"_blank\" rel=\"noopener\">Pelvis<\/a>) g\u1ed3m c\u00f3 hai x\u01b0\u01a1ng ch\u1eadu, \u1edf ph\u00eda sau n\u1ed1i v\u1edbi x\u01b0\u01a1ng c\u00f9ng b\u1edfi hai kh\u1edbp c\u00f9ng ch\u1eadu; \u1edf ph\u00eda tr\u01b0\u1edbc b\u1edfi kh\u1edbp mu. M\u1ed7i x\u01b0\u01a1ng ch\u1eadu c\u00f3 \u1ed5 c\u1ed1i l\u00e0 th\u00e0nh ph\u1ea7n ch\u00ednh c\u1ee7a <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/trat-khop-vai-khuyu-hang\/\">kh\u1edbp h\u00e1ng<\/a>.<\/p>\n<p>X\u01b0\u01a1ng ch\u1eadu ph\u1ea7n l\u1edbn l\u00e0 x\u01b0\u01a1ng x\u1ed1p. \u1ede khung ch\u1eadu c\u00f3 nh\u1eefng v\u00f9ng y\u1ebfu nh\u01b0 gi\u1eefa c\u00e1nh ch\u1eadu, c\u00e1c ng\u00e0nh x\u01b0\u01a1ng mu v\u00e0 \u1edf c\u00e1c l\u1ed7 c\u1ee7a x\u01b0\u01a1ng c\u00f9ng.<\/p>\n<p>Khung ch\u1eadu c\u00f3 nhi\u1ec1u c\u01a1 bao ph\u1ee7 v\u00e0 h\u1ec7 th\u1ed1ng c\u00e1c d\u00e2y ch\u1eb1ng r\u1ea5t ch\u1eafc ch\u1eafn c\u00f3 nhi\u1ec7m v\u1ee5 gi\u1eef v\u1eefng khung ch\u1eadu, b\u1ea3o v\u1ec7 ph\u1ee7 t\u1ea1ng b\u00ean trong v\u00e0 l\u00e0 \u0111i\u1ec3m t\u1ef1a c\u1ee7a chi d\u01b0\u1edbi.<\/p>\n<p><img fetchpriority=\"high\" decoding=\"async\" width=\"275\" height=\"190\" class=\"wp-image-1035\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-1-1.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-1-1.png 275w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-1-1-18x12.png 18w\" sizes=\"(max-width: 275px) 100vw, 275px\" \/> <img decoding=\"async\" width=\"275\" height=\"191\" class=\"wp-image-1036\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-2-1.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-2-1.png 275w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-2-1-18x12.png 18w\" sizes=\"(max-width: 275px) 100vw, 275px\" \/><\/p>\n<p><strong>H\u00ecnh 7.1. <\/strong>H\u1ec7 th\u1ed1ng d\u00e2y ch\u1eb1ng tr\u01b0\u1edbc v\u00e0 sau kh\u1edbp c\u00f9ng ch\u1eadu gi\u1eef v\u1eefng t\u0129nh khung ch\u1eadu <em>(theo Rockwood &amp; Green)<\/em><\/p>\n<p>Ch\u1ea5n th\u01b0\u01a1ng l\u00e0m g\u00e3y khung ch\u1eadu th\u01b0\u1eddng l\u00e0 ch\u1ea5n th\u01b0\u01a1ng r\u1ea5t m\u1ea1nh, cho n\u00ean ngo\u00e0i x\u01b0\u01a1ng g\u00e3y c\u00f2n ph\u1ea3i ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c t\u1ed5n th\u01b0\u01a1ng ph\u1ed1i h\u1ee3p: b\u1ee5ng, ng\u1ef1c, b\u1ed9 ni\u1ec7u, sinh d\u1ee5c. G\u00e3y khung ch\u1eadu, nh\u1ea5t l\u00e0 g\u00e3y c\u00e1nh ch\u1eadu l\u00e0m ch\u1ea3y nhi\u1ec1u m\u00e1u n\u00ean d\u1ec5 c\u00f3 bi\u1ebfn ch\u1ee9ng s\u1ed1c do m\u1ea5t m\u00e1u, c\u00f3 khi t\u1eed vong.<\/p>\n<p>Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-kin\/\">g\u00e3y x\u01b0\u01a1ng<\/a> ch\u1eadu kh\u00f4ng ph\u1ea3i ch\u1ec9 c\u00f3 l\u00e0m <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/cham-lanh-xuong-va-khong-lanh-xuong\/\">li\u1ec1n x\u01b0\u01a1ng<\/a> m\u00e0 c\u00f2n \u0111\u00f2i h\u1ecfi ph\u1ea3i ph\u1ee5c h\u1ed3i l\u1ea1i h\u00ecnh d\u00e1ng gi\u1ea3i ph\u1eabu: kh\u00f4ng l\u00e0m h\u1eb9p ti\u1ec3u khung, kh\u00f4ng l\u00e0m h\u1eb9p v\u00e0 l\u1ec7ch c\u1ed5 b\u1ecdng \u0111\u00e1i, kh\u00f4ng l\u00e0m ng\u1eafn chi, kh\u00f4ng \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng h\u01b0 kh\u1edbp h\u00e1ng.<\/p>\n<p>G\u00e3y khung ch\u1eadu kh\u00f4ng v\u1eefng s\u1ebd l\u00e0m b\u1ec7nh nh\u00e2n \u0111au nhi\u1ec1u khi xoay tr\u1edf, v\u00ec v\u1eady, c\u00f3 nhi\u1ec1u nguy c\u01a1 g\u1eb7p bi\u1ebfn ch\u1ee9ng c\u1ee7a n\u1eb1m l\u00e2u nh\u01b0 lo\u00e9t do t\u01b0 th\u1ebf, nhi\u1ec5m tr\u00f9ng ti\u1ec3u, vi\u00eam ph\u1ed5i,&#8230;<\/p>\n<p>C\u00e1c g\u00e3y \u1edf c\u00e0nh x\u01b0\u01a1ng mu th\u01b0\u1eddng k\u00e8m theo t\u1ed5n th\u01b0\u01a1ng b\u1ecdng \u0111\u00e1i v\u00e0 ni\u1ec7u \u0111\u1ea1o; vi\u1ec7c \u0111i\u1ec1u tr\u1ecb ph\u1ea3i k\u1ebft h\u1ee3p nhi\u1ec1u khoa: Ch\u1ec9nh h\u00ecnh, Ti\u1ebft ni\u1ec7u. \u0110\u00f4i khi c\u00f2n k\u00e8m theo t\u1ed5n th\u01b0\u01a1ng tr\u1ef1c tr\u00e0ng, ph\u1ea3i m\u1edf h\u1eadu m\u00f4n t\u1ea1m. Cho n\u00ean vi\u1ec7c s\u0103n s\u00f3c m\u1ed9t b\u1ec7nh nh\u00e2n g\u00e3y khung ch\u1eadu n\u1eb7ng s\u1ebd v\u00f4 c\u00f9ng ph\u1ee9c t\u1ea1p.<\/p>\n<h2>PH\u00c2N LO\u1ea0I<\/h2>\n<p>C\u00f3 nhi\u1ec1u c\u00e1ch ph\u00e2n lo\u1ea1i, nh\u01b0ng \u0111\u01a1n gi\u1ea3n nh\u1ea5t (theo Merle d\u2019Aubign\u00e9) chia th\u00e0nh ba nh\u00f3m ch\u00ednh:<\/p>\n<ul>\n<li>G\u00e3y m\u1ed9t ph\u1ea7n khung ch\u1eadu: g\u00e3y kh\u00f4ng ho\u00e0n to\u00e0n v\u00f2ng ch\u1eadu, khung ch\u1eadu c\u00f2n \u0111\u01b0\u1ee3c gi\u1eef v\u1eefng \u1ed5n \u0111\u1ecbnh.<\/li>\n<li>G\u00e3y khung ch\u1eadu th\u1ef1c s\u1ef1: l\u00e0m cho khung ch\u1eadu m\u1ea5t v\u1eefng, kh\u00f4ng \u1ed5n \u0111\u1ecbnh.<\/li>\n<li>G\u00e3y khung ch\u1eadu c\u00f3 k\u00e8m v\u1ee1 \u1ed5 c\u1ed1i.<\/li>\n<\/ul>\n<h3>G\u00e3y m\u1ed9t ph\u1ea7n khung ch\u1eadu<\/h3>\n<p>\u0110\u00f3 l\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng khung ch\u1eadu \u1edf m\u1ed9t ho\u1eb7c hai n\u01a1i tr\u00ean x\u01b0\u01a1ng ch\u1eadu m\u00e0 kh\u00f4ng l\u00e0m gi\u00e1n \u0111o\u1ea1n v\u00f2ng ch\u1eadu. C\u00e1c lo\u1ea1i g\u00e3y khung ch\u1eadu th\u01b0\u1eddng g\u1eb7p l\u00e0:<\/p>\n<ul>\n<li>G\u00e3y c\u00e1nh ch\u1eadu.<\/li>\n<li>G\u00e3y 1 \u2013 2 c\u00e0nh x\u01b0\u01a1ng mu ho\u1eb7c \u1ee5 ng\u1ed3i m\u1ed9t b\u00ean C\u01a1 ch\u1ebf th\u01b0\u1eddng l\u00e0 ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp.<\/li>\n<\/ul>\n<h4>Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/h4>\n<p><em>V\u1ee1 c\u00e1nh ch\u1eadu<\/em><\/p>\n<ul>\n<li>S\u01b0ng b\u1ea7m m\u1ed9t b\u00ean c\u00e1nh ch\u1eadu<\/li>\n<li>\u0110au khi \u1ea5n v\u00e0o c\u00e1nh ch\u1eadu; \u00e9p b\u1eeda khung ch\u1eadu \u0111au v\u00e0 c\u00f3 th\u1ec3 nghe ti\u1ebfng l\u1ea1o x\u1ea1o<\/li>\n<li>Gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean m\u1ed9t b\u00ean c\u00f3 th\u1ec3 h\u1ea1 th\u1ea5p xu\u1ed1ng<\/li>\n<li>V\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng hai b\u00ean kh\u00f4ng \u0111au.<\/li>\n<\/ul>\n<p><em>G\u00e3y 1 \u2013 2 c\u00e0nh x\u01b0\u01a1ng mu<\/em><\/p>\n<ul>\n<li>S\u01b0ng b\u1ea7m m\u1ed9t b\u00ean x\u01b0\u01a1ng mu g\u1ea7n n\u1ebfp b\u1eb9n, c\u00f3 th\u1ec3 c\u00f3 b\u1ea7m t\u00edm v\u00f9ng t\u1ea7ng sinh m\u00f4n (b\u1ea7m t\u00edm h\u00ecnh c\u00e1nh b\u01b0\u1edbm)<\/li>\n<li>\u1ea4n \u0111au ch\u00f3i (\u00e9p b\u1eeda khung ch\u1eadu \u0111au)<\/li>\n<li>V\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng th\u01b0\u1eddng \u0111au \u00edt b\u00ean g\u00e3y.<\/li>\n<\/ul>\n<p><strong><em>X-<\/em><\/strong><em>quang<\/em><\/p>\n<p>X Quang d\u00f9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh.<\/p>\n<h4>\u0110i\u1ec1u tr\u1ecb<\/h4>\n<p>\u0110\u00e2y l\u00e0 lo\u1ea1i g\u00e3y khung ch\u1eadu v\u1eefng, d\u1ec5 li\u1ec1n, th\u01b0\u1eddng ch\u1ec9 c\u1ea7n cho b\u1ec7nh nh\u00e2n n\u1eb1m ngh\u1ec9 t\u1ea1i gi\u01b0\u1eddng m\u1ed9t th\u1eddi gian, khi h\u1ebft \u0111au c\u00f3 th\u1ec3 cho ng\u1ed3i d\u1eady v\u00e0 t\u1eadp \u0111i l\u1ea1i.<\/p>\n<p>\u0110\u1ed1i v\u1edbi g\u00e3y c\u00e1nh ch\u1eadu, n\u1ebfu c\u00f3 di l\u1ec7ch nhi\u1ec1u; c\u00f3 khi l\u00e0m th\u00e0nh kh\u1ed1i m\u00e1u t\u1ee5 to. X\u01b0\u01a1ng g\u00e3y c\u00f3 th\u1ec3 n\u1eafn l\u1ea1i \u0111\u01b0\u1ee3c nh\u01b0ng kh\u00f3 gi\u1eef, v\u00ec v\u1eady, c\u1ea7n ph\u1ea3i m\u1ed5 c\u1ed1 \u0111\u1ecbnh b\u1eb1ng vis x\u1ed1p ho\u1eb7c n\u1eb9p vis.<\/p>\n<p>Ti\u00ean l\u01b0\u1ee3ng t\u1ed1t.<\/p>\n<h3>G\u00e3y ho\u00e0n to\u00e0n khung ch\u1eadu<\/h3>\n<p>C\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 g\u00e3y khung ch\u1eadu th\u1ef1c s\u1ef1; l\u00e0 lo\u1ea1i g\u00e3y n\u1eb7ng v\u00e0 l\u00e0m m\u1ea5t v\u1eefng khung ch\u1eadu.<\/p>\n<h4>Ph\u00e2n lo\u1ea1i<\/h4>\n<p>Ph\u00e2n lo\u1ea1i g\u00e3y ho\u00e0n to\u00e0n khun ch\u1eadu theo Pennal v\u00e0 Tile c\u00f3 ba c\u01a1 ch\u1ebf ch\u00ednh. T\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu t\u00f9y thu\u1ed9c v\u00e0o c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n<p><img decoding=\"async\" width=\"464\" height=\"296\" class=\"wp-image-1037 aligncenter\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-3.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-3.png 464w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-3-300x191.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-3-18x12.png 18w\" sizes=\"(max-width: 464px) 100vw, 464px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>H\u00ecnh 7.2. <\/strong>C\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng g\u00e3y khung ch\u1eadu: L\u1ef1c x\u00e9 d\u1ecdc (A); \u0111\u00e8 \u00e9p b\u00ean (B) [1]<\/p>\n<ul>\n<li>APC: (Antero-Posterior Compression): c\u01a1 ch\u1ebf n\u00e0y \u0111\u01b0\u1ee3c v\u00ed nh\u01b0 \u201cm\u1edf quy\u1ec3n s\u00e1ch\u201d. L\u1ef1c d\u1ed3n n\u00e9n t\u1eeb tr\u01b0\u1edbc ra sau. V\u00ed d\u1ee5, b\u1ecb \u00e9p gi\u1eefa hai toa t\u00e0u, b\u1ecb tai n\u1ea1n \u00f4 t\u00f4 \u0111\u1ee5ng tr\u1ef1c ti\u1ebfp, b\u1ecb t\u01b0\u1eddng \u0111\u00e8,\u2026 N\u1ebfu l\u1ef1c \u00e9p ngay gi\u1eefa kh\u1edbp mu, c\u00f3 th\u1ec3 b\u1ecb g\u00e3y b\u1ed1n c\u00e0nh x\u01b0\u01a1ng mu, c\u00f3 th\u1ec3 k\u00e8m v\u1ee1 b\u1ecdng \u0111\u00e1i v\u00e0 ni\u1ec7u \u0111\u1ea1o. N\u1ebfu l\u1ef1c \u00e9p \u1edf m\u1ed9t b\u00ean c\u00e1nh ch\u1eadu, c\u00f3 th\u1ec3 l\u00e0m g\u00e3y hai c\u00e0nh x\u01b0\u01a1ng mu c\u00f3 di l\u1ec7ch xa ho\u1eb7c to\u00e1c kh\u1edbp mu; to\u00e1c kh\u1edbp c\u00f9ng ch\u1eadu v\u1edbi \u0111\u1ee9t d\u00e2y ch\u1eb1ng c\u00f9ng ch\u1eadu tr\u01b0\u1edbc.<\/li>\n<li>LC: (Lateral Compression): c\u01a1 ch\u1ebf n\u00e0y \u0111\u01b0\u1ee3c v\u00ed nh\u01b0 \u201ckh\u00e9p quy\u1ec3n s\u00e1ch\u201d. L\u1ef1c d\u1ed3n n\u00e9n t\u1eeb m\u1ed9t b\u00ean h\u00f4ng. T\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 g\u1eb7p: g\u00e3y hai c\u00e0nh x\u01b0\u01a1ng mu di l\u1ec7ch ch\u1ed3ng, c\u00f9ng b\u00ean ho\u1eb7c hai b\u00ean. Tr\u1eadt kh\u1edbp c\u00f9ng ch\u1eadu do \u0111\u1ee9t d\u00e2y ch\u1eb1ng c\u00f9ng ch\u1eadu sau. T\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng c\u00f9ng \u2013 gai (Sacrospinous ligament) v\u00e0 d\u00e2y ch\u1eb1ng c\u00f9ng \u2013 u (Sacrotuberous ligament).<\/li>\n<li>VS: (Vertical Shear): l\u1ef1c x\u00e9 d\u1ecdc th\u1eb3ng \u0111\u1ee9ng. Th\u01b0\u1eddng do t\u00e9 t\u1eeb cao xu\u1ed1ng, g\u00e2y di l\u1ec7ch m\u1ed9t b\u00ean c\u00e1nh ch\u1eadu l\u00ean tr\u00ean. T\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p l\u00e0: to\u00e1c kh\u1edbp mu ho\u1eb7c g\u00e3y hai c\u00e0nh x\u01b0\u01a1ng mu b\u00ean di l\u1ec7ch l\u00ean tr\u00ean; g\u00e3y c\u00e1nh ch\u1eadu sau ho\u1eb7c tr\u1eadt kh\u1edbp c\u00f9ng ch\u1eadu ho\u1eb7c g\u00e3y x\u01b0\u01a1ng thi\u00eang (th\u01b0\u1eddng g\u1ecdi l\u00e0 g\u00e3y Malgaigne).<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" width=\"535\" height=\"607\" class=\"wp-image-1038 aligncenter\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-4.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-4.png 535w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-4-264x300.png 264w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-4-11x12.png 11w\" sizes=\"(max-width: 535px) 100vw, 535px\" \/><\/p>\n<h4>Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/h4>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a g\u00e3y khung ch\u1eadu: \u00e9p b\u1eeda khung ch\u1eadu \u0111au, b\u1ea7m m\u00e1u v\u00f9ng t\u1ea7ng sinh m\u00f4n v\u00e0 c\u00e1nh ch\u1eadu.<\/p>\n<p>Khung ch\u1eadu m\u1ea5t c\u00e2n x\u1ee9ng:<\/p>\n<ul>\n<li>\u0110\u00f9i xoay ngo\u00e0i, kh\u1edbp mu d\u00e3n r\u1ed9ng (trong c\u01a1 ch\u1ebf APC)<\/li>\n<li>\u0110\u00f9i xoay trong, trong c\u01a1 ch\u1ebf (LC)<\/li>\n<li>Ng\u1eafn chi nh\u01b0ng \u0111o chi\u1ec1u d\u00e0i tuy\u1ec7t \u0111\u1ed1i v\u00e0 t\u01b0\u01a1ng \u0111\u1ed1i kh\u00f4ng th\u1ea5y ng\u1eafn (c\u01a1 ch\u1ebf VS). V\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf v\u00ec \u0111au, do khung ch\u1eadu m\u1ea5t v\u1eefng.<\/li>\n<\/ul>\n<p>Ngo\u00e0i ra, c\u1ea7n t\u00ecm th\u00eam c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng \u0111i k\u00e8m ho\u1eb7c bi\u1ebfn ch\u1ee9ng nh\u01b0 s\u1ed1c, t\u1ed5n th\u01b0\u01a1ng ni\u1ec7u \u0111\u1ea1o, b\u1ecdng \u0111\u00e1i, tr\u1ef1c tr\u00e0ng.<\/p>\n<h4>X-quang<\/h4>\n<p>Ch\u1ee5p <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/x-quang-trong-chan-thuong-chinh-hinh\/\">X-Quang<\/a> to\u00e0n b\u1ed9 khung ch\u1eadu b\u00ecnh di\u1ec7n m\u1eb7t chu\u1ea9n.<\/p>\n<ul>\n<li>X\u00e1c \u0111\u1ecbnh c\u00e1c \u0111\u01b0\u1eddng g\u00e3y v\u00e0 di l\u1ec7ch<\/li>\n<li>X\u00e1c \u0111\u1ecbnh to\u00e1c kh\u1edbp mu v\u00e0 kh\u1edbp c\u00f9ng ch\u1eadu<\/li>\n<li>Trong c\u01a1 ch\u1ebf APC: c\u00e1nh ch\u1eadu b\u00ean t\u1ed5n th\u01b0\u01a1ng to ra. Trong c\u01a1 ch\u1ebf LC th\u00ec ng\u01b0\u1ee3c l\u1ea1i.<\/li>\n<\/ul>\n<p>\u0110\u1ec3 xem r\u00f5 ph\u1ea7n tr\u01b0\u1edbc eo ch\u1eadu, c\u1ea7n ch\u1ee5p t\u01b0 th\u1ebf \u201cInlet\u201d (ch\u1ee5p b\u00ecnh di\u1ec7n m\u1eb7t nh\u01b0ng tia ch\u1ebfch 45<sup>o<\/sup> t\u1eeb tr\u00ean xu\u1ed1ng). \u0110\u1ec3 xem r\u00f5 ph\u1ea7n sau eo ch\u1eadu, ch\u1ee5p t\u01b0 th\u1ebf \u201cOutlet\u201d (ch\u1ee5p b\u00ecnh di\u1ec7n m\u1eb7t nh\u01b0ng tia ch\u1ebfch 45<sup>o<\/sup> t\u1eeb d\u01b0\u1edbi l\u00ean).<\/p>\n<h4>\u0110i\u1ec1u tr\u1ecb<\/h4>\n<p>C\u1ea7n \u01b0u ti\u00ean \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 t\u1ed5n th\u01b0\u01a1ng \u0111i k\u00e8m.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" width=\"551\" height=\"208\" class=\"wp-image-1040 aligncenter\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-5.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-5.png 551w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-5-300x113.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-5-18x7.png 18w\" sizes=\"(max-width: 551px) 100vw, 551px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>H\u00ecnh 7.6. <\/strong>Ch\u1ee5p X-quang khung ch\u1eadu t\u01b0 th\u1ebf \u201cinlet\u201d A: t\u01b0 th\u1ebf ch\u1ee5p; B: h\u00ecnh \u1ea3nh th\u1ea5y \u0111\u01b0\u1ee3c [2]<\/p>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" width=\"544\" height=\"192\" class=\"wp-image-1041\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-6.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-6.png 544w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-6-300x106.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-6-18x6.png 18w\" sizes=\"(max-width: 544px) 100vw, 544px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>H\u00ecnh 7.7. <\/strong>Ch\u1ee5p X-quang khung ch\u1eadu t\u01b0 th\u1ebf \u201coutlet\u201d A: t\u01b0 th\u1ebf ch\u1ee5p; B: h\u00ecnh \u1ea3nh th\u1ea5y \u0111\u01b0\u1ee3c [2]<\/p>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" width=\"514\" height=\"182\" class=\"wp-image-1042\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-7.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-7.png 514w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-7-300x106.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-7-18x6.png 18w\" sizes=\"(max-width: 514px) 100vw, 514px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>H\u00ecnh 7.8. <\/strong>\u0110i\u1ec1u tr\u1ecb g\u00e3y khung ch\u1eadu b\u1eb1ng k\u1ebft h\u1ee3p x\u01b0\u01a1ng [3]<\/p>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" width=\"496\" height=\"162\" class=\"wp-image-1043\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-8.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-8.png 496w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-8-300x98.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-8-18x6.png 18w\" sizes=\"(max-width: 496px) 100vw, 496px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>H\u00ecnh 7.9. <\/strong>\u0110i\u1ec1u tr\u1ecb g\u00e3y khung ch\u1eadu b\u1eb1ng c\u1ed1 \u0111\u1ecbnh ngo\u00e0i [4]<\/p>\n<p>V\u1ec1 x\u01b0\u01a1ng g\u00e3y c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n hay ph\u1eabu thu\u1eadt t\u00f9y theo \u0111\u1ed9 v\u1eefng c\u1ee7a khung ch\u1eadu, c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111i k\u00e8m v\u00e0 bi\u1ebfn ch\u1ee9ng. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 l\u00e0:<\/p>\n<ul>\n<li><strong>N\u1eb1m ngh\u1ec9 t\u1ea1i gi\u01b0\u1eddng 2 \u2013 4 tu\u1ea7n, <\/strong>xoay tr\u1edf \u0111\u1ec3 ch\u1ed1ng lo\u00e9t: \u00e1p d\u1ee5ng cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p m\u00e0 khung ch\u1eadu c\u00f2n t\u01b0\u01a1ng \u0111\u1ed1i v\u1eefng, x\u01b0\u01a1ng di l\u1ec7ch \u00edt, b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au nhi\u1ec1u khi xoay tr\u1edf.<\/li>\n<li><strong>N\u1eb1m v\u00f5ng: <\/strong>\u0111i\u1ec1u tr\u1ecb to\u00e1c kh\u1edbp mu.<\/li>\n<\/ul>\n<p>V\u00f5ng l\u00e0m b\u1eb1ng t\u1ea5m v\u1ea3i d\u00e0y, r\u1ed9ng \u00f4m h\u1ebft c\u1ea3 m\u00f4ng v\u00e0 treo hai \u0111\u1ea7u l\u00ean ph\u00eda tr\u1ea7n nh\u00e0 \u0111\u1ec3 n\u00e2ng m\u00f4ng l\u00ean kh\u1ecfi m\u1eb7t gi\u01b0\u1eddng kho\u1ea3ng 1 \u2013 2 cm. N\u1eb1m v\u00f5ng \u0111\u1ec3 \u00e9p kh\u1edbp mu l\u1ea1i, gi\u1eef 4 \u2013 6 tu\u1ea7n \u0111\u1ec3 c\u00e1c d\u00e2y ch\u1eb1ng li\u1ec1n l\u1ea1i.<\/p>\n<ul>\n<li><strong><a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/keo-lien-tuc-trong-chan-thuong\/\">K\u00e9o li\u00ean t\u1ee5c<\/a> qua l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i <\/strong>\u0111\u1ec3 k\u00e9o m\u1ed9t b\u00ean c\u00e1nh ch\u1eadu xu\u1ed1ng trong g\u00e3y Malgaigne (VS).<\/li>\n<\/ul>\n<h5>\u0110\u1eb7t khung c\u1ed1 \u0111\u1ecbnh ngo\u00e0i<\/h5>\n<h6>Khung Gantz<\/h6>\n<p><em>Khung Gantz: <\/em>d\u00f9ng hai \u0111inh to c\u00f3 ph\u1ea7n ch\u1eb7n \u1edf \u0111\u1ea7u, \u0111\u1eb7t ph\u00eda sau ngo\u00e0i hai b\u00ean c\u00e1nh ch\u1eadu r\u1ed3i v\u1eb7n \u00e9p l\u1ea1i (nh\u1edd c\u00f3 ph\u1ea7n ch\u1eb7n \u1edf \u0111\u1ea7u m\u00e0 \u0111inh kh\u00f4ng th\u1ee7ng c\u00e1nh ch\u1eadu). M\u1ee5c \u0111\u00edch l\u00e0 c\u1ea7m m\u00e1u nh\u1edd \u00e9p c\u00e1c m\u1eb7t g\u00e3y l\u1ea1i.<\/p>\n<p>\u01afu \u0111i\u1ec3m l\u00e0 \u0111\u1eb7t nhanh v\u00e0 kh\u00f4ng g\u00e2y v\u01b0\u1edbng khi c\u1ea7n ph\u1eabu thu\u1eadt v\u00f9ng b\u1ee5ng. Khuy\u1ebft \u0111i\u1ec3m: khung kh\u00f4ng v\u1eefng ch\u1eafc v\u00e0 kh\u00f4ng n\u1eafn h\u1ebft di l\u1ec7ch.<\/p>\n<p>Ch\u1ec9 d\u00f9ng khung n\u00e0y trong c\u1ea5p c\u1ee9u \u0111\u1ec3 c\u1ea7m m\u00e1u, ch\u1ed1ng s\u1ed1c.<\/p>\n<h6>Khung h\u00ecnh ch\u1eef nh\u1eadt<\/h6>\n<p>D\u00f9ng \u0111inh Schanz \u0111\u1eb7t v\u00e0o c\u00e1nh ch\u1eadu, m\u1ed7i b\u00ean \u00edt nh\u1ea5t hai \u0111inh. L\u1eafp khung c\u1ed1 \u0111\u1ecbnh ngo\u00e0i gi\u1eef ch\u1eb7t b\u1ed1n \u0111inh nh\u01b0 b\u1ed1n g\u00f3c c\u1ee7a h\u00ecnh ch\u1eef nh\u1eadt. Khung c\u00f3 th\u1ec3 n\u1eafn ch\u1ec9nh \u0111\u01b0\u1ee3c, nh\u1edd v\u1eady c\u00f3 th\u1ec3 n\u1eafn s\u1eeda x\u01b0\u01a1ng cho hai m\u1eb7t g\u00e3y \u00e1p v\u00e0o nhau. Khung ch\u1eadu \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh ngo\u00e0i s\u1ebd v\u1eefng v\u00e0ng h\u01a1n, gi\u00fap b\u1ec7nh nh\u00e2n xoay tr\u1edf d\u1ec5 d\u00e0ng, ng\u1ed3i d\u1eady s\u1edbm.<\/p>\n<p>Khuy\u1ebft \u0111i\u1ec3m c\u1ee7a khung l\u00e0 kh\u00f4ng \u0111\u1eb7t \u0111\u01b0\u1ee3c khi c\u00f3 g\u00e3y c\u00e1nh ch\u1eadu, g\u00e2y v\u01b0\u1edbng \u1edf ph\u1ea7n b\u1ee5ng, g\u00e2y kh\u00f3 kh\u0103n khi c\u1ea7n m\u1ed5 b\u1ee5ng, \u0111\u00f4i khi l\u00e0m b\u1ec7nh nh\u00e2n ng\u1ed3i d\u1eady kh\u00f3. C\u00f3 th\u1ec3 b\u1ecb nhi\u1ec5m tr\u00f9ng ch\u00e2n \u0111inh v\u00e0 s\u1ef1 n\u1eafn ch\u1ec9nh c\u0169ng t\u01b0\u01a1ng \u0111\u1ed1i ch\u1ee9 kh\u00f4ng th\u1eadt ho\u00e0n h\u1ea3o, nh\u1ea5t l\u00e0 v\u1edbi lo\u1ea1i g\u00e3y VS.<\/p>\n<h5>K\u1ebft h\u1ee3p x\u01b0\u01a1ng<\/h5>\n<p>D\u00f9ng khi c\u1ed1 \u0111\u1ecbnh ngo\u00e0i kh\u00f4ng \u0111\u1ea1t y\u00eau c\u1ea7u. Th\u01b0\u1eddng \u00e1p d\u1ee5ng trong tr\u1eadt kh\u1edbp c\u00f9ng ch\u1eadu v\u00e0 to\u00e1c kh\u1edbp mu nhi\u1ec1u.<\/p>\n<h4>Bi\u1ebfn ch\u1ee9ng<\/h4>\n<p>G\u00e3y khung ch\u1eadu c\u00f3 th\u1ec3 c\u00f3 nh\u1eefng bi\u1ebfn ch\u1ee9ng sau:<\/p>\n<p>&#8211; Bi\u1ebfn ch\u1ee9ng s\u1edbm:<\/p>\n<p>+ <em>S\u1ed1c ch\u1ea5n th\u01b0\u01a1ng<\/em>: do m\u1ea5t nhi\u1ec1u m\u00e1u v\u00e0 \u0111au. C\u1ea7n b\u1ed3i ho\u00e0n m\u00e1u v\u00e0 d\u1ecbch, d\u1ef1 ph\u00f2ng c\u00f3 th\u1ec3 g\u00e2y t\u00ea v\u00e0o c\u00e1nh ch\u1eadu v\u1edbi 100 \u2013 200 mL Novocain 0,25%<\/p>\n<p>+ <em>V\u1ee1 b\u1ecdng \u0111\u00e1i: <\/em>trong ho\u1eb7c ngo\u00e0i ph\u00fac m\u1ea1c: b\u00ed \u0111\u00e1i kh\u00f4ng c\u00f3 c\u1ea7u b\u00e0ng quang,&#8230;<\/p>\n<p>+ <em>\u0110\u1ee9t ni\u1ec7u \u0111\u1ea1o sau: <\/em>b\u00ed \u0111\u00e1i c\u00f3 c\u1ea7u b\u00e0ng quang + ch\u1ea3y m\u00e1u mi\u1ec7ng l\u1ed7 s\u00e1o,&#8230;<\/p>\n<p>+ <em>Th\u1ee7ng tr\u1ef1c tr\u00e0ng: <\/em>c\u1ea7n th\u0103m tr\u1ef1c tr\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n.<\/p>\n<p>+ <em>\u0110\u1ee9t m\u1ea1ch m\u00e1u v\u00f9ng ch\u1eadu: <\/em>h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c nh\u01b0ng huy\u1ebft \u00e1p v\u1eabn t\u1ee5t v\u00e0 Hct th\u1ea5p, c\u1ea7n m\u1ed5 th\u00e1m s\u00e1t, n\u1ebfu \u0111\u1ee9t ph\u1ea3i n\u1ed1i l\u1ea1i ho\u1eb7c c\u1ed9t n\u1ebfu kh\u00f4ng ph\u1ea3i l\u00e0 \u0111\u1ed9ng m\u1ea1ch ch\u1eadu ngo\u00e0i.<\/p>\n<p>+ <em><a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-ho\/\">G\u00e3y h\u1edf<\/a>: <\/em>ch\u00fa \u00fd c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 v\u1ee1 ni\u1ec7u \u0111\u1ea1o, th\u1ee7ng tr\u1ef1c tr\u00e0ng \u0111\u1ec1u \u0111\u01b0\u1ee3c xem l\u00e0 g\u00e3y khung ch\u1eadu h\u1edf.<\/p>\n<p>&#8211; Bi\u1ebfn ch\u1ee9ng mu\u1ed9n: can l\u1ec7ch:<\/p>\n<p>+ L\u00e0m h\u1eb9p ti\u1ec3u khung sinh \u0111\u1ebb kh\u00f3<\/p>\n<p>+ L\u00e0m h\u1eb9p v\u00f9ng c\u1ed5 b\u1ecdng \u0111\u00e1i (do c\u00e1c c\u00e0nh x\u01b0\u01a1ng mu di l\u1ec7ch) g\u00e2y kh\u00f3 kh\u0103n cho c\u00e1c ph\u1eabu thu\u1eadt v\u00f9ng ni\u1ec7u \u0111\u1ea1o<\/p>\n<p>+ Ch\u00e2n ng\u1eafn \u0111i c\u00e0 th\u1ecdt l\u00e2u ng\u00e0y l\u00e0m bi\u1ebfn d\u1ea1ng c\u1ed9t s\u1ed1ng v\u00e0 h\u01b0 kh\u1edbp h\u00e1ng.<\/p>\n<h3>G\u00e3y \u1ed5 c\u1ed1i<\/h3>\n<p>\u0110\u00e2y l\u00e0 lo\u1ea1i g\u00e3y x\u01b0\u01a1ng th\u1ea5u kh\u1edbp, c\u00f3 th\u1ec3 l\u00e0m c\u1ea5p k\u00eanh m\u1eb7t kh\u1edbp, d\u1ec5 c\u00f3 \u1ea3nh h\u01b0\u1edfng c\u01a1 n\u0103ng kh\u1edbp h\u00e1ng nh\u01b0 h\u01b0 kh\u1edbp, c\u1ee9ng kh\u1edbp.<\/p>\n<p>G\u00e3y \u1ed5 c\u1ed1i c\u0169ng do m\u1ed9t ch\u1ea5n th\u01b0\u01a1ng n\u1eb7ng, c\u01a1 ch\u1ebf c\u00f3 th\u1ec3 l\u00e0 tr\u1ef1c ti\u1ebfp (xe c\u00e1n, b\u1ecb \u0111\u1ee5ng \u00e9p) ho\u1eb7c gi\u00e1n ti\u1ebfp do ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i t\u00f4ng m\u1ea1nh v\u00e0o.<\/p>\n<h4>Ph\u00e2n lo\u1ea1i<\/h4>\n<p>Ta th\u01b0\u1eddng g\u1eb7p c\u00e1c th\u1ec3 g\u00e3y nh\u01b0 sau:<\/p>\n<ul>\n<li>G\u00e3y c\u00e1nh ch\u1eadu, eo ch\u1eadu ph\u1ea1m v\u00e0o \u1ed5 kh\u1edbp<\/li>\n<li>G\u00e3y b\u1edd sau \u1ed5 c\u1ed1i k\u00e8m tr\u1eadt kh\u1edbp h\u00e1ng ra sau<\/li>\n<li>G\u00e3y nhi\u1ec1u m\u1ea3nh \u1ed5 c\u1ed1i, ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i l\u00fan s\u00e2u v\u00e0o trong g\u1ecdi l\u00e0 tr\u1eadt kh\u1edbp h\u00e1ng trung t\u00e2m<\/li>\n<\/ul>\n<p>Theo Judet v\u00e0 Letournel, khung ch\u1eadu \u0111\u01b0\u1ee3c chia th\u00e0nh hai tr\u1ee5:<\/p>\n<p>+ Tr\u1ee5 ch\u1eadu mu hay tr\u1ee5 tr\u01b0\u1edbc<\/p>\n<p>+ Tr\u1ee5 ch\u1eadu ng\u1ed3i hay tr\u1ee5 sau. T\u00f9y theo \u0111\u01b0\u1eddng g\u00e3y n\u1eb1m trong tr\u1ee5 n\u00e0o, di l\u1ec7ch ra sao m\u00e0 c\u00f3 h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb. Judet \u2013 Letounel ph\u00e2n chia g\u00e3y <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/rach-sun-vien-o-chao-khop-vai\/\">\u1ed5 ch\u1ea3o<\/a> l\u00e0m hai lo\u1ea1i: \u0111\u01a1n gi\u1ea3n v\u00e0 ph\u1ee9c t\u1ea1p.<\/p>\n<p><strong><em>G\u00e3y \u0111\u01a1n gi\u1ea3n: <\/em><\/strong>n\u0103m ki\u1ec3u:<\/p>\n<ul>\n<li>G\u00e3y v\u00e1ch sau<\/li>\n<li>G\u00e3y tr\u1ee5 sau<\/li>\n<li>G\u00e3y v\u00e1ch tr\u01b0\u1edbc<\/li>\n<li>G\u00e3y tr\u1ee5 tr\u01b0\u1edbc\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><img loading=\"lazy\" decoding=\"async\" width=\"918\" height=\"317\" class=\"wp-image-1044\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-9-1.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-9-1.png 918w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-9-1-300x104.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-9-1-768x265.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-9-1-18x6.png 18w\" sizes=\"(max-width: 918px) 100vw, 918px\" \/> G\u00e3y ngang: \u0111\u01b0\u1eddng g\u00e3y t\u1eeb tr\u1ee5 tr\u01b0\u1edbc ra tr\u1ee5 sau \u2013 v\u00f2m \u1ed5 ch\u1ea3o n\u01a1i ch\u1ecbu s\u1ee9c n\u1eb7ng c\u00f2n nguy\u00ean v\u1eb9n.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>H\u00ecnh 7.10. <\/strong>Khung ch\u1eadu nh\u00ecn ngo\u00e0i v\u00e0 trong [1]<\/p>\n<p><strong><em>G\u00e3y ph\u1ee9c t\u1ea1p: <\/em><\/strong>c\u0169ng c\u00f3 n\u0103m ki\u1ec3u<\/p>\n<ul>\n<li>G\u00e3y h\u00ecnh T<\/li>\n<li>G\u00e3y tr\u1ee5 sau k\u1ebft h\u1ee3p v\u00e1ch sau<\/li>\n<li>G\u00e3y ngang ph\u1ed1i h\u1ee3p v\u00e1ch sau<\/li>\n<li>G\u00e3y v\u00e1ch tr\u01b0\u1edbc hay tr\u1ee5 tr\u01b0\u1edbc ph\u1ed1i h\u1ee3p g\u00e3y ngang n\u1eeda sau<\/li>\n<li>G\u00e3y c\u1ea3 hai tr\u1ee5.<\/li>\n<\/ul>\n<p>Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:<\/p>\n<ul>\n<li>S\u01b0ng \u0111au kh\u1edbp h\u00e1ng<\/li>\n<li>\u00c9p b\u1eeda khung ch\u1eadu \u0111au<\/li>\n<li>V\u1eadn \u0111\u1ed9ng kh\u1edbp h\u00e1ng \u0111au<\/li>\n<li>C\u00f3 th\u1ec3 c\u00f3 bi\u1ebfn d\u1ea1ng xoay ngo\u00e0i ho\u1eb7c xoay trong v\u00e0 ng\u1eafn chi<\/li>\n<li>C\u00f3 th\u1ec3 c\u00f3 bi\u1ebfn d\u1ea1ng nh\u01b0 tr\u1eadt kh\u1edbp h\u00e1ng (g\u00e3y b\u1edd sau \u1ed5 c\u1ed1i k\u00e8m tr\u1eadt kh\u1edbp h\u00e1ng ra sau).<\/li>\n<\/ul>\n<h4>X-quang<\/h4>\n<p>Ch\u1ee5p khung ch\u1eadu th\u1eb3ng: xem c\u00e1c \u0111\u01b0\u1eddng g\u00e3y v\u00e0 c\u00e1c di l\u1ec7ch c\u01a1 b\u1ea3n.<\/p>\n<p>Ch\u1ee5p khung ch\u1eadu t\u01b0 th\u1ebf xoay trong 45<sup>o<\/sup> v\u00e0 xoay ngo\u00e0i 45<sup>o<\/sup> hay c\u00f2n g\u1ecdi l\u00e0 t\u01b0 th\u1ebf Letournel \u0111\u1ec3 xem c\u00e1c di l\u1ec7ch c\u1ee7a tr\u1ee5 tr\u01b0\u1edbc v\u00e0 tr\u1ee5 sau.<\/p>\n<p>Ch\u1ee5p CT-scan \u1ed5 c\u1ed1i l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u1ea7y \u0111\u1ee7 di l\u1ec7ch c\u1ee7a c\u00e1c m\u1ea3nh g\u00e3y.<\/p>\n<h4>\u0110i\u1ec1u tr\u1ecb<\/h4>\n<ul>\n<li>G\u00e3y khung ch\u1eadu kh\u00f4ng di l\u1ec7ch: n\u1eb1m ngh\u1ec9 t\u1ea1i gi\u01b0\u1eddng 6 \u2013 8 tu\u1ea7n, t\u1eadp v\u1eadn \u0111\u1ed9ng nh\u1eb9 nh\u00e0ng kh\u1edbp h\u00e1ng.<\/li>\n<li>G\u00e3y khung ch\u1eadu c\u00f3 di l\u1ec7ch:<\/li>\n<\/ul>\n<p>+ <em>G\u00e3y b\u1edd sau \u1ed5 c\u1ed1i + tr\u1eadt kh\u1edbp h\u00e1ng: <\/em>n\u1eafn tr\u1eadt kh\u1edbp, n\u1ebfu sau khi n\u1eafn kh\u1edbp t\u01b0\u01a1ng \u0111\u1ed1i v\u1eefng t\u1ee9c l\u00e0 \u00edt kh\u1ea3 n\u0103ng tr\u1eadt l\u1ea1i th\u00ec <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/bo-bot\/\">b\u00f3 b\u1ed9t<\/a> ch\u1eadu b\u00e0n ch\u00e2n, tr\u01b0\u1eddng h\u1ee3p sau n\u1eafn kh\u1edbp h\u00e1ng d\u1ec5 d\u00e0ng tr\u1eadt l\u1ea1i th\u00ed c\u1ea7n ph\u1ea3i m\u1ed5 \u0111\u1eb7t l\u1ea1i m\u1ea3nh g\u00e3y v\u00e0 k\u1ebft h\u1ee3p x\u01b0\u01a1ng b\u1eb1ng c\u00e1c vis x\u1ed1p.<\/p>\n<p>+ <em>G\u00e3y nhi\u1ec1u m\u1ea3nh di l\u1ec7ch c\u00e1c tr\u1ee5 tr\u01b0\u1edbc sau:<\/em><\/p>\n<ul>\n<li>K\u00e9o li\u00ean t\u1ee5c qua l\u1ed3i c\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i, sau 2 \u2013 3 ng\u00e0y ch\u1ee5p l\u1ea1i X-quang ki\u1ec3m tra, n\u1ebfu c\u00f3 s\u1ef1 t\u01b0\u01a1ng th\u00edch gi\u1eefa ch\u1ecfm v\u00e0 \u1ed5 c\u1ed1i th\u00ec duy tr\u00ec k\u00e9o li\u00ean t\u1ee5c cho \u0111\u01b0\u1ee3c 6 tu\u1ea7n.<\/li>\n<li>Tr\u01b0\u1eddng h\u1ee3p \u1ed5 c\u1ed1i di l\u1ec7ch nhi\u1ec1u, m\u1ea5t t\u01b0\u01a1ng th\u00edch gi\u1eefa ch\u1ecfm v\u00e0 \u1ed5 c\u1ed1i th\u00ec c\u1ea7n ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p x\u01b0\u01a1ng b\u1eb1ng n\u1eb9p vis sau khi n\u1eafn l\u1ea1i c\u00e1c m\u1ea3nh g\u00e3y.<\/li>\n<\/ul>\n<p>Bi\u1ebfn ch\u1ee9ng v\u00e0 d\u1ef1 h\u1eadu:<\/p>\n<ul>\n<li>S\u1ed1c ch\u1ea5n th\u01b0\u01a1ng<\/li>\n<li>Can l\u1ec7ch \u2192 D\u1ec5 b\u1ecb h\u01b0 kh\u1edbp h\u00e1ng<\/li>\n<li>Tr\u1eadt ho\u1eb7c b\u00e1n tr\u1eadt kh\u1edbp h\u00e1ng.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"688\" class=\"wp-image-1045 aligncenter\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-10.jpeg\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-10.jpeg 600w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-10-262x300.jpeg 262w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-10-10x12.jpeg 10w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>H\u00ecnh 7.11. <\/strong>Ph\u00e2n lo\u1ea1i g\u00e3y \u1ed5 c\u1ed1i theo A0<\/p>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" width=\"511\" height=\"320\" class=\"wp-image-1046\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-11.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-11.png 511w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-11-300x188.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-11-18x12.png 18w\" sizes=\"(max-width: 511px) 100vw, 511px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>H\u00ecnh 7.12. <\/strong>Ch\u1ee5p X-quang khung ch\u1eadu t\u01b0 th\u1ebf xoay trong hay ch\u00e9o b\u1ecbt (A) v\u00e0 t\u01b0 th\u1ebf xoay ngo\u00e0i hay ch\u00e9o ch\u1eadu (B) (theo RockWood) [1]<\/p>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" width=\"586\" height=\"284\" class=\"wp-image-1047\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-12.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-12.png 586w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-12-300x145.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-12-18x9.png 18w\" sizes=\"(max-width: 586px) 100vw, 586px\" \/><\/p>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" width=\"543\" height=\"186\" class=\"wp-image-1048\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-13.png\" alt=\"\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-13.png 543w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-13-300x103.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/03\/word-image-751-13-18x6.png 18w\" sizes=\"(max-width: 543px) 100vw, 543px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>H\u00ecnh 7.14. <\/strong>G\u00e3y \u1ed5 c\u1ed1i ph\u1ee9c t\u1ea1p, di l\u1ec7ch m\u1eb7t kh\u1edbp th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p x\u01b0\u01a1ng (<em>theo Rockwood<\/em>)<\/p>\n","protected":false},"featured_media":1049,"comment_status":"open","ping_status":"closed","template":"","tags":[83,49,82,46,84],"chuyen-muc":[35],"class_list":["post-751","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","tag-gay-canh-chau","tag-gay-ho","tag-gay-khung-chau","tag-gay-kin","tag-gay-o-coi","chuyen-muc-nhap-mon-chan-thuong-chinh-hinh"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/751","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=751"}],"version-history":[{"count":0,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/751\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/1049"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=751"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=751"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=751"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}