{"id":154,"date":"2026-10-06T10:09:18","date_gmt":"2026-10-06T03:09:18","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/06\/chan-thuong-day-chang-cheo-truoc-acl-co-che-chan-doan-va-phuong-phap-dieu-tri\/"},"modified":"2026-10-06T10:09:18","modified_gmt":"2026-10-06T03:09:18","slug":"chan-thuong-day-chang-cheo-truoc-acl-co-che-chan-doan-va-phuong-phap-dieu-tri","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/06\/chan-thuong-day-chang-cheo-truoc-acl-co-che-chan-doan-va-phuong-phap-dieu-tri\/","title":{"rendered":"Ch\u1ea5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc (ACL): C\u01a1 ch\u1ebf, ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<h2>C\u01a1 ch\u1ebf t\u1ed5n th\u01b0\u01a1ng v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc<\/h2>\n<p>Ch\u1ea5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc (ACL) th\u01b0\u1eddng x\u1ea3y ra trong c\u00e1c ho\u1ea1t \u0111\u1ed9ng nh\u01b0 gi\u1ea3m t\u1ed1c \u0111\u1ed9 \u0111\u1ed9t ng\u1ed9t, nh\u1ea3y ho\u1eb7c thay \u0111\u1ed5i h\u01b0\u1edbng. M\u1eb7c d\u00f9 c\u01a1 ch\u1ebf kinh \u0111i\u1ec3n l\u00e0 va ch\u1ea1m kh\u00f4ng ti\u1ebfp x\u00fac, c\u00e1c l\u1ef1c t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp v\u00e0o kh\u1edbp c\u0169ng c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng [8].<\/p>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p bi\u1ebfn ch\u1ee9ng n\u1eb7ng h\u01a1n nh\u01b0 tr\u1eadt kh\u1edbp g\u1ed1i, t\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi c\u00e1c ch\u1ea5n th\u01b0\u01a1ng li\u00ean quan kh\u00e1c nh\u01b0 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n\u534a\u6708, \u0111\u1ee9t g\u00e2n ho\u1eb7c g\u00e3y x\u01b0\u01a1ng. Kho\u1ea3ng 50% c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u1eadt kh\u1edbp g\u1ed1i c\u00f3 v\u1ebft r\u00e1ch \u1edf ph\u1ea7n gi\u1eefa c\u1ee7a d\u00e2y ch\u1eb1ng [1]. Ph\u1ea7n g\u1eafn li\u1ec1n v\u00e0o x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 x\u01b0\u01a1ng \u1ed1ng ch\u00e2n c\u0169ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng theo th\u1ee9 t\u1ef1 ph\u1ed5 bi\u1ebfn. Ngo\u00e0i ra, d\u00e2y ch\u1eb1ng ch\u00e9o sau (PCL) th\u01b0\u1eddng b\u1ecb r\u00e1ch t\u1ea1i \u0111i\u1ec3m g\u1eafn v\u1edbi x\u01b0\u01a1ng \u0111\u00f9i trong g\u1ea7n 75% c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u1eadt kh\u1edbp g\u1ed1i [1].<\/p>\n<h2>D\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/h2>\n<p>B\u00e0i kh\u00e1m v\u1eadt l\u00fd l\u00e0 b\u01b0\u1edbc \u0111\u1ea7u ti\u00ean \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng. Th\u1eed nghi\u1ec7m Lachman \u0111\u01b0\u1ee3c coi l\u00e0 nh\u1ea1y c\u1ea3m nh\u1ea5t (95%) \u0111\u1ec3 ph\u00e1t hi\u1ec7n d\u1ecbch chuy\u1ec3n tr\u01b0\u1edbc c\u1ee7a x\u01b0\u01a1ng \u1ed1ng ch\u00e2n, trong khi th\u1eed nghi\u1ec7m xoay tr\u1ee5c (pivot shift) t\u00e1i t\u1ea1o chuy\u1ec3n \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng \u1edf kh\u1edbp g\u1ed1i thi\u1ebfu d\u00e2y ch\u1eb1ng [8]. C\u00e1c d\u1ea5u hi\u1ec7u bao g\u1ed3m \u00e2m thanh &#8220;popping&#8221; khi kh\u1edbp b\u1ecb tr\u1eadt v\u00e0 s\u01b0ng kh\u1edbp x\u1ea3y ra trong v\u00f2ng v\u00e0i gi\u1edd sau ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n<p>K\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111\u00f3ng vai tr\u00f2 then ch\u1ed1t. Ch\u1ee5p X-quang th\u01b0\u1eddng c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng, nh\u01b0ng m\u1ed9t v\u1ebft g\u00e3y x\u01b0\u01a1ng n\u1ed5i b\u1eadt \u1edf x\u01b0\u01a1ng \u1ed1ng ch\u00e2n (eminence) cho th\u1ea5y r\u00e1ch \u0111i\u1ec3m g\u1eafn c\u1ee7a d\u00e2y ch\u1eb1ng [4]. Fracture Segond l\u00e0 d\u1ea5u hi\u1ec7u \u0111\u1eb7c tr\u01b0ng cho t\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc. Tia ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) \u0111\u01b0\u1ee3c xem l\u00e0 k\u1ef9 thu\u1eadt h\u1eefu \u00edch nh\u1ea5t, v\u1edbi \u0111\u1ed9 ch\u00ednh x\u00e1c \u0111\u1ea1t 95-100% khi \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng [4]. MRI c\u0169ng c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c v\u1ebft s\u01b0ng x\u01b0\u01a1ng (bone bruises) \u1edf v\u00f9ng \u0111\u1ea7u ngo\u00e0i x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 s\u1ee5n \u1ed1ng ch\u00e2n trong 80% b\u1ec7nh nh\u00e2n.<\/p>\n<h2>Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb: Ph\u1eabu thu\u1eadt v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng<\/h2>\n<p>Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u cho ch\u1ea5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng bao g\u1ed3m ph\u1eabu thu\u1eadt s\u1eeda ch\u1eefa ho\u1eb7c t\u00e1i t\u1ea1o s\u1edbm k\u00e8m theo ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng t\u00edch c\u1ef1c [1]. \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u1eadt kh\u1edbp g\u1ed1i th\u1eb3ng (anterior ho\u1eb7c posterior) \u1ed5n \u0111\u1ecbnh sau khi gi\u1ea3m \u0111au k\u00edn, vi\u1ec7c n\u00e0y c\u00f3 th\u1ec3 \u0111\u1ea1t k\u1ebft qu\u1ea3 t\u1ed1t sau gi\u1ea3m \u0111au v\u00e0 c\u1ed1 \u0111\u1ecbnh ng\u1eafn h\u1ea1n. Tuy nhi\u00ean, c\u00e1c lo\u1ea1i tr\u1eadt kh\u1edbp kh\u00e1c th\u01b0\u1eddng kh\u00f4ng \u1ed5n \u0111\u1ecbnh sau gi\u1ea3m \u0111au v\u00e0 c\u1ea7n ph\u1eabu thu\u1eadt s\u1eeda ch\u1eefa ho\u1eb7c t\u00e1i t\u1ea1o t\u1ea5t c\u1ea3 c\u00e1c c\u1ea5u tr\u00fac m\u00f4 m\u1ec1m b\u1ecb t\u1ed5n th\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n tr\u1ebb [5].<\/p>\n<p>Vi\u1ec7c ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1o ACL c\u00f3 t\u1ef7 l\u1ec7 th\u1ea5t b\u1ea1i kho\u1ea3ng 10-25% trong c\u00e1c b\u00e1o c\u00e1o g\u1ea7n \u0111\u00e2y [2]. C\u00e1c y\u1ebfu t\u1ed1 d\u1eabn \u0111\u1ebfn th\u1ea5t b\u1ea1i bao g\u1ed3m k\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt (\u0111\u1eb7t \u1ed1ng sai v\u1ecb tr\u00ed), l\u1ef1a ch\u1ecdn m\u00f4 gh\u00e9p, v\u1ea5n \u0111\u1ec1 v\u1edbi s\u1ef1 t\u00edch h\u1ee3p c\u1ee7a d\u00e2y ch\u1eb1ng v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng sau ph\u1eabu thu\u1eadt [6]. Sai s\u00f3t trong k\u1ef9 thu\u1eadt nh\u01b0 \u0111\u1eb7t \u1ed1ng sai v\u1ecb tr\u00ed l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u00f3 th\u1ec3 tr\u00e1nh \u0111\u01b0\u1ee3c [6].<\/p>\n<h3>Ch\u1ea9n \u0111o\u00e1n c\u00e1c ch\u1ea5n th\u01b0\u01a1ng li\u00ean quan ph\u1ee9c t\u1ea1p<\/h3>\n<p>B\u00ean c\u1ea1nh ACL, c\u00e1c ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp g\u1ed1i th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi g\u00e3y x\u01b0\u01a1ng. Fracture Type III (R\u00e1ch s\u1ee5n) chi\u1ebfm kho\u1ea3ng 16% c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u1eadt kh\u1edbp v\u00e0 th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn \u0111i\u1ec3m g\u1eafn s\u1ee5n [7]. Fracture Type IV (G\u00e3y \u00e9p vi\u1ec1n) x\u1ea3y ra trong 12% c\u00e1c tr\u01b0\u1eddng h\u1ee3p, g\u00e2y ra s\u1ef1 l\u1ec7ch v\u1ecb c\u1ee7a x\u01b0\u01a1ng \u1ed1ng ch\u00e2n v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn g\u00e3y \u00e9p vi\u1ec1n tr\u01b0\u1edbc, gi\u1eefa ho\u1eb7c sau c\u1ee7a kh\u1edbp [3]. C\u00e1c ch\u1ea5n th\u01b0\u01a1ng n\u00e0y th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc ho\u1eb7c ch\u00e9o sau \u1edf h\u01a1n 3\/4 c\u00e1c ca v\u00e0 t\u1ef7 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh m\u1ea1ch m\u00e1u cao (12-30%) [3] [7].<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<ul>\n<li>[1] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2747<\/li>\n<li>[2] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2726<\/li>\n<li>[3] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 3118<\/li>\n<li>[4] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2697<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2747<\/li>\n<li>[6] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2726<\/li>\n<li>[7] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 3118<\/li>\n<li>[8] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2697<\/li>\n<\/ul>\n<p><!-- aiwriter:6b9d58e7af064f35a1bd2b14 --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Kh\u00e1m ph\u00e1 to\u00e0n di\u1ec7n v\u1ec1 ch\u1ea5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc (ACL) bao g\u1ed3m c\u01a1 ch\u1ebf g\u00e2y th\u01b0\u01a1ng, d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng, k\u1ef9 thu\u1eadt ch\u1ee5p MRI v\u00e0 c\u00e1c chi\u1ebfn l\u01b0\u1ee3c ph\u1eabu thu\u1eadt hi\u1ec7n \u0111\u1ea1i.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-154","post","type-post","status-publish","format-standard","hentry","category-noi-soi-khop"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - 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