V\u00ed d\u1ee5 v\u1ec1 g\u00e3y x\u01b0\u01a1ng h\u1edf c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u00eam x\u01b0\u01a1ng t\u1ee7y (osteomyelitis) l\u00e0 m\u1ed9t trong nh\u1eefng bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u1ea5t c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh, \u0111\u1eb7c bi\u1ec7t khi t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m nghi\u00eam tr\u1ecdng ho\u1eb7c m\u1ea5t \u1ed5n \u0111\u1ecbnh m\u1ea1ch m\u00e1u [1]. Khi c\u00e1c vi khu\u1ea9n x\u00e2m nh\u1eadp tr\u1ef1c ti\u1ebfp v\u00e0o x\u01b0\u01a1ng qua v\u1ebft th\u01b0\u01a1ng m\u1edf, ch\u00fang c\u00f3 th\u1ec3 g\u00e2y ra qu\u00e1 tr\u00ecnh nhi\u1ec5m tr\u00f9ng m\u00e3n t\u00ednh, d\u1eabn \u0111\u1ebfn ho\u1ea1i t\u1eed x\u01b0\u01a1ng (sequestrum) v\u00e0 t\u1ea1o th\u00e0nh h\u1ed1c m\u1ee7, l\u00e0m ph\u1ee9c t\u1ea1p h\u00f3a \u0111\u00e1ng k\u1ec3 quy tr\u00ecnh h\u1ed3i ph\u1ee5c [7].<\/p>\n
Violam x\u01b0\u01a1ng t\u1ee7y sau ch\u1ea5n th\u01b0\u01a1ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean c\u01a1 ch\u1ebf nhi\u1ec5m tr\u00f9ng. Nhi\u1ec5m tr\u00f9ng li\u00ean ti\u1ebfp (contiguous infection) x\u1ea3y ra do s\u1ef1 x\u00e2m nh\u1eadp tr\u1ef1c ti\u1ebfp c\u1ee7a m\u1ea7m b\u1ec7nh v\u00e0o x\u01b0\u01a1ng, ph\u1ed5 bi\u1ebfn trong g\u00e3y h\u1edf [9]. C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y b\u1ec7nh nh\u00e2n b\u1ecb t\u1ed5n th\u01b0\u01a1ng c\u01a1 nghi\u00eam tr\u1ecdng c\u00f3 nguy c\u01a1 cao nh\u1ea5t ph\u00e1t tri\u1ec3n vi\u00eam x\u01b0\u01a1ng t\u1ee7y sau khi g\u00e3y x\u01b0\u01a1ng \u0111\u00f9i ho\u1eb7c s\u1ecd ch\u00e2n l\u1edbn b\u1ecb ch\u1ea5n th\u01b0\u01a1ng li\u00ean quan \u0111\u1ebfn chi\u1ebfn tranh [1]. Ngo\u00e0i ra, c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 thi\u1ebfu h\u1ee5t t\u01b0\u1edbi m\u00e1u ho\u1eb7c th\u1ea7n kinh c\u0169ng \u0111\u00f3ng vai tr\u00f2 then ch\u1ed1t trong vi\u1ec7c l\u00e0m suy y\u1ebfu kh\u1ea3 n\u0103ng ph\u00f2ng v\u1ec7 t\u1ef1 nhi\u00ean c\u1ee7a c\u01a1 th\u1ec3 [2].<\/p>\n
B\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng th\u01b0\u1eddng g\u1eb7p ph\u1ea3i c\u00e1c bi\u1ebfn ch\u1ee9ng n\u00e0y do m\u1ea5t c\u1ea3m gi\u00e1c b\u1ea3o v\u1ec7 v\u00e0 suy gi\u1ea3m ch\u1ee9c n\u0103ng mi\u1ec5n d\u1ecbch, d\u1eabn \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng li\u00ean quan \u0111\u1ebfn thi\u1ebfu h\u1ee5t m\u1ea1ch m\u00e1u ho\u1eb7c th\u1ea7n kinh [2]. Vi\u1ec7c kh\u00f4ng ki\u1ec3m so\u00e1t t\u1ed1t v\u1ebft th\u01b0\u01a1ng ban \u0111\u1ea7u c\u0169ng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 l\u1edbn, \u0111\u1eb7c bi\u1ec7t khi c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a v\u1eadt li\u1ec7u c\u1ea5y gh\u00e9p c\u1ed1 \u0111\u1ecbnh b\u00ean trong x\u01b0\u01a1ng.<\/p>\n
Vi\u00eam x\u01b0\u01a1ng t\u1ee7y sau ch\u1ea5n th\u01b0\u01a1ng th\u01b0\u1eddng do c\u00e1c vi khu\u1ea9n Gram d\u01b0\u01a1ng g\u00e2y ra. Staphylococcus aureus l\u00e0 t\u00e1c nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t, chi\u1ebfm 35\u201350% c\u00e1c tr\u01b0\u1eddng h\u1ee3p [5]. C\u00e1c lo\u1ea1i staphylococcus kh\u00f4ng t\u1ea1o k\u1ebft \u0111\u00f4ng (coagulase-negative) c\u0169ng xu\u1ea5t hi\u1ec7n v\u1edbi t\u1ea7n su\u1ea5t \u0111\u00e1ng k\u1ec3 t\u1eeb 9\u201325%, trong khi Enterococcus v\u00e0 Streptococcus \u0111\u00f3ng g\u00f3p th\u00eam v\u00e0o g\u00e1nh n\u1eb7ng nhi\u1ec5m tr\u00f9ng \u0111a vi khu\u1ea9n [5].<\/p>\n
\u0110\u00e1ng lo ng\u1ea1i l\u00e0 t\u1ef7 l\u1ec7 nhi\u1ec5m tr\u00f9ng \u00e2m t\u00ednh v\u1edbi v\u0103n h\u00f3a (culture-negative infection) \u0111ang gia t\u0103ng. Kho\u1ea3ng 32% b\u1ec7nh nh\u00e2n vi\u00eam x\u01b0\u01a1ng t\u1ee7y sau ch\u1ea5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c m\u1ea7m b\u1ec7nh th\u00f4ng qua ph\u01b0\u01a1ng ph\u00e1p nu\u00f4i c\u1ea5y truy\u1ec1n th\u1ed1ng, l\u00e0m ch\u1eadm tr\u1ec5 ch\u1ea9n \u0111o\u00e1n v\u00e0 khi\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh tr\u1edf n\u00ean mang t\u00ednh th\u1ef1c nghi\u1ec7m thay v\u00ec nh\u1eafm m\u1ee5c ti\u00eau ch\u00ednh x\u00e1c [5].<\/p>\n
\u0110\u00e1nh gi\u00e1 ban \u0111\u1ea7u t\u1eadp trung v\u00e0o to\u00e0n v\u1eb9n c\u1ee7a da v\u00e0 m\u00f4 m\u1ec1m, \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh c\u1ee7a x\u01b0\u01a1ng v\u00e0 tr\u1ea1ng th\u00e1i th\u1ea7n kinh m\u1ea1ch m\u00e1u c\u1ee7a chi [1]. Tuy nhi\u00ean, c\u00e1c x\u00e9t nghi\u1ec7m ph\u00f2ng th\u00ed nghi\u1ec7m nh\u01b0 t\u1ed1c \u0111\u1ed9 l\u1eafng h\u1ed3ng c\u1ea7u (ESR) v\u00e0 protein C-reactive (CRP) th\u01b0\u1eddng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00e0 ch\u1ec9 t\u0103ng cao \u1edf ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n; s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng cao ch\u1ec9 xu\u1ea5t hi\u1ec7n \u1edf 35% tr\u01b0\u1eddng h\u1ee3p [1].<\/p>\n
Ph\u00e2n t\u00edch m\u00f4 sinh h\u1ecdc t\u1eeb x\u01b0\u01a1ng b\u1ecb nhi\u1ec5m tr\u00f9ng v\u1eabn \u0111\u01b0\u1ee3c coi l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n, bao g\u1ed3m \u0111\u00e1nh gi\u00e1 histologic v\u00e0 vi sinh v\u1eadt [7]. H\u00ecnh \u1ea3nh h\u1ecdc \u0111\u00f3ng vai tr\u00f2 h\u1ed7 tr\u1ee3 quan tr\u1ecdng trong vi\u1ec7c l\u1eadp k\u1ebf ho\u1ea1ch ph\u1eabu thu\u1eadt. Ch\u1ee5p X-quang th\u01b0\u1eddng l\u00e0 b\u01b0\u1edbc \u0111\u1ea7u ti\u00ean \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u nh\u01b0 ph\u00e1 h\u1ee7y v\u1ecf x\u01b0\u01a1ng ho\u1eb7c ph\u1ea3n \u1ee9ng m\u00e0ng x\u01b0\u01a1ng [8].<\/p>\n
Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT) cung c\u1ea5p \u0111\u1ecbnh ngh\u0129a tuy\u1ec7t v\u1eddi v\u1ec1 c\u1ea5u tr\u00fac v\u1ecf x\u01b0\u01a1ng v\u00e0 gi\u00fap x\u00e1c \u0111\u1ecbnh c\u00e1c m\u1ea3nh x\u01b0\u01a1ng ho\u1ea1i t\u1eed (sequestra), trong khi ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) cho ph\u00e9p \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c h\u01a1n ph\u1ea1m vi t\u1ed5n th\u01b0\u01a1ng c\u1ee7a x\u01b0\u01a1ng v\u00e0 ph\u00f9 n\u1ec1 m\u00f4 m\u1ec1m xung quanh [8]. Tuy nhi\u00ean, MRI c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf v\u1ec1 chi ph\u00ed v\u00e0 kh\u1ea3 n\u0103ng h\u00ecnh \u1ea3nh h\u00f3a g\u1ea7n c\u00e1c v\u1eadt li\u1ec7u kim lo\u1ea1i c\u1ea5y gh\u00e9p [8].<\/p>\n
Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb vi\u00eam x\u01b0\u01a1ng t\u1ee7y m\u00e3n t\u00ednh th\u01b0\u1eddng ph\u1ee9c t\u1ea1p v\u00e0 \u0111\u00f2i h\u1ecfi s\u1ef1 can thi\u1ec7p ph\u1eabu thu\u1eadt \u0111\u1ec3 lo\u1ea1i b\u1ecf m\u00f4 ho\u1ea1i t\u1eed v\u00e0 l\u00e0m s\u1ea1ch khu v\u1ef1c nhi\u1ec5m tr\u00f9ng. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f3 kh\u0103n, vi\u1ec7c s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p v\u1ebft th\u01b0\u01a1ng \u00e1p su\u1ea5t \u00e2m (negative-pressure wound therapy) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng khi t\u00e1i t\u1ea1o m\u00f4 m\u1ec1m kh\u00f4ng kh\u1ea3 thi [4].<\/p>\n
\u0110\u1ed1i v\u1edbi g\u00e3y x\u01b0\u01a1ng c\u1ed5 \u0111\u00f9i ho\u1eb7c g\u00e3y x\u01b0\u01a1ng l\u1ed3i c\u1ea7u k\u00e8m theo vi\u00eam x\u01b0\u01a1ng t\u1ee7y m\u00e3n t\u00ednh, ph\u1eabu thu\u1eadt thay kh\u1edbp h\u00e1ng (THA) th\u01b0\u1eddng l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u \u0111\u1ec3 lo\u1ea1i b\u1ecf \u0111au \u0111\u1edbn do ph\u00e1 h\u1ee7y \u0111\u1ea7u x\u01b0\u01a1ng v\u00e0 kh\u1edbp ch\u1eadu, \u0111\u1eb7c bi\u1ec7t khi c\u00f3 s\u1ef1 x\u00e2m nh\u1eadp c\u1ee7a thi\u1ebft b\u1ecb c\u1ed1 \u0111\u1ecbnh n\u1ed9i b\u1ed9 [3]. Vi\u1ec7c s\u1eed d\u1ee5ng th\u00e2n \u1ed1ng xi m\u0103ng (cemented stems) \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb trong c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y do t\u1ef7 l\u1ec7 s\u1eeda ch\u1eefa v\u00f4 khu\u1ea9n th\u1ea5p h\u01a1n \u1edf c\u00e1c implant kh\u00f4ng xi m\u0103ng [10].<\/p>\n
B\u1ec7nh nh\u00e2n vi\u00eam x\u01b0\u01a1ng t\u1ee7y m\u00e3n t\u00ednh c\u00f3 th\u1ec3 g\u1eb7p c\u00e1c bi\u1ebfn ch\u1ee9ng \u0111\u00e1ng k\u1ec3 nh\u01b0 h\u00ecnh th\u00e0nh h\u1ed1c m\u1ee7, t\u1ea1o th\u00e0nh \u0111\u01b0\u1eddng d\u1eabn (sinus tracts) v\u00e0 t\u0103ng nguy c\u01a1 bi\u1ebfn c\u1ed1 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u [4]. M\u1ed9t m\u1ed1i quan t\u00e2m l\u00e2u d\u00e0i l\u00e0 nguy c\u01a1 chuy\u1ec3n h\u00f3a \u00e1c t\u00ednh (Marjolin ulcer), m\u1eb7c d\u00f9 \u0111\u00e2y kh\u00f4ng ph\u1ea3i l\u00e0 bi\u1ebfn ch\u1ee9ng ph\u1ed5 bi\u1ebfn nh\u1ea5t nh\u01b0ng c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd [11]. K\u1ebft qu\u1ea3 ch\u1ee9c n\u0103ng c\u1ee7a b\u1ec7nh nh\u00e2n vi\u00eam x\u01b0\u01a1ng t\u1ee7y sau ch\u1ea5n th\u01b0\u01a1ng th\u01b0\u1eddng th\u1ea5p h\u01a1n so v\u1edbi d\u00e2n s\u1ed1 chung, ngay c\u1ea3 khi nhi\u1ec5m tr\u00f9ng \u0111\u00e3 kh\u1ecfi ho\u00e0n to\u00e0n [4].<\/p>\n
Qu\u1ea3n tr\u1ecb hi\u1ec7u qu\u1ea3 \u0111\u00f2i h\u1ecfi ti\u1ebfp c\u1eadn \u0111a ng\u00e0nh, bao g\u1ed3m b\u00e1c s\u0129 ch\u1ec9nh h\u00ecnh, b\u00e1c s\u0129 ung th\u01b0 h\u1ecdc v\u00e0 c\u00e1c chuy\u00ean gia kh\u00e1c, \u0111\u1eb7c bi\u1ec7t trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng do b\u1ec7nh di c\u0103n ho\u1eb7c vi\u00eam x\u01b0\u01a1ng t\u1ee7y ph\u1ee9c t\u1ea1p [6]. Vi\u1ec7c ph\u1ed1i h\u1ee3p gi\u1eefa ph\u1eabu thu\u1eadt l\u00e0m s\u1ea1ch, kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng l\u00e0 ch\u00eca kh\u00f3a \u0111\u1ec3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
Vi\u00eam x\u01b0\u01a1ng t\u1ee7y sau ch\u1ea5n th\u01b0\u01a1ng l\u00e0 bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng c\u1ee7a g\u00e3y x\u01b0\u01a1ng h\u1edf. B\u00e0i vi\u1ebft ph\u00e2n t\u00edch nguy\u00ean nh\u00e2n nhi\u1ec5m tr\u00f9ng, c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng, ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh ch\u00ednh x\u00e1c v\u00e0 chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111a khoa \u0111\u1ec3 ng\u0103n ng\u1eeba th\u1ea5t b\u1ea1i ph\u1eabu thu\u1eadt.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-178","post","type-post","status-publish","format-standard","hentry","category-gay-xuong"],"yoast_head":"\n