{"id":188,"date":"2026-10-10T16:22:47","date_gmt":"2026-10-10T09:22:47","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/10\/dieu-tri-viem-loi-cau-ngoai-xuong-canh-tay-phau-thuat-va-lieu-phap-hien-dai\/"},"modified":"2026-10-10T16:22:47","modified_gmt":"2026-10-10T09:22:47","slug":"dieu-tri-viem-loi-cau-ngoai-xuong-canh-tay-phau-thuat-va-lieu-phap-hien-dai","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/10\/dieu-tri-viem-loi-cau-ngoai-xuong-canh-tay-phau-thuat-va-lieu-phap-hien-dai\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb vi\u00eam l\u1ed3i c\u1ea7u ngo\u00e0i x\u01b0\u01a1ng c\u00e1nh tay: Ph\u1eabu thu\u1eadt v\u00e0 li\u1ec7u ph\u00e1p hi\u1ec7n \u0111\u1ea1i"},"content":{"rendered":"<h2>Nguy\u00ean nh\u00e2n v\u00e0 b\u1ea3n ch\u1ea5t b\u1ec7nh l\u00fd c\u1ee7a vi\u00eam l\u1ed3i c\u1ea7u ngo\u00e0i x\u01b0\u01a1ng c\u00e1nh tay<\/h2>\n<p>H\u1ed9i ch\u1ee9ng Tennis Elbow, hay vi\u00eam l\u1ed3i c\u1ea7u ngo\u00e0i x\u01b0\u01a1ng c\u00e1nh tay (lateral epicondylitis), l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng g\u00e2y \u0111au ph\u1ed5 bi\u1ebfn t\u1ea1i v\u00f9ng khu\u1ef7u tay b\u00ean ngo\u00e0i. M\u1eb7c d\u00f9 t\u00ean g\u1ecdi g\u1ee3i \u00fd li\u00ean quan \u0111\u1ebfn v\u1eadn \u0111\u1ed9ng vi\u00ean qu\u1ea7n v\u1ee3t, b\u1ec7nh n\u00e0y th\u1ef1c t\u1ebf xu\u1ea5t hi\u1ec7n nhi\u1ec1u h\u01a1n \u1edf nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng t\u1eadp luy\u1ec7n th\u1ec3 thao [2]. C\u01a1 ch\u1ebf b\u1ec7nh sinh \u0111\u00e3 thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 qua c\u00e1c th\u1eadp k\u1ef7; t\u1eeb vi\u1ec7c coi \u0111\u00e2y l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh vi\u00eam nhi\u1ec5m ban \u0111\u1ea7u, c\u1ed9ng \u0111\u1ed3ng chuy\u00ean m\u00f4n hi\u1ec7n nay \u0111\u00e3 th\u1ed1ng nh\u1ea5t r\u1eb1ng t\u00ecnh tr\u1ea1ng n\u00e0y b\u1eaft ngu\u1ed3n t\u1eeb m\u1ed9t v\u1ebft r\u00e1ch vi m\u00f4 (microtear) t\u1ea1i g\u1ed1c c\u1ee7a g\u00e2n Extensor Carpi Radialis Brevis (ECRB) [2].<\/p>\n<p>Vi\u1ebft d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi, c\u00e1c b\u1eb1ng ch\u1ee9ng cho th\u1ea5y s\u1ef1 h\u00ecnh th\u00e0nh m\u00f4 t\u00e1i t\u1ea1o ch\u01b0a tr\u01b0\u1edfng th\u00e0nh, t\u01b0\u01a1ng t\u1ef1 nh\u01b0 qu\u00e1 tr\u00ecnh t\u0103ng sinh angiofibroblast [3]. M\u1eb7c d\u00f9 qu\u00e1 tr\u00ecnh b\u1ec7nh l\u00fd ch\u1ee7 y\u1ebfu t\u1eadp trung v\u00e0o g\u1ed1c c\u1ee7a ECRB, n\u00f3 c\u0169ng c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn g\u00e2n Extensor Carpi Radialis Longus v\u00e0 Extensor Digitorum Communis. Vi\u1ec7c x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c v\u1ecb tr\u00ed \u0111au t\u1ea1i g\u1ed1c ECRB, kho\u1ea3ng 5 mm xa h\u01a1n v\u00e0 ph\u00eda tr\u01b0\u1edbc so v\u1edbi \u0111i\u1ec3m gi\u1eefa c\u1ee7a \u0111\u1ea7u x\u01b0\u01a1ng tr\u1ee5, l\u00e0 ch\u00eca kh\u00f3a \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n [3].<\/p>\n<h2>Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/h2>\n<p>Nh\u1eadn d\u1ea1ng \u0111\u00fang b\u1ec7nh l\u00fd r\u1ea5t quan tr\u1ecdng v\u00ec m\u1ed9t s\u1ed1 t\u00ecnh tr\u1ea1ng kh\u00e1c c\u00f3 th\u1ec3 g\u00e2y \u0111au \u1edf v\u00f9ng l\u00e2n c\u1eadn. V\u00ed d\u1ee5, h\u1ed9i ch\u1ee9ng h\u1ed1c th\u1ea7n kinh tr\u1ee5 (radial tunnel syndrome) th\u01b0\u1eddng x\u1ea3y ra \u0111\u1ed3ng th\u1eddi v\u1edbi vi\u00eam l\u1ed3i c\u1ea7u ngo\u00e0i x\u01b0\u01a1ng c\u00e1nh tay \u1edf kho\u1ea3ng 5% b\u1ec7nh nh\u00e2n [3]. Tuy nhi\u00ean, \u0111au c\u1ee7a h\u1ed9i ch\u1ee9ng n\u00e0y n\u1eb1m c\u00e1ch xa h\u01a1n (3-4 cm) so v\u1edbi l\u1ed3i c\u1ea7u ngo\u00e0i x\u01b0\u01a1ng v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u00e1i t\u1ea1o b\u1eb1ng vi\u1ec7c du\u1ed7i ng\u00f3n tay ch\u1ed1ng l\u1ea1i s\u1ee9c c\u1ea3n. C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c c\u1ea7n lo\u1ea1i tr\u1eeb bao g\u1ed3m vi\u00eam g\u00e2n Brachioradialis, tho\u00e1i h\u00f3a kh\u1edbp khu\u1ef7u b\u00ean ho\u1eb7c tho\u00e1t v\u1ecb s\u1ee5n [7].<\/p>\n<p>Nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 bao g\u1ed3m gi\u1edbi t\u00ednh n\u1eef, ti\u1ec1n s\u1eed h\u00fat thu\u1ed1c, lao \u0111\u1ed9ng th\u1ee7 c\u00f4ng v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c \u0111i\u1ec1u tr\u1ecb cholesterol [2]. B\u1ec7nh c\u00f3 xu h\u01b0\u1edbng xu\u1ea5t hi\u1ec7n \u1edf \u0111\u1ed9 tu\u1ed5i 40-50. Vi\u1ec7c hi\u1ec3u r\u00f5 c\u00e1c y\u1ebfu t\u1ed1 n\u00e0y gi\u00fap b\u00e1c s\u0129 \u0111\u00e1nh gi\u00e1 \u0111\u00fang \u0111\u1ed1i t\u01b0\u1ee3ng c\u1ea7n can thi\u1ec7p.<\/p>\n<h2>Ph\u1eabu thu\u1eadt: Ch\u1ec9 \u0111\u1ecbnh v\u00e0 ph\u01b0\u01a1ng ph\u00e1p<\/h2>\n<p>D\u00f9 ch\u1ec9 kho\u1ea3ng 2% b\u1ec7nh nh\u00e2n vi\u00eam l\u1ed3i c\u1ea7u ngo\u00e0i x\u01b0\u01a1ng c\u00e1nh tay c\u1ea7n ph\u1eabu thu\u1eadt, nh\u01b0ng n\u1ebfu \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n k\u00e9o d\u00e0i t\u1eeb 6 \u0111\u1ebfn 12 th\u00e1ng kh\u00f4ng hi\u1ec7u qu\u1ea3, ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc [4]. M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 d\u1ef1 \u0111o\u00e1n nhu c\u1ea7u ph\u1eabu thu\u1eadt bao g\u1ed3m y\u00eau c\u1ea7u b\u1ed3i th\u01b0\u1eddng lao \u0111\u1ed9ng, ti\u1ec1n s\u1eed ti\u00eam thu\u1ed1c, h\u1ed9i ch\u1ee9ng h\u1ed1c th\u1ea7n kinh tr\u1ee5 v\u00e0 th\u1eddi gian tri\u1ec7u ch\u1ee9ng h\u01a1n 12 th\u00e1ng [4].<\/p>\n<p>Trong khi nhi\u1ec1u th\u1ee7 thu\u1eadt \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3, t\u00e1c gi\u1ea3 Campbell \u1ee7ng h\u1ed9 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn h\u1ea1n ch\u1ebf h\u01a1n. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y bao g\u1ed3m ph\u01a1i nhi\u1ec5m v\u00f9ng g\u1ed1c ECRB b\u1ecb b\u1ec7nh, c\u1eaft b\u1ecf m\u00f4 tho\u00e1i h\u00f3a v\u00e0 c\u00f3 th\u1ec3 l\u00e0 s\u1eeda tr\u1ef1c ti\u1ebfp g\u00e2n g\u1eafn v\u00e0o x\u01b0\u01a1ng [1]. M\u1ed9t k\u1ef9 thu\u1eadt ph\u1ed5 bi\u1ebfn kh\u00e1c l\u00e0 gi\u1ea3i ph\u00f3ng ph\u1eabu thu\u1eadt (release) \u0111\u1ec3 gi\u1ea3m c\u0103ng k\u00e9o l\u00ean g\u00e2n.<\/p>\n<h2>So s\u00e1nh gi\u1eefa ph\u1eabu thu\u1eadt m\u1edf v\u00e0 n\u1ed9i soi<\/h2>\n<p>K\u1ef9 thu\u1eadt n\u1ed9i soi \u0111\u00e3 tr\u1edf n\u00ean ng\u00e0y c\u00e0ng ph\u1ed5 bi\u1ebfn nh\u01b0 m\u1ed9t l\u1ef1a ch\u1ecdn \u00edt x\u00e2m l\u1ea5n thay th\u1ebf cho ph\u1eabu thu\u1eadt m\u1edf. C\u00e1c \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p h\u1ec7 th\u1ed1ng so s\u00e1nh hai k\u1ef9 thu\u1eadt n\u00e0y v\u00e0 kh\u00f4ng t\u00ecm th\u1ea5y s\u1ef1 kh\u00e1c bi\u1ec7t l\u00e2m s\u00e0ng \u0111\u00e1ng k\u1ec3 v\u1ec1 \u0111i\u1ec3m s\u1ed1 DASH (Disabilities of the Arm, Shoulder, and Hand), c\u01b0\u1eddng \u0111\u1ed9 \u0111au, m\u1ee9c \u0111\u1ed9 h\u00e0i l\u00f2ng c\u1ee7a b\u1ec7nh nh\u00e2n ho\u1eb7c t\u1ef7 l\u1ec7 th\u1ea5t b\u1ea1i [1].<\/p>\n<p>Tuy nhi\u00ean, \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi c\u00f3 li\u00ean k\u1ebft v\u1edbi vi\u1ec7c quay tr\u1edf l\u1ea1i c\u00f4ng vi\u1ec7c s\u1edbm h\u01a1n. M\u1ed9t nghi\u00ean c\u1ee9u b\u00e1o c\u00e1o t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng cao h\u01a1n v\u00e0 c\u00e1c k\u1ebft qu\u1ea3 ch\u1ee9c n\u0103ng t\u1ed1t h\u01a1n sau ph\u1eabu thu\u1eadt n\u1ed9i soi so v\u1edbi ph\u01b0\u01a1ng ph\u00e1p m\u1edf truy\u1ec1n th\u1ed1ng [1]. L\u1ee3i \u00edch c\u1ee7a n\u1ed9i soi bao g\u1ed3m kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng m\u00e0 kh\u00f4ng c\u1ea7n hy sinh g\u1ed1c g\u00e2n chung, cho ph\u00e9p ki\u1ec3m tra kh\u1edbp trong \u0111\u1ec3 t\u00ecm c\u00e1c qu\u00e1 tr\u00ecnh b\u1ec7nh l\u00fd kh\u00e1c v\u00e0 c\u00f3 th\u1ec3 r\u00fat ng\u1eafn th\u1eddi gian ph\u1ee5c h\u1ed3i sau ph\u1eabu thu\u1eadt [1].<\/p>\n<h2>Li\u1ec7u ph\u00e1p b\u1ed5 tr\u1ee3 v\u00e0 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb<\/h2>\n<p>Tr\u01b0\u1edbc khi \u0111\u1ebfn giai \u0111o\u1ea1n ph\u1eabu thu\u1eadt, c\u00e1c li\u1ec7u ph\u00e1p nh\u01b0 ti\u00eam corticosteroid c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 ch\u1ee9c n\u0103ng v\u00e0 gi\u1ea3m \u0111au trong ng\u1eafn h\u1ea1n [4]. Tuy nhi\u00ean, vi\u1ec7c ti\u00eam t\u1ef1 huy\u1ebft thanh (autologous blood) ho\u1eb7c plasma gi\u00e0u ti\u1ec3u c\u1ea7u (PRP) \u0111\u01b0\u1ee3c coi l\u00e0 hi\u1ec7u qu\u1ea3 h\u01a1n trong giai \u0111o\u1ea1n trung gian b\u1ea5t k\u1ec3 ph\u01b0\u01a1ng ph\u00e1p chu\u1ea9n b\u1ecb [4]. M\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y Edwards v\u00e0 Calandruccio \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng 79% trong vi\u1ec7c gi\u1ea3m \u0111au \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u00e0 t\u1ea5t c\u1ea3 c\u00e1c li\u1ec7u ph\u00e1p b\u1ea3o t\u1ed3n kh\u00e1c \u0111\u00e3 th\u1ea5t b\u1ea1i [6].<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt, m\u1eb7c d\u00f9 kh\u00f4ng hi\u1ec7u qu\u1ea3 h\u01a1n so v\u1edbi \u0111i\u1ec1u tr\u1ecb gi\u1ea3 (sham) trong m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u v\u1ec1 gi\u1ea3m \u0111au ho\u1eb7c c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng t\u1ed5ng qu\u00e1t, v\u1eabn cho th\u1ea5y hi\u1ec7u qu\u1ea3 \u1edf 90% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u00fang c\u00e1ch [4]. Vi\u1ec7c th\u1ea5t b\u1ea1i ph\u1eabu thu\u1eadt th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n ban \u0111\u1ea7u kh\u00f4ng ch\u00ednh x\u00e1c (v\u00ed d\u1ee5: nh\u1ea7m l\u1eabn v\u1edbi h\u1ed9i ch\u1ee9ng h\u1ed1c th\u1ea7n kinh tr\u1ee5) ho\u1eb7c thi\u1ebfu h\u1ee5t bao m\u00e0ng ho\u1eb7c d\u00e2y ch\u1eb1ng d\u1eabn \u0111\u1ebfn c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 t\u00fai bao m\u00e0ng ho\u1eb7c b\u1ea5t \u1ed5n posterolateral [5].<\/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 2852<\/li>\n<li>[2] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2851<\/li>\n<li>[3] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2851<\/li>\n<li>[4] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2852<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2852<\/li>\n<li>[6] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2851<\/li>\n<li>[7] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2851<\/li>\n<\/ul>\n<p><!-- aiwriter:45ca3ff055504488b2d38a4c --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hi\u1ec3u r\u00f5 nguy\u00ean nh\u00e2n vi m\u00f4 v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt nh\u01b0 gi\u1ea3i ph\u00f3ng g\u00e2n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 h\u1ed9i ch\u1ee9ng Tennis Elbow khi can thi\u1ec7p b\u1ea3o t\u1ed3n th\u1ea5t b\u1ea1i.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-188","post","type-post","status-publish","format-standard","hentry","category-chi-tren"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - 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