{"id":191,"date":"2026-10-10T16:27:22","date_gmt":"2026-10-10T09:27:22","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/10\/gay-dau-duoi-xuong-quay-o-nguoi-lon-tuoi-dau-hieu-suy-yeu-va-chien-luoc-dieu-tri\/"},"modified":"2026-10-10T16:27:22","modified_gmt":"2026-10-10T09:27:22","slug":"gay-dau-duoi-xuong-quay-o-nguoi-lon-tuoi-dau-hieu-suy-yeu-va-chien-luoc-dieu-tri","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/10\/gay-dau-duoi-xuong-quay-o-nguoi-lon-tuoi-dau-hieu-suy-yeu-va-chien-luoc-dieu-tri\/","title":{"rendered":"G\u00e3y \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng quay \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i: D\u1ea5u hi\u1ec7u suy y\u1ebfu v\u00e0 chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

G\u00e3y \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng quay: D\u1ea5u hi\u1ec7u c\u1ee7a t\u00ecnh tr\u1ea1ng suy y\u1ebfu ti\u1ec1m t\u00e0ng<\/h2>\n

\u1ede ng\u01b0\u1eddi l\u1edbn tu\u1ed5i, g\u00e3y x\u01b0\u01a1ng \u0111\u1ea7u d\u01b0\u1edbi (subtrochanteric) ho\u1eb7c g\u00e3y x\u01b0\u01a1ng ch\u1eadu (trochanteric) kh\u00f4ng ch\u1ec9 l\u00e0 ch\u1ea5n th\u01b0\u01a1ng c\u01a1 h\u1ecdc m\u00e0 c\u00f2n \u0111\u01b0\u1ee3c xem l\u00e0 d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o s\u1edbm v\u1ec1 t\u00ecnh tr\u1ea1ng suy y\u1ebfu hi\u1ec7n h\u1eefu ho\u1eb7c ti\u1ec1m t\u00e0ng \u1edf ng\u01b0\u1eddi tr\u00ean 50 tu\u1ed5i [1]<\/strong>. C\u00e1c b\u00e1c s\u0129 khuy\u1ebfn ngh\u1ecb ph\u00e1t tri\u1ec3n c\u00e1c quy tr\u00ecnh l\u00e2m s\u00e0ng trong b\u1ec7nh vi\u1ec7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n \u0111i\u1ec1u ki\u1ec7n n\u00e0y th\u00f4ng qua \u0111\u1ed9i ng\u0169 \u0111a ng\u00e0nh bao g\u1ed3m c\u1ea3 ph\u1eabu thu\u1eadt v\u00e0 l\u00e3o khoa [1]<\/strong>. Fracture n\u00e0y \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t “fracture ch\u1ec9 s\u1ed1” (index fracture), \u0111\u1eb7c bi\u1ec7t \u1edf \u0111\u1ed9 tu\u1ed5i 50 tr\u1edf \u0111i, v\u1edbi t\u1ef7 l\u1ec7 nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng th\u1ee9 hai trong c\u01a1 th\u1ec3 g\u1ea7n g\u1ea5p \u0111\u00f4i so v\u1edbi nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng t\u1eebng b\u1ecb g\u00e3y [7]<\/strong>.<\/p>\n

Nguy\u00ean nh\u00e2n tr\u1ef1c ti\u1ebfp th\u01b0\u1eddng l\u00e0 ng\u00e3 t\u1eeb t\u01b0 th\u1ebf \u0111\u1ee9ng, nh\u01b0ng nguy\u00ean nh\u00e2n s\u00e2u xa li\u00ean quan m\u1eadt thi\u1ebft \u0111\u1ebfn m\u1ea5t m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng do tu\u1ed5i t\u00e1c, k\u00e8m theo suy gi\u1ea3m ph\u1ed1i h\u1ee3p, s\u1ee9c m\u1ea1nh (sarcopenia), kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng v\u00e0 th\u1ecb gi\u00e1c [4]<\/strong>. \u1ede b\u1ec7nh nh\u00e2n gi\u00e0 y\u1ebfu, c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111a thu\u1ed1c (polypharmacy) v\u00e0 thi\u1ebfu dinh d\u01b0\u1ee1ng c\u0169ng l\u00e0 m\u1ed1i quan t\u00e2m l\u1edbn c\u1ea7n \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft trong qu\u00e1 tr\u00ecnh ch\u0103m s\u00f3c [4]<\/strong>.<\/p>\n

Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 \u0111\u00e1nh gi\u00e1 ti\u1ec1n ph\u1eabu<\/h2>\n

B\u1ec7nh nh\u00e2n b\u1ecb g\u00e3y x\u01b0\u01a1ng \u0111\u1ea7u d\u01b0\u1edbi kh\u00f4ng th\u1ec3 ch\u1ecbu tr\u1ecdng l\u01b0\u1ee3ng tr\u00ean chi b\u1ecb th\u01b0\u01a1ng, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n r\u00fat ng\u1eafn so v\u1edbi chi \u0111\u1ed1i b\u00ean. Ph\u00f9 n\u1ec1 \u0111\u00e1ng k\u1ec3 v\u00e0 b\u1ea7m t\u00edm quanh v\u1ecb tr\u00ed g\u00e3y l\u00e0 nh\u1eefng d\u1ea5u hi\u1ec7u ph\u1ed5 bi\u1ebfn [2]<\/strong>. C\u1ea7n ki\u1ec3m tra k\u1ef9 l\u01b0\u1ee1ng da \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c v\u1ebft r\u00e1ch h\u1edf ho\u1eb7c bong b\u00f3ng n\u01b0\u1edbc do ma s\u00e1t, v\u00ec ch\u00fang \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn v\u1ecb tr\u00ed \u0111\u1eb7t v\u1ebft c\u1eaft sau n\u00e0y [2]<\/strong>. Ngo\u00e0i ra, c\u1ea7n \u0111\u00e1nh gi\u00e1 ti\u1ec1n s\u1eed s\u1eed d\u1ee5ng bisphosphonate v\u00e0 t\u00ecm ki\u1ebfm c\u00e1c ch\u1ea5n th\u01b0\u01a1ng li\u00ean quan kh\u00e1c nh\u01b0 g\u00e3y x\u01b0\u01a1ng c\u1ed5 ch\u1eadu, c\u1ed9t s\u1ed1ng ho\u1eb7c b\u00e0n ch\u00e2n (fracture dashboard\/jumper’s) [8]<\/strong>.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/h3>\n

X-quang th\u01b0\u1eddng quy l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n cho g\u00e3y x\u01b0\u01a1ng \u0111\u1ea7u d\u01b0\u1edbi. C\u00e1c h\u00ecnh chi\u1ebfu tr\u01b0\u1edbc sau (AP) v\u00e0 b\u00ean c\u1ee7a kh\u1edbp h\u00e1ng v\u00e0 \u0111\u00f9i b\u1ecb th\u01b0\u01a1ng, c\u00f9ng v\u1edbi h\u00ecnh chi\u1ebfu AP ch\u1eadu, c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n [9]<\/strong>. Vi\u1ec7c ghi nh\u1eadn \u0111\u1ed9 d\u00e0i \u0111o\u1ea1n g\u1ea7n, \u0111\u01b0\u1eddng k\u00ednh k\u00eanh \u0111\u00f9i v\u00e0 m\u1ee9c \u0111\u1ed9 v\u1ee1 n\u00e1t l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 l\u1eadp k\u1ebf ho\u1ea1ch c\u1ed1 \u0111\u1ecbnh. N\u1ebfu kh\u00f4ng th\u1ec3 x\u00e1c \u0111\u1ecbnh r\u00f5 ph\u1ea1m vi g\u00e3y tr\u00ean phim X-quang, si\u00eau \u00e2m ho\u1eb7c CT c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi c\u00f3 nghi ng\u1edd t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh m\u1ea1ch m\u00e1u [9]<\/strong>.<\/p>\n

Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u1ed9i m\u00e0ng v\u00e0 k\u1ef9 thu\u1eadt n\u1eb9p<\/h2>\n

\u0110\u1ed1i v\u1edbi g\u00e3y x\u01b0\u01a1ng \u0111\u1ea7u d\u01b0\u1edbi, ph\u1eabu thu\u1eadt n\u1ed9i m\u00e0ng (intramedullary nailing) l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c \u01b0u ti\u00ean. Vi\u1ec7c \u0111\u1eb7t n\u1eb9p c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n khi b\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda ho\u1eb7c b\u00ean, t\u00f9y thu\u1ed9c v\u00e0o \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a g\u00e3y v\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 th\u1ec3 [10]<\/strong>. C\u00e1c lo\u1ea1i n\u1eb9p nh\u01b0 Gamma, TFNA ho\u1eb7c InterTAN th\u01b0\u1eddng ph\u00f9 h\u1ee3p v\u1edbi b\u1ec7nh nh\u00e2n l\u00e3o khoa v\u00ec ch\u00fang kh\u1edbp t\u1ed1t h\u01a1n v\u1edbi b\u00e1n k\u00ednh cong c\u1ee7a \u0111\u00f9i [3]<\/strong>.<\/p>\n

K\u1ef9 thu\u1eadt “ki\u1ec3m so\u00e1t qu\u1ef9 \u0111\u1ea1o” (trajectory control) \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c gi\u1ea3m sai l\u1ec7ch v\u1ecb tr\u00ed. \u0110i\u1ec1u n\u00e0y bao g\u1ed3m thi\u1ebft l\u1eadp ch\u00ednh x\u00e1c c\u1eeda n\u1eb9p g\u1ea7n d\u01b0\u1edbi d\u01b0\u1edbi s\u1ef1 h\u01b0\u1edbng d\u1eabn c\u1ee7a fluoroscopy, \u0111\u1ea3m b\u1ea3o h\u1ed7 tr\u1ee3 v\u1ecf s\u1ee5n tr\u01b0\u1edbc v\u00e0 b\u00ean, tr\u00e1nh vi\u1ec7c khoan l\u1ec7ch t\u00e2m [3]<\/strong>. M\u1ed9t s\u1ed1 nh\u00e0 s\u1ea3n xu\u1ea5t cho ph\u00e9p s\u1eed d\u1ee5ng m\u00e1y khoan k\u00eanh (channel reamer) \u0111\u1ec3 gi\u1ea3m thi\u1ec3u vi\u1ec7c khoan l\u1ec7ch t\u00e2m v\u00e0 sai l\u1ec7ch kh\u00f4ng \u0111\u00fang v\u1ecb tr\u00ed [3]<\/strong>.<\/p>\n

K\u1ebf ho\u1ea1ch ph\u1ee5c h\u1ed3i v\u00e0 qu\u1ea3n l\u00fd k\u1ef3 v\u1ecdng<\/h2>\n

Khuy\u1ebfn kh\u00edch k\u00edch th\u00edch s\u1edbm v\u00e0 l\u1eadp k\u1ebf ho\u1ea1ch ph\u1ee5c h\u1ed3i t\u1eeb s\u1edbm l\u00e0 y\u1ebfu t\u1ed1 then ch\u1ed1t. Tuy nhi\u00ean, c\u1ea7n qu\u1ea3n l\u00fd k\u1ef3 v\u1ecdng r\u00f5 r\u00e0ng cho b\u1ec7nh nh\u00e2n: th\u1eddi gian ph\u1ee5c h\u1ed3i th\u01b0\u1eddng k\u00e9o d\u00e0i t\u1eeb 6 \u0111\u1ebfn 12 th\u00e1ng sau g\u00e3y x\u01b0\u01a1ng \u0111\u1ea7u d\u01b0\u1edbi, v\u00e0 ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u1ec3 l\u1ea1i m\u1ed9t m\u1ee9c \u0111\u1ed9 t\u00e0n t\u1eadt nh\u1ea5t \u0111\u1ecbnh [1]<\/strong>. M\u1eb7c d\u00f9 c\u00e1c k\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt \u00edt x\u00e2m l\u1ea5n h\u01a1n v\u00e0 di chuy\u1ec3n s\u1edbm \u0111\u00e3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, th\u1ef1c t\u1ebf l\u00e0 s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n b\u1ecb g\u00e3y x\u01b0\u01a1ng h\u00e1ng ng\u00e0y c\u00e0ng gi\u00e0 y\u1ebfu v\u00e0 d\u1ec5 t\u1ed5n th\u01b0\u01a1ng [6]<\/strong>.<\/p>\n

Qu\u1ea3n l\u00fd sau ph\u1eabu thu\u1eadt<\/h3>\n

T\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng \u0111\u01b0\u1ee3c gi\u1eef kh\u00f4ng ch\u1ecbu tr\u1ecdng l\u01b0\u1ee3ng ho\u1eb7c ch\u1ec9 ch\u1ecbu tr\u1ecdng l\u01b0\u1ee3ng b\u1eb1ng \u0111\u1ea7u ng\u00f3n ch\u00e2n trong 6 \u0111\u1ebfn 12 tu\u1ea7n \u0111\u1ea7u ti\u00ean [5]<\/strong>. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 l\u1ea1i m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng, nguy c\u01a1 ng\u00e3 v\u00e0 c\u00e1c b\u1ec7nh l\u00fd n\u1ec1n l\u00e0 b\u1eaft bu\u1ed9c sau khi \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 ph\u00f2ng ng\u1eeba g\u00e3y x\u01b0\u01a1ng th\u1ee9 ph\u00e1t [7]<\/strong>.<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
    \n
  • [1] Rockwood and Green's Fractures in Adults, 10th Edition, 2025, trang 2733<\/li>\n
  • [2] Rockwood and Green's Fractures in Adults, 10th Edition, 2025, trang 2739<\/li>\n
  • [3] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 3461<\/li>\n
  • [4] Rockwood and Green's Fractures in Adults, 10th Edition, 2025, trang 2690<\/li>\n
  • [5] Rockwood and Green's Fractures in Adults, 10th Edition, 2025, trang 2416<\/li>\n
  • [6] Rockwood and Green's Fractures in Adults, 10th Edition, 2025, trang 2733<\/li>\n
  • [7] Rockwood and Green's Fractures in Adults, 10th Edition, 2025, trang 2733<\/li>\n
  • [8] Rockwood and Green's Fractures in Adults, 10th Edition, 2025, trang 2739<\/li>\n
  • [9] Rockwood and Green's Fractures in Adults, 10th Edition, 2025, trang 2739<\/li>\n
  • [10] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 3461<\/li>\n<\/ul>\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

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