H\u1ed9i ch\u1ee9ng De Quervain: Gi\u1ea3i ph\u00e1p cho c\u01a1n \u0111au g\u00e2n c\u1ed5 tay<\/p>\n
H\u1ed9i ch\u1ee9ng De Quervain, hay c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 vi\u00eam g\u00e2n d\u1ea1ng d\u00e0i (stenosing tenosynovitis) c\u1ee7a ng\u00f3n c\u00e1i, l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng ph\u1ed5 bi\u1ebfn g\u00e2y \u0111au v\u00e0 s\u01b0ng t\u1ea1i khu v\u1ef1c \u0111\u1ea7u x\u01b0\u01a1ng tr\u1ee5 (radial styloid). \u0110i\u1ec1u n\u00e0y x\u1ea3y ra khi c\u00e1c g\u00e2n Extensor pollicis brevis (EPB) v\u00e0 Abductor pollicis longus (APL) b\u1ecb vi\u00eam trong khoang dorsal th\u1ee9 nh\u1ea5t c\u1ee7a c\u1ed5 tay [1]. T\u00ecnh tr\u1ea1ng n\u00e0y kh\u00f4ng ch\u1ec9 g\u00e2y kh\u00f3 ch\u1ecbu m\u00e0 c\u00f2n c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nh\u1eefng tri\u1ec7u ch\u1ee9ng c\u01a1 h\u1ecdc nghi\u00eam tr\u1ecdng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c can thi\u1ec7p \u0111\u00fang c\u00e1ch.<\/p>\n
M\u1eb7c d\u00f9 nguy\u00ean nh\u00e2n ch\u00ednh x\u00e1c v\u1eabn ch\u01b0a ho\u00e0n to\u00e0n r\u00f5 r\u00e0ng, nh\u01b0ng c\u00e1c y\u1ebfu t\u1ed1 g\u00f3p ph\u1ea7n v\u00e0o s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a h\u1ed9i ch\u1ee9ng n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn r\u1ed9ng r\u00e3i. Ho\u1ea1t \u0111\u1ed9ng l\u1eb7p \u0111i l\u1eb7p l\u1ea1i c\u1ee7a b\u00e0n tay, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c c\u1eed \u0111\u1ed9ng n\u1eafm ch\u1eb7t ho\u1eb7c n\u1eafm b\u1eaft (gripping\/grasping), t\u1ea1o ra ma s\u00e1t gi\u1eefa g\u00e2n v\u00e0 v\u1ecf bao g\u00e2n xung quanh, d\u1eabn \u0111\u1ebfn vi\u00eam v\u00e0 d\u00e0y l\u00ean [3].<\/p>\n
Ngo\u00e0i ra, c\u00e1c b\u1ec7nh l\u00fd n\u1ec1n nh\u01b0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p v\u00e0 c\u00e1c vi\u00eam kh\u1edbp d\u1ecb sinh kh\u00e1c l\u00e0m t\u0103ng nguy c\u01a1 ph\u00e1t tri\u1ec3n tenosynovitis h\u1eb9p [3]. Nh\u1eefng thay \u0111\u1ed5i n\u1ed9i ti\u1ebft t\u1ed1 trong thai k\u1ef3 c\u0169ng l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u00e1ng k\u1ec3. Trauma c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t t\u00ecnh tr\u1ea1ng n\u00e0y, nh\u01b0ng nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed ch\u1ea5n th\u01b0\u01a1ng r\u00f5 r\u1ec7t.<\/p>\n
\u0110\u1eb7c bi\u1ec7t, c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu c\u1ee7a m\u1ed7i ng\u01b0\u1eddi \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng. Kho\u1ea3ng 21% c\u00e1c m\u1eabu gi\u1ea3i ph\u1eabu \u0111\u00e3 ghi nh\u1eadn s\u1ef1 bi\u1ebfn \u0111\u1ed5i v\u1ec1 khoang v\u1eadn \u0111\u1ed9ng [5]. Tr\u00ean th\u1ef1c t\u1ebf, t\u1ef7 l\u1ec7 n\u00e0y c\u00f3 th\u1ec3 cao h\u01a1n t\u1ea1i th\u1eddi \u0111i\u1ec3m ph\u1eabu thu\u1eadt (t\u1edbi 85% trong m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u), v\u1edbi nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00f3 g\u00e2n “l\u1ec7ch l\u1ea1c” ho\u1eb7c g\u00e2n tr\u00f9ng l\u1eb7p (th\u01b0\u1eddng l\u00e0 APL). S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c g\u00e2n n\u00e0y \u0111\u00f4i khi ch\u00e8n \u00e9p m\u1ea1nh m\u1ebd v\u00e0o kh\u1edbp tr\u1ee5, l\u00e0m t\u0103ng nguy c\u01a1 vi\u00eam [5].<\/p>\n
\u0110\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c h\u1ed9i ch\u1ee9ng De Quervain, b\u00e1c s\u0129 th\u01b0\u1eddng ti\u1ebfn h\u00e0nh th\u1eed nghi\u1ec7m Finkelstein. Trong b\u00e0i ki\u1ec3m tra n\u00e0y, b\u1ec7nh nh\u00e2n n\u1eafm ch\u1eb7t m\u1ed9t v\u1eadt nh\u1ecf (nh\u01b0 t\u1edd gi\u1ea5y) b\u1eb1ng ng\u00f3n c\u00e1i v\u00e0 c\u00e1c ng\u00f3n c\u00f2n l\u1ea1i, sau \u0111\u00f3 xoay b\u00e0n tay v\u1ec1 h\u01b0\u1edbng ulnar (c\u1ea1nh trong) nhanh ch\u00f3ng [1]. N\u1ebfu d\u01b0\u01a1ng t\u00ednh, c\u01a1n \u0111au s\u1ebd xu\u1ea5t hi\u1ec7n r\u00f5 r\u1ec7t \u1edf \u0111\u1ec9nh x\u01b0\u01a1ng tr\u1ee5 radial.<\/p>\n
B\u00ean c\u1ea1nh \u0111\u00f3, c\u00e1c d\u1ea5u hi\u1ec7u nh\u01b0 s\u01b0ng, \u0111au v\u00e0 ti\u1ebfng k\u00eau “kh\u00edt” (crepitus) c\u0169ng th\u01b0\u1eddng g\u1eb7p. C\u1ea7n ph\u00e2n bi\u1ec7t r\u00f5 r\u00e0ng gi\u1eefa vi\u00eam g\u00e2n d\u1ea1ng d\u00e0i n\u00e0y v\u1edbi c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn c\u1ea5u tr\u00fac s\u00e2u h\u01a1n ho\u1eb7c c\u00e1c b\u1ec7nh l\u00fd th\u1ea7n kinh c\u1ee7a d\u00e2y tay ngo\u00e0i [2]. Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh nh\u01b0 si\u00eau \u00e2m ho\u1eb7c MRI c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 x\u00e1c nh\u1eadn n\u1ebfu tri\u1ec7u ch\u1ee9ng kh\u00f4ng r\u00f5 r\u00e0ng sau khi th\u0103m kh\u00e1m.<\/p>\n
H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam g\u00e2n d\u1ea1ng d\u00e0i, k\u1ec3 c\u1ea3 lo\u1ea1i h\u1eb9p, \u0111\u1ec1u \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi ph\u01b0\u01a1ng ph\u00e1p b\u1ea3o t\u1ed3n tr\u01b0\u1edbc khi \u0111\u1ebfn ph\u1eabu thu\u1eadt. C\u00e1c bi\u1ec7n ph\u00e1p bao g\u1ed3m ngh\u1ec9 ng\u01a1i, s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng vi\u00eam v\u00e0 ti\u00eam corticosteroid [3]. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 g\u1eb7p \u0111au t\u0103ng l\u00ean ngay sau khi ti\u00eam, \u0111\u00e2y l\u00e0 ph\u1ea3n \u1ee9ng b\u00ecnh th\u01b0\u1eddng c\u1ee7a m\u00f4 vi\u00eam.<\/p>\n
Khi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n kh\u00f4ng hi\u1ec7u qu\u1ea3 ho\u1eb7c tri\u1ec7u ch\u1ee9ng k\u00e9o d\u00e0i qu\u00e1 3-4 tu\u1ea7n, ph\u1eabu thu\u1eadt gi\u1ea3i ph\u00f3ng g\u00e2n (surgical release) \u0111\u01b0\u1ee3c xem x\u00e9t. Ph\u1eabu thu\u1eadt n\u00e0y li\u00ean quan \u0111\u1ebfn vi\u1ec7c c\u1eaft m\u1edf khoang dorsal th\u1ee9 nh\u1ea5t \u0111\u1ec3 gi\u1ea3m ch\u00e8n \u00e9p l\u00ean g\u00e2n EPB v\u00e0 APL [4].<\/p>\n
Trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt, b\u00e1c s\u0129 c\u1ea7n th\u1eadn tr\u1ecdng v\u1edbi c\u00e1c bi\u1ebfn th\u1ec3 gi\u1ea3i ph\u1eabu nh\u01b0 g\u00e2n APL ch\u00e8n v\u00e0o x\u01b0\u01a1ng tr\u1ee5 ho\u1eb7c c\u01a1 abductor pollicis brevis [5]. Ngo\u00e0i ra, vi\u1ec7c tr\u00e1nh l\u00e0m t\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh c\u1ea3m gi\u00e1c v\u00e0 m\u1ea1ch m\u00e1u l\u00e0 \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u. Sau khi ph\u1eabu thu\u1eadt, b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u01b0\u1ee3c b\u0103ng b\u00f3 trong kho\u1ea3ng 6 tu\u1ea7n \u0111\u1ec3 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng b\u00ecnh th\u01b0\u1eddng.<\/p>\n
H\u1ed9i ch\u1ee9ng De Quervain l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 c\u01a1 x\u01b0\u01a1ng kh\u1edbp th\u01b0\u1eddng g\u1eb7p, \u0111\u00f2i h\u1ecfi s\u1ef1 hi\u1ec3u bi\u1ebft v\u1ec1 gi\u1ea3i ph\u1eabu v\u00e0 nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh. T\u1eeb c\u00e1c y\u1ebfu t\u1ed1 l\u1eb7p l\u1ea1i, thay \u0111\u1ed5i n\u1ed9i ti\u1ebft \u0111\u1ebfn bi\u1ebfn th\u1ec3 gi\u1ea3i ph\u1eabu, vi\u1ec7c nh\u1eadn di\u1ec7n s\u1edbm qua th\u1eed nghi\u1ec7m Finkelstein s\u1ebd gi\u00fap h\u01b0\u1edbng d\u1eabn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t cho t\u1eebng b\u1ec7nh nh\u00e2n.<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
T\u00ecm hi\u1ec3u nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam g\u00e2n d\u00e0i ng\u00f3n c\u00e1i (De Quervain), c\u00e1c d\u1ea5u hi\u1ec7u nh\u1eadn bi\u1ebft qua th\u1eed nghi\u1ec7m Finkelstein v\u00e0 quy tr\u00ecnh ph\u1eabu thu\u1eadt gi\u1ea3m \u0111au hi\u1ec7u qu\u1ea3.<\/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-195","post","type-post","status-publish","format-standard","hentry","category-chi-tren"],"yoast_head":"\n