{"id":211,"date":"2026-10-10T17:18:27","date_gmt":"2026-10-10T10:18:27","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/10\/thay-khop-hang-o-benh-nhan-hoai-tu-vo-mach-chom-xuong-dui-sau-chan-thuong-co-che-va-phuong-phap-dieu-tri\/"},"modified":"2026-10-10T17:18:27","modified_gmt":"2026-10-10T10:18:27","slug":"thay-khop-hang-o-benh-nhan-hoai-tu-vo-mach-chom-xuong-dui-sau-chan-thuong-co-che-va-phuong-phap-dieu-tri","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/10\/thay-khop-hang-o-benh-nhan-hoai-tu-vo-mach-chom-xuong-dui-sau-chan-thuong-co-che-va-phuong-phap-dieu-tri\/","title":{"rendered":"Thay kh\u1edbp h\u00e1ng \u1edf b\u1ec7nh nh\u00e2n ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i sau ch\u1ea5n th\u01b0\u01a1ng: C\u01a1 ch\u1ebf v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Ch\u1ea5n th\u01b0\u01a1ng tr\u1eadt kh\u1edbp h\u00e1ng l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nh\u1eefng h\u1eadu qu\u1ea3 l\u00e2u d\u00e0i cho kh\u1edbp h\u00e1ng. M\u1ed9t trong nh\u1eefng bi\u1ebfn ch\u1ee9ng \u0111\u00e1ng lo ng\u1ea1i nh\u1ea5t l\u00e0 s\u1ef1 h\u00ecnh th\u00e0nh ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i<\/strong>, m\u1ed9t qu\u00e1 tr\u00ecnh b\u1ec7nh l\u00fd ti\u1ebfn tri\u1ec3n g\u00e2y ch\u1ebft m\u00f4 x\u01b0\u01a1ng v\u00e0 cu\u1ed1i c\u00f9ng d\u1eabn \u0111\u1ebfn suy tho\u00e1i kh\u1edbp.<\/p>\n

Nghi\u00ean c\u1ee9u chuy\u00ean s\u00e2u ch\u1ec9 ra r\u1eb1ng ho\u1ea1i t\u1eed x\u01b0\u01a1ng x\u1ea3y ra trong kho\u1ea3ng t\u1eeb 4% \u0111\u1ebfn 22% c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u1eadt kh\u1edbp h\u00e1ng kh\u00f4ng k\u00e8m theo g\u00e3y ch\u1ecfm ho\u1eb7c s\u1ee5n kh\u1edbp ch\u1eadu [1]. M\u1ed9t \u0111i\u1ec3m m\u1ea5u ch\u1ed1t trong vi\u1ec7c ph\u00e1t tri\u1ec3n bi\u1ebfn ch\u1ee9ng n\u00e0y l\u00e0 th\u1eddi gian \u0111\u1ec3 th\u1ef1c hi\u1ec7n gi\u1ea3m kh\u1edbp<\/strong>. C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 x\u00e1c \u0111\u1ecbnh m\u1ed1i t\u01b0\u01a1ng quan tr\u1ef1c ti\u1ebfp gi\u1eefa th\u1eddi gian t\u1eeb ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ebfn khi kh\u00f4i ph\u1ee5c l\u01b0u th\u00f4ng m\u00e1u v\u00e0 t\u1ef7 l\u1ec7 xu\u1ea5t hi\u1ec7n c\u00e1c thay \u0111\u1ed5i ho\u1ea1i t\u1eed. Ngay c\u1ea3 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c x\u1eed l\u00fd nhanh nh\u1ea5t, m\u1ed9t ph\u1ea7n b\u1ec7nh nh\u00e2n v\u1eabn ph\u00e1t tri\u1ec3n nh\u1eefng bi\u1ebfn ch\u1ee9ng v\u1ec1 t\u01b0\u1edbi m\u00e1u [1].<\/p>\n

C\u01a1 ch\u1ebf h\u00ecnh th\u00e0nh v\u00e0 di\u1ec5n ti\u1ebfn c\u1ee7a ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch<\/h2>\n

Ho\u1ea1i t\u1eed ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i (tr\u01b0\u1edbc \u0111\u00e2y g\u1ecdi l\u00e0 ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch) \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ti\u1ebfn tri\u1ec3n \u1ea3nh h\u01b0\u1edfng ch\u1ee7 y\u1ebfu \u0111\u1ebfn b\u1ec7nh nh\u00e2n trong \u0111\u1ed9 tu\u1ed5i t\u1eeb 30 \u0111\u1ebfn 50 [2]. V\u1ec1 m\u1eb7t \u0111\u1ecbnh ngh\u0129a, \u0111\u00e2y l\u00e0 t\u00ecnh tr\u1ea1ng ‘x\u01b0\u01a1ng ch\u1ebft’ do m\u1ea5t tu\u1ea7n ho\u00e0n t\u1eeb nhi\u1ec1u nguy\u00ean nh\u00e2n ti\u1ec1m \u1ea9n. Khi tr\u1edf n\u00ean c\u00f3 tri\u1ec7u ch\u1ee9ng, n\u00f3 th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn s\u1ef1 s\u1ee5p \u0111\u1ed5 c\u1ee7a ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 suy gi\u1ea3m ch\u1ee9c n\u0103ng kh\u1edbp h\u00e1ng. \u01af\u1edbc t\u00ednh c\u00f3 kho\u1ea3ng 20.000 ca m\u1edbi c\u1ee7a ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1ed7i n\u0103m t\u1ea1i Hoa K\u1ef3 [2].<\/p>\n

M\u1ed1i li\u00ean h\u1ec7 v\u1edbi tr\u1eadt kh\u1edbp h\u00e1ng<\/h3>\n

D\u00f9 vi\u1ec7c gi\u1ea3m kh\u1edbp k\u1ecbp th\u1eddi l\u00e0 m\u1ee5c ti\u00eau \u01b0u ti\u00ean, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n v\u1eabn ph\u00e1t tri\u1ec3n ho\u1ea1i t\u1eed ngay c\u1ea3 sau khi x\u1eed l\u00fd \u0111\u00fang quy tr\u00ecnh. Nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb tr\u1eadt kh\u1edbp h\u00e1ng ph\u00eda sau v\u00e0 c\u00f3 nhi\u1ec1u ch\u1ea5n th\u01b0\u01a1ng k\u00e8m theo d\u01b0\u1eddng nh\u01b0 c\u00f3 nguy c\u01a1 cao h\u01a1n trong vi\u1ec7c h\u00ecnh th\u00e0nh ho\u1ea1i t\u1eed [3]. H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p ho\u1ea1i t\u1eed xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng trong v\u00f2ng 2 n\u0103m sau ch\u1ea5n th\u01b0\u01a1ng, d\u00f9 \u0111\u00e3 c\u00f3 nh\u1eefng b\u00e1o c\u00e1o hi\u1ebfm hoi v\u1ec1 c\u00e1c thay \u0111\u1ed5i tr\u00ean X-quang mu\u1ed9n \u0111\u1ebfn 5 n\u0103m [3].<\/p>\n

D\u1ea5u hi\u1ec7u v\u00e0 bi\u1ebfn ch\u1ee9ng kh\u00e1c<\/h3>\n

B\u00ean c\u1ea1nh ho\u1ea1i t\u1eed, thay kh\u1edbp h\u00e1ng<\/strong> (vi\u00eam x\u01b0\u01a1ng kh\u1edbp) l\u00e0 bi\u1ebfn ch\u1ee9ng ph\u1ed5 bi\u1ebfn nh\u1ea5t sau tr\u1eadt kh\u1edbp. M\u1ed9t s\u1ed1 l\u01b0\u1ee3ng \u0111\u00e1ng k\u1ec3 b\u1ec7nh nh\u00e2n ph\u00e1t tri\u1ec3n c\u00e1c thay \u0111\u1ed5i vi\u00eam x\u01b0\u01a1ng kh\u1edbp ngay c\u1ea3 khi kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u X-quang c\u1ee7a ho\u1ea1i t\u1eed. Vi\u1ec7c ph\u00e2n bi\u1ec7t gi\u1eefa hai th\u1ef1c th\u1ec3 n\u00e0y tr\u00ean X-quang c\u00f3 th\u1ec3 kh\u00f3 kh\u0103n, do \u0111\u00f3 ch\u1ee5p MRI th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c [3]. Ngo\u00e0i ra, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng d\u00e2y th\u1ea7n kinh quai d\u01b0\u1edbi (sciatic nerve palsy) l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng ph\u1ee9c t\u1ea1p c\u1ee7a tr\u1eadt kh\u1edbp h\u00e1ng ph\u00eda sau, x\u1ea3y ra \u1edf 13% b\u1ec7nh nh\u00e2n, nh\u01b0ng kh\u00f4ng c\u00f3 b\u00e1o c\u00e1o n\u00e0o v\u1ec1 h\u1eadu di ch\u1ee9ng th\u1ea7n kinh sau khi tr\u1eadt kh\u1edbp ph\u00eda tr\u01b0\u1edbc [3].<\/p>\n

C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/h2>\n

Khi ho\u1ea1i t\u1eed \u0111\u00e3 h\u00ecnh th\u00e0nh, m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng c\u1ee7a ch\u1ecfm x\u01b0\u01a1ng \u0111\u00f9i. C\u00e1c k\u1ef9 thu\u1eadt nh\u01b0 khoan\u51cf\u538b (core decompression) ho\u1eb7c gh\u00e9p x\u01b0\u01a1ng s\u1ed1ng chi \u0111\u00e3 ch\u1ee9ng minh k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t cho c\u00e1c t\u1ed5n th\u01b0\u01a1ng nh\u1ecf \u0111\u1ebfn v\u1eeba (< 30% di\u1ec7n t\u00edch s\u1ee5n kh\u1edbp b\u1ecb li\u00ean quan) \u1edf b\u1ec7nh nh\u00e2n tr\u1ebb, n\u01a1i vi\u1ec7c tr\u00ec ho\u00e3n thay kh\u1edbp h\u00e1ng ho\u00e0n to\u00e0n l\u00e0 t\u1ed1i \u01b0u [4]. B\u1ec7nh nh\u00e2n d\u01b0\u1edbi 55 tu\u1ed5i th\u01b0\u1eddng c\u00f3 k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n so v\u1edbi nh\u00f3m l\u1edbn tu\u1ed5i, v\u00e0 nh\u1eefng ng\u01b0\u1eddi ho\u1ea1i t\u1eed do nguy\u00ean nh\u00e2n t\u1ef1 ph\u00e1t ho\u1eb7c h\u1eadu ch\u1ea5n th\u01b0\u01a1ng l\u00e0m t\u1ed1t h\u01a1n so v\u1edbi nh\u1eefng ng\u01b0\u1eddi b\u1ecb ho\u1ea1i t\u1eed do r\u01b0\u1ee3u ho\u1eb7c corticosteroid [4].<\/p>\n

Vai tr\u00f2 c\u1ee7a thay kh\u1edbp h\u00e1ng to\u00e0n ph\u1ea7n<\/h3>\n

N\u1ebfu ho\u1ea1i t\u1eed chi\u1ebfm tr\u00ean 30% di\u1ec7n t\u00edch \u0111\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i, hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c k\u1ef9 thu\u1eadt b\u1ea3o t\u1ed3n c\u00f3 xu h\u01b0\u1edbng gi\u1ea3m s\u00fat. M\u1ed9t khi qu\u00e1 tr\u00ecnh s\u1ee5p \u0111\u1ed5 b\u1eaft \u0111\u1ea7u, kh\u1edbp h\u00e1ng ch\u1eafc ch\u1eafn s\u1ebd ti\u1ebfn tri\u1ec3n sang giai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a vi\u00eam x\u01b0\u01a1ng kh\u1edbp [5]. C\u00e1c l\u1ef1a ch\u1ecdn cho t\u1ed5n th\u01b0\u01a1ng l\u1edbn v\u00e0 b\u1ec7nh l\u00fd ti\u1ebfn tri\u1ec3n bao g\u1ed3m ph\u1eabu thu\u1eadt ph\u1ee7 s\u1ee5n (resurfacing arthroplasty) v\u00e0 thay kh\u1edbp h\u00e1ng to\u00e0n ph\u1ea7n. M\u00e0ng s\u1ee5n kh\u1edbp ch\u1eadu \u1edf c\u00e1c kh\u1edbp h\u00e1ng c\u00f3 b\u1ec7nh Ficat giai \u0111o\u1ea1n III th\u01b0\u1eddng b\u1ecb h\u01b0 h\u1ea1i \u0111\u00e1ng k\u1ec3, l\u1eadp lu\u1eadn r\u1eb1ng n\u00ean tr\u00e1nh ph\u1eabu thu\u1eadt b\u00e1n ph\u1ea7n (hemiarthroplasty). T\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u0111i\u1ec1u tr\u1ecb g\u00e3y c\u1ed5 x\u01b0\u01a1ng \u0111\u00f9i, th\u1eddi gian theo d\u00f5i l\u00e2u d\u00e0i \u0111\u00e3 \u1ee7ng h\u1ed9 vi\u1ec7c s\u1eed d\u1ee5ng thay kh\u1edbp h\u00e1ng to\u00e0n ph\u1ea7n h\u01a1n l\u00e0 b\u00e1n ph\u1ea7n [5].<\/p>\n

H\u1ea1n ch\u1ebf c\u1ee7a t\u00e0i li\u1ec7u tham kh\u1ea3o<\/h3>\n

B\u00e0i vi\u1ebft n\u00e0y t\u1ed5ng h\u1ee3p ki\u1ebfn th\u1ee9c d\u1ef1a tr\u00ean c\u00e1c t\u00e0i li\u1ec7u chuy\u00ean khoa v\u1ec1 ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh v\u00e0 ch\u1ea5n th\u01b0\u01a1ng. M\u1eb7c d\u00f9 cung c\u1ea5p th\u00f4ng tin c\u01a1 b\u1ea3n v\u1ec1 m\u1ed1i li\u00ean h\u1ec7 gi\u1eefa tr\u1eadt kh\u1edbp v\u00e0 ho\u1ea1i t\u1eed, c\u0169ng nh\u01b0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p can thi\u1ec7p \u0111i\u1ec1u tr\u1ecb hi\u1ec7n h\u00e0nh, nh\u01b0ng ph\u1ea1m vi c\u1ee7a d\u1eef li\u1ec7u c\u00f3 th\u1ec3 kh\u00f4ng bao qu\u00e1t to\u00e0n b\u1ed9 c\u00e1c bi\u1ebfn th\u1ec3 \u0111i\u1ec1u tr\u1ecb m\u1edbi nh\u1ea5t ho\u1eb7c m\u1ecdi kh\u00eda c\u1ea1nh c\u1ee7a qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng trong th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng.<\/p>\n

K\u1ebft lu\u1eadn<\/h2>\n

T\u00f3m l\u1ea1i, vi\u1ec7c qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n sau ch\u1ea5n th\u01b0\u01a1ng tr\u1eadt kh\u1edbp h\u00e1ng \u0111\u00f2i h\u1ecfi s\u1ef1 hi\u1ec3u bi\u1ebft s\u00e2u s\u1eafc v\u1ec1 c\u01a1 ch\u1ebf h\u00ecnh th\u00e0nh ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch v\u00e0 di\u1ec5n ti\u1ebfn c\u1ee7a n\u00f3. Th\u1eddi gian \u0111\u1ec3 gi\u1ea3m kh\u1edbp \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh nguy c\u01a1 bi\u1ebfn ch\u1ee9ng. \u0110\u1ed1i v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng nh\u1ecf \u1edf b\u1ec7nh nh\u00e2n tr\u1ebb, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p b\u1ea3o t\u1ed3n v\u1eabn l\u00e0 l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u, trong khi c\u00e1c tr\u01b0\u1eddng h\u1ee3p s\u1ee5p \u0111\u1ed5 ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng l\u1edbn s\u1ebd c\u1ea7n \u0111\u1ebfn gi\u1ea3i ph\u00e1p thay kh\u1edbp h\u00e1ng to\u00e0n ph\u1ea7n \u0111\u1ec3 tr\u00e1nh suy tho\u00e1i kh\u1edbp kh\u00f4ng th\u1ec3 kh\u1eafc ph\u1ee5c \u0111\u01b0\u1ee3c.<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
    \n
  • [1] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 3792<\/li>\n
  • [2] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 455<\/li>\n
  • [3] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 3793<\/li>\n
  • [4] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 461<\/li>\n
  • [5] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 461<\/li>\n<\/ul>\n

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