{"id":213,"date":"2026-10-10T17:24:08","date_gmt":"2026-10-10T10:24:08","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/10\/sung-dau-keo-dai-sau-thay-khop-goi-nguyen-nhan-va-cach-danh-gia\/"},"modified":"2026-10-10T17:24:08","modified_gmt":"2026-10-10T10:24:08","slug":"sung-dau-keo-dai-sau-thay-khop-goi-nguyen-nhan-va-cach-danh-gia","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/10\/sung-dau-keo-dai-sau-thay-khop-goi-nguyen-nhan-va-cach-danh-gia\/","title":{"rendered":"S\u01b0ng \u0111au k\u00e9o d\u00e0i sau thay kh\u1edbp g\u1ed1i: Nguy\u00ean nh\u00e2n v\u00e0 c\u00e1ch \u0111\u00e1nh gi\u00e1"},"content":{"rendered":"<p>S\u01b0ng \u0111au k\u00e9o d\u00e0i (chronic pain) l\u00e0 m\u1ed9t trong nh\u1eefng bi\u1ebfn ch\u1ee9ng ph\u1ed5 bi\u1ebfn nh\u1ea5t m\u00e0 b\u1ec7nh nh\u00e2n g\u1eb7p ph\u1ea3i sau khi th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i (Total Knee Arthroplasty &#8211; TKA). Vi\u1ec7c hi\u1ec3u r\u00f5 c\u00e1c nguy\u00ean nh\u00e2n \u0111a d\u1ea1ng g\u00e2y n\u00ean t\u00ecnh tr\u1ea1ng n\u00e0y l\u00e0 b\u01b0\u1edbc \u0111\u1ea7u ti\u00ean \u0111\u1ec3 \u0111\u01b0a ra chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3. C\u00e1c t\u00e0i li\u1ec7u chuy\u00ean khoa ch\u1ec9 ra r\u1eb1ng \u0111au \u0111\u1edbn kh\u00f4ng ch\u1ec9 xu\u1ea5t ph\u00e1t t\u1eeb b\u1ea3n th\u00e2n thi\u1ebft b\u1ecb implant m\u00e0 c\u00f2n li\u00ean quan m\u1eadt thi\u1ebft \u0111\u1ebfn k\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt, qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 gi\u1ea3i ph\u1eabu \u0111\u1eb7c th\u00f9.<\/p>\n<h2>Nguy\u00ean nh\u00e2n do v\u1ecb tr\u00ed kh\u1edbp v\u00e0 c\u01a1 h\u1ecdc b\u1ea5t th\u01b0\u1eddng<\/h2>\n<p>M\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y s\u01b0ng \u0111au k\u00e9o d\u00e0i l\u00e0 do s\u1ef1 sai l\u1ec7ch v\u1ec1 v\u1ecb tr\u00ed c\u1ee7a c\u00e1c b\u1ed9 ph\u1eadn thay th\u1ebf. Khi c\u00e1c tr\u1ee5c kh\u1edbp kh\u00f4ng \u0111\u01b0\u1ee3c c\u0103n ch\u1ec9nh \u0111\u00fang chu\u1ea9n gi\u1ea3i ph\u1eabu, n\u00f3 t\u1ea1o ra l\u1ef1c c\u0103ng b\u1ea5t th\u01b0\u1eddng l\u00ean d\u00e2y ch\u1eb1ng v\u00e0 g\u00e2n bao quanh kh\u1edbp.<\/p>\n<ul>\n<li><strong>Loe x\u00ea d\u1ecbch v\u00e0 xoay tr\u1ee5c:<\/strong> S\u1ef1 xoay tr\u1ee5c b\u1ea5t th\u01b0\u1eddng (off-axis rotation) c\u1ee7a c\u00e1c th\u00e0nh ph\u1ea7n c\u00f3 th\u1ec3 g\u00e2y ra vi\u00eam to\u00e0n th\u00e2n \u1edf kh\u1edbp g\u1ed1i do ligament ch\u1ecbu stress kh\u00f4ng b\u00ecnh th\u01b0\u1eddng trong su\u1ed1t chu k\u1ef3 \u0111i b\u1ed9 [4].<\/li>\n<li><strong>Vi\u00eam g\u00e2n bao quanh kh\u1edbp:<\/strong> Tr\u00ean l\u00e2m s\u00e0ng, kh\u1edbp c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u1ecf hay s\u01b0ng r\u00f5 r\u1ec7t, nh\u01b0ng vi\u1ec7c palpate (ki\u1ec3m tra b\u1eb1ng tay) c\u00e1c g\u00e2n v\u00e0 d\u00e2y ch\u1eb1ng xung quanh nh\u01b0 g\u00e2n patella, d\u00e2y ch\u1eb1ng b\u00ean, d\u1ea3i iliotibial ho\u1eb7c g\u00e2n popliteus th\u01b0\u1eddng g\u00e2y ra \u0111au [4].<\/li>\n<li><strong>B\u1ea5t \u1ed5n \u0111\u1ecbnh kh\u1edbp:<\/strong> M\u1ed9t d\u1ea5u hi\u1ec7u \u0111\u1eb7c tr\u01b0ng l\u00e0 s\u1ef1 m\u1edf r\u1ed9ng c\u1ee7a kh\u1edbp v\u00e0i \u0111\u1ed9 khi b\u1ecb stress trong tr\u1ea1ng th\u00e1i s\u1ecd (varus ho\u1eb7c valgus) \u1edf g\u00f3c t\u1eeb 20 \u0111\u1ebfn 40 \u0111\u1ed9, m\u1ed9t hi\u1ec7n t\u01b0\u1ee3ng kh\u00f4ng x\u1ea3y ra v\u1edbi kh\u1edbp g\u1ed1i t\u1ef1 nhi\u00ean [4].<\/li>\n<\/ul>\n<p>H\u00ecnh \u1ea3nh h\u1ecdc th\u01b0\u1eddng cho th\u1ea5y implant \u0111\u01b0\u1ee3c c\u0103n ch\u1ec9nh t\u1ed1t v\u00e0 n\u1eb1m \u0111\u00fang v\u1ecb tr\u00ed, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u l\u1ecfng l\u1ebbo v\u00f4 khu\u1ea9n hay nhi\u1ec5m tr\u00f9ng, nh\u01b0ng c\u00f3 th\u1ec3 ghi nh\u1eadn patella b\u1ecb l\u1ec7ch h\u01b0\u1edbng [4].<\/p>\n<h2>V\u1ea5n \u0111\u1ec1 v\u1ec1 d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc (ACL) v\u00e0 y\u1ebfu c\u01a1<\/h2>\n<p>D\u00f9 ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i ch\u1ee7 y\u1ebfu t\u1eadp trung v\u00e0o c\u00e1c c\u1ea5u tr\u00fac ngo\u1ea1i vi, t\u00ecnh tr\u1ea1ng \u0111au k\u00e9o d\u00e0i c\u0169ng c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 n\u1ed9i t\u1ea1i nh\u01b0 d\u00e2y ch\u1eb1ng ch\u00e9o tr\u01b0\u1edbc. C\u00e1c b\u00e1o c\u00e1o g\u1ea7n \u0111\u00e2y cho th\u1ea5y t\u1ef7 l\u1ec7 th\u1ea5t b\u1ea1i trong t\u00e1i t\u1ea1o ACL dao \u0111\u1ed9ng t\u1eeb 10% \u0111\u1ebfn 25%, v\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn l\u00e0 do v\u1ecb tr\u00ed \u0111\u1eb7t \u0111\u01b0\u1eddng h\u1ea7m (tunnel) kh\u00f4ng ch\u00ednh x\u00e1c, d\u1eabn \u0111\u1ebfn k\u00e9o c\u0103ng d\u00e2y graft v\u00e0 m\u1ea5t \u1ed5n \u0111\u1ecbnh kh\u1edbp [2].<\/p>\n<p>B\u00ean c\u1ea1nh \u0111\u00f3, y\u1ebfu c\u01a1 l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 quan tr\u1ecdng. \u0110au \u1edf ph\u00eda tr\u01b0\u1edbc \u0111\u1ea7u g\u1ed1i sau ph\u1eabu thu\u1eadt n\u1ed9i x\u01b0\u01a1ng tibia c\u00f3 th\u1ec3 li\u00ean quan m\u1eadt thi\u1ebft \u0111\u1ebfn s\u1ef1 y\u1ebfu c\u1ee7a c\u01a1 t\u1ee9 \u0111\u1ea7u (quadriceps) [3]. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u1ee5c h\u1ed3i \u0111\u1ea7y \u0111\u1ee7, c\u01a1 y\u1ebfu s\u1ebd l\u00e0m gi\u1ea3m \u0111i\u1ec3m ch\u1ee9c n\u0103ng kh\u1edbp g\u1ed1i l\u00e2u d\u00e0i v\u00e0 duy tr\u00ec c\u1ea3m gi\u00e1c \u0111au m\u00e3n t\u00ednh.<\/p>\n<h3>H\u1eadu qu\u1ea3 c\u1ee7a ph\u1eabu thu\u1eadt n\u1ed9i x\u01b0\u01a1ng tibia<\/h3>\n<p>\u0110au \u1edf ph\u00eda tr\u01b0\u1edbc \u0111\u1ea7u g\u1ed1i l\u00e0 bi\u1ebfn ch\u1ee9ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o nhi\u1ec1u nh\u1ea5t sau khi n\u1eb9p n\u1ed9i x\u01b0\u01a1ng tibia. Kho\u1ea3ng 56% b\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t m\u1ee9c \u0111\u1ed9 \u0111au m\u00e3n t\u00ednh v\u00e0 g\u1eb7p kh\u00f3 kh\u0103n trong vi\u1ec7c g\u1eadp \u0111\u1ea7u g\u1ed1i [3]. C\u00e1c y\u1ebfu t\u1ed1 g\u00f3p ph\u1ea7n bao g\u1ed3m s\u1ef1 n\u1ed5i b\u1eadt c\u1ee7a \u0111inh nail tr\u00ean v\u1ecf tibia g\u1ea7n, r\u00e1ch\u534a\u6708 (meniscus), ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng kh\u1edbp kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n. M\u1eb7c d\u00f9 c\u01a1n \u0111au th\u01b0\u1eddng gi\u1ea3m theo th\u1eddi gian, nh\u01b0ng s\u1ef1 suy y\u1ebfu c\u01a1 t\u1ee9 \u0111\u1ea7u v\u1eabn t\u01b0\u01a1ng quan v\u1edbi \u0111i\u1ec3m ch\u1ee9c n\u0103ng th\u1ea5p trong d\u00e0i h\u1ea1n [3].<\/p>\n<h2>Kh\u00f3 kh\u0103n trong ph\u1eabu thu\u1eadt v\u00e0 bi\u1ebfn ch\u1ee9ng k\u1ef9 thu\u1eadt<\/h2>\n<p>N\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e3 t\u1eebng tr\u1ea3i qua ph\u1eabu thu\u1eadt n\u1ed9i x\u01b0\u01a1ng tibia ho\u1eb7c c\u00e1c th\u1ee7 thu\u1eadt li\u00ean quan, nguy c\u01a1 g\u1eb7p ph\u1ea3i c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 chuy\u1ec3n \u0111\u1ed9ng b\u1ecb h\u1ea1n ch\u1ebf l\u00e0 r\u1ea5t cao. C\u00e1c y\u1ebfu t\u1ed1 d\u1eabn \u0111\u1ebfn bi\u1ebfn ch\u1ee9ng bao g\u1ed3m: \u0111i\u1ec1u ki\u1ec7n chu\u1ea9n b\u1ecb tr\u01b0\u1edbc ph\u1eabu thu\u1eadt kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7, s\u01b0ng kh\u1edbp tr\u01b0\u1edbc \u0111\u00f3, v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 thi\u1ebfu ph\u1ea1m vi chuy\u1ec3n \u0111\u1ed9ng \u0111\u1ea7y \u0111\u1ee7 (bao g\u1ed3m c\u1ea3 hyperextension) [2].<\/p>\n<p>Nh\u1eefng sai s\u00f3t k\u1ef9 thu\u1eadt trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt c\u0169ng \u0111\u00f3ng vai tr\u00f2 then ch\u1ed1t. V\u00ed d\u1ee5, vi\u1ec7c \u0111\u1eb7t \u0111\u01b0\u1eddng h\u1ea7m femur ho\u1eb7c tibia kh\u00f4ng ch\u00ednh x\u00e1c, thi\u1ebfu notchplasty th\u00edch h\u1ee3p d\u1eabn \u0111\u1ebfn si\u1ebft ch\u1eb7t qu\u00e1 m\u1ee9c ho\u1eb7c va \u0111\u1eadp (impingement), g\u00e2y ra thi\u1ebfu h\u1ee5t chuy\u1ec3n \u0111\u1ed9ng [2]. Ngo\u00e0i ra, vi ph\u1ea1m v\u1ecf sau c\u1ee7a x\u01b0\u01a1ng \u0111\u00f9i ho\u1eb7c g\u00e3y gh\u00e9p c\u0169ng l\u00e0 nh\u1eefng nguy\u00ean nh\u00e2n tr\u1ef1c ti\u1ebfp g\u00e2y \u0111au v\u00e0 b\u1ea5t \u1ed5n \u0111\u1ecbnh [2].<\/p>\n<h2>Y\u1ebfu t\u1ed1 nguy c\u01a1 t\u1eeb ti\u1ec1n s\u1eed ph\u1eabu thu\u1eadt kh\u00e1c<\/h2>\n<p>T\u00ecnh tr\u1ea1ng \u0111au k\u00e9o d\u00e0i c\u00f2n c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi c\u00e1c v\u1ea5n \u0111\u1ec1 \u1edf kh\u1edbp kh\u00e1c trong c\u00f9ng m\u1ed9t b\u00ean c\u01a1 th\u1ec3. V\u00ed d\u1ee5, n\u1ebfu kh\u1edbp h\u00e1ng \u0111\u00e3 \u0111\u01b0\u1ee3c fusion (gh\u00e9p x\u01b0\u01a1ng c\u1ed1 \u0111\u1ecbnh), n\u00f3 l\u00e0m t\u0103ng \u00e1p l\u1ef1c c\u01a1 h\u1ecdc l\u00ean kh\u1edbp g\u1ed1i \u0111\u1ed1i di\u1ec7n v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra \u0111au l\u01b0ng ho\u1eb7c \u0111au kh\u1edbp g\u1ed1i c\u00f9ng b\u00ean [5]. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c kh\u1edbp l\u00e2n c\u1eadn nh\u01b0 c\u1ed9t s\u1ed1ng th\u1eaft l\u01b0ng l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y \u0111au kh\u00e1c, ch\u1eb3ng h\u1ea1n nh\u01b0 \u0111\u0129a \u0111\u1ec7m l\u1ed3i xu\u1ea5t \u1edf th\u1eaft l\u01b0ng [1].<\/p>\n<p>\u0110\u1ed1i v\u1edbi c\u00e1c ca ph\u1eabu thu\u1eadt ph\u1ee9c t\u1ea1p h\u01a1n nh\u01b0 chuy\u1ec3n \u0111\u1ed5i t\u1eeb fusion h\u00e1ng sang thay kh\u1edbp h\u00e1ng, vi\u1ec7c \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng c\u01a1 co r\u00fat (abductors) l\u00e0 quan tr\u1ecdng. C\u01a1 y\u1ebfu li\u00ean quan \u0111\u1ebfn k\u1ebft qu\u1ea3 ch\u1ee9c n\u0103ng k\u00e9m h\u01a1n [6]. C\u00e1c th\u1ee7 thu\u1eadt n\u1ed9i soi c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra \u0111au n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd t\u1ed1t trong qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi c\u00f3 c\u00e1c t\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh nh\u01b0 d\u00e2y th\u1ea7n kinh d\u01b0\u1edbi patella b\u1ecb t\u1ed5n th\u01b0\u01a1ng [3].<\/p>\n<p>T\u00f3m l\u1ea1i, s\u01b0ng \u0111au k\u00e9o d\u00e0i sau thay kh\u1edbp g\u1ed1i l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng \u0111a y\u1ebfu t\u1ed1. N\u00f3 \u0111\u00f2i h\u1ecfi s\u1ef1 \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n bao g\u1ed3m ki\u1ec3m tra l\u00e2m s\u00e0ng chi ti\u1ebft (\u0111\u00e1nh gi\u00e1 s\u01b0ng d\u1ecbch, \u0111i\u1ec3m \u0111au c\u1ee5c b\u1ed9, kh\u1ea3 n\u0103ng co c\u01a1), h\u00ecnh \u1ea3nh h\u1ecdc \u0111\u1ec3 lo\u1ea1i tr\u1eeb l\u1ecfng l\u1ebbo ho\u1eb7c nhi\u1ec5m tr\u00f9ng, v\u00e0 ph\u00e2n t\u00edch k\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt tr\u01b0\u1edbc \u0111\u00f3. Vi\u1ec7c nh\u1eadn di\u1ec7n s\u1edbm c\u00e1c nguy\u00ean nh\u00e2n nh\u01b0 sai l\u1ec7ch c\u01a1 h\u1ecdc, vi\u00eam g\u00e2n m\u00e3n t\u00ednh hay y\u1ebfu c\u01a1 s\u1ebd gi\u00fap b\u00e1c s\u0129 ch\u1ec9nh h\u00ecnh \u0111\u01b0a ra h\u01b0\u1edbng x\u1eed l\u00fd ph\u00f9 h\u1ee3p nh\u1ea5t cho t\u1eebng b\u1ec7nh nh\u00e2n.<\/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 296<\/li>\n<li>[2] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2726<\/li>\n<li>[3] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3360<\/li>\n<li>[4] Calipered Kinematically aligned Total Knee Arthroplasty, 1st Edition, 2021, trang 149<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 296<\/li>\n<li>[6] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 296<\/li>\n<\/ul>\n<p><!-- aiwriter:987db29db0b749f7bc4e997c --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Kh\u00e1m ph\u00e1 c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y s\u01b0ng \u0111au k\u00e9o d\u00e0i sau ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i, bao g\u1ed3m v\u1ea5n \u0111\u1ec1 c\u01a1 h\u1ecdc, vi\u00eam g\u00e2n v\u00e0 y\u1ebfu c\u01a1. 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