\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (RA) c\u00f3 t\u1ed5n th\u01b0\u01a1ng s\u1ee5n v\u00e0 x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n trung \u0111\u1ebfn n\u1eb7ng, ph\u1eabu thu\u1eadt thay kh\u1edbp to\u00e0n ph\u1ea7n l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 \u0111\u01b0\u1ee3c m\u1edf r\u1ed9ng \u0111\u00e1ng k\u1ec3. M\u1ee5c ti\u00eau ch\u00ednh c\u1ee7a can thi\u1ec7p n\u00e0y l\u00e0 gi\u1ea3m \u0111au v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng trong h\u1ea7u h\u1ebft c\u00e1c kh\u1edbp [1]. C\u00e1c ch\u1ec9 \u0111\u1ecbnh ch\u00ednh cho ph\u1eabu thu\u1eadt thay kh\u1edbp khu\u1ef7u tay bao g\u1ed3m \u0111au \u0111\u1edbn kh\u00f4ng ki\u1ec3m so\u00e1t v\u00e0\/ho\u1eb7c m\u1ea5t \u1ed5n \u0111\u1ecbnh kh\u1edbp, \u0111\u1eb7c bi\u1ec7t khi c\u00f3 bi\u1ebfn d\u1ea1ng v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng m\u00e0 kh\u00f4ng c\u00f2n \u0111au (\u0111i\u1ec1u n\u00e0y tr\u00e1i ng\u01b0\u1ee3c v\u1edbi tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 c\u00f3 bi\u1ebfn d\u1ea1ng nh\u01b0ng kh\u00f4ng \u0111au) [3].<\/p>\n
B\u1ec7nh nh\u00e2n ph\u00f9 h\u1ee3p nh\u1ea5t \u0111\u1ec3 th\u1ef1c hi\u1ec7n thay kh\u1edbp khu\u1ef7u to\u00e0n ph\u1ea7n l\u00e0 ng\u01b0\u1eddi b\u1ecb vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p g\u00e2y \u0111au \u0111\u1edbn nghi\u00eam tr\u1ecdng v\u00e0 l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng, k\u00e8m theo ki\u1ebfn tr\u00fac kh\u1edbp \u0111\u00e3 thay \u0111\u1ed5i [3]. Tuy nhi\u00ean, quy\u1ebft \u0111\u1ecbnh ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc th\u1eadn tr\u1ecdng do t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng r\u1ea5t cao \u1edf c\u00e1c b\u1ec7nh nh\u00e2n tr\u1ebb h\u01a1n, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi d\u01b0\u1edbi 50 tu\u1ed5i [2].<\/p>\n
K\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt thay kh\u1edbp khu\u1ef7u tay cho vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p trung b\u00ecnh \u0111\u1ea1t kho\u1ea3ng 90% h\u00e0i l\u00f2ng, \u0111\u00e2y l\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed1t nh\u1ea5t khi so s\u00e1nh v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p thay kh\u1edbp do bi\u1ebfn ch\u1ee9ng sau ch\u1ea5n th\u01b0\u01a1ng [6]. M\u1ed9t nghi\u00ean c\u1ee9u d\u00e0i h\u1ea1n (10-20 n\u0103m) v\u1ec1 thi\u1ebft b\u1ecb b\u00e1n gi\u1edbi h\u1ea1n v\u00e0 kh\u00f4ng gi\u1edbi h\u1ea1n \u0111\u00e3 ghi nh\u1eadn t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t trung b\u00ecnh \u1edf 75%, nh\u01b0ng con s\u1ed1 n\u00e0y gi\u1ea3m xu\u1ed1ng c\u00f2n 61% sau 20 n\u0103m n\u1ebfu t\u00ednh c\u1ea3 c\u00e1c thi\u1ebft k\u1ebf c\u1ed5 \u0111i\u1ec3n [6]. N\u1ebfu lo\u1ea1i b\u1ecf c\u00e1c b\u00e1o c\u00e1o t\u1eeb c\u00e1c thi\u1ebft k\u1ebf c\u00f3 kh\u1edbp (hinged), t\u1ef7 l\u1ec7 k\u1ebft qu\u1ea3 h\u00e0i l\u00f2ng \u0111\u1ea1t g\u1ea7n 90% [6].<\/p>\n
Khi ph\u1eabu thu\u1eadt thay kh\u1edbp th\u1ea5t b\u1ea1i, n\u00f3 tr\u1edf th\u00e0nh m\u1ed9t th\u1ee7 t\u1ee5c c\u1ee9u c\u00e1nh. C\u00e1c ti\u1ebfn b\u1ed9 trong thi\u1ebft k\u1ebf implant v\u00e0 k\u1ef9 thu\u1eadt c\u1ed1 \u0111\u1ecbnh b\u1eb1ng xi m\u0103ng \u0111\u00e3 gi\u00fap gi\u1ea3m thi\u1ec3u s\u1ef1 l\u1ecfng l\u1ebbo c\u1ee7a implant [2]. Ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1o khu\u1ef7u tay l\u00e0 l\u1ef1a ch\u1ecdn v\u01b0\u1ee3t tr\u1ed9i v\u1ec1 ch\u1ee9c n\u0103ng so v\u1edbi c\u1eaft b\u1ecf x\u01b0\u01a1ng (resection arthroplasty) khi th\u00e0nh c\u00f4ng [2]. Tuy nhi\u00ean, ph\u1eabu thu\u1eadt s\u1eeda ch\u1eefa cho kh\u1edbp khu\u1ef7u c\u00f3 th\u1ec3 c\u1ef1c k\u1ef3 kh\u00f3 kh\u0103n do s\u1eb9o, co r\u00fat v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng x\u01b0\u01a1ng k\u00e9m \u1edf b\u1ec7nh nh\u00e2n RA [7].<\/p>\n
T\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng sau thay kh\u1edbp to\u00e0n ph\u1ea7n trong b\u1ec7nh nh\u00e2n vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p th\u01b0\u1eddng cao h\u01a1n so v\u1edbi b\u1ec7nh nh\u00e2n vi\u00eam x\u01b0\u01a1ng kh\u1edbp do c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 l\u00e0nh th\u01b0\u01a1ng k\u00e9m, nhi\u1ec5m tr\u00f9ng s\u00e2u (4,1% nhi\u1ec5m tr\u00f9ng mu\u1ed9n), co c\u1ee9ng g\u1eadp m\u1ea1nh, l\u1ecfng l\u1ebbo kh\u1edbp n\u1eb7ng, lo\u00e3ng x\u01b0\u01a1ng nghi\u00eam tr\u1ecdng v\u00e0 s\u1ef1 tham gia c\u1ee7a nhi\u1ec1u kh\u1edbp kh\u00e1c h\u1ea1n ch\u1ebf ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng [8]. M\u1ed9t s\u1ed1 l\u00fd thuy\u1ebft cho r\u1eb1ng vai tr\u00f2 c\u1ee7a corticosteroid c\u00f3 th\u1ec3 ch\u1ecbu tr\u00e1ch nhi\u1ec7m v\u1ec1 c\u00e1c bi\u1ebfn ch\u1ee9ng v\u1ebft th\u01b0\u01a1ng v\u00e0 nhi\u1ec5m tr\u00f9ng h\u01a1n l\u00e0 qu\u00e1 tr\u00ecnh b\u1ec7nh t\u1ef1 n\u00f3 [8].<\/p>\n
T\u00f9y ch\u1ecdn ph\u1eabu thu\u1eadt bao g\u1ed3m c\u1ea3 k\u1ef9 thu\u1eadt n\u1ed9i soi v\u00e0 m\u1edf, m\u1eb7c d\u00f9 v\u1edbi k\u1ef9 thu\u1eadt hi\u1ec7n t\u1ea1i, ph\u1eabu thu\u1eadt synovectomy m\u1edf \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u00edt h\u01a1n do s\u1ef1 s\u1eb5n c\u00f3 c\u1ee7a k\u1ef9 thu\u1eadt n\u1ed9i soi [5]. \u0110\u1ed1i v\u1edbi c\u00e1c thi\u1ebft b\u1ecb thay kh\u1edbp, \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn implant l\u00e0 b\u1ea3o t\u1ed3n t\u1ed1i \u0111a kh\u1ed1i l\u01b0\u1ee3ng x\u01b0\u01a1ng, \u0111\u1ea3m b\u1ea3o c\u1ed1 \u0111\u1ecbnh \u1ed5n \u0111\u1ecbnh l\u00e2u d\u00e0i, c\u00f3 kh\u1edbp ho\u1ea1t \u0111\u1ed9ng b\u1ec1n v\u1eefng v\u00e0 c\u1ea3\u690d\u5165 c\u0169ng nh\u01b0 s\u1eeda ch\u1eefa t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u01a1n gi\u1ea3n [2].<\/p>\n
Thi\u1ebft k\u1ebf implant cho ph\u00e9p chuy\u1ec3n \u0111\u1ed9ng valgus, varus v\u00e0 quay t\u1ea1i \u0111i\u1ec3m gh\u00e9p n\u1ed1i c\u1ee7a thi\u1ebft b\u1ecb b\u00e1n gi\u1edbi h\u1ea1n gi\u00fap ti\u00eau t\u00e1n l\u1ef1c \u1edf khu\u1ef7u tay [2]. S\u1eed d\u1ee5ng m\u1ed9t c\u00e1nh ng\u1eafn tr\u00ean th\u00e2n x\u01b0\u01a1ng \u0111\u00f9i (\u00edt h\u01a1n m\u1ed9t ph\u1ea7n t\u01b0 chi\u1ec1u d\u00e0i th\u00e2n) \u0111\u00e3 \u0111\u01b0\u1ee3c li\u00ean k\u1ebft v\u1edbi hi\u1ec7n t\u01b0\u1ee3ng l\u1ecfng l\u1ebbo [7]. Ngo\u00e0i ra, c\u00e1c nghi\u00ean c\u1ee9u h\u1ec7 th\u1ed1ng cho th\u1ea5y ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf v\u00e0 l\u00e0m s\u1ea1ch (debridement) m\u1edf ho\u1eb7c n\u1ed9i soi c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n g\u00f3c g\u1eadp v\u00e0 du\u1ed7i, \u0111\u1ed3ng th\u1eddi gi\u1ea3m \u0111i\u1ec3m s\u1ed1 Mayo Elbow Performance Score v\u1edbi t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng th\u1ea5p [4].<\/p>\n
Ph\u1eabu thu\u1eadt thay kh\u1edbp khu\u1ef7u tay to\u00e0n ph\u1ea7n l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 qu\u1ea3n l\u00fd \u0111au \u0111\u1edbn v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng cho b\u1ec7nh nh\u00e2n vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5o c\u00f3 t\u1ed5n th\u01b0\u01a1ng kh\u1edbp n\u1eb7ng. M\u1eb7c d\u00f9 k\u1ebft qu\u1ea3 trung b\u00ecnh r\u1ea5t t\u1ed1t (kho\u1ea3ng 90% h\u00e0i l\u00f2ng), c\u00e1c b\u00e1c s\u0129 c\u1ea7n th\u1eadn tr\u1ecdng trong vi\u1ec7c l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i v\u00e0 ho\u1ea1t \u0111\u1ed9ng cao, \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 l\u1ecfng l\u1ebbo implant v\u00e0 bi\u1ebfn ch\u1ee9ng l\u00e2u d\u00e0i [2].<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
Ph\u1eabu thu\u1eadt thay kh\u1edbp khu\u1ef7u tay l\u00e0 l\u1ef1a ch\u1ecdn hi\u1ec7u qu\u1ea3 cho b\u1ec7nh nh\u00e2n vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p n\u1eb7ng, mang l\u1ea1i k\u1ebft qu\u1ea3 h\u00e0i l\u00f2ng kho\u1ea3ng 90%. Tuy nhi\u00ean, c\u1ea7n th\u1eadn tr\u1ecdng v\u1edbi nh\u00f3m tr\u1ebb d\u01b0\u1edbi 50 tu\u1ed5i do t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng cao.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[],"class_list":["post-223","post","type-post","status-publish","format-standard","hentry","category-thay-khop"],"yoast_head":"\n