{"id":263,"date":"2026-10-10T19:51:19","date_gmt":"2026-10-10T12:51:19","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/10\/huong-dan-tap-di-nang-an-toan-cho-nguoi-gay-xuong-chi-duoi\/"},"modified":"2026-10-10T19:51:19","modified_gmt":"2026-10-10T12:51:19","slug":"huong-dan-tap-di-nang-an-toan-cho-nguoi-gay-xuong-chi-duoi","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/10\/huong-dan-tap-di-nang-an-toan-cho-nguoi-gay-xuong-chi-duoi\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn t\u1eadp \u0111i n\u1ea1ng an to\u00e0n cho ng\u01b0\u1eddi g\u00e3y x\u01b0\u01a1ng chi d\u01b0\u1edbi"},"content":{"rendered":"<h2>T\u00e1c \u0111\u1ed9ng c\u1ee7a l\u1ef1c c\u01a1 h\u1ecdc trong qu\u00e1 tr\u00ecnh di chuy\u1ec3n<\/h2>\n<p>Vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p t\u1eadp \u0111i n\u1ea1ng l\u00e0 y\u1ebfu t\u1ed1 then ch\u1ed1t trong quy tr\u00ecnh \u0111i\u1ec1u tr\u1ecb g\u00e3y x\u01b0\u01a1ng chi d\u01b0\u1edbi, v\u00ec c\u00e1c ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y sinh ra nh\u1eefng l\u1ef1c kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed v\u00e0 t\u01b0 th\u1ebf c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. Nghi\u00ean c\u1ee9u ch\u1ec9 ra r\u1eb1ng khi th\u1ef1c hi\u1ec7n \u0111i b\u1ed9 b\u1eb1ng n\u1ea1ng (crutch ambulation), t\u1ea3i tr\u1ecdng t\u00e1c \u0111\u1ed9ng l\u00ean kh\u1edbp vai c\u00f3 th\u1ec3 v\u01b0\u1ee3t qu\u00e1 1,0 l\u1ea7n tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 (BW) v\u00e0 cao \u0111\u1ebfn 1,7 l\u1ea7n BW so v\u1edbi c\u00e1c ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y b\u00ecnh th\u01b0\u1eddng [2]. T\u01b0\u01a1ng t\u1ef1, vi\u1ec7c s\u1eed d\u1ee5ng g\u1eady h\u1ed7 tr\u1ee3 b\u1ed1n ch\u00e2n gi\u00fap gi\u1edbi h\u1ea1n t\u1ea3i tr\u1ecdng \u1edf chi d\u01b0\u1edbi d\u01b0\u1edbi 50% BW trong khi v\u1eabn duy tr\u00ec l\u1ef1c t\u01b0\u01a1ng \u0111\u01b0\u01a1ng 1 BW t\u1ea1i vai [2].<\/p>\n<p>Tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd r\u1eb1ng c\u00e1c thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 \u0111i b\u1ed9 ch\u1ee7 y\u1ebfu c\u00f3 ch\u1ee9c n\u0103ng chu\u1ea9n h\u00f3a l\u1ea1i ki\u1ec3u d\u00e1ng \u0111i b\u1ed9 v\u00e0 ng\u0103n ng\u1eeba c\u00e1c l\u1ef1c c\u1ef1c \u0111\u1ea1i (\u0111\u1ebfn 870% BW) x\u1ea3y ra khi m\u1ea5t th\u0103ng b\u1eb1ng ch\u1ee9 kh\u00f4ng ch\u1ec9 \u0111\u01a1n thu\u1ea7n l\u00e0 gi\u1ea3m t\u1ea3i kh\u1edbp [7]. Th\u1ef1c t\u1ebf cho th\u1ea5y, nhi\u1ec1u b\u1ec7nh nh\u00e2n g\u1eb7p kh\u00f3 kh\u0103n trong vi\u1ec7c tu\u00e2n th\u1ee7 h\u01b0\u1edbng d\u1eabn h\u1ea1n ch\u1ebf tr\u1ecdng l\u01b0\u1ee3ng (non-weight-bearing), v\u1edbi t\u1ef7 l\u1ec7 kh\u00f4ng tu\u00e2n th\u1ee7 \u0111\u1ea1t 27% ngay c\u1ea3 sau khi \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n [7].<\/p>\n<h3>Nguy\u00ean t\u1eafc gi\u1ea3m t\u1ea3i v\u00e0 l\u1ef1a ch\u1ecdn thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3<\/h3>\n<p>M\u1ee5c ti\u00eau c\u1ed1t l\u00f5i c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng n\u1ea1ng ho\u1eb7c g\u1eady l\u00e0 gi\u1ea3m l\u1ef1c truy\u1ec1n qua v\u00f9ng g\u00e3y \u0111\u1ec3 b\u1ea3o v\u1ec7 c\u1ea5u tr\u00fac c\u1ed1 \u0111\u1ecbnh. C\u00e1c b\u00e0i t\u1eadp \u0111\u1ed9ng kh\u00f4ng ch\u1ecbu tr\u1ecdng l\u01b0\u1ee3ng nh\u01b0 tr\u01b0\u1ee3t g\u00f3t ch\u00e2n (heel slides) hay nghi\u00eang ch\u1eadu t\u1ea1o ra l\u1ef1c th\u1ea5p nh\u1ea5t, ch\u1ec9 kho\u1ea3ng 38% so v\u1edbi t\u1ea3i tr\u1ecdng t\u1ef1 do [3]. Ng\u01b0\u1ee3c l\u1ea1i, c\u00e1c co c\u01a1 \u0111\u1eb3ng tr\u01b0\u01a1ng c\u1ee7a nh\u00f3m c\u01a1 m\u00f4ng v\u00e0 m\u1edf r\u1ed9ng h\u00f4ng sinh ra l\u1ef1c l\u1edbn h\u01a1n 50% t\u1ea3i tr\u1ecdng kh\u00f4ng gi\u1edbi h\u1ea1n [3]. Do \u0111\u00f3, vi\u1ec7c tu\u00e2n th\u1ee7 nghi\u00eam ng\u1eb7t ch\u1ebf \u0111\u1ed9 \u0111i n\u1ea1ng ho\u1eb7c g\u1eady l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o l\u1ef1c t\u00e1c \u0111\u1ed9ng l\u00ean c\u1ea5u tr\u00fac c\u1ed1 \u0111\u1ecbnh kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 ng\u01b0\u1ee1ng ch\u1ecbu \u0111\u1ef1ng.<\/p>\n<p>\u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng \u0111\u01a1n gi\u1ea3n, kh\u00f4ng d\u1ecbch v\u1ecb ho\u1eb7c d\u1ecbch v\u1ecb t\u1ed1i thi\u1ec3u (\u22642 mm), \u0111\u1eb7c bi\u1ec7t \u1edf tr\u1ebb em kh\u00f4ng li\u00ean quan \u0111\u1ebfn v\u00f9ng v\u00f2m acetabular tr\u00ean, \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n bao g\u1ed3m ngh\u1ec9 ng\u01a1i ng\u1eafn h\u1ea1n tr\u00ean gi\u01b0\u1eddng v\u00e0 \u0111i b\u1ed9 kh\u00f4ng ch\u1ecbu tr\u1ecdng l\u01b0\u1ee3ng b\u1eb1ng n\u1ea1ng l\u00e0 ph\u00f9 h\u1ee3p [1]. \u0110\u1ed1i v\u1edbi tr\u1ebb l\u1edbn h\u01a1n c\u00f3 th\u1ec3 tu\u00e2n th\u1ee7 \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn n\u00e0y, \u0111i b\u1ed9 b\u1eb1ng n\u1ea1ng l\u00e0 l\u1ef1a ch\u1ecdn th\u00edch h\u1ee3p. Tuy nhi\u00ean, \u0111\u1ed1i v\u1edbi tr\u1ebb nh\u1ecf kh\u00f4ng th\u1ec3 tu\u00e2n th\u1ee7, vi\u1ec7c c\u1ed1 \u0111\u1ecbnh b\u1eb1ng b\u1ed9t spica th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u01a1n [1].<\/p>\n<h2>R\u1ee7i ro v\u00e0 bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba trong ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng<\/h2>\n<p>D\u00f9 c\u00e1c thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 gi\u00fap gi\u1ea3m t\u1ea3i l\u1ef1c (gi\u1ea3m 12% \u0111\u1ebfn 30% l\u1ef1c kh\u1edbp, gi\u1ea3m m\u00f4-men 20% \u0111\u1ebfn 30%), nh\u01b0ng kh\u1ea3 n\u0103ng tu\u00e2n th\u1ee7 c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c l\u1edbn. M\u1ed9t s\u1ed1 ng\u01b0\u1eddi kh\u00f4ng th\u1ec3 duy tr\u00ec \u0111\u01b0\u1ee3c gi\u1edbi h\u1ea1n tr\u1ecdng l\u01b0\u1ee3ng 200 N ngay c\u1ea3 khi c\u00f3 s\u1ef1 h\u1ed7 tr\u1ee3 t\u1eeb tr\u1ecb li\u1ec7u vi\u00ean [7]. Ngo\u00e0i ra, nguy c\u01a1 ng\u00e3 v\u00e0 t\u00e9 ng\u00e3 cao \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy gi\u1ea3m x\u01b0\u01a1ng (osteoporosis) ho\u1eb7c c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe kh\u00e1c c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1ea3i tr\u1ecdng b\u1ea5t th\u01b0\u1eddng l\u00ean c\u1ea5u tr\u00fac c\u1ed1 \u0111\u1ecbnh [8].<\/p>\n<p>Trong qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i, vi\u1ec7c theo d\u00f5i s\u00e1t sao th\u00f4ng qua ch\u1ee5p X-quang trong v\u00e0i tu\u1ea7n \u0111\u1ea7u ti\u00ean l\u00e0 b\u1eaft bu\u1ed9c \u0111\u1ec3 x\u00e1c nh\u1eadn s\u1ef1 th\u1eb3ng h\u00e0ng c\u1ee7a g\u00e3y x\u01b0\u01a1ng [1]. \u0110\u1ed1i v\u1edbi c\u00e1c g\u00e3y x\u01b0\u01a1ng \u1edf tr\u1ebb em, c\u1ea7n \u0111\u1eb7c bi\u1ec7t ch\u00fa \u00fd \u0111\u1ebfn vi\u1ec7c b\u1ea3o t\u1ed3n s\u1ef1 th\u1eb3ng h\u00e0ng c\u1ee7a s\u1ee5n tam gi\u00e1c (triradiate cartilage) nh\u1eb1m \u0111\u1ea3m b\u1ea3o t\u0103ng tr\u01b0\u1edfng b\u00ecnh th\u01b0\u1eddng sau n\u00e0y [5]. N\u1ebfu ph\u00e1t hi\u1ec7n d\u1ecbch v\u1ecb ti\u1ebfn tri\u1ec3n theo th\u1eddi gian, \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ch\u1eadm li\u1ec1n ho\u1eb7c sai l\u1ec7ch kh\u1edbp n\u1ed1i [4].<\/p>\n<p>Bi\u1ec7n ph\u00e1p can thi\u1ec7p ngo\u1ea1i khoa nh\u01b0 k\u00e9o x\u01b0\u01a1ng (skeletal traction) l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn cho nh\u1eefng g\u00e3y x\u01b0\u01a1ng hi\u1ebfm g\u1eb7p c\u00f3 th\u1ec3 ch\u1ec9nh s\u1eeda l\u1ea1i th\u00e0nh \u22642 mm d\u1ecbch v\u1ecb ho\u1eb7c khi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt [1]. V\u1ecb tr\u00ed ch\u00e8n pin k\u00e9o th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf ph\u1ea7n d\u01b0\u1edbi ch\u00e2n \u0111\u00f9i \u0111\u1ec3 tr\u00e1nh t\u1ed5n th\u01b0\u01a1ng \u0111\u1ebfn s\u1ee5n sinh l\u00fd, \u0111\u1eb7c bi\u1ec7t c\u1ea7n th\u1ef1c hi\u1ec7n d\u01b0\u1edbi g\u00e2y m\u00ea v\u00e0 theo d\u00f5i b\u1eb1ng hu\u1ef3nh quang [6].<\/p>\n<h2>K\u1ebft lu\u1eadn<\/h2>\n<p>T\u1eadp \u0111i n\u1ea1ng an to\u00e0n cho ng\u01b0\u1eddi b\u1ecb g\u00e3y x\u01b0\u01a1ng chi d\u01b0\u1edbi \u0111\u00f2i h\u1ecfi s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa hi\u1ec3u bi\u1ebft v\u1ec1 c\u01a1 h\u1ecdc l\u1ef1c h\u1ecdc kh\u1edbp v\u00e0 kh\u1ea3 n\u0103ng tu\u00e2n th\u1ee7 nghi\u00eam ng\u1eb7t c\u1ee7a b\u1ec7nh nh\u00e2n. Vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u00fang thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 gi\u00fap gi\u1ea3m t\u1ea3i l\u1ef1c l\u00ean v\u00f9ng g\u00e3y, nh\u01b0ng kh\u00f4ng \u0111\u1ea3m b\u1ea3o ho\u00e0n to\u00e0n n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng gi\u1eef \u0111\u00fang t\u01b0 th\u1ebf ho\u1eb7c g\u1eb7p ph\u1ea3i t\u00ecnh hu\u1ed1ng m\u1ea5t th\u0103ng b\u1eb1ng. C\u00e1c b\u00e1c s\u0129 c\u1ea7n \u0111\u00e1nh gi\u00e1 t\u1eebng ca c\u1ee5 th\u1ec3, c\u00e2n nh\u1eafc gi\u1eefa \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n v\u00e0 ph\u1eabu thu\u1eadt d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 d\u1ecbch v\u1ecb v\u00e0 kh\u1ea3 n\u0103ng tu\u00e2n th\u1ee7 c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. Vi\u1ec7c theo d\u00f5i c\u1eadn l\u00e2m s\u00e0ng \u0111\u1ecbnh k\u1ef3 l\u00e0 y\u1ebfu t\u1ed1 kh\u00f4ng th\u1ec3 thi\u1ebfu \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 sai l\u1ec7ch kh\u1edbp n\u1ed1i ho\u1eb7c ch\u1eadm li\u1ec1n x\u01b0\u01a1ng.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<ul>\n<li>[1] Rockwood and Green&#x27;s Fractures in Children, 9th Edition, 2020, trang 1404<\/li>\n<li>[2] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 34<\/li>\n<li>[3] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 33<\/li>\n<li>[4] Rockwood and Green&#x27;s Fractures in Children, 9th Edition, 2020, trang 1044<\/li>\n<li>[5] Rockwood and Green&#x27;s Fractures in Children, 9th Edition, 2020, trang 1403<\/li>\n<li>[6] Rockwood and Green&#x27;s Fractures in Children, 9th Edition, 2020, trang 1404<\/li>\n<li>[7] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 34<\/li>\n<li>[8] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 34<\/li>\n<\/ul>\n<p><!-- aiwriter:d16ee0ea556749a494bee944 --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>T\u00ecm hi\u1ec3u quy t\u1eafc t\u1eadp \u0111i n\u1ea1ng \u0111\u00fang c\u00e1ch sau ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ec3 gi\u1ea3m t\u1ea3i l\u1ef1c l\u00ean kh\u1edbp, ph\u00f2ng ng\u1eeba c\u1ed1 \u0111\u1ecbnh th\u1ea5t b\u1ea1i v\u00e0 th\u00fac \u0111\u1ea9y ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng 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":[1],"tags":[],"class_list":["post-263","post","type-post","status-publish","format-standard","hentry","category-gay-xuong"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - 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