H\u1ed9i ch\u1ee9ng \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng quay: Tri\u1ec7u ch\u1ee9ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n<\/p>\n
H\u1ed9i ch\u1ee9ng \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng quay (Carpal Tunnel Syndrome – CTS) l\u00e0 m\u1ed9t trong nh\u1eefng r\u1ed1i lo\u1ea1n th\u1ea7n kinh ngo\u1ea1i bi\u00ean ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf chi tr\u00ean, do s\u1ef1 ch\u00e8n \u00e9p c\u1ee7a d\u00e2y th\u1ea7n kinh gi\u1eefa (median nerve) b\u00ean trong \u1ed1ng c\u1ed5 tay. B\u1ec7nh th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi t\u1eeb 30 \u0111\u1ebfn 60 tu\u1ed5i v\u00e0 c\u00f3 xu h\u01b0\u1edbng \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u h\u01a1n ph\u1ee5 n\u1eef so v\u1edbi nam gi\u1edbi [4]. Vi\u1ec7c nh\u1eadn di\u1ec7n ch\u00ednh x\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c b\u01b0\u1edbc ch\u1ea9n \u0111o\u00e1n ph\u00f9 h\u1ee3p l\u00e0 ch\u00eca kh\u00f3a \u0111\u1ec3 \u0111\u01b0a ra ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3.<\/p>\n
Tri\u1ec7u ch\u1ee9ng ch\u1ee7 \u0111\u1ea1o c\u1ee7a h\u1ed9i ch\u1ee9ng \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng quay th\u01b0\u1eddng l\u00e0 c\u1ea3m gi\u00e1c t\u00ea b\u00ec, ng\u1ee9a ran trong v\u00f9ng ph\u00e2n b\u1ed1 c\u1ea3m gi\u00e1c c\u1ee7a d\u00e2y th\u1ea7n kinh gi\u1eefa (ng\u00f3n c\u00e1i, ng\u00f3n tr\u1ecf, ng\u00f3n gi\u1eefa v\u00e0 n\u1eeda \u0111\u1ea7u ng\u00f3n \u00e1p\u6307). M\u1ed9t \u0111\u1eb7c \u0111i\u1ec3m quan tr\u1ecdng gi\u00fap ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c l\u00e0 s\u1ef1 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng khi th\u1ef1c hi\u1ec7n c\u00e1c b\u00e0i t\u1eadp v\u1eadn \u0111\u1ed9ng ho\u1eb7c thay \u0111\u1ed5i t\u01b0 th\u1ebf [5]. Ngo\u00e0i ra, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 th\u1ea5y s\u1ef1 y\u1ebfu c\u01a1 ho\u1eb7c teo c\u01a1 nh\u00f3m c\u01a1 thenar (c\u01a1 \u1edf l\u00f2ng b\u00e0n tay) trong kho\u1ea3ng th\u1eddi gian d\u00e0i n\u1ebfu ch\u00e8n \u00e9p k\u00e9o d\u00e0i [5].<\/p>\n
Tuy nhi\u00ean, vi\u1ec7c ch\u1ec9 d\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u00f4i khi g\u1eb7p kh\u00f3 kh\u0103n do s\u1ef1 ch\u1ed3ng ch\u00e9o v\u1edbi c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c. C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y ch\u00e8n \u00e9p c\u00f3 th\u1ec3 bao g\u1ed3m ch\u1ea5n th\u01b0\u01a1ng (nh\u01b0 g\u00e3y c\u1ed5 tay Colles), vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, gout, ho\u1eb7c c\u00e1c t\u00ecnh tr\u1ea1ng vi\u00eam m\u00e0ng g\u00e2n [6]. Do \u0111\u00f3, b\u00e1c s\u0129 c\u1ea7n lo\u1ea1i tr\u1eeb c\u00e1c ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t nh\u01b0 b\u1ec7nh \u0111\u0129a \u0111\u1ec7m c\u1ed5 s\u1ed1ng (cervical radiculopathy) ho\u1eb7c h\u1ed9i ch\u1ee9ng tho\u00e1t v\u1ecb c\u1ed9t s\u1ed1ng ng\u1ef1c [5].<\/p>\n
B\u01b0\u1edbc \u0111\u1ea7u ti\u00ean trong qu\u00e1 tr\u00ecnh \u0111\u00e1nh gi\u00e1 l\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c b\u00e0i ki\u1ec3m tra g\u1ee3i \u00fd nh\u1eb1m x\u00e1c nh\u1eadn m\u1ee9c \u0111\u1ed9 ch\u00e8n \u00e9p. Trong s\u1ed1 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn, b\u00e0i ki\u1ec3m tra Phalen (g\u1eadp c\u1ed5 tay) \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 t\u00ednh nh\u1ea1y c\u1ea3m cao nh\u1ea5t [1]. Ng\u01b0\u1ee3c l\u1ea1i, d\u1ea5u hi\u1ec7u Tinel (ch\u1ea1m nh\u1eb9 d\u1ecdc theo d\u00e2y th\u1ea7n kinh) tuy \u00edt nh\u1ea1y c\u1ea3m h\u01a1n nh\u01b0ng l\u1ea1i c\u00f3 t\u00ednh \u0111\u1eb7c hi\u1ec7u cao h\u01a1n [1].<\/p>\n
D\u00f9 v\u1eady, m\u1ed9t b\u00e0i ki\u1ec3m tra kh\u00e1c mang t\u00ean Durkan (\u00e1p l\u1ef1c tr\u1ef1c ti\u1ebfp l\u00ean \u1ed1ng c\u1ed5 tay trong 30 gi\u00e2y) \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 c\u00f3 c\u1ea3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao h\u01a1n so v\u1edbi hai ph\u01b0\u01a1ng ph\u00e1p tr\u00ean (90% \u0111\u1eb7c hi\u1ec7u v\u00e0 87% nh\u1ea1y c\u1ea3m) [1]. Ngo\u00e0i ra, c\u00f4ng c\u1ee5 CTS-6 s\u1eed d\u1ee5ng l\u1ecbch s\u1eed b\u1ec7nh \u00e1n v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng c\u0169ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn h\u1eefu \u00edch \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n x\u00e1c su\u1ea5t m\u1eafc b\u1ec7nh m\u00e0 kh\u00f4ng c\u1ea7n th\u00eam c\u00e1c x\u00e9t nghi\u1ec7m ph\u1ee9c t\u1ea1p [1].<\/p>\n
Khi l\u00e2m s\u00e0ng ch\u01b0a \u0111\u1ee7 r\u00f5 r\u00e0ng ho\u1eb7c c\u1ea7n \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng, c\u00e1c x\u00e9t nghi\u1ec7m b\u1ed5 tr\u1ee3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh. Nghi\u00ean c\u1ee9u d\u1eabn truy\u1ec1n th\u1ea7n kinh (NCS) v\u00e0 \u0111i\u1ec7n c\u01a1 (EMG) l\u00e0 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p x\u00e1c nh\u1eadn x\u00e2m l\u1ea5n \u0111\u00e1ng tin c\u1eady. C\u00e1c gi\u00e1 tr\u1ecb tr\u1ec5 \u0111\u1ed9ng c\u01a1 \u1edf \u0111\u1ea7u cu\u1ed1i tr\u00ean 4.5 ms v\u00e0 tr\u1ec5 c\u1ea3m gi\u00e1c tr\u00ean 3.5 ms th\u01b0\u1eddng \u0111\u01b0\u1ee3c coi l\u00e0 b\u1ea5t th\u01b0\u1eddng [7]. Tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd r\u1eb1ng c\u00e1c x\u00e9t nghi\u1ec7m n\u00e0y \u0111\u00f4i khi c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng ngay c\u1ea3 khi b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng, ho\u1eb7c b\u1ea5t th\u01b0\u1eddng \u1edf nh\u1eefng ng\u01b0\u1eddi ch\u01b0a c\u00f3 tri\u1ec7u ch\u1ee9ng [2].<\/p>\n
V\u1ec1 h\u00ecnh \u1ea3nh h\u1ecdc, si\u00eau \u00e2m \u0111\u00e3 cho th\u1ea5y \u0111\u1ed9 nh\u1ea1y tr\u00ean 97% khi \u0111\u01b0\u1eddng k\u00ednh d\u00e2y th\u1ea7n kinh gi\u1eefa l\u1edbn h\u01a1n 10 mm t\u1ea1i m\u1ee9c x\u01b0\u01a1ng pisiform [3]. Ng\u01b0\u1ee3c l\u1ea1i, ch\u1ee5p MRI kh\u00f4ng \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y l\u00e0 h\u1eefu \u00edch trong ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng quay v\u00e0 th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb l\u00e0m x\u00e9t nghi\u1ec7m \u0111\u1ea7u ti\u00ean [3].<\/p>\n
T\u00e0i li\u1ec7u chuy\u00ean khoa ch\u1ec9 t\u1eadp trung v\u00e0o c\u00e1c kh\u00eda c\u1ea1nh v\u1ec1 h\u1ed9i ch\u1ee9ng \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng quay, d\u00e2y th\u1ea7n kinh gi\u1eefa v\u00e0 m\u1ed9t s\u1ed1 h\u1ed9i ch\u1ee9ng ch\u00e8n \u00e9p kh\u00e1c nh\u01b0 h\u1ed9i ch\u1ee9ng tay c\u00e1i (pronator syndrome). C\u00e1c th\u00f4ng tin v\u1ec1 h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay kh\u00f4ng bao qu\u00e1t to\u00e0n di\u1ec7n m\u1ecdi bi\u1ebfn th\u1ec3 \u0111i\u1ec1u tr\u1ecb ho\u1eb7c c\u00e1c b\u1ec7nh l\u00fd hi\u1ebfm g\u1eb7p kh\u00e1c m\u00e0 c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng r\u1ed9ng l\u1edbn h\u01a1n [5]. Do \u0111\u00f3, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u1eabn ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean s\u1ef1 tinh t\u1ebf c\u1ee7a b\u00e1c s\u0129 v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng, v\u1edbi c\u00e1c x\u00e9t nghi\u1ec7m b\u1ed5 tr\u1ee3 ch\u1ec9 d\u00e0nh cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n r\u00f5 r\u00e0ng [3].<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
T\u00ecm hi\u1ec3u c\u00e1c d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o, b\u00e0i ki\u1ec3m tra g\u1ee3i \u00fd v\u00e0 quy tr\u00ecnh ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u0111\u01b0\u1eddng h\u1ea7m x\u01b0\u01a1ng quay d\u1ef1a tr\u00ean t\u00e0i li\u1ec7u chuy\u00ean khoa. Ph\u00e2n bi\u1ec7t tri\u1ec7u ch\u1ee9ng v\u1edbi c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c.<\/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-292","post","type-post","status-publish","format-standard","hentry","category-chi-tren"],"yoast_head":"\n