{"id":346,"date":"2026-10-11T09:22:42","date_gmt":"2026-10-11T02:22:42","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/11\/phuc-hoi-bien-do-gap-goi-toi-da-sau-phau-thuat-thay-khop-va-chinh-hinh\/"},"modified":"2026-10-11T09:22:42","modified_gmt":"2026-10-11T02:22:42","slug":"phuc-hoi-bien-do-gap-goi-toi-da-sau-phau-thuat-thay-khop-va-chinh-hinh","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/11\/phuc-hoi-bien-do-gap-goi-toi-da-sau-phau-thuat-thay-khop-va-chinh-hinh\/","title":{"rendered":"Ph\u1ee5c h\u1ed3i bi\u00ean \u0111\u1ed9 g\u1eadp g\u1ed1i t\u1ed1i \u0111a sau ph\u1eabu thu\u1eadt thay kh\u1edbp v\u00e0 ch\u1ec9nh h\u00ecnh"},"content":{"rendered":"<h2>Y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i v\u1eadn \u0111\u1ed9ng sau ph\u1eabu thu\u1eadt<\/h2>\n<p>Sau c\u00e1c can thi\u1ec7p ph\u1eabu thu\u1eadt l\u1edbn nh\u01b0 thay kh\u1edbp g\u1ed1i ho\u1eb7c x\u1eed l\u00fd g\u00e3y x\u01b0\u01a1ng \u0111\u00f9i, vi\u1ec7c kh\u00f4i ph\u1ee5c l\u1ea1i ph\u1ea1m vi chuy\u1ec3n \u0111\u1ed9ng (ROM) l\u00e0 m\u1ed9t trong nh\u1eefng m\u1ee5c ti\u00eau h\u00e0ng \u0111\u1ea7u. Tuy nhi\u00ean, nhi\u1ec1u b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam kh\u1edbp tho\u00e1i h\u00f3a ph\u00e1t sinh sau ch\u1ea5n th\u01b0\u01a1ng g\u00e3y x\u01b0\u01a1ng th\u01b0\u1eddng l\u00e0 ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i v\u00e0 kh\u00f4ng ph\u1ea3i l\u00e0 \u1ee9ng vi\u00ean l\u00fd t\u01b0\u1edfng cho ph\u1eabu thu\u1eadt thay kh\u1edbp g\u1ed1i. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, c\u00e1c b\u00e1c s\u0129 s\u1ebd c\u00e2n nh\u1eafc k\u1ef9 l\u01b0\u1ee1ng gi\u1eefa ph\u01b0\u01a1ng ph\u00e1p ch\u1ec9nh h\u00ecnh x\u01b0\u01a1ng (osteotomy) \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh l\u1ec7ch tr\u1ee5c v\u00e0 ph\u1eabu thu\u1eadt thay kh\u1edbp to\u00e0n ph\u1ea7n t\u00f9y theo m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng c\u1ee7a c\u00e1c ng\u0103n kh\u1edbp [1].<\/p>\n<p>Vi\u1ec7c ra quy\u1ebft \u0111\u1ecbnh ph\u1eabu thu\u1eadt ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1 quan tr\u1ecdng bao g\u1ed3m: tu\u1ed5i t\u00e1c, ph\u1ea1m vi chuy\u1ec3n \u0111\u1ed9ng ban \u0111\u1ea7u, s\u1ef1 hi\u1ec7n di\u1ec7n hay v\u1eafng m\u1eb7t c\u1ee7a co g\u1eadp g\u1ed1i (flexion contracture), v\u00e0 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng. \u0110\u1eb7c bi\u1ec7t, b\u1ea3o t\u1ed3n ho\u1eb7c kh\u00f4i ph\u1ee5c c\u01a1 ch\u1ebf k\u00e9o c\u0103ng khu\u1ef7u tay (extensor mechanism) \u0111\u00f3ng vai tr\u00f2 then ch\u1ed1t trong vi\u1ec7c \u0111\u1ea1t \u0111\u01b0\u1ee3c g\u1eadp g\u1ed1i ch\u1ee7 \u0111\u1ed9ng [1][6].<\/p>\n<h2>K\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt v\u00e0 c\u1ed1 \u0111\u1ecbnh \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a v\u1eadn \u0111\u1ed9ng<\/h2>\n<p>Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng \u0111\u00f9i \u0111o\u1ea1n d\u01b0\u1edbi, ti\u1ebfn b\u1ed9 v\u1ec1 sinh h\u1ecdc v\u00e0 k\u1ef9 thu\u1eadt c\u1ed1 \u0111\u1ecbnh \u0111\u00e3 gi\u00fap k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea1t m\u1ee9c t\u1ed1t ho\u1eb7c xu\u1ea5t s\u1eafc \u1edf 80% ca b\u1ec7nh. Tuy nhi\u00ean, c\u00e1c v\u1ea5n \u0111\u1ec1 nh\u01b0 m\u1ea5t m\u00e1t x\u01b0\u01a1ng, t\u1ed5n th\u01b0\u01a1ng c\u01a1 ch\u1ebf k\u00e9o c\u0103ng khu\u1ef7u tay v\u00e0 c\u1ee9ng kh\u1edbp sau ph\u1eabu thu\u1eadt v\u1eabn c\u1ea7n \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u th\u00eam \u0111\u1ec3 c\u1ea3i thi\u1ec7n ph\u1ee5c h\u1ed3i v\u1eadn \u0111\u1ed9ng [1].<\/p>\n<p>\u0110\u1ed1i v\u1edbi k\u1ef9 thu\u1eadt c\u1ed1 \u0111\u1ecbnh b\u1eb1ng b\u1ea3ng (plate fixation), n\u1ebfu \u1ed5n \u0111\u1ecbnh \u0111\u1ea1t \u0111\u01b0\u1ee3c th\u00ec kh\u00f4ng c\u1ea7n d\u00f9ng n\u1eb9p ho\u1eb7c khung g\u1eadp. Vi\u1ec7c b\u1eaft \u0111\u1ea7u c\u00e1c b\u00e0i t\u1eadp chuy\u1ec3n \u0111\u1ed9ng s\u1edbm ngay l\u1eadp t\u1ee9c l\u00e0 r\u1ea5t quan tr\u1ecdng nh\u1eb1m tr\u00e1nh c\u1ee9ng kh\u1edbp li\u00ean quan \u0111\u1ebfn s\u1eb9o h\u00f3a c\u01a1 b\u1eafp. V\u1ec1 v\u1ea5n \u0111\u1ec1 mang n\u1eb7ng, n\u00f3 th\u01b0\u1eddng \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u khi c\u00f3 d\u1ea5u hi\u1ec7u l\u00e0nh x\u01b0\u01a1ng tr\u00ean phim X-quang, c\u00f3 th\u1ec3 s\u1edbm sau 6 tu\u1ea7n n\u1ebfu c\u00f3 callus h\u00ecnh th\u00e0nh [2].<\/p>\n<h3>Quy tr\u00ecnh hai giai \u0111o\u1ea1n v\u00e0 k\u1ebft h\u1ee3p ph\u1eabu thu\u1eadt<\/h3>\n<p>\u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p bi\u1ebfn d\u1ea1ng kh\u1edbp g\u1ed1i nghi\u00eam tr\u1ecdng (g\u00f3c &gt;15\u00b0), vi\u1ec7c th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt thay kh\u1edbp to\u00e0n ph\u1ea7n (TKA) sau khi \u0111\u00e3 th\u1ef1c hi\u1ec7n ch\u1ec9nh h\u00ecnh x\u01b0\u01a1ng (osteotomy) c\u00f3 th\u1ec3 l\u00e0 l\u1ef1a ch\u1ecdn. Ph\u01b0\u01a1ng ph\u00e1p hai giai \u0111o\u1ea1n n\u00e0y cho ph\u00e9p duy tr\u00ec m\u1ee9c \u0111\u1ed9 kh\u1edbp, d\u00e2y ch\u1eb1ng ch\u00e9o sau (PCL) v\u00e0 chi\u1ec1u cao s\u1ee5n b\u00e1nh ch\u00e8 m\u1ed9t c\u00e1ch t\u1ed1t h\u01a1n [4].<\/p>\n<p>M\u1eb7c d\u00f9 ph\u01b0\u01a1ng ph\u00e1p hai giai \u0111o\u1ea1n gi\u1ea3m thi\u1ec3u r\u1ee7i ro nhi\u1ec5m tr\u00f9ng v\u00e0 x\u00e2m l\u1ea5n so v\u1edbi ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p, nh\u01b0ng n\u00f3 \u0111\u00f2i h\u1ecfi hai l\u1ea7n g\u00e2y m\u00ea v\u00e0 hai chu k\u1ef3 ph\u1ee5c h\u1ed3i. Do \u0111\u00f3, vi\u1ec7c k\u1ebft h\u1ee3p ch\u1ec9nh h\u00ecnh x\u01b0\u01a1ng v\u00e0 thay kh\u1edbp trong c\u00f9ng m\u1ed9t ca ph\u1eabu thu\u1eadt l\u00e0 m\u1ed9t th\u1ee7 thu\u1eadt ph\u1ee9c t\u1ea1p nh\u1eb1m tr\u00e1nh c\u00e1c nh\u01b0\u1ee3c \u0111i\u1ec3m n\u00e0y [9][10].<\/p>\n<h2>Ch\u0103m s\u00f3c h\u1eadu ph\u1eabu \u0111\u1ec3 \u0111\u1ea1t bi\u00ean \u0111\u1ed9 g\u1eadp g\u1ed1i t\u1ed1i \u0111a<\/h2>\n<p>Sau khi c\u1ed1 \u0111\u1ecbnh n\u1ed9i ti\u1ebft ch\u1eafc ch\u1eafn, chi d\u01b0\u1edbi th\u01b0\u1eddng \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 trong n\u1eb9p g\u1eadp khu\u1ef7u cho \u0111\u1ebfn khi v\u1ebft th\u01b0\u01a1ng l\u00e0nh. N\u1ebfu kh\u00f4ng, m\u1ed9t c\u00e1i cast d\u00e0i ch\u00e2n v\u1edbi kh\u1edbp g\u1ed1i \u1edf t\u01b0 th\u1ebf m\u1edf r\u1ed9ng s\u1ebd \u0111\u01b0\u1ee3c \u0111eo trong 4 tu\u1ea7n [8]. Vi\u1ec7c b\u1eaft \u0111\u1ea7u c\u00e1c b\u00e0i t\u1eadp \u0111\u1ed9ng t\u00e1c ch\u1ee7 \u0111\u1ed9ng v\u00e0 th\u1ee5 \u0111\u1ed9ng s\u1edbm gi\u00fap ng\u0103n ch\u1eb7n s\u1ef1 h\u00ecnh th\u00e0nh s\u1eb9o c\u1ee9ng kh\u1edbp.<\/p>\n<p>\u0110\u1ed1i v\u1edbi ph\u1eabu thu\u1eadt thay kh\u1edbp vai th\u1ea5t b\u1ea1i ho\u1eb7c c\u00e1c tr\u01b0\u1eddng h\u1ee3p ph\u1ee9c t\u1ea1p kh\u00e1c, m\u1ee5c ti\u00eau ph\u1ee5c h\u1ed3i c\u0169ng bao g\u1ed3m kh\u00f4i ph\u1ee5c ch\u1ee9c n\u0103ng v\u00e0 v\u1eadn \u0111\u1ed9ng. B\u1ea3o v\u1ec7 s\u1eeda ch\u1eefa c\u01a1 d\u01b0\u1edbi c\u00e1nh tay (subscapularis) l\u00e0 nguy\u00ean t\u1eafc governing c\u1ee7a h\u1ea7u h\u1ebft c\u00e1c giao th\u1ee9c ph\u1ee5c h\u1ed3i [3].<\/p>\n<h2>\u0110\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 b\u1eb1ng thang \u0111i\u1ec3m ch\u1ee9c n\u0103ng<\/h2>\n<p>K\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt kh\u00f4ng ch\u1ec9 d\u1ef1a tr\u00ean \u0111o l\u01b0\u1eddng kh\u00e1ch quan m\u00e0 c\u00f2n \u0111\u00e1nh gi\u00e1 c\u1ea3m nh\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n. C\u00e1c thang \u0111i\u1ec3m th\u01b0\u1eddng bao g\u1ed3m: s\u1ef1 th\u1eb3ng h\u00e0ng v\u00e0 m\u1ea5t \u1ed5n \u0111\u1ecbnh (chi\u1ebfm 50 \u0111i\u1ec3m), ph\u1ea1m vi chuy\u1ec3n \u0111\u1ed9ng \u0111\u01b0\u1ee3c t\u00ednh b\u1eb1ng 1 \u0111i\u1ec3m cho m\u1ed7i 5 \u0111\u1ed9 cung chuy\u1ec3n \u0111\u1ed9ng t\u1ed5ng c\u1ed9ng, tr\u1eeb \u0111i \u0111i\u1ec3m cho co g\u1eadp g\u1ed1i v\u00e0 tr\u1ec5 m\u1edf r\u1ed9ng [5].<\/p>\n<p>Ph\u1ea1m vi chuy\u1ec3n \u0111\u1ed9ng th\u1ef1c t\u1ebf c\u1ee7a kh\u1edbp c\u1ed5 ch\u00e2n sau ph\u1eabu thu\u1eadt thay kh\u1edbp \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn t\u0103ng t\u1eeb trung b\u00ecnh 18.5 \u0111\u1ed9 l\u00ean 23.4 \u0111\u1ed9, tuy nhi\u00ean c\u00e1c \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng v\u1ec1 ph\u1ea1m vi chuy\u1ec3n \u0111\u1ed9ng th\u01b0\u1eddng kh\u00f3 t\u00e1i t\u1ea1o v\u00e0 c\u00f3 th\u1ec3 kh\u00f4ng ch\u00ednh x\u00e1c trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 c\u1ea3i thi\u1ec7n th\u1ef1c s\u1ef1 [7].<\/p>\n<h2>K\u1ebft lu\u1eadn<\/h2>\n<p>T\u00f3m l\u1ea1i, \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c bi\u00ean \u0111\u1ed9 g\u1eadp g\u1ed1i t\u1ed1i \u0111a sau ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh ho\u1eb7c thay kh\u1edbp, c\u1ea7n k\u1ebft h\u1ee3p gi\u1eefa l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt ph\u00f9 h\u1ee3p (ch\u1ec9nh h\u00ecnh hay thay kh\u1edbp), k\u1ef9 thu\u1eadt c\u1ed1 \u0111\u1ecbnh ch\u1eafc ch\u1eafn v\u00e0 quy tr\u00ecnh ch\u0103m s\u00f3c h\u1eadu ph\u1eabu t\u1eadp trung v\u00e0o v\u1eadn \u0111\u1ed9ng s\u1edbm. C\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 b\u1ea3o t\u1ed3n c\u01a1 ch\u1ebf k\u00e9o c\u0103ng khu\u1ef7u tay, ki\u1ec3m so\u00e1t nhi\u1ec5m tr\u00f9ng v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111a chi\u1ec1u v\u1ec1 ch\u1ee9c n\u0103ng s\u1ebd quy\u1ebft \u0111\u1ecbnh th\u00e0nh c\u00f4ng c\u1ee7a qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<ul>\n<li>[1] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 2914<\/li>\n<li>[2] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 2810<\/li>\n<li>[3] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 757<\/li>\n<li>[4] Osteotomies around the Knee, 1st Edition, 2008, trang 242<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 510<\/li>\n<li>[6] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1133<\/li>\n<li>[7] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 645<\/li>\n<li>[8] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1040<\/li>\n<li>[9] Osteotomies around the Knee, 1st Edition, 2008, trang 241<\/li>\n<li>[10] Osteotomies around the Knee, 1st Edition, 2008, trang 242<\/li>\n<\/ul>\n<p><!-- aiwriter:7b60d3c9acd145aaa31e063f --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ph\u1ee5c h\u1ed3i v\u1eadn \u0111\u1ed9ng, k\u1ef9 thu\u1eadt c\u1ed1 \u0111\u1ecbnh n\u1ed9i ti\u1ebft v\u00e0 quy tr\u00ecnh ch\u0103m s\u00f3c h\u1eadu ph\u1eabu \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c bi\u00ean \u0111\u1ed9 g\u1eadp g\u1ed1i t\u1ed1i \u01b0u.<\/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-346","post","type-post","status-publish","format-standard","hentry","category-thay-khop"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - 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