Vi\u00eam kh\u1edbp nhi\u1ec5m khu\u1ea9n (septic arthritis) l\u00e0 t\u00ecnh tr\u1ea1ng c\u1ea5p c\u1ee9u c\u1ea7n can thi\u1ec7p s\u1edbm nh\u1eb1m ng\u0103n ng\u1eeba t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng v\u00e0 m\u1ea5t ch\u1ee9c n\u0103ng kh\u1edbp. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam kh\u1edbp nhi\u1ec5m khu\u1ea9n giai \u0111o\u1ea1n s\u1edbm, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 ch\u1ecbu \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt, ph\u01b0\u01a1ng ph\u00e1p n\u1ed9i soi kh\u1edbp \u0111\u00e3 tr\u1edf th\u00e0nh l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u thay th\u1ebf cho ph\u1eabu thu\u1eadt m\u1edf truy\u1ec1n th\u1ed1ng.<\/p>\n
N\u1ed9i soi kh\u1edbp cho ph\u00e9p th\u1ef1c hi\u1ec7n r\u1eeda kh\u1edbp v\u00e0 c\u1eaft b\u1ecf m\u00f4 vi\u00eam (synovectomy) d\u01b0\u1edbi t\u1ea7m nh\u00ecn tr\u1ef1c ti\u1ebfp, mang l\u1ea1i k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ph\u01b0\u01a1ng ph\u00e1p m\u1edf nh\u01b0ng c\u00f3 m\u1ee9c \u0111\u1ed9 x\u00e2m l\u1ea5n th\u1ea5p h\u01a1n [1]. \u0110\u1ed1i v\u1edbi c\u00e1c kh\u1edbp l\u1edbn nh\u01b0 \u0111\u1ea7u g\u1ed1i, vai, c\u1ed5 tay v\u00e0 m\u1eaft c\u00e1 ch\u00e2n, k\u1ef9 thu\u1eadt n\u00e0y gi\u00fap gi\u1ea3m thi\u1ec3u t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m xung quanh, h\u1ea1n ch\u1ebf bi\u1ebfn ch\u1ee9ng d\u00ednh kh\u1edbp v\u00e0 r\u00fat ng\u1eafn th\u1eddi gian n\u1eb1m vi\u1ec7n so v\u1edbi ph\u1eabu thu\u1eadt m\u1edf truy\u1ec1n th\u1ed1ng.<\/p>\n
K\u1ef9 thu\u1eadt r\u1eeda kh\u1edbp n\u1ed9i soi n\u00ean \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam nhi\u1ec5m c\u1ea5p t\u00ednh di\u1ec5n ra s\u1edbm, c\u1ee5 th\u1ec3 l\u00e0 tr\u01b0\u1edbc 2 tu\u1ea7n k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t c\u1ee7a b\u1ec7nh (giai \u0111o\u1ea1n I ho\u1eb7c II theo ph\u00e2n lo\u1ea1i G\u00e4chter) [2]. Vi\u1ec7c can thi\u1ec7p mu\u1ed9n c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng t\u00e1i ph\u00e1t v\u00e0 c\u1ea7n ph\u1ea3i ph\u1eabu thu\u1eadt l\u1ea1i nhi\u1ec1u l\u1ea7n. \u0110\u00e1nh gi\u00e1 h\u00ecnh \u1ea3nh b\u1eb1ng MRI ho\u1eb7c CT gi\u00fap x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed \u1ed5 abscess, \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng khi c\u00f3 tr\u00e0n d\u1ecbch sau kh\u1edbp (popliteal abscess) \u1edf \u0111\u1ea7u g\u1ed1i ho\u1eb7c c\u00e1c bi\u1ebfn ch\u1ee9ng ph\u1ee9c t\u1ea1p kh\u00e1c.<\/p>\n
Quy tr\u00ecnh ph\u1eabu thu\u1eadt n\u1ed9i soi th\u01b0\u1eddng bao g\u1ed3m c\u00e1c b\u01b0\u1edbc ch\u00ednh: aspirate \u0111\u1ec3 l\u1ea5y d\u1ecbch kh\u1edbp, r\u1eeda s\u1ea1ch b\u1eb1ng dung d\u1ecbch mu\u1ed1i sinh l\u00fd ho\u1eb7c dung d\u1ecbch ph\u1ed1i h\u1ee3p kh\u00e1ng sinh, v\u00e0 c\u1eaft b\u1ecf m\u00f4 vi\u00eam d\u01b0\u1edbi t\u1ea7m nh\u00ecn tr\u1ef1c ti\u1ebfp [3]. \u0110\u1ed1i v\u1edbi kh\u1edbp g\u1ed1i, k\u1ef9 thu\u1eadt ba c\u1eeda (anterior, posterior, superior) cho ph\u00e9p ti\u1ebfp c\u1eadn g\u1ea7n nh\u01b0 to\u00e0n b\u1ed9 khoang kh\u1edbp. T\u1ea1i vai, v\u1ecb tr\u00ed \u0111\u1eb7t kim aspirate th\u01b0\u1eddng n\u1eb1m \u1edf kho\u1ea3ng c\u00e1ch b\u1eb1ng m\u1ed9t n\u1eeda gi\u1eefa qu\u00e1 tr\u00ecnh coracoid v\u00e0 r\u00eca ngo\u00e0i tr\u01b0\u1edbc c\u1ee7a m\u1ecfm acromion [5].<\/p>\n
Trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam nhi\u1ec5m ph\u1ee9c t\u1ea1p ho\u1eb7c c\u00f3 \u1ed5 abscess l\u1edbn, ph\u1eabu thu\u1eadt m\u1edf v\u1eabn l\u00e0 l\u1ef1a ch\u1ecdn khi c\u1ea7n thi\u1ebft. V\u00ed d\u1ee5, t\u1ea1i kh\u1edbp g\u1ed1i, n\u1ebfu khoang sau b\u1ecb c\u0103ng ph\u1ed3ng nghi\u00eam tr\u1ecdng, c\u00e1c c\u1eaft ngang song song k\u1ebft h\u1ee3p v\u1edbi c\u00e1c v\u1ebft c\u1eaft Henderson (posterolateral v\u00e0 posteromedial) th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng [4]. Ng\u01b0\u1ee3c l\u1ea1i, t\u1ea1i kh\u1edbp c\u1ed5 tay ho\u1eb7c m\u1eaft c\u00e1 ch\u00e2n, n\u1ed9i soi c\u0169ng l\u00e0 ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 tr\u00e1nh bi\u1ebfn ch\u1ee9ng nh\u01b0 b\u1ea5t \u0111\u1ed9ng kh\u1edbp ho\u1eb7c vi\u00eam bao g\u00e2n.<\/p>\n
T\u00f3m l\u1ea1i, n\u1ed9i soi \u0111i\u1ec1u tr\u1ecb vi\u00eam kh\u1edbp nhi\u1ec5m khu\u1ea9n giai \u0111o\u1ea1n s\u1edbm l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3, ph\u00f9 h\u1ee3p v\u1edbi nhi\u1ec1u lo\u1ea1i kh\u1edbp kh\u00e1c nhau. S\u1ef1 th\u00e0nh c\u00f4ng c\u1ee7a k\u1ef9 thu\u1eadt n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm, l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n ph\u00f9 h\u1ee3p v\u00e0 th\u1ef1c hi\u1ec7n \u0111\u00fang quy tr\u00ecnh r\u1eeda kh\u1edbp c\u00f9ng c\u1eaft b\u1ecf m\u00f4 vi\u00eam d\u01b0\u1edbi t\u1ea7m nh\u00ecn tr\u1ef1c ti\u1ebfp.<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
N\u1ed9i soi kh\u1edbp l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u01b0u vi\u1ec7t \u0111\u1ec3 x\u1eed tr\u00ed vi\u00eam kh\u1edbp nhi\u1ec5m khu\u1ea9n giai \u0111o\u1ea1n s\u1edbm, mang l\u1ea1i k\u1ebft qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng ph\u1eabu thu\u1eadt m\u1edf v\u1edbi \u00edt x\u00e2m l\u1ea5n h\u01a1n.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-370","post","type-post","status-publish","format-standard","hentry","category-noi-soi-khop"],"yoast_head":"\n