V\u1ea5n \u0111\u1ec1 ch\u1ea5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng s\u00ean m\u00e1c tr\u01b0\u1edbc (ACL) \u1edf tr\u1ebb em ch\u01b0a tr\u01b0\u1edfng th\u00e0nh \u0111\u00f2i h\u1ecfi ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c bi\u1ec7t nh\u1eb1m tr\u00e1nh l\u00e0m t\u1ed5n th\u01b0\u01a1ng v\u00f9ng sinh l\u00fd. M\u1ed9t trong nh\u1eefng k\u1ef9 thu\u1eadt ti\u00ean ti\u1ebfn nh\u1ea5t \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong c\u00e1c t\u00e0i li\u1ec7u ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh hi\u1ec7n \u0111\u1ea1i l\u00e0 Ph\u1eabu thu\u1eadt n\u1ed9i soi t\u00e1i t\u1ea1o d\u00e2y ch\u1eb1ng s\u00ean m\u00e1c tr\u01b0\u1edbc b\u1ea3o t\u1ed3n sinh l\u00fd<\/strong> (Physeal-sparing reconstruction). Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y, do Kocher, Garg v\u00e0 Micheli ph\u00e1t tri\u1ec3n, k\u1ebft h\u1ee3p gi\u1eefa s\u1eeda ch\u1eefa n\u1ed9i kh\u1edbp v\u00e0 ngo\u1ea1i kh\u1edbp nh\u1eb1m ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng m\u00e0 kh\u00f4ng l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a x\u01b0\u01a1ng [1].<\/p>\n K\u1ef9 thu\u1eadt n\u00e0y s\u1eed d\u1ee5ng gh\u00e9p t\u1ef1 th\u00e2n t\u1eeb d\u00e2y r\u1ed1n (iliotibial band) \u0111\u1ec3 t\u00e1i t\u1ea1o d\u00e2y ch\u1eb1ng. Quy tr\u00ecnh b\u1eaft \u0111\u1ea7u b\u1eb1ng vi\u1ec7c x\u00e1c nh\u1eadn s\u1ef1 suy y\u1ebfu c\u1ee7a d\u00e2y ch\u1eb1ng d\u01b0\u1edbi t\u00e1c d\u1ee5ng g\u00e2y m\u00ea t\u1ed5ng h\u1ee3p [1]. Ti\u1ebfp theo, m\u1ed9t v\u1ebft c\u1eaft kho\u1ea3ng 6 cm \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n theo h\u01b0\u1edbng ch\u00e9o t\u1eeb \u0111\u01b0\u1eddng kh\u1edbp \u0111\u1ebfn bi\u00ean tr\u00ean c\u1ee7a d\u00e2y r\u1ed1n \u1edf m\u1eb7t ngo\u00e0i \u0111\u00f9i. D\u00e2y r\u1ed1n sau \u0111\u00f3 \u0111\u01b0\u1ee3c t\u00e1ch ra kh\u1ecfi m\u00f4 d\u01b0\u1edbi da \u1edf ph\u1ea7n g\u1ea7n (proximal) nh\u01b0ng v\u1eabn gi\u1eef nguy\u00ean v\u1ecb tr\u00ed g\u1eafn li\u1ec1n \u1edf ph\u1ea7n xa (distal) t\u1ea1i \u0111i\u1ec3m Tubercle Gerdy [1].<\/p>\n Gh\u00e9p d\u00e2y r\u1ed1n \u0111\u01b0\u1ee3c k\u00e9o c\u0103ng v\u00e0 \u0111\u01b0a v\u00e0o kh\u1edbp. Vi\u1ec7c c\u1ed1 \u0111\u1ecbnh \u0111\u1ea7u g\u1ea7n c\u1ee7a gh\u00e9p th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch g\u1eafn n\u00f3 v\u00e0o m\u00e0ng ngo\u00e0i x\u01b0\u01a1ng (periosteum) c\u1ee7a x\u01b0\u01a1ng ch\u00e0y tr\u01b0\u1edbc, s\u1eed d\u1ee5ng nhi\u1ec1u m\u0169i ch\u1ec9 s\u1ed1 1 Ethibond v\u1edbi k\u1ef9 thu\u1eadt kh\u00e2u h\u00ecnh ch\u1eef t\u00e1m (figure-of-eight stitches) [2]. \u0110\u1ed1i v\u1edbi ph\u1ea7n \u0111\u1ea7u xa, c\u00e1c ch\u1ec9 FiberWire s\u1ed1 5 \u0111\u01b0\u1ee3c bu\u1ed9c qua v\u00edt tibia \u0111\u1eb7t \u1edf v\u1ecb tr\u00ed gi\u1eefa m\u00e0ng sinh l\u00fd ch\u00e0y v\u00e0 th\u1ea5p h\u01a1n \u0111\u1ea7u ph\u00e1t tri\u1ec3n c\u1ee7a x\u01b0\u01a1ng [2].<\/p>\n \u0110\u1ec3 \u0111\u1ea3m b\u1ea3o kh\u1edbp ho\u1ea1t \u0111\u1ed9ng t\u1ed1t, ph\u1eabu thu\u1eadt vi\u00ean c\u1ea7n ki\u1ec3m tra n\u1ed9i soi xem c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng va ch\u1ea1m c\u1ee7a gh\u00e9p v\u00e0o khe gi\u1eefa c\u00e1c s\u00ean kh\u00f4ng. Th\u00f4ng th\u01b0\u1eddng, vi\u1ec7c c\u1eaft b\u1edbt ph\u1ea7n tr\u01b0\u1edbc c\u1ee7a khe n\u00e0y l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft tr\u1eeb khi gh\u00e9p g\u00e2y ch\u00e8n \u00e9p r\u00f5 r\u1ec7t trong t\u01b0 th\u1ebf du\u1ed7i ho\u00e0n to\u00e0n [2]. Cu\u1ed1i c\u00f9ng, m\u00f4 d\u01b0\u1edbi da v\u00e0 da \u0111\u01b0\u1ee3c \u0111\u00f3ng l\u1ea1i theo quy tr\u00ecnh th\u00f4ng th\u01b0\u1eddng, sau \u0111\u00f3 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111eo n\u1eb9p c\u00f3 kh\u1edbp (hinged brace) \u0111\u1ec3 h\u1ed7 tr\u1ee3 ph\u1ee5c h\u1ed3i [1].<\/p>\n Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y l\u00e0 m\u1ed9t s\u1ef1 c\u1ea3i ti\u1ebfn so v\u1edbi c\u00e1c k\u1ef9 thu\u1eadt k\u1ebft h\u1ee3p n\u1ed9i v\u00e0 ngo\u1ea1i kh\u1edbp truy\u1ec1n th\u1ed1ng c\u1ee7a MacIntosh v\u00e0 Darby, ch\u1ee7 y\u1ebfu b\u1eb1ng c\u00e1ch \u00e1p d\u1ee5ng cho b\u1ec7nh nh\u00e2n c\u00f3 x\u01b0\u01a1ng ch\u01b0a tr\u01b0\u1edfng th\u00e0nh, h\u1ed7 tr\u1ee3 ph\u1eabu thu\u1eadt n\u1ed9i soi, k\u1ef9 thu\u1eadt c\u1ed1 \u0111\u1ecbnh gh\u00e9p v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng gia t\u1ed1c [1]. Vi\u1ec7c ph\u1ee5c h\u1ed3i ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh ph\u00f9 h\u1ee3p v\u1edbi \u0111\u1ed9 tu\u1ed5i c\u1ee7a tr\u1ebb em \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng c\u1ee7a kh\u1edbp g\u1ed1i trong t\u01b0\u01a1ng lai.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" T\u00ecm hi\u1ec3u v\u1ec1 k\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt n\u1ed9i soi t\u00e1i t\u1ea1o d\u00e2y ch\u1eb1ng s\u00ean m\u00e1c tr\u01b0\u1edbc (ACL) b\u1ea3o t\u1ed3n sinh l\u00fd, \u0111\u1eb7c bi\u1ec7t d\u00e0nh cho tr\u1ebb em ch\u01b0a tr\u01b0\u1edfng th\u00e0nh, s\u1eed d\u1ee5ng gh\u00e9p d\u00e2y r\u1ed1n.<\/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-371","post","type-post","status-publish","format-standard","hentry","category-noi-soi-khop"],"yoast_head":"\nK\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng gh\u00e9p d\u00e2y r\u1ed1n<\/h3>\n
Vi\u1ec7c c\u1ed1 \u0111\u1ecbnh v\u00e0 ho\u00e0n thi\u1ec7n ph\u1eabu thu\u1eadt<\/h3>\n
L\u1ee3i \u00edch c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p b\u1ea3o t\u1ed3n sinh l\u00fd<\/h3>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
\n