{"id":389,"date":"2026-10-11T17:59:28","date_gmt":"2026-10-11T10:59:28","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/11\/chan-doan-va-dieu-tri-dau-vung-cung-cut-coccydynia-phan-loai-hinh-thai-hoc-va-can-thiep\/"},"modified":"2026-10-11T17:59:28","modified_gmt":"2026-10-11T10:59:28","slug":"chan-doan-va-dieu-tri-dau-vung-cung-cut-coccydynia-phan-loai-hinh-thai-hoc-va-can-thiep","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/11\/chan-doan-va-dieu-tri-dau-vung-cung-cut-coccydynia-phan-loai-hinh-thai-hoc-va-can-thiep\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111au v\u00f9ng c\u00f9ng c\u1ee5t (Coccydynia): Ph\u00e2n lo\u1ea1i h\u00ecnh th\u00e1i h\u1ecdc v\u00e0 can thi\u1ec7p"},"content":{"rendered":"<p>\u0110au t\u1ea1i v\u00f9ng c\u00f9ng c\u1ee5t (coccydynia) l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng ph\u1ed5 bi\u1ebfn trong chuy\u00ean khoa ch\u1ec9nh h\u00ecnh, th\u01b0\u1eddng \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u00e0 c\u01a1n \u0111au ngay l\u1eadp t\u1ee9c, d\u1eef d\u1ed9i sau ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp ho\u1eb7c do t\u1ed5n th\u01b0\u01a1ng t\u00edch l\u0169y t\u1eeb t\u01b0 th\u1ebf ng\u1ed3i l\u00e2u. Kh\u00e1c v\u1edbi c\u00e1c g\u00e3y x\u01b0\u01a1ng kh\u00e1c c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh qua X-quang th\u00f4ng th\u01b0\u1eddng, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n g\u00e3y c\u00f9ng c\u1ee5t hay ch\u1ee9ng \u0111au c\u00f9ng c\u1ee5t (coccydynia) \u0111\u00f2i h\u1ecfi s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa kh\u00e1m l\u00e2m s\u00e0ng k\u1ef9 l\u01b0\u1ee1ng v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc \u0111\u1eb7c bi\u1ec7t.<\/p>\n<h2>Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng v\u00e0 vai tr\u00f2 c\u1ee7a h\u00ecnh \u1ea3nh h\u1ecdc<\/h2>\n<p>Radiograph th\u00f4ng th\u01b0\u1eddng kh\u00f3 x\u00e1c \u0111\u1ecbnh g\u00e3y x\u01b0\u01a1ng c\u00f9ng do c\u1ea5u tr\u00fac ph\u1ee9c t\u1ea1p g\u1ed3m nhi\u1ec1u \u0111o\u1ea1n nh\u1ecf, s\u1ee5n v\u00e0 x\u01b0\u01a1ng b\u1ecb che khu\u1ea5t b\u1edfi m\u00f4 m\u1ec1m [1]. Tuy nhi\u00ean, x\u00e9t nghi\u1ec7m n\u1ed9i tr\u1ef1c tr\u00e0ng k\u1ef9 thu\u1eadt s\u1ed1 (digital rectal examination) c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111au d\u1eef d\u1ed9i khi \u1ea5n v\u00e0o v\u00f9ng c\u00f9ng c\u1ee5t v\u00e0 s\u1ef1 di \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng c\u1ee7a c\u00e1c m\u1ea3nh v\u1ee1 x\u01b0\u01a1ng [1]. \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c \u0111au m\u00e3n t\u00ednh, ch\u1ee5p X-quang b\u00ean (lateral radiographs) v\u1edbi h\u00f4ng g\u1eadp t\u1ed1i \u0111a gi\u00fap l\u1ed9 r\u00f5 g\u00e3y x\u01b0\u01a1ng ho\u1eb7c g\u00f3c xoay sau \u0111\u1ec9nh (apex posterior angulation), m\u1ed9t bi\u1ebfn th\u1ec3 b\u00ecnh th\u01b0\u1eddng c\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi t\u1ed5n th\u01b0\u01a1ng [1].<\/p>\n<p>B\u00ean c\u1ea1nh \u0111\u00f3, c\u00e1c nghi\u00ean c\u1ee9u ch\u1ec9 ra r\u1eb1ng ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3 (BMI) c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan v\u1edbi c\u1ea5u h\u00ecnh c\u00f9ng c\u1ee5t v\u00e0 lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng: b\u1ec7nh nh\u00e2n b\u00e9o ph\u00ec ch\u1ee7 y\u1ebfu b\u1ecb tho\u00e1i v\u1ecb sau, b\u1ec7nh nh\u00e2n c\u00e2n n\u1eb7ng b\u00ecnh th\u01b0\u1eddng c\u00f3 c\u00f9ng c\u1ee5t l\u1ecfng l\u1ebbo ho\u1eb7c b\u00ecnh th\u01b0\u1eddng tr\u00ean X-quang, trong khi b\u1ec7nh nh\u00e2n g\u1ea7y ch\u1ee7 y\u1ebfu b\u1ecb tho\u00e1i v\u1ecb tr\u01b0\u1edbc v\u00e0 c\u00f3 gai x\u01b0\u01a1ng [2]. Ch\u1ee5p MRI ho\u1eb7c qu\u00e9t x\u01b0\u01a1ng b\u1eb1ng Technetium-99m c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n vi\u00eam v\u00f9ng sacrococcygeal, h\u1ed7 tr\u1ee3 lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh l\u00fd ti\u1ec1m \u1ea9n nh\u01b0 u s\u1ee3i th\u1ea7n kinh (chordoma) [4].<\/p>\n<h3>Ph\u00e2n lo\u1ea1i h\u00ecnh th\u00e1i h\u1ecdc c\u1ee7a c\u00f9ng c\u1ee5t<\/h3>\n<p>\u0110\u1ec3 \u0111i\u1ec1u tr\u1ecb ch\u00ednh x\u00e1c, vi\u1ec7c ph\u00e2n lo\u1ea1i h\u00ecnh th\u00e1i h\u1ecdc c\u1ee7a c\u00f9ng c\u1ee5t \u0111\u00f3ng vai tr\u00f2 then ch\u1ed1t. C\u00e1c lo\u1ea1i bao g\u1ed3m:<\/p>\n<ul>\n<li><strong>Type I:<\/strong> L\u00f5m nh\u1eb9 v\u1ec1 ph\u00eda tr\u01b0\u1edbc.<\/li>\n<li><strong>Type II:<\/strong> \u0110\u01b0\u1eddng cong r\u00f5 r\u1ec7t v\u1edbi \u0111\u1ec9nh h\u01b0\u1edbng th\u1eb3ng ra tr\u01b0\u1edbc.<\/li>\n<li><strong>Type III:<\/strong> G\u00f3c nghi\u00eang m\u1ea1nh gi\u1eefa c\u00e1c \u0111o\u1ea1n 1-2 ho\u1eb7c 2-3.<\/li>\n<li><strong>Type IV:<\/strong> Tho\u00e1i v\u1ecb tr\u01b0\u1edbc \u1edf kh\u1edbp sacrococcygeal ho\u1eb7c li\u00ean k\u1ebft gi\u1eefa c\u00e1c \u0111o\u1ea1n.<\/li>\n<li><strong>Type V:<\/strong> Xoang ng\u01b0\u1ee3c c\u00f9ng c\u1ee5t (retroversion) k\u00e8m gai x\u01b0\u01a1ng [3].<\/li>\n<li><strong>Type VI:<\/strong> Bi\u1ebfn d\u1ea1ng c\u1ed9t s\u1ed1ng cong (scoliotic deformity).<\/li>\n<\/ul>\n<p>Sau khi lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c nh\u01b0 ung th\u01b0, l\u1eafng \u0111\u1ecdng tinh th\u1ec3 hay nhi\u1ec5m tr\u00f9ng, \u0111au c\u00f9ng c\u1ee5t \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean c\u01a1 ch\u1ebf l\u00e0 do tho\u00e1i h\u00f3a \u0111\u0129a v\u00e0 kh\u1edbp li\u00ean c\u00f9ng, ho\u1eb7c do c\u00e1c y\u1ebfu t\u1ed1 h\u00ecnh th\u00e1i v\u00e0 m\u1ee9c \u0111\u1ed9 di \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng [5].<\/p>\n<h2>Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb: T\u1eeb b\u1ea3o t\u1ed3n \u0111\u1ebfn ph\u1eabu thu\u1eadt<\/h2>\n<p>\u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u cho coccydynia bao g\u1ed3m NSAIDs v\u00e0 s\u1eed d\u1ee5ng \u0111\u1ec7m v\u00f2ng (donut cushion), ph\u01b0\u01a1ng ph\u00e1p n\u00e0y th\u00e0nh c\u00f4ng kho\u1ea3ng 90% c\u00e1c tr\u01b0\u1eddng h\u1ee3p [4]. Khi c\u00e1c bi\u1ec7n ph\u00e1p kh\u00f4ng x\u00e2m l\u1ea5n th\u1ea5t b\u1ea1i, ti\u00eam c\u1ee5c b\u1ed9 d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn hu\u1ef3nh quang v\u1edbi anesthetic v\u00e0 corticosteroid l\u00e0 l\u1ef1a ch\u1ecdn ti\u1ebfp theo. \u0110i\u1ec3m ti\u00eam th\u01b0\u1eddng nh\u1eafm v\u00e0o \u0111\u0129a t\u00e0n d\u01b0 t\u1ea1i v\u1ecb tr\u00ed \u0111au nh\u1ea5t [5].<\/p>\n<p>\u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1eb1ng ch\u1ee9ng h\u00ecnh \u1ea3nh v\u1ec1 m\u1ee9c \u0111\u1ed9 di \u0111\u1ed9ng qu\u00e1 m\u1ee9c ho\u1eb7c tho\u00e1i v\u1ecb, ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf \u0111o\u1ea1n c\u00f9ng c\u1ee5t linh ho\u1ea1t (excision of the mobile segment) ho\u1eb7c c\u1eaft to\u00e0n b\u1ed9 (coccygectomy) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh. T\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng c\u1ee7a ph\u1eabu thu\u1eadt dao \u0111\u1ed9ng t\u1eeb 60% \u0111\u1ebfn 91% trong nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y [6]. Tuy nhi\u00ean, k\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt kh\u00f4ng t\u1ed1t b\u1eb1ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c \u0111\u1ed9 di \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng v\u00e0 ch\u1ec9 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc khi \u0111au gi\u1ea3m t\u01b0\u01a1ng \u1ee9ng v\u1edbi th\u1eddi gian t\u00e1c d\u1ee5ng c\u1ee7a anesthetic c\u1ee5c b\u1ed9.<\/p>\n<p>Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t nh\u01b0 b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh (ankylosing spondylitis), g\u00e3y x\u01b0\u01a1ng d\u00f9 do ch\u1ea5n th\u01b0\u01a1ng nh\u1eb9 c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t l\u00e0 g\u00e3y th\u1ef1c s\u1ef1 do c\u1ea5u tr\u00fac b\u1ea5t \u1ed5n, \u0111\u00f2i h\u1ecfi c\u1ed1 \u0111\u1ecbnh ph\u1eabu thu\u1eadt ph\u1ee9c t\u1ea1p do nguy c\u01a1 bi\u1ebfn ch\u1ee9ng cao [7].<\/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 1384<\/li>\n<li>[2] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2421<\/li>\n<li>[3] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2421<\/li>\n<li>[4] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2421<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2421<\/li>\n<li>[6] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2421<\/li>\n<li>[7] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2421<\/li>\n<\/ul>\n<p><!-- aiwriter:40da1081742447e8bb625e15 --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110au v\u00f9ng c\u00f9ng c\u1ee5t hay coccydynia l\u00e0 ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng d\u1ef1a tr\u00ean h\u00ecnh th\u00e1i x\u01b0\u01a1ng c\u00f9ng, m\u1ee9c \u0111\u1ed9 di \u0111\u1ed9ng v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 li\u00ean quan \u0111\u1ebfn BMI.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12],"tags":[],"class_list":["post-389","post","type-post","status-publish","format-standard","hentry","category-chi-duoi"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - 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