{"id":397,"date":"2026-10-11T18:18:05","date_gmt":"2026-10-11T11:18:05","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/11\/chan-vong-kieng-o-nguoi-lon-nguyen-nhan-dau-hieu-va-phuong-phap-dieu-tri\/"},"modified":"2026-10-11T18:18:05","modified_gmt":"2026-10-11T11:18:05","slug":"chan-vong-kieng-o-nguoi-lon-nguyen-nhan-dau-hieu-va-phuong-phap-dieu-tri","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/11\/chan-vong-kieng-o-nguoi-lon-nguyen-nhan-dau-hieu-va-phuong-phap-dieu-tri\/","title":{"rendered":"Ch\u00e2n v\u00f2ng ki\u1ec1ng \u1edf ng\u01b0\u1eddi l\u1edbn: Nguy\u00ean nh\u00e2n, d\u1ea5u hi\u1ec7u v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Ch\u00e2n v\u00f2ng ki\u1ec1ng (g\u1ecdi l\u00e0 genu varum<\/strong> trong y h\u1ecdc) l\u00e0 m\u1ed9t d\u1ecb d\u1ea1ng x\u01b0\u01a1ng kh\u1edbp khi\u1ebfn c\u01a1 th\u1ec3 ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh b\u1ecb cong v\u1eb9o v\u1ec1 ph\u00eda trong. \u0110\u00e2y l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a nh\u01b0 vi\u00eam x\u01b0\u01a1ng th\u1eadn ho\u1eb7c c\u00e1c b\u1ec7nh l\u00fd di truy\u1ec1n kh\u00e1c [2]. \u0110\u1ec3 hi\u1ec3u r\u00f5 v\u1ec1 t\u00ecnh tr\u1ea1ng n\u00e0y, c\u1ea7n ph\u00e2n t\u00edch d\u1ef1a tr\u00ean c\u00e1c tr\u1ee5c gi\u1ea3i ph\u1eabu v\u00e0 \u0111\u01b0\u1eddng c\u01a1 h\u1ecdc c\u1ee7a chi d\u01b0\u1edbi.<\/p>\n

\u0110\u1ecbnh ngh\u0129a v\u00e0 ch\u1ec9 s\u1ed1 \u0111o l\u01b0\u1eddng \u0111\u1eb7c tr\u01b0ng<\/h2>\n

Trong tr\u01b0\u1eddng h\u1ee3p genu varum, g\u00f3c gi\u1eefa tr\u1ee5c gi\u1ea3i ph\u1eabu x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 tr\u1ee5c tr\u1ee5 x\u01b0\u01a1ng ch\u00e0y (aFTA) c\u00f3 gi\u00e1 tr\u1ecb l\u1edbn h\u01a1n 173\u2013175\u00b0 [1]. M\u1ed9t d\u1ea5u hi\u1ec7u quan tr\u1ecdng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 d\u1ecb d\u1ea1ng l\u00e0 \u0111\u01b0\u1eddng c\u01a1 h\u1ecdc (MAD). Khi c\u00f3 sai l\u1ec7ch \u0111\u00e1ng k\u1ec3 v\u1ec1 h\u01b0\u1edbng v\u1eb9o, \u0111\u01b0\u1eddng th\u1eb3ng \u0111i t\u1eeb t\u00e2m \u0111\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i \u0111\u1ebfn gi\u1eefa kh\u1edbp m\u1eaft c\u00e1 ch\u00e2n s\u1ebd ch\u1ea1y xa h\u01a1n 4 mm so v\u1edbi trung t\u00e2m kh\u1edbp g\u1ed1i, v\u00e0 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p nghi\u00eam tr\u1ecdng, s\u1ef1 l\u1ec7ch c\u1ee7a tr\u1ee5c c\u01a1 h\u1ecdc so v\u1edbi trung t\u00e2m kh\u1edbp g\u1ed1i s\u1ebd v\u01b0\u1ee3t qu\u00e1 15 mm v\u1ec1 ph\u00eda medial (trong) [1].<\/p>\n

B\u00ean c\u1ea1nh \u0111\u00f3, kho\u1ea3ng c\u00e1ch gi\u1eefa hai \u0111\u1ea7u x\u01b0\u01a1ng ch\u00e0y (intercondylar distance) th\u01b0\u1eddng t\u0103ng l\u00ean \u1edf b\u1ec7nh nh\u00e2n ch\u00e2n v\u00f2ng ki\u1ec1ng [1]. Ng\u01b0\u1ee3c l\u1ea1i, trong ch\u00e2n v\u1eb9o ngo\u00e0i (genu valgum), g\u00f3c aFTA nh\u1ecf h\u01a1n 173\u2013175\u00b0 v\u00e0 \u0111\u01b0\u1eddng Mikulicz ch\u1ea1y ra ph\u00eda b\u00ean ngo\u00e0i \u0111i\u1ec3m 4 mm. S\u1ef1 l\u1ec7ch tr\u1ee5c c\u01a1 h\u1ecdc t\u1ea1i genu valgum \u0111\u00e1ng k\u1ec3 th\u01b0\u1eddng l\u1edbn h\u01a1n 10 mm v\u1ec1 ph\u00eda lateral [1].<\/p>\n

Ph\u00e2n t\u00edch gi\u1ea3i ph\u1eabu v\u00e0 nguy\u00ean nh\u00e2n<\/h2>\n

C\u01a1 th\u1ec3 ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh b\u1ecb ch\u00e2n v\u00f2ng ki\u1ec1ng th\u01b0\u1eddng c\u00f3 s\u1ef1 bi\u1ebfn d\u1ea1ng \u0111\u1ed3ng th\u1eddi \u1edf x\u01b0\u01a1ng \u0111\u00f9i, x\u01b0\u01a1ng ch\u00e0y v\u00e0 x\u01b0\u01a1ng \u1ed1ng ch\u00e2n, trong \u0111\u00f3 ph\u1ea7n sau hai x\u01b0\u01a1ng n\u00e0y th\u01b0\u1eddng b\u1ecb cong n\u1eb7ng h\u01a1n [2]. Kh\u00f4ng ch\u1ec9 c\u00f3 s\u1ef1 cong v\u1eb9o v\u1ec1 m\u1eb7t b\u00ean, c\u00f2n c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng xo\u1eafn n\u1ed9i t\u1ea1i (internal torsion) c\u1ee7a x\u01b0\u01a1ng. S\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa c\u00e1c y\u1ebfu t\u1ed1 gi\u1ea3i ph\u1eabu v\u00e0 c\u01a1 h\u1ecdc t\u1ea1o n\u00ean d\u00e1ng \u0111i kh\u00f3 kh\u0103n \u0111\u1eb7c tr\u01b0ng cho b\u1ec7nh nh\u00e2n.<\/p>\n

N\u1ebfu x\u00e9t trong b\u1ed1i c\u1ea3nh c\u00e1c r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a nh\u01b0 vi\u00eam x\u01b0\u01a1ng th\u1eadn, vi\u1ec7c th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh l\u00e0 kh\u1ea3 thi nh\u01b0ng \u0111\u00f2i h\u1ecfi quy ho\u1ea1ch k\u1ef9 l\u01b0\u1ee1ng v\u00e0 \u1ed5n \u0111\u1ecbnh chuy\u1ec3n h\u00f3a tr\u01b0\u1edbc m\u1ed5 [2]. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u00e1p cao kh\u00e1ng tr\u1ecb th\u01b0\u1eddng c\u00f3 tu\u1ed5i th\u1ecd ng\u1eafn v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c xem l\u00e0 \u1ee9ng vi\u00ean cho ph\u1eabu thu\u1eadt. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u0111\u1ec3 c\u1ea3i thi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng tr\u00ean l\u00e2m s\u00e0ng c\u0169ng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 c\u1ea7n thi\u1ebft tr\u01b0\u1edbc khi can thi\u1ec7p ph\u1eabu thu\u1eadt [2].<\/p>\n

Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt<\/h2>\n

M\u1ee5c ti\u00eau ch\u00ednh c\u1ee7a ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh ch\u00e2n v\u00f2ng ki\u1ec1ng l\u00e0 s\u1eeda ch\u1eefa d\u1ecb d\u1ea1ng v\u00e0 s\u1eafp x\u1ebfp l\u1ea1i tr\u1ee5c \u0111\u1ec3 m\u1eb7t ph\u1eb3ng c\u1ee7a m\u1ed7i kh\u1edbp g\u1ed1i n\u1eb1m ngang ho\u00e0n to\u00e0n khi b\u1ec7nh nh\u00e2n \u0111\u1ee9ng [3]. Ph\u1eabu thu\u1eadt th\u01b0\u1eddng bao g\u1ed3m osteotomy (c\u1eaft x\u01b0\u01a1ng) \u1edf x\u01b0\u01a1ng ch\u00e0y v\u00e0 x\u01b0\u01a1ng \u1ed1ng ch\u00e2n g\u1ea7n \u0111\u1ec9nh cong nghi\u00eam tr\u1ecdng nh\u1ea5t. Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, c\u00e1c b\u00e1c s\u0129 c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n c\u1eaft x\u01b0\u01a1ng \u1edf c\u1ea3 hai b\u00ean trong m\u1ed9t l\u1ea7n ph\u1eabu thu\u1eadt duy nh\u1ea5t [2].<\/p>\n

\u0110\u00f4i khi, vi\u1ec7c c\u1eaft x\u01b0\u01a1ng \u1edf x\u01b0\u01a1ng \u0111\u00f9i c\u0169ng l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 th\u1eb3ng h\u00e0ng t\u1ed1i \u01b0u [3]. Ngo\u00e0i ra, k\u1ef9 thu\u1eadt \u0111i\u1ec1u tr\u1ecb t\u0103ng tr\u01b0\u1edfng h\u01b0\u1edbng d\u1eabn (guided-growth modulation) th\u00f4ng qua hemiepiphysiodesis c\u0169ng \u0111\u00e3 cho th\u1ea5y k\u1ebft qu\u1ea3 h\u1ee9a h\u1eb9n, \u0111\u1eb7c bi\u1ec7t trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam c\u00f2i x\u01b0\u01a1ng kh\u00e1ng vitamin D, gi\u00fap gi\u1ea3m nhu c\u1ea7u ph\u1eabu thu\u1eadt c\u1eaft x\u01b0\u01a1ng n\u1ebfu \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd y t\u1ebf th\u00edch \u0111\u00e1ng [5].<\/p>\n

T\u1ed5ng quan v\u1ec1 quy tr\u00ecnh can thi\u1ec7p<\/h3>\n

\u0110\u1ec3 \u0111\u1ea3m b\u1ea3o th\u00e0nh c\u00f4ng c\u1ee7a ph\u1eabu thu\u1eadt, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 n\u1ec1n t\u1ea3ng chuy\u1ec3n h\u00f3a ph\u1ee9c t\u1ea1p, vi\u1ec7c ki\u1ec3m so\u00e1t thi\u1ebfu m\u00e1u, \u0111\u1ee7 l\u01b0\u1ee3ng n\u01b0\u1edbc, ure-mi v\u00e0 c\u00e2n b\u1eb1ng \u0111i\u1ec7n gi\u1ea3i l\u00e0 b\u1eaft bu\u1ed9c tr\u01b0\u1edbc khi g\u00e2y m\u00ea [4]. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3, l\u1ecdc b\u1ee5ng ho\u1eb7c l\u1ecdc m\u00e1u c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft \u0111\u1ec3 chu\u1ea9n b\u1ecb cho ph\u1eabu thu\u1eadt. C\u1ea7n l\u01b0u \u00fd r\u1eb1ng n\u1ebfu d\u1ecb d\u1ea1ng n\u1eb7ng \u1edf tr\u1ebb l\u1edbn m\u00e0 ch\u01b0a t\u1eebng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb y t\u1ebf, vi\u1ec7c ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt trong tr\u1ea1ng th\u00e1i chuy\u1ec3n h\u00f3a b\u00f9 tr\u1eeb (d\u00f9 ch\u01b0a ho\u00e0n to\u00e0n \u1ed5n \u0111\u1ecbnh) \u0111\u00f4i khi l\u00e0 l\u1ef1a ch\u1ecdn t\u1ed1t h\u01a1n so v\u1edbi vi\u1ec7c b\u1ed5 sung li\u1ec1u cao vitamin D, canxi v\u00e0 photpho tr\u01b0\u1edbc m\u1ed5 \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 t\u0103ng canxi m\u00e1u [4].<\/p>\n

Vi\u1ec7c th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt c\u1eaft x\u01b0\u01a1ng cho c\u00e1c b\u1ec7nh nh\u00e2n vi\u00eam x\u01b0\u01a1ng th\u1eadn c\u1ea7n s\u1ef1 qu\u1ea3n l\u00fd y t\u1ebf chuy\u00ean s\u00e2u t\u1eeb m\u1ed9t \u0111\u1ed9i ng\u0169 \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o \u0111\u1eb7c bi\u1ec7t v\u1ec1 \u0111i\u1ec1u tr\u1ecb suy th\u1eadn m\u00e3n t\u00ednh. N\u1ebfu kh\u00f4ng c\u00f3 s\u1ef1 qu\u1ea3n l\u00fd n\u00e0y, t\u1ef7 l\u1ec7 t\u00e1i ph\u00e1t d\u1ecb d\u1ea1ng sau khi l\u1ea5y d\u1ee5ng c\u1ee5 ph\u1eabu thu\u1eadt l\u00e0 r\u1ea5t cao [5].<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
    \n
  • [1] Osteotomies around the Knee, 1st Edition, 2008, trang 34<\/li>\n
  • [2] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 1512<\/li>\n
  • [3] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 1512<\/li>\n
  • [4] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 1512<\/li>\n
  • [5] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 1513<\/li>\n<\/ul>\n

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