{"id":408,"date":"2026-10-11T18:50:39","date_gmt":"2026-10-11T11:50:39","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/11\/chenh-lech-chieu-dai-hai-chan-bam-sinh-danh-gia-va-phuong-phap-mang-giay-chinh-hinh\/"},"modified":"2026-10-11T18:50:39","modified_gmt":"2026-10-11T11:50:39","slug":"chenh-lech-chieu-dai-hai-chan-bam-sinh-danh-gia-va-phuong-phap-mang-giay-chinh-hinh","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/11\/chenh-lech-chieu-dai-hai-chan-bam-sinh-danh-gia-va-phuong-phap-mang-giay-chinh-hinh\/","title":{"rendered":"Ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i hai ch\u00e2n b\u1ea9m sinh: \u0110\u00e1nh gi\u00e1 v\u00e0 ph\u01b0\u01a1ng ph\u00e1p mang gi\u00e0y ch\u1ec9nh h\u00ecnh"},"content":{"rendered":"<h2>C\u00e2n b\u1eb1ng chi\u1ec1u d\u00e0i hai ch\u00e2n: T\u1ea1i sao l\u1ea1i quan tr\u1ecdng?<\/h2>\n<p>Ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i hai ch\u00e2n (limb-length discrepancy &#8211; LLID) kh\u00f4ng ch\u1ec9 l\u00e0 v\u1ea5n \u0111\u1ec1 th\u1ea9m m\u1ef9 m\u00e0 c\u00f2n \u1ea3nh h\u01b0\u1edfng tr\u1ef1c ti\u1ebfp \u0111\u1ebfn ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng v\u00e0 s\u1ee9c kh\u1ecfe t\u1ed5ng th\u1ec3. Khi c\u00f3 s\u1ef1 ch\u00eanh l\u1ec7ch, ng\u01b0\u1eddi b\u1ec7nh s\u1ebd g\u1eb7p kh\u00f3 kh\u0103n trong \u0111i b\u1ed9 do t\u01b0 th\u1ebf h\u00f4ng b\u1ecb nghi\u00eang \u0111\u1ec3 b\u00f9 l\u1ea1i, d\u1eabn \u0111\u1ebfn ti\u00eau hao n\u0103ng l\u01b0\u1ee3ng nhi\u1ec1u h\u01a1n v\u00e0 t\u0103ng nguy c\u01a1 \u0111au l\u01b0ng, \u0111au kh\u1edbp g\u1ed1i ho\u1eb7c \u0111au h\u00f4ng [3].<\/p>\n<p>Tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd r\u1eb1ng kho\u1ea3ng 10% \u0111\u1ebfn 12% d\u00e2n s\u1ed1 b\u00ecnh th\u01b0\u1eddng c\u00f3 ch\u00eanh l\u1ec7ch t\u1eeb 0,5 \u0111\u1ebfn 2 cm m\u00e0 kh\u00f4ng tri\u1ec7u ch\u1ee9ng. Th\u00f4ng th\u01b0\u1eddng, ch\u1ec9 khi ch\u00eanh l\u1ec7ch l\u1edbn h\u01a1n 2,5 cm th\u00ec m\u1edbi \u0111\u01b0\u1ee3c coi l\u00e0 \u0111\u00e1ng k\u1ec3 v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y ra c\u00e1c c\u01a1n \u0111au \u1edf kh\u1edbp g\u1ed1i, h\u00f4ng ho\u1eb7c c\u1ed9t s\u1ed1ng [3].<\/p>\n<h2>Nguy\u00ean nh\u00e2n v\u00e0 c\u00e1ch \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u<\/h2>\n<p>Ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i ch\u00e2n c\u00f3 th\u1ec3 do nguy\u00ean nh\u00e2n b\u1ea9m sinh (v\u00ed d\u1ee5: thi\u1ebfu x\u01b0\u01a1ng \u1ed1ng ch\u00e2n ho\u1eb7c \u0111\u00f9i) ho\u1eb7c ph\u00e1t tri\u1ec3n kh\u00f4ng \u0111\u1ec1u (do ch\u1ea5n th\u01b0\u01a1ng, vi\u00eam kh\u1edbp tr\u1ebb em, u t\u1ee7y x\u01b0\u01a1ng, v.v.) [7]. Trong giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a vi\u1ec7c \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng, b\u00e1c s\u0129 c\u1ea7n x\u00e1c \u0111\u1ecbnh tu\u1ed5ichronologic v\u00e0 tu\u1ed5i x\u01b0\u01a1ng \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 ch\u00eanh l\u1ec7ch cu\u1ed1i c\u00f9ng d\u1ef1a tr\u00ean t\u1ef7 l\u1ec7 co r\u00fat hi\u1ec7n t\u1ea1i [1].<\/p>\n<p>\u0110\u1ed1i v\u1edbi tr\u1ebb em c\u00f3 b\u00e0n ch\u00e2n ch\u1ee9c n\u0103ng b\u00ecnh th\u01b0\u1eddng v\u00e0 ch\u00eanh l\u1ec7ch nh\u1ecf d\u01b0\u1edbi 5%, m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb l\u00e0 c\u00e2n b\u1eb1ng chi\u1ec1u d\u00e0i chi v\u00e0 s\u1eeda ch\u1eefa d\u1ecb d\u1ea1ng b\u00e0n ch\u00e2n. Ph\u01b0\u01a1ng ph\u00e1p mang gi\u00e0y ch\u1ec9nh h\u00ecnh (shoe lifts) th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong giai \u0111o\u1ea1n t\u0103ng tr\u01b0\u1edfng \u0111\u1ec3 gi\u00fap c\u00e2n b\u1eb1ng chi\u1ec1u d\u00e0i [1].<\/p>\n<h3>C\u00f4ng th\u1ee9c t\u00ednh to\u00e1n ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i<\/h3>\n<p>\u0110\u1ec3 d\u1ef1 \u0111o\u00e1n ch\u00ednh x\u00e1c chi\u1ec1u d\u00e0i chi khi tr\u01b0\u1edfng th\u00e0nh, c\u00e1c chuy\u00ean gia s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p nh\u00e2n s\u1ed1 (multiplier method). C\u00f3 hai c\u00f4ng th\u1ee9c ch\u00ednh d\u1ef1a tr\u00ean lo\u1ea1i b\u1ea5t th\u01b0\u1eddng:<\/p>\n<ul>\n<li><strong>B\u1ea5t th\u01b0\u1eddng b\u1ea9m sinh:<\/strong> S\u1eed d\u1ee5ng c\u00f4ng th\u1ee9c $Dm = D \\times 3M$, trong \u0111\u00f3 $D$ l\u00e0 ch\u00eanh l\u1ec7ch hi\u1ec7n t\u1ea1i v\u00e0 $M$ l\u00e0 nh\u00e2n s\u1ed1 t\u0103ng tr\u01b0\u1edfng c\u00f2n l\u1ea1i [2].<\/li>\n<li><strong>B\u1ea5t th\u01b0\u1eddng ph\u00e1t tri\u1ec3n:<\/strong> S\u1eed d\u1ee5ng c\u00f4ng th\u1ee9c $Dm = D \\times (1 + I\/3G)$, v\u1edbi $I$ l\u00e0 t\u0103ng tr\u01b0\u1edfng c\u00f2n l\u1ea1i v\u00e0 $G$ l\u00e0 t\u1ed5ng t\u0103ng tr\u01b0\u1edfng c\u00f2n l\u1ea1i [2].<\/li>\n<\/ul>\n<p>Nh\u00e2n s\u1ed1 ($M$) thay \u0111\u1ed5i t\u00f9y theo \u0111\u1ed9 tu\u1ed5i c\u1ee7a tr\u1ebb. V\u00ed d\u1ee5, \u1edf tr\u1ebb s\u01a1 sinh, nh\u00e2n s\u1ed1 cho b\u00e9 trai kho\u1ea3ng 5,08, trong khi \u1edf tr\u1ebb 14 tu\u1ed5i th\u00ec gi\u1ea3m xu\u1ed1ng c\u00f2n 1,08 [6].<\/p>\n<h2>Vai tr\u00f2 c\u1ee7a gi\u00e0y ch\u1ec9nh h\u00ecnh v\u00e0 c\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb kh\u00e1c<\/h2>\n<p>Mang gi\u00e0y ch\u1ec9nh h\u00ecnh l\u00e0 gi\u1ea3i ph\u00e1p kh\u00f4ng ph\u1eabu thu\u1eadt ph\u1ed5 bi\u1ebfn cho ch\u00eanh l\u1ec7ch nh\u1ecf. Tuy nhi\u00ean, n\u1ebfu ch\u00eanh l\u1ec7ch l\u1edbn h\u01a1n ho\u1eb7c c\u00f3 nguy c\u01a1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn chi\u1ec1u cao cu\u1ed1i c\u00f9ng, b\u00e1c s\u0129 c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc c\u00e1c ph\u01b0\u01a1ng ph\u00e1p can thi\u1ec7p:<\/p>\n<ul>\n<li><strong>Epiphysiodesis (\u0111\u00f3ng kh\u1edbp sinh l\u00fd):<\/strong> C\u1eaft b\u1ecf m\u1ed9t ph\u1ea7n v\u00f9ng sinh l\u00fd c\u1ee7a x\u01b0\u01a1ng d\u00e0i \u0111\u1ec3 l\u00e0m ch\u1eadm t\u0103ng tr\u01b0\u1edfng \u1edf ch\u00e2n d\u00e0i h\u01a1n, gi\u00fap c\u00e2n b\u1eb1ng v\u1edbi ch\u00e2n ng\u1eafn. \u0110\u00e2y l\u00e0 l\u1ef1a ch\u1ecdn \u01b0u ti\u00ean n\u1ebfu kh\u00f4ng mu\u1ed1n c\u1eaft gi\u1ea3m chi\u1ec1u cao t\u1ed5ng th\u1ec3 [1].<\/li>\n<li><strong>K\u00e9o d\u00e0i chi ho\u1eb7c amputation:<\/strong> N\u1ebfu ch\u00eanh l\u1ec7ch qu\u00e1 l\u1edbn (tr\u00ean 11% so v\u1edbi chi\u1ec1u d\u00e0i b\u00ecnh th\u01b0\u1eddng) v\u00e0 b\u00e0n ch\u00e2n v\u1eabn ch\u1ee9c n\u0103ng, b\u00e1c s\u0129 ph\u1ea3i c\u00e2n nh\u1eafc k\u1ef9 l\u01b0\u1ee1ng gi\u1eefa vi\u1ec7c k\u00e9o d\u00e0i chi qua ph\u1eabu thu\u1eadt ph\u1ee9c t\u1ea1p ho\u1eb7c amputation \u0111\u1ec3 s\u1eed d\u1ee5ng ch\u00e2n gi\u1ea3 [5].<\/li>\n<li><strong>X\u1eed l\u00fd b\u00e0n ch\u00e2n:<\/strong> Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, amputation b\u00e0n ch\u00e2n c\u00f3 th\u1ec3 gi\u00fap c\u00e2n b\u1eb1ng chi\u1ec1u d\u00e0i t\u1ed1t h\u01a1n v\u00e0 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng so v\u1edbi nhi\u1ec1u th\u1ee7 thu\u1eadt k\u00e9o d\u00e0i chi [5].<\/li>\n<\/ul>\n<p>Vi\u1ec7c k\u1ebft h\u1ee3p k\u00e9o d\u00e0i chi v\u1edbi \u00e9p sinh l\u00fd \u1edf \u0111\u1ea7u d\u01b0\u1edbi \u0111\u00f9i ho\u1eb7c m\u1eaft c\u00e1 ch\u00e2n c\u0169ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh \u0111\u01b0\u1eddng th\u1eb3ng (valgus alignment) [5].<\/p>\n<h2>H\u1ea1n ch\u1ebf v\u00e0 th\u00e1ch th\u1ee9c trong \u0111\u00e1nh gi\u00e1<\/h2>\n<p>C\u1ea7n ph\u00e2n bi\u1ec7t r\u00f5 gi\u1eefa ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i th\u1ef1c t\u1ebf \u0111o \u0111\u01b0\u1ee3c tr\u00ean X-quang v\u00e0 c\u1ea3m nh\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n. M\u1ed9t kh\u1ea3o s\u00e1t cho th\u1ea5y 30% b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt thay kh\u1edbp h\u00e1ng b\u00e1o c\u00e1o c\u1ea3m th\u1ea5y ch\u00e2n kh\u00f4ng c\u00e2n b\u1eb1ng, nh\u01b0ng ch\u1ec9 c\u00f3 36% trong s\u1ed1 \u0111\u00f3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1edfi h\u00ecnh \u1ea3nh y khoa [4].<\/p>\n<p>\u0110\u00f4i khi, ng\u01b0\u1eddi b\u1ec7nh c\u1ea3m th\u1ea5y ch\u00eanh l\u1ec7ch d\u00f9 th\u1ef1c t\u1ebf chi\u1ec1u d\u00e0i x\u01b0\u01a1ng \u0111\u00e3 b\u1eb1ng nhau do teo c\u01a1 ho\u1eb7c co c\u1ee9ng m\u00f4 m\u1ec1m g\u00e2y nghi\u00eang h\u00f4ng. Tr\u01b0\u1eddng h\u1ee3p n\u00e0y th\u01b0\u1eddng \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi v\u1eadt l\u00fd tr\u1ecb li\u1ec7u thay v\u00ec ph\u1eabu thu\u1eadt [4].<\/p>\n<p>T\u00f3m l\u1ea1i, vi\u1ec7c qu\u1ea3n l\u00fd ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i hai ch\u00e2n l\u00e0 m\u1ed9t quy tr\u00ecnh ph\u1ee9c t\u1ea1p \u0111\u00f2i h\u1ecfi \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n v\u1ec1 nguy\u00ean nh\u00e2n, ch\u1ee9c n\u0103ng kh\u1edbp v\u00e0 mong \u0111\u1ee3i c\u1ee7a gia \u0111\u00ecnh tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<ul>\n<li>[1] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1346<\/li>\n<li>[2] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1363<\/li>\n<li>[3] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1358<\/li>\n<li>[4] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 304<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1346<\/li>\n<li>[6] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1363<\/li>\n<li>[7] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1358<\/li>\n<\/ul>\n<p><!-- aiwriter:fc7cae1d64874c24b1149d56 --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>T\u00ecm hi\u1ec3u v\u1ec1 nguy\u00ean nh\u00e2n, c\u00e1ch \u0111o l\u01b0\u1eddng ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i ch\u00e2n b\u1ea9m sinh v\u00e0 vai tr\u00f2 c\u1ee7a gi\u00e0y ch\u1ec9nh h\u00ecnh trong giai \u0111o\u1ea1n t\u0103ng tr\u01b0\u1edfng \u0111\u1ec3 c\u00e2n b\u1eb1ng t\u01b0 th\u1ebf.<\/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-408","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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