{"id":414,"date":"2026-10-11T19:12:17","date_gmt":"2026-10-11T12:12:17","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/11\/ton-thuong-chac-ba-sun-vung-hang-o-tre-em-chan-doan-bien-chung-va-phuong-phap-dieu-tri\/"},"modified":"2026-10-11T19:12:17","modified_gmt":"2026-10-11T12:12:17","slug":"ton-thuong-chac-ba-sun-vung-hang-o-tre-em-chan-doan-bien-chung-va-phuong-phap-dieu-tri","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/11\/ton-thuong-chac-ba-sun-vung-hang-o-tre-em-chan-doan-bien-chung-va-phuong-phap-dieu-tri\/","title":{"rendered":"T\u1ed5n th\u01b0\u01a1ng ch\u1ea1c ba s\u1ee5n v\u00f9ng h\u00e1ng \u1edf tr\u1ebb em: Ch\u1ea9n \u0111o\u00e1n, bi\u1ebfn ch\u1ee9ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<h2>T\u1ed5n th\u01b0\u01a1ng ch\u1ea1c ba s\u1ee5n: C\u01a1 ch\u1ebf sinh l\u00fd h\u1ecdc v\u00e0 di\u1ec5n bi\u1ebfn<\/h2>\n<p>V\u00f9ng h\u00e1ng \u1edf tr\u1ebb em c\u00f3 c\u1ea5u tr\u00fac \u0111\u1eb7c bi\u1ec7t v\u1edbi s\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a <strong>ch\u1ea1c ba s\u1ee5n (triradiate cartilage)<\/strong>, m\u1ed9t ph\u1ea7n quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh ph\u00e1t tri\u1ec3n kh\u1edbp h\u00e1ng. Ch\u1ea1c n\u00e0y \u0111\u00f3ng vai tr\u00f2 then ch\u1ed1t trong s\u1ef1 t\u0103ng tr\u01b0\u1edfng li\u00ean t\u1ebf gi\u1eefa c\u00e1c x\u01b0\u01a1ng ch\u1eadu: x\u01b0\u01a1ng mu, x\u01b0\u01a1ng m\u00f4ng v\u00e0 x\u01b0\u01a1ng \u1ed1ng ch\u00e2n [1]. Khi ch\u1ea1c b\u1ecb t\u1ed5n th\u01b0\u01a1ng do ch\u1ea5n th\u01b0\u01a1ng, n\u00f3 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ng\u1eebng ph\u00e1t tri\u1ec3n (growth arrest), g\u00e2y ra ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i chi v\u00e0 h\u00ecnh th\u00e0nh b\u1ea5t th\u01b0\u1eddng c\u1ee7a kh\u1edbp h\u00e1ng [2].<\/p>\n<p>Ch\u1ea5n th\u01b0\u01a1ng x\u00e2m nh\u1eadp v\u00e0o ch\u1ea1c ba s\u1ee5n l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng \u0111\u00e1ng lo ng\u1ea1i sau c\u00e1c g\u00e3y x\u01b0\u01a1ng ch\u1eadu ho\u1eb7c r\u1ea1n n\u1ee9t. Trong khi tr\u1ebb em c\u00f3 kh\u1ea3 n\u0103ng t\u00e1i t\u1ea1o t\u1ed1t, t\u1ed5n th\u01b0\u01a1ng nghi\u00eam tr\u1ecdng d\u1eabn \u0111\u1ebfn h\u00ecnh th\u00e0nh c\u1ea7u x\u01b0\u01a1ng (osseous bridge) \u1edf m\u1eb7t trong c\u1ee7a ch\u1ea1c c\u00f3 th\u1ec3 g\u00e2y ra s\u1ef1 \u0111\u00f3ng s\u1edbm v\u00e0 b\u1ea5t th\u01b0\u1eddng v\u0129nh vi\u1ec5n [1]. S\u1ef1 m\u1ea5t c\u00e2n b\u1eb1ng ph\u00e1t tri\u1ec3n gi\u1eefa c\u00e1c ph\u1ea7n kh\u00e1c nhau c\u1ee7a ch\u1eadu do t\u1ed5n th\u01b0\u01a1ng n\u00e0y s\u1ebd l\u00e0m gia t\u0103ng t\u00ednh kh\u00f4ng kh\u1edbp c\u1ee7a kh\u1edbp h\u00e1ng theo th\u1eddi gian, d\u1eabn \u0111\u1ebfn tho\u00e1i h\u00f3a kh\u1edbp th\u1ee9 ph\u00e1t [5].<\/p>\n<h2>Ph\u00e2n lo\u1ea1i ch\u1ea5n th\u01b0\u01a1ng v\u00e0 ti\u00ean l\u01b0\u1ee3ng d\u1ef1a tr\u00ean \u0111\u1ed9 tu\u1ed5i<\/h2>\n<p>T\u1ed5n th\u01b0\u01a1ng ch\u1ea1c ba s\u1ee5n th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh hai m\u00f4 h\u00ecnh ch\u00ednh: t\u1ed5n th\u01b0\u01a1ng ki\u1ec3u Salter-Harris I ho\u1eb7c II (c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t cho s\u1ef1 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng) v\u00e0 t\u1ed5n th\u01b0\u01a1ng ki\u1ec3u Salter-Harris V (ch\u00e8n \u00e9p, c\u00f3 ti\u00ean l\u01b0\u1ee3ng k\u00e9m do \u0111\u00f3ng s\u1edbm c\u1ee7a ch\u1ea1c) [1]. Ti\u00ean l\u01b0\u1ee3ng c\u1ee7a c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y ph\u1ee5 thu\u1ed9c m\u1ea1nh m\u1ebd v\u00e0o \u0111\u1ed9 tu\u1ed5i c\u1ee7a tr\u1ebb khi ch\u1ea5n th\u01b0\u01a1ng x\u1ea3y ra.<\/p>\n<ul>\n<li><strong>Tr\u1ebb nh\u1ecf h\u01a1n 10 tu\u1ed5i:<\/strong> \u0110\u00e2y l\u00e0 nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng d\u1ec5 b\u1ecb \u1ea3nh h\u01b0\u1edfng nh\u1ea5t. T\u1ed5n th\u01b0\u01a1ng \u1edf giai \u0111o\u1ea1n n\u00e0y th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn d\u1ecb t\u1eadt kh\u1edbp h\u00e1ng do s\u1ef1 ph\u00e1t tri\u1ec3n b\u1ea5t th\u01b0\u1eddng c\u1ee7a ch\u1ea1c ba s\u1ee5n. S\u1ef1 t\u0103ng tr\u01b0\u1edfng kh\u00e1c bi\u1ec7t gi\u1eefa hai b\u00ean s\u1ebd l\u00e0m gia t\u0103ng t\u00ednh kh\u00f4ng kh\u1edbp c\u1ee7a kh\u1edbp h\u00e1ng v\u00e0 g\u00e2y ra tho\u00e1i h\u00f3a kh\u1edbp ti\u1ebfn tri\u1ec3n [1].<\/li>\n<li><strong>Tr\u1ebb tr\u00ean 10 tu\u1ed5i:<\/strong> T\u1ed5n th\u01b0\u01a1ng x\u1ea3y ra sau \u0111\u1ed9 tu\u1ed5i n\u00e0y th\u01b0\u1eddng \u00edt \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u00ecnh th\u00e1i kh\u1edbp h\u00e1ng do l\u01b0\u1ee3ng c\u00f2n l\u1ea1i c\u1ee7a s\u1ef1 ph\u00e1t tri\u1ec3n \u0111\u00e3 gi\u1ea3m. Tuy nhi\u00ean, vi\u1ec7c theo d\u00f5i v\u1eabn c\u1ea7n thi\u1ebft \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c d\u1ea5u hi\u1ec7u b\u1ea5t th\u01b0\u1eddng [1].<\/li>\n<\/ul>\n<h2>D\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/h2>\n<p>V\u00ec t\u1ed5n th\u01b0\u01a1ng ch\u1ea1c ba s\u1ee5n c\u00f3 th\u1ec3 b\u1ecb b\u1ecf qua tr\u00ean phim X-quang ban \u0111\u1ea7u, t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng ch\u1eadu \u0111\u1ec1u c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i l\u00e2m s\u00e0ng v\u00e0 ch\u1ee5p X-quang trong \u00edt nh\u1ea5t 1 n\u0103m [5]. C\u00e1c d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o bao g\u1ed3m:<\/p>\n<ul>\n<li>S\u1ef1 \u0111\u00f3ng s\u1edbm c\u1ee7a ch\u1ea1c ba s\u1ee5n (premature closure).<\/li>\n<li>D\u1ecb t\u1eadt kh\u1edbp h\u00e1ng th\u1ee9 ph\u00e1t (acetabular dysplasia) v\u1edbi chi\u1ec1u s\u00e2u kh\u1edbp gi\u1ea3m.<\/li>\n<li>T\u00ecnh tr\u1ea1ng tho\u00e1i h\u00f3a kh\u1edbp ti\u1ebfn tri\u1ec3n ho\u1eb7c tho\u00e1t v\u1ecb \u0111\u1ea7u x\u01b0\u01a1ng \u0111\u00f9i [4].<\/li>\n<\/ul>\n<p>Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh th\u01b0\u1eddng d\u1ef1a tr\u00ean phim X-quang, MRI v\u00e0 CT scan \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u1ea7u x\u01b0\u01a1ng h\u00ecnh th\u00e0nh trong ch\u1ea1c ba s\u1ee5n. H\u00ecnh \u1ea3nh CT gi\u00fap x\u00e1c nh\u1eadn s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u1ea7u x\u01b0\u01a1ng v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng ch\u00ednh x\u00e1c [3].<\/p>\n<h2>Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/h2>\n<p>Nguy\u00ean t\u1eafc qu\u1ea3n l\u00fd ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng ch\u1eadu \u1edf tr\u1ebb em kh\u00f4ng kh\u00e1c bi\u1ec7t nhi\u1ec1u so v\u1edbi ng\u01b0\u1eddi l\u1edbn, nh\u01b0ng c\u1ea7n ch\u00fa tr\u1ecdng b\u1ea3o v\u1ec7 c\u00e1c c\u1ea5u tr\u00fac t\u0103ng tr\u01b0\u1edfng c\u00f2n l\u1ea1i. \u0110\u1ed1i v\u1edbi g\u00e3y x\u01b0\u01a1ng r\u1ea1n n\u1ee9t ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng ch\u1ea1c ba s\u1ee5n:<\/p>\n<ul>\n<li><strong>H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng v\u00e0 n\u1eafn k\u00edn:<\/strong> C\u00e1c ch\u1ea5n th\u01b0\u01a1ng nh\u1eb9 th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng, m\u1eb7c d\u00f9 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i chi t\u1eeb 1-5 cm [7].<\/li>\n<li><strong>Can thi\u1ec7p ph\u1eabu thu\u1eadt:<\/strong> Khi c\u00f3 d\u1ecbch chuy\u1ec3n \u0111\u00e1ng k\u1ec3 ho\u1eb7c m\u00f4 h\u00ecnh g\u00e3y kh\u00f4ng \u1ed5n \u0111\u1ecbnh, n\u1eafn k\u00edn v\u00e0 c\u1ed1 \u0111\u1ecbnh ph\u1eabu thu\u1eadt l\u00e0 c\u1ea7n thi\u1ebft. \u0110\u1ed1i v\u1edbi tr\u1ebb nh\u1ecf h\u01a1n 10 tu\u1ed5i b\u1ecb t\u1ed5n th\u01b0\u01a1ng ch\u1ea1c ba s\u1ee5n, vi\u1ec7c c\u1eaft b\u1ecf c\u1ea7u x\u01b0\u01a1ng (physeal bar excision) th\u01b0\u1eddng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 ng\u0103n ch\u1eb7n \u0111\u00f3ng s\u1edbm [1].<\/li>\n<\/ul>\n<p>Ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf c\u1ea7u x\u01b0\u01a1ng c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n qua ti\u1ebfp c\u1eadn Pfannenstiel m\u1edf r\u1ed9ng ho\u1eb7c ti\u1ebfp c\u1eadn ilioinguinal d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn CT. K\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt cho th\u1ea5y kh\u1ea3 n\u0103ng duy tr\u00ec s\u1ef1 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng c\u1ee7a kh\u1edbp h\u00e1ng v\u00e0 ng\u0103n ng\u1eeba d\u1ecb t\u1eadt trong d\u00e0i h\u1ea1n [6]. \u0110\u1ed1i v\u1edbi tr\u1ebb l\u1edbn h\u01a1n, k\u1ef9 thu\u1eadt c\u1ed1 \u0111\u1ecbnh c\u1ea7n tr\u00e1nh l\u00e0m t\u1ed5n th\u01b0\u01a1ng th\u00eam c\u00e1c c\u1ea5u tr\u00fac t\u0103ng tr\u01b0\u1edfng c\u00f2n l\u1ea1i n\u1ebfu ch\u1ea1c v\u1eabn \u0111ang m\u1edf [5].<\/p>\n<h2>T\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c ph\u00f2ng ng\u1eeba s\u1edbm<\/h2>\n<p>T\u1ed5n th\u01b0\u01a1ng ch\u1ea1c ba s\u1ee5n c\u00f3 t\u1ef7 l\u1ec7 x\u1ea3y ra t\u1ed5ng th\u1ec3 d\u01b0\u1edbi 5% sau ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp ch\u1eadu \u1edf tr\u1ebb em, nh\u01b0ng h\u1eadu qu\u1ea3 l\u00e2u d\u00e0i l\u00e0 nghi\u00eam tr\u1ecdng [7]. Vi\u1ec7c nh\u1eadn di\u1ec7n v\u00e0 x\u1eed l\u00fd s\u1edbm tr\u01b0\u1edbc khi h\u00ecnh th\u00e0nh c\u1ea7u x\u01b0\u01a1ng ho\u00e0n to\u00e0n ho\u1eb7c g\u00e2y ra \u0111\u00f3ng l\u1ec7ch pha gi\u1eefa hai b\u00ean l\u00e0 y\u1ebfu t\u1ed1 then ch\u1ed1t \u0111\u1ec3 tr\u00e1nh d\u1ecb t\u1eadt v\u0129nh vi\u1ec5n. C\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i chi v\u00e0 \u0111au l\u01b0ng m\u00e3n t\u00ednh [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 1414<\/li>\n<li>[2] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1818<\/li>\n<li>[3] Rockwood and Green&#x27;s Fractures in Children, 9th Edition, 2020, trang 1413<\/li>\n<li>[4] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1819<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1819<\/li>\n<li>[6] Rockwood and Green&#x27;s Fractures in Children, 9th Edition, 2020, trang 1414<\/li>\n<li>[7] Rockwood and Green&#x27;s Fractures in Children, 9th Edition, 2020, trang 1413<\/li>\n<\/ul>\n<p><!-- aiwriter:49e925cde3604b7dbcf622f7 --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hi\u1ec3u r\u00f5 t\u1ed5n th\u01b0\u01a1ng ch\u1ea1c ba s\u1ee5n (triradiate cartilage) gi\u00fap ph\u00f2ng ng\u1eeba d\u1ecb t\u1eadt kh\u1edbp h\u00e1ng. B\u00e0i vi\u1ebft ph\u00e2n t\u00edch c\u01a1 ch\u1ebf ch\u1eadm ph\u00e1t tri\u1ec3n x\u01b0\u01a1ng, d\u1ea5u hi\u1ec7u s\u1edbm v\u00e0 can thi\u1ec7p ph\u1eabu thu\u1eadt ph\u00f9 h\u1ee3p theo \u0111\u1ed9 tu\u1ed5i.<\/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-414","post","type-post","status-publish","format-standard","hentry","category-chi-duoi"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>T\u1ed5n th\u01b0\u01a1ng ch\u1ea1c ba s\u1ee5n v\u00f9ng h\u00e1ng \u1edf tr\u1ebb em: Ch\u1ea9n \u0111o\u00e1n, bi\u1ebfn ch\u1ee9ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb - BS NGUY\u1ec4N TH\u00c0NH LONG - BS C\u01a0 X\u01af\u01a0NG KH\u1edaP - CH\u1ea4N TH\u01af\u01a0NG CH\u1ec8NH H\u00ccNH<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/11\/ton-thuong-chac-ba-sun-vung-hang-o-tre-em-chan-doan-bien-chung-va-phuong-phap-dieu-tri\/\" \/>\n<meta property=\"og:locale\" content=\"vi_VN\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"T\u1ed5n th\u01b0\u01a1ng ch\u1ea1c ba s\u1ee5n v\u00f9ng h\u00e1ng \u1edf tr\u1ebb em: Ch\u1ea9n \u0111o\u00e1n, bi\u1ebfn ch\u1ee9ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb - BS NGUY\u1ec4N TH\u00c0NH LONG - BS C\u01a0 X\u01af\u01a0NG KH\u1edaP - CH\u1ea4N TH\u01af\u01a0NG CH\u1ec8NH H\u00ccNH\" \/>\n<meta property=\"og:description\" content=\"Hi\u1ec3u r\u00f5 t\u1ed5n th\u01b0\u01a1ng ch\u1ea1c ba s\u1ee5n (triradiate cartilage) gi\u00fap ph\u00f2ng ng\u1eeba d\u1ecb t\u1eadt kh\u1edbp h\u00e1ng. 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