{"id":488,"date":"2026-10-12T12:24:00","date_gmt":"2026-10-12T05:24:00","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/12\/viem-gan-co-nhi-dau-dai-tai-ranh-nguyen-nhan-dau-hieu-va-cach-xu-tri-trong-chan-thuong-khop-vai\/"},"modified":"2026-10-12T12:24:00","modified_gmt":"2026-10-12T05:24:00","slug":"viem-gan-co-nhi-dau-dai-tai-ranh-nguyen-nhan-dau-hieu-va-cach-xu-tri-trong-chan-thuong-khop-vai","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/12\/viem-gan-co-nhi-dau-dai-tai-ranh-nguyen-nhan-dau-hieu-va-cach-xu-tri-trong-chan-thuong-khop-vai\/","title":{"rendered":"Vi\u00eam g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u d\u00e0i t\u1ea1i r\u00e3nh: Nguy\u00ean nh\u00e2n, d\u1ea5u hi\u1ec7u v\u00e0 c\u00e1ch x\u1eed tr\u00ed trong ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp vai"},"content":{"rendered":"<h2>Vai tr\u00f2 c\u1ee7a g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u d\u00e0i trong gi\u1ea3i ph\u1eabu v\u00e0 ch\u1ee9c n\u0103ng kh\u1edbp vai<\/h2>\n<p>Vi\u00eam g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u d\u00e0i t\u1ea1i r\u00e3nh nh\u1ecb \u0111\u1ea7u (bicipital groove) l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng th\u01b0\u1eddng g\u1eb7p, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed ch\u1ea5n th\u01b0\u01a1ng x\u01b0\u01a1ng kh\u1edbp ho\u1eb7c m\u1eafc c\u00e1c b\u1ec7nh l\u00fd tho\u00e1i h\u00f3a. \u0110\u1ec3 hi\u1ec3u r\u00f5 v\u1ec1 nguy\u00ean nh\u00e2n v\u00e0 c\u00e1ch x\u1eed tr\u00ed, c\u1ea7n n\u1eafm v\u1eefng gi\u1ea3i ph\u1eabu h\u1ecdc chi ti\u1ebft c\u1ee7a v\u00f9ng n\u00e0y.<\/p>\n<p>Gi\u1eefa hai m\u00e0o x\u01b0\u01a1ng (lesser v\u00e0 greater tuberosities) l\u00e0 r\u00e3nh nh\u1ecb \u0111\u1ea7u, n\u01a1i g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u d\u00e0i di chuy\u1ec3n t\u1eeb \u0111i\u1ec3m b\u00e1m tr\u00ean supraglenoid tubercle xu\u1ed1ng ph\u00eda tr\u01b0\u1edbc c\u00e1nh tay. R\u00e3nh n\u00e0y c\u00f3 \u0111\u01b0\u1eddng \u0111i xo\u1eafn \u1ed1c t\u1eeb tr\u00ean v\u00e0 b\u00ean ngo\u00e0i h\u01b0\u1edbng v\u1ec1 gi\u1eefa d\u01b0\u1edbi [1]. V\u1ec1 m\u1eb7t gi\u1ea3i ph\u1eabu, r\u00e3nh \u0111\u01b0\u1ee3c bao ph\u1ee7 b\u1edfi d\u00e2y ch\u1eb1ng ngang (transverse ligament) v\u00e0 \u0111i\u1ec3m b\u00e1m c\u1ee7a d\u00e2y ch\u1eb1ng coracohumeral [1]. Xung quanh r\u00e3nh l\u00e0 c\u00e1c c\u01a1 quan quan tr\u1ecdng kh\u00e1c nh\u01b0 c\u01a1 supraspinatus \u1edf ph\u00eda tr\u00ean, c\u01a1 subscapularis \u1edf ph\u00eda d\u01b0\u1edbi, v\u00e0 x\u01b0\u01a1ng coracoid \u1edf ph\u00eda trong, t\u1ea1o th\u00e0nh m\u1ed9t kho\u1ea3ng c\u00e1ch \u0111\u1eb7c bi\u1ec7t r\u1ea5t quan tr\u1ecdng trong ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh [2].<\/p>\n<p>Vai tr\u00f2 c\u1ee7a g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u d\u00e0i kh\u00f4ng ch\u1ec9 \u0111\u01a1n thu\u1ea7n l\u00e0 h\u1ed7 tr\u1ee3 v\u1eadn \u0111\u1ed9ng. N\u00f3 \u0111\u00f3ng vai tr\u00f2 then ch\u1ed1t trong vi\u1ec7c duy tr\u00ec c\u00e2n b\u1eb1ng gi\u1eefa l\u1ef1c c\u0103ng c\u1ee7a c\u01a1 tam \u0111\u1ea7u (deltoid) v\u00e0 s\u1ef1 t\u00e1i t\u1ea1o c\u00e1c m\u00e0o x\u01b0\u01a1ng sau ch\u1ea5n th\u01b0\u01a1ng [8]. Khi g\u00e2n b\u1ecb vi\u00eam ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng, n\u00f3 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1ea3 n\u0103ng quay trong (internal rotation) c\u1ee7a c\u00e1nh tay v\u00e0 t\u00ednh \u1ed5n \u0111\u1ecbnh ch\u1ed1ng l\u1ea1i d\u1ecbch chuy\u1ec3n tr\u01b0\u1edbc c\u1ee7a kh\u1edbp vai. S\u1ef1 m\u1ea5t \u1ed5n \u0111\u1ecbnh n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn hi\u1ec7n t\u01b0\u1ee3ng tr\u01b0\u1ee3t ra ngo\u00e0i (subluxation), v\u1edbi nghi\u00ean c\u1ee9u cho th\u1ea5y kho\u1ea3ng 45% c\u00e1c tr\u01b0\u1eddng h\u1ee3p r\u00e1ch bao xoay (rotator cuff tears) k\u00e8m theo s\u1ef1 b\u1ea5t \u1ed5n \u0111\u1ecbnh c\u1ee7a g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u, trong \u0111\u00f3 80% l\u00e0 d\u1ea1ng tr\u01b0\u1ee3t [4].<\/p>\n<h2>Nguy\u00ean nh\u00e2n v\u00e0 k\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt trong ch\u1ea5n th\u01b0\u01a1ng g\u00e3y x\u01b0\u01a1ng tr\u00ean c\u00e1nh tay g\u1ea7n<\/h2>\n<p>Trong b\u1ed1i c\u1ea3nh ch\u1ea5n th\u01b0\u01a1ng g\u00e3y x\u01b0\u01a1ng tr\u00ean c\u00e1nh tay g\u1ea7n (proximal humeral fractures), vi\u1ec7c x\u1eed tr\u00ed vi\u00eam g\u00e2n ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng g\u00e2n li\u00ean quan \u0111\u1ebfn r\u00e3nh nh\u1ecb \u0111\u1ea7u \u0111\u00f2i h\u1ecfi k\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt tinh vi. C\u00e1c b\u00e1c s\u0129 th\u01b0\u1eddng th\u1ef1c hi\u1ec7n c\u1eaft g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u (tenotomy) v\u00e0 c\u1ed1 \u0111\u1ecbnh l\u1ea1i n\u00f3 (tenodesis) \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng t\u1ed1i \u01b0u [3]. M\u1ed9t sai l\u1ea7m ph\u1ed5 bi\u1ebfn l\u00e0 c\u1ed1 g\u1eafng ti\u1ebfp c\u1eadn m\u00e0o x\u01b0\u01a1ng l\u1edbn tr\u01b0\u1edbc khi lo\u1ea1i b\u1ecf ph\u1ea7n \u0111\u1ea7u x\u01b0\u01a1ng, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 g\u00e2y kh\u00f3 kh\u0103n cho vi\u1ec7c thao t\u00e1c. Ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c \u01b0a chu\u1ed9ng hi\u1ec7n nay l\u00e0 lo\u1ea1i b\u1ecf \u0111\u1ea7u x\u01b0\u01a1ng tr\u01b0\u1edbc, sau \u0111\u00f3 m\u1edbi x\u1eed l\u00fd c\u00e1c m\u1ea3nh v\u1ee1 c\u1ee7a m\u00e0o x\u01b0\u01a1ng, gi\u00fap t\u1ea1o kh\u00f4ng gian l\u00e0m vi\u1ec7c thu\u1eadn l\u1ee3i h\u01a1n [9].<\/p>\n<p>Vi\u1ec7c t\u00e1i t\u1ea1o v\u1ecb tr\u00ed gi\u1ea3i ph\u1eabu ch\u00ednh x\u00e1c gi\u1eefa \u0111\u1ea7u x\u01b0\u01a1ng v\u00e0 m\u00e0o x\u01b0\u01a1ng c\u0169ng c\u1ef1c k\u1ef3 quan tr\u1ecdng. N\u1ebfu m\u00e0o x\u01b0\u01a1ng l\u1edbn li\u1ec1n qu\u00e1 g\u1ea7n l\u00ean ph\u00eda tr\u00ean, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u0103ng l\u1ef1c kh\u00f4ng \u0111\u1ee7 c\u1ee7a bao xoay v\u00e0 g\u00e2y k\u1eb9t d\u01b0\u1edbi acromion; ng\u01b0\u1ee3c l\u1ea1i, n\u1ebfu \u0111\u1eb7t qu\u00e1 th\u1ea5p s\u1ebd l\u00e0m t\u0103ng nguy c\u01a1 r\u00e1ch d\u00e2y ch\u1eb1ng [6]. Ngo\u00e0i ra, v\u00f9ng r\u00e3nh nh\u1ecb \u0111\u1ea7u \u0111\u01b0\u1ee3c bao b\u1ecdc b\u1edfi l\u1edbp s\u1ee5n x\u01b0\u01a1ng c\u1ee9ng, n\u00ean ch\u1ec9 b\u1ecb g\u00e3y trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ea5n th\u01b0\u01a1ng n\u0103ng l\u01b0\u1ee3ng cao ho\u1eb7c lo\u00e3ng x\u01b0\u01a1ng n\u1eb7ng [7].<\/p>\n<h2>Quy tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng sau ph\u1eabu thu\u1eadt<\/h2>\n<p>\u0110\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3, ph\u1eabu thu\u1eadt c\u1ea7n \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 c\u00e2n b\u1eb1ng tinh t\u1ebf gi\u1eefa c\u0103ng c\u01a1 tam \u0111\u1ea7u v\u00e0 t\u00e1i t\u1ea1o gi\u1ea3i ph\u1eabu c\u1ee7a c\u00e1c m\u00e0o x\u01b0\u01a1ng. Sau khi th\u1ef1c hi\u1ec7n can thi\u1ec7p, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh trong b\u1ed9t g\u1ea1c gi\u1eef kh\u1edbp \u1edf t\u01b0 th\u1ebf 90 \u0111\u1ed9 abducted, 90 \u0111\u1ed9 quay ngo\u00e0i v\u00e0 20 \u0111\u1ed9 tr\u01b0\u1edbc [5]. V\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 c\u00e1c b\u00e0i t\u1eadp v\u1eadn \u0111\u1ed9ng ch\u1ee7 \u0111\u1ed9ng m\u1edbi b\u1eaft \u0111\u1ea7u sau kho\u1ea3ng 6 tu\u1ea7n \u0111\u1ec3 ph\u00e1t tri\u1ec3n kh\u1ea3 n\u0103ng abducted v\u00e0 quay ngo\u00e0i c\u1ee7a kh\u1edbp vai [5].<\/p>\n<p>T\u00f3m l\u1ea1i, vi\u00eam g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u d\u00e0i t\u1ea1i r\u00e3nh kh\u00f4ng ch\u1ec9 l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111au \u0111\u1edbn m\u00e0 c\u00f2n li\u00ean quan m\u1eadt thi\u1ebft \u0111\u1ebfn c\u1ea5u tr\u00fac \u1ed5n \u0111\u1ecbnh c\u1ee7a kh\u1edbp vai. Vi\u1ec7c hi\u1ec3u bi\u1ebft s\u00e2u s\u1eafc v\u1ec1 gi\u1ea3i ph\u1eabu v\u00f9ng n\u00e0y, c\u0169ng nh\u01b0 c\u00e1c nguy\u00ean t\u1eafc ph\u1eabu thu\u1eadt \u0111\u1ec3 t\u00e1i t\u1ea1o v\u1ecb tr\u00ed v\u00e0 ch\u1ee9c n\u0103ng, gi\u00fap b\u00e1c s\u0129 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t cho t\u1eebng b\u1ec7nh nh\u00e2n.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<ul>\n<li>[1] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 1347<\/li>\n<li>[2] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 1351<\/li>\n<li>[3] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 1392<\/li>\n<li>[4] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2992<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 1699<\/li>\n<li>[6] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 1347<\/li>\n<li>[7] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 1348<\/li>\n<li>[8] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 1392<\/li>\n<li>[9] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 1392<\/li>\n<\/ul>\n<p><!-- aiwriter:9375d750537d46c58bd5b705 --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hi\u1ec3u r\u00f5 gi\u1ea3i ph\u1eabu g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u d\u00e0i v\u00e0 vai tr\u00f2 c\u1ee7a n\u00f3 trong \u1ed5n \u0111\u1ecbnh kh\u1edbp vai gi\u00fap b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c vi\u00eam g\u00e2n v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan sau ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-488","post","type-post","status-publish","format-standard","hentry","category-chi-tren"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - 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