T\u1ed5n th\u01b0\u01a1ng \u0111\u00e1m r\u1ed1i th\u1ea7n kinh c\u00e1nh tay th\u1ec3 Erb-Duchenne \u1edf tr\u1ebb s\u01a1 sinh<\/p>\n
T\u1ed5n th\u01b0\u01a1ng \u0111\u00e1m r\u1ed1i th\u1ea7n kinh c\u00e1nh tay (brachial plexus birth palsy), c\u00f2n \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn v\u1edbi t\u00ean g\u1ecdi Erb-Duchenne khi li\u00ean quan \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng r\u1ec5 C5-C6, l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh ph\u1ed5 bi\u1ebfn x\u1ea3y ra trong qu\u00e1 tr\u00ecnh sinh. M\u1eb7c d\u00f9 c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 s\u1ea3n khoa \u0111\u00e3 ph\u00e1t tri\u1ec3n, t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh n\u00e0y v\u1eabn t\u1ed3n t\u1ea1i v\u00e0 c\u00f3 xu h\u01b0\u1edbng gi\u1ea3m d\u1ea7n theo th\u1eddi gian [5]. C\u01a1 ch\u1ebf ch\u00ednh g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn ch\u1ea5n th\u01b0\u01a1ng c\u01a1 h\u1ecdc do k\u00e9o c\u0103ng (traction injury) trong qu\u00e1 tr\u00ecnh sinh, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi x\u1ea3y ra t\u00ecnh tr\u1ea1ng t\u1eafc ngh\u1ebdn vai (shoulder dystocia) ho\u1eb7c c\u00e1c kh\u00f3 kh\u0103n trong vi\u1ec7c s\u1ea3n xu\u1ea5t [2].<\/p>\n
Vi\u1ec7c hi\u1ec3u r\u00f5 c\u01a1 ch\u1ebf t\u1ed5n th\u01b0\u01a1ng gi\u00fap x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh. T\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng do l\u1ef1c k\u00e9o t\u00e1c \u0111\u1ed9ng l\u00ean vai khi \u0111\u1ea7u thai nhi b\u1ecb k\u1eb9t l\u1ea1i trong qu\u00e1 tr\u00ecnh chuy\u1ec3n v\u1ecb [2]. T\u00f9y thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng c\u1ee7a \u0111\u00e1m r\u1ed1i th\u1ea7n kinh, b\u1ec7nh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i kh\u00e1c nhau, t\u1eeb t\u1ed5n th\u01b0\u01a1ng r\u1ec5 tr\u00ean (Erb’s palsy \u1ea3nh h\u01b0\u1edfng C5-C6) \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng r\u1ec5 d\u01b0\u1edbi ho\u1eb7c to\u00e0n b\u1ed9 \u0111\u00e1m r\u1ed1i [2]. M\u1ed9t \u0111i\u1ec3m quan tr\u1ecdng c\u1ea7n l\u01b0u \u00fd l\u00e0 vi\u1ec7c c\u1eaft t\u1eed cung (cesarean section) kh\u00f4ng lo\u1ea1i tr\u1eeb ho\u00e0n to\u00e0n kh\u1ea3 n\u0103ng x\u1ea3y ra t\u1ed5n th\u01b0\u01a1ng n\u00e0y, nh\u01b0ng c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m x\u00e1c su\u1ea5t t\u1eeb 0,2% xu\u1ed1ng c\u00f2n 0,02% [2].<\/p>\n
\u0110\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng v\u00e0 ti\u00ean l\u01b0\u1ee3ng ph\u1ee5c h\u1ed3i, c\u00e1c b\u00e1c s\u0129 th\u01b0\u1eddng ph\u00e2n bi\u1ec7t gi\u1eefa t\u1ed5n th\u01b0\u01a1ng ti\u1ec1n h\u1ea1ch (preganglionic) v\u00e0 h\u1eadu h\u1ea1ch (postganglionic). T\u1ed5n th\u01b0\u01a1ng h\u1eadu h\u1ea1ch \u0111\u01b0\u1ee3c chia th\u00e0nh ba c\u1ea5p \u0111\u1ed9: neurapraxia (t\u1ed5n th\u01b0\u01a1ng ch\u1ee9c n\u0103ng kh\u00f4ng c\u00f3 tho\u00e1i h\u00f3a ngo\u1ea1i vi), axonotmesis (suy tho\u00e1i tr\u1ee5c th\u1ea7n kinh nh\u01b0ng m\u00f4 xung quanh c\u00f2n nguy\u00ean v\u1eb9n) v\u00e0 neurotmesis (ph\u00e1 v\u1ee1 ho\u00e0n to\u00e0n d\u00e2y th\u1ea7n kinh v\u00e0 m\u00f4 h\u1ed7 tr\u1ee3) [2]. Trong khi t\u1ed5n th\u01b0\u01a1ng neurapraxia th\u01b0\u1eddng ph\u1ee5c h\u1ed3i ho\u00e0n to\u00e0n, c\u00e1c tr\u01b0\u1eddng h\u1ee3p axonotmesis c\u1ea7n th\u1eddi gian d\u00e0i h\u01a1n \u0111\u1ec3 t\u00e1i sinh s\u1ee3i th\u1ea7n kinh, c\u00f2n neurotmesis c\u00f3 ti\u00ean l\u01b0\u1ee3ng k\u00e9m do kh\u00f4ng t\u1ef1 h\u1ed3i ph\u1ee5c ch\u1ee9c n\u0103ng n\u1ebfu r\u1ec5 th\u1ea7n kinh b\u1ecb nh\u1ed5 ra kh\u1ecfi t\u1ee7y s\u1ed1ng [8].<\/p>\n
H\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh c\u1ee7a t\u1ed5n th\u01b0\u01a1ng th\u1ec3 Erb bao g\u1ed3m vai n\u1eb1m trong v\u1ecb tr\u00ed xoay trong (internal rotation), h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng co gi\u00e3n, b\u00e0n tay b\u1ecb du\u1ed7i ho\u1eb7c ng\u00f3n c\u00e1i du\u1ed7i [6]. Trong tr\u01b0\u1eddng h\u1ee3p li\u1ec7t to\u00e0n b\u1ed9 c\u00e1nh tay v\u00e0 b\u00e0n tay, chi tr\u00ean s\u1ebd m\u1ec1m y\u1ebfu ho\u00e0n to\u00e0n. M\u1ed9t d\u1ea5u hi\u1ec7u \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng l\u00e0 h\u1ed9i ch\u1ee9ng Horner (h\u01a1i m\u1edd m\u1eaft, tr\u0169ng m\u00ed) do t\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh giao c\u1ea3m T1, \u0111\u00e2y th\u01b0\u1eddng l\u00e0 ch\u1ec9 \u0111\u1ecbnh cho k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb k\u00e9m [6].<\/p>\n
Tuy nhi\u00ean, m\u1ed9t t\u00ecnh tr\u1ea1ng c\u1ea7n ph\u1ea3i ph\u00e2n bi\u1ec7t ch\u00ednh x\u00e1c l\u00e0 “gi\u1ea3 li\u1ec7t” (pseudoparalysis). \u0110\u00e2y l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng tr\u1ebb kh\u00f4ng v\u1eadn \u0111\u1ed9ng c\u00e1nh tay do \u0111au \u0111\u1edbn li\u00ean quan \u0111\u1ebfn g\u00e3y x\u01b0\u01a1ng \u0111\u00f2n ho\u1eb7c g\u00e3y x\u01b0\u01a1ng tr\u00ean vai g\u1ea7n \u0111\u00f3, ch\u1ee9 kh\u00f4ng ph\u1ea3i do t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh th\u1ef1c s\u1ef1 [3]. G\u00e3y x\u01b0\u01a1ng \u0111\u00f2n th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 c\u00f3 th\u1ec3 \u0111i k\u00e8m v\u1edbi t\u1ed5n th\u01b0\u01a1ng \u0111\u00e1m r\u1ed1i th\u1ea7n kinh trong 10% \u0111\u1ebfn 15% c\u00e1c tr\u01b0\u1eddng h\u1ee3p [6]. \u0110\u1ec3 ph\u00e2n bi\u1ec7t gi\u1ea3 li\u1ec7t v\u00e0 li\u1ec7t th\u1ef1c s\u1ef1, b\u00e1c s\u0129 c\u1ea7n theo d\u00f5i di\u1ec5n bi\u1ebfn c\u1ee7a ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng. N\u1ebfu h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng k\u00e9o d\u00e0i h\u01a1n 1 th\u00e1ng tu\u1ed5i, kh\u1ea3 n\u0103ng cao l\u00e0 c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111\u00e1m r\u1ed1i th\u1ea7n kinh \u0111\u1ed3ng th\u1eddi [6]. Ng\u01b0\u1ee3c l\u1ea1i, n\u1ebfu tr\u1ebb b\u1ecb gi\u1ea3 li\u1ec7t do g\u00e3y x\u01b0\u01a1ng \u0111\u00f2n, t\u00ecnh tr\u1ea1ng n\u00e0y th\u01b0\u1eddng s\u1ebd c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t sau khi v\u1ebft th\u01b0\u01a1ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m \u0111au trong v\u00f2ng 10 \u0111\u1ebfn 21 ng\u00e0y [6].<\/p>\n
Do tr\u1ebb s\u01a1 sinh ch\u01b0a th\u1ec3 th\u1ef1c hi\u1ec7n c\u00e1c l\u1ec7nh v\u1eadn \u0111\u1ed9ng ph\u1ee9c t\u1ea1p, vi\u1ec7c \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u01b0\u1eddng d\u1ef1a tr\u00ean quan s\u00e1t ho\u1ea1t \u0111\u1ed9ng t\u1ef1 ph\u00e1t ho\u1eb7c s\u1eed d\u1ee5ng c\u00e1c thang \u0111i\u1ec3m chuy\u00ean bi\u1ec7t. C\u00e1c c\u00f4ng c\u1ee5 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 bao g\u1ed3m: Thang \u0111i\u1ec3m Toronto (Toronto Test Score), Thang chuy\u1ec3n \u0111\u1ed9ng ch\u1ee7 \u0111\u1ed9ng c\u1ee7a B\u1ec7nh vi\u1ec7n Sick Children (Hospital for Sick Children Active Movement Scale) v\u00e0 Thang Mallet [1]. Trong \u0111\u00f3, Thang Mallet l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ph\u1ed5 bi\u1ebfn nh\u1ea5t, s\u1eed d\u1ee5ng c\u00e1c m\u1ee9c \u0111\u1ed9 t\u1eeb 1 \u0111\u1ebfn 5 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng \u0111\u1ed1i tr\u1ecdng v\u00e0 kh\u00f4ng \u0111\u1ed1i tr\u1ecdng, bao g\u1ed3m c\u00e1c c\u1eed \u0111\u1ed9ng nh\u01b0 xoay trong, co du\u1ed7i vai v\u00e0 \u0111\u01b0a tay v\u00e0o b\u1ee5ng [7]. Vi\u1ec7c \u0111o l\u01b0\u1eddng th\u1ee5 \u0111\u1ed9ng xoay trong v\u00e0 ngo\u00e0i c\u1ee7a kh\u1edbp vai c\u0169ng l\u00e0 m\u1ed9t ph\u1ea7n quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh \u0111\u00e1nh gi\u00e1 [1].<\/p>\n
Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1ee5 thu\u1ed9c l\u1edbn v\u00e0o m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u00e1c h\u1ee3p ch\u1ee9ng kh\u1edbp. \u0110\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng to\u00e0n b\u1ed9 \u0111\u00e1m r\u1ed1i (global plexus palsies) \u0111i k\u00e8m h\u1ed9i ch\u1ee9ng Horner, vi\u1ec7c can thi\u1ec7p vi ph\u1eabu thu\u1eadt \u1edf kho\u1ea3ng 3 th\u00e1ng tu\u1ed5i th\u01b0\u1eddng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb do ti\u00ean l\u01b0\u1ee3ng ph\u1ee5c h\u1ed3i t\u1ef1 nhi\u00ean k\u00e9m [4].<\/p>\n
\u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ee9t g\u00e3y trong \u0111\u00e1m r\u1ed1i (intraplexus ruptures), y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh c\u1ea7n th\u1ef1c hi\u1ec7n kh\u00e1m v\u00e0 t\u00e1i t\u1ea1o th\u1ea7n kinh l\u00e0 s\u1ef1 ph\u1ee5c h\u1ed3i c\u1ee7a l\u1ef1c co c\u01a1 ch\u1ed1ng tr\u1ecdng l\u1ef1c \u1edf kh\u1edbp khu\u1ef7u. \u0110a s\u1ed1 c\u00e1c t\u00e1c gi\u1ea3 khuy\u1ebfn ngh\u1ecb can thi\u1ec7p vi ph\u1eabu thu\u1eadt n\u1ebfu l\u1ef1c co ch\u1ed1ng tr\u1ecdng l\u1ef1c kh\u00f4ng \u0111\u00e3 ph\u1ee5c h\u1ed3i \u0111\u1ebfn kho\u1ea3ng 3 \u0111\u1ebfn 9 th\u00e1ng tu\u1ed5i [4]. C\u00e1c k\u1ef9 thu\u1eadt \u0111i\u1ec1u tr\u1ecb bao g\u1ed3m c\u1eaft b\u1ecf u th\u1ea7n kinh (neuroma resection), gh\u00e9p d\u00e2y th\u1ea7n kinh t\u1eeb d\u00e2y th\u1ea7n kinh s\u1ed1ng l\u01b0ng (sural nerve grafting) ho\u1eb7c chuy\u1ec3n m\u1ea1ch d\u00e2y th\u1ea7n kinh t\u1ea1i ch\u1ed7, trong \u0111\u00f3 ph\u01b0\u01a1ng ph\u00e1p chuy\u1ec3n m\u1ea1ch v\u00e0 gh\u00e9p d\u00e2y t\u1ea1i ch\u1ed7 \u0111ang tr\u1edf th\u00e0nh ti\u00eau chu\u1ea9n thay th\u1ebf cho gh\u00e9p d\u00e2y th\u1ea7n kinh s\u1ed1ng l\u01b0ng [4].<\/p>\n
Vi\u1ec7c theo d\u00f5i \u0111\u1ecbnh k\u1ef3 th\u00f4ng qua c\u00e1c x\u00e9t nghi\u1ec7m l\u00e2m s\u00e0ng gi\u00fap x\u00e1c \u0111\u1ecbnh th\u1eddi \u0111i\u1ec3m ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng v\u00e0 ph\u00e1t tri\u1ec3n c\u00e1c h\u1ee3p ch\u1ee9ng kh\u1edbp, t\u1eeb \u0111\u00f3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t cho t\u1eebng ca b\u1ec7nh c\u1ee5 th\u1ec3 [1].<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
T\u00ecm hi\u1ec3u v\u1ec1 t\u1ed5n th\u01b0\u01a1ng \u0111\u00e1m r\u1ed1i th\u1ea7n kinh c\u00e1nh tay th\u1ec3 Erb-Duchenne, nguy\u00ean nh\u00e2n g\u00e2y ra, d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u0111\u1eb7c tr\u01b0ng, ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng v\u00e0 c\u00e1c l\u1ef1a ch\u1ecdn can thi\u1ec7p ph\u1eabu thu\u1eadt t\u1ed1i \u01b0u cho tr\u1ebb em.<\/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-495","post","type-post","status-publish","format-standard","hentry","category-chi-tren"],"yoast_head":"\n