{"id":570,"date":"2026-10-13T06:11:11","date_gmt":"2026-10-12T23:11:11","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/13\/phau-thuat-noi-soi-khop-vai-sua-chua-rach-gan-duoi-vai-quy-trinh-va-chi-dinh\/"},"modified":"2026-10-13T06:11:11","modified_gmt":"2026-10-12T23:11:11","slug":"phau-thuat-noi-soi-khop-vai-sua-chua-rach-gan-duoi-vai-quy-trinh-va-chi-dinh","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/13\/phau-thuat-noi-soi-khop-vai-sua-chua-rach-gan-duoi-vai-quy-trinh-va-chi-dinh\/","title":{"rendered":"Ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp vai s\u1eeda ch\u1eefa r\u00e1ch g\u00e2n d\u01b0\u1edbi vai: quy tr\u00ecnh v\u00e0 ch\u1ec9 \u0111\u1ecbnh"},"content":{"rendered":"

Ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp vai s\u1eeda ch\u1eefa r\u00e1ch g\u00e2n d\u01b0\u1edbi vai<\/strong> l\u00e0 k\u1ef9 thu\u1eadt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00e0 kh\u00e2u l\u1ea1i g\u00e2n d\u01b0\u1edbi vai khi t\u1ed5n th\u01b0\u01a1ng c\u00f2n kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i v\u1ec1 v\u1ecb tr\u00ed b\u00e1m. Vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng ch\u1ec9 d\u1ef1a v\u00e0o h\u00ecnh \u1ea3nh ch\u1ee5p m\u00e0 c\u00f2n c\u1ea7n \u0111\u00e1nh gi\u00e1 tr\u1ef1c ti\u1ebfp m\u1ee9c \u0111\u1ed9 r\u00e1ch, \u0111\u1ed9 co r\u00fat, ch\u1ea5t l\u01b0\u1ee3ng g\u00e2n v\u00e0 kh\u1ea3 n\u0103ng di \u0111\u1ed9ng trong qu\u00e1 tr\u00ecnh n\u1ed9i soi [2][4].<\/p>\n

Khi n\u00e0o c\u00e2n nh\u1eafc ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp vai s\u1eeda ch\u1eefa r\u00e1ch g\u00e2n d\u01b0\u1edbi vai?<\/h2>\n

G\u00e2n d\u01b0\u1edbi vai l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a nh\u00f3m g\u00e2n ch\u00f3p xoay. T\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 n\u1eb1m \u1edf ph\u1ea7n tr\u00ean c\u1ee7a g\u00e2n, lan r\u1ed9ng h\u01a1n ho\u1eb7c r\u00e1ch to\u00e0n b\u1ed9. T\u00e0i li\u1ec7u s\u1eed d\u1ee5ng ph\u00e2n lo\u1ea1i Lafosse: lo\u1ea1i I l\u00e0 r\u00e1ch b\u00e1n ph\u1ea7n \u1edf m\u1ed9t ph\u1ea7n ba ph\u00eda tr\u00ean; lo\u1ea1i II l\u00e0 r\u00e1ch ho\u00e0n to\u00e0n m\u1ed9t ph\u1ea7n ba ph\u00eda tr\u00ean; lo\u1ea1i III l\u00e0 r\u00e1ch ho\u00e0n to\u00e0n hai ph\u1ea7n ba ph\u00eda tr\u00ean; lo\u1ea1i IV l\u00e0 r\u00e1ch to\u00e0n b\u1ed9 nh\u01b0ng ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay v\u1eabn \u1edf trung t\u00e2m v\u00e0 th\u00e2m nhi\u1ec5m m\u1ee1 kh\u00f4ng qu\u00e1 giai \u0111o\u1ea1n 3; lo\u1ea1i V l\u00e0 r\u00e1ch to\u00e0n b\u1ed9 k\u00e8m b\u00e1n tr\u1eadt ra tr\u01b0\u1edbc v\u00e0 th\u00e2m nhi\u1ec5m m\u1ee1 t\u1eeb giai \u0111o\u1ea1n 3 tr\u1edf l\u00ean [2].<\/p>\n

Ph\u00e2n lo\u1ea1i n\u00e0y c\u00f3 \u00fd ngh\u0129a trong quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb. M\u1ed9t s\u1ed1 r\u00e1ch l\u1edbn v\u1eabn c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c kh\u00e2u n\u1ebfu g\u00e2n \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng v\u00e0 \u0111\u01b0a v\u1ec1 v\u1ecb tr\u00ed b\u00e1m m\u00e0 kh\u00f4ng t\u1ea1o l\u1ef1c c\u0103ng qu\u00e1 m\u1ee9c. Ng\u01b0\u1ee3c l\u1ea1i, r\u00e1ch lo\u1ea1i V th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c xem l\u00e0 ph\u00f9 h\u1ee3p \u0111\u1ec3 kh\u00e2u ph\u1ee5c h\u1ed3i; chuy\u1ec3n g\u00e2n ho\u1eb7c thay kh\u1edbp vai \u0111\u1ea3o ng\u01b0\u1ee3c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc trong nh\u1eefng t\u00ecnh hu\u1ed1ng nh\u01b0 v\u1eady [2].<\/p>\n

\u0110\u00e1nh gi\u00e1 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt<\/h2>\n

Ch\u1ea9n \u0111o\u00e1n r\u00e1ch g\u00e2n d\u01b0\u1edbi vai c\u1ea7n k\u1ebft h\u1ee3p kh\u00e1m l\u00e2m s\u00e0ng, ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u00e0 n\u1ed9i soi khi c\u1ea7n. MRI c\u00f3 th\u1ec3 gi\u00fap \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 co r\u00fat, th\u00e2m nhi\u1ec5m m\u1ee1, teo c\u01a1, ch\u00e8n \u00e9p d\u01b0\u1edbi m\u1ecfm qu\u1ea1 v\u00e0 t\u00ecnh tr\u1ea1ng tr\u1eadt ho\u1eb7c b\u00e1n tr\u1eadt g\u00e2n \u0111\u1ea7u d\u00e0i c\u01a1 nh\u1ecb \u0111\u1ea7u. Tuy nhi\u00ean, \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a MRI \u0111\u1ed1i v\u1edbi r\u00e1ch g\u00e2n d\u01b0\u1edbi vai c\u00f3 th\u1ec3 th\u1ea5p h\u01a1n so v\u1edbi c\u00e1c r\u00e1ch ch\u00f3p xoay ph\u00eda sau; v\u00ec v\u1eady, \u0111\u00e1nh gi\u00e1 n\u1ed9i soi c\u00f3 vai tr\u00f2 quan tr\u1ecdng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng th\u1ef1c t\u1ebf [6].<\/p>\n

G\u00e2n d\u01b0\u1edbi vai c\u00f3 li\u00ean quan ch\u1eb7t ch\u1ebd v\u1edbi g\u00e2n \u0111\u1ea7u d\u00e0i c\u01a1 nh\u1ecb \u0111\u1ea7u. V\u00ec th\u1ebf, b\u1ec7nh l\u00fd g\u00e2n nh\u1ecb \u0111\u1ea7u nh\u01b0 \u0111\u1ee9t ho\u1eb7c tr\u1eadt v\u00e0o trong c\u00f3 th\u1ec3 \u0111i k\u00e8m. Trong khi s\u1eeda ch\u1eefa g\u00e2n d\u01b0\u1edbi vai, b\u00e1c s\u0129 c\u00f3 th\u1ec3 ph\u1ea3i x\u1eed tr\u00ed \u0111\u1ed3ng th\u1eddi g\u00e2n nh\u1ecb \u0111\u1ea7u b\u1eb1ng th\u1ee7 thu\u1eadt c\u1eaft g\u00e2n ho\u1eb7c c\u1ed1 \u0111\u1ecbnh g\u00e2n, t\u00f9y t\u00ecnh tr\u1ea1ng c\u1ee5 th\u1ec3 [6].<\/p>\n

Ph\u1eabu thu\u1eadt n\u1ed9i soi di\u1ec5n ra nh\u01b0 th\u1ebf n\u00e0o?<\/h2>\n

Th\u00f4ng th\u01b0\u1eddng, b\u00e1c s\u0129 b\u1eaft \u0111\u1ea7u b\u1eb1ng n\u1ed9i soi kh\u1edbp qua c\u1ed5ng sau \u0111\u1ec3 ki\u1ec3m tra kh\u1edbp vai, s\u1ee5n, s\u1ee5n vi\u1ec1n, g\u00e2n nh\u1ecb \u0111\u1ea7u v\u00e0 g\u00e2n d\u01b0\u1edbi vai. M\u1ed9t s\u1ed1 r\u00e1ch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u1eed l\u00fd t\u1eeb khoang d\u01b0\u1edbi m\u1ecfm c\u00f9ng vai, v\u1edbi h\u01b0\u1edbng quan s\u00e1t t\u1eeb ph\u00eda tr\u01b0\u1edbc-b\u00ean v\u00e0 d\u1ee5ng c\u1ee5 l\u00e0m vi\u1ec7c \u1edf ph\u00eda tr\u01b0\u1edbc [1]. V\u1ecb tr\u00ed c\u1ed5ng n\u1ed9i soi \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn theo c\u1ea5u h\u00ecnh r\u00e1ch v\u00e0 v\u00f9ng c\u1ea7n thao t\u00e1c.<\/p>\n

C\u00e1c b\u01b0\u1edbc ch\u00ednh c\u00f3 th\u1ec3 bao g\u1ed3m:<\/p>\n

    \n
  • X\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed, h\u00ecnh d\u1ea1ng v\u00e0 ph\u1ea1m vi r\u00e1ch.<\/li>\n
  • Gi\u1ea3i ph\u00f3ng c\u00e1c d\u00ednh \u1edf m\u1eb7t kh\u1edbp, m\u1eb7t t\u00fai thanh d\u1ecbch v\u00e0 v\u00f9ng kho\u1ea3ng xoay khi c\u1ea7n.<\/li>\n
  • \u0110\u00e1nh gi\u00e1 \u0111\u1ed9 di \u0111\u1ed9ng c\u1ee7a g\u00e2n b\u1eb1ng d\u1ee5ng c\u1ee5 k\u1eb9p ho\u1eb7c ch\u1ec9 k\u00e9o.<\/li>\n
  • \u0110\u01b0a g\u00e2n v\u1ec1 c\u1ee7 b\u00e9 m\u00e0 kh\u00f4ng t\u1ea1o l\u1ef1c c\u0103ng qu\u00e1 m\u1ee9c.<\/li>\n
  • \u0110\u1eb7t neo ch\u1ec9 g\u1ea7n b\u1edd m\u1eb7t kh\u1edbp v\u00e0 lu\u1ed3n ch\u1ec9 qua g\u00e2n \u0111\u1ec3 t\u1ea1o c\u1ea5u h\u00ecnh kh\u00e2u ph\u00f9 h\u1ee3p [3][5].<\/li>\n<\/ul>\n

    \u1ede nh\u1eefng r\u00e1ch l\u1edbn ho\u1eb7c co r\u00fat nhi\u1ec1u, vi\u1ec7c quan s\u00e1t t\u1eeb m\u1eb7t t\u00fai thanh d\u1ecbch qua c\u1ed5ng tr\u01b0\u1edbc-b\u00ean c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 thao t\u00e1c. Ng\u01b0\u1ee3c l\u1ea1i, r\u00e1ch nh\u1ecf th\u01b0\u1eddng d\u1ec5 quan s\u00e1t v\u00e0 huy \u0111\u1ed9ng h\u01a1n qua c\u1ed5ng sau \u1edf m\u1eb7t kh\u1edbp [2][7]. M\u1ee5c ti\u00eau k\u1ef9 thu\u1eadt l\u00e0 ph\u1ee5c h\u1ed3i g\u00e2n v\u1ec1 v\u00f9ng b\u00e1m gi\u1ea3i ph\u1eabu v\u1edbi \u0111\u1ed9 c\u0103ng ph\u00f9 h\u1ee3p, thay v\u00ec ch\u1ec9 \u0111\u00f3ng k\u00edn \u0111\u01b0\u1eddng r\u00e1ch.<\/p>\n

    \u01afu \u0111i\u1ec3m v\u00e0 gi\u1edbi h\u1ea1n c\u1ee7a k\u1ef9 thu\u1eadt n\u1ed9i soi<\/h2>\n

    So v\u1edbi \u0111\u01b0\u1eddng m\u1ed5 m\u1edf, s\u1eeda ch\u1eefa n\u1ed9i soi cho ph\u00e9p ki\u1ec3m tra v\u00e0 x\u1eed tr\u00ed c\u00e1c t\u1ed5n th\u01b0\u01a1ng trong kh\u1edbp, tr\u00e1nh t\u00e1ch c\u01a1 delta, gi\u1ea3m b\u00f3c t\u00e1ch m\u00f4 m\u1ec1m v\u00e0 s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng r\u1ea1ch nh\u1ecf h\u01a1n. N\u1ed9i soi c\u0169ng gi\u00fap \u0111\u00e1nh gi\u00e1 \u0111\u00e1ng tin c\u1eady h\u01a1n k\u00edch th\u01b0\u1edbc r\u00e1ch, ch\u1ea5t l\u01b0\u1ee3ng g\u00e2n, \u0111\u1ed9 di \u0111\u1ed9ng v\u00e0 v\u1ecb tr\u00ed \u0111\u1eb7t neo ch\u1ec9 [4]. Tuy nhi\u00ean, m\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p \u0111\u01b0\u1ee3c tr\u00edch d\u1eabn trong t\u00e0i li\u1ec7u kh\u00f4ng ghi nh\u1eadn kh\u00e1c bi\u1ec7t v\u1ec1 th\u1eddi gian ph\u1eabu thu\u1eadt, \u0111i\u1ec3m ch\u1ee9c n\u0103ng ho\u1eb7c \u0111i\u1ec3m \u0111au gi\u1eefa s\u1eeda ch\u1eefa n\u1ed9i soi v\u00e0 s\u1eeda ch\u1eefa mini-open [4]. V\u00ec v\u1eady, l\u1ef1a ch\u1ecdn k\u1ef9 thu\u1eadt c\u1ea7n d\u1ef1a tr\u00ean h\u00ecnh th\u00e1i r\u00e1ch, kh\u1ea3 n\u0103ng huy \u0111\u1ed9ng g\u00e2n, t\u1ed5n th\u01b0\u01a1ng ph\u1ed1i h\u1ee3p v\u00e0 kinh nghi\u1ec7m c\u1ee7a ph\u1eabu thu\u1eadt vi\u00ean.<\/p>\n

    Kh\u1ea3 n\u0103ng kh\u00e2u th\u00e0nh c\u00f4ng c\u00f3 th\u1ec3 b\u1ecb h\u1ea1n ch\u1ebf khi g\u00e2n r\u00e1ch l\u1edbn, co r\u00fat, ch\u1ea5t l\u01b0\u1ee3ng k\u00e9m ho\u1eb7c c\u00f3 th\u00e2m nhi\u1ec5m m\u1ee1 v\u00e0 teo c\u01a1 \u0111\u00e1ng k\u1ec3. N\u1ebfu sau c\u00e1c b\u01b0\u1edbc gi\u1ea3i ph\u00f3ng m\u00e0 g\u00e2n v\u1eabn kh\u00f4ng th\u1ec3 \u0111\u01b0a v\u1ec1 c\u1ee7 b\u00e9 m\u1ed9t c\u00e1ch an to\u00e0n, s\u1eeda ch\u1eefa gi\u1ea3i ph\u1eabu c\u00f3 th\u1ec3 kh\u00f4ng kh\u1ea3 thi; khi \u0111\u00f3 c\u1ea7n th\u1ea3o lu\u1eadn c\u00e1c ph\u01b0\u01a1ng \u00e1n t\u00e1i t\u1ea1o kh\u00e1c. Ph\u1ea1m vi t\u00e0i li\u1ec7u \u0111\u01b0\u1ee3c cung c\u1ea5p t\u1eadp trung v\u00e0o \u0111\u00e1nh gi\u00e1 v\u00e0 k\u1ef9 thu\u1eadt s\u1eeda ch\u1eefa n\u1ed9i soi, kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 tr\u00ecnh b\u00e0y chi ti\u1ebft ph\u00e1c \u0111\u1ed3 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng sau m\u1ed5 ho\u1eb7c ti\u00ean l\u01b0\u1ee3ng ri\u00eang cho t\u1eebng ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

    K\u1ebft lu\u1eadn<\/h2>\n

    Ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u1edbp vai s\u1eeda ch\u1eefa r\u00e1ch g\u00e2n d\u01b0\u1edbi vai<\/strong> ph\u00f9 h\u1ee3p khi g\u00e2n c\u00f2n kh\u1ea3 n\u0103ng huy \u0111\u1ed9ng v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0a v\u1ec1 v\u1ecb tr\u00ed b\u00e1m v\u1edbi l\u1ef1c c\u0103ng ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c. Ch\u1ea9n \u0111o\u00e1n c\u1ea7n k\u1ebft h\u1ee3p kh\u00e1m, MRI v\u00e0 \u0111\u00e1nh gi\u00e1 n\u1ed9i soi; \u0111\u1ed3ng th\u1eddi ph\u1ea3i ki\u1ec3m tra g\u00e2n \u0111\u1ea7u d\u00e0i c\u01a1 nh\u1ecb \u0111\u1ea7u v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng ph\u1ed1i h\u1ee3p. Quy\u1ebft \u0111\u1ecbnh cu\u1ed1i c\u00f9ng n\u00ean \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 h\u00f3a sau khi b\u00e1c s\u0129 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 r\u00e1ch, co r\u00fat, ch\u1ea5t l\u01b0\u1ee3ng g\u00e2n v\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1.<\/p>\n

    T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
      \n
    • [1] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 3202<\/li>\n
    • [2] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 3208<\/li>\n
    • [3] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 3210<\/li>\n
    • [4] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 2829<\/li>\n
    • [5] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 3203<\/li>\n
    • [6] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 3208<\/li>\n
    • [7] Campbell's Operative Orthopaedics, 15th Edition, 2026, trang 3208<\/li>\n<\/ul>\n

      <\/p>\n","protected":false},"excerpt":{"rendered":"

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