{"id":591,"date":"2026-10-13T08:54:40","date_gmt":"2026-10-13T01:54:40","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/13\/noi-soi-khau-sun-chem-all-inside-ky-thuat-hien-dai-thay-the-canula\/"},"modified":"2026-10-13T08:54:40","modified_gmt":"2026-10-13T01:54:40","slug":"noi-soi-khau-sun-chem-all-inside-ky-thuat-hien-dai-thay-the-canula","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/13\/noi-soi-khau-sun-chem-all-inside-ky-thuat-hien-dai-thay-the-canula\/","title":{"rendered":"N\u1ed9i soi kh\u00e2u s\u1ee5n ch\u00eam All-inside: K\u1ef9 thu\u1eadt hi\u1ec7n \u0111\u1ea1i thay th\u1ebf canula"},"content":{"rendered":"<p>K\u1ef9 thu\u1eadt N\u1ed9i soi Kh\u00e2u S\u1ee5n Ch\u00eam B\u1eb1ng Thi\u1ebft B\u1ecb All-inside<\/p>\n<p>Trong ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh kh\u1edbp g\u1ed1i hi\u1ec7n \u0111\u1ea1i, vi\u1ec7c b\u1ea3o t\u1ed3n m\u00f4 s\u1ee5n ch\u00eam c\u00f2n nguy\u00ean v\u1eb9n \u0111ang d\u1ea7n thay th\u1ebf xu h\u01b0\u1edbng c\u1eaft b\u1ecf (meniscectomy) nh\u1eb1m gi\u1ea3m thi\u1ec3u m\u00e0i m\u00f2n kh\u1edbp v\u00e0 duy tr\u00ec ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng l\u00e2u d\u00e0i. M\u1ed9t trong nh\u1eefng ti\u1ebfn b\u1ed9 \u0111\u00e1ng ch\u00fa \u00fd l\u00e0 c\u00e1c thi\u1ebft b\u1ecb kh\u00e2u s\u1ee5n ch\u00eam d\u1ea1ng &#8220;all-inside&#8221; (t\u1ea5t c\u1ea3 b\u00ean trong), ti\u00eau bi\u1ec3u nh\u01b0 h\u1ec7 th\u1ed1ng FasT-Fix, gi\u00fap th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt m\u00e0 kh\u00f4ng c\u1ea7n m\u1edf th\u00eam v\u1ebft m\u1ed5 ph\u1ee5 \u0111\u1ec3 \u0111\u1eb7t canula truy\u1ec1n ch\u1ec9.<\/p>\n<h2>Nguy\u00ean l\u00fd v\u00e0 \u01afu \u0111i\u1ec3m c\u1ee7a Thi\u1ebft b\u1ecb All-inside<\/h2>\n<p>C\u00e1c thi\u1ebft b\u1ecb kh\u00e2u s\u1ee5n ch\u00eam d\u1ea1ng all-inside ho\u1ea1t \u0111\u1ed9ng d\u1ef1a tr\u00ean c\u01a1 ch\u1ebf t\u1ea1o n\u1eb9p (fixator) b\u00ean trong kh\u1edbp, gi\u00fap c\u1ed1 \u0111\u1ecbnh m\u1ea3nh v\u1ee1 s\u1ee5n ch\u00eam m\u00e0 kh\u00f4ng c\u1ea7n x\u00e2m l\u1ea5n m\u00f4 bao kh\u1edbp qua c\u00e1c c\u1ed5ng ph\u1eabu thu\u1eadt m\u1edf r\u1ed9ng. Theo t\u00e0i li\u1ec7u chuy\u00ean ng\u00e0nh c\u1eadp nh\u1eadt, l\u1ef1c gi\u1eef c\u1ee7a c\u00e1c thi\u1ebft b\u1ecb n\u00e0y v\u00e0 t\u1ef7 l\u1ec7 l\u00e0nh th\u01b0\u01a1ng ng\u1eafn h\u1ea1n ti\u1ebfp c\u1eadn g\u1ea7n v\u1edbi k\u1ef9 thu\u1eadt kh\u00e2u truy\u1ec1n th\u1ed1ng d\u00f9ng canula (inside-out) [4].<\/p>\n<p>\u01afu \u0111i\u1ec3m n\u1ed5i b\u1eadt c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p all-inside bao g\u1ed3m:<\/p>\n<ul>\n<li><strong>T\u00ednh thu\u1eadn ti\u1ec7n cao:<\/strong> Kh\u00f4ng c\u1ea7n m\u1edf th\u00eam v\u1ebft m\u1ed5 ph\u1ee5 \u0111\u1ec3 \u0111\u1eb7t canula, gi\u00fap gi\u1ea3m \u0111au v\u00e0 t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m.<\/li>\n<li><strong>Gi\u1ea3m x\u00e2m l\u1ea5n:<\/strong> Ph\u00f9 h\u1ee3p v\u1edbi nguy\u00ean t\u1eafc b\u1ea3o t\u1ed3n m\u00f4 kh\u1edbp trong ph\u1eabu thu\u1eadt n\u1ed9i soi.<\/li>\n<\/ul>\n<p>Tuy nhi\u00ean, ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u0169ng c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf c\u1ea7n l\u01b0u \u00fd. Vi\u1ec7c tri\u1ec3n khai thi\u1ebft b\u1ecb c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam do c\u01a1 ch\u1ebf bu\u1ed9c ch\u1eb7t, v\u00e0 kh\u00f3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ed9 c\u0103ng th\u1eb3ng theo chi\u1ec1u d\u1ecdc (vertical repair) t\u1ed1i \u01b0u nh\u01b0 k\u1ef9 thu\u1eadt canula truy\u1ec1n ch\u1ec9 [4]. Ngo\u00e0i ra, chi ph\u00ed cho c\u00e1c thi\u1ebft b\u1ecb chuy\u00ean d\u1ee5ng n\u00e0y c\u0169ng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 c\u1ea7n c\u00e2n nh\u1eafc trong k\u1ebf ho\u1ea1ch ph\u1eabu thu\u1eadt.<\/p>\n<h2>Ch\u1ec9 \u0111\u1ecbnh v\u00e0 L\u1ef1a ch\u1ecdn K\u1ef9 thu\u1eadt Kh\u00e2u<\/h2>\n<p>K\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt n\u1ed9i soi kh\u00e2u s\u1ee5n ch\u00eam th\u01b0\u1eddng v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi c\u1eaft b\u1ecf s\u1ee5n ch\u00eam, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i. Tuy nhi\u00ean, kh\u00f4ng ph\u1ea3i v\u1ebft th\u01b0\u01a1ng n\u00e0o c\u0169ng ph\u00f9 h\u1ee3p \u0111\u1ec3 kh\u00e2u. C\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng th\u00e0nh c\u00f4ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean m\u1ed9t s\u1ed1 ti\u00eau ch\u00ed quan tr\u1ecdng:<\/p>\n<ul>\n<li><strong>V\u1ecb tr\u00ed v\u1ebft th\u01b0\u01a1ng:<\/strong> Kh\u00e2u hi\u1ec7u qu\u1ea3 nh\u1ea5t khi v\u1ebft th\u01b0\u01a1ng n\u1eb1m \u1edf ph\u1ea7n r\u00eca ngo\u1ea1i vi (outer third) v\u00e0 h\u01b0\u1edbng d\u1ecdc (vertical tear). C\u00e1c v\u1ebft th\u01b0\u01a1ng ngang ho\u1eb7c b\u00e1n nguy\u1ec7t h\u00ecnh ly t\u00e2m (radial tears) g\u1ea7n g\u1ed1c s\u1ee5n ch\u00eam b\u00ean ngo\u00e0i c\u00f3 th\u1ec3 l\u00e0nh nh\u01b0ng ch\u1ee9c n\u0103ng c\u01a1 h\u1ecdc sau kh\u00e2u v\u1eabn c\u00f2n nghi ng\u1edd [1].<\/li>\n<li><strong>Tu\u1ed5i t\u00e1c:<\/strong> K\u1ef9 thu\u1eadt kh\u00e2u th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 40 tu\u1ed5i. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n tr\u00ean 40 tu\u1ed5i, t\u1ef7 l\u1ec7 th\u1ea5t b\u1ea1i t\u0103ng l\u00ean do ch\u1ea5t l\u01b0\u1ee3ng m\u00f4 s\u1ee5n gi\u1ea3m s\u00fat [7].<\/li>\n<li><strong>Ch\u1ea5t l\u01b0\u1ee3ng m\u00f4 v\u00e0 t\u1ed5n th\u01b0\u01a1ng li\u00ean quan:<\/strong> S\u1ef1 k\u1ebft h\u1ee3p ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1o d\u00e2y ch\u00e9o tr\u01b0\u1edbc (ACL reconstruction) ho\u1eb7c s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p k\u00edch th\u00edch l\u00e0nh th\u01b0\u01a1ng nh\u01b0 huy\u1ebft kh\u1ed1i fibrin c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng. Ng\u01b0\u1ee3c l\u1ea1i, c\u00e1c v\u1ebft th\u01b0\u01a1ng d\u00e0i h\u01a1n 4 cm ho\u1eb7c n\u1eb1m \u1edf v\u00f9ng v\u00f4 m\u1ea1ch (white-white area) th\u01b0\u1eddng kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u1ec3 kh\u00e2u [6].<\/li>\n<\/ul>\n<h2>K\u1ef9 thu\u1eadt Th\u1ef1c hi\u1ec7n: T\u1eeb Chu\u1ea9n b\u1ecb \u0111\u1ebfn Kh\u00e2u S\u1ee5n Ch\u00eam<\/h2>\n<p>Quy tr\u00ecnh ph\u1eabu thu\u1eadt n\u1ed9i soi s\u1ee5n ch\u00eam b\u1eb1ng thi\u1ebft b\u1ecb all-inside \u0111\u00f2i h\u1ecfi s\u1ef1 chu\u1ea9n b\u1ecb k\u1ef9 l\u01b0\u1ee1ng v\u1ec1 v\u1ecb tr\u00ed kh\u1edbp v\u00e0 thao t\u00e1c ch\u00ednh x\u00e1c \u0111\u1ec3 tr\u00e1nh t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh m\u1ea1ch m\u00e1u.<\/p>\n<h3>V\u1ecb tr\u00ed Kh\u1edbp v\u00e0 Chu\u1ea9n b\u1ecb Kh\u1edbp G\u1ed1i<\/h3>\n<p>\u0110\u1ed1i v\u1edbi ph\u1eabu thu\u1eadt s\u1ee5n ch\u00eam, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ph\u1ee9c t\u1ea1p ho\u1eb7c r\u00e1ch g\u1ed1c sau, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1edf t\u01b0 th\u1ebf h\u00ecnh ch\u1eef V (figure-four position). T\u01b0 th\u1ebf n\u00e0y gi\u00fap gi\u1ea3m c\u0103ng gi\u00e3n kh\u1edbp t\u1ed5ng th\u1ec3 v\u00e0 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n quan s\u00e1t r\u00f5 h\u01a1n [2].<\/p>\n<p>Tr\u01b0\u1edbc khi kh\u00e2u, m\u00f4 s\u1ee5n ch\u00eam c\u1ea7n \u0111\u01b0\u1ee3c l\u00e0m s\u1ea1ch v\u00e0 chu\u1ea9n b\u1ecb k\u1ef9. N\u1ebfu v\u1ebft th\u01b0\u01a1ng l\u00e0 c\u1ea5p t\u00ednh v\u00e0 n\u1eb1m trong v\u00f9ng \u0111\u1ecf m\u1ea1ch m\u00e1u (vascular red zone), ch\u1ec9 c\u1ea7n chu\u1ea9n b\u1ecb nh\u1eb9 nh\u00e0ng r\u00eca s\u1ee5n \u0111\u1ec3 kh\u00e2u. Ng\u01b0\u1ee3c l\u1ea1i, v\u1edbi v\u1ebft th\u01b0\u01a1ng m\u1ea1n t\u00ednh, b\u1ec1 m\u1eb7t r\u00e1ch c\u1ea7n \u0111\u01b0\u1ee3c l\u00e0m ph\u1eb3ng v\u00e0 l\u00e0m s\u1ea1ch b\u1eb1ng d\u1ee5ng c\u1ee5 g\u1ecdt nh\u1ecf (rasp) \u0111\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n l\u00e0nh th\u01b0\u01a1ng t\u1ed1t nh\u1ea5t [5].<\/p>\n<h3>Quy tr\u00ecnh Kh\u00e2u B\u1eb1ng Thi\u1ebft b\u1ecb All-inside<\/h3>\n<p>K\u1ef9 thu\u1eadt th\u1ef1c hi\u1ec7n c\u1ee5 th\u1ec3 th\u01b0\u1eddng bao g\u1ed3m c\u00e1c b\u01b0\u1edbc sau:<\/p>\n<ol>\n<li><strong>V\u1ea1ch da v\u00e0 ti\u1ebfp c\u1eadn:<\/strong> Th\u1ef1c hi\u1ec7n m\u1ed9t v\u1ebft c\u1eaft nh\u1ecf tr\u00ean da, m\u1edf r\u1ed9ng qua m\u00f4 d\u01b0\u1edbi da xu\u1ed1ng \u0111\u1ebfn m\u00e0ng kh\u1edbp \u0111\u1ed1i di\u1ec7n v\u1ecb tr\u00ed r\u00e1ch s\u1ee5n ch\u00eam.<\/li>\n<li><strong>Thao t\u00e1c v\u1edbi kim:<\/strong> D\u01b0\u1edbi quan s\u00e1t n\u1ed9i soi, \u0111\u01b0a kim 18-gauge t\u1eeb ngo\u00e0i v\u00e0o trong (outside-to-inside), xuy\u00ean qua r\u00eca s\u1ee5n ch\u00eam v\u00e0 m\u1ea3nh v\u1ee1 s\u1ee5n ch\u00eam.<\/li>\n<li><strong>T\u1ea1o n\u1eb9p:<\/strong> Lo\u1ea1i b\u1ecf \u1ed1ng d\u1eabn (stylet) v\u00e0 \u0111\u01b0a d\u00e2y ho\u1eb7c ch\u1ec9 s\u1ed1 20 (PDS) qua kh\u1edbp. Sau \u0111\u00f3, s\u1eed d\u1ee5ng kim ho\u1eb7c d\u00e2y l\u00e0m ph\u01b0\u01a1ng ti\u1ec7n v\u1eadn chuy\u1ec3n (shuttle) \u0111\u1ec3 \u0111\u01b0a \u0111\u1ea7u c\u1ee7a ch\u1ec9 kh\u00f4ng tan xuy\u00ean qua s\u1ee5n ch\u00eam.<\/li>\n<li><strong>T\u1ea1o ch\u1ec9 d\u1ecdc:<\/strong> L\u1eb7p l\u1ea1i quy tr\u00ecnh v\u1edbi m\u1ed9t kim c\u00e1ch nhau 3-4 mm so v\u1edbi kim tr\u01b0\u1edbc \u0111\u00f3. \u0110\u01b0a d\u00e2y qua kim v\u00e0 l\u1ea5y ra qua canula \u0111\u1ec3 v\u1eadn chuy\u1ec3n ph\u1ea7n c\u00f2n l\u1ea1i c\u1ee7a ch\u1ec9, t\u1ea1o th\u00e0nh kh\u00e2u d\u1ecdc (vertical mattress suture).<\/li>\n<li><strong>\u0110\u00f3ng ch\u1eb7t:<\/strong> B\u00e1m ch\u1ec9 v\u00e0o m\u00e0ng kh\u1edbp v\u00e0 l\u1eb7p l\u1ea1i qu\u00e1 tr\u00ecnh cho \u0111\u1ebfn khi v\u1ebft r\u00e1ch \u0111\u01b0\u1ee3c \u1ed5n \u0111\u1ecbnh ch\u1eafc ch\u1eafn. \u0110\u1ed1i v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng ngo\u1ea1i vi l\u1edbn \u1edf m\u1eb7t trong, c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p k\u1ef9 thu\u1eadt inside-out v\u00e0 outside-inside [3].<\/li>\n<\/ol>\n<h3>L\u01b0u \u00fd Quan tr\u1ecdng v\u1ec1 An to\u00e0n<\/h3>\n<p>B\u00ean c\u1ea1nh v\u1ea5n \u0111\u1ec1 k\u1ef9 thu\u1eadt kh\u00e2u, an to\u00e0n th\u1ea7n kinh m\u1ea1ch m\u00e1u l\u00e0 \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u. Kim c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u1ecbnh h\u01b0\u1edbng tr\u00e1nh c\u00e1c c\u1ea5u tr\u00fac th\u1ea7n kinh m\u1ea1ch m\u00e1u v\u00e0 \u0111\u1eb7t \u0111i\u1ec3m d\u1eebng kim \u1edf kho\u1ea3ng 14-16 mm \u0111\u1ec3 xuy\u00ean qua r\u00eca ngo\u1ea1i vi m\u00e0 kh\u00f4ng x\u00e2m l\u1ea5n qu\u00e1 s\u00e2u, nh\u1eb1m tr\u00e1nh bi\u1ebfn ch\u1ee9ng [4]. \u0110\u1ed1i v\u1edbi r\u00e1ch g\u1ed1c tr\u01b0\u1edbc (anterior root tears), k\u1ef9 thu\u1eadt d\u00f9ng suture anchor l\u00e0 l\u1ef1a ch\u1ecdn ph\u1ed5 bi\u1ebfn nh\u1ea5t.<\/p>\n<h2>K\u1ebft lu\u1eadn<\/h2>\n<p>Thi\u1ebft b\u1ecb kh\u00e2u s\u1ee5n ch\u00eam d\u1ea1ng all-inside \u0111\u1ea1i di\u1ec7n cho m\u1ed9t h\u01b0\u1edbng \u0111i quan tr\u1ecdng trong ph\u1eabu thu\u1eadt n\u1ed9i soi ch\u1ec9nh h\u00ecnh, c\u00e2n b\u1eb1ng gi\u1eefa t\u00ednh x\u00e2m l\u1ea5n th\u1ea5p v\u00e0 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. M\u1eb7c d\u00f9 c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf v\u1ec1 chi ph\u00ed v\u00e0 k\u1ef9 thu\u1eadt thao t\u00e1c so v\u1edbi canula truy\u1ec1n ch\u1ec9, nh\u01b0ng kh\u1ea3 n\u0103ng b\u1ea3o t\u1ed3n m\u00f4 kh\u1edbp v\u00e0 gi\u1ea3m \u0111au sau m\u1ed5 l\u00e0 nh\u1eefng l\u1ee3i \u00edch v\u01b0\u1ee3t tr\u1ed9i. Vi\u1ec7c l\u1ef1a ch\u1ecdn \u0111\u00fang ch\u1ec9 \u0111\u1ecbnh b\u1ec7nh nh\u00e2n (tu\u1ed5i, v\u1ecb tr\u00ed v\u1ebft th\u01b0\u01a1ng) v\u00e0 tu\u00e2n th\u1ee7 nghi\u00eam ng\u1eb7t c\u00e1c nguy\u00ean t\u1eafc an to\u00e0n trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt s\u1ebd quy\u1ebft \u0111\u1ecbnh th\u00e0nh c\u00f4ng c\u1ee7a ca ph\u1eabu thu\u1eadt.<\/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 3065<\/li>\n<li>[2] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3058<\/li>\n<li>[3] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3068<\/li>\n<li>[4] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3073<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3066<\/li>\n<li>[6] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3065<\/li>\n<li>[7] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3065<\/li>\n<\/ul>\n<p><!-- aiwriter:f39c5ebec6574dc3866872e0 --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ph\u00e2n t\u00edch k\u1ef9 thu\u1eadt n\u1ed9i soi kh\u00e2u s\u1ee5n ch\u00eam b\u1eb1ng thi\u1ebft b\u1ecb All-inside (FasT-Fix) d\u1ef1a tr\u00ean nguy\u00ean l\u00fd Campbell&#8217;s Operative Orthopaedics 2026, so s\u00e1nh \u01b0u nh\u01b0\u1ee3c \u0111i\u1ec3m v\u00e0 ch\u1ec9 \u0111\u1ecbnh.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-591","post","type-post","status-publish","format-standard","hentry","category-noi-soi-khop"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - 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