{"id":595,"date":"2026-10-13T09:16:41","date_gmt":"2026-10-13T02:16:41","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/13\/noi-soi-khop-vai-cat-bo-u-nang-chen-ep-than-kinh-huong-dan-phau-thuat-an-toan\/"},"modified":"2026-10-13T09:16:41","modified_gmt":"2026-10-13T02:16:41","slug":"noi-soi-khop-vai-cat-bo-u-nang-chen-ep-than-kinh-huong-dan-phau-thuat-an-toan","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/13\/noi-soi-khop-vai-cat-bo-u-nang-chen-ep-than-kinh-huong-dan-phau-thuat-an-toan\/","title":{"rendered":"N\u1ed9i soi kh\u1edbp vai c\u1eaft b\u1ecf u nang ch\u00e8n \u00e9p th\u1ea7n kinh: H\u01b0\u1edbng d\u1eabn ph\u1eabu thu\u1eadt an to\u00e0n"},"content":{"rendered":"<h2>M\u00f4 h\u00ecnh b\u1ec7nh l\u00fd: U nang ch\u00e8n \u00e9p d\u00e2y th\u1ea7n kinh \u1edf kh\u1edbp vai<\/h2>\n<p>U nang d\u1ea1ng h\u1ea1ch (ganglion cyst) t\u1ea1i v\u00f9ng kh\u1edbp vai, \u0111\u1eb7c bi\u1ec7t l\u00e0 u nang t\u00fai d\u01b0\u1edbi \u0111\u00f2n (suprascapular nerve entrapment), l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng chi\u1ebfm ch\u1ed7 c\u00f3 th\u1ec3 g\u00e2y ch\u00e8n \u00e9p d\u00e2y th\u1ea7n kinh v\u00e0 d\u1eabn \u0111\u1ebfn \u0111au c\u00f9ng suy y\u1ebfu c\u01a1. C\u00e1c h\u00ecnh \u1ea3nh c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) th\u01b0\u1eddng cho th\u1ea5y u nang xu\u1ea5t ph\u00e1t t\u1eeb m\u1eb7t sau tr\u00ean c\u1ee7a kh\u1edbp h\u00e1ng, n\u1eb1m trong khe spinoglenoid ho\u1eb7c g\u1ea7n c\u1ed5 x\u01b0\u01a1ng \u0111\u00f2n [1]. B\u1ec7nh nh\u00e2n th\u01b0\u1eddng b\u00e1o c\u00e1o c\u1ea3m gi\u00e1c \u0111au s\u00e2u, \u00e2m \u1ec9 v\u00e0 lan t\u1ecfa, k\u00e8m theo suy y\u1ebfu kh\u1ea3 n\u0103ng xoay ngo\u00e0i v\u00e0 n\u00e2ng c\u00e1nh tay khi th\u1ef1c hi\u1ec7n c\u00e1c ho\u1ea1t \u0111\u1ed9ng qu\u00e1 \u0111\u1ea7u [7].<\/p>\n<p>Tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt, \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n bao g\u1ed3m h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng, s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAIDs) v\u00e0 ch\u01b0\u01a1ng tr\u00ecnh ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng kh\u1edbp vai n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t l\u00e0m ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ea7u ti\u00ean. Tuy nhi\u00ean, n\u1ebfu \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n th\u1ea5t b\u1ea1i ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 ch\u00e8n \u00e9p th\u1ea7n kinh \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn r\u00f5 r\u00e0ng c\u00f9ng v\u1edbi t\u1ed5n th\u01b0\u01a1ng chi\u1ebfm ch\u1ed7, ph\u1eabu thu\u1eadt s\u1edbm th\u01b0\u1eddng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 tr\u00e1nh c\u00e1c k\u1ebft qu\u1ea3 ti\u00eau c\u1ef1c theo th\u1eddi gian [7].<\/p>\n<h2>K\u1ef9 thu\u1eadt ph\u1eabu thu\u1eadt: L\u1ef1a ch\u1ecdn gi\u1eefa n\u1ed9i soi v\u00e0 m\u1ed5 m\u1edf<\/h2>\n<p>C\u1ea3 hai ph\u01b0\u01a1ng ph\u00e1p n\u1ed9i soi v\u00e0 m\u1ed5 m\u1edf \u0111\u1ec1u \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 cho vi\u1ec7c gi\u1ea3i ph\u00f3ng d\u00e2y th\u1ea7n kinh do u nang g\u00e2y ra. Tuy nhi\u00ean, t\u00e1c gi\u1ea3 th\u01b0\u1eddng \u01b0u ti\u00ean ti\u1ebfp c\u1eadn n\u1ed9i soi v\u00ec t\u00ednh \u0111\u00e1ng tin c\u1eady trong c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng [1]. Ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf u nang n\u00e0y kh\u00f4ng ch\u1ec9 l\u00e0 m\u1ee5c ti\u00eau gi\u1ea3i ph\u00f3ng d\u00e2y th\u1ea7n kinh m\u00e0 c\u00f2n c\u00f3 th\u1ec3 bao g\u1ed3m c\u1eaft b\u1ecf c\u00e1c gai x\u01b0\u01a1ng (osteophytes) li\u00ean quan n\u1ebfu ch\u00fang t\u1ed3n t\u1ea1i \u1edf kh\u1edbp h\u00e1ng, v\u1ed1n g\u00e2y m\u00e0i m\u00f2n g\u00e2n v\u00e0 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam t\u00ecnh tr\u1ea1ng ch\u00e8n \u00e9p [6].<\/p>\n<p>M\u1eb7c d\u00f9 t\u1ef7 l\u1ec7 ph\u1ee5c h\u1ed3i ho\u00e0n to\u00e0n s\u1ee9c m\u1ea1nh xoay ngo\u00e0i c\u00f3 th\u1ec3 bi\u1ebfn \u0111\u1ed9ng, vi\u1ec7c gi\u1ea3i ph\u00f3ng d\u00e2y th\u1ea7n kinh k\u1ebft h\u1ee3p v\u1edbi s\u1eeda ch\u1eefa trong tr\u01b0\u1eddng h\u1ee3p r\u00e1ch c\u01a1 quay vai \u0111\u1ed3ng th\u1eddi \u0111\u00e3 cho th\u1ea5y l\u1ee3i \u00edch [1]. Ng\u01b0\u1ee3c l\u1ea1i, kh\u00f4ng c\u00f3 l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c gi\u1ea3i ph\u00f3ng d\u00e2y th\u1ea7n kinh th\u01b0\u1eddng quy khi kh\u00f4ng c\u00f3 ch\u1ee9ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh \u0111\u01b0\u1ee3c ghi nh\u1eadn b\u1eb1ng \u0111i\u1ec7n sinh h\u1ecdc (EMG) [8].<\/p>\n<h2>C\u00e1c \u0111i\u1ec3m nguy hi\u1ec3m v\u00e0 bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba trong ph\u1eabu thu\u1eadt<\/h2>\n<p>D\u00f9 u nang kh\u1edbp vai kh\u00e1c bi\u1ec7t v\u1edbi u nang b\u00e0n tay, nguy\u00ean t\u1eafc an to\u00e0n v\u1ec1 m\u1eb7t gi\u1ea3i ph\u1eabu v\u1eabn r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 tr\u00e1nh t\u1ed5n th\u01b0\u01a1ng c\u00e1c c\u1ea5u tr\u00fac l\u00e2n c\u1eadn. Trong ph\u1eabu thu\u1eadt n\u1ed9i soi ho\u1eb7c m\u1ed5 m\u1edf, \u0111\u1eb7c bi\u1ec7t khi ti\u1ebfp c\u1eadn v\u00f9ng sau c\u1ee7a x\u01b0\u01a1ng \u0111\u00f2n, d\u00e2y th\u1ea7n kinh d\u01b0\u1edbi \u0111\u00f2n (axillary nerve) l\u00e0 \u0111\u1eb7c bi\u1ec7t d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng trong qu\u00e1 tr\u00ecnh c\u1ed1 \u0111\u1ecbnh xuy\u00ean kh\u1edbp, di chuy\u1ec3n c\u01a1 tam gi\u00e1c v\u00e0 gi\u1ea3i ph\u1eabu d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f2n khi th\u1ef1c hi\u1ec7n thay kh\u1edbp ng\u01b0\u1ee3c [4].<\/p>\n<p>B\u00ean c\u1ea1nh \u0111\u00f3, d\u00e2y th\u1ea7n kinh c\u01a1-c\u1eaft (musculocutaneous nerve) c\u0169ng n\u1eb1m \u1edf m\u1ee9c \u0111\u1ed9 r\u1ee7i ro cao. Nerve n\u00e0y b\u1eaft ngu\u1ed3n t\u1eeb d\u00e2y th\u1ea7n kinh c\u00e1nh tay v\u00e0 c\u00f3 nh\u00e1nh v\u1eadn \u0111\u1ed9ng g\u1ea7n nh\u1ea5t \u0111\u1ebfn c\u01a1 coracobrachialis n\u1eb1m trung b\u00ecnh 3\u20137 cm xa \u0111\u1ea7u x\u01b0\u01a1ng \u0111\u00f2n [4]. Khi ph\u1eabu thu\u1eadt, c\u1ea7n tr\u00e1nh vi\u1ec7c k\u00e9o c\u0103ng qu\u00e1 m\u1ee9c g\u00e2n li\u00ean h\u1ee3p (conjoined tendon) v\u00ec \u0111i\u1ec1u n\u00e0y l\u00e0m t\u0103ng nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng c\u1ea3 d\u00e2y th\u1ea7n kinh c\u01a1-c\u1eaft v\u00e0 d\u00e2y th\u1ea7n kinh c\u00e1nh tay [4].<\/p>\n<p>Trong qu\u00e1 tr\u00ecnh m\u1ed5 m\u1edf, vi\u1ec7c b\u00f3c t\u00e1ch m\u00e0ng ngo\u00e0i x\u01b0\u01a1ng qu\u00e1 m\u1ee9c l\u00e0 b\u1ecb c\u1ea5m \u0111o\u00e1n v\u00ec c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn h\u00ecnh th\u00e0nh sequestra v\u00f2ng ho\u1eb7c s\u1ef1 ph\u00e1t tri\u1ec3n b\u1ea5t th\u01b0\u1eddng c\u1ee7a x\u01b0\u01a1ng. C\u00e1c nh\u00fa x\u01b0\u01a1ng n\u1ed5i b\u1eadt c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c c\u1eaft b\u1ecf \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111\u1ec7m m\u1ec1m t\u1ed1t v\u00e0 b\u1ec1 m\u1eb7t x\u01b0\u01a1ng tr\u01a1n tru [5].<\/p>\n<h3>K\u1ef9 thu\u1eadt s\u1eeda ch\u1eefa d\u00e2y th\u1ea7n kinh n\u1ebfu t\u1ed5n th\u01b0\u01a1ng x\u1ea3y ra<\/h3>\n<p>Tuy nhi\u00ean, trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm hoi khi u nang g\u00e2y \u0111\u1ee9t g\u00e3y ho\u00e0n to\u00e0n ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng nghi\u00eam tr\u1ecdng d\u00e2y th\u1ea7n kinh, c\u00e1c k\u1ef9 thu\u1eadt s\u1eeda ch\u1eefa c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft. Khi quy\u1ebft \u0111\u1ecbnh th\u1ef1c hi\u1ec7n neurorrhaphy (d\u1ec7t d\u00e2y th\u1ea7n kinh), vi\u1ec7c c\u1eaft b\u1ecf c\u00e1c \u0111\u1ea7u g\u1ea7n v\u00e0 xa c\u1ee7a d\u00e2y th\u1ea7n kinh \u0111\u1ebfn m\u00f4 b\u00ecnh th\u01b0\u1eddng l\u00e0 b\u1eaft bu\u1ed9c [2].<\/p>\n<p>Vi\u1ec7c s\u1eed d\u1ee5ng k\u00ednh ph\u1eabu thu\u1eadt ho\u1eb7c m\u00e1y vi ph\u1eabu l\u00e0 y\u1ebfu t\u1ed1 then ch\u1ed1t \u0111\u1ec3 th\u1ef1c hi\u1ec7n gi\u1ea3i ph\u1eabu trong d\u00e2y th\u1ea7n kinh m\u00e0 kh\u00f4ng l\u00e0m t\u1ed5n th\u01b0\u01a1ng m\u00f4 d\u00e2y th\u1ea7n kinh nguy\u00ean v\u1eb9n. Vi\u1ec7c k\u00e9o c\u0103ng d\u00e2y th\u1ea7n kinh qu\u00e1 m\u1ee9c khi s\u1eeda ch\u1eefa l\u00e0 b\u1ea5t l\u1ee3i cho t\u00e1i sinh m\u00e3n t\u00ednh [9]. N\u1ebfu c\u00f3 kho\u1ea3ng c\u00e1ch l\u1edbn gi\u1eefa hai \u0111\u1ea7u d\u00e2y th\u1ea7n kinh, vi\u1ec7c gh\u00e9p d\u00e2y th\u1ea7n kinh ho\u1eb7c di chuy\u1ec3n d\u00e2y th\u1ea7n kinh t\u1eeb v\u1ecb tr\u00ed g\u1ea7n h\u01a1n (v\u00ed d\u1ee5: ph\u00eda sau kh\u1edbp th\u00e1i d\u01b0\u01a1ng d\u01b0\u1edbi c\u1ee7a c\u00e1nh tay) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc [3].<\/p>\n<p>\u0110\u1ed1i v\u1edbi c\u00e1c d\u00e2y th\u1ea7n kinh nh\u1ecf h\u01a1n, n\u1ebfu k\u00edch th\u00edch kh\u00f4ng t\u1ea1o ra ph\u1ea3n \u1ee9ng quan tr\u1ecdng v\u00e0 h\u1ea7u h\u1ebft c\u00e1c b\u00f3 s\u1ee3i \u0111\u1ec1u b\u1ecb \u0111\u1ee9t, vi\u1ec7c c\u1eaft b\u1ecf kh\u1ed1i u th\u1ea7n kinh (neuroma) v\u00e0 th\u1ef1c hi\u1ec7n neurorrhaphy c\u00f3 th\u1ec3 l\u00e0 ch\u1ec9 \u0111\u1ecbnh ph\u00f9 h\u1ee3p. Ng\u01b0\u1ee3c l\u1ea1i, n\u1ebfu v\u1eabn c\u00f2n m\u1ed9t s\u1ed1 b\u00f3 s\u1ee3i nguy\u00ean v\u1eb9n \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi k\u00edch th\u00edch, vi\u1ec7c s\u1eeda ch\u1eefa t\u1eebng b\u00f3 s\u1ee3i th\u01b0\u1eddng kh\u00f4ng kh\u1ea3 thi v\u1ec1 m\u1eb7t k\u1ef9 thu\u1eadt [2].<\/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 2847<\/li>\n<li>[2] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3853<\/li>\n<li>[3] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 4171<\/li>\n<li>[4] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 1351<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 840<\/li>\n<li>[6] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 4563<\/li>\n<li>[7] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2847<\/li>\n<li>[8] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2847<\/li>\n<li>[9] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3853<\/li>\n<\/ul>\n<p><!-- aiwriter:0174195259114e899475bdfe --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ph\u1eabu thu\u1eadt n\u1ed9i soi v\u00e0 m\u1edf \u0111\u1ec3 gi\u1ea3i ph\u00f3ng d\u00e2y th\u1ea7n kinh do u nang kh\u1edbp vai g\u00e2y ra. \u0110\u00e1nh gi\u00e1 ch\u1ec9 \u0111\u1ecbnh, k\u1ef9 thu\u1eadt tr\u00e1nh t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u v\u00e0 quy tr\u00ecnh ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng.<\/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-595","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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