{"id":599,"date":"2026-10-13T09:27:07","date_gmt":"2026-10-13T02:27:07","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/13\/phan-loai-ton-thuong-rach-sun-chem-tren-hinh-anh-noi-soi-va-mri\/"},"modified":"2026-10-13T09:27:07","modified_gmt":"2026-10-13T02:27:07","slug":"phan-loai-ton-thuong-rach-sun-chem-tren-hinh-anh-noi-soi-va-mri","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/13\/phan-loai-ton-thuong-rach-sun-chem-tren-hinh-anh-noi-soi-va-mri\/","title":{"rendered":"Ph\u00e2n lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng r\u00e1ch s\u1ee5n ch\u00eam tr\u00ean h\u00ecnh \u1ea3nh n\u1ed9i soi v\u00e0 MRI"},"content":{"rendered":"<h2>Qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh trong t\u1ed5n th\u01b0\u01a1ng kh\u1edbp g\u1ed1i<\/h2>\n<p>H\u00ecnh \u1ea3nh n\u1ed9i soi kh\u1edbp g\u1ed1i \u0111\u00f3ng vai tr\u00f2 then ch\u1ed1t trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh tr\u1ef1c ti\u1ebfp c\u00e1c t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam, b\u1ed5 sung cho c\u00e1c x\u00e9t nghi\u1ec7m kh\u00f4ng x\u00e2m l\u1ea5n nh\u01b0 MRI. M\u1eb7c d\u00f9 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a MRI th\u01b0\u1eddng v\u01b0\u1ee3t qu\u00e1 90% trong vi\u1ec7c ph\u00e1t hi\u1ec7n r\u00e1ch s\u1ee5n ch\u00eam [9], s\u1ef1 kinh nghi\u1ec7m c\u1ee7a b\u00e1c s\u0129 gi\u1ea3i ph\u1eabu v\u00e0 k\u1ef9 thu\u1eadt th\u1ef1c hi\u1ec7n n\u1ed9i soi v\u1eabn \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a ch\u1ea9n \u0111o\u00e1n cu\u1ed1i c\u00f9ng [3]. Vi\u1ec7c so s\u00e1nh h\u00ecnh \u1ea3nh ti\u1ec1n ph\u1eabu v\u1edbi h\u1eadu ph\u1eabu gi\u00fap x\u00e1c \u0111\u1ecbnh c\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u1edbi, \u0111\u1eb7c bi\u1ec7t khi b\u1ec7nh nh\u00e2n \u0111\u00e3 t\u1eebng ph\u1eabu thu\u1eadt tr\u01b0\u1edbc \u0111\u00f3 [6].<\/p>\n<h3>Nguy\u00ean t\u1eafc c\u01a1 b\u1ea3n trong ph\u00e2n lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng<\/h3>\n<p>Nhi\u1ec1u h\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t d\u1ef1a tr\u00ean v\u1ecb tr\u00ed, nguy\u00ean nh\u00e2n g\u00e2y ra v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh th\u00e1i. C\u00e1c ph\u00e2n lo\u1ea1i ph\u1ed5 bi\u1ebfn nh\u1ea5t t\u1eadp trung v\u00e0o h\u01b0\u1edbng c\u1ee7a v\u1ebft r\u00e1ch khi quan s\u00e1t d\u01b0\u1edbi k\u00ednh n\u1ed9i soi ho\u1eb7c tr\u00ean phim ch\u1ee5p c\u1eaft l\u1edbp [7]. \u0110\u1ec3 \u0111\u1ea3m b\u1ea3o \u0111\u1ed9 ch\u00ednh x\u00e1c, c\u00e1c t\u1ed5n th\u01b0\u01a1ng s\u1ee5n ch\u00eam c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a theo hai y\u1ebfu t\u1ed1: v\u1ecb tr\u00ed (th\u00e2n tr\u01b0\u1edbc, th\u00e2n gi\u1eefa, th\u00e2n sau, r\u00eca t\u1ef1 do ho\u1eb7c ngo\u1ea1i vi) v\u00e0 h\u01b0\u1edbng (ngang, d\u1ecdc\/chi\u1ec1u d\u00e0i, b\u00e1n nguy\u1ec7t c\u1ea7u ho\u1eb7c ph\u1ee9c t\u1ea1p) [9].<\/p>\n<h2>C\u00e1c ki\u1ec3u r\u00e1ch s\u1ee5n ch\u00eam ch\u00ednh \u0111\u01b0\u1ee3c ghi nh\u1eadn tr\u00ean h\u00ecnh \u1ea3nh<\/h2>\n<p>Vi\u1ec7c ph\u00e2n lo\u1ea1i ch\u00ednh x\u00e1c gi\u00fap b\u00e1c s\u0129 l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t gi\u1eefa ph\u1eabu thu\u1eadt s\u1eeda ch\u1eefa hay c\u1eaft b\u1ecf. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 c\u00e1c nh\u00f3m t\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu:<\/p>\n<h3>R\u00e1ch d\u1ecdc (Longitudinal Tears)<\/h3>\n<p>L\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t do ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp l\u00ean s\u1ee5n ch\u00eam b\u00ecnh th\u01b0\u1eddng [2]. V\u1ebft r\u00e1ch n\u00e0y \u0111\u01b0\u1ee3c \u0111\u1ecbnh h\u01b0\u1edbng th\u1eb3ng \u0111\u1ee9ng, song song v\u1edbi r\u00eca c\u1ee7a s\u1ee5n ch\u00eam v\u00e0 xuy\u00ean qua to\u00e0n b\u1ed9 \u0111\u1ed9 d\u00e0y c\u1ee7a m\u00f4. Khi v\u1ebft r\u00e1ch ho\u00e0n to\u00e0n, m\u1ea3nh v\u1ee1 b\u00ean trong th\u01b0\u1eddng b\u1ecb d\u1ecbch chuy\u1ec3n t\u1ea1o th\u00e0nh r\u00e1ch ki\u1ec3u &#8220;gi\u1ecf quai&#8221; (bucket-handle tear), n\u01a1i m\u1ea3nh v\u1ee1 di chuy\u1ec3n v\u00e0o khe li\u00ean \u0111i\u1ec1u c\u1ed1t [2].<\/p>\n<h3>R\u00e1ch ngang (Horizontal Tears)<\/h3>\n<p>Th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i, \u0111\u1eb7c bi\u1ec7t t\u1eadp trung \u1edf n\u1eeda sau c\u1ee7a s\u1ee5n ch\u00eam trong ho\u1eb7c gi\u1eefa \u0111o\u1ea1n s\u1ee5n ch\u00eam b\u00ean ngo\u00e0i [2]. C\u01a1 ch\u1ebf h\u00ecnh th\u00e0nh li\u00ean quan \u0111\u1ebfn l\u1ef1c c\u1eaft l\u00e0m chia t\u00e1ch hai b\u1ec1 m\u1eb7t tr\u00ean v\u00e0 d\u01b0\u1edbi c\u1ee7a s\u1ee5n ch\u00eam. Ph\u1eabu thu\u1eadt th\u01b0\u1eddng th\u1ea5y c\u00e1c v\u1ebft r\u00e1ch d\u1ea1ng l\u00e1 (flap tears) b\u1eaft \u0111\u1ea7u v\u1edbi th\u00e0nh ph\u1ea7n t\u00e1ch ngang, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 r\u00e1ch l\u00e1 tr\u00ean ho\u1eb7c d\u01b0\u1edbi t\u00f9y thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed c\u1ee5 th\u1ec3 [2].<\/p>\n<h3>R\u00e1ch b\u00e1n nguy\u1ec7t c\u1ea7u (Radial\/Oblique Tears)<\/h3>\n<p>L\u00e0 nh\u1eefng v\u1ebft r\u00e1ch ch\u1ea1y xi\u00ean t\u1eeb r\u00eca trong c\u1ee7a s\u1ee5n ch\u00eam v\u00e0o th\u00e2n s\u1ee5n ch\u00eam, t\u1ea1o th\u00e0nh g\u00f3c v\u1edbi tr\u1ee5c d\u1ecdc [8]. R\u00e1ch b\u00e1n nguy\u1ec7t c\u1ea7u ho\u00e0n ch\u1ec9nh ho\u1eb7c kh\u00f4ng ho\u00e0n to\u00e0n c\u00f3 h\u01b0\u1edbng th\u1eb3ng \u0111\u1ee9ng, m\u1edf r\u1ed9ng t\u1eeb r\u00eca trong ra ngo\u1ea1i vi. C\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e0y th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng xoay v\u00e0 th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf v\u00f9ng g\u1ed1c sau c\u1ee7a s\u1ee5n ch\u00eam b\u00ean ngo\u00e0i [2].<\/p>\n<h2>C\u00e1c bi\u1ebfn th\u1ec3 \u0111\u1eb7c bi\u1ec7t v\u00e0 t\u1ed5n th\u01b0\u01a1ng ph\u1ee9c t\u1ea1p<\/h2>\n<p>B\u00ean c\u1ea1nh c\u00e1c ki\u1ec3u r\u00e1ch c\u01a1 b\u1ea3n, h\u00ecnh \u1ea3nh n\u1ed9i soi c\u00f2n gi\u00fap ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u1eb7c th\u00f9 li\u00ean quan \u0111\u1ebfn c\u1ea5u tr\u00fac h\u1ed7 tr\u1ee3 ho\u1eb7c \u0111i\u1ec1u ki\u1ec7n b\u1ec7nh l\u00fd ri\u00eang bi\u1ec7t.<\/p>\n<h3>R\u00e1ch g\u1ed1c s\u1ee5n ch\u00eam (Meniscal Root Tears)<\/h3>\n<p>L\u00e0 v\u1ebft r\u00e1ch b\u00e1n nguy\u1ec7t c\u1ea7u t\u1ea1i ho\u1eb7c c\u00e1ch 1 cm t\u1eeb \u0111i\u1ec3m b\u00e1m c\u1ee7a s\u1ee5n ch\u00eam v\u00e0o kh\u1edbp [1]. R\u00e1ch g\u1ed1c b\u00ean ngo\u00e0i h\u1eadu th\u01b0\u1eddng l\u00e0 ch\u1ea5n th\u01b0\u01a1ng c\u1ea5p t\u00ednh li\u00ean quan \u0111\u1ebfn r\u00e1ch d\u00e2y ch\u00e9o tr\u01b0\u1edbc, trong khi r\u00e1ch g\u1ed1c b\u00ean trong th\u01b0\u1eddng do tho\u00e1i h\u00f3a \u1edf ng\u01b0\u1eddi trung ni\u00ean [1]. Tr\u00ean h\u00ecnh \u1ea3nh MRI, c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c nh\u1eadn di\u1ec7n qua s\u1ef1 d\u1ecbch chuy\u1ec3n b\u1ea5t th\u01b0\u1eddng c\u1ee7a s\u1ee5n ch\u00eam ho\u1eb7c khe h\u1edf ch\u1ee9a d\u1ecbch t\u1ea1i \u0111i\u1ec3m b\u00e1m [6].<\/p>\n<h3>R\u00e1ch d\u1ed1c (Ramp Tears)<\/h3>\n<p>L\u00e0 v\u1ebft r\u00e1ch d\u1ecdc n\u1eb1m \u1edf v\u00f9ng n\u1ed1i gi\u1eefa s\u1ee5n ch\u00eam v\u00e0 bao kh\u1edbp, \u0111\u1eb7c bi\u1ec7t ph\u1ed5 bi\u1ebfn \u1edf ph\u1ea7n sau c\u1ee7a s\u1ee5n ch\u00eam trong b\u00ean [1]. T\u1ed5n th\u01b0\u01a1ng n\u00e0y th\u01b0\u1eddng li\u00ean k\u1ebft v\u1edbi ch\u1ea5n th\u01b0\u01a1ng d\u00e2y ch\u00e9o tr\u01b0\u1edbc v\u00e0 c\u01a1 ch\u1ebf t\u1ed5n th\u01b0\u01a1ng l\u00e0 s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa l\u1ef1c c\u0103ng l\u1ec7ch ngo\u00e0i v\u00e0 xoay trong c\u1ee7a x\u01b0\u01a1ng g\u00f3t ch\u00e2n [1].<\/p>\n<h3>T\u1ed5n th\u01b0\u01a1ng ph\u1ee9c t\u1ea1p (Complex Tears)<\/h3>\n<p>\u0110\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi k\u1ebft h\u1ee3p c\u00e1c y\u1ebfu t\u1ed1 c\u1ee7a r\u00e1ch d\u1ecdc, ngang v\u00e0 b\u00e1n nguy\u1ec7t c\u1ea7u [7]. Th\u01b0\u1eddng do c\u01a1 h\u1ecdc s\u1ee5n ch\u00eam thay \u0111\u1ed5i k\u00e9o d\u00e0i ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng l\u1eb7p \u0111i l\u1eb7p l\u1ea1i. C\u00e1c t\u1ed5n th\u01b0\u01a1ng tho\u00e1i h\u00f3a n\u00e0y th\u01b0\u1eddng th\u1ea5y s\u1ef1 b\u1ea5t th\u01b0\u1eddng r\u00f5 r\u1ec7t v\u00e0 r\u00e1ch ph\u1ee9c t\u1ea1p \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i [8].<\/p>\n<h3>\u0110i\u1ec1u ki\u1ec7n \u0111\u1eb7c bi\u1ec7t: S\u1ee5n ch\u00eam d\u1ea1ng \u0111\u0129a (Discoid Meniscus)<\/h3>\n<p>M\u1eb7c d\u00f9 hi\u1ebfm g\u1eb7p h\u01a1n, s\u1ee5n ch\u00eam d\u1ea1ng \u0111\u0129a c\u00f3 h\u00ecnh th\u00e1i b\u1ea5t th\u01b0\u1eddng nh\u01b0 d\u00e0y ho\u1eb7c ph\u1eb3ng, th\u01b0\u1eddng th\u1ea5y \u1edf b\u00ean ngo\u00e0i [6]. H\u00ecnh \u1ea3nh MRI c\u00f3 th\u1ec3 hi\u1ec3n th\u1ecb r\u00f5 r\u00e0ng c\u00e1c b\u1ea5t th\u01b0\u1eddng n\u00e0y v\u00e0 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a &#8220;l\u1ea1ng m\u1eaft b\u01b0\u1edbu&#8221; (bow-tie sign) l\u00e0 d\u1ea5u hi\u1ec7u \u0111\u1eb7c tr\u01b0ng cho t\u1ed5n th\u01b0\u01a1ng d\u00e2y li\u00ean k\u1ebft g\u1ed1c s\u1ee5n ch\u00eam [6].<\/p>\n<h3>T\u00fai mao s\u1ee5n ch\u00eam (Meniscal Cyst)<\/h3>\n<p>L\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 g\u1eb7p khi s\u1ee5n ch\u00eam b\u1ecb r\u00e1ch, t\u1ea1o th\u00e0nh t\u00fai ch\u1ee9a d\u1ecbch n\u1eb1m s\u00e1t v\u1edbi r\u00eca c\u1ee7a s\u1ee5n ch\u00eam [3]. H\u00ecnh \u1ea3nh si\u00eau \u00e2m ho\u1eb7c MRI th\u01b0\u1eddng cho th\u1ea5y kh\u1ed1i t\u0103ng c\u01b0\u1eddng t\u00edn hi\u1ec7u hyperintense n\u1eb1m li\u1ec1n k\u1ec1 v\u1edbi s\u1ee5n ch\u00eam v\u00e0 t\u1ed5n th\u01b0\u01a1ng r\u00e1ch li\u00ean quan \u1edf b\u1ec1 m\u1eb7t kh\u1edbp [3].<\/p>\n<h2>T\u00f3m t\u1eaft v\u00e0 \u00fd ngh\u0129a l\u00e2m s\u00e0ng<\/h2>\n<p>Vi\u1ec7c ph\u00e2n lo\u1ea1i ch\u00ednh x\u00e1c c\u00e1c ki\u1ec3u r\u00e1ch s\u1ee5n ch\u00eam tr\u00ean h\u00ecnh \u1ea3nh n\u1ed9i soi v\u00e0 MRI l\u00e0 n\u1ec1n t\u1ea3ng \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh ph\u1eabu thu\u1eadt. C\u00e1c nguy\u00ean t\u1eafc chung trong ph\u1eabu thu\u1eadt s\u1ee5n ch\u00eam nh\u1ea5n m\u1ea1nh vi\u1ec7c b\u1ea3o t\u1ed3n s\u1ee5n ch\u00eam ch\u1ee9c n\u0103ng b\u1eb1ng c\u00e1ch c\u1eaft b\u1ecf v\u00e0 \u0111\u1ecbnh h\u00ecnh l\u1ea1i m\u00f4 b\u1ecb h\u01b0 h\u1ecfng thay v\u00ec ch\u1ec9 \u0111\u01a1n thu\u1ea7n l\u00e0 c\u1eaft b\u1ecf [5]. Khi c\u00f3 th\u1ec3, s\u1eeda ch\u1eefa c\u00e1c v\u1ebft r\u00e1ch d\u1ecdc \u1edf v\u00f9ng m\u1ea1ch m\u00e1u v\u00e0 c\u00e1c v\u1ebft r\u00e1ch ngang\/b\u00e1n nguy\u1ec7t c\u1ea7u \u1edf b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 b\u1ea3o v\u1ec7 s\u1ee5n kh\u1edbp [5].<\/p>\n<p>Tuy nhi\u00ean, vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p s\u1eeda ch\u1eefa hay c\u1eaft b\u1ecf ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1 bao g\u1ed3m tu\u1ed5i t\u00e1c (\u00edt h\u01a1n 40 tu\u1ed5i), k\u00edch th\u01b0\u1edbc t\u1ed5n th\u01b0\u01a1ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng m\u00f4 [4]. C\u00e1c v\u1ebft r\u00e1ch b\u00e1n nguy\u1ec7t c\u1ea7u g\u1ea7n g\u1ed1c c\u1ee7a s\u1ee5n ch\u00eam b\u00ean ngo\u00e0i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 l\u00e0nh \u0111\u01b0\u1ee3c, nh\u01b0ng ch\u1ee9c n\u0103ng sinh h\u1ecdc c\u01a1 h\u1ecdc c\u1ee7a c\u00e1c s\u1eeda ch\u1eefa n\u00e0y v\u1eabn \u0111ang \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 [4].<\/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 2631<\/li>\n<li>[2] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3057<\/li>\n<li>[3] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 189<\/li>\n<li>[4] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3065<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3058<\/li>\n<li>[6] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 190<\/li>\n<li>[7] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2629<\/li>\n<li>[8] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 3057<\/li>\n<li>[9] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 189<\/li>\n<\/ul>\n<p><!-- aiwriter:a3400982c6ec4c45b343568e --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>H\u01b0\u1edbng d\u1eabn ph\u00e2n bi\u1ec7t c\u00e1c ki\u1ec3u r\u00e1ch s\u1ee5n ch\u00eam nh\u01b0 r\u00e1ch d\u1ecdc, ngang, b\u00e1n nguy\u1ec7t c\u1ea7u tr\u00ean h\u00ecnh \u1ea3nh n\u1ed9i soi v\u00e0 MRI \u0111\u1ec3 \u0111\u1ecbnh h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb ch\u00ednh x\u00e1c.<\/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-599","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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