{"id":602,"date":"2026-10-13T09:31:58","date_gmt":"2026-10-13T02:31:58","guid":{"rendered":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/13\/dau-than-kinh-toa-do-truot-dot-l4-l5-nguyen-nhan-trieu-chung-va-phac-do-dieu-tri\/"},"modified":"2026-10-13T09:31:58","modified_gmt":"2026-10-13T02:31:58","slug":"dau-than-kinh-toa-do-truot-dot-l4-l5-nguyen-nhan-trieu-chung-va-phac-do-dieu-tri","status":"publish","type":"post","link":"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/13\/dau-than-kinh-toa-do-truot-dot-l4-l5-nguyen-nhan-trieu-chung-va-phac-do-dieu-tri\/","title":{"rendered":"\u0110au th\u1ea7n kinh t\u1ecda do tr\u01b0\u1ee3t \u0111\u1ed1t L4-L5: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p>Tr\u01b0\u1ee3t \u0111\u1ed1t s\u1ed1ng th\u1eaft l\u01b0ng (spondylolisthesis), \u0111\u1eb7c bi\u1ec7t \u1edf m\u1ee9c L4-L5, l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn g\u00e2y ra h\u1ed9i ch\u1ee9ng \u0111au th\u1ea7n kinh t\u1ecda. Khi x\u01b0\u01a1ng tr\u01b0\u1ee3t v\u1ec1 ph\u00eda tr\u01b0\u1edbc, n\u00f3 l\u00e0m gi\u1ea3m kh\u00f4ng gian trong h\u1ed1c th\u1ea7n kinh v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ch\u00e8n \u00e9p tr\u1ef1c ti\u1ebfp ho\u1eb7c k\u00e9o c\u0103ng r\u1ec5 th\u1ea7n kinh, d\u1eabn \u0111\u1ebfn c\u00e1c tri\u1ec7u ch\u1ee9ng ph\u00f3ng x\u1ea1 xu\u1ed1ng ch\u00e2n [1]. Vi\u1ec7c x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c li\u1ec7u b\u1ec7nh nh\u00e2n ch\u1ee7 y\u1ebfu b\u1ecb \u0111au c\u01a1 h\u1ecdc \u1edf l\u01b0ng hay \u0111au th\u1ea7n kinh t\u1ecda s\u1ebd quy\u1ebft \u0111\u1ecbnh lo\u1ea1i \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t, bao g\u1ed3m c\u1ea3 ph\u1eabu thu\u1eadt khi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n th\u1ea5t b\u1ea1i [1].<\/p>\n<h2>C\u01a1 ch\u1ebf g\u00e2y \u0111au v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/h2>\n<p>\u1ede m\u1ee9c L4-L5, r\u1ec5 th\u1ea7n kinh L5 c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng do h\u1eb9p h\u1ed1c th\u1ea7n kinh b\u00ean (lateral recess stenosis) ho\u1eb7c \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n do \u0111\u0129a \u0111\u1ec7m tho\u00e1t v\u1ecb \u1edf m\u1ee9c \u0111\u0129a L4 [1]. M\u1ed9t nguy\u00ean nh\u00e2n quan tr\u1ecdng kh\u00e1c l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng &#8220;tho\u00e1t gi\u1ea3&#8221; (pseudoherniation). Khi \u0111\u0129a \u0111\u1ec7m tho\u00e1i h\u00f3a v\u00e0 m\u1ea5t \u0111\u1ed9 cao, v\u00f2ng ngo\u00e0i c\u00f2n d\u00ednh v\u1edbi \u0111\u1ea7u d\u01b0\u1edbi c\u1ee7a \u0111\u1ed1t s\u1ed1ng tr\u00ean. Khi \u0111\u1ed1t s\u1ed1ng n\u00e0y tr\u01b0\u1ee3t v\u1ec1 ph\u00eda tr\u01b0\u1edbc, v\u00f2ng ngo\u00e0i di chuy\u1ec3n ra sau v\u00e0 chi\u1ebfm ch\u1ed7 trong h\u1ed1c th\u1ea7n kinh, l\u00e0m gi\u1ea3m di\u1ec7n t\u00edch c\u1eaft ngang c\u1ee7a n\u00f3 [1].<\/p>\n<p>Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee5 th\u1ec3 cho ch\u00e8n \u00e9p r\u1ec5 L5 bao g\u1ed3m:<\/p>\n<ul>\n<li><strong>\u0110au:<\/strong> Theo m\u00f4 h\u00ecnh ph\u00e2n b\u1ed1 c\u1ea3m gi\u00e1c (dermatome) c\u1ee7a r\u1ec5 L5, lan t\u1eeb m\u1eb7t tr\u01b0\u1edbc b\u00ean \u0111\u00f9i xu\u1ed1ng m\u1eb7t ngo\u00e0i ch\u00e2n v\u00e0 l\u00f2ng b\u00e0n ch\u00e2n, bao g\u1ed3m ng\u00f3n c\u00e1i [2].<\/li>\n<li><strong>Suy gi\u1ea3m v\u1eadn \u0111\u1ed9ng:<\/strong> C\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u01a1 g\u00e2n c\u1ed1t ng\u00f3n c\u00e1i d\u00e0i (extensor hallucis longus), c\u01a1 g\u00f3t gi\u1eefa (gluteus medius) ho\u1eb7c c\u01a1 g\u00e2n c\u1ed1t d\u00e0i v\u00e0 ng\u1eafn (extensor digitorum longus v\u00e0 brevis) [2].<\/li>\n<li><strong>Suy gi\u1ea3m c\u1ea3m gi\u00e1c:<\/strong> C\u1ea3m gi\u00e1c gi\u1ea3m tr\u00ean m\u1eb7t tr\u01b0\u1edbc b\u00ean ch\u00e2n, l\u00f2ng b\u00e0n ch\u00e2n v\u00e0 ng\u00f3n c\u00e1i l\u1edbn [2].<\/li>\n<\/ul>\n<p>M\u1eb7c d\u00f9 c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y r\u1ea5t \u0111i\u1ec3n h\u00ecnh, b\u00e1c s\u0129 c\u1ea7n l\u01b0u \u00fd r\u1eb1ng n\u1ebfu \u0111au ho\u1eb7c y\u1ebfu huy\u1ec7t c\u00f3 t\u00ednh ch\u1ea5t k\u1ef3 l\u1ea1 ho\u1eb7c \u0111\u1ed3ng nh\u1ea5t, ch\u1ea9n \u0111o\u00e1n \u0111\u0129a \u0111\u1ec7m tho\u00e1t v\u1ecb \u0111\u01a1n thu\u1ea7n n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t l\u1ea1i. C\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 suy y\u1ebfu v\u00e0 t\u00ea b\u00ec th\u01b0\u1eddng gi\u00e1n \u0111o\u1ea1n v\u00e0 thay \u0111\u1ed5i theo ho\u1ea1t \u0111\u1ed9ng [5].<\/p>\n<h2>Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n<\/h2>\n<p>H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n tr\u01b0\u1ee3t \u0111\u1ed1t s\u1ed1ng (\u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u00f3m 20-45 tu\u1ed5i) kh\u00f4ng c\u00f3 khuy\u1ebft t\u1eadt th\u1ea7n kinh \u0111\u00e1ng k\u1ec3 s\u1ebd \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u b\u1eb1ng c\u00e1ch ngh\u1ec9 ng\u01a1i ng\u1eafn h\u1ea1n, thu\u1ed1c ch\u1ed1ng vi\u00eam v\u00e0 th\u01b0 gi\u00e3n c\u01a1 [1]. Tuy nhi\u00ean, \u0111\u1ed1i v\u1edbi tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean b\u1ecb tr\u01b0\u1ee3t h\u01a1n 2 mm, vi\u1ec7c s\u1eed d\u1ee5ng khung n\u1eb9p (orthosis) th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb v\u00ec kh\u1ea3 n\u0103ng li\u1ec1n x\u01b0\u01a1ng g\u00e3y l\u00e0 kh\u00f4ng mong \u0111\u1ee3i v\u1edbi d\u1ecbch chuy\u1ec3n \u0111\u00e1ng k\u1ec3 [1].<\/p>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p \u0111\u0129a \u0111\u1ec7m tho\u00e1t v\u1ecb \u0111\u01a1n b\u00ean \u1edf L4-L5 g\u00e2y ch\u00e8n \u00e9p r\u1ec5 L5, ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n bao g\u1ed3m ngh\u1ec9 ng\u01a1i v\u00e0 thu\u1ed1c gi\u1ea3m \u0111au. M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t \u0111\u0129a n\u1ed9i soi (discography) \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c m\u1ee9c l\u00e2n c\u1eadn nh\u01b0ng ch\u00fang ta ch\u01b0a t\u00ecm th\u1ea5y n\u00f3 \u0111\u00e1ng tin c\u1eady; thay v\u00e0o \u0111\u00f3, ti\u00eam c\u1ee5c anestetic d\u00e0i t\u00e1c d\u1ee5ng v\u00e0opars c\u00f3 th\u1ec3 h\u1eefu \u00edch nh\u01b0 m\u1ed9t c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n khi c\u00f3 nhi\u1ec1u bi\u1ebfn \u0111\u1ed5i tho\u00e1i h\u00f3a [3].<\/p>\n<h2>\u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt v\u00e0 k\u1ebft qu\u1ea3<\/h2>\n<p>Khi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n th\u1ea5t b\u1ea1i ho\u1eb7c c\u00f3 khuy\u1ebft t\u1eadt th\u1ea7n kinh ti\u1ebfn tri\u1ec3n, ph\u1eabu thu\u1eadt l\u00e0 l\u1ef1a ch\u1ecdn. M\u1ed9t th\u1ee7 t\u1ee5c quan tr\u1ecdng l\u00e0 c\u1eaft \u0111\u0129a l\u1eb7p l\u1ea1i (repeat lumbar discectomy), th\u01b0\u1eddng d\u00f9ng cho tho\u00e1t v\u1ecb t\u00e1i ph\u00e1t [6]. Quy tr\u00ecnh bao g\u1ed3m chu\u1ea9n b\u1ecb v\u00f9ng l\u01b0ng, x\u00e1c \u0111\u1ecbnh c\u00e1c gai \u0111\u1ed1t s\u1ed1ng L3-L5-S1, l\u00e0m r\u1ea1ch gi\u1eefa \u0111\u01b0\u1eddng v\u00e0 b\u00f3c t\u00e1ch c\u01a1 \u0111\u1ec3 ti\u1ebfp c\u1eadn kh\u00f4ng gian \u0111\u0129a \u0111\u1ec7m. V\u1ecb tr\u00ed \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng X-quang tr\u01b0\u1edbc khi thao t\u00e1c [6].<\/p>\n<p>\u0110a s\u1ed1 b\u1ec7nh nh\u00e2n tr\u01b0\u1ee3t \u0111\u1ed1t m\u1ee9c th\u1ea5p (low-grade isthmic spondylolisthesis) \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt c\u00f3 k\u1ebft qu\u1ea3 t\u00edch c\u1ef1c. Nghi\u00ean c\u1ee9u c\u1ee7a Seuk et al. tr\u00ean 105 b\u1ec7nh nh\u00e2n cho th\u1ea5y t\u1ef7 l\u1ec7 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 c\u1ea3i thi\u1ec7n t\u1ed1i thi\u1ec3u clinically quan tr\u1ecdng (MCID) trong thang \u0111i\u1ec3m VAS cho v\u00f9ng l\u01b0ng l\u00e0 80% v\u00e0 v\u00f9ng ch\u00e2n l\u00e0 73%. T\u1ef7 l\u1ec7 c\u1ea3i thi\u1ec7n theo ch\u1ec9 s\u1ed1 ODI c\u0169ng \u0111\u1ea1t 83% sau trung b\u00ecnh 77 th\u00e1ng theo d\u00f5i [8].<\/p>\n<p>Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t nh\u01b0 g\u00e3y n\u1ed5 (burst fracture), vi\u1ec7c s\u1eafp x\u1ebfp l\u1ea1i c\u1ea5u tr\u00fac x\u01b0\u01a1ng v\u00e0 c\u1ed1 \u0111\u1ecbnh \u1ed5n \u0111\u1ecbnh th\u00f4ng qua ti\u1ebfp c\u1eadn h\u1eadu m\u00f4n c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn gi\u1ea3i ph\u00f3ng gi\u00e1n ti\u1ebfp k\u00eanh s\u1ed1ng, ngay c\u1ea3 khi kh\u00f4ng c\u00f3 ph\u1eabu thu\u1eadt tr\u01b0\u1edbc \u0111\u00f3. Tuy nhi\u00ean, ti\u00ean l\u01b0\u1ee3ng ch\u1ee7 y\u1ebfu ph\u1ee5 thu\u1ed9c v\u00e0o tr\u1ea1ng th\u00e1i th\u1ea7n kinh t\u1ea1i th\u1eddi \u0111i\u1ec3m nh\u1eadp vi\u1ec7n [4].<\/p>\n<p>Qua c\u00e1c t\u00e0i li\u1ec7u chuy\u00ean khoa, vi\u1ec7c k\u1ebft h\u1ee3p \u0111\u00e1nh gi\u00e1 h\u00ecnh \u1ea3nh (CT v\u00e0 MRI) \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n c\u1ee5 th\u1ec3 c\u1ee7a tri\u1ec7u ch\u1ee9ng r\u1ec5 th\u1ea7n kinh l\u00e0 b\u01b0\u1edbc then ch\u1ed1t trong l\u1eadp k\u1ebf ho\u1ea1ch ph\u1eabu thu\u1eadt ch\u00ednh x\u00e1c [7].<\/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 2404<\/li>\n<li>[2] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2353<\/li>\n<li>[3] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2405<\/li>\n<li>[4] Rockwood and Green&#x27;s Fractures in Adults, 10th Edition, 2025, trang 2288<\/li>\n<li>[5] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2352<\/li>\n<li>[6] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2364<\/li>\n<li>[7] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2405<\/li>\n<li>[8] Campbell&#x27;s Operative Orthopaedics, 15th Edition, 2026, trang 2405<\/li>\n<\/ul>\n<p><!-- aiwriter:1e1ae154ae9c42ff9f64a263 --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tr\u01b0\u1ee3t \u0111\u1ed1t L4-L5 c\u00f3 th\u1ec3 g\u00e2y \u0111au th\u1ea7n kinh t\u1ecda do ch\u00e8n \u00e9p r\u1ec5 th\u1ea7n kinh. B\u00e0i vi\u1ebft ph\u00e2n t\u00edch c\u01a1 ch\u1ebf b\u1ec7nh sinh, d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u0111\u1eb7c tr\u01b0ng v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p can thi\u1ec7p t\u1eeb b\u1ea3o t\u1ed3n \u0111\u1ebfn ph\u1eabu thu\u1eadt d\u1ef1a tr\u00ean t\u00e0i li\u1ec7u chuy\u00ean khoa.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12],"tags":[],"class_list":["post-602","post","type-post","status-publish","format-standard","hentry","category-chi-duoi"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>\u0110au th\u1ea7n kinh t\u1ecda do tr\u01b0\u1ee3t \u0111\u1ed1t L4-L5: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb - BS NGUY\u1ec4N TH\u00c0NH LONG - BS C\u01a0 X\u01af\u01a0NG KH\u1edaP - CH\u1ea4N TH\u01af\u01a0NG CH\u1ec8NH H\u00ccNH<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/bscoxuongkhop.io.vn\/index.php\/2026\/10\/13\/dau-than-kinh-toa-do-truot-dot-l4-l5-nguyen-nhan-trieu-chung-va-phac-do-dieu-tri\/\" \/>\n<meta property=\"og:locale\" content=\"vi_VN\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u0110au th\u1ea7n kinh t\u1ecda do tr\u01b0\u1ee3t \u0111\u1ed1t L4-L5: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb - BS NGUY\u1ec4N TH\u00c0NH LONG - BS C\u01a0 X\u01af\u01a0NG KH\u1edaP - CH\u1ea4N TH\u01af\u01a0NG CH\u1ec8NH H\u00ccNH\" \/>\n<meta property=\"og:description\" content=\"Tr\u01b0\u1ee3t \u0111\u1ed1t L4-L5 c\u00f3 th\u1ec3 g\u00e2y \u0111au th\u1ea7n kinh t\u1ecda do ch\u00e8n \u00e9p r\u1ec5 th\u1ea7n kinh. 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