B\u1ec7nh vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp (ankylosing spondylitis – AS) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd vi\u00eam m\u1ea1n t\u00ednh \u1ea3nh h\u01b0\u1edfng ch\u1ee7 y\u1ebfu \u0111\u1ebfn tr\u1ee5c c\u1ed9t s\u1ed1ng, c\u00e1c kh\u1edbp ch\u1eadu h\u00f4ng v\u00e0 x\u01b0\u01a1ng \u1ee9c [1]. \u0110\u00e2y l\u00e0 m\u1ed9t d\u1ea1ng spondyloarthropathy \u00e2m t\u00ednh kh\u00e1ng th\u1ec3, th\u01b0\u1eddng kh\u1edfi ph\u00e1t \u1edf ng\u01b0\u1eddi tr\u1ebb t\u1eeb 20 \u0111\u1ebfn 40 tu\u1ed5i, nam gi\u1edbi chi\u1ebfm \u0111a s\u1ed1 h\u01a1n n\u1eef gi\u1edbi v\u1edbi t\u1ef7 l\u1ec7 kho\u1ea3ng 3:1 [1]. M\u1eb7c d\u00f9 c\u00f3 li\u00ean quan m\u1eadt thi\u1ebft v\u1edbi kh\u00e1ng nguy\u00ean HLA-B27 (88-96% b\u1ec7nh nh\u00e2n d\u01b0\u01a1ng t\u00ednh), nh\u01b0ng ch\u1ec9 m\u1ed9t ph\u1ea7n nh\u1ecf trong d\u00e2n s\u1ed1 mang gen n\u00e0y m\u1edbi ph\u00e1t tri\u1ec3n th\u00e0nh b\u1ec7nh [1].<\/p>\n
Trong qu\u00e1 tr\u00ecnh ti\u1ebfn tri\u1ec3n, vi\u00eam kh\u1edbp t\u1ea1i c\u00e1c \u0111\u1ed1t s\u1ed1ng v\u00e0 c\u00e1c \u0111i\u1ec3m b\u00e1m (enthesopathies) g\u00e2y ra \u0111au \u0111\u1edbn m\u00e3n t\u00ednh v\u00e0 c\u1ee9ng kh\u1edbp, d\u1eabn \u0111\u1ebfn hi\u1ec7n t\u01b0\u1ee3ng d\u00ednh kh\u1edbp ti\u1ebfn tri\u1ec3n (ankylosis) [2]. Qu\u00e1 tr\u00ecnh d\u00ednh th\u01b0\u1eddng di\u1ec5n ra t\u1eeb d\u01b0\u1edbi l\u00ean tr\u00ean (t\u1eeb caudal sang cephalad), b\u1eaft \u0111\u1ea7u b\u1eb1ng s\u1ef1 h\u1ee3p nh\u1ea5t hai b\u00ean kh\u1edbp ch\u1eadu h\u00f4ng tr\u01b0\u1edbc khi lan r\u1ed9ng l\u00ean c\u1ed9t s\u1ed1ng [4].<\/p>\n
Vi\u1ec7c d\u00ednh c\u1ee9ng c\u00e1c \u0111\u1ed1t s\u1ed1ng g\u00e2y m\u1ea5t \u0111i \u0111\u1ed9 cong t\u1ef1 nhi\u00ean c\u1ee7a c\u1ed9t s\u1ed1ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 m\u1ea5t lordosis v\u00f9ng th\u1eaft l\u01b0ng v\u00e0 ph\u00e1t tri\u1ec3n g\u00f9 l\u01b0ng (kyphosis) t\u1ea1i v\u00f9ng c\u1ed5 v\u00e0 ng\u1ef1c [4]. S\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa bi\u1ebfn d\u1ea1ng kyphosis c\u1ed5-th\u1eaft l\u01b0ng v\u00e0 teo kh\u1edbp h\u00e1ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng th\u00e2n ng\u01b0\u1eddi nghi\u00eam tr\u1ecdng. B\u1ec7nh nh\u00e2n g\u1eb7p kh\u00f3 kh\u0103n trong c\u00e1c ho\u1ea1t \u0111\u1ed9ng c\u01a1 b\u1ea3n nh\u01b0 nh\u00ecn l\u00ean ph\u00eda tr\u00ean ho\u1eb7c n\u1eb1m xu\u1ed1ng gi\u01b0\u1eddng, t\u1ea1o ra nh\u1eefng b\u1ea5t l\u1ee3i ch\u1ee9c n\u0103ng t\u00e0n t\u1eadt [4].<\/p>\n
B\u00ean c\u1ea1nh bi\u1ebfn d\u1ea1ng c\u1ed9t s\u1ed1ng, b\u1ec7nh nh\u00e2n AS c\u00f3 nguy c\u01a1 b\u1ecb g\u00e3y x\u01b0\u01a1ng r\u1ea5t cao do s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa lo\u00e3ng x\u01b0\u01a1ng (osteopenia) v\u00e0 c\u00e1c \u0111o\u1ea1n c\u1ed9t s\u1ed1ng \u0111\u00e3 d\u00ednh c\u1ee9ng [3]. G\u00e3y c\u1ed9t s\u1ed1ng \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y th\u01b0\u1eddng l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong trong b\u1ec7nh vi\u1ec7n. C\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 va \u0111\u1eadp k\u00e9o gi\u00e3n (extension injury), v\u00ed d\u1ee5 nh\u01b0 ng\u00e3 t\u1eeb m\u1ed9t \u0111\u1ed9 cao th\u1ea5p ho\u1eb7c b\u1ecb \u0111\u00e1nh v\u00e0o \u0111\u1ea7u khi \u0111ang n\u1eb1m s\u1ea5p, khi\u1ebfn c\u1ed9t s\u1ed1ng kh\u00f4ng th\u1ec3 h\u1ea5p th\u1ee5 n\u0103ng l\u01b0\u1ee3ng do c\u00e1c \u0111\u0129a \u0111\u1ec7m v\u00e0 ph\u1ea7n m\u1ec1m \u0111\u00e3 b\u1ecb x\u01b0\u01a1ng h\u00f3a [6].<\/p>\n
\u0110i\u1ec3m \u0111\u1eb7c bi\u1ec7t c\u1ee7a g\u00e3y x\u01b0\u01a1ng t\u1ea1i b\u1ec7nh nh\u00e2n AS l\u00e0 t\u00ednh ch\u1ea5t b\u1ea5t \u1ed5n \u0111\u1ecbnh v\u00e0 th\u01b0\u1eddng b\u1ecb ph\u00e1t hi\u1ec7n mu\u1ed9n. Ngay c\u1ea3 khi ch\u1ea5n th\u01b0\u01a1ng r\u1ea5t nh\u1eb9 ho\u1eb7c ch\u1ec9 g\u00e2y \u0111au, b\u1ea5t k\u1ef3 s\u1ef1 thay \u0111\u1ed5i n\u00e0o v\u1ec1 t\u01b0 th\u1ebf c\u1ed9t s\u1ed1ng \u0111\u1ec1u ph\u1ea3i \u0111\u01b0\u1ee3c xem x\u00e9t nh\u01b0 m\u1ed9t g\u00e3y x\u01b0\u01a1ng cho \u0111\u1ebfn khi c\u00f3 b\u1eb1ng ch\u1ee9ng ng\u01b0\u1ee3c l\u1ea1i [3]. G\u00e3y x\u01b0\u01a1ng th\u01b0\u1eddng x\u1ea3y ra \u1edf v\u00f9ng c\u1ed5 C5-T1 v\u00e0 c\u00f3 th\u1ec3 kh\u00f4ng li\u00ean t\u1ee5c (non-contiguous), v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong t\u1eeb 6% \u0111\u1ebfn 10% trong v\u00f2ng 7-10 ng\u00e0y \u0111\u1ea7u sau ch\u1ea5n th\u01b0\u01a1ng [6].<\/p>\n
Ch\u1ea9n \u0111o\u00e1n g\u00e3y x\u01b0\u01a1ng \u1edf b\u1ec7nh nh\u00e2n AS l\u00e0 r\u1ea5t kh\u00f3 kh\u0103n tr\u00ean phim X-quang th\u01b0\u1eddng quy do c\u00e1c thay \u0111\u1ed5i tho\u00e1i h\u00f3a s\u1eb5n c\u00f3 (ph\u00f9 gai, s\u1ee5n kh\u1edbp d\u00e0y) v\u00e0 c\u1ea5u tr\u00fac c\u1ed9t s\u1ed1ng b\u1ea5t th\u01b0\u1eddng [7]. C\u00e1c d\u1ea5u hi\u1ec7u ban \u0111\u1ea7u c\u1ee7a AS nh\u01b0 hi\u1ec7n t\u01b0\u1ee3ng “c\u1ed9t s\u1ed1ng tr\u00fac tre” c\u00f3 th\u1ec3 che l\u1ea5p h\u00ecnh \u1ea3nh g\u00e3y x\u01b0\u01a1ng th\u1ef1c s\u1ef1. Do \u0111\u00f3, vi\u1ec7c ch\u1ee5p CT to\u00e0n b\u1ed9 tr\u1ee5c c\u1ed9t s\u1ed1ng v\u00e0 MRI l\u00e0 v\u00f4 c\u00f9ng c\u1ea7n thi\u1ebft \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng vi m\u00f4 ho\u1eb7c g\u00e3y x\u01b0\u01a1ng d\u1ecbch chuy\u1ec3n nguy hi\u1ec3m [7].<\/p>\n
B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed AS ho\u1eb7c \u0111\u1eb7c \u0111i\u1ec3m bi\u1ebfn d\u1ea1ng kyphotic t\u1ea1i v\u00f9ng c\u1ed5-th\u1eaft l\u01b0ng c\u1ea7n \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 duy tr\u00ec t\u01b0 th\u1ebf g\u00f9 trong qu\u00e1 tr\u00ecnh \u0111\u00e1nh gi\u00e1, kh\u00f4ng n\u00ean n\u1eb1m ph\u1eb3ng [5]. Khi di chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u1ec3 ph\u1eabu thu\u1eadt ho\u1eb7c thay \u0111\u1ed5i t\u01b0 th\u1ebf (v\u00ed d\u1ee5: n\u1eb1m s\u1ea5p), c\u1ea7n l\u1eadp k\u1ebf ho\u1ea1ch c\u1ea9n th\u1eadn v\u00e0 s\u1eed d\u1ee5ng khung m\u1edf \u0111\u1ec3 tr\u00e1nh g\u00e2y \u0111\u00e8 n\u00e9n l\u00ean c\u1ed9t s\u1ed1ng \u0111\u00e3 d\u00ednh c\u1ee9ng [9].<\/p>\n
B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh t\u1ea1m th\u1eddi b\u1eb1ng \u00e1o halo tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt, v\u00ec c\u1ed5 \u0111i\u1ec3n kh\u00f4ng \u0111\u1ee7 kh\u1ea3 n\u0103ng c\u1ed1 \u0111\u1ecbnh. Vi\u1ec7c \u1ed5n \u0111\u1ecbnh ph\u1eabu thu\u1eadt v\u1edbi h\u1ec7 th\u1ed1ng c\u1ed1 \u0111\u1ecbnh sau d\u00e0i l\u00e0 c\u1ea7n thi\u1ebft do ch\u1ea5t l\u01b0\u1ee3ng x\u01b0\u01a1ng k\u00e9m, m\u1eb7c d\u00f9 t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng cao [8].<\/p>\n
V\u00ec vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 g\u00f9 l\u01b0ng m\u1ea5t th\u0103ng b\u1eb1ng v\u00e0 g\u00e3y x\u01b0\u01a1ng d\u1ec5 t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh, vi\u1ec7c nh\u1eadn di\u1ec7n s\u1edbm \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 s\u1eed d\u1ee5ng \u0111\u00fang ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh l\u00e0 \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u. C\u00e1c b\u00e1c s\u0129 c\u1ea7n duy tr\u00ec s\u1ef1 nghi ng\u1edd cao v\u1ec1 ch\u1ea5n th\u01b0\u01a1ng c\u1ed9t s\u1ed1ng ngay c\u1ea3 khi ch\u1ea5n th\u01b0\u01a1ng nh\u1eb9 \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u1ec3 tr\u00e1nh h\u1eadu qu\u1ea3 kh\u00f4ng th\u1ec3 h\u1ed3i ph\u1ee5c.<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
Vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp g\u00e2y m\u1ea5t th\u0103ng b\u1eb1ng th\u00e2n ng\u01b0\u1eddi, bi\u1ebfn d\u1ea1ng c\u1ed9t s\u1ed1ng v\u00e0 t\u0103ng nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng. Hi\u1ec3u r\u00f5 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng.<\/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-607","post","type-post","status-publish","format-standard","hentry","category-chi-duoi"],"yoast_head":"\n