{"id":8521,"date":"2020-05-22T22:28:36","date_gmt":"2020-05-22T15:28:36","guid":{"rendered":"https:\/\/yhoccongdong.org\/ung-thu\/hoai-tu-vo-mach-hoai-tu-xuong\/"},"modified":"2020-05-22T22:28:36","modified_gmt":"2020-05-22T15:28:36","slug":"hoai-tu-vo-mach-hoai-tu-xuong","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/ung-thu\/hoai-tu-vo-mach-hoai-tu-xuong\/","title":{"rendered":"Ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch, ho\u1ea1i t\u1eed x\u01b0\u01a1ng"},"content":{"rendered":"<h2><strong>Ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch l\u00e0 g\u00ec?<\/strong><\/h2>\n<p>Ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch (AVN), c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ho\u1ea1i t\u1eed x\u01b0\u01a1ng, l\u00e0 t\u00ecnh tr\u1ea1ng x\u1ea3y ra khi c\u00e1c khu v\u1ef1c x\u01b0\u01a1ng b\u1ecb ho\u1ea1i t\u1eed v\u00ec cung c\u1ea5p m\u00e1u k\u00e9m. AVN c\u00f3 th\u1ec3 x\u1ea3y ra nh\u01b0 l\u00e0 m\u1ed9t t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a m\u1ed9t s\u1ed1 b\u1ec7nh ung th\u01b0 ho\u1eb7c \u0111i\u1ec1u tr\u1ecb ung th\u01b0.<\/p>\n<p>Tr\u1ebb em \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticosteroid li\u1ec1u cao (dexamethasone v\u00e0 prednison) c\u00f3 nguy c\u01a1 cao h\u01a1n.<\/p>\n<p>AVN c\u00f3 th\u1ec3 nh\u1eb9 v\u00e0 t\u1ef1 kh\u1ecfi sau khi \u0111i\u1ec1u tr\u1ecb ung th\u01b0 k\u1ebft th\u00fac, ho\u1eb7c t\u00ecnh tr\u1ea1ng c\u00f3 th\u1ec3 nghi\u00eam tr\u1ecdng, g\u00e2y \u0111au \u0111\u1edbn v\u00e0 t\u00e0n ph\u1ebf l\u00e2u d\u00e0i.<\/p>\n<h2><strong>AVN \u1edf tr\u1ebb b\u1ecb ung th\u01b0<\/strong><\/h2>\n<p>AVN l\u00e0 m\u1ed9t t\u00e1c d\u1ee5ng ph\u1ee5 ph\u1ed5 bi\u1ebfn c\u1ee7a \u0111i\u1ec1u tr\u1ecb b\u1ec7nh b\u1ea1ch c\u1ea7u v\u00e0 ung th\u01b0 h\u1ea1ch. C\u00f3 t\u1edbi m\u1ed9t n\u1eeda s\u1ed1 tr\u1ebb em \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh b\u1ea1ch c\u1ea7u c\u1ea5p d\u00f2ng lympho (ALL) c\u00f3 m\u1ed9t s\u1ed1 m\u1ee9c \u0111\u1ed9 AVN. Tr\u1ebb em \u0111\u01b0\u1ee3c gh\u00e9p t\u1ee7y x\u01b0\u01a1ng c\u0169ng c\u00f3 nguy c\u01a1 m\u1eafc AVN cao.<\/p>\n<p>T\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ea5t k\u1ef3 x\u01b0\u01a1ng n\u00e0o. Tuy nhi\u00ean, \u1edf tr\u1ebb b\u1ecb ung th\u01b0, AVN th\u01b0\u1eddng \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y \u1edf g\u1ea7n \u0111\u1ea7u x\u01b0\u01a1ng d\u00e0i, m\u1ed9t khu v\u1ef1c \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u0111\u1ea7u x\u01b0\u01a1ng.<\/p>\n<p>AVN c\u00f3 th\u1ec3 g\u00e2y \u0111au v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng kh\u1edbp, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf \u0111\u1ea7u g\u1ed1i, h\u00f4ng, vai v\u00e0 m\u1eaft c\u00e1 ch\u00e2n. T\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng v\u00e0 kh\u1edbp c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 l\u00e2u d\u00e0i bao g\u1ed3m d\u00ednh kh\u1edbp v\u00e0 vi\u00eam kh\u1edbp.<\/p>\n<p>Tr\u1ebb l\u1edbn v\u00e0 thi\u1ebfu ni\u00ean c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng ph\u00e1t tri\u1ec3n AVN trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0 so v\u1edbi tr\u1ebb nh\u1ecf v\u00e0 ng\u01b0\u1eddi l\u1edbn. N\u00f3 \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf tr\u1ebb d\u01b0\u1edbi 10 tu\u1ed5i.<\/p>\n<p>Giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a AVN c\u00f3 th\u1ec3 kh\u00f3 ph\u00e1t hi\u1ec7n. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 kh\u00f4ng b\u1ecb \u0111au ho\u1eb7c kh\u00f4ng c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c cho \u0111\u1ebfn khi t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng nghi\u00eam tr\u1ecdng. Tr\u1ebb em c\u00f3 nguy c\u01a1 cao m\u1eafc AVN n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb AVN ph\u1ee5 thu\u1ed9c v\u00e0o \u0111au v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng. \u0110i\u1ec1u tr\u1ecb \u0111au v\u00e0 v\u1eadt l\u00fd tr\u1ecb li\u1ec7u c\u00f3 th\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n gi\u1ea3m tri\u1ec7u ch\u1ee9ng. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u1ea7n ph\u1eabu thu\u1eadt \u0111\u1ec3 c\u1ea3i thi\u1ec7n l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0 gi\u1ea3m \u00e1p l\u1ef1c trong x\u01b0\u01a1ng. N\u1ebfu t\u1ed5n th\u01b0\u01a1ng nghi\u00eam tr\u1ecdng ho\u1eb7c d\u00ednh kh\u1edbp x\u1ea3y ra, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u1ea7n ph\u1eabu thu\u1eadt thay kh\u1edbp.<\/p>\n<h2><strong>Tri\u1ec7u ch\u1ee9ng c\u1ee7a AVN<\/strong><\/h2>\n<p>M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 tri\u1ec7u ch\u1ee9ng n\u00e0o, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong giai \u0111o\u1ea1n \u0111\u1ea7u. Khi t\u00ecnh tr\u1ea1ng x\u1ea5u \u0111i, \u0111au kh\u1edbp v\u00e0 x\u01b0\u01a1ng c\u00f3 th\u1ec3 x\u1ea3y ra. C\u00e1c gia \u0111\u00ecnh c\u00f3 th\u1ec3 nh\u1eadn th\u1ea5y m\u1ed9t \u0111\u1ee9a tr\u1ebb \u0111i kh\u1eadp khi\u1ec5ng, tr\u00e1nh n\u00e9 \u0111\u1ed9ng t\u00e1c, ho\u1eb7c b\u1ecb c\u1ee9ng ho\u1eb7c gi\u1ea3m v\u1eadn \u0111\u1ed9ng. AVN \u0111\u00f4i khi c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ti\u00eau x\u01b0\u01a1ng v\u00e0 c\u01a1n \u0111au c\u00f3 th\u1ec3 tr\u1edf n\u00ean t\u1ed3i t\u1ec7 h\u01a1n.<\/p>\n<p>AVN c\u00f3 th\u1ec3 b\u1ecb gi\u1edbi h\u1ea1n \u1edf m\u1ed9t v\u1ecb tr\u00ed ho\u1eb7c c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nhi\u1ec1u x\u01b0\u01a1ng (\u0111a ti\u00eau x\u01b0\u01a1ng). B\u1edfi v\u00ec h\u00f3a tr\u1ecb t\u00e1c \u0111\u1ed9ng tr\u00ean kh\u1eafp c\u01a1 th\u1ec3, AVN th\u01b0\u1eddng x\u1ea3y ra \u1edf nhi\u1ec1u kh\u1edbp \u1edf tr\u1ebb b\u1ecb ung th\u01b0, th\u01b0\u1eddng l\u00e0 \u0111\u1ea7u g\u1ed1i v\u00e0 \/ ho\u1eb7c h\u00f4ng. C\u00e1c kh\u1edbp kh\u00e1c c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng bao g\u1ed3m vai v\u00e0 m\u1eaft c\u00e1 ch\u00e2n.<\/p>\n<h3><strong>\u0110au v\u00e0 t\u00e0n t\u1eadt th\u01b0\u1eddng ph\u1ee5 thu\u1ed9c v\u00e0o<\/strong><\/h3>\n<ul>\n<li>Nh\u1eefng khu v\u1ef1c c\u1ee7a x\u01b0\u01a1ng b\u1ecb \u1ea3nh h\u01b0\u1edfng<\/li>\n<li>C\u00f3 bao nhi\u00eau v\u1ecb tr\u00ed b\u1ecb AVN<\/li>\n<li>Ti\u1ebfn tri\u1ec3n AVN nhanh hay ch\u1eadm<\/li>\n<li>Kh\u1ea3 n\u0103ng t\u1ef1 s\u1eeda c\u1ee7a x\u01b0\u01a1ng<\/li>\n<\/ul>\n<p>Tuy nhi\u00ean, \u0111au kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t ch\u1ec9 s\u1ed1 \u0111\u00e1ng tin c\u1eady v\u1ec1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a AVN. C\u00e1c v\u00f9ng nh\u1ecf AVN c\u00f3 th\u1ec3 r\u1ea5t \u0111au \u0111\u1edbn. Nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00e1c c\u00f3 th\u1ec3 kh\u00f4ng b\u1ecb \u0111au, ngay c\u1ea3 khi di\u1ec7n t\u00edch AVN r\u1ea5t l\u1edbn.<\/p>\n<h3><strong>Tri\u1ec7u ch\u1ee9ng AVN<\/strong><\/h3>\n<ul>\n<li>\u0110au (c\u00f3 th\u1ec3 tho\u00e1ng qua ho\u1eb7c k\u00e9o d\u00e0i)<\/li>\n<li>C\u1ee9ng 1 kh\u1edbp<\/li>\n<li>\u0110i kh\u1eadp khi\u1ec5ng ho\u1eb7c thay \u0111\u1ed5i d\u00e1ng \u0111i<\/li>\n<li>Tr\u00e1nh s\u1eed kh\u1edbp n\u00e0o \u0111\u00f3 ho\u1eb7c h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng<\/li>\n<li>G\u1eb7p v\u1ea5n \u0111\u1ec1 \u0111i l\u00ean\/xu\u1ed1ng c\u1ea7u thang<\/li>\n<\/ul>\n<h2><strong>AVN: Ai c\u00f3 nguy c\u01a1?<\/strong><\/h2>\n<ul>\n<li>Dexamethasone ho\u1eb7c prednison li\u1ec1u cao trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0<\/li>\n<li>Tr\u1ebb em tr\u00ean 10 tu\u1ed5i<\/li>\n<li>B\u1ec7nh h\u1ed3ng c\u1ea7u h\u00ecnh li\u1ec1m<\/li>\n<li>Ph\u00f3ng x\u1ea1 li\u1ec1u cao v\u00e0o x\u01b0\u01a1ng<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb b\u1eb1ng asparaginase c\u1ed9ng v\u1edbi dexamethasone<\/li>\n<li>Di truy\u1ec1n<\/li>\n<\/ul>\n<h2><strong>Nguy\u00ean nh\u00e2n c\u1ee7a AVN<\/strong><\/h2>\n<p>AVN l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh ph\u1ee9c t\u1ea1p. Nguy\u00ean nh\u00e2n ch\u00ednh c\u1ee7a AVN l\u00e0 m\u1ea5t ngu\u1ed3n cung c\u1ea5p m\u00e1u cho x\u01b0\u01a1ng. Khi c\u00e1c m\u1ea1ch m\u00e1u qu\u00e1 nh\u1ecf ho\u1eb7c b\u1ecb h\u01b0 h\u1ecfng ho\u1eb7c b\u1ecb t\u1eafc, c\u00e1c ch\u1ea5t dinh d\u01b0\u1ee1ng v\u00e0 oxy kh\u00f4ng th\u1ec3 v\u00e0o x\u01b0\u01a1ng v\u00e0 c\u00e1c t\u1ebf b\u00e0o x\u01b0\u01a1ng b\u1eaft \u0111\u1ea7u ch\u1ebft.<\/p>\n<p>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ung th\u01b0, bao g\u1ed3m h\u00f3a tr\u1ecb v\u00e0 x\u1ea1 tr\u1ecb, c\u00f3 th\u1ec3 khi\u1ebfn c\u00e1c t\u1ebf b\u00e0o x\u01b0\u01a1ng ch\u1ebft v\u00e0 \/ ho\u1eb7c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn qu\u00e1 tr\u00ecnh ch\u1eefa l\u00e0nh. Do \u0111\u00f3, x\u01b0\u01a1ng c\u00f3 th\u1ec3 b\u1ecb ph\u00e1 h\u1ee7y nhanh h\u01a1n n\u00f3 c\u00f3 th\u1ec3 t\u1ef1 s\u1eeda ch\u1eefa. \u0110i\u1ec1u tr\u1ecb c\u0169ng c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c cung c\u1ea5p m\u00e1u cho x\u01b0\u01a1ng, d\u1eabn \u0111\u1ebfn AVN.<\/p>\n<p>Nhi\u1ec1u tr\u1ebb em s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c <em><strong>corticosteroid<\/strong><\/em> (v\u00ed d\u1ee5: prednisone, dexamethasone) nh\u01b0 l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a h\u00f3a tr\u1ecb. Nh\u1eefng lo\u1ea1i thu\u1ed1c n\u00e0y c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u00fap ki\u1ec3m so\u00e1t c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 bu\u1ed3n n\u00f4n v\u00e0 vi\u00eam. Tuy nhi\u00ean, corticosteroid c\u00f3 th\u1ec3 l\u00e0m t\u0103ng c\u00e1c ch\u1ea5t b\u00e9o (lipid) trong m\u00e1u. S\u1ef1 t\u00edch t\u1ee5 ch\u1ea5t b\u00e9o c\u00f3 th\u1ec3 khi\u1ebfn c\u00e1c m\u1ea1ch m\u00e1u b\u1ecb t\u1eafc ngh\u1ebdn. Nh\u1eefng lo\u1ea1i thu\u1ed1c n\u00e0y c\u0169ng c\u00f3 th\u1ec3 thay \u0111\u1ed5i c\u00e1c t\u1ebf b\u00e0o th\u00e0nh m\u1ea1ch m\u00e1u, khi\u1ebfn c\u00e1c m\u1ea1ch m\u00e1u tr\u1edf n\u00ean m\u1ecfng ho\u1eb7c y\u1ebfu.<\/p>\n<p><em><strong>Dexamethasone<\/strong><\/em> li\u1ec1u cao, li\u00ean t\u1ee5c c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 m\u1eafc AVN cao nh\u1ea5t so v\u1edbi prednisone ho\u1eb7c dexamethasone xen k\u1ebd. M\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c, ch\u1eb3ng h\u1ea1n nh\u01b0 asparaginase, c\u0169ng c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ho\u1ea1t \u0111\u1ed9ng c\u1ee7a dexamethasone v\u00e0 l\u00e0m t\u0103ng nguy c\u01a1 m\u1eafc AVN do c\u00e1ch th\u1ee9c c\u00e1c lo\u1ea1i thu\u1ed1c ph\u1ed1i h\u1ee3p v\u1edbi nhau. C\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c bao g\u1ed3m methotrexate (MTX) c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng v\u00e0 c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 AVN, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi s\u1eed d\u1ee5ng v\u1edbi corticosteroid.<\/p>\n<h2><strong>Ch\u1ea9n \u0111o\u00e1n AVN<\/strong><\/h2>\n<p>C\u00e1c trung t\u00e2m y t\u1ebf kh\u00e1c nhau trong c\u00e1ch h\u1ecd x\u00e1c \u0111\u1ecbnh v\u00e0 theo d\u00f5i b\u1ec7nh nh\u00e2n nguy c\u01a1. C\u00e1c x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c v\u00f9ng AVN, \u0111\u00f4i khi \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 t\u1ed5n th\u01b0\u01a1ng. Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) l\u00e0 x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh nh\u1ea1y nh\u1ea5t \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n AVN. X-quang \u00edt nh\u1ea1y c\u1ea3m h\u01a1n nh\u01b0ng c\u00f3 th\u1ec3 h\u1eefu \u00edch \u0111\u1ec3 theo d\u00f5i ti\u1ebfn tri\u1ec3n v\u00e0 theo d\u00f5i b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt. C\u00e1c lo\u1ea1i x\u00e9t nghi\u1ec7m kh\u00e1c bao g\u1ed3m Bonescans v\u00e0 ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT) c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng.<\/p>\n<p><em>\u0110\u1ecdc th\u00eam &#8211; S\u00e0ng l\u1ecdc ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1<\/em><\/p>\n<h2><strong>S\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a AVN<\/strong><\/h2>\n<p>S\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a AVN l\u00e0 kh\u00f3 d\u1ef1 \u0111o\u00e1n. C\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 bi\u1ebfn m\u1ea5t, \u1ed5n \u0111\u1ecbnh ho\u1eb7c tr\u1edf n\u00ean t\u1ed3i t\u1ec7 h\u01a1n. Ti\u1ebfn tri\u1ec3n c\u00f3 th\u1ec3 ch\u1eadm ho\u1eb7c nhanh.<\/p>\n<p>M\u1ee9c \u0111\u1ed9 n\u1eb7ng ho\u1eb7c giai \u0111o\u1ea1n c\u1ee7a AVN r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 l\u00ean k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb.<em><strong> C\u00e1c b\u00e1c s\u0129 xem x\u00e9t hai y\u1ebfu t\u1ed1 ch\u00ednh<\/strong><\/em>:<\/p>\n<ul>\n<li>K\u00edch th\u01b0\u1edbc c\u1ee7a t\u1ed5n th\u01b0\u01a1ng<\/li>\n<li>Cho d\u00f9 t\u1ed5n th\u01b0\u01a1ng l\u00e0 trong x\u01b0\u01a1ng h\u1ed7 tr\u1ee3 b\u1ec1 m\u1eb7t kh\u1edbp<\/li>\n<\/ul>\n<p>N\u1ebfu x\u01b0\u01a1ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng th\u1ec3 h\u1ed7 tr\u1ee3 b\u1ec1 m\u1eb7t kh\u1edbp, x\u01b0\u01a1ng d\u01b0\u1edbi s\u1ee5n s\u1ebd b\u1eaft \u0111\u1ea7u ti\u00eau. L\u1edbp s\u1ee5n tr\u01a1n nh\u1eb5n th\u01b0\u1eddng n\u1ed1i c\u00e1c kh\u1edbp b\u1eaft \u0111\u1ea7u bong ra. \u0110i\u1ec1u n\u00e0y d\u1eabn \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 kh\u1edbp nh\u01b0 vi\u00eam kh\u1edbp, g\u00e2y \u0111au v\u00e0 h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp.<\/p>\n<p>Ti\u00eau kh\u1edbp c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng n\u1ebfu t\u1ed5n th\u01b0\u01a1ng:<\/p>\n<ul>\n<li>X\u1ea3y ra trong x\u01b0\u01a1ng g\u1ea7n v\u1edbi b\u1ec1 m\u1eb7t kh\u1edbp<\/li>\n<li>Chi\u1ebfm 30% ho\u1eb7c nhi\u1ec1u h\u01a1n b\u1ec1 m\u1eb7t<\/li>\n<li>X\u1ea3y ra \u1edf kh\u1edbp ch\u1ecbu tr\u1ecdng l\u01b0\u1ee3ng (h\u00f4ng, \u0111\u1ea7u g\u1ed1i)<\/li>\n<\/ul>\n<p>B\u1edfi v\u00ec \u0111\u1ea7u g\u1ed1i v\u00e0 h\u00f4ng l\u00e0 kh\u1edbp ch\u1ecbu tr\u1ecdng l\u01b0\u1ee3ng, s\u1ef1 ti\u00eau kh\u1edbp l\u00e0 ph\u1ed5 bi\u1ebfn khi AVN n\u1eb7ng. \u1ede h\u00f4ng, khi AVN \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u01a1n 30% b\u1ec1 m\u1eb7t kh\u1edbp, s\u1ef1 ti\u00eau kh\u1edbp th\u01b0\u1eddng x\u1ea3y ra trong v\u00f2ng 2 n\u0103m.<\/p>\n<h2><strong>\u0110i\u1ec1u tr\u1ecb AVN<\/strong><\/h2>\n<p>\u0110i\u1ec1u tr\u1ecb AVN d\u1ef1a tr\u00ean t\u1eebng b\u1ec7nh nh\u00e2n. <em><strong>C\u00e1c b\u00e1c s\u0129 s\u1ebd xem x\u00e9t<\/strong><\/em>:<\/p>\n<ul>\n<li>Tu\u1ed5i b\u1ec7nh nh\u00e2n<\/li>\n<li>S\u1ee9c kh\u1ecfe b\u1ec7nh nh\u00e2n v\u00e0 giai \u0111o\u1ea1n ung th\u01b0<\/li>\n<li>C\u00e1c \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00e0 l\u1ecbch tr\u00ecnh h\u00f3a tr\u1ecb<\/li>\n<li>Giai \u0111o\u1ea1n AVN<\/li>\n<li>X\u01b0\u01a1ng v\u00e0 kh\u1edbp b\u1ecb \u1ea3nh h\u01b0\u1edfng<\/li>\n<li>M\u1ee9c \u0111\u1ed9 \u0111au<\/li>\n<\/ul>\n<p>M\u1ee5c ti\u00eau ch\u00ednh c\u1ee7a \u0111i\u1ec1u tr\u1ecb l\u00e0 ki\u1ec3m so\u00e1t c\u01a1n \u0111au, duy tr\u00ec ch\u1ee9c n\u0103ng kh\u1edbp v\u00e0 ng\u0103n ng\u1eeba t\u1ed5n th\u01b0\u01a1ng th\u00eam.<\/p>\n<p><strong>Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 bao g\u1ed3m<\/strong><\/p>\n<h3><strong>Thu\u1ed1c<\/strong><\/h3>\n<p>B\u00e1c s\u0129 c\u00f3 th\u1ec3 k\u00ea \u0111\u01a1n thu\u1ed1c gi\u1ea3m \u0111au nh\u01b0 <em><strong>NSAID<\/strong><\/em> (meloxicam, celecoxib) ho\u1eb7c acetaminophen. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c gi\u1ea3m \u0111au c\u0169ng c\u00f3 th\u1ec3 khi\u1ebfn b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u, c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 gan ho\u1eb7c th\u1eadn v\u00e0 t\u0103ng t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a h\u00f3a tr\u1ecb. Gia \u0111\u00ecnh n\u00ean trao \u0111\u1ed5i v\u1edbi b\u00e1c s\u0129 tr\u01b0\u1edbc khi d\u00f9ng b\u1ea5t k\u1ef3 lo\u1ea1i thu\u1ed1c n\u00e0o, k\u1ec3 c\u1ea3 thu\u1ed1c kh\u00f4ng k\u00ea \u0111\u01a1n, \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o r\u1eb1ng n\u00f3 kh\u00f4ng t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c ho\u1eb7c l\u00e0m cho t\u00e1c d\u1ee5ng ph\u1ee5 tr\u1edf n\u00ean t\u1ed3i t\u1ec7 h\u01a1n.<\/p>\n<p>C\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u \u0111ang nghi\u00ean c\u1ee9u l\u00e0m th\u1ebf n\u00e0o c\u00e1c lo\u1ea1i thu\u1ed1c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn l\u01b0u l\u01b0\u1ee3ng m\u00e1u, \u0111\u00f4ng m\u00e1u, vi\u00eam, chuy\u1ec3n h\u00f3a lipid v\u00e0 \/ ho\u1eb7c t\u1ebf b\u00e0o x\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ng\u0103n ng\u1eeba ho\u1eb7c \u0111i\u1ec1u tr\u1ecb AVN. Tuy nhi\u00ean, k\u1ebft qu\u1ea3 \u0111\u00e3 kh\u00f4ng cho th\u1ea5y s\u1ef1 t\u01b0\u01a1ng \u0111\u1ed3ng.<\/p>\n<h3><strong>V\u1eadt l\u00fd tr\u1ecb li\u1ec7u<\/strong><\/h3>\n<p>V\u1eadt l\u00fd tr\u1ecb li\u1ec7u r\u1ea5t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n m\u1eafc AVN. M\u1ed9t B\u00e1c s\u0129 v\u1eadt l\u00fd tr\u1ecb li\u1ec7u c\u00f3 th\u1ec3 \u0111\u1ec1 xu\u1ea5t nh\u1eefng c\u00e1ch \u0111\u1ec3 b\u1ec7nh nh\u00e2n gi\u1ea3m c\u00e2n v\u00e0 tr\u00e1nh c\u00e1c ho\u1ea1t \u0111\u1ed9ng \u0111au \u0111\u1edbn. H\u1ecd c\u00f3 th\u1ec3 \u0111\u01b0a ra c\u00e1c li\u1ec7u ph\u00e1p c\u1ee5 th\u1ec3 nh\u01b0:<\/p>\n<ul>\n<li>C\u00e1c b\u00e0i t\u1eadp \u0111\u1ec3 gi\u1ea3i quy\u1ebft c\u00e1c v\u1ea5n \u0111\u1ec1 nh\u01b0 y\u1ebfu c\u01a1, c\u1ee9ng kh\u1edbp ho\u1eb7c kh\u00f3 \u0111i l\u1ea1i.<\/li>\n<li>C\u00e1c thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 (\u0111i b\u1ed9, n\u1ea1ng ho\u1eb7c g\u1eady) \u0111\u1ec3 gi\u00fap di chuy\u1ec3n v\u00e0 gi\u1ea3m tr\u1ecdng l\u01b0\u1ee3ng \u0111\u00e8 v\u00e0o kh\u1edbp \u0111au. M\u1ed9t nh\u00e0 v\u1eadt l\u00fd tr\u1ecb li\u1ec7u s\u1ebd cung c\u1ea5p c\u00e1c l\u1ef1a ch\u1ecdn ph\u00f9 h\u1ee3p nh\u1ea5t v\u00e0 d\u1ea1y cho b\u1ec7nh nh\u00e2n c\u00e1ch \u0111i b\u1ed9 v\u1edbi thi\u1ebft b\u1ecb.<\/li>\n<li>N\u1eb9p kh\u1edbp h\u1ed7 tr\u1ee3 cho c\u00e1c kh\u1edbp \u0111au \u0111\u1ec3 gi\u00fap gi\u1ea3m \u0111au trong c\u00e1c ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y<\/li>\n<li>H\u01b0\u1edbng d\u1eabn ch\u0103m s\u00f3c t\u1ea1i nh\u00e0 bao g\u1ed3m c\u00e1c b\u00e0i t\u1eadp, h\u01b0\u1edbng d\u1eabn ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t, v\u00e0 li\u1ec7u ph\u00e1p nhi\u1ec7t v\u00e0 \/ ho\u1eb7c \u0111\u00e1 l\u1ea1nh.<\/li>\n<\/ul>\n<h3><strong>AVN v\u00e0 ho\u1ea1t \u0111\u1ed9ng mang v\u00e1c<\/strong><\/h3>\n<p>Gi\u1ea3m mang v\u00e1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 ng\u0103n ng\u1eeba t\u1ed5n th\u01b0\u01a1ng kh\u1edbp, ki\u1ec3m so\u00e1t c\u01a1n \u0111au v\u00e0 cho ph\u00e9p ch\u1eefa l\u00e0nh sau khi ph\u1eabu thu\u1eadt. Tuy nhi\u00ean, nhi\u1ec1u b\u00e1c s\u0129 v\u00e0 nh\u00e0 v\u1eadt l\u00fd tr\u1ecb li\u1ec7u khuy\u00ean b\u1ec7nh nh\u00e2n n\u00ean v\u1eadn \u0111\u1ed9ng trong gi\u1edbi h\u1ea1n cho ph\u00e9p. Ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 t\u0103ng l\u01b0u th\u00f4ng, th\u00fac \u0111\u1ea9y s\u1eeda ch\u1eefa x\u01b0\u01a1ng v\u00e0 t\u0103ng c\u01b0\u1eddng c\u01a1 b\u1eafp h\u1ed7 tr\u1ee3 kh\u1edbp.<\/p>\n<p>B\u1ec7nh nh\u00e2n m\u1eafc AVN n\u00ean tr\u00e1nh c\u00e1c ho\u1ea1t \u0111\u1ed9ng v\u1eadn \u0111\u1ed9ng m\u1ea1nh nh\u01b0 ch\u1ea1y, nh\u1ea3y v\u00e0 c\u00e1c m\u00f4n th\u1ec3 thao t\u01b0\u01a1ng t\u00e1c. \u0110i\u1ec1u n\u00e0y \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb AVN n\u1eb7ng h\u01a1n \u0111\u1ec3 ng\u0103n ng\u1eeba ch\u1ea5n th\u01b0\u01a1ng v\u00e0 ti\u00eau kh\u1edbp.<\/p>\n<h3><strong>\u0110i\u1ec1u tr\u1ecb b\u1ed5 sung ho\u1eb7c t\u00edch h\u1ee3p<\/strong><\/h3>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c li\u1ec7u ph\u00e1p ch\u0103m s\u00f3c c\u01a1 th\u1ec3 nh\u01b0 xoa b\u00f3p, ch\u00e2m c\u1ee9u, ph\u1ea3n h\u1ed3i sinh h\u1ecdc v\u00e0 c\u00e1c k\u1ef9 thu\u1eadt th\u01b0 gi\u00e3n. C\u00e1c k\u1ef9 thu\u1eadt c\u1ee5 th\u1ec3 c\u00f3 th\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n ki\u1ec3m so\u00e1t c\u01a1n \u0111au, gi\u1ea3m c\u0103ng th\u1eb3ng, gi\u1ea3m c\u0103ng c\u01a1 v\u00e0 c\u1ea3i thi\u1ec7n l\u01b0u l\u01b0\u1ee3ng m\u00e1u. C\u00e1c gia \u0111\u00ecnh n\u00ean n\u00f3i chuy\u1ec7n v\u1edbi nh\u00f3m ch\u0103m s\u00f3c c\u1ee7a h\u1ecd tr\u01b0\u1edbc khi th\u1eed b\u1ea5t k\u1ef3 li\u1ec7u ph\u00e1p m\u1edbi n\u00e0o \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o n\u00f3 an to\u00e0n v\u00e0 ph\u00f9 h\u1ee3p v\u1edbi t\u1eebng b\u1ec7nh nh\u00e2n.<\/p>\n<h3><strong>\u0110i\u1ec1u ch\u1ec9nh h\u00f3a tr\u1ecb<\/strong><\/h3>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p AVN n\u1eb7ng, nh\u00f3m ch\u0103m s\u00f3c c\u00f3 th\u1ec3 \u0111\u1ec1 ngh\u1ecb thay \u0111\u1ed5i k\u1ebf ho\u1ea1ch h\u00f3a tr\u1ecb \u0111\u1ec3 gi\u1ea3m corticosteroid. Nh\u1eefng quy\u1ebft \u0111\u1ecbnh n\u00e0y ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc c\u00e2n b\u1eb1ng v\u1edbi nguy c\u01a1 \u1ea3nh h\u01b0\u1edbng \u0111\u1ebfn to\u00e0n tr\u1ea1ng b\u1ec7nh nh\u00e2n.<\/p>\n<h3><strong>Ph\u1eabu thu\u1eadt<\/strong><\/h3>\n<p>M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u1ea7n ph\u1eabu thu\u1eadt \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb AVN. Ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u00fap th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh l\u00e0nh x\u01b0\u01a1ng v\u00e0 ng\u0103n ng\u1eeba t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng n\u1eb7ng h\u01a1n. Ph\u1eabu thu\u1eadt c\u0169ng c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft \u0111\u1ec3 thay th\u1ebf kh\u1edbp. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p bao g\u1ed3m:<\/p>\n<h4><strong>Khoan gi\u1ea3m \u00e1p<\/strong><\/h4>\n<p>Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m \u00e1p l\u1ef1c b\u00ean trong x\u01b0\u01a1ng, th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh l\u00e0nh x\u01b0\u01a1ng v\u00e0 t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u. Trong khoan gi\u1ea3m \u00e1p, b\u00e1c s\u0129 ph\u1eabu thu\u1eadt khoan c\u00e1c l\u1ed7 nh\u1ecf v\u00e0o x\u01b0\u01a1ng b\u1ecb \u0111\u1ec3 ph\u00e1 v\u1ee1 c\u00e1c m\u00f4 b\u1ecb t\u1ed5n th\u01b0\u01a1ng. Sau khi m\u00f4 ch\u1ebft \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf, m\u1ed9t v\u1eadt li\u1ec7u gh\u00e9p x\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u00eam v\u00e0o \u0111\u1ec3 l\u1ea5p \u0111\u1ea7y kho\u1ea3ng tr\u1ed1ng. Ph\u1eabu thu\u1eadt n\u00e0y l\u00e0 x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u v\u00e0 s\u1eed d\u1ee5ng m\u1ed9t v\u1ebft m\u1ed5 r\u1ea5t nh\u1ecf, ph\u1ee5c h\u1ed3i sau v\u00e0i tu\u1ea7n. B\u1ec7nh nh\u00e2n th\u01b0\u1eddng h\u1ed3i ph\u1ee5c nhanh ch\u00f3ng, gi\u1ea3m \u0111au v\u00e0 ph\u1ee5c h\u1ed5i ch\u1ee9c n\u0103ng.<\/p>\n<h4><strong>Gh\u00e9p x\u01b0\u01a1ng<\/strong><\/h4>\n<p>Ph\u1eabu thu\u1eadt \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb AVN c\u00f3 th\u1ec3 bao g\u1ed3m gh\u00e9p x\u01b0\u01a1ng \u0111\u1ec3 thay th\u1ebf v\u00e0 x\u00e2y d\u1ef1ng l\u1ea1i x\u01b0\u01a1ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng. \u0110i\u1ec1u n\u00e0y li\u00ean quan \u0111\u1ebfn vi\u1ec7c c\u1ea5y gh\u00e9p m\u00f4 x\u01b0\u01a1ng kh\u1ecfe m\u1ea1nh t\u1eeb m\u1ed9t b\u1ed9 ph\u1eadn kh\u00e1c c\u1ee7a c\u01a1 th\u1ec3 (t\u1ef1 gh\u00e9p) ho\u1eb7c t\u1eeb m\u1ed9t ngu\u00f2i cho kh\u00e1c (d\u1ecb gh\u00e9p). V\u1eadt li\u1ec7u nh\u00e2n t\u1ea1o c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. N\u1ebfu s\u1ee5n b\u1ecb t\u1ed5n th\u01b0\u01a1ng, m\u1ea3nh gh\u00e9p c\u00f3 th\u1ec3 bao g\u1ed3m c\u1ea3 x\u01b0\u01a1ng v\u00e0 s\u1ee5n (gh\u00e9p x\u01b0\u01a1ng). Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, c\u00e1c m\u1ea1ch m\u00e1u \u0111\u01b0\u1ee3c c\u1ea5y gh\u00e9p c\u00f9ng v\u1edbi m\u00f4 x\u01b0\u01a1ng. \u0110\u00e2y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 gh\u00e9p x\u01b0\u01a1ng m\u1ea1ch m\u00e1u v\u00e0 c\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n vi\u1ec7c cung c\u1ea5p m\u00e1u cho kh\u1edbp. Trong AVN, gh\u00e9p x\u01b0\u01a1ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng c\u00f9ng v\u1edbi gi\u1ea3i n\u00e9n l\u00f5i.<\/p>\n<h4><strong>N\u1ed9i soi kh\u1edbp &#8211; N\u1ed9i soi kh\u1edbp<\/strong><\/h4>\n<p>L\u00e0 m\u1ed9t lo\u1ea1i ph\u1eabu thu\u1eadt x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u s\u1eed d\u1ee5ng m\u1ed9t camera nh\u1ecf v\u00e0 d\u1ee5ng c\u1ee5 ph\u1eabu thu\u1eadt nh\u1ecf \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o qua c\u00e1c v\u1ebft m\u1ed5 nh\u1ecf. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n m\u1eafc AVN, n\u1ed9i soi kh\u1edbp c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 s\u1eeda ch\u1eefa s\u1ee5n r\u00e1ch, l\u00e0m ph\u1eb3ng b\u1ec1 m\u1eb7t x\u01b0\u01a1ng ho\u1eb7c lo\u1ea1i b\u1ecf c\u00e1c m\u1ea3nh m\u00f4 l\u1ecfng l\u1ebbo trong kh\u1edbp. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 gi\u00fap \u0111\u1ee1 v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 \u0111au, c\u1ee9ng kh\u1edbp v\u00e0 ch\u1eb9n ngh\u1eb9t kh\u1edbp.<\/p>\n<h4><strong>C\u1eaft b\u1ecf x\u01b0\u01a1ng<\/strong><\/h4>\n<p>Ph\u1eabu thu\u1eadt n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u1ecbnh h\u00ecnh l\u1ea1i ho\u1eb7c \u0111\u1ecbnh v\u1ecb l\u1ea1i x\u01b0\u01a1ng \u0111\u1ec3 gi\u1ea3m tr\u1ecdng l\u01b0\u1ee3ng tr\u00ean khu v\u1ef1c b\u1ecb t\u1ed5n th\u01b0\u01a1ng. Trong ph\u01b0\u01a1ng ph\u00e1p n\u00e0y, m\u1ed9t n\u00eam x\u01b0\u01a1ng \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf \u0111\u1ec3 x\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xoay thay \u0111\u1ed5i t\u1ea3i tr\u1ecdng tr\u00ean x\u01b0\u01a1ng. C\u00e1c t\u1ea5m, ghim ho\u1eb7c \u1ed1c v\u00edt gi\u1eef x\u01b0\u01a1ng \u1edf v\u1ecb tr\u00ed m\u1edbi \u0111\u1ec3 ch\u1eefa b\u1ec7nh. C\u1eaft b\u1ecf x\u01b0\u01a1ng c\u00f3 th\u1ec3 gi\u00fap ng\u0103n ng\u1eeba s\u1ef1 ti\u00eau kh\u1edbp.<\/p>\n<h4><strong>Thay kh\u1edbp <\/strong><\/h4>\n<p>C\u00f3 th\u1ec3 c\u1ea7n ph\u1eabu thu\u1eadt thay kh\u1edbp n\u1ebfu t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng. Ph\u1eabu thu\u1eadt n\u00e0y bao g\u1ed3m lo\u1ea1i b\u1ecf x\u01b0\u01a1ng b\u1ecb h\u01b0 h\u1ecfng v\u00e0 thay th\u1ebf n\u00f3 b\u1eb1ng kh\u1edbp nh\u00e2n t\u1ea1o. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n tr\u1ebb s\u1ebd c\u1ea7n thay kh\u1edbp sau khi ti\u00eau kh\u1edbp. Tuy nhi\u00ean, thay th\u1ebf kh\u1edbp c\u0169ng ph\u1ed5 bi\u1ebfn \u1edf nh\u1eefng ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh b\u1ecb vi\u00eam kh\u1edbp ho\u1eb7c gi\u1ea3m ch\u1ee9c n\u0103ng kh\u1edbp nhi\u1ec1u n\u0103m sau khi \u0111i\u1ec1u tr\u1ecb k\u1ebft th\u00fac. B\u1ec7nh nh\u00e2n thay kh\u1edbp \u1edf tu\u1ed5i tr\u1ebb c\u00f3 th\u1ec3 s\u1ebd c\u1ea7n ph\u1eabu thu\u1eadt b\u1ed5 sung trong t\u01b0\u01a1ng lai. Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm AVN r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u00fap ng\u0103n ng\u1eeba ho\u1eb7c tr\u00ec ho\u00e3n ph\u1eabu thu\u1eadt thay kh\u1edbp.<\/p>\n<h2><strong>AVN &#8211; L\u1eddi khuy\u00ean cho b\u1ec7nh nh\u00e2n v\u00e0 gia \u0111\u00ecnh<\/strong><\/h2>\n<ul>\n<li><strong>Bi\u1ebft nguy c\u01a1 c\u1ee7a b\u1ea1n.<\/strong> N\u00f3i chuy\u1ec7n v\u1edbi nh\u00f3m ch\u0103m s\u00f3c c\u1ee7a b\u1ea1n v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ung th\u01b0 (bao g\u1ed3m c\u1ea3 li\u1ec1u nh\u1eadn \u0111\u01b0\u1ee3c) v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c.<\/li>\n<li><strong>Theo d\u00f5i c\u00e1c tri\u1ec7u ch\u1ee9ng.<\/strong> N\u00f3i v\u1edbi nh\u00f3m ch\u0103m s\u00f3c khi b\u1ea1n \u0111au ho\u1eb7c c\u00f3 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 kh\u1edbp, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng m\u1edbi ho\u1eb7c x\u1ea5u \u0111i. Sau khi \u0111i\u1ec1u tr\u1ecb, \u0111\u1ea3m b\u1ea3o s\u1ee9c kh\u1ecfe x\u01b0\u01a1ng l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a k\u1ebf ho\u1ea1ch ch\u0103m s\u00f3c s\u1ed1ng s\u00f3t c\u1ee7a b\u1ea1n.<\/li>\n<li><strong>H\u00e3y v\u1eadn \u0111\u1ed9ng t\u00edch c\u1ef1c.<\/strong> S\u1eeda \u0111\u1ed5i c\u00e1c ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t \u0111\u1ec3 gi\u1ea3m mang tr\u1ecdng l\u01b0\u1ee3ng. Tr\u00e1nh c\u00e1c ho\u1ea1t \u0111\u1ed9ng v\u1eadn \u0111\u1ed9ng m\u1ea1nh v\u00e0 th\u1ec3 thao t\u01b0\u01a1ng t\u00e1c \u0111\u1ec3 b\u1ea3o v\u1ec7 x\u01b0\u01a1ng v\u00e0 kh\u1edbp c\u1ee7a b\u1ea1n. N\u1ebfu b\u1ea1n kh\u00f4ng ch\u1eafc ch\u1eafn v\u1ec1 m\u1ed9t ho\u1ea1t \u0111\u1ed9ng n\u00e0o \u0111\u00f3, h\u00e3y h\u1ecfi b\u00e1c s\u0129 ho\u1eb7c nh\u00e0 v\u1eadt l\u00fd tr\u1ecb li\u1ec7u.<\/li>\n<li><strong>Mang gi\u00e0y h\u1ed7 tr\u1ee3 v\u00e0 s\u1eed d\u1ee5ng d\u1ee5ng c\u1ee5 ch\u1ec9nh h\u00ecnh v\u00e0 c\u00e1c thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 theo quy \u0111\u1ecbnh.<\/strong> \u0110i\u1ec1u n\u00e0y r\u1ea5t quan tr\u1ecdng, gi\u00e0y d\u00e9p ph\u00f9 h\u1ee3p c\u0169ng c\u00f3 th\u1ec3 gi\u00fap ng\u0103n ng\u1eeba t\u00e9 ng\u00e3 v\u00e0 ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp.<\/li>\n<li>\u0110\u1ed1i v\u1edbi s\u1ee9c kh\u1ecfe x\u01b0\u01a1ng v\u00e0 s\u1ee9c kh\u1ecfe n\u00f3i chung, <strong>m\u1ed9t l\u1ed1i s\u1ed1ng l\u00e0nh m\u1ea1nh<\/strong>\u00a0r\u1ea5t quan tr\u1ecdng: \u0102n m\u1ed9t ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng l\u00e0nh m\u1ea1nh, ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t, duy tr\u00ec c\u00e2n n\u1eb7ng kh\u1ecfe m\u1ea1nh v\u00e0 kh\u00f4ng h\u00fat thu\u1ed1c.<\/li>\n<\/ul>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<p class=\"simple-title\"><a href=\"https:\/\/together.stjude.org\/en-us\/diagnosis-treatment\/side-effects\/avascular-necrosis-avn-osteonecrosis.html\" target=\"_blank\" rel=\"noopener\">Avascular Necrosis (AVN) \/ Osteonecrosis<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ho\u1ea1i t\u1eed v\u00f4 m\u1ea1ch (Ho\u1ea1i t\u1eed x\u01b0\u01a1ng) l\u00e0 t\u00ecnh tr\u1ea1ng x\u01b0\u01a1ng b\u1ecb ho\u1ea1i t\u1eed v\u00ec cung c\u1ea5p m\u00e1u k\u00e9m, x\u1ea3y ra nh\u01b0 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a m\u1ed9t s\u1ed1 b\u1ec7nh ung th\u01b0 ho\u1eb7c \u0111i\u1ec1u tr\u1ecb ung th\u01b0.<\/p>\n","protected":false},"author":470,"featured_media":8522,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[3239],"tags":[3258,2489],"series":[2108],"coauthors":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.8 - 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