- Theo doi thifdng xuyen mach, HADM ap kpe TM TW vit so lifting nude til u, day la chi so danh gia b^nh nhan diityc truy&i du djch hay khfing.
4.CHAN DOAN: Chan doan sdm thtfdng d§, sd thay cac moc xtfdng, muon thi stfng ne Thtfdng thay khi trat khuyu la: cang tay d ttf the gap chifng 45 do, cang tay
Thtfdng thay khi trat khuyu la: cang tay d ttf the gap chifng 45 do, cang tay trong nhtf ngan lai, canh tay trong nhtf dai ra. Sd trtfdc nep khuyu thay bd xtfdng tron cua dau dtfdi xtfdng canh tay, sd phia sau thay mom khuyu nho ra sau, gan cd tam dau cang cling, gap khuyu nhe, tha ra co dau hieu lo xo.
Mom khuyu va hai mom tren loi cau va tren rong roc khong con quan he tam giac ma ngang nhau. Sd dtfdc chom xtfdng quay phia sau ngoai khdp.
Can kham m ach mau va than kinh: bat mach quay, mach tru d co tay, kham van dong va cam giac d dau chi.
Ve mach mau: dong mach canh tay thtfdng bi cang dan, doi khi bi chen ep co khi bi tac mach m uon do bi dap noi mac. Neu sau nan trat, mach khong binh thtfdng can mo kiem tra, c i t noi cho dap, ghep tlnh mach hien.
Ve th in kinh: co the bi mot trong 3 sdi la than kinh giUa, than kinh tru va than kinh lien cot trtfdc. D a so t h in kinh chi bi dung dap nhe, hoi phuc nhanh. Neu bi liet qua 3 thang: mo th&m do t h in kinh. Khi bi liet sau nan c in mo tham do ngay.
X quang: chup khuyu de xac dinh kieu trat va dac biet de xem co gay xUdng kem theo hay khong.
5. DIEU TRj
5.1. Dieu trj trat khdp khuyu mdi
• Vo cam: . Nan
Benh nhan n&m n gh ien g hdi sap, de kh u yu vu on g goc, th on g ban tay xuoi xuong, n&n th eo ch ieu tron g lUc. H ai ngon cai d&y m om k huyu ra trUdc, kiem tra sau n;in xem gap duoi co binh thUdng khong, khi du oi het khdp cd vCtng khong.
Sau n&n, bat dong nep bot 10 n gay roi c\i d on g sdm, k h oa n g n gay thti 7 c6
trUdng hdp bi trat lai tron g b ot do khdp k h on g vting, cd co keo.
Gay m e k h on g n ln vao dUdc la do k et khdp, bi gay xUdng noi khdp, do chen phan mem , phai m o de nan.
N ln vao kem viJng do rach phan mem nhieu, cho bat dong 3-4 tuan, sau do tap. Chu y tap duoi cho het.
5.1.1. Ket qua
Sau n&n, khuyu de bi cting khdp hdn la m at vutng, hay bi m at duoi 5-10 do.
5.1.2. Trat khdp kem gay xuong: khoang 12%
• Trat khuyu kem gay mom tren loi cau trong, m anh gay hay bi ket v&o khdp. Nan khdp xong thi c^f dong khong mem mai, cho kiem tra X quang thi thay, chi dinh m o lay bo.
• Trat khuyu kem gay mom khuyu Colton chia ra 2 kieu:
Kieu 1: gay khong lech, lech it < 2mm, kha nang duoi tot, co the duoi khuyu chong trong luc (Frenkel 3).
Kieu 2: gay di lech, bao gom: 2A: bong rdi
2B: gay ngang hay cheo 2C: gay vun
2D: gay trat
Xii tri: Gay khong lech, bo bot de khuyu 90°
Gay co lech: mo ket hdp xUdng mom khuyu theo phUdng phap H aubanage:
• Trat khuyu kem gay mom vet: chiem 10% trat khuyu Keagan chia gay mom vet thanh 3 kieu (hinh 16.3) Kieu 1: bong xUdng d dinh mom vet
Kieu 2: gay xUdng rdi ra 50% Kieu 3: gay xUdng rdi ra 50%
Hinh 16.3. Cac loai gay mom vet
Xii tri: mo co' dinh m anh gay vdi lo khau xuyen xUdng, vd manh to co dinh vdi vit.
• Trat kh u yu kem gay chom xUdng quay: tren 30% trat khuyu co kem gay chom xUdng quay.
M ason phan loai (hinh 16.4) Kieu 1: gay khong lech (adsbygoogle = window.adsbygoogle || []).push({});
Kieu 2: gay rdi mot m anh to di lech Kieu 3: gay vun chom
Kieu 4: gay kem trat chom quay
Hinh 16.4. Cac loai gay chom quay
Chi dinh chung: m anh gay di lech dtfdi 2mm dieu tri bao ton. Khi gay vun chom (kieu III) thi cat bo chom hoac thay bang chom kim loai. So con lai co gang bao ton bang ket hdp xUdng vdi vit cd be (hinh 16.5)
Hinh 16.5. Thay chom quay ho3c bat vit nho
Noi chung, trat khdp khuyu kem gay chom quay, ket qua cd nang kem
Theo Broberg: bat dong lau bi ctfng khujki. Khi thtfdng ton bo ba la trat khuyu kem gay mom vet kem gay chom quay thi thtfdng bi trat tai phat, ket qua xau.
5.2. Dieu trj trat khdp khuyu cu la trat khdp tren 3 tuan
Trat khdp khuyu cu luon luon d ttf the xau, khuyu duoi 0 do, c ln g tay m&'t chtfc nang, vi the buoc phai mo.
Mo dat lai xtfdng neu thdi gian chtfa lau (dtfdi 3 thang) hoSc lam cling khdp d
ttf the cd nang: khuyu gap 90 do, c&ng tay trung gian (trat khdp qua lau neu d§t lai khdp se bien dang d ttf the khong m ong muon).