{"id":7038,"date":"2021-09-01T10:35:38","date_gmt":"2021-09-01T03:35:38","guid":{"rendered":"https:\/\/cms.drdoan.vn\/?p=7038"},"modified":"2021-10-28T17:01:59","modified_gmt":"2021-10-28T10:01:59","slug":"keo-dai-chan-bang-dinh-noi-tuy-tu-dan-uu-nhuoc-diem-va-kha-nang-ap-dung","status":"publish","type":"post","link":"https:\/\/cms.drdoan.vn\/keo-dai-chan-bang-dinh-noi-tuy-tu-dan-uu-nhuoc-diem-va-kha-nang-ap-dung\/","title":{"rendered":"K\u00e9o d\u00e0i ch\u00e2n b\u1eb1ng \u0111inh n\u1ed9i t\u1ee7y t\u1ef1 d\u00e3n: \u01b0u nh\u01b0\u1ee3c \u0111i\u1ec3m v\u00e0 kh\u1ea3 n\u0103ng \u00e1p d\u1ee5ng"},"content":{"rendered":"\t\t
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K\u00e9o d\u00e0i ch\u00e2n b\u1eb1ng \u0111inh n\u1ed9i t\u1ee7y t\u1ef1 d\u00e3n: \u01b0u nh\u01b0\u1ee3c \u0111i\u1ec3m v\u00e0 kh\u1ea3 n\u0103ng \u00e1p d\u1ee5ng<\/strong><\/h2>

\u00a0<\/p>

V\u00e0o nh\u1eefng n\u0103m 1990, \u0111inh n\u1ed9i t\u1ee7y c\u00f3 kh\u1ea3 n\u0103ng c\u0103ng d\u00e3n<\/strong> \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 \u1ee9ng d\u1ee5ng l\u00e2m s\u00e0ng. C\u00f3 3 lo\u1ea1i l\u00e0 \u0111inh t\u1ef1 d\u00e3n: lo\u1ea1i b\u1eb1ng c\u01a1 h\u1ecdc (Albizzia v\u00e0 ISKD, Betzbone), \u0111inh t\u1ef1 d\u00e3n b\u1eb1ng m\u00f4 t\u01a1 (Fitbone) v\u00e0 \u0111inh \u0111i\u1ec1u khi\u1ec3n b\u1eb1ng t\u1eeb tr\u01b0\u1eddng (Precice, Stryde)<\/strong>. Khi k\u00e9o d\u00e0i ch\u00e2n b\u1eb1ng lo\u1ea1i \u0111inh n\u00e0y, b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3i mang khung c\u1ed1 \u0111\u1ecbnh ngo\u00e0i n\u00ean tr\u00e1nh \u0111\u01b0\u1ee3c c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 phi\u1ec1n to\u00e1i do khung c\u1ed1 \u0111\u1ecbnh ngo\u00e0i g\u00e2y ra, r\u1ea5t thu\u1eadn l\u1ee3i \u0111\u1ec3 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng, s\u1eb9o m\u1ed5 th\u1ea9m m\u1ef9 h\u01a1n…Tuy nhi\u00ean, \u0111inh n\u1ed9i t\u1ee7y t\u1ef1 d\u00e3n v\u1eabn c\u00f2n nhi\u1ec1u nh\u01b0\u1ee3c \u0111i\u1ec3m c\u1ea7n nghi\u00ean c\u1ee9u v\u00e0 kh\u1eafc ph\u1ee5c.<\/p>

1. \u0110inh Albizzia<\/strong> \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 k\u00e9o d\u00e0i \u0111\u00f9i, \u0111\u01b0\u1eddng k\u00ednh 11-15 mm, d\u00e0i 24-32 cm, kh\u1ea3 n\u0103ng c\u0103ng d\u00e3n t\u1eeb 6-10 cm. B\u1ec7nh nh\u00e2n t\u1ef1 c\u0103ng d\u00e3n b\u1eb1ng c\u00e1ch xoay trong v\u00e0 ngo\u00e0i c\u1eb3ng ch\u00e2n so v\u1edbi \u0111\u00f9i, c\u1ee9 15 l\u1ea7n xoay s\u1ebd c\u0103ng d\u00e3n \u0111\u01b0\u1ee3c 1 mm. Tuy nhi\u00ean, nhi\u1ec1u b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n \u0111au nhi\u1ec1u khi c\u0103ng d\u00e3n. Garcia-Cimbrelo b\u00e1o c\u00e1o g\u1eb7p 5\/24 BN \u0111au r\u1ea5t nhi\u1ec1u khi xoay ch\u00e2n \u0111\u1ec3 c\u0103ng d\u00e3n v\u00e0 4\/24 b\u1ec7nh nh\u00e2n ph\u1ea3i ng\u1eebng c\u0103ng d\u00e3n do \u0111au. Guichet J.M. th\u00ec g\u1eb7p 13\/41 BN c\u1ea7n v\u00e0i l\u1ea7n g\u00e2y m\u00ea \u0111\u1ec3 c\u0103ng d\u00e3n. V\u00ec v\u1eady, hi\u1ec7n nay \u0111inh n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng.<\/p>

\u0110inh ISKD<\/strong> (Intramedullary Skeletal Kinetic Distractor) l\u00e0 \u0111inh \u0111\u01b0\u1ee3c c\u1ea3i ti\u1ebfn t\u1eeb \u0111inh Albizzia. \u0110inh c\u00f3 \u0111\u01b0\u1eddng k\u00ednh 10,5-14,5 mm, c\u00f3 c\u01a1 ch\u1ebf c\u0103ng d\u00e3n t\u01b0\u01a1ng t\u1ef1 \u0111inh Albizzia, nh\u01b0ng ch\u1ec9 c\u1ea7n xoay ch\u00e2n 30 \u0111\u1ed9, n\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f2n \u0111au nhi\u1ec1u khi c\u0103ng d\u00e3n nh\u01b0 khi k\u00e9o d\u00e0i ch\u00e2n b\u1eb1ng \u0111inh Albizzia. \u0110inh c\u00f3 th\u1ec3 c\u0103ng d\u00e3n 5-8cm. Cole J.D \u0111\u00e3 k\u00e9o d\u00e0i cho 16 x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 14 x\u01b0\u01a1ng ch\u00e0y v\u1edbi m\u1ee9c k\u00e9o d\u00e0i trung b\u00ecnh 4,9 cm. T\u1ed1c \u0111\u1ed9 c\u0103ng d\u00e3n trung b\u00ecnh 0,82 mm\/ng\u00e0y (0,4-1,7 mm\/ng\u00e0y). Kh\u00f4ng g\u1eb7p nhi\u1ec5m khu\u1ea9n, li\u1ec1n l\u1ec7ch, kh\u00f4ng li\u1ec1n x\u01b0\u01a1ng, h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp, nh\u01b0ng c\u00f3 2 b\u1ec7nh nh\u00e2n b\u1ecb g\u00e3y \u0111inh khi c\u0103ng d\u00e3n v\u00e0 ph\u1ea3i thay \u0111inh. V\u00ec b\u1ec7nh nh\u00e2n ch\u1ec9 c\u1ea7n xoay ch\u00e2n 30 \u0111\u1ed9 l\u00e0 c\u0103ng d\u00e3n \u0111\u01b0\u1ee3c, n\u00ean \u0111inh c\u00f3 nh\u01b0\u1ee3c \u0111i\u1ec3m l\u00e0 kh\u00f3 ki\u1ec3m so\u00e1t t\u1ed1c \u0111\u1ed9 c\u0103ng d\u00e3n. Kenawey M. th\u00ec l\u1ea1i g\u1eb7p 1\/37 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u0103ng d\u00e3n \u0111\u01b0\u1ee3c \u1ed5 c\u1eaft x\u01b0\u01a1ng, 8\/37 b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed1c \u0111\u1ed9 c\u0103ng d\u00e3n l\u1edbn h\u01a1n d\u1ef1 \u0111\u1ecbnh n\u00ean b\u1ecb ch\u1eadm li\u1ec1n x\u01b0\u01a1ng. Schieldel F.M. th\u1ea5y, t\u00ecnh tr\u1ea1ng c\u0103ng d\u00e3n ph\u1ee5 thu\u1ed9c v\u00e0o ho\u1ea1t \u0111\u1ed9ng v\u00e0 m\u1ee9c ch\u1ecbu \u0111\u1ef1ng \u0111au c\u1ee7a b\u1ec7nh nh\u00e2n. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ph\u1ea3i b\u1eaft \u0111\u1ea7u qu\u00e1 tr\u00ecnh c\u0103ng d\u00e3n d\u01b0\u1edbi v\u00f4 c\u1ea3m, 18% kh\u00f4ng \u0111\u1ea1t chi\u1ec1u d\u00e0i c\u0103ng d\u00e3n nh\u01b0 d\u1ef1 \u0111\u1ecbnh, 36% \u00a0b\u1ecb g\u00e3y \u0111inh ho\u1eb7c \u0111inh kh\u00f4ng c\u0103ng d\u00e3n \u0111\u01b0\u1ee3c, 8 b\u1ec7nh nh\u00e2n c\u00f3 can x\u01b0\u01a1ng k\u00e9m. Mahboubian S. th\u1ea5y vi\u1ec7c ki\u1ec3m so\u00e1t c\u0103ng d\u00e3n kh\u00f3 kh\u0103n h\u01a1n v\u00e0 t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng c\u1ea7n can thi\u1ec7p ph\u1eabu thu\u1eadt l\u1ea1i cao h\u01a1n so v\u1edbi k\u00e9o d\u00e0i ch\u00e2n b\u1eb1ng khung c\u1ed1 \u0111\u1ecbnh ngo\u00e0i k\u1ebft h\u1ee3p \u0111inh n\u1ed9i t\u1ee7y.<\/p>

2. \u0110inh Fitbone<\/strong> l\u00e0 \u0111inh n\u1ed9i t\u1ee7y c\u0103ng d\u00e3n x\u01b0\u01a1ng b\u1eb1ng m\u00f4 t\u01a1. B\u1ec7nh nh\u00e2n \u0111i\u1ec1u khi\u1ec3n m\u00f4 t\u01a1 qua h\u1ec7 th\u1ed1ng nh\u1eadn v\u00e0 d\u1eabn truy\u1ec1n t\u00edn hi\u1ec7u \u0111\u01b0\u1ee3c \u0111\u1eb7t d\u01b0\u1edbi da. \u0110inh c\u00f3 \u0111\u01b0\u1eddng k\u00ednh 11-13 mm, c\u00f3 th\u1ec3 k\u00e9o d\u00e0i x\u01b0\u01a1ng \u0111\u00f9i 8,5 cm v\u00e0 x\u01b0\u01a1ng ch\u00e0y 6 cm. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng \u0111\u00e3 cho th\u1ea5y t\u1ef7 l\u1ec7 tin c\u1eady v\u00e0 th\u00e0nh c\u00f4ng cao h\u01a1n khi s\u1eed d\u1ee5ng \u0111inh Fitbone trong k\u00e9o d\u00e0i ch\u00e2n. Tuy nhi\u00ean, v\u1eabn c\u00f3 bi\u1ebfn ch\u1ee9ng k\u1eb9t \u0111inh, g\u00e3y \u0111inh, h\u1ecfng m\u00f4 t\u01a1, ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i chi, gi\u00e1 c\u1ee7a \u0111inh c\u00f2n \u0111\u1eaft… Theo Singh S. \u0111\u00e3 b\u00e1o c\u00e1o th\u1ef1c hi\u1ec7n k\u00e9o d\u00e0i 13 x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 11 x\u01b0\u01a1ng ch\u00e0y v\u1edbi m\u1ee9c k\u00e9o trung b\u00ecnh l\u00e0 4cm. Th\u1eddi gian li\u1ec1n x\u01b0\u01a1ng trung b\u00ecnh l\u00e0 35 ng\u00e0y\/cm. Tuy nhi\u00ean, c\u00f3 2 b\u1ec7nh nh\u00e2n ph\u1ea3i thay \u0111inh Fitbone l\u1edbn h\u01a1n, v\u00ec m\u00f4 t\u01a1 kh\u00f4ng c\u0103ng d\u00e3n \u0111\u01b0\u1ee3c x\u01b0\u01a1ng, 2 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u0103ng d\u00e3n \u0111\u1ee7 chi\u1ec1u d\u00e0i nh\u01b0 d\u1ef1 ki\u1ebfn; 3 x\u01b0\u01a1ng ch\u00e0y ch\u1eadm li\u1ec1n x\u01b0\u01a1ng n\u00ean ph\u1ea3i gh\u00e9p x\u01b0\u01a1ng v\u00e0 1 b\u1ec7nh nh\u00e2n ph\u1ea3i thay \u0111inh; 1 BN c\u00f3 ch\u00eanh l\u1ec7ch chi\u1ec1u d\u00e0i chi d\u01b0\u1edbi 1 cm sau k\u00e9o d\u00e0i 2 ch\u00e2n. N\u0103m 2006, Krieg A.H. k\u00e9o d\u00e0i 6 x\u01b0\u01a1ng \u0111\u00f9i v\u00e0 2 x\u01b0\u01a1ng ch\u00e0y cho 8 b\u1ec7nh nh\u00e2n, v\u1edbi m\u1ee9c k\u00e9o t\u1eeb 2,9 – 4,7 cm. Th\u1eddi gian li\u1ec1n x\u01b0\u01a1ng trung b\u00ecnh l\u00e0 26 ng\u00e0y\/cm. Tuy nhi\u00ean, 1 \u0111inh b\u1ecb k\u1eb9t, 1 \u0111inh b\u1ecb g\u00e3y.<\/p>

\u0110inh Betzbone (\u0110\u1ee9c), l\u00e0 \u0111inh n\u1ed9i t\u1ee7y t\u1ef1 d\u00e3n theo ph\u01b0\u01a1ng ph\u00e1p c\u01a1 h\u1ecdc, \u0111inh n\u00e0y c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb \u0111inh Fitbone, nh\u01b0ng \u0111\u00e3 c\u1ea3i ti\u1ebfn lo\u1ea1i b\u1ecf c\u00e1c nh\u01b0\u1ee3c \u0111i\u1ec3m v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng th\u00e9p v\u00e0 c\u1ea5u h\u00ecnh, vi\u1ec7c v\u1eadn h\u00e0nh \u0111\u01a1n gi\u1ea3n, \u0111inh kh\u1ecfe, \u0111\u1ee7 kh\u1ea3 n\u0103ng ch\u1ecbu l\u1ef1c to\u00e0n b\u1ed9 c\u01a1 th\u1ec3 ngay sau khi ph\u1eabu thu\u1eadt, v\u00ec v\u1eadn h\u00e0nh b\u1eb1ng c\u01a1 h\u1ecdc n\u00ean c\u00f3 th\u1ec3 s\u1ea3n xu\u1ea5t \u0111inh k\u00edch th\u01b0\u1edbc nh\u1ecf 9mm (ri\u00eang \u0111inh n\u00e0y, \u0111\u01b0\u1eddng k\u00ednh \u1ed1ng t\u1ee7y bao nhi\u00eau th\u00ec \u0111\u00f3ng \u0111inh s\u1ed1 \u0111\u00f3, kh\u00f4ng c\u1ea7n khoan r\u1ed9ng h\u01a1n). \u0110\u1eb7c bi\u1ec7t l\u00e0 \u0111inh n\u00e0y c\u00f3 th\u1ec3 k\u00e9o d\u00e0i t\u1eeb 10 \u2013 12cm \u1edf \u0111\u00f9i, 8 \u2013 10cm \u1edf c\u1eb3ng ch\u00e2n. Hi\u1ec7n \u0111inh n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u nh\u1ea5t \u1edf \u0110\u1ee9c v\u00e0 ch\u00e2n \u00c2u. Nh\u01b0 v\u1eady, \u0111inh n\u00e0y kh\u00e1 ph\u00f9 h\u1ee3p v\u1edbi k\u00edch th\u01b0\u1edbc c\u1ee7a \u0111a s\u1ed1 ng\u01b0\u1eddi Vi\u1ec7t Nam.<\/p>

3. \u0110inh \u0111i\u1ec1u khi\u1ec3n b\u1eb1ng t\u1eeb tr\u01b0\u1eddng (Precice, Stryde):<\/strong> N\u0103m 2011, \u0111inh Precice c\u1ee7a M\u1ef9 b\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 k\u00e9o d\u00e0i ch\u00e2n. \u0110inh Precise c\u00f3 th\u1ec3 c\u0103ng d\u00e3n v\u00e0 n\u00e9n \u00e9p d\u01b0\u1edbi s\u1ef1 ki\u1ec3m so\u00e1t c\u1ee7a b\u1ed9 ph\u1eadn \u0111i\u1ec1u khi\u1ec3n b\u00ean ngo\u00e0i b\u1eb1ng t\u1eeb tr\u01b0\u1eddng; t\u1ed1c \u0111\u1ed9 c\u0103ng d\u00e3n \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t h\u01a1n. Tuy nhi\u00ean, \u0111inh n\u00e0y v\u1eabn t\u1ed3n t\u1ea1i nhi\u1ec1u nh\u01b0\u1ee3c \u0111i\u1ec3m. \u0110inh Precise th\u1ebf h\u1ec7 1 c\u00f3 \u0111\u01b0\u1eddng k\u00ednh nh\u1ecf nh\u1ea5t l\u00e0 10,7 mm, th\u1ebf h\u1ec7 2 (ra \u0111\u1eddi n\u0103m 2013) c\u00f3 lo\u1ea1i c\u00f3 \u0111\u01b0\u1eddng k\u00ednh 8,5 mm. Kh\u1ea3 n\u0103ng c\u0103ng d\u00e3n t\u1eeb 5 – 8 cm. \u0110i\u1ec3m \u0111\u1eb7c bi\u1ec7t ch\u00fa \u00fd l\u00e0, \u1ed1ng t\u1ee7y ph\u1ea3i \u0111\u01b0\u1ee3c khoan r\u1ed9ng h\u01a1n \u0111\u01b0\u1eddng k\u00ednh c\u1ee7a \u0111inh \u00edt nh\u1ea5t 2 mm (\u0111\u00e2y l\u00e0 \u0111i\u1ec3m m\u1ea5u ch\u1ed1t kh\u00e1 kh\u00f3 \u00e1p d\u1ee5ng cho nh\u1eefng ng\u01b0\u1eddi c\u00f3 t\u1ea7m v\u00f3c th\u1ea5p \u1edf Vi\u1ec7t Nam, trung b\u00ecnh ng\u01b0\u1eddi Vi\u1ec7t nam b\u00ecnh th\u01b0\u1eddng c\u00f3 \u0111\u01b0\u1eddng k\u00ednh x\u01b0\u01a1ng \u0111\u00f9i ch\u1ee7 y\u1ebfu t\u1eeb 9 \u2013 10mm, x\u01b0\u01a1ng ch\u00e0y 8 \u2013 9mm). B\u1ed9 ph\u1eadn \u0111i\u1ec1u ch\u1ec9nh b\u00ean ngo\u00e0i c\u00f3 t\u1eeb tr\u01b0\u1eddng m\u1ea1nh v\u00e0 ch\u1ec9 \u0111\u01b0\u1ee3c FDA cho ph\u00e9p s\u1eed d\u1ee5ng t\u1ea1i c\u01a1 s\u1edf y t\u1ebf, n\u00ean phi\u1ec1n to\u00e1i l\u00e0 b\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u1ebfn b\u1ec7nh vi\u1ec7n h\u00e0ng ng\u00e0y \u0111\u1ec3 c\u0103ng d\u00e3n ho\u1eb7c ph\u1ea3i \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa trong su\u1ed1t qu\u00e1 tr\u00ecnh c\u0103ng d\u00e3n. \u0110inh n\u00e0y c\u0169ng nh\u01b0 c\u00e1c \u0111inh t\u1ef1 d\u00e3n kh\u00e1c, l\u00e0 nguy c\u01a1 b\u1ecb g\u00e3y khi t\u00ec n\u00e9n to\u00e0n b\u1ed9 c\u01a1 th\u1ec3. K\u1ec3 c\u1ea3 khi ng\u1eebng c\u0103ng d\u00e3n, b\u1ec7nh nh\u00e2n ch\u1ec9 \u0111\u01b0\u1ee3c t\u00ec n\u00e9n t\u1ed1i \u0111a 22kg v\u1edbi \u0111inh \u0111\u01b0\u1eddng k\u00ednh 8,5 mm v\u00e0 10,7 mm, v\u00e0 34kg v\u1edbi \u0111inh c\u00f3 \u0111\u01b0\u1eddng k\u00ednh 12,5 mm; ch\u1ec9 khi c\u00f3 bi\u1ec3u hi\u1ec7n li\u1ec1n x\u01b0\u01a1ng tr\u00ean Xquang m\u1edbi \u0111\u01b0\u1ee3c t\u1ef3 n\u00e9n t\u0103ng d\u1ea7n. N\u0103m 2013, Harris M., Paley D. B\u00e1o c\u00e1o \u0111\u00e3 k\u00e9o d\u00e0i ch\u00e2n n\u00e2ng chi\u1ec1u cao cho 17 b\u1ec7nh nh\u00e2n, v\u1edbi m\u1ee9c k\u00e9o d\u00e0i t\u1eeb 2,7 – 6,5 cm. T\u1ed1c \u0111\u1ed9 c\u0103ng d\u00e3n t\u1eeb 0,53 – 1,11 mm\/ng\u00e0y. Tuy nhi\u00ean, c\u00f3 3 \u0111inh b\u1ecb g\u00e3y v\u00e0 6 \u0111inh h\u1ecfng b\u1ed9 ph\u1eadn c\u0103ng d\u00e3n, 1 c\u1eb3ng ch\u00e2n b\u1ecb ch\u00e8n \u00e9p khoang, 4 c\u1eb3ng ch\u00e2n ph\u1ea3i ph\u1eabu thu\u1eadt can thi\u1ec7p ph\u1ea7n m\u1ec1m.<\/p>

N\u0103m 2016, Wiebking U. b\u00e1o c\u00e1o k\u1ebft qu\u1ea3 s\u1eed d\u1ee5ng \u0111inh Precice \u0111\u1ec3 k\u00e9o d\u00e0i cho 9 b\u1ec7nh nh\u00e2n (4 x\u01b0\u01a1ng \u0111\u00f9i, 3 x\u01b0\u01a1ng ch\u00e0y) \u1edf B\u1ec7nh vi\u1ec7n Tr\u01b0\u1eddng \u0111\u1ea1i h\u1ecdc y Hannover, tu\u1ed5i trung b\u00ecnh l\u00e0 32 tu\u1ed5i, \u1ed5 k\u00e9o d\u00e0i trung b\u00ecnh l\u00e0 3,5cm, k\u1ebft qu\u1ea3 l\u00e0 c\u00f3 2 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng li\u1ec1n x\u01b0\u01a1ng, 1 tr\u01b0\u1eddng h\u1ee3p b\u1ecb g\u00e3y \u0111inh ph\u1ea3i thay \u0111inh kh\u00e1c.<\/p>

N\u0103m 2019, Calder P.R. v\u00e0 c\u1ed9ng s\u1ef1 \u1edf b\u1ec7nh vi\u1ec7n ch\u1ec9nh h\u00ecnh qu\u1ed1c gia Stanmore, Ho\u00e0ng gia Anh c\u00f3 t\u1ed5ng k\u1ebft 107 \u1ed5 k\u00e9o d\u00e0i x\u01b0\u01a1ng \u0111\u00f9i, \u1edf 92 b\u1ec7nh nh\u00e2n. Trong \u0111\u00f3, c\u00f3 73 ch\u00e2n \u0111\u00f3ng \u0111inh t\u1eeb tr\u00ean xu\u1ed1ng (k\u00e9o \u0111\u01b0\u1ee3c trung b\u00ecnh 4,65cm), 34 ch\u00e2n \u0111\u00f3ng \u0111inh t\u1eeb d\u01b0\u1edbi l\u00ean (k\u00e9o \u0111\u01b0\u1ee3c trung b\u00ecnh 4,64cm). C\u00f3 100 \u1ed5 k\u00e9o li\u1ec1n x\u01b0\u01a1ng, th\u1eddi gian li\u1ec1n x\u01b0\u01a1ng trung b\u00ecnh l\u00e0 31,6 ng\u00e0y\/cm. Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t k\u1ebft qu\u1ea3 gi\u1eefa 2 nh\u00f3m, nh\u01b0ng t\u1ef7 l\u1ec7 c\u00e1c b\u1ec7nh nh\u00e2n n\u1eef b\u1ecb h\u1ea1n ch\u1ebf kh\u1edbp h\u00e1ng v\u00e0 kh\u1edbp g\u1ed1i trong v\u00e0 sau khi ho\u00e0n th\u00e0nh k\u00e9o d\u00e0i cao h\u01a1n so v\u1edbi nam gi\u1edbi. M\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng x\u1ea3y ra nh\u01b0: 3 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng li\u1ec1n x\u01b0\u01a1ng, 5 tr\u01b0\u1eddng h\u1ee3p ph\u1ea3i ph\u1eabu thu\u1eadt b\u1ed5 sung \u0111\u1ec3 n\u1edbi d\u00e0i g\u00e2n c\u01a1 \u0111\u00f9i \u0111\u1ec3 c\u1ea3i thi\u1ec7n g\u1ea5p g\u1ed1i. C\u00f3 m\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng nh\u1ecf nh\u01b0 cong ch\u1ed1t ngang, cong \u0111inh nh\u01b0ng kh\u00f4ng \u1ea3nh h\u01b0\u1edfng t\u1edbi qu\u00e1 tr\u00ecnh k\u00e9o d\u00e0i ch\u00e2n.<\/p>

D\u00f9 v\u1eady, \u0111inh Precice c\u00f3 nh\u01b0\u1ee3c \u0111i\u1ec3m r\u1ea5t l\u1edbn l\u00e0 sau m\u1ed5 kh\u00f4ng th\u1ec3 t\u1ef3 n\u00e9n \u0111\u01b0\u1ee3c to\u00e0n b\u1ed9 c\u01a1 th\u1ec3, do \u0111inh y\u1ebfu, nguy c\u01a1 cong v\u00e0 k\u1eb9t \u0111inh r\u1ea5t cao. Do \u0111\u00f3, \u0111\u1ebfn n\u0103m 2018, m\u1ed9t th\u1ebf h\u1ec7 \u0111inh m\u1edbi kh\u1eafc ph\u1ee5c nh\u01b0\u1ee3c \u0111i\u1ec3m c\u1ee7a \u0111inh Precice ra \u0111\u1eddi c\u00f3 t\u00ean l\u00e0 \u0111inh Stryde, \u0111inh n\u00e0y thay th\u1ebf \u0111inh Precice, do c\u00f3 \u01b0u \u0111i\u1ec3m l\u00e0 kh\u1ecfe h\u01a1n. C\u00f3 3 c\u1ee1 \u0111\u01b0\u1eddng k\u00ednh l\u00e0 10mm, 11,5mm v\u00e0 13mm t\u01b0\u01a1ng \u1ee9ng kh\u1ea3 n\u0103ng ch\u1ecbu \u0111\u1ef1ng \u0111\u01b0\u1ee3c 68kg, 91kg v\u00e0 114kg, ca m\u1ed5 \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00e0o th\u00e1ng 5\/2018.<\/p>

T\u1eeb 5\/2018 \u0111\u1ebfn 10\/2019, \u00a0Robbin C. v\u00e0 Paley D. (3\/2020) \u0111\u00e3 b\u00e1o c\u00e1o k\u1ebft qu\u1ea3 s\u1eed d\u1ee5ng \u0111inh n\u00e0y k\u00e9o d\u00e0i cho 106 b\u1ec7nh nh\u00e2n v\u1edbi 187 ch\u00e2n. Trong \u0111\u00f3, 57 b\u1ec7nh nh\u00e2n k\u00e9o d\u00e0i 2 ch\u00e2n n\u00e2ng chi\u1ec1u cao (k\u00e9o \u0111\u00f9i 41 ca, k\u00e9o c\u1eb3ng ch\u00e2n 4 ca, k\u00e9o \u0111\u1ed3ng th\u1eddi c\u1ea3 \u0111\u00f9i v\u00e0 c\u1eb3ng ch\u00e2n 12 ca), 49 b\u1ec7nh nh\u00e2n k\u00e9o d\u00e0i do ch\u1ec7nh l\u1ec7ch 2 ch\u00e2n (37 x\u01b0\u01a1ng \u0111\u00f9i, 12 x\u01b0\u01a1ng ch\u00e0y). C\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ec1u cho t\u1ef3 n\u00e9n ho\u00e0n to\u00e0n sau m\u1ed5, tr\u1eeb 12 tr\u01b0\u1eddng h\u1ee3p k\u00e9o d\u00e0i \u0111\u1ed3ng th\u1eddi c\u1ea3 x\u01b0\u01a1ng ch\u00e0y v\u00e0 x\u01b0\u01a1ng \u0111\u00f9i. K\u1ebft qu\u1ea3 l\u00e0, ch\u1ec9 c\u00f3 1 tr\u01b0\u1eddng h\u1ee3p b\u1ecb h\u1ecfng do k\u1eb9t \u0111inh kh\u00f4ng c\u0103ng d\u00e3n \u0111\u01b0\u1ee3c, ph\u1ea3i thay b\u1eb1ng \u0111inh kh\u00e1c. T\u1ea5t c\u1ea3 c\u00e1c p\u1ed5 k\u00e9o d\u00e0i x\u01b0\u01a1ng \u0111\u1ec1u li\u1ec1n t\u1ed1t, kh\u00f4ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p n\u00e0o kh\u00f4ng li\u1ec1n x\u01b0\u01a1ng ph\u1ea3i gh\u00e9p th\u00eam x\u01b0\u01a1ng. Nh\u01b0 v\u1eady, \u0111\u00e2y l\u00e0 k\u1ebft qu\u1ea3 r\u1ea5t t\u1ed1t, tuy nhi\u00ean, ch\u1ea5t li\u1ec7u \u0111\u1ec3 s\u1ea3n xu\u1ea5t \u0111inh b\u1eb1ng v\u1eadt li\u1ec7u l\u00e0 Biodur 108, hi\u1ec7n \u0111ang c\u1ea7n ph\u1ea3i \u0111\u00e1nh gi\u00e1 l\u1ea1i, h\u01a1n n\u1eefa, \u0111inh n\u00e0y ch\u1ec9 c\u00f3 3 c\u1ee1 s\u1ed1, c\u1ee1 b\u00e9 nh\u1ea5t l\u00e0 10mm – \u0111\u1ec3 \u0111\u00f3ng \u0111\u01b0\u1ee3c \u0111inh n\u00e0y th\u00ec \u0111\u01b0\u1eddng k\u00ednh \u1ed1ng t\u1ee7y ph\u1ea3i 12mm (trung b\u00ecnh \u0111\u01b0\u1eddng k\u00ednh \u1ed1ng t\u1ee7y ng\u01b0\u1eddi Vi\u1ec7t nam t\u1eeb 10 \u0111\u1ebfn 11mm, n\u00ean kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi \u0111\u1ea1i \u0111a s\u1ed1 ng\u01b0\u1eddi Vi\u1ec7t nam).<\/p>

Nh\u01b0 v\u1eady, vi\u1ec7c s\u1eed d\u1ee5ng \u0111inh Precice, Stryde l\u00e0 m\u1ed9t xu h\u01b0\u1edbng v\u1eabn \u0111ang \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u00e1p d\u1ee5ng, c\u00e1c \u0111inh n\u00e0y ch\u01b0a \u00e1p d\u1ee5ng r\u1ed9ng r\u00e3i \u0111\u01b0\u1ee3c, t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng c\u0169ng c\u00f2n kh\u00e1 cao, \u0111inh y\u1ebfu, th\u1eddi gian \u0111i l\u1ea1i tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng l\u00e2u (\u0111inh Precice), \u0111inh Stryde th\u00ec kh\u1ecfe, \u0111i l\u1ea1i s\u1edbm sau m\u1ed5 \u0111\u01b0\u1ee3c, nh\u01b0ng kh\u00f4ng c\u00f3 k\u00edch th\u01b0\u1edbc ph\u00f9 h\u1ee3p v\u1edbi th\u1ec3 tr\u1ea1ng ng\u01b0\u1eddi Vi\u1ec7t Nam. C\u1ea3 \u0111inh Precice v\u00e0 \u0111inh Stryde\u00a0 l\u1ea1i \u0111\u1ec1u c\u00f3 m\u1ee9c k\u00e9o d\u00e0i h\u1ea1n ch\u1ebf, ch\u1ec9 k\u00e9o d\u00e0i \u0111\u01b0\u1ee3c t\u1ed1i \u0111a l\u00e0 5cm (lo\u1ea1i 10mm), 6,5cm (lo\u1ea1i 11mm) v\u00e0 8cm (lo\u1ea1i 13mm). \u0110\u1eb7c bi\u1ec7t l\u00e0 gi\u00e1 th\u00e0nh kh\u00e1 \u0111\u1eaft, trung b\u00ecnh chi ph\u00ed 1 ca m\u1ed5 s\u1eed d\u1ee5ng \u0111inh Precice, Stryde \u0111\u1ec3 k\u00e9o d\u00e0i ch\u00e2n \u1edf M\u1ef9, Ch\u00e2u \u00c2u chi ph\u00ed h\u1ebft 95.000 – 105.000 USD, \u1edf H\u00e0n Qu\u1ed1c l\u00e0 70.000 USD (ch\u01b0a k\u1ec3 chi ph\u00ed \u0103n, \u1edf, \u0111i l\u1ea1i trong th\u1eddi gian ngo\u1ea1i tr\u00fa). Hi\u1ec7n nay, \u0111inh n\u00e0y c\u0169ng ch\u01b0a ph\u00e2n ph\u1ed1i \u1edf c\u00e1c n\u01b0\u1edbc \u0110\u00f4ng Nam \u00c1.<\/p>

T\u00f3m l\u1ea1i, k\u00e9o d\u00e0i ch\u00e2n b\u1eb1ng khung c\u1ed1 \u0111\u1ecbnh ngo\u00e0i k\u1ebft h\u1ee3p v\u1edbi \u0111inh n\u1ed9i t\u1ee7y b\u00ean trong, m\u1eb7c d\u00f9 c\u00f3 phi\u1ec1n to\u00e1i khi mang khung do v\u01b0\u1edbng v\u00edu, c\u00f3 nguy c\u01a1 nhi\u1ec5m tr\u00f9ng ch\u00e2n \u0111inh, n\u00ean ph\u1ea3i ch\u0103m s\u00f3c ch\u00e2n \u0111inh, nhi\u1ec1u s\u1eb9o h\u01a1n v\u00e0 ch\u1ec9 \u00e1p d\u1ee5ng cho k\u00e9o d\u00e0i \u1edf c\u1eb3ng ch\u00e2n. Nh\u01b0ng c\u0169ng c\u00f3 kh\u1ea3 n\u0103ng k\u00e9o d\u00e0i \u0111\u01b0\u1ee3c nhi\u1ec1u<\/strong>, t\u1ef7 l\u1ec7 li\u1ec1n x\u01b0\u01a1ng cao<\/strong>, \u0111i l\u1ea1i t\u1ef3 n\u00e9n s\u1edbm h\u01a1n<\/strong> do s\u1eed d\u1ee5ng \u0111inh b\u00ean trong \u0111\u1eb7c, kh\u1ecfe h\u01a1n, n\u00ean ch\u00fang t\u00f4i ch\u01b0a g\u1eb7p ca n\u00e0o b\u1ecb g\u00e3y \u0111inh, gi\u00e1 th\u00e0nh h\u1ee3p l\u00fd<\/strong> v\u1edbi \u0111\u1ea1i \u0111a s\u1ed1 ng\u01b0\u1eddi Vi\u1ec7t Nam, r\u1ebb ch\u1ec9 b\u1eb1ng 1\/10 so v\u1edbi \u0111inh t\u1ef1 gi\u00e3n th\u1ef1c hi\u1ec7n \u1edf ng\u01b0\u1edbc ngo\u00e0i.<\/p>

Khi s\u1eed d\u1ee5ng \u0111inh t\u1ef1 d\u00e3n c\u00f3 \u01b0u \u0111i\u1ec3m<\/strong> l\u00e0, c\u00f3 th\u1ec3 k\u00e9o \u0111\u01b0\u1ee3c c\u1ea3 \u0111\u00f9i v\u00e0 c\u1eb3ng ch\u00e2n, trong qu\u00e1 tr\u00ecnh k\u00e9o, b\u1ec7nh nh\u00e2n sinh ho\u1ea1t tho\u1ea3i m\u00e1i h\u01a1n, t\u1eadp ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng thu\u1eadn l\u1ee3i, tr\u00e1nh \u0111\u01b0\u1ee3c c\u00e1c bi\u1ebfn ch\u1ee9ng do khung c\u1ed1 \u0111\u1ecbnh ngo\u00e0i, s\u1eb9o m\u1ed5 th\u1ea9m m\u1ef9 h\u01a1n. Tuy nhi\u00ean, v\u1eabn c\u00f3 t\u1ef7 l\u1ec7 nh\u1ecf k\u1eb9t \u0111inh, h\u01a1n n\u1eefa \u0111inh c\u00f3 gi\u00e1 th\u00e0nh \u0111\u1eaft, m\u1ee9c \u0111\u1ed9 k\u00e9o d\u00e0i h\u1ea1n ch\u1ebf (t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 8cm), \u0111a s\u1ed1 c\u00e1c \u0111inh n\u00e0y l\u1ea1i c\u00f3 \u0111\u01b0\u1eddng k\u00ednh l\u1edbn, l\u1edbn h\u01a1n so v\u1edbi \u1ed1ng t\u1ee7y x\u01b0\u01a1ng ch\u00e0y v\u00e0 x\u01b0\u01a1ng \u0111\u00f9i c\u1ee7a ng\u01b0\u1eddi Vi\u1ec7t Nam, nh\u1eefng ng\u01b0\u1eddi c\u00f3 t\u1ea7m v\u00f3c th\u1ea5p (tr\u1eeb \u0111inh Betzbone). V\u00ec v\u1eady, hi\u1ec7n nay lo\u1ea1i \u0111inh n\u00e0y ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf m\u1ed9t s\u1ed1 n\u01b0\u1edbc ph\u00e1t tri\u1ec3n Ch\u00e2n \u00c2u v\u00e0 B\u1eafc M\u1ef9. Qua t\u00ecm hi\u1ec3u v\u00e0 \u0111\u00e1nh gi\u00e1, ch\u00fang t\u00f4i th\u1ea5y \u0111inh Betzbone l\u00e0 ph\u00f9 h\u1ee3p v\u00e0 \u00e1p d\u1ee5ng t\u1ed1t cho ng\u01b0\u1eddi Vi\u1ec7t Nam.<\/strong><\/p>

\"\" \"\" \"\"<\/p>

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u1ea2nh. C\u00e1c lo\u1ea1i \u0111inh n\u1ed9i t\u1ee7y t\u1ef1 d\u00e3n \u0111i\u1ec7n t\u1eed<\/strong><\/p>

A: \u0110inh Fitbone\u00a0\u00a0 * Ngu\u1ed3n: Theo<\/em> Harris, M., Paley, D.(2013).<\/em><\/p>

B: \u0110inh Precice\u00a0 * Ngu\u1ed3n: Theo Krieg, A. H.(2008).<\/em><\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

K\u00e9o d\u00e0i ch\u00e2n b\u1eb1ng \u0111inh n\u1ed9i t\u1ee7y t\u1ef1 d\u00e3n: \u01b0u nh\u01b0\u1ee3c \u0111i\u1ec3m v\u00e0 kh\u1ea3 n\u0103ng \u00e1p d\u1ee5ng \u00a0 V\u00e0o nh\u1eefng n\u0103m 1990, \u0111inh n\u1ed9i t\u1ee7y c\u00f3 kh\u1ea3 n\u0103ng c\u0103ng d\u00e3n \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 \u1ee9ng d\u1ee5ng l\u00e2m s\u00e0ng. C\u00f3 3 lo\u1ea1i l\u00e0 \u0111inh t\u1ef1 d\u00e3n: lo\u1ea1i b\u1eb1ng c\u01a1 h\u1ecdc (Albizzia v\u00e0 ISKD, Betzbone), \u0111inh […]<\/p>\n","protected":false},"author":3,"featured_media":7043,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/cms.drdoan.vn\/wp-json\/wp\/v2\/posts\/7038"}],"collection":[{"href":"https:\/\/cms.drdoan.vn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cms.drdoan.vn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cms.drdoan.vn\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/cms.drdoan.vn\/wp-json\/wp\/v2\/comments?post=7038"}],"version-history":[{"count":34,"href":"https:\/\/cms.drdoan.vn\/wp-json\/wp\/v2\/posts\/7038\/revisions"}],"predecessor-version":[{"id":7191,"href":"https:\/\/cms.drdoan.vn\/wp-json\/wp\/v2\/posts\/7038\/revisions\/7191"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cms.drdoan.vn\/wp-json\/wp\/v2\/media\/7043"}],"wp:attachment":[{"href":"https:\/\/cms.drdoan.vn\/wp-json\/wp\/v2\/media?parent=7038"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cms.drdoan.vn\/wp-json\/wp\/v2\/categories?post=7038"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cms.drdoan.vn\/wp-json\/wp\/v2\/tags?post=7038"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}