NANG BAO HOẠT DỊCH Ở TRẺ EM

DANH MỤC CHIA SẼ
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1. Đại cương

– Nang bao hoạt dịch hay u bao hoạt dịch (synovial cyst) được hình thành khi áp lực bên trong của bao khớp tăng lên có thể tạo ra tình trạng tăng tiết và thoát dịch khớp qua chỗ bao khớp lỏng lẻo. Biểu hiện thường thấy là khối tròn xuất hiện tại vùng khớp, sờ nhẵn, có thể mềm hoặc chắc, ít di động, khối tiến triển to dần theo thời gian. Thường gặp tại khớp cổ tay, khớp gối (kén Baker), khớp bàn ngón, khớp liên đốt ngón tay, cổ chân…

– Nang bao hoạt dịch có kích thước lớn có thể tác động đến dây thần kinh lân cận tạo cảm giác tê bì, khó chịu, làm hạn chế tầm vận động của khớp và mất thẩm mỹ.

– Một số trường hợp nang bao hoạt dịch xảy ra tại khớp liên đốt xa có thể biểu hiện viêm (sưng, nóng, đỏ, đau) hay biến dạng móng tay.

Nang_bao_hoat_dich

2. Các yếu tố nguy cơ

– Không khởi động tốt trước khi chơi thể thao; cử động khớp quá đà; vận động khớp bị lặp đi lặp lại hoặc mang vác vật nặng tạo áp lực lớn trong thời gian dài lên khớp.

– Những yếu tố trên dễ làm bao khớp lỏng lẻo hoặc bị kích thích, gây tăng tiết dịch khớp dẫn đến u nang bao hoạt dịch. Do đó, trước khi cho trẻ tham gia thể thao cần có khởi động tốt, chơi vừa phải để hạn chế vận động quá sức lên khớp và có thời gian nghỉ ngơi hợp lý sau khi vận động cơ thể.

3. Chẩn đoán

– Lâm sàng: khối u tròn nhẵn vùng khớp, ít di động, kích thước tăng dần theo thời gian, làm giảm tầm vận động khớp khi kích thước quá to, có thể biểu hiện viêm.

-Cận lâm sàng: siêu âm hổ trợ chẩn đoán, có thể dùng Xquang để phân biệt với u xương

4. Điều trị

– Theo dõi: Trường hợp nang không gây phiền phức cho người bệnh, nổi cộm nhẹ dưới da thì chỉ theo dõi, cho khớp nghỉ ngơi, hạn chế vận động tránh tổn thương thêm.

-Hút dịch:Nếu nang bị đau, mất thẩm mỹ, hay khớp bị hạn chế vận động do nang kích thước lớn thì có thể chọc hút dịch trong nang ra. Tuy nhiên tỉ lệ tái phát cao,vì thế giải pháp phẫu thuật sẽ được xem xét.

– Phẫu thuật: Cắt nang bao hoạt dịch, thắt chặt gốc nang và khâu phục hồi vị trí bao khớp lỏng lẻo để hạn chế tái phát.

– Khi bé có những triệu chứng hay biểu hiện nghi ngờ bệnh lý nang bao hoạt dịch có thể đưa bé đến khám tại khoa Ngoại Nhi của Bệnh viện Sản Nhi An Giang, nơi đã thực hiện tư vấn và điều trị thành công rất nhiều trường hợp nang bao hoạt dịch.

4. Tái khám và theo dõi

– Tái khám nếu có sốt, viêm tấy, chảy dịch chảy máu tại vị trí chọc dò…

– Hạn chế vận động, cố định khớp có nang bao hoạt dịch từ 4-6 tuần sau can thiệp điều trị, nhằm đảm bảo không tái phát bệnh,

TÀI LIỆU THAM KHẢO

1. Bộ Y tế (2001). “Quy trình kỹ thuật hút nang bao hoạt dịch”.Hướng dẫn quy trình kĩ thuật bệnh viện, tập II.Nhà xuất bản Y học.

2. OrthoInfo (2013). “Ganglion Cyst of the Wrist and Hand”. American Academy of Orthopaedic Surgeons (AAOS). https://orthoinfo.aaos.org/en/diseases–conditions/ganglion-cyst-of-the-wrist-and-hand

3. Adam Gendy, Haripriya S Ayyala and Ramazi Datiashvili (2015).“Pediatric Ganglion Cysts: Case Series and Review of the Literature”. J Surg Open Access, 2(3).
https://www.sciforschenonline.org/journals/surgery-open-access/article-data/JSOA-2-119/JSOA-2-119.pdf

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