phai d ngu'di (HIV/AIDS) (2007). Dilu 4.
7. Tmng tdm Phong, chIng HIV/AIDS Didn Bien (2010): "Danh gia hogt dpng phdng, chlng HIV/AIDS nam 2010 va phuang hudng nhidm vy ndm 2011" - Ndm 2010. Trang 1,2 va 6
8. Trung tam Phdng, ehing HIV/AIDS Didn Bien (2011): "Danh gia hogt dpng phdng, chlng HIV/AIDS
nam 2011 va phu'ong hu'dng nhidm vy nam 2012" - Nam2011. Trang 2 - 5 .
9. Tmng tdm phdng, chlng HIV/AIDS Didn Bien (2012): "Danh gia hogt dpng phdng, chong HIV/AIDS nam 2012 vd phu'ang hu'dng nhidm vy nam 2013" - Nam 2012. Trang 1,2,3 va 6.
MOI U l N QUAN GIUTA TAN SUAT TRAT KHIJP VAI TAI DIEN von TON THUnrNG SUN VIEN K H A P V A I TRONG NOI SOI KHOTP VAI
TOM T A T
Af{xc tieu nghien cOv: Xic djnh mdi lien quan cOa tin suit tr$t kh&p vai tii didn v&i hinh thii tin thwang cOa syn viin trong tr$t kh&p vai tii didn ra trw&c. Doi tu^ng vi phuong phap nghidn c^u: Hdi cOv 55 trw&ng h&p n^i soi kh&p vai diiu tri fich sy/i viin do trit vai tH diin ra trw&c tai b$nh viin Vi$t DOv, B$nh vi$n Bach mai vi b$nh viin D^i Hoc Y Hi N6i tir 2009 din 2013. Ket quS nghiin ciru: Cd mdi liin h$ cd y nghla thdng k§ giO'a tan suit trit kh&p vai tii diin v&i mCrc do l&n cda dw&ng rich sijn viin.
Khdng c6 mdi Iidn he cd y nghTa thdng ki giu-a tin suit trit vai vi vi tii rich cQng nhw loai rich. Kit lu$n: Cd mdi Iidn hi cd ^ nghla thdng k§ giu-a tin suit tr§t vai vi tin thwang si.in viin kh&p vai.
7(3" khoi: tr$t vai tii diin, ndi soi kh&p vai.
SUMMARY
THE RELATIONSHIP OF LABRUM TEAR MORPHOLOGY AND RECURRENT SHOULDER DISLOCATION FREQUENCY
Objective: To define the relationship between recurrent shoulder di^ocation frequency with the morphology of labmm tear. Patients and method:
retrospective study in 55 patient unden^ent arthroscopic treatment for labrum tear due to recurrent shoulder dislocation. Results: Them is a significant relationship between the mcunent shoulder dislocation frequency with the size of labmm tear with p < 0,05.
Them is no significant relationship between the recurrent shoulder dislocation with the location and type of labmm tear Conclusion: The relationship between recunent shoulder dislocation fmquency and the morphology of labmm tear is significant
Keywords: recurrent shoulder dislocation, shoulder arthroscopy
DAT V A N C e
Trdt khdp vai t i i didn la thuat ngd d l chi tinh trgng trdt va ban trdt eua c h i m xyang d n h tay ra khdi I e h l o xyang ba vai [1]. Do khdp vai Id khdp ed bidn 66 Idn, I c h l o xyang b l vai ndng n i n m i t vyng khdp vai ed t h i d nhilu vj tri khac nhau, thydng gap nhIt la ra trydc va ra sau, ca bidt cd trydng hap m i t vdng nhilu hydng trong dd chu y l u la trat va ban trat ra trydc, chilm kholng 97% d e tnj'dng hpp. D i l u tri
TRAN TRUNG DUNG* NGUYEN MAI HONG*',
*Trumig D^i Hgc Y Hi N^i; **Bfnh vi^n B^ch Mai trdt khdp vai tai didn bIng p h l u thudt 6i dygc t i l n hdnh ti> r i t lau vdi r i t nhilu phyang phap khac nhau vdi nhdng k i t qua k h i quan [1,2].
Hinh thai thyang t i n cOa syn v i i n trong trdt khdp vai tai d i l n khd da dgng, t d kich thyde du'dng raeh, vj tri dydng raeh, 6$c d i l m cOa syn vien bj rdeh, .. nhu'ng mdt trong nhdng khd khan khi danh gia hinh thai ton thyang tren edng hu'dng t d thu'dng it xdc
^ n h du'p'c ey the do dd ke hoach p h l u thudt ddi khi phai du'a vdo tham kham qua npi soi khdp. Cd nhilu y l u t l I n h hydng d i n hinh thdi t i n thyang eOa syn v i i n trong trdt khdp vai tai didn nhy: ca e h l trdt l i n d I u , t i n suit trdt khdp vai, kha nSng n i n trdt l l n d I u d l dang hay kiid khan, ... trong dd y l u to t i n s u i t trat khdp vai duac nhilu tdc gia nhic d i n nhu' 1 y l u t l cd lien quan chqit che vdi hinh thdi t i n thu'ang cOa syn v i i n khdp vai. V l m$t 1)? thuyit, khi t i n s u i t trdt Idn, vide tr$t di trdt Igi eua chdm xyang cdnh tay Idm cho dydng rdeh eua syn v i l n rdng ra, sun v i i n b|
c h i n thyang nhieu l l n ed nguy ea thilu du'dng ho^c cd the gay ddt sun v i l n ben canh vide lam raeh syn vien khdi bif I chao. Nhdng tru'dng hpp trat tai d i l n nhilu l l n , kha nang n i n trat dd ddng thu'dng kdm theo t i n thyang khuyit xyang eOa I chao eOng nhy chom xyang canh tay (tin thu-ang Hill Saehs)[1,2].
xac dinh hinh thai syn v i l n trydc m l kha quan trpng vi nd giOp cho p h l u thu$t vidn tidn lypng dypc kha nang thdnh cdng cOa p h l u thuat cung nhu' cae tien lu'png xa, kha nang tai phat, ... de giai thich eho bdnh nhSn. Vide xac djnh d e y l u t l Iidn quan giOp eho p h l u thuat vidn tidn lu'p'ng dyp'c chinh xac han t i n thyang bdn cgnh vide tham kham lam sang va phim cdng hydng t d , chinh vi vdy chung tdi t i l n hanh nghien edu ndy n h l m :
- xac djnh m i l Iidn quan eua t i n s u i t trdt khdp vai tdi d i l n vdi hinh thdi ton thyang cOa sun v i l n trong tr$t khdp vai tdi didn ra trydc
D 6 I TugrNG vA PHUONG PHAP NGHIEN cCru
- D l i typ'ng nghiin edu: 55 bdnh nhan ton thyang syn v i l n trong trat khdp vai tai d i l n ra trydc d y p c p h l u thu^t khau lai syn v i l n qua n|i soi khdp vai t$i bdnh vipn Vi$t Ddc, Bdnh vidn Bgch mai vd b0nh vidn Dai Hpc Y Hd Ndi t d nam 2009 d i n 2013
- Phyang phap nghiin edu: nghidn edu md t l
Y HOC THirC HANH (931) - S6 9/2014
- K? thudt p h l u thu§t: bdnh nhan dyp'c gay md toan than, du-pc m l theo 1 trong 2 tu' t h i : J u ' t h i nda n i m nda ngli (beachchair) va tu' t h i nam nghidng (Decubitus). Vdo khdp theo 3 dydng' du'dng sau, dydng trydc va du'dng tnj'de dydi, trong dd 2 du'dng trydc va trydc du-di cd sd dung trocart nhya dd thu$n tidn cho vide khdu syn vien qua ndi soi. S d dyng bam ap lye nyde de gian khdp, danh gia todn bd sun v i l n khdp vai phia tru'dc, Idn tren vd syn v i l n phia sau Xdc djnh ranh gidi kich thu'dc va vj tri t i n thyang sun vien trydc, phan vCing theo sa do mat d i n g h i d l thudn tidn cho viec md ta t i n thu'ang
- Phan lo?i ton thu'ang chung tdi chia ra theo vj tri, phan chia theo sa d l mat dong ho
BIng 1: M i l Iidn quan gida t i n s u i t trat khdp vai vdi mdc dd t i n thyang syn vien
Hinh 1 :So' d i m^t a6ng h i d l phan chia ton thu'ong syn viln trudc
xac Q\nh mdc dd Idn cua ton thu'ang dya trdn s l vit neo sd dyng d l khau sun vien vdi khoang cdch trung binh gida cdc neo khoang 1-1,5cm, chia ra thanh 3 mdc d d
+ Dd 1' chi phai khau vdi 1 vit neo + Dd 2: phai khau vdi 2 vit neo + Dd 3: phai khau vdi 3 vit neo
xac (Inh hinh thai t i n thu'ang syn v i l n g I m cac loai:
+ Logi 1' Rdeh syn vien khoi eho bam vdo I chao, phin raeh di ddng t y do
+ Logi 2: Raeh syn vien, phan sun vien raeh l i l n vdo bd dydi I chao
+ Logi 3: Raeh syn vien, 1 phan sun vien raeh tidu ho$c thodi hoa
- X d ly s l lidu bIng SPSS 16 0 bang cdc thuat toan thing kd y sinh hpc, phdn tich m i l tu'ong quan gida t i n s u i t tr$t khdp vai vdi dp ton thu'ang, loai ton thyang vd vj tri t i n thu'ang bang test Khi binh phyang
- Dgo ddc nghidn edu: Tat ea cac bdnh nhdn d i n g y phlu thuyit, dong y eho phep sd dung cdc thdng tin y hpc phyc vy nghien edu va dam bao bi mdt thdng tin cd nhSn.
K £ T Q U A NGHIEN CCfU
T i t d cac bdnh nhdn bj ton thyang vao tay phai, Chung tdi khdng g^p trydng hpp nao t i n thu'ang tay trai. G i n nhy toan bp bpnh nhan la nam chilm 98,2%
(54/55 bdnh nhan), chi c6 1 bpnh nhan n d la vdn ddng vidn bdng chuyen, c h i n thu-ang khi thi d I u . T u l i tnjng binh cOa d c benh nhdn la 24,6 ±3,34 trong dd tre nhIt Id 20 t u l i vd Idn t u l i nhat id 30 t u l i .
T6n thu'O'nq DC) 1 vS 2 DO 3 T6nq
TrUt < 5 Ian 35
9 44
Trgt >= 5 lln 9 3 11
Tfing 43 12 55 Nhdn xdt: Cd moi lien quan c h | t che cd J nghTa t h i n g kd gida s l Ian trdt vai tai didn va mdc dd Idn cua dydng raeh syn vien vdi p < 0,05
Bang 2. M i l Iidn quan gida t i n suat trdt khdp vai vdi loai ton tiiygng sun v i l n
Logi 1 vS 3 Loai 2 T6ng
Trat < 5 iSn 29 15 44
Trat >= 5 lln 6 5 11
T6nq 35 20 55 Nhdn xdt: Khdng ed moi lien quan chat chd gitra t i n s u i t tr$t khdp vai vdi loai t i n thyang sun viin
Bdng 3' Moi Iidn quan gida t i n s u i t trat khdp vai
vdi vj tri t i n thu'ang cOa sun v i l n \ Vjtri
Tru'dc dud!
va phdc tap
Trgt < 5 lln I Trgt >= Slan" T6ng
4 4 I 11 I 5S '^
Nhdn xdt: Khdng cd m l i Iidn quan chat chg c i ^ nghTa thing kd gida t i n s u i t trdt khdp vai vdi vjiri
t i n thyang cCia syn v i l n '^
BAN LUAN
Da s6 cac bdnh nhdn trat khdp vai tdi diln la c^c bdnh nhdn trd, hay hogt ddng the thao[3]. T i t ca cSc bdnh nhdn trong nghidn edu cOa chung tdi du'pc can thidp bIng ndi soi. Mdt trong nhdng tidu chi r i t quan trpng d l ehi ^ n h can thidp ndi soi Id chya d ho$cc6 nhyng t i n thyang xu'ang it, khdng d n phai can thi^p tao hinh v l xyang, ehi can can thidp phin mIm don thuln[4,51. T i n s u i t trdt eua cae benh nhdn chCing \S\
khdng qua nhilu, khdng ed trydng hpp nao tr^t qud 20 l l n , cac tnj'dng hp'p trat deu nan lai khdng dS dang. Dd la nhdng yeu t l cho t h i y t i n thu-ang sgn v i l n dan thuin, mdc dp gian eOa bao khdp chu-a nhilu, t i n thyang x y a n g chya d . Ddy la nhdng iSlu kidn thu$n Ipi d l phyc hoi syn v i l n qua ndi soi d$t k^
q u i cao[6].
Qua b l n g 1 cho t h i y , ed m l i Iidn quan ch^t chl gida dd Idn cOa dydng raeh syn v i l n va t i n sulll tr|t khdp vai. S l l l n trdt khdp vai cang nhilu thi du-frng rdeh eOa syn v i l n d n g Idn. Da so cac tac gii cQng d i n g y vdi nh$n tSnh eua chOng tdi ve mli Iidn quan nay [5,6,7,81 va m i l Iidn quan ndy dyp'c ly giai IS do m l i l l n trdt, syn vien Igi bj t i n thyang thdm ndn tr^t cdng nhilu l l n thi dydng raeh syn v i l n d n g Idn. VS m$t giai p h l u , syn vien giong nhu' 1 vanh cao su bao quanh I chao va ISm sau thdm 6 chao xyang cSnh tay, khi syn v i l n bj raeh khoi vien I chao do Ian W d I u t i l n , d c l l n tiep theo, chom xu'ang d n h tay l?i tr^t qua vj tri cQ v l thuc v i o sun v i l n 6i bi rdch idm cho dydng raeh cua syn v i l n khdi I chio d n g k6o dai t h i m . COng vdi t i n thyang syn vien, bao khdp s6 bj lam gian dan ra sau mdi l l n trSt va bd tmdc 6
Y HOC THirC HANH (931) - s 6 9l7^
chao cQng nhy chdm xyang canh tay se bi mdn khi s l l l n t r a t t a n g d l n l § n [ 1 , 2 1 .
Tan s u i t gap rdeh syn w i n vdi syn vien di ddng t y do gap nhilu nhIt chiem 50,9% cac tnj-dng hp'p, cung vdi logi 3 Id t i n thyang syn v i l n b i l u hidn tieu ho^c t h i l u du'dng chilm 63,3%. Loai ton thu'ang ndy khdc biet vdi t i n thyang loai 2 d e h l , t i n thyang logi 2 thi 1 p h i n syn v i l n dS dinh vao mat ^u'de xu'ang canh tay, ngay b d dydi I chao, tu'ong dng vdi vj tri trat cua c h l m xyang canh tay Mdt s l tac g i i [2,9] ly giai r i n g , s y l i l n eua syn v i l n vao phia du'di cOa bd trydc I chao x u l t hidn ngay t d Ian trat dau tidu, syn v i l n bj rdeh va di Idch xuong du-di, qua trinh n i n tr$t, b i t ddng lam syn v i l n l i l n vdi bd trydc I chlo do dd khdng cdn dam b i o dypc chdc nang sinh 1;^ cOa syn vien trud'c. Ddy ed t h i coi Id 1 trong nhdng t h i t bgi cOa vide d i l u trj b i o t i n . Hien tu'O'ng l i l n cOa syn vien vdi bd t w d e I chao chi xay ra khi rdch sun v i l n Idn, kha nang di Idch cOa syn vien khdi vi ^ i cao ndn mdi cd the xay ra s y l i l n vdi bd tnj'de 6 c h l o dypc.
K i t qua d b l n g 2 cOa chOng tdi cho thay khdng ed m l i lien quan ed ^ nghTa t h i n g kd gida tan s u i t trdt vai va loai t i n thu-ang. ChOng tdi cho rang, vdi t i n thu-ang logi 2 thydng 6i Id t i n thu-ang Idn nhyng do da dinh vdi bd trydc I c h l o ndn ode Ian trat sau it cd kha nang lam t i n thu-ang thdm. Dieu nay khde vdi t i n thyang syn v i l n t y do se d l t i n thyang thdm khi trat tai didn. Mdt s6 tac g i i cOng eho rang, vide dinh syn v i l n vao phia dydi cOa b d tru'dc I chao eOng ed gia tri tich eye lam eho k h i nang raeh them syn v i l n khdng t i l p tyc vd nguy ea tieu hoac thieu du'dng syn vien giam di [8,9].
Nhdng k i t q u i eua bang 3 cung cho t h i y Id khdng d m l i Iidn hd eh^t che gida t i n s u i t t i n thyang vd vj tri t i n thyang. Ca e h l cOa tr$t tdi d i l n khdp vai Id chdm xyang cdnh tay trat lai qua vj tri t i n thyang Ian tnj'de. It khi vipe trdt xay ra d 1 vj tri khdc vl vj tri trdt l l n trydc dd trd thanh d i l m y l u nhIt r l i , ffieu nay dyp'c da s6 cdc tdc gia thda nhan [2,5]. V l mdt gidi p h l u sinh 1^", vj tri trydc dydi khdp vai cd t h i coi id diem y l u nhIt cOa khdp vi khdng cd nhilu c l u trOc hd trp, han nda cdc ddng tdc t h i thao chO y l u gdy thOc chdm xyang cdnh tay ve phia tru'dc dydi trong cdc ddng tdc ndm, lao hodc tranh chap trdn cao khdc, do dd hay tr$t d vj tri ndy nhatfl].
K t T LUAN
Qua nghidn edu trdn 55 bdnh nhdn dypc npi soi d i l u trj trdt khdp vai tdi d i l n ra trydc chOng tdi thay r i n g : t i n s u i t trat khdp vai ed Iidn quan chdt che vdi dd Idn eua ton thu-ang rdeh syn v i l n . Khdng nhan t h i y ed moi lien quan giu-a t i n s u i t trdt khdp vai vdi vi tri rdeh va loai rdeh syn v i l n trydc.
T A I L I E U THAM K H A O
1. Buriiart AC, Debski RE (2002): Anatomy and function of the glenohumeral ligaments in anterior shoulder instability Clin Orthop Relat Res 2002; (400):
32-39.
2. Dumont GD, Russell RD, Robertson WJ. (2011),
"Anterior shoulder instability: a review of pathoanatomy, diagnosis and treatment". Curr Rev Muscuioskelet Med. 2011 Dec; 4(4): 200-7
3. Hovelius L, Sandstrom B, Sundgren K, Saebo M (2004): One hundred eighteen Bristow- Latarjet repairs for recurent anterior dislocation of the shoulder prospectively followed for fifteen years: Study I- clinical results. J Shoulder Elbow Surg. 13: 509- 516,
4. Godin J, Sekiya JK. (2011), "Systematic review of arthroscopic versus open repair for recurrent anterior shoulder dislocations". Sports Health. 2011 Jul;
3(4):396-404.
5. Anakwenze OA, Huffman GR. (2011), "Evaluation and treatment of shoulder instability". Rhys Sportsmed.
2011 May; 39(2):149-57.
6. Privitera DM, Bisson LJ, Marzo JM. (2012),
"Minimum 10-year follow-up of arthroscopic intra- articular Bankart repair using bioabsorbable tacks". Am J Sports Med. 2012 Jan; 40(1):100-7.
7. Ricchetli ET, Ciccotti MC, O'Brien DF, DiPaola MJ, DeLuca PF, Cieeotti MG, Williams GR Jr, Lazarus MD (2012), "Outcomes of arthroscopic repair of panlabral tears of the glenohumeral joint". Am J Sports Med. 2012 Nov,40(11):2561-8.
8. Van der Linde JA, van Kampen DA, Terwee CB, Dijksman LM, Kleinjan G, Willems WJ.(2011), "Long- term results after arthroscopic shoulder stabilization using suture andiors: an 8- to 10-year follow-up". Am J Sports Med. 2011 Nov;39(11):2396-403.
9 Kralinger FS, Golser K, Wischatta R, Wambacher M, Sperner G(2002). Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med 2002;30(1): 116-120.
NGHIEN CIAJ ANH HUtTNG CUA THOI GIAN BAO QUAN TOn CHAT LUONG KHOI TIEU CAU
TOM T A T
M(ic tidu: Nghiin c&u mdt sd thay ddi hda sinh, hinh thii vi chOc nSng tiiu ciu trong th&i gian bio quin. Doi tuo-ng vi phuxyng phip nghien cihi: 30 khdi tiiu ciu miy tich tO- mgt ngw&i cho bing miy tich ti bio Haemonetic, bio quin & 22fC, lie Iidn tuc. Thu th$p cic ch! sd: sd Iwong tiiu ciu, MPV, DPV, P-LCR, pH, glucose, lactate vi dp ngwng t$p
N G U Y I N QUANG DONG - Vi^n Bdng Quoc gia tiiu ciu tai cic th&i diem ngiy 1, ngiy 3, ngiy 5 cOa th&i gian bio quan. Ket qui: Sd Iw&ng tiiu ciu tmng qui trinh bio quin, ngiy thO- nhit1401±331, ngiy thCf hai:13651311. ngiy thCf ba: 1196±234 G/l. Cic ch! sd tieu cau MPV, DPV, P-LCR ting ngay tir ngiy bio quin thO" ba (p<0,05). Dd pH cOa khdi tiiu ciu twang Ong v&i cic ngiy 1, ngiy 3, ngiy 5 li:
6,99±0,11; 6,88±0,16; 6,83±0,18. Ndng dd glucose
Y HOC THVC HANH (931) - s 6 9/2014
