Y HQC VigT NAM THANG 7 • SO V2013
C O N G T R I N H N G H I E N C O U
NHAN X^T MOT SO MOI TUVNG QUAN GIOA MO MEM VA MO CUNG VUNG SO MAT TREN PHIM XQ SO NGHIENG TUTXA Of MOT NHOM SINH VIEN CO KHflTP CAN ANGLE LOAI I
Nguyen Thj Thu Phu'dng, Vo Tru'dng NhU Ngpc, Tran Thj Phu'dng T h a o ( * )
TOM T A T
Nghien cifu dUdc tien hanh tren 89 sinh vien co khdp can Angle I tuoi tir 18-25 nhSm muc tieu: nhan xet mpt so' moi tuWng quan giiJa mo mem va mo cimg viing sp m|t tren phim XQ sp nghieng chyp theo ky thuat td xa. Phu'dng phap nghien cu'u: mo ta cSt ngang. Cac sinh vien co kiidp can loai I, dii cac tieu chuan nghien cuTu dUOc chyp phim XQ sp nghieng theo ky thuat tLf xa de do va phan tich. Ket qua nghien ciru: SU khac biet gia tn dp nho xUdng ham tren, do nho moi tren cf cac nhom goc SNA la co y nghTa thong ke vdl p < 0,05. Do nho xUdng tai A (A-NPog) co sU tUdng quan dong bien co y nghia (p < 0,05) vdi chi so dp nho mat (goc Gl' - Sn- Pog') va goc mui - moi (Cm- Sn-Ls). Cac chi so mo xUdng ciia ham dUdi cd tUdng quan co y nghTa vdi chi so mo mem la gdc SNB va gdc SND. Ket luan: gdc SNA ty le thuan vdi do nho ham tren va do nho moi tren. Dp nho xUOng ham tren tai A ty le thuan vdi dp nho ciia mat va gdc mui-moi. Trong tuong quan vdi xUOng ham dUdi: gdc SNB va gdc SND ty le thuan vdi dp nho ham dudi.
SUMMARY
THE CORRELATION BETVl/EEN CRANIOFACIAL SOFT TISSUES AND HARD TISSUES ON THE
PROFILE TELERADIOGRAPHY I N CLASS I STUDENTS
The study was conducted in 89 class I students aged 18 - 25 to evaluation of correlation between craniofacial soft tissues and hard tissues on teleradiography of the profile. Method: cross-sectional descnptive study. Class I students with full of research standards were taken profile teleradiography for measunng and analyzing. Results: the difference in the protruding values of maxilla and upper lip of SNA angle groups is statistically significant as p<0.05. The significantly statics correlation (p < 0,05) was found between the bony protrusion at A (A-NPog) and the facial protrusion index (Gl'-Sn-Pog') and nose-lip angle (Cm-Sn-Ls). The indices of mandible is significantly correlated to the indices of soft tissues (SNB and SND angles). Conclusion: SNA angle is directly propotional to the protrusion of the maxilla and upper lip. The maxillary protmsion at A is directly proportional to the {*J Vien Dao Tao Rang Ham Mat
Phan hi€n iihoa hgc: GS.TS. Le Gia Vinh
facial protrusion and the nose-lip angle. In relation to mandible: SNB and SND angles is directly proportional to the mandibular protrusion.
I. O ^ T V A N o l
Tren the gidi da co nhieu nghien ciru moi tUdng quan giu'a mo mem va mo cO'ng ciia viing sp mat de tim hieu anh hUcfng ciia yeu to xUtfng den tham my khuon mat [ 4 ] , [ 5 ] . 6 Viet Nam co nhieu de tai nghien cii'u so mat tren phim XQ so nghieng chup theo ky thuat tii' xa nhUng cac tac gia chil trpng den yeu to xUdng hay phan mem rieng biet, chUa chu y tim hieu sd tddng hdp ciia hai thanh phan nay [1],[2],[3]. Chinh vi vay chiing toi nghien cu'u de tai nay vdi muc tieu;
nhan xet mpt so moi tUdng quan giij'a mo mem va mo cUng viing sp mat tren phim XQ so nghieng chup theo ky thuat tir xa d mpt nhom sinh vien co khdp can loai I dang hpc tai Vien Dao Tao Rang Ham Mat.
II. TONG Q U A N
Khi phan tich mo mem chiing ta khong the khong chii y den he thong nang d d ben dUdi mat dii khi danh gia tham my khuon mat chu yeu la danh gia mo mem. Hinh thai mo mem ben ngoai CO tUdng xiTng vdi mo rang-xUdng ben trong hay khong? Mo mem nhin nghieng cd phan anh dUdc he thong xUdng-rang theo chieu tn/dc sau hay khong? Van de nay dUdc ban cai tir lau va den nay van con c6 nhieu quan diem trai ngUdc nhau [7].
Be nghien ciru mdi tUdng quan giUa mo cirng va mo mem thi phUdng phap nghien ciru tren phim sp mat tir xa la chi'nh xac nhat. Khi thUc hien cac nghien cifu tren phim sp mat tir xa hien nay phan Idn cac tac gia deu cho rang mdi tUdng quan giu'a mo mem va xUdng khong chat che. Mo mem nhin nghieng khong chi ra chfnh xac dUdc tot vj tri mo xUdng nhin nghieng ben dudi va ngUdc lai [5],[6].
Y HOC VI$T NAM THAHG 7 - S6 1/2013
II. 061TU0NG VA PHUONG PHAP NGHIEN COU
Nghien cu\i dirdc thu'c hien tren sinh vien Vien dao tac Rang Ham IMSt do tuoi tir 19-25.
Tieu chuan lu'a chgn: Ooi tu'dng nghien cu'u ia ngu'di Viet Nam, ti/ nguydn tham gia nghien cii'u. Tinh trang siTc Ichoe tot. Khuon mSt doi XLTng qua du'dng giij'a. Co day du cac rSng vinh viin {i<h6ng tinh rang 8). Tu'dng quan rSng 6 hang I ca hai ben.
Tieu chuan io^i trif: Co bat thudng so mat. Cd tien sir chan thu'dng ham mSt. Cd tSn thu'dng to chirc cimg mat ben cac r^ng (da hoSc chu^ du'dc phuc hoi). Oa dUdc dieu tri Chinh nha va/hoac Phuc' hinh. Da dUdc dieu tri ve phau thuat tham my hay tao hinh viing ham mat.
Thdi gian va dia Stem nghiin c&u; Thdi gian nghien ciru: tir thang 09/2010 den thang 06/2011. Oia diem nghien cii'u; Trung tam Nha l<hoa 225 - Vien dao tao Rang Ham l^at, tru'dng Oai hoc Y Ha Npi.
Thiet ke nghien cijru
Nghien ciru dUdc thiet ke theo phUdng phap mo ta cat ngang
C8 mau:
_ _ „ : p( 1 - p)
n: Cd mau, a: I^irc y nghia thong i<e; a
=0,05 -> he sd gidi han tin cay Z-)l - a/2 = 1,96, p: Ty ie l<hdp can Angle I trong cong dong.
U'dc tinh p =0,637, d; I^liTc diing sai, chpn d = 0,1. Tir cong thirc tren tinh du'dc sd ddi tu'dng nghien ciru la 89.
Thu thap va xiif ly so llSu: Sir dung phan
mem Vistadent va SideAxis d^ do dac. So lieu du'dc nhap va xir iy bang phan mem SPSS16.0 va mot so thuat toan thong Ice i<hac.
Cac diem moc xu'dng can xac djnh: diem Giabella (Gl), diem Seiia^(S), dierri Condylion (Co), diem Porion (Po), diem sau chom LC, diem Basion (Ba), diem DC, diem Articular (Ar), diem l«ienton (Me), diem uon canh ien va ngang XHp, diem Gonion (Go), diem Pogonion (Pog), diem Gnathion (Gn), diem Pm, diem D (tam M cam), diem B, diem infradental (Id), diem Prosthion (diem Pr), diem ANS, diSm A ^ A', diem Ptm, diem PNS, diem Pterygo (Pt), diem Orbitaie (Or), diem chop rang cira tren, mat ngoai RCT, ria can RCT, ria can RCD, mat ngoai RCD, chdp RCD, diem sau ciia MP can, diem tru'dc ciia MP can, dinh mui gan R6 tren, dinh mui gan R6, dinh miii xa R6 tren, dinh miii xa R6 du'di, ho trung tam R6 dudi, chdp chan gan R6 tren, chop chan gan R6 dudi.
Cac diem mo mem: Trichion (Tr), Gl', Na', Na", Pronasale (Prn), Subnasaie (Sn), SS, Li, St- s, St-I, Stm, Ls, Sm, Pog', Gn', l^e', C.
Dao d&c nghien ciifu
Nghien ciru dUdc tien hanh idii cd siT dong y cua ddi tu'dng nghien cu'u. Moi thdng tin lien quan den danh tinh ca nhan hoan toan bao mat.
Sd lieu dl/dc thu thap, xiy iy va phan ti'ch mgt each chinh xac, tin cay dam bao tinh diing dan ciia i<et qua nghien ciru.
Hi. KET QUA NGHIEN CliU VA BAN LUAN
Trong so 89 sinh vien ciia Vien dao tao Rang Ham Mat dUdc chon vao nghien ciru cd 39 nam (chiem 43,8%), 50 nii' (chiem 56,2%). Qua nghien ciru chung toi cd mot so i(et qua va ban luan sau
Bang 1. Tu'dng quan gii/a chi sd md xUdnq va mo mem d xUdnq ham tren
chi soSNA (°)
Nho XHT tai A- NPog (mm)
< 80°
80° - 89°
>89°
P
< 0 0-2
> 2 P
GI'-Sn-Poq'(°) 8,5±5,68 10,3±4,72 13,5±0,71
>0,05 1±2,12 7,9±4,25 12,3±3,79
<0,05
Sn-G(HP)» (mm) -1,4±2,94 3,7±2,98 9,4±0,99
< 0,05 1,7±3,44 2,8±3,95 2,9±3,59
>0,05
Ls-SnPog'(°) 6,1±1,21 6,1±1,62 8±0
<0,05 6,4±0,89 5,6±1,32 6,5±1,65
>0,05
Cm-Sn-Ls O 86±11,44 90,6±9,07 102±7,07
>0,05 80,6±8,01 90,5±10,12 90,6±9,39
<0,05
Nhan xet: Gdc SNA ty le thuan vdi chi so
dp nho xUdng ham tren va dp nho mdi tren. SU khac biet gia tri dp nhd xUdng ham tren, do nhd mdi
tren d cac nhdm goc SNA (< 80°, tCr 85° den 89° va
> 89°) la cd y nghTa thong ke vdi p < 0,05.
£)p nho xUdng tai A (A-NPog) co sU tUdng
Y HOC VI$T NAM THANG 7 - SO 1/2013 quan dong bien cd y nghia (p < 0,05) vdi chi so
dp nho mat (goc Gl' - Sn- Pog') va gdc mui - mdi (Cm-Sn-Ls).
Chl so goc SNA cd tUdng quan dong bien vdi hai chi so mo mem la dp nho ham tren (Sn-G (HP)*). Trj so gdc SNA cang nhd thi dp nho ham tren cang nho. Op nhd mdi tren (Ls-SnPog'), do nhd mat (Gl'-Sn-Pog') va gdc mui-mdi (Cm-Sn- Ls) khdng cd khac biet co y nghia thong ke vdi gdc SNA (p > 0,05). SU l<hac nhau ve mdi lien he giiJa gdc SNA vdi cac thdng so the hien sU nho ra trUdc ciia nu^ tren tang mat giu'a cd the ly giai dUdc. Gdc SNA la gdc bieu thj moi tUdng quan cua ham tren vdi nen so theo chieu trUdc-sau, gdc SNA cang ldn thi xUdng ham tren cang nho ra trUdc. Khi xUdng ham tren nho ra trUdc se day md mem phia ngoai nhd ra theo vi the, do nhd ham tren cd gia trj Idn la dieu hdp ly. Cac gia trj dp nho mat, dp nhd mdi tren va gdc mui-mdi
cung tang theo gia trj gdc SNA, tuy nhien kiem djnh khong cd sU khac biet nen khdng the khang djnh dUdc ba gdc nay phu thuoc vao gia t n gdc SNA. Sd dT nhu vay la do gia t n ciia ba gdc nay con phy thudc vao vj tri cua diem Gl'(dp nho ciia tran), vi t r i cua diem Pog' (vj tri ciia cam) hay vj tri diem Ls. Vl the dp bien thien it phu thupc vao tUdng quan giu'a xUdng ham tren va nen so.
Cd sU tUdng quan chat che g\da dp nhd xuWng ham b-en tai A va dp nhd mat vi dp nhd xUdng ham tren la khoang each tir diem A den dudng thang NPog, dp nhd mat ngoai diem Sn oon phu thudc vao sU thay doi vj trf diem Gl' va Pog'. Ca hai chi sd nay d^u bj chi phoi tadi cac diem moc thupc tran va cam.
Dp nhd ham tren ciing chiu anh hUdng ciia mat phang dutig dpc qua diem Gl', nhuTig khdng phy thudc vao vj tn ciia diem Pog' nen it tUdng quan vdi dp nhd xUdng tai A.
Bang 2. TUdnq quan qlij'a chi so md xUdnq va md mem d xu'dng ham dudi chi so
SNB(°)
NPog- POr(°)
MeGo- NPog (°)
SND(°)
< 75°
75° - 82°
>82°
P
<87°
87° - 93°
>93°
P
<64°
64° - 72°
>72°
P
<76°
76° - 77°
>77°
P
Pog'- G ( H P ) ' n
-8,3±9,14 -5,2±5,14 3,3±3,25
<0,05 -5,5±7,41
-2,2±5,5 5,1±2,69
>0,05 -2,5±7,36 -1,9±6,64 -6,1±5,36
>0,05 -7,7±5,22 -3,4±6,7S 2±3,69
<0,05
Li-SnPog' (mm) 3,8±2,25
5,7±2,3 4,8±2,04
>0,05 5,7±2,9 5,1±1,86 4,6±1,S1
• > 0,05 6,5±2,91 5,4±1,96 4,3±2,35
>0,05 5,4±2,15
6±2,41 4,89±2,38
>0,05
Sm-LiPog' ( m m ) -4,9±1,0S -4,7±1,04 -5,1±0,95
>0,05 -4,8±1,02 -4,9±1,04 -5,4±0,55
>0,05 -4,7±0,65 -4,9±1,05 -4,8±1,09
>0,05 -4,8±1,04 -4,4±0.92 -5.1±0,96
>0,05
Li-Sm-Pog' 119,3±10,62
n
121,4±12,32 U6,9±l,84
> 0,05 122,2±12,8 118,7±10,21
116,6±3,62
> 0,05 125,1±U,59
119±116 119±9
>0,05 121,8±13,04 121,9±10,72 117,2±S,39
>0,05 IVfjin xet: Cd sU tUdng quan giij'a cac chi
sd xUdng ham dUdi vdi chl sd md mem. Dac biet la chl sd dp nho xUdng ham dudl (Pog'-GI' (HP)*) va dp nhd mdi dudi (Li-PrPog'). Gdc SNB va gdc SND ty le thuan cd y nghia thdng ke (p < 0,05) vdl do nhd XHD. Gdc mat (NPog-POr) va gdc cam (IMeGo-NPog) khdng cd mdi tUdng quan vdi 4 chi so md mem tren. Khdng cd chi so xUdng nao cd mpi tUdng quan vdi chi sd do sau ranh mdi dudi (Sm-LsPog') va gdc cam - mdi (LiSm-Pog').
Cac chi so md xUdng ciia ham dUdi cd tUdng quan cd y nghia vdi chl so md mem la gdc SNB
va gdc SND. Trong cac chi so md mem dUdc lUa chpn thi chi cd dp nhd ham dUdi (Pog'-G(HP)*) cd tUdng quan vdi chi so md xUdng. Khi t n sd gdc SNB va gdc SND tang len thi dp nhd ham dudi cung tang len. Gia trj gdc SNB va SND ndi len vj trf ciia xUdng ham dUdi va vi trf ciia cam so vdi nen so, vi the anh hUdng trUc tiep den dp Idn ciia dp nhd ham dudi.
Dp sau ranh mdi dudi (Sm-LiPog') la yeu td dUdc ky vpng cd lien quan den cac chi so xUdng ciia ham dudi nhat. NhUng qua nghien ciTu ta khdng nhan thay dUdc sU tUdng quan vdi bat ky
Y Hpc VigT NAM THANG 7 - S61/2013 chi SO nao. SU khac nhau ve do day ciia phan
mem moi va cSm cd the gial thich cho dieu nay.
Vi trj so ciia dd sau ranh mdi dUdi khdng chi dUdc quyet djnh bdi vi tri diem Sm ma con phu thupc vao diem Ll va Pog'; vi trf hai diem nay bien thien Idn do dp cang cd, trUdng lUc cd va dp day cd d moi ca the rat khac nhau. Hdn nu'a, khi diem B va Pog ciing nhd ra trUdc thi hai diem Li va Pog' cung tinh tien theo, gia trj cua dp sau se khdng thay dol. Gdc cSm-mdi (Li-Sm-Pog') la trudng hdp tUdng tU.
Trong khi dp nhd mdi tren ty le thuan vdi gdc SNA thi dp nhd mol dudi khdng cd sU lien quan vdi gdc SNB. Do dp nhd mdi dUdi phu thudc vao diem Sn thudc ham tren, nen mir do chat che trong tUdng quan vdi md xUdng ham dUdi se giam di. Gia trj ciia dp nhd mdi dudi khdng chi do vj tri ciia cam va vj tri xUdng ham dUdi quyet dinh, khi xuWng ham tren thay doi, diem Sn thay dd'i cDng dan tdi nhUng thay dd"i ciia dp nhd mdi dUdi.
IV. KET LUjElN
Qua nghien ciTu tren phim XQ sp nghieng chup theo ky thuat t i f xa ciia 89 sinh vien cd khdp can loai I tuoi tir 18-25 chung tdi cd mdt sd ket luan sau: Xet tUdng quan vdl xUdng ham tren: gdc SNA ty ie thuan vdi dp nhd ham tren va dp nhd mdi tren. Dp nhd xUdng ham tren tai A ty le thuan vdi dp nhd ciia mat va gdc mui-mdi.
Trong tUdng quan vdi xUdng ham dUdi: gdc SNB va gdc SND ty le thuan vdl dp nhd ham dUdi.
TAI LIEU T H A M K H A O
1 Ho Thj Thu^f Trang, Hoang Tii* Hi^ng. "NhOVig (J|c trUng cua khu6n m§t hai hoa qua anh chyp va phim sp nghieng". Luan van Th^ic sy Y hpc, Dai hoc Y di/cfc thanh phS Ho Chi Mmh, 1999.
2 Nguyen Thj Minh H^nh, Odng Khac T h i m . "Kicli thudc mol ngudi trUdng thanh co hang xUdng I v^ II tren phim st? nghieng". Tieu luan tot nghifp Bac sy Rang hSm mSt, Dai hpc Y dU^c thanh pho^Ho Chf Minh, 2004.
3 Vo Thj Kim Lien, Mai Dinh HUng. "Nhan xet khuon mSt tren lam sang va phim cephalometric tren nhom sinh vi&n 18 tuoi". Luan van th^c sy Y hpc, Dai hpc R3ng ham mSt, 2006.
4 Abdulah et ai. "Steiner cephalometric analysis:
prediction and actual outcome". Orthod Craniofac 2006; Res 9: 77-83.
5 Amjad Al Taki, Fatma Oguz, Eyas Abuhijieh.
"Facial soft tissue values m Persian adults with normal occlusion and well-balance faces". Angle Orthod2009;
79(3):491-4,
6 Anusha V. "Companson of different soft tissue analyses in the evaluation of Beauty in Soutti Idian Adults". Degree of Master of dental surgery, Febnjary 2005.
7 Kenneth K,K. Lew, BDS, MDS, AM et al. "Soft- tissue cephalometric norms in Chinese aldults with esthetic facial profile". Journal of Oral and fifaxillofaciai Surgery, Nov 1992; 50(ll):1184-9.
NGHIEN CUU CHAN DOAN, KET QUA DIEU TRj CHAN THUDNG COT SONG CO TAI BENH VIEN VIET Ddc
DiTdng D a i H a * T O M T A T
Muc tieu nghien cuTu: Oanh gia ket qua dieu tn chan thuong cpt song co (CSC). Dol tU^ng va phUdng phap ngliien cu'u: Nghien cUu tien cUu 103 benh nhan chan doan va dieu tr; tai khoa phau thuat than kinh benh vien Viet DUc td 4/2008 den 10/2008.
Ket qua nghien cu'u: Tuoi trung binh 42,34±14,87.
Tai nan lao dpng la 48,5%. 82,5% chan thUOng CSC thap. Chup CLVT c6 ton thUdng xUdng la 83,1%. Chup CHT dap tiiy la 62%. Dieu tri phau thuat 55,3%, dieu tn bao ton 44,7%. Ket qua dieu trj tdt 11,7%, trung binh 80,6%, xau 7,7%. Ket luan: Ket qua dieu trj chan thu'dng CSC phu thupc tinh trang lam sang ciia benh nhan khi vao vien va phUdng phap dieu tn.
SUMMARY
EVALUATION OF THE RESULTS OF SPINAL CORD INJURY TREATMENT AT VIETDUC hOSPHAL.
Objectives: The aime of this study is to evaluate the results of spinal cord injury treatment Material and method: A prospective study in 103 patients diagnosed and treated m Neurosurgery Department of Vietduc hospital in period from 4/2008 to 10/2008. Results: Average age is 42,34±14,87.
Working accident; 48,5%, lower spinal cord injury:
82,5%. CT-scan shows bone fracture: 83,1%. MRI shows medullar contusion: 62%. Surgical treatment:
55,3%, medical treatment: 44,7%. Good outcome:
11,7%, moderate outcome: 80,6% and bad outcome:
* Khoa PTTK Benh vien Viet Diit; Tru'dng Dai hoc Y Ha n Phan bien khoa hoc: PGS.TS. Nguyen The Hao 10
