TCNCYH Phu truong 80 (3B) - 2012
TAC DUNG CAl THIEN CHLPC NANG SINH HOAT HANG NGAY C O A T I E M DEPOMEDROL NGOAI MANG CLPNG TRONG DIEU TRj DAU THAN KINH HONG DO THOAT Vj DIADEM
Nguyen Cong Hoan, Nguyen Van Ligu Truung Dg/ Aipc YHa Npi Nghien cuv dux;rc thi/c hi$n nhim danh gia t^c di^ng cai thiin chirc nang sinh ho^t h^ng ng^y cua tiem Depomedrol ngoai mang cu'ng. Ket qua cho thay tiem Depomedrol ngoii mang cimg diiu tri dau thin kinh hong do tlioat vi dfa d^m giup cai thien s&m chu'c nang sinh ho^t hang ngay cho b$nh nhin ngay tu" tuin thir 2. Sau mdt thcing ty /g bdnh nhin cd chi so sinh /logf hang ngiy
& miK tSt va kha la 78%. Chux; nang sinh ho^t hang ng^y cua b$nh nhan duxyc cai thien 6n dinh sau 2 thing vol mux: do tdt va kha a 82%, chi cdn 8% b$nh nhin & mux: dQ kem.
Tu khoa: Thoat vi dTa dgm, dau than ktnh hong I. OAT V A N Dt
Dau thin kinh hdng la mpt ehung bgnh hit sue pho bien. Cb nhieu nguyOn nhin dau thit lung hong, trong dd nguyen nhan chu ylu l i do thoit vi dia dgm. Tuy phin Idn cac trudng hpp khbng nguy hilm den tinh mgng nhung dau thin kinh hong anh hudng rat Idn den sinh hogt, ebng viOc cung nhu chat lupng sing eiia ngudi bgnh
Ca che dau trong thoit vj dTa dem phii'c tgp, trong db eb phin dau nhgn cam tai eho (Nociceptive Pain) va dau do co ehl thin kinh (Neuropathic Pain). Trong dau than kinh hbng do thoat vj dTa dgm dau l i ylu to chinh lam ngudi bgnh rit khb chju, dong thdi dau lam han che dp gian ebt song, lam hgn che kha nang chju dung khi eang r l thin kinh, hgn che kha nang di bb, kha nang dung liu cung nhu mpi hoat dpng xa hpi va nghe nghigp-
MyctiOu nghien euu nhim danh gia vai trb
cai thign chCi'c nang smh hogt hang ngay ciia tiem Depomedrol ngoai mang cu'ng trong dieu tn dau thin kinh hbng do thoat vj dTa dem.
II. D 6 I T U ( ? N G V A PHUaNG PHAP 2.1. Ooi tup'ng nghien cdu
- Nhdm chung gdm 50 bgnh nhan dau than kinh hbng do thoat vi dTa dgm dupe dieu tri bang thuoc gian ea, giam dau than kinh, vitamin nhdm B, an thin.
- Nhdm nghien cuu gdm 50 benh nhan dau thin kmh hdng do thoat vj dTa dgm duac dieu trj hoan toan nhu nhdm ehung nhung dupe tiem Depomedrol ngoii mang cung tgi vj tri chen Op 3 lin, each nhau moi lin 1 tuan.
Lieu luang 40 mg mdi lin tiem.
2.2. Phuang phap nghien ciru Tiln cuu can thiOp, so sanh kit qua trudc va sau dieu tri, Danh gia chuc nang sinh hoat hing ngiy Iheo thang diem OSWESTRY.
TCNCYH Phy trUOng 80 (38) - 2012 II. K^T QUA
Bangi. Tuoi cua nhbm bgnh nhan nghien cu'u va nhbm chung
Nhbm tuoi Nhdm chirng
%
Nhbm nghien ci>u
%
Duoi 30 Tu 30- 40 Tir 41 den 50 Tu' 51 din 60 Til' 61 din 70
1 4 9 16 10
2,0 8,0 18,0 32,0 20,0
1 5 8 17 9
2,0 10,0 16,0 34,0 18,0 Trbn 70
>0,05
Tuli trung binh 58,8 ±13.7
BOnh nhin cua nhbm nghiOn cdu v i nhdm chung cb sy tuang ding v l db tuli v i tuli tmng binh. Thoit vj dTa dOm ehu ylu ggp sau tuoi 40,
Thdi gian bj bgnh Nhom chung Nhom nghien ciru
%
Dudi 1 thang Tir 1 thang - du6i 3 thang Tir 3 thang - duoi 6 thang Tir 6 thang - 1 nam
9 28
8 3
18,0 56,0 16,0 6,0
11 27 8 2
22,0 54,0 16,0 4,0
>0,05
4,0 4,0
Tong so
Bang 2. Thdi gian bj bgnh cua nhom nghien cuu va nhom chung Thdi gian bj bOnh cua nhbm nghiOn cdu v i nhbm chung tuang ding. Phan Idn cictnjdng hpp bgnh tien triln dudi 3 thing.
Mire dp Nhom chung Nhdm nghien cuu
Tnjdc dilu trj Sau dieu trj P, Trude dilu trj Sau dieu tri Pj
Tit Kha Trung binh
ni 0 5 10
%
0,0 10,0 20,0
n^
5 14 8
%
10,0 28,0 16,0
%
0 2 16
0,0 4,0 32,0
17 24 11
34,0 48,0 22,0
Kem 35 74,0 23 46,0 32 64,0 8 16,0
B^ng 3. Oanh gia chirc nang sinh ho^t hang ngay sau dieu trj 2 tuan 164
TCNCYH Phy trUdng 80 (3B) - 2012 Ciing vdi t i c dyng giam dau, chue nang sinh hogt hing ngay cua bgnh nhan dupe eai IhiOn sdm. Cb sy eai thign rb rOt d nhbm nghien cdu so vdi nhbm chung.
Bang 4. Oanh gia chuc nang sinh hoat hang ngay sau dieu trj 1 thing
Mue dp Nhbm chii'ng Nhbm nghien cii'u
Tordc dilu tn Sau dieu trj P, Tru'dc dilu trj Sau dilu trj Pj
Tit Kha Trung binh
ni 0 5 10
%
0,0 10,0 20,0
n2 10 14 10
%
20,0 28,0 20,0
0 0 18
0,0 0,0 36,0
21 18 7
42,0 36,0 14,0 35 74,0 16 32,0
Sau 1 thing phan Idn cic bgnh nhan nhdm nghi&n cu'u (78%) cd chi so sinh hoat hang ngay tot hoOe khi Khic bigt cd y nghTa thong ke so vdi nhdm ehung .
Bang 5. Danh gia chuc nang sinh hoat hang ngay sau dieu trj 2 thing
Muc dp Nhbm chung Nhbm nghien cuu
Trude dieu tri Sau dieu tri P, Tardc dieu tri Sau dieu trj P2
Tit Kha Trung binh
ni 0 5 10
%
0,0 6,0 20,0
"2
12 18 8
%
24,0 36,0 1 16,0
n.
0 0 18
%
0,0 0,0 36,0
"2
24 17 5
%
48,0 34,0 10,0 35 74,0 12
Kit qua dieu trj rat tot va on djnh sau 2 thang voi hlu hit cic benh nhan nhdm nghien ciru (82%) cd chi so sinh hoat hang ngay tit ho?c l<ha va chi con 8% benh nhan nhom nay 6 mire do l<em.
IV. BAN LUAN
Bac diem chung cua nhom nghien CCPU Tuli tmng binh cua nhom nghien cu'u la 59,3 ± 13,4 va cua nhdm chirng la 58,8 ± 13,7.
Trong do thuo'ng gap nhat la dp tuoi 51 din 60. Tuli trung binh 6 day cao hon i) mpt s6 nghien ciru khac do co nhilu b$nh nhan thoat vj dTa dem nang, co chi djnh phlu thugt nhung tuli cao nen xin tilp tuc dilu trj npi khoa [2,3], 14], Kit qua nghien cu'U bang IvS 2 cho thiy sy tuong ding giu'a nhom nghien ciru va nhom chirng v l dO tuoi v^ thdi gian bi bpnh.
Tac dung cua tiem Depomedrol ngoai mang cirng tai vj tri chen ep doi vd'i boat dong hang ngay cua benh nhan
Dau that lung hong va dau r l thin kinh anh hudng nghiem trpng din cong vlpc, va sinh hogt hang ngay cua benh nhan. t!y thcri dilm trucrc dilu trj, ty Ip benh nhan co mire dp sinh hoat hang ngay kem va trung binh cua nhbm nghien cifU la 96%. Ty le nay o nhdm chimg la 90%. 6l oa nhom nghien ciru va nhom chu'ng chi s6 OSWESTRY dlu d mire tir 41 % tro len.
Bpnh nhan ngoi, dirng, di bp va sinh hoat rat
TCNCYH Phy trUdng 80 (3B) - 2012 khb khin. Dieu niy anh hudng rit nhieu din ebng vigc, nghi nghiOp v i chit lupng sing.
Tinh trgng sinh hogt hang ngay cua bgnh nhin dupe cii Ihign rit nhanh d nhdm nghiOn cuu. Sau hai tuin dilu trj ty 10 bOnh nhin cb muc dO kOm giam lu' 64% xuIng cdn 16%, ding thdi s l bOnh nhin trd v l mij'c dfy l i t dgt 34% 6' nhbm dii chung sinh hoat hing ngiy d muc dp kOm vin cbn 46% v i d muc dp tot ehi eb 10%. Sy khae bigt niy cb '^ nghTa thong ke vdi P < 0,05. Phin Idn bOnh nhOn trong nhdm nghiOn euu ed t h l trd Igi vdi sinh hogt tuo'ng doi binh Ihudng,
Sau mpt thing dieu trj chuc ning sinh hogt hang ngiy eua nhdm bOnh nhan nghiOn euu du'iyc eai thiOn ro rgt. 78% s l bOnh nhin dupe tiem Depomedrol ngoii ming cd ehl s l sinh hogt hang ngay d mue dp tot hoOc khi, chi cdn 8% d muc dp kem. Cung thai dilm nay d nhbm chung ty le bgnh nhin dgt mire sinh hoat hing ngiy tot hoOe kha ehl dgt 48%
va cbn tai 32% d muc db kem Sy khae bigt ve chi so sinh hogt hing ngiy giO'a nhbm nghien cuu v i nhbm chung d thdi dilm mpt thing sau dieu tn rat rb rOt, vdi P < 0,05.
Sau hai thing, 82% bgnh nhin nhbm nghiOn cdu cb chi so sinh hogt hing ngay d mue tot hoge kha (Chi s l OSWESTRY tu 0 din 40% ). Trong khi db nhbm chung ty 10 bOnh nhan mire tot hoOe kha chi dgt 60% v i cbn tdi 24% so bOnh nhan d muc kem.
V. KET LUAN
- Cung vdi higu qua giam dau rd rOt, tiem Depomedrol ngoii mang eO'ng trong dilu trj dau thin kinh hbng do thoit vj dTa dOm giiip eai thiOn sdm chuc nang sinh hogt hing ngiy cua bOnh nhan.
- Ty le bOnh nhin cb chi so sinh hogt hang ngiy mue dp kem giam nhilu ngay tu tuin thu
Ty 10 bOnh nhin cb ehi so sinh hogt hing ngiy d mire tot v i khi ting lOn den 78% sau mbt thing.
- Chdc ning sinh hogt hing ngiy ciia bOnh nhOn dupe eii thiOn I n dinh sau 2 thing vdi muc db tit v i khi d 82% bgnh nhin, chi cdn 8% bOnh nhin d muc dO kOm.
TAI LIEU THAM KHAO 1. Nguyen Van Dang (2007). Dau than kinh hdng, Thye hinh thin kinh, Nhi xuit ban Y hpc H i Npi: 308-330.
2. Phgm Van DCrc (2011). Danh gii hi?u qua bii tOp duoi Mckenzie kit hpp vgt ly trj ligu trong dieu trj benh nhan thoit vj dTa dgm cpt sing thit lung, LuOn van Thge sT Y hpc, Dgi hpc Y H i Npi.
3. Trin Thai H i (2007). Dinh gii tic dyng dieu trj thoat vi dTa dgm cpt song thit lung bing phuang phip dign chim, xoa bbp kit hpp vdi vgt ly tri ItOu, Lugn van Thgc sT Y hoc, Dgi hpc Y H i Npi
4. Nguyen Van Hai (2007). Dinh gii kgl qui dilu tq dau than kinh tpa do thoat vj dia dOm bing bim kOo nin, LuOn vin tit nghi?p Bic s? chuyOn khoa cip 2, Dgi hpe Y Hi Npi.
5. Cao Hoang Tam Phuc (2011). Oanh gia hiOu q u i tiOm Hydrocortison ngoii mang cdng trong phyc hoi chuc ning cho benh nhan dau thin kinh tpa dothoatt vi dTa dOm, Luan van Thgc sy Y hpc, Dgi hpc Y Ha Npi.
6. Heliovaara M (1998). Epidemiology of Sciatica and Herniated lumbar disc, Helsinki:
Research Institute for Social Security.
7. Kaneda K, Shiral Y (2001). An epidemiological study on occupational low back pain among people vi/ho work in construction, J Nippon Med Sch, 68(4): 310 - 317.
166
T C N C Y H P h y trUdng 80 (3B) - 2012
S u m m a r y
T H E EFFECT O F T H E IMPROVEMENT OF DAILY ACTIVITIES FUNCTION OF THE E P I D U R A L I N J E C T I O N D E P O M E D R O L IN T H E TREATMENT THE SCIATICA
DUE T O HERNIATED L U M B A R DISC
Our study was to evaluate the effect on the improvement of daily activities function of the epidural injection DepomedroL The results indicated that the epidural injection of Depomedrol In the treatment the Sciatica due to Herniated lumbar disc help to improve the dally activities function right from the second week. After one month, the proportion of patients having good and fairy good index of daily activities was 78%. Daily activities function ofpaytients have been improved stably after two months with 82%, of patients are at good and fairly good level; only 8% are at bad level
K e y w o r d s : H e r n i a t e d l u m b a r d i s c , Sciatica
CHi DjNH VA KY THUAT P H A U T H U A T Ndi SOI KHOP HANG
Tran T r u n g Dung Trw&ng Dai Hoc Y Ha Ndi Vai trd cOa nqi soi kh&p hing trong chin doin va dieu tri cac binh ly khap hing. Nghien ciru du&c thi/c hi$n nhim nhin xet ve chi dinh va ky thuit phiu thuit noi soi kh&p hang. Kit qua nghien ciru cho thay cic chi djnh chinh li u xuxyng sun ming hoat dich chiem 22.2%o. rich sun viin chiim 33.3%o, hdi chimg impingement chiem 26.7%, va viem mang hoat dich kh&p hang chiim 11,1%,. Tu thi phiu thuat chu yiu la nim ngua, keo chin vi s u dung du&ng vio truxyc vi tru&c ngoii. Ta cd kit luan: NQI soi kh&p hang da gdp phan nang cao khi nang chan doan va diiu trj cic b$nh ly kh&p hang.
T u k h o a : n p i s o i k h d p , k h d p h a n g
L D A T V A N D ^
P h i u thugt nbi soi k h d p da cb nhO'ng budc p h i t tnen vui^t bOc trong n h u n g nam trd Igi d i y , giup eho eon n g u d i eb the tham kham. d i n h g i i d i n t u n g ngdc n g i c h nhb nhit eua eae k h d p tren c a the. Tgi ViOt n a m , trong nhieu n i m t r d Igi d a y p h i u t h u i t npi soi da iLfng b u d e phat trien mgnh me ea ve s l lupng v i c h i t lup'ng, dgc biOt la p h i u thugt npi soi khdp goi va k h d p vai da tien hanh dupe nhu'ng ky thuOt ngang t i m khu v y c va t h l gidi. Khdp h i n g l i k h d p Idn nhung n i m sau va khoang khdp khbng thgt s y rpng rai do 3b, phau thuOt npi soi k h d p hang v i n hgn e h l
han v l sd l u p n g va logi ky thuat t h y e hien.
Benh vign Dai Hpc Qube Gia Chonnam Han q u I e (DHQGCN) la bgnh vien hang d i u v l phau thugt khdp nbi chung va phau thugt npi soi' khdp hang ndi rieng eua Han quoc. P h i u thugt npi soi khap h i n g da d u p e trien khai d d i y tren 5 nam v d i sb l u p n g bgnh nhan p h i u thugt trung binh 150 ca 1 nam. Trong thdi gian 2 t h i n g tgi bgnh vign, chung tbi da tham gia 15 ea npi soi khdp hang v i hoi e u u Igi ho s a eua 30 bgnh nhan da d u p e p h i u thugt ndi soi khdp hang g i n n h i t de n h i m myc tieu: nhan xet ve chi dinh va ky thugt p h i u thugt npi soi khdp hang tgi benh vign n a y
