Y HQC VigT NAM T H A N G 4 - SO 2/2013
NGHIEN COU LAM SANG VA KET QUA Dl£U TRj VIEM THj T H A N KINH HAU NHAN cAu TAI BENH VIEN CH? R A Y
N g u y e n Hu'u Chu'c*
T 6 M TAT:
Mifc tieu nghign cuTu: Danh gi^ ISm sang, c|n lam sang, ket qua dieu tn tren benh nhSn viem than kinh thi sau nhan cSu vdi corticosteroid dieu tri t^i bgnh vi?n ChO Ray. Doi tu'ang v i phu'dng p h i p nghiSn cuTu: Tien ctfu, quan sat hang loat ca iSm sing bgnh nhan viem than kinh thi sau nhan c3u tai khoa MSt b?nh vign ChO ray ttf 01/01/2011 den 31/12/2011, Kfit qua: Benh nhan co ty lg 1 nam/2,8 ntf, trong do tuoi ttf 20 den 50: 95,6%Thdi glan b?nh nhan du'dc nhap vien va chan doan benh s 7 ngay cd 74,9%. t h i lyc giam nhiieu theo hu'dng tSng dan, ttf sang toi (-) den DNT Im chiem 69,1%. Benh nhan co cam giac dau khi van dong nhan cau: 82,3%. Gai thj binh thu'dng. Ton thyOng dong ttf hu'dng tam gSp d tat ca cac benh nhan. Dien the gOi thi giac (VEP) thdi gian tiem phyc keo dai, bien do giam. Rdi loan s3c giac. MRI, co 86,8% tang tin hieu va kfeh' thydc thi than kinh. Dieu tri vdi corticosteroid, dap tfng '..ot, thj lUc bat dau hoi phue sau 10 ngay den 2 tuan dieu tn, sdm nhat la ngay thtf 4 sau dd tang dan, on dinh ttii lUc sau 6 thang. Benh nhan khi bat dau dieu trj co thj lyc ST (•) hoi phue kem hdn benh nhan co thj lyc ttf ST {+) trd len. Ket luan: Benh viem than kinh thj sau nhan cau gSp d ntf nhieu hon nam 2,8 lan, thUdng gap d do tuoi 20 den 40. Dac diem lam sang: thi lUc giam nhieu, theo hu'dng tang dan. Ton thyong dong ttf hydng tam. Co bat thu'dng dien the gdi tht giac, roi loan sac giac. Tren MRI, tang tin hieu va kich tiiudc than kinh thj. Co lien quan va thUdng la khdi diu oia benh xd CLrtig rai rac Dieu tn. vdi cortcosteroid, thi lut hoi piiyc tot sau 10 ngay den 2 tuan, do on (flnh sau 6 thang.
Tiy khoa: Viem than kmh thi sau nhan cau, benh xd cuhg rai rac.
SUMAAARY:
CLINICAL STUDY ON THE TREATMENT OUTCOMES OF RETROBULBAR NEURITIS
AT CHO RAY HOSPITAL Objectives: Clinical assessment and treatment outcomes in patients with retrobulbar neuritis managed with corticosteroid at Cho Ray hospital.
Subjects and methods: Prospective, observation on a series of clinical cases of retrobulbar neuritis seen at Cho Ray from 01/01/2011 to 31/12/2011. Results:
Patient gender ration is male: female 1:2.8, 95.6%
aged 20 to 50. 74.9% of patients were hospitalized in less than 7 days. Patient usually present with an acute ' Khoa Mk - Benti vi$n Ch<? RSy
Phan bi^n khoa hgc: PGS.TS. TrSn Minh Tru-frng
reduction of visual acuity. Orbital pain exacerbated bf eye movement: 82.3%. The optic disc appearance is normal. A mild afferent pupillary defect was seen in all patients. Visual evoked potentials (VEP) have latent^
prolonged recovery, decreased amplitude, dyschromatopsia. MRI shows 86.8% enhanced signal and increased size of the optic nerve. Treatnftnt with corticosteroids provides good response with viaon starting to recover after 10 days to 2 weeks of treatment, as early as day 4 and then mo-eases gradually, stable vision after 6 months. Patients starting treatment with vision ST (-) have worse prognosis than those with vision ST (+) or better.
Conclusion: is 2.8 bmes more often seen in women than men, most occurnng between 20 and 40 years of age. Clinical charactenstics accelerating vision loss, afferent pupillary defect, abnormal visual evoked potentials, dyschromatopsia. Enhanced signal and increased optic nerve size on MRI. Reb-obulbar neuritis IS the presenting feature of multiple sclerosis.
Treatment with corticosteroids provides good response with vision starting to recover after 10 days to 2 weeks of treatment and stabilized after 6 months.
Keywords: Relmbuibar neurits, mulbple sc^txsis I. O A T V X N OE:
Viem than kinh thj sau nhan (^u la mot dang viem than kinh thi theo each phan loai dtfa tren soi day mat. Vung than kinh thj bj ton thydng nam ttf sau nhan cau den nao. Nhieu nguyen nhan co the gap nhu":
- Nhiem trung trong viem mang nao, giang mai. Virus.
- Thuoc, hoa chat.
- D i tfng - Khoi u
- Benh xd ctfng rai rac l^LEUW
Nhieu trtfdng hdp chtfa ro nguyen nhan.
Song thtfdng gap nhat la do mat myelin cap trong benh xd ctfng rai rac, co nguy cd phat trien benh xd ctfng rai rac cao'^^'''*'. Trong khi tal cac ntfdc chau A, theo bao cao ciia cac tac gia tai Nhat, ty le b^nh x d ciitig rai rac sau viem than kinh thj chi chiem khoang 6,0%^^^-.
Tai My, t y le viem than kinh thj mcfi hang nam gap 5/100.000 dan. Tai Nhat, t / le nay la 1,6/100.000. Benh gay giam thj Itfc d nhieu mu'c
Y HQC VigT NAM THANG 4 - S6 2/2013 dp ttf nhe den mu hoan toan. Ltfa tuoi thtfdng
gap trung binh: 32, da so la phu ntf. Thtfdng gSp 1 mat nhtfng ca 2 mat co the bj anh htfdng. Vdi cac bieu hien lam sang nhtf: giam thj lu'c, cd diem mu tai hoac gan trung tam, roi loan sSc giac, giam phan xa dong ttf htfdng tam, khiem khuyet thi trtfdng, cam giac dau khi di chuyen nhan cau. Cac ky thuat chup cong htfdng ttf (MRI), dien the gdi thj giac la nhutig phtfdng tien giijp cho Chan doan chi'nh xac'^'-^''^''^*.
Van de dieu trj va theo doi benh ly viem thj than kinh sau nhan cau rat quan trpng. Co mpt so trtfdng hdp benh ttf tien trien mSc du khong CO can thiep nao, song nhieu nghien ctfu cho thay viec dieu trj sdm la can thiet. Stf dung corticosteroid lieu cao dtfdc cac tac gia danh gia
tgt3),[1].[6],[7)
Tai Viet Nam, co mpt so tac gia de cap den van de nay. Theo Le Minh Thong va cpng stf, benh thtfdng gap d do tuoi 20 den 30, ty le Nam/Ntf la 1:2,1. Dieu tri bang corticosteroid co hieu qua cai thien thj Itfc sau 2 tuan, cai thien thi trtfdng dan theo thdi gian 2 tuan, 1 thang, 3 thang va 6 thang^^'.
Tai benh vien Chd Ray, benh ly viem thj than kinh kha thtfdng gap, vdi stf ho trd cua cac chuyen khoa than kinh, tham do chtfc nang va Chan doan hinh imh, de tai ''Nghien ciiii ISm sSng va kei qua dieu tri viem thi than ldnh hau nhan cau"6\iac thtfc hien vdi cac muc tieu:
- Danh gia ve lam sang va can lam sang benh viem than kinh thj sau nhan cau tren benh nhan den dieu trj tai benh vien Chd Ray.
- Phan tich ket qua dieu trj tren benh nhan viem than kinh thj sau nhan cau vdi corticosteroid.
tl. o6l TUpNG VA PHUONG PHAP NGHIEN CCU:
2.1. DcS tu'0ig nghien ah/: Benh nhan viem than kinh thi sau nhan rau dudc dieu trj tai Benh vien Chd Ray ttf 01/1/2011 den 31/12/2011.
Tieu chuan chgn miu: Benh nhan dtfdc chan doan viem than kinh thj sau nhan cau tren
mpt mat thdi gian ttf liic co trieu chtfng khdi phat den llic dieu tri < 2 tuan. Mat con lai thj Itfc sau chinh ki'nh > 8/io, thi trtfdng, VEP binh tiitfdng.
Khong co benh ly khac lam anh htfdng den thj Itfc, thj trtfdng, VEP.
Tieu chuan loai trO':
Benh nhan co benh ly viem thi than kinh, xd ctfng rai rac da dtfdc theo doi, dieu trj ttf trtfdc.
Benh nhan dang dung thuoc hoSc benh ly khac anh htfdng den sac giac.
Benh nhan khong hdp tac khi do thj trtfdng, VEP, sac giac.
Benh nhan khong dong y tham gia nghien ciili 2.2. Phu'dng phap nghien cu'u
Thiet ke nghien cuV
Tien ctfu, quan sat, mo ta tam sang, lay mau hang loat trtfdng hdp
Phu'dng phap tien hanh
- Chpn benh nhan du tieu chuan dtfa vao mau nghien ctfu.
- Thtfc hien cac kham nghiem lam sang va can lam sang.
- Oieu trj bang corticosteroid lieu cao: stf dung solumedrol 1000 mg pha trong 50ml glucose 5,0% truyen tmh mach XXX gipt/phiit.
Trong 3 ngay, sau do uong prednisone 11 ngay vdi lieu Img/lkg can nang.
Benh nhan dtfdc chia ra 3 nhom theo thj Itfc khi nhap vien.
-Nhoml: Thi Itfc ST (-) - Nhdm 2: Thi Itfc ST (-1-)-1/10.
- Nhom 3:Thiltfc>l/10
III. KET QUA NGHIEN COU^
3.1. Ket qua ve djch te
Benh nhan viem than kinh thj sau nhan cau dtfdc dieu tri tai Benh vien Chd Ray ttf 01/1/2011 den 31/12/2011 du dieu kien dtfdc chpn vao nhdm nghien ctfu la 68.
3.2. D3c diem ve gldl tinh Nam; 18 (26,5%). Ntf: 50 (73,5%) Nhtf vay benh nhan ntf chiem da so vdl ty le 2,8 niJ'/l nam.
TuSi
Bang 1:-Tu6\ cua benh nhan viem than kinii thj sau nhan cau (n = 68)
Tudi2 0 - 3 0
> 30 - 40
> 40 - 50
>50 Tonq so
Sd lu'O'ng 36 22 07 03 68
Ty 1? (%) 52.9 32,4 10,3 4,4 100,0
Y HQC VigT NAM THANG 4 - s6 2/2013 Benh gap d dp tuoi 20 den-40 chiem 85,3% trong nhom nghien cuu.
Bang 2: Phan bo nghe nghiep ciia benh nhan (n = 68)
Ngh6 nghidpNong dfln Cong nh^n Nghe bi^n~
HQC sinh, smh vi!n Ngh^ khac
f 6 n g s<^
8 6 l u y n g Ti lg %
Sd Itfdng benh nhan la cong nhan chiem ty le 30,9 %, cao hdn so vdi cac nganh nghe khac.
3.3. Cac bieu hign lam sang
7 J ; Thdi qian khcfi phat berThd'i qian
< 48 qid-
> 48 giCT - 72 giff
> 72 qidy - 7 nqay
> 7 nqav-10 nqay
> 10 nqay- 14 nqay Tdnq sd
h den l<hi nhap vien {n=68
Sd lu'O'ng09 19 23 12 05 68
T'j If (%) 13,2 27,9 33,8 17,7 7.4 100,0
Benh nhan den kham trirdc 48 gicf chi co 13,2 %. Ba so den sau 2 den 7 ngay.
g 4. Thi ll/c benh nhan khi n Thi lyc
S T H ST(+)aenBNT1m T0'DNT>1mtlGn 1/10
Tir > 1/10 den 3/10 Tu'>3/10
Tdnq sd
hap vien (n=68)
Sd lu'ong21 26 14 04 03 68
Ty le (•/.) 30.9 38.2 20.6 5.9 4.4 100,0
Thj lire khi benh nhan den kham va dieu trj rat thap. Co 30,9% benh nhan co thi li/c ST (-) Tinh chat giam thj iiTc thu'crng tir tCr, co 5 benh nhan giam dot ng6t.
Bangs; Bieu hien lam sang tren benh nhan viem tiian kinh thi sau nhan cau
B i l u hien lam sangOau khl van fldnq nhan cau Ton thu'O'ng dong Mn hu'dng tam Hinh anh gai thi binh thu'dnq Thj tru'd'ng
-Am diem trung tam -Am drem canh trung tam -M^t thi tru'dng ngang
Cd dau hi$u than kinh khu trii. te mdi chi
Sd lup'ng 56/68
10/17 03/17 04/17
Ty Id (%)
58/8%
5,9%
7,4%
3.4.Cac dau hieu can lam sang Bang 6: Bien the qgi thi giac (VEP) (n=681
lylat binh thu'dng
Thdi glan tidm phue '100 Imsl
- Thc(i gian tiem phue PlOO (ms): keo dai thong ke, (P= 0,005)
Bien dp PI 00 (mV)
vfli mat khong bj benh, si/ khac biet co y nghia Bien do PlOO (pV): giam so vdi mat khong bj beni, sir khac biet co y nghia thong ke (P=0,001)
^^icS^ ' " ' " " " ' " " * ' ""^ " "'°' * * ' ' " ^'^' *=> ^"^ "^^" '^° t^i?" '"-^ng Slim hole
roi loan sac giac.
Y HQC VI$T NAM THANG 4 - S6 2/2013 Hinh anh MRI:
Bang 7: Hinh anh tren MRI ciia than kinh thi va mo nao (n=6l Hinh anh IVIRI
Tren than kinh thj - TSng tin hi^u va kich thu'O'c
Tin higu v^ kich thu'6'c BT Trfin mo nSo - Ton thu'ong ch^t tr^ng MS - T6n thiygng chM triing bgnh ly mgch m^u
S6 luyng Tyi#(%)
26,5 10,3
3.5. K€t qua dieu tri
Benh nhan dtfdc dieu tn bang:Methylprednisolone, lieu 500 mg x 2 lan / ngay x 3 ngay, pha trong 50ml glucose dang trtfdng, truyen tinh mach cham XXX gipt /phiit.
Sau do:
- Udng prednisone vdi lieu Img/kg can nang x 11 ngay.
- Phdi hdp thuoc bao ve mem mac da day.
Bang 8: SQ phan tram trung binh cai thien thj Itfc sau dieu tri tfnh theo thdi gian (n=68)
Thj Ig'CNhdm ST (-) (n=2)) Nhdm ST (+) den 1/10 ln=40) Nhdm>1/10(n=7)
1 2 tudn 22.8 %
±8.6 28.4%
±10.7 31.2%
±3.2
1thdnq 24 2%
±6 3 30.6%
±8.2 34.6%
±4,1
3 thanq 27,4 %
±7,3 32,7%
±9,3 36,8%
±5.6
6 thanq 28.3 %
±6.2 33.5%
±6.2 37.6%
±4.6
Nhtf vay tat ca cac nhdm thj Itfc deu cai thien sau khi dieu trj, song d nhdm thj Itfc ST (-) cai thien it hdn. Stf khac biet nay co y nghTa thong ke (p=0,005).
Bang g 5/Thi li/c benh nhan sau 6 thanq dieu tr
Thi lu'cST(-) ST(+)denDNT1m Tir BNT >1m den 1/10
Tu'> 1/10 asn 3/10 Tir > 3/10
Tdng sd
(n=68) Sd lu'O'ng
5 7 11 16 29 68
Tyld(%) 7.4 10.3 16.2 23.5 42.6 100,0
IV. BAN LUAN:
Trong nhdm benh nhan dii dieu kien nghien ctfu, ntf CO ty le cao, vdi 1 nam/2,8 ntf. Phii hdp vdi nghien ctfu trong ntfdc ciia tac gia Le Minh Thong va cong sxP-^ cho biet ty le benh nhan nam/ntf la 1/2,1, cung nhtf nhieu tac gia tren the gidi nhtf Katz B. phan tfch tren 457 benh nhan, cd 77,0% la benh nhan nij^^^
Tuoi benh nhan da so < 50 tuoi, trong do ttf 20 den 40 tuoi 85,3%. Chi cd 3 benh nhan >50 tuoi (4,4%). Phu hdp vdl danh gia trong nghien ctfu cua Le Minh Thong: tuoi benh nhan tap trung ttf 20 den 50 tuoi, cao nhat: 20 den 30.
Tren the gidi: Chan JW. cho biet benh nhan cd tuoi ttf 16 den 55. Theo Beck RW. tuoi benh co the gap ttf 10 den 70 tuoi. Nhtf vay, cac tac gia deu thong nhat benh xay ra d do tuoi tre hoac ttfdng doi tret^i't^^'t^i't'i.
Thdi gian benh nhan dtfdc nhap vien va chan doan benh thtfdng trtfdc 7 ngay, trong do benh nhan den trtfdc 72 gid: 41,1%. Theo nghien ctfu ciia tac gia Le Minh Thong, thdi gian khdi phat ttf 1 den 7 ngay co 74,2%. Choi M Y cho biet khdi phat ttf 5de 10 ngay'^ Song, danh gia chfnh xac thdi gian khdi phat benh tren benh nhan trong hoan canh ntfdc ta thtfc stf la dieu kho khan, vi cd nhieu trtfdng hdp ngtfdi benh khong biet ma chi tlnh cd thay 1 mat bi giam thi Itfc roi di kham.
Th! Itfc benh nhan khi nhap vien giam nhieu theo htfdng tang dan. Thj Itfc ttf sang toi (-) den DNT Im chiem 69,1%. Thj Itfc >3/i0 chi co 4,4%. Oieu nay phii hdp vdi nghien ctfu ciia tac gia Le l^inh Thong, Choi 1^1 Yt^i't^'.
Cd 82,3% benh nhan nhan thay cam giac
dau khi van dpng nhan cau, co the giai thfch do
Y HQC VI$T NAM T H A N G 4 - S6' 2/2013 hien ttfdng mat my- e - lin, cac sdi true ciia than
kinh thj eg sat trtfc tiep vdi cac sdi ke can nen vdi sdi cam giac se tao cam giac dau. Song mtfc do rat khac nhau tuy theo stf chju dung va nhay cam cua ttfng ca the.
Khi kham lam sang, soi ho§c chup hinh day mat, hinh anh gai thj thtfdng khong cd bieu hien gi dac biet, dieu nay phu hdp vdi trieu chtfng kinh dien ciia viem than kinh tlij sau nhan cau va nhieu nhan xet ciia cac nghien ctfu trong ntfdc cung nhtf tren the gidi. Ton thtfdng dong ttf htfdng tam gap d tat ca cac benh nhan. Dieu nay xay ra do sdi true ton thtfdng, toe dp dan truyen bi anh htfdng, ttf do dong ttf dan ra de co the nhan dtfdc anh sang nhieu hdn. Nhtf vay day la mdt dau hieu lam sang co gia tri trong chan doan va theo doi benh.
Cac dau hieu than kinh khu tru nhtf te moi chi chi gap d 20,6% benh nhan, thtfdng la nhe, benh nhan cam nhan du'dc khi benh khdi phat.
Oieu nay phu thuoc nhieu vao y thtfc cua ttfng benh nhan.
Ton thu'dng than kinh thi, thi trtfdng thtfdng rat du'dc quan tam, song vi giam thi Itfc nhieu, khong the kiem tra tren tat ca benh nhan. Trong nghien ctfu nay cd 17 benh nhan (25,0%) do dtfdc thi trtfdng, trong do 58,8% cd am diem trung tam, am diem canh trung tam gap 5,9% va mat thi trtfdng ngang: 7,4%. Nhtf vay, thi tru'dng khong c6 gia tri nhieu trong chan doan, nhtfng can thiet de theo doi tien trien benh trong qua trinh hoi phue.
Oien the gdi thi giac (VEP) co gia tri tham do tinh trang mat my - e - lin. Trong nghien ctfu ghi nhan thdi gian tiem phue keo dai, bien dp giam so vdl mat binh thtfdng. Co gia trj eao trong chan doan ke ca vdi cac benh nhan da hoi phyc chtfc nang thj giae gan nhtf binh thtfdng. Giup danh gia tinh trang mat my - e- lin tien lam sang ciia than kinh thj. Dong thdi dieu nay cung dtfdc tfng dung de ehan doan xd ctfng rai rac''^'^^^'.
Viec kiem tra sac giac rat kho thiTe hien do thj lire benh nhan giam nhieu. Cd 7 benh nhan dtfdc danh gia, thay hien ttfdng giam hoac roi loan sac giae.
Tren hinh anh MRI, co 86,8% tang tin hieu va kich thtfdc thj than kinh. Tren mo nao, g i p 26,5% hinh anh ton thtfdng ehat trang tren T2W, song CO ve nam d phan sau hdn so vdi benh xd etfng. Dieu nay phu hdp vdi nhan xet ciia tae gia
Le Minh Thong va Choi M Y. '^^'t^^ Nhtf vay MRI la phtfdng tien co the ho t r d chan doan va theo doi danh gia mtfc do dap tfng dieu t n .
Ket qua dieu tri vdi corticosteroid, nghien ctfu nhan thay da so thj Itfc h)enh nhan bat dau hoi phue sau 10 ngay den 2 tuan dieu trj, sdm nhat la ngay thtf 4. Sau do tang dan, mtfc dp on djnh thj Itfc d thdi diem khoang 6 thang. Phii hdp vdi nhan xet ciia Chan JW.: Thj Itfc hoi phue trong vong 2 den 3 tuan, kaD dai tdi 6 thang ho§c cd the hdn^^^
Nhtfng benh nhan khi bSt dau dieu tri co thj Itfc ST (-) hoi phue kem hdn nhom benh nhan co thi Itfc ttf ST ( + ) t r d len. Benh nhan thi Itfc ST (-) len 2 hang co 66,7%, trong khi benh nhan thj It/c ST ( + ) t r d len ty le nay la 8 9 , 4 % . Thdi gian nhap vien, phat hien benh t t f khi khdi phat ciing co anh htfdng den ket qua. Neu den trtfdc 7 ngay, thi Itfc tang 2 hang se la 8 4 , 3 % , sau 7 ngay:
64,7%. Tuoi benh nhan < 40, mtfc dp tang thj lu'c cao hdn nhu'ng stf khae biet khong co y nghTa. Gidi tfnh khong anh htfdng den ket qua dieu tri.
V. KET LUAN:
- Benh viem than kinh thj sau nhan d i u , ntf thtfdng gap hdn nam, vdi t y le 1 nam/2,8 ntf.
Benh nhan ttf 20 den 40 tuoi ed 85,3%. Thcfi gian nhap vien va chan doan trtfdc 7 ngay co 83,4%, trong do benh nhan den trtfdc 72 gid 4 1 , 1 % . Thj li/e giam nhieu, theo htfdng tang dan. Ton thu'dng dong ttf htfdng tam.
- Roi loan sac giae. Oien the gdi thj giac (VEP)cd thdi gian tiem phue keo dai, bien do giam. Tren MRI, cd 8 6 , 8 % tang tin hieu va kfcli thtfdc thi than kinh.
- Ket qua dieu trj vdi (xirticosteroid, thi lu'c thtfdng hoi phue sau 10 ngay den 2 tuan, sdm nhat la ngay thtf 4, sau dd tang d i n , mtfc dp on djnh thj Itfc sau 6 thang. Benh nhan khi bat dau dieu trj co thi Itfc ST (-) hoi phue kem hdn nhdm benh nhan CO thi Itfc ttf ST ( + ) t r d len. Thdi gian nhap vien, dieu trj < 7 ngay, ket qua tdt hdn den muon.
TAI UEU T H A M KHAO:
1. Dang Xuan Mai, " Khao sat su" bien doi ciia dien the goi thi giac trong benh ly dau than kmh thj", Y hgc thanh pho Ho Chi Minh, phu ban ciia tap 11, So 1, DHYDTP HCM., (2007), trang: 92-98.
2. Le Minh Thong va cong sy", "Danh gia chan doan va ket qua dieu tn viem than kinh till hau
Y HQC VigT NAM T H A N G 4 - S6 2/2013 cau", Y hpc thanh pho Ho Chi Minh, phu ban ciia
tap 14, So 1, (2010), b-ang: 62-67.
Arnold A C , "Evolving management of optic neuritis and multiple sclerosis". Am J Ophthalmol, (2005), 139, PP: 1101-1108.
Beck RW., et al "Visual function more than 10 years after optic neuritis; experience of the Optic Neuritis Treatment Tnal", Am J Ophthalmol, (2004), 137, PP: 77-83.
5. Chan JW., "Optic neuntis in multiple sclerosis", Occular Immunology and Inflamation, (2002), VIO (3), PP:161 -186.
6. Choi MY. et al, Optic neuritis associated with multiple sclerosis in Koreans", Neuro- ophthalmology, (2000),V23 (2), PP: 75-82.
7. Katz B,, et al, "The dyschromatopsia of Optic Neuritis: A descriptive analysis of data from the Optic Neuritis Treatment Trial", Trans Am Ophthalmol Soc, (1995), 93, PP:685 - 708.
TiNH HINH MAT RANG HAM SUA S ^ CUA HOC SINH TRUIffNG TIEU HOC PHUNG CHAU, HUYEN CHUONG MYJP. HA NOI
TOM
T A T :Kham rang mieng va phong van toan bo hgc smh khoi 3 va khoi 4 gom 185 hoc sinh (HS) 9 - 10 tuoi, da moc du rang ham Idn vinh vien thtf nhat va da moc dii 4 rang ctfa vTnh vien cua tru'dng tieu hoc Phung Chau ChL/dng My Ha Noi cho ket qua: Ti le hgc sinh da mat rang ham stfa sdm (MRHSS) la 22,70%. Ti le MRHSS t i c loai xet theo vi tri rang: Ring ham stfa (RHS) th0 2 h^m du'di cao nhat: 44,90%, RHS thtf 1 ham trdn thap nhat: 7,14%. So hgc smh co mgt cung rang bj MRHSS la 83,33%, co 2 cung rang bi MRHSS la 11,90%. Nguyen nhan MRHSS chu yeu do bien chtfng sau rang: 92,86%.
SUMMARY
SITUATION OF PREMATURE LOSS OF DECIDUOUS MOLARS ON MALOCLUSION OF CHILDREN IN PHUNG CHAU PRIMARY SCHOOL,
CHUONG MY DISTRICT, HA NOI Dental examination and interviewing of all 185 pupils of grade 3 and grade 4 at 9 - 10 years old who have had full first permanent molars and have had full 4 permanent incisors m Phung Chau Primary School, Chuong My, Hanoi causes result: That pupil rate who have early losing primary molars is 22,70%. Rate of losing primary molars of each type under tooth position: The highest losing rate of second primary molars in lower jaw: 44,90%, the lowest losing rate of the first primary molars in upper jaw: 7,14%. The number of pupils that have a part of jaw early losing deciduous molars is 83,33%, the number of pupils that have two parts of jaw early losing deciduous molars is
* B$nh vi$n Vi$t Nam Cu Ba Ha N^i Phan bi#n khoa hpc: PGS.TS. B6 Quang Trung
Oao T h j D u n g * , Phung Thj Thu H a * 11,90%. Early losing deciduous molars are caused by side - efect of tooth decay: 92,86%.
I.
OAT VAN DEHam rang siJa gom 20 chiec mpc xong liic 2 tuoi, ttf 6 den 12 tuoi la ltfa tuoi co ham rang hon hdp, rang sifa se dtfdc thay the dan bang rang ylnii vien.
a ntfdc ta, ty le sau rang d hoc sinh (HS) cdn cao dae biet la rang stfa, viee dieu tri sau rang cho tre edn chtfa dap tfng dtfdc nhu cau.
Theo dieu tra stfc khoe rang mieng toan quoc nam 2002 cua Tran Van Trtfdng va cong stf thi ty le sau rang stfa la 84,9%, ty le sau rang cao nhtfng ty le dtfdc han rat thap dan den phai nho rang sdm.
Hdn nffa, stf thieu hieu biet va quan tam o i a cae bac cha me, cho rang rang stfa se dtfdc thay bang rang vTnh vien nen khong can cham sdc va y thtfc ve sinh rang mieng kem eiia HS lam cho tinh trang sau rang tram trpng hdn, nhanh ehdng bi viem ttiy, viem quanh cuong va nho rang sdm, dan den mat khoang. Day la mot trong nhtfng nguyen nhan phai chinh nha sau nay [2],[6]. Vi vay, gdp phan dtf phong lech lae rang cho HS chiing toi tien hanh nghien ctfu de tai vdi muc tieu sau: Tinh hinh mat rang ham stf& sdm va nguyen nhan mat rang ham stfa sdm d HS 9- 11 tuoi trtfdng tieu hpe Phung Chau, huyen Chtfdng My, thanh pho Ha Noi.
