Y HOC VigT NAM THANG 4 - s 6 2/2015 ehinh kfnh ciia benh nhan cao va tang dan t d 1
ngay sau mo den 3 thang, thj Ide 20/20 sau 3 thang chlem t i le 7 9 % va 9 5 % ed thj Idc cao hdn 20/40. Thj Idc chinh kfnh eiia benh nhan van bao toan sau md va ed 5% tang tlij Idc len 1 hang.
Trong phan thi Idc ehinh kinh, d niidm ed dp loan thi eao thj tang i hang nhieu hdn so vdi dp loan thj thap, CO the glal thfch vi trddc mo vdi dp loan cao nen dp quang sal eao, lam thj Ide khdng cao bang liic sau phau thuat. Dp cau tddng dddng sau phau thuat 3 thang trong khoang ±0.13D chiem t i le cao, tuy ciing cd mpt sd trddng hdp thSng chiiih va thieu chinh. Qua do eung phan nao the hien ddde tinh hieu qua va an toan ciia p h l u thuat SMILE. Ket qu^ nay tddng t d vdi ket qua ciia cac tac gia Kim [ 4 ] , Ivarsen [ 2 ] , Sekundo [ 5 1 Verdaguer [ 6 ] .
Sau phau thuat, tai eae thdi diem tai kham dp eau tu'dng dddng tiiay ddi khdng nhieu va s d kliae biet khdng cd y nghTa thong ke, Ngoai ra, sd khac biet giCi^ hai nhdm loan thj eao va thap cung khong cd y nghTa. Dieu nay cung the hien d thj Idc^khdng chinh kfnh, thj Ide tang d tuan 1 sau md va sau do gan nhd dn djnh. Trong nhuhg nghien cud thdc hien theo doi sau 6 thang, 1 n i m cun^ ghi nhan ket qua tu'dng t d . Do do, p h l u thuat SMILE cho thay b'nh dn djnli qua thdi gian bat dau tir 1 tuan sau p h l u thuat.
V. Kir^LUjaiN
Phau thuat SMILE cho thay tinh an toan, hieu qua va dn djnh trong dieu tri loan thj ca dd cab va t h i p . So vdi p h l u thuat LASIK thi dp leeli tnjc va dp try ton d d sau phau thuat tddng t y
Tuy cd sy thieu chinh it va xoay true nhdng khdng anh hddng nhieu den thj Idc ciia benh nhan sau phau thuat.
TAI LIEU T H A M KHAO
1 . All et al. Companson of astigmatic correction after femtosecond lentieule extraction and wavefront-guided LASIK for myopic astigmatism. J Refract Surg. 2014;30(12):806-811
2. Ivarsen A, Hjortdai 1. Correcbon of myopic astigmatism with small incision lentieule extraction. J Refract Surg. 2014;30(4): 240-247.
i . Ivarsen A, NDser K, Hjortdai J. Laser in situ keratomileusis for high astigmatism In myopic and hyperopie eyes. J Cataract Refract Surg.
2013;39:74-80
4. Kim et al. Efficacy, predictability, and safety of small incision lentieule extraction: 6-months prospective cohort study. BMC Ophthalmology 2014; 14:117
5. Sekundo W, Kunert KS, Blum M. Small incision corneal refractive surgery using the small incision lentieule extraction (SMILE) procedure for ttie correction of myopia and myopic astigmatism:
results of a 6 month prospective study. Br J Ophtiialmol. 2011;95:335-339
6. Verdaguer P, El-Husseiny MA, Elies Daniel, Gris O, Manero F, Biarnes M, Guell J I . Small incision lentieule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism.
JEmmetropia. 2014;4; 191-196
/ . Zhang et al.: Vector analysis of low to moderate astigmatism with small lentieule extraction (SMILE); results of 1-year follow up, BMC Ophthalmology. 2015;15:8
NGHIEN CU'U VA U'NG DUNG GHEP XU-ffNG DI LOAI TRONG NANG XOANG H(y
T6IVI TAT
Nghien eiiti nang xoang hd va ghep xuong dj loai I i ky thuit \kn t3ng ehieu eao xddng ham tr^n trong ky thuat Implant nha khoa. Sau khi nang xoang, ed thg ghep xudng b/ than, xdOng dong toal dong kho
* Binh vien TLfQD 108 Chju trach nhlSm chinh: Ta Anh Tuan Email: [email protected] Ot: 0903235523 Ngdy nh$n bal: 6.2.2015
NgSy phSn blen khoa hpc: 28.2.2015 Ngay duyet bai: 5.3.2015
Tg Anh Tu^n*
khd khoang. Trong nghien edu nay chiing toi sd dgng xddng dj loai dang 4Bone ghep eho 43 benh nh§n(25 nam,18 nO^, dp tudi tudi trung binh \k 46,49, 56 Implant ddpc cay la 72 ddn vi. Chieu cao xddng ham 3-5mm chiem 55,6%, Tren 5mm ehiem 37,5%. Ky thugt ghep xddng va eay ghep trong 1 thi 93,1%.
Ghep xddng va sau 3 thang mdi caiy Implant la 6.9%.
Ket qua cay ghep thanh cong 97,2%. Qua b-inh ti§u xddng sau khi phuc hinh r^ng: khong tieu xddng chiem 39,7%, tieu dudi 1,5mm chigm 58,6%. Tieu tren 1,5mm chiem 1,7%. Kha nSng Sn nhai; Tot chiem 62%. Kha: 27%. Tmng binh 9,7%.
140
Y HOC VIET NAM THANG 4 - SO 2/2015
SUMIVIARY
REASEARH AND APPLICATION HETEROLOGOUR BONE GRAP OPEN S I N U S AUGMENTATION Research lift the sinus openings and heterologous bone graft technique is to increase the thickness of the maxillary dental implant techniques. After sinus augmentation with autologous bone graft can, freeze- dried bone demineralization fellow. In this study we used heterologous bone graft 4Bone format for 43 patients (25 male, 18 female), aged an average age of 46.49, 72 The Implant is implanted unit. Height jaw 3- 5mm 55.6%, 37.5% Over 5mm. Bone grafting techniques and implants in 1 is 93.1%. Bone grafting and implant implants after 3 months was 6.9%.
Results 97.2% implant success. The process of bone resorption after dental restorations: not accounted for 39.7% bone, accounbng for 58.6% spent less than 1.5 mm. Standard on 1.5 mm accounted for 1.7%. The ability to chew food: Good for 62%. Quite: 27%.
Average 9.7%.
Keywords: open sinus augmentation. Implant placemen. Bone grap
LDATVXNOI
Implant nha khoa la mpt ky thuat mang lai kdt qua an nhal, tham my va phat am tot [1], Chfnh vi vay, ky thuat nay ngay cang phat trien.
Tuy nhien xudng tai ndi cay ghep phai du ehieu cao, Cd nhieu phudng phap lam tang ehieu cao xudng nhdng phudng phap nang xoang hd la phddng phap hieu qua va de kiem soat. Vat lieu trong nang xoang hd co the la xu'dng ty than, xudng dong lo^l, xudng dj loai. Moi mpt phddng phap de CO nhuhg dac diem rieng. Sd dyng xddng dj loai cd the chu dpng ve khdi lddng xddng, thao tac ky thuat khong qua phdc tap, do vay trong nghien cifu nay chiing toi sir dyng xudng dj loai cd nguon gdc td xddng bo da khd khoang vdi muc tieu: Danh gia ket qua khi d0t
Implant sau nSng xoang ghip xu'dng dj ioai.II. €)0I TU'plSJG VA PHirONG PHAP NGHIEN CUU 2.1. Ddl tu'dng nghien cu'u
Nghien edu ddpc tien hanh tren 43 benh nhan, trong do gom 25 nam va 18 nEJ'
Tudt trung binh la 46,49 ± 4,284, Tudi eao nhat la 56, thap nhat la 40 tudi
Tieu chuan chpn t}enh nhan - Chieu cao xddng edn lai <2-8mm
- Tinh trang nha chu: khong ed tinh trang viem nha ehu cap tinh.
- Sde khde tdng quat tdt, cac b6nh ly y khoa dMc kiem soat tdt.
Tieu chuan loai tru'
- Dj dang xoang ham. Niem mac xoang giam chdc nang hay seo do ehan thddng, phau thuat,
2.2. Phu'dng phdp nghien cu'u:
2.2.1. Tien cii'u, mo ta cat ngang 2.2.2. M6takythu$t:
* Trang thiet bi, vat lieu:
- May ghe chu'a rang, may phau thuat cat xddng sieu am, bp dung cu nang xoang hd, - Xddng dj loai 4 Bon. Mang collagen td tieu Salvin oralmem(R)absorbab!e collagen membrance. ImplantMIs eiia Ddc
* Ky thuat:
Sir dung mui khoan tron Tungsten & tay khoan tdc dp eham, kdt hdp vdi may cat xddng sieu am de md cda sd xoang, sau dd diing dung ey cam tay de nang mang xoang, md cifa sd sao eho thanh dddi cda sd each day xoang 3mm.
Nhoi bpt xddng nang xoang theo yeu cau ky thuat. Trong qua trinh nhoi bpt xddng luon kiem soat tranh lam ton thddng mang xoang
Sda soan lo dat implant nhd hdn dudng kinh implant. Dat implant bang dyng cy chm tay de kiem soat hddng va cam glac dp on dinh ban dau. Dat mang tieu collagen, Khau tai tao vat
2.3. Tieu chi danh gia: Do chieu eao xddng ham: X quang Cone beam. Xac djnh dp chac chan gluS Implant va xddng ham: Dyng cu dat lyc
in. K ^ QuA NGHIEN CO'U Tcfng s6i: 43 benh nhan
Tudi trung btnh: la 46,49±4,284, tudi cao nhat la 56, thap nhat la 40 tudi Nam 25 benh nhan chiem 58,1%. Nu' 18 benh nhan chiem 41,9 %
Bang J/Vj tri cay Implant
Vi tri cay ghIp
R16 R17 R16,17
N (Ddn vi) 3 4 26
4,2 %
5,6
36,1
Y HOC VIET NAM THANG 4 - SO 2/2015
R26 R27 R26,27
Tonq
2 5 32 72
2,8 6,9 44,4 100,0 Bang 2: Chieu cao xddng
Chieu cao xifOng l-2mm 3-5mm
> 5mm Tdnq
N (eon vi) 5 40 27 72
»/o 6,9 55,6 37,5 100,0 3^/1^5; Phu'dng phap
PhlTdng phap cay ghep Tire thi Sau 3 thang
Tdng
N (Sdn vi) 67
5 72
93,1 %
6,9 100,0 Bing 4: Mat dd xUdnq
Loai mSt dd xu'dng Tdt Trung binh
Kem Tdnq
N (Odn vi) 58 12 2 72
80,6 %
16,7 2,8 100,0 Bang 5: Miit dp tieu xddng
Khdnq tiiu xu'dng Tieu du'di 1.5mm Tiiu trIn 1.5mm
Tdng
N (Bdn vi) 25 41 6 72
34,7 %
56,9 8,3 100,0 7ffft"Thammy
Loai Tot Kha Trung binh
Tong
N (Bdn vi) 45 20 7 72
»/o 62,5 27,8 9,7 100,0 Bangi 7: Kha nang an nhai
Tdt Kha Kem Tdng
N (Cdn vi) 52 18 2 72
°/o 72,2 25,0 2,8 100,0 Bini r A'Vi tri Implant
VI tri Nqanq mao xu'dng
TrIn mao xu'dng Du'di mao xu'dng
Tdng
N (Bdn vi) 68
1 3 72
94,4 %
1,4
4,2
100,0
Y HOC V\ET NAM THANG 4 - SO 2/2015
Bing 5."Tu'dng quan qiO^ mu'c tieu xu'Onq vdi chiet Mu'c do tieu xi/Ong
Khdng tieu xu'Ong Tieu dudi 1,5mm Tiiu tren 1,5mm
N
%
IM%
NTdng
%
%
cao xu'Onc con iai Chiieu cao l-2mm
0 0,0%
3 60,0%
2 40,0%
5 100,0%
3-5mm 6 15,0%
30 75,0%
4 10,0%
40 100,0%
> 5mm 19 70,4%
8 29,6%
0 0,0%
27 100,0%
Tong 25 34,7%
41 56,9%
6 8,3%
72 100,0%
Bing J£^;Tu'dng quan giu^ tieu xu'dng vdi mat dd xu'dnq Mii'c d$ tieu xu'Ong
Khdng tieu xu'dng Tiiu du'di 1,5mm Tllu trIn 1,5mm
Tdng
N
%
N%
N%
N%
Mat do xu'dng Tdt
23 39.7%
34 58,6%
1 1,7%
58 100,0%
Trung binh 2 16,7%
6 50,0%
4 33,3%
12 100,0%
Kem 0 0,0%
1 50,0%
1 50,0%
2 100,0%
Tong 25 34,7%
41 56,9%
6 8,3%
72 100,0%
Bing 11: JMng quan giii'a kha Chilu cao xu'dng
Chieu eao l-2mm 3-5mm
> 5mm T *
N
%
N%
N%
N%
nang an nhai vdi chieu cao xu'dng Kha nang nhai Tot
0 0,0%
26 50,0%
26 50,0%
52 100,0%
Kha 3 16,7%
14 77,8%
1 5,6%
18 100,0%
Kem 2 100,0%
0 0,0%
0 0,0%
2 100,0%
Tdng 5 6,9%
40 55,6%
27 37,5%
72 100,0%
Bing 12: Kit qua cay ghep Ket qua That bai (dao thai)
TTianh cong Tong
N (Bdn v|) 70 72
97,2 100,0
IV. BAN LUAN
- Vj tn mat rang trong nghiln cull nay d rang 26,27 chiem tdi 44,4% trong khi dd 16,17 la 36,1%. Cac vj tri so 6 hoac so 7 chi chiim ty le thap. Mat ca 2 rang thu'dng cd nghia la mat gidi han xa khd cd t h i phuc hinh eo djnh ngoai phu'dng phap eay ghep. Day cung la diem manh cua ky thuat. Chieu cao ehilm ty le Idn nhat la 3- 5mm. Vdi ehieu cao nay ky thuat Implant de dat dude li/c bam glii' sa khdi. Chieu eao 1-2 mm chi chllm 5 ddn vj
- Trong nghien eiru nay ty l | cay ngay trong thi nang xoang ghep xu'dng la 93,1%. B|nh nhan dLTdc cay ciing thi nang xoang tiet kiem du'dc thdi gian la 3 thang
- Xu'Ong ham tren la xddng xop, kha nang tieu xu'Ong cao hdn so vdi vj tri la xu'dng ham dddi.
Si/ tiiu xu'dng phu thuoc vao nhieu yeu td trong dd chat lu'dng Implant rat quan trpng. Ty 11 34,7% khdng tieu xddng tap trung vao nhdm cd xu'dng >3-5mm (bang 10) the hien chat lu'dng xu'dng vdi qua trinh tieu xu'dng. Sau khi phuc hinh, rang chiu mdt lu'c tai khi an nhai. Luc nay
Y HOC VIET NAM THANG 4 - SO 2/2015 qua trinh tieu xddng phu thudc nhieu vao chat
Idpng xddng. Chat lddng xddng tot khong tieu xddng chiem 39,7%, tieu dddi 1,5mm chiem 58,6%. Tieu tren 1,5mm ehl chiem 1,7%
- Kha nang an nhai phy thude vao kha nang chju tai ciia rang khi nhai. Vdl chieu cao xddng cang Idn thi kha nang chju tai ciia rang cang t6t[4]. Trong nghien cdu nay chieu eao xddng >5 mm la 26 rang cung la nhdm kha nang nhai cao nhat (50%) - Peleg [2] va cpng s d xuat ban mot nghien cdu nang xoang theo doi trong 9 nam cho 731 benh nhan vdi 2,132 implant 6d(ic dat dat 97.9%
Implant thanh cdng, Tae gia Jensen OT, Schulman L [3] chia chieu cao xddng ham tren Iam3 nhdm: nhdm 1 cd ehieu cao xddng cdn lai l-2mm ed t / le thanh cdng 95.9%; nhdm 2 tir 3- 5mm cd ty le thanh cdng la 98,5% va nhdm 3 CO chieu eao xddng cdn lai tren 5mm vdi ty le thanh cdng la 98.4%, Trong nghien cdu ciia chiing toi thanh eong 97,2 vdi chieu eao 3-5 mm
V . KET LUAN
Ket qua thanh cong cay ghep implant ed ghep xddng dj loai 4 Bon khi ehieu eao xddng cdn lai Idn hdn 3-5mm 97,2%. Sau phuc hinh rang tren implant 3 4 , 7 % khdng tieu xddng, tieu
< l , 5 m m : 56,9%. Tieu tren 1,5: la B,3%
TAI LIEU T H A M KHAO
1. T? Anh Tuan (2007) 'T>lghlen cifu liYig dung ky thuat implant de nang cao hieu qua phyc hinh nha khoa" die tai cap b6 quoc phong 2. Peleg M, Mazor Z, Garg AK. Augmentation
grafting of the maxillary sinus and simultaneous implant placement in patients with 3 to 5 mm of 3. Jensen OT, Schulman L (eds). Academy of
osseolntegratlonsinus graft consensus conference, Int J Oral Maxlllofac Implants 1998; 13 4. Kasemo B, Lausmaa J. Metal selection and
surface charecteristles. In:Branemark P-I, Zarb GA, Albrektsson T (eds). Tissue-Integrated Prostheses: Osseolntegration in Clinical Dentisby.
Chicago :Quintessence, 1985:99-116.
B U a C DAU DANH GIA HIEU QUA CUA PHlTaNG PHAP TRIET DOT CaN RUNG NHI KICH PHAT B A N G NANG LU-aNG S 6 N G CO T A N SO RADIO
Ph^m Tran Linh*, Ph^in Quoc Kh^nh'^, Nguyin LSn Vift*
T6MTAT
Myc tISu: Chiing tdi ti§n hanh nghign cdu triet dot qua catheter cho 42 benh nhin bj cdn rung nhi kjch phat dap iitig kem vdi diSu trj noi khoa dddi sd trd giOp lap ban do npi mac 3 chieu buong tim. D^i cu'dng: Chiing toi dieu tri tnet ddt cdn rung nhi bSng nSng ludng sdng en tan sd radio (RF) tao ra eae dudng ddt lien bjc co lap eae thanh ph^n trong tam nhT trii va tam nhT phai. Chiing toi dy^ vao he thong lap b^n do 3 ehiSu buSng tim de tao cac dddng dot lien tuc va ben vuhg. PhuWtg phdp va ket qua:
Trong 42 benh nhan nghien cufu, ehiing toi sd dung
* Vien Tim mach Viet Nam - B^nh vi^n Bach Mai Chju traeh nhiem ehinh: Nguyen Lan Viet Email: [email protected] Ot: 0913507007 Ngiy nhan bii:
Ngiy phan blen khoa hpe:
Ngiy duyet b i i :
di§n cut l^p ban do ndi mac buong tim ket hpp vdi he thdng dinh vj 3 ehieu lap ban do di§n hpc buong tim.
Chiing toi triet dot bang RF de tao ra cic dudng ddt lien tuc: mpt dddng bao quanh cac tinh mach phdi d tam nhi trai. Chung toi eung triet dot m$t so dudng khac 6 trong nhT phai, eo nhi trai de logl bo eac d khdi phat khac trong tam nhi gay rung nhT. Sau can thiep, co 37 b^nh nhan duy b-| dupc nhjp xoang (88,1%). Theo doi doc 12 tiiang tiiang cd 26/35 bpnh nhin edn duy bi ddpc nhlp xoang (74,3%) cd 11,4% benh nhgn tal phit Gir\ mng nhT. Kgt l u ^ n : Tnet dot edn mng nhT bang RF qua catheter I i mpt phddng phip dude lya chpn de duy tin nhjp xoang cho nhutig BN RN dieu frj nfil khoa that bai. Sif dung he thong ISp ban do npi m?c ba ehieu dam bao sd ehinh xac, an thoin, giam Oileu bien chiibg, giam Hidi gian thu thuat va thdi gian chieu tia X quang.
Turkhda: rung nhl - triet dot - kjch phat - RF.
