Y HOC VIET NAM THANG 5 - SO 2/2015
Bing 12. Mdt sd thdi quen anh hu'dnq tdi sire khoe cua nou'dan fn=300) Thoi quen
Diinq chunq khan mat Chung ban chai Hut thuoc la Uonq bia ru'du An qdi ea, hai san sonq Uonq nu'de la Khdng rira tay tru'dc khi an Khdng rira tay sau khi di ve sinh Sir dunq thu'c pham bi di
So ngu'di 41 24 228 291 247 173 230 238 12
T v le (O/o) 13,7
8,0 76,0 97,0 82,3 57,6 76,7 79,3 4,0
Mot so thoi quen sinh hoat chua tot cua ng& dan trong khi danh bat xa bd anh h&dng den s&c khoe chlem ty le cao nh&: hut thuoc la 76,0%, udng bia r&du 97%; an gol ca, hai san sdng 82,3%; khong ru& tay tr&dc khi an 76,7%; khong r&a tay sau khi dl ve sinh 79,3%...
IV. KIT LUAN
Dieu kien lao dpng eiia ngu* dan danh bat hai san xa bd tai huyen Van Don cd nhieu bat ldi ve vi khi hau, tieng on, dieu kien sinh hoat, nu'de sach, bao hp lao ddng, an toan lao dpng chu'a dam bao, ngu" dan pho bien d mire do hpc van thap, ton tai nhieu thdi quen sinh hoat khdng tdt anh hu'dng siife khde ran tang cu'dng cac giai phap cai thien mdi tru'dng, dieu kien lao dpng.
T A I LigU THAIVI K H A O
1. B 9 Y t e ( 2 0 0 2 } , Tieu Chuan ve sinh lao dong dieo Quyet dinh so 3733/2002/qD-BYT, Ha Noi,'2002.
2. Ta Quang Buti (1992), " 0 nhiem tieng on tai mot s5 ddn vj thuoc nganh kinh te bien" Ky yeu cong binh Yhpc bien, Dai hpc Y Hai Phong, tr. 21-22.
3. BiJi Thj Ha (2002), Nghien c&u dac die'm moi trudng lao dpng vS cac ra loan benh ly co tfnh chat nghe nghiip cua thuyen vien van tai xang
dau dddng bien, Luan an tien si Y hpc. Hoc vi?n Quan y.
4. Le Hong Minh ( 2 0 1 2 ) , Nghiin cud dieu kien lao dpng va s&c khoe nghe nghiep cua ngd dan dM bat xabdd mot so tinh phia Nam, Luan an tien sf Y hgc, Hpc vien Quan y.
5. Nguyen Thj Ngan, Nguyen Tru'dng Stfn (2004), "ThiTc trang sire khoe va cd cau benh t^t ciia thuyen vien Vosco", Ky yeu toan vin cac di tai nghien cud khoa hpc, Nha xuat ban Y hpc.
6. Nguyen Thj Yen ( 2 0 0 7 ) , Nghien c&u dieu ki^n lao dpng va cd cau benh tat cua ngd dan etanh bat cac xa bd thupc xa Lap Le, Thiiy Nguyin, Hai Phong nim 2006, Luan vSn th?c si Y hpc, Hpc viC.). uany.
7. Rapisarda et al ( 2 0 0 4 ) , "Noise related occupational risk aboard fishsing vessels;
consideration for prevention and the protection of exposed workers", G. Ital. Med. Lav. Ergon., 26(3), pp. 192-196.
KET QUA PHAU THUAT THAY T O A N BQ KHaP H A N G VQ'IO COI DI DONG KEP
T6M TAT
Myc tieu: danh gia ket qua bu'dc dau va rut ra mot so nhan xet ye chi dinh va ky thuat thay toan bp khdp hang vdi 6 cw di dpng kep. 061 tu'dng va
* Benh viin Viet D&c
Chju tracli nhiem chinh: Nguyin Manh Khanh Email: [email protected] Ot; 0913588199 Ngay nhan bai: 19/1/2015
Ngay phan bien khoa hoc: 3/3/2015 Ngay duyet bai; l/4/20i5
Nguyen M^nh Khanh*
phu'dng phap nghien cuTu: 40 bgnh nhan dUdcthay toan bo khdp hang vdi d coi di dpng kep tir 2013-2014^
tai Benh vien Viet Dire. Ket qua nghien cufu: ty l§' rat tot 77,5%, tdt 15%, kha 7,5% theo thang di^m Merle d'Aubigne. Khong cd tru'dng hop nao trat khdp sau mo. Ket luan: Thay khdp hang toan bp vdi 6 coi di dpng kep co the la mot lya chon de han'che nguy Cd trat khdp sau mo va cai thien bien cJp van dong khdp hang, ket qua bu'dc dau kha quan ky thu^t' khong phu'c tap hdn so vdi thay khdp hanq th6ng
thu'dng. ^
Y HOC VliT NAM THAN6 5 - SO 2/2015 TWkhoa: thay khdp hang toan bg, 6 coi di dong
kep, trat khdp.
SUMIVIARY
RESULTS OF TOTAL H I P ARTHROPLASTY W I T H DUAL M O B I L I T Y CUPS Objectives: evaluate the results of pnmary total hip arthroplasty (THA) with dual mobility cups in Viet Due University Hospital. Subjects and Methods; THA with dual mobility cups were perfomed in 40 patients, Results: The functional results, according to tlie rating scale of Merle d'Aubigne, were rated as excellent in 77,5%, very good in 15% and good in 7,5% of ttie patients. The dislocation rate (the small and large articulation) was 0%. Conclusion: dual mobility cups can be a choice in patients who need THA in preventing dislocation and improving ROM of hip.
Keywords: total hip arthroplasty, dual mobility cups, dislocabon.
I.OATVANOI
Thay toan bp khdp hang la mdt trong nhiTng phau thuat mang lai nhieu ldi ich cho ngu'di benh, cd the chi dinh vdi nhieu benh ly khac nhau viing khdp hang nhu" gay co xu'dng diii, hoai tir vo khuan chdm xu'dng diil hay thoai hda khdp hang... nham muc dich giam dau va cai thien chu'c nang khdp hang [1-5]. Mac du vay phau thuat nay khong phai la khdng ed cac nguy cd hay bien chu'ng, trong do cd trat khdp hang sau mo vdi ty le trat khdp sau thay lan dau va thay lai toan bp khdp hang tir 7-25% [1]. Cac yeu to nguy cd trat khdp hang kha da dang, cd the tir phia benh nhan (tuoi, gidi, mat ddng tac dang) hoac li§n quan den phau thuat (du'dng vao, dat khdp sai tu' the, du'dng kinh chdm xu'dng diii). Trat khdp sau thay toan bd khdp hang van la nguyen nhan chi'nh, chlem tdi 32,4%
\ia 22,5% trong tong so benh nhan phai phau thuat lai va thay lai khdp hang tai Hoa ky [1]. De lam giam nguy cd trat khdp da cd nhieu cai tien trong phau thuat nhu' di du'dng mo phfa tru'dc, :ang cu'dng phan mem phia sau, tang offset, tai ap siTc cang khdi cd dang hay sir dung chdm (U'dng dill ldn hdn, Chuyen dd'i sang khdp lu'dng lire (bipolar) va Idp lot han che trat (constrained Iner) la mot giai phap tinh the trong nhu'ng Tu'dng hdp trat khdp tai dien nhu'ng cd the lam jiam bien dp van ddng va tuoi thp khdp [1-3].
Khdp hang nhan tao vdi thanh phan 6 coi di long kep (dual mobility cups) gan day da thu
hut du'dc sir ehii y nhd la mpt lu'a chpn trong phau thuat va phdng ngiTa trat khdp trong ca thay lan dau va thay lai toan bp khdp hang nhd lam tang dp viJng ciia khdp ma khong anh hu'dng den ket qua lam sang va tuoi thp khdp nhan tao [1]. 0 cdi di dpng kep du'dc phat trien bdi giao s^ Gilles Bousquet va ky sd Andres Rambert (1974), ket hdp nguyen ly "ma sat thap" ciia Charnley vdi khai mem McKee-Farrar sir dung chdm xu'dng diii cd du'dng kfnh Idn hdn de lam tang dp viTng cua khdp [4].
Muc tieu ciia khdp hang di dpng kep la dat bien dp van dpng Idn nhat cd the trong mpt 6 khdp vu'ng va lam giam nguy cd mdn ciia vat lieu khdp hang nhan tao. Gan day, tai Viet Nam da bat dau trien khai phau thuat loai khdp nay nhu'ng chu'a cd nhieu bao cao. Chung tdi thu'c hien nghien ciiu nay nham danh gia ket qua bu'dc diu va rut ra mpt so nhan xet ve chi d|nh va ky thuat thay toan bp khdp hang vdi 6 edi di dpng kep.
II. OOI TU'QWG VA PHU'OTMG PHAP NGHIIN COU 2.1. Doi tu'dng nghien cu'u
40 benh nhan du'dc phau thuat thay toan bd khdp hang vdi 6 edi di ddng kep bdi ciing 1 phau thuat vien trong thdi gian tir thang 8/2013 den thang 11/2014 tai Benh vien Viet Ode.
2.2. Phu'dng phap nghien cii'u Chi dinh: Benh nhan cd chi dinh thay toan bp khdp hang do eae nguyen nhan khac nhau (gay co xu'dng diii, hoai tir vd khuan chdm xu'dng dui, thoai hda khdp hang...)
Ky thuit: Vd cam gay te tiiy song. Tu" the benh nhan: nam nghieng 90° ve phia chan lanh.
Du'dng vao: du'dng Moore. Bpc Id khdp hang.
Lay bd chdm xu'dng diii. Doa d" coi va xu'dng diii.
Thay toan bp khdp hang loal 6 coi di ddng kep khdng cd xi mang MDM^" (Stryker, Hoa ky). 6 coi du'dc thay bang 6 coi nhan tao (shell) nhd thdng thu'dng, sau do lap them Idp Idt cd du'dng kinh phii hdp du'dc cau tao bang Co-Cr cd dp lang bdng eao. Xu'dng diil du'dc thay vdi chuoi khdp khdng xi mang, chdm xu'dng diii kim loai du'dng kfnh 22,2 hoac 28 mm se du'dc lap vdi Idp Idt polyethylene (PE) di dpng trong 6 khdp cd du'dng kinh mat ngoai tu'dng irng 38 hoac 42 mm. Dat lai khdp hang, kiem tra dp vUng va tu"
the khdp. Dan luxi kin, ap lire am. Khau phuc hoi
phan mem theo cac Idp giai phau.
Y HOC VIET NAM THANG5-SO 2/2015
Hinh 1. Hinh anh X quang tru'dc va sau mo thay toan bd khdp hang phai do thoai hda
--^-mm w^m." A * .
Tap luyen sau mo; Tap van dong thu dgng sdm khdp hang va khdp gdi ngay ngay dau sau md Ngoi day ngay ngay thiT hai. Tap van dong chii dong khdp hang va khdp goi, tap du'ng va di lai vSI khung trd dd ngay thiJ ba sau mo. Danh gia ket qua; theo Merle d'Aubigne [6].
III. K^ QuA
Chung toi da phau thuat 40 benh nhan (31 nam va 9 nff), tuoi trung binh 50,4 (22-75 tuoi).
Bang 1. Chi djnh thay toan bo khdp hang (n=40) Nguyen nhan
Hoai tu* vo khuan chdm xu'dng dui Gay CO xu'dng diJi
TTioai hda khdp hang
Hoai tilr chdm xu'dng dui sau chan thu'dng Viem dinh khdp hang
Legg-Perthes-Calves
n 26 7 2 2 2 1
Ty 1^ Vo 65,0%
17,5%
5,0%
5,0%
5,0%
2,5%
Nhin xit; Chi djnh chi'nh de thay toan bd khdp hang la hoai tir vo khuan chdm xu'dng dui (65%). 14 benh nhan (35%) bj dau ca hai ben khdp hang. 7 benh nhan co benh phoi hdp: dai thao du'dng (3 ca), cao huyet ap, nghien ru'du, ung thu' thanh quan, viem cot sdng dinh khdp.
Kich thirdc 0 coi nhan tao cd du'dng kinh tir 46-54 mm, trong do pho bien la 48-50 mm (75%). C3 chuoi thu'dng diing la 7-8 (5-10) chiem 72,5%. So lu'dng benh nhan thay chdm du'dng kinh 22,2 va 28mm tu'dng iJng la 25 (62,5%) va 15 (37,5%).
Chiing toi khong gap tru'dng hdp nao bj tai bien, bien chung trong mo. Lu'dng mau mat trong md trung binh 100 ml (50-300 ml). ThSi gian nam vien trung binh 5 ngay (4-10 ngay).
Khdng cd tru'dng hdp nao nhiem triing, tu mau hoac cac bien chirng khac (viem phoi, tac mach...) sau phau thuat.
Chiing tdi theo doi sau mo vdi thdi gian trung binh 6,2 thang, trong dd cd 25 benh nhan dUdc theo doi tren 6 thang. Khong cd tru'dng hdp nao bj trat khdp sau mo. Khong cd tru'dng hdp nao phai phau thuat lai do cac nguyen nhan trat, ket khdp, Idng khdp, nhiem triing..
Bang 2. Ket qua theo l^erle d'Aubigne (n=40) Ketj^ua
Rat tot Tot Kha Kem Tong so
n 31 6 3 0 40
Ty le % 77,5%
15,0%
7,5%
0%
100%
/VA?n xet: ty le rat tot va tot sau mo 92,5%, kha 7,5%, khdng cd tru'dng hdp nao ket qua kem,
Y HOC VIET NAM THANG 5 - SO 2/2015
IV. BAN LUAN
Chi dmh: Muc tieu ban dau ciia o cdi di dpng kep khi du'dc gidi thieu vao cuoi nhu'ng nam 1970 la giam nguy ed trat khdp sau khi thay khdp hang. Cd ehe lam tang bien dp van dpng khdp hang eua 6 cdi di ddng kep thdng qua hai khdp ndi. Trong 6 khdp thu" nhat, chom bj "mac ket" nhu'ng di dpng trong idp Idt PE (hinh IB). Khi phan CO xu'dng diii bat dau tiep xiic vdi Idp Idt PE, khac vdi loai khdp thdng thu'dng (hinh IC), d' khdp thu' hai bat dau hoat dpng giUa phan lutig cua Idp Idt PE vdi Idp vd 6 cdi kim loal (hinh ID),
Dieu nay cho phep bien dp van ddng khdp hang tang len cho tdi khi xay ra sir va cham (impingement) giu^ phan eo xu'dng dui vdi Idp vd 6 coi. Ve mat ly thuyet phirc hdp chdm-ldp lot hoat dpng nhd mot chdm xu'dng diii Idn, lam tang ty le c6-chdm va bien dp van dpng tru'dc khi khdp trat. Tren thy'c nghiem cho thay 6 edi di dpng kep vdi chdm du'dng kinh 22,2 va 28 mm lam tang bien dp van dpng cd y nghia thdng ke so vdi 0 coi thdng thu'dng cd kich thu'dc chdm tu'dng tir.
Hinh 2. Khdp thong thu'dng CA,C) va khdp di dpng kep (B,D)[1]
^,
(^ \ fm \
Tren the gidi, 6 coi di dong kep du'dc xem la luS chpn hang dau vdi bat eir benh nhan nao co nguy cd trat khdp cao sau khi thay lan dau hoac thay lai khdp hang va trat nhieu lan khdp hang.
Cac benh nhan cd nguy cd trat cao bao gom benh than kinh cd, roi loan nhan thiTc, diem ASA
>3, tren 75 tuoi cd tien sir phau thuat viing hang. |\|goai ra, khdp di dpng kep cdn du'dc chi dinh trong gay cd' xu'dng diii, sau md lay u viing hang... hay thay lai khdp hang vi bat ky ly do nao [1-4].
Trong nghien ciru nay, vdi mue dieh han che nguy cd trat khdp hang nhan tao va tang bien dp van dpng khdp hang nen chiing tdi chi djnh cho nhu'ng benh nhan hoai tir chdm xu'dng diii, thoai hda khdp hang hay gay co xu'dng diii tren 60 tuoi. Vdi nhiJng tru'dng hdp du'di 40 tuoi, chiing tdi ap dung cho benh nhan cd nguy cd trat khdp sau mo cao nhu" dfnh hang do benh ly viem cpt sdng dfnh khdp hoac thoai hda khdp hang do di chu'ng benh Perthes. Chi djnh nay cung phu hdp vdi cac tac gia khac tren the gidi [1-5].
Ky thuat: Ky thuat thay toan bp khdp hang vdi 0 cdi di dpng kep khdng ed sir khac biet nhieu so vdi khdp hang nhan tao thdng thu'dng d thi thay chuoi xu'dng diii. Tuy nhien, can lu'u y d thi thay 6 cdi la Idp lot kim loal (metallic insert) khi ddng vao Idp vd 6 col (shell) khong cd gd chdng trat nhu Idp Idt PE trong khdp thdng thu'dng, do vay, can dam bao chinh xac hu'dng ciia Idp vd 6 edi. Ngoai ra, tru'dc khi lap chdm xu'dng diii vao Idp Idt PE can thir chfnh xac chieu dai chi va dp can bang phan mem do khi da lap khdp that se rat khd khan de thay chdm xu'dng dill khac vi chdm nam "ket" trong Idp Idt PE, khac vdi khdp thdng thu'dng cd the thay de dang phan chdm xu'dng diii vdi chieu cao ciia co khac nhau.
So vdi thay khdp thong thu'dng, chiing toi thay khdng cd sd khac biet ve thdi gian phau thuat.
Hinh 3. Hinh anh X quang tru'dc va sau mo thay toan bd khdp hang trai do tieu chdm
Y HOC VIET NAM THANG 5 - SO 2/2015
Ket q u a : Nhieu nghien ciru cua cac tac gia nhu' Farizon, Philippot, Lautridou, Vielpeau... cho thay ty le trat khdp sau md thay toan bo khdp hang vdi 6 cdi di dpng kep rat thap, theo ddi sau 15 nam thay ty le trat khdp chi tir 0 - 1 % . Guyen, Ledercq va Vielpeau theo ddi sau 3-6 nam tren 167, 200 va 231 khdp hang vdi d' coi di ddng kep thay ty le trat khdp sau mo 0 % [2,4]. Mot so nghien cu'u cho thay ty ie trat trong khdp (khdp nhd) dao ddng tir 0-5,2%. Boyer theo doi 240 tru'dng hdp sau 10 nam thay ty le 4 , 1 % trat trong khdp. Philippot thay ty le tifdng tu' 4 % qua 1960 khdp hang vdi thdi gian theo doi trung binh 14 n5m [3].
Chiing tdi khdng gSp tru'dng hdp nao trat trong khdp (trat giu^ phan chdm xu'dng diii va Idp Idt PE di dong) hoac trat khdp (trat giij^
phan Idp Idt PE di ddng va 6 coi). Tarasevicius [5] so sanh ty le trat sau thay toan bp khdp hang thdng thu'dng va khdp hang di dgng kep vdi du'dng md sau tren benh nhan gay co xu'dng dui, theo ddi sau 1 nam t^ le trat d nhdm khdp hang thdng thu'dng la 14,3%, trong khi d nhdm di ddng kep la 0%. Bay la u'u diem vu'dt trpi cua khdp hang vdi d coi di ddng so vdi khdp hang nhan tao thdng thirdng.
Ket qua chung sau md cua chung tdi cung tu'dng tiT nhff cac tac gia khac vdi ty le rat tot la 77,5%, tot 15%, kha 7,5%. Nhii'ng tru'dng hdp cd ket qua kha deu la benh nhan khdp hang bj bien dang nang trffdc m d do viem dfnh hang hoac tdn thffdng ca hai khdp nhffng sau md ch(j'£
nang, bien do van dpng va sff hai Idng ciJa ngudl benh cai thien rd ret so vdi trffdc md.
Hinh 4. Hinh anh X quang trffdc va sau md thay toan bd khdp hang phai do thoai hda
Nguy cd cd the gap sau khi thay khdp hang di dpng kep la mdn Idp Idt PE. Boyer, Philippot thay ty le mdn 1,6-2% vdi Idp Idt PE the he dau [3]. Be han che nguy cd nay cac the he vat lieu sau sff dung UHMWPE sieu lien ket cheo va PE gan vitamin E. Nghien ciru ciia Bauchu (2008) khdng gap trffdng hap nao mdn Idp PE [1]. Mot bien chiihg khac cd the gap la Idng o col (t^ le 6- 8,3%), thffdng dffdc cho la thieu sff cd djnh vdi 6 coi the he dau, do vay cac the he sau deu dffdc thiet ke them cac vit giup co dinh vuHg chac 6 coi nhan tao [3,4]. Nghien ciru ciia chiing tdi do thdi gian theo ddi cdn ngan nen can tiep tuc danh gia cac nguy cd nay.
V. KE'T L U § N
Tliay khdp hang toan bo vdi 6 coi di dong kep la mot Iffa chon de han che nguy cd trat khdp va cai thi?n bien do van dong khdp hanq, CO the chi djnh vdi nhiing trffdng hdp can phau thuat thay khdp hang, dac biet tren benh nhan
cd nguy cd trat khd|3 sau mo cao. Nghien cull cho thay ket qua bffdc dau kha quan, ky thu?t khdng phffc tap hdn so vdi thay khdp hang thdng thffdng, can tiep tuc theo ddi xa hdn de danh gia cac nguy cd nhff trat trong khdp do mdn Idp Idt polyethylene...
T A I LIEU T H A M KHAO
1. De Martino I (2014), "Dual mobility cups in total hip arthroplasty", Worid J Orthop, 5 (3), pp 180-187.
2. Guyen O (2009), "Use of a dual mobility socket to manage total hip arthroplasty instability", O l Orf/iop/;e/3f/!e5, 467, pp 465-472.
3. Philippot R, Camilleri JP, Boyer B, Adam P, Farizon F (2009), 'The use of a dual-articulaBon acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years" //if Ordiop, 33, pp 927-932.
4. Vielpeau C, Lebel B, Arilouin L, Burdin G, Uatridou C (2011), 'The dual mobility socket concept: expenence viith 668 cases", Int Ortim 35, pp 225-230. ' ^
Y HOC VIST NAM THANG 5 • SO 2/2015
Tarasevicius S (2010), "Dual mobility cup reduces dislocaton rate after arthroplasty for femoral neck fracture", BMC Musculoskeid: Disord, 11,175.
Merle d'AubignD R (1970), "Cotabon chiffrDe de la function de la hanche". Rev Chir Ortho Reparatrice Appar Mot, 56 (5), pp 481-86.
DANH GIA PHUC HOI CHU'C NANG SAU PHAU THUAT NOI SOI TAI TAG DAY CHANG CHEO TRU'O'C BANG GAN Ca BAN GAN VA GAN CO* THON
T 6 M
TAT
Nghien cdu mo ta ckt ngang, danh gia phuc hoi chirc nSng van dpng sau phau thuat npi soi tai tao day chSng cheo tru'dc khdp gdi bang gan cd ban gSn va gan cd thon tren 60 benh nhan du'dc chan doan chan thuWng khdp - diit day chSng cheo trydc (DCCT) tai Vien Chan thu'dng Chinh hinh- BV Trung u'dng Quan Doi 108, nam 2010. Tap van dong sau m d Kgt qua sau m6 benh nhan phuc hoi chii'c nSng khdp goi theo thang diem Lysholm tang tu" 52 diem len 93,5 diem, ty le tot var&t tot dat 97,7%.
TWkhda: chan thu'Ong khdp goi, diit day chang cheo b'u'dc, phuc hoi chCfc n5ng
SUMIVIARY
ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION U S I N G THE SEMITENOINOSUS T E N D O N AND GRACILIS
TENDON - EVALUATE REHABILITATION Cross-sectional descriptive study, evaluate rehabilitation of anterior crucaite ligament reconstruction using the semitendinosus tendon and gracilis tendon in 60 patients diagnosed joint injury - arterior crucial ligament at Institute for Traumatology and Orthropaedics - 108 Military Central Hospital, 2010, postoperative mobilization. Results postoperative patient rehabilitation Lysholm knee scale under increased from 52 points to 93.5 points, good and very good rate reached 97.7%.
Keywords: diagnosed injured joints - arterior crucial ligament, rehabilitation
LDATVANOI
Chan thu'dng khdp goi la mot ton thu'dng thirdng gap trong chan thu'dng the thao, tai nan
*Binh vipn Viet Tiep Hal Phong
**Binh vien Trung udng Quan doi 108 Chiu trach nhiem chinh: Hoang Phi Email: [email protected] Dt: 0986668885 Ngay nh?n bai: 6/3/2015
Ngay phan bi?n khoa hpc: 6/4/2015 Ngay duyet bai: 20/4/2015
Hoang Phi*, Nguyen Quoc Dung**
lao dong va tai n^n giao thong. Chan doan va dieu trj doi hoi phai chinh xac kjp thdi de tranh nhu'ng di chu'ng khong dang co anh hu'dng chii'c nang van dpng cua khdp [ 1 ] , Cac phu'dng phap phau thuat tai tao DCCT d i u nham muc dich phuc hoi lai day chang, lam cho khdp gol vQlig t r d lai, phuc hoi lai bien do va chu'c phan cua khcfp goi cho ngu'di benh. Phau thuat tai tao DCCT bang npi sol mang lai ket qua phuc hoi chii'c nang (PHCN) nhanh hdn, tot hdn so vdi cac phau thuat khdp md. Nghien CLTU danh gia ket qua phau thuat bang ky thuat treo gan bang nut chan 6 loi cau ngoai xu'dng dui dung Retro button sOr dung manh ghep gan cd ban gan va gan cd thon. I^luc tieu: Dinh gii phyc hoi chWc ning khdp gol sau phau thuit ngi sol
W. OOI TU'QWG VA PHUONG P H A P NGHIEN CUTJ 2 . 1 . Doi tu'dng:
* Tieu chui'n Iffa chgn:
- Cac benh nhan du'dc chan doan xac dinh diit DCCT - Tuoi td 20 den 60
* Tliu chui'n loal trW:
- Tuoi du'di 20 va tren 60
- Diit DCCT tren BN co benh ly thoai hoa khdp goi - Diit DCCT kem theo ton thu'dng DCCS, cac day Chang ben.
• Cac BN CO benh noi khoa khong co chi djnh phau thuat.
2.2. C d mau:
60 BN bj dut day chang cheo tn/dc khdp gS dude dieu tri tai Vien Chan thu'dng Chinh hinh- BV Trung u'dng Quan Doi 108 Ha Noi tirthang 08/2009 den 12/2010 bang phau thuat tai tao DCCT
2.3. Phu'dng phap nghien cu'u mo t a cat ngang
Ky thuat thu thap thong tin di/a tren ho sd benh an benh nhan du'dc li/a chpn, Tieu chuan ctian doan diTa vao 1 trong nhihig tieu chuan sau: ngan keo tru'dc(H-+); Lachman(++); Pivot
