VIETNAM MEDICAL JOURNAL N''1 • MARCH • 2018
TINH HiNH Xff HOA Cff ITC DON CHUM ff TRE 0-12 THANG TUOI QUA CHU-ffNG TRiNH S A N G LOC P H A T HIEN SffM KHUYET TAT
TAI T H A I B I N H
Pham Thi Tinh', Biii Thi Thao', Pham Thi Thanh HuyV
T O M TAT
Muc tieu: Dieu tra ty le va nhan xet mot so d3c diem lam sang d tre 0 - 12 thang tuoi mac ditat xd hoa cd IJ'C don chum tai hai huy|n cua^tinh Thai Biph.
Phu'dng phap: Nghien cffu mo ta cat ngang. Sang loc 6.571 tre tff 0 - 12 thang tuoi tai 66 xa thugc_^2 huyen ciia tinh Thai Binh, Wiam lam sang de chan doaii dl tat. Ket qua nghien cffu: Ty le xcJ hoa cd ffe ddn chum d tre 0- 12 thang tuoi dffcJc phat hien la 0,35%. So tre nam bi di tat chiem 65,2%. Tre di tat co ngoi thai bat thUcfng chiem 21,7%. Tre di tat phai mo de chiem 30,45; Can thiep san khoa khac chiem 17,4%. Dl tat bSn phai chiem 65,3%. Cac tneu chimg lam sang die tru'ng la: Sd ro khoi u (100%); Dau tre ngieng ve ben benh (82,6%); Mat tre ngieng ve ben dS dien khong co dinh (100%).
Tdkhda: Dj tat bam sinh, xd hda cd ffe ddn dium.
SUMMARY
CURRENT SITUATION OF CONGENITAL MUSCULAR TORTICOLLIS I N 0 - 12 MONTH
CHILDREN THROUGH EARLY SCREENING TO DEIECr raSABOITYIN THAIBINH PROVINCE Objective: To Investigate the number of children with congenital muscular torticollis (twisted neck) and its clinical charactenstics in two districts of Thaibinh province. Methodology: a cross-sectional descriptive study was carried out and 6.571 children aged 0-12 months in 66 communes of two districts in Thaibinh province were screened to detect congenital malformations. Results: the incidence of congenital muscular torticollis in children aged 0-12 years was 0.35%. Male children with malformations accounted for 65.2%. Disabled children with abnormal pregnancy accounted for 21.7%. Deformed children having cesarean section accounted for 30.45; and deformed children that need other obstetric interventions were 17.4%. Those with right-side disability accounted for 65.3%. Typical clinical symptoms in these disabled children were: palpable tumor (100%); Children's head tilted to the disease side (82.6%); The child's face tilted to the opposite side but unfixed (100%).
Key word: Congenital malformation, congenital muscular torticollis.
I. DAT V X N OE
Xd hda cd ffe ddn chum la tinh trang benh ly xd hda mot phan ed ffe ddn chum do tff the bao
•' TrWdng Dai h^c Y DUdc Thii Binh Chju trach nhiem chinh: Pham Thj Tinh Email: [email protected]' Ngay nhan bai: 26.12.2017 Ngay ph^n bien khoa hoc: 2.2.2018 Ngay duyet bai: 12.2.2018
thai hoae tai bien trong khi sinh lam ban eheSm van dpng cua cpt sdng eo. Day la dj tat co ty |e eao, tuy nhien chi khoang 0,5% trffdng hdp duljc phat hien sdm (trong khoang 7- 10 ngay t i i % Benh hay gap d tre de ngoi ngffdc. Thong ke cua Benh vien Nhi Dong I eho thay 65% tre sinh ngffdc bj dj tat nay. Cac trieu ehffng lam sang thffdng gap la day va cffng chac d phan giife ai ffe ddn chum lam eho dau tre bi nghieng, mat xoay ve ben doi dien, ban ehe dong tac xoay cd Nhffng trffdng hdp nang cd the kem theo veo cpt song. Benh gap d ca tre nam va nff. Do benii dien bien tff tff va am tham nen thffdng bj IM qua. Tuy khdng anh hffdng den tfnh mang tre nhffng neu phat hien va dieu trj muon benh thffdng de lai nhffng di chffng lam anii hufing nhieu den tham my, chffe nang sinh hoatva Iclia nang lao dong sau nay eiia tre. Ngffdc lai, neu dddc phat hien va can thiep sdm, tre xd hda cd LTC don chijm ed the phat trien hoan toan binh tiiuQng.
Xuat phat tff eac van de tren, ehiing toi nghien cuff d ^ tai vdi muc tieu,- Dieu tra tyli vi nhin >st^
mot so dac diem lam sang dtre 0- 12 thing tuoi bi xd hda cd dc don tsi 2 huyen tinh Thii Binh.
II. 0 6 l TU'ONG VA PHU'OfNG PHAP NGHIEN ClKj 2 . 1 . Ooi tu'dng, dja diem va thdi gian nghien cu'u: Nghien cffu 6.571 tre sd smh tai 66 xa thuoe 2 huyen ciia tinh Thai Binh trong thdi gian tff 01/03/2007 den 29/02/2008.
2.2. Phu'dng phap nghien cffu 2.2.1. ThiSt ke nghiin cdu: Ap dung phffdng phap nghien eiru djch te hpe md ta qua
dieu tra cat ngang. ^ 2.2.2. Cffmai/.-Ap dung cong thffe b'nh cdmau
Thay cac gia tn vao eong thffc ti'nh dffdc n=
6.542 tre. Ttiffe te so tre trong NC la 6.571 t l | thda man yeu cau e3 mau.
2.3. Noi dung va cac bien so sff dung trong nghien cu'u:
- Thdng tin chung ve tre: Do tuoi, gidi, thuf ty
con trong gia dinh... _ ^ - Tieu chuan chan doan xd hda ed ffe ddn chQ^
Dau hieu nhan biet sdm tff 0 - 3 thang tuoi Khoi u cd the sd thay dffdc ngay sau sint hoac muon hdn (thong thffdng gap 10 ngay flei
124
TAP CHl Y HQC VigT NAM T^P 464 - THANG 3 - SO 1 - 2018 2 tuan sau sinh) vdi cac tfnh chat sau:
+ Khong ndng, dd, dau.
+ Mat do chac. Ranh gidi cd the khong ro nhffng vj tri thffdng d giffa than ed hoac khu trii gan sat dau bam cua ed vdi xffdng ddn.
+ Di dpng nhe theo cd ffe ddn chum.
+ Kfch thudc to nhanh trong nhffng thang dau.
- Han ehe tam van dpng cpt song co: Dau tre nghieng sang ben ed khdi u, mat xoay sang ben doi dien nen tre thffdng hay chay nffdc dai phia ben ed khdi u xd.
Lam sang: Khoi u nhff tren nhffng mat dd ehae hdn nhieu. Tan van ddng cpt song cd han che nhieu do khoi xd qua ehae.
- Lic mat. Mat can xffng d mat, mat ben cd khoi u c d t h e nhd hdn.
- Veo ed rd ret: Khi bien dang nang vai ben benh ed the nang len.
2.4. Cdng cu t h u thap so lieu: Bd Phieu nghien effu
2.5. Phu'dng phap xu' ly so lieu: So lieu dffde nhap va xff ly bang ehffdng trinh SPSS tai Phdng Quan ly khoa hpc - Trffdng Dai hpc Y Dffdc Thai Binh.
I l l KET QUA NGHIEN CCrU
Trong NC ehung toi phat hien dffde 23 tie cd di tat xd hda cd ffe ddn chum trong do cd 15 tre nam (55,2%) va 8 tre nff (34,8%). Ty ie gidi la 1,8.
Bang 1. Ty li dl tai theo so thd tU con trong gla d/nh
So thu* tu* con Con thu' nhat
Con thu* hai TirconthiJStrcllen.
Tong
n 15 7 I 2 3
TV le % 65,2 30,4 4,4 100 NhanxetsTre bi u xd cd ffe don chum la con thff nhat trong gia dinh chiem ty le cao nhat 65,2%. Cd 1 tre b| xd hda cd ffe ddn chum la eon thff 3 trong gia dinh.
BangZ Tyledit$t theo ngdi thai vaa^de Ngoi
thai Binh thffdng"
Bat thffdng
Mode
Cuoc Can thiep sande khoa khac De thffdng Tong
18
23
Ty le %
78,3 21.7 30,4 17,4 52,2Nhan xSt: Da so tre bi dj tat xd hda ca ffe don chum CO ngoi thai binh thffdng (78,3%). So tre bj dj tat od ngoi thai bat thffdng ehiem 21,7%.
So tre bi dj tat xd hda cd ffe ddn chum phai md de chigm 30,4%; Can thiep san khoa khac chiem 17,4%;
Bangs. Thdi dlS'm phat hien dl tat Thdi di@m phat hien
d i t a t Giai doan 56 sinh Sd sinh - < 3 thanq
3 - 6 thanq Tong
n 13 4 6 23
Ty le °/o S6,5 17,4 26,1 100 Nhan xet: Ty le tre xd hda cd ffe ddn chum dffdc phat hien d giai doan sd sinh chiem 56,5%, giai doan 3 - 6 thang chiem 2 6 , 1 % .
~' 4. Vi tri khdi xd V i t r i
Ben phai Ben trai Tong
n 15 8 23
Ty le »/o 65,3 34,7 100 Nhan xet: Ty le tre b| xd hda cd ffe ddn chum d ben phai ehiem 65,3%.
Bang 5. Cac dac diem lam sang Cac dac diem lam sang n Ty le "/o
Sd ro khdi xd Dau tre nghieng ve ben benh
Mat nghieng ben doi dien khdng co djnh M§t nghieng ben da dien co djnh
Lac mat Mat can xiTng d mat
23
0
82,6
0 Tong I 23 j 100 Nhan xet: Ve eac dac diem lam sang d tre mac dj tat xd hda cd ffe ddn chijm thi: Sd rd khoi xd: 100%. Dau tre nghieng ve ben benh: 82,6%.
Mat nghieng ben doi dien khdng ed djnh: 100%.
Mat nghieng ben doi dien cd djnh: 0%. Lie mat:
0%. Mat can xffng d mat: 0%.
IV. BAN LUAN
Xd hda ed ffe ddn chum la mpt dj tat It diidc de cap den trong eae nghien effu ve khuyet tat d tre em. Da so eae tre mac di tat nay deu dddc phat hien va can thiep rat mudn nen han ehe nhieu den ket qua phuc hoi. Mpt sd nguyen nhan iam cho phan Idn di tat nay thffdng bj bd qua la:
- Dj tat khdng gay nguy hiem tffc thdi den tinh mang ciia tre.
- ckc trffdng hdp nhe khd phat hien sdm do cae dau hieu lam sang kjn dao.
- Cac kien thffc pho thdng ve dj tat nay it dffdc cac nhan vien y te cd sd biet den.
Trong nghien cffu nay ehung tdi xin ban luan mpt so van de sau:
* V e gidi: Ket qua NC cua chimg tdi thay rang: Trong so 23 tre xd hda ed ffe ddn ehijm cd 15 tre nam, 8 tre nff. Ty le gidi la 1,8.
Mpt so quan diem da dffdc dffa ra de giai thi'ch eho sff khae nhau ve ty le mae di tat giij^
hai gidi nam va nff. Cd quan diem cho rang tre trai hay bj cac bien chiTng trong thdi ky thai
125
VIETNAM MEDICAL JOURNAL N°1 - MARCH • 201B nghen, dan den tinh trang han che phat trien
thai Irong tff eung. Tanner eho rang sff phat then cua thai nhi gai de vffdt qua tac ddng cua eae yeu td anh hffdng hdn thai nhi trai. Tuy nhien ty ie gidi cijng phu thupc vao tffng loai di tat. Mpt so dj tat thffdng gap nhieu d tre nam nhff: Sfft moi, hd ham ech (1,5/1), thoat vj ben (4/1)... Ngffdc lai eac dj tat nhff trat khdp hang bam sinh, thoat vj nao tuy lai gap tan so cao hdn d t r e em nff [1].
Ket qua NC cua Benh vien Chinh hinh - Phuc hoi chffe nang thanh pho Ho Chi Minh cho ty le:
Nam 28/39 tre ehiem t / te 71,8%; Nff 11/39 tre chiem 28,2% [4]. Trong 23 tre di tat dffdc phat hien so tre la eon thff nhat trong gia dinh chiem ty le cao nhat (65,2%); Con thff 2 chiem 30,4%
va con thff 3 chiem 4,4% (bang 1). Ket qua trong NC eiia ehiing tdi eung tffdng tff mdt so tac gia khac.
Nam 2004, Nguyen Thj Quynh Thd khlNC ve tinh hinh di tat bam sinh va dac diem nhilm sac the cua ngffdi bj di tat bam sinli tai mpt so xa eiia b'nh Thai Binh clio thay; Tre mae dj tat bam sinh la con thff nhat trong gia dinh ehiem 55,3% [5].
* V e m o t so y e u t o lien q u a n : Ket qua NC bang 2 cho thay: Trong tdng sd 23 tre xd hda cd ffe ddn chijm thi: Tre ed ngoi thai bat thffdng ehiem 21.7% (5 tre). Mo de ehiem 30,4%. Cae can thiep san khoa khac chiem 17,4%.
Ket qua NC eua Nguyen Ngpc Hffng (Benh vien Nhi Trung ffdng) d nhdm tre ed u xd cd ffe ddn chum can phau thuat cho thay: Mo de chiem ty le 9,5%. Cac can thiep san khoa khac chiem 14,3%. Ngoai ra vi tri bat thffdng eiia thai nhi trong tff eung, ngdi thia bat thffdng, can thiep san khoa... eung la nhffng nguyen nhan dffde nhieu tae gia de cap den khi nghien cffu ve di t3t nay[3],[4].
David va Mubaraek khi chup cdng hffdng tff cho 10 tre nhd ed u xd cd ffe ddn chum thay dau hieu trong cd tffdng tff nhff khi quan sat eang tay hoac eang ehan sau hpi chffng khoang. Khi eat va tiem tren tff thi tae gia cung xae djnh dffdc khoang trong cd ffe ddn chiim. Nhffng xac djnh nay da hffdng cho cac tac gia dffa ra gia thiet u xd ed ffe ddn chijm la dj tat cd tff thdi ky bao thai. Ngoai ra eae nguyen nhan trong khi sinh cung dffdc nhieu NC (fe cap den:
^ - Nam 1838 Stromeyer lan' dau tien eho rang ton thffdng khi sinh la nguyen nhan gay di tat nay.
- Nam 1944 Chandle va Altrenberg tim thay ty le tre dt tat phii hdp vdi tien sff sinh de khd khan va phai can thiep san khoa.
- Nam 1966 Sanerkin va Edwards mot lan nffa
thay rang tien sff khi sinh chiem 50% so trifSng hpp benh nhan cd u xd ed ffe ddn chijm [3].
* V ^ t h d i d i e m p h a t hien d | t a t : Ket qua nghien cffu bang 3 cho thay: Trong tong so 23 tre, cd 13 tre dffdc phat hien ngay d giai doan sfl sinh chiem 56,5%. Sd tre dffdc phat hien trong giai doan < 3 thang ehiem 17,4%; Sd tre du'dc phat hien d giai doan 3 - 6 thang ehiem 26,1%, Khdng ed tre nao phat hien sau 6 thang tuoi.
Cd sff khac biet nay la do: Trong NC ciia ehiing tdi thffe hien sang Ipc tai eong dong cho tre 0 - 1 2 thang tudi, edn tac gia nghien cu^
tren cae benh nhan den p h l u thuat tai Benh vien nhi Trung ffdng nen van ed nhffng tre phat hiin sau 12 thang tuoi.
Di tat xd hda ed ffe ddn ehijm khdng gay hiu qua den tfnh mang tre, tuy nhien neu phat hifn va can thiep mudn se gay anh hffdng nhieu d|n ket qua dieu tri cung nhff sff phat trien binh thffdng ciia tre. Chfnh vi vay, phat hien va can thiep PHCN eho eac trffdng hdp xd hda cd (fc ddn ehiJm can dffdc tien hanh e^ng sdm eang iat (Can thiep ngay sau khi phat hien thay khoi xc^.
Thdi gian vang cho dieu tri phue hoi ehffc nang la thang dau sau sinh. Thdi diem can thiep sau 3 thang trd len thi kha nang khoi giam di rat nhieu.
Can can thiep tai cac khoa PHCN theo tirhg dot va can thiep tai gia dinh trong 2 nam dau. 6 i djnh phau thuat trong nhffng trffdng hdp tre Idn, cd ffe ddn chum co rut lam veo ban co sang ben cd khoi xd [6], [ 7 ] . Muc dfch eua can thiep sdm;
- Lam mem khoi xd.
- Duy tri tam van dpng cua cot song cd.
- De phdng bien dang thff phat d sg matva cpt song cd.
Tff ket qua tren chiing tdi nhan thay rang:
Cae nghien effu tai cdng ddng mac du cdn nhiftig han che (cd the bd sdt di tat dac biet vd^ nhffiii dj tat khd phat hien vi can nhieu phffdng tien de kham va chan doan...) nhffng cung cd nhieu u'u diem. Od la viec phat hien sdm dffde nhieu loai dj tat dae biet vdi nhffng dj tat can can thiep sdm nhff xo hda cd ffe ddn chum. Vi vay trien kiiai ehffdng trinh phat hien sdm, can thiep sdm cac khuyet tat cho tre em ndi chung la viec lam thiS thffe nham han ehe cae hau qua ciia khuyet t|t,..
* V i t r i k h o i xtf: Trong NC cua chiing toi, § tre ed khoi xd ben phai ia 15 tre ehiem 65,3%
ben trai la 8 tre ehiem 34,7% (bang 4).
Ket qua HC eua chung tdi cung phii hdp vffi mdt so tae gia khae: Nguyen Ngpc Hffng Nghien cuVi tai benh vien Nhi Trung ffdng cho thay;
Trong tdng so 68 tre thi so tre cd khoi xd cd w/ucs ddn chum ben (P) la 42/68 chiem 61,6%, ben (T) la 26/68 chiem 38,4%.
TAP CHl Y HOC VIET NAM TAP 464 - THANG 3 - s6 1 - 2018
* V e mpt so dac diem lam sang: Ket qua nghien effu bang 5 cho thay cae dac diem lam sang cua tre xd hda ed ffe ddn chum la: Sd ro khdi xd: 100%; Dau tre nghieng ve ben benh:
82,6%; Mat nghieng ben doi dien khdng codinh:
100%; Mat nghieng ben doi dien cd djnh: 0%;
Lie mat: 6%; Mat can xffng d mat: 0%
So sanh vdi ket qua nghien ciru ciia Nguyen Ngpc Hffng: Sd ro khoi xd: 100%; Dau tre ngieng ben benh: 100%. (68 BN); Mat ngieng ve ben doi dien Wiong cd djnh: 100%; Mat ngieng ben doi dien co djnh: 0; Nang vai ben benh: 100%.
Nhff vay eac dac diem nhff sd ro khoi xd vung ed ffe ddn chum, dau tre ngieng ve ben benh, mat tre ngieng ve ben ddi dien ia nhffng dau hieu dac trffng d tre mac d| tat xd hda cd ffe ddn chum. Trong nghien effu nay ehung tdi khdng gap tre nao cd dau hieu lac mat hoac mat can xffng d mat. Dieu nay la hoan toan hdp ly vi ddi tffdng nghien cffu cua ehung toi ia tre 0 - 1 2 thang tudi. Mat khac 23 tre mac dj tat xd hda cd ffe ddn chijm deu dffdc phat hien sdm trong vdng 6 thang tudi. Vdi thdi gian ngan thi dj tat chffa gay anh hffdng den tff the dau, mat cung nhff cdt sdng cua tre.
Vdi cac phffdng phap dieu trj bang xoa bdp va keo gian cho ket qua phuc hoi tot ma khong can phau thuat. Ty le phau thuat d tre 3 - 6 thang tudi la 25%; Ty le nay d tre 6 - 18 thang tuoi la 70% va tren 18 thang tudi la 100%. Tae gia ciJng thdng bao ty le tre bj di tat ed tien sff san khoa lien quan la 48 tre trong do hut thai ia 4 tre, Foeeep la 6 tre. Cd 2 tre ed ngdi thai bat thffdng va 11 tre phai mo de.
V. KET LUiBiN
Dj tat xd hda ed ffe ddn chum la mpt trong nhffng dj tat khd phat hien vi vay gia dinh tre thffdng bd qua dj tat nay, ke ca can bp y te ed
sd neu khong cd nhffng kien thffc va ky nang nhat dmh. Cd dffde ket qua tren ehung tdi thay vai trd eua dpi ngu nhan vien y te cd sd dae biet nff hd sinh la nhffng ngffdi trffc tiep tham gia vao eupe de va tiep xue vdi tre sdm nhat. Vi vay, tang effdng trang bj kien thffe, ky nang ve pliat hien sdm mdt sd khuyet tat d tre em trong dd ed di tat xd hda ed ffe ddn ehum cho dpi ngu nhan vien y te cd sd ia viec lam can thiet, cap baeh nham han che hau qua cua khuyet tat va giup tre khuyet tat phat trien cung nhff hda nhap xa hdi tdt hdn.
TAI LIEU T H A M KHAO
1. Tran Thj Thu Ha^Tran Tron^ Hai (2005), "Phat hien sdrfi, can thiep sdm xO hoa cd ffe don chum d tre em", Phat hien sdm, can thiep sdm mdt sfi dang tan tat 0 tie em Viet Nam, NXB Y hoc, tr. 77 - 81.
2. Phan Thj Hoan (l£002), "M^han tfch mot so yeu to nguy cd sinh con d| tat bam sinh 6 mot so nhdm dan cu" mien bac Viet ham", Di truyen hpc va iiTig dung, Chuyen san Di truyen Y hoc, so dac biet diao m'iitig J.O0 nam TrUdng Dai hoc Y ha Noi, tr. 25 - 30.
3. Nguyen N30C Hffng (2004), "tJ xOjxJ ffe don chum", Phau thuat cliinh hinh di tat bam sinh cd quan van dong d tre em, Chinh hinh nhi khoa (Tap 1), NKB Yhoc, tr. 7 - 2 1 ,
4. Nguyen Ngoc Hu'ng (2007), "Nhan xet ky thuat Ferket trong dieu tri xd hoa cd ire don chum d tre em". Tap chi Nghien ciiu Y hoc so 47 (Tap 1), tr.
" Z3.
tinh Thai Binh", Tap chi 273/2007, tr. 4 0 - 4 5 .
, Do. Twee. T (2006), " Congenital muscular torticollis: Current concepts and review of treatment". Current Opinion in Pediatric, volume 18, Issue 1, pp 26-29.
. Lee Y.T; Yoon K.; Chung P. et all (2011),
"Clinical features and outcome of physiotneraphy in early presenting congenital muscular torticollis widi severe fibrosis on ultrasonography: A prospective study". Journal of Pediatric Surgery, vol 48 (8), pp.1526 -1531.
DAC DIEM LAM SANG V A CAN LAM SANG BENH TAC TA TRANG BAM SINH TAI BENH VIEN VIET DU'C GIAI DOAN 2 0 1 0 - 2015
T6MTAT
Mpc diu: Mo ta dac di^m lam sang va can lam sang benh nhi tae ta trang bam sinh tai benh vien Viet 'B^h vl$n Viet Dut.
^Tn/H/na d^ihoc YHi Ngi.
Chju bich nhiem ehinh: Vu Hdng Tuan Email: [email protected] Ngay nhan bai: 27.12.2017 Ngay phan bien khoa hoe: 28,01.2018 Ngay duyet bai: 12.3.2018
Vu Hong Tuan''^ Nguyen Vi6t Hoa'
Dffc giai doan tff n3m 2010 den n3m 2015. Ddi tUdng va phu'dng fjhap nghien cdu: Hoi ciru 45 trffcSng hdp mo tac ta trang bam smh tai khoa phau thuat nhi benh vien Viet Dffc tii thang nam 2010 den nani 2015. KH qua: Tat ca cac trffdng hdp (100%) deu du'dc sieu am trUdc sinh. Sieu am dffdc thu'c hien d cac tuyen y te khac nhau. Hinh anh tren sieu am ffu'dc sinh la " Bdng ddi da day" 55,8%, da oi 72,1%.Cac ffieu chffng bung ehffdng 76,7%, ia phan xu 60,5%, tren X_quang bung: 67,6% ed 2 mffc nUde hdi. Ketluan:Tai khoa phau thuat nhi benh vien Viet Dffc tac ta trang ngay cang dUdc chan doan sdm. Sieu
