chi phd huy thdnh d a nd. Trong nghidn ciru ndy, ung thy dype tim thIy thud-ng Id dgng hfln hpp vdi thd- typ UTBMT md hpc khde chd- khdng phdi Id mflt mfl hinh thuln ta^. Cdu trdc nang n h i y cd thd gdp. Cdc nang ndy thudng chd-a d l y ehlt n h i y vd dypc Idt bing te bdo d chdn hodc cdc td tido chd n h i y khde. Nhuflm PAS, cdc mdng h d c ^ m ehdt nhdy d l u duvng tlnh.
* Ung Uiy bilu mfl tuyen typ rudt: Chdng tfli ehl gdp 1 fru-dng hpp d bidn the d y trong nghien cd-u. Ddy Id m l u U13MT d ddc diem hinh thdi vd hda mfl mien d j d gidng vdi UTBMT < ^ - tivc tidng. Chin d d n ddt ra khi tiidnh phin rudt vuvt qud 50%. Chdn dodn phan biflt Uiu- typ ndy vdi di edn UTBMT dgi tn/e trdng, logi ung tiiy md khdng d hinh thdi md hpe d m$t trong UTBMT phdi nguydn phdt nhu tdng frudng lepidic.
Hinh ttidi tiiudng gdp Id d e d u friie tuydn vd/ho$c nhd, ddi khi d u tiiie dgng sdng. dupe Idt bdi d e td bdo u hinh fru eao vdi hat nhdn phdn tdng, hogi td- trang Idng vd mdnh vd nhdn ndi b$t. Khdi u bidt hda kdm d tiid d htnh tiidi dde.
K£T LUAN
Qua nghidn d u MBH eda 92 frudng hp'p UTBMT phdi, phdn logi tiieo d n g phdn logi md hpe d e u phdi eda TCYTTG (2014), didng tdi nit ra k i t ludn sau:
1. UTBMT gdp it nam nhidu hon d- nD-, fi Id nam/nu- Id 2,54/1. Bdnh ed thd gdp d tudi 20 ddn 80 song eao nhdt d nhdm tiidi 61 - 70 ( d i d m 34,78%). Cde tiid- typ d a UTBMT dd dugc tim tiidy d 92/92 tiudng hpp, trang dd khdng ed trudng hpp ndo Id tdn tiiuong tien xdm tin vd UTBMT xdm t i n tdi tiiilu. Thd- typ ehdm nang ehidm ti Id cao nhit (55,43%). kd d i n Id thd- typ nhd (18,48%) vd thi> typ lepidie (8,70%), It gdp nhdt Id biln till UTBMT typ mdt vdi 1.09%. Cd 3/4 bidn till dd dype tim thIy Id ung thu- tuydn nhiy xdm tdn, UTBMT
"dgng keo' vd UIBMTtyp mflt.
2. Vd dde didm MBH, UTBMT cd s y bidt hda dng, tuydn ho$c c h l tidt chdt nhiy cda td bdo u. Cdc t l bdo u cd nhdn Idch vd ddy, hgt nhdn rd; lypng bdo
tuong vd-a phdi, u a kidm vd thudng cd ^ ^ ^ ° ehd-a ehlt nhdy. Xde dinh thd- typ eda ^r , °^,^
vdo klch thudc, mtrc dfl xdm t i n vd hinh :!> au true chidm uu ttid (lepidie, ehum nang, nl- i ' ] " " ^ y ddc). Khi nghi ngd cd s y htgn didn eua • ^i nhdy trdn tidu bdn nhuflm HE, cd till nhuflm PAS dd khdng djnh c h i n dodn.
T A I L I $ U THAM K H A O
1. Bemard W.S. Christopher PW. (2014), Worid Cancer Report 2014, Intemational Agency for Research on Cancer, World Health Organization, Lyon.
2. Traws W.D, Brambilla E, Burite A.P, et al. (2014).
WHO classification of tumours of the Lung, Pleura, Thymus and Heart. lARC Press.
3. PhLing Thj Phu-ong Anh (1999). Typ mfl hpc d a ung tiiu phe quan qua 4 n ^ 1995 - 1998 d nhung bdnh nhdn dd phiu tiiudt. Ludn dn Thgc sT y hpc. Dgi hpc Y Hd Npi.
4. Ld Tmng Thp (2002). Ddc dilm md bdnh hpc ung thu bilu mfl tuyen phd quan theo phdn logi cua TCYTTG tin thd- 3 -1999. Bdo cdo khoa hpe Hfli nghj nghidn cd-u sinh 11/2002. Dgi hpcY Ha Npi.
5. Patrida R.M, Frank C.Dettert>eek, Dana P.Loomis (2001). Epidemiology and dassification of lung cancer.
Diagnosis and troatment of Lung Cancer. 25 - 40.
6. Nguyen Ngpc Hdng, Nguydn Hdng Phdc (2010), Nghidn edu md bflnh hpc va hoa mfl midn djch ung thu phdi tgi Bdnh vidn 103. Tgp chi Y hpc Thanh phd Ho Chi Minh, chuyen dd Ung budu hpc, phy ban. 14(5). 23 - 39
7. Phgm Nguyen Cudng.(2015). Nghien dru phdn lost mo bdnh hpc ung thu bidu md phdi tiieo WHO 2004 vd lASLC/ATS/ERS 2011 d su- dyng d l u an hoa mfl miln djch, Ludn dn Tidn sT Y h p c - Ha Nfli 2015.
8. Wartii A, Muley T, Meister M, et al. (2012). The Novel Histologic Intemational Assodation ft)r tiie Studying of Lung Cancer/American Thoradc Sodety/European Respiratory Sodety Classification System of Lung Adenocardnoma ts a Stage - Independent Predidor of Survival. Joumal of Clinical Oncology, 2.
THOAI HOA KHOP GDI U DENH NHAN GAY MAM CHAY LOAI V VA VI THEO PHAN LOAI SCHATZKER DIEU TRj D A N G KET HOP XUUNG TOI THIEU DEN TRONG
VA CO DINH NGOAI ILIZAROV
T6M TAT
Muc tidu: Tim hidu tp 1$ thoii hda khdp gdi d bdnh nhdn gdy mdm chiy loai V vi VI theo phdn loai Schatzker didu tii bing kdt hgp xuong (d; thidu bdn trtmg vd ed dinh ngoii llizamv
D&' tugng vi phuong phdp: Nghidn cuv md ti cit ngang. 105 bdnh nhdn gdy mdm diiy (20 loai V, 85 loai VI theo phin loai Schatzker) (Sdu tri bing kdt hgp xuong tdi thidu bdn tmng vi cd djnh ngodi Ilizarov.
Chgp XQ vd MRI fg/ thdi adm khdm cudi Kdt qui:
-43,8%cd thodi hda khdp gdi trdn phim XQ. Nguy ca thodi hda khdp gdi cd lidn quan ddn lOn mim ehdy
HOANGDIJICTHAI ngodi sau md(p < 0,001; OR = 9.96; KTC 95%: 2.77- 35,85); ting bd rdng mdm chiy sau md (p = 0,026; OR
= 3,71; KTC95%: 1,17-11,77)
- Trdn phim MRI: 21/34 tnrdng hop chidm 61,8%
ed thoii hda khdp.
• Tp Id tidnh nhin bj thodi hda khdp vd mdc dd thoii hda khdp trdn phim MRI phdt hidn li eao han so vdi phim XQ.
Kdt ludn: Theo dOi Idu dii dd phdt i:i6n thoii hda khdp gdi sau giy mim chiy li didu cdn u.:^t MRI hi$u qui han XQ tiong phit hi$n tp 1$ cOng ;•,., rnOc Od thoii hda khdp.
Y HOC THVC HANH (971) -
Tie khda: Giy kin mim chiy, khung c6 dmh ngodi llizatov. thodi hda khdp
SUMMARY
KNEE OSTEOARTHRITIS FOLLOWING TIBIAL PLATAEU SCHATZKER TYPE-V AND TYPE-Vl FRACTURE TREATED WITH MININAL INTERN/^
FIXATION AND ILIZAROV FIXATOR
Puqjose: Estimating the rate of knee odeoarthriUs Allowing Schatzker type-V and tpe-VI fradures treated with minimal intemal fixation and llizamv fixator
Patients and methods: Cross-sectional dudy 105 filial hadures (induding 20 Schatzker type-V and 85 Schatzker type-Vl fradumsjwere opemted with llizamv fixator and minimal intemal fixation. Xray and MRI were taken on the last visiting.
(1) 43.8% eases having signs of osteoarthritis <xi Xray images. Knee osteoarthritis was associated with lateral tibial plataeu compression fracture (p < 0.001;
OR = 9.96; 95% Cl: 2.77 - 35.85) and widening tibial p/ateeo posf-operatfon (p = 0.026; OR = 3.77; 95% Cl:
1.17- 11.77).
(2) On MRI: 61.8% cases (21/34) having dgns of osteoarthritis.
(3) osteoarthritis mte on MRI is higher than one on Xray
Condusion: a long-lasting fotlow-up after tibial plateau fmdure is neecesary for eariy indentitication of knee osteoarthritis. MRI is more effective than Xray for indentifing symptoms and grade of degeneration.
Keywords: dosed tibial plataeu fmdure, llizamv fixator, osteoarthritis.
DATVAND£
Hidn tupng t h d i hda khdp gdi bidu hidn td s y hgp khe khdp nhp khflng lidn tyc tidn d i n d i n hgp t d n bd vd cd gai xyong. Theo y vdn, ty Id thodi h d khdp d khde nhau. Nhilu nghidn edu dd dd-ng minh ring m$t khdp khdng bdng phlng, khdp m i t vdng d ttid d i n din thodi hda khdp sdm sau d d n thuong [11. [2].
Theo ddi Idu ddi dd phdt hidn tiiodi hda khdp gdi sau gdy mdm ehdy Id didu d n tiiilt. Nhilu tde gid d o ring, thodi hda'khdp xult hidn sau gdy mdm didy khdnQ3-10ndm[61,[81.
Xuat phdt td- vdn dd dd. chdng tdi tiln bdnh nghidn cd-u: 'Thodi hda khdp gdi d bdnh nhdn giy mim ehdy loai V vd VI tiieo phdn lo^i Schatzker bdng kdt hgp xuong tdi thiiu bdn tmng vi cd dinh ngodi Ilizarov'
DO) T U ^ N G V A P H U X T N G P H A P NGHIEN COU 1. Ddl ttfp'ng nghidn c i h i
Gdm 105 trudng hpp bj c h i n thyong vdng gdi d gdy mdm ehdy (20 logi V. 85 logi Vl theo phdn logi d a Schatzker). du-pc d i i u til phdu tiiudt bang kdt hpp xuong tdi thidu bdn frong vd d d\nh ngodi Ilizarov tgi B$nh vidn Chdn ttiuong d i n h hinh Thdnh phd Hd Chi Minh tir thdng 4/2009 ddn thdng 12/2011. Tdt d d e fru-dng hpp ddu d d l y dd hd so bdnh dn. phim XQ qui udc.
2. P h u v n g phdp nghidn ed-u
- Nghidn ed-u tidn edu, md td d t ngang khdng ddi d d n g .
- Chgp X-quang khdp gdi trdn hai binh didn tiling vd nghidng. Chyp d hai ehdn eho tdt d 105 bdnh nhdn.
- Chgp MRI khdp gdi ben chdn gdy 34 bdnh nhdn.
- Cde sd lidg tiiu nhdn dup'c nhdp Ndu b i n g phdn mdm Excel vd phdn tieh sd lidu vdi phdn mdm SPSS 16.0
K £ T Q U A NGHIEN CI>U
Mdc dd ttiodi hda khdp dupe d d n g tdi ghi nhdn d l l n khdm cudi b i n g chgp X quang 2 gdi, d 34/105 trudng hpp dupe d g p MRI gdi ton tiiuong tgi ttidi d i l m khdm cudi,
Thdi d i l m khdm cudi o d d thdi d i l m md kdt hop xuong gdy mdm d d y tmng binh Id 45.6 ± 8,56 thdng.
ngln nhit Id 36 ttidng. cao nhit 67 ttidng. Sd bdnh nhdn dupe theo ddi td- ndm thd- 5 trd idn chilm 28.6%.
s d bdnh nhdn ttieo ddi dudi 36 tiidng chidm 13,3%.
Bdng 1. Ty Id tiiodi hda khdp gdi tgi tiidi didm khdm cudi frdn phirn Xquang
Chdn Ml>cdd thodi hda
Khdnq B d i eid2 B«3 Bd4 Tdng
Bdn SdBN
69 30 10 3 3 105
gay Tyid%
56.2 28,6 9.5 2.9 2.9 100.0
Bdn ithdng gay SdBN
87 12 5 1 0 105
T«id%
82,9 11.3 4.8 1.0 0 100,0 Nhdn xdt: tgi tiidi (Xdm khdm cudi, ty Id bdnh nhdn cd thodi hda khdp gdi d e md-e dd d bdn ehdn gdy Id 43,8% eao hon d bdn chdn khflng gdy 17,1%. Sy khde bidt Id d y nghTa ( p < 0,001).
Bing 2. So sdnh mdc dd ttidi hda khdp gdi giO-a bdn gfiy vd bdn Idnh trdn phim Xquang
Chan gay
T Khdng
B d i Bd2 Bd3 Gd4 dng
Chan i<hdng gdy Khdng
59 28 0 0 0 87
eai 0 2 9 1 0 12
Bd2 0 0 1 2 2 5
Dd3 0 0 0 0 1 1
Tdng 69 30 10 3 3 105 Nhdn xdt: so vdi bdn d d n gdy, mdc dO tiidi h d d bdn ehdn Idnh gdp vdi ty Id It hon vd mdc dd ttidi hda khdp gdi cdng nhg hon.
Bdng 3. Mdi lidn quan giO-a mdc dfl ttidi h d khdp gdi bdn d d n gdy vdi cdc ydu td tdn thuong mdm ehdy(MC) sau md
"""ThedUida kh6p gdi Hinh thait!nTnn.siia_
Bdgdy BdiOn MC ngodi
saumd BdiilnMC tiDng sau md
LoalV Loai VI Omm 1-4 mm
Omm 1.3 mm
Khdng 15 44 45 14 63 6
Cd 5 41 19 27 39 7
P*
0,18
<
0,001 0,46
OR
9,96 KTC 96%
2,77- 35,85
Y HOC THVC H A N H (971) - S6 7/2015
edtangbd i«ngMC Bddildch MC tnrdc sau Co nit gdngdt VidmidiAp gdi sau dian thironq
Omm 1-5 mm
Omm 1-5 mm Khdng Khdnq
ca
Cd 45 14 46 13 67 2 59 0
28 18 37 9 39 7 34 12
0,026 0,54
0.82 1
3,71 1,17-
11,77 dd d bdn ehdn gdy Id 43,8% eao hon khdng gdy 17.1%. S y khde bidt Id d 0,001). So vdi bdn chdn gdy, mdc dfl tiic ehdn tdnh gdp vdi ^ 1$ it hon vd md-c khdp gdi eung nhg hon. Nhy vdy d ti gdy mdm ehdy Id yeu td quan trong ' • ttidi h d khdp gdi d ede bdnh nhdn di
(*:
gidi) Nhdn xdt:
- Nguy CO t h d i h d khdp gdi d nhdm d lun mdm ehdy n g d i sau md eao g i p 9,96 l l n so vdt nhdm khflng d ldn mdm d d y ngodi sau md (p < 0,001; OR
= 9,96; KTC 95%: 2.77-35,85).
- Nguy eo tiiodi h d khdp gdi d nhdm d tdng bd rdng mdm ehdy sau md cao gdp 3,71 tdn so vdi nhdm khflng d tdng b l rdng mdm d d y sau md (p = 0,026;
OR = 3,71; KTC 95%: 1.17-11,77)
Bdng 4. M d c dfl ttidi hda khdp gdi frdn ptiim MRI Mi>cdd1hoaihaa
Khdng thodi hda B d i Bd2 Bd3 Cdng
Sd iinp.nq bdnh nhdn {n=34) 13 11 9 1 34
T ; Id % 38,2 32,4 26.6 2.9 100 Nhdn xdt: frdn phim MRI tgi ttidi didm khdm cudi phdt hidn 21/34 frudng hpp chidm 61,8% d t h d i hda khdp gdi cdc muc dd-
Blng 5. So d n h ty Id tiiodi khda khdp gdi tgi thdi didm khdm cudi trdn phim MR! vd phim XQuang
Trdn phirr MRI
Khdng
Tfdn phim XQuang
Khflng Tdng
T6ng j 21 | 13 j 34 , Nhdn xdt: cd 8/ 34 tiu-dng hpp chidm 23.5% fren phim XQuang kdt ludn Id khdng ttidi hda khdp. nhung bdn phim MRI Igi kdt ludn d ttidi hda khdp. S y khde bidt Id d y nghTa vdi p<0,001 (test Fisher's chinh xdc)
Bdng 6. Md-e dd thodi hda khdp gdi l l n khdm cudi trdn phim MRI vd phim XQuang
Phlm MRI
Khdng B d i B«2 Bd3 Tdng
Phim XQuar^
Khdnq 13 8 0 0 21
Bd1 0 3 6 0 9
0 Bd2 0 0 3 1 4
Tdng 13 11 9 1 34 Nhdn xdt: ty Id bdnh nhdn bj ttiodi hda khdp vd mdc dd tiiodi hda khdp frdn phim MRI phdt hidn Id cao hon so vdi phim XQuang.
B A N LUAN
Theo ddi Idu ddi dd phdt hidn ttiodi hda khdp gdi sau gdy mdm d d y Id d i l u d n tiiilt. Nhilu tdc gid d o ring, tiiodi hda khdp w j i t hidn sau gdy mdm d d y k h d n g 3 - 1 0 ndm [6]. [8].
Trong nghidn edu d a chdng tdi, tgi thdi d i l m khdm cudi, ty Id bdnh nhdn ed tiidi hda khdp gdi ede mdc
.ldn iP <
_ d b d n j d i hda .,:,cing dinh nud-ng ddn , theo ddi xa.
dl • iva ivMU|j yui u ^fOVi u^Mi i iiiioi i u i ' ,_
Khi phan tich don K i n , wA hiSu chinh theo tuOl va gi*i d l tim h i l u xem y l u t l nSo trong t6n thirong mSm ch4y anh h u * n g d i n hi^n tuong tho4i k h i a Kli*P 9°'.
chCing tOi nh§n thIy:
- Nguy CO ttioS hi5a iihiip g i i a nhdm cd iCin mSm chiy ngoii sau m i cao g i p 9.96 l l n so v6i nhdm ithlng cd mn mam chay ngoai sau m l (p < 0,001; OR
= 9,96; KTC 95%: 2,77 - 35,85)
- Nguy CO thoai hda i(h*p g i i o nhdm cd tang b l rdng mSm ehdy sau m l cao g i p 3,71 l l n so vd-l nhdm khdng Cd tdng b l t«ng mSm chSy sau m l (p = 0,026;
OR = 3,71; KTC 95%: 1,17-11,77)
Nhan xdt cilia chdng tdi cQng co bSn phCi hop vdi cdc tac gid l<hac i<hi theo ddi b$nh nhan gSy mam ehdy vdi thdi gian dai.
Theo y van, t f I I thodi hda ithdp cd khac nhau.
Nhllu nghiin cdu da chd^g minh r i n g mat khdp khdng bang phSng. khdp mat vu-ng cd I h l d i n d i n thodi hda khdp sdm sau c h i n thuwng [11,[31. Hi$n Itrong thodi hda khdp g i i b i l u hi$n Id svt h?p khe khdp nhe khing lidn tgo t i l n d i n d i n h?p todn b i vd cd gai xuoing. Jensen [2] bdo cdo s y thay d i i hinh i n h XQuang cua thodi hda khdp g i i tCe md« d i trung binh (h?p khe khdp nh?) d i n miJc d i nJng (hep khe khdp todn b i vd cd gai xu^ng) id 20% d- 106 t r u i n g hop.
K i t qud nghiin cdu cua Rasmussen [7] t r i n 260 binh nhan cho t h I y cd 17% thodi hda khdp g i i sau gSy mdm ehdy cdc loai, ty l i thodi hda khdp g i i d nhdm gay hai l i i c l u Id 42%. Nghiin cO'u cOa Nikolaos vd cs [6] cho t h I y d l u hieu thodi hda khdp g i i trdn phim XQuang a 33 BN (26,4%) trong s i 12S BN, vd d l u hilu thodi hda khdp d nhO-ng b i n h nhdn gdy Schatzker V, VI id 58%. Theo Nikolaos M. va cs 83%
BN cd sy thay d i i hinh dnh XQuang sau 1 ndm d i i vdi mat mam chay bj gay thdnh nhilu mdnh n h i [6].
Ngodi chgp XQuang va chyp cdt Idp vi tinh thi chyp cing hyding tir hat nhan (Magnetic Resonance Imaging - MRI) cQng cd gia tri cao trong ddnh gid t i n thyong gay mdm chay. Tuy nhlln, do d i l u kiin kinh t l va k? thuat, da p h i n cdc tac gid s y dgng MRI d l chin doan t i n thuwng p h i n m i m k i t hop vdi gay xyong nhy sgn chdm, day ching..., [4], [5], [9]. B i n canh viic danh gid sgn c h i m , day China, MRI c i n cd kha nang ddnh gia todn t i l n hon cdc t i n thyong khic * khdp g i i trong d i c i v i n d l hep khe khdp hay thodi hda khdp so vdi phim XQuang. O 34 b#nh nhdn chgp MRI tai thdi d i l m khdm c g i i . cd 21/34 trudng hop (chilm 61,8%) c i thodi hda khdp g i i cdc mijc aO- Vd khi so sdnh vdi k i t q u i t r i n phim XQuang chunn t i i I h l y cd 8/34 tnidng hop (chilm 23,5%) t r i n phim'xQuang k i t luin la khing thoai h i a khdp, nhyng trdn :^ M R I Igi k i t ludn cd thodi hda k h d p S y khde b i l l j } nghTa
Y HOC THVC H A N H (971)
\
vdi p < 0.001. Ddng ttidi ty Id bdnh nhdn bj ttwdi hda khdp vd muc dfl ttiodi hda khdp ti^n phim MRI phdt hign td cao hon so vdi phim XQ.
K^TLUAN
Theo ddi Idu ddi dd phdt htfln ttiodi h d khdp gdi sau gdy mdm ehdy Id didu d n tiiidt. MRI hidu qud hon XQ trong phdt hidn ty Id cdng nhy mdc dfl t h d i hda khdp.
T A I U $ U THAM K H A O
1, Chih-Hsin Hsieh and et al (2010). /interior approach for posteromedial tibial plateau fractures.
Kaohsiung J Med Sd. 26, p. 130 -135.
2 Jensen D. B. and et al (1990). Tibial plateau fractures. A comparison of conservative and surgical treatment J Bone Joint Surg Br. 72: p. 49 - 52.
3. Lansinger O. and et al (1986), 7Td/a/ condylar frachjres. A twenty-years fdlow-up. J Bone Joint Surg fim.
68-A(1):p.13-19.
4. M. Parkkinen and et al (2014), TTie usehjlness d MRI and arthroscopy in the diagnosis and treatinent of soft-tissue injuries assodated witii split-depression fractures of ihe lateral tibial condyle. Bone Joint J 96B: p.
1631 - 6.
5. Maritus Paritkinen and et al (2013), Treatinent of LatemI Tibial Plateau Fmdures - Do We Need Mhroscopy? Suomen Ortopedia ja Traumatologia 36: p.
21-23.
6. Nikolaos Manidakis and et at (2010), Tlbid plateau fractures: Funtional outcome and inddence of osteoartiiritis in 125 cases. Intemational orthopeadics. 34:
p, 565 - 570.
7. Rasmussen P. S (1973), Tibial condylar tiadures:
impainnent of knee joint stability as an indication for surgical treatinent J Bone Joint Surg, 55: p. 1331-1350.
8. ROBERT D. WELCH and et al (2003), Experimental Tibial Plateau Fradures Augmented with Caldum Phosp/iate Cement or Addogous Bone Graft.
JOURNAL OF BONE AND JOINT SURGERY. 85 A(2): p, 222-230.
9. Rutii Crawford and et al (2007). Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathdogy, concentrating on meniscd leskxis and Ai^ tears: a systematic review. British l^edical Bulletin.
84: p. 5-23.
CAN THAO GO CAC KHO KHAN TRONG CONG TAG Y TE TRUING HOC
Chdng ta d l u bidt, ngudn lye tdi ehlnh eho edng tdc y t l tm-dng hpe (YTTH) hidn nay d- nude ta ndu theo vdn d n . hdu nhu duy nhit td dya vdo thdng t u sd 14/2007m--BTC (Hd Ndi. ngdy 8 thdng 3 ndm 2007 (xem mge 1.1) '^'. md "Ddi tuong thgc hidn thdng t u ndy Id d e eo s d gido dge edng Idp thude hd thdng gido dge qudc ddn theo quy djnh eda Ludt Gido dye (sau ddy gpi t i t td co sd gido dge)". Trang khi dd.
chdng ta tiily. hogt dflng YTTH eda d e eo sd gido dye d n g tdp thudc hd thdng gido dgc Qudc ddn d nuflc ta nhirng ndm qua phdi d s y giup dd r i t t i d eye cda ngdnh y td. nhung ngdnh y td Igi khdng phai Id ddl hrpng tiiyc hidn tiidng t u sd 14/2007m"-BTC cua Bfl Tdi chinh.
Xem qua thflng t u sd 14/2007/TT-BTC eda Bfl Tdi Chinh, ngudi dpc dd nghT. ddi vdi ngdnh Gido dge Ddo Tgo (GDDTj dd Id vdn bdn hop ly vd d thd dd ddp irng ddng vd ngudn kinh phi sO dgng cho d n g tde YTTH tgi cdc co so gido dge hidn nay d Vidt nam..
Nhung ehdng ta d l u dd thdy. 8 ndm qua, td- khi thdng hf sd 14/2007nT-BTC eda Bfl Tdi Chinh ra ddi eho ddn nay. edng tde YTTH tgi d e eo s d gido dge frong nude ta vdn dang g$p khd nhilu khd khdn trong hogt ddng " , nhit Id vd kinh phi. Tgi cdc Hdi nghj t d n qude triln khai cflng tde YTTH ndm 2015 vd qua ttiye td thyc hidn d n g tdc gidm sdt hogt ddng YTTH hdng ndm tgi d c tinh phia Nam. ehdng tfli nhdn tiidy. d c eo sd gido dge d nude ta hidn nay h i u nhu chi khai
NGUYIN DOAN THANH V/gn Y te Cdng cpng TP HCM -BpYti thdc duy nhdt ngudn kinh phf dupe dd Igi td- quy khdm ehO-a bdnh bdo h i l m y t l t y nguydn eua ddi tupng hpc sinh, sinh vidn ttieo quy d\nh hidn hdnh cho hogt dflng YTTH. Mpi ndm, cd noi dupe frich tgi cho hogt ddng YTTH td 15 - 20%, nhung ndm nay 2015, nhu phdn dnh cda eo sd gido dgc ti'nh Qudng Ninh tai hfli nghj tgi Dd Ndng, k h d n ndy d T hidn chi edn dupe frich Igi Id khoang 7%. Cdn hai ngudn tiln tiieo thflng t u ndy, eo s d gido dge duve phdp sd- dyng kinh phi cho cflng tdc YTTH. dd Id ngudn ngdn sdeh Nhd nude bd frt trong ehl s y nghidp gido dge vd ddo tgo hdng ndm cua cdc c o sd' gido due theo phdn d p ngdn sdch hign hdnh vd ngudn tdi tiv d a d e td chd-c, d nhdn frong vd ngodi nude h d c ngudn thu hpp phdp khde (ndu d ) thi hdu nhy khflng mdy don vj G D D T khai thdc duqc vd thye td, h i u nhu rdt hiem cde c o s d gido dge tgi ede tinh d dupe kinh phi YTTH td- nhO-ng nggdn ndy, ed ehdng, dd chi Id mdt sd tinh ed s y phdi hpp lidn ngdnh Y t l - Gido dge d l d dupe nhd-ng dd dn YTTH cho dja phuong minh, vi dg nhu thdi gian qua, d phia Bde d Hd Ndi, phia Nam Id ede tinh d dd dn edng tdc YTTH nhu tinh Bd Ria - VOng Tdu, tfnh Ldm Ddng *^'. Nhu vdy. neu dya vdo thdng t u sd 14/2007/TT-BTC cda Bd Tdi ehfnh, ddi tupng thye hidn thdng t u ndy chi duy nhdt Id ede eo s d gido dgc cdng l$p thgdc hd thong gido dye Qude ddn theo quy dtnh eua Ludt Gido dgc vd ndg sd- dgng kinh phi qga thdng t u ndy
Y HOC THVC HANH (971) - S6 7/2015
