Ghi chd:
- Ldy khufin so khdi d i m : F l : lUC mut ndn h i m (kg);
F2: luc keo do duOc hidn thj trfin lift: kfi (kg);
- Ldy khufin thfing thudng: F l ' : LiiC mut ndn ham(kg); F2': luc keo do dupc hiln thj trfin luo kdjkg)
- ri ,r2: khoang c i c h tir diem c i n b i n g tdi didm dat life; r1+r2 = 23,2cm
- a Dfi chdnh l i c h luti mOt h i m khi Ifiy b i n g 2 phuong phip
KfiT L U A N
* Ldy khufin sd khdi dfim:
- Gia tri luc mut h i m g i i cfla bfinh nhfin cao (cao nhdt la 0,623kg; thdp nhfit la 0,20; trung binh khoang 0,425 kg). Kdt qua n i y efi p nghia thfing kfi vdi p<0,05.
* Ldy khufin sd khdi thfing thudng
- Gia tn luc mut h i m g i i efla bfinh nhan thfip hdn (eao nhfit la 6,567 kg; thfip nhdt la 6,175 kg; tmng binh khoing 0,321 kg), Kdt q u i n i y cfi p nghta thdng kfi vdi p < 0,05.
* Dfii vdi tUng bfinh n h i n gia tri luti mflt tang Ifin
d i n g ke oang pnuong pirap pay MIUUH a^ rwi^, - o ^ j . Lite mflt ham t5ng giup ham g i i bam dfnh tdt hon, tSng eudng luu giu* khi Sn nhai.
T A I L I $ U THAM K H A O :
1. Trin Thien Lfic, Le Hd Phuong Trang, Nguyen Thj Cdm Binh, Nguyin Hidu Hanh: Phuc hinh rSng thao tofin ham; Nha xufit bin y hoc; 2003
2. Taddei, Lfi Hd PhuOng Trang, Jean Nonclercq:
Phyc hinh rfing thao toan ham - CSn ban v l iam sang va ky thuat labo; Nha xufit bin y hpe; 2003
3. Bishop M., Lamb D.J. (1997), "A Comparison Of Two Methods For Recording The Rebuded Jaw Relation In Edentulous Subjects", Eur. J.Prosbiodont. Restor. Dent 5(1), pp. 11-15.
4. BoucherC.O. (1970), "Related Factors Of Complete Denture Constmction', Swenson's Complete Denture, pp.
3-320.
5. Taddfii C , Nonclercq J., Sehlienger A. (1998), "La Chaine Prothetique En Prothfise Complfite", Les etapes Cliniques.
NGHIEN CUU PHAN LOAI LOM NGOC 229 TRUCTNG HOP
mc DIEU TR! BANG PHAU THUAT XAM LAN Tdi THIEU TAI BENH VIEN CHO RAY
LAM VAN NOT B^nh vi^n Ch^Riy
TOM TAT
Ddt vin de: Xay dimg bang phan loai Idm nguc giUp dp dung eho mue dieh diiu tri ngiy dng tdt han.
Cd nhiiu phdn loai ldm nguc duge dua m, nhung chua cd bang phdn loai ndo dugc cdng nhan rdng rai.
ChOng tdi danh gid dd ndng eda idm nguc dua vao quan sat vd do dd sdu hi Idm trdn ldm sang ed nhiiu uu diim hdn. Trong khi Nuss D. ddnh gid mdc dg ndng da Idm ngue dua tren chgp dt Idp didn todn.
Mgc tiiu: Xdy dimg bing phdn loai ldm nguc d ngudi Viet Nam. Phuong phdp: md ti doe, tiin edu.
Kei qua: Dang diim 33 trudng hgp (14.4%,). Dang dien 169 trudng hgp (73,8%,). Thung lung 16 trudng hgp (7%,). Him nOi Idn 11 trudng hap (4,8%,), Nguc ldp 11 trudng hgp (4,8%,). Ldm nguc khdng ddi xUng cd 154 trudng hgp, tild 67.2%,. Tmng 154 trudng hap 16m nguc khdng ddi ximg. ho ldm Idch vi bin phai ed tlld da sd 76.6%,. Ldm 2/3 dudi xuang Uc 141 tnfdng hgp (61,6%). Kit tu$n: Lgl Ich cOa bing phdn loai mdi ehl dua trdn Idm sdng di phan loai ldm nguc id nhe den ndng ma khdng can dua tren can ISm sing, ding thdi ed thi lua chgn phuang phdp diiu tri thich hgp cho timg bdnh nhdn.
Tdkhda: phan loai 16m nguc DAT V A N D E
Dj dang thanh nguc dUOc chia thanh 2 nhfim, di dang thanh ngUe trudc va di dang thinh nguc sau. Dj dang thanh ngUe sau gdm gfl, veo cot sdng. Dj dang
thanh nguc trudc gfim Idm ngiJc, nguc Uc ga, hfii chflng Poland, khe hd xuong dc. tim ngoii long nguc... Trong do. lorn ngUC chiem tl le da so c i c di dang thanh nguc trudc [5, 10]. Lfim nguc la do sU qufi phat efla cac sun sUdn d^y xuOng ilc vdo bfin trong tao thanh ngUC ldm. Theo thdng ke d My trong 1000 tre sinh ra thi cd 1 tre bi lom nguc, tl Ifi nam:ni^ la 4:1.
Ldm nguc chiem 87% trong tat ca bifin dang Idng nguc. D; tat nay it xay ra d ngudi chau Phi [4, 6].
Nam 1998. Nuss D. cfing bd tong quan 10 nam kinh nghifim dieu tn Ifim ngiie bam sinh bang phiu thuat xam lan toi thieu. Phau thuat nay nhanh ehdng duoc c i c phfiu thuat vifin Ifing ngUC d My va c h i u Au Dng hfi,
TU dau nam 2008 den nay, khoa Ngoai Ldng ngiic - Mach mau, bfinh vien Chp Rfiy da trien khai phiu thuat thudng quy dieu tri 16m ngUC b^m sinh bang phfiu thufit xfim Idn tdi thieu cOa Nuss, bUdc dau cho kdt qua r i t toL Chflng tfii nhfin thay rang day la phiu thuat an toan, hieu qua, thdi gian hoi phuc nhanh va it bien ehCmg. Sd lUdng bfinh nhan Idm nguc den khim va dieu trj tai benh vifin Chp R i y ngay cang tang [1].
Vi vay, chung tfii tien hanh nghien ciifu Ung dung p h i u thuat xfim lan tdi thieu dieu tri 16m ngUC bam sinh v6i muc tifiu: "Xay dung bang phSn loai 16m ngUC d ngudi Viet Nam", nham giup cho muc dfch dieu trj n g i y c i n g tdt hOn.
Y HOC THUC HANH (881) - s d 10/2013
T6NG QUAN
Tnrdc day, phan loai 16m nguc khdng dUOe quan tam cho den khi ed su can thifip ngoai khoa sifa ehura dl tat 15m nguc. C i c p h i u thufit vifin da cfi gang x i y dong bang phan loai Ifim nguc giflp ap dung cho muc dich dieu tri ngay c i n g tfit hdn. P h i n loai ddn gian nhat gfim 2 loai: 16m nguc dong t i m v i 16m nguc Ifich tam. Dua vao vj trf hd 16m sau nhat so vdi dudng giii^
xUong ifc. Diem sau nhdt hd 16m nam tren xuong ifc goi la ldm ddng tfim, nfiu diem s i u nhdt hfi 16m nam ben phai hay bfin trai xUdng ifc gpi l i 16m Ifich tam.
Hifin nay ed nhieu phan loai 16m nguc dupe dUa ra, nhung ehu^ cd b i n g phan loai n i o dupc efing nhan rong rai. Bang p h i n loai cfla Nuss D. dua tren htnh ding hd Idm, tinh dot xiimg vfi mifc dd Idm. Bang phfin loai cfla Park H. J chia 16m nguc thfinh 7 loai ENREF 13.
Phfin loai theo Donald Nuss
Hinh 3: L6m ngiTC dang Grand Canyon D(J Idm ngtfi:: MflC dp nfing efla lorn ngUc la yeu tfi quan trong nhfit, dupe xae dmh bdi su giim khoing cich Uc-sdng. Dinh gia chfl yfiu mdc do lorn ngUC dua v i o so sanh dd sdu efla d i y hfi 16m vdi dudng kfnh trudc sau vfi vdi dudng kinh ngang cfla Idng nguo. Do ede ehieu d i i nay d i ^ vao Uiudc, hinh anh X-quang hoac trfin chup cat Idp difin toin (do Ifing ngUC d tuthfi dimg thing hay dung hon tuthe nam ngifa).
Phfin loai theo Hyung Joo Park.
Type 1 • Lom dfii xiimg.
- Type 1A: Ldm ddng tfim, dfii xdng, sau d phfin dudi xuong ii'e,
- Type I B : Lfim ddng tam, ndng. rdng, ddi xiimg.
Hint) 1 Ldm ngUC hinh chdn Hinh ddng: phan ehia dau tien cfla Idm nguc dua vao sU khac_bifit nhU: lom hinh chen - d i y sau, khu tru, hodc eho lom hinh dTa day nong v i rong hdn, hay nhu dang ngiJC lep bieu hien bang sU g i i m dudng kinh trudc sau cfla long nguc, lom nong xuong Uc va bd rdng hfi lom lien quan tdi dp ddc efla xuong sudn, bat dau vdi xupng sudn sd 2; lom hinh dTa hay nguc lep thudng khfi xde djnh r6 dupc bd cfla hfi lom.
Hinh 4: Lom ngUC Type 1A Type 2: Ldm khfing ddi xflmg.
Type 2A: Tam xuong iic nam d dudng giufa, nhung hd Idm nam d mfit bfin xuong ilc:
Type 2 A l Tfim lom nam mdt ben, khu tru.
Type 2 A2' Lom lech tam, ndng, rong mot ben.
Type 2 A3' Lom sau, dai tir xUong ddn den phan dudi Idng nguc, day la loai 16m nguc Ifich tfim nang nhat, cdn goi lom nguc dang Grand Canyon.
Hinh 2: Lfim nguc hinh dia
Tfnh ddi xdng: L6m nguc efi thfi dfii xUng hofic khflng ddi ximg vdi hd 16m nam d vj trf bfin phai vuot troi hdn bfin trai efla long ngue. Lom ngUc khdng ddi xifng duoc xae djnh bdi do xoay cfla xuong Uc vfi chieu eao efla bd hfi Ifim khdng deu d mdt bfin, hofic ca hai dupe tao ra do su keo dai khfing deu efla e i c sun sudn. Nhifiu t i c gia k h i c cung phin ehia Ifim ngirc khfing ddi xung nhu: lech tfim, khdng can bing -.^dira trfin su bdt thudng tam efla xuong iTc va tam hdlom
Hinh 5: Lfim ngUC Type 2 Al Hinti 6: Lflm nguc Type 2 A3 Type 2B: Ldm hai bfin khdng can xflng, tam lom nam d dudng giua, bd hfi Idm bfin nay thap hdn ben kia.
Hinh 6: Ldm ngirc Type 2B Loai 2C Phfil hdp Type 2A vfi Type 2B.
VHOC THUC HANH (881) - S6 10/2013
D 6 | TUpNG VA PHUONG P H A P N G H I S N CLTU Thie't ke nghifin cufu: Mfi ta dpc, tifin ciru Thdi gian nghien cflu: TU t h i n g 02 nfim 2009 dfin thing 08 nam 2012.
Dja di^m nghifin cijfu: Tai khoa Ngoai Lfing ngUC - Maeh m i u , bfinh vifin Cho R i y , Tp Hd Chf Minh.
Cd mSu: 299 bfinh n h i n . Tifiu chui*n chpn b^nh
Tfit c i nhung bfinh n h i n lfim ngUC tir 6 tudi trd ISn duoc ehl dinh p h i u t h u i t
HallerCT Index > 3,25.
Lfim ngUc dang tifin tridn kfit hpp nhung trifiu chifrig di kim^
Tieu chui^n loal irit Bfinh nhfin nhd hon 6 tudi.
Chdn thuong thfinh nguc trudc gfly Ifim nguc.
Bfinh nhfin hd xuong iic.
Hfii chflng Poland.
Xdy dung bing phdn ioai Idm nguc di/a vdo cdc tidu chuin sau:
Hinh d i n g hd lom: Ifim dang didm (khu tni), Ifim dang didn (lan rdng).
Tinh ddi xiJng: Ifim doi xiimg khi tfim hfi Idm n i m tren xuong ire, Idm khfing ddi xflng khi t i m hd Idm nam bfin p h i i hay ben trai xuong iife.
Dp sau cfla hd lfim (d): dfi sfiu hd 16m tfnh tU bd cao nhdt cfla hd lom den ddy ho Ifim theo dUdng thing diimg: d < 2 cm' binh thudng; 2em < d < 3 cm:
15m nguc nhe; d > 3 cm: lom nguc nang,
tudi day thi cao gap 3 lan khdi bfinh sau sinh.
2. Phan Ioai lom n g ^
Hinh 7: Do do sau ho lom [7]
Chidu dai hd Idm: tinli theo ehieu dai cfla xUOng Uc. 1/3 dudi xuong ijfc, 2/3 dudi xUOng tfC, hdn 2/3 xUong ire.
Xiir \p: Stata phien bang 10.0 K ^ T Q U A
1. D$c tinh m l u nghien cflu Bang 1. Gidi (n=22g)
GiDI Nam NO
Sfitnjdnqhop 184 45
T l l « ( % ) 80 20 T l Ig n a m la 8 0 % , c h i ^ m d a s o , g a p 4 l a n nu".
B a r i q 2 . P h S n b S t h e o n h 6 m t u d i ( n = 2 2 9 ) Ntl6m tuA
6-12 13-17
*18 Tmng b i n h '
Sti tnidng hop 34 114 81 16,2 ± 4
TII6(%) 15 50 35 (6-28) (*J Tuii tmng binh va dd Idch chuin Nhfim tudi tit 13 - 17 chiem da sfi 114 trudng hop, tl Ifi 50%. Tudi tmng binh la 16,2 vdi dfi Ifich chuin ± 4; liho nhdt 6 tudi, Idn nhdt 28 tudi. Tl lfi khdi bfinh Iflc
BISn sfi HInlidIa Hinh cti6n Thuna lOng Grand Canvon
Ngitc ldp
Sdtruemgtiop 169 33 16 11 11
TII«(%) 73,8 14,4 7,0 4,8 4,8 Hinh dang lom ngub da s6 la hinh dta, c6 169 truSng hap, tl 14 73,8%. Dang thung lOng + Grand Canyon c6 27 tiiidng hop, ti IS 11,8%. Dang ngyc lap c6 11 trudng hpp, ti le 4,8%.
B^ng 4. Hinh dang lom nque (n=229).
Bi£nsfi Danfl d i ^ Dang dien Thung long Hdm nOi Idn
Hwc Idn
Sd tnrdng hop 33 169 16 11 11
TII»«) 14,4 73,8 7,0 4,8 4,8 Da sci \i 18m ngUd dang dien c6 169 tn/dng hop, t l§ 73,8%.
Bang 5. Tinh d6l xOng cfla hd lom (n=229) Bifinsti
Otf xCmq KhOng S& xOng
Ldch phdi Ldchlrdi
SdlnidnqhOD 75 154 118 36
TI»«)
32,8 67,2 76,6 23.4 Ldm nguc khong dfii xdng c6 154 tnidng hdp, tl lfi 67,2%, Trong 154 tn/dng hpp 16m ngUC kh6ng ddi xdng, hd Idm Ifich ve ben phai cd tl lfi da sfi 76,6%.Bang 6. Dfi dfii ho lom b'nh theo chifiu d i i xUdng Dddalhdldm
1/3 dl/di XLlong dc 2/3xironqdc Hon 2/3 xudng Cic
Sdln/dnghdp 31 110 88
TII6I%) 13,5 48,1 38,4 Bang 7. 0 6 sau hd lom (n=229)
Od sdu d (cm) 2<d<3 3<d<4 4 < d < 5 5<d<6 6 < d < 7 d>7
Sfi tiudng hdp 11 190 21 4 1 2
Tiiem
4,8 83 32 1,8 0,4 0.9 Da sfi lom nguc cfi dfi sdu hd lom tU 3 den 4 cm cd 190 tn/dng hpp, tl le 83%. Ldm ngUc cd d6 sau hfi Ifim trfin 7 em cd 2 tn/dng hpp, tl lfi 0,9%.Dd sdu d (cm) 2<d<3 3<d<4 4<d<5 5<d<6 6 < d < 7 d>7 Tfing
Nhdm tufii n (%
6-12 1 (2,9) 26 (76,5) 4(11,7) 2(5,9) 0 1 (2,9) 34 (14,8)
13-17 5(4,4) 94 (82,5) 12(10,5) 2(1,8) 1 (0,9)
0 114(49.8)
>17 5(6,2) 70(86,4)
5(62) 0 0 111,2) 81 (35,4) ;
Y HOC THirc HANH (881) - s 6 10/2013
Oa so benh nhan trong nhfim tudi 13-17 efi 114 Irudng hop, tl le 49,8%, Ldn hdn 17 tudi cd 81 trUdng hop, llle 35,4%.
Mot sd hinh anh thu du^c trong qua trinh nghien citu
C B Hinh 1: A: Lfim ngiiti d?ng thung lOng k^m hfii chifng Marfan;
B: Lfim ngUb dang di^m;
C: Lfim ngirc dang dl8n;
D: Lfim ngUC dang Grand Canyon.
BAN LUJB^N
Gidi: M i u nghien cUu efla chflng tdi cd 229 trudng hpp 16m nguc, trong do co 184 nam (80%) va 45 nu"
(20%), tl le nam/nu- la 4/1. Theo tae gia Pilegaard H.K vaj^ng sU (2008): thUe hien p h i u thufit xam lan tdi thieu dieu tri eho 383 bfinh nhan lom ngUc trong giai doan tir nam 2001 den nSm 2006 tai Dan Mach, trong (36 cd 86% nam va 14% nU, va cfing trinh nghifin ciiu g^n day eda tae g i i nfim 2011, dieu trj 700 bfinh nhan 16m nguc thi tl lfi nam la 85%, nu-15%. Theo tae gia Kelly R.E va cdng sU (2010): nghifin eUu vfi dieu trj 1215 benh nhi lom nguc tai bang Virginia (My) trong giai doan tU dm 1987 den nam 2008, ti le nam /nii'la 4/1 [9]. Park H.J va cdng sU (2010), phan tfch dO lieu tu 1170 benh nhan lom nguc dupe dieu tn bang phiu thuat xfim Idn tdi thieu trong tfidi gian tir nam 1999 ddn nam 2008 tai bfinh vifin Mary (Seoul, Han Qudc), trong dfi cd 941 nam va 229 nif, tl le namlnQla 4/1. Nhu vay, vdi tl lfi nam gap 4 lan nU, sfi lieu ci^a chung tfii tUdng dUOng vdi mpt sfi tfic gia khac trfin thfi gidi.
Tuoi; Tudi trung binh eiia nghien cifu la 16,2 vdi do lech chuan ± 4, tudi nho nhat 6 va Idn nhat 28 tuoi.
C6^3 nhdm tudi trong nghien edu nay: nhdm 6 - 1 2 tuoi cfi 34 tnidng hpp (15%), nhdm 13 - 17 tudi chiem da sd 114 trudng hop (50%), nhdm tudi trUdng thanh va ngUdi Idn cd 81 tnflifng hpp (35%). Kelly R.E va cdng su (2010), cfing bo cdng trinh nghien cdu 21 nam kinh nghiem dieu tri Ifim nguc tai bfinh vifin nhi khoa, bang Virginia (M?) eho 1215 bfinh nhfin lom ngufc trong thdi gian tU nSm 1987 den nam 2008, tuoi
tmng binh dieu tri 10 nfim dfiu la 6 vfi 11 nam sau la 14 tudi, nho nhdt la 1 va Idn nhat 31 tudi [9].
Pilegaard H.K va cdng sU (2008), thuc hifin p h i u thufit xam lan tfii thieu eho 383 bfinh nhan Idm ngUc t u nfim 2001 den nam 2006. Tudi tmng binh ia# 16, nho nhat 7 v i Idn nhdt 43 tudi. NSm 2009, Olbrecht V.A va cong sU nghien citu vfi dieu tri 307 bfinh n h i n lom nguc bang phau thuat xam lan tfii thieu trong glal doan tir nfim 1997 den nam 2009 tai benh vifin John Hopkins, Baltimore (My), tudi taing binh ciia bfinh nhfin la 15,5 tudi. Mpt sfi tae gia k h i c thUc hifin p h i u thufit eho tre lorn nguc sdm hon nhom tudi tren, dfie biet dfii vdi tre Idm nguc cd trifiu ehiifng [3].
Phan loai lom nguc: Trong 229 bfinh nhdn Idm ngyc dupe nghifin cdu, phan loai Idm nguc theo Nuss, D. cd 33 tardng hpp lom ngUC hinh chen 14,4%, cd 169 tardng hpp hinh dia (73%), dang thung lung cfi 16 tnjdng hpp. Grand Canyon cd 11 tn/dng hop (7%), nguc lep cd 11 tmdng hop (7%). Theo bing phan loai ciia chUng t6i tai benh vifin Chd Riy: lom ngUe dang diem 33 tmdng hop (14,4%), dang difin 169 tmdng hop (73,8%). Da sd ed dp sau hd lom tU 3-4 cm: 190 trudiig hop (83%), dudi 3 cm: ed 11 tmdng hdp (4,8%), tir 4-5 cm' ed 21 trUdng hpp (9,2%), tir 5-6 em: cd 4 tnJdng hpp (1,8%), tir 6-7 cm: ed 1 tmdng hop (0,4%) vfi tren 7 em. CO 2 tmdng hop (0,9%). Dp sau hfi lom theo nhfim tudi, chijng toi ghi nhan da sfi benh nhan trong nhdm tudi 13-17 ed 114 trudng hop, tj le 49,8%, Dp sfiu hd Idm tU 3-4 em chiem da sd: nhfim 6-12 cd 26 tmdng hpp (76,5%), nhdm 13-17 tuoi ed 94 trudng hdp (82,5%), nhdm tren 17 tudi efi 70 tmdng hdp (86,4%), 2 trudng hop lom ngUc rdt nang, dp sau hd ldm Idn hdn 7 cm cd chen ep tim - phdi.
Lom ngUe ddi xdng cd 75 trudng hpp (32,8%), khong ddi xung 154 trudng hdp (67,2%), da sd ldm khdng ddi xifng ed fam hd lom lech ben phii xuong itc 118 trudng hpp (76,6%), tdm hd lom Ifich ben trai XUdng Uc cd 36 tn/dng hpp (23,4%). Tinh theo chieu dat xuong Ue cfi 141 trudng hpp lom 2/3 xuOng ifc xudng mui Ue (61,5%), 16m .hon 2/3 xUOng Ue 88 tn/dng hdp (ti Ifi 38,5%).
Cartoski, M. P. va cdng su (2006). nghifin eiiU hinh dang lom ngUC eda 64 bfinh nhan, t i c g i i nhfin thay da sd eae trudng hpp 16m ngUe khdng ddi xirng vdi tam hd lom nam ve ben phai cQa xUOng Uc ehl ed 3 tn/dng hpp co tam ho lom nam ve ben trai xuong Oc [5]. Zeng Q. va epng sU (2008), nghifin eiifu hinh d i n g Idm nguc cOa 403 benh nhan dieu tri bang phiu thufit xfim lan toi thieu tU nfim 2002 den nam 2007. Lfim ngUe ddi ximg ed 257 trudng hpp (63,8%), khfing ddi xUng 146 trudng hpp (36,2%).
Theo Kelly R.E va cong sU (2013), nghien cifu ve hinh dang Idm ngUc d 300 bfinh nhin: dang hinh chen 201 trUdng hpp (67%), hinh dTa 63 trudng hpp (21%), 3 trudng hpp vita Idi vUa lom kem theo (1%), dang Grand Canyon 30 tardng hop (10%); cfi 240 tmdng hop (80%) Idm nguc khdng dfii xifng vdi tam hd Idm lech ve bfin phai eCia xuong ii'e, cfi 30 trudng
Y HOC THVC HANH (881) - s 6 10/2013
hpp Ifich vd bfin t r i i xUOng CfC (10%), 30 ta/dng hpp Ifim ddi x i ^ g vdi tfim hfi lfim nam trfin xuong iJfc, cfi 225 tn/dng hdp (75%) lom tCr 1/2 xuong CfC ddn mQi CfC v i 75 tn/dng hdp efin lai (25%) 16m ngUC nam p h i n trfin xuong CfC. Mflt sd trUdng hpp khd x i c djnh chidu d i i eClng nhu chifiu rfing eda hfi Ifim do khfi x i c djnh chinh x i c bd hfi Ifim.
Tnang q u i trinh didu tri nhiifng bfinh nhan Idm nguc cd dang hinh chfin - d i y s i u . dang Idm khdng dfii xiJng nSng hay Ifim dang Grand Canyon l i thieh thClc trong q u i trinh difiu trj va ddi hdi thudng p h i i dat 2 thanh [9].
Theo Park H.J v i cfing su dfi nghj sCr dung thanh dfii xiJng cho bfinh nhan Ifim ngi/c ddi xifng, thanh khfing dfii ximg cho nhiifng bdnh nhfin Idm nguc khfing ddi xifng.
Ddi vdi bfinh n h i n cfi nguc Idm lifin quan dfin p h i n trfin nguc, khfing efin thifit ddt thanh q u i cao vi c i n trd vung nich v i c i c cfiu trdc quan trpng khic.
Nhiifng bfinh nhfin cd dj t i t phfii hpp vira Idm vifa ldi, sau khi riit thanh tinh trang ngUC ldi vSn cdn duy tri, dat biet nfiu bdnh nhan 16m ngUc kfim x o i n vSn xuong ifC dng [2, 8]. NhU vfiy so vdi nghifin citu dc tac gia trfin, nghifin eiru eda chung tfii cfi mfit sfi diem tuong ddng nhU da sd cac trudng hdp Idm ngUC cfi hinh dang khfing ddi xCmg, tam hfi Ifim ehCi yfiu nam ve bfin phai xUOng ifc. Nfiu tinh theo chieu dai xUdng ifc, Idm ngifc chd yeu xay ra d 1/3 hay niia dudi xuong ire hon la phfin trfin xUdng iifc.
So sanh phan loai lom ngi/c Tdc qiS
Nuss, 0, (2004) Nut, L, V, (2013)
Gifing nhau - Hinh ddng - Tinh ddi xiimg -WddihfilOfn - Hinh ddng - Tinh (Jdi xiJng -QOdaihdICm
lOidc nhau Mirc 6b nang ciia Ifim nguc:
HI > 3,25 Mi}c dd nSng cOa lom ngi/c:
d>3cm
LTii/WiuvS Ddnh gia dfi nSng cQa Ifim ngi/c dua trfin chi^p cSt ldp dien toan Qdnh gid dfi n^ng cOa lfim ngi/c di/a vdo quan sdt vd do dO sdu hd Ifim trdn ldm sdnp Trong q u i qufi trinh xay dung b i n g phan loai mdi, chung tfii nhan thdy b i n g phan loai ci^a chung toi co mfit sd tuong dfing vdi phan loai lom ngi/c Nuss, D.
nhu: dua vao hinh dfing eua hd lfim, tinh ddi xifng, dfi dai hfi Ifim tinh theo chieu d i i xuOng ire. Tuy nhifin danh gia mifC dd 15m nguc, chOng tfii dUa trfin quan s i t va do dd s i u d (em) hd 16m trfin l i m s i n g , trong khi Nuss, D. d i n h g i i mifc dp nSng eda Idm ngUC dUa trfin chup cat Idp difin tofin. Chiing tfii ghi n h i n vdi dfi sau d >3 cm tuong dUdng vdi HI >3,25. Trong khi dd, bang phfin loai eOa tfie gia Pari<, H. J. ehia Idm ngUc thanh 7 loai, ehi tiet v i kho nhd hdn so vdi Nuss, D.
va cua chiing tdi.
Trong qua trinh nghifin cdU, ehiing tdi nhfin thay bang phan loai trfin ddn gian v i de i p dung trong q u i trinh phfiu thuat vi chi c i n quan s i t hinh dang, tinh dfii xdng, do dfi sfiu v i ti'nh chieu d i i cOa hd Ifim so vdi xuong iiic. Lom nguc dang diem trUdc tudi day thi (6-12 tuoi), chi c i n dfit 1 thanh. Nhiifng bfinh nhan lom nguc dang dien, ngUe lep, Grand Canyon, khdng
dfii xiifhg hay Idn hon 13 tufii ddi hoi phai dat 2 thanh.
BSnh nhfin cd dfi sfiu hfi Ifim Idn hdn 7 cm, can ndi soi hfi tr^ trong q u i trinh p h i u thuat.
K£'T LUAN
Theo bang p h i n loai mdi cOa ehiing tdi, Idm ngUe khfing dfii xCmg chifim tl lfi da sfi (67,2%), vdi t i m hd 16m p h i n Idn Ifich bfin p h i i vfi chQ yeu Ifim 2/3 dudi xUong dc. Lpi ich cOa b i n g phan loai mdi la chdng tdi ehl dua trfin lam sfing de phan loai Ifim nguc tif nhe dfi^n n^ng ma khfing efin dua trfin can lfim sang, ddng thdi cfi thd \Ua chgn phuong phap dieu tri thfch hpp eho timg bfinh nhfin, Dfii vdi tre nho efi lfim nguc dang d i l m ehi c i n dat 1 thanh, trong nhiJng tn/dng hdp Ifim nguc d tufii day thi hay Idn hdn hofic Idm nguc dang difin, lom nguc khdng ddi xdng ddi hoi p h i i dat 2 thanh.
TAI U$U THAM KHAO
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WorfdJSurg, 31,(1), 26-9; discussion 30.
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Schmitt, W. Coerdt, J. M. Wihim, F. Schier, C. J.
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Proud, D. P. Croitom, T. Gustin, K. Mitchell, E. Vasser, R. E. Kelly, Jr. (2006) "Classification of the dysmorphology of pectus exeavatum", J Pediatr Surg, 41.(9), 1573-81.
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M. Botero, H. M. van Gelder, C. I. Tchen/enkov (2002)
"Minimally invasive endoscopic repair of pectus exeavatum". Eur J Carcf/of/ioracSu^, 21, (5), 869-73.
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Steidley, C. Deschamps (2010) "Cunent management of pectus exeavatum: a reviev/ and update of therapy and treatment recommendations". J Am Board Fam Med, 23, (2). 230-9.
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A. Kuhn, R. Redlinger, T. S. Haney, A. Moskowitz, D.
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Y HOC THlTC HANH f88l1 - S(
