Xet nghiem ddm tim vi khuan lao Id "tieu chuan vdng" de chan doan lao phdi, nhung d tre kha nang ho khac kem vd thdi quen nudt ddm, nen it lay dUdc ddm de xet nghiem. Vi vay, viee lay djeh da day, dich phe quan tim vi khuan lao Id xet nghiem thUdng tien hanh d tre em. Ket qua xet nghiem djeh da day tim vi khuan lao trong nghien cUu cua chiing tdi nhU sau:
soi true tiep (30,3%), PCR (44,6%), nudi cay (30,3%) cao hdn ke't qua eua Somu N (1992), Stuart J Dickson (2003), khi nudi cay vi khuan lao trong dich daday17-21%[7][8].
KET LUAN
1. Ode diem lam sang, can lam sdng lao phdi tre em: Lao phdi la the lao thudng gap d tre em, lUa tudi mie lao phdi phan Idn tU 0-5 tudi (64,6%). Trieu chCmg gap nhieu nha't Id ho khan, ho ed ddm, sdt. met mdi, an kem, g i y siit, ra md hdi trdm, da xanh. Kham phdi thi cdc trieu ehUng thUe the ngheo ndn. Benh nhi tie'p xuc ngudn lay lao 35,4%), phan Ung Mantoux du- dng tinh 55,4%. Xquang phdi vdi tdn thUdng tham nhiim, ndt (56,9% vd 67,7%)), CT Idng ngUe cd hinh anh ddng ddc 80%), npi soi phe quan 94,4%. benh nhi cd hlnh anh tdn thUdng phe quan, trong dd 19,4% lao phe quan.
2. Xet nghiem dich da day tim vi khua'n lao mang lai hieu qua cao: nhuom soi trUc tiep (30,3%), PCR (44,6%) va nuoi cay (30,3%) gdp phan chan doan sdm lao phdi tre em.
TAI LIEU THAM KHAO
1. Nguyen Viet Co vd cpng sU (2002), Bdnh hgc lao.
NXB YH Ha Ndi. '
2. Nguyin Thu Ha (2000), Nghien cUu hieu qua chan doan lao mang nao tre em bing phan ifng chu6i Polymerase (PCR). Luan vdn thac sy y hpe, TrUdng dai hoc y Ha Ndi.
3. Le Thu Thuy (2001), Nghien cUu tinh hinh nhiirp va mic lao cCia tre tU 0 de'n 5 tuoi tie'p xuc ngUdi Idn mic lao. Ludn vdn thac sy y hoc. Hpe vien quan y.
4. b e Blic J. (1991), "The value of flexible bronchoscopy in childhood pulmonary tuberculosis"
Chest, 100: pp. 688-692.
5. Flement S.M. (1997), "Histoire naturelle de 1 injection tuberculosis et reaction eutane tuberculinique".
Rev Mai Respir Masson de Paris, 14 : pp. 27-32.
6. Im J.G. (1995), "CT Pathology correlation of Pulmonary Tuberculosis". Crit Rev Diagn Imaging, 36(3):
pp. 227-85.
7. Somu N., Swaminathan S., Paramasivan C N . (1992), "Value of bronehoalveolar lavage and gastric lavage in the diagnosis of pulmonary tuberculosis in chidren". Tubercle and lung diseases, 76: pp.295- 299.
8. Stuart J.D. (2003), "Comparison of Bronchoscopy and Gastric Washings in the Investigation of Smear- Negative Pulmonary Tuberculosis", Clinical Infectious Diseases, 37: pp. 1649-53.
9. WHO (1996), Epidemiological review of tuberculosis in the Westem Pacific region, pp 1-10.
DOAC DAU DANH GIA KET QUA PHAU THUAT GHEP XUUNG 6 RANG
TOM T A T
Khuyit hong xwang 6 rang la mgt thi benh ly rat hay gap trong Rang Ham M^t, gay ra bai nhiiu nguyen nhan khac nhau, nhQ'ng khuyit hong cd thi nho nhwng cung CO the rqng gay mat rang. Viec diiu trj nhirng khuyit hong nay dwoc dat ra vai muc tieu loai trir hit cac to chirc benh ly, phue hii lai cac ton thwong xwong da mat qua dd phue hdi toi da cac chirc nang cho ngwai benh.
Nhiiu phwang phap diiu trj da dwgc ap dung nhw ghep xwang tw than, ghep cac vat li$u sinh hoc... mqt trong cac phwang phap dd la ghep xwang dong kho dong loai da dwgc khir khoang, san pham nay da dwgc san xuat tai bq mon Mo, trwdng Dai hgc Y Ha Ngi. Dwgc nghien ciru sir dung tren 8 benh nhan gom 18 khuyit ton xwang 6 rang vai nhiiu kich thwac va vj tri khac nhau, benh nhan dwgc phiu thuat lay bo to chirc benh ly sau dd dwgc ghep xwong dong kho dong loai va Cerasorb dwgc theo doi, danh gia sau phiu thuat 6 thing. Kit qua nghien ciru cho thay hieu qua dieu tri khong co sw khac biet giu'a 2 nhom. Phwang phap nay co the sir dung thuan tien a cac ca sa y ti vol mire chi phi thap, di sir dung, di bao quan.
Tir khoa: Khuyit hong xwang 6 rang SUMMARY
Alveolar bone defects is a frequent fomn in odonto stomata logy, occurred by different cause. The
N G U Y I N DINH PHUC, MAI DINH HUNG
deficiencies may be small but may be also large caused missing teeth. The treatment of these deficiencies is set up with target to eliminate all pathological tissues, recover lost bone injuries, though that to rehabilitate maximally function for patient. There are many treatment methods which have been applied'as auto bone graft with biological materials. One of those methods is dry freezing auto bone graft has been deminerallzed, this product has been produced at Department of Histology, Hanoi Medical College. To be studied and used to over 8 cases of 18 alveolar bone deficient injury with different size and sites. Those patients have been operated, eliminated pathological tissues and then grafted by deminerallzed freeze - dried bone and Cerasorb, followed and assessed after six months . The study results show the success in treatment is same between 2 grups. This method can use conveniently at medical institutions with low expense, easy to use, easy to preserve.
Keywords: Alveolar bone defects
DATVANDfe
Xuang d rdng Id thdnh phin quan trpng trong clu triic giai phlu cua td chu'c quanh rang, mat ngodi dupe ehe phu bdi td chu'c Ipi, mat trong dm todn bp chdn rang, cdc thdnh phin ndy tgo nen td chiPC quanh rdng.
Xuang d rdng bj phd huy Id tinh trgng thudng gap trong
Y HOC THlJC HANH (727) - SO 7/2010
23benh ly td ehiPC quanh rang, khi xuang d rang bj phd huy nhilu m i t p h i n bam dinh quanh rang, thilu hdng xuang vd td chipc quanh rdng, khi dd bpnh quanh rang da t i l n triln ndng cd nguy ca gay mat rang hdng logt trong thdi gian n g l n . Myc tieu d i l u tri trong giai doan ndy tai tgo Igi p h i n bdm dinh mdi thdng qua vipe tdi tgo lai xuang d rang qua can thiep b i n g phau thugt, ly tudng Id tdi tgo Igi mptcach hodn chinh dan vj quanh rang g i n vdi e l u true binh thudng cua nd. D l dgt dupe myc tieu ndy nhilu bipn phdp ghep eho xuang d rdng da dupe thyc hien nhu ghep xuang t y than, ghep xuang ddng loai, ghep xuang khac loai, ghep vat lieu sinh hpe, ghep c h i t kieh thich tdi tgo xuang....
Ghep xuang t y than ve mat ly thuylt Id ly tudng nhat nhung ddi khi viee l l y xuang t y thdn khd thyc hipn do benh nhdn sp va cd the gdy ra tdn khuyet xuang Idn khac, vipe SLP dyng xuang t y thdn ddi khi khdng ddp ipng dupc nhQ'ng yeu c l u ve c h i t lupng dae bipt Id sd lupng ma thyc t l ddi hdi.
Ghep c h i t kieh thich tdi tgo xuang cd hipu qua tdt trong qua trinh tdi tgo vd hinh thdnh td chipc xuang mdi sinh ly, chat kich thich tdi tgo xuang thdnh p h i n chu y l u la Hydroxyte Canxi vdi n h i l u dang khde nhau, Thanh phan chinh eua Cerasorb mpt t h i hp md'i cua c h i t kich thich tdi tao xuang Id (J- Tricancium Phosphate (U - TCP) cho k i t qua r i t tdt trong ITnh vyc ghep xuang, dae bipt trong phau thuat ham mat, tuy nhien ehi phi r i t eao.
D l khac phye nhupe d i l m cua cdc phuang phdp tren vipe lua chpn ghep xuang ddng loai ddng khd Id giai phap dupc lya chpn nghien cu'u. Xuang ddng khd ddng loai Id td ehiPC xuang ngudi dupc XLP ly khdng cd mach mdu va t l bao sdng ed t h i dap ipng dupe nhu'ng yeu e l u ghep xuang do khdng cd tinh kieh thich nai nhgn, da dupc tipt trung, d l bao quan [1][2]
Xuat phdt tu' nhu cau trong d i l u tri chiing tdi nghien ciPU nham mue dich: So sinh kit qua phau thuit phgc hii xwang o rang bang ghep xwang dong kho dong loai khir khoang vai ghep chat kich thich tai tao xwang.
OOl TU'ONG VA PHU'ONG P H A P NGHIEN CU'U 1. Odi tu'O'ng n g h i e n CLFU
Doi tupng nghien cipu Id 18 tdn khuyit xuang d rang tren 8 bpnh nhan d i n kham vd d i l u tri tai Khoa Rang Ham Mgt Bpnh vien Viet Nam - Cu Ba t u 7/2005 tdi 9/2006.
1.1. Tieu chuan chpn benh nhan : - Benh nhdn khdng cd benh todn than
- Benh nhan cd tui nha chu sdu it n h i t 6mm vd cd it nhit 2 tdn thuang trong xuang, tdn thuang cd 2 d i n 3 vach xuang.
Vdi tieu chuin ndy ehung tdi ed 18 tdn thuang trong xuang tren 8 benh nhdn
1.2. Tieu chuan loai trip;
-Todn than: Cd benh ly v l mdu, bpnh hp thdng, tdm t h i n , phy nu cd thai.
- Benh nhdn vp sinh rdng mipng kem, bpnh nhdn nghien thudc Id nang.
2. Phu'cng phap nghien CLPU: Nghien cu'u thip nghiem Idm sdng
3. Cac bu'd'c tien hanh nghien cii'u
* Bu'd'c 1. Tham kham lam sang:
T i t ca cdc ddi tupng nghien CLPU dupc thdm khdm lam sang theo m i u bpnh an thdng n h i t dupe thilt k l san, thu thap eac thdng sd ve lam sang, xquang.
* Bu'd'c 2. Xet nghiem can lam sang:
- Xet nghiem mdu ca ban, chyp X quang, do kich thudc tdn thuang xuang d rdng, cdc ehi sd dp sdu tui Ipi, mu'c bam dinh Ipi.... bang thdm cham cua td chu'c y t l t h i gidi cd chia dp
* Bu'd'c 3. Thyc hien d i l u trj t i l n p h l u thuat:
^- Ddnh gid mu'c dp vp sinh rdng mieng, l l y eao rang.
D i l u tri tuy cdc rang cd lien quan.
* Bu'd'c 4. Thyc hien phlu thuat:
- Gdy te vung p h l u thuat
- Rgch tao vat niem mgc Ipi ' ' ^ - - Ngo sgch td chu'c hgt
- Lam nhan b l mat chdn rang b i n g sieu am - Vgt lipu c i y ghep Id xuang ddng khd ddng logi khip khodng hoge Cerasorb, vat lipu ghep khdng Idm qua d l y
- Khau ddng vgt niem mac bang Vicryl 4.0 - Bdng v l t md bang Paste Eugenate trong 7 ngdy
* Budc 5. D i l u tri sau p h l u thugt:
Khdng sinh todn thdn, giam dau, phu n l vd bam ru'a vp sinh rang mieng.
K^T QUA VA B A N L U A N
Vi sd lupng benh nhdn vd sd lupng tdn thuang dupe ddnh gid k i t qua d i l u tri sau 6 thang edn it nen kit qua d i l u tri dupe the hien ey t h i ddi vdi tipng bpnh nhdn. Tren 8 benh nhan dupe p h l u thudt, t i t ca cdc ton thuang sau 6 thdng d i l u tri d i u Idnh thuang tdt, Ipi tren xuang d rdng cd mdu s l e , b l mat khoe mgnh.
1. Danh gia ve sw thay doi cua do sau tui lgi Banc
Benh nhan
1 2 3 4 5 6 7 8 Gia tri
TB Op lech
chuan
1: Dp Sc ju cua tu 1 lai Nhom SU' dyng
Cerasorb Truac
PT
6 8 7 8 8 9 6 10
6 7,6 1,4
Sau 6 thang
4 5 4 5 4 5 4 3 3 4,1 0,8
MLPC giam dp sau tui
2 3 3 3 4 4 2 7 3 3,4 1,5
Nhom SLP dyng XOKKK T r u d c
PT
7 5 6 5 4 9 5 7 8 6,2 1,6
Sau 6 thdng
3 3 2 3 2 5 3 3 4 3,1 0,9
MiPC giam dp sdu till
4 2 4 2 2 4 2 4 4 3,1 1,1 D p s d u tui Ipi Id k h o a n g each d u p c t i n h t u b d vien c u a Ipi c h o t d i d d y tui I p i . D u n g eay t h d m c h a m t h d m dd q u a n h r a n g eua t d chipc y t l t h i g i d i c d chia vgch lu'ng milimet, d o c i i n g vj tri t r o n g cdc l l n d o
T r u d e p h l u t h u d t d d s a u tui Ipi c u a n h d m SIP d y n g C e r a s o r b Id 7,6 ± 1,4, s a u p h l u thudt 6 t h d n g d p sdu till Ipi g i a m 3,4 ± 1,5. N h d m SLP d y n g X D K K K t h i d p sau tiii Ipi trude p h l u thudt la 6,2 ± 1,6 va sau p h l u thugt 6 thdng giam 3,1 + 1,1. So sdnh vdi tieu chi ddnh gid sy giam dp sdu tui Ipi > 3mm dupe ddnh gid Id tdt thi k i t qua dieu tri cua 2 nhdm d i u dgt k i t qua tdt, tuy nhien de loai trip cae y l u td gay nhieu, ehung ta c i n ddnh gid song song giu'a sy thay ddi dp sdu tui Ipi vd mu'c dp m i t bam dinh eua Ipi. K i t qua nay phu hpp vdi k i t qua nghien cipu eua Brown, G. D. vd cpng s y (1998) [5] khi
24
Y HOC THUC HANH (727) - SO 7/2010
SLP dyng Hydroxyaptite k i t hpp vdi phau thugt Igt vgt trong dieu tri khuyit xuang vung quanh rdng da la giam dp sau tui Ipi Id 2,4 mm cdn vdi nhdm su dyng xuang ddng logi ddng khd khu' khodng thi dp sdu tui Ipi giam 3,1mm.
Phu hpp vdi k i t qua nghien CLPU eua Nguyen Dipc T h i n g [3] khi ghep xuang ddng logi ddng khd khCp khoang sau 2 ndm phau thudt giam dp sdu trung binh tui quanh rdng Id 2,88mm.
2. Danh gia ve sw thay doi dien bam dinh cua lgi Bang
Benh nhan
1 2 3 4 5 6 7 8 Gia tri
TB 06 lech
chuan
2: Dipn bam dm h cua K Nhom SLP dung
Cerasorb Mat
bdm dinh truac
PT 6 9 8 10
8 8 9 10
7 8,4 1,3
Mat bam dinh sau 6 thang 4 7 7 7 5 5 6 3 5 5,4 1,4
Tang bdm dinh
2 2 1 3 3 3 3 7 2 3,0 1,7
7>
Nhdm SLP dyng XOKKK Mat
bdm dinh trude
PT 8 7 10
5 7 10
8 7 5 7,4 1,8
Mat bam dinh sau 6 thdng 4 5 6 3 5 6 5 3 4 4,6 1,1
Tdng bdm dinh
4 2 4 2 2 4 3 4 1 2,9 1,2 MU'C bdm dinh ciia Ipi duac do bdng khoang cdch tu' dudng ndi men- cement chdn rang (dudng ndi men- ngd) tdi ddy tui Ipi.
MiPC Tdng bdm dinh sau phau thudt 6 thdng d nhdm SLP dyng Cerasorb Id 3,0 ± 1,7 edn d nhdm SLP dyng XDKKK Id 2,9 ± 1,2 so sdnh vdi tieu c h u i n ddnh gid dupe coi Id tot khi dp tdng bdm dinh sau d i l u tri >
2,5mm thi k i t qua d i l u tri d 2 nhdm d i u dgt k i t qua tdt.
k i t qua ndy cQng phu hpp vdi k i t qua nghien cii'u thyc nghipm eiia Becker, W., R va cpng s y (1995) [4] vd k i t qua nghien cipu eua Nguyen DLPC T h i n g [3]
Bang 3: So sdnh gid tri trung binh cua 2 nhdm
Giam dp sdu till Ipi Tang bam
dinh n=9
Nhdm SLP dyng Cerasorb 3,4 ±1,5 3,0 ± 1,7
Nhdm sip dung XOKKK
3,1 ±1,1 2,9 ± 1,2
y nghTa P= 0,594 P= 0,875
Sy khde biet khdng ed y nghTa thdng ke (p> 0,05) Ket hgp kit qua cua 3 bang tren ta nhan thay Ddnh gid gid tri trung binh cua miPC dp giam dp sdu tui Ipi tren lu'ng nhdm SLP dyng Cerasorb Id 3,4 ± 1,5 vd nhdm SLP dyng XDKKK la 3,1 ± 1,1 thi cd y nghTa (p <
0,05) va khi so sdnh glQ'a 2 nhdm thi khdng tim t h i y sy khac bipt ed y nghTa thdng ke (p > 0,05). Tuang t y nhu vgy vdi k i t qua d chi sd ddnh gid miPC dp tang bdm dinh Ipi sau dieu tri d rieng re lu'ng nhdm cd y nghTa (p <
0,05) va khi so sdnh k i t qua d i l u tri glQ'a 2 nhdm thi khdng tim t h i y su khde biet cd y nghTa thdng ke (p <
0,05).
3.Danh gia mire dg tut Igi
Bang 4; Dp tyt Ipi cua 2 nhdm Bpnh
nhdn
1 2 3 4 5 6 7 8 Gia tri TB
Op Ipch ehuin
Nhom SLP dyng Cerasorb Trude PT
0 1 1 2 0 0 3 0 1 0,9 1,05
Sau 6 thdng 0 2 3 2 1 0 3 0 1 1,3 1,2
Nhdm su'dyng XOKKK TruPe PT
1 2 4 0 3 1 0 0 0 1,2 1,5
Sau 6 thdng
1 2 4 0 3 1 1 0 1 1,4 1,3 MiPC dp tyt Ipi dupe ddnh gid bang khoang cdch tip bd eua v i l n Ipi cho tdi dudng ndi men- cement ehan rang (dudng ndi men- ngd).
MU'C dp tyt Ipi trudc p h l u thugt eua 2 nhdm sau p h l u thuat 6 thdng Id
1,3 ± 1,2 vd 1,4 ± 1,3 so vdi miPC dp tyt Ipi trudc p h l u thudt Id 0,9 vd 1,2. K i t qua ndy cQng phu hpp vdi nghien CLPU cua Duval, B. T. va cpng s y (2000) [6] sau 6 thdng p h l u thuat mu'c dp tyt Ipi Id 0,88 mm. Dieu ndy chi ra r i n g sau khi thiet lap vj tri mdi eua Ipi b i n g p h l u thudt thi qua trinh l i l n xuang, tdi tgo xuang, huy xuang, su xdm nhdp cua cdc t l bdo bieu md Id r i t manh me.
K^T LUAN
Tieu xuang d rdng Id mpt bpnh r i t thudng gap, n l u khdng dupc d i l u tri kjp thdi se Idm benh nha chu ndng them vd hgu qua cd t h i gdy m i t rang hdng logt trong thdi gian n g l n . D i l u tri p h l u thuat tdi tgo Igi xuang d rang b i n g cdc vat lipu ghep Id mdt ky thuat d i thyc hipn, dem lai hipu qua eao. Ghep xuang ddng khd ddng logi cho k i t qua eao khdng khde biet so vdi ghep Cerasorb, khang djnh vai trd cua xuang ddng khd trong viec ddp LPng nhu c l u vgt lieu ghep xuang trong rdng hdm m a t .
T A I LIEU THAM K H A O
1. Ngo Tip Minh (2003), Gh^p xuvng dong loai dong kho thwc nghiem va ung dung iam sang, Ludn an tien sy Y hpe. TruPng Dai hpe Y Ha Npi.
2. Pham Quang Ngpc (1995), "Xay dung tieu chuan vdi mc xuang ghdp ddng loai". Tap chi Ngoai khoa, 25 (3) tr14-21. _
3. Nguyin OLPC Thing (2004), Nghien ciru dieu tri phiu thuat viem quanh rSng bang ghep bot xuang dong loai dong kho khir khoing, Luan an tien sy Y hpe. Truang Dai hpe Y Ha Npi.
4. Becker W., Sehenk R., Higuchi K. , et al. (1995), 'Variations in bone regeneration adjacent to implants augmented with barrier membranes alcne or with deminerallzed freeze-dried bone or autolpgpus grafts", Int J Oral Maxillofac Implants, 10(2), pp. 143-54.
5. Brown G.D., Mealey B.L., Nummikoski P.V. , et al.
(1998), 'Hydroxyapatite cement implant for regeneration pf periodontal pssepus defects in humans", J Periodontal, 69(2), pp 146-57.
6. Duval B.T., Maynard J.G., Gunselley J.C. , et al.
(2000), Treatment of human mucpgingival defects utilizing a bioabscrbable membrane with and withput a deminerallzed freeze-dried bene allograft" J Periodontal 71(11), pp 1687-92.
