MOI LIEN QUAN GIUA CAN TROT CAN RA TRU6C VA SANG BEN Vdl TRIEU CHUfdG LAM SANG CUA BENH NHAN MAC LOAN NANG THAI DUVNG H A M
TOM T A T
Loan ning thii duang ham la mdt benh ly hay gap.
nhiiu tic gii cho ring can trd can dupe xem li mot trong nhOng nguyen nhan chinh gay benh. Nghien cUu cin trd cin d tu thi dua ham ra trudc vi sang ben dupc thuc hien tren 46 bdnh nhin mic loan nang thii duang ham cho thiy khdng cd bing chifng rd ring vi mii liin quan giOa cac loai can trd can nay vdi cic trieu chOng cQa loan ning thai duang ham.
Tir khda: Loan ning thai dudng ham. cin trd can.
SUMMARY
STUDY THE RELATIONSHIP BETWEEN BALANCING AND PROTRUSIVE INTERFERENCE WITH CLINICAL SYMPTOMS OF PATIENTS WITH TEMPOROMANDIBULAR DISORDER
Temporomandibular disorder is a common disease, many authors consider occlusal interference being one of the main causes of disease, the most damaging occlusal interference is premature contact. Study on balancing and protrusive interierence are realiser on 46 patients with temporomandibular disorder showing no clear evidence about relationship between this kind of interierent with symptoms of Temporomandibular disorder.
Keywords: Temporomandibular disorder, occlusal interierence.
DAT VAN Bi
Loan nang thai dUdng ham (tieng Anh la TMD:
TemporoMandibuIar Disorders) la mot benh ly ciia bp may nhai gdm nhiJfng hdi chdng chinh nhu loan nang cd nhai va loan nang khdp thai duting ham.
Theo nghien cifu ciia hiep hpi TMD My thi ed khoang 5-13% dan sd mac. Theo nghien cUu cDa Hd Thi Ngoc Linh (2003) tren 1020 cdng nhan cua cdng ty det phong phu TP HCM cho thay so ngudi ed bieu hien LNTDH chiem ty le rat cao den 60,5%. Trieu chdng hay gap nhat la tieng keu khdp ehiem 39,1%.
Mac dii tJ le mac t>enh_cao nhung cong tae chan doan va dieu tri LNTDH van la 1 chu de gay nhieu tranh cai. Benh nguygn van cdn nhieu gia thuyet trai ngupc nhau. hau het cac nha nghien cUu deu eho rang LNTDH cd nguyen nhan do: rdi loan khdp can, rdi loan tu the, chan thuang, rdi loan tam ly... trong dd can trd can khi dua ham ra trUdc va sang ben cd vai trd quan trpng. Nham gdp phan nghien cCsu yeu td benh nguyen khdp can trong loan nang thai duting ham d Viet Nam chimg tdi thuc hidn de tai vdi muc tieu:
Xae dinh cin trd cin dua ham ra trudc va sang ben cOa binti nhan bi LNTDH.
Nghidn cOu ma lien quan giOa can trd can dua ham ra trudc va sang ben vdi trieu chUng lam sing cQa nhdm benh nhan niy.
PHAM N H J HAI, THAI KHAC VINH Khoa Rang B^nh vien Vigt Nam Cuba
DOI TUONG VA PHl/ONG PHAP NGHieN ClJU
1. Doi tLfdng nghien ciiU
La tat ca benh nhan den kham tai khoa Rang Benh vien Viet Nam Cuba Ha Npi va phdng kham 225 Tmdng Chinh, Ha Noi tU thang 1/2010 den thang 12/2014 dUdc chan doan LNTDH theo tidu chuan cisa McNeil [2] gdm:
- Dau d he thong cd nhai, khdp thai duting ham va/hoac vung quanh tai, thudng tang them khi sd nan hoac hoat ddng ehUc nang.
- Lech ham khi ha mieng cd hoac khong kem theo tieng keu khdp.
- Han che ha mieng (< 40 mm).
Da dutic kham cac chuyen khoa liSn quan' Tai mui hpng, ndi than kinh, ndi khdp, tam than... de loai liil cac benh thUC the lien quan
Ddng y tham gia nghien cUu.
Tieu chuan loai trir
- Nhung ngudi benh dupe chan doan viem da khdp, chan thUdng cap tinh, nhilm triing, khiem khuyet do qua trinh phat trien va khdi u.
- Nhiing ngudi benh mac benh tam than.
2. PhUdng phap nghien culi PhUdng phap thu thap sd lieu:
Chimg tdi tien hanh kham toan bd nhUng benh nhan ed da'u hieu LNTDH, sau dd lua chpn ra nhijhg benh nhan cd tieu chuan ciia McNeil de dUa vio nhdm nghien cuU:
- Hdi benh: Khai thac ly do vao vien, eae thdi quen xau va eae trieu cd nang.
- Kham cd nhai va cac cd viing cd mat de danh gia tinh trang dau tu nhien, dau khi sd nan, vj tri dau.
- Kham khdp thai dUdng ham: Ghi nhan cac trieu chUng: Tieng keu khdp, Dau khdp, Dp ha mieng, Dudng ha ngam mieng, Danh gia bien do van dpng sang ben.
- Danh gia su dau khdp, dau cd khi ham dudi van ddng: Dau khi van ddng 1 hudng hay van dpng cac hudng deu dau.
- Kham tdng quat tinh trang rang mieng: Chung tdi danh gia chi so sau mat tram, danh gia tinh trang nha chu, mdn rang, rang gia... eua benh nhan.
- Kham danh gia can trd can khi dUa ham ra trUdc va sang ben bang giay can xanh va dd tren mieng va m l u ham tren gia khdp.
- Cac thdng tin can thu thap dupc dupe ghi vao benh an nghien ciJfu.
- X d ly sd lieu bang phan m^m Epi info 16.0. Kiem djnh thdng ke bang thuat toan x' hoac Phi and Cramer's V.
Y HOC THUC HANH (957) - S6 4/2015
KET QuA NGHIEN CLfU
1. Xac dmh can t r d can dua ham ra trudc va sang ben cua benh nhan bj LNTDH
• Can frci sani ben bin lam vi^c (n = 2)
• Can tra sang ben ben kii6n2lamvi?e(n= 13)
• ICIiongcocanti'C'iane b e u ( n = 5 1 )
Bleu do 1. Ti le can trd k h ^ can trong van dong sang ben C d 3 2 , 6 % d d i t U d n g c d c a n t r d s a n g b e n , t r o n g d d can trd b e n k h d n g l a m v i e c c h i e m 2 8 . 2 % .
B a n g 2 . M o i lien q u a n giCfa c a n b d s a n g b e n b e n l a m v i e c v d i t r i e u e h u n g l a m s a n g c i i a L N T D H
Trieu ChOng
Dau khdp Tienq k6u khOp
Dauca Han ch^ ha miSnq til nhien
Han che he mieng cuanqbi)c Lech di/cmg ha ngam mieng
sanqben LecJl diidnq he mienq ziczac
Giei han 6da hem sanq phai Giei han diia ham sanq trai
Giqi han dua ham ra tn/dc
Can trft sang ben iem viec Co SL
2 2 1 1 1 1 1 1 0 1
TL 100%
100%
50%
50%
50 50%
50%
50%
0%
50%
Khong SL 39 39 32 29 15 36 8 25 25 26
TL 88,6%
88,6%
72,7%
65,9%
34,1 81,8%
18,2%
56,8%
56,8%
59,1%
P
0.614 0,614 0,485 0,644
0,267
0,849
0,798
8.7%
Khong cd sU khac biet cd y nghla cua cac trieu chimg gii^a nhdm cd va khdng ed can trd can sang ben ben lam viec.
Bang 3. Mdi lien quan giua can trd ra trudc ben khdng lam viec vdi bleu chimg eua LNTDH
Bieu do 2. Ti le cin trd khdp cin trong van dong ra tnJdc 39,1% cd can trd can trong dd can trd ben iam viec chi^m 8.7%. Ben khdng lam viec ehiem 30,4%.
2. Nghien cUu mdi lien quan giOra can t r d can dua ham ra trudc va sang ben vdi trieu chufng lam sang cua nhdm benh nhan nghien cCfu
Bang 1. Mdi lien quan giUa can trd sang ben ben khong lam viec vdi trieu chimg iam sang eua LNTDH
Tneu chifng
Dau khdp Ti^nq keu khdp
Dau CO Han ch^ ha mieng tu nhien Han che ha mienq cudnq b ^ Lech dudng he ngam mieng
sanqben Lech dudng ha mieng ziczac Gidi han dua ham sanq phai Gidi han dua ham sanq trai Gidi han dua ham ra tn/dc
Can t/dia tmdc ben khenq iam viec Cd SL 13 13 11 11 3 11 3 7 9 9
TL 92,9%
92,9%
78,6%
78,6%
21,4%
78.6%
21,4%
50%
64.3%
64.3%
KhOnq SL 28 28 22 19 13 26 9 19 16 28
TL 87.5%
87.5%
68.8%
59.4%
40.6%
81,2%
19,6%
59,4%
50%
66,3%
P
0.591 0.591 0.496 0.208
0.833 0.555 0.371 0.611
Tneu chimg
Dau khdp Tl^nq keu khdp
Daucd Hanchehemiengtunhien
Han che he mieng cudnqbdc Lech dudng ha ngam mieng
sanqben Lech dudng he midnq ziczac Sdfhandifahdmsanqphai Gidf han du3 hem sanq trai GXI han dua hem ra tmdc
Cent/d sang ben khdng iam viec Cd SL 10 10 11 11 2 12 1 7 4 6
SL 76.9%
76.9%
84.6%
84.6%
15,4%
92,3%
7,7 53.9%
30.8%
46.2%
KhCnq SL 31 31 22 19 14 25 8 19 21 21
r TL 93.9%
93.9%
66.7%
57.6%
42.4%
75.8%
24,2 5/,6%
63,6%
63,6%
P
0,095 0,095 0,223 0,083
0,203 0,818 0,044 0,278
K h d n g c d k h a c biet m a n g y nghTa U i d n g k e t r o n g trieu c h i m g i a m s a n g c u a n h d m c d v a k h d n g e d c a n t r d c a n r a t r u d c b e n k h d n g l a m v i e c , v d i p > 0 , 0 5 .
B a n g 4 . M o i lien q u a n g i d a c a n t r d r a t r u d e b e n l a m v i e e vdi trieu c h i m g c i j a L N T D H
S u k h a c n h a u giij'a t i l e c a c trieu chiimg cOa n h d m c d v a k h d n g c d c a n t r d s a n g b e n b e n k h d n g l a m v i e c k h d n g c d y nghTa t h d n g k e v d i p > 0 . 0 5 ,
Trieu chdng
Dau khdp Tienq keu khdp
Daucd Han chd ha mieng tu nhien
Hancheham^ng cuenq bdc Lech dudng ha ngam mieng
sanqben Lech dudng ha mieng
ziczac Gidi han dua ham sanq phai
Gift han dua ham sanq trai Gidi han dua ham ra ta/dc
Can t/d ra tmdc ben iam viec Cd
Sd iuonq
3 4 4 2 2 3 1 2 1 3
Tiid 75%
100%
100%
50%
50%
75%
25%
50%
25%
75%
Khdnq Sd iudnq
38 37 29 28 14 34 8 24 24 24
Tiie 90,5%
88,1%
69%
66,7%
33,3%
81%
19%
5 7 1 % 57.1%
57.2%
P 0.342 0.465 0.189 0.504
0.774
0.783 0217 0.488
Y H O C T H V C H A N H (957) - s 6 4/2015
Khdng cd sU khac biet mang y nghTa thdng ke giiJa cae trieu chung lam sang giiia nhdm cd va khdng cd can trd can lam viec ra trudc, vdi p > 0,05.
BAN LUAN
Nhieu nghien ciiU da chi ra tac hai ien bd may nhai ciia cac can trd can trong van dpng sang ben, dae biet la cac can trd ben khdng lam viec, cac can trd sang ben thudng xuyen la ngudn gdc gay roi loan chUc nang so - mat, lam tram trpng cac ton thUdng nha ehu [4], eac can trd sang ben ben khdng lam viec gay nen nhiing sang chan tram trpng cho rang va mo nang dd, loai can trd nay ket hpp vdi sang chan tam ly cd the la khdi diem eho thdi quen nghien rang lech tam, gay ra cac phan xa tranh va gay di ehuyen ham dUdi lam tang hoat ddng ed. doi khi la nguyen nhan gay LNTDH [1], cac can trd ben lam vi^c thi it tram trpng han va vdi chi mot rang hudng d i n sang ben (khdng phai rang nanh) cd md nha chu khoe manh cung cd the khdng gay ra bat cU benh ly nao [1 ]. Trong nghien ciru nay, chijng tdi nhan thay rang tl le benh nhan cd can trd sang ben kha thap, chiem 32,3%, trong dd can trd ben khdng lam viec la chii yeu, ehiem 28,2% va chi cd 2 trudng hpp cd can trd ben lam viec, ca hai trUdng hdp nay can trd deu nam d rang ham Idn thd nhat ham tren ben phai va rang coi Idn thd nhat ham dUdi ben phai, eac can trd ben khong lam viec phan bo deu tren ca cac rang edi nhd va coi Idn, ehung tdi cung khdng tim dupc mdi lien he nao gida can trd sang ben vdi trieu ehUng eua LNTDH. Nhieu tae gia cung ghi nhan can sang ben thudng ehiem ti le kha thap so vdi eae can trd can khac, Mohlin B, Koop S [3] chi tim thay 13% doi tupng nghien cifu cd can trd sang ben. Ingervall B va cs da tim thay can trd dua ham sang ben d 28% trudng hdp, trong dd can trd ben lam viec chiem 8% va can trd ben khdng lam viec chiem 20%, tuy nhien Dodic, Vladimir Sinobad (2009) va ddng sU [5] da ghi nhan 66,3%
tnidng hdp cd can trd ben khong iam viec trong hudng d i n sang ben, cao hdn so vdi ket qua c^a ehiing tdi, va tac gia nay cung nhan thay cac can trd nay thudng nam d eac rang cdi Idn.
Khi ham dudi van ddng ra trudc, 39,1% ddi tUdng
nghien ciiu xuat hien can trd can, trong dd can trd can ben lam viec diiem 8,7%, ben khdng lam viec chiem 30,4%. ket qua nay ding tUdng tuvdi nhieu nghien dAi khac. Dodic, Vladimir Sinobad (2009) va ddng sU [5]
cung da tim thay 40% ddi tutJng cd can trd can ra trUdc, trong dd ed 1 truGng hdp can trd nam d rang ham nhd thd nhat, rang ham nhd thu" hai gap d 3 trudng hpp va ea rang ham nhd thU nhat va thd hai gap d 3 tnidng hdp, trong nghien cifu cua chung tdi cac can trd cung gap nhieu hdn tren cac rang ham nhd hai ham (6 trudng hpp), trong dd cd 1 trudng hdp can trd nam tren rang 13, 43 da day lech ham dudi ve ben ddi dien Mh\ ham dudi chuyen dong ra budc. Butler cung da ghi nhan can trd ra trude tren 32% benh nhan.
KET LU^N
Qua nghien cifu s d lUdng diem cham khdp, diem cham sdm, diem cham qua mdc b"en 46 benh nhan mac LNTDH chiing tdi nhan thay:
Can trd van dong sang ben (32,3%) va ra tmdc (39.1%) tuong ddi it gap, ehii yeu la can trd ben khdng lam viec (30,4%).
Khong cd mdi lien quan giu^ can trd van ddng sang ben va ra trudc vdi trieu chifng loan nang thai dupng ham.
TAI LIEU THAM KHAO
1. Hoang Td Hung va cs (2003), Nghidn cOu thim dd tiip xOc cin khdp d vi tri long mOi td) da vi tmng cac van ddng truot cOa ham dUdi. Tuyen tap c6ng trinh nghien cifu Rang Ham MSt 2003, trang 103 - 1 1 0 .
2. Mc Neill C (1997). Temporomandibular Disorders:
Guidelines for Classification, Assessment, and Management. Quintessence Publishing (IL); 2.
3. Mohlin B, Koop S. A clinical study on the relationship between malocclusion, occlusal interference and mandibular pain and dysfunction. Swed Dent J. 1978;
2: 105-10.
4. Vd TaiPng Nhu Ngoc. Tham kham hinh trinh ngam mieng sinh ly. Bai giang khdp can hpc, bp mdn khdp can trudng Dai hpc Y Ha Npi.
5. Slobodan Dodic, Vladimir Sinobad (2009). The Role of Occlusal Factor in the Etiology of Temporomandibular Dysfunction. S;p>VhCeto^Le/(. 137(11-12): 613-618.
DANH GIA TAC DUNG CUA CHE PHAM' PTH1-BCA" TRONG DIEU TRI BENH VIEM K H 6 P DANG THAP GIAI DOAN l-ll
TOM TAT
Nghien ctJtJ dupe tiin hinh tren 60 bdnh nhan viem khdp dang thap giai doan l-ll, trong dd 30 benh nhan dugc diiu tri t)ang ehi pham "PTH1-BCA" vi 30 benh nhan dupc diiu tri bing bai thuoc co phUdng "Bdc hoat tang ky sinh" (PTH2) lieu trinh 1 thing. Thuoc nghidn cUu^ PTH1-BCA va thuoc doi chOng PTH2 dude bao chi dudi dang vien hoan mem 8g bpc trong vd nhUa hinh cau. Nghien cUU cho thiy, tuoi trung binh cOa benh nhan la 48 ± 9,82 (nhom nghien cuuj vi 49 ±
NGUYEN TUAN BINH, HOANG THj DIEP Benh vien Yhpc cd truyen, Bp Cdng an 10,21 (nhdm chiing). Tj? Id mic benh viem khdp dang thip giOa nam/nQ-ii 17/43 (28,33%/71.66%). Kit qui:
Nhdm nghien cOu dat loai tot+kha (A*B): 24/30 bdnh nhan (80,0%); tmng binh + kem (C+D): 6/20 benh nhan (20,0%). Nhdm chimg: loai tot+kha (A+B): 23/30 benh nhan (76.7%); loai trung blnh+kdm (C+D): 7/30 binh nhan (23,3%). Thuoc khdng cd tic dung phu tren lam sing, khdng lim thay doi chOc nang gan, thin, hdng cau, huyet sic ti.
TCf khda: PH1-BCA; viem khdp dang thap.
Y HOC THT/C H A N H (957) - SO 4/2015
