C H U Y S H B S : HQI NGHI KHKT CAC TINH VUNQ DUVeN HM B A C B O LAN THtf H H A T
DANH GIA KET QUA DIEU TRI GAY XI/ONG H A M DU'OI BANG PHAU THUAT KET HgfP XUONG NEP VIT
TAI BENH VIEN DA KHOA TINH THAI BINH
I- OAT VAN OE
Chan thuang hdm mdt la mgt cap ciai hay gap trong cupc song hdng ngay do nhigu nguyen nhan gdy nen, trong dd tai nan giao thdng chigm ty le cao nhdt. Thdy ty lg b$nh nhan chdn thuong ndi chung. chdn thuang hdm mat ndi rigng da tdng ca ve sd lirgng va mirc dg trdn trgng.
Tai benh vien Da khoa tinh Thdi Binh chan thuang hdm mat den dieu tri trong dd cd mdt ty Ie 15 -20% Id gay xuang ham dudi.
Viec chdn dodn va dieu tri gay xuang ham dudi tai khoa Rdng Hdm Mat cd nhieu tien bd dac biet Id dieu tri bang phdu thuat cd tir nhieu nam nay Iuc dau sir dung chi thep dg ket hgp xucmg nhung gdn ddy su dung ket hpp xucmg bang nep vit, da dem lai nhihig kgt qua kha quan. Dg gdp phdn ndng cao hieu qua trong chdn dodn va dieu tri, chiing tdi tign hanh nghign ciru de tai: "Bdnh gid kit qud dieu trj gdy xuffng hdm dird'i bdng phdu thudt dung nep vit kit hffp xu-ffng tgi Benh viin Ba khoa Tlidi Binh tu 01/2011 - 10/2012" nham muc tieu:
1. Nhgn xet dgc diim ldm sdng, X quang gdyxuwng hdm du&i do va dgp.
2. Bdnh gid kit qud diiu tri gdy xuffng hdm du&i bdng phdu thugt diing nep vit kit hffp xuffng.
II- DOI TJpNG VA PHUONG P H A P NGHIEN COU
2.1. Thoi gian, dia diem nghien ciiu Thdi gian: tir 01/2011 10/2012, Tai
Tran Binh Minh*
khoa RHM Benh vi?n Da khoa tinh 2.2. Doi tiring nghien cihi Gom 106 b?nh nhan bi gdy xuong ham dudi do tai nan dugc phau thydt ket hop xuang bdng nep vit.
- Tieu chudn l^-a chpn:
+ Benh nhdn gdy xuong hdm dudi do va dap cd dil didu ki?n chi dinh phau thuat ket hgp xucmg.
+ Benh nhdn cd nguypn vpng phdu thifit kgt hpp xucmg bdng nep vit va chap nhan tham gia nghien cim.
- Tieu chudn logi trir.
+ Tdt cd cdc benh nhan bi gay xuong hdm dudi do benh ly, hod khi.
+ Gay xucmg hdm dudi phdn gay loi cau dan thudn.
2.3. Phuong phap nghien cihi: Nghien cim md ta tien cim, iing dung kT thuat mdi trgn ldm sdng khdng so sanh.
Npi dung chinh trong nghien curu nay 2.3.7. Dgc diim mdu nghien curu - Tudi va gidi tinh
Nguygn nhdn, thdi gian gay chan thuang
2.3.2. Nghiin cu-u ldm sdng:
• Khdm todn thdn* Khdm tai chd:
2.3.3. Can ldm sdng • Xquang: • Xet nghiem:
2.3.4. Chdn dodn: Dua vao lam sang va X quang de xac djnh chinh xdc:
2.3.5. Ke hoach dilu tri
2.3.5.7. Xd- tri cdp cu-u vd diiu tri buk dau
* Benh vien Da lihoa Thdi Binh
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Y HOC VIJT NAM THANG 5 - SO DjjiC Bt|T 12013
2.3.5.1 Chl dinh phiu thuat 2,3,5,4. Ddnh gid kit qud diiu trj: Dira 2,3.5,3. Bieu trj hd tra- Diing khang tren co so hai noi dung co ban la chiic nang sinh,Giam dau, giam phii nk, sinh t6 ... va tham my cua viing ham mat
+Ket qua gan: sau khi thao co dinh ham +Ket qua xa; sau ra vien 3,9 thang.
Ill- KET QCIA NGHIEN COU
Chung toi xin trinh bay mpt so bang bieu co ban trong tSng thi kk qua nghien ciru Bieu do 1; Nguyen nhan gay xirong ham duoi
80.2%
n
a . r-i
a TNGT DTNLD aTN.SH BTNK TNGT TNLD TNSH TOK
Bang 1: Vi tri gay XHD theo gidi phdu (n^ 166)
Vj t r i ton thu'crng Xu'ong 6 rang
Viing cam Nganh ngang
Goc ham Nganti len LOI rau + mom vet
Cpng
So lu'tfng du'dng gay 6 75 26 36 10 13 166
Ty le % 3.6 45.2
15.7 21.7 6.0 7.8 100
Ket qud diiu tri ghn (ngay sau khi thdo cd dinh 2 hdm) Bang 2. Kgt qud digu tri gan (n= 106) K€t qua dieu tri
So lu'dng Ty le %
Bai KSt qua dieu tri
So IUdng Ty le %
Tot 71 67.0
Kha 19 17.9 lg 3: Ket qua dieu tri sau 3 thang
Tot 71 76.3
Kha 12 12.9
Kem 16 15.1 ( n = 93 )
Kem 10 10.8
Tong 106 100
Tong 93 100
CHUVeH DJ: HOI NGHj KHKT CAC TJNH VJING DUYfeN HAI B A C BQ L A N THCT NHAT
Bang 4: Ket qua dieu tri sau 9 thdng (n= 71 ) Ket qua dieu trj
So lu'dng Ty le %
Tot 57 80.3
Kh^
11 15.5
Kem 3 4.2
Tong 71 100
IV- KET LUAN
Qua nghien ciru 106 b?nh nhan gay xuong liam duoi dugc dieu trj phau thuat kk hgp xuong bang n?p vit tai b?nh vien Da khoa tinh Thai Binh tir thang 1 n8m 2011 dSn thang 9 nSm 2012. Chiing toi riit ra nhO'ng ket Iuan sau:
I. Dac diem lam sang gay xutmg ham duoi Tuoi va gioi tinh: Lira tudi hay gSp nhit la 21- 30 tu6i chiSm 43,4%. Ty le nam/nQ = 5,6/1. Tu6i nho nhjt la II thang, ion nhat la 80 tuoi
- Nguyen nhan hay gap nhit do tai nan giao thong chiSm 80,2%.
- Co 64,2% dugc so ciru bing cac bien phap khac nhau, trong do chi co 12,3% dugc CO dinh xuong gay.
- Co 11,3% CO t6n thuong sg nao kh hgp 6 cac mirc do vira va nhe; t6n thuong phin mem 67,8%; co 17,0% gay xuong ham tren ket hgp.
- Benh nhan gay 2 duong chiSm da so 47,2%; Vi tri gay thuong gap nhit la viing cim 45,2%, goc ham 21,7%; nganh ngang
15,7%, s6BN.
- Cac trieu chirng lam sang thirong gap nhu dau viing duoi ham, diim dau choi c6 dinh 100 %; dau viing ham duoi 100%; Trieu chiing sai khop cin co y nghTa chin doan chiim 91,5%).
2. Odnh gia l{et quS dieu tri Da so dirge phau thugt ttong th6i gian to 3- 7 ngiy dau sau khi xay ra tai n?n cliSSi 34,0%.
- BN dugc chi djnh phau thusit do gSj xuong di l|ch nhieu chiim 28,3%, gSy ho
chilm 19,8% g - Duimg m6 trong mi?ng dugc lifa ch^
nhieu hon, chiem 66,7%; duong ngoai mi?iiB
chiim 33,3%. ^ - 100%! sau phau thujt dugc ci djnh 2
ham. trong do 68,9%> sir dyng nut bupc Ivys 31,1 % CO dinh ham bing cung TiguerstedJI - C6 82.1% dugc co djnh 2 ham iiMl tuin 17.9%> dugc c6 djnh 2 ham tien 2 tuS tang cuimg sau phlu thuat kit xuong.
- Bien chijmg hay gJp sau phau thiijt:
Nhiem trimg phin mim 13,2%; Te mdi c k keo dai 7,5%; co khit ham 6,6%.
Ket qua diiu tri gin dat loji tit la 66,9%, kha 17,9%i, kem 15,1%.
- Ket qua dieu tri sau 3 thang: Tit la 76,3%, khd 12,9%, kem 10,8%.
- Ket qua diiu tri sau 9 thang: Tot la 85.9%. kha 11.3%, kem 2,8%.
MOT SO KIEN NGHI
- Khi CO benh nhan nghi ngo hoSc gay xucmg ham duoi chuyin benh nhan din coso , y te dil dieu kien de dugc chin doan va dieu y.
tri kjp thai tranh bo sot, tai biin hoac di chimg cho BN.
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YHQCVIETNAMTHANGS-SOP^C B1$T/2013
Hinh anh minh hoa BN : Pham Van Cuong 51 tu6i SBA: 167 DIA CHl: X6m 4- Dong LTnh - Dong Hung - TB NGAY VAO VIEN: 21. 3. 2010
NGAY RA VIEN: 05. 4. 2010
CHAN DOAN: gay XHD viing c5m, viing c6 16i ciu trai
TAI UEU THAM KHAO
1. LAM NGQC AN, BUI HUU LAM, LAM HOAI PHU'ONG (1994), Diiu trj g^y loi cau bang phuong phap bao ton, ky yeu cong trinh khoa hoc vien RHM - TpHCM 1994: 137-140.
2. NGUYEN QUOC DUC (1998) " Giy x-
• inmg ham duoi thoi binh, danh gia kit ' qua diiu tri tai Vien RHM Ha npi" Luan van thac sy y hoc nSm 1998.(Tr. 20-25) 3. LE VAN HAN (2004), Nhan xet chin
thucmg xuong ham duoi do tai nan giao thong. Lu^ van thac sy y hoc nam 1998.(Tr. 20-25)
NGUYEN HUY PHAN (1963), "110 tr- uong hgp gay xuong ham do chan thu- ong, chan doan va dieu tri". Tai lieu nghien cim RHM si 04/1963 (Tr.36-39).
NGHIEM TRI PHUONG (2002), "Danh gia hieu qua phuong phap dieu trj ket hop xuong ham duoi bang nep vit". Luan van bac sy ngi trii benh vien Ha ngi nam (2002).
LY HAN THANH (2002). "Nhan xet dac diem lam sang va danh gia ket qua dieu trj bang phlu thu^t gay xuong ham duoi phirc hgp nhieu duong tai Vien RHM Ha ngi (2000-2002)". Luan van thac sy y hpc Ha npi nSm 2002.
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