Y HOC VIET NAM THANG 5 - SO 1/2013
KET QUA Bimc DAU NEP NEO GlU TRONG NAN CHINH RANG
TOM TAT
Vit neo giir la mot phu'Ong tien khdng the thieu trong nan chinh rSng hien dai. Vit neo giU thUdng du'dc dat ke gii?a cac chan rang, va vi vay nguy cO cham vao chan rang rat cao. Ben canh day do du'dng kinh nhd, chieu dai ngan nen kha nang chiu li/c eiia vit rat kem. Viec sir dung nep neo giiT da dUdc img dung tir lau tren the gidi tuy nhien d Viet Nam con it tac gia nghien ciru danh gia. Vi vay viee danh gia kha nang iTng dung ciia nep neo g\d tren ngu'di Viet Nam la mpt ddng gop thiet thuc cho viec phat tnen nganh nan chinh rang md ra kha n3ng ifng dung ciia nep neo giu trong nan chinh rang.
SUMMARY
FIST INVESTIGATIONS OF MINI PLATE ANCHORAGE IN ORTHODONTICS Minivis anchorage is a modern method in current orthodontic. Minivis is placed usually in space between .2 dental roots, and has risk to damage dental root.
With a small diameter, short length cause minimal tension resistence. Mini plate anchorage has been applied in world wide but not yet popular in Vietnam.
This research has a significant contribution to Vietnamese orthodontics,
I.
OAT V&Nof
Nganh nan chinh rang Viet Nam cdn non tre, tru'dc day nan chinh rang chii yeu bang ky thuat nan chinh thao lap, it hieu qua va nhieu tai bien. Ky thuat nan ehinh rang ed dinh ehi mdi phat trien trong vdng 20 nam lai day, giup dat diTde ket qua dieu tri tot va giam thieu tai bien.
Mae di sau so vdi the gidl nhu'ng nganh nan chinh rang Viet Nam cung dat du'dc nhieu thanh ti/u dang khich le, bu'dc dau van dung du'dc eae thanh ti/u khoa hpc the gidi vao trong chuyen nganh. Sir dung thanh cdng mac cai day thang, day cung sieu dan hoi, mae eai mat lu'di vao trong dieu tri cho benh nhan lech lac rang.
Khoa rang, Benh vien Viet Nam Cuba Ha Npi la mdt trong eac cd dau tien eiia Viet Nam utig dung vit neo giCT trong nan chinh rang, day la mpt phu'dng tien khdng the thieu trong nan chinh rang hien dai, tuy nhien vit neo giu'cd mdt so nhu'dc diem la kha nang chju li/e kem va nguy cd gay ton thu'dng chan rang cao. D I that bai neu dat vao viing xu'dng ham xop. Viec sd dung
* BSnh vien Viet Nam - CuBa Ha noi Phan bien khoa hgc: PGS.TS. Truo-ng Manh Dung
D a o Thj D u n g * , Pham Nhif H a l * nep neo giu" giup khac phue cac nhu'dc diem tren ciia vit neo. Tuy nhien cho den nay d Viet Nam cd it tac gia nghien ciTu ve viee siydung nep neo 910", ehinh vi vay ehiing tdi tien hanh de tai vdi muc tieu:
1. Ap dung nep neo gid trong nan chfnh rang.
2. Danh gia cac tai bfen, td day rut kinh nghiem ap dung lam sang.
W. OOI TUONG VA PHUONG PHAP NGHIEN CLftJ 2 . 1 . Doi tu'dng nghien culi: la eae benh nhan den kham va dieu tri tat Benh vien VN-CB ed:
V Sai khdp Angle I va Angle I I . V Ddi hdi neo giiJ ldn.
^ Khoang each gitTa eac chan rang khdng cho phep dat vit neo giiJ.
V Cau triic xu'dng ham xop cd nguy co rung vit cao
^ That bai nhieu lan vdi vit neo gitT.
^ Dp tudi tir 18-40
^ Ddng y tham gia nghien ciTu.
Chiing tdi da thu'c hien ca'y di/dc 10 nep neo giO' VLing tru gd ma ham tren cho 7 benh nhan.
2.2. Phu'dng phap nghien cufu: Can thiep thir nghiem lam sang
2.3. Phu'dng tien nghien cu'u:
V Bd dung cu tieu phau
•^ Tay khoan phau thuat, mui khoan phau thuat
•^ Nep vit phau thuat.
2.4. Vj tri dat nep:
Do ham tren thu'dng ddi hdi neo giiT eao, xu'dng ham tren xdp, vi vay nhieu tru'dng hdp eay vit neo giiT nhieu lan van that bai nen ddi hdi phai dimg nep neo giiT. Vi ham xu'dng ham tren nhij'ng tru'dng hdp nay rat xdp nen chiing tdi chpn vi tri dat la viing tru gd ma va phan du'di than xu'dng gd ma ciia ham tren. Ddi vdi ham du'di thi xu'dng dac hdn rat nhieu nen thu'dng thanh edng vdi vit neo gitT ma can den nep neo giiT.
2.5. Cac bu'dc dat nep neo giu' v^ Gay te tai ehd
^ Raeh ldi di ddng vung can dat nep neo giiJ'
•^ Bde tach bdc Id xu'dng viing can dat nep vit
•^ Kiem tra mat do xu'dng viing d i / kien dat nep
•^ Udn nep theo diing hinh thai xu'dng viing can dat
97
Y HOC VI^T NAM THANG 5 - SO 1/2013
^ Khoan tao lo vit Y Bat vi't cd djnh nep
•/ Oat li/e keo 200g ngay sau khi dat nep 2.6. Phu'dng phap d a n h gia Danh gia ket qua sau 1 tu'an, 1 thang, thang theo cae tieu ehi:
</ o p chac ciia nep theo thdi gian: dp lung lay ciia nep neo gitj'
/ Cam giac ciia benh nhan: dau khi lung lay nep.
•/ Xquang: Vit dat xa chan rang.
' Tinh trang kich img ciia t d ehirc niem mac
Do lunq lay eiia nep neo qiU Cam qiac ciia benh nhan Xquanq
Kich irng to chirc mem mae
Tot Khonq lunq lay khonq dau xa chan rSnq khonq kich imq
Khong tot Lunq lay
Dau
C3m cham vao chan ranq Cd kich iTnq
Oanh gia cac tai bien: dau rang ben canh, viem xoang ham, viem tiiy rang ben canh, nhiem triing viing lan can, chay mau keo dai....
III. KET QUA VA BAN LUAN
3 . 1 . Ty le thanh cong cua nep neo giu":
Bang 3 . 1 . Ty le thanh cdnq eiia nep neo giiT van sir dung tot sau 3 thang
Thanh cong That bai Tong so
So luong nep Tyle
Ty le thanh edng eiia nep neo giir la 70%, Sau 3 thang thi ed 3 nep bi lung lay, benh nhan dau sau day phai lay ra, trong day ed 1 benh nhan sau 2 lan eay van that bai. Ty le nay thap hdn nghien ciru ciia De Ciere EE, Swennen GR. [4] dat 99 nep neo giiT du'di gay me toan than vdi ty le thanh edng 9 7 % sau 3 thang. Dieu nay cd the do ky thuat dat cua chiirig tdi chu'a du'dc thanh thao, viec ehon vi tri cay nep khdng du'dc tdt va dat nep bang gay te tai ehd nen khd danh gia vi tn' cay nep hdn. Va ILTC dat eiia ehung tdi Idn hdn 200g so vdi 150g ciia cac tac gia nay.
3.2. Dp lung lay cua nep neo giu':
Bang 3 . 2 . Dd lunq lay ciia nep neo q\d sau 3 Sd liTdnq nep
Tyle
Khonq lunq lav 6 60%
thanq lung lay
4 1 40%
tonq 10 100%
Trong so 10 nep neo q\d thi cd 1 nep bat dau lung lay sau 1 thang, 2 nep lung lay nhieu sau 2 thang, cd 1 nep lung lay nhe sau 2 thang nhu'ng van dimg lam neo giCT du'dc. So vdi nghien ciTu ciia De Clerc EE, Swennen GR. [4] ed 5 /99 nep bi lung lay nhu'ng sau day cd 2 nep chac lai thi sd lu'dng nep bi lung lay eiia ehiing tdi ldn hdn nhieu. Tuy nhien day mdi ehi la nghien eiru bu'dc dau ciia ehiing tdi, Khi chiing tdi hoan thien du'dc qui trinh cay nep thi sd lu'dng nep lung lay se cang it dan.
3.3. Oanh gia t r e n Xquang:
Bang 3.3. Lien quan eiia nep neo giiT so vdi ehan rang Sd luong nep
Tyie
Cach xa chan rang 10
Cham vao chan rang Tong 10 0%
Nhu" vay khdng ed nep neo giiT nao gay ton thu'dng chan rang lan can, Oay chinh la Idi diem ciia nep neo giiJ.
3.4. Kich u'ng t o chu'c lan c a n :
Bang 3.4. Kich irng to chiTc lan can theo ddi sau 3 thang 56 iu'onq nep
Tyle
Khong kich Li'nq 7 70%
Kich irng 3 30%
Tonq 10 100%
So lifting benh nhan bi kich irng ciia chiing toi la 3 0 % , so vcli nghien ciru De Clerck EE, Swennen GR. CO 4/99 (4,04%) nep gay kich iing thi nhom benh nhan ciia chung toi bi kich iJng nhieu hdn.
Y HOC VIET NAM THANG 5 - SO 1/2013
Tinh trang kich u'ng thu'dng do dau nep sac thd ra ngoai sau day chi can mai nhan va bpe sap thi benh nhan het kich u'ng. Neu dau nep thd ra ngoai nhu'ng khdng lung lay thi se it gay kieh irng hdn.
3.5. Tinh trang phii ne:
Bang 3.5 Tinh tranq phu ne sau khi dat nep
Tinh trang phii neSd lu'dng nep Tyle
< 3 ngay 3 30%
> 3 ngay 7 70%
Tong 10 100%
Nhu' vay 100% vi t r i cay deu gay phii ne trong dd 7 0 % phii ne nhieu. Danh gia bu'dc dau chiing toi nhan thay mire dd phii ne lien quan nhieu den thdi gian thu'c hien ky thuat, cang thu'c hien ky thuat keo dai va cang banh keo nhieu thi phii ne se cang nang ne. Tinh trang phii ne day khdng phai do nhilm trung, trong tong sd 7 benh nhan thi khdng ed benh nhan nao ed bieu hien nhiem triing, cd nghta la cd phii ne nhu'ng an tai cho khdng dau nhieu va ed xu hu'dng giam dan, khdng cd tneu ehirng eiia ndng dd, khong sdt.
QUI tnnh dat nep. bOL lo vung tru chan ham va dat nep, sau do khau vet md
nep neo g\W giup keo ddng thdi toan bo cae rang 1 ben trai de ehinh du'dng giJia | 3.6. Oanh gia cac tai bien khac:
Bau rang ki' bin vung dat nep: chiing tdi da hen kham go va hdi cam giac eiia benh nhan tren eac rang ben canh sau dat nep 1 tuan, 1 thang va 3 thang tren 10 vi tri nep dat thi khdng thay cd bieu hien dau hay lung lay eac rang lan can. nhu' vay nep neo giiT la mot phu'dng tien an toan eho cac rang xung quanh.
Viim xoang ham: chiing toi danh gia cae dau hieu viem xoang tren 7 benh nhan: dau viing xoang, an dau vung xoang, su'ng ndng dd viing mo mem quanh xoang ham, ehay mui mil, tac mui, nghet mui tren cae benh nhan du'dc eay trong vdng 3 thang thi khdng benh nhan nao cd cac dau hieu tren. Nhu' vay mae du khi dat nep
cd the ehiing ta de vit xuyen vao trong xoang ham d nhu'ng vi tri thanh xoang mdng nhu'ng neu thu thuat dam bao vd triing thi van khdng anh hu'dng den xoang ham
Viem tuy rang bin canh: trang nhdm benh nhan nghien eiTu, chiing toi theo doi sau 3 thang thi khdng co benh nhan nao bi viem tiiy rang.
Nhiem triing vung lan can: khdng benh nhan nao bi viem md te bao viing lan can trong 3 thang theo doi. Do dau nep di/dc dUa ra ngoai xa khdi vi tri dat nen khong gay kieh irng td ehire xung quanh va vi vay khdng gay nhiem triing viing lan can trong qua trinh sir dung.
Y HQC VigT NAM THANG 5 • SO 1/2013 f V . KET LU&N
Nep neo glO" cd the ap dung du'dc trong dieu kien ciia Viet Nam, vdi thanh cdng ban dau la 70% thap hdn nhieu so vdi bao cao ciia mpt sd tae gia tren the gidi. Tuy nhien day la ket qua dang khich le, de cd the danh gia sau hieu qua ciia nep neo giu' thi can cd cae nghien ciTu vdi so lu'dng Idn benh nhan de du'a ra du'dc qui trinh dat nep trong dieu kien Viet Nam cung nhu" du'a ra khuyen eao eho bac sT dieu trj.
TAI UEU T H A M K H A O
1. Chung-Chen Jane Yao, JangOaer Lee, Hsing-Yu Chen, Zwei-Chieng Jenny Chang, Hsin-Fu Chang and Yi-Jane Chen. (2005)
"Maxillary Molar Intrusion w/ith Fixed Appliances and Mini-implant Anchorage Studied in Three Dimensions". The Angle Orthodontist 75:5,754-760 Cumhur Tuncer, Mustafa Sancar Atag, Burcu Balo$ Tuncer and Emre Kaan. (2008)
"Osteotomy Assisted Maxillary Postenor Impaction w/ith Miniplate Anchorage". The Angle Orthodontist 78:4, 737-744
De Clerck EE, Swennen GR.( 2011 Nov)"
Success rate of miniplate anchorage for bone anchored maxillary protraction" Angle Orthodontist.81{6): 1010-3.
Firdevs Vezlroglu, Sina Uckan, Utku Ahmet Ozden and Ayca A r m a n . (2008) "Stability oF Zygomatic Plate-Screw Orthodontic Anchorage System". The Angle Orthodontist 78:5, 902-907
NHAN THUTC CUA PHU NUfVE PHONG CHONG BENH LAY TRUYEN QUA DUUNG TINH DUC VA HIV/AIDS TAI MOT SO XA, TINH PHU THO
N g u y e n Ddc T h a n h * , V u Phong Tuc*
TOM TAT
Dieu tra cat ngang md ta tren 210 phu nir' dang nuoi con nhd di/di 2 tuoi tren dia ban mpt sd xa tinh Phil Thp ve niian thu'c ve phong chong benh lay truyen qua du'dng tinh due va HIV/AIDS. Ket qua cho thay Viec tiep can thong tin cham soc sire khoe smh san ciia cae phu nff chu'a thiTc sU dong deu: 2 chii de la cac bien phap tranh thai va each eham soc phu niJ khi ed thai dUde 100% so phu niT ke den, nhieu hdn dang ke so vdi eae chii de khac. Ngoai TV/radio, sach bao va phim anh, kich thi nhan vien y te, can bo hoi/doan the, va cpng tac vien dan so la nhij'ng nguon thdng tin chinh eung cap thong tin ve sire khde sinh san (dupe tren 90% sd ddi tu'dng de cap den). Ty le doi tUPng biet den benh phu khoa, benh lau, benh giang mai dat tren 90%. Nguyen nhan "quan he tinh due vdi ngu'di mac benh ma khong diing bao cao su" dUpc eac doi tupng de cap den vdi ty le cao nhat (99%). Co rat it ddi tUPng de cap den cac hau qua ciia benh nhiem khuan du'dng sinh san va benh lay truyen qua du'dng tinh due nhu "tang nguy cd nhiem HIV", "de bi ung thU tir cung" (9,1% va 7,2%). Kien thiTc ve du'dng lay HIV ciia cac dd'i tUPng nghien ciTu 6 miTe kha tot vdi ty le cao (tren 95%) eac doi tu'Ong de cap tdi du'dng lay do "quan he tinh due khong diJng bao eao su", "truyen mau" va "diing chung bdm kim tiem"
Tir khoa: Benh lay truyen qua dUdng tinh due, HIV/AIDS
* Trudng Oai hoc V Thai Binh
Phan bien khoa hoc: PGS.TS. Vu-o-ng Thi Hoa 1 0 0 • •
S U M M A R Y
KNOWLEDGE OF WOMEN ON SEXUALLY TRANSMITTED DISEASES AND HIV/AIDS IN SOME
VILLAGES, PHU THO PROVINCE The descriptive cross-seetional survey on 210 women who are raising children under 2 years of age in some communes in Phu The province to descnbe their awareness on prevention of sexually transmitted diseases and HIV/AIDS. The results: The access to reproductive health care information of the women was not uneven: two topics of contraception and how to care for pregnant women was menboned by 100%
of the women, significantly higher than the rate of those mentioning the other topics. In addition to the information sources including TV/radio, books/movies/drama, the health staff, social association/union staff and population collaborators were main sources of informabon on reproductive health production for the women (over 90% of the surveyed subjects menboned). The rates of women who knew about the rate of gynecological diseases, gonorrhea, and syphilis were over 90%. The cause of
"having sex with infected person without using condom" was mentioned by the highest rate of the surveyed subjects (99%). Very few survey subjects mentioned the consequences of reproductive trad:
infections and sexually transmitted diseases such as
