Khoa hpc Y - DUpc i
Ket qua phau thuat chuyen ngon chan phuc hoi ngon tay cai
Lc Van Doan, Xgo Thai Hu-ng, Nguven \ let Tan", Nguven \iet Nam. Ch§ Dinh N{;hTa, Nguven Nan Phii Benh vien Trung uung Qudn doi Ids
Ngav nhan bai 3/7/2019: ngay chuyen phan bien 8/7/2019: ngay nhan phan bien 26 S 2019; ngay chap nh^n dang .3/9/2019
Tdm tdt:
Ngon tay cai chiem 50% chirc nang eua ban tav. Hien nay tren the gioi. phau thuat chuyen ngon chan phuc hoi ngon tav cai bSng ky thuat vi phau la phirong phap diroc lira chon hang dau cho ton thirong n^y. Nghien ciru nhSm danh gia ket qua ciia phau thuat nay tren ngiroi 6-\ict Nam. Nghien cihi du-gc thyc hien tir thang 9/2015 den 3/2018 theo phiroTig ph^p tien ciru tren 30 benh nhan (BN) co tuoi trung binh la 28.6 {7-55 tuoi), ty lc nam/ntr la 25/5. Co 6 mom cut ngon c^i kem theo mat toan b^ co' 5 mo cai dirp'c tao hinb bang vat ngon chan cai thu nho lay tren khop biin ngon chan; 24 mom cut ng6n cai con o mo cai dirac tao hinh bang 6 vat ngon chan cai thu nho v^ 18 vat ngon chiin Ihir 2. Ket qua cho thay, sau mo trung binh 19 thang {12-33 thang), 100% ngon chuyen song hoan toan. \ o i ket qua xa, diem phan bi9t cam gidc 2 diem tinh trung binh la 13,4 mm, 5/30 trucmg hop (16,7%) bj l^ch trye ng6n chuyen, 13/30 truimg h9p (43,3%) bj bien ehiing dinh gan. Tat ca cac BN deu eo the sir dung chii dpng ngon chuyen trong sinh hoat
\k lao dong hang ngay. Voi 6 mom cut ngon cai khong con 6 mo cai: 4/6 trucmg hcrp phuc hoi dup'C dpng tac doi chieu CO' ban ctia ngon cai. V6i 24 mom cut ngon cai con o mo cai: diem doi chieu Kapandji trung binh lit 8,2; lire n^m vfi I\rcnh6n trungblnh lan lupt Ea 80,7 va 51,7% so voi ben lanh. Nhu vay, phau thuat chuyen ng6n ehan phuc hoi ng6n tay cdi 1^ an toin, vif\ ly le thanh cong cao (100%), cho ket qua phuc hoi chirc nang tot ve van dpng va cam giic.
Tir khda: mom cut ngon cai, phau thuat chuyen ngon chan, lao hinh ngon cai.
Chi sd phdn loai: 3.2
m v^n eh
Ngon lay cai chiem den 50% chiic nang cua ban lay. Do do, niifrng lon Ihirang gay cut, mat ngon tay cai deu anii hirong ldn den chuc nang, Iham my va tam Iy cho ngudi benh. Trong cac phau thuat phuc hoi mom cut ngon tay cai.
phau thuat chuyen ngon chan bang ky thuat vi phau co nhieu uu diem, cho kh qua lot ca chuc nang va tham my, va ngay nay duoc coi la sir lua chon hang dau lai cac nuoc phat tnen.
Tai Viet Nam, vdi xu hirdng gia tang cua cac vu tai nan lao dpng va giao thong Ihl ton thuong cut, mat ngon tay cai khong phai la hiem gap. Phau thual chuyen ngdn chan phuc hdi ngon tay cai da dugc thuc hien lai Benh vien Tmng uong Quan dpi 108 tir nam 1988. GSn day, cung cd mot sd tmng tam chdn thuong chinh hinh trong nuoc budc dau th^rc hien phiu thuat nay Tuy nhien, so lupng cac bao cao.
nghien cuu \'t phau thuat tren con han che. mdt chi dimg lai la nhimg thong bao ve ket qua budc dau vdi sd lugng BN khiem ton. Vi vay, chting toi tien hanh nghien ciru nay vdi muc tieu "danh gia kCn qua phuc hoi chirc nang ban tay sau phau thuat chuyen ngdn chan phuc hdi ngdn tay cai".
'Tacgia lien he: Emad Drngiivenyietlaniagmail com
Dtil nrOng va phiTdng phap nghien ciKU
Ddi lurang nghien ctru: nghien ciru dirac thuc hi^n lir tir Ihang 9/2015 ddn 3/2018 tren 30 BN dircrc phau thuat chuyen ngdn chan phuc hoi ngon tay cai.
Tieu chudn lira chgn: BN bj cut ngdn cai don lhuan;
ban tay cdn it nhat mdt ngdn dai khdng bi cut hoac ton Ihuang; BN dong y tham gia nghien ciru; day dii ho so tu lieu nghien ciru.
Tieu chudn loai trir: BN khong dii dieu kien phau thual, gay me hoi sire; cut ca 5 ngdn tay; thdi gian theo ddi dudi 12 thang, thieu ho sa, lu lieu.
Phirffng phdp nghien ciru: nghien ciru tien cuu, theo
ddi dgc. khdng nhdm chung.
Ddnh gid kit qud gan: ly le ngdn sdng, lac mach, chay mau. nhiem triing.
Ddnh gid ket qud xa dgt dirffc tai bdn tay
• Danh giii chiic nang van dgng:
+ Vdi dyng cu kham ban tay ciia hang Jamar: do long
bien do van dgng khdp ban ngdn, khdp lien dot (TAM). Do
I Khoa hpc Y - DUpc
The results of toe-to-thumb transfer surgery
Van Doan Le. Thai Hunf; N^n. \ icl Tan Nguven'.
\ i c l Nam Njiuvin. Dinh Nghia C h e . \"an Phu Nguven IDS .Mditan Central Haspiial Received .1 Julv 2(i|<) acccpttd ' Sopicmbcr 2111 •' Abstract:
T h u m b makes up 50",, of hand function. In the vvorld.
toC'to-thumb transfer surgerv using microsurKcrv technique is the s t a n d a r d t r e a t m e n t for t h u m b reconstruction. \ cohort studv was performed in 30 patients from September. 2015 to March. 2018 » i l h the age average of 28.6 ( r a n g e : 7-55). and male li-ni.iii' rale of 25/5. Si\ t h u m b s t u m p s without t h e n a r muscles were reconstructed bv t r a n s - m e t a t a r s a l trimmed great loc flap; 24 t h u m b s t u m p s with t h e n a r muscles vM-re reconstructed by six t r i m m e d great toe Haps and 18 second loe Hups, \ v c r a g e follnw-up time was 19 months ( r a n g e : 12-33 months). Primarv result e\hibited 1110°..
transferred toes survived completclv. Seiimdarv results:
Ihe average of sialic 2-p«int discrimination vv.is 13.4 m m ; 5/30 (16.7".,) had mal-roiation of transferred Iocs: 13/30 (43.3".,) had tendon adhesion complication.
.\ll patients aetivelv used the reconstructed t h u m b s for living and hibov :ieiM ities. Kour out of six t h u m b stump patients without t h e n a r imisclcs achieved basic t h u m b opposition. In 24 t h u m b s l u m p s vt ith t h e n a r muscles, the average of K a p a n d j i t h u m b oppositiiin score was 8.2:
the average of grip strength and kev pinch strength » a s 80.7 and 51.7"., of the uninjured side, respecliveh. In conclusion, loe-to-thumb transfer surgery v^as safe and otfcctive v\ith high successful rate ( 1 0 0 % ) . and exhibited good outcomes in iniMenieiii and sensory restoration.
Kc\ tcords: t h u m b reconstruclion. t h u m b s l u m p , transfer.
Cla.ssjficafion number: 3.2
toe
V z ^.^ >anh luc n i m . luc nhon tai b;in lay d u a c ph-iu iluuil \ a
>o sanh voi ben lanh.
- Tinh diOm ddi chiC-u ngdn cai theo ihang dicni Kapandji
'M
- Danh eia phyc hdi cam giac bang lest phan biel 2 diem linh va dpng. ur do phan dp phuc hdi cam giac theo Hgi ddngv hgc Anh [2].
- Tim cac nhugc dilm v l tham mv va chirc nang. cac hien chiing dinh gan. cirng khcVp. cac bicn chimg khac.
- Kiem tr^ xucnigqua phim X-quang: true .\uang. sir lien
\ m m g
- Danh gia dua ircn chu quan cua BN qua bg cau hdi:
ddnh gia cl^irc nang ban lav theo Michigan (Michigan hand
^.uicomes questionnaire) tren 6 ticu chi: chirc nang chung, kha nang smh hoat. kha nang lao dgng, miic dg dau, diem tham my. dp hiii long [3].
\irly so lieu: so lieu dirge xii ly bang Uuiat loan thdng ke > hpc vdi phan mem SPSS 21.0.
l t l e u a
Dgc diem ddi tirirng
Tudi imng binh cua BN la 28,6 (7-55 ludi), Ty le nam/
nii la 25 5
Niiu>en nhan gay cui. mat ngon lay cai: 6 6 , 7 % do tai nan lao dpng. 26,7% do tai nan sinh hoai, 3 , 3 % do lai nan giao ihong va 3,3% do hpi chimg vdng that bam sinh.
Tay phai/trai la 19/11. Tay ihuan/tay khong thuan la '>iS.
Trong dd, cd 24 mdm cut ngdn cai d a n thuan (van cdn d md cai) dugc lao hinh bSng 6 vat ngdn chan cai thu nhd va 18 val ngdn chan thii 2; 6 mdm cut ca d md cai d u g c tao hinh bang vat ngdn chan cai thu nhd lay tren khdp ban ngdn.
Thdi gian theo ddi irung binh la 19 thang (12-33 ihang).
Ket ijiid gdn
Ty ie ihanh cdng la 30/30 ngdn song hoan toan (100%).
Tuv nhien. cd 2 irudng hgp bi chen ep tinh mach (TM) sau md. 0 2 irudng hgp nay, trong phau thual lan diiu, chung toi chi thirc hien mpt mieng ndi TM. Qua kicm tra, chung toi phal hign mgt trudng hgp mieng ndi TM n m tdt;'irudng hap cdn iai. mieng ndi TM da bi tSc. X u tri. mdt tnrdng hop phai ndi lai TM va I trudng hgp chi c i n l^v mau tu va cam mau vet md.
Mdt tnrdng hgp bi bicn chimg nhiem trung mdi ndi PS
ISMGNGHE\ ^ \m ^
Khoa hpc Y - DUpc •
Ket qud xa
Kcl qua phuc hdi van ddng: ket qua phyc hdi van dona cua nhdm khong cdn ca d mo cai. til ca 6 BN d nhdm nay deu cd ihe sir dung chii ddng ngdn chuyen irong sinh hoai va lao dgng hang ngay. Trong dd, 4/6 BN phyc hdi dugc dgng tac ddi chieu ciia ngdn cai, tir dd cd the cam ndm va nhdn nhat. 2/6 BN chua phuc hdi dugc dgng tac ddi chilu ciia ngdn cai va chi cd the cam, nam dugc cac dd vat lo (ca. cdc) nhung khdng nhdn nhat dugc cac dd val nhd. 6 2 trudng hpp nay, ton thuang trudc md la nang ne. vi tri mdm cut d tren khdp thang ban, cac xuang tu cdt d bd quay bj mil. Dac dicm, vj tri mdm cyl va kel qua d 6 BN nay dugc md la chi tiet irong bang I.
Bang 1. Ket qua phyc hoi van dong va cam giac ciia nhom khong c6nco'6m6cai(n=6).
. . _ Vj Iri rnfim cui ?{f"" Lv<: nh*" Li;c nim
BN Tay ', ,, * M TWl Mk (°''° ben Unh) (% ben Unh)
ngbii c^l
Tlil Kliiii ig cui Tril KOn xifong ban I Tnii Men i m m ; ; H i l l Trai Khu: 1(1 Clii Phil \'i}[i \ m n i g han 1 Phil Khoi w cfll
Kcl qua phyc hdi van ddng ciia nhdm cdn d md cai: cd 24 mdm cyt ngdn cai cdn ca d md cai Kel qua phyc hdi van dpng ciJa hai nhdm dugc tao hinh bang ngdn chan cai thu nho va ngdn 2 dugc the hien trong bang 2
Bang 2. So sanh phuc hoi van dpng tai nh6m dup'C tao hinh bing ngon cai thu nho va ngon chan Ihip 2 (n=24j
Ngdn chuvfin ^ 9 t "g^n ehan V^t ngdn
""~~~. cai thu nho chan thir 2 il thu nho chan t h i r l (n=6) (n-18)
Di«m doi i^hieu 8,3±1.9 Lire nhdn (% vai ben lanh) 64,4^ 22,'J lifc niSni (% vcn t>cn lanh) 73,2±30,5
1AM 42.5±29,8 Diem chue nang ban lay S9,5±8,2
X,2±1.3 0.134 47.4±20.6 0.768 83,2±32.9 0.675 38.3±23.6 0,364 S4.7±12,7 0.54S
Ket qua bang 2 cho thay, khdng cd su khac biet ve phuc hdi chirc nang ciia nhdm dugc tao hinh bang ngdn chan cai Ihu nhd va vdi ngdn chan thir 2 vdi p>0.05.
So sanh su phuc hdi van ddng giua hai nhdm mat v a cdn 0 md cai: ket qua bang 3 cho thay, cd su khac biet trong ket qua phuc hdi van ddng ciia nhdm cdn ca d md cai va khdng cdn cg d md cai vdi p<0.05.
Bang 3. So sanh diem ket qua van ddng dat duvc giua nhom cut ngdn cai khong con co- 6 mo cai va nhom cut ngon cai con co 6 mo cai.
Cgt ngdn cdi C|;t ngdn cd khdng cdn c a d c6n ca a mA md cdi (n=6) c i i {n=24)
S.2=!.4 0,000
!*ll.7=32.n 0.03 DiOm ddi ehieu
Sue nim Co ben lanh)
Diem ehijc nangban lay 68.3±I9,7 ,S5,>)=II.4 0.021
Phuc hoi ci'im giac- diem phan biet cam giac 2 diem tmh trung binh la 13.4-3.8 mm. Diem phan biet cam giac 2 diem dgng trung binh la 6,5±2,0 mm. Theo phan dp cam giac cua Hdi ddng y hgc .Anh. 24 ngdn phyc hdi cam giac dat mirc S3(+) va 6 ngdn phyc hoi cam giiic dat S3.
Bien chimg lech inic, dinh gdn. 5 ngdn lay cd bien dang lech true ngdn tay. Ty le dinh gan sau phau thu^l la 13/30 (43,3%). trong dd cd 7/13 BN da dirac phiu Ihuat gd dinh gan. 6 BN khdng cd nguyen vgng gd dinh gan.
Kel qud thdm my: diem Iham my trung binh la 79.7± 17.0.
Trong 12 mdm cut ngdn cai dugc tao hinh bang val ngdn chan cai thu nhd, ngdn van to va thd han ngdn Ihudng, dau ngdn to va bitp ngdn day. Cd 5/12 BN da Ihyc hien phau thual thu nhd ngdn chuyen thi 2. 18 mdm cyl dugc chuyen ngdn chan thii 2 thi ngdn chuyen nhd, gay, cd ba dot, dau ngdn hinh be va mdng be. ngan. Cd 3/18 BN da ihyc hien phau thual ddng cimg khdp lien dot xa sau chuyen ngdn thi 2. Diem Iham my ciia hai nhdm dugc the hien trong bang 4.
Bang 4. Diem Iham my dal dup'C.
V ui agon chan Diem Ihiim mf
V?l ngon cai Ihu nho (n=l2) 75,8±I6,6 Viii ngon [hw 2 (n= 18) 82,3± 17,2
Nhan xet: vdi danh gia chii quan ciia ngudi benh Ihi khdng cd su khac biel irong kel qua tham my khi lao hinh bang val ngdn chan cai thu nho hay ngdn chan Ihu 2.
Do hdi long- do hai long trung binh la 7S,0±18,7. Kel qua so sanh dp hai ldng cua BN giiia hai nhdm dugc chuyen vat ngdn chan cai thu nhd va vat ngdn chan ihd 2 dugc the hien trong bang 5,
Bang 5. Op hai long dat dupc.
Vtil ngon chdn Vat ngon cai ihu nh6(D-12) Vat neon i h i r 2 ( n = l 8 )
D9 hdi ldng 73.7±17,5
Nhan xet: khdng cd su khac biet ve do hai ldng ciia
ngudi benh khi tao hinh bang vat ngdn chan cai thu nhd hay
ngdn chan thir 2.
I Khoa hpc Y - Dupc
hit qua gdn
Trong nghien cim cua Gu va cs (1989) tren 22(i ca chuyen ngdn chan lon ngdn ia\, iv 1^ ihanh cdng la '^4.~".>
(214 22''I va 12 ca thai bai [4] Trong dd, cd 77 trucmg hgp I ' 4 . 1 % ) cd nhOng bien chung I5c mach trong va sau md.
Theo nghiOn cim cua Jain va cs (2009) irC-n UC- BN. tv le thanh cdng la '>S"., nhung ciing co lai 13 ca (12.6° o I bi bien chimg t i c m^ch [5]
Tn>ng nghien cim nay, tv 10 Ihanh cdng la UIO"!! Tuy nhicn co 2 trudng hgp bj lac nghin TM va can phau thuat kiem tra lai mdi ndi. Qua hdi ciru cho thay dav l.i 2 irong 7 trudng hgp ma chimg ldi chi ihyc hi^n 1 miene ndi I M irong thi md. Miu vpv. vice ndi tir hai TM tra len co Lie dyng tang tuan hoan cho ngon ehuven vj han che nhung bicn chimg iSc, nghOn T \ l •uu md
KUt qud .\a
Ki'l qua ui'i iliiiig kel qua a nhdm mom cyl khdng cdn d md cai. ldn Ihuong gay cyt ngdn cai lai cd tay (cyl ngon cai va mat loan bg d md cai) la mpt ldn thuang n$ng nc. do do kcl qua lao hinh d^t dugc cung sO la rat han chi- ft mom cyt ngon t.iv cai khdng con ca d md cai dugc tao hinh vdi Vill ngdn chan cai ihu nho dugc l.iv ircn khiTp ban ngdn So sanh kcl qua ve v^in dgng va chuc ning ban lav dat JiniL cua nhdm n.iv vdi nhdm cdn d md cai cho "-y kbjc bi^l cd
\' nghia thong ke (p<0.05). \ ai ldn thuong nav. ngdn cai dugc igo hinh co v.ii trd chi nhu mgl "gong kim". Do v;i\.
di' dal iliroc chirc niSng ban lay thi dieu quan trgng nhal va quv cl dinh thanh cdng cu.i phau thuat la v i iri ngdn cai dugc CO dinh \ g o i i cai cdn phai diroc cd dinh a lu the giang, ddi chieu va s.ip sao cho kc ngdn tay du rdng dc cd the cam duac CIC dd v .it lo, ddng ihdi sao cho cac ngdn dai cung cd Ihe cli.im v;io d.iu mui ngon cai de iham gia ddng tac nhdn.
nhjt [6. 7]
Co 4'6 BN d^l dugc chirc nang ddi chieu ca ban. Kel qua d^t dugc cung rat kh.i quan. Iyc nam dat dugc l9-t0()"o. Iyc nhdm d^i duoc 19-44" o so v ai ben lanh.
(. o 2 (i BN khdng dal dugc chirc ning ddi chieu co han.
chi CO ihc ciii! ndm dutffc cac dd vat to (nhu ca. cdc) nhung khdng Ihe nhdn nh$l do s.ii li-cb v i iri cua ngon chuyen. Mdi l\ do khach quan cho ki'l qua a 2 BN nav la idn thucmg trudc md n.'lng nc, nira KT qua; cua khdi Nuong lu cdt bi mat. Do dd. vice cd dinh vung chJc ngon ehuven vao phan con lai cua khdi \ i n m g tu cdi a v i iri ddi chieu uong 1 ihi md ihuc sy la mgt thach ihiic. Tu\ nhien. b.in tay duac tao hinh o 2 iiN n.iv la tay irdi. lav khdng ihuan nen IJN eflng khdng cd nguv^*n vgng phau thu^l chinh sua iryc \ m m g ihi 2
Chung ldi CO iham khao nhieu bao cao ve chuyen neon
Chan phuc hdi ngdn lay. nhtmg so lirgng vc clu.vui n , chAn phuc hdi neng cho nhom mom ctii khdng con o mo ..i i. han ch^ Cac bao cao cung mdi chi la ihdng bao ve mgt :• k ' h u a t . . . ^d lugng BN cdn thap. Nam 2 0 1 3 . Sabapathy . a cs bao eao kC-t qua chuyen ngdn chan thu 2 de lao liinn Phuc hdi ncdn cai cho S Iruimg h..Tp mdm cyt ngon cai 1^1 Lh:T than.;b3n. 6 S trudng hgp dat dugc chirc nang co ban cua ban lav [6] Tuv nhien. luc nhdn nhal trong kci qua cua Sabapalhv'va cs la'vcii va khdng dii de do dugc tr^n luc ke.
S h u vav 'ly*: nhdn cua ngdn lav cai mdi trong nghien cuu cua chung ldi la cao lion trong nghien ciru ciia Sapabathy va cs
Kcl qua a nhdm mdm cyl cdn d md cai so sanh ket qua :hu dugc giua chuydn val ngdn chan cai hoac v at ngdn chan thu hai cho dOn nay van la mgt van di} tranh cai. Da sd a i c lai li?u irong y van deu cho rTing. kel qua chirc nang va tham mv dal dugc a ban lay khi tao hinh ngdn lay cai bdng ngdn chJn cai sO can han la vdi ngdn chan thu 2 [S, 9]. Dieu nay cung dc hicu bdi \ci vO giai phau thi ngdn chan cai gidng V di ngdn i.iv cai han lit ngdn chan thir 2. Hon nira, cac phau thuat ihu nho val ngdn chan cai sau chuyen de nang cao tham my cung la dan giiin. Tuy nhien, nhirng nhan xel ciia cac lac gia cimg bo mdi chi la nhOmg y kien mang tinh chii quan ca nhan ma chua the hien bang mdt nghien ciru cu the.
Nam 2011. Liii \ii cs nghien cim va so sanh giira cac dang ngon chuyen dya ircn y hgc bang chimg vol 450 vat ngdn chan cho kcl qua khdng cd sy khac biet ve kel qua dat d u g c giiia 4 dang ngdn chuyen la: val ngdn chan cai, val ngdn chan i.ai thu nhd. val bgc ngdn chan cai. vat ngdn chan thu 2 [10] Ngiiv saudd, Waljee va cs (2013) cho rang, nhan xet cua Lin va cs (2011) chua ihuyet phyc vi each liep can trong nghien ciru nay la lap hgp cac nghien ciru don le ve loat ca benh [11] Trong bao cao ciia minh, tac gia thay cd su khac biel V e kel qua giua cac dang vat ngdn chan va cho rSng c^n cd mpl nghien ciru he thdng hem vdi su ddng nhSt vk s6 lieu ki'l qua de cd nhan xel xac dang ve ket qua phyc hoi giiia cac dang val ngdn chan.
Trong nghien ciru nay, 24 mdm cyl ngdn cai cdn d m o cai da dugc lao hinh bang 6 val ngdn chan cai thu nho va IS V ai ngdn chan thii 2 So sanh kdt qua dat dugc d ban tay giu^ hai dang vat nay qua bang 2 d6u khdng cho \hky su khac biel vdi p>0,05. Tuy nhien, trong nghien ciru nay, so lugng BN cdn thap nen van can cd cac nghien ciru ti^p iheo vdi sd lugng BN Idn hon, ddng nhal han de tra lai cho vSn de dat ra.
Kel qud phuc Imi cam gidc. 24 BN phyc hdi cam giac dai muc S3+ va 6 BN chi dat mirc S 3 . Trong nghien ciru ciia
\ \ e i va cs (2000). tac gia cho thay diSm phan bicl cam giac 2 diem ddng cd tuang quan vdi sd cac lieu the Meissner tai biip ngdn 112]. Sd Iuang lieu the Meissner lai da mat yan
nMGNGHE\'^\ani
62(5) 5.202020
Khoa hpc Y - Oupc i
ngdn chan trudc chu>en trung binh la 0.94 da giam xudng chi cdn trung binh la 0.37 sau phau thuai chuyen ngdn vi Ihoai hda khi ma cac xung ddng dien kich thich tir a.\on than kinh chua the iruyen tdi nd trong ihdi ky lai lao than kinh (udc tinh 1 mm/ngay). Do do, dii cd the nao thi cam giac ciia ngdn chuyen cung khdng the dat dugc nhu la ngdn lay binh thucmg. Ket qua phyc hdi cam giac cua chiing tdi cung tuang lu nhu ciia cac tac gia.
Cdc hail che- mac dii da dugc tu van hudng dan va kham lai dinh ky sau ra vien nhung ty le dinh gan sau phau thual chuyen ngdn trong nghien ciru nay la kha cao: 13/30 BN (43.3%) va cd chi dinh phai Ihuc hien phau thual gd dinh gan thi 2. So vdi ngdn tay. bien do van ddng cac khdp cua ngon chan ciing khdng the linh boat va binh ihudng cac ngdn chan ciing thudng duac giir lai vi tri bat ddng. Do dd.
that !a khd khan de yeu cau ngdn chuyen cd the phyc hdi cac bien dg van dgng bet nhu ngdn tay binh Ihudng. Theo kinh nghiem ciia Henry va cs (2010), phau thual bd sung thi 2 cung Ihudng xuyen dugc Ihuc hien sau phau ihuat chuyen ngdn va chii yeu la gd dinh gan va cac phau thuat nham cai thiv'n tham my sau chuyen ngdn [13], Kel qua nghien ciru ciia Buncke va cs cung cho Ihay, phau thual thi 2 la can thiet va chii yiiu la cac phau thual gd dinh va thu nhd ngdn [14].
Trong nghien ciiu nay, cd 7/13 BN bi dinh gan da thuc hien phau thuat gd dinh va 8 trudng hgp ihuc hien phau thual nhJm cai thien iham my cua ngdn chuyen thi 2
Kei qud Ihdm my vc'i d() hai long cua BN' ve phuang di^n tham my, viec sir dyng ngdn chan cai se cho tham my l6t han ngdn chan thir 2 [8, 9. 13]. Nguyen nhan chinh xual phat tir dac diem giai phau. So vdi ngdn tay cai. ngdn chan cai lo han. dirdng kinh ngang va trudc sau ldn ban. Mdng ciia ngdn chan cai cung rgng hon ngdn tay 3-4 mm. Ngdn chan thir 2 nhd, &hu ngdn be hinh cii hanh hoac hinh diii trong. mdng vuong. hep va ngan trong khi mdng cua ngdn lay cai cd hinh trdn.
Trong nghien ciiu nay. so sanh ket qua tham my v a do hai long dat dugc giu:a hai nhdm chuyen ngdn chan cai thu nho va ngdn thir 2 khdng cd su khac biet vdi p>0.05. Tuy nhicn, each tinh diem tham my va do hai ldng nay la chi dua hoan toim vao danh gia chii quan ciia ngudi benh. Ket qua nay mdt ISn nua khang dmh vai trd ciia cdng tac tu van tnrdc md. Cd lc. \ iec su dung cdc hinh mau bang dat set hay in 3D se giiip BN hinh dung tdt hon v k kk qua tham my dat dutTc Irong luong lai va iam lang sir hai Idng ciia BN sau phaulhuiii [15].
ftkMn
PhSu thuat chuyen ngdn chan phuc hdi ngdn tay cai la phdu thuat an loan, hieu qua vdi ty le thanh cong cao (100%); k^t qua phyc hdi van dgng dat cao. 100% dat cam
giac tir S3 tra len, diem tham my va dd hai Idng trung binh lan lugt la "9." 100 va 78.0/100. \ a i kdl qua n;iv. ngudi benh cd ihe nhanh chdng trd lai sinh hoat. lao dgng va tai hda nhap cdng ddng.
TAI LIEU THAM KHAO
[ t j A. Kapandji ( ^ 8 6 1 . "Clinieai lesl iit apposilion and cnunicr- a p p o s U i o n o i ' i h e i h u m b " . Ann Cbir A/ii;fi, 5(1), pp 67-73
[2] B- Ro'icn t i . Lundborg (20011), n model insirtimenl fiw ihe doe u men la I ion ol ouitcnie at^er nerve [epair". J Hand V'^'i; •('" . 2?, pp 535->43
|3] K.C. Chung, ei al (1998).-Uelialiiliiv andvalidiiv lesiiin; o^lh^.•
mlchigan hand outcomes questionnaire"../ Hand Surgen. 23 \ . pp 575-
1 4 | Y D C u M M \ V u . H . R . L i ( 1 9 8 ' ! ) , " C i r e u l a i o r > e r i s i M n r r e e l ( > e - to-hand transfer and iis maiiagemcnr Clinieal evpt'rienee", ./ l{eeon.sli.
\lu,-<MU,g.5i2) pp 111-114
[5] V. Jam. F.C. Wei (2009), TrimmedgiviU loe transplimiatum iTTTI )oi thumb ret orLsiruclion. Siiigeiy af the injured hand toward functional
reiwrHfion.Jaypee Brothers Medieal Publishers (P) LTD. pp I W - l ^ ' ) , [6j S R Sahapathv. ci al (2013), "Roeonslruction of ihe tinimh ampuiaiion at the earpomelaearpal joint level by groin dap and seeond toe iransfer". Injun- Im J Caiv lnp,i-e,l. -14. pp 370-375.
[71C H Lin. e i a l (2008). "•Osleoplaslie Ihumb ray restoralion with nr w lihoun secondarv loe transfer lor reeonslriielion ofopposable basie hand ruiKlion". Plasi Recoinir Siiig . 121, pp. 12HS-1297.
[S) F.C Wei e l a l (1994). "Mierosurgical thumb reconstruclion with loe iransfer: Selection of various lecliniques". Plasi Reeonstr Suig.
W{2).pp._U5-35l
in. Springer Nature [9] S H. Woo (20191, MiLrosuigUid Ren
Singapore Pte Lid, pp 331-365.
[10] P.Y Lm. e l a l . (2011), "A systematic review o f o lo-ihumb transfers for isolated iraumatic thumb ampuialion". Hand (NY).
6 ( 3 ) . p p r - 5 - : 4 3 .
[11] J F Ualjee. K.C. Chung (2013). "Toe - lo - band iransfer evoK ing indications and relevant oulcomes". .J. Hand Siir^ Am . 38(7).
pp 1431-1434.
[12] F.C Wei. et al. (2000). "Sensory r e c o i e i y and Meissner corpuscle number after toe - 10 - band Iransplantation". PlasI Keuinsu.
Sing. 105(7). pp 2405-2411
[13] S.L Hcnr>. F.C. Wei (2010). " T h u m b reconsiruelion with toe Iransfer". J H,md Micrasiug.. 2(2). pp.72-7«
[ 1 4 | G - M Buncke e i a l . (2007). "Great t o e - l o - t h u m b microvascular transplantation after Iraumalic ampuiaium". Hand Clin.. 23 pp 105-115.
[15] C.W Zang. et al (2017). "31) printing technology in planning ihumb recon^irueiions v.\\h second loe iransplanl", Orlhp Sing 'H2\
pp,215-220
