Y HOC VIET NAM THANG 10 - SO 2/2010
KET QUA BirdfC DAU DIEU TR! HEP ONG SONG THAT LONG BANG
P H A UTHUAT DAT DUNG CU COPLEX
TAI BENH VIEN TINH PHU THO 2009-2010
Nguyen Van San, Nguyin Van Thu D6 Manh Hai (*)
TOMTAT
r^ucdfch nghien cu'u: Nhan xet bUdc dau ket qua dieu tn hep dng sdng that lUng bang phau thuat dat dung cu lien gai sau (Coflex) tai benh vien tinh Phu Thg.
Phuang phap nghien cu'u: Nghien cu'u md ta hoi ciiu, 19 benh nhan hep ong sdng that lu'ng du'dc phau thuat tir 2/2009 den 5/2010.
Ket qua : 13 nam, 6 nu'; Tud'i thap nhat 35, cao nhat 77 vdi da sd cd thdi gian dau lUng ia 2- 3 nam; Dau viing cot sdng that lu'ng lan xudng 1 chan l a l i benh nhan (58%), 2 chan la 8 benh nhan (42%); Phau thuat dat Coflex vj tri L3-L4 la 2benh nhan (10,5%), L4-L5 la 17 benh nhan (89,5%); Dat koflex ddn thuan cho 12 benh nhan (63%), kem vdi lay nhan thoat vj dTa dem 1 benh nhan (5%), kem md ciia so cung sau ddt lien ke cho 6 benh nhan (31,5%).
15 benh nhan (80%) het dau hoan toan sau mo, 4 benh nhan (21%) cdn dau nhe, 2 (10,5%) benh nhan md lai lay bd Coflex.
Kit luan: Phau thuat dat Coflex lien gai sau dieu trj hep dng sdng that lUng tai benh vien tinh Phu Thg da du'dc trien khai an toan va hieu qua.
ABSTRACT nc The purpose of this study was to determine
the safety and efficacy of the Coflex interspinous implant in patients with diagnosis of spinal stenosis in Phu Tho
province general hospital.
Retrospective data were gathered on 19 patients between the ages of 35 and 77 years (*) Sink vien tinh Phil Tho
old. Almost patients had low back pain during 2 to 3 years, 11 patients (58%) had pain in 1 foot, 8 patients (42%) had pain in 2 foots.Coflex interspinous implant was performed at level of L3-L4 in 2 patients (10,5%), at level of L4-L5 in 17 patients (89,5%). Discostomy and Coflex interspinous was performed in 1 patient, minilaminectomy neighboring level and Coflex interspinous in 6 patients (31,5%).
15 patients (80%) were satisfactory without any pain, 4 patients (21%) still had gentle back pain after operating.
2 patients were reoperated to remove Coflex 6 months after firt operation.
Conclusion: Coflex interspinous implant for treatment spinal .stenosis was performed safely and efficiently in Phu Tho province general hospital.
I. OATVANOE
Hep dng sdng thit lung do thoai hoa la benh ly phd bien d ngudi cao tuoi. Benh gay ban che van ddng di lai ciia benh nhan anh hudng xau den tam ly va chit lugng cugc sdng. Hep dng sdng that lung dugc verbiet md ta dau tien vao nam 1954 vdi cac trieu chimg dau kieu re hai ben va trieu chiing each hdi thau kinh khdng lien tuc cam giac khd chiu va yeu hai chan.
- Muc dich dieu tri hep dng sdng la giai
ep cho dng sdng tra lai chirc nang chdng do
cho cdt sdng giiip ngudi benh van ddng
dugc. Viec giai chen ep dugc thuc hien bing
HOI CHAN THOONG CHJNH HINH VIET NAM - HOI NGHj KHOA HOC TOAN QUOC LAN THlf IX
cac ky thuat nhu cat cung sau ddt sdng, liy bg day chang vang, lay nhan dia dem... va ket hgp vdi phau thuat lam viing cdt sdng do viec giai chen ep dng tao nen.
- Vdi img dung bat vit chan cung ddt sdng vao nhirng nam 80 va manh ghep cdt sdng vao nhirng nam 90 phau thuat lam ciing khdp cdt sdng dugc ap dung cho dieu tri hep dng sdng. Tuy nhien theo nhieu nghien ciiru thi ty le bien chimg tdi 33%). Hon nira lam Cling cdt sdng cd the dan tdi benh ly mat khdp va thoai boa nhiing tang ke can trong thdi gian dai sau md.
- Dung cu lam viing lien gai (coflex device) dugc thiet ke bdi samani nam 1994 cho phep cd dinh ban ddng va dieu tri nhieu tinh trang khac nhau anh hudng len cdt sdng thoai boa. Dung cu lam viing lien gai giiip giam chen ep md mem hep dng sdng va giam hieu luc nen len dia dem thoai boa
- Benh vien da khoa tinh Phii Thg lan dau tien ap dung phau thuat dat dung cu lien gai (coflex) de dieu tri cho benh ly hep dng sdng tir 2/2009 cho den n£iy chiing tdi da phau thuat dugc 19 trudng hgp.
- Chiing tdi thuc hien de tai "Nhan xet kit qua bir&c ddu tiin diiu tri hep dng song that limg bdng phdu thuat dat dung cu liin gai tai binh viin Tinh Phd Thg" vdi muc tieu:
1. Nhan xet ve do an toan.
2. Nhan xet ve hieu qua dieu tri cua phau thuat dat dung cu coflex.
H. 0 6 l TUONG VA PHUONG PHAP L Doi tugng nghien cuu:
Tat ca cac benh nhan dugc chan doan la hep dng sdng that lung da dugc phau thuat tai Benh vien Da Khoa Tinh Phii Thg bang phau thuat dat dung cu coflex bao gdm: 19 benh nhan.
2. PhuoTig phap nghien cuu: Chiing tdi ap dung phuong phap md ta hdi cuu thu thap thdng tin nghien ciiu theo mdt miu benh an thdng nhit cac thdng tin nghien ciiu bao gdm:
2.1 Lam sdng: -Tudi, gidi
- Thdi gian dau thit lung, vi tri dau lan - Di each hdi: khoang each.
- Cac trieu chimg benh phdi hgp:
2.2 Can lam sdng:
- Xet nghiem co ban: Huyet hgc, sinh hoa mau, dien tim, XQ tim phdi ....
- XQ cdt sdng that lung thudng quy - MRI cdt sdng that lung.
2.3 Diiu tri phdu thuat:
- Raeh da dudng giUa gai ddt sdng bi hep qua dinh vi cam, cat day chang lien gai, liy bd day chang vang. Lay nhan dia dem hoac khdng tuy timg trudng hgp. Dat coflex lien gai sau.
3. Xir ly so lieu: Theo phuong phap thdng ke y hgc.
III. KET QUA NGHIEN CCTU BAN LUAN
1. L a m sang: .T.^;
1.1 Tuoi, gidi: Trong 19 benh nhan cua chiing tdi cd 13 nam va 6 Nil. Vdi trung bmh tuoi la 53,5 ±8. Thap nhat 35 tudi, cao nhat 77 tudi.
Nghien cuu cua chung tdi phii hgp vdi nhan xet ciia cac tac gia khac do hep dng sdng la benh Iy phd bien d ngudi cao tuoi nguyen nhan do thoai hoa dia dem va day chang xung quanh dng sdng gay nen.
1.2 Biiu hiin lam sdng;
100%) benh nhan ciia chung tdi cd thdi
gian dau viing that lung tir 4 nam trd len co
trudng hgp dau ddn 10 nam. 11 benh nhan co
dau lan xudng 1 chan (58%)), cd ddn 8 benh
nhan dau xudng ca 2 chan (42%)), 13 Benh
nhan cd kem theo teo CO chan. ,'
Y HOC VIET NAM THANG 10 - 5 0 2/2010
Nhu vay tat ca cac benh nhan ciia chiing tdi deu cd trieu chimg cua benh ly hep dng sdng rd rang. Cd nhiing trudng hgp chi ddng y phau thuat trong trudng hgp dieu tri ndi khoa 3-4 dgt khdng cai thien trieu chiing co nang mac du da dugc giai thich phau thuat ngay tir dgt nhap vien diu tien. .,
2. Dieu trj phau thuat 2.1 Vi tri dat coflex:
- Dat coflex lien gai sau L4-L5 la 17 benh nhan (89,5%), vi tri L3-L4 dugc ap dung cho 2 benh nhan (10.5%)). Ciing gidng nhu ket qua nghien ciiu cua cac tac gia khac vi tri dat coflex tai L4-L5 chiem ty le cao ban. Day la vi tri giai phau chiu luc tac ddng nhieu nhat va la vi tri van ddng nhieu nhat trong cac dot sdng vimg that lung, din den viec day chang dia dem va than ddt sdng bi tdn thuong thoai boa nhieu nhat.
2.2 Sd Iwang coflex duac dat:
19 benh nhan cua chiing tdi dugc dat 01 coflex mac dii tren MRI cd nhiing benh nhan cd tdn thuang hep dng sdng 2 ddt. Nhiing trudng hgp nhu vay chung tdi lira chgn giai ep va dat coflex vao vi tri lien gai sau ddt sdng nao bi hep nhieu ban ke ca tren bieu hien lam sang va chup MRI.
Mdt sd tac gia da thuc hien dat 02 coflex lien gai sau de dieu tri hep dng sdng that lung trong trudng hgp cd 02 ddt sdng hep vdi ket qua tdt. Day se la hudng dieu tri mdi cd le chiing tdi se ap dung trong thdi gian tdi.
2.3 Cdc ky thuat phoi hap:
Chiing tdi cd 06 benh nhan dugc dat coflex lien gai sau kem vdi md cira sd xuong cung sau ben ddt lien ke 31,5%) . Ky thuat nay chiing tdi ap dung cho nhiing benh nhan cd tdn thuong hep dng thit lung 2 ddt. Chiing tdi lira chon dat coflex vao ddt nao cd tdn thuong hep nang ban va md cira sd cung sau ben ddt sdng cdn lai. ;, > •• v
- 12 Benh nhan (63%) ciia cua chiing tdi dugc dat coflex don thuan sau khi giai phdng hep dng sdng bang lay bd day chang vang
- 1 benh nhan (5%) dugc ap dung lay nhan thoat vi dia dem kem theo. Theo mgt sd tac gia viec lay nhan dia dem se lam tang tinh trang mat viing ciia cdt sdng sau phau thuat do vay viec lay nhan dia dem chi nen thuc hien vdi nhiing trudng hgp thoat vi ngoai bao va Cling khdng nen lay dia dem mdt each triet de neu khdng mudn ap dung dat mieng ghep dia dem nhan tao.
2.4 Tai biin ciiaphdu thuat:
- Chay mau trong md chung tdi khdng che bang dat surgicel va bonewax khdng cd benh nhan nao gap tai bien chay mau sau md.
- Chiing tdi gap 2 benh nhan raeh mang tuy trong md. Phat hien dugc do dich nao tuy trao ra dugc xir tri khau lai bang chi vicryI4.0 theo hau phau ca 2 benh nhan deu dien bien tdt.
- Raeh mang tuy cd the gap khi thuc hien ddng tac lay bd day chang vang do day chang vang day va thoai boa dinh chac vao mang tuy.
- Raeh mang tuy cd the lam tang nguy co viem mang tuy sau md va dd dich nao tuy qua vet md da dugc cac tac gia khac de cap tdi dac biet la nhiing trudng hgp raeh nhd khdng phat hien dugc trong md.
3. Ket qua dieu tri:
- 15 Benh nhan ciia chiing tdi bet dau lung va te chan hoan toan sau phau thuat (80%) va benh nhan da cam thay rat hai ldng khi dugc hdi.
- 2/19 benh nhan (10,5%)) dau va te chan cd giam nhung van cdn.
- 2/19 benh nhan (10,5%) khdng thay ddi CO nang so vdi trudc md phai mo lai va thao bd coflex va dat nep vit cdt sdng. Hdi ciiu lai ca 2 benh nhan nay deu cd kem theo trugt ddt
HOI CHAN THOONG CHINH HINH VIET NAM - HOI NGHI KHOA HOC TOAN QUOC LAN THLf IX
sdng L5-S1 trudc khi md. Sau khi phau thuat tinh trang trugt ddt sdng lai tang them.
IV. KET LUAN
Qua nghien ciiu 19 benh nhan dugc dieu tri hep dng sdng thit lung bing dat dimg cu lien gai sau coflex tai benh vien Da Khoa Tinh Phii Thg chiing tdi xin dua ra mdt sd nhan xet nhu sau:
- Khdng cd tai bien nghiem trgng trong md 10.5%o tai bien nhd xir tri an toan.
- 80%) cd ket qua sau md tdt - Khdng cd bien chiing sau md.
Phau thuat dieu tri hep dng sdng that lung bang dat dung cu coflex lien gai sau da dugc trien khai an toan va hieu qua tai Benh Vien Da Khoa Tinh Phu Thg.
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