CHAO MdNG 45 NAM NGAY TRUYEN THONG BENH VIEN QUAN Y 211 - QUAN DOAN 3 (31/12/1965 - 31/12/2010)
Ket qua phuc hoi chiic nang benh nhan bi han che tam van dpng khop khuyu sau chan thuong
Result in rehabilitation for patients with limited motion of elbow joint after trauma , . ,
• , • }':•'•:. .•'.. •
Nguyin Cao Vien - . f c r ; .i i . Benh vien Qudny 211
•• :' 'li • _ . d • - : ' • / - *
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Tom t a t
Tac gia theo doi dnh hinh thu dung va dieu tri phuc hoi chiTc nang cho 30 benh nhan bi chan thddng khdp khuyu sau giai doan bat dong va nhan thay ty le mac benh d benh nhan tre tuoi kha cao (60% nhom tuoi 6-19), hinh thai gay xddng ngoai khdp chiem 70%, trong dd hau het benh nhan den dieu tri phuc hoi chdc nang kha muon, chi cd 13,3% dddc dieu tri trddc 1 thang. Ap dung bai tap van dpng khdp khuyu ket hdp mot so phddng phap dieu tri vat ly nhd nhiet nong (paraffin, hong ngoai), dien xung, dien phan da mang lai ket qua kha quan;
chirc nang va tam van dpng khdp khuyu phuc hoi tot dat 73,3%. Vi vay, can co sd phdi hpp tdt giiJa nganh chan thu'dng chinh hinh va phuc hoi chirc nang de mang lai ket qua dieu tri tdt va ban che phat trien tan tat do tinh trang chan thddng ciia khdp khuyu gay ra. , ; , . ' , t . ' , M .^ t
Summary
Observation of rehabilitation for 30 patients with limited motion of elbow joint after trauma has found that a rather high percentage in young people group (sixty percent in group of 6-19 years old) with a fracture condition outside of joint is seventy percent of patients, in which most of them are to be rehabilitation treated be late and only 13.3% percent are treated before one month after trauma. Application of active excersise program for elbow joint movement associated with some physiotherapies such as thermotherapy (paraffin, infrared), iontophoresis, pulse current e.g has had a satisfactory result with 73.3% percents of patients with elbow joint's range of motion in good progess. Thus, it's necessary to be co-ordinated between orthopedist and rehabilitation doctors so that to be get the more result and protect the elbow joint from sequela after trauma.
1 . Oat van de dimg ngay tir dau thi phan Idn sau bat ddng cd djnh Tam van ddng khdp khuyu la sd van ddng gap khdp thddng de lai di chirng teo cP cirng khdp lam duoi cang tay vdi canh tay trong mpt mat phang, tam giam kha nang lao ddng, anh hddng den sinh boat va boat dpng tir 0-150° va sd van ddng sap ngira cang cdng tac ciia benh nhan. Do dd, sau khi ddpc xd ly tay, tam boat ddng tir 0-90° vdi sd boat dpng ciia cae dieu trj chan thdPng chinh hinh, viec phuc hdi chiTc khdp canh tay quay, canh tay tru va khdp quay tru nang tam van ddng khdp khuyu la mdt yeu cau can tren, vdi sd tham gia chii yeu ciia cd nhj dau canh thiet de han ehe tan tat, de phdng eac di chirng sau tay, cP tam dau canh tay; khi eac thanh phan cua chan thdPng.
khdp, XdPng canh tay, xdPng eang tay bj tdn thdPng Oe gdp phan danh gia ket qua ciia viec dieu trj hoac do bong gan sai khdp dan den xP boa gan cP va phuc hdi chirc nang sau can thiep ehinh hinh, chiing day chang sau chan thdPng. Neu khdng ddpc dieu trj tdi tien hanh de tai nay nham hai muc tieu:
Phan bien khoa hpc: PGS.TS. N G U Y I N T R Q N G LU'U 70
Y HOC VIET NAM SO DAC BIET THANG 10/2010
- Danh gia mot sd dac diim lam sang, can lam sang ciia benh nhan bi han chi tam van dqng khdp khuyu sau chan thu'dng.
- Danh gia kit qua dieu tri phuc hoi chti'c nang khdp khuyu sau giai doan can thiep chinh hinh.
2. Doi tu'dng va phu'dng phap nghien eu'u 2.1. Ddi titdng nghiin cdu
- Tat ca nbiTng benh nhan bj ban che tam van dpng khdp khuyu do ehan thdPng da ddpe xd ly bang phdPng tien ed djnh va bat ddng keo dai.
- Nguon benh nhan tir cae khoa trong Benh vien girl den trong thdi gian tir thang 3 den thang 9 nam 2010.
- Tong sd benh nhan la 30.
2.2. Phddng phap danh gia
- Kham lam sang va ehup XQ khdp khuyu Idpng gia mire dp ton tiidPng va ban che tam van dpng khdp.
- Danh gia mire dp phuc hdi tam van dpng khdp khuyu dda vao hai tieu chuan: tam van dpng ehii ddng eiia khdp khuyu va ldc eO viing canh tay, cang tay eiia ngddi benh.
Mirc do
Tdt Kha Trung binh Kem
Tam van ddnq ehii ddnq (Od qde) Gap
> 140°
120-140°
100-120°
< 100°
Dudi 1 0 - 0 ° 20 - 10°
30 - 20°
> 3 0 °
Sire eP gap dudi (Bac)
4-5 4 3
< 3
2,3, Cac bien phap vat ly trj Tiiu va phuc hoi chdc nang
2.3.1. Tap van dong
- Giai doan cdn cd dinh: xoa bdp nhe nhang phan tren va dddi viing tdn thdPng; tap co cP tinh viing canh tay va cang tay de tranh teo cd; van ddng cac khdp t d d o va ben lanh de ki'ch thi'ch ben tdn thdPng.
- Giai doan bet ed dinh: xoa bdp va tap van dpng gap-duoi thu ddng khdp khuyu, tap sap-ngira eang tay de gia tang tam van ddng khdp; khi cd ben bd, cho tap chii ddng ed de khang tang dan (bang tay eiia KTV, bang ta, bao cat trpng Idpng tang dan 1-2 kg).
- Hddng dan benh nhan tiep tuc t d t a p tai nha.
2.3.2. Dieu tri ho trd
- Nhiet trj Heu: dap paraffin hoac chieu tia hdng ngoai tai chd, nhiet dp 50°C, thdi gian 20 phiit, dieu trj hang ngay trddc khi tap van dpng.
- Giam dau bang dien xung CS-210 eiia Nhat Ban, mdi lan 20 phiit.
- Dien phan Hydroeortison (benh nhan bj xO hoa gan eP va day chang) hoac Novocain (de giam dau va tang cddng dinh dddng tai cho).
3. Ket qua
3.1, Dae dli'm ed cau binh 3.1.1. Cd cau benh theo tudi gidi
- Trong sd 30 benh nhan, tuoi thap nhat la 6;
tudi eao nhat la 62; dp tudi tir 6-19 tudi gap 18 benh nhan (bang 60%).
- Nam: 16 benh nhan (bang 53,4%); Nd: 14 benh nhan (bang 46,6%).
O'W
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CHAO MdNG 45 NAM NGAY TRUYEN THONG BENH VIEN QUAN Y 211 - QUAN DOAN 3 (31/12/1965 - 31/12/2010)
3.1.2. Cdcau benh theo vi trf tdn thu'dng
Sd IdPnq Ty le %
Gay than XdPng canh tay
4 13,3
Ngoa Gay tren
ldl eau XdPng canh tay
12 40
khdp Gay XdPng cang tay
5 16,7
Tong cdng
21 70%
Gay XdPng
pham khdp
6 20
Pham khdp Khdng thay tdn
thdOng XdPng
3 10
Tong cdng
9 30%
Gay xddng ngoai khdp ehlem ty le cao (70%); gay xdOng pham khdp chi ed 20%; ngoai ra, 10% khdng phat hlen thay ton thdPng xddng tren X quang; gay tren ldl cau xddng canh tay chiem ty le cao (40%).
3.1.3. Cdcau benh theo thdi gian bat dgng din khi dddc PHCN
Thdi gian Sd IdPnq Ty le %
< 1thang 4 13,3
1-3 thang 17 56,7
> 3 thang 9 30
Hau bet benh nhan ed giai doan bat ddng keo dai va den phuc hdi chirc nang mudn (56,7% den sau 1-3 thang; 30% den sau 3 thang; td'ng cdng 86,7%); ehi ed 13,3% ddpe dieu tri trddc 1 thang.
3,2, Kit qua diiu trj dat dddc
Mire dd
Sd IdPnqTy le %
Tdt 8 26,7
Kha 14 46,6
Trung binh 6 20
Kem 2 6,7
Ket qua tdt dat 26,7%; kha dat 46,6%; td'ng sd tdt va kha dat 73,3%; trung binh dat 20% va chi ed 6,7%
ket qua kem.
4. Ban luan
Chan thdPng xddng khdp ciia chi tren la loai chan thdPng kha phd bien trong cdng dong do dac die'm sir dung ddng tac nhieu trong sinh boat, lao ddng va huan luyen. Mot trong nhii'ng dl chirng nang ne ciia chan thdPng la tinh trang cirng khdp, ban che tam van ddng ciia khdp khuyu, nhat la d nhu'ng benh nhan phai bat ddng keo dai va khdng ddpc dieu tri phuc hdi chire nang sdm.
Hien nay, viec can thiep dieu tn ve chan thdPng chinh hinh da ddpc lam tdt, hau het benh nhan deu ddpc xd ly sdm sau chan thdPng. Tdy nhien, sau giai doan ehinh hinh xdPng khdp, yeu cau tap luyen va phuc hoi ehire nang ket hpp la rat can thiep, nham
ngan chan xay ra cac bien chiTng (nhiem trimg, dau, phii ne) va di chirng (teo cP, cirng khdp) dan tdi tan tat lam giam kha nang van ddng ciia ngddi benh.
Theo ddi thu dung va dieu trj tai Benh vien 211, chiing tdi nhan thay hau het benh nhan sau giai doan xd ly chinh hinh cdn chda ddpc quan tam dimg mirc den viec dda di dieu tri phuc hdi chirc nang, vi vay hau het benh nhan deu den mudn (sau 1-3 thang) khi da phat trien sang giai doan di chirng, lam anh hddng nhieu den tam van ddng khdp va ngddi benh gap khd khan trong sinh boat, lao ddng, cdng tac vi khdng sir dung ddpc ddng tae. Khi dd, viee di'eu trj trd nen khd khan va ket qua cung rat ban ehe.
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Cac bai tap van ddng va dieu trj diJdc ap dung tuy theo dac die'm tdn thdPng eu the ciia tirng ngddi benh, nhdng theo nguyen tac kien tri, ben bi va Hen tue, tap thu dpng giai doan dau khi ldc cP cdn yeu, tam van ddng khdp edn gidi ban nhieu; khi da ben bd thi khuyen khi'ch van ddng chii ddng het tam boat dpng khdp, ket hpp sir dung ldc de khang tang dan (bang tay eiia ngddi ky thuat vien, bang ta...) de cai thien tinh trang ldc cO, hd trp cho tam boat ddng ciia khdp khuyu (tam boat ddng gap duoi binh thddng ciia khdp khuyu dat tir 0 den 150°). Oe ho trp cho viec tap luyen ddpc thuan lpi, cac phdPng phap dieu trj vat ly ket hpp nhd nhiet ndng (paraffin, hong ngoai), giam dau (dien xung), chdng xP boa (dien phan)...
cung ddpe chimg tdi sir dung va dat ddpc ket qua tdt vdl ty le phuc hdi chirc nang khdp khuyu la kha quan (73,3% dat ket qua tdt).
- Gay XdPng ngoai khdp chiem ty le cao (70%);
gay xdPng pham khdp ty le thap (20%); cd 10%
khdng phat hien thay tdn thdPng xdPng tren X quang; gay tren loi cau xdPng canh tay cd ty le eao (40%).
- Hau bet benh nhan khdng ddpe dieu trj phuc bdi chirc nang sdm: chi ed 13,3% dieu tri trddc 1 thang; 86,7% dieu trj sau 1-3 thang.
- Ket qua phuc hdi chire nang la kha quan: ty le benh nhan tien bd tdt dat 73,3%; nhii'ng benh nhan tdn thdPng pham khdp hoac den phuc hoi chire nang mudn dat ket qua trung binh va kem.
- Can phdi hpp chat che giu'a khoa chan thdPng chinh hinh va khoa PHCN chi djnh cho benh nhan ddpc dieu tri phuc bdi chiTc nang sdm, gdp phan ban che bien chiTng va di chiTng khdp, giam ty le tan tat do cirng khdp khuyu sau chan thdPng.
5. Ket luan
Theo ddi ket qua dieu trj 30 benh nhan bi ban che tam van ddng khdp khuyu sau chan thdPng, chimg tdi rut ra mdt sd ket luan sau day:
- Benh nhan bj chan thdPng khdp khuyu ed han che tam van dpng khdp gap nhieu d liTa tudi tre (6-19 tud'l ehlem 60%); nam nhieu hPn nii' (nam 53,4% so vdl nd 46,6%.
Tai lieu tham khao
1. Phuc hdi chirc nang (1991), Bai giang cho can bo chuyen khoa phuc hoi chiTe nang. Td'ng hpl y ddpe bpc Viet Nam - Hdi phuc hdi chiTc nang Viet Nam, Ha Npi.
2. Vat ly tri Heu va Phuc hdi chiTe nang (2003), Giao trinh giang day dai hpc va sau dai hpc Hpc vien Quan y. Nha xuat ban Quan dpi Nhan dan.
I ;^