I. of NAM NGHIENG, DUONG VAO LA HARDINGE CAI TIEN TAI BENH VIEN VIET TIER HAI PHONG KET QUA PHAU THUAT THAY KHCfP HANG V6l TUTHE

HOI NGHI KHOA HOC BENH V I E N H Q U NGHj VI^T TI$P H A I PHONG LAN THLf 37

KET QUA PHAU THUAT THAY KHCfP HANG V6l

TUTHE NAM NGHIENG, DUONG VAO LA HARDINGE CAI TIEN TAI BENH VIEN VIET TIER HAI PHONG

• • • « •

Dinh The Hiing*, Nguyen Tien Binh*

TOM T A T

Phau thuat thay khdp hang vdi tU the n§m nghieng, dUdng vac la du'dng Hardinge cai tien la ky thuat mdi dUdc ap dung d Viet Nam. Khoa Chan thUdng chinh hinh-Benh vien Viet Tiep Hai Phbng b3t dau ap dung ky thuat nay tir thang 12/2006 den thang 9/2011 cho 120 benh nhan(BN) vdi 132 khdp ( 6 BN thay ca 2 ben). Ket qua dat dUdc: rat tot 41,18%; tot 45,88%; kha 11,76%; trung binh 1,18%. Da so BN hai long vdi ket qua sau mo.

Tir khoa: Thay khdp hang; DUdng Hardinge cai tien.

SUMMARY

REMARK ON HIP REPLACEMENT WITH UTERAL POSITION, USING MODIFIED HARDINGE APPROACH AT HAI PHONG GENERAL

HOSPITAL

Hip replacement with using modified Hardinge approach is technique recently appliqued in Vietnam.

The Orthopeadie-Traumatology of Haiphong General Hospital started this technique from 12/2006 to 9/2011 and replaced 120 patients with 132 hips (both: 6 patients). Results: 41,18% are excellent; 45,88% are good; 11,76% are rather good; 1,18% are average.

Most of patients satisfied with post-operative result.

Key words: Hip replacement; Modified Hardinge approach.

I.

OAT VAN

of

Phau thuat thay thh khap hang nhan tao ngay nay thuc sir phat triln tren toan thh giai.

Hang nam co hang tram ngan khap hang vai

* Benh vien Vi^t Tiep Hdi Phong ** Hoc vi^n Qudn Y

nhicu ky thuat khac nhau nhu tir the BN, dm'rng vao kh('rp...da dirge thay the dem lai kcl qua rat tot cho ngiroi benh. Khoa CTCH Benh vitMi Vict Tiep Hai Phong da bat day lri6n khai thay khop hang tir thang 8/1995 cho 194 khap. Tir thang 12/2006 tai thang 9/2011 vai tu the nam nghieng, dircmg vao la duang I lardinge cai tien, chiing toi da thay the cho 132 khcrp 6 120 BN.

Muc tieu cua nghien ciru nhdm: ddnh gia ket qua buac ddu cua cdc khap da dugc thiFj the vd riit ra kinh nghiem ve AT thudt phau thudt nay.

II. OOI TU9NG VA PHUONG PHAP NGHIEN CCW 1. Doi tu-9ng nghien cihi:

120 BN vai 132 khop (6 BN thayca2 ben) da dugc phau thuat. Tuoi tir 22 den 98, trung binh la 68.12; nam: 49; nir: 83. CacBN CO dhy dii Benh an, phim X quang truoc va sau phau thuat.

2. Phuong phap nghien cihi:

- Nghien ciai tien cim.

- lieu c h u k chon BN: cac BN cocW dinh tha> khop hang.

Lvra chpn loai khop nhan tao.

Ky thuat: Tu the BN nim nghieng Duong rach da la duong Hardinge cai tien(li duong ra phia truac vai cm so vol duonj Hardinge goc).

228

Y HOC VIET NAM THANG 10 - SO DAC BIET/2011

- Xe doc can ca cang can diii theo duong

•ach da. Xe doc 1 phan ca mong nha. ca nong nho. Boc lo bao khap. Ma bao khop linh chii T. Lam trat khap ra truac. Cat c6

<uang diii tren mau chuyin nho 1 cm, \hy bo

\di6i CO chom xuong diii. LSp 6 coi \ a chuoi

; ;heo ky thuat kinh dihn.

5 Danh gia ket qua: tinh trang \hx m6, X

^uang kiem tra sau mo, dinh ky kham lai sau l;3;6;12 thang \'a cac nam tiep theo. Danh gia ket qua xa dua vao tieu chuan ciia Merle

D'Aubigne- Postel.

III. KET QuA NGHIEN CCfU

T6ng s6 132 khap a 120 BN. 6 BN thay ca 2 ben. Nam: 49BN; nir: 83BN. Tuoi trung binh 68,12 T( tir 22-98).

1. Tuoi BN Iiic thay khop:

Tir 22-50: 17BN (12,88%). Tir 51-60:

17BN (12,88%). Tir 61-70:27 BN (20,45%).

Tir 71-80: SOBN (37,88%). Tir 81-90: 18BN (13,64%). Tir 91-100:3 BN (2,27%)

"

: ^~~~"~-^^.,„^^^Do tuoi Loai khdp ^""~^~^^^

A. Moore

Bipolar co xi manq Bipolar khong xi manq Hybrid

AML Corail ITong

Bang

22-50 0 0 0 2 6 9 17

; 1 : Tuoi BN theo loai k h a p nhan tao

51-60 0 1 0 1 3 12 17

61-70 0 12

7 2 1 5 27

71-80 12 20 13 2 0 3 50

81-90 3 8 6 1 0 0 18

91-100 1 1 1 0 0 0 3

Tong 16 42 27 8 10 29 132

I 2. Cac chi dinh thay khop:

Gay mai c6 xuong diii: 90 khop (68,18%)). Khop gia, tieu co chom xuong diii sau bo 30t, thu6c nam, m6 ket hop xuong: 10 khap(7,58%)). Hoai tir chom, thoai boa khop: 29 khop 21,97%)). Cirng khop do viem cot s6ng dinh khop: 2 khop (1,51%). Trat khap hang cii: 1 chop (0,76%).

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HOI NGHI KHOA HOC BENH VI§N HLfU NGHI VIET TIER H A I PHONG LAN THLf 37

Bang 2: Cac benh ly, chan thuang khap hang

Chan thu'dng, bgnh ly khdp hang Gay mdi co xu'dng dui

Khdp gia, tieu co xu'dng dui sajj slyxUdng Hoai tir chom, thoai hoa khdp

Cifng khdp do viem cot song di'nh khdp Trat khdp hang cu

Tong

So lu'dng 90

10 29

132

Ty Ig % 68,18

7,58 21,97

i ^

0,76 100

3. Cac loai khop nhan tao:

Chom A. Moore; 16; Chom Bipolar co xi mang: 42; Chom Bipolar khong \i mang:

27; khop loan phiin Hybrid: 8; khap toan phan khong xi mang (AML): 10; khap toan phan khong xi mang Corail (xai cac duang kinh chom: 28; 32; 36): 29.

4. Ket qua dieu tri:

- Ket qua sau mo: khong co BN nao bi thiing 6 coi. 5 BN nirt dau tren xuong diii.

Lien \et mo ky dau, khong bi nhiem triing vet mo. Cat chi vet mo sau 12 ngay.

- X quang kiem tra lai khop nhan tao dat dung vitri 100%).

- Cac tai bien, bien chimg:

+ 2 BN bi tir vong sau mo: 1 BN tir vong sau mo ngay thir 2 vi sac thirc an, 1 BN tir vong sau mo ngay thir 15 vi \iem ph6i nang.

+ 1 BN bi trat khop sau m6 10 thang. Do la BN nam 72 tu6i bi trat khop hang da 19 nam, gay dhu tren xuong diii 8 nam. Sau m6

10 thang, 6 coi bj troi, chung toi da phau thuat dat lai 6 coi va thay chom co dg dai Ion hon.

+ Co 5 BN bi nirt dhu tren xuong diii: 3 BN bi nut khi rap 6ng tiiy xuong diii, 2 BN bi nut khi dong chuoi that vao. Ca 5 truong hgp nay deu dugc dimg vong dai tliep tSng cuong.

Ket qua xa: Theo doi tir 3 thang d6n 4 nam 11 thang o 85 BN cho kht qua rk tot la 35 BN (41,18%); t6t la 39 BN (45,88%); kha la 10 BN (11,76%); trung binh la 1 BN (1,18%)). Khong co kht qua xhu.

IV BAN LUAN ^ 4.1. Vc tuoi cua BN

Doi voi nhirng BN cao tuoi, hi gay c6 xucrng diii, khap gia, bi tieu chom xuong diii dugc tliay chom A. Moore; Bipolar (co xi mang hoac khong xi mang). Thai gian giin day chom A. Moore dugc chung toi sir dung it ban ma thuang sir dung chom Bipolar, Nhirng BN co kem theo va mau chuyen lan thi dugc tang cuong bang nhung vong dai thep. Nhirng BN na\ chung toi cho tap muon ban va thay rang chirc nang khap ciing khong bi han che. NhCrng BN cao tuoi thuong CO cac benh ly toan than kem theo: tim mach, huyet ap, dai thao duong... chiing toi phoi hgp voi cac chuN en khoa khac de dieu tri.

DtM \ tVi nhimg BN tre tuoi han (<70T) bi gay co xuong diii, khop gia tieu co xucmg diii sau ga> co xuong diii; nhung benh nhan bi hoai tir chom. thoai hoa khop hang (29 khop) dugc tha> khop hang toan phan khong

\i mtog (.AML, Corail).

4.2. Cac tai bien, bien chirng:

2 BN bi tir vong sau mo:

+ 1 BN tir vong sau mh ngay thii 2 vi sac thirc an, do la BN nir 72 tu6i hi gay CXD dugc tha>' khop Bipolar khong xi mang do an chao bi sac tran day vao trong 2 phoi.

+ 1 BN tir vong sau mo ngay thu 15 vi viem phoi nang. BN nay la nir 87 tuoi bi gay nen CXD co vo mhu chuyen Ion 1 thang, chung toi mo thay chom Bipolar co xi mang 230

Y HOC VIET NAM THANG 10 - SO DAC BIET/2011 (2 goi), diing chuoi dai (240 mm) va c6 dinh

mau chuyen Ion bang vong dai thep. BN khong bi nhiem triing \ht mb. X quang kilm tra lai: chom va chuoi dung vi tri nhirng bi viem phoi nang.

- Co 1 BN bi trat khop sau m6 10 thang.

Do la BN nam 72 tu6i bi trat khop hang da 19 nam truoc nhung khong nhn lai khofp, gay dau tren xuong diii 8 nam truoc va dugc mo KHX bang gam dinh va b6 bgt chau lung chan. Khi den \ ai chiing toi. BN dau va ban che van dgng khop hang mgi tam, chan ngan ban ben lanh 4 cm. BN da dugc phau thuat tao hinh lai 6 co, dat 6 coi khong xi mang, cat doan dau tren xuong diii 3.5 cm: KHX bang nep vis \ a dai thep, lap chuoi co xi mang, 10 thang sau BN bi trat khop vi 6 coi bj troi va dugc phau thuat ghep xuong, dat lai 6 coi, diing chom co do dai Ion hon. X quang kiem tra sau mo khong co gi bat thuang. Den nay BN vandi lai dugc.

Co 5 BN bi nirt dau tren xuong diii dugc tang cuong bang cac vong dai thep, ' chung toi cho tap ky nen cham hon (sau 1 thang). Bhn nay kiem tra lai xuong diii da liln t6t, chuoi khop khong bi lun.

V. KET LUAN

' Phau thuat thay khop hang voi tu the

• nim nghieng, duong vao la duong Hardinge '' cai tiln 6 120 BN (132 khop) cho kit qua rk tit va t6t la 87,06%. Kha la 11,76%. Trung binh la 1,18%. Khong co kit qua xhu. 100%

BN liln vit m6 thi dhu, 2 BN bj tir vong. 1 BN bi trat khop sau mo 10 thang. 5 BN bj nut dau tren xuong dui.

TAI UEU THAM KHAO.

1. Nguyen Tien Binh, Nguyen Ngoc Liem:

Nhan xct ket qua 126 truong hgp thay khop hang ban phan, toan phan tai benh vien Trung uong quan doi 108. Bao cao khoa hoc Dai hoi Hoi Ngoai khoa Vicl Nam lan thir X, trang 135 137, Ha Noi 10/1999.

2. Tran Dinh Chien, Pham Diing Ninh: Mo so nhan xet qua 10 nam irng dung phau thuat tlia\ khop hang tai khoa Chan thuong chinh hinh benh vien 103. Tap ciii Y dirge hoc quan sir, trang 90 - 95, .so 34, thang 2/2009.

3. Thai Van Dy: Mot so duang vao khop hong.

Bai giang dai cuong chan thuang, tap 1, trang 151 153, Dai hoc quan y - 1997.

4. Dinh The Hung: Danh gia kit qua thay khop hang toan phan khong xi mang. Luan van thac sTy hoc. Hoc vien quan y 2003.

5. Dominique C. R. Hardy, Patrick Frayssinet: Hydroxypatite coated Femoral arthroplasties a long term study through 29 corail prostheses explanted durings ten year survey. Surgical technology international X, Universal medical press, Inc 2006

6. Engh C A . et a!.: In 'Long-term resuhs of use of the Anatomic Medullary Locking prosthesis in Total Hip Arthroplasty'. JBJS No. 79A, Vol.2 February 1997

7. Engh C.A.: Extensively Porous-Coated implants: A historical perspective.

Orthopedics Today, November 2002.

8. Jeal Pierre Vidalain, MD: Corail stem Long term results based upon the 15 year artro group experience. Springer Verlag France 2004.

9. Nicholas G. SotereanosMark C. Miller, PhD, Brett Smith, MD, Robert Hude, MD, Jeffrey J. Sewecke, DO, and David Wohlrab, MD: Using Intraoperative Pelvic Landmarks for Acetabular Compoment Placement in Total Hip Arthroplasty. The Journal of Arthroplasty Vol.21 No.6, 2006.

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