Y HQC VIET NAM THANG 6 - SO 2/2014
NGUYEN NHAN VA THITC TRANG THIEU KHOANG CUNG H A M DO RANG MOC LECH LAC TREN BENH NHAN DEN KHAM VA DIEU TR! NAN CHJNH RANG HAM TAI BENH VIEN VIET NAM - CUBA
T 6 M TAT
Myc t i e u nghien cuTu: Nghien cuU tren 172 benh nhan den kham va dieu trj chinh nha tai khoa Ring Mieng benh vien Viet Nam - Cu Ba xac djnh nguyen nhan va thUc trang thieu khoang cung ham ciia ring xoay true, r3ng mpc ngam va ring lac cho.
Phu'dng phap nghien c i h i : Mo ta cSt ngang hoi ciiU va tien CIJIJ. Ket qua: nguyen nhan gay rSng mpc lech l?c vj trf; thieu cho mpc trong cung ham chiem 68,6%.
Ty le thieu khoang cua ca hai ham 75,6 %, thieu khoang ham dffdi la 16%, thieu khoang ham dwdi ciiiem ty le thSp nhat Id 8,4%. Ket lu$n: Nguyen nhan chinh gay ra rang mpc ledi lac vj tri la thieu cho mpc trong cung ham. Ty le thieu khoang ciia ca hai ham la Idn nhat.
Tit khda: rang lech i?c, thieu khoang.
S U M M A R Y
I D E N T I F Y REASON OF T R A N S P O S I T I O N , ROTATED A N D I M P A C T E D T O O T H , A N D THE REALITY OF DENTAL ARCH LENGTH OF THE PATIENTS I N O T H O R D O N T I C DEPARTMENT
OF V I E T N A M - CUBA H O S P I T A L Objectives: studying in 172 patients in othordontic department of Viet Nam- Cuba Hospital to identify reason of transposition, rotated and impacted tooth, and the reality of dental arch length. Methods:
cross-sectional analysis. Results: Lack of space causes 68,6% of tooth anomalies cases. The rate of space lacking of both arches was 75,6%, while that in upper arch and lower arch were 16% and 8,4%, respectively. Conclusions: The main reason of transposition, rotated and impacted tooth is the lack of space. The highest rate of space lacking of both arches was the highest number.
Keywords: lack of space, anomalies, dental arch.
L D i ^ T V ^ N O l
T / 1^ rSng fech lac d benh nhan chinh nha tffdng doi cao, trong d d rSng bj xoay true, r3ng mpc ngam va rSng lac cho la nhffng trffdng hdp hay g^p, chiem 16,9% (theo thong ke cua khoa nSn chlnh rSng, vien Rang Ham M^t 1994). Theo
*Vi$nD^ot?o RHM - DH YHa Ngi Phan bi$n khoa hpc: PGS.TS Mai Oinh Hffng
Nguyen Thj Thu PhyoTig* va cong su-
so lieu dieu tra ciia Nguyen Thj Thu Phffdng 6 895 dieu tri chinh nha tei khoa nan chinh rang vien rang ham mat Ha Npi thi ty !e rang phia trffdc b| xoay true, mpc sai cho hoac mpc ngam chiem 28,5% [ 1 ] . Loai lech lac ve vi tri cua rSng nay gay anh hffdng nhieu den tham my va tam ly ciia benh nhan, va anh hffdng den chffc nang 3n nhai dac biet de gay viem ldi ,viem quanh rSng, sau rang do ve sinh rang mieng kho. Rang lech lac CO the se dan den kha nang ve sinh rSng mieng kem, sau rang va mat rang sdm. Theo nghien cffu cua Vien Rang ham m3t quoc gia, ty le sau rang d l i i ^ tuoi 9 - 11 la 54,6% va d Iffa tuoi tff 15 - 17 la 68,6%; 75,2% d tuoi 18 - 34 va tang len 89,7% d tuoi tren 45 [ 1 ] . Mat khac, lech lac rang co the gay ra nhutig bien chffng phffc tap hdn ve khdp rSng va khdp thai during ham. Theo nghien cihj ciia Pham Nhff Hai, ty le ton thffdng khdp thai dffdng ham d ngffdi Viet Nam la 79,2% trong do co nguyen nhan do sai khdp cUn [ 2 ] . Vi tinh pho bien, nhDhg bien chihig va anh hffdng phffc tap cua bSt thffdng vj tri ciia rang den qua trinh chinh nha chung toi tien hanh nghien cihJ de tai nay vdi muc tieu xac djnh nguyen nhan va thffc trang thieu khoang cung ham ciia rang xoay true, rang mpc ngam va rSng lac cho.
II. DOI T l / p N G VA P H l / d ^ G P H A P NGHIEN COU Nghien CU\J tren 172 benh nhan den kham va dieu tri chinh nha tai khoa Rang Mieng b^nh vi$n Viet Nam - Cu Ba Ha Npi tff 1/2011 - 8/2013.
2 . 1 . T i e u chuSn lu'a c h o n : Cac benh nhSn den kham va dieu trj chlnh nha dffdc chuan doan CO rang vTnh vien xoay true, rang mpc ngam (trff R8) va rang lac cho. Khong co tien sff y khoa ddc biet nhff benli nhan mSc cac dj tat bam sinh, hpi chihig teo n i i ^ m3t. Chu^ tihig dieu trj chinh nha trffdc do. Khong co chan thffdng rang trffdc khi dieu trj chinh nha.
2.2. T i e u c h u a n l o a i trCt: Benh nhan khong hdp tac. Benh nhan cd roi loan tam than.
Benh nhan dieu trj chinh nha l?i.B?nh nhan chi cd r3ng 8 mpc ngam.
Y HOC VIET NAM THANG 6 - SO 2/2014 Benh nhan den chinh nha trffcfc thdi gian
nghien ciTu khong co benh an hay benh an khong CO day dii thong tin, khong co mau hoac phim.
2.3. Thdi gian nghien cu'u va dfa diem nghien ciVu:
Tff 1/2011 - 8/2013 tai Khoa Rang mieng benh vien Viet Nam - Cu Ba: 37 Hai Ba Trffng Ha Npi.
2.4. Phu'dng phap thu thap thong tin Benh an: Ten,tuoi, dja chi.Ly do den kham.
Mau ham: Phan loai khdp can theo Angle. Dp can chia, dp can phii, mffc dp thieu khoang. Dem so Iffdng rang, rang thffa, rang lech ti-gc...Dffdng
cong spee, hinh dang cung rang.
XQ va anh chup: Xac djnh kieu mat cua benh nhan: binh thffdng, nho, lom.Tlnh trang rang, mam rang, rang ngam, u, nang.-Tffong quan xffdng ham- nen sp, xffdng - rang, rang - rang, xffdng ham -xffdng ham.
2.5. Khia canh dao du'c cua nghien cuXi Tat ca cac doi tffdng dffdc nghien cffu hoan toan tren tinh than tff nguyen va dffdc giff bi mat. De tai nghien cffu chi nham muc dich phuc vu nghien cffu khoa hpc nang cao sffc khoe cho bdnh nhan.
III. KET QUA NGHIEN CU'U 3.1. liidng tin vig benh nhan
Tl le benh nhan den dieu tri nan chinh rang dp tuoi tff 14 - 20 tuoi chiem ti le cao nhat la 51,16%i sau day la dp tuoi 6 - 13 tuoi vdi ti le 28,49%, dp tuoi > 20 chiem ty le thap nhat la 20,35%.
Ty le benh nhan nff den chinh nha nhieu hdn benh nhan nam, chiem ty le 66.86%.
3.2. Nguyen nhan gay lech lac
Jang 3.1. Phan loai theo nquyen nhan lech lac Nguyen nhan
Co rSng thiTa (da moc hoac rang ngam) Con rang sii'a
Phanh moi bam thap Thieu cho moc
Tong so
So benh nhan 34
5 15 118 172
Ty le o/o 19,8
2,9 8,7 68,6 100
3.3. VlCtc dp thieu khoang tren cung ham cua cac b^nh nhan Bang 3.2. Thieu khoang tren cung ham
Ham tren Ham du'di Ca hai ham
long so
So benh nhan 11 21 99 131
Ty le o/o 8,4%
16,0%
75,6%
100 IV. BAN LU;^N
4.1. e$c eiSm vS gi6i va lu'a tuoi Ti le nff den dieu trj cao hdn nam gidl co le do nhu cau tham ml 6 nO' cao hdn nam va tam If ciia cac bac phu huynh thu'dng quan tam nhieu den tham ml cho be gai cao hdn cac be trai. Oay cung la mpt trong nhu'ng yeu to gop phan lam cho ti le benh nhan nu' cao hdn nam. Nhdm tuoi 14 - 20 chiem ty^ le cao nhat, chijng toi cho rang d lij^ tu6l nay cac em cd kha nang nhan Vnitc va nhu cau tham my ve rang mieng.
4.2. Nguyen nhan giy benh
Tiiieu cho mpc tren cung ham ia nguyen nhan chinh gay rang mpc lee lac vi tri trong nghien culi cua chung toi, chiem 68,6%. Do sir bat tu'dng xutig gluS kich thu'dc giiia rang va
ham cd the do rang qua to hoac xu'dng ham qua nhd hoac trung binh, hoac ket hdp g\Qa di nguyen nhan do rang va ham da dan den tinh trang^thieu khoang tren cung ham, khong du cho cho rang mpc dan den tinh trang rang moc lech lac vj tri.^Theo Nguyen Thj Thu Phu'dng [ i ] t^ 1$
thieu cho chiem 38,0% trong 895 tru'dng hdp chinh hinh rang mieng den khoa nan chinh rSng vien rSng ham mat Ha npi, sd di cd sy khac nhau nay la do muc dich nghien ciju cua Nguyen Thj Thu Phu'dng chi gidi han d benh nhan cd rSng tru'dc bj xoay true , mpc sai cho ho5c ring moc ngam. Ket qua nghien ciili ciJa chung toi gan vol ket qua cua Le Thj Nhan [3] ti le thieu cho chiem 60% d tre em tdi dieu trj tai khoa nan chinh rSng Vien Rang ham mat trung Lfdng.
Y HOC V1|T NAM T H A N G 6 - SO 2/2014 Nguyen nhan thii' hai la do cd rang thira (da
mpc hoac rang ngam) chiem ty le 19,8%. Khi cd rang thii^ da mpc hoac mpc ngam se lam tang so lu'dng rSng moc tren cung ham gay hau qua rang moc xoay true, rang mpc ngam hoac rang mpc lac cho. Chung toi nhan thay phan ldn rang thii^ mpc ra nam d giii^ hai rang cira giiia hoac nam d giiJa rang ciia giii'a vdi rang ciia ben. die rang thifa thu'dng cd hinh dang bat thu'dng; than va chan ngan hdn binh thu'dng, nhd va nhpn.
Khi rang thira mpc ngam cd the can trd rang vTnh vien tren diidng rang moc vao khoang mieng gay thieu rang tren cung ham. Mat khac nd con lam lech sir phat trien cua rang vmh vien ben canh, la nguyen nhan gay bat thu'dng vj trf cua rang nhy; rang mpc sai vi trf, rang xoay true, khe hd, rang troi.
Nguyen nhan thy ba la do phanh moi bam thap chiem ty le 8,7%, theo Ph?m Hong Ngpc [4]
ty le nay la 3,3 %. Cd sy khac biet giiia ti le ciia chiing toi vdi ti le nay cd le la do sy khac nhau ve ddi tydng nghien eiru. 061 tydng nghien ciiu cua chung tdi la benh nhan cd bSt thydng vj tri eiia rSng cdn trong nghien ciru ciia Pham Hong Ngpe doi typng nghien ciiu tr^n benh nhan chinh nha ed rang xoay true tai benh vien Viet Nam- Cu Ba.
Phanh mdi bam thap lam cho rang dia khong khit vdi nhau can phai phau thuat dd la; day chSng cd khoi lydng binh thydng nhyng bam thap, day chSng to ngan can ed hpe hai rang eya giii^a sat vao nhau.
CSn rSng siia chiem ty le tha^ nhat vdi 2,9%. Nguyen nhan rang siia den tuoi thay van cdn tren cung ham thydng do mam rang vTnh vien khdng mpc dung vj trf cua chan rang sffa lam chan r3ng siia khdng tieu.
4.3. Anh hu'dng giii'a bat thu'dng vj tri den cung r3ng va khdp can
Mu'c do thieu khoang ciia ca hai ham chiem ty 1^ eao nhat vdi 75,6%, ty le thieu khoang ham dydi la 16%, thieu khoang him dydi ehiem ty le thSp nhat la 8,4%. Theo nghien cirU ciia Pham Hdng Ngoc [4] thi ty le thiSu khoang ca hai ham la 74,l%i ty le thieu khoang ham dydi la 14,8%, ham trin la 11,1%. Cd sy khac biet giiis ti le ciia . chiing tdi vdi ti le nay ed Ie la do sy khae nhau ve doi tydng nghiin ciru va ed mau. Ddi typng nghlSn cifu ciia chung tdi la benh nhan ed rang xoay tryc, rang mpc ngam va rang lac eho tren b^nh nhan den kham va nan ehinh rang edn trong nghien cffu ciia Pham Hong Ngpe thi doi tuVng nghien eiru la b?nh nhan edrang xoay true. Bat thydng ve vj tri eiia r5ng ed_ the Ja nguyen nhan gay sai khdp eIn va la nguyen nhan gay tai phat sau dieu trj ehinh nha, do dd^nhiing bat thydng ve ring can phai nghien culi can than khi Chan doin va len ke hoach trydc khi chinh
nha.Theo nghien cffu ciia chung tdi bat thu'dng vj tn eiia rang thydng gap d CL2, sau dd la CLl, KC hon hdp cudi ciing la CL3.Theo nghien cii^j ctia chiing tdi trong 159 benh nhan cd rang xoay true thi benh nhan ed khdp can CL2 cd rang xoay true ehiem ty le cao nhat la 52,2%, sau day la benh nhan cd khdp can CLl vdi ty le 21,4%, binh nlian cd khdp can hon hdp la 20,7%, thap nhat la benh nhan cd khdp can CL3 la 5,7%. Ttieo nghien effu ciia Pham Hong Ngpc [5] thi ty le gap rang xoay true tren sai khdp can Angle I chiem ti le 66,7%, Angle II chiem 13,3% va Angle III chiem 6,7%. Cd sy khae biet giiJa ti le ciia chung toi vdi ti le nay cd le la do sy khac nhau ve ddi ttrpng nghien effu, ddi tu'dng nghien cffu ciia Pham Hong Ngpc la benh nhan den kham va dieu tri ehinh nha cd rang xoay tryc, cdn doi tupng nghien ciru ciia Chung tdi la t^t ca nhiitig benh nhan ehinh nha den kham va dieu trj.Theo nghien eiiu ciia chung tdi trong 8 benh nhan ed rang mpc ngam thi benh nhan cd khdp can CL2 ed rang mpc ngam chiem ty le cao nhat la 50%, sau day la benh nhan cd khdp can CLlvdi ty le 37,5%, benh nhan cd khdp can hon hdp la 12,5%, thap nhat la benh nhan ed khdp cUn CL3 la 0%.Theo nghien cffu ciia Becker (1995) [5]
thay 9% benh nhan khdp can CL3 va 3,3 % benh nhan CL2 tieu loai 1 cd r3ng nanh ngam d tien dinh va khau cai.
Theo nghien ciiu eiia chiing toi trong 52 benh nhan cd rang mpc lac cho thi b$nh nhan cd klidp can CL2 ed rang moc lae cho chiem ty le eao nhat la 53,8% (28/52), sau day la benh nhan cd khdp can hon hdp vdi ty le 28,8 % (15/52), benh nhan cd khdp can CLl la 13,5%, thap nhat la benh nhan cd khdp can CL3 la 3,9%.Theo nghidn cffu ciia Kotsomitis va edng sU (1996) [6] tren 101 cap sinh ddi benh nhan chinh^nha thay 29,7
% beiih nhan cd rang moc lac eho, theo nghien ciru ciia chiing tdi thi ty le rang mpc Igc eho la 30,2%. Cd sy khac biet giiia ti le ciia chiing tdl vdi ti le nay ed le la do sy khac nhau ve ddi tydng nghien cffu va cd mau.
V. KCT LUAN
Thieu cho mpc tren eung ham la nguyen nhan chinh gay rang mpc lech igc vi tri trong nghien ciiu ciia chung tdi, chiem 68,6%. Mffc dp thieu khoang eiia ca hai ham do rang mpc l?ch lae chiem ty le cao nhat vdi 75,6%, ty le thieu khoang ham dydi la 16%, thieu klioang ham dydi chiem ty le thap nhat la 8,4%. Can thyc hien tot cdng tac tuyen truyen giao due cho hpc sirih ve cac nguyen nhan gay nen tinh trang 1 ^ lac vj trf cua rSng, thyc hien tot cdng tSe phong ngu^ de giam nhe viee dieu trj chinh hinh ve sau.
Y HOC VIET HAM THANG 6 - SO 2/2014
TAI UEU T H A M KHAO
1 . Nguyen Thi Thu Phu'dng (1996) - Stf dung khj cu CO dinh vdi mac cai dan tru'c tiep fren rang de dieu tn rang tru'dc mpc ngam - sai dio - ledi true.
Luan van tot nghiep thac sy, diuyen nganh RHM.
2. Pham Nhu" Hai (2006) - Nghien CU\J djch te hoc loan nang bp may nhai va de xuat giai phap can thiep. Luan an Tien sy Y hpc, Tru'dng Dai hpc Y khoa Ha Noi.
3. L^ Thj Nhan (1977)- Mpt so each phan loai lech lac rSng ham . RSng Ham Mat t i p 1- Nha xuat ban Y hpc-1977, tr. 450- 463.
Ph?m Hong Ngpc (2011) Nhan xet d|c tfiem lam sang, Xquang va danh gia k€t qua dieu trj nan chinh rang xoay true bang khf cu co dinh. Luan van tot nghiep Thac sy, chuyen nganh RHM.
Becker A (1995) Palatal canine displacement Guidance theory or an anomaly of genetic origin?
A letter with response from Seldon et al. Angle Orthodontist 65: 95-98.
Kotsomitis N, Dunne MP, Freer 13. A genetc aetiology for some common dental anomalies: a pilot twin study. Aust Orthod J 1996b; 14(3): 172-8.
DANH GIA KET QUA DIEU TRI BENH VIEM NOI TAM MAC NHIEM KHUAN TAI BENH VIEN HOTU NGH| VIET TIEP HAI PHONG
Tir THANG 1/2010- THANG 6 / 2 0 1 3
TOM TAT
MMC tidu: Danh gia ket qua dieu tri 31 BN mac bSnhVNTMNK tai BV hutJ nghj Viet Tiep Hai Phong tCr thang 1/2010- thang 6/2013 Phu'dng phap: Can thiep lam sang, chpn lpc, khong doi chdng. Ket qua:
Tuoi mSc 40,8 ±14,5 nSm, nam 54,8%, nff 45,2%.
Tien SLT 90,6% BN co benh thap tim, tim bam sinh.
Tri§u chtimg ISm sSng hay gip: sot keo dai 37,5°C- 39°C,suy tim tien trien.Ty le cay m^u (+) la 38% , not sCit d mep van tim va lo thong lien that (100%). Ket lu$n: Chan doan lam sang, c?n lam sang cua VNMTNK la 2 aSu chuan chinh (38,7%) hole 1 tieu chuan chinh va 3 tieu chuan phg theo tieu chuan Duke la 61,3%[3].Thdi gian dieu tri npi khoa khoi ra vi§n la 33,1 ± 7,8 ngay. Ket hdp it nliat 2 loai KS. Cac phac do ket hdp 2 KS hay dung: p lactam + Aminozld, p lactam + Quinolon, Vancomycin + Aminozid, p lactam + Vancomycin. Oieu tri suy tim nang, soc t i m : Digoxin 0,5mg-lmg/TM.S6c tim dung Dopamine 20-50 pg/kg/phut/TM va hoSc Dobutamine 30- 80pg/kg/phut^M. Oieu t r j toan than: Albumlne Human 50ml/24 gid/truyenTM va ho3c Plasma 250mI/24 gid/truyenTM 12,9%. Ty le dieu trj npi khoa khoi la 7 1 % , ty I? tii" vong 29%. C^c bien chuYig suy tim nSng, khong hoi phuc 41,9%, tSc mach 22,6%, soc nhiem khuin (9,7%).
rd'A/fda/Vlem npi tam mac nhiem khuan, Benh vi?n hiJu nghj Viet -Tiep Hal phong. Not sCii, dac diem c$n lam sang, tieu chuan ciia Duke.
Nguyen Hong H^nh*
• Tru&ng Cao dSng y Quang Nini)
Phan bifn khoa hgc: PGS.TS Ph^m M^nh Hung
S U M M A R Y
TREATMENT OUTCOMES ASSESSMENT OF I N F E C T I V E E N D O C A R D I H S I N CZECHOSLOVAKIA-VIETNAM HAIPHONG
F R E N D S H I P HOSPITAL FROM JANUARY 2 0 1 0 T O JUNE 2 0 1 3 Objective; Evaluate the results of treatment for 31 patients with Infective Endocarditis at Czechoslovakia-Vietnam Haiphong frendship hospital from January 2010 to June 2013 Methods: Oinical Intervention, selectively, not control. Results: Age with 40.8±14.5 years, 54.8% male, 45.2% female.
90.6% of patients with a history of rheumatic heart disease, congenital heart Disease. Common clinical symptoms: fever lasts 37.5" C - 39°C, avanced feilure heart. Rate of blood culture (+) is 38 %, Vegetation on the edge of the heart valves and ventricular septal hole (100%). Conclusion: Clinical diagnosis, subclinical manifestations VNMTNK are 2 major criteria (38.7%) or 1 major criterion and 3 sub-standard criteria Duke is 61.3 % [ 3 ] . Duration of therapy Is discharged from 33.1±7.8 days. Combining at least two types of antibiotics. The tv/o regimens combined or used antibiotics: Aminozid + p lactam, quinolone + P lactams, vancomycin + Aminozid, p lactam + vancomycin. Treatment of severe heart failure, cardiogenic shock: taking Digoxin 0,5mg-lmg/IV, Dopamine 20-50 \iql kg/mln/IV and or Dobutamine 30-80pg/kg/min/IV. Treatment recovery for all body:
Human albumin 50ml/24 hour/IV and 250ml/24 or fresh Plasma /IV(rate 12.9%). The rate of effective therapy is 7 1 % , 29% mortality rate. The complications