. . . ^ MAM THANG 6 • sd' 1/2014
NGHIEN Ciru U?JG DUNG DIEU TRI GAY Xu'aNG H A M D u ' a ! BANG NEP VfT CO DINH W N G CHAC
T6M TAT
De tai tien hanh nghien culi ben cuTU de dieu trj gay xu'dng ham dudi bSng nep vit co djnh vu^g chac tren 65 benh nhSn vd dieu tri bSng cac phu'dng phap Idiac vdi 90 b^nh nh§n.
Oanh^ia vS theo doi Icet ^ua cSn CLT vao cac yeu to giai phau, chOTc nSng va tham m9, chCing tdi nh^n thay sOr dung he thong nep vft co djnh vQlig chSc de dieu trj gay xuUng ham dUdi trong cac trudng hdp gay khdng g§y thi^u hong \& chu'c xu'dng, cac ring con tren hai cung hdm diJ de xdc tdp du'^c tUdng quan khdp cSn, k^ qud rat ^ t , ddc biet benh nhan khong phdi co-djnh hai hdm trong suot qua trinh dieu tri nen c6 th€ dn nhai, v§ sinh rdng mieng vd tdng thim chat luUng cude song.
SUIVIMARY
STUDY ON THE APPLICATION OF TREATMENT OF MANDIBULAR FACTURESBY
USING COMPRESSION SCREW PLATE This is a study for the prospective treatment of mandibular frat^res by using compression screw plate (CS-plate) on 65 patients and other methods 90 patients. The study has taken place at the Department of Odontostomatology of Khanh Moa province hospital.
The evaluation of this study was based on the stability of the mandibular architecture and function, and the looks of the outeome. We observed that using CS-plate treatment would give the best results to the case of mandibular fracture fixation, in which the number of teeth on maxilla and mandible were enough to give an approrlate centric occlusion. The outcome was very positive, especially that treated patients could function normally with their mouths, do dental hygiene, improve the quality of their mastication and good for quality of life (QL).
I.OATVXNOI
L|ch sir con ngu'di ghi ch^p \^\ cho thay chan thuOng hdm m$t dutfc nhan biet tii thdi k^ chu^
o6 each tx\ li^u hay chl chu y nhutig nguyen tac s0 ddng ve ngogi khoa. Qua nhieu tai lieu tham khao cho thay gay xu'dng ham du'dc mo ta bdi ngu'di Al C$p cfch day 2.500 - 3.000 nam tru'dc cong nguy§n vd ngu'di co xu:a da biet sir dung chi buQt rang de o5 djnh xu'dng hdm bj gay (77?d? ky Smith Papyrus 1650 nim trudc cong nguyen ) .
* Twttng Cao dSng Yte Khanh Hda ifhin bi$n kitoa iigc: PGS.TS Ph^m VSn U$u
Nguyen The Dung*
Loai nep khong gay su'c ep vao cac dau xu'dng gay nay du'dc Thoma, Bigelow,Pint, Snell, Dott, Heiss va Crasser ciing cong sU cai tien ra nhieu dang va ap dung rpng rai trong dieu trj co dinh xu'dng ham bang nep IJat vi't.
Ngdy nay dung cac loai nep bat vft nho cd tang su'c ep d hai dau xutfng gay, giup cho thao tac CO djnh xu'dng gay nhanh le va d l dang hdn.
Viec CO dinh cac doan xu'dng gay du'dc tot ya chac chan hdn, tien ldi cho benh nhan sau phau thuat vi khong phai co djnh hai ham, do do co the an nhai du'dc, ve sinli rang mieng de dang, su'c khoe mau hdi phuc, chat lu'dng cuoc sdng dUdc nang cao.
Be di sau nghien cOt: i « tinh chit ijenh ly cua gay xiAing ham dudi va phi/dng phap dieu tri bang nep vft codinh viing chac cho tmg the loai lam sang khac nhau, van con chu^ du'dc nghien cuU nhieu. Chung tdl tien hanh nghiin cuU niy dexem xet sif an toan vi hieu qua cua phudng phap dieu tri gay xudng harh dddi bing n?p vit cddinh vGfig chac nhim myc tiiuj Danh gia hieu qua cua nep vit co dinh vthig chac trong dieu tn gay xu&ng him dudi.
II. E)6i TU<?i^ vA PHircTNG PHAP NGHISN cCru 2.1. Doi tu'ang: Tat ca cac tru'dng hdp gay xu'dng ham du'di du'dc thu dung dieu trj tai khoa Rdng ham mat (RHI^l) b$nh vien da khoa tinh Khanh Hda tiTthang 6/2004 - 6/2006.
Bfnh nhan du'dc chia lam 2 nhdm. Chan doan xac djnh benh du^ theo tieu chuan chfin doan va phan toai cua l<illey H.C. va Natvlg P. cd ket hdp vdi phim X quang.
2.2. Phu'dng phdp nghidn cti^u Day la loai nghien cihi tien cu\i, ckt ngang, mo ta, day so lieu bfnh nhan du'dc thu thap qua 2 ndm tu'dng dot day du va hoan chtnh nen thudn ldi cho viec xac djnli cac d3c diem chung, do do chung toi khao sat dich te lipc de mo ta tru'c tiep tCmg tru'dng hdp tren lam sang va ghi vao phieu tom tat nhij'ng du' kien can nghien CUXJ.
2.3. Ddnh gid k€t qua dieu trj: Ddnh gid theo cac yeu to giai phau, chu'c nang va tham my.
2.4. ym ly sU ll$u: Xir ly so lifu bdng chu'dng trinh SPSS for Windows 16.0. B§m tSn so, tfnh trj so trung binh, tinh gia trj " p " (t test;
Mann-Whitney U test).
Y Hpc yier NAM THANG 6 - s d 11201*
III. K^TQUA NGHIEN curu
Vdi 155 tru'dng hdp gay xu'dng iiam du'di du'dc tiiu dung dieu tri, ciiung toi ngiiien cull piian b'cii, tiiu du'dc nliulig ket qua sau:
Bing 1. Benh niian piian tiieo qidi va niiqm tuoi
WT
1 - 5 I 6 - 10 I 11 - 18 I 19 - 40 I 41- 60 I Tren 60 15-
Cong 135 20 ' Cong I 2 I 3 I 18 I 113 I 16 I 3 I ISS^
Nhom tudi 19 - 40 tudi ci tan so nhap vien cao nhat (72,90%) sojKli dc nhdm khac. S&khic biet nay d y nghia thong ke vdi x^ = 362.587, df = 5, p = 0,000. Tuoi trung binh cua binh nhan nhap vien la 27,85 tuoi vdi do lich chuan li 0,70 vi khdng d s&khic biit dy nghia thdng ke ve tuoi gi&a 2'gidi vdip > 0, 05.
Bang 2. Phan theo nquyen nlian Nguyen nhan Tai nan giao thong Tai nan sinh hoat Tai nan lao dong
Cong
S& benh nhan 113
32 10 155
Ty le % 72.9 20.6 6.5 100.0 Bing 3. Phan loai qay xu'dng ham du'di du:a theo cau true qial phau VI tri gay xhd
XUdnq d ranq Vunq cam Canh nqang Gdc ham Canh cao Ldicau i^dm vet
C6ng
So tru'dng hdp 04 63 27 45 05 09 02 155
Ty le % 2,6%
40,6%
17,4%
29%
3,2% • 5,8%
1,3%
100 °/o
So du'dng gay 04 76 38 53 05 09 02 187 Bing 4, So du'dnq^qay
—-___ Loai gay VitrlgaT
Xi/dnq 6 rSnq Vunq cam Canh nqanq Gdc ham Canh cao Ldicau Mdm vet
Cpng Ty le %
GSy 1 du'dng 04 57 24 19 03 07 02 116 62,03°/o
G3y 2 du'dng 15 11 28 02 02 58 31,01°/o
Gay £ 3 du'dng 04 03 06
13 6,95%
C§ng 04 76 38 53 05 09 02 187 100%
BingS. VI trf dudnq qav XiHD lien GSy xu'dng —--______^
Gav xi/dnq d rSnq Gav vunq cam Gay canh nqanq Gav qdc ham Gay canh cao Gay liil cau Gav mdm vet
Cdng Ty le %
quan den chan r3nq Chan rang Nam tren
du'dng gay 18 15 29
62 33,15%
Nam ben du'dng qav
58 23 22
103 55,08%
Khong lien quan
04 02 05 09 02 22 11,76%
C$ng 04
%
38 53 05 Od OJ 187 100 %Y H9C V l ^ NAM T H A H G 6 - SO 1/2014
Bang 6. Gay XHD phoi hdp vol gay cac xu'dng khac Gay ph6i
ndp Gay ^
xu'dng 6 rang
Gay vijng c3m
Gay canh . ngang
Gay gdc ham
Gay canh cao
Gay Idi Gay
mom vet Cong XGI^
XHT-XGM XUONG KHAC"
Cgng 19 8
Ddnh gid k i t qud diieu trj
E}€ dieu trj gay xu'dng ham du'di, chung toi khong tien harih sdm qua hoac mupn qua, nhat la trong tru'dng hdp cd t£n thu'dng so nao, (^n de on djnh^cung nhu' giam bdt phii ne, nham tao lai hinh the Idioi m^t dung chu'c nang cua nd. Do
dd yeu cau cua phu'dng phap dieu trj la lam the nao de nan chinh lai xu'dng gay, co djnh xu'dng gay va ngan ngu^ cac bien chulig xay ra. De dat du'dc cac yeu cau tren, chung toi da ap dung cac phu'dng phap chinh hinh va phau thuat de dieu trj cho 155 benh nhan ket qua nhUsau:
Bing 7. Ket qua dieu tri theo tuYiq phddnq phap Ket qua - Dieu tri
Tdt Kha Kem Chuv^n, trdn vien
C9ng
PhUdng phap dieu tri Ket hdp
xu'dng t}ang nep
vi't ' 63
2 0 65
Kliau 0 rang, cddinh lien rang
4 0 0 4
CojJjnh bang cung, chi thep
40 18 0 58
Ket hdp xu'dng bang chi thep
10 17 0 27
Chuyen vl^n, trdn vien
0 0 1 1
C^ng
117 37 1 155 IV. BAN LU$N
Qua nghien cihi 155 tru'dng hdP gay xu'dng him du'di du'dc thu dung dieu trj t^l Khoa RHM b^nh vi^n da khoa tinh Khinh Hoa, chijng toi thSy cd m$t so van de can ban luan sau:
4.1. TuSi, gidl v i nguySn nhSn: Tong sd benh nhin 155 ngu'di, trong dd Nam 135 va NiJ' 20; tuoi nhd nhat 3, Idn nhat 72. Tuoi trung binh nhip vl$n cija Nam va Nii' qua cic nim nghien cuu l i 27,85. Sir Ithic bl|t giua Nam v i Nu' ve tuSi trung binh nhap vi$n khong cd y nghia thong ke vdi ,t' = 53.194, p = 0,079. Trong tat ca cac nhdm tuoi nhip vien thi nhdm 19-40 tuoi chiem ty l | cao nhat 72,90% so vdi cac nhdm khic. Sir khic b i ^ giiia nhom 19-40 tuoi v i cic nhom khic cd ^ nghTa thong ke (p=0,000). Ty i? niy khdng miy khac bi?t so vdi cic tic gii trong v i ngoil nudc. Trong cac nguyen nhin gay ra chan thuUng giy XHD d Khinh Hoi thi tai n^n giao thdng (TNGT) chiem ty 1$ cao nhat 72,90%. Dieu niy cho thiy nhdm tuoi tru'dng thinh tCr 19-40 giff vj tri lao dpng chinh trong gia dinh, phu'dng a?n dl 1^1 thudng su' dung hing ngiy la cac toal xe gin miy v i TNGT l i nguyen nhin chinh gay giy XHD cho nhdm tudi niy.
4.2. Phan loai gSy xu'dng him du'di: Qua bang 3 chung toi thay ty 1$ cic viing gay XHD cua cic tic gii cd ten tudi tren the gidl nhU Kllley, Paul Natvlg... tuy co khac nhau nhuHg stj khic biet niy nam trong gidi han nhit djnh. Trii lai tai Khinh Hoi ty le gay XHD CD khac vdi cac tic gii nu'dc ngoil nhu' ty le gay loi CSM chung tdl gip 5,8%, trong khi dd cic tic gii nudc ngoil gip rat cao nhu' Ljeon A.Assael 29,1% [12], Dingman-Paul Nagvit 36% [9]. Cd ie do b'nh chit thudng ton ludn phu thudc vio nguyen nhin giy chan thu'dng, hu'dng dl v i cu'dng dp cila Ig'c tic dpng gay chan thu'dng. Hai yeu td niy lien quan mat thiet den ddi song, kinh te, xa hoi. Nu'dc ta chu yeu thu'dng ton gay nen gay XHD la do TNGT va xe gan miy l i phu'dng ti$n d u ' ^ ngu'di din sii dung phd bien trong cupe song hing ngiy. Khi tai nan xiy ra, ngu'di ngdi tren xe se bj te xudng dat, sang ben phai hoic ben trii theo iu'c quin tinh v i viliig cam, cinh ngang XHD se bj va Cham xudng dat tru'dc tien giy nen gay XHD v i xuHng go m i . Trong khi dd TNGT do xe hdi khi xiy ra thi ngudi lim chii phu'dng ti^n de va vio bang hop sd ciia xe nen lu'c tic dpng manh vio vung cim de gay gay vimg cim v i loi cau.
27
Y Hpc VI|T NAM THANG 6 - SO 1 ^
• V7 tri cua chin rang so vdi dwdng gay:
Trorig 187 du'dng giy XHD cua 155 benh nhan, cd 62 du'dng gay di qua chin rang chiem 33,15%. Sd di cd sy lien quan nay bdi vi than XHD cd cic huyet o rang la cac hoc' nhd cua chin rang cam vio. Rang cd ldi nhutig cung bat ldi vi l i nguyen nhan cua nhiilig tru'dng hdp gay xudng viing ham mat. riot mat si/ hien dien ciia chiing khien xu'dng glim di sir vffng chac va de g|y, nhuliq mat khac, rang cd tic dung hu'dng dan khi nan chinh nhutig manh gay cho dung khdp v i cddinh hai him.
• GSy phCfchdp xu'dng him du'di xu'dng him trin;
Cd 12 tru'dng hdp gay XHD-XifT chiem ty le 7,4% so vdi tong so BN du'dc nghien ciiti, t9 le niy thap trong khi so vdi I^.Coy v i cdng sit tai Kansas ty le nay chiem 40%. Bdi le lire chan thu'dng giy giy phiic hdp XHD-XHT thu'dng xiy ra ty le thu?n vdi toe do xe ch?y.
• Cic t&t thWi/ng phSi hap:
O cic nu'dc cdng nghiep phit trien, cic ton thu'dng phoi hdp vdi giy XHD sau chan thu'dng sp nio v i cgt sdntg cd l i vet thu'dng long nguC roi den cac chl. Trai l?l theo so lieu cua chung tdl d Khanh Hoa ty le gay XHD cd kem chan thtfdng sp nao l i 21,93%, trong dd gay XHD phdl hdp gay cac xudng khac cd kem chan thu'dng sp nio l i 17,41 % v i cic tSn thu'dng phoi hdp sau chan thu'dng so nao l i gay chl chiem ty le 4,51%, nhiitig vet thu'dng Idng ngu'c, bung v i cot sdng cd chiem ty I? thap 3,22%.
4.3. Dieu tri
Vdl 155 tru'dng hdp gay XHD dutJc dieu trj vdi nhilu phu'dng phip khic nhau dua vao ti'nh chit CLia thu'dng ton, ioai gay xu'dng, sd du'dng giy v i s\i dl lech.
- Phu'dng phip nan chinh hinh va co dinh mot hay hai him blng cung hay bang chi th^p du'dc sii' dgng rdng rai, chiem ty le cao nhat 37,41%
- Phu'dng phip khiu ket hdp xu'dng (KHX) bing chi thep chiem ty le 17,41%.
- Phu'dng phip khiu KHX bing nep vit chiem ty le 41,93%. Tat c i deu dat ket qui kha v i tot.
Vdi ket qui dieu tn; nhtf tren cho thay hinh inh benh ly gay xu'dng him du'di tai tinh Khinh Hoi tu'dng doi ddn giin, khdng may phut tap.
Oi dieu trj gay XHD trong hoan cinh nuidc ta hi|n nay, cic ioai nep bat vit tang sii'c ep d hai diu xu'dng gay (CS-Piate) cua Luhr (OOfc) [13,14]
gii thinh qua cao so vdi ddi sdng kinh te ciia ngudi dan nen khdng may phii hdp, hien nay cac io^i n^p vit ting su'c ep d hai daii xu'dng gay ciia tip ddan ShakH Orthopaedic Industries (P) LTD.
(An Op) gii thinh re m i chat lu'dng khdng thua kem gi ciia Ou'c. Benh nhin gay XHD du'dc co djnh bing cic ioai nep vit cd nhieu uti diem vu'dt
trdi nhu cd djnh viitig chac hai dau xifdng gay va khdng can phii co dinh hai him trong suot qua trinh dieu tri tir 6-8 tuan, do dd benh nhan cri the an nhai va ve sinh rang mieng de ding trong thdi gian dieu trj, Trii lai phUdng phip nan chinli cd dinh hai him bang chi thep, bang cung hay KHX bang chi thep cd tang cUdng nin chinh bang cung hien nay dUdc sii dung rdng rai d nhieu dja phu'dng chua cd dieu kien siydung nep vft.
4.4. Chat lu'dng cuoc sdng: Ket qui theo bing diem chat lu'dng cuoc sdng d 2 Id benli nhan, sU khac biet cd y nghTa thong ke. Oieu dang lull y d diy la trong qui trinh dilu tri gay XHD bang nep vrt co djnh vOrig chic, benh nhin khdng phil cd djnh 2 him, do do cd the h i mieng de an nhai, ve sinh rang mieng sach se thoil mii, it oi nguy cd nhiem triing vet md, gdg phan benh mau hdi phuc, tang chat ludng cuoc song.
V. KET LUAN
Qua khao sat nghien diu dieu trj gay xudng him dudi bing nep vit co djnh viitig chic tren 65 benh nhin v i dieu trj bang cic phu'dng phip khic 90 benh nhan, chung tdi cd mot sd ket lu|n:
i. Oieu tri gay xu'dng hirfi dudi bing nep vi't cd djnh vijttg chic cho nhiitig tru'dng h^p co tu'dng quan khdp can dung ket qua tot__63/65 tru'dng hdp, chiem ty le 96,92% so vdl tdng so benh nhan du'dc co djnh bing nep vit va chat tu'dng cude sdng dUdc ning cao.
2. Nhiitig tru'dng hdp gay xu'dng him dudi co thieu hdng td chiic, khdng xac djnh duljc tu'dng quan khdp cin sir dung cac ky thu$t dieu trj khic mang lai kit qui kha quan, tuy nhien benh nhin phil cd djnh 2 ham, do dd khdng i n nhai duijc trong qui trinh dieu trj, v l sinh ring mieng kem nen chat lu'dng cuoc sdng chi d mu'c trung binh.
TAILI^UTHAMKHAO
1. Ph^m Du'dng Chiu, Ph^m Hoing TuSn, Bio Bich Thiiy. Bing gia kit qua diiu bi phiu thl4t 88 trudng hpp gay loi cau x&dng him dM T?p chl Y lipc VN so 10,11, nim 1999: 93-95.
2. Nguyin The Dung. Nh$n xit kit qui phin hfl va dieu tri gay x&dng ham d&di t?l binh viin tinli Khanh Hoa. Tuyen t$p cong trinh nghien cull Mios hpc RHM 2003. Nhi xuat bin Y hpc.
3. Lam Hoil Phu'dng, NguySn Vin TuSn. BuDc dau dinh gii hiiu qua s& dpng hi thdng Kp Ik nho tmng dieu bf gay xuong him dudi. TuySi tto cdng trinh nghien cuti khoa hpc RHM 2006. Nm xuat ban Y hpc: 110-114.
4. Lim Hoai PhUdng, H3 Nguyin Thanh Chdn.
Binh gii hieu qua gay x&dng him dudi blng h(
thdng nep vii nen. Tuyin tip cdng trinh nghlfti diu khoa hpc RHI^ 2006. Nha xuit bin Y hpc.
Y HOC VltT NAM THANG 6 • SO 1/2014 ANTHONY WOLFE S., STEPHAN BARKER,
Faaal fiat^res, Thfeme Medical publishers Inc., NewYork 1993.
ARDARY W C , Prmpectjve dinical evaluation of the ux of compression plates and saws in the
man^ement of mandlt}le fractures. J. Oral Maxillofec. Surg. 1989, 7 ( 1 1 ) : 1150-1153.
BAKER S.; WOLFE. SA., Facial fractures, Thiem Medical Publishers Inc., Newyork 1993.
K H A O S A T B A T THirONG NHIEM SAC THE TRONG HOI CHITNG LOAN SINH T O Y BANG K? THUAT NHUOM BANG G TAI BENH VIEN TRUYEN MAU HUYET HOC TP.HCM
T6MTAT
Khoing 50 - 60% b^nh nhan (BN) loan sinh tiiy (LST) c6 b i t thudng nhilm sic thS (NSli. Hien nay, k?
thu^t nhudm bing G phan tfch bp NST dang dupc sir dgng r$ng r i l trong cic phong xet nghiem di tnjy@n d l phit hl^n cic bat thirdng NST do g i i thinh re va phat lil^n dtrpc c i cic b i t thu'dng phu'c t^p. T^i b$nh vi^n TruySn MSu Huya Hpc, tir thing 1/2012 d i n thing 12/2013, vdi 35 trudng hpp 1.ST dupc nudi ciy, 31 BN nuii ciy thinh cdng (88,6%) cho thiy cd 12 tnrdng hpp o5 NST as binh thudng v i 19 tru'dng hop c6 bat thudng NST. Trong 19 BN cd b i t thudng NST thi 7 BN c i b i t thudng ddn ddc, 8 BN cd tir 2 b i t thu'dng NST tni lln v i 4 BN cd da bpl NST gan 3n. Kit qui cua nghiin diu glOp cic bic sT lam sing lu^ chpn hudng dilu tri ph6 hpp cho b|nh nhan.
SUMIVIARY
D E T E C n O N OF CHROMOSOMAL A B N O R M A L I T I E S I N MYELODYSPLASTIC
SYNDROME U S I N G G - B A N 6 D I N G AT BLOOD TRANSFUSION A N D HEMATOLOGY
HOSPITAL I N H O C H I M I N H CITY 50 - 60% of patients who are diagnosed as myelodysplastlc syndrome (MDS) are detected chromosomal abnomiaiities. Nowadays, G banding is used to analyse karyotypes because of low cost and capability to detect a large numtier of complex chromosomal abnomiaiities. At Blood TransfiJSlon and Hematology Hospital, from 1/2012 to 12/2013, 31/35 MDS cases whkh vrere cultured successfully (88.6%) showed that 12 cases were normal karyotypes and 19 cases had abnormal karyotypes. Of those 19 cases, 7
• Binh viin Tniyin miu Huyit hpc TP.HCM
"Oaihpc rDupC TP.HCM vi (Sim O&Sd Yte TP.HCM Phin Nin khoa hpc: PGS TrSn VSn Binh
Phan Thi Xinh*, Nguyen Tan Binh**
cases had single abnonnalities, 8 cases had more double abnonnalities and 4 cases appeared near- triploldy. These results helped medical doctors selecting suitable regimen for treatment.
L DAT V A N e l
Hpi chutig loan sinh hJy ( H O S T ) l i benh ly huyet hpc do rdi loan te b i o gdc tpo mau, d^c trutig b^l sir loan sinh trong tuy xddng, tao mau khdng hieu q u i g i y nen g l i m te bao mau va nguy cd cao phat trien thanh bach cau c i p ddng tiiy '^•'•''. Ty le m i c bpnh nay la 5 tru'dng hdp tren 100000 ngudi tren moi n i m ndi chung v i ty 1^ nay t i n g d ngt/di tren^eo tudi ™. H O S T thddng gap d ngu'di Idn tudi, benh jJien tien cd the keo d i l nhieu n i m va kill chuyen c i p bpnh thudng cd b'en lu'dng xau *^''''^'.
Khoing 50 - 6 0 % benh n h i n (BN) loan sinh hJy (LST) cd bat thudng nhiem s i c the (NST).
Cic bat thudng NST thudng l i bat thudng ddn ddc bao gom dei(5q), monosomy 7 h o i c del(7q), trisomy 8, v i del(20q)^^', tuy nhien v l n cd mpt sd tru'dng hdp cd bat thudng phi/c tap. Hien nay, cd nhieu ky t h u i t p h i t hien bat thu'dng NST nhu NST d d , lai tai cho p h i t huynh quang (F7SM), CGH (comparative genomic hybridization),., nhutig ky t h u i t nhupm b i n g G phan b'ch bd NST dang dddc sir dung rpng rai trong c i c phdng XN di truyen de p h i t hien cac bat thudng NST do gia thanh re va p h i t hien dddc c i c i c bat ttiudng phii'c tap.
TTieo cac he thdng phan nhdm tien lUdng quoc te (IPSS; Intemational prognosis scoring system) thi viec p h i t hien cac bat thu'dng NST gdp phan d i n h gia tien lu'dng b^nh, giup l u ^ chpn hu'dng dieu trj phii hdp cho b | n h n h i n ' ^ " . T?i benh vien Truyen Mau Huyet Hpc (BV.TMHH), tir n i m 2011 chung tdi d i Wen khai
