HOI CHAN THUONG CHJNH HINH VIET NAM - HOI NGHj KHOA HOC TOAN QUOC LAN T H U IX
DANH GIA KET QUA DIEU TRj HEP ONG SONG THAT LUNG DANG PHAU THUAT DAT DUNG CU LIEN GAI SAU (COFLEX) TAI DENH VIEN HUU NGHj VIET DliTC.
Nguyen Xuan Dien*, Nguyen Van Thaeh*
T O M T A T
Muc dich nghien cu'u: Danh gia ket qua lam sang ciia phau thuat dat dung cu lien gai sau (nep chi? U) trong hep dng sdng that lu'ng.
PhUtfng phap nghien cu\i: Nghien ciiU hdi ciiu du'dc lay tir 31 benh nhan da du'dc phau thuat vdi chan doan hep dng sdng that lutig cd hoac khdng phdi hdp vdi thoat vj dia dem cdt sdng that lUng tu' thang 03 nam 2007 den thang 09 nam 2009. Thdi gian theo doi h i 16 thang den 3 nam.
Chiing toi da danh gia ket qua lam sang bang thang diem VAS tru'dc md va sau md. Trieu chu'ng chii yeu la dau lu'ng, di khap khiing cd can nguyen than kinh va dau chan, thdi gian dau trung binh tu' 2 den 4 nam.
Ket qua: Nam la 12(38,7%), nCi 19 (61,3%). Tudi trung binh la (43,16±13,14), trong dd tre tud'i nhat la 26 tuoi, ldn nhat la 78 tudi.
Phau thuat giai ep va dat Coflex cho 31 benh nhan (48,38%) cd phdi hdp lay nhan thoat vj cho 16 benh nhan. Hau het benh nhan cd giam dau lu'ng rd ret (82,84%), giam dau chan la (80,12%), khong cd benh nhan nao cd bien chu'ng sau md. Thang diem VAS dau lu'ng tru'dc md trung binh la (8,45±0,624), sau m6(l,45± 1,338), dau chan tru'dc md(7,9±0,978) va sau md'(l,57±l,612).
Ban luan : Phau thuat giai ep va dat Coflex trong hep dng sdng that lu'ng vdi gidi ban thdi gian theo ddi ngan va dai sau md cho ket qua tdt. Benh nhan giam rd ret cac trieu chu'ng dau lu'ng va dau chan.
ABSTRACT ip-'';
Treatment result evaluation of lumbar spinal stenosis with interspinous U (Coflex) surgery in
Vietnamese-Germany friendship hospital.
Objective: Clinical result evaluation of LSS(
lumbar spinal stenosis) with decompression surgery and interspinous U. The preoperative patients have had leg pain and low/ back pain.
•Methods: A retrospective study was conducted for a consecutive series 31 patients with LSS between mars 2007 and September 2009. we included only the patients completed minimum 16 months follow evaluation. Mean time is 1.5 years. Clinical outcome is evaluated by visual analogue scale ( VAS) pre and postoperative.
Results: The patients in 12 males and 19 females, mean age is (43,16±13,14), the youngest patient is 26 years old, the oldest is 78. Microsurgical decompression surgery and use Coflex for 31 patients and co-operate disk herniation. Most of patients have relieved low back pain and leg pain (82.84%), relieved leg pain (80.12%). There is nobody who has complication after operation Preoperative lower bacl<
pain belong to VAS (8.45±0.624) and postoperative (1.45±1.338), The VAS of leg pain: Preoperative (7.9±0.978) and postoperative (1.57±1.612).
Conclusion: Microsurgical decompression surgery and use Coflex this demonstrates excellent short term and long term results for improvement in back pain, leg pain.
* Khoa Phdu thudt cot song •
** Benh vien Phoi TW
B$nh vien Viet Due
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I. OAT VAN OE
Hep dng sdng cd thi la hep bit ky vi tri nao cua dng sdng nhu dng sdng trung tam hoac hep ngach ben hoac Id lien hop. Nguyen nhan chu yeu ciia hep dng sdng la do thoai hoa cot sdng nhu thoai hda dia'dem, thoai hoa day chang, phi dai khdp, thudng gap nhit tir tudi trung nien din ngudi gia.
Trong dieu tri phau thuat benh ly hep 6ng song that lung phucmg phap cat cung sau giai ep da dugc sir dung tir lau. Tuy nhien, phuang phap nay cd the gay mat virng cdt song sau md va dac biet nhung trudng hgp ma BN bi mat viing cdt sdng hoac trugt ddt song va nhiing trudng hgp hep dng sdng nang thi phucmg phap giai ep rdng rai sau dd han xuong dugc coi la tieu chuan vang, nhung nd cung cd nhirng mat ban chi cua nd nhu khdp gia, thoai hda doan ke can ... Trong mot sd trudng hgp thi bien phap giai ep va han xuofng qua rdng, nhung neu giai ep cit toan bd cung sau thi cd the gay mat vimg cho BN. Chinh vi the nhimg dung cu cd dinh dong da lan lugt ra ddi.
Dimg cu lien gai sau Coflex la mdt trong so cac dung cu lien gai sau cd dinh ddng, do bac SI ngudi Phap Jacques Samani sang che ra vao nam 1994 va nd tiep tuc dugc su dung tir nam 1995 d My. Nep lien gai sau Coflex dugc sir dung dieu tri cho benh hep ong sdng that lung. Dung cu nay dugc thiet ke dac biet de lam vimg ma khdng ban xucmg d nhimg trudng hgp cd hoac khdng cd phi dai khdp va hep ngach ben dng sdng, hep Id lien hgp va hoac trugt ddt sdng mite do nhe.
Dung cu Coflex da dugc sir dung d BV Viet Due tir thang 3 nam 2007 cho d6n nay budc dau cho k6t qua tdt. Chimg tdi tien hanh dh tai nghien cuu nay nham danh gia ket qua dilu tri, hieu qua va tmh an toan cua diing cu nay.
II. 001 TUONG VA PHUdNG PHAP NGHIEN COU
2.1. Doi tirang nghiin ciru
Chung tdi nghien cuu hdi eim tir 31 benh nhan dugc chan doan la hep dng sdng that lung cd hoac khdng kem theo thoat vi dia dem va da dugc phau thuat dat dung cu lien gai sau tir thang 3 nam 2007 den thang 9 nam 2009 tai Benh vien hilu nghi Viet Dire.
2.2. Tiiu chudn chgn lira binh nhdn:
- Tat ca benh nhan chan doan hep dng sdng that limg, khdng cd trugt ddt sdng nang, dieu tri ndi khoa > 3 thang khdng kit qua.
Trong nghien eim nay tat ca benh nhan diu dugc phau thuat giai ep sau dd dat nep chii
"U" va benh nhan khdng cd md gi d viing cdt sdng that lung trudc dd.
2.3. Tiiu chudn loai trir
- Khdng lay vao nghien eim nhiing BN cd benh ndi khoa nang: suy gan, suy than, suy tim...
- Khdng lay vao nghien cuu benh ly hep dng sdng kem u tiiy sdng, nhiem trimg dng sdng.
Tat ca 31 benh nhan ciia chiing tdi da dugc kham lam sang, chup XQ thudng quy, chup XQ ddng va chup cdng hudng tir cdt sdng, dugc theo ddi 3 thang, 6 thang, 1 nam va hang nam sau md.
Cac thi md: Benh nhan nam sap, raeh da tucmg ling vi tri gai sau L4L5, bgc Id va cat day chang lien gai, giai ep rl hai ben va trung tam, bdc ldc rd cac re, kiem tra re d vi tri tuang ling Id lien hgp. Thir cd nep (d nghien cuu nay tat ca benh nhan deu dimg nep cd 12), dat nep, cd dinh nep vao gai sau, kiem tra trudc khi ddng vet md.
Hau phau bat ddng dai lung mem, ngay thii hai sau md cho benb nhan diing day tap di lai. Sau 5 ngay cho ra vien, nep lung dat trong vdng 3 den 4 tuan. Hen kham lai sau 1 thang, 3 thang, 6 thang, 12 thang.
:i',' UU
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HOI CHAN THUONG CHJNH HINH VIET NAM - HOI NGHI KHOA HOC TOAN QUOC LAN T H U I X
in.KETQUA -^
3.1. Dac diem chung .' .«
- Tudi trung bmh benh nhan (43,16 ± 13,14), tre nhat la 26 tudi, cao tudi nhat la 78 tudi.
- Gidi:
+ Nam 12 benh nhan (38,7%), nir 19 benh nhan (61,3%)
+ Gidi nil>nam, ty le nil/nam=l .58
- Nghi nghiep: lao ddng nang 18 (58.06%), lao ddng nhe 8 (25.80%), nghi huu 5(16.14%).
3.2. Dac diem
- Lam sang trudc md cd 29 (93,5%)) benh nhan dau lung, 7 benh nhan (22,6%)) dau chan, 31 benh nhan (100%) cd te chan
- Trong dd 7 benh nhan dau te chan phai, 7 benh nhan dau te chan trai, 17 benh nhan dau te ca hai chan.
- Tiln sir dau >12 thang trudc khi den vien la 30 benh nhan (96,8%).
- Dau kieu re L4 cd 6 benh nhan (19,4%), L5 cd 27 (87,1%) benh nhan, SI cd 1 (12,4%) benh nhan.
- Sd tang benh ly: 1 tang cd 24 (77,4%) benh nhan, 2 tang cd 7 (22,6%) benh nhan.
Tang L3L4 cd 3 benh nhan, L4L5 cd 31, L5S1 cd 4 benh nhan.
- Chiing tdi sir dung thang diem VAS de danh gia miic do dau lung va dau chan trudc va saumd. .
-I- VAS trudc md trung binh ciia dau lung: 8,45 ± 0,624
-I- VAS trung binh trudc md dau chan la:
7,9 ± 0,978
- Phuang phap md la giai ep: md cira sd xuang 2 ben (laminotomy), cat day chang tren va lien gai, sau dd dat nep chir "U", cd nep Coflex la 12mm.
- Theo thang diem VAS thu dugc tir ket qua ciia nghien ciiu nay sau md ddi vdi dau
lung (1.45 ± 1.338), ddi vdi dau chan (1.57 ± 1.612)
- Kit qua nay da chiing minh dugc giam dau lung din 82.84%) benh nhan, giam dau chan 80.12%.
- Chiing tdi khdng gap tai bien trong ml (raeh mang tuy, tdn thuang re, tdn thuang mach mau ldn hoac cac tang trong d bung).
IV. BAN LUAN
Benh hep dng sdng that lung dang ngay cang dugc chan doan tang len theo tudi, theo vien nghien eim tim mach Framingham thi co
\% nam gidi va 1.5% nil gidi d ranh gidi san sang mac benh hep dng sdng (tudi trung binh 54) va tang len 11% d nam, 25% d nir theo ddi tiep tuc 25 nam sau. Phau thuat dat dung cu lien gai sau trong hep dng sdng nham muc dich lam giam cac trieu chiing dau lung va dau chan cho benh nhan chii khdng phai chiia khdi hoan toan benh nay [1]. Cimg vdi sir xuat hien nhieu phuang tien chan doan ho trg nhu MRI thi benh hep dng ngay cang duac sang td, ve dieu tri ciing cd nhieu phuang phap nhu phau thuat giai ep, phau thuat giai ep va dat nep Coflex, nep ban ddng, Diam...
mdi phuang phap tren deu cd uu va nhugc diem rieng. Rieng phau thuat giai ep va dat coflex trong hep dng sdng that lung vdi thdi gian theo ddi gan 2 nam cho ket qua tot the hien d thang diem VAS la ban 80% giam dau lung va dau chan.
- Trong nghien ciiu ciia chiing tdi tuoi trung binh cua BN la 43 tudi. Day la do tuoi trung nien trong do tudi lao ddng, viec cho BN sdm trd ve vdi cugc sdng xa hdi la muc tieu quan trgng ciia phau thuat so vdi cac phau thuat liy thoat vi don thuan hoac giai ep don thuin. Nghien ciiu cua chiing tdi tuang ddng vdi nghien cuu cua Chen cho kit qua 172
Y HOC VIET NAM THANG 10 - SO 2/2010
tuoi trung binh BN 45 tudi [2]. Vl gidi ty le TAI nil > nam, phii hgp vdi nghien ciiu ciia tac 1.
giaAdeh[l]. ' ' ••
Ve ket qua iam sang phuang phap nay da chiing minh dugc giam rd ret cac trieu chiing lam sang nhu dau lung, dau chan, te chan (cac kit qua diu dat tren 80% theo thang 2.
dilm VAS), nhu vay vdi thdi diem trung binh gin 2 nam sau phlu thuat phuang phap dat nep lien gai sau coflex cho thay hieu qua
va an toan [4]. 3.
Trong nghien ciiu nay chiing tdi thay khong cd benh nhan nao cd bien chiing sau mo, ket qua kham lai va chup MRI, chup XQ deu cho ket qua tdt. Thdi gian md , lugng mau mat cua phuang phap cd sir dung dung 4.
cu Coflex it ban phuang phap md giai ep cd ghep xuang [3].
UEU THAM KHAO
Adeh D., Samani J., et al (2007) " Coflex interspinous Stabilization: Clinical and Radiographic Results from an international Multicenter Retrospective Study" Paradigm Spine Journal • Number 1/2007 • 1.
Chen, Y. H., D. Xu, et al. (2009). "[Coflex interspinous dynamic internal fixation for the treatment of degenerative lumbar spinal stenosis]." Zhongguo Gu Shang 22(12): 902-905.
Park, S. C , S. H. Yoon, et al. (2009).
"Minimum 2-year follow-up result of degenerative spinal stenosis treated with interspinous u (coflex)." J Korean Neurosurg Soc 46(4): 292-299.
Xu, D., Y. H. Chen, et al. (2009). "[A short- term follow-up results of lumbar disc herniation by Coflex]." Zhonghua Wai Ke Za Zhi 47(18): 1379-1382.
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