TAP CHi Y HOC VlgT NAM T^P 459 • THANG 10 - SO 2 - 2017
KET QUA PHAU THUAT DIEU TRI GAY COT SONG LU-NG VA THAT LU-NG DO CHAN THlTaNG BANG NEP VIT DVaNG VAO LOI SAU TAI BENH VIEN QUAN Y 103
Hoang Thanh Tung*, Vo Van Nho**, Nguyen Hung Minh*
TOM TAT
Muc tieu: Oanh gia ket qua phau thuat gay cot song I'uhg va that luhg do chan thu'dng bang nep vit loi sau. Phu'dng phap: 89 benh nhan chan thu'dng cot song lutig va that lung dude phau thuat bang nep vft loi sau. Danh gia ket qua sau phau thuat 10 ngay va d I3n kham cuoi ciing (trung binh 14,47 thang) theo cac taeu chi ve nan chinh, phuc hoi than kjnh, phuc hdi lao dong. Ket qua va ket luan: Ket qua nan chinh: goc gii viing chain thu'dng loai gay liin nhom 1 la 6,6 ± 3,3° va d lan kham cuoi ciing la 7,8 ± 3,5°; nhom 2 i n lu'crt la 4,5 ± 3,2° va 5,4 ± 3,2". Loai gay v6 than dot nhieu manh nhdm 1 la 6,9 + 5,2° va 8,4 ± 5,1"; nhom 2 la 8,5 ± 7,7° va 9,8 ± 7,6°. Loai gay trat chi g^p nhom 1 (9,0± 1,0° va 10,8± 1,3°).
Giam chieu cao cot tru'dc than ddt gay liin nhdm 1 la 14,6 ± 1,5% va 17,3 ± 1,5%; nhom 2 la 15,7 ± 1,2%
va 18,0 ± 1,0%. Loai gay v8 than dot nhieu manh nhom 1 la 10,5 ± 2,4% va 12,4 + 2,5%; nhdm 2 la 10,2 ± 2,3% va 11,8 ± 2,4%. Loai gay trat chi gap nhom 1 (10,2 ± 3,1% va 13,2 ± 3,9%). Ket qua phuc hoi than kinh: ty le phuc hdi la 77,14% trong do phuc hoi it nhat hai dp Frankel chiem 37,14% va phuc hoi hoan toan chiem 48,57%. Mdc do phuc hdi lao dong:
do I la chii yeu (chiem 71,91%), do II (7,87%), do III (4,49%), do IV(3,37%) va do V (12,36%).
Titkhda: nan chinh, goc gii, cot song lu'ng va that lung, chan thddng
SUMMARY
RESULTS OF THORACOLUMBAR AND LUMBAR SPINAL INJURISES SURGERY BY PEDICLE
SCREWS FIXATION W I T H POSTERIOR APPROACH AT 103 MIUTARY HOSPITAL Objective: assessment the results of Sioracolumbar and lumbar spinal injuries surgery by pedicle screws fixabon with posterior approach.
Methods: 89 patients injuried thoracolumbar and lumbar spine have been surgery by pedicle screws fixation with posterior approach. Evaluation of results after 10 days of surgery and final examination (average 14.47 months) with criteria about correction, nerve restoration, labor recovery. Results and conclusions: Results of correction: local kyphosis angle (compression fracture has group 1; 6.6 ± 3.3 and final examination 7.8 ± 3.5°; group 2: 4.5± 3.2°
*H(3C vien Quan y
**Benh vien Ngoai than kinh qudc te ChjU trach nhiem chinh: Hoang Thanh Tiing Email: [email protected] Ngay nh|n bai: 11.8.2017 Ngay phan bien khoa hpc: 3.10.2017 Ngay duyet bai: 10.10.2017
and 5.4± 3.2°. Burst fracture has group 1: 6.9 ± 5.2°
and 8.4 ± 5.1°; group 2: 8.5 ± 7,7° and 9.8 ± 7.6".
Dislocation fracture has only group 1: 9.0 + l.O" and 10.8 ± 1.3°). Antenor veterbral body height loss (compression fracture has group 1: 14,6 ± 1.5% and 17.3 ± 1.5%; group 2: 15.7 ± 1.2% and 18.0 ± 1.0%.
Burst fracture has group 1: 10.5±2.4% and 12,4 ± 2.5%; group 2: 10.2±2.3% and 11.8 ±2.4%.
Dislocation fracture has only group 1: 10.2 ± 3.1%
and 13.2 ± 3.9%). Results of nerve restoration: rate of restoration 77.14% which recovers at least 2 Frankel grade 37.14% and complete restoration 48.57%, Labor recovery grade: grade I is the most commong (71.91%), grade II (7,87%), grade III (4.49%), grade IV(3.37%) and grade V (12.36%).
Key words: correction, local kyphosis angle, thoracolumbar and lumbar, spinal injury I. OAT VAN BE
Chan thddng cot sdng Idng va that Idng ta loai chan thddng thddng gap nhat trong chan thddng cot song chiem khoang 90%. Theo Mark S. Greenberg ty ie chan thddng doan cot sdng ban le Idng va that Idng ehiem 64%, trong do ty le khdng c d t o n thddng than kinh ehiem khoang 70% [1]. Dieu tri chan thddng cot sdng luYig va that Idng ngay cang ed nhii'ng tien bp vddt bac, nhat la phddng phap phau thuat loi sau cang trd nen pho bien va chiem du the. Nhd vao sd phat trien kT thuat vit chan eung eiia Royeamile va Margel, kT thuat giai ep loi sau cua Levin, phat hien ciia Denis ve sd de lien xddng trong gay v3 than song nhieu manh, vai trd eiia he thong day chang phia sau trong eau triic vu'ng eua cot song eiing sd phat trien manh me eiia trang thiet bi va dung cu phau thuat. Day la kl thuat khong qua ptiirc tap do vay thuan Idihdn trong uTng dung.
Hau phau nhe nhang, thdi gian dieu trj ngan va ehi phi dieu tn thap hdn cting la du viet ldn cua phddng phap phau thuat dddng vao loi sau so vdi dddng vao Idl trdde. Vi vay, chung toi thdc hien de tai nay vdi muc tieu danh gia ket qua phlu thuat dieu tri gay edt song idng va that Idng do chan thddng bang nep vit dddng vao ldi sau.
II. OOI UrONG VA PHUffNG PHAP NGHIEN COXJ 2.1 Ooi tu'dng nghien cu'u.
2.1.1 Tieu chui'n Ida chpn benh nhin - Benh nhan dddc chan doan xae djnh chan thddng cot song Idng va that lu^g mat vQ'ng va ddric phau thuat nan ehinh, co dinh, giai ep
VIETNAM MEDICAL JOURNAL N°2 • OCTOBER - 2017 bang nep vft Idi sau.
- Khdng phan biet gidi tinh, tudi > 18.
2.1.2 Tieu chui'n loai trd:
- Benh nhan ed cae benh man tfnh. Cd tdn thddng ket hdp nang kem theo. Ton thddng nghi ngd do ung thd, lao, rdi loan tam than. Benh nhan khdng hdp tac dieu trj, khdng tuan thii quy trinh theo doi tai kham sau phau thuat va khong ed day dii ho sd nghien cdu.
2.2 Phu'dng phap nghien cu'u.
2.2.1 Dja diem nghien cu'u: Khoa ngoai than kinh, Benh vien Quan y 103
2.2.2 Thdi gian nghien cu:u: t d 12/2010 den 1/2013.
2.2.3 Thiet ke nghien cii'u: tien cdu, cd can thiep.
2.2.4. Noi dung nghien cu'u:
- Thong tin ehung ve benh nhan: tuoi, gidi, nghe nghiep, loai tai nan, thdi gian t d liie tai nan den luc nhap vien.
- Danh gia ket qua phau tliuat sau 10 ngay va d lan kham cuoi eiing (sau mo dung binh 14,47 thang).
+ Danh gia phuc hoi than kinh theo phan loai ciia Frankel-Bradford [2]
B C
D D l D.!
Ui E
Mat hoan toan van dbnq+oin cam qiw-""
Sire ctJ 1/5 - 2/5 + con cam aiar Sii'c cd 3/5 va/hoac liet cd tron _ Su'c aJ 3/5 - 4/5 va/hcac rdi toan oltifilj Sire cd 4/5 va/hoac cd tron binh thutft^
Van dcng + ram gac va cdtron bWi thuMl + Danh gia ket qua nan chinh tren phim cf X-quang quy dde[3],[4]: Goc gii vung chin thddng va giam ehieu eao cot trdde than ddt.
+ Oanh gia mire do phuc hoi lao dong theo Denis [5]
Oo 1 2 3 4 5
H e u c h u i n danh gia i^
Quay lai cdng viec trdde day ^ Cd kha nang quay lai cong vieetrulScli
day nhdng han che ™ Khdng cd kha nang quay lai cdng viee nang
trdde day, lam dii gid vdi conq viec mdi Khdng the quay lai cdng viee cu , lam j viec khdng du gid va doi khi phai nghi i,
viec do dau Idnq '"'•
Mat kha nang lao donq hoan toan f
i \
\ :
0 6 A
Oac diem ton thu'dng Mat hoan toan van donq + cam giac
Thu thap va x d ly sd lieu theo thuat toettjf thdng ke y hoc (phan mem SPSS 16.0). ' ^>
III. KET QUA NGHIEN CCrU 3 . 1 . Ket qua gan Bang 1
.oai gay Gay liin Gay v3 than dot
Gay ciii cang Gay trat
Ket gua nan chinh bien dang sau phau thuat 10 ngay Bien dang
Nhdm 1 Nh6m2 Nhom 1 Nh6m2 Nhdm 1 Nhom 2 Nhom 1 Nhdm2
suat 6 11 37 30 0 0 5 0
Nho nhat a 2 2 2 2
8
|i 12 14 4 5
7
Ldn nhat a 10 10 19 33
10 16
P
18 15 15
15
Trung binh a 6,6 4,5 6,9 8,5
9,0 P 14,6 15,7 10,5 10,2
10,2
Do lech chuan a 3,3 3,2 3,2 7,7
1,0 P 1,5 1,2 1,2 2,3
3,1
^ *Nh6m 1: giai ep trde tiep hoac ton thddng day chang. Nhom 2: giai ep gian tiep.
- Loai gay liin:
+ Nhdm 1 CO gia tn a nhd nhat la 1°, Idn nhat 10°, trung binh 6,6° vdi dd lech chuan 3,3°; p nho nhat 12%, ldn nhat 16%, trung binh 14,6%
vdi dp lech chuan 1,5%.
+ Nliom 2 cd gia tri a nhd nhat 2", ldn nhat 10°, trung binh 4,5° vdi do lech ehuan 3,2°; p nho nhat 14%, Idn nhat 18%, trung binh 15,7%
vdi do lech ehuan 1,2%.
- Loai gay vd than sdng nhieu manh:
+ Nhdm 1 CO gia trj a nho nhat la 2°, Idn nhat
19", trung b nh 6,9° vdi dd lech chuan 5,2°; pnhi nhat 4%, ldn nhat 15%,' trung binh 10,5% vfii do lech ehuan 2,4%.
+ Nhdm 2 ed gia trla nhd nhat 2°, Idn nhit 33°, trung binh 8,5° vdi dd lech chuan 7,7°; p nho nhat 5%, ldn nhat 15%, trung binh 10,20%
vdi do lech chuan 2,3%.
- Loai gay trat:
+ Nhdm 1 cd gia tri a nhd nhat 8°, ldn nhat 10°, trung binh 9,0° vdi do lech chuan 1,0"; p nho nhat 7%, ldn nhat 15%, trung binh 10,2%
vdi dd lech chuan 3 , 1 % .
+ Nhdm 2 khdng ed trddng hdp nao.
Bang 2. Ket qui hoi phuc than kinh sau phau thuit 10 naiv Do Frankel -
Bradford 1 A
Sau mo 10 ngav
A I B I C 1 D l 1 D2 1 D3 I E
6 1 1 1 1 1 1
Tdng 6
TAP CHi Y HOC VlgT NAM T ^ P 459 - THAHG 10 - S 6 2 - 2017
Trircic mo
T B C Dl D2 D3 E
ong e
3
3 6
6 3
3 2
2 1 2 3 6
4 5 54 63
3 11
1 6 8 54 89
Chiing toi nhan thay trong tdng so 89 tru'dng hdp nghien cdu, trdde mo ed 54 trddng hdp Frankel E va 35 trddng hdp c6 ton thddng than kinh gom 6 Frankel A, 3 Frankel B, 11 Frankel C, 1 Frankel D l , 6 Frankel D2, 8 Frankel D3. Sau md 10 ngay da ed 63 tru'dng hdp Frankel E va 26 trddng hdp eon ton thudng than kinh gom 6 Frankel A, 3 Frankel B, 6 Frankel C, 3 Frankel D l , 2 Frankel D2, 6 Frankel D3.3.2. Ket qua xa
Loai gay Gay lijn Gay v3 than dot
Gay ciii canq Gay trat
Bien dang Nhom 1 Nhdm 2 Nhdm 1 Nhdm 2 Nhdm 1 Nhdm 2 Nhdm 1 Nhdm 2
Tan suat 5 11 37 30 0 0 5 0
N h o n a 3 3 3 3
9 l a t
15
P
1/
b
/
lU
Ldn nhat a 12 11 20 34
12 P 19 20 17 17
20
Trung binh a 7,8 5,4 8,4 9,8
10,8 P 17,3 18,0 12,4 11,8
13,2
Do iech chuan a 3,5 3,2 5,1 7,6
1,3 P 1,5 1,0 2,5 2,4
3,9 Khao sat tren phim chup xquang qui ddc sau
mo d lan kham cuoi eiing eua 89 trddng hdp da phau thuat trong mau nghien edu ehimg tdi nhan thay:
- Loai gay lim:
+ Nhdm led gia tri a nho nhat la 3°, ldn nhat 12°, trung binh 7,8° vdi dp lech ehuan 3,5°; p nhd nhat 15%, ldn nhat 19%, trung binh 17,3%
vdi do lech chuan 1,5%.
+ Nhdm 2 CO gia tri a nhd nhat 3°, tdn nhat 11°, trung binh 5,4° vdi do lech ehuan 3,2°; p nho nhat 17%,Jdn nhat 20%, trung binh 18%
vdi dp lech chuan 1,0%.
- Loai gay v3 than sdng nhieu manh:
Nhdm 1 ed gia tri a nhd nhat la 3°, Idn nhat 20°, trung binh 8,4° vdi do lech ehuan 5,1°; p nho nhat 5%, ldn nhat 17%, trung binh 12,4%
vdi dp lech ehuan 2,5%.
+ Nlidm 2 CO gia tn a nhd nhat 3°, ldn nhat 34°, trung binh 9,8° vdi do lech chuan 7,6°; p nhd nhat 7%, ldn nhat 17%, trung binh 11,8%
vdi dp lech ehuan 2,4%.
- Loai gay trat;
+ Nhdm 1 CO gia tri a nhd nhat 9°, ldn nhat 12°, trung binh 10,8° vdi do lech chuan 1,3°; p nhd nhat 10%,Jdn nhat 20%, trung binh 13,2%
vdi do lech ehuan 3,9%.
+ Nhdm 2 khong cd trddng hdp nao.
Bang 4. Kei gua hoi phuc than itinh dian kham cuoi cijng 0 6 Frankel -
Bradford
Tnfdc mo
T A B C D l D2 D3 E onq
Lan Kham cuoi cung A
4
4 B 2 2
4 C 1 2
3 D l
3
3 D2
2 D3
2 E
2 6
Tonq 6 3 11 6
Tru'dc mo cd 54 t r i / i n g hdp Frankei E va 35 tru'dng hdp cd tdn thu'dng than kinh gSm 6 Frankel A, 3 Frankel B, 11 Frankel C, 1 Frankel D l , 6 Frankel D2, 8 Frankel D3. Tai Bn kham sau ciing da cd 71 tru'dng hdp Frankel E va 18 trirdng hdp cdn td'n thu'dng than kinh gBm 4 Frankei A, 4 Frankel B, 3 Frankel C, 3 Frankel D l , 2 Frankel D2, 2 Frankel D3.
Kha nang lao dong D d i
f a n suat 64 Bo I I 1 / Bo I I I 1 4
T v l e C / o ) 71,91
7,87 4,49
OdlV BdV Tonq
3 11 89
3,37 12,36
100
Trong so 89 trddng hdp da phau thuat, kha nang phuc hoi lao ddng dp I chiem ciiu yeuVIETNAM MEDICAL JOURNAL N°2 - OCTOBER - 2017
(71,91%), do II (7,87%), dd III (4,49%), do IV (3,37%), dp V (12,36%).
IV. BAN L U A N
4 . 1 . Ket qua nan chinh: Ket qua^ bang 1 eho thay, trong tdng nhdm gay, sir nan ehinh bien dang gap goc viing chan thddng va duy tri ket qu^ nan chinh dat dddc sd on dinh trong gidi han giai phau va sinh ly, khac phuc dddc hi|n tu'dng gii tien trien sau phau thuat. Xet tren phddng dien nan chinh khoi phuc va duy tri chieu cao cot trdde than dot ehiing toi thu dddc ket qua ddi vdi loai gay liin nhdm 1 la 14,6 + 1,5% va 17,3 + 1,5%; nhdm 2 ia 15,7 ± 1,2% va 18,0 + 1,0%. Loai gay v3 than dot nhieu manh nhom 1 la 10,5 ± 2,4% va 12,4+ 2,5%; nhdm 2 la 10,2 ± 2,3% va 11,8 ± 2,4%. Loai gay trat nhom 1: 10,2 ± 3 , 1 % va 13,2 ± 3,9%. Nhd vay sd nan ehinh khoi phuc va duy tri chieujao cot trdde than dot sau mo dat hieu qua va on dinh.
Sd dl ehiing tdi dat dddc ket qua on djnh trong nan ehinh va duy tri eau triie vihig ben canh Ida chon cau hinh cd dinh lam vii'ng, edn do trong phau thuat ehiing toi ludn ehii trong bao tdn khdi khdp va he thong day chang phia sau dac biet la day chang tren gai.
4.2. Ket qua phuc hoi than ktnh: Chung tdi nhan thay sau mo 10 ngay khong cd trddng hdp nao nang hdn len va da ed 17 trong 35 tru'dng hdp tdn thddng than kinh phuc hoi it nhat mot dp Frankel chiem 48,57% trong do ed 12 trddng hdp hoi phuc ddric hai do Frankel hoac hoi phuc hoan toan chiem 34,29%. Day la mot yeu to tien lu'dng mang y nghTa kha quan chdng td bdde dau phddng phap phau thuat da mang lai hieu qua, gdp phan loai bd dddc nguy ed ton thiidng than Idnh thir phat va tao dieu kien thuan Idl cho thddng tdn than kinh hdi phuc.
t a i lan kham cuoi cimg tir thang thir 12 sau md trd di chiing tdi nhan thay sd phuc hoi than kinh la r a t r o ret va dang ghi nhan. So sanh vdi mdc dp tdn thu'dng than kinh trdde phau thuat da eho thay sd khac biet ro ret cd y nghla. Dieu nay noi len sii'c cd ban dau ngay sau chan Uiddng cd y nghta va vai tro quan trong trong tien Iddng cung nhd phuc hoi thu'dng ton than kinh. Tuy nhien, viec phuc hoi sde ed va cam giac cung la mot tin hieu kha quan trong qua trinh phuc hdi than kinti sau p h l u thuat trong tddng lai doi vdi trddng hdp nay. Dieu nay dat ra van de quan trgng^an nghien ciru eac giai phap trong tddng lai nham phdi hdp dieu tri va ho trd cho qua trinh phue hoi than kinh sau phau thuat nhiihg tru'dng hdp cd ton thddng than kinh nang ne (Frankel A, B) de dat ddric hieu qua tdi du nliat.
Nhu" vay sd phue hoi than kinh phu thuoc vao mdc dp ton thu'dng than_kinh ban dau ngay sau chan thddng nhu'ng phau thuat nan chinh, co dinh va giai ep giup cud vdt nhOdg phan than kinh chda tdn thddng hoac tdn thu'dng cliife hoan toan tao dieu kien thuan ldi cho qua trinh hoi phuc dat dddc hieu qua cao [7]. Sd phuc hBi nay mang y nghTa vd eiing to ldn khong chi tra lai cupc sdng, su'c lao dpng cho ngddi benh va xa hpi ma edn khang dinh phau thuat la phu'dng phap dieu trj toi du va la hu'dng dl dung dan trong nghien eiru dieu trj chan thu'dng cot song noi chung.
4.3. Ket qua phuc hoi lao dpng: Phuc hoi kha nang lao dpng la mot muc tieu ed b^n va quan trpng can dat den trong phau thuat chan thddng cot song nham khac phuc, ban che dl chirng va phue hoi sde lao dpng cho ngddi benh noi rieng va toan xa hgi ndi chung. Chiing toi danh g\asd phuc hoi kha nang lao dpng theo thang diem eiia Denis. Ket qua nghien cifli cho thay sd benh nhan trd lai cong viec lao dong la 87,64% trong do so trd lai eong viee nhd tru'dc la 71,91%. So mat hoan toan kha nang lao dong chiem 12,36%, day la nhii'ng benh nhan d dp V.
Nhd vay ehimg toi nhan thay ket qua ciia chiing tdi la tddng du'dng vdi cac tac gia trong ciing thdi gian theo doi, dieu nay chirng to ket qua lam vu'ng va Hen xddng sau phau thuat la kha quan va cho ket qua tdt. Tuy nhien so tru'dng hdp mat kha nang lao dong con cao hdn so vcli mdt sd tac gia. Nguyen nhan la bdi vi trong nghien cdu eiia chung tdi cd 22,47% ^ n thddng than kinh nang (Frankel A, B, C) tru'dc phau thuat va d lan kham eudi eiing con 12,36% ton thu'dng than kinh d mdc nay.
V. KET L U A N
- Ket qua nan ehinh: gap gde viing chan thu'dng loai gay liin nhdm 1 la 6,6 ± 3,3° va d lan kham cuoi ciing la 7,8 ± 3,5°; nhdm 2 lan Iddt la 4,5 ± 3,2° va 5,4 ± 3,2°. Loai qay vd than dot nhieu manh nhdm 1 la 6,9 ± 5,2° va 8,4 ± 5,1°; nhom 2 la 8,5 + 7,7° va 9,8 ± 7,6°. Loai gay dat chi gSp nhdm 1 (9,0 ± 1,0° va 10,8 + 1,3°). Giam ehieu cao cot trdde than dot gay lun nhom 1 la 14,6 ± 1,5%
va 17,3 ± 1,5%; nhdm 2 la 15,7 ± 1,2% va 18,01 1,0%. Loai gay v3 than dot nhieu manh nhom 1 la 10,5 ± 2,4% va 12,4 ± 2,5%; nhom 2 la 10,2 ± 2,3% va 11,8 + 2,4%. Loai gay b^t chi gap nhom 1 (10,2 ± 3 , 1 % va 13,2 ± 3,9%).
- Ket qua phue hoi than kinh: t / le phuc hoi la 77,14% trong dd phue hoi it nhat hai dp Frankel ehiem 37,14% va phuc hoi hoan toan diiem 48,57%.
TAP CHi Y HOC VIJT NAM TAP 459 - THANG 10 - SO 2 - 2017 - Mire dp phuc hoi lao ddng: do I la chii yeu
(chiem 71,91%), do I I (7,87%), dd I I I (4,49%), do IV (3,37%) va dp V (12,36%).
TAI LIEU T H A M KHAO
1. Mark S.Greenberg (2010), Spine injuries, Handbook of Neurosurgery, sevenOi edition, Thiem Medical Publisher New Yori<, New York, pp 930-1002.
2. Hiromi Ataka, Takaaki Tanno, Masashi Yamazaki (2009), "Postenor intrusmented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteporotie thoracolumbar spine", Eur Spine J, 18, pp 69-76.
3 Andrzej Kaminski, Ernst Josef Muiler, Stefan Hankemeier, Gert Muhr (2003), ''Low Lumbar Spine Fracture-Results of Posterior Internal Fixation and Transpedicular Bone Grafting", European Journal of Trauma, 29, pp 23-30.
4. Benjamin Ulmar, Alexander Brunner, Markus Guhring, Traude Schmalzle, Kuno Weise, Andreas Badke (2010); "Inter - and intraobserver reliability of the vertebral, local and segmental kyphosis in 120 traumatic lumbar and thoracic burst fracture:
evaluation in lateral X-rays and sagitall computed tomographies", Eur Spine J, 19, pp 558-566.
5. Jen-Chung Liao, Kuo-Fon Fan (2017),
"Postenor short-segment fixation in thoracolumbar unstable burst fractures - Transpedicular grafting or six-screw construct". Clinical Neurology and Neurosurgery, 153, pp 56-63.
6. Bulent Ozdemir, Ayhan Kanat (2017), Restoraton of Anterior Vertebral Height by Short-Segment Pedide Screw Fixation with Screwing of Fractured Vertebra for the Treatment of Unstable Thoracolumbar", W/orld Neurosurgery, 99, pp 409-417.
7. Srivastava R.N., Raj S. (2012) "Motor segmental recovery in spinal cord injury a blessing in disguise", BSS, spineweek, pp. 65.
DAC DIEM LAM SANG/CAN LAM SANG VA GIA TRI CUA THANG DIEM SCAP TRONG PHAN TANG NGUY Ca BENH NHAN
VIEM PHOI CONG DONG TAI BENH VIEN BACH MAI
TOM TAT
De danh gia cac dac diem lam sang, can lam sang va irng dung thang diem SCAP trong tien liTOng benli nhan viem phoi mac phai cong dong, chiing toi thu'c hien nghien ciru tren 146 benh nhan da du'dc chan doan xac dmh viem phoi mae phai cong dong tai benh viei Bach Mai txT 01/2014 6en 12/2016. Ket qua cho thay cac trieu chirtig Oiirdng gap ciia tienh nhan VPMPCO la kho thd (88.4%)^, ho (67.1%), sot (63.7%^. Diem S«P can^ cao ty le benh nhan nhap ICU, thd may, soc nhiem khuan, tir vong cang tang (p<0.01).
Tdkhda: viem phoi cong dong, SCAP SUMMARY
CHARACTERISnCOF CLINICAL/PARACUNICAL AND THE VALUE OF
THE SCAP SCALE I N STRATIFICA'nON FOR PATIENTS WITH COMMUNITY - ACQUIRED
PNEUMONIA I N BACH MAI HOSPITAL To shjdy dinical, paraclinical characteristics and apply SCAP score for patjents diagnosed community acquired pneumonia (CAP), sample size of the study was 146 patients hospitalized at Bach Mai hospital 'Benh vien Quan Y105 - Tong cue Hau Can
^Benh vien Bach Mai
Chiu trach nhiem chinh: Le Hal song Ha Email: [email protected] Ngay nhan bai: 12,7.2017 Ngay phan bien khoa hgc: 28.9.2017 Ngay duyet bai: 4.10.2017
Le Hai Song Ha , Nguyin Van Chi^
Tr4n Huu Thong^, Nguyen Dat Anh^
from January 2014 to December 2016. The main of study showed that, the most common symtoms of CAP were dyspnea feeling (88.4%), cough (67.1%), fever (63.7%), The higher the SCAP score was, the higher the incidence of ICU admission, mechanical ventilation, sepsis, and mortality were.
Keywords: community acquired pneumonia, SCAP I. DAT VAN OE
Viem phoi mac phai cf cong dong (VPMPCO) bao gom cae nhiem khuan phoi xay ra cf ngoaL benh vien, bieu hien bang viem phoi thiiy, viem phoi dom, hoac viem phoi khong dien hinh. Tae nhan gay viem phoi eo the la eac vl khuan, virus, niim nhu'ng khong phai do tru'c khuan lao. Tren the gidi viem phoi mac phai epng dong van la benh ly nang va thu'dng gap, dac biet la d ngu'di cao tuoi, ty le mac cf moi quoc gia khac nhau va tan suat mac d tuoi tir 65 - > 85 la 18,2 - 52,3/1000 dan moi nam [1]. Tai My, viem phoi (Jimg hang thir 6 trong so cae can nguyen gay tir vong va la nguyen nhan tir vong so 1 trong so cac benh truyen nhiem, hang nam co khoang 5,6 tritu tru'dng hop mac va co hOn 1,1 trieu tru'dng hcfp phai nhap vien, khoang 10% trong so nay tien trien thanh viem phoi mae phai eong dong nang can dieu trj tai khoa hoi sire tich eire.
Nhii'ng benh nhan ngoai trii ed ty le tir vong thap tir 1 - 5%, trong khi d benh nhan noi trii trung
