JOURNAL OF 108 - CLINICAL MEDICINE ANDPHARMACY Vol.12 - N»3/2017
Nghien cuu hinh anh thoai hoa cot s6ng thSt lirag tren phim chup X-quang so hoa
Research on degenerative lumbar spine of the patient taking Digital Radiography
TrSn Van Vi|t*, 'Trudng Dgi hgc Ky thuat Y te Hdi Duang Nguy£n Xuan Hien " Benh vien Bgch Mai
Tom tat
Muc tiiu: Md ta dac diem hinh dnh thoai hda cot sdng thdt lung cCia b i n h nhdn den chup X-quang sd hda tai Binh vien Da khoa Hda Binh. Bd/ tugng vd phuang phdp: Nghien cdu md td cat ngang, doi tupng nghiin cdu la tat ed b i n h nhdn den chup X-quang sd hda va ed hinh dnh thoai hda cdt sdng that lung tai Binh vien Da khoa Hda Blnh thang 12 nam 2015. Kit qud: Vj tri dot sdng thoai hda hay gap la L4 (29,15%). Cd 35,37% sd b i n h nhan cd 2 dot sdng bj thoai hda va so benh nhan cd 4 dot sdng bj thoai hda chiem 9,76%. Cdc dau hieu thoai hda cdt song that lUng: Hay gap nhdt Id gai xUong (98,78%), gap nhieu hinh dnh dac xuang dudi sun (76,83%). Vj trf gai xUOng thudng gap nhat Id d L4 (29,82%), it gap nhat la d LI (8,27%). Trong 36 b i n h nhan cd vdi hda day ehdng, vdi hda ddy chang dpc trudc gap nhieu nhat vdi ty l i 77,78%, it nhat la vdi hda day chdng dpc sau va vdi hda ddy chang vdng vdi ty l i 0%. Trong sd benh nhan bj bien ddi t u the cdt sdng that lung, sd benh nhan bi gidm dudng cong sinh ly cot sdng that lung gap nhieu nhat chiem ty le 24,39%, sd b i n h nhan bj veo cdt sdng that lung va gii cdt sdng that lUng It nhat cCing chiem 1,22%. Kit ludn: Hinh dnh thoai hda cot sdng that lung da dang phu thudc tdng giai doan thoai hda eCia b i n h nhdn.
Tdkhda: X-quang cot sdng thdt lung, thoai hda cdt sdng thdt lung, chup X-quang sd hda.
Summary
Objective: To research on lumbar spine degeneration of the patient taking Digital Radiography at Hoa Binh Hospital. Subject and method: Descriptive cross-sectional study, the subject was all patients taking Digital Radiography (DR) and having degenerative of lumbar spine at the Hoa Binh Hospital in December 2015. Result The main location of degeneration was at L4 (29.15%). There were 35.37% of patients with 2 degenerated vertebraes and 9.76% of patients with 4 degenerated vertebraes. The degenerative lumbar spine signs: The most common bond spurs was osteophytes (98.78%), subchondral sclerosis (76.83%). The main location of lumbar spine degeneration was at L4 (29.82%), the degenerative was sparsely located at LI (8.27%). Regarding 36 patients with calcified ligaments, the calcification ofthe anterior longitudinal ligament occurred commonly with the percentage of 77.78%, the lowest rate of calcification is the posterior longitudinal and plavum ligament with the percentage of 0%. For all the patients who have postural change of lumbar spine, the number of patients with reducing curve spine accounted for 24.39%. The rate of scolieosis and kyphosis was at least 1.22%. Conclusion: The degenerative lumbar spine images is various, depending on the stage of degeneration patients.
Keywords: L-spine X-ray, lumbar spine degeneration, DR.
Ngdy nhdn bdi: 04/01/2017, ngdy chdp nhdn ddng: 06/02/2017
Ngumphdn hoi- Trdn Vdn Viet, Email: lranvanviet201 [email protected] - Tmdng Dai hoc Ky thudt Yte Hdi Duong
TAP CHlYDUOC LAM SANG 101 Tap 12-So 3/2017
1. Dat va n di
Vai trd cda cdt sdng rat quan trpng ddi vdi eon ngudi, cdt sdng vUa Id tru cdt duy nhat cua co the vda la CO quan chda dung than kinh, cdt song ndi lien va dieu khii'n eac khdp xuang thdng qua he thdng ea bap, day chang, than kinh, tao nen khd nang van ddng va chuyen dpng linh hoat cho con ngudi [1].
Mpi boat ddng trong sinh hoat, lao ddng san xuat vd vui choi gidi tri deu lien quan den su van ddng eOa cdt sdng, ngay ea khi d trong trang thai tinh cdt sdng van phdi chju mot dp lUc cua trpng lue co the, t d dd cd rat nhieu yeu t d tdc ddng bat Ipi den cdt sdng, gay ra cac tinh trang b i n h ly ddi vdi cdt sdng [2]. Mdt trong sd dd la benh 1^ thoai hda cot sdng that lUng (CSTL). T r i i u chdng thoai hda ed the gap la dau cdng khdp, dau mdi l i ^ g , con dau man tinh keo ddi, tuy nhien cung cd nhdng ngUdi khdng cam thay bat ed con dau nao, do do dan den viec khi ngudi b i n h tim den bac sT tinh trang b i n h thudng d giai mudn, khd di^u tri dUt diem [3].
N g h i i n cdu benh ly thoai hda cot sdng that lung cd mdt y nghTa quan trpng bdi vi b i n h kha phd bien d mpi tang Idp nhan dan, eung la benh ly phd bien d Viet Nam eung nhU t r i n the gidi. H i i n nay, vdi su phdt trien eCia nen y hpc hien dai da xuat hien nhieu phUdng phap mdi chan dodn vd ddnh gid tinh trang b i n h ly thodi hda CSTL vdi do nhay va dp dac hieu cao nhU eat Idp vi tinh CSTL, cpng hUdng t d CSTL. Tuy nhien, ky thuat chup X-quang CSTL van ed gia tri cao trong c h i n doan b i n h thoai hda CSTL, dac b i i t t r i n phim chup sd hda cho dp phan gidi cao, rd net va cd the do duac eac t h d n g sd [8]. Vi vay, chung tdi nghien cdu de tdi: "Nghien cdu hinh dnh thoai hda cdt song thdt lung tren phim chup X- quang" nhdm muc t i i u Md td dac diim hinh anh thodi hda cot sdng thdt lung cua binh nhdn den chup X-quang so hda tai Benh viin Da khoa Hda Binh.
2. Ddi tuong va phUdng phap 2.l.06itUcmg
Gdm 82 benh nhan cd hlnh anh thodi hda cot sdng that lUng t r i n phim X-quang sd hda tai Benh vien Ba khoa Hda Binh thdng 12 ndm 2015.
2.2. Thiet ke
Tien hdnh n g h i i n cdu theo phuang phap n g h i i n cUu md ta cdt ngang.
2.3. PhUotng tiin
May chup X-quang DR tai Khoa Chan doan Hinh dnh - Benh vien Ba khoa Hda Binh, den doc phim, may dnh.
2.4. Phuang phdp phdn tich xCfly so lieu XU ly sd lieu theo phuang phap thdng ke y hpc.
3. Ket qud
3.1. Ty le mdc binh thodi hoa CSTL phdn bd theo gidi
Bang 1 . T^ le mSc b f nh thoai hda CSTL phan bo theo gidi Gidi
Nam NO
Tong
So benii nli3n 34 48 S2
T y l e % 41,46 58,54 100 Nhdn xit Trong t d n g sd 82 b i n h nhdn dUpc n g h i i n edu tU ngdy 01/12/2015 den 31/12/2015 tai Binh v i i n Ba khoa Hda Binh chiing tdi nhan thay: Ty le n d mac thoai hda CSTL nhieu hOn nam (nd chiem tj- l i 58,54%, nam chiem t? Ii41,46%).
3.2. Phan bS so dot song f/idt lUng (OSTL) bi thodi hda tren phim chup X-quang
Bdng 2. Phan bd sd DSTL bj thoai hoa tren phim chup X-quang So DSTL
Mot DSTL HaiBSTL BaBSTL Bon BSTL Nam DSTL T6ng
Sdb§nlinlian 10 29 26 8 9 82
TJIe%
12,20 35,37 31,70 9,76 10,97
100 Nhdn xit Trong tdng sd 82 benh nhan dugc nghien cdu, b i n h nhan thodi hda hai BSTL vd ba BSTL gap nhieu nhat, vdi X^ le tuang dng 35,37% va 31,70%. Benh nhan thoai hda mdt BSTL, bon BSTL, nam DSTL gap sd lUpng it, chiem ty le Ian luat Id 12,20%, 9,76%, 10,97%.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.l2-N°3/2017
3.3. Phdn bo thodi hoa dot song thSt lung theo
Bang 3. Phan bo thoai hoa DSTL theo vj tri
Vjtritlioai hoa CSTL LI L2 L3 L4 L5
Tong
So lucmg 18 32 57 65 51 223
T ^ l e % 8,07 14,35 25,56 29,15 22,87 100 NhdnxetlxowQ 82 benh nhan dupe nghien edu, thodi hda CSTL hay gap d cae vj t r i L3, L4, L5, vdi cae ty l i tuong dng 25,56%, 29,15%, 22,87%.
Thoai hda CSTL it gap d vj t r i L2 (14,35%), LI thoai hda vdi ty le thap nhdt 8,07%.
3.4. Cdc ddu hieu hinh anh thodi hoa CSTL tren phim X-quang
Bang 4. Cac dau hieu hinh anh thoai hoa CSTL tren phim X-quang Hinli dnh thoai hoa CSTL
tren phim X-quang Gai xuong Vol hoa day chang Dac XUdng dudi sun Xep dot s6ng thoai hoa Truut dot song thoai hoa Bien ddi t u the cot song
So benh nhan
81 32 63 11 9 22
T J I S % 98,78
39 76,83 13,42 10,98 26,83 NhdnxetTrong tdng sd 82 benh nhan thodi hda CSTL, hinh dnh gai xUOng gap nhi^u nhat vdi t^ le 98,78%. ft cac trudng hap xep ddt sdng thodi hda va trucft ddt sdng thoai hda vdi ty le tUOng iir\g la 13,42% va 10,98%.
3.5. Hinh anh gai xUcfng d6t song that lung tren phim X-quang
Bang 5. Hinh dnh gai xUong OSTL tren phim X-quang Gal xucng
LI U L3 L4 L5
Tong
Soluong IS 32 55 65 48 218
T J I e % 8,27 14,68 25,23 29,82 20,00 TOO Nhdn xit Trong 82 benh nhdn dupe nghien cUu, hinh dnh gai xuong DSTL L3 va L4 chiem t j l i cao vdi ty le 25,23% va 29,82%. Hlnh anh gai xuong BSTL LI chiem t y le ft nhat vdi ty le 8,27%.
3.6. Hinh dnh vol hoa cdc ddy chang tren phim X-quang
Bdng 6. Hinh dnh voi hda cac day chang t r i n phim X-quang
Vol hoa dSy chang Day chang dpc trudc Day chang dpc sau Day chang vang D l y chang tren gai
Tong
S6UMng 28
0 0 8 3S
T J I e % 77,78 0 0 22,22
100 Nhdn xet Trong 82 b i n h nhdn dupe nghien cUu, hinh dnh vdi hda day chang doe trUde gap nhieu nhat vdi Xy l i 77,78%, hinh dnh vdi hda day chang t r i n gai bat gap it vdi ty le 22,22%. Khdng gap trUdng h c ^ vdi hda day chang dpc sau vd vdi hda day chang vang.
3.7. Hinh dnh bien doi tU the cot sdng trin phim chup X-quang
Bdng 7. Hinh dnh bien ddi t u t h e cot sdng tren phim chup X-quang Bien ddi t u t h e
cot song GiSm do cong sinh ly Veo CSTL Gil CSTL
Sdb#nh nhdn
20 1 1
T J I c % 24,39
1,22 1,22 Nhdn xet Gidm dudng cong sinh ly CSTL chiem ty- l i 24,39%, veo CSTL chiem 1,22%, gij CSTL chlem 1,22%.
TAP CHf y DUOC LAM SANG 108 Tap 12-S6 3/2017
4. Ban luan
Trong nghien cdu cua chung tdi nhdn thay t^* l i thodi hda CSTL d nam chiem 41,46%, n d chiem 58,54%. !•)/ (e nay eung tUong duang vdi tac gid Kenneth C, vdi t ^ le benh nhdn n d va benh nhdn nam xap xi nhau d ed 2 nhdm (53,33% so vdi 46,67%) [7]. Su khac nhau ve ket qud nghien cdu cd the do cd mdu nghien cdu khac nhau, trong nhdm nghien cdu cda ehung tdi ed ed mdu nhd han tac gia Valal YP.
Trong t d n g sd 82 benh nhdn dupe n g h i i n cdu, benh nhan thoai hda hai BSTL va ba BSTL gap nhieu nhat. Thodi hda tai vj t r i L3, L4, L5 chiem ty l i cao vdi 25,6%, 29,15% va 22,87%. Ba ddt sdng L3, L4, L5 cd t j l i thoai hda eao do cdc ddt sdng nay nam d vung bdn le hoat ddng ehu yiu cua cot sdng, t h u d n g xuyen phdi chju dp luc trpng tdi cao nhat ke ed sU n i n ep edn ddi hoac khong can ddi, trong ed dieu kien tTnh va ddng. B d chinh Id ca sd cho su phat sinh thoai hda d ba ddt sdng nay [4].
Cac dau hieu thoai hda gai xuong, vdi hda ddy chdng, ddc xuang dudi sun, xep dot song thodi hda, trupt dot sdng thoai hda, bien ddi t u the cot sdng trong dd dau hieu gai xUang la hay gap nh^t vdi 98,78% trong cdc trudng hpp thoai hda CSTL duac nghien edu, vi t r i hay gap la gai xUang L I . Theo Nguyen V - Bdc [5] ed nhieu n g u y i n nhdn dan den hinh thdnh gai xUdng cdt sdng nen ty le gai xUong cung gap nhieu trong benh thoai hda CSTL.
Hinh dnh vdi hda gay chang dpc trUdc gap nhi^u nhat trong cae vdi hda ddy chdng tren phim X-quang vdi 77,8%. Khdng gap trudng hdp vdi hda ddy chang doe sau va vdi hda day chang vang. Theo Trdn Van Viet [6] ed the gap tuy rat hi^m hlnh dnh cdt hda day chang dpc sau. Sd khdc nhau ve ket qua nghiin cdu cd the do cd mau nghien cdu eua chung tdi chua dCi Idn di bdt gap trudng hdp vdi hda ddy chang dpc sau va day chang vdng.
Gidm do cong sinh ly hay gap nhdt trong eac bien ddi t u the cdt sdng vdi 24,39%. Rat it gap cdc trudng hpp thodi hda gdy gu cot sdng hay veo cot sdng. Bi^u nay chdng t d chat lupng qudn ly va cham
sdc cac trudng hpp b i n h nhdn bj thodi hda cdt song tdt len.
5. Ket luan
Bdc diem hinh dnh thodi hda CSTL da dang, vj tri hay gap nh^t la tai vj tri L4 (29,15%), vj tri it gap nhat la LI (8,07%). Sd lupng ddt sdng bj thoai hda t r i n mpt benh nhdn eao nhat la 2 dot sdng bj thoai hda (35,37%). Cac dau hieu thoai hda CSTL Hay gap nhat la gai xUong (98,78%). Vj tri gai xUOng thudng gap nhat la d L4 (29,82%), it gap nhat la d LI (8,27%). Vdi hda ddy chang dpc trude gap nhieu nhat trong sd cac benh nhan bj vdi hda day chang vdi ty le 77,78%.
Tai lieu tham khao
1. Le Trinh (2005) Dau cot sdng dogn thdt lung. Nha Xuat bdn Y hpc, tr. 7-16.
2 Hoang Ky, NguyM Duy Hue, Pham Minh Thdng (2007) Bdi gidng chdn dodn hinh dnh. Nha Xudt bdn Yhpe.
3. Nguyen Mai Hdng (2002) Thodi hod khdp vd cdt sdng. Tai lieu dao tao chuyen nganh ca - xUOng - khdp Binh v i i n Bach Mai, tr. 78-140.
4. Hd Vdn Ldc, Bao Thj Van Khanh (2007) Thodi khdp.
Giao trinh sau dai hoc Binh ca xuang khdp, tr. 48-54.
J. Nguyen Y - Ddc (1986) Binh gai cdt sdng vd cdch diiu tri. Nha Xuat bdn Y hpc, tr. 45-47.
6. Tran Vdn Viet (2015) Ky thudt chup cong hUdng td.
Nha Xuat ban Y hpc, tr. 205-224.
Kenneth CK (2009) Diagnosis and classification of osteoarthritis. Uptodate January 17:92-188.
8. Clifton OB (2007) Bone and Osteoarthritis. Novel Osteoarthritis Therapeutics 4:181 -264.
