Y Hpc VI^T NAM THANG B - stf flAC 6161/2012
Hllu QUA sur DUNG T I BAO GOC TUY XUUNG JlflHiH TRONG DIEU TRI M O T SO TON THUITNG XUDNG KHAP KHD H 6 | PHyC
NguySn Thanh Binh*, NguySn Thj Thu Hk\ Lf Tuin Khki\
Bko Xufin Tfch", Dfi Ti^n Dflng*, L6 H^ng HAi*, NguySn M^nh KhAnh***
T 6 M T ^ T :
Sir dgng t6 bdo gAc tOy xu-cng diftu tri mOt s6 t6n thirang xirong khdp e& du-p-c nghidn ci>u Mnh cdng trdn thd gidi. 0 Vi$t Nam, vdn dd ndy bit ddu difTC quan tdm nghidn ci>u. Myc tl$u ttghiSn c&u: ddnh gid l<dt qud didu trj khdp gid than xir(7ng ddi, khuydt hdng xuvng sau kdo ddi chi vd hogi tir vfi khuSn chdm xirang dCii bdng ghSp td bdo gdc tOy xt/ang tvr thdn vd xdc djnh mdi lidn quan giOa sd lu^ng td bdo gdc du-^c glidp vdi hidu qud ^du trj. {>6l tti^ng nghl6n c&u: 133 bdnh nhdn chia Uidnh 3 nh6m: nh6m I gdm 73 bdnh nhdn khdp gid thdn xu-ang ddi;
nh6m II gdm 30 bdnh nhdn tdm v6c thdp vd mdt Co^n xirong kdo ddi chi theo nguydn ly llizarov hdt giai do^n cdng ddn; nhdm III gdm 30 b$nh nhdn ho9i tO vfi khudn chdm xu'ang dCii giai dogn IJI (theo ARCO). Phuvng phip nghl6n cOv:
Ithdi td bdo gdc ti/ thdn cd thd tich 20-30 ml du'pc chidt tdch tCr 250-350 djch hiit tuy xu'ang vd fJifCfc fdm trvc tidp vdo vi tri tdn thu-ang. Ket qui: nh6m I cd 85,7% bdnh nhdn dat du-dc lidn ' wrong, cdc bdnh nhdn lidn xuwng nhdn du'Q'c ' nhiiu td bdo gdc tmng md hen so vdi cac bdnh nhdn khflng dgt du'Q'c lidn xu'crng; nhdm II cd thdi gian lidn xuwng trung bInh cho 1 cm kdo ddi Id 32,1 ± 5,9 ngdy; nhdm III cd 80 % bdnh nhdn dgt
^k qua didu trj t£r khd ddn tdt (theo thang didm Harris), cdc bdnh nhdn dgt kdt qud didu trj ti> khd ,flln tdt du'Q'c ghdp sd lu-gng td bdo gdc tnjng mO cao hen c6 $ nghTa so vdi nhdm dgt kdt qud didu tri trung binh vd kdm. Ket lu$n: td bdo gdc tuy xircng tM" thdn cd thd du'Q'c sO dgng mOt cdch lii$u q\ik vd an todn trong didu trj mdt sd tdn thirang xu-ong khdp khd hdi phyc.
T£F khda: ti bko g6c tOy xifong. iihOp gik.
k6o dki chi, hom tO? vO khuin chdm xifong <JOi ABSTRACT:
THE EFFECT OF AUTOLOGOUS BONE MARROW STEM CELLS IN TREATMENT OF SOME BONE AND JOINT DISEASES
Using bone marrow stem cell in treatment of bone and joint diseases has been Interested to resean:h. Objectives: evaluate Uie effect of using autologous bone marrovi/ stem cell in treatment of nonunion of long bone, bone defect caused by distraction osteogenesis and aseptic osteonecrosis of the femoral head and determine the relationship between the number of stem cells which were grafted and the clinical outcome.
Subjects: 133 patients were divided in to 3 groups: group I included 73 patients with nonunion of long bone, group II included 30 patient with short stature and in limb length discrepancy that were lengthened by llizarov's piinciple; gnsup III include 30 patients with aseptic osteonecrosis of the femoral head.
Methods: 20-30 milliliters of bone marrow stem cell mass were created from 250-350 milliliters of aspirated bone marrow fluid then injected in to sites of bone lesion. Results: in group I, 85.6%
patient achieved bone union; in group II, the average bone healing time for 1 centimeter of length was 32,1 i 5,9 days; in group III, 80%
patients had good outcome. There was relationship between the numbers of stem cell grafted and the clinical outcome in group I and II.
Conclusions: bone marrow grafting was a safe and effective method in treatment of some bone
Key words: bone marrow stem cell, nonunion, distraction osteogenesis, aseptic osteonecrosis of the femoral head.
B$nh vi$n Tl/QD 108. '* Truing D$i hpc Y Hk N0i, * ' B$nh vi$n Vi$t DOc
551
C H U Y £ N Bi: Hpl NOH| KHOA HQC HUVe'T HQC • TRUYgN M A U T O A N QUtfc 2012
I,OATVXND£:
b ea thi truimg tliAnh tily xuong chiia nhiiu lo(ii ti bio g6c (TBG) IchSc nhau nhu TBG tfio m4u, TBG trung mfl, ti bio tiin thSn nJi m(ic,,,,NhOng TBG niy c6 tk nhiiu tiim ning Ichic nhau, dui^e i>ng dvng trong nhttng liju phip diiu trj dva trSn co sdr ti bio, die bi(t li nhOng phuong phip diiu trj sila chtta, tii tao t i chile. SCr dvmg TBG oila hiy xuong trong diiu tri nhttng t6n thuong xuong, khdp nhu khdtp gii cic thin xuong dii, mdt doan xucmg, hoai tit vfl khuin chflm xuomg dCli,... cttng li mflt trong nhttng ihig dyng thuflc loai niy, di du^c mflt si tic gii tr£n thi gidri nghiin cihi trong mflt vii nim g ^ diy vi bu6c diu di thu dugic nhitng kit quidiyhiitah«n[4],[6],[8],
fl Vi^t Nam, tft nim 2007 nhflm nghiSn cuu cila chung tfli g6m cic bic si chuy£n khoa Huyit h(?c vi chuySn khoa Chin thucmg chinh hinh di nghidn cftu ip dyng phucmg phip sft dvmg TBG tfty xuong tvr than trong diiu trj mflt s6 tin thuong xuong khdp khfl hii phyc nhu khdp gii (KG) thin xucmg dii, khuyit hong xuong (KHX) do k6o dii chi, hoai tft vfl khuin chflm xuong dui (CXD). Trong phuang phip diiu trj niy djch tuy xuong dugc chpc hut tft xuong chju, sau dfl tich lay thanh phan te bio don nhin (giiu ti bio goc) vi gh6p vio vj tti tin thuong xuong. Day li nhttng ky thujit lin diu ip dving tai Vi?t Nam, do d6 chiing tfli nghien cftu di tii niy v6i mvic tiSu dinh gii kit qui diiu trj KG than xuong dii, KHX sau keo dii chi vi hoai tft vfl khuin CXD bing ghip TBG tuy xuong tv than vi xic djnh mii lien quan gitta so lugmg TBG dugrc ghip vdi hi?u qua diiu ttj.
II. 061 TUpNG VA PHUONG PHAP NGHIEN COU:
2.1, Doi tygng nghien cuii
Gim 133 b?nh nhin (BN) tuoi tnring thinh (104 nam, 29 ntt) cfl cic ton thuong xuong khdp dugrc diiu trj bing ghip TBG tfty xuong tv thin t^i V i ^ Chan thuong Chinh hlnh - Binh v i ^ Trung Uomg ()uln d$i 108 vi Khoa Chin thuong Chinh hinh - Binh viin Viit Dftc tft 01/2008 - 03/2011, chia thinh 3 nhflm:
- Nhflm 1:73 binh nhin KG than xuong did - Nhdm II: 30 binh nhin KHX (15 BN tim vdc thip, IS BN mit doan chi dudi > 3 cm) diiu trj kio dii chi theo nguyin ii llizarov hit giai d o ^ cing din.
Nhflm III: 30 BN ho^ tft vfl khuin CXD giai do?n I, II (theo ARCO [3]).
2.2. Phinnig p U p nghiin ciru Z2.L Thiit iJnghUn ciht: Ttin ciu, can thifp Um sing dl ngung cd theo idl dpc
2.2.2. Cic kf thuit sir dtfng trong nghiin cuu:
Qui trinh diiu trj chiing tfli ip dyng dieo kJ) thu$t cua Hemigou [S], [6]: tiin hinh chpc hut 250 ml djch tuy xuong tft xuong mio ch$u, tich chiit cfl d$c di thu dugc 30 ml khii TBG, sau dd tiin hinh ghip khii TBG niy vio vj td ton thucmg. Vdi 250 ml djch tuy xucmg d u ^ hut ra, sau khi tach chiit cfl die khoi TBG si chfta trung binh 51000 TBG trung mfl. Cic ky thuat cu thi nhu sau:
- Xit nghiflm t i bio miu vi tfty xuong:
sft dyng miy dim t i bio tu dgng CD1800 (Abbott- Hoa Ky) vi phuong phip ti bao hgc
kinh diin. „ - T(io khoi TBG tft djch hftt tfty xuong: 1 ^
BN dui?c chgc hut thu gom 250-350 ml djch tiiy xuong tft hai mio chau sau. Khoi TWJ isnf^
tich bing phuong pli^ ly tim gradient tytrpng sft dung dung djch Ficoll (p=l,077) hole miy tich te bao tv dflng CONflEC (CHLB Bic), huyin djch bing nude muoi sinh ly di ci the tich cufli cung la 30 ml.
Y HQC VigT NAM THANO 6 • S 6 CAC BISTOOI 2
- Xic djnh thinh phin TBG t?o miu CD34*: sft dvmg phucmg phip ti bio dflng chay theo hudmg din cfta ISHAGE [9]. Kit qui dugrc tinh bing tjr li phin trim vi ting si ti bio CD34+ trong 30 ml khii TBG (JCD34+).
- Xic djnh TBG trung mfl bing ky thujt nu6i cay cvim nguyin bio spi CFU-F (Colony forming unit - Fibroblast) vdi moi tmdng nufli ciy cfta Stem cell technologies (Canada). Kit qui dupe tinh bing si lugng CFU-F mpc khi nufli ciy lO' ti bio cd nhin ciia khii TBG [hay cfln gpi li hiiu qui tao cym - colony foiming efficiency (CFE)] vi ting si lupng CFU-F ttong 30 ml khii TBG (JTFU-F).
- Ky thuit tiim TBG tfty xuomg vio i KG va fl cing din: Khii TBG tfty xuong
dupe ghip qua da vio i KG t(ii phdng mi vfl ttilng, cd ttp giftp eia Xquang ting sing vi C-arm.
Dinh gii kit qui sau ghip tft 6 thing trd lin dvra ttin khim lim sing vi hinh inh trin phim X quang.
- Ky thuit tiim TBG vio chflm xuong dfti hoai tft: Khii TBG ttiy xuong dupe ghip vio vj tri i ho?i tft CXD qua dudng khoan giim ip tai phdng mi vfl trftng, cfl ttp giftp cfta Xquang ting sing vi C - arm.
Dinh gii kit qui theo thang diim Harris tai cic thdi diim sau ghip I thing, 3 thing, 6 thing, I nim, nhttng nim sau mii nim I lin.
2.Z3. Xir /J> si llfu: Si liiu dupe xft ii bing cic thuat toan thing ki vdi phin mim SPSS 18.0.
III. KET QuA NGHllN COU:
3.1. Kit qua xic djnh cic thinh phin ciia khii TBG
Bing 1. Tlianh phan TBG tao mau va TBG trung mfl trong khfli TBG
Chi sfl Nh£m I (n=73)
IxtSD)
Nhdm II (n=30) (X ± SD)
Nhdm III (n=30) (X±SD) TyliTBCD34W(%)
'tBCD34(-H/1ml(x10°)
1,23 ±0,66 1.03 ±0,64
0,56 ± 0,32
TingSLTBCD34(-t-)(x10°) 16,37 ± 8,62 13,71 ±11,48
CFU-F/10°TB 67,96±29,34' 57,32 ± 32,55 47,24±20,26C)
N6ng de CFU-F/ml 2214,44 ±1490,25' 1831,34 ±1243,43 1232,75 ± 699,65' T6ng SL CFU-F trong khfli TBG
70,57±51,88* 48,56 ±30,9"
r "<0,05
Nhfn xit: Cac chi so dinh gia thinh phan TBG tao mau ttong khfli TBG la Wong ty nhau giiia 3 nhdm BN. Hiiu qui tao cum CFU-F ttin 10' te bio eua khii TBG, ning dg ti bao cd kha ning tao cum CFU-F ttong 1 ml va ting so lupng ti bio cd kha ning tao cym CFU-F tiong khii TBG cua nhdm I cao hon cd y nghia thing ke so vdi nhdm III (p<0,05), gitta cac nhom con lai sy khac biit khflng ed y nghia thong ke (p>0,05).
3.2. Kit qua liin xuomg ciia nhdm KG thin xirong dii (nhdm I):
Co 63/73 (86,3%) BN dupe danh gii kit qua vdi thdi gian theo doi ttraig binh 18 thing (5
;,-39f
CHUYSN B6: HQI NQHI KHOA HQC HUY^T HQC • TRUYDN MAU TOAN outfc 2012 Bing 2. Ti if liin xuong vi thdri gian liin xuong trin phim X quang
Vj trI KG Cing chin (n=38) OOI(n=rie) Cinh tay(n=2) Cing tay (n:5) Tit c i (n=63)
Liin xurvng n 33 IS 1 S 64
%
86,8 83.3 50 100 S8,7
Thdl gian LX (XlSD)(tuin)
21,4±10,1 16,4 ±4,3 12,0 22.2 ± 13,6
ie,9±9,3
Khflng liin n 5 3 1 0 9
%
13.2 16,7 50
0
»fi^
Nhfn xit: Ti if dat liin xuong cfta tit ci cic BN li 85,7% (54/63 binh nhin). Thdi gian liin xuong tiin phim X quang cia tit ci cic BN li 19,9 ± 9,3 tuin; cd 9/63 BN khflng liin xuong, chiim t^ li 14,3%.
Bing 3. Liin quan gitta si Iupng TBG dupe ghip vdi kit qui diiu trj liin xuomg
Chili SLTBCD34(+)/ml (xlO") T4ngSLTBC034(+) (xlO'i SLTB tao cym CFU-F/ml Tflng SLTB tao cum CFU-F (x10°)
Lidn xuvmg (ne54) ( X l SO) 0,57 ± 0,32 16,99 ±8,42 2397,16±1434,99 79,59 ±54.16
Khflng liin (n=9) (X ± SD) 0,56 ± 0,39 16.90 ±11,66 1026,67±1001,17 31.04 ±29,74
P
>0.05
>0,05
<0,05
<0,05 Nhfn xil: (!) nhflm BN d^t dupe lien xuong, cie thinh phin cua khii TBG ghip vio vj tri tin thuong nhu nong dg ti bio CD34(+)/ml, ting si lupng ti bio CD34(+) ttromg ty d nhiSm BN khflng dat dupe liin xuong, nhung ning dfl TB tao cym CFU-F vi ting si lupng TB tao cym CFU-F eao hon cfl i nghia thing ki (p <0,05),
33. Kit qui liin xuvng ciia nhdm khuyit hing xinmg sau kio dii chi (nhim II) - Kit qui liin xuomg dugrc dinh gii trin 37 i kit xuong cing din (cfta 14 BN kio dii cM vi 11 BN kit xuong hai i ) di liin xuong
Bing 4. Thdi gian lien xuong /1 cm kio dii xuong Nhdm BN
Nhdm kdo dii ohi (n=26) Nhdm kk xu'ong 2 4 (n=11) Titci(n=37)
T,glan LX/1cm k i o d i i |X ± SD) (ngiy) 29,8 ± 4,5
36,1 ±6,2 32,1 ± 5,9
P p< 0,05
Nhfn xit: thdi gian liin xuong /I cm cfta i kit xucmg cing din cfta ca nhdm binh nUn nghiin cftu li 32,1 ± 5,9 ngiy, cd sy khie nhau gitta flidi gian liin xuong/1 cm keo dai ciia nhdm kio dii chi vi nhdm kit xucmg hai i, sy khic bigt niy cd y nghia fliong ki vdi p<0,05, • - Chua fliay sy ttrong quan ed nghia fliing ki giOa flidi gian liin xuong/1 cm kio dii vdi si lupng TBG tao miu vi TBG ttomg mfl dupe ghip,
3.4. Kit qui diiu trj cua nhdm ho^i ti^ vo khuin CXD (nhdm III)
rSt
Y HQC VI$T NAM THANG 8 - s d e Ac BI$T/2012
Bang S. K i t qui diiu ttj flieo diim chfte ning khdp hing Harris ttudc v i sau ahin TBGTX
Diim Harris
< 60(Kdm) 60-69 (Tmng binh) 70-79 (Khi) 80-89 (Tdt) 91-100 (Rit tflt)
Trurdrc ghip TBG n
0 6 17 4 3
%
0 20,0 56,7 13,3 10,0
Sau ghip TBG (9 thina din 39 thino) n
1 6 2 2 20
%
3,3 16,7
6,7 6,7 66,6 Nhfn xit: Theo thang diem Harris sau ghip TBG cd 24 (80%) BN dat k i t q u i k h i , t i t v i i t , 5 (16,7%) BN cd ket q u i trung binh, 1 (3,3%) BN cd k i t q u i k i m .
Bing 6. L i i n quan giOa s6 lupng TBG vdi k i t q u i diiu trj theo thang diim Harris C h l s i
SLTBCD34(+)/ml (xlO") Ting SLTBCD34(+) (xlO"
SLTB tao cym CFU-F/ml T4ng SLTB tgo cym CFU-F (xlO^)
Tit, r i t t i t , khi (n=24) 0,39 ± 0,30 14,81 ± 7,20 1333,43±88S,21
46,67 ± 36,87
T,blnh v i kim (n=6) 0,36 ± 0,09 13,63 ±6,27 918,86 ±205,65
32,16 ± 9,24 P
>0,05
>0,05
<0,05
<0,05 Nhfn xit: Nong dg TB CD34(+)/ml, ting so lupng TBCD34(+) ttong khfli TBG cfta nhom BN cd kit qui dieu tri tft kha din tot tuong ty nhu nhdm BN cd ket qua dieu trj kem vi trung bmh. Tuy nhien, nong do TB tao evun CFU-F/ml va so lupng TB tao cym CFU-F cfta nhom BN cd kit qui diiu trj tu kha dintitcaohonnhdmBNcdkit qua diiu trj trung binh va kem, sy kliac biet ed y nghia thflng ke (p<0,05)
IV, BAN LUAN:
Nghien cftu dupe tiin hinh tten 133 BN deu d tuii trudng thanh, ttong do cd 104 nam va 29 ntt. Vi mit tin fliucmg ed 73 BN bj khdp gia hoac cham lien xuong cac than xuong dai (dui, cing chin, canh tay va cing lay), 30 BN keo dai chi (15 BN tam vdc thip phai keo dai chi nang chieu eao va 15 BN khuyit hing xuong >3cm phai kit xuong hai 6) va 30 BN bi hoai tft vfl khuin CXD giai 4op I va II. Cac BN duoc diiu trj tiieo ky thusit cua Hemigou [5], [6] va Gangji [4] theo qui trinh tiling nhit: chpc hut khoing 250- 350 ml djch tuy xuong tft xuong mao chau, tach chiit co dac di thu duoc khii TBG vdi thi tich 20-30 ml. D6i vdi BN khdp gia va keo dai chi, khii TBG dupe tiem qua da vao ton thuang dudi hudng din cfta C-arm va
Xquang ting sing; doi vdi binh nhan hoai tft vfl khuin CXD, khii TBG dupe dua vio vung hoai tft chdm qua dudng Idioan giam ap, ed hudng din cfta C-arm va X quang tang sing.
Ci nhdm binh nhan KG than xuong dai (nhdm I), khfli TBG ghip vio 6 KG ed ting si lupng TBG tao mau la 16,37 ± 8,62 xlO' vi ting so lupng TBG trung mfl la 70,57±5I,88 xlO^ (bang 1). Thdi gian danh gia kit qua liin xuong toi thieu 6 thing sau ghep TBG tuy xuong, sau 6 thing ma khflng thiy liin xuong dupe coi la thit bai, cin xem xet ghep TBG tuy xuong ISn 2 hoic chuyin phuong phip diiu ttj khao. Trong nghiin cuu nay, chiing toi dinh gia dupe kit qua d 63 benh nhan vdi ty li liin xuong la 85,7%
(54/63 BN), trong dd xucmg cing chan la
C H U Y S N flg: Hpl NOHI KHOA HQC HUYgT HQC • TRUYgN M A U T O A N QUtfc 2012
86,8% (33/38 BN), xuong dfti li 83,3%
(15/18 BN), xuong einh tay li 50% (1/2 BN) vi hai xuong cing tay li 100% (5/5 BN);
tfidi gian liin xuong li 19,9 ± 9,3 tuin (bing 2). Hemigou ghip tui xuong di qua xft \i ly tim eho 60 ttvdng hpp KG teo dit thin xuong chiy dat ti if liin xuong 88,3% vi thdi gian liin xuong li trung binh 12 tuin (4- 16 tuin) [6]. Mflt si nghiin cftu khic cho ti if liin xuong 57% - 94% (trich din theo [7]).
Kit qui d bing 3 eho thiy nhdm BN liin xuong dupe nhin khii TBG cd ning dfl TBG tt™g mfl (TB tao cym CFU-F)/ml vi ting si lupng TBG trung mfl eao hom cd y nghia thing ki so vdi nhdm BN khflng liin xuong, cfln ning dfl vi ting si lugmg TBG tao miu thi tuong ty nhau giita hai nhdm. Nhu vay, cie fliinh phin te bio cfl ttong khii TBG diu inh hudng din hiiu qui liin xuomg, nhung vai ttd cfta tftng lo^ te bio li khflng ngang nhau. Cy flii li vai ttfl eua thinh phin TBG tao miu li khflng nhiiu, cfln inh huflmg cua thanh phin TBG ttung mfl li rd ring nhit.
Theo Hemigou, so lupng TBG ttong tuy xuong ghip eho BN inh hudng tdi kit qui liin xuong. Trong 60 BN khdp gii thin xuong chiy dupe ghip tuy xuong sau ly tam, tie gii thiy 7 BN khong liin xuong ed nong dp va ting si TBG trung md (xie djnh qua nufli ciy CFU-F), tuong ung li 634 ± 187 TB/cm' vi 19324 ± 6843 TB, thip hon cfl y nghia thong ki so vdi 53 BN liin xuong [6],
O nhdm 11, thdi gian lien xuong trung binh eho 1 cm kio dii li 32,1 ± 5,9 ngiy, ttong dd nhdm kio dii chi ning chiiu eao cd thdi gian lien xuong trung binh cho I cm kio dii la 29,8 ± 4,5 ngay, ngin hon so voi nhdm BN kit xucmg hai o la 36,1 ± 6,2 ngay (p
<0,05) (bang 4). Kitoh H, Kitakoji T vi cgng sy (2006) [8] Aim ti bio gic trung md liy tft tuy xuong ty than sau khi nufli ciy vao o
cing din trong kio dii chi di dat dupe th6i gian liin xuong trung binh li 28,6 ngiy/lcm kio dii d nhdm kio dii chi ning chiiu cao vdi d9 dii trung binh cia i cing din M 8,3 cm. Nhu v$y thdi gian liin xuong tnmg bhih cfta nhdm kio dii chi trong nghiin cftu cia ching tfli tuong duong vdi kit qui nghiin cftu eua Kitoh H. va e$ng sy vflri p <0,05, Do Tiin DOng (2001) [I] kio dii chi ning chiiu cao (trung binh 5,8 cm) cho 101 BN nhung khflng tiim TBG tiy xuong vio i cing din, kit qui thflri gian liin xuong trung binh cho I em kio dii li 39 ngiy. Nhu viy vdi viic tiem bi xung TBG tiy xucmg vio i cing din, thdi gian liin xuong cho 1 em kio dii cia chung tfli di giim dupe khoing 25%. Nguyin Via Tin (1995) [2] diiu tti ngin ehi do mat dop xuong bing phuong phip kit xuong 2 i theo nguyin ly llizarov (khflng sft dvmg TBG tuy xuomg) cho thiy thflri gian liin xuong tmng binh cho I cm kio dii li 45 ngiy, dii hon khoing 20% so vdi kit qui ngliiin cftu ciia ehiing toi (trung binh 36,1 ngiy). Diiu nay cho thiy ring, khoi TBG cd higu qui lim ting khi ning liin xuong khi dupe tiim vao 0 cing din ngay sau khi hit giai doan keo dii. Diiu niy rit ed y nglua vi thdi gian lien xuong dupe rftt ngin si lim giim tiidi gian nim vign, giim chi phi, BN dupe tip v?n dgng sflrm si lim giim nguy eo biin chiing vi nhanh chdng phyc hfli chfte ning v$n dgng eia hai chi dudi.
6 nhdm BN hoai tti v6 khuin CXD, khii TBG dupe tiim vio vj tti ho^ tft d chom qua duflmg khoan giim ip ed si lupng ti bio CD34+la 13,71 ± 11,48 xlO', si lupng TBG trung mfl li 48,56 ± 30,9 xlO' (bing I). Thii gian theo doi sau ghip TBG trung binh la 22,8 fliing (tft 9-39 fliing). Binh gii theo tiiang diim Harris sau ghip TBG co 22 (73,3%) BN dat kit qua tot vi rit tit, 2
Y HQC VigT NAM T H A N G 8 • Sfi BAC BI$T/2012
(6,7%) BN cd kit qui khi, 5 (16,7%) BN cd kit qui tiimg binh, I (3,3%) BN cd kit qui kim (bing 5). Nhflm BN cfl kit qui diiu trj tit khi tt* lin nhin dupe khoi TBG cfl ting si lupng TBG trung mfl cao hon ed y nghia thing ki so vdi nhdm BN cd kit qui diiu trj tnmg binh vi kem (46,67 ± 36,87 xlO' so vdi 32,16 ± 9,24 xlO', p<0,05). Cdn tiiinh phin TBG tao mau eia khii TBG tiii tuong ty nhau giiia hai nhdm (bing 6). Vdi nhttng si liiu ed dupe cd the thiy BN dupe ghip nhieu TBG trung mfl hon cd kit qui diiu trj tit hon. Hemigou vi cgng sy [4] di thdng bio kit qui nghiin cftu d 116 BN vdi 189 khdp hing dupe diiu trj bing khoan giim ip vi tiim TBG, nhOmg BN niy dupe theo dfli trung binh li 07 nim (5-11 nim) ket qui trong 189 khdp hing thi cd 34 khdp hing (chiim 18%) cin phii thay khdp hing nhin t^. Tic gii cimg nhin thay nhihig BN phai thay khdp hing nhin t?o dupe ghip so lupng TBG ttimg mfl it hon ed y nghia thing ki so vdi cac BN cdn lai.
Tom lai d ei 3 nhdm BN sft dung TBG tiiy xuong diu cho thiy higu qui diiu trj liin xuomg vi phyc hii tin thuong mpt cich rfl ret, ttong dd vai ttd cia TBG trung md tiy xuong li ro rit hon ei. Tuy nhiin diy chi la nhitag kit qua budc diu do si lugmg BN cdn han chi, cin tiip tye md rgng nghiin cuu vdi si lugng binh nhan Idn hon.
V. KET LU$N:
Qua nghiin cftu ung dyng phuong phip diiu tri ghip TBG tfty xucmg ty than cho 133 BN (104 nam, 29 ntt) taoi trudng tiiinh ed cic tin thuong xuong khdp Idid hfli phyc tai B?nh viin Trung LTong Quan doi 108 vi Bfnh vien Viit Due tft 01/2008 - 03/2011 di cho fliiy TBG ttiy xuong ed hiiu qui ro rgt
ttong diiu trj liin xuomg vi phyc hoi cie tin tiiuomg xuong khdp, ey thi li:
- Nhdm binh nhin KG thin xuong dii cd ty li liin xuong li 85,7% (54/63 BN) vdi flidi gian lien xuong li 19,9 ± 9,3 tuin. Cic BN liin xuong nhin dupe khii TBG cd si lugmg TBG trung md cao hon ed y nghia thong ke so vdi cic BN khdng liin xuong.
- Nhdm BN kio dii chi vi kit xuong 2 i ed thdi gian lien xuong trung binh cho I cm kio dii li 29,8 vi 36,1 ngiy, ngin hon ding ki so vdi khflng sft dvmg TBG tfty xuomg.
- Nhdm BN hoai tit vfl khuan CXD: 80%
(24/30) BN cd kit qui diiu ttj tft tit din khi (theo thang diim Harris) di dupe ghip si lupng TBG trung mfl cao hon id rgt so vdi 20% (6/30) BN ed kit qui ttimg binh vi kim.
TAI UEU THAM K H A O :
1. D 5 Tiin Dung (2001), "Diiu chinh sy chenh lech dp dai hai chi dudi bing phau thuat keo dai ehi theo nguyin ly eua llizarov." Ludn dn tien sy y hpc. Hpc vlfn qudn Y.
2. Nguyen Van Tin (1995), " Diiu bi mit doan xuong-ldidp gii cd ngin clii d chi dudi bing phuong phip kit xuong hai o theo nguyin ly cua llizarov", Ludn dn tlin spy hpc, Hpc vlfn qudny.
3. ARCO (Association Research Circulation Osseous) (1992),
"Committee on Terminology and Classification", ARCO News: p. 41-46.
4. Gangji V, Hauzeur JP, Matos C, et aL (2004), "Treattment of Osteonecrosis of the Femoral Head with Implantation of Autologous Bone-Marrow Cells. A Pilot Study", J Bone Joint Surg Am. 86: p.
1153-1160.
5. Hernigou P and Beaujean F (2002),
"Treatment of osteonecrosis with
CHUYSN Bi: HQI NOHJ KHOA HQC HuygT HQC • TRUYDN MAU TQAN QU6C 2012 autologous bone marrow grafting", CllnO
rthop Relat Res. 405: p. 14-23.
, Hernigou P, Poignard A, Beaujean F, ct aL (2005),- "Percutaneous Autologous Bone-Marrow Grafting for Nonunions.
Influence of the Number and Concentration of Progenitor Cells", / Bone Joint Surg Am. 87: p. 1430-1437.
, Ippokratis P, Theodora G, George K, et al, (2010), "Efficacy of minimally invasive techniques for enhancement of fracture healing: evidence today".
International Orthopaedics (SICOT). 34;
p. 3-l2,DOI I0.1007/S00264-009-0892-0.
8. Kitoh H, Kitokoji T, and Tsuchiyi (2007), "Transplantation of culture expanded bone marrow cells and platelet rich plasma in distraction osteogenesis of the long bones". Bone. 40: p. 522-528.
9. Sutherland DR, Anderson L, Keeney M, ct ai. (1996), "The ISHAGE guidelines for CD 34+ cell determination by flow cytometry", J.Hematolhenqty. 5:
p. 213-236.
BI/lDfC DAU DANH GlA HlEU QUA DifU TRj B | N H XUAT H U Y ^ GIAM TI^U cAu
M l i N DjCH MAN TINH Of TRE EM BANG PHUDNG PHAP CAT LACH NOI SOISo Thj Hai VSn*, V8 Thj Thanh Tri-c*, Phii Chi Ding*
T6iA TAT;
Dit v i n d i ; Xuit huyit giim tiiu ciu (XHGTC) la mflt trong nh&ng binh 1^ huyil hoc thudng gip nhit d t r i em, Viflo diiu trj cho cic tid em iJinh XHGTC min tinh hay XHGTC ning trin iim sing i i ftng eft viin eho eit iich hiin vSn cdn dang dupe bin cii. Myc t l i u : dinh gii hiiu qui diiu tri ITP min d trd em cua phuong pliip cit lich nfli soi tai BV TIVIHH TPHCM trong thdi gian 5 nim 1/2007 din thing 12/2012. D i i tirgrng v i phuong p h i p nghien cftu: h i i cftu qua 34 h i so bgnh i n , d i i u trj ITP m i n bing phuong phip cit lach ngi soi. K i t qui:
T} l i asp ftng sdm sau cit iich khoing 79.4%, 5 trudng hop thit bai, chiim 14.8% 1 tnrdng hpp xuit hiin viim phdi khdng die hiiu do Chlamydia pneumonia, chiim tJ Ifl 2 94%, trong khi dii 97.06% binh nhin khdng gip biin chdng
nio khic sau m i . K i t l u i n : Cit lich i i in(t phuong phip diiu trj xuit huyit giam tiiu ciu miin djch min tinh cd t^ 1$ dip ftng cao cing nhu cfl tuong dii an toin, giip binh nhi giim duoc cic biin chftng do phii ding thuic liu dii.
ABSTRACT:
Background: Immune thrombocytopenic purpura (ITP) is one of the most common hematologic disease in children. The treatment of chronic ITP with splenectomy is still controvereial.
Objective: To evaluate the effectiveness of splenectomy in the treatment of childiiood chronic ITP at HCIVI C Blood transfusion- Hematology Hospital in 5 years time from 1/2007 to 12/2012. Subjects, and Methods;
Rettospectively through 34 medical reconls, chronic ITP treated with
* Binh viin Tmyin miu - Huyit hpc TP. Hi Chi IVIinh Phin blin khoa hgc: TS Huynh Nghia
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