TAP CHt Y HOC VIET HAM TAP 465 - THANG 4 • SO 2 - 2018 TAI LI^U THAIVl KHAO
1. Constantinos H Karabatsas, Stuart D Cook, John M Sparraw (1999), "Proposed dassifkation for topographic pattems seen a f ^ penetrating keratoplasiy'; BrJQ^thalmd. 83, pp. 403-409.
2. Hayashi K, Hayashi H. (2006), "Long-term changes in corneal surface configuration after penetrating keratoplasty'J Am J Ophdialmol . 141(2), pp. 241 - 247.
s. Hoang Th| Minh ChSu (1992), Nghien cu'u lam sang va th'i/c nqhiem phUdng phip ghep giic mac ndng xuyen, Luan an Pho tien sy khoa hoc Y dUcfc, Tru'dng dai hoc V Ha Noi.
4. Isager P, Hjortdai 30, Ehlers N. (2000), "Stability of
gtaft refractive power afta- penetrating t^atoptasty"
Ada Q^thalmoi Scand.. 78(6), pp. 623-6.
5. Khong AM, Mannis M ] , Plotnik RD, Johnson CA. (1993), "Computerized topographic analysis of the healing graft after penetrating keratoplasty for keratoconus" Am J OphdialmoL 115(2), pp.
209-15.
6. L Lim, K Pesudovs, M Goggin, and D J Coster (2004), "Late onset post-keratoplasty astigmatism in patients with keratoconus'; Br J Ophthalmol J. Musch DC, Meyer RF, Sugar A. (1988), The
effect of removing running sutures on astigmatism after penetrating keratoplasty". Arch Ophthalmol . 106(4), pp. 488-92.
DANH GIA KET QUA PHAU THUAT THAY DIA DEM NHAN TAO TRONG D I E U TRI THOAT VI DIA DEM COT SONG CO
T O M T A T
Tong quan: Phlu thuat thay dia dem_^ nhan tao (CTDR) dieu trj thoat vi dia dem cgt sonq co giup dam bao ctiufe nang van dpng cot song cd, giam ty le thoai hoa dia dem lien ke so v6i cac phUdng phap phap plilu thuat thong thu'dng tru'dc day.^WitfC tieu: Gidi thieu 1^ thuat va danh gia ket qua phau thuat thay dia detri nhan tao dieu trj thoat vj dia dim cot song co.
D& tupng va phddng phap nghiin cdu: Nghien cull mo ta tien ojli 59 benh nhan dUdc md thay dia dem nhan tao cot song eo td thang 1/2009 den thang 1/2018. Kdiquir. tuoi trung binh 47.58 ± 7.14 tudi, 16 benh nhan co frieu chiihg ehen ep re (dau, te bi), 26 benh nhan co trieu chdng ehen ep tuy, 17 benh nhan ch phS hdp trieu chuhg chen ep re va chen ep tuy. Tnj'dc md JOA trung binh 8.07 ± 2.51, VAS 6.71
± 1.18 diem, NDI 61.23 ± 12.84%. Sau mo JOA frung binh 16.13 ± 2.79 diem VAS 1.29 ± 1.69 diem, NDI 7.32 ± 13.63%. Ty le thoai hoa dia dem lien ke 0.85%/nam. Chut nana ept song ed tdt sau moj 100%
bSnh nhan dat t / le hoi phuc hgi chiiYig tuy co tdt va rat tot. Ket luin: Phau thuat thay dia dem nhan tao dteu tri thoat v! dia dem c6t son^ co qua danh gia 59 b|nh rihan chd ket qua tot vS hoi phuc thSn kinh_va diufc nang cgt song cd, giam tJ' 1^ thoai hoa dia dem lien ke.
Td khda: Thoat vj dia dem cgt song co, ACDF, thay dia dem nhan tao (CTDR).
SUIVIMARY
RESULTS OF TOTAL DISC REPLACEMENT SURGERY I N THE TREATMENT OFCERVICAL DISC HERNIATION
*Khoa Chan thUdng chinh hinh vi Cdt sdng- Benh vien Bach Mai.
Ciiiu trach nhiem chinh: Hoang Gia Du Eniail: [email protected] Ngay nhan bai: 9.01.2018 Ng^y phin bien khoa hoc: 19.3.2018 Ngay duyet bat: 30.3.2018
Hoang Gia Du*
Background: Total disc replacement surgery in the treatment of cervical disc hemiation helps remain movement function, reduce adjacent segment degeneration rate. Objectives: Describe the CTDR technique and analysis short-term results of CTDR In the treatment of cervical disc herniation. Materials and Methods: A descriptive, prospective study conduct 59 cases with total cervical disc replacement from 1/2009 to 1/2018. Results: mean age: 47.58 ± 7.14 age, 16 patients had radiculopathy (pain, numbness), 26 myelopathy, 17 combine radiculopathy and myelopathy. Mean of preoperation JOA: 15.5 ± 0.7 points, VAS: 5.22 ± 0.44 points, NDI: 61.23 ± 12.84% and postoperabon JOA: 16.5 ± 0.7, VAS: 1.11
± 0.33points, NDI: 7.32 ± 13.63%. Adjacent segment degeneration rate was 0.85%/yr. The cervical function was good after surgery, fwiyelopa&iy recovery rate was 100% at good and very good. Ctoncft/s/ortsr Total disc replacement surgery in tiie treatment of cen/icat disc hemiation has good results in clinical neurological impnDvement and cervical function, reduce the adjacent segment degeneration rate.
Keywords: Cervical disc herniation, ACDF, CTDR.
I. OAT VAN OE
Thoat vj dTa dem cgt song ed la benh li thu'dng gap, chi dinh dieu tri ngoai khoa khi dieu trj not khoa dung phae do khdng ket qua. Cd nliieu phu'dng phap dteu trj phau thuat nhu" lay thoat vj dTa dem ddn thuan, lay dta dem lam cutig ktidp t^eo phu'dng phap Smith - Robinson (ACDF)... Tuy nhien nhffng phu'dng phap nay co han che do ddng eutig khdp lam tang ap It/c ten dfa dem lien ke dan den thoai hda nhanh cac dTa dem lien ke sau p h l u thuat, lam giam tarn van dong CO. Hilibrand AS va cong sd nghien ciiu 374 BN sau mo lay dTa dem ed ddng eu'ng dot song, theo idol trong 10 nam ty le thoai hoa khdp tan can la 2.9% /nam va sau 10 nam xuat hten
VIETNAM BflEDICAL JOURNAL N°2 - APRIL - 2013 trl^u chdng lam sang cita thoai hoa dTa dem la
25.6%. Phau thuat thay dia dem cot song cd bang dia dem nhan tao (CTDR) ra ddi da khac phuc dddc tinh trang nay. Khi benh nhan du'dc thay dia dem nhan tao cgt song cd, bien do van dgng tang phau thuat du'dc bao ton, ap li/c van dgng cua nhDtig dTa dem tten ke hau nhu' khdng thay dot, chieu cao lien dot du'dc phuc hoi nen toe do thoat hda eae dia dem hen ke giam dang k^ so vdi phau thuat ddng eutig cgt song eo'.
Phu'dng phap nay cd y tu'dng tir' nhD'ng nam 50 eho den nhutig nam 80, den thap ky 90 mdi bat dau thi/e hien thay dTa dem nlian tao [1], [ 2 ] . Oen nam 2004, FDA mdt cdng nhan phu'dng phap dieu trj nay. Tat Viet Nam, phau thuat thay dTa dem nhan tao dieu tri thoat vi dTa dem cgt sdng CO da dddc chung toi tien hanh ian dSu tien nam 2009 tat Benh vien Viet Du'c va nam 2015 tai Benh vien Bach r4al. IHien nay, phau thuat tiiay i3Ta dem nhan tao cgt song cd ngay eang du'dc sir dung rgng rat de thay the cae phu'dng phap phau thuat khac trong dieu trj benh ly dTa dem cgt song cd. I^yc dich cua bao cao nham gidi thieu ky thuat, diem lai y van va danh gia ket qua phau thuat thay dta dem nhan tao cgt sdng cd.
II. OOI TU'ONG VA PHU'aNG PHAP N G H I I N C O U Odi tydng nghien ciitJ gom 59 benh nhan du'dc chan doan thoat vj dTa dem cpt song co va du'dc phau thuat thay dta dem nhan tao (CTDR) trong 10 nSm tu* nam 2009 den thang 1/2018 tai Benh vien Viet OLTC (50 benh nhan) va Benh vien Bach Mai (9 benh nhan).
Phu'dng phap nghien ciJli mo ta lam sang tien cuti. Chung tdi md ta, phan tich cac trteu chutig tam sang tru'dc va sau md, sau kham tat danh gla theo thang dtem JOA, danh gia mii'c dp dau theo thang dten VAS, danh gia chu'c nang cot song cd theo chi so NDI. Tat ca benh nhan du'dc ehup Xquang qui u'dc va chup cat Idp de ptian tich thu'dng ton xu'dng, danh gia sd mat vutig, do tam van dgng_^cgt sdng cd, ehijp cgng hu'dng td de xac djnh^tdn thddng dTa dem, mtfc do thoat vj, thu'dng tdn tuy cd.
Hinh 1. Thoii vi dia dim trim MR^
Chi dinh md thay dfa dim nhin tao cotsaig cd'[6]:
+ Thoat vi dTa dem cgt song cd gay chen ep than kinh cd trieu chutig lam sang.
+ Cpt song khdng mat vutig tren Xquang.
+ Oieu trj not khoa, vat ly trj lieu > 6 tuan khong cai thien.
• Yeu cau phu'dng tten: Carm hoac may 0- arm trong md, kfnh hien vi phau thuat
<• Tu' the: benh nhan nam ngufa, gay me npi khi quan
• Ky thuat:
+ Rach da du'dng cd ti'u'dc ben phat hoac trai theo Smith - Robinson
Hinh 2. DUdng rach da^ Xquang tiong mB + Bgc to cgt sdng eo
+ Xac dinh vj tri dTa dem tren Xquang trong mo + Lay thoat vj dia dem du'di kinh vi phau thuat, glal phdng chen ep than kinh
+ Tao hinh vj tri dat dTa dem nhan tao
Hinh 3. Liy bd dia dim thoat vi, dat dia dinfnhan tao irong mo
TAP CHI Y HOC VIET NAM TAP 465 - THANG 4 - SO 2 - 2018
+ Pat dia dem nhan tao, kiem tra du'di Xquang hoac 0-arm trong mo
• « '
, : ^
H/nh 4. Chup Xquang, O-arm kiem tra dfa dim trong mo trUdc vi sau md
Hinh 5. Xquang dfa dim nhin iao C4C5 - CgCg sau md
III. KET QUA NGHIEN CU'U
T d nam 2009 den thang 1/2018, chung toi da tten hanh thay dTa dem nhan tao cgt sdng eo eho 59 t)enh nhan du'dc mo theo du'dng md Smith - Robinson trong do cd 15 benh nh§n nam va 44 benh n h i n nD', do tudt tijr 39 den 60 tudi (trung binh 47.58 ± 7.14 tuoi). Oanh gia lam sang cd 16 benh nhan cd trieu chutig chen ep re, 26 benh nhan cd trteu chutig chen ep tuy, 17 lienh nlian c6 ca hai hot chu'ng, 26 benh nhan cd teo cd nhe va JOA tirung binh 8.07 ± 2.51 diem.
100% benh nhan cd dau re, tk bi. VAS ti\idc md trung binh 6.71 ± 1.18 diem. NDI trung binh 61.23 ± 12.84%j
Dac dtem chan doan hinh anh: Tren Xquang tam van dong cat song co (RO|w]) trung binh tu' the cui het'cd 18.04° ± 7.84*' (5 - 35°), ngu^ het c3 30.00° ± 11.52° (11 - 35°). Tren phtm I^RI cd 57.15% thoat vi tai vj tri CsQ, 18.18% thoat vj tai mSl vi tri QC^ya C^C?, cdn iai 6.49% tai C3C1.
Tu'dng ijtig vdi ton tliUdng tren hinh anh cgng hu'dng tif, chung tot tien hanh phau thuat thay dTa dem nhan tao cho 59 tru'dng hdp vdi tong so 77 dTa dhm ESP Prosthetic. Thdi gian phau thuat trung blrih 95.28 ± 21.04 phut/1 dia, 138.33 ± 34.33 phut/2dTa va 230.00 ± 42.43 phut/3 dTa.
7 J. VI tri tiioit vl trin phim MRI Vitri thoat vl tren MRI
C C C,Cs CQi
&C, Tdng Bang 2, Bac diSm lam
n 5 14 44 14 77 sAng, a
6.49
%
18.18 57.15 18.18 100 ic chi sd
Dac d i i m Dau re (n) Te b i ( n ) Teo cd (n) VAS (diem) NDI (%)
JOA (diem)
ROM T r i / a c
m o 59 26 26 6.71 ±
1.18 61.23 ±
12.84 8.07 ±
2.51 Sau m o
0 15 26 3.86 ±
1.33 6.55 ±
3.08 10.59 ±
3.02 Sau Idiam lai
0 5 10 1.29 ±
1.69 7.32 ±
13.63 16.13 ±
2.79 100% benh nhan khdng cd tat bten, bten chu'ng trong va sau phau thuat. Sau mo, cac benh nhan dddc van dpng co sdm, deo nep cd mem, chu'c nang co trd tat binh thu'dng. Thdi gian nam vten trung binh 8.74 ± 2.26 ngay (4 - 10 ngay). Oanh gia tinh trang lam sang sau md;
100% benh nhan het dau re, 15/26 benh nhan het te bi, 26 benh nhan chen ep tuy edn teo cd, te nhe vdi JOA sau mo trung binh 10.59 ± 3.02 diem. Ty te hot phuc (RR) sau phau thuat kht ra vien 35.90 ± 1.40%.
Thdi gian kham lat trung binh la 37.66 ± 9.28 thang. 100%^ benh nhan dat ty le hoi phuc hot chutig tuy cd tot va rat tot. VAS sau kh^m lat trung binh 1.29 ± 1.69, JOA trung binh 16.13 ± 2.79 dtem, NDI trung binh 7.32 ± 13.63 %, ty le hoi phuc (RR) 87.29 ± 17.90%. Tren phim Xquang 100% benh nhan tren khong mat vDhg cgt sdng eo, dTa dem nhan tao deu d vi tri tdt, khong di lech hay tru'dt thu" phat, khdng phat hien tru'dng hdp nao tun dTa dem. NhDhg tienh nhan sau mo 6 thang ROI^ gdc cut trung iJinh 27.79 ± 7.94° (tru'dc md 17.76 ± 8.22°, n = 38), ROM goc ngu-a trung binh 45.63 ± 13.28° (tru'dc mo 28.55 ± 11.14°, n = 38). 3/48 vi tri thay dTa dem nhan tao qua phat xu'dng d dp I (6.25%), 45/48 vj tri thay dTa dem binh tiiddng do 0 (93.75%) (n=48), ty le qua phat xu'dng tat vj tri thay dTa dem 1.99%/nam. Ty le thoai hda dTa dem lien ke la 0.85%/nam. MIJ'C do hat long cua benh nhan dat 97.37%.
VIETNAM MEDICAL JOURNAL N°2 • APRIL - 2018
IV. BAN LUAN
Thoat vi dTa dem cgt song^^cd la benh ly cgt song thu'dng gap, dieu tri phlu thuat da du'dc tien hanh td nhu'ng nam 50 cua the ky tru'dc.
Oieu trj phau thuat thong thu'dng va hieu qua nhat diidc ap dung tiJ" tru'dc den nay la phu'dng phap lay bo dTa dem, ghep xu'dng, nep vit loi tru'dc (ACDF). Tuy nhien nhu'dc diem cua phu'dng phap nay la tam eutig khdp dan den mat van dgng cot song tai vj tri phau thuat, iam tang ap ILTC ten eae dTa dem lien ke do do lam tang nhanh qua trinh thoai hda tai eae dTa dem nay.
Theo nghien cull cua Hilibrand va cgng si/, ty te nay khoang 2.9% mgt nam du'dc theo doi tren chan doan hinh anh. Theo eac dff lieu tur cae nghien effu khac cho thay, ty le thoai hda dia dem lien ke nam trong khoang tff 3% den 8%
moi nam, ty le nay ehiem 25% hay Vn sd benh nhan se quay trd lai benh vten sau thdi gian 10 nam thy'c hien ky thuat ACDF. Cdn vdi thay dTa dem nhan tao cgt sdng eo (CTDR) sff van ddng cgt song cd van dam bao binh thffdng, ap Iffc van dpng cua nhutig dTa dem lien ke hau nhu' kiiong thay ddi, nen toe dd thoai hda cac dia dem lien ke giam dang ke so vdi ky thuat ACDF [3]/ [**]. [5]- Hdn nffa viec han xffdng khi tien hanh k^ thuat ACDF lam cffng cpt song da Jam giam tam van dong (ROM) cua edt song cd so v d i k y t h u a t C r D I ^ [ 6 ] , [ 7 ] .
Vi tri ttioat vj dTa dem trong nghien cffu eiia chung tot chu yeu tat dia dem C5C6 (57.15%).
Cpt song CO la phan linh hoat nhat cua cdt sdng, trong sinh hoat cDng nhff trong lao dgng dTa dem CsCe tham gia nhieu vao cac dpng tac cut, uSn eua cgt sdng co, la vj tri chiu ap tffc nhieu nhat, thffdng xuyen chiu tat trgng Idn cua cd the va tffc bo sung. Vi vay dTa dem tai nhffng vl tri nay cd toe do thoai hda nhanh hdn va de bi thoat vj hdn so vdt cae vj tri khac. Ket qua nay cDng phu hdp vdi nghien cffu ciia cac t i e gia trong va ngoat nffde.
Chi djnh phau thuat thay dTa dem nhan tao cdt song eo (CTDR) cung giong nhff cae trffdng hdp md lay dia dem, ghep xffdng, nep vit (ACDF). Chdng chi djnh md khi cd mat vffng cdt song cd, khe khdp lien dot song hep nhieu, cot hda day chang dpc sau, hej> ong song cd do chen ep tff than dot song co, benh nhan loang xu'dng [7]. Nhffhg benh nhan cua chung tot da phan la nhffng b§nh nhan tre (trung binh 47.58
± 7.14 tuoi), thoat vj dTa dem ddn thuan, chu yeu thoat vj mdt tang vdt hot chffng chen ep re hoac tuy ed ngang mffc dia dem ton thu'dng nen
thi'ch hdp vdt p h l u thuat CTDR.
Tat bien, bien chffng trong va sau phau thuat vdi ky thuat thay dta dem nhan tao cpt song co tffdng tff nhff k^ thuat ACDF vi deu thi/e hien theo dffdng m6 co trffdc. Mgt so cac bten chirng hiem gap nhff Idng dTa dem nhan tao, tut tniBt dia dern nhan tao ... khi tten hanh theo dot lau dai [7]. Nhutig benh nhan cua ehung toi khong gap eac tat bien bien ehffng nao trong mo va thcfi gian dau sau mo, thdi gian nam vien ngan, bfnti nhan khong phai deo nep cd lau, cd the deo nep cd mem thay vi deo nep co cffng nhu' cac phffdng phap ddng cffng khdp giup benh nhan sdm hda nhap lat vdi cuoc song. Sau mo cac trieu chffng tam sang (dau, te bi), thang dien VAS, thang diem JOA, chi so suy giam ehffc nang cgt song cd NDI cat thien rd ret cho thay ket qua phlu thuat thay dTa dem nhan tao dieu trj thoat vi dia dem nhan tao cdt song co dat ket qua tot va la minh chffng cho sff hat long eua ngu'di benh (97.37%).
Tren phim Xquang sau kham lat, nghien cufu cua chijng toi 45/48 vi t r i thay dTa dem binti thu'dng do 0 (93.75%), ty le qua phat xiTdng tai vi tri thay dia dem 1.99%/ nam la phu hdp, rat cd y nghia vi khi thay dia dem nhan tao ktidp da dffdc hoi phuc dan den ty le qua phat giam so vdi ddng cffng khdp. Trong thdt gian theo dot la 37.66 ± 9.28 thang, ty le thoai hda dTa dem tten ke la 0.85%/ nam, t } le nay cua ehung toi la thap hdn mot sd tac gia vdi phffdng phap dong cffng khdp, day cDng la dieu ffu viet khi thay dia dem nhan tao. S. Litrtco va cpng sff nghien CU\J 288 BN phau thuat dia dem cgt song cd co dong cuYig khdp, vdi tlidi gian theo doi 14,5 nam thay ty le thoai hda dTa dem lien ke la 5.9%. Reginald J. Davis, MD va cpng sy nghien cffu 339 BN v6i thdi gian theo dot 48 tliang cho thay tl le thoai hda dia dem lien ke eua nhdm ddng cffng khiip chiem 6.7% cao hdn nhdm thay dia dem la 2.1%
(5 BN), ty ie phai phau thuat tai cua nhom thay dTa dem la 3.8% (9/234), ntidm dong eutig khdp la 14.3%. Theo chiing tpi sau khi phlu thuat thay dTa dem, trteu chutig dau co cua Bl^ du'dc cai thien nhieu, t i m van dgng CSC co bien io idn hdn dan den ngffdt benh se van dpng co nhieu hdn giup cho qua trinh thoai hoa nidnq Cham lai [ 8 ] .
Trffdc md 38 benh nhan dffdc kham tat sau 6 thang, (ROM) do dffdc qdc cut 17.76° ± 8.22", gdc ngCte 28.55 ± 11.14°. Sau mo vao thdi diem kiem ti-a lai do dffdc gdc cui 27.79° ± 7.94° goc ngffa 45.63 ± 13.28°. Nhff vay, sau phau thuat
TAP CHt Y HQC VigT NAM TAP 465 - THANG 4 - SO 2 - 2018 ehi so ROM da dydc eat thien mpt each dang ke,
sff khae biet nay ed y nghTa thong ke vdt p <
0.05. Sau khi phau thuat cae md xu'dng da dddc lay dt, dTa dem thoat hda, nhan nhay thoat vj eDng dffdc lay dt, tat tao ehieu cao khoang gian dot sdng, va tien hanh thay dTa dem nhan tao cd khdp. Nhff vay, ben canh dat dffdc sff giai phdng ehen ep than ktnh, tai tao ehieu cao khoang gian than ddt song nhu' cac p h l u thuat ACDF thi thay dTa dem nhan tao cd khdp edn ffu the hdn han d duy tri va cai thien tam van dgng CSC.
Ve cat thien chffe nang cdt sdng co, trydc phau thuat NDI trung binh 61.23 ± 12.84 %.
Sau p h l u thuat vdi thdi gian kham lai 37.73 ± 9.40 thang, NDI trung binh 7.32 ± 13.63 %. So sanh trffdc mo va sau mo thay sy khae blet ed y nghTa thong ke vdi P<0.01. Mffc dp dau cd anh hffdng den eac hoat dgng, sinh hoat thffdng ngay eiia ngu'di benh da dffdc giai quyet, ngydi benh khdng cdn klio chju vi cam gtac dau cd, cac cdng viee sinh hoat ban than da tff minh thye hien dffdc.
V. KET LUAN
Thay dia dem nhan tao cgt sdng co (CTDR) la mgt ky thuat tiieu qua, an toan va u'u viet hdn so vdi cae phffdng phap phau thuat dieu tri thoat vj dTa dem khac trong eai thien ctiffc nang cot song CO, gtam ti le thoat hda dTa dem lien ke.
TAt UEU THAIVl KHAO
1. Ali A. Baaj, M.D., Juan S. Uribe, M.D., Fernando L. Vale, M.D., Mark C. Preul, M.D., and Neil R. CrawiFord, Ph.D. History of cervical disc arthroplasty. Neurosurgical FOCUS Sep 2009, Vol. 27, No.3, Page ElO: ElO.
^. Hoang Le, M.D., Issada Thongtrangan, M.D., Daniel H. Kim, M.D. Historical review of cervical arthroplasty. Neurosurgical FOCUS Sep 2004, Vol.
17, No. 3, Paaes 1-9: 1-9.
3. Hilibrand AS. Carlson GD. Palumbo MA. Jones PK, Bohtman HH fl999). Radiculooathv and mvelocathv at seaments adjacent to the site of a orewous anterior (xrvicai arthrodesis. Journal of Bone and Joint Suraerv-American. Volume 81A: 519-528.
4. Yue WM. Brodner W, Hiahland TR (2005). Lono-term results after anterior cervical discectomv and fusion with alloaraft and olatlna: a 5- to 11-vear radioloalc and clinical follow-up studv. Soine fPhila Pa 19761 30: 2138-2144. • 5. Robertson JT, PaDadODCulos SM. Travnelis VC
f20051. Assessment of adiacent-seament disease in oatients treated with cervical fusion or arthroolastv: a orosDectlve 2-vear study. Journal of Neurosurgery-Spme 3: 417-423.
6. Yujie Zhang, Chengzhen Uang, Yiqing Tao, Xiaopeng Zhou, Hao Li, Fangcai Li, Qixin Chen.
Cervkat Total Disc Replacement Is Superior to Antenor Cervical Decompression and Fusion: A Meta- Anaiysis of Pmspective Randomized Contmiied Trials.
PLoSOne. 2015; 10(3): e0117826.
7. Branko Skovrlj, Dong-Ho Lee, John Michael Caridi, and Samuel Kang-Wook Cho.
Reoperabons Following Cervical Disc Replacement.
Asian Spine J. 2015 Jun; 9(3): 471^82.
THU'C TRANG DIEU KIEN Cff 56", TRANG THIET BI, DUNG CU TAI CAC BEP A N TAP THE TRiraNG MAM NON THI TRAN MOC CHAU VA THI TRAN NONG TRU'DNG HUYEN MOC CHAU N A M 2 0 1 7
T O M TAT
Mpc tieu: Mo ta dieu kien ed sd, trang thiet bi, dung eu tai eac bep an tap the (BATT) Tru'dng Mam non Thi tran Moc Chau va Th| tran Nong Tru'dng huyen Moc Chau nam 2^017. PhUdng phip nghien cui/: Ngliien euli dich te hoc mo ta. Kei qua: Ty le BATT dat dieu kien ve sinh tap the la 85,7%. So BATT dgt dieu kien ve sinh dung cu la 85,0%. So BATT dat dieu ki|n vS sinh trong che bien, bao quan TP la 98,4%. Ty te BATT dat ho stJ ghi chep tai BATT la 70,66%.
*Tru&ng Dai hoc YDdc^ Thii Binh Chju tr^ch nhiem ehi'nh: Vu Trung Kien Email: [email protected] Ngay nhan bai: 18.2.2018 Ngay phan bien khoa hpe: 29.3.2018 Ng^y duyet bat: 10.4.2018
Ninh Thi Nhung*, Vu Trung Kien*
Td khda: An toan thi/e pham; Bep 5n tap the;
Moc Chau.
SUMIVIARY
CURENT STATUS OF FACILITIES AND EQUIPMENT I N THE COLLECTIVE KITCHEN
OF KINDERGARTEN SCHOOLS AT MOCCHAU TOWN AND FARM T O W N , MOC
CHAU DISTRICT I N 2 0 1 7 Objectives: Describing the facilities and equipment in the collective kitchen of kindergarten schools at Mocchau town and Farm Town, Moc Chau District in 2017. Methods: The descriptive epidemiology method. Results: The percentage of collective kitchen achieving food safety was 85.7%.
The percentage of of collective Idtcliens reaching sanitaty conditions was 85.0%. The percentage of collective kitchens achieving food safety in processing
