Y HOC V I | T NAM THANG 4 • SO oAc BIET/2013
HIEU QUA Sir UUNG IE BAO GOC TUY XUDNG TUTHAN TRONG DIEU TRj KHCTP GIA, HOAI TUrvO KHUAN CHOM XUDNG OUI VA KEO OAI CHI
Nguyen Thi Thu Ha , Ly Tuan Khai, Nguyen Thanh Binh*, Do Tien Diing*, Le H^ng Hai*, Nguyen Manh Khdnh**
T O M T A T
Te bao goc tuy xu'dng s i i dung trong dieu tri mdt sd ton thypng xu'dng khdp dang dypc quan tam nghien cdu. Muc tieu nghien ciht: l ) B a n h gla ket qua dieu t n khdp gia than xu'dng dai,hoa[
t l i vd khuan chdm xypng dui, keo dai chi bSng ghep te bao goc tuy xUdng t y than;2) Xac dinh mdi lien quan gjii^ so lypng te bao goc ddpc ghep vdi hieu qua dJeu trj. Doi tu'ang nghien cihi: 228 benh nhan gom 142 benh nhan khdp gia than xydng dai, 50 benh nhan hoai tu" vo khuan chdm xypng dui giai doan I,II (theo ARCO) va 36 benh nhan tam vdc thap dypc keo dai chi. Phu'tfng phap nghien cu'u: 20-30 ml khoi te bao goc t i / chiet tach tii' 250-350 dich tuy xu'dng du'pc tiem triTc tiep vao vj trf ton thu'dng.
Kei qua: 84,5% benh nhan khdp gia da lien xu'dng vdi thdi gian trung binh la 19,8 ± 9,5 tuan da dupc ghep nhieu te bao goc trung md hOn so vdi nhijhg benh nhan khdng lien xu'dng; 82 % benh nhan hoai tu' vd khuan chom xu'dng dui dat ket qua dieu fri hJ' kha, tdt den rat tdt (theo thang diem Harris) da du'dc ghep sd lu'png te bao goc trung md nhieu hdn so vdi nhwn dat ket qua dieu tri trung binh va kem; nhijhg benh nhan keo dai chi dupc ghep te bao goc co thdi gian lien xu'dng trung binh cho 1 cm keo dai la 29,5 ± 4,5 ngay, giam dang ke so vdi khdng su' dung te bao goc. Kei luan: te bao goc tuy xu'dng t d than sir dung trong dieu tri khdp gia, hoai tir vd khuan chdm xu'dng diii va keo dai chi cd hieu qua tot va an toan, cd moi lien quan giite sd lu'dng te bao goc dddc ghep va ket qua dieu tri.
Tiy khoa: te bao goc tuy xu'dng, khdp gia, hoai hi' vd khuan chdm xu'dng dui, keo dai chi.
" Benh vi?n TU'QD 108: ^'^ Benh vien Vi?t Biic Phm bISn Ithoa hgc: PGS.TS. Le Van Oong
S U M M A R Y
THE EFFECT OF AUTOLOGOUS BONE MARROW STEM CELL I N TREATMENT OF LONG BONE NONUNIONS, ASEPTIC FEMORAL
HEAD OSTEONECROSIS AND U M B LENGTHENING
Using bone marrow stem cell in treatment of bone and joint diseases has been interested to research. Objectives: 1) evaluate the effect of autologous bone man-ow stem cell in freatment of long bone nouinions, aseptic femoral head osteoneaosis and limb lengthening; 2) determine the relationship between the number of stem cells grafted and the clinical outcome. Subjects: 142 patients with long bone nonunions, 50 patients with aseptic femoral head osteonecrosis and 36 patients with limbs lengthened by IlizanDv's principle Methods: 20-30 milliliters of autologous bone marrow stem ceil mass were separated from 250- 350 milliliters of aspirated bone man^ow fluid and injected in to sites of bone leston. Results: 84.5%
patients with bone nouinions achieved bone union with bone healing time of 19,8 ± 9,5 weeks; 82%
patients with aseptic femoral head osteonecrosis had good outcome(based on Harris criteria); the bone healing time fbr 1 centimeter of length in patients with limbs lengthened and bone marrow stem ceil grafted was 29,5 ± 4,5 days, significantly shorter when compared with patients without grafting bone marrow stem cell . Conclusions: autologous bone marrow stem cell grafting was a safe and effective method in treatment of long bone nonunion, aseptic femoral head osteoneaosis and limb lengthening;
There was relationship between the numbers of stem cell grafted and the dinical outcome.
Hdi NGHI KHOA HpC VJ TJ BAD G 6 C TOAN QUdC LAN THCT 11
Key words: bone mantiw stem cell, nonunion, aseptic femoral head osteonecrosis, limb lengthening
LDjj^TVANOI
Tuy xuong 1^ m^t to chuc chda nhieu lo^
td bao gde (TBG) khac nhau nhu TBG tao mau, TBG trung md, t^ b^o tien t h ^ npi mac,...Nhihig TBG nay cd rat nhieu tiem nSng va da dupc dng dyng trong nhi^u phuang phap dieu tri d\ra tren ca sd te bao , dSc bipt la nhung phuang phdp dieu tri sua chiia, tai tao td chirc. Mpt trong nhChig ung dung thupc Ioai nay dS dupc mdt so tac gia tren the gidi nghien curu trong nhihig nSm gan day va da thu dupc nhung ket qua day hua hen do la su dung TBG tuy xuang trong dieu tri nhirng tdn thuang xuang, khdp khd hdiphuc[6, 7, 9].
O Viet Nam, tir nSm 2007 nhdm nghien cmi cua chiing toi gdm cac bac sy chuyen nganh Huyet hpc va Chan thucmg chinh hinh lan dau tien da tien hanh dd tai nghien cdu:
"Sir dung TBG tuy xuang tu than trong dieu tri khdp gia, hoai tii vd khuan chdm xuong dui va keo dai chi" vdi 2 muc tieu 1) danh gia ket qua didu tri cac tdn thuang; 2)xac dinh mdi lien quan giiia sd lupng TBG dupc ghep vdi hieu qua dieu tri.
II. OOI TU0NG VA PHI/ONG PHAP NGHIEN CCfU 2.1. Doi tu(fng nghien cuu
-228 benh nhan (BN) tudi tir 18 ddn 58 (166 nam va 62 nii)
cd cdc tdn thuang xuang khdp dupc dieu tri bang ghep TBG tuy xuong t\r than tai Vi?n Chdn thuang Chinh hinh - Benh vipn Trung Uong Quan dpi 108 vd Khoa Chdn thuang Chinh hinh - Benh vipn Viet Due tir 02/2007 -8/2012, bao gdm:
+ 142 BN khdp gia (KG) than xuang dai (nhdm I)
+ 50 BN ho^i tiJr vd khudn chdm xucmg diii giai doan I, II (theo ARC0[1]) (nhdm II)
-I- 36 BN dieu tri keo dai chi theo nguygn ly Ilizarov het giai doan cdng dan (nhdm III).
- 40 BN tam vdc thap didu tri keo dai chi theo nguyen ly Ilizarov dan thudn khong gh6p TBG.
2.2. Phuang phdp nghien cu-u 2.2.1. Thiit ki nghien cuu: Tien cdu , can thipp ldm sang cdt ngang cd theo dcH dpc.
2.2.2. Cdc ky thudt sit dung trong nghien cuu:
- Xdt nghiem td bao mdu va tuy xuong:
sir dyng mdy ddm td bao tu dpng CD 1800 (Abbott- Hoa Ky) vd phuang phap te bao hpc kinh dien.
- Tach khdi TBG tir djch hut tuy xuang:
moi BN dupc chpc hut thu gom 250-350 ml dich tiiy xucmg tir hai mdo chdu sau. Khoi TBG dupc tach bang phuang phap ly tdm gradient ty trpng sir dung dung dich Ficoll (p^l,077) hoac may tach te bao tu dpng COMTEC (Fresenius-Duc), huydn dich bdng nudc mudi sinh ly de cd the tich cudi cimg la 30 ml [6].
- Xac dinh thdnh phdn TBG t^o mau CD34'^: sir dung phuang phdp td bao dong chay theo hudng dan cua ISHAGE [11].
- Xdc dinh TBG trung md bdng ky thu$t nudi cdy cum nguyen bdo soi CFU-F (Colony forming unit - Fibroblast) vdi moi trudng nudi cdy cua Stem cell technologies (Canada) [3].
- Ky thuat tiem TBG tiiy xuang vao 6 KG va d cdng dan: Khdi TBG tuy xuong duac ghep qua da vao d KG tai phdng md vo trimg, cd trp giup cua Xquang tang sang va C-arm[8].
Ddnh gid kit qud sau ghep tir 6 thang trd len dya tren kham lam sdng va hinh anh tren phim X quang.
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Y Hpc VI$T MAM THANG 4 - S6 PAC Bl|T/2013
- Ky thudt tiem TBG vao chdm xuang dui ho^i tli: Khdi TBG tuy xuang dupc ghep vdo vi hi d hoai tir CXD qua dudng khoan gidm dp tai phdng md vo triing, cd trp giiip cua Xquang tang sang va C- arm [4],[7].
Ddnh gid ket qud theo thang didm Harris
tgi cac thdi diem sau ghdp 1 thang, 3 thdng, 6 thdng, 1 nam, nhOng ndm tidp theo mSi nam 1 lan [5].
2.2.3. Xu ly sd lieu: bdng cac thudt toan thdng ke vdi phdn mdm SPSS 18.0.
III. KET QUA NGHIEN CLTU
3.1. Kit qud xdc dinh cdc thdnh phin cua kiwi TBG
Bang 1. Thanh phan TBG tao mdu va TBG trung md trong khdi TBG
c h i so
n Ty le TBCD34(+)(%) Tonq soTBCD34(+)txlO'l SLTB tao cum CFU-F/ml (xlO^) Tonq so CFU-F ( x l O ' )
N h 6 m l (X ± S D )
1 4 2 1,25 ± 0,60
16,4 ± 8,6 2,21± 1,50 70,6± 51,9
N h o m I I X ± S D )
5 0 1,04 ± 0,61 13,7 ± 11,5 1,23± 0,70 '•'
• 48,6 ± 31,0'''
Nhom I I I X ± S D )
3 6 1,29 ± 0,64
14,9 ± 9,3 1,83± 1,24 60,1 ± 36,8
^'p'-"<0,05
Nhgn xet: Cac chi sd danh gia thanh phan TBG tao mdu(ty le va tdng sd TBCD34-I-) trong khdi TBG la tuang duong giiia 3 nhdm BN, su khdc bidt khdng cd y nghia thdng ke.
Cac chi sd ddnh gia thanh phan TBG trung md trong khdi TBG (ndng dp td bdo tao cum CFU- F cd trong 1 ml va tdng sd te bao tao cym CFU-F) cua nhdm I (nhdm BN KG) cao hon so vdi nhdm II (nhdm BN hoai tu chdm xucmg dui) c6 y nghta thdng ke vdi p<0,05.
3,2. Kit qud liin xuang cua nhdm KG thdn xuang ddi (nhdm I):
Ket qua dupe danh gia d 142 BN cd 142 d KG vdi thdi gian theo doi trung binh 21 thang (9-39 thdng)
Bang 2. Ty le Hen xucmg vd thdi gian lien xuong tren phim Xquang
VI t r i KG
Cang chan Biii Canh tay Cang tay Tong so
n 95 19 10 18 142
Lien xu'cjng n 81 16 08 15 120
%
85,3 84,2 80,0 83,3 84,5
T h d i g i a n UC ( X ± SD) ( t u 3 n )
21,4 ± 10,2 16,8 ± 4,5 15,5 ± 3,8 22,7 ± 13,6 19,8 ± 9,5
K h o n g lien n 14 03 02 03 22
%
14,7 15.8 20,0 16.7 ,'• iS,5
Nhan xel: Ty le dat lien xuang cua tat ca cac BN la 84,5% (120/142 BN). Thai gian lien xuang tren phim X quang cua tit ca cac BN la 19,8 ± 9,5 tuan; co 22/142 BN khong lito
Hpl NSHI KHOA HPC v i T f BAO G 6 C TOAN Qu6c U N THi> II
Bang 3. Lien quan giiia s6 luong TBG duprc ahec v6i kft qud diSu tri lien xuang
Chi so n TyleTBCD34(+)(%) Tonq soTBCD34(+)(xlO') SLTB tao cum CFU-F/ml(xlO') Tonq so CFU-F (xlO^)
Lfen xu'dng (X ± SD]
120 0,57 ± 0,35 17,5 ± 8,50 2,40 ±1,43 79,6 ± 54,3
Khong iren ( X ± S D )
22 0.56 ± 0,39 16,9 ± 11,8 1,03 ± 0,98 31,1 ± 29,9
P
>0,05
>0,05
<0,05
<0,05 Nhflt xet-. So lu<;mg td bao CD34(+)/ml, t6ng so ti bao CD34(-(-) dugc ghep cua nhom BN dat ducjc liSn xucmg tuang tv nhu cua nh6m BN khong dat ducjc liSn xuang nhung s6 luang TB tao cum CFU-F/ml va tSng so TB t^o cum CFU-F cao han c6 y nghTa thdng ke (p <0,05).
3.3. Ket qua diiu Iri cia nhom hoai tir vo khuin CXD (nhdm II)
Bang 4. K6t qua digu tri theo diem chiic nang khop hang Hams tntcrc va sau ghep TBGTX
Diem Harris
< 60 (Kem) 60-69 (Tranq binh) 70-79 (Kha) 80-89 (Tot) 91-100 (Rat tot) Tonq so
Tru'dc ghep TBG n
0 10 28 07 05 50
%
0 20,0 56,0 14,0 10,0 100
Sau ghep TBG (10 den 40 thanq)
n 01 08 06 06 29 50
%
2,0 16,0 12,0 12,0 58,0 100 Nhdn xet; Danh gia theo thang diem Hams , sau ghep TBG tiiy xucmg tu than da co 41 BN (82%)datkaquakha,t6t,ratt6tva 8 BN (16%) co kft qua trung binh, 1 BN (2 %) co kjt qua kem.
S6 BN dat rit t6t tang dang kS tir 5 BN (10%) truoc ghep Ien 29 BN (58%) sau khi dugc ghep TBG.
Bang 5. Lien quan giiia s6 lugng TBG dugc ghep vol ket qua digu tri theo thang diem Hairis Chi so
n TvleTBCD34(+)(%) Tonq soTBCD34(+)(xl0') SLTB teo cum CFU-F/ml(xlO=) Tonq so CFU-F (xlO^)
Kha, tot rat tnt 41 0,39 ± 0,30 14,81 ± 7,20
1,33 ± 0.93 47,7 ± 36,8
Trung binh, kem 9 0,36 ± 0,09 13,63 ± 6,27 0,92± 0,20 32,2 ± 19,2
p
>0,05
>0,05
<0,05
<0,05
Nhfn xet: Ty lg TBCD34(+), t6ng s6 lugng TBCD34(-f) trong kh5i TBG dugc ghep cua nhom BN CO ket qua dieu tri tii kha dSn t6t tuang tu nhu nhom BN co kit qua digu tri kem va tnmg binh.
Tuy nhien, sa lugng TB tao cum CFU-F/ml va tAng s6 TB tao cym CFU-F dugc ghep cua nhom BN CO ket qua dieu tri tir kha dgn t6t cao hon nhom BN co kgt qua digu tri trung binh va kem, svr khac biet co y nghia thdng ke (p<0,05)
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Y HOC Viei NAM THANG 4 - S6 OAC BIET/2013
3.4. Kel qud lien xuamg cda nhom khuyit hdngxiafng sau keo ddi chi (nhom III) Bang 6. Cac chi so tg bao cua khgi TBG tiem vao 6 cang dSn
Chi so' n TyleTBCD34(-l-)(%) Tonq s6TBCD34(+)(xlO') SLTB tao cum CFU-F/ml (xlO') Tonqsoa=U-F(xlO')
Khoi TBG thu autfc 36 1,29 ± 0,64
14,9 ± 9,3 1,83± 1,24 60,1 ± 36,8
Khoi TBG tiem choi 6 cdng dan
72 1,25 ± 0,60 8,70 ± 4,20 1,83 ± 1,24 30,8 ± 26,2 Nhdn xetKhoi TBG thu duoc sau chiet taeh ciia moi BN duge chia thanh 2 phan deu nhau de tiem vao 2 d cdng dan cua 2 chi nen tdng sd TBCD34(+) va CFU-F eua khdi TBG tiem cho 1 d cdng dan chi tucmg duang '/z chi sd cua khdi TBG thu dugc cua 1 BN.
Bang 7. Thdi gian lien xuang /I cm keo dai xuang
Nhom BN Keo dai chi Keo dai chi + tiem TBG
n 80 72
Do dai 6 cang dan(cm)
5,9 ±2,9 7,2 ± 4,1
T.gian LX/lcm keo dai (ngay)
39,3 ± 6,3 29,5 ± 4,5
P
<0,001
Nhdn xet: thdi gjan lien xucmg ciia nhdm keo dai chi theo phuang phdp Ilizarov dan thudn va nhdm ed kdt hop tiem TBG cd sir khdc biet cd y nghia thdng kd vdi p<0,001.
IV. BAN LUAN
Nghien cim dugc tien hdnh tren 228 benh nhdn (BN) tudi trudng thdnh (166 nam, 62 nil). Vd mat tdn thuang cd 142 BN bi khdp gia cde than xuang ddi (dui, cang chan, cdnh tay vd cdng tay), 50 BN bi hoai tu vd khudn CXD giai doan I va II theo ARCO va 36 BN keo ddi chi nang chieu cao. Cac BN dugc didu tri dya theo phuang phap cua Gangji [4] va Hemigou [7], [8] theo mot qui trinh thdng nhdt: chgc hut khoang 250-350 ml dich tuy xuong tir xuang mao chau, tdch chidt cd dac dd thu dugc khdi TBG vdi the tich 20-30 ml. Ddi vdi BN khdp gia va keo dai chi, khdi TBG dugc tiem qua da vao tdn thucmg dudi hudng dan cua C-arm va Xquang tang sdng; ddi vdi benh nhdn ho^i tu vd khudn CXD, khdi TBG dugc dua vao vung hoai tu chdm qua dudng khoan giam dp, cd hudng ddn cua C-arm vd X quang tdng sdng.Tdt cd cac BN da dugc tidn hdnh qui
trinh dieu tri an toan, khdng co bien chung phdi xu ly ngoai trir 1 BN hoai tu vd khuan chdm xuang dui khi tidm TBG bi rd ri dieh vao khe khdp nen benh nhdn dau phai xu tri va kdt qua dieu tri bi anh hudng (kdt qua kem)
CJ nhdm benh nhan KG than xuong dai (nhdm I), khdi TBG ghep vao d KG cd tdng sd 1 TBG tao mau la 16,4 ± 8,6 xlO^ va tdng sd TBG trung md la 70,6± 51,9 xlO^ (bang 1). Thdi gian ddnh gia ket qud lien xuang tdi thidu 6 thdng sau ghep TBG tuy xuang. Sau 6 thang ma khdng thay bieu hien lien xuang dugc coi la thdt bai va phai xem xet ghep TBG tuy xuong ldn 2 hodc chuyen phucmg phap dieu tri Ichac. Trong nghien cuu nay, chung tdi danh gia ket qua d 142 benh nhan cd 142 d KG vdi ty Id lidn xuang Id 84,5 % (120/142 BN), trong dd xuang cdng chan la 85,3% (81/95 BN), xuang dui la 84,2%
(16/19 BN), xuang cdnh tay la 80% (8/10 BN) vd xuang cdng tay la 83,3 % (15/18
H$l NGHI KHOA HOC VJ Tg'BAO Q6C TOAN QUtfC LAN THd 11
BN); thdi gian lidn xuang !a 19,8 ± 9,5 tuan (bdng 2). Hemigou ghdp TBG tuy xuang cho 60 trudng hgp KG teo ddt thdn xuang chdy dat ty 1$ lidn xuang 88,3% vd thdi gian lien xuang la trung binh 12 hidn (4-16 tudn) [8].
Mgt s6 nghidn curu khdc dd cong bo ty 1^ li^n xuang, la 57% 94% (trich dan theo Ippokratis [9]. K4t qud d bdng 3 cho thay nhdm BN lien xuong dugc nh|in khoi TBG cd ndng dg TBG trung md (TB tao cym CFU-F)/ml )va tdng sd lugng TBG trung mo cao han ed y nghia thong ke so vdi nhdm BN khdng lien xuang, cdn ndng dg va tdng sd lugng TBG tao mau thi tuang tu nhau giiia hai nhom. Nhu vay, cac thanh phan td bdo cd trong khdi TBG cd anh hudng den hieu qua lien xuang nhung vai trd cua tung loai te bao la khdng ngang nhau.Anh hudng cua TBG tao mdu khdng ro ret edn anh hudng cua sd lugng TBG trung md tdi qua trinh lien xuang Id khd ro rang. Theo Hemigou, sd lugng TBG tuy xuong ghep cho BN anh hudng tdi ket qud lien xucmg. Trong 60 BN khdp gia than xuong chay dugc ghep TBG tuy xuang, tdc gid thdy 7 BN khdng lien xuang cd ndng do va tdng sd TBG trung md dugc xac dinh qua nudi cay CFU-F tuong ung la 634 ± 187 TB/cm' vd 19324 ± 6843 TB, thdp han cd y nghia thdng ke so vdi 53 BN lien xucmg [8].
6 nhdm BN hoai tir vd khudn CXD (nhdm II), khdi TBG dugc tiem vdo vj tri hoai tu d chdm qua dudng khoan giam dp cd sd Iugng td bdo CD34+ la 13,7 ± 11,5 xlO^
sd Iugng TBG hung md la 48,6 ± 31,0 x 10^
(bdng 1). Thdi gian theo ddi sau ghep TBG tmng binh Id 23,8 thdng (tir 10-40 thdng).
Danh gid theo thang didm Harris sau ghep TBG cd 6 BN (12%) d^t kdt qua kha, 6 BN (12%) dat kdt qua tdt vd 29 BN (58%) dat kdt qua rdt tdt. Cdn lai 8 BN (16%) cd kdt qud trung binh, 1 BN (2%) cd kdt qua kem (bang
4). Nhdm BN cd ket qua didu tri tir kha trd ldn nhan dugc khdi TBG cd tdng sd lugng TBG tmng md cao hon cd y nghia thong kd so vdi nhdm BN cd ket qud didu tri tmng binh va kem (47,7 ± 36,8 xlO^ so vdi 32,2 ± 19,2 x\0\ p<0,05). Cdn thanh phdn TBG tao mdu ciia khdi TBG thi tuang ty nhau giua hai nhdm (bdng 5). Vdi kdt qud thu dugc cd thd thay BN dugc ghdp nhidu TBG tmng mo ban cd ket qua dieu tri tot han. Hemigou va cdng sy dd thdng bdo kdt qua nghien cuu d 116 BN vdi 189 khdp hdng dugc dieu tri bdng khoan gidm dp va tiem TBG , nhimg BN nay dugc theo ddi tmng binh Id 07 ndm (5- 11 ndm) ket qud trong 189 khdp hang thi co 34 khdp hang (chiem 18%) can phdi thay khdp hang nhdn tao. Tdc gid cihig nhdn thay nhihig BN phdi thay khdp hang nhan tao dugc ghep sd lugng TBG trung mo it hon co y nghia thdng ke so vdi cac BN cdn lai [7].
Ci nhiing benh nhdn keo ddi chi, thanh phan va so lugng cdc TBG dugc tiem vao 6 cang dan dugc trinh bdy d bang 6.Thdi gian Iidn xuang tmng binh cho 1 cm keo dai d nhdm BN cd kdt hgp ghep TBG vdi d§ ddi tnmg binh cua 6 cdng dan 7,2 cm la 29,5 ± 4,5 ngay , ngdn han cd y nghia (p <0,001) so vdi nhdm BN chi dieu tri keo ddi chi b5ng phuang phap cdng dan theo nguyen ly Ilizarov dan thudn vdi do ddi trung binh cua d cdng ddn la 5,9 cm(bdng 7).Kitoh va cgng sy (2006) [10] tiem td bdo goc hung mo ldy tir tuy xuang ty than sau khi nudi cdy vao 6 cdng ddn trong keo dai chi da dat dugc thdi gian lien xuang tnmg binh la 28,6 ngay/lcm keo dai d nhdm keo dai chi nang chidu cao vdi do dai tmng binh cua d cdng ddn Id 8,3 cm. Nhu vdy thdi gian lidn xucmg trung btnh cua nhdm keo dai chi trong nghien curu cda chiing tdi ciing tucmg duong vdi k^t qua nghien curu cua Kitoh va cdng sy. D5 Tien
38
Y HOC Vl|T NAM THANG 4 - S6 OAC Bl|T/2013
DOng (2001)[2] tidn hanh keo ddi chi ndng chidu cao cho 10! BN vdi nh&ng 6 cdng ddn c6 dd ddi trung binh 5,8 cm nhung khdng tiem TBG hay xuang, k^t qua dat dugc thdi gian lidn xuang tmng binh cho 1 cm keo ddi Id 39 ngay. Trong nghidn cuu ndy chung tdi cung da theo doi d6ng thdi 40 BN keo dai chi vdi 80 d cang ddn theo nguyen ly Ilizarov don thuan khdng ghdp TBG, thdi gian lidn xuong trung binh cho 1 cm keo ddi dat dugc la 39,3 ± 6,3 ngdy( bdng 7).Nhu vay vdi viec tidm bd xung TBG tuy xuang vao d cdng dan, thdi gian lien xuang cho 1 cm k^o ddi da gidm di ddng kd (khodng 25%). K^t qud nay da cho thay, tiem khdi TBG tuy xucmg vao d cang dan ngay sau khi het giai doan cdng dan rat cd hieu qua vi thdi gian lien xuong dugc rut ngan se lam gidm thdi gian nam vien, giam chi phi, BN dugc tap van dgng sdm Idm gidm bien chdng vd nhanh chong phuc hdi chdc ndng van ddng cua hai chi dudi.
Tdm Iai d cd 3 nhdm BN su dung TBG tuy xuong ty than ghep vdo vi tri tdn thuong ddu cho thay hidu qud rd ret trong dieu tri lidn xuong vd phuc hdi ton thuang trong dd sd lugng TBG trung md dugc ghep cd tuong quan vdi kdt qua dieu tri. Tuy nhien ddy ciing chi Id nhihig kdt qud budc dau, can tidp tuc md rdng nghidn curu vdi sd lugng benh nhdn ldn hem, thdi gian theo ddi lau ban va cd nhfing phuong phdp danh gid tdt hon de cd the minh chung mdt each chinh xdc vai trd cua TBG tliy xuong trong didu tri.
V. KET LUAN
Qua nghidn cihi ung dung phuang phdp didu tri ghep TBG tuy xuang ty than cho 228 BN cd cac tdn thuang xuong khdp khd hdi phuc tai Benh vidn Tmng U'ong Quan dgi
108 vd B?nh vi$n Vi?t Dire tir 02/2007 - 8/2012 da cho thdy :
- Ghep TBG tiiy xuong cd hidu qua r6 r^t trong didu tri lien xucmg vd phuc hdi cdc ton thuang xuong khdp:
+ Nhdm bdnh nhdn KG than xuong ddi cd ty 1? lien xuong Id 84,5 % vdi thdi gian lien xuong la 19,8 ± 9,5 tudn.
+ Nhdm BN hoai tilr vd khudn CXD: 82
% BN cd ket qua dieu trj tir khd ddn rdt tdt theo thang diem Harris.
+ Nhdm BN keo dai chi cd thdi gian lien xuong trung binh cho 1 cm keo dai Id 29,5 ± 4,5 ngdy.
- Cd mdi lidn quan giii'a sd lugng te bdo gde dugc ghep vd kdt qua didu tri:
+ Cdc BN khdp gid lien xuong va nhihig BN hoai tu vo khuan chdm xuang dui cd ket qud dieu tri tir khd den rdt tdt da dugc ghep sd lugng TBG tmng md cao hon ro ret so vdi nhihig BN khdp gid khdng lidn xucmg vd nhiing BN hoai tii vd khuan chdm xuong dui cd ket qua dieu tri tnmg binh, kem.
+ Cac BN keo ddi chi ket hgp vdi ghep TBG tuy xucmg cd thdi gian lien xuang trung binh cho 1 cm keo ddi hgan hon dang kd so vdi nhdm khdng sir dyng TBG tuy xuong (29,5 ± 4,5 ngay va 39,3 ± 6,3 ngdy)
TAI LIEU THAM KHAO
1. ARCO (Association Research Circulation Osseous) (1992), "Committee on Terminology and Classification", ARCO News: p. 41-46.
2. Do Tien Dung (2001), "Diau chinh sy chenh l^ch do dai hai chi dudi bing phau thuat keo dai chi theo nguyen ly cua Ilizarov." Lugn dn tien syy hgc. Hgc vi^n qudn Y.
3. Emer C(2005), "CuIUire of Human and Mouse Mesenchymal Cells". Methods in Molecular Biology, vol. 290: Basic Cell Culture Protocols, Third Edition, Edited by:
Hdi NGHI KHOA HQC VJ TJ BAG G 6 C TOAN QUdC LAN THd II
C. D. Helgason and C. L. Miller © Humana Press Inc., Totowa, NJ.
Gangji V, Hauzeur JP, Matos C, et al.
(2004), "Treatment 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.
Harris W.H. (1969), "Traumatic arthritis of the hip after dislocation and acetabular fractures; treatment by mold arthroplasty. An end-result study using a new method of result evaluation". J Bone Joint Surg Am, 51(4): p.
737-55.
Nguyen Thi Thu Ha va CS (2011), Nghien curu xay dyng qui trinh sti dyng te bao g6c tao mau ty than de dieu trj cac ton thirong CO, khdp, xucmg kho Uer\"Di tdi Dpc Igp cdp Nha nu-dc, ma so DTDL2008 T/J5 da nghiem thu
Hemigou P and Beaujean F (2002),
"Treatment of osteonecrosis with autologous
bone marrow grafting", ClinO rthop Relat
^ e j . 405:p. 14-23.
Hernigou P, Poignard A , Beaujean F, et al. (2005), "Percutaneous Autologous Bone- Marrow Grafting for Nonunions. Influence of the Number and Concentration of Progenitor Cells", J Bone Joint Surg Am. 87: p. 1430- 1437.
Ippokratis P, Theodora G, George K, et aL (2010), "Efficacy of minimally irvvasive techniques for enhancement of fracture healing: evidence today", International Orthopaedics (SICOT). 34: p. 3-12.D01 10.1007/s00264-009-0892-0.
I. Kitoh H, Kitokoji T, and Tsuchiya (2007),
"Transplantation of culture expanded bone marrow cells and platelet rich plasma in distraction osteogenesis of the long bones", Bone. 40: p. 522-528.
. Sutherland DR, Anderson L, Keeney M, et al. (1996), "The ISHAGE guidelines for CD 34-H cell determination by flow cytometry", J.Hematotherapy. 5: p. 213-236.
