TAP CHl NGHIEN CU'U Y HQC •
DAC TINH SINH HOC CUA NEP VIT T y TIEU DUNG TRONG P H A U THUAT
Tru'cng Manh DQi Vidn Ddo tgo Rdng Hdm ti^$t - Trudng D,gi hgc Y Hd I Nghidn cuv nhim ddnh gid thdi glen phin hOy hodn todn ciia cdc logi ngp vit tw tidu dung trong ph thuit vd phin ung bit Igii md cua cdc logi ngp vit tu' tidu. Kit qud cho thiy thdi gian tidu hodn todn tru binh cug ngp vit PLLA Id 4.57 ndm. thdi gian tidu hodn todn trung binh cda ngp vit P(D/L)LA 70/30 Id 2, ndm. thdi gian tidu hbdn todn trung binh cua ngp vit PGLA Id 1,26 ndm. Ty Id cd phdn ung md mim c ngp vit PGLA Id thip nhit (0.087%) Kit ludn: Ngp vit logi PGLA cd thdi gian tu Hdu nhanh nhit vd cd phdn Ong phu cda md mim cd thi dugfc sd dung rdng rdi.
Key words: n^p vit ty tidu, d$c tfnh sInh hpc I. DAT V A N oe
Ngp vit ty tidu Id mOt logi vdt lidu ty tidu sinh hpe duac nhdc din gan 20 ndm ngy. Ngp vit ty tieu duoc su dyng d l ddng nhu nep vit Titanium vd khdng can phdu thudt thdo bo nep do qud trinh ty phdn huy ciJa ngp trong ea thi thanh CO2 vd H2O sau thdi gian trung binh 36 - 60 thang, qua trinh phdn huy bit dau sau 6 thdng [1] Td khi eO nep vit ty tidu ra ddi thi cac bdnh nhdn duoc hudng nhilu lai leh hon.
Cde bdnh nhdn khdng cin phai tien hdnh phlu thudt lln 2 d l thdo nep vit. Dde bi$t ngp vit ty tieu cO hidu qua trong dilu trj phiu thudt ung thu nhlt Id khi tdi ldp vd ghdp cde mdnh xuang nho vl chiing khOng anh hudng gl din lidu phdp xg trj sau phlu thudt Tuy cO nhilu loi ich khi su dyng nhung ngp vit ty tidu vln ehyg duae chip nhdn thay thi ngp .Titgnium.
Ly do chlnh Id ngp vit ty tidu khOng du dO bin can thilt, phan dng vdi mO vd khd ndng tidu khdng hodn todn [3]. Cdc nghidn cdu v l dde tinh sinh hge cua ngp vit ty tidu cdn nhilu tranh ludn. Do vdy nghidn cdu ndy nhlm ddnh gid thdi gian phdn huy hodn todn eua cdc logi ngp vit ty tidu dung trong phlu thudt vd phan dng bit lai mO cua cdc logi ngp vit ty tidu.
II. D 6 I TU'O'NG VA PHU'aNG PHAP Cdc nghidn cdu thu nghidm Idm sdng c nhOm chdng v l cdc dde tlnh sinh hgc cua n?
vlt ty tidu duac xult bdn trdn PubMed td nSi 1995 din nay duac phdn tich Igi theo phuon phdp ting quan (meta-analyssis). Tidu chu^
lya chpn bao gom cdc nghidn cdu thu nghldr Idm sdng cd nhdm chdng trdn in vivo va 1 vitro duoc xult ban bdng tilng Anh, Tifi chuin loai trd bao gom cdc bai bdo ting quai mO ta, cdc nghidn cdu chi cO phan tOm ti khOng day du thOng tin vd quy trinh nghi&
cdu khdng rO rdng, cdc nghidn cuu khOng 6\
dO tin cdy, cdc nghidn cdu khOng xult b^i blng tilng Anh. Nghidn cdu duoc thuc hi$i trong giai dogn td 1/3 din 1/10/2010. Sudyrx phln mim EndNote 4,0, eO 26 nghidn ciru d nghidn cdu v l cdc ddc tinh sinh hgc cua nef vlt ty tidu duoc lya chgn.
III. KtT QUA
Nghidn cdu gim 3 nhdm vdt lidu: PLU PLGA vd P (D/L)LA 70/30. Tong so ed 26 nghidn cdu, trong dO cd 7 nghien cdu vl nep vit ty tidu PLGA chilm ty Id 26,9%, 11 nghiSn cdu v l ngp vlt PLLA chilm ty td 42,3%,,^
nghidn cdu v l nep P(D/L) LA 70/30 chilm tf
Id-26,9% 1 nghidn cdu v l nep PLGA va
• TAP CHl NGHIEN CU'U Y H p C P(D/L) LA 70/30 Chilm ty Id 3,9%,
Nghien c d u tren n g y d i c h i l m ty Id 7 3 , 1 %
;i9/26) cao han rO rdt so vdi cdc nghidn cdu rdn dOng vat (7/26). S u khdc bigt gida hai nhdm nghidn cdu cO y nghTa t h i n g kd vdi p < 0,05
Cdc nghidn c d u d u a e chia thdnh 3 ITnh ju-c phdu thudt: phdu thudt sp mdt, p h i u thudt l d m m a t v d phdu thudt xuang khdp, ddy
c h l n g . S l lug'ng nghidn c d u v l p h i u thudt hdm mdt e h i l m ty 1$ cao n h l t 42,3% (11/26).
S l lug'ng nghidn edu v l p h l u thudt sg ehilm ty Id 30,8% (8/26) vd p h l u thugt xuong khdp, ddy chdng e h i l m ty Id 26,9% (7/26) S y khde bidt giua cdc ITnh v y c nghidn c d u khOng cO y nghTa t h i n g kd vdi p > 0,05.
Dde d i l m sinh hge cua ngp vit t y tidu B a n g 1 . T h d i g i a n t i e u h o a n t o a n cua n e p vft P L L A
_ . . . T h d i gian
" ? * ! ! " Tac gia nghien cu-u ^ * LTnii v ^ c p l i l u t h u ^ t tleu'ho'^n ' ' ^ " i ' T " ^ t o i n (nam) , „ j ^ ,
Ngi^di
Bergsma 1995 10 PhSu thuSt him mSt P h i u thuat t j l tao d$y ch^ng
5,7
4.57 ± 1 , 6 3 4 (n = 30)
Bong
Peltoniem 1998 Suuronen 1998 Jukkala-Partio 2002
9 6 10
PhSu thuat so PhSu thuat him mat Phlu thuat xu'ong dCii
2 5 3
Laitinen 2002 18 Phdu thudt x y o n g diii 4,53,67 ±1,11 ( n = 4 2 )
Thdi gian tidu hodn todn trung binh eua nep vlt PLLA tren ngudi la 4,57 ndm eao hon so vdi thdi gian tidu hodn todn trung binh cua nep vit PLLA tren dong vdt Id 3,67 ndm. Sy khde bidt giua thdi gian tidu hoan todn trung binh cua nep vit PLLA trdn ngudi vd dpng vdt khdng cO y nghla thing kd vdi p > 0,05
B a n g 2. T h d i g i a n t i d u h o d n t o a n c u a n g p v i t P G L A
Nhdm
nghien Tac gia nghidn CI!FU CU'U
8 6
l u v n g LTnh viPC phdu t h u a t
T h d i gian T h d i gian tieu hodn tieu t r u n g
t o d n binh (nam) (nam)
Ngudi
Phau thudt hdm mdt 1,7 Landes
2006
1,26 + 0,69 Phau thudt hdm mdt 1 (" = "^2)
DOng vgt
Eppley 1997 Peltoniem 1999
Phdu thudt so
1,50 + 0,39 (n = 68)
TAP CHl NGHlgN CI^U Y H(JC
Th*i gian ti6u hoin toSn trung binh cua nep vlt PGLA trSn ngu'di la 1,26 nSm thSp hon so v(
thin gian tiSu hoSn toan trung binh oua n?p vlt PGLA trSn fling vSt la 1,50 nam. Sif khac bi(
giO-a th« gian ti6u hoSn toan trung binh oua nep vlt PGLA trSn ngu-ffl va dOng v^t khang c6 nghTa th6ng k6 v6'i p > 0,05.
Bing 3. Phin O'ng cua mfl mim v&\ c4c lo?l n?p vit tif ti^u
LofI n^p vit
Tic gia
S6
lu'9'ng Linh V\IK phiu thuit
S6 lu'O'ng d6i tiling nghidn ci>u cd phdn l>ng md mem
Tyi#cd phdn (rng md ment
PLLA
PGLA
P (D/L) LA 70/30
Warden 1999 Kallela 1999 Arata 2003 Kallela 2005 Kaeding 2006 Ashammakhi 2004 Eppley 2004 Serlo 2007 Serlo 2001 Hoffmann 2002 Cheung 2004 Yerit 2005 Barber 2005 Bell 2006
10 11 16 40 48 165 1883
10 2 22 30 13 61 59
PhSu thuat tai tao day chSng PhSu thuSt ham mSt
PhSu thuSt xu'ong khdp PhSu thuat ham mit PhSu thuat tai tao day
Chang PhSu thuat so PhSu thuat sp a tre em PhSu thuat SQ d tre em
PhSu thuat so PhSu thuSt ham mat PhSu thuat ham mat PhSu thuat ham mat PhSu thujt tai tao day
Chang PhSu thu$t ham mat
1 0- 2 2 6 6 12 0 0 2 2 0 0
11/125 (8.8%)
18/2058 (0,087%)
(3,74%)
Ty \i ci phin ii'ng mO mSm cu^ nep vlt PLLA la 8,8% (11/126) cao hon rO r$t ty I* c6 phan Lcng mfl mSm cua nep vit PGLA la 0.087% (18/2058). SU' khac biat glO-a tJ 1$ c6 phan O'ng mS mem oua nep vit PLLA va nep vit PGLA c6 y nghla th6ng ke vdi p < 0,05. Ty li CO phan u'ng mfl mim cua nep vit P(D/L)LA 70/30 la 3,74% (7/187) cao hon rfl ret ty 1$ cd
phSn U'ng mfl mem cua nep vit PGLA IS 0,087% (18/2068). Si,r khac bi$t giO'a ty I6c6 ph^n LPng mfl mem cua nep vlt P(D/L)I^
70/30 va nep vit PGLA ofl y nghla th6ng te
vdi p < 0,06. Ty 1$ cd phan t^ng mfl mim cOa
nep vlt PLLA la 8,8% (11/126) cao hon t} 16
cd phSn i>ng mfl mSm cOa nep vlt P(D/L)LA
70/30 la 3,74% (7/187). Sif khac blM gi»a t(
<Tm mj Y Hpc
Id CO phan dng mO mem cCia ngp vit PLLA vd nep vit P(D/L)LA 70/30 khdng cO y nghTa t h i n g kd vdi p > 0,05.
IV. BAN LUAN
Thdi gian tieu hodn todn trung binh eua nep vit PLLA Id ddi nhdt (4,57 ndm), thdi gian tieu hodn toan trung binh eua ngp vit P(D/L)LA 70/30 Id 2,41 nam, thdi gian tidu hodn todn trung binh eua nep vit PGLA Id ngdn n h l t (1,26 ndm). S y khde bidt gida thdi gian tidu hodn todn trung binh eua cdc logi ngp vit ndy eO y nghla thong kd. Nghidn cuu ndy eung cho eiing k i t qua vdi cde nghidn edu t i n g quan ndm 2000 [3, 5].
Thdi gian tidu hodn todn trung binh cua ngp vit PLLA tren dOng vdt Id 3,67 ndm ddi han so vdi thdi gian tieu hodn todn trung binh cua nep vit PGLA tren dOng vdt Id 1,50 nam [4]. S u khdc biet giua thdi gian tidu hodn todn trung binh cua hai loai nep vlt nay cd y nghTa t h i n g kd vdi p > 0,05. K i t qua nay eho thay nep vit PLLA cd thdi gian tieu hodn todn ddi han thdi gian tieu hodn todn cua nep vlt PGLA trdn ca ngudi va dOng vat. Thai gian tidu hodn todn trung binh cua nep vit PLLA trdn ngudi Id 4,57 ndm cao hon so vdi thdi gian tidu hodn todn trung binh cua nep vit PLLA trdn ddng vat la 3,67 ndm Thdi gian tidu hodn todn trung binh eua nep vit PGLA tren ngudi Id 1,26 nam thdp han so vdi thdi gian tidu hodn todn trung binh cua ngp vit PGLA trdn ddng vdt td 1,50 ndm [2]. S u khdc bidt gida thdi gian tieu hodn todn trung binh cua nep vlt PLLA, PLGA trdn ngudi vd dpng vat khOng eO y nghTa thdng ke. Ty Ig cO phan dng mO m i m cua nep vit PLLA (8,8%) va nep vit P(D/L)LA 70/30 (3,47%) cao hon ty Id eo phan dng md
m i m eua ngp vlt PGLA (0,087%) [3]. Sy khdc bidt gida ty Id ed phan dng mO m i m cua ngp vit PLLA vd ngp vlt P(D/L) LA vdi ngp vft PGLA CO y nghTa t h i n g kd.
V. KtT LUAN
Thdi gian tidu hodn todn trung binh eiia ngp vit PLLA Id 4,57 ndm, thdi gian tidu hodn todn trung binh cua ngp vlt P(D/L)LA 70/30 Id 2,41 ndm, thdi gign tidu hodn todn trung binh cua nep vit PGLA Id 1.26 ndm. Ty Id cd phdn dng mO m i m cua ngp vlt PGLA Id t h i p n h l t (0.087%).
TAI LIEU THAM KHAO
1. A m b r o s e CG, Clanton TO (2004).
Bioabsorbable implants: Revievi/ of clinical experience in orthopedic surgery Ann Biomed Eng; 32, 171-177.
2. Arata J , Ishikawa K, Sawabe K et al (2003). Osteosynthesis in digital replantation using bioabsorbable rods Ann Plast Surg 2003;
50, 350-353.
3. A s h a m m a k h i N, Peltonremt H, Waris E et al. Developments in craniomaxiliofaeiai sur- gery: Use of self-reinforced bioabsorbable osteofixation devices Plast Reeonstr Surg;
108, 167-180
4. Barber FA, Dockery WD (2008). Long- term absorption of beta-tncaleium phosphate poly-L-lactic acid interference screws Arthro- scopy, Apr; 24 (4), 441-447.
5. Yerif KC, Hainieh S, Enlslidis G et al (2005). Biodegradable fixation of mandibular fractures in children' stability and early results Oral Surg Oral IVled Oral Pathol Oral Radiol Endod, 100, 17-24
TCNCYH 79 (2) - 2012
T«P CHi NGHliN CI>U Y HQC
Summary
BIOLOGICAL CHARACTERISTICS OF BIOABSORBABLE PLATES
The study was to evaluate the complete absorption time of bioabsorbable plates in surger) and adverse tissue reactions of the type of plates. The results show that time of full absorption o PLLA is 4.67 years, time of full absorption of P(D/L) LA is 2 41 years, time of full absorption o PGLA IS 1 26 years Adverse tissue reactions of PGLA is the lowest (0.087%). In conclusion.
PGLA bioabsorbale plates has appropriate absorption time and has the lowest adverse tissue reactions, which can be widely used
Key words: bioabsorbable plates, bioabsorbable materials
LCNG DUNG LAM SANG CCiA KEO P H A U THUAT LEPAMED TREN DONG VAT
Ngo Duy Thin\ Cao van Dilm' 'TruvngD^Ihi?c YHiNiii^Viin Tmng thiet bi vi Cing trinh Vti-BiVte Keo dinh phiu thuit (suigical adhesive glue) hay keo sinh hoc (biogiue) sir dung trong ngo$i ithoa ie cim mau. ket dinh vet thuong da du^ sin xuat va su dung phi biin Irin thi gidi Keo phiu ttiu^
Lepamed do viin Trang thiet bi va Cong trlnh ytiBOY ti Viet Nam chi tao nSm 2008 Tnmc khi dua vao . sir dung lien lim sing cin phai duvc thir nghlim Irin ding vit Di tai lien hinh nhim dinh gii khi nang
cim mau va danh gii khi ning phu hqtp mi vi liin mi eia keo lepamed Kit qui cho thiy keo Lepamei CO kha ning cim miu, kit dinh vi lam liin mi a da, gan
lip khoa; keo dinh phlu thu$t, Iteo sinh h^c, Lepamed, cSm mdu, phu hg'p md
I. BAT
V A NDt
sulfacrylate cua Nga v.v... Nam 2008, vi^n Keo phiu thuat da du-oc the gi*! san xuat Trang thiet bi va CSng trinh y t4 - BO Y tl ffl va siJ dung tit nhttng nam 1940 Trong chiln sin xult thanh cOng l<eo phiu thuat Lepamed.
tranh thi gi6i thij 2 dupe dung d l cim mau, Thanh phin h<Sa hpc ciJa keo Lepamed gom N kit dinh vet thu-ong. Tit nhCrng nim 1960, _ Butyl cyanoacrylate (99,99%), sulfua lu»
trong chiln tranh Viat Nam, quan dOi IWly aa huynh va axit acetic,
cung da sii dung keo nay d l oim mau tam BSn canh tac dgng cim mau, cac keo sinli thdi cho thu-ong binh trong khi ohuyin v l hoc odn o6 tac dung kit dinh cac m6, khSng benh vi$n tuyin sau [11. Ba phin keo dinh cin khau, gulp banh nhan rut ngin thOi gian sinh hoc dlu c6 nguin gic tO- cyanoacrylate nim vi#n do chO- cat chi. Keo cung gitip * nhu- keo sinh hpc Glubran, Glubran 2 ciJa cac bac sT bit cac IB thijng nho ma khong cJn Italia, keo dinh ngoai khoa Bioglue Surgical khau, k l o i l6 thiJng giac mao [2]. Keo hS tf!
Adhesive (BSA) oua MJ, h i ohing vi6m, cac bac si nOi soi d l dang thu-o hi^n oac thao khang khuin diing trong ngoai khoa tac trong phlu thuat, ke o i nhO-ng phau thujl
