TAP CHt V HOC VigT HAM TAP *S5 - THANG 4 - sg 2 - 2018
IV. K f r LU&N
Than ktnh thanh quan khdng quat ngu'dc la mpt hten tu'dng giai phau hiem gap (0,3 - 1 % ) , va tang nguy cd bj ton thu'dng trong khi phau thuat, thu'dng dan tdt liet day thanh tam thdi hoac vTnh vien. Sii hteu biet ro ve tan suat, nguon goc, nguyen nhan xuat hien than kinti thanh quan khong quat ngu'dc giup gtam thieu nguy cd tam ton thu'dng than kinh thanh quan khong quat ngu'dc, va dong thdi gdp phan vao thanh cong cua cuoc phau thuat.
TAI LIEU THAIVl KHAO
1. Marches! M, Biffoni M, Faloci C, Nobili Benedetti R, Notari P, Mariotti F, et al. The inferior nonrecurrent laryngeal nerve; A report of 7 cases
observed since 1987. G Chir. 2000;21:25-8.
z. Brandon Michael Henry, Silvia Sanna, Hatttiew J. Graves, et al. The Non-Recurrent Laryngeal Nen/e: a meta-analysis and clinical considerations.
PeerJ. 2017; 5: e3012
3. Toniato A, Mazzarotto R, Piotto A, Bernante P, Pagetta C, Petizzo MR, Identification of the nonrecurrent laryngeal nerve during thyroid surgery: 20-year experience. World J Surg.
2004;28:659-661.
4. Casal, D., Pegas, A., Sousa, D. & Rosa-Santos.
A non-recurrent inferior laryngeal nen/e m a man undergoing thyroidectomy: a case report. Journal of Medical Case Reports. 2010; 4:386.
5. Campbell, P. R., Serpell, 3. W. & Young, E.
Non-Recurrent Laryngeal Nerves. The Role of Digital Subtraction Angiography to Identify Subjects. Australian and New Zealand Journal of Surgery. 1991; 61,358-9.
DANH GIA TINH TRANG KHUC XA GIAC MAC SAU GHEP GlAC MAC XUYEN
Le xuSn Cung*, Ph^m Ngoc Dong*, Nguyen Dinh Ngan**
T6IVI TAT
Mpc tieu: Nghien ciTu nham danh gia tinh trang khue xa giac mac va sii bien dSi ciia khiic xa giac mac sau ghep giac mac xuyen dieu tri mot so benh ly giac mac. oiSi iU0ig nghien cui/: 35 mat ciia 35 benh nhSn bj cac tD#nh ly giac mac da dUdc ghep giac mac xuyen dieu tri tai khoa Ket giac mac, Benh vien Mat Trung u'dng trong thdi gian 2 nam 2012 - 2013, PhUdng phap nghien cdir. Nghien ciili mo ta hoi CLTU. Kei qua nghien cdu: Tnidc mo, tat ca m§t nghien ciin co thi li/c dUdi 2Q1100, trong do nhieu nhat la nhom thj lUc du'di dem ngon tay l m (54,3%).
Sau m6, thj IUc diidc cai thien dang ke vdi mu'c thi lu'c trung liinh tai thdi diem sau 3 thang la 20/170 (p<0,05), thi lyc tang dan va on djnh d 24 thang.
Tnidc mo khong do du'dc khue xa giac mac benh ly, sau mo khiic xa giac mac trung binh la 41,68D ± 4,67D tai thdi diem 3 thang va on djnh den 24 thang sau phau ttiuat vdi tat ca cae mSt deu co loan thi vdi do loan thi sau 3 thang trung btnh la 5,82D ± 3,038D, sau do dp loan thj giam dan va on dinh t^i thdi diem sau phau thuat 24 thang vdi dp loan th| trung binh la:
5,56D ± 2,35D. Kei luan: Sau phau thuat ghep giac mac xuyen thi lu'c du'dc eai thien dang ke nhuYig khong cao do hau het giac mac ghep dSu bi loan thj vdi do loan thj kha cao, dp loan thj giam dan theo thdi
*Binh viin Mat Trung l/dng
**Binh viin Quan Y103 Chju trach nhiem chinh: Le Xuan Cung Eniail; [email protected] Ngay nhan bai: 2.2.2018 Ngciy phiin bien khoa hoe: 30.3.2018 Ngay duyet bii: 10.4.2018
gian va on dinh sau phau thuat 24 thang. Do vay, ran oo cac bi|n phap diiu chinh loan tJij giac mac ghep sau phau thu|t de cai thien hdn nu^ th| li/c cho ngUdi binh.
Tdkhda: ghep giac mac xuyen, khue xa giac mac, loan thi,
SUIVltVlARY
ASSESSEMENT THE CORNEAL REFRACTION AFTER PENETRATING KERATOPLASTY Objectives. This study aimed to assess the corneal refraction and its changes after penetrating keratoplassty. Subjectives: Thirty five eyes (35 patients) with corneal diseases were undergone penetrating keratoplasty in the Corneal and External Disease Department, National Institute of Ophthalmology from year 2012 to 2013. Method:
Retrospective observation. Results: Before surgery, 35 eyes had visual acuity below 20/200 with most of them were under countfingers (54.3%). After surgery t^e visual acuity of all eyes were improverd significaltly, the average visual acuity was 20/170 at 3 postoperative months, it increased and stabilized at 24 months postoperatively. Preoperative corneal refraction could not be got because of corneal diseases. The average corneal refraction was 41,68D
± 4,670 in 3 postoperative months, it changed and stabilized In 24 montJis postoperatively. After surgery all eyes had corneal astigmatism with its average of 5,82D ± 3,038D in 3 postoperative months. The corneal astigmatism was decreased and stabilized at 24 months with 5,56D ± 2,35D. Conclusion: Almost corneal grafts had high astigmatism, which decreased by following time and stabilized at 24 postoperative months. Correcting corneal astigmatism should be done to improve the visual acutity of the patients
Keywords: penetrating keratoplasty, refraction, astigmatism.
VIETHAM MEDICAL JOURNAL N°2 • APRIL - 2018
I. BAT VAN OE
Ghep giac mac xuyen quang hpc vdt ty le thanh cong cao (khoang hdn 90%) da trd thanh mpt trong nhu'ng phu'dng phap phau thuat pho bien nhat dem lai anh sang cho benh nhan bj mii do benh ty giac mac. Ngu'dc tat vdi nhuTig thanh eong ve mat giat phau, trong mot so tru'dng hdp thj lu'c benti nhan khong du'dc cat thien nhteu ma nguyen nhan quan trpng dd ta bten dot khiic xa giac mac sau phau thuat. Cong suat khue xa gtac mac ctilem 2/3 cong suat khiic xa chung ciia toan nhan cau. Chi'nh vi vay can thiep vao giac mac trong phau thuat ghep gtac mac xuyen dan den nhi?ng tiiay dot khiic xa tdn. Co rat nhieu nguyen nhan gay nen su" bien doi khue xa giac mac sau phau thuat nhutig nguyen nhan chii yeu lien quan den khoan tao nen ghep, manh ghep va ky thuat khau manh ghep. Cau true ciia bd manh ghep va nen ghep khong hoan toan triing khit, do eang ciia cac mui ehi khdng ddng deu tao ra nhiiYig viing gtac mac det hdn binh ttiu'dng, tao dp doc d trung t3m manh ghep va dp tpan t^i Ididng deu cao sau phau thuat.
O nddc ta, da cd nhieu cong trinh nghien eiiu ve ghep giac mac xuyen. Tuy nhien, chu^ cd nghien eufU nao ve bien doi cua khiic xa giac mac sau phau thuat ghep gtac mac xuyen. Vi vay ehung tot tten hanh nghien CIJ\J danh gla tinh trang khiic xa giac mac sau phau thuat ghep giae mac xuyen tai Wioa K§t gtac mac, benli wen Mat VN.
IL o d l TUQNG VA PHU'aNG PHAP NGHIEN COU 1. Ddi tu'dng nghien cilI'u: Nghien cdu dddc tien hanh tat khoa Ket giac mac, benh vten t^^t Trung u'dng tir thang 11 nam 2013 den tliang 9 nam 2014. Ooi tu'dng nghien ciru la nhu'ng benh nhan du'dc ghep giac mac xuyen quang hpc khong bi phan iing loai manh ghep tai thdi dtem nghien CIJVJ, benh nhan dong y va Uian thu theo quy trinh nghien cii'u.
2. Phifdng phap nghien cu'u: Nghien ciiu mo ta hoi ciTu.
3. Cach thii'c nghien cihi
- Lap ra danh sach nhu?ig benh nhan tham gta nghien cii\i mdt den kham lai. Thong tin ve ngu&i benh, qua trinh phau thuat, dieu tri dude lay tie ho sd benh an lull tru" tai Benh vien l^at TW.
- B|nh nhan du'dc kham lat tat' cac thdi diem sau ptiau thuat 1, 3, 6, 12, 18 va 24 thang. Tai cac thdi diem nghtgn cuXi, benh nhan se du'dc do thj tyc khong kinh, thj ILTC sau khi chinh kinh, kham danh gia tinh trang be mat nhan cau, not nhan va tten hanh do ban do giac mac (sir dung ban do true va ban do khue xa). f a i mot thdi
diem kiem tra, benh nhan du'dc do ban do gi|;
mac nhteu tan va se ghi nhan ket qua ban do it sai so nhat.
Ve khiic xa gi^c mac sau phau thu|it
^ Cong suat khue xa gtac mac (tinh cong suat cau tu'dng du'dngj
•^ Loan thi sau phau thuat theo cac hinh tfiai (Phan ioai diTa vao thang mau tuyet dot tren l)^n do giac m a c ) [ l ]
^ Khong loan thj
v' (2).Loan thj deu: Tren ban (J6 giac mac the hten d hinh that nd doi xirng hoac khong dfii xirng nhau.
^ (3).Loan thj khong deu: kht hai nii^ doc nhat tao thanh gdc > 20 do. Loai nay cdn diTdc gpi la nd cheo
^ Ban do giac mac diTa vao bang phan loai cac kieu ban dd gtac mac sau phau thuat ghep giac mac xuyen[2]
^ Giac mac khong ban thj (Non-astigmatiaoDmeas)
^ Loan thj deu (Regularastigmatism) Kieu liau due (Oval)
Kieu doc that nd doi xiitig (Prolate symmetiic bow t]e (PSBT))
Kieu ddc that nd khong dot xirtig (Prolate asymmetric bow; tie (PAST))
Kieu phang that nd dot xiTng (Oblate symmetric bow tie (OSBT))
Kieu phang that nd khong doi xirng (Oblate asymmetric bow tie (OABT))
v'Loan thj khong deu Phot hdp (r^ixed)
Kieu doc khong deu (Prolate irregular (PI)) Kieu phang khong deu (Oblate irregular (OI))i.
Kieu hinh mdng ngu^ ("'horseshoe" patten) Kieu bp ba C'triple" pattern)
Kieu ddc;/ phang (steep/ flat (SF)) Kieu ddc khu tru (localised steep) Khdng phan loat (unclassttied)
- Quy trinh kham, danh gia va phan loai dude tien hanh bdt ciing mot bac sy. Xir ly so lieu tren chu'dng trinh SPSS 16.0, diing eae thuat toan.
test Paired Sample T-Test, test T- student^, va test T de phan tfch, so sanh ket qua.
- Ket qua du'dc the hien du'di dang ty le %, cac so trung binh, ket qua so sanh su" khac bi^
du'dc cot la CO y nghTa thong ke kht p < 0,05.
4, f)ao du'c trong nghien cihi: Cac da tu'dng nghien ciru tiT nguyen tham gla nghin Cii'u, thdng tin du'dc dam bao bi mat. Nghien ciiu chi nham muc dich gdp phan dem lai thj li/c cho ngu'di benh. Boi tu'dng nghien culi cd quyen ket thiic viec nghien cilii bat cii' lijc nao.
TAP CHi Y HQC V | | T NAM TAP 465 - THANG 4 - SO 2 - 2018
III. KET QUA N G H l l N CU'U
1 . Tinh hinh benh nhSn: Nghien culJ du'dc thdc hien tren 35 fjenh nhan vdi 35 mSt, trong do CO 22 benh nhan nam (chtem ^62.9%) va 13 binh nhan nO' (chtem 37,1%). Tuot thap nhat la l i tudt, cao nhat ia 74 tudt, do tudt trung binh la 39.09 ± 17.94.
2. Thj lu'c b@nh nhSn tru'dc phSu thu$t Bangl: Tinh trangtitilutbjydcf^u thuat
3. Dac diem chan doan tru'dcjihau thuat Bing 2: Chan doan trUdcphiu thuat
Thj lu'c
< O N T l m OlfT l m - DNT 3m DNT 3m^- < 20/200
Tdng so
So mat ( % )
19 (54.3%) 14 (40.0%) 2 (5.7%) 35 (100%)
Hau het mat tru'dc phau thuat (94,3' lu'c < DNT 3m.Nguyen nhan Seo va due
giac mac Loan du'dng giac mac di truyen Benh giac mac
hinh chdp Tong so
So mat
14 (40%)
15 (42.9%)
6 (17.1%) 35 (lOQo/o)
Tudi trung binh 30.5 ± 13.7
54.4 ± 11.3
20.0 ± 5.6
Trong nghien cu'u, benh nhan bj loan du©ng giac mac di truyen chiem ty le cao nhat la 42.9%
v6i 15 mat, benh giac mac hinh chop chiem ty le thap nhat la 17,1% vcfi 6 mat.
4. Tinh trang thj lu'c sau phau thuat ghep giac mac xuyen Bang 3. "tmh trang thj lu'c sau phau thuat ghep giac mac xuyen
<DNT 3m O N T 3 m - 2 0 / 2 0 0 -
2 0 / 2 0 0 2 0 / 8 0 : 2 0 / 8 0 Tong TL trung
% binh 1 thanq
17(48.6%) 12(34.3%) 6(17.1'
0(0%)35(100%)
20/300 3 thang5(14.3%) 10(28.6%) 16(45.7%)
3(8.6%)35(100%) 20/170
6 thang 2(5.7%)11(31.4%) 19(54.3%)
3(8.6%)35(100%)
12 thang1(2.9%) 5(14.3%) 24(68.e 5(14.3 35(100%) 20/150
18 thang
2(7.1%) 4(14, 18(64.3%) 4(14.3%) 28(100%) 20/150
24 thang
1(4%) 3(12%) 15(60%) 6(24%) 25(100%) 20/143
Kht so sanh th life sau mo d cac thdi diem, chung toi nhan thay thi lu'c sau mo se t i n g den khoang 3 thang sau mo va on dinh den 24 thang sau mo.
5. Thay doi cong suat ichuc xa giac mac sau p h l u thuat ghep giac mac xuyen Bang 4: So sanh khue xa giic mac tai cac thdt diem sau phau thuat.
Thdi gian So mat Hieu chenh lech thi lu'c trung binh Trung binh
Sau FT 3 thanq - 6 thang 33 Sau FT 6 thanq - 12 thanq Sau PT 12 thang - 18 thang Sau PT 18 thanq - 24 thang
Tai thdi diem sau mo 1 thang, do loan thj giac mac cao chung toi chi do ban d5 giac mac dUOc 12 mat. Do vay, chung toi khong du'a vao phan tfch cong suat cau tu'dng du'dng d thdi diem 1 thang sau mo. Tai cac thdi diem con lai cong suat khijc xa cau tu'dng du'dng trung binh d cac thdi diem sau mo giao dpng tir 41.67D den 41.95D. Khi so sanh cong suat cau tu'dng du'dng tai cac thdi diem, chung tni nhan thay trj so nay khong co su' khac biet co y nghTa thong ke vdi gla trj P > (j.05. Nhu' vay, cong suat khue xa cau tu'dng dudng on djnh tLT thdi diem 3 thang den 24 thang. ^
6. Mii'c d6 ioan thi sau phau thuat Bang 5: M&c do loan thi sau phau thuat
6 thang 12 thang 18 thanq 24 thang
5.63 ± 2.25 5.49 ± 2.33 5.47 ± 2.34 5.56 ± 2.35 Tat thdt diem 3 thang sau phau thuat, dp loan thj trung binh la 5.82 ± 3.038, gla tri loan thj thap nhat la 4.36D, gia tri loan thi cao nhat la 9.5D. Bp loan thj sau 24 thang la 5.56 ± 2 . 3 5 .
7. Phan lo^i ki€u loan thj sau phau thuat ghep giac mac xuyen
Bmg6:fiianto^kia/bmiddsm/pl^tin^
Thdi gian 3thang
Oo lo^n thj trung binh ± P d lech ( P i o p l
Kieu loan thj
Khdng loan ttii Loan thi deu
6 thang So m a t
0 (0%) 7 (21.9%)
12 thang S S m a t
0 (0%) 6 (20.68%)
24 thang So mat
0 (0%) 6 (24%)
VIETHAM MEDICAL JOURN/U. N°2 • APRIL - 201S
Oval PSBT BAEfT OSBT OABT Loan thi khonq deu
PI 01
MixedSF LS
Tong sooco%)
3 (9.4%) 3 (9.4%) 1 (3.1%) 0 (0%)
25 (78.1%) 3 (9.4%) 4(12.5%) 9(28.1%) 3 (9.4%) 6(18.8%) 32
(100%)0 3 (10.3%) 2 (6.69%) 1 (3.44%) 0 (0%)
23 (79.32%) 2 (6.69%) 2 (6.69%) 10(34.48%)
1 (3.44%) 8(27.56%)
29
(100%)1 (4%) 2i8%J_
3 C12%J_
0 (0%) 19 (76%) 3 (12%)
2 (8%) 6 (24%) 1 (4%) 7 (28%) 25
(100%) Sau phau thuat ghep giac mac xuyen ty te loan thi Ichong deii (78,1%) cao hdn gap khoang 3 tan loan thj deu (21,9%) va tu'dng doi on dmh trong 24 thang sau mo, trong do kieu loan thi khong deu gap nhieu nhat la kieu phot hdp vdi 9 mat (28.1%).IV. BAN LUAN
Ghep giac mac la phu'dng phap duy nhat cd hieu qua de dieu tri cac benh Iy gay due giac mac, tron^ do ghep giac mac xuyen la phu'dng phap pho bten nhat du'dc ap dung khi ton thu'dng due gtac mac chiem het be day gtac mac [2,3]. Mac dCi sau phau thuat thj \iic benh nhSn du'dc cat thien dang ke nhuhg khdng cao do loan thj giac mac. Cd rat nhieu nguyen nhan gay loan thj giac mac sau ghep giac mac xuyen, ky thuat khoan tao nen ghep, manh ghep va ky thuSt khau manh ghep, cau true cua bd manh ghep va nen ghep khdng hoan toan trung khit, dp cang cua cac mul chi khdng dong d§u.
TnDng nghien culi nay, cdng suat khue xa cau tuUng du'dng trung binh d cac thdi diem sau mo giao dpng tiJ" 41.67D den 41.95D. Ket qua nay phij hdp vdt nghien cdu cua tac gta Isager P [4], thap hdn nghien cuU cua tac gia Ll Lim va Ken Hayashi [2]. Ket qua ve cong suat khue xa giac mac trung binh trong nghien CLTU cua chung tdi cho thay ban kinh cong trung binh cua manh ghep CO xu hu'dng phang gay tinh trang vien thi sau phau thuat. Giai thich ve dieu nay chung toi cho rang, do dteu kien kho khan ve dung cu phau thuat vdi khoan giac mac du'dc dting nhieii lan nen khdng con sac, khi Ichoan tao nen ghep se lam cho kich thu'dc nen ghep Idn lidn d y djnh.
Do vay, khi khau manh ghep vao nen gtiep, manh ghep se bi phSng hdn binh thu'dng. Khi so sanh cdng suat khue xa giac mac tai cac thdi dtem sau phau t h u i t , chung tdt nhan thay trj so nay khong cd sir khac biet cd y nghla thdng ke
vdi gia tri P > 0.05. Nhu" vay, cdng suat khiic xa giac mac on dinh tu* thdi diem 3 thang den 24 thang..
Tuy nhi§n, theo nhieu tat lieu da cong bo cdng suat khue xa giac mac trung btnh on (flnh tru'dc thdi diem 3 thang. Theo nghien ciiu cija cac tae gia nu'dc ngoai nhu" Ken Hayashi [2], Khong Al^ [5], Ll Urn [6] cdng suat khiic xa giac mac tang mot each ty" nhien trong thang dau tien sau mo va on djnh den khi ed cac tac dong khac tren be mat giac mac nhu* chinh chi. Bieu nay cd the ly glal do tnDng nhQYig tuan diu sau phau thuat, bd manh ghep va manh ghep giac mac cdn phij ne. Sau khoang 1 thang sau phau thuat, manh ghep gtam phu ro ret va dat do trong sudt tu'dng dot.
Trong nghien cdu cua chting toi, tai thdi diem 3 thang sau phau thuat, dp loan thi trung binh la 5.82D ±3.038, gia trj loan thi thap nhat la 4.36D, eao nhat la 9.5D. Ket qua nay thap hdn eiia tac gia I^useh DC (1998) [ 7 ] , cao hdn nghien cuti cua ket qua Touzeau 0 (2001). Dteu nay du'dc (Jr giat bdi sd khac biet ve_dung cu phau thuat oia cd^sd y te, trJnh iJp phau thuat vien va mii'c dp eham soc sau mo cua benh nhan. Theo chung toi, tai Benh vien Mat Trung u'dng, dtjng cu ghep giac mac xuyen cdn han che, it dddc doi nidi. Cy the la h | thdng khoan lay manh ghep va nen ghep khong du sac nen dot kht vet cat bl tray xu'dc, khong deu. Od cd the la mot trong nhifng nguyen nhan gay dp loan thi cao sau phau thuat Nghien cdu cua chung toi da lam ro rang cac tham so phan anh su" thay ddt khiic xa gtac mac bao gom cong suat cau tu'dng du'dng, dp loan thj deu, dp loan thi khdng deu thay dot theo thcfi gian sau khi phau t h u a t Thi lu'c sau khi ehinh kinh eung du'dc cat thien^dan dan. Tuy nhien thcfl diem ma nhiJng thay dot nay di vao dn djnh la khong gidng nhau. Oieu dd rat quan trong d l quyet dinh thdi diem va phu'dng phap can thiep lam giam dp loan thj giac mac giiip tang thi lire cho ngu'di benh.
V. KET LUijiN
Sau phau thuat ghep giac mac xuyen thj \\ic cai thien nhieu. Tuy nhien, thj \dc khong d?t diTdc tot da do cong suat khiic xa va loan thj cila gtac mac ghep, tinh trang nay thu'dng on dinh sau md 3 thang den 24 thang. Trong do, ty 1§
m a t b j loan thj khong deu cao hdn loan thj deu.
V i v a y , can phat ap dung cac bten phap dieu chinh loan thj sau phau thuat gtiep gtac mac xuyen de cd the cat thien thi lu^c cho ngudi benh.
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
