. JOURNAL N ' 2 - r ^CEMBER-Z016 Vat nhanh xuy§r! niong tren
thu'dng dudc cac tfe -. --• -LJU t h i a Ite vdi kich thudc ldn ^(f d -^ - / a n cua A. Hurbungs (2012), hay 12 13an dia Yuan- Sheng Tzeng va cpng su" (2u07). Hai Heng-lin va cona su"
(2013) sir dung v?tc6 ta'ch thu'dc trun? •-'-'- ^ f
18,2an, Tran Van Anh (2011; ^ dung vat ro chieu dai ldn nhSt i: -;jeu r6ng ldn nhat la 12cm de che p^ .U,^L hong nio mem vung ciing cut) [1], [2],t f ? ] - Jrong nghien ciili cua chung toi, vst co kicfi thu'dc ldn nhat 1^ ISOcm^ v^ chiSu dar lon nhat cua vat la 18 cm va chieu rong ldn nhat trong cac v?t la 10cm. Theo doi tinh trang vat ngay sau mo co 34/37 vat tot chiem 89,4% va 4/37 vat trung binh khong vat xau. Vat xep ioai trung binh do bj thieu dudng be mat da nong sau do tuan hoan vat tSt nSn vat Ichong bj hoai tu". Ty le nay tu'dng dutfng vdi cac nghien cihi cua Yuan-Sheng Tzeng va cgng su* (2007) vdi ti le 1/12 vat xuat hiSn hoai tO' nhe, A.Hurbungs, H. Ramkalaw/an (2012) vdi ti le i/10 trudng hdp xuat hien mau tu sau phau t h u i t [2], [7].
Theo doi va chim soc h i u phau rat quan trgng dSi vdi vat nhanh xuyin dong m^ch mong tren. Chay mau la bien chuhg thui&ng gap. Trong nghien culi cua chung toi xay ra 3 trudng hdp nhutig nhd theo doi ky va xu" ly Wp thdi nen ft anh hudng den tudi mau cho vat cua nhanh xuy€n.
Cac van dil quan trgng diit ra da du'dc chung t5i giai quyet tren thifc te lam sang trong thiet ke d i i n tfch vat du che phu khuyet hong, dong da ndi cho vat thi dau, hinh thii'c su* dung vat phCi hdp v ^ tu" the nam cua tuYig benh nhan va theo doi ky kjp thdi phat hien v i xuf trf bien chuhg sdm tranh ton.thu'dng vat.
V. K^ LU^N I
Dieu tri phlu thuat che phu ton WiuyS viing i ,- - cyt d mu'c dp I I I , IV bang vat da can c6 r c ,dng mach nuoi la nhanh xuyen cua dgng mach mong tren co do day vCfti du, che phu h i t dien tich khuyet hong, ndi cho vat du^c dong da m6t thi d^u la si/ lu'e chpn hdp iy cho bfnh nhan bi loet vCing cung cut man tfnh mi^c dg n^ng.
TAI LIEU THAM KHAO
1. Tran Vin Anh, VQ Quang Vinh (2011), "Nghien o ^ ling dung vat da nhanh xuyen cua d&ng m^dl mong tren trong dieu tri loet vung cCing cyt do ty de", Tap chf Tham hga va Bdng, trang 20&-214.
2. A. Huriiungs, H. Ramkalawan (2012) "Sacral pressure sore reronstiudion - the pedidett superior gluteal artery peribrator flap", SaJS, vol 50, no.l.
3. Hai Hens-linetal (2013) "QuadrJiobed superior gluteal artery perforator flap for sacrococcygeal defects", Chinese Med«3f Journal •,126{9) 4. Koshima I , Moriguchi T, Soeda Setal (1993),
"The gluteal perforator - base flap for repair of sacral pressure sore", fltesf Reconstr Surg 91, 678-683. ^ r 9. Cillnger Meltem, Cellk Esra, FIndlk Hasan, '^
Duman Ali (2004) 'The gluteal peribrator "^^1 based flap in repair of pressure sores". The British' Association of Plastic Surgeons 57, 342-347. ' | 1 6. Tarek Mahboub (2004) "Superior gluteal artery™
perforator flap for closure of large sacral defectsJ;^
Egypti Jf^a^ReconsirSurg, Vol 28, No 2, i7S-l>^J|
7. Yuan-Sheng Tzeng, et al. (2007) "Modification c ^ superior gluteal artery perforator flap fbr reconstruction of sacral sores", J Med Sd, 27 ( ^ 9
253-258. 'm
D A N H GIA K E T Q U A D I E U T R | TOY RANG H A M L Q N THU" NHAT
HAM DU-ffl CO six DUNG HE THONG PATHFILE VA PROTAPER
T 6 M TAT
Myc tietr. Danh gia k^ quei dieu trj ndi nha d rSng ham I6n thu' nhat ham dudi c6 su" dung h# thong 'Binh M«fJ Rang Ham MSt 71/Ha No!
Chju trach nhiem chfnh: Pham Thj Thu Hien Email: [email protected] Ngay nh$n bai: 30/8/2016 Ngay phan bign khoa hoc: 15/10/2016 Ng^y duyet b^I: 20/11/2016
Ph?m Thi Thu Hi^n*, Lg VSn BSng*
Pathfile va Protaper.0^ t^png vi phtfiing phip nghlSn cihr. Nghien ciru d 36 benh nhSn vdl 36 rdng ham ldn thii- nhSt ham du'di (RHLTIHD), dui?c chSn do^n viem tCiy khong hBi phye (VTXHP). TiSn hSnh mi tuy, sir dyng tram pathfile vS Protaper de siiz so?n Sng tliy. Han kfn 6ng tuy bSng gutta perdia, ThiStki nghiSn cdir. can thi§p lam sSng Wi6ng dSi diiStig- Ket qua: Tai bien gay dyng cu diiem ty le 2,8%.
Ngay sau hhn Sng tuy, k a qu^ tSt chiem ty I? 97,2%, trung binh diigm ty Mf 2,8%, kem 1^ 0%. Sau 1 tuan, tft
YH0CVieTMAMTAP<49.THANB12.s62-M1li H W , tajng binh 5,6%, l<an 0%. Sau theo dS 6
Oang, Ift 96,77%, tnjng Mnh 3,23%, kem 0%.
A ^ ' ' " • * * ' * ^ Bleu tti l i y rang ham Wn thiy nhat ham dutti, Pathfile.
SUMMARY
EVALUAHON OF TREATMENT RESULTS MARROW FIRST M O U R S LOWER JAW BY
SYSTEMS PATHFILE AND PROTAPER t r a t S S ? " ' " f '"' ^ ' " ' " ^ '^ ' ^ " " ^ " f endodontic fr^ent in lower first molars using pathfile and d L S ^ H " * ^ ' " = ' " " ^ " ' * ' ' • ™Wd, were diagnosed as ineversible pulpitis. iHilp access was Praaper and canals were obturated with gutta pen3,a.
Murfy d^gm uncontrolled clinical trials. Results:
T n ^ L U ' l f ' ^ . " ' ' ' " " ^ " Instruments was 2.8%.
Immediately alter ohturadon, the proporton of good
rZfE.' ^ 'S? "^'^ " ^ ^ ' ' • » ' 2.8%, and 0%.
respeavely. After 1 week, 94.4% were g i j d , 5 6%
" H W i ^ , 0% was considered as iMd. After 6 H H H ^ B H R J P , 96.77% showed good results, 3.23%
showedavcrageresults, and 0% showed bad results m o l a l r S f ' ° ° ' ' ' ™ ' ' ^ ' ^ ' " ' ' " ^ ° ™ = ' * " * L O i H T V i N O t
t „ , „ ? ' ^ i l ' ! . " ' ' J i ' ' t ' " ^ f Sial doan quan trong trong nha khoa bao ton nhSm glO- lai chu'c ning an nhai va tham my cho mot rSng bjnh ly. Trong do, vl$c sua soan ong tlJy t a dong vai tri, quan J j n g de dieu m thanh oong, khong chi nhd loai M CSc m6 nhiem trung, ma d8ng thdi tao hinh dang ong tuy thuan M cho vISc han kin 5ng tiiy theo khong glan ba chlSu. Bay la giai doan chiem nhieu thOi gian va doi hdi sij- dunq nhlSu dung CIJ nhat [7]. '
Vijc SiJdung NiTi trong san xuat dung cu noi nha vao thap nien 80 ciia the ki 20 la m t t trong nhuTig lien bg quan tipng nhat trong linh vut tao III. K E T Q U A N Q H I S N C t r u
3.1. Tal biat trang qua trinh iSgu tri tur Bang 1 . Tal blen t r o n g nuA t r i n h t a i hinh jinn t u «
Tal b i i n ^ . . ^ . . ^ J -
hinh ong tuy. Mac dii cd nhieu Uu diem vuHt tioi sp vdi bam thep khong gi bpng kha n5ng tao Iwih nhu- hleu qua cat nga toti giam chuyen dich chop rang, nJt ngan thdi gian lam viec va iao ong bjy CO do thuon ly tu8ng...[l]. Tuy nhiSn, he mong tram N m van ton tai nhffng han che nhai:
djnh, trong dd bnh an toan la mot tiong nhulig yeu to dang de cap nhat. Trong nhihig nghien ortJ gan day, B le gay file thep khong gi ming bmh khoang 1 % , trong dd tf le gay bam N i ^ Prataijer dao dpng tiy 2,4-2,6% [5].
Vdi su- ra ddi cua he thong bam Pathfile, giup cho viec md rpng sd khdi va tao du'dng bvot bong ong bjy duHc thuan idl. Qua dd g i t a dtfdc cac tal blen, glam thdi gian tao hinh Sng tuy bang he thong bam Sep theo v j do la chia Khoa mang lai^thanh cong bpng dieu tri npi nha.
!!-». J ? " i " ? " '^ 1;^ * * 9 " " > m i l can cd nhuhg danh gla cu the tien lam sang, do vay, chung ta ben hanh nghien cuu de tai: '•Banh ^ ItS qji
^ ^ not nha a mng han IOn m nhiit ham dum CO su-dung he thong PamaevaPmlaper.~
II. BfilTUpNG VA PHUIONG P H A P N G H I § N C O U Chung toi ben hanh nghiSn ciib trSn 36 benh nhan Vdl 36 RHLTIHD, du'dc chan doan la S m biy khong hoi phuc. Cac iSng du'dc dieu tri nS
m m : . ™ T , " , i ' '™"5 " " " S " = N6i, thdi gian tir 01/03/2014 den 31/10/2014. Tie'n hanh mi tliy, a r dujy tram_pathfiie va Protaper de siis soan ong ket qua dieu bi sau 1 hian va sau 6 thang
Phu'dng phap nghien ciiM: Can thiep ISm sang khong doi chuhg
spssll.o'* " ^ " " " * ' " * '* '^"S ""=" " ^
G§v dune; cu ThiJnq OT Tgo khac Loe, T^dn cuong ring
Khonq tai blen
Sg Itftfng rSnfl T » l e o ^ _2,8
I Mwng BJ Dien 35 ' —^
VIETNAM MEDICAL JOURNAL N°2 - DECEMBER - 2016
3.2.Kit qua dieu tti sau han ong ttjy 1 tuan
94.4 100
50
0
I
T?t Tnmg binh Kem Ket qua ^ 0 Bieu do 1 . K€t qua dieu t r i sau t r a m bit OT 1 t u i nNh$tt x4t: K^ qua dieu tri sau tram bft OT 1 tuan trong nghien CUXJ cua chung toi cho thay: Ty te tot la 94,4%, tmng binh la 5,6%, kem la 0%.
3.3.Ketqui d!Bu tri sau 6 thang
Sau 6 th^ng chiing tQl danh gia k S qua dieu tri bSng kham lam sang va^diMP X-quang ki^m tra du'tfc 31 r^ng tren tong so 36 ring duWc nghiSn ciiU. Ket qua dieu tr| du'pc the hien d bieu (K sau.
T7l
mgD7Io2.KgtquA b l n h
diSu tr) sau 6 tHSng^' Ket qua
Nh$nx^J</ 1$ ttidnh cong cua d ^ b i npl nha sau theo doi 6 th^ng la 96,77%. Tmng blnh la 3,23% vS K6m ta 0%.
IV. BAN LU$N
4.1. Tai bi€n trong qui trinli t^o Mn/i dngtu^.
Trong nghien d h i oia chung toi ab mpt tnrimg hpp bj gSy d^ng cu, chiem ty le 2,8%.
G$p d rSng cb 6OIQ tuy chSn ^ n trong, vfi^ oong vCft hep. TrSm bj gay Id t r i m Pathfile so 013, sijf d i ^ ISn thir 5, do^n gSy nSm d 1/3 cuong ong biy Chan r3ng. Theo chiing t a , co the nguyen nhgn gay 1& do l^t uon va lut xo3n tac dpng len di/ng cv qui ldn d OT hpp va cong vupt qua si/
chju d^Tig m ^ m ^ cua v$t li&j. Qiung tdi da khSc f^uc bSng each, dung file so 8, lach nhe nhing b ^ c^nh doan gay 1 ^ hpp b ^ bdn bSng glyde ^ thong qua duWc doan gay t * du'pc vung
lU'dngM t h ^ cuong dian ring va han kin duWc CT blnh thu'dr 6i lei doan gay nSm trong OT. Sau d^u bl 6 baih nhan ndy v§n cho ket qua dat tft.
Tuy nhien, vSn de gay dung cu b^ng OT la mpt nguy cd that bai b-ong diSu bl vd Id m$t ttidch thii'c m6l doi viS nha khoa hi§n del. Tronj baiSng hpp ndy cSn thdl glan theo do! ddi hdn nDa, tuy vay chiing tei khuyen cao nen danh oa hinh thdl OT qua lam sdng d glal di OT b5ng b-am tay va X quang bUdc OT cong, hep ngn sir diing bp trSm mcfi, gidm li/c xo3n ciia may, vd tuSn ngdt Wiuyen cao cua nhd sdn xuat Chii khuy&i cdo mol bam Pathfile chi nSn 5 lan hap sSy dung cu de dam bdo an
YHOC VIETNAM TAP ^ 4 9 . THAHG 1 2 - 5 0 2 - 2 0 1 6 Trang nghien ciili chung toi su'dung may X-
mart dia hang Dentsply cho trim xoay, cd the dBu chinh toe do va luc xo5n de dang cho bam Pathffle va Protaper. TSc do » 300 rpm va lu'e xoan 5-6 N/cm du'dc khuyen cao cho Sam Pathffle [3]. chinh vl vay, cac bac sy nha khoa sir dung tay khoan noi nha thay the may X- mart can lutl tam de banh tai bien va dat hieu qua cao trong sii" dung.
4.2. Kit qua dieu tri
- Ket qui dieu trf sau tram bft OTl tuan.
Sau khi han o r 1 tuan, da so benh nhan khim lai dSu khong dau, an nhai du'dc, ngach ldi binh thudng, go rang khong dau va du'dc danh n gla ket qua la tot, chiem ty le 94,4%, cd 2 rang cAn dau nh? khi nhai vS gd doc hdi dau du'dc danh gia ket qua la frung binh chiem 5,5%, kem
^ Wnonq cd fru'dng hdp nao.
•"J^uadleu'trlsau theo doi6 tiiang, Sau 6 thang nghien culi, chiing t6i kham lai du'dc 31 bSnh nhan cd 31 rSng dudc dieu trj, ChiSm ty \i 86,1%. 5 tru'dng hop ijenh nhan khong t^i kham du'dc.
n^ so nghien ciib dua ra k S qua nhu' sau:
NghiSn ciJu ciia Nguyen Thi Phu'dng NgS [4] cho ket quS tot la 100% sau theo doi 6 thSng.Tran TTii Lan Anh [1] o i ty I? thanh cong frin X-quang la 100%. Ket qua sau dieu tr| noi nha 9 thang ciia Nguyin Thi Ngpc Dung [2] la 96,87%. Ciia Nguyin Quoc Trung [5] la 93,1%.
Ve lau dal, mdt trong nhii'ng tieu chi thanh
• c6ng cua dieu frj noi nha la keo dai ket qua dieu frj va duy tn chii'c nSng ciia rSng. Carter va cong siS [7], chi ra rSng md ngS cila i^ng sau dl5u frj U biy cd dp cUlig va do dan hoi thap hdn rSng biy (I sSng, ciing vdl vl$c mat cau friic mo ring do sau
rSng vS md biy chuan b| buong biy cho dieu trt, I' IJm cho hSu h a cac ring thu'dng bi nut, gay '( theo thdi glan. Vi v j y cac iSng tSn dudc lam
^' chyp b^o v§ sau dieu tri biy.
Aquilino va cpng sir [6], cho ring cac ring j CO than ring duBc phgc hoi sau dieu fri b5ng j chgp thi ty le tBn tal cao gap 6 lan so vdi nhffng -^ ring khong dudc bao ve bSng chgp ring.
i, TfDhg nghien ciiu ciia chiing toi, da so b^nh I nhan dSu duBc tu' van ddng chot chin ring, lam
chup ring sau khi han vinh vien bSng glass ionomer cement hay composite de bao ve l i n g . Mpt so benh nhan chua lam chgp thi khi tai kham sau 6 thing chiing tdi nhan thay benh nhan thu'dng bj v8 cac thanh tiian rang, V f i mieng han, dac biet d nam gidl. Tuy nhien chua CO frudng hdp nao benh nhin bj gay than rang, CO the do thdi glan theo ddi con i t Vi viy vin de W van cho ngudi benh va chi dinh lam chup ring e&
bao ve k a qua dieu di noi nha la h a sii'c (Sn thia.
V.KET LUAN
Qua nghien ciju dieu fri biy RHLTIHD cd i i dung bam Pathfile, bam Protaper va miy X- Smart tai Benh ViSn Rang Ham M i t frung u'dng Ha Npi tff thing 3/2014 den thing 10/2014, chiing toi thu duWc k a qua:
_Sau fram bit CT 1 tuan: ty le dieu fri tSt chiSm 94,4%, frung blnh chiem 5,6%, kem 0%.
Sau theo doi 6 t h i n g : Tot 96,77%, frung binh 3,23%, kem 0%.
TAI U l u THAM KHAO
1. Tian Thj Uin Anh (2005), Binh gii saii hliu qua lam sang s& dgng dam xoay Nm Pntaper Img dieu tq tuy, LuJn vSn th?c sy Y hpc, TniSng
2. Nguyin-mi Ngpc Dung (2007), NhSn xit llm umg, Xquang va dinh gii ltd qui dSu tr/ tiy rang 6,7 ham dudl vdi dung cg file t^m tay thuting vdl dung cu die itaiaper miy, Lu|n vSn chuyen khoa cap 2, Tnidng Oai hpc YHJN6I.
3. BUI Q U £ Dirong (1998), Nhiitig phutjng phSp silS soan^Sngtuy, Cfp nhSt nha Ichoa It), 125-136
•.. NgovM Thj Phuuig N g i (2009), Nghiin cit, dieu 01 tuy ling ham Idn thu-nhSI, thdhalhim , - S • ^ * « ' t^i" Protaper va miy X-Smart Lusn V3n -Thsc s7 Y hpc, Tm»ng Dsi hpc Y HN.
5.Ngiiyen Quoc Tnmg (2009), nghUn cdu dieu trt tuy nhim ring ham cd chin cong bing phudng phip sui soan eng tuy vdl trim xoay miy i3
^ lay Ni -n LuSn i n Tien si Y hpi, Tn&ng
Dal Hpc Rang Him Mat. ^ 6.Aquilino S J t , Caplan DJ.(2002), Relationship
2 ! f " . ' ^ ? r *cement and the survival of
a S "^"^^ ''^' -"*°*^*'« 87,
' • '^J^' " J , ' * " ' " « ' " S E . r t a l . ( 1 9 8 3 ) , Punch
? . ? r l S S ° ^ ^ ^ * ' ="" indodontlcally freated teeth, J Biomech. 16,841-849,
