lesion". Acta Neurol Scand, (102), 371 - 377. study". Arch Phys Med Rehabilitation, (75), 8. Nadina B.L, Ruth H.P, Catherine D.V. (1999), pp.852 - 857.
"Randomized, controlled trial to evaluate increased I Q . Sabari JS, Lim AL, Velozo CA, Lehman L, intensity of physiotherapy treatment of arm function ^ieran O, Lai JS, "Assessing arm and hand after stroke", Stroke, (30), 5 7 3 - 5 7 9 . f ^ ^ ^ ^ i ^ ^ ^^^^^ ^^^^1^^. ^ ^ ^ l i ^ ^ y test of the 9. Nakayama H., Jorgensen H.S (1994), hierarchical scoring system used in the motor
"Compensation in recovery of upper extremity assessment scales for stroke". Arch Phys Med function after stroke: the Copenhagen Stroke Rehabil 2005; 86; 1609 - 1614.
Summary
PRELIMINARY EVALUATION ON FACTORS RELATED FUNCTIONAL IMPAIRMENT OF AFFECTED HAND IN STROKE PATIENTS
Objective: To describe the functional impairment of affected hand in stroke patients and evaluation some factors (age, gender, dominated hand, type of brain lesion, site and volume of lesion). Method: 80 hemiplegic individuals from stroke with affected functional hand who were examinated, diagnosed and treated for 4 weeks in Neurology unit and Rehabilitation department of BachMai hospital, using T - test and relational coefficient r to assess the relaionship between factors and the level of functional hand.
Results and conclusion: The frequency of loss of motor function in affected hand is 38,8%, the frequency of loss of skilful hand is 57.5%. The older individuals are, the worse their hand funcions get with weak relationship (r = - 0.219), with p < 0.05 initial indicating that strong relationship (r > 0.5) was found between hand function and the volome of lesions in tempo - parietal and frontal lobes (p < 0.05).
Keywords: hand function, stroke, related factor
KET QUA CAI THIEN SLfC NGHE SAU P H A U THUAT TAO HINH xaONG CON BAN PHAN BANG GOM SINH HOC
C a o M i n h T h a n h , , • . . ;•. ' TrUdng Dai hge Y Ha Ndi
Muc tieu: danh gia ket qua cai thien sdc nghe sau phiu thuat tao hinh xuang con ban phan (PORP) bang gdm sinh hge san xuat trong nUdc (BIPVIT). Ddi tagng va phaang phap nghien cdu: md ta tdng ca cd can
thiep tren 87 benh nhan duac chan doan xae dinh va phiu thuat thay the xuang con ban phan bang gdm BIPVIT. Chat lieu: tru din thay the xUang con bang gdm sinh hge BIPVIT, can ca thai duang tuai. Ket qua:
PTA trade phiu thuat la 54,91 ± 12,6 dB d 4 tin sd la 0,5, 1, 2va 3 kHz va sau phiu thual la 36,47 ± 12,56 dB. Mde tang ABC va PTA d 2 loai thay the xuang con la nhU nhau, tuang Ung ia 19,02 & 18,49 dB vdi 17 67
& 17,42 dB. Ket luan: mde do cai thidn sUc nghe sau phiu thuat tao hinh xUang con ban phan bane edm sinh hoc cung gin tUang tU nhu cac chat lieu khac.
TU khoa: gdm sinh hpc san xuat tai Viet Nam (BIPVIT)
I. D A T V A N DE
•Viem tai gida man (VTGM) la benh kha phd bien d nUdc ta, chiem ty le 2 - 4 % dan sd. Di chdng thudng gap nhat cua VTGM la suy giam sdc nghe. Nam 2004, W H O xep suy giam sdc nghe vao nhdm ngUdi tan tat, theo dU doan cua W H O thi cbi sd DALYs (disability - adjusted life - years) la sd nam sdng tU d i i u chinh theo mde mat kha nang do nguyen nhan nghe kem hang nam la 2,613 trieu ngudi, va 94% sd nay gap d cac nUdc dang phat trien [6]. Mpt trong nhdng nguyen nhan gay suy giam sdc nghe nang d benh VTGM la tdn thuong gian doan xUdng cen. Theo chUdng trinh phdng chdng diec va nghinh ngang cda WHO de giam ty le DALYs thi chdng ta phai dieu trj va quan ly tdt nhUng benh nhan VTGM, p h l u thuat tao hinh be thdng truyin am mang nhT - xUOng con ddng vai trd quan trpng trong chUPng trinh nay. 6 cac nUde phat trien thi p h l u thuat tao hinh xUOng con la kha phd bien vdi n h i i u loai chat lieu ddpc sd dung. 6 nddc ta thi phlu thuat tao hinh xUOng con cdn n h i i u han ehe do khdng che tao dddc tru d i n de thay the. D i tai nghien cdu nay dng dung tru gdm sinh hpc dddc san xuat trong nifdc de thay the xUOng con bj tdn thifdng vdi muc tieu:
Danh gia sdc nghe sau phiu thuat PORP bang
gdm sinh hge. ,
li. DOI TUONG vA PHUONG
PHAPNGHIEN CUu
1. Dd^i tupng nghien cu'u
- Ngudn: benh nhan kham va d i i u trj tai Benh vien Tai Mui Hpng trung Udng, chan doan V T G M tdn thuong xUdng con. Td 2005 - 2008.
- Tieu chuan chon benh nhan : + Cd Id thung mang nhT, nghe kem.
+ Phim CLVT XUdng thai difdng hoae npi soi tai xae djnh tdn thuong gian doan he thdng xUdng con (GDHTXC).
+ Do thfnh b e ddn am trUde mo va sau md.
2. PhUdng phap nghien cu'u
Md hinh nghien cdu: md ta tdng ca ed can thiep.
PhUPng tien nghien cdu:
Npi soi optic 1,9 va 2,7 mm loai 30°.
May chup CLVT cat Idp, lat cat 0,75mm.
Chup CLVT xdOng thai ddOng vdi 4 mat cat, 2 mat cat ngang (Axial), 2 mat cat ddng ngang (Coronal).
May do thfnh lUc SD50 cua Ddc.
Chat lieu nghien cdu: gdm sinh hpc san xuat tai Trifdng Dai hpc Bach khpa Ha Npi, Sau dd phai tao phdi va tao hinh trifdc de thay the xUdng cdn bj tdn thUdng, goi la BIPVIT. Kieu dang va kfch thudc do chfnh tac gia bai viet nay thdc hien.
*'^-r
Hinh 1. Tru dan thay the xaang bua - de
Hinh 2. Tru din thay the xaang de
(Dau tren hdp vdi true gdc 60°, cd 2 mat nghieng hdp vdi true 1 gdc 60° va 45°)
- Manh can cd thai difdng tddi.
Ky thuat
- Phlu thuat di theo difdng trong d'ng tai.
- Va mang nhT theo ky thuat Underlay.
Danh gia ket qua s.-v - So sanh PTA (trung binh dUdng khf d 4 t i n sd 0,5, 1, 2 va 3 kHz), ABG (khoang each giUa 2 dudng khf va xddng) trUdc va sau phau thuat PORP.
- So sanh PTA va ABG gida 2 nhdm tao hinh.
Xd ly sd lieu bang chddng trinh Epi6.04 va StatalO.O.
III. KET QUA
1. Dac diem chung
* Tudi gidi
Tudi trung bmh la 31,53 nam (SD = 13,48).
Tudi nhd nha't la 1 1 , tudi Idn nhaft la 58 Gidi : ty le nU/nam = 1,5.
Mpt sd dac diem lam sang
- Ly do vao vien: benh nhan vao vien vi chay mu tai nghe kem, chiem 51,7%, chay mu tai, tai phat sau p h l u thuat chiem 15,7%, chay mu tai chiem 15,0% .
- Thdi gian bi benh: thdi gian chay mu tai trung binh 27,28 nam chay khdng Men tuc (SD = 13,89).
2. Dac diem can lam sang
Gia trj chan doan dung tdn thUdng GDXC cua chup cat ldp 74,5%.
Gia trj chan dean dung tdn thUdng GDXC cua ndi soi tai la 85,2%.
r
Hinh 3. Hinh anh mat xaang de
k
Hinh 4. Mat can bua
Thinh lUc dd
4- Trung binh dUdng xUong la 12,51 dB (SD = 10,6);
-I- Trung binh dUdng khf PTA la 54,91 dB (SD = 12,6);
, -^ ABG la 42,72 dB (SD = 8,36).
Ket qua phau thuat
Mang nhT: mang nhT Men sau p h l u thuat 3 thang la 93,0%, sau va 1 2 thang la 90,8%, khac biet khdng cd y nghTa thdng ke vdi p > 0,05.
Tru dSn gdm sinh hpc - Tru d i n thay the xUOng con
C h i i u dai trung binh eua tru d i n thay the xddng de la 4,18 mm (SD = 0,66). Khdi lUpng t m n g b i n h 12,5 mg (SD = 2,4).
Tru d i n thay the xddng bua de cd c h i i u dai tmng binh la 3,12 mm (SD = 0,28). Khdi Idpng trung binh 16 mg ( SD = 1,9).
- Tinh trang tru dSn sau phlu thuat
Day ldi mang nhT sau 12 thang chiem ty le 4,5 % (4/87), trat khdp tru d i n thay the xUPng con la 1,1 %.
Ty le that bai chung la 5,6 %.
- Thinh lUc dd: so sanh PTA va ABG trUde va sau p h l u thuat. ,; ,
Nhan xet bang 1: PTA trUdc p h l u thuat la 54,91 dB, sau p h l u thuat la 36,47 dB. SU khae biet cd y nghTa thd'ng ke vdi p < 0 , 0 0 1 . PTA tang trung binh sau p h l u thuat 1 8,1 3 dB (SD = 1 0,75).
ABG trddc p h l u thuat la 42,72 dB sau phlu
thuat la 24,86 dB. Su khac biet cd y nghTa thdng ke vdi p < 0 , 0 0 1 . ABG tang trung binh sau p h l u thuat la 17,86 dB ( S D = 11,72). ,: ... ..,,.,. • ; :
Bang 1. So sanh trung
Thdi gian TrUdc phau
Trung binh(dB) thuat PTA 54,91 ± 12,6
ABG 42,72 ± 8,36
binh sdc nghe trade
6 thang 34,81 ± 12,05
24,57 ± 8 , 0 2
va sau phau thuat
Sau phau thuat 12thang 35,66 ± 12,45
24,67 ± 7,76
Trung binh 36,47 ± 12,56
24,86 ±8,21 So sanh PTA va ABG giUa 2 loai tao hinh
Bang 2. So sanh hieu qua trung binh sdc nghe gida 2 loai tao hinh xaang de va bua de
Loai TH
De (n = 47)
Bua de (n = Thdi
40)
gian TrUdc PTA 54,53 ±
11,54 55,02 ±
13,91
phau thuat ABG 42,64 ±
7,43 42,36 ±
9,49
Sau phau PTA 34,95 ±
12,25 36,35 ±
14,72
thuat ABG 24,19 ±
8,16 24,49 ±
8,79
Hieu qua PTA 19,02 ±
11,72 1 7 , 6 7 ±
12,61
phau thuat ABG 18,49 ±
10,65 17,42 ±
12,06 Nhan xet: PTA sau phiu thuat ciia loai thay xUang de la 34,95 dB cd gia tri nho han so vdi 36,35 dB ciia lo^i thay xuang bua de. Sif khac biet khdng ed y nghTa thdng ke vdi p > 0,05. ,. . . .
Gia tri ABG sau phau thuat cua 2 loai thay the xUdng con la nhu nhau.
PTA tang sau phau thuat cua loai thay xUPng de la 19,02 dB (SD = 11,72), cao hon so vdi loai thay xifdng bua de la 17,67 dB (SD = 12,61). SU khac biet khdng cd y nghTa thdng ke vdi p > 0,05.
ABG tang sau p h l u thuat cua b a i thay xddng de la 18,49 dB (SD = 10,65), cao hdn so vdi loai thay xddng bda de la 17,42 dB (SD = 12,06). SU khac biet khdng ed y nghTa thd'ng ke vdi p > 0,05.
IV. B A N LUAN
1. Dac diem chung
Tudi trung binh la 31,53 nam (SD = 12,35).
Nhieu tudi nha't la 58 va ft tudi nha't la 1 1 . NhU vay thudng gap d Ida tudi dang la lao dpng chinh.
Gidi: ty le Nd/nam = 1,5. Ket qua cua nghien edu nay khac vdi G.Babighian [1], vi ty le nay khdng cd tfnh dai dien cho qeiln the.
2. Dac diem lam sang va can lam sang 2.1. Lam sang
Thdi gian bj benh trung binh la 26,53 nam (SD = 12,8). '..' i •.• • -:• ..; r - : 1
Ly do thudng gap nha't la chay mu tai va nghe kem chiem 52,7%, chay mu tai tai phat sau phau thuat chiem 25,7%.
Gia trj chan doan dung tdn thdOng GDXC cua npi soi la 85,2%. Cd dp tin cay cao, ky thuat ddn gian, giam chi phf chda benh.
2.2. Can lam sang
Gia trj cua chan duan dung tdn thUOng GDXC tfnh tren phim CT xUdng thai dUOng 74,5%, {y le chan doan sai la 25,5%. Chan doan sai vi tdn thuong kfn dao nhU chi ma't mom dau cua xUdng de, lat cat kheng chfnh xae.
2. Sijfc nghe sau phlu thuat
Mde dp thay ddi PTA va AGB trUde va sau
phau thuat. , -..u,.- . . ; Ket qua cua nghien cdu nay thi PTA trddc p h l u thuat la 54,91 dB (SD = 1 2,6), sau p h l u thuat la 36,47 dB (SD = 12,56). TUdng tU ket qua cua Murugasu [5] vdi chat lieu bang HydrexyApatite cd PTA trddc p h l u thuat la 56,7 dB, sau p h l u thuat la 36,8 dB,
Mde tang PTA sau p h l u thuat trong nghien cdu nay la 18,13 dB (SD = 10,75), tha'p hdn ket qua cua Fish [4] la 21,4 dB, nhdng cao hdn cua Dorn- hoffer [3] la 16,6 dB. SU khac biet nay cd the do chat lieu tao hinh, do kinh nghiem cua p h l u thuat vien, vi cdng mpt chat lieu va thdc hien tren cung 1 nhdm benh nhan vdi 2 p h l u thuat vien khac nhau se cho ket qua khac nhau.
Mde dp thay ddi PTA va ABG gida 2 b a i tao hinh:
PTA tang trung binh sau p h l u thuat 12 thang cua loai thay xddng de la 19,02 ± 11,72 dB, loai thay XUdng bua de la 17,67 ± 12,61 dB. Cd sU khac biet gida 2 loai nhdng khdng cd y nghTa thd'ng ke vdi p > 0,05. Ket qua nay tha'p hdn ket qua cua De Vos [2] khi sd dung Titanium de tao hinh XdOng con la 20,1 4 dB.
ABG tang sau p h l u thuat cua loai thay xifOng de la 18,49 ± 10,65 dB, loai thay xUdng bda de la 17,42 ± 12,06 dB. Kheng cd sU khac biet gida 2 loai. Ket qua nghien cdu nay tdOng tU ket qua cda De Vos [2] vdi cha't lieu Titanium ABG tang sau p h l u thuat la 18,1 dB (SD = 14,8).
I I I . K E T L U A N
Phlu thuat PORP dat ket qua tang sdc nghe cho ngudi benh trung binh la 1 8,1 3 dB (SD = 10,75).
Mde dp tang PTA va ABG sau p h l u thuat gida 2 loai thay the xUdng con bang gdm sinh hpc la tUdng tu nhau.
Tru d i n thay the xUdng con lam bang gdm sinh hpc san xuat trong nUdc, cung dat ket qua cai thien sdc nghe gan nhd cac chat lieu khac do nddc ngoai san xuat.
T A I LIEU THAM KHAO
1. Babighian G (1985), "Bioactive Ceramic versus Proplast Imlant in Ossiculoplasty", The American Journal of Otology, 6(4), Thieme Stratton NewYork, pp.285 - 290.R
2. De Vos C et.al(2007), "Progndstic Factors in Ossiculoplasty", Otology & Neurotobgy, 28(1), Otology & Neurotobgy. Inc, pp.61 - 67
3. Dornhoffer JL (1998), "Hearing Results with the Dornhoffer Ossicular Replacement Prosthesis", The Laryngoscope, Vol 108,Lippincott - Raven Publishers, Philadelphia, pp.531 - 536.
4. Fish U (2004), "A New - Shaped Titanium Prosthesis for Total Reconstruction of the Ossicular Chain", Otology & Neurotobgy, Vol 25, Otology &
Neurotobgy. Inc, 891 - 902.
5. Murugasu E et.al(2005), " Malleus - to - footstape versus Malleus - to - headstape ossicular reconstruction Prostheses: Temporal bone press gain measurements and clinical audiobgieal data". Otology & Neurotobgy, 26(4), Otology &
Neurotobgy Inc, pp.572 - 582.
6. W H O (2004), Chronic Suppurative Otitis Media - Burden of Illness and Management Option, World Health Organisation, Geneva, Switzerland, 7 - 48.
,!';i:.'. .. ii<. i Sy
Summary ' ''^
RESULTS OF IMPROVED HEARING IN SURGERY PARTIAL OSSICULAR RECONSTRUCTION PROSTHESES (PORP) WITH USING THE BIOCERAMIC
Objective: the purpose of this study was assess the value of hearing improvement postoperative ossiculoplasty with bioceramic Prostheses. Method: Prospective study at National ENT Hospital in 87 patients were operated partial ossicular reconstruction bioceramic prostheses from 2005 to 2008. Results:
the pre - postoperative PTA were 54.91 ± 12.6 dB for four frequencies (0,5, 1, 2 and 3 kHz) compared to 36.47 ± 12.56 dB . The ABG improvements for four frequencies and PTA with 2 groups are 19.02 & 1 8.49 dB and 17.67 & 17.42 dB. Conclusion: The results of hearing improvement in Bioceramic partials Ossiculoplasty as well as other materials
Keywords: BIPVIT (Bioceramic Prostheses Made in Viet Nam)
PHAN BO TY LE VO SINH
TAI CAC VUNG SINH THAI VIET NAM NAM 2009
Nguyin Viet T i e n \ Bach Huy Anh^, Ngo Van Toan^
^Tnfdng Dai hge Y Ha Ngi, ^Benh vien Phu san Trung ugng
Vd sinh la mdt van de kha phd bien, mang tinh xa hdi va can sU tham gia va phdi hap cua toan xa hdi.
Muc tieu: xae dinh ty IS vd sinh chung, vd sinh nguyen phat va thd phat trong ca nUdc cung nhU tai cae vung sinh thai va mot sd yeu td dae trUng ea nhan anh hudng den vd sinh. Doi tagng va phaang phap nghien cdu:
bao gdm 14396 cap vg ehong trong do tudi sinh de, tudi td 15 - 49, tU nguyen tham gia nghien cdu tai 8 tinh dai dien eho 8 vung sinh thai eua ea nude. Thiet ke nghien cdu md ta sd dung ky thuat chgn miu 60 cum/
tinh va phdng van cap vg ehong theo bg phiiu phdng van da duge ehuan hoa. Ket qua: ty le vd sinh chung tren pham vi toan qudc la 7,7%o, trong dd vd sinh nguyen phat la 3,9%o va vd sinh thU phat la 3,8%,. Ty le vd sinh chung eao nhat la d tinh Khanh Hoa (13,9%o) va tha'p nha't la d tinh Hai Phdng (3,8%o) va Quang Ninh (3,9%o). NhUng phu nd tudi tren 30, can bg va cdng nhan, ed trinh dd hge van trung hge ca sd, dan tdc Kinh, khdng theo tdn giao va sd'ng d ndng thdn cd nguy ca vd sinh cao han nhUng nhdm phu nd khae. Ket luan va kien nghi: ty le vd sinh tai Viet Nam d mde trung binh va cd sU khac biet gida cac vung sinh thai. Nghien cdu de xuat nganh y te ndi ehung va nganh san phu khoa can cd nhdng chinh sach va ke hoaeh de giai quyet tinh trang vd sinh tai Viet Nam.
Tijf khoa: vo sinh, vijng sinh thai, cac yeu td ca nhan • ' ' i I. DAT V A N D E dan, khdng sd dung bat ky mpt bien phap tranh
Vp sinh la mpt van d i kha phd bie'n, mang thai nao nhdng khong cd thai trong vdng 12 thang tfnh xa hpi va tfnh nhan dao rat eao trong mpi xa trddc khi nghien cdu [IJ. Ty le vd sinh chung (bao hpi. Theo djnh nghTa cua Td chdc Y te The gidi gdm vo sinh nguyen phat va vd sinh thd phat) tren (TCYTTG), vd sinh la tinh trang ma cac cap vd the gidi dad dpng trong khoang td 6 - 12% [2].
chdng mong mudn cd thai, sinh boat tinh due deu Viee xae djnh ty le vd sinh cua cac cap vp chdng
