Y HOC VIET NAM THANG 7 - SO 1/2010 3

Y HOC VIET NAM THANG 7 - SO 1/2010 3- Noi soi phe quan la mot ky thuat cha'n

doan an toan va co do dac hieu cao trong viec lay benh pham xac dinh vi khuan gay benh.

TAI LIEU THAM KHAO

1. Giang Thuc Anh, Vu the Hong, Vu Van Dinh (2002), "Tinh hinh nhiem khuan benh vien va ty le khang khang sinh tai khoa dieu tri tich cut tu¹ thang 1-6 nam 2002". HN hoi suC va chong doc toan quoc 2003.tr.66-71.

2. Vo Hong Linh (2001), "Khao sat nhiem khuan benh vien tai khoa san soc dac biet BV Chd Ray".

Luan van tot nghiep bac si npi tru. TrUdng DHYDTPHCM.

3. Pham Hong TrUdng (2005), "Nghien cUu ty le

mac phai, ty le tU vong, yeu to nguy ccf, tac nhan gay viem phoi d benh nhan thd may". Luan van bac sT chuyen khoa II, HVQY.

4. Apostolopoulou E, Balakos P, Ka Tostaras T.

(2003), Incedence and risk factor for ventilator- associated pneumonia in multidiscipplinary intensive care unit in Athen, Greece Respiratory care 48: 681-8.

5. Chastre J, Wolff M, Fegon J.L. (2003), Comparision of two duration of antibiotic therapy to treat ventilator associated pneumonia Am J Respir Crit care Med, 167:12-21.

6. Ofelia CT, Larry J.A, Richard B. (2003), Guidelines for preventing Health Care Associated pneumonia MMWR 53: 1-36.

HIEU QUA DIEU TRI THOAI HOA COT SONG CO BANG KY THUAT KEO GIAN

Ta Van Tram*

T6M TAT

Thoai hoa cot song co la benh ly thudng gap d ngUdi cao tud'i. Muc tieu nghien cuu: Danh gia hieu qua cua dieu tri thoai hda cdt song cd bang ky thuat keo gian. Ket qua: Benh gap d ntf nhieu hdn nam, gSp nhieu d lira tud'i tren 40, nghe nghiep la ndi trp (30%), ndng dan (26,7%) va can bp nha nUdc (16,7%). Da so den benh vien mudn sau 3 thang. Ket qua: 80% benh nhan cai thien, 16,7% dien tien tdt. Ket luan: Day la mdt ky thuat ddn gian hieu qua va an toan.

Tit khoa: Hieu qua, thoai hda cdt sdng cd, ky thuat keo gian.

SUMMARY

Effectiveness of treatment of the cervical vertebrae degeneration by using puller technique.

Pain due to degeneration of the cervical vertebrae was a common disease in the elderly.

Aims: Evaluate the effectiveness cf treatment df the cervical vertebrae degeneration by using puller technique. Method: Clinical trials without control group. Results: Most cf them were females, with 95% among them elder than 40 years did. Mdst df them were housewives (30%), farmers (26.7%) personnels (16.7%). 53.4% went to the hospital

late, after 3 mdnths. Treatment results: disease improved 80%, recoverd ccmpletely 16.7%.

Conclusion: This technique was very simple, effective and safe.

Keywords: Effectiveness, cervical vertebrae degeneration, puller technique.

I. OAT VAN OE

Benh thoai hda khdp ndi chung va thoai hda cdt song ndi rieng la mdt can benh cua sU lao hda va tinh trang chiu ap lut qua tai keo dai cua sun khdp va dTa dem, sU suy giam khdi lUdng xUdng, giam dich bao khdp, giam ldp sun bao quanh khdp dan den sU dau ddn moi khi cU ddng. Thoai hda cdt song la benh cua cdt sdng man b'nh, gay dau va bien dang, khdng cd bieu hien tinh trang viem, la chUng benh thudng gap d ca hai gidi nam va nu^-, cd le, khdng ai khdng bj it nhat mdt lan trong ddi bi dau cdt song. Theo cac so lieu thdng ke, Udc tinh cd 80% nhung ngUdi tren 30 tud'i thudng bi thoai hda cdt song that lUng va khoang 20% cd thoai hda cdt song

cg(3),(4M5)_ r£c ^n n |y tpogj h.^ opt song cd thudng dien tien tU tir, man b'nh, gay anh hudng den ngudi benh d nhieu mUc dp, tir giam hieu qua lao dpng den

* Benh vien da khoa linh Tien Giang 50

Y HOC VIET NAM THANG 7 • SO 1/2010 nang hdn nUa la han che rat nhieu kha nang sinh

hoat thUdng ngay cua ngUdi benh^(3>.

Dieu tri bang keo gian cot song co la phUdng phap dUdc ap dung giup ngUdi benh giam dUdc cac trieu chUng cua benh, phuc hoi kha nang sinh hoat, lao dpng hang ngay va han che phan nao nhUng hau qua cua benh gay nen^(2)(4>. Benh vien Da Khoa Tien Giang ap dung phUdng phap keo gian cot song co trong dieu tri thoai hoa cot song co tU 2 nam qua. Chung toi tien hanh de tai nay nham danh gia hieu qua ve dieu tri, phuc hoi chUc nang cho benh nhan thoai hoa cot song co bang ky thuat keo gian cot song co.

II. DOI TUONG VA PHUONG PHAP NGHIEN CUD 1. Doi ttfdng: Benh nhan thoai hoa cot song

co dUdc chan dean va dieu tri bang phUdng phap keo gian cot song co tai Khoa Phuc hoi chUc nang ciia Benh vien Da Khoa Tien Giang trong 2 nam 2008-2009.

2. PhUdng phap nghien cu'u: Can thiep,

thU nghiem lam sang khong doi chUng.

Benh nhan dUdc dieu tri bang phUdng phap keo gian cot song co bang may keo TM 300 va TM 400 n"0 ket hdp vdi cac phUdng phap vat ly tri lieu phuc hoi chUc nang thong thUdng nhU dung thudc, hong ngoai,...

- Cach thUc tien hanh dieu tri bang may keo gian:

Budc dai keo vao earn, cd, dau benh nhan sao cho day keo tao thanh vdi mat ban mdt gdc 20-30°.

Lut keo khdi dau la 60N (6kg), tang dan moi ngay ION (1kg). Lut keo tdi da tU 100N (10kg) den 140N (14kg). Trong qua trinh keo, tuy ngUdng chiu dUng, cam giac cua benh nhan de dieu chinh IUc keo cho thich hdp, thdi gian keo 60 giay, thdi gian nghi 30 giay, moi dot keo la 10 phut.

- Tieu chuan danh gia:

+ Tot: Cac trieu chUng giam han hoac khdng cdn bieu hien.

+ Cai thien: Cac trieu chUng cd giam, van bi anh hudng khi lao ddng, sinh hoat.

+ Khdng ket qua: Cac trieu chutig khdng giam.

III. KET QUA

Trong 2 nam 2008-2009, chiing tdi cd 60 benh nhan dUdc dieu tri tai Khoa Phuc hdi chUc nang ciia Benh vien Da Khoa Tien Giang gdm 26 nam (43,2%) va 34 nff (56,8%).

3.1. Phan bdtheo gidi, tudi : Gidi

Tudi Nam NS Tong so

< 40 2 (3,3%) 1 (1,7%) 3 (5%)

40-49 12 (20%) 14 (23,3%) 26 (43,3%)

50-59 8 (13,3%) 14 (23,3%) 22 (36,7%)

> 60 4 (6,6%) 5 (8,4%) 9 (15%)

Benh nhan d dp tud'i 40-49 chiem ti le cao nhat (43,3%).

3.2. Theo nghe nghiep:

Nghe nghiep Sd benh nhan Ti le %

Cdng nhan 4 6,6

Ndnq dan 16 26,7

Can bd nha nude 10 16,7

Hoc sinh 2 3,3

Ndi trd 18 30,0

Nghe khac 10 16,7

Benh nhan ndi trd, ndng dan, can bp nha nUdc chiem da so.

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Y HOC VIET NAM THANG 7 - SO 1/2010 3.3. Trieu chirng lam sang:

Trieu chiing So benh nhan Ti le %

Nhirc dau 32 53,3

Dau vung co-canh tay 50 83,4

Dau vung gay cap 12 20,0

Dau vung gay keo dai 50 83,4

Benh nhan co trieu chirng: Dau vung cd-canh tay, dau vung gay keo dai va nhirC dau chiem ti le cao nhat.

3.4. X quang:

Dau hieu X quang So benh nhan Ti le %

MpC qai xUOnq 24 40,0

Hep khe khdp 48 80,0

Dac xUdng 40 66,7

Dau hieu hep khe khdp chiem ti le cao nhat 80%

3.5. Thdi gian mac benh:

Benh nhan den muon hdn 3 thang chiem ti le cad nhat.

3.6. Ket qua dieu trj;

Thdi gian Sd benh nhan Ti le %

< 2 tuan 2 3,3

2 tuan-3 thanq 26 43,3

> 3 thang 32 53,4

Ket qua Sd benh nhan Ti le %

Tot 10 16,7

Cai thien 48 80,0

Khdng tot 2 3,3

Benh nhan dUdc cai thien 80%, tot 16,7%, IV. BAN LUAN

- Tuoi va gidi: Trong 60 benh nhan, ntf gap nhieu hdn nam va tip trung d nhdm tudi > 40 tud'i.

Loang xudng la tien trinh tir nhien ciia cd the, am tham trong qua trinh lao hda, dac trUng bdi su" mat chat xudng lam cho xudng trd nen ddn va de gay. O phu ntr cd nhurig cdng viec ddi hdi kien nhan, lau dai, cd nhurig dieu kien khdng thuan ldi tac ddng den cdt song cd mdt each tir tir, dan den thoai hda; d ciing mot dp tudi, phu nO¹ cd nhurig bien dd'i thoai hda, lao hda nhanh hdn d nam do nhurig bien dd'i ve ndi tiet trong cd the ntf gidi theo thdi gian, dac biet la d tud'i tien man kinh va sau tud'i man kinh⁽³⁾.

Lira tud'i hay gap nhat la dp tud'i 40-49 tud'i.

Qua trinh lao hda keo dai trong nhieu nam, sau 30 tud'i da bat dau xuat hien mat chat xudng d mdt so xudng trong cd the. Qua trinh nay ked dai trdng 20-30 nam cho den cudi ddi. Liic dau tinh trang loang xudng cdn nhe, ngUdi benh hoan toan khdng cam thay dau ddn hay te nhirc, cho den khi mat hdn 50% chat xUdng, trieu chirng dau xuat hien, chii yeu la dau cdt song, nhat la cdt song cd va cdt song lung. Sau nhieu nam tien trien cd the gay ra bien dang cdt song, ldn xep dot song⁽³⁾.

Ket qua nghien ciru ciia chiing tdi phii hdp vdi nhan dinh ciia tac gia Tran Ngoc An, Phan Hiru Phudc, ciia Pham Van Minh trong nghien citu thoai hda cdt song cd. Cac tac gia deu cho 52

Y HOC VIET NAM THANG 7 - SO 1/2010 rang qua trinh thoai hoa cot song co bat dau tU

40 tuoi trd di, tuoi cang cao thi nguy cd thoai hoa cot song cd cang nhieu<3)(4)(5).

Phan bd theo nghe nghiep cd 26,7% benh nhan la ndng dan, 16,7% la can bp nha nUdc, 30% la ndi trd.

Trong cudc sdng hang ngay, cac tiT the xau trong sinh hoat, lao ddng, ngdi lau bat ddng khi lam viec, sir dung may tinh lien tuc gay anh hudng len cdt song, cac ddng tac qua manh, dot ngpt, sai tu the khi mang vac, day, xach, nang cung rat anh hudng den thoai hda cdt sdng.

Benh thudng gap d phu nff ndi trd ldn tudi, nhat la bi beo phi do thoai hda khdp dien tien dan theo thdi gian (chiem 30%). Trong mdt xa hdi phat then cudc song sinh hoat va lam viec ngay cang thuan ldi, khdng phai van ddng nhieu tao cho con ngUdi mdt sUc y rat ldn, de dan den thoai hda cdt sdng, hay gap d nhdm lam viec van phong, lao ddng trong mdi trUdng hien dai (can bp nha nUdc chiem 16,7%), hoac d nhdm ndng dan lao ddng nang vdi nhUng ddng tac lao ddng qua manh, dot ngpt, sai tu the (26,7%).

- Trieu chting lam sang: Trieu chUng dau cd-canh tay, dau viing gay keo dai la trieu chUng thudng gap nhat. Trieu chUng dau dau cung chiem ti le cao. Tuy nhien, trieu chUng dau dau khdng dac hieu cho thoai hda cdt sdng cd nen thUdng benh nhan chUa di kham benh neu chi cd trieu chung nay. Chi khi benh dien tien nang, keo dai xuat hien cac trieu chiing dau sau gay, dau cd-canh tay,.. ngUdi benh mdi di kham va dieu tri benh.

Dau hieu X quang: Hep khe khdp chiem ti le cao nhat (80%), rdi den dau hieu dac xUdng (66%), moc gai xUdng (40%) phii hdp vdi cac tac gia trong va ngoai nUdc. Cac dau hieu X quang dPn thuan thudng it giup chan doan xac dinh benh thoai hda cdt song cd ma phai ket hdp lam sang-can lam sang va lam them cac xet nghiem cao cap khac trong chan doan Icang xUdng nhU do ti trpng xUdng bang sieu am, chup cat ldp ti trpng,...

- Thdi gian mac benh: Benh nhan thudng den muon sau 3 thang (53,4%). Dd benh dien tien tir tU, tien trien dan, ngUdi benh khdng den benh

vien ngay, khdng dupe dieu tri dut diem, tich cut ngay tU dau ma thudng dieu tri bang nhieu thU thudc, tai phat nhieu dot mdi vao benh vien.

- Ket qua dieu tri: Benh nhan dUdc cai thien 80%, 16,7% dien tien tdt, chi cd 3,3% that bai trong dieu tri. Dieu nay cho thay hieu qua cua viec dieu tri thoai hda cdt song cd bang phUdng phap keo gian cdt sdng cd". Ket qua cua chiing tdi phu hdp vdi cac ket qua nghien cdu cua Phan Van Minh, Nguyln Xuan Nghien va nhieu tac gia khac ( 1 ) { 2 ) < 4 ).

SU danh gia hieu qua dieu tri dira vac cac cam giac trieu chUng dau giam han hoac cd giam cua benh nhan cd the chUa hoan toan thuyet phuc. Tuy nhien, da so cic benh nhan cua chung tdi deu cam thay tinh trang benh diln tien tdt sau cic ddt dieu tri bang may keo gian cdt sdng cd.

V. KET LUAN

Nghien cUu hieu qua ciia dieu tri thoai hda cdt sdng cd bang phUdng phap keo gian, chiing tdi nhan thay:

Thoii hda cdt sdng cd hay gap d nU nhieu hdn nam, gap nhieu d lUa tud'i tren 40 tud'i va nghe nghiep la ndng dan, ndi trd va can bp nha nUdc.

Trieu chUng lam sang: thudng gap dau vung gay keo dai, dau viing cd-canh tay. Da so benh nhan deu den benh vien mudn tren 3 thang.

Ket qua dieu tri cho thay ket qua tot va cai thien nhieu.

TAI LIEU THAM KHAO

1. Bo mon Noi, Dai hoc Y Dirge Hue (2009), Benh cd xUdng khdp, giao trinh sau dai hoc.

2. Nguyen Xuan Nghien (1996), Nghien cUu chan doan va danh gia ky thuat keo nan trong dieu trj dau khdp cot song do tac nghen, Luan an Pho tien sT khoa hoc Y DUdc.

3. Phan Hiru Phudc (2000), Benh loang xUdng, Bao SUc khoe va ddi song

4. Pham Van Minh (2008), Danh gia hieu qua dieu trj thoai hoa cot song cd bang may keo gian, Tap chi Y hoc thut hanh (614+615), so 8/2008.

5. Tran Ngoc An (1999), Benh thap khdp, Nha xuat ban Y hoc.

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