Nhận xét kết quả điều trị thoái hóa khớp gối bằng phẫu thuật thay khớp gối toàn bộ

thang). Nhty vay, thu thuet lam LEEP da mang lai
TAI LIEU THAM KHAO
hieu qua cao trong viec ngan chan tien trien thanh
1. VG Ba Quyet, Le Trung The, 13C1i Thi M9 Hanh,
ung thu CTC cua nhirng twang hop CO tan san not
Tran Van Chuang (2013), Ket qua sang lac to bao hec
bleu m6 vay (CIN). Rieng vai cac truang hop AGC,
phu khoa cua phu nir thanh oho Hea Binh. Y hoc flux
viec chin dean ten cac phien dO TBH can rat can
hanh, so (899) 12/2013, 150-152.
2. Phan Thi Kim Anh (1993), Nghien cCru tuft deu
nhac vi nhirng bien d6i ve hinh thai to bao khong
thuc sty r6 rang de xac nhan mot bat thuang bieu m6
danh gia ten suet mac bOnh cua nhiem khan du,ong
sinh duc du,oi & phy nu' den kham tai Vien BVBMTSS.
tuyen thtyc sty (hat., het cac truang hop trong nghien
Luan van BSCKII. DHYHN
aru nay cieu lien quan den ton thuang phan ung).
. 3. Duang Thi Cuang, Nguyen Thin va CS (1984),
Viec nao kenh Ong c6 la can thiet de CO chan doan
Dieu tra benh phi) khoa th6ng thuang va ung thu, du,ang
xac dinh.
sinh duc &Ail 6, phu nip n6ng thOn mien Nam va mien
KET LUAN
Bac. 1-16i nghi tOng ket nghien co,u khoa hec 1984.
Nghien aru min iff0 ph6 hop giCra chart (loan TBH
4. Nguy6n Wang, Trinh Quang Dien, Iran Van Hap,
cua 24 truang hap co to bao bieu m6 bat thuang vai
Le Dinh Hoe, Le Trung The, Nguyen Thuy Huang, Sang
ket qua MBH, theo doi sau 12 thang vai nhirng
Van Duvng, Tran Dire Huang, BO Thi M9 Hanh va CS

truang hop nay bang xet nghiem TBH CTC-AD va
(2000), Phat hien sam ung thu, c6 tir cung qua sang lac
danh gia hieu qua dieu tri viem cua 438 truang hop
to bao hoc. N tai cap Nha nutk, BO KH& CN, Tong h6i
viem CTC-AD trong chuang trinh sang loc TBH phu
y dime lux Viet Nam.
khoa cho 850 phu nO, tai 5 phirang cua thanh ph6
5. Dowd T.C, West R.R (1996), Evaluation of a rapid
Nola Binh, chung t6i ce mOt s6 ket Wen sau:
diagnostic test for bacterial vaginosis. Bristish Journal of
Obstetrics and Gynecology, Vol 103, 366-370.
- Mcrc dO phu hap gitla chin (loan TBH va MBH
6. Allen KA, Zaleski S, Cohen MB (1994): Review of
cao nhat d6i vai HSIL (100%) va SCC (100%), tY le
Negative Papanicolaou Tests. Is the Retrospective 5phu hap thap clan vai LSIL (77,8%), ASC-H (66,7%),
Year Review Necessary? Am J Clin Pathol 101: 19-21.
ASC (53,8%) va AGC (33,3%).
7. Aral S.0 (1992), Sexual behavior as a risk factor
- Ty le khoi hoan toan viem do tap khuin sau dieu
for
sexually transmitted disease. Reproductive tract
tri (2 tuen) la 69,6%, do Gardnerella (GV) la 81,2%,
infections: Global impact and priorities for women's
do nem Candida là 90,9%, do Trichomonas Vaginalis
repoductive health. 185-199.
(TV) la 100,0% va do Actinomyces la 87,5%. Rieng 2
8. De May.RM (2005). An overview of the Bethesda
truang hop viem do Herpet deu tai phat.
System. The Pap test, pp.235-244.
- Theo dai sau 12 thang ce 1 truang hop ASC

9. Nguyen Virang, Le Trung The (2001), Te bao vay
khong thay d6i, cac twang hop da lam LEEP CTC
khong dien hinh, y nghia chua xac dinh: M6t yen de thai
su, trong sang I9c ung thu, co tip cung. ThOng tin Y hoc
deu khong they co to bao bat thuang.
lam sang, trang 13-17.

NHAN XET KET QUA DIEU TRI THOAI HOA HMO GOI
BANG PHAU THUAT THAT KHdP GOI TOAN BO
NGUYEN VAN HOC*, NGO VAN TOAN*, TRAN TRUNG DUNG**

* BOnh vin ViOt DOC, ** Truing Dai Hoc Y Ha NOi
TOM TAT

Dat van de: Thaai h6a khdep (THK) la ton thuang
thoai h6a sun khdp, do qua trinh sinh tOng hap cac
chat ca ban cua t4 bao sun c6 scr bat thuteng. Thay
khap g6i la phau thuat thay lap sun IX bao man bang
vat lieu nhan tao, day la phuung phap triOt de di6u tri
THK giai doan muOn. Muc dich cua nghien ceru nay 16
danh gia kat qua thay khap gOi toan phan trong cigu trt
thoei has khap g6i. DOi hiring va "pang phap
nghien cav: Chung tai ti4n hanh nghien ciru 50 benh
nhan (BN) (52 khap g60 clutk thay khap g6i toan phan
(KGTP) tai Denh vien ViOt Dix ter 11/2010 den 4/2012.
Cac BN &vac danh gia truik va sau m6 dira vao thang
diem KS va KFS. Nghien ceru hoi ciru va thong ke ma
to (phan mem SPSS 16.0). Ket qua: Vai thai gian theo
dOi trung binh 13 thang. Diem trung binh KS fru-6c m6
la 48,14 ±8,12, sau m6 là 86±7,61. Diem trung binh

Y HQC URIC HANI1 (916) — SO 5/2014

KFS truck m6 la 40,1±9,61, sau mo la 82±7, 76
(p<0,05). Tam van Ong got trung binh: 113,2 ± 5,2. Ty
rat tOt la 80,77%, tOt 13,46%, trung binh 5,77%. CO
1 truang hap dau khOp the dal sau m6. Ket !clan:
Phau thuat thay KGTP mang lai kat qua Om dau tot
cho ngurYi benh thoai h6a khap g6i giai Boon muan.
SUMMARY

Background: Osteoarthritis is degenerative lesions
of articular cartilage, due to the biosynthesis of basic
properties of cartilage cells are abnormal. Total knee
arthroplasty is the surgery that replaces articular
cartilage by artificial materials. This is the thorough
method to treat late stage of osteoarthritis. The
purpose of the present study was to evaluate the
results of total knee arthroplasty in the treatment of
knee osteoarthritis. Materials and method We
studied 50 patients (52 knees) were total knee

41


arthroplasty in Viet Duc hospital from 11/2010 to
4/2012. The patients were evaluated with the use of
Knee Score (KS) and Knee Function Score (KFS)
scale. Retrospective cohort study and descriptive
statistics ( SPSS 16.0 soft-ware). Results: With the

mean duration of follow-up was 13 months. The mean
preoperative KS was 48.14 ±8.12, postoperative KS
was 86±7.61. The mean preoperative KFS was
40.1±9.61, postoperative KFS was 82±7.76 (p<0.05).
The mean range of motion 113.2 ± 5.2. The proportion
of postoperative Knee Society Score was 80.77% of
excellent, 13.46% of good, 5.77% of fair. There was
one patient with pain of patellofemoral articular.
Conclusions: Total knee arthroplasty yielded good
pain relief for patients with later stage of osteoarthritis.
Keywords: Osteoarthritis, total knee arthroplasty,
Viet Duc hospital
DAT VAN DE
Hien nay tai Viet Nam benh 19 khap g6i ngay cang
ph6 bien, trong d6 t9 le benh nhan thoai hoa khOp
tien phat, thoai hoa khOp sau chan thuvng, that)
khdep, viern cot song dinh khdep ngay cang tang anh
hiserng den sinh hoat cua ngiy61 benh. Co nhieu
phwyng phap de dieu tri benh nhu' Bleu tri n6i khoa
ket two phuc, hal chtk nang, Om can, not soi lam
sach khap, cat xuang siva truc xu'o'ng chay..:_va khi
cac phuvng phap dieu tri ma ngubi benh van con
dau, bien clang nhieu, co rut khap, tech truc ca hoc,
tren X-quang hinh anh thoai hoa kh# r6 thi benh
nhan co chi dinh thay khdrp g6i.
Tren the giai ph5u thuat thay khap gOi wan phan
da duvc tien hanh tfy nhirng nam 1970 va dem lai
chat lu'ang cu6c song tot cho benh nhan thoai hoa
khdep g6i. Ngay nay su' phat then cua khoa hoc k9
thuat cho ra dai nhieu the he kh&p mai co u'u diem

yu,cyt trOi, cung yi;yi su' tien 130 ye vo khuan, gay me
hal sirc va dac biet la sir tien b0 ye ph5u thuat ...lam
cho ph5u thuat thay khap gOi ngay cang ph6 'Dien va
flat du' c nhieu thanh cong.
CY Viet Nam ph5u thuat thay khap gOi clu,c7c tien
hanh flan 10 nam nay a cac trung tam Ian. Tai Viet
Dirc ph5u thuat thay khap g6i toan phan ciing duvc
tien hanh ten 10 nam, cho den nay ngay cang nhieu
benh nhan duvc thay Mick, gOi tai vien Chan thuvng
Chinh hinh.
Chung toi tien hanh nghien ciru nay nharn mix
dich danh 9i6 ket qua dieu tri ph5u thuat thay khap
961 toan phan tai Benh vien Viet Dim.
DOI TUVNG VA PHU'O'NG PHAP NGHIEN CU'U
1. e6i tuvng nghien apt,:
Là nhipng BN duvc ph5u thuat thay khdep gOi toan
phan tai Benh vien Viet Dirc. Cac BN nay co day du h6
so* benh an, co phim chup X-quang tuck va sau mO.
2. Phuvng phap nghien cryti:
Nghien ciru me to h6i ciru duvc tien hanh theo
cac bulk:
- Lkra chon tat ca cac h6 sce benh an da mO thay
khc5,p gOi tai Benh vien Viet Dim Ur 11/2010 den
4/2012.

42

- Ghi day du th6ng tin can thiet nghien ciru.
- Hen kham lai BN de thu thap thong tin.
- Phan tich va sir 19 s6 lieu bang phan mem

SPSS 16.0.
3. Ky thuat m6:
- Sir dung khang sinh truVc m6 30 phut, Garo sat
ben voi ap ly'c 450 mmHg.
- Rach da dutmg giiYa g6i.
- B0c 10 khap: rach bao khbp trong cach bb trong
xuvng banh the 1 cm Ur mao chay tai ca thang
sau da b6c 10 va lam trot gOi ra truck. Chu 9 tranh
lam ton thuvng day chang ben chay va mac.
- Cat phan 161 cOu

Hinh 1: Cit be phAn mat khap xu'ung die bi t6n thutong
- Cat phan mam cha
p
oftibia
removed ted

Hinh 2: Cit be Olin mat khap xu'o'ng chay bi ton thutong
- {Oat dung cu thin danh gia xem co du6i hoan
toan khong, mivc ef6 vizng trong-ngoai va truc gOi.
Dam bao khoang gap bang khoang duoi.

Hinh 3: The, khap nhan to
ngoai kh6p va
Dat ktufvp nhan tao, d5n
dong vet mO

Hinh 4: D4t khap nhan tao

Y HOC THVC HANH (916) — SO 5/2014

KET QUA
- D4c di6m cua nhOm bOnh nhan nghien aru:
Trong so 50 BN vai 52 khap, t9 la nO'/nam la
2,33/1. Tuoi trung binh 16 64,2 ±11,03 (35-83), s6 BN
tiF 60 tuOi to; len chiem 70%. T9 le BN beo phi va
thiYa can chiem 30%.
- DOc diOm tOn thu'o'ng kho'p
Trong nhorn nghien ciru cua chung toi THK tier)
phat chiem da so vai 94%, cac banh ly khac (VKDT,
THK sau chart thtyang) chiem 6%. CO 34 BN thay
khap ben phai, 14 BN thay khrfrp ben trai va 2 BN
thay ca 2 ben
- Thai gian bi benh trung binh là 3,55 nam. Ca
khap g6i 1,5 va 2 chiem da so vai 68%.
1. Ket qua phiu thuat
Truyen mau trong mO co 2 BN (4%). Thai gian mO
trung binh 89 phitt, thai gian nem vian trung binh 9,3
ngay (3-28 ngay). Chyp X-quang sau mO 100% dung
vi tri.
2. Ket qua sau mo
- Thai gian theo doi sau m6 trung binh la
13,24±4,37 (6-23 thang). Bien dO van dOng gOi trung
binh 113,2° ± 5,2°, 100% so BN co bien dO gap g6i
ten 90°.
- Ket qua chung duvc danh gia theo thang diem
Knee Scociety Scoring system gOm 2 phan Knee
Score (KS) va Knee Functional Score (KFS)
+ Theo KS: Diem trung binh truck mO: 48,14 ±

8,12, sau mo la 86 ±7,61.
khac brat coy nghia
th6ng ke vai p<0,05.
+ Theo KFS: Diem trung binh truck mO: 40,1 ±
9,61, sau m6 la 82 ±7,76. Sy' khac brat co 9 nghia
thong keyeri p<0,05.
3. Bien chirng
Truyen mau trong mO co 2 trugng hop chiem 4%.
Kh6ng co twang hop nao tOn thtyang mach mau,
than kinh hay dat sai khOp.
BAN LUAN
Tuoi trung binh la 64 tu6i, trong do s6 BN tren 60
tuoi chiem 70%, dieu nay phu hop vai banh 19 THKG
chir yeu gap 0, ngirai Ian tuOi. Hun nira khOp nhan
tao co tuOi tho nhat dinh nen chi dinh thay khcfrp g
nhu'ng BN tre can can nhac.
BN nCr chiem da so 70%, do dac diem cua THKG
lien quan den thay d6i nOi tiet to nu, a tuOi tien man
kinh. Dieu nay da duvc chung minh qua nghien ciru
tren invitro va dich to hoc.
SO BN bi this can va beo phi chiem 30%. Theo
Hart va Spector beo phi la yeu to quan trong nhat cua
THKG. Theo Ong neu trong luvng co' the tang 5kg thi
nguy ca mac banh se tang 35%.
Thoai h6a khap tien phat yen la chi dinh chit yeu
cua thay khap gOi (94%). Dieu nay la do banh THKG
tien phat ngay cang ph6 bien. Phau thuat thay khOp
goi la mot pheu thuat Ian, chi phi cao va quan trong
la tuOi tho cua khdep co giai hart. Chinh vi vay ma ten
the gidri cung nhu' a Viet Nam thay KGTP chir yeu o'

nhirrig .BN THKG tien phat.
Thoai hOa khap gOi sau chan thtyang chiem 2%,

Y HOC THUC HANH (916) — SO 5/2014

co 1 BN THKG sau gay mam chay. O' nhOm BN nay
chung toi gap kho khan trong viec can bang phan
mem de tao sty virng chac cua khap do phan mem
cua khap g6i sau chan thtyang bi co rut va ben clang
nhieu. Nhorn BN viern da khdp clang thap chiem 4%,
nhOm BN nay kh6ng chi sun khap bi hong ma bao
khOp bi viern dOng thai chat luvng Arcing cung
khong tot vi vay BN thugng dau sau mO nhieu han
anh hugng den phuc hoi chin nang sau mO, day la
nguyen nhan lam ket qua KFS sau mo chi dat ket qua
trung binh.
Trong nghien ciyu t9 la BN thay khap gOi ben phai
chiem da s6 68%, co 4% duvc thay Ca 2 khap.
THKG thiyang bi ca 2 ben, chi dinh thay ben nao tby
thu6c vao lam sang, neu thuan chan phai thi viec chiu
Ikrc trong thai gian dai se lam cho khdtp tOn thuvng
nang hon. Han nipa, pheu thuat thay KGTP la phau
thuat Ian, chi phi cao, dal hoi cao ye phuc h6i chin
nang cung nhty the d6 sinh hoat sau m6 nen chi dinh
thay ca 2 khOp con han the.
Cac BN deu co thai gian dieu tri ttyang doi dai ke
tir khi dau khap g6i den khi dugc thay khap g6i (3,55
nam). Khi banh khOng da, dien bien nang den, dau
ngay cang tang, bien clang khap goi, kh6ng dap Crng
thuOc hoac anh Wang den da day. MOt yen de riCra

lam keo dai thai gian pheu thuat la tai chinh. SO BN
sir dung co' khap 1,5 va 2 chiem 68% la phir hop vai
tem vOc cua ngtygi Viet Nam.
Thai gian nem vien trung binh dai (9,3 ngay) do
BN Ian tu6i, thirang c6 banh ly nOi khoa phoi hgp va
chung toi cung muOn BN co thai gian dugc hugng
den tap phuc hoi chin nang sau m6.
Ve k9 thuat m6: Thay KGTP la pheu thuat Ian nen
chOng toi thao tac het sCrc can than (trial gian mO
trung binh 89 ph0t). Tat ca cac khc;rp gan vao xtyang
CO xi mang (fix bearing). Do sir dung garo hal nen
Om Clang Ice met mau trong mo (CO 2 trugng hap
truyen 500 ml h6ng cau kh6i).
Thai gian theo dOi sau mo trung binh la 13 thang,
tem van dOng khap trung binh 113° lam BN hai long.
MOt s6 yeu to nhu' khdp ben clang nhieu, tern van
dOng kern trugc m6, su, kern nang dOng cua ngutri
gia kern theo benh 19 nOi khoa ph6i hap anh Wang
den ket qua tren
Get) CI Met du6i <10° Duel cung (n)
Tren Ngoc Tuen
Nguyen Tien San
Truang Chi FICru

110
105
105

(n)
2

1
2

0
0
0

Kat qua phuc h6i chirc nang theo KSS: T9 la rat
tOt 80,77%, tot 13,46%, trung binh 5,77%. So sanh
vai 1 s6 tac gia nhu' Ranawat t9 le rat tOt 83%, Scott
la 88%.
Dieu nay là do da s6 BN thuang den vin a giai
(loan mu6n, bien clang goi nhieu, dac bit la nhOm BN
viern da khap clang thap ye thoai heta khOp sau cher)
thirang, (Jong thai trong giai doan dau chOng toi thieu
kinh nghiem ye can bang phan mem khap gOi va Ciao
brat do hoar' canh khach quan viec phyc h6i chirc
43


nang cho ngutei benh chu'a dOng PO.
Trong nhOm nghien cizu co 1 tripang hap dau
khap the dui sau m6. Cac [Dien chUng khac nhu,
khong gap tru,ang hap nao,
nhiem trung, tat
chu'a
nhieu, thai gian theo doi
BN
co the do s6 krceng
sau m6 con ngen.

KET LUAN
Phu thuat thay KGTP mang lai ket qua giam dau
tot cho ngtrai benh thoai hOa khap g6i giai loan
muOn, dung thai mang lai chin nang van dOng khap
g6i tot cho BN, tir c:16 cai thien chat Itrang cuOc song.

TAI LIEU THAM KHAO
1. Nguyen Thj Ai (2006), "Nghien cut, dac diem lam

sang, can lam sang va ap dung cac tie u chuan chin
down benh thodi boa khdep gar, Luan van that s9 Y hoc.
Twang Dai hoc Y Ha N6i.
2. Nguyen Thj Ngoc Lan (2004), "Thoei h6a khap va
cOt song", Benh hoc n6i khoa T1. NXB Y hoc: tr. 422435.
3. Gunston F.H (1971), "Polycentric knee

arthroplasty. Prosthetic simulation of normal knee
movement", JBJS, 53-B: tr. 272.
4. Nguyen Thanh Chan & Ng6 Bao Khang (2005), "

Chen thutmg Chinh hinh Sai GOn-ITO", Y hoc thanh phi!)
HO Chi Minh, 9(2): tr. 134-136.
5. Tru'ang Chi Him (2008), "Ket qua ban Tau thay
khdep gal toan phan tai Banh vian Chen thirang Chinh
hinh thanh phO H6 Chi Minh", KY yeu Hoi nghj Chen
thtyang Chinh hinh thanh ph6 HO Chi Minh Ian thir XV:
tr. 69-71.
6. Nguyen Tien San & Doan Viet Quart (2010), "

Dinh gia ket qua buac dau thay toan b6 kh&p g6i tai
Benh Wen Viat Dire.
7. T D Spector & D J Hart (1994), "Incidence &
progression of osteoarthritis in women with unilateral
knee disease in general population: The effect of
obesity", Ann-Rheum-Dis, 53: tr. 565-568.
8. Ranawat C.S, Flynn W.F, Saddler S & KK Hansjai
(1993), "Long stem, results of the total condylar knee
arthroplasty 15-year survivorship study".Clin, Orthop,
286: tr. 94-102.
9. W N Scott, M Rubinstein & G Scuderi (1988),
"Results after total knee arthroplasty", JBJS, 70(8): tr.
1163-1173.
10. Morrison J.B (1970), "The mechanics of the knee
joint in relation to normal walking", J Bioech, 3: tr. 51.

Ket qua butjec dau thay khap gel toan phan tai Banh vin

THUG TRANG VA MOT So YtU TO LIEN QUAN DEN NHIEM KHUAN HO HAP CAP TiNH
Cult THE DUVI 5 TUOI TAI MOT SO XA- HUYEN QU'iNH LUb, TINH NGHE AN
DAM THI TUYET — Truong DO hoc Y duoc Thai Nguyen
TRAN THI HANG — Benh vien Da khoa huyen Quynh Luu, tinh Nghe An
TOM TAT
SC, dung phvang phap dieu tra cat ngang de
nghien cOv ye tinh hinh nhiem khuan h6 hap cep tinh
va 'Of so yeti t6 lien quan den nhiem khuan h6 hap
cep tlnh & fro du'&i 5 tuoi tai 2 xa huyen Quynh Luv,
tinh Nghe An chOng t6i they:
- Ty le tre mac nhiem khuan he hap cep tlnh & Oa
diem nghien ciru con cao (38,34%), trong CIO tY le

khOng viem phoi: Ho hoac cam lenh (34,54%); Viem
phoi: 3,8%.
- Ty le mac nhiem khuan h6 her) cep tinh cao
lira tuoi ter 12 - 35 thing tuoi (41,04%).
- Cac yeti to lien quan den nhiem khuan h6 hap
cep tint) de tre tai Ira diem nghien cOv le: Kien thor
cue be me ye nhiem khuan h6 hap cep tinh cho tre
kern, tiem chang khOng day du hoac du nhung khOng
dung lich, tie cai sCra sam, lam chu6ng gia sue gen
nha, tinh trang nha, bap dun trong nha, gia dinh tre
co ngutei but thu6c 0, thu6c lao trong nha.
Tel' kh6a: Nhiern khuan hO hap cap tinh, Nghe An.
SUMMARY
Using a cross-sectional survey to study on a
situation of acute respiratory infection in children and
some risk factors related to acute respiratory infection
at 2 communes in Quynh Luu district — Nghe An
province, we found that:
44

The prevalence rate of acute respiratory infection
in children in the study area was still high (38.3%);
the rate of children suffering from cough and cold was
34.5%; the rate of children suffering from bronchitis
was 3.8%.
The prevalence rate of acute respiratory infection
in children was still high from 12 -35 months old
(43.8%).
Factors related to the acute respiratory infection
in children in the study area are: Mother's

knowledge on child care was closely, Children who
were not fully vaccinated or were fully vaccinated but
an incorrect schedule, children weaned early, animal
sheds near the house, a housing condition, a indoor
kitchen, indoor smoking.
Keywords: Acute respiratory infection, Nghe An.
DAT VAN DE
Nhiem khuan h6 hap cep le berth ph6 bien co t9 le

mac benh va tir vong cao 6, tre em, (lac biet do viem
ph6i a tre du,eyi 5 tuoi tai cac nut,c sang phat trien.
Theo so lieu dm TO chin Y to The giai, moi tre trung
binh trong 1 nem mac nhiem khuan h6 hap cep tir 4 9 Ian, vac tinh ten Wan eau moi nem CO khoang 2 t9
loaf tre mac nhiem khuan h6 hap cep, trong do
khoang 40 trieu Vat le viem phoi [3].

Y HOC THUG HANH (916) - SO 5/2014