Đặc điểm tổn thương đại thể đứt dây chằng chéo trước khớp gối qua 200 trường hợp phẫu thuật

TAP CHI NGHIEN CIYU YHQC

DAC DI E M TON THU'O'NG DAI THE DOT DAY CHANG CHEO
TRUtiC KH&P GO! QUA 200 TRLY(YNG HgP PHAU THUAT
D6 Van Minh, Trin Trung Dung
O
Twang Doi Hoc Y Ha Ni
tren 200 benh nhan
TOn thuang dirt day chang cher, truor khOp g6i khe thuang gap. Nghien art] hoi
dupe ph5u thuat to hinh day chang cheo trtrop khap g6i qua nOi soi tai benh vien Viet Dar va benh vien
Doi HOC Y Ha NOi nham mO to dac diem hinh thai ton thuang doi the dirt day chang cheo trubp khOp g6i qua
nOi soi va xac clinh mOt s6 yeu to lien quan den hinh thai ton thuang dirt day chAng cheo troop khap g6i. Kat
qua nghien ciru cho they hinh thai t6n thuang gap nhieu nhat la kieu F (tieu day chang) chrem 41,5% va kieu
D (t6n thuang ch6 barn 161 cau d6i) 27,5%. Thai gian tir khi chan thuang clan khi ph5u thuat, co dieu tri nOi
khoa hay khOng la nhang yeti to lien quan den hinh thai t6n thuang day chang coy nghia th6ng

Tir ktioa: dirt day ching cheo truerc, nOi soi g6i
I. DAT VAN DE
Day ch5ng cheo trip:5'c la cau truc giai

dung la nhirng yeu to anh huang trcfc tiep

ph5u rat quan trong cua khap goi, clang vai

den hinh thai ton thuang day ch5ng [4]. Ve

tro chinh trong viec lam virng khap gal theo

ca ban, da so cac ph5u thuat vien quan tam

chieu truac sau va chong xoay khap goi. TOn

den yen de day chkg con hay dirt, dirt hoan

thuang day ch5ng cheo trgrac kha thuang

toan hay khOng vi lien quan den chi dinh va

gap trong cac chan thuang khap gOi [1]. Ve

k9 thuat ma it quan tam den hinh thai t6n

giai ph5u, day ch5ng cheo trt.rac di tir mat

thuang dirt cua day ch5ng. Hinh thai ton

trong cua 161 cau ngoai nrang dui den dien

thuang cua day ch5ng phan anh nhieu yeu to

gian mem chay tuft cua Arang chay, nhu,

lien quan nhLr ca the chan thuang, thai gian

vay ve mat logic, tem thuang dirt day chang

can thiep, cau true giai

CO the gap a 3 vi tri: diem barn vao lOi cau
xvong dui, than day ch5ng va diem barn vao
mem chay [2; 3]. Cau triic giai ph5u hai b6 va

CO dOng hoc twang dai phirc tap la nhirng
yew t6 lam thuang ton dirt day ch5ng cheo
Ben canh
tarac them da dang phong
da, ca the chan thuang, thai gian can thiep
muOn hay sem, dac diem mach mau nuOi

Viec chan doan va chi dinh ph5u thuat ton
thuang day ch5ng cheo trutec du'a chu yeu
vao them kham lam sang, danh gia chine nang
khap goi va cac them do hinh anh. MOt so tac
gia khuyen cao viec dieu tri bao ton tru'Oc ke
Ca co ton thuang dirt day chkg, sau dO neu
khong hiau qua mai ph5u thuat [4]. Vay thi
viec dieu tri bao ton ca hiau qua hay khOng?
NO co lien quan den hinh thai tem thuang day

Dia chi lien he: Trhn Trung Dung. BO mon Ngopi, truOng
D.* hoc Y Ha NOi
Email: dungbacsy©dungbacsy.com
NO)/ nhen:
Ngay dupc chap thuOn: 26/06/2014

68

ch5ng hay khOng?
Tai benh vien Viet Dirc va benh vien Dai
hoc Y Ha NOi, trcrc tiep tac gia da thgrc hien

TCNCYH 88 (3) - 2014

TAP CHI NGHIEN

ciru Y HQC

ph5u thuat cho hcen 500 benh nhan trong c16

200 benh nhan c6 duvc ph5u thuat Lao

hinh thai ton thkrung duvc m6 to chi tiet va cu

hinh day chang cheo trkrac khap goi qua n6i

the la 200 benh nhan. Nghien ciru du'ac thirc

soi tai benh vien Viet arc va benh vien Dai

hien nham muc tieu:

hoc Y Ha Nbi tir 2009 den 2012.

MO to dac diem hinh thai ton thkrung dai
the dirt day chang cheo truVc kh6,6 goi qua
nOi soi.
Xac dinh mot so yeu to lien quan den hinh
thai ton thuvng dirt day chang cheo trkrac
khap goi.

2. Phtrang phap: nghien ciru mO to hoi

ciru.
Danh gia hinh thai ton thkrung day chang
qua nbi soi khdep gOi dkra tren phan loaf cua
Gachter cai tien do tac gia Lo va cOng sir [5]
giai thieu Om 7 hinh thai ton thkrung:

II. DOI TUVNG VA PHUO'NG PHAP
1. 06i twang
Class A

Class B

Class C

/-;;//

ro.
Dun ei than day ening

ow bung bao
mang
cacn con Novi°

Bong ditim Pim wang

horn

Class D

Class E

Class F

Class G

•)

)

)

..)
1°
diem biun161

DUI

va barn van PCL

Tait, day cning

Ha, au dirt Mph wad nnau

Hinh 1. Phan Ioai tem thtrang dint day ching cheo trmfec
(Phan Ioai Gachter cai ti6n do Lo va cong sty gidei thieu [5])

Nhorn A: TOn thuvng dirt hoan toan & than day chang
Nhorn .B: Tan thuvng dirt trong bao, day chang con duvc bao phu bai mang hoat dich nhu'ng
long, khi ph5u tich, cac sal collagen d5 thoai hoa hoan toan.

NhOm C: Ton thiyang bong cho barn day chang a mam chay.
Nhom D: Ton thkrung dirt day chang tai diem barn vao loi ceu dOi.
Nh6m E: Dirt day chang 6' diem barn loi ceu dui, dau dirt dinh vao day chang cheo sau.
Nhorn E: Ton thkrung dirt day chang lau, day chang d5 bi tieu hoan toan.
Nhorn F: TOn thkrang cu ciia day chang, CO the do dung dap hoac dirt nhu'ng c6 bieu hien hai
dau dirt dinh vao nhau.

TCNCYH 88 (3) - 2014

69


TAP CHI NGHIEN CU'U Y HQC
Phan tich so lieu: cilia tren cac thuet town

Xac dinh cac yeu to lien quan:

thong ke y sinh hoc co sir dung phan mem

- Nguyen nhan tai nan (giao th6ng, lao

SPSS 16.0.

dOng, the thao).
- Thoi gian tir khi char' thtrang den khi

Dao diPc nghien ciPu: Tat Ca cac benh

pheu thuet.

nhan deu dor-1g 9 cho phep S6' dung thOng tin
y khoa phut vu muc dish nghien cCru khoa hoc

- Benh nhan co duvc dieu tri bao ton sau

va dam bao bi met thOng tin ca nhan.

chan thwyng hay kh6ng.

III. KET QUA
Bang 1. Cac loai ton thtpung
n

0/0

Kieu A

14

7

Kieu B

16

8

Kieu C

10

5

Kieu D

55

27,5

Kieu E

19

9,5

Kieu F

83

41,5

Kieu G

3

1,5

Tong so

200

100%

Loai ton thu'o'ng

TOn thirang thiromg gap nhat la kieu F (41,5%) va kieu D (27,5%).
Bang 2. Lien quan giipa tho'i gian tip khi chan thuvng den khi du'o'c phau thuat
Kieu F

Cac kieu khac

T6ng s6

< 6 thang

7

87

94

> 6 thang

76

30

106

83

117

200

CO sty khac biet co 9 nghia thong ke giCra nhOm ton thuang kieu F va cac nh6m khac lien
quan voi thol gian den sam hay den muon.

70

TCNCYH 88 (3) - 2014


TAP CHI NGHIEN CCM Y HQC
Bang 3. Lien quan gid,a nguyen nhan chAn thircong vai cac kieu ton thiyang
Ten thircong

Tai nan giao thong

Tai nan lao dOng

TNSH

T6ng s6

Kieu A

7

3

4

14

Kieu B

8

2

6

16

K ieu C

8

0

2

10

Kieu D

26

8

23

55

Kieu E

9

1

9

19

Kieu F

31

15

37

83

Kieu G

0

1

2

3

TOng s6

89

28

83

200

Khi so sanh theo tirng nh6m mot thi kh6ng they co skr lien quan chat the giO,a nguyen nhan
ton thiyang va loai ton thLyang.
Dieu tri bao ton la nhem muc (itch lien day cheng, tuy nhien mot so tac gia e ngai viec dieu tri
bao tOn khong giOp cho day cheng lien nen co quan diem nen mO sam. Chung tOi phan loai cac
ton thtyang thanh 2 nhom: 1 nhOm co bieu hien lien day cheng (B,E,G) va 1 nham khOng co bieu
hien lien day cheng (A, C, D, F) va danh gia m6i lien quan vai viec co dieu tri bao tOn khi chen
thtyang tru'ac dO hay khOng. Ket qua &rag the hien qua bang 4.
Bang 4. Lien quan giira co dieu tri bao ton tru,o,c dO

ton thwang

Loai B, E,G

Loai A,C,D,F

T6ng s6

CO dieu tri

33

40

73

Khong dieu tri

5

122

127

Tong so

38

162

200

CO
khac !Diet co 9 nghia thong ke giCra ton thvang loai B, E, G (co bieu hien lien day cheng)
va cac loai khac.

IV. BAN LUAN
dui) va kieu G (day cheng dirt va CO bieu hien
Qua bang 1 to they, tat ca cac hinh thai ton

lien tai cho nhumg ko co chtYc nang) la kieu

thuang deu gap tren thu'c hanh lam sang vai

ton thtyang it gap nhet. Dieu nay phi., hap vai

tan suet khac nhau, trong do gap nhieu nhet la

dac diem giai pheu va sinh l9 day cheng cheo

ton thuang kieu F (tieu day cheng) va sau db

tuft la day cheng co sin cang nen khi dirt

la kieu D (dirt a deu barn vao 16i cau xuang

thirang hai ciau bi keo xa nhau vi vey kha

TCNCYH 88 (3) - 2014

71


TAP CHI NGHIEN CC11.1 Y HQC
nang lien thu,ang kh6 xay ra. Viec lien day
cheng tai cho (ton thu,ang kieu G) thiyang xay

den yeu to giai ph5u cua day cheng cheo.
Kich thiyac giai ph5u diem barn mam chey Ian

ra doi vai cac tOn thkrang dirt kh6ng hoan
toan, can dinh 1 phan nen hai dhu diet khOng

ghp 1,5 len so vai diem barn loi cau xuang did
clang thai cau trix giai phAu diem barn mam

bi keo xa nhau vi vay viec lien day cheng mai

chey cua day cheng co cau triic rat dac biet

co the xay ra [6]. Tren phim cong hu,ang

bao Om 4 viing chuyen tiep tir cau trirc gen

hinh anh day chang cheo truck con quan sat
they nhu'ng ten lam sang, kherp gOi long,
chirc nang goi giarn nen benh nhan duvc chi
dinh ph5u thuat [4]. Dieu nay cho they viec
chi dinh ph5u thuat d6i vai tOn thu,ang day
chang cheo triyerc khOng chi dan thuen dkra

sang cau true nrang vi vay nen tOn thiyang
diem barn mam chey hiem gap han va neu co
gap thi thu,ang la ton thtyang bong diem barn
chic kh6ng co ton thkrang dirt day chang tai
diem barn [1; 2; 3]. TOn thkrang diem barn ioi

cau diJi hay gap nhat do Ityc cang dOt ngOt cua

tren cac thkrang tem tr'en phim cong hiyang tu'

day cheng se tac dOng vao vi tri diem barn

ma yeu to rat quan trong dO la them kham

nhieu nhat, hurl nCra day la vi tri chuyen tiep

lam sang. Hinh thai ton thLrang kieu F gap
nhieu nhet vai 41,5% cac tru,ang hop.
Nguyen nhan chinh then chiing tOi la da so
cac benh nhan den muOn, nuoi du,ang day

cua day chang dinh vao xtyang, cau trirc
twang tu, nhu, vi tri barn cua cac day chang
khac nen de ton thiyang han diem barn mam
chey. 06i vai than day chang, nhirng hieu biet

cheng sau khi bi dirt kern nen day chang bi
tieu di [1; 2; 3]. Ket qua bang 2 cho they co

ye cau triic hai b6 va sirc cang cua hai b6
khac nhau khi gOi chuyen d6ng cho they kha

sty khac bet coy nghia thong ke giCra ton
thkrang kieu F so vai cac ton twang khac lien

nang dirt Wan be) than day cheng, tirc la dirt

ca hai be) ciing lac it gap han va thverng doi

quan vai thai gian tir khi chen thirang den khi

hoi ca the chen thuang kha phirc tap, [1].

mO coy nghia th6ng ke. D6i vai day chang
cheo trkrac, ton thkrang dirt co the xay ra a 1
trong 3 vi tri: than day chang, diem barn vac)
101 cau .xu,ang dui va diem barn vao mam
chey. Trong cac hinh thai ton thiyang chiing ta
CO the they then hinh 1 va bang 1:

Ket qua a bang 3 cho they khOng CO mai
lien quan chat the nao giCra nguyen nhan
chen thkrang va loai thiyang ton vi vay khai
thac nguyen nhan chan thiyang it goi y cho ta
ye hinh thai ton thuang dm day chang.
MOt yen de ma da so cac tac gia quan tam

Ton thkrang diem barn mam chey (kieu C)
chiern 5%.
Ton thiyang than day chang (kieu A, B, G)
chiern 16,5%.
TOn thiyang diem barn 161 cau dui (kieu D,
E, F) chiern 79,5%.
Nhiy vay, vi tri ton thuang day chang
thkrang gap nhet la diem barn vao 161 cau
xiyang dui. Cac tac gia khac cang co kat luan
twang tkr [4; 6]. Dieu nay lien quan chat the

72

la doi vai tOn thiyang chen thtyang goi, dieu tri
bao tOn co hieu qua khOng. Chung toi tam
phan cac ton thu'ang ra hai nhen, mot la cac
nh6m co cau truc day chang con lien tuc (B, E,
G) va cac nham co cau trirc khOng lien tuc (A,
C, D, F). Viec (lieu tri bao ton dirac coi la tieu
chu5n vai bet clOng gOi 3 tuen kern then dung
thu6c. Ket qua bang 4 cho they ca su, khac
brat coy nghia thong ke giCra co dieu tri bao
tOn va khOng dieu tri vai cau trirc day chang
co lien tuc hay khong. Cau trirc day chang lien
TCNCYH 88 (3) - 2014


TAP CHI NGHIEN ciru Y HOC
tuc cho they la co bieu hien lien day cheng va

TAI LIEU THAM KHAO

mac dO, cac tarang hap nay, day cheng CO
lien nhung khong dam bao dkrac chirc neng
nen phai ph5u thuet vi vay to van CO the they
hieu qua cua dieu tri bac ton trong truteng hap
ton thu'ang day cheng do chen thu'ang. Dieu
do cho they khuyen cao dieu tri bao ton tnyac
doi vai cac chen thu'ang mai van con nguyen
gia tri, [4].

V. KET LUAN

1. Petersen W, Tillmann B (2006). Anatomy and function of the anterior cruciate ligament. Orthopade, 31(8), 710 - 718.
2. R. Strocchi (1992). The human anterior
cruciate ligament histological and ultrastructural observations, Journal of Anatomy, 80,
515 - 519.
3. Zhu J, Zhang X, Ma Y et al (2012). UItrastructural and morphological characteristics
of human anterior cruciate ligament and ham-

Qua nghien CUU 200 trateng hap tem thu'ang
day cheng cheo trutc chi:mg toi nhen they:

string tendobs. Anat Rec (Hoboken). 295(9),
1430 - 1436.

- Ton thu'ang day cheng cheo trirac co Tay

4.
. Panisset JC, Duraffour H, Vasconcelos W et al (2008). Clinical, radiological and
arthroscopic analysis of the ACL tear. A prospective study of 418 cases. Rev Chir Orthop
Reparatrice Appar Mot, 94(8), 362 - 368.
5. Lo IK, de Maat GH, Valk JW, Frank CB
(1999). The gross morphology of torn human
anterior cruciate ligaments in unstable knees.

du cac hinh thai trong d6 hay gap nhet la ton
&Krung kieu F Neu day cheng) 41,5% va ton
thu'ang kieu D (ton thu'ang diem barn 161 ceu
dui) chiem 27,5%.
- Thai gian

khi cher) thu'ang den khi
ph5u thuet, viec dieu tri bao ton la nhirng yeu
to anh huang den hinh thai ton thu'ang day
cheng.

Arthroscopy, 15, 301 - 306.
6. Crain EH, Fithian DC, Paxton EW,

Levi cam an
Tao gia xin tran trong cam an benh vien
HCru Nghi Viet arc va benh vien Dai hoc Y Ha
NOi de tao dieu kien de cheng tOi thkrc hien
nghien ciru nay.

Luetzow WF (2005). Variation in anterior cruciate ligament scar pattern : does the scar pattern affect anterior laxity in anterior cruciate
ligament - deficient - knees? Arthroscopy, 21,
19 - 24.

Summary
MACROGRAPHIC LESION OF ANTERIOR CRUCIATE LIGAMENT
RUPTURE: 200 CASES REPORT
Anterior cruciate ligament rupture is quite common. Retrospective study of 200 patients undergoing arthroscopic anterior cruciate ligament reconstruction in Viet Duc University Hospital and
Hanoi Medical University Hospital was performed with 2 objectives: 1) Describe the character of
macrographic lesion of anterior cruciate ligament rupture; 2) Determine the factor related to the
macrographic lesion. The results of the study showed that the most common classes of lesion are
Class F (41,5%) and Class D (27,5%). The length of time between the injury to receiving surgery
and treatment correlate significantly to the type of injury.
Keywords: anterior cruciate ligament rupture, knee arthroscopy
TCNCYH 88 (3) - 2014

73