Đánh giá kết quả điều trị liệt thần kinh quay cao theo phương pháp boyes tại bệnh viện việt đức

prospectively followed for fifteen years: Study I- clinical
results. J Shoulder Elbow Surg, 13: 509- 516.
6. Kashani F.0, Eghbal S, Seyed, Nadi M (2008): Is
the Bristow- Latarjet operation effective for every
recurrent anterior shoulder dislocation? Iranian Med, 11

(3): 270- 273.
7. Matthes G et al (2007): Oldie but goldie: BristowLatarjet proceduce for anterior shoulder instability. J Orth
Surg, 15 (1): 4- 8.

DANH GIA KET QUA DIEU TRI LIFT THAN KINH QUAY CAO
THEO PHU'UNG PHAP BOYES TAI BENH VIM VIET WC
TRAN MANH HUNG - 14nh vien ViOt Dix
TRAN TRUNG DUNG, NGUYEN XUAN THUY - TrIperng DH Y Ha Ni;li
HOANG VAN - BOnh vien tinh Thanh Hoa
TOM TAT:
M& Cleu: bat than kinh quay cao thuang gap trong
lam sang, viac chuyen gan theo phuang phap Boyes
la can thief. MK
Danh gia kat qua ph3u thuat
chuyen gan di& tri fiat then kinh quay cao theo
phuang phap chuyen gan Boyes. D6i Wong ve
phuang phap nghien ctru: Nghien ceru h6i cirri fret) 32
BN fiat then kinh quay claw ph3u thuat chuyen gan
theo phuang phap Boyes tai benh Wan Vint Duv.Ket
qua nghien cOu: D6 tu6i trung binh la 28, Ty la nam/nt-r
la 5,4, 31/32 BN liat then kinh trui'c ma, Kat qua ph3u
thuOt dat rat tat va tat la 82,1%. Phyc heti chirp nang
lien quan chat cite tai kat qua ph3u thuat. Kat Juan:
Ph3u thuat chuyen gan theo ky thuat Boyes cho kat
qua tat dai yeti clieu tri fiat then kinh quay.

Ti, khoa: Liat then kinh quay cao, ky thuat Boyes,
chuyen gan
SUMMARY
Introductions: High level radial nerve paralysis is
quiet common in clinical, Boyes method tendon
transfer is necessary. Objectives: To assess the
results of Boyes method tendon transfer surgery for
radial nerve paralysis. Patients and methods:
retrospective study 32 patients underwent tendon
transfer for radial nerve paralysis with Boyes
technique in Viet Duc University Hospital. Results:
average age is 28, male/female ratio is 5.4, surgical
results achieved very good and good are 82.1%.
Rehabilitation is closely related to surgical results.
Conclusions:Tendon transfer with Boyes technique is
useful for radial nerve paralysis treatment.
Keywords: Radial nerve paralysis, Boyes
technique, tendon transfer.
DAT VAN DE
Liat than kinh quay cao la tan thvang thvang gap,
nguyen nhan chinh la do char,' thvang, dac het trong
gay than xvang canh tay. Theo nhieu nghien am, tje
le ton thvang than kinh quay trong gay than xvang
canh tay tip 1,8% den 16% [1], 10% den 20% ton
thvang than kinh quay la kh6ng h6i phuc.
Liet than kinh quay cao la mOt ton thuting dAn den
tan tat nghiem trong ye chin nang ban tay, anh Wang
Ian tai sinh hopt va lao de ng cua ngutei benh. Ngvai
benh khong the du6i dot I cac ngdon tay va clang du6i
ng6n cai, met du6i chi) dOng co tay, lam anh huang

.

72

nghiem tong den chirc nang cern nem va lam Om

luc b6p ban tay. Do vay phgu thuat chuyen gan trong
liet then kinh quay kh6ng hoi phuc la cen thiet.
Vi vay nghien ciru "Danh gia ket qua dieu tri phgu
thuat het then kinh quay cao theo phvang phap
Boyes tai Benh vien htlu nghl Viet Din" thvc hien vdei
2 muc tieu:
Danh gia ket qua phgu thuOt chuyen gan clieu
tri liOt then kinh quay cao theo phumg phap
chuyen gan Boyes.
DOI TUVNG, PHU'aNG PHAP NGHIEN CU'U
Nghien ciru m6 to cat ngang 32 BN Het then kinh
quay cao kh6ng h6i phyc dixac pheu thuat chuyen
gan theo phiyang phap cue Boyes tai Benh vien Viet
Dil,c tip nem 2008 den nem 2013.
Tieu chuan Iva chon benh nhan
Benh nhan dvqc char) doan Het then kinh quay
cao kh6ng h6i phyc
Benh nhan dtrgc pheu thuat chuyen gan theo
phvang phap BOYES
Day du h6 sa benh an
Quy trinh nghien ciru:
BN duvc chan doan Het then kinh quay cao kh6ng
h6i phuc, nguyen nhan, ca the chan thvang, chup XQ
Pheu thuat: BN duvc gay to dam r6i, du6i mau va

garo canh
b6c 10 va chuyen gan gep n6ng ngon
III cho gan du6i chung cac ng6n2 gan gep nong ngon
IV cho gan du6i ng6n cai va du6i rieng ngOn tro, gan
gep co
tay quay cho gan clang dai va du6i ngan ng6n
cai, gan ca sep ton cho gan du6i co tay quay ngan
va co tay quay dai [2] ; thao garo, bam rCra va dong
vet thvang; dat mang
CBT tu' the 6 tuan
Tap PHCN theo bai tap
Danh gia ket qua
Bien d0 van Ong cac khop theo bang phan loci
ket oua cue Chuinard 131
C6 tay
NgOn cai
Ng6n tay
Gip
Mk
Du6i
diu
DuOi
d6
Du6i Gip
ngon Dang khdep
ban
ng6n tai nep
lien dot
gan tay
Rat tat >50° >30°

<10°
0
>40°
<0°
10°10 - 0- 1.25 30°- 0
0
Tot
0 - 15
50°
30°
25°
cm
40°

Y HOC THIIC HANH (922) - SO 6/2014


Tb

<25°

<10°61 >25°

1.25cm

<30°

>15°

)(au

Khong that'd i so vdri tru'&c mo(Khong cai thien)
Cach thin xep loaf:
Neu c6 5 hoc 6 muc cOng mot mic thi ket qua
efuvc xep a mirc d6.
Neu 2 hoac > 2 myc & cac MOT khac nhau thi ket
qua AID 6 mirc thap hen.
Xir ly so lieu bang thuat town thong ke y sinh hoc
co sir dyng phan mem SPSS 16.0
Dao dirc nghien ciru: De ctrang da &roc hOi diOng
khoa hoc benh vien phe duyet. Cac benh nhan tham
gia nghien ciru cl6ng thuan.
KET QUA NGHIEN CU'U
CO 27 nam (84.4%), 5 nO' (15.6%), ty le nam/nCr It
5.4. D6 tu6i trung binh la 28 tu6i, thap nhat la 17 va
cao nhat la 50 tu6i, BN tap trung 6 tuoi 20-40 tu6i
chiem 78.1%. Co 18 BN Het sau khau n6i TK that bai
(56.2%), 14 BN do gay xu,ang canh tay, trong do 13
BN Het TK trtydrc khi KHX. Vi tri tan thtrang than kinh
quay 1/3 giCra co 17 BN, 1/3 dirt:el co 15 BN.CO 31/32
BN duvc chuyen gan sau het TK 6 thong.
Trong 32 BN duvc phau thuat CO 28 BN kharn lai,
cac BN deu duvc danh gia kat qua sau 6 thong thu
duvc ket qua:
Chu'c nang du6i co tay
Bana 1. Ket aua du6i co tav(n=28)
Kat qua
SO benh nhan
Ty le%
57,2%
R6t tot >50°

16
10
Tot : 25°- 50°
35,7%
2
7,1%
Trung binh <25°
:Kau
0
0%
28
100%
Tong s6
Nhan xet: Ket qua rat tot la 26/28 benh nhan
chiem ty le 92.9%
Chin nang du6i cac ngon 11 III IV V
Bana 2. Ket aua du6i kha ban n On (n=28)
Ty le
Ket qua
So benh nhan
15
53,6%
Rat tot <10°
11
39,3%
Tot :10°- 25°
7,1%
Trung binh >25°
2
)(au

0
0%
TOng sO
28
100%
Nhan xet: Ket qua tot va rat tot chiem ty le 92,9%
Chirc nang du6i ngon cai
Bana 3. Ket aua duoi noon cai n=28
So benh nhan
Ty le
Kat qua
Rat tot <0°
21
75%
21,4%
T6t 0°- 15°
6
Trung binh >15°
1
3,6%
)(au
0
0%
28
100%
Tong sO
Ket qua tot va r tt t chiem tjr le cao 96,4%
Chin nang dang ngon cai.
Bang 4. Ket qua dang ngOn cai(n=28)
S6 benh nhan

Ty le
Kat qua
64,3%
Rat t6t >40°
18 .
TOt 30°- 40°
8
28,6%
Trung binh <30°
2
7,1%
)(au
0
0
T6ng so
28
100%

Y HQC THLiC HANH (922) - SO 6/2014

Nhan xet: Ket qua tot va rat tot chiem le 92,9%
Danh gia theo bang diem Chuinard.
Bang 5. Ket qua theo bang diem Chuinard(n=28)
S6 benh nhan
Ty le
Kat qua
13
46,4%
Rat tot
10

Tot
35,7%
5
Trung binh
17,9%
0
Xu
0
28
100%
Tong so
Nhan xet: Ket qua rat tot co 13/28 BN (46,4%), tot
co 10/28 BN (35,7%)
Trong 28/32 tru,Ong hop benh nhan den khan, lai
khong trirOng hop nao gap phai bien chirng nhu': Nhiam
tri -1g, m6i khau long leo, dirt m6i n6i, Binh gan ca.
BAN LUAN
Dich to Hat than kinh quay cao.
- Trong nghien ciru cua chimg tei BN Hat than kinh
quay cao co d6 tu6i trung binh la 28 tu6i, tap chung
nhOm tuOi 20 — 40 tu6i chiem 78,1%, gap chi) yeu
nam gi61 27/32 BN. Kat qua nay tuvng ty, kat qua
cua cac tac gia trong va ngoai nu,drc.
- Trong 32 BN list than kinh quay co 18 tru,orng
hap liet TK kh6ng hOi phyc sau khau n6i that bai, 13
tnyerng hap do gay xtyang, 1 trutyng hop sau KHX .
Vi tri ton thin:mg 100% & 1/3 giCra va 1/3 dirdri ncti
than kinh quay di sat xtyang va dan ra nong; ket qua
nay phO hop vOi cac nghien ciru tac gia khac.
Ket qua phau thuat:

Bien df0 van dOng kh&p co tay thu duvc 26/28 BN
dat ket qua tot va rat tot, 2/28 BN dat kat qua trung
binh. Ket qua dm Chung t6i dot twang ty, nhu' kat qua
tot va rat tot cua V6 Van Chau la 12/14 BN, Hoang
Vinh Phitc 13/15 BN, Chuinard 16 21/21 BN. Ket qua
cho they viec sir dyng ca sap tr6n chuyen gan cho 2
gan du6i co tay dat kat qua tot.
Kat qua chuyen gan gap nong ngOn III cho gan
du6i chung cac ng6n dat ket qua rat tot va tot la 26/28
BN. Ket qua nay krang tty kat gait& va rat tot cOa
cac tac gia VO Van Chau 14/14 BN, Le Manh San
26/30 BN, Hoang Vinh Phitc 14/15 BN, Chuinard 16
21/21 BN. Nhu' vay viec sir dyng ca gap nong ngOn
III chuyen cho ca duoi chung cac ngOn giitp giO, lai
gan gap co tay tru dat ket qua tot ma khong anh
Wong t61 viec gap cita ng6n III va khOng anh htydrng
tdri tryc co tay.
_Nghien ciru chuyen gan gap nong ngOn IV vao gan
du6i ng6n cai va du6i rieng ngOn II dat It& qua tot va
rat tot la 27/28 BN kh6ng khac biet vOi kat qua dm cac
tac gia khac. Kat qua cho they viec chuyen gan gap
nong ngon IV kh6ng chi cho ket qua tot ma giup ngon I
va II boat dOng dOc lap vdri 3 ngOn con lei glut) dam
bao chic nang tinh to dm ban tay, day 16 u'u diem dm
phau thuat Boyes so vOi cac phirang phap khac.
Viec chuyen gan gap co tay quay co gan dubi
ngon va dang dal ngdin I dat kat qua tot va rat tot IA
26/28 BN. Ket qua nay twang ty' nhu' ket qua dm cac
tac gia trong va ngoai ntrac.
Nghien ciru chuyen gan theo phtyang phap Boyes

73


theo nghien ciru chua chung tai theo ket qua theo
phan lopi cOa Chuinard dat rAt. tot 13/28 BN, tot 10/28
BN, trung binh 5/28 BN. Ket qua nay twang tty ket
qua cua Le Manh San 14/30 BN rat tat, 10/ 30 BN tot;
Chuinard rat tot 10/21 BN, tat 6/21 BN. Ket qua cho
they viec chuyen gan theo phvang phap Boyes cai
thien Clang ke chirc nang cua ban tay giCip BN cO the
lao Clang va sinh host &Pao tat.

KET LUAN
Nghien an, ph5u thuat chuyen gan 32 BN theo
phvang phap Boyes thu duvc ket luan sau
Liet then kinh quay cao thirang gap 6' nam gibi
27/32 BN, tuoi trung binh la 28, 100% BN do ton
thvang then kinh quay b 1/3 gia'a va dvai, 31/32 BN
do liet then kinh tuft ph5u thuat.
Ket qua phAu thuat fiat ret tat 13/28 BN, tot 10/28
BN, trung binh 5/28 BN, ket qua nay lien quan chat
the vai phyc hOi chirc nang.

TAI LIEU THAM KHAO
1. Green DP (2006) Operative Hand surgery, 6th Ed.
Elsevier Churchill Livingstone, Philadelphia, Chapter 33.
2. Boyes JH (1960) Tendon transfers for radial palsy.
Bull Hosp Joint Dis 21, 97- 105.
3. Chuinard RG, Boyes JH, Stark HI-I, Ashworth CR

(1978) Tendon transfers for radial nerve palsy: Use of
superficialis tendons for digital extension. J Hand Surg 3,
560- 570.
4. Va Van Chau, Nguyen Duy Luat (2000) Chuyen
gan ca phuc hai cir (Tang du6i ban tay va ng6n tay de
dieu trj lit than kinh quay. Phu thuat tao hinh, tap VI .
SO 1, 33- 35.
5. Hoang Vinh Phuc (2005) Danh gia ket qua dieu trj
di chirng het then kinh quay cao bang phvang phap
ph5u thuat chuyen gan theo Iselin tai banh vin 103
tuan van thac si y hoc, 37- 46
6. Le Mpnh San (2005) Danh gia ket qua pheu thuat
chuyen gan cua Boyes dieu tri lit than kinh quay tai
banh vin Viet Dirc. Luan van thpc si y hoc, 35- 50.

TIDING QUAN GlITA NGUY CO BINH KHONG LAY NHIEM IA MOT SO 1111 TO XA1101
NGUOI DAN IOC THAI TAI HUYIN DIN BIEN NAM 2014
TRAN THI THANH HUCJNG - Truifing Dai hoc If Ha NO
TOM TAT
Trong nhOng nam On day, banh
DX van
kh6ng lay nhi6m (BKLN) da (Ivor coi nhu mOt trong
cOa Chien lutec y to Vi6t Nam nhung cac
cac
s6 liau lion quan tai you t6 nguy ca cOa BKLN b dan
tic It ngutvi, trong CIO c6 dan tic Thai vain cOn rat hon
ch6. Mtrc tiOu: "Xac dinh twang quan giCra yeu t6 nguy
ca BKLN vai mOt s6 yeu t6 xa h6i b ngu'&i dan tic
Thai 25-64 tuoi tai huyan Dian BiOn nam 2014 D6i
tuang va phuring phap: 300 nguai dan tOc Thai, hian

Clang song & 7 xa cOa huyan Dian BiOn duryc chon
ng5u nhian dan va thu ththp se) li¢u theo phuang phap
STEP cOa T6 chOr Y to th6 giai. Kot qua: Hirt thu6c
16 hang ngthy c6 mai turfing quan vai gitvi nam (OR:
0,009; 95% Cl: 0,001-0,07) va ngh6 nghiap 16 n6ng
dan. Hoot ding th6 Ivy ththp c6 mai timing quan vai
trinh d6 hoc An. NhOm tuoi va trinh dO hoc van c6
mai tuang quan veri tj? 10 tang huy6t 6p. Tang throng
huyet c6 twang quan vai nhOm tu6i 35 — 44 tu6i (OR:
2,38; 95% Cl = 1,03 -5,44) va nhOm 55 — 64 tu6i (OR:
4,11; 95% Cl: 1,81 — 9,34). Ket luan: Can chi.' )"/ cac
mai tuyyng quan gas you to nguy ca BKLN va cac
you t6 xa hOi khi xem xtht cac giai phap can thiep
BKLN cOa ngu'&i dan tic Thai tai Dian Bien.
Ter khoa: You t6 nguy ca, you to xa h6i, banh
kh6ng lay nhi6m, nhOm tuoi 25 — 64, dan tOc Thai.
SUMMARY
ASSOCIATION BETWEEN RISK FACTORS OF NONCOMMUNICABLE DISEASES AND SOME SOCIAL
FACTORS IN THAI ETHNICITY IN DIEN BIEN DISTRICT
2014
Background: Recently, non-communicable
diseases (NCDs) is priority of Health Strategy on

74

Vietnam but there is no study to investigate
association between risk factors of NCDs and social
factors in ethnicity in Vietnam. Objectives: To identify
association between risk factors of NCDs and some
social factors in the Thai ethnicity people at the group

25 — 64 in Dien Bien District 2014. Subjects and
methods: 300 Thai people in 7 communities in Dien
Bien District were simple randomly selection and data
collection follow STEP approach from WHO.
Findings: Daily smoking had association with male
(OR: 0.009; 95% Cl: 0.001-0.07) and occupation as
famer. Low physical activity has association with level
of education. Age group and educational level have
association with hypertension. Hyperglycemia has
association with age group 35-44 year (OR: 2.38;
95% Cl = 1.03 -5.44) and group 35-44 year ((OR:
4.11; 95% Cl: 1.81 — 9.34). Conclusion: It is needed
to consider association between risk factors of NCDs
and social factors in selectin the appropriate way in
prevention and control in Thai ethnicity in Dien Bien
Keywords: Association, risk factors, social
factors, non-communicable disease, Thai ethnicity.
9AT VAN DE
Theo bao cao TO chirc Y to the gibi (TCYTTG) thi
BKLN la nguyen nhan gay tir vong cho 36 trieu nguai
(chiem 63%) tren the gibi trong nam 2008, va 80%
trong s6 nay (twang Ung vaei 29 trieu ngu'ai) dang song
tai cac quoc gia cO thu nhap thap va trung binh [1].
Cung theo du, bao cua to chin nay thi tji la tir
vong do BKLN se tang 15% tren toan ceu trong
khoang thai gian tir 2010 den 2020 [2].
Tpi Viet Nam thi BKLN cang co xu Wang gia tang

Y HOC THVC HANH (922) - SO 6/2014