Đánh giá kết quả điều trị trật khớp vai tái diễn ra trước bằng phẫu thuật latarjet bristow tại bệnh viện việt đức

nam 2010, Ha N6i.

9. BO Y M (2006), ThOng tu, lien tich s6 02/TTLTBYT-BNV-BTC Huang din thy'c hien Quyet dinh
276/2005/QD-TTg c0a ThO tuerng Chinh 070 ve the d6
Lev dai nghe, Ha Nei
10. B6 Y M (2008), Bao cao kiem tra cOa 932 benh
vien cOa Cuc quan ly Kham chaa benh, Ha N6i.
11. Chinh Phi, (2006), Nghl Binh s6 43/2006/ND-CP
quy dinh quyen ty' cho ty' chin trach nhiem ye thy hien
nhiem vu, to chuc b(). may, Wen the va tai chinh doi vai

dan vi six nghiep cling lap, Ha NOi.
12. Chinh Phi, (2008), Nghl djnh 13/2008/ND-CP
ngay 0402/2008 clia Chinh phO ve.viec quy dinh to chuy
cac ca quan chuyen men thu6c Uy ban nhan dan tinh,
thanh phO trur thusec trung trang, Ha N6i.
13. Uy ban nhan dan tinh Ha Giang (2013) Quyet
djnh se 898/QD - UBND ngay 15/5/2013 coa Uy ban
nhan dan tinh Ha Giang ye ban hanh danh myc cac rnh
vur can thu hat fret- ) Man ban tinh Ha Ging nam 2013.

DANH GIA KET QUA DIEU TR! TRAT KHJP VAI TAI DIN RA TRU' C
BANG PHAU THUR LATARJET - BRISTOW TAI BENH VIEN VICT Bit
DO VAN MINH, TRAN TRUNG DUNG - Truing flai hpc Y Ha Npi
NGO VAN TOAN - BOnh vien Viet DKFC

TOM TAT
Myc
1.MO to dac diem lam sang cila benh
nhan trot khOp vai tai dien ra truck. 2.flanh gia kat
qua di& tri trat khOp vai tai dien (TKVTD) ra tank

bang phau thuat Latarjet- Bristow. Phuryng phap
nghien cUu: Nghien cCru mO to vim her cCru, viva flan
cCru 42 trtrong hap. Ghi nhOn lan trot khOp deu tien,
ca che chen thutng, tong s6 len tai trot. Danh gia
chCrc nang khOp vai sau m6 bang thang diem WalchDuplay. Kat qua: Denh gia chung chUc nang kherp vai
sau m6 la tot vai diem Walch- Duplay trung binh la 84
diem, trong do 13 BN bat kat qua ret tot, 17 BN dot
kat qua tot, 11 BN apt ket qua' trung binh va 1 BN dot
kat qua kern. CO 1 BN bi tai trot sau ph5u thuOt. Kat
luOn: Ph5u thuOt Latarjet- Bristow dem !pi ket qua tot
cho BN TKVTD ra truck do chen thvang.
TO, kh6a: Trat khop vai tai dien ra truck, LatarjetBristow
SUMMARY
Purposes: 1. To describe the clinical
characteristics of recurrent anterior glenohumeral
dislocation. 2. To analyze the functional outcome of
the Bristow- Latarjet procedures in patient with
recurrent anterior glenohuhumeral dislocation.
Methods: Records of 42 patients (42 glenohumeral
joints) were reviewed retrospectively and
prospectively. Date of first dislocation, mechanical
injury, and number of recurrent dislocation before and
after surgery were recorded. The overall function and
instability of the glenohumeral joint were evaluated.
Results: All of the glenohumeral joint dislocations
were caused by trauma. The overall functional
outcome was good, with the mean Walch- Duplay
scores of 84 points. Scores of 13 of the patients were
excellent, 17 were good, 11 were fair and 1 was poor.
Conclusions: The Bristow- Latarjet procedure is a

good surgical treatment for recurrent anterior
dislocation of the glenohumeral joint.
Keywords: Recurrent anterior glenohumeral
dislocation, Latarjet- Bristow

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

DAT VAN DE
Trot khCrp vai tai dien (TKVTD) la tinh trang tat tai
di tai lai cCia met phAn hoac toan bO chum xt.rang
canh tay ra kh6i 6 ch5o xtrang vai. TKVTD CO the )(ay
ra b phia trtrac, phia sau, phia &Peri hay nhieu
hutmg nhu'ng chu yeu la TKVTD ra truck, chiern
khoang 97% cac trutmg hgp. C6 han 150 phipang
phap m6 mer khac nhau dieu tri TKVTD ra trutt cia
duvc gibi thieu va ap dung ten lam sang. Tuy nhien,
do ton thtrang giai phAu benh cCia TKVTD ret phirc
tap nen kh6ng mOt phirang phap phAu thuet nao
(Iwo coi la toan then cho (lieu tri MQi benh nhan
TKVTD. Phu 0101 (PT) Latarjet- Bristow la mOt
ph5u thuet kinh dien &Ivo coi la mOt phirang phap
CO hieu qu5 di& tri TKVTD ra trirgc vgi tji 10 tai tat
thap. Tai benh vien Viet Dim, nal CM ap dung kha ph6
bien PT Latarjet- Bristow trong di& tri TKVTD ra
trutt nhu'ng chu'a c6 met Clanh gia tong ket nao.
Chung toi tier) hanh nghien cCru de tai nay nh5m muc
tieu: 1. MO to dac diem lam sang benh nhan TKVTD
ra truck. 2.Danh gia kat qua di& tri TKVTD ra truck
bang phau thuat Latarjet- Bristow.
DOI TU'gNG, PHU'O'NG PHAP NGHIEN CU'U

e6i twang nghien civu: Gem 42 BN (42 khap
vai) di.mc chen doan TKVTD ra tru,bc, cluvc tien
hanh pilau thuet Latarjet- Bristow de dieu tri, tai Benh
vien Viet
trong th6i gian tir thang 7 nam 2006
tten het than9 6 nam 2011.
Tie u chuan lua chon:
Khong phan biet tu6i, giai, Oa
Ch5n Cloan xac dinh TKVTD ra truerc du'a tren
benh sir, kham lam. sang, ton thiyang X quang va ton
thirang trong m6.
Dirac tien hanh phau thuet Latarjet- Bristow de
dieu tri.
argc kham lai, chirp X quang khdrp vai kiem tra
sau phAu thuet it Met 3 thang.
Tieu chug!? loci tnr
Benh nhan (BN) ce tien sir phAu thuet khdep vai
bubo CTO.

69


BN co benh ly man tinh cCia khap vai: viem quanh
khap vai, thoai h6a
BN trat khap vai ra sau, trat da htyang.
Phu'o'ng ph5p nghien ciru: Nghien cCru m6 ta,
khong nh6m chUng, hOi ciru va tien aru.
Ket qua:
Dac diem lam sang cOa benh nhan TKVTD ra
trtrac.

42 BN (42 khap vai) Om 38 nam va 4 nCr, a dO
tuOi trung binh 25,7 ± 5,3 tuOi.
Trat khop vai cep tinh Ian dau do chaff the thao:
31 BN (73,8%), tai nan giao thong: 6 BN (14,3%), tai
nan sinh hoat: 2 BN (4,8%), tai nan hoc dirang: 2 BN
(4,8%) va tai nan lao clang: 1 BN (2,4%).
Thai gian to khi bi chan thu'ang den khi ph5u
thuat trung binh 32,8 ± 25,0 thang.
Co 29 BN co 56 len TKVTD > 10 Ian, 12 BN tir 5•
10 Ian va 1 BN dual 5 Ian.
Trat khOp vai trail phai: 21/21. Trat khap vai tay
thuan/ khOng thuan: 22/20.
Ket qua dieu tri TKVTD ra trutc bang phAu thuat
Latarjet- Bristow:
Thai gian theo dal trung binh sau ph5u thuat la
30,5 ± 16,3 thang.
Diem Walch- Duplay trung binh sau ph5u thuat la
83,7 ± 16,3 diem, trong do ret tOt: 13 BN, tOt: 17 BN,
trung binh: 11 BN va kern: 1 BN.
Danh gia muc d6 met vCrng cua khap vai sau mo:
Nghiem phap e sa throng tinh b 4/42 BN, nghiem
phap tao ranh &rang tinh a 2/42 BN.
Dau khap vai khi hoat dOng gang sCrc: 10/42 BN
(23,8%).
Bien da xoay ngoai trung binh cua khap vai ben
Tac gia

So BN/ S6
khc!rp vai

Carol va cs [0]
Banas va cs [0]
Allain va cs [0]
Hovelius va cs [0]
Matthes va cs [0]
Dossim va cs [0]
Kashani va cs [0]
ChOng toi

44/ 47
79/79
56/58
113/118
29/29
84/93
35/35
42/42

Theo doff
x
sau mo
(thang)
43
103
171
182
38
98
25
30,5

. . .
Ty le tat
_
trat (%)

. .
T9 le ban
tat (%)

0
4
0
4
0
5,4
0
2,4

0
2
9
3
2,7
0
0

DA co nhieu nghien cCru danh gia ket qua dieu tri
TKVTD ra trutc bang PT Latarjet- Bristow. M6i tac
gia sir dung cach danh gia rieng nhu'ng nhin chung

cac tac gia deu ghi nhan PT Latarjet- Bristow dem lai
ket qua tOt cho BN met vCrng khap vai tai dien ra
tarac. Ty le BN dupc tOt va ret tOt sau phau thuat
Latarjet- Bristow theo thang diem Rowe hoac WalchDuplay giao d6ng tb, 69% den 100%.
Danh gia muc da virng cCia khap vai sau ph-au
thuat, chOng toi ghi nhan nghiem phap e sa du'ang
tinh a 4 BN (9,5%) va nghiem phap tao ranh du'ang
tinh a 2 BN (4,8%) trong do co 2 BN dirang tinh vai
ca hai nghiem phap. Trong 2 BN nay co 1 BN co bieu
hien tai trat that su' va 1 BN cam they e sa dai clang

70

ph5u thuat Om 15, 2° ± 5,7° so vai ben kh6ng ph5u
thuat.
36/42 BN (khap vai) CO chaff the thao trutc mo
trong do 12,5% BN tra lai hoat dong the thao nhu,
trutc, 25% van chaff duvc nhang mon the thao trutc
do nhu'ng khong con duy tri dupc phong d6 nhu'
truck, 21,9% benh nhan phai chuyen sang mon the
thao khac it nguy ca han va 40,6% benh nhan khong
con tham gia chaff the thao sau mo.
M6t trung hop tai trat sau phau thuat 15 thang.
BAN LUAN
Phau thuat (lieu tri TKVTD duvc biet den tir thai
Hypocrats. Cho den nay, co han 150 phu,ang phap mo
mb khac nhau duvc gibi thieu va ap dung tren lam
sang, trong do co nhang phau thuat dirac coi la tieu
chuan yang cho dieu tri TKVTD vai tY le tai trat thap.
Tuy nhien, do ton thlyang giai phau benh ly cCia

TKVTD ret phCrc tap nen khOng mat phu'ang phap
phau thuat nao disac coi la toan dien cho dieu tri moi
benh nhan TKVTD. MOt phu'ang phap dieu tri ly tutng
cho (lieu tri TKVTD khi no co du,ac cac tieu chuan sau:
tY le trat tai hOi thap, tY le bien chirrig thap, ty le mo lai
thap, khong gay hai (viem khap), duy tri van d6ng
khap vai, co the ap dung cho hau het cac trutng hop,
de danh gia sau m6, sCra chaa cactht.rang ton giai
phau va khong qua kh6 tht,rc hien. Phau thuat LatarjetBristow la mat phau thuat kinh dien, duvc coi la c6
hieu qua trong dieu tri TKVTD.
Danh gia chirc nang khap vai sau phau thuat theo
thang diem Walch- Duplay chung toi ghi nhan tY le
BN sau phau thuat Latarjet- Bristow dat ket qua tOt va
ret tOt dat 71,4%, diem Walch- Duplay trung binh la
84 diem.
.x
Thang diem Rowe/ Walch- Duplay
TB
Rat tot
<
Kern (°/0)
(%)
Tot (%)
(%)
62
74
64
71
59
30

31
30,9

25
11
24
15
24
43
69
40,5

11
9
9
11
10
16
0
26,2

2
6
6
4
7
10
0
2,4

nhu'ng chu'a Ian nao trat lai thu,c scr. Allain va cong
Sly theo doi 58 khap vai sau mo trung binh 14,3 nam
ghi nhan, khOng CO mat BN nao tai tat, co 1BN cam
they met yang dai dang va ban trat. Tuy nhien them
kham lam sang kh6ng xac Binh duvc tinh trang met
vCmg khap vai bai nghiem phap e sa am tinh va
kh6ng tim they dau hieu long bao khap phia trutc. 6
khap vai (10%) co cam giac e sa nhu'ng chi co 1 BN
du'ang tinh vai nghiem phap e sa va khOng co BN
nao co bleu hien long bao khap phia truck tren lam
sang. 51 BN (88%) cam they khap vai yang, tham
kharn lam sang kh6ng co BN nao co dau hieu met
yang khap vai.
Danh gia mCrc d6 dau khi hoat clang khap vai sau

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


ph5u thuat, chung toi ghi nhan co 10 BN, chiem
23,8%, c6 bieu hien dau mai khdep vai khi hoat dOng
gang Stk. Tat ca nhirng BN nay cleu c6 thOi gian sau
ph5u thuat it nhat 30 thang. Juy nhien bleu chirng
xuat hien khong thut,ng xuyen va BN khong phai
dieu tri bang bat cir lopi thu6c giam dau nao. Danh
gia chCrc nang kherp vai c6a nh6m BN nay chCing t6i
nhan thay c6 7 BN a nh6m tot va 3 BN b nhOm trung
binh. Allain va cong sty, theo dOi 58 khap vai &rot
ph5u thuat Latarjet- Bristow trong theri gian trung binh
14,3 nam nhan thay, c6 38 BN (chiem 66%) khong c6
bleu hien dau khOp vai, 15 BN (chiem 26%) c6 bleu

hien dau khO,p vai khi van clang the tut va 5 khdep vai
(chiem 9%) dau khc5p vai hang ngay ve phai dieu tri
bang thuOc giam dau.
Bien CIO xoay ngoai cCia khcYp vai sau phAu thuat
han the han so vdei ben khdep vai khong phAu thuat.
Dieu nay cOng duvc ghi nhan beri nhieu tac gia. Dart
gia Clang tac xoay ngoai c6a khdep vai qua 2 tu' the 16
canh tay khep vao than minh va canh tay clang 90°,
chCing toi nhan they, bien d6 xoay ngoai cua khap vai
ben phAu thuat bi han the han so vCri ben lanh
khoang 15°. H&J het cac tac gia ghi nhan han the
bien CIO xoay ngoai trung binht6a kherp vai sau ph5u
thuat Latarjet- Bristow so vai ben khOng phAu thuat la
6°- 12° va cung c6 mat so th6ng bao rang con so nay
c6 the len den 20°. Carol va cOng su' theo del 44 BN
trung binh 3,7 nam sau PT Latarjet- Bristow nhan
they hpn the bien c10 xoay ngoai trong to the canh
tay dpng 90° la 12°. Allain va cOng sly theo del 58
khap vai (lox PT Latarjet- Bristow sau th61 gian
trung binh 14,3 nam nhan they, bien do xoay ngoai
cua khdep vai sau ph5u thuat la 42° ± 17° so vai khap
vai khong phAu thuat la 63° ± 14°. -lac gia cung ghi
nhan bien do xoay ngoai cua nh6m BN dirac phau
thuat c6 khau chang mep On co' du'O'i vai kieu khau
to ao la 35° ± 12°, so vai ben khau gan co'
vai
kieu not tan- ten la 48° ± 18°. Nhu' vay, khdep vai ben
ph5u thuat c6 bien do xoay ngoai giam khoang 21° so
vOi ben khOng ph5u thuat. 18 khap vai sauphau
thuat duvc khau ch6ng mep gan ca dui vai kieu to

ao bi giam bien dO xoay ngoti trung binh khoang 29°,
36 khOep vai sau phAu thuat &tit khau gan ca du,dei
vai kieu nOi tan - tan 131 OM bien dO xoay ngoai
khoang 15°. Han the van efOng xoay trong gap Cr 19
khdep vai, chiem 33% va cach khau n6i gan co' &poi
vai khong anh hty&ng den bien da xoay trong.
Matthes va Ong sty theo dal 29 khdep vai &rot PT
Latarjet- Bristow nhan they, bien do xoay ngoai trung
binh cua khOp vai sau phAu thuat la 32° so vdri ben
khOng ph5u thuat la 43u, tuy nhien, si,r khac biet nay
la kh6ng c6 9 nghia thong ice.
DAM gia mire do tro' lai hopt Ct6ng the thao c6a
BN sau ph5u thuat Latarjet- Bristow duvc ghi nhan
khac nhau tiny *rig tac gia. Trong nghien cCru cua
chung toi chi c6 36/ 42 BN trutt phAu thuat c6 tham
gia chai the thao khi ranh r6i, chiem 78,6% cac
truteng hap. Trong so BN nay chiing tai ghi nhan c6
12,5% BN sau phAu thuat trO lai hopt Clang the thao

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

nhu, khi tank khi ph5u thuat, 25% BN sau phau thuat
c6 tham gia the thao tro, Ipi nhu'ng phong do kh6ng
con duvc nhu' trutec, 21,9% BN sau phAu thuat phai
chuyen sang chai mon the thao khac thuac nh6m it
c6 nguy ca han va c6 40,6% BN sau phAu thuat
kh6ng chai the thao tro' Ipi. Theo Allain va cOng si,r,
c6 49/ 56 BN (vdei 51/ 58 khOp vai) co tham gia the
thao truck khi ph5u thuat, 40 BN (vc5'i 41 khap vai,
80%) tro' 1pi hopt (ging the thao nhu' trutt va 5 BN

(vCri 6 khOp vai, 12%) chai lai &rot the thao nhu'ng
mut CIO that) han; c6 1 BN m6 ca hai khOp vai (2%)
khOng the trer lai chai the thao va 3 BN (6%) phai
chuyen sang mon the thao khac it nguy ca han. Cac
BN tra lai hopt Ong the thao sau phAu thuat 4 thang.
ChCing toi ghi nhan 1 BN bi Vat khap vai tai dien
sau ph5u thuat. DO la truteng hap BN nam, bi Vat
khdrp vai tai dien ra thrac sau tai nan eta b6ng nga.
BN bi tat tai dien ret nhieu Ian trong 2 nam. BN duvc
dieu tri TKVTD ra thrOt bang PT Latarjet- Bristow
nam 19 tuOi. Sau ph5u thuat 15 thang BN bi tai tat
Ian deu ben khi Clang nem ng6. Theo dOi BN den nay
duvc 25 thang sau mO, BN c6 tat a 3 len tai tat.
Tham kham lam sang cho they benh nhan c6 long
khdep town than. Danh gia X quang b len than) kham
cu6i cOng cho they vi tri mom qua tot va da c6 su' lien
xtyang giCra mom qua va 6 chao xtyang vai. Danh gia
tje la tai tat sau mO thirang duvc ghi nhan la co gia
tri sau theri gian theo dOi it nhat IA 2 nam. -19 la tai trot
sau phAu thuat Latarjet- Bristow duvc ghi nhan khac
nhau tuy tirng tac gia, giao Ong tO, 0% den 6%. C6
nhieu yeu to duvc chi ra rang co lien quan mat cach
c6 9 nghia den kat qua kern sau m6, bao g6m: BN
met virng khop vai to 9, BN da ph5u thuat lam virrig
khaep vai trutt d6 nhu'ng that bpi, tu6i cCia BN va thoei
gian bet Clang khOy vai sau m6 qua ngen.
KET LUAN
Ph5u thuat Latarjet- Bristow dem Ipi kat qua tOt
cho BN tat kh6,p vai tai dien do nguyen nhan chen
thLrang. Day la mot ph5u thuat khong qua phirc tap,

khong doi h6i nhieu phtyang tian, dung cu va khOng
c6 nhieu bier) chCrng.
TAI LIEU THAM KHAO
1. Allain J, Goutallier D, Glorion C (1998): Long- term
result of the Latarjet proceduce for the treatment of
anterior instability of the shoulder. J Bone Joint Surg Am,
80: 841- 852.
2. Bannas M.P, Dalldorf P.G, Sebastianelli W.J et al
(1993): Long- term follow up of the modified Bristow
proceduce. Am J. Sport Med, 37 (9): 1792- 1797.
3. Carol E.J, Falke L.M, Kortmann J.H.J.P.M et al
(1985): Bristow- Latarjet repair for recurrent anterior
shoulder instability. An eight- year study. Netherlands. J.
Surg, 37: 109- 113.
4. Dossim A, Abalo A, Dosseh E et al (2008):
Bristow- Latarjet repair for anterior instability of the
shoulder: clinical and radiographic result at mean 8.2
years follow- up. Chir. Main, 27 (1): 26- 30.

5. Hovelius L, Sandstrom B, Sundgren K, Saebo M
(2004): One hundred eighteen Bristow- Latarjet repairs
for recurent anterior dislocation of the shoulder

71


prospectively followed for fifteen years: Study I- clinical
results. J Shoulder Elbow Surg, 13: 509- 516.
6. Kashani F.0, Eghbal S, Seyed, Hadi 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 TR! LICE THAN KINH QUAY CAO
THEO MUTING PHAP BOYES TAI BNB VIM VICT DOC
TRAN MANH HUNG - Benh vien Viet Di
TRAN TRUNG DUNG, NGUYEN XUAN THOY - Trtpdyig OH Y Ha NCli
HOANG VAN - Benh vien tinh Thanh Hod
TOM TAT:
Ma dew Lift than kinh quay cao thuang gap trong
lam sang, vifc chuy4n gan theo phuang phap Boyes
la can thief. Muc tieu: Danh gia ket qua ph3u thuft
chuyen gan dieu tri lift then kinh quay cao theo
phuang phap chuAn gan Boyes. D61 tuang va
phuang phap nghien ciru: Nghien aru h6i cut' tren 32
BN lift then kinh quay dupe ph3u thuat chuyen gan
theo phuang phap Boyes tai bfnh WO Viet Derc.Ket
qua nghien caw D6 tudi trung binh la 28, Ty If nam/nCe
la 5,4, 31/32 BN lift then kinh truac mo, K4t qua ph3u
thuat dot rit tot va tot la 82,1%. Phyc h6i cht'rc nang
lien quan chat the tbi ket qua phau thuat. Ket Juan:
Ph3u thuat chuydn gan theo k37 thuat Boyes cho ket
qua tot d6i vai dieu hi lift then kinh quay.
Td khda: Lift then kinh qbay 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
Liet then kinh quay cao la ton thuvng tht.rerng gap,
nguyen nhan chinh la do cheri thuvng, dac biet trong
gay than Arang canh tay. Theo nhieu nghien aru, tY
le ton thuvng then kinh quay trong gay than nrang
canh tay tir 1,8% den 16% [1], 10% den 20% tOn
thutrng then kinh quay la khong h6i phgc.
Liet then kinh quay cao la mOt tOn thirang an den
tan tat nghiem tong ve chive nang ban tay, anh hverng
Ibn tbi sinh hoat va lao d6ng cua ngutri benh. Nguti
benh khong the du6i dot I cac ng6n tay va dang du6i
ngOn cai, met du& chit d6ng co tay, lam anh throng

72

nghiern trong den chU'c nang cern nem va lam Om

ly'c bhp ban tay. Do vey ph5u thuet chuyen gan trong
liet then kinh quay khOng h6i phyc la can thiet.
Vi vey nghien aru "flanh gia ket qua dieu tri ph5u
thuat liet then kinh quay cao theo phuang phap
Boyes tai Benh vien him nghi Viet arc" thyt hien vdri
2 muc tieu:
Ohnh gid ket qud phiu thuOt chuyen gan dik
tri liet thhn kinh quay cao theo pinpang phdp
chuyen gan Boyes.
DOI TU'Q'NG, PHU'O'NG PHAP NGHIEN CU'U
Nghien CO'll m6 to cat ngang 32 BN het then kinh
quay cao khOng h6i phuc duvc phau thuat chuyen
gan theo phuvng phap cua Boyes tai Benh vien Viet
Din tir nam 2008 den nam 2013.
chon benh nhan
Tieu chuen
Benh nhan duvc chen doan liet then kinh quay
cao kh6ng h6i phuc
Benh nhan duvc ph5u thuet chuyen gan theo
phirang phap BOYES
Day du h6 sa benh an
Quy trinh nghien dru:
BN duvc chen doan 'let then kinh quay cao khong
h6i phuc, nguyen nhan, ca the chart thirang, chup XQ
PhAu thuet: BN duvc gay to dam r6i, du6i mau va
garo canh tay; b6c 10 va chuyen gan gep nong ngon
III cho gan duoi chung cac ng6n, gan gep nong ng6n
IV cho gan du6i ng6n cai va duOi rieng ngon tro, gan
gep co tay quay cho gan clang dai va duoi ngan ngon
cai, gan ca sap ton cho gan duoi co tay quay ngan

va co tay quay dai [2] ; that) garo, bum rim va dong
vet thuvng; dat mang b6t CBT the 6 tuen
Tap PHCN theo bai tap
Danh gia ket qua
Bien (10 van d6ng cac kherp theo bang phan lopi
ket qua cua Chuinard 131
Ng6n cai
NgOn tay
CO tay
Gap
DuOi
Mk
Du6i
deu
ban
ngon Dang khaep
dO
Du6i Gap
lien d6t
ngOn t6i nep
gan tay
<0°
<10°
0
>40°
Rat tot >50° >30°
10 - 0- 1.25 30°25°- 10°n
0°15°
TOt
25°

cm
4050°
30°

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