Nhận xét kết quả điều trị thoái hóa khớp gối bằng phẫu thuật nội soi tạo tổn thương dưới sụn

TuOi mac Wit trung sieu am, FNA, STTT, MBH binh la 45,3 ± 13,7 tu6i Phan Iden gap & giai nu', tY le nidnam la 2/1 Ly den kham chi yeu tkr phat hien khOi sung %king co 53,3% Kham lam sang phat hien &roc hpch co chiem 26,7%, tap trung chu yeu la hpch nhom III, IV chiem 87,5% vai cac tinh chat: 100% mat dO chac, 100% cac hpch c6 khong c6 bieu hien dau, 87,5% ranh giai khong CO, 87,5% di dOng hpn che Doi chieu hpch tren lam sang va ket qua mO berth hoc hach co: DO nhpy cao nhat b nhom III kham phat hien tren lam sang, chiem tY le 50%, nhom IV 46,7%, nhom V 40% DOi chieu vi tri hach di can vai khOi u tuyen Op: PhAn Ian hpch di can cung ben vai khOi u tuyen giap chiem 66,1% DOi chieu giCra sieu am hach co va ket qua ma berth hoc hpch co: Sieu am có dO nhpy 100% vai hach di can nhom I, dO nhpy 85,7% vai hach di can nhom III, nhom IV la 80% 06i chieu hach co phat hien phAu thuat va ma b'enh hoc hpch co: Phu thuat nao vet hach co nhom I có dO nhpy cao nhAt chiem 100%, hpch nhom II, Ill, IV dO nhay twang dOi giOng Ian luvt la 83,3%; 82,3; 83,3% DO nhay cua nao vet hpch co vai nhom VI chiem 65,2%, thap hurl a nhom V la 40% TAI LIEU THAM KHAO Delisle M J, Schvartz C, Theobald S et al (1996), Cancers of the thyroid Value of a regional registry on 627 patients diagnosed, treated and followed by a multidisciplinary team, Ann Endocrinol (Paris) 57(1), 41-49 Candy B va Rossi RL (1991), Sugery of Thyroid and Parathyroid Glands, Third Edition, W.B Saunders Company, 14-151 Nguyen BS DCrc (1999), Ung thu, tuyen giap trang, Huong clan thuc hanh, char, doan lieu tri ung Chu, NXB Y hoc, 135 - 149 Le Van Quang (2003), Vai tit dia xet nghiem to bac hoc qua choc but bang kim nho chhn doan cac buteu nhan tuyen giap, Tap chi Ngoai khoa (2), 1-7 Rossi R L, Cady B, Silverman M L et al (1988), Surgically incurable well-differentiated thyroid carcinoma Prognostic factors and results of therapy, Arch Surg 123(5), 569-74 Pham Van Him, Le Minh Kjf, T6ng Xuan Th6ng et al (2015), Nghien ciru dac diem di can hpch co cua ung thu bleu mO tuyen giap the nhil tai Benh vien Tai Mui Hong Trung wyng, Tap chi Tai MOi Hong Viet Nam 61(31), 5-10 Nguyen Xuan Phong (2011), Nghien cOu dac diem lam sang va mot so )(et nghiem ung thin bieu me tuyen giap, Luan van thac s9 y hoc, Dai hoc Y Ha NOi Nguyen Van Wing (2013), Danh gia ket qua diet, tri ung Chu' Myer) giap tai Benh vien Tai MOi Hong Trung uong va Benh vier? Bach Mai giai dopn 2007 2013, Luan van Thac s9 Y hoc, Dai hoc Y Ha NOi, Ha NOi Nguyen Thi Bich Ngoc (2014), Nghien cOv dac diem lam sang, can lam sang hach c6 di can cOa ung thu' bleu m6 tuyen giap the nhu, Luan van Thac s9 y hoc, Dpi hoc Y Ha NOi, Ha NOi NHA N XET KET QUA DIEU TRI THOAI HOA KHo'P GOI BANG PHAU THUAT NOI SOI TAO TON THU'O'NG DU'O'I SUN NGUYEN HOANG THAI', TRAN TRUNG DUNG' NGUYEN TRAN QUANG SANG' 'Hoc vien cao hoc kh6a 23, Truang Dai hoc Y Ha N6 i Troong Dai hoc Y Ha N6i TOM TAT Muc lieu nghien ceru: Danh gia Vet qua pheu thuOt nOi soi (PTNS) va tao tem thuung dux"i sun dieu tri thoai hea khop gOi (THKG) bang Chang diem VAS (Visual Analogue Scale) va (hang diem KOOS (Knee Injury and Osteoarthritis Outcome Score) Del tugng va phuung phap nghien aftr: Gem 27 benh nhan (BN) THKG de I va de II da ducc chen doan va u trj bang ph& thuat 170i soi tai Benh vien Xanh Pen Tat cd cac BN da duryc kham theo doi va danh gia de dau, bien de van Ong gOi, va SI/ hai !Ong ctia BN sau ph5u thuat theo Chang diem VAS va KOOS Chju trach nhiem: Nguyen Hoang Thai Dia chi: Trueng Dai hoc Y Ha Nei Email: bshoangthai2503@gmail.corn Ngay nhan:26/9/2016 NO)/ phan bien: 21/10/2016 Ngay duyet bai: 28/10/2016 Ngay met ban: 20/11/2016 HQ(: TIIVC HAN11 (1026)- SO 11/2016 tai cac th&i diem thang, (hang, (hang, (hang va 11 Mang Ket qua nghien aru: bleu het cac bent) nhan sau mO deu CO str cal Mien re ret ye mat lam sang Ira chat luting cuec song so vai lac truer ph5u thuat Thang diem KOOS (rung binh sau mO clpt 86,47 diem, VAS van deng (rung binh sau mO apt 1,78 diem Ket luau: THKG dq II va II dieu tri bang phgu thuat Wei soi tao then thuung dudi sun dal /a phuung phap dieu trj cho ket qua tot, giap cai thien ro ref cac trieu chirng sau ph5u thuat TO, khoa: Thodi hoa khop goi, 0o ton thuung dutvi sun (MF = Micro fractures), Chang diem VAS, Chang diem KOOS SUMMARY Objectives of the study: is to evaluate the result of Knee Laparoscopic surgery and Knee Microfracture surgery under treatment knee osteoarthritis by VAS (Visual Analogue Scale) and Koos (Knee Injury and Osteoarthritis Outcome Score) Subjects and 65 research methodologies: including 27 patients of level I and level II who have been diagnosed with knee osteoarthritis and treated by endoscopy surgery at the St Paul Hospital All of the patients are checked, recorded and evaluated with the pain level, knee motion degrees, satisfaction level in accordance with VAS and KOOS after month, months, months, months and 11 month of treatment Study Findings: Most patients after surgery have significantly improvement in the clinical signs and the quality of life in comparison to the time before surgery Average score of Koos reached 86.47 points postoperatively, the average VAS postoperative mobilization score reached 1.78 points Conclusion: Treatment of early stage knee osteoarthritis by laparoscopic surgery and microfracture acquires good result and significantly improves the symptoms after surgery Keywords: Knee osteoarthritis, microfracture (MF = Micro fractures), VAS scale, Koos scale DAT VAN DE THKG la banh ly qua trinh r6i loan chuyen hOa, lam mat can bang giu'a tong hap va huy hopi cua sun va xuang &rad sun gay bong, mat clan sun khap, sun khap kh6ng co kha nang tu' phuc hOi khong co mach nu6i Ma nguyen nhan tac d6ng co hoc va yeu to co the nhu': di truyen, phat trien, chuyen hoa va chan thuang [1] Theo thong ka nam 2010 tai co khoang 13% dan so tren 60 tuoi co cac triau chirng cOa THKG Tai Viet Nam thoai h6a khdp chiem 10,41% cac banh 19 xuang khap [2] T9 le benh nhan THKG goi cang tang t9 la thuan vai di) tang cua tuoi tho, t9 le nguai tang can va beo phi nOi Chung CO nhieu phuang phap dieu tri THKG toy thuOc vac) giai doan banh nhu' dieu tri nOi khoa kat hop phuc hOi chi:rc Wang, Om can, nOi soi, thay khap THKG giai doan I va II duac dieu tri khong phau thuat (it nhat thang) nhung khong cai thian cac triau chirng lam sang thi chi dinh ph5u thuat nOi soi duac xem xet de giai quyet tinh trang banh Ph5u thuat nOi soi dieu tri cac ban', ly khap gOi 11 nam tra lai day tai Viet Nam cang phat then Banh vin Xanh P6n da ap dung phu'o'ng phap nOi soi tao ton thuang dual sun dieu tri thoai hem gOi nhieu nam nay, nhu'ng chu'a co bao cao nao danh gia ket qua dieu tri cua phuang phap Chung toi tien hanh de tai "Nhan xet ket qua dieu tri thoai hoa khap gal bang phu'o'ng phap nOi soi tao ton thu'o'ng dual sun" nham muc Bich danh gia ket qua ye chirc nang cung nhu• muc dO hai long cua banh nhan sau phau thuat theo thang diem VAS va KOOS DOl TU'O'NG, PHU'O'NG PHAP NGHIEN COU - Doi twang nghien ciru: GOm 27 banh nhan dieu tri tai Banh vin Xanh P6n khoang thai gian to thang 9/2015 den thang 10/2010 +Tieu chuan chon: Dau ( Pain —P) Trieu cht:rng tai g6i ( Symptoms —S) Sinh hoat hang (Acticities Daily Living- A) The thao (Sport- SP) Ch6t luting cuoc song (Quality of life —Q) 66 Banh nhan &lac chan doan THKG dO I, II (theo tieu chuan cua Kellgren-Lawrence) [3] Khong CO cac banh ly chOng chi dinh PTNS Banh nhan duac theo clai sau phau thuat vai theii gian tOi thieu la thang Phu'o'ng phap nghien cirul theo phuang phap tien cuu, mo to + Nghien khong nhom chirng + K9 thuat PTNS: Lam sach khdp gOi bang PTNS, lay b6 di vat va x6 ly cac ton thuang Khoan hoac dui nhang 16 nh6 vao xuang tai vung bi mat sun + Danh gia ket qua sau phau thuat bang thang diem VAS thai diem thang, thang, thang, thang, 11 thang, va thang diem KOOS thai diem thang, thang thang, 11 thang Thang diem VAS: la thuac mirc dO dau cua banh nhan, ap dung cho nguai Ian Tren thang diem ca 10 mac dau tir 0-10, tu'o'ng Ong muc dO nang [4] dau nhe 0- khOng dau 1- Dau rat nhe, hau nhu' khOng cam nhan va nghi den no 2- Dau nhe, thinh thoang dau nhoi de cam nhan 3- Dau lam riguai banh ch0 y, mat tap trung cong viec, CO the thich &rig vai no 4- Dau vira phai, banh nhan CO the quen di can dau neu dang lam viec 5- Dau nhieu han, banh nhan kh6ng the quen dau sau nhieu phut, van co the lam viec 6- Dau nhieu anh huang den cac sinh hoat hang ngay, kh6 tap trung 7- Dau nang, anh hu.ang den cac giac quan va han the nhieu den sinh hoat hang cua banh nhan Anh huang den giac ng6 8- Dau du clOi, han the nhieu hoat dOng, can phai no It.rc rat nhieu 9- Dau kinh khong, khoc, kho kiem soat 10- Dau khong the not chuyen &rot, nam hat givang va co the me sang Thang diem KOOS: Danh gia chirc nang khap gOi sau phau thuat thang, thang, thang va sau 11 thang dcra vao thang diem KOOS (Knee Injury and Osteoarthritis Outcome Score) [5] Cau triic thang diem KOOS: la bO cau hal (Om 42 cau) phong van nguai banh ye chCrc nang cua khap gOi, gOm dau gOi (9 cau); cac triau chCrng tai goi (7 cau); kha nang sinh hoat hang (17 cau): kha nang Choi the thao (5 cau); chat luvng cuoc song (4 cau) MOi cau hoi duuc chia lam mirc dO nhe den nang, twang Ong vai diem tu• - Hinh thi:rc danh gia: phong van tru.c tiep, qua dien thoai, qua email Diem KOOS, duac tinh theo cong thirc sau: Theo do, tong s6 diem cang cao chirc nang khap gOi cang &Jac cai thian (100 — tong diem tir P1-P9 x 100)/36 (100 — tong diem tir S1-S7 x 100)/28 (100 — tong diem tir A1-A17 x 100)/68 (100 — tong di6rn tir SP1-SP5 x 100)/20 (100 — tong diem tir Q1-04 x 100)/16 Y 119C TH VC HANH (1026)- SO 11/2016 KET QUA NGH;EN COU DOc diem nhom d6i twang nghien ciru 1.1 DOc diem tuOi, gibi, nghe nghiep, BMI va then gian phat benh Bang Phan bo BN theo tu6i, gibi, nghe nghiep Dac diem Tu6i Gi61 Lien quan nghe nghiep 40 - 49 50 - 59 60 - 70 Nam NC, Lao Ong chan tay Lao dOng tri 6c T6ng s6 d6i tuvng nghien cCru (n = 27) n 26 37 10 37 10 25,9 74,1 20 63 17 37 10 Nhan xet: D6 tu6i trung binh la 55,78 ( 41-67) NhOm tu6i chiem tit le cao nhat la tir 50- 59 tu6i va nhOm 60- 70 tali (37%), nh6m tu6i tir 40-49 tu6i chiem ti le that) nhat la 26% chiem 74,1 %, cao Tjf le nu' giod nghien han so vai nam gibi (chi chiem 25,9%) NO' nhieu han nam vai tjt le la 3:1 Ket qua nghien cOu cho they, nhOm doi tuvng tham gia nghien ciru la lao d6ng chan tay chiem hi le 63%, cao han nhOm doi tuvng lao dOng tri tic (chiem 37%) Nhan xet: Thong ke cho they, tat ca benh nhan nh6m nghien ciru deu có trieu chirng dau gOi Trieu chirng "lyc cyc khap gOi" chiem 92,6 %, dau hieu "cirrig gOi bu6i sang" chiem 74,1% CO benh nhan c6 dau hieu bao gó chiem 3,7% 1.3 Diem VAS trutec mO hai trang thai van dOng Ira nghi ngai Bang 3: Diem VAS tru,ac mO Diem VAS trung binh Trang thai 5,07 ± 0,68 Van dOng ( n = 27) 2,56 ± 0,51 Nghi ngai (n= 27) NhOn )(Of: MUc d6 dau theo VAS khac a hai trang thai van d6ng va nghi ngai C trang thai van d6ng, diem VAS trung binh 5,07 ± 0,68 Y trang thai nghi ngai, diem VAS trung binh la 2,56 ± 0,51 1.4 Chem 'hang Mop gOi trutec mO theo KOOS Tronp cac hoat d6ng lien quan den chirc nang khap goi thi chat luting cuOc song bi anh Wang nhieu nhat vai diem KOOS trung binh la 28 ± 13,24 Hoat ding the thao co KOOS trung binh chi dat 33,7 ± 8,62 Cac trieu chirng tai vung gOi vol KOOS trung binh 38,35± 7,26 Trieu chi:mg dau (KOOS = 41,47 ±11,02) ,hopt Ong hang (KOOS = 44,47 ± 9,6) 1.5 Phan lopi thoai hoa khOp gOi Bang Phan lop' thoai h6a gOi Phan loai THKG THKG nguyen phat THKG thin phat 1.2 Nhikng bleu hien lam sang chinh cua nh6m benh nhan nghien caw Bang Cac bieu hien lam sang chinh Trieu chirng Dau g6i CI:mg goi buoi sang ( < 30 phOt) Tieng lyc cyc khap g6i Dau hieu bao g6 VAS nghi ngai VAS van Ong Trithc mo (n=27) 2,55 5,07 0/0 27 20 25 SM1 thang (n=27) 2,22 4,85 100 74,1 92,6 3,7 Trutec m6 (n=27) SM thang (n=27) SM thang (n=24) SM thang (n=10) SM11 thang (n=4) Dau g6i 41,47 62,04 81,25 93,89 97,9 KOOS trung binh SM6 thang (n=24) 1,21 2,13 SM9 thang (n=10) 0,7 1,5 SM11 thang (n=4) vai Ian danh gia truac dO * Cai thien chirc nang khap gOi Bang Cai thien chin nang khap gOi theo KOOS Trieu chirng tai g6i Sinh hoat hang 38,35 44,77 51,06 63,9 79,36 59,65 91,17 65,36 94,47 65,17 Nhan xet: Ti' bang 65 cho they, chirc nang khap gOi duvc cai thien r6 ret sau mO 3, 6, 9, va 11 thang (p