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 chan thuang clan 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 cua khap goi, clang vai den hinh thai ton thuang day ch5ng [4] Ve tro chinh 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 hay dirt, dirt hoan thuang day ch5ng cheo trgrac kha thuang toan hay khOng vi lien quan den chi dinh va gap 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 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 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 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 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 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 tac gia Lo va cOng sir [5] giai thieu Om hinh thai ton thkrung: II DOI TUVNG VA PHUO'NG PHAP 06i twang Class A Class B Class C /-;;// ro Dun ei than day ening ow bung bao mang cacn 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 Phan Ioai tem thtrang dint day ching cheo trmfec (Phan Ioai Gachter cai ti6n Lo va cong sty gidei thieu [5]) Nhorn A: TOn thuvng dirt hoan toan & than day chang Nhorn B: Tan thuvng dirt bao, day chang duvc bao phu bai mang hoat dich nhu'ng long, 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 dung dap hoac dirt nhu'ng c6 bieu hien hai dau dirt dinh vao 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 char' thtrang den Dao diPc nghien ciPu: Tat Ca cac benh pheu thuet nhan deu dor-1g 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 Cac loai ton thtpung n 0/0 Kieu A 14 Kieu B 16 Kieu C 10 Kieu D 55 27,5 Kieu E 19 9,5 Kieu F 83 41,5 Kieu G 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 Lien quan giipa tho'i gian tip chan thuvng den du'o'c phau thuat Kieu F Cac kieu khac T6ng s6 < thang 87 94 > thang 76 30 106 83 117 200 CO sty khac biet co 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 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 14 Kieu B 16 K ieu C 10 Kieu D 26 23 55 Kieu E 9 19 Kieu F 31 15 37 83 Kieu G 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, 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 nhom: nhOm co bieu hien lien day cheng (B,E,G) va 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 chen thtyang tru'ac dO hay khOng Ket qua &rag the hien qua bang Bang 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 122 127 Tong so 38 162 200 CO khac !Diet co 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 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 phi., hap vai tan suet khac nhau, 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 dirt la kieu D (dirt a deu barn vao 16i cau xuang thirang hai ciau bi keo xa vi vey kha TCNCYH 88 (3) - 2014 71 TAP CHI NGHIEN CC11.1 Y HQC nang lien thu,ang kh6 xay 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 doi vai cac tOn thkrang dirt kh6ng hoan toan, can dinh 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 vi vay viec lien day cheng mai chey cua day cheng co cau triic rat dac biet co the xay [6] Tren phim cong hu,ang bao Om viing chuyen tiep tir cau trirc gen hinh anh day chang cheo truck 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 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 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 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 bi dirt kern nen day chang bi tieu di [1; 2; 3] Ket qua bang cho they co ye cau triic hai b6 va sirc cang cua hai b6 khac 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 chen thirang den 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 a 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 va bang 1: Ket qua a bang 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 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 hai nhen, mot la cac nh6m co cau truc day chang 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 tuen kern then dung thu6c Ket qua bang 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 truteng hap ton thu'ang day cheng chen thu'ang Dieu cho they khuyen cao dieu tri bao ton tnyac doi vai cac chen thu'ang mai van nguyen gia tri, [4] V KET LUAN Petersen W, Tillmann B (2006) Anatomy and function of the anterior cruciate ligament Orthopade, 31(8), 710 - 718 R Strocchi (1992) The human anterior cruciate ligament histological and ultrastructural observations, Journal of Anatomy, 80, 515 - 519 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 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 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 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 cher) thu'ang den 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 Crain EH, Fithian DC, Paxton EW, Levi cam an Tao gia xin tran 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 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 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 ... Ket qua &rag the hien qua bang Bang 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 122 127 Tong so 38 162 200 CO... 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... cho hcen 500 benh nhan 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