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- MOt so bien phap lam gi5m t9 le mac berth: + Tien hanh truyen thong giao duc ye can berth de' mei nguiii phu nit 15-49 tut)) not chung va có gia dinh not rieng y thus ye can berth + Thilang xuyen di kham benh dinh k9 de phat hien dieu tri that de benh BO thoi quen ye sinh kh6ng hdp ye sinh nhi/ ngam chau, cho tay vao am dao Dung bang ve sinh phit hop, thdc hien k6 hoach hoa gia dinh, chi nen sinh 1-2 va cAi thien nguon Hunt sit dung Tranh diing nude be mat ma dung nuUc ngem hop ve sinh TAI LIEU THAM KHAO BO Y te (2001) "Chien krdc gia ye cham sot bac) ye sift khoe giai doan 2001- 2010", NXB Quan dei nhan clan Tr -22 Nguy8n Hal COc.(2001), "Tinh hinh mac benh phu khoa cila phu nit tai xa huyen Kim Bang, Ha Nam", Luan van tot nghiep chuyen khao cap II, twang Dai hoc Y Ha Nei Doan Thi Hanh (2010), "Thdc tang viem nhi8rn &king sinh duc ditoi va cac yeu to" lien quan if phu nit 1953 tu6i co ch6ng quan H6ng Bang H5i Phong nam 2010", Luan van t6t nghiep bac s9 chuyen khoa cap II, DHY H5i Phong Wong Tien Hoa (2000), "Nhi8m khuen diking sinh s5n va sitc khoe phu nit', Tap chi Khoa hoc ye phy nit, Trung tam Khoa hoc Xa hei va Nhan van Qucic gia Tr 4652 Vu Quang Kh5i (2007), "Tinh hinh viem nhi8rt &tong sinh duc dikti a phy nit dQ tuCii sinh de thong tai huyen Thanh Ha, tinh Hai along" Luan van that sy Y te tong tong, tri/Ong Dai hoc Y H5i Ph6ng Khoa Y tong d6ng, trilang DO hoc Y HA NOi, "Silt khoe sinh san" Dao Van Lan (2009), "Thyc trang viem nhi8m &Ong sinh duc dud thiteng gap va cat ye'u tO lien quan chinh d phy nit 18-52 tu6i tai Kien An" Luan van that s9 Y hoc Dai hoc Y Hai PhOng Cac Van Tiern (2011), "Thdc trang viem nhi6-m &tong sinh duc dikti va kien thOt thut hanh tl phu nit co thong tu6i sinh de tai huyen An Lao ph/5 Hai Ph6ng nam 2011" Luan van bac s9 chuyen khoa cap II, Dai hoc Y Thai Binh Tniong Thi Van (2005), "Thdc trang va mot so" yeu VS lien quan den benh phu khoa a phi/ nit 15-49 tu6i c6 thong tai huyen Gia Lam Ha Nei" Luan van that s9 Y tong tong-DHY Ha Nei 10 Amsel, totte PA, Spiegel Ca (1983), "Nonspecific vaginalitis", Aj Med74, PP14-22 11.Caiyan X et al (2012), "Prevalence and risk factors of lower genital tract infections among women in Beijing China" J Obstet Gynaecol, 38(1): 310-5 12 Kane Degutis Saywward Onofri (2004), "Compliance with the Centre for Disease Control and Prevention recommendation for the diagnosis and treatment of sexually transmitted disease" Acoad Emrg Med 11,317 MINH GIA Kb' QUA Tutu TR! PHAU THUAT GAY XMING THUYEN MA NGOC THANH, TRAN TRUNG DUNG Dai hoc Y Ha NO NGUYEN Dt:IC PHUC - Benh vien Da khoa Tinh Hai Duong TOM TAT Oat van de: Gay xuong thuyen hay gap gay Axing vung c6 tay, ce trieu chiing lam sang ngheo nan nen de bi be set, de nhern vdi cac chin thuung day chang veing c6 tay Muc fiat, nghien cifu: 1) NW )(et (lac diem 15m sang va Xquang benh nhan gay miring thuyen; 2) Danh gia kat qua dieu tri phau thuat gay xuting thuyen D6i tuUng va phuong phap nghien ciiu: Nghien cat' m6 to hei car 32 benh nhan dtipc chen doan va di& tri pilau thuat gay xuung thuyen tai Vien CTCH Benh vien HN Viet Dix to 6/2008-6/2012 M6 to ciao diem lam sang, phan 100 gay xuung theo vi tri giai pheu va Trojan Russe Ghep Wring mao chau hoac dau dUdi xuting quay Danh gia ket qua theo bang diem dm Mayo Kat qua: TO thang nam 2008 den thang nam 2012 da m6 cho 32 benh nhan Tuo'i: De tuei gap nhieu nhlt 20-30 tu6i, chiem 68,8%.Gi6i: nam chiem ty le 93,8% Ten thuung gian tiep gap 27 benh nhan (84,4%) Gay ngang eo chiem 71,9% Kat qua: tot va rift kit 27 benh nhan (84,4%) Ket Juan: Gay Wring thuyen thuting de bi be set trieu chung lam sang ngheo nan, can ce cac to the' chup phim dac biet, co the chan thuting hay gap la 52 gian tiep Chen dean va dieu tri sem mang lai ket qua kha quan hon TrAhod: Gay xuong thuyen SUMMARY THE RESULTS OF SURGICAL TREATMENT FOR SCAPHOID FRACTURE Introduction: Scaphoid fracture appears commonly in carpal fracture Fractures of the scaphoid occur most commonly from a fall on the outstretched hand (indirect mechanism) There are a few symptoms Objectives: 1) Describe the clinical and radiographic characters of scaphoid fracture; 2) Evaluate the result of surgical treatment for scaphoid fracture Material and Method: Retro-observational study basing on records of 32 patients diagnosed scaphoid fracture and surgical treatment by fixation and bones graft or not at Viet Duc University hospital from June 2008 to June 2012 Describing the characteristics of clinical, Radiographic grade was classified according to anatomical position Trojan Russe Bone graft was performed at iliac crest and distal radius Using Mayo score to evaluate results Results: We has performed 32 patients in surgical treatment The age occur most commonly from 20-30 Y HOC THU'C HANH (957) - SO 4/2015 years old (68.8%) Male amount of 93.8% Mechanism appears 27 patients of indirection Xray: scaphoid fracture at waist in 71.9% Exellent and good is 84.4% (27 patients) Conclusion: Fracture of the scaphoid often overlooked boat so poor clinical symptoms, should have taken the stance particularly Xray, common mechanism of injury is indirect Early diagnosis and early treatment brings better results Keywords: Scaphoid fracture D4T VAN of Gay xuong thuy6n la loai hay gap nhgt s6 cac twang hdp gay xuong vung co tay, &mg thu' hai sau gay du dual xuong quay Gay xudng thuy6n thuting gap a nhung banh nhan nam co tuOi tit 20-30 [1], [2] Gay Wong thuy6n có Mau chtlng lam sang ngheo nan nen chgn thudng ngUoi banh thuang nghi don glen la bong gan vling co tay Dieu tri muan co the' gap cac bin chUng: Khoo gia, hoai tit, mat vimg co' tay, hai chung ang cob tay, hit khop gay anh Wang clan chitc nang co' ban tay va chat luring cuac sang cOa banh nhan Gay wong thuy6n thutng co cha chgn thudng gian bap: Nga ch6ng tay voi c6 tay dual qua mit co the' gap bi tai nan the thao, tai nan giao th6ng hoac tai nan lao dung Tren the" gidi a co nhieu tong trinh nghien cau v6 di6u tri gay )(acing thuyen, brat la cac phuong phap phau thuat cita: Adams (1928), Leyshon A, Iveland J (1984), Stark A, Bostrom L.A, Svartengren (1987), Herbert (1990) Cac phUcIng phial) dieu tri dau mang lai kat qua kite quan [6], [7, [8] a Woo to nghien cau v6 gay xuong vling c6 ban tay can chua dulc quan tam mat cach thich dang Tai Vign CTCH 134nh vien HN Vi6t DUc dieu tri gay )(acing thuy6n nhi6u nam Tuy nhien chua thgy co bao cao nao tong kat, danh gia tong nhutheo doi kat qua digu tri gay xudng thuy6n de duo met phac de di6u tri higu qua nhgt Tit do, chung toi nghien cOu de tai nh5m muc tieu: Nhan xet dac diem lam sang va X quang gay wring thuyen Danh gia kg qua dieu to ph& thuat gay xuting thuyen 061TUDING VA PHUONG PHAP NGHIEN CUU 1.Dal Wong nghien cau Tign hanh nghien cOU 32 b4nh nhan duoc chgn doan gay xuong thuyen mai, CO va khOp gia xudng thuygn disc di6u tri bang phuung phap KHX kern theo ghep Along hoac kh6ng tai Vign Chgn thudng ch]nh hinh Bgnh vign HEM nghi Vigt DUc tit thang nam 2008 dgn thang nam 2012 Phuong phap nghien cau: Phudng phap nghien a:1u m6 to hoi Phuong phap phAu thuat • Outing md'vao xtiOng thuyen 121171 Evang m' vao xudng thuygn tren h6 lao giai phau:Rach da 3cm doc ten horn lao giai phau, bec le horn lao Rath can doc theo &fang rach da giira gan duoi dai va duoi nggn ngen cal Wing farabeuf keo can va gan duel dai, duoi ng5n ngen cai sang hai ben se thgy cac nhanh cua deng mach quay va than kinh Y HOC THVC HANH (957) - SO 4/2015 quay Pilau tich va keo chung sang ben dg bec to bao khdp M6 doc vao khap co' tay bec le midng thuy6n * Ke'l hQp min: Lam sach O gay, dat lai xitiOng theo dung giai phau va kgt hop xudng bang kim Kirschner, vit AO * Ghep Wong x6p tit ngugn xuring x6p mao chair hoac dau dUUi xUang quay Tap phyc chac nang: Bang cac bai tap co gi5n co' tay Danh gia kat qui digu V]: Theo hg thong bang digm caa Mayo KET QUA NGHIEN CUU Tugi: Do tugi gap nhigu nhgt la 20-30 kr& chigm 68,8% Do tuOi chigm t9 16 thgp nh'gt la < 20 Wei, chigm 3,1% Giai: Nam chiam t9 la 93,8% Thai gian tit bi chin thudng dgn phAu thuat: CO 18 b6nh nhan di:0c phau thugt tugn dau, chigm t910 56,4% Digu tri talc phau thuat: T910 lagnh nhan d5 &lc di6u tri bang thu6c nam IA 43,8% Co 25% biOnh nhan dudc be bet trudc vao vi4n va 31,2% chua duoc digu tri DOc digm lam sang va Xquang: Nguyen nhan va co chg chgn thudng: n le) bOnh nhan TNGT la cao nh'at chigm 53,1%, sau dgn tai nan the thao chi6m 31,3% Cd ch6 chgn thUdng: Chu ygu gap cd ch6 gian tip (27 trUang hdp, chigm 84,4%) Dac digm hinh anh XQ: Phan loai Ming gay theo vi tri giai phau: Vi tri gay gap nhi6u nhgt IA gay ngang eo chigm 71,9% Gay cuc xa chigm t9 14 thgp nhgt 9,3% Phan loai Wang gay xudng theo Trojan, Russe: Gay ngang hay gap nhgt chigm 56,3%, rgi dgn gay theo chigm 40,6%, thgp nhgt IA gay doc chigm 3,1% Cac ten thudng xuong ph6i hop: T9 16 bgnh nhan co On thudng phei hop va trot xudng nguygt la cao nhgt, chigm 34,4% Co 15,6% bgnh nhan co kern gay mom tram quay Bang 1: Cac kv thuat phau thuat cac k9 thuat phSu thuat S6 benh nhan -11io % Kim Kirschner 23 71,9 Vit AO 21,8 Phuang phap khac 6,3 T6ng 32 100 _Kg qui gin: Khong co bign chUng sau phau thuat XQ sau mg: lit ca cac trudng hop mO KHX dgu dat xudng dung vi tri giai phau, kh6i phut tet mai quan h4 thuygn-nguy4t Ban 2: Kgt qua xa theo bang diem Ma Kgt qua S6 banh nhan Tje la % Rat ttit 21,9 T6t 20 62,5 Trung binh 9,4 Xau 6,2 T6ng 32 100 53 Kgt qua lien zutIng teen phim XQ: CO 96,4% banh nhan lign Along sau kham lai Mat s6 ygu t6 anh hUang d6n k6t qua phau thugt: Thai diem phau thugt va k6t qua pilau thugt: Nhom lognh nhan c6 the,' diem phau thuat tU chin thuang d6n mo dual tun c6 ka qui phau thugt tot kin cat nh6m bgnh nhan khac CO 18/18 banh nhan có k6t qua rgt tot va tot, khong có bgnh nhan có_kgt qua khOng toot PhVong phap KHX va MI qua pilau thuat: Bgnh nhan &pc phau thuat bang bign phap vit AO co 6/7 Wang hop dat k6t qu5 toot Banh nhan duck phau thuat clang kim Kirschner co 21/23 truang hop dat ka qua t6t Phuc h6i chac nang sau phau thugt: CO 14/14 bgnh nhan phut h6i tai vign co kgt qua t6t va 10/12 banh nhan tap phut h6i chac nang tai nha tfch cut c6 ka qua tot Hinh 1: KHX bang vit AO Hinh 2: KHX bang kim Kirschner (co tre't Wong nguyet) BAN LUAN Nguyen nhan: Gay xuang thuygn tai nan giao thong chigm ti la cao nhat (53,1%), lai la chin thuang the thao (31,3%) 19 la cling pha hop vii cac nghign tau caa Nguyen Thuc Bai Chau [1] Trong cat tai nan giao thong gay gay Wong thuy6n dau lien quan dgn xe may, nga ch6ng tay (17/ 17 truing hOp), chung toi cho rang day la dac diem Hang caa cat nUac dang phat trien, xe may dang la phuang tign phO bin de di lai Khac vai cac nghign cau coa nuoc ngoai, nguygn nhan chgn thuong the thao la cao nhgt rgi mai dgn tai nan giao thong Theo Filan S.L, Herbert T.J [6], qua nghign cal 413 trUang hop gay xuang thuy6n thy nguygn nhan chin thuang the thao chigm 45% va tai nan giao thong chigm 30% Gay )(acing thuygn co ch6 chgn thuong gian tigp chigm ti le cao (84,4%) Nga ch6ng tay vii cob tay duoi qua mac Trong 32 Thai gian tit gay Wong den twang hop nghign cau caa chung toi trUang hop c6 thai gian nggn nhat la va dai nhgt la > nam Theo Chapmann, Michael W.[5]: Gay xuang thuy6n cang dUcfc phan loai theo khoang the,' gian giaa chin thuong va chin doan, gay Wong mai la duoc than doan 3- tun dgu, chain lien hoac kh6ng Ifen duac chin doan kho5ng 4- thang nhign khoang thai gian van dang tranh cai, 54 khong lign &too chin doan gay xuong ten thang Theo phan loaf caa Herbert T.J, Filan S.L [6]: Gay Wong thuygn mai la gay Wong &roc chin doan < tugn, gay khong lien Wang la gay duoc then doan man tren tugn Phuang phap phiu thu5t: Phau thuat KHX thuy6n t9 la nhigu nhgt la dung kim Kirschner (71,9%), kim Kirschner c6 nhigu uu diem nha: Gia re, de lam, de kigm, rat linh hoat, de clang cher' vao, de dang lgy N6 co the xuygn qua da hoac qua duang rach da, du gift yang )(Long gay dac biat no duoc dung cho nhang twang hop manh gay nha kh6ng the KHX bang vit Tuy nhign kim Kirschner cang bac la nhang nhuoc diem nha: Gay nhiem tang than dinh, Tau dinh co vao da gay dau va khOng co dinh yang chgc bang vit [1], [6] Con KHX vai vit ngobi nhang uu diem la co" dinh Wong yang chgc thi vit c6 nhang nhuOc diem: Kho tim, k9 thugt dat vit phai chinh xac tranh cac bign chang chain lanh hoac khong lanh xuang Thai digm phiu thu5t: Ka qua tot a nhorn bath nhan có thai diem phau thugt tit chat thing dgn mob dual tun co kgt qu5 phau thuat tot kin cac nh6m bath nhan khac Co 18/18 banh nhan co kgt qua rgt tot va t6t, khong co banh nhan c6 kgt qua kh6ng tot Banh nhan phau thuat sau gay tren thang co kgt qua di6u tri thgp nhgt 4/7 bgnh nhan cal ka qu5 va 3/7 banh nhan c6 kgt qua kh6ng tot St, khac co nghia th6ng kg vaf p = 0,017 (< 0,05) KEY LUAN 05c digm lam sang va hinh 5nh XQ cua gay xuang thuygn Nguyen nhan chin thuang, thuang tai nan giao thong (53,1%) vai cd chgn thuong cho ygu la nga ch6ng tay vai co' tay du6i (84,4%) Cac dgu higu lam sang thilang gap: Dau horn lao (76,7%), dau d6n ngon cal (50%) Sung tai ham lao (43,8%), sung toan Ix) tay (56,2%) Trgn phim Xquang: vi tri &tang gay thitang gap: Gay ngang eo (71,9%), gay ngang chgo (56,3%) (theo phan loaf cila Trojan, Russe) Ket qu5 dieu tri ChOng toi dua vao hg thgng thang diem caa MayO dinh gia, kgt qu5 thu duck nhu sau: Ka qua tot va rgt tot chigm 84,4% bgnh nhan dat kgt qu5 binh va )(au dgu flan nhorn mO muan, khong tuan WI dung thai gian 1)6 bat va qua trinh phut h6i chat nang Di& tri pilau thugt miring thuy6n co t9 I§ lign xuang cao (96,4%) TAI LIN THAM KHAO Nguyen -Wm Bai Chau (2002), Dieu tri gay ca xuong thuyen bang phuang phap xuyen kim va ghat) xuung, Lugn van CK II truting OH Y Duoc TP H6 chi Minh Bui Van Dim (2010), "Gay ;clang thuygn", Chen thutmg chinh hinh chi tren, NXB The duc the thao, tr 429- 540 Amadio P.C, Moran S.L (1999), "Fractures of the carpal bones", Green's operative hand surgery, chapter 17, pp 809-837 Bucholz, Robert W Heckman, James D.; CourtBrown, Charles M (2006), "Fractures and dislocations of Y HOC THUG HANH (957) - SO 4/2015 the capus", Rockwood & Greens fractures in Adults, pp 816 Chapman, Michael W (2001), "Fractures of the carpal bones", Chapman'n Orthopaedic Surgery, ad Edition, Chapter 42, pp 1359-1367 Filan S.L., Herbert T.J (1996), "Herbert screw fixation of scaphoid fractures", The Journal of Bone and Joint Surgery, 78B, pp 519-529 Herbert TJ (1990), "The fractured scaphoid", St Louis: Quality Medical Publisshing Leyshon A., Ireland J., Trickey E L (1984), "The traitment of delayed union of the carpal scaphoide by screw fixation", The Journal of bone and Joint surgery66B, no1 Stark H.H, Rickard T.A, Zemel N.P (1988), "Treament of ununited of the scaphoid by iliac bone grafts and Kirschner wire fixation", The Journal of bone and Joint surgery, 70A, pp 982-991 10 Wolfe SW (2004), "Fractures of the carpus: scaphoid fractures", In: Berger RA, Weiss APC, eds Hand surgery, vol Philadelphia, London, Tokyo: Lippincott Williams & Wilkins, pp 381-408 DANH GIA HET QUA NGHIEN Clkl AP DUNG CAT AMIDAN BANG COBLATOR NGUYEN CONG HOANG Be men Tai Mui Hong DO hoc Y Duoc Thai Nguyen TOM TAT Qua nghlen cim 14 trudng hdp tchnh ly Amidan chi dinh phau thuat cho they: Tudi nh6 nhat le 7, Idn nhet la 55 tu6i Tr* cht:mg lam sang hay ghp la dau hong: 100%, nu6t vudng 64%; Amidan qua phat hai ben: 58%, cac bleu chimg khac it ghp hon Nhu vay, nghien cuu cho they trihu chi/iv Amidan c6 chi dinh pilau thuat: amidan viem man tinh, qua phat hai ben, gay dau hong, sot nhieu Phuung phap pilau thuat cat amidan bang COBLATOR cho they: COBLATOR c6 the cat amidan cac chi dinh nhu: viem nhieu Ian, viem sau tay, ap xe, chinh hinh man hhu, ladi ga„ u amidan SO' dung thu6c sau md trung binh: 6,5 ThOi gian nem vien trung binh: 1,8 -3,6 Thdi gian hei phuc: 7,5 H6c and 100% Gen trie'n tot sau thti 14 Gia phhu thuat thep Ket qua (ran cho they: Cat amidan bang CBLATOR cb thd tier, hanh moi lua tu67 va an loan Takhea: Amidan, COBLATOR SUMMARY EVALUATION OF RESULTS OF TONSILLECTOMY BY COBLATOR METHOD IN THAI NGUYEN CENTRAL, GENERAL HOSPITAL By studying 14 cases of tonsils with surgical indications, we found that the minimum age was 7, the largest was 55 years old Common clinical symptoms were sore throat: 100%, difficult swallowing: 64%; The tonsils developing in both sides: 58%, other symptoms were less common Thus, the study showed that symptoms of tonsils with surgical indications included: chronic inflammation of the tonsils, so developing in both sides, causing sore throat, fever of many times Tonsillectomy by COBLATOR showed that COBLATOR could be applied in cases such as lows: inflammation of many times, inflammation after swelling, abscesses, faucial orthopedics, reed, tumor of tonsils Mean days of using drugs after surgery: 6.5 days The average length of hospital stay: 1.8 - 3.6 days Recovery time: 7.5 days For hallow of operation, 100% was a good progress after 14 days Cost for operation was low Above results showed that Y HOC THVC HANH (957) - S6 4/2015 tonsillectomy by COBLATOR could be done in all age groups and safety Keywords: Tonsils, COBLATOR DAT VAN DE Phu thuat cat Amidan la can thiet, hien la phau thuat ph6 bien nhat nganh Tai M CA Hong CO nhi6u phudng phap cat Amidan: Phudng phap kinh dien: Bang dung cu Sluder :Ballanger, thong long Phudng phap hien dai nhu: Cat bang dao dien cao tan luting cac (Bipolar), Laser, Coblation, dao sieu am (Ultrassound - Harmonic Skalpel) Phudng phap phau thuat cat Amidan bang Coblation dudc thuc hien Ian dau tien tren the gidi vao nem 1997, Viet Nam ap dung vao khoang nhirrig nem 2000 Do có Uu the giam thdi gian va lUdng mau mat phau thuat, de thUc hien nen TA tra phildng phap ph6 bien tuyen trung Udng nhUng chtla &roc ap dung rang raj tai dia phu'dng V&i mac dich gop phan nghien cau thilc day ang dung k9 thuet mdi chuyen nganh tai mui hong tai benh vien tuyen tinh Chung t6i tin hanh thuc hien d6 tai: "Danh gia kat qua nghien ceiu ap dung cat Amidan bang Coblator" Muc tieu: M6 to hinh thai lam sang cue Amidan cb chi dinh phau thuat va danh gia ket qua phuong phap cat amidan bang Coblator tai khoa Tai mui hong Bhnh vien Da khoa Trung acing Thai Nguyen DOI TUONG VA PHUCJNG PHAP NGHIEN CUU D6i tuvng nghien cau: La nhimg benh nhan c6 chi dinh cat Amidan MAu nghien cUu: G6m 14 benh nhan &roc chi dinh phau thuat cat amidan bang Coblation - Thai gian va dia diem nghien cau: Nghien cifu &pc ben hanh tai Khoa TMH BVEKTUTN, tU thang 8/2014 den thang 12/2014 - lieu chuan chon benh nhan: + Benh nhan bi viem amidan man tinh + Kham co chi dinh phau thuat (Theo quy dinh cue nganh) + CO day h6 sd benh an 55
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