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1 B GIO DC V O TO B Y T TRNG I HC Y H NI NGUYN HU TNG ĐáNHGIáHIệUQUảPhẫuthuậtTREOCƠTRáNSửDụNGCÂNCƠĐùiTựTHÂNLấYBằNGdụngcụ tớc CÂNĐIềUTRịSụPMIBẩMSINH LUN VN THC S Y HC H NI - 2015 B GIO DC V O TO B Y T TRNG I HC Y H NI NGUYN HU TNG ĐáNHGIáHIệUQUảPhẫuthuậtTREOCƠTRáNSửDụNGCÂNCƠĐùiTựTHÂNLấYBằNGdụngcụ tớc CÂNĐIềUTRịSụPMIBẩMSINH Chuyờn ngnh: Nhón Khoa Mó s: 60720157 LUN VN THC S Y HC Ngi hng dn khoa hc: PGS.TS Trn An TS Quang Ngc H NI - 2015 DANH MC CH VIT TT SMBS : Sp mi bm sinh SM : Sp mi MRD1 : Marginal reflex distance - khong cỏch b mi trờn - ỏnh phn x giỏc mc CC : Cõn c ựi CCDTT : Cõn c ựi t thõn DCC : Di chu chy CNCNM : Chc nng c nõng mi MC LC PH LC DANH MC BNG DANH MC HèNH T VN Sp mi bm sinh l bnh mt thng gp tr em Hu nm 1987 tin hnh nghiờn cu trờn triu ngi Trung Quc cho thõy t l sp mi bm sinh l 0,18% [1] Sp mi bm sinh khụng ch nh hng n thm m, n tõm lý v i sng sinh hot ca bnh nhõn m cũn nh hng n chc nng th giỏc Nghiờn cu ca Hornbass v cụng s cho thõy 19% bnh nhõn sp mi bm sinh b nhc th [2] iu tr sp mi bm sinh ch yu bng phu thut Cú rõt nhiu phng phỏp phu thut khỏc iu tr sp mi tựy thuục vo mc ụ sp mi, chc nng c nõng mi, iu kin c s vt chõt v trỡnh ụ, thúi quen ca tng phu thut viờn Nhng phng phỏp phu thut c cỏc tỏc gi cp n nhiu nhõt l ct ngn sn mi-kt mc-c Muller (Fasanella-Sevat), rỳt ngn c nõng mi, treomi trờn vo c trỏn [3-6] Nhng trng hp sp mi nh v va cú chc nng c nõng mi cũn tt thỡ ct ngn sn mi-kt mc-c Muller hoc rỳt ngn c nõng mi l la chn u tiờn Treomi trờn vo c trỏn l mụt phng phỏp c ỏp dng iu tr cỏc trng hp sp mi nng chc nng c nõng mi kem Trong phng phỏp ny cỏc tỏc gi trờn th gii ó dựng nhiu loi vt liu khỏc nhau: cỏc loi ch khụng tiờu, cõn c ựi bo qun, cõn c ựi t thõn, cõn c thỏi dng, dõy silicon [6-13] Trong cỏc nguyờn liu c s dng ú cõn c ựi t thõn t lõu c cho l s la chn hng u Nm 2001, Wasserman so sỏnh cỏc vt liu s dng phu thut treo c trỏn v cho thõy rng s dng cõn c ựi t thõn treomi trờn vo c trỏn cho kt qu rõt tt v chc nng cng nh thm m, ớt li cỏc bin chng (sp mi tỏi phỏt, viờm nhim, o thi vt liu, u ht) nh s dng cỏc vt liu khỏc Tuy nhiờn vic lõy cõn c ựi di cho phu thut treo c trỏn li hu qu so ựi di v xõu nh hng ln n thm m ca bnh nhõn [14] Vic s dng dng c tc c ca Crawford vi ng rch nh khong 2cm c cho l phng phỏp tt nhõt lõy cõn c ựi vi ụ di cõn lõy c ti u t 12-20 cm [6, 15-17] Ti Vit Nam cng ó cú nhiu nghiờn cu iu tr sp mi bm sinh bng phu thut treo c trỏn s dng cỏc loi vt liu khỏc t cỏc loi vt liu tng hp n cõn c ựi t thõn [18-22] Tuy nhiờn cho n cha cú nghiờn cu no cp n vic s dng dng c tc cõn ca Crawford lõy cõn c ựi T nhu cu thc tin v kt qu ca cỏc tỏc gi nc cng nh th gii chỳng tụi tin hnh nghiờn cu ti: ỏnh giỏ hiu qu phu thut treo c trỏn s dng cõn c ựi t thõn ly bng dng c tc cõn iu tr sp mi bm sinh" nhm mc tiờu: ỏnh giỏ kt qu ca phng phỏp treomi vo c trỏn, s dng cõn c ựi t thõn ly bng dng c tc cõn iu tr sp mi bm sinh Nhn xột mt s yu t nh hng n kt qu phu thut v u nhc im ca k thut ly cõn c ựi bng dng c tc c Chng TNG QUAN 1.1 CU TO GII PHU V SINH Lí HC CC C THAM GIA VO NG TC NNG MI 1.1.1 C nõng mi trờn Hỡnh 1.1 C nõng mi (nhỡn t trờn)[17] - Gii phu hc c nõng mi trờn: + Ch xuõt phỏt: c nõng mi trờn l mụt di c xuõt phỏt t gõn Zinn + ng i liờn quan: t ch xuõt phỏt nhng th c ny i trc sỏt thnh trờn hc mt v i trờn c trc trờn,on ny di 40mm on trc vỏch 10mm c tr thnh di cõn Cỏc si cõn dc lm i hng ngang ca cỏc si cõn dõy chng Whitnall, hũa vo ri i xung di trc Dõy chng Whitnall nm gn ch giao gia phn c v phn cõn ca c nõng mi trờn Khi i trc thnh di cõn xoố nh hỡnh nan qut, chia lm hai sng: sng v sng ngoi + Bỏm tn: Sng bỏm vo mo l sau Sng ngoi chia tuyn l thnh thựy mt v thựy mi trc bỏm vo gũ mt ngoi Trc ti 10 b trờn sn mi trờn, cõn c nõng mi trờn hp nhõt vi vỏch ngn mt, mụt phn si cõn i xung v bỏm vo 1/3 di mt trc sn mi trờn Phn trc ca phn cõn hp nhõt ny bỏm vo c vũng cung mi trc sn v da mi to nờn np mi trờn [17] Hỡnh 1.2 Gii phu mi trờn v mi di [17] + Mch mỏu ca c nõng mi: * ụng mch: cỏc nhỏnh ca ụng mch mt i vo c nõng mi theo b ca c, ụi cũn cú mụt nhỏnh ca ụng mch trờn hc n nuụi vựng ny Ngoi phớa trc c nõng mi cũn nhn nhỏnh ca ụng mch l i vo theo b ngoi ca c * Tnh mch: trung phn trc ca c phn hc mt ca c, mỏu chy v phớa thỡ theo tnh mch mt hay r trờn ca tnh mch ny, phớa ngoi thỡ theo tnh mch l phn mi, cỏc tnh mch ca c nõng mi c vo cung tnh mch trờn sn + Thn kinh chi phi: c nõng mi nhỏnh trờn thn kinh III chi phi i vo c 1/3 sau mt di c [23, 24] 1.1.2 C trỏn C trỏn (nm hai bờn trỏn) cựng c chm (nm v trớ tng ng trờn xng chm) to thnh h cõn c s MT S HèNH NH MINH HA Trn Hoi A 5t Chn oỏn: MT Sp mi bm sinh ụ III CNCNM: 1mm Tin s : BN sp mi t nh cha phu thut Ch nh : MT Treo c trỏn s dng cõn c ựi t thõn o Yn N 6t Chn oỏn: MT Sp mi bm sinh ụ III CNCNM: 3mm Tin s : BN sp mi t nh cha phu thut Ch nh : MT Treo c trỏn s dng cõn c ựi t thõn Nguyn Hiu T 9t Chn oỏn: MP Sp mi bm sinh ụ III CNCNM: 0mm Tin s : BN sp mi t nh cha phu thut Ch nh : MP Treo c trỏn s dng cõn c ựi t thõn Thựy D 10t Chn oỏn: MT Sp mi bm sinh ụ II CNCNM: 4mm Tin s : BN sp mi t nh cha phu thut Ch nh : MT Treo c trỏn s dng cõn c ựi t thõn Trn Anh Q 17t Chn oỏn: MT Sp mi bm sinh ụ III, tỏi phỏt CNCNM: 2mm Tin s : BN ó c phu thut ln MT Treo c trỏn s dng ch Mersilene Ch nh : MT Treo c trỏn s dng cõn c ựi t thõn TI LIU THAM KHO Hu DN (1987), "Prevalence and Mode of Inheritance of Major Genetic Eye Diseases in China", J Medical Genetic, 24, tr 584-588 Hornblass A, Kass LG, Ziffer AJ (1995), "Amblyopia in Congenital Ptosis", Ophthalmic Surgery, 26(4), tr 334-337 Michael J Denk James H Carraway (1994), "Refinements in Ptosis Surgery Using Frontalis Sling Technique", Operative Techniques in Plastic and Reconstructive Sugery, 1(3), tr 113-119 Brenda C Edmonson, Allan E Wulc (2005), "Ptosis Evaluation and Management", Otolaryngologic Clinics of North America 38, tr 921-946 Alon Skaat et al (2013), "Congenital Ptosis Repair - Surgical, Cosmetic and Functional Outcome: a report of 162 cases", Can J Ophthalmol 48, tr 93-98 Jeffrey R SooHoo, Brett W Davies, Felicia D Allard, Vikram D Durairaj (2014), "Congenital Ptosis", Survey of ophthalmology 30, tr 1-10 Michael Patipa (1994), "Frontalis Sling Fixation with Silicone Rods for The Treatment of Severe Blepharoptosis", Operative Techniques in Plastic and Reconstructive Sugery, 1(3), tr 172-180 Susan R.Carter, William J Meecham, Stuart R Seiff (1996), "Silicone Frontalis Sling for the Corection of Blepharoptosis : Indications and Efficacy", Ophthalmology, 103, tr 623-630 Igal Leibovitch, Leah Leibovitch, Jean Paul Dray (2003), "Long-term Results of Frontalis Suspension Using Autogenous Fascia Lata for Congenital Ptosis in Children Under years of Age", American Journal of Ophthalmogogy, 136, tr 866-871 10 Guy J Ben Simon et al (2005), "Frontalis Suspension for Upper Eyelid Ptosis : Evaluation of Different Surgical Designs and Suture Material", American Journal of Ophthalmogogy, 140(5), tr 877-885 11 Kengo Hayashi et al (2013), "Comparision of Nylon Monofilament Suture and Polytetraflouroethylene Sheet for Frontalis Suspension Sugery in Eye With Congenital Ptosis", American Journal of Ophthalmogogy, 155(4), tr 654-663 12 Kyung Ah Kwon et al (2014), "Microstructure and Mechanical Properties of Synthetic Brow-suspension Materials", Materials Science and Engineering, 35, tr 220-230 13 Kyung In Woo, Yoon Duck Kim, Yong Hwan Kim (2014), "Surgical Treatment of Severe Congenital Ptosis in Patients Younger Than Two Years of Age Using Preserved Fascia Lata", American Journal of Ophthalmogogy, 157, tr 1221-1226 14 Barry N Wasserman, Derek T Sprunger, Eugene M Helveston (2001), "Comparison of Materials Used in Frontalis Suspension", Arch Ophthalmol, 119, tr 687-691 15 Crawford J.S (1977), "Repair of Ptosis Using Frontalis Muscle and Fascia Lata: A 20-Year Review", Ophthalmic Surgery, 8(4), tr 31-40 16 Crawford J.S, Doucet T.W (1982), "Uses of Fascia in Ophthalmology and the Benefits of Autogenous Sources", Journal of Pediatric Ophthalmology and Strabismus, 19(4), tr 21-25 17 Arnab Biswas (2010), Ptosis Surgery, Jaypee Brothers Medical Publishers Ltd, India, 239 18 Trn An (2003), "Nghiờn cu iu tr sp mi bm sinh bng phu thut treo c trỏn", B Y t 19 Lờ Tuõn Dng, Trn An (2003), "Nghiờn cu s dng ch Polypropylene treomi vo c trỏn phu thut iu tr sp mi bm sinh", Trng i hc Y H Ni 20 Trn Tuõn Bỡnh, Lờ Th Kim Xuõn (2009), "ỏnh giỏ kt qu lõu di ca phu thut treo c trỏn s dng ch Mersilene iu tr sp mi bm sinh", Trng i hc Y H Ni 21 Nguyn Th Thanh Chi, H Th Ngc, Trn Nh Tho (2012), "ỏnh giỏ kt qu s dng dõy silicon phu thut iu tr sp mi bm sinh tr em bng phng phỏp treo c trỏn", Tp nhón khoa Vit Nam, 28, tr 36-39 22 Nguyn Th Thu H, Phm Trng Vn (2014), "iu tr sp mi bng phu thut phi hp rỳt ngn c nõng mi ti a v treo c trỏn bng cõn c ựi", Trng i hc Y H Ni 23 Nguyn Xuõn Nguyờn, Phan Dn, Thỏi Th (1993), "Mi mt", Gii phu mt ng dng lõm sng v sinh lý th giỏc, tr 24-30 24 Nguyn Quang Quyn (1995), C quan th giỏc, Bi ging gii phu hc, Vol 1, Nh xuõt bn Y hc 25 Nguyn c Anh (1998), Sp mi, Hc mt, mi mt v h thng l, Vol 7, Nh xuõt bn Y hc, 121-127 26 Crawford J.S (1968), "Fascia Lata: Its Nature And Fate After Implantation And Its Use In Ophthalmic Surgery", Transactions of the American Ophthalmological Society, 66 27 Ozlem A Gundeslioglu, Nebil M Selimoglu, Mehmet Bekerecioglu (2013), "An Frontalis Sling Operation Using an Autogenous en-bloc, fan-shaped Tensor Fascia Lata Graft for Blepharoptosis", Journal of Plastic, Reconstructive and Aesthetic Surgery, 66, tr 224-230 28 El Essawy R, Elsada MA (2013), "Clinical and Demographic Characteristics of Ptosis in Children: a National Tertiary Hospital Study", Eur J Ophthalmol., 23, tr 356-360 29 Griepentrog GJ, Diehl NN, Mohney BG (2011), "Incidence and Demographics of Childhood Ptosis", Ophthalmology, 118, tr 1180-1183 30 Phm Trng Vn Phan Dn (1998), Sp mi, Phu thut to hỡnh mi mt, Nh xuõt bn Y hc, H Nụi, 145-169 31 Trn Thit Sn (2000), "iu tr sp mi bm sinh bng phng phỏp ct ngn c nõng mi trờn", Phu thut to hỡnh, 4(1), tr 20-24 32 Sang Yeul Lee Jin Sook Yoon (2009), "Long-term Funtional and Cosmetic Outcomes after Frontalis Suspension Using Autogenuos Fascia Lata for Pediatric Congenital Ptosis", Ophthalmology, 116, tr 1405-1414 33 Helveston EM, Wilson DL (1975), "A suture-reinforced scleral sling Technique for suspension of the ptotic upper lid.", Arch Ophthalmol., 93(8), tr 643-645 34 Sternberg I, Seelenfreund MH, Sternberg N (1988), "A new sling material for ptosis patients", Ophthalmic Surg., 19(1), tr 64-66 35 C Philandrianos, P Galinier, B Salazard, J Bardot, G Magalon (2010), "Congenital Ptosis: Long-term Outcome of Frontalis Suspension Using Autogenous Temporal Fascia or Fascia Lata in Children", Journal of Plastic, Reconstructive and Aesthetic Surgery, 63, tr 782-786 36 Medel R, Alonso T, Giralt J, Torres J, Gonzỏlez-Candial M, GarcớaArumớ J (2006), "Frontalis muscle flap advancement with a pulley in the levator aponeurosis in patients with complete ptosis and deep-set eyes", Ophthal Plast Reconstr Surg., 22(6), tr 441-444 37 Katowitz JA (1979), "Frontalis suspension in congenital ptosis using a polyfilament, cable-type suture", Arch Ophthalmol., 97(9), tr 1659-1663 38 Zweep HP, Spauwen PH (1992), "Evaluation of expanded polytetrafluoroethylene (e-PTFE) and autogenous fascia lata in frontalis suspension A comparative clinical study", Acta Chir Plast., 34(3), tr 129-137 39 Min Joung Lee et al (2009), "Frontalis Sling Operation Using Silicone Rod Compared with Preserved Fascia Lata for Congenital Ptosis : a Three-year Follow up Study", Ophthalmology, 116, tr 123-129 40 Crawford J.S (1956), "Repair of ptosis using frontalis muscle and fascia lata", Trans Am Acad Ophthalmol, 60, tr 672-678 41 Friedenwald J.S., Guyton J.S (1948), "A simple ptosis operation: Utilization of the frontalis by means of a single rhomboid-shaped suture", Am J Ophthalmol, 31, tr 411-414 42 Fox S.A (1966), "Congenital ptosis II Frontalis sling", ", J Pediat Ophthalmol, 3(2), tr 25 43 Jeong S., Ma Y.R., Park Y.G (2000), "Histopathological study of frontalis suspension materials", Jpn J Ophthalmol, 42(2), tr 171-174 44 Dag Krohn-Hansen, Erling Haaskjold, Bjorn Niclolassen (2015), "Suspension Surgery with Autogenous Fascia Lata via a Les Invasive Modification of the Crawford Method on 85 Patients with Severe Eyelid Ptosis", Journal of Plastic Surgery and Hand Surgery Early Online, tr 1-6 45 H Huy Ti, Phm Ngc Bớch, Trn Thu Thy (1991), "Phu thut sp mi bng rỳt ngn c nõng mi trờn", K yu Hi ngh Khoa hc k thut ngnh mt H Ni, BNH N NGHIấN CU S: H v tờn bnh nhõn: Tui: _ Gii: a ch: _ ST: _ Ngy vo vin: _ S bnh ỏn: _ KHM BNH A Tin s: Xuõt hin t nh Tin s gia ỡnh: Xuõt hin muụn Cú Tin s phu thut: Cú B Khụng Khụng Khỏm: Th lc khụng kớnh MP: MT: Dõu hiu i kốm Cú Cỏc bõt thng phi hp Lỏc Cú Epicanthus, Hp khe miCú Marcus Gunn Cú Khỏc Mt sp miCú MP Th lc cú kớnh MP: MT: Khụng Khụng Khụng Khụng Khụng MT ụ sp mi MP Nng Trung bỡnh Nh MT Nng Trung bỡnh Nh Chc nng c nõng mi MP Tt Trung bỡnh Kem S mt phu thut Mụt mt Vụ cm Tờ C Cỏc din bin m Chy mỏu nhiu mi mt Bin dng mi Rỏch hoc t cõn Cõn ựi lõy c: Ngn MT Tt Trung bỡnh Kem Hai mt Mờ Cú Khụng Di D ỏnh giỏ kt qua Sau tun Tiờu ỏnh giỏ Phng phỏp ỏnh giỏ Mc ụ ci thin sp mi Hiu qu thm m So ựi Cỏc dõu hiu khỏc vựng ựi lõy cõn Bin chng Tỏi phỏt Hi lũng bnh nhõn Hi lũng nghiờn cu ca nhúm - Tt: im - Trung bỡnh: im - Kem: im - Mi cong u, np mi hai bờn cõn bng nhau: im - Khỏc: im - Tt: So nh, m im - Khụng tt: So to, di, li im Thoỏt v c ựi, t mỏu, sng n, au ụng - Khụng: im - Cú: im H mi, qum, phn ng ti ch (viờm, u ht) - Khụng bin chng: im - Cú bin chng: im - Khụng tỏi phỏt: im - Cú tỏi phỏt: im - Hi lũng: im - Khụng hoc cha hi lũng: im - Hi lũng: im - Khụng hoc cha hi lũng: im Kt qu phu thut sau tun: - Tt: 9-10 im - Kh quan: 7-8 im - Thõt bi: 0-6 im Sau thỏng Tiờu ỏnh giỏ Mc ụ ci thin sp mi Hiu qu thm m So ựi Phng phỏp ỏnh giỏ - Tt: im - Trung bỡnh: im - Kem: im - Mi cong u, np mi hai bờn cõn bng nhau: im - Khỏc: im - Tt: So nh, m im - Khụng tt: So to, di, li im Cỏc dõu hiu khỏc vựng ựi lõy cõn Bin chng Tỏi phỏt Hi lũng bnh nhõn Hi lũng nghiờn cu ca nhúm Thoỏt v c ựi, t mỏu, sng n, au ụng - Khụng: im - Cú: im H mi, qum, phn ng ti ch (viờm, u ht) - Khụng bin chng: im - Cú bin chng: im - Khụng tỏi phỏt: im - Cú tỏi phỏt: im - Hi lũng: im - Khụng hoc cha hi lũng: im - Hi lũng: im - Khụng hoc cha hi lũng: im Kt qu phu thut sau thỏng: - Tt: 9-10 im - Kh quan: 7-8 im - Thõt bi: 0-6 im 10 Sau thỏng Tiờu ỏnh giỏ Mc ụ ci thin sp mi Hiu qu thm m So ựi Cỏc dõu hiu khỏc vựng ựi lõy cõn Bin chng Tỏi phỏt Hi lũng bnh nhõn Hi lũng nghiờn cu ca nhúm Phng phỏp ỏnh giỏ - Tt: im - Trung bỡnh: im - Kem: im - Mi cong u, np mi hai bờn cõn bng nhau: im - Khỏc: im - Tt: So nh, m im - Khụng tt: So to, di, li im Thoỏt v c ựi, t mỏu, sng n, au ụng - Khụng: im - Cú: im H mi, qum, phn ng ti ch (viờm, u ht) - Khụng bin chng: im - Cú bin chng: im - Khụng tỏi phỏt: im - Cú tỏi phỏt: im - Hi lũng: im - Khụng hoc cha hi lũng: im - Hi lũng: im - Khụng hoc cha hi lũng: im Kt qu phu thut sau thỏng: - Tt: 9-10 im - Kh quan: 7-8 im - Thõt bi: 0-6 im Nhõn xột: ... TO B Y T TRNG I HC Y H NI NGUYN HU TNG ĐáNH GIá HIệU QUả Phẫu thuật TREO CƠ TRáN Sử DụNG CÂN CƠ Đùi Tự THÂN LấY BằNG dụng cụ tớc CÂN ĐIềU TRị SụP MI BẩM SINH Chuyờn ngnh: Nhón Khoa Mó s: 60720157... Hornbass v cụng s cho thõy 19% bnh nhõn sp mi bm sinh b nhc th [2] iu tr sp mi bm sinh ch yu bng phu thut Cú rõt nhiu phng phỏp phu thut khỏc iu tr sp mi tựy thuục vo mc ụ sp mi, chc nng c nõng mi, ... acetylcholine, dn ti sp mi 18 - Sp mi bm sinh phi hp vi nhng d dng mt + Chng nhón cu nh bm sinh mụt bờn + Thiu sn mụ m + Khuyt mi bm sinh 1.3.2.2 C ch bnh sinh ca sp mi bm sinh Theo Arnab Biswas: