III. HOI CHUNG KHE CAC CO BAC THANG (HOI CHUNG KHE SUON CO BAC THANG, HOI CHUNG
4. Nguyen nhan
Nguyen nhan cua hoi chtfng khe cac cd bac thang: do cd bac thang trtfdc bi xd hoa, phi dai, co ctfng.
Nguyen nhan cua hoi chtfng khe stfdn - don (sydrome du defile costo - claviculaire) do di dang xtfdng stfdn 1 (ctfc trtfdc cua xtfdng stfdn 1 phi dai), do co ctfng cd hoac yeu dai vai.
- Nguyen nhan cua hoi chtfng stfdn cd: mom ngang dot song CVII dai ra nhtf mot xtfdng stfdn cut gay hep khe stfdn - ddn.
5. Chan doan
a. Chan doan xac dinh
- Chan doan xac dinh hoi chtfng stfdn cd, dtfa vao: + Trieu chtfng lam sang (trieu chtfng than kinh, trieu chtfng mach mau, dau hieu Adson - Coffey dtfdng tinh, dau hieu tai cho)
+ X.quang: chup X.quang cot song cd CVII - DI thay cd stfdn cd VII (tieu chuan vang)
- Chan doan hoi chtfng stfdn - ddn: dtfa vao trieu chtfng lam sang (trieu chtfng than kinh, trieu chtfng mach mau, dau hieu Adson - Coffey dtfdng ti'nh, dau hieu tai chd), chu yeu la dau hieu tac mach quay va cac trieu chtfng lam sang tang len khi lam nghiem phap dtfa khdp vai ra sau va xuong dtfdi
- Chan doan hoi chtfng cd bac thang trtfdc: dtfa vao trieu chtfng lam sang (trieu chtfng than kinh, trieu chtfng mach mau, dau hieu Adson - Coffey dtfdng tinh, dau hieu tai chd).
ft. Chan doan phan biet
Can phan biet cac hoi chiing tren vdi:
- Hoi chiing chen ep r l cd phan biet vdi hoi chiing khe cac cd bac thang bang nghiem phap Schpurling: ty len dau va nghieng dau sang mot ben (cd bac thang ben do se trung), neu xuat hien dau tang len la do chen ep re than kinh vi lam hep lo gian dot song cung ben.
- Viem dong mach, tinh mach chi tren d benh
Raynaud phan biet vdi hoi chiing sifdn co (hinh anh chup X quang dot song CVII - DI binh thiidng).
- Thoat vi dla dem cot song cd thap: benh nhan thiidng dau khi ho hoac quay dau sang ben.
- Hoi chiing chen ep dam roi than kinh canh tay do cai d dau ngoai mat trong x U d n g ddn bi gay cu.
- Hoi chiing Pancoast - Tobias: ung thu thiidng bi (carcinome) dinh phoi chen ep dam roi than kinh canh tay.
Hoi chiing Raynaud: mdi d iu d cac ngon tay (it khi d chan) do co that dong mach nho, xuat hien khi gap lanh, ngon tay bi te buot roi tim lai, mat cam giac hoac dau nhoi, nhung tay vao ntfdc nong het dau, cdn dau keo dai vai phut tdi vai gid. Tien trien cd the khoi hoac tien tdi hoai thu dau chi.
Hoi chUng thieu mau cap tinh d chi tren do bien chUng t ic mach d benh nhan cd benh tim.
6. Dieu tri
- Dieu tri hoi chUng cd bac thang trUdc
thoat vi dla dem cot song cd nham cai thien tinh trang veo, tfdn qua mtfc cua cot song cd de md rong lo gian dot song. Cac phtfdng phap dieu tri chinh la: bai tap van dong cai thien tU the veo, qua tfdn cot song cd, keo gian, deo "dai cd" de bat dong cot song cd, thuoc gian cd, tiem tai cho vao cd thang b ln g novocain, phau thuat tach cO bac thang (tac hai lam giam stfc chiu dtfng cua cot song cd).
Dieu tri hoi chiing khe stfdn - don:
Cai thien ttf the, tang ctfdng do uon cua cot song cd, tang ctfdng cd ltfc cua dai vai
Dieu tri hoi chtfng stfdn cd
Trtfdc day chi cat bd mot phan stfdn cd hoac cat cac cd bac thang trtfdc va gitfa. Ket qua thtfdng phai can thiep lai. Gan day can ctf vao dac diem giai phau, nguyen nhan gay chen ep khong phai chi do stfdn cd ma cd the cdn do cac thanh phan khac tao nen cac khe hep, cd the cac cd bac thang bi xd hoa ddn thuan, cd the do di dang xtfdng stfdn 1 hoac do stfdn cd cd dai cd dinh vdi ctfc trtfdc stfdn
1... vi vay phtfdng phap xtf ly toi tfu la cach giai quyet tat ca cac nguyen nhan gay ra chen ep de dat dtfdc muc dich cuoi cung la giai phong cac nhanh than kinh va bd mach bi chen ep, neu cd bien chtfng mach mau nang hdn than kinh, cd the cat bd hach giao cam ngtfc hoac cd tac gia de nghi c i t bd to chtfc giao cam quanh mach mau. Nhtfng tai bien trong va sau md thtfdng khong cd gi dac biet.