- Vong cung cd - bit bi gian doan
- Hai mau chuyen xtfdng dui bi che lap
- C.T.Scanner de danh gia mtfc do loang xtfdng
Hinh 22.8. Vong cung cd - bjt binh thtfdng (a) va gian doan (b)
4. DIEU TRj4.1. Muc dich 4.1. Muc dich
Ctiu song benh nhan khoi cac bien chting toan than ca trtfdc v& sau phiu thuat. Phiu thuat thay khdp nhan tao la phtfdng phap tot nh&'t de dieu tri gay co xtfdng dui den muon, dac biet la khi da co cac bien chting: tieu chom, khdp gia, va thoai hoa khdp.
4.2. Cac phtfdng phap
4.2.1. Dieu trj bao ton
• C hi dinh
- Vdi ngtfdi con tre khoe, co kha nang mang dtfdc bot - Vdi loai PI, hoac gay cai
- Loai gay co - mau chuyen (nen co)
• C ac phitcfng p h a p
- Phtfdng phap v§n dong sdm Lucas - Cham pioniere: Cho thuoc giam dau, dtfng benh nhan ngoi day sdm de tranh cac bien chtfng toan than. Phtfdng phap nay thtfdng ap dung cho nhtfng BN qua gia yeu, khong the chiu dtfng dtfdc cuoc p h iu thu&t, nh&m ctfu song BN la chinh.
- Bo bot W hitm an
- K6o lien tuc: ngay nay it dung
- Xuyen mot chum kim vko cd xtfdng dui dtfdi man huynh quang tang sang
4.2.2. Dieu trj phau thuat
• C hi d in h
- Cac loai gay cd xtfdng dui di lech - Co bien chtfng 6 cd xtfdng dui
• C ac p h itd n g p h a p
- Thay chom - khdp (hinh 22.9)
+ Ngtfdi gia > 60 tuoi, gay sat chom, tieu chom, khdp gia + Gay cd xtfdng dui co thoai hoa khdp: thay toan bo khdp + Gay cd xtfdng dui tdi muon (sau 3 tuan)
Cac loai chom Moore, Charnley, Muller...
- Nep vit co ep DHS. Tot nhat de dieu tri gay nen co (hinh 22.10) - Dinh nep mot khoi: Clou - Plaque, Lam - Plaque
- Bat 2-3 vit xop
- Ngoai ra con co cac phtfdng phap khac:
+ Mo ghep xtfdng co cuong mach khi bi khdp gia cd xtfdng dui d ngtfdi tre + Due xtfdng dtfdi mau chuyen de thay doi vi tri ti nen khi bi can lech cd
xtfdng dui (guc cd dtfdi 100 do).
G A Y THAN XUONG DUI
1. DAI CUONG
Gay than xtfdng dui (GTXD) gap d moi liia tuoi, tu! sd sinh den ngtfdi 16n. Dac biet nhieu nhat d tuoi trtfdng thanh: 20-40 tuoi. (adsbygoogle = window.adsbygoogle || []).push({});
Xtfdng dui la mot xtfdng to khoe, lai co cd bao boc chung quanh, nen thtfdng phai co mot ltfc tac dong manh m6i be gay dtfdc, GTXD gap nhieu trong tai nan giao thong, tai nan lao dong.
Vi tri gay than xtfdng dui: 5cm dtfdi mau chuyen 16n va tren loi cau xtfdng dui 5cm.
GTXD de gay soc: do dau, do mat mau (500m l-1000m l) nen phai hoi stfc tot va bat dong khi van chuyen.
2. GIAI PHAU BENH LY
2.1. Than xtfdng dui: khong phai la mot xtfdng thang ma hdi cong vao trong, do do nep vit A.O bat vao than xtfdng phai bat d phia loi. nep vit A.O bat vao than xtfdng phai bat d phia loi.
2.2. Ong tuy xtfdng dui: thu hep d phia 1/3 gitfa than xtfdng, rong d 2 dau xtfdng do do khi gay d 1/3 gitfa than xtfdng dong dinh noi tuy tot, gay 1/3 tren, 1/3 dtfdi, dong do khi gay d 1/3 gitfa than xtfdng dong dinh noi tuy tot, gay 1/3 tren, 1/3 dtfdi, dong dinh se bi long, d day vai tro co" dinh cua nep vit A. O tot hdn.
Muon co hinh ong tuy to bang that (tren cac phim chup th&ng, chup nghieng) de chon dinh noi tuy thich hdp, can de bong X quang cach xa dui 1,2-1,5m.
2.3. Khi gay 1/3 dtfdi: cac bo mach than kinh d vung khoeo hoac vung ong Hunter co the bi tdn thtfdng (hinh 23.1). co the bi tdn thtfdng (hinh 23.1).
2.4. Dtfdng gay
2.4.1. Dlfdng gay ngang: neu cac dUdng nay n h in nhu tien rrn'a thi de nan nhUng
cu n g de lech thU phat. N eu dudng gay can g rang cUa thanh bac thi khc> nan nhUng khi da ch ap du n g rang, bac thi l't nguy cd di lech thU phat trong bot.
2.4.2. Duting gay cheo vat hay cheo xoan: de di lech thU phat khi n in giu trong bot.
2.4.3. Gay CO them manh phu: hinh can h budm h oac gay thanh 2 tan g h oac co cac
m anh vun deu dUdc xep vao loai gay k h on g viing, k h o nan ch in h va giii b a n g bot.
2.5. Vj tri gay va cd che di lech
2.5.1. Gay O vj tri 1/3 tren: Vdi khoi cd m on g k h oe k eo ven h doan tru n g tam ra
ngoai va ra trUdc, khoi cd khep keo m anh doan ngoai vi va o tron g gay nen gap goc nhieu. Rat kho chinh doan tru n g tam , chi co kha n an g ch in h doan n goai vi theo hUdng cua doan tru n g tam .
2.5.2. Gay 6 vi tri 1/3 giOa
0 doan trung tam bi keo venh ra ngoai con cd khep lai vao trong. Khoi cd dui d day khoe cho nen co keo nhieu lam cho di lech gay n g ln chi rat d&m (co khi ng&n 5 -10cm). M uon n in chinh tot d day can gay me va gian cd that tot.
2.5.3. Gay O vj tri 1/3 duoi
Di lech: D oan dudi bi keo guc ra sau do tac don g cua cac cd sinh doi co nguy cd ton thUdng bo m ach than kinh d vu n g khoeo. M u on nan ch in h tot can de gap nhe khdp goi.
2.6. Gay xtfdng dui d tre em
- 6 tre em xUdng dui con d a n g do phat trien ldn th eo ch ie u dai va chieu n ga n g nen co the tu dieu ch in h dUdc. it de lai di chUng vdi cac trUdng hdp n g ln 1- 2cm va gap goc lOo. Tuy nhien xUdng tre em k h on g tu ch in h dUdc di lech x o ln van theo true.
— Gay xUdng dui tre em cd the bon g sun ket hdp gay nen ch a n dai. ngan ve sau nay (hinh 23.2).
3. PHAN LOAI: theo W inquist (1984) GTXD chia 4 loai:
3.1. Gay ddn gian: gay doi ngang, gay cheo3.2. Gay co manh rdi nho: dtfdi 50% dtfdng kinh 3.2. Gay co manh rdi nho: dtfdi 50% dtfdng kinh
3.3. Gay nhieu tang hoac gay cd manh rdi ldn tren 50% dtfdng kinh3.4. Gay nhieu manh, cac dau gay di lech xa nhau 3.4. Gay nhieu manh, cac dau gay di lech xa nhau
4. LAM SANG
4.1. Trieu chumg lam sang
Trong tai nan, nan nhan cd the cam nhan thay tieng gay rac d dui, tiep dd la trieu chtfng dau dtf doi. (adsbygoogle = window.adsbygoogle || []).push({});
Cd nang van dong dui, cang chan giam hoac mat hoan toan
Nan nhan den kham co the thay: toan than cd bieu hien soc chan thtfdng: mat nhdt nhat, va mo hoi, mach nhanh, huyet ap ha (soc do dau + mat mau).
Kham thtfc the: dui stfng to nhanh, chi ng&n, gap goc, co the cam nhan dtfdc cho go cua d lu xtfdng gay d nhiing ca stfng to vuta, dau goi xoay ngoai, canh ngoai
ban chan do sat mat gitfdng, cac trieu chtfng bam tim d vung thap va tran dich khdp goi xuat hien muon. Cac dau hieu cii dong bat thtfdng va lao xao xtfdng khdng nen tim vi se rat dau cho nan nhan, lam tram trong them trieu chtfng soc chan thtfdng.
4.2. Chup X quang (hinh 23.3): sau khi co dinh tam thdi va chong soc (neu cd)
chuyen nan nhan di chup X quang: chup 2 ttf the chinh: thang va nghieng, nhd chup xa de co hinh giong nhtf that cua ong tuy.
Hinh 23.3. X quang gay than xirong dui 5. D IEU TRj
5.1. C ap ctiu ban d lu