·~.~.~!..~2~g.}~~~ .3. N~ti viem gan hoac mang hoat dich anh huang d~~~~~d6~gkh&p;Ap· _ ..dung thea t6n thuong khop tirong irng

~~!!~l! l!'!l!g ~(lf!Jlf!f!tf:!i~~~~Chua ~~~ huong Y~l!~2~g~~~~h<!p . 6 - 102. Anh huang van dong cua khop: Ap dung thea tam hoat dong cua tungkhop

55

}~ 1d ~~l!g~~~hoat ~i~h~~~!l~3.1. K~t qua t6t3.2. K~t qua chua t6t, hoac bi tai phat 11 - 15

. -l- I

6 - 10

XXVIII. Viem sun (k€ ca sun chem): Ap dung thea t6n thuong khoptuong irngXXIX D] dang, di t(it c9t sang gay gil, vfO, lriln 16 - 20

~: !!Lt~tJ~f~l!'.~I!f!l!g!.JfJlt!P .1. Di dang, di t~t h~ CO'Xirong Khop neu tuong tu nhu cac t6n thuong h~CO'Xuong Khop dfl duoc neu trong Chuong mlY thi ap dl,mg ty l~% TTCT

~~~~~~~h~?,~g~':!.?:~g~':!.<!~g~~~~~~E~~gg~~<!l!g .?~!?!~51~g'.~j!~!h~.g<!~~<!~g~~-<!P~~~~ ...........--?~)~~~~~gg~YE~i19~~~~~~~~~g2.2. Gay r6i lo~n ch(rc nang: Ap d\lng ty l~ % TTCT M\IC2.1 va cQng v&i

....ty}~~ IIgIE~i l~~~~~~~l!~~g ~h~~..p~~~gp~~p ~2~g!~iT~~~g !ll· .2.3. Di€u tri can thi~p k~t qua t6t: Tinh b~ng ty l~ % TTCT do phuO'ng

p~~p ~~l!!hi~p~? g~YE~4. Di€u tri can thi~p k~t qua khong t6t: Ty l~ % TTCT duQ'c tinh b~ng ty l~% TTCT M\lc 2.3 va cQng thea phuO'ng phap cQng t~i Thong tu v6i ty l~ %TTCT di ch(rng ch(rc nang

~!. E~!~t!~,!q'l!g~l!t~4tiqg4)!~'!f!'l!g~f!~!lJi.....!...~....Q.~Y..~_ll:<!l!g...~.~l!h!~Y................!~!Q~Y9.~~!E~~~~<!~g~~~h!~y(!_tJ:~~gi~iph~~ ~~'<!l~l!)1.1.1. Va, tieu chom d~u xuO'ng canh tay d~n d~n h~u qua han kh6p vai

hg~~l~l!gU~~g(~~l,lEP~il!l?<-9~~I~g;.,:~~~ig~)1.1.2. Can li€n t6t, nhung co teo cO'va h~n ch~ dQng tac kh6'p vai mLI'CdQ

vua1.1.3. Can li€n xitu, teo cO'Delta, dai vai va canh tay, h~n ch~ dQng tackh6'p vai nhi€u

.....l.:?: g~y!h~~~~<!l!g~~l!ht~yl!l2! ~~l~ .1.2.1. Can li€n t6t, tr\lc th~ng, khong ng~n chi, canh tay CLfdQng tuO'ng d6i

binh thuOng

0-5

41 - 45

21 - 25

31 - 35

11 - 15

21 - 25

1.2.3. Can lien xfru, true lech, ngan chi, teo co do giam van dong, ngan 26 - 30diroi 3 em1.2.4.c~~ii~~~~~:t~~~i~~h:~~i~~hi:t~~~;d~~iil~ ;~~ d6~~,~gi~t~3 31 - 35cm tro len

}:?:?:g~~~~~,~~i~~~g~y<?~~~g~~~~ 36 - 401.3. Gfry d~u dU'aixuong canh tay mot beni.3.1.G~; t~€~i6i ~~~h~i~g~ygifr~h~ii6i ~~~,h~~~h{~~~,d~8ikh6p 21 - 25khuyu nhe

2.1.1. Khong lien xuong hoac mfrt do~n xuang t~o th~mhkh6'p gia hai

.....~l!S!~g,.I~~~p...g~~...<?~.~t.....2.1.2. Kh6ng li~n xuang ho~c mfrt do~n xuang t~o thanh kh6'p gia hai

.....~.l!.S!~.g,~.cjp g.~.~l.?g.g.

.....?:}.:}:g~~}~.~.~~§~~~¥<?..~.~.~~.g,<?~~<?~.~~.g..<?~~g~~yg~~~~l! ~.i.~~..!~.l!.~.~g .?:! :4:X:U'S!~gl}~~~~~,!~¥<?!~<?~,<?~i~g~~<?~i~g~~~U'cji}<?l~2.l.5. Xuang li~n xfru, trvc l~ch, chi ng~n tren 3cm, anh huang d€n chilc

~~~g~~E~~g~~<?~~gt~XY~Y~~~9~g ~~~~cjE~? t~y2.1.6. B6n d~u xuang gay dinh nhau, can xfru, mfrt sfrp ngua cimg tay, teoca kern thea

?:?: Q~y ~~~~U'q~~~~~i~l!S!~gq~~X~El,l~~~<??!~y?:?}: !i~~~~~~~~<?~~~g~~qE~? ~~yi!Y~Y~~Q~?/?~9~g !~~~? !~y)?:? :?: !i~~~~~~~~~~~~g~~qp <??!~XE1~~~~(tE~~3. ~911g~~<?<??!~X)?:?: Q~y t~~~ ~l!(?'~gq~~y2.3.l. Can li~n t6t, trvc th~ng, kh6ng ng~n chi, chuc nang c~ng tay tuangd6i binh thucmg1·····················································_ "c _ _ _ _ _ _ _...................................................................................................................................j _ _ .

2.3.2. Can li~n xfru, trvc l~ch ho~c chi bi ng~n tr~t kh6p quay - tn,l va h~n ch~

c~~<?nang s~p - ngua2.3.3. Kh6ng li~n xuang ho~c m~t do~n xuang t~o thanh kh6'p gin xuang

q~~y,~~qEg~~<?~~! .2.3.4. Kh6ng li~n xuang ho~c mfrt do~n xuang t~o thanh khap gia xuang

q~~y,~~qEg~~}?~g

56

1.3.2. Gfry nhir l.3.1 nhung can lien xfru, di lech dfrn d~n hau qua cirng,

~~~~qE ~l!Y.~:Iy.}~~ ITgI~U'9:<?y~~~~l!!?~ !~U'?:~g~~qE~~l!Y~.......!..:?.:.?.: M~~.<?~~~.5l:~!~i ~.~.l!.~.?:~!~~~~.,..khong ~~.~~l!~~g..~~.~~qp .......! :.4:M~t.~.<?~£l~U'<!~g~..~~.~!~y~.~(?.t.~~~~.~.~.~.g}.~......!:.4:.!: !S.~qpgi.~<?b.~!......!:4:?:.!S.~~:Pg.~..~ ~..~..~.g _......?:Q~y~U'?:~g~~~g..t.~y .?:}: Q~y~~~~U'?:~g~~~gt.~y

3 - 5

31 - 3541 - 45

26 - 30

31 - 35

6 - 1026 - 3031 - 35

31 - 35

11 - 1521 - 25

6 - 10

21 - 25

11 - 15

21 - 25

2.4. G~y d<1utren xuong quay co di chirng lam tro ngai g~p - du6i khop

.....~~.~.~.y.l:I.Y~..~..~.~~~.~~.~P.,~g~.~~.~.~g..t.~X,l~~.~.!~~(?~.~..<? ~<! .?:?: Q~X~~~~l!q~~l!~~gg~~y (~i~~R<?l:I~~~~=g(?II~~)?:?:!: ~~!q~~~~~~~~L~§~,~~~~9:~g}~~<)!?g~~~g}~~ 6 - 10?:?:?:!i~~?~~y'~~~9~g~~!?g~~X'~<?~~X !}.=}52.6. G~y than xuong tru

i·~·j·~~~j~¥~t.~i;i!~~i~~~g,~~~~~~l?g~~~gi~yj~~~g~i~~~~~~:lig2.6.2. Can lien x~u, true lech hoac hai d<1ugily dinh voi xuong quay lam

.....~??A~~~~?!?.~!?g~~p?!?g~.~?~!?g!~y....... . .2.6.3. Khong lien xirong hoac m~t dean xuong tao thanh khop gia, khopgia chat

~: Q~y~'!<!!?g!?g~!?~~y...~:!:Q~x~l!<!!?g1~9!!?g~!?!~y~~~!?g..~~ ....~l!<!!?gY~!?~9~g ... 1 - 24.2. G~y xuO'ng m(>t ngon tay anh huang v~n d(>ng tfnh thea muc d(>hi;ln 1 - 3ch~ v~n d(>ng cua khap tuO'ng ung ti;liChuang ty l~ t6n thuO'ng Co'th6 dob~nh t~t h~ Co' - XuO'ng - Khap5.G~y~~;~~d~i

57

2.6.4. Khong lien xuong hoac m~t doan xuong tao thanh khop gia, khopgia long2.7. G~y mom khuyu xuong tru gay hau qua bien dang khop khuyu, cirng

.....~.~.~p:Ap.~~~?g!~~<?~9.~.!~l!<!~g~~.<?P .?:~:Q~YEqi.morn !~~~??q~~X~<?~?~~~t:l?~~~l~~?x~~~~P?<? !~y......~..:Q~X.~l!?!?g~.~!?!~X .3.1. Gily m(>t,hai xuO'ng ban tay, n~u ban tay khong bi bi~n di;lngva khong

~~~?~~?~~~!?~~g.~~!?!~y= ~g?~ ~~X3.2. Gily tren hai xuO'ng ban tay, ho~c trucmg hqp can xuO'ng x~u, ban tay

!?~~~~~!?g,~!?~~l!<!!?g!?~i~~~~~~~~?!?~l?g~~!?~~X,!?g~!?!~y3.3. M~t dOi;lnXUO'llgnhi~u XUO'llgban tay lam ban tay bi~n d<;mgva gay hi;lnch~ chuc nang nhi~u.

21 - 25

51

6 - 1021 - 25

11 - 15

16 - 20

6 - 10

6 - 10

16 - 20

21 - 25

?:):!: g~!?l~~!?!§!, !E~? !~~~g,!?~l!pg?~!~<???5.1.2. Can li~n x~u, tf\lC l~ch, Co'teo nhi~u, chi ng~n duai 4cm, chuc nang

...~<!p ~~!?g~j~~!??~~.. .?:}:?: g~~ li~l?~~~,!E~?l~?~,~? ~~<?~i~~l ?~i ~g~ll t~~~~?1~5.104. G~y c6 xuO'ng dui, tieu cham5.1:5:Mfitd~~~~~~~ h~~~kh6~~ii~n XUO'llgti;lOthanh khap gia c6 xuO'ng

......~.~.i,~c?pgi~ ~.~~!.5.1.6. M~t dOi;ln xuO'ng ho~c khong li~n xuO'ng ti;lo thanh khap gia c6

..~l!<!~g~~i, l(~~pgi~l~~g}~(? ..

26 - 3031 - 35

41 - 4551

41 - 45

~·i·g~y~§.~~~~g~~i,~~ph~~ih~~tih~;~h~l~;6~;t~?5.3. Glly than xuong dui (y 1/3 gifra hoac duoi da dieu tri 6n dinh~·~·i·g~;ji¥~i~i.,ii¥~i.h~~g;~h~~~h~~~.hibi~hth~~~; .?:?:~:~~!1:1i~!1:~~~'.!E¥~!~~??:.?:.?:~~!1:?':~.~.'.!~¥.~!.~~~'~~}!1:g~!1:~.l!<!.i~E!!l .5.3.4. Can xau, true lech, chi ngan tren 4 em5.4. G~;d~~d~6i~~~~~·d~i~~~~~tibi~~~h~~~t6~th~~~~161a~~di .clnrng han ch~ van dong khop g6i: Ap dung ty l~ % TTCT t6n thuong

khop g6i................................................................................................................................._

6.3.1. Glly than xuO'ng chay (y b~t k~ do~n nao, can t6t, tr\lc th~ng, kh6ng 15ng~n chi

58

?: Q~y ~l!?:!1:g~~!1:g;~~~??:1:Q~y hai ~l!?:!1:g;~~!1:g~~~!1:?!: 1: ~~~ li~~t§!, !EY~~~A~g,}~~<?~g;~g;~~chi6.1.2. Can xuong x~u, hoac can dinh hai xuong, cang chan bi VyO va nganduoi 2 em

?: !:?: Q~~~~!1:g;~~l!MY~?: !:~ nhung chi ~g;~~!,!~~!!l~~~~l!<!.i?~1!l?:! :~:pi ~~~~g~~l!MY~?:!:~ !1:~l!!1:g~~i~g;~~!,!?~1?1!E~'l~~?:~:Q~y g~y ~?~!~?~~~~}~l!<!~g~~~x,l!l~~~~g!~~~hl<.h<!Pgi~?:~:!: ~~<!Pgi~~~i~l!?:~g~~~~, ~~i~g~~ ~l!<!.i?~1!l?:~:~:~~<!.pgi~~~i ~l!?:~g;l.~~g;~~~~~g~!1:!E~!1:?~lP

2126 - 3031 - 3541

16 - 2021 - 25

26 - 3031 - 35

31 - 3541 - 45

du6i 2 cm6.3.2. Glly than xuO'ng chay a b~t k~ do~n nao, can x~u, trl)c l~ch, chi ng~n 21

tu 2cm d~n < 5cm•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• M .......................... H H....... . ·..·H·.•. ··.······..·······

6.3.4. Glly than xuO'ng chay a b~t k~ do~n nao, can x~u, tr\lc l~ch, chi ng~ntu 5 cm tra len

...................................................................... M·..•••••••••••••

?:}:?:Q~y!~~~~l!?:~g~~~y~~U~~~?l!~g,!~~~ ~l!<!!1:g~~~l~!?~y~!l<!.~.... 21 - 25~:~:g~xg;~X !!l~!~~~~~l!<!!1:g~~~X!~S'!~~!1:~~~<!.pg~~~:~:!:~~<!.pg~~~~~~

.?:?:Q~y~S'~~yq!!l~!!l~~~y?:?:}: pi¥~~ELp~¥~h?i t§!~l<.h<!Pg§~l~~<?~g~~~g 156.5.2. Di chung cung kh6p g6i ho~c hEm kh6p thea M\lc t6n thuO'ng kh6pg61

....?:?: g~y~~~~ yq}?i.~~!~l!<!.~lP~l!l~~.~X.. 9?:7: Q~y!~~~ ~~~~g!!l~~ IP9~~~~~

•••••••••••·M..·M•••••••••••

6.3.3. Glly than xuO'ng chay (y b~t k~ do~n nao, can x~u, tr\lc l~ch, chi ng~n

.....~.:.?:}:!=.?l!?:~.gg~.y~ ~/?.gi.~.~~(?~~..!E~~.'.~.~.~~.i..~.~ !§t .

21 - 25

26 - 30

21 - 2531 - 35

35

.........................................1.. J5

59

6.7.2. G~y d<1utren xuang mac, can xau 76.7.3.G~;ki~~D~~~;t;~~(d~~d~&i~~~~g~~~~),~~~~§~,h~~~h{~h~· 6 - 10khop c6 chan6.7.4. G~y ki€u Dupuytren (d<1uduoi xuong mac), can xau, c6 chan bi 11 - 15

cirng khapp~x....................................................... om.

.....?:Q~y~~<:r~g~<?~y.~m~.l!.~.g~~y~}_ _ _ _ _m •

7.1. G~y xuang do~ _ _ _

8.2. Gay m9t ho~c hai xuang SUC)'ll, can x~u ho~c t6n thuang ba d~n nam 6 - 9xuang SUC)'ll can t6t

...?:...~...:..~...:....g.~~....u~~....~.~~.~.....~.~.~.g...~}?~~~g .....7·~_:?:g~~U~~~~~? g~,~t!~gy~iy~ ~~~anh ~l!~~g~~~ g~~~,y~~..?:?: g~Y~~<:r~g~~y~~f!19~_~~11....?:.?:~:Q~Y,y.~h..<?~?~? ~§}~~.~.>'.~.~~ than ~.l!<:r~.g.?:?:?:Q~XY!!?: ~g~t.1:~~g~~g7.2.3. G~y va phan 6 khop vai dan thuan, cham xuong canh tay khong bi

~?~~~~<:r~g~~~~g~~ lai ~~l!ql!~~~~!.~~~~ Y~L7.2.4. Va 6 khop kern t6n thuong cham gay hau qua cirng, han khop vai:AI? ~y~g ~y._!~~ ITgr. ~<?~~~l!<:r~g~~c!py~i.....?.:.....Q~Y~~<:r~g~~~t.1:.....?:~:I?~!.~~<:r~gf!19~~<?~~~~i ~l!~g ~l!~~' (?~t.1:!~~)

8.3. Gay ba d~n nam xuO'ng suo'n, can x~u ho~c t6n thuO'ng sau xuangSUC)'ll tra len, can t6t

?:~:g~x~~l!~l!<:r~g~l!<?:~tE~l~~, ~~~~~l!8.5. M~t ~?'<;l~~<?~~~~~~~ 1!l9!.~?~~~~}~l!<:r~g~l!<?:~...8.?: M~!~?'<;l~ ~<?~?E~~~~ ~~~~~~~l!l~l!<:r~g~l!~~?:7: M~!.~?'<;l~~<?~~~~~~~ ~~~~l!<:r~g~l!~~~E~l~~8.8. T6n thuang xuang SUC)'ll gay r6i lo~n thong khi ty l~ % TTCT duQ'cc9ng vai ty l~ % TTCT r6i lo~n thong khi tuang (rng thea phuO'ng phapc9ng t~i Thong tu.

11 - 15

6 - 1016 - 20

6-911 - 1516 - 20

3 - 5

II-15

16 - 2011 - 1516 - 2021 - 25

60

Churrng 8

TYL~PHANTRAMT6NTHUONGCaTHEDO B~NH H~ MIEN DJCH

Benh he Mi~n dich.. . Ty I~%TTCT

!'l'/!f! ~!t'!l!t!gtfl!.~~l!gt{4p~~I!g,!!~~,!tfi~Jl(qt!41!!~'!L) ~Q':I.~l~~~~yp~}(q':l~~~~ ~~~~~))~): §§~p~~~y~~~~~g~~}~i~i ~~ll:~g1.2. S6c phan v~ c6 t6n thuong co quan dich d€ lai di chirng: Ap dung ty~~~rIgr ~~~~~~~~I!?:~g~?:q':l~~~9p~~~!I!?:~gll:l]g1.3. Benh Atopi (may day atopi, cham atopi, hen atopi, chung s5t mila~~~pi,~:~):Ap ~l,l~g~y'l.~~ rIgr~~~~?~thuongco q':l~1]!l!q~gll:l2g.....?~.g':l.~l~~I]~yp~~..~(q':I..~~~I] g~y.~9~~.~~..~~.) .?:): !?~I]~~~I!~~~~i~':l~}~12}~~~~~g2.2. Benh da c6 bieu hien Him sang, dang a giai doan dieu tri duy tri,

21 - 25cung c6 ...Ghi chu: Khi benh dd co t6n thuong cac co quan, be)phdn khac, tY l¢ %TTCT duac xac dinh bang ty l¢ % TTCT cua Muc 2.2 cong voi ty l¢ %TTCT cua t6n thuO'ng cO' quan, be)ph(m do theo phuO'ng phap ce)ng t(Ji

IT hon ""'g h r............................................................................................................................................................................................................................................................................................................................................1 .

?~Q':l~l~~~~yp~~!~(q':l~1~~12~~I~l2g~9I]gp~lJ.:~~S!PEl~}~12~j~~).....?~}~!?~.~.~~.~I!~~.~~.i~':l~~.~I2l.~l~~~l2g .3.2. B~nh da c6 bi€u hi~n lam sang, dang a giai do~n di~u tri duy tri,cung c6Ghi chu: Khi b¢nh da co t6n thuong cac co' quan, be)ph(m khac, tY l¢ %TTCT dU(Jcxac djnh bling tY l¢ % TTCT cua M~c 3.2 ce)ng vO'i tY l¢ %TTCT cua t6n thuO'ng cO' quan, be)phljn do thea phuO'ng phap ce)ng t(JiThong tu

~~Qt}~~~~ ~yp~Ty(q':l~J~~121~':l912).~~}~!?~~~~~l!~~~~i~':I.~i~~l~l~~~l2g.4.2. B~nh da c6 bi€u hi~n lam sang, dang a giai do~n di~u tri duy tri,cung c6Ghi chu: Khi b¢nh da co t6n thuO'ng cac cO' quan, be)phljn khac, tY l¢ %TTCT dU(Jcxac dinh bling tY l¢ % TTCT cua M~c 1.4.2 ce)ng val tY l¢ %TTCT cua t6n thuO'ng cO' quan, be)phljn do theo phuong phap cc;5ngt(JiThong tu

I!·T~'!..~!t~~l!..l!gtfl!.~!z.!.~'!..I!~l!g'!!!.~'!tfi~..!t(~'!..Jl..g!.~,!!'!..?/~~?~!i~!tL...!.~§':l.ygi~I~..l~i~I2~.t~~.!!.~l2g.!.i!Y!A!Q§.

o

6 - 10

6 - 10

21 - 25

6 - 10

21 - 25

61

I.:I.:~~~~gh~~~:!gy'~~qgg~~~h;__Tgp~~_~~?gQ!~~~g/~!!~?:J~~I.:?:~~!~g~}~~!l:!iI.y'~~q~g!~~~;T_gp~~!~}?g~~g~~~!?gQ!~~~g/~LI.}: ~~~~g~~~lP:~!y. ~~<!~gtinh; Tgp~f !~_?9.g~~~~~~i}?g ~~~~?/~}1.4. Xet nghiern: HIV dirong tinh; TCD4+ duoi 200 t~ bao/ul..................................................................................................................................................................................................................................................................................................................................., .

}:?:~~~~g~}~lP:~!y'~~q~g !~~~;Tgp~~~~~i l.9.g!~~~g/~!* Ghi chit: Niu co biin chung a co quan b9 phdn new thi ducc cong voitY l¢ % TTCT cia tim thuong co' quan bo phdn do thea phuong phap congtai Thong tu

31 - 3541 - 4551 - 5561 - 6571 - 75

?: ~~Xg}~l:~l!li~~~i~~lienquan 9~1!q~~t.Eil!~l~(? ~~~2.1. Ngiroi cao tu6i tro len (Nam 2': 60 tuoi, Ntr 2': 55 tuoi) bi suy giarnmien dich duoc danh gia tren xet nghiem mien dich, chua c6 bi~u hientren lam sang2.2. N~u c6 t6n thuong tren lam sang: Ap dung ty l~% TTCT Muc 2.1 vacong veri ty l~ % TTCT t6n thuong cua co quan, bQphan tuong ling thea

E~.~?:~.g..P~~P~2~g~~i..I~.~.~g!~ .?:~~ygi~I.~I.!l}~~<:!I~h!!~~q~~~~~~~~~~~~~}y~~!f~~Suy giam mi~n djch dUQ'cxac djnh do mQt b~nh 1y ac tfnh: ty l~ % TTCTduQ'ctfnh b~ng ty l~% TTCT t6n thuO'ng cua cO'quan, bQph~n d6 t~i cacChuang ty l~ t6n thuO'ng Co'th~ do b~nh, t~t tuO'ng ling (khong tinh d~n

~~~~~~~Iyy~~!l~~_Y~~<!q~~~!~(?l!l~~)4. Suy giam mi~n dich do qua trinh di~u tri cac b~nh ly di ling va til mi~n

.....(~~yg~~lp~~}.~.~<:!I~h~.~.~.p_h.~i~(?~~.~.~..~~j.).4.1. Suy giam mi~n djch miic phai do di~u tri, chua c6 bi~u hi~n tren lamsang4.2. C6 bi~u hi~n tren lam sang: Ap dl,lng ty l~ % TTCT t~i M~lC2.4.1 vacQng veri ty l~ % TTCT t6n thuO'ng cua Co'quan, bQph~n tuO'ng ling theaphuang phap cQng t~i Thong tu

....!.!.!.· !}_'!_!.!!1:!~f!:'!g c!_f!..c;.~.c;~.~~!!!..!it.lf_fI!_~~fl_ .

......!:g_~~'.l~~..~.i.~.~~.~.~.~..l.~I.!l~.~.~g.2. C6 bi~u hi~n t6n thuO'ng tren lam sang, dang a giai do~n di~u tri 6nd!nhGhi chit: Khi b¢nh co di chung tim thuang giai ph6u, ch{rc nang cO'quan,b9 ph(tn khilc: Ap dl/-ng tY l¢ % TTCT tc;tiMl/-c3.2 c9ng tY l¢ % TTCT cuat6n thU'O'ngcO' quan, b9 ph()n tuO'ng ung theo phuO'ng philp c9ng tc;tiThong tuIV. TOn thu'ong h~ miln dich d(mg han hfJp (r6i loc;tnmiln dich tang, giamh6n h9P): CQng tY l~% TTCT t6n thuang Co'th~ t~i cac ml,lCtuong ling theaphuang phap cQngt~i Thong tu

11 - 15

11 - 15

11 - 1521 - 25

62

Chuong 9TY L~ PHAN TRAM TON THUONG CO THE DO B~NH MAu

B~nh Mau va co' quan tao mau Ty l~%TTCT

I. Tlti~umdu

l. Mire dQ 1 (nhe)......... .............. ................................-........

11 - 152. Mire dQ2 (vua) 26 - 30

.......................................................................... --...._ ...........

1.3. Muc dQ3 (nang) 41 - 454. Mire dQ4 (rdt nang) 61 - 65

...........................................................................................................,................................··..·....··....··..f ..·..·........·..........··..············,.........··......................,..................................................................................................,........................................".................................

Ghi chu: Benh thieu mdu neu co bien chung thi tY I¢ % TTCT duoc congvoi tV Ie % TTCT bdn chime thea ohuone phdp can)! tai Than)! tuII. Cdc bfnh tang sinh tang sinh tuong man, de unhi: B~cl1da h6~g c~~ ~gliy€~ph~t (P~iycytha~i;;ia~era):-T~ng ii€li c~~nguyen phat (Primary thrombocythemia), XO' my nguyen phat(Myelofibrosis), Loxemi kinh dong bach du hatl.l. Chua bien chirng

l.l.l. Chua c6 chi dinh di~u tri 21 - 25

1.1.2. C6 chi dinh l€Utri 61 - 65l.2. C6 bien chirng :titc mach, chay mau, soi than, gut, loet dC;lday hanhta trang ... ): Ty l~ % TTCT Muc l.l. cong ty 1~%TTCT bi~n chung cuacac cO'quan, bQphan lien quan thea phuong phap cong tai Thong tu

.... .......~............. ......................~••••.•........2. LO'xemi kinh dong lympho (phan lOC;ligiai dean thea Rai - Sawitsky)

2.1. Giai dOC;lnkhong (0), mQt va hai.•••.•................. ,.................................................................................... " ..................................... '1...,.......................................... ,...................

- 252.1.1. Chua c6 chi dinh dieu tri 212.1.2: C6 chid!cl1 di€liire· ................... ..•.•......_ ............ ....._ ..........

41 - 452.2. Giai dOC;ln3 61 - 652.3. Giai do~n 4 71 - 75

* Ghi chu: B¢nh tang sinh lympho m(;tnac tinh co bi~} chimg thi apd7,mgtY I¢ % TTcr cac giai aoqn va c<5ngvai tY l¢ % TrCr bdn chirngcua cac cO' quan, b<5ph(tn lien quan thea phuO'ng phap c<5ngtqi Thong tu

III. La' - xe - mi cOpl. Di€u tri dC;ltlui b~nh hoan toan 61

2. Di€u tri kh6ng d~t lui b~nh hoan toan ho~c tai phat 71 - 75............__ ................

3. Kh6ng dap ung di€u tri 91

IV. U /ymplto ac tinlt (U Iympho Hodgkin va U lympho khong Hodgkin)

....................._ ................. ...........~.........

63

1. Giai dean 1

2. Giai doan II

3. Giai doan III4. Giai doan IV (IVA hoac IVB)

Ghi chu: Benh U lympha ac tinh gay bien chung tai co quan/bo phdnkhac thi ap dung ty l¢ % TTCT giai doan tuong ung cua benh va congvoi ty l¢ % TrCT bien chung thea phuong phap cong tai Thong tu

61 - 65

71 - 75

81 - 8591

V. Nhom cac b~nh gay giam s6 lutmg viLIho(ic hinh thai, chtec nang Iibaa nuiu . ................................•••••••~ .

l.Giam hong cau: Ty l~% TTCT duoc tinh nlnr tY l~% TTCT cua rmrc dQthieu mau (M\lc 1)

2. Giam bach c~u

2.1. Mire dQ 1 (nhe)

2.2. Muc dQ2 (vim)

2.3. Muc dQ3 (nang)

2.4. Mire dQ4 (dt nang)

3. Giam tieu cau

3.1. Muc dQ 1 (nhe)

3.2. Mire dQ2 (vim)

3.3. Mire dQ3 (nang)

3.4. Mire dQ4 (r~t nang)4. HQi clnrng r6i loan sinh tuy, Tuy giam sinh; HQi chung th\l'c baa T€baa mau; Tan mau4.1. Giam mQt dong t~ baa mau: Ap d\lng ty l~% TTCT cac M\lc 1; 2; 3tuang ung4.2. Giam tu hai dong tra len: Ap d\lng ty l~% TTCT M\lc 4.1 cQng v6'ity l~% TTCT giam cac dong thea phuang phap cQng tc;tiThong tu khactuang ung* Ghi chu: Nhom cac b¢nh gay giam s6 lU'(mgva ho(jc hinh thai, chu'cnang td baa mau ndu co biin chung t(li ca quan, b(jph(m khac thi apd?/ng tY l¢ % TTCT thea mt'rca(j b¢nh va c(jng vai tY l¢ % TTCT cua biinchung thea phuang phap c(jng t(li Thong tu.

J;,/~!!_~'!_~ t!C! ~~~~J!~l!:{)'f!g ......1. Giai dac;tn1

1.1. Di€u tri k~t qua t6t1.2. Di~u tri k~t qua khong t6t

11 - 1521 - 25

31 - 35

51 - 55

11 - 15

21 - 25

31 - 35................~............... .. .

41 - 45

41

61 - 65

64

2. Giai doan 2

2.1. Ui~u tri kct qua t6t

2.2. Ui~u tri k~t qua khong t6t3. Giai dean 3

3.1. Ui~u tri k~t qua t6t

3.2. Ui~u tri khong ket qua

VII Benh thiiu yiu ta dong mdu1. Benh Hemophilia (A: thieu yeu t6 VIII; B: thieu yeu t6 IX), benh VonWillebrand (benh chay mau di truyen do thieu hut y~u t6 VIllc va yeu t6Willlebrand)

1.1. Mire de>1: nong de>y~u t6 dong mau tir 5 d~n 30%

61 - 65

71 - 75

71 - 7591

21

1.2. Mire de>2: nong de>y~u t6 dong mau nr 1 d~n 5%

1.3. Mire de>3: nong de>y~u t6 dong mau < 1%

2. Benh thieu y~u t6 dong rnau khac

2.1. Mire de>1: nong de>y~u t6 dong mau 5 d~n 30%2.2. Mire de>2: nong de>y~u t6 dong mau 1 den 5%

2.3. Mire de>3: nong de>y~u t6 dong mau < 1%

* Ghi chu:- Truong hop thieu yeu t6 dong mau nhung co khang dong luu hanh

can kit hop thuoc uc chi miln djch, yiu t6 VIla ... thi tY l¢ % TTCT dU(Jcc9ng them 10% thea phuang phap c9ng tc;liThong tu- Cac b¢nh ly thiiu yiu t6 dong mau gay biin chung t6n thuO'ng cO'

quan b9 phljn khac (xudt huyit, huyit kh6i ...) thi ap dl,mg tY l¢ %TTCT b¢nh ly thidu yiu t6 dong mau va c9ng v6'i tY l¢ % TTCT biinch(mg thea phuO'ng phap c9ng tc;ziThong tu.

26 - 3031 - 35

21 - 25

26 - 30

31 - 35

* Ghi chu: Niu dong mau riIi rac trang long mQch co bidn chl,{:ng6' cO'quan, b9 phljn khac (xudt huyit, huyit kh6i, suy gan, suy thljn, ...) thic9ng v6'i tY l¢ % TTCT cua biin chung thea phuO'ng phap c9ng tQi ThongtuIX. T6n thu'O'ngh(lch ngo(li bien khong do cac b~n!t mau velco' quemt(lo mau (viem /t(lc/t, lao /t(lc/t ...) gay t6n t/tu'o'ngCO'quan tan c~n: Apd\1ng ty 1~% TTCT t6n thuong cua co quan d6

31 - 35

65

Chuo'ng 10TV L~ PHAN TRAM TON THUONG CO THE

DO B~NH, T~T DA vA MD DUal DA

B~nh, t~t Da va mf dutri da

!:r£~'!_~i!~'l!?~gc{l!~ 1ft!.t!LC:_!~,!flJf.~fl_!~Jt~~i!,,!gt!_~f!:EJt~~C:_'!_~!~g~!~~l!~~!t4'!! '!!J!. . .~:I?~ !~,:!~~g~~~g~~!!~~y~?~~~l!~~~~~~<?~~E~r~g~!l~~~!~1.1.Vung mat, c6

1 - 2.........................._ _ .

3-45 - 9

}:?: y~l!lg 1':!1'1g:1'1g¥~~~l,11'1g~:~:~:Q~~!l!i~h!?!l!h':!~g.~':!?~Q~?<y?~~~!l!~~~~~!~~}:~:?: Qi~!ltich !?!l!~':!~1'1g!~g,?~~~l!.~':1:~·i}~~i~!l!}~~~g'!~~~:?:?:g~~!l!i~~!?~ !~,:!~g ~ ~~? ~~~~y?~~~!l!i~~~~!~~}:~:~: Qi~!l.!~~h!?!l!h':!~g!~?~o. ~~!l~~ ~~~!l1.i.~h~~!~~....~..:.?:..?: Q~~!l.!~.~h!?!l.1.~':!.~.g!~ ?.~ ~~!l}7~ ~i~!l!f~h.~?:1.~.~.1.2.6. Di~ntich t6n thuong til 18%d~n27% di~ntich ca th~l.2.7. Di~n tich t6n thuong til 28% d~n36% di~ntich cath~1.3.Chi tren ho~c chi du6i mQtben

~:?:~:gi~1'1ti~~ ~,:!?~g,?~~i~~1.i.~~~g!~~}}:?: P'i~~ !i.~h!?1'1!~,:!~~g!~Q~?~ ~~1'1~~~~}~o~i~~1.i~h~~ !~~}..:}..:?.:p.~.~1'1..!i~~!?~ !~':!~g !~ I~ ~~1'1~~~.~.~1'1!.i~~~~.1.h.~ .}}:~: P'i~1'1!i~~!<?!l!~~~~g!~ ?~o~~~?~o~~~~!i~~.~~!~~ .} :?:?:gi~~ !i~~!?1'1!~,:!~g!~ ?~ ~~!l}?~?~i~1'1!i~~~~ !~~.....?:.I<?!l!h.~.~g~~ ~~~g~5?~gy~y.(~.~h<?~.~!!!.q),~¥.~1'1':!?~,~.~~~y.U~h.~.!l..hg~ .2.1. Vung m~t, c6

5 - 9............................_•••.•..•......

11 - 15

}.:.!:..!..:..Q~~.~y~h~~.~iQ~?~~~.~.~..1.i.~~~.?:!.~.~ .!:}:?:p~~1'1!i~~1.~g,?~O~~!l~,:!?i}~ ~}~~1.i~h~~!~~I:}:}: pi~1'1tich !<?!l1.h~~!lgt~} ~ ~~1'1~~?i 1,?~o~i~1'1tich ~()'!~~}:..!:.~.:.Pi~!l...!~~~...!<?!l.!h':!?:!l.g!~}~.?~o...~~!l?~o..~i~!l...!i.~.~....~.~...t~~.........}:~:?:Pi~1'1!i~~!<?!l!~~?:!lg1.~!~~~}~ ~i~!l!i.~~~?:!~~

?:!:!:gi.~!l !i~~!<?!l1.h~?:!lg~~?ig~?~o~~~~!~~~E~1.~~?:~:~:Qi~1'1!i~~1.<?1'11.h':!?:!lg!~g,?~ ~~!l~l!:<!.i}~ ~i~!l!i~~~()'!h~?:!:?:Pi~1'1 !i~~!<?!l!h~?:1'1g!~~<Yo.~~1'1~~?i 1,?<yo~!~1'1ti~l!.~()'!l?~?:1.:4:PJ~!l!i~~ t9!1.!~~(),!1.g!~),?<y?~~!l}<Yo~~~l'lt.i~~~()'th~.....?:1.:?:P.i.~!l!i~h !.?1'1!~':!()'l'l.g.!~!~.~!1.?<yo~i~!l!r~.~~.~..!~~......... .?:?: y~!lg l':!!lg,~g1f~,~¥!lg .?:?:): p.i.~!l!i~~!?~ 1.~':!~!lg~l!:?ig,?<yo~i~!l.ti~~~()'!~~?:?:?: P'i~1'1.!i~~1.<?l?!~~?:!lg.t~·g,?<yo.~~!l~~<!i}~ ~i~l?ti~~~()'!~~

Tyl~ %TTCT

11- 1516 - 20

1- 23 - 4

16 - 2021 - 2526 - 30

1 - 23-45 - 911 - 1516 - 20

1 - 35-911 - 1516 - 20............._ .

21 - 25..............._ .

1 - 23 - 4

66

?':?'}:Q!~~!i~~t6n thuong til 1% de~~~~}~~~i~~~<!!~~.................._.?':?:~:Q!~t.?_~i~~~?~~~l!~g!~?~~~~~~dien tich co th~..?:?:?:pi~~!i~~!?~~~l!~g!~?~ ~~~}7~o~i~~~i~~~O'th~..?:?~: Qi~~!i~~~?~~~l!~g!~ !~~o~~~?7~o~i~~Y~h~C!!h~?:?:7:Qi~l!!i~~!?!.l~~l!~g!~??~~~~?~% dien tich co th~..2.3.Chi tren hoac chi duoi mot ben

?:?:!: Qi.~!.l_!iE~~?!.l!~'!<!l!g~l!~i.Q'.?~~i.~~!r~h~C!~~~?}:?: Qi.~l!~i~~~?!.l!~l!<!l!g!~Q~.?~~~~~I!~i!~~i~l!!i~~~<!!.~~..?:?}: pi~t.?tich !?!.l!~l!~g ~}~ 9~~~~ ~~~~!iE~~<!~~~?}·~:P~~!.l!i~~t§~!~I!<!~g!~?~o9~~?~odien ~i~~~<!t~~?:}:?: Dien !~~~!.?~!~l!~g t.~?~ ~~l'l!?~o~i~l'l!i~~~5?'t.~~;?:T§~!~I!~g ~~~~!.lg~~Y~~!.lg~.~~(?~~,~~~'.!.l~!.'.~~'.~~~'..~~L.....}:.!...:...y.~!.lg...~P:~!,....~.§.....}:!:!. Qi.~~!i~~~?!.lt.~'!c!!.lg~l!~ig,?~ ~}~~!i~h~C!t.~~?:!:?: Qi.~l'l!i~~!.?~!~'!<!!.lgt.~g'.?~o9~!.l~I!c!i!~ ~i~l'l!i~~~<!!~~;?:! :?:pi~l'l !i~~~?~!~l!<!!.lg!~}~ 9~~~l!c!i_},?~o~i~!.l!i~~~<!!~~?:!:~:Pi~~_!~~~!.?l!!~~<!!.lg_!~},?~o.~~!.l~l!~~?~o.~i~~!~~~?<!!~~?:!:?: Q}~~~r~~!§l'l!~l!C!~g!~?~ ~i~!.l~i~~~<!!~~~E~}~!.l..?:? Y~!.lgil!!.lg,~glf~,?~!.lg.}:?:}: pi~~ y~~~?!.l~~l!~g ~l!c!ig,?~ ~i~l'l!r~~~<!~~~}:?:?:Qi~l'l !i~~~?~!~,!5?'~g~~g'.?~~~~~I!c!i}~o.(ji~l'l!i~l!~<!t~~?:?). Di~ntich t6~_!huO'ngtil 1% den 4 % di~n_tichcO'th~?:?:~:Pi~~!i~~~?~~~l!C!~g!~?~9~!.l ?~o~i~!.l~i~~~<!t~~?:?.?: Qi~~!i~~~?l!~~'!c!!.lg~~?~ 9~!.l}7~ ~}~~!i~~~C!~~~?:?:~:pi~~ !i~~!?!.l!~'!<!!.lg~~}?~~~l'l}~~ ~i.~~!i~~~C!!~~3.3. Chi tren ho~cchi du6i mQtben

}:?:!:Qi~l'l!~~~!?!.l~~,!~g~l!~i.g'.?~~i.~~!~~~~<!~~t..}:?:?: Pi~l'l~.~.~~!?!.l.~~l!<!!.lg!~?..~ 9~~~l!~i._..!..~~i~~!i.~.~~<!..!~~ .?:?:?:P}~!.ly?~!.?!.l.!~'!<!!.lg!~}~9~!.l~~ (j}~l!!.i~~~<!!.~~.}.}:~:pi~l'l !i~~~?~~~l!~g!~ ?~ 9~!.l~~Ai~~~r~~~<!~~~ .3.3.5.Di~ntich t6n thuO'ngtil 9% den 18%di~ntich cO'th~II. Tgn tltuo'ng da d(lI1gXO'ckng da Ito(lc nUt da Itoijc gitin da Itoijc tgntltu'o'ng da gay co keo biin d(l/lg unit Ituifng cltirc nang da, clttrc nang cO'

..q~/c!f!H?~~(l,!c!~~~~ ~!~~~~'!!i..!: Y~l'lg9~~,l!!~!,~?1.1.Vung da d~u

11- 1516 - 2021 - 2526 - 3031 - 35

1 - 35 - 9...................~ .

11- 1516 - 2021 - 25

5 - 911- 1516 - 20

.......•...............••. M··

21 - 2526 - 30

1 - 35-9

16 - 2021 - 25

••••••••••••••••••• M•••••• •• ••• •••

26 - 3031 - 35

5 - 911 - 1516 - 2021 - 2526 - 30

1.1.1.Nhi€u t6n thuO'ng(tl1nam t6n thuO'ngtra len) va ducmgkinh cua m6it6n thuO'ngdu6i 2cm

3 - 5

, ~ ~ .

1.1.2. T6n thuong duong kinh tren Scm hoac nhieu t6n thuong (tir nam t6n 7 - 9

.....!~~q~g ..!~?:}.~?)y~~~q~g~i~.~5~~~~.§i !~~..!~~S!?g!~?~.~~.~.~.?~l!l .1.l.3. Dien tich han mra da dftu hoac mra da dftu dil diroc ph~u thuat tao 26 - 30

~i~~ ~?~iA~~i~~ ~'.l.~,g~y~y~g!~~ kern !~~(?~i chirng dau ~A~ .

67

1.104. Dien tich han mra dien tich da dftu, toe khong moe lai duoc phai mang

!~~g}~~~lP!~~'? ~i ~~~~g~'.l.~~~~}:?: y~~g~'.l.~p~!1.2.1. T6n thuong duong kinh diroi Scm, mat bien dang it co anh huong r5d€n tham my1.2.2. T6n thuong duong kinh tir Scm d~n 10cm, co keo bien dang mat vua,

~~~ ~~?:~gy~~ ~~~!~~!!lJP9. .. .....l.2.3. T6n thuong duong kinh tren 10cm co keo bien dang mat nang, anh

.....~~~~g~~~g....~.~~....!~~~!!ly}:?: I~~!~~q~gy~?g~~1.3.1. H~n ch€ v?n d<)ng c6 muc d<)nhy (kh6ng co keo va bi€n d~ng) h~n

..~~~~g~~~C?~~g~'.l.Y~~ . ....) :.?:.?:B~!?~.~.~Y~~.~2.~g~~lP~~ ..~2Y.~.'.l.~..~~~~t?g~~,q.~.~Y~.~........ . .1.3.3. H~n ch€ v?n d<)ng c6 muc d<)n?ng (T6n thuO'ng gay dinh dim - c6 -

~glf~)~~~~g~~q~~y~~Ghi chu:- Niu co t6n thuong din chuc nang c~lacac cO' quan, bi)ph(ln thi ap dl;lng

tY l¢ % TTCT M1;lc1 va ci)ng vai tY l¢ % TTCT t6n thuO'ng chu'c nang citacac cO' quan, bi)ph(ln theo phuO'ngphap ci)ng tqi Thong tu.- Cac d6i tu(Yng la diJn vien, giao vien, nhan vien dich V1;lgiao ttip, nam

nfr thanh nien chua l(lp gia dinh ci)ng them 5 - 10% thea phuO'ng phap ci)ngtqi Thong tu

2.1. Di~n tich duai 6% ~~~J?tich cO'th~2.2. Di~n tich tu 6% d€n 8%A~~~tich cO'th~2.3. Di~n tich tu 9% d€n 11% di~n tich cO'th~204. Di~n tich tu 12 % d€n 17% di~n tich cO'th~

31 - 35

11 - 15

21 - 25

31 - 35

5 - 9

11 - 1521 - 25

6 - 1011 - 1516 - 2021 - 25

2.5. Di~n tich tu 18% d€n 27% di~n tich cO'th~ 26 - 30

2.6. Di~~!ich ill28% d€n 36% di~~ tich cO'th~2.7. Di~n tich tren 36% di~n tich cO'th~Ghi chu: T6n thuO'ngM1;lc2:

- Niu di¢n tich da bi t6n thuong chiim tit 20 % di¢n tich co' thi tro' lenanh huang di~u tiit ci)ng them 10% thea phtwng phap ci)ng tqi Thong tu.- T6n thuO'ngmdt num vu a nfr giai duai 55 tu6i thi ci)ng vo'i tY l¢ % TTCT

.....t?~.t~~~?!!g'!!:4ty~J!}~?P~t!_(!l}g.P~4.P~9l}gJ5?.!.T~ql}gt~~........... . . .

31 - 3546 - 50

68

}: T~~!hl!~~g~ ~P9!~~~ '?hi!~~~3.1. Vung nach, canh tay: gay anh huang den dong tac cua khop vai: Apdung ty l~ % TTCT theo Chuang ty l~ t6n thuong co th~ do benh t~t h~

..Ih.~~ k..inh,..G~=~l!~~g= ISh?p .3.2. Vung khuyu tay, ding tay: AM huang d~n chirc nang khop khuyu, t6nthuong than kinh: Ap dung Chuang ty l~ t6n thuong co th~ do benh t~t h~

Ih~~ ~i.~~,g~ =Xuong =ISh?p3.3. Vung c6 tay, ban tay, ngon tay: Anh huang clnrc nang ban tay, ngontay: Ap dung ty l~ % TTCT theo Chuang ty l~ t6n thuong co th~ do benh t~t

h~Th~~~~~h,gq= ~l!~~g =ISh?p~:T~~ thirong ~ ~9! ~~~chi duoi . _ .4.1. Vung mong, dui: AM huang d~n chirc nang cua kh6p hang (dang, khep,gftpxoay trang, xoay ngoai, du6i ra sau) va t6n thuang th~n kinh, ca:Ap dVngty l~% TTCT theo Chuang ty l~ t6n thuang ca th~ do b~nh t~t h~ Th~n kinh,

.g~ =~l!q~g =IS~?p4.2. Vung khoeo chan, g5i: Anh huang chfrc nang khap g5i, t6n thuangth~n kinh, ca: Ap dVng tY l~ % TTCT theo Chuang ty l~ t6n thuang ca th~

~g~~~h!~~h~T~~~l~i.~~,g~=~~r.~~g=IS~<?p4.3. Vung c~ng chan: Anh huang v~n d(>ng: Ap dVng Chuang ty l~ t6n

~hl!q~g,?g!~~~(?~~~~~~t~~Th~~l~i~b,g~ =~l!q~g =ISb?p4.4. Vlmg c6 chan - ban chan - ngon chan: Anh huang d~n chuc nang kh&pc6 chan: Ap dvng Chuang ty l~ t6n thuang ca th~ do b~nh t~t h~ Th~n kinh,

gq=~l!~~g=~?P ....5. T6n thuang bong bu5t do nguyen nhan th~n kinh vai t6n thuang th~nkinh tuang ung t~i Chuang ty l~ t6n thuang co' th~ do b~nh, t~t h~ Th~n

1~i.~b'?9~g~b~(?Ehl!q~gph~p ,?9~g~~iIh~~g~l!6. Vung t~ng sinh mon, sinh dvc: Ap dVng Chuang ty l~ t6n thuang ca th~do b~nh, t~t, h~ Ti~t ni~u - Sinh dvc

..!!!·T~I_! ~!l.'!~f!·'!g..!f!¢.~~.f!{lJ ..~(l.:c!C!l.'.~~~.~ c!'!:t!~(JC! .1.: T~~g~l!~~g~i~b '?~'?§19~~~l!?i.l,?'?lP~:T~~g~l!~~g~i~b '?~'?~}(?~~~~1,?,?1!l~~~~l!c?'i?'?~}:T~~g ~l!~~g~~~b'?~'?~}(?~!!~}'?l!l~~~~l!<!i?,?l!l.....~.:T~~g~l!~~g..~i~b'?~'?~!(?.~!!~?'?.l!l~.~1!1.9.'?~!l .. ?: T~~g~l!~~gl~~~b..'?~'?..~ !(?~~!~.~.~..)g '?~!l .Ghi chu: N€u nhiJu logi t6n thuang (trong M1:lc1, 2, 3 neu tren) [)'cimg mr5tvj tri thi ap d1:lngty I? % TTCT c~la logi t6n thuang co tY l? % TTCT caonh6tIV. Cacb~nh da tli [(Ii di chimg iinh hU'ii'ngchuc nang da, tham my va cac CO'

.....q~~~t.'!H~I_!...q'!C!1_!

1 - 23 - 56 - 1016 - 2021 - 25

69

11 - 1516 - 20

l.T6 ala long ban tay, ban chan

..i.1:~i~~ !~L!l~l!!lg!~iP?~! ~l!<!i~}~!l !E<?!lg1~9~nam 11 - 15}:?: ~~~~!~~!l?l!!lg~~iE~~!~~!lg~<?~~tE~!l} l~!ltrongrnot !l~l~ 16 - 20~:}:~~~~!~t~?!lg~~!q~~.... 26 - 30?:_I:3~!l?P~<?!lg . ... . . ..2.1. Dieu tri au li8U da h6a tri lieu, h~t thai gian giam sat nhung can dichirng thi ty l~ % TTCT duoc tinh thea mire aQ di clnrng cua cac co quan,bQphan2.2. Di8u tri au li8u da h6a tri lieu, nhung dang thoi gian giam satNeu c6 di chirng thi 15' l~ % TTCT diroc cong voi 15' l~ % TTCT mire aQ di

.....?~~g~~.'l. ~.~~~'! q~'l.!l,~.9.P~.~!~.~<?..phuongphap ..~9.!lgt.(;liI~.?!lg~: .2.3. Di~u tri au lieu da h6a tri lieu, nhung dang thai gian giarn sat bi bienchimg (can vi khuan va/hoac tai phat, can phan irng phong)N~u c6 di clnrng thi ty l~ % TTCT duoc cong voi ty l~ % TTCT mire aQ di

.....~~~!lg~~.'l.~~~~'!q~'l.!l~..~.9..phan !~.~<?..P~l!'!!lg..P~~P~9!lgt.(;liI~?!lg ~.: .3. Lao da

11 - 15

41 - 45

3.1. Di8u tri k~t qua t6tTy l~% TTCT t6n thuang auQ'ctinh thea di chlrng t6n thuang cua da aMl,lC1ho~cMl)c 2 hoi;tcM\lc 3.N~u c6 di chlrng anh huang a~n cac ca quan, bQph~n khac thi ty l~% TTCTduQ'ccQng vai ty l~% TTCT muc dQdi chUng cua cac co quan, bQph~n thea

....Pb.l!'!!lgP~~P~9.!lg!(;l~I~.?!lg~ .3.2. Di~u tri k~t qua kh6ng t6t (T6n thuang kh6ng kh6i vaJhoi;tccan vi khukvaJhoi;tctai phat)N~u c6 di chUng thi 15' l~ % TTCT duQ'c cQng vai 15' l~ % TTCT mtrc dQ di

.....~.~f~!lg...~.~'l.....~~~...~'!q~'l.!l'.?9....Pb.~!l...!~.~<?..P~l!'!!lg..P?~P..~9!lg~(;l~...I~?!lg ..!l!...........4. B~nh yay n~n

~:~:I~!l !~l!g!lg~!~~~~ ~~~~l!<!~l.gr?Ai~!l !~~~~'!t.~~4.1.:1. ~i8u tri duy tri tai phat duai nam l~n trong mQt nam

.....~.:~:.?:~i.~.~!~j9.~X!E~t..~.iP.~.~.t.t.E~!l~.~.I!I.~!l!E<?!lg!~9t.J!~t.~....... . .4.2. T6n thuang Ian rQng vua tu 10% d~n duai 50% di~n tich ca th~ hoi;tcmang Ian

31 - 35

~:?:~:~i~~ !EL~~Y~E~t.~~p~~!9l!<!~!l~!l!}~!l t~<?!lg1~9t.!l~l~~:~:~:~i~~ !Et~~X!E~!~~Eh~!tE~g~~g)~!l!E<?!lgt.~9!!l~t.!l

16 - 2021 - 25

..~:?:~:Pi~~.t.EL~?!lg~~t.q~~~~!lh9i.~!l~i~!lli~!l!V~ .. ??~}O4.3. T6n thuang Ian rQng b~ng hoi;tc Ian han 50% di~n tich ca th~, yay n~n

!~t~~]?,y~x!l~!l t.?~1~~, !~~~? 9~!<?~!l!b.~!l......... .. . ......... . . . . .4.3.1. Di~u tri duy tri tai phat duai nam l~n trong mQt nam hoi;tc nh6 hon

~<?~~~~!lg~~iyi t~r~~<!p~<?~~Y~Y!l~!l!~~~~ l~~~!E~31 - 35

70

4.3 .2. Di~u tri duy tri tai phat tren nam l~n trong mot nam hoac tren hai vi tri

~qp ~S?~~y~y nen t~~ IP~ ~?~~than ~()~~t~~ ('1(')~~l!C)~~t~~~~:?:}: pi~~!~L~~~~g ~~!q~~1?~~~~i~~1?i~~1i~pW~* Ghi chu: Niu co ton thuong toi cac co quan, bo phdn lien quan thi congvoi tY l¢ % TTCT ton thuong cua cac ca quan lien quan thea phuong phap

.~9f}gt9iT~~f}gfl!:5. Benh da do nam5.1. Cac benh nam nang tuy thea rmrc de) t6n thirong ty 1~% TTCT t6n

~~1!C!~g('11!2~~l?~¥~g ~~1!~¥~ ~~S?~~~¥~ ~ hoac ~1,l~}:5.2. Cac benh nam sau, nam h~ thongTuy thea rmrc dQ t6n thuong da ap dung ty 1~% TTCT tuong irng nhir Muc1,Muc 2, Muc 3. N~u co t6n thuong cac co quan lien quan thi cong voi ty 1~

<y<> TIgT ~~~~~~~~1!C!~g~C!q~~~('1<?t~~()P~1!C!~gl?~~P~2~g t~i I~~~g !1!:6. B~nh B~ch t~ngN~u co di chung t6n thuO'ng anh huang tai cO'quan, bQ ph~n khac thi ty 1~% TTCT duQ'c cQng vai ty 1~% TTCT cua t6n thuO'ng cO'quan, be)ph~n do

t~~S?P~1!<!~gp~~l?~2~g t~}I~~~g !11..7: J?~y~~~g l<?~g1?~~!~Y,1?~~5~~~~.}}: I-?~~l:l!EL~~l1~g!~iE~~!~l1~i1??~}~11!~()~gIp2! ~~I:t~?:~:I-?i~l:l!~J~~l1~g~~ip~~! !~~~1?~}~~!~?~g ~P2t.11~~....?:.?: I-?i.~.l:l!~t~~~~.g ~.~~..ql:l.~1?~.~~~i~~ 1?~~~~.~.~.~~¥.~.8. Cac b~nh da khac

36 - 40

41 - 45

56 - 60

11 - 1516 - 20

·····························_·············f·········· ·1

26 - 30

8.1. D€ l~i di chung t~i da thi ty 1~% TTCT t6n thuO'ng cO'th€ duQ'c Hnh

!~~Ot~~g ~~~ ('12!~~ !~l1<!~g~~~~~ !1!C!~g~l1g (~V~ 1, ~1,l~ ~, ~\l~})8.2. Cac b~nh da d€ l~i di chung t~i da va anh huang tai cac cO'quan lienquan thi ty 1~% TTCT duQ'c Hnh thea tung mfrc dQ t6n thuO'ng cua datuO'ng frng (M\lc 1, M\lc 2, M\lc 3) cQng vai ty 1~% TTCT t6n thuO'ng cuacac cO'quan lien quan (ap d\lng thea cac ChuO'ng ty 1~t6n thuO'ng cO'th€ do

...1?~~~!~! !~'C!~gfl'~g)t~~()p~11C!l1gp~~P...c2~g !~i I~ol1gtl19. Cac b~nh tv mi~n, h~ th6ng (ap dl;tngthea tieu chudn Mlin djch)Niu co t6n thuO'ng da thi tY l¢ % TTCT Ql;rO'Cc(Jng vai Ml;tc 1 ha¢c Ml;lC2ha¢c Ml;tc3 thea phuO'ng phap c(Jng tqi Thong tu

~ !?~~~!~c:An: t'l)!~l!~~ .1. Trung ca th€ thong thucmg

T~t~~~S?IP~~ ~?11t~l1C!l1gt5'~l?~¥l1g}~t.il1~~~11~1,l~ I:}2. Trung ca d~ng s~n do, nang bQc, XO'xung quanh kern thea qua phat 16i,15mTuy thea muc dQ SvO 15' 1~% TTCT t6n thuung ap d\lng M\lc 1.3 va M\lC 2

(~9~g !~~S?P~1!C!l1gp~~p~2I1gt~iT~~~g !1!)...

3. Tnrng ca dang san do, nang boc, xo xung quanh kern thea qua phat l6i,15m. Tuy thea mire d<)seo ty l~% TTCT t6n thuong ap dung Muc 1.4 va Muc

2 (cong thea phirong phap cong tai 1"'h?~g!~) _ _

4.2. Do mat thuong xuyen _ _ _4.2.1. C6 gian mao mach 11 - 15

71

~: !E~~g~~ ~~ !h?~g !h~~~g+:!: ~~l~*t ~?~g t.h~~~g ~l.:1X~~(~<:)~~~~~) 6 - 10

4.2.2. C6 gian mao mach v:.~~~~~~_ _ _ mI.? ~~9 _4.2.3. C6 gian mao mach nhieu, phu cirng, c6 san

!:1.: gh'!~ anh h~<'!!'lg~~!'l~~~~?:q~~!'lI~~!'lq~~!'l1...:..1._:..1...: §§. I'!9'!'lg~'!q~ 1.9 h<:).*~!<?~g9.i~!'l.!~.~h!'l.h~..h?~ 1.g~g{ _ ?_~ 1.9 .): 1.:?: §§.},!9~g~~g hg~~ l~ 1.9 hg~~!6!'lg9.~~!'l!i~h t.~}g~l11~~~~}gq~I:!~1.1.3. Cac u c6 ducmg kinh Ian han 10 cm rai rac kh~p ca th€ ho~c lien k~t

Il..~..,l t~..,o thanh kh6i16'n.................................................................................................................................................................................................................................................................................................................+ .1.2. Anh huang d~n cac ca quan lien quan: Ty l~ % TTCT M\lc 1.1 c<)ngtyl~ % TTCT cua t6n thuang cac ca quan lien quan tuang ung thea phuangEh~p ~9~g!cti !h?!'lg!~* Ghi chit:Niu t6n thuang 6'm(jt thi ty l¢ % ITer c¢ng them 10% thea phuong

P~9PE9'!gJ9~ T~9'3gfl£.2. Cac u ti€n ung thu va ung thu da

N~u kern thea bien dang co quan vung mat, c6 nguc, lien ba, lung gaychirng miii su til thi ty l~ % TTCT diroc cong voi l11UC d<)bien dang co quanthea phuong phap cong tai Thong tu (t6n thuong da ap dung Muc 2)VI. Cdc II da va rno duoi da1. Cac u lanh tinh

?: 1.: g~~!~~~~~gt.h~~~ ~~~~!ELh}~!'l!ct~<?~~i!'lh....... .?:?: g~~ !i~!'ll.:1~g!h~ ~~ ~i~~ t~Lh~~I!tcti l~h?!'lg<?!'l~i~h2.3. Cac ung thu da

21 - 25

16 - 2021 - 25

31 - 35................................ '•••....•...- _ .

36 - 40

~:?:}:~~~~t.~Lh<:)~~~~Eh~~!h~~! hi~El!ct~<?~~i~h:..?.:?:~.:~ ..~ p.h.~~!hl.:1.~!~~!ql.:1~~.~l.:1..hg~.~l~.?~g ~.~..~hi ~i!'lhph~l.:1.t.h~.~.t..2.3.3. Da di din: Tuy t6n thuang ap d\lng ty l~ % TTCT M\lc 2.3.1 ho(lc2.3.2 c<)ngvai ty l~ % TTCT ca quan b<)ph~n bi di din thea phuang phapc<)ngt~i Thong tu

..~!!.C;lj~~~/~!tl!¢Jq~gt~~....1.: ~y~g !~~}~?~g ~X<:)1.: 1.: I~~E¥..!'lg!~!'l!?~1~~~~hg !~~ l~~!'lgy~ !h~~ ~i1.:?: !~~E¥~g !h~!'lh~~l~ (~~~ ~L~th~i ~p~g~,!9'~ t.~~hth~g ~~¥~~~y)1.:?:1.: §§.1'!9..~g~?h?~? ~~I!.l'~~'~'!'lg~r~h 9.~~i ?~I~ .

41 - 4571

16 - 20

6 - 10

72

1.2.2. S6 IUQ'ngbing hoac Ian han 5 dam, dirong kinh bing hoac Ian hanScm

................ * ..

.......~..~?}.~}?~~~~i~~..~~~.~?g~..~.~~~~..!<??..~.?~g ..1~~.9?I51i~~<7~p~.~i~~g ..~<??gi.~ .1.2.4. Rung toe toan b9 (Rung toe va rung long may, long mi, long sinh due,

.....I?~g~~y.:.J§~g~~~~).?: ~¥~g!<?~~<?~X?(~~lp~~~9!~~~~~~~g~~~~~)2.1. Rung toe Ian toa nho han hoac bing 50% dien tich da dfru hoac rung toethanh tung dam duong kinh dtroi Scm toe thua d~ gfry, d6i rnau, soi toe biendang kern thea day sung nang long da dfru kho, xu xi tho rap hoac S{fO xo,teo.2.2. Rung toe Ian toa tren 50% dien tich da d~u hoac rung toe thanh tungdam duong kinh bing hoac Ian han Scm da dfru kho xu xi tho rap hoac xo,teo phai mang toe giaN~u kern thea t6n thirong a vung diu, long sinh due tuy thea mire diroc congthem 10% (Muc 2.1) hoac 15% (Muc 2.2) thea phirong phap cong tai Thongtu* Ghi chu: Niu S?O r1:lngtoc do b¢nh khac gay nen thi ap d1:lngty l¢ %TTCT M1:lC2 va c(5ng vai tY l¢ % TTCT di chung tim thuO'ng cua cac b¢nh

!1£C!rlg..tj:'YgJ~f!~ E..~.1£C!'YgE..~(!P~.9'YgtC}_{I.~?'Yg !1!:............ . . _ .

}: ~~lp}§~gg~y'~~ ~l!<??g~~~!~~~p~py3.1. Di~n tich duai 10% di~n tich cO'th~

.......................................................................... H·..•••••

3.2. Di~n tich tu 10% dSn duai 30% di~n tich cO'th~

11 - 15

26 - 3046 - 50

26 - 30

31 - 35

11 - 1516 - 20

3.3. Di~n tich tu 30% dSn duai 60% di~n tich cO'th~ 21 - 25..................._ ......

3.4. Di~n tich tu 60% dSn duai 90% di~n tich cO'th~

~:?:P'i~~ !i~~ !l! ?Q~ ~i~~ !i~~ ~~ !~~~E<!l~~ (~g~qi ~<?i)* Ghi chu:- Niu t6n thuO'ng a m(it thl'(JCc(5ng them 10% theo phuO'ng phap c(5ng t9i

Thong tU'.- Cac ddi tU'(Jngla diln vien, giao vien, nhan vien djch V1:lgiao tzip, nam nu

thanh nien chua lljp gia dinh... dU9'Cc(5ngthem 5 - 10% theaphuO'ngphap c(5ngt9i Thong tu.- Niu co t6n thuO'ng a cac co' quan, b(5phljn lien quan thi dU(Jcc(5ng vai

tY l¢ % TTCT cua t6n thuang do theo phuong phap c(5ng t9i Thong tu .

......~!!!~}1f~!!.1 y.~'!!.q!!g y.~~.~.~4f ..C!~~·~g.(~[~!1 C!!I.l!'!!9t.C!!:'l)....... . _ .1. T6n thuO'ng mong tay ho~c mong chan cua m9t chi d~ l~i di chung: d6imi'lU,sfrn sui co vin ngang dQc hoac viem quanh mong di~u tr1 khong kSt

q~.~~.~y!.~.~P.~.~!:.1.1. Ttl' m9t d~n ba mong1.2. Tu b6n dSn nam mong

26 - 3031 - 35

1 - 46 - 10

73

2. V~t thuong mong tay hoac mong chan cua mot chi bi bi~n dang mong

..~s>~~~Y~E\l~g2.1. Til' mot d~n ba mong 6 - 102.2. Til' bon d~n nam mong 11 - 15

ix. 9~c:~fl!!~!~)!~~l!)!~1!lJ'!f! ~'!i!~~g~~'!!~4_f~C:1. Benh I~u

........................_.......... . .. _ .

1.1. £)i~u tri ket qua t6t (khoi hoan toan) nhung con di chirngAp dung ty 1~% TTCT thea rmrc dQdi chirng cua cac co quan, bQphan lien

..gl!~~~'!<!~g~~g....1.:~: ¥>i~l!~~tI~~!gl!~~<?~g!~!1.2.1. Con bi~u hien viem nieu dao, viem c6 nr cung, ti~t dich am dao, nieud<;to1.2.2. Co di clnrngAp dung ty I~ % TTCT nhu Muc 1.2.1 va cong voi ty I~ % TTCT di chirng

~~~~9p~~~,~<!gl!~~!,!<!~g~~g!~~s>E~'!<!~gE~~P~2~g~~~Th<?~g~'!~:!?~~~gic:t~g~p~i .2.1. £)i~u tri k~t qua khong t6t co di clnrng* Niu co di chung: C(jng vai tY l¢ % TTCT thea muc t1(j di chung cua cac

.....p.9..ph9'!:, ~C?·q.1!:.q'!:..~'!f!'!:g.!.~'!:gth~.C?.p~.'!f!'!:g.P~qp~.9,!:gJ9iT~9,!:gJ!.~: .2.2. Giang mai b~m sinh*Niu co di chung: C(jng vai tY l¢ % TTCT thea mu'c t1(jdi chUng cua cac b(jP!?9'!:,~f! ql!:q'!:J'!f!'!:gi{'l'}gt~~?P~'!f!'!:gp!1qp~9'!:gfc;ILTJ??'!:gt!.l:.3. Sui mao ga

}: 1.: ¥>i~~!~t.~~!gl!~!~~(~h<?~g~~9i~~f!~gy~/~g~~l~<?~g~~LEh~t}3.2. £)i~u tri k~t qua kh6ng t6t (tai phM va! ho~c t6n thuang Ian rQng)* Niu co di chung: C(jng vai tY l¢ % TTCT di chimg t6n thuO'ng cua cac cO'

..q"'!q'!:,P9..P.~.9'!:P.{q_i~~z!'!:g..t.~.~.C?P~!.~f!'!:g.P~qp..~9'!:g..t9t ..Th?'!:g ..t'!: .4. Oic b~nh lay truy~n qua du6ng tinh d\lc khac: Ap dl,mgty l~ % TTCT t6nthuang cO' th~ do b~nh, t~t h~ Ti~t ni~u - Sinh d\lc, B~nh Suy giam mi~ndich m~c phai ap d\lng thea Chuang ty 1~t6n thuang Co' th~ do b~nh Iy h~Mi~n dichX. Cdc bfnh niem m(lc mifngAp dl,mgChuang ty l~ t6n thuO'ng cO'th~ do b~nh t~t Rang, Ham, M~t

21 - 25

21 - 25

26 - 30

6 - 1021 - 25

Xl. Di dfll1g, di tq.t da va mo dU'ui da1. Di d<;tng,di t<\itDa va m6 du6'i da n~u tuang W nhu cac t6n thuang Da vam6 du6'i da da duqc neu trong Chuang nay thi duqc ap dl,mg ty I~% TTCTcua t6n thuang tuang duang da neu trong ChuO'ng2. Di d<;tng,di t~t da va m6 du6'i da khac2.1. Chua gay t6n thuO'ng chuc nang 0-5

74

2.2. Gay t6n thuong chirc nang: Ty l~% TTCT Muc 2.1 cong ty l~% TTCTr6i loan chirc nang thea phirong phap cong tai Thong nr2.3. Di€u tri can thiep k~t qua t6t: Tinh bang ty l~% TTCT do phuong phapcan thiep d6 gay ra2.4. Dieu tri can thiep k~t qua khong t6t: Ty l~ % TTCT Muc 2.3 cong ty l~% TTCT di chirng chirc nang thea phuong phap cong tai Thong tir

75

Chuong 11TV L:¢ PHAN TRAM TON THUONG CO THE

DO B~NH, T~T CO QUAN THJ GIA.C

Benh, t~t co' quan th] giac Ty l~%TTCT

t. !f!f! ~!.z.t.~l!f}g~!.11£~~!1~t!_,!!:9~'!!_4~~f}!.z.Jll!!q·f}g4._4f}J!.~L!I£E1. Can cir VaGthi hJC, ap dung Bang ty l~% TTCT do giam thi hrc vi t6n

~~'!<:!!1:g~<:!ql:1i:t!1:thi g~~~2. Mil mot mat, n~u chua khoet b6 nhan du 41

.....~: ~~g~~.~?...!1:~~!1:...~_~~,...}.~P....~'!<.!~m!!.1..~~...g.i.~........ 5 14. Da khoet bo mot nhan cau, khong 1~pduoc m~t gia (do bien dang mi, 55can cung dE>,va thanh xuong hoc mat), anh huang tham my

tt. !_q'! ~!.ll!!l!f~g~~'!_~~~~t!_~l!J'!!_4t~~!.~~l!!q·f}gi{4'!~~L!I£E .....1. Can cir VaGthi hJC, ap dung Bang 1)' l~% TTCT do giam thi hrc vi t6n

~~'!<:!!1:g~?q~i:t!1:!~tgi~~ ....~:M9~~~! khoet ~~ !1:~~!1:~~l:1'~P9!!?A! ~P~~~~J!~!1:~!1:g2.1. Mot mat khoet bo nhan c~u (khong l~p duoc mat gia), mot mat matchirc nang2.2. Mot m~t khoet bo nhan c~u (lap duQ'c m~t gia), m<)tm~t m~t chucnang3. M~t chilc nang hai m~t (thi hJc tir sang t6i fun tfnh d~n d~m ngon tay :::;3,Om)

~: M~ !l:1X~!~~~~i:t~~P~~(!~j}lf~ ~~?g !~i ~~P!f!1:~).....?:_IS~<?~!..~? ..~.i:tL!1:~~.!1:~.~~l.~P~'!9.~.~.~.!g~.~ .6. Khoet b6 hai nhan c~u khong l~p duQ'cm~t gia

88 - 89

87

81 - 85

879195

III. Am tliim trung tam1.Am di~m a m<)tben m~t2. Am di~m a ca hai m~t

21 - 2541 - 45

!~§l!~gP1L ....... 1.: §g!1:g!bJ <?' IP9~l'!lA! . 1 1 - 152. Song thi ca hai m~t 21 - 25

~ !!r~!~li§4~gJ4~ ..1.: Pi ~~,!9'!1:g~A~gi~~ ~A~?~il'1~ 11 - 152. R6i lo~n s~c giac m~c phai 16 - 20

~!.T~'! ~!l~l!',!g l!.~~g~~~C:_l!~f}gl!~,!g'!!_~c:~~t.~,!gJ~'!':Can cil vao thi h.rc ap dl)ng Bang ty 1~% TTCT do giam thi hJc vi t6nthuang ca quan thi giac

76

2. T6 clnrc hoa dich kinh: Can cir van thi luc, ap dung Bang ty l~ %TTCT do giam thi lire vi t6n thirong co quan thi giac va cong them 5%d~n 10% thea phuong phap cong tai Thong nr do nguy co anh huangkich thich viem lau dai.

vtu. l:!'t~ '!!t~'! '!!4~c!_l!~4C!,!gll)!~/~'!~~'! .1. Chua m6: Can cir van thi hrc ap dung Bang cy l~% TTCT do giam thi IIJcvi t6n thuong co quan thi giac va cong 10% thea phuong phap cong taiThong ill2. Dil m6: Can cir van thi hrc ap dung Bang ty l~% TTCT do giam thi hrcvi t6n tlnrong co quan thi giac va cong 10% thea phuong phap cong taiThong tu vi melt di~u ti~t sau m6 nhung khong duoc qua 41% mot mat

!Jf.· ~J..l! ..g!4C!'!~..~.~4.l! C!4_C!..'!g~.Y~'! '!!.~~'! .Can cu van thi hJc, ap d\mg Bang ty l~ % TTCT do giam thi h,rc vi t6nthuang cO'quan thi giac va cQng 10% thea phuO'ng phap cQng t(;tiThongtu

Jf l}?'!!~Ji ~!~Ig!4C!J~C!L'!!4~......~:!S~?~g~?~~.~g~~L.~:~~~~g~?~9E~N3. Khong c6 phu thiXl. Mit do b?nh Iy than kinh (mit nao, teo than kinh thj): Ap d\lng M\lC1 hoi;ic2 trong Chuang ty l~ t6n thuO'ng Co'th~ do b~nh, t~t Co'quan thigiac~!!.!!~L~~u.:i!·,!g!!t~~f:.p.(~?~?~~hl!CYEgI"l_~?Y~T}g~h~l!!)1: !hL!~l!qT}g~?T}~<?~T}g}g~~~T}gq~~~~ ~i~l~ ~§ ~i~h

.......~..:.!: I~.i!!1!?·T}g~h~~yp ~ 1?9~..~.~.T}l!!A! .~:~: I~L!~l!qT}g~h~~xP?~ ~~i ~~T} l?~!~: T~i!~l!qT}g??T}~~?~I"l_g}g~~~T}gq~~T}~~i.~t.??§ ~iI"l_~2.1. d mQt ben m~t2.2. d ca hai m~t

21 - 2531 - 35.......... --_ _ .

36 - 40

6 - 1021 - 25

21 - 25................ _ .

61 - 65

2. Ban manh con!~i hJc tr~ng Him2.1. Ban manh g6c 114tren 11 - 152.2. Ban manh g6c 114du6'i 21 - 25I =:.=..: = =:..~..~ :.::.:.:.:..~..=.~.:,:,:::> : : : .....•.. : : : : .• : ........................................•.....•........................................................................••••.••..••...........................•••.....................•.•••..................................•..........•...•..... I .

2.3. Ban manh ngang tren

X!!!~§4/~ '!~C!~~!t(~(?t<?I"l_~~l!(_)'l~g~ gi~(? !}:l(?~t~Lgi~?)1. Ban manh kem thea melt thi h,rc trung tam mQt ben hay ca hai ben: Cancu van thi hJc, ap d\lng Bang ty l~ %TTCT do giam thi h,rcvi t6n thuO'ng

2.4. Ban manh nQanQdu6'i11 - 15

......................_ .

36 - 40

77

~~ <;_~c?TqtJl!(!'!l!~'!t{e'!gc?lI:_'!'!!('!!4tl. SVPmi

11 - 15

.....?:?: !?~.~..~P~~~..~~~g..~.~.~(p.~~~~S>~~~.~~i).2.6. Ban manh khac ben2.6.1. Phi a miii

26 - 30

21 - 252.6.2. Phi a hai thai duong 61 - 65

1.1. 8Q 1: SVP rru che giac mac > 2mm: Can cir thi lire, 1)' l~ % TTCTduoc tinh theo Bang ty l~ % TTCT do giam thi hrc vi t6n thirong co quanthi giac va cong 5% theo phuong phap cong tai Thong tu do anh huangtham my1································,,···················· _ - - 1·········- - .

1.2. 8Q 2: SVPmi che giac mac d~n tren d6ng nr: Can cir thi lire, 1)' l~ %TTCT tinh theo Bang ty l~ % TTCT do giam thi hrc vi t6n thuong co quanthi giac va cong 5% theo phuong phap cong tai Thong ill do anh huangtham my1.3. 8Q 3: SVPmi che giac mac qua bo dong ur phia diroi: Can cir thi 1\IC,1)' l~ % TTCT duoc tinh theo Bang ty l~ % TTCT do giam thi lire vi t6nthuong co quan thi giac va cong 10% theo phuong phap cong tai Thong ill

~ganh ~~~g !~~l?~y. ..2. Ha 1111: Can Cll vao thi l\Ic, Ap dvng Bang ty l~ % TTCT do giam thil\Ic vi t6n thuO'ng cO'quan thi giac va cQng 10% theo phuO'ng phap cQng t~iThong tu do anh huang thfrm my ho~c kho m~t

!~f~r~t{~~'!!.~~~l!~!.~r~C?l! C?f! t{~,!gJ~~l.MQtben m~t 11 - 151···················,·······························_· + _ .2. Ca hai m~t 21 - 25

X~!·Ji'!~lggJ~t'!!1~'!E4'!}: ~~~ggi~t.<!.1P9!~~!?: ~~~gg~~t.~~~~~~p~t.* Ghi chit: Niu gzam thi lllC, c9ng vai tY l¢ % TTCT do giam thi hrctuong ung theo phuong phap cr,5ngtqi Thong tu,

6 - 10...................._ .

XVII. Li¢t m{Jt hay nhiJu day tldm kinh v~n d{Jng nhiln cem (day so III- nhanh v~n dQng nhan cau; so IV; so VI): Ap dVng Chuang ty [~ t6nthuO'ng cO'th~ do b~nh, t~t h~ Thfrn kinhXVIII. ran tlltfO'ng nluinlt 1day them kinlt s8 V (VI): Ap dVng Chuangty l~ t6n thuO'ng Co'th~ do b~nh, t~t h~ Thfrn kinhXIX. Cac di t~t bam sinh, tlwai hoa va 10(lndtdmg (giac mqc, Idt m9c) CanCllvao thi h,rc ap dVng Bang ty l~ % TTCT do giam thi [\Ic vi t6n thuo'ngCo'quan thi giac. N~u co anh huang thfrm my cQng ttf 5% d~n 10% theophuO'ngphap cQng t~i Thong tu nhung khong qua 41% mQtm~t

78

XXIII. B~nlt k~t m{lc va bi! mi man tinlt 1 - 3

1. Kh6i u lanh tinhCan cir VaGthi hrc ap dung Bang ty l~ % TTCT do giarn thi luc vi t6nthuong co quan thi giac va cong them 5% d~n 10% thea phuong phap

.....~.9.~gt..~.~I~.~gg !I!.~g..anh ~1!.0~g..t.~~1~1~9 .2. Kh6i u ac tinh2.l. Chua phftu thuatCan cir vao thi hrc ap dung Bang ty l~ % TTCT do giam thi lire vi t6nthuong co quan thi giac va cong them 5% d~n 10% thea phuong phap cong

t.~iI~~~gt.l!.~g ~~~I!.~g~~~~ ~~t .. .2.2. Ba duoc phftu thuatCan cir VaGthi luc ap dung Bang ty l~ % TTCT do giam thi luc vi t6nthuong co quan thi giac va cong them 5% d~n 10% thea phuong phap cong

t.~iI~~~gt.l!.~g~~I!.~g~~~l~~t . . .2.3. Khong co chi dinh phftu thuatCan cir VaGthi hrc, ap dung Bang ty l~ % TTCT do giam thi luc vi t6nthuong co quan thi giac, t6i da khong qua 61% va cQng thea phuang phapcQngt~i Thong illv6i cac t6n thuang do di din ngoai m~t n~u coXXI. Lac mdt1. Khong co chi dinh m6 ho~c chua m6Can Cll VaGthi Ivc ap d\mg Bang ty l~ % TTCT do giam thi lvc vi t6nthuO'ng cO'quan thi giac va cQng them tu 5% d~n 10% thea phuO'ng phap

..?9~g~~i..I~~.~g!I!. ~g ~.~.~~I!.~~.gt.~At.~..~9:............ .2. Co chi dinh m6Can Cll VaGthi lvc ap d\mg Bang ty l~ % TTCT do giam thi l\fCvi t6nthuO'ng cO'quan thi giac va cQng them tu 5% d~n 10% thea phuO'ng phapcQng t~i Thong tu n~u can anh huang thfrm my

'5:'5:!!. pi ~!lt!~!g~fl!!! '!!4t~9JCan clr VaG thi lvc ap d\mg Bang ty l~ % TTCT t6n thuO'ng cO'th~ dogiam thi lvc vi t6n thuO'ng cO'quan thi giac va cQng them tu 5% d~n 10%thea phuO'ng phap cQng t~i Thong tu do anh huang thfrm my (n~u co).

XX!'G l!fl!!l ...!f ...t!flf!..}: I~? (~~ ~?~??~I!.~p~~~ t.~~~!)2. Ro l~ d~o

6 - 10

2.2. Ba phftu thu~t k~t qua khong t5t ho~c chua phftu thu~t

6 - 1011 - 15

'5:'5:Y: PLl_iJ!l!lhC!L~~t~l!q~c!l!~!lLg!4~1. Di d~ng, di t~t cO'quan thi giac n~u tuO'ng tv nhu cac t6n thuO'ng cO' 0 - 5

q.~.~.~t.~i gi~? ~.~~I!.S!?.~.~~t.E<?~gg~.I!..<?Pg~~)' t.~..~~I!.CZ?~P ~I,l.~.gt.y l.~ !:? .

79

IIgI!?~!~~~~g!':!.~~g~~<!~g~~~~l!trongChirong

~~Pt9~~g,4i!~~~5!ql!~~t~Lgi.~~khac~~1~g~~~g~y~§~thuong ~~~~ nang2.2. Gay t6n thuong chirc nang: Cong voi ty 1~% TTCT r6i loan chirc

~~~gtheo p~~~g P~~P~9~g!'t~I~<?~g~~ . .. .....2.3. Ui~u tri can thiep ket qua t6t: Tinh bang ty 1~% TTCT do phuong

E~~E~~~!~i~p~~g~YE~2.4.Dieu trican thiep ketqua khong t6t: Ty 1~% TTCT Muc 2.3 congvoi ty 1~% TTCT di clnrng chirc nang thea phuong phap cong tai Thongtu

0-5

XXVI. BANG TY L:¢ % TTCT DO GIAM THJ LVC vi TON THUONG COQUAN THJ GIAC

- Giao diem cua 2 true tung - true hoanh la ty 1~% TTCT chung cua hai mit dogiam thi luc (thi lire sau khi dff dircc chinh kinh, cac mire dQ tir giam r~t nhe den mLItuyet d6i).

- Thi lire cua m6i mit ducc bieu di€n tren 1 true (true tung hoac true hoanh) phanra cac dQ 8110 - 1011 0 (binh thm'mg), 711 0 - 611 0 (giam r~t nhy), 5/10, 4/10 ... densang/t6i am tinh.

Thi 10/10 7110 DU'mSang

SilO 4/10 3/10 2/10 1110 1120 T6ill)'c 8/10 6/10 1120

(-)

10/100 8 31 415 11 14 17 21 25

81107/10 355 8 11 14 17 21 25 31 456/10SilO 8 11 14 17 21 25 31 35 41 51

4/10 11 14 17 21 25 31 35 41 45 55

3/10 14 17 21 25 31 35 41 45 51 61

2/10 17 21 25 31 35 41 45 51 55 65

1110 21 25 31 35 41 45 51 55 61 71

1120 25 31 35 41 45 51 55 61 71 81

DU'O'i 61 81 8531 35 41 45 51 55 711120Sang

41 45 51 55 61 65 71 81 85 87T6i (-)

80

Churrng 12

TY L:¢ PHAN TRAM TON THUONG CO THEDO B~NH, T~T RANG - HAM - M~T

B~nh, t~t Rang - Ham - M~t Ty l~%TTCT

I. Rang

1: :E3:~~g~~ ~ t.P9~~~~h,~!19~!1:g~l!lhg~~ 1!19~~h~!1:g~~}2'i~E~I!!1.1. Chua c6 bi€n chung

-----·----·-··----·-·------·-----·---------·---1-------1 - 3

__!_.b_~a c~ bi€~hung t~i ch6 (vielp-n~i~m, sau c6 ding",,_7_..-'.), 1--_6_-_1__° _2. Rang sau nga sau; Mon c6 rang; Mon mat nhai; Thi~u san men rang(chua ho~c ~adi~u t~i_) ... .__... ._. 1 _

_1_~Tu 5 d€n 10 rang_ __ __ __ _ _ _ _ _ 3 -_~__2.2. Tl_!___!_!__§€n20 ral!_g_2.3. Tren 20 rang

6 - 10

3. M~t rang11 - 15

3.1. M~t m6i_ra_I?:gcua, rang nanh (s5 1,2,3) . 1)0 __3 .2. M~t m6i rang h~n nhQ (s5 4-'_2) 1,~l___3.3. M~t m6i rang ham Ian s5 7 1,503.4. M~t m6i rang ham Ian s5 6 23.5. M~t toan b<)rang hai ham 31-------~-~--------------------I--

3.6. M~t toan b<)1 ham ho~c m~t tu 20 rang tra len a ca 2 ham 21 - 253.7. M~t tu 8 d€n 19 rang a ca 2 ham 15 - 18_ _--------- --_ .._._-----_ ----_ _--- -----_._._-_.- ._-_.__.- --_. -----_ .._ •....__ ._---_ ..-

------------- -_._------------ ------- ------_._---- - ---

3.8. M~t duoi 8 rang a ca hai ham thi tinh ty l~% TTCT thea Muc 3.1d€n 3.4* Ghi chu:- Rang viem tuy, hoai tir tuy chua dieu tri hoac co bien chung viem quanhcuong rang gay mdt kha nang nhai; Rang bi gay, va hoan toan than rang;rang lung lay nhiJu (a6 3, a6 4), kh6ng con tac dung nhai, co chi dinlinho thi coi nhu mdt rang: Ap dung tj; I¢% TTCT thea Muc 3- Mdt mot rang thi rang adi xung kh6ng con tac dung niia nen tj; I¢ %TTCT au9'c nhan a6i (ndu kh6ng llip rang gid).- TruiYng h9'P aa llip rang gid thi tinh bjng 50% cua tj; l¢ % TTCT mdtm6i rang.

1.1. Viem lQ'im~n Hnh toan b<)m<)tham ho~c c6 tu 12 rang tra xu5ng bi 3 - 5viem lQ'im~n tinh a ca hai ham 1

1.2._Yi§_m.J_Q'in~~ntinh ~~n _!J<)~(lL~~!-r:!_ho~£c_~_~~_en12_I.angbj_y_~em1_2'1_' 2__:__~ _

_1.Vjem lQ'i . . _

81

~---.,------.-."-,-----,.,-",~.--.-----.",---~-,.".,-,.""'"----,_,---,,--,-----,-

man tinh 6 ca hai ham~-~------.----- - •...._ ...• -._ .....•_----,._-_ ...""."-,_.",",.,_.",,""__.,._-"--- - - _.'-_._.,_,,"",.__ .._------- ,,--~---,.-"-"'-,--,-- ,----

2. Viem quanh rang--" -.~-----. ---. ------------ ---- - - - -------- -" .--~-

2.1. Viem quanh rang thai ky dau toan b(>mot ham hoac co tu 12 rang bi 6 - 10viem quanh rang 6 ca hai ham, tui IQ'isau ::;3mm------- -

2.2. Viem quanh rang thai ky d~u toan b(>hai ham hoac co tren 12 rang bi 11 - 15viem quanh ding 6 ca hai ham, tui IQ'isau ::;3mm

-- ---

2.3. Viem quanh rang nang toan b(>mot ham hoac co tir 12 rang tro 16 - 20xuong bi viern quanh rang nang 6 ca_~Cliham, tui _lQ'i sau ~ 4mm2.4. Viem quanh rang nang toan b(>hai ham hoac co tren 12 rang bi viem 21 - 25quanh rang nang 6 ca hai ham, tui IQ'isau ~ 4mm3. Viem quanh rang co bien clnrng m§.trang:

-~--_-----~--"--

3.l. M§.t duoi 19 rang: Cong ty l~ % TTCT viem quanh rang voi ty l~ %TTCT mat rang (M\-lc 3.1 d~n 3.4 va 3.7) thea phuang phap c(>ng t~iTh6ngtu

--------.----- ..-._-~----- -- "-- --

3.2. M§.t tu 20 rang tro len: ap dung ty l~ % TTCT mat rang Muc 3.5 va3.6III. Bfnh If khop Tluii_dlfO'ng_-:Ham

----- ----"'---

l. Viem khop Thai dirong - Ham man tinh; Thoai hoa khop Thai duong - 16 - 20Ham (mot hoac ca hai ben) hoac tr~t khop ham hay tai phat

---- ~------

2. Viem khap Thai duang - Ham m~n tinh; Thoai hoa khap Thai duang -_H~~~(l_~(>t~o~~~~ hai_Q~) _g~ydinh khap~_!!~n__ch~h~mi~_l)_g_________________--...-.~------.-.--2.l. Tu 1,5 cm d~n 3 cm 21- 25

_--------_ ------,-------_ ..,"'--"-"-"'-"--, _ ._,--,-----"

2.2. Duai 1,5 cm 36 - 40_Iv. Sai jjhop can ~ -- - - - -- _-_- -------~--

_L_Kh_~'Pc~n Io~i I (rang che~ ChLl~IQ_nx(>f!)_____ "_ I - 3- -_-_,,_ ------ -""'-----

__?_~_hap_~~_~~_~g_~~_g______________."...."." 6 - 10.,'._" .. """-.-~-----~-,,'----~--. ---._..~--. "'""-,,-~.-.----.-+-.,---"----~,---,-_._---"---- ..__._-,---

3. Khap c~n Angle III 11 - 154. Khap c~n cheo 6 -105. Khap dn h6 (6 vung rang cua) rang c~n sau 11 - 15

____f. Di t{lt biim_§_j!_t!!_vimg_!lamm(lt._--,.,-"._--" ..---~---,,--..-- -.-~-~--- ---------_._---,_ ..----

1. Khe h6 m6i dan thu~n- "--_-'"'--------~--~---- ----- ._-----------

1.1. Khe h6 m6i kh6ng toan b(>m(>tben 11 - 151.2. Khe h6 m6i kh6ng toan b(>hai ben 16 - 202. Khe ho' m6i toan b6r-----"--"------"---------. "---------------- ----"- "--"-"----""._ ....- --~ ..--.--- ~--- "-_._--_ .._--- _._------" ..,-- ..--~

2.1. Khe h6 m6i toan b(>m(>tben 16 - 20-.~.------ ------_., ..._ .._---,. ---- - - _.._-- ----_ .._--.- - --".----""~~----

2.2. Khe h6 m6i toan b(>hai ben 26 - 30------ ----- --- -- _-~------- --- ---_---- --- ---_. - - - --- -_------ ----~------

3. Khe h6 vom mi~ng dan thu~n-"-

3.1. Khe h6 luai ga 11 - 15------ " ..---...-----~ -----~

).2. Khe h6_Iu:ai g_~_~_~9~l!_!lli~ngl~~~ 26 - 30- -,,-_-- ..,,--- _. --_.__..- _ ---- -- - -- _______ .._1 ..__...... _- "------ ---

82

,------------------------------- ----,----------,

3.3. Khe ha lucriga - yom mieng m~m - yom mi_~n_gctmgtm 19rfu:!_g_~fratru:~:£_ l!__=l1 __4. Khe ha moi k€t hqp_v_qi_khe_~_<!~9!!lm}~ng_____ __ _ _ _4.1. M9t ben 41 - 45I------''----~----------- ------------------------------

4.2. Hai ben 51 - 55---------- ------------------------- - ----------------------- --------------------

2. Da di can 81

5. Khe ha m(tt hi€m (Khe ha cheo m(tt; ~_l_l_~__l_l_S>'ngangm(tt) 41 - 4_L__6. Cac bien dang mat trong qua trinh phat tri~n (Teo mra mat dfin dan; 46 - 50

__Q~_.~_..P_~a_!__~~~rl1(to.__ ----- ----- ---------------------1------- -----------

7. Di t~t bAm sinh vung ham mat da ph§.u thuat khong anh huong den 11 - 15~l_!_uC_E_~_J:)__gp~~L~m,__l_l_()___l_l_~p~_an n_l_l_~}-,~_l_l_ian~ hua_!1g_!h~nn~y _8. Di t~t bAm sinh vung ham mat da ph§.u thuat c6 anh huang d€n chirc 31 - 35_nan_g_p_~atam, __l_l__§__?~P' ~n ~h_~j__yatl:!An:!_mL _9. Di dang lucri (Lucri se doi a dfiu lucri; Dinh lucriVaGsan mieng; Tat lucri tohoac phi d~i lu5i~1_______________ _ _ _ _9.1. Chua anh huang chuc nang lucri (phat am, nu6t, ho h~p_._._J_ ,----6---1-0--,9.2. C6 anh huang chirc nang hroi 21 - 25

VI. Ung tlue vung mitng - ham m{lt1. Chua di can 61

VII. Nang va u tanh tinh vung mieng - ham m{lt:1. U hoac nang chua lam bien dang xuong vung ham mat nhung c6 anhhuang tham my (u mau, u s~c 16... ): Ap dung ty 1~% TTCT t6n thuongcua muc tuong img trong Chuang ty l~ t6n thuO'ng Co' 1h~ do b~nh t~t Dava mo duo-i da - - -- - ~- - -- - --

2. U ho~c nang lam bi€n d~ng xuO'ng ham tren ho~c duai; anh huangthAm my; sai l~chkh6'p c~n, anh ~~a~g__an nhai. ·_:__ I------I

3. U ho~c nang lam bi€n d~ng ca xuO'ng ham tren va duo-i; anh huong

21 - 25

31 - 35

-±_.3. K€t qua khong t6t, can x~u, di l~ch kh6'p c~n4.4. K~t qua khong t6t, can x~u, viem xuO'ng, di l~ch khap c~n, anh 26 - 30huang thAm my ... _____________------- --- -------------1-----1

5. Khuy€t m9t phfin xuO'ng ham tren ho~c m9t ph§n xuO'ng ham duai tu'canh cao_E:_ax~6ng (da_tinh ca ty l~_~ TIg_T _m~t_!ang)__ ___ _ 1

6. Khuy€t m9t phfin xuO'ng ham tren va m9t phdn xuO'ng ham duo-i tucanh cao tra xu6ng (da tinh ca ty 1~% TTCT m~t rang)

31 - 35

6.1. Cung ben 41 - 45

6.2. Khac ben--------------------------- -- -------- ---------- --------51 - 55

83

6.3. M~t toan bQxuong ham tren hoac xirong ham duoi 61* Ghi chit: Trong truong h9P phdu thudt phai ghep xuong, ghep mo, da,co ... ti: than thi tY l¢ % TTCT aU9'Ccong them voi tY l¢ % TTCT cuaphdn xuong, mo ... aa lay theo phuong phap cong tai Thong tuVIII. Cdc b~nlt iffu'O'i (phiii pit au tltu~t)1.M~t mot phan nho dfru hroi, c6 anh huang d€n an, n6i 11 - 152. C~t cut 112d€n 2/3 hroi 31 - 35

_l:_9~t_~vt (mftt) 3/4 luai, ~~_~i!duong gai c_hQ'__Y tr§'_~~(cQ_Qg6c_Iuai) __~ ~L~~ _* Ghi chit: Niu liet luiii do t6n thuong thdn kinn dp dung Chuang ty l¢ t6nthuong Co'thi do benh, tdt h¢ Thdn kinh

!X !_~n tI~_U'o'ng!_!f!!!_~~g__tuy_inn_,!o'cb(J_!_______ __ _ _ __1. Gay_!~t:!_g_!_i~!__Quq_~~9!_______ _ 1---3---- _5 __?.:_Qma gaX kho mi~ng ho!~_!~cJ~g tul'~_Q__!l:l!~C_E_9t__3. Gay hau qua kho mieng

6 - 1021 - 25

X Plz{mmJm, Sf01. Khuyet hong Ian a chung quanh hoc mieng, t6n thuong moi, rna nhung 51 - 55

~hua _<l~q~_p_ll_~':!_thu~tt?O_hinh 1~~__tr_<!_I]_g?i~€n an, u6_~_&_Il_~i__ ____!_: 1. K€t qua sau .Qhllut~u~t !~!znhung c6 an~_huang_ nhi~u d€n thiim my r--_26 - ~1.2. K€t qua sau phllu thu~t chua t6t, con anh huang nhi~u d€n th~m my 31 - 35va chuc nangXI. Viem foet if niem m{l_cmi~ng~ ~I------1

1. N€u la tri~u chung bi~u hi~n t?i mi~ng do cac b~nh, t~t khong thuQcRang Ham Mi;it gay ra ap dvng ty l~ % TTCT theo b~nh, t~t la nguyennhan gay viem loet niem 11!_~~mi~ng_ _ _ __ _ __ _ ~ __2. Viem loet niem m?c mi~ng: ecpet; ap-ta ... hay tai phat, imh hu6'ng 1 - 3nhi~u d€n an u6ng _ _ ~ ~_* Ghi chit: Cac t6n thuang da va phdn mJm khac ap d~ng Chuang tY l¢t6n thuang Co'thi do b¢nh, t(jt Da va mo duai daXII. Dj d{lng, dj t~t Rang Ham M(lt___ ---"------"---_£'----____c'-----'-__ _2_ ----'- -- ------- ---- ---------- -~-

1. Di d?ng di t~t Rang H~llnMi;it tuang tl,r nhu cac t6n thuo'ng Rang HamMi;itda duqc neu trong Chuang nay thi duqc ap dvng ty I~ % TTCT t6nthuang tuang ~~ang__<l_~n~~trong__~hl!_S)'_rlg_ ~ ___ _ ~ _2. Di d?ng di t~t Rang Ham Mi;itkha~___ __~ ~I_____--~---I

_2.1. Chua gay t6n thuang chuc nang 0_-_5_----j2.2. Gay t6n thuang chuc nang: Ap dl,mg ty l~ % TTCT M~lc 2.1 va cQngvai ty I~% TTCT r6i lo?n ch(rc nang theo phuang phap cQng t<;tiThongtu1------- --------------- -- ------ -- - - --- ------ ---- - - --- ---- --- - - ----- -- --- -- ---------------

2.3. Di~u td can thi~p k€t qua t6t: Tinh b~ng ty l~ % TTCT do phuangphap can thi~p d6 gay ra '- ,

84

~-.--~-- ----- -------- -- ...-.----- ..- ..-.---------~-----,------------,

2.4. f)i~u tri can thiep k€t qua khong t6t: Ty l~% TTCT duoc tinh bang tyl~ % TTCT Muc 2.3 va cong voi ty l~% TTCT di chung chuc nang theaphuong phap cong tai Thong tir

85

Chirong 13

TV Lt PHAN TRAM TON THUONG CO THEDO B~NH, T~T TAl - Min - HQNG

Benh, t~t Tai - Mfii - Hong Ty I~0/0

TTCTI, Nghe kemNghe kern hai tai1.1. Nghe kern nhe hai tai

21 - 25................................. _ _ .

1.2. Nghe kern nhe mot tai, trung binh mot tai...................................................................................................................- - - - ..........................................•....................•.....

...!.~.~:~g~~~.~~E~~x..~E9!!~~.,..q~~?~.~.glE9t..t.~i. _ .}~?~~g~~l~~lp!!~?gbinh ~~}!~~}:?~~~M~~~2!(t.~i~~~¥t.t.~i~~~1!~!~}?~ ~~~~?~o)~:?:?~M9:~~2g_(!~~~~hutthinh !¥~t.~~?~ ~~~??~)..~~.?:~g~~~.~~Pt.!~~g.~.~.~~~2!t.~i.,nghe ~~~~~?g ~E2!!~i...... _ .}:7~~g~~~~lp!!~?gbinh lE2!!~i,~g~~l~_~lEE~!~~~g~P9!!~i!:?~~g~~l~~lp~~~gh~itai _ .}~~:!~M~~~2! (!~i~~~¥t.t~i~~!¥~!~ ??~ ~_~~??~o)1:?~?~M~~~2g(!~~~~~V!!~r~~}¥~t.~??~~~~7?~?)!:?:~g~~_~~1!1nangmot !~~,~g~~q~~~~~gl!l2!!~~}: ~g:~g~~~~1!1q~~~~~g~~~!~i} ~Ig~~~M~~~2~(!h}~~hut thinhluc t~ 7?~O~~~??~).!:}g.~..~:M~~~.2Il..(!~i.~.~hut !.~i~~1.lf.~I..9Q~} .~~~gh~ ~~1?1!19t.t.~~...~:.!:~g~.~kern ~.hx .~~~~~g~~~~lEt.!~?g~i.~~..?}~~g~~~~l!1~~~g .....2.4. Nghe kem qua n~ng

6 - 1016 - 2021 - 25.......................... _ .

26 - 30

26 - 3031 - 3536 - 40

41 - 4546 - 5051 - 55

61 - 6571

39

11 - 1516 - 20

!!~l}f~!!~tqJ ,!gf!~!~~!:~i~l!()'~g~?!l:g ~~h~l!?:!l:g~~~~~~~~~~~g~E2t.~<?~~h~i!~i......... 1 - 32. L6i xuang 6ng tai ngoai mQt ho~c hai tai gay thu~n lQ'ihinh thanh nut 6 - 10day tai phat3. L6i xuang 6ng tai ngoai c6 kich thuac Ian anh huang d€n chuc nang

~gh~:Ap~~~g!y l~ ~~~~~~~?gh~~~~!E~X~~~:Qj ~~~gY~~h!~~~~~hl!?:~gt.~~~~?Y~()'~t.h~~~l!l2t.t.~i? :gL~~?gY~!l:ht.~i~~~~l!~g !~~~~EY~()'!l:!h~~~h~i!~i(:)~gj~~~g~xP?~g~~i~g<?~~:Ap~¥?g!y l~~?rrgr ~gh~l~~l?

3 -56 - 10

86

7. Di dang vanh tai va 6ng tai ngoai anh hirong tham my va chirc nangnghe: Ap dung ty I~% TTCT Muc 4 hoac 5 cong ty I~% TTCT nghe kerntheo P~l!<!£lgp~~p~9£lg!<;iir~<?~g~l!....?: PS>.}~~~~~I.g~y~p:~~~y(_).~~~..~g~~~S>!~.~P.~.~~~~~~.<?(1!19~~.(_).~.~.!~D . ? : !.9?:Y}~I.?:~~~£lg~~~~<?~(_)~~yi~~ §~g!~~~g(_)~i.~(_)~~~~~I.!11!19!!~~hay !~ip~~~ 3 - 510. Nitm 6ng tai ngoai hay Uti phat ap dung thea ty I~mitt sire nghe (ty l~tarn thai)

12.2. Hai benN~u co nghe kern thi duoc cong voi ty l~ % TTCT nghe kern thea phuongphap cong tai Thong tu

3 - 56 - 10

11. Cholesteatom 6ng tai ngoai.......~ + j

11.1. MQt ben 11 - 151l.2. Hai ben 21 - 25N~u co nghe kern thi ducc cong voi ty l~ % TTCT nghe kern thea phuong

J?~~P..~9£lg!~ir~<?~g!l! ...!?:y(_)lyp§~g~~i~g(_)~}.12.l. MQt ben

..!!!.l}?'!!z tl!igJi!f!I. Viem mang nhi dan thuan (khong ton thuong cac thanh phan khac cuatai gitra), viem tai gitra man tinh da di~u tfi nQi khoa 6n dinh chua anh

~I!<!.~g~~'!~£l~~g!~i£l~l¥~ ..2. Di chung viem tai gifra thanh dich (tui co keo, x~p nhI, s~o thung mimgnhI sau d~t 6ng thong khi ... ): Tinh thea muc dQ nghe kem; Giai doC;tncu6icua viem tai x~p va tui co keo tinh thea viem tai cholesteatome

6 - 10

3. Viem tai gifra3.1. Viem tai gifra mC;tntinh nguy hi~m co cholesteatome: Ap dVng ty l~ %TTCT thea muc dQ nghe kern cQng v6i 10% (n~u viem mQt tai) ho~c 15%

.....(~.~~y.}~l!1...!:.~.~...!.~D.!~~(_)...P~l!<!~gp~.~P.....~9~.g!<;ii....r~<?~g...tl! ...3.2. Viem tai gifra co bi~n chung tC;ticac cO'quan khac (nhu viem t~c HnhmC;tchben, ap - xe nao, li~t day thfrn kinh s6 VII ... ): Ap dl,lng ty l~% TTCTthea mu'c dQ nghe kern va cQng v6i ty l~ % TTCT bi~n chung thea phuO'ng

P~~P~9~g !~i.}~<?~g!l! .. . t··································t

?: ?\§p~<!!~i: Ap~l,l£lg!Y}~~g~~}~~l!1?:PL!~!~~!!1~i.~~~!~9£lg~~~!~y~£l~~~!~igi~~:AI? ~¥~g!yI~~g~~l~~l!17. U cUQncanh7.l. LoC;tiA - U cUQnnhI 41 - 457.2. T r.,,; B - U canh - nhI 56 - 60

f················L v ".,.H....................................................................................................................................................................................................................................................................................................................................................................t .

7.3. LOC;tiC - U cUQncanh

87

7.3.1. Lo~i C 1 - 27.3.2. Lo~i C 3-4

?:~:!:(?5liQ)~~y~<?!~(?~g~9......~..: 1!y~.~.g..!~.i= ~.'!..<?:~g!~.~.~4'!.<?:~.g.8.1. U lanh tinh: Ap dung ty l~ % TTCT nghe kern va cong voi t6n thuongti~n dinh va t6n thuong than kinh (neu c6) thea phuong phap cong taiThongtu8.2. U ac tinhNiu co t6n thuong ti~n dinh, than kinh thi duac cong voi t6n thuang do

J~~9.p~~'·q,!gp~ilp~9,,!g(qJ !~(j_'!_gtl£8.3. GranulomeNiu co ton thuong ti~n dinh, than kinh thi dirac cong voi t6n thuong do

.....t~~.9...P~1!q'!gp~ilE~.9"!g.(9L..T~9'!_gt.1£ .9. Cac benh v~ tai gifra da ph~u thuat: Ap dung ty l~ % TTCT nghe kern.- Neu c6 cholesteatom mot tai duoc cong 10%, neu cholesteatom hai taiducc cong 15% thea phuong phap cong tai Thong tu.- N€u can thiep ph~u thuat c6 bien clnrng thi duoc cong vai ty l~ % TTCTcua bi€n chung thea phuO'ng phap cQng t~i Thong tu.Luu y: Tnt b¢nh u cu(3n dmh, u than kinh s6 VIII, ung thu tai aCftinh tY l¢% TTCT thea giai aaqn, kh6ng tinh thea hi¢u qua ai~u tr;

61 - 6571 - 7581 - 85

61

41

1. T~t ca cae trucyug hQ'pgay di€e ti€p nh~n: Ap dvng ty l~ % TTCT m~tsuc nghe

f····················~································..........................................................................................................................................................................................................................................................................................................................................+ _ .2. Viem me nhI ho~c b~nh sling nuac me nhI (b~nh Meniere): Ap dl,mg tyl~ % TTCT m~t sue nghe va eQng vai mue dQ r6i lo~n thang bing thea

p~'!.<?:~gl?~~P~9~g~5l~T~?~g!'!.~3. R6i lo~n thang bing (hQi ehung ti~n dinh): Ap d\mg ty l~ % TTCT HQichung ti~n dinh trong Chuang ty l~ t6n thuO'ng cO'th€ do b~nh, t~t h~ Th<1nkinh4. U day th<1nkinh s6 VIII: Ap dVng Chuang ty l~ t6n thUffi1gCo' th€ dob~nh, t~t h~ Th<1nkinhV. Lift day thrm kinh sa VII ngo(li bienAp dvng Chuang ty l~ t6n thuO'ng Co' th€ do b~nh, t~t h~ Th<1nkinh

J~l~!!?I!!t. '!_~~!,~f!c!l!g}: yi~l~ l~~i ~<?:~~~~~~~~'!.~g~~p~~!~(?~~!?<?~iQ?~2. Viem mlii c6 qua phat chua e6 thoai h6a

1 - 3

?:~:g~~~~Pt!~gyq~!~~§.~~g~~5l~~__.... _.... .?:?~!:~P~t.r.~g!~~'.~~l?~~g~~~yqi !h~§.~~<?~:;t~~?:?: ~~p ~'!.~~g!h~, ~?~g~~pl.!~gyqi. !h~9~~(?1~5l~~

6 - 10...............__ ..

11 - 1516 - 20...·.··.H.··.·..·················H .

6.1·M9~ben 16 _206.2. Hai ben 31 _ 35

.7:!?~~~~~g ?1P:~i~? l':l<?g~y ~y? ~YE~?l~g~,~ ~l}'~g toi ~~'!~l?~~g ~~~ 16 _20

?:! :T?l? ~~~?:~g~~<!~g,~~~~~~~gl~~i8.l.1. Mili "yen ngva": S~p 1/3 tren va 1/3 giu'a cua song mili do t6n 11 _ 15~~l}:<!~gE~~~.l(~?l?gy~~~~g~~ ~gi8.1.2. Mili "6ng nhom" do S((Oti;lOthanh o' ria h6 Ie cua milj . 11 _ 158.l.3. Mili "vyt" do huy hO<;tiphan s\ln cua vach ngan va vUng da cua n6 11 _ 15~~l!~g ~l!<!~g~?~g Ipgi y.~~~<'>~8.1.4. Mili "ch6 bulO'd6" do phan tru6'c vach ngan mili va cac S\ln nho a 16 _20mili bi pha huy, toan b9 mili ngoai (canh va dinh mili) 15m sau vao trongh6c mili

88

3. Viern mili co thoai hoa

3.1.: CU6n diroi th<?aihoa, dap ung.k6ll voi thuoc co m~c~ .

}:?: ~l}?~ ~~~i ~~<?~~hoag~i~l}, k~<?~g~~p,!~g y~i thuoc ~? I~~~~~~i~~?~:?~~~lty.~~~~g~~4.1. }-?i hinh vach~g~~

~:!:}:!S~<?~g~~~~~?~g ~~_i~~'!~ ~~~g ~~?, ~g~J~:}:?:A~~~~~~g ~~'!~ ~~~g t~~, gg~i ~~'!~~9Y~'~....~:.!..:}..:...A.~.~~l!?~g....~.~'!~..~.~.~g...~~~,....~.g~i I??~·~.....~9 ..~.~I?g.....~:?:I~~~g y.~~~~g~~5. Benh 19 da a miii: viern tuyen nang long, gian mao mach dau mui. .. : Ap

dung Chtrong~yl~~?~~~~<!~g~<!!~~~<?~~~~ ~~!P~Y~ ~P<?~~~i ~~6. TrYmili(Q:z:en) - viem mili teo

8. gi':l:~gmai mui

8.2. T6n thuO'ng niem m~c, xuO'ng cU6n mili, t6n thuO'ng t6 chuc cuO'ng cua~l}§~~l!?J~E~~~g ~$'l~~ IIgI~~~yi~~ ~~}!~?9. Viem dan xoaWl

9.2. Hai ben11 - 15

10.2. Hai ben

11. Viem mili.l(?':l~g do nfrm

6 - 10

11 - 1516 - 20

1 - 311 - 1516 - 2011 - 15

16 - 2026 - 30

21 - 2531 - 35

11.2. Hai ben

12 Viem xoang c6 bien chung sang cO'quan khac (m~t. .. ) c9ng v6'i ty l~ %fITCT cua bien chUng theo phuang phap c9ng t~i Thong tu.

~{l: Ii!?q! l! y~,!g ,!!.i!_~-:~f?C!!!g .

89

......................................................................................................................................................................................................................................................................................................................................................................................................._ .

1. U lanh tinh

I:!:~<?!yp~miii ~~<:>~!'lg(~I?~ ~l!~!'lg t~i chirc I?~1'lgt~~)1.1.1. M9!ben d<)1,21.1.2. M9t ben d<)31.1.3. Mot ben d<)4

11 - 1516 - 2021 - 25

}:?:?: -y_lI'~: ~ ~~1'lsui, !'lg't! !!lQ.~!~1'lg1~I?'~~ ~~~y !!l~~...... 21 - 25....~:?}:~~1'lg: ~ ~~1'l~~~,~J! t~~ ~P2!~~1'l~P~~'~~~~~YF1'l~~ 31 - 351::3·l!~C!Y?lP Ip~i ~9!'lg(g~X I?g't!, !~~JP~i)1}:}:~~x:!'lg't!!!l~i1'l~xlP2!~~I? 16 - 201.3.2. Vira: ngat rniii tang len, soi rniii th~y u nhan, chiem mot phan phi a sau 21 - 25hoac san rniii

1.3.3. Nang: ngat miii ca hai ben, n6i giong miii kin, kham miii sau thay u 26 - 30che l~p ca hai 16mfii sau1.3.4. R~t nang u XO' phat trien vao cac t6 chirc xung quanh: s~p ham ech, 36 - 40h6 chan birorn ham, 6 mat, nen SQC(Jng vO'i tinh trc;mg thdu rnilu ai kern do xudt huyit theo phuO'ng philp0?'}g~9f T~c?'}gJ1!:1:~:y ~~c!I?g~E~~~<?~I?g1:~:}: Y ~l!c!!1:gl~~~!~~!E<?1'lG;~<:>~I?g~~~~ ~~ ~Ei~~~~fJ'l!g1:~:?:Y ~l!C!l!gl~~~!1~~!E<?1'lg~<:>~I?gg~yI?g't! Ip~i, 1'li~lPIp't~!~¢>i}:~}:y ~l!C!1'lgg~Y~~~I?~'t!'lg ~P~!Y~~~Y~~I?~~~!~~~~~~~J!1:gq~J~I?~I:?: l! 1~!1:~!iI?~IP~~~<:>~I?gl~~~(If '}~qx::)I:?:~:l! !~I?~y~ ~~ !~~~ Ip~i ~~~'~~~ ~l!~1'lg~~I?~~~~ 1'l~!1:g1'lg~i,~~~:::~:?:?:Y}~1'l~til:~ ~~ !~~~<:>~1'lg~~~'~~11~~~:~1'lg~~1'l~~lrc1'lal1g1:?}: l! 1~1'l~!i1'l~~~~ !~~TI1~i~I?~~l!~11g~~1'l~~~J'~1'l~r:lgI1g~i, t~a1.6. Granuloma ham m~t

1.1.4. Hai ben: cong thea phuong phap cong tai Thong tu voi ty l~ %

r!g!tl!C!l1g~1'lgy~i ~2 ~~~E<?lyptP'1'lG;~~1'lI:?: Papilom ~p~i(~I?~ ~l!~!1:G;!<?:(~~~.~I?~I?g!~~,~~ig~p?'lP9t ~~1'l)

16 - 20

II - 1521 - 2536 - 40

6 - 1011 - 1516 - 20

2. U ac tinh51 - 55

2.1. U ac tinh vom mfii hQng2.1.1. Giai do~n 1 51 - 55

61 - 652.1.2. Giai do~n 2

71 - 752.1.3. Giai do~n 3

812.1.4. Giai dO<;ln42.2. U ac tinh mfii xn~ng

51 - 552.2.1. Giai dO<;ln1

61 - 652.2.2. Giai dO<;ln2....................................................1 .

90

71 - 752.2.3. Giai doan 32.2.4. Giai doan 4

..............................

81~~~~.!i4! !l!!l..'!~!~t!'!..gJ4c;,.1. R6i loan khiru giac

6 - 101.1. M('>tben1.2. Hai ben2.M~tkhuugiachoantoan

16 - 20

11 - 152.1. M('>tben2.2. Hai ben* Ghi chu: Cong them tic 5 din 10% d6i voi nhiing nghJ ddc biet sir dungkhtcu giac nhu: scm xudt nutrc hoa, huang lieu, ndu an ... thea phuong phapcong tai Thong tu

21 - 25

ix.!!f,!!l !~!~~!!~l!{l,.,!g t!..~t!..l!J!'c;,.p~~'!..!!1,,!~!1. Phau thuat c6 ket qua t6t khong anh huang den chirc nang va tham my 6 - 10Truong hop truce ph~u thuat, benh chi c6 ty l~ % TTCT :::;10% thi khong~11~)tyl.~...!,? TTgT£1~ll ~(i~Pl1~~...thuat ~~£1l1..khoihoan t<:l~£1..?:Yl1.~.~..t.l1~~t.}~~t...g~~ ~111!(it§t. ~£1l1l1~~Cr£1g~~£1.tl1~l~l~l2.1. Seo vung mat dinh xau: Ap dung ty l~ % TTCT a muc 1 cong voi ty l~

.....!'?TTgT t.9~ !111!'!~g~(i!11..~.?.P.111!'!£1gPl1~P~.9£1gt..~iTl1?£1g~1!.?:?: ~l1~~Pl1~l!!l1l!~t.taohinh g~y ~i~~~~~g ~~!}: ~11~~thuat ~~t g~~ ~111!(lt§t. ~~l1l1l!Cr~g~~£1~11~~~~£1g3.1. B~nh v~n khong khoi: Ap d\lng ty l~ % TTCT b~nh nhu chua ph~uthu~t

21 - 25

3.2. H(,>ichung mUi r6ng (empty nose): do c~t m('>tphiin ho~c giin hoan 26 - 30toan m('>tho~c nhi~u cu6n mUi gay ra anh huang den chuc nang thO',ngui,gay kho mUi ...3.3. Ph~u thu~t mUi - xoang gay di chung a cac ca quan khac th) c('>ngvaity l~ % TTCT di chung cac ca quan d6 thea phuang phap c('>ngtc;tiThongtuX Di c/ucng do bfnh vJ h(Jng,thanh qulin linh /uri)'ng cac chil'c nang phatam, nu6t, thi)'

1: ~11? £1~§!~<:l?~~11Cr119~g~~l1l1l!Cr£1g1.1. Kh6 nu6t nh~ (kh6 nu6t chdt d¢c) 11 - 151.2. Kh6 nu6t ch~t long 26 - 301.3.An qua 6ng thong (sonde) ho~c phai rna thong dc;tday do khong an dugcq~(l~l!~g 119£1g?: g§i}<:l~£1!i~~g ~?} ~<:l~~~11~~(lt.11(i£ll19~~£1~119~g11<:l~~~~~~'! Y1!£1g~92.l. N6i kh6

71 - 75

16 - 20L .

91

26 - 3041 - 4561

3 - 5

?:1:~:ryrt:r~49 y~~(tz!'rzgt~¢l1g)z.I}:ryrt:r~49 !l~!lg(~~()l1gt~ ti¢l1g)~:~: ~~?~g noi 4l!s!~E~~Lgi~<?!i~E~~~g~~l!yi~!, hinh2.3. R6i loan phat am (do benh noi thanh qllan - day thanh)2:3:1.N6ikhi~ti~~~······ .. 11 - 15

2.3.2. G19ng d6i 16 - 20f································ , ••.•.•~ ........................••...........•••••••••.••.•.................................•.••.•..........................•..•.•••••••...........................•..•..•••...•.•••••••.•.•...•...........................................•..•.•.....••................................................•...•........•.•....•.•.....................................+ ..~:}}: ~?i g~9~g ~~} (mui kin- miii ~<'!) 16 - 20

21 - 2541 - 4511 - 15

2.3.4. N6i kh6ng ra tieng2:3:5:M~tti~~~ -~:B9~clnrng !lgl!~g tho 4<:) ~~~ ~gllY~~~~~~ thuoc tai l!l~i hong.~: ~§~}<?~~ho ~~p4<:) nguyennhan <'!thanh quan ..g~Y~~~... ........... . .

~:1: ~~?!~<'!!l~x(~~L:'7~4t~f¢rz~~!~c:qtiJ911gg4rzg~z!'E(ll!~bJ¢t) 21 - 25~:~:~~9tho y~~ (~~?t~q:'7~4t~f¢11~~i~(!ig4rzg~t!c)~}:~~9!~<'!!l~~g (jc_~(? t~q t~1!c!_l1g:'7~X~rz,~¢~9~~frzg~Ll1gC!z)4.4. Phai rna khi quan vinh vi~n (da bao g6m bien chirng)

41 - 4561 - 65

81?Q. !}?:f~!l,t~~Jlel!g1. Viem hong man tinh2. B~nh cua Amidan2.1. Viem amidanl!l~~ tinh2.1.1. Chua c6 chi dinh m6 3 - 52.1.2. C6 chi dinh m6 6 - 102.2. Qua phat mom tram amidan gay trieu clnrng co nang nhu dau nh6i,

~~l!lgi~~Yl!~~g (i!11~411g?~rz~J~1!c!_l1gl2.2.1. M<)tben 3 - 52.2.2. Hai ben 6 - 103. Viem d~c hi~u a h9ng, thanh quan do lao, n~m ty l~ % TTCT ap d\mg

!~~<?l!lt:r~~~~ ~l!<,!~g~~t:r~~~~g ~~Cl~9~g: ~ll?t, !~<'!,p~atAl!l~: pi ~~~!lg !?~ !~l!<?:~g~9~g~!~Cl~~gll~~ 4<:) giCll:gJ!lCli +.................. I

4.1. Chua gay anh huang cac chuc nang nU6t, phat am, tha (SyO vUng h9ng 6 - 10va thanh quan)4.2. Gay anh huang d~n cac chuc nang nU6t, phat am, tha (thung man h~u,SyO rum h9ng va thanh qUEm)tinh thea ty l~ % TTCT tuang u'ng v6"imuc

....~.~.~....~l!<'!!lg....~.~.~.....~~t:r~...~~~g..4? .....?: ~Cl~gY~E<? Y~!lg~? y~ l!l~!5.1. Nang ben c6 11 - 155.2. R6 khe mang 4 11 - 155.3. R6 khe mang 1 16 - 205.4. R6 khe mang 2 16 - 205.5. R6 khe mang 3 21 - 25

92

6. Nang va ro giira mat c6...............................................................................................................................................6.l. R6 re mGi 11 _ 15

?~?~Y 1!~l!ggiap ~~?l!g(I!~l!g §I!g gi~p}l!?:i) 11 - 15?:?~~~ §I!gg~~p}l!?:i thirphat ~~~~ 1!~l!ggi~pI.~?l!g 16 - 206.4. N€u nang va ro gitra mat c6 dff phfru thuat k€t qua t6t ty l~ % TTCTth~.o t6n thuong bQ.ph~n do phfru thuat d?ga:YI!~I!. .6.5. N€u nang va ro giira mat c6 dff phfru thuat c6 bi€n chirng thi cong voi tY l~

~ IIgI cua ~~~I!<?h~g !h~<?p~l!~gp~~p <?91!g!'ti Thongtu

7. U lanh tinh vung hQI!K.....................................................................................................................

7.3.2. Khong khoi, tai phat: Ty l~ % TTCT Mvc 7.3.1 cQng ty l~ % TTCT4i <?hl!l!g<?hl!<?I!~~g!~~<?E~~?:~g P~~P<?9~g !~iI~~~g!l!8. Ung thu Amidan, thanh ben va thanh sau hQng............................................. .8.1. Giai do~m 1 51 - 55

61 - 65

7:~~y}~~~ !il!~ chua ~I!~ ~l!~l'1g <?h~<?~~I!g 6 - 107.2. U lanh tinh anh huang toi chirc nang: Ty l~ % TTCT tinh thea anh~~:~l'1g<?~l!?l'1~l'1g(I!~§!, !~~, <?~~g~~<?:~)?}~Y}~I!~ Yl!~~~~E~~~!~~~!7.3.1. Di€u tri khoi: Ty l~ % TTCT tinh thea t6n thirong do ph~u thuat gaynen

.......................................................................................................................................................................................................................................................................................................................................························1·····································,···········1

8.2. Giai d(?c;tl'128.3. Giai~o~n 3 71 - 75

818.4. Giai do~n 4: CQng v6'i ty l~ % TTCT cac t6n thuO'ng di can t~i cac cO'g~~l'1~~<? y~ !<?~I!!Ec;tl'1g!h~(? P~l!<!I1gp~~p ?9I1g!c;ti I~()l'1g tl!?~YI1g!~l!~~h9I!g9.1. Giai d0c;t!?1 51 - 559.2. Giai do~n 2 61 - 65

71 - 7581

9.3. Giai do~n 3

9.4. Giai do~n 4: CQng v6'i ty l~ % TTCT cac t6n thuO'ng di can t~i cac cO'quan khac va toan tr~ng thea phuang phap cQng t~i Thong tu....?QI: lif.'.'_!l! ~~t..~!~l!'!!.zq'!~'.'_ .}: J?~l'1~!~?~ ~ !~~~~g~~~1~~~yi~l~ 4~Y ~i~!? l?c;t? ~?c;tl?yl?~, ~'t!~<?',pl:)lyp~ l:l I1~~g 4~x!~~l'11?1.2. Li~t ho~c nhuQ'c cO' day thanh mQt ho~c hai ben day thanh (muc dQ li~tnhy, g~n hoan toan va hoan toan): Ap dvng ty l~ % TTCT kh6 thO' va phatam

1·· ..........···..··.. ·······..·······..........

11 - 15

1~?~P.~pil?~??~!~~l'1hg~~l'11.4. B~ch san lay thanh

36 - 40

2. Cac kh6i u lanh tinh svn thanh quan chua anh huang t6'i chuc nang thi?~g!x l~ ~ IIgT!~?:~g!¥ l'1~l!~ ~~~g ~~yl~~i

46 - 506 - 10

}~ ~~g !~':!thanh qt.I.~~3.1. Giai doan l 51-551···········································u.':' ~.,..Il _............................................................. t _ _ .

3.2. Giai~<?~r:t2

93

61 - 653.3 Giai dean 3 71 - 753.4. Giai doan 4: Cong thea phuong phap cong tai Thong tu voi cac t6nthuong di din t~~~ac co qu_ankhac va taall trang _4. Di t~t - di dang thanh quan: Tinh ty l~ % TTCT thea rmrc d<)kh6 tho vaphat am

....?:.....~..~.Il.~....!.~t.y~....~9Ilg ...: ...t.~'.lIl.~....quan...~~<?ggE~.~.i....~.~Il~_..~~....tinh ....~.~..J?~~.~....t~~~t. ..5.1. K~t qua t6t khong anh huang d~n chirc nangRieng truong h9'P u tanh tinh day thanh hodc u tanh tinh vung hong (unang. ..) sau diJu tri phdu thudt benh khoi hoan toan kh6ng tai phat thikhong tinh tYJ¢ % TTCT5.2. K~t qua chua t6t anh huang d~n chirc nang:- Benh chua khoi tinh thea ty l~% TTCT cua benh chua ph~u thuat- Anh huang d~n clnrc nang nao thi tinh thea ty l~% TTCT tuong img

cua chuc nang d6: nu6t, phat am, tha ...- Gay di chung a cac cO'quan khac da bi~n chung sau ph~u thu~t h9ng

thanh quan thi c<)ng v&i ty l~ % TTCT di chung cac cO' quan d6 theaE~,:!<?'.~gp~~p~2gg t.~~Ih<?~g!1!5.3. K~t qua chua t6t anh huang d~n th~m my: Ap dVng ty l~ % TTCT t6nt.~,:!<?'.~g~<?'.!~~~<? ~~~~ t.~t.~'.ly~ 11!<?~l!&i da5.4. K~t qua chua t6t anh huang ca th~m my va chuc nang: C<)ngv&i ty l~% TTCT tuO'ng ung v&i tung muc d<)di chung thea phuO'ng phap c<)ngt~iThongtu

81

6 - 10

BO YTEDQc I~p - Tl}'do - H~nh phiic

CONG HOA xA HOI CHU NGHiA VIET NAM. . .

Bang 3

TY L:¢ PHAN TRAM TON THUONG CO THEDO DI cHirNG ROI LO~ TAMTHAN vA IIANH VI

SAU cHAN TRUONG, vET TRUONG SQ NAO

(Kern thea Thong tus6 22 120191TT-BYTngay 28 thdng 8 ndm 2019cila B9 truiYngB9 Y ti)

Di chirng rBi loan tam thAn va hanh vi san chAn thuong,v~t thuong Sf} nao

I. Sa sut tri tn~ (mAt tri Dementia)

1. Sa slit tri tu~ mire d{>nhe

2. Sa slit tri tu~ mire d{>vira (trung binh)................................................................................................................ OM •••••••••••••••• ... ••••••••••• •••••••••••••••• H •••••••••

3. Sa slit tri tu~ rmrc d{>nang (trdm trong)

21 - 25

41 - 45

61 - 63........................................................................................................................................................................................... H •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• _ ••••••••• __ _ ••_ _ .

81 - 834. Sa slit tri tu~ rmrc d{>r~t nang (hoan toan )

II. RBi loan tam thAn san chAn dQng nao........................................................................._ _ _ __ __ _ _ ..__ _ _._-- - _ __ _.__ ._._ .

1. R6i loan tam than sau ch~n dong nao diSu tri khoi 0................................................- _ _ _ _ _ _-_ _ __ _ _ - . _ __ _ _ _ _---

2. R6i loan tam thAn sau chan dong nao diSu tri 6n dinh 11 - 15

3. R6i loan tam than sau chan d{>ngnao diSu tri khong kSt qua 25 - 30III RBi loan nhan each

1. R6i loan nhan each diSu tri khoi.................................................................................................._ , " , - _ ..

2. R6i loan nhan each diSu tri 6n dinh........_-_ _ _._-_._._ _ _ _ _ _ _-_ - _.- """"" __ ._._ .._ _ __._.._ ".._ _ _ ,,----_.._----

3. R6i loan nhan each diSu tri khong kSt qua

IV. RBi loan cam xiic

o21 - 25

" _ _" -""._ _._ _-,,-,._ _ .._.

41 - 45

1............................................................-_ __ - " "",, "" "."" ""..".." , "", _ _ .

R6i lo~n cam xlic diSu tri khoi....................................................................."""".""., " "...................................................... . " _ ..

2. R6i lo~n cam xuc diSu tri 6n dinh

3. R6i lo~n cam xlic diSu tri khong kSt qua

o21 - 25

41 - 45V. HQi chung Korsakoff

..................._ _ _-_",,---__.__ _ __ _ _ """""-" __ ,,,,- - " __ _._ _._ ..- - _.- _ __ _ _ .

1. H{>ichUng Korsakoff diSu tri khoi 0......... __ _ _ __ _ -_-_ _ ..- _._ _ _ _ - _ _ _ ", __-_ _ .._._ _._ _.__ ._. _._- _ __ .

2. H{>ichUng Korsakoff diSu tri 6n dinh 21 - 25................................................. " _._ - _ _ _ _ ,_ ""-""', " "" ,,,. .. ,.." " " .._ __ ,_.._ ..

3. H{>ichUngKorsakoff diSuhi khong kSt qua 31 - 35

;;.

2

VI. Quen nguoc chi~u

o31 - 3561 - 63

Quen nguqc chien di@utri kh6i . . _1. o21 - 2531 - 35

2. . Q':l§~gg~5!~~h~~':l~i~':l~~L~~~i~3. Quen nguoc chi@udi@utri khong kSt quaVII. Ao ghic

1. Ao giac dieu tri khoi o21 - 2541 - 45

2. A(?g~~~~~~~~~i~~.~i~..3. Ao giac di@utri khong kSt qua

Hoang tuong di@utri kh6i....................... .. _.1.

2.

3. Hoang tuong dieu tri khong kSt qua

!~.. g§i ~~~~~~~~~~1l.~~~n. ... __-'~: ~~~!<?9:~!(?~':l~h\!.~~~~.~~~':l~~L~§i . . . 9 _~: ~~i loanlo ~':l~h¥~~~~~~~':l~~L~!l~.i~ ___ !? ~_~O3. R6i lo~m10au th\l'c t6n di@utri khong kSt qua 31 - 35

X. g§~}~~~p~~~}y!~1l.~!~~ _ .._1. R6~ 10~mphan ly thirc t6~_di@utri ~~~ __ . _ _ 0

R6i_10~mphan ly ~hvc t6n di@utri 6n ~i.~R6i 10~mphan ly thuc t6n di@utri khong kSt qua

2.

3.15 - 20....................................._-

31 - 35A.manh

..................•...•.••••••••••...._ _ _ _ _ _ _._ .XI.

1. Am anh diSu tri khoi o~: A~~~~h~~~':l!~t~g_~j~ _ _ _ !_5=~g __3. Am anh di@utri khong kSt qua 31 - 35

BOYTE CONG HOA xA HOI CHU NGHiA VIET NAM. . .DQc I~p - Tl)' do - H~nh phuc

Bang 4

TYL~PHANTRAMT6NTHUONGCaTHEDO BENH ROI LOAN TAM THAN vA HANH VI. .

do benh, r6i loan tam than va hanh vi sir dung trong giam dinh phap y(Kem thea Thong tus6 2212019/TT-BYTngay 28 thdng S ndm 2019

coo BtJ truang BtJ Y ti)

B~nh rBi loan tam th§n, hanh vi Ty I~ (%)J. Sa s.ut tri tu?_(~4~~':L=!!_e11!_~!.!!_!.a) _ _ _J:..Mfl'~~2_.!1hx....... . __ _ _ __ ~!=_~? .2. Mile dQvira (trung binh) ~~ :1? ._?:Mfl'_~~2.~.~~g.{!~~~!~9!.?:g2____ _ __ __. __. .._.. ~L=S?~.4. Mile dQd.t n~ng (hoan toan) 81 - 85

II.Ch_9:!!!:_/!!!_4.ttri~1!:!lim t1z._4'!_.. _._ __ _}:Mfl'~~9. ~x. _._. _ . _2. Mile dQvira

21 - 2541 - 4561 - 65

4. Mile dQtrAm trong 81 - 85III. B?n~ tiim tha'!_./!!!_~nli~t

2. DiSu tri khong An ~i~............................................................................ . ?.~..=??3. DiSu tri khong kSt qua 61 - 65IV. RBi loan loan thaI! d(lng 0,0 giac _ ._1.Ao gi~.~~~Su~ri~6i . . _ . _ .2. AS>._giae4!~~tri 9.~_dinl?:__ _ .._ .. _~:A(?_g~~~~~~~!~L~<?J:?:g 9.~~i~4. Ao giac diSu tri khong kSt qua

21 - 2531 - 3541 - 45

V. RBi 1l!f1:1!:.!th(~4~JcO,'!!~~l!l.. _ _ ..1.DiSu tri khoi

21 - 253. DiSu tri kh<?~gAndinh.. ._4. DiSu tri khong kSt qua

31 - 3541 - 45

......!.: ~~~~!~i_khoi _2. DiSu tri Andinh

__ ••••••••••• H _ _. __ _ _ ••••••••••••• __ ••_ ••••••••••••••• _ •••••• _ .. 11 - 15

o

o

o

2

~:_~~~~!~L~_~!!_g6~_~_t~.. _ _.... . .4. Di~u tri khong kSt quaVII. Phiin tmg VOl Stress (ding thdng) tram trong va rai loan s(l'thich ung................................................................ _ . . _ _ _ _ _ __ .

21 - 2531 - 35

J:_~~.~.~!~_i_~~~.........................................................................._ _ __ _.._ _.. 9___.2. £>.~~~_!~L§.g~jnh __.3. Di~utri khong 6n dinh 21 - 254. Truong hop ca biet t6n thuong man tinh dang suy giam chirc nangco quan, bQphan ty l~ diroc tinh then rmrc dQsuy giam chirc nang coquan, bQphan do (ty l~ tam thai)

6 - 10

......!:!:?_~~~!~t~_OL . _ _ .__ _ _ 9 __.~:.~~~~!~t.~~~j~h _............._ _____.._3. Di~u tri khong 6n dinh!!~_~~~_r_~~!.~~1l___!!!:~_~!!:_~'!!!:~~___ _ _ _.____ _ _ ___ .}:~~~~!~i.~§L... .. .. ......~..~~.~~~_!~t§.~~j~ __..__ _._3. Di~u tri khong 6n dinh

6 - 1021 - 25

o6 - 10...._ _-_ .._ ..__ ._------21 - 25

X. Rai loan 10auJ: _~~.~~..!!t~9..L _ _._ _. _ _ _ _ . o

11 - 15............................................................................................ H ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• _ H••••••••

21 - 25~:__~~~~_~i~9.gg§.g..~j~_._ _..__ __.._4. Di~utri khong kSt qua 31 - 35

......!~~~~~.!~t~~.~ _ _.............................................................__ ._ _ 9.__.

....~:_~~~~!~i9.~_~i~__ __.___ _.._. . __ _ _.___ 11 - 15

.....~:~~~~.!~t~~~g.9.J?~i~ _ .4. Di~u tri khong kSt qua

21 - 25................................................................... •• ••••••• _ •••••••••••••••••••• M........

....~!!~...!l:~(!.f!_~~.~~~~_hJ. I.:?~.~.~!~i.._kh~~ _ _ _ _ Q _ _2. E?~.~~~ri6~di~~.__. __ . _..__ _..___ ._.._. I~::_~g.....~:~~~~!~L~~~g_9.~.~t~ ...4. Di~u tri khong kSt qua

31 - 35

31 - 35••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• M •••••••••••••••••••••••••••••••••••••••••••••••••••••• M•••••••••

41 - 45XIII. Rai 10{lnnhan eaeh iI~e hi~u d{lngParanoid, d{lngphan li~t,.4~~g~1!~~g_~i!_!!:p.~ _ _ _.____ .___.. ._1. f.?~~~!!i~~!._ .._ __Q._ .......~:~~~~!~_i9.!1~i.J?h _ _ _ _ _ _~1.=.~?3·_~~_~~!~L~§_J?g9.J?~I~... _ . _ _._~:~~_~~!~L~_~~g~~!q~~ . .

41 - 4561 - 65

3

XIV. Cdc rai loan nhiin each due hieu khdc...................................................................................................! ~ " ~ .

41 - 45

1.DiSu tri khoi....................................................................................................................................................................................................................................................................................................................................................~

.?~~.~.~~~~t9.!!~i~................ _ __..__ _ __ _.._

......~~.Di~~ tri khong 6~_~i~ _ . ___ __ .._ _ __}_!- 354. DiSu tri khong kSt qua

21 - 25

XV~~tjE..':_~!Jf!{l~'!:~~'!: ~~c_~.~~.~~ __ __}:~!~~~~i~9i....?: ~!~~~~i 9.9.-di~ _ _........ 21 - 253. DiSu tri kh9ng 6n dinh . . .. .~} - 354. DiSu tri khong kSt qua 41 - 45

o1 - 3......................................................... ~6 - 10

?: ~~~~ ~~t9.1?:_~i9.-~.... _~:-~~~-l:!!~t_~§.P.:g_§.t.?_~i~_ _ _ .__ _4. Di@utri khong kSt quaGhi chu: D6i voi tre em duoi 18 tu6i cho tj; I? tam thai.

11 - 15

XVII. Cdc rai loan d~e hi?u vi phtu triJn 1m noi va ngon ngir, cdc!9!'!:~'!:g__!!e_~.~~P___ .._ . _ __ .___ .__ _ _}:.Mf!~ ~2~~ _ __!6 - 202. Mire do vua 31 - 35

41 - 454. Mire dQr~t nang 51 - 55Ghi chu: D6i voi tre em duoi 18tuoi cho tj; I? tam thai.~y'III. Rai loan Ian t~a sy-phat triJ'!........ .. .. _ _ ._ .1.Mt!~~2~t...... _ .__ ____._ _ _ __ __. L~:?g2. Mire dQvira 41 - 45~: Mire ~2P.:~1?:g . ... .. ..... ......~! =9.?4. Mire dQr~t nang 81 - 85Ghi chu: D6i vai tre em duai 18 tu6i cho tj; I? tqm thai .

. DSu tri kh6i o........................................................................................................................................................................................................................................................................................................................................................................... • M H .

~:~}~~~~t9.9.-_~i~ _ _ _. . _ . _. .. .!=~___~. E>.L@utri khong 6n dinh _ ._ . _ __.__l}:J_?4. DiSu tri khong kSt qua 31 - 35-~~~~~':_~!!.f!'l_'!: g!4~ ..'!:g~ _ _ _ _ __

o.....?:~!~~~~t9.1?:~igh _ _ _ } :? _......~.:~.!.~~~~i~§.!?:.g_9.1?:~i~ .. .._ _ !} :.!..?4. DiSu tri khong kSt qua 21 - 25

o

o

4

?5?S:J~li~! !f!~1}.!.~I}gt!et!_g~~.'!_~t!_!!~(~ !'!_f!f!'!_.!!!!~'!_t!_~~t!_!~Mfr.~~2~x .. 6 - 102. Mire dQ trung binh................................................................................................................................................................. . ))1 - 15}~Mfr.~~2~~~g. 21 - 25