Bai Giang CTHM-New

7/27/2019 Bai Giang CTHM-New

1/22

TRNG I HC Y H NIB MN RNG HM MT

CHN THNG HM MT

MC TIUBI GING

1. Trnh by c cc c im gii phu lin quan n chn thng hm mt.2. Trnh by cch x l ban u cc cp cu trong chn thng hm mt.3. Trnh by cch phn loi v cc bc x l vt thng phn mm vng hm

mt4. Trnh by cc triu chng chnh pht hin gy xng hm5. Chn on v hng x tr gy xng hm trn .6. Chn on v hng x tr gy xng hm di.I. Tng quan

Nhng nm gn y i i vi s bng pht v cc phng tin giao thng lchn thng hm mt tng mnh. Tn thng hm mt rt a dng, phc tp,thm ch dn n t vong. Vic chn on v phc hi chc nng, thm m cho

bnh nhn sau chn thng rt phc tp i hi tn nhiu thi gian v tin bc.

1. Nguyn nhn: c 4 loi- Tai nn giao thng- Tai nn lao ng- Tai nn sinh hot- Tai nn do cc nguyn nhn khc

Trong :- T l tai nn giao thng chim 80% (theo s liu ca vin RHM -H

Ni thng 10/2000)- T l tai nn do lao ng chim 8%- T ltai nn do sinh hot chim 8%- T l tai nn do cc nguyn nhn khc chim 4%

2. Tui-Tui b tai nn a phn l la tui ang di do v sc lao ng. Theo s

liu ca vin RHM-H Ni ( thng 10/2000 ) th la tui hay gp tai nn

t 2039 tui chim 65,15% cc trng hp.3. Gii

- Tai nn nam gii nhiu hn n gii rt nhiu.T l Nam = 5,7

N 14. V tr tn thng

4.1 Xng hm trn


2/22

- Gy t hn xng hm di, t l 4/6- Phi hp vi cc xng khc chim 20%- Gy ngang nhiu hn gy dc. Theo phn loi ca Lefort th Lefort

II v Lefort III chim khong 50%, gy dc gia chim 15%4.2 Xng hm di

- ng gy i qua vng cm, cnh ngang, gc hm chim a s 85%. Cn li l gy vng li cu, cnh cao, mm vt.

Hnh 1: T l % ng gy ca cc vng xng hm di

II. c im gii phu lin quan n chn thng hm mt1. c im v xng hm

1.1. c im xng hm trn-Gii phu

+ Xng hm trn l mt xng chnh tng gia mt. Tip khpvi xng khc cng to thnh mt, h mi, xoang hm, vmming v nn s.

+ Xng hm trn l xng xp, hnh th nh mt hnh tr vung chai mt (trong v ngoi), bn b v bn gc, c bo v xung

quanh bng xng trn, hm di, g m.-c im chn thng+ ng gy : ng gy ngang nhiu hn ng gy dc+ Mu chy nhiu, lin xng nhanh v kh nng chng nhim trng

cao.

+ Gy xng hm trn thng lin quan vi chn thng s no,mt, tai mi hng v cc xng khc nh : cung tip, g m,xng chnh mi.


3/22

+ Xng hm trn gy khi c lc tc ng trc tip vo tng giamt

1.2 c im xng hm di-Gii phu

+ Xng hm di l mt thn xng, cng, mnh, c nhiu ngcong.

+ Xng di ng nh khp thi dng hm hai bn gm : hm cho,sn chm, c li cu, bao khp v dy chng.

+ im yu : cc huyt rng, l cm.

Hnh 2: Xng hm trn v cc xng xung quanh

Xng trn

Xng l Xng thidng

Xng chnhmi

Xngg m

Xng hm trn

Xng hm di

Cnh lnxng bm

Xng nh

Vch lma


4/22

Hnh 3: Xng hm trn bn phi

-c imchn thng+ ng gy thng i qua huyt rng v l cm + Thng c cc ng gy gin tip. V d: khi lc tc ng vo

vng cm gy gy xng vng cm, ngoi ra cn c th gy gchm hoc c li cu.

+ Di lch xng theo chiu c co ko+ Lin xng chm, kh nng chng nhim khun km hn xng

hm trn

Mm ln

C hm

Rnh di mt

L di mt

Mm thp

nanh

L rng sau

rng ca


5/22

Hnh 4: Gii phu xng hm di1.3. Cu trc cc tr v x ca mt:

- Theo Sicher v Weiman, cu trc ca xng hm gm cc tr v x chulc.

+ Tr ng: ca xng hm trn

+ Tr nanh hay tr trn mi: i t h nanh n ngnh ln xng hmtrn.

+ Tr hm trn - g m: i t hm trn g m mm trn.+ Tr chn bm hm: T li c XHT ln xng chn bm.

-X ngang:

+ X xng trn.+ X trn ngoi l xng g m.+ X b dihc mt.+ X cung rng hm trn.+ X cung rng hm di

1.3. c im c-C bm da mt : l c bm vo da. Khi rch da thng c xu hng toc

rng v qun mp da.-C bm hm trn : l c hin nt mt v vy khng lc co ko xng

hm di lch. Di lch ca xng hm trn thng do lc sang chn.-C bm xng hm di: l c i khng thc hin chc nng n, nhai vpht m.

- H thng c nng hm : ko hm ln pha trn v ra pha trc, ahm sang hai bn.

+ C cn:

Nguyn u: Cung tip, g m.Bm tn: Mt ngoi gc hm.+ C thi dng:

Nguyn u: H thi dng.Bm tn: Mm vt.+ C chn bm trong

Nguyn u: H chn bm.Bm tn: Mt trong gc hm.+ C chn bm ngoi

Nguyn u: Mt ngoi cnh ln xng bm.Bm tn: Sn chm v c li cu.

- H thng c h hm: ko hm xung di v ra sau+ C cm mng:

Nguyn u: Mt trong vng cm xng hm di.Bm tn: Thn xng mng.

+ C hm mngNguyn u: Mt trong vng cm, cnh ngang xng hm di.Bm tn: Thn xng mng.


6/22

+Thn trc c nh thnNguyn u: Mt trong vng cm.Bm tn: Sng ln xng mng.

Khi xng hm di gy, c i khng co ko gy di lch nhiu.

1.4. c im mch mu Gii phu:

- Vng mt c nui dng bi cc nhnh ca ng mch cnh ngoi, vivng ni phong ph.

- ng mch cnh ngoi c 6 nhnh bn v 2 nhnh tn:+ Nhnh bn: - ng mch gip trng bn.

- ng mch hu ln- ng mch mt- ng mch chm- ng mch tai sau

+ Nhnh tn: - ng mch thi dng nng- ng mch hm trong+ Vng ni: C 2 vng ni, vng ni ng mch cnh ngoi vi ng mch

cnh ngoi bn i din v vng ni ng mch cnh ngoi vi ngmch cnh trong.

- Vng ni ng mch cnh ngoi vi ng mch cnh ngoi bn idin:

. tuyn gip 2 ngmch gip trng trn.

. quanh ming 2 ng mch mt.

. hu 2 ng mch hu ln.

. chm 2 ng mch chm.- Vng ni ng mch cnh ngoi - ng mch cnh trong:

. Ni quanh hc mt, gm ng mch mt v ng mch mt.c im lm sng:

- Chy mu nhiu.- Ph n ln.-Nui dng tt, lin so nhanh.

1.5. c im thn kinh- Vng mt c chi phi bi h thng thn kinh dy c nh dy II, III,

IV, VI vng mt, dy V, dy VII, dy IX, dy XII cho vng mt.- Dy I khu gic, dy VIII thnh gic.

Tn thng dy thn kinh no gy lit hoc mt cm gic vng .- Dy thn kinh s V chi phi cm gic vng mt. Nu t nhnh no th

mt cm gic vng m n chi phi.- Dy thn kinh s VII chi phi vn ng vng mt. Trong chnthng c

th gy t mt nhnh hoc c dy thn kinh s VII gy lit khu tr hocc 1/2 mt.


7/22

1.6. c im tuyn nc bt- Trong h thng tuyn nc bt lu tuyn mang tai v tuyn di hm.

Chn thng c th gy t nhu m tuyn hoc ng tuyn, gy d nc

bt.

III. Cp cu chn thng hm mt1. Ngt th

1.1. Ngt th do nguyn nhn d vt-Vt thng thng hc ming c d vt nh : mnh rng, cc mnh t chcri hoc d vt t ngoi vo cng vi mu ng v nc bt trn vo ng bahng gy kh th.-X tr:

- Mc hng ly b d vt- Ht m di- Cm mu, loi b t chc sp ri ra- bnh nhn nm nghing v khng c c nh hai hm khi vn

chuyn bnh nhn hoc bnh nhn ang hn m1.2. Tt li ra sau

- Nguyn nhn :

- Ph n sn ming- Gy cnh ngang xng hm di 2 bn- V nt vng cm + cnh ngang

-X tr:

-

Ko li ra trc- C nh li bng ch khu u li, mt u ch buc vo khuy o

Hnh 5: Ko li ra trc

1.3. Kh th do ph n vng thanh qun,h hng


8/22

-Nguyn nhn l vt thng ng dp vng hm hu cnh c- X tr:

- t kh qun, m kh qun- Nu khng m c kh qun th dng kim ln hn s 17 chc qua

mng sn gip nhn v chuyn bnh nhn ln tuyn trn.

2. Chy muChy mu trong chn thng c th t phn mm hoc xng

Chy mu phn mm c th x l bng phng php sau :- Bng p- Khu cm mu ti ch

Chy mu trong gy xng hm trn- Nht bc mi trc v sau- C nh xng gy bng bng vng cm u

Chy mu trong gy xng hm di

- C nh xng gy bng buc ch thp vo 2 rng bn cnh nggy

- Bng vng cm u

Hnh 6: Bng vng cm u

Trng hp t mch mu ln hoc cm mu nh trn khng kt qu thphi tht ng mch cnh ngoi.

3. Shock vchongThng gp trong a chn thng phi hp vi cc chn thng nng khc

nh s no, v tng, gy chi- Nguyn nhn:


9/22

- Do mt mu- Do au

-X tr:- Theo nguyn nhn- Thuc

+ Gim au+ An thn (tr chn thng s no)+ Corticoid

+ Truyn dch+ Truyn mu nu bnh nhn thiu mu

4. Chng nhim trng- Tim phng un vn-Khng sinh phng chng nhim trng

IV. Vt thngphn mm

1. Vt thng xy st-Do mt tr st trn mt vt nhm gy bong lp thng b, vt thng rm

mu, au rt, c th c nhiu d vt nh bi than v ct. Vng tn thngc th nh nhng cng c th chim na mt. c bit vt thng c dvt nh bi, than hoc cc ho cht c mu. Khi x tr nu khng loi bht cc d vt th sau ny vt thng lin da vng s nhim mu cad vt.

-X tr+ Gy t ti ch+ Gp b ht d vt

+ Dng nc mui phun di p lc+ Nu vt thng c ln ho cht cn phi chn dung mi phhp ty ra.

+ Nu vt thng rng th phi gy m. Dng x phng trungtnh v bn chiloi b cc d vt.

+ Bng m khng sinh.2. Vt thng ng dp

-Do vt c u t tc ng, da khng rch, tn thng t chc di da, gynn ph n t chc v mu t.

-Mu t di da nh c th t tan, nu mu t thnh khi bt buc phiphu thut ly mu t.

3. Vt thng rch da-y l vt thng phn mm c th n gin cng c th vt thng rtphc tp hoc phi hp vi gy xng hm, vt thng c th sch hocbn, bnh nhn c th n sm hay mun.

-X l qua cc bc sau :- V cm: gy thoc gy m.


10/22

- Lm sch : Gp b ht d vt, c bit lu nhng d vt nm lntrong t chc, nu vt thng c ln ho cht c mu, cn phi chndung mi ph hp ty ra. Trong trng hp vt thng rng,dp nt, ln nhiu d vt th dng x phng v bn chi phu thut loi b ht d vt. Dng nc mui sinh l bm di p lc hoc

H2O23 th tch ra vt thng.- Ct lc: tit kim : xn 2 mp vt thng cho phng, ct b phn

cn, c b hoi t.- Cm mu: bng kp, dao din, buc mch.- ng vt thng:

Nu vt thng sch c th ng kn vt thng. Nguyn tcphi khu kn nim mc trc, sau khu c, cui cng lng da.

Nu vt thng bn: Lm sch, bm ra, ng vt thng th2 khi vt thng sch.

Vt thng phn mm phi hp vi gy xng hm th x tr gyxng trc sau mi ng phn mm. Nu a phng cha x lgy xng th ch nn khu phn mm cm mu bng cc mi ch thari chuyn ln tuyn trn iu tr tip.

4. Vt thng mt t chc- Vt thng phn mm mt t chc cn lm sch, bng vt thng v

chuyn n chuyn khoa to hnh.

V. Gy xng hm trn1. Phn loi

-

Gy mt phn+ Gy rng v xng rng + Gy nghnh ln xng hm trn+ Gy li c, b di mt

- Gy ton b+ Gy dc+ Gy ngang

2. Gy rng vxng rng:Tn thng thng xy ra nhm rng ca, c nhiu mc :- Rng lung lay, mt rng hoc nhm rng.X tr: + Gy t

+ Nn rng v ng v tr+ C nh rng bng ch thp hoc np.

- Rng bt khi rng: Nu rng cn nguyn vn, rng tt nn ngm rng vonc mui sinh l tin hnh cm li rng.- Rng gy: Rng gy chn, cn nh b. Rng gy mt phn thn rng, c th iutr tu bo tn rng.


11/22

- Gy rng v xng rng: l tn thng gy xng rng v rng, thng gymt nhm rng ca.Khm: + Chy mu trong ming.

+ Ngm ming: Khp cn sai.+ Mt nhm rng v xng rng vo pha trong.

+ Li qua ng gy rch, chy mu.X tr:+ Gy t.

+ Nn rng v xng rng v ng v tr.+ C nh rng v xng rng, np hoc mng.

3. Gy ngang xng hm trn phn loi theo Lefort3.1. ng gy Lefort I

-ng gy t nn hc mi i ngang trn cc cung rng qua li c v ctxng chn bm 1/3 di.

- ng ct qua vch ngn mi 1/3 di3.2. ng gy LefortII

-ng gy qua xng chnh mi, ct ngnh ln xng hm trn vo thnhtrong hc mt qua xng l ra ngoi ct b di hc mt ri i dixng g m v i ra sau ct xng chn bm 1/3 gia.

-ng gy ct xng vch ngn mi 1/3 gia.3.3. ng gy Lefort III (tch ri s mt)

-ng gy qua ng khp xng chnh mi v xng trn vo thnhtrong hc mt qua xng l, xng giy, ti khe bm ri ct qua 1/3 trnxng chn bm.

-ng ct qua mu mt ngoi ca xng trn v g m n thnh ngoica mt n khe bm v ct qua xng chn bm 1/3 trn.

-ng ct qua cung tip g m.-ng ct qua vch ngn mi 1/3 trn.

Lefort III

Lefort I Lefort II

Hnh 7: Gy Lefort xng hm trn

4. Lm sng4.1. Ton thn


12/22

-C th chong nh hoc nng tu thuc vo cc tn thng km theo.4.2. Ti ch

-Lefort I : Bm tm mi trn, nghch tin nh hm trn c du hiu bmtm hnh mng nga, n au chi. Dng ngn tay tr v ngn ci tay phicm nhm rng ca trn di ng thy khi xng di ng. Khi ngm

ming ch c rng trong cng chm cn cc rng khc h, gi l khp cnh ca.

-Lefort II : Mt sng n, tng gia mt c th thp v di, chy mu mitrc hoc c mi trc v sau, t mu vng tip hpmt, n c du hiu

bc thang hoc au chi b di mt, mi trn c th t b, h minghn ch, khp cn sai h ca, xng hm trn di ng.

- Lefort III : Mt sng n, chy mu mi, c du hiu eo knh dm. Tnggia mt c th thp v di, c du hiu bc thang hoc au chi mumt ngoi v cung tip g m, gc mi, h ming hn ch, khp cn sai hca, xng hm trn di ng.

4.3. X quang-Chp phim Blondeau, mt nghing, Hirtz, CT. scan

5. Gy dc xng hm trn:Xng hm trn c c im cu to hnh tr ng nn gy dc t gp hn sovi gy ngang. Gy dc xng hm trn c hai ng gy thng gp:- Gy dc chnh gia, tch i xng hm trn phi v tri. - Gy dc bn, ng gy ct ngang qua k rng 2,3.

Hnh 8: Gy dc gia xng hm trn- Rt him gp gy dc xng hm trn n thun, thng phi hp vi gyngang xng hm trn.- Gy dc gia xng hm trn: tc l ng gy tch ri khp ni gia 2xng hm trn. ng gy i t gai mi trc, tch ri xng k rng 11v 21, dc theo ng gia vm ming cng n bum hu


13/22

- Gy dc bn l ng gy 1 phn thn xng hm trn. Thng phi hpvi ng gy Lefort I, ng gy tch qua k cc rng 1 bn cung hm,tch 1 phn vm cng, c th ko di n bum hu.- Triu chng lm sng:

+ Thng gp lc tc ng vo mi trn hoc cung rng hm trn.

K rng 2 bn ng gy tch ra, chy mu.+ Vm ming c vt rch thng ln hc mi hoc vt bm tm dc theong gy.+ Khp cn sai, cung rng hm trn chuyn dch ra ngoi cung rng hmdi, cung rng bn gy chm cn bn i din h.+ Di ng bt thng cung rng gy

- X quang: Chp Blondeau, Hirtz,Panorama, CT Scanner, Belot.

Hnh 9: a. Phim Blondeau b. Phim Hirtz

VI. Gy xng hm di1. Phn loi

-Gy xng hm di 1 phn- Gy rng v xng rng- Mm vt

- Gy ton b- Mt ng- Hai, ba ng- V nt

2. Lm sng:gy xng hm di ton b2.1. Ngoi ming

-Sng n, rch daphn mm, chy mu ng tai ngoi- Mt bin dng.-S b di xng hm di c du hiu au chi, khuyt hnh bc thang

hay lo xo xng .


14/22

- Khm li cu : Dng ngn tay tr vo l tai ngoi 2 bn, ngn tay ci trc np tai, bo bnh nhn nhai. Thy du hiu au chi, c ng licu gim hoc hm cho rng.

2.2. Trong ming:-H ming hn ch

-Khp cn sai: Khi bnh nhn ngm ming li thy hai hm khng kht. Ccc dng khp cn sai sau:

+ Rng 1 bn hm khng chm Gp trong gy xng hm di 1ng.

+ Mt nhm rng hoc mt bn khng chm gp trong gy xnghm di 2-3 ng.

+ Ch c rng trong cng hm di chm gp trong gy c li cu 2bn

- Di ng bt thng: dng ngn tr v ngn ci, hai tay cm 2 bn xnghm gy di ng theo chiu ln xung thy xng hm di ng.

- K rng 2 bn ng gy rng.- Li bm tm hoc rch dc chn rng.2.2.1. Gy mt ng

- Gy vng cm: T rng 3.3 n rng 4.3, ng gy thng i cho sangbn, hoc c hai bn to thnh hnh (lamda). Gy vng cm t di lch v cn bnglc ca c, nu c di lch th theo chiu trn di hoc trong ngoi. Triu chng:chy mu qua ng gy, k rng hai bn ng gy rng, li nh th bm tm,nng th rch dc theo chn rng, khp cn sai, di ng bt thng xng hm.

-Gy vng bn t rng 4 n rng 8 hm di: ng gy thng i qua lcm chch xung di v sang bn, on xng hm di b ko ln trn ra trc

v vy, cc rng trn on ny chm rng hm trn. on xng hm di b koxungdi v ra sau v vy, rng trn on ny khng chm rng hm trn. Triuchng: Chy mu nhiu v ng gy gy t b mch thn kinh rng di, sngn, hn ch h ming, li rch, khp cn sai, ch mt nhm rng chm rng hmtrn, cc rng cn li khng chm; c di ng bt thng.

- Gy vng gc hm:ng gy i qua rng s 8, ng gy vt ra sau,cnh cao xng hm di b ko ra trc, xng hm cn li b ko xung div ra sau. Triu chng: chy mu nhiu qua ng gy, ph n vng di hm,sn ming, h ming hn ch, di ng bt thng, khp cn h bn gy.

- Gy cnh cao: t gp, thng gy dc, on trc b c thi dng ko lntrn vo trong, on sau b c ko lch ra ngoi v sau. Triu chng: sng n bmtm phn mm dc cnh cao, h ming hn ch, khp cn sai, chm rng bn gy,

bn lnh h.- Gy c li cu mt hoc hai bn:Triu chng: au, chy mu ng tai ngoi, h ming hn ch, c ng li cu

gim, hm cho rng nu li cu bt khi khp. Khp cn sai, nu gy c li cumt bn th cung rng lch sang bn gy, chm rng bn gy, bn lnh h. Nu


15/22

gy c li cu hai bn th cung rng li ra sau, khp cn h ca, ch c rng trongcng hai bn chm vi rng hm trn.

2.2.2. Gy xng hm di nhiu ng- Thng gp gy hai ng khng i xng nhiu hn i xng, thng gp

cc ng phi hp:+ Gy vng cm + gy c li cu.+ Gy vng cm + gc hm.

- Triu chng: au, kh nut, kh ni, h ming hn ch, li rch, chy mu,nhm rng nm gia hai ng gy tt xung thp, ra cn, mt nhai ra ngoi.Xng hm di ng bt thng, khp cn sai.

2.2.3. V nt xng hm di:c im v nt l chy mu nhiu, thng phi hp vi vt thng phn

mm phc tp. Triu chng: au, kh ni, kh nut, s vt thng thy loxo, hming hn ch, rng trn vng xng v, lch khi cung rng, li, nim mcrch l xng, chy mu nhiu. Khp cn sai, di ng bt thng.

Hnh 10:Cc ng gy xng hm di3. Gy li cu xng hm di:3.1.Phn loi gy li cu:

3.1.1.Phn loi theo v tr gii phu:- Gy chm li cu.

- Gy c li cu.- Gy di c li cu.

3.1.2.Phn loi theo mc di lch:- Gy khng di lch.- Gy di lch.- Bt li cu khi khp

3.1.3. Gy 1 bn hoc 2 bn:


16/22

- Gy li cu 1 bn.- Gy li cu 2 bn.

3.1.4.Phn loi theo bao khp:- Gy trong bao khp( gy chm li cu)- Gy ngoi bao khp( gy c li cu).

3.2. Lm sng:Thng do lc va p vo vng cm( chim khong 60% trng hp), hoc

cnh ngang xng hm di.- Sng n vng khp thi dng hm.- C th chy mu ng tai ngoi. n khp au chi.- H ngm ming hn ch.- Hm di lch v pha bn gy nu gy li cu 1 bn.- Hm di li ra sau nu gy li cu 2 bn.- Khp cn h ca.- Ch chmrng sau cng.

- Di chng ca gy li cu l: Khp cn sai hoc dnh khp thidng hm4. X quang

- X-quang thng quy: mt thng, Shuller, hm di chch, panorama (toncnh).- CT scan

6.4. Chn on:Da vo lm sng v X quang- Lm sng: + au chi.

+ Khuyt bc thang.+ Khp cn sai.

+ Di ng bt thng.- Triu chng ph: + Khng nhai c.+ Chy mu.+ Mt bin dng.

- X quang.


17/22

Hnh 11: Phim PanoramaVII. Gy rng v xng rng:

1. Gy rng v xng rngThng gp nhm rng ca. Rng v xng rng b y vo pha trongv chi ln.Khm thy 1 nhm rng lch vo trong so vi cung rng li rch, bm tm,chy mu, di ng bt thng, cn rng hm khng kht2. Chn thng rng:Gm 2 loi:

- Rng bt khi rng.

- Gy thn rng.- Gy chn rng.3. X-quang: Panorama, phim cn chp.

VIII. Gy xng hm tr em:1. c im gy xng hm tr em:

- Xng hm tr em thng gy kiu cnh ti.- Trong lng xng c mm rng vnh vin.- Rng trn cung hm l rng sa hoc hm rng hn hp.- Xng hm di c cc trung tm pht trin.- Bnh nhn thng khng hp tc iu tr

2. Nguyn tc iu tr gy xng hm tr em:- C nh 1 hm

- Chng ch nh kt hp xng.

IX. iu tr:1. Thi x tr trc 1 bnh nhn CTHM:

1.1.Khai thc bnh s v din bin ca bnh nhn qua: bnh nhn, nginh, ngi a bnh nh, h s ca tuyn trc.


18/22

1.2.Khm, pht hin, iu tr, tnh trng cp cu:- Kh th, ngng th.- Chy mu, tt huyt p- Chong, shock.

1.3.Khm, pht hin chn thng ton thn:

- Chn thng s no- Chn thng lng ngc- Chn thng bng- Chn thng chi- Chn thng mt

....

1.4.Khm, chn on, X-quang chn thng vng hm mt.Bc ny ch c tin hnh sau khi chn on v iu tr phihp vi cc chuyn khoa khc

2.iu tr:

2.1.Nhng phng php c nh hm gy:2.1.1. C nh 2 hm:- Phng php bng vng cm u: l phng php c nh tmthi.- Phng php buc nt Ivy: l phng php buc c nh rng 2hm cht.

Hnh 12:C nh bng nt Ivy-Phng php c nh bng cung Tiguersted: l phng php cnh 2 hm chun gin, c nh hm tt, c bit c kh nng ko nnxng di lch.


19/22

Hnh 13: Cung Tiguersted

2.1.2.Phng php c nh ng gy:-Phng php buc ch thp:+ u im: n gin, kinh t.+Nhc im: C nh ng gy khng chc chn, v vy fi phihp vi c nh 2 hm.

Hnh 14:kt hp xng bng ch thp


20/22

-Phng php c nh cht bng np vt:Tc gi Hansmann l ngi u tin dng np (plate) c nhxng vng hm mt. Luhr gii thiu h thng np vis p lc vonm 1968 ngy nay c p dng rng ri trn th gii. Hin nay np kt hp xng vng hm mt c lm bi 3 vt liu:

+ Vitanium+ Titanium

+ Sinh hc (Bioplate)Phn loi np:c 4 loi-Plate gi ch(np phc hi- Reconstruction plates): dy >2mm, dng

phc hi xung hm di sau khi ct on xng hm.-Plate maxi: dy 1,7 mm, dng c nh gy xng hm di.-Miniplate: dy 1 mm, dng c nh gy xng hm trn.-Microplate: dy 0,5 mm, dng c nh gy ca xng mng.Hnh dng np ph hp vi tng v tr gii phu v tu vo hng sn xut,

da trn thc t phu thut vin chn np: Thng thng gy thn xnghm di dng np dy t 1,25 3,5 mm v ng knh ca vt (screw) t2,03,5mm. Vi gy xng hm trn, dng np dy t 0,7 - 1mm v vtc ng knh 2mm.+ u im: c nh chc, khng phi c nh 2 hm lu.+Nhc im: k thut v gi thnh cao.

Hnh 15: H thng np- vt2.2.iu tr gy xng hm trn:+ Gy khng di lch: c nh 2 hm 3-5 tun+ Gy di lch: nn chnh, c nh

2.2.1.Nn chnh:Bc l ng gy, a khi hm trn ln trn, ra trc cho n khirng hm trn cn kht vi rng hm di v xng gy khp khtvi nhau.2.2.2. C nh:


21/22

-Phng php treo Adams: do Milton Adams a ra vo nm 1942.Phng php c 2 bc:+ C nh rng 2 hm bng nt Ivy hoc cung Tiguersted.+ Treo xng hm trn vo mu ngoi ca xng trn, hoc cung gm, hoc b di mt.

Thi gian c nh 2 hm 4 - 5 tun.-Phng php c nh bng np vt: Dng miniplate t cc v trtrlc. Phng php ny ch c nh 2 hm t 1-2 tun.

2.3. iu tr gy xng hm di:+ Gy khng di lch: c nh 2 hm t 6 - 8 tun.+ Gy di lch: nn chnh xng gy, c nh.

2.3.1.Nn chnh:Bc l ng gy, nn cho rng hm di cn kht vi rng hm trn

v din xng gy kht vi nhau.2.3.2. C nh:-Kt hp xng bng ch thp: phi phi hp vi c nh 2 hm.Thi gian 4 - 6 tun.- C nh bng np vt: C th khng phi c nh 2 hm.

Hnh 16: C nh xng hm bng np vt

X. iu tr v theo di sau m:1. Thuc:

- Khng sinh.

- Gim au- Chng ph n


22/22

2. Theo di sau m:- Chy mu.-Nhim trng.

3.Bin chng:- Xng lin sai: dn n khp cn sai

Documents

Bai Giang CTHM-New