Nhn xt hnh nh cng hng tthot v a m ct sng tht lngNguyn Quc HngMai Vn Nam, Phm Ngc Nhin

t vn

Nghin cu bnh l thot v a m (TV) c mt ngha quan trng bi v bnh kh ph bin.Bnh TV l nguyn nhn quan trng lm tn tht n n kh nng hot ng th lc ca con ngi la tui lao ng.Do c im v chc nng c hc ca tng on ct sng nn bnh l a m ct sng tht lng chim mt t l cao nht vi 61,94% sau n ct sng c 36,1% (theo Cramer Jurgen).

Chp X-Quang ct sng tht lng khng chn on tnh trng TV p vo ng ty, bao r thn kinh v cc cu trc phn mm ca a m v ng ty khng cn quang.Chp CLVT c bm thuc cn quang ng sng c tc dng chn on TV kh tt, cn hn ch v kh nh gi uc cc thot v bn, khng pht hin bnh giai on sm, khng kho st ton b a m ca ct sng tht lung.Chp cng hung t (CHT) chn on tnh trng TV p vo ng ty, bao r thn kinh, chp an ton, khng can thip, khng dng thuc cn quang, c bit l khng gy nhim x.

i tng v phng php nghin cu

i tung: Tt c cc bnh nhn n chp CHT ct sng tht lung ti khoa CHA bnh vin Vit-Tip, Hi Phng. Phung php nghin cu: M t vi c mu l ton b bnh nhn n chp CHT ct sng tht lung ti khoa CHA t 1/1/2007 n 30/6/2008. Phung tin nghin cu: Thc hin trn my Siemens, t lc 0,2 Tesla, khng tim thuc i t.X l s liu: Theo phung php thng k n thun.

Kt qu nghin cuTrong 1112 bnh nhn n chp ct sng tht lung, trong c 812 bnh nhn TV

1. Theo nhm tui:

Nhn xt: tui TV gp nhiu nht 40-49 chim t l 37,19% ca Trn Trung 36,45. La tui hay gp t 50-59 l 21,06% ca Trn Trung 20,4%. Kt qu trn khng khc vi cc nghin cu trong v ngoi nuc.

Nhm tui< 2020-2930-3940-4950-59> 60Tng sS BN11 83 167 302 171 78 812%1,35 10,22 20,57 37,19 21,06 9,61 100

2. T l mc bnh theo gii

Nhn xt: Nhm nghin cu t l mc bnh, nam nhiu hn n vi t l 55,17% v 44,83% Theo Trn Trung t l ny l 54,2% v 45,8% .

GiiS BNT l %N 364 44,83 Nam448 55,17 Tng s812100

3. T l mc bnh theo tin s c chn thung hay khngNhn xt: Cng nh cc nghin cu khc bnh v bnh TV ct sng tht lng, c tin s chn thng khng lin quan nhiu chim t l 2,34%

TS chn thungS BNT l %C192,34Khng79397,66Tng s812100

4. T l cc du hiu lm sngNhn xt: Ni bt nht l du hiu au lng 89,78% ca Trn Trung 89,5 %. Du hiu teo c t gp 0,62 %.

Triu chngS trng hpT l %au lng72989,78RL cm gic50462,07Yu chn415,05Teo c chn50,62RL c trn00

5. Hnh nh CHT phn loi TV:

Nhn xt: TV ct sng tht lng ra sau chim u th 98,28% ca Trn Trung 97,2%. Chng ti khng gp trng hp no TV bn ngoi l tip hp.

Loi TVS trng hpT l %Ra sau79898,28Ra trc91,11Trong l ghp101,23Ngoi l ghp00Ni sng10212,56

6. Hnh nh CHT cc th TV ra sau

Nhn xt: Hu ht cc TV ra sau u l trung tm cnh bn . Hinh nh TV ln trn v xung di u gp t .

Loi TVS trng hpT l %Trung tm25130,91Trung tm cnh phi17922,04Trung tm cnh tri25531,4Cnh hai bn29235,96Trung tm ln151,85Trung tm xung546,65

7. Hnh nh CHT phn b s tng TV Nhn xt: Bnh nhn c hinh nh CHT bnh TV mt tng chim t l cao 58,5% ca Trn Trung l 58,2%. Hinh nh TV c 5 tng him gp 0,49% .

S tng TVS trng hpT l %Mt tng47558,5Hai tng33040,64Ba tng9711,95Bn tng374,56Nm tng40,49

8. Hnh nh CHT phn b tng TV theo v tr c th

Nhn xt: Hu ht cc bnh nhn TV u v tr L4-L5, L5-S1 chim t l 46,02% v 28,79% cn Trn Trung l 46,5% v 28,9% . Cn TV v tr L1-L2, L2-L3 rt him gp .

V tr TVS trng hpT l %L1 L2453,11L2 L3775,33L3 L424216,75L4 L566546,02L5 S141628,79Tng s1445100

9. Hnh nh CHT mc hp ng sng

Nhn xt: Hp ng sng l hu qu ca TV v thoi ha ct sng tht lng. a s l hp 1/4 v 2/4 ng sng .

Hnh nh CHTS trng hpT l %Hp 1/4 ng sng28034,48Hp 2/4 ng sng18222,41Hp 3/4 ng sng15819,46Hp 4/4 ng sng00

10. Hnh nh CHT cc r thn kinh c th b chn pNhn xt: Tng s trong nhm nghin cu l 1730 trng hp do TV chn p r thn kinh trong r thn kinh trong ng sng 32,56% ca Trn Trung l 34,47%. Cc r thn kinh L1, L2 b chn p, chng ti khng gp .

R TK b chn pS lngT l %R TK L100R TK L200R TK L3683,94R TK L421712,53R TK L556132,42R TK S132118,55R TK trong ng sng56332,56Tng s1730100

11. Hnh nh CHT thoi ha a m Nhn xt: Gim cao l 88,05% cn ca Trn Trung l 88,4% . Hinh nh thoi ha nhn din tt trn CHT c ba du hiu: Gim cao , gim tn hiu trn T2W v phinh .

Hnh nh CHTS lngT l %Gim cao 71588,05Gim tn hiu T2W 72689,41Phnh 24830,54

12. Hnh nh CHT thoi ha CSTL Nhn xt: TV thng i km du hiu thoi ha CSTL nhn bit c trn my CHT, c bit l my c t tnh cao. C mm xng l 29,06% cn ca Trn Trung 29,4% . Cc du hiu khc t gp, c l do my CHT c t lc thp.

Hnh nh CHTS BNT l %Mm xng thn t23629,06Ph i mm khp mc sng00Bin i tn hiu mn sn00Vi ha, dy dy chng dc trc00Vi ha, dy dy chng dc sau00Vi ha, dy dy chng vng00Mt ng cong sinh l52764,9Trt thn t sng546,65

Bn lun

Tui mc bnh:

Mc bnh cao nht TV CSTL t 40 n 49 tui chim, 34,6%, tui gp cao nht l 78 tui v thp nht 19 tui.TV lin quan n la tui v bnh l thoi ha ch yu do mt nc. TV ct sng tht lng xy ra c nam v n trong vi t l 1,2 /1 c tnh ph bin cao.TV vng CSTL chim t l cao gn 40% tng s bnh nhn n khm xt bng CHTDu hiu lm sng: au vng tht lng v ri lon cm gic l hai du hiu thng gp nht vi t l 89,5% v 61,4%.

Hnh nh CHT:

Mc phn loi TV trn hnh nh CHT, c gi tr thc tin cao l la chn ph hp la chn ph hp cc phng php iu tr. Phn loi TV trn CHT ph hp vi nhiu tc gi, trong TV ra sau chim t 97,2% n 100% ,trong phn loi TV cn chia thnh nhiu t th thot v.Tng TV trn nh CHT, TV mt tng thng gp nhiu hn 56%-58,2%, so vi thot v nhiu tng, trong v tr hay gp L4-L5 chim 82,%.TV gy hp ng sng trn CHT, mc hp l du hiu quan trng cc nh Ngoi khoa c quyt nh phu thut hay khng.TV gy chn p r thn kinh trn CHT, y l hnh nh tt nht hin nay m cc phung php khm hnh nh khc khng c uc.

Hnh nh thoi ha trn CHT l giai on khi u ca TV, CHT l phng php duy nht nh gi y cc du hiu bnh, thoi ha trn CHT c th hin bng 3 du hiu:Gim cao a m.Gim tn hiu trn T2W chim t l 99,2%. Du hiu phnh a m

Thoi ha CSTL trn CHT: Nhn chung cc du hiu ca thoi ha ct sng u nhn nh c trn CHT nhu m xng, trt thn t sng, v ha dy chng... Mt s chui xung v mt ct x dng trong bnh TV: Xung T1W, T2W cho mt ct sagital & xung T2W cho mt ct axial, chng ti ch dng thuc i t khi cn chn on phn bit vi tn thng khc nh u di cn, vim...

Kin ngh

Bnh nhn c au ko di, c la tui t 40 n 59 nn chp CHT mi nh gi c y tn thng a m, chn p ng ty v r thn kinh, trong khi nu chp XQ thng qui hay chp CLVT u khng c thng tin y .Nn c my CHT t lc cao hn c th nh gi tn thng cc dy chng, r thn kinh chi tit hn...

Kt lun

Bnh TV l bnh l thng gp, ph bin.CHT l mt phng php tt nht trong chm on bnh TV .Bnh nhn khng b nhim x l im mnh hn chp CLVT.Nhn nh cc tn thung nh m xung, vi ha dy chng ct sng th CHT vn cn kh khn hn chp CLVT, khc phc vn trn cn c my chp CHT c phn gii cao hn.Khng c k thut mi no, hin i n u c th t ti gi tr tuyt i c th thay th phng php khc, chng cn b xung cho nhau

Nam, 39t ID: 07 Chp ngy 31/ 12/ 2007

Khi thot v lch tri

Nam, 27t ID: 10 Chp ngy 31/11/2007

Thot v hai tng L4 L5, L5 S1 trung tm, lch tri

Xin trn trng cm n