XQ XNG

Bs.Le Van Dung

Khoa CHA -BV Ch Ray

2010

MUC TIEU
Cau tao xng:
-Cau truc va phat trien he xng
-XQ xng bnh thng
Bat thng xng tren Xquang:
-am o, cau truc, hnh dang.
Vai benh ly lam sang

Hnh anh he xng

-XQ quy c.
-Khac:Chup cat lp vi tnh(CT),cong
hng t (MRI), xa hnh
Ket hp lam sang va xet nghiem
3

CAU TAO XNG

1.Mo xng.
2. Cac loai xng:
Xng ngan, dai, dep co ty le mo xop va ac
khac nhau
Xng truc va xng chi.

Xng dai

S phat trien xng

-Xng phat trienBan sun phat trien.
-Xng trng thanh.
+Vo xng Xng ac
+Xng xop: Be xng + Te bao tuy xng.
-Nhng thay oi tuy xng:
+Tuy o Vang
+Ngoai bien Trung tam (25 tuoi)
-Vit D va tuyen can giap Xng.
8

TRIEU CHNG HOC X-QUANG XNG

Bat thng ve am o:
a.Giam am o (Osteopenia)
Phim XQ Lng Ca giam tren 30%:
*Toan the
-Loang xng(Osteoporosis).
-Nhuyen xng(Osteomalacia).
-Thay oi tuy xng.
-Cng tuyen can giap
*Khu tru: Viem, bat ong, u.
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Bnh thng

Loang xng
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12

THALASEMIA

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14

GIAM AM O XNG KHU TRU

( U MACH XNG)

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TRIEU CHNG HOC X-QUANG XNG

Bat thng ve am o(tt):
b.Tang am o(Osteosclerosis):
Tang s can quang cua xng.
*Toan the: Bam sinh (benh xng a), chuyen
hoa(tang Vit D), U(di can, lymphoma..), t phat
(benh Paget)
*Khu tru:ao xng, nhoi mau cu, u, s lanh
xng sau cac ton thng...
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TANG AM O KHU TRU

DI CAN XNG

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ao xng

18

U xng dang xng

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TANG AM O KHU TRU

Lymphoma

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Huy xng dang tham va sau ieu tr /Lymphoma

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Tang am o xng lan toa

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Tang am o
xng lan toa.

Benh xng a.
(Osteopetrosis)

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DI CAN, LYPHOMA, PAGET

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TRIEU CHNG HOC XQ XNG

Bat thng ve cau truc:

a.Qua trnh huy xng.
-Tao hnh khuyet vung thau quang: U, viem, e
nen

-Bieu hien chat ton thng:

n oc hay nhieu o
B co vien x hay khong Xac nh tien trien..
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Huy xng

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Huy b x

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Huy xng b ro/NOF

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32

-EG TE, M:F=2:1

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Viem 34
xng

Huy xng mot gam (Di can)

35

Dang tham(Leukemia)

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Di can va GCT

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TRIEU CHNG HOC X-QUANG XNG

b.Qua trnh tao xng:

-T xng: Tao t cac be xng.

-Phan ng mang xng:T mat trong mang xng
+Dang tien trien cham:
Lien tuc, mot lp, ong nhat.
Phat trien cham:U lanh, viem, gay xng
+Dang tien trien nhanh:
Khong lien tuc, nhieu lp, hnh tua gai.
Viem, u ac.
c.Qua trnh hon hp.
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Dang lp day ac
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Gay suy yeu

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Dang lp(viem xng man tnh, LCH)

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Mot lp/ mot gam/

Langerhans cell
histiocytosis

43

Dang lp

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Ewing

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Dang lp va khong lien tuc/lymphoma

46

Dang tua gai

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Codman
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Codman/Ewing

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NGUYEN NHAN GAY PHAN NG MANG XNG

+Phan ng mang xng tien trien cham.

-NHIEM TRUNG
-U LANH, U HAT A AXI, KHAC.

+Phan ng mang xng tien trien nhanh.

-VIEM XNG TUY XNG
-U AC TNH: Osteosarcoma, chondrosarcoma,
fibrosarcoma, lymphoma, leukemia, metastasis

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Qua trnh hon hp Tao va huy xng

Huy(T hanh xng than xng)+ x xng Benh Paget

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TRIEU CHNG HOC X-QUANG XNG

Bat thng hnh dang:

Ph ai, thay oi truc, mong xng
-Bam sinh.
-Mac phai.

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Ph ai than xng/ Paget

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U mach mo mem

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Vai benh ly lam sang

1.
2.
3.
4.

Gay xng
Viem xng tuy xng,
U xng
Benh ly khac

58

Gay

xng

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GAY XNG

AI CNG

-Ket hp LS va XQ.
-Thng chup hai the thang goc.
-Xac nh co gay xng khong?
-Xac nh loai gay.
-Ton thng phoi hp.
60

CAC DANG GAY XNG

-DANG NG: GAY NGANG, CHEO, XOAN.

-GAY LUN: TANG AM O VUNG GAY,THAY

OI HNG BE XNG
-GAY CANH TI, GAY BONG AU, GAY
GIAT, CONG,..
-GAY PHC TAP: NHIEU MANH,VUNG SAU
-GAY BENH LY.
61

O DI LECH

GAY XNG

-PHU THUOC VAO C CHE:

CHAN THNG, CO C, TRONG LC.
-XAC NH O DI LECH:
GAP GOC, XOAY, RI RA, CHONG.

62

CAC LOAI GAY

Gap
ng gay

Gay bong au

NG GAY

GAY XNG

Tnh tien

Xoay

Chong

DI LECH
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Gay canh ti(tre em)

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Gay xng benh ly

U XNG

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Gay xng phc tap

(Vung mat khp)
67

Ton thng au xng Harris-Salter

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Xquang gay xng

1. Mat lien tuc vo xng va ng sang
ngang quang xng ke can
2. Gay xuat hien ng m (Chong cac be
xng len nhau)
3. Xem tren hai the vuong goc khi nghi
ng gay hoac trat khp
4. Hnh anh lanh xng:
-Voi hoa nhe quanh o gay(Can xng nguyen thuy).
-ng gay xoa dan kem Can xng ac.
-Xuat hien cac be xng ben trong Can.
-Thi gian lanh xng tuy thuoc:Kieu gay, loai
xng, tuoi, nhiem trung

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GAY XNG

2tuan
2thang

4 thang

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Sau 3 tuan

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Sau 10 thang

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Bin chng gay xng

Bien chng ben trong xng gay:
Cham tre lien xng va khp gia
Lien xng sai v tr va ngan chi
Hoai t
Nhiem trung
Benh ly thoai hoa khp
Bien chng ben ngoai xng gay:
Ton thng mach mau, than kinh, gan ke can
Ton thng vao cac tang
Tac do m (Thuyen tac phoi do m tuy xng)73

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Ngan chi

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Lech truc

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Cac nguyen nhan gay gay ngan xng

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Viem xng-tuy xng

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-Mach mau, vet thng, phau thuat.

-Hanh xng
-Nguyen nhan: Sinh mu, khong sinh mu
-Ngi hay gap tre em, ngi gia
-Hnh anh XQ a dang
79

VIEM XNG
Cap tnh(3-5 ngay)
-LS: au vung xng +H/C nhiem trung.
-XQ t gia tr.
-Hnh anh khac: MRI, xa hnh
-Tien trien: Lanh khong e lai di chng
hoac chuyen tien trien va man tnh.

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VIEM XNG
Hnh anh thay oi xng(10-15ngay)
-Luc au: Loang xng khu tru kem
phan ng mang xng.
-Ve sau: Hoai t xng t hoac nhieu
kem manh xng chet.
-Phan ng bao ve hnh thanh ngoai
vi: Tang x xng, day xng, b
khong eu.
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Viem xng cap tnh: trc va sau 6 tuan

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Brodie's abscess

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Viem xng

84

Viem xng man tnh

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U xng

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PHAN LOAI
-Phan loai theo ac tnh:
U lanh va u ac (Nguyen phat va th phat)

-Phan loai theo mo hoc:

U co nguon goc t sun, xng, mo lien ket,
tuy xng, mach mau, khong ro.

87

1. Xac nh tien trien.

(Kieu pha huy va phan ng xng)

2. Nguon goc ton thng

3. V tr.
4. Tuoi.
5. Lien quan vo xng, mo mem.
Ket hp LS va XN
88

anh gia s bo cau truc

S khoang hoa Nghi ng:
-Dang sun: Dang cung hoac om hoac khong
Enchondroma, chondrosarcoma (pha huy).
-Dang xng: am o cao ong nhat, am(U xng
hoac phan ng tao xng)Osteoid osteoma,
osteosarcoma, viem xng man, ton thng sau
ieu tr
-Dang si: M knh uc, om, khongFibrous
dysplasia
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Voi hoa lom om/ U noi sun

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enchondroma

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Cau truc dang xng/Sarcom xng

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M knh duc

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U A TUY

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Ton thng ac tnh theo tuoi

+Di 1 tuoi: Di can t neuroblastoma,
lymphoma, leukemia.
+1-10 tuoi: U Ewing(xg. ong).
+10-30 tuoi: Sarcom xng, u Ewing (xg. det)
+30-40 tuoi: Sarcom te bao noi mo, sarcom si,
lymphoma
+Tren 40 tuoi: Di can, sarcom sun, Kahler...
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Ton thng lanh tnh theo tuoi

+Di 10 tuoi: Khuyet vo si, EG
+5-15 tuoi: Nang xng n oc
+10-20 tuoi: ABC, u x vo, NOF, u nguyen bao
sun
+15-30 tuoi: U nguyen bao xng, u xng
dang xng, u si sun niem, u noi sun.
+20-40 tuoiGCT
100

U noi sun
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CHAN OAN PHAN BIET U LANH VA AC

U LANH

U AC

NG B:

LIEN TUC, B RO,

CO VIEN X.

VO XNG:

BNH THNG,
PHONG TO.
T ANH HNG

B NHAM
NH,M,MAT LIEN
TUC
HUY

PHAN NG
MANG XNG:

NHIEU LP,HNH
TUA GAI

XAM LAN:

T ANH HNG

CO

TIEN TRIEN:

CHAM

NHANH
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PHAN BIET U LANH VA AC

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