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33 - NH GI KT QU PHU THUT IU TR SANG THNG QUANH CHP RNG T THNG 9/1999 N THNG 9/2001
Hunh Kim Dim*, Phm Th Hng Loan*, L c Lnh*
TM TT
Mc tiu: Nhm nh gi kt qu phu thut iu tr sang thng quanh chp rng, thc hin hi cu trn 24 bnh nhn (34 rng). Phng php: Bnh nhn c ti khm v nh gi dc trn cc tiu chun v lm sng v X quang, Kt qu cho thy hu ht cc trng hp u c lnh thng hon ton trn xng (70%), kt qu tt trn lm sng (80%). Kt lun: Cc trng hp lnh thng xng khng hon ton u lin quan n tnh trng ni nha khng t v thi gian t lc ni nha n lc phu thut di.
ABSTRACT
APICAL RESECTION: AN EVALUATION OF TREATMENT RESULTS (1999 TO 2001) Hunh Kim Dim*, Phm Th Hng Loan*, L c L{nh* * Y Hoc TP. Ho Chi Minh * Vol. 11 Supplement of No 2 - 2007: 240 247 Objective: In order to evaluate the results of apicoectomy, a retrospective study was carried out on 24 cases. Method: Patients were re-examined and apical lesion evaluated using radiographic and clinical criteria. Conclusion: Most cases with incomplete bone repair were related to unacceptable endodontic treatment and/or delayed surgery following eudodontic treatment. ho|n to|n nhng m bnh,< v| quan trng l| T VN s c lp c h thng ng ty vi mi Mc tiu chung ca iu tr ni nha l| bo trng xung quanh. Mt s nh| l}m s|ng cho tn rng, hu ht c{c rng cn iu tr tu u rng vic tr{m ngc cho php c lp h {p ng tt vi phng ph{p iu tr khng thng ng ty mt c{ch hiu qu v| l| mt phu thut. Tuy nhin khi iu tr ni nha yu t v cng quan trng trong s th|nh thng thng gp kh khn, khng th thc cng ca phu thut ct chp. {nh gi{ s hin, hoc mt phc hnh khng th th{o th|nh cng ca phu thut ct chp, c{c t{c g,< hay mt sang thng c kch thc qu{ gi u cho rng ngo|i vic {nh gi{ v vi ln (m| nu ch iu tr ni nha thng thng sinh hc, cn da v|o phim tia X v| mt s s khng th em li s l|nh thng ho|n tiu chun l}m s|ng sau thi gian phu thut. ho) th phng ph{p iu tr bng phu Ti b mn Nh Rng-Tiu Phu Thut, thut s c ch nh nhm mc ch loi b Khoa Rng H|m Mt, i Hc Y Dc nhng nguyn nh}n g}y bnh vng chp v| TP.HCM chng ti thc hin vic iu tr bo tn rng. c{c sang thng quanh chp bng phng Phu thut ct chp ch}n rng nhm loi ph{p phu thut ct chp v| c hay khng c b m bnh vng chp v| c hoc khng c tr{m ngc cho nhiu trng hp l}m s|ng. km tr{m ngc; th|nh cng ca phu thut Nhm {nh gi{ kt qu iu tr v| gp phn ph thuc v|o nhiu yu t, nh mc v x}y dng s liu l thuyt ging dy ca B trng ca qu{ trnh phu thut, s loi b
* Khoa RHM i Hc Y Dc TP. HCM.
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thut: rng mang phc hnh, ng ty b calci ho{ v| yu t kt hp. Thi gian t lc iu tr ni nha n lc phu thut: tc th sau mt ng|y tr{m bt ng ty (mt ng|y sau khi iu tr ni nha, bnh nh}n c chuyn sang phu thut chp), di s{u th{ng hay t s{u th{ng tr ln. Phim X quang: trn phim quanh chp ghi nhn tnh trng v| kch thc sang thng (u ht, nang), kch thc <1cm hay 1 cm. Tnh trng ni nha: quan s{t vin 1 (ThS. inh Th Kh{nh V}n, B mn Cha Rng) {nh gi{ tnh trng ni nha trn phim quanh chp theo tiu chun sau: Tt: vt liu tr{m bt cn quang ng nht v| c{ch chp ch}n rng t 0,5 n 1mm, khng c khong thu quang gia vt liu tr{m v| th|nh ng ty. Khng tt: khi ng ty thiu d|y c, c ch trng cha c tr{m bt, c khong trng gia vt liu tr{m bt v| th|nh ng ty, c ng ty cha c tr{m (i vi rng nhiu ng ty), ng ty b m rng qu{ mc hay thiu chun b c v chiu d|i v| chiu rng. Khng thy vt liu tr{m bt ng ty (VLTBOT). Ghi nhn lc phu thut: c tr{m ngc hay khng c tr{m ngc. Sau phu thut: Mi bnh nh}n tr li {nh gi{ trn l}m sng v X quang. Phng vn trc tip bnh nh}n c hay khng c triu chng lin quan n rng nguyn nh}n iu tr, bao gm: au sau phu thut, cm gi{c kh chu,< {nh gi{ kt qu l}m s|ng (quan st vin 2). Tt: bnh nh}n ho|n to|n khng c triu chng au nhc ti rng nguyn nh}n. M nha chu bnh thng, nim mc {y h|nh lang vng rng tng ng khng ph n, sung huyt, khng c l d.
Chuyn Rng Hm Mt
241
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Trung bnh: bnh nh}n vn cn cm gi{c au nhc m h, khng r r|ng ti rng nguyn nh}n. M nha chu, nim mc {y h|nh lang bnh thng. Xu: bnh nh}n vn cn au ti rng nguyn nh}n, nim mc {y hnh lang ph n, sung huyt, c hoc khng c l d. ng thi ghi nhn c hay khng c i m|u nu ti v tr tr{m ngc. {nh gi{ kt qu trn X quang: l|nh thng trn xng v| tnh trng tr{m ngc (nu c) So s{nh phim trc v| sau phu thut {nh gi{ s l|nh thng trn xng(Quan s{t vin 3). - Lnh thng hon ton: khi c s thu hp hoc mt ho|n to|n sang thng, c hnh th|nh c{c th xng trong vng sang thng vi mt cn quang tng ng vi xng lnh xung quanh. - Lnh thng khng hon ton: kch thc sang thng thu hp so vi ban u, c hnh th|nh xng trong vng sang thng nhng mt cn quang km hn xng l|nh xung quanh. - Khng lnh thng: khi sang thng khng gim kch thc hay ph{t trin ln hn (hnh nh thu quang lan rng), khng c s t{i to xng trong vng sang thng. o kin nh trong vic {nh gi{ s l|nh thng trn X quang, sau ln {nh gi{ u tin 15 ng|y chng ti chn ngu nhin 12 phim c li, ghi nhn kt qu v| so s{nh vi kt qu c ln mt. Kt qu cho thy khng c s khc bit c ngha gia hai ln c phim (p > 0,05).
KT QU
C 24 bnh nh}n (BN) vi 34 rng (R) tha c{c tiu chun chn mu trn; s liu thu thp gm c{c s liu trc phu thut v| sau phu thut. Thu thp trc phu thut (ghi nhn t h s bnh {n)
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S lng R T l %
Bng 10: Lnh thng trn lm sng theo tnh trng ni nha
Tt Khng tt Khng thy VLTBOT Trung Xu Tng bnh cng 13R 11 02 0 (0%) 13 (84,6%) (15,4%) (100%) 20R 16 (80%) 01 (5%) 03 20 (15%) (100%) 01R 0 (0%) 0 (0%) 01 01 (100%) (100%) n Tt
Chuyn Rng Hm Mt
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thc hin vic iu tr ni nha ng tiu chun cn phi c mt khong thi gian theo di s l|nh thng (ti thiu 06 th{ng), nu sau sang thng vn khng gim kch thc hay cn tn ti c{c triu chng l}m s|ng th lc by gi mi c quyt nh phu thut. Mt s t{c gi kh{c cho rng nn phu thut ngay sau khi iu tr ni nha nu tn thng tiu xng qu{ ln hoc c lin quan n nhiu rng, kch thc 1cm l| kch thc tiu chun cho vic ch nh phu thut. Donald v| Dimitroulis cn ch nh phu thut ct chp kt hp vi xt nghim gii phu bnh nu sang thng quanh chp khng lin h r r|ng vi rng nguyn nh}n hoc nghi ng vi c{c chn o{n kh{c. Ngo|i ra, mt s t{c gi cng a ra c{ch iu tr gii quyt tc thi i vi nhng bnh nh}n khng c iu kin nh khng c thi gian, bnh nh}n xa< Trong nghin cu ca chng ti loi ch nh tc thi chim mt ti l {ng k: 41,7%. Ch nh kh{c phu thut cn c {p dng trn nhng rng mang phc hnh c tnh trng ni nha khng tt hoc cha ni nha nhng khng th th{o phc hnh ra iu tr li theo phng ph{p thng thng, c{c rng n|y ang g}y bin chng hoc tnh c c ph{t hin c sang thng quanh chp. Theo mt s t{c gi, s th|nh cng ca phu thut trong nhng trng hp n|y khng cao v t bn th}n ming tr{m ngc khng th m bo s kht s{t ho|n to|n b mt ct ca chp rng khi phn cn li ca ng ty ch}n rng khng c m bo v trng. Trong nghin cu, loi ch nh n|y chim 26,5% (9 rng) v| to|n b c{c rng n|y u c tnh trng ni nha khng tt (bng 5) trong 88,9% (8 rng) c triu chng l}m s|ng, 11,1% (1 rng) c ch nh iu tr d phng do tnh c ph{t hin c sang thng quanh chp >1cm.
244
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Hnh 1: i mu nu ti v tr trm ngc Bc u {nh gi{ cho phep ghi nhn: a s c{c rng c l|nh thng xng v| kt qu l}m s|ng tt u c thi gian t lc ni nha n lc phu thut ngn (phu thut tc th v| phu thut sau ni nha 6 th{ng). Phi chng thi gian theo di sau ni nha 6 th{ng l| thi im sau cng quyt nh thc hin phu thut ct chp hay khng, vn n|y c tip tc nghin cu.
KT LUN
Hi cu h s bnh {n ca 24 bnh nh}n vi 34 rng c phu thut ct chp (c v khng c tr{m ngc) ti B mn Nh Rng Tiu Phu Thut t th{ng 09/1999 n th{ng 09/2001, cho phep rt ra mt s kt lun sau:
V c im dch t
a s c{c rng phu thut ct chp l| rng hm trn (79,4%). Bnh nh}n thng n kh{m do c triu chng trn l}m s|ng (79,2%). Ch nh phu thut ct chp ch yu lin quan n yu t sinh hc (70,6%). 61,7% rng chuyn phu thut ct chp l| c tnh trng ni nha khng t, trong s c{c rng n|y c 85,7% c triu chng trn l}m s|ng.
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4.
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11. 12.
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Chuyn Rng Hm Mt
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