{"id":27245,"date":"2023-04-23T10:45:50","date_gmt":"2023-04-23T03:45:50","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27245"},"modified":"2023-05-02T09:47:27","modified_gmt":"2023-05-02T02:47:27","slug":"lanh-thuong-trong-qua-trinh-dieu-tri-noi-nha-rang-truong-thanh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/lanh-thuong-trong-qua-trinh-dieu-tri-noi-nha-rang-truong-thanh\/","title":{"rendered":"L\u00e0nh th\u01b0\u01a1ng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha r\u0103ng tr\u01b0\u1edfng th\u00e0nh."},"content":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y cung c\u1ea5p g\u00f3c nh\u00ecn cho b\u1ea1n \u0111\u1ecdc v\u1ec1 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd tu\u1ef7 – m\u00f4 quanh ch\u00f3p, \u0111\u1ed3ng th\u1eddi \u0111\u1ec1 c\u1eadp \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 l\u00e0nh th\u01b0\u01a1ng c\u1ee7a ch\u00f3p r\u0103ng v\u00e0 m\u00f4 quanh ch\u00f3p sau qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha tr\u00ean l\u00e2m s\u00e0ng. C\u00f9ng t\u00ecm hi\u1ec3u k\u1ef9 h\u01a1n v\u1ec1 kh\u00e1i ni\u1ec7m n\u00e0y.<\/strong><\/p>\n

1. G\u00f3c nh\u00ecn v\u1ec1 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd tu\u1ef7 – m\u00f4 quanh ch\u00f3p<\/h2>\n

T\u00ecnh tr\u1ea1ng vi\u00eam c\u1ee7a m\u00f4 t\u1ee7y \u2013 m\u00f4 quanh ch\u00f3p c\u00f3 th\u1ec3 b\u1eaft ngu\u1ed3n t\u1eeb nhi\u1ec1u y\u1ebfu t\u1ed1 nh\u01b0 s\u00e2u r\u0103ng, ch\u1ea5n th\u01b0\u01a1ng, t\u1ed5n th\u01b0\u01a1ng h\u00f3a h\u1ecdc \u2013 c\u01a1 h\u1ecdc ho\u1eb7c b\u1ec7nh nha chu. Tuy v\u1eady, s\u00e2u r\u0103ng \u2013 m\u1ed9t b\u1ec7nh l\u00fd vi\u00eam nhi\u1ec5m g\u00e2y ra do c\u00e1c m\u1ea3ng b\u00e1m v\u00e0 biofilm, v\u1eabn l\u00e0 nguy\u00ean nh\u00e2n ch\u1ee7 y\u1ebfu. N\u1ebfu s\u00e2u r\u0103ng kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb th\u00ec ng\u00e0 r\u0103ng s\u1ebd d\u1ea7n d\u1ea7n b\u1ecb ph\u00e1 h\u1ee7y. \u0110\u1ed9c t\u1ed1 c\u1ee7a vi khu\u1ea9n v\u00e0 c\u00e1c s\u1ea3n ph\u1ea9m chuy\u1ec3n h\u00f3a c\u1ee7a ch\u00fang s\u1ebd th\u00e2m nh\u1eadp v\u00e0o c\u00e1c \u1ed1ng ng\u00e0, \u0111i v\u00e0o t\u1ee7y r\u0103ng \u0111\u01b0a \u0111\u1ebfn c\u00e1c \u0111\u00e1p \u1ee9ng th\u00e0nh \u1ed1ng t\u1ee7y v\u00e0 c\u00e1c \u0111o\u1ea1n eo t\u1ee7y, sau \u0111\u00f3 x\u00e2m nh\u1eadp v\u00e0o c\u00e1c \u1ed1ng ng\u00e0 v\u00e0 c\u00e1c \u1ed1ng t\u1ee7y ph\u1ee5\/\u1ed1ng t\u1ee7y b\u00ean. V\u00ec v\u1eady r\u1ea5t kh\u00f3 \u0111\u1ec3 lo\u1ea1i b\u1ecf ph\u1ea7n l\u1edbn l\u01b0\u1ee3ng vi khu\u1ea9n trong h\u1ec7 th\u1ed1ng \u1ed1ng t\u1ee7y ch\u1ec9 v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p c\u01a1 \u2013 h\u00f3a h\u1ecdc. Nh\u01b0 \u0111\u00e3 n\u00f3i \u1edf tr\u01b0\u1edbc, r\u0103ng vi\u00eam t\u1ee7y kh\u00f4ng h\u1ed3i ph\u1ee5c nh\u01b0ng kh\u00f4ng c\u00f3 vi\u00eam quanh ch\u00f3p th\u00ec ti\u00ean l\u01b0\u1ee3ng t\u1ed1t h\u01a1n r\u0103ng c\u00f3 vi\u00eam quanh ch\u00f3p sau \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha kh\u00f4ng ph\u1eabu thu\u1eadt. Hi\u1ec3u bi\u1ebft v\u1ec1 l\u00e0nh th\u01b0\u01a1ng c\u1ee7a ch\u00f3p r\u0103ng v\u00e0 m\u00f4 quanh ch\u00f3p sau \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha s\u1ebd gi\u00fap c\u00e1c nh\u00e0 l\u00e2m s\u00e0ng ch\u1ec9 \u0111\u1ecbnh ph\u00f9 h\u1ee3p, t\u1eeb \u0111\u00f3 \u0111\u1ea1t k\u1ebft qu\u1ea3 l\u00e0nh th\u01b0\u01a1ng t\u1ed1t.<\/p>\n

2. S\u1ef1 l\u00e0nh th\u01b0\u01a1ng c\u1ee7a ch\u00f3p r\u0103ng v\u00e0 m\u00f4 quanh ch\u00f3p sau \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha<\/h2>\n

\u0110i\u1ec1u tr\u1ecb n\u1ed9i nha tr\u00ean l\u00e2m s\u00e0ng \u1edf c\u1ea3 r\u0103ng nhi\u1ec5m tr\u00f9ng (ho\u1ea1i t\u1eed ho\u1eb7c \u0111i\u1ec1u tr\u1ecb t\u1ee7y l\u1ea1i) v\u00e0 kh\u00f4ng nhi\u1ec5m tr\u00f9ng (r\u0103ng s\u1ed1ng) bao g\u1ed3m vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c d\u1ee5ng c\u1ee5 v\u00e0 t\u00e1c nh\u00e2n kh\u00e1ng khu\u1ea9n \u0111\u1ec3 l\u00e0m s\u1ea1ch, kh\u1eed tr\u00f9ng (trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 nhi\u1ec5m tr\u00f9ng), t\u1ea1o h\u00ecnh \u1ed1ng t\u1ee7y c\u0169ng nh\u01b0 s\u1eed d\u1ee5ng v\u1eadt li\u1ec7u \u0111\u1ec3 tr\u00e1m b\u00edt. Nh\u1eefng \u1ea3nh h\u01b0\u1edfng t\u00edch l\u0169y t\u1eeb th\u1ee7 thu\u1eadt \u0111i\u1ec1u tr\u1ecb s\u1ebd kh\u00f4ng tr\u00e1nh kh\u1ecfi vi\u1ec7c g\u00e2y t\u1ed5n th\u01b0\u01a1ng \u0111\u1ebfn m\u00f4 quanh ch\u00f3p. S\u1ef1 m\u1edf r\u1ed9ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng khi \u0111\u00e3 c\u00f3 t\u1ed5n th\u01b0\u01a1ng g\u00e2y ra t\u1eeb ngu\u1ed3n b\u1ec7nh ban \u0111\u1ea7u n\u00ean \u0111\u01b0\u1ee3c gi\u1edbi h\u1ea1n nh\u1ea5t c\u00f3 th\u1ec3 \u0111\u1ec3 kh\u00f4ng g\u00e2y \u1ea3nh h\u01b0\u1edfng x\u1ea5u \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

Qu\u00e1 tr\u00ecnh l\u00e0nh th\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia th\u00e0nh s\u1ef1 t\u00e1i t\u1ea1o v\u00e0 s\u1ef1 s\u1eeda ch\u1eefa. T\u00e1i t\u1ea1o l\u00e0 s\u1ef1 th\u00e0nh l\u1eadp l\u1ea1i nh\u1eefng m\u00f4 b\u1ecb t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c b\u1ecb m\u1ea5t, c\u00f2n s\u1eeda ch\u1eefa l\u00e0 s\u1ef1 thay th\u1ebf m\u1ed9t s\u1ed1 c\u1ea5u tr\u00fac ban \u0111\u1ea7u b\u1eb1ng m\u00f4 x\u01a1. Qu\u00e1 tr\u00ecnh l\u00e0nh th\u01b0\u01a1ng \u1edf h\u1ea7u h\u1ebft c\u00e1c v\u1ecb tr\u00ed trong c\u01a1 th\u1ec3, \u0111\u1ec1u c\u00f3 li\u00ean quan \u0111\u1ebfn m\u1ed9t lo\u1ea1t c\u00e1c giai \u0111o\u1ea1n ph\u1ed1i h\u1ee3p v\u00e0 ch\u1ed3ng ch\u00e9o nhau sau \u0111\u00e2y: \u0111\u00f4ng m\u00e1u, vi\u00eam, t\u0103ng sinh, t\u00e1i t\u1ea1o c\u1ea5u tr\u00fac m\u00f4 v\u00e0 ph\u00e2n h\u1ee7y m\u00f4. \u0110i\u1ec1u tr\u1ecb n\u1ed9i nha \u1edf nh\u1eefng r\u0103ng b\u1ecb vi\u00eam t\u1ee7y kh\u00f4ng h\u1ed3i ph\u1ee5c c\u00f3 th\u1ec3 coi l\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng. M\u00f4 t\u1ee7y b\u1ecb c\u1eaft \u0111\u1ee9t t\u1ea1i v\u1ecb tr\u00ed \u0111i\u1ec3m th\u1eaft ch\u00f3p v\u00e0 \u0111\u00e1p \u1ee9ng vi\u00eam t\u1ee9c th\u00ec \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi m\u1ed9t khu v\u1ef1c ho\u1ea1i t\u1eed, trong \u0111\u00f3 bao g\u1ed3m c\u00e1c ph\u1ea7n kh\u00e1c nhau c\u1ee7a g\u1ed1c t\u1ee7y c\u00f2n l\u1ea1i. \u0110\u1ed1i v\u1edbi r\u0103ng ho\u1ea1i t\u1eed t\u1ee7y, sau khi lo\u1ea1i b\u1ecf m\u1ea3nh v\u1ee5n m\u00f4 ho\u1ea1i t\u1eed v\u00e0 nhi\u1ec5m tr\u00f9ng, b\u1ec1 m\u1eb7t v\u1ebft th\u01b0\u01a1ng ngay m\u1ee9c ch\u00f3p \u1ed1ng t\u1ee7y \u0111\u01b0\u1ee3c th\u00e0nh l\u1eadp trong m\u00f4 \u0111a ph\u1ea7n l\u00e0 t\u1ee7y s\u1ed1ng. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch l\u00e0 do m\u00f4 t\u1ee7y ch\u01b0a ho\u00e0n to\u00e0n b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi qu\u00e1 tr\u00ecnh ho\u1ea1i t\u1eed t\u1ee7y v\u1ec1 ph\u00eda ch\u00f3p, m\u00f4 h\u1ea1t trong \u1ed1ng t\u1ee7y ch\u00e2n r\u0103ng \u0111\u00e1p \u1ee9ng v\u1edbi s\u1ef1 gia t\u0103ng nhi\u1ec5m tr\u00f9ng, v\u00e0 ngay c\u1ea3 m\u00f4 nghi\u00ean c\u1ee9u c\u0169ng t\u0103ng sinh trong ch\u00f3p \u1ed1ng t\u1ee7y. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 nh\u1eefng b\u1ec1 m\u1eb7t v\u1ebft th\u01b0\u01a1ng kh\u00e1c, c\u00f3 th\u1ec3 th\u1ea5y s\u1ef1 t\u00edch l\u0169y nhi\u1ec1u b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh, v\u00e0 sau th\u1eddi gian t\u1eeb v\u00e0i ng\u00e0y \u0111\u1ebfn v\u00e0i tu\u1ea7n s\u1ebd \u0111\u01b0\u1ee3c thay th\u1ebf b\u1eb1ng s\u1ef1 th\u00e2m nhi\u1ec5m m\u1ea1n t\u00ednh.<\/p>\n

Giai \u0111o\u1ea1n ti\u1ebfp theo th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 bi\u1ebfn m\u1ea5t t\u1eeb t\u1eeb c\u1ee7a hi\u1ec7n t\u01b0\u1ee3ng vi\u00eam trong m\u00f4 quanh ch\u00f3p, t\u00e1i t\u1ea1o x\u01b0\u01a1ng v\u00e0 t\u00e1i th\u00e0nh l\u1eadp d\u00e2y ch\u1eb1ng nha chu. \u0110\u1ed1i v\u1edbi \u1ed1ng t\u1ee7y \u0111o\u1ea1n ch\u00f3p, c\u00f3 th\u1ec3 quan s\u00e1t th\u1ea5y m\u1ed9t m\u00f4 li\u00ean k\u1ebft s\u1ee3i kh\u00f4ng b\u1ecb vi\u00eam, ch\u1ee7 y\u1ebfu l\u00e0 c\u00e1c s\u1ee3i t\u1eeb th\u00e0nh ph\u1ea7n t\u1ebf b\u00e0o.<\/p>\n

\"lanh-thuong-1\"
(a) R\u0103ng nanh h\u00e0m tr\u00ean ho\u1ea1i t\u1eed t\u1ee7y v\u00e0 vi\u00eam quanh ch\u00f3p kh\u00f4ng tri\u1ec7u ch\u1ee9ng \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n nam 41 tu\u1ed5i. (b) \u1ed0ng t\u1ee7y \u0111\u01b0\u1ee3c s\u1eeda so\u1ea1n v\u00e0 b\u0103ng thu\u1ed1c v\u1edbi Ca(OH)2. M\u1ed9t tu\u1ea7n sau r\u0103ng \u0111\u01b0\u1ee3c tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p nh\u1ed3i d\u1ecdc v\u1edbi GP v\u00e0 cement b\u00edt. (c) XQ ki\u1ec3m tra sau 9 n\u0103m c\u00f3 th\u1ec3 th\u1ea5y t\u00ecnh tr\u1ea1ng m\u00f4 quanh ch\u00f3p b\u00ecnh th\u01b0\u1eddng. R\u0103ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. (d) 19 n\u0103m sau b\u1ec7nh nh\u00e2n tr\u1edf l\u1ea1i v\u1edbi tri\u1ec7u ch\u1ee9ng s\u01b0ng n\u01b0\u1edbu m\u1eb7t ngo\u00e0i. Th\u0103m d\u00f2 cho k\u1ebft qu\u1ea3 \u0111\u1ed9 s\u00e2u t\u00fai nha chu m\u1eb7t ngo\u00e0i l\u00e0 8 mm. XQ ki\u1ec3m tra cho th\u1ea5y m\u1ed9t khi\u1ebfm khuy\u1ebft x\u01b0\u01a1ng \u1edf g\u00f3c xa. L\u01b0u \u00fd h\u00ecnh \u1ea3nh m\u00f4 quanh ch\u00f3p v\u1eabn r\u1ea5t b\u00ecnh th\u01b0\u1eddng. R\u0103ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 g\u00e3y d\u1ecdc v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c nh\u1ed5 b\u1ecf. (e) L\u00e1t c\u1eaft \u1edf g\u1ea7n trung t\u00e2m \u1ed1ng t\u1ee7y, bao g\u1ed3m c\u1ea3 \u0111o\u1ea1n \u1ed1ng t\u1ee7y ch\u00f3p v\u00e0 l\u1ed7 ch\u00f3p (foramen). Quan s\u00e1t th\u1ea5y s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a m\u00f4 b\u1ecb canxi h\u00f3a \u1edf \u0111o\u1ea1n \u1ed1ng t\u1ee7y c\u1eadn ch\u00f3p (nhu\u1ed9m hematoxylin v\u00e0 eosin). (f) H\u00ecnh \u1ea3nh chi ti\u1ebft foramen. Hi\u1ec7n t\u01b0\u1ee3ng canxi h\u00f3a m\u00f4 x\u1ea3y ra v\u00e0 l\u1ea5n chi\u1ebfm \u0111o\u1ea1n \u1ed1ng t\u1ee7y c\u1eadn ch\u00f3p n\u00e0y gi\u1ed1ng nh\u01b0 cement, v\u00e0 n\u00f3 b\u1ecb c\u1eaft ngang b\u1edfi m\u1ed9t d\u1ea3i s\u1ee3i m\u00f4 li\u00ean k\u1ebft. M\u00f4 nha chu c\u00f2n s\u00f3t l\u1ea1i tr\u00ean b\u1ec1 m\u1eb7t ch\u00f3p ch\u00e2n r\u0103ng khi nh\u1ed5 r\u0103ng ra th\u00ec th\u1ea5y kh\u00f4ng b\u1ecb vi\u00eam. (g) H\u00ecnh \u1ea3nh chi ti\u1ebft m\u00f4 m\u1ec1m t\u1ea1i foramen. Ch\u1ec9 quan s\u00e1t th\u1ea5y c\u00e1c nguy\u00ean b\u00e0o s\u1ee3i v\u00e0 s\u1ee3i collagen, kh\u00f4ng h\u1ec1 c\u00f3 t\u1ebf b\u00e0o vi\u00eam n\u00e0o.<\/figcaption><\/figure>\n

\u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0 do ph\u1ea7n m\u00f4 t\u1ee7y ban \u0111\u1ea7u c\u00f2n s\u00f3t l\u1ea1i ho\u1eb7c m\u00f4 nha chu t\u0103ng sinh trong \u0111o\u1ea1n ch\u00f3p \u1ed1ng t\u1ee7y. S\u1ef1 h\u00ecnh th\u00e0nh cement tr\u1ea3i d\u00e0i t\u1eeb b\u1ec1 m\u1eb7t ngo\u00e0i c\u1ee7a ch\u00e2n r\u0103ng v\u00e0o l\u1ed7 ch\u00f3p ch\u00e2n r\u0103ng (foramen) c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y, l\u00e0m thu h\u1eb9p mi\u1ec7ng l\u1ed7 ch\u00f3p \u1edf nhi\u1ec1u m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau. Theo th\u1eddi gian, c\u00e1c l\u1edbp cement li\u00ean ti\u1ebfp nhau s\u1ebd t\u00edch l\u0169y d\u1ea7n cho \u0111\u1ebfn khi s\u1ef1 \u0111\u00f3ng ch\u00f3p g\u1ea7n ho\u00e0n t\u1ea5t. M\u00f4 li\u00ean k\u1ebft trong c\u00e1c \u0111o\u1ea1n \u1ed1ng t\u1ee7y ch\u00f3p \u0111\u00f3 b\u1ecb thu h\u1eb9p l\u1ea1i c\u00f2n r\u1ea5t m\u1ecfng. M\u00f4 nha chu xung quanh ch\u00f3p r\u0103ng ho\u00e0n to\u00e0n kh\u00f4ng b\u1ecb vi\u00eam.<\/p>\n

Ngu\u1ed3n: Clinical Guide for Optimal Treatment Outcome – Springer International Publishing Switzerland 2017<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y cung c\u1ea5p g\u00f3c nh\u00ecn cho b\u1ea1n \u0111\u1ecdc v\u1ec1 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd tu\u1ef7 – m\u00f4 quanh ch\u00f3p, \u0111\u1ed3ng th\u1eddi \u0111\u1ec1 c\u1eadp \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 l\u00e0nh th\u01b0\u01a1ng c\u1ee7a ch\u00f3p r\u0103ng v\u00e0 m\u00f4 quanh ch\u00f3p sau qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha tr\u00ean l\u00e2m s\u00e0ng. C\u00f9ng t\u00ecm hi\u1ec3u k\u1ef9 h\u01a1n v\u1ec1 kh\u00e1i ni\u1ec7m n\u00e0y. […]<\/p>\n","protected":false},"author":21,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[28,33],"tags":[],"yoast_head":"\nL\u00e0nh th\u01b0\u01a1ng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha r\u0103ng tr\u01b0\u1edfng th\u00e0nh.<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft n\u00f3i v\u1ec1 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd tu\u1ef7-m\u00f4 quanh ch\u00f3p, \u0111\u1ed3ng th\u1eddi \u0111\u1ec1 c\u1eadp \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 l\u00e0nh th\u01b0\u01a1ng sau qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha. 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