{"id":28354,"date":"2023-04-25T17:01:05","date_gmt":"2023-04-25T10:01:05","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28354"},"modified":"2023-05-02T08:40:25","modified_gmt":"2023-05-02T01:40:25","slug":"yeu-to-trong-dieu-tri-tien-luong-toi-benh-ly-tuy-rang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/25\/yeu-to-trong-dieu-tri-tien-luong-toi-benh-ly-tuy-rang\/","title":{"rendered":"Y\u1ebfu t\u1ed1 trong \u0111i\u1ec1u tr\u1ecb ti\u00ean l\u01b0\u1ee3ng t\u1edbi b\u1ec7nh l\u00fd tu\u1ef7 r\u0103ng."},"content":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 trong \u0111i\u1ec1u tr\u1ecb N\u1ed9i nha v\u00e0 ti\u00ean l\u01b0\u1ee3ng t\u1edbi b\u1ec7nh l\u00fd tu\u1ef7 r\u0103ng. Th\u00f4ng th\u01b0\u1eddng, c\u00e1c y\u1ebfu t\u1ed1 n\u00e0y c\u00f3 m\u1ed1i li\u00ean h\u1ec7 ch\u1eb7t ch\u1ebd \u0111\u1ed1i v\u1edbi k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, quy\u1ebft \u0111\u1ecbnh k\u1ebft qu\u1ea3 t\u1ed1t hay kh\u00f4ng, g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ng\u01b0\u1eddi b\u1ec7nh hay kh\u00f4ng,… V\u00ec th\u1ebf, vi\u1ec7c ki\u1ec3m so\u00e1t t\u1ed1t c\u00e1c y\u1ebfu t\u1ed1 n\u00e0y gi\u00fap t\u0103ng t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng v\u00e0 h\u01b0\u1edbng Nha s\u0129 \u0111\u1ebfn th\u00e0nh c\u00f4ng \u0111\u1ed1i v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd tu\u1ef7 r\u0103ng. C\u00f9ng t\u00ecm hi\u1ec3u.<\/strong><\/p>\n

\"trong-dieu-tri-1\"
Minh ho\u1ea1 b\u1ec7nh l\u00fd tu\u1ef7 r\u0103ng<\/figcaption><\/figure>\n

1. S\u1eed d\u1ee5ng \u0111\u00ea cao su<\/h2>\n

S\u1eed d\u1ee5ng \u0111\u00ea cao su l\u00e0 b\u1eaft bu\u1ed9c trong \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha. \u0110\u00ea cao su kh\u00f4ng ch\u1ec9 \u0111\u1ec3 b\u1ea3o v\u1ec7 b\u1ec7nh nh\u00e2n trong su\u1ed1t qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt m\u00e0 c\u00f2n l\u00e0m t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. C\u00f3 m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u00ea cao su trong \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha. Trong m\u1ed9t nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u, s\u1eed d\u1ee5ng \u0111\u00ea cao su su\u1ed1t qu\u00e1 tr\u00ecnh s\u1eeda so\u1ea1n \u0111em l\u1ea1i t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng cao \u0111\u00e1ng k\u1ec3. M\u1ed9t nghi\u00ean c\u1ee9u nh\u1eadn th\u1ea5y k\u1ebft qu\u1ea3 c\u1ee7a \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha l\u1ea1i c\u00f3 s\u1eed d\u1ee5ng \u0111\u00ea cao su cao h\u01a1n nhi\u1ec1u so v\u1edbi vi\u1ec7c c\u00f4 l\u1eadp b\u1eb1ng g\u00f2n. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c c\u0169ng k\u1ebft lu\u1eadn r\u1eb1ng kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u00ea cao su l\u00e0 nguy\u00ean nh\u00e2n ch\u1ee7 y\u1ebfu g\u00e2y ra \u0111au sau \u0111i\u1ec1u tr\u1ecb.<\/p>\n

2. C\u00e1c y\u1ebfu t\u1ed1 trong \u0111i\u1ec1u tr\u1ecb li\u00ean quan \u0111\u1ebfn vi\u1ec7c l\u00e0m s\u1ea1ch v\u00e0 t\u1ea1o h\u00ecnh \u1ed1ng t\u1ee7y<\/h2>\n

K\u1ebft qu\u1ea3 test vi khu\u1ea9n<\/strong><\/p>\n

Trong m\u1ed9t b\u00e0i t\u1ed5ng quan h\u1ec7 th\u1ed1ng, ph\u01b0\u01a1ng ph\u00e1p ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p cho th\u1ea5y t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng c\u1ee7a r\u0103ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha l\u1ea7n \u0111\u1ea7u v\u1edbi ch\u1ee7ng vi khu\u1ea9n tr\u01b0\u1edbc tr\u00e1m b\u00edt b\u1ecb b\u1ea5t ho\u1ea1t kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 so v\u1edbi r\u0103ng c\u00f3 vi khu\u1ea9n c\u00f2n ho\u1ea1t \u0111\u1ed9ng, b\u1ea5t k\u1ec3 t\u00ecnh tr\u1ea1ng m\u00f4 quanh ch\u00f3p th\u1ebf n\u00e0o. Khi c\u00e1c k\u1ebft qu\u1ea3 \u0111\u00f3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho nh\u1eefng r\u0103ng kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p th\u00ec kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3<\/p>\n

K\u00edch th\u01b0\u1edbc l\u1ed7 ch\u00f3p v\u00e0 \u0111\u1ed9 thu\u00f4n \u1ed1ng t\u1ee7y sau khi s\u1eeda so\u1ea1n<\/strong><\/p>\n

Nh\u1eefng d\u1eef li\u1ec7u hi\u1ec7n c\u00f3 li\u00ean quan \u0111\u1ebfn nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0y ho\u1eb7c l\u00e0 kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 ho\u1eb7c l\u00e0 r\u1ea5t kh\u00e1c bi\u1ec7t. Tuy nhi\u00ean h\u1ea7u h\u1ebft s\u1ed1 li\u1ec7u \u0111\u1ec1u kh\u00f4ng \u0111\u1ed3ng t\u00ecnh v\u1edbi \u00fd ki\u1ebfn cho r\u1eb1ng vi\u1ec7c lo\u1ea1i b\u1ecf vi khu\u1ea9n s\u1ebd hi\u1ec7u qu\u1ea3 h\u01a1n khi s\u1eeda so\u1ea1n l\u1ed7 ch\u00f3p l\u1edbn v\u00e0 \u0111\u1ed9 thu\u00f4n \u1ed1ng t\u1ee7y l\u1edbn<\/p>\n

S\u1ef1 qu\u00e1 ch\u00f3p c\u1ee7a d\u1ee5ng c\u1ee5<\/strong><\/p>\n

Orstavik b\u00e1o c\u00e1o r\u1eb1ng d\u1ee5ng c\u1ee5 s\u1eeda so\u1ea1n qu\u00e1 ch\u00f3p c\u00f3 th\u1ec3 g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha l\u1ea1i, m\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y r\u1eb1ng d\u1ee5ng c\u1ee5 qu\u00e1 ch\u00f3p l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng \u0111\u00e1ng k\u1ec3 so v\u1edbi khi d\u1ee5ng c\u1ee5 \u0111\u01b0\u1ee3c gi\u1edbi h\u1ea1n trong \u1ed1ng t\u1ee7y, b\u1ea5t k\u1ec3 t\u00ecnh tr\u1ea1ng m\u00f4 quanh ch\u00f3p tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb nh\u01b0 th\u1ebf n\u00e0o.<\/p>\n

Sjogren v\u00e0 c\u1ed9ng s\u1ef1 nh\u1eadn th\u1ea5y \u0111\u1ed1i v\u1edbi r\u0103ng c\u00f3 vi\u00eam quanh ch\u00f3p tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb, 90% tr\u01b0\u1eddng h\u1ee3p l\u00e0nh th\u01b0\u01a1ng khi d\u1ee5ng c\u1ee5 ch\u1ec9 gi\u1edbi h\u1ea1n \u0111\u1ebfn \u0111i\u1ec3m th\u1eaft ch\u00f3p, nh\u01b0ng ch\u1ec9 60% tr\u01b0\u1eddng h\u1ee3p l\u00e0nh th\u01b0\u01a1ng khi kh\u00f4ng s\u1eeda so\u1ea1n \u1ed1ng t\u1ee7y \u0111\u1ebfn h\u1ebft to\u00e0n b\u1ed9 chi\u1ec1u d\u00e0i. S\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha l\u1ea1i.<\/p>\n

M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c s\u1eed d\u1ee5ng ch\u00f3p r\u0103ng tr\u00ean phim l\u00e0m \u0111i\u1ec3m tham chi\u1ebfu v\u00e0 nh\u1eadn th\u1ea5y, m\u1ee9c gi\u1edbi h\u1ea1n c\u1ee7a d\u1ee5ng c\u1ee5 s\u1eeda so\u1ea1n trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng th\u00ec c\u00e1ch xa ch\u00f3p r\u0103ng tr\u00ean phim (1.23\u00b10.13 mm) h\u01a1n so v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb kh\u00f4ng th\u00e0nh c\u00f4ng (0.20\u00b10.09 mm), so s\u00e1nh tr\u00ean nh\u1eefng r\u0103ng c\u00f3 t\u00ecnh tr\u1ea1ng t\u1ee7y r\u0103ng v\u00e0 m\u00f4 quanh ch\u00f3p b\u00ecnh th\u01b0\u1eddng tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb. Tuy nhi\u00ean, k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng v\u1edbi r\u0103ng ho\u1ea1i t\u1eed t\u1ee7y v\u00e0 vi\u00eam quanh ch\u00f3p th\u00ec c\u00f3 m\u1ee9c chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c g\u1ea7n ch\u00f3p r\u0103ng tr\u00ean phim h\u01a1n (0.55\u00b10.12 mm) so v\u1edbi nh\u1eefng r\u0103ng kh\u00f4ng th\u00e0nh c\u00f4ng. \u0110\u1ed1i v\u1edbi nh\u1eefng r\u0103ng c\u00f3 vi\u00eam quanh ch\u00f3p, m\u1ea5t 1 mm chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng th\u1ea5t b\u1ea1i l\u00ean \u0111\u1ebfn 14%.<\/p>\n

3. L\u1ed7i th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt trong \u0111i\u1ec1u tr\u1ecb<\/h2>\n

G\u00e3y d\u1ee5ng c\u1ee5<\/strong><\/p>\n

C\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c nhau cho k\u1ebft qu\u1ea3 tr\u00e1i ng\u01b0\u1ee3c nhau. M\u1ed9t v\u00e0i nghi\u00ean c\u1ee9u cho th\u1ea5y g\u00e3y d\u1ee5ng c\u1ee5 khi \u0111ang \u0111i\u1ec1u tr\u1ecb kh\u00f4ng l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng. Nh\u1eefng nghi\u00ean c\u1ee9u kh\u00e1c l\u1ea1i nh\u1eadn th\u1ea5y, khi kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p th\u00ec s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a d\u1ee5ng c\u1ee5 g\u00e3y c\u00f3 th\u1ec3 kh\u00f4ng l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha. V\u00e0i nghi\u00ean c\u1ee9u cho r\u1eb1ng trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p, g\u00e3y d\u1ee5ng c\u1ee5 c\u00f3 th\u1ec3 g\u00e2y ch\u1eadm l\u00e0nh th\u01b0\u01a1ng ho\u1eb7c nhi\u1ec5m tr\u00f9ng dai d\u1eb3ng. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c b\u00e1o c\u00e1o d\u1ee5ng c\u1ee5 g\u00e3y l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng ch\u1ec9 khi r\u0103ng b\u1ecb ho\u1ea1i t\u1eed t\u1ee7y. M\u1ed9t b\u00e0i \u0111\u00e1nh gi\u00e1 t\u1ed5ng quan (ch\u1ec9 d\u1ef1a tr\u00ean 2 nghi\u00ean c\u1ee9u) kh\u00f4ng t\u00ecm th\u1ea5y s\u1ef1 \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 c\u1ee7a d\u1ee5ng c\u1ee5 g\u00e3y \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

Th\u1ee7ng<\/strong><\/p>\n

V\u1ecb tr\u00ed th\u1ee7ng v\u00e0 k\u00edch th\u01b0\u1edbc c\u1ee7a n\u00f3 d\u01b0\u1eddng nh\u01b0 g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn s\u1ef1 x\u1ea3y ra t\u1ed5n th\u01b0\u01a1ng m\u00f4 nha chu li\u00ean quan v\u1edbi ch\u1ed7 th\u1ee7ng. Th\u1ee7ng ngang m\u1ee9c m\u00e0o x\u01b0\u01a1ng \u1ed5 r\u0103ng g\u00e2y ra nh\u1eefng thay \u0111\u1ed5i b\u1ec7nh l\u00fd v\u00f9ng m\u00f4 nha chu nghi\u00eam tr\u1ecdng h\u01a1n so v\u1edbi \u1edf th\u00e2n r\u0103ng ho\u1eb7c t\u1eeb ch\u00f3p \u0111\u1ebfn m\u00e0o x\u01b0\u01a1ng. M\u1ed9t v\u00e0i nghi\u00ean c\u1ee9u b\u00e1o c\u00e1o r\u1eb1ng th\u1ee7ng l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng. Nh\u1eefng nghi\u00ean c\u1ee9u kh\u00e1c nh\u1eadn th\u1ea5y trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 vi\u00eam quanh ch\u00f3p, th\u1ee7ng g\u00e2y ch\u1eadm l\u00e0nh th\u01b0\u01a1ng ho\u1eb7c nhi\u1ec5m tr\u00f9ng dai d\u1eb3ng. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c cho bi\u1ebft th\u1ee7ng l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb ch\u1ec9 khi r\u0103ng b\u1ecb ho\u1ea1i t\u1eed t\u1ee7y.<\/p>\n

Ki\u1ec3m tra c\u1ea9n th\u1eadn c\u00e1c nghi\u00ean c\u1ee9u n\u00f3i tr\u00ean cho th\u1ea5y l\u1ed7i th\u1ee7 thu\u1eadt c\u00f3 th\u1ec3 kh\u00f4ng ph\u1ea3i l\u00e0 nguy\u00ean nh\u00e2n tr\u1ef1c ti\u1ebfp g\u00e2y ra b\u1ec7nh l\u00fd n\u1ed9i nha. Ng\u01b0\u1eddi ta cho r\u1eb1ng sai s\u00f3t khi th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt kh\u00f4ng ph\u1ea3i l\u00e0 nguy\u00ean nh\u00e2n tr\u1ef1c ti\u1ebfp g\u00e2y th\u1ea5t b\u1ea1i khi \u0111i\u1ec1u tr\u1ecb, m\u00e0 s\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a c\u00e1c m\u1ea7m b\u1ec7nh trong h\u1ec7 th\u1ed1ng \u1ed1ng t\u1ee7y m\u1edbi l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y ra b\u1ec7nh l\u00fd quanh ch\u00f3p. Nh\u1edd s\u1ef1 gi\u1ea3i th\u00edch n\u00e0y, Gorni v\u00e0 Gagliani \u0111\u00e3 chia c\u00e1c t\u00ecnh hu\u1ed1ng l\u00e2m s\u00e0ng khi \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha th\u00e0nh 2 nh\u00f3m: t\u00f4n tr\u1ecdng h\u00ecnh th\u00e1i \u1ed1ng t\u1ee7y (root canal morphology respected – RCMR) \u2013 bao g\u1ed3m s\u1ef1 v\u00f4i h\u00f3a, \u0111i\u1ec3m ch\u1eb7n ch\u00f3p, d\u1ee5ng c\u1ee5 g\u00e3y v\u00e0 \u1ed1ng t\u1ee7y ch\u01b0a tr\u00e1m b\u00edt \u2013 v\u00e0 thay \u0111\u1ed5i h\u00ecnh th\u00e1i \u1ed1ng t\u1ee7y (root canal morphology altered \u2013 RCMA), bao g\u1ed3m d\u1eddi v\u1ecb tr\u00ed ch\u00f3p, th\u1ee7ng, kh\u1ea5c v\u00e0 n\u1ed9i ti\u00eau. Theo k\u1ebft qu\u1ea3 c\u1ee7a \u0111\u00e1nh gi\u00e1 \u0111\u00f3 th\u00ec t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng chung c\u1ee7a RCMA th\u1ea5p h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi RCMR (47.8% v\u00e0 83.3%). S\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y c\u00f2n l\u1edbn h\u01a1n nhi\u1ec1u khi c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p, tr\u00e1i v\u1edbi khi kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p th\u00ec kh\u00e1c bi\u1ec7t kh\u00f4ng nhi\u1ec1u.<\/p>\n

B\u01a1m r\u1eeda v\u00e0 b\u0103ng thu\u1ed1c n\u1ed9i t\u1ee7y<\/strong><\/p>\n

C\u00f3 m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u t\u1eadp trung v\u00e0o hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c b\u01a1m r\u1eeda v\u00e0 b\u0103ng thu\u1ed1c n\u1ed9i t\u1ee7y l\u00ean k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha. Tuy nhi\u00ean, do s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u, s\u1ef1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u00e0 c\u00e1ch th\u1ee9c \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau m\u00e0 k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u r\u1ea5t kh\u00e1c nhau. M\u1ed9t b\u00e0i vi\u1ebft t\u1ed5ng h\u1ee3p \u0111\u00e3 th\u1ea5t b\u1ea1i trong vi\u1ec7c ch\u1ee9ng minh m\u1ed9t lo\u1ea1i thu\u1ed1c b\u01a1m r\u1eeda hay b\u0103ng \u1ed1ng t\u1ee7y n\u00e0y t\u1ed1t h\u01a1n hay hi\u1ec7u qu\u1ea3 h\u01a1n so v\u1edbi nh\u1eefng lo\u1ea1i thu\u1ed1c kh\u00e1c. Ch\u1eb3ng h\u1ea1n nh\u01b0, m\u1ed9t b\u00e0i vi\u1ebft kh\u00f4ng kh\u1eb3ng \u0111\u1ecbnh \u0111\u01b0\u1ee3c calcium hydroxide l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c b\u0103ng n\u1ed9i t\u1ee7y c\u00f3 t\u00e1c d\u1ee5ng lo\u1ea1i b\u1ecf vi khu\u1ea9n kh\u1ecfi \u1ed1ng t\u1ee7y ho\u1eb7c l\u00e0m t\u0103ng t\u1ec9 l\u1ec7 l\u00e0nh th\u01b0\u01a1ng sau \u0111i\u1ec1u tr\u1ecb. \u0110\u1ed1i v\u1edbi ch\u1ea5t b\u01a1m r\u1eeda, c\u00e1c b\u00e0i vi\u1ebft v\u1ec1 \u0111i\u1ec1u tr\u1ecb t\u1ee7y ho\u1eb7c \u0111i\u1ec1u tr\u1ecb t\u1ee7y l\u1ea1i kh\u00f4ng t\u00ecm th\u1ea5y \u0111\u1ee7 d\u1eef li\u1ec7u \u0111\u1ec3 ph\u00e2n t\u00edch th\u00eam.<\/p>\n

4. S\u1ed1 l\u1ea7n h\u1eb9n<\/h2>\n

Hai b\u00e0i vi\u1ebft t\u1ed5ng h\u1ee3p \u0111\u00e3 t\u00ecm th\u1ea5y s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha m\u1ed9t l\u1ea7n h\u1eb9n v\u00e0 nhi\u1ec1u l\u1ea7n h\u1eb9n. M\u1ed9t nghi\u00ean c\u1ee9u b\u00e1o c\u00e1o r\u1eb1ng t\u1ec9 l\u1ec7 l\u00e0nh th\u01b0\u01a1ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb t\u1ee7y m\u1ed9t l\u1ea7n h\u1eb9n v\u00e0 nhi\u1ec1u l\u1ea7n h\u1eb9n l\u00e0 nh\u01b0 nhau. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c l\u1ea1i th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha khi \u0111\u00e1nh gi\u00e1 th\u00e0nh c\u00f4ng b\u1eb1ng phim X quang gi\u1eefa \u0111i\u1ec1u tr\u1ecb m\u1ed9t l\u1ea7n v\u00e0 nhi\u1ec1u l\u1ea7n h\u1eb9n.<\/p>\n

5. \u0110au k\u1ecbch ph\u00e1t (flare \u2013 up)<\/h2>\n

T\u1ec9 l\u1ec7 trung b\u00ecnh c\u1ee7a \u0111au k\u1ecbch ph\u00e1t \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 kho\u1ea3ng 84%, v\u00e0 h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ec1u cho th\u1ea5y n\u00f3 kh\u00f4ng g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha. Tuy nhi\u00ean, m\u1ed9t nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y cho th\u1ea5y c\u01a1n k\u1ecbch ph\u00e1t x\u1ea3y ra l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb.<\/p>\n

6. Tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y<\/h2>\n

V\u1eadt li\u1ec7u, k\u0129 thu\u1eadt v\u00e0 lo\u1ea1i ch\u1ea5t d\u00e1n (sealer)<\/strong><\/p>\n

C\u00f3 2 b\u00e0i vi\u1ebft t\u1ed5ng h\u1ee3p kh\u00f4ng t\u00ecm th\u1ea5y \u0111\u1ee7 d\u1eef li\u1ec7u \u0111\u1ec3 ph\u00e2n t\u00edch \u1ea3nh h\u01b0\u1edfng c\u1ee7a v\u1eadt li\u1ec7u tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y, k\u0129 thu\u1eadt tr\u00e1m b\u00edt v\u00e0 lo\u1ea1i sealer l\u00ean k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha.<\/p>\n

Gi\u1edbi h\u1ea1n tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y so v\u1edbi ch\u00f3p<\/strong><\/p>\n

M\u1ed9t b\u00e0i vi\u1ebft t\u1ed5ng h\u1ee3p c\u00e1c r\u0103ng m\u1edbi \u0111i\u1ec1u tr\u1ecb t\u1ee7y l\u1ea7n \u0111\u1ea7u cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 v\u1ec1 t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng gi\u1eefa \u0111i\u1ec1u tr\u1ecb t\u1ee7y khi tr\u00e1m b\u00edt \u0111\u1ee7 chi\u1ec1u d\u00e0i (ng\u1eafn h\u01a1n 0 \u2013 2 mm so v\u1edbi ch\u00f3p r\u0103ng tr\u00ean phim) v\u00e0 thi\u1ebfu chi\u1ec1u d\u00e0i (c\u00e1ch ch\u00f3p r\u0103ng tr\u00ean phim >2 mm) \u1edf nh\u1eefng r\u0103ng kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p. Tuy nhi\u00ean, v\u1edbi r\u0103ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p th\u00ec tr\u00e1m b\u00edt \u0111\u1ee7 chi\u1ec1u d\u00e0i c\u00f3 t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng cao h\u01a1n. Tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y \u0111\u1ee7 chi\u1ec1u d\u00e0i lu\u00f4n lu\u00f4n c\u00f3 t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng cao h\u01a1n so v\u1edbi tr\u00e1m b\u00edt qu\u00e1 m\u1ee9c (qu\u00e1 ch\u00f3p r\u0103ng tr\u00ean phim) b\u1ea5t k\u1ec3 t\u00ecnh tr\u1ea1ng m\u00f4 quanh ch\u00f3p th\u1ebf n\u00e0o. Tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y ng\u1eafn cho t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng cao h\u01a1n tr\u00e1m qu\u00e1 ch\u00f3p trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p, nh\u01b0ng trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p th\u00ec kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 gi\u1eefa tr\u00e1m d\u00e0i v\u00e0 ng\u1eafn.<\/p>\n

\u0110\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb t\u1ee7y l\u1ea1i, tr\u00e1m b\u00edt ng\u1eafn ho\u1eb7c \u0111\u1ee7 c\u00f3 t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng cao h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi tr\u00e1m b\u00edt qu\u00e1 ch\u00f3p. Khi c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p th\u00ec c\u00e1c quan s\u00e1t c\u0169ng cho k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 nh\u01b0ng s\u1ef1 kh\u00e1c bi\u1ec7t nh\u1ecf h\u01a1n.<\/p>\n

M\u1ed9t b\u00e0i vi\u1ebft t\u1ed5ng quan kh\u00e1c v\u1ec1 chi\u1ec1u d\u00e0i tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y t\u1ed1i \u01b0u cho th\u1ea5y, sau 2 n\u0103m theo d\u00f5i, c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u00e1m b\u00edt ng\u1eafn h\u01a1n 0 \u2212 1 mm so v\u1edbi ch\u00f3p r\u0103ng tr\u00ean phim cho k\u1ebft qu\u1ea3 th\u00e0nh c\u00f4ng cao h\u01a1n so v\u1edbi khi tr\u00e1m ng\u1eafn h\u01a1n 1 \u2013 3 mm, v\u00e0 c\u1ea3 2 tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec1u cho t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng cao h\u01a1n so v\u1edbi khi tr\u00e1m b\u00edt qu\u00e1 ch\u00f3p.<\/p>\n

Ch\u1ea5t l\u01b0\u1ee3ng tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y<\/strong><\/p>\n

T\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb c\u00f3 ch\u1ea5t l\u01b0\u1ee3ng tr\u00e1m b\u00edt t\u1ed1t (b\u00edt k\u00edn v\u00e0 kh\u00f4ng c\u00f3 k\u1ebd h\u1edf) cao h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi tr\u00e1m b\u00edt ch\u1ea5t l\u01b0\u1ee3ng k\u00e9m. S\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y \u0111\u01b0\u1ee3c th\u1ea5y l\u00e0 cao h\u01a1n \u1edf nh\u1eefng r\u0103ng \u0111i\u1ec1u tr\u1ecb t\u1ee7y l\u1ea1i so v\u1edbi nh\u1eefng r\u0103ng \u0111i\u1ec1u tr\u1ecb t\u1ee7y l\u1ea7n \u0111\u1ea7u.<\/p>\n

Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00f3i tr\u00ean nh\u1ea5n m\u1ea1nh m\u1ed9t th\u1ef1c t\u1ebf l\u00e0 b\u1ec7nh l\u00fd n\u1ed9i nha ch\u1ee7 y\u1ebfu do nhi\u1ec5m tr\u00f9ng t\u1eeb vi khu\u1ea9n. V\u00ec v\u1eady, b\u1ea5t k\u1ef3 sai s\u00f3t trong vi\u1ec7c tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y \u0111\u1ec1u s\u1ebd l\u00e0m gia t\u0103ng \u1ea3nh h\u01b0\u1edfng c\u1ee7a vi khu\u1ea9n. Trong tr\u01b0\u1eddng h\u1ee3p y\u1ebfu t\u1ed1 nhi\u1ec5m tr\u00f9ng \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t th\u00ec nh\u1eefng sai s\u00f3t n\u00f3i tr\u00ean kh\u00f4ng g\u00e2y t\u00e1c \u0111\u1ed9ng nhi\u1ec1u l\u00ean k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. S\u1ef1 quan s\u00e1t n\u00e0y c\u0169ng ph\u00f9 h\u1ee3p v\u1edbi nh\u1eefng nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00e2y. \u1ede m\u1ed9t nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt, khi s\u1eeda so\u1ea1n \u1ed1ng t\u1ee7y t\u1ed1t nh\u01b0ng kh\u00f4ng tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y th\u00ec r\u0103ng v\u1eabn l\u00e0nh th\u01b0\u01a1ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 r\u0103ng \u0111\u00e3 tr\u00e1m b\u00edt d\u00f9 c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p. Lin c\u0169ng nh\u1eadn th\u1ea5y r\u1eb1ng, gi\u1edbi h\u1ea1n ph\u00eda ch\u00f3p c\u1ee7a vi\u1ec7c tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y, ch\u1eb3ng h\u1ea1n nh\u01b0 ch\u01b0a t\u1edbi ch\u00f3p, ngang ch\u00f3p ho\u1eb7c qu\u00e1 ch\u00f3p d\u01b0\u1eddng nh\u01b0 kh\u00f4ng c\u00f3 m\u1ed1i li\u00ean quan v\u1edbi vi\u1ec7c \u0111i\u1ec1u tr\u1ecb th\u1ea5t b\u1ea1i. Trong m\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c, ng\u01b0\u1eddi ta nh\u1eadn th\u1ea5y r\u00f5 r\u00e0ng l\u00e0 khi kh\u00f4ng c\u00f3 vi khu\u1ea9n hi\u1ec7n di\u1ec7n th\u00ec s\u1ef1 l\u00e0nh th\u01b0\u01a1ng lu\u00f4n x\u1ea3y ra b\u1ea5t k\u1ec3 ch\u1ea5t l\u01b0\u1ee3ng tr\u00e1m b\u00edt nh\u01b0 th\u1ebf n\u00e0o. Nh\u01b0ng khi c\u00f3 m\u1eb7t vi khu\u1ea9n t\u1ea1i th\u1eddi \u0111i\u1ec3m tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y th\u00ec c\u00f3 s\u1ef1 li\u00ean h\u1ec7 gi\u1eefa ch\u1ea5t l\u01b0\u1ee3ng tr\u00e1m b\u00edt v\u00e0 v\u1ea5n \u0111\u1ec1 kh\u00f4ng l\u00e0nh th\u01b0\u01a1ng.<\/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 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 trong \u0111i\u1ec1u tr\u1ecb N\u1ed9i nha v\u00e0 ti\u00ean l\u01b0\u1ee3ng t\u1edbi b\u1ec7nh l\u00fd tu\u1ef7 r\u0103ng. Th\u00f4ng th\u01b0\u1eddng, c\u00e1c y\u1ebfu t\u1ed1 n\u00e0y c\u00f3 m\u1ed1i li\u00ean h\u1ec7 ch\u1eb7t ch\u1ebd \u0111\u1ed1i v\u1edbi k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, quy\u1ebft \u0111\u1ecbnh k\u1ebft qu\u1ea3 t\u1ed1t hay kh\u00f4ng, g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ng\u01b0\u1eddi b\u1ec7nh hay kh\u00f4ng,… […]<\/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":"\nY\u1ebfu t\u1ed1 trong \u0111i\u1ec1u tr\u1ecb ti\u00ean l\u01b0\u1ee3ng t\u1edbi b\u1ec7nh l\u00fd tu\u1ef7 r\u0103ng. - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft n\u00e0y \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 trong \u0111i\u1ec1u tr\u1ecb N\u1ed9i nha v\u00e0 ti\u00ean l\u01b0\u1ee3ng t\u1edbi b\u1ec7nh l\u00fd tu\u1ef7. 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