{"id":28596,"date":"2023-04-26T16:31:47","date_gmt":"2023-04-26T09:31:47","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28596"},"modified":"2023-05-01T23:50:23","modified_gmt":"2023-05-01T16:50:23","slug":"ty-le-ket-qua-dieu-tri-noi-nha-co-phau-thuat-goc-nhin","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/26\/ty-le-ket-qua-dieu-tri-noi-nha-co-phau-thuat-goc-nhin\/","title":{"rendered":"T\u1ef7 l\u1ec7 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha c\u00f3 ph\u1eabu thu\u1eadt – G\u00f3c nh\u00ecn."},"content":{"rendered":"

B\u00e0i vi\u1ebft nh\u1eb1m \u0111\u00e1nh gi\u00e1 t\u1ef7 l\u1ec7 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha c\u00f3 ph\u1eabu thu\u1eadt theo ti\u00eau chu\u1ea9n c\u1ee7a Strindberg v\u1ec1 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha. Vi\u1ec7c n\u1eafm \u0111\u01b0\u1ee3c nh\u1eefng d\u1eef li\u1ec7u thu \u0111\u01b0\u1ee3c t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ed1i v\u1edbi qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb s\u1ebd ph\u1ea7n n\u00e0o gi\u00fap Nha s\u0129 c\u00f3 c\u00e1i nh\u00ecn s\u00e2u s\u1eafc v\u00e0 to\u00e0n di\u1ec7n h\u01a1n tr\u00ean l\u00e2m s\u00e0ng. C\u00f9ng t\u00ecm hi\u1ec3u.<\/strong><\/p>\n

1. T\u1ef7 l\u1ec7 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha c\u00f3 ph\u1eabu thu\u1eadt<\/h2>\n

K\u1ebft qu\u1ea3 c\u1ee7a nh\u1eefng nghi\u00ean c\u1ee9u ban \u0111\u1ea7u theo ti\u00eau chu\u1ea9n c\u1ee7a Strindberg v\u1ec1 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha v\u00e0o l\u1ea7n t\u00e1i kh\u00e1m cu\u1ed1i c\u00f9ng sau th\u1eddi gian theo d\u00f5i 4 n\u0103m \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y \u1edf b\u1ea3ng d\u01b0\u1edbi \u0111\u00e2y.<\/p>\n\n\n\n\n\n
Qu\u1ea7n th\u1ec3 vi khu\u1ea9n<\/b><\/td>\nTh\u00e0nh c\u00f4ng (%)<\/b><\/td>\nTh\u1ea5t b\u1ea1i (%)<\/b><\/td>\nKh\u00f4ng x\u00e1c \u0111\u1ecbnh (%)<\/b><\/td>\n<\/tr>\n
Kh\u00f4ng c\u00f3 vi khu\u1ea9n<\/span><\/td>\n88.6<\/span><\/td>\n11.4<\/span><\/td>\n0<\/span><\/td>\n<\/tr>\n
C\u00f3 m\u1eb7t vi khu\u1ea9n<\/span><\/td>\n68.6<\/span><\/td>\n25.4<\/span><\/td>\n6.0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

B\u1ea3ng 1. M\u1ed1i li\u00ean h\u1ec7 gi\u1eefa qu\u1ea7n th\u1ec3 vi khu\u1ea9n ho\u1ea1t \u0111\u1ed9ng v\u1edbi ti\u00ean l\u01b0\u1ee3ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha<\/p>\n

Nh\u1eefng d\u1eef li\u1ec7u n\u00e0y \u0111\u00e3 ch\u1ee9ng minh t\u1ef7 l\u1ec7 k\u1ebft qu\u1ea3 th\u00e0nh c\u00f4ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha th\u1ea5p h\u01a1n \u0111\u00e1ng k\u1ec3 tr\u00ean nh\u1eefng r\u0103ng ho\u1ea1i t\u1eed t\u1ee7y c\u00f3 vi\u00eam quanh ch\u00f3p so v\u1edbi r\u0103ng c\u00f3 m\u00f4 quanh ch\u00f3p b\u00ecnh th\u01b0\u1eddng (p<0.05). T\u1ef7 l\u1ec7 k\u1ebft qu\u1ea3 ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p v\u00e0 ph\u00e2n lo\u1ea1i ch\u1ea9n \u0111o\u00e1n quanh ch\u00f3p tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb ch\u1ee9ng minh m\u1ed1i quan h\u1ec7 m\u1eadt thi\u1ebft gi\u1eefa ch\u1ea9n \u0111o\u00e1n n\u1ed9i nha v\u00e0 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. Do \u0111\u00f3, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a th\u1ea5u quang quanh ch\u00f3p tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb, th\u1ec3 hi\u1ec7n m\u1ed9t vi\u00eam quanh ch\u00f3p, c\u0169ng l\u00e0 m\u1ed9t ch\u1ec9 b\u00e1o ti\u00ean l\u01b0\u1ee3ng m\u1ea1nh m\u1ebd. Ph\u00e1t hi\u1ec7n n\u00e0y \u0111\u01b0\u1ee3c l\u1eb7p l\u1ea1i trong nhi\u1ec1u nghi\u00ean c\u1ee9u.<\/p>\n

M\u1ed9t nghi\u00ean c\u1ee9u k\u1ebft qu\u1ea3 \u0111\u00e3 l\u1ea5y m\u1eabu vi khu\u1ea9n tr\u01b0\u1edbc khi tr\u00e1m b\u00edt, s\u1eed d\u1ee5ng ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean nghi\u00ean c\u1ee9u vi khu\u1ea9n. K\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb sau 4 n\u0103m \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 theo ti\u00eau chu\u1ea9n Strindberg. K\u1ebft qu\u1ea3 cho th\u1ea5y r\u0103ng v\u1edbi h\u1ec7 vi khu\u1ea9n c\u00f2n ho\u1ea1t \u0111\u1ed9ng tr\u01b0\u1edbc tr\u00e1m b\u00edt, th\u1ec3 hi\u1ec7n m\u1ed9t nhi\u1ec5m tr\u00f9ng c\u00f2n t\u1ed3n t\u1ea1i, th\u00ec c\u00f3 t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng th\u1ea5p h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi r\u0103ng c\u00f3 h\u1ec7 vi khu\u1ea9n b\u1ecb b\u1ea5t ho\u1ea1t.<\/p>\n

S\u1ef1 l\u00e0nh th\u01b0\u01a1ng l\u00e2u d\u00e0i (8 \u2013 10 n\u0103m sau \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha) cho t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng l\u00e0 96% \u1edf r\u0103ng c\u00f3 t\u1ee7y s\u1ed1ng v\u00e0 98% \u1edf r\u0103ng ho\u1ea1i t\u1eed t\u1ee7y kh\u00f4ng c\u00f3 th\u1ea5u quang quanh ch\u00f3p tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb. Tuy nhi\u00ean ch\u1ec9 86% r\u0103ng ho\u1ea1i t\u1eed t\u1ee7y c\u00f3 t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p \u0111\u01b0\u1ee3c th\u1ea5y l\u00e0nh th\u01b0\u01a1ng sau \u0111i\u1ec1u tr\u1ecb. Do v\u1eady, ti\u00ean l\u01b0\u1ee3ng nh\u1eefng r\u0103ng kh\u00f4ng c\u00f3 th\u1ea5u quang quanh ch\u00f3p tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb thu\u1eadn l\u1ee3i h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p (p<0.0001). M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c xem x\u00e9t vai tr\u00f2 c\u1ee7a nhi\u1ec5m tr\u00f9ng \u0111\u1ed1i v\u1edbi ti\u00ean l\u01b0\u1ee3ng n\u1ed9i nha 5 n\u0103m sau \u0111i\u1ec1u tr\u1ecb, s\u1eed d\u1ee5ng ti\u00eau chu\u1ea9n Strindberg. T\u1ea5t c\u1ea3 c\u00e1c r\u0103ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ho\u1ea1i t\u1eed t\u1ee7y v\u00e0 vi\u00eam quanh ch\u00f3p \u0111\u1ec1u \u0111\u01b0\u1ee3c ph\u00e2n t\u00edch vi khu\u1ea9n tr\u01b0\u1edbc khi tr\u00e1m b\u00edt. Nghi\u00ean c\u1ee9u n\u00e0y c\u0169ng cho t\u1ec9 l\u1ec7 duy tr\u00ec \u1ea5n t\u01b0\u1ee3ng 5 n\u0103m sau \u0111i\u1ec1u tr\u1ecb l\u00e0 96%. K\u1ebft qu\u1ea3 cho th\u1ea5y t\u1ec9 l\u1ec7 l\u00e0nh th\u01b0\u01a1ng ho\u00e0n to\u00e0n \u1edf 94% tr\u01b0\u1eddng h\u1ee3p r\u0103ng c\u00f3 h\u1ec7 vi khu\u1ea9n b\u1ecb b\u1ea5t ho\u1ea1t tr\u01b0\u1edbc tr\u00e1m b\u00edt v\u00e0 68% tr\u01b0\u1eddng h\u1ee3p c\u00f3 h\u1ec7 vi khu\u1ea9n ho\u1ea1t \u0111\u1ed9ng tr\u01b0\u1edbc tr\u00e1m b\u00edt (p<0.05).<\/p>\n\n\n\n\n\n
Qu\u1ea7n th\u1ec3 vi khu\u1ea9n<\/b><\/td>\nTh\u00e0nh c\u00f4ng (%)<\/b><\/td>\nTh\u1ea5t b\u1ea1i (%)<\/b><\/td>\n<\/tr>\n
Kh\u00f4ng c\u00f3 vi khu\u1ea9n<\/span><\/td>\n94<\/span><\/td>\n6<\/span><\/td>\n<\/tr>\n
C\u00f3 m\u1eb7t vi khu\u1ea9n<\/span><\/td>\n68<\/span><\/td>\n32<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

B\u1ea3ng 2. \u1ea2nh h\u01b0\u1edfng c\u1ee7a nhi\u1ec5m tr\u00f9ng t\u1ea1i th\u1eddi \u0111i\u1ec3m tr\u00e1m b\u00edt l\u00ean k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha c\u1ee7a nh\u1eefng r\u0103ng c\u00f3 vi\u00eam quanh ch\u00f3p<\/p>\n

Nghi\u00ean c\u1ee9u Toronto \u0111\u00e3 \u0111\u01b0a ra k\u1ebft qu\u1ea3 d\u1ef1a tr\u00ean \u0111i\u1ec3m s\u1ed1 PAI (Periapical Index). R\u0103ng kh\u00f4ng c\u00f3 vi\u00eam quanh ch\u00f3p tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb (\u0111i\u1ec3m s\u1ed1 PAI <3) cho t\u1ec9 l\u1ec7 l\u00e0nh th\u01b0\u01a1ng l\u00e0 92%, trong khi nh\u1eefng r\u0103ng c\u00f3 vi\u00eam quanh ch\u00f3p tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb (PAI 23) th\u00ec t\u1ec9 l\u1ec7 l\u00e0nh th\u01b0\u01a1ng l\u00e0 74%.<\/p>\n

M\u1ed9t b\u00e0i t\u1ed5ng quan c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng v\u1ec1 th\u00e0nh c\u00f4ng v\u00e0 th\u1ea5t b\u1ea1i c\u1ee7a \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha kh\u00f4ng ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi t\u1ec9 l\u1ec7 k\u1ebft qu\u1ea3 th\u00e0nh c\u00f4ng chung tr\u00ean X quang l\u00e0 81.5% trong th\u1eddi gian 5 n\u0103m. M\u1ed9t b\u00e0i t\u1ed5ng quan kh\u00e1c v\u1ec1 k\u1ebft qu\u00e1 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha l\u1ea7n \u0111\u1ea7u \u0111\u00e3 k\u1ebft lu\u1eadn r\u1eb1ng t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng kh\u00f4ng thay \u0111\u1ed5i trong 4 ho\u1eb7c 5 th\u1eadp k\u1ec9 qua. T\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o r\u1ed9ng r\u00e3i trong c\u00e1c nghi\u00ean c\u1ee9u c\u00e1 nh\u00e2n kh\u00e1c nhau l\u00e0 do c\u00e1c ti\u00eau chu\u1ea9n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. Khi c\u00e1c ti\u00eau chu\u1ea9n nghi\u00eam ng\u1eb7t \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 ph\u00e2n t\u00edch k\u1ebft qu\u1ea3 th\u00ec t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng trung b\u00ecnh dao \u0111\u1ed9ng t\u1eeb 31% – 96.2%, v\u1edbi t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng g\u1ed9p l\u1ea1i l\u00e0 74.7%. Ng\u01b0\u1ee3c l\u1ea1i, khi ti\u00eau chu\u1ea9n t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 ph\u00e2n t\u00edch th\u00ec t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng thay \u0111\u1ed5i t\u1eeb 60% – 100%, v\u00e0 t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng g\u1ed9p l\u1ea1i l\u00e0 85.2%. Nh\u1eefng k\u1ebft qu\u1ea3 n\u00e0y cho th\u1ea5y t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng trung b\u00ecnh th\u1ea5p h\u01a1n 10% khi c\u00e1c ti\u00eau chu\u1ea9n nghi\u00eam ng\u1eb7t \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. T\u1ef7 l\u1ec7 k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 c\u0169ng thu \u0111\u01b0\u1ee3c trong m\u1ed9t nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u, cho bi\u1ebft t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha l\u00e0 83% khi c\u00e1c ti\u00eau chu\u1ea9n nghi\u00eam ng\u1eb7t \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

2. T\u1ed5ng k\u1ebft l\u1ea1i v\u1ea5n \u0111\u1ec1<\/h2>\n

G\u1ea7n \u0111\u00e2y, khi ph\u00e2n lo\u1ea1i k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha, quan ni\u1ec7m v\u1ec1 \u201cr\u0103ng c\u00f3 ch\u1ee9c n\u0103ng\u201d (functional tooth) \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u. T\u01b0\u01a1ng t\u1ef1, \u201cr\u0103ng c\u00f2n t\u1ed3n t\u1ea1i\u201d (tooth survival) c\u0169ng \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn v\u00e0 \u0111\u01b0\u1ee3c \u0111\u1eb7t song song v\u1edbi c\u00e1c ti\u00eau chu\u1ea9n ph\u1ed5 bi\u1ebfn c\u1ee7a implant nha khoa. M\u1ed9t kh\u00e1c bi\u1ec7t quan tr\u1ecdng l\u00e0 m\u1eb7c d\u00f9 vi\u1ec7c gi\u1eef l\u1ea1i m\u1ed9t r\u0103ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00f3 th\u1ef1c hi\u1ec7n ch\u1ee9c n\u0103ng v\u1edbi m\u1ed9t t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p r\u00f5 r\u00e0ng c\u00f2n t\u1ed3n t\u1ea1i tr\u00ean phim X quang c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t k\u1ebft qu\u1ea3 quan tr\u1ecdng cho b\u1ec7nh nh\u00e2n, nh\u01b0ng n\u00f3 c\u0169ng l\u00e0 m\u1ed9t ch\u1ec9 b\u00e1o cho th\u1ea5y s\u1ef1 lo\u1ea1i b\u1ecf nhi\u1ec5m tr\u00f9ng kh\u00f4ng th\u00e0nh c\u00f4ng nh\u01b0 \u0111\u00e3 n\u00f3i trong c\u00e1c nghi\u00ean c\u1ee9u m\u00f4 h\u1ecdc. K\u1ebft ch\u1ee9c n\u0103ng v\u00e0 t\u1ed3n t\u1ea1i n\u00e0y kh\u00f4ng ng\u1ee5 \u00fd k\u1ebft qu\u1ea3 m\u00f4 b\u1ec7nh h\u1ecdc th\u00e0nh c\u00f4ng. Tr\u00e1i l\u1ea1i, k\u1ebft qu\u1ea3 m\u00f4 b\u1ec7nh h\u1ecdc th\u00e0nh c\u00f4ng th\u00ec c\u00f3 ngh\u0129a l\u00e0 k\u1ebft qu\u1ea3 ch\u1ee9c n\u0103ng v\u00e0 t\u1ed3n t\u1ea1i qu\u1ea3 v\u1ec1 th\u00e0nh c\u00f4ng. C\u00e1c nh\u00e0 l\u00e2m s\u00e0ng c\u1ea7n ph\u1ea3i hi\u1ec3u r\u00f5 s\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y, \u0111\u00f4i khi \u0111\u1ec3 gi\u1ea3i th\u00edch nh\u1eefng kh\u00e1i ni\u1ec7m n\u00e0y cho b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, s\u1ef1 hi\u1ec7n di\u1ec7n hay v\u1eafng m\u1eb7t c\u1ee7a c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p tr\u00ean phim c\u00f2n t\u1ed3n t\u1ea1i hay \u0111\u00e3 ti\u00eau bi\u1ebfn v\u1eabn l\u00e0 nh\u1eefng th\u01b0\u1edbc \u0111o ch\u00ednh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/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 nh\u1eb1m \u0111\u00e1nh gi\u00e1 t\u1ef7 l\u1ec7 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha c\u00f3 ph\u1eabu thu\u1eadt theo ti\u00eau chu\u1ea9n c\u1ee7a Strindberg v\u1ec1 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha. 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