{"id":32037,"date":"2023-05-05T16:42:52","date_gmt":"2023-05-05T09:42:52","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32037"},"modified":"2023-05-05T19:58:12","modified_gmt":"2023-05-05T12:58:12","slug":"mui-khoan-xoang-dac-hieu-phuong-phap-tiep-can-moi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/mui-khoan-xoang-dac-hieu-phuong-phap-tiep-can-moi\/","title":{"rendered":"M\u0169i khoan xoang \u0111\u1eb7c hi\u1ec7u – Ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn m\u1edbi."},"content":{"rendered":"

K\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng m\u0169i khoan xoang \u0111\u1eb7c hi\u1ec7u \u0111\u00e3 th\u1ec3 hi\u1ec7n \u01b0u \u0111i\u1ec3m c\u1ee7a n\u00f3: \u0110\u01a1n gi\u1ea3n h\u00f3a c\u00e1c th\u00e1ch th\u1ee9c ph\u1eabu thu\u1eadt, \u0111\u1ed3ng th\u1eddi gi\u1ea3m th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u00e0 nguy c\u01a1 b\u1ec7nh t\u1eadt cho b\u1ec7nh nh\u00e2n. M\u1eb7c d\u00f9 n\u00e2ng xoang gh\u00e9p x\u01b0\u01a1ng \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t ph\u1eabu thu\u1eadt c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t, nh\u01b0ng nh\u1eefng nghi\u00ean c\u1ee9u ti\u1ebfp theo trong t\u01b0\u01a1ng lai c\u1ea7n \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf trong th\u1eddi gian d\u00e0i v\u00e0 v\u1edbi c\u1ee1 m\u1eabu l\u1edbn. B\u00e0i vi\u1ebft sau t\u1eadp trung khai th\u00e1c v\u1ec1 \u01b0u \u0111i\u1ec3m c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y, \u0111\u1ed3ng th\u1eddi ti\u1ebfn h\u00e0nh \u0111\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 v\u00e0 n\u00eau ra t\u1ea7m quan tr\u1ecdng c\u1ee7a th\u01b0\u01a1ng s\u1ed1 \u1ed5n \u0111\u1ecbnh Implant \u0111\u1ed1i v\u1edbi qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt. C\u00f9ng t\u00ecm hi\u1ec3u.<\/strong><\/p>\n

1. \u01afu \u0111i\u1ec3m c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn s\u1eed d\u1ee5ng m\u0169i khoan xoang \u0111\u1eb7c hi\u1ec7u trong n\u00e2ng xoang h\u00e0m<\/h2>\n

Kh\u00e1c v\u1edbi k\u1ef9 thu\u1eadt \u0111\u1ee5c x\u01b0\u01a1ng (osteotome), k\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng m\u0169i khoan xoang n\u00e0y kh\u00f4ng s\u1eed d\u1ee5ng b\u00faa. \u0110i\u1ec1u n\u00e0y s\u1ebd lo\u1ea1i tr\u1eeb bi\u1ebfn ch\u1ee9ng nh\u01b0 ch\u00f3ng m\u1eb7t l\u00e0nh t\u00ednh \u0111\u1ed3ng th\u1eddi gi\u1ea3m n\u1ed7i s\u1ee3 nha khoa trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt. Ngo\u00e0i ra, \u201cm\u0169i khoan b\u1ed9c l\u1ed9 xoang” \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 an to\u00e0n v\u1edbi m\u00e0ng xoang trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng. M\u0169i khoan n\u00e0y c\u00f3 \u0111\u1ea7u t\u1eadn c\u00f9ng ph\u1eb3ng, cho ph\u00e9p khoan x\u01b0\u01a1ng m\u00e0 kh\u00f4ng l\u00e0m r\u00e1ch m\u00e0ng Schneiderian.<\/p>\n

2. \u0110\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 khi th\u1ef1c hi\u1ec7n<\/h2>\n

\u0110\u1ed9 d\u00e0y m\u00e0ng xoang, \u0111\u1ed9ng m\u1ea1ch x\u01b0\u01a1ng \u1ed5 tr\u00ean sau (PSA), l\u1ed7 xoang, v\u00e0 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a nang ni\u00eam d\u1ecbch. M\u00e0ng xoang d\u00e0y h\u01a1n 3 mm \u0111\u01b0\u1ee3c xem l\u00e0 vi\u00eam xoang m\u1ea1n. \u0110\u1ed9ng m\u1ea1ch x\u01b0\u01a1ng \u1ed5 tr\u00ean sau th\u01b0\u1eddng n\u1eb1m c\u00e1ch m\u00e0o x\u01b0\u01a1ng 16.4 mm theo Elian v\u00e0 c\u1ed9ng s\u1ef1. N\u1ebfu l\u1ed7 xoang kh\u00f4ng th\u00f4ng tho\u00e1ng th\u00ec s\u1ebd c\u00f3 nguy c\u01a1 vi\u00eam xoang sau ph\u1eabu thu\u1eadt cao h\u01a1n. Nang ni\u00eam d\u1ecbch c\u00f3 th\u1ec3 l\u00e0m t\u1eafc l\u1ed7 xoang sau ph\u1eabu thu\u1eadt n\u00e2ng xoang.<\/p>\n

B\u1ea3o t\u1ed3n b\u1ed1n v\u00e1ch x\u01b0\u01a1ng (ngo\u00e0i, trong, g\u1ea7n, v\u00e0 xa) c\u1ee7a \u1ed5 r\u0103ng l\u00e0 \u0111i\u1ec1u quan tr\u1ecdng nh\u1ea5t trong k\u1ef9 thu\u1eadt nh\u1ed5 r\u0103ng. Ngu\u1ed3n c\u1ea5p m\u00e1u cho v\u1eadt li\u1ec7u gh\u00e9p v\u00e0 implant l\u00e0 t\u1eeb c\u00e1c v\u00e1ch x\u01b0\u01a1ng. N\u1ebfu b\u1ea3n x\u01b0\u01a1ng ngo\u00e0i b\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u00ec s\u1ebd l\u00e0m m\u1ea5t \u0111i ngu\u1ed3n c\u1ea5p m\u00e1u quan tr\u1ecdng cho v\u1eadt li\u1ec7u gh\u00e9p. S\u1ef1 x\u00e2m l\u1ea5n bi\u1ec3u m\u00f4 s\u1ebd x\u1ea3y ra, v\u00e0 cu\u1ed1i c\u00f9ng v\u1eadt li\u1ec7u gh\u00e9p s\u1ebd b\u1ecb \u0111\u00e0o th\u1ea3i. Do \u0111\u00f3, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i b\u1ea3o t\u1ed3n c\u1ea3 b\u1ed1n v\u00e1ch x\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 b\u1ea3n x\u01b0\u01a1ng ngo\u00e0i b\u1edfi v\u00ec n\u00f3 m\u1ecfng nh\u1ea5t v\u00e0 \u0111\u01b0\u1ee3c t\u1ea1o th\u00e0nh t\u1eeb x\u01b0\u01a1ng b\u00f3. S\u1eed d\u1ee5ng Periotome \u0111\u1ec3 chia ch\u00e2n r\u0103ng, v\u00e0 \u0111\u1ea7u \u00e1p ph\u1eabu thu\u1eadt (piezo) th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 b\u1ea3o t\u1ed3n b\u1ea3n x\u01b0\u01a1ng ngo\u00e0i khi nh\u1ed5 r\u0103ng.<\/p>\n

M\u00e0ng xoang d\u00e0y th\u01b0\u1eddng g\u1ee3i \u00fd v\u1ec1 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a vi\u00eam xoang – m\u1ed9t t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng trong xoang. Ch\u00fang ta ph\u1ea3i tr\u00ec ho\u00e3n th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt n\u00e2ng xoang cho \u0111\u1ebfn khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb y khoa ph\u00f9 h\u1ee3p. N\u1ebfu \u0111\u1ed9 d\u00e0y > 3 mm, th\u00ec n\u00ean chuy\u1ec3n b\u1ec7nh nh\u00e2n cho b\u00e1c s\u0129 tai-m\u0169i-h\u1ecdng, b\u1edfi v\u00ec n\u00f3 \u0111\u01b0\u1ee3c xem l\u00e0 vi\u00eam xoang m\u1ea1n.<\/p>\n

Khi ch\u1ee5p CT scan, ch\u00fang ta ph\u1ea3i xem x\u00e9t:<\/p>\n

    \n
  • s\u1ef1 th\u00f4ng tho\u00e1ng c\u1ee7a l\u1ed7 xoang<\/li>\n
  • \u0111\u1ed9 d\u00e0y c\u1ee7a m\u00e0ng Schneiderian<\/li>\n
  • s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a nang ni\u00eam d\u1ecbch<\/li>\n
  • s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a polyp<\/li>\n
  • v\u1ecb tr\u00ed c\u1ee7a c\u00e1c nh\u00e1nh n\u1ed1i n\u1eb1m trong x\u01b0\u01a1ng c\u1ee7a \u0111\u1ed9ng m\u1ea1ch x\u01b0\u01a1ng \u1ed5 tr\u00ean sau<\/li>\n
  • \u0111\u1ed9 d\u00e0y c\u1ee7a th\u00e0nh b\u00ean, th\u00e0nh ngo\u00e0i, th\u00e0nh trong (gi\u1ea3i ph\u1eabu\/k\u00edch th\u01b0\u1edbc)<\/li>\n
  • s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a v\u00e1ch ng\u0103n.<\/li>\n<\/ul>\n

    3. T\u1ea7m quan tr\u1ecdng c\u1ee7a th\u01b0\u01a1ng s\u1ed1 \u1ed5n \u0111\u1ecbnh Implant (ISQ)<\/h2>\n
    \"mui-khoan-xoang\"
    H\u1ec7 th\u1ed1ng m\u00e1y \u0111o ISQ<\/figcaption><\/figure>\n

    Phim X-quang kh\u00f4ng c\u00f3 \u0111\u1ed9 nh\u1ea1y cao trong vi\u1ec7c ph\u00e1t hi\u1ec7n implant th\u1ea5t b\u1ea1i\/kh\u00f4ng l\u00e0nh m\u1ea1nh. Ng\u01b0\u1ee3c l\u1ea1i, th\u01b0\u01a1ng s\u1ed1 \u1ed5n \u0111\u1ecbnh c\u1ee7a implant (ISQ) cho ph\u00e9p \u0111o l\u01b0\u1eddng \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh c\u1ee7a implant b\u1eb1ng \u0111i\u1ec7n tr\u1edf t\u1eeb. Do \u0111\u00f3, n\u00f3 c\u00f3 \u0111\u1ed9 nh\u1ea1y cao h\u01a1n trong vi\u1ec7c \u0111o l\u01b0\u1eddng s\u1ef1 th\u00e0nh c\u00f4ng c\u1ee7a implant. ISQ \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111o gi\u00e1 tr\u1ecb \u0111\u1ecbnh l\u01b0\u1ee3ng nh\u1eb1m \u01b0\u1edbc l\u01b0\u1ee3ng th\u1eddi \u0111i\u1ec3m t\u1ea3i l\u1ef1c th\u00edch h\u1ee3p tr\u00ean implant. Ng\u01b0\u1eddi ta \u0111\u1ec1 ngh\u1ecb n\u00ean \u0111o ISQ ngay sau khi \u0111\u1eb7t implant (l\u00e0m d\u1eef li\u1ec7u ban \u0111\u1ea7u), v\u00e0 sau \u0111\u00f3 so s\u00e1nh n\u00f3 v\u1edbi ISQ sau l\u00e0nh th\u01b0\u01a1ng (sau 2-6 th\u00e1ng) \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 h\u00ecnh th\u00e0nh \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh th\u1ee9 c\u1ea5p. V\u00ed d\u1ee5, n\u1ebfu ISQ l\u00e0 70, n\u00f3 c\u00f3 ngh\u0129a l\u00e0 ch\u00fang ta \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh c\u01a1 h\u1ecdc ho\u1eb7c \u1ed5n \u0111\u1ecbnh c\u01a1 h\u1ecdc t\u1ed1t v\u00e0 c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh t\u1ea3i l\u1ef1c t\u1ee9c th\u00ec. N\u1ebfu ISQ l\u00e0 65-70 th\u00ec ch\u00fang ta n\u00ean th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt hai th\u00ec. N\u1ebfu n\u00f3 < 60 th\u00ec n\u00ean s\u1eed d\u1ee5ng implant \u0111\u01b0\u1eddng k\u00ednh l\u1edbn h\u01a1n \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh ban \u0111\u1ea7u.<\/p>\n

    B\u1eb1ng c\u00e1ch khoan x\u01b0\u01a1ng h\u01a1i h\u1eb9p h\u01a1n, ch\u00fang ta c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh s\u01a1 kh\u1edfi t\u1ed1t h\u01a1n \u1edf x\u01b0\u01a1ng D3 v\u00e0 D4 (b\u1ecf qua m\u0169i khoan cu\u1ed1i c\u00f9ng theo khuy\u1ebfn ngh\u1ecb c\u1ee7a nh\u00e0 s\u1ea3n xu\u1ea5t). C\u00f3 b\u1ed1n lo\u1ea1i ch\u1ea5t l\u01b0\u1ee3ng x\u01b0\u01a1ng: D1 ho\u00e0n to\u00e0n l\u00e0 x\u01b0\u01a1ng v\u1ecf v\u00e0 n\u1eb1m \u1edf v\u00f2m s\u1ecd. D2 ch\u1ee7 y\u1ebfu l\u00e0 x\u01b0\u01a1ng v\u1ecf v\u00e0 n\u1eb1m \u1edf x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi ph\u00eda tr\u01b0\u1edbc, th\u1ec9nh tho\u1ea3ng \u1edf x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi ph\u00eda sau. X\u01b0\u01a1ng D3 c\u00f3 x\u01b0\u01a1ng v\u1ecf m\u1ecfng h\u01a1n, \u0111\u01b0\u1ee3c bao quanh ch\u1ee7 y\u1ebfu b\u1edfi x\u01b0\u01a1ng t\u1ee7y. Lo\u1ea1i x\u01b0\u01a1ng n\u00e0y n\u1eb1m \u1edf x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi ph\u00eda sau v\u00e0 x\u01b0\u01a1ng h\u00e0m tr\u00ean ph\u00eda tr\u01b0\u1edbc. X\u01b0\u01a1ng D4 ch\u1ee7 y\u1ebfu l\u00e0 x\u01b0\u01a1ng t\u1ee7y v\u00e0 n\u1eb1m \u1edf x\u01b0\u01a1ng h\u00e0m tr\u00ean ph\u00eda sau. D3 v\u00e0 D4 c\u00f3 khuynh h\u01b0\u1edbng \u1ed5n \u0111\u1ecbnh ban \u0111\u1ea7u k\u00e9m, do \u0111\u00f3, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 b\u00e1c s\u0129 ph\u1eabu thu\u1eadt ph\u1ea3i khoan x\u01b0\u01a1ng \u00edt h\u01a1n, hay s\u1eed d\u1ee5ng implant d\u1ea1ng thu\u00f4n v\u00e0 c\u00f3 ren, \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c h\u01a1n 35 Nam ho\u1eb7c ISQ t\u1eeb 65 tr\u1edf l\u00ean.<\/p>\n

    T\u1ed5ng k\u1ebft l\u1ea1i, k\u1ef9 thu\u1eadt n\u00e0y \u0111\u01a1n gi\u1ea3n h\u00f3a c\u00e1c th\u00e1ch th\u1ee9c ph\u1eabu thu\u1eadt, \u0111\u1ed3ng th\u1eddi gi\u1ea3m th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u00e0 nguy c\u01a1 b\u1ec7nh t\u1eadt cho b\u1ec7nh nh\u00e2n. M\u1eb7c d\u00f9 n\u00e2ng xoang gh\u00e9p x\u01b0\u01a1ng \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t ph\u1eabu thu\u1eadt c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t, nh\u01b0ng nh\u1eefng nghi\u00ean c\u1ee9u ti\u1ebfp theo trong t\u01b0\u01a1ng lai c\u1ea7n \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf trong th\u1eddi gian d\u00e0i v\u00e0 v\u1edbi c\u1ee1 m\u1eabu l\u1edbn.<\/p>\n

    Ngu\u1ed3n t\u00e0i li\u1ec7u: Clinical Cases in Implant Dentistry, First Edition – Published 2017 by John Wiley & Sons, Inc.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

    K\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng m\u0169i khoan xoang \u0111\u1eb7c hi\u1ec7u \u0111\u00e3 th\u1ec3 hi\u1ec7n \u01b0u \u0111i\u1ec3m c\u1ee7a n\u00f3: \u0110\u01a1n gi\u1ea3n h\u00f3a c\u00e1c th\u00e1ch th\u1ee9c ph\u1eabu thu\u1eadt, \u0111\u1ed3ng th\u1eddi gi\u1ea3m th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u00e0 nguy c\u01a1 b\u1ec7nh t\u1eadt cho b\u1ec7nh nh\u00e2n. M\u1eb7c d\u00f9 n\u00e2ng xoang gh\u00e9p x\u01b0\u01a1ng \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t ph\u1eabu thu\u1eadt c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t, […]<\/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":"\nM\u0169i khoan xoang \u0111\u1eb7c hi\u1ec7u - Ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn m\u1edbi. - Vinmec<\/title>\n<meta name=\"description\" content=\"K\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng m\u0169i khoan xoang \u0111\u1eb7c hi\u1ec7u c\u00f3 \u01b0u \u0111i\u1ec3m: \u0110\u01a1n gi\u1ea3n ho\u00e1 ph\u1eabu thu\u1eadt, gi\u1ea3m th\u1eddi gian \u0111i\u1ec1u tr\u1ecb, gi\u1ea3m nguy c\u01a1 b\u1ec7nh t\u1eadt. 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