Ưu thế của PLDD so với các kỹ thuật can thiệp xâm lấn tối thiểu khác trong điều trị thoát vị đĩa đệm cột sống

uu THE CUA PLDD SO VOTI CAC KY THUAT CAN THIEP XAM LAN TOI THIEU KHAC

TRONG DIEU TRI THOAT V| DI A DEM COT SONG

M d DAU .

Thoat vj dTa dem IS tdn thu'ang thu'dng gap trong

bpnh ly opt sdng. Tru'dc day, md hd du'pe coi IS tieu

chuan vSng khi dilu trj bao tdn khong mang lai kit qua.

Tuy nhien, md ho la mpt can thipp xam lin manh, co

nhilu biln chUng nhir mit vu'ng cpt sdng, tao mo xo d

vlt md bdp nghpt eae ciu true thin kinh, eae bien ehUng

cua gay me. v.v.

D l khac phye cae nhirpc dilm ciia md hd, cac ky

thuat can thipp tdi thilu du'pe phat minh. Cac ky thuat do

la: lay nhan dpm qua da, phan buy nhan dpm bang men,

tgo hinh nhan dpm bang sdng radio, va PLDD

PLDD (vilt tat ciia Percutaneous Laser Disc

Decompression - Giam Sp dTa dpm cpt sdng bang laser

qua da) la ky thuat da du'pe chiing toi dang ap dung tu

11 nam nay vol gin 4.200 bpnh nhan.

Bai vilt nSy so sanh ky thuat PLDD voi 3 ky thuat

can thiep xam lin tdi thieu con lai vUa k l tren.

PHUONG PHA P NGHIEN CLfU

Su so sSnh eSc ky thuat thu'c hien tren eae eo sd:

- Phan tich nguyen ly vS phu'ang thUe thu'c hipn

chiing;

- Tham khao y kiln eua eSc chuyen gia qua y van;

- Phan tich kit qua lam sang ciia ban than nhom

nghien cUu va cac tac gia khac.

K^T QUA

1. Nguyen ly cac ky thuat can thifp xam ll n tdi

thieu

Nguyen ly eSc ky thugt noi tren deu dua tren mo hinh

coi dTa dem cpt sdng IS mpt hp thuy lire kin, gidng nhu"

chat long dirng trong mpt binh cd thanh eung.

That vay, dTa dpm co ciu true mat ben la bao xo ci u

tao tir cac vong spi ehUa chii yl u collagen virng chae;

phia tren va phia dual dupc gioi ban bdi cac mam sun

ciia eae ddt sdng liln kl . Ngoai ra, nd con du'pe ehe phii

bdi cac day chang dpc truac vS dpc sau. CSc ci u triic

vUa k l tao thSnh thSnh cUng. Dong vai trd ehit long la

nhan nhay (nhan dem) dupe ciu tao bdi mpt luoi lien

kit gdm cac spi mem ep chgt vSo nhau trong chUa mpt

chat CO ban nhiy Idng, chua nhilu nu'dc. d ngu'di tre,

ham lu'png nu'dc trong nhan dpm khoang 80-85%, song

lu'png nu'dc nay giam din theo qua trinh thoai hoa do

tudi tae hoac eae nguyen nhan khac. Thoat vj dTa dpm

xiy ra khi vong spi xo rgn rach mpt phan hoac mit kha

nang dan hdi, tao dilu kien cho nhan nhiy djeh chuyin

khoi vj tri sinh ly eiia no, gay chen ep len cac eau triic

than kinh.

De dong vai trd nhu mpt gdi do, Sp suit nhan nhiy

phai Idn hon Sp suit khi quyin d l can bang eSc Sp lye

dgt len dTa dpm. Do tinh virng chae ciia bao xo nen hp

sd Ung suit khdi ciia dTa dpm rit cao. Mpt su thay ddi

nhd v l the tich cung di n tdi sy thay ddi rit Ion v l mat

ap suit.

HA VIET HI§N, TRAN CONG DUYET,

VO HONG HANH, VU CONG LAP

Vien Ngoai khoa Laser

Cic ky thuat can thipp qua da ndi tren di u dya tren

nguyen ti e IS ISm giam mpt th i tich nhd nhan nhiy, qua

do lam giam ap suit npi dTa, giai phong su chen ep len

cac ciu true thin kinh. Co ehi giam th i tich nhan nhiy

CO th i IS CO hpe (liy nhan dpm qua da), hda hoc (phan

hiiy nhan dpm bang men), nhiet (dipn, laser), plasma

(song radio). Ngoai ra, cac ky thugt nay eon eo mpt diem

ehung la djnh vj du'di cac phirong tien chin doan hinh

anh nhu" X-quang, CT scanner hoac MRI.

a. LSy nhan dem qua da (Percutaneous

nueleetomy)

Hljikata la ngiroi thyc hien eSc eas md nay di u tien

tu nam 1975. Ky thugt dupe thyc hipn bang eSc dung cu

vi phau ludn qua catheter 4mm djnh vj duoi X-quang.

Nhieu tac gia bom chat can quang vao nhan dTa dpm de

CO th i quan sat du'pe vipe li y nhan.

Biln the ciia ky thugt nSy IS Li y nhan dTa dem cpt

sdng that lung ty dpng qua da (Automated

Percutaneous Lumbar Discectomy). Nhan nhiy du'pe

ISm nat bang mpt lu'oi dao quay ed 300 vPng/phiit vS

hilt ra bang may hiit. Trong 136 bpnh nhan di u tien,

Hijikata thong bao eo 72% hai Idng voi kit qua.

Trong khoang thoi gian 1984-1987, James Morris da

thyc hipn ky thuat nSy eho 479 bpnh nhan, trong do ed

269 ngu'di dap ung di y dii cae tieu chi chpn bpnh nhan,

con 210 nguoi dap ung khong di y du. Ty le thSnh eong d

nhdm thu nhit IS 73,5%, d nhom thU hai IS 67,1%. ThSnh

eong eo nghTa IS bpnh nhan thiy giam dau ro rpt, khong

Ip thupc vao thudc giam dau, khong cin phiu thugt tilp

theo, thiy thudc vS benh nhSn hSi long voi kit quS.

Ty Ip thSnh e6ng trung binh trong 70 bpnh nhan do

Onik phau thugt IS 72%, vS ddi voi 30 bpnh nhan cudi IS

80%. Schweigel cong bd ty Ip thSnh eong 82% ddi vol

150 bpnh nhan dupe chpn Ipc ky.

Noi ehung, hieu qua cua eae ky thugt nay, qua eong

bd cua nhilu tac gia la 49,4 - 82%, nhirng giam xudng

theo thoi gian. Theo Sgpiro, sau 2,5 nam ehi eo 5%

bpnh nhan du'pe dilu trj ndi hit hoSn toan trieu chUng

thin kinh tpa.

b. Phan huy nhan dem bing men

(Chemonucleolysis)

Ban chit eiia ky thuat nay la dung men phan hiiy eSc

dgi phan tii' proteoglycan va glicoprotein, la eae thSnh

phin chinh eiia nhan nhiy. Men thu'dng dupe sir dung

IS chymopapain, du'pe Jansen vS Balls phat hipn va

chilt xuat dau tien tu mil qua du dii vao nam 1941. Vi

proteoglican va glicoprotein IS nhu'ng phan tir bao niroc,

nen khi hSm lupng chiing giam xudng thi ham lupng

nude ma trgn ngogi bSo eiig nhgn nhiy cung glim

xudng ISm giam truang lye dTa dpm. NgoSi vipe giam Sp

suit npi dTa, chymopapain con cd the ed tSe dyng khSng

viem d re thin kinh. Watts cho rang chymopapain tuang

tac vdi cae spi cam giac d bao xa tao nen hieu Ung ci t

Y HOC THl/C HANH (729) - SO 8/2010 41