Luan van Cao hoc

IEU TR TON THNG

MONTEGGIA CU TRE EM
hor vIan . 88. hguyan Thanh hhan
Thay huong dan . F8. 88. Vo Thanh Fhung
I. kT Vkh E
II. M06 TIE0 hhIEh 600
III. T0h 0kh TkI LIE0
IV. 0I T00h Vk FF hhIEh 600
V. kET 0k Vk 8kh L0kh
VI. kET L0kh
Ton Ihuong MonIaggIa Ia IoaI Ion Ihuong phur Iap
hau duor phaI hIan som Ih vIar dIau Ir} (rhu yau
Ia dIau Ir} bao Ion) sa da dang va hIau qua
hau bo soI Ion Ihuong sa dan dan suy gIam rhur
nang, dIau Ir} kho khan, phur Iap, kam hIau qua
Trong nuor hIan rhua ro nghIan ruu nao quan
Iam sau sar dan van da nay
I. kT Vkh E
0 nuor ngoaI. so ra banh I kInh nghIam?
8axIar WIIIIs (Z008). dIau Ir} van ron dang ban raI
VIaI ham noI rhung, rar Inh pha nam noI rIang,
vIar dIau Ir} gay xuong, IraI khop, bong gan van
ron nhIau saI soI. 6on gap nhIau Iruong hop bo soI
6an nghIan ruu va dIau Ir} Ion Ihuong MonIaggIa
ru, Im hIau nguyan nhan bo soI Ion Ihuong va rarh
khar phur
I. kT Vkh E
+ Mur IIau Iong quaI
Banh gia ket qua dieu tri tun thuJng Munteggia cu J
tre em bang hau thuat. 0iJi thieu ky thuat Buuyala
+ Mur IIau rhuyan bIaI
Banh gia ve dac diem tun thuJng Munteggia J tre
em J BvCTCh TF. hCM
Banh gia ket qua dieu tri tun thuJng Munteggia cu
J tre em bang hau thuat rut kinh nghiem
Tim hieu nguyen nhan bu sut tun thuJng, va ca ch
khac huc
II. M06 TIE0 hhIEh 600
+ I0VkhhI 8kTI8Tk M0hTEIk. dau tien (1B14)
+ Bat ten chu M0hTE00A (1901)
+ 108E L00I8 8k0 (196B). thuat ngu va han luai
nen tang chu viec hieu ru cJ che CT va dieu tri
chu cac luai tun thuJng Munteggia khac nhau
+ 0 tre em. han luai theu LETT8 (19B6)
LCH S CUA GAY MONTEGGIA
III. T0h 0kh TkI LIE0
III. T0h 0kh TkI LIE0
Fhan IoaI rua 8ado (196B)
Loai I
Loai II
Loai III
Loai IV
III. T0h 0kh TkI LIE0
Fhan IoaI rua LaIIs (19B6)
6hkh 0kh
hhan manh rang cac gay xuJng vung cang tay, hai
kham ky khJ 0TT va 0T0, hai nghi ngJ cu trat chum
quay.
IE0 T[ T0h Th00h M0hTEIk M0I
0 tre em, da su ca c tac gia chu thay ket qua tut vJi
dIau Ir} bao Ion nan kin bang tay
Man tang sang (Carm) rat huu ich
Thumsun va hamiltun (1O5O). dung dinh nui tuy
wilkins (2OO2). nhan manh den hau thuat can thie
tui thieu
III. T0h 0kh TkI LIE0
IE0 T[ T0h Th00h M0hTEIk 60
+ }nh ngha. Ton Ihuong ru Ia Ion Ihuong duor
rhan doan muon lu mal lkaag sau ckaa lkuaag
(kkLkM6hI)
hien nay, viec dieu tri ru rang va bat buuc gum.
Khung cat chum quay (ke ca J nguJi lJn)
ur xuong sua Irur xuong Iru, trung du BXST cau
mang lai nhieu hieu qua
han IaI rhom quay b} IraI, ro Iha kam Ihao hoar
khong IaI Iao day rhang vong
III. T0h 0kh TkI LIE0
ur xuong sua Irur xuong Iru .
k. kkLkM6hI 8. hIkYkMk 6. Tk1IMkY08hIZ0
A B C
III. T0h 0kh TkI LIE0
kY Th0kT 800YkLk
+ 8ouyaIa (197B). ur xuong sua Irur rao xuong Iru
+ ubur (19B4), kaIamrhI (19B6), hIrayama (19B7),
8ouyaIa (19BB), VarnaraI (19B9), va gan day Ia
Inoua va 8hIonoya (19BB) xar d}nh Inh hIau qua
III. T0h 0kh TkI LIE0
hguyan Iy dur xuong sua Irur
O ur xuong sua Irur rao xuong Iru kao rhom
quay qua Irung gIan.
Mang gIan roI
ay rhang rhao (6. WaIIbrarhI)
O X8T mo pha Iruor (IraI ra sau), mo pha sau
(IraI ra Iruor), vao Irong (IraI ra ngoaI)
III. T0h 0kh TkI LIE0
hguyan Iy dur xuong sua Irur
Tar dung rua mang gIan roI yau Irong X8T
Ihan xuong Iru, manh Irong X8T rao
III. T0h 0kh TkI LIE0
hguyan Iy dur xuong sua Irur
ur xuong sua Irur o sau kao rhom quay
ra sau, o Iruor kao rhom quay ra Iruor
III. T0h 0kh TkI LIE0
kY Th0kT 800YkLk
BuJng mu. BuJng Buyd
BXST xuJng tru ngay duJi mum vet
han chum quay vau truJc XuJng tru tu nan,
mJ guc theu huJng thich hJ. KhX ne uc
Tai tau day chang vung
OI TNG VA PHNG PHAP
NGHIE N CU
0I T00h hhIEh 600.
+ Tat ca benh nhi tu 15 tuui trJ xuung cu tun thuJng
Munteggia cu duJc hau thuat tai khua hhi BvCTCh
TF. hCM tu OG/2OO1 den 12/2OO8
+ Cac benh nhi cu tun thuJng Munteggia cu duJc dieu
tri bang hau thuat truJc day tai khua hhi, dang duJc
theu dui, huac va u lay dung cu, huac den theu thu mJi
0I T00h hhIEh 600
60 Mk0 hhIEh 600.
+ Tien cuu tu thang OG/2OO1 12/2OO8. 41
+ Cac truJng hJ hui cuu. 12
TIE0 6h 6h0h Mk0.
+ Tleu ck Jua vaa:
Benh nhi tu 15 tuui trJ xuung bi tun thuJng Munteggia
cu du chan thuJng, bat ke thJi gian, thua dieu kien.
Khung cu bien dang lui cau canh tay va chum quay
Khung cu gay, can lech, ga guc chum quay
0I T00h hhIEh 600
+Tleu ck laal lru:
+ Cac truJng hJ trat chum quay bam sinh
+ Trat chum quay du cac benh ly khac. liet dam rui
than kinh canh tay, benh chui xuJng nhieu nJi
ThIET kE hhIEh 600
hghien cuu tien cuu va hui cuu, mu ta su lieu thu nha
duJc, han tich ket qua rut ra nhung kinh nghiem
trung dieu tri tun thuJng Munteggia cu J tre em
0I T00h hhIEh 600
Th0 ThkF 80 LIE0
* hghIan ruu IIan ruu
Cac benh nhi bi tun thuJng Munteggia cu se duJc
la hu sJ benh an theu mau benh an thiet ke rieng.
Cac du lieu thu tha gum.
Tuui, giJi, nJi cu tru
hui ky ve nguyen nhan, cJ che chan thuJng, thJi
gian bi chan thuJng, chan duan va dieu tri truJc day
Fh00h FhkF hhIEh 600
Kham lam sang. danh gia chuc nang van dung cua
khuyu va cang tay, du vung khuyu, guc mang, cac
tun thuJng than kinh
Can lam sang. X quang thang, nghieng cua khuyu
va cang tay danh gia ca c bien dang, han luai Badu
Truc tie tham gia hau thuat. danh gia trung mu,
ghi nhan hau thuat, theu dui sau mu
Fh00h FhkF hhIEh 600
O hghIan ruu IIan ruu
Fh00h FhkF hhIEh 600
Fh00h FhkF hhIEh 600
O hghIan ruu hoI ruu
Tra cuu lai hu sJ cu, ghi nhan lai ca c tham su can
nghien cuu nhu trung tien cuu. Kham lam sang danh
gia lai chuc nang, chu X quang
Fh00h FhkF hhIEh 600
O hghIan ruu hoI ruu
A
B
C D
k. 8. X qyang Iruor mo,
sau mo (07l1999)
6. . hoI ruu (0BlZ008)
Fh00h FhkF hhIEh 600
Fh00h FhkF hhIEh 600
Fh00h FhkF Fhk0 Th0kT
Chi dinh hau thuat. benh nhi thua tieu chi dua va u
Chuan bi benh nhan. mu chuJng trinh
0ung cu.
Fh00h FhkF hhIEh 600
Fh00h FhkF Fhk0 Th0kT
BuJng mu. rach da theu duJng Buyd
vau khJ chum quaylui cau. duJng mu Kucher
Fh00h FhkF hhIEh 600
Fh00h FhkF Fhk0 Th0kT
Lam sach u khJ
BXST duJi mum vet 1 cm, chinh ga guc theu
nguyen ly cua Buuyala
Fh00h FhkF hhIEh 600
Fh00h FhkF Fhk0 Th0kT
han chum quay, ket hJ xuJng tru bang ne uc
Thu lai du vung cua chum quay
TT 0Cv huac xuyen kim qua lui cauchum quay
khop quayIoI rau
6o duoI ro Iay Iru
khop quayIoI rau
6o khuyu
Fh00h FhkF hhIEh 600
Sau mu. bu but canh ban tay rach duc, X0 k tra
84 tuan sau, cat but ta van dung 00, tang dan.
G8 tuan ta Sh cang tay. Theu dui mui thang
Lay ne uc. sau G thang
Fh00h FhkF hhIEh 600
anh gIa kaI qua dIau Ir} rua kndarson
Can xau, khung lien xuJng hay viem xuJng tuy
man khung giai quyet duJc
ThaI baI
Lanh xuJng vJi mat 00 khuyu va cu tay > 8O
O
Mat Sh cang tay > 5O%
khong IoI
Lanh xuJng vJi mat 00 khuyu va cu tay 2O
O
Mat Sh cang tay 5O%
ToI
Lanh xuJng vJi mat 00 khuyu va cu tay 1O
O
Mat Sh cang tay 25%
aI IoI
Fh00h FhkF hhIEh 600
anh gIa kaI qua dIau Ir}
Fh00h FhkF hhIEh 600
X0 LY Vk Fhkh T6h 0 LIE0
0u lieu thu nha duJc duJc han tich bang
han mem thung ke SFSS 1O.O
KET QUA VA BAN LUAN
80 LIE0.
Tu thang OG/2OO1 den thang 12/2OO8
kET 0k Vk 8kh L0kh
Tien cuu . 41
Theu dui duJc . 85
hui cuu . 12
kET 0k Vk 8kh L0kh
55,7
33,3
100,0
B
4
1Z
70,7
29,3
100,0
Z9
1Z
41
8a IraI
8a gaI
Tong rong
Ty Ia % 8o ra Ty Ia % 8o ra IoI Inh
hoI ruu TIan ruu
Ty le heak akaa kaa ha lkea glal lak
N
Nam
70,7 %
29,3 %
hhan xet.
8a IraI rhIam da so (70,7%,
66,7%)
Ty Ia nam nu . Z Z,4 . 1
kET 0k Vk 8kh L0kh
Ty le heak akaa kaa ha lkea J]a ly
33,3
55,7
100,0
4
B
1Z
19,5
80,5
100,0
B
88
41
TF. h6M
6ar Inh
Tong rong
Ty Ia % 8o ra Ty Ia % 8o ra IoI Inh
hoI ruu TIan ruu
hhan xaI.
8anh nhan o rar Inh rhIam Iy Ia rhu yau (B0,6%, 66,7%)
Fhan bo o khap rar Inh, Ihanh pha nam, Inh mIan Irung,
Iay nguyan
xaI rIang Iung Inh, Ihanh Ih TF. h6M ro Iy Ia rao nhaI
(19,6%, 88,8%)
kET 0k
Ty le heak akaa kaa ha lkea xu lr haa Jau
33,3
50
8,3
8,3
100,0
4
6
1
1
1Z
14,5
51
22
2,4
100,0
6
Z6
9
1
41
khong T g
8o boI
8o Ihuor
T noI khoa
Tong rong
Ty Ia % 8o ra Ty Ia % 8o ra IoI Inh
hoI ruu TIan ruu
8kh L0kh
Xu lr haa Jau
hhan xet.
Bu but cu ty le cau nhat (G1%, 5O%)
hguyen nhan bu sut tun thuJng tu nganh y te.
G8,4%, 58,8%
0leesun va Beattie (1OO4). 22O ca gay cang tay
+ 5O%. bac si thuJng tru khua Tai nan va CC
+ 25%. bac si X quang
huJng dan cach kham lam sang va X quang dung
kET 0k Vk 8kh L0kh
Fkaa laal lkea 8aJa
hhan xaI.
6ao nhaI. 8ado I
(76,6%, 76%)
Thu haI. 8ado III
(ZZ%, Z6%)
0
10
20
30
40
50
60
70
80
Bado I Bado II Bado III
Tie n c u
Ho i c u
75,6
2,4
22
75
25
FrarIura In 6hIIdran Z001. 8ado I (70%), 8ado III (Z8%)
hguyan Van ThaI. nguoI Ion 8ado II (Z0%), nhu y van
Fkaa laal lkea 8aJa . Cu 8 ca dac biet
6a 1. ba gaI 8 IuoI, rhay Ia
rhong Iay, 7 Iuan, dap Ihuor
6a Z. ba IraI 10 IuoI, Ia ray
rao Z,6m, 4 Iuan, bo boI
6a 8. ba gaI 9
IuoI, ThT, Z
Ihang, bo boI
kET 0k Vk 8kh L0kh
hhan xaI.
Tien cuu. 1 thang O nam (TB . 12,O7 28,82)
hui cuu . 1 thang 8 nam (TB . O,85 11,1G)
Ty le sau 1 nam. 2G,8%, 25%
+ Cac tac gia khac.
Buuyala (1O82). 2 nam,
Freedman va CS (1O88). G nam,
Eng lee. G,5 nam, Seel va Fetersun (1OOO). 7 nam
Tkal glaa ha sal laa lkuaag
kET 0k Vk 8kh L0kh
TIan ruu. khuyu veu nguai. O/41 (22%), veu trung.
8/41 (7,8%), duui khuyu qua muc. 8/41 (7,8%)
Buuyala. 12/15 (8O%) khuyu veu ngua i. Xuat hien sau
1 nam, un dinh sau 84 nam, khung qua 8O
O
Mal vuag kkuyu
kET 0k Vk 8kh L0kh
Tien cuu. 7 (2 Badu , 5 Badu )/41 (17,1%)
hui cuu . 1 (Badu )/12 (8,8%)
hhan xet trung mu. chen e that su, cu mu xJ, teu
nhu thay dui mau sac, than kinh hung tu sau giai e
8lea ckuag lkaa klak llel lkaa klak glaa cal sau
6hom quay rhan ap
hhanh nong
Ihan kInh quay
hhanh gIan roI sau
b} rhan ap Iao nho
kET 0k Vk 8kh L0kh
O hhan xet. 5 ca theu dui duJc
ThJi gian huc hui rat nhanh, sJm nhat sau 4 tuan
mu giai e (2 ca)
Fhau thuat giai e thanh cung vJi ca muun 1O thang
But huan tuan than kinh quay (1 ca), nui than kinh vi
hau chu ket qua tut
Trung dieu kien chung ta, nen hau thuat giai e sJm,
nen mu bang duJng truJc nguai
Can hat hien sJm, tranh duJc bien chung than kinh
8lea ckuag lkaa klak llel lkaa klak glaa cal sau
8lea ckuag lkaa klak llel lkaa klak glaa cal sau
kET 0k Vk 8kh L0kh
+ ThJi gian hau thuat.
Tien cuu. 5O12O hut (TB . 78,7O 18,O1)
hui cuu . 5512O hut (TB . 82,5O 21,1G)
ky lkual ma
B
Z
0
Z
1Z
ZB
8
8
1
86
8ouyaIa
8ouyaIa + TT 6V
8ouyaIa + xuyan kIm
ky IhuaI khar
Tong rong
hoI ruu TIan ruu ky IhuaI mo
kET 0k Vk 8kh L0kh
Tien cuu. 8 (2 tut, 1 that bai)
hui cuu . 2 (1 tut, 1 that bai)
Buuyala. TT0Cv khung hai ngan trat lai chum quay.
Cu 5/15 trat lai
0ner va 0iestraten (1OO8). 7 ca nan chum, TT0Cv
bang gan cJ ba dau. Cu 2 ca Badu trat lai
nuue va Shiunuya (1OO8). 12 ca, G ca BXST chinh
ga guc, khung TT0Cv, tut. G ca cun lai (8 ca trat lai)
0e Bueck (1OO7). bien chung huai tu cu xuJng quay
Tal laa Jay ckaag vaag
kET 0k Vk 8kh L0kh
Tien cuu. 8 ca (8, 4, 8 nam). (1 tut, 2 khung tut)
Buuyala, verneret, King, Stanley va 0e La 0ar/a, vin/
va CS
O Mut su diem rut ra.
Chu truJng hJ lui cau, chum quay bien dang nhieu
Bam bau BXST tut, chum quay nan vau dung vi tri
Kim lJn (duJng kinh tu 8mm), chinh huJng that tut
Rut kim sJm (khuang 1 tuan sau mu )
Xuyea klm ua lal cau-ckam uay
kET 0k Vk 8kh L0kh
Khung muun qua (12 thang), cun can lech xuJng tru.
Fha can, KhX tru, nan chum quay TT0Cv
Khung muun qua, xuJng tru thang truc (trat chum quay
dJn thuan). han chum quay, TT0Cv
Muun, xuJng tru thang truc huac cun di lech it. Buuyala
0ua muun, chum quay khung vung, cu bien dang.
Buuyala TT0Cv, xuyen kim giu chum
Badu . BXST, TT0Cv (ky thuat Seel va Fetersun)
Lua ckaa ky lkual ma
kET 0k Vk 8kh L0kh
Mo xo. 6l41 (14,6%)
6hom quay, IoI rau bIan dang. 7l41 (17,1%). ThoI
gIan bo soI (B Ihang B nam)
6hom quay + IoI rau bIan dang. 4 (1, 8, 4, B nam)
8ouyaIa. bIan dang (sau Z nam)
lal kau kac lraag ma
* 8au 1 nam, Iang kha nang
bIan dang IoI rau, rhom quay
yau Io anh huong IIan Iuong
ruor mo
LoI rau daI
kET 0k Vk 8kh L0kh
0a khuyu. 148,82
O
4,O8
O
, mat ga khung qua 2
O
0uui khuyu. mat duui trung binh 1,82
O
4,4
O
hui cuu. 12 ca khung giJi han 00
Sa cang tay. giJi han, ty le rat cau (88,G%, O1,7%).
0iJi han > 45
O
(4O%, 41,7%). Mat sa TB (48
O
, 4G
O
)
hgua cang tay. giJi han, rat it. 2/41 (5,7%), 8/12
(25%) (45
O
, 8O
O
, 8O
O
)
Stanley va 0e La 0ar/a. 00 huc hui nhanh, Sh
mat GO thang, sa cang tay se giJi han vinh vien
Ahh lA kLT uA lLu Tl
kET 0k Vk 8kh L0kh
Rudger va CS (1OOG). 7 ca. Mat sa cang tay 8G
O
,
mat ngua cang tay 27
O
Mat Sh G8
O
(TC . 45
O
)
hey 0ruves . ||c t|uat J|cu tr| p|a| Jam |ac iua
cai tay va tu i||ci sc Jam |ac sap cai tay
Ahh lA kLT uA lLu Tl
kET 0k Vk 8kh L0kh
aak gla kel ua Jleu lr] lkea AaJersaa
0
10
20
30
40
50
Ra t to t To t Kho ng to t Tha t ba i
Tie n c u
Ho i c u
35,3
47,1
8,8
8,8
25
50
16,7
8,3
ThJi gian theu dui. 428 thang (TB. O,58 4,8O) va
15G5 thang (TB. 8O,17 14,G)
Rat tut va tut (82,4%, 75%), that bai (8,8%, 8,8%)
kET 0k Vk 8kh L0kh
kel ua Jleu lr] cua cac lac gla kkac
Buuyala. G chan thuJng (8 rat tut, 8 tut), 8 ca giJi han
Sh nhieu (bien du van dung. 8O
O
, GO
O
, 5O
O
)
Rudgers va CS (1OOG). 7 (8 tut, 2 trung binh, 2 xau)
wattincuurt va CS (1OOO). 12/14 nan chum quay,
BXST dau gan, TT0Cv (GG% rat tuttut, 25% trung
binh, O% xau)
Stull, willis va Fatersun (1OO2). chu ket qua tut vJi
nhu hJn 1O tuui
kET 0k Vk 8kh L0kh
6ac yeu la aak kuaag Jea kel ua Jleu lr]
1. Tuui. Stull, willis va Fatersun (1OO2). 1O tuui, ket
qua tut. 0nne Sandblum. 1O tuui, chinh ga guc 2O
O
2. ThJi gian bu sut tun thuJng. Buuyala. sau 2 nam, ket
qua khung tut. Luan van. sau 1 nam, kha nang bien
dang lui cau va chum quay tang
8. huJng trat chum quay. trat chum quay ra sau
4. ThJi gian theu dui. Buuyala. trat lai va cung khJ
trung nhung thang dau Stanley. GO thang
kET 0k Vk 8kh L0kh
6A6 8lLh 6huh 6uA lLu Tl FhAu ThuAT
25
+ Cu 8 bien chung. lu ne uc, can lech xuJng tru,
trat lai chum quay. Ty le chung. 2O% va 25%
0
8,3
15,7
25
0
1
Z
8
5,7
5,7
8,5
20
Z
Z
8
7
Lo nap or
6an Iarh
TraI IaI rhom
Tong rong
Ty Ia % 8o ra Ty Ia % 8o ra 8Ian rhung
hoI ruu (h=1Z) TIan ruu (h=86)
La ae ac
25
Lu ne uc. 2/85 (5,7%). hguyen nhan. KhX khung
vung, ne nam ngay duJi da, vung ti de. Khac huc.
tranh ti de, KhX vung chac, ne mung, lay ne sJm
6aa leck xuaag lru: 2/85 (5,7%)
hguyan nhan. X8T Ihap, khX khong vung
khar phur. X8T rao o hanh xuong
hguyan nhan. rhua rhnh haI ran Iarh doan 1l8 gIua
khar phur. rhnh haI ran Iarh xuong Iru (Iua rhon ky IhuaI mo)
Tral lal ckam uay : 8/85 (8,G%).
hguyan nhan. 8ado II, 1Z T, 8 nam, bIan dang, Iua rhon ky
IhuaI mo. khar phur. X8T xuong Iru, TT6V ky IhuaI moI?
hguyan nhan. bIan dang ro xuong quay, danh gIa Iruor mo
khar phur. danh gIa ky Iruor mo
Tral lal ckam uay : 8/85 (8,G%).
hguyan nhan. 8ado I, 9 T, 1
nam, bIan dang ra IoI rau va
rhom quay
khar phur. danh gIa Iruor mo
kET 0k Vk 8kh L0kh
Tal saa laa lkuaag Maaleggla a lre em Je h]
ha sal 6ack kkac kuc
weisman va CS (1OOO). 1O ca chan duan muun/ 11O
ca tun thuJng Munteggia. 8 khung xem ky X quang, 2
trat lai va u ngay 2O, 21
Linculn va Mubarack (1OO4).
nghien cuu 8 nam ca c ca trat
chum quay dJn thuan
Jau caag xuaag lru
kET 0k Vk 8kh L0kh
0leesun va Beattie (1OO4). hui cuu 22O ca gay xuJng
cang tay tre em 5O% du bac si thuJng tru khua Tai
nan va Ca cuu, 25% du bac si X quang
+ Mal sa aguyea akaa gay kka kkaa cka vlec ckaa
Jaaa :
Kham lam sang khu khan
Cu cac luai gay xuJng dac biet (han lua i cua Letts)
Trung tam cut hua chum quay cu the khung thay
duJc tren X quang
Cu truJng hJ nan vau sau du trat lai
MoI so dIam ran Iuu y.
- Tat ca cac gay xuJng vung cang tay tre em deu hai
nghi ngJ cu trat chu m quay
- Kham la m sang that ky neu duJc
- X quang thang, nghieng cua cang tay hai qua 2 khJ
- Khung duJc quen dau chu i (duJng Sturen), dau cung
xuJng tru
- Theu dui sat dieu tri trung thang dau
kET L0kh
ua nghIan ruu 41 Iruong hop IIan ruu va 1Z
Iruong hop hoI ruu. 6o rar kaI Iuan sau.
1. ar dIam Ion Ihuong MonIaggIa o Ira am o 8V
6T6h TF. h6M. 8ado I (76,6%), 8ado II (Z,4%),
8ado III (ZZ%). 6o 8 Iruong hop dar bIaI.
TT 8ado I kam gay mom Iran rong ror rung ban
ay 88Th mom khuyu, rhom quay IraI ra ngoaI
TT 8ado I va gay Ihan xuong duI rung ban
kET L0kh
25
Z. 8o Iuong kha nhIau. 41l Z,6 nam. ThoI gIan bo
soI Ion Ihuong raI Iau. B9 nam. hguyan nhan bo
soI Iu nganh y Ia ro Iy Ia rao. 68,4% va 6B,8%
8. Iau Ir} bang phau IhuaI ro kaI qua Iuong doI
kha quan. 6o Iha ap dung ky IhuaI 8ouyaIa. Tuy
Iung Iruong hop Iua rhon dIau Ir} Ihrh hop. 6on
gap raI nhIau kho khan
4. 6an phaI hIan som, dIau Ir} bao Ion, Iranh ruor
mo va rar bIan rhung
kET L0kh
25
kET L0kh
18-10-2007
kET L0kh
kET L0kh