Y Hpe VigT NAM T H A N B 8 • 8 6 1/201Z
IV. BAN L U $ N
1. Ket q u i dieu tr|
- TJ IS dap Omg cd ndng (gidm tri^u chiifng
ldm sdng) Id 77,7%: trong dd tJ 1$ ddp iJng
hodn todn Id 20%, giSm mdt phin tridu chCmg
Id 57,7%, tJ 16 cila chCing tdi thSp hdn cOa tdc
giJ VD van va (85%) od le do b^nh nhdn cOa
chiing tdi 6 giai do^n IV, cd ch! sd KPS < 80%
nhi^u hon.
- Khdng cd bftnh nhdn dat hiftu q u i ddp
Ong hodn todn, nhung tJ IS ddp iltig chung cila
chung tdi tuong ddi cao (31,1%), tudng duong
vdi nghien oJu cOa Bellani Id (32%) [4], Karen
vd cs Id 30% [5].
Thdi gian sfing thSm trung binh trong cdc
nghiSn citu sir dung phac dd Paclitaxel
Carboplain dao d^ng tir 6.1 -11,2 thdng. Trong
nghien clJfu ciia chdng tdi Id 10,66 thdng. Thdi
gian sfing thSm giam dan tir 34,7% tai thdi
di^m sau Inam xufing cdn 6,7% sau nam thif
2, khfing cd BN ndo sfing tdi nam thif 3.
2. Mot so'tdc dung phu cija phdc do
Doc ti'nh Id van de luon phai dfii mdt trong
dieu tri hod ch^t, dac bifit vdi nhOf. Ndi chung
tac dung phu trSn tie tao huyet thudng rat nhe
vd cd kha ndng hoi phuc nhanh.
NGHIEN Cl)U V! TRi DAT VIT NEO Gllir AN TOAN TRANH XA CHAN RANG
TRONG NAN CHINH RANG
T6MTAT
Vit neo giu: la mdt phudng tien khong the thieu
trong nan chinh rdng hien dai. Vit neo giiJ" thudng
duoc ddt ke giu:a cac chan rdng, vd vi vay nguy cd
Cham vao chan rdng rat cao. Viec ddt vft neo b vi trt
xa chan rang giup tranh dudc nguy cd ndy. vdi viec
tim ra cac vi tri cay vit an todn tranh duac chan rdng
cd <j nghla to Idn trong viec giOp ifng dyng rong rai
vit neo gii?trong nan chinh rdng.
• Tn/lSng khoa Rang BVVH CuBa Hi n6i
Phan bl$n khoa hoc: PGS.TS. Mai Dinh Hung
V. KiT U)i.H
Paclitaxel- carboplatin Id sir phSi hdp
mang l^i hi^u quj, khd nang dung nap cOiig
nhu cdc \i}\ dilm v^ tdc dgng phy. Phdc dfi ndy
di«3c dp diing rdng rdi trSn thfi gidi cho didu tri
UTPKPTBN giai do^n III, IV.
TAI l l f u THAM K H A O
1. Nguyin BdDtiic (2006), Tinh hinh ung thu'« Vift
Nam glai doan 2001 - 2004 qua ghi nhin ung thu't?l
5 tinh thJnh Vl?t Nam", T^ chiy hipc ihut hinh, (sS
541/2006), Bd Y te xua bSn, trang 9.
2. UICC (1993), "Ung thU phdi vd mdng phdi",
Ung thu hqc lam sing, Nhd xu5t bdn Y hpc. Ha
Ndi, trang 348 - 360.
3. Baquiran DC, Gallagher ] (2000), UpiMmtls
cancer chemotherapy handbook, Upplncott
Philadelphia, NewYork, 165 - 253.
4. Belani CP, Lee IS, Sodnskl MA et al (2005),
"Randomized phase I I I trial CBm;janng Cisplatin -
Etoposide to Carboplatin - P;:'^axel in advanced
or metastatic non small celi'i,.',ig cancer", Ann
Oncol, 16(7), 1069 - 1075.
5. Karen Kelly, John Crowley, Paul A. Bunn, 3r,
Cary A. Present, Patra K. Grevstad, et al
(2001), "Randomized phase I I I trial of Paditaxel
plus Carboplatin versus Vinorelbine plus Qsplatin
in the treatment of patient with advanced non
small cell lung cancer: a South West Oncology
Group trial", J ain Oncol, 19, 3210 - 3218.
Pham Nhir Hal*
ABSTRACT
Investigation of safe position far from dental
roots for minivis anchorage In orthodontic
Minivis anchorage is a modem method in
current orthodontic. Minivis is placed usually in
space betv^een 2 dental roots, and has risk to
damage dental root, fylinivis placed far away from
dental roots help to avoid this risk. Finding a safe
position for minivis have a big significance in minivis
application in orthodontic.
 Y HQC VI$T NAM THANO 8 • 86 1/2012
I, DAT V JN oi
Ngdnh nSn chinh rdng Vl^t Nam cdn ndn
\ti, tn/flc ddy nSn ch!nh rang chO y4u bdng k j
thuJt nSn oh!nh thdo l^p, (t hi^u qud vd nhilu
tai biln. Ky thufit nSn chinh rang c« dlnh ch!
mdi phdt triln tfong vdng 20 nam I9I ddy, giOp
d^t duipc kit qud dllu tr| tit vd gidm thilu tai
blln. M^c dl sau nhimg ngdnh ndn chinh rdng
Vi$t Nam cOng dat dui;c nhllu thdnh tt/ti ddng
kWch l#, btldc aits v^n dicing dupc ode thdnh
ti/u khoa hge t h l gidi vdo trong chuyin ngdnh.
SU dyng thdnh o6ng mdc cdi ddy thing, ddy
cung silu ddn hfii vdo trong dllu tft cho
b|nh nhdn l|ch lac ring.
Bit ddu tif cufii nam 2002 dd c6 m^t sfi
nhd nghiin oJu hdn qufic. sau diy Id My din
Vi^t Nam bdo cdo v l vi|c ifng dgng vlt neo giCf
trong nin chinh rdng, tilp theo diy Id hdng Jell
ciia Nam trilu tiln vdo gidi thilu shn phim ciia
hang. Nam 2004, lln diu tiSn is Vi^t Nam vlt
neo giu: dd dUdc s^ dung thdnh cfing tai khoa
Rang miSng blnh viSn HOfu nghj ViSt Nam -
Cuba Hd N^i, vd khoa Rang miSng trd thdnh
cd sd di diu ca nudc hien nay trong viSc ifng
dung ky thudt ndy trong dieu tri nin chinh rang.
Sau diy dd cd nhieu cd sd khde cQng bit diu
ap dung vd bao cao ket qud.
Nam 2007: bao cdo ddnh gia bu6c dSu sU
dung vit neo giOr ke giira chdn rdng 5-6 trSn 30
Benh nhan d khoa rang Blnh viSn ViSt Nam
Cuba trong dieu trj nin chinh rang, vdi tJ IS
thanh cdng cOa vft Id 84% tai hfii nghj Rang
hdm mat todn qufic.
Vit neo giCr cho thiy ed hiSu qud rit rd rSt
trong nin chinh rdng, tuy nhiSn ky thuat ddt vit
neo giu* 6 ke giira chdn rang ddi hdi dfi chfnh
xac cao nhung eung khd trdnh cham vdo chdn
rang bSn canh. Cd nhilu tdc gia dd d l nghj
cac vj trf ciy vft khde b xa chan rdng an todn
hdn nhu vdo viing 6 rang nho. viing tam gide
Dinh gii kit qui theo cic tiiu chi:
Do lunq lay cua vit neo
Cam qiac cua benh ntian
Xquang
Kfch Crnq to chu'c niem mac
h$u hdm, vung III eO xuong hdm trin.... d Vljt
Nam chua cd m^t nghlSn cCfu v l oly v(t 4 v| tfl
xa chdn rang nhu nSu trin, chinh vl v$y ohilng
tdi Iiln hdnh d l tdi vdi muc tilu:
1. Dinh gii tf ti thinh cdng cOa vlt neo
gin ciy d cic vl trl xa chin ting nim (rang
khoang miing.
2. So sinh vdl t} li thidh cdng nhdm vd
nso glO ciy glOa cic chin ring, til dSy dirU
gii khi ning Ong dt/ng lim sing cie vlt neo
gin ciy xa chin ring.
II. Otfl TUpNO VA PHUONO PHAP NGHliN C(3U
1. Bit tu^ng nghlln ciiru: b^nh nhdn nin
chinh rdng cd chi djnh c i y vlt neo.
Chiing tdi chia Idm 2 nhdm: mfit nhdm c^
vft neo vdo kd chdn rang, mdt nhdm d y vt
neo 6 vi tri xa chdn rdng i trong khoang miens:
gui mQi tn/dc, 6 rdng nhl, viing dudi thdn
XUdng gd md, Ifii cO xi/dng hdm trdn, vijnij
khiu cdi trude vd sau, tam gide hdu hdm hdm
dudi, bd trudc cdnh lln.
Chung tfii dd thuc hiln d y du^e 220 vii
neo cho 79 bdnh nhdn. trong dfi 60 vlt d y xa
chdn rdng, 160 vlt d y vdo kd chdn rdng
2. Phudng phdp nghidn cilu:
Dinh gii kit qui 1 tuin, 1 thing, 6
thing theo cic Uiu chi:
- Dp chSc cira implant theo thdi gian: do
lung lay cua implant
- Cam giac cua benh nhan: dau khi lung
lay Implant
Xquang: khoang each glii^ Implant vdi la
cuhg ciia xuOng 0 rdng
- Tinh trang kich uhg dia to chiit niem mac
Cac tai bien: dau rdng tten canh, wo
xoang ham, viem tuy rdng ben canh, nhien
triing viing Idn can, chay mau keo dai....
- Toe dp di chuyen rSng, dp khit ciia khdp
cin, yeu cau dieu bi da dat dudc.
Tot Khong t6t
Khonq lunq lay Lunq lav
Iclidna dau dau
> 1 mm < 1 mm
khonq kfch uTiq CO kich LTnq
 Y HQC VI$T NAM THANG 8 • S61/2012

III. KET QuAvA BAN IU$N

3.1. Ty If thdnh cdng cua vlt xa chin ring » vdi vlt k§ chdn rdng
Bdng 3.1. Ty II thanh c6hg cda vdl xa chin rdng so vdi vlt kS chdn ring
Thdnh o5na TMtbal Tlngsg
xa ChSn r^nq 50
ke qilfa chdn rdng 10
Ty 1$ thanh cfing ciia vit ke chdn rSng la 93,75%, edn ciia vlt cSy xa chdn rSng Id 83,33%,
khac bidt cd y nghla thfing kd d milt p=0,01. Nhu' vdy vit ke chdn rdng id vi tri uti tidn khi cay vit neo
giir, va day Id vj W ma da so cdc tdc gia trdn the gidl khuyen dimg vl ky t'hu$t cay ddn glan, d l d$t
life keo tren lam sdng.
3.2.Ty 1$ thdnh cong cua vit cSy giO'a cdc chin rdng:
Bang 3.2. Thanh eon q ciia vft qiu^ Chan rdnq
Theo hdm Thdnhcdng ThSt bai Tong sff
Ham tren 133 93.36% 8 6.64% 141
Hdm dudi 17 89.17% 2 10.53% 19

Trong 160 vit cay d ke chSn r^ng, c6 134 vk 7 la gSn nhau nhuYig chieu rpng cua xu'dng 6
cay d vung ke chan rSng 5-6 ham tren v(S ty 1^ rang d vung n^y lai la Idn nhat vi vgy kha nSng
thanh cong 94%, 7 vft diy d vi tri glite 2 rSng 6-7 thanh cong cao. C6n ham du'di thi thu'dng ban
ham tren vcfi ty le thanh cong la 100%, 1 vit cay xuUng vd ciitig va mong nen kha nSng thanh
d v| tri ke giu^ 2 chan rSng 6 tren, 11 vi't cay d cong la thap hdn.
vjt tri giuS chan rSng 5-6 du'di vdi ty le thanh Vft du'dc cay trong vung Idi dfnh cd ty le
cong la 90%, 7 vit cay d vj trf giuS 2 chSn rSng thanh cong cao hdn cay trong vung thap cua
6-7 dudi vdi ty le thanh cong 87,5%. Nhif vay niem mac di dpng. vi ro rang yeu to ve sinh ddng
chiing ta thay cay d vj tri giu^ rang 6-7 ham tren vai trd quan trpng, ldi dfnh [a vung co the lam
a5 ty le thanh cong cao nhat, sau day la giij^ sach mpt each de dang va khong gay kfch utig
chan rang 5-6 tren, cuoi cung la glQ^ chan rang niem mac xung quanh. Con vung ldi di dpng thi
6-7 dudi. dieu nay cho thay vung giu^ chan ring kho ve sinh rang mieng hdn nhieu, lai rat de gay
6-7 tren la viJng co Hie sii" dung de cay vit an kfch LTng niem mac nen ty le that bai se phai cao
toan vi m3c du khoang each giu^ 2 chan rSng 6, hdn la tat nhien.
3.3.Ty id thdnh cong cua vit cay theo vj tri cu the:
Bang 3.3. Ty Id thanh conq theo vi tri vit qiil^ cac chan rdnq
Vitri Thanh cong T h n bai Tong
R5-R6 tren 126 (94%) 8 (6%) 134 (100%)
R6-R7 tren 7 (100%) 0 7 (100%)
R 5-6 di/dl 10 (90%) 1 (0%) (%) 11 (100%)
R 6-7 dudi 7 (87,5%) 1 (12,5%) 8 (100%)
Giij^ 2 chan rdng 6 tren '1 (100%) 0 (0%) 1 (100%)
Tonq 151 (93,8%) 10 (6,2%) 161 (100%)
Trong 160 vft cay d ke chan rang, cd 134 vft cay d vung ke chan rang 5-6 ham tren vdi ty le
thanh cong 94%, 7 vft cay d vj tri giij'a 2 rang 6-7 ham tren vdi ty le thanh cong la 100%, 1 vit cay d
vj tri ke giffla 2 chan rang 6 tren, 11 vft cay d vjt tri giiJa chan rang 5-6 du'di vdi ty le thanh cong la
90%, 7 vft cay d vi tri giO'a 2 chan r§ng 6-7 dUdi vdi ty le thanh cong 87,5%. Vft cay giu^ chan rSng
5-6 chiem so lu'dng nhieu nhat va ty le thanh cong la 94%, day la ty le tu'dng ttr nh\i vdi cac tac gia
tren the gidi, cac vj tri cay vft khac do so lu'dng ft nen chu'a dii de danh gia.
3.4. Ty \& thcinh cong ciia vit cay xa cac chan rang:
Bang 3.4. Ttianh cong cua vft xa chan rang
Theo ham Thanh cong That bai Tong so
Ham tren 45 83.33% 9 16.67% 54
Ham dirdi 4 66.67% 2 33.33% 6
 Y HQC VlgT NAM T H A N O a • Stf 1/2012

Hdm t r i n cSy dutjc 54 vit xa chdn rdng trong dd thdnh cdng K vit, c h i l m ty l | 83,33%. Ham
dutSI thdnh cfing 4/6 vit cdy c h i l m 66,67%, Do y l u cdu neo gii? cao n i n hdm b-ln ed chi djnh cay vit
hdn, bSn e?nh ddy n i u hdm t r i n cd n h l l u vj trf chpn li/a cdy vlt xa chdn rdng khde nhau thi hdm duU
chi c6 m$t vj trf id tam gidc h$u hdm ddy Id ly do t f l sao sS lu'dng vit e l y A hdm du'di it hdn trong
nghlln cittj ciia chung tfii

Bdng 3.5. VI trf cu t h l ciia vit xa chdn rdnq

Vitri T h i n h cfing Thdt bai Tffno
VCina qal mQi trudc 11 (7857%) 3 (21.43%)
0 rSnq nh6 6 (60%) 2
-- (40%)
14
10
VLinq dudi thSn xUdnq q6 m i 16 88,9%) 2 (11,1%) 18
viing khSu cii 8 (80%) 2 (20%) 10
Vung ISi cii XUdng him tren 2 (100%) 0 2
viing tam glic hSu him 4 (100%) 0 4
vimg bd budc cinh len 0 2 (100%) 2
t6ng5d 49 (81,7%) 11 (18,3%) 60

Ty 1$ thanh cdng cua vung gal miji trutic la V. K^T L U A N

78.57%, cua vung 6 rSng nh6 \k 6 0 % , cua vCing
du^i thdn xutJng gd mh \h 88,9%, ciia viing kh^u
chi la 80%, ciia viing loi cii xu'dng hdm trSn lii
100%, ciia vitng tam g l i c hSu hdm \h 100%, ciia
viing bd tru'dc canh ten thi cay 2 vft thSt b?i ca 2.
Nhu" vay cSy vft xa chan rSng ndi chung cd ty le
thanh cong thap hdn \h cSy d vit d giii^ che chSn
r3ng. Vl tri cay d loi cu xu'dng hdm tren va tam
g i i c hau ham la 100% tuy nhien vi so lu'dng
chu^ nhieu nen khong the danh gia du'dc. cay vft
xa chan r i n g cd utj diem la an toan, khong sd
cham vao chan r i n g , tuy nhien c6 nhu'pc diem la
thu'dng cay vdo viing giai phau khong thuat Iq^f,
hoac la the tfch xu'dng khong dii nhu' la viing
khau cai hoSc la cay vao viing ldi dl dpng gay
viem nhiem nhieu. cho nen khi cay vft vj b-f chon
lu'a uU tien Id vung ke giiJ^ chan rdng, neu khong
dUdc thi mdi chpn vung xa chan rdng. Ty le
thanh cdng cua vft xa chan rdng thap hdn cd y
nghla thong ke. Tuy nhien si/ khac bl^t day Id
khong Idn. trong mpt so tru'dng hdp thi vft xa
chan rdng td vj trf cay vft duy nhat du'(?c chi dmh,
vd ty le thanh cong tu'dng doi cao trong nghien
cuXi ciia chiing tdi cho thay la chiing ta cd the sty
dimg cac vj tri nay trong viec cay vft neo lam
diem ti/a de di chuyen rdng hieu qua
Vlt cay giu^ cdc chSn rdng c6 ty l | thanh
cdng cao 93,75% hdn vft cay xa chan rdng. Vj tri
cdy vft xa chdn rdng cung c6 ty le thdnh cong
83,33% Id m0t ty l# dang khich l | cho chf djnh
cay vft. Vl trf cay vft xa chdn rdng co ty 1^ t h ^
cong cao la: 0 rdng nho, viing duv^ than xuUng
go ma, vung tam giac hau hdm, vung loj cu
xu'dng hdm tren, vung gai mui trudc, vung khau
cdi tru'dc vd khau cai sau.
JA\ L l f u T H A M K H A O
1. Chang C S, HsiehC. H, Tseng Y. C & Shen
Y. S (2006), T h e use of microimplants m
orthodontic anchorage". 3 Oral Maxillofec Surg
64pp. 1209.
2. Hyo-Sang Parlt, Sung-Mln Bae, Hee-Moon
Kyung & Jae-Hyun Sung (2001), "Mkro-
Implant anchorage for treatment of skeletal dass
I bialveolar protrusion", Jco, Inc, 35(7).
3. Hyo-Sang Park & Tae-Geon Kwon (2004),
"Sliding mechanics with mkroscrew impbrt
anchorage", Angle Orthodonist, 74(5), pp. 703-7m
4. Long Suk Lee, Jung Kook Kim, Young-CtMl
Park & Vanarsdall R. L (2007), Applications Of
Orthodontic Mini-Implants, Quintessence
Publishing Co, Inc, Canada.
J. Seong-Min Bae, Hyo-Sang Park, Hee-
Moon Kyung & Jae-Hyun Sung (2002),
"Ultimate anchorage control", Texas Dental
Journal, 76(8), pp. 580-591.