TMJ

Ni dung
Gii phu Khp thi dng hm
S chuyn ng
Gii phu cu trc lin quan
Mt s bnh l v phng php iu tr chung
Phu tch vo khp thi dng hm
ng dng trong nn chnh trt khp ra trc
Ni soi, bm ra khp?
Trt khp thi dng hm
(JAW DISLOCATION)
Mt tnh trng xy ra khng
thng xuyn. Gm trt khp cp
v mn tnh.
Trt khp cp thng xy ra trong
thc hnh lm sng, c th iu tr
nn chnh bng tay.
Trt khp mn hay ti din l mt
thch thc trong iu tr
Trt khp thi dng hm
(JAW DISLOCATION)
Dng ph bin nht l trt khp ra trc. Thng xy ra sau ngp ln
hoc nhai.
Ngoi ra cn c cc dng khc:
Vo trong
Ra ngoi
Lui sau
Ln trn vo h s gia
Nhng trng hp ny thng him v i km vi chn thng
Cch nn chnh (Reduction)
trong trng hp trt khp ra trc

Cch truyn thng: phng php trong ming

Nhc im:
C th phi gy t.
Xoa du bnh nhn.
C th b cn vo ngn tay.
Cch nn chnh (Reduction)
trong trng hp trt khp ra trc

The Journal of Emergency Medicine, Volume 47, Issue 6, December 2014, Pages 676681

https://www.ncbi.nlm.nih.gov/pubmed/25278137
Cch nn chnh (Reduction)
trong trng hp trt khp ra trc

Thc hin trn 31 bnh nhn trt khp TDH cp tnh khng do chn
thng, kt qu:
30 ca nn chnh thnh cng
24 ca c nn chnh trong thi gian di 1 pht
Khng c s ti pht sau 3 ngy theo di.
Cch nn chnh (Reduction)
trong trng hp trt khp ra trc

K thut:
Th thut chc khp thi dng hm
(Arthrocentesis)
Ting Hy Lp:
Arthros = a joint
Kentesis = puncture
y l th thut n gin nht
trong cc loi phu thut can
thip vo vng khp.
Dng mt ci kim chc vo vng
khp b thng tn, v bm ra
khp vi cht lng v trng.
Th thut chc khp thi dng hm
(Arthrocentesis)
Th thut ny c xem nh l phc iu tr phu thut
trc nht cho nhng bnh nhn ri lon khp thi dng hm
m khng p ng vi iu tr duy tr (Liu php vt l, thuc,
n nh, thay i hnh vi, mang mng nhai)
y l th thut can thip ti thiu, c thc hin di gy t
ti ch, ngoi mt.
Ra bung khp trn vi cht lng: nc mui, Ringer, thuc
khng vim, gim au, steroid.
Th thut chc khp thi dng hm
(Arthrocentesis)
Ch nh:
Di a khp ra trc hi phc/khng hi phc
Dnh a khp
H ming hn ch
Vim sn khp,
Lm du cn au trong vim khp dng thp thoi ha cp
Chng ch nh:
Bnh tm thn.
Cng khp dng xng/si
Khi u vng khp.
Bnh nhim trng vng khp.
Th thut chc khp thi dng hm
(Arthrocentesis)
K thut:
1. Gy t
2. nh du:
V ng thng t im gia ca bnh
tai n gc mt ngoi.
2 kim s m vo 2 v tr c nh
du: v tr (1) cch bnh tai 10mm trn
ng thng, di 2mm.
y l vng tng i chun vo mt
cho ln nht hm khp.
T da, kim i vo 25mm s n trung tm
ca bung khp.
Th thut chc khp thi dng hm
(Arthrocentesis)
2. nh du:
V tr (2): Cch bnh tai 20mm, v
di 10mm.
y l v tr ca li khp
3. a 2 kim 18 vo 2 v tr:
Bm 100-300ml Ringer vo 1 kim
v s chy ra ngoi qua kim cn li.
Gip ra khoang khp
Ni soi khp
(Arthroscopy)
Arthroscopy c ngha n gin l looking
into the joint
Bt ngun t: arthros = joint and scopien
= to view
L k thut dng thm khm v kim
tra cu trc khp bn trong bng vic
nhn trc tip vo.
V thc hin cc th thut phu thut
di s kim sot bng th gic vi vic
s dng Arthroscope (Knh soi khp).
c gii thiu ln u tin vo nm
1974 bi Ohnishi (ngi Nht)
Ni soi khp
(Arthroscopy)
Gm 2 loi c bn: Chn on v
iu tr
Chn on (Diagnostic): single-
puncture arthroscopy, c th thc
hin chn on v nhng iu tr
n gin.
iu tr (Therapeutic):
Multipunctures, c kh nng thc
hin nhiu th thut iu tr phu
thut ni soi hn.
Ni soi khp
(Arthroscopy)
Ch nh
Bnh nhn au v lon nng hm khng p ng vi iu tr khng
phu thut (iu tr rng/ thuc)
Thng trt khp thi dng hm
au dai dng vng trc tai
Vim xng khp
Nhng phn nn sau chn thng
Gi u
Sinh thit
Ni soi khp
(Arthroscopy)
Chng ch nh
Cng khp dng si bin i, dng xng, vim xng khp cng
khp. Phu thut m
Nhim trng vng da bn trn.
U c tnh
Tiu dng phc tp hm khp
Tng nguy c chy mu t mu khp.
Ni soi khp
(Arthroscopy)
u im:
ng rch da nh so khng ng k
Gim tn thng TK VII
C nhiu li ch cho chn on v iu tr.
Nhc im:
K thut thc hin kh
Dng c mc tin
Ni soi khp
(Arthroscopy)
Cc thnh phn:
A: Telescope vi v bc
B: Video camera
C: Kp sinh thit
Ni soi khp
(Arthroscopy)
K thut
Gy m ni kh qun
TMJ c tip cn t 2 trocars, arthroscope c a vo t mt l,
v l ny cng c th c dng nh mt l bm ra.
L th 2 dng ht v a dng c vo.
Kim tra v s nn khp, xc nh v tr ca u li cu bng s
chuyn ng ca khp.
Ni soi khp
(Arthroscopy)
nh du v tr ca trocar:
V mt ng thng t trung
tm bnh tai n gc mt ngoi
Cch im trung tm bnh tai
10mm trn ng thng, i
xung 2mm. nh du im A:
cho trocar th 1
Cch im trung tm bnh tai
20mm trn ng thng, i
xung 10mm. nh du im B:
cho trocar th 2
Ni soi khp
(Arthroscopy)
Kt lun
Ti liu tham kho
Peterson's Principles of Oral and Maxillofacial Surgery-3rd.ed
The Journal of Emergency Medicine, Volume 47, Issue 6, December
2014, Pages 676681