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Thoat vi dia dem cot song co the gay tan phe (Ky I)

TS. BS. Nguyen Vinh Ngoc (Khoa khop, Benh vien Bach Mai)

Ky I: Nguyen nhan va bieu hien cua thoat vi dia dem cot song

Thoat vi dia dem cot song luon la mot van de thoi su vi do la mot nguyen nhan pho bien gay dau cot song co, cot song that lung cung nhu dau chan tay. O Viet Nam co toi 17% nguoi tren 60 tuoi bi mac chung dau lung. Con o My, hang nam co khoang 2 trieu nguoi phai nghi viec do dau that lung, voi chi phi dieu tri len toi 21 ty do-la. Hieu biet van de nay giup chung ta du phong co hieu qua thoat vi dia dem cot song va giam bot chi phi dieu tri benh.

Cac nguyen nhan gay thoat vi dia dem

Co nhieu nguyen nhan gay nen thoat vi dia dem cot song. Dau tien do la cac chan thuong cot song. Thu hai la tu the xau trong lao dong. Dau thuong xuat hien khi ta nhac vat nang o tu the xau. Tuoi tac va cac benh ly cot song bam sinh hay mac phai nhu gai doi cot song, gu veo, thoai hoa cot song cung la cac yeu to thuan loi gay benh. Can chu y rang ton thuong dia dem cung co the do nguyen nhan di truyen. Neu bo me co dia dem yeu do bat thuong ve cau truc thi con cai cung de bi thoat vi dia dem. Co che thoat vi dia dem duoc giai thich nhu sau. Binh thuong dia dem nam o khe giua hai dot song, co lop vo soi boc nhan nhay o trung tam. Nho tinh dan hoi, dia dem lam nhiem vu nhu mot bo phan giam xoc, bao ve cot song khoi bi chan thuong. O nhung nguoi tren 30 tuoi, dia dem thuong khong con mem mai, nhan nhay co the bi kho, vong sun ben ngoai xo hoa, ran nut va co the rach. Tren co so do neu co mot luc tac dong manh vao cot song (chan thuong, gang suc...), nhan nhay co the qua cho rach cua dia dem thoat vi ra ngoai chui vao ong song, chen ep re than kinh gay dau cot song.

Cac bieu hien cua thoat vi dia dem

Dau cot song va dau re than kinh la cac trieu chung noi bat nhat cua benh. Dau thuong tai phat nhieu lan, moi dot keo dai khoang 1-2 tuan, sau do lai khoi benh. Co khi dau am i nhung thuong dau du doi, dau tang khi ho, hat hoi, cui. Ngoai ra con co cam giac kien bo, te cong, kim cham tuong ung voi vung dau. Dan dan, dau tro nen thuong xuyen, keo dai hang thang neu khong duoc dieu tri.

 Thoat vi dia dem chen ep vao re than kinh.

Tuy theo vi tri dia dem thoat vi co the co cac trieu chung dac trung. Thoat vi dia dem cot song co se gay dau cot song co, dau vai gay, dau canh tay. Neu thoat vi dia dem cot song lung thi se co trieu chung dau than kinh lien suon. Benh nhan se thay dau vung cot song lung, lan theo hinh vong cung ra phia truoc nguc, doc theo khoang lien suon. Con neu thoat vi dia dem xay ra o vung that lung thi benh nhan se thay dau that lung cap hay man tinh, dau than kinh toa, dau than kinh dui bi.

Nguoi benh co tu the ngay lung hay veo ve mot ben de chong dau, co canh cot song co cung. Co truong hop dau rat du doi va nguoi benh phai nam bat dong ve ben do dau.

Kha nang van dong cua benh nhan bi giam sut ro ret. Benh nhan rat kho thuc hien cac dong tac cot song nhu cui ngua, nghieng xoay. Khi re than than kinh bi ton thuong thi benh nhan kho van dong cac chi. Neu ton thuong than kinh canh tay thi benh nhan khong the nhac tay hay kho gap, duoi canh tay, kha nang lao dong va sinh hoat bi anh huong nghiem trong. Neu ton thuong than kinh toa thi benh nhan co the khong nhac duoc got hay mui chan. Dan dan xuat hien teo co chan ben ton thuong. Khi benh nang nguoi benh thay chan te bi, mat cam giac o chan dau hay dai, tieu tien khong kiem soat duoc.

Chan doan thoat vi dia dem

Chan doan thoat vi dia dem khong phai de dang. Tren thuc te benh hay bi chan doan nham voi nhieu benh khac hay bi chan doan muon. Do la do cac trieu chung lam sang chi co tinh chat goi y. De chan doan xac dinh can phai lam cac xet nghiem hien dai, ton kem ma khong phai benh nhan nao cung co dieu kien de lam. Chup Xquang cot song thong thuong khong phat hien duoc thoat vi dia dem vi ton thuong dia dem khong can quang, do do khong thay duoc tren phim. Nguoi ta chi gian tiep danh gia ton thuong dia dem khi thay giam chieu cao khe lien dot song, veo cot song. De “nhin thay” dia dem bi ton thuong va thoat vi, phai chup bao re can quang, chup cat lop vi tinh, cong huong tu hat nhan. Khi do dia dem duoc “cat thanh tung lat” nhu khi nguoi ban thit o cho cat mieng thit tren sap de cho nguoi mua xem. Qua do nguoi ta co the danh gia duoc hinh thai, tinh chat ton thuong dia dem, vi tri thoat vi vao ong song hay vao lo lien hop, cung nhu muc do hep ong song do thoat vi dia dem gay ra. Tu do bac si lap ra ke hoach de quyet dinh cac bien phap dieu tri hop ly.

Hau qua cua thoat vi dia dem

Thoat vi dia dem co the de lai nhung hau qua va nhung bien chung nguy hiem cho nguoi benh. Thu nhat, benh nhan co the bi tan phe suot doi do bi liet trong truong hop dia dem thoat vi chen ep tuy co. Khi bi chen ep cac day than kinh vung that lung cung, benh nhan co the bi chung dai tieu tien khong tu chu do roi loan co tron. Ngoai ra benh nhan bi teo co cac chi nhanh chong, khien sinh hoat bi anh huong nghiem trong, tham chi mat kha nang lao dong. Tat ca cac bien chung do anh huong lon den chat luong cuoc song cua nguoi benh, chua ke nhung ton kem do chi phi dieu tri.

Tom lai, thoat vi dia dem cot song la mot benh kha thuong gap, co the de lai nhieu hau qua, anh huong den cuoc song va sinh hoat cua nguoi benh. Do vay khi benh nhan co cac trieu chung noi tren can den kham o co so y te chuyen khoa, tot nhat la gap cac bac si chuyen khoa co xuong khop de duoc chan doan va dieu tri benh kip thoi.