Fractura de Tibie
January 9, 2021 | Author: Anonymous | Category: N/A
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CUPRINS
Cap. I ISTORIC
Cap. II ANATO ANATOMIE MIE SI FIZIOLOGIE
Cap. III FRACTURA DE GLEZNA 1. DEFINITIE 2. ETIOPRTOGENIE 3. SIMPTOMATOLOGIE SIMPTOMATOLOGIE 4. DIAGNOSTIC 5. EVOLUTIE SI COMPLICATII COMPLICATII 6. TRATAMENT TRATAMENT 7. PROFILAXIE 8. CONCLUZII
Cap. IV INGRIIREA !OLNAVULUI !OLNAVULUI CU FRACTURA DE GLEZNA " CAZURI CLINICE
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. LAUSMAN
CAPITOLUL I
ISTORIC
F/a$-/(* 0 $()( '( p/#+- '-+$ a$(-+( a* apa/a$-*-( *###$#/ (a/ ('$#/(-* apa/a$-*-( *###$#/ ' '-p/ap-+ - ('$#/(a #-*-( . D+-(/a 0 &#/$#p0( &#/$#p0 ( a #'$ (+$/#0-'a (+$/#0- 'a 0 NIC9OLS ANDR: a/ (+ 1841 p-)*(a *-/a/a (+$($-*a$a &O/$#p0(a 'a- a/$a a/$a 0 a #/$a 0(#/($a$(* *a #p(( #p(( &. E$(#*#( -,a+$-* '$ 0 #/((+ /aa % &#/$;#' < 0/p$ '( &pa(0(a < /'$/ (a/ $/a-a$#*#(a p/#,(+ 0 *a -,a+$-* & $/a-a< /a+a $-*)-/a/ *#a*a '( +/a*a p/#0-'a 0 -+ a+$ =$/+ a'-p/a #/a+('-*-( . I+ $(p #/$#p0(a '( $/a-a$#*#(a a- 0,+($ # '(+-/a 'p(a*($a$ 'p(a*($a$ '"a- 0'p/(+' 0(+ ;(/-/(a +/a*a a -/a/ a -+-( p/#' 0 a--*a/ #+$(+-a 0#)a+0(+0 -+ ap 0 a$(,($a$ '( $#0#*#( p/#p/(. Oa+(( p/(($(,( p/a$(a- # '/( 0 p/#0 $/ap-$( $/ap-$( (>,#/a$ 0(+ (+'$($-* (+'$($-* 0 #+'/,a/ #+'/,a/ 'a- 0(+ +'($a$ +'($a$ " /0-/a /0-/a '( (#)(*(>a/a -+#/ /a$-/( p+$/- (+*a$-/a/a 0-//(( D(+ &p#a 0 a-/ & a -*$-/(( *+ *($/a$-/a 0(a*a a pa'$/a$ # '/( 0 *-/a/( ;(/-/(a* a* #*$(( ;(p#/a$( ;(p#/a$( a/ ' #-pa 0 /a$-/( *-=a$(( '( p*a( . M0((+a /aa a a--*a$ -+#'$(+$ ;(/-/(a* )#a$ *a$ 0 +-* *-( 9(p#/a$ 0(+ #' &C#/p-' 9(pp#/a$(- 9(pp#/a$(- " 6? 0 *-/a/(@. D(+$/ '/(/(* '/(/(* *-( a(+$( $/a$a$*% P/( P/(
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CAPITOLUL I
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F/a$-/(* 0 $()( '( p/#+- '-+$ a$(-+( a* apa/a$-*-( *###$#/ (a/ ('$#/(-* apa/a$-*-( *###$#/ ' '-p/ap-+ - ('$#/(a #-*-( . D+-(/a 0 &#/$#p0( &#/$#p0 ( a #'$ (+$/#0-'a (+$/#0- 'a 0 NIC9OLS ANDR: a/ (+ 1841 p-)*(a *-/a/a (+$($-*a$a &O/$#p0(a 'a- a/$a a/$a 0 a #/$a 0(#/($a$(* *a #p(( #p(( &. E$(#*#( -,a+$-* '$ 0 #/((+ /aa % &#/$;#' < 0/p$ '( &pa(0(a < /'$/ (a/ $/a-a$#*#(a p/#,(+ 0 *a -,a+$-* & $/a-a< /a+a $-*)-/a/ *#a*a '( +/a*a p/#0-'a 0 -+ a+$ =$/+ a'-p/a #/a+('-*-( . I+ $(p #/$#p0(a '( $/a-a$#*#(a a- 0,+($ # '(+-/a 'p(a*($a$ 'p(a*($a$ '"a- 0'p/(+' 0(+ ;(/-/(a +/a*a a -/a/ a -+-( p/#' 0 a--*a/ #+$(+-a 0#)a+0(+0 -+ ap 0 a$(,($a$ '( $#0#*#( p/#p/(. Oa+(( p/(($(,( p/a$(a- # '/( 0 p/#0 $/ap-$( $/ap-$( (>,#/a$ 0(+ (+'$($-* (+'$($-* 0 #+'/,a/ #+'/,a/ 'a- 0(+ +'($a$ +'($a$ " /0-/a /0-/a '( (#)(*(>a/a -+#/ /a$-/( p+$/- (+*a$-/a/a 0-//(( D(+ &p#a 0 a-/ & a -*$-/(( *+ *($/a$-/a 0(a*a a pa'$/a$ # '/( 0 *-/a/( ;(/-/(a* a* #*$(( ;(p#/a$( ;(p#/a$( a/ ' #-pa 0 /a$-/( *-=a$(( '( p*a( . M0((+a /aa a a--*a$ -+#'$(+$ ;(/-/(a* )#a$ *a$ 0 +-* *-( 9(p#/a$ 0(+ #' &C#/p-' 9(pp#/a$(- 9(pp#/a$(- " 6? 0 *-/a/(@. D(+$/ '/(/(* '/(/(* *-( a(+$( $/a$a$*% P/( P/(
'a/# D'p/ -';(@ P/( a#+ D'p/ /a$-/(@ &P/( a/$;#+ D'p/ a/$(-*a$((@ D'p/ (+'$/-+$* 0 /0-/ a/ -p/(+0 -+#'$(+$ 0 $/ap-$(a ;(/-/(a*a #/$#p0(a /aa' /aa' ,a*a)(* pa+a (+ >(** +#a'$/ . S$-0(/a a+a$#(( '( a )#*(*#/ apa/a$-*-( *###$#/ a *-a$ a,a+$ '( (+ p/(#a0a '#*(( 0(+ A*=a+0/(a p/(+ 9EROFIL ERASISTRAT CELSUS aa'$a 0'/((+0 #a/$ )(+ *(+(-* (+*aa$(( (+*aa$(( '-p-/a$(a '-p-/a$(a '( -+* $;+(( $;+(( 0 ;(/-/( ;(/-/( '( #/$#p0( . D(+ E,-* M0(- a- /aa' * 5 ,#*- /-+($ (+ &Ca+#+-* 0((+(( (+ a/ AVICENA A!U ALI I!NSINA@ 0( $a0B( " p/'a+ 0'/( -*$ )#*( '( $;+(( 0 p/a$(a #/$#p0(a #/$#p0(a . I+ '#*-* XVI ;(/-/(( p(/(( 0 *a 'a$ /0-a- *-=a$((* '( /a$-/(* '( apa/ a'$* ;(/-/(( )a/)(/( p/a$(a- $/a-a$#*#(a -/+$a . I+ 1852 ANT9ONIUS MAT9ISSEN MAT9ISSEN ap*(a $;+(a apa/a$*#/ ;(p'a$ (a/ pa$/0+(( a( $a/>(- LANNELONUE '( AC9RAD (+$/#0- /a0(a$((* X (+ 0(a+#'$(-* )#*(*#/ #'#a' /a$-/(*#/ /a$-/(*#/ '( *-=a$((*#/ *-=a$((*#/ P/(+$/ ( a/ a- #+$/()-($ *a 0>,#*$a/a #/$#p0(( (+ aa'$a p/(#a0a ($a p% DUPU:TREN DUPU:TREN L.. PETIT PETIT N.I. PIROGOV PIROGOV CAROL DAV DAVILA DESAULT DESAULT . G;(p'-* '-) #/a '*#/ ;(p'a$ (+ $/a$a+$-* /a$-/(*#/ apa/ 0( a # (+,+$( a #*a+0>-*-( MAT:SSEN a '( a ;(/-/-*-( /-' N.I. PIROGOV -*$(-* #*#'(+0 apa/a$* ;(p'a$ (+ Ra>)#(-* 0(+ C/(a 1853@. MORTON MORTON 0'#p/a '( #*#''$ $/-* '( *#/#/-* a a+'$>(. L-/a/(* *-( LISTER '( PASTEUR (+ ap*(a/a a+$('p'(( a- /0-' #p*(a$((* 'p$( a* #p/a$((*#/. LANE '( LAM!OTTE (+$/#0- (p*a+$* $a*( 0(+ a*(aB 0 #$* (+ #'$#'(+$>. #'$#'(+$>. D'#p/(/a /a>*#/ X 0 a$/ ROTGEN a 0,+($ -+ (B*# (p#/$a+$ 0 0(a+#'$(. T;#a I#+'- p/a$(a /a;(a+'$>(a (+a*$a ap#( B#a'a #*#'($a p 'a/a *a/a (+ ;(/-/(a )/*#/ (+/(#a/ . UVARA a (+$/#0-' +-/#a' $;+(( 0 #'$#'(+$>a a /a$-/(*#/ . I+$/#0-/a a+$()(#$/ap(( FLEMMING "14?@ p/- '( 0>,#*$a/a $;+(#" '$((+$((a a (+'$/-+$a/-*-( '( a apa/a$-/(( #/$#p0(#" ;(/-/(a* a- ()#a$($ p/#/a+$* a'$( a'$( 'p(a*($a$( 'p(a*($a$( . I+a*a'( $(p *a +#( (+ $a/a # '/( 0 ;(/-/( a% AL. COSACESCU COSACESCU D. PINTILIE AL. RADULESCU I. G9IULAMILA I. TURAI E. MARES T9. FIRICA I. FAGARASANU "a0- #+$/()-$(( (p#/$a+$ (+ ;(/-/(a #/$#p0(a . T#$#0a$a ATSON ATSON TRUETA TRUETA MARLE MAR LE DAU!IGNE DAU! IGNE PAIELS UDET PETIT a- /a$ / a$ +$/ + $/ #0/+ 0 #/$#p0( '( $/a-a$#*#( a0-a+0 (+ a*a'( $(p #+$/()-$(( (p#/$a+$ (+ #'$#'(+$>a '( )(#a+(a #'$#a/$(-*a/a .
CAPITOLUL II
ANAT ANATOMIA SI FIZIOLOGIA SISTEMULUI OSOS " TI!IA SI FI!ULA
Oa'* '-+$ p(' 0-/ '#*(0 />('$+$ (+$/"# #a/a/ a'-/a ;(a/ *a'$( a/ p/(+ a/$(-*a$((* a/$(-*a$((* 0(+$/ * #/a>a #/a>a ';*$-* " pa/$a pa/$a pa'(,a a apa/a$-*-( *###$#/ . T()(a T()(a '( ()-*a p/#+-*@ (+$/a (+ a*a$-(/a ';*$-*-( a)( 0a/ '( a* *>+(@ '-+$ #a' *-+( a/ a- -+ #/p +-($ 0(a(>a '( 0#-a =$/($a$( +-($ p((> . Oa'* $()(( '( ()-*( p/>(+$a '-p/a$ 0 a/$(-*a/ - #a'* ,(+ a#p/($ 0 a/$(*aB-* a/$(-*a/ ;(a*(+ . P/>(+$a 0 a'+a ap#(> '( $-)/#>($a$( /a$ p/(+ $/a$(-+( p/*-+($ 'a- 'a+$-/( '( #'$ 0$/(+a$ 0 p/'(-+( =/($a$ a'-p/a #'-*-( . P/(+ a/;($$-/a 'a #'-* '$ a0ap$a$ -+$(( 0 a />('$a *a p/'(-+ '( $/a$(-+ '( ' '-p-+ p/(+(p(-*-( &- a$/(a* p-$(+ a=(- 0 />('$+$a &. La +(,*-* 0(a(>( #a'*#/ *-+( (+ +$/- ' a''$ a+a*-* 0-*a/ +$/a*@ a/ a0ap#'$'$ a0-,a #'#a'a '( a/ '$ (+#+B-/a$ 0 # >#+a 0 $'-$ #'#' #pa$ . I+ aa/a $'-$-*-( #pa$ ' /a/a p/(#'$-* # )/a+a #+B-+$(,#",a'-*a/a #+B-+$(,#",a'-*a/a - /#* (+ /'$/a #'-*-( (+ /#'( '( (+ /a/a $'-$-*-( #'#' *a +(,*-* /a$-/(*#/ . E'$ )#a$ (+/,a$ '( '$ a0/+$ *a #' p/(+ =('$+$a ()/*#/ *a'$( pa$/-+0 (+ a'$a "()/* *-( S;a/p . P/(#'$-* a/ /#* (p#/$a+$ (+ ,(a$a #'-*-(% (+ p/(#a0a #'$#+>( * pa/$((pa *a #/a/a $'-$-*-( #'#' (a/ *a a0-*$ a,a+0 /#* (+ +-$/($(a #'-*-(. D a'+a a/ /#* (p#/$a+$ (+ #/a/a a*-'-*-( (+ a> 0 /a$-/( p/- '( *a /pa/a/a -+#/ p(/0/( *(($a$ 0 '-)'$a+$a #'#a'a . La *#-* 0 -+(/ a 0(a(>( - p((>* *a #a'* $(+/ ' a*a a/$(*aB-* 0 /'$/ 'a- 0(a(>#"p((>a/ .
Ma0-,a #'#a'a ' a''$ (+ #a'* *-+( *a +(,*-* a+a*-*-( +$/a* p/- '( (+ a/#** $'-$-*-( 'p#+(#' 0(+ p((> . Ea a/ /#* (+ /($/#p#>a 0( p/#0- ;a$((. Ma0-,a #'#a'a /($/#p#$(a 'a- ;aa$#+a a/ -*#a/ /#'( '( #-pa *a +a'$/ $#a$ a,($a$(* #a'*#/ . C- (+a(+$a/a (+ ,a/'$a a0-,a /#'( ' /$/a (+ p((>* #a'*#/ *-+( 0a/ '( *a +(,*-* #a'*#/ '-/$ '( *a$@. R'$-* a0-,( $/ (+ /pa-' /($/#p#$( '( 0,(+ a0-,a a*)+a - />/, 0 /a'(@. La ,a/'$ (+a(+$a$ a0-,a a*)+a '$ (+,a0a$a 0 $'-$ #+B-+$(, ()/#' 0,+(+0 a0-,a +-'( *a$(+#a'a@ a/ #+$(+ *+$ #+B-+$(, '( +- a( p#a$ ( /-p/a$a p+$/- /($/#p#>a . Ca+0 '$ +'a/a # /'$/ a +-a/-*-( 0 ;a$(( a0-,a /#'( ' =$(+0 '( (+ $/($#/(-* #-pa$ 0 a0-,a a*)+a 'p#/(+0 '-p/aa$a 0 p/#0-$( a ;a$((*#/ . T'-$-* #'#' '$ -+ a0,a/a$ #p*= #/#-+$(#+a* - /#* a+( 0a/ '( - /#* $a)#*( 0'$-* 0 (p#/$a+$ . R#*-* $a)#*( a* #'-*-( ' 0a$#/a>a (+ 'p(a* />/,( (+/a* " (+ 'p(a* (#+( 0 Ca '( P - /#* (+ +$(+/a ;(*()/-*-( #'#a*( p/- '( />/,( ;a$( p/(+ a0-,a #'#a'a $a+a/a . D(+ p-+$ 0 ,0/ ;('$#*#( $'-$-* #'#' '$ a*a$-($ 0(+% " *-* #'#a' " ()/ #*a+ " '-)'$a+$a -+0a+$a*a . C*-** #'#a' '-+$ 0 $/( $(p-/(% 1." #'$#)*a'$ " *-* $(+/ a/ '/$a '-)'$a+$a p/#'#a'a * (+#+B#a/a #p*$@ p/#$##*a+ '( #'a$a>a a*a*(+a a'$a '$a+0 *a )a>a ,(($#/-*-( $'-$ #'$#(0 +(+/a*(>a$ . 2." #'$#($ " *-* - #/a #,a*a/a '( $-/$($a - -*$ p/*-+(/( . E* '-+$ a0ap#'$($ (+ a,($a$( '$*a/ 'a- -'(#/ +-($ #'$#p*a'$ . A'$a #-+(a (+$/ * p/(+ +-/#a' a+a*(-* #'#a' '-)$(/( a/ ' a+a'$##>a>a - a+a*(-** #'$#p*a'$*#/ (+,(+a$ . P/(+ a'$ a+a*(-* pa/$-+0 p/*-+(/(* #'$#($*#/ a/ +' a+a'$##>a>a - * ,(+ .
3." #'$#*a'$-* " *-*a (a+$(a -*$(+-*a$a a/ (+0p*(+'$ -+$(a 0 0('/$-/ '( *(($a/ a $'-$-*-( #'#' (+ -+$( 0 +'($a$(* (>(#*#( . A/ -+ )#a$ ;(pa+$ +>(a$( . Ma$/(a p/#$(a $/aa p/#$(a 'a- $'-$-* p/#'#'@ a #'-*-( '$ a*a$-($a 0(+ ()/* #*a+ '( '-)'$a+$a -+0a+$a*a . F()/* #*a+ #+/a " p/(+ '$/-$-/a *#/ " />('$+$a #'-*-( *a '#*(($a/(* a+( (+ 'p(a* *a #/a/ '( $/a$(-+ . S-)'$a+$a -+0a+$a*a '$ #/a$a ;(( 0(+$/"-+ #p*= a/##*-*a/% p/#$#*(a+( a*a$-($( 0(+ *##a(+#*(a+( '( -#p/#$(+ . O'-* p/#a'pa$ #+$(+% 5?H 'a/-/( (+/a* 25H '-)'$a+$ p/#$( 1? " 25H apa .O'-* -'a$ a/% 7?H 'a/-/( (+/a* p/#+$* ,a/((+0 (+ -+$( 0 ,a/'$a )#*( 'a- 0-pa 0(/($* pa/$( a* #'-*-( . Sa/-/(* (+/a* '-+$ a*(-* '( #'#/-* (a/ * a( (p#/$a+$ '$ #'a$-* $/(a*( ;(0/a$a$ '-) #/a 0 (/#/('$a* 0 ;(0/#=(apa$($a . S$/-$-/a (+/a*a a #'-*-( #+/a a'$* />('$+$a a( a*' *a #/$* 0 #p/'( . D a'+a /p/>(+$a -+ a0,a/a$ (>,#/ 0 'a/-/( (+/a* a'(-/a+0 ;#'$a>(a (#+(a a #/a+('-*-( . I+ -+$( 0 0('p-+/a *a**#/ #'#a' =('$a 0#-a ,a/($a$( 0 $'-$ #'#'% #pa$ '( 'p#+(#' . T'-$-* #'#' #pa$ " #/a>a 0((>a #a'*#/ *-+( . I+ 0(a(>a -+-( #' *-+ p '$(-+ $/a+',/'a*a ' #)'/,a +$/a* a+a*-* 0-*a/ - a0-,a /#'( *a a$@ '( a*)+a *a a0-*$@. La =$/(#/ p/(#'$-* a#p/a 0(a(>a . I+$/ p/(#'$ '( a+a*-* 0-*a/ ' a*a '-)'$a+$a #'#a'a a 0(+(>( a* a/( *a* #'#a' '-+$ 0('p-' #++$/( (+ B-/-* -+#/ a+a* '-)$(/( " a+a** 9a,/' . I+ (+$/(#/-* a'$#/ a+a* ' a'' $/(+a$(( +/,#a' ap(*a/ 'a+-(+ '( $'-$ #+B-+$(, *a= (+ a+$($a$ /0-'a . Ca+a** 9a,/' '$/a)a$ #'-* p $#a$a *-+(a *-( '( ' *aa (+$/ * p/(+ a+a* #)*( 'a- $/a+',/'a* . A+'a)*-* #/a$ 0 -+ a+a* 9a,/' - *a** #'#a' a/ (* (+#+B#a/a '( #p#++$* a*a$ (+ a'$ #/a$(-+( #'$#p*a'$ - #'$#($@ #+'$($- # -+($a$ #/#*#(a '( -+$(#+a*a ' +-'$ #'$#+ 'a- '('$ ;a,/'(a+ .
T'-$ #'#' 'p#+(#' " ' a*a (+ p((>* #a'*#/ *-+( . La** 'a* #'#a' ' +-+' $/a)-* a/ ' (+$/$a( 0*(($a+0 a,($a$( +-($ a/#* 0 a'p$ '( a/(( 0(/($ a/ 0a- #'-*-( a'p$-* -+-( )-/$ . A/#** #-+(a (+$/ * '( #+$(+ a0-,a #'#a'a /#'( . F/a$-/(* 0 *>+a a$>a $()(a '( ()-*a p/#+-*@ a/ (p/-+a a*a$-(' ';*$-* a)( .
TI!IA '$ -+ #' *-+ p/; #/a$a 0(+$/"-+ #/p '( 0#-a =$/($a$( . C#/p-* a/ #/a 0 p/('a $/(-+;(-*a/a p/>+$a+0 $/( $% 0(a*a *a$/a*a '( p#'$/(#a/a '( $/( a/(+(% a+$/(#a/a 0(a*a '( *a$/a*a . Ma/(+a a+$/(#a/a +-($a &/a'$a $()(( '$ a'-$($a p/#(+a+0 '-) p(* . Ma/(+a *a$/a*a +-($a &/a'$a (+$/#'#a'a '/,'$ *a (=a/a )/a+( (+$/#'#a' a a)( . E=$/($a$ '-p/(#a/a p/>(+$a% #+0/(*(( $()(( 0(a* '( *a$/a*@ a,($a$(* *+#(0 a* $()(( 0(a*a '( *a$/a*a@ $-)/($a$a $()(( '( a$a a/$(-*a/a p+$/- ap-* ()-*( . C#+0/(*(( $()(( '-+$ 0#-a a' #'#a' ,#*-(+#a' '($-a$ 0 # pa/$ '( 0 a*$a a p((>( '-p/(#a/ a $()(( . Ca,($a$(* *+#(0 a* $()(( '-+$ $ a/$(-*a/ -'#/ #+a, (+ a/ (+$/a #+0/(*(( -/a*( - a/ ' a/$(-*a>a $()(a . T-)/#>($a$a $()(( '$ # p/#(++$a #'#a'a a'>a$a p a$a a+$/(#a/a a p((>( '-p/(#a/ . P a ' (=a>a $+0#+-* /#$-*( . Fa$a a/$(-*a/a p+$/- ap-* ()-*( '$ '($-a$a p #+0/(*-* *a$/a* . E=$/($a$a (+/(#a/a p/>(+$a% a*#*a 0(a*a 'a- (+$/+a # p/#(++$a #'#a'a - ,a/-* (+ B#' a/ ' a/$(-*a>a - #'-* a'$/aa* # a$a a/$(-*a/a p+$/- ()-*a '( # a$a a/$(-*a/a p+$/- $/#;*a a'$/aa*-*-( .
FI!ULA 'a- p/#+-* '$ -+ #' *-+ p/; a/ (p/-+a - $()(a #/a>a ';*$-* a)( . T()(a '$ a'>a$a 0(a* (a/ ()-*a *a$/a* . F()-*a ' #p-+ 0(+$/" -+ #/p '( 0#-a =$/($a$( . C#/p-* ()-*( /p/>(+$a # /a'$a (+$/#'#a'a p a/ ' p/(+0 )/a+a (+$/#'#a'a a a)( .
E=$/($a$a '-p/(#a/a +-($a '( ap-* ()-*( p/>(+$a # '-p/aa$a a/$(-*a/a p+$/- #+0(*-* *a$/a* a* $()(( '( # p/#(++$a #'#a'a +-($a ,a/-* ap-*-( 'a- ap#(>a '$(*#(0a a ()-*(. E=$/($a$a (+/(#a/a p/>(+$a # #/a$(-+ #'#a'a a/ #)#a/a '-) +(,*-* =$/($a$(( (+/(#a/ a $()(( 0+-($a a*#*a *a$/a*a 'a- =$/+a a/ ' a/$(-*a>a - a'$/aa*-* '( # '-p/aa$a a/$(-*a/a p+$/- $()(. La +(,*-* *>+( ' a''% a/$(-*a$(a $()(#()-*#$a*a/a '( -';(( #/'p-+>a$#/( . A/$(-*a$((* '-+$ #/a+ 0 *a$-/a (+$/ #a' . E* a'(-/a #a'*#/ 0(/($ /a0 0 #)(**($a$ p/($a+0-"* a'$#/a 'a"'( (+0p*(+a'a -+$(a -+0a+$a*a 0 pa/;( (+ -/'-* $-a/(( ('a/(*#/ (p/(a$ 0 -';(. D-pa /a0-* *#/ 0 #)(*($a$ON1J * ' (pa/$ (+ $/( a/( a$#/((% a/$(-*a$(( (= ()/#a' 'a'(+a/$/#> a/$(-*a$(( a/$(*a(+#a' a(a/$/#> '(#)(* '( a/$(-*a$(( #)(* '(+#,(a*@ 'a- 0(a/$/#>. A/$(-*a$(a $()(#"()-*#$a*a/a '$ # a/$/#0( a/$(-*a$( #)(*a@. D(a/$/#>* '-+$ a/$(-*a$(( '(+#,(a* #)(* (+ a/ #a'* a/$(-*a/ $-a>a ('a/( 0 0(/($ ap*($-0(+(. D-pa /a0-* 0 #)(*($a$ a* #a'*#/ a/$(-*a/ * ' (pa/$ (+ 0#-a a$#/((% a/$/#0(( 'a- a/$(-*a$(( #)(*@ '( a(a/$/#> a/$(-*a$(( '(#)(*@. O a/$/#0( '$ a*a$-($a 0(+ -/a$#a/* *+$% $ a/$(-*a/ a/$(*aB a/$(-*a/ ap'-*a a/$(-*a/a *(a+$ a/$(-*a/ '( )/a+a a/$(-*a/a.
SCOA!A TI!IOPERONIERA '$ a*a$-($a 0(+ p-+$ 0 ,0/ a+a$#( 0(+% a*#*a $()(a*a (+$/+a@ p*a#+-* $()(a* '( a*#*a p/#(/a =$/+a@. T()(a '( p/#+-* '-+$ -+($ 0('$a* p/(+$/"# a/$(-*a$( '(+a/$/#>a@ (=a - -+ *(a+$ a+$/(#/ -+-* p#'$/(#/ '( -+-* (+$/+ p/*-+(/ a )/a+( (+$/#'#a'@. D a'+a * 0#-a a*#* '-+$ -+($ 0 a'$/aa* '( 0 a*a+- p/(+$/"-+ '('$ 0 *(a+$ /-pa$ (+$/"-+ *(+$ #*a$/a* =$/+ '( -+-* #*a$/a* (+$/+ 0*$#(0(a+@. I+ a'$ * ' #/a>a # p+'a 'a- '#a)a '-p*a a/ ' a0ap$a>a 0(+'(-+(*#/ '/(p$-*-( a'$/aa*(a+ a( ,#*-(+#' (+ pa/$a 'a a+$/(#a/a. A0ap$/a p+'( a*#*a/ *a ,a/($a$(* 0 *a/( a* a'$/aa*-*-( '$ a'(-/a$a p/(+ *a'$(($a$a a'$#/ *(a+$ '( p/(+ $#+-'-* -';(*#/ p/(a/$(-*a/(. A'$* (+ $(p-* *=(( pa/$a a+$/(#a/a a a'$/aa*-*-( a( *a/a " p+$/a p-$a (+$/a (+ (+$/(#/-* '#a)( " (p(+ a*#*a p/#+(/a (+ aa/a (a/ (+ -/'-* =$+'(( p+'a a*#*a/a ' '$/a+. A'$ B# p/'-p-+ ('a/a *()/a a a/$(-*a$((
$()(# " p/#+(/ ap$ a/ $/)-( a,-$ (+ ,0/ a$-+( a+0 ' $/a$a>a *>(-+( $/a-a$( a* #/$>( $()(# " p/#+(/. SINDESMOZA TI!IOFI!ULARA " Ca '-p/a$ a/$(-*a/ a'(% (+(>(a ()-*a/a p $()( a/ '$ # $('#a/a $/(-+;(-*a/a -'#/ #+a,a (a/ 0(a* 0 *#*a *a$/a*a a ()-*( a'( # a*$a $('#a/a p*a+a 'a- -'#/ #+a,a. S-p/a$* a/$(-*a/ '-+$ a#p/($ - -+ '$/a$ (+ 0 p/(#'$. M(B*#a* 0 -+(/ '-+$% *(a+$-* $()(#()-*a/ a+$/(#/ '( *(a+$-* $()(#()-*a/ p#'$/(#/ a/ '$ a( '-/$ 0a/ a( />('$+$ 0a$ p/0+$-*. P#/$(-+a 'a p/#-+0a '( (+/(#a/a #/a>a *(a+$-* $/a+',/' (+/(#/. A'$ *(a+$ $/ 0(+#*# 0 a/(+(* #a'*#/ '( #/a>a # pa/$ 0(+ '-p/aa$a a/$(-*a/a p+$/- $a*-'. L(a+$-* (+$/#'#' ' #+$(+-a (+ '-' - )/a+a (+$/#'#a'a /-/a*a #/a$a 0(+ a'(-* p-$/+( $/ (+$/ $* (+,(+a$ a* $()(( '( ()-*(.
MEM!RANA INTEROSOASA CRURALA '$ # #/a$(-+ ()/#a'a />('$+$a a/ (+;(0 'pa$(-* 0(+$/ $()( '( ()-*a 0'pa/$(+0 -';(( a+$/(#/( a( a)( 0 ( p#'$/(#/(. E'$ a*a$-($a 0 a'(-* ()/#a' #)*( 0'+0+$ 0 *a $()( *a ()-*a. I+ pa/$a '-p/(#a/a p/>(+$a -+ #/(((- a/ p/(+ a/ $/ ,a'* $()(a* a+$/(#a/K (+ pa/$a (+/(#a/a a'( # 0';(0/ (+-'$a p+$/- $//a /a-/(( p/#/a+$ a a/$/( ()-*a/. M('a/(*% (+ '(+0'#>a $()(#()-*a/a ' p/#0- ('a/( 0 #a/$ (a (+$(+0/. E* ' /0- *a '(p* ap/#p(/( '( (+0pa/$a/( a* $()(( 0 ()-*a. S p/#0- a( a*' (+ -/'-* =-$a/(( ('a/(( 0 *=( 0#/'a*a a p((#/-*-(. D /a/a$ a a'$ ('a/( +' 0a$#/a>a (+$/,+$(( -+#/ -';( ( #+#/a$(( 'p(a* a $/#;*( $a*-'-*-( a/ '$ a( *a$a (+ pa/$a a+$/(#a/a 0a$ (+ a p#'$/(#a/a. Ca+0 p((#/-* ' *$a>a 0#/'a* $/#;*a $a*-'-*-( pa$/-+0 - pa/$a 'a *a/($a (+$/ * 0#-a #a' a)(+ p a/ * (+0pa/$a>a 0$/(+a+0 (+$(+0/a *(a+$*#/. Ca+0 p((#/-* ' *$a>a p*a+$a/ #a'* a)(+ ' ap/#p( 0#a/ p#/$(-+a a( (+-'$a a $a*-'-*-( #-pa *#-* 0(+$/ $()( '( ()-*a.
OSTEOGENEZA '$ p/#'-* 0 0>,#*$a/ '( /'$/ a #a'*#/ 0 $/a+'#/a/ a ';*$-*-( a/$(*a(+#' '( #+B-+$(, " ()/#' a* )/(#+-*-( (+ ';*$-* #'#' a* a0-*$-*-(. P/#'-* a/ *# (+ 0#-a a>%
"a>a 0 #'((a/ p/(a/a (+ a/ p/0#(+a p/#'* #+'$/-$(, (+ -/a a/#/a ' /a*(>a>a #'-* )/-$ +-+$(#+a*. "a>a 0 #'((a/ '-+0a/a 0 /a+(/@ (+ a/ p/#'* #+'$/-$(, ' 0'a'#a/a #+#($+$ - * 0 0('$/-/ '( a/ 0- *a #/a/a #'-*-( -+$(#+a* - *a** #'#a' 0('p-' p 0(/$((* *(+((*#/ 0 #/$a. O'((a/a p#a$ (% 0'/a*a 0 )/a+a@ 'a- +#+0/a*a 0 a/$(*aB@. O'((a/a 0'/a*a /a*(>a>a /'$/a (+ /#'( a #a'*#/ *-+( p 'aa p/(#'$-*-(. I+$/"# )/a+a #+B-+$(,a $a+a/a (+ +$/ 0 #'((a/ ()/* #*a+ ' (+-*$' '( ' a0-+a #/a+0 a'(-*. O'(+a '/$a$a 0 #'$#)*a'$ (+*#)a>a ()/* #*a+. O'((a/a (/a0(a>a 0 *a +$/- *a p/(/( /p$a+0-"' '( (+ a*$ +$/ 0 #'((a/. P/(+ ->(-+a $-$-/#/ +$/(*#/ 0 #'((a/ ' #/a>a #'-* 0(+($(,. O'((a/a +#+0/a*a 0a +a'$/ #a'*#/ )/*#/K p/(+ a'$ $(p 0 #'((a/ ' /a*(>a>a /'$/a (+ *-+( a #'-*-( *a +(,*-* a/$(*aB-*-( 0 /'$/ . I+ #0*-* a/$(*a(+#' a* #/(a/-( #' *-+ apa/ p-+$ 0 #'((a/ a( (+$a( (+ 0(a(> -*$/(#/ '( (+ p((>. A'$a ' +-' p-+$ 0 #'((a/ p/(($(,a. I+$/"# p/(a $apa *-**a/$(*a(+#a' ' -*$(p*(a ' ;(p/$/#(a>a 0,(+ a/(@ 0-pa a/ (+p 'a 0+/> *a'a+0 (+ *#-* *#/ +('$ a,($a$(. I+ B-/-* a'$#/a (+ '-)'$a+$a -+0a+$a*a a a/$(*aB-*-( ' 0p-+ 'a/-/( 0 a*(- a/ #/a>a # '/( 0 *(+(( 0(/$#a/ $/,@. I+ $apa -/a$#a/ 0(+ p/(#+0/- )/a+a #+B-+$(,#",a'-*a/a a/ ()/aa a/$(*aB-*@ p*aa --/(( #+B-+$(,#",a'-*a/( a/ (+a(+$a>a p/#/'(, (+ p('a a/$(*a(+#a'a. I+ $'-$-* #+B-+$(, 0(+ a+a* (+p p/#'-* 0 #'$#+>a. C*-** >+;(a* ' a'a>a p p/$(( $/a,*#/ 0,+(+0 #'$#)*a'$( a/ (+p 'a '/$ #'(+a. Aa'$a ' (p/+a>a - 'a/-/( 0 a*(- #/a+0 $'-$-* #'#' p/(a/. La #a'* *-+( #'$#)*a'$* a0-' 0 --/(( #+B-+$(,#",a'-*a/( 0('$/- #'-* p/(a/ '( #/a>a a+a*-* 0-*a/ (+ +$/-* 0(a(>(. Ma0-,a 0(+ (+$/(#/-* a+a*-*-( 0-*a/ ' #/a>a $#$ p 'aa a'$#/ --/( #+B-+$(,#" ,a'-*a/(. I+ -/a /a+(/(( ' ,#/ #/a '('$* 9a,/' (+ 0(a(>a '( $'-$ 'p#+(#' (+ p((>a '( (+ #a'* '-/$. O'((a/a p((>*#/ (+p a( $a/>(- 0-pa a- aB-+' ap/#ap 0 0(+'(-+(* 0(+($(,. Raa+ a/$(*a(+#a' 0#a/ a/$(*aB* 0 #+B-a/ 0(a(>#p((>a/ 'a- 0 /'$/@. C*-** a'$#/ a/$(*aB p/#*(/a>a 0#a/ 'p/ 0(a(>a /a*(>a+0 p/#'-* 0 /'$/ (+ *-+( a #'-*-(. C/'$/a (+ /#'( '$ a'(-/a$a 0 p/(#'$-* #'$#+.
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META!OLISMUL OASELOR DUPA INCETAREA CRESTERII E=p/(+$* - (>#$#p( /a0(#a$(,( a- 0#,0($ p/a++$a /(+#(/ (>(#*#(a a #p#++$*#/ (+/a* a* #a'*#/ $a)#*('-* (+$+' '( p*a'$(($a$a a/ a a'$-( $'-$ *a #-* a0-*$ ;(a/ '( 0-pa $/(+a/a p/(#a0( 0 /'$/ #)a$a+0 a'$* #+p$(a (+,;($a a/ #+'(0/a $'-$-* #'#' 0/p$ -+ $'-$ (+/$. T#$ a'$ =p/(+$ a- a/a$a$ a *+$* (+/a* a* #'-*-( ' p#$ /a'( (+ a*$ $'-$-/( 'a- -#/(. A'$* a*(-* 0(+ #a' p#a$ ( /a'($ (+ *ap$* 0 aa (+ $(p-* *a$a$((. S"a a( a/a$a$ a +-a( *a 0#-a (+-$ 0 *a (+B$a/a (+$/a,+#a'a 0 a*(- a/a$ a'$a (+p 'a ' (=> (+ '-)'$a+$a (+/a*a a #'-*-( (a/ 0-pa (/a 8"1? #/ ?H 0(+ a*(-* (+B$a$ '$ (=a$ (+ #a'. R>-*$a$* a'$#/ =p/(+$ (+0(a -+ ';() p/a++$ (+$/ a*(-* 0(+ 'a+ '( * 0(+ #a'. P/#'-* 0 (=a/ a a*(-*-( (+ #a' '-) #/a 'a/-/(*#/ (+/a* #p*= p#a/$a +-* 0 (+/a*(>a/ (a/ p/#'-* (+,/' 0 0'a/ a 'a/-/(*#/ (+/a* #p*= 0 *a +(,*-* #'-*-( '( 0 *()/a/ a a*(-*-( (+ 'a+ '( (+ **a*$ *(;(0 0(+ #/a+(' ' +-'$ 0(+/a*(>a/. I+$/ a'$ 0#-a p/#' #p-' =('$a -+ ;(*()/#+'$a+$ *a +$(+/a a/-(a pa/$((pa pa/a$;#/#+-* ;#/#+ pa/a$(/#(0(a+@ a*($#+(+a ;#/#+ $(/#(0(a+@ p/- '( a*$( ;#/#+(. A'$#/a *( ' a( a0a-a ,($a(+* 0(+ /-p-* D ,($a(+a A '( ,($a(+a C. E;(*()/-* 0(+$/ p/#'-* 0 (+/a*(>a/ '( * 0 0(+/a*(>a/ a #'-*-( '$ /p/>+$a$ "(+ '+$a" 0 ;(*()/-* #'#a*( a* #/a+('-*-( a/ p/'-p-+ +- 0#a/ (=a/a a*(-*-( '( a #'#/-*-( ( '( a)'#/)$(a /pa/a$(a *((+a/a /*a/a '( /#*-* a*(-*-( '( a #'#/-*-( (+ #/a+('.
!(*a+$-* a*(-*-( a0(a 0(/+$a 0(+$/ ap#/$ '( *((+a/ '$ p#>($(, *a #p((( a*a$( (+ /'$/ a*(-* ' (=a>a (+ #a'@ a* - >/# *a a0-*$-* +#/a* '( +a$(, *a )a$/a+( #a'* ' 0a*((a@. D'(-/ )(*a+$-* a*(-*-( '$ '( (+ -+$( 0 ap#/$-* a*(+$a/. A'$* (+ #+0($((* -+( a*(+$a$(( *(p'($ 0 a*(- a/ *# # #)(*(>a/ a a'$-(a (+ #a' (a/ *a a0-*$ 0- *a 0a*((/a #a'*#/ 'a- *a a'a +-($-* p/#' 0 #'$#a*a(. U+ /#* (p#/$a+$ (+ /*a/a a+$($a$(( 0 a*(- 0(+ #/a+(' (* a- ;#/#+-* pa/a$(/#(0(a+ '( ,($a(+* 0(+ /-p-* D. 9#/#+-* pa/a$(/#(0(a+ a/'$ /'#/)$(a a*(-*-( a*/a+0 #)(*(>a/a a*(-*-( 0(+ #a' +$(+a+0 (+ *(($ (>(#*#( a*(-* p*a'a$(. E=$(/pa/a =p/(+$a*a a *a+0*#/ pa/a$(/#(0 a/a$a # /'$/ a =/$(( 0 a*(- p/(+ -/(+a *a # 'a0/ a +(,*-*-( 'a- (+ 'a+ '( *a apa/($(a 0 #+$/a$(( -'-*a/ a+#/a* $$a+(@ '( ;(a/ *a #a/$. Ia/ '/$(a 0 ;#/#+ pa/a$(/#(0(a+ '$ 0*a+'a$a 0 (+'-'( +(,*-* a*(-*-( 'a+-(+. Ca+0 a'$ +(,* '$ 'a>-$ '/$(a '$ '$(-*a$a a+0 * '$ /'-$ '/$(a '$ (+;()a$a. V($a(+a D pa/$((pa *a /*a/a a+$($a$(( 0 a*(- 0(+ #/a+(' '( a a*(-*-( (#+(>a$ 0(+ p*a'a p/(+ (+$/,+$(a ( a'(-/a p/#'-* 0 a)'#/)$( (+$'$(+a*a a a*(-*-( '( /'p$(, a #'#/-*-(. Ea a,#/(>a>a a)'#/)$(a a*(-*-( ;(a/ '( a+0 /ap#/$-* CaP +0pa''$ ,a*#a/a 0 ?5. O a*$a a$(-+ a ,($a-+( D '$ aa 0 a a,#/(>a (=a/a (#+-*-( 0 a*(- (+ $'-$-* #'#'. N,#(a >(*+(a 0 #'#/ p+$/- -+ a0-*$ '$ (+ B-/ 0 1 /. I+ #/a+(' #'#/-* ' a''$ (+0#')( (+ 'a+ '( $'-$-/(. I+ $'-$-/( #'#/-* '$ #++$/a$ (+0#')( (+ #a' '( 0(+$(. I+ #a' #'#/-* ' a*a 0p#>($a$ '-) #/a 0 ;(0/#=(apa$($a 0 #'a$ +-$/- 0 a*(- '( 0 #'a$( 0 M Na '( . R*a/a a+$($a$(( 0 #'#/ 0(+ #/a+(' '$ 0$/(+a$a 0 # -*$($-0(+ 0 a$#/( '( (+ p/(-* /a+0 0 ;#/#+-* pa/a$(/#(0(a+ a/ a,#/(>a>a *((+a/a#'#/-*-( p/(+ /(+(;( '( 0 ,($a(+a D.
ROLUL OASELOR IN ORGANISM
1. D-/($a$a '( />('$+$a #a'*#/ 0$/(+a #/a/a #/p-*-( #+'$($-(+0 (p/-+a - a/$(-*a$((* 0(+$/ * '-p#/$-* pa/$(*#/ #( % ';*$-*.
2. Ma0-,a /#'( 0(+ p((>* #a'*#/ *-+( '$ -+ #/a+ ;a$#p#$(. 3. C#p#++$a (+/a*a a #a'*#/ #+'$($- -+ 0p#>($ 0 '-)'$a+$ #'#a*( p a/ #/a+('-* (* p#a$ #)(*(>a '( -$(*(>a *a +,#( . =. p/(#a0a 0 'a/(+a *a (@. 4. Oa'* a- /#* (p#/$a+$ (+ ('a/a #/p-*-( a,a+0 /#*-* -+#/ pa/;((. 5. Oa'* p#$ /$(+ $p#/a/ '( *+$ $#=( p+$/- #/a+(' a% P) a/'+ $.0 aa ' p#a$ #+'(0/a a (+0p*(+' -+/#* a+$($#=(.
REZOR!TIA OSOASA
S a/a$/(>a>a p/(+ 'a0/a #++$/a$(( #'#' /a//a$(/@ pa+a *a 0('pa/($(a #p*$a a #'-*-( #'$#*(>a@ '-) 0p+0+$a #'$#*a'$*#/ (+*-+$a$ 0 (+a$(,($a$a (>(a '( 0 $-* ;#/#+-*-( pa/a$(/#(0(a+. P/(+ />#/)$( #'#a'a ' p(/0 #+$(+-$-* (+/a* '( * #/a+( $/a,* #'#a' 0,(+ a( '-)$(/( '( a( /a/. I+ -/'-* ,($(( '$/-$-/a #'#a'a '-/a # /a+(/ (++#($#a/ *+$a '( #+$(+-a #/a+0-"' #' +#- *a p/(/(a #'$#+(*#/ (a/ *+$* #'#a' ,;( ' />#/) (+ +$/-* #'$#+( pa+a 0('pa/. N#/a* =('$a -+ ;(*()/;##'$a$( (+$/ +#+a* 0 #'((a/ '( />#/)$(. Oa'* p#$ '-/( #0((a/( #/#-+$(#+a* p/(+ a$#/( ;#/#+a*( pa$#*#(( 'a- $/a-a$((. L-/a/a 0 a$a ' #-pa 0 #0((a/(* '-/($ 0 #a'* a)( '-) a$(-+a a+$(*#/ $/a-a$(( 0$/(+a /a$-/( *a a'$ +(,*.
CONSOLIDAREA FRACTURILOR < CALUSUL
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CAPITOLUL III
FRACTURA DE GLEZNA
1. DEFINITIE
F/a$-/a *>+( ' p#a$ 0(+( *a'( a ((+0 # '#*-$( 0 #+$(+-($a$ *a +(,*-* #a'*#/ *>+( (+ -/a -+-( $/a-a$(' ,(#*+$. Da/ a p#a$ apa/ 0-pa -+ $/a-a$(' 0 (a (p#/$a+$a a$(#+a>a a'-p/a #'-*-( )#*+a, /a(*(>a$ p/(+$/"# '-/(+$a a+$/(#a/a #'$#p#/#>a $-#a/ #'#a'a #'$($a@. D aa AL. RADULESCU a *a'((a$ "(+ +/a*" /a$-/(* (+%
/a$-/( a* #a'*#/ 'a+a$#a'
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2. ETIOPATOGENIE
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'a- '-+$% (+,/'(-+a '( ,/'(-+a . I+,/'(-+a '$ '-p(+a$( a'#(a$a - a)0-$( (a/ ,/'(-+a '$ p/#+a$( a'#(a$a - a)0-$(. P/(+ (+,/'(-+ p((#/-* )a'-*a>a (+ B-/-* -+-( a= a+$/#"p#'$/(#/ p*a+$a p/(,(+0 0(a* /#$a$( (+$/+a@. I+ aB#/($a$a a>-/(*#/ 0a>a a*#*a =$/+a a/ '$ /a$-/a$a p/(+ '-*/. A'$* apa/ # /a$-/a -+(a*#*a/a a/a 0p*a'a/. Ca+0 $/a-a$('-* #+$(+-a a'$/aa*-* *()/a$ (+ pa/$a 'a 0(a*a apa'a p a*#*a =$/+a p/#,#a+0 /a$-/a p/#+-*-(. R>-*$a 0( # /a$-/a )(a*#*a/a - 'a- a/a 0p*a'a/. F/a$-/a p/#+-*-( ' p/#0- *a $/( +(,* (a/ (+ -+$( 0 a'#(/a a'$(a - /a$-/a a*#*( $()(a* />-*$a $/( *>(-+( 0('$(+$% 1. a@ F/a$-/a )(a*#*a/a $(p DUPU:TREN B#a'a " a+0 p/#+-* ' /a$-/a>a *a )a>a a*#*(K )@ F/a$-/a $(p DUPU:TREN (+a*$a " a+0 p/#+-* ' /a$-/a>a a( '-' *a 7"8 0 ,a/-* a*#*(K 2. F/a$-/a $(p MAISONNEUVE " a+0 /a$-/a ' p/#0- *a +(,*-* a$-*-( p/#+(/K 3. F/a$-/a $/(a*#*a/a " p/#0-'a p/(+ ,/'(-+.
DIASTAZIS TI!IOPERONIER E'$ # *>(-+ *(a+$a/a - +-/#a' p-+$ #-+ - /a$-/(* a*#*a/ (+ a p/(,'$ a+('-* 0 p/#0-/ '(p$#a$#*#(a '( $/a$a+$-*. A/$(-*a$(a $()(#p/#+(/a (+/(#a/a '$ # '(+a/$/#>a. La +(,*-* ( p(*#+-* $()(a* a/ # p#/$(-+ #+a,a (+ a/ pa$/-+0 a$a 0(a*a a p/#+-*-(. Ra0(#*#( apa/ # >#+a (a 0 '-p/ap-+/ a *#/ 0#-a '+$ #'#a'. I+ 0(a'$a>(' p/#+-* ' 0p*a'a>a *a$/a* (a/ /a0(#*#( apa/ -+ 'pa$(- *()/ (+$/ $()( '( p/#+-. C*(+( ' #+'$a$a ('a/( a+#/a* 0 *a$/a*($a$ a/ p#$ ( (p/(a$ a'$/aa*-*-( p/#,#aa (+'$a)(*($a$ a/$(-*a/a. E'/ # '$a/ a+#/a*a (+#pa$()(*a - -+ 'p/(B(+ '( a( a*' - -+ /' )-+. Ca+0 a, (+'a # /a$-/a )(a*#*a/a - '-)*-=a$( (+$/+a *>(-+a '$ -*$ a( /a,a '( (p*(a *>(-+( *(a+$a/ '( ap'-*a/ (p#/$a+$ a/ +'($a $/a$a+$ - # 0-/a$a a( a/.
P/(+ ,/'(-+ p((#/-* )a'-*a>a (+ B-/-* -+-( a= a+$/#"p#'$/(#/ a/(+a 'a =$/+a ' /(0(a (a/ p*a+$a p/(,'$ =$/+ /#$a$(a =$/+a@. I+ p/(a a>a ,a ( (+$(+' *(a+$-* #*a$/a* (+$/+ 0*$#(0(a+@ a/ ' p#a$ /-p pa/$(a* 'a- $#$a 0-a+0 *a 0(/($ /a0 0 +$#/' 0a/ (+ aB#/($a$a a>-/(*#/ ' /a$-/a>a a*#*a (+$/+a 0$a'a+0-"' 0 /-*a ,a/-*. S p/#0- # /a$-/a -+(a*#*a/a (+$/+a - (a 0p*a'a/. Ca+0 $/a-a$('-* #+$(+-a a'$/aa*-* *()/a$ (+ pa/$a 'a 0(a*a apa'a p a*#*a =$/+a p/#,#a+0 /a$-/a a'$(a. R>-*$a # /a$-/a )(a*#*a/a - 'a- a/a 0p*a'a/. D-pa p/#,#a/a a'$(a a+0 ' p/#0- $#/'(#+a/a p/#+-*-( a/ *# '( '-*/a a/(+(( p#'$/(#a/ a p(*#+-*-( $()(a* '#*(0a/a - p/#+-* p/(+ *(a+$-* p#'$/(#/ a* a/$(-*a$(( $()(#p/#+(/ (+/(#a/. Apa/ /a$-/a )(a*#*a/a '( $/(a*#*a/a a/(+a*a p#'$/(#a/a@ p/(+ ,/'(-+. P#a$ ( (+'#$($a 0 '-)*-=a$( p#'$/#"=$/+a a p((#/-*-(.
3. SIMTOMATOLOGIE
Ta)*#-* *(+( . E=a+-* *(+( +- ,(0+$(a>a 0a$ pa$#+##+(. S-)($(, (+ /a$-/(* p(*#+-*-( $()(a* apa/ 0-//( ,(( '( (p#$+$a -+$(#+a*a pa/$(a*a 'a$#$a*a a *'+(. La a'$a ' a0a-a 0#/a$(a /(-+(( ,(0+$a *a )#*+a,(( - /a$-/( a*#*a/ a'#(a$. O)($(, =('$a a+-($ *+$ p#$ (+0(a '0(-* p#'()(* a* /a$-/((. P((#/-* (+ -(+ - $-a$(a a/a$a a /(-+(( a;(*+ '( '+'()(*($a$a *a apa'a/a /(-+(( *a$/#"a;(*+ p*0a>a p+$/- # /a$-/a a/(+a*a p#'$/(#a/a. I+ ';() a*-+(/a p((#/-*-( - $-a$(a a+$/(#a/a '( '+'()(*($a$ *a /)#/0-* a+$/(#/ a* p(*#+-*-( $()(a* p*0a>a p+$/- # /a$-/a a/(+a*a p#'$/(#a/a. I+ a>-* /a$-/(*#/ a*#*a/ - 0p*a'a/ '( '-)*-=a$( a* p((#/-*-( ' #)'/,a 0p*a'a/a a'$-(a *a$/a* '( p#'$/(#/. F/a$-/(* -+(a*#*a/ ' a+('$a p/(+ 0-//( ,(( '( (p#$+$a -+$(#+a*a (+#p*$a /'-* ((+0 -+#/( p#'()(*. T-(/a *a (+p-$ *#a*(>a$a ' =$(+0 /p0 *a $#a$a *>+a . P#a$ apa/ '( # ;(#>a '-)a*#*a/a. Pa*pa/a a+$-a>a
0-//a a/ a$(+ a=(-* 0 (+$+'($a$ (+ 0/p$-* #a/-*-( 0 /a$-/a 'p/ ,a/-* 'a )a>a a*#*(. P((#/-* p#a$ ( '-)*-=a$ p#'$/(#/ - a*a+-* p/0#(+a -*$ (+ap#( (a/ a'$/aa*-* ((+0 -*$ 0p*a'a$ (+ap#( p((#/-* p#a$ ( '-/$a$. Daa a(0+$-* '$ ,a>-$ ,a a( $a/>(- $-(/a a/ '$ (+$(+'a p $#a$a *>+a a';a>a (+ pa/$ a'$ 0#/a$((. F*($+* (+ 'p(a* p a/a (+$/+a ('( a '( * apa/($(a 0aa /a$-/a +- a #'$ /0-'a 0 -/+$a. E* ' '-p/a(+$a>a -'#/ '( (p(0(a +- +-a( (+$/,+$(a ;(/-/(a*a ( '( ap*(a/a -+-( '(p*- apa/a$ (p'a$. I+ /a$-/(* a/a 0p*a'a/ '0(-* 0-//(( *a )a>a a*#**#/ #+'$($- a0'a '(+-/-* '+ *(+( /,*a$#/.
4. DIAGNOSTICUL
D(a+#'$(-* 0 /$($-0(+ ' p-+ - aB-$#/-* =a+-*-( /a0(#*#( a/ (+ /a$-/( +- -/a/'$ +-a( ,/((a/a 0(a+#'$(-*-( a/ p#a$ ( '$a)(*($ 0 * a( -*$ #/( *(+( ( p/(>a>a 0aa =('$a 'a- +- # 0('*#a/ a /a+$*#/ '( (+ '+' '"a p/#0-' aa'$a. Ma( p/(>a>a 0aa /a$-/a '"a p/#0-' *a -+ #' 'a+a$#' 'a- *a -+-* a/ p/>(+$a -+ p/#' pa$#*#(. D a'+a =a+-* /a0(#*#( + a/a$a $(p-* 0 /a$-/a a/a$/-* $/a($-*-( 0aa '$ # /a$-/a a/$(-*a/a 'a- +- p/(+ a+(' '"a p/#0-' '( + aB-$a *a (+'$($-(/a $/a$a+$-*-( -/a/(+0 '( ,#*-$(a '( ,(+0a/a. F/a$-/a (+ +/a* ' $/a0- /a0(#*#( p/(+ $/a($-* 'a- *(+(a 0 /a$-/a a/ p#a$ 'a ' a+('$ ,a/(a$ (+ /ap#/$ - 0(/($* *-/( 0 /a$-/a. C* a( /,+$ (+'a $/a($-* 0 /a$-/a a/ a'p$-* -+( *(+(( $/a+'pa/+$ (+$/ * 0#-a =$/($a$( a* $/a($*#/ 0 /a$-/a -'#/ (+0pa/$a$ (+$/ *. E=$/($a$(* a- #+$-/ - a'p/($a$( '( *(+(a 0 /a$-/a $/a+'pa/+$a p a/ # 0*(($a>a p#a$ ( 0(+$a$a.
I+ a>-* /a$-/(*#/ 0 p(*#+ $()(a* =a+-* /a0(#*#( '$ =-$a$ #)*(a$#/(0(+ * p-$(+ 0#-a p#>($((% a$a '( p/#(* *a a/ ' p#$ a0a-a (+(0+$ #)*(. E=a+-* /a0(#*#( '$ (+0('p+'a)(* a$a$ p+$/- #+(/a/a /a$-/(*#/ a*#*a/ a$ '( a( a*' p+$/- ap/(/a 0(a'$a>('-*-( $()(#p/#+(/ (+/(#/ '( a '-)*-=a$((*#/ a/ a$-+( a+0 '-+$ (( p#$ 'apa =a+-*-( *(+(. Daa p # /a0(#/a( 0 a$a -)/a $-)/'-*-( $()(a* =$/+ +- ' '-p/ap-+ a*#*( p/#+(/ a$-+( ' p#a$ a(/a a =('$a -+ 0(a'$a>('. I+ '-)*-=a$( =$/+a 'pa$(-* a/$(-*a/ 0(+$/ a*#*a $()(a*a '( a'$/aa* apa/ *a/($ a$a 0 /'$-* 'pa$(-*-( +a(=('$a+0 -+ pa/a**(' p/$ (+$/ * 0#-a '-p/a$ a/$(-*a/. S-)*-=a$(a p#'$/(#a/a ' p-+ (+ ,(0+$a p /a0(#/a(a 0 p/#(* (a/ # pa/$ 0(+ '-p/aa$a a/$(-*a/a a+$/(#a/a a p(*#+-*-( $()(a* +- a( '$ (+ #+$a$ - a'$/aa*-* a/ '$ 0p*a'a$ (+ap#(. D(a+#'$(-* 0(/+$(a* (+ /a$-/(* a*#*a/ ' a -/+$ - # +$#/'a 0 *>+a (+ a/ pa(+$-* p#a$ 'a a/a (0(a$ 0-pa a(0+$ 0-//(* a+$-(+0-"' 0-pa a$,a #/ (a/ *a =a+-* *(+( 0-//a '( $-(/a '-+$ *#a*(>a$ p/(a*#*a/. S a( p#$ p-+ (+ 0('-$( /a$-/(* 0 a'$/aa* '( a*a+-.
5. EVOLUTIE SI COMPLICATII
E,#*-$(% F/a$-/(* 0 p(*#+ $()(a* ,#*-a>a 'p/ #+'#*(0a/ '( +- 0- ap/#ap +((#0a$a *a p'-0a/$/#>. F((+0 /a$-/( a/$(-*a/ p/#+#'$(-* *#/ 0p(+0 0 /a*(>a/a -+( /0-/( a$ a( p/$. F/a$-/(* a*#*a/ #/$ $/a$a$ #+'#*(0a>a (+ 2"3 *-+( 0 >(*. E* ' ,(+0a a/a ';* - #+0($(a -+( /0-/( a$ a( p/# '( a( p/$ 0-)*a$a 0 # (#)(*(>a/ /(-/#a'a a$+$ '-p/a,;a$a.P/#+#'$(-* '$ #+0($(#+a$ 0 *-* /a$-/(( a'#(/a - *-=a$(( 'a- '-)*-=a$(( *-* $/a$a+$-*-( '( ,a/'$a )#*+a,-*-(.
C#p*(a$((* '-+$ +/a* '( *#a*. C#+'#*(0a/a /a$-/(( ' ap/(a>a *(+( p/(+% Q 0('pa/($(a (p#$+$( -+$(#+a*K Q p/p/a a*-'-*-( *a pa*pa/K Q 0('pa/($(a 0-//(( (+ #a/. Ca -/a/ a /a$-/(( '( *a$ 0 p/#'-* 0 ,(+0a/ a a'$(a ' p/#0- # '/( 0 $-*)-/a/( *#a* '( +/a* ,a*a)(* p+$/- #/( * 0 /a$-/a. T-*)-/a/( *#a*% T-*)-/a/( -'-*a/ /a$-/a (+'#$(+0-"' 0 a$/#( -'-*a/a ;(a/ 0aa +- '$ (#)(*(>a$aK aa'$a '$ a+$-a$a a+0 )/-* '$ (#)(*(>a$ '( #a/$ /0-'a 0aa ' (+'$($- p/# $/a$a+$-* -+$(#+a* 0 /-p/a/. T-*)-/a/( a/$(-*a/% a/$(-*a$((* '-p/a" '( '-)(a+$ #a/-*-( 0 /a$-/a '-+$ '0(-* -+-( /,a/'a$ '(+#,(a* p/#. M#0((a/(* a/$(-*a/ $a/0(, '-+$ '-) #/a /0#a/( a/ / pa+a *a a+;(*#>a ()/#a'a. R0#a/a '$ a,#/(>a$a 0 (#)(*(>a/ '( p#a$ ( p/,+($a p/(+ (#)(*(>a/a p/# a a/$(-*a$((. I+ a'$ '#p $/)-( ,($a$ (#)(*(>a/(* p/*-+($ (+ apa/a$ (p'a$. D a(( />-*$a '-p/(#/($a$a #'$#'(+$>( / (+ $/a$a+$-* /a$-/(*#/ 0#a/ 0('p+'a+0 0 (#)(*(>a/a (p'a$a p/($ /*-a/a p/# a ('a/(*#/ a/$(-*a/. T-*)-/a/( (/-*a$#/((% (+ p/(* >(* 0 *a /a$-/a ' (+'$a*a>a -+ 0 a/ 0a>a 0-pa 0#-a 'ap$aa+( (+ a'$ #+$ ap/((+0-"' *(+( $#p(/a a'( -'-*a/. D-pa '#a$/a apa/a$-*-( (p'a$ *a )/-* (+/(#/ (+0(/+$ 0 *#a*(>a/ '( /*-a/a /'-*-( ' p#a$ p/#0- /apa/($(a -+-( 0 $/a+>($#/(- a/ 0a>a 0-pa a$,a >(*. Ca+0 * '$ p/'('$+$ p/#0- $-*)-/a/( ,a'##$#/(( 0$/(+a$ 0 $/#)#>a ,+*#/ p/#-+0. T-*)-/a/( +/a*%0(+ a->a (+$/0p+0+$( '$/a+' a #'-*-( - **a*$ #/a+ /pa/a/a /a$-/(( p-+ (+ B# +-/#a' a+(' 0 /*a/ a a a p/#'-* 0 (a$/(>a/ 'a #+'$($- # a0,a/a$a )#a*a ' p#a$ (+'#$( 0 # '/( 0 a+('$a/( +/a*% (+'#+( #)#'a*a a+#/=( ;(p/$/(.
COMPLICATIILE GENERALE IMEDIATE 0p(+0 0 ,(#*+$a $/a-a$('-*-( 0a/ '( 0 $/+-* )#*+a,-*-(% #+'$( p-*#+a/a a/ ' (+'$a*a>a *a )a$/a+( p#'$ $/a-a$( #+0-a+0 *a # )/#+;#p+-#+( /a,a '( $-*)-/a/( -/(+a/ 'a- (+$(( /$+$( 0 -/(+a '( a>#$(%0(a)$ 'a- )#*( /a'#a'a a/ apa/ 0'$-* 0 /,+$. G/a'(a 0-*a/a ,;(-*a$a 0 *a +(,*-* #a/-*-( 0 /a$-/a p/#0- )#*(( /a'#a' p-*#+a/ - 0('p+@ B-+;( $#/a( pa*#a/ '+>a$(a 0 #a/$ ((++$a. E)#*((* /a'#a' /)/a* (+0- '$a/a 0 '#+#*+$a #+->( 'a- $-*)-/a/( ,(>-a*. I+ a>-* *#/ *a 2"3 >(* 0 *a a(0+$ -/(+(* #+$(+ p(a$-/( (+ 0 /a'( (a/ -+#/( apa$a -+ a/a$/ *a$'+$.
COMPLICATIILE LOCALE IMEDIATE I+ a>-* /a$-/(*#/ a*#*a/ % "*>(-+( ,a'-*#+/,#a' #a/$ /a/@ 0a/ a$-+( a+0 ' p/#0- p#$ p/#,#a ;#/a(( a/( p/(+ /-p/a -+#/ ,a' (p#/$a+$ - (+'$a*a/a -+#/ a+(( /a,. D a'+a*>a/a +/,-*-( '(a$( p#p*($- =$/+ '$ #a/$ /a/a 0'/('a 0 -+* /a$-/( 0 $(p a('#++-, "/a$-/a 0';('a (+0#')( *a +(,*-* a*#*( $()(a*. C#-+(a/a #a/-*-( 0 /a$-/a - 0(-* =$/+ ' p#a$ a p/(+$/"# p*aa p/#0-'a 0(+ aa/a 0 a$/ a+$-* ,-*+/a+$. I+ #/( a> #-+(a/a #a/-*-( 0 /a$-/a - 0(-* =$/+ a a ;a$#-* 'a ' '-/a '( p/(+ aa'$a 'a (+$a/>( p/#'-* 0 (a$/(>a/ (a/ p 0 a*$a pa/$ ' 0';(0 p#a/$a p+$/- (+$(. I+$a/a #a/-*-( 0 /a$-/a p/$-/)a (+ #0 /a, p/#'-* 0 #+'#*(0a/ aB-+a+0-"' *a #'$($a '( p'-0a/$/#>a '-p-/a$a. D aa /a$-/a 0';('a $/)-( #p/a$a 0 =$/a -/+$a aa+0-"' 0)/(0a/ *a/a '( =(>(. E=p*#/a/a '('$a$(a a a/$(-*a$(( $()(#$a/'(+ ' (p-+ p+$/- -/a$(/a p/$a a a,($a$(( a/$(-*a/ (+ a/ - #a>(a a(0+$-*-( p#$ pa$/-+0 0(/($ #/p-/( '$/a(+. I+ a>-* /a$-/(( a/(+a* 0 p(*#+ $()(a*% "/a$-/a 0';('a +'($a $/a$a+$ ;(/-/(a* 0 -/+$a "a'#(/ - *-=a$(( 'a- '-)*-=a$(( a* p((#/-*-( +'($a+0 /0-/a 0 -/+$a "*>(-+( ,a'-*#"+/,#a' +'($a $/a$a+$ ;(/-/(a* 0 -/+$a.
L>(-+(* +/,#a' / 0 *a '(p*a #+$->( a +/,-*-( +-/ap/a=(@ *a (+$pa/a +/,-*-( - (+$//-p/a (*(+0/a'(*#/ a=#+#$'('@ pa+a *a '$(#+a/a #p*$a +-/#$'('@. I+ a*a'( $(p (+$pa/a -+-( ,a' 0 a*()/- a/ 0- *a #+'$($-(/a ;a$#-*-( p-*'a$(* 'a- a a+,/('-*-(.
COMPLICATII LOCALE TARDIVE I+ a>-* /a$-/(( a*#*a/%
a*-'-/(* ,((#a' '-+$ #p*(a$(a aB#/a a a'$#/ /a$-/(. P#$ ( #+'(+$a -+#/
/'*( $/ap-$( '-/,+(+0 0 /-*a 0(+ a->a -+( /0-/( (+'-((+$ 'a- a -+( 0p*a'a/( '-+0a/ '-) ;(p' a( /a/ 0-pa /*-a/a p/a $(p-/( a /'-*-(. I+ /a$-/(* )( a*#*a/ p/(+ a)0-$( - #/'('$+$a 0p*a'a/(( =$/+ a /a+$-*-( p/#+(/ )a'-*a/a $/a+'*a$(a '( /#$a$(a (+ aa/a a'$/aa*-*-( a a /-$a$a #/p-*-( 'a a0a (+a-+$/-* '-p/a$( 0 'p/(B(+ a a*a+-*-( p/#,#a+0 p((#/-* p*a$ ,a*. F#a/$ /a/ aa'$a 0#/a/ '$ #+'(+$a -+( /a$-/( )(a*#*a/ p/(+ a)0-$( 0a$#/($a ;(p/#/$((. D#/a/a (+ ,a/-' a p((#/-*-( '$ a( /a/ #)'/,a$a '( apa/ 0-pa /a$-/( )(a*#*a/ p/(+ a)0-$( a/ +- a- #'$ '-((+$ 0 )(+ /0-'. Ea '$ *a * 0 /- 0 '-p#/$a$ a '( 0#/a/a (+ p*a$ ,a* /'-* ((+0 0(((* '( 0-//#' 0(+ a->a (+0-//a$((*#/ $-+$a/ 0 p a/(+a =$/+a a p((#/-*-(. D a'+a />('$+$a -+-( 0(a'$a>(' ;(a/ #0/a$ p/#0- $-*)-/a/( a/( *a /' '( #p#/$a /('-* -+( a/$/#> '-+0a/. I+ +/a* ,#/)(+0 a'$ a*-'-/( ,(-#a' +- aB-+ *a # a0ap$a/ -+$(#+a*a 'a$('aa$#a/ 0a$ (+ a-/( =p$(#+a*. I+$/-a$ a'$/aa*-* '-p#/$a $#a$a /-$a$a #/p-*-(p a/ # $/a+'($ *a )#*$a p*a+$a/a p#'$/(#/ p/(+ '-)a'$/aa*(a+a (a/ a+$/(#/ p/(+ 0(#$a/'(a+a '$ (/' a #/( (p/$(-+ p/(,(+0 /a/a a+a$#(( p+'( a*#*a/ 'a 0$/(+ # a/$/#>a $()(#"$a/'(a+a a( 'a- a( p-$(+ (+,a*(0a$a a/ a$a>a $/p$a$ '( a*$ a/$(-*a$(( a* p((#/-*-(. I+ /a$-/(* ,((#' #+'#*(0a$ a/ +- aaB-+' (+a (+ a* '$a0(- 0 ->-/a a/$(*a(+#a'a 0-//a '$ =p*(a$a p/(+ $/a$(-+(* *(a+$a/ +#)('+-($ #+'(+$a a 0>a=a/(( '( '-p/a$*#/ a/$(-*a/.
*>(-+( 0 a/$/#>a p/'('$+$a -+#/ '-)*-=a$(( +'($a #'$#$#(( 0 #/$( $-a$ p a*#* 'a- ;(a/ a/$/#0>a $()(#a'$/aa*(a+a. A/$/#0>a *>+( $()(#"a'$/aa*(a+a@ '$ # (+$/,+$( ;(/-/(a*a a/ #+'$a (+ '-p/(a/a a/$(-*a$(( $()(#"a'$/aa*(+ p/(+ /a*(>a/a -+( '-0-/('(+#'$#>a@ (+$/ $()( '( a'$/aa*.F->(-+a #'#a'a +'($a (+'a 4 *-+( 0 (#)(*(>a/. #'$#p#/#>a a*(a p#'$ $/a-a$(a " -+#'-$a '( '-) 0+-(/a 0 '(+0/#-* SUDEC"LERIC9E '-/,(+ (+ +/a* 0-pa -+ $/a$a+$ /a- #+0-' (#)(*(>a/ (+'-((+$a@. A'$ '(+0/# a*#0('$/#( ' a+('$a p/(+$/"-+ 0 a* *>+( '( p((#/-*-( a( a+$-a$ 'a/a - 0-//( '( /0#a/ a/$(-*a/a *a a/ ' a0a-a # 0a*((/ a( -*$ 'a- a( p-$(+ a/a+$a ;(p/( (a+#>a;(p/'$>(. Ra0(#*#( ' #+'$a$a 0(+/a*(>a/a (+$+'a a #a'*#/ *>+( '( a =$/($a$(*#/ #a'*#/ *-+( 0(+ ,(+a$a$. Da*((/a '$ *a (+p-$ *a-+a/a - a*$/+a+$ 0 >#+ #'#a' - '$/-$-/a +#/a*a - a*$* (+ a/ #/( '$/-$-/a 0('pa/ #+/(+0 #a'*#/ -+ a'p$ pa$a$. Ca+0 0a*((/a '$ a( (+$+'a #a'* apa/ $/a+'pa/+$ +-a( #+$-/a$ 'a- a- a'p$ $-*)-/ a +#/(( p /. I+ +$/* 0 0(+/a*(>a/ a=(a p a*#-/( 0('pa/ '( #+$-/-/(* #'#a'.I+ '$a0(-* 0 /,+(/ #+$-/-* #'#' (+p 'a ( ,(>()(* a '( '$/-$-/a $/a)-*a/a (+/#a/a. I+ '(+0/#-* SUDEC" LERIC9E '$ p/>+$a 0-//a.O'$#p#/#>a (+ a0/-* a*#0('$/#(( a/ a a$#/ 0*a+'a$#/ p+$/- p/$-)a/(* $a)#*( a$#/-* ,a'-*a/. I+$(+(/a -//(( 'a+*-( (+ /(-+ 0a$#/($a ,a'#'pa'-*-( -/a$ 0 ,a'#0(*a$a$( pa/a*($(a /*= '(pa$(@ p/#0- /'$/a p9 "-*-( 'a+,(+ '( ;(p#=(. I+ a'$ #+0($(( a$(,($a$a '/$#/( a #'$#)*a'$*#/ 0((+-a (a/ a$#/(( *()/a$( *#a* (+ p/(+(pa* p/#'$a*a+0(+*@ p/#0- a$(,a/a #'$#)*a'$*#/ '( 0a/a/a +#+*#/ #'$#*($(. La a'$a ' a0a-a (+a$(,($a$a p#'$ $/a-a$(a '( a-$#(+$/$(+/a +#+-*-( p/(+ p/'('$+$a p9"-*-( 'a>-$ a ;(p#=((. O'$#p#/#>a a*(a (+ a0/-* '(+0/#-*-( SUDEC " LERIC9E '$ # $apa $a/0(,a 0(((*a 0 $/a$a$. P/#'$a*a+0(+* a- a$(-+ 0 '$(-*a/ a />#/)$(( #'#a' #'$#*a$( -p*a+0 a'$* #'$##/a/a - #'$#*(>a. O'$#)*a'$* a- /p$#/( p+$/- PGE@. I+ /a$-/a 0 p(*#+ $()(a* a a( /a,a #p*(a$( $a/0(,a '$ a/$/#>a p#'$ $/a-a$(a - #+'(+$ /a, a'-p/a *>+(. E'$ 0$/(+a$a 0 a/a$/-*
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6. TRATAMENTUL
P/(+ $/a$a+$-* #/(a/( /a$-/( 0( '( a /a$-/(( 0 *a>+a ' -/a/'$ #+'#*(0a/a a'$(a 0a/ p p/(-* p*a+ ' '($-a>a /'$a)(*(/a -+$((. D aa -+ a*-' p#a$ 'a +- ( /a0(#/a( '$$( (a/ a=-* #'-*-( p#a$ 'a +- ( (+$#$0a-+a (0a* '( $#$-'( -+$(a )/-*-( /'p$(, 'a ( p/$a. T#$#0a$a -+ a*-' p/$ /a0(#*#( p#a$ 'a apa/$(+a -+-( '+$ a/ 'a p/>(+$ # /0#a/ a/$(-*a/a p/#+-+$a$a #+'(+$* -+$(#+a* /'p$(,-'#/ 0 (a(+a$. TRATAMENT DE URGENTA% P/(+$/ p/(* a'-/( *-a$ *a *#-* a(0+$-*-( ' '($-a>a a*a/a 0-//(( a/ p/,(+ '#-* '( /*a=a>a -';(( p/(+$ap(+a+0 (+$/" # #a/a/ a'-/a 0p*a'a/a '( a( a/ a /a+$*#/ #'#a'. P/(-* aB-$#/ *a *#-* a(0+$-*-( (* a#/0a a0/* 'a+($a/ 0(( $/)-( 'a a'(-/ a'('$+$a &(+a(+$a '#'(/(( 0(-*-( '( a'('$+$a (+ *#-* 0(-*-(F/(*(+@ 0aa '$ +'a/. Ca*a/a 0-//(( ' a p/(+ a0(+('$/a/ 0 '0a$(, '( a+$a*(%a*#a*(+ /#/a+ 1 (#*a 0 5? 'a- (a*(+ 1 (#*a 'a- #/(+a '( p/(+ (#)(*(>a/a p/#p/(-">('a - a$* 'aapa/a$ a /a$-/((. Aa'$a (#)(*(>a/ '$ p/#,(>#/( '( +- a/ p/$+$(a 0 a ( (0a*a a,a+0 '#p-* 0 a p-+ (+ /pa-' #a/-* 0 /a$-/a. Daa /0-/a a #'$ )-+a *a (+p-$ a$*a 'a- apa/a$-* (p'a$ (+($(a*@ p#$ ( #*#'($ '( (+ #+$(+-a/. Daa +- a- #'$ )-+ $/a$a+$-* /a$-/(( ' ,a #+$(+-a a( 0pa/$ 0 -+ 0( 'p(a*('$ #/$#pa0. I+ a> 0 p#*($/a-a$(' a+,/* 0 p/( aB-$#/ $/)-( ap*(a$ (+a(+$ 0 (#)(*(>a/ '-+$% *()/a/a 'a- 0aBa/a )/-*-( a(0+$a$ '( (+0pa/$a/a 0 *a *#-* a(0$-*-( a pa(+$-*-(K
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/'p(/a$#/( ap*(a/a a/#-*-( p+$/- #p/(/a ;#/a(( (+*a$-/a/a ()/aa(+$(( 0aa =('$a '-'p((-+a -+#/ /a+( a/ $/)-(' -/a$a$ '( pa+'a$. S a/ (+'a /(Ba 'a ' 0>)/a a( (+$a( )/-* 'a+a$#' '( 'a ' ()/a (+$a( )/-* )#*+a,. Ca+0 0>)/aa/a '$ 0(((*a ' p//a 'a/((a/a ()/aa(+$(( p/(+ 0'#a'/ 'a- $a(/. S#p-* #/(a/( (#)(*(>a/( '$% 0 a (p(0(a ('a/(* a$(, 'a- pa'(, p+$/- a p-+ (+ /pa-' #/a+* '( $'-$-/(* $/a-a$(>a$K 0 a +$(+ (=a/a #/$a a )/-*-( a$-+( a+0 /a+$* +- '-+$ 0p*a'a$ 'aa+0 a- p-$-$ ( /0-'#/$ - #a>(a a#/0a/(( p/(-*-( aB-$#/K
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PRINCIPIILE UNEI IMO!ILIZARI CORECTE %
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TRATAMENTUL ORTOPEDIC% ' a *a 'p($a* -+0 (+a(+$ 0 #/( a+,/a 0 /0-/ '( 0-pa /a0(#*#( '"a #+(/a$ 0(a+#'$(-* ' p/#0a>a *a a+'$>( '#p-* 0 a /*a=a -'-*a/-/a. A+'$>(a 0p(+0 0 '$a/a +/a*a a )#*+a,-*-( '( 0 ,a/'$a *-(. La #a+(( ,a/'+(( '$ (+-$(* -+#/( 'a ' aa a+'$>( p+$/- a (+ #0 +#/a* p/>(+$a # a/ /*a=a/ -'-*a/a. La ( $(+/( (+ ';() a+'$>(a '$ a)'#*-$ +'a/a. A+'$>(a ' p#a$ /a*(>a *#a* /a;(0(a+ '( +/a*. I+0(a$(a a'-p/a *-*-( 0 a+'$>( # a ;(/-/-* (p/-+a - a+'$>('$-*'( '$ (+ (+$( 0 ,a/'$a 0 '$a/a +/a*a a )#*+a,-*-( 0 (p#/$a+$a a+,/( 0 /0-/. I+ $#a$ a>-/(* ' -/a/'$ # a$ a( )-+a /*a=a/ -'-*a/a a/ -'-/a>a a+,/* 0 /0-/ a /a$-/((. I0a* '$ a # /a$-/a 'a ( /0-'a '( (#)(*(>a$a a$ a( /p0 0-pa p/#0-/a a(0+$-*-(.
REDUCEREA +'($a (+ +/a* # =$+'( # #+$/a=$+'( '( #ap$a/. E=$+'(a # a (+ +/a* - aB-$#/. C#+$/a=$+'(a # a * 0"a* 0#(*a aB-$#/ 'a- # ;(+a (=a$a (+ p/$K (a/ ;(/-/-* p/(+ a+,/ )(+ a+0($ /a*(>a>a p/(+ pa*pa/a a+-a*a a #a/-*-( 0 /a$-/a # #ap$a/ a$ a( )-+a '( # a=a/ p/$a a /a+$*#/ #'#a'. R0-/a 0,(+ 0(((*a a+0 ' (+$/p-+ -+ -';( ap'-*a 'a- $+0#+ (p(0(a ,+(/a (+ #+$a$ a /a+$*#/ #'#a' (+ a'$ a> ' /-/ *a $#0a 0 /0-/ 'a+/a+0a. Aa'$a /0-/ p a/ # a ;(/-/-* 0 #)(( a+-a* *a '-/$ $(p 0-pa a(0+$ ' +-'$ /0-/ =$p#/a+. Da/ /0-/a ' p#a$ $-a '( - 0('p#>($(, a+( 0(+$/ a/ +$(#+a a'a #/$#p0(a '( 0(/($* a0/ /0-$#a/. D( =('$a /0-/ (+ $(p a/ '$ (+0(a$a (+/a$-/( - a' -'-*a/ ,#*-(+#a' '( a/ '$ /- 0 /a*(>a$ p/(+ a+,/ a+-a*. I+ a'+a a>-/( ' -*a -*a )#*+a,-* (+ 0-)($ 0#/'a* )/-* /a$-/a$ ' p-+ p # a$*a !/a-+ (a/ =$+'(a (+ $(p ' /a*(>a>a p/(+$/"# )/#'a $a*(a a/ ' (+$/#0- (+ p*(+ #' *a 0('$a+$a 0 #a/-* 0 /a$-/a@. Aa'$a =$a+'( #+$(+-a '( a/ a '#p 0 a ' /a*(>a 0 a ' &#)#'( -';(( /a+0-"' #+0($(( a,#/a)(* p+$/- a=a/a 'p#+$a+a '( /0-/a #/$a a /a$-/(*#/ #'#a'. D-pa =$+'( '( #ap$a/ /a+$* $/)-( (#)(*(>a$ (+$/"# p#>($( #/$a (+ apa/a$ (p'a$. P+$/- a ( ((+$ apa/a$-* (p'a$
$/)-( 'a (#)(*(>> * p-$(+ # a/$(-*a$( 0 0a'-p/a '( -+a 0 '-) #a/-* 0 /a$-/a,($a+0 ('a/(* 0 /#$a$( (+ a=. M)/-* $/)-( (#)(*(>a$ p a$ p#'()(* (+ p#>($( -+$(#+a*a p+$/- a p/,+( /0#/(* a$/#(a -'-*a/a '( #'#a'a. P+$/- $/a$a/a #/$#p0(a a /a$-/(*#/ *#*a/ '( a 0(a'$a>('-*-( $()(#p/#+(/ ' #*#''$ apa/a$-* ;(p'a$ /-/#p0(#' ('a@ 'p(a* 0'$(+a$ 0p*a'a/(( - 'p/(B(+ p )/-* /a$-/a$. C* a( -$(*(>a$ apa/a$ 0 a'$ $(p '$ ;(p'-* 0 /' - a/a *()/a G/a(+. I+ $(p-* a+,/*#/ 0 /0-/ '( a( a*' 0-pa (#)(*(>a/ ' ,#/ $-a #+$/#a* /a0(#*#( /a0(#/a(( 0(+ a$a '( p/#(*@ '( (+a(+$a (+$a/(/(( ;(p'-*-( p+$/- a ' #/$a ,+$-a** 0>a=a/( 'a- /0-/( (+#p*$. I+ $(p-* =$+'(( #+$(+- ' ,a a #+$/#*-* /a0(#*#( p/(#0( a/ p/($ -+* #/$a/( a* /0-/(( a/(/a 'a- ('#/a/a /-$a$(( 0p*a'a/a *a$/a*a a /a+$*#/ - aB-$#/-* -+#/ p*#$ 'p(a*@. T/a$a+$-* #/$#p0( '$ 0(/+$(a$ (+ -+$( 0 $(p-* a+a$##$#p#/a( a* /a$-/((% 1. F/a$-/( a/(+a* a+$/(#a/ " ' (+a/a /0-/a #/$#p0(a a'>a+0 p((#/-* (+ -(+ p#>($( (+ a/ ' (#)(*(>a>a (+ apa/a$ ;(p'a$ $(p 0 2"3 *-+( 0(+ a/ +a*a 0#-a *-+(. R0-/a $/)-( 'a ( p/$a p+$/- a #/( (p/$(-+ a '-p/a$( a/$(-*a/ a+$/(#a/ a p*a#+-*-( $()(a* a/ #+'(+$ 0>a'$/-#a' a'-p/a a/$(-*a$(( *>+(. D aa 0aa (+/a/a 0 /0-/ #/$#p0(a '-a>a 'a- ' p/#0- /0p*a'a/( '-) ;(p' '$ (+0(a$ $/a$a+$-* ;(/-/(a* " (=a/ '-) '-/-). 2. F/a$-/( a/(+a* p#'$/(#a/ " 0aa '-+$ (>p*a$ ' (+a/a /0-/a #/$#p0(a )#*+a,-* ((+0 a'>a$ (+ 0-)($ 0#/'a* - a)a '-p/(#a/a p a/(+a '(. P'$ a)a ' $/ # 'a/a a* a/( ap$ '-+$ (=a$ *a p#0a 0 p((#/-* #p/a$#/-*-(. C#+#($+$ ' apa'a - a)* a(+( p((#/-* pa(+$-*-( (+/a+0 a"( (p/(a a+,/a 0 &'#' ('a=$+'(a '( (p(+/a a*a+-*-( (+ '-'@ 0a$#/($a a'#(/(( /,+$ a '-)*-=a$(( p#'$/(#a/ a p((#/-*-(. D-pa ' ap/(a>a a '"a /0-' '-)*-=a$(a ' *$a>a 0#/'a* p(#/-* '( ' #0*a>a 0 *a $a*-' (>a ;(p'a$a (+a*$a ,a ( p-/$a$a $/( *-+( 0(+ a/ # *-+a '( B-a$a$ ' a*a.
TRATAMENTUL C9IRURGICAL% ' $-a>a a+0 a+,/* 0 /0-/ '( (#)(*(>a/ +- '-+$ (+-+-+a$ 0 '-'. Aa'$a #p/a$( ' +-'$
OSTEOSINTEZA. M/* Da-)(+ a 'p-' a+0,a% &a $/a$a # /a$-/a (+;('a p/(+ #'$#'(+$>a (+'a+a a 0';(0 -'a -+( a,+$-/(. Ap*(a/a 0(,/'*#/ p(' $a*( (+ #'$#'(+$> ' a (+$#$0a-+a '-)p/(#'$( - ,-$a/a 0 0>*(p(/( p/(#'$( +aBa+0 (+ a'$ * "p a$ p#'()(*" ,a'-*a/(>a$(a #'-*-(. O'$#'(+$>a '$ # #p/a$( 0 # 0#')($a (+$ '( (+-$(#>($a$ a/ a/a$a -+#'$(+$* ;(/-/-*-( (+ * a( (( 0$a*(( a* )(#*#(( a/$(-*a/ '( (+ 'p(a* p a a #'-*-(. O'$#'(+$>a ' /a*(>a>a - aB-$#/-* -+#/ (p*a+$ $a*( $(B 'a- -( p*aa #+$(#+a$ 0(+ $/(a* (+#=(0a)(* 'p(a* a/ 'a ( (+/$ '( a/ 'a + p/#0-a +(( # /a$( a0,/'a 0(+ pa/$a #/a+('-*-(. C- $#a$ a'$a 0aa a$-* ;(/-/(a* +- a/ *# (+ #+0($(( a'p$( -*$ a( /(-/#a' 0a$ * /*aa ;(/-/(a +/a*a '( +- '$ p/a$(a$a 0 -+ ;(/-/ =p/(+$a$ a/ $#a$ a$/(a** +'a/ #'$#'(+$>a p#a$ p-+ ,(a$a )#*+a,-*-( (+ p/(#*. I+ /a$-/(* a*#*a/ $/a$a+$-* '$ #/$#p0( 'a- ;(/-/(a* 0-pa '($-a$(. D a$ #/( '$ p#'()(* ' a $/a$a+$ #+'/,a$#/ #/#p0(@. S-) a+'$>( /a;(0(a+a 'a+/a*a ' a /0-/a #/$#p0(a '( (#)(*(>a/a. P+$/- /a$-/(* -+(a*#*a/ 0 /-*a a/a 0p*a'a/ '$ '-((+$ (#)(*(>a/a (+$/"# (>a ;(p'a$a 0 /''-) +-+;( $(p 0 # *-+a. S p/($ 'p/(B(+-* p )/-* /a$-/a$ *a # 'ap$aa+a 0 *a a(0+$. P+$/- /a$-/(* )(a*#*a/ 0'#/( $#$ a/a 0p*a'a/ ' ap*(a # (>a ;(p'$a 0 /' '-) +-+;( p+$/- 6 'ap$aa+( '( ' p/($ 'p/(B(+-* p )/-* /a$-/a *a 0#-a 'ap$aa+( 0 *a a(0+$. P+$/- /a$-/(* $/(a*#*a/ '( * -+(" '( )(a*#*a/ - '-)*-=a$(( $/a$a+$-* '$ -*$ a( *-+. D-pa /0-/a #/$#p0(a ' a # (#)(*(>a/ (+(>a ;(p'a$a p'$ +-+;( -/#pa0a*a $(p 0 3 'ap$aa+( ap#( '-) +-+;( pa+a *a 3 *-+( (a/ 'p/(B(+-* p )/-* (+/(#/ ' p/($ 0-pa # 'ap$aa+a 0 *a (#)(*(>a/ $(p +'a/ p+$/- /a/a #/a$(-+(*#/ ()/#a' ap'-*a/ '( *(a+$a/@. R0-/a /a$-/(( $/(a*#*a/ - '-)*-=a$( ' a p/(+ $#0a 0 &'#a$/ a (>( (a/ (#)(*(>a/a ' ,a a - p((#/-* (+ p#>($( 0 -+;( 0/p$ a$a 0 a)a. D-pa (#)(*(>a/ ' ,a a #+$/#* /a0(#*#( *a 5 '( 15 >(* p+$/- a ' ,/((a +$(+/a /0-/(( /$-/( - 0p*a'a/ 'a- '-)*-=a$(@. Daa ' p/#0- 0p*a'a/( '-) apa/a$ ;(p'a$ ' /(a /0-/a 'a- ' $/ * $/a$+$ ;(/-/(a*. A$-a*+$ ' #p/a>a 0 *a (+p-$ $#a$ /a$-/(* )(a*#*/ '( $/(a*#*a/ - 0p*a'a/ *a a/ /a+$-* a/(+a* p#'$/(#/ a/ '-p/aa$a a/$(-*a/a a( a/ 0 #
$/( 0(+ (+$/aa '-p/aa$a a/$(-*a/a a p(*#+-*-( $()(a*,(0+$(a$a p/(+ /a0(#/a(a 0 p/#(*. D a'+a ' #p/a>a '( /a$-/(* -+(*#*a/ - 0p*a'a/ +/0-$()(* #/$#p0(. O'$#'(+$>a ' a 0 /-*a - '-/-)-/( (a/ 0-pa #p/a$( (#)(*(>a/a '$ aa'( a '( (+ a>-* /a$-/(*#/ $/a$a$ #/$#p0(. Ca+0 ' p/#0- #+'#*(0a/a (+ p#>($( ,((#a'a ' ap*a>a *a a/$/#0>a a/ #+'$a (+$/"# a+;(*#>a $/ap-$(a 0*()/a$a 0- *a 0'((+$a/a ('a/(*#/ *a +(,*-* a/$(-*a$(( $()(#a'$aa*(+ p a/ ;(/-/(a*a. I+ a> 0 0(a'$a>(' $()(#p/#+(/ $/a$a+$-* '$ ;(/-/(a* '( 0 -/+$a #+'$a+0 (+ /0-/a 0(a'$a>('-*-( '( ()(*(>a/a *>+( (+$/"# (>a ;(p'a$a (+a*$a p+$/- $/( 'ap$a+( ap#( (>a '-) +-+;(. R0-/a '-)*-=a$(( =$/+ ' a p/(+ apa'a/ # a+a '-) a*#*a =$/+a '( - a*$a 0a'-/a a*#*( $()(a* (p/(a+0 p((#/-*-( # ('a/ 'p/ ,a/-'. Ma+,/a ' +$(+ pa+a *a (+$a/(/a ;(p'-*-(. S-)*-=a$(a p#'$/(#a/a ' /0- p/(+ a+,/a 0 &'#a$/ a (>( & $/aa+0 p-$/+( 0 a*a( (+ '-' '( (+a(+$ - p((#/-* 'p/ p#>($(a 0 $a*-' (+ $(p -+ aB-$#/ apa'a p a$a a+$/(#a/a a p(*#+-*-( $()(a*. I#)#*(>a/a (+ apa/a$ ;(p'a$ 0-/a>a $/( *-+( 0(+ a/ B-a$a$ +- ' p/($ 'p/(B(+-* (+ p((#/. I+ '-) *-=a$(a p#'$/(#a/a (>a ;(p'a$a ,a ( 0a'-p/a +-+;(-*-( - # *=( 0 a$,a /a0 a a'$-(a * p-$(+ p+$/- p/(a B-a$a$ a p/(#a0( 0 (#)(*(>a/. T/a$a+$-* ;(/-/(a* #+'$a (+$/"# (=a/ - -+ '-/-) *-+ 0 'p#+( a/ $/ 0(+ a*#*a p/#+(/a pa+a (+ #/$(a*a #p-'a a $()((. I#)#*(>a/a '( /0-/a 'p/(B(+-*-( '$ aa'( a (+ $/a$a+$-* #/$#p0( p+$/a$-/(* )(a*#*a/. D-pa pa$/- 'ap$aa+( 0 *a #p/a$( ' =$/a (+'a a$/(a*-* $a*( 0 #'$#'(+$a>a p+$/- a p/,+( ,+$-a*($a$a -+( '(+#'$#> $()(#p/#+(/ '-0-/a p#'$ "#p/a$#/( a 0#-a '+$ #'#a' a/ +- '-+$ -+($ (+ #0 +#/a* @. S #+$-+-a - $/a$a$a+$ -+$(#+a* 0 /-p/a/ a/$(-*a/a #p*=. I+0(a$((* a)'#*-$ 0 $/a$a+$ ;(/-/(a* '-+$ -/a$#a/* % /a$-/a $/(a*#*a/a (+ a/ /a+$-* a/(+a* p#'$/(#/ '$ 0p*a'a$ '( /p/>(+$a 13 0(+ /#'(a p(*#+-*-(K
/a$-/a 0 a*#*a $()(a*a a a/( 0p*a'a/ +- ' /0-K
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* $/a+'#/a # /a$-/a (+;('a (+$/"-+a 0';('aK
0'( $-a$ (+ #+0($(( #p$( 0 a+$('p'( '( a'p'( * p#a$ 0';(0 a*a 'p/ # ,+$-a*a (+$(K * (+$/#0- (+ p*(+ #' '-)'$a+$ a+#/a+( $a*@ a/ (+ (-0a p/$(#+a/(( a*(aB*/ #+'$($-( $#$-'( #/p-/( '$/a(+K #p/a$((* p #' (p*(a % 0>*(p(/a '( '$(#+a/a p/(#'$-*-( #/a/a #'-*-( )-/;( '$(#+a/a #'-*-( - (/a'$/a( ((+0 #a>(( 0 a ,=a #'-* '( 0 a"( ('#/a ,($a*($a$a. A,a+$aB-* a/ a* #'$#'(+$>*#/ />-*$a 0(+ p#'()(*($a$a p a/ # a, 0 a /(+p a$ a( /p0 /0-a/a -+$#+a*a a/ +- '$ p#'()(*a *a a$-/a (#)(*(>a$a (+ apa/a$ ;(p'a$ (a/ B-'$((a/a *#/ #+'$a (+ p/$(#+a/a $-a/(( *#/.
TRATAMENTUL DE RECUPERARE% '$ $#$ a$a$ 0 (p#/$a+$ a '( /0-/a '( (p)(*(>a/a /a$-/((. T/a$a+$-* (+>(#*#( (+ '#p-* /-p/a/(( -+$(( p/(+ '$(-+ a'-p/a -';((*#/ '( a/$(-*a$((*#/ ,a ( - a$a$ a( ((+$ - a$ ,a ( (+'$($-($ p/# '( ,a ( -/a$ a/a (+$//-p/(. I+ ap/#ap $#a$ a>-/(* =/($((* 0 #+$/a$(( -'-*a/p#$ ( (+p-$ *a a$,a >(* 0 *a /0-/a /a$-/(( '( * ' ,#/ a0/'a /-p*#/ -'-*a/ '+$(a* 0 *a +#,*-* '+$-*-( /a$-/a$K a'$a +- ,#/ ( +((#0a$a p/a ,(#*+$ a'$* (+a$ 'a B+> p/#'-* 0 #+'#*(0a/. !#*+a,-* ,a ( (+-/aBa$ 'a"'( #+$/a$ -'-*a$-/a )/*#/ *()/ p/(+$/"-+ p/#/a 0 (+a'$(a #+0-' 0 a$/ 0( 'a- 0 a$/ a0/ 'p(a*(>a$ a* '/,((-*-( 0 /-p/a/ #)(*(>a+0-"'( a/$(-*a$((* a/ +- a- #'$ -p/(+' (+ apa/a$-* ;(p'a$. A$/#((* -'-*a/ /0#/(* a/$(-*a/ ';** p#'$"$/a-a$( '( p#'$"#p/a$#/(( a a =('$+$a -+-( '/,((- 0 (+a'$(a 0(a*a '( (>(#" '( a+#"$/ap( p *+a -+ '/,((- 0 #p$#p0( 'a #+'$($-( # #+0($( '+$(a*a -*$-/a (>(a 0(a*a% CFM@.
D-pa '#a$/a apa/a$-*-( ;(p'a$ =/($((* -'-*a/ '( a/$(-*a/ ,#/ ( (+$+'((a$ a-$ a/a (+$//-p/ p $#a$a 0-/a$a >(*(. La (+a>($/ap( ' a'#(a>a (+ a*a'( '#p "a* /-p/a/(( -+$(#+a*" a'aB-* (>(#$/ap(a '( )a*+#$/ap(a.
7. PROFILAXIE
I+ $(p (+ #/$#p0( '( $/a-a$#*#( '"a- #+$-/a$ 0#-a *+$ -+0a+$a*% -/+$a '( p/#(*a=(a. I+ p/>+$ ' 0('-$a p/#)*a a'#/0a$a p/(-*-( aB-$#/ (+ '#($a$'+a* *a+'a$ 0 O/a+(>a$(a M#+0(a*a a Sa+a$a$(( a/ a/a$a a /('-* #/$(( p/(+ a(0+$ (+ p/(#a0a 0 ,a/'$a 15 " 2? 0 a+( '$ 0 $/( #/( a( a/ 0a$ p/(+ )#a*a. M#/$a*($a$a 0-pa a'$ /a, a(0+$ #-pa *#-* 4 0-pa )#*(* a/0#(,a'-*a/ )#a*a a+/#a'a '( )#*(* apa/a$-*-( /'p(/a$#/. U/+$a '( p/#(*a=(a '-+$ '$/a+' (+$/0p+0+$. R>#*,a/a #/$a a /a$-/(*#/ '#a)( $()(#p/#+(/ #+'$($- a a( )-+a p/#(*a=( a a*-'-/(*#/ ,((#a' a* *>+( a/ 0(+ /((/ ' (+$a*+' a'$a>( $#$ a( /a/. Ca+0 ' p/#0- * $/)-( #p/a$ a*/a (+$/,+$(( aa+0-"' a( a*' (+ -+$( 0 ,;(a *>(-+(*#/ '( 0 '$a/a a+a$#(a a a/$(-*a$((. U+ a* 0#(*a a'p$ 0 p/#(*a=( '$ a*a 0 a p/,+( # a=a/ /'($a a -+-( )/- p/- '( 0 a p/,+( # a$($-0(+ ,((#a'a p#'$"$/a-a$('a*a.
8. CONCLUZII
1. F/a$-/(* 0 $()( '( p/#+- '-+$ a$(-+( a* apa/a$-*-( *###$#/.
2. Oa'* '-+$ p(' 0-/ '#*(0 />('$+$ (+$/"# #a/a/ a'-/a ;(a/ *a'$( a/ p/(+ a/$(-*a$((* 0(+$/ * #/a>a ';*$-* " pa/$a pa'(,a a apa/a$-*-( *###$#/. 3. M$a)#*('-* #a'*#/ 0-pa (+$a/a /'$/((%
(+/a*(>a/a '( 0(+/a*(>a/a
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a$#/(( a/ (+*-+$a>a #+'#*(0a/a /a$-/(*#/ '-+$ +/a*( '( *#a*(. 5. N-a/-* /a$-/(*#/ '$ 0#')($ 0 a/ a( a*' (+ #+0($((* ,($(( #0/+%
' ap/(a>a a /a$-/(* (+ +/a* /p/>(+$a 1?H 0(+ $#$a*-* $/a-a$('a*#/K
/a$-/(* 0 *>+a (+$#a( a #/( /a$-/a' (+$a*+' *a $#a$ ,a/'$* 0a/ (+(0a+$a a a( a/ '$ (+$/ 2? " 5? 0 a+( p/(#a0a 0 a$(,($a$ a=(a. 6. Ta)*#-* *(+( +- ,(0+$(a>a 0a$ pa$#+##+(. 7. D(a+#'$(-* 0 /$($-0(+ ' p-+ - aB-$#/-* =a+-*-( /a0(#*#(. 8. I+ 0(a+#'$(-* 0(/+$(a* /a$-/(* a*#*a/ ' p#$ #+-+0a - a+$#/'a 0 *>+a /a$-/(* 0 a'$aa* '( 0 a*a+-. . C#p*(a$((* '-+$ +/a* '( *#a*. 1?. T/a$a+$ " P/(+ $/a$a+$-* #/(a/( /a$-/( 0( '( a /a$-/(( 0 *>+a ' -/a/'$ #+'#*(0a/a a'$(a 0a/ p -+ p/( p*a+ ' '($-a>a /'$a)(*(/a -+$(( #/a/a #'-*-( #+'#*(0a$ ((+0 '-+0a/a.
11. Ma'-/( p/#(*a$(.
!I!LIOGRAFIE
1. A+a$#(a '( (>(#*#(a #-*-( " ##/0. p/#. G. !ALTA *. aX"a *( 'a+($a/ E.D.P. 186
CEZAR T9. NICULESCU RADU CIRMACIU
2. A$*a' 0 a+a$#( -a+a ,#*.II "188 " R.D. SINELNIOV
3. A+a$#(a #-*-( "apa/a$-* *###$#/ " V. PAPILIAN
4. C#p+0(- 0 a+a$#( '( (>(#*#( " G9. MOGOS E0($-/a S$((+$((a " 175
5. O/$#p0(a '( $/a-a$#*#(a M(a E+(*#p0( E.S.E. "187
AL. IANCULESCU
"#+. 0/. A. VOINEA
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