Tendinopathies Poignet Chapitre Livre

8/20/2019 Tendinopathies Poignet Chapitre Livre

http://slidepdf.com/reader/full/tendinopathies-poignet-chapitre-livre 1/8

dg SWGP^CHO‘[ DH[GC[G

@cshk [khgokg cod Vgrthogot Coctaey

[gvgrci tgres crg usgd ta dgskrh`g tbg kaodhthao an tgodaogotrcpegot. Citbaujb nrgqugotiy rgngrrgd ta cs tgoasyoavhths, dgSugrvcho‘s dhsgcsg hs earg ckkurctgiy tgregd tgodavcjhohths (nrae

tbg Ictho nar ’tgodao sbgctb― cod Jrggl nar ’hoffceecthao―) arstgoashoj tgodavcjhohths. goasyoavhths sujjgsts hoffceecthao antbg syoavhue< bawgvgr, `hapsy an tbg syoavhue ho dg Sugrvcho‘sdhsgcsg bcs sbawo ihttig ho tbg wcy an hoffceectary thssug.3,0 Hodg Sugrvcho‘s dhsgcsg, tbg rgthockuicr sbgctb kavgrhoj tbg tgodaosan tbg ffirst kaepcrtegot hs swaiigo cod hoffcegd. Avgr theg, tbghoffceectary prakgss igcds ta ocrrawhoj an tbg rhjhd rgthockuicrsbgctb, cod tbhs ecy prajrgss ta c kaodhthao tbct ecy g hrrgvgrs-hìg cod hs `gst dgskrh`gd cs stgoashoj tgodavcjhohths.

Tg ffirst darsci kaepcrtegot hs c shtg an kaoshdgrcìg coc-taehk vcrhcthao. Tg kaepcrtegot hs co astgaihjcegotaus tuooginaregd `y co assgaus jraavg ct tbg rcdhci styiahd cod tbg avgriy-hoj gxtgosar rgthockuiue.; Tg tuoogi kaotchos tbg tgodaos antbg c`duktar paiihkhs iaojus (CVI) cod tbg gxtgosar paiihkhs `rg-

vhs (GV@). Citbaujb coctaehk tgxts antgo sbaw aoiy c shojig CVItgodao trcvgrshoj tbg kaepcrtegot, tbhs hs jgogrciiy oat tbg kcsg.Ho nckt, tbgrg crg twa ar earg sihps an tbg CVI tgodao ho 76% ta84% an pcthgots.3‛> Kaovgrsgiy, tbg GV@ tgodao bcs `ggo nauodta `g c`sgot ho 7% ta :% an su`mgkts.7,:

Tg GV@ cod CVI tgodaos crg dhvhdgd `y c sgptcthao ho tbgffirst kaepcrtegot ho 06% ta >6% an pgapig.3‛: Ths sgptcthaogstgkthvgiy krgctgs sgpcrctg kaepcrtegots nar tbg rcdhci CVI tgo-daos cod tbg uiocr GV@ tgodao. C tbhrd kaepcrtegot baidhojco coaeciaus tgodao bcs cisa ggo dgskrh`gd.2 [gvgrci sgrhgs bcvgrgpartgd tbg hokhdgokg an sgpcrctg kaepcrtegots—dhskavgrgddurhoj surjhkci rgigcsg—ta `g bhjbgr tbco ho gcrihgr coctaehkstudhgs.;,8,36 Ths sujjgsts tbct kaosgrvcthvg trgctegot ho pcthgots whtb c su`dhvhshao an tbg ffirst kaepcrtegot hs earg ihlgiy ta nchi.

Tg GV@ gotrcpegot tgst wcs dgskrh`gd cs c egtbad an dgtgr-ehohoj wbhkb pcthgots ecy bcvg c sgpcrctg kaepcrtegot nar tbgGV@ tgodao. Tg tgst kaepcrgs rgshstgd tbue` egtckcrpapbc-icojgci gxtgoshao ta rgshstgd pciecr c`dukthao. Vcthgots wbasgpcho hs jrgctgr whtb tbue` gxtgoshao crg earg ihlgiy ta bcvg csgpcrctg kaepcrtegot nar tbg GV@ tgodao. Tg GV@ gotrcpegottgst wcs nauod ta `g 23% sgoshthvg.33

Hodhkcthaos cod Dhstgrgothci Dhcjoashs

Vcthgots whtb dg Sugrvcho‘s dhsgcsg typhkciiy prgsgot whtb pcho,swgiihoj, cod tgodgrogss avgr tbg ffirst darsci kaepcrtegotcppraxhectgiy 3 ke praxheci ta tbg rcdhci styiahd. Tg kaodhthao

east kaeeaoiy cstgkts tbasg ho tbg shxtb cod sgvgotb dgkcdgs aihng cod hs earg kaeeao ho waego tbco ho ego.

Nholgistgho‘s tgst hs c usgnui dhcjoasthk tgst ta bgip hdgothnypcthgots whtb tgodavcjhohths an tbg ffirst darsci kaepcrtegot. Nholgistgho30 arhjhociiy dgskrh`gd c ecoguvgr ho wbhkb tbg pcthgot‘tbue` hs jrcspgd cod usgd ta uiocriy dgvhctg tbg bcod. Ghkbast,3

bawgvgr, cktuciiy dgskrh`gd tbg tgst tbct antgo hs ehsocegd csNholgistgho‘s, ho wbhkb tbg tbue` hs kicspgd ho tbg ffist cod tbgo uiocriy dgvhctgd. @atb ecoguvgrs pradukg syeptaes, ut Ghkbast‘tgst ct thegs pradukgs syeptaes ho oareci hodhvhducis.

[gvgrci kaodhthaos prgsgot ho c ecoogr shehicr ta tbct adgSugrvcho‘s dhsgcsg. Hotgrsgkthao syodraeg hs tgodavcjhohths atbg sgkaod darsci kaepcrtegot. Vcthgots cisa prgsgot whtb pchoswgiihoj, cod tgodgrogss an tbg dhstci rcdhci nargcre, ùt tbg pchokco jgogrciiy `g iakcihzgd ta c pahot earg praxheci tbco tbct atbg typhkci prgsgotcthao an dg Sugrvcho‘s tgoasyoavhths.

Nhrst kcrpaegtckcrpci (KEK) mahot crtbrhths, skcpbatrcpgzhatrcpgzahd ([) mahot crtbrhths, cod Zcrtgo`grj‘s syodraegcii ecy `g ehstclgo nar dg Sugrvcho‘s dhsgcsg. Ao pbyshkci gxcehocthao, oathoj tbg iakcthao an mahot tgodgrogss ciaoj whtb

rcdhajrcpbs ciiaws dhstgrgothcthao an dg Sugrvcho‘s dhsgcsg nraecrtbrhths an ghtbgr tbg KEK ar [ mahot. Vcthgots whtb Zcrtgo`grj‘s syodraeg, ar ogurhths an tbg supgrffikhci rcdhci ogrvgprgsgot whtb pcho ciaoj tbg rcdhci styiahd cod ecy bcvg c pashthvgNholgistgho‘s tgst rgsuit. Woihlg dg Sugrvcho‘s pcthgots, tbasg whtb Zcrtgo`grj‘s syodraeg ecy bcvg c pashthvg hogi‘s shjo ta pgrkusshao avgr tbg supgrffikhci rcdhci ogrvg cod ecy bcvg dgkrgcsgdsgoscthao ho tbg rcdhci sgosary ogrvg dhstrhùthao.

Oaoapgrcthvg Trgctegot

C vcrhgty an homgktcìg stgrahd prgpcrcthaos crg ckkgptcìg nar tbgtrgctegot an dg Sugrvcho‘s dhsgcsg. Aur prgngrgokg hs ta usg cehxturg an 3 eI `gtcegtbcsaog (> ej/eI) cod ; eI 3% ihda-kchog whtbaut gphogpbrhog. Tg ihdakchog hs bgipnui ho kaoffirehoj ckkurctg pickgegot an tbg homgkthao, shokg prapgr pickgegoan iakci cogstbgthk hota tbg ffirst kaepcrtegot usuciiy rgsuits hoheegdhctg hepravgegot an syeptaes. Pgjcrdigss an tbg ehxturusgd, aog sbauid g cwcrg an patgothci cdvgrsg gstgkts sukb cs slhobypaphjegotcthao cod su`kutcogaus ctrapby.

C 07- ar 0:-jcujg oggdig kco `g usgd ta homgkt tbg ffirst kaepcrtegot cppraxhectgiy 3 ke praxheci ta tbg rcdhci styiahd. T CVI cod GV@ tgodaos crg jgogrciiy gcshiy pcipctgd ciaoj tbg rcdhci wrhst. C pap ecy `g ngit ao gotgrhoj tbg tgodao sbgctb, codc prajrgsshoj ffuhd wcvg ecy `g a`sgrvgd cs tbg stgrahd ehxturgffiiis tbg ffirst kaepcrtegot. Vcthgots wba da oat rgspaod ecy uodgrja c sgkaod homgkthao cntgr cppraxhectgiy 4 wggls. Pgpgctgd

78

K B C V T G P Tgodhoapctbhgs= NKW, GKW,dg Sugrvcho‘s, cod Hotgrsgkthao

[yodraeg Ci`grt P. Bcrrhs, ED, Masgpb C. Hzzh, Mr., ED, codDcvhd Dgoohsao, ED



Vcrt RH Hoffceectary cod Dgjgogrcthvg Kaodhthaos62

homgkthaos crg dhskaurcjgd `gkcusg an tbg patgothci nar cdvgrsg gn-ngkts. Citbaujb tbg ihtgrcturg dags oat ogkgsscrhiy suppart tbg usgan spihothoj,8 wg sthii astgr c tbue` sphkc spihot ta pcthgots hocddhthao ta tbg homgkthao.

Apgrcthvg Trgctegot

Zbgo oaoapgrcthvg trgctegot nchis ta pravhdg rgihgn, surjhkcirgigcsg an tbg ffirst darsci kaepcrtegot ecy `g pgrnaregd whtbghtbgr iakci ar rgjhaoci cogstbgshc. Tg usg an c taurohqugt ciiawsnar gcshgr hdgothffikcthao an tbg pgrthogot coctaey cod gspgkhciiynar hdgothffikcthao an tbg sgosary `rcokbgs an tbg rcdhci ogrvg. Zhtb iakci cogstbgshc ciaog, pcthgots crg jgogrciiy cìg ta taigr-ctg tbg taurohqugt nar tbg sbart theg rgquhrgd nar tbg prakgdurg.Ho cddhthao, hotrcvgoaus sgdcthao hs c usgnui cdmuokt nar pcthgotkaenart.

C 0-ke iaojhtudhoci ar trcosvgrsg hokhshao hs ecdg ho tbg slhostcrthoj 3 ke praxheci ta tbg rcdhci styiahd (Nhj. 78-3). Aìhqugar ]-sbcpgd hokhshaos crg cisa apthaos, ùt wg nggi tbct tbg trcos-vgrsg hokhshao hs cgstbgthkciiy supgrhar, wbgrgcs tbg iaojhtudhocihokhshao ciiaws nar c earg gxtgoshig gxpasurg hn rgquhrgd. Aokgtbraujb tbg slho, ìuot dhssgkthao sbauid `g usgd ta rgckb tbgcotg`rckbhci ncskhc wbhig rgtrckthoj tbg su`kutcogaus thssug codsgosary `rcokbgs an tbg rcdhci ogrvg (Nhjs. 78-0 cod 78-;). Tg

usg an narkgps ta jrcsp tbg su`kutcogaus thssug sbauid `g cvahdgdta bgip pratgkt tbg sgosary `rcokb an tbg rcdhci ogrvg nraepatgothci homury.

Tg rgthockuiue avgriyhoj tbg ffirst kaepcrtegot hs hokhsgdsbcrpiy ciaoj hts rcdhci àrdgr rgigcshoj tbg tgodaos (Nhj. 78-4).Tg kaepcrtegot sbauid tbgo g gxpiargd, gosurhoj tbct cii sihpsan àtb tbg CVI cod GV@ tgodaos bcvg `ggo rgigcsgd (Nhjs. 78-7 cod 78->). Hn co hotrckaepcrtegotci sgptue hs prgsgot, ht sbauid`g dhvhdgd. Tg wrhst sbauid `g rcojgd tbraujb nuii ffgxhao codgxtgoshao wbhig tbg kihohkhco a`sgrvgs nar tgodao suìuxcthao.godao suìuxcthao kco `g trgctgd `y iaasg suturhoj an tbg rgth-ockuiue ar `y pastapgrcthvg spihothoj.

Kaepihkcthaos

Pgicthvgiy ngw kaepihkcthaos crhsg nrae apgrcthvg trgctegot an dgSugrvcho‘s dhsgcsg. Homury ta tbg rcdhci sgosary ogrvg hs `y ncr tbgeast sgrhaus kaepihkcthao an ffirst darsci kaepcrtegot rgigcsg.Vcho nrae homury ta tbg rcdhci ogrvg kco `g dhscìhoj cod nrg-qugotiy hs warsg tbco tbg pcthgot‘s syeptaes nrae dg Sugrvcho‘sdhsgcsg. Atbgr kaepihkcthaos hokiudg hokaepigtg pcho rgihgn,hokaepigtg tgodao rgigcsg sgkaodcry ta nchiurg ta hdgothny cohotrckaepcrtegotci sgptue, pciecr ar darsci suìuxcthao an tbgtgodaos, cod bypgrtrapbhk skcrrhoj.

NHJWPG 78-3 Iaojhtudhoci slho hokhshao nar rgigcsg an tbg ffirstgxtgosar kaepcrtegot.

NHJWPG 78-0 Hdgothffikcthao cod pratgkthao an tbg supgrffikhci`rcokb an tbg rcdhci ogrvg.

NHJWPG 78-; Tbg ffirst darsci kaepcrtegot rgthockuiue.

NHJWPG 78-4 Hokhshao rgigcshoj tbg ffirst darsci kaepcrtegot.



KBCVTGP 78 Tgodhoapctbhgs= NKW, GKW, dg Sugrvcho‘s, Hotgrsgkthao [yodraeg

Autkaegs

Ho 3287, Nrhtz dg Sugrvcho, c [whss surjgao, wcs tbg ffirst tadgskrh`g tgodavcjhohths an tbg ffirst darsci gxtgosar kaepcrtegot,tbg kaodhthao tbct oaw `gcrs bhs oceg.

Dg Sugrvcho‘s dhsgcsg hs c kaodhthao an tgodao gotrcpegotcstgkthoj tbg kaeeao sbgctb an tbg CVI cod GV@ tgodaos. Tgkaodhthao jgogrciiy rgsuits nrae hoffceecthao an tbg ffirst gxtgosarkaepcrtegot cs c rgsuit an rgpgththvg eathao ar, igss nrgqugotiy,nrae ckutg trcuec. Dg Sugrvcho‘s dhsgcsg hs c kaeeao kcusg an wrhst pcho, cod pbyshkhcos sbauid `g wgii vgrsgd ho hts dhcjoashscod trgctegot.

Tg gstgkthvgogss an kaosgrvcthvg trgctegot ho dg Sugrvcho‘sdhsgcsg hs saegwbct kaotravgrshci. Heea`hihzcthao whtb tbgtbue` c`duktgd cod tbg wrhst ho sihjbt gxtgoshao bcs `ggo sbawo`y saeg ta `g c vhcìg trgctegot apthao, gspgkhciiy ho ckutgkcsgs.0,2 Atbgrs nggi tbct heea`hihzcthao ciaog hs an ihehtgd usg-nuiogss. Ho aog praspgkthvg study, spihothoj ciaog wcs nauod tabcvg c nchiurg rctg an ogcriy :6%.8

Karthkastgrahd homgkthao, ghtbgr ciaog ar kae`hogd whtb he-ea`hihzcthao, hs c earg gstgkthvg trgctegot an dg Sugrvcho‘sdhsgcsg. [tgrahd homgkthao an tbg ffirst darsci kaepcrtegot hs gn-ngkthvg ho 76% ta 26% an pcthgots, gspgkhciiy tbasg whtb ckutgsyeptaes.0,8,36,34 Vcthgots ecy rgquhrg earg tbco aog homgkthao

`gnarg rgsaiuthao an syeptaes, cod sukkgss rctgs ecy `g iawgr hopcthgots whtb dhc`gtgs.8

[urjhkci rgigcsg hs ihlgiy ta `g sukkgssnui wbgo ht hs pgrnaregdnar tbg karrgkt dhcjoashs, whtb gxquhshtg pratgkthao an tbg sgosary`rcokb an tbg rcdhci ogrvg, cod whtb tbaraujb gxpiarcthao an tbgkaepcrtegot cod rgigcsg an cii hotrckaepcrtegotci sgptc.

HOTGP[GKTHAO [XODPAEG

Gthaiajy cod Vgrthogot Coctaey

Hotgrsgkthao syodraeg hs c pchonui cfflhkthao an tbg nargcre tbcrgsuits nrae tgoavcjhohths an tbg sgkaod darsci wrhst kaepcrtegot. Vcthgots whtb tbhs kaodhthao prgsgot whtb pcho cod swgiihojho tbg rgjhao wbgrg tbg euskig `giihgs an tbg CVI cod GV@ tgo-daos hotgrsgkt (ar krass càvg) tbg tgodaos an tbg gxtgosar kcrprcdhcihs iaojus (GKPI) cod gxtgosar kcrph rcdhcihs rgvhs (GKP@)[yeptaes crg usuciiy iakcihzgd ta c rgjhao cppraxhectgiy 4 kepraxheci ta tbg rcdhci styiahd. Ho sgvgrg kcsgs, pcthgots ecy cisabcvg grytbgec cod krgphtus, wbhkb ecy `g pcipcìg ar cudhìggspgkhciiy whtb c stgtbaskapg.

Tg gthaiajy an hotgrsgkthao syodraeg hs uokigcr. Tg prakgs

wcs arhjhociiy tbaujbt ta `g sgkaodcry ta nrhkthao `gtwggo tbgrcdhci wrhst gxtgosars cod tbg euskig `giihgs an tbg CVI cod GV@rgsuithoj ho c tgodhohths ar urshths.37‛32 Jruod`grj cod Pgcjco3

sujjgstgd tbct tbg syodraeg hs c rgsuit an tgoasyoavhths an tbgtgodaos an tbg sgkaod darsci kaepcrtegot. Bawgvgr, wbgtbgtbg dhsgcsg hs c trug hoffceectary prakgss an tbg syoavhue, arhoffceecthao an tbg tgodao sbgctb cs ho dg Sugrvcho‘s dhsgcsgbcs ygt ta `g gstcìhsbgd.


Kaosgrvcthvg ecocjgegot hs tbg echostcy an trgctegot nar hotgrsgkthao syodraeg. @gkcusg tbg prakgss hs east antgo c rgsuit aavgrusg, tbg ecmarhty an pcthgots hepravg whtb `gbcvhar eadhffikcthao, heea`hihzcthao, cod co akkcshaoci stgrahd homgkthao

Vcthgots sbauid `g ecocjgd hohthciiy whtb spihothoj tbg wrhst hocppraxhectgiy 37 dgjrggs an wrhst gxtgoshao nar c pgrhad an 0 ta; wggls. Oaostgrahdci coth-hoffceectary egdhkcthaos ecy `g`gogffikhci cs wgii.

Vcthgots wbasg syeptaes pgrshst ecy `g jhvgo c stgrahd ho mgkthao hota tbg sgkaod kaepcrtegot. Tg rcdhci wrhst gxtgosarsbauid `g pcipctgd must dhstci ta tbg CVI cod GV@ euskig `gi-ihgs ta hdgothny tbg sgkaod kaepcrtegot. Ho c ecoogr shehicr tatbct dgskrh`gd nar dg Sugrvcho‘s dhsgcsg, c 07- ar 0:-jcujg oggdigecy `g usgd ta homgkt c ehxturg an `gtcegtbcsaog cod iakci cogstbgthk. Vcthgots sbauid bcvg heegdhctg hepravgegot ho tbghrsyeptaes nrae tbg iakci cogstbgthk, kaoffirehoj homgkthao ho tbprapgr iakcthao.

Apgrcthvg TrgctegotPgicthvgiy ngw pcthgots crg uorgspaoshvg ta kaosgrvcthvg ecocjgegot, ùt tbasg wba crg sbauid `g kaoshdgrgd nar apgrcthvghotgrvgothao. [urjhkci rgigcsg kco `g pgrnaregd whtb ghtbgr iakcar rgjhaoci cogstbgshc. Co uppgr gxtrgehty taurohqugt sbauid `gusgd ta ciiaw prapgr vhsucihzcthao an coctaehk strukturgs.

C iaojhtudhoci hokhshao hs ecdg ho ihog whtb tbg rcdhci wrhsgxtgosars, stcrthoj ct tbg darsci wrhst krgcsg cod gxtgodhoj praxheciiy ta tbg crgc an jrgctgst swgiihoj. Tg gxtgosar rgthockuiuecod cotg`rckbhci ncskhc avgriyhoj tbg sgkaod kaepcrtegot crghokhsgd iaojhtudhociiy. Tg CVI cod GV@ ecy `g ea`hihzgd tadhvhdg tbg ncskhc uodgr tbg euskigs. Tg tgodaos an tbg sgkaod

NHJWPG 78-7 Pgigcsgd ffirst darsci kaepcrtegot.

NHJWPG 78-> Hospgkthao nar kaepigtg rgigcsg an ciic`duktar paiihkhs iaojus cod gxtgosar

paiihkhs rgvhs tgodaos.




kaepcrtegot crg gigvctgd cod hospgktgd nar coy pctbaiajy. Vast-apgrcthvgiy, tbg wrhst hs tbgo spihotgd ho sihjbt gxtgoshao nar : ta36 dcys.

Kaepihkcthaos

Cs whtb dg Sugrvcho‘s dhsgcsg, ngw kaepihkcthaos crhsg cntgr sur-jgry nar hotgrsgkthao syodraeg. [uìuxcthao an tbg rcdhci wrhstgxtgosars hs c tbgargthkci passh`hihty, ùt bcs oat `ggo rgpartgd.

Atbgr patgothci kaepihkcthaos crg hongkthao, ogrvg homury, codbypgrtrapbhk skcrrhoj.

Ihtgrcturg Pgvhgw

Hotgrsgkthao syodraeg wcs arhjhociiy dgskrh`gd `y ^gipgcu ho3243, ùt wcs oat jhvgo tbg oceg ’hotgrsgkthao syodraeg― uothi38:2.37,3> Tg syodraeg bcs `ggo cssakhctgd whtb nrgqugot arrgpgththvg eathaos an tbg wrhst cod hs nrgqugotiy sggo ho ctbigtgspcrthkhpcthoj ho sparts sukb cs rawhoj cod wghjbt-ihnthoj.06 Eastpcthgots rgspaod ta oaoapgrcthvg trgctegots whtbaut rgkur-rgokg an syeptaes.38,03 Apgrcthvg trgctegot bcs `ggo sbawota `g co gstgkthvg trgctegot ho kcsgs rgkcikhtrcot ta kaosgrvcthvgtbgrcpy.38

NIGRAP KCPVH WIOCPH[ TGODHOHTH[,TGODHOAVCTBX, COD VH[ATPHSWGTPCIDX[NWOKTHAO

@cshk [khgokg cod Vgrthogot Coctaey

Tg ffgxar kcrph uiocrhs (NKW) hs aog an tbg euskuicr uohts tbctckts tbraujb tbg usg an c sgsceahd àog—tbg phshnare—wbhkbcrthkuictgs whtb tbg trhqugtrue. Ths nuokthaoci uoht pravhdgs tbgNKW whtb co hokrgcsgd cs wgii cs earg kaoshstgot eaegot cretbraujbaut c vcrhgty an tgodao iacds. Tg NKW bcs twa bgcds codarhjhoctgs nrae atb tbg buegrus cod tbg uioc. Tg buegrci bgcdcrhsgs nrae tbg kaeeao ffgxar tgodao an tbg egdhci gphkaodyigcod tbg uiocr bgcd nrae tbg aigkrcoao cod pastgraegdhci ardgr

an tbg uioc. Tg NKW hosgrts dhstciiy ao tbg phshnare, bcectg,cod ffintb egtckcrpci, wbgrg ht pravhdgs wrhst ffgxhao cs wgii cscsshstcokg whtb uiocr dgvhcthao cod giàw ffgxhao (Nhj. 78-:).Woihlg tgodaos tbct crg praog ta stgoashoj tgoasyoavhths nraepcsshoj tbraujb c sbgctb, tbg NKW hs uosbgctbgd.

Hoffceecthao ct tbg dhstci tgodhoaus parthao an tbg NKW kcoakkur `gkcusg an kcikhffik tgodhohths, cod krystci dgpashthao dhsgcsgcod bcs ggo wgii dgskrh`gd.00 Woihlg tbg hoffceectary kcusgs anpcho ct tbg dhstci NKW tgodao, ckthvhty-rgictgd pcho bcs rgkgotiy`ggo dgskrh`gd cs tgodhoapctby ar dgjgogrcthvg tgodhoashs. @u-dast cod kaiigcjugs0; kahogd tbg tgre NKW tgodhoapctby `gkcusgan tbg bhstaiajhk ffiodhojs ct tbg theg an surjgry nar rgkcikhtrcotkcsgs. Tgy nauod dgjgogrcthvg tgodhoashs (cojhaffi`raìcsthk by-pgrpicshc) shehicr ta tbct nauod ho tbg ratctar kust cod whtb ict-grci gphkaodyihths (tgoohs giàw) cs tbg prhecry pctbaiajy ho tbghrkcsgs.

Tg dhstgrgothci dhcjoashs an NKW tgodhohths cod tgodhoapc-tby hokiudgs phsatrhqugtrci dysnuokthao cod crtbrhths. Tg phsh-nare hs c sgsceahd àog tbct crthkuictgs whtb tbg trhqugtrue.[hehicr ta tbg pctgiiangearci mahot (Nhj. 78-2), tbg phsatrhqugtrci mahot kco `g cstgktgd `y dgjgogrcthvg kbcojg cod hs aog an tbgeast kaeeao shtgs nar dgjgogrcthvg crtbrhths ho tbg wrhst. Tgphsatrhqugtrci mahot hs c kaepigx crthkuicthao whtb àtb prhecrycod sgkaodcry stc`hihzgrs. Tg prhecry stc`hihzgrs crg tbg phsa-bcectg, phsaegtckcrpci, cod uiocr phsatrhqugtrci ihjcegots. Tgsgkaodcry stc`hihzgrs crg tbg trcosvgrsg kcrpci ihjcegot cod tbg

rcdhci phsatrhqugtrci ihjcegots. Homurhgs an tbg prhecry stc`hihzgrsecy igcd ta hostc`hihty tbct prgdhspasgs tbg mahot ta dgjgogrcthvgkbcojgs.04

Hodhkcthaos cod Dhstgrgothci Dhcjoashs

Vcthgots whtb NKW tgodhohths ar tgodhoapctby cod phsatrhqugtrcicrtbrhths prgsgot whtb pcho iakcihzgd ta tbg vaicr cod uiocr cspgktan tbg wrhst. Tg dhstgrgothci dhcjoashs an NKW tgodhohths hokiudgs

NHJWPG 78-2 Crtbraskaphk vhgw an tbg phsatrhqugtrci mahot. V, phshnare< T, trhqugtrue. (Kaurtgsy an Kbcrigs

Kcsshdy, ED.)

T

V

NHJWPG 78-: [cjhttci EPH vhgw an tbg phsatrhqugtrci mahotcod tbg ffgxar kcrph uiocrhs (NKW) tgodao.

V, phshnare< T, trhqugtrue.

T

V

NKW




phsatrhqugtrci crtbrhths, c jcojihao arhjhocthoj nrae tbg phsatrh-qugtrci mahot (ar atbgr ecss), bcectg ar phshnare nrckturg, coduiocr crtgry tbraeàshs.07 Vcthgots whtb kcikhffik tgodhohths antgoprgsgot whtb pcho, swgiihoj, cod iakcihzgd tgodgrogss ta pcipcthao, wbhkb kco hokiudg grytbgec ho tbg cstgktgd crgc. Pcdhajrcpbhkgvciucthao hokiudhoj c ;6-dgjrgg suphoctgd ictgrci rcdhajrcpb(Nhj. 78-8) ecy rgvgci kcikhffikcthao an tbg pgrhtgodhoaus rgjhao

ar tgodhoaus rgjhao an tbg NKW must praxheci ta tbg hosgrthao aotbg phshnare. Tg suphoctgd ictgrci rcdhajrcpb, ciaoj whtb kaeputgd taeajrcpby (K) gvciucthao (Nhj. 78-36), hs cisa bgipnuho gvciucthoj tbg phsatrhqugtrci mahot nar dgjgogrcthvg kbcojgsWoihlg kcikhffik tgodhohths, pcthgots whtb NKW tgodhoapctby rcrgiyprgsgot whtb grytbgec ho tbg cstgktgd rgjhao cod nrgqugotiy rgparckthvhty-rgictgd pcho. [hehicr ta pcthgots whtb kcikhffik tgodhohthstbgy bcvg pcho whtb rgshstgd wrhst ffgxhao cod uiocr dgvhcthao

Bawgvgr, tbgsg pcthgots typhkciiy bcvg tgodgrogss ta pcipcthaocppraxhectgiy ; ke praxheci ta tbg phshnare.0;

Tg phsatrhqugtrci mahot sbauid ciwcys `g gxcehogd kaokaehtcotiy, shokg phsatrhqugtrci crtbrhths cod NKW tgodhoapctby ecyakkur sheuitcogausiy. Tg phsatrhqugtrci kaeprgsshao tgst (gspgkhciiy whtb tbg wrhst gxtgodgd) cod strgss tgsts crg pcrthkuicriyusgnui ho tbg dhstgrgothci dhcjoashs. Durhoj tbg phsatrhqugtrckaeprgsshao tgst, tbg wrhst hs gxtgodgd cod stc`hihzgd wbhig tbgxcehogr‘s tbue` pickgs c kaeprgsshvg narkg ao tbg pciecr surnckg an tbg phshnare ho c darsci dhrgkthao. Tg phsatrhqugtrci sbukl(ar sbgcr) tgst hs pgrnaregd `y trcosicthoj tbg phshnare rcdhciiy`y c narkg dhrgktgd nrae tbg uiocr cspgkt. Bawgvgr, kcrg eust`g tclgo durhoj tbg gxcehocthao oat ta kaonusg pcho whtb kaeprgsshao an tbg phsatrhqugtrci mahot nrae pcho whtb pcipcthao a

tbg hosgrthao an tbg NKW ao tbg phshnare htsgin. Dhcjoasthk codtbgrcpguthk iakci cogstbgthk cod karthkastgrahd homgkthaos kco `gpcrthkuicriy bgipnui ho a`tchohoj tbg karrgkt dhcjoashs cod ho pravhdhoj pcho rgihgn.


Kaosgrvcthvg ecocjgegot an NKW tgodhohths cod phsatrhqugtrccrtbrhths sbauid ciwcys `g ecxhehzgd `gnarg kaoshdgrhoj apgrcthvg hotgrvgothao. Tg echostcy an kaosgrvcthvg ecocjgegohokiudgs oaostgrahdci coth-hoffceectary egdhkcthaos, spihothojcod akkupcthaoci tbgrcpy, hokiudhoj strgtkbhoj cod strgojtbgohojcs wgii cs tbg usg an uitrcsauod cod haotapbargshs.

Dhcjoasthk iakci cogstbgthk homgkthaos cod/ar karthkastgrahdhomgkthaos crg bgipnui ta pravhdg juhdcokg tawcrd tbg karrgk

dhcjoashs nar tbg pcthgot cod pbyshkhco. Tg phsatrhqugtrci mahohs homgktgd nrae tbg uiocr cspgkt an tbg wrhst, wbgrg tbg phsatrh-qugtrci mahot ihog hs gcshiy pcipctgd. Ho tbg kcsg an ckutg kcikhffiktgodhohths, c karthkastgrahd ecy `g homgktgd dhrgktiy hota tbg shtgan krystciihog dgpashthao (whtb cttgeptgd csphrcthao an tbg kcikhffik

NHJWPG 78-8 Tbhrty-dgjrgg suphoctgd ictgrci rcdhajrcpbdgeaostrcthoj phsatrhqugtrci crtbrhths.

V, phshnare< T, trhqugtrue.

TV

NHJWPG 78-36 [cjhttci (C) cod cxhci (@) KT vhgws dgeaostrcthoj phsatrhqugtrci crtbrhths.

C @




ectgrhci). Kaokaehtcot arci oaostgrahdci coth-hoffceectaryegdhkcthao ecy cisa g gogffikhci. Ho rcrg kcsgs an kbraohk kcikhffiktgodhohths tbct hs rgnrcktary ta kaosgrvcthvg ecocjgegot, rupturgan tbg tgodao ecy akkur. Tg bciiecrls an tgodao rupturg ho-kiudg sgvgrg pcho, wgclogss, cod tbg hoc`hihty ta pcipctg c tcuttgodao whtb rgshstgd wrhst ffgxhao. Nrgqugotiy, pcthgots rgpart cbhstary an pgrkghvgd papphoj an tbg tgodao. Wonartuoctgiy, tbgsurjhkci apthaos nar tbg cttrhthaoci NKW rupturg crg ihehtgd.

Apgrcthvg Trgctegot

East kcsgs an kcikhffik tgodhohths rgspaod ta kaosgrvcthvg egcsurgs.Bawgvgr, hn syeptaes pgrshst dgsphtg cjjrgsshvg oaosurjhkciecocjgegot, apgrcthvg trgctegot ecy `g hodhkctgd. Tg NKW hsusuciiy cpprackbgd tbraujb c iaojhtudhoci hokhshao dhrgktiy vaicrta tbg NKW cod gxtgods dhstciiy avgr tbg phshnare, wbgo oggdgd,ushoj c zhjzcj hokhshao stcrthoj ct tbg wrhst krgcsg. Tg NKW hshdgothffigd cod tbg uiocr ogrvg cod crtgry crg pratgktgd. Tg krys-tciihog ectgrhci cod coy dgjgogrcthvg tgodao cod hoffceectarythssug crg tbgo dg`rhdgd.

Woihlg whtb kcikhffik tgodhohths, @udast cod kaiigcjugs0; rgvgcigdtbct NKW tgodhoapctby akkurs cppraxhectgiy ; ke praxheci tatbg hosgrthao an tbg NKW ao tbg phshnare. Cjcho, co hokhshao avgr

tbg NKW hs pgrnaregd ct tbg rgjhao an ecxheci tgodgrogss, codìuot dhssgkthao hs usgd ta hdgothny cod pratgkt tbg uiocr ogu-ravcskuicr ùodig. Tg NKW tgodao hs tbgo spiht iaojhtudhociiyho tbg ehdihog ar tbraujb tbg crgc an pctbaiajy hn ht hs jrassiya`vhaus. C @gcvgr ìcdg ar skcipgi hs tbgo usgd ho c skrcphoj ea-thao ta kcrgnuiiy dg`rhdg tbg nrhcìg thssug, cs dgskrh`gd nar tbgtrgctegot an ictgrci gphkaodyihths.0> Tg iaojhtudhoci spiht hs tbgorgpchrgd whtb hotgrruptgd c`sar`cìg suturgs. Tg su`kutcogausthssugs cod slho crg kiasgd, cod c spihot hs cppihgd nar 3 ta 0 wgglscntgr tbg prakgdurg.

Tg syeptaecthk crtbrhthk phsatrhqugtrci mahot hs trgctgd surjh-kciiy `y rgsgkthao an tbg phshnare, cpprackbgd `y c vaicr hokh-shao avgr tbg phshnare. Tg slho hs rgtrcktgd cod tbg uiocr ogu-ravcskuicr ùodig hs pratgktgd. Tg NKW hs spiht iaojhtudhociiy

avgr tbg kgotgr an tbg phshnare cod hs dhssgktgd dhrgktiy ast an tbgphshnare (Nhj. 78-33). C tbrgcdgd [tghoecoo pho ar L whrg kco g

kgotrciiy hosgrtgd hota tbg phshnare cod usgd cs c maysthkl ta nckhih-tctg rgeavci. @y rgeavhoj tbg phshnare ho tbhs ecoogr, tbg dhstcihosgrthao an tbg NKW, tbg phsabcectg, cod tbg phsaegtckcrpciihjcegots ecy `g prgsgrvgd.0: Tg iaojhtudhoci spiht ho tbg tgo-dao kco `g rgpchrgd whtb c`sar`cìg suturgs, cod tbg slho hskiasgd ho tbg stcodcrd ncsbhao. Vastapgrcthvgiy, c spihot hs usgd narcppraxhectgiy ; wggls ar uothi tbg pcthgots crg kaenartcìg autan tbghr spihot.

Zg kurrgotiy trgct phsatrhqugtrci crtbrhths eukb earg nrg-qugotiy tbco NKW tgodhohths ar tgodhoashs. East pcthgots tgod targspaod hohthciiy ta spihothoj cod homgkthao, cod c secii pgrkgot-cjg an tbasg pcthgots uithectgiy bcvg tbghr phshnare gxkhsgd. Tgprakgdurg hs rgicthvgiy strchjbtnarwcrd ut rgquhrgs kcrgnui dhssgk-thao ta ehohehzg coy homury ta tbg NKW ar uiocr oguravcskuicrùodig.

Kaepihkcthaos

Kaepihkcthaos an tbg ecocjgegot an NKW tgodhohths cod tgo-dhoapctby crg ngw ùt sgrhaus. Cs prgvhausiy egothaogd, c rcrgkaepihkcthao an rgkcikhtrcot kcikhffik tgodhohths hs rupturg an tbgtgodao. Wonartuoctgiy, ngw kihohkci shjos ar syeptaes prgdhkthepgodhoj rupturg. Bawgvgr, ecjogthk rgsaocokg hecjhoj

(EPH) gvciucthao an tbg hovaivgd rgjhao hs saegthegs bgipnui hogvciucthoj tbg gxtgot an tbg dhsgcsgd tgodao.

Cs whtb tbg surjhkci trgctegot an NKW tgodhohths, kcrgsbauid `g tclgo ta pratgkt tbg uiocr oguravcskuicr ùodig dur-hoj rgeavci an tbg phshnare ta prgvgot tbhs rcrg ùt patgothciiysgrhaus kaepihkcthao. East pcthgots bcvg ogcr-kaepigtg rgihgn anpcho, ùt pgrshstgot ehid dhskaenart bcs `ggo rgpartgd.02 Atb-gr patgothci kaepihkcthaos hokiudg hongkthao cod bypgrtrapbhkskcrrhoj.

Autkaegs

@udast cod kaiigcjugs0; puìhsbgd c pastapgrcthvg sgrhgs anffivg pcthgots whtb NKW tgodhoapctby rgnrcktary ta kaosgrvc-thvg egcsurgs. Naur pcthgots wgrg naiiawgd up nar co cvgrcjg an

06 eaotbs, cod cii naur rgpartgd kaepigtg ar ogcr-kaepigtgrgihgn an syeptaes. Ht hs hotgrgsthoj tbct aog pcthgot ho tbg sgrhgsbcd pgrshstgot pcho ct tbg phsatrhqugtrci mahot cod uodgrwgotsu`sgqugot gxkhshao. Tg cutbars cisa pgrnaregd bhstaiajhkcociyshs ao gckb an tbg pcthgots cod kaoshstgotiy nauod cojha-ffi`raìcsthk bypgrpicshc ho cii kcsgs kaoshsthoj an bypgrtrapbhk,piuep, ckthvg ffi`raìcsts, vcskuicr bypgrpicshc, cod dhsarjcohzgdkaiicjgo.

Ouegraus cutbars bcvg gxcehogd wrhst nuokthao cntgr gxkh-shao an tbg phshnare, cod east rgpart ehoheci nuokthaoci dgffikhtskaepcrgd whtb tbg kaotrcictgrci gxtrgehty.0:‛;6 Ice cod kai-igcjugs02 nauod oa stcthsthkci dhstgrgokg ho jrhp strgojtb, wrhsteathao, stcthk strgojtb, cod dyocehk strgojtb ho 06 pcthgotsgxcehogd ct co cvgrcjg an >7 eaotbs.

GRTGO[AP KCPVH WIOCPH[ TGODHOHTH[

Gthaiajy cod Vgrthogot Coctaey

Tg gxtgosar kcrph uiocrhs (GKW) arhjhoctgs nrae tbg kaeeaogxtgosar arhjho nrae tbg ictgrci gphkaodyig an tbg buegrus codnrae tbg pastgrhar àrdgr an tbg uioc. Ht hosgrts dhstciiy ao tbguiocr shdg an tbg ffintb egtckcrpci `csg. @gnarg hts hosgrthao, tbgGKW pcssgs uodgr tbg gxtgosar rgthockuiue cod c sgpcrctg dggpffi`ra-assgaus sbgctb, tbg GKW su`sbgctb, wbhkb hs naregd crauodht. Tg tgodao tbgo tclgs co uiocr cojuicthao cs ht pcssgs tbraujb

NHJWPG 78-33 Cxhci EPH hecjg dgeaostrcthoj tbg praxhehtyan tbg uiocr oguravcskuicr ùodig ta tbg

phshnare. V, phshnare< WC, uiocr crtgry < WO, uiocr ogrvg.

V

WO

WC




tbg uiocr jraavg ao tbg darsci cspgkt an tbg dhstci uioc `gnarg htshosgrthao ao tbg `csg an tbg ffintb egtckcrpci. Tg GKW su`sbgctbhs c pcrt an tbg trhcojuicr ffi`rakcrthicjg kaepigx (NKK) codechotchos tbg GKW whtbho tbg uiocr jraavg. Tg trug gxtgosarrgthockuiue pcssgs dhrgktiy càvg tbg su`sbgctb cod hs whtbautdhrgkt cttckbegot ao tbg dhstci uioc. Tg gxtgosar rgthockuiuehs kaoffugot whtb tbg cotg`rckbhci ncskhc cod cisa hosgrts ao tbgphshnare, trhqugtrue, ffintb egtckcrpci, cod vaicr sant thssugs.;3

Tg echo nuokthao an tbg GKW hs gxtgoshao cod uiocr dgvhcthaoan tbg wrhst, cod ht hs aog an tbg east hepartcot stc`hihzgrs an tbgdhstci rcdhauiocr mahot (DPWM).;0 Jhvgo tbct tbg tgodao akkuphgs86% an tbg ffi`ra-assgaus sbgctb, tbg cojuicthao an tbg kaursgan tbg tgodao, cod tbg rgstrchots an tbg su`sbgctb ta rgshst tbgocturci tgodgoky tawcrd suìuxcthao, tbg GKW hs prgdhspasgd tatgodhohths.;; Ho cddhthao, rgpgththvg strgss ao tbg su`sbgctb kcokcusg tgoasyoavhths, hostc`hihty, cod gvgo dhsiakcthao an tbg tgo-dao nrae hts jraavg.

Vcthgots whtb GKW tgodhohths prgsgot whtb pcho cod nrgqugot-iy whtb swgiihoj ao tbg uiocr cspgkt an tbg wrhst avgr tbg GKW, wbhkb hs gxckgr`ctgd `y rgshstgd wrhst gxtgoshao cod pcipcthao.Gxcehocthao an tbg wrhst hokiudgs pcipcthao nar tgodgrogss arkrgphtcthao, rgshstgd suphocthao, ffgxhao, cod uiocr dgvhcthao cs

wgii cs kaepcrhsao ta tbg kaotrcictgrci shdg ta gvciuctg nar su`-iuxcthao ar dhsiakcthao an tbg tgodao. Vcthgots antgo crg cìg tadgeaostrctg tbg suìuxcthao whtb c kae`hocthao an tbgsg eavg-egots ta tbg gxcehogr cs wgii. Tg NKK cod DPWM sbauid cisa`g tbaraujbiy gvciuctgd ta ruig aut cddhthaoci pctbaiajy sukb csc tgcr an tbg NKK, DPWM hostc`hihty, ar crtbrhths.

Pcdhajrcpbs crg usgnui ta ruig aut kcikhffikcthao ct tbg ho-sgrthao an tbg GKW, homury ta tbg uiocr styiahd, cod dgjgog-rcthvg kbcojgs whtbho tbg DPWM. EPH gvciucthao sbauid `ghotgrprgtgd whtb kcuthao cod karrgictgd kihohkciiy, shokg csye-ptaecthk shjoci kbcojg an tbg GKW bcs `ggo rgpartgd cs ckaeeao ffiodhoj ;4 (Nhj. 78-30). Bawgvgr, EPH hs bgipnui hotbg dhstgrgothci dhcjoashs cs wgii cs ho surjhkci picoohoj ho tbgkcsg an kaokaehtcot pctbaiajy. Ho cddhthao, uitrcsauod ecy

bcvg c raig ho tbg gvciucthao an hostc`hihty an tbg GKW ùt hsihehtgd ta tbg gxpgrhgokg an tbasg pgrnarehoj cod hotgrprgthojtbg gxcehocthao.


Oaoapgrcthvg ecocjgegot an GKW tgodhohths hokiudgs ckthvhtyeadhffikcthao, gxtgoshao spihothoj, coth-hoffceectary egdhkcthaos, akkupcthaoci tbgrcpy, cod karthkastgrahd homgkthaos. GKWhomgkthaos crg pgrnaregd `y pcipcthoj tbg GKW tgodao must dhstci ta tbg uioc cod homgkthoj dhrgktiy tbraujb tbg sbgctb, ffiiihojtbg patgothci spckg `gtwggo tbg tgodao cod su`sbgctb. Baw

gvgr, tbg gstgkthvgogss an oaoapgrcthvg ecocjgegot bcs `ggoqugsthaogd,;7 wbgrgcs atbgrs bcvg rgpartgd jaad rgsuits nar pchorgihgn whtb àtb kaosgrvcthvg cod apgrcthvg ecocjgegot an tgodaohths.;>‛;2

Apgrcthvg Trgctegot

[urjhkci hotgrvgothao hs hodhkctgd nar pcthgots wba crg uorgspaoshvg ta kaosgrvcthvg ecocjgegot cod ho wbae pchonusuìuxcthao ar dhsiakcthao gxhsts. Pgkcikhtrcot tgodhohths whtbaut suìuxcthao ar dhsiakcthao kco g trgctgd whtb rgigcsg an tbgtgodao sbgctb ciaog ar whtb c ]-picsty tgkbohqug ta whdgo tbgtuoogi. [cthsncktary rgsuits whtbaut rgpchr an tbg sbgctb bcvg`ggo rgpartgd. Lhp cod Vghegr;2 rgpartgd ao 30 kcsgs ecocjgd `y dgkaeprgsshao whtbaut rgpchr an tbg sbgctb, wbhkb

rgsuitgd ho oa DPWM ar GKW hostc`hihty. Dgkaeprgsshao an tbgGKW kaepcrtegot hs cpprackbgd vhc c iaojhtudhoci hokhshaoavgr tbg dhstci GKW tgodao godhoj dhstciiy ct tbg ffintb egtckcrpci `csg. Tg darsci kutcogaus `rcokb an tbg uiocr ogrvgsbauid `g pratgktgd tbraujbaut tbg prakgdurg. Tg rgthockuiue cod su`sbgctb an tbg tgodao crg hokhsgd iaojhtudhociiy cttbg ehdihog an tbg tgodao. Hn hodhkctgd, c tgoasyoavgktaeyecy `g pgrnaregd. Tg su`kutcogaus thssug cod slho crg kiasgdho tbg usuci ecoogr, cod c spihot hs cppihgd nar cppraxhectgiy0 wggls.

[uìuxcthao cod dhsiakcthao an tbg GKW crg cpprackbgd hoc shehicr ecoogr. C iaojhtudhoci slho hokhshao hs ecdg avgr tbgrcdhci cspgkt an tbg GKW kaepcrtegot, cod tbg darsci sgosary`rcokb an tbg uiocr ogrvg hs pratgktgd. Tg gxtgosar rgthockuiue

hs hokhsgd iaojhtudhociiy avgr tbg GKW kaepcrtegot, cod tbgsu`sbgctb hs hospgktgd. Hn tbg su`sbgctb hs an scthsncktary qucihty, c prhecry rgpchr ecy `g kaepigtgd—whtb kcuthao sa cs taprgvgot krgcthoj c ogw stgoathk sbgctb—naiiawgd `y kiasurg atbg gxtgosar rgthockuiue. Citgrocthvgiy, c tgkbohqug dgskrh`gd`y rueìg kco `g gepiaygd.;8 Cntgr hokhshoj tbg gxtgosar rgthockuiue, tbg GKW tgodao whtbho hts sbgctb hs gigvctgd ho c su`pgrhastgci ncsbhao. Tg tgodao kco `g rgdukgd hota hts jraavdhstciiy wbhig twa ar tbrgg suturg cokbars crg pickgd ciaoj tbgjraavg‘s uiocr cspgkt. Tg suturgs crg pcssgd tbraujb tbg sbgctbho c barhzaotci ecttrgss ecoogr he`rhkcthoj coy rgduodcosbgctb. Ths tgkbohqug bcs ggo gkckhaus wbgrg tbg su`sbgctbhs an sukhgot qucihty, wbhkb bcs `ggo a`sgrvgd ho tbg ecmarhtyan kcsgs. Ho kcsgs ho wbhkb tbg su`sbgctb hs oat rgkaostrukthì

ar tbg qucihty an tbg uiocr jraavg dags oat pgreht rgkaostrukthao, c sihoj ecy `g ncsbhaogd nrae tbg gxtgosar rgthockuiueta sgkurg tbg tgodao nrae nurtbgr hostc`hihty. [phoogr codLcpico;0 dgskrh`gd c tgkbohqug ho wbhkb tbg kgotrci tbhrd an couiocr-`csgd strhp an rgthockuiue wcs pcssgd dggp ta tbg GKWcod tbgo `ckl avgr tbg tgodao cod sgkurgd ao tbg rcdhci cspgkt Zg prgngr c eadhffikcthao an tbhs tgkbohqug tbct usgs tbg sgptue`gtwggo tbg ffintb cod shxtb gxtgosar kaepcrtegots cs tbg ratcthao pahot nar tbg sihoj (Nhj. 78-3;). Tg gxtgosar rgthockuiuesu`kutcogaus thssugs, cod slho crg kiasgd ho tbg stcodcrd ncsbhao. C iaoj-cre spihot hs cppihgd nar cppraxhectgiy 4 wggls hoogutrci ratcthao.

NHJWPG 78-30 EPH (cxhci T0-wghjbtgd) hecjg dgeaostrcthojgxtgosar kcrph uiocrhs (GKW) tgodhohths

cod tgoasyoavhths.

GKW




Kaepihkcthaos

[uìuxcthao an tbg GKW hs c tbgargthkci passh`hihty cntgr rgigcsg narstgoashoj tgoasyoavhths, ùt bcs oat `ggo rgpartgd. Atbgr patgo-

thci kaepihkcthaos hokiudg hongkthao cod ogrvg homury, gspgkhciiyta tbg uiocr sgosary ogrvg. Ho kcsgs rgquhrhoj rgkaostrukthao, kcrgsbauid `g tclgo oat ta avgrthjbtgo tbg sihoj, wbhkb kauid rgstrhkttgodao jihdhoj cod/ar kcusg sgkaodcry tgodaohths.

PGNGPGOKG[

3. Lgao-Kabgo @= Dg Sugrvcho‘s dhsgcsg. M @aog Mahot [urj \@rU 3873<;;=8>‛88.

0. Igca I= Dg Sugrvcho‘s dhsgcsg= c kihohkci cod coctaehkci study. M @aog Mahot[urj \CeU 3872<46=36>;‛36:6.

;. Ihpskae` VP= [tgoashoj tgoasyoavhths an tbg rcdhci styiahd prakgss (dg Sugr-vcho‘s dhsgcsg). Coo [urj 3873<3;4=336‛337.

4. Jhigs LZ= Coctaehkci vcrhcthaos cstgkthoj tbg surjgry an dg Sugrvcho‘s dhs-

gcsg. M @aog Mahot [urj \@rU 38>6<40=;7;‛;77. 7. Ehocehlcwc X, Vghegr KC, Kax ZI, gt ci= Dg Sugrvcho‘s syodraeg= surjh-

kci cod coctaehkci studhgs an tbg ffi`raassgaus kcoci. Artbapgdhks 3883<34=747‛748.

>. @cbe M, [zcà ], Naukbgr J= Tg coctaey an dg Sugrvcho‘s dhsgcsg. HotArtbap 3887<38=068‛033.

:. Igsihg @E, Grhksao Z@ Mr, Eargbgcd MP= Hokhdgokg an c sgptue whtbho tbgffirst darsci kaepcrtegot an tbg wrhst. M Bcod [urj \CeU 3886<37=22‛83.

2. Iaaehs IL= crhcthaos an stgoashoj tgoasyoavhths ct tbg rcdhci styiahd prakgss. M @aog Mahot [urj \CeU 3873<;;=;46‛;4>.

8. Zghss CVK, Clgieco G, c`ctc`ch E= rgctegot an dg Sugrvcho‘s dhsgcsg. M Bcod [urj \CeU 3884<38=787‛782.

36. Bcrvgy NM, Bcrvgy VE, Barsigy EZ= Dg Sugrvcho‘s dhsgcsg= surjhkci aroaosurjhkci trgctegot. M Bcod [urj \CeU 3886<37=2;‛2:.

33. Cigxcodgr PD, Kctcicoa IZ, @crrao AC, Jihklgi []= Tg gxtgosar paiihkhs`rgvhs gotrcpegot tgst ho tbg trgctegot an dg Sugrvcho‘s dhsgcsg. M Bcod [urj\CeU 0660<0:=23;‛23>.

30. Nholgistgho B= [tgoashoj tgodavcjhohths ct tbg rcdhci styiahd prakgss. M @aog Mahot [urj 38;6<30=768‛746.

3;. Ghkbast G= ]ur pctbajgogsg dgr godavcjhohths stgoascos. @ruos @ghtrcjg ]Liho Kbhr 380:<KRRRHR=:4>‛:77.KRRRHR=:4>‛:77.=:4>‛:77.

34. Vbcigo J[= [tgoashoj tgoasyoavhths= trhjjgr ffiojgrs, trhjjgr tbue`, coddg Sugrvcho‘s dhsgcsg= ckutg kcikhffikcthao ho wrhst cod bcod. Ho Muphtgr M@(gd)= Niyoo‘s Bcod [urjgry, 4tb gd. @cithearg= Zhiihces & Zhilhos, 3883,pp. 4;8‛44:.

37. Da`yos MB, [he NB, Ihoskbghd PI= [parts strgss syodraeg an tbg bcod cod wrhst. Ce M [parts Egd 38:2<>=0;>‛074.

3>. Bawcrd OM= Vgrhtgodhohths krgphtcos. M @aog Mahot [urj \CeU 38:><38=44:‛478.

3:. Taepsao CP, Vigwgs IZ, [bcw GJ= Vgrhtgodhohths krgphtcos cod she-pig tgoasyoavhths= c kihohkci study an 744 kcsgs ho hodustry. @r M Hod Egd3873<2=376‛3>6.

32. Zaad EG, Ihoskbghd PI= C`duktar paiihkhs iaojus ùrshths. Kiho Artbap38:;<8;=08;‛08>.

38. Jruod`grj C@, Pgcjco D[= Vctbaiajhk coctaey an tbg nargcre= hotgrsgkthaosyodraeg. M Bcod [urj \CeU 3827<36=088‛;60.

06. Zaad E@, Da`yos MB= [parts-rgictgd gxtrccrthkuicr wrhst syodraegs. KihoArtbap 382><060=8;‛360.

03. Vcotulasht [, Vgtkblruc Z, [thgos [C= Hotgrsgkthao syodraeg ho @urh-rce Basphtci= c 4-yr praspgkthvg study. Ce M Vbys Egd Pgbc`hi 0663<26=>7>‛>>3.

00. Dhiigy DN, aolho EC= Ckutg kcikhffik tgodaohths ho tbg bcod cod wrhst. M Bcod [urj \@rU 3883<3>=037‛03>.

0;. @udast MG, Lrcusbccr @[, Cycic D= Nigxar kcrph uiocrhs tgodhoapctby. M Bcod[urj \CeU 0667<;6=307‛308.

04. Pcyco JE, Mcegsao @B, Kbuoj LZ= Tg phsatrhqugtrci mahot= coctae-hk, `haegkbcohkci cod rcdhajrcpbhk cociyshs. M Bcod [urj \CeU 0667<;6=78>‛>60.

07. Lighoeco Z@, Jrcbce = Dhstci uiocr homury cod dysnuokthao. Ho VghegrKC (gd)= [urjgry an tbg Bcod cod Wppgr Gxtrgehty, Ogw Xarl= EkJrcw-Bhii, 388>, pp. >>:‛:68..

0>. Ohrskbi PV= Ictgrci tgoohs giàw. gkb [bauidgr Giàw [urj 0666<3=380‛066.

0:. Vciehgrh M= Vhshnare crgc pcho trgctgd `y phshnare gxkhshao. M Bcod [urj\CeU 3820<:=4::‛426.

02. Ice L[, Zaad`rhdjg [, @urlg ND= Zrhst nuokthao cntgr gxkhshao an tbgphshnare. M Bcod [urj \@rU 066;<02=>8‛:0.

08. Kcrrai PG, Kayig EV Mr = Dysnuokthao an tbg phsatrhqugtrci mahot= trgctegot`y gxkhshao an tbg phshnare. M Bcod [urj \CeU 3827<36=:6;‛:6:.

;6. Jaegz KI, Pgocrt HV, Vumcis MH, gt ci= Dysnuokthao an tbg phsatrhqugtrci mahot= dgjgogrcthvg crtbrhths trgctgd `y gxkhshao an tbg phshnare. Artbapgdhks0667<02=467‛462.

;3. Cdces @= Dhstci rcdhauiocr mahot hostc`hihty= Ho Jrggo DV (gd)= Jrggo‘sApgrcthvg Bcod [urjgry, 7tb gd. Vbhicdgipbhc= Gisgvhgr Kburkbhii Ihvhoj-staog, 0667, pp. >67‛>44.

;0. [phoogr E, Lcpico @= Gxtgosar kcrph uiocrhs= hts rgicthaosbhp ta tbg stc`hihtyan tbg dhstci rcdha-uiocr mahot. Kiho Artbap 38:6<>2=304‛308.

;;. [crrhs H, Ohklaicas D, Eusjrcvg D, [atgrgcoas DJ, gt ci= goasyoavhths=trhjjgr ffiojgr, dg Sugrvcho‘s syodraeg, ffgxar kcrph rcdhcihs, cod gxtgosarkcrph uiocrhs. Ho rueìg , @udast MG, Karowcii P (gds)= Bcod, Giàw codGiàw cod

[bauidgr [urjgry. Vbhicdgipbhc= Eas`y Gisgvhgr, 066>, pp. 030‛003. ;4. hehos EG, A‘Kaoogii [G, Grhklsao [M, Aogsao [P= EP hecjhoj an tbg

wrhst= oareci ffiodhoj tbct ecy sheuictg dhsgcsg. Pcdhajrcpbhks 388><3>=82:‛887.

;7. Ockbhoaikcr WJ, Lbcoailcr L@= [tgoashoj tgoavcjhohths an tbg gxtgosarkcrph uiocrhs. M @aog Mahot [urj \@rU 3822<:6=240.

;>. Bcmm CC, Zaad E@= [tgoashoj tgoasyoavhths an tbg gxtgosar kcrph uiocrhs. M Bcod [urj \CeU 382><33=738‛706.

;:. Dhklsao D, Iuklgy K= goasyoavhths an tbg gxtgosar kcrph uiocrhs tgodaosbgctb. M @aog Mahot [urj \CeU 3842<;6=86;‛86:.

;2. Lhp VK, Vghegr KC= Pgigcsg an tbg shxtb darsci kaepcrtegot. M Bcod [urj\CeU 3884<38=788‛>63.

;8. EckIgooco C, Ogegkbgl OE, Zchtcycwhoyut , rue ig = Dhcjoashs cod C, Ogegkbgl OE, Zchtcycwhoyut , rueìg = Dhcjoashs codcoctaehk rgkaostrukthao an gxtgosar kcrph uiocrhs suìuxcthao. M Bcod [urj\CeU0662<;;=78‛>4.

NHJWPG 78-3; Gxtgosar kcrph uiocrhs su`sbgctb (GKWss) rgkaostrukthao whtb gxtgosar rgthockuicr (GP) sihoj csgd ao tbg sgptue`gtwggo tbg ffintb cod shxtb gxtgosar kaepcrtegots. GDE, gxtgosar dhjhth ehoheh. (Kaurtgsy an PC @grjgr, ED, VbD.)

GKW[[ GKW

GDE

^ / ^H

GP

Documents

Tendinopathies Poignet Chapitre Livre