METODE DE RECUPERARE MEDICALA BALNEOFIZIOTERAPEUTICE N FRACTURA DE

COL FEMURAL
PLANUL LUCRARII
PARTEA I
I. Generaliti - deiniie! "la#ii"are! date e$ide%i&l&'i"e
II. Eti&$at&'enie - "a()e! %e"ani#%e! anat&%ie $at&l&'i"
III. Criterii de #(#inere a dia'n&#ti"(l(i*
+,E-a%en(l "lini"-.e%ne #(/ie"ti0e #i &/ie"ti0e
1,In0e#ti'aii $ara"lini"e! e-a%en radi&l&'i"! $r&/e de la/&rat&r!e0al(are
%(#"(lara #i arti"(lara
I2. E0&l(ie 3i $r&'n&#ti"-.tadiali)are
2. Trata%ent*
+,Pr&ila-ia
1,Trata%ent i'ien&-dieteti"
4,Trata%ent %edi"a%ent&#
5,Trata%ent &rt&$edi"&-"6ir(r'i"al
PARTEA aII-a
2I. Trata%ent re"($erat&r B.F.T
+,Prin"i$iile #i &/ie"ti0ele trata%ent(l(i B.F.T.
1,Trata%ent(l $rin 6idr&-ter%&tera$ie7te6ni"a! ee"te,
4,Trata%ent(l $rin ele"tr&tera$ie 7te6ni"a! ee"te,
5,Trata%ent(l $rin %a#a8*
a,de#"rierea anat&%i"a a )&nei ae"tate
/,te6ni"a %a#a8(l(i
",ee"tele i)i&l&'i"e ale %a#a8(l(i
9,:inet&tera$ia.Te6ni"i de %&/ili)are #i $r&'ra% de e-er"iii
re"($erat&rii
;,Tera$ia &"($ai&nal
<,Trata%ent(l /alne&l&'i"7a$e %inerale! n%&l(ri,! #tai(nile
/alne&"li%ateri"e.
2II. Bi/li&'raie



+
PARTEA I.
I. GENERALItI - Deiniie! "la#ii"are! date e$ide%i&l&'i"e
Fra"t(rile de "&l e%(ral
.(nt %ai ale# nt=lnite la /tr=ni! iind "ara"teri)ate at=t $rin re'0ena l&r! "=t 3i $rin 'ra0itate.
Gra0e! de&are"e $&t da & %&rtalitate ridi"at la 0=r#tni"i> din $(n"t de 0edere (n"i&nal! de&are"e #e
"&n#&lidea) r( 3i #e "&%$li" de#e&ri "( ne"r&)a i#"6e%i" a "a$(l(i e%(ral> #(nt 'ra0e #(/
ra$&rt al 0iit&r(l(i (n"i&nal al 3&ld(l(i re#$e"ti0. T&ate a"e#tea a( "(t $e a(t&rii an'l&-#a-&ni
7Di"?#&n, # le den(%ea#" @Ara"t(ri ne
re)&l0a/ileA.
Traie"t(l ra"t(rii le "la#ii" n*
-ra"t(ri "er0i"ale #(/"a$itale! n "are linia de ra"t(r tre"e $rin 8&n"ti(nea "artila8(l(i arti"(lar "(
"&l(l>
-ra"t(ri trn#"er0i"ale in $lin "&l e%(ral! "( traie"t &/li" #a( 0erti"al>
-ra"t(ri /a)i"er0i"ale! "and linia de ra"t(ra e#te #it(ata la 8&n"ti(nea "&l(l(i "( %a#i0(l
tr&6anterian.
F&arte re"0ent! ra"t(rile de "&l #(nt "( de$la#are! dat&rita de &/i"ei a$t(l(i "a d($a ra"t(rare
$a"ient(l #e #$ri8ina $e $i"i&r #a( dat&rita tra"ti(nil&r e-er"itate de %a#ele %(#"(lare $(terni"e.
E-i#ta d&(a de$la#ari $rin"i$ale*
-de$la#area "are reali)ea)a & "&)a 0ara! in "are "a$(l e%(ral e#te in 0ar #i in r&tatie interna! in ti%$
"e ra'%ent(l di#tal e#te in r&tatie e-terna>
-de$la#area in "&)a 0al'a.
E0&l(tia #$&ntana a ra"t(ril&r de "&l e#te! in 'eneral! nea0&ra/ila.
D&ar in "a)(l (nei ra"t(ri #i%$le! ara de$la#are! "are n( a inl(intat 0a#"(lari)atia! ne $(te%
a#te$ta la & e0&l(tie a0&ra/ila "( "&n#&lidare 7$rin i%&/ili)area, /(na! rea"ere de tra0er#e &#&a#e
n&r%ale. In a"ea#ta )&na! "al(#(l n( e#te ni"i&data 6i$ertr&i"! "a in alte $arti.
A"ea#ta e0ent(alitate e0&l(ti0a e#te in#a rara! "a"i %ai re"0ent ra"t(ra e#te "( de$la#are! iar
0a#"(lari)atia "a$(l(i e%(ral e#te "&%$r&%i#a $rin intere#area "&n"&%itenta a 0a#el&r "a$#(lare.
De a"eea! $#e(dartr&)a #i ne"r&)a i#"6e%i"a a "a$(l(i e%(ral #(nt "ele d&(a %ari $eri"&le $entr(
a"e#t ti$ de ra"t(ra.
Deinitie*
N(%i% ra"t(ra! ntrer($erea "&ntin(itatii (n(i &#.
Ea #e $r&d("e $rin a"i(nea dire"t #a( indire"t a (n(i a'ent tra(%ati" a#($ra &#(l(i.
A"i(nea a'ent(l(i tra(%ati" tre/(ie # ie &arte 0i&lent $entr( a $r&d("e & ra"t(r.
La $er#&anele n 0=r#ta! la "are e-i#ta (n $r&"e# de rareiere 7di#tr('ere, a #tr("t(rii &#&a#e B
&#te&$&r&)a B re)i#tenta &#(l(i #"ade &arte %(lt! a#tel n"=t ra"t(ra #e $&ate $r&d("e 3i d($
tra(%ati#%e %ai %i"i. .$re e-e%$l(! (n /tr=n $&ate a"e & ra"t(r de "&l e%(ral "6iar da" a
")(t n ti%$ "e %er'ea.
Oa#ele C$at&l&'i"eC "are a( n ele a/"e# #a( &r%ai(ni t(%&rale! #e ra"t(rea) "( (3(rinta
la ni0el(l le)i(nii.
CLA.IFICAREA FRACTURILOR*
E-i#t 0ariate %&daliti de "la#ii"are a ra"t(ril&r*
- $rin %e"ani#%(l de $r&d("ere a ra"t(rii*
a, ra"t(ri dire"te B #e $r&d(" la l&"(l (nde a a"ti&nat a'ent(l tra(%ati">
/, ra"t(ri indire"te B #e $r&d(" la di#tanta de l&"(l de a"ti(ne a &rtei tra(%ati"e>
- d($a a#$e"t(l anat&%& B $at&l&'i" al ra"t(rii*
a, ra"t(ri n"6i#e B "=nd n( e-i#ta #&l(tie de "&ntin(itate la ni0el de te'(%ent #i &#(l n( le)ea)a
%(#"6i! ner0i! 0a#e! iar #e'%entele &#&a#e #(nt a"&$erite "el $(in de $iele>
1
/, ra"t(ri de#"6i#e B &#(l a8(n'e n "&nta"t "( e-teri&r(l! $&ate #a a$ara (n $r&"e# #e$ti" "are
nt=r)ie 0inde"area #a( $&ate da na#tere #i alt&r "&%$li"atii> #(nt intere#ati %(#"6i! 0a#e! te'(%ente>
- d($a #edi(l ra"t(rii*
a, e$ii)are>
/, diai)are>
", diai)& B e$ii)are 7inter%ediare,>
- d($a ti$(l ra"t(rii*
a, ra"t(ri in"&%$lete B i#(ra! ra"t(ra n le%n 0erde! n(ndarea 7&a#ele "rani(l(i,>
/, ra"t(ri "&%$lete B #(nt &arte 'ra0e*
", ra"t(ri tran#0er#ale>
d, ra"t(ri &/li"e>
e, ra"t(ri n 0=r de "larinet>
, ra"t(ri l&n'it(dinale> ra"t(ri #$ir&ide>
', ra"t(ri n &r%a de l(t(re! et".
6, ra"t(ri "( #i ara de$la#are>
CLA.IFICAREA FRACTURILOR DE COL FEMURAL
Traie"t(l ra"t(rii le "la#ii"a in*
-ra"t(ri "er0i"ale #(/"a$itale! in "are linia de ra"t(ra tre"e $rin 8&n"ti(nea "artila8(l(i arti"(lar "(
"&l(l>
-ra"t(ri trn#"er0i"ale in $lin "&l e%(ral! "( traie"t &/li" #a( 0erti"al>
-ra"t(ri /a)i"er0i"ale! "and linia de ra"t(ra e#te #it(ata la 8&n"ti(nea "&l(l(i "( %a#i0(l
tr&6anterian.
- D($a %e"ani#%(l de $r&d("ere al ra"t(rii - BD6ler indi0id(ali)ea)a ra"t(rile*
$rin a/d("tie>
$rin add("tie.
- Din $(n"t de 0edere %e"ani" B Pa(Eel# le-a %$artit n*
ti$(l I traie"t(l de ra"t(ra a"e "( &ri)&ntala (n (n'6i %ai %i" de 4F3.
ti$(l II B (n'6i(l e#te de 4F3- 9F3>
ti$(l III B (n'6i(l e#te %ai %are de <F3.
- D($a 'rad(l de de$la#are a ra'%entel&r B Garden le "la#ii"a a#tel*
'rad(l I B ra"t(ra in"&%$leta>
'rad(l II B ra"t(ra "&%$leta ara de$la#are>
'rad(l III B ra"t(ra "&%$leta "( de$la#are $artiala>
'rad(l I2 B ra"t(ra "&%$leta "( de$la#are t&tala.
II. ETIOPATOGENIE- "a()e! %e"ani#%e! anat&%ie $at&l&'i"a
Fa"t&rii eti&l&'i"i de$ind de*
+."alitatea &#(l(i.
Fra"t(rile de "&l e%(ral #(nt &arte re"0ente! n #$e"ial la /atr=ni 7%ai ale# la e%ei,! <9G din
ra"t(ri #e $r&d(" d($a 0=r#ta de ;F de ani.
1. %e"ani#%(l de $r&d("ere.
Pentr( ntele'erea %e"ani#%(l(i de $r&d("ere a ra"t(rii de "&l e%(ral tre/(ie #a $ri0i% #tr("t(ra
e-tre%itatii #($eri&are a e%(r(l(i. A"ea#ta e-tre%itate! #(/ a#$e"t(l ten#i(nil&r "are #e e-er"ita
a#($ra ei! #e a#ea%ana "( /rat(l (nei %a"arale.
La ni0el(l e-tre%itatii #($eri&are e%(rale 'a#i% #(/#tanta &#&a#a di#$(#a n d&(a #i#te%e
tra/e"(lare i%$&rtante.
Un #i#te% tra/e"(lar #e ra#ira "a (n e0antai la ni0el(l "&l(l(i.
P&rne#te de la ata #($eri&ara a a"e#t(ia! ndre$t=nd(-#e n 8&# #i e-tern "atre "&rti"ala ineri&ara a
"&l(l(i e%(ral! "&n#tit(ind e0antai(l de #(#tinere Dellet.
4
A"e#t e0antai! la $artea #a ineri&ara! #e "&nden#ea)a ntr-& )&na den#a! "&n#tit(ind $inten(l Ada%#!
iar $artea ineri&ara e#te "&n#tit(ita din la%ele d(re #i "&%$a"te "are &r%ea)a $inten(l Mer?el.
Un al d&ilea #i#te% tra/e"(lar de)0&ltat $e dire"tia &rtel&r de ten#i(ne "are tind #a le"te)e "&l(l
e%(ral! $&rne#te din $artea ineri&ara a "&l(l(i e%(ral #i #e ndrea$ta n #(# #i e-tern "atre
"&rti"ala #($eri&ara a "&l(l(i e%(ral.
A"e#t #i#te% tra/e"(lar #e inter#e"tea)a "( tra0eele #i#te%(l(i de #(#tinere! n"=t "&nera "a$(l(i
e%(ral & re)i#tenta de&#e/ita! "a$(l iind de a$t $artea "ea %ai re)i#tenta a e-tre%itatii #($eri&are
a e%(r(l(i.
Re)i#tenta #a "ea %ai %are e#te n "entr(! (nde #e n"r("i#ea)a "ele d&(a #i#te%e tra/e"(lare
&#&a#e! %aterial(l de #inte)a 0a 'a#i la a"e#t ni0el (n $(n"t #&lid de #$ri8in.
In re'i(nea tr&6anteriana! d&(a a#"i"(le tra/e"(lare! $&rnind de la "&rti"ala diai)ara interna #i
e-terna! #e n"r("i#ea)a! &r%=nd & &'i0a.
Intre #i#te%(l tra/e"(lar de #(#tinere de la ni0el(l "a$(l(i e%(ral #i "el &'i0al de la ni0el(l
%a#i0(l(i tr&6anterian! n $&rti(nea %i8l&"ie a "&l(l(i e%(ral! e-i#ta & )&na B )&na Hard n "are
den#itatea te#(t(l(i &#&# e#te %ai %i"a.
Re)i#tenta di%in(ata a "&l(l(i e%(ral n a"ea#ta )&na a"e "a $=na la 0=r#ta de 59 de ani re"0enta
ra"t(ril&r %edi&"er0i"ale #a ie %ai rare de"=t a "el&r $retr&6anteriene.
A"ea#ta #tr("t(ra tra/e"(lara den#a #i ntretaiata #e %&dii"a "( 0=r#ta.
D($a ;F de ani a#i#ta% la & re#&r/tie a tra0eel&r &#&a#e! n"=t la /atr=ni a$are & )&na de re)i#tenta
%e"ani"a #"a)(ta ! n #$e"ial la ni0el(l #t=l$(l(i e-tern al #i#te%(l(i &'i0al! "eea "e a"e "a
ra"t(rile /a)i"er0i"ale #i "ele $ertr&6anteriene #a ie %ai re"0ente d($a a"ea#ta 0=r#ta.
Ba"?%an! arata "a ra"t(ra "&l(l(i e%(ral n( $&ate #a ai/a l&" de"=t da"a! n "adere! #e $r&d("e (n
0al'(# "&%/inat "( & %i#"are de ra#("ire a "&l(l(i e%(ral ata de "a$(l /l&"at n "&til! $rin
"&%$re#i(nea tra(%ati#%(l(i #i "&ntra"t(ra %(#"(lara.
In &ri"e ra"t(ra a "&l(l(i e%(ral e-i#ta (n %e"ani#% initial de 0al'(# 7re)(ltat al r&tatiei e-terne
a#&"iata B t&r#i(nea, "are d("e la ra"t(ra n "&)a 0ara! "( i%$a"tarea $&#ter&#($eri&ara a
ra'%entel&r 7ra"t(ra $rin a/d("tie an'renata,. C=nd ra"t(ra #e de)an'renea)a $entr( a reali)a
ra"t(ra n "&-a 0&ra 7add("tie,! a"ea#ta n( #e $&ate "&ntin(a! e-a'er=nd (n(l din "ele d&(a
"&%$&nente ale #ale! n (n"tie de re)i#tenta nt=lnita la ni0el(l $eretel(i $&#teri&r al "&l(l(i. Da"a
r&tatia e-terna $red&%ina #i "&l(l "edea)a la $artea #($eri&ara! #e $r&d("e ra"t(ra n "&-a 0&ra
7add("tie, "( ta#are #a( "&%in(tie $&#teri&ara.
Da"a ten#i(nea $red&%ina #i $eretele $&#teri&r al "&l(l(i e%(ral re)i#ta! #e $r&d("e ra"t(ra
#$ir&ida "( "i&" $r&-i%al.
ANATOMIA PATOLOGICA
Traie"t(l de ra"t(ra! n $&rti(nea #($eri&ara e#te #it(at 8(-ta"eali". El $&ate #a n"ea$a e-a"t
la $erieria "artila8(l(i arti"(lar #i n a"ea#ta #it(atie are t&ate "&nditiile #a le)e)e $edi"(l(l 0a#"(lar.
De la a"e#t ni0el! traie"t(l de ra"t(ra #e ndrea$ta #$re %ar'inea ineri&ara a "&l(l(i! ra%=n=nd
#tri"t #(/ "a$(l e%(ral 7ra"t(ra %edi&"er0i"ala,. A"e#t traie"t de ra"t(ra n( e#te neted! "i $re)inta
n(%er&#i dinti "&rti"ali! iar la $artea $&#teri&ara e#te %&dii"at $rin ta#are #i $rin "&%in(tia
"&rti"alei.
O /(na radi&'raie de $r&il a "&l(l(i e%(ral $&ate #a e0identie)e $re)enta (n(ia #a( a %ai %(lt&r
ra'%ente "&rti"ale n(ndate la ni0el(l ra"t(rii.
Pre)enta a"e#tei "&%in(tii $&#teri&are la ni0el(l traie"t(l(i de ra"t(ra a"e "a! n %&%ent(l
red("erii ra"t(rii! #a a$ara (n #$ati( '&l "er0i"&"eali" $&#teri&r.
E-i#tenta a"e#t(i #$ati( '&l la $artea $&#teri&ara a "&l(l(i e%(ral a"e "a &#te&#inte)a! at(n"i "=nd
ntinderea a"e#t(i #$ati( e#te %ai %are de +I4 din 'r&#i%ea "&l(l(i e%(ral! #a ie in#ta/ila #i #a
d("a la re$la#area ra'%entel&r.
A"ea#ta n&ti(ne "a$itala tre/(ie l(ata n "&n#iderare "=nd #e de"ide ale'erea %&nta8(l(i n ti%$(l
&#te&#inte)ei ra"t(rii.
In a $atra #i a "in"ea )i de la ra"t(ra! te#(t(l $atr(nde n 6e%at&%(l "e n"&n8&ara &"ar(l de
ra"t(ra! re)&r/=nd(-l #i &r'ani)=nd(-l.
5
F&r%area de &# n&( n"e$e $entr( ra'%ent(l di#tal n )i(a a J-a! iar $entr( "el $r&-i%al n )i(a a
+5-a. Unirea "el&r d&(a ra'%ente are l&" "el %ai de0re%e n #a$ta%=na a ;-a! dar de &/i"ei n 8(r(l
#a$ta%=nii a K-a.
O $arti"(laritate a %&dii"arii ra"t(ril&r la a"e#t ni0el e#te li$#a #trat(l(i "an/i(% n $&rti(nea
intra"a$#(lara a "&l(l(i! iind ne"e#ara & red("ere anat&%i"a #i an(larea &ri"arei %i#"ari n &"ar
$rintr-& &#te&#inte)a #&lida.

III. CRITERII DE .U.TINERE A DIAGNO.TICULUI*
+,e-a%en "lini"-#e%ne #(/ie"ti0e #i &/ie"ti0e
1,in0e#ti'atii $ara"lini"e* e-. Radi&l&'i"! $r&/e de la/&rat&r! %&/ilitatea #i &rta %(#"(lara

a, ELAMEN CLINIC
Ta/l&(l "lini" e#te &r%at din #e%ne 'enerale #i l&"ale.
- #e%ne 'enerale B #tare 'enerala alterata! ri#&ane #i te%$erat(ra 7$&ate a8(n'e la 4J
F
C
A"e#te #e%ne di#$ar d($a i%&/ili)are la #"(rt ti%$.
- #e%ne l&"ale B d(rerea $(terni"a! e"6i%&)a! 6e%at&%! de&r%area re'i(nii! ntrer($erea
"&ntin(itatii &#(l(i! #"(rtarea re'i(nii! i%$&terta (n"ti&nala! "re$itatii &#&a#e! %&/ilitatea
an&r%ala! li"6tene! te%$erat(ra l&"ala ridi"ata #i ede% l&"al.
/, ELAMENUL RADIOLOGIC
In &ri"e #(#$i"i(ne de ra"t(ra e#te &/li'at&ri( #a #e e-e"(te (n e-a%en radi&l&'i".
A"ea#ta $re"i)ea)a dia'n&#ti"(l! arata "( e-a"titate #edi(l #i a#$e"t(l ra"t(rii! da"a e-i#ta #a( n(
de$la#are a ra'%entel&r &#&a#e! da"a ra"t(ra e#te "&%in(ti0a! da"a e-i#ta #"(rtare &#&a#a! et".
Pe /a)a radi&'raiei #e $&ate a"e #i $r&'n&#ti"(l ra"t(rii #i %ai ale# #e $&ate #ta/ili
atit(dinea tera$e(ti"a.
E-a%en(l de la/&rat&r e#te ne"e#ar n "a)(rile de ra"t(ri %(lti$le! $l(rira'%entare
7"nd e#te ne"e#ar inter0enia "6ir(r'i"al, #a( "nd inter0in "&%$li"aii 7ine"ii,.
Bilant(l %(#"(lar*
Pentr( a e0al(a &rta %(#"(lara etal&na% 0al&area a"e#teia in 'rade a#tel*
Grad(l F-$arali)ia "&%$leta a %(#"6il&r
Grad(l +-rea"tie t&ni"a $er"e$ti/ila in tend&n #a( %(#"6i
Grad(l 1-%i#"are de a%$lit(din n&r%ala da"a eli%ina% 'ra0itatia
Grad(l 4-indi"a reali)are a"el(ia#i ti$ de %i#"are "( inter0entia (nei 're(tati in #e'%ent(l
%&/ili)at!
Grad(l 5-%i#"are "are #e reali)ea)a "&ntra (nei re)i#tente
Grad(l 9-&rta %(#"(lara a (n(i %(#"6i n&r%al
Bilant(l arti"(lar
.e in0e#ti'6ea)a t&ate arti"(latiile in dire"tie "rani&"a(dala ara a %&/ili)a e-"e#i0 /&lna0(l..e
$rinde $ar'6ia di#tala a (nei arti"(latii #i #e %ani$(lea)a in dierite $lan(ri.A"ea#ta $rindere #e 0a
a"e (tili)and (n /rat "at %ai l(n' de $ar'6ie $entr( a a0ea "at %ai %(lta &rta #i $re"i)ie.N( #e 0a
%&/ili)a & arti"(latie $rin inter%edi(l altei arti"(latii.Par'6ia $r&-i%ala a arti"l(atiei #e i-ea)a
a$li"and-& $e (n $lan re)i#tent #i $rintr- & "&ntra$rindere a n&a#tra.
Ma#(area a%$lit(diniii %i#"aril&r arti"(lare #e a"e de &/i"ei 0i)(al &l&#ind linii i%a'inare "ed
re$re)inta a-ele $&)itiei i)i&l&'i"e #i a-ele $ar'6iei di#tale arti"(lare! in #it(atii $at&l&'i"e "and
arti"(latiile n( $&t i ad(#e la $&)itia F 'rade i)i&l&'i" (n'6i(l #e "al"(lea)a $rin dierenta ra$&rtat
la i)i&l&'i".
9
I2. E2OLUTIE .I PROGNO.TIC-.TADIALIZARE
Fra"t(rile de "&l e%(ral a( & e0&l(tie ine'ala #i "reea)a %(lte de"e$tii "6iar da"a #(nt
"&re"t tratate.
Cara"teri#ti"ile 0a#"(lari)atiei "&l(l(i #i "ele ale "a$(l(i e%(ral #i ra$&rt(l a"e#teia "( traie"t(l de
ra"t(ra! "&nditi&nea)a n %a#(ra "&0=r#it&are e0&l(tia &"ar(l(i de ra"t(ra #i 0italitatea "a$(l(i
e%(ral
2a#"(lari)area e#te a#i'(rata $rin artera li'a%ent(l(i r&t(nd #i $rin $ed(n"(lii "are na#" din arterele
"a$#(lare.
E0&l(tia ra"t(ril&r de "&l e%(ral e#te n (n"tie #i de ti$(l de ra"t(ra.
E-e%$l(*
ra"t(rile $rin a/d("tie a( & e0&l(tie a0&ra/ila! "&n#&lid=nd(-#e n K #a$ta%=ni>
ra"t(rile $rin add("tie! n( "&n#&lidea)a da"a n( #(nt tratate "6ir(r'i"al 7de#e&ri! ni"i d($a a"e#t
trata%ent,>
ra"t(rile "er0i"&tr&6anteriene "&n#&lidea)a nt&tdea(na! dar "( $ret(l (n(i "&-a 0&ra! #i (nei
#"(rtari a r&tatiei e-terne.
PROGNO.TICUL FRACTURILOR
A( $r&n&#ti" dierit #i "reea)a %(lte de"e$tii! "6iar da"a #(nt "&re"t tratate. Cara"teri#ti"ile
0a#"(lari)atiei 'at(l(i #i "a$(l(i e%(ral #i ra$&rt(l a"e#teia "( trae"t(l de ra"t(ra "&nditi&nea)a in
%are %a#(ra 0inde"area &"ar(l(i de ra"t(ra #i 0italitatea "a$(l(i e%(ral.
In tra(%ati#%ele in"6i#e $r&'n&#ti"(l e#te a0&ra/il! iar in "ele de#"6i#e e#te %ai 'ra0 dar
dat&rita %i8l&a"el&r de "6ir(r'ie tra(%ati#%ele "&%$li"ate a( $ierd(t %(lt din 'ra0itatea l&r.
M(lte "a)(ri de ra"t(ra de "&l e%(ral d(" la "&-artr&)a.
2. TRATAMENT
+ Pr&ila"ti"
In "adr(l trata%ent(l(i $r&ila"ti" #e in"l(d %a#(rile de $re0enire l(ate $entr( e0itarea (n(i
tra(%ati#% "a de e-e%$l(* e0itarea %er#(l(i iarna %ai ale# "ei "are a( & ra'ilitate %ai %are a
&a#el&r #i atentie de&#e/ita la l&"(rile de %(n"a "ei "are l("rea)a in %ina! in "&n#tr("tii et".
1 Trata%ent(l i'ien&-dieteti"
Re"($erarea #e"6elel&r $re"&"e tre/(ie "&%$letata "( & #erie de $re#"ri$tii $e "are $a"ient(l le 0a
(r%a a"a#a l(ni #i ani de )ile! (ne&ri t&ata 0iata. A"e#te $re#"ri$tii a" $arte din "eea "e #-a n(%it
@i'iena #&ld(l(iC*
- #"aderea in 're(tate! "6iar #(/ 're(tatea ideala>
- e0ita %er#(l $e teren a""identat #i #"ari>
- e0ita #"6i&$atarea $rin "&ntr&l(l %ental al %er#(l(i>
- e0ita &rt&#tati#%(l #i %er#(l $rel(n'it>
- de "el $(tin d&(a &ri $e )i #e 0a $a#tra (n re$a(# la $at! "( %e%/rele ineri&are intin#e>
- #$ri8in in /a#t&n $e di#tante %ai l(n'i>
- %er# )ilni" $e /i"i"leta #a( r(lare la /i"i"leta i-a>
- de d&(a &ri $e )i 0a ee"t(a 'i%na#ti"a $re#"ri#a $entr( %&/ilitate #i t&niiere %(#"((lara>
- "&re"tarea #"(rti%ii %e%/r(l(i ineri&r 7da"a de$a#e#te d&i "enti%etri,>
- in"alta%inte "( t&"(ri %&i>
4 Trata%ent %edi"a%ent&#
;
Medi"atia antiinla%at&rie #e a#&"ia)a int&tdea(na $r&"e#el&r i)i"ale. .e (tili)ea)a in &rdinea
$reerintel&r* Fenil/(ta)&na! Ind&%eta"ina! A#$irina! e0ent(al Pira%id&n(l. Br(en(l #i Per"l(#&ne
ra%an re)er0ate $entr( "a)(rile in "are antiinla%at&arele de %ai #(# #(nt $rea a're#i0e $entr(
tra"t(l di'e#ti0 al $a"ientil&r. Un'(entele antiinla%at&rii a$li"ate l&"al $rin ri"ti(ne in#i#tenta 7de
$reerat d($a #edinta de ter%&tera$ie, $ar #a ie (n ad8(0ant $reti&#! %ai ale# $entr( en&%enele
$eriarti"(lare.
Iniltratia intraarti"(lara "( Midr&"&rti)&n #i Lilina! $re"edata #a( n( de e0a"(area $artiala a
li"6id(l(i arti"(lar da re)(ltate /(ne. T&t(#i! in %a#(ra in "are "( "elelalte %et&de #e &/tine &
e0&l(tie a0&ra/ila a $r&"e#(l(i inla%at&r! "are $&ate ad("e %ari ne$la"eri.
Medi"atia antal'i"a &/i#n(ita & ad%ini#tra% int&tdea(na "and d(rerile a( inten#itati %ari. In
#tarile d(rer&a#e arti"(lare %ai 0e"6i! trenante! la indi0i)i "( (n $ra' d(rer&# "&/&rat! #e indi"a
a#&"ierea ti%&le$ti"el&r 7Antide$ri% #i Te$erin, #a( ne(r&le$ti"el&r 7Ti&rida)in,.
5.Trata%ent &rt&$edi" #i "6ir(r'i"al
Pr&'re#ele "6ir(r'iei &rt&$edi"e %&derne a( #al0at atat 0ietile! "at #i 0iit&r(l (n"ti&nal al
#&ld(l(i la $a"ientii 0ar#tni"i "( ra"t(ri de "&l.
E#te de"i e-$li"a/il de "e in #er0i"iile de i)i&tera$ie #i re"($erare #e intalne#" t&t %ai %(lti a#tel de
$a"ienti.
D&(a atit(dini tera$e(ti"e #(nt a#ta)i "el %ai re"0ent (tili)ate*
- &#te&#inte)ele
- $r&te)ele $artiale "eali"e
O#te&#inte)a "( "(i .%it6-Peter#en! $ra"ti"ata $rintr-& %ini%a inter0entie 7in"i)ie e-terna, in
"are #e intr&d("e "(i(l #a( #(r(n(rile #(/ "&ntr&l radi&l&'i" #a( a#&"ierea &#te&#inte)ei "( 're&n
&#&#! a( a0anta8(l de a i &arte /ine #($&rtate de $a"ient! dar n( $er%it rel(area %er#(l(i "( #$ri8in
de"at d($a 5-9 l(ni. In $l(#! $r&"ent(l de $#e(dartr&)e #e ridi"a! in (n"tie de #tati#ti"a! de la +FG
7Merie DNA(/i'ne! B&Od, la 14-1<G 7Rie(na(! Ban?#,. De a#a%anea! in"identa ne"r&)ei i#"6e%i"e
atin'e 4FG 7Ban?#, #i "6iar 59G 7Merie DNA(/i'ne,.
De#i n(lt %ai la/&ri&a#a! #i din a"e#t $(n"t de 0edere a0and ri#"(rile (nei &$eratii $rel(n'ite #i
#&"ante! %(lti &rt&$e)i $reera a)i $r&te)a "eali"a! "e eli%ina t&ate ne$la"erile &#te&#inte)ei.
<
PARTEA A II-A
2I.Trata%ent re"($erat&r BFT
I PRINCIPIILE .I OBIECTI2ELE TRATAMENTULUI BFT
Balne&i)i&tera$ia e#te & ra%(r a %edi"inii 'enerale "are &l&#e3te n #"&$ tera$e(ti"
a'eni i)i"i nat(rali #a( artii"iali.
Balne&i)i&tera$ia are "ele %ai lar'i re"&%andri! "( "ele %ai ei"iente re)(ltate. A$r&a$e
" n( e-i#t "&ntraindi"aii ! e-"l()nd /inenele# n(%ai &r%ele "&%$li"ate 7"ardia"i! $(l%&nari
de"&%$en#ai! et",.
Mi8l&a"ele i)i"ale "ele %ai &l&#ite #(nt din d&%eni(l ele"tr&tera$iei! ter%&tera$iei 3i
/alne&tera$iei.
In ra"t(ra de "&l e%(ral a"ea#ta ra%(ra %edi"ala 'ra/e#te en&%en(l de 0inde"are#i
inlat(ra %ai re$ede i%$&tenta (n"ti&nala.

1, Trata%ent(l $rin 6idr&-ter%&tera$ie7te6ni"a! ee"te,
Midr&tera$ie *
.e intele'e $rin 6idr&tera$ie a$li"area in #"&$ $r&ila"ti" #i "(rati0 a (n(i n(%ar 0ariat de
$r&"ed(ri! "are a( la /a)a a$a la dierite te%$erat(ri #i #(/ dierite #tari de a're'atie! "a #i (nele
te6ni"i #tran# le'ate de a"ea#ta.

-D(#(l "( a/(ri
D(#(l "( a/(ri "&n#ta in $r&e"tarea 0a$&ril&r #($raan"al)iti a#($ra re'i(nii li%itate.
Te6ni"ian(l tre/(ie #a ie atent "a n( "(%0a #a #tr&$ea#"a /&lna0(l "( $i"at(ri de a$a ier/inte
$r&0enite din "&nden#area 0a$&ril&r $e (rt(n #i $e $&rti(nea %etali"a a d(#(l(i. E#te ne0&ie "a
in#talatia $entr( d(#(l "( a/(ri #a ie $re0a)(ta "( di#$&)iti0e de #e$arare a a$ei de "&nden#are #i "(
#($raan"al)it&are $entr( a/(ri. Inainte de a a$li"a 8et(l de 0a$&ri a#($ra /&lna0(l(i! te6ni"ian(l #i-l
$r&e"tea)a $e $al%a $entr( a #e a#i'(ra de li$#a $i"at(ril&r de a$a ier/inte.
D(rata d(#(l(i "( a/(ri e#te de 4-; %in(te #e $&ate #a ie dat "a $r&"ed(ra de #ine #tatat&are!
$&ate #a $re"eada & /aie 'enerala #a( #e $&ate a#&"ia "( %a#a8.
La #ar#it #e a$li"a & $r&"ed(ra de ra"ire-#$alare #a( d(# de +K-1F
F
.
M&d(l de a"ti(ne* d(#(l "( a/(ri are & a"ti(ne $(terni"a a#($ra "ir"(latiei! $r&0&"and
6i$ere%ie #i re#&r/tie l&"ala.

-D(#(l-%a#a8
A"e#ta "&n#ta in a$li"area %ai %(lt&r d(#(ri r&)eta la te%$erat(ra de 4K-5F
F
!"&n"&%itent
a$li"and(-#e #i %a#a8(l! "&n&r% te6ni"ii &/i#n(ite. Pentr( a$li"area l(i e-i#ta in#talatii #$e"iale "(
5-; d(#(ri 0erti"ale! in r&)eta! #it(ate (n(l lan'a alt(l! "are #e $(n #i%(ltan #a( #e$arat in (n"ti(ne.
In li$#a (nei in#talatii #$e"iale! #e $&ate ee"t(a #i "( (n d(# %&/il! la "a$at(l "ar(ia #e a$li"a &
r&)eta. D(rata %a#a8(l(i e#te de K-+9 %in(te.
B&lna0(l e#te "(l"at de)/ra"at "&%$let $e (n $at #$e"ial de le%n. .e de#"6id d(#(rile #i in
ti%$ "e a$a "(r'e $e "&r$! te6ni"ian(l e-e"(ta %a#a8(l "&n&r% te6ni"ii "(n&#"(te.
M&d(l de a"ti(ne* d(#(l-%a#a8 $r&0&a"a & 6i$ere%ie i%$&rtanta! %ai ale# in re'i(nea tratata>
are (n i%$&rtant ee"t re#&r/ant #i t&niiant.

-Baia ?inet&tera$e(ti"a
E#te /aie "alda! la "are #e a#&"ia)a %i#"ari in t&ate arti"(latiile /&lna0(l(i. .e ee"t(ea)a
intr-& "ada %ai %are "a "ele &/i#n(ite! "are #e (%$le P "( a$a la te%$erat(ra de 4;-4<
F
C

#i %ai rar
4K
F
.
B&lna0(l e#te in0itat #a #e (r"e in "ada #i! ti%$ de 9 %in(te! e#te la#at lini#tit. D($a a"ea#ta!
te6ni"ian(l e-e"(ta 7#(/ a$a, la t&ate arti"(latiile! t&ate %i#"arile $&#i/ile. Te6ni"ian(l #ta la
drea$ta /&lna0(l(i.
K
T&ate a"e#te %i#"ari #e e-e"(ta intr-& $eri&ada de ti%$ de 9 %in(te. D($a a"eea /&lna0(l #ta
in re$a()! d($a "are e#te in0itat #a re$ete #in'(r %i#"arile i%$ri%ate de te6ni"ian.
D(rata /aii e#te de 1F-4F %in(te! d($a "are /&lna0(l e#te #ter# #i la#at #a #e &di6nea#"a.
M&/ili)area in a$a e#te %ai $(tin d(rer&a#a din "a()a rela-arii %(#"(lare "are #e $r&d("e
#(/ inl(enta a$ei "alde #i $ierderii 're(tatii "&r$(l(i "&n&r% le'ii l(i Ar6i%ede.
D(3(l #(/a"0al*
C&n#t din a$li"area #(/ a$ a (n(i d(3 #(l de %are $re#i(ne 4-; at%&#ere "( te%$erat(ra
%ai %are de"=t a a$ei de /aie. El #e $&ate ee"t(a ntr-& "ad "( a$ la 49-4KC "( a8(t&r(l (n(i
d(3 #(l %&/il "( $re#i(ne %are "are #e intr&d("e n a$ $e #e'%ent #(/ "&ntr&l(l (neia din %=inile
a#i#tent(l(i $=n la 9-+F"% de re'i(nea de a$li"at. D(rata $r&"ed(rii e#te de 9-+F%in(te. A"i(nea
inten# a d(3(l(i #(/a"0al #e dat&re3te te%$erat(ril&r dierite /aie 3i d(3 $re"(% 3i %a#a8(l(i
$(terni" al "&l&anei de a$ "are "&%$ri% $(terni" e#(t(rile.
Ee"t(l e#te a#e%nt&r d(3(l(i %a#a8 dar e#te #($&rtat %ai /ine dat&rit /ii "alde.
Ter%&tera$ia*
-C&%$re#ele "( a/(ri
A0e% ne0&ie de* d&(a /("ati de lanela! & /("ata $an)a #i%$la #a( (n $r&#&$! & $an)a
in$ernea/ila! & 'aleata "( a$a! la te%$erat(ra de ;F-<FQ.
.e $la#ea)a $e re'i(nea intere#ata & lanela (#"ata $e#te "are #e a$li"a & /("ata de $an)a
#a( $r&#&$(l %(iat in a$a ier/inte #i /ine #t&r#! iar $e#te a"ea#ta #e a$li"a "ealalta lanela. T&t(l #e
a"&$era "( /l()a in$ernea/ila #a( #e a$li"a (n ter%&&r.
D(rata t&tala a $r&"ed(rii e#te de %ini% 1F de %in(te #i de %a-i%(% ;F de %in(te.
M&d(l de a"ti(ne* re#&r/ti0! anal'e)i"! anti#$a#ti"
.
-In$a"6etarea "( $araina
.e ia & "antitate $&tri0ita 7a$r&-i%ati0 +9F-1FF ', #i #e t&$e#te intr-(n 0a# la te%$erat(ra
de ;9-<FQ> in a#a el "a #a %ai ra%ana "ate0a /("ati net&$ite! in #"&$(l e0itarii #($rain"al)arii. C(
a8(t&r(l (nei $en#(le late de K"%. #e $en#(lea)a re'i(nea. Gr&#i%ea #trat(l(i e#te de F!9-+"%. Pe#te
#trat(l de $ataina #e a$li"a /("ati de 0ata #a( lanela #i a$&i #e a"&$era re'i(nea "( $at(ra.
D(rata in$a"6etarii e#te de 1F-;F %in(te. Inlat(rarea $arainei #e a"e "( (#(rinta din "a()a
tran#$iratiei "are are l&" #(/ #trat(l de $araina. Pr&"ed(ra #e ter%ina "( & #$alare la te%$erat(ra de
1F-11Q.
M&d(l de a"ti(ne* are & a"ti(ne l&"ala #i $r&0&a"a & in"al)ire $r&(nda #i (ni&r%a a
te#(t(ril&r. .($raata $ielii #e in"al)e#te $ana la 4K-5FQ. La l&"(l de a$li"are #e $r&d("e & 6i$ere%ie
$(terni"a #i tran#$iratie a/(ndenta.
-Un'erile "( na%&l
B&lna0(l "&%$let de)/ra"at #ta "ate0a %in(te la #&are $ana i #e in"al)e#te $ielea! a$&i #e
(n'e "( na%&l $r&a#$at "&%$let #a( $artial. .e e-$(ne din n&( ti%$ de 1F-;F %in(te! $ana "and
in"e$e na%&l(l #a #e (#("e. In a"e#t inter0al de ti%$ 0a $(rta & "&%$re#a re"e la r(nte iar "a$(l ii
0a i a$arat de #&are "( & $alarie #a( (%/rela.
D($a a"ea#ta & #"(rta /aie in la" #a( in %are! #e 0a #ter'e! #e 0a i%/ra"a #i #e 0a &di6ni la
(%/ra #a( intr-& "a%era! a$r&-i%ati0 & &ra.
M&d(l de a"ti(ne* (n'erile "( na%&l i#i /a)ea)a a"ti(nea $e ele%ent(l ter%i" alternant!
re"e la in"e$(t! a$&i "ald! dat&rita in"al)irii na%&l(l(i la #&are #i din n&( re"e! dat&rita /aii din la"
#i rea"tiei 0a#"(lare la a"ea#ta> al d&ilea ele%ent e#te re$re)entat de a"ti(nea #$e"ii"a a
#(/#tantel&r re#&r/ite in &r'ani#%.
J
4 Trata%ent(l $rin ele"tr&tera$ie7te6ni"a! ee"te,
Ele"tr&tera$ia e#te a"eea $arte a i)i&tera$iei! "are #t(dia)a (tili)area a"ti(nii di0er#el&r
&r%e ale ener'iei ele"tri"e a#($ra &r'ani#%(l(i! "( #"&$ "(rati0 #a( $r&ila"ti".
In re"($erarea ra"t(ril&r de "&l e%(ral #e re"&%anda*
+. C(rent(l 'al0ani"* e#te (n %i8l&" "la#i" 3i idel de #edare a d(reril&r ne0ral'i"e. Ele"tr&d(l
$&)iti0 are & a"i(ne #edati0 l&"al! "a 3i "(renii de#"endeni 3i "(reni a#"endeni a$li"ai
"&ntralateral d(" la & "re3tere a $ra'(l(i de #en#i/ilitate.
Gal0ani)area $&ate # (tili)e)e "&n"&%itent 3i intr&d("erea de i&ni "( a"i(ne antal'i"
7i&n&&re) tran#0er#al "( n&0&"ain! a"&nidin #a( re0(l#i0 "( 6i#ta%in,.
1. C(rent(l diadina%i"* #e $re#"rie n a$li"aii tran#0er#ale #a( l&n'it(dinale* & $eri&ad l(n'! de 5
%in(te 7are ee"t #edati0,! dia)at i- 5 %in(te a%/ele! + dat $e )i. .e re"&%and +F---+5 3edine.
-C(rentii Tra/ert* #(nt "(renti "( i%$(l#(ri de re'0enta +5F M)! i%$(l# 1 %#! $a()a 9 %#! la "are
t&t "at&d(l e#te ele"tr&d(l a"ti0 antal'i". D(rata trata%ent(l(i e#te de +9-1F %in(te! "( "re#tere
tre$tata a inten#itatii. .e re$eta de +-1 &ri $e )i.
Atat "(rent(l diadina%i"! "at #i "(rent(l Tra/ert deter%ina & $(terni"a #en)atie! "( a#$e"t
0i/rat&r! & e-"itatie a %e"an&re"e$t&ril&r te#(t(ril&r de #(/ ele"tr&)i. Ee"tele antal'i"e #e e-$li"a
t&"%ai $rin a"ea#ta #en)atie.
4. C(rent(l aradi"
.e indi" aradi)area "( $eri(a #a( "( r(l&(l! $li%/ate $e re'i(nea d(rer&a# $(drat "(
tal"! le'ate de ele"tr&d(l ne'ati0! "(rent(l iind tetani)at.
A"e#te $r&"ed(ri #(nt /ine re"e$tate 3i t&lerate de $a"ieni $entr( #tarea de /ine $e "are &
de'a8 3i %&d(l n "are! "&re"t=nd de)e"6ili/r(l! #e %/(nte3te (n"i&nalitatea.
5. Ultra#(netele #(nt (tili)ate n "&n#&lidarea ra"t(ril&r! dat&rit ee"t(l(i de R%a#a8 %e"ani"C!
ti#(lar! $r&(nd! iind indi"at $entr( d(rere! inla%aie! %&/ilitate.
9. Undele de"i%etri"e #i %i"r&(ndele
.(nt e%i#e de (n di$&l #(/ &r%a (n(i a#"i"(l de (nde ele"tr&%a'neti"e 7"a la radar,
dire"ti&nat #$re )&na de tratat. .(nt %et&de radiante "( "are $(te% in"al)i te#(t(rile $e $r&(n)i%i
0aria/ile in (n"tie de ti$(l e%itat&r(l(i! de di#tanta a"e#t(ia! de te'(%ent! de d&)a8! de d(rata
trata%ent(l(i.
;. Radiatia inrar&#ie
In aara de l(%ina #&lara! "are e#te de&#e/it de /&'ata in radiatii inrar&#ii #i "are e#te
(tili)ata in tera$e(ti"a #(/ &r%a a#a Bn(%itei 6eli&tera$ii.
A$li"atiile de radiatii inrar&#ii in tera$e(ti"a #e $&t a"e in d&(a %&d(ri* in #$ati(l in"6i#!
#(/ &r%a a#a-n(%itel&r /ai de l(%ina $r&"ed(ri inten#e ter%&tera$i"e #a( in #$ati( de#"6i#! in aer
li/er! #(/ &r%a a#a-n(%%itel&r a$li"atii de #&ll(-.
In /aile de l(%ina #e reali)ea)a & in"al)ire a aer(l(i $ana la te%$erat(ri ridi"ate 7;F-<F-
KFQ,.
In (n"tie de #"&$(l (r%arit! /&lna0(l 0a #ta in /aia de l(%ina intre 9-1F %in(te. D($a
e-$irarea ti%$(l(i $re#"ri# #e a$li"a /&lna0(l(i & $r&"ed(ra de ra"ire $artiala.
Ee"t(l radiatiil&r inrar&#ii *
Radiatiile inrar&#ii a( a"ti(ne "al&ri"a. Ele a"ti&nea)a a#($ra "ir"(latiei din der%
$r&0&"and & 0a#&dilatatie #(/"a$ilara! inten#ii"area #"6i%/(ril&r dintre "el(lele de "re#terea
en&%enel&r &#%&ti"e #i "re#terea de/it(l(i #an'0in.

+F
5 Trata%ent(l $rin %a#a8*
Prin n&ti(nea de %a#a8 #e intele'e & #erie de %ani$(latii %an(ale 0ariate! a$li"ate la
#($raata &r'ani#%(l in #"&$ tera$e(ti" #a( i'ieni".
E#te i%$&rtant "a! inainte de a in"e$e %a#a8(l! #a #e "&ntr&le)e #tarea te'(%ent(l(i
/&lna0(l(i (r%arind(-#e in #$e"ial ! e0ent(ale ine"tii ale $ielii "are "&ntraindi"a %a#a8(l! $re"(%
#i e0ent(alele e"6i%&)e.
D(rata (nei #edinte 0aria)a intre 9-+F %in(te iar re"0enta e#te de &/i"ei de & #edinta $e )i.
D(rata trata%ent(l(i $&ate i intre 1 #i 5-; #a$ta%ani! (ne&ri "6iar %ai %are! "a in ae"ti(nile
&rt&$edi"e.
a, - De#"rierea anat&%i"a a re'i(nii #&ld(l(i #i "&a$#ei*
Oa#ele B C&-al(l e#te (n &# $ere"6e! de &r%a nere'(lata! "are $r&0ine din #(darea a trei
&a#e $ri%iti0e! #i an(%e* i#"6i&n! ili&n #i $(/i#. Pana la 0ar#ta de +9-+; ani! "ele trei &a#e
"&%$&nente ale "&-al(l(i #(nt arti"(late intre ele $rin "artila8e. D($a a"ea#ta 0ar#ta! "artila8ele
intraarti"(lare #e &#ii"a! a#a in"at la ad(lt &a#ele re#$e"ti0e #(nt "&%$let #(date! &r%and &#(l
"&-al.
Fe%(r(l e#te (n &# l(n'! $ere"6e! "are &r%ea)a #"6elet(l "&a$#ei. El #e "&%$(ne dintr-(n
"&r$ #i d&(a e-tre%itati. E-tre%itatea #($eri&ara $re)inta "a$(l e%(r(l(i! 'at(l e%(r(l(i!
tr&6anter(l %are #i %i"! "rea#ta intertr&6anteriana.
M(#"6ii B "are #e ala in re'i(nea /a)in(l(i &r%ea)a in 8(r(l arti"(latiei "&-&e%(rale &
%a#a %(#"(lara "are %&/ili)ea)a e%(r(l in 8(r(l "el&r trei a-e $er$endi"(lare (na $e alta. A"e#ti
%(#"6i #(nt di#$(#i in d&(a l&8e! (na anteri&ara #a( ilia"a #i alta $&#teri&ara re$re)entata de "&l&ana
0erte/rala #i de /a)in(l &#&# iar in#ertia de e-tre%itatea $r&-i%ala a e%(r(l(i.
In re'i(nea anteri&ara #e 'a#e#" d&i %(#"6i* $#&a#(l %are #i %(#"6i(l ilia".
In re'i(nea $&#teri&ara #e 'a#e#" trei %(#"6i* e#ier(l %are! e#ier(l %i8l&"i( #i e#ier(l
%i".
M(#"6ii "&a$#ei #e in$art in trei 'r($e*
- %(#"6ii re'i(nii anteri&ate a "&a$#ei* ten#&r al a#"iei lata! "r&it&r #i "0adri"e$#.
- %(#"6ii re'i(nii %ediale a "&a$#ei #(nt* 'ra"ili#! $e"tine( #i add("t&r.
- %(#"6ii re'i(nii $&#teriare a "&a$#ei #(nt* /i"e$# e%(ral! #e%itendin&# #e%i%e%/ran&#.
Arterele #i 0enele- Artera ilia"a e-terna #e intinde de la l&"(l (nde #e /i(r"a artera ilia"a
"&%(na $ana la ie#irea din /a)in! (nde #e "&ntin(a "( artera e%(rala.
Artera e%(rala #e intinde de la ni0el(l li'a%ent(l(i in'6inal $ana la ni0el(l inel(l(i
tendin&# al %(#"6i(l(i add("t&r(l %are! de (nde #e "&ntin(a "( artera $&$litee.
2ena e%(rala (r%ea)a trae"t(l arterei e%(rale intin)and(-#e de la inel(l %(#"6i(l(i
add("t&r %are $ana la li'a%ent(l in'6inal! (nde #e "&ntin(a "( 0ena ilia"a e-terna.
Ner0ii B %arele #i %i"(l #"iati" a" $arte din ner0ii $r&(n)i. Marele #"iati" ie#e din
re'i(nea e#iera #i $atr(nde in re'i(nea $&#teri&ara a "&a$#ei intre %arele add("t&r #i l(n'a $&rti(ne
a /i"e$#(l(i. Mi"(l #"iati" 0ine din re'i(nea e#iera #i $lea"a $ana in re'i(nra $&$litee #i #e de#$arte
in d&(a ra%(ri #i ra%(rile l(i tra0er#ea)a a$&ne0r&)a a"e#tei re'i(ni #i #e ter%ina "( ra%(ri "6iar
$ana la $iele.
/,Te6ni"a %a#a8(l(i
a,Ma#a8(l re'i(nii e#iere
Re'i(nea e#iera e#te li%itata in #(# de "rea#ta ilia"a! in 8&# de $li"a e#iera.
Ma#a8(l re'i(nii e#iere 0a "&n#ra in nete)iri #i $re#i(ni ee"t(ate "( $(l$a de'etel&r
re(nite! (r%ate de (n %a#a8 0i/rat&r! in#i#tent %ai ale# in $li"a e#iera! la ni0el(l %arii #"&/it(ri
#"iati"e.
/,Ma#a8(l arti"(latiei "&-&e%(tale
E#te &arte dii"il! dat&rita %(#"(lat(rii %a#i0e "are in"&n8(ra arti"(latia. A""e#(l la
"a$#(la arti"(lara e#te $&#i/il n(%ai $rin d&(a $(n"te*
- la ni0el(l in#ertiei %(#"6i(l(i "r&it&r! $e $artea l(i interna! $e (nde #e $atr(nde $rin a$a#are
#i #e e-e"(ta %i#"ari 0i/rat&rii.
++
- intre tr&6anter #i t(/er&)itatea i#"6iati"a! (nde #e $atr(nde $(nand /&lna0(l #a le"te)e
'en(n"6i(l #i #a a"a & (#&ara a/d("tie a "&a$#ei. Ai"i #e $&ate e-e"(ta (n %a#a8 0i/rat&r #i
"6iar /aterea.
",%a#a8(l "&a$#ei
C&a$#a are &r%a (n(i tr(n"6i de "&n "( /a)a in #(#. Di#tin'e% la "&a$#a re'i(nea
e%(rala anteri&ara #i $&#teri&ara.
In re'i(nea e%(rala anteri&ara $ielea e#te %ai 'r&a#a $e $artea laterala de"at $e "ea
interna e#te %ai %&/ila! al(ne"and $e $lan(rile #(/ia"ente. Ma#e(r(l tre/(ie #a re#$e"te $artea
#($eri&ara a "&a$#ei! tri(n'6i(l ."ar$a.
Re'i(nea e%(rala $&#teri&ara are $ielea de a#e%enea &arte %&/ila! "( e-"e$tia $artii
e-terne.
Ma#a8(l "&a$#ei in"e$e "( nete)irea "( $re#i(ne /i%an(ala! %ai intai $e ata anteri&ara #i e-terna!
/&lna0(l iind in de"(/it d&r#al! a$&i $e ata $&#teri&ara #i interna! /&lna0(l iind in de"(/it 0entral.
.e e-e"(ta a"e#te %ete)iri "( $&li"ele $e ata anteri&ara #i "( "elelalte $atr( de'ete $e ata
$&#teri&ara a "&a$#ei in"e$and din dre$t(l 'en(n"6i(l(i in #(# "atre /a)a "&a$#ei.
Ur%ea)a ra%antarea %(#"(lat(rii "&a$#ei! "are #e $&ate a"e "( ener'ie! #(/ t&ate
&r%ele! de la $re#i(ne "( & %ana #a( "( a%/ele %aini in $etri#a8! "( t&r#i(ne a %(#"(lat(rii.
In re'i(nea laterala a "&a$#ei! $e ten#&r(l a#"iei lata #e a"e %a#a8(l "( d&#(l alan'el&r!
#(/ &r%a de $ie$tene! de 8&# in #(#.
",Ee"tele i)i&l&'i"e ale %a#a8(l(i
Ee"te l&"ale*
+. A"i(ne #edati0 a#($ra*
- d(reril&r de ti$ ne0ral'i">
- d(reril&r %(#"(lare 3i arti"(lare.
A"i(nea #edati0 #e &/ine $rin %ane0re (3&are! lente "are #ti%(lea) re$etat e-tra"e$t&rii 3i
$r&$ri&"e$t&rii e-i#tenti.
1. A"i(nea 6i$ere%iant l&"al #e %anie#t $rin n"l)irea 3i nr&3irea te'(%ent(l(i a#($ra "r(ia
#e e-er"it %a#a8(l a"ea#t a"ii%e #e e-er"it $rin %ane0re %ai ener'i"e "are "&%$ri% alternati0
0a#ele #an'0ine.
4. Snde$rtarea li"6idel&r de #ta) "( a""elerarea $r&"e#el&r de re#&r/ie n )&na %a#at. Ma#a8(l
$er%ite nlt(rarea li"6idel&r de #ta). A"e#t ee"t e#te /enei" la $er#&ane "( in#(i"ien 0en&a#
$erieri" 3i a$are d($ %ane0re $r&(nde "are "&nd(" li"6id(l de #ta) de la $erierie #$re "entr(.
Ee"te 'enerale
Cre3terea %eta/&li#%(l(i /a)al #ti%(lea) (n"iile a$arat(l(i re#$irat&r 3i "ir"(lat&r!
inl(entea) a0&ra/il #tarea 'eneral a &r'ani#%(l(i! %/(nte3te #&%n(l! nde$rtea) &/&#eala
%(#"(lar.
T&ate a"e#te ee"te 'enerale #e e-$li" $rin a"i(nea %a#a8(l(i a#($ra $ielii "are e#te (n
&r'an /ine 0a#"(lari)at 3i %ai ale# /&'at iner0at.
Cea %ai i%$&rtant a"i(ne i)i&l&'i" a %a#a8(l(i e#te re$re)entat de %e"ani#%(l rele-
a#($ra &r'anel&r interne. A"ea#ta #e e-$li" $rin #ti%(lii "are $lea" $rin e-ter&"e$t&ri 3i
$r&$ri&"e$t&ri! "are #i%t de dierite inten#iti $e "ale aerent "tre .NC! iar de a"&l& $e "ale
eerent! a8(n' la &r'anele interne n #(erin. T&ate a"i(nile "are #e $etre" la e-teri&r(l "&r$(l(i
a8(n' 3i la di#tan 7la &r'anele interne,. Fie"are &r'an #e %anie#t $rin #en)aii d(rer&a#e $e
te'(%ent! de"i ie"r(i &r'an i "&re#$(nde la e-teri&r & )&n "(tanat rele-&'en #a( %eta%eri"!
+1
"are tre/(ie "(n&#"(t de %a#e(r $entr( a 3ti # a"i&ne)e "( %ane0re #$e"ii"e $entr( &r'anele
interne.
Un alt %e"ani#% al %a#a8(l(i e#te a"i(nea %e"ani" $r&d(# de %ane0rele %ai d(re "a
r%=ntarea* "&ntrati%$(l! %=n'l(irea! r(lat(l! "i($it(l! ta$&ta%ent(l "are #e a"e tran#0er#al $e
i/rele %(#"(lare "eea "e d("e la t&niierea %(#"(lat(rii! %/(ntirea (n"iei 3i &rei %(#"(lare
"are $arti"i$ la %i3"area ntr-& arti"(laie.
Prin a"ea#t a"i(ne %e"ani"! li"6idele inter#tiiale n e-"e# din %(3"6i! #e re#&r/ n #=n'e
$entr( a i eli%inate de &r'anele e-"ret&are> %/(nte3te a"ti0itatea "ir"(laiei #=n'el(i "are d("e
la %(taia ele%entel&r anat&%i"e din ntre' &r'ani#%(l 3i &dat "( a"ea#ta red("erea a"ti0itii
ini%ii.

9, :inet&tera$ia.Te6ni"i de %&/ili)are #i $r&'ra% de e-er"itii re"($erat&rii
M&/ili)area #&ld(l(i tre/(ie in"e$(ta i%ediat "e de0ine $&#i/ila! de"i "6iar din $eri&ada de
i%&/ili)are la $at a $a"ient(l(i.
Ca $rin"i$i( (ni0er#al 0ala/il! ra%ane &rientarea ti$(l(i #i inten#itatii ?inet&tera$iei d($a
re'(la @n&nC d(rerii.
A.Rea"erea %&/ilitatii #i rea"erea &rtei %(#"(lare
.e 0&r a/&rda in a"e#t "&nte-t d&ar a#$e"tele le'ate de re"($erarea a%$lit(dinii %i#"aril&r
#i re"a#ti'area &rtei %(#"(lare $entr( %i#"arile i)i&l&'i"e.
Reed("area le-iei #e $&ate a"e $rin*
+.Prin ad&$tarea an(%it&r $&#t(ri >
E-er"iti(l +- C&r$(l $e & $lan#eta in"linata* $i"i&r(l 6&%&lateral #e #$ri8ina $e (n #"a(nel*
inalti%ea #"a(nel(l(i e#te in (n"tie de "a$a"itatea de le-ie a arti"(latiei "&-&e%(rale! in"linarea
$lan#etei iind (n %i8l&" de 'radare.
E-er"iti(l 1 B #$ri8in $e %e%/r(l ineri&r #anat&#! "( $i"i&r(l 6&%&lateral ridi"at $e (n
#"a(n* inalti%ea #"a(n(l(i #i a$le"area tr(n"6i(l(i in ata %are#" 'rad(l de le-ie a arti"(latiei.
1.Prin %&/ili)ari $a#i0e>
A"e#tea #e reali)ea)a $rin le-ia e%(r(l(i $e /a)in #a( a /a)in(l(i $e e%(r. Int&tdea(na
'en(n"6i(l tre/(ie #a ie le"tat $entr( a de#tinde i#"6i&'a%/ierii.
E-er"iti(l + B Pa"ient(l in de"(/it d&r#al! "( %e%/r(l ineri&r #anat&# e-tin#* a#i#tent(l
a$li"a $ri)a $e trei%ea ineri&ara a "&a$#ei! e-e"(tand le-ia arti"(latiei "&-&e%(rale 7'en(n"6i(l
e#te le"tat,.
E-er"iti(l 1 B Pa"ient(l in #e)and la %ar'inea %e#ei* a#i#tent(l! "( "&r$(l #a(! i-ea)a
"&a$#a #(erinda $rintr-& $re#i(ne a#($ra 'en(n"6i(l(i in a-(l "&a$#ei> $a"ient(l a$lea"a tr(n"6i(l
inainte> a#i#tent(l $rinde "( a%/ele %aini re'i(nea l&%/ara %arind /a#"(larea anteri&ara a
/a)in(l(i.
4.Prin %&/ili)ari a(t&$a#i0e>
E-er"iti(l + B Pa"ient(l in de"(/it d&r#al* i#i $rinde "( %ainile "&a$#a #i #e tra"ti&nea)a>
da"a (n'6i(l de le-ie e $rea %i" $entr( a $(tea a8(n'r la "&a$#a! #e $&ate tra"ti&na $rin inter%edi(l
(nei "6in'i tre"(te $e#te $i"i&r #a( $e#te 'en(n"6i(l le"tat.
E-er"iti(l 1 B Din $&#t(ra $atr($eda #e &rtea)a le-ia "&-&e%(ralei $rin 're(tatea
tr(n"6i(l(i> &/li"itatea "&a$#ei deter%ina 0ariatiile (n'6i(l(i de le-ie.
5.Prin %i#"ari a"ti0e
E-er"iti(l + B Din &rt&#tati#% "( #$atele la $erete le"tea)a "&-&e%(rala "( 'en(n"6i(l
le"tat! tra'and "&a$#a la $ie$t> t&t din &rt&#tati#%! 0a e-e"(ta 'en(le-i(ni! "( tr(n"6i(l (#&r
a$le"at inainte.
E-er"iti(l 1 B Din #e)and $e $&dea! #e le"tea)a "&a$#a! a$le"area tr(n"6i(l(i #$re "&a$#a
%are#te a%$lit(dinea le-iei "&-&e%(ale.
Reed("area e-ten#iei
+.Prin ad&$tarea an(%it&r $&#t(ri>
+4
E-er"iti(l + B Pa"ient(l in de"(/it d&r#al "( & $erna #(/ e#e> %e%/r(l ineri&r ae"tat
intin#! "el "&ntra lateral %(lt le"tat.
1.Prin %&/ili)ari $a#i0e>
E-er"iti(l + B Pa"ient(l in de"(/it 0entral* a#i#tent(l "( & %ana! i-ea)a $e %a#a /a)in(l!
iar "( ante/rat(l #i %ana "ealalta! tre"(te $e #(/ 'a%/a! 'en(n"6i #i "&a$#a! reali)ea)a e-ten#ia.
E-er"iti(l 1 B Pa"ient(l in de"(/it lateral! "( %e%/r(l ineri&r &$(# %(lt le"tat #i i-at de
"atre a#i#tent "( & %ana> "( a-ila a"el(ia#i %e%/r( #($eri&r! a#i#tent(l i-ea)a /a)in(l! iar "( %ana
&$(#a reali)a)a e-ten#ia "&a$#ei de dea#($ra.
4.Prin %i#"ari a(t&$a#i0e>
E-er"iti(l + B Pa"ient(l #e ala in de"(/it d&r#al %entinand "( %ainile 'en(n"6i(l
%e%/r(l(i &$(# la $ie$t! %e%/r(l ae"tat intin# $e (n $lan in"linat.
5.Prin %i#"ari a"ti0e>
E-er"iti(l + B Pa"ient(l in de"(/it 0entral! "i /a)in(l i-at* #e e-e"(ta e-ten#ii ale
"&-&e%(ralei! "( #i ara le"tarea 'en(n"6i(l(i.
E-er"iti(l 1 B Pa"ient(l in de"(/it lateral 7$e $artea #anat&a#a, #e a"e e-ten#ia "&a$#ei! in
ti%$ "e a#i#tent(l i in$in'e in ata /a)in(l.
Reed("area a/d("tiei
+.Prin ad&$tarea an(%it&r $&#t(ri>
E-er"iti(l + B Pa"ient(l in de"(/it d&r#al "( (n #($&rt tri(n'6i(lar intre "&a$#e #a( "( &
$erna intre 'en(n"6i $entr( a/d("tia /ilaterala.
E-er"iti(l 1 B In $&)itia @#e)and "alareC $e & /an"6eta.
1. Prin %&/ili)ari $a#i0e>
E-er"iti(l + B Pa"ient(l in de"(/it d&r#al! (tili)ea)a %e%/r(l ineri&r #anat&# "a
#ta/ili)at&r a"e#ta iind in a/d("tie! "( 'a%/a @"a)(taC la %ar'inea %e#ei.
E-er"iti(l 1 B Pa"ient(l in &rt&#tati#%! "( $i"i&arele inde$artate* a#i#tent(l! la #$atele l(i ii
$rinde "( %ainile din lateral! /a)in(l in$in'and(-l #$re $artea #anat&a#a.
4. Prin %i#"ari a(t&$a#i0e>
E-er"iti(l +- Pa"ient(l in &rt&#tati#%! "( %e%/r(l ineri&r le)at intin# #i in (#&ara
a/d("tie! "( $i"i&r(l #$ri8init $e (n %i" #($&rt* e-e"(ta & 'en(le-i(ne $e %e%/r(l ineri&r #anat&#.
5. Prin %i#"ari a"ti0e>
E-er"iti(l + B Pa"ient(l in de"(/it lateral $e $artea #anat&a#a* #e ridi"a 7'en(n"6i(l e-tin#,
%e%/r(l ineri&r le)at.
E-er"iti(l 1 B Din &rt&#tati#% #e a" andari laterale.
Reed("area add("tiei
+.Prin ad&$tarea an(%it&r $&#t(ri>
E-er"iti(l + B Din de"(/it d&r#al $a"ient(l in"r("i#ea)a %e%/rele ineri&are "( 'en(n"6ii
intin#i! %e%/r(l ineri&r le)at e#te dede#($t! #i din $&)itia #e)and #e $&ate in"r("i#a "&a$#a 7$&)itia
@$i"i&r $e#te $i"i&rC,.
E-er"iti(l 1 B Pa"ient(l in de"(/it 6&%&lateral! "( & $erna #(/ 'rn(n"6i! %e%/r(l ineri&r
e#te le"tat din "&-&e%(rala #i 'rn(n"6i.
1.Prin %&/ili)ari $a#i0e>
E-er"iti(l + B Pa"ient(l in de"(/it d&r#al* #e le"tea)a arti"(latia "&-&e%(rala #i a#i#tent(l
e-e"(ta tra"ti(nea de add("tie! a0and 'ri8a #a i-e)e /a)in(l.
E-er"iti(l 1 B Pa"ient(l in de"(/it "&ntralateral "( %e%/r(l ineri&r le"tat din
"&-&e%(rala #i 'en(n"6i! de'a8and $&#i/ilitatea de add("tie $entr( %e%/t(l ineri&r de dea#($ra>
da"a /a)in(l e#te la %ar'inea %e#ei! add("tia $&ate i %(lt a%$lii"ata.
4. Prin %i#"ari a(t&$a#i0e
E-er"iti(l +- Pa"ient(l in de"(/it 6&%&lateral "( %e%/r(l ineri&r le)at $rin# in "6in'i de
(n #"ri$ete #i tra"ti&nat in add("tie "( %ana.
5. Prin %i#"ari a"ti0e
E-er"iti(l + B In de"(/it d&r#al* in"r("i#ari ale %e%/rel&r ineri&are 7'en(n"6i(l intin#,.
Ide%! "( %e%/rele li$ite* #e a" %i#"ari de lateralitate "( a%and&(a! "&n"&%itent.
+5
Reed("area r&tatiei
+.Prin ad&$tarea an(%it&r $&#t(ri>
E-er"iti(l +- B&lna0(l #e)and $e #&l! "( 'en(n"6ii le"tati #i $i"i&arele in aara a-(l(i
"&a$#ei 7r&tatie interna, #a( ina(ntr(l a-(l(i 7r&tatie e-terna,.
1.Prin %i#"ari $a#i0e>
E-er"iti(l + B Pa"ient(l in de"(/it d&r#al* a#i#tent(l $rinde trei%ea ineri&ara a "&a$#ei!
r(land-& ina(ntr( #a( inaara 7'en(n"6i(l intin#,.
E-er"iti(l 1 B Pa"ient(l in #e)and! "( 'en(n"6i(l le"tat* a#i#tent(l (tili)ea)a 'a%/a "a $e
(n le0ier* #e a"e $ri)a $e "&ndilii e%(rali! iar "( ante/rat(l %&/ili)ea)a 'a%/a.
4.Prin %i#"ari a(t&$a#i0e
.e $&t e-e"(ta %ai %(lte %&nta8e "( a8(t&r(l #"ri$etil&r.
5.Prin %i#"ari a"ti0e>
E-er"iti(l + B Pa"ient(l in de"(/it 0entral! "( 'en(n"6i(l le"tat* de$la#area 'a%/ei intr-&
$arte #i in alta.
E-er"iti(l 1 B Pa"ient(l #ta $e (n #"a(n "( "&a$#ele! 'en(n"6ii #i 'a%/ele li$ite (nele de
altele* #e a" de$la#ari ale 'a%/el&r #$ere #tan'a #i #$re drea$ta.
B. Rel(area %er#(l(i
E-er"itiile de rel(are a %er#(l(i in"e$! de#i'(r! "( $eri&ada de ada$tare la &rt&#tati#% "are
in #$e"ial la 0ar#tni"i "a$ata i%$&rtanta de&#e/ita.
In %&%ent(l in "are #tati(nea in $i"i&are e#te $&#i/ila ara t(l/(rari de e"6ili/r(! #e in"e$e
%er#(l.
+.Mer#(l! ara #$ri8in $e %e%/r(l ineri&r ae"tat e#te a$r&a$e re'(la intr-& $ri%a eta$a! in
re"($erarea tra(%ati#%el&r #&ld(l(i. Pa"ient(l e#te in0atat #a %ear'a "( "ar8e a#tel*
a, #$ri8in $e %e%/r(l #anat&#>
/, "ar8ele #e d(" in ata>
", %e%/r(l ae"tat #e d("e intre "ar8e! ara in"ar"are 7atin'e d&ar #&l(l,>
d, #e tre"e 're(tatea "&r$(l(i $e "ar8e $rin /alan#area in ata a a"e#t&ra>
e, %e%/r(l ineri&r #anat&# #e tre"e $rintre "ar8e #i #e #$ri8ina $e #&l inaintea "ar8el&r!
"&n"&%itent "( tre"erea 're(tatii "&r$(l(i de $e "ar8e $e %e%/r(l #anat&#.
Pa"ient(l 0a i in0atat #a (r"e #i #a "&/&are & #"ara. .e (r"a "( %e%/r(l #anat&# a$&i "ar8ele
#i %e%/r(l ae"tat a$&i e#te ad(# $i"i&r(l #anat&# $e a"ea#i trea$ta.
1.Mer#(l "( in"ar"are a %e%/r(l(i ae"tat #e reia tre$tat! in (n"tie de ti$(l le)i&nar. In ra"t(ra
in"6i#a de "&l e%(ral in"ar"area $e %e%/r(l ae"tat in"e$e d($a JF )ile A"e#te %&%ente n(
in#ea%na rel(area #$ri8in(l(i +FFG! "i d&ar in"e$(t(l "( (n $r&"ent de K-+FG din 're(tatea
"&r$(l(i.
4.Mer#(l in /a#t&n #e in"e$e "and $a"ient(l a a8(n# la & in"ar"are de a$r&-i%ati0 9FG #i $el0i#(l
n( %ai /a#"(lea)a dat&rita in#(i"ientei a/d("t&ril&r.
Ba#t&n(l #e tine in %ana &$(#a %e%/r(l(i ae"tat #i #e de$la#ea)a in$re(na. In"ar"area in
"&ntin(are #e 'radea)a #la/ind #$ri8in(l %ainii $e /a#t&n. E-i#ta /a#t&ane dina%&%etri"e "are
inre'i#trea)a $re#i(nea %ainii. Une&ri %er#(l "( #$ri8in in /a#t&n #e 0a $a#tra t&ata 0iata.
Rea"erea "&%$leta a %er#(l(i "ere & #erie de e-er"itii "&%$le-e* %er# li/er! %er# $e $anta!
%er# ina$&i! %er# in lateral! %er# "( $i"i&arele in"r("i#ate! %er# in )i'-)a'! int&ar"eri et".
;,Tera$ia &"($ati&nala
E#te & %et&d de reed("are a"ti0 "are "&%$letea) ?inet&tera$ia &l&#ind di0er#e a"ti0iti
ada$tate la ti$(l de dei"iene %&t&rii ale indi0id(l(i "( #"&$ re"reati0 3i tera$e(ti"! a8(t=nd
/&lna0(l # &l&#e#" %ai /ine %(3"6ii r%a3i inde%ni 3i re"($er=nd (n"ia "el&r ae"tai de /&al!
"&ntri/(ind a#tel la reada$tarea (n"i&nal la 'e#t(rile 0ieii "(rente.
Prin a"ea#t tera$ie #e e0it $a#i0itatea n "are #e i-ea) /&lna0(l #$itali)at $e $eri&ade %ai
l(n'i! tre)ind(-i intere#(l $entr( di0er#e %i3"ri (tile 3i "&ntri/(ind a#tel la reada$tarea (n"i&nal
la e&rt.
+9
Ur%are#te $rel(n'irea e-er"itiil&r de ?inet&tera$ie $entr( %&/ili)are arti"(lara #iI#a(
t&niierea %(#"(lara! (tili)and & #erie de a"ti0itati "&%$le-e di#tra"ti0e #a( "a$a"itea)a atentia #i
ra/darea $a"ient(l(i $entr( & $eri&ada %ai l(n'a de ti%$. In 'eneral! a"e#te a"ti0itati #e e-e"(ta "(
%ainile dar &rta %&tri"a e#te reali)ata de %e%/rele ineri&are $rin di0er#e ti$(ri de %&/ili)are*
- $edala8 de /i"i"leta>
- al(ne"area $i"i&r(l(i intr-(n 8'6ea/ r&t(nd>
- %i#"are laterala 7a/d("tie-add("tie,>
- %er# $e $lan a#"endent>
- %er# $e /anda #a( $e #"ara r(lanta.
<,Trata%ent(l /alne&l&'i"7a$e %inerale! na%&l(ri, #tati(nile /alne&-"li%ateri"e
Intr("at #e"6elele $&#ttra(%ati"e ale #&ld(l(i in"l(de de re'(la dei"ite (n"ti&nale
deter%inate de le)i(ni $r&d(#e la ni0el(l #tr("t(rii &#te&arti"(lare! $eriarti"(lare #i %(#"(lare "ar&ra
li #e ada('a ee"tele ne'ati0e de %&/ili)are in a)a &rt&$edi"a! "6ir(r'i"ala in ae"ti(nile
$&#ttra(%ati"e.
Fra"t(ra de "&l e%(ral /enei"ia) %(lt de trata%ent(l /alnear. Ale'erea #tai(nii 3i
indi0id(ali)area trata%ent(l(i #e 0&r a"e n (n"ie de 0=r#ta /&lna0(l(i! de #tarea ne(r&0e'etati0
"a 3i de /&lile a#&"iate.
P(te% # indi"% B a$ele ter%ale #i%$le! (3&r radi&a"ti0e de ti$(l Feli-> a$ele #rate -
i&d(rate de la Brea)a! Olane#ti! G&0&ra> 6eli&ter%ale de la .&0ata 3i O"na .i/i(l(i! a$ele #(l(r&a#e
ter%ale de ti$(l Mer"(lane 3i "ele ater%ale de la G&0&ra! Olne#ti! P("i&a#a! n%&l(l de ti$(l "el&r
de la Te"6ir'6i&l! E&rie! A%ara! .&0ata! O"na .i/i(l(i.
."6e%ati"! n(%r(l de /i e#te de +1-+5 $e #erie! te%$erat(ra e#te de 4<-4K 'rade Cel#i(#! d(rata
e#te de +9-1F %in(te.
Tera$ia "( n%&l a"i&nea) $rin "ei trei a"t&ri "(n&#"(i* ter%i"! i)i" 7%e"ani", 3i "6i%i".
Te"6ir'6i&l 73i t&t lit&ral(l, "are are n%&l #a$r&$eli">
A%ara! .&0ata! Tele'a! Ba)na! .lni" Pra6&0a 7n%&l(ri de la"(ri #rate,>
2atra D&rnei! B&r#e"! Feli- 7t(r/,>
G&0&ra 7n%&l #ili"&# 3i i&dat,>
Ge&a'i( 7n%&l(ri er('in&a#e,
Pentr( n%&l te%$erat(ra e#te de 5F-55 'rade Cel#i(#! d(rata 4F-5F %in(te. .e a#&"ia) "(
$r&"ed(ri i)i&tera$e(ti"e 3i 6eli&tera$e(ti"e! de la "a) la "a).
In a)ele in"i$iente de /&al! "a 3i n "ele tardi0e! nen#&ite de "&%$li"aii! $(te% # indi"% "(
#(""e# (n'erile "( n%&l (r%ate de /i de G6i&l.
BIBLIOGRAFIE
+. Pat&l&'ia "6ir(r'i"ala 2&l. 1 de T6. B(r'6ele> Edit(ra %edi"ala
1. C&%$endi( de anat&%ie #i i)i&l&'ie de G6. M&'&# #i Al.Ian"(le#"(> Edit(ra .tiintii"a
4.Tra(%at&l&'ia $ra"ti"a de A(rel Deni#"6i! I. I&ne#"(! 2. Nea'(> Edit(ra Medi"ala
5.Re"($erarea %edi"ala a #e"6elel&r $&#ttra(%ati"e a %e%/rel&r de T. ./en'6e> Edit(ra Medi"ala
9.Balne&i)i&tera$ie de dr. D. C&n#tantine#"(! dr. N. Tele?i! dr. I. TOer"6a> Edit(ra Medi"al
+;