Tulburari de Statica Rahidiana

7/25/2019 Tulburari de Statica Rahidiana

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TULBURRI DE STATICTULBURRI DE STATIC

RAHIDIANRAHIDIANCLINICA DE CHIRURGIE SI ORTOPEDIECLINICA DE CHIRURGIE SI ORTOPEDIE

PEDIATRICPEDIATRIC

PROF. UNIV. DR. TICA CONSTANTINPROF. UNIV. DR. TICA CONSTANTIN


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CLINICA DE CHIRURGIE SI ORTOPEDIE PEDIATRICCLINICA DE CHIRURGIE SI ORTOPEDIE PEDIATRICPROFESOR UNIVERSITAR DR. TICA CONSTANTINPROFESOR UNIVERSITAR DR. TICA CONSTANTIN

TULBURRI DE STATIC RAHIDIANTULBURRI DE STATIC RAHIDIAN

Motiv frecvent e con!"#t$%ie &eic$#'Motiv frecvent e con!"#t$%ie &eic$#'E($&en"# co#o$nei verte)r$#e * oriceE($&en"# co#o$nei verte)r$#e * orice

)i#$n% &eic$#)i#$n% &eic$#T"#)"r'ri e !t$tic' verte)r$#' * e($&enT"#)"r'ri e !t$tic' verte)r$#' * e($&en+ener$# !t$t"ro,-oner$# i ne"ro-!i/ic+ener$# !t$t"ro,-oner$# i ne"ro-!i/ic


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Atit"ini tr$t$te inte&-e!tivAtit"ini tr$t$te inte&-e!tivMoific'ri !tr"ct"r$#e ne+#i0$te c" -oten%i$#Moific'ri !tr"ct"r$#e ne+#i0$te c" -oten%i$#

e $+r$v$ree $+r$v$reN" !"nt c"no!c"teN" !"nt c"no!c"teN" !"nt rec"no!c"teN" !"nt rec"no!c"te


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12oto 3 co-i#"# n" e!te "n $"#t 4n12oto 3 co-i#"# n" e!te "n $"#t 4n&ini$t"r'&ini$t"r'

Cretere$ * feno&en contin" -5n' #$Cretere$ * feno&en contin" -5n' #$v5r!t$ $"#t"#"iv5r!t$ $"#t"#"iE(i!t' -erio$e e cretere -referen%i$#'E(i!t' -erio$e e cretere -referen%i$#'

-entr" fiec$re !e+&ent e cor--entr" fiec$re !e+&ent e cor-


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E(tre&it$te$ cef$#ic' cretere 4n -ri&ii 6E(tre&it$te$ cef$#ic' cretere 4n -ri&ii 6$ni -5n' #$ 789 :-eri&etr"# cr$ni$n;$ni -5n' #$ 789 :-eri&etr"# cr$ni$n;

Me&)re#e inferio$re 3 4ntre 6 i < $niMe&)re#e inferio$re 3 4ntre 6 i < $niD"reri noct"rne e cretereD"reri noct"rne e cretereV$r"! ini%i$#V$r"! ini%i$#V$#+"! 4n -ri&ii $ni e vi$%'V$#+"! 4n -ri&ii $ni e vi$%'Nor&$#i=$re$ 4n 0"r e < $niNor&$#i=$re$ 4n 0"r e < $ni


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-re-")ert$r :c5tev$ #"ni 4n$inte$ $-$ri%iei-re-")ert$r :c5tev$ #"ni 4n$inte$ $-$ri%iei-i#o=it'%ii -")iene;-i#o=it'%ii -")iene;Perio$' critic' -entr" !co#io=' i $#tePerio$' critic' -entr" !co#io=' i $#te

t"#)"r'ri e !t$tic't"#)"r'ri e !t$tic'A-$ri%i$ &en!tre#or i $ -i#o=it'%ii f$ci$#eA-$ri%i$ &en!tre#or i $ -i#o=it'%ii f$ci$#e

:)$r)'> &"!t'%i #$ )'ie%i; * !f5rit"# -erio$ei:)$r)'> &"!t'%i #$ )'ie%i; * !f5rit"# -erio$eie cretere r$-i'e cretere r$-i'


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C"r)e#e e cretere 3 -"%in "ti#i=$te #$ noiC"r)e#e e cretere 3 -"%in "ti#i=$te #$ noi:n"&'r"# e c& e cretere 3 4n f"nc%ie e:n"&'r"# e c& e cretere 3 4n f"nc%ie ev5r!t' i !e(;v5r!t' i !e(;

E($&en"# c"r)e#or e cretere 3 ro#E($&en"# c"r)e#or e cretere 3 ro#

e!en%i$# 4n e-i!t$re$ t"#)"r'ri#or ee!en%i$# 4n e-i!t$re$ t"#)"r'ri#or e!t$tic'!t$tic'


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Defini%iiDefini%ii Sco#io=$ e!te o efor&$re 4n -#$n front$# $ r$/i!"#"i?Sco#io=$ e!te o efor&$re 4n -#$n front$# $ r$/i!"#"i? Cifo=$ re-re=int' $ccent"$re$ c"r)"rii or!$#eCifo=$ re-re=int' $ccent"$re$ c"r)"rii or!$#e

fi=io#o+ice 4n -#$n !$+it$#?fi=io#o+ice 4n -#$n !$+it$#? Loro=$ e!te $ccent"$re$ c"r)"rii #o&)$re 4n -#$nLoro=$ e!te $ccent"$re$ c"r)"rii #o&)$re 4n -#$n

!$+it$#!$+it$#Atit"ini#eAtit"ini#e!"nt evieri f"nc%ion$#e :$tit"ini !co#iotice!"nt evieri f"nc%ion$#e :$tit"ini !co#iotice

!$" cifotice;!$" cifotice;

Defor&$%ii#e !tr"ct"r$#e !"nt $no&$#ii $#e co#o$neiDefor&$%ii#e !tr"ct"r$#e !"nt $no&$#ii $#e co#o$neiverte)r$#e :!co#io=e !$" cifo=e $ev'r$te !$"verte)r$#e :!co#io=e !$" cifo=e $ev'r$te !$"!tr"ct"r$#e; c" $+r$v$re 4n ti&-"# creterii? nece!it'!tr"ct"r$#e; c" $+r$v$re 4n ti&-"# creterii? nece!it'e-i!t$re -recoce> !"-r$ve+/ere i tr$t$&ente-i!t$re -recoce> !"-r$ve+/ere i tr$t$&ent$$-t$t.$$-t$t.


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E($&en"# c#inicE($&en"# c#inicCo-i# e=)r'c$t 4n !#i- @, !"tien 3 -"o$re$Co-i# e=)r'c$t 4n !#i- @, !"tien 3 -"o$re$

co-i#"#"ico-i#"#"iE($&en"# e f$%'E($&en"# e f$%'U&eri !i&etrici $!i&etriciU&eri !i&etrici $!i&etriciB$=in"# e!te ec/i#i)r$tB$=in"# e!te ec/i#i)r$t

Gen"nc/ii !"nt )ine $($%iGen"nc/ii !"nt )ine $($%iPicior"# e!te 4n rot$%ie intern' e(tern'Picior"# e!te 4n rot$%ie intern' e(tern'


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E($&en"# c#inicE($&en"# c#inicE($&en"# e -rofi#E($&en"# e -rofi#E(i!t' !$" n" /i-er#oro=' #o&)$r'E(i!t' !$" n" /i-er#oro=' #o&)$r'

E($&en"# c" !-$te#e $-#ec$t 4n$inte -"ne 4nE($&en"# c" !-$te#e $-#ec$t 4n$inte -"ne 4nevien%' +i)o=it'%i#e :coco$';evien%' +i)o=it'%i#e :coco$';

Di$+no!tic"# e !co#io=$ e!te c#inicDi$+no!tic"# e !co#io=$ e!te c#inic


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E($&en"# c#inicE($&en"# c#inicE($&en ifici# 3 co-i#"# &icE($&en ifici# 3 co-i#"# &icV$ri$%ie nor&$# -$to#o+ic :"r&'rire 4nV$ri$%ie nor&$# -$to#o+ic :"r&'rire 4n

in$&ic';in$&ic';


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SCOLIOASCOLIOAR$/i!"# nor&$# 3 recti#ini" 4n -#$n front$#> 4nR$/i!"# nor&$# 3 recti#ini" 4n -#$n front$#> 4n

-#$n !$+it$#-#$n !$+it$#C"r)"ri fi=io#o+ice 3 #oro=$ cervic$#$> cifo=$C"r)"ri fi=io#o+ice 3 #oro=$ cervic$#$> cifo=$

or!$#$> #oro=$ #o&)$r'or!$#$> #oro=$ #o&)$r'


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E($&en"# co#o$nei verte)r$#e 3 e($&enE($&en"# co#o$nei verte)r$#e 3 e($&en!i!te&$tic e )i#$n%!i!te&$tic e )i#$n%

C'"t$re$ "nei t"#)"r'ri e !t$tic'C'"t$re$ "nei t"#)"r'ri e !t$tic'r$/ii$n'r$/ii$n'Afir&$re$ c$r$cter"#"i f"nc%ion$# !$"Afir&$re$ c$r$cter"#"i f"nc%ion$# !$"

!tr"ct"r$#!tr"ct"r$#A-reciere$ c$r$cter"#"i i orient$re$A-reciere$ c$r$cter"#"i i orient$re$

con"itei ter$-e"ticecon"itei ter$-e"tice


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Sco#io=$ !tr"ct"r$#'Sco#io=$ !tr"ct"r$#'Pro+no!tic vit$#Pro+no!tic vit$#

Pre0"ici" f"nc%ion$#> co!&eticPre0"ici" f"nc%ion$#> co!&eticCorec%ie inco&-#et'Corec%ie inco&-#et'Tr$t$&ent co!ti!itor> ifici#> n" f'r' ri!cTr$t$&ent co!ti!itor> ifici#> n" f'r' ri!c

Screeningul, depistarea i tratamentulScreeningul, depistarea i tratamentulprecceprecce


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Afir&$re$ !co#io=ei !tr"ct"r$#eAfir&$re$ !co#io=ei !tr"ct"r$#eC$r$cter"# !co#io=eiC$r$cter"# !co#io=ei

Etio#o+ieEtio#o+ieEvo#"tivit$teEvo#"tivit$te Inic$%ie ter$-e"tic'Inic$%ie ter$-e"tic'


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Et$-e e inve!ti+$re 4n !co#io='Et$-e e inve!ti+$re 4n !co#io='Afir&$re$ !co#io=eiAfir&$re$ !co#io=eiA-reciere$ c$r$ctere#orA-reciere$ c$r$ctere#orC'"t$re$ etio#o+ieiC'"t$re$ etio#o+ieiA-reciere$ evo#"%ieiA-reciere$ evo#"%ieiSt$)i#ire$ con"itei ter$-e"ticeSt$)i#ire$ con"itei ter$-e"tice


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Afir&$re$ !co#io=eiAfir&$re$ !co#io=eiGi)o=it$te$ , -$to+no&onic'Gi)o=it$te$ , -$to+no&onic' E($&en"# !-$te#"i $-#ec$t 4n$inte c" -"nere$ 4nE($&en"# !-$te#"i $-#ec$t 4n$inte c" -"nere$ 4n

evien%' $ +i)o=it'%iievien%' $ +i)o=it'%iiGi)o=it$te$ c/i$r i!cret'> $fir&' o !co#io='Gi)o=it$te$ c/i$r i!cret'> $fir&' o !co#io='

!tr"ct"r$#' :c/i$r $c' eviere$ $-ofi=e#or !-ino$!e!tr"ct"r$#' :c/i$r $c' eviere$ $-ofi=e#or !-ino$!ee!te -"%in vi=i)i#';e!te -"%in vi=i)i#';

Gi)o=it$te$ !e &'!o$r' "-' &$rc$re$ $-ofi=e#orGi)o=it$te$ !e &'!o$r' "-' &$rc$re$ $-ofi=e#or!-ino$!e!-ino$!e

Dific"#t'%i 4n e-i!t$re$ +i)o=it'%iiDific"#t'%i 4n e-i!t$re$ +i)o=it'%iiSi&-#$ $!i&etrie $ &"!c"#$t"rii -$r$verte)r$#e 4n r$/i!"#Si&-#$ $!i&etrie $ &"!c"#$t"rii -$r$verte)r$#e 4n r$/i!"#

#o&)$r#o&)$rSi&-#$ !"-r$riic$re co!t$#' 4n r$/i!"# or!$#Si&-#$ !"-r$riic$re co!t$#' 4n r$/i!"# or!$#


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A-reciere$ c$r$ctere#or !co#io=eiA-reciere$ c$r$ctere#or !co#io=eiN"&'r"# i !en!"# c"r)"ri#or con!t$t$teN"&'r"# i !en!"# c"r)"ri#or con!t$t$te

:!en!"# efinit e conve(it$te;:!en!"# efinit e conve(it$te;Sei"# or!$#> #o&)$r> or!o#o&)$r !$" ")#">Sei"# or!$#> #o&)$r> or!o#o&)$r !$" ")#">

or!$# i #o&)$ror!$# i #o&)$rLi&ite#e i $n+"#$%i$ c"r)"rii 3 e($&enLi&ite#e i $n+"#$%i$ c"r)"rii 3 e($&en

r$io#o+icr$io#o+ic


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Reguli pentru un e!amen radilgic crectReguli pentru un e!amen radilgic crectM'ri&e$ c#ie"#"i tre)"ie !' c"-rin' 4ntre$+$M'ri&e$ c#ie"#"i tre)"ie !' c"-rin' 4ntre$+$

co#o$n' :$t5t "&erii c5t i )$=in"#;co#o$n' :$t5t "&erii c5t i )$=in"#; C#ie" e f$%'> 4n ec")it> e -rofi#C#ie" e f$%'> 4n ec")it> e -rofi# C#ie" c"#c$t c" $-reciere$ re"cti)i#it'%iiC#ie" c"#c$t c" $-reciere$ re"cti)i#it'%ii C"r)"r$ e!te efinit' e verte)re#e #i&it' !$" e(tre&eC"r)"r$ e!te efinit' e verte)re#e #i&it' !$" e(tre&e S"nt verte)re#e ce#e &$i 4nc#in$te -e ori=ont$#' i ce#S"nt verte)re#e ce#e &$i 4nc#in$te -e ori=ont$#' i ce#

&$i -"%in rot$te&$i -"%in rot$te

Rot$%i$ verte)r$#' $-reci$t' e $!i&etri$ -eic"#i#or iRot$%i$ verte)r$#' $-reci$t' e $!i&etri$ -eic"#i#or i-roiec%i$ $-ofi=e#or !-ino$!e-roiec%i$ $-ofi=e#or !-ino$!e Verte)r$ in v5rf"# c"r)"rii 3 ce$ &$i rot$t'Verte)r$ in v5rf"# c"r)"rii 3 ce$ &$i rot$t' Lini$ ce "nete -#$to"ri#e verte)r$#e #i&it' * "n+/i"#Lini$ ce "nete -#$to"ri#e verte)r$#e #i&it' * "n+/i"#

#"i Co))#"i Co))

Un+/i"# #"i Co)) $-reci$=' i&-ort$n%$ c"r)"riiUn+/i"# #"i Co)) $-reci$=' i&-ort$n%$ c"r)"rii


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Etio#o+ieEtio#o+ieAnc/et' etio#o+ic'Anc/et' etio#o+ic' I!toric> e($&en c#inic co&-#et> e($&enI!toric> e($&en c#inic co&-#et> e($&en

ne"ro#o+ic> e($&en r$io#o+icne"ro#o+ic> e($&en r$io#o+icNe"ro#o+ice 3 89Ne"ro#o+ice 3 89Di!-#$=ice> &$#for&$tive> $#te#e 3 89Di!-#$=ice> &$#for&$tive> $#te#e 3 89E!en%i$#e 3 89E!en%i$#e 3 89


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Sco#io=e e iferite c$"=e :!co#io=e !ec"n$re;Sco#io=e e iferite c$"=e :!co#io=e !ec"n$re;M$#for&$%ii con+enit$#e verte)r$#e * !co#io=eM$#for&$%ii con+enit$#e verte)r$#e * !co#io=e

&$#for&$tive :/e&iverte)r'> )#oc verte)r$#>&$#for&$tive :/e&iverte)r'> )#oc verte)r$#>$no&$#ii;$no&$#ii;

Sco#io=e ne"ro#o+ice :-$r$#i=ii $#e &"!c"#$t"riiSco#io=e ne"ro#o+ice :-$r$#i=ii $#e &"!c"#$t"riir$/i!"#"i> -$r$#i=ii $#e &e&)re#or inferio$re;r$/i!"#"i> -$r$#i=ii $#e &e&)re#or inferio$re;

Infec%ii $#e r$/i!"#"i :o!teo&ie#it'> &or) Pott;Infec%ii $#e r$/i!"#"i :o!teo&ie#it'> &or) Pott; Bo#i c5ti+$te !$" ereit$re e !tr"ct"r' o!o$!'Bo#i c5ti+$te !$" ereit$re e !tr"ct"r' o!o$!'

!$" %e!"t e#$!tic :ne"rofi)ro&$to=$ M$rf$n;!$" %e!"t e#$!tic :ne"rofi)ro&$to=$ M$rf$n; Sco#io=$ e!en%i$#' 3 89Sco#io=$ e!en%i$#' 3 89 C" -rei#ec%ie !e("# fe&ininC" -rei#ec%ie !e("# fe&inin


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A-reciere$ evo#"%ieiA-reciere$ evo#"%iei Evo#"tivit$te$ $-reci$t' -rin e($&ene re+"#$te c#inicEvo#"tivit$te$ $-reci$t' -rin e($&ene re+"#$te c#inic

i r$io#o+ici r$io#o+ic Evo#"%i$ e-ine e &$t"r$re$ !e("$#' :e=vo#t$reEvo#"%i$ e-ine e &$t"r$re$ !e("$#' :e=vo#t$re

!5ni> -i#o=it$te $(i#$r'> -")i$n';!5ni> -i#o=it$te $(i#$r'> -")i$n';Gr$"# e &$t"r$re o!o$!' :v5r!t$ o!o$!' 3Gr$"# e &$t"r$re o!o$!' :v5r!t$ o!o$!' 3

r$io+r$fie &5n'> o!ific$re$ cre!tei i#i$ce 3 te!t"#r$io+r$fie &5n'> o!ific$re$ cre!tei i#i$ce 3 te!t"#Ri!!er;Ri!!er;

C"r)$ #"i D"v$#,Be$"-ere 3 evo#"%i$ !co#io=ei inC"r)$ #"i D"v$#,Be$"-ere 3 evo#"%i$ !co#io=ei inti&-"# creteriiti&-"# creterii #ent -5n' #$ -")ert$te#ent -5n' #$ -")ert$te r$-i> !e&ne -")ert$re 4n$inte$ &en!tre#orr$-i> !e&ne -")ert$re 4n$inte$ &en!tre#or o-rire 3 !f5rit"# creterii


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C"r)$ #"i D"v$#,Be$"-ereC"r)$ #"i D"v$#,Be$"-ere


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St$)i#ire$ con"itei ter$-e"ticeSt$)i#ire$ con"itei ter$-e"ticeTr$t$&ent"# ifici# e !t$)i#itTr$t$&ent"# ifici# e !t$)i#itDe-ine e n$t"r$ !co#io=ei> evo#"tivit$te>De-ine e n$t"r$ !co#io=ei> evo#"tivit$te>

v5r!t'> &$t"r$re o!o$!'v5r!t'> &$t"r$re o!o$!'M$#for&$%i$ &$i +r$v' 3 tr$t$&ent"# &$i ifici#M$#for&$%i$ &$i +r$v' 3 tr$t$&ent"# &$i ifici#

:intere! -entr" e-i!t$re$ -recoce;:intere! -entr" e-i!t$re$ -recoce;

Tr$t$&ent orto-eic 3 inetoter$-ie> cor!eteTr$t$&ent orto-eic 3 inetoter$-ie> cor!eteTr$t$&ent c/ir"r+ic$#Tr$t$&ent c/ir"r+ic$#


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Tr$t$&ent"# !co#io=eiTr$t$&ent"# !co#io=ei Protoco# St$+n$r$Protoco# St$+n$r$

8,68 3 1inetoter$-ie8,68 3 1inetoter$-ie:+i&n$!tic$ &eic$#$;:+i&n$!tic$ &eic$#$;

68,J8 3 1inetoter$-ie @,68,J8 3 1inetoter$-ie @,cor!etcor!et

Pe!te J8 , inic$%iePe!te J8 , inic$%iec/ir"r+ic$#'c/ir"r+ic$#'


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1inetoter$-i$ :+i&n$!tic$ &eic$#$;1inetoter$-i$ :+i&n$!tic$ &eic$#$; In to$te et$-e#e ter$-e"tice $#e "nei !co#io=eIn to$te et$-e#e ter$-e"tice $#e "nei !co#io=eN" e!te contr$inic$t !-ort"#> inc#"!ivN" e!te contr$inic$t !-ort"#> inc#"!iv

-erfor&$nt$-erfor&$nt$N" $re nici o efic$cit$te #$ !co#io=e#e -e!teN" $re nici o efic$cit$te #$ !co#io=e#e -e!te

68,6J ec$t $!oci$t$ c" $#te -roceee68,6J ec$t $!oci$t$ c" $#te -roceee

ter$-e"ticeter$-e"tice


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Cor!et"#Cor!et"# In"ti# !") 68In"ti# !") 68N" corecte$=$ c"r)"r$> -revine $+r$v$re$N" corecte$=$ c"r)"r$> -revine $+r$v$re$Eficient in -erio$$ e cre!tereEficient in -erio$$ e cre!tereTre)"ie -"rt$t 7,/ in f"nctie e ti-"#Tre)"ie -"rt$t 7,/ in f"nctie e ti-"#

c"r)"rii !i $+re!ivit$te$ )o#iic"r)"rii !i $+re!ivit$te$ )o#ii

Eficient $c$ #$ !f$r!it"# cre!terii v$#o$re$Eficient $c$ #$ !f$r!it"# cre!terii v$#o$re$c"r)"rii e!te e @, Jc"r)"rii e!te e @, J


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Tr$t$&ent"# c/ir"r+ic$#Tr$t$&ent"# c/ir"r+ic$# Interventie c" +r$ &$re e ific"#t$teInterventie c" +r$ &$re e ific"#t$teUn+/i Co)) K J,J8Un+/i Co)) K J,J8Artroe=$ c" in!tr"&ent$tie &et$#ic$ -entr" $Artroe=$ c" in!tr"&ent$tie &et$#ic$ -entr" $

o)tine "n +r$ e corectie $ c"r)"riio)tine "n +r$ e corectie $ c"r)"rii


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CLINICA DE CHIRURGIE SI ORTOPEDIE PEDIATRIC


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Atitudinea sclitic"Atitudinea sclitic"nc"r)$re #$ter$#' $ r$/i!"#"inc"r)$re #$ter$#' $ r$/i!"#"iDi!-$re #$ e($&en"# c" !-$te#e $-#ec$t 4n$inteDi!-$re #$ e($&en"# c" !-$te#e $-#ec$t 4n$inteN" !e $!oci$=' c" +i)o=it'%iN" !e $!oci$=' c" +i)o=it'%iAce!te c$r$ctere 3 iferen%iere f$%' e !co#io=$Ace!te c$r$ctere 3 iferen%iere f$%' e !co#io=$

!tr"ct"r$#'!tr"ct"r$#'Atit"ini#e !"nt ne"rero$!eAtit"ini#e !"nt ne"rero$!eC5n !"nt "rero$!e !$" ri+ie 3 efor&$%ieC5n !"nt "rero$!e !$" ri+ie 3 efor&$%ie

re$c%ion$#' :infec%ii> t"&ori;re$c%ion$#' :infec%ii> t"&ori;

CLINICA DE CHIRURGIE SI ORTOPEDIE PEDIATRICCLINICA DE CHIRURGIE SI ORTOPEDIE PEDIATRIC


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Atitudinile scliticeAtitudinile scliticePri&$ c$"='Pri&$ c$"=' Ine+$#it$te e #"n+i&e !$" $no&$#ii $#eIne+$#it$te e #"n+i&e !$" $no&$#ii $#e

&e&)re#or&e&)re#orDe=ec/i#i)r" e )$=inDe=ec/i#i)r" e )$=inCorect$re$ ine+$#it'%iiCorect$re$ ine+$#it'%iiEc/i#i)r$re )$=in 3 i!-$re $tit"ine$Ec/i#i)r$re )$=in 3 i!-$re $tit"ine$

A o"$ c$"=' 3 -o=i%ii vicio$!e -o!t"r$#eA o"$ c$"=' 3 -o=i%ii vicio$!e -o!t"r$#e



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Atitudinea ci#tic"Atitudinea ci#tic"S-$te rot"n> "&eri -roiect$%i 4n$inteS-$te rot"n> "&eri -roiect$%i 4n$inteCorect$re vo#"nt$r' !$" 4n e(ten!ieCorect$re vo#"nt$r' !$" 4n e(ten!ieN" e(i!t' "reri> r$io+r$fie nor&$#'N" e(i!t' "reri> r$io+r$fie nor&$#'Vici" e -o!t"r'Vici" e -o!t"r'Nece!it' +i&n$!tic' e corect$reNece!it' +i&n$!tic' e corect$reSe -o$te tr$n!for&$ 4n cifo=$ evo#"tiv'Se -o$te tr$n!for&$ 4n cifo=$ evo#"tiv'



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Cifo=e#e !tr"ct"r$#eCifo=e#e !tr"ct"r$#eM$i -"%in frecvente ec5t !co#io=e#eM$i -"%in frecvente ec5t !co#io=e#eA+r$v$re 4n -erio$$ e cretereA+r$v$re 4n -erio$$ e cretere

Etio#o+ie 4n conte(t c#inic 3 r$io#o+icEtio#o+ie 4n conte(t c#inic 3 r$io#o+ic

Cifo=e &$#for&$tive , !e $!oci$=' c" !co#io=$Cifo=e &$#for&$tive , !e $!oci$=' c" !co#io=$:cifo!co#io=$;:cifo!co#io=$;

M$#$i$ Sc/e"r&$nn 3 $o#e!cent ,J $ni> !-$teM$#$i$ Sc/e"r&$nn 3 $o#e!cent ,J $ni> !-$terot"n> "rero!rot"n> "rero!

R$io+r$fie e -rofi# 3 ire+"#$rit$te -#$to"ri verte)r$#e>R$io+r$fie e -rofi# 3 ire+"#$rit$te -#$to"ri verte)r$#e>verte)re c"neifor&everte)re c"neifor&e

Nece!it' tr$t$&ent orto-eicNece!it' tr$t$&ent orto-eic



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De re$inut%%%De re$inut%%%Diferen%$ intre $tit"ine i !co#io=$Diferen%$ intre $tit"ine i !co#io=$

!tr"ct"r$#' 3 e($&en"# c#inic!tr"ct"r$#' 3 e($&en"# c#inicAtit"ine$ !co#iotic' i!-$re #$ f#e(i$Atit"ine$ !co#iotic' i!-$re #$ f#e(i$

tr"nc/i"#"i 4n$inte> n" $re +i)o=it$tetr"nc/i"#"i 4n$inte> n" $re +i)o=it$teO !co#io=' !tr"ct"r$#' -er!i!t' #$ f#e(i$O !co#io=' !tr"ct"r$#' -er!i!t' #$ f#e(i$

tr"nc/i"#"i i !e $co&-$ni$=' e +i)o=it$tetr"nc/i"#"i i !e $co&-$ni$=' e +i)o=it$teL$ o !co#io=' c" reo$re i "rere tre)"ieL$ o !co#io=' c" reo$re i "rere tre)"ie

e#i&in$t' o #e=i"ne infec%io$!' intr$r$/ii$n'e#i&in$t' o #e=i"ne infec%io$!' intr$r$/ii$n'


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