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FO MGTTNR OE K@AT_TMAO BO FG

LGAERN_TEAW_OR _[O AE @GEB [_TMOTQ

Srnjossour K`rastage Bulnetaor, LB, S`BKoetro bo fg Lgae, Mugbofnupo

www.bauk`arurmaolgae.nrm

http://www.diuchirurgiemain.org/

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G RN_TEAW_OR A[ _[OJ_FRN [RNS DFOOBAEM !

_saem g tnureaquot ne wgr

nporgtane t`ogtor as usojuf GEBent botraloetgf

@nwovor, gjtor twn `nurs nj uso,

t`o rash nj jgskantnly as aekrogsob

Hrgm` IJ Ir, ]gftors RI, Dgor BM, Jnx KI, ]gbo KO, [gfaegs I, @nfknld ID. Srgktakgf uso nj olormoeky tnureaquots tn

stnp dfoobaem ae lginr fald trgulg. I Rrgulg. 4330 Jod8:2(4 [uppf)9[;0-21

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]O EOOB G RN_TEAW_OR AE @GEB[_TMOTQ !

Knufb g iowofor ropgar g wgtk`allorsob ae aeh > ([torfaemDueeoff)

G tnureaquot `ofps ae t`o prokasoaboetakgtane nj gegtnlakgfstrukturos, bokrogsos t`o eoob jnr

trgesjusane geb s`nrtoes nporgtaemtalo.

Dut at bnos ent sudstatuto jnr gprokaso surmakgf `olnstgsas +++

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@N]OZOT, R@O _[O NJ G RN_TEAW_ORA[ ENR ]AR@N_R KNE[OW_OEKO[

7. At gfwgys fogbs tn pnstnporgtavo k`gemos t`gt lgyaetorjoro wat` `ogfaem geb/nr juektanegf roknvory

4. At lgy fogb tn knlpfakgtanes t`gt ynu grorospnesadfo jnr +++

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J_EKRANEGF K@GEMO[

Kgrpgf tueeof rofogso w/w tnureaquot geb OLM stuby

gt ; woohs pnst surmory!==% nj pgtaoets prosoetob

wat` boeorvgtane ofsow`oro t`ge t`oegr olaeoeko !

Srnspoktavo rgebnlazob stuby nj ?2 pgtaoets wat` kfnsob

gehfo jrgkturos (4: w/ 40w)!aekrogso pnst-nporgtavo

swoffaem geb pgae ae pgtaoets wat` tnureaquot uso

HNETGB, M., LGTHLAFFOT, L., FOEAK@, G., LGQT, O., T_RROT, G.RN_TEAW_OR[ LGQ AEKTOG[OSN[RNSOTGRAZO []OFFAEM GEB SGAE GJROT AEROTEGF JAPGRANE NJ GEHFO JTGKR_TO[. KFAEAKGF

NTR@NSGOBAK[ GEB TOFGROB TO[OGTK@ 433?8 2;;, 701712.

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KNLSFAKGRANE[ JNT RN_TEAW_OR _[O

Knlpfakgtanes rgto 7/?333 7/0333

7/?333 (uppor fald) tn 7/7;333 (fnwor fald) - Gustrgfag-71=3

:;202 surmakgf aetorvoetanes wat` tnureaquot uso9 4:

knlpfakgtanes (7/4224) buo tn t`o tnureaquot aekfubaem 7?

eournfnmakgf (; _p-fald 7/:7??8 74 Fn-fald 7/;=?4) nj w`ak`

twn woro boeatavo

NBAE[[NE G, JAE[OE Z. RN_TEAW_OR _[O GEB AR[ KNLSFAKGRANE[ AE ENT]GQ. IDI[ DT. 433:G_M800(0)97313-4.SGFLOT GH9 KNLSFAKGRANE[ JTNL RN_TEAW_OR _[O. @GEB KFAEAK[ 710:849;37-;3?.

M_OTTG ID9 OW_ASOLOER LGFJ_EKRANE. @GEB KFAEAK[ 711287392?-?4.

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SGRAOER [GJORQ TOSNTR NJ SOEE[QFZGEAG

723 knlpfakgtanes buo tn tnureaquot ae ? yogrs

27% robeoss, swoffaem, nobolg,...!oxkossavo prossuro

71% p`fyktoeufgo

!

pnnr gppfakgtane nj t`o tnureaquot

72% ueoxpoktb dfoobaem !Snnr knetrnf nj t`o tnureaquot / Dfnnb

prossuro

0% woro fojt ae pfgko lnro t`ge 4 `nurs

pnnrfy pnsataneob, wrnem sato,

Sg Sgtaoet [gj Gbvas 4373 [op8=X;\91=-737.

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KNLSFAKGRANE[ NJ RN_TEAW_OR _[O GTO ENR

GEOKBNRAKGF GEB QN_ GTO TO[SNE[ADFO JNT

Qnu eoob tn henw `nw at s`nufb do usob

Qnu s`nufb do gdfo tn togk` t`o rnnl eursos

Qnu s`nufb vorajy, jrnl talo tn talo, t`gt ovoryneo `gs woff

ueborstnnb

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@A[RNTAKGF @ofanbnras (rnlge surmone usob at jnr

glputgtanes)

IS Sotat, 7=70 aetrnbuko t`o eglo tnureaquot

IJ Zne Oslgk`, 70=;, usob `as suspoebors tn

stnp dfoobaem ae ge glputoo

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@A[RNTAKGF

@grvoy Kus`aem, 7132,

aetrnbukob t`o peoulgtak

tnureaquot

Lk Owoe, 03s, aetrnbukob t`o

lnbore bovako wat` ofoktrneak

knetrnf9 lnro ojkaoet geb sgjo

(+ 21% `ystorosas ae prossuro nj +/-

433 ll@m)

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KNERTG-AEBAKGRANE[ >

R`o jnffnwaem Toknlloebob [tgebgrbs nj

Srgktako woro rosogrk`ob geb wrattoe dyt`o G[R Obukgtane geb Srnjossanegf[tgebgrbs Knllattoo geb `gvo dooe

gpprnvob dy t`o G[R Dngrb nj Baroktnrs.R`oy gro ojjoktavo Gpraf 7;, 433=.

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KNERTG-AEBAKGRANE[ >

Npoe jrgkturos (bajkuft tn gegfyso t`o vatgfaty nj tassuos. Fogvaem eokrntak tassuos

aekrogsos pnstnporgtavo aejoktane rgto)

Aetrglobuffgry egafaem (Aekrogsos t`o rash nj jgtty oldnfasl)

[ovoro grtoranpgt`y (aekrogsos t`o rash nj bastgf oldnfa)

[ovoro krus` aeiury, knlpgrtloet syebrnlo

[ovoro `ypor dfnnb prossuro

[hae mrgjt uebor t`o tnureaquot

Lgfameget tulnrs

QO[

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[@N_FB ]O SGB R@O [HAE _EBOT R@ORN_TEAW_OR >

Qos / En

]`y > Oxpfgae !

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QO[ - ]O [@N_FB SGB R@O [HAE _EBOTR@O RN_TEAW_OR

Mun [. As Zofdgeb staff g sgjo geb knst ojjoktavo shae prntoktane doeogt` t`o

tnureaquot ae `geb surmory> @geb [urm. 437787:(7)9?-0.

Bae, T., Mobbos, R., 4332. [hae prntoktane doeogt` t`o tnureaquot, g prnspoktavorgebnlasob tragf. Geeugf Eow Yogfgeb Inuregf nj [urmory =2, =47=44.

Nfavokrneg, K., Raborlgggrh, I., @gldorm, S., Snezor, [., Kobjorjigff, K., 433:. [hae

prntoktane ueboreogt` t`o peoulgtak tnureaquot buraem tntgf heoo gr t`rnpfgsty.

Gktg Nrt`npgobakg == (;), ?71?4;.

[gfo` HI. Ge ofgstak stnkhaeotto uebor g peoulgtak tnureaquot prntoktob gmgaest

t`o bovofnploet nj dfastors buraem tntgf heoo grt`rnpfgsty. I Dneo Inaet [urm Gl.

433= Jod801(4)92?1.

http://www.ncbi.nlm.nih.gov/pubmed?term=Saleh%20KJ%5BAuthor%5D&cauthor=true&cauthor_uid=17272479

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G stnkhaeotto, ge ofgstakstnkhaeotto, G Zofpogu

kropo dgebgmo,.

dottor bastraduto prossuro,gvnab shae dfastoraem, .

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]@OTO RN SFGKO R@O

RN_TEAW_OR >

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Ne t`o bagp`ysas, w`oro t`oluskufgr lgss as t`akhor

Grl nr Jnrogrl9

[glo tnforgeko (Obwgrbs) nrovoe suporanr gt t`o jnrogrl(+2?% aj 6 ;3 le)

[urmones gro foss sgtasob gtt`o jnrogrl ( Nbaessne)

]off tnforgtob aj 6 43

Obwgrbs [G, @grpor MB, Mabbaes MO. Ojkgky nj jnrogrl vorsus uppor grl tnureaquot jnr fnkgf gegost`otaksurmory nj t`o `geb.I @geb [urm Dr. 4333 Bok84?(:)9?=;-2.

Nbaessne G, Jaesoe Z. R`o pnsatane nj t`o tnureaquot ne t`o uppor fald. IDI[ Dr 43348 02-D8 434-432

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]@AK@ [AYO [@N_FB QN_

K@NN[O >

Neosazo

tsg

ff>

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RN_TEAW_OR [AYO

R`o fgrmost t`o dost !stnps t`o dfnnb fflnw jnr gfossor prossuro 8!balaeas`os boop prossuro

uebor t`o kujj

R`o tnureaquot kujj s`nufb do fnemor nj =-7? kl

!tnn s`nrt, at waff jgaf8!tnn fnem, at aekrogsos

prossuro uebor t`o kujj geb t`o rash nj shae dfastors

Ndoso pgtaoets `gvo kneakgf s`gpo (uso g kurvob

tnureaquot nr lgho t`o fald kyfaebrakgf)

]abt` nj t`o tnureaquot < 7/4 fald baglotor

Lnnro LT, Mgre [T, @grmoes GT. ]abo tnureaquots ofalaegto dfnnb fflnw gt fnw aefflgtane

prossuros. I @geb [urm Gl. 710= Env874(:)9733:-77.

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@N] BN QN_ OP[GEM_AEGRO R@O FALD >

Ofovgtane jnr g jow laeutos

@geb-nvor-`geb tok`eaquo

Zofpogu dgebgmo

Ofgstak dgebgmo (Dafflox,

Oslgk` dgebgmo

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BN ENR _[O O[LGK@ DGEBGMO !

R`o lnro ynu ture grnueb

t`o fald, t`o `am`or t`o

prossuro ne t`o snjt-tassuos

Bogbfy puflnegry

oldnfasl `gvo dooe

boskradob (? kgsos ae

trgulgtnfnmy, 7 buraem

Heoo ropfgkoloet,)

Bgrlgeas9 Aeiury 4333

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BN ENR RTQ RN OLSRQ R@O FALD !

@geb-nvor-`geb tok`eaquo `gs prnvoe ojkaoet ae 14% nj kgsos

Ent olptyaem g fald9

gffnws jnr g dottor vasugfazgtane nj vossofs (Rnureaquots bn

ent ropfgko `olnstgsas ++)

Lgaetgae g fovof nj EN t`gt prntokt gmgaes jroo rgbakgfsburaem ro-porjusane nj t`o fald

Atgr ot gf. Bnos t`o lot`nb nj oxprossane nj voenus dfnnb gjjokt ask`golag/roporjusane bglgmo ae tnureaquotuso> Ge oxporaloetgf stuby ne rgddats. Aeiury 437;8 229721;-721=

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]@AK@ STO[[_TO > Nvor 7?3 surmones, fnwor oxtrolaty

prossuro wgs ;33 ll (rgemo, 7?3-233),geb t`o lobage _O prossuro wgs 4?3ll (rgemo, 7?3-;33).

Foss t`ge 43% nj rospneboets rnutaeofyusob prossuros nj 4?3 ll nr foss jnr

t`o fnwor oxtrolaty. Jnr upporoxtrolaty, nefy 77.;% usob prossuros gtnr dofnw 433 ll (roknlloebobvgfuos)

Fovy N, Bgvab Q, @oal L, Ofbgr A, K`otrat G, Oemof I. Laealgf tnureaquot prossuro tn lgaetgae grtoragf kfnsuro ae upporfald surmory. I @geb [urm Dr. 711; Gpr870(4)9432-:.

Roiwgea EK7, Allorlge A, Gk`ge S, Omnf HG, LkFgurae R. Rnureaquot kujj prossuro9 R`o mufj dotwooe skaoeko gebprgktako. I Rrgulg. 433: Bok8:7(:)9727?-0.

http://www.ncbi.nlm.nih.gov/pubmed/?term=McLaurin%20T%5BAuthor%5D&cauthor=true&cauthor_uid=16983305http://www.ncbi.nlm.nih.gov/pubmed/?term=Egol%20KA%5BAuthor%5D&cauthor=true&cauthor_uid=16983305http://www.ncbi.nlm.nih.gov/pubmed/?term=Achan%20P%5BAuthor%5D&cauthor=true&cauthor_uid=16983305http://www.ncbi.nlm.nih.gov/pubmed/?term=Immerman%20I%5BAuthor%5D&cauthor=true&cauthor_uid=16983305http://www.ncbi.nlm.nih.gov/pubmed/?term=Tejwani%20NC%5BAuthor%5D&cauthor=true&cauthor_uid=16983305

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RN_TEAW_OR STO[[_TO

]o eoob ?3-733 ll @m

5 [ystnfak DS (usugffy

4?3-;33 ll@m)

_saem Bnppfor knetrnf9 713

+/- 42 ll @m

@am`or prossuro aekrogsostnureaquot

bgemornusaty wat`nut

gey doeot

Kurroet muabofaeos9

[gjoty lgrmae nj 23 ll@m

jnr FNS 6 7;3 ll@M

:3 ll@M aj

7;76FNS6713 ll@m

03 ll@M aj 5 713 ll@M

Ae k`afbroe, gbb ?3 ll@m

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@N] FNEM >

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@N] FNEM [@N_FB ]O HOOS AE SFGKO GRN_TEAW_OR >

Eournfnmakgf aeiuraos (lnborgto) woro ndsorvob

gjtor ? `nurs ae kgts, geb sovoro gjtor 0 `nurs

(Hnrt`gfs ot gf. I Eournf 71:?)

Dotwooe ;3 le geb 2 `nurs.en ovaboeko

13-743 le sools g rogsnegdfo lgxalul

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GEB AJ ]O EOOB LNTO RALO >

Bofflgtaem t`o tnureaquot tn gffnw roporkussane >

En skaoetak ovaboeko suppnrts t`as prgktako.

Rassuos fnso strukturgf jogturos, lghaem bassoktane

bajkuft,

Obolg lghos wnueb kfnsuro grbunus.

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]@GR GTO R@O KNLSFAKGRANE[ NJRN_TEAW_OR _[O >

Eournfnmakgf bokat!Srossuro

Snst-tnureaquot syebrnlo!Ralo

Knlpgrtloet syebrnlo!Srobaspnsatane

Dures geb shae bglgmos![urmakgf lastghos

@olnrr`gmo![urmakgf lastghos (pnnr `olnstgsas, talo)

Oldnfasl, ask`olag, mgemroeo !probaspnsaem jgktnrs, wrnem

aebakgtane

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EO_TNFNMAKGF AEI_TAO[ GTO B_O RNRN_TEAW_OR STO[[_TO

Ask`olag fogbs tn g knebuktane dfnkh wat`ae ;3 tn 13 le wat` knlpfoto

roknvory aj ask`olag as foss t`ge : ` - ]`afo prossuro fogbs tn boeatavo

eorvo aeiuraos gt t`o prnxalgf obmo nj t`o tnureaquot wat`ae 4 `nurs

Tgbagf 5 _fegr 5 Lobage (7/=?3 tn 7/77333 kgsos)

Oxporaloetgf stubaos9

Eorvos gro 7/4 tn 7/2 nj ats baglotor - Bo-lyofaeasgtane, fnss nj

oebneourgf prntoaes, squoozaem n Tgevaors enbos,

Lnro sovoro gt t`o obmos nj t`o tnureaquot

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TA[H JGKRNT[ NJ

EO_TNFNMAKGF AEI_TAO[

Qnuem gmo

@am` prossuro (5 233 ll@m)

Fnemor talo (Nbb Tgtan nj 4,0 jnr ovory ;3 legjtor 4 `nurs nj tnureaquot)

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SN[R-RN_TEAW_OR [QEBTNLO

Mavo 2 knesoquoekos nj g prnfnemob ask`olag >

Gkabnsas, `yporhgfaolag, geb dyprnbukts nj luskfo

droghbnwe (lynmfndae) gro rofogsob aetn t`o

systolak strogl.

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SN[R-RN_TEAW_OR [QEBTNLO

Fald nobolg

[tajjeoss

Sgfnr, ask`olag

Luskufgr wogheoss

!Luskufgr knetrgktafaty

"pnst-np glyntrnp`y

#Luskufgr eokrnsas Sgrost`osago

@ypor`olagusugffy rosnfvo wat`ae 7 lnet`

@ypor`olag

NobolgDfoobaem

Aefflgllgtane

Ask`olag

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SN[R-RN_TEAW_OR [QEBTNLO

"73% nj fald vnfulo gjtor tnureaquot rofogso

Lnro alpnrtget ae t`o gdsoeko nj `olnstgsas geb aj t`o brossaem as lgbo dojnro rofogsaem t`o

tnureaquot

Tofogso tnureaquot dojnro kfnsuro >

Snst-np brossaem aekrogsos fald prossuros buraem ; `nurs dut falats t`o fald obolg (dgebgmo Gee T Knff [urm Oemf. 4373 Nkt814(=)9?=;-:.

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JAEMOT RN_TEAW_OR

Rwn prndfols9

Jnrmot tn rolnvo t`otnureaquot

]`ak` prossuro asbofavorob >

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LGFFGTB J, [GAER-KG[R Q, TAK@N_ I, FO EOE B. T[_FRGR[JNEKRANEEOF[ FNEM ROTLO BA[K@LAO[ BAMARGFO[[N_[ MGTTNR 9 STNSN[ BO RTNA[ ND[OTZGRANE[.

K@AT_TMAO BO FG LGAE ;7 (4374) ;?0;:;

[oquofgo +++

Sgae (lgaefy buo tn knfb),bysost`osago, gffnbaey8 grtakufgr

stajjeoss

Rrnp`ak basturdgekos geb

knslotak soquofgo gro knestget

(t`ae emor,)

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]@AK@ STO[[_TO A[ BOFAZOTOB >

Soernso tudo9 =4= ll@m

Jaemor mfnvo wat` g kfglp9 2;1 ll@M

Tnffob emor mfnvo9 4:= ll @M

Rnurea-knt(r) 9 42: ll @M

R-Taem (r)9 7?7 ll@M

Fg``gl [, Ru H, Ea L, Rrge Z, Fntpnur [, Geborsne KF, Jnx IK. Knlpgrasne nj prossuros gppfaob dy bamatgftnureaquots ae t`o olormoeky bopgrtloet.]ost I Olorm Lob. 4377 Lgy874(4)9424-1.@axsne JS ot gf. Bamatgf tnureaquots9 g prossuro stuby wat` kfaeakgf rofovgeko. I @geb [urm Gl 710:8 77(:)90:?-0:0.

]@GR A _[O

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Fox%20JC%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Anderson%20CL%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Lotfipour%20S%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Tran%20V%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Ni%20M%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Tu%20K%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Lahham%20S%22%5BAuthor%5D

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]@GR A _[O

G 0,? mfnvo wrgppob grnueb t`o wrast (773-4:3 ll @m)

G slgff sazo mfnvo wat` ne emor rnffob nvor (at `gs dooe s`nwe

t`gt aj t`o mfnvo usob as t`o sglo sazo gs t`o pgtaoets `geb t`o

loge prossuro moeorgtob wgs ;?? ll@m, geb ueajnrlfy fosst`ge ?33 ll@m aebopoeboet nj t`o nporgtnrs oxporaoeko nj

t`o tok`eaquo)

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KNEKF_[ANE < STOZOERANE

[trgtomaos jnr Seoulgtak Rnureaquot _soJgafuro nr lasuso nj peoulgtak tnureaquots kge fogb tn luskfo ask`olag, eorvo bglgmo,

knevufsanes, geb knlg. Gbbrossaem kujj gvgafgdafaty geb obukgtaem stgjj gdnut kujj sofoktane,gppfakgtane, geb aefflgtane prossuro gro juebgloetgf strgtomaos tn gvnab knlpfakgtanes.

Gjtor Gppfyaem g Rnureaquot Kujj Bn ent gffnw proppaem snfutane tn lamrgto uebor kujj.

Botorlaeo laealul fald nkkfusane prossuro (FNS).

Sfgko g Bnppfor stot`nsknpo ne g bastgf grtoragf pufso.

Aekrogso kujj prossuro uetaf t`o pufso stnps.

[ot kujj aefflgtane prossuro jnr gbuft pgtaoets gt FNS pfus9

23 ll @m aj FNS as foss t`ge 7;3 ll @m,

:3 ll @m aj FNS as dotwooe 7;7 geb 713 ll @m, nr

03 ll @m aj FNS as mrogtor t`ge 713 ll @m.

[ot kujj aefflgtane prossuro jnr pobagtrak pgtaoets gt FNS

pfus ?3 ll @m.

Laealazo kujj aefflgtane talo.

Dojnro Sgtaoet _so Lgaetgae ge gboqugto sofoktane nj kujjs.

Knetnurob kujjs gro bosargdfo jnr oxkossavofy tgporob falds.

Bn ENR rouso saemfo-uso kujjs.

Oesuro ofoktrneak knetrnffors gro kneeoktob tn faeo pnwor geb/nr `gvo gboqugto dgttory kgpgkaty8 porjnrl sofj-tost.

[ofokt t`o prnpor sazo kujj, geb fnnh jnr krgkhob tu daem geb fnnso kneeoktnrs. Hoop tudaem njj t`o fflnnr geb rnutob tn gvnab gkkaboetgf knetgkt dy porsneeof.

Gppfy g snjt pgbbaem ueajnrlfy tn t`o nporgtavo fald kujj sato.

Entajy t`o surmakgf togl nj ofgpsob aefflgtane

talo gt romufgr aetorvgfs.

Lneatnr kujj prossuro buraem t`o prnkoburo,

ospokagffy w`oe ropnsataneaem t`o fald.

Tolnvo kujj geb pgbbaem allobagtofy

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