nerf thoracique Long

Embed Size (px)

Citation preview

  • 8/20/2019 nerf thoracique Long

    1/14

    Brtli`n mrlkldb`

    Imfprnsslmd eu dnrh tgmrbilius `mdkus(Dnrh en Igbr`ns-An``)

    Ndtrbpfndt bde pbrb`ysls mh tgn tgmrbilius `mdkus dnrvn

    I. Eufmdtlnr  b,a,*, F. Ymuanyrbd  i, U. @bsibr  e, O. @bu`bd  n

    b  Ldstltut en `b fbld, 8, Yqubrn-Omuvndnt, ;>:28 Zbrls, Hrbdina Ynrvlin e“mrtgmpìeln nt en iglrurkln en `b fbld (Zr Emursmudlbd), gõpltb` Ybldt-Bdtmldn, 275, run eu Hbuamurk-Ybldt-Bdtmldn,

    ;>>;2 Zbrls inenx 21, Hrbdini  Gõpltbux en Zbrls, Hrbdin

    e  Gõpltb` Zrldinssn-Krbin, bvndun Zbstnur, , I8 nt trçs smuvndt en I;, `n dnrh tgmrbilius `mdkus b ud trbont prmhmde nt tmurfndtì ? l` pbssn suiinsslvnfndt nd pbrtln

    ê trbvnrs `ns fusi`ns sib`çdns, ignvbuign `b enuxlçfn iõtn, puls `mdkn `n fusi`n snrrbtus bdtnrlmr. @“bttnldtn pbrb`ytlqun eu snrrbtus, alnd qunrbrn, b ìtì rbppmrtìn rìku`lçrnfndt ebds `b `lttìrbturn. @ns ibusns pmssla`ns smdt fu`tlp`ns nt vbrlìns, fbls ud fìibdlsfn en trbitlmd sur `n dnrh tgmrbilius `mdkus b ìtì trçs hrìqunffndt rbppmrtì. @b imfprnsslmd lsm̀ ìn eu dnrh tgmrbilius `mdkus b ìtì p`uslnurs hmls ìvmquìn, fbls snu`s `nstrbvbux bdbtmflquns nt iglrurklibux en @bu`bd nt b`. mdt pnrfls en rntrmuvnr udn zmdn en imfprnsslmd ebds `n tgmrbx, nd rnkbre en `b > n iõtn,bu dlvnbu eu irmlsnfndt ndtrn `n dnrh tgmrbilius `mdkus nt `“brtçrn tgmrbimemrsb`n. Dmus bvmds rnvu udn trçs krbden pbrtln en `b `lttìrbturn ntprìsndtmds `ns rìsu`tbts ens prldilpbux trbvbux bdbtmflquns, bldsl qun dmtrn nxpìrlndinebds `b dnurm`ysn eu dnrh tgmrbilius `mdkus. ^d rbppn`ens prldilpbux trbltnfndts pb``lbtlhs b ìkb`nfndt ìtì hblt ibr anbuimup en pbtlndts imdsu`tndt tbrelvnfndt, bu stben en sìqun``ns.© 1::5 N`snvlnr YBY. Umus ermlts rìsnrvìs.

    Bastrbit

    Ugn tgmrbilius `mdkus dnrvn mrlkldbtns hrmf tgn I>, I8 bde fmst mhtnd I; rmmts. Lts bdbtmflib` ensirlptlmd ls fben elhfliu`t ay tgn tmrtumusimursn mh tgn dnrvn wglig pbssns, ld pbrt, tgrmukg tgn sib`ndus fusi`ns, spbd mvnr tgn snimde rla bde tgnd fldlsgns lts imursn md tgn snrrbtus

    fusi`n. Ynrrbtus fusi`n pbrb`ysls, b`tgmukg rbrn, gbs annd rnku`br`y rnpmrtne ld tgn `ltnrbturn. Fbdy ibusns gbvn annd pmstu`btne, tgn fmsthrnqundt annldk b trbitlmd ldoury. Lsm`btne tgmrbilius `mdkus dnrvn ndtrbpfndt gbs smfntlfns annd pmstu`btne aut md`y tgn bdbtmflib` bdesurklib` wmrcs mh @bu`bd nt b`. Gbvn enfmdstrbtne b imfprnsslmd ldoury md tgn dnrvn bt lts irmssldk wltg tgn tgmrbim-emrsb` brtnry, bamut tgn`nvn` mh tgn flhtg rla. [n rnvlnwne b `brkn bfmudt mh pua`libtlmds bde prnsndt tgn rnsu`ts mh tgn fmst slkdlflibdt bdbtmflib` wmrcs, bde murnxpnrlndin ld tgnsurklib` rn`nbsn mh tgn tgmrbilius`mdkus dnrvn ndtrbpfndt.Zb``lbtlvn trnbtfndtsbrn b`sm rnpmrtne bs fmst pbtlndts prnsndt `btnwltg enfldltn snqun`bn.© 1::5 N`snvlnr YBY. Umus ermlts rìsnrvìs.

     Fmts i`ìs ? Dnrh tgmrbilius `mdkus 3 Imfprnsslmd 3 Yibpu`b b`btb 3 Bdbtmfln 3 Iglrurkln 3 Urbltnfndt pb``lbtlh 

    Cnywmres? Ugmrbilius `mdkus dnrvn3 Yurknry3 Ndtrbpfndt3 Bdbtmfy3 Yibpu`b b`btb3 Zb``lbtlvn trnbtfndt

    * Butnur imrrnspmdebdt. Bernssn n-fbl` ? igrlstlbd.eufmdtlnrJsbt.bp-gmp-pbrls.hr (I. Eufmdtlnr).

    Iglrurkln en ̀ b fbld 19 (1::5) Y89’Y;8

    gttp?//hrbdin.n`snvlnr.imf/elrnit/IGLFBL/ 

    21

  • 8/20/2019 nerf thoracique Long

    2/14

    2. Ldtrmeuitlmd

    @n dnrh tgmrbilius `mdkus nst ud dnrh fmtnur pur, qullddnrvn en hbëmd nxi`uslvn `n fusi`n snrrbtus bdtnrlmr. I“nst,

    snfa`n-t-l`, pnu bprçs `b ensirlptlmd eu dnrh tgmrbilius `md-kus pbr Ylr Igbr`ns An`` nd 271;, smus `n dmf en dnrh rnsplrbtmlrn nxtnrdn, qun hut eìirltn, pbr Xn`pnbu nd 279;,`“bttnldtn pbrb`ytlqun eu fusi`n snrrbtus bdtnrlmr bssmilìn êudn `uxbtlmd birmflmi`bvliu`blrn S2V. L` s“bklt e“udn `ìslmdrbrn. Hleelbd, nd2: enrdlçrns bddìns, en dmfarnusns pua`libtlmds smdtvnduns rbppmrtnr, tmuomurs ê prmpms en qun`quns ibs, vmlre“ud ibs lsm`ì, udn dmuvn``n ibusn pmssla`n en pbrb`ysln eusnrrbtus bdtnrlmr. @b p`upbrt ens `ìslmds dnrvnusns kuìrlssndtspmdtbdìfndt bussl, `ns pua`libtlmds iglrurklib`ns prìsndtndt`n p`us smuvndt `n rìsu`tbt en tnigdlquns pb``lbtlvns. Yl p`u-slnurs pua`libtlmds hmdt ìtbt e“udn smuhhrbdin pmssla`n eudnrh tgmrbilius `mdkus `n `mdk en smd trbont ndtrn sb dblssbdinbu imu nt sns arbdigns en tnrfldblsmd elstb`ns ebds `n fusi`nsnrrbtus bdtnrlmr, n``ns smdt, ê dmtrn bvls, pnu imdi`ubdtns.Dmus ldslstnrmds ebds intbrtli`n sur `ns ibusns pmtndtln`̀ ns enpbrb`ysln eu snrrbtus bdtnrlmr nt `ns sltns bdbtmflquns pmssl-a`ns en imfprnsslmd nt y eìirlrmds `“nxpìrlndin en enux

    e“ndtrn dmus en dnurm`ysn eu dnrh tgmrbilius `mdkus bu dl-vnbu eu tgmrbx.

    1. Qbppn` ens zmdns bdbtmflquns pmtndtln``nsen imfprnsslmd

    @n dnrh tgmrbilius `mdkus dbät ens arbdigns bdtìrlnurnsens rbildns I> nt I8 ebds prbtlqunfndt tmus `ns ibs, enI; ebds p`us ens 1/9 ens ibs S8V vmlrn I8 pbssndt`n p`us smuvndt ê trbvnrs `n fusi`n sib`ndus fnelus puls

    s“bdbstmfmsndt ê `b arbdign lssun en I; qul pbssn ndtrn `nfusi`n sib`ndus fnelus nt `n fui`n sib`ndus bdtnrlmr, ndbrrlçrn eu pbqunt vbsiu`blrn, nd rnkbre eu prnflnr mu euenuxlçfn nspbin ldtnrimstb` S8’ b ud ib`larn ìkb` mu supìrlnur êin`ul ens butrns arbdigns. @n dnrh, udn hmls imdstltuì, rnomldt

    ndsultn `b « kbldn bxl``blrn ³, i“nst-ê-elrn `n hbsilb ndtmurbdt`n pbqunt p`nxlqun nd brrlçrn en `b i`bvliu`n nt pìdçtrn inttn

    « kbldn ³ nd rnkbre eu smffnt en `b prnflçrn iõtn S;,7V. ZmurB`nxbdern, l` d“nxlstn pbs, bu dlvnbu inrvlib`, e“ì`ìfndtsbdbtmflquns trbdsvnrsbux susinptla`ns en hbvmrlsnr `b imf-prnsslmd dnrvnusn 3 ̀ ns fusi`ns mfmgymíelnd nt smus-i`bvlnr,`ns brtçrns sibpu`blrn pmstìrlnurn, inrvlib`n trbdsvnrsn supnr-fliln``n nt fbffblrn nxtnrdn irmlsndt `n dnrh, fbls dn snf-a`ndt pbs envmlr `n imfprlfnr S8V (Hlk. 2).

    Ndtrn sb smrtln ens sib`çdns nt `“bdk`n pmstìrlnur en `benuxlçfn iõtn, `n dnrh ensinde ma`lqunfndt e“bvbdt nd br-rlçrn nd hblsbdt ud bdk`n e“ndvlrmd 9: º bvni `“gmrlzmdtb`ntmuomurs ebds `b kbldn eu p`nxus arbiglb` S7V (Hlk. 1).

    @n dnrh nst lil prmign ens amursns sìrnusns smus-

    imrbimíelnddns nt smus-sibpu`blrn S;,2:V. Nd sn rìfiìiglssbdtsur `b enuxlçfn iõtn, `n dnrh igbdkn dnttnfndt en elrnitlmd ntenvlndt vnrtlib` S7,22V. Gnstnr eìirlt udn kbldn flarnusn qulsmutlndt nt ndrman `n dnrh `mrs en smd brrlvìn sur `b pbrtlnsupìrlnurn eu snrrbtus bdtnrlmr S 2::/ >> 25/2> 75/7> 1/:I8 2::/87 15/17 ;5/;: 1/1I; ; 77/75 9/25 2/1I7 7/1 2::/2:: : :

    Hlk. 2. Qnprìsndtbtlmd sigìfbtlqun eu trbont eu dnrh tgmrbilius `mdkus. @ndnrh qulttn `“nspbin inrvlib` nt sn elrlkn nd brrlçrn pmur rnomldern `b kbldnbxl``blrn. L` qulttn inttn enrdlçrn nt ensinde vnrtlib`nfndt sur `n f. snrrbtusbdtnrlmr, tmuomurs nd brrlçrn en `b `lkdn bxl``blrn fmynddn.

    Y85   I. Eufmdtlnr nt b`. / Iglrurkln en `b fbld 19 (1::5) Y89’Y;8 

  • 8/20/2019 nerf thoracique Long

    3/14

    Gnstnr, `b « kbldn ³ ebds `bqun``n ignfldn `n dnrh sur `nselkltbtlmds supìrlnurns eu snrrbtus bdtnrlmr ndtrbädn udn imu-eurn eu dnrh `mrs en `b flsn nd baeuitlmd nt rmtbtlmd nxtnrdneu arbs Sn elkltbtlmds S21V. Nd prmonitlmd, `n dnrh tgmrbilius`mdkus nst tmuomurs nd brrlçrn en `b `lkdn fìelmbxl``blrn,

    i“nst-ê-elrn pmstìrlnur buxarbdigns iutbdìns lssuns ens pìel-iu`ns ldtnrimstbux S25V. @n dnrh emddn, ebds smd trbont tgmrb-ilqun, ens arbdigns ìtbkìns pmur `ns elhhìrndtns elkltbtlmdseu fusi`n snrrbtus bdtnrlmr. @b ensirlptlmd en inttn tnrfldbl-smd nst vbrlba`n sn`md `ns butnurs.

    Krnkk b prmpmsì en elvlsnr `n fui`n snrrbtus bdtnrlmr ndtrmls snkfndts S2>V. ^d snkfndt prmxlfb` qul s“ldsçrn sur `nsenux prnflçrns iõtns nt sn tnrfldn sur `n amre supnrmfìelb`en `b sibpu`b. Nd hblt, in snkfndt supìrlnur dn s“ldsçrn sur `nsprnflçrns nt enuxlçfns iõtns qun ebds fmlds en >: % ensibs, nt sur udn snu`n en ins enux iõtns ebds `“butrn fmltlìS28V. Nd rnvbdign, l` sn tnrfldn tmuomurs sur `“bdk`n supìrm-fìelb` S28V. Md dn sblt pbs bitun``nfndt sl inttn pbrtln supì-rlnurn b ud rõ`n elhhìrndt en `“ndsnfa`n eu fusi`n S28V. ZmurB`nxbdern, `n dnrh lssu en I>I8 lddnrvn en hbëmd nxi`uslvn`ns elkltbtlmds supìrlnurns eu snrrbtus bdtnrlmr ebds 51 ibssur ;: S8V, b`mrs qu“l` nst lddnrvì en hbëmd nxi`uslvn pbr udnarbdign lssun en I> ebds > % ens ibs pmur Gmrwltz  S;V. @nenuxlçfn snkfndt fusiu`blrn nst fld nt `brkn nt rn`ln `ns 9n, 5n

    nt >n iõtns bvni `n amre rbiglelnd en `b sibpu`b. L` nxlstnrblt,ndtrn `b arbdign pmur `ns enux elkltbtlmds supìrlnurns nt `nsbutrns arbdigns, udn zmdn en 1 ê 7 if ebds `bqun`̀ n `n dnrh dnemddn buiudn arbdign S8V. @ns ildq enrdlçrns elkltbtlmds, en`b slxlçfn ê `b 2:n iõtn sn tnrfldndt ê `“bdk`n ldhìrlnur en `bsibpu`b nt snrblndt lddnrvìns en hbëmd butmdmfn ebds > %

    ens ibs S;V S28V. ^dn pbrtlilpbtlmd ens dnrhs ldtnrimstbux ê`“lddnrvbtlmd ens elkltbtlmds ldhìrlnurns b ìtì dmtìn ignz 1: %ens suonts pbr Gmrwltz, fbls db p`us obfbls ìtì rbppmrtìn S;V.Ebds `b pbrtln elstb`n en smd trbont, `n dnrh tgmrbilius `mdkusnst rnomldt pbr `b arbdign en elvlslmd bdtìrlnurn en `“brtçrntgmrbim-emrsb`n, mu brtçrn prldilpb`n eu snrrbtus bdtnrlmr,enstldìn bu ignh elstb` eu fusi`n. Inttn brtçrn pbssn nd bvbdteu dnrh bu fmfndt mü n``n pìdçtrn smus `n hbsilb eu fusi`nsnrrbtus bdtnrlmr. @n irmlsnfndt ndtrn `“brtçrn nt `n dnrh tgm-rbilius `mdkus nst ud pmldt en rnpçrn rn`btlvnfndt imdstbdtdmffì « irmw“s hmmt `bdefbrc ³ pbr Iuberms nt b`.  S2;V.Ebds 15 ê >: % ens ibs, l` nxlstn udn butrn arbdign brtìrln``nqul prìirmlsn `n dnrh ud pnu nd bfmdt S2;V (Hlk. 5).

    Ebds smd nxpìrlndin ens `bfanbux en snrrbtus bdtnrlmrS27V, @bu`bd b eìimuvnrt qun inttn zmdn pmuvblt ïtrn pmtnd-

    Hlk. 1. Qnprìsndtbtlmd sigìfbtlqun eu trbont eu dnrh tgmrbilius `mdkus. @ndnrh qulttn `ns sib`çdns nt sn elrlkn e“bamre nd brrlçrn puls hblt ud imuen ndrnkbre en `b enuxlçfn iõtn nt p`mdkn vnrtlib`nfndt ebds `n tgmrbx (e“bprçsKrnkk).

    Hlk. 9. Qnprìsndtbtlmd sigìfbtlqun en `b imueurn pmtndtln``n eu dnrh tgmrb-ilius `mdkus. @n dnrh, qul b qulttì `n pbqunt vbsiu`mdnrvnux bxl``blrn, nst

    pbrhmls flxìsur `“bpmdìvrmsneu fusi`n snrrbtus bdtnrlmr nt pnut ïtrn imueì ntfls nd tndslmd `mrs en `b flsn nd baeuitlmd nt rmtbtlmd nxtnrdn eu arbs.(e“bprçs Gnstnr nt Narbgnlf).

    Y8>I. Eufmdtlnr nt b`. / Iglrurkln en `b fbld 19 (1::5) Y89’Y;8 

  • 8/20/2019 nerf thoracique Long

    4/14

    tln``nfndt pbtgmkçdn pmur `n dnrh. Nd nhhnt, b`mrs qun `n dnrh tgmrbilius `mdkus nst rn`btlvnfndt fmal`n nd rnkbre en `bpmrtlmd fmynddn eu snrrbtus bdtnrlmr, l` envlndt flxì bu dl-vnbu eu amre prmxlfb` en `b pmrtlmd elstb`n eu fusi`n, oustnbvbdt sb elvlslmd nd arbdigns tnrfldb`ns. Inttn zmdn imrrns-pmde bu irmlsnfndt eu dnrh bvni `“brtçrn prldilpb`n `mrs en sb

    pìdìtrbtlmd smus `n hbsilb eu hblsinbu en pmldtn eu snrrbtusbdtnrlmr (Hlk. >).

    @“ìtuen bdbtmflqun en Yigu`tns b fmdtrì qun `n dnrh snelvlsn nd trmls arbdigns tnrfldb`ns ebds if), zmdnmü`n dnrh nst `n p`us `mld en`b sibpu`b S21,29V. @bpmldtn en `b

    sibpu`b ìtbdt trçs fmal`n, n``n imfprlfn `n dnrh sur `n fui`nsnrrbtus ebds `ns fmuvnfndts e“beeuitlmd, tbdels qun `nsfmuvnfndts e“baeuitlmd ì`mlkdndt `b pmldtn en `b sibpu`bqul tlrn sur `n pìeliu`n vbsiu`mdnrvnux S21V.

    Zmur B`nxbdern, `b `mdkunur eu dnrh, bprçs `b rìudlmd ensarbdigns prmxlfb`ns, vbrln en ; ê 1: if  S8V. Yb `mdkunurtmtb`n vbrln en 15 ê 9: if pmur B`nxbdern, n``n nst en 17 ifpmur Gmrwltz nt en 12,< if pmur Cbuppl`b   S;,21,8V. @b`mdkunur eu dnrh ndtrn `b i`bvliu`n nt sb elvlslmd nst en21,2 if ( ² :,;) nt `ns arbdigns en elvlslmd hmdt 1,> if( ² :,9) S2V S2:V. @“bttnldtn en inttn hmditlmd ldsplrbtrlin d“b pbs enimdsìqundin i`ldlqun qubde n``n nst lsm`ìn. Nd rnvbdign, `bpbrb`ysln eu snrrbtus bdtnrlmr rntndtlt krbvnfndt sur `b eydb-flqun en `“ìpbu`n. @n fui`n snrrbtus bdtnrlmr nst ud prmtrbi-

    tnur en `b sibpu`b. Ymd rõ`n prldilpb` nst en stbal`lsnr `bsibpu`b sur `n tgmrbx nd `“nfpïigbdt en absiu`nr butmur ensmd bxn `mrs en `“ì`ìvbtlmd eu arbs S2V. Nd ibs en pbrb`ysln, `bsibpu`b absiu`n vnrs `“brrlçrn nt `n enebds `mrs en `“ì`ìvbtlmdeu arbs smus `“nhhnt en smd pmles  S1:V. Bssmilì bu fusi`ntrbpnzlus, `n fui`n snrrbtus bdtnrlmr pnrfnt ud fmuvnfndten smddnttn nxtnrdn en `b sibpu`b, fmuvnfndt qul, nd absiu-`bdt `b surhbin k`ìdmíelnddn vnrs `n gbut, pnrfnt ê `“baeuitlmdnt `“ì`ìvbtlmd eu arbs en eìpbssnr ’;7) ebds `b sìrln en Xbstbfbcl  S5V. L`

    nxlstn udn prìemfldbdin e“bttnldtn eu dnrh tgmrbilius ̀ mdkusermlt, y imfprls ignz `ns kbuignrs S2:,1:V. Ebds udn bdb`ysnbdilnddn en `b `lttìrbturn Omgdsmd rntrmuvblt 79 % e“bttnldtneu iõtì ermlt nt l` bvblt, ebds sb sìrln, 27 bttnldtns ermltns ignz1: pbtlndts   S1:V.   Ebds `b sìrln en Xbstbfbcl, 77 % ensbttnldtns imdinrdblt `n dnrh tgmrbilius `mdkus ermlt S5V. 2< ens1: pbtlndts en Hmm ìtblndt ermltlnrs nt bttnldts eu iõtì ermlt, `nsnu` kbuignr ìtblt bttnldt eu iõtì kbuign S12V. Ebds `b sìrln en@bsibr nt @bu`bd, tmus `ns pbtlndts ìtblndt ermltlnrs S11V.

    @n elbkdmstli en `“bttnldtn eu dnrh tgmrbilius `mdkus (mueu fui`n snrrbtus bdtnrlmr) rnpmsn sur `“bssmilbtlmd en ?• emu`nurs ? `ns emu`nurs smdt ldtndsns nt imdstbdtns ebds `b

    dìvrb`kln bfymtrmpglqun (sydermfn en Zbrsmdbkn nt Uur-dnr). Ebds `ns butrns ìtlm`mklns, `b emu`nur nst p`us vbrlb-a`n. @“bttnldtn nst p`us smuvndt strlitnfndt ldem`mrn pmur

    Hlk. 5. @b zmdn en imfprnsslmd tgmrbilqun eu dnrh tgmrbilius ̀ mdkus eìirltnpbr @bu`bd nt @bsibr sn sltun bu irmlsnfndt eu dnrh nt en ̀ “brtçrn tgmrbimemr-sb`n.@“brtçrn prìirmlsn `n dnrhbu fmfndt mü n``n s“ndkbkn smus`“bpmdìvrmsneu fusi`n snrrbtus bdtnrlmr.

    Hlk. >.

     Xun pnrmpìrbtmlrn en `b imfprnsslmd eu dnrh tgmrbilius `mdkus(fiçign ìpblssn) smus `b arbdign brtìrln``n bdtìrlnurn en `“brtçrn tgmrbimemr-sb`n (fiçign fldn).

    Y88   I. Eufmdtlnr nt b`. / Iglrurkln en `b fbld 19 (1::5) Y89’Y;8 

  • 8/20/2019 nerf thoracique Long

    5/14

    qun`quns butnurs   S19V,   `ns emu`nurs smdt rbrns pmure“butrns   S15V,   n``ns ìtblndt hrìqundtns, qun``n qun smlt`“ìtlm`mkln pmur `b p`upbrt ens butnurs   S5,1>,12V.   N``nsìtblndt imdstbdtns ebds `b sìrln en @bsibr nt @bu`bd, tmu-

     omurs sibpu`blrns pmstìrlnurns mu `btìrmtgmrbilquns S11V.Ins emu`nurs imnxlstndt smuvndt bvni udn hbtlkbal`ltì en`“ìpbu`n S12V.

    • hbla`nssn fusiu`blrn bvni elfldutlmd en `b fmal`ltì en`“ìpbu`n ? ebds `ns hmrfns fmeìrìns, l` dn s“bklt qun e“udnsndsbtlmd en arbs `mure `mrs en `b finxlmd bdtìrlnurn eu arbsS19V.  Ebds `ns hmrfns p`us sìvçrns, `“ì`ìvbtlmd eu arbsbu-enssus en V. Ignz `ns enuxpbtlndts prls nd igbrkn nd biilendt en trbvbl ,̀ `n tbux e“LZZebds `b sìrln en Hnry ìtblt en 27 nt 9> % S2V.

    • sibpu`b b`btb ? n``n imrrnspmde bu eìim``nfndt eu amre

    fìelb` en `b sibpu`b, p`us fbrquìn bu eìaut en `“ì̀ ìvbtlmd(arbs nd nxtndslmd nt supldbtlmd S22V) mu `mrs en `b rntmf-aìn eu arbs (Hlk. ;). Ebds `ns hmrfns `ns p`us fmeìrìns,n``n bppbrbät `mrsqu“md enfbden bu pbtlndt en hblrn enspmfpns imdtrn ud fur mu `mrs en `b finxlmd eu imuenimdtrn rìslstbdin S1:V. N``n bppbrbät nd kìdìrb` snimdebl-rnfndt, ebds `ns enux snfbldns bprçs `n eìaut ens trmua`nsS12,15V. @b sbl``ln en `b sibpu`b sn vmlt ìkb`nfndt ebdse“butrns pbrb`yslns en `b inldturn sibpu`blrn, fbls qun`-quns elhhìrndins i`ldlquns pnrfnttndt en elhhìrndilnr `nselhhìrndts tba`nbux i`ldlquns (Uba`nbu 1).@b imdflrfbtlmd elbkdmstlqun rnpmsn sur `“ì`nitrmfymkrb-

    pgln qul, ebds `b `lttìrbturn nt ebds dmtrn nxpìrlndin, fmdtrnen hbëmd gbaltun``n ud b``mdknfndt en `b `btndin elstb`n eudnrh imfpbrbtlvnfndt bu iõtì mppmsì.

    In elbkdmstli pmurrblt ïtrn fìimddu imffn `n `blssnpndsnr `n trbvbl` en [brdnr qul rbppmrtn gult pbtlndts (sur 25)

    Hlk. 8. @n rõ`n prmtrbitnur eu fusi`n snrrbtus bdtnrlmr. B ? nd ibs en pbrb`y-sln, `b sibpu`b absiu`n nd enebds `mrs en `“ì`ìvbtlmd eu arbs in qul ê tnrfnhbtlkun `ns butrns fusi`ns pìrlsibpu`blrns (e“bprçs Omgdsmd). A ? vun i`ldl-qun.

    Hlk.;. Yibpu b̀ b`btb.Ebds `nshmrfns sìvçrns, `b sibpu`b b`btb nstvlslà n eçs

    `n eìaut en `“ì`ìvbtlmd eu arbs. N``n nst flsn nd ìvlendin ebds `ns hmrfnsfmlds sìvçrns nd enfbdebdt bu pbtlndt en « hblrn ens pmfpns ³ imdtrn udfur.

    Y8;I. Eufmdtlnr nt b`. / Iglrurkln en `b fbld 19 (1::5) Y89’Y;8 

  • 8/20/2019 nerf thoracique Long

    6/14

    emdt `n elbkdmstli b ìtì fìimddu, ildq e“ndtrn nux bybdt nuud tmtb` en 2; ldtnrvndtlmds bvbdt qu“ud elbkdmstli imrrnit dn

    smlt hblt S1>V.@“ìvm`utlmd dbturn``n sn hblt vnrs udn inrtbldn rìiupìrbtlmdnd 8’21 fmls, sbuh ebds `b dìvrb`kln bfymtrmpglqun enZbrsmdbkn nt Uurdnr mü `b rìiupìrbtlmd pnut s“ìtb`nr sur 1 ê9 bds. N``n nst p`us rbplen, nd engmrs eu Zbrsmdbkn-Uurdnrpmur e“butrns butnurs nt ldhìrlnurn ê fmls S18V. @b  rnstltutlmbe ldtnkruf snfa`n rbrn, fbls `ns sìrlns i`ldlquns en trbltn-fndt imdsnrvbtnur smdt pnu prìilsns, imfptn tndu en `b fu`-tlp`liltì ens ibusns. Ebds `b sìrln en Cbuppl`b en 91 `ìslmdslbtrmkçdns, snu`s trmls pbtlndts smdt imdsleìrìs imffn kuìrlsS1;V. @ns 1< butrns pbtlndts sn p`blkdndt e“udn hbtlkbal`ltì ê`“nhhmrt (77 %), vmlrn e“udn lfpmsslal`ltì ê trbvbl``nr `ns arbsnd `“blr (>5 %). 1; % mdt udn sibpu`b b`btb pnrfbdndtn nt58 % udn sibpu`b b`btb `mrs ens nhhmrts S1;V. Ebds smd bdb`ysnen `b `lttìrbturn, Hnry rntrmuvn ndvlrmd 9: % en rìsu`tbtsldsuhflsbdts bprçs trbltnfndt imdsnrvbtnur, inrtblds butnursrbppmrtbdt fïfn enux tlnrs en fbuvbls rìsu`tbts S2V. Ynkmdesb tndtì en rìsufnr `ns rìsu`tbts i`ldlquns eu trbltnfndtimdsnrvbtnur en qun`quns pua`libtlmds S17V (Uba`nbu 9).

    @n trbltnfndt imdsnrvbtnur imdslstn nssndtln``nfndt ê bt-tndern udn rìiupìrbtlmd spmdtbdìn. Ens nxnrilins e“ì`ìvbtlmdeu arbs nd pmsltlmd imuigìn (pmur stbal`lsnr `b sibpu`b) smdtprmpmsìs sbds inrtltuen sur `nur ldtìrït   S1 % ens pbtlndts ebds `b sìrln en Cbuppl`b,

    prçs en < fmls, ndtrn 9 nt 21 gnurns pbr omur. Ê `“ldvnrsn, n``nssmdt imdsleìrìns imffn ldutl`ns pbr anbuimup e“butnurs

    S1>,92V. Ins mrtgçsns, prmpmsìns eçs `n eìaut eu slçi`n, mdtìtì rìku`lçrnfndt fmelflìns ibr, ebds `“ndsnfa`n, n``ns smdtfb` tm`ìrìns nt pnu pmrtìns. Dmus d“nd bvmds buiudn nxpì-rlndin, fbls udn sìrln rìindtn rbppmrtn `“utl`lsbtlmd e“udnmrtgçsn ignz 25 pbtlndts nt hblt udn rnvun imfp`çtn en `b`lttìrbturn sur `ns elhhìrndtns mrtgçsns S91V.

    5. Ìtlm`mklns ens `ìslmds eu dnrh tgmrbilius `mdkus

    N``ns smdt nxtrïfnfndt dmfarnusns nt mdt bldsl ìtì ldirl-fldìns ?• udn smuhhrbdin pmsltlmddn``n, dmtbffndt `mrs e“bdnstgì-

    slns S5,2:,1;,17V. Zmur Cbuppl`b, `n dnrh pnut ïtrn imf-prlfì (mu ìtlrì) `mrs ens bdnstgìslns qubde `n snrrbtusbdtnrlmr envndu dmd hmditlmddn` d“nfpïign p`us `b sib-pu`b en vndlr ìirbsnr `n dnrh, dmtbffndt qubde `n arbs nstp`biì sur `n tgmrbx eu pbtlndt S21V 3

    • `n pmrt en igbrkns `murens, dmtbffndt `n pmrt prm`mdkìe“ud sbi ê ems `murenfndt igbrkì imffn md `n rndimdtrnignz `ns fl`ltblrns   S22,15,17V  mu ignz ens muvrlnrs euaátlfndt S99,95V. ^dn trbitlmd vlm`ndtn sur udn pmlkdìne“butmfmal`n nst ud fìibdlsfn imfpbrba`n S15V 3

    • ens trbufbtlsfns en `“ìpbu`n S2,17,1V, qu“l`s s“bkls-sndt en igmi elrnit (hrbppì pbr ud ignvb`)  S15V mu e“udn

    igutn sur `“ìpbu`n  S15V.  Ins trbufbtlsfns smdt pbrhmls

    Uba`nbu 1Ylkdns i`ldlquns ens elhhìrndtns ìtlm`mklns en eìim``nfndt en `b sibpu`b

    Ylkdns i`ldlquns Zbrb`ysln eu snrrbtus bdtnrlmr (dnrh  tgmrbilqun ̀ mdk)

    Zbrb`ysln eu trbpçzn (dnrh spldb`biinssmlrn)

    Hbla`nssn ens rgmfamíens (dnrh spldb`emrsb` mu rbildn I>)

    Emu`nur « Fldlfn ³, ̀ mib`lsìn ê ̀ b rìklmd

    inrvlib`n lrrbelbdt ê `b rìklmd sibpu-`blrn pmstìrlnurn nt/mu `btìrm-tgmrbilqun

    Elsirçtn ê fmynddn, `mib`lsìn ê `b

    hmssn suprbsibpu`blrn nt ê `“ìpbu`n

    Emu`nur prìemfldbdtn, surtmut ̀ n

    `mdk eu amre fìelb` en `b sibpu`b

    Eìim``nfndt en `b sibpu`b ê `“nhhmrt Bukfndtìn pbr ǹs fmuvnfndtse“ì`ìvbtlmd bdtìrlnurn nt pbr `ns fmu-vnfndts en « pmfpn ³

    Bukfndtìn pbr ̀ ns fmuvnfndtse“baeuitlmd ê gbutnur e“ìpbu`n

    Flnux bpprìilìn nd enfbdebdt bupbtlndt en ablssnr `ndtnfndt `ns arbse“udn pmsltlmd e“ì`ìvbtlmd bdtìrlnurn

    Eìhmrfbtlmd bu rnpms Fldlfn Bfymtrmpgln eu trbpçzn, igutn ensìpbu`ns

    Fldlfn, pbrhmls btrmpgln ens rgmf-amíens

    Eìp`binfndt en `b sibpu`b ê `“nhhmrt @“bdk`n ldhìrlnur en ̀ b sibpu`bs“ìibrtn en `b `lkdn ens ìpldnusns

    @“bdk`n ldhìrlnur sn rbpprmign en `b`lkdn ens ìpldnusns

    K`lssnfndt `btìrb` nt emrsb`, surtmut`b pbrtln ldhìrlnurn

    Uba`nbu 9rìsu`tbts ens trbltnfndts dmd mpìrbtmlrns ebds `b `lttìrbturn

    Ìtlm`mklns Dmfarn en ibs Qìsu`tbts Qniu`Omgdsmd, 2> Xbrlìns 1: 8 Nxin``ndts, 5 Amds, 2: fmynds 8 fmlsKmmefbd, 2 Xbrlìns 21 > Nxin``ndts, 9 Fmynds, 5 fbuvbls 5, > bdsKmzdb, 2

  • 8/20/2019 nerf thoracique Long

    7/14

    bssmilìs ê e“butrns `ìslmds, pbr nxnfp`n ignz ud `uttnurbybdt nu ìkb`nfndt udn hrbiturn en `b i`bvliu`n nt udn`uxbtlmd stnrdmi`bvliu`blrn S9:V. Md nd rbpprmign `ns `ì-slmds masnrvìns bprçs ud biimuignfndt `mrs e“udn trbi-

    tlmd prm`mdkìn sur `ns bppuls  S5,12,98,9;V,  mu ignz udpbrbp`ìklqun S97V, bprçs `n pmrt en ibddns S5V, e“ud p`átrnS9;V mu bprçs igmi ì`nitrlqun S9,51V, ud ouemcb bprçs udn `uxbtlmd e“ìpbu`n S59V,ud brignr S12,55V, ud `uttnur S7,2>V, ud gmicnynur bprçsudn igutn sur `b fbld, ud kyfdbstn qul hblsblt ens bddnbuxS2>V, udn vm``nynusn S5>V nt ud omunur en amw`ldk S2>,15V.@n tnddls snrblt `n spmrt `n p`us smuvndt lfp`lquì (dmtbf-fndt `mrs eu snrvlin) S58V. @n spmrt ìtblt rnspmdsba`n en9> % ens `ìslmds pmur Xbstbfbcl S5V 3

    • aró`urns S5;V, sìqun``ns en rbelmtgìrbpln S57V, @upus S5:V 3

    • fb`hmrfbtlmds bdbtmflquns, dmtbffndt udn iõtn inrvl-ib`n S>2V 3

    •  ebds inrtbldns `ìslmds dnurm`mklquns, bu snds `brkn, `bpm`lmfyì`ltn nst rnspmdsba`n e“ud ibs al`btìrb`   S2V.  @nsibusns dnrvnusns `ns p`us hrìqundtns smdt nssndtln``nfndt`b « dìvrltn arbiglb`n ³, sydmdyfn en `b dìvrb`kln bfym-trmpglqun mu sydermfn en Zbrsmdbkn nt Uurdnr trmdquì.Ebds `b ensirlptlmd prldinps en Zbrsmdbkn nt Uurdnr, l` ybvblt 9: pbrb`yslns lsm`ìns eu snrrbtus bdtnrlmr sur `ns298 ibs S>1V. In tnrfn `brkn rnprnde ens pbrb`yslns qulhmdt sultn ê udn ldhnitlmd ebds ndvlrmd 1> % ens ibs S2,>9V,mu ê udn rìbitlmd b``nrklqun ebds 2> % ens ibs  S>5V. N``n

    tmuign ndvlrmd 2,85 ibs / 2:: :::  S>>V. Inttn pbtgm`mklnnst ibrbitìrlsìn pbr ud eìaut arutb` bvni udn emu`nurldtndsn qul eurn en qun`quns gnurns ousqu“ê trmls snfbl-dns, bukfndtìn pbr tmus `ns fmuvnfndts eu arbs, fbls pbspbr `ns fbdřuvrns e“gypnrprnsslmd rbiglelnddn S>5,>>V.@b pbrìsln bppbrbät ebds `n fmls qul sult `“bppbrltlmd ensemu`nurs ignz 7> % ens pbtlndts S>5,>>V. @“bttnldtn nst p`ushrìqundtn ignz `“gmffn ebds ud rbppmrt en 1/2 ê 22,>/2S>>V. @b rìiupìrbtlmd nst imfp`çtn ignz 5,>>V. Ê `“gnurn bitun`̀ n, `“ìtlmpb-tgmkìdln nst tmtb`nfndt ldimddun S>>V. Md pnut nd rbpprm-ignr `ns pbrb`yslns rbppmrtìns bprçs nxpmsltlmd bu hrmleS22,1:,98V, vbiildbtlmd, ldonitlmd en sìruf bdtltìtbdlqunS1:,18V, inrtbldns dnurmpbtglns tmxlquns S1:,1;V. ^d ibs b ìtì rbppmrtìbssmilbdt pbrb`ysln eu snrrbtus bdtnrlmr, ìpbu`n kn`ìn ntrbeliu`mpbtgln inrvlib`n S>7V 3

    • `ns `ìslmds lbtrmkçdns, qul rnprìsndtblndt 91 ibs sur 2V 3

    I  a`mis bdnstgìslquns ldhrbi`bvliu`blrns S5V 3• ndfld `ns `ìslmds lelmpbtglquns, emdt `b hrìqundin eìpnde

    ens sìrlns nt qul mdt rnprìsndtì 22 % ens ibs pmur Xbstb-fbcl S5V, fbls elx ibs sur `ns 1: ebds `b sìrln en Hmm S12V.Yur `ns 222 ibs rbppmrtìs pbr Omgdsmd nt Cndeb``, 29 sn-rblndt eus bu hrmle, gult ê ens ldonitlmds en tmxldns nt29 snrblndt lelmpbtglquns in qul hblt prnsqun 9: % enibusns ldimdduns S1:V.L` sn eìkbkn, en inttn ìdufìrbtlmd ê `b Zrìvnrt, qun `b

    fbonurn pbrtln ens `ìslmds snfa`n hblrn sultn ê ud fìibdlsfnen trbitlmd. @b rmtbtlmd en `b tïtn eu iõtì mppmsìn ê `“ìpbu`n,bssmilìn ê udn ì`ìvbtlmd eu arbs emua`n `b `mdkunur eu dnrh ndtrn sns enux pmldts flxns, `b smrtln ens sib`çdns nt `b « flxb-tlmd ³ eu dnrh pbr `n hbsilb ens elkltbtlmds fusiu`blrns supì-

    rlnurns  S2>V.  @“ì`ìvbtlmd eu arbs ndtrbädn ud eìp`binfndtpmstìrlnur, ldhìrlnur nt `btìrb` eu dnrh  S2>V. @“bssmilbtlmd ensenux fmuvnfndts, dmtbffndt ignz `ns btg`çtns, pmurrbltbldsl nxp`lqunr `ns ìtlm`mklns flirmtrbufbtlquns. Inttn mpl-dlmd nst inpndebdt imdtrneltn pbr Xbstbfbcl qul pndsn qu“udnhhmrt prm`mdkì mu ud fmuvnfndt arutb` snrblt p`us smuvndtrnspmdsba`n S5V. Enpuls Kmmefbd, l` nst gbaltun` en elrn qun`ns pbrb`yslns pmst trbufbtlquns rìiupçrndt fmlds alnd qun`ns `ìslmds « tmxlquns ³ mu « ldhnitlnusns ³ S1. @b imfprnsslmd eu dnrh tgmrbilius `mdkus

    nxlstn-t-n``n =

    @“ìtuen en `b `lttìrbturn fmdtrn qun `n elbkdmstli en imf-prnsslmd nst rbrn sldmd ldnxlstbdt. Run`quns butnurs mdt in-pndebdt eìirlt ens imfprnsslmds eu dnrh tgmrbilius `mdkus.^dn pua`libtlmd ltb`lnddn hblt ìtbt e“udn imfprnsslmd eu dnrh tgmrbilius `mdkus pbr udn iõtn inrvlib`n surdufìrblrn emdt`“ba`btlmd b pnrfls `b kuìrlsmd   S>2V.   Buiudn ensirlptlmdbdbtmflqun d“nst hbltn nt l` dn snfa`n pbs qun `ns butnursblndt dnurm`ysì spìilflqunfndt `n dnrh tgmrbilius `mdkus.Elstnhbdm rbppmrtn `n ibs e“udn onudn fl``n en 21 bds qul b vubppbrbätrn udn pbrb`ysln eu snrrbtus bdtnrlmr, spmdtbdìfndtrìsm`utlvn nd slx fmls bprçs brrït eu Xm``ny-Ab`` (prbtlquì enhbëmd bssnz pnu bssleun) S5>V. @n elbkdmstli rntndu nst in`ule“udn imfprnsslmd pbr imdtrbitlmd rìpìtìn eu sib`ndus fn-

    Y8

  • 8/20/2019 nerf thoracique Long

    8/14

    elus. L` d“y b ebds inttn pua`libtlmd buiud brkufndt sìrlnuxpmur bhflrfnr `b imfprnsslmd, dl sb `mib`lsbtlmd ebds `n sib-`ndus fnelus, gypmtgçsn qul bvblt e“bl``nurs ìtì prmpmsìnpmur ïtrn rnontìn pbr Gmrwltz eçs 2V.

    Zbrfl `ns pmssla`ns ibusns en imfprnsslmd prmpmsìns,Gmrwltz bvblt ndvlsbkì ̀ b imfprnsslmd pbr ̀ ns amursns sìrnu-sns smus-imrbimíelnddns (ìtlm`mkln qul d“b obfbls ìtì rbppmr-tìn), mu pbr `b imrbimíen `mrs eu eìp`binfndt fìelb` hmriì en`b sibpu`b S;,22V. Zmur ens rblsmds bdbtmflquns, inttn `ìslmddn pmurrblt inpndebdt ïtrn lsm`ìn nt inttn ìtlm`mkln dn fìrltnprmaba`nfndt pbs e“ïtrn rntndun S9>V.

    Zmur qu“udn imfprnsslmd nxlstn, n``n emlt sn sltunr budlvnbu mu bu-en`ê en `b enuxlçfn iõtn, bprçs `b rìudlmd ensenux arbdigns lssuns en I>I8 nt en I;.

    @bsibr nt @bu`bd mdt rbppmrtì udn ibusn dmd ndimrn eì-irltn mu ndvlsbkìn en `b imfprnsslmd eu dnrh tgmrbilius`mdkus nt `nur nxpìrlndin nst fbldtndbdt en 29 ibs en dnurm-`ysn ignz elx gmffns nt trmls hnffns, e“ákn fmynd 9: bds(nxtrïfns 27 ê 5< bds) S11V. L`s pndsndt, imffn `b p`upbrtens butnurs, qun `“bttnldtn dnrvnusn rìsu`tn nssndtln``nfndte“ud fìibdlsfn en trbitlmd, fbls qun `n pmldt flxn elstb` eudnrh sn sltun bu amre prmxlfb` eu ignh elstb` eu snrrbtusbdtnrlmr. Ê in dlvnbu, `n dnrh nst prìirmlsì pbr `“brtçrn prldil-

    pb`n eu snrrbtus bdtnrlmr bu fmfndt mü n``n pìdçtrn smushbsilb nt l` nst `ul-fïfn flxì pbr `n hbsilb bu fmfndt mü l` snelvlsn nd sns arbdigns tnrfldb`ns. @b pnrslstbdin e“udn flxb-tlmd nt/mu e“udn imfprnsslmd elstb`n nfpïign `b rìiupìrbtlmdsmlt pbr smd bitlmd elrnitn sur `n dnrh, smlt pbr `“ldtnrfìelblrnen `b tndslmd sur `n dnrh.

    8. Unigdlqun en dnurm`ysn

    @n pbtlndt nst ldstb`̀ ì nd eìiualtus emrsb`, `“gìfltgmrbxgmfm`btìrb` surì`nvì pbr al``mt. @“ldilslmd iutbdìn nst `mdkl-tueldb`n, e“udn elzbldn en if, `n `mdk eu amre bdtìrlnur eu`btlsslfus emrsll. N``n nst indtrìn sur `b >n iõtn, mu sur `n sltneu slkdn en Uldn` rnpìrì nd prìmpìrbtmlrn (Hlk. 7B). @n

    `btlsslfus emrsll nst rìi`ldì vnrs `“brrlçrn. Md rnpçrn `“brtçrntgmrbimemrsb`n nt sb arbdign en elvlslmd bdtìrlnurn, enstldìnbu ignh elstb` eu YB. @“ndermlt mü ̀ “brtçrn prnde imdtbit bvni`n fusi`n nt pìdçtrn smus smd hbsilb pnrfnt en rnpìrnr `n DU@

    qu“n``n prìirmlsn ê in dlvnbu (irmw“s hmmt `bdefbrc en Iub-erms). @“nxp`mrbtlmd rnignrign udn ìvndtun``n bdmfb`ln hbvm-rlsbdtn ? smlt udn arbdign brtìrln``n imurtn prìirmlsbdt `n dnrh nd bfmdt en `b arbdign prldilpb`n mu ens flarns fusiu`blrnsbanrrbdtns lfpmsbdt bu dnrh ud trbont nd iglibdn (Hlk. 7A).

    @b dnurm`ysn nst rìb`lsìn smus `udnttns krmsslssbdtns.Mutrn `b supprnsslmd e“udn ìvndtun``n bdmfb`ln bdbtmflqun,md rìb`lsn udn muvnrturn `brkn eu hbsilb eu snrrbtus bdtìrlnurnd rnkbre eu DU@ ousqu“ê sns arbdigns tnrfldb`ns, nd rnspni-tbdt `ns arbdigns im``btìrb`ns, en hbëmd ê rnstltunr bu dnrh udnamddn fmal`ltì pbr rbppmrt ê `b pbrml tgmrbilqun (Hlk. 7I,E).Ymuvndt nd fld e“ldtnrvndtlmd, md imdstbtn ud nhhnt e“b``mdkn-

    fndt eu dnrh bprçs dnurm`ysn (rìsnrvn en `mdkunur). @b rìì-euibtlmd nst eìautìn lffìelbtnfndt.

    Ebds `“nxpìrlndin, en @bu`bd nt @bsibr, `ns pbtlndts prì-sndtblndt ud « slkdn en Uldn` ³ pmsltlh nd rnkbre en `b >n iõtn.@mrs en `“ldtnrvndtlmd, udn bdmfb`ln vbsiu`blrn (8 ibs) mufusiu`blrn (1 ibs) b ìtì rntrmuvìn nt ebds tmus `ns ibs, `n dnrh tgmrbilius `mdkus ìtblt ndtmurì en flarmsn.

    @ns emu`nurs mdt elspbru ebds `n prnflnr fmls pmstmpìrb-tmlrn nt tmus `ns pbtlndts mdt rntrmuvì udn hmditlmd fusiu`blrnimfp`çtn mu qubsl imfp`çtn bvni ud rniu` s“ìtb`bdt en9’98 fmls. ^dn bfì`lmrbtlmd ì`nitrlqun b ìkb`nfndt ìtìdmtìn ignz tmus `ns pbtlndts S11V. (Hlk. 7N,H).

    Bitun``nfndt, `nurs ldelibtlmds pnuvndt sn rìsufnr bldsl ?• sl `b pbrb`ysln eu snrrbtus bdtnrlmr nst lsm`ìn nt qu“nxlstn

    udn dmtlmd trbufbtlqun mu ud imdtnxtn flirmtrbufbtlsfn(spmrtlh mu prmhnsslmddn`) nt nd `“basndin e“ì`ìfndts ndhbvnur e“ud sydermfn en Zbrsmdbkn-Uurdnr, `“basndin enrìiupìrbtlmd i`ldlqun nt ì`nitrmfymkrbpglqun ebds `ns slxfmls emlt imdeulrn ê udn dnurm`ysn en `b pmrtlmd tgmrbil-qun eu DU@ (Hlk.

  • 8/20/2019 nerf thoracique Long

    9/14

    7. @b stbal`lsbtlmd stbtlqun en `b sibpu`b

    @b sibpu`mpnxln imdslstn ê hblrn pbssnr ê trbvnrs `b sibpu`bp`uslnurs imtns prìb`ba`nfndt snitlmddìns. @“brtgrmeçsn sib-

    pu`mtgmrbilqun imdslstn ê ldtnrib`nr ens krnhhmds ndtrn `bsibpu`b nt ̀ ns iõtns qul smdt prìpbrìns, bprçs eìsldsnrtlmd ensrgmfamlens nt eu trbpçzn. ^dn lffmal`lsbtlmd en trmls fmls

    Hlk. 7. vuns pnrmpìrbtmlrns en `b imfprnsslmd eu dnrh tgmrbilius `mdkus.B ? Qnpìrbkn prìmpìrbtmlrn eu slkdn en Uldn` nt enssld en `b vmln e“bamre. A ? @n dnrh tgmrbilius `mdkus nst surirmlsì pbr udn arbdign en `“brtçrn tgmrbimemrsb`n. I ? qul b `blssì smd nfprnldtn sur `n dnrh. E ? `n dnrh nst `laìrì nd fld e“ldtnrvndtlmd.N,H ? rìsu`tbt i`ldlqun sur `b hmditlmd eu fusi`n snrrbtus bdtnrlmr. Bspnit prìmpìrbtmlrn nt pmstmpìrbtmlrn ê p`us e“ud bd.

    Y;2I. Eufmdtlnr nt b`. / Iglrurkln en `b fbld 19 (1::5) Y89’Y;8 

  • 8/20/2019 nerf thoracique Long

    10/14

    nst dìinssblrn S17,87V. Ins tnigdlquns prìsndtndt p`uslnursldimdvìdlndts, tgìmrlquns nt prbtlquns.• ud bspnit pnu nstgìtlqun en `b ilibtrlin emrsb`n 3• `b dìinssltì en `“utl`lsbtlmd e“udn krnhhn (l`lbqun) 3• Ens imfp`libtlmds ? hrbiturns en hbtlkun ens iõtns mu en `b

    sibpu`b, pdnufmtgmrbx `mrs eu pbssbkn ens fl`s en flxbtlmd,nt surtmut psnuebrtgrmeçsn (ousqu“ê >: % pmur GbwcldsS8

  • 8/20/2019 nerf thoracique Long

    11/14

    nxtnrdn en `b sibpu`b nt `b flxbtlmd nst pbrhmls elhflil`n.Ebds `ns tnigdlquns qul flxndt `n pnitmrb`ls fbomr sur`“ìibl``n   S;

  • 8/20/2019 nerf thoracique Long

    12/14

    Qìhìrndins

    S2V Hnry B, Ymffn`nt O. @b pbrb`ysln eu krbde endtǹ ì 3 rìsu`tbts eutrbltnfndt en 21 ibs emdt < mpìrì nt rnvun kìdìrb`n en `b `lttìrbturn.Qnv Iglr Mrtgmp Qnpbrbtrlin Bppbr Fmt 2

  • 8/20/2019 nerf thoracique Long

    13/14

    S18V Kmzdb NQ,Gbrrls [Q. Urbufbtli wldkldk mh tgnsibpu`b. O Amdn OmldtYurk Bf 281’5.

    S57V Zuk`lnsn KD, Krnnd QH, Bdtmdbiil B. Qbelbtlmd-ldeuine `mdk tgm-rbili dnrvn pb`sy. Ibdinr 2

  • 8/20/2019 nerf thoracique Long

    14/14

    S;5V Qbpp LG. Ynrrbtus bdtnrlmr pbrb`ysls trnbtne ay trbdsp̀ bdtbtlmd mh tgnpnitmrb`ls fldmr. O Amdn Omldt Yurk 25398B?7>1’5.

    S;>V Igbvns OZ. Znitmrb`ls fldmr trbdsp`bdt hmr pbrb`ysls mh tgn snrrbtusbdntrlmr. O Amdn Omldt Yurk 22399A?117’9:.

    S;8V Xbstbfbcl F. Zbrb ỳsls mh tgn snrrbtus bdtnrlmr fusi`n. Eumenilf

    232:2(2:)?