Rhizarthrose QATAR 2014

8/9/2019 Rhizarthrose QATAR 2014

1/45

AE^WZ GFG LCE@Z B^ZD^EZEW

GD^EWZEB@ J[FC@ZEK^, FJ, XDJ


2/45

NBWEGW< CWZKC-B^ZD^EZEW

• Arkquk`t, jesbnie`m, gcstiy jeskbsk

• Xrk

vbik`gk 2;% (2558) ! 24% (>8>8)

• >,4% ca jesbneiety (2558) ! 7,1% (>8>8)

• 2% ca EX ([WB)


3/45

NBWEGW - CWZKCB^ZD^EZEW CAZDK DB@J B@J AE@MK^W

• Db`j brtdretes es arkquk`t

• 1=%♈ ;;% ♎ batkr ;; ykbrs ca bmk jc dbvk b

rbjecicmegbi CB

• Wyfptcfbteg e` >8% ca gbsks

• ]etdcut rbjec-gie`egbi gcrrkibtec` `ketdkr bt c`k jby, cr

jure`m kvciutec`

• Efpcrtb`t au`gtec`bi jkflget, sbfk bs ^B (Wpbgko >88:)


4/45

« ^DE\B^ZD^CWEW ¿- 2WZ GFG LCE@Z CB

• Acrkstekr (257=)

• >`j CB e` arkquk`gy (9 EXJ)

• Bmk-bjlustkj prkvbik`gk< 2;%♈?

=% ♎ - rbrk nkacrk ;8 yrs (4% ca

wcfk`)

• ;=% ca GFG-2 CB batkr 18

• =2-288 yrs < syfptcfbteg >1%

akfbiks, 2:% fbiks (\db`m >88>)V

♈ :4 b`s

Bmk-spkgeflg prkvbik`gk rbtks (Dbbrb >88:)

Okiimrk` mrbjk >, 7, :

Okiimrk` mrbjk 7, :


5/45

• Iembfk`tcus ibxety• Dcrfc`bi

• Brteguibr dypkrfcneiety (Lñ`ssc` 255;, >884)

• Ejecpbtdeg

• Fbrab`, Kdikr ‗Jb`ics

• Au`gtec`bi cvkricbj (fbiks, TQEtd gk`tury)

• Zrbufb < Brteguibr arbgturk, iuxbtec`

• Dypcpibseb ca trbpkzeuf

KZECICMU

Xrkvk`tevk trkbtfk`t 3


6/45

EZ EW WCA^KR[K@Z, EW

ZDK^KWCFKZDE@M EWDC[IJ O@C]ZDBZ E BF @CZ

B]B^K CA 3


7/45

NECFKGDB@EGW

• Zdk 2st GFG lce`t es b gcfpikx c`k

• Gcfpbrkj tc b sbjjik c` b sgciecteg dcrsk


8/45

NECFKGDB@EGW

• Zdk lce`t es e`dkrk`tiy u`stbnik ^cik ca iembfk`ts


9/45

ZF LCE@Z E@WZBNEIEZU

• Abvcrkj ny jyspibseb ca tdk trbpkzk b`j tdk puii ca

tk`jc`s (BXI +++)


10/45


11/45

NECFKGDB@EGW

• Demdiy gc`strbe`kj lce`t< b 2om puip

pe`gd sdkbre`m icbjs ca 27 om

• " gdc`jrbi gc`strbe`ts, jcrsc-

rbjebi suniuxbtec`, 2st wkn

sdcrtk`e`m,

FX lce`t fkgdb`egbigc`skquk`gks


12/45

EZ EW B ^KMEC@BI JEWKBWK

• Escibtkj ZF lce`t e`vcivkfk`t

es rbrk

• ZF + WZZ(78-18%), Zz-

Zzcãjk (7;%), Zz->`j

fktbgbrpbi (41%)

• Ea WZZ es e`vcivkj ZF (58%)


13/45


• ^kmec`bi lce`t e`stbneiety<

• FX +++< Arc`tbi cr sbmettbi e`stbneiety -gbusk ca abeiurk ca surmegbi trkbtfk`t _Jk Wfkt, >881V -

Wtbneiesbtec` ea FX kxtk`sec` 0 78¸

• 2st wkn spbgk < Gicsurk - gbusk ca abeiurk casurmegbi trkbtfk`t _Fegdc`, 254;. Jk Wfkt, >881V


14/45


• Wcat-tessuk rkmec`bi jeskbsk< Gbrpbi tu``ki< :-:1%

ca gbsks? Zk`je`etes< AG^, Jk Rukrvbe`―s, tremmkr

fl`mkr


15/45

GIE@EGBIKTBFE@BZEC@

• Wem`s ca CB<

• Fkgdb`egbi pbe` (jure`m pe`gd -

wkbre`m temdts, tur`e`m b oky)

• Xbe` bt pbipbtec`, mreje`m tkst +,

• Wy`cvetes, jkacrfety,...

• Icss ca strk`mtd

• Zdk`br btrcpdy

• Jc `ct acrmkt tc kxbfe`k tdk FX lce`t


16/45

^BJECICMU

• Wpkgebi T-rbys

e`gejk`gks (Obpb`jle)

• Wem`s ca CB<

gc`jk`sbtec`,

sgikrcses, lce`t

`brrcwe`m,cstkcpdytks (2st

wkn), suniuxbtec`,…


17/45

Wpkgebi efbme`m tkgd`equks brk uskikss


18/45

Kbtc` (25=7, 254:) Jkii (25=4, 2558) Gcftkt (>882)

Wtbjk 8E`stbneietå. E`tkriem`k `crfbi

cu åibrme. Wuniuxbtec`

råjugtenik

Wtbjk 2Gc`tcurs brteguiberks

`crfbux

E`tkriem`k `crfbi cu feèfk

pe`gkfk`t cu iåmärk

cståcgc`jk`sbtec` scus-

gdc`jrbik. Xbs jk suniuxbtec`,

cu j―cståcpdytk

Feèfk pe`gkfk`t.

Cstkcpdytks. Wuniuxbtec` `c`

råjugtenik

Wtbjk >

Feèfk pe`gkfk`t cu iåmärk


gdc`jrbik. Cståcpdytks cu

gcrps åtrb`mkrs 9 >ff

Xe`gkfk`t, cståcgc`jk`sbtec`

scus-gdc`jrbik. Cståcpdytks.

Wuniuxbtec` 9 2/7 surabgk

brteguiberk fåtbgbrpek``k

Jåtårecrbtec` ZF,

dypkrkxtk`sec` FX råjugtenik

Wtbjk 7

Xe`gkfk`t fbrquå, måcjks kt


gdc`jrbiks. Wuniuxbtec`

vbrebnik. Arbmfk`ts

brteguiberks 0 >ff

Xe`gkfk`t fbrquå, måcjks kt


gdc`jrbiks. Cstkcpdytks.

Wuniuxbtec` 0 2/7 surabgk

brteguiberk fåtbgbrpek``k.

Jåtårecrbtec` ZF kt FX,

dypkrkxtk`sec` FX `c`

råjugtenik

Wtbjk : Brtdrcsk ZF + WZZ Brtdrcsk ZF kt WZZ. Brtdrcsk ZF kt WZZ


19/45

Z^KB ZFK@Z

• Fkjegbi

• Xdbrfbgcicmegbi ZZZ (Xbe`-oeiikrs, @WBEJ, sicw-bgtec`

b`te-brtdretes fkjegbtec` ieok scjeuf gdc`jrcekte`suiabtk), crtdcses +++, Xdysegbi ZZZ (pbrbafl`, dkbt,…)

• Wtkrcej e`lkgtec`s, Dybiurc`eg bgej e`lkgtec`s

• Es sbej tc nk kaflgek`t e` 58% ca gbsks - pbe` rkieka e`

4-22 ykbrs (Bfcr)


20/45

C^ZDCWKW

• =1% ca pbtek`ts wetd fcjkrbtk e`vcivkfk`t b`j ;:% wetd

skvkrk jeskbsk dbvk b 18% efprcvkfk`t wetd b` crtdcses(Wwembrt, 2555)

# Nk`kflgk es effkjebtk (cr `kvkr)

• Zdk typk ca crtdkses +/- pdysectdkrbpy dbs `c e`uk`gk c`tdk kvciutec` bt 1 wkkos (]blc`, Bust L Xdysectdkr >88;) - Xbtek`ts prkakr

tc effcneiezk FX & ZF lce`t cvkr c`iy tdk ZF (]kess, L Db`j Zdkr >88:) • @c jeaakrk`gk nktwkk` sdcrt (wrest es arkk) cr ic`m crtdcsks, nut

pbtek`ts prkakrrkj sdcrt crtdcsks (]kess, L Db`j Zdkr >888)

• @c jeaakrk`gk nktwkk` remej cr suppik crtdcses, nut pbtek`tsprkakrrkj tdk fcrk suppik c`k (Nuurok, Gie` ^kdbn 2555)


21/45

Z^KBZFK@Z

• K[IB^ ^kgcffb`jbtec`s (\db`m B^J >88=)<

Wurmkry es b` kaflgek`t trkbtfk`t acr GFG lce`t

brtdrcsks b`j gb` nk jc`k e` pbtek`ts wdc brkpbe`aui cr wetd b efpcrtb`t au`gtec`bi jkflget batkr

abeiurk ca fcrk gc`skrvbtevk trkbtfk`ts (AJ^ 6

14).


22/45

W[^MKÛ

• Fb`y tkgdèquks

• Wyfptcfbteg trkbtfk`t

• Brtdrcjkses (Fuiikr, 25:5)

• Cstkctcfy (]eisc`, 25=7)

• Brteguibr rkskgtec` (e.k. trbpkzkgtcfy w/wc stbneiesbtec`,

e`tkrpcsetec`,…) _Mkrves, 25:5? Arcefsc`, 25=8? Kbtc` 25=7V

• Xrcstdksks - efpib`ts _Wwb`sc`, 25=>V cr prcstdkses _Jk ib Gbaflèärk,25=:V

• Xrkvk`tevk Zrkbtfk`t 3

B td j e 27 A[


23/45

ZF B^ZD^CJKWEW

• [subiiy prcpcskj e` ycu`m pkcpik (tc fbe`tbe`

tdker strk`mtd) wetd scfk icss ca fcneiety

• @c jeaakrk`gk e` rksuits e` tdk (rbrk, rktrcspkgtevk)

gcfpbrbtevk stujeks

• 4:% sbtesabgtcry rksuits (>; ykbrs A[)

• :8% rk-e`tkrvk`tec` _GdbfbyV (Dbrjwbrk rkfcvbi,@cùèc` :%, Jk-brtdrcjkses 1%)

• « Guiturbi ¿ e`jegbtec`s tdbt jefeèsd

Brtdrcjkses ‗27 yrs A[


24/45

Z^BXK\EKGZCFU

• Xbrtebi cr gcfpiktk

• ]etd / wc e`tkrpcsetec`

• ]/wc stbneiesbtec`

www.fbetresk-crtdcp.gcf

• Zrbpkzekgtcfy biwbys ikbj tc b

jefe`utec` ca oky-pe`gd strk`mtd_Qb`jk`nrcugok, 255=V.

# Bii pbtek`ts weii gcfpibe` ca b icss ca

strk`mtd batkr trbpkzekgtcfy +++

http://www.maitrise-orthop.com/


25/45

XCZK@ZEBI X^CNIKFW

• Zdufn gciuf` weii

gciibpsk e`tc tdk

jkbj spbgk wetd tefk(8,; ff / ykbr)

• Bnutfk`t wetd

trbpkzcej b`j/crsgbpdcej

B

N

Zrbpåzebi Wpbgk ^btec 6 B/N

Objeybib & Jcw`e`m, LDW, 2551.


26/45

KNF< Z^BXK\EKGZCFU +/- E@ZK^XCWEZEC@+/- WZBNEIEWBZEC@ (JBQEW - X^CWXKGZEQKWZ[JEKW)

• 247 pbtek`ts, wetd 7 & 2> fc`tds A[

• 4>% mccj rksuits, 14% suaflgek`t strk`mtd

• Ic`m rkgcvkry (1 fc`tds). « @crfbi ¿

Fcneiety

• @c jeaakrk`gk nktwkk` mrcups# @c gcrrkibtec` nktwkk` tdk fktbgbrpbi

sdcrtk`e`m b`j oky-pe`gd strk`mtd


27/45

GCGD^B@K JBZBNBWKWUWZ ^KQ >88;

• = stujeks (; tkgd`equks) wetd 74: pbtek`ts wkrkkiemeniks

• Mbe` ca pbe` ca >=-;=/288, ca au`gtec`bi jkflget24->:/288

• @c jeaakrk`gk nktwkk` tkgd`equks

• Ikss gcfpiegbtec`s e` tdk sefpik trbpkzekgtcfymrcup (p98.882)

• 22% fcrk gcfpiegbtec`s e` tdk I^ZE mrcup(p68.87)


28/45

ZF X^CWZDKWKW

• Fb`y jksem`s

• Fcstiy Ark`gd

• 2st gbsk, Jk Ib Gbafl`eärk,

25=:


29/45

BJQB@ZBMKW CA ZFX^CWZDKWKW

• Kbriy rkgcvkry (>-7 fc`tds) - @c rkdbneietbtec`

• @c tdufn sdcrtk`e`m (Gb` nk uskj kvk` ea FX

dypkrkxtk`sec`) - kstdkteg

• 288 pts, 47% mccj rksuits (: ykbrs A[ _^km`brj >881V)

= b`s


30/45

GCFXIEGBZEC@W

• Bncut 2;%, tdbt e`grkbsk wetd tefk

• Iccsk`e`m (+/- 2;%), jesicgbtec` (+/- =%), trbpkzebi

arbgturk,…

• G/E< Zrbpkzebi jyspibseb, sdcrt cr tde` trbpkzeuf,

FX brtdrcjkses, FGI e`suaflsek`gy (FX), WZZ

brtdrcsks (ycu`m pbtek`t)


31/45

W[^QEQBI CA ZF X^CWZDKWKW

• Wurvevbi rbtk nktwkk` < 14 tc 45% (jkib Gbafl`eärk, >882? @egdcibs kt Gbijkrwcj, 255>? Qb`

Gbpkiik kt bi., 2555? Gdborbnbte kt bi., 255=? Bpbrj kt

Wbe`t-Gbst, >88=? Woytb kt bi., >88;? ]bgdti kt bi., 255=?

Gcftkt, >888? Nrutus kt Oe``k`, >88:? Lbgcuikt, >88;?

Wgdudi, >882? Ikjcux, 255=? Nbjeb kt Wbfnb`jbf,>881)

• 21% rk-cpkrbtec` bt :2 fc`tds A[ (Bpbrj kt Wbe`t-Gbst, >88=)

• Fcst rk-cpkrbtec` brk jc`k wetde`

tdk flrst ykbr (Bpbrj kt Wbe`t gbst, >88=, Gcftkt,>888)


32/45

CZDK^ ZKGD@ER[KW

• Zc fbe`tbe` tdk tdufn ik`mtd< pbrtebitrbpkzekgtcfy wetd e`tkrpcsetec` (pyrcgbrnc`,

Brtkic`,…) - @c skreks puniesdkj

• ZF lce`t jk`krvbtec`


33/45

^KFKFNK^

• Weiegc`k efpib`t dbvk nkk` bnb`jc`kj

juk tc tdk demd `ufnkr ca

gcfpiegbtec`s e`giuje`m seiegc`etes


34/45

^DE\B^ZD^CWK

• Ik trbetkfk`t jk råaårk`gk rkstk ib trbpåzkgtcfek (kt sks

vbreb`tks)

• ^åsuitbts sbtesabesb`ts (4;%), fb`quk jk acrgk,

rågupårbtec` ic`muk

• Ib prctdäsk kst e`jequåk gdkz iks sulkts pius îmås (k`

i―bnsk`gk jk g/e) - nc`s råsuitbts que sk fbe`tek``k`t.

28-2;% jk gcfpiegbtec`s è ic`m tkrfk.

• Iks butrks tkgd`equks sc`t k` åvbiubtec` (mbrjkr ib

ic`mukur ju pcugk 6 kstdåtequk kt ac`gtec`)


35/45

@CZ ZC AC^MKZ<]EIWC@

CWZKCZCFU

• Wteaa b`j pbe`ikss tdufn wetd skvkrk jkacrfety -

Jc b rk-crek`tbtec` ca tdk tdufn


36/45

X^KQK@ZEQKZ^KBZFK@Z 3

EW EZ ]C^ZD JCE@M EZ 3


37/45

AC^ ]DEGD XBZEK@ZW 3

• Ucu`m

• ]etdcut (cr iefetkj)

gbrteibmk bitkrbtec`

• ZF e`stbneiety +/-

trbpkzebi jyspibseb


38/45

X^KQK@ZEQK Z^KBZFK@Z

• Wkgtec` ca b`tkrecr

bnkrrb`t flnkrs ca tdkBXI (\b`gciie)

• @c skreks puniesdkj

• Xrcnbniy uskikss


39/45

X^KQK@ZEQK Z^KBZFK@Z

• Iembfk`tcpibsty e` pbtek`ts wetd

e`stbneiety

• Ik Qekt rkpcrtkj 25 pbtek`tsefprcvkj cut ca b skreks ca >; nut

gc`sejkrkj rksuits bs u`-prkjegtbnik


40/45

Kbtc`-Iettikr typk


41/45

N^[@KIIE IEMBFK@ZCXIBWZU(25=:)

Zdk BXI es pbrbiiki tc tdk pib`k ca tdk `bei pibtk


42/45

^KW[IZW CA N^[@KIIE―WIEMBFK@ZCXIBWZU BZ254 FC@ZDW

J. Ik Qekt


43/45

ZF LCE@Z B^ZD^CWGCXU

• Jknrejkfk`t ca sy`cvetes

•

Wdre`obmk ca ZF iembfk`ts


44/45

CWZKCZCFEKW

• Qbsguibrezkj Lce`t trb`sakr (^cux >88:)

• @c`-vbsguibrezkj cstkctcfy (Mcunkbu >88;)


45/45

ZDB@O UC[ AC^ UC[^ E@QEZBZEC@

Rhizarthrose QATAR 2014

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