neurochirurgie curs 1

8/16/2019 Neurochirurgie Curs 1

http://slidepdf.com/reader/full/neurochirurgie-curs-1 1/5

24.02.2016 DRAGOBETE

PLEXUL LOMBAR

Nv femuro-cutanat – rad L2 strabate musc!u" #s$as% !&cuc!sea'a musc!u" !"!ac%stabate musc!! $b"!c! abd$m!&a"! s! musc!u" cr$!t$r% "a (&a" da&d 2 ramur!% a&ume

u& ram )es!er care as!*ura !&er+at!a cuta&ata a re*!u&!! )es!ere s! u& ram )em$ra"

care as!*ura !&er+at!a se&'!t!+a a re*!u&!! a&ter$,e-ter&a a c$a#se!.

au'e"e care det a)ectarea &+ )emur$,cuta&at% m!sc de /-,e-ts )$rtata c$a#sa #e

ba'!& sau mec de c$m#res!e% &+ este !& *e&era" su#er(c!a"% aceasra c$m#res!e se

#$ate rea"!'a "a 2 &!+. La '$&a su#ra)ete! &+ sau se #$ate $bt!&e c$m#res!e !&

tra!ectu" !&traabd$m!&a" a" &+% c$m#res!a #utu&d ( e-erc!tata (e "a &!+ +ertebra" sau

u-ta+ertebra"% a"atur! de c$"$a&a #r!& )e&$me&e care t!& de +ertebra% res#ect!+e

s#$&d!"!ta sau s#$&d!"$'a.

& tra!ectu" !&traabd$m!&a" &+ ma! #$ate ( . & structur! de"!m!tat$are de s#at!u% (e

ca este +$rba de #e"+!&e% (e de uter *ra+!d #e #arcursu" de'+$"tar!! sarc!&!!. 3au $

c$m#res!e ma! #$ate ( )ractur!"e c$-a"e sau

&/amat!a "a &!+ structur!"$r &+ #e care "e strabate sau #e care trece. P$ate ( +$rba

de #s$!da.

A )r!*$re – #r!& e-#u&erea $r*s "a )act$r term!c rece% (e ca este +$rba de cure&t!

rec!.

+ )emur$,cuta&at este &+ se&'!t!+% e" &u are (bre m$t$r!!.

A)ectarea acestu! &er+ det mera"*!a #areste'!ca. Este +$rba de d!'ester!! sau

#areste'!! #e .. a#are se&'at!a de #!e"e cart$&ata sau se #$ate au&*e "a durer!

acute.

D#d+ $b!ect!+ a#ar )e&$me&e de !#$este'!e "$ca"!'ata% ma&e+re"e care #$t sa

determ!&e durer!"e su&t5 ma&e+re"e de e-te&s!e a c$a#se! #e ba'!&% !& c$&d!t!!"e !&

care &+ su)era u& #r$cess de !&carcerare s! #$' de /e-!a ca"mea'a durerea. De

$b!ce! #a"#area !&tre ce"e 2 s#!&e !"!ace a&t dec"a&sea'a $ durere e-treme de

+!$"e&ta.

Pre'e&ta aceste! su)er!&te care dec"a&sea'a durere "a e-te&s!e !&duce !& t!m# $

#$'!t!e +!c!$asa s! a&ume !&duce #$'!t!a de /e-!e s! r$t e-t a c$a#se!.

Nv crural/femural



D#d+ a&at$m!c% $r!*!&ea sa este !& rad a&ter!$are a"e ramur!"$r L2%L%L4 care !&

*r$s!mea mare"u! #s$as su&t em!se.

Tra!ectu" acestu! &+ mer*e #e mar* musc!u"u! #s$as #a&a "a &!+ arcade! crura"e

#este care trece #r!& tr!u&*!u" scar#a s! "a &!+ tr!&*!u"u! scar#a &+ da ce"e 4 ramur!

term!&a"e.

Ramur!"e term!&a"e a"e &+ crura" su&t urmat$are"e5

, + muscu"$cuta&at e-ter&5 care da ramur! e-ter!$are #t musc!u" cr$!t$r s!

ramur! cuta&ate #t )ata a&ter$,e-t a c$a#se!% ca s! u& ram r$tu"!a& e-ter&

, + musc$cuta&at !&ter&5 da ramur! muscu"are #t musc!u" #ect!&eu s! u& ram

#t adduct$ru" "u&*% ramur!"e cuta&ate as!*ura !&ter+at!a se&'!t!+a a re*!u&!!

su#er$,!&t a c$a#se!

, + c+adr!ce#su"u!

, + sa)e& !&ter&5 #$r&!&d u& ram r$tu"!a& !&ter& s! u& ram *amb!er care

as!*ura !&er+at!a se&'!t!+a a *ambe!

D!& tru&c!u" &+ crura" #$r&esc s! ramur! c$"atera"e #t5

, Ps$as !"!ac, Pect!&eu

D$me&!u" se&'!t!+ a" &+ crura" e c$&st!tu!t de )ata a&t a c$a#se!% )ata !&t a *amebe!

s! #!c% !& +reme ce d$me&!u" m$t$r e c$&st!tu!t de 4 musc!5

, Ps$as,!"!ac5 care este /e-$r a" c$a#se! #e ba'!& s! r!d!cat$r a" c$a#se! (!&d

$b"!*at$r !& mers. E" me&t!&e !m#reu&a cu musc!! abd$m!&a"! s! m s#!&a"!

#$stura +ert!ca"a.

, r$!t$r5 /e-$r a *ambe! #e c$a#sa s! a c$a#se! #e ba'!&% )ace abduct!e s!

r$tat!e e-t a c$a#se! 7 r$tat!e !&t de *e&u&c!.

, +adr!ce#su"5 e-ter&s$r *ambe! #e c$a#sa% (!&d $b"!*at$r !&d!s#e&sab!" !&

mers s! stat!u&ea +ert!ca"% !ar #r!& s!&*uru" sau )asc!cu" b!"atera" s! a&ume

dre#tu" a&t% m c+adr!ce#s #art!c!#a s! "a /e-!a c$a#se! #e ba'!&.

, Pect!&eu"5 e" este /e-$r a" c$a#se! #e ba'!&% adduct$r a" c$a#se! s! r$tat$r

e-ter& a" c$a#se!

au'e"e care det a)ectarea &+ crura"5

1. Le-!u&!"e #r$-!ma"e 8"e'!u&! !&a"te95 #$ate ( +$rba de "e'!u&! +ertebra"e5

!&/amat$r!!% de*e&erat!+e% traumat!ce% tum$ra"e: #r$cese d!sca"e "a &!+ L2%L



sau s#$&d!"$'e se+ere% $ste$(ta mare% #s$!de% !&/amat!! a"e m #s$as sau

a#ar!t!a u&$r tum$r! sau "!m)$ame.

2. A#ar!t!a de #r$cese abd$m!&a"e cu caracter c$m#res!+ sau de*e&erat!+e5

a&e+r!sme de a$rta% a$rta abd$m!&a"a% tum$r! sau abcese abd$m!&a"e sau

#e"+!&e% e-!sta r!scu" a#ar!t!e! u&e! c!catr!c! care sa !&carcere'e &+% sa a#ara $&eur$#at!e carcerara care ar #utea sa *e&ere'e durer! !& !&t &+ crura".

. &ter+e&t!! c!rur*!ca"e #e s$"d5 #r$te'area s$"du"u!.

4. 3u)er!&te cu caracter *e&era"5 ca'u" em$("!e!.

er+u" crura" este e-term de se&s!b!" "a !scem!e. Or!ce !scem!e #rec$ce #r$dusa

!&tr,u& c$&te-t *e&era"% cum ar ( !& ca'u" u&e! a*e&e$#at!! sc"er$t!ce% atu&c! ca&d

cr$&!ca /u-u" sa&*+!& a#are aceasta !scem!e care se e-#r!ma #r!& a#ar!t!a

mu"t ma! ra#!da% (e ca e +$rba de e"$&*at!a &+% (e de u& e- e-treme de

e"$c+e&t% #r!+!&d se&s!b!"!tatea "a !scem!e #ara"!'! de &+ b!"atera" #$st#artum% du#a

2 cat durea'a tra+a"!u" ..

;ata de a"t! &er+!% cau'e"e d!sta"e su&t mu"t ma! emat$mu" #$st!&c!'!e se #$ate

#r$duce c!catr!cea ce"$!da sau !&ter)erarea . P$t de*e&era c$m#res!e asu#ra

&er+u"u!.

Arter$*ra(a5 !&ectarea u&e! substa&te de c$&trast . t$t "a acest &!+ se #$t

+ sa)r! !&t #$ate ( !&carcerat% dec! e u& #$rc mec% sau !& c$&d u&$r tru&c!ur!

+e&$ase #$ate ( !&carcerat !& c!catr!ce. D!& &+ sa)re !&t #$r&esc ramur! !&tra#ate"are

care !&er+ea'a re* !&ter&a a *e&u&c!u"u! s! #$ate sa #r$duca $ *$&a"*!e#ar$t$*!ca.

D#d+ c"!&!c% e-!sta $ )$rma de a)ectare a &+ crura" care este )$arte rara% stat!u&ea s!

mersu" su&t e-treme de *re"e% a#r$a#e !m#$s!b!"e% *e& sca#a recurbatum% $r!ce

!&cercare de /e-!e a *e& det der$barea% urcatu" scar!"$r este !m#$s!b!". T$&usu"

muscu"ar a" "$e! su# a c$a#se! este sc'ut #a&a "a d!s#ar!t!e ! se #r$duce atr$(a%

sca'a&d 1 cm d!& c!rcum)er!&ta #e '!. Re/e-u" r$tu"!a& este s"ab!t.

E-!sta $ #ara"!'!e su#er!$ara !& care re/e-u" #at$"$*!c este u-tatubu"ar sau

!&tra#s$as. Aceasta #ara"!'!e su# a)ectea'a t$t! musc!!% rar a#are d!& #u&ct de

+edere as$c!at.

Para"!'!a med!e5 !& acest ca'% "e'area &+ se #r$duce "a &!+ !es!r!! musc!u"u! #s$as

sau "a &!+ tr!u&*!u"u! scar#a% $r! #e drum. & ca'u" acest$ra sca#a #s$as!"!acu"%

de$arece ramur!"e care !&er+ea'a #s$as!"!acu" s,au des#r!&s dea.

Para"!'!a !&)5 #ara"!'!e d!s$c!a"a5 #r!me"e !&teresate su&t ramur!"e term!&a"e a"e &+5



, eur$#at!a $bturat$r!e cu de(c!t !& care de(c!tu" musc este ma! !m#$rta&t%

scade )$arte mu"t ca# de adduct!e a c$a#se!.

PLEXUL 3ARAT

NV SCIATIC

neurochirurgie curs 1

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