herni de disc.ppt
TRANSCRIPT
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Hernia de disc prin Hernia de disc prin suprasolicitare profesionala a suprasolicitare profesionala a
coloanei lombarecoloanei lombare- studiu de caz -- studiu de caz -
EugeniaEugenia NAGHI NAGHI 1,21,2
Agripina RASCU Agripina RASCU 1,21,2
Claudia HANDRA Claudia HANDRA 1,21,2 RalucaRaluca MAROIUMAROIU ²² Irina FOCIUC Irina FOCIUC ²²
¹ ¹ DisciplinDisciplina de Medicia de Medicinnaa Muncii - UMF ”Carol Davila”Muncii - UMF ”Carol Davila” Bucuresti Bucuresti
²² Clinica de Clinica de MMedicina edicina MMuncii - Spitalul Clinic Colentinauncii - Spitalul Clinic Colentina,, Bucureşti Bucureşti
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D.C. – barbat, 37 aniD.C. – barbat, 37 ani
- fara APP semnificative- fara APP semnificative
- turnator-formator- turnator-formator
- vechime profesionala 17 ani- vechime profesionala 17 ani
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Ruta profesionalaRuta profesionala
1989 prezent1989 prezentTurnator - formator
Turnatorie fonta
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Proces tehnologicProces tehnologic
ELABORARE ALIAJE (TOPIRE)
FORMARE / MIEZUIRE
TURNARE
DEZBATERE
SABLARE
FINISARE
LIVRARE
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Operatiuni indeplinite in Operatiuni indeplinite in cadrul procesului tehnologic cadrul procesului tehnologic
Confectionarea formelor/ miezurilor (nisip, lianti)Confectionarea formelor/ miezurilor (nisip, lianti)
- umplerea manuala a ramelor cu amestecul de formare- umplerea manuala a ramelor cu amestecul de formare
- presarea amestecului (ciocan pneumatic)- presarea amestecului (ciocan pneumatic)
Turnarea aliajului in formeTurnarea aliajului in forme
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Turnarea si umplerea formelor cu metal lichid
http://www.go.ise.ro
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Umplerea unei linguri de turnat cu metal lichid dintr-un rezervor
http://www.go.ise.ro
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NoxeNoxe
Efort fizicEfort fizicManipulare manuala de mase Manipulare manuala de mase (500 kg/ schimb)(500 kg/ schimb)
Pozitii vicioase Pozitii vicioase ortostatism prelungitortostatism prelungit
pozitie aplecat prelungitapozitie aplecat prelungita
miscari frecvente de rotatie a trunchiuluimiscari frecvente de rotatie a trunchiului
VibratiiVibratiiTransmise intregului organismTransmise intregului organism
Transmise sistemului mana-bratTransmise sistemului mana-brat
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Microclimat nefavorabilMicroclimat nefavorabil
ZgomotZgomot
SiOSiO22 liber cristalin liber cristalin
Iritanti respiratori (gaze de turnatorie)Iritanti respiratori (gaze de turnatorie)
NoxeNoxe
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Motivele internarii:Motivele internarii:
- dureri lombosacrate cu iradiere pe fata posterioara a membrului pelvin - dureri lombosacrate cu iradiere pe fata posterioara a membrului pelvin dreptdrept
- contractura musculara paravertebrala - contractura musculara paravertebrala
- mers pe calcaie dificil- mers pe calcaie dificil
- parestezii haluce drept- parestezii haluce drept
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IstoricIstoric
Debutul simptomatologiei Debutul simptomatologiei
- octombrie 2007- octombrie 2007
- brusc, dupa ridicarea si purtarea manuala de - brusc, dupa ridicarea si purtarea manuala de greutati (ldm) greutati (ldm)
► ► Medicul de familie Medicul de familie fara ameliorarefara ameliorare
TRATAMENT
(AINS / decontracturante)
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IstoricIstoric
08.10 - 12.10.2007 – 08.10 - 12.10.2007 – medicina internamedicina interna
Lombosciatica dreapta L5Lombosciatica dreapta L5
Ameliorarea simptomatologiei pe parcursul internariiAmeliorarea simptomatologiei pe parcursul internarii
!! Trimitere clinica medicina muncii – stabilirea diagnosticului de !! Trimitere clinica medicina muncii – stabilirea diagnosticului de profesionalitateprofesionalitate
TRATAMENT:
AINS, antialgice, decontracturante, anxiolitice
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23.10.2007- 23.10.2007- internare Clinica medicina muncii, Bucurestiinternare Clinica medicina muncii, Bucuresti
► ► Examenul clinic:Examenul clinic:
● ● dureri la percutia CV lombaredureri la percutia CV lombare
●● contractura musculara paravertebrala contractura musculara paravertebrala (> dreapta)(> dreapta) ●● limitarea flexiei CV lombarelimitarea flexiei CV lombare ●● Lassegue +45°Lassegue +45° ●● mers pe calcaie dificilmers pe calcaie dificil
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► ► Rg coloana lombara (F+P) – pensare posterioara a Rg coloana lombara (F+P) – pensare posterioara a spatiului L4-L5spatiului L4-L5
►► Consult ortopedieConsult ortopedie
suspiciune hernie de disc L4-suspiciune hernie de disc L4-L5 L5
► ► Consult neurologieConsult neurologie
RMN coloana vertebralaRMN coloana vertebrala
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►► RMN coloana lombaraRMN coloana lombara – Hernie de disc L4 – L5 cu – Hernie de disc L4 – L5 cu stenoza foraminala dreapta si stenoza foraminala dreapta si compresie radiculara dreapta; compresie radiculara dreapta; protruzie discala L5-S1protruzie discala L5-S1
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► ► Consult neurochirurgieConsult neurochirurgie - HD L4-L5 cu deficit - HD L4-L5 cu deficit motor al muschilor extensori ai degetelor si tulburari motor al muschilor extensori ai degetelor si tulburari de sensibilitatede sensibilitate
Cura chirurgicala
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DiagnosticDiagnostic
Hernie de disc L4-L5 cu stenoza Hernie de disc L4-L5 cu stenoza foraminala dreapta, prin foraminala dreapta, prin suprasolicitare profesionala a suprasolicitare profesionala a coloanei lombarecoloanei lombare
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RecomandariRecomandari
Internare neurochirurgie cura Internare neurochirurgie cura chirurgicala a herniei de discchirurgicala a herniei de disc
Tratament simptomaticTratament simptomatic
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DiscutiiDiscutii
Pacient tPacient tâânnăăr r
Suferinta invalidanta interventie Suferinta invalidanta interventie
chirurgicala chirurgicala
Incapacitate temporara de munca – perioada Incapacitate temporara de munca – perioada nedeterminatanedeterminata
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DiscutiiDiscutii
Prognostic functional – rezervat Prognostic functional – rezervat
Schimbarea locului de muncaSchimbarea locului de munca
Evita efortul fizic, manipularea de mase, Evita efortul fizic, manipularea de mase, pozitiile vicioase prelungitepozitiile vicioase prelungite
Reorientare profesionalaReorientare profesionala
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