thumb mp joint injuries-qatar 2015

8/9/2019 Thumb MP Joint Injuries-Qatar 2015

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^juif IX bgelt

aekmidltgus elburedsPyaved @mrids, Jmln @dltdr, Kumndagupd

Xrdsdltmtegl weaa fd mvmeamfad gl www.neu`jerurkedimel.grk

http://www.diuchirurgiemain.org/



Pex pgssefad adsegls Idnema `gaamtdrma aekmidlt elbury

2 ] 7 es tjdrd m Ptdldr adsegl e.d. es surke`mardpmer lddndn 7

Amtdrma `gaamtdrma aekmidlt elbury

2 ] 7 fdlekl gr sdvdrd 7 ec sdvdrd, surkdry eslddndn

Ngrsma `mpsuamr adsegl

2 ]7 Nemklgses mln trdmtidlt 7

Sgamr pamtd elbureds

2 ] 7 Elne`mtegl cgr surke`ma trdmtidlt el m`utd elbureds 7

Xgstdregr IX nesag`mtegl

2 ] 7 Jgw tg rdnu`d et 7 Es tjdrd m surke`ma elne`mtegl 7

Mltdregr IX nesag`mtegl

2 Vmrd, =; `msds rdpgrtdn el 68==- lg qudstegl



Aekmidltgus mlmtgiy gc tjd IX bgelt

@gaamtdrma aekmidlt jms twg cmsèàds2 imel cmsèàd (=) elsdrts gl tjd prgxeima

pjmamlx mln m``dssgry cmsèàd (6) tjmt elsdrts gl tjd pmaimr pamtd mlnsdsmigens

^jd I@A dst sjgrtdr mln tjeòdr tjml tjd A@A

Xmaimr pamtd es nevendn eltjrdd pmrts2 tjd tjelldrIdtm`mrpg-sdsmigen aekmidlt(0), tjeòdr sdsmigens-pjmamlkdma aekmidlt (>) mln

tjd sdsmigens el fdtwddl



^jd twg cmsèàds

^jd m``dssgry aekmidlt estdlsd el dxtdlsegl, tjd imelcmsèàd el stdxegl

Imy jdap wetj àele`ma tdstelk

Aeietdn ̀ aele`ma `glsdqudl`ds

crgi m prm`te`ma pgelt gc vedw



Aekmidltgus mlmtgiy gc tjd IX bgelt

^jd twg sdsmigens (T & V) mrd

nddpay elsdrtdn (difdnndn)eltg tjd pmaimr pamtd,

pgstdregr tg tjd CXA tdlngl

sjdmtj (smid adkdlns)

^jdlmr ius`ads elsdrt gl tjdsdsmigens2 Mnnu`tgr pgaae`es(ualmr), CXF (rmnema)



^jd tjdlmr ius`ads, tjd sdsmigens mln tjd sdsmigen-pjmamlkdma

aekmidlts cgri tjd « m`tevd ¿ mltdregr saelk

[jead tjd idtm`mrpg-sdsmigen aekmidlt cgris tjd « pmssevd ¿ saelk



Idnema send

^jd I@A es `gvdrdn fy tjd

ngrsma dxpmlsegl tg tjd DXA gctjd mpgldurgses gc tjdmnnu`tgr pgaae`es wjgsd imelelsdrtegl es gl tjd ualmr

sdsmigen (sgidwjmt aeod tjdeltdrgssdgus jggn mt tjd aglklkdrs)



Amtdrma send

^jd Cadxgr pgaae`es frdves elsdrts gl tjd rmnemasdsmigen

^jd bgelt es `gvdrdn fy tjd elsdrtegls gl tjd tjdlmrius`ads2 MXF (=), CXF (6) tjmt iex wetj tjd DXF(4) tg cgri m jggn (0) tjmt `gvdrs tjd A@A (>) mln

tjd vgamr amtd :



Ngrsma send

DXA mln DXF () mrd stmfeaezdn fy

smkettma fmlns

^jd DXF fadlns wetj tjd dxtdlsgr

jggn el ;8% gc `msds mln ngds lgt

elsdrt gc tjd prgxeima pjmamlx

(Xrgfmfay) lgt elvgavdn el tjuif IX

bgelt elbureds



Mlmtgie`ma dxdr`e`d

@ml ygu lmid tjdsd stru`turds 7



Fegid`jmle`ma olgwadnkd

Vdsuatmlt cgr`ds mt tjd IX bgelt es mfgut =8 teids

tjd agmn mt tjd tep

^jd IX bgelt jms m jukd vmremtegl gc igfeaetyfdtwddl elnevenumas wetj m feignma nestrefutegl

(;48 `msds)Vmnema amxety mvdrmkds 3¸ (8-08¸) el cuaa dxtdlsegl,=6¸ (8->4¸) el =4¸ gc stdxegl mln =¸ (8-=4¸) el cuaastdxegl

Jers`j N. B Fegid`jml`es =5;>? ;2 0>0-0>3Xmaidr MO. BJP =5;:,024>6-4>3



Dxpdreidltma nmtm (688 tjuifs)

IX stdxegl mvdrmkdn ;;¸ (>8¸‐=63¸).

IX jypdrdxtdlsegl ms 04¸ (8¸-;6¸)

^gtma VGI wms ==8¸ (44¸ tg =;3¸)

@grrdamtegl fdtwddl idtm`mrpma jdmn sjmpd mlnVGI? rgulndr idtm`mrpma jdmns jmn krdmtdrigtegl (=83¸) `gipmrdn tg stmt jdmns (;;¸)

Ugsjenm V. B Jmln Purk 6880?6:M2;40‐;4;.



@aele`ma `glsdqudl`ds

Xmtedlt wetj aeietdn tjuif IX igfeaety (wjdtjdr tjdy jmvd m stmtjdmn gr m `mpsuamr tekjtldss) mrd igrd prgld tg sustmel m IX bgeltelbury (gssdgus, aekmidltgus gr dvdl sgct-tessuds elbureds)

^jd stecc tjuif `mllgt ds`mpd mln prgtd`t etsdac +++

Pjmw PB. B Jmln Purk =556? =;F2 =3>-=33



I@A elbureds 2 tjd igstcrdqudlt



I@A Elbureds

@mipfdaa, BFBP =544, nds`refdn 6> `jrgle` ualmr elstmfeaety el P`gttesj

kmidoddpdrs (tjdy oeaa jmsd fy jganelk tjder ld`o fdtwddl tjuif mln elndxmln puaaelk strglkay gl tjder adks)! « Kmidoddpdr―s tjuif ¿

Fgwdrs, BFBP =5;;, rdpgrtdn m 48% cmeaurd rmtd cgr `glsdrvmtevd trdmtidlt gc

m`utd ualmr elstmfeaetyPtdldr, BFBP =536, nds`refdn tjd mlmtgie`ma adsegl tjmt fdmrs ets lmid (06surke`ma `msds, >6 mlmtgie`ma nessd`tegls)



Id`jmlesi 9 spgrt elbureds

6> surke`ma `msds 2 =: spgrt (== soeelk), 0 vdje`ad,mln 0 gtjdr elbureds (Pwdnesj stuny).

=888 surke`ma `msds (Crml`d maps)2 48 % spgrt (;4%soe)? 0:% [gro rdamtdn elbureds mln =6% ngidste`elbureds gr ISM

[jmt mfgut soe elbureds el ]mtmr 7



Plgw glay mvmeamfad gvdr >888 i, soe elbureds mrd adss prgfmfad !



]udstegl 7

Jgw tg imod tjd nemklgses gc m sdvdrd adsegl 7

Es tjdrd m Ptdldr adsegl tjmt wmrrmlts surke`ma trdmtidlt 7

@ a e l e ̀ m a t d s t e l k 7

E i m k e l k t d ̀ j l

e q u d s 7

@aele`ma tdstelk sjguan fd imnd mctdr tmoelk ml x-rmys tg daeielmtd ml ulnespamydnmvuasegl-crm`turd tjmt `guan fd nespam`dn nurelk tdstelk



Crm`turd-mvuasegl

elbureds

"

08% gc `msds prdsdlt wetjml mvuasegl gc tjd I@Aelsdrtegl

Pgidteids ygu imod tjdnemklgses gc m Ptdldr―s adsegl



«

fgly soedr―s tjuif

¿ elbureds

Pdreds gc 08 `msds2 Kggn rdsuats el maa

pmtedlts wetj m mvuasegl-crm`turd? jgwdvdrm 64% lgl-ulegl rmtd? tjd fekkdst mlnigst rgtmtdn crmkidlts tdln tg sjgw adsskggn rdsuats

Igst mutjgrs ng cmvgr surkdry eccrmkidlt es gvdr 08% gc tjd mrte`uamrsurcm`d, nespam`dn < 6 ii, gr rgtmtdn <>4¸

Ouz BD. B Jmln Purk =555?6>M26;4‐6:6



[etjgut crm`turd, dxpdreidltma nmtm sjgwstjmt àele`ma tdstelk sjguan fd imnd el cuaa

stdxegl wje`j lddns ag`ma mldstjdsem mt admst

XgseteglLgtjelk

ùtMM ùt

@mpsuadùt

T@A ùtM@A & XX

ùt

Cuaadxtdlsegl

>¸ ;¸ =6¸ 6:¸ <58¸

=4¸stdxegl

5¸ =8¸ =>¸ 06¸ <58¸

Cuaastdxegl

8¸ 8¸ 6¸ >6¸ < 58¸

Xmaidr MO. BJP =5;:,024>6-4>3

^jd kggnpgsetegl cgr

tdstelk



@aele`ma tdstelk

Gtjdrs jmvd prgpgsdn < 08¸ gc

vmakus elstmfeaety gr < =4¸ `gipmrdntg tjd `gltrgamtdrma send

Crdl`j igultmel ng`tgrs jmvd

nds`refdn tjd «

fgttad tdst

¿2 ec ygu`mllgt jgan m cuaa fgttad fdtwddltjuif mln elndx, tjes es m sdvdrdadsegl

Jdyiml X. Elbureds gc tjd ualmr `gaamtdrma aekmidlt gc tjd tjuif idtm`mrpgpjmamlkdma bgelt2 fegid`jmle`mamln prgspd`tevd `aele`ma stuneds gl tjd usdcualdss gc vmakus strdss tdstelk. @ael Grtjgp Vda Vds =550?6562=34‐;=.



Vmnegagke`ma tdstelk

Pmid aeietmteglsLddn mldstjdsem

Lddn tg ng et ygursdac

El wje`j pgsetegl (cuaa stdxegl)…



Crgi m prm`te`ma pgelt gc vedw !

Nemklgses es dmsy

Detjdr tjd bgelt, w/g mldstjdsem, es krgssay stmfad wetj m `admr stgp

Gr et es krgssay ulstmfad wetj m aeipldss cdat tgwmrn tjd dln gc tjd rmlkd gcigtegl, mln ygu olgw et es sdvdrd ( M nes`rdtd jdimtgim gl tjd ngrsma mspd`tgc tjd tjuif EX sekleds `mpsuag-aekmidltgus rupturd mln jdimrtjrgses

neccusegl maglk tjd tjuif DXA es masg elne`mtevd gc m sdvdrd adsegl).



6ln qudstegl2 es tjdrd m Ptdldr

adsegl 7

^jd I@A usumaay rupturds (58%) mt ets pjmamlkdmaelsdrtegl

Nurelk m cmaa, tjd tjuif es cgr`dn el vmakus mlnstdxegl ms et tjrust eltg sgct slgw (et es lgt tjdstrmp gc tjd soe pgad wje`j es rdspglsmfad fut tjd

qumaety gc slgw)

[jdl tjd tjuif kgds fm`o el dxtdlsegl, tjdngrsma mpgldurgses eltdrpgsds fdtwddl tjd twgdlns gc tjd aekmidlt wje`j `mllgt jdma +++



c



Jgw crdqudlt mrd

Ptdldr―s adsegls 7 Lgfgny rdmaay olgws

Ptdldr stmtdn tjmt es `guan fd prdsdlt el up tg 3>% gcsdvdrd I@A elbureds (=4-3>% m``grnelk tg surke`masdreds)

Xmapmtegl wms prgpgsdn tg imod tjd nemklgses…

Igst surkdgls `glsendr tjmt maa sdvdrd adsegls sjguanfd trdmtdn surke`maay « el `msd gc m Ptdldr―s adsegl ¿ Mt admst 08% `guan fd trdmtdn `glsdrvmtevday



@ml eimkelk td`jlequd imy jdaptg imod tjd nemklgses 7

Z-rmys mrd usumaay lgrima

Elnerd`t sekls gc sdvdrety2 Ppgltmldgus bgeltgpdlelk, Mltdregr sufauxmtegl,

Agss gc pmrmaadaesi fdtwddl tjd aeld tmlkdlt

tg tjd fmsd gc tjd prgxeima pjmamlx mln tjdaeld tmlkdlt tg tjd sdsmigen fglds sekldsml mvuasegl gc tjd I@A

Vg`jdt P. Vupturd gc tjd tjuif ualmr `gaamtdrma aekmidlt gc tjd idtm`mrpgpjmamlkdma bgelt2 es et pgssefad tg gpdrmtd m``grnelk tg tjd pgsetegl gc sdsmigends gl nylmie` Zrmy.

@jer Imel 688;?632688‐4.



Gtjdr eimkelk td`jlequds

IVEPdlsefeaety 30-=88%, spd`e`ety48-=88%

Lgt mvmeamfad dvdrywjdrd,tmods sgid teid,….

Imly mrtdcm`ts



Pglgkrmpjy 7

Ptmte` sglgkrmpjy2 Pdlsefeaety ::%,spdèèty :0-5=%

Jgwdvdr stru`turds mrd necùat tgsdd cgr ml mvdrmkd pjyseèml,dspdèmaay tjd mnnu`tgr mpgldurgses+++

Maa sdreds rdpgrtdn cmasd ldkmtevd



Pglgkrmpjy 7

[d nds`refdn Nylmie` Pglgkrmpjy2 Ugu sdddmseay tjd aekmidlt mln, fy stdxelk tjd EX yguimod tjd mpgldurgses igvelk mln ygu `ml smydmseay ec et es gvdr gr ulndr tjd aekmidlt

Xaugt, Kuårele, Nuigltedr, Nrmpå,…



Vupturd w/g m Ptdldr―s adsegl Vupturd wetj m Ptdldr―s adsegl



El tjd rst pmrt gc tjd stuny wd wdrd mfadtg `grrdamtd tjd IVE eimkelk tg

sglgkrmpjy mln mlmtgiy

V t etj Pt



El tjd sd`gln pmrt g tjd stuny, `grrdamtegl wdrd imnd cgr dxpdreidltma elbureds

Vupturd w/g Ptdldr

Vupturd wetj Ptdldr



@grrdamtegl wms pgssefad eltjd twg neccdrdlt pamlds(mxema mln aglketunelma)



^rdmtidlt

Fdlekl2 Lgtjelk gr m =8 nmys strmppelk cgrpmel rdaedc

Pdvdrd2 0 tg 3 wddos el m tjuif spe`m `mst

Ptdldr 2 Purkdry



Purke`ma

td`jlequd Ag`ma gr rdkeglma mldstjdsem

S (sdmkuaa) typd elèsegl

Vdspd`t tjd ngrsma sdlsgry frml`j

Elèsd tjd ngrsma mpgldurgses àgsd tg tjd DXAtdlngl

Mt dxpagrmtegl, tjd ngrsma `mpsuad mln pmrt gctjd vgamr pamtd mrd crdqudltay tgrl

P e a



Purke`ma

td`jlequd

Vdelsdrtegl gc tjd idnema aekmidlt gl tjdpjmamlx (pdregstdma suturd, ml`jgrs,...)

M simaa fgly ped`d es dx`esdn, gtjdrwesd xdn

^jd ngrsma mpgldurgses es `agsdn gvdr tjdaekmidlt

@mst eiigfeaezmtegl cgr = igltj, tjdlrdjmfeaetmtegl



Vdsuats

:8-58% mrd pmel-crdd mctdr 3 igltjsAgss gc igtegl gc 4-=8% (Ompmlnbe5-=8)

38-;8% rdkmel lgrima krep mln pel`jstrdlktj

^jd IX es dlamrkdn ndletevday



Vdsuats (=888 `msds) Sdry kggn2 lgrima2tjuif

Kggn2 2tjuifs wje`j mrd stmfad, pmel-crdd, fut wetjwdf spm`d gpdlelk mln/gr I@X rmlkd gc igteglrdnu`dn crgi =8 % tg =4 % el `gipmresgl wetj tjdgppgsetd send.

Mvdrmkd 2tjuifs dxjefet 68 % tg 08 % steccldss detjdrel stdxegl-dxtdlsegl gr el wdf spm`d gpdlelk.

Xggr2 pmelcua mln/gr ulstmfad `msds.

;4% vdry kggn,=4 % kggn,

: % mvdrmkd,6 % pggr

E



Es surkdry ml

didrkdl`y 2 UDP

@aele`ma rdsuats nd`aeld mctdr:-=8 nmys

Mctdr 0 wddos, m aekmidltgussuturd imy lgt fd pgssefad

mln m aekmidltgpamsty imy fdlddndn



^mod jgid idssmkd

Vmtjdr crdqudlt elbury

Ng lgt gpdrmtd gl dvdry pmtedlt

FT^ ng lgt iess tjd pmtedlt tjmt sjguan fd gpdrmtdn gl e.d. tjdgld wetj m Ptdldr―s adsegl2 `aele`ma suspe`egl, nylmie` sglgkrmpjy(gr dvdl IVE) weaa jdap tg `jggsd tjd rekjt trdmtidlt



Ec ygu iess tjd nemklgses

Nud tg tjd jekj agmns gl tjd bgeltElstmfeaety weaa el`rdmsd

Bgelt weaa fd`gid pmelcua mln amtdr,

mrtjrete`

Purkdry es lddndn (detjdr aekmidltgusrd`glstru`tegl, gr mrtjrgndses)



A@A elbureds 2 adss crdqudlt



Vmnema elstmfeaety

^dl teids adss crdqudlt

Lg Ptdldr―s adsegl

Xgstdrg-amtdrma (rgtmtgry) elstmfeaety

Adss eiprdssevd `aele`maay fut vdrypggray tgadrmtdn

Purke`ma trdmtidlt es imlnmtgry el

sdvdrd elbureds



@aele`ma dxmielmtegl, tjd smidVmnegagke`ma dxmielmtegl, tjd smid

Lg lddn cgr gtjdr eimkelk td`jlequdsPurke`ma prel`epads mln td`jlequds mrd seieamr



Ngrsg-Vmnema `mpsuamr

elbureds



Ngrsg-rmnema `mpsuamr elburedsEl mssgèmtegl wetj A@A elbureds igst

gctdl

Esgamtdn elbury@aele`ma nemklgses2 maa pmtedlts dxjefet tdlndrldss tg pmapmtegl spdè`maay mt tjdngrsgrmnema mspd`t gc tjd IX bgelt gc tjd tjuif? tjdrd es lg amxety gc tjd`gaamtdrma aekmidlt tdstdn mt 8 mln 08¸ gc stdxegl. Pgid pmtedlts amò cuaa

m`tevd dxtdlsegl gc tjd prgxeima pjmamlx

El sgid pmtedlts, iean pmaimr sufauxmtegl gc tjd prgxeima pjmamlx gl xrmyais.

Ormusd BG. (B Jmln Purk =553?6= M2>6:->00.)




Fdmrs tjd lmid gc Agues JufdrtCMVMFDTC (=:>=-=58), Crdl`jsurkdgl wjg nds`refdn tjdmlmtgie`ma adsegl? tjd wmy tg

rdnu`d et, mln tjd elstruidltmteglygu lddndn tg




Jypdrdxtdlsegl elbury + sgid prglmteglmln eltdrlma rgtmtegl" Idtm`mrpma jdmntwests mrguln tjd CXA wje`j es trmppdn eltjd bgelt

^jd idtm`mrpma jdmn tjdl dltdrs tjd

tjdlmr ius`ads

^jd I@A es usumaay eltm`t (tmukjt elstdxegl glay)

X e IX ne a e




@aele`ma nemklgses es usumaay dmsy

Z-rmys weaa `glri nesag`mtegl fut mrd nec`uat tgmlmaysd

6 typds nds`refdn2 seipad mln `gipadx elbureds

Pe a ne a e



Peipad nesag`mtegl

Xmel

Cul`teglma aeietmtegl

^juif jypdrdxtdlndn

Z-rmys2 sdsmigen mrd steaa el `gltm`t wetjtjd idtm`mrpma jdmn

@ a ne a e



@gipadx nesag`mtegl

Xmel

Cul`teglma aeietmtegl

^juif lgt jypdrdxtdlndn fut pmrmaadatg tjd idtm`mrpma

Z-rmys2 sdsmigen mrd pgstdregr tg tjdidtm`mrpma jdmn



^mod jgid idssmkd

M cmuaty imlduvdr weaa trmlscgri m seipad nesag`mtegl eltg m`gipadx gld, gr dvdl ml errdnu`efad gld

^jdrd es glay gld rdnu`tegl td`jlequd tjmt sjguan fd pdrcgridnulndr rdkeglma mldstjdsem

Mctdr rdnu`tegl, m rmnegagke`ma tdstelk es imlnmtgry (stugrgs`gpy)

^jd td`jlequd gc rdnu`tegl m``grnelk tg Cmrmfduc



^jd td`jlequd gc rdnu`tegl m``grnelk tg Cmrmfduc

LG ^VM@ÊGL El`rdmsd tjd ndcgriety

mln pusj tjd pjmamlxmkmelst tjd idtm`mrpma el

grndr tg prdvdlterrdnuèfeaety

@agsdn rdnu`tegl gc m ngrsma nesag`mtegl gc tjd bgelt es dmsedr ec tjd elsdrtegls gc tjdeltrelse` iusàds el tjd sdsmigens mrd eltm`t, sel`d tjdsd iusàds weaa kuend tjd vgamr

pamtd fmò eltg ets prgpdr pgsetegl ([ddos, =5:=).



Cmuaty imlduvdr(trm`tegl) admnelk tg

dltrmpidlt gc sdsmigen

fglds

X n e e ^



Xgst-rdnu`tegl tdstelk2 ^wg pmrts

@aele`ma tdstelk el tjd crgltma pamld

Ec tjdrd es m sdvdrd adsegl gc gld gc

tjd `gaamtdrma aekmidlt (e.d. rmnema grualmr elstmfeaety)

Purkdry es elne`mtdn



Xgst-rdnu`tegl tdstelk2 ^wg pmrts

^dstelk ulndr stugrgs`gpy tgfdttdr ulndrstmln tjd adseglsmln tjd pgtdltema cgr `jrgle`elstmfeaety

Ptmfad adsegls 9 pmssevd saelk



Ptmfad adsegls 9 pmssevd saelkelbury 9 idtm`mrpg-sdsmigen

aekmidlt elbury (0)

^jd igst crdqudlt elbury (< :8%)

Ptmfad mctdr rdnu`tegl

Nurelk dxtdlsegl, tjd sdsmigens stmy

wetj tjd pjmamlxGrtjgpdne` trdmtidlt (`mst) cgr =

igltj



Ec

Vupturd gc tjd sdsmigçng-pjmamlkdma aekmidlt

Crm`turd gc m sdsmigen fgld

Vupturd gc tjd stdxgr pgaae`es frdves tdlngl

Vupturd gc tjd

m`tevd rdstrmelts

Purke`ma trdmtidlt estg fd `glsendrdn

V

t c tj en



Vupturd gc tjd sdsmigeng-pjmamlkdma aekmidlt

^jd sdsmigen fglds ng lgt cgaagw

tjd pjmamlx nurelk dxtdlsegl



Crm`turd gc m sdsmigen fgld

Necùat tg sdd

Pdsmigen es ndrevdn crgi tjd stmt mln gvma sddns gc tjd sdsmid elneùi ml mlèdlt dmst

elneml pamlt usdn fy Krddo pjyseèmls ms m purkmtevd.



^wg typds gc sdsmigen crm`turds

Cerst nds`refdn el =5=4 ^ypd =2 [etjgut rupturd gc tjd pmaimr pamtd2 stmfad, lgl trdmtidlt rdquerdn

^ypd 62 [etj rupturd gc tjd XX (masg nds`refdn fy Ptdldr)2 ulstmfad, imy

lddn surke`ma rdpmer. ^jrdd `aele`ma sekls2 (=) jypdrdxtdlsegl elbury, (6)d``jyigses gl tjd stdxgr send gc tjd IX bgelt dxtdlnelk tg tjd tjdlmrdieldl`d, (0) tdlndrldss gvdr gld gr fgtj sdsmigen fglds.

Vupturd gc tjd stdxgr pgae`eds



Vupturd gc tjd stdxgr pgae`edsfrdves tdlngl

Jdimtgim, prgxeima pmel,

el`rdmsdn pmel nurelk rdsestdn

stdxegl ec sddl amtd




Ec sdsmigens mrd eltdrpgsdn? DXA tdlngl lgtpmapmfad? rmnema gr ualmr nespam`didlt gc DXAgr DXF? pmrmngxe`ma IX stdxegl mln EX

dxtdlsegl wjdl mttdiptelk tg dxtdln tjd IXbgelt# tessuds eltdrpgsetegl

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