Sistema de presión negativa en el tratamiento de las fracturas abiertas: presentación de caso clínico y revisión de la literatura

July 12, 2017 | Autor: A. Merchan Galvis | Categoría: Fracture, Ortopedia
Share Embed


Descripción

3'4%&$')"')+,(%

%$%&":'()"(>!"%$G.(."K'&$#'(".("*(&!'&':$".&9()"(*'%( +!',&-!'%('H$"!&'%J(>!"%".&',$G.()"(,'%9(,*R%7-"'9P6'-$9)3*6'*3'+$&$'*%'9)3&$Q'0"'j)*'$-"67$3"3' )3"'*%*K"&"'9$#+"%7&"&'0'&76-"O"-7&"&'O*#9"3*3+*'UCWN'I%' $R2*+7K$'*3'*%'+#"+"97*3+$'&*'%"6'T#"-+)#"6'"R7*#+"6'*6'$R+*D 3*#')3'#PO7&$'-)R#797*3+$'&*'%$6'+*27&$6'R%"3&$6'0'i6*$6Q'%"' -$36$%7&"-7i3'&*'%"'T#"-+)#"'0'O*#97+7#')3"'O#$3+"'#*]"R7%7D +"-7i3'&*%'O"-7*3+*N /$6' O".6*6' &*' 73Z#*6$6' R"2$6' 0' 9*&7"3$6' +7*3*3' %"' 9"0$#' -"#Z"' &*' *3T*#9*&"&' 0' %"6' +"6"6' 9P6' "%+"6' &*' 9$#+"%7&"&' &*R7&"6'"'+#")9"+769$6'-")6"&$6'O$#'*6+*'+7O$'&*'"--7&*3D +*N'1%'+7*9O$'j)*'6$3'O$-$6'%$6'O".6*6'j)*'&76O$3*3'&*')3"' %*Z76%"-7i3' 73+*Z#"%' 0' &*' &"+$6' T7"R%*6' 6$R#*' +#")9"+769$6' -")6"&$6'O$#'*%'+#P367+$'U;WN' I3'*%'"k$'?BBCQ'*3'*%'@3T$#9*'e)3&7"%'6$R#*'(#*K*3-7i3'&*'%$6' H#")9"+769$6'4")6"&$6'O$#'*%'+#P367+$Q'6*'6*k"%"'j)*'"3)"%D 9*3+*' 6$3' 9P6' &*' :Q?' 97%%$3*6'&*' O*#6$3"6' %"6' j)*' 9)*#*3' "'-$36*-)*3-7"'&*')3' +#")9"+769$' -")6"&$'O$#'*%'+#P367+$'0' 9P6'&*';'97%%$3*6'&*'%*67$3"&$6Q'%$'j)*'*j)7K"%*'"3)"%9*3+*' "'-*#-"'&*'E;'%*67$3"&$6'0'O*#6$3"6'-$3'&76-"O"-7&"&'O$#'-"&"' O*#6$3"'T"%%*-7&"'U:WN /"6'*6+"&.6+7-"6'"-+)"%*6'O)R%7-"&"6'O$#'%"'b#Z"375"-7i3'("3"D 9*#7-"3"' &*' %"' A"%)&' Ub(AW' 9)*6+#"3' j)*' ^#"67%Q' 4$%$9R7"Q' I6+"&$6'J37&$6Q'eSn7-$'0'8*3*5)*%"'6$3'%$6'-73-$'O".6*6'-$3' *%'9"0$#'3>9*#$'&*'9)*#+*6'#*%"-7$3"&"6'-$3'*%'+#P367+$'U:WN

/"6'T#"-+)#"6'"R7*#+"6'6$3')3"'&*'%"6'9P6'T#*-)*3+*6'-")6"6'&*' +#")9"'$#+$OS&7-$'0'*%'9"3*2$'&*'%"6'%*67$3*6'&*'+*27&$6'R%"3D &$6'"6$-7"&"6'"'*%%"6Q')3'K*#&"&*#$'#*+$N'I3'%$6'>%+79$6'"k$6'6*' ]"3'*9O%*"&$'&7K*#6$6'9S+$&$6'0'676+*9"6'*3'*%'-)R#797*3+$' &*'%$6'+*27&$6'R%"3&$6'0'i6*$6l')3$'&*'*%%$6'*%'A(=Q'-)0$')6$'*3' *%'+#"+"97*3+$'&*']*#7&"6'+7*3*'#".-*6'"3+7Z)"6Q'")3j)*'*%'-$3D -*O+$'&*'+*#"O7"'-$3'O#*67i3'3*Z"+7K"'*6'3)*K$'UmWN'I6+*'676+*9"' +7*3*'*3+#*'%$6'9*-"3769$6'&*'"--7i3'%$6'67Z)7*3+*6X'#*&)--7i3' &*'*&*9"'+76)%"#Q'")9*3+$'&*'%"'T$#9"-7i3'&*'+*27&$'&*'Z#"3)%"D -7i3Q'*6+79)%"-7i3'&*'%"'O#$%7T*#"-7i3'&*'+*27&$6'"&0"-*3+*6'"'%"' ]*#7&"'0'&76973)-7i3'&*'%$6'37K*%*6'R"-+*#7"3$6'%$-"%*6N I%' 676+*9"' -$36+"' &*' K"#7$6' *%*9*3+$6' *6*3-7"%*6N' A*' )+7%75"' )3"'*6O$32"'&*'O$%7)#*+"3$'-$3'O$#$6'&*'CBB'"'MBB'97-#$3*6' j)*'6*'-$3*-+"Q'"'+#"KS6'&*'+)R$6'&*'&#*3"2*'3$'-$%"O6"R%*6Q' "' )3"' R$9R"' &*' "6O7#"-7i3N' /"' -$%$-"-7i3' &*%' +)R$' "' +#"KS6' &*'%"'*6O$32"'"6*Z)#"'%"'&76+#7R)-7i3')37T$#9*'&*'%"'O#*67i3' *3'+$&"'%"']*#7&"N' /)*Z$'&*'#*"%75"#'*%'&*6R#7&"97*3+$'&*'%"' ]*#7&"'6*'#*-$#+"'%"'*6O$32"'&*'9$&$'j)*'%"'"R"#j)*'*3'+$&"' 6)'*n+*367i3Q'673'"O$0"#'6$R#*'O7*%'6"3"l'*6+$'6*'6*%%"'-$3')3' "Oi67+$'+#"36O"#*3+*'"&]*67K$Q'&*'9"3*#"'j)*'-)R#"'%"'*6O$3D 2"'0'*%'+)R$'&*'&#*3"2*Q'+$9"3&$'%"'O#*-")-7i3'&*'j)*'*%'+)R$' &*'"6O7#"-7i3'3$'*6+S'*3'-$3+"-+$'&7#*-+$'-$3'%"'O7*%Q'0"'j)*' O)*&*'-")6"#'%*67i3'&*'%"'9769"N'I6+*'O#$-*&797*3+$'O*#97+*' T$#9"#')3'676+*9"'-*##"&$'-$9O)*6+$'O$#'%"']*#7&"Q'%"'*6O$3D 2"Q'%"'%)5'&*%'+)R$'0'*%'#*6*#K$#7$'UVWN'I6+"'+S-37-"'&*'K"-.$'&*' -*%&"'"R7*#+"']"'67&$')+7%75"&"'O$#')3"'K"#7*&"&'&*'&76-7O%73"6' j)7#>#Z7-"6' U:BQ::WQ' ")3j)*' 6)' )6$' *3' O"-7*3+*6' $#+$OS&7-$6' ]"'67&$'%797+"&$'0'O#*%7973"#N I%'$R2*+7K$'&*'*6+*'+#"R"2$'*6'9$6+#"#'*%')6$'&*%'A(='O$#'9*D &7$' &*%' 676+*9"' 814Q' *3' *%' +#"+"97*3+$' &*' )3' O"-7*3+*' -$3' T#"-+)#"'*nO)*6+"'*3'*%'!JA`'0'#*K76"#'%"'%7+*#"+)#"'6$R#*'%$6' "K"3-*6'0')6$6'"-+)"%*6N ,4R/(58Z325/

I3'4$%$9R7"Q'6*Z>3'*%'4*36$'?BB;Q')3':M{'&*'%"6'O*#6$3"6' -$3' &76-"O"-7&"&' #*Z76+#i' -$9$' -")6"' "%Z>3' +7O$' &*' "--7D &*3+*'R7*3'6*"'&*'+#P367+$Q'O$#'-$3T%7-+$'"#9"&$Q'K7$%*3-7"' $' *3T*#9*&"&' O#$T*67$3"%N' A73' *9R"#Z$Q' 6*Z>3' *%' _*Z76+#$' ="-7$3"%' &*' %"' a76-"O"-7&"&Q' 6i%$' )3' :E{' &*' %"6' O*#6$3"6' 73-%)7&"6'&*-%"#"'"'%$6'+#")9"+769$6'#*6)%+"3+*6'&*%'+#P367+$' -$9$'-")6"'&*'6)'&76-"O"-7&"&N I%'O*#T7%'*O7&*97$%iZ7-$'*3'4$%$9R7"'*6+P'&$973"&$'*3'Z#"3' O"#+*'O$#'*%'+#")9"'0'%"'"--7&*3+"%7&"&N'/$6']$9R#*6'#*6)%D +"3'9P6'T#*-)*3+*9*3+*'"T*-+"&$6'O$#'%*67$3*6'j)*'&*#7K"3' &*%'+#")9"'0'%"'K7$%*3-7"Q'97*3+#"6'j)*'%"6'9)2*#*6'#*6)%+"3' "T*-+"&"6' -$3' 9"0$#' T#*-)*3-7"' O$#' *3T*#9*&"&*6' &*' +7O$' -#i37-$' 0' &*Z*3*#"+7K$N' A*Z>3' )3' *6+)&7$' #*"%75"&$' *3' *%' !$6O7+"%' J37K*#67+"#7$' A"3' `$6S' U!JA`W' &*' %"' -7)&"&' &*' ($D O"0P3Q'*3+#*'&*'%$6'+#")9"+769$6'&*'97*9R#$6'O$#'"--7&*3D +*6' &*' +#P367+$Q' %"6' T#"-+)#"6' &*' +7R7"' #*O#*6*3+"#$3' )3' "%+$' O$#-*3+"2*'UC:{W'*3+#*'+$&"6'%"6'%*67$3*6'j)*'-$36)%+"#$3'*%' 6*#K7-7$'&*')#Z*3-7"6'UMWN

''

("-7*3+*' 9"6-)%73$Q' &*' ;C' "k$6Q' j)7*3' -$36)%+i' *3' 2)37$' &*' ?B::'O$#'"--7&*3+*'&*'+#P367+$'O$#'-$%767i3'*3+#*'9$+$-7-%*+"'0' ")+$9iK7%N'1%'73Z#*6$'"%'6*#K7-7$'&*')#Z*3-7"6'*%'*n"9*3'T.67-$' #*K*%i']*#7&"'*3'O"#+*'O#$n79"%'&*'%"'O7*#3"'&*#*-]"'&*'Cn;' -96Q'-$3'6"3Z#"&$'9$&*#"&$'*'73-"O"-7&"&'T)3-7$3"%'673'"%D +*#"-7$3*6'3*)#$%iZ7-"6'$'K"6-)%"#*6N'A*'+$9"#$3'#"&7$Z#"T."6' j)*' 9)*6+#"#$3' T#"-+)#"' *n+#"D"#+7-)%"#' &*' %"' 9*6*+"' +7R7"%' 0' 6*'&7"Z3$6+7-i'-$9$'T#"-+)#"'"R7*#+"',@@@1'&*'+7R7"'O#$n79"%N I%'O"-7*3+*'T)*'%%*K"&$'&*3+#$'&*'%"6'O#79*#"6'M']$#"6'"'-7#)D Z."Q'&$3&*'6*'#*"%75i'&*6R#7&"97*3+$'j)7#>#Z7-$Q'-)#*+"2*'i6*$' *'739$K7%75"-7i3'&*'%"'*n+#*97&"&N'($6+*#7$#'"%'O#$-*&797*3+$Q' 6*'737-7"#$3'"3+7R7i+7-$6'0'-)#"-7$3*6'&7"#7"6'&)#"3+*'%"6'O#7D 9*#"6'm?']$#"6N'J3"'6*9"3"'&*6O)S6Q'6*'#*"%75i'$6+*$6.3+*676' -$3'O%"-"6'0'+$#37%%$6N'A73'*9R"#Z$Q'%"'*K$%)-7i3'3$'T)*'iO+79"Q' -$3'O*#676+*3-7"'&*'67Z3$6'73T%"9"+$#7$6Q'&*]76-*3-7"'O#$Z#*D 67K"'&*'6)+)#"6'0'6*'"R#*'%"']*#7&"'-$3'6*-#*-7i3'0'*nO$67-7i3' &*%'9"+*#7"%'&*'$6+*$6.3+*676N'A7*+*'&."6'&*6O)S6Q'T)*'%%*K"&$'"'

!"#$%&'()'*+,&'-(.$"/*$'%(-"(,'((0',+-1(2/$#"3%$-'-(-",(.'+*' 45,(67((851(9((:+/$5(9;6<

)3'3)*K$'&*6R#7&"97*3+$'*3'j)7#iT"3$Q'"-$9O"k"&$'&*'&$6' %"K"&$6'j)7#>#Z7-$6'-$3'73+*#K"%$6'&*'CF']$#"6N'UL7Z)#"':WN

+2SX04(ET'_*6)%+"&$'O$6+*#7$#'"%')6$'&*%'676+*9"'814'*3'*%'O"D -7*3+*'-$3'T#"-+)#"'*nO)*6+"'&*'+7R7"N

+2SX04(AT'I6+"&$'737-7"%'&*'%"']*#7&"'&*%'O"-7*3+*'-$3'T#"-+)#"' *nO)*6+"'&*'+7R7"N

A*'737-7i'+*#"O7"'A(=Q'#*"%75"3&$'-)"+#$'#*-"9R7$6'-$3'*6O"-7$' &*'&$6'6*9"3"6'*3+#*'-"&"')3$'0'6*'%$Z#i'-$3+#$%"#'%"'73T*--7i3' $R+*37*3&$' Z#"3)%"-7i3' &*' %"' ]*#7&"l' "' %"' $-+"K"' 6*9"3"Q' "%' -$9O%*+"#' %$6' -"9R7$6' &*%' 676+*9"Q' 6*' #*"%75"#$3' 732*#+$6' &*' O7*%'0'O$6+*#7$#9*3+*'*K$%)-7$3i'"'%"'-7-"+#75"-7i3'+$+"%'-$3' 67Z3$6'&*'-)#"-7i3'&*'%"'73T*--7i3Q'%$Z#"3&$'&"#'"%+"'"%'O"-7*3D +*'*3'*%'9*6'&*'6*O+7*9R#*N'UL7Z)#"6'?'0'EWN +2SX04( BT( J6$' &*%' &76O$67+7K$' 814' *3' %"' ]*#7&"' &*%' O"-7*3+*' -$3'T#"-+)#"'*nO)*6+"'&*'+7R7"N

!"#$%$G.()"(*'(*$&"!'&-!' O2R7/024(1W8(%>. `)3$&Q'&*6&*'*%'"k$':FC:Q'6*3+i'O#*-*&*3+*'-$3'*%')6$'&*'O#*D 67i3'3*Z"+7K"'-$9$'+*#"O7"'Z*3*#"%N'1O%7-"R"'-"9O"3"6'&*'K7D $'j)*'O#$K$-"R"3'6)--7i3'6$R#*'%"'O7*%'6"3"'Z*3*#"3&$'%$' j)*'S%'&*3$973"R"'o]7O*#*97"'+*#"OS)+7-"p'U:?WN'I3':V;?Q'_"D TT*%'&*6-#7R7i'%"'"O%7-"-7i3'&*'&#*3"2*6')+7%75"3&$'O#*67i3'3*D Z"+7K"'R"2$'%$6'-$%Z"2$6'&*#9$Z#"6$6'%)*Z$'&*'%"'9"6+*-+$9."Q' -$3'*%'T73'&*'*K7+"#'-$9O%7-"-7$3*6'O$6+$O*#"+$#7"6'-$9$'6*#$D 9"Q']*9"+$9"'*'73T*--7i3'U:EWN'I3':VMM'K"#7$6'")+$#*6'#)6$6' "O%7-"#$3'*6+*'-$3-*O+$'&*'-$%$-"-7i3'&*'&#*3"2*'"6O7#"+7K$'*3' ]*#7&"6'-*##"&"6N'I3':VFVQ'*3'%$6'I6+"&$6'J37&$6Q'g"97*#$[6D u7Q' )3' -7#)2"3$' O%P6+7-$Q' O"+*3+i' )3' &76O$67+7K$' j)*' O*#97+7i' %"'7##7Z"-7i3'0'%"'*K"-)"-7i3'-$3+73)"'&*']*#7&"6'-)R#7S3&$%"6' O$#')3"'9*9R#"3"'79O*#9*"R%*'U:?WN I%'9769$'9S+$&$'T)*'&*6-#7+$'O$#'L%*76-]9"33'*3':VVE'*3'1%*D 9"37"Q'-)"3&$'"O%7-i'O#*67i3'6)R"+9$6TS#7-"'*3':;'O"-7*3+*6' -$3'T#"-+)#"6'*nO)*6+"6N'($6+*#7$#9*3+*Q'*%'9769$'")+$#')+7D %75i'*%'9S+$&$'*n7+$6"9*3+*'*3'*%'6.3&#$9*'-$9O"#+79*3+"%' *3'97*9R#$6'73T*#7$#*6'-$3'73T*--7$3*6'"Z)&"6'0'-#i37-"6'-$3' R)*3$6'#*6)%+"&$6N'I3'%"'9769"'T*-]"'O*#$'*3'I6+"&$6'J37&$6Q' 1#Z*3+"'0'e$#0u["6'+)K7*#$3')3"'*nO*#7*3-7"'6797%"#'-$3'*%'

!"#$%&'()'*+,&'-(.$"/*$'%(-"(,'((0',+-1(2/$#"3%$-'-(-",(.'+*' 45,(67((851(9(:+/$5(9;6<

'(

)6$'&*'O#*67i3'3*Z"+7K"Q'O$#'%$'-)"%'O"D +*3+"#$3' )3' &76O$67+7K$' O"#"' 6)' "O%7-"D -7i3'-%.37-"'U:CWN !W5/3R70X55263(1W(1WhW57/R(1W(7W_21/( ^8431/(5/3(%>. /"'#*-$36+#)--7i3'&*')3"'*n+#*97&"&'73D T*#7$#' +#")9"+75"&"' O)*&*' ]"-*#6*' 6i%$' &*6O)S6' &*' #*O"#"#' %"' %*67i3' K"6-)%"#Q' T72"#' *%' ])*6$Q' 0' *n+7#O"#' +$&$' *%' +*27&$' &*R7%7+"&$' 0' -$3+"973"&$N' I%' O#73-7O7$' RP67-$'&*'&*6R#7&"97*3+$'&*'+$&$'+*27&$' &*R7%7+"&$' *6' -#)-7"%' O"#"' *%' Sn7+$' T73"%' &*'-)"%j)7*#'#*-$36+#)--7i3'0'"'9*3)&$Q' #*j)7*#*'&*'&*6R#7&"97*3+$6'$O*#"+7K$6' 6*#7"%*6' "3+*6' &*' -)"%j)7*#' -$R*#+)#"' T7D 3"%'&*')3"']*#7&"'UmWN /"'-$R*#+)#"'+*9O#"3"'&*'+*27&$'R%"3&$' *6+P'"6$-7"&"'-$3')3"'R"2"'+"6"'&*'-$9D O%7-"-7i3'0'O$#'%$'+"3+$'*%'$R2*+7K$'*6'-*D ##"#']*#7&"6'&*3+#$'&*'67*+*'i'&7*5'&."6' O"#"' &76973)7#' *%' #7*6Z$' &*' 73T*--7i3Q' $6+*$97*%7+76' 0' 9P6' OS#&7&"' &*' +*27&$N' ^0#&' 0' -$%N' *3-$3+#"#$3' j)*' *%' O$#-*3D +"2*'&*'-$9O%7-"-7i3'Z*3*#"%'&*']*#7&"6' -*##"&"6' &*3+#$' &*' %"' O#79*#"' 6*9"3"' &*'%*67i3Q'*#"'&*':F{'-$9O"#"&$'-$3'*%' ;B{' *3' %"6' ]*#7&"6' -*##"&"6' *3' %"' T"6*' 6)RD"Z)&"'j)*'K"'&*'%"'O#79*#"'"'%"'6*nD +"'6*9"3"6'UmQ:;WN I3+#*'%"6'$O-7$3*6'&*'+#"+"97*3+$'*6+P'%"' -$R*#+)#"'&*'%"']*#7&"'j)*'&*R*']"-*#6*' %$'9P6'*T7-7*3+*9*3+*'O$67R%*N'J3"'K*5' j)*'*6+S'%79O7"'0'R7*3'K"6-)%"#75"&"Q'6*' *6-$Z*' )3"' &*' %"6' $O-7$3*6' j)*' $T#*-*' %"' *6-"%*#"' #*-$36+#)-+7K"' U:MQ:mWN' /"' 6$%)-7i3' "&*-)"&"' &*O*3&*' &*%' *6+"&$' O#*K7$'&*'6"%)&'&*%'O"-7*3+*Q'%"'O#$T)3D &7&"&'&*'%"']*#7&"Q')R7-"-7i3'&*'S6+"'0' %"'*nO*#7*3-7"'&*%'-7#)2"3$N'!$0'*3'&."Q' 73-%)6$' ]*#7&"6' 9P6' -$9O%*2"6' *3' +*3D &i3Q' "#+7-)%"-7i3' $' ])*6$' *nO)*6+$6Q' j)*'*n7Z."3'*3'*%'O"6"&$'#*-$36+#)--7i3' -$3'-$%Z"2$Q'O)*&*3'+#"+"#6*'-$3'9S+$D &$6'9P6'679O%*6'U:FWN 4$3'*%'&76O$67+7K$'814'6*'O)*&*'T$#9"#' +*27&$' &*' Z#"3)%"-7i3' 6$R#*' *%' +*3&i3Q' ])*6$'$'"#+7-)%"-7$3*6'j)*'%)*Z$'O)*&*3' 6"3"#6*Q'0"'6*"'O$#'73+*3-7i3'6*-)3&"#7"' $' O$#' 732*#+$' &*' O7*%' U:MQ:VWN' @3&*O*3D &7*3+*9*3+*'&*'%"'#*-$36+#)--7i3Q'*6'79D

')

O$#+"3+*'739$K7%75"#'%"']*#7&"'6$R#*')3"' "#+7-)%"-7i3' j)*' 6*' 9)*K*' 0' "%7K7"3"#%"' O"#"'*K7+"#'j)*'%"6'T)*#5"6'-$#+"3+*6'73D +*##)9O"3'*%'O#$-*6$'&*'6"3"-7i3'U?BWN /"6' ]*#7&"6' +#"+"&"6' -$3' %"' +S-37-"' &*' 814' O)*&*3' 6*#' "Z#)O"&$6' *3' 3)*K*' -"+*Z$#."6' &*6-#7O+7K"6X' :D' ]*#7&"6' "' %"6' j)*' 6*' "O%7-"' )3' 732*#+$' &*' O7*%' &*' *6O*6$#' O"#-7"%Q' ?D' ]*#7&"6' 73T*-+"&"6' U&*6O)S6' &*%' &*6R#7&"97*3+$WQ' ED' ]*D #7&"6' &*' T#"-+)#"' "R7*#+"Q' CD' ]*#7&"6' &*' +*27&$6'R%"3&$6'"Z)&"6'U-$3'*nO$67-7i3' &*%' +*3&i3Q' %$6' ])*6$6' 0\$' "#+7-)%"-7$D 3*6WQ';D']*#7&"6'&*'T"6-7$+$9."'&*6O)S6' &*%' 6.3&#$9*' -$9O"#+79*3+"%Q' MD' %"6' ]*#7&"6' -#i37-"6' U&)#"-7i3' ƒ' E' 9*6*6WQ' mD' j)7#>#Z7-"' ]*#7&"6' j)*' 6$3' &7T.-7%*6' &*'-*##"#'&*R7&$'"'%"'+*367i3Q'FD']*#7&"6' -$3'O73*6'*n+*#3$6'&*'T72"-7i3'$'+)R$6'$' *3' %$6' 67+7$6' &*' -"+S+*#' -$3' 7##7+"-7i3' 0' &#*3"2*'0'VD']*#7&"6'j)7#>#Z7-"6'j)*'%%$D #"3' %.j)7&$' 6*#$6$' &*6O)S6' &*%' &."' &*%' O$6+$O*#"+$#7$'6*Z)3&$'U?:WN I%'A(='*nO$3*'%"'6)O*#T7-7*'&*'%"']*#7&"' "' O#*67i3' 3*Z"+7K"Q' *%7973"' %$6' %.j)7&$6' &*%' *6O"-7$' *n+#"K"6-)%"#Q' 9*2$#"' %"' -7#D -)%"-7i3' 0' *6+79)%"' %"' O#$%7T*#"-7i3' &*%' +*27&$' &*' Z#"3)%"-7i3N' /$6' &76O$67+7K$6' j)*' 6*' -$9*#-7"%75"3' +7*3*3' -"O"-7&"&' O"#"' "2)6+"#' 37K*%*6' &*' O#*67i3' &*6&*' D;B' 99!Z' ]"6+"' D?BB' 99!Z' 0' O)*&*3' 6*#'O#$Z#"9"&$6'&*'T$#9"'-$3+73)"'$'73D +*#97+*3+*Q'"&*9P6'&*'O#$K**#'&76+73+$6' +"9"k$6'&*'*6O)9"'U??WN 4$3'#*6O*-+$'"%'-#*-797*3+$'R"-+*#7"3$Q' )3' *6+)&7$' 97&7i' *6+$6' .3&7-*6' &*' -#*-7D 97*3+$'0'*3-$3+#i'j)*'%"6']*#7&"6'+#"+"D &"6' -$3' A(=' 9"3+)K7*#$3' )3"' -"3+7&"&' O$#' &*R"2$' &*' :B;' 97-$$#Z"3769$6' O$#' Z#"9$' &*' +*27&$Q' 97*3+#"6' j)*' *3' %"6' ]*#7&"6'&*%'Z#)O$'&*'-$3+#$%'*6+)K7*#$3' O$#'"##7R"'&*'*6"'-7T#"'U?BQ?:Q?EWN'I%'A(=' +7*3*')3'*T*-+$'"3+7*&*9"+$6$'0'6*'O)*D &*'"O%7-"#'6$R#*'732*#+$6'&*'O7*%'O"#-7"%Q' %$' j)*' T"K$#*-*' 0' "-*%*#"' 6)' "&]*#*3-7"' "%'+*27&$'&*'Z#"3)%"-7i3'UVWN'1&*9P6Q'6*' O)*&*3' +$9"#' 9)*6+#"6' &*' 9"+*#7"%' -$D %*--7$3"&$' O"#"' -)%+7K$6' 673' 3*-*67&"&' &*'&*6-)R#7#'%"']*#7&"'U?CWN'A*Z>3'*%'&$D -)9*3+$'-$36*36$'&*'%"'s$#%&'J37$3'$T' s$)3&'!*"%73Z'A$-7*+7*6'O"#"'*%')6$'&*%' 676+*9"'814'U?;WQ'%$6'*T*-+$6'O#73-7O"%*6'

6$3X'#*&)--7i3'&*'*&*9"'+76)%"#Q'")9*3D +$'*3'%"'T$#9"-7i3'&*'+*27&$'&*'Z#"3)%"D -7i3Q'*6+79)%"-7i3'&*'%"'O#$%7T*#"-7i3'&*' +*27&$6'"&0"-*3+*6'"'%"']*#7&"'0'&76973)D -7i3'&*'%$6'37K*%*6'R"-+*#7"3$6'%$-"%*6N /"'-$R*#+)#"'&*'%"6']*#7&"6'6*'-$367&*#"' 9*2$#' 67' 6*' ]"-*' &*3+#$' &*' m?' ]$#"6' &*' %"' %*67i3N' I6+*' 73+*#K"%$' 6*' ]"' %%*K"&$' ]"6+"' &*3+#$' &*' MDF' ]' &*' %"' %*67i3Q' $' %"' #*-$36+#)--7i3' 739*&7"+"' &*T737+7K"' &*' %$6'+*27&$6'R%"3&$6'0'*6+"R7%75"-7i3'&*'%"' T#"-+)#"'*3'"%Z)3$6'-"6$6'-$3'#*6)%+"&$6' *n-*%*3+*6N' I%' $R2*+7K$' *6' *6+"R7%75"#' %"' T#"-+)#"' 0' %$Z#"#' %"' -$R*#+)#"' "3+*6' &*%' &*6"##$%%$' &*' %"' 73T*--7i3N' 4$9O%7-"-7$D 3*6'#*%"-7$3"&"6'+"3+$'-$3'%"'T#"-+)#"'0' %"']*#7&"'*3'6.'6)#Z*3'-$3'T#*-)*3-7"'*3' %"6']*#7&"6'&*2"&"6'"R7*#+"6'&)#"3+*'9P6' &*'m?']N'/"'73T*--7i3'&*%'+*27&$'R%"3&$'0' ])*6$Q' -$36$%7&"-7i3' K7-7$6"Q' O6*)&$"#D +#$676Q'%"'9"%"'73+*Z#"-7i3'&*%'732*#+$'0'%"' "%*+"Q'%"']$6O7+"%75"-7i3'0'9>%+7O%*6'O#$D -*&797*3+$6' j)7#>#Z7-$6' O#$%$3Z"&$6' 0' #*O*+7&$6'6$3'+$&$6'*3'*6O*-7"%'")9*3+i' *3'-7*##*'&*'%"']*#7&"'6*'#*+#"6"'O$#'9P6' &*':'6*9"3"'&*6O)S6'&*'%"'%*67i3'U?EWN 4$3'#*%"-7i3'"'6)'*T7-"-7"'&*%'814Q'K"#7$6' 9$&*%$6'"379"%*6'%"']"3'K"%7&"&$'U?MWN' A73'*9R"#Z$Q'%"'*K"%)"-7i3'-%.37-"'&*'%"' -7-"+#75"-7i3'&*']*#7&"6'*6'"%Z$'6)R2*+7K"N' I6+$' ]"-*' j)*' 6*"' &7T.-7%' &*' O#$&)-7#' 73D K*6+7Z"-7i3'-%.37-"'6i%7&"'j)*'&*9)*6+#"' -%"#"9*3+*' %"' 6)O*#7$#7&"&' &*' %"6' +S-37D -"6'&*'814'$'&*'$+#$'+7O$'*3'-$9O"#"-7i3' -$3'%"6'"%+*#3"+7K"6'U?:WN ,/358XR2/3WR A*' O#*6*3+i' )3' -"6$' -%.37-$' &*' T#"-+)#"' "R7*#+"' Z#"K*' -$3' &*T*-+$' &*' +*27&$6' R%"3&$6'"'37K*%'&*'%"'O7*#3"'j)*'T)*'9"D 3*2"&$'-$3'*%'676+*9"'814'-$3')3"'#*6D O)*6+"'6"+76T"-+$#7"N /"' #*K767i3' &*' %"' %7+*#"+)#"' 6)Z7*#*' j)*' *%' 676+*9"' 814' -$36+7+)0*' )3"' $O-7i3' -$3'3$+$#7"6'K*3+"2"6'-$9$'&76973)7#'*%' 3>9*#$' &*' O#$-*&797*3+$6' j)7#>#Z7-$6' &*'&*6R#7&"97*3+$Q'+*3*#')3"'R"2"'9$#D R7%7&"&' 0' Z*3*#"#' +*27&$' &*' Z#"3)%"-7i3' &*'T$#9"'#PO7&"'0'*T7-"5N'A73'*9R"#Z$Q'6*' #*j)7*#*'&*')3"'9"0$#'*nO*#7*3-7"'-%.37D -"' *3' *%' )6$' &*%' A(=' 0' #*"%75"#' *6+)&7$6'

!"#$%&'()'*+,&'-(.$"/*$'%(-"(,'((0',+-1(2/$#"3%$-'-(-",(.'+*' 45,(67((851(9((:+/$5(9;6<

9P6' "9O%7$6' j)*' O*#97+"3' 6$O$#+"#' %"6' #*-$9*3&"-7$3*6'&*')6$N 'S041W52Y2W37/R 1' ="3-0' `"#"97%%$Q' a7*Z$' /"+$##*Q' s7%D 6$3'/iO*5'0'd)%0'IN'e)k$5Q'*6+)&7"3+*6' &*%'O#$Z#"9"'&*'e*&7-73"'&*'%"'J37K*#D 67&"&'&*%'4")-"N

:BN''

::N'' !"+"!".,$'% :N'' b(A'bN'H#")9"+769$6'-")6"&$6'O$#' *%'+#P367+$'0'&76-"O"-7&"&N'?B::N ?N'' ($%7+#")9"' *3' 1#Z*3+73"Q' %"' *3D T*#9*&"&'67%*3-7$6"'&*'%"6'6$-7*D &"&*6' 9$&*#3"6N' _*K76+"' 1#Z*3D +73"' &*' e*&7-73"' 0' 47#)Z."' &*%' H#")9"N'?BBBl:U;WN EN'' |)7Z%*0'e_Q'87&$K7-]'aQ'4"3+*%%"'aQ' s7%R*#Z*#'`IQ'e"#$$3'`4Q' a7"9$3&' aN'a*T7373Z'+]*'%797+6'$T'6)#K7K$#6D ]7O'"T+*#'K*#0'6*K*#*']*"&'732)#0N'`' H#")9"N':VVmlC?U:WXmD:BN CN'' s$#%&'!*"%+]'b#Z"375"+7$3'Us!bWl' J37+*&' 3"+7$36' I-$3$97-Q' "3&' A$-7"%' 4$997667$3' T$#' 167"' "3&' +]*' ("-7T7-' UJ3IA41(WN' a76"R7%7+0' A+"+76+7-6X' H#"7373Z' e"3)"%' Ua#"T+W' beAQ',73*R#"N ;N'' s!b\b(AN'@3T$#9*'6$R#*'*%'*6+"&$' &*'%"'6*Z)#7&"&'K7"%'*3'%"'_*Z7i3'&*' %"6'19S#7-"6N'?BBVN MN'' 4$3-]"' `eQ' @%%*#"' e`Q' 1%K"#"&$' ^IN'IK"%)"-7i3'&*%'+#"+"97*3+$'&*' T#"-+)#"6' -*##"&"6' &*' %"' &7PT7676' &*' %"' +7R7"' -$3' -%"K$6' 73+#"9*&)D %"#*6' T#*6"&$6' 0' 3$' T#*6"&$6N' _*K' 4$%' &*' b#+$O' 0' H#")9N' "Z$6+$' &*' ?BB:l:;U?WX:VDEBN mN'' ^0#&' !AQ' 47*#30' ,' @@@Q' H*RR*++6' `^N' e"3*2$' &*' T#"-+)#"6' "R7*#+"6' &*' %"' +7R7"' -$3' OS#&7&"' &*' +*27&$' R%"3&$' "6$-7"&$X' T72"-7i3' *n+*#3"' -$3' -$D R*#+)#"' +*9O#"3"' &*' -$%Z"2$N' (%"6+' _*-$36+#'A)#ZN':VF:lMFXmEDF?N FN'' ^0#&' !AQ' 47*#30' ,' @@@Q' H*RR*++6' `^N' e"3*2$' &*' T#"-+)#"6' "R7*#+"6' &*' %"' +7R7"' -$3' OS#&7&"' &*' +*27&$' R%"3&$' "6$-7"&$X' T72"-7i3' *n+*#3"' -$3' -$D R*#+)#"' +*9O#"3"' &*' -$%Z"2$N' (%"6+' _*-$36+#'A)#ZN':VF:lMFXmEDF?N VN'' _7$Q' e"#-*%$l' 4$%$9R$Q' e"#+73l' ,"R"6Q' a)7%7$l' ,$++*#Q' ,)7%%*#9$l' 13Z]*R*3Q' I&)"#&$l' A""Q'`$6*N' H#"D

!"#$%&'()'*+,&'-(.$"/*$'%(-"(,'((0',+-1(2/$#"3%$-'-(-",(.'+*' 45,(67((851(9(:+/$5(9;6<

:?N'' :EN''

:CN''

:;N''

:MN''

:mN''

:FN''

:VN''

?BN''

+"97*3+$' -$3' R$9R"' &*' O#*67i3' 3*Z"+7K"'O"#"'%"6'%*67$3*6'&*'O"#+*6' R%"3&"6'*3'%$6'97*9R#$6N'_*K'16$-' 1#Z*3+' b#+$O' H#")9"+$%N' 6*O+7*9D R#*'&*'?BBMlm:UEWX?::DMN 4]"3Z' y(Q' H6"7' 44Q' /73' HeQ' /"7' 4AQ' /73Q'AaN'13'"%+*#3"+7K*'&#*6673Z'T$#' 6u73'Z#"T+'799$R7%75"+7$3X'=*Z"+7K*' O#*66)#*N'^)#36N'?BB:l?mXFEVDC?N !"#%"3'`sN'H#*"+9*3+'$T'$O*3'6+*#D 3"%' [$)3&6' [7+]' +]*' K"-))9D"6D 676+*&' -%$6)#*' 606+*9X' 1' 6"T*Q' #*%7"D R%*' 9*+]$&N' (%"6+' _*-$36+#' A)#ZN' ?BB?l:BVXm:BD?N ,#**#' ' AN' s]7+]*#' 6)R"+9$6O]*#7-'' O#*66)#*''&#*6673Zw'133"%6'$T'(%"6+7-' A)#Z*#0N'?BBBlC;UEWXEE?DCN ^%"-uR)#3' @@' `N' =*Z"+7K*' O#*66)D #*' &#*6673Z6' "6' "' R$%6+*#' T$#' 6u73' Z#"T+6N' 133"%6' $T' (%"6+7-' A)#Z*#0N' :VVFlCBUEWXC;EDmN H]$9"'AN'13'73+#$&)-+7$3'+$'+]*')6*' $T' K"-))9' "6676+*&' -%$6)#*N' •@3+*#D 3*+€N'?BB:N'_*-)O*#"&$'"'O"#+7#'&*X' 13' 73+#$&)-+7$3' +$' +]*' )6*' $T' K"D -))9'"6676+*&'-%$6)#*N 47*#30',Q'^0#&'!AQ'`$3*6'_IN'4$R*#D +)#"'&*'+*27&$'R%"3&$'O#79"#7"'K*#D 6)6' -$R*#+)#"' &*' +*27&$' R%"3&$' +"#D &."' *3' T#"-+)#"6' "R7*#+"6' Z#"K*6' &*' %"'+7R7"X'-$9O"#"-7i3'&*'#*6)%+"&$6N' 4%73'b#+]$ON':VFEl:mFX;;DMEN ("##*++'^eQ'e"+#$6'IQ'(#7R"5'``Q'b#D Z7%%' a(N' H#")9"' *3' %"' *n+#*97&"&' 73T*#7$#X' +*3&*3-7"6' *3' *%' 9"3*2$' &*' #*-$36+#)--7i3' &*' +*27&$' R%"3D &$' &*' T#"-+)#"6' "R7*#+"6' &*' %"' +7R7"' 0' *%' O*#$3SN' (%"6+' _*-$36+#' A)#ZN' ?BBMl::mX:E:;D??N ^#*9' !Q' A]**]"3' (Q' _$6*3R*#Z' !`Q' A-]9*7&*#'`AQ'^$)%+$3'1`N'(#$+$-$%$' R"6"&$'*3'%"'*K7&*3-7"'O"#"'>%-*#"6' *3'*%'O7*'&*%'&7"RS+7-$N'(%"6+'_*-36+#' A)#ZN'?BBMl::mX:VEAD?BVAN' ^#7"3' eN' ("##*++Q' `)%7"3' `N' (#7R"5N' _*-$36+#)--7i3' &*' *n+#*97&"&' 73T*#7$#N' _*K' e*&' 4%73' 4$3&*6N' ?B:Bl?:U:WXmMDF;N e"+]*6' A`Q' ="]"7' LN' 4%"67T7-"-7i3' &*' %"' "3"+$9."' K"6-)%"#' &*' %$6' 9>6-)%$6X' -$##*%"-7i3' *nO*#79*3D +"%' 0' -%.37-"N' (%"+' _*-$36+#' A)#N' :VF:lMmX:mmDFmN e7-]"*%' HN' 1#-]&*"-$3Q' eaQ' eAI' "3&' ("+#7-u' e*66*#6-]97++Q' ^AN'

?:N''

??N''

?EN''

?CN''

?;N''

?MN''

e$&*#3' ("O73*")' H*-]37j)*' s7+]' 8"-))9D16676+*&' 4%$6)#*N' `' b#+]$O' H#")9"N'?BBMl?BU?WX:ECDmN /"[#*3-*' GN' s*RRN' =*[' H*-]D 37j)*6' 73' s$)3&' e"3"Z*9*3+X' 8"-))9D16676+*&' s$)3&' 4%$6)D #*N' `$)#3"%' $T' +]*' 19*#7-"3' 1-"D &*90' $T' b#+]$O"*&7-' A)#Z*$36N' ?BB?l:BU;WXEBED::N ("R%$' AN' _$+*%%"' d' L*#3"3&$' _N' 8"D %*#$' ^"#ZN' H#"+"97*3+$' &*' &*T*-D +$6' &*' -$R*#+)#"' *3' %$6' 97*9R#$6' -$3' *%' 676+*9"' &*' O#*67i3' 3*Z"+7K"' *3' O"-7*3+*6' -$3' -)%+7K$' O$67+7K$N' _*K' 16$-' 1#Z*3+' b#+$OH#")9"+$%N' ?B::lmMU:WX;?DVN `"9*6' (N' A+"33"#&Q' ="K**3' A73Z"D 3"9"%"Q' a"K7&' 1N' 8$%Z"6N' L7n' "3&' T%"O' 73' +]*' *#"' $T' K"-))9' 6)-+7$3' &*K7-*6X's]"+'&$'[*'u3$['73'+*#96' $T' *K7&*3-*' R"6*&' 9*&7-73*w' @3+*#D 3"+7$3"%'`$)#3"%'$T'+]*'4"#*'$T'+]*' @32)#*&N'?B:BlC:XmFBDMN e$$3*0' `LQ' *+' "%N' H#*"+9*3+' $T' 6$T+' +766)*' &*T*-+6' )3' O*&7"+#7-' O"+7*3+6' )673Z'+]*'814'606+*9N'4%73'b#+]$ON' ?BBBlEmMX?MDE:N s$#%&'J37$3'$T's$)3&'!*"%73Z'A$D -7*+7*6N' A76+*9"' &*' -7*##*' "%' K"-.$X' #*-$9*3&"-7$3*6'&*')6$N'a$-)9*3D +$'&*'-$36*36$N'?BBFN e$#0u["6' e`Q' 1#Z*3+"' /4Q' A]*%D +$3D^#$[3' I@Q' e-,)7#+' sN' 8"D -))9D"6676+D*&' -%$6)#*X' 1' 3*[' 9*+]$&' T$#' [$)3&' -$3+#$%' "3&' +#*"+9*3+N' 1379"%' 6+)&7*6' "3&' R"67-' T$)3&"+7$3N' 133' (%"6+' A)#ZN' :VVmlEFX;;EDM?N

'*

Lihat lebih banyak...

Comentarios

Copyright © 2017 DATOSPDF Inc.