4642-003C 徒手治療:脊椎、四肢動態關節鬆動術(第二版)

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ү۰Ԕ֏

2010 ѐߏԧ౵‫˘ޢ‬ѨՀາώ३˞ĂϏֽົѣາү۰ᆷ΍Հ р۞າ३Ą఺˘̷ౌึ‫׎‬ҋ൒Ċ າ‫̰۞ۍ‬टѣֱᖙາᄃ७ϒĄ֭ͷќᐂ˞˘ֱԧΩ˘ώ३ Įҋԧ‫ڼ‬ᒚ˭ࡦăᐚഛăα۳˟‫( ۍ‬Self Treatment for Back, Neck and Limbs)į۞̰टĄώ३ߏࠎ˘ਠ̂ி҃ᄦүĂ༊൒˵ ᝃ߁˞າ۞ҋԧ‫ڼ‬ᒚ‫ޙ‬ᛉĄ ֽҋ፫̂Ӏֲ۞ Mark Oliver ϡԧࣇ۞៍‫ڼه‬ᒚᖧ㎪ᙯ༼ᄃ 㝅ᙯ༼Ą΁ѣ఺͞ࢬ۞३૟ࢋ΍‫ۍ‬ĂЯѩϏќᐂдԧ۞३̚Ą д ‫ ڼ‬ᒚ ᐝ ຶ ͞ ࢬ Ă Frank Gargano ߏ ૞ छ Ă ୬ ۢ ྎ ଐ ኛ ˯ www.bmulligan.com.შ৭ߤವĄ Б͵ࠧѣధкഇΏ͚޺ԧࣇ۞‫ڼ‬ᒚ͞‫ڱ‬Ăͽ̈́ᙋ‫ځ‬ԧࣇ௑ Ъ၁ᙋ‫ڼ‬ᒚ૞छ۞ᅮՐćԧࣇѣ෹࿅ 120 ቔ૞ຽ۞၁ᙋᗁጯ͛ ᚥ൳ᐂд www.bmulligan.com.შ৭˯ĂΞឰ᝝۰ΝߤྙĄ જၗᙯ༼ᗫજఙ (“MWM”)Ăдᑕϡ˯‫࠹׶‬ᙯᅳાᔘѣ൴ ण۞ሕ˧Ąԧࣇυืຏᔁ Bill Vicenzino ି଱ă Toby hall ă Kim Robinson ă Sue Reid ‫ ׶‬Darren Rivett ି଱ඈഅགྷࡁտ൴ܑજၗ ᙯ༼ᗫજఙ۞ˠࣇĄ ԧࣇഅ࿃࿅ధк҉҇ă੻ᐪ۞া‫ې‬Ăࡶߏ҉҇੻ᐪ୧Іዋ Ъઇव͘‫ڼ‬ᒚ۞ˠĂϡજၗᙯ༼ᗫજఙ‫ڼ‬ᒚĂड़‫ߏڍ‬౵ഔ۞Ą व͘‫ڼ‬ᒚ۞͞‫ڱ‬ѣ‫ޝ‬к჌ĂЧѣ‫׎‬ዋϡ۞ঽˠĄֹϡٙѣ ώ३̚۞ԫμॡĂт‫ߏڍ‬ዋᑕাĂ‫ົ݋‬ѣϲӈ۞ᒚड़Ąт‫ڍ‬൑ ड़Ă࣎ˠᄮࠎߏ‫ڼ‬ᒚ͞ё̙၆Ăᑕဘྏ‫ڼ΁׎‬ᒚ͞‫ڱ‬ĄҰ̙ਕ ˘ۡϡ൑ड़۞͞‫ڼڱ‬ᒚঽˠĂࡶ౵‫ޢ‬ঽˠ՟ซՎĂٕಶ෧Ҍа

v


vi

व͘‫ڼ‬ᒚĈਖഛăα۳જၗᙯ༼ᗫજఙ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

෧̝ม՟ѣԼචĂ‫݋‬υืຐҾ჌͞‫ڼֽڱ‬ᒚঽˠĄֹϡ ņMWMŇ૱ѣមˠ۞ᒚड़Ăԧᓁߏԓ୕౵‫ޢ‬ѣ؈ᖹ൴ϠĄ дѩԧГѨຏ‫˵ז‬ᑕຏᔁ Jonathan Hoffman ٙనࢍ۞‫ڼ‬ᒚ Ԗ (ATM2)Ăֹϡ఺ৠ؈۞న౯ਕឰዋᑕাঽˠᒠมྋੵূ ൭Ą(cf “MWMS”)Ą

ү۰ඕᄬ ώ३۞ϫ۞ߏឰ᝝۰˞ྋԧ۞‫ڼ‬ᒚԫμĄࡶ੨ЪྎႽዋ༊۞ ྋ࣠ጯᄃϠ‫˧ۏ‬ጯĂ‫݋‬Հ΄ˠ႕ຍĄώ३̰टΒ߁‫ۏ‬ந‫ڼ‬ᒚरሢ ଉ۞ྋ࣠ጯᄃϠ‫˧ۏ‬ጯĂ఺͞ࢬ˵ѣధкିࡊ३Ξͽણ҂Ą ౵ѣड़۞ҋԧ੊ቚᄃጯ௫̍‫ߏ׍‬ਖഛᄃα۳ᙯ༼ሀ‫ݭ‬Ă҃ ௟༼ჟቁͷѣᇅّ۞ሀ‫ݭ‬ΞϡֽШঽଈྋᛖ‫ڼ‬ᒚ۞ϫ۞Ą ఺ಶߏৌϒ۞ņNAGSŇ ăņSNAGSŇ ăņMWMSŇ Ą

၁ᙋᗁጯ ϒт݈˘‫ۍ‬३ٙ̚೩̈́۞Ă෸ֽ෸кซҖ̚۞ࡁտ͚޺ԧ ࣇ۞ந‫ه‬Ą 2009 ѐ۞‫ۿ‬ΐ઼࣯ᅫࡊጯົᛉᄃ 2011 ѐ۞ཬ෈Ͱ઼ᅫࡊ ጯົᛉ˯Ăԧࣇᐝ‫׌‬Ѩ൴ܑ SNAG ۞៍‫ه‬ă၁ᙋ‫׶‬ᘹఙĂ҃ͷ ‫ܧ‬૱јΑĄனд̪̙ᕝѣາ൴னᄃጯ௫າְ‫ۏ‬ĂឰϠ‫·׻‬႕ሄ ኷ᄃᎸጬĄ ԧ۞ˠϠৌߏ‫ྻض‬Ą


ϫᐂ

ௐ˘ొ̶

ǵ

ਖഛᙯ༼ᗫજఙ

3

A. ᐚഛ̈́˯਒ഛƟ 5 1.Ķ̈ࢬᙯ༼ᗫજఙķ(NAGS) ۞̬௜Ɵ 5 2.ĶͅШ̈ࢬᙯ༼જၗᗫજఙķ(REVERSE NAGS)Ɵ 8 3.Ķજၗ̈ࢬᙯ༼ᗫજఙķ(SNAGS)Ɵ 11 4.Ķҋӄё SNAGSķ(SELF SNAGS)Ɵ 23 5. જၗਖഛᙯ༼ᗫજఙ੨Ъ͘ᓖજү (SMWAMS)Ɵ 27 6. ‫ڼ΁׎‬ᒚᐚഛă਒ഛ۞͞‫ڱ‬Ɵ 32

B. ˯ᐚഛયᗟ۞পঅᒚ‫ڱ‬Ɵ 35 1. ᐝ൭Ɵ 35 2. োຶă⪰͕ăഛજਔব৫া࣏ཏƟ 46

C. ཕഛƟ 49 1. “SNAGS”Ɵ 49 2. ҋӄёજၗ̈ࢬᙯ༼ᗫજఙ (SELF SNAGS)Ɵ 61

D. ᖧ㎪ᙯ༼Ɵ 65 E. ਒ഛƟ 70 F. ਒၏Ɵ 74 G. ඕኢƟ 78

ix


व͘‫ڼ‬ᒚĈਖഛăα۳જၗᙯ༼ᗫજఙ

x

Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

Ƕ

‫΁׎‬ਖഛᒚ‫ڱ‬

79

ௐ˟ొ̶

α۳Ķજၗᙯ༼ᗫજఙķ

107

ௐˬొ̶

α۳‫΁׎‬ᒚ‫ڱ‬ A. ূ൭ቤྋன෪ԫμůņPRPSŇƟ 160 B. ‫΁׎‬۳វ̝‫ڼ‬ᒚƟ 175

ણ҂͛ᚥƟ 189 ৶͔Ɵ 191

159


ௐ˘ొ̶ I . ਖഛᙯ༼ᗫજఙ II. ‫΁׎‬ਖഛᒚ‫ڱ‬


ௐ˘ొ̶

I.

ਖഛᙯ༼ᗫજఙ Spinal Mobilisations

F ʕ F ᖎ̬ (Introduction) дव͘‫ڼ‬ᒚᅳા̚Ă‫ڼ‬ᒚरдጯ௫ፋਖఙॡĂ૱జӘۢࢋ ‫ڦ‬ຍ̈ࢬᙯ༼ (facet joint) ۞֕ШĂ఺ߏ‫ܧ‬૱ѣ኷۞ְଐĄ ᑒଈ۰ፋਖॡĂ߉˧۞͞Шᄃ̈ࢬᙯ༼֕Шѣ૜̷۞ᙯ ܼĂ͍‫ߏ׎‬ፆү୊ᖼፋਖᄃ઎ᝈፋਖ۞ॡ࣏Ą˘ਠ҃֏Ăᑒଈ ۰ઇᙯ༼ᗫજఙॡĂಶ՟ѣૻአࢋ‫ڦ‬ຍ̈ࢬᙯ༼֕ШĂҭԧᔘ ߏົͽπҖ̈ࢬᙯ༼۞֕Шٕϒቁ۞֎‫ֽޘ‬ઇᙯ༼ᗫજఙĄΩ γĂ‫ڼ‬ᒚα۳ᙯ༼ॡĂ‫ڼ׎‬ᒚπࢬтТ Freddy M Kaltenborn ۞ ඾ү (Mobilization of the Extremity Joint) ٙᄲ۞Ăα۳ᙯ༼۞ ‫ڼ‬ᒚπࢬ۞‫ڻ‬඾Όࢬᙯ༼Ą ‫ڼ‬ᒚπࢬᐌ඾ᙯ༼Όࢬ҃ொજĂЯѩ‫ۏ‬ந‫ڼ‬ᒚरሢଉٙѣ ਖഛᙯ༼ࢬ۞֕Шߏυࢋ۞Ą ༊᝝۰ሢ᝝ώ३ॡĂົ൴னԧ‫ڼ‬ᒚᐚഛă˯਒ഛĂࠤҌፋ ࣎ਖഛ۞ॡ࣏Ăౌߏឰଈ۰۞֗វ఍‫ࢦྶٺ‬ଐ‫˭ڶ‬Ăֽፆүજ

3


4

व͘‫ڼ‬ᒚĈਖഛăα۳જၗᙯ༼ᗫજఙ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ၗᙯ༼ᗫજఙĞঽˠ৭඾ٕӱ඾ତ‫ڼצ‬ᒚğĄ఺ᕇ‫ܧ‬૱ࢦࢋĂ Яࠎ็௚֗វ̙ྶࢦ۞‫ڼ‬ᒚ‫ߏڱ‬ঽଈ዁඾ତ‫ڼצ‬ᒚĂҭߏ༊ঽ ଈ‫ڼ‬ᒚԆல৭੓ֽॡĂᒚड़ົঐεଫĄ ᔵ൒͛̚՟ѣ೩̈́Ăҭү۰˵ࢋТॡ೩ֻ‫΁׎‬ዋЪ۞‫ۏ‬ந ‫ڼ‬ᒚ͞ёĄд఺྆ԧυื޽΍Ăѣ჌ঽଐ̙ዋЪϡજၗᙯ༼ᗫ જఙĂಶߏӱ੻ৠགྷ൭ౄјཕഛ઎ᝈĞ੻࠴้୆ğĂ఺჌ଐ‫ڶ‬ ϡ R. A. McKenie д΁۞३ņThe Lumbar SpineŇٙ̚ୃࢗ۞͞ ‫ڼֽڱ‬ᒚঽˠྵዋЪĞણ҂͛ᚥ 9ğ Ą


ௐ˘ొ̶āI. ਖഛᙯ༼ᗫજఙ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

A ᐚഛᄃ˯਒ഛ “NAGS”, “SNAGS”, “MWMS”, “SMWAMS” ETC.

ᙌ΀ᛟ

1 Ķ̈ࢬᙯ༼ᗫજఙķ(NAGS) ۞̬௜ F ʕ F ᄲ‫( ځ‬Explanation) ņNAGSŇߏ Natural Apophyseal Glides ۞ᒺᆷĂ఺჌Ϥԧ ‫׻‬Щ۞ॎજᙯ༼ᗫજఙ (oscillatory mobilisation) ‫ڼ‬ᒚ‫ڱ‬ዋϡ‫ٺ‬ ௐ˟ᐚഛ‫ז‬ௐ˛ᐚഛ۞ᙯ༼ࢬĄ ԧࣇдֹϡņNAGSŇॡĂߏ‫ڻ‬඾ٙᏴ‫ؠ‬ਖഛ۞‫ڼ‬ᒚπࢬĂ ֹ̝‫˯ـ‬ă‫݈ـ‬໣જĂ໣જ۞ቑಛଂ̚ม‫ז‬౵௣֎‫( ޘ‬middle to end-range)Ăૻ‫͔̙ͽޘ‬੓ঽˠ۞ূ൭ࠎࣧ‫݋‬Ăӈঽˠຏᛇ‫ז‬ ѣᕇ̙න‫˧۞ڇ‬྽ӈΞĄ఼૱ԧࣇឰঽˠͽ౵͞‫ڼܮ‬ᒚ۞‫ݻ‬๕ ӱдഎ̄˯Ă͍‫ߏ׎‬ዷࡦ۞ঽˠĂ̙ࢋ࢔඾ĂЯࠎঽˠдӱϲ ۞‫ݻ‬๕˭ፆүņNAGSŇ ĂΞͽΐ˯˘ֱ஝͔۞˧ณĂֹঽˠන ‫ֱ˘ڇ‬Ą ņNAGSŇϡ‫ٺ‬ᆧΐਖഛ߿જ‫׶ޘ‬ഴᅅূ൭Ăͷ‫ܧ‬૱ዋЪϡ‫ٺ‬ ᅮࢋ໢ߘ‫ר‬᜕۞ҁˠĄΩγņNAGSŇ˵ዋϡдᐚഛ߿જ‫ޘ‬ᚑࢦ‫צ‬ ࢨ۞ঽˠĂҭᐚഛඕၹᚑࢦ‫צ‬ຫ۞ঽˠٕ‫΁׎‬༰ԟা̙ዋϡĄ т‫ڍ‬ঽˠ۞ঽଐዋЪઇņNAGSŇ ĂдፆүņNAGSŇॡĂঽ ˠಶ̙ົ൭ĂઇԆņNAGSŇॡĂঽˠٕధົѣᕇᅕĂ఺ߏϒ ૱ன෪Ą༊ԧࣇᑒঽˠઇԆņNAGSŇ̝‫ޢ‬Ă૱૱ତ඾ઇ ņRevers NAGSŇ Ăώ३д‫̬ົࢬޢ‬௜Ą

5


व͘‫ڼ‬ᒚĈਖഛăα۳જၗᙯ༼ᗫજఙ

6

Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

F ʕ F “NAGS” ۞ဦྋ (Description)Ğဦ 1ğ ဦ̚ঽˠනዋгӱдတٕ̄എ̄˯ćЯЧঽˠវ‫̙ݭ‬ТĂ т‫ڍ‬ळഎΞአፋ੼‫ޘ‬Ă၆‫ڼ‬ᒚົ‫ޝ‬ѣᑒӄĄ ‫ڼ‬ᒚरࡶၚϡΠ͘ĂΞ৭дঽˠΠ઎ĂϡཛొያღঽˠΠ ઎۞۷჻Ăϡ਒ొ෭ღঽˠΠ઎۞ᓚᐙֽ‫ؠ׽‬ঽˠĄ ‫ڼ‬ᒚर۞Π݈ᓖᒖ‫ٱ‬ঽˠν઎۞㝅ዱᙯ༼Ăঽˠ۞ᐝܲ ޺дϒ̚ҜཉĂᔖҺᐝొ୊ᖼă઎ᝈĂт‫ڼڍ‬ᒚरߏّ̃Ă Ξдсᄃଈ۰۞ᐝొ̝มါ˘๴హါĂ҃ԧ‫ߏ݋‬ါ˘ૺ৽Ă ่̙୻ሒ኎ϠĂ҃ͷΞͽᔖҺّ̃ঽˠ۞̼㣢‫זڭݡ‬ԧ۞җ ‫ࢬ˯ڇ‬Ą

ဦ1

̈ࢬᙯ༼ᗫજఙ‫ڼ‬ᒚ̚ᐚഛ (“NAGS” to the mid cervical spine)Ą


ௐ˘ొ̶

II.

‫΁׎‬ਖഛᒚ‫ڱ‬ Other Spinal Therapies ӓ‫̚ؠ‬

A ፋഛఙ Manipulation ѣˠᄲ૟ፋഛఙϡֽ‫ڼ‬ᒚᐚഛă਒ഛ‫׶‬ཕഛͧϡֽ‫ڼ‬ᒚ˭ ཕഛѣड़Ăԧ͚޺఺࣎ᄲ‫ڱ‬Ă఺ߏЯࠎ̈ࢬᙯ༼၆ূ൭ѣྵۡ ତ۞ͅᑕĄ‫ۏ‬ந‫ڼ‬ᒚरΞͽણ҂ 1987 ѐņSpineŇ఺ώ३̚Ϥ V. Mooney ൴ܑ۞IJ൭ߏଂֽ֤྆۞Ĕ(Where Is The Pain Coming From)ij͛ౢۢ̚ፍĞણ҂͛ᚥ 12ğ Ą дԧᓾཕഛņSNAGSŇౢ༼۞Ԕ֏̚അᆷ‫ז‬Ăਖഛдજү ۞࿅඀̚ĂᅮࢋѣΞҩण۞̈ࢬᙯ༼Ă೩ֻഛมሹѣϒ૱۞ԛ តĄ༊ԧࣇઇፋഛఙॡĂཕഛᙯ༼‫غז‬൴Ϡ˞̦ᆃְ‫׸‬Ĕԧࣇ Ξͽ᝘‫̈́ז‬ຏᛇ‫ז‬ಁધ۞ᓏࢰĂ̂ొ̶۞ፆү۰ᄮࠎ఺఼૱ߏ ̈ࢬᙯ༼۞ᓏࢰĄѣֱঽˠົϲӈຏ‫ז‬ቤྋĂҭѣˠ‫ݒ‬ᛇ଀՟ ѣ̦ᆃमҾĂӈֹҰቁ‫̏ؠ‬఍ந‫˞ז‬ϒቁ۞ഛ༼ĂԧΪਕᄲĂ ॲፂፋഛఙ౹ؕ۰۞ᄲ‫ڱ‬Ăፋഛఙֹ̈ࢬᙯ༼ϒ૱г໣જĂொ

79


80

व͘‫ڼ‬ᒚĈਖഛăα۳જၗᙯ༼ᗫજఙ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ੵഛมሹ̙ϒ૱۞ԮᖼĄҭઇԆፋഛఙ‫ޢ‬၆ᙯ༼ౄј˞۩มĂ ᙯ༼̪̙ਕдϒ૱۞જүĂٙͽΞͽϡņSNAGSŇ Ăᔵ൒ѣֱ ঽˠ၆఺ֱ‫ڼ‬ᒚౌ՟ѣр۞ͅᑕĂҭߏԧࣇдઇԆፋഛఙ‫ޢ‬Ă ᔘߏࢋගঽˠઇņSNAGSŇ࠻࠻Ąಶԧֽ࠻Ăፋഛఙ۞Пᐍّ ߏֽҋ‫ٺ‬ઇĶ᏾ᙝķĄ൑‫ڱ‬ឰ̈ࢬᙯ༼ѣϒ૱໣જ۞࢖ྫĄт ‫ڍ‬Ᏼ᏾ᙝֽઇፋഛఙĂ҃ͅົឰ਑ऴ۞ഛมሹ‫זצ‬࿅к̙ϒ૱ ۞ԮᖼԛតĂۡ‫ז‬ҰઇԆፋഛఙ‫ޢ‬ĂҰ̖ົ൴னҰֹഛมሹ۞ ଐ‫ڶ‬Հೋ̼˞Ąԫఙр۞ፆү۰Ξͽഴ͌఺ֱПᐍĂЯࠎ΁ࣇ д߉˧ॡĂΞͽϡ‫ז‬౵̈ͷޫμ۞˧ณĂ༊൒ņSNAGSŇ࠹ྵ ߏྵщБĄ

B ϡ૲̄஝͔ԫఙ Belt Traction Techniques ԧд݈ࢬ͛̚ᓾ‫ז‬ཕഛņSNAGSŇॡĂٙϡ‫̄૲۞ז‬Ξͽ ोֽϡд̚਒ഛ‫ז‬ཕഛ˯Ą ‫ڼ‬ᒚ̚਒ഛ‫ז‬ཕഛॡĂឰঽˠЈ዁‫ڼٺ‬ᒚԖ˯ĂԖ˯⯴ͤ ໣ါĄࠎ˞ᔖҺঽˠజ஝͔ॡԖ൴ϠொજĂͽ̈́ࠎ˞ԧࣇ͞‫ܮ‬ አፋ੼‫ޘ‬Ă‫ڼ‬ᒚԖ౵р‫ٸ‬дѣ⯴гദ۞г‫˯ڕ‬Ą ૟૲̄‫ٸ‬дѣયᗟഛ༼۞˯˘༼ਖഛ۞ഌࡎ˯Ă֭૟૲̄ ᒖᖒ࿅‫ڼ‬ᒚर۞ᗕ۷Ğтဦ 27ğ Ąд‫ڼ‬ᒚ਒ഛॡĂঽˠࢋԯᗕ ͘‫ٱ‬ҝ‫ڼ‬ᒚर۞ཕĂрឰ۷ࡨ੻‫ڻ‬඾਒ጨ‫ـ‬γ઎ொજĄঽˠᐝ ొ˭͞Ξͽါ˘࣎‫ڋ‬ᐝĄ᝝۰ଂဦ 27 ̚Ξͽ࠻‫ז‬Ă‫ڼ‬ᒚर۞។


ௐ˘ొ̶āII. ‫΁׎‬ਖഛᒚ‫ڱ‬ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ဦ 27

਒ഛٕཕഛϩ૲஝͔‫( ڱ‬Belt traction for thoracic or lumbar spine)Ą

ᙯ༼ൾ຋ᝈѡĂ఺ᇹΞͽឰ΁۞֗វઃ঻дঽˠ֗វ۞˯͞Ą ‫ڼ‬ᒚर۞͘Ξͽ‫ٸ‬д‫ڼ‬ᒚԖ˯Ăүࠎજүॡ۞͚ᇣᕇĄତ඾Ă ૟͘ᓖҩۡĂឰ૲̄Ξͽᘦ‫׽‬г‫ٸ‬дٙᏴ۞ഛ༼˯Ă൒‫ͽޢ‬ҩ ۡ۞͘ᓖࠎค͕Ă૟֗វШ‫้ޢ‬୆Ăͽ஝͔ਖഛĄ‫˘۞ࢋࢦޝ‬ ᕇߏĂࢋ૟ค͕‫ٸ‬д͘ᓖ˯Ă҃ͷਖഛߏ՟ѣᑅ˧۞Ą д஝͔ॡĂт‫ڍ‬ঽˠྫྷ඾‫˯ـ‬໣જĂಶࢋઃͤ‫ڼ‬ᒚ˞Ąт ‫ڍ‬ឰঽˠᗕჿ̶ฟͷ̈ჿ‫ݬ‬дԖ۞‫׌‬ᙝĂ‫ڼ‬ᒚरಶΞͽ߉̟ྵ ̂۞஝͔˧ณĂҭт‫ڍ‬ঽˠຐࢋͽ఺࣎͞‫ྏڱ‬඾ϡᗕჿღያҝ ԖቡĂ‫ڼ݋‬ᒚ՟ѣड़‫ڍ‬ĂЯࠎ΁υืࢋԆБ‫ٸ‬ᗫĂ̖ਕ྿‫ז‬౵ р۞ड़‫ڍ‬Ą

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