ﻪﻠﺠﻣ مﻮﻠﻋ يزارﻲﻜﺷﺰﭘ هرود 18 ، هرﺎﻤﺷ 93 ، ﺪﻨﻔﺳا 1390 ﻲﺸﻫوﮋﭘ ﻪﻟﺎﻘﻣ ﻪﻣﺪﻘﻣ شﺮﺘﺴﮔ زﺎﺘﺳﺎﺘﻣ ﻚﻳ نﺎﻃﺮﺳ ﻪﺑ نﻮﺘﺳ تاﺮﻘﻓ زا ﻲﻧاﺮﮕﻧ يﺎﻫ ﻞﺑﺎﻗ ﻪﺟﻮﺗ ﻲﻧﺎـﮕﻤﻫ و ﻲﻧﺎـﻣرد ﻲﻨﻴﻟﺎـﺑ ﺖﺳا و رد ﻚﻳ مﻮﺳ نارﺎﻤﻴﺑ ،ﻲﻧﺎﻃﺮﺳ زﺎﺘﺳﺎﺘﻣ ﺎﻫ ﺎـﺗ ﺖﻤﺴﻗ ﻲﻋﺎﺨﻧ نﻮﺘﺳ تاﺮﻘﻓ ﻢﻫ ﻪﻌﺳﻮﺗ ﻲـﻣ ﺪـﻨﺑﺎﻳ ) 1 ( . ﻦﻳا ﻪﻌﺳﻮﺗ ﻚﻴﺗﺎﺘﺳﺎﺘﻣ ﻢـﻳﻼﻋ يرﺎﻴـﺴﺑ ار ﻪـﺑ هاﺮﻤﻫ دراد زا ﻪﻠﻤﺟ ،درد ،ﻲﮕﺘﺴﻜﺷ لﻼﺘﺧا ﻲﺒﺼﻋ و ﺺﻘﻧ ﻮﻀﻋ ﺖـﺸﮔﺮﺑ ﺮﻳﺬـﭘﺎﻧ ) د نﺎـﻣر ﺮﻳﺬـﭘﺎﻧ ( ﻪـﻛ مﺎﻤﺗ ﻦﻳا ضراﻮﻋ ﺖﻴﻔﻴﻛ ﻲﻗﺎﺑ هﺪﻧﺎﻣ رﺎـﻤﻴﺑ ﺮـﻤﻋ ار ﺶﻫﺎﻛ ﻲﻣ ﺪﻫد . ﺐﺳﺎﻨﺘﻣ ﺎﺑ ﺖﻓﺮﺸﻴﭘ ﺎﻫ رد ﻲﻧﺎﻣردﻮﻳدار و ﻲﻤﻴـﺷ ﻲﻧﺎﻣرد ا ، بﺎﺨﺘﻧ نﺎـﻣرد ﻪـﺑ ﻲـﺣاﺮﺟ ﻪﻠﻴـﺳو ياﺮـﺑ ﺶﻫﺎــﻛ ضراﻮــﻋ ﻲﻨﻴﻟﺎــﺑ طﺎــﻘﻧ يزﺎﺘــﺳﺎﺘﻣ ﻞــﺤﻣ ﻪــﺸﻗﺎﻨﻣ ﺖــﺳا و ﻲﺘﻴﻌﻗﻮــﻣ ﺶﻟﺎــﭼ ﺰــﻴﮕﻧاﺮﺑ ياﺮــﺑ نﺎﺣاﺮﺟ ﻪﺑ دﻮﺟو هدروآ ﺖﺳا . زا فﺮﻃ ﺮﮕﻳد ﻲﻜﻳ زا ﻦﻳا نﺎﻣرد ﺎﻫ ياﺮﺑ ﻢﻫاﺮﻓ ندﺮﻛ ﻦﻳﺮﺗﻻﺎﺑ ﺮﺛا ﻦﻴﻜﺴﺗ ﻲﮔﺪﻨﻫد و ﻦﻴﻳﺎﭘ ندروآ تاﺮﺛا ﻲـﻔﻨﻣ ﻲﺒﻧﺎـﺟ ﺪـﻳﺎﺑ بﺎﺨﺘﻧا ﺪﻧﻮﺷ ) 2 -4 (. يﺎﻫرﻮﺘﻛﺎﻓ يرﺎﻴﺴﺑ ياﺮﺑ بﺎﺨﺘﻧا ﻦﻳﺮـﺘﻬﺑ نﺎـﻣرد دﻮﺟو ،ﺖﺷاد ﺎﻣا ﺶﻫوﮋﭘ ﺮﻴﺧا نﺎﺸﻧ داد ﻪﻛ رﻮﺘﻛﺎﻓ ﻲﺳﺎﺳا رد بﺎـﺨﺘﻧا ﺖـﻟﺎﺣ ﺐـﺳﺎﻨﻣ نﺎـﻣرد ، ﺶﻴـﭘ ﻲﻨﻴﺑ ﺎﻘﺑ ) predicting survival ( ﺖـﺳا ) 5 -11 ( . زا ﺎﺳ ل 1987 ﻲﺷﺎﻫﻮﻛﻮﺗ و ﺶﻧارﺎﻜﻤﻫ ﻚـﻳ ﻢﺘـﺴﻴﺳ رﺎﻴﻌﻣ ﺶﻳاﺰـﻓا ﻪـﻄﻘﻧ يا ) Point-Addition-Type ( ﺮﺘﻛد ﺎﺿر ﻼﻣ ﻲﻨﻴﺴﺣ : رﺎﻳدﺎﺘﺳا و ﺺﺼﺨﺘﻣ ﻲﺣاﺮﺟ ﺰﻐﻣ و ،بﺎﺼﻋا هﺎﮕﺸﻧاد مﻮﻠﻋ ﻲﻜﺷﺰﭘ و تﺎﻣﺪﺧ ﻲﺘﺷاﺪﻬﺑ ﻲﻧﺎﻣرد ناﺮﻬﺗ ، ناﺮﻬﺗ ، ناﺮﻳا . r_mollahoseini@yahoo.com * ﺮﺘﻛد نﺎﻜﺷا ﻮﺟاﻮﺧ : ﺺﺼﺨﺘﻣورﺎﻳدﺎﺘﺳا ﻲﺣاﺮﺟ ﺰﻐﻣ و ،بﺎﺼﻋا هﺪﻜﺸﻧاد ﻲﻜﺷﺰﭘ هﺎﮕﺸﻧاد آ داز ﻲﻣﻼﺳا ناﺮﻬﺗ ، اﺮﻬﺗ ،ن ناﺮﻳا ). * ﻒﻟﻮﻣ لﻮﺌﺴﻣ ( a.khajoo@gmail.com ﺮﺘﻛد ﺐﻨﻳز نﺎﻴﻔﻳﺮﺷ : ﻲﻣﻮﻤﻋﻚﺷﺰﭘ ، ناﺮﻬﺗ ا، ناﺮﻳ . z.sharifian@gmail.com ﺮﺘﻛد ﺪﻴﺳ ﺮﻴﻣ ﻞﻀﻔﻟاﻮﺑا ﻲﻌﻴﻄﻣ : يﻮﺠﺸﻧاد ،ﻲﻜﺷﺰﭘ نﺎﺘﺳرﺎﻤﻴﺑ ،ﺮﮔزوﺮﻴﻓ هﺎﮕﺸﻧاد مﻮﻠﻋ ﻲﻜﺷﺰﭘ و تﺎﻣﺪﺧ ﻲﺘﺷاﺪﻬﺑ ﻲﻧﺎﻣرد ناﺮﻬﺗ ، ناﺮﻬﺗ ، ناﺮﻳا . heart_iums@yahoo.com
ﻲﺷﺎﻫﻮﻛﻮﺗ
هﺮﻤﻧ
شزرا
ﻲﺑﺎﻳزرا
(Tokuhashi)رد
ﻦﻴﻴﻌﺗ
يﺎﻘﺑ
نارﺎﻤﻴﺑ
رﺎﭼد
زﺎﺘﺳﺎﺘﻣ
ﻪﺑ
نﻮﺘﺳ
تاﺮﻘﻓ
هﺪﻴﻜﭼ فﺪﻫ و ﻪﻨﻴﻣز : ﻲﻜﻳ زا ﻢﻬﻣ ﻦﻳﺮﺗ يﺎﻫرﺎﻴﻌﻣ ﺶﻨﻳﺰﮔ ياﺮﺑ ﻞﻤﻋ ﻲﺣاﺮﺟ نﻮﺘﺳزﺎﺘﺳﺎﺘﻣ ،تاﺮﻘﻓ ﺪﻴﻣا ﻪﺑ ﻲﮔﺪﻧز ﺖﺳا و ﻦﻳﺮﺗﻢﻬﻣ ﻢﺘﺴﻴﺳ ياﺮﺑ ﻦﻴﻨﭼ ﺶﻴﭘ ﻲﻨﻴﺑ ﻂﺳﻮﺗ ﻲﺷﺎﻫﻮﻛﻮﺗ ﻪﻳارا هﺪﻳدﺮﮔ ﺖﺳا . فﺪﻫ ﻦﻳا ﻪﻟﺎﻘﻣ ﻲﺑﺎﻳزرا ﺖﻗد ﻲﺼﻴﺨﺸﺗ رﺎﻴﻌﻣ ﻲﺷﺎﻫﻮﻛﻮﺗ ، ﺖﻬﺟ ﻦﻴﻴﻌﺗ يﺎﻘﺑ نارﺎﻤﻴﺑ ﺎﺑ زﺎﺘﺳﺎﺘﻣ ﻪﺑ نﻮﺘﺳ تاﺮﻘﻓ ﻲﻣ ﺪﺷﺎﺑ . شور رﺎﻛ : عﻮﻧ ﻪﻌﻟﺎﻄﻣ مﺎﺠﻧا هﺪﺷ ترﻮﻫﻮﻛ ﻲﻣ ﺪﺷﺎﺑ . زا ﺖﺸﻬﺒﻳدرا 1386 ﺎﺗ دادﺮﺧ 1389 ، 180 رﺎﻤﻴﺑ ، ﻪﻛ زا يﺎﻫرﻮﻣﻮﺗ ﻚﻴﺗﺎﺘﺳﺎﺘﻣ نﻮﺘـﺳ تاﺮـﻘﻓ ﺞـﻧر ﻲﻣ ،ﺪﻧدﺮﺑ ﻪﻛﺪﻧﺪﺷﻲﺳرﺮﺑ 71 ﻞﻴﻟدﻪﺑﺮﻔﻧ زﺎﺘﺳﺎﺘﻣ ﻪﺑ طﺎﻘﻧ ،ﺮﮕﻳد مﺪﻋ ﺖﻳﺎﺿر رﺎﻤﻴﺑ ﺎﻳ رد سﺮﺘﺳد ندﻮﺒﻧ تﺎﻋﻼﻃا ، زا ﺶﻫوﮋﭘ جرﺎﺧ ﺪﻧﺪﺷ . ﻪﻌﻟﺎﻄﻣ ﺎﺑ 109 رﺎﻤﻴﺑ ﻲﻗﺎﺑ هﺪﻧﺎﻣ ﻪﻛ زا يﺎﻫزﺎﺘﺳﺎﺘﻣ ﻢﻴﺧﺪﺑ ﻪﺘﺧﺎﻨﺷ هﺪﺷ نﻮﺘﺳ تاﺮﻘﻓ ﺞﻧر ﻲﻣ ،ﺪﻧدﺮﺑ مﺎﺠﻧا ﺪﺷ ) 56 ﺮﻔﻧ ﺚﻧﻮﻣ ) 51 (% و 53 ﺮﻔﻧ ﺮﻛﺬـﻣ ) 49 (% رد هدوﺪـﺤﻣ ﻲﻨﺳ 12 ± 57 .( ﻲﺷﺎﻫﻮﻛﻮﺗ ﻢﺘﺴﻴﺳ ﻲﺑﺎﻳزرا ياﺮﺑ ﻲﻬﮔآ ﺶﻴﭘ يﺎﻫرﻮﻣﻮﺗ ﻚﻴﺗﺎﺘﺳﺎﺘﻣ نﻮﺘﺳ تاﺮﻘﻓ ﻪﻛ ياﺮﺑ مﺎﻤﺗ نارﺎﻤﻴﺑ هدﺎﻔﺘﺳا ﻲﻣ ﺪﺷ ار درﻮﻣ ﻲﻨﻴﺑزﺎـﺑ راﺮﻗ داد . هرود ﻲﻳﺎﻘﺑ ﻪﻛ ﻪﺑ ﻪﻠﻴﺳو ﻦﻳا ﻢﺘﺴﻴﺳ ﺖﻬﺟ ﻲﻬﮔآﺶﻴﭘ ﺶﻴﭘ ﻲﻨﻴﺑ هﺪﺷ دﻮﺑ ﺎﺑ هرود يﺎﻘﺑ ﻲﻌﻗاو لﺎﺳﻚﻳ ﺲﭘ زا نآ ﻪـﺴﻳﺎﻘﻣ ﺪـﺷ . نﻮـﻣزآ يﺎـﻫ يرﺎﻣآ ﻪﺑ رﺎﻛ ﻪﺘﻓر ﻞﻣﺎﺷ نﻼﭘﺎﻛ -،ﺮﻳﺎﻣ نﻮﻴﺳﺮﮔر ﺲﮔﺎﻛ ﻚﻣو رﺎﻤﻧ ﻲﻣ ﺪﻨﺷﺎﺑ . ﻪﺘﻓﺎﻳ ﺎﻫ : يﺎﻘﺑ ﺶﻴﭘ ﻲﻨﻴﺑ هﺪﺷ ﻖﺒﻃ رﺎﻴﻌﻣ هﺮﻤﻧ ﻲﻫد ﻲﺷﺎﻫﻮﻛﻮﺗ رد 38 رﺎﻤﻴﺑ ) 34 (% ﺮﺘﻤﻛ زا 6 هﺎﻣ ) 9 / 34 (% ، رد 39 رﺎﻤﻴﺑ ) 35 (% 6 ﺎﺗ 12 هﺎـﻣ ) 8 / 35 (% و رد 32 رﺎﻤﻴﺑ ) 29 (% ، ﻚﻳ لﺎﺳ ﺎﻳ ﺮﺘﺸﻴﺑ ) 4 / 29 (% دراد . يﺎﻘﺑ ﻲﻌﻗاو رد ﺶﻫوﮋﭘ ﻦﻴﻨﭼ ،دﻮﺑ 39 رﺎﻤﻴﺑ ) 8 / 35 (% رد ﺶﺷ ﻪﻫﺎﻣ ﺲﭘ زا نﺎـﻣرد تﻮـﻓ ،ﺪﻧﺪـﺷ 28 رﺎﻤﻴﺑ ) 7 / 25 (% رد هرود ﺶﺷ ﻪﻫﺎﻣ مود تﻮﻓ ﺪﻧﺪﺷ و 42 رﺎﻤﻴﺑ ) 5 / 38 (% ﺎﺗ نﺎﻳﺎﭘ لﺎﺳ هﺪﻧز ﻲﻗﺎﺑ ﺪﻧﺪﻧﺎﻣ . فﻼﺘﺧا يرﺎﻣآ يرادﺎـﻨﻌﻣ نﺎـﻴﻣ نﺎـﻣز يﺎـﻘﺑ ﺶﻴﭘ ﻲﻨﻴﺑ هﺪﺷ و نﺎﻣز يﺎﻘﺑ ﻲﻌﻗاو دﻮﺟو ﺖﺷاﺪﻧ ) 116 / 0 = p ( . ﻪﺠﻴﺘﻧ يﺮﻴﮔ : ﺪﺷﻲﻨﻴﺑزﺎﺑرﺎﻴﻌﻣ ه يدﺮﺑرﺎﻛﻲﺷﺎﻫﻮﻛﻮﺗ ﺖﺳا ﻢﺘﺴﻴﺳزاو ﺪﻨﻨﻛﻲﻳﻮﮔﺶﻴﭘيﺎﻫ ه ﻲـﻫدهﺮـﻤﻧﻢﺘﺴﻴﺳرد،ﻻﺎﺑﻲﮔﺪﻨﻨﻛﻲﻨﻴﺑﺶﻴﭘلﺎﻤﺘﺣاﺎﺑ تاﺮﻘﻓنﻮﺘﺳﻚﻴﺗﺎﺘﺳﺎﺘﻣنارﺎﻤﻴﺑياﺮﺑ،ﻲﺣاﺮﺟﻞﻤﻋزاﻞﺒﻗ ﺪﺷﺎﺑﻲﻣ . هژاوﺪﻴﻠﻛ ﺎﻫ : زﺎﺘﺳﺎﺘﻣ نﻮﺘﺳ ،تاﺮﻘﻓ رﺎﻴﻌﻣ ،ﻲﺷﺎﻫﻮﻛﻮﺗ ﺪﻴﻣا ﻪﺑ ﻲﮔﺪﻧز . ﺖﻓﺎﻳردﺦﻳرﺎﺗ : 16 / 5 / 90 شﺮﻳﺬﭘﺦﻳرﺎﺗ : 26 / 11 / 90ﺮﺘﻛد ﺎﺿر ﻼﻣ ﻲﻨﻴﺴﺣ نارﺎﻜﻤﻫ و 2 لوﺪﺟ 1 . ردﻢﻴﻤﺼﺗياﺮﺑﻲﺷﺎﻫﻮﻛﻮﺗهﺪﺷﻲﻨﻴﺑزﺎﺑﻲﺑﺎﻳزراﻢﺘﺴﻴﺳ تاﺮﻘﻓنﻮﺘﺳﻚﻴﺗﺎﺘﺳﺎﺘﻣيﺎﻫرﻮﻣﻮﺗدرﻮﻣ ﻪﺼﺨﺸﻣ رﺎﻴﻌﻣ ) هﺮﻤﻧ ( ﻲﻣﻮﻤﻋﺖﻴﻌﺿو ﻒﻴﻌﺿ ) 40 % -10 % PS ( 0 ﻂﺳﻮﺘﻣ ) 70 % -50 % PS ( 1 بﻮﺧ ) 100 % -80 % PS ( 2 ﻲﻋﺎﺨﻧجرﺎﺧﻲﻧاﻮﺨﺘﺳايﺎﻫزﺎﺘﺳﺎﺘﻣداﺪﻌﺗ 3 ≥ 0 1 -2 1 0 2 تاﺮﻘﻓنﻮﺘﺳرديﺎﻫزﺎﺘﺳﺎﺘﻣداﺪﻌﺗ 3 ≥ 0 2 1 1 2 ﻲﻠﺧادﻲﻠﺻايﺎﻫماﺪﻧاﻪﺑزﺎﺘﺳﺎﺘﻣ ﺖﺷادﺮﺑﻞﺑﺎﻗ 0 ﺖﺷادﺮﺑﻞﺑﺎﻗﺮﻴﻏ 1 زﺎﺘﺳﺎﺘﻣنوﺪﺑ 2 نﺎﻃﺮﺳﻪﻴﻟواﻞﺤﻣ ناﻮﺨﺘﺳانﺎﻃﺮﺳ ، ،ﻢﻜﺷ ،ﻪﻧﺎﺜﻣ ساﺮﻜﻧﺎﭘ ، يﺮﻣ و ﻪﻳر 0 اﺮﻔﺻﻪﺴﻴﻛ،ﺪﺒﻛ و ﺺﺨﺸﻣﺎﻧ 1 ﺮﮕﻳديﺎﻫماﺪﻧا 2 ﻪﻴﻠﻛ و ﻢﺣر 3 مﻮﺘﻛر 4 وﺮﻴﺗ ﻳ ،ﺪﻴ ،نﺎﺘﺴﭘ تﺎﺘﺳوﺮﭘ و مﻮﻨﻴﺳرﺎﻛيﺎﻫرﻮﻣﻮﺗ 5 ﻲﮔدﺎﺘﻓارﺎﻛزا ) ندﺮﻛﺞﻠﻓ ( ﻞﻣﺎﻛ (Frankel A, B) 0 ﻞﻣﺎﻛﺎﻧ (Frankel C, D) 1 ماﺪﻛﭻﻴﻫ (Frankel E) 2 ياﺮﺑ ﺶﻴﭘ ﻲﻨﻴﺑ ﺶﻴـﭘ زا ﻞـﻤﻋ ﺖـﻬﺟ ﻪـﺑ ﺖـﺳد ندروآ هرود ﺎﻘﺑ رﺎﻛ ﻪﺑ ﻲﻣ هدﺮـﺑ ﺪـﻧا ﺎـﺗ ﻪـﻨﻳﺰﮔ يﺎـﻫ ﻲﻧﺎﻣرد ار بﺎﺨﺘﻧا ﺪﻨﻨﻛ ) 8 -10 (. رﺎـﺑ ﺮـﮕﻳد ﺎﻫﺪـﻌﺑ ﻦﻳا ﻢﺘﺴﻴﺳ ﻪﺑ ﻪﻠﻴﺳو وا زﺎﺑ ﻲﻨﻴﺑ ﺪﺷ ﺎﺗ ﺮﺑرﺎﻛ د نآ ، ﻦﻴﻴﻌﺗياﺮﺑ ﺪﻴﻣا ﻪـﺑ ﻲﮔﺪـﻧز ) Life Expectancy ( هوﺮﮔ ﻲﻳﺎﻫ ﻪﻛ نﺎـﻣرد هﺪـﻧراﺪﻬﮕﻧ و ﻆـﻔﺣ هﺪـﻨﻨﻛ ﺖﻓﺎﻳرد ﻲﻣ ﺪﻧدﺮﻛ ، ﻲﺑﺎﻳزرا دﻮﺷ . ﺮﺑﺎﻨﺑ ﻦﻳا زا 1998 ﻢﺘﺴﻴﺳ ﺶﻴﭘ ﻲﻨﻴﺑ هﺪـﻨﻨﻛ ﻲﻨﻴﺑزﺎـﺑ هﺪـﺷ لواﺪـﺘﻣ ﺪﻳدﺮﮔ ) 11 (. رد ﻦﻳا ﻪﻌﻟﺎﻄﻣ ناﺰـﻴﻣ ﺖـﻗد هﺮـﻤﻧ ﻲـﺷﺎﻫﻮﻛﻮﺗ و ترﺪــﻗ ﻲﻳﻮﮕــﺸﻴﭘ ﻲﮔﺪــﻨﻨﻛ نآ رد ﻦﻴــﻤﺨﺗ يﺎــﻘﺑ نارﺎﻤﻴﺑ ﻲﺳرﺮﺑ ﺪﻫاﻮﺧ ﺪﺷ ، ـﻛ ﻪ ﻪـﺑ ناﻮـﻨﻋ ﻲـﺷور ﺖﻬﺟ بﺎﺨﺘﻧا عﻮﻧ نﺎﻣرد رد داﺮﻓا ﻼﺘﺒﻣ ﻪﺑ نﺎﻃﺮـﺳ ﺎﺑ زﺎﺘﺳﺎﺘﻣ ﻪﺑ نﻮﺘﺳ تاﺮﻘﻓ ﺪﻨﻤﺷزرا ﺪﻫاﻮﺧ دﻮﺑ . رﺎﻛشور عﻮﻧ ﻪﻌﻟﺎﻄﻣ مﺎـﺠﻧا هﺪـﺷ ترﻮـﻫﻮﻛ ﻲـﻣ ﺪـﺷﺎﺑ . زا درا ﺖﺸﻬﺒﻳ 1386 ﺗ دادﺮﺧ ﺎ 1389 ، ا ز 180 يرﺎﻤﻴﺑ ﻪﻛ زا يﺎـﻫرﻮﻣﻮﺗ ﻚﻴﺗﺎﺘـﺳﺎﺘﻣ نﻮﺘـﺳ تاﺮـﻘﻓ ﺞـﻧر ﻲﻣ ﺪﻧدﺮﺑ و ﻪﺑ ﻚﻴﻨﻴﻠﻛ يﺎﻫ يژﻮـﻟﻮﻜﻧا و ﻲﭘاﺮﺗﻮـﻳدار نﺎﺘــﺳرﺎﻤﻴﺑ ﺮــﮔزوﺮﻴﻓ ﺪــﻧﺪﻣآ ، 71 رﺎــﻤﻴﺑ ﻞــﻴﻟدﻪــﺑ زﺎﺘﺳﺎﺘﻣ ﻪﺑ طﺎﻘﻧ ،ﺮﮕﻳد مﺪـﻋ ﺖﻳﺎـﺿر رﺎـﻤﻴﺑ ﺎـﻳ رد سﺮﺘــﺳد ندﻮــﺒﻧ تﺎــﻋﻼﻃا رﺎــﻨﻛ ﻪﺘــﺷاﺬﮔ وﺪﻧﺪــﺷ ﺶﻫوﮋﭘ ﺑ ﺎ 109 رﺎﻤﻴﺑ ﻲﻗﺎﺑ هﺪﻧﺎﻣ ﻪﻛ زا يﺎﻫزﺎﺘﺳﺎﺘﻣ ﻢﻴﺧﺪﺑ ﻪﺘﺧﺎﻨﺷ هﺪﺷ ﻪﺑ نﻮﺘﺳ تاﺮﻘﻓ ﺞﻧر ﻲﻣ ﺪﻧدﺮﺑ ، ا مﺎﺠﻧ ﺪﺷ ) . 56 ﺮﻔﻧ ﺚﻧﻮﻣ و 53 ﺮﻔﻧ ﺮﻛﺬﻣ رد دوﺪـﺣ ﻨﺳ ﻲ 57 ± 12 لﺎﺳ .( مﺎﻤﺗ ﺖﻛﺮﺷ نﺎﮔﺪﻨﻨﻛ ﺖﻘﻓاﻮﻣ ﻪﻣﺎﻧ ﻲـﺒﺘﻛ ياﺮـﺑ رد ﺖﻛﺮﺷ ﻦﻳا ﺶﻫوﮋﭘ ﺪﻧداد , ﻪﻛ ﻪﺑ ﻪﻠﻴﺳو ﻪـﺘﻴﻤﻛ ﻲﺳرﺮﺑ ﻲﻗﻼﺧا مﻮﻠﻋ ﻲﻜﺷﺰﭘ هﺎﮕﺸﻧاد ناﺮـﻬﺗ ﺪـﻴﻳﺎﺗ دﻮﺑهﺪﺷ . ﺎﻣ ﻪﺨﺴﻧ ﻲﻨﻴﺑزﺎﺑ هﺪﺷ رﺎﻴﻌﻣ ﻲـﺷﺎﻫﻮﻛﻮﺗ ار ياﺮـﺑ ﻲﺑﺎﻳزرا ناﺰﻴﻣ ﺪﻴﻣا ﻪﺑ ﻲﮔﺪﻧز ﺶﻴﭘ زا ﻞﻤﻋ نارﺎﻤﻴﺑ زﺎﺘﺳﺎﺘﻣ نﻮﺘﺳ تاﺮﻘﻓ ﻪﺑ رﺎﻛ ،ﻢﻴﺘﻓﺮـﮔ ﺎـﻣا رد ﻚـﻳ ﻲﺳرﺮﺑ ،ﻲﻟﺎﻤﺟا هﺮﻤﻧ ﻲﻳﺎﻬﻧ ﻦﻳا ﻪﺨـﺴﻧ زا ﻢﺘـﺴﻴﺳ ﻲﺑﺎﻳزرا 15 ﺷ ﺪ ) 12 ( . لوﺪﺟ 1 ﻞﺻﺎﺣ ﻊﻤﺟ ﺶـﺷ رﻮﺘﻛﺎــﻓ ﻞــﻳذ ﺖــﺳا . ﻂﻳاﺮــﺷ ،ﻲﻣﻮــﻤﻋ داﺪــﻌﺗ زﺎﺘــﺳﺎﺘﻣ يﺎــﻫ ناﻮﺨﺘــﺳا نوﺮــﻴﺑ ﻋﺎــﺨﻧ ﻲ ) No of
extraspinal bone metastases
( ، داﺪﻌﺗ ﺎﻫزﺎﺘﺳﺎﺘﻣ رد نﻮﺘــﺳ تاﺮــﻘﻓ ) No of metastases in vertebral body ( ردﺎﻫزﺎﺘـﺳﺎﺘﻣبﺎـﻴﻏ ﺎـﻳرﻮﻀﺣ، ماﺪﻧا تﺪـﺷ و ﻪﻴﻟوا ﻪﻌﻳﺎﺿ ﻞﺤﻣ ،ﻲﻠﺧادﻲﻠﺻا يﺎﻫ ﻦﻴﻣز ندﺮـﻛ ﺮﻴﮔ ) 10 و 11 (. ﻪـﻛ ﻲﻧارﺎـﻤﻴﺑ درﻮـﻣرد ﺮﻤﻧ ه ﻲﻳﺎﻬﻧ 8 ﻴﺑزﺎـﺑ رﺎـﻴﻌﻣزا ارﺮـﺘﻤﻛﺎـﻳ هﺪـﺷ ﻲﻨ ﺪﻧدﺮﻛﺖﻓﺎﻳرد ) نﺎـﺷ هﺪـﺷﻲﻨﻴﺑ ﺶﻴﭘﺎﻘﺑ هرودﻪﻛ زا ﺮﺘﻤﻛ 6 ﺖﺳا هﺎﻣ ( ، و هﺪـﻨﻫدﻦﻴﻜـﺴﺗ يﺎﻫﻪﻳور دﻮﺑ ﻲﺑﺎﺨﺘﻧاهﺪﻧراﺪﻬﮕﻧ . هﺮـﻤﻧﻪـﻛ ﻲﻧارﺎﻤﻴﺑدرﻮﻣ رد ﻲﻳﺎﻬﻧ 9 ﺎﺗ 11 ﺪﻧدﺮﻛ ﺖﻓﺎﻳرد ) ﺶﻴـﭘﺎـﻘﺑهرود ﻪـﻛ نﺎــﺷهﺪــﺷﻲــﻨﻴﺑ 6 ﺎــﺗهﺎــﻣ 1 دﻮــﺑلﺎــﺳ ( ﻞــﻤﻋ ،ﻦﺘﺷادﺮﺑ ،ترﺪﻧﻪﺑ ﻪﻌﻳﺎﺿ ﻚﻳياﺮﺑ دﺮﻔﻨﻣ نوﺪـﺑو نﺎﮔرا ﻪﺑ زﺎﺘﺳﺎﺘﻣ ،ﻲﻠﺧاد يﺎﻫ ﺪـﺷ مﺎﺠﻧا . درﻮـﻣ رد ﻲﻧارﺎﻤﻴﺑ نآﻲﻳﺎـﻬﻧ هﺮﻤﻧﻪﻛ ﺎـﻫ 12 دﻮـﺑﺮﺘـﺸﻴﺑﺎـﻳ ) ﺶﻴﭘﺎﻘﺑهرود هﺪﺷﻲﻨﻴﺑ ،نﺎﺷ 1 لﺎﺳ دﻮﺑﺮﺘﺸﻴﺑ ﺎﻳ (
ﻲﺷﺎﻫﻮﻛﻮﺗهﺮﻤﻧشزراﻲﺑﺎﻳزرا (Tokuhashi) ... 3 لوﺪﺟ 2 . ﻪﺼﺨﺸﻣﺮﻫﻲﻧاواﺮﻓﻊﻳزﻮﺗ اﻢﺘﺴﻴﺳرد هﺪﺷﻲﻨﻴﺑزﺎﺑﻲﺑﺎﻳزر ﻲﺷﺎﻫﻮﻛﻮﺗ ﻪﺼﺨﺸﻣ داﺪﻌﺗ ﺪﺻرد ﻲﻣﻮﻤﻋﺖﻴﻌﺿو ﻒﻴﻌﺿ ) PS 10 ﺎﺗ 40 (% 6 5,5 ﻂﺳﻮﺘﻣ ) PS 40 ﺎﺗ 80 (% 69 63,3 بﻮﺧ ) PS 80 ﺎﺗ 100 (% 34 31,1 ﻲﻋﺎﺨﻧجرﺎﺧﻲﻧاﻮﺨﺘﺳايﺎﻫزﺎﺘﺳﺎﺘﻣداﺪﻌﺗ 3 ≥ 47 43,1 1 -2 10 9,2 0 52 47,7 نﻮﺘﺳﻞﺧادﺎﻫزﺎﺘﺳﺎﺘﻣداﺪﻌﺗ تاﺮﻘﻓ 3 ≥ 78 71,6 2 15 13,8 1 16 14,7 ﻲﻠﺧادﻲﻠﺻايﺎﻫماﺪﻧاﻪﺑزﺎﺘﺳﺎﺘﻣ ﺖﺷادﺮﺑﻞﺑﺎﻗﺮﻴﻏ 32 29,4 ﺖﺷادﺮﺑﻞﺑﺎﻗ 3 2,8 زﺎﺘﺳﺎﺘﻣنوﺪﺑ 74 67,9 نﺎﻃﺮﺳﻪﻴﻟواﻞﺤﻣ ﻲﻧاﻮﺨﺘﺳاﻲﻤﻴﺧﺪﺑ , ،هﺪﻌﻣ , ،ﻪﻧﺎﺜﻣ ساﺮﻜﻧﺎﭘ , ﻳﺮﻣ ﻮ ﻪﻳر 18 16,5 اﺮﻔﺻﻪﺴﻴﻛ،ﺪﺒﻛ و ﺺﺨﺸﻣﺎﻧ 4 3,7 ﺮﮕﻳديﺎﻫماﺪﻧا 13 11,9 ﻬﻴﻠﻛ ﻮ ﻢﺣر 2 1,8 مﻮﺘﻛر 3 2,8 وﺮﻴﺗ ﻴﻳ ،ﺪ ،نﺎﺘﺴﭘ ،تﺎﺘﺳوﺮﭘ و ﺎﻣﻮﻨﻴﺳرﺎﻛرﻮﻣﻮﺗ 69 63,3 ﻲﮔدﺎﺘﻓارﺎﻛزا ) ندﺮﻛﺞﻠﻓ ( ﻞﻣﺎﻛ (Frankel A, B) 10 9,2 ماﺪﻛﭻﻴﻫ (Frankel E) 89 78,9 دﺮﻜﻠﻤﻋﺖﻴﻌﺿو PS= ﺪـﺷ بﺎـﺨﺘﻧا،ﻪﻌﻳﺎﺿ ﻦﺘﺷادﺮﺑ ﻲﺣاﺮﺟ ﻞﻤﻋ ) 11 ( . ﻪﻧﻮﻤﻧ ﺪـﺷبﺎـﺨﺘﻧاهوﺮﮔ ﻪﺳنﺎﻴﻣزاﺎﻣيﺎﻫ . ﻚـﻳ رﺎــﻴﻌﻣسﺎــﺳاﺮﺑنارﺎــﻤﻴﺑﺺﻴﺨــﺸﺗزاﺲــﭘلﺎــﺳ ﺪﻧﺪﺷﻢﻴﺴﻘﺗهوﺮﮔ ﻪﺳﻪﺑﻲﺷﺎﻫﻮﻛﻮﺗ . 1 ( يداﺮﻓا ﻲﻨﻴﺑ ﺶﻴﭘ ﻖﻴﻗد ترﻮﺻ ﻪﺑ نﺎﺷﺎﻘﺑ ﻪﻛ دﻮﺑهﺪﺷ ) داﺪﻌﺗ : 67 ( . 2 ( ﻲـﺷﺎﻫﻮﻛﻮﺗهﺪـﺷ ﻲﻨﻴﺑزﺎـﺑرﺎـﻴﻌﻣﻪﻛﻲﻧارﺎﻤﻴﺑ ﺪﻧدﻮﺑهدزﻦﻴﻤﺨﺗﺮﺘﺸﻴﺑارنﺎﺷﺎﻘﺑ ) داﺪﻌﺗ : 16 ( . 3 ( ﻪﻛيداﺮﻓا ﻲـﺷﺎﻫﻮﻛﻮﺗهﺪـﺷ ﻲﻨﻴﺑزﺎﺑ رﺎﻴﻌﻣ ﻪﻛ ﺪﻧدﻮﺑهدز ﻦﻴﻤﺨﺗﺮﺘﻤﻛارنﺎﺷﺎﻘﺑ ) داﺪﻌﺗ : 26 ( . ﻢﺘــﺴﻴﺳيﺮــﻴﮔﻢﻴﻤــﺼﺗ رﺎــﻴﻌﻣﺖﺤــﺻﺲﭙــﺳ نارﺎـﻤﻴﺑهرﺎـﺑردارهﺪﺷ ﻲﻨﻴﺑزﺎﺑ ﻞـﻴﻠﺤﺗوﻪـﺴﻳﺎﻘﻣ ﻢﻳدﺮﻛ . ﻞــﻴﻠﺤﺗ يرﺎــﻣآيﺎــﻫ : نﻼﭘﺎــﻛ -ﻳﺎــﻣ ،ﺮ نﻮﻴــﺳﺮﮔر هدﺎﻔﺘـﺳاﺎـﻫهدادﻞـﻴﻠﺤﺗ ياﺮـﺑرﺎﻤﻧ ﻚﻣ وﺲﮔﺎﻛ ﺪﻧﺪﺷ . ﺎﻋﻼﻃا ت ﻦﻴﮕﻧﺎـﻴﻣ ترﻮﺻ ﻪﺑ ± SD شراﺰـﮔ ﺖﺳا هﺪﺷ . 05 / 0 < p ﻲﻨﻌﻣ ﺪﻧﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ ردراد . نﻮﻣزآ مﺎﻤﺗ يراﺰـﻓا مﺮﻧ ﻢﺘﺴﻴﺳ ﺎﺑ ﺎﻫ SPSS مﺎـﺠﻧا ﺪﺷ . ﺎﻫﻪﺘﻓﺎﻳ ﻦـﺳﻂﺳﻮﺘﻣ 109 ﺎـﻣﺶﻫوﮋـﭘ ردﻪـﻛيرﺎـﻤﻴﺑ ﺪﻨﺘﺷادرﻮﻀﺣ ) 12 ± ( 57 دﻮﺑلﺎﺳ ﻪـﻛ 56 زاﺮـﻔﻧ نآ ﺎــﻫ ) 4 / 51 (% نز ﺪــﻧدﻮﺑ . هﺮــﻤﻧﻪــﻌﻟﺎﻄﻣوﺪــﺑرد ياﺮـﺑ ﻲـﺷﺎﻫﻮﻛﻮﺗ ﻲﺑﺎﻳزراﻢﺘﺴﻴﺳ ﻖﺒﻃﻲﺷﺎﻫﻮﻛﻮﺗ رﺎﻤﻴﺑ ﺮﻫ ﺪﺷبﺎﺴﺣ . لوﺪـﺟرد تﺎـﺼﺨﺸﻣ ﻦﻳا 2 هﺪﺷهدادﺶﻳﺎﻤﻧ ﺪﻧا . ﻲﺷﺎﻫﻮﻛﻮﺗ هﺮﻤﻧ ﻦﻴﮕﻧﺎﻴﻣ 4 / 9 ± ) 9 / 2 ( دﻮﺑ . نﺎـﻣز ﻘﺑ ﻲﻌﻗاو ﺎ 24,92 نﺎـﻣز ﻦـﻳا ﻦﻴﮕﻧﺎـﻴﻣ ودﻮـﺑ هﺎـﻣ 9 / 13 هﺮﻃﺎــﺨﻣوﺎــﻘﺑرادﻮــﻤﻧ،دﻮــﺑهﺎــﻣ (Hazard) ﻞﻜﺷردنارﺎﻤﻴﺑ 1 ﺖﺳا هﺪﺷهدادنﺎﺸﻧ . ﻲـﻨﻴﺑزﺎـﺑ ﻲﺑﺎـﻳزراﻢﺘـﺴﻴﺳحﺮﻃياﺮﺟا زاﺶﻴﭘ ﺪﺷ ه ، ﻲﺑﺎﻳزراﻲﺷﺎﻫﻮﻛﻮﺗ ﻞـﻤﻋ زاﺲﭘﻪﻛدﻮﺑهدﺮﻛ ﻲﺣاﺮﺟ 38 زاﺮﺘﻤﻛﺪﻳﺎﺑ رﺎﻤﻴﺑ 6 ،ﺪـﻨﻧﺎﻤﺑ هﺪﻧزهﺎﻣ 39 رﺎﻤﻴﺑ 6 ﺎﺗ 12 وهﺎﻣ 32 ﻪـﻛﺖـﺳاﻦﻜﻤﻣ رﺎﻤﻴﺑ زاﺶﻴﺑ 12 ﺪﻨﻧﺎﻤﺑهﺪﻧزهﺎﻣ . ﺎﻘﺑ ﻲﻌﻗاونﺎﻣز زاﺪـﻌﺑ 1 داد نﺎﺸﻧﻦﻴﻨﭼلﺎﺳ : 39 زاﺮـﺘﻤﻛرﺎﻤﻴﺑ 6 هﺎـﻣ ، 28 ﺎﻤﻴﺑ ر 6 -12 هﺎﻣ و 42 زاﺶﻴﺑرﺎﻤﻴﺑ 12 هﺎﻣ ﻪﻛ ﻢﻴـﺴﻘﺗهوﺮـﮔ ﻪـﺳﻪـﺑ نارﺎﻤﻴﺑ ﻪﺠﻴﺘﻧ ﻦﻳاسﺎﺳاﺮﺑ ﺪﻧﺪﺷ . 1 ( ﻲﻨﻴﺑ ﺶﻴﭘﻖﻴﻗدترﻮﺻ ﻪﺑنﺎﺷﺎﻘﺑ ﻪﻛﻲﻧارﺎﻤﻴﺑ دﻮﺑهﺪﺷ ، ﻞﻣﺎﺷ 67 ﺮﻔﻧ ) 47 / 61 (% . 2 ( ﺪﺷ ﻲﻨﻴﺑزﺎﺑ هﺮﻤﻧ ﻪﻛﻲﻧارﺎﻤﻴﺑ ه ﻲﺷﺎﻫﻮﻛﻮﺗ ، ﺎـﻘﺑ دﻮــﺑهدزﻦﻴــﻤﺨﺗﺮﺘــﺸﻴﺑارنﺎــﺷ . 16 رﺎــﻤﻴﺑ ) 68 / 14 (% . 3 ( ﻲﻧارﺎﻤﻴﺑ ﺪـﺷ ﻲﻨﻴﺑزﺎـﺑ هﺮـﻤﻧ ﻪـﻛ ه ﻲـﺷﺎﻫﻮﻛﻮﺗ ﺎــﻘﺑ دﻮــﺑهدزﻦﻴــﻤﺨﺗ ﺮــﺘﻤﻛارنﺎــﺷ 26 ﺮــﻔﻧ ) 85 / 23 (% . هوﺮﮔﻦﻴﺑ ﻲﻬﺟﻮﺗﻞﺑﺎﻗ توﺎﻔﺗ ﺎﻣا يﺎﻫ مود ) ﺮﺘﺸﻴﺑ ﺪﻧﺪــﺷهدزﻦﻴــﻤﺨﺗ ( ﻮــﺳو م ) هدزﻦﻴــﻤﺨﺗ ﺮــﺘﻤﻛ ﺪﻧﺪﺷ ( دراﺪﻧدﻮﺟو ) 116 / 0 = p .( ﻪـﻛ ﻢﻳدﺮـﻛ ﻲﺳرﺮﺑ ،ﺲﻛﺎﻛ نﻮﻴﺳﺮﮔر ﻞﻴﻠﺤﺗ رد
ﺮﺘﻛد ﺎﺿر ﻼﻣ ﻲﻨﻴﺴﺣ نارﺎﻜﻤﻫ و 4 ﻞﻜﺷ 1 . هﺮﻃﺎﺨﻣوﺎﻘﺑرادﻮﻤﻧ لوﺪﺟ 3 .
p-value 95% CI for Exp(β)
β
Exp( Lowerβ) Upper SE Wald df ﻲﺷﺎﻫﻮﻛﻮﺗهﺪﺷﻲﻨﻴﺑزﺎﺑرﺎﻴﻌﻣيﺎﻫﻪﺼﺨﺸﻣ
0,001 < -0,92 0,4 0,25 0,65 0,25 13,9 1 تاﺮﻘﻓنﻮﺘﺳﻞﺧادﺎﻫزﺎﺘﺳﺎﺘﻣداﺪﻌﺗ 0,022 -0,61 0,54 0,32 0,92 5,210,27 1 ( دﺮﻜﻠﻤﻋﺖﻴﻌﺿو )ﻲﻣﻮﻤﻋﺖﻴﻌﺿو 0,001 < -0,48 0,62 0,54 0,72 0,08 39,79 1 نﺎﻃﺮﺳﻪﻴﻟواﻞﺤﻣ 0,002 -0,45 0,480,64 0,85 0,14 9,68 1 ﻲﻠﺻاﻲﻠﺧاديﺎﻫماﺪﻧاﻪﺑزﺎﺘﺳﺎﺘﻣ 0,055 -0,43 0,65 0,42 1 0,22 3,7 1 (ندﺮﻛﺞﻠﻓ)ﻲﮔدﺎﺘﻓارﺎﻛزا ﺎـﺑﻲﻟﺎـﻌﻔﻧاو ﻞـﻌﻓﭻﻴﻫ نارﺎﻤﻴﺑ ﻦﺳﺎﻳ ﺖﻴﺴﻨﺟﺎﻳآ ﺮﻤﻧ ه ﺪﺷ ﻲﻨﻴﺑزﺎﺑ ه ﻪـﻧ ﺎﻳ درادﺎﻘﺑ و ﻲﺷﺎﻫﻮﻛﻮﺗ . ﺮـﻫ ود ي وﺪﻧﺪـﺷ فﺬـﺣلﺪﻣزا يرﺎﻣآيﺎﻫﺮﻴﻐﺘﻣ ﻦﻳا ﺮــﻤﻧﺎــﻘﺑردﺮﺛﻮــﻣرﻮﺘﻛﺎــﻓﺎــﻬﻨﺗ ه ﺪــﺷﻲﻨﻴﺑزﺎــﺑ ه دﻮﺑﻲﺷﺎﻫﻮﻛﻮﺗ ، ﺮﻴﺛﺎـﺗ ﻦﻴﻴﻌﺗياﺮﺑﺎﻣﻪﺠﻴﺘﻧرد ﺮـﻫ ﻪﺼﺨﺸﻣ زا ﻚﻳ هﺪـﺷ ﻲﻨﻴﺑزﺎـﺑﻲﺑﺎﻳزرا ﻢﺘﺴﻴﺳيﺎﻫ نآمﺎﻤﺗ ،ﻲﺷﺎﻫﻮﻛﻮﺗ نﻮﻴـﺳﺮﮔرلﺪـﻣ ﻚـﻳرد ارﺎﻫ ﻢﻳدﺮﻛدراو ﺲﻛﺎﻛ . ﻪـﻛيﺮـﻴﻐﺘﻣﺎﻬﻨﺗ لﺪـﻣﻦـﻳازا جرﺎــﺧﻲﻧاﻮﺨﺘــﺳايﺎﻫزﺎﺘــﺳﺎﺘﻣداﺪــﻌﺗ،ﺪــﺷفﺬــﺣ ﻋﺎﺨﻧ ﻲ
(No. of extraspinal bone metastases)
دﻮﺑ . ﻪـﺑ وﺪـﻧدﻮﺑﺮﺛﻮـﻣ ﺎـﻘﺑردﺮﮕﻳديﺎﻫﻪﺼﺨﺸﻣ مﺎﻤﺗ ﺪﻧﺪﺷدراولﺪﻣ ) لوﺪﺟ 3 .( ﻪـﺼﺨﺸﻣﻦﻳﺮﺗﺮﺛﻮﻣ " ﻞـﺧاديﺎﻫزﺎﺘـﺳﺎﺘﻣداﺪـﻌﺗ تاﺮﻘﻓنﻮﺘﺳ " دﻮﺑ . يﺪـﻌﺑﻪﺒﺗر ردﻲﻣﻮﻤﻋ ﺖﻴﻌﺿو ﻓﺮﮔراﺮﻗ ﺖ . ،نﺎﻃﺮﺳﻪﻴﻟواﻞﺤﻣﺐﻴﺗﺮﺗﻪﺑ نآزاﺪﻌﺑ زﺎﺘﺳﺎﺘﻣ ماﺪﻧا ﻪﺑ ﻲـﻠﺧاد ﻲﻠﺻايﺎﻫ ﻲﮔدﺎـﺘﻓارﺎﻛزا و ) ﻓ ندﺮــﻛﺞــﻠ ( ﺪــﻧدﻮﺑ . ﮔدﺎــﺘﻓارﺎﻛزاﺮﻴﺛﺎــﺗ ﻲ ) ﻓ ــﻠ ﺞ ( ﻧ ﺳاﺺﺨﺸﻣﺎ ﺖ ) 055 / 0 = p ( ، ﻲﻤﻧﺎﻣﻦﻳاﺮﺑﺎﻨﺑ ﻢﻴﻧاﻮـﺗ ﺮﺛﻮﻣﻪﺑ ﺖﺒﺴﻧ ﻢﻴﺷﺎﺑ ﻦﺌﻤﻄﻣﺎﻘﺑ ردﺶﻧدﻮﺑ . ﻪﺠﻴﺘﻧوﺚﺤﺑ يﺮﻴﮔ هار نﺎـﻣرد ﻦﻳﺮـﺘﻬﺑ بﺎﺨﺘﻧا ياﺮﺑ يدﺪﻌﺘﻣ يﺎﻫ نﻮﺘـﺳﻚﻴﺗﺎﺘـﺳﺎﺘﻣ يﺎـﻫرﻮﻣﻮﺗﻪﻛﻲﻧارﺎﻤﻴﺑ ياﺮﺑ ﺪﻧراد تاﺮﻘﻓ ، ﻲـﻣدﺎﻬﻨﺸﻴﭘ دﻮـﺷ . ﺐﺣﺎـﺻ ﻲـﻀﻌﺑ اﺮﻈﻧ ن هدﺮﻛ لﻻﺪﺘﺳا ﻪـﺑ نﺎـﻣرد بﺎـﺨﺘﻧا ﻪـﻛﺪﻧا ﻠﻴﺳو ﻪ ﻪﺘﺴﺑاو ﻲﺣاﺮﺟﻞﻤﻋ وﻪﻴﻟوانﺎﻃﺮﺳ عﻮﻧﻪﺑ ـﺳا يرﺎـﻤﻴﺑشﺮﺘﺴﮔ ناﺰﻴﻣ ﺖ ) 13 -15 ( . ﻲـﻀﻌﺑ ﺶﻫوﮋﭘ دﺎﻬﻨـﺸﻴﭘ ﺮـﮕﻳد يﺎﻫ هدﺮـﻛ ﻪـﻛﺪـﻧا شور ﺤﻟﺎـﺼﻣوناﻮﺨﺘـﺳاﺐـﻳﺮﺨﺗيﺎﻨﺒﻣﺮﺑﺪﻳﺎﺑنﺎﻣرد ﻪ ﺒــﺼﻋ ﻲ ) Neurologic Compromise ( بﺎــﺨﺘﻧا دﻮــﺷ ) 16 (. ﺎــﻣا ﻖــﻴﻘﺤﺗ ﻪــﻛداد نﺎــﺸﻧﺮــﻴﺧا ﻢﻬﻣ رﺎﻴﻌﻣﻦﻳﺮﺗ ، ﺖﺳارﺎﻤﻴﺑياﺮﺑﻲﮔﺪﻧزﻪﺑﺪﻴﻣا . ﺶﻫوﮋـﭘ،ﻢﻴﻧاﺪﺑﺖﺳا بﻮﺧ شزرا،ﻲـﻤﻛيﺎـﻫ ﺶﻴﭘ ﻪﺑﺪﻴﻣا ياﺮﺑﻲﺷﺎﻫﻮﻛﻮﺗرﺎﻴﻌﻣ ﻲﮔﺪﻨﻨﻛﻲﻨﻴﺑ ﻚــﻳارﻲﮔﺪــﻧز ﻲﺑﺎــﻳزراﺺﻴﺨــﺸﺗ زاﺲــﭘ لﺎــﺳ هدﺮــﻛ ﺪــﻧا . ﻠــﺴﻳﺮﮔوﺮــﻓرودﺮﺑا ﺪ 38 ﺎــﺑرﺎــﻤﻴﺑ وﺪــﻧدﺮﻛلﺎــﺒﻧدارتوﺎــﻔﺘﻣ ﻲﻳاﺪــﺘﺑايﺎــﻫرﻮﻣﻮﺗ ﻲﺷﺎﻫﻮﻛﻮﺗ رﺎﻴﻌﻣ ﻪﻛﺪﻨﻫدنﺎﺸﻧ ﺪﻨﺘﺴﻧاﻮﺗ 3 هﺎـﻣ نﺎﻣردزاﺪﻌﺑ اتوﺎﻔﺘﻣ يﺎﻫ ز 8 / 0 ﻪـﺑ 4 / 2 ﺶﻫﺎـﻛ ﻓﺎﻳ ﺖ ) 6 ( . ﻌﻟﺎﻄﻣ ﻪ يﺮﮕﻳد ﺪـﻧﺮﻴﮔ ﻢﻴﻤﺼﺗ شزراﺮﺑ ه ﺖﺒـﺴﻧ
ﻲﺷﺎﻫﻮﻛﻮﺗهﺮﻤﻧشزراﻲﺑﺎﻳزرا (Tokuhashi) ... 5 ،ﺖﺷاﺬﮔ ﻪﺤﺻﻲﺷﺎﻫﻮﻛﻮﺗ ﻣا ﺎ نﺎﻴﺑ ﺖـﺷاد ياﺮـﺑ يدﺮﺑرﺎﻛ ﻪﻴﻟواﻪﺘﺧﺎﻨﺷﺎﻧ يﺎﻣﻮﻨﻴﺳرﺎﻛ اﺪﻧ در ) 13 ( . ﻦﻴــﺑاريرادﻲــﻨﻌﻣطﺎــﺒﺗراﺶﻧارﺎــﻜﻤﻫو ﻞــﮕﻳر ﺎـﻘﺑوﻲﺷﺎﻫﻮﻛﻮﺗرﺎﻴﻌﻣ 139 دادنﺎـﺸﻧرﺎـﻤﻴﺑ ـﻧ ﺪ ) 17 ( . ﻲﮔﺪـﻨﻨﻛﻲﻨﻴﺑ ﺶﻴﭘ شزراﻲﻧﻮﻨﻛﺶﻫوﮋﭘ نﻮﺘـﺳ ﻚﻴﺗﺎﺘـﺳﺎﺘﻣ نارﺎﻤﻴﺑ رد ﻲﺷﺎﻫﻮﻛﻮﺗ رﺎﻴﻌﻣ ﺪﻨﺘﺴﻫﻲﺗوﺎﻔﺘﻣﻪﻴﻟوا يﺎﻫرﻮﻣﻮﺗﻞﺻﺎﺣﻪﻛتاﺮﻘﻓ ﻲـﻣﺪﻴﻳﺎﺗ ﺺﻴﺨﺸﺗ زا ﺲﭘلﺎﺳﻚﻳ رد ار وﺪـﻨﻛ ﻲﮔﺪـﻧز ﻪـﺑ ﺪـﻴﻣاﺮـﺘﻤﻛﺎـﻳ ﺮﺘـﺸﻴﺑﻦﻴﻤﺨﺗ ياﺮﺑ ﺎﻗ ﻲﺗوﺎﻔﺗنارﺎﻤﻴﺑ ـﻳ ﻲـﻤﻧ ﻞ دﻮـﺷ . ﺎـﺑﻪـﺠﻴﺘﻧ ﻦـﻳا ﻠﺒﻗﺶﻫوﮋﭘ ﻲ درادﻲﻧاﻮﺧﻢﻫ . وﺖﻴﺴﻨﺟﺶﻫوﮋﭘ ﻦﻳازاﻞﺻﺎﺣ ﺞﻳﺎﺘﻧسﺎﺳاﺮﺑ ﻚﻴﺗﺎﺘـﺳﺎﺘﻣرﺎـﻤﻴﺑ ﺎـﻘﺑﺮـﺑﻲﺘﺒﺜﻣ ﺮﻴﺛﺎﺗﭻﻴﻫ ﻦﺳ ﺪﻨﺘـﺷاﺪﻧﻲﺗاﺮﻘﻓنﻮﺘﺳ . نﻮﻴـﺳﺮﮔرﻞـﻴﻠﺤﺗﺮﺑﺎـﻨﺑ هﺪـﻨﻨﻛﻲـﻨﻴﺑ ﺶﻴـﭘ لﺪﻣ زا درﻮﻣ ودﻦﻳا ﺲﻛﺎﻛ ﺪﻧﺪﺷ ﻪﺘﺷاﺬﮔ رﺎﻨﻛ . ﻪﺑﺎـﺸﻣ ﻪـﺠﻴﺘﻧ ﻦـﻳا ﻖـﻴﻘﺤﺗ ﻪـﻛﺖﺳا ﻲﻠﺒﻗ نآرد داد نﺎـﺸﻧ ـﺷه ،ﺪ ﺖﻴـﺴﻨﺟ ﻢﻴﻤﺼﺗ ﺮﺑ يﺮﻴﺛﺎﺗ ﮔ ﻲﻳﺎـﻬﻧ يﺮـﻴ ) د هﻮـﺤﻧدرﻮـﻣ ر يرﺎﻤﻴﺑ نﺎﻣرد ( راﺪﻧ د ) 18 ( . زاﻚــﻳﺮــﻫ ﺮﻴﺛﺎــﺗﻦﻴــﻴﻌﺗياﺮــﺑ نﺎــﻳﺎﭘرد ﻪــﺼﺨﺸﻣ ﻲﻨﻴﺑزﺎــﺑ ﻲﺑﺎــﻳزراﻢﺘــﺴﻴﺳيﺎــﻫ ﺪــﺷ ه دراﻮﻣ مﺎﻤﺗ ﻲﺷﺎﻫﻮﻛﻮﺗ ﺲﻛﺎـﻛنﻮﻴﺳﺮﮔر لﺪﻣ رد ﺲﻛﺎــﻛلﺪــﻣ زاﻪــﻛ يدرﻮــﻣﺎــﻬﻨﺗوﺪﻧﺪــﺷدراو ﻳدﺮﮔ فﺬﺣ ،ﺪ جرﺎﺧ ﻲﻧاﻮﺨﺘﺳا يﺎﻫزﺎﺘﺳﺎﺘﻣ داﺪﻌﺗ ﻋﺎﺨﻧ ﻲ دﻮﺑ . ﻚﻴﻨﻜﺗ ﻞﺻﺎﺣ ﻻﺎﻤﺘﺣا ﺞﻳﺎﺘﻧ ﻦﻳا يﺎﻫ رد ﺎـﻫﻚـﻴﻨﻜﺗ ﻦـﻳا ﻲﻧاﻮﺗﺎـﻧ ويﺮﻳﻮـﺼﺗ ﻲﻧﺎﻣرد ﻲـﺗاﺮﻘﻓ جرﺎﺧ ﻲﻧاﻮﺨﺘﺳايﺎﻫزﺎﺘﺳﺎﺘﻣ مﺎﻤﺗ نﺎﻣرد ﺖﺳا ﻲﻧﺎﺴﻧا . مﺎﻤﺗ ﺎﻣا دراﻮﻣ ﺎـﻘﺑﺮﺑﺮﮕﻳد ي دراو وﺪـﻧﺮﺛﻮﻣرﺎـﻤﻴﺑ ﻲــﻣلﺪــﻣ ﺞﻳﺎــﺘﻧ ﻦــﻳا،ﺪﻧﻮــﺷ ﺎــﺑ ﻲــﻠﺒﻗﺶﻫوﮋــﭘ زﺎﮔزﺎﺳ ــﺳا ،ﺖ ــﻫرﻮﻣﻮﺗهﺎــﮕﻳﺎﺟﻪــﭼ ﺮــﮔا ﺎ ﺎــﺑ ـﺳاتوﺎـﻔﺘﻣﻲﻠﺒﻗﺶﻫوﮋﭘ ردنﺎﺸﻫﺎﮕﻳﺎﺟ ﺖ ) 9 ( . ﻢﻬﻣ ﻪﻴﻟوا رﻮﻣﻮﺗ ﻞﺤﻣﻪﻛﺐﻠﻄﻣ ﻦﻳا رﻮﺘﻛﺎﻓ ﻦﻳﺮﺗ ﺳاﺎﻘﺑ ياﺮﺑهﺪﻨﻨﻛﻦﻴﻌﺗ ،ﺖ وهﺪـﺷﻪﺘﻓﺮﻳﺬﭘﻼﻣﺎﻛ ﻠﻴﺳوﻪﺑ ﻪ ،ﺖـﺳاهﺪـﺷ تﺎﺒﺛاناﺮﮕﺸﻫوﮋﭘ يرﺎﻴﺴﺑ ﻪـﻛﺪـﻧدادنﺎـﺸﻧ ﺶﻫوﮋﭘ ﻦﻳازاﻞﺻﺎﺣﺞﻳﺎﺘﻧ ﺎﻣا ﻢﻬﻣ درﺎـﻤﻴﺑﺎﻘﺑ ياﺮﺑهﺪﻨﻨﻛ ﻦﻴﻴﻌﺗرﻮﺘﻛﺎﻓﻦﻳﺮﺗ ر اﺮﻳا ن دﻮﺑ تاﺮﻘﻓنﻮﺘﺳ ﻞﺧاد رد ﺎﻫزﺎﺘﺳﺎﺘﻣ داﺪﻌﺗ هﺎـﮕﻳﺎﺟردﺮـﺿﺎﺣ ﺶﻫوﮋﭘردﻪﻴﻟوا رﻮﻣﻮﺗ ﻞﺤﻣو ﻓﺮﮔراﺮﻗﻲﻣﻮﻤﻋﺖﻴﻌﺿوزاﺪﻌﺑومﻮﺳ ﺖ ) 9 ( . ﻪﺘﻓﺎﻳ ﻲـﻣﺪـﻴﻛﺎﺗ ﻦﻳاﺮﺑﺮﺿﺎﺣ ﺶﻫوﮋﭘ يﺎﻫ ﺪـﻨﻨﻛ ﺪﺷﻲﻨﻴﺑزﺎﺑ رﺎﻴﻌﻣ ﻪﻛ ه يدﺮﺑرﺎﻛ ﻲﺷﺎﻫﻮﻛﻮﺗ ﺖـﺳا ﻢﺘﺴﻴﺳ زا و ﺶﻴﭘ يﺎﻫ ﺪـﻨﻨﻛ ﻲﻳﻮـﮔ ه ﺎـﺑ لﺎـﻤﺘﺣا ﺶﻴﭘ ﻲﻨﻴﺑ ﻲـﻫد هﺮـﻤﻧﻢﺘـﺴﻴﺳرد ،ﻻﺎـﺑ ﻲﮔﺪﻨﻨﻛ ﻚﻴﺗﺎﺘـﺳﺎﺘﻣ نارﺎـﻤﻴﺑياﺮـﺑ،ﻲﺣاﺮﺟﻞﻤﻋ زاﻞﺒﻗ اﺮﻘﻓنﻮﺘﺳ ت ﻲﻣ ﺪﺷﺎﺑ . ﺮﻳﺪﻘﺗ و ﺮﻜﺸﺗ ﻦﻳا ﻪﻟﺎﻘﻣ ﻞﺻﺎﺣ نﺎﻳﺎﭘ ﻪﻣﺎﻧ نﺎﻜـﺷا ﺮـﺘﻛد يﺎـﻗآ ﻮﺟاﻮﺧ رد ﻊﻄﻘﻣ بﺎﺼﻋاو ﺰﻐﻣ ﻲﺣاﺮﺟ ﺺﺼﺨﺗ ﻪﺑ ﺮﺘﻛد يﺎﻗآﻲﻳﺎﻤﻨﻫار ﺎﺿر ﻼﻣ ﻲﻨﻴـﺴﺣ هروﺎـﺸﻣ و ﺮﺘﻛد نﺎﻫﺮﻓ رد لﺎﺳ 1389 و ﺪﻛ 886 ﻣ ﻲ ﺪـﺷﺎﺑ ﻪﻛ ﺎﺑ ﺖﻳﺎﻤﺣ هﺎﮕﺸﻧاد مﻮﻠﻋ ﻲﻜـﺷﺰﭘ ناﺮـﻬﺗ ﺮـﺟا ا هﺪﺷ ﺖﺳا . ﻊﺑﺎﻨﻣ 1. Tang SG, Byfield JE, Sharp TR, Utley JF, Quinol L, Seagren SL. Prognostic factors in the management of metastatic epidural spinal cord
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Original Article
Evaluation of the Tokuhashi Score value for the life expectancy of
patients with spinal metastases
Reza Molla Hoseini, MD. Assistant Professor of Neurosurgery. Tehran University of Medical Sciences, Tehran, Iran.
r_mollahoseini@yahoo.com
*Ashkan Khajoo, MD. Assistant Professor of Neurosurgery. Islamic Azad University of Tehran, Faculty of Medicine,
Tehran, Iran. (*Corresponding author) a.khajoo@gmail.com
Zeynab Sharifian, MD. General Practitioner,Islamic Azad University of Tehran, Faculty of Medicine, Tehran, Iran.
z.sharifian@gmail.com
Seyed Mir-Abolfazl Motiee, Medical student, Firoozgar hospital, Tehran University of Medical Sciences, Tehran, Iran.
heart_iums@yahoo.com
Abstract
Background: Life expectancy of patients with spinal metastasis is an important factor to manage these patients. Tokuhashi is a scoring system which was the sum of the points of six items: 1.general condition, 2. number of extraspinal bone metastasis, 3. number of metastasis in the vertebral body, 4. presence or absence of metastasis to major internal organs, 5. site of the primary lesion, 6. the severity of palsy. This score can predict survival time. Our study is going to evaluate predictive value of Tokuhashi score in order to select more useful treatment for patient with spinal metastases.
Methods: This study is cohort. We had 109 patients with spinal metastasis that selected from February 2007 to March 2009.Tokuhashi score is determined for all patients. We compare the predicted survival from this score with actual survival. Analysis based on Kaplan_Meier, Cox regression and McNemar tests.
Results: The predicted survival, based on Tokuhashi score, in 38 patients was less than 6 months, in 39 patients, 6-12 months (, and 1 year or more in 32 patients and the actual survival was: 39 patients died at first 6 months of the follow up, 28 at the second six-month period and 42 patients were alive at the end of the year. No significant difference was seen between predicted and actual Survival time (p=0.116). Present study showed that the Tokuhashi revised scoring system may be practicable and highly predictive preoperative scoring systems for patients with spinal metastases.
Conclusion: Our study showed the Tokuhashi score system can highly predict the survival of patients with spinal metastasis and it is a trustful tool to use for management of these patients.
