* ﺝ
دﺎـﺘﺳا ﻲﺣاﺮﺟ هوﺮﮔ رﺎﻳ ﻞﺻﺎﻔﻣ و ناﻮﺨﺘﺳا
هﺎﮕﺸﻧاد ، ناﺮـﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ ،
ﻤﻴﺑ ﺎـﻨﻴﺳ نﺎﺘﺳرﺎ ﺶﺨﺑ ، ﻞﺻﺎﻔﻣ و ناﻮﺨﺘﺳا ﻲﺣاﺮـﺟ ﻮـﮕﺨﺳﺎﭘ ةﺪﻨﺴﻳﻮﻧ
: ﺮﺘﻛد ﻲﺷوﺎﻴﺳ ﻚﺑﺎﺑ
ﺸﻧاد**
ﻲﺣاﺮﺟ هوﺮﮔ رﺎﻴ ﻞﺻﺎﻔﻣ و ناﻮﺨﺘﺳا
هﺎﮕﺸﻧاد ، ناﺮـﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ ،
ﺎـﻨﻴﺳ نﺎﺘﺳرﺎﻤﻴﺑ ﺶﺨﺑ ،
ﻞﺻﺎﻔﻣ و ناﻮﺨﺘﺳا ﻲﺣاﺮـﺟ ﻦﻔﻠﺗ
: 66701041
ﺘﺳد***
ﻲﺣاﺮﺟ هوﺮﮔ رﺎﻴ ﻞﺻﺎﻔﻣ و ناﻮﺨﺘﺳا
هﺎﮕﺸﻧاد ، ﺰﭘ مﻮﻠﻋ ناﺮـﻬﺗ ﻲﻜﺷ ، ﺎـﻨﻴﺳ نﺎﺘﺳرﺎﻤﻴﺑ ﺶﺨﺑ ،
ﻞﺻﺎﻔﻣ و ناﻮﺨﺘﺳا ﻲﺣاﺮـﺟ Email: [email protected]
لﻮﺻو ﺦﻳرﺎﺗ : 22 / 10 / 1387
شﺮﻳﺬﭘ ﺦﻳرﺎﺗ :
23 / 01 / 1388
و ﻞﻠﻋ نﺎﻣرد يﺎﻫﺪﻣﺎﻴﭘ
47 درﻮﻣ ﻟﺎﮕﻨﭼ ﻲ نﺪﺷ ا نﺎﺘﺸﮕﻧ ﺎﭘ
ﺎﻣوﺮﺗ زا ﺲﭘ
ناﺮﻬﺗ ﺎﻨﻴﺳ نﺎﺘﺳرﺎﻤﻴﺑ رد
ﺘﻛد ـ ﺮ ﻲﺷوﺎﻴﺳ ﻚﺑﺎﺑ ،
*ﺮﺘﻛد تادﺎﺳ ﻲﻔﻄﺼﻣﺮﻴﻣ ،
**ﺶﺨﺒﻠﮔ ﺎﺿرﺪﻤﺤﻣ ﺮﺘﻛد ،
*ﺘﻛد ـ ﺮ نﺎﺷﻮﻛ ﻲﻠﻋ ﺘﻛد ،
***ـ ﻨﭘ نﺎﺴﺣا ﺮ ـ
***
راﺪ
ﻭ ﻩﮊﺍ ﻱﺪﻴﻠﻛ ﻱﺎﻫ :
ﻥﺪﺷ ﻲﻟﺎﮕﻨﭼ ،
ﺎﻣﻭﺮﺗ ،ﺎﭘ
ﻩﺪﻴﻜﭼ :
ﺯ ﻣ ﻨﻴ ﻪ ﻑﺪﻫ ﻭ : ﻥﺪﺷ ﻲﻟﺎﮕﻨﭼ ﺎﭘ ﻥﺎﺘﺸﮕﻧﺍ
ﹰﻻﻮﻤﻌﻣ ﻱﺭﺎﻤﻴﺑ ﺭﺩ ﻲﻣ ﻩﺪﻳﺩ ﻲﻧﻼﻀﻋ ﻲﺒﺼﻋ ﻱﺎﻫ ﻪﺑﺮﺿ ﺪﻨﻧﺎﻣ ﺩﺭﺍﻮﻣ ﺯﺍ ﻲﻀﻌﺑ ﺭﺩ ﻭ ﺩﻮﺷ
ﺎﭘ ﻕﺎﺳ ﻪﺑ ﺎﺑ ﻥﻭﺪﺑ ﺎﻳ
ﺐﻴﺳﺁ ﺎﻳ ﻲﮕﺘﺴﮑﺷ ﺩﻮﺒﻬﺑ ﻝﺎﺒﻧﺩ ﻪﺑ ﺎﻳ ﻭ ﻲﮕﺘﺴﮑﺷ ﺖﺳﺍ ﻦﮑﻤﻣ ﺰﻴﻧ ﻡﺮﻧ ﺖﻓﺎﺑ ﻱﺎﻫ
، ﺩﻮﺷ ﻩﺪﻳﺩ . ﻲﻣ ﺵﻼﺗ ﺎﻣ ﻥﺎﻣﺭﺩ ﺎﻳ ﻭ ﻞﻠﻋ ﻪﮐ ﻢﻴﻨﮐ
ﻥﺁ ﺐﺳﺎﻨﻣ ﻱﺎﻫ ﻢﻴﻨﮐ ﻦﻴﻴﻌﺗ ﺍﺭ
.
ﺵﻭﺭ ﻭ ﺩﺍﻮﻣ ﺎﻫ
: ﺎﻣ ﻥﺍﺮﻬﺗ ﺎﻨﻴﺳ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ۴۷
ﻝﺎﺳ ﺭﺩ ﺍﺭ ﺭﺎﻤﻴﺑ ﻱﺎﻫ
۱۳۸۲ ﺎﺗ ۱۳۸۶ ﻢﻳﺩﺮﮐ ﻲﺳﺭﺮﺑ .
ﺍ ﺲﭘ ﺭﺩ ﻭ ﻥﺍﺭﺎﻤﻴﺑ ﺯﺍ ﻩﺯﺎﺟﺍ ﺐﺴﮐ ﺯ ﻞﺋﺎﺴﻣ ﻦﺘﺷﺍﺩ ﺮﻈﻧ
ﻢﻳﺩﺮﮐ ﻪﻌﻟﺎﻄﻣ ﺩﺭﺍﻭ ﺍﺭ ﺎﻬﻧﺁ ﻲﻗﻼﺧﺍ .
ﺪﻧﺩﻮﺑ ﻩﺩﻮﻤﻧ ﻪﻌﺟﺍﺮﻣ ﺎﻣ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺲﻧﺍﮊﺭﻭﺍ ﻪﺑ ﻪﻴﻟﻭﺍ ﺐﻴﺳﺁ ﺯﺍ ﺲﭘ ﻪﮐ ﺪﻧﺩﻮﺑ ﺎﻣ ﻪﻴﻟﻭﺍ ﻥﺍﺭﺎﻤﻴﺑ ﺎﻬﻧﺁ ﻡﺎﻤﺗ ۴۲
ﻱﺍﺭﺍﺩ ﺎﻬﻧﺁ ﺩﺭﻮﻣ
ﻭ ﻲﮕﺘﺴﮑﺷ ۵
ﺖﻳﺰﻳﻭ ﺭﺩ ﺪﻧﺩﻮﺑ ﻲﮕﺘﺴﮑﺷ ﻥﻭﺪﺑ ﺰﻴﻧ ﺩﺭﻮﻣ ﻴﮕﻴﭘ ﻱﺎﻫ
ـ ﻱﺮ ﺎﮕﻨﭼ ﻥﺪﺷ ﻲﻟ ﺪﺷ ﻩﺪﻫﺎﺸﻣ ﺎﻬﻧﺁ ﺭﺩ .
ﺯﺍ ﺍﺭ ﺎﻬﻧﺁ ﺎﻣ ﻦﻳﺍﺮﺑﺎﻨﺑ ﺮﻈﻧ
ﻭ ﻲﺴﺣ ﺩﺮﮑﻠﻤﻋ ﺘﻛﺮﺣ
ﻪﻨﻳﺎﻌﻣ ﻲ
ﺠﻧﺍ ﻪﻠﻀﻋ ﻭ ﺐﺼﻋ ﺭﺍﻮﻧ ﻭ ﻲﻓﺍﺮﮔﻮﻳﺩﺍﺭ ﺎﻬﻧﺁ ﻱﺍﺮﺑ ﻭ ﻩﺩﺮﮐ ـ
ﻢﻳﺩﺍﺩ ﻡﺎ . ﺪﺷ ﻡﺎﺠﻧﺍ ﺱﻮﻟﺎﮐ ﻦﺘﺷﺍﺩﺮﺑ ﻡﻭﺰﻟ ﺕﺭﻮﺻ ﺭﺩ ﻭ ﺎﻫﺭﻮﺴﮑﻠﻓ ﻲﻣﻮﺗﻮﻨﺗ ﺎﻬﻧﺁ ﻱﺍﺮﺑ .
ﻪﺘﻓﺎﻳ ﺎﻫ : ﻴﻫ ﺎﻣ ﭽ ﻲﺴﺣ ﺩﺮﮑﻠﻤﻋ ﻝﻼﺘﺧﺍ ﻪﻧﻮﮕ ـ
ﻳ ﻭ ﻲﺘﮐﺮﺣ ﮑﻧ ﺍﺪﻴﭘﺎﻬﻧﺁ ﻪﻠﻀﻋ ﻭ ﺐﺼﻋ ﺭﺍﻮﻧ ﺭﺩ ﻝﻼﺘﺧﺍ ﺎ ـ
ﻢﻳﺩﺮ . ﭽﻴﻫ ﺎﻬﻧﺁ ﻲﻓﺍﺮﮔﻮﻳﺩﺍﺭ ﺭﺩ ﮕ
ﺿﺍﻭ ﺱﻮﻟﺎﮐ ﻪﻧﻮ ﺢ
ﺖﺷﺍﺪﻧ ﺩﻮﺟﻭ ﻭ
ﺩﻮﺟﻭ ﺎﭘ ﮏﭼﻮﮐ ﻞﺻﺎﻔﻣ ﺐﻳﺮﺨﺗ ﺎﻳ ﻭ ﻥﺍﻮﺨﺘﺳﺍ ﻥﺩﺭﻮﺨﻧ ﺵﻮﺟ ﺪﻨﻧﺎﻣ ﻲﻌﻴﺒﻃ ﺮﻴﻏ ﻞﺋﺎﺴﻣ ﺮﮕﻳﺩ ﻭ ﻲﻧﺍﻮﺨﺘﺳﺍ ﻲﮕﺘﺴﮑﺷ ﻪﻧﻮﮕﭽﻴﻫ ،ﺎﭘ ﻲﻓﺍﺮﮔ ﺭﺩ
ﺖﺷﺍﺪﻧ .
ﻪﺠﻴﺘﻧ ﻴﮔ ـ ﻱﺮ : ﮐ ﺵﻼﺗ ﺎﻣ ـ ﺍ ﻲﻀﻌﺑ ﻪﮐ ﻢﻳﺩﺮ ﻠﻋ ﺯ
ـ ﻞ ﻨﭼ ـ ﺷ ﻲﻟﺎﮕ ـ ﻥﺪ ﮕﺑ ﺭﺎﻨﮐ ﺍﺭ ﺎﭘ ـ
ﻢﻳﺭﺍﺬ . ﮕﭽﻴﻫ ـ ﺛﺍ ﻪﻧﻮ ـ ﺮ ﻟﺎﮐ ـ ﺟﻭ ﺱﻮ ـ ﺖﺷﺍﺪﻧ ﺩﻮ . ﻧ ﺭﺩ ـ ﻀﻋ ﻭ ﺐﺼﻋ ﺭﺍﻮ ـ
،ﻪﻠ
ﻴﺳﺁ ـ ﺒﺼﻋ ﺐ ـ ﺭﺩ ﻭ ﻲ ﮔﻮﻳﺩﺍﺭ ـ ﺸﻣ ،ﻲﻓﺍﺮ ـ ﺨﺘﺳﺍ ﺕﻼﮑ ـ
ﺟﻭ ﻲﻧﺍﻮ ـ ﺷﺍﺪﻧ ﺩﻮ ـ ﺖ . ﻤﺗ ـ ﻣﺎ ـ ﻣ ﻲ ـ ﮏﻳ ﺩﺭﺍﻮ ﻃ ـ ﺑ ﻪﻓﺮ ـ ﮐ ﻩﺩﻮ ـ ﻌﺑ ﻪ ـ ﺗ ﺯﺍ ﺪ ـ ﺠﻳﺍ ﺎﻣﻭﺮ ـ ﺷ ﺩﺎ ـ ﺑ ﻩﺪ ـ ﺧ ﻪﮐ ﺩﻮ ـ ﻦﻳﺍ ﺩﻮ
ﻟﺎﺣ ـ ﻤﻴﺑ ،ﺖ ـ ﻱﺭﺎ ) ﺒﺼﻋ ﻀﻋ ﻲ ـ ﻲﻧﻼ ( ﻧـ ﮑﺳﺎﻣﻭﺭﻮ ـ ﻲﻣ ﺩﺭ ﺍﺭ ﺮﻟﻮ ﮐ
ـ ﺩﺮ . ﻣ ـ ﮑﻓ ﺎ ـ ﺮ ﻲﻣ ﻴﻨﮐ ـ ﻳ ﻪﮐ ﻢ ـ ﻌﻗﺍﻭ ﮏ ـ ﺒﻴﻓ ﻪ ـ ﻴﺗﻭﺮ ـ ﻌﺑ ﮏ ـ ﻴﺳﺁ ﺯﺍ ﺪ ـ ﺐ ﻟ ﻱﺎﻫ ـ ﻨﻨﮐ ﻪ ـ ﻀﻋ ﺭﺩ ﻩﺪ ـ ﺕﻼ
ﺳ ـ ﺠﻳﺍ ﻕﺎ ـ ﻲﻣ ﺩﺎ ﺷ ـ ﻲﻣ ﻪﮐ ﺩﻮ ﺗـ ﻋﺎﺑ ﺪﻧﺍﻮ ـ ﻓﺩ ﻦﻳﺍ ﺚ ـ ﺩﻮﺷ ﻲﺘﻴﻣﺭﻮ .
ﻨﻴﻣز ﻪ ﺪﻫ و ف
ﻨﭼ ـ ﻟﺎﮕ ـ ﺷ ﻲ ـ نﺪ ﮕﻧا ـ ـﺘﺸ ـ
ـﺷ ﻪـﻛ ﺎـﭘ نﺎ ـ
ﻦـﺸﻜﻠﻓ ﻞﻣﺎ
ﻞـــﺻﺎﻔﻣ ﺮـــﭽﻛﺮﺘﻨﻛ (Distal Interphalangeal) DIP
و
) (Proximal Interphalangeal ﻲﺘـــﺸﮕﻧا ﺪـــﻨﺑ ﻦﻴـــﺑPIP
ﻞـﺼﻔﻣ ﺮﭽﻛﺮﺘﻨﻛ ﻦﺸﻨﺘﺴﻛا و ﺎﭘ نﺎﺘﺸﮕﻧا لﺎﺘﺴﻳد و لﺎﻤﻳﺰﻛوﺮﭘ (Metatarsophalangeal Joint)
،ﺖﺳاMIP زا ﻲﻳﺎـﻤﻧ ًﻻﻮﻤﻌﻣ1
يرﺎﻤﻴﺑ ﻫ ﻋ يﺎ تﻮﻛرﺎﺷ ﻞﺜﻣ ﻲﻧﻼﻀﻋ ﻲﺒﺼ ـ
يرﺎﻣ ـ ثﻮﺗ
2، ﻠﻓ ـ ﺞ
ﻔﻃا ـ
3لﺎ ﻠﻓ و ـ ﻐﻣ ﺞ ـ
4يﺰ ﻲﻣ ﺪﺷﺎﺑ . ﻨﭼ ـ ﻟﺎﮕ ـ ﺷ ﻲ ـ نﺪ ﺑ ﺎﻬﻨﻳا رد ﻪ
ﻴﺳآ ﺖﻠﻋ ـ ﻀﻋ ﺐ ـ ﻲـﻧورد تﻼ Intrisic)
( ﻲـﻣ ﺪـﺷﺎﺑ . تﻼـﻀﻋ
ﻄﺳ رد ﺎﭘ ﻲﻧورد ـ
ﻔﻠﺧ ﺢ ـ ﻞﻣﺎـﺷ و ﻪـﺘﻓﺮﮔ راﺮـﻗ ﻲﻳﺎـﭘ ﻒﻛ و ﻲ
ﺒﻣﻮﻟ تﻼﻀﻋ ـ
ﻴﺑ و لﺎﻜﻳﺮ ـ
ﺨﺘﺳا ﻦ ـ ﻲﻣ ﻲﻧاﻮ
ـﺑ ﻪـﻛ ﺪﺷﺎﺑ ﻪ
ﺖـﻠﻋ
ﻨﺒﺴﭼ ـ نوﺪﻧﺎﺗ ﻪﺑ ﺎﻬﻧآ ﻲﮔﺪ ﻠﻓ ﺚﻋﺎﺑ نﺎﺘﺸﮕﻧا يﺎﻫ
ﻜ ﻞﺼﻔﻣ نﻮﻴﺴ
)MTP
Metatarsophalangeal ﺘﺴﻛا و (
ﻨ ﻞــﺻﺎﻔﻣ ﻦــﺸ وPIP
ﻲﻣDIP دﻮﺷ . ،تﻼﻀﻋ ﻦﻳا دﺮﻜﻠﻤﻋ رد لﻼﺘﺧا ﻪﻧﻮﮔ ﺮﻫ ﻦﻳاﺮﺑﺎﻨﺑ
لﻼﺘـﺧا ﺖﻠﻋ ﻪﺑ هاﻮﺧ و ﻲﻧﻼﻀﻋ ﻪﻴﻟوا يرﺎﻤﻴﺑ ﻚﻳ ﺖﻠﻋ ﻪﺑ هاﻮﺧ ﺘـﺧا ﻪﺑ ﻪﻳﻮﻧﺎﺛ ،تﻼﻀﻋ ﻦﻳا دﺮﻜﻠﻤﻋ ﻼ
ﻲـﻫد ﺐـﺼﻋ ل )
ﻴﺑ يرﺎـﻤ
ﻚـﻴﺗﺎﻣوﺮﺗ ﺎﻳ ﻲﺒﺼﻋ (
و ﺎﻫرﻮـﺴﻜﻠﻓ لدﺎـﻌﺗ رد لﻼﺘـﺧا ﺚـﻋﺎﺑ
ﻲـﻣ ﺎـﭘ نﺎﺘﺸﮕﻧا يﺎﻫرﻮﺴﻨﺘﺴﻛا ﺚـﻋﺎﺑ ﺖـﻟﺎﺣ ﻦـﻳا ﻪـﻛ دﻮـﺷ
ﻓد ـ ﻞـﺻﺎﻔﻣ رد نﺪـﻧﺎﻣ ﻢـﺧ ﻲﺘﻴﻣرﻮ وDIP
ﻲﺘﻴﻣرﻮـﻓد وPIP
ﻧﺎﻣ ﺖﺳار ـ ﻞﺼﻔﻣ رد نﺪ ﻪـﻋﻮﻤﺠﻣ ﻪﺑ ﻪﻛ هﺪﺷ ﺎﭘ نﺎﺘﺸﮕﻧاMIP
ﻓد ﺎﻬﻨﻳا ـ
ﻲـﻣ ﮓـﻨﻳوﻼﻛ ﻲﺘﻴﻣرﻮ ـﮔ
ـ ﺪﻨﻳﻮ . ﻢـﺋﻼﻋ تﻻﺎـﺣ ﻦـﻳا
ﻠﻛ ﻲـﺻﺎﺼﺘﺧا يﺎـﻤﻧ ﻪﻠﻤﺟ زا ﺪﻧراد ﺺﺨﺸﻣ ﻲﻜﻨﻴﻠﻛارﺎﭘ و ﻲﻜﻨﻴ
NCV رد EMG / ﻮﻴﺑ رد ﺎﻳ6
ﭘ ﻲﻧﻼﻀﻋ ﻲﺴ
7. يرﺎـﻤﻴﺑ تاﺮﻫﺎﻈﺗ
هﺪﺷ زﺎﻏآ ﻲﮕﭽﺑ زا ﺎﻬﻨﻳا رد
هﺪﺷ ﺪﻳﺪﺸﺗ ﺪﺷر و غﻮﻠﺑ ﻦﻴﺣ رد و8
ﺪﻧراد ﻢﻫ ﻲﺘﻛﺮﺣ ﺎﻳ و ﻲﺴﺣ ﺺﻳﺎﻘﻧ و
9. ﺰﻴﻧ ﺮﮕﻳد تﻻﺎﺣ زا ﻲﻀﻌﺑ
ﻲﻣ ﻲﺘﻴﻣرﻮﻓد دﺎﺠﻳا ﺪﻨﻧاﻮﺗ ﺑﺎﻗ ﻪﻛ ﺪﻨﻨﻛ ﻲﻳﺎﻫ
ﺎﺑ هﺎﺒﺘﺷا ﻞ ﻲﻟﺎـﮕﻨﭼ
نﺪﺷ نﺎﺘﺸﮕﻧا ندرﻮﺧ شﻮﺟ ﺪﺑ ﺪﻨﻧﺎﻣ ﺖﺳا
10. ﻲﻧﺎـﻣز ﺖﻟﺎﺣ ﻦﻳا
ﻲﻣ قﺎﻔﺗا و ﺎـﭘ نﺎﺘﺸﮕﻧا ﻪﺑ ﺐﻴﺳآ ،ﻪﻴﻟوا ﺐﻴﺳآ ﻦﻴﺣ رد ﻪﻛ ﺪﺘﻓا
ﺪـﻧدﺮﮕﻧ ﻲـﺳرﺮﺑ ﻲﺑﻮـﺧ ﻪﺑ و هﺪﺷ شﻮﻣاﺮﻓ ﺎﻬﻧآ ﻲﮕﺘﺴﻜﺷ .
رد
ﻲـﻣ شﻮـﺟ ﺪﺑ ﺖﻴﻌﺿو ﻚﻳ رد نﺎﺘﺸﮕﻧا ﻪﺠﻴﺘﻧ دﺎـﺠﻳا و ﺪـﻧرﻮﺧ
ﻪﺑ ﻪﻴﺒﺷ ﻲﺘﻟﺎﺣ نﺪﺷ ﻲﻟﺎﮕﻨﭼ
ﻲـﻣ ﺪـﻨﻨﻛ . نﻮـﭼ ﺎـﻬﻨﻳا رد ﻲـﻟو
ﻞﻣﺎﻛ ﻞﻜﺷ ﻪﺑ ﻞﻜﺷ ﺮﻴﻴﻴﻐﺗ ﻢﻳراﺪﻧ ﻲﻧورد تﻼﻀﻋ ﺐﻴﺳآ و
دﻮـﺟ
ﺖﺴﻴﻧ رﺎﺘﻓﺮﮔ نﺎﺘﺸﮕﻧا مﺎﻤﺗ ﻦﻴﻨﭽﻤﻫ و دراﺪﻧ )
ود ﺎـﻳ ﻚﻳ ًﻻﻮﻤﻌﻣ
ﺖﺳا ﻲﮕﺘﺴﻜﺷ رﺎﭼد ﺖﺸﮕﻧا .(
ﻲﮕﺘﺴﻜﺷ ﻦﻳا ﻲﻓاﺮﮔﻮﻳدار رد ﺎﻫ
ﺖﺳا ﺺﺨﺸﻣ .
ﻲﺘﻴﻣرﻮـﻓد ﺮﮕﻳد ﻞﻠﻋ زا Checkrein
ﻪـﻛ ﺖـﺳا
ﻲﻣ ﺑﺎﺸﻣ ﻲﺘﻴﻣرﻮﻓد ﺪﻧاﻮﺗ ﻪ
نﺪﺷ ﻲﻟﺎﮕﻨﭼ ﺪﻨﻛ دﺎﺠﻳا
. ﺖـﻟﺎﺣ ﻦﻳا
ﻲﻣ دﺎﺠﻳا ﻲﻧﺎﻣز لﺎـﻛ ﻚـﻳ ﺎـﻴﺒﻴﺗ ﻲﮕﺘـﺴﻜﺷ ﻞﺤﻣ رد ﻪﻛ دﻮﺷ
ﻚــﻳ ﺮﺗردﺎــﻧ رﻮــﻃ ﻪــﺑ ﺎــﻳ و هﺪــﺷ دﺎــﺠﻳا گرﺰــﺑ ﻲﻧاﻮﺨﺘــﺳا ناﻮﺨﺘﺳا ﺑﺎﻧ يزﺎﺳ ﺠ ﺎـﻬﻨﻳا ﻪـﻛ هﺪـﺷ دﺎـﺠﻳا قﺎﺳ مﺮﻧ ﺖﻓﺎﺑ رد ﺎ ﻲﻣ
ـﻧﺎﺗ ﻦﺘﻓﺮﮔ راﺮﻗ ﺶﺸﻛ ﺖﺤﺗ و فاﺮﺤﻧا ﺚﻋﺎﺑ ﺪﻨﻧاﻮﺗ ﺪ
نو يﺎـﻫ
ﺎﻣز و هﺪﺷ قﺎﺳ رﻮﺴﻜﻠﻓ ﻲﻣ ﻲﻌﺳ يرﺎﻤﻴﺑ ﻪﻛ ﻲﻧ
ار ﺎـﭘ ﭻﻣ ﻪﻛ ﺪﻨﻛ
ﺪﻫد راﺮﻗ ﻦﻴﻣز يور ﺮﺗﻮﻧ ﺖﻟﺎﺣ رد ﻲﮔﺪﺷ ﻢﺧ رﺎﭼد ﺎﭘ نﺎﺘﺸﮕﻧا ،
ﻲﻣ ﺪﻧﻮﺷ .
و ﺮﺗﺪﻳﺪـﺷ ﻲﺘﻴﻣرﻮـﻓد ﺎﭘ ﭻﻣ ندﺮﺑ ﻻﺎﺑ ﺎﺑ دراﻮﻣ ﻦﻳا رد
،ﺎﭘ ﭻﻣ ندﺮﺑ ﻦﻴﻳﺎﭘ ﺎﺑ ﻲﻣ ﺮﺘﻬﺑ ﻲﺘﻴﻣرﻮﻓد
دﻮﺷ . ﻦﻳا ﻲﻓاﺮﮔﻮﻳدار رد
ﻣ هﺪﻳد ﺎﻴﺒﻴﺗ فاﺮﻃا ﻲﻧاﻮﺨﺘﺳا هدﻮﺗ ﻚﻳ نارﺎﻤﻴﺑ ﻲ
ﺑ دﻮﺷ ﻪ ﺖـﻠﻋ
تﻼﻀﻋ دﺮﻜﻠﻤﻋ لﻼﺘﺧا نارﺎﻤﻴﺑ ﻦﻳا رد ﻪﻜﻨﻳا ﻲﻧورد
ﻪـﺑ ﻢﻳراﺪﻧ
نآ ﻨﭼ ـ ﻟﺎﮕ ـ ﺷ ﻲ ـ نﺪ ﻲﻣ بذﺎﻛ ﺪﻨﻳﻮﮔ
.
ﻓد ـ ﻲﺘﻴﻣرﻮ ﻟﺎﮕﻨﭼ ـ نﺪﺷ ﻲ ﻲﻣ ﺪﻧاﻮﺗ ﻒﻄﻌﻨﻣ ) ﺢﻴﺤﺼﺗ ﻞﺑﺎﻗ
ﻓد نﺪﺷ ـ ﺖﺳد ﺎﺑ ﻲﺘﻴﻣرﻮ (
فﺎـﻄﻌﻧا ﻞـﺑﺎﻗﺮﻴﻏ ﺎـﻳو )
ﻞـﺑﺎﻗ ﺮـﻴﻏ
ﺳد ﺎﺑ ﺢﻴﺤﺼﺗ ـ
ﺖ ( ﺷﺎﺑ ـ ﺪ . ﺑ ﻪ ﻦﻴـﺣ نﺎﺘـﺸﮕﻧا ﺪﺑ ﺖﻴﻌﺿو ﺖﻠﻋ
ﺶﻔﻛ يﺎﻫﺪـﻨﺑ ﻦﻴـﺑ ﻞﺻﺎﻔﻣ يور ﻪﺘﻳزﻮﻟﺎﻛ دﺎﺠﻳا نﺎﻜﻣا نﺪﻴﺷﻮﭘ
ﻲﻣ ﻪﻛ دراد دﻮﺟو ﺎﭘ نﺎﺘﺸﮕﻧا هار رد لﻼﺘـﺧا و درد ﺚـﻋﺎﺑ ﺪﻧاﻮﺗ
دﻮﺸﺑ ﻦﺘﻓر .
ﻣ ـ شور و داﻮ ﺎﻫ
لﺎﺳ ﻦﻴﺑ يﺎﻫ 1382 ﺎﺗ 1386 داﺪﻌﺗ 193 ﻲﮕﺘﺴﻜﺷ ﺎﺑ رﺎﻤﻴﺑ
ﻢﻳدﺮﻛ ﻲﺳرﺮﺑ ار ﺎﭘ قﺎﺳ ﻪﺑ ﺎﻣوﺮﺗ ﺎﻳ قﺎﺳ .
ﺗ ﺎﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا ﺄ
ﺮـﺑ ﺪﻴﻛ
ﻼﺧا ﻞﺋﺎﺴﻣ ﺪـﺷ مﺎﺠﻧا نارﺎﻤﻴﺑ زا هزﺎﺟا ﺐﺴﻛ و ﻲﻗ
. ﻦﻴـﺣ ﺮـﮔا
ﺖﻳﺰﻳو زا يدرﻮﻣ ،يﺮﻴﮕﻴﭘ يﺎﻫ نﺪـﺷ ﻲـﻟﺎﮕـﻨﭼ
ﺎﻣوﺮﺗ لﺎﺒﻧد ﻪﺑ
ﻲﻣ اﺪﻴﭘ دﻮﺷ ) ﻦـﺸﻜﻠﻓ و لﺎﻳﮋﻧﻻﺎﻓﻮﺳرﺎﺗﺎﺘﻣ ﻞﺼﻔﻣ رد ﻦﺸﻨﺘﺴﻛا
ﻞﺼﻔﻣ رد لﺎﻳﮋﻧﻻﺎﻓﺮﺘﻨﻳا لﺎﻤﻳﺰﮔوﺮﭘ و لﺎﺘﺴﻳد يﺎﻫ
( دراو ار ﺎﻬﻧآ ،
و ار ﺎﻬﻧآ ﻪﺑ طﻮﺑﺮﻣ تﺎﻋﻼﻃا و هدﺮﻛ ﻪﻌﻟﺎﻄﻣ ﻲﺗﺎـﻋﻼﻃا لواﺪﺟ درا
ﻲﻣ ﻢﻳدﺮﻛ . ﺐﻴﺗﺮﺗ ﻦﻳﺪﺑ 47
زا ﻲﺗﺎﺟرد ﺎﺑ رﺎﻤﻴﺑ نﺪـﺷ ﻲـﻟﺎﮕـﻨﭼ
ﺷ هﺪﻫﺎﺸﻣ ـ
ﺪﻧﺪ . ﻴﺣ ـ ﻌﻣ ﻦ ـ ﻲﻨﻴﻟﺎـﺑ تﺎﻨﻳﺎ
، ـﻜﻠﻤﻋ ـ و ﻲـﺴﺣ دﺮ
ﻓد ﺎﭘ قﺎﺳ ﻲﺘﻛﺮﺣ ـ
ﻲﺘﻴﻣرﻮ ﺎـﭘ و ﺎـﭘ ﭻـﻣ رد دﻮﺟﻮﻣ يﺎﻫ )
ﻞـﺜﻣ
نﺪـﺷ ﻲـﻟﺎﮕـﻨﭼ (
ﻟﺎﻛ هزاﺪﻧا و ـ
ﻪﺘﻳزﻮ لواﺪـﺟ رد و ﺺﺨـﺸﻣ ﺎﻫ
ـﺑ ﻒﻄﻌﻨﻣ ﺲﭙﺳ هﺪﺷ ﺖﺒﺛ طﻮﺑﺮﻣ ﻲﺘﻴﻣرﻮـﻓد ندﻮـﺒﻧ ﺎـﻳ و ندﻮ
ﺪﺷ ﻲﺳرﺮﺑ )
حﻼـﺻا ﻞﺑﺎﻗ يرﺎﻜﺘﺳد ﺎﺑ ﻲﺘﻴﻣرﻮﻓد ﻪﻛ ﻲﺗرﻮﺻ رد
ـﻴﻏ ترﻮـﺻ ﻦﻳا ﺮﻴﻏ رد و ﻒﻄﻌﻨﻣ دﻮﺑ ـ
ـﻈﻧ رد فﺎـﻄﻌﻧا ﻞﺑﺎﻗﺮ ـ
ﺮ
ﺪﺷ ﻪﺘﻓﺮﮔ (
. ﮔﻮﻳدار ﺲﭙﺳ ـ
ﻣ زا ﻲﻓاﺮ ـ راﻮـﻧ ﻦﻴـﻨﭽﻤﻫ و ﺎـﭘ و ﭻ
ﺪـﺷ مﺎﺠﻧا ﺰﻴﻧ ﻲﻧﺎﺘﺤﺗ ماﺪﻧا ﻪﻠﻀﻋ و ﺐﺼﻋ .
ﻦـﻳا مﺎـﻤﺗ زا ﺲـﭘ
ﻣ ـ ﻤﻴﺑ رد ،دراﻮ ـ
ﻲﻧارﺎ ﻓد ﻪﻛ ـ ﺘﻴﻣرﻮ ـ ﻴﻏ ﺎﻬﻧآ ﻲ ـ
ـﻄﻌﻧا ﻞﺑﺎﻗ ﺮ ـ
فﺎ
ﺑ ـ ﻗ يرﺎﻜﺘﺳد ﺎﺑ و دﻮ ـ
ﻴﺤﺼﺗ ﻞﺑﺎ ـ
ﮔﻮﻳدار رد و دﻮﺒﻧ ﺢ ـ
قﺎﺳ ﻲﻓاﺮ
شﻮـﺟ ﺪﺑ زا ﻲﻤﺋﻼﻋ ﺎﭘ ﻲﻓاﺮﮔ رد و گرﺰﺑ سﻮﻟﺎﻛ ﺮﺑ لاد ﻲﻤﺋﻼﻋ ﺧ ـ ﺟو ندرﻮ ـ ﺖﺷاﺪﻧ دﻮ
، ﺤﺗ ـ
ﺪـﻨﺘﻓﺮﮔ راﺮـﻗ ﻲﺣاﺮﺟ ﻞﻤﻋ ﺖ .
زا
ﻲﻣﻮـﺗﻮﻨﺗ ﻲﻧﺎـﻴﻣ ﺪﻨﺑ رد ﺖﺸﮕﻧا ﺮﻫ ﺮﻳز ﻚﭼﻮﻛ شﺮﺑ ﻚﻳ ﻖﻳﺮﻃ ﻧﺎﺗ ﺪ نو ﻳزﻮﻟﺎﻛ دﻮﺟو ترﻮﺻ رد و ﺪﺷ مﺎﺠﻧا رﻮﺴﻜﻠﻓ يﺎﻫ ـﺘ
يور ﻪ
ﺘﺸﮕﻧا ﻦﻴﺑ ﻞﺼﻔﻣ ـ
ـﻤﻳﺰﮔوﺮﭘ ﻲ ـ
ـﻬﻧآ ،لﺎ ـ ـﺘﺷادﺮﺑ ﺎ ـ
ـﺷ ﻪ ـ و هﺪ
ﻧﺎﺗ و ﻞﺼﻔﻣ لﻮﺴﭙﻛ ـ
ﺴﻨﺘﺴﻛا نوﺪ ـ
ﻟﺎﻛ ﺮﻳز رﻮ ـ
ﻳزﻮ ﺘ شﺮـﺑ ﺎـﺑ ،ﻪ
ﺖﻓﺎﺑ ندﺮﻛ ﻚﻳدﺰﻧ و لﺎﻜﻴﺘﭙﻴﻟا رد و هﺪـﺷ ﻢﻴﻣﺮﺗ هﺪﻧﺎﻤﻴﻗﺎﺑ يﺎﻫ
ﺪﻳﺪﺷ دراﻮﻣ نﺪـﺷ ﻲـﻟﺎﮕـﻨﭼ
د نﺎﺘﺸﮕﻧا ﻦﺘﺷاﺪﻬﮕﻧ ، ﺖﻴﻌﺿو ر
تﺪﻣ ﻪﺑ ﻦﻴﭘ زا هدﺎﻔﺘﺳا ﺎﺑ ﺢﻴﺤﺻ 3
ﺎـﻳ 4
ﺪـﺷ مﺎـﺠﻧا ﻪـﺘﻔﻫ .
رد
ﺖﻳﺰﻳو ﻪـﺘﻔﻫ رد يﺮﻴﮕﻴﭘ يﺎﻫ يﺎـﻫ
2
، 4 و 8 هﺎـﻣ و يﺎـﻫ 3 و 6 ،
ﺶــﻔﻛ نﺪﻴــﺷﻮﭘ زا ﻲــﺷﺎﻧ تﻼﻜــﺸﻣ و ﻲﺘﻴﻣرﻮــﻓد ﺖــﺸﮔزﺎﺑ ﺐﻴﺳآو ﺪﺷ ﻲﺳرﺮﺑ مﺮﻧ ﺞﺴﻧ ﻲﻟﺎﻤﺘﺣا زوﺮﻜﻧ و ﺎﻫ .
ﻪـﻛ ﻲﻧارﺎـﻤﻴﺑ
ـﻴﮕﻴﭘ ياﺮﺑ ﻞﻤﻋ زا ﺪﻌﺑ ـ
زا ﺪـﻧدﺮﻜﻧ ﻪـﻌﺟاﺮﻣ يﺮ رﺎـﻨﻛ ﻪـﻌﻟﺎﻄﻣ
ﺪﻧﺪﺷ ﻪﺘﺷاﺬﮔ .
ﻪﺘﻓﺎﻳ ﺎﻫ
ﻪﻌﻟﺎﻄﻣ نﺎﻳﺎﭘ رد 47
ﺪـﻧﺪﻧﺎﻣ ﻲﻗﺎﺑ رﺎﻤﻴﺑ
، 43 رﺎـﻤﻴﺑ ) 5 / 91 (%
دﺮﻣ و 4 درﻮﻣ ) 5 / 8
% ( نز دﻮﺑ . رد 4 درﻮﻣ ) 5 / 8 (%
ﻪـﻓﺮﻃ ود ﺰﻴﻧ
دﻮﺑ و رد 40 درﻮﻣ ) 85
% ( ﺖـﺷاد دﻮﺟو ﻻﻮﺒﻴﻓ و ﺎﻴﺒﻴﺗ ﻲﮕﺘﺴﻜﺷ
رد ﻲﻟو 2 درﻮﻣ ) 4
% ( رد و ﺖﺷاد دﻮﺟو ﻻﻮﺒﻴﻓ ﻲﮕﺘﺴﻜﺷ ﻂﻘﻓ 5
درﻮﻣ ) 10
% (
ًﻼﺻا ﻢﻫ
ﺖـﺷاﺪﻧ دﻮـﺟو ﻻﻮـﺒﻴﻓ و ﺎﻴﺒﻴﺗ ﻲﮕﺘﺴﻜﺷ .
ﻣ ﻦﻴﮕﻧﺎﻴ نارﺎﻤﻴﺑ ﻲﻨﺳ 30
دﻮﺑ لﺎﺳ ) زا 18 ﺎﺗ 45 لﺎﺳ .(
ـﺗ ـ يﺎﻣوﺮ
ﻣ فدﺎﺼﺗ ،لﻮﺌﺴﻣ ـ
ﻠﻜﻴﺳ رﻮﺗﻮ ـ
رد ﺖ 40 رﺎﻤﻴﺑ ) 85
% ( يﺎﻣوﺮﺗ و
ﻪﻴﻘﺑ رد ﺮﮕﻳد ﻞﻠﻋ ﻪﺑ قﺎﺳ ﻢﻴﻘﺘﺴﻣ )
15
% ( دﻮﺑ . نارﺎـﻤﻴﺑ مﺎﻤﺗ رد
ﻨﻣاد ﺔ دﻮﺑ ﻪﺘﻓﺎﻳ ﺶﻫﺎﻛ ﺎﭘ ﭻﻣ ﻲﺘﻛﺮﺣ .
فﺮـﻃ ﻪﺑ ﺖﺒﺴﻧ قﺎﺳ ﺮﻄﻗ
ﻘﻣ ـ ﺘﻓﺎﻳ ﺶﻫﺎﻛ ﻞﺑﺎ ـ
دﻮﺑ ﻪ )
ﻪـﻓﺮﻃ ود دراﻮـﻣ رد ﺰـﺠﺑ .(
رد راﻮـﻧ
ﺪـﺸﻧ هﺪﻫﺎـﺸﻣ ﻲﻧاﻮﺨﺘﺳا ﻦﻴﺑ تﻼﻀﻋ رد ﻲﺼﻘﻧ ﻪﻠﻀﻋ و ﺐﺼﻋ .
رد 35 رﺎﻤﻴﺑ ) 75 (%
دراﻮـﻣ رد و دﻮﺑ فﺎﻄﻌﻧا ﻞﺑﺎﻗ ﺮﻴﻏ ﻲﺘﻴﻣرﻮﻓد
ﻤﻴﻗﺎﺑ ـ هﺪﻧﺎ ) 25
% ( ﻓد ـ دﻮﺑ ﻒﻄﻌﻨﻣ ﻲﺒﺴﻧ رﻮﻃ ﻪﺑ ﻲﺘﻴﻣرﻮ .
رد 34
رﺎﻤﻴﺑ ) 5 / 73
% ( ﻤﻫ ﺢﻴﺤﺼﺗ ﺎﺑ هاﺮ نﺪـﺷ ﻲـﻟﺎﮕـﻨﭼ
ندﺮﻛ ﻞﻳﻮﻃ
ﺠﻧا ﺰﻴﻧ ﻞﻴﺷآ نوﺪﻧﺎﺗ ـ
ﺪﺷ مﺎ . نوﺪـﻧﺎﺗ ﻲﻣﻮﺗﻮﻨﺗ نارﺎﻤﻴﺑ مﺎﻤﺗ رد
ﺪﺷ مﺎﺠﻧا ﺖﺸﮕﻧا ﺮﻳز ﻚﭼﻮﻛ شﺮﺑ ﻚﻳ ﺎﺑ نﺎﺘﺸﮕﻧا ﺪﻨﻠﺑ رﻮﺴﻜﻠﻓ رد ﻪﻛ 41 رﺎﻤﻴﺑ ) 87 (%
ـﻤﻫ ﻪﺑ ـ ﻳزﻮﻟﺎﻛ ﻦﺘـﺷادﺮﺑ نآ هاﺮ ـﺘ
يور ﻪ
ﺪﺷ مﺎﺠﻧا ﺰﻴﻧ ﻲﺘﺸﮕﻧا ﻦﻴﺑ ﻞﺻﺎﻔﻣ .
اﻮﺨﺘـﺳا يور ﻲﻣاﺪﻗا ﭻﻴﻫ ن
ﺠﻧا ـ ﺸﻧ مﺎ ـ ﻣ ﺪ ﻴﮕﻧﺎﻴ ـ ﻦ ﻣز ـ دوﺪﺣ ﻞﻤﻋ نﺎ 40
دﻮـﺑ ﻪﻘﻴﻗد )
ﻦﻴـﺑ
30 ﺎﺗ 55 ﻴﻗد ـ ﻪﻘ ( ﺜﻛا ﻪﻛ ـ ندﺮـﻛ ﺪـﻨﻠﺑ ﻪـﺑ طﻮﺑﺮﻣ ﻞﻤﻋ نﺎﻣز ﺮ
ﻟﻮﺴﭙﻛ و ﻞﻴﺷآ ـ
ﺢﻴﺤـﺼﺗ و دﻮﺑ ﺎﭘ ﭻﻣ ﻲﻔﻠﺧ ﻲﻣﻮﺗﻮ ﻲــﻟﺎﮕـﻨﭼ
نﺪـﺷ دﻮﺒﻧ ﺮﺑ نﺎﻣز .
ﺚﺤﺑ ﻪﺠﻴﺘﻧ و يﺮـﻴﮔ
ﻪـﻴﻟوا ﺐﻴﺳآ دﻮﺒﻬﺑ زا ﺪﻌﺑ )
و ﺐﻴـﺳآ ﺎـﻳ ﻲﮕﺘـﺴﻜﺷ ﻞـﺜﻣ
ﻲﮕﺘﻓﻮﻛ ( ﻲﻀﻌﺑ
ﻲـﻣ ﻪـﻛ ﺪـﺷ ﺪﻨﻫاﻮﺧ ﺮﻫﺎﻇ ضراﻮﻋ زا ﺪـﻨﻧاﻮﺗ
ﺪﻨﻨﻛ دﺎﺠﻳا ار ﻲﺗﻼﻜﺸﻣ )
ﺪﻨﻧﺎﻣ
نﺪــﺷ ﻲــﻟﺎﮕـﻨﭼ .(
ﺮـﻈﻧ ﻪـﺑ ﻲﻣ
ﻦﻳا ﻪﻛ ﺪﺳر نﺪـﺷ ﻲـﻟﺎﮕـﻨﭼ
ﺮﺛا ﺖﻠﻌﺑ Checkenin
سﻮﻟﺎﻛ
رد گرﺰـﺑ سﻮﻟﺎﻛ نارﺎﻤﻴﺑ ﻦﻳا زا ﻲﻓاﺮﮔ رد اﺮﻳز ﺪﺷﺎﺒﻧ ﻲﻧاﻮﺨﺘﺳا ﺪﺸﻧ هﺪﻫﺎﺸﻣ ﻲﮕﺘﺴﻜﺷ ﻞﺤﻣ و قﺎﺳ فاﺮﻃا
14. ﺎـﻬﻨﻳا ﻦﻴـﻨﭽﻤﻫ
ءﺰﺟ ﭼ نﺪـﺷ ﻲـﻟﺎﮕـﻨ ﺪﻨﺘﺴﻴﻧ ﺰﻴﻧ ﺮﻟﻮﻜﺳﺎﻣورﻮﻧ
، ﻚﻳ زا ﺪﻌﺑ اﺮﻳز
ﺿاو يﺎﻣوﺮﺗ ﺢ
ﺪﻧﺪﺷ دﺎﺠﻳا )
ﻲﮕﭽﺑ زا ﻪﻧ (
نارﺎـﻤﻴﺑ ﺮﺜﻛا ﻦﻴﻨﭽﻤﻫ
ﻚﻳ ﺪﻧدﻮﺑ ﺮﻴﮔرد ﻪﻓﺮﻃ )
ﻪـﻓﺮﻃ ود ﻪﻛ ﺮﻟﻮﻜﺳﺎﻣورﻮﻧ عﻮﻧ فﻼﺧ ﺮﺑ
ﺪﻨﺘﺴﻫ ( . عﻮﻧ ﻦﻳا نﺪــﺷ ﻲـﻟﺎﮕـﻨﭼ شﻮـﺟ ﺪـﺑ ﺎـﺑ ﻦﻴـﻨﭽﻤﻫ
ﺖـﺳا توﺎـﻔﺘﻣ ﺰﻴﻧ نﺎﺘﺸﮕﻧا ندرﻮﺧ .
ﻼﻋ ﻪـﻧﻮﮕﭽﻴﻫ اﺮـﻳز ﺖـﻣ
ﺖـﺷاﺪﻧ دﻮـﺟو ندرﻮـﺧ شﻮـﺟ ﺪﺑ ﺮﺑ لاد ﻲﻜﻳژﻮﻟﻮﻳدار .
ﭻﻴـﻫ
ﺖﺷاﺪﻧ دﻮﺟو ﻪﻠﻀﻋ و ﺐﺼﻋ راﻮﻧ رد ﻲﻟﻼﺘﺧا .
ﺮـﻜﻓ ﺎـﻣ ﻪﺠﻴﺘﻧ رد
ﻲﻣ ﻒـﻴﻔﺧ نﺎـﻤﺗرﺎﭙﻤﻛ مرﺪﻨـﺳ ﻚﻳ ﻪﺿرﺎﻋ ﺖﻟﺎﺣ ﻦﻳا ﻪﻛ ﻢﻴﻨﻛ
15ﺖﺳا ﻨﻴﻠﻛ بﺎﺳ ترﻮﺻ ﻪﺑ ﻪﻛ ﻴ
زوﺮـﺒﻴﻓ زا ﺪﻌﺑ و ﺖﺳا هدﻮﺑ لﺎﻜ
نﺎﺸﻧ ﻞﻜﺷ ﻦﻳا ﻪﺑ ار دﻮﺧ ﺎﻬﻧآ ﺮﭽﻛﺮﺘﻧﻮﻛ و تﻼﻀﻋ ﺖـﺳا هداد
.
ﺎﺑ ﺖﻟﺎﺣ ﻦﻳا نﺪـﺷ ﻲـﻟﺎﮕـﻨﭼ
يرﺎـﻤﻴﺑ زا ﻲـﺷﺎﻧ ﻲـﻘﻴﻘﺣ يﺎـﻫ
ﺖﺳا توﺎﻔﺘﻣ ﺰﻴﻧ ﺮﻟﻮﻜﺳﺎﻣورﻮﻧ .
ﺎﻬﻨﻳا رد ) ﺎﻫﺮﻟﻮﻜﺳﻮﻣورﻮﻧ (
مﺪـﻋ
ﺿاو لدﺎﻌﺗ ﺢ
دراد دﻮﺟو ﺎﭘ ﻲﻧورد تﻼﻀﻋ رد لﻼﺘﺧا و
16. رد ﻲﻟو
تﻼـﻀﻋ رد لﻼﺘـﺧا و هدﻮـﺑ لﺎﻣﺮﻧ ﺎﭘ ﻲﻧورد تﻼﻀﻋ ﺎﻣ نارﺎﻤﻴﺑ ﺖﺷاد دﻮﺟو قﺎﺳ .
رد ﺮﻈﻧ زا
،ﻲـﺣاﺮﺟ و نﺎﻣ ندﺮـﻛ دازآ نﺎـﻜﻣا
نوﺪﻧﺎﺗ ندﺮﻛ ﻞﻳﻮﻃ و تﻼﻀﻋ دﻮـﺟو قﺎﺳ ﻲﻳﺎﻬﺘﻧا ﺖﻤﺴﻗ رد ﺎﻫ
17دراد ) ﻲﻠﺧاد كزﻮﻗ ﺖﺸﭘ و يﻻﺎﺑ رد لﺎﺜﻣ رﻮﻃ ﻪﺑ .(
ﻦﻳا رد ﻲﻟو
ﻞـﺒﻗ و دراد دﻮﺟو ﺎﭘ ﻲﻠﺻا بﺎﺼﻋا و قوﺮﻋ ﺐﻴﺳآ لﺎﻤﺘﺣا ﻞﺤﻣ زا يزﺎﺳدازآ
دﺮـﻛ نﺎـﻳﺎﻤﻧ ﻞـﻣﺎﻛ رﻮﻃ ﻪﺑ ار ﺎﻬﻧآ ﺪﻳﺎﺑ .
ﻦﻴـﻨﭽﻤﻫ
ا ﻦﻜﻤﻣ ﺑ ﺰﻴﻧ ﻲﺘﺳﻮﭘ ﺶﺷﻮﭘ درﻮﻣ رد ﻲﺗﻼﻜﺸﻣ ﺖﺳ ﻪ
ﺪـﻳآ دﻮﺟو
) ﺖﺳﻮﭘ ﻦﺘﻓر ﺖﺳد زا (
،ﻚـﭼﻮﻛ شﺮـﺑ ﻚـﻳ ﺎـﺑ ﻂـﻘﻓ ﺎـﻣ ﻲﻟو
ار بﺎـﺼﻋا و قوﺮـﻋ ﺐﻴﺳآ لﺎﻤﺘﺣا و هدﺮﻛ حﻼﺻا ار ﻲﺘﻴﻣرﻮﻓد ﻢﻳراﺪﻧ . ﻞـﺤﻣ رد اﺪـﺟ شﺮـﺑ ﻚـﻳ ﻖـﻳﺮﻃ زا ﻞﻴﺷآ ندﺮﻛ ﺪﻨﻠﺑ
ﻲﻣ مﺎﺠﻧا نآ ﻚﻴﺳﻼﻛ
18دﻮﺷ ﻪﺘﻳزﻮﻟﺎﻛ و ﻦﻴـﺑ ﻞـﺻﺎﻔﻣ يور يﺎﻫ
ﺑ ﻲﺘﺸﮕﻧا ﺖـﺳﻮﭘ و هﺪـﺷ ﻪﺘﺷادﺮﺑ لﺎﻜﻴﺘﭙﻴﻟا شﺮﺑ ﻚﻳ ﻪﻠﻴﺳو ﻪ
ﻲﻣ ﻢﻴﻣﺮﺗ نآ يور ددﺮـﮔ
. ﺖـﻳﺰﻳو رد ﻪـﻧﻮﮕﭽﻴﻫ يﺮـﻴﮕﻴﭘ يﺎـﻫ
دﻮـﺟو ﻲﺘﻴﻣرﻮـﻓد ﺖـﺸﮔزﺎﺑ ﻦﻴﻨﭽﻤﻫ و ﺎﭘ ﺖﺳﻮﭘ ياﺮﺑ ﻲﻠﻜﺸﻣ ﻢﻴﺘـﺷاد ﻲﺘﻴﻣرﻮـﻓد ﺪﺣ زا ﺶﻴﺑ ﺢﻴﺤﺼﺗ درﻮﻣ ﻚﻳ ﻂﻘﻓ ﺖﺷاﺪﻧ ) ﻲﺘﺸﮕﻧا ﻦﻴﺑ ﻞﺼﻔﻣ ﻦﺸﻨﺘﺴﻛا ﺮﭙﻳﺎﻫ (
دﺪـﺠﻣ ﻲﺣاﺮﺟ ﻪﺑ زﺎﻴﻧ ﻪﻛ
ﺢﻴﺤﺼﺗ ﺖﻬﺟ ﺖـﺷاﺪﻧ نآ
. ﺪـﻳرو و نﺎﻳﺮـﺷ ﺐﻴـﺳآ ﻪـﻧﻮﮕﭽﻴﻫ
ﻢﻴﺘﺷاﺪﻧ . ﻪـﺑ و ﺪﻨﺘـﺷاد ﺖﻳﺎـﺿر ﺮﻫﺎﻇ و ﻞﻤﻋ ﻪﺠﻴﺘﻧ زا نارﺎﻤﻴﺑ
ﻲﻣ ﺶﻔﻛ ﻲﺘﺣار ﺪﻧﺪﻴﺷﻮﭘ
. ﺑ ار شور ﻦﻳا ﺎﻣ ﻪ
ﻣ هار ﻚﻳ ناﻮﻨﻋ ﺆ
ﺮﺛ
ﺢﻴﺤﺼﺗ ﺖﻬﺟ ﻦﻤﻳا و نﺪـﺷ ﻲـﻟﺎﮕـﻨﭼ
ﻪﺑﺮﺿ ﺐﻗﺎﻌﺘﻣ نﺎﺘﺸﮕﻧا
ﻲﻣ دﺎﻬﻨﺸﻴﭘ ﻢﻴﻨﻛ
. شور ﺮﻳﺎﺳ حﻼـﺻا يﺎﻫ
ﻨﭼ ـ ـﻟﺎﮕ ـ ـﺷ ﻲ ـ نﺪ
يور ﺮﺘـﺸﻴﺑ ﺖـﺳا هﺪـﻣآ تﻻﺎـﻘﻣ و نﻮـﺘﻣ رد ﻪـﻛ ﻲﺘﻴﻣرﻮﻓد ﻲﻣ مﺎﺠﻧا نﺎﺘﺸﮕﻧا يﺎﻫرﻮﺴﻨﺘﺴﻛا حﻼﺻا ﻪﺑ ﻪﺘﺴﺑ و ﺪﻧﻮﺷ
يﺮﻳﺬﭘ
ﻲﻣ ﻲﺘﻴﻣرﻮﻓد زا ﺪﻧاﻮﺗ
Dermodesis Capsulodesis ﺎﺗ
و هﺎـﺗﻮﻛ
ندﺮـﮔ وﺮـﺳ ﻦﺘـﺷادﺮﺑ ﺖـﻳﺎﻬﻧ رد و رﻮـﺴﻨﺘﺴﻛا نوﺪﻧﺎﺗ ندﺮﻛ لﺎﻤﻳﺰﮔوﺮﭘ ﺲﻜﻧﻻﺎﻓ ﺪﺷﺎﺑ ﺮﻴﻐﺘﻣ19
. شور ﻦﻳا ﻪﺘﺒﻟا بﻮﺧ ﺞﻳﺎﺘﻧ ﺎﻫ
ﺖﻳﺎﺿر و ﻪﺘﺷاد ﻲﺸﺨﺑ ﻲﻣ ﻲﻟو ﺪﻧا
تﻼـﻀﻋ ﺶـﺸﻛ ﻪـﻛ ﻢﻴـﻧاد
نوﺪﻧﺎﺗ هار زا ﻚﻴﺴﻨﻳﺮﺘﻨﻳا
ﻲـﻣ لﺎـﻤﻋا رﻮﺴﻜﻠﻓ يﺎﻫ دﻮـﺷ
. اﺬـﻟ
نوﺪﻧﺎﺗ يور ﻲﺣاﺮﺟ ﺪﻳﺎﺷ
ًﺎﻤﻴﻘﺘـﺴﻣ رﻮﺴﻜﻠﻓ يﺎﻫ دﺎـﺠﻳا ﻞـﻣﺎﻋ
ــﻓد ـ ــﻓر ار ﻲﺘﻴﻣرﻮ ـ
لﺎــﻣﺮﻧ ﺲﻧﻻﺎــﺑ هدﺎــﻋا ﺐﺒــﺳ و ﺪــﻨﻛ ﻊ
دﻮﺷ ﺎﻫرﻮﺴﻜﻠﻓ و ﺎﻫرﻮﺴﻨﺘﺴﻛا .
ﻲﻣ ﻪﺘﺒﻟا ﻧاد ﻦـﻳا ﺞﻳﺎـﺘﻧ ﻪـﻛ ﻢﻴ
ﻲﻣ ﻲﻟو ﺖﺴﻴﻧ ﻞﻛ ﻪﺑ ﻢﻴﻤﻌﺗ ﻞﺑﺎﻗ ﻪﺟو ﭻﻴﻫ ﻪﺑ ﻪﻌﻟﺎﻄﻣ ار نآ ناﻮﺗ
ﻪﻴﻟوا ﻪﻌﻟﺎﻄﻣ ﻚﻳ ﻲﻋﻮﻧ ﻪﺑ )
تﻮﻠﻳﺎﭘ ( ﻞﻣﺎﻛ ﻪﻌﻟﺎﻄﻣ ياﺮﺑ ﺑ ﻪﻛ يﺮﺗ
ﻪ
ﻪﺴﻳﺎﻘﻣ ترﻮﺻ شور ﻦﻴﺑ يا
حﻼﺻا يﺎﻫ نﺪـﺷ ﻲـﻟﺎﮕـﻨﭼ
ﺪـﺷﺎﺑ
دروآ بﺎﺴﺣ ﻪﺑ .
Abstract:
Causes and Outcomes of Treatment of 47 Cases of Post Traumatic Clawing of Foot in Sina Hospital Tehran
Siavashi B. MD*, Sadat M.M. MD**, Golbakhsh M.R. MD*, Koshan A. MD***, Pendar E. MD***
(Received: 11 Dec 2008 Accepted: 12 April 2009)
Introduction & Objective:Clawing of toes of foot are usually seen in neuromuscular disorders, but in some instances, after trauma to leg ,which may be accompanied with fracture or not, after healing of fracture or soft tissue injuries, clawing deformity of foot may be appeared. We try to determine the cause of it and the most appropriate treatment for it.
Materials & Methods: We studied 47 patients from1382 to1386. After getting patients approval, they enter our study. All of them were our original patients who were referred to emergency room of our hospital for their first trauma. 42 of them had fracture of leg but in 5 cases there were no fracture of leg. In the follow up visits of them, we clawing of their foot so we examine them for sensory and motor function and took radiography and electromyography (EMG) of their lower extremity. We did tenotomy of the flexors of their toes and removed callosities when it was necessary.
Results: There were no sensory or motor deficit in their traumatized lower extremities and also there were no abnormality in their EMG. In their X rays, there were no obvious or huge callus mass. In the radiography of their foot, there were no fracture of foot bones and also no abnormality of their toes like malunion or destruction of small joints of their feet.
Conclusions: We tried to rule out some causes of the clawing of foot .There were no checkrein effect of the fracture callus, and in EMG, there were no nerve injury nor any bony abnormality in X rays. They had only unilateral problem and their clawing began after trauma. So neuromuscular diseases could be ruled out.
We think a fibrotic event after crush injury to calf muscles can produce this deformity.
Key Words: Clawing, Foot, Trauma
*Assistant Professor of Orthopedic Surgery, Tehran University of Medical Sciences and Health Services, Sina Hospital, Tehran, Iran
**Associate Professor of Orthopedic Surgery, Tehran University of Medical Sciences and Health Services, Sina Hospital, Tehran, Iran
***Resident of Orthopedic Surgery, Tehran University of Medical Sciences and Health Services, Sina Hospital, Tehran, Iran
References:
1. Myerson M: Claw toes, crossover deformity, and instability of the second metatarsophalangeal joint. In Myerson M, ed: Current therapy in fool and ankle surgery. St Louis, 1993, Mosby.
2. Sahir M, Lyttle D: Pathogenesis of Charcot-Marie- Tooth disease: gait analysis and electrophysiologic, genetic, histopathologic, and enzyme studies in a kinship, Clin Orthop 184: 223, 1984.
3. S.Terry Canale. Campbell’s operative orthopedics.
Mosby, 10th ed. 2003 Vol 2 p 1288.
4. Eilert RE: Cavus foot in cerehra] palsy, Foot Ankle 4:
185, 1984.
5. Goldner JL, Ward WG: Traumatic horizontal deviation of the second toe: mechanism of deformity, diagnosis, and treatment, Bull Hasp it Dis 47: 123, 1987.
6. Sabir M, Lyttle D: Pathogenesis of Charcot-Marie- Tooth disease: gait analysis and electrophysiologic.
Genetic. histopathologic, and enzyme studies in a kinship, Clin Orthop 184: 223. 1984.
7. Mubarak 5J, Chambers HG, Wenger DR:
Percutaneous muscle biopsy in the diagnosis of neuromuscular disease. J Pediatr Orthop 12: 191.
1992.
8. Firth M, Gardner-Medwin D, Hoskin G, et al:
Interviews with parents of boys suffering from Duchenne muscular dystrophy, Dev Med Child NellraI25: 466, 1983.
9. Gcorgicff M. Hoffman-Williamson M. Spungcn L. ct al: Abnormal muscle tone as an indicator of later
development in preterm infants. Orthop Tram 8: 108.
1984.
10. Johnson J, Ltbib S, Fowler R. Intramedullary screw fixation of the fifth metatarsal: an anatomic study and improved technique. Foot Ankle /nl 2004: 25: 274- 277.
11. Bhandari M, Adii A, Leone J, et al: Early versus delayed operative management of closed tibial fractures, Clin Orthop 368: 230, 1999.
12. Clawson DK: Claw toes following tibial fracture, Clin Orthop 103: 47, 2001.
13. Puno RM, Teynor JT, Nagano J, Gustilo RB:
Critical analysis of results of treatment of 201 tibial shaft fractures, Clin Orthop 212: 113, 1986.
14. Waddell JP, Reardon GP: Complications of tibial shaft fractures. Clin Orthop 178: 173, 1983.
15. Hope (M, McQueen MM. Acute compartment syndrome in the absence of fracture) Orthop Trauma 2004; 18(4): 220-224.
16. Nerlich M, Dziadzka 5, Schmidl U. Compartment syndrome of the lower leg. Longterm results.
UnJallchirurg 1991; 94(5): 257-261.
17. Finkelstem JA, Hunter GA, Hu RW. Lower limb compartment syndrome: course after delayed fasciotomy. j Trauma 1996; 40(J): 342-344.
18. Cooper DM, Deitz FR: Treatment of idiopathic clubfoot: a thirty-year follow-up note, J Bone Joint Surg 77A: 1477. 1995.
19. S. Terry Canale. Campbell’s operative orthopedics.
Mosby, 10th ed. 2003, Vol 4, p4149.
