* ﺝ
ﻪﻤﻃﺎﻓ تﺮﻀﺣ نﺎﺘﺳرﺎﻤﻴﺑ ،ناﺮﻳا ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻚﻴﺘﺳﻼﭘ و ﻲﻤﻴﻣﺮﺗ ﻲﺣاﺮﺟ هوﺮﮔ رﺎـﻴﺸﻧاد )
س ( ﻮـﮕﺨﺳﺎﭘ ةﺪﻨﺴﻳﻮﻧ
: ﺮﺘﻛد ﻲﻧادﺰﻳ ﺪﺒﻋ ﻞﻀﻔﻟاﻮﺑا
ﻪﻤﻃﺎﻓ تﺮﻀﺣ نﺎﺘﺳرﺎﻤﻴﺑ ،ناﺮﻳا ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻚﻴﺘﺳﻼﭘ و ﻲﻤـﻴﻣﺮﺗ ﻲﺣاﺮﺟ هوﺮﮔ رﺎﻴﺘﺳد**
) س ﺗ (
ﻦﻔﻠ : 88717272
ﻪﻤﻃﺎﻓ تﺮﻀﺣ نﺎﺘﺳرﺎﻤﻴﺑ ،ناﺮﻳا ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻚﻴﺘﺳﻼﭘ و ﻲﻤـﻴﻣﺮﺗ ﻲﺣاﺮﺟ هوﺮﮔ رﺎﻳدﺎﺘﺳا***
) س ( E-mail: [email protected]
ﻪﻤﻃﺎﻓ تﺮﻀﺣ نﺎﺘﺳرﺎﻤﻴﺑ ،ناﺮﻳا ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻜﺷﺰﭙﻣاد هوﺮﮔ رﺎﻳدﺎﺘﺳا****
) س (
*****
هﺎﮕﺸﻧاد ،ﻲﻋﺎﻤﺘﺟا ﻲﻜﺷﺰﭘ ﺺﺼﺨﺘﻣ ﻪﻤﻃﺎﻓ تﺮﻀﺣ نﺎﺘﺳرﺎﻤﻴﺑ ،ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ
) س (
لﻮﺻو ﺦﻳرﺎﺗ : 29 / 03 / 1389
شﺮﻳﺬﭘ ﺦﻳرﺎﺗ :
10 / 12 / 1389
ﺳرﺮﺑ ﻲ ﺎﻘﻣ ﻳ ﻪﺴ ا ي ﻨﻣآ ﺶﺷﻮﭘ ﺮﺛا ﻴ
ﻧﻮ ﻲ رو فﻼﻏ ﺎﺑ ﻳ
ﺪ ي رد
ﻢﻴﻣﺮﺗ ﺐﺼﻋ ـ ﺣ ﻪﻌﻟﺎﻄﻣ ﻴ
ﻧاﻮ ﻲ
ﺮﺘﻛد ﺳ ﻴ ﻦﺗوﺮﻓ لﺎﻤﻛ ﺪ
ﺪﺒﻋ ﻞﻀﻔﻟاﻮﺑا ﺮﺘﻛد ،
*ﻳ ﻧادﺰ
**
ﻲ ﺴﺣ ﺮﺘﻛد ، ﻴ
ﺮﺒﻛا ﻦ
***
ي
ﻤﻃﺎﻓ داﻮﺟ ﺪﻤﺤﻣ ﺮﺘﻛد ـ
*
ﻲ ﺘﻛد ، ـ ﺮ ﻣ ﻴ ﺮ ﭘ ﺮﻬﭙﺳ ـ
****
مارﺪ ﺘﻛد ، ـ ﺳ ﺮ ﻴ ﻣ ﺮﺑﺎﺟ ﺪ ـ
ﻮﺳﻮ
*****
ي
ﻭ ﻩﮊﺍ ﻱﺪﻴﻠﻛ ﻱﺎﻫ :
ﮔ ﺒﺼﻋ ﺖﻓﺍﺮ ﻲ
ﻨﻣﺁ ﺶﺷﻮﭘ ، ﻴ
ﻧﻮ ﻲ ﻣﻭﺮﺘﮑﻟﺍ ، ﻴ ﻓﺍﺮﮔﻮ ﻲ
ﻩﺪﻴﻜﭼ :
ﺯ ﻣ ﻨﻴ ﻪ ﻑﺪﻫ ﻭ : ﺪﻨﺘﺴﻫ ﻭﺮﺑﻭﺭ ﻲﺒﺼﻋ ﻪﻌﻳﺎﺿ ﺯﺍ ﻲﺷﺎﻧ ﻲﺘﮐﺮﺣ ﺕﻼﮑﺸﻣ ﺎﺑ ﻥﺍﺭﺎﻤﻴﺑ ﺯﺍ ﻱﺩﺎﻳﺯ ﺩﺍﺪﻌﺗ ﻪﻧﺎﻴﻟﺎﺳ .
ﺕﺎﻌﻳﺎﺿ ﻦﻳﺍ ﺢﻴﺤﺻ ﻢﻴﻣﺮﺗ ﺐﺳﺎﻨﻣ ﺵﻭﺭ ﺎﺑ
ﺖﻬﺟ
ﺖﻴﻟﺎﻌﻓ ﺖﺸﮔﺮﺑ ﻋ ﻱﺎﻫ
ﺖﺳﺍ ﻢﻬﻣ ﺭﺎﻴﺴﺑ ﻲﻧﻼﻀ .
ﺶﺷﻮﭘ ﻩﺍﺮﻤﻫ ﻪﺑ ﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺪﻧﻮﻴﭘ ،ﻲﻳﺎﻬﻨﺗ ﻪﺑ ﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺪﻧﻮﻴﭘ ﻲﺣﺍﺮﺟ ﺵﻭﺭ ﻪﺳ ﻪﺴﻳﺎﻘﻣ ﺶﻫﻭﮋﭘ ﻦﻳﺍ ﺯﺍ ﻑﺪﻫ
ﻲﻣ ﻩﺪﺷ ﻊﻄﻗ ﻚﻴﺗﺎﻴﺳ ﺐﺼﻋ ﻢﻴﻣﺮﺗ ﻱﺍﺮﺑ ﻥﻮﻴﻨﻣﺁ ﺶﺷﻮﭘ ﻭ ﻱﺪﻳﺭﻭ ﺪﺷﺎﺑ
.
ﺵﻭﺭ ﻭ ﺩﺍﻮﻣ ﺎﻫ
: ۳۶ ﻥﺯﻭ ﺎﺑ ﺩﺍﮋﻧ ﮏﻳ ﺯﺍ ﺮﮐﺬﻣ ﺕﺭ ۳۵۰
- ۲۵۰ ﺑ ﻲﻓﺩﺎﺼﺗ ﺕﺭﻮﺻ ﻪﺑ ﻡﺮﮔ ﮔ ﻪﺳ ﻪ
ـ ﺪﻧﺪﺷ ﻢﻴﺴﻘﺗ ﻱﻭﺎﺴﻣ ﻩﻭﺮ .
ﻲﺑ ﺯﺍ ﺲﭘ ﮏﻴﺗﺎﻴﺳ ﺐﺼﻋ ،ﻲﺴﺣ
ﻤﺗ ﺭﺩ ﻥﺎﺴﮑﻳ ﺕﺭﻮﺻ ﻪﺑ ـ
ﺕﺭ ﻲﻣﺎ ﺪﺷ ﻊﻄﻗ ﺎﻫ . ﻔﺘﺳﺍ ﺎﺑ ﻩﺩﺎﺳ ﻢﻴﻣﺮﺗ ﻝﻭﺍ ﻩﻭﺮﮔ ﺭﺩ ـ
ﻴﻣﺮﺗ ﻡﻭﺩ ﻩﻭﺮﮔ ﺭﺩ ،ﺎﻬﺘﻧﺍ ﻭﺩ ﺭﻮﭼﻮﺳ ﺯﺍ ﻩﺩﺎ ـ
ﻔﺘﺳﺍ ﺎﺑ ﻢ ـ ﻩﺩﺎ ﻴﻨﻣﺁ ﺀﺎﺸﻏ ﺶﺷﻮﭘ ﺯﺍ ـ
ﻭ ﻲﻧﻮ
ﻏ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ﺎﺑ ﻢﻴﻣﺮﺗ ﻡﻮﺳ ﻩﻭﺮﮔ ﺭﺩ ـ
ﺠﻧﺍ ﻱﺪﻳﺭﻭ ﻑﻼ ـ
ﺪﺷ ﻡﺎ . ﺖﺷﺬﮔ ﺯﺍ ﺲﭘ ۱۲
ﺟ ﺯﺍ ﻪﺘﻔﻫ ـ ﺘﮑﻟﺍ ﺯﺍ ،ﻲﺣﺍﺮ ـ
ﮔﻮﻴﻣﻭﺮ ـ ﮑﻠﻤﻋ ﻥﺍﺰﻴﻣ ﻦﻴﻴﻌﺗ ﻱﺍﺮﺑ ﻲﻓﺍﺮ ـ
ﻢﻴﻣﺮﺗ ﺐﺼﻋ ﺩﺮ
ﺪﺷ ﻩﺩﺎﻔﺘﺳﺍ ﻩﺪﺷ .
ﻫ ﻱﺍﺮﺑ ـ ﺕﺭ ﺯﺍ ﮏﻳ ﺮ ﺠﻧﺍ ﻲﻧﻮﺴﮐﺁ ﺵﺭﺎﻤﺷ ﺎﻫ
ـ ﺪﺷ ﻡﺎ . ﻴﻨﭽﻤﻫ ـ ﻥﻮﻣﺯﺁ ﺯﺍ ﻦ Foot Print
ﻴﻣ ﻦﻴﻴﻌﺗ ﺖﻬﺟ ﺰﻴﻧ ـ
ﺒﻬﺑ ﻥﺍﺰ ـ ﻪﺘﻔﻫ ﺭﺩ ﺐﺼﻋ ﻱﺩﻮ ﻝﻭﺍ ﻱﺎﻫ
ﺪﺷ ﻩﺩﺎﻔﺘﺳﺍ ﻢﻫﺩﺯﺍﻭﺩ ﻭ .
ﻥﻮﻣﺯﺁ Paired Sample T-Test ﻥﻮﻣﺯﺁ ﻭ ﻝﻭﺍ ﻪﺘﻔﻫ ﺎﺑ ﻢﻫﺩﺯﺍﻭﺩ ﻪﺘﻔﻫ ﺞﻳﺎﺘﻧ ﻪﺴﻳﺎﻘﻣ ﺖﻬﺟ
One Way ANOVA ﻪﺴﻳﺎﻘﻣ ﺖﻬﺟ
ﻩﻭﺮﮔ ﺭﺩ ﺞﻳﺎﺘﻧ ﺪﺷ ﻪﺘﻓﺮﮔ ﺭﺎﮐ ﻪﺑ ﻪﻧﺎﮔ ﻪﺳ ﻱﺎﻫ
.
ﻪﺘﻓﺎﻳ ﺎﻫ : ﻥﺁ ﺮﮕﻧﺎﻴﺑ ﺞﻳﺎﺘﻧ ﺍ
ﺖﻴﻌﺿﻭ ﻪﮐ ﺖﺳ Foot Print
ﻲﺳﺭﺮﺑ ﺩﺭﻮﻣ ﻩﻭﺮﮔ ﻪﺳ ﺮﻫ ﺭﺩ ﻥﺎﻣﺯ ﺖﺷﺬﮔ ﺎﺑ ﺖﺳﺍ ﻪﺘﻓﺎﻳ ﺩﻮﺒﻬﺑ
. ﻢﻫﺩﺯﺍﻭﺩ ﻪﺘﻔﻫ ﺭﺩ ﺭﺍﺩﺎﻨﻌﻣ ﺕﻭﺎﻔﺗ
ﻩﻭﺮﮔ ﻦﻴﺑ ﻱﺭﺎﻣﺁ ﻲﻧﻮﻴﻨﻣﺁ ﺶﺷﻮﭘ ﺎﺑ ﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺯﻮﻣﻮﺘﺳﺎﻧﺁ ﻱﺎﻫ
) ۷۵ /
±۱۹ ۷۵ / ۵۳ - ( ﻩﺩﺎﺳ ﻱﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺯﻮﻣﻮﺘﺳﺎﻧﺁ ﻩﻭﺮﮔ ﺎﺑ )
۷۹ /
±۱۱ ۶۸ / ۷۹ - ( ﺖﺳﺍ ﻪﺘﺷﺍﺩ ﺩﻮﺟﻭ
)
P=0.017 ﻳﮊﻮﻟﻮﻳﺰﻴﻓﻭﺮﺘﻜﻟﺍ ﻲﺳﺭﺮﺑ ﺯﺍ ﻞﺻﺎﺣ ﺞﻳﺎﺘﻧ (.
ﺷﻮﭘ ﻩﺍﺮﻤﻫ ﻪﺑ ﻲﺒﺼﻋ ﺖﻓﺍﺮﮔ ﻩﻭﺮﮔ ﺭﺩ ﺮﺘﻬﺑ ﺞﻳﺎﺘﻧ ﺮﮕﻧﺎﻴﺑ ﮏ
ﺞﻳﺎﺘﻧ ﻪﮑﻧﺁ ﻦﻤﺿ ،ﺖﺳﺍ ﻩﺩﻮﺑ ﻲﻧﻮﻴﻨﻣﺁ ﺶ
ﺖﺳﺍ ﻪﺘﺷﺍﺩ ﻱﺭﺍﺩﺎﻨﻌﻣ ﺕﻭﺎﻔﺗ ﻱﺭﺎﻣﺁ ﻅﺎﺤﻟ ﺯﺍ ﻱﺪﻳﺭﻭ ﺶﺷﻮﭘ ﺎﺑ ﻲﺒﺼﻋ ﺖﻓﺍﺮﮔ ﻩﻭﺮﮔ ﻭ ﻩﻭﺮﮔ ﻦﻳﺍ ﻦﻴﺑ ﮏﻳﮊﻮﻟﻮﻳﺰﻴﻓﻭﺮﺘﮑﻟﺍ
)
P=0.044 ﻧ.(
ﺖﻓﺎﺑ ﻲﺳﺭﺮﺑ ﺞﻳﺎﺘ ﻲﺳﺎﻨﺷ
ﻥﺁ ﺯﺍ ﻲﮐﺎﺣ ﺍ
ﻲﻧﻮﺴﮐﺍ ﺵﺭﺎﻤﺷ ﻪﮐ ﺖﺳ ﻳﺎﻘﻣ ﺭﺩ ﻭ ﻩﺩﻮﺑ ﺮﺘﺸﻴﺑ ﻲﻧﻮﻴﻨﻣﺁ ﺶﺷﻮﭘ ﺎﺑ ﻲﺒﺼﻋ ﺖﻓﺍﺮﮔ ﻩﻭﺮﮔ ﺭﺩ
ﺕﻭﺎﻔﺗ ﻱﺪﻳﺭﻭ ﺶﺷﻮﭘ ﺎﺑ ﻲﺒﺼﻋ ﺖﻓﺍﺮﮔ ﻩﻭﺮﮔ ﺎﺑ ﻪﺴ
ﺖﺳﺍ ﻩﺪﺷ ﻩﺪﻫﺎﺸﻣ ﻱﺭﺎﻣﺁ ﺭﺍﺩﺎﻨﻌﻣ
)
P=0.041
.(
ﻪﺠﻴﺘﻧ ﻴﮔ ـ ﻱﺮ : ﺞﻳﺎﺘﻧ ﺞﻳﺎﺘﻧ ﻱﺎﺘﺳﺍﺭ ﺭﺩ ﻖﻴﻘﺤﺗ ﻦﻳﺍ ﺗ ﻪﺑﺎﺸﻣ ﺕﺎﻘﻴﻘﺤﺗ
ﺄ ﻲﻨﻌﻣ ﻭ ﺪﻴﻔﻣ ﺕﺍﺮﺛﺍ ﻩﺪﻨﻨﮐ ﺪﻴﻳ ﺭﺍﺩ
ﺎﺑ ﻪﺴﻳﺎﻘﻣ ﺭﺩ ﻥﻮﻴﻨﻣﺁ ﺮﻳﺎﺳ
ﺖﻓﺍﺮﮔ ﺖﺳﺍ ﻲﺒﺼﻋ ﻱﺎﻫ .
ﻨﻴﻣز ﻪ فﺪﻫ و
ﻟﺎﺳ ﻴ ز داﺪﻌﺗ ﻪﻧﺎ ﻳ
دﺎ ي ﺑ زا ﻴ ﺘﻛﺮﺣ تﻼﻜﺸﻣ ﺎﺑ نارﺎﻤ ﻲ
ﺷﺎﻧ ﻲ زا
ﺎﺿ ﻳ ﺒﺼﻋ ﻪﻌ ﻲ ﺪﻨﺘﺴﻫ وﺮﺑور .
ﺪﺑ ﻳ ﻬ ﻲ ا ﺳآ ﻪﻛ ﺖﺳ ﻴ
ﺐ ﺎﻫ ي بﺎﺼﻋا
ﺤﻣ ﻴ ﻄ ﻲ ﺛﺄﺗ ﻴ ﺪﺟ ﺮ ي ور ي ﺪﻧراد نﺎﺴﻧا ﺖﺷﻮﻧﺮﺳ .
ﺘﻗو ﻲ دﺮـﻜﻠﻤﻋ
ﺴﺣ ﻲ ﻳ ﺘﻛﺮﺣ ﺎ ﻲ ماﺪﻧا رد
ًﺎﺻﻮﺼﺧ ﺎﻫ ﻧﺎﻗﻮﻓ ماﺪﻧا
ﻲ ﻐﺗ ﻴﻴ ﻣ ﺮ ﻲ
،ﺪﻨﻛ
ﮔﺪﻧز ﻲ ﻟﺎﻌﻓ و ﻴ ﻠﻐﺷ ﺖ ﻲ ﻣ لﻼﺘﺧا رﺎﭼد دﺮﻓ ﻲ
دﻮﺷ . ﻣﺮﺗ ﻴ ﺤﺻ ﻢ ﻴ ﺢ
اﻳ ﺎﺿ ﻦ ﻳ ﻟﺎﻌﻓ ﺖﺸﮔﺮﺑ ﺖﻬﺟ تﺎﻌ ﻴ
ﺖ ﺎـﻫ ي ﻧﻼـﻀﻋ ﻲ ـﺴﺑ ﻴ ﻢـﻬﻣ رﺎ
ﺖﺳا
1.
و
32
% ﺑ ﻴ دﺪﻌﺘﻣ تﺎﻣﺪﺻ ﺎﺑ نارﺎﻤ (Multiple Injury)
ﻼﺘﺒﻣ
ﺳآ ﻪﺑ ﻴ و ﺪﻨﺘﺴﻫ ﺐﺼﻋ ﺐ 5
% ﻢﺧز زا ﺎﻫ ي ماﺪﻧا زﺎﺑ ﺎـﻫ ﻊـﻄﻗ ﺎـﺑ ،
ﺪﻨﺘﺴﻫ هاﺮﻤﻫ ﺐﺼﻋ
1.
و
رد2
ﺑ ﻴ ﺷﺎﻧ نارﺎﻤ ﻲ
ﮓﻨﺟ ﺔﻣﺪﺻ زا 10
% ﺎـﺑ
ﻫوﺮﮔ زا و ﺐﺼﻋ ﺔﻣﺪﺻ ﻲ
ﺪـﻧراد ماﺪـﻧا ﺔﻣﺪـﺻ ﻪﻛ
، 20
% ﺎـﺗ 30 %
اراد ي اﻳ ﺪﻨﺘﺴﻫ ﻪﻣﺪﺻ ﻦ
3. ﭘ زا ﺲﭘ ﻴ ﻪﻧاﻮﺟ ﺐﺼﻋ ﺪﻧﻮ ﺎﻫ
ي ﺒﺼﻋ ﻲ
ﺰﮔوﺮﭘ ﺖﻤﺴﻗ زا ﻳ
ﻪﻟﻮﻟ ﻞﺧاد ﻪﺑ لﺎﻤ ﺎﻫ
ي د ﺖﻤﺴﻗ رد ناﻮﺷ ﻳ
لﺎﺘﺴ
ﺎﻬﻧ رد و هدﺮﻛ ﺪﺷر ﻳ
ﻪﺤﻔﺻ ﻪﺑ ﺖ ﺎﻫ
ي ﺎﻬﺘﻧا ﻲﻳ ﻣ ﻲ ﺪﻨـﺳر
4. ﺖـﻬﺟ
ﻘﻓﻮﻣ ﻴ رد ﺖ ر ﻳ روﺎﻜ ي ﺳآ رد ﻴ ﺤﻣ بﺎﺼﻋا ﺐ ﻴ
ـﻄ ﻲ ﺎـﺗ ﺖـﺳا مزﻻ
ﻌﺿو زا ﺐﺼﻋ ﻴ
ﺳ لﺎﻘﺘﻧا ﺖ ﻴ
ﻌـﺿو ﻪـﺑ لﺎﻨﮕ ﻴ
ﻣﺮﺗ ﺖ ﻴ ـﻤ ﻲ ﻐﺗ ـﻴﻴ ﺮ
ﻫﺎﻣ ﻴ ا ﻪﻛ ﺪﻫﺪﺑ ﺖ ـﻳ
ﻦ ـﻳ ﻐﺗ ﻚ ـﻴﻴ
ﻟﻮﻠـﺳ ﻞـﺧاد ﺮ ﻲ
ـﻣ ﻲ ﺪـﺷﺎﺑ
4.
يﺎﻫرﻮﺘﻛﺎﻓ ﻓوﺮﺗ
ﻴ ﻚ لﻮﻠـﺳ و ﺎﻫژﺎﻓوﺮﻛﺎﻣ ﻂﺳﻮﺗ ﺎـﻫ
ي ﻠﮔ ـﻴ رد لﺎ
فﺪﻫ ﺖﻓﺎﺑ )
ﺎﻬﺘﻧا رد ي د ﻳ
ـﺳآ ﺐـﺼﻋ لﺎﺘـﺴ ﻴ
د ﺐ ـﻳ هﺪ ( ﻟﻮﺗ ـﻴ ﺪ
ﻣ ﻲ ﺘﻧا ﻂﺳﻮﺗ و ﺪﻧﻮﺷ ﺎﻬ
ي ﺰﮔوﺮﭘ ﻳ رد ﺐﺼﻋ لﺎﻤ ﻳ
ـﻣ ﺖﻓﺎ ﻲ و ﺪﻧﻮـﺷ
ﺮﮔوﺮﺗر ترﻮﺼﺑ ﻳ
ـﻣ ﻞـﻘﺘﻨﻣ لﻮﻠﺳ ﻢﺴﺟ ﻪﺑ ﺪ ﻲ
ﻮـﻠﺟ و ﺪﻧﻮـﺷ ي
ﻣ ار زﻮﺘﭘﻮﭘآ ﻲ
ﮔ ﻴ ﺪﻧﺮ . ﺎﻣزآ رد ﻳ دﺪـﻌﺘﻣ تﺎﺸ ي
ﺎـﻬﺘﻧا نآ رد ﻪـﻛ ي
ﺰﮔوﺮﭘ ﻳ ﺎﻬﺘﻧا زا ﺐﺼﻋ لﺎﻤ ي
د ﻳ ﺑ لﺎﺘﺴ ﻪ ﻓ ترﻮﺻ ﻴ ﺰ ﻳ ژﻮﻟﻮ ﻳ اﺪﺟ ﻚ
هﺪﺷ و ﺪﻧا ﻳ ﺑ رد ﻊﻧﺎﻣ ﻚ ﻴ
،ﺖﺳا هﺪﺷ ﻪﺘﺷاﺬﮔ ﺎﻬﻧآ ﻦ ﻟﻮﻠﺳ گﺮﻣ
ﻲ
اﺰﻓا ﻳ ﺶ د فﺮﻃ زا و ﺖﺳا ﻪﺘﺷاد ﻳ
ﺘﻗو ﺮﮕ ﻲ ﺎﻬﺘﻧا ي ﺰﮔوﺮﭘ ﻳ و لﺎـﻤ
د ﻳ ﻂﺳﻮﺗ ﺐﺼﻋ لﺎﺘﺴ ﻳ
ﻏ ﺔﻟﻮﻟ ﻚ ﻴ
ﻪﺑ ذﻮﻔﻧ ﻞﺑﺎﻗ ﺮ ﻳ
ﺪﻜ ﻳ ﻞـﺼﺘﻣ ﺮﮕ
هﺪﺷ
،ﺪﻧا ﻟﻮﻠﺳ گﺮﻣ ﻲ
ﺶﻫﺎﻛ ﻳ ﺖﺳا ﻪﺘﻓﺎ .
اﻳ ﻦ ﻳ ﺖـﺳا ﺮﮕﻧﺎﺸﻧ ﻚ
ﺎﻫرﻮﺘﻛﺎﻓ ﻪﻛ ي
ﻟﻮﺗ لﻮﻠﺤﻣ ﻴ
ﺎﻬﺘﻧا رد هﺪﺷ ﺪ ي
د ﻳ ﻊﻄﻗ ﺐﺼﻋ لﺎﺘﺴ
اراد هﺪﺷ ي ﻤﻫا ﻴ ﮕﻤﺸﭼ ﺖ ﻴ
ﺮ ي ﻣ ﻲ ﺪﻨﺷﺎﺑ
5.
دراﻮﻣ رد ي ﻪﻛ ﺎﻬﺘﻧا ود ي ﻪـﺑ ﺐﺼﻋ ﻳ
ﺪـﻜ ﻳ لﺎـﺼﺗا ﻞـﺑﺎﻗ ﺮﮕ
،ﺖﺳا ﻣﺮﺗ ﻴ ﻟوا ﻢ ﻴ د دراﻮﻣ رد و ﻪ ﻳ
ﺒـﺼﻋ ﺖـﻓاﺮﮔ زا ﺮﮕ ﻲ
هدﺎﻔﺘـﺳا
ﻣ ﻲ دﻮﺷ .
ﺎﻤﺗ ﻪـﺑ ﻪـﺟﻮﺗ ﺎﺑ ـﻳ
ور ﺲـﭘ ﻞ ي
(Retraction) ر
ﻳ ﺔـﺸ
،بﺎﺼﻋا ﻪﻴﺨﺑ ﺎﻬﺘﻧا ﻪﺑ ﺎﻬﺘﻧا ي
ﺳآ ﺐﺼﻋ ﻴ
د ﺐ ﻳ ﻧﺎـﻣز هﺪ ﻲ ﻣ ﻴ ﺮـﺴ
ز رﺎﺸﻓ ،ﻪﻛ ﺖﺳا ﻳ
دﺎ ي ﺣﺎﻧ رد ﻴ ﺳآ ﺐﺼﻋ نﺪﻧﺎﺳر ﻢﻬﺑ ﺔ ﻴ
د ﺐ ـﻳ هﺪ
ﺑ ﻪ ﻧ دﻮﺟو ﻴ ﺎ ﻳ ﺪ
6.
ﺒﺼﻋ تﺎﻣﺪﺻ رد ﻲ
ﺑ زا ﺚﻋﺎﺑ ﻪﻛ ﻴ
ﺘﻤﺴﻗ ﻦﺘﻓر ﻦ ﻲ
ﺐـﺼﻋ زا
ﻣ ﻲ
،دﻮﺷ شور ﺎﻫ ي ـﻔﻠﺘﺨﻣ ﻲ ا ﺖـﻬﺟ ﻳ
ـﺑ طﺎـﺒﺗرا دﺎـﺠ ﻴ
ﺮـﺳ ﻦ
ﺰﮔوﺮﭘ ﻳ د و لﺎﻤ ﻳ ﺎﻣزآ هﺪﺷ ﻊﻄﻗ ﺐﺼﻋ لﺎﺘﺴ ﻳ
زا و ﺖـﺳا هﺪﺷ ﺶ
ﺖﻓﺎﺑ ﺎﻫ ي رو ﺪﻨﻧﺎﻣ ﻒﻠﺘﺨﻣ ﻳ
،ﺪ ـﺷﺎﻓ ﻴ هﺪـﺷ هدﺎﻔﺘـﺳا ﻪﻠـﻀﻋ و ﺎ ﺖﺳا
7.
-
ﻪﻟﻮﻟ9
ﺎﻫ ي رو ﻳ ﺪ ي
هدﺎﻔﺘـﺳا و ﺪـﻧراد لﺎـﻣردوﺰﻣ ﺄﺸﻨﻣ زا
ﺗﺎﻌﻟﺎﻄﻣ رد نﻮﻨﻛﺎﺗ ﺎﻬﻧآ ﻲ
ﺖﺳا هﺪﺷ ﻪﺑﺮﺠﺗ
10.
ا ﺮﺑ هوﻼﻋ ﻳ
ﻨﻣآ ءﺎﺸﻏ ﺶﺷﻮﭘ زا ﻦ ﻴ
ﻧﻮ ﻲ ﻧ ﻴ ناﻮـﻨﻋ ﻪـﺑ ﺰ ـﻳ
ﻚ
ﻓوﺮﺗورﻮﻧ هدﺎﻣ ﻴ
ﺮﺴﺗ ﺖﻬﺟ ﻚ ﻳ
ﻣﺮـﺗ ﺪﻧور ﻊ ﻴ
ﻪـﻌﻟﺎﻄﻣ ﺪـﻨﭼ رد ﻢ
ﺖﺳا هﺪﺷ هدﺎﻔﺘﺳا
11.
-
13
ﺷ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﻴ
ﻻﺎﺑ عﻮ ي ﺎﻫﺎﻣوﺮﺗ ي ﺮﺠﻨﻣ ﺳآ ﻪﺑ ﻴ ﺒـﺼﻋ ﺐ ﻲ و
ﺛا ـ ا ءﻮﺳ تاﺮ ﻳ
ﺳآ ﻦ ﻴ ﮔﺪﻧز ﺮﺑ ﺐ ﻲ
ﻌﻓ و ـ ﻟﺎ ﻴ ﺖ ﺎﻫ ي ﻠﻐﺷ ﻲ ﺑ ﻴ نارﺎـﻤ
ﻨﭽﻤﻫ و ﻴ ا رد دﻮﺟﻮﻣ كﺪﻧا تﺎﻌﻟﺎﻄﻣ ﻦ ﻳ
ﻣز ﻦ ﻴ
ﺪـﺷ نآﺮـﺑ ،ﻪـﻨ ﻳ
ﻢ
ﻪﻌﻟﺎﻄﻣ ا ي ﺣ عﻮـﻧ زا ـﻴ
ﻧاﻮ ﻲ Rat) ( ﺎﺘـﺳار رد ي
ﺎﻘﻣ ﻳ تاﺮـﺛا ﻪـﺴ
ﻨﻣآ ءﺎﺸﻏ ﺶﺷﻮﭘ ﻴ
ـ ﻧﻮ ﻲ رو ﺶﺷﻮﭘ و ﻳ
ﺪ ي ﻣ ﺮﺑ ﻴ ﻣﺮﺗ ناﺰ ﻴ ﺒﺼﻋ ﻢ ﻲ
ﻫد مﺎﺠﻧا ﻴ ﻢ .
ﻣ ـ شور و داﻮ ﺎﻫ
هوﺮﮔ ﺎﻫ
ا رد ﻳ ﻦ ﺶﻫوﮋﭘ ﻌﺗ ـ داﺪ 36 و داﮋﻧ تر ﻳ
رﺎﺘـﺴ ) Wistar ﺎـﺑ(
نزو 250 - 350 ﮔ ـ ﺘﺴﻧا زا مﺮ ﻴ
ﺘ ـ ﻬﺗ رﻮﺘﺳﺎﭘ ﻮ ـ
ﻬﺗ ناﺮ ـﻴ ﺪﻧﺪـﺷ ﻪ .
ﻣ رد ـ ﻘﺤﺗ تﺪ ﻴ ﺣ ﻖ ﻴ ـ ﺎﻣزآ رد تﺎﻧاﻮ ﻳ
ﺸ ـ ﺣ هﺎﮕ ﻴ تﺎﻧاﻮ ﺑ ﻴ نﺎﺘﺳرﺎﻤ
ﻪﻤﻃﺎﻓ تﺮﻀﺣ )
س ( اﺮﺷ رد ﻳ
اﺬـﻏ و بآ ،رﻮـﻧ ﻂ ي
رد و ﺐـﺳﺎﻨﻣ
ﺲﻔﻗ ﺎﻫ ي ﺰﻠﻓ ي راﺪﻬﮕﻧ ي ﺪﻧﺪﺷ .
ﺣ ﻴ ﻪﺑ تﺎﻧاﻮ ﻓدﺎﺼﺗ ترﻮﺻ ﻲ
ﻪﺑ 3 هوﺮﮔ وﺎﺴﻣ ي ﺴﻘﺗ ﻴ ﺪﻧﺪﺷ ﻢ
زا ﺪﻨﺗرﺎﺒﻋ ﻪﻛ :
1 - ﻣﺮﺗ هوﺮﮔ ﻴ
ﺎـﻬﺘﻧا ﻪـﺑ ﺎـﻬﺘﻧا رﻮﭼﻮﺳ زا هدﺎﻔﺘﺳا ﺎﺑ هدﺎﺳ ﻢ :
ﺳ ﺐﺼﻋ ﻴ ﺗﺎ ﻴ ﻢـﻫ ﻪـﺑ هﺪـﺷ ﻊـﻄﻗ ﺐـﺼﻋ ﺮﺳ ود و ﻊﻄﻗ ﭗﭼ ﻚ
ﺪﺷ ﻪﺘﺧود .
2 - ﻣﺮﺗ هوﺮﮔ ﻴ ﺎﺸﻏ ﺶﺷﻮﭘ زا هدﺎﻔﺘﺳا ﺎﺑ ﻢ ء
ﻨﻣآ ﻴ نﻮ ﻧﺎـﺴﻧا ﻲ :
ﺳ ﺐﺼﻋ ﻴ ﺗﺎ ﻴ ﺪﺷ ﻪﺘﺧود ﻢﻫ ﻪﺑ هﺪﺷ ﻊﻄﻗ ﺐﺼﻋ ﺮﺳ ود و ﻊﻄﻗ ﻚ
ﺸﺷﻮﭘ و ﻲ ﺸﻏ زا ءﺎ ﻨﻣآ ﻴ ﻧﻮ ﻲ ﻧﺎﺴﻧا ﻲ ﺘﻧآ ﻪﻛ ﻲ ژ ن ـﻫ ﺎ ي ـﺑ زا نآ ﻴ ﻦ
دﻮﺑ هﺪﺷ هدﺮﺑ
، ور ي ﭘ ﻞﺤﻣ ﻴ ﺪﺷ هداد راﺮﻗ ﺪﻧﻮ .
3 - ﻣﺮـﺗ هوﺮﮔ ﻴ
رو ﺶـﺷﻮﭘ زا هدﺎﻔﺘـﺳا ﺎـﺑ ﻢ ـﻳ
ﺪ ي : ﺐـﺼﻋ
ﺳ ﻴ ﺗﺎ ﻴ و ﺪـﺷ ﻪـﺘﺧود ﻢـﻫ ﻪﺑ هﺪﺷ ﻊﻄﻗ ﺐﺼﻋ ﺮﺳ ود و ﻊﻄﻗ ﻚ
رو زا ﻪﻛ يﺪﻳرو فﻼﻏ زا ﻲﺸﺷﻮﭘ ﻳ
تر ﭗـﭼ ﺖﻤـﺳ رﻻﻮـﮔوژ ﺪ
دﻮﺑ هﺪﺷ ﻪﺘﺷادﺮﺑ
، ﺪﺷ هداد راﺮﻗ ﺪﻧﻮﻴﭘ ﻞﺤﻣ يور .
ﺣاﺮﺟ ﻲ
ﻣﺮﺗ ﻴ ﺎﺳ ﻢ ﺎﻬﺘﻧا ﻪﺑ ﺎﻬﺘﻧا هد )
هوﺮﮔ ﻳ ﻚ (
ﺎﻤﻧ زا ﺲﭘ ﻳ
ﺳ ﺐﺼﻋ ﻦﺘﺧﺎﺳ نﺎ ﻴ
ﺗﺎ ﻴ زﺎـﺳاﺪﺟ و ﭗﭼ ﻚ ي
نآ
ﻗ زا هدﺎﻔﺘﺳا ﺎﺑ فاﺮﻃا ﺪﻨﺒﻤﻫ ﺖﻓﺎﺑ زا ﻴ
ﭽ ﻲ ﺘﺳا ﻴ ﺲﻧﻮ ، رد ﺐـﺼﻋ
ﻣ ﺖﺴﻗ ﻴ ﻧﺎ ﻲ ﻊﻄﻗ هﺪﺷ
ًادﺪﺠﻣ و ﺎﻬﺘﻧا ود ي
ﻪـﺘﺧود ﺐـﺼﻋ ﺪـﺷ
.
ﺨﺑ ﺦﻧ زا هدﺎﻔﺘﺳا ﺎﺑ ﺲﭙﺳ ﻴ
ﺣ ﺖﺳﻮﭘ ﻪ ﻴ
ناﻮ ﺨﺑ ﻴ ﺪـﺷ ﻪ . ﺎـﻬﺘﻧا رد
ﺨﺑ ﻞﺤﻣ ﻴ ﻧﻮﻔﻋ ﺪﺿ ﻪ ﻲ
هﺪﺷ و تر ﺤﻣ رد و ﺲﻔﻗ نورد ﻴ
ﻄ ﻲ مﺮـﮔ
راﺮﻗ ﺪﺷ هداد ﺑ ﺎﺗ
ﻪ آ شﻮﻫ ﻳ ﺪ . بآ ﺲﭙﺳ
، ﻓﺎﻛ ﺖﺑﻮﻃر و اﺬﻏ ﻲ
رد
ﺘﺧا ﻴ ﺣ رﺎ ﻴ هداد راﺮﻗ ناﻮ ﺪﺷ
.
ﻣﺮﺗ ﻴ ﻨﻣآ ﺶﺷﻮﭘ زا هدﺎﻔﺘﺳا ﺎﺑ ﻢ ﻴ
نﻮ ) مود هوﺮﮔ (
ﻠﺒﻗ شور ﺪﻨﻧﺎﻤﻫ ﻲ
ﺳ ﺐﺼﻋ ﻴ ﺗﺎ ﻴ ﺎﻤﻧ ﻚ ـﻳ و نﺎ ﻊـﻄﻗ زا ﺲـﭘ
ﺳ ﺐﺼﻋ ﻴ ﺗﺎ ﻴ ﭘ و ﻚ ﻴ ﺎﻬﺘﻧا ود ﺪﻧﻮ ي
ـﺸﺷﻮﭘ هﺪﺷ ﻊﻄﻗ ﻲ
ﺎـﺸﻏ زا ء
ﻨﻣآ ﻴ ـ ور ﺮﺑ نﻮ ي ﭘ ﻞﺤﻣ ﻴ ﺪﻧﻮ هدراﺬﮔ ﺪﺷ . ﺖـﺳﻮﭘ ﺲﭙـﺳ ﺨﺑ
ـﻴ ﻪ
هﺪﺷ ﺣ و ﻴ ـ اﺮﺷ رد و ﺲﻔﻗ نورد ناﻮ ﻳ
اﺬـﻏ و بآ ﻂ ﻲﻳ
بﻮـﻠﻄﻣ
راﺮﻗ ﺪﺷ هداد .
ﻣﺮﺗ ﻴ رو ﺶﺷﻮﭘ زا هدﺎﻔﺘﺳا ﺎﺑ ﻢ ﻳ
ﺪ ي ) مﻮﺳ هوﺮﮔ (
ﻠﺒﻗ شور ﺪﻨﻧﺎﻤﻫ ﻲ
ﺳ ﺐﺼﻋ ﻴ ﺗﺎ ﻴ ﺎﻤﻧ ﻚ ـﻳ و نﺎ ﻊـﻄﻗ زا ﺲـﭘ
ﺳ ﺐﺼﻋ ﻴ ﺗﺎ ﻴ ﭘ و ﻚ ﻴ ﺎﻬﺘﻧا ود ﺪﻧﻮ ي
ـﺸﺷﻮﭘ هﺪﺷ ﻊﻄﻗ ﻲ
فﻼـﻏ زا
رو ﻳ ﺪ ي ور ﺮﺑ ي ﭘ ﻞﺤﻣ ﻴ ﺪﺷ هداد راﺮﻗ ﺪﻧﻮ .
ﺨﺑ ﺖـﺳﻮﭘ ﺲﭙـﺳ ـﻴ
ﻪ
ﺣ و هﺪﺷ ﻴ ـ اﺮﺷ رد و ﺲﻔﻗ نورد ناﻮ ﻳ
اﺬـﻏ و بآ ﻂ ﻲﻳ
بﻮـﻠﻄﻣ
ﺪﺷ هداد راﺮﻗ .
ﺮﭘ تﻮﻓ ﻳ ﺖﻨ
زا ﺲﭘ ﻳ و ﻚ 12 ﺎﭘ ﻒﻛ ﻪﺘﻔﻫ ي
تر و ﺪﺷ ﻪﺘﺸﻏآ ﺮﻫﻮﺟ ﻪﺑ ﺎﻫ
ﺎﭘ ﺮﺛا ي زرا درﻮﻣ ﻦﺘﻓر هار مﺎﮕﻨﻫ ﺎﻬﻧآ ﻳ
ﺑﺎ ﻲ
،ﺖـﻓﺮﮔ راﺮﻗ ا ﻪـﺑ
ـﻳ ﻦ
ﻨﻬﭘ ﻪﻛ ترﻮﺻ ـ
ﺎ ي ﻮﻃ ﻪﺑ ﺎﭘ ﺮﺛا ﻗد ر
ﻴ هزاﺪﻧا ﻖ ﮔ ﻴ ـ ﺮ ي و ﺪـﺷ ﺖﺒﺛ .
ا ﻊﻗاو رد ﻳ ﺷور نﻮﻣزآ ﻦ ﻲ
زرا ﺖﻬﺟ ﻳ ﺑﺎ ﻲ ﻟﺎﺑ ﻴ ﻨ ﻲ ﻣ ﻴ ﺖـﺸﮔزﺎﺑ ناﺰ
ــﺘﻛﺮﺣ دﺮــﻜﻠﻤﻋ ﻲ
ﻣﺮــﺗ ﺐــﺼﻋ ﻴ
ــﻣ هﺪــﺷ ﻢ ﻲ
ﺪــﺷﺎﺑ . ﺺﺧﺎــﺷ
SFI(Sciatic Functional Index)
ذ لﻮـﻣﺮﻓ زا هدﺎﻔﺘـﺳا ﺎﺑ ـﻳ
ﻞ
زرا و ﻪﺒﺳﺎﺤﻣ درﻮﻣ ﻳ
ﺑﺎ ﻲ ﺖﻓﺮﮔ راﺮﻗ :
SFI= -38.3 (epl-npl) /npl+109.5 (ets-nts)/ nts+13.3 (eits-nits) /nits-8.8
ﻓوﺮﺘﻜﻟا ﻴ ﺰ ﻳ ژﻮﻟﻮ ي
12 ﻪﺘﻔﻫ ﺲـﭘ ـﺣاﺮﺟ زا ﻲ ﺗ ﺖـﻬﺟ ﺄ ـﻴﻳ ﻪـﻌﻄﻗ ود لﺎـﺼﺗا ﺪ
ﺴﻛوﺮﭘ ﻴ ﻤ ـ د و لﺎ ﻳ ﺴ ﺘ ارﺎﻛ و ﺐﺼﻋ لﺎ ﻲﻳ
ﻣﺮـﺗ ﺐﺼﻋ ﻴ
زا ،هﺪـﺷ ﻢ
ﺘﻜﻟا ـ ﻣوﺮ ﻴ ﻓاﺮﮔﻮ ﻲ هدﺎﻔﺘﺳا ﺪـﺷ . اﺮـﺑ ي اﻳ
تر اﺪـﺘﺑا رﺎـﻜﻨ ار ﺎـﻫ
ﺑ ﻴ ﻬ ـ هدﺮﻛ شﻮ و
ﺤﻣ ـ ﺟ ﻞ ـ ﺣاﺮ ﻲ زﺎـﺑ ﺖـﺳﻮﭘ ﺪـﺷ
. ﺎـﺗ ﺖـﺳﻮﭘ
ﺎﭘ ﺖﻤﺴﻗ ﻴﻳ
ـ ﻦ ـﺷ زﺎﺑ قﺎﺳ ـ
ﺪ
، ز ـﻳ
ﻤﻨﻛﺮﺘـﺳﺎﮔ ﻪﻠـﻀﻋ زا اﺮ ﻴ
سﻮ
) (GC اﺮﺑ ي هدﺎﻔﺘﺳاEMG
ـﻣ ﻲ دﻮـﺷ .
ـﺣاﺮﺟ ﻞـﺤﻣ ﺲﭙـﺳ ﻲ
رﻮﻠﭙﺴﻛا ﺎﻬﺘﻧا رد و ي
ﺴﻛوﺮﭘ ﻴ ﻤ ـ
ﺮﺤﺗ دوﺮـﺘﻜﻟا ود ،ﻪـﻟﻮﻟ لﺎ ـﻳ
ﻚ
هﺪﻨﻫد ﺒﻌﺗ ﻴ ﺪﺷ ﻪ . ﺘﻜﻟا ـ ﻣز دوﺮ ﻴ ﻦ ﻧ ﻴ
ﻤﻜـﺷ ﺖﻤـﺴﻗ دراو ﺰ ﻲ
تر
ﺪﺷ . ﻛ ود زا ﺲﭙﺳ ﺎ
پ ) (Cup ور ﺮﺑ ﻪﻛ ي ﻪﻠﻀﻋ ﻛوﺮﺘﺳﺎﮔ ﻨ ﻤ ﻴ سﻮ د و
ﻳ ﮕ ـ ﺮ ي ور ﺮﺑ ي ﻮﻧاز ي ﮔ تر ـ ﻣ ﻪﺘﺷاﺬ ﻲ هدﺎﻔﺘـﺳا ،دﻮﺷ ﺪـﺷ
.
نآ زا ﺲﭘ ﺤﺗ
ـ ﺮ ﻳ دراو ﻚ هﺪﺷ ﺳﺎﭘ و ـ ﺦ ﺪـﺷ ﺖﺒﺛ .
ﺖـﺒﺛ ﺦـﺳﺎﭘ
ﻞﻣﺎﺷ هﺪﺷ Amplitude
Latencyو ﻣ
ﻲ ﺪﺷﺎﺑ . رﺎـﻛ مﺎﻤﺗا زا ﺲﭘ
ﺟ ﺖﻤﺴﻗ ـ
ﺣاﺮ ﻲ ﺷ ـ ﻓ لﻮﻠﺤﻣ دراو و ﻪﺘﺷادﺮﺑ هﺪ ﻴ
ﺗﺎﺴﻜ ﻴ ﺖﻬﺟ ﻮ
ﺳرﺮﺑ ﻲ ﺘﻓﺎﺑ ﻲ ﺪﺷ .
ﺳﺎﻨﺷ ﺖﻓﺎﺑ ﻲ
12 ﻪﺘﻔﻫ ﺲﭘ ﺣاﺮﺟ زا ﻲ
، زا ﺪﻌﺑ ندﻮﻤﻧ زﺎﺑ ندز رﺎﻨﻛ و ﺖﺳﻮﭘ
ﻣﺮﺗ ﺐﺼﻋ ،تﻼﻀﻋ ﻴ
ﺎﻤﻧ هﺪﺷ ﻢ ﻳ
نﺎ ﺪﺷ . زﺎﺳاﺪﺟ زا ﺲﭘ ي
ﺖﻓﺎﺑ زا
ﺎﻬﺘﻧا ود ،فاﺮﻃا ي
ﺮﺑ ﺐﺼﻋ ﻳ هﺪ هﺪﺷ اﺪﺟ ، ﺋﺪﻟآ رﺎﺗﻮﻠﮔ نورد و
ـﻴ ﺪ
5 / 2 ناﻮﻨﻋ ﻪﺑ ﺪﺻرد pre _ fix
راﺮﻗ ﺪﺷ هداد . ﺐﻟﺎﻗ زا ﺲﭘ ﮔ
ﻴ ﺮ ي
ﻣﺮﺗ ﺐﺼﻋ ﻴ
ﻬﺗ و هﺪﺷ ﻢ ﻴ
مﻻ ﻪ ﺎـﻫ ي درﻮـﻣ ﻧ ـﻴ زﺎ زا هدﺎﻔﺘـﺳا ﺎـﺑ ،
ﻣ ﻴ رﻮﻧ پﻮﻜﺳوﺮﻜ ي
) Olympus PROVIS Ax 70،
Japan، ( ﺎـﺑ
ﺎﻤﻨﮔرﺰﺑ ﻲﻳ 100 × و 80 × وﺎﺼﺗ ﻳ ﻬﺗ ﺮ ﻴ ﺪﺷ ﻪ ه
وﺎـﺼﺗ ﺲﭙـﺳ و ﻳ
ﺎـﺑ ﺮ
ﺮﮔ ﻳ ﺪ 200µm ﺴﻘﺗ ﻴ ﻢ ﺪﻨﺑ ي ﺪﺷ .
آ ﻟﺎﻧ ﻴ رﺎﻣآ ﺰ ي
ا رد ﻳ
ـﻓا مﺮـﻧ زا ﻪﻌﻟﺎﻄﻣ ﻦ ـ
ـﻣآ راﺰ ـ رﺎ ي وSPSS ـﻳ اﺮ ﻳ ﺶ 16
ﻬﺟ ـ ﺠﺗ ﺖ ـ ﺰ ﻳ ـﻠﺤﺗ و ﻪ ـ ﻴ ـﺘﻧ ﻞ ـ ﺎ ﻳ ـﻔﺘﺳا ﺞ ـ ـﺷ هدﺎ ـ ﺪ . نﻮـﻣزآ
Paired Sample T-Test ﺎﻘﻣ ﺖﻬﺟ
ﻳ ﻪﺴ ﺎﺘﻧ ﻳ ﺎﺑ ﻢﻫدزاود ﻪﺘﻔﻫ ﺞ
ﺪﺷ ﻪﺘﻓﺮﮔ رﺎﻛ ﻪﺑ لوا ﻪﺘﻔﻫ .
ﻨﭽﻤﻫ ﻴ ﻦ ﺎﻘﻣ ﺖـﻬﺟ ﻳ
ﺎـﺘﻧ ﻪـﺴ ﻳ
رد ﺞ
هوﺮﮔ ﺎﻫ ي ﻪﻧﺎﮔ ﻪﺳ زا نﻮﻣزآ One Way ANOVA نآ زا ﺲـﭘ و
زا آ نﻮﻣز ﻲﺒﻴﻘﻌﺗ هدﺎﻔﺘﺳا ﺪﺷ .
ﻪﺘﻓﺎﻳ ﺎﻫ
ﺮﭘ تﻮﻓ ﻳ ﺖﻨ
ﺎﺘﻧ ﻳ ﺳرﺮﺑ زا ﻞﺻﺎﺣ ﺞ ﻲ
Foot Print ﻜﻔﺗ ﻪﺑ هوﺮﮔ ﻪﺳ رد
ﻴ ﻚ
لوﺪﺟ رد 1
ارا ﻳ ﺖﺳا هﺪﺷ ﻪ .
ﻮﻄﻧﺎـﻤﻫ
ـﻣ هﺪﻫﺎـﺸﻣ ﻪـﻛ ر ﻲ
دﻮـﺷ
ﻌﺿو ﻴ ﺖ Foot Print درﻮـﻣ هوﺮـﮔ ﻪـﺳ ﺮـﻫ رد نﺎﻣز ﺖﺷﺬﮔ ﺎﺑ
ﺳرﺮﺑ ﻲ دﻮﺒﻬﺑ ﻳ ﺖﺳا ﻪﺘﻓﺎ )
دﺰﻧ ﺮﻔﺻ ﻪﺑ ﺎﻫدﺪﻋ ﻳ
هﺪﺷ ﻚ ﺪﻧا .(
ا ـﻳ ﻦ
ﻣ ﻴ دﻮﺒﻬﺑ ناﺰ ي
نﻮﻣزآ سﺎﺳا ﺮﺑ Paired t-test
هوﺮـﮔ ﻪﺳ ﺮﻫ رد
ﺖﺳا هدﻮﺑ رادﺎﻨﻌﻣ )
لوﺪـﺟ 1 .(
ـﺳرﺮﺑ ﻲ ﺎـﻫ ي نﻮـﻣزآ زا ﻞـﺻﺎﺣ
ANOVA ﻛﺎﺣ
ﻲ ﺑ ﻪﻛ ﺖﺳا نآ زا ﻴ
رد ﻪـﻌﻟﺎﻄﻣ درﻮـﻣ هوﺮﮔ ﻪﺳ ﻦ
رﺎﻣآ رادﺎﻨﻌﻣ توﺎﻔﺗ لوا ﻪﺘﻔﻫ ي
دراﺪﻧ دﻮﺟو 735)
/ 0 P= ( رد ﺎـﻣا
رﺎـﻣآ رادﺎﻨﻌﻣ توﺎﻔﺗ ﻢﻫدزاود ﻪﺘﻔﻫ ﺎﺑ ﻪﻄﺑار ي
ـﺑ ﻴ هوﺮـﮔ ﻦ ﺎـﻫ ي
ﻨﻣآ ﺶﺷﻮﭘ ﺎﺑ ﺎﻬﺘﻧا ﻪﺑ ﺎﻬﺘﻧا زﻮﻣﻮﺘﺳﺎﻧآ ﻴ
ﻧﻮ ﻲ زﻮﻣﻮﺘـﺳﺎﻧآ هوﺮـﮔ ﺎـﺑ
ﺎﻬﺘﻧا ﻪﺑ ﺎﻬﺘﻧا ي
هدﺎﺳ هﺪﺷ هﺪﻫﺎﺸﻣ ﺖﺳا
17) / 0 P= ( .
ﻝﻭﺪﺟ ۱ - ﺘﻧ ﺎﻳ Foot Print ﺞ ﮑﻔﺗ ﻪﺑ
ﻴ ﻢﻫﺩﺯﺍﻭﺩ ﻭ ﻝﻭﺍ ﻪﺘﻔﻫ ﺭﺩ ﻩﻭﺮﮔ ﻪﺳ ﮏ
ﻩﻭﺮﮔ ﻣﻴ
ﮕﻧﺎ ﻴ ﻪﺘﻔﻫ ﺭﺩ ﻦ
ﻝﻭﺍ ﻌﻣ ﻑﺍﺮﺤﻧﺍ
ﻴ ﺭﺩ ﺭﺎ
ﻝﻭﺍ ﻪﺘﻔﻫ ﻣﻴ
ﮕﻧﺎ ﻴ ﻪﺘﻔﻫ ﺭﺩ ﻦ
ﻢﻫﺩﺯﺍﻭﺩ ﻌﻣ ﻑﺍﺮﺤﻧﺍ
ﻴ ﻪﺘﻔﻫ ﺭﺩ ﺭﺎ
ﻢﻫﺩﺯﺍﻭﺩ ﻝﺎﻤﺘﺣﺍ ﺭﺍﺪﻘﻣ
ﻩﺩﺎﺳ ﯼﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺯﻮﻣﻮﺘﺳﺎﻧﺁ
۶۸ / ۹۹ - ۶۲
/ ۱۶ ۶۸
/ ۷۹ - ۷۹
/ ۱۱ ۰۱۰
/ ۰
ﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺯﻮﻣﻮﺘﺳﺎﻧﺁ ﻲﻧﻮﻴﻨﻣﺁ ﺶﺷﻮﭘ ﺎﺑ ﺎﻬﺘﻧ
۰۸ / ۹۰ - ۱۳
/ ۲۷ ۷۵
/ ۵۳ - ۷۵
/ ۱۹ ۰۰۸
/ ۰
ﺭﻭ ﺶﺷﻮﭘ ﺎﺑ ﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺯﻮﻣﻮﺘﺳﺎﻧﺁ ﻳ
ﺪ ﻱ ۳۵ / ۹۹ - ۸۴
/ ۴۱ ۴۴
/ ۶۴ - ۲۲
/ ۱۲ ۰۲۵
/ ۰
ﻓوﺮﺘﻜﻟا ﻴ ﺰ ﻳ ژﻮﻟﻮ ي
ﺎﺘﻧ ﻳ ﺳرﺮﺑ زا هﺪﻣآ ﺖﺳﺪﺑ ﺞ ﻲ
ﻣوﺮﺘﻜﻟا ﻴ ﻓاﺮﮔﻮ ﻲ هوﺮﮔ رد ﺎـﻫ ي
ا رد ﻪﻌﻟﺎﻄﻣ درﻮﻣ ﻳ
ﻘﺤﺗ ﻦ ﻴ ز حﺮﺷ ﻪﺑ ﻖ ﻳ
ﻣ ﺮ ﻲ ﺪﺷﺎﺑ ) رادﻮﻤﻧ 1 ( .
a
b
c
ﺭﺍﺩﻮﻤﻧ ۱ ـ ﻓﻭﺮﺘﮑﻟﺍ ﺭﺍﺩﻮﻤﻧ ﻴ
ﺮ ﻳ ﮊﻮﻟﻮ ﻱ ﻩﻭﺮﮔ ﺭﺩ ﺎﻫ ﻱ ﻪﻧﺎﮔ ﻪﺳ
a)
= ﻨﻣﺁ ﺶﺷﻮﭘ ﺎﺑ ﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺯﻮﻣﻮﺘﺳﺎﻧﺁ ﻴ
ﻧﻮ ﻲ b،
= ﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺯﻮﻣﻮﺘﺳﺎﻧﺁ
ﺭﻭ ﺶﺷﻮﭘ ﺎﺑ ﻳ
ﺪ ﻱ c ،
= ﺎﻬﻨﺗ ﻪﺑ ﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺯﻮﻣﻮﺘﺳﺎﻧﺁ ﻲﻳ
( ﻔﺘﺳا ﺎﺑ
ـ ﻣزآ زا هدﺎ ـ
رﺎﻣآ نﻮ ي One-way ANOVA رد ﺎـﺑ و
ﮔ ﺮﻈﻧ ـ ﻓﺮ ﻦﺘ ﺣ ـ دوﺪ ﻤﻃا ﻴ ﻨ ـ نﺎ 95 ﺪﺻرد ﺘﻧ ، ـ ﺎ ﻳ ﺑ ﺞ ﻪ هﺪﻣآ ﺖﺳد
ﺳرﺮﺑ زا ـ ﻲ ﻓوﺮﺘﻜﻟا ﻴ ـ ﺰ ﻳ ژﻮﻟﻮ ي ﺑ ﻴ ﮔ ﻦ ـ هوﺮ ﺎﻫ ي ﮔ ـ ـﺼﻋ ﺖﻓاﺮ ـ
ﺒ ﻲ
رو ﺶﺷﻮﭘ هاﺮﻤﻫ ﻪﺑ ﻳ
ﺪ ي ) 72 / 3 ( و ﮔ ـ ﺒـﺼﻋ ﺖﻓاﺮ ﻲ
هاﺮـﻤﻫ ﻪـﺑ
ﻨﻣآ ﺶﺷﻮﭘ ﻴ
نﻮ ) 63 / 4 ﻣآ فﻼﺘﺧا ،( ـ
رﺎ ي ـﻨﻌﻣ ـ ﻲ راد ي نﺎـﺸﻧ ار
ﻣ ﻲ ﺪﻫد ) P=0.044 .(
ﻨﭽﻤﻫ ﻴ ـ ـﻔﺘﺳا ﺎﺑ ﻦ ـ
رﺎـﻣآ نﻮـﻣزآ زا هدﺎ ي
One-way ANOVA ﻈﻧ رد ﺎﺑ و
ـ ـﮔ ﺮ ـ ﻦﺘﻓﺮ ـﺣ ـ دوﺪ ﻤﻃا ﻴ نﺎـﻨ
95 % ﺎﺘﻧ ،ﺪﺻرد ﻳ
ـﺑ زا هﺪﻣآ ﺖﺳﺪﺑ ﺞ ـ
ﺳرﺮ ﻲ ـﺘﻜﻟا ـ ﻓوﺮ ﻴ ﺰ ﻳ ژﻮﻟﻮ ي
ﺑ ﻴ هوﺮﮔ ﻦ ﺎﻫ ي ﺒﺼﻋ ﺖﻓاﺮﮔ ﻲ
ﻤﻫ ﻪﺑ ـ ﺷﻮﭘ هاﺮ ـ رو ﺶ ﻳ ﺪ )ي 72 / 3 (
و ﺒﺼﻋ ﺖﻓاﺮﮔ ﻲ
ﺶﺷﻮﭘ نوﺪﺑ )
27 / 2 ( رﺎﻣآ فﻼﺘﺧا ، ي
ﻨﻌﻣ ﻲ راد ي
ﻣ نﺎﺸﻧ ار ﻲ
ﺪﻫد ) P=0.048 .(
ﻔﺘﺳا ﺎﺑ ـ ﻣزآ زا هدﺎ ـ
نﻮ رﺎﻣآ ي One-way ANOVA رد ﺎﺑ و
ﮔ ﺮﻈﻧ ـ ﻤﻃا ﻪﺟرد ﻦﺘﻓﺮ ﻴ
ـ نﺎﻨ 95
% ﺘﻧ ، ـ ﺎ ﻳ ـﺑ ﺞ ﻪ زا هﺪـﻣآ ﺖـﺳد
ﺑ ـ ﺳرﺮ ﻲ ﺘﻜﻟا ـ ﻓوﺮ ﻴ ﺰ ﻳ ﻟﻮ ـ ژﻮ ي ﺑ ﻴ ﮔ ﻦ ـ هوﺮ ﺎﻫ ي ﺒـﺼﻋ ﺖﻓاﺮﮔ ﻲ
ﻪـﺑ
ﻤﻫ ـ ﻨﻣآ ﺶﺷﻮﭘ هاﺮ ﻴ
ـ نﻮ ) 63 / 4 ( ﮔ و ـ ﺒﺼﻋ ﺖﻓاﺮ ﻲ
ﺶﺷﻮﭘ نوﺪﺑ
) 27 / 2 ( رﺎــﻣآ فﻼﺘــﺧا ، ي
ــﻨﻌﻣ ـ ﻲ راد ي ) P<0.026 (
نﺎــﺸﻧ ار
ﻣ ﻲ ﺪﻫد ) لوﺪﺟ 2 .(
ﻝﻭﺪﺟ ۲ ﺎﺘﻧ ـ ﻳ ﻥﻮﻣﺯﺁ ﺞ ANOVA ﻩﻭﺮﮔ ﺭﺩ
ﮑﻔﺗ ﻪﺑ ﻪﻧﺎﮔ ﻪﺳ ﯼﺎﻫ ﻴ
ﯽﻧﺎﻣﺯ ﮏ
ﻩﻭﺮﮔ ﻣﻭﺮﺘﮑﻟﺍ
ﻴ ﯽﻓﺍﺮﮔﻮ ﯽﻧﻮﺴﮐﺍ ﺵﺭﺎﻤﺷ
ﻩﺩﺎﺳ ﯼﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺯﻮﻣﻮﺘﺳﺎﻧﺁ
۰۴۸ / ۰ ۰۹۱
/ ۰
ﺎﺑ ﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺯﻮﻣﻮﺘﺳﺎﻧﺁ ﻲﻧﻮﻴﻨﻣﺁ ﺶﺷﻮﭘ ۰۲۶
/ ۰ ۰۱۸
/ ۰
ﺎﺑ ﺎﻬﺘﻧﺍ ﻪﺑ ﺎﻬﺘﻧﺍ ﺯﻮﻣﻮﺘﺳﺎﻧﺁ ﻱﺪﻳﺭﻭ ﺶﺷﻮﭘ ۰۴۴
/ ۰ ۰۴۱
/ ۰
ﺳﺎﻨﺷ ﺖﻓﺎﺑ ﻲ
Latency Amplitude
Amplitude Amplitude
Latency Latency
ﺎﺘﻧ ﻳ ﺳرﺮﺑ زا ﻞﺻﺎﺣ ﺞ ﻲ
ﻧﻮﺴﻛا شرﺎﻤﺷ ﻲ
هوﺮﮔ رد ﺎﻫ ي درﻮـﻣ
ز راﺮﻗ ﻪﺑ ﻪﻌﻟﺎﻄﻣ ﻳ
ﻣ ﺮ ﻲ ﺪﺷﺎﺑ ) رادﻮﻤﻧ 2 ( .
ﺭﺍﺩﻮﻤﻧ ۲ ـ ﺍﺪﻌﺗ ﯽﻧﻮﺘﺳ ﺭﺍﺩﻮﻤﻧ ﺩ
ﺁ ﻥﻮﺴﻛ ﻣﺮﺗ ﯼﺎﻫ ﻴ ﻩﻭﺮﮔ ﺭﺩ ﻩﺪﺷ ﻢ ﺩﺭﻮﻣ ﯼﺎﻫ
ﻪﻌﻟﺎﻄﻣ . ﻩﻭﺮﮔ ﻩﺪﻨﻫﺩ ﻥﺎﺸﻧ ﯽﻘﻓﺍ ﺭﻮﺤﻣ ﯽـﻣ ﻪﻌﻟﺎﻄﻣ ﺩﺭﻮﻣ ﯼﺎﻫ
ﺭﻮـﺤﻣ ﻭ ﺪـﺷﺎﺑ
ﺸﻧ ﯼﺩﻮﻤﻋ ﺎ
ﻣ ﻩﺪﻨﻫﺩ ﻥ ﻴ ﮕﻧﺎ ﻴ ﺩﺍﺪﻌﺗ ﻦ ﺁ ﻥﻮﺴﻛ ﻣﺮﺗ ﯼﺎﻫ ﻴ ﻩﻭﺮـﮔ ﺮـﻫ ﺭﺩ ﻩﺪـﺷ ﻢ
ﯽﻣ ﻪﻌﻟﺎﻄﻣ ﺩﺭﻮﻣ ﺪﺷﺎﺑ
ﺳرﺮﺑ ﻲ هداد ﺎﻫ ي ﻣآ ـ رﺎ ي ﻔﺘﺳا ﺎﺑ ـ راﺰﻓا مﺮﻧ زا هدﺎ SPSS 16
ﻣزآ و ـ ﻣآ نﻮ ـ رﺎ ي One-way ANOVA ﺎﺑ و
ـﺣ ـ دوﺪ ﻤﻃا ﻴ نﺎـﻨ
95 ﺪﺻرد ﻣ نﺎﺸﻧ ﻲ ﺑ ﻪﻛ ﺪﻫد ﻴ هوﺮﮔ ﻦ ﺎـﻫ ي
ﺒـﺼﻋ ﺖـﻓاﺮﮔ ﻲ
ﻪـﺑ
ﻤﻫ ـ رو ﺶﺷﻮﭘ هاﺮ ﻳ
ﺪ ي ) 58 / 86 (
ﺒـﺼﻋ ﺖـﻓاﺮﮔ و ﻲ
هاﺮـﻤﻫ ﻪـﺑ
ﺷﻮﭘ ـ ﻨﻣآ ﺶ ﻴ نﻮ ) 33 / 134 ( رﺎـﻣآ فﻼﺘﺧا ي
ـﻨﻌﻣ ﻲ راد ي دﻮـﺟو
دراد ) P=0.041 (
. ﻨﭽﻤﻫ ﻴ ﺑ ﻦ ﻴ هوﺮﮔ ﻦ ﺎﻫ ي ﺒﺼﻋ ﺖﻓاﺮﮔ ﻲ
هاﺮﻤﻫ ﻪﺑ
ﻨﻣآ ﻴ نﻮ ) 33 / 134 (
ﺒـﺼﻋ ﺖـﻓاﺮﮔ و ﻲ
ﺶـﺷﻮﭘ نوﺪـﺑ )
59 / 74 (
رﺎﻣآ فﻼﺘﺧا ي
ﻨﻌﻣ ﻲ راد ي دراد دﻮﺟو )
P=0.018 .(
ﺎﺘﻧ ﻳ رﺎـﻣآ ﺞ ي
ـﺳرﺮﺑ زا ﻞـﺻﺎﺣ ﻲ
ﻧﻮـﺴﻛا شرﺎﻤـﺷ ﻲ
ـﺑ ﻴ ﻦ
هوﺮﮔ ﺎﻫ ي ﺒﺼﻋ ﺖﻓاﺮﮔ ﻲ
ﻫ ﻪﺑ
رو ﺶـﺷﻮﭘ هاﺮـﻤ ـﻳ
ﺪ ي ) 58 / 86 ( و
ﺒﺼﻋ ﺖﻓاﺮﮔ ﻲ
ﺶﺷﻮﭘ نوﺪﺑ )
59 / 74 ( رﺎﻣآ فﻼﺘﺧا ي
ﻨﻌﻣ ﻲ راد ي
) P =0.091 (
ﻤﻧ نﺎﺸﻧ ار ﻲ
ﺪﻫد ) لوﺪﺟ 2 .(
ﺳرﺮﺑ ﻲ ﺳﺎﻨﺷ ﺖﻓﺎﺑ ﻲ
هوﺮـﮔ رد ﺎـﻫ ي نﺎـﺸﻧ ﻪـﻌﻟﺎﻄﻣ درﻮـﻣ
ﻣ ﻲ هوﺮﮔ ﻪﻤﻫ رد ﻪﻛ ﺪﻫد
ﻣﺮـﺗ ﺐـﺼﻋ ،ﺎـﻫ ﻴ
ﺎـﻬﺘﻧا زا و هﺪـﺷ ﻢ ي
ﺴﻛوﺮﭘ ﻴ ﺎﻬﺘﻧا ﻪﺑ لﺎﻤ ي
د ﻳ ﺳر لﺎﺘﺴ ﻴ
و ﺖﺳا هﺪ آ
ﻮﺴﻛ ن ﺎﻫ ي ﻣﺮﺗ ﻴ ﻢ
ﻣ ﺺﺨﺸﻣ ﻻﺎﺑ ﻢﻛاﺮﺗ ﺎﺑ هوﺮﮔ ﺮﻫ رد هﺪﺷ ﻲ
ﺪﻨﺷﺎﺑ . رد ﻪﻛ رﻮﻄﻧﺎﻤﻫ
ﻞﻜﺷ د ﺎﻫ ﻳ ﻣ هﺪ ﻲ ﭘا دﻮﺷ ﻲ رﻮﻧ ﻳ ﺮﭘ و مﻮ ي رﻮﻧ ﻳ ﺖـﻓﺎﺑ ناﻮـﻨﻋ ﻪﺑ مﻮ ﻣﺮﺗ ﺐﺼﻋ فاﺮﻃا ﺪﻨﺒﻤﻫ
ﻴ ﻨﭽﻤﻫ و هﺪﺷ ﻢ ﻴ
نﻮﺴﻛا ﻦ ﺎﻫ
ي ﻣﺮـﺗ ﻴ ﻢ
ﻣ فﻼﻏ هاﺮﻤﻫ ﻪﺑ هﺪﺷ ﻴ
ﻠ ﻴ ـ
وﺎـﺼﺗ رد ﺎـﻬﻧآ ﻦ ﻳ
د ﺮ ـﻳ ـﻣ هﺪ ﻲ دﻮـﺷ
) ﺮﻳﻮﺼﺗ 1 ( . ﺼﺗ رد ﺎ و ﻳ قوﺮﻋ ﺮ ﻧﻮﺧ ﻲ ﻜـﺸﺗ ﻴ ﺖـﻓﺎﺑ نورد هﺪـﺷ ﻞ
ﻣﺮﺗ ﻴ ﻧ هﺪﺷ ﻢ ﻴ د حﻮﺿو ﻪﺑ ﺰ ﻳ
ﻣ هﺪ ﻲ ﺪﻧﻮـﺷ . ﺗ طﺎـﻘﻧ ـﻴ رد ﮓـﻧر هﺮ
ﻪﻧﻮﻤﻧ ﻂﺳو ﺎﻫ
ي ﺘﻓﺎﺑ ﻲ ﺗرآ ، ﻴ ﻣ ﺖﻜﻔ ﻲ ﺪﻨﺷﺎﺑ .
ﺚﺤﺑ ﻪﺠﻴﺘﻧ و يﺮـﻴﮔ
ﻃ رد ﻲ ﺑ نﺮﻗ ﻴ
ﻏ داﻮـﻣ ﻢﺘـﺴ ـﻴ
ﺑ ﺮ ﻴ ژﻮﻟﻮ ـﻳ ﺮﺘـﺳا ﺪـﻨﻧﺎﻣ ﻚ
زﻮﻟﻮﻠﺳ ي
، ﺗ ﻴ ﺗﻻژ بﻮ ﻴ ﻨ ﻲ ﺘﺳﻻ و ﻴ ﻜ ﻲ ﻨﭽﻤﻫ و ﻴ ﺑ داﻮﻣ ﻦ ﻴ ژﻮﻟﻮ ـﻳ ﻚ
رو ﺪﻨﻧﺎﻣ ﻳ
،ﺪ
،ﺐﺼﻋ ﻪﻠﻀﻋ ﻨﻣآ و ﻴ ﻣﺮﺗ رد نﻮ ﻴ
ﺤﻣ بﺎﺼﻋا ﻢ ﻴ
ﻄ ﻲ رد
لﺪﻣ ﺎﻫ ي ﺎﻣزآ ﻳ ﻫﺎﮕﺸ ﻲ
ﺖـﺳا هﺪـﺷ هدﺎﻔﺘﺳا .
ـﻃ ﻲ لﺎـﺳ ﺪـﻨﭼ
زا هدﺎﻔﺘﺳا ﻪﺘﺷﺬﮔ ﻨﻣآ هدﺮﭘ
ﻴ ﻣﺮﺗ رد نﻮ ﻴ
ﺤﻣ بﺎﺼﻋا ﻢ ﻴ
ﻄ ﻲ رﻮـﻄﺑ
هدﺮﺘﺴﮔ ا ي ﺗ و ﺖﺳا هﺪﺷ حﺮﻄﻣ ﺄ
ﺛ ﻴ ﺳاﺮﻧژ ﺮﺑ نآ ﺮ ﻴ
ﺒـﺼﻋ نﻮ ﻲ
ﺎـﺑ
شور ﺎــﻫ ي ﻟﺎــﻧآ ﻴ ﻫ ﺰ ﻴ ﻮﻟﻮﺘــﺴ ژ ﻳ ﻧﻮــﺴﻛآ شرﺎﻤــﺷ ﻞﻣﺎــﺷ ﻚ ﻲ
،
هزاﺪﻧا ﮔ ﻴ ﺮ ي ﻣ ﺖﻣﺎﺨﺿ ﻴ
ﻠ ﻴ
،ﻦ دﺮﻜﻠﻤﻋ دﻮﺒﻬﺑ ي
ﻣوﺮﺘﻜﻟا و ﻴ ﻓاﺮﮔﻮ ﻲ
ﺳرﺮﺑ ﻲ دﺮﮔ ﻳ ﺖﺳا هﺪ .
ﻨﻣآ هدﺮﭘ ﻴ ﻣﺮﺗ رد ترﻮﺻ ود ﻪﺑ نﻮ ﻴ
ﻢ ا لﺪـﻣ رد بﺎﺼﻋ ﺎـﻫ
ي
ﺣ ﻴ ﻧاﻮ ﻲ
ﺖـﺳا ﻪـﺘﻓر رﺎﻜﺑ :
ﻨﻣآ هدﺮـﭘ ـﻴ
ـﺑ نﻮ ﻪ
ﻪـﻟﻮﻟ ترﻮـﺻ ا
ي
) (Amniotic Tube ﺑ
ﻴ د ﻪﻌﻄﻗ ود ﻦ ﻳ
ﺰﮔوﺮﭘ و لﺎﺘﺴ ﻳ
ﺐـﺼﻋ لﺎـﻤ
ﻄﻗ ـ ـﻗ هﺪﺷ ﻊ ـ
ـﻣ هداد راﺮ ﻲ
ـﺷ ـ دﻮ مود ﻞﻜـﺷ رد و ﻻ
ـﻳ ﻪ ا ي زا
آ ﻨﻣ ﻴ نﻮ ) (Amniotic Covering ﭼﻮﺳ فاﺮﻃا رد
ﻮ راﺮـﻗ ﺐﺼﻋ ر
ﻣ هداد ﻲ دﻮﺷ . ﻪﻌﻟﺎﻄﻣ رد Zhang Q
ﻧارﺎـﻜﻤﻫ و ﺶ
لﺎـﺳ رد ﻪـﻛ 2006
رد
ﭼ رﻮﺸﻛ ﻴ ﻨﻣآ ءﺎﺸﻏ ﻪﻛ هﺪﺷ هداد نﺎﺸﻧ ﺖﺳا هﺪﺷ مﺎﺠﻧا ﻦ ـﻴ
نﻮ
ﺎﺘﻧ رد ﻳ ﻣﺮﺗ ﺮﺘﻬﺑ ﺞ ﻴ
ﺖﺳا ﺮﺛﺆﻣ ﺐﺼﻋ ﻢ
12.
ﻤﻫ ﭽ ﻨ ﻴ ﻪﻌﻟﺎﻄﻣ رد ﻦ Henry FP
ﻧارﺎﻜﻤﻫ و ﺶ لﺎـﺳ رد ﻪـﻛ
2009 ا رد ﻳ ﺎ ور ﺮﺑ هﺪﺤﺘﻣ تﻻ ي
شﻮﮔﺮﺧ ﺎـﻫ ي ﻔـﺳ ﻴ ﻧ ﺪ ﻴ ﺪـﻨﻟزﻮ ي
ﺗرﻮـﺻ رد ﻪﻛ ﺪﺷ هداد نﺎﺸﻧ ﺖﺳا هﺪﺷ مﺎﺠﻧا ﻴ
ﻣﺮـﺗ ﻞـﺤﻣ ﻪﻜ ﻴ
ﻢ
ﻨﻣآ هدﺮﭘ ﺎﺑ كﺮﺘﺸﻣ لﺎﻧوﺮﭘ ﺐﺼﻋ ﻴ
ﻧﻮ ﻲ ظﺎﺤﻟ زا ﻢﻫ دﻮﺷ هﺪﻧﺎﺷﻮﭘ
ﻫ ﻴ ژﻮﻟﻮﺘﺴ ﻳ ﻓوﺮﺘﻜﻟا ظﺎـﺤﻟ زا ﻢﻫ و ﻚ ﻴ
ژﻮﻟوﺰ ـﻳ ﺎـﺘﻧ ﻚ ﻳ ﻣﺮـﺗ ﺞ ﻴ ﻢ
ﺮﺘﻬﺑ ي ﺖﺷاد ﺪﻫاﻮﺧ
14.
ﻪــﻌﻟﺎﻄﻣ Mohammad J ﻧارﺎــﻜﻤﻫ و
ﺶ لﺎــﺳ رد 2000
رد
اﻳ ﻟد ،هﺪﺤﺘﻣ تﻻﺎ ﻴ
ا ﻞ ـﻳ ﺛﺄـﺗ ﻦ ﻴ
ﻨﻣآ ءﺎـﺸﻏ ﺖـﺒﺜﻣ ﺮ ـﻴ
ﻧﻮ ﻲ رد ار
ﺎﻫرﻮﺘﻛﺎﻓ ي ﭘوﺮﺗورﻮﻧ ﻴ ﺖﺳا ﻪﺘﺴﻧاد نآ ﻚ
11.
ﺮﻳﻮﺼﺗ ۱ ـ ﻣ ﻞﻜﺷ ﻴ ﺳ ﺐﺼﻋ ﺯﺍ ﯽﭘﻮﻜﺳﻭﺮﻜ ﻴ
ﺗﺎ ﻴ ﻣﺮﺗ ﻚ ﻴ ﻩﻭﺮﮔ ﺭﺩ ﻩﺪﺷ ﻢ ﻪﻧﺎﮔ ﻪﺳ ﯼﺎﻫ
۱۲ ﻪﺘﻔﻫ ﺲﭘ ﯽﺣﺍﺮﺟ ﺯﺍ ) ﺑ ﺎﻤﻨﮔﺭﺰ ﻳ ﯽ
× ۸۰ ﻭ
× ۱۰۰ ﻣﺁ ﮓﻧﺭ ، ﻴ ﻮﺗ ﯼﺰ ﺋﻮﻟ ﻴ ﺪ ﻳ ﻮﻠﺑ ﻦ (
ﻪﻌﻟﺎﻄﻣ سﺎﺳا ﺮﺑ Ozgenel GY
و ﻧارﺎﻜﻤﻫ ﺶ لﺎـﺳ رد 2004
ﻛﺮﺗ رﻮﺸﻛ رد ﻴ
ور ﺮـﺑ ﻪﻛ ﻪ ي
ﻪـﻛ ﺪـﻧداد نﺎـﺸﻧ ﺪـﺷ مﺎـﺠﻧا تر
ﻔﺘﺳا ـ ﻨﻣآ هدﺮﭘ زا مأﻮﺗ هدﺎ ﻴ
ـﺳا و نﻮ ﻴ
ﻫ ﺪ ﻴ ﻧورﻮﻟﺎ ـﻴ ا زا ﻚ ﻳ دﺎـﺠ
ﭘ ﺐﺼﻋ فاﺮﻃا رﺎﻜﺳا ﻴ
ﮕﺸ ﻴ ﺮ ي ﻣ ﻲ ﺪﻨﻛ
13. ﺎﺘﻧ ﺎﺑ ﻪﺑﺎﺸﻣ ﻳ
ﻪـﻌﻟﺎﻄﻣ ﺞ
ﻪﻌﻟﺎﻄﻣ رد ،ﺎﻣ Schroeder
ﻜﻤﻫ و ﻧارﺎ ﺶ رد لﺎﺳ 2007 رﻮـﺸﻛ رد
ا نﺎﻤﻟآ ﻳ ﺛﺄﺗ ﻦ ﻴ ﺑﻮﺧ ﻪﺑ ﺖﺒﺜﻣ ﺮ ﻲ
هﺪﺷ هداد نﺎﺸﻧ ﺖﺳا
15. ﻠﻛ رﻮﻃ ﻪﺑ
ﻲ ، ﺘﻧ ـ ﺎ ﻳ ا زا ﻞﺻﺎﺣ ﺞ ـﻳ
ﻘﺤﺗ ﻦ ـﻴ ـ ﻖ ـﺘﺳار رد ـ ﺎ ي
ﺎﺘﻧ ﻳ ﻘﺤﺗ ﺞ ﻴ ﻘ ـ ﺸﻧ ﻪﺑﺎﺸﻣ تﺎ ـ
ﻣ نﺎ ﻲ ﻫد ـ ﻔﺘﺳا ﻪﻛ ﺪ ـ
ـﭘ زا هدﺎ ـ هدﺮ
ﻨﻣآ ﻴ ﺘﺣ نﻮ ـ ﻲ ﺷﻮﭘ ترﻮﺻ ﻪﺑ ـ
ﻣﻮﺘﺳﺎﻧآ ﻞﺤﻣ رد ﺶ ـ
ـﺒﺼﻋ زﻮ ـ ﻲ
ﻣ ﻲ
ـﺘﻣارﺎﭘ ﺪـﻧاﻮﺗ ـ
ﺎﻫﺮ ي ﻣﺮﺗ ـﻴ ـ ﺒـﺼﻋ ﻢ ﻲ ﺪـﻨﻧﺎﻣ
،SFI وEMG
ﻧﻮـﺴﻛآ شرﺎﻤﺷ ﻲ
ـﻄﺑ ار ـ ـﻨﻌﻣ رﻮ ﻲ راد ي
ـﺑﺮﺠﺗ لﺪـﻣ رد ﻲ
تر
اﺰﻓا ﻳ ﺪﻫد ﺶ .
Abstract:
Comparison between the Effect of Amniotic Membrane and Vein Conduit in Nerve Repair - Animal Study
Forootan S.K. MD*, Abde Yazdani A. MD**, Akbari H MD***, Fatemi M. J. MD* Pedram M. S MD****, Mosavi S. J. MD*****
(Received: 19 June 2010 Accepted: 1 March 2011)
Introduction & Objective:Annually, a lot of patients experience motor problems due to nerve lesions.
Reviving the muscle activity is essential to bodily function. There are a variety of methods which can be adopted to repair motor difficulties. The aim of this study was to compare and contrast the three methods of invasive transplantation surgery, namely: end-to-end alone, end-to-end coverage with vein tube and coverage with amniotic membrane.
Materials & Methods: 36 male rats weighing 250-350 grams, and of the same breed were randomly divided into three equal groups. After being treated with anesthesia, the sciatic nerve in all three examined rat groups was cut. Surgery was performed on the three groups of rats, using the three mentioned invasive methods. The first group of rats were operated upon using two suture ends, the second group was operated upon using the amniotic membrane, and for the third group, the venous conduit was used. Twelfth weeks after surgery, EMG was used to determine the restoration of nerve function. For each rat axon counted.
Furthermore, the Foot Print test was used in the first and the Twelfth weeks to determine nerve function.
Paired sample t-test was used to compare the results of the first and twelfth weeks, and one way Anova test used to compare the results of the three groups.
Results: The results of this research indicate that the foot print gradually improved in all three groups.
There were significant statistical differences between end to end anastomosis with amniotic membrane coverage (-53.75+/-19.75) and simple end to end anastomosis (-79.68/+-11.79) groups in the 12th week (P=0.017). The best electrophysiological result was in the end to end anastomosis with amniotic coverage group. The electrophysiological results indicate that there are significant statistical differences between end to end anastomosis with amniotic membrane coverage and end to end anastomosis with vein conduit coverage groups (P=0.044). The histological results showed that the most axonal count were in the end to end anastomosis with amniotic membrane coverage group. The axonal count indicate that there were significant statistical differences between end to end anastomosis with amniotic membrane coverage and end to end anastomosis with vein conduit coverage groups (P=0.041).
Conclusions: The result of this research, in line with results from similar studies, confirms a significant and beneficially effective Amniotic membrane on nerve grafts as compared with other grafts.
Key Words: Nerve Graft, Amniotic Membrane, Electromyography
*Associate Professor of Plastic Surgery, Iran University of Medical Sciences and Health Services, Hazrate Fateme Hospital, Tehran, Iran
**Resident of Plastic Surgery, Iran University of Medical Sciences and Health Services, Hazrate Fateme Hospital, Tehran, Iran
***Assistant Professor of Plastic Surgery, Iran University of Medical Sciences and Health Services, Hazrate Fateme Hospital, Tehran, Iran
****Assistant Professor of Veterinary, Iran University of Medical Sciences and Health Services, Hazrate Fateme Hospital, Tehran, Iran
*****
Preventive and Community Medicine Specialist, Tehran University of Medical Sciences, Tehran, Iran
References:
1. Malizos KN, Dailiana ZH, Anastasiou EA, Sarmas I،
Soucacos PN. Neuromas and gaps of sensory nerves of the hand: management using vein conduits. Am J Orthop. 1997 Jul; 26(7): 481-5.
2. Zhang F, Blain B, Beck J, Zhang J, Chen Z، Chen ZW, Lineaweaver WC. Autogenous venous graft with one-stage prepared Schwann cells as a conduit for repair of long segmental nerve defects.J Reconstr Microsurg. 2002 May; 18(4): 295-300.
3. Tos P, Battiston B, Nicolino S, Raimondo S, Fornaro M, Lee JM, Chirila L, Geuna S, Perroteau I.
Comparison of fresh and predegenerated muscle- vein-combined guides for the repair of rat median nerve. Microsurgery. 2007 Jan 8; 27(1): 48-55.
4. Jiang B, Zhang P, Zhang D, Fu Z, Yin X, Zhang H.
Study on small gap sleeve bridging peripheral nerve injury. Artif Cells Blood Substit Immobil Biotechnol.
2006; 34(1): 55-74.
5. Mersa B, Agir H, Aydin A, Sen C. Comparison of expanded polytetrafluoroethylene (ePTFE) with autogenous vein as a nerve conduit in rat sciatic nerve defects. Kulak Burun Bogaz Ihtis Derg. 2004; 13(5- 6): 103-11.
6. Keskin M, Akbas H، Uysal OA, Canan S, Ayyldz M،
Agar E, Kaplan S. Enhancement of nerve regeneration and orientation across a gap with a nerve graft within a vein conduit graft: a functional،
stereological, and electrophysiological study. Plast Reconstr Surg. 2004 Apr 15; 113(5): 1372-9.
7. Tseng CY, Hu G, Ambron RT, Chiu DT. Histologic analysis of Schwann cell migration and peripheral nerve regeneration in the autogenous venous nerve conduit (AVNC). J Reconstr Microsurg. 2003 Jul;
19(5): 331-40.
8. Geuna S, Raimondo S, Nicolino S, Boux E, Fornaro M, Tos P, Battiston B, Perroteau I. Schwann-cell proliferation in muscle-vein combined conduits for bridging rat sciatic nerve defects.J Reconstr Microsurg. 2003 Feb; 19(2): 119-23.
9. Karacaoglu E, Yuksel F, Peker F, Guler MM. Nerve regeneration through an epineurial sheath: its functional aspect compared with nerve and vein grafts. Microsurgery. 2001; 21(5): 196-201.
10. Battiston B, Tos P, Cushway TR, Geuna S. Nerve repair by means of vein filled with muscle grafts I.
Clinical results. Microsurgery. 2000; 20(1): 32-6.
11. Mohammad J, Shenaq J, Rabinovsky E, Shenaq S.
Modulation of peripheral nerve regeneration: a tissue- engineering approach. The role of amnion tube nerve conduit across a 1-centimeter nerve gap. Plast Reconstr Surg. 2001 Feb; 107(2): 622-3.
12. Zhang Q, Gu XM, Yu GY, Mao TQ, Zheng JC, Tong QY. Repair of peripheral nerve defect by a scroll of amnion derivative compound with cultured autogenous Schwann cell in a rat model. Department of Stomatology, General Hospital of Chinese People's Armed Police Force، Beijing 100039, China. 2006 Feb; 41(2): 98-101.
13. Ozgenel GY, Filiz G. Combined application of human amniotic membrane wrapping and hyaluronic acid injection in epineurectomized rat sciatic nerve.
Department of Plastic and Reconstructive Surgery،
Division of Hand Surgery, Uludağ University Medical School, 16059 Görükle, Bursa, Turkey. 2004 Feb; 20(2): 153-7.
14. Henry FP, Goyal NA, David WS, Wes D، Bujold KE, Randolph MA, Winograd JM, Kochevar IE،
Redmond RW, Improving electrophysiologic and histologic outcomes by photochemically sealing amnion to the peripheral nerve repair site, Plastic Surgery Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA, 2009 Mar;145(3): 313-21.
15. Schroeder A, Theiss C, Steuhl KP, Meller K, Meller D. Effects of the human amniotic membrane on axonal outgrowth of dorsal root ganglia neurons in culture. Department of Cytology, Institute of Anatomy, Ruhr-University Bochum, Bochum, Germany. 2007 Sep; 32(9):731-8.