1. No category

‫ﻣﻘﺎﻟﻪ‬
‫ﮔﺎﻥ‬
‫ﻧﺎﻡ ﻧﻮﻳﺴﻨﺪ‬
‫ﺗﺤﻘﻴﻘﺎﺗﻲ‬
‫ﻣﺠﻠﻪ ﻋﻠﻤﻲ ﭘﮋﻭﻫﺸﻲ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﺍﺭﺗﺶ ﺟﻤﻬﻮﺭﻱ ﺍﺳﻼﻣﻲ ﺍﻳﺮﺍﻥ‬
‫ﺷﻤﺎﺭﻩ ‪4‬‬
‫ﺳﺎﻝ ﻫﺸﺘﻢ‬
‫ﺻﻔﺤﺎﺕ ‪ 277‬ﺗﺎ ‪282‬‬
‫ﺯﻣﺴﺘﺎﻥ ‪1389‬‬
‫ﺑﺮﺭﺳﻲ ﺗﺎﺛﻴﺮ ﺗﺴﺖ ﻓﺎﻳﺮ )‪ (Fair‬ﺑﺮ ﺭﻭﻱ ﺭﻓﻠﻜﺲ ‪ H‬ﻋﻀﻠﻪ ﮔﺎﺳﺘﺮﻭﻛﻨﻤﻴﻮﺱ‬
‫ﺩﺭ ﻣﺒﺘﻼﻳﺎﻥ ﺑﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻭﻣﻘﺎﻳﺴﻪﻱ ﺁﻥ ﺑﺎ ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ‬
‫ﺩﻛﺘﺮ ﺷﺮﻳﻒ ﻧﺠﻔﻰ‪ ،1‬ﺩﻛﺘﺮ ﻛﺎﻣﺮﺍﻥ ﺁﺯﻣﺎ‪ ،2‬ﺩﻛﺘﺮ ﺳﻴﺮﻭﺱ ﻋﺰﻳﺰﻯ‪* ،3‬ﺩﻛﺘﺮ ﻋﻠﻴﺮﺿﺎ ﻋﻤﺎﺩﻯ‪ ،4‬ﺩﻛﺘﺮ ﺍﺣﻤﺪ ﻣﺤﻤﻮﺩ ﺁﺑﺎﺩﻯ‪ ،5‬ﺩﻛﺘﺮ ﺳﻴﻤﻴﻦ ﺳﺠﺎﺩﻯ‬
‫ﺗﺎﺭﻳﺦ ﺍﻋﻼﻡ ﻭﺻﻮﻝ‪89/5/13 :‬‬
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‫ﺗﺎﺭﻳﺦ ﺍﻋﻼﻡ ﻗﺒﻮﻟﻰ ﻣﻘﺎﻟﻪ‪89/9/20 :‬‬
‫ﭼﻜﻴﺪﻩ‬
‫ﺳﺎﺑﻘﻪ ﻭﻫﺪﻑ‪ :‬ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻳﻜﻲ ﺍﺯ ﻋﻠﻞ ﺩﺭﺩﻫﺎﻱ ﺳﻴﺎﺗﻴﻚ )ﺳﻴﺎﺗﻴﻜﺎ( ﻣﻲﺑﺎﺷﺪ‪ .‬ﺍﻳﻦ ﺳﻨﺪﺭﻡ ﻣﺘﻌﺎﻗﺐ ﺍﻳﺠﺎﺩ ﻓﺸﺎﺭ ﻋﻀﻠﻪ‬
‫ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻭﻳﺎ ﻓﺎﺷﻴﺎﻱ ﺁﻥ ﺑﺮ ﺭﻭﻱ ﻋﺼﺐ ﺳﻴﺎﺗﻴﻚ ﻳﺎ ﻗﺴﻤﺘﻲ ﺍﺯ ﻋﺼﺐ ﺳﻴﺎﺗﻴﻚ‪ ،‬ﺩﺭ ﻣﺤﻞ ﻋﺒﻮﺭ ﻋﺼﺐ ﺍﺯ ﺷﻴﺎﺭ ﺳﻴﺎﺗﻴﻚ ﺑﺰﺭگ‬
‫ﻟﮕﻦ ﺍﻳﺠﺎﺩ ﻣﻲﮔﺮﺩﺩ‪ .‬ﻋﻠﻴﺮﻏﻢ ﺍﻳﻨﻜﻪ ﺍﻳﻦ ﺑﻴﻤﺎﺭﻱ ﺍﺯ ﺳﺎﻟﻬﺎ ﭘﻴﺶ ﺷﻨﺎﺧﺘﻪ ﺷﺪﻩ ﺍﺳﺖ‪ ،‬ﻭﻟﻲ ﻫﻨﻮﺯ ﺣﺘﻲ ﺭﻭﺵﻫﺎﻱ ﺗﺸﺨﻴﺼﻲ ﭘﻴﺸﺮﻓﺘﻪﺍﻱ‬
‫ﻫﻤﭽﻮﻥ ‪ MRI، CT-scan‬ﻭ ﺗﺴﺖﻫﺎﻱ ﺍﻟﻜﺘﺮﻭﻓﻴﺰﻳﻮﻟﻮژﻱ ﺩﺭ ﺗﺸﺨﻴﺺ ﻗﻄﻌﻲ ﺁﻥ ﻣﺤﺪﻭﺩﻳﺖ ﺩﺍﺭﻧﺪ‪ .‬ﻫﺪﻑ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﺑﺮﺭﺳﻲ ﻳﻚ ﺭﻭﺵ‬
‫ﺗﺸﺨﻴﺼﻲ ﻏﻴﺮ ﺗﻬﺎﺟﻤﻲ ﺍﻟﻜﺘﺮﻭﺩﻳﺎﮔﻨﻮﺳﺘﻴﻚ ﺟﻬﺖ ﺗﺸﺨﻴﺺ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻣﻲﺑﺎﺷﺪ‪.‬‬
‫ﻣﻮﺍﺩ ﻭ ﺭﻭﺵﻫﺎ‪ :‬ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﻳﻚ ﻣﻄﺎﻟﻌﻪ ‪ Case -Control‬ﻣﻲﺑﺎﺷﺪ‪ .‬ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ‪ 15‬ﺍﻧﺪﺍﻡ ﺗﺤﺘﺎﻧﻲ ﻣﺒﺘﻼ ﺑﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ )ﺍﺯ ‪14‬‬
‫ﻧﻔﺮ( ﺑﺎ ‪ 19‬ﺍﻧﺪﺍﻡ ﺗﺤﺘﺎﻧﻲ ﺳﺎﻟﻢ ﻛﻨﺘﺮﻝ )ﺍﺯ ‪ 16‬ﻧﻔﺮ( ﺑﺮﺭﺳﻲ ﺷﺪﻧﺪ‪ 7 .‬ﻋﺪﺩ ﺍﺯ ﭘﺎﻫﺎﻱ ﻛﻨﺘﺮﻝ‪ ،‬ﭘﺎﻱ ﻣﻘﺎﺑﻞ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ‬
‫ﺑﻮﺩ‪ .‬ﺍﻓﺮﺍﺩ ﺩﻭﮔﺮﻭﻩ ﺍﺯ ﻧﻈﺮ ﺳﻦ ﻭﺟﻨﺲ ﻫﻤﺴﺎﻥ ﺳﺎﺯﻱ ﺷﺪﻩ ﺑﻮﺩﻧﺪ‪ .‬ﺍﺯ ﻫﺮ ﺩﻭﮔﺮﻭﻩ ﺭﻓﻠﻜﺲ ‪ H‬ﺑﻪ ﻃﺮﻳﻖ ﻧﺮﻣﺎﻝ )ﻭﺿﻌﻴﺖ ‪ (Prone‬ﻭﺩﺭ ﺣﺎﻟﺖ‬
‫‪ (Flexion – adduction – internal rotation) FAIR‬ﮔﺮﻓﺘﻪ ﻭ ﺳﭙﺲ ﺍﻃﻼﻋﺎﺕ ﺩﺭ ﻧﺮﻡ ﺍﻓﺰﺍﺭ ‪ SPSS‬ﻭﻳﺮﺍﻳﺶ‪ 16‬ﺗﺤﺖ ﻣﻄﺎﻟﻌﺎﺕ ﺁﻣﺎﺭﻱ ﻗﺮﺍﺭ‬
‫ﮔﺮﻓﺖ‪.‬‬
‫ﻳﺎﻓﺘﻪﻫﺎ‪ :‬ﺍﺯ ﻧﻈﺮ ﺗﻔﺎﻭﺕ ‪ LATENCY‬ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﺩﻭ ﺣﺎﻟﺖ ﻭﺿﻌﻴﺖ ﻧﺮﻣﺎﻝ ﻭ ‪ FAIR‬ﺍﺧﺘﻼﻑ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺑﻴﻦ ﮔﺮﻭﻩ ﺑﻴﻤﺎﺭ ﺑﺎ ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ‬
‫ﺳﺎﻟﻢ ﺩﻳﺪﻩ ﺷﺪ ﻭﻟﻲ ﺍﺯ ﻧﻈﺮ ﺗﻔﺎﻭﺕ ﺩﺍﻣﻨﻪ )‪ (Amplitude‬ﺭﻓﻠﻜﺲ ‪ H‬ﺍﺧﺘﻼﻑ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺑﻴﻦ ﺩﻭ ﮔﺮﻭﻩ ﺩﻳﺪﻩ ﻧﺸﺪ‪ .‬ﻣﺘﻮﺳﻂ ﺍﻓﺰﺍﻳﺶ ﻭﺗﺎﺧﻴﺮ‬
‫ﺩﺭ ‪ LATENCY‬ﺭﻓﻠﻜﺲ ‪ 2/346 ms H‬ﺑﻮﺩ‪.‬‬
‫ﺑﺤﺚ ﻭ ﻧﺘﻴﺠﻪﮔﻴﺮﻱ‪ :‬ﺗﺴﺖ ﻓﺎﻳﺮ ﺑﺎﻋﺚ ﺍﻓﺰﺍﻳﺶ ﻭﺗﺎﺧﻴﺮ ﺩﺭ ‪ LATENCY‬ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻣﻲﮔﺮﺩﺩ‪.‬‬
‫ﻛﻠﻤﺎﺕ ﻛﻠﻴﺪﻱ‪ :‬ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ‪ ،‬ﺭﻓﻠﻜﺲ ‪ ،H‬ﺗﺴﺖ ﻓﺎﻳﺮ‬
‫ﻣﻘﺪﻣﻪ‬
‫ﻓﻮﻗﺎﻧﻲ – ﺩﺍﺧﻠﻲ ﺗﺮﻭﻛﺎﻧﺘﺮ ﺑﺰﺭگ ﺍﺳﺘﺨﻮﺍﻥ ﻓﻤﻮﺭ ﻣﻲﭼﺴﺒﺪ )ﺷﻜﻞ‪.(1‬‬
‫ﻋﻀﻠﻪ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻳﻚ ﻋﻀﻠﻪ ﭘﻬﻦ ﻭﻫﺮﻣﻲ ﺷﻜﻞ ﺑﻮﺩﻩ ﻛﻪ ﺍﺯ ﺳﻄﺢ‬
‫ﻭﺍﺭﻳﺎﺳﻴﻮﻧﻬﺎﻱ ﺁﻧﺎﺗﻮﻣﻴﻚ ﻣﺘﻌﺪﺩﻱ ﺑﻴﻦ ﻋﺼﺐ ﺳﻴﺎﺗﻴﻚ ﻭﻋﻀﻠﻪ‬
‫ﻭﻧﺘﺮﻭﻟﺘﺮﺍﻝ ﻣﻬﺮﻩﻫﺎﻱ ‪ S2-S4‬ﻣﻬﺮﻩﻫﺎﻱ ﺳﺎﻛﺮﻭﻡ ﻧﺸﺄﺕ ﮔﺮﻓﺘﻪ ﻭﺳﭙﺲ‬
‫ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺩﻳﺪﻩ ﺷﺪﻩ ﺍﺳﺖ )‪ .(1‬ﺩﺭ ﺗﻘﺮﻳﺒ ًﺎ ‪ %20‬ﺟﺎﻣﻌﻪ‪ ،‬ﻋﻀﻠﻪ‬
‫ﺍﺯ ﺷﻴﺎﺭ ﺳﻴﺎﺗﻴﻚ ﺑﺰﺭگ ﻭﺧﻠﻒ ﻋﺼﺐ ﺳﻴﺎﺗﻴﻚ ﻋﺒﻮﺭ ﻛﺮﺩﻩ ﻭﺑﻪ ﺳﻄﺢ‬
‫ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺗﻮﺳﻂ ﻋﺼﺐ ﺳﻴﺎﺗﻴﻚ ﻭﻳﺎ ﻗﺴﻤﺘﻲ ﺍﺯ ﺁﻥ ﺑﻪ ﺩﻭ ﻗﺴﻤﺖ‬
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‫ﺍﺳﺘﺎﺩﻳﺎﺭ‪ ،‬ﺍﻳﺮﺍﻥ ‪،‬ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻰ ﺁﺟﺎ‪ ،‬ﮔﺮﻭﻩ ﻃﺐ ﻓﻴﺰﻳﻜﻰ ﻭ ﺗﻮﺍﻥﺑﺨﺸﻰ‪ ،‬ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺍﻣﺎﻡ ﺭﺿﺎ)ﻉ(‬
‫ﺍﺳﺘﺎﺩﻳﺎﺭ‪ ،‬ﺍﻳﺮﺍﻥ ‪،‬ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻰ ﺁﺟﺎ‪ ،‬ﮔﺮﻭﻩ ﻃﺐ ﻓﻴﺰﻳﻜﻰ ﻭ ﺗﻮﺍﻥﺑﺨﺸﻰ‪ ،‬ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺍﻣﺎﻡ ﺭﺿﺎ)ﻉ(‬
‫ﺍﺳﺘﺎﺩﻳﺎﺭ‪ ،‬ﺍﻳﺮﺍﻥ ‪،‬ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻰ ﺁﺟﺎ‪ ،‬ﮔﺮﻭﻩ ﻃﺐ ﻓﻴﺰﻳﻜﻰ ﻭ ﺗﻮﺍﻥﺑﺨﺸﻰ‪ ،‬ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺍﻣﺎﻡ ﺭﺿﺎ)ﻉ(‬
‫ﭘﮋﻭﻫﺸﮕﺮ‪ ،‬ﻣﺘﺨﺼﺺ ﻃﺐ ﻓﻴﺰﻳﻜﻰ ﻭ ﺗﻮﺍﻥﺑﺨﺸﻰ ‪ ،‬ﺍﻳﺮﺍﻥ ‪،‬ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻰ ﺁﺟﺎ‪ ،‬ﮔﺮﻭﻩ ﻃﺐ ﻓﻴﺰﻳﻜﻰ ﻭ ﺗﻮﺍﻥﺑﺨﺸﻰ‪ ،‬ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺍﻣﺎﻡ ﺭﺿﺎ)ﻉ( )*ﻧﻮﻳﺴﻨﺪﻩ ﻣﺴﻮﻭﻝ(‬
‫ﺁﺩﺭﺱ ﺍﻟﻜﺘﺮﻭﻧﻴﻚ‪Dremady@yahoo.com :‬‬
‫ﺗﻠﻔﻦ‪021-85953476 :‬‬
‫ﭘﮋﻭﻫﺸﮕﺮ‪ ،‬ﻣﺘﺨﺼﺺ ﻃﺐ ﻓﻴﺰﻳﻜﻰ ﻭ ﺗﻮﺍﻥﺑﺨﺸﻰ ‪ ،‬ﺍﻳﺮﺍﻥ ‪،‬ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻰ ﺁﺟﺎ‪ ،‬ﮔﺮﻭﻩ ﻃﺐ ﻓﻴﺰﻳﻜﻰ ﻭ ﺗﻮﺍﻥﺑﺨﺸﻰ‪ ،‬ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺍﻣﺎﻡ ﺭﺿﺎ)ﻉ(‬
‫ﭘﮋﻭﻫﺸﮕﺮ‪ ،‬ﻣﺘﺨﺼﺺ ﻃﺐ ﻓﻴﺰﻳﻜﻰ ﻭ ﺗﻮﺍﻥﺑﺨﺸﻰ ‪ ،‬ﺍﻳﺮﺍﻥ ‪،‬ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻰ ﺁﺟﺎ‪ ،‬ﮔﺮﻭﻩ ﻃﺐ ﻓﻴﺰﻳﻜﻰ ﻭ ﺗﻮﺍﻥﺑﺨﺸﻰ‪ ،‬ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺍﻣﺎﻡ ﺭﺿﺎ)ﻉ(‬
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‫ﺳﺎﻝ ﻫﺸﺘﻢ‬
‫ﻣﺠﻠﻪ ﻋﻠﻤﻲ ﭘﮋﻭﻫﺸﻲ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﺍﺭﺗﺶ ﺟﻤﻬﻮﺭﻱ ﺍﺳﻼﻣﻲ ﺍﻳﺮﺍﻥ‬
‫ﺷﻤﺎﺭﻩ ‪4‬‬
‫ﺯﻣﺴﺘﺎﻥ ‪ 1389‬ﺷﻤﺎﺭﻩ ﻣﺴﻠﺴﻞ ‪32‬‬
‫ﻣﻲﺑﺎﺷﺪ ﻛﻪ ﺑﻌﺪ ﺍﺯ ﻭﺭﻭﺩ ﺑﻪ ﺷﺎﺥ ﺧﻠﻔﻲ ﻧﺨﺎﻉ ﺑﺎ ﻓﻴﺒﺮﻫﺎﻱ ﺣﺮﻛﺘﻲ‬
‫ﺁﻟﻔﺎ ﻛﻪ ﺑﻪ ﻋﻀﻠﻪ ﻋﺼﺐ ﺩﻫﻲ ﻣﻴﻜﻨﻨﺪ ﺳﻴﻨﺎﭘﺲ ﻣﻲﻛﻨﻨﺪ )‪ .(22 ،21‬ﺍﺯ‬
‫ﺟﻤﻠﻪ ﺧﺼﻮﺻﻴﺎﺕ ﻣﻬﻢ ﺭﻓﻠﻜﺲ ‪ H‬ﺛﺎﺑﺖ ﺑﻮﺩﻥ ﺯﻣﺎﻥ ﺷﺮﻭﻉ‬
‫‪(Onset‬‬
‫)‪ Latency‬ﻭ ﺷﻜﻞ ﻣﻮﺝ ﻭﻣﺘﻐﻴﺮ ﺑﻮﺩﻥ ﺩﺍﻣﻨﻪ )‪ (amplitude‬ﺁﻥ ﺑﺎ ﺗﻐﻴﻴﺮ‬
‫ﺷﺪﺕ ﻭﺗﺤﺮﻳﻚ ﺍﺳﺖ )‪.(23‬‬
‫ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﺍﻧﺪﺍﻡ ﺗﺤﺘﺎﻧﻲ ﺍﺯ ﻋﻀﻠﻪ ﮔﺎﺳﺘﺮﻭﻛﻨﻤﻴﻮﺱ – ﺳﻮﻟﺌﻮﺱ‬
‫ﻗﺎﺑﻞ ﺛﺒﺖ ﺍﺳﺖ ﻭﺩﺭ ﻃﻲ ﺍﻳﻦ ﻣﺴﻴﺮ ﺁﻭﺭﺍﻥ – ﻭﺍﺑﺮﺍﻥ ﺩﻭﺑﺎﺭ ﺍﺯ ﻋﻀﻠﻪ‬
‫ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻋﺒﻮﺭ ﻣﻲﻛﻨﺪ‪ .‬ﺍﺯ ﺁﻧﺠﺎﺋﻲ ﻛﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ‬
‫ﻳﻚ ﻋﺎﻣﻞ ﻓﺸﺎﺭ ﻓﻴﺰﻳﻜﻲ ﻭ ﻋﻤﻠﻜﺮﺩﻱ‬
‫‪(physical and functional‬‬
‫)‪ impingement‬ﺍﺳﺖ‪ ،‬ﭘﻴﺸﻨﻬﺎﺩ ﺷﺪﻩ ﺍﺳﺖ ﻛﻪ ﺑﺎ ﻗﺮﺍﺭ ﺩﺍﺩﻥ ﺍﻧﺪﺍﻡ ﺗﺤﺘﺎﻧﻲ‬
‫ﺩﺭ ﻭﺿﻌﻴﺖ ﻓﺎﻳﺮ )‪ (FAIR: flexion, adduction, internal rotation‬ﺑﺎﻋﺚ‬
‫ﺗﺸﺪﻳﺪ ﻋﻼﺋﻢ )‪ (25 ،24‬ﻭ ﺗﺸﺪﻳﺪ ﻓﺸﺎﺭ ﻋﻀﻠﻪ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺑﺮ‬
‫ﺷﻜﻞ‪ -1‬ﻧﻤﺎﻱ ﻋﻀﻠﻪ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺍﺯ ﺧﻠﻒ ﻟﮕﻦ‬
‫ﺭﻭﻱ ﻋﺼﺐ ﺳﻴﺎﺗﻴﻚ ﻳﺎ ﻗﺴﻤﺘﻲ ﺍﺯ ﺁﻥ ﺩﺭ ﺑﻴﻦ ﺩﻭ ﻗﺴﻤﺖ ﺗﺎﻧﺪﻭﻧﻲ ﻳﺎ‬
‫ﻋﻀﻼﻧﻲ ﻋﻀﻠﻪ ﻭﺩﺭ ﻧﺘﻴﺠﻪ ﻃﻮﻻﻧﻲ ﺷﺪﻥ ﺭﻓﻠﻜﺲ ‪ H‬ﮔﺮﺩﺩ‪(27-25) .‬‬
‫ﺗﻘﺴﻴﻢ ﻭﻋﺼﺐ ﺍﺯ ﺑﻴﻦ ﻋﻀﻠﻪ ﻣﻲﮔﺬﺭﺩ‪ ،‬ﻭ ﺩﺭ ‪ % 10‬ﺍﻓﺮﺍﺩ ﺟﺎﻣﻌﻪ ﺍﻋﺼﺎﺏ‬
‫ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﺑﺎ ﺑﺮﺭﺳﻲ ﺍﺛﺮ ﺗﺴﺖ ﻓﺎﻳﺮ ﺑﺮ ﺭﻭﻱ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺸﻜﻮﻙ ﺑﻪ‬
‫ﺗﻴﺒﻴﺎﻝ ﻭﭘﺮﻭﻧﺌﺎﻝ ﺩﺭ ﻳﻚ ﻏﻼﻑ ﻭﺩﺭ ﻧﺰﺩﻳﻜﻲ ﻫﻢ ﻧﻴﺴﺘﻨﺪ ﻭﻣﻌﻤﻮﻻً ﺩﺭ‬
‫ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻭﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ ﺳﻌﻲ ﺑﻪ ﺍﺭﺍﺋﻪ ﺭﻭﺷﻲ‬
‫ﺍﻳﻦ ﺣﺎﻟﺖ ﺍﻛﺜﺮﺍ ً ﻗﺴﻤﺖ ﭘﺮﻭﻧﺌﺎﻝ ﻭﺑﻨﺪﺭﺕ ﺗﻴﺒﻴﺎﻝ ﺧﻠﻔﻲ ﻭﺍﺭﺩ ﻋﻀﻠﻪ‬
‫ﺟﻬﺖ ﺗﺸﺨﻴﺺ ﺩﻗﻴﻖﺗﺮ ﻭ ﻏﻴﺮ ﺗﻬﺎﺟﻤﻲ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺩﺍﺭﺩ‪.‬‬
‫ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻣﻲﺷﻮﻧﺪ )‪.(8-1‬‬
‫ﻋﻀﻠﻪ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻣﻲﺗﻮﺍﻧﺪ ﺑﺎﻋﺚ ﺗﺤﺮﻳﻚ ﻭﻳﺎ ﻓﺸﺎﺭ ﺑﺮ ﺭﻭﻱ ﻋﺼﺐ‬
‫ﻣﻮﺍﺩ ﻭ ﺭﻭﺵﻫﺎ‬
‫ﺳﻴﺎﺗﻴﻚ ﻳﺎ ﻗﺴﻤﺘﻲ ﺍﺯ ﺁﻥ ﺩﺭ ﺣﻴﻦ ﻋﺒﻮﺭ ﺍﺯ ﻟﮕﻦ ﮔﺮﺩﻳﺪﻩ ﻭ ﺑﺎﻋﺚ‬
‫ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺍﺯ ﻧﻮﻉ ﻣﻮﺭﺩ‪-‬ﺷﺎﻫﺪ )‪ (case – control‬ﻣﻲﺑﺎﺷﺪ‪ .‬ﺩﺭ ﺑﺪﻭ ﺍﻣﺮ‬
‫ﻋﻼﺋﻢ ﺳﻴﺎﺗﻴﻜﺎ ﻭﺩﺭ ﻧﺘﻴﺠﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﮔﺮﺩﺩ‪ .‬ﺍﺯ‪ %0/25‬ﺗﺎ‬
‫ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﻄﺎﻟﻌﺎﺕ ﻗﺒﻠﻲ ﻭ ﻣﻄﺎﻟﻌﺎﺕ ﺁﻣﺎﺭﻱ ﺗﻌﺪﺍﺩ ‪ 15‬ﻧﻤﻮﻧﻪ ﺑﺪﺳﺖ‬
‫‪ %36‬ﻋﻠﻞ ﺳﻴﺎﺗﻴﻜﺎ ﺭﺍ ﻧﺎﺷﻲ ﺍﺯ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻣﻲﺩﺍﻧﻨﺪ )‪.(13-9‬‬
‫ﺁﻣﺪ )ﺷﺎﻣﻞ ‪ 1‬ﺑﻴﻤﺎﺭ ﺑﺎ ﺩﺭﮔﻴﺮﻱ ‪ 2‬ﭘﺎ ﻭ ‪ 13‬ﺑﻴﻤﺎﺭ ﺑﺎ ﺩﺭﮔﻴﺮﻱ ﻳﻚ ﭘﺎ(‪.‬‬
‫ﻭﻟﻲ ﻫﻴﭽﮕﻮﻧﻪ ﺍﺭﺟﺤﻴﺖ ﻭﺍﺿﺢ ﺳﻨﻲ ﻭﺟﻨﺴﻲ ﺑﺎﺭﺯ ﺩﻳﺪﻩ ﻧﺸﺪﻩ ﺍﺳﺖ‬
‫ﺟﺎﻣﻌﻪ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺷﻜﺎﻳﺖ ﺩﺭﺩ ﻧﺎﺣﻴﻪ ﮔﻠﻮﺗﺌﺎﻝ ﺑﻮﺩ ﻛﻪ‬
‫)‪.(14 ،10‬‬
‫ﺩﺭ ﻃﻲ ﺳﺎﻝ ‪ 1388‬ﺑﻪ ﺑﺨﺶ ﻃﺐ ﻓﻴﺰﻳﻜﻲ ﻭ ﺗﻮﺍﻥﺑﺨﺸﻰ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ‬
‫ﻣﺘﺎﺳﻔﺎﻧﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﻮﻗﻌﻴﺖ ﺍﻳﻦ ﻋﻀﻠﻪ ﺩﺭ ﻟﮕﻦ ﻭﻋﺪﻡ ﺩﺳﺘﺮﺳﻲ‬
‫ﺍﻣﺎﻡ ﺭﺿﺎ )ﻉ( ﻣﺮﺍﺟﻌﻪ ﻛﺮﺩﻩ ﺑﻮﺩﻧﺪ‪ .‬ﺑﻴﻤﺎﺭﺍﻥ ﺗﺤﺖ ﺑﺮﺭﺳﻲ ﺍﺯ ﻧﻈﺮ‬
‫ﻭﺑﺮﺭﺳﻲ ﻣﺴﺘﻘﻴﻢ ﺟﻬﺖ ﻣﻌﺎﻳﻨﻪ ﻭﻫﻢ ﭼﻨﻴﻦ ﻧﺒﻮﺩ ﻳﻚ ﺭﻭﺵ ﺗﺸﺨﻴﺼﻲ‬
‫ﺗﻨﺪﺭﻧﺲ ﻋﻤﻘﻲ ﺩﺭ ﻧﺎﺣﻴﻪ ﺷﻴﺎﺭ ﺳﻴﺎﺗﻴﻚ ﺑﺰﺭگ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﻭﺳﭙﺲ‬
‫ﻛﻠﻴﻨﻴﻜﻲ ﻳﺎ ﭘﺎﺭﺍﻛﻠﻴﻨﻴﻜﻲ ﻗﻄﻌﻲ ﺑﺮﺍﻱ ﺁﻥ‪ ،‬ﺍﻳﻦ ﺳﻨﺪﺭﻡ ﻫﻤﻮﺍﺭﻩ ﺑﺼﻮﺭﺕ‬
‫ﺩﺭ ﺻﻮﺭﺕ ﺷﻚ ﺑﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺍﺯ ﺗﺴﺖﻫﺎﻱ ﻛﻠﻴﻨﻴﻜﻲ‬
‫ﺗﺸﺨﻴﺼﻲ ﻧﺎﺷﻨﺎﺧﺘﻪ ﻭ ﻣﻮﺭﺩ ﺍﺧﺘﻼﻑ ﻧﻈﺮ ﺑﻮﺩﻩ ﻭﭘﺲ ﺍﺯ ﺭﺩ ﺑﻘﻴﻪ‬
‫‪ PACE‬ﻭ ‪ Freiberg‬ﻭﺩﺭ ﻧﻬﺎﻳﺖ ﺗﺴﺖ ﭘﺎﺭﺍﻛﻠﻴﻨﻴﻜﻲ ‪Nerve conduction‬‬
‫ﻋﻠﻞ ﺩﺭﺩ ﺳﻴﺎﺗﻴﻚ‪ ،‬ﻣﻄﺮﺡ ﻣﻴﮕﺮﺩﺩ )‪ .(19-15‬ﻳﻜﻰ ﺍﺯ ﺭﻭﺵﻫﺎﻱ‬
‫)‪ studying (NCS‬ﺟﻬﺖ ﺑﺮﺭﺳﻲ ﻭ ﺭﺩ ﻋﻠﻞ ﺭﺍﺩﻳﻜﻮﻟﻮﭘﺎﺗﻲ‪ ،‬ﻧﻮﺭﻭﭘﺎﺗﻲ‪،‬‬
‫ﺗﺸﺨﻴﺼﻲ ﭘﻴﺸﻨﻬﺎﺩ ﺷﺪﻩ‪ ،‬ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﻓﻠﻜﺲ ‪ H‬ﻣﻲﺑﺎﺷﺪ‪ .‬ﺭﻓﻠﻜﺲ ‪H‬‬
‫ﻣﻴﻮﭘﺎﺗﻲ ﺍﺳﺘﻔﺎﺩﻩ ﮔﺮﺩﻳﺪ‪ .‬ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺩﺭﺩ ﻧﺎﺣﻴﻪ ﻛﻤﺮ‪ ،‬ﺗﺰﺭﻳﻖ ﺩﺭ‬
‫ﺍﺑﺘﺪﺍ ﺗﻮﺳﻂ ﻫﺎﻓﻤﻦ ﺩﺭ ﺳﺎﻝ ‪ 1918‬ﻣﻴﻼﺩﻱ ﺷﺮﺡ ﺩﺍﺩﻩ ﺷﺪ )‪ .(20‬ﺍﻣﺎ‬
‫ﻧﺎﺣﻴﻪ ﺑﺎﺳﻦ ﺩﺭ ﻳﻚ ﻣﺎﻩ ﺍﺧﻴﺮ‪ ،‬ﺳﺎﺑﻘﻪ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺩﻳﺴﻚ ﻛﻤﺮ ﻭ‬
‫ﻛﺎﺭﺑﺮﺩﺑﺎﻟﻴﻨﻲ ﺁﻥ ﺗﺎ ﺳﺎﻝ ‪ 1956‬ﻭ ﻣﻄﺎﻟﻌﺎﺕ ﻣﺎﮔﻼﻭﺭﻱ ﻭ ﻣﻜﺪﻭﮔﺎﻝ‬
‫‪ EMG‬ﻏﻴﺮ ﻃﺒﻴﻌﻲ ﺍﺯ ﻣﻄﺎﻟﻌﻪ ﺧﺎﺭﺝ ﺷﺪﻧﺪ‪ .‬ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ ﺳﺎﻟﻢ ﺷﺎﻣﻞ‬
‫‪Ia‬‬
‫ﭘﺎﻫﺎﻱ ﻣﻘﺎﺑﻞ ﺑﻴﻤﺎﺭ )‪7‬ﭘﺎﻱ ﻛﻨﺘﺮﻝ ﺳﺎﻟﻢ( ﻭﺑﻴﻤﺎﺭﺍﻥ ﻣﺮﺍﺟﻌﻪ ﻛﻨﻨﺪﻩ ﺑﻪ‬
‫ﺁﻭﺭﺍﻥ ﻣﻨﺸﺎ ﮔﺮﻓﺘﻪ ﺍﺯ ﻋﻀﻠﻪ ﺑﺎ ﺷﺪﺕ ﻛﻤﺘﺮ ﺍﺯ ﻣﺎﮔﺰﻳﻤﻢ )‪(Sub Maximal‬‬
‫ﻋﻠﻞ ﻏﻴﺮ ﺍﺯ ﻣﺸﻜﻼﺕ ﺍﻧﺪﺍﻡ ﺗﺤﺘﺎﻧﻲ ﻭﻛﻤﺮ ﺑﻪ ﺑﺨﺶ ‪ NCS‬ﺑﻮﺩﻧﺪ‪ .‬ﺑﻘﻴﻪ‬
‫ﻣﺸﺨﺺ ﻧﺒﻮﺩ )‪ .(21‬ﺭﻓﻠﻜﺲ ‪ H‬ﻧﺘﻴﺠﻪ ﺗﺤﺮﻳﻚ ﻓﻴﺒﺮﻫﺎﻱ ﺣﺴﻲ‬
‫ﺩﻛﺘﺮ ﺷﺮﻳﻒ ﻧﺠﻔﻲ ﻭ ﻫﻤﻜﺎﺭﺍﻥ‬
‫ﺍﺛﺮ ﺗﺴﺖ ﻓﺎﻳﺮ ﺩﺭ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ‬
‫‪279‬‬
‫ﭘﺎﻫﺎﻱ ﻣﻘﺎﺑﻞ ﺑﻪ ﻋﻠﻠﻲ ﻫﻤﭽﻮﻥ ﺭﺍﺩﻳﻜﻮﻟﻮﭘﺎﺗﻲ‪ ،‬ﺗﺮﻭﻣﺎ ﻭﺗﺰﺭﻳﻖ ﺩﺭ ﮔﺮﻭﻩ‬
‫ﺑﺎ ﺗﻨﻈﻴﻤﺎﺕ‪ :‬ﺩﻳﻮﺭﻳﺸﻦ ﺗﺤﺮﻳﻚ ‪ ،1ms‬ﻓﺮﻛﺎﻧﺲ ﺗﺤﺮﻳﻚ ‪، sensivity:‬‬
‫ﻛﻨﺘﺮﻝ ﻟﺤﺎﻅ ﻧﮕﺮﺩﻳﺪﻧﺪ‪.‬‬
‫‪ 0/2 mv/dsweep: 10 ms/d، 0/5hz‬ﻭ ﻓﻴﻠﺘﺮ ‪ low freq: 20 hz‬ﻭ ‪high freq:‬‬
‫ﺍﺯ ﻫﺮ ﺩﻭﮔﺮﻭﻩ ﺍﺑﺘﺪﺍ‪ ،‬ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﺣﺎﻟﺖ ﺁﻧﺎﺗﻮﻣﻴﻚ ‪) Prone‬ﺗﻜﻨﻴﻚ‬
‫‪ 10 Khz‬ﺍﻧﺠﺎﻡ ﻣﻲﮔﺮﻓﺖ‪ .‬ﺟﻬﺖ ﻛﻨﺘﺮﻝ ﻭﺩﻗﺖ ﭘﺎﺳﺦ‪ ،‬ﺭﻓﻠﻜﺲ ‪ 2 H‬ﺑﺎﺭ‬
‫ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻣﻌﺮﻓﻲ ﺷﺪﻩ ﺗﻮﺳﻂ ﻫﺎﻓﻤﻦ( ﮔﺮﻓﺘﻪ ﺷﺪ )‪ (28‬ﻭ ﺳﭙﺲ ﺑﺎ‬
‫ﺗﻜﺮﺍﺭ ﻣﻲﮔﺮﺩﻳﺪ‪ .‬ﻭﺟﻮﺩ ﺗﻐﻴﻴﺮﺍﺕ ﺩﺭ ﺩﺍﻣﻨﻪ ﻭﺗﻐﻴﻴﺮﺍﺕ ﺧﻴﻠﻲ ﺟﺰﺋﻲ ﺩﺭ‬
‫ﺛﺒﺖ ﻣﺤﻞ ﺗﺤﺮﻳﻚ ﻭﺑﺪﻭﻥ ﺣﺮﻛﺖ ﺩﺍﺩﻥ ‪ PICK UP‬ﻭ ﮔﺮﺍﻧﺪ‪ ،‬ﺑﻴﻤﺎﺭ ﺩﺭ‬
‫‪ latency‬ﺩﺭﻃﻲ ﺗﺴﺖﻫﺎﻱ ﺩﻳﮕﺮ ﺍﺛﺒﺎﺕ ﺷﺪﻩ ﺍﺳﺖ )‪.(35-28‬‬
‫ﻭﺿﻌﻴﺖ ﻟﺘﺮﺍﻝ ﺩﻛﻮﺑﻴﺘﻮﺱ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﻃﻮﺭﻳﻜﻪ ﭘﺎﻱ ﺳﺎﻟﻢ ﺯﻳﺮ ﻭﭘﺎﻱ‬
‫ﺗﻐﻴﻴﺮﺩﺭ ‪ latency‬ﻭ ﺩﺍﻣﻨﻪ ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﺩﻭ ﺣﺎﻟﺖ ﻧﺮﻣﺎﻝ ﻭﻓﺎﻳﺮ ﺑﻄﺮﻳﻖ‬
‫)‪(flexion‬‬
‫ﺗﻔﺮﻳﻖ ﺟﺒﺮﻱ )ﻣﺜ ّ‬
‫ﻼ ‪ latency‬ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﺣﺎﻟﺖ ﻓﺎﻳﺮ ﻣﻨﻬﺎﻱ ‪latency‬‬
‫ﺷﺪﻩ ﻭﺗﺎ ﺣﺪ ﺍﻣﻜﺎﻥ ﺩﺭ ﻣﻮﻗﻌﻴﺖ ‪ adduction‬ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﻭ ﺳﺎﻕ ﺣﺪﻭﺩ‬
‫ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﺣﺎﻟﺖ ﺁﻧﺎﺗﻮﻣﻴﻚ ﻧﺮﻣﺎﻝ( ﻣﺤﺎﺳﺒﻪ ﻭﺳﭙﺲ ﺍﻃﻼﻋﺎﺕ‬
‫‪ 45‬ﺩﺭﺟﻪ ﻳﺎ ﺣﺪ ﻗﺎﺑﻞ ﺗﺤﻤﻞ ﺑﻴﻤﺎﺭ ﺑﻪ ﺍﻳﻨﺘﺮﻧﺎﻝ ﺭﻭﺗﻴﺸﻦ ﺑﺮﺩﻩ ﺷﻮﺩ‬
‫ﺑﺪﺳﺖ ﺁﻣﺪﻩ ﺗﻮﺳﻂ ﻧﺮﻡ ﺍﻓﺰﺍﺭ ﺁﻣﺎﺭﻱ ‪ SPSS‬ﻭﻳﺮﺍﻳﺶ ‪ 16‬ﺁﻧﺎﻟﻴﺰ ﻭ ﻧﺘﺎﻳﺞ‬
‫ﻛﻪ ﺑﺎﻋﺚ ﺍﻳﻨﺘﺮﻧﺎﻝ ﺭﻭﺗﻴﺸﻦ ﭘﺎﺳﻴﻮ ﺭﺍﻥ ﻧﻴﺰ ﻣﻲﮔﺮﺩﺩ )ﭘﻮﺯﻳﺸﻦ ‪(Fair‬‬
‫ﺑﻪﺻﻮﺭﺕ ﺟﺪﻭﻝ ﻭ ﻧﻤﻮﺩﺍﺭ ﺍﺭﺍﺋﻪ ﮔﺮﺩﻳﺪ‪.‬‬
‫ﻣﺒﺘﻼ ﺑﺎﻻ ﻗﺮﺍﺭ ﺑﮕﻴﺮﺩ‪ ،‬ﻭﺳﭙﺲ ﻫﻴﭗ ﻭﺯﺍﻧﻮ ﺗﺎ ‪ 90‬ﺩﺭﺟﻪ ﺧﻢ‬
‫ﻭ ﺑﻌﺪ ﺭﻓﻠﻜﺲ ‪ H‬ﺩﻭﺑﺎﺭﻩ ﮔﺮﻓﺘﻪ ﻣﻲﺷﻮﺩ‪ .‬ﻭﺿﻌﻴﺖ ﻓﺎﻳﺮﻣﻌﻤﻮﻻً ﺑﺮﺍﻱ‬
‫ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭﺩﻧﺎﻙ ﺍﺳﺖ ﺍﻣﺎ ﺑﺮﺍﻱ ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ ﺑﺎﻋﺚ ﺩﺭﺩ ﻧﻤﻲﺷﻮﺩ )‪.(24‬‬
‫ﻳﺎﻓﺘﻪﻫﺎ ﻭ ﻧﺘﺎﻳﺞ‬
‫)ﺷﻜﻞ ‪(2‬‬
‫ﮔﺮﻭﻩ ﺑﻴﻤﺎﺭ ﺷﺎﻣﻞ ‪ 15‬ﭘﺎ ﺍﺯ ‪ 14‬ﻧﻔﺮ )‪ 9‬ﺯﻥ )‪ (%64‬ﻭ ‪ 5‬ﻣﺮﺩ )‪ (%36‬ﺑﺎ‬
‫ﻣﺘﻮﺳﻂ ﺳﻨﻲ ‪ 43/7‬ﺳﺎﻝ ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ ﺳﺎﻟﻢ ﺷﺎﻣﻞ ‪ 16‬ﻧﻔﺮ ‪ 8‬ﺯﻥ )‪(%50‬‬
‫ﻭ ‪ 8‬ﻣﺮﺩ )‪ (%50‬ﺑﺎ ﻣﺘﻮﺳﻂ ﺳﻨﻲ ‪ 41/8‬ﺳﺎﻝ ﻣﻲﺑﺎﺷﺪ‪.‬‬
‫‪ %47‬ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺳﺎﺑﻘﻪ ﺗﺮﻭﻣﺎﻱ ﻣﺴﺘﻘﻴﻢ ﺑﻪ ﻟﮕﻦ ﻭ ﻳﺎ ﻏﻴﺮ ﻣﺴﺘﻘﻴﻢ ﻧﺎﺷﻲ‬
‫ﺍﺯ ﻓﻌﺎﻟﻴﺖﻫﺎﻱ ﺷﻐﻠﻲ‪ ،‬ﻭﺭﺯﺷﻲ ﻭ ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﺭﺍ ﺫﻛﺮ ﻣﻲﻛﺮﺩﻧﺪ‬
‫ﻭﻟﻲ ‪ %53‬ﺳﺎﺑﻘﻪﺍﻱ ﺍﺯ ﺗﺮﻭﻣﺎ ﻧﺪﺍﺷﺘﻨﺪ‪.‬‬
‫ﺗﺴﺖ‬
‫ﺷﻜﻞ ‪ -2‬ﻭﺿﻌﻴﺖ ﻓﺎﻳﺮ‬
‫‪PACE‬‬
‫ﺩﺭ ‪ %78/6‬ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺜﺒﺖ ﺷﺪ ﻭﻟﻲ ﻧﺘﻴﺠﻪ ﺁﺯﻣﻮﻥ‬
‫‪ FREIBERG‬ﺑﺮﺍﻱ ﻓﻘﻂ ‪ %50‬ﺍﺯ ﺍﻓﺮﺍﺩ ﻣﺜﺒﺖ ﮔﺮﺩﻳﺪ ﻭ ﺩﺭ ‪ %28/5‬ﻣﻮﺍﺭﺩ‬
‫ﺍﺯ ﻣﻜﺎﻧﻴﺴﻢﻫﺎﻱ ﺗﺴﻬﻴﻞ ﻛﻨﻨﺪﻩ ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﺗﻤﺎﻡ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺳﺘﻔﺎﺩﻩ‬
‫ﻫﺮ ﺩﻭ ﺁﺯﻣﻮﻥ ﻣﺜﺒﺖ ﮔﺮﺩﻳﺪ‪.‬‬
‫ﻣﻲﺷﺪ ﻭ ﻋﻠﻲﺭﻏﻢ ﺫﻛﺮ ﺍﻳﻦ ﻧﻜﺘﻪ ﻛﻪ ﺣﺘﻲ ﺩﻣﺎﻱ ﭘﺎﺋﻴﻦ ﻭ ﺳﺮﻣﺎ ﻫﻴﭻ‬
‫ﻣﻴﺎﻧﮕﻴﻦ ﻣﺘﻮﺳﻂ ﺗﻔﺎﻭﺕ ‪ latency‬ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﮔﺮﻭﻩ ﺑﻴﻤﺎﺭ ‪،2/346 ms‬‬
‫ﺍﺛﺮ ﻭﺍﺿﺤﻲ ﺑﺮ ﺭﻓﻠﻜﺲ ‪ H‬ﻧﺪﺍﺭﺩ )‪ ،(29‬ﺑﺎ ﺍﻳﻦ ﺣﺎﻝ ﺩﻣﺎﻱ ﺍﻧﺪﺍﻡ ﻣﻮﺭﺩ‬
‫ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ ﺳﺎﻟﻢ ‪ 0/368 ms‬ﻛﻪ ﺍﻳﻦ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭ ﺑﻮﺩ )ﺟﺪﻭﻝ ‪(1‬‬
‫ﻣﻌﺎﻳﻨﻪ ﺑﺎ ﺗﺮﻣﻮﻣﺘﺮ ﺩﻳﺠﻴﺘﺎﻟﻲ ﺍﻧﺪﺍﺯﻩﮔﻴﺮﻱ ﺷﺪﻩ ﻭ ﺩﺭ ﺻﻮﺭﺗﻲ ﻛﻪ ﻛﻤﺘﺮ‬
‫ﻣﻴﺎﻧﮕﻴﻦ ﻣﺘﻮﺳﻂ ﺗﻔﺎﻭﺕ ﺩﺍﻣﻨﻪ ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﺩﻭﺣﺎﻟﺖ ‪Base to Peak‬‬
‫ﺍﺯ ‪ 30‬ﺩﺭﺟﻪ ﺳﺎﻧﺘﻴﮕﺮﺍﺩ ﺑﻮﺩ ﺗﻮﺳﻂ ﻻﻣﭗ ﮔﺮﻣﺎﻳﻲ ﺑﻪ ﺑﺎﻻﻱ ‪ 30‬ﺩﺭﺟﻪ‬
‫ﻭ ‪ Peak to Peak‬ﻧﻴﺰ ﺩﺭﺩﻭ ﮔﺮﻭﻩ ﻣﻘﺎﻳﺴﻪ ﮔﺮﺩﻳﺪ ﻛﻪ ﺍﺧﺘﻼﻑ ﻣﻌﻨﻲﺩﺍﺭﻱ‬
‫ﺭﺳﺎﻧﺪﻩ ﻣﻲﺷﺪ‪.‬‬
‫ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﻴﻦ ﻫﻴﭻ ﻛﺪﺍﻡ ﻣﺸﺎﻫﺪﻩ ﻧﺸﺪ )‪) .(P>0/5‬ﺟﺪﻭﻝ ‪(2‬‬
‫ﺗﻤﺎﻣﻲ ﺭﻓﻠﻜﺲﻫﺎ ﺗﻮﺳﻂ ﻳﻚ ﻓﺮﺩ ﻣﺘﺒﺤﺮ‪ ،‬ﻭﺑﺎ ﺩﺳﺘﮕﺎﻩ ‪ Medtronic‬ﻭ‬
‫ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﻣﻴﺎﻧﮕﻴﻦ ﺗﻔﺎﻭﺕ ‪ latency‬ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ‪ 7‬ﭘﺎﻱ ﺳﺎﻟﻢ ﺍﻓﺮﺍﺩ ﺑﻴﻤﺎﺭ‬
‫ﺟﺪﻭﻝ ‪ – 1‬ﻣﻘﺎﻳﺴﻪﻱ ﺗﻔﺎﻭﺕ ‪ latency‬ﺭﻓﻠﻜﺲ ‪ H‬ﻗﺒﻞ ﻭﺑﻌﺪ ﺍﺯ ﺗﺴﺖ ‪ Fair‬ﺩﺭ ﮔﺮﻭﻩ ﺑﻴﻤﺎﺭ ﻭ ﻛﻨﺘﺮﻝ‬
‫‪t‬‬
‫»‪ÉY{ÊÀ ‬‬
‫‪ÃÁ€³‬‬
‫»¬|‪ÃZ»M Y‬‬
‫]‪µ€fÀ¯ Á Z¼Ì‬‬
‫‪7/485‬‬
‫‪<0/001‬‬
‫]‪ÊeZa·°Ë{Y Á Z¼Ì‬‬
‫‪7/570‬‬
‫‪<0/001‬‬
‫‪1/930‬‬
‫¯‪ÊeZa·°Ë{Y Á µ€fÀ‬‬
‫‪-0/168‬‬
‫‪0/868‬‬
‫‪-0/048‬‬
‫‪P-value‬‬
‫»‪ZÅcÁZ¨e ¾Ì´¿ZÌ‬‬
‫‪ZÅcÁZ¨e {Y|¿Zf‡Y ¥Y€v¿Y‬‬
‫§‪ZÅcÁZ¨e |{ 95 ½ZÀ̼—Y ĸZ‬‬
‫‪ÓZ] |u‬‬
‫‪¾ÌËZa |u‬‬
‫‪1/978‬‬
‫‪0/264‬‬
‫‪2/516‬‬
‫‪1/439‬‬
‫‪0/254‬‬
‫‪2/455‬‬
‫‪1/404‬‬
‫‪0/287‬‬
‫‪0/539‬‬
‫‪-0/635‬‬
‫‪280‬‬
‫ﺳﺎﻝ ﻫﺸﺘﻢ‬
‫ﻣﺠﻠﻪ ﻋﻠﻤﻲ ﭘﮋﻭﻫﺸﻲ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﺍﺭﺗﺶ ﺟﻤﻬﻮﺭﻱ ﺍﺳﻼﻣﻲ ﺍﻳﺮﺍﻥ‬
‫ﺷﻤﺎﺭﻩ ‪4‬‬
‫ﺯﻣﺴﺘﺎﻥ ‪ 1389‬ﺷﻤﺎﺭﻩ ﻣﺴﻠﺴﻞ ‪32‬‬
‫ﺟﺪﻭﻝ ‪ - 2‬ﻣﻘﺎﻳﺴﻪﻱ ﺗﻔﺎﻭﺕ ﺩﺍﻣﻨﻪ ﺭﻓﻠﻜﺲ ‪ H‬ﻗﺒﻞ ﻭﺑﻌﺪ ﺍﺯ ﺗﺴﺖ ﻓﺎﻳﺮ ﺩﺭ ﮔﺮﻭﻩ ﺑﻴﻤﺎﺭ ﻭ ﻛﻨﺘﺮﻝ‬
‫‪ÃÁ€³‬‬
‫‪Amplitude‬‬
‫]‪µ€fÀ¯Á Z¼Ì‬‬
‫]‪Á Z¼Ì‬‬
‫‪ÊeZa·°Ë{Y‬‬
‫¯‪µ€fÀ‬‬
‫‪ÊeZa·°Ë{YÁ‬‬
‫»¬|‪ÃZ»M Y‬‬
‫»‪ÉY{ÊÀ ‬‬
‫‪t‬‬
‫‪P-value‬‬
‫»‪ZÅcÁZ¨e ¾Ì´¿ZÌ‬‬
‫‪{Y|¿Zf‡Y ¥Y€v¿Y‬‬
‫‪ZÅcÁZ¨e‬‬
‫§‪|{ 95 ½ZÀ̼—Y ĸZ‬‬
‫‪ZÅcÁZ¨e‬‬
‫‪ÓZ] |u‬‬
‫‪¾ÌËZa |u‬‬
‫‪amplitude-BP‬‬
‫‪0/438‬‬
‫‪0/664‬‬
‫‪0/032‬‬
‫‪0/073‬‬
‫‪0/182‬‬
‫‪-0/117‬‬
‫‪amplitude-PP‬‬
‫‪0/347‬‬
‫‪0/731‬‬
‫‪0/06‬‬
‫‪0/173‬‬
‫‪0/412‬‬
‫‪-0/292‬‬
‫‪amplitude-BP‬‬
‫‪1/724‬‬
‫‪0/097‬‬
‫‪0/139‬‬
‫‪0/0807‬‬
‫‪0/305‬‬
‫‪-0/027‬‬
‫‪amplitude-PP‬‬
‫‪0/932‬‬
‫‪0/360‬‬
‫‪0/155‬‬
‫‪0/167‬‬
‫‪0/500‬‬
‫‪-0/188‬‬
‫‪amplitude-BP‬‬
‫‪1/265‬‬
‫‪0/216‬‬
‫‪0/107‬‬
‫‪0/084‬‬
‫‪0/280‬‬
‫‪-0/066‬‬
‫‪amplitude-PP‬‬
‫‪0/498‬‬
‫‪0/622‬‬
‫‪0/095‬‬
‫‪0/192‬‬
‫‪0/489‬‬
‫‪-0/298‬‬
‫)ﻋﻀﻮ ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ( ﺑﺎ ﺑﻘﻴﻪ ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ )‪12‬ﭘﺎ( ﺍﺧﺘﻼﻑ ﻣﻌﻨﻲﺩﺍﺭﻱ‬
‫ﺑﺤﺚ ﻭ ﻧﺘﻴﺠﻪﮔﻴﺮﻱ‬
‫ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ )‪.(p-value > 0/05‬‬
‫ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﺘﻮﺳﻂ ﻣﻴﺰﺍﻥ ﺗﺎﺧﻴﺮ ‪ latency‬ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﮔﺮﻭﻩ ﺑﻴﻤﺎﺭ‬
‫ﺗﻔﺎﻭﺕ ﻣﻴﺎﻧﮕﻴﻦ ﺍﺧﺘﻼﻑ ﺗﺴﺖ ﺩﺭ ﺩﻭ ﺣﺎﻟﺖ ﺑﻴﻦ ﺍﻳﻦ ﺩﻭ ﮔﺮﻭﻩ‬
‫‪ 2/346 ms‬ﺑﻪﺩﺳﺖ ﺁﻣﺪ ﻛﻪ ﺑﻄﻮﺭ ﻭﺍﺿﺤﻲ ﻃﻮﻻﻧﻲﺗﺮ ﺍﺯ ﮔﺮﻭﻩﻫﺎﻱ‬
‫ﻣﻌﻨﻲﺩﺍﺭ ﻧﻴﺴﺖ )‪ .(p-value > 0/05‬ﺑﻪ ﺍﻳﻦ ﻣﻌﻨﺎ ﻛﻪ ﺍﺧﺘﻼﻑ ﻣﻌﻨﻲﺩﺍﺭﻱ‬
‫ﻛﻨﺘﺮﻝ ﺑﻮﺩ ﻭﻧﺸﺎﻧﺪﻫﻨﺪﻩ ﺍﺛﺮ ﺗﺴﺖ ﻓﺎﻳﺮ ﺑﺮ ‪ latency‬ﺭﻓﻠﻜﺲ ‪ H‬ﻣﻲﺑﺎﺷﺪ‪.‬‬
‫ﻣﻴﺎﻥ ﻣﻴﺎﻧﮕﻴﻦ ﭘﺎﻱ ﺳﺎﻟﻢ ﺍﻓﺮﺍﺩ ﺑﻴﻤﺎﺭ ﺑﺎ ﭘﺎﻱ ﮔﺮﻭﻩ ﺳﺎﻟﻢ ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ‪.‬‬
‫ﺍﻳﻦ ﻳﺎﻓﺘﻪ ﺑﺎ ﻣﻄﺎﻟﻌﻪ ‪ Fishman‬ﻭ ﻫﻤﻜﺎﺭﺍﻥ )‪ (25‬ﻛﻪ ‪ 2/66 ms‬ﮔﺰﺍﺭﺵ‬
‫ﮔﺮﻭﻩ ﺑﻴﻤﺎﺭ ﺍﺯ ﻧﻈﺮ ﻣﺪﺕ ﺯﻣﺎﻥ ﺑﻴﻤﺎﺭﻱ ﺑﻪ ﺳﻪ ﺩﺳﺘﻪ ‪ 0-6‬ﻣﺎﻩ‪6-12 ،‬‬
‫ﺷﺪﻩ ﺍﺳﺖ ﻣﻄﺎﺑﻘﺖ ﺩﺍﺭﺩ‪ .‬ﻭﻟﻲ ﻫﻴﭻﮔﻮﻧﻪ ﺍﺭﺗﺒﺎﻃﻲ ﺑﻴﻦ ﺍﺛﺮ ﺗﺴﺖ ﻓﺎﻳﺮ ﺑﺮ‬
‫ﻣﺎﻩ ﻭﺑﻴﺶ ﺍﺯ ‪ 12‬ﻣﺎﻩ ﺗﻘﺴﻴﻢ ﺑﻨﺪﻱ ﺷﺪ ﻛﻪ ﺍﺧﺘﻼﻑ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺍﺯ ﻧﻈﺮ‬
‫ﺩﺍﻣﻨﻪ ﺭﻓﻠﻜﺲ ‪ H‬ﺑﻪﺩﺳﺖ ﻧﻴﺎﻣﺪ ﻛﻪ ﺍﻳﻦ ﻣﺴﺌﻠﻪ ﺷﺎﻳﺪ ﺑﻪ ﺩﻟﻴﻞ ﻭﺍﺑﺴﺘﮕﻲ‬
‫ﺗﻔﺎﻭﺕ ‪ latency‬ﺭﻓﻠﻜﺲ ‪ H‬ﻗﺒﻞ ﻭﺑﻌﺪ ﺍﺯ ﺗﺴﺖ ﻓﺎﻳﺮ ﺩﻳﺪﻩ ﻧﺸﺪ ﻭﻟﺬﺍ‬
‫ﺩﺍﻣﻨﻪ ﺭﻓﻠﻜﺲ ‪ H‬ﺑﻪ ﻓﺎﻛﺘﻮﺭﻫﺎﻱ ﻣﻬﺎﺭ ﻛﻨﻨﺪﻩ ﻭﺗﺴﻬﻴﻞ ﻛﻨﻨﺪﻩ ﺑﺮ ﺁﻥ ﺑﺎﺷﺪ‪.‬‬
‫‪H‬‬
‫‪ Fishman‬ﻭ ﻫﻤﻜﺎﺭﺍﻧﺶ ﺑﺮ ﺭﻭﻱ ﺩﺍﻣﻨﻪ ﻫﻴﭻ ﺑﺮﺭﺳﻲ ﻧﻜﺮﺩﻩﺍﻧﺪ ﻭﮔﺰﺍﺭﺷﻲ‬
‫ﻣﺪﺕ ﺯﻣﺎﻥ ﺑﻴﻤﺎﺭﻱ ﺗﺎﺛﻴﺮﻱ ﺑﺮ ﻣﻴﺰﺍﻥ ﺍﺧﺘﻼﻑ ‪ latency‬ﺭﻓﻠﻜﺲ‬
‫ﻧﺪﺍﺷﺖ )‪.(P>0/5‬‬
‫ﺩﺭ ﺍﻳﻦ ﺑﺎﺭﻩ ﻧﺸﺪﻩ ﺍﺳﺖ‪ .‬ﺑﻪﻋﻼﻭﻩ ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ‪ ،‬ﻫﻴﭻ ﺭﺍﺑﻄﻪﺍﻱ ﺑﻴﻦ‬
‫ﺍﺯ ﻧﻈﺮ ﺑﺮﺭﺳﻲ ﺗﺎﺛﻴﺮ ﺟﻨﺴﻴﺖ ﺑﺮ ﺭﻭﻱ ﻣﻴﺰﺍﻥ ﺗﻔﺎﻭﺕ ‪ latency‬ﺭﻓﻠﻜﺲ ‪H‬‬
‫ﺍﺛﺮ ﺗﺴﺖ ﻓﺎﻳﺮ ﺑﺮ ﺭﻓﻠﻜﺲ ‪ H‬ﻋﻀﻠﻪ ﮔﺎﺳﺘﺮﻭﻛﻨﻤﻴﻮﺱ – ﺳﻮﻟﺌﻮﺱ ﺩﺭ‬
‫ﺩﺭ ﻗﺒﻞ ﻭﺑﻌﺪ ﺍﺯ ﺗﺴﺖ ﻓﺎﻳﺮ ﻧﻴﺰ ﺍﺧﺘﻼﻑ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺩﻳﺪﻩ ﻧﺸﺪ )‪.(P>0/5‬‬
‫ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺑﺮ ﺣﺴﺐ ﺳﻦ‪ ،‬ﺟﻨﺲ ﻭﻃﻮﻝ‬
‫ﻣﺪﺕ ﺑﻴﻤﺎﺭﻱ ﺑﺪﺳﺖ ﻧﻴﺎﻣﺪ‪ .‬ﻓﺎﻛﺘﻮﺭﻫﺎﻱ ﻣﺬﻛﻮﺭ ﺩﺭ ﺳﺎﻳﺮ ﻣﻄﺎﻟﻌﺎﺕ‬
‫ﺟﺪﻭﻝ ‪ - 3‬ﻣﻘﺎﻳﺴﻪﻱ ﻣﻴﺎﻧﮕﻴﻦ ﺗﻔﺎﻭﺕ ‪ latency‬ﻗﺒﻞ ﻭ ﺑﻌﺪ ﻓﺎﻳﺮ ﺑﻴﻦ ﭘﺎﻱ ﺳﺎﻟﻢ‬
‫ﺍﻓﺮﺍﺩ ﺑﻴﻤﺎﺭ ﻭﺑﻘﻴﻪ ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ‬
‫ﺑﺮﺭﺳﻲ ﻧﺸﺪﻩﺍﻧﺪ‪.‬‬
‫ﻫﻴﭻ ﺭﺍﺑﻄﻪﺍﻱ ﺑﻴﻦ ﺍﺛﺮ ﺗﺴﺖ ﻓﺎﻳﺮ ﺑﺮ‬
‫‪latency‬‬
‫ﺭﻓﻠﻜﺲ‬
‫‪H‬‬
‫ﻋﻀﻠﻪ‬
‫‪{Y| e‬‬
‫»‪¾Ì´¿ZÌ‬‬
‫‪{Y|¿Zf‡Y ¥Y€v¿Y‬‬
‫ﮔﺎﺳﺘﺮﻭﻛﻨﻤﻴﻮﺱ – ﺳﻮﻟﺌﻮﺱ ﺩﺭ‪ 7‬ﭘﺎﻱ ﺳﺎﻟﻢ )ﻋﻀﻮ ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ(‬
‫‪Z¼Ì] {Y€§Y º·Z‡ ÉZa‬‬
‫‪7‬‬
‫‪0/0714‬‬
‫‪0/546‬‬
‫ﻣﺒﺘﻼ ﺑﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺑﺎ ﺑﻘﻴﻪ ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ )‪12‬ﭘﺎﻱ ﺍﻓﺮﺍﺩ ﺳﺎﻟﻢ(‬
‫‪º·Z‡ ÃÁ€³‬‬
‫‪12‬‬
‫‪0/541‬‬
‫‪0/951‬‬
‫ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ‪ .‬ﺍﻳﻦ ﺷﺎﻳﺪ ﻧﺸﺎﻧﺪﻫﻨﺪﻩ ﺍﻫﻤﻴﺖ ﻭ ﻧﻘﺶ ﻣﻬﻤﺘﺮ ﻓﺎﻛﺘﻮﺭﻫﺎﻱ‬
‫ﺧﺎﺭﺟﻲ )ﺍﻛﺴﺘﺮﻧﺴﻴﻚ( ﻧﺴﺒﺖ ﺑﻪ ﻓﺎﻛﺘﻮﺭﻫﺎﻱ ﺩﺍﺧﻠﻲ )ﺍﻳﻨﺘﺮﻧﺴﻴﻚ(‬
‫ﺟﺪﻭﻝ ‪ - 4‬ﻣﻘﺎﻳﺴﻪﻱ ﻣﻴﺎﻧﮕﻴﻦ ﺗﻔﺎﻭﺕ ‪ latency‬ﺩﺭ ﺩﻭ ﺣﺎﻟﺖ ﺑﺮﺍﻱ ﭘﺎﻱ ﺳﺎﻟﻢ‬
‫ﺍﻓﺮﺍﺩ ﺑﻴﻤﺎﺭ ﺑﺎ ﺑﻘﻴﻪ ﮔﺮﻭﻩ ﻛﻨﺘﺮﻝ‬
‫»¬|‪Y‬‬
‫‪t ÃZ»M‬‬
‫»‪ÉY{ÊÀ ‬‬
‫»‪¾Ì´¿ZÌ‬‬
‫‪ZÅcÁZ¨e‬‬
‫‪-0/229‬‬
‫‪0/821‬‬
‫‪-0/113‬‬
‫§‪½ZÀ̼—Y ĸZ‬‬
‫‪¥Y€v¿Y‬‬
‫‪{Y|¿Zf‡Y‬‬
‫‪ÓZ] |u‬‬
‫‪¾ÌËZa |u‬‬
‫‪0/492‬‬
‫‪0/926‬‬
‫‪-0/153‬‬
‫ﻣﻮﻟﺪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺑﺎﺷﺪ‪ .‬ﺩﺭ ﺳﺎﻳﺮ ﻣﻄﺎﻟﻌﺎﺕ ﻧﻴﺰ ﻓﺎﻛﺘﻮﺭ ﻓﻮﻕ‬
‫ﺑﺮﺭﺳﻲ ﻧﺸﺪﻩ ﺍﺳﺖ‪.‬‬
‫ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺩﺭﺻﺪ ﺗﺮﻭﻣﺎﻱ ﻣﺴﺘﻘﻴﻢ ﻳﺎ ﻏﻴﺮ ﻣﺴﺘﻘﻴﻢ ﺑﻪ ﻟﮕﻦ ‪%47‬‬
‫ﺑﺪﺳﺖ ﺁﻣﺪ‪.‬ﺩﺭ ﺑﻌﻀﻲ ﻣﻨﺎﺑﻊ ﻧﻴﺰ ﺑﻄﻮﺭ ﻣﺘﻮﺳﻂ ‪ %50‬ﺫﻛﺮ ﺷﺪﻩ ﺍﺳﺖ ﻛﻪ‬
‫ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﻘﺶ ﻣﻬﻤﻲ ﻛﻪ ﺑﺮﺍﻱ ﺗﺮﻭﻣﺎ ﺩﺭ ﺍﻳﺠﺎﺩ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ‬
‫ﺩﻛﺘﺮ ﺷﺮﻳﻒ ﻧﺠﻔﻲ ﻭ ﻫﻤﻜﺎﺭﺍﻥ‬
‫ﺍﺛﺮ ﺗﺴﺖ ﻓﺎﻳﺮ ﺩﺭ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ‬
‫‪281‬‬
‫ﻗﺎﻳﻞ ﻫﺴﺘﻨﺪ‪ ،‬ﺷﺎﻳﺪ ﺍﻳﻦ ﺩﺭﺻﺪ ﺑﺎﻻﺗﺮ ﺑﺎﺷﺪ ﻭ ﺑﻪ ﻋﻠﺖ ﺳﻴﺮ ﺁﻫﺴﺘﻪ‬
‫ﺍﺳﺖ ﻭﺩﺭ ﺍﻧﺠﺎﻡ ﺍﻳﻦ ﻭﺿﻌﻴﺖ ﻣﺎ ﺍﺯ ﺩﻳﺪ ﭼﺸﻤﻲ ﻭﻧﻪ ﺍﻧﺪﺍﺭﻩﮔﻴﺮﻱ‬
‫ﻭﺗﺸﺨﻴﺺ ﺩﻳﺮﺭﺱ ﺑﻴﻤﺎﺭﻱ ﺍﻏﻠﺐ ﺗﻮﺳﻂ ﺑﻴﻤﺎﺭ ﻓﺮﺍﻣﻮﺵ ﺷﺪﻩ ﺑﺎﺷﺪ‪.‬‬
‫ﺩﻗﻴﻖ ﺯﻭﺍﻳﺎﻱ ﻓﻠﻜﺸﻦ‪ ،‬ﺍﺩﺍﻛﺸﻦ ﻭﺍﻳﻨﺘﺮﻧﺎﻝ ﺭﻭﺗﻴﺸﻦ ﺍﺳﺘﻔﺎﺩﻩ ﻛﺮﺩﻩﺍﻳﻢ‬
‫‪ (37 ،36) Freiberg‬ﻭ ‪ (38) Sunderland‬ﻭ ﺑﻌﻀﻲ ﺍﺯ ﻣﺤﻘﻘﻴﻦ )‪(10 ،4‬‬
‫ﻛﻪ ﺍﻳﻦ ﻣﻲﺗﻮﺍﻧﺪ‪ ،‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺩﺭﺩﻧﺎﻛﻲ ﺗﺴﺖ ﻭﻋﺪﻡ ﺗﺤﻤﻞ ﺑﻴﻤﺎﺭ ﺩﺭ‬
‫ﭘﻴﺸﻨﻬﺎﺩ ﻛﺮﺩﻩﺍﻧﺪ ﻛﻪ ﻗﺴﻤﺖ ﭘﺮﻭﻧﺌﺎﻝ ﻋﺼﺐ ﺳﻴﺎﺗﻴﻚ ﻧﺴﺒﺖ ﺑﻪ ﻗﺴﻤﺖ‬
‫ﺍﻓﺮﺍﺩ ﺑﺎﻋﺚ ﺯﻭﺍﻳﺎﻱ ﻛﻤﺘﺮﻱ ﺩﺭ ﮔﺮﻭﻩ ﺑﻴﻤﺎﺭ ﻭﺩﺭ ﻧﺘﻴﺠﻪ ﻛﺎﻫﺶ ﺍﺧﺘﻼﻑ‬
‫ﺗﻴﺒﻴﺎﻝ ﺑﻪ ﺁﺳﻴﺐ ﻣﺴﺘﻌﺪﺗﺮ ﺍﺳﺖ ﻭ ‪ (3) Yeoman ،(2) Pecina‬ﻭ ‪Gotlin‬‬
‫ﺑﻴﻦ ﮔﺮﻭﻩ ﺑﻴﻤﺎﺭ ﻭﻛﻨﺘﺮﻝ ﮔﺮﺩﺩ‪.‬‬
‫)‪ (8‬ﺩﺭﻳﺎﻓﺘﻨﺪ ﻛﻪ ﻗﺴﻤﺖ ﭘﺮﻭﻧﺌﺎﻝ ﺑﻴﺸﺘﺮ ﺍﺯﺑﻴﻦ ﺗﺎﻧﺪﻭﻥ ﺩﻭ ﻗﻄﻌﻪ ﺷﺪﻩ‬
‫ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺷﻴﻮﻉ ﻓﺮﺍﻭﺍﻥ ﺩﺭﺩ ﺳﻴﺎﺗﻴﻚ ﻭﻫﺰﻳﻨﻪﻫﺎﻱ ﺩﺭﻣﺎﻧﻲ ﻭﺍﻗﺘﺼﺎﺩﻱ‬
‫ﻋﻀﻠﻪ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻣﻲﮔﺬﺭﺩ ﻭﺗﺤﺖ ﻓﺸﺎﺭ ﻗﺮﺍﺭ ﻣﻲﮔﻴﺮﺩ‪ .‬ﺍﻳﻦ ﻣﻄﺎﻟﻌﺎﺕ‬
‫ﻭﺍﺭﺩﻩ ﺑﺮ ﺑﻴﻤﺎﺭ ﻭ ﺟﺎﻣﻌﻪ ﻭﻫﻤﭽﻨﻴﻦ ﺷﻴﻮﻉﻫﺎﻱ ﻣﺘﻐﻴﺮ ﺳﻨﺪﺭﻡ‬
‫ﺑﺮ ﺭﻭﻱ ﺍﺟﺴﺎﺩ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺍﺳﺖ ﻭﻫﻴﭻ ﻣﻄﺎﻟﻌﻪﺍﻱ ﺑﺮ ﺭﻭﻱ ﺍﺭﺗﺒﺎﻁ‬
‫ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﭘﻴﺸﻨﻬﺎﺩ ﻣﻲﮔﺮﺩﺩ ﻛﻪ ﻗﺒﻞ ﺍﺯ ﻫﺮﮔﻮﻧﻪ ﻋﻤﻞ ﺟﺮﺍﺣﻲ‬
‫ﺑﻴﻦ ﻋﻼﺋﻢ ﻛﻠﻴﻨﻴﻜﻲ ﺑﺎ ﻳﺎﻓﺘﻪﻫﺎﻱ ﻭﺍﺭﻳﺎﺳﻴﻮﻧﻬﺎﻱ ﺁﻧﺎﺗﻮﻣﻴﻜﻲ ﻋﺼﺐ‬
‫ﺟﻬﺖ ﺩﺭﻣﺎﻥ ﺳﻴﺎﺗﻴﻜﺎ ﺑﺮ ﺭﻭﻱ ﻛﻤﺮ ﻭﻟﮕﻦ ﻭﺩﺭ ﺣﻴﻦ ﺍﻧﺠﺎﻡ‬
‫‪EDX‬‬
‫ﻭﻋﻀﻠﻪ ﺩﺭ ﺍﻓﺮﺍﺩ ﺯﻧﺪﻩ ﺍﻧﺠﺎﻡ ﻧﺸﺪﻩ ﺍﺳﺖ )‪ .(24‬ﺍﺯ ﺁﻧﺠﺎ ﻛﻪ ﺭﻓﻠﻜﺲ ‪H‬‬
‫ﺟﻬﺖ ﺑﻴﻤﺎﺭ ﻣﺒﺘﻼ ﺑﻪ ﺳﻴﺎﺗﻴﻚ‪ latency ،‬ﺭﻓﻠﻜﺲ ‪ H‬ﺑﻪ ﻃﺮﻳﻖ ﻓﺎﻳﺮ ﻧﻴﺰ‬
‫ﺍﺯ ﻋﻀﻠﻪ ﮔﺎﺳﺘﺮﻭﻛﻨﻤﻴﻮﺱ ﮔﺮﻓﺘﻪ ﻣﻲﺷﻮﺩ ﻭﺑﺮﺭﺳﻲﻫﺎ ﻧﺸﺎﻥ ﻣﻲﺩﻫﻨﺪ‬
‫ﺍﻧﺠﺎﻡ ﮔﻴﺮﺩ ﺗﺎ ﺍﺯ ﺗﺤﻤﻴﻞ ﺟﺮﺍﺣﻲ ﻭﻫﺰﻳﻨﻪﻫﺎﻱ ﻏﻴﺮ ﺿﺮﻭﺭﻱ ﺑﺮ ﺑﻴﻤﺎﺭ‬
‫ﻛﻪ ﺩﺭ ﻣﺒﺘﻼﻳﺎﻥ ﺑﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺍﻏﻠﺐ ﺭﻓﻠﻜﺲ‪ H‬ﭘﺮﻭﻧﺌﺎﻝ ﺑﺎ‬
‫ﺟﻠﻮﮔﻴﺮﻱ ﮔﺮﺩﺩ‪.‬‬
‫ﻭﻳﺎ ﺑﺪﻭﻥ ﺗﺴﺖ ﻓﺎﻳﺮ ﺑﺪﺳﺖ ﻧﻤﻲﺁﻳﺪ‪ ،‬ﺣﺘﻲ ﺩﺭ ﻣﻮﺍﺭﺩ ﺷﺪﻳﺪ ﺣﻀﻮﺭ‬
‫ﭘﻴﺸﻨﻬﺎﺩ ﻣﻲﺷﻮﺩ ﻛﻪ ﺩﺭ ﻃﻲ ﻳﻚ ﭘﮋﻭﻫﺶ ﺟﺪﺍﮔﺎﻧﻪ ﺑﺎ ﺗﻌﺪﺍﺩ ﻧﻤﻮﻧﻪ ﺑﻴﺸﺘﺮ‪،‬‬
‫ﻋﻼﻳﻢ ﺑﺎﻟﻴﻨﻲ ﻓﺸﺎﺭ ﺑﺮ ﻋﺼﺐ ﭘﺮﻭﻧﺌﺎﻝ ﻧﻴﺰ ‪ latency‬ﺭﻓﻠﻜﺲ ‪ H‬ﻃﻮﻻﻧﻲ‬
‫ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺑﺎ ﺗﺴﺖ ﻓﺎﻳﺮ ﺗﺸﺨﻴﺺ ﺩﺍﺩﻩ ﺷﺪﻩ ﻭﻣﻘﺎﻳﺴﻪﺍﻱ‬
‫ﻣﻲﮔﺮﺩﺩ )‪.(24‬‬
‫ﺑﻴﻦ ﺭﻭﺵﻫﺎﻱ ﻣﺨﺘﻠﻒ ﺩﺭﻣﺎﻧﻲ )‪ (45-39‬ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺍﻧﺠﺎﻡ‬
‫ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺩﺍﺭﺍﻱ ﻣﺤﺪﻭﺩﻳﺘﻬﺎﻳﻲ ﻧﻴﺰ ﺑﻮﺩﻩ ﺍﺳﺖ‪:‬‬
‫ﺷﻮﺩ‪.‬‬
‫ﻣﺤﺪﻭﺩﻳﺖ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﻓﻠﻜﺲ ‪ H‬ﺩﺭ ﺍﻓﺮﺍﺩ ﻣﺴﻦ ﻛﻪ ﮔﺎﻫﻲ ﺑﻄﻮﺭ ﻧﺮﻣﺎﻝ‬
‫ﻭ ﺩﻭﻃﺮﻓﻪ ﺭﻓﻠﻜﺲ ‪ H‬ﻧﺪﺍﺭﻧﺪ‪.‬‬
‫ﺗﺸﻜﺮ ﻭ ﻗﺪﺭﺩﺍﻧﻰ‬
‫ﻣﺒﺘﻼﻳﺎﻥ ﺑﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﻫﻤﺮﺍﻩ ﺑﺎ ﻛﻤﺮﺩﺭﺩ ﺟﻬﺖ ﺭﻓﻊ ﻫﺮﮔﻮﻧﻪ‬
‫ﺑﺪﻳﻦﻭﺳﻴﻠﻪ ﺍﺯ ﺍﺳﺎﺗﻴﺪ ﻣﺤﺘﺮﻡ ﺑﺨﺶ ﻃﺐ ﻓﻴﺰﻳﻜﻰ ﻭ ﺗﻮﺍﻥﺑﺨﺸﻰ ﺗﺸﻜﺮ‬
‫ﺳﻮﮔﻴﺮﻱ )‪ (BIAS‬ﺍﺯ ﺟﺎﻣﻌﻪ ﺁﻣﺎﺭﻱ ﺣﺬﻑ ﺷﺪﻩﺍﻧﺪ‪.‬‬
‫ﻭ ﻗﺪﺭﺩﺍﻧﻰ ﻣﻰﮔﺮﺩﺩ‪.‬‬
‫ﻭﺿﻌﻴﺖ ﻓﺎﻳﺮ ﺑﺮﺍﻱ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻨﺪﺭﻡ ﭘﻴﺮﻳﻔﻮﺭﻣﻴﺲ ﺩﺭﺩﻧﺎﻙ‬
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JAUMS
Volume 8
Number 4
Winter 2011
41
How Could FAIR Test Modify the H Reflex in Gastrocnemius
Muscle in Patients with Piriformis Syndrome?
Najafi. Sh; MD1, Azma. K; MD2, Azizi S; MD3, *Emadi. AR; MD4, Mahmoudabadi. A; MD5, Sajadi S; MD6
Received: 4 Aug 2010
Accepted: 11 Dec 2010
Abstract
Introduction: Piriformis syndrome (PS) is defined by a loose cluster of symptoms arising from entrapment
of one or both divisions of the sciatic nerve as they pass the sciatic notch. This paper presents a method of
using the H-reflex as an aid in the diagnosis of PS.
Methods: Forcible pressure from the piriformis muscle on the sciatic nerve can be induced by internal
rotation of an affected limb in an adducted and flexed position (FAIR). This pressure is reflected in a delay of
the H-reflex. The length of delay seen in 15 legs of 14 patients who met the criteria for PS is compared with
that seen in 7 unaffected contralateral limbs.
Results: Mean delay of H-reflex was 2.346 msec for affected legs and 0.368 msec for the combined
control groups (p<0.01).
Conclusion: There were no Significant differences in delay latency between control group and amplitude
between all groups (p>0.05).
Keywords: Piriformis Syndrome, H Reflex, FAIR Test
1234-
Assistant Professor, Army University of Medical Science, Medical Faculty, dept. of Physical Medicine and Rehabilitation, Tehran, Iran.
Assistant professor, Army University of Medical Science, Medical Faculty, dept. of Physical Medicine and Rehabilitation, Tehran, Iran.
Assistant professor, Army University of Medical Science, Medical Faculty, dept. of Physical Medicine and Rehabilitation, Tehran, Iran.
(*Corresponding Author) Researcher, Physiatrist, Army University of Medical Science, Medical Faculty, dept. of Physical Medicine
and Rehabilitation, Tehran, Iran. Tel: 021-85953476 E-mail: Dremady@yahoo.com
5. Researcher, Physiatrist, Army University of Medical Science, Medical Faculty, dept. of Physical Medicine and Rehabilitation, Tehran, Iran.
6. Researcher, Physiatrist, Army University of Medical Science, Medical Faculty, dept. of Physical Medicine and Rehabilitation, Tehran, Iran.