تاريخ سیستم اسکلتی PDF

‫ﺑﻪ ﻧﺎﻡ ﺧﺪﺍ‬ ‫ﺳﻴﺴﺘﻢ ﺍﺳﻜﻠﺘﻲ‬ ‫ﺩﻛﺘﺮ ﻇﻬﻴﺮﻱ‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﻓﺖ ﻫﻤﺒﻨﺪ ﻭﻳﮋﻩ )ﺳﺨﺖ ﻭ ﻣﺤﮑﻢ( ﻣﺮﮐﺐ ﺍﺯ ﺳﻠﻮﻟﻬﺎ ﻭ ﻣﺎﺩﻩ ﺯﻣﻴﻨﻪ ﺍی ﻣﻴﻨﺮﺍﻟﻴﺰﻩ ﺷﺪﻩ )ﻣﺎﺗﺮﻳﮑﺲ( ﻣﯽ ﺑﺎﺷﺪ‪.‬‬ ‫‪‬‬ ‫ﺍﺟﺰﺍی ﻣﺎﺗﺮﻳﮑﺲ‪:‬‬ ‫‪‬‬...

‫ﺑﻪ ﻧﺎﻡ ﺧﺪﺍ‬ ‫ﺳﻴﺴﺘﻢ ﺍﺳﻜﻠﺘﻲ‬ ‫ﺩﻛﺘﺮ ﻇﻬﻴﺮﻱ‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﻓﺖ ﻫﻤﺒﻨﺪ ﻭﻳﮋﻩ )ﺳﺨﺖ ﻭ ﻣﺤﮑﻢ( ﻣﺮﮐﺐ ﺍﺯ ﺳﻠﻮﻟﻬﺎ ﻭ ﻣﺎﺩﻩ ﺯﻣﻴﻨﻪ ﺍی ﻣﻴﻨﺮﺍﻟﻴﺰﻩ ﺷﺪﻩ )ﻣﺎﺗﺮﻳﮑﺲ( ﻣﯽ ﺑﺎﺷﺪ‪.‬‬ ‫‪‬‬ ‫ﺍﺟﺰﺍی ﻣﺎﺗﺮﻳﮑﺲ‪:‬‬ ‫‪‬‬ ‫‪ -١‬ﻣﻮﺍﺩ ﺁﻟﯽ‬ ‫‪‬‬ ‫‪ -٢‬ﻣﻮﺍﺩ ﻣﻌﺪﻧﯽ‬ ‫‪‬‬ ‫‪ -٣‬ﺁﺏ‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﻣﻮﺍﺩ ﺁﻟﯽ‪:‬‬ ‫‪‬‬ ‫‪ ٩٠‬ﺩﺭﺻﺪ ﺍﺯ ﮐﻼژﻥ ﻧﻮﻉ ﻳﮏ ﻭ ‪ ١٠‬ﺩﺭﺻﺪ ﺍﺯ ﭘﺮﻭﺗﺌﻮﮔﻠﻴﮑﺎﻧﻬﺎ )ﮐﻮﻧﺪﺭﻭﺍﻳﺘﻴﻦ ﺳﻮﻟﻔﺎﺕ‪ ،‬ﮐﺮﺍﺗﺎﻥ ﺳﻮﻟﻔﺎﺕ ﻭ ﺍﺳﻴﺪ‬ ‫‪‬‬ ‫ﻫﻴﺎﻟﻮﺭﻭﻧﻴﮏ( ﻭ ﮔﻠﻴﮑﻮﭘﺮﻭﺗﺌﻴﻨﻬﺎ )ﺳﻴﺎﻟﻮﭘﺮﻭﺗﺌﻴﻦ‪ ،‬ﺍﻭﺳﺘﺌﻮﮐﻠﺴﻴﻦ ﻭ ﺍﻭﺳﺘﺌﻮﻧﮑﺘﻴﻦ(‬ ‫ﺩﺭ ﺭﻧﮓ ﺁﻣﻴﺰی ﺑﻌﻠﺖ ﻓﺮﺍﻭﺍﻧﯽ ﮐﻼژﻥ ﻧﻮﻉ ﻳﮏ ﺍﺳﻴﺪﻭﻓﻴﻞ ﺍﺳﺖ‪.‬‬ ‫‪‬‬ ‫‪‬‬ ‫ﻣﻮﺍﺩ ﻣﻌﺪﻧﯽ‪:‬‬ ‫‪‬‬ ‫ﻋﻤﺪﻩ ﺗﺮﻳﻦ ﻣﻮﺍﺩ ﮐﻠﺴﻴﻢ ﻭ ﻓﺴﻔﺮ‪ ،‬ﺑﻴﺸﺘﺮ ﺑﻪ ﺷﮑﻞ ﺑﻠﻮﺭﻫﺎی ﻫﻴﺪﺭﻭﮐﺴﯽ ﺁﭘﺎﺗﻴﺖ ﻣﯽ ﺑﺎﺷﺪ‪.‬‬ ‫‪‬‬ ‫ﺑﻘﻴﻪ‪ :‬ﻳﻮﻧﻬﺎی ﮐﺮﺑﻨﺎﺕ‪ ،‬ﻓﺴﻔﺎﺕ‪ ،‬ﺳﻴﺘﺮﺍﺕ‪ ،‬ﺳﺪﻳﻢ‪ ،‬ﻣﻨﻴﺰﻳﻢ ﻭ ﻓﻠﻮﺭ‬ ‫‪‬‬ ‫ﻗﺎﺑﻞ ﺑﺮﺩﺍﺷﺖ ﺍﺯ ﺍﺳﺘﺨﻮﺍﻥ ﻭ ﺗﺒﺎﺩﻝ ﺑﺎ ﻣﺎﻳﻌﺎﺕ ﺑﺪﻥ‬ ‫‪‬‬  ‫ﺩﺭ ﻳﻚ ﺗﻘﺴﻴﻢ ﺑﻨﺪﻱ ‪ 5‬ﻭﻇﻴﻔﻪ ﺍﺻﻠﻲ ﺑﺮﺍﻱ ﺳﺎﺧﺘﺎﺭ ﺍﺳﻜﻠﺘﻲ ﻣﻲ ﺗﻮﺍﻥ ﺑﺮﺷﻤﺮﺩ ‪:‬‬ ‫ﻣﺤﺎﻓﻈﺖ‪ :‬ﺑﺎﻓﺘﻬﺎﻱ ﻧﺮﻡ ﻭ ﺍﻧﺪﺍﻣﻬﺎﻱ ﺩﺍﺧﻠﻲ ﺑﺪﻥ ﻏﺎﻟﺒﺎ ﺑﻮﺳﻴﻠﻪ ﺍﺳﺘﺨﻮﺍﻧﻬﺎ ﺍﺣﺎﻃﻪ ﺷﺪﻩ ﺍﻧﺪ‪.‬‬ ‫‪‬‬ ‫ﺣﻤﺎﻳﺖ‪ :‬ﺍﺳﺘﺨﻮﺍﻧﻬﺎ ﻭ ﻏﻀﺮﻭﻓﻬﺎ ﺍﺯ ﻛﻞ ﺑﺪﻥ ﺩﺭ ﻣﻘﺎﺑﻞ ﺿﺮﺑﻪ ﻫﺎ ﻭ ﺻﺪﻣﺎﺕ ﺣﻤﺎﻳﺖ ﻣﻲ ﻛﻨﻨﺪ‪.‬‬ ‫‪‬‬ ‫ﺫﺧﻴﺮﻩ ﻛﺮﺩﻥ‪ :‬ﺍﺳﺘﺨﻮﺍﻧﻬﺎ ﻣﻘﺪﺍﺭ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ ﻣﻮﺍﺩ ﻣﻌﺪﻧﻲ ﻣﺜﻞ ﻛﻠﺴﻴﻢ ﻭ ﻓﺴﻔﺎﺕ ﺭﺍ ﺩﺭ ﺧﻮﺩ ﺫﺧﻴﺮﻩ ﻣﻲ‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﻛﻨﻨﺪ‪.‬ﺑﻌﻼﻭﻩ ﺳﻠﻮﻟﻬﺎﻱ ﭼﺮﺑﻲ ﺩﺭ ﺣﻔﺮﻩ ﻫﺎﻱ ﺩﺍﺧﻠﻲ ﺑﺴﻴﺎﺭﻱ ﺍﺯ ﺍﺳﺘﺨﻮﺍﻧﻬﺎ ﺑﻪ ﺻﻮﺭﺕ ﺑﺎﻓﺖ ﻟﻴﭙﻴﺪ ﺫﺧﻴﺮﻩ ﻣﻲ‬ ‫ﺷﻮﻧﺪ ﺗﺎ ﺑﻪ ﻋﻨﻮﺍﻥ ﻣﻮﺍﺩ ﺍﻧﺮژﻱ ﺯﺍ ﻣﺼﺮﻑ ﺷﻮﻧﺪ‪.‬‬ ‫ﺳﺎﺧﺖ ﺳﻠﻮﻟﻬﺎﻱ ﻗﺮﻣﺰ ﺧﻮﻥ‪ :‬ﺳﻠﻮﻟﻬﺎﻱ ﻗﺮﻣﺰ ﺧﻮﻥ ﻭ ﺑﺴﻴﺎﺭﻱ ﺍﺯ ﺍﺟﺰﺍﻱ ﺩﻳﮕﺮ ﺧﻮﻥ ﺩﺭ ﺣﻔﺮﻩ ﻫﺎﻱ‬ ‫‪‬‬ ‫ﺩﺍﺧﻠﻲ ﺑﺴﻴﺎﺭﻱ ﺍﺯ ﺍﺳﺘﺨﻮﺍﻧﻬﺎ ﺗﻮﻟﻴﺪ ﻣﻲ ﺷﻮﻧﺪ‪.‬ﺩﺭ ﻭﺍﻗﻊ‪ ،‬ﺳﻠﻮﻟﻬﺎﻱ ﻗﺮﻣﺰ ﺧﻮﻥ ﺗﻮﺳﻂ ﺳﻠﻮﻟﻬﺎﻳﻲ ﻣﻮﺳﻮﻡ ﺑﻪ‬ ‫ﺍﺭﻳﺘﺮﻭﺑﻼﺳﺖ ﻫﺎ ﺩﺭ ﻣﻐﺰ ﻗﺮﻣﺰ ﺍﺳﺘﺨﻮﺍﻥ ﺳﺎﺧﺘﻪ ﻣﻲ ﺷﻮﻧﺪ‪.‬‬ ‫ﺍﻳﺠﺎﺩ ﻧﻘﺶ ﺳﻴﺴﺘﻢ ﺍﻫﺮﻣﻲ‪ :‬ﺍﺳﺘﺨﻮﺍﻧﻬﺎ ﺑﺎ ﺍﻳﻔﺎﻱ ﻧﻘﺶ ﻳﻚ ﺳﻴﺴﺘﻢ ﻣﺎﺷﻴﻨﻲ ﺑﺎ ﺍﻧﻘﺒﺎﺽ ﻋﻀﻼﺕ ﺍﺳﻜﻠﺘﻲ‬ ‫‪‬‬ ‫ﺩﺭ ﻣﻔﺎﺻﻞ ﺍﻳﺠﺎﺩ ﺣﺮﻛﺖ ﻣﻲ ﻛﻨﻨﺪ‪.‬‬  ‫ﺍﻧﻮﺍﻉ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺮ ﺍﺳﺎﺱ ﺷﻜﻞ )ﻃﺒﻘﻪ ﺑﻨﺪﻱ ﻋﻤﻮﻣﻲ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎ(‬ ‫‪‬‬ ‫ﺍﺯﻧﻈﺮ ﺷﻜﻞ ﻣﻲ ﺗﻮﺍﻥ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎ ﺭﺍ ﺑﻪ ﭘﻨﺞ ﮔﺮﻭﻩ ﺗﻘﺴﻴﻢ ﻛﺮﺩ‪:‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫*ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﺩﺭﺍﺯ ﻣﺎﻧﻨﺪ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﺭﺍﻥ‪ ،‬ﺑﺎﺯﻭ ﻭ ﺳﺎﻕ ﭘﺎ‬ ‫*ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﻛﻮﺗﺎﻩ ﺍﺯ ﻗﺒﻴﻞ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﻣﭻ ﺩﺳﺖ ﻭ ﭘﺎ‬ ‫*ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﭘﻬﻦ ﻫﻤﺎﻧﻨﺪ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﻫﻴﭗ )ﺑﻲ ﻧﺎﻡ( ﻭ ﺍﺳﻜﺎﭘﻮﻻ )ﻛﺘﻒ(‬ ‫*ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﻧﺎﻣﻨﻈﻢ ﻛﻪ ﺷﻜﻞ ﻣﻌﻴﻨﻲ ﻧﺪﺍﺭﻧﺪ ﻣﺜﻞ ﻣﻬﺮﻩ ﻫﺎ ﻭ ﺍﺳﺘﺨﻮﺍﻥ ﺧﺎﺟﻲ )ﺳﺎﻛﺮﻭﻡ(‬ ‫*ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﺳﺰﺍﻣﻮﺋﻴﺪ )ﻛﻨﺠﺪﻱ( ﻣﺎﻧﻨﺪ ﻛﺸﻜﻚ‬  ‫ﺳﻠﻮﻟﻬﺎﻱ ﺑﺎﻓﺖ ﺍﺳﺘﺨﻮﺍﻧﻲ ﺑﺮ ﭼﻬﺎﺭ ﻧﻮﻉﺍﻧﺪ ﻛﻪ ﻫﻤﺰﻣﺎﻥ ﻗﺎﺑﻞ ﺭﻭﻳﺖ ﻧﻴﺴﺘﻨﺪ‪.‬‬ ‫ﺍﺳﺘﺌﻮﺳﻴﺘﻬﺎ‬ ‫‪‬‬ ‫ﺍﻳﻦ ﺳﻠﻮﻟﻬﺎ ﺳﺘﺎﺭﻩﺍﻱ ﺷﻜﻞﺍﻧﺪ ﻭ ﻫﺴﺘﻪ ﺑﻴﻀﻲ ﻭ ﭘﺮ ﺍﺯ ﻛﺮﻭﻣﺎﺗﻴﻦ ﺩﺍﺭﻧﺪ‪.‬‬ ‫‪‬‬ ‫ﻫﺮ ﺍﺳﺘﺌﻮﺳﻴﺖ ﺩﺭ ﭘﻴﺮﺍﻣﻮﻥ ﺧﻮﺩ ﻻﻛﻮﻧﺎ ﺩﺍﺭﺩ‪.‬ﺑﺮﺍﻱ ﺟﻠﻮﮔﻴﺮﻱ ﺍﺯ ﻣﺮگ ﺳﻠﻮﻟﻲ ‪ ،‬ﺍﺳﺘﺌﻮﺳﻴﺘﻬﺎ ﺗﻮﺳﻂ ﺯﻭﺍﻳﺪ‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺑﺴﻴﺎﺭ ﻇﺮﻳﻒ ﺳﻴﺘﻮﭘﻼﺳﻤﻲ ﺑﻪ ﻳﻜﺪﻳﮕﺮ ﻣﺮﺗﺒﻂ ﻫﺴﺘﻨﺪ‪.‬‬ ‫ﺗﺎ ﺯﻣﺎﻧﻲ ﻛﻪ ﺻﺪﻣﻪﺍﻱ ﺑﻪ ﺍﺳﺘﺨﻮﺍﻥ ﻭﺍﺭﺩ ﻧﺸﻮﺩ‪ ،‬ﺍﺳﺘﺌﻮﺳﻴﺘﻬﺎ ﺗﻘﺴﻴﻢ ﻧﻤﻲﺷﻮﻧﺪ‪.‬‬ ‫‪‬‬ ‫ﺑﺎ ﺍﻳﺠﺎﺩ ﺿﺎﻳﻌﻪ ‪ ،‬ﺗﻘﺴﻴﻤﺎﺕ ﺳﻠﻮﻟﻬﺎ ﺁﻏﺎﺯ ﻣﻲﺷﻮﺩ‪.‬ﺗﻌﺪﺍﺩﻱ ﺍﺯ ﺁﻧﻬﺎ ﺑﻪ ﺻﻮﺭﺕ ﺍﺳﺘﺌﻮﺑﻼﺳﺖ ‪ ،‬ﻣﺎﺩﻩ ﺯﻣﻴﻨﻪﺍﻱ‬ ‫‪‬‬ ‫ﺑﻲﺷﻜﻞ ﺭﺍ ﻣﻲﺳﺎﺯﻧﺪ ﻭ ﺧﻮﺩ ﺑﻪ ﺍﺳﺘﺌﻮﺳﻴﺖ ﺗﺒﺪﻳﻞ ﻣﻲﺷﻮﻧﺪ ﺑﺮﺧﻲ ﺩﻳﮕﺮ ﺑﻪ ﺻﻮﺭﺕ ﺳﻠﻮﻟﻬﺎﻱ ﺍﺟﺪﺍﺩﻱ‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﻗﻲ ﻣﻲﻣﺎﻧﻨﺪ‪.‬‬  ‫ﺍﺳﺘﺌﻮﺑﻼﺳﺘﻬﺎ‬ ‫‪‬‬ ‫ﺳﻠﻮﻟﻬﺎﻳﻲ ﻫﺴﺘﻨﺪ ﭼﻨﺪ ﺿﻠﻌﻲ ﻭ ﻫﺴﺘﻪ ﺍﻱ ﻛﻪ ﺩﺭ ﺧﺎﺭﺝ ﺍﺯ ﻣﺮﻛﺰ ﺳﻠﻮﻝ ﻗﺮﺍﺭ ﺩﺍﺭﺩ‪.‬‬ ‫‪‬‬ ‫ﺍﻳﻦ ﺳﻠﻮﻟﻬﺎ ﺩﺭ ﻣﺤﻠﻲ ﻛﻪ ﻓﻌﺎﻟﻴﺖ ﺳﺎﺯﻧﺪﮔﻲ ﺯﻳﺎﺩ ﺍﺳﺖ ﻓﺮﺍﻭﺍﻥﺍﻧﺪ ﻭ ﺩﺍﺭﺍﻱ ﺷﺒﻜﻪ ﺁﻧﺪﻭﭘﻼﺳﻤﻲ ﻧﺎﺻﺎﻑ ﻭ‬ ‫‪‬‬ ‫ﺩﺳﺘﮕﺎﻩ ﮔﻠﮋﻱ ﻫﺴﺘﻨﺪ‪.‬ﺍﻳﻦ ﺩﻭ ﻧﺸﺎﻥ ﺩﻫﻨﺪﻩ ﻓﻌﺎﻟﻴﺘﻬﺎﻱ ﺗﺮﺷﺤﻲﺍﻧﺪ‪.‬‬ ‫ﻫﻨﮕﺎﻡ ﻓﻌﺎﻟﻴﺖ ‪ ،‬ﻗﺎﺩﺭﻧﺪ ﻣﺎﺩﻩ ﺯﻣﻴﻨﻪﺍﻱ ﺑﺴﺎﺯﻧﺪ ﻭ ﺑﻪ ﻫﻤﻴﻦ ﺩﻟﻴﻞ ﺳﻠﻮﻟﻬﺎﻱ ﺳﺎﺯﻧﺪﻩ ﺧﻮﺍﻧﺪﻩ ﻣﻲﺷﻮﻧﺪ‪.‬ﻫﻨﮕﺎﻡ‬ ‫‪‬‬ ‫ﻓﻌﺎﻟﻴﺖ ﻣﻜﻌﺒﻲ ﺷﻜﻞ ﻭ ﺑﺎﺯﻭﻓﻴﻠﻲ ﻭﻫﻨﮕﺎﻡ ﺍﺳﺘﺮﺍﺣﺖ ‪ ،‬ﭘﻬﻦ ﻭ ﺍﺳﻴﺪﻭﻓﻴﻠﻲ ﻫﺴﺘﻨﺪ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬  ‫ﺍﺳﺘﺌﻮﻛﻼﺳﺘﻬﺎ‬ ‫‪‬‬ ‫ﺍﺳﺘﺌﻮﻛﻼﺳﺘﻬﺎ ﺍﺯ ﻣﻮﻧﻮﺳﻴﺘﻬﺎﻱ ﺧﻮﻥ ﺗﻮﻟﻴﺪ ﻣﻲﺷﻮﻧﺪ‪.‬‬ ‫‪‬‬ ‫ﺍﺳﺘﺌﻮﻛﻼﺳﺘﻬﺎ ﻣﺴﺌﻮﻝ ﺗﺠﺰﻳﻪ ﻣﺎﺩﻩ ﺯﻣﻴﻨﻪ ﺍﺳﺘﺨﻮﺍﻥ ﺩﺭ ﻫﻨﮕﺎﻡ ﺍﺳﺘﺨﻮﺍﻥ ﺳﺎﺯﻱ ﻫﺴﺘﻨﺪ‪.‬‬ ‫‪‬‬ ‫ﻧﻘﺶ ﺍﺳﺘﺌﻮﻛﻼﺳﺘﻬﺎ ﻋﻜﺲ ﺍﺳﺘﺌﻮﺑﻼﺳﺘﻬﺎﺳﺖ ﺑﻪ ﻫﻤﻴﻦ ﺩﻟﻴﻞ ﺳﻠﻮﻟﻬﺎﻱ ﻣﺨﺮﺏ ﻧﺎﻣﻴﺪﻩ ﻣﻲﺷﻮﻧﺪ‪.‬‬ ‫‪‬‬ ‫ﺍﻳﻦ ﺳﻠﻮﻟﻬﺎ ‪ ،‬ﺍﺑﺘﺪﺍ ﻣﺎﺩﻩ ﺯﻣﻴﻨﻪﺍﻱ ﺑﻲﺷﻜﻞ ﻭ ﺳﭙﺲ ﻛﻼژﻥ ﺭﺍ ﺗﺠﺰﻳﻪ ﻣﻲﻛﻨﻨﺪ‪.‬ﺍﺳﺘﺌﻮﻛﻼﺳﺘﻬﺎ ﻣﻌﻤﻮﻻ‬ ‫‪‬‬ ‫ﺳﻠﻮﻟﻬﺎﻳﻲ ﻏﻮﻝ ﺁﺳﺎ ﺑﺎ ﺳﻴﺘﻮﭘﻼﺳﻢ ﻭﺳﻴﻊﺍﻧﺪ ﻭ ﺗﻌﺪﺍﺩ ‪ 6‬ﺗﺎ ‪ 50‬ﻫﺴﺘﻪ ﺩﺍﺭﻧﺪ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺍﺳﺘﺌﻮﻛﻼﺳﺘﻬﺎﻱ ﺟﻮﺍﻥ ﺗﻚ ﻫﺴﺘﻪﺍﻱ ﺑﻮﺩﻩ ﻭ ﺩﺭ ﻫﻨﮕﺎﻡ ﻓﻌﺎﻟﻴﺖ ﺑﺎﺯﻭﻓﻴﻠﻲ ﻭ ﻫﻨﮕﺎﻡ ﺍﺳﺘﺮﺍﺣﺖ ﺍﺳﻴﺪﻭﻓﻴﻠﻲ‬ ‫ﻫﺴﺘﻨﺪ‪.‬‬ ‫ﺑﻪ ﻋﻼﻭﻩ ﻫﻨﮕﺎﻣﻲ ﻛﻪ ﻣﻴﺰﺍﻥ ﻛﻠﺴﻴﻢ ﺧﻮﻥ ﺑﻪ ﻋﻠﺖ ﻋﻤﻞ ﻫﻮﺭﻣﻮﻥ ﺗﻴﺮﻭﻛﺴﻴﻦ ﻭ ﭘﺎﺭﺍﺗﻮﺭﻣﻮﻥ ﻛﺎﻫﺶ‬ ‫‪‬‬ ‫ﻣﻲﻳﺎﺑﺪ‪ ،‬ﺍﺳﺘﺌﻮﻛﻼﺳﺖ ﻛﻠﺴﻴﻢ ﺭﺍ ﺍﺯ ﺍﺳﺘﺨﻮﺍﻥ ﻣﻲﮔﻴﺮﺩ ﻭ ﺑﻪ ﺟﺮﻳﺎﻥ ﺧﻮﻥ ﻣﻲﻓﺮﺳﺘﺪ‪.‬ﺍﺳﺘﺌﻮﻛﻼﺳﺘﻬﺎ ﻧﺰﺩﻳﻚ‬ ‫ﺳﻄﺢ ﺍﺳﺘﺨﻮﺍﻥ ﺍﺯ ﺣﻔﺮﻩﺍﻱ ﺍﺯ ﻣﺎﺩﻩ ﺍﺳﺘﺨﻮﺍﻧﻲ ﺩﺭ ﺣﺎﻝ ﺗﺨﺮﻳﺐ ﻗﺮﺍﺭ ﺩﺍﺭﻧﺪ‪.‬‬ ‫ﺑﺎﻓﺖ ﺍﺳﺘﺨﻮﺍﻧﻲ ﺗﺎﺯﻩ ﺗﺸﻜﻴﻞ ﺭﺍ ﻛﻪ ﺩﺍﺭﺍﻱ ﺍﺳﺘﻘﺎﻣﺖ‪ ،‬ﻣﺘﺮﻳﻜﺲ ﻭ ﻣﻮﺍﺩ ﺁﻫﻜﻲ ﻛﻢ ﻭ ﺳﻠﻮﻟﻬﺎﻱ ﺍﺳﺘﺌﻮﺳﻴﺖ‬ ‫‪‬‬ ‫ﻓﺮﺍﻭﺍﻥ ﺍﺳﺖ ﺑﻪ ﻧﺎﻡ ﺍﺳﺘﺨﻮﺍﻥ ﻧﺎﺑﺎﻟﻎ ﻳﺎ ﺍﻭﻟﻴﻪ ) )‪Imature Woven or Primary bone‬‬ ‫ﻣﻲﻧﺎﻣﻨﺪ ﻛﻪ ﻃﺮﺯ ﻗﺮﺍﺭﮔﻴﺮﻱ ﺭﺷﺘﻪﻫﺎﻱ ﻛﻼژﻥ ﺩﺭ ﺁﻥ ﻧﺎﻣﺸﺨﺺ ﺍﺳﺖ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺑﺎﻓﺖﻫﺎﻱ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻛﻪ ﭘﺲ ﺍﺯ ﺍﺳﺘﺨﻮﺍﻧﻬﺎﻱ ﺍﻭﻟﻴﻪ ﭘﺪﻳﺪ ﻣﻲﺁﻳﺪ‪ ،‬ﺩﺍﺭﺍﻱ ﻣﺘﺮﻳﻜﺲ ﻭ ﺗﻴﻐﻪﻫﺎﻱ ﻓﺮﺍﻭﺍﻥ ﻭ‬ ‫‪‬‬ ‫ﺍﺳﺘﻘﺎﻣﺖ ﺑﻴﺸﺘﺮﻱ ﻣﻲﺑﺎﺷﻨﺪ‪.‬ﺍﻳﻦ ﮔﻮﻧﻪ ﺑﺎﻓﺖ ﺍﺳﺘﺨﻮﺍﻧﻲ ﺭﺍ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﻟﻎ ﻳﺎ ﺛﺎﻧﻮﻳﻪ ) ‪Mature,‬‬ ‫)‪Lamellae or Secondary bone‬ﻣﻲﮔﻮﻳﻨﺪ‪.‬‬  ‫ﺑﺎﻓﺖ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻣﺘﺮﺍﻛﻢ )‪(Compact bone tissue‬‬ ‫‪‬‬ ‫ﺍﺳﺘﺨﻮﺍﻥﻫﺎﻱ ﻣﺘﺮﺍﻛﻢ ﺩﺭ ﺩﻳﺎﻓﻴﺰ ﺍﺳﺘﺨﻮﺍﻧﻬﺎﻱ ﻃﻮﻳﻞ ﻭ ﺩﺭ ﺳﻄﺢ ﺍﺳﺘﺨﻮﺍﻧﻬﺎﻱ ﺍﺳﻔﻨﺠﻲ ﺩﺭ ﺯﻳﺮ ﭘﺮﻳﻮﺳﺖ ﻗﺮﺍﺭ‬ ‫‪‬‬ ‫ﺩﺍﺭﻧﺪ‪.‬‬ ‫ﺍﻳﻦ ﺑﺎﻓﺖ ﺷﺎﻣﻞ ﺳﻴﺴﺘﻢﻫﺎﻱ ﻫﺎﺭﻭﺱ‪.‬ﺗﻴﻐﻪﻫﺎﻱ ﺑﻴﻨﺎﺑﻴﻨﻲ‪ ،‬ﺗﻴﻐﻪﻫﺎﻱ ﺍﻃﺮﺍﻓﻲ ﺩﺍﺧﻠﻲ ﻭ ﺧﺎﺭﺟﻲ‪ ،‬ﭘﺮﻳﻮﺳﺖ ﻭ‬ ‫‪‬‬ ‫ﺍﻧﺪﻭﺳﺖ ﻣﻲﺑﺎﺷﺪ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺑﺎﻓﺖ ﺍﺳﺘﺨﻮﺍﻧﻲ ﺍﺳﻔﻨﺠﻲ )‪(Spongy bone tissue‬‬ ‫‪‬‬ ‫ﺍﻳﻦ ﺑﺎﻓﺖ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻛﻪ ﺍﺯ ﺧﺎﺭﺝ ﺗﻮﺳﻂ ﻻﻳﻪﺍﻱ ﺍﺯ ﭘﺮﻳﻮﺳﺖ ﭘﻮﺷﻴﺪﻩ ﺷﺪﻩ ﺍﺳﺖ‪ ،‬ﺩﺭ ﺩﺍﺧﻞ ﺁﻥ ﺗﻴﻐﻪﻫﺎﻱ‬ ‫‪‬‬ ‫ﺍﺳﺘﺨﻮﺍﻧﻲ ﻧﺎﻣﻨﻈﻢ ﻗﺮﺍﺭ ﺩﺍﺭﻧﺪ‪.‬‬ ‫ﺩﺭ ﺑﻴﻦ ﺍﻳﻦ ﺗﻴﻐﻪﻫﺎ ﻓﻀﺎﻫﺎﻳﻲ ﻗﺮﺍﺭ ﺩﺍﺭﺩ ﻛﻪ‬ ‫‪‬‬ ‫ﺗﻮﺳﻂ ﺍﻧﺪﻭﺳﺖ ﭘﻮﺷﻴﺪﻩ ﺷﺪﻩ ﻭ ﻣﺎ ﺑﻴﻦ ﺁﻧﻬﺎ‬ ‫ﺭﺍ ﻣﻐﺰ ﺍﺳﺘﺨﻮﺍﻥ ﭘﺮ ﻣﻲﻛﻨﺪ‪.‬‬ ‫ﺩﺭ ﺯﻳﺮ ﭘﺮﻳﻮﺳﺖ ﺍﺳﺘﺨﻮﺍﻧﻬﺎﻱ ﺍﺳﻔﻨﺠﻲ ﻻﻳﻪﺍﻱ‬ ‫ﺍﺯ ﺑﺎﻓﺖ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻣﺘﺮﺍﻛﻢ ﻗﺮﺍﺭ ﺩﺍﺭﺩ‪.‬‬  ‫ﻓﺮﺁﻳﻨﺪ ﻫﺎﻱ ﺍﺳﺘﺨﻮﺍﻥ ﺳﺎﺯﻱ ﺩﺭ ﺑﺪﻥ‬ ‫‪‬‬ ‫‪. 1‬ﺩﺍﺧﻞ ﻏﺸﺎﻳﻲ ‪ :‬ﺩﺭ ﺩﻭﺭﺍﻥ ﺟﻨﻴﻨﻲ ﻳﻚ ﺳﺮﻱ ﺻﻔﺤﺎﺕ ﺍﺯ ﺟﻨﺲ ﺑﺎﻓﺖ ﻫﻢ ﺑﻨﺪ ﻣﺰﺍﻧﺸﻴﻤﻲ ﺍﻃﺮﺍﻑ ﻣﻐﺰ ﺭﺍ‬ ‫ﺍﺣﺎﻃﻪ ﻣﻲ ﻛﻨﻨﺪ )ﭘﻮﺳﺘﻪ ﺍﻱ ﺍﺯ ﺟﻨﺲ ﺑﺎﻓﺖ ﻫﻢ ﺑﻨﺪ ﻣﺰﺍﻧﺸﻴﻤﻲ( ﺩﺭ ﺩﺍﺧﻞ ﺁﻥ ﭘﻮﺳﺘﻪ ﻣﺮﺍﻛﺰ ﺍﺳﺘﺨﻮﺍﻥ‬ ‫ﺳﺎﺯﻱ ﺍﻳﺠﺎﺩ ﻣﻲ ﺷﻮﺩ ﻭ ﺩﺭ ﻧﻬﺎﻳﺖ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﭘﻬﻦ ﺟﻤﺠﻤﻪ ﺑﻪ ﻭﺟﻮﺩ ﻣﻲ¬ﺁﻳﻨﺪ‪.‬‬ ‫ﺩﺭﻭﻥ ﻏﺸﺎﻳﻲ ﻳﻌﻨﻲ ﺩﺭﻭﻥ ﺑﺎﻓﺖ ﻫﻢ ﺑﻨﺪ ﻣﺰﺍﻧﺸﻴﻤﻲ‪.‬ﻳﻌﻨﻲ ﺍﺑﺘﺪﺍ ﺑﺎﻓﺖ ﻫﻢ ﺑﻨﺪ ﻣﺰﺍﻧﺸﻴﻤﻲ ﺗﺸﻜﻴﻞ ﻭ ﺳﭙﺲ‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺗﺒﺪﻳﻞ ﺑﻪ ﺍﺳﺘﺨﻮﺍﻥ ﻣﻲ ﺷﻮﺩ‪.‬‬ ‫ﺩﺭ ﻭﺍﻗﻊ ﺑﺎﻓﺖ ﻫﻢ ﺑﻨﺪ ﻣﺰﺍﻧﺸﻴﻤﻲ ﺩﺭ ﺍﻃﺮﺍﻑ ﺳﻠﻮﻟﻬﺎﻱ ﻣﻐﺰ ﺟﻨﻴﻦ ﻳﻚ ﭘﻮﺳﺘﻪ ﺗﺸﻜﻴﻞ ﻣﻲ ﺩﻫﺪ ﻭ ﻳﻜﺴﺮﻩ‬ ‫ﺗﻮﺳﻂ ﺍﺳﺘﺨﻮﺍﻥ ﺳﺎﺯﻱ ‪ ،‬ﻣﺰﺍﻧﺸﻴﻢ ﺗﺒﺪﻳﻞ ﺑﻪ ﺍﺳﺘﺨﻮﺍﻥ ﻣﻲ ﺷﻮﺩ‪.‬‬ Dr. Maria Zahiri ‫‪. 2‬ﺩﺍﺧﻞ ﻏﻀﺮﻭﻓﻲ ‪ :‬ﺍﺑﺘﺪﺍ ﺑﺎﻓﺖ ﻫﻢ ﺑﻨﺪ ﻣﺰﺍﻧﺸﻴﻤﻲ ﺗﺒﺪﻳﻞ ﺑﻪ ﻏﻀﺮﻭﻑ ﻣﻲ ﺷﻮﺩ ﺳﭙﺲ ﻣﺮﺍﻛﺰ ﺍﺳﺘﺨﻮﺍﻥ‬ ‫‪‬‬ ‫ﺳﺎﺯ ﺩﺭ ﻏﻀﺮﻭﻑ ﺷﺮﻭﻉ ﺑﻪ ﺳﺎﺧﺖ ﺍﺳﺘﺨﻮﺍﻥ ﻣﻲ ﻛﻨﻨﺪ ﻭ ﻏﻀﺮﻭﻑ ﺗﺒﺪﻳﻞ ﺑﻪ ﺍﺳﺘﺨﻮﺍﻥ ﻣﻲ ﺷﻮﺩ‪.‬‬ ‫ﻣﺮﺍﻛﺰ ﺍﺳﺘﺨﻮﺍﻥ ﺳﺎﺯﻱ ﺛﺎﻧﻮﻳﻪ ﺩﺭ ﺩﻭ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺩﺭﺍﺯ ﻫﺴﺘﻨﺪ ﻭ ﭘﺲ ﺍﺯ ﻣﺪﺗﻲ ﺷﺮﻭﻉ ﺑﻪ ﺍﺳﺘﺨﻮﺍﻥ ﺳﺎﺯﻱ‬ ‫ﻣﻲ ﻛﻨﻨﺪ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺩﺭ ﻧﻬﺎﻳﺖ ﻓﻘﻂ ﻳﻚ ﺳﺮﻱ ﺻﻔﺤﺎﺕ ﺭﺷﺪ ﺩﺭ ﺩﻭ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﻗﻲ ﻣﻲ ﻣﺎﻧﺪ ﻛﻪ ﻣﺴﺌﻮﻝ ﺭﺷﺪ ﻃﻮﻟﻲ‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﻫﺴﺘﻨﺪ ﻛﻪ ﺩﺭ ﺳﻦ ‪ 25 - 20‬ﺳﺎﻟﮕﻲ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻣﻲ ﺷﻮﻧﺪ ﻭ ﺭﺷﺪ ﻃﻮﻟﻲ ﻣﺘﻮﻗﻒ ﻣﻲ ﺷﻮﺩ‪.‬‬ Dr. Maria Zahiri  ‫ﺟﻮﺵ ﺧﻮﺭﺩﻥ ﺍﺳﺘﺨﻮﺍﻥ )‪(BONE HEALING‬‬ ‫ﺍﮔﺮ ﺷﺮﺍﻳﻂ ﺑﺮﺍﻱ ﺍﺳﺘﺨﻮﺍﻥ ﺷﻜﺴﺘﻪ ﻣﻄﻠﻮﺏ ﺑﺎﺷﺪ‪ ،‬ﺗﺮﻣﻴﻢ ﻭ ﺑﻬﺒﻮﺩﻱ ﺍﺳﺘﺨﻮﺍﻥ ﺍﺗﻔﺎﻕ ﺍﻓﺘﺎﺩﻩ‪ ،‬ﺑﻪ ﺗﺪﺭﻳﺞ ﺳﺨﺖ ﻭ‬ ‫‪‬‬ ‫ﻣﺴﺘﺤﻜﻢ ﺷﺪﻩ ﻭ ﺑﺎﺯﺳﺎﺯﻱ ﻣﻲ ﮔﺮﺩﺩ‪.‬‬ ‫ﺟﻮﺵ ﺧﻮﺭﺩﮔﻲ ﺩﺭ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﻟﻮﻟﻪ ﺍﻱ )ﺗﻮﺑﻮﻟﺮ( ﻛﻪ ﺩﺍﺭﺍﻱ ﻣﺠﺮﺍﻱ ﻣﺪﻭﻟﺮ )ﻣﺠﺮﺍﻱ ﻣﻐﺰ ﺍﺳﺘﺨﻮﺍﻥ( ﻫﺴﺘﻨﺪ‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺍﺯﻃﺮﻳﻖ ﺗﺸﻜﻴﻞ ﻛﺎﻝ ﺍﺳﺘﺨﻮﺍﻧﻲ )ﻛﺎﻟﻮﺱ( ﺩﺭ ﻣﺤﻞ ﺷﻜﺴﺘﮕﻲ ﺍﻳﺠﺎﺩ ﻣﻲ ﮔﺮﺩﺩ )ﺑﻪ ﺻﻮﺭﺕ ﻛﺎﻝ ﺩﺍﺧﻠﻲ ﻭ ﻛﺎﻝ‬ ‫ﺧﺎﺭﺟﻲ(‪.‬‬ ‫ﻛﺎﻝ ﺍﺳﺘﺨﻮﺍﻧﻲ ﺗﺮﻛﻴﺒﻲ ﺍﺯ ﻏﻀﺮﻭﻑ‪ ،‬ﺑﺎﻓﺖ ﻟﻴﻔﻲ )ﻓﻴﺒﺮﻭﺯ( ﻭ ﺍﺳﺘﺨﻮﺍﻥ ﺍﺳﺖ ﻛﻪ ﻗﺎﺑﻠﻴﺖ ﺗﺒﺪﻳﻞ ﺑﻪ ﺑﺎﻓﺖ ﺍﺳﺘﺨﻮﺍﻧﻲ ﺭﺍ‬ ‫‪‬‬ ‫ﺩﺍﺭﺩ‪.‬‬ ‫ﺩﺭ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﺍﺳﻔﻨﺠﻲ ﻳﺎ ﻛﻨﺴﻠﻮﺱ )ﻫﻤﺎﻧﻨﺪ ﻣﻬﺮﻩ ﻫﺎﻱ ﺳﺘﻮﻥ ﻓﻘﺮﺍﺕ( ﺑﻪ ﻋﻠﺖ ﺳﻄﺢ ﺗﻤﺎﺱ ﺑﻴﺸﺘﺮ ﻭ ﻋﺮﻭﻕ‬ ‫‪‬‬ ‫ﺧﻮﻧﻲ ﻣﻨﺎﺳﺐ‪ ،‬ﺟﻮﺵ ﺧﻮﺭﺩﮔﻲ ﺳﺮﻳﻊ ﺗﺮ ﺻﻮﺭﺕ ﻣﻲ ﮔﻴﺮﺩ ﻭ ﻟﺰﻭﻣﻲ ﺑﻪ ﺗﺸﻜﻴﻞ ﻛﺎﻝ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻫﻤﺎﻧﻨﺪ ﺍﺳﺘﺨﻮﺍﻥ‬ ‫ﻫﺎﻱ ﻟﻮﻟﻪ ﺍﻱ ﻧﻴﺴﺖ‪.‬ﺍﻳﻦ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎ ﻓﺎﻗﺪ ﻣﺠﺮﺍﻱ ﻣﺪﻭﻟﺮ ﻫﺴﺘﻨﺪ‪.‬‬ ‫ﺩﺭ ﭘﺮﻭﺳﻪ ﺟﻮﺵ ﺧﻮﺭﺩﮔﻲ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎ‪ ،‬ﺍﺳﺘﺌﻮﺑﻼﺳﺖ ﻫﺎ )‪ (Osteoblasts‬ﺑﺎﻋﺚ ﺍﻳﺠﺎﺩ ﻣﺎﺗﺮﻳﻜﺲ ﺑﻴﻦ ﺳﻠﻮﻟﻲ‬ ‫‪‬‬ ‫ﻣﻲ ﮔﺮﺩﻧﺪ ﻛﻪ ﺷﺎﻣﻞ ﻛﻼژﻥ ﻭ ﭘﻠﻲ ﺳﺎﻛﺎﺭﻳﺪ ﺍﺳﺖ ﻛﻪ ﺑﻪ ﺗﺪﺭﻳﺞ ﺑﺎ ﺭﺳﻮﺏ ﺍﻣﻼﺡ ﻛﻠﺴﻴﻢ ﺩﺭ ﺁﻥ ﺑﻪ ﭘﻴﺪﺍﻳﺶ‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﻣﻲ ﺍﻧﺠﺎﻣﺪ‪.‬‬ ‫ﺍﮔﺮﭼﻪ ﺍﺳﺘﺌﻮﺑﻼﺳﺖ ﻫﺎ ﺩﺭ ﻃﻲ ﻓﺮﺁﻳﻨﺪ ﺟﻮﺵ ﺧﻮﺭﺩﮔﻲ ﺑﺎﻋﺚ ﺍﺳﺘﺨﻮﺍﻥ ﺳﺎﺯﻱ ﻣﻲ ﺷﻮﻧﺪ ﻭﻟﻲ ﺩﺭﺍﺭﺗﺒﺎﻁ ﺑﺎ ﻣﻨﺸﺎء‬ ‫‪‬‬ ‫ﺍﻳﻦ ﺳﻠﻮﻝ ﻫﺎ ﻭ ﭼﮕﻮﻧﮕﻲ ﻓﻌﺎﻝ ﺷﺪﻥ ﺁﻧﻬﺎ ﭘﺲ ﺍﺯ ﺷﻜﺴﺘﮕﻲ ﺍﺗﻔﺎﻕ ﻧﻈﺮ ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ‪.‬‬  ‫ﻣﺮﺍﺣﻞ ﺟﻮﺵ ﺧﻮﺭﺩﮔﻲ ﺍﺳﺘﺨﻮﺍﻥ‬ ‫‪‬‬ ‫ﺑﻪ ﻃﻮﺭﻛﻠﻲ ﺟﻮﺵ ﺧﻮﺭﺩﻥ ﺍﺳﺘﺨﻮﺍﻥ ﺭﺍ ﻣﻲ ﺗﻮﺍﻥ ﺑﻪ ﺳﻪ ﻣﺮﺣﻠﻪ ﺗﻘﺴﻴﻢ ﻛﺮﺩ‪:‬‬ ‫‪‬‬ ‫*ﻣﺮﺣﻠﻪ ﺍﻟﺘﻬﺎﺑﻲ )‪(Inflammatory stage‬‬ ‫‪‬‬ ‫*ﻣﺮﺣﻠﻪ ﺗﺮﻣﻴﻤﻲ )‪(Reparative stage‬‬ ‫‪‬‬ ‫*ﻣﺮﺣﻠﻪ ﺷﻜﻞ ﮔﻴﺮﻱ ﻣﺠﺪﺩ )‪(Remodeling stage‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫‪‬‬ ‫ﻣﺮﺍﺣﻞ ﻓﻮﻕ ﺑﺼﻮﺭﺕ ﺟﺪﺍ ﺍﺯ ﻳﻜﺪﻳﮕﺮ ﻧﺒﻮﺩﻩ ﻭ ﻧﻮﻋﻲ ﺗﺪﺍﺧﻞ ﻭ ﻫﻤﭙﻮﺷﺎﻧﻲ ﺑﻴﻦ ﺁﻧﻬﺎ ﻭﺟﻮﺩ ﺩﺍﺭﺩ‪.‬ﺑﺎ ﺍﻳﻨﺤﺎﻝ‪،‬‬ ‫‪‬‬ ‫ﻛﻮﺗﺎﻫﺘﺮﻳﻦ ﻣﺮﺣﻠﻪ ﺑﻬﺒﻮﺩﻱ ﺍﺳﺘﺨﻮﺍﻥ ﻣﺮﺑﻮﻁ ﺑﻪ ﻓﺎﺯ ﺍﻟﺘﻬﺎﺑﻲ ﻭ ﻃﻮﻻﻧﻲ ﺗﺮﻳﻦ ﺁﻥ ﺩﺭﺍﺭﺗﺒﺎﻁ ﺑﺎ ﻓﺎﺯ ﺷﻜﻞ ﮔﻴﺮﻱ‬ ‫ﻣﺠﺪﺩ ﺍﺳﺖ‪.‬‬  ‫ﻣﺮﺣﻠﻪ ﺍﻟﺘﻬﺎﺑﻲ )‪(Inflammatory stage‬‬ ‫‪‬‬ ‫ﺷﻜﺴﺘﮕﻲ ﺍﺳﺘﺨﻮﺍﻥ ﻣﻨﺠﺮﺑﻪ ﺁﺳﻴﺐ ﻋﺮﻭﻕ ﺧﻮﻧﻲ ﻣﻲ ﮔﺮﺩﺩ ﻛﻪ ﻧﺘﻴﺠﻪ ﺁﻥ ﺧﻮﻧﺮﻳﺰﻱ ﺩﺭ ﻧﺎﺣﻴﻪ‬ ‫‪‬‬ ‫ﺷﻜﺴﺘﻪ ﺍﺳﺖ‪.‬ﺑﺮﺧﻲ ﺍﺯ ﻋﺮﻭﻕ ﺧﻮﻧﻲ ﻛﻪ ﻣﻤﻜﻦ ﺍﺳﺖ ﺑﻪ ﻫﻨﮕﺎﻡ ﺷﻜﺴﺘﮕﻲ ﺁﺳﻴﺐ ﺑﺒﻴﻨﻨﺪ‬ ‫ﻋﺒﺎﺭﺗﻨﺪﺍﺯ‪:‬‬ ‫*ﻋﺮﻭﻕ ﺧﻮﻧﻲ ﺍﺳﺘﺨﻮﺍﻥ‬ ‫‪‬‬ ‫*ﻋﺮﻭﻕ ﺧﻮﻧﻲ ﭘﺮﻳﻮﺳﺖ )ﺿﺮﻳﻊ ﻳﺎ ﭘﺮﺩﻩ ﺑﻴﺮﻭﻧﻲ ﺍﺳﺘﺨﻮﺍﻥ(‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫*ﻋﺮﻭﻕ ﺧﻮﻧﻲ ﻋﻀﻼﺕ‬ ‫‪‬‬ ‫*ﻋﺮﻭﻕ ﺧﻮﻧﻲ ﻣﻐﺰ ﺍﺳﺘﺨﻮﺍﻥ‬ ‫‪‬‬ ‫ﺧﻮﻧﺮﻳﺰﻱ ﺩﺭ ﻧﺎﺣﻴﻪ ﺷﻜﺴﺘﻪ ﺑﺎﻋﺚ ﺗﺸﻜﻴﻞ ﻫﻤﺎﺗﻮﻡ )‪ (Hematoma‬ﺩﺭ ﺁﻥ ﻧﺎﺣﻴﻪ ﻭ ﺍﻃﺮﺍﻓﺶ‬ ‫‪‬‬ ‫ﻣﻲ ﮔﺮﺩﺩ‪.‬ﺩﺭ ﺍﻳﻦ ﻣﺮﺣﻠﻪ ﺑﻪ ﻋﻠﺖ ﻧﻘﺺ ﺧﻮﻧﺮﺳﺎﻧﻲ ﺩﺭ ﻟﺒﻪ ﺍﺳﺘﺨﻮﺍﻥ ﺷﻜﺴﺘﻪ‪ ،‬ﺍﻳﻦ ﻧﻮﺍﺣﻲ ﺩﭼﺎﺭ‬ ‫ﻧﻜﺮﻭﺯ ﻭ ﻣﺮﺩﮔﻲ ﻣﻲ ﮔﺮﺩﻧﺪ‪.‬ﻧﺴﺞ ﻣﺮﺩﻩ ﻣﺮﺑﻮﻁ ﺑﻪ ﻟﺒﻪ ﺍﺳﺘﺨﻮﺍﻥ ﺷﻜﺴﺘﻪ ﻭ ﺑﺮﺧﻲ ﺍﺯ ﺑﺎﻓﺖ ﻫﺎﻱ‬ ‫ﺩﻳﮕﺮ ﻣﻨﺠﺮﺑﻪ ﻳﻚ ﻭﺍﻛﻨﺶ ﺍﻟﺘﻬﺎﺑﻲ ﺩﺭ ﻣﻨﻄﻘﻪ ﺷﻜﺴﺘﻪ ﺷﺪﻩ ﻭ ﺍﻳﺠﺎﺩ ﻋﻼﻳﻤﻲ ﻫﻤﺎﻧﻨﺪ ﺗﻮﺭﻡ ﻭ‬ ‫ﻗﺮﻣﺰﻱ ﻣﻲ ﻛﻨﺪ‪.‬ﺳﻠﻮﻝ ﻫﺎﻳﻲ ﻛﻪ ﻭﺍﺭﺩ ﺍﻳﻦ ﻧﺎﺣﻴﻪ ﻣﻲ ﺷﻮﻧﺪ ﺷﺎﻣﻞ ﺳﻠﻮﻝ ﻫﺎﻱ ﭼﻨﺪ ﻫﺴﺘﻪ ﺍﻱ ﻭ‬ ‫ﻣﺎﻛﺮﻭﻓﺎژﻫﺎ ﻫﺴﺘﻨﺪ‪.‬ﻣﺮﺣﻠﻪ ﺍﻟﺘﻬﺎﺑﻲ ﻛﻮﺗﺎﻫﺘﺮﻳﻦ ﻣﺮﺣﻠﻪ ﺑﻮﺩﻩ ﻛﻪ ﻣﺪﺕ ﺯﻣﺎﻥ ﺁﻥ ﺩﻭ ﺍﻟﻲ ﺳﻪ ﺭﻭﺯ‬ ‫ﺍﺳﺖ‪.‬‬  ‫‪ ‬ﻣﺮﺣﻠﻪ ﺗﺮﻣﻴﻤﻲ )‪(Reparative stage‬‬ ‫‪ ‬ﺍﻳﻦ ﻣﺮﺣﻠﻪ ﺷﺎﻣﻞ ﺗﻜﺜﻴﺮ ﺳﻠﻮﻟﻲ ﻭ ﻫﻤﭽﻨﻴﻦ ﻧﻔﻮﺫ ﻋﺮﻭﻕ ﺧﻮﻧﻲ ﺩﺭ ﻧﺎﺣﻴﻪ ﺷﻜﺴﺘﻪ ﺍﺳﺖ‪.‬ﺑﺮﺧﻲ‬ ‫ﻣﻌﺘﻘﺪﻧﺪ ﻫﻤﺎﺗﻮﻣﻲ ﻛﻪ ﺩﺭ ﻣﺮﺣﻠﻪ ﺍﻟﺘﻬﺎﺑﻲ ﺗﺸﻜﻴﻞ ﺷﺪﻩ ﺑﻮﺩ‪ ،‬ﺩﺭ ﻣﺮﺣﻠﻪ ﺗﺮﻣﻴﻤﻲ ﺍﺭﮔﺎﻧﻴﺰﻩ ﻭ ﺳﻔﺖ‬ ‫ﺷﺪﻩ ﻭ ﺑﻪ ﺗﺪﺭﻳﺞ ﺑﺎﻋﺚ ﺍﻳﺠﺎﺩ ﺑﺎﻓﺖ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻣﻲ ﮔﺮﺩﺩ‪ ،‬ﺩﺭﺣﺎﻟﻴﻜﻪ ﺩﻳﮕﺮﺍﻥ ﺍﻋﺘﻘﺎﺩ ﺩﺍﺭﻧﺪ ﻛﻪ‬ ‫ﻧﻘﺶ ﻫﻤﺎﺗﻮﻡ ﺩﺭ ﺗﺮﻣﻴﻢ ﺑﺴﻴﺎﺭ ﻛﻢ ﺑﻮﺩﻩ ﻭ ﻳﺎ ﺍﺻﻼ ﻧﻘﺸﻲ ﻧﺪﺍﺭﺩ‪ ،‬ﺑﻠﻜﻪ ﻫﻤﺎﺗﻮﻡ ﺍﺯﻃﺮﻳﻖ ﺑﺎﻓﺖ ﺩﺭ‬ ‫ﺣﺎﻝ ﺗﻜﺜﻴﺮ ﺣﺬﻑ ﻣﻲ ﮔﺮﺩﺩ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫‪ ‬ﺁﻧﭽﻪ ﻛﻪ ﺩﺭ ﻣﺮﺣﻠﻪ ﺗﺮﻣﻴﻤﻲ ﺍﻫﻴﻤﺖ ﺩﺍﺭﺩ ﺍﻳﺠﺎﺩ ﻛﺎﻝ ﺍﺳﺘﺨﻮﺍﻧﻲ )ﻛﺎﻟﻮﺱ( ﺩﺭ ﺑﻴﻦ ﻗﻄﻌﺎﺕ‬ ‫ﺷﻜﺴﺘﻪ ﺍﺳﺖ ﻛﻪ ﺩﺭ ﺍﺑﺘﺪﺍ ﻧﺮﻡ ﺑﻮﺩﻩ ﻭ ﺑﻪ ﺗﺪﺭﻳﺞ ﺳﻔﺖ ﻣﻲ ﺷﻮﺩ‪.‬ﻛﺎﻝ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻛﻪ ﺩﺭ ﺷﺮﻭﻉ‬ ‫ﻧﺎﺭﺱ ﺍﺳﺖ ﺗﻮﺳﻂ ﺍﺳﺘﺌﻮﺑﻼﺳﺖ ﻫﺎ ﺑﻪ ﻭﺟﻮﺩ ﻣﻲ ﺁﻳﺪ ﻛﻪ ﺑﻪ ﺍﻳﻦ ﺍﺳﺘﺨﻮﺍﻥ ﻧﺎﺭﺱ‪" ،‬ﺍﺳﺘﺨﻮﺍﻥ‬ ‫ﺑﺎﻓﺘﻪ" )‪ (Woven bone‬ﻣﻲ ﮔﻮﻳﻨﺪ‪.‬ﺍﺳﺘﺌﻮﺑﻼﺳﺖ ﻫﺎ ﺑﻪ ﺗﺪﺭﻳﺞ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﻓﺘﻪ ﺭﺍ ﺑﻪ‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﻟﻎ ﺗﺮ ﺗﺒﺪﻳﻞ ﻣﻲ ﻛﻨﻨﺪ ﻛﻪ ﺩﺍﺭﺍﻱ ﺳﺎﺧﺘﻤﺎﻥ ﺗﻴﻐﻪ ﺍﻱ ﺍﺳﺖ‪.‬‬ ‫ﻫﻤﭽﻨﻴﻦ ﻣﻤﻜﻦ ﺍﺳﺖ ﺑﺎﻓﺖ ﻏﻀﺮﻭﻓﻲ ﺑﻪ ﻣﻴﺰﺍﻥ ﻛﻢ ﻳﺎ ﺯﻳﺎﺩ ﺍﺯﻃﺮﻳﻖ‬ ‫ﺳﻠﻮﻝ ﻫﺎﻱ ﻏﻀﺮﻭﻑ ﺳﺎﺯ )ﻛﻨﺪﺭﻭﺑﻼﺳﺖ ﻫﺎ( ﺍﻳﺠﺎﺩ ﮔﺮﺩﻧﺪ ﻭﻟﻲ‬ ‫ﻏﻀﺮﻭﻑ ﻫﺎ ﺩﺭ ﭘﺮﻭﺳﻪ ﺍﻟﺘﻴﺎﻡ ﺷﻜﺴﺘﮕﻲ ﺍﺳﺘﺨﻮﺍﻥ ﺟﺰء ﺍﺻﻠﻲ ﻣﺤﺴﻮﺏ ﻧﻤﻲ ﺷﻮﻧﺪ‪.‬‬  ‫ﻣﻨﺸﺎء ﺍﺳﺘﺌﻮﺑﻼﺳﺖ ﻫﺎ ﻭ ﻧﺤﻮﻩ ﻓﻌﺎﻝ ﺷﺪﻥ ﺁﻧﻬﺎ‬ ‫‪‬‬ ‫ﻫﻤﺎﻧﻄﻮﺭ ﻛﻪ ﺩﺭ ﺑﺎﻻ ﻧﻴﺰ ﺫﻛﺮ ﺷﺪ ﺩﺭ ﭘﺮﻭﺳﻪ ﺟﻮﺵ ﺧﻮﺭﺩﮔﻲ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎ‪ ،‬ﺍﺳﺘﺌﻮﺑﻼﺳﺖ ﻫﺎ ﺑﺎﻋﺚ ﺍﻳﺠﺎﺩ‬ ‫‪‬‬ ‫ﻣﺎﺗﺮﻳﻜﺲ ﺑﻴﻦ ﺳﻠﻮﻟﻲ ﻣﻲ ﮔﺮﺩﻧﺪ ﻛﻪ ﺷﺎﻣﻞ ﻛﻼژﻥ ﻭ ﭘﻠﻲ ﺳﺎﻛﺎﺭﻳﺪ ﺍﺳﺖ ﻛﻪ ﺑﻪ ﺗﺪﺭﻳﺞ ﺑﺎ ﺭﺳﻮﺏ ﺍﻣﻼﺡ‬ ‫ﻛﻠﺴﻴﻢ ﺩﺭ ﺁﻥ ﺑﻪ ﭘﻴﺪﺍﻳﺶ ﺍﺳﺘﺨﻮﺍﻥ ﻣﻲ ﺍﻧﺠﺎﻣﺪ‪.‬ﺍﮔﺮﭼﻪ ﺍﺳﺘﺌﻮﺑﻼﺳﺖ ﻫﺎ ﺩﺭ ﻃﻲ ﻓﺮﺁﻳﻨﺪ ﺟﻮﺵ ﺧﻮﺭﺩﮔﻲ‬ ‫ﺑﺎﻋﺚ ﺍﺳﺘﺨﻮﺍﻥ ﺳﺎﺯﻱ ﻣﻲ ﺷﻮﻧﺪ ﻭﻟﻲ ﺩﺭﺍﺭﺗﺒﺎﻁ ﺑﺎ ﻣﻨﺸﺎء ﺍﻳﻦ ﺳﻠﻮﻝ ﻫﺎ ﻭ ﭼﮕﻮﻧﮕﻲ ﻓﻌﺎﻝ ﺷﺪﻥ ﺁﻧﻬﺎ ﭘﺲ ﺍﺯ‬ ‫ﺷﻜﺴﺘﮕﻲ ﺍﺗﻔﺎﻕ ﻧﻈﺮ ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ‪.‬‬ ‫ﺑﺎ ﺍﻳﻨﺤﺎﻝ ﻣﻤﻜﻦ ﺍﺳﺖ ﻣﺤﻘﻘﻴﻦ ﻣﻨﺸﺎء ﺍﺳﺘﺌﻮﺑﻼﺳﺖ ﻫﺎ ﺭﺍ ﺑﻪ ﻣﻮﺍﺭﺩ ﺯﻳﺮ ﻧﺴﺒﺖ ﺩﻫﻨﺪ‪:‬‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫*ﺳﻠﻮﻝ ﻫﺎﻱ ﻣﺰﺍﻧﺸﻴﻤﻲ ﻻﻳﻪ ﻋﻤﻘﻲ ﭘﺮﻳﻮﺳﺖ ﻳﺎ ﺿﺮﻳﻊ )‪(Periosteum‬‬ ‫‪‬‬ ‫*ﺳﻠﻮﻝ ﻫﺎﻱ ﻣﺰﺍﻧﺸﻴﻤﻲ ﺍﻧﺪﻭﺳﺖ )‪) (Endosteum‬ﺑﺎﻓﺘﻲ ﻛﻪ ﺩﺍﺧﻞ ﻣﺠﺮﺍﻱ ﻣﻐﺰ ﺍﺳﺘﺨﻮﺍﻥ ﺭﺍ ﻣﻲ‬ ‫‪‬‬ ‫ﭘﻮﺷﺎﻧﺪ(‬ ‫*ﺳﻠﻮﻝ ﻫﺎﻱ ﻣﺰﺍﻧﺸﻴﻤﻲ ﻣﻐﺰ ﺍﺳﺘﺨﻮﺍﻥ )‪(Bone marrow‬‬ ‫‪‬‬ ‫*ﺳﻠﻮﻝ ﻫﺎﻱ ﺍﻧﺪﻭﺗﻠﻴﺎﻝ ﻣﻮﻳﺮگ ﻫﺎﻳﻲ ﻛﻪ ﻭﺍﺭﺩ ﻫﻤﺎﺗﻮﻡ ﻣﻲ ﺷﻮﻧﺪ‬ ‫‪‬‬ ‫‪‬‬  ‫ﻣﺮﺣﻠﻪ ﺷﻜﻞ ﮔﻴﺮﻱ ﻣﺠﺪﺩ )‪(Remodeling stage‬‬ ‫‪‬‬ ‫ﺍﻳﻦ ﻣﺮﺣﻠﻪ ﻧﺴﺒﺖ ﺑﻪ ﺩﻭ ﻣﺮﺣﻠﻪ ﺩﻳﮕﺮ ﻃﻮﻻﻧﻲ ﺗﺮ ﺑﻮﺩﻩ‪ ،‬ﺑﻪ ﻃﻮﺭﻱ ﻛﻪ ﻣﻤﻜﻦ ﺍﺳﺖ ﺣﺘﻲ ﺗﺎ ﭼﻨﺪﻳﻦ ﺳﺎﻝ‬ ‫‪‬‬ ‫ﺍﺩﺍﻣﻪ ﻳﺎﺑﺪ‪.‬ﻣﺮﺣﻠﻪ ﺷﻜﻞ ﮔﻴﺮﻱ ﻣﺠﺪﺩ ﺩﺭ ﻓﺮﺁﻳﻨﺪ ﺍﻟﺘﻴﺎﻡ ﺍﺳﺘﺨﻮﺍﻥ ﻣﺮﺣﻠﻪ ﺍﻱ ﺍﺳﺖ ﺟﻬﺖ ﻧﺰﺩﻳﻚ ﺷﺪﻥ ﻛﺎﻝ‬ ‫ﺍﺳﺘﺨﻮﺍﻧﻲ ﺑﻪ ﺣﺎﻟﺖ ﺍﻭﻟﻴﻪ ﺍﺳﺘﺨﻮﺍﻥ ﻃﺒﻴﻌﻲ‪.‬ﺩﺭ ﺑﺮﺧﻲ ﺍﺯ ﻣﻮﺍﺭﺩ ﺑﻪ ﻫﻨﮕﺎﻡ ﺟﻮﺵ ﺧﻮﺭﺩﮔﻲ ﻛﺎﻝ ﺑﺰﺭﮔﻲ‬ ‫ﺗﺸﻜﻴﻞ ﻣﻲ ﺷﻮﺩ‪-‬ﻛﻪ ﻧﻪ ﺗﻨﻬﺎ ﻓﺎﺻﻠﻪ ﺑﻴﻦ ﻗﻄﻌﺎﺕ ﺷﻜﺴﺘﻪ ﺭﺍ ﭘﺮ ﻣﻲ ﻛﻨﺪ ﺑﻠﻜﻪ ﺩﺭ ﺩﺍﺧﻞ ﻣﺠﺮﺍﻱ ﺍﺳﺘﺨﻮﺍﻥ ﻭ‬ ‫ﺍﻃﺮﺍﻑ ﺁﻥ ﻧﻴﺰ ﺍﻳﺠﺎﺩ ﻣﻲ ﺷﻮﺩ‪ -‬ﻛﻪ ﺑﻪ ﻭﺍﺳﻄﻪ ﻣﺮﺣﻠﻪ ﺷﻜﻞ ﮔﻴﺮﻱ ﻣﺠﺪﺩ‪ ،‬ﺑﺨﺶ ﻫﺎﻱ ﺍﺿﺎﻓﻲ ﺣﺬﻑ ﺷﺪﻩ ﻭ‬ ‫ﻫﻤﭽﻨﻴﻦ ﺳﻄﻮﺡ ﺍﺳﺘﺨﻮﺍﻥ ﻭﺿﻌﻴﺖ ﻣﻨﺎﺳﺐ ﺗﺮﻱ ﭘﻴﺪﺍ ﻣﻲ ﻛﻨﻨﺪ‪.‬ﺩﺭ ﻓﺎﺯ ﺷﻜﻞ ﮔﻴﺮﻱ ﻣﺠﺪﺩ‪ ،‬ﺳﻠﻮﻝ ﻫﺎﻱ‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺍﺳﺘﺌﻮﻛﻼﺳﺖ ﻭ ﺍﺳﺘﺌﻮﺑﻼﺳﺖ ﺑﺎ ﻳﻜﺪﻳﮕﺮ ﻓﻌﺎﻝ ﺑﻮﺩﻩ ﺑﻪ ﻧﺤﻮﻱ ﻛﻪ ﺍﺳﺘﺌﻮﻛﻼﺳﺖ ﻫﺎ ﻭﻇﻴﻔﻪ ﺣﺬﻑ ﻗﺴﻤﺖ‬ ‫ﻫﺎﻱ ﺍﺿﺎﻓﻲ ﻭ ﺳﻄﻮﺡ ﻧﺎﻣﻨﻈﻢ ﺭﺍ ﺑﺮﻋﻬﺪﻩ ﺩﺍﺷﺘﻪ ﻭ ﺍﺳﺘﺌﻮﺑﻼﺳﺖ ﻫﺎ ﺑﻪ ﻭﻇﻴﻔﻪ ﺍﺳﺘﺨﻮﺍﻥ ﺳﺎﺯﻱ ﺧﻮﺩ ﺩﺭ‬ ‫ﺟﻬﺖ ﻫﺮ ﭼﻪ ﻃﺒﻴﻌﻲ ﺷﺪﻥ ﺳﺎﺧﺘﻤﺎﻥ ﺍﺳﺘﺨﻮﺍﻥ ﺍﺩﺍﻣﻪ ﻣﻲ ﺩﻫﻨﺪ‪.‬ﺑﻨﺎﺑﺮﺍﻳﻦ ﺩﺭ ﺍﻳﻦ ﻣﺮﺣﻠﻪ‪ ،‬ﻣﺠﺮﺍﻱ ﻣﺪﻭﻟﺮ‬ ‫)ﻣﺠﺮﺍﻱ ﺍﺳﺘﺨﻮﺍﻥ( ﺩﺭ ﻧﺎﺣﻴﻪ ﺷﻜﺴﺘﻪ ﻛﻪ ﻗﺒﻼ ﺗﻮﺳﻂ ﻛﺎﻝ ﺍﺳﺘﺨﻮﺍﻧﻲ ﭘﺮ ﺷﺪﻩ ﺑﻮﺩ‪ ،‬ﺑﻪ ﺗﺪﺭﻳﺞ ﺩﻭﺑﺎﺭﻩ ﺑﻪ‬ ‫ﻭﺿﻌﻴﺖ ﻃﺒﻴﻌﻲ ﺧﻮﺩ ﺑﺮﻣﻲ ﮔﺮﺩﺩ‪.‬‬ ‫ﻣﺮﺣﻠﻪ ﺷﻜﻞ ﮔﻴﺮﻱ ﻣﺠﺪﺩ ﺩﺭ ﻛﻮﺩﻛﺎﻥ ﻧﺴﺒﺖ ﺑﻪ ﺍﻓﺮﺍﺩ ﺑﺎﻟﻎ ﻭﺿﻌﻴﺖ ﻣﻄﻠﻮﺏ ﺗﺮﻱ ﺩﺍﺭﺩ‬ ‫‪‬‬ ‫ﺑﻪ ﻧﺤﻮﻱ ﻛﻪ ﺩﺭ ﺑﺴﻴﺎﺭﻱ ﺍﺯ ﻣﻮﺍﺭﺩ‪ ،‬ﺍﻣﻜﺎﻥ ﺗﺸﺨﻴﺺ ﻧﺎﺣﻴﻪ ﺷﻜﺴﺘﻪ ﭘﺲ ﺍﺯ ﺍﻧﺠﺎﻡ‬ ‫ﺭﺍﺩﻳﻮﮔﺮﺍﻓﻲ ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ ﻭﻟﻲ ﺩﺭ ﺍﻓﺮﺍﺩ ﺑﺎﻟﻎ ﺩﺭ ﺑﻴﺸﺘﺮ ﻣﻮﺍﺭﺩ ﺑﻪ ﻭﺍﺳﻄﻪ ﺍﺳﻜﻠﺮﻭﺯ‬ ‫ﺗﺸﺨﻴﺺ ﺩﺍﺩﻩ ﻣﻲ ﺷﻮﺩ‪.‬‬  ‫ﺍﺳﺘﺌﻮﭘﻮﺭﺯ‪:‬‬ ‫ﻛﺎﻫﺶ ﺗﺮﺍﻛﻢ ﺍﺳﺘﺨﻮﺍﻥ ﻭ ﺍﺯ ﺩﺳﺖ ﺭﻓﺘﻦ ﻛﻴﻔﻴﺖ ﺭﻳﺰﺳﺎﺧﺘﺎﺭ ﺍﺳﺘﺨﻮﺍﻥ‪ ،‬ﻣﻨﺠﺮ ﺑﻪ ﺍﻓﺰﺍﻳﺶ ﺧﺎﺻﻴﺖ‬ ‫‪‬‬ ‫ﺷﻜﻨﻨﺪﮔﻲ ﺍﺳﺘﺨﻮﺍﻥ ﻭ ﺩﺭ ﻧﺘﻴﺠﻪ ﺍﻓﺰﺍﻳﺶ ﺧﻄﺮ ﺷﻜﺴﺘﮕﻲ ﻣﻲﺷﻮﺩ ‪.‬ﺍﻫﻤﻴﺖ ﺍﺳﺘﺌﻮﭘﺮﻭﺯ ﺩﺭ ﺷﻜﺴﺘﮕﻲ ﻧﺎﺷﻲ‬ ‫ﺍﺯ ﺁﻥ ﺍﺳﺖ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬  ‫ﺍﺳﺘﺌﻮﭘﺘﺮﻭﺯ) ﺍﺳﺘﺨﻮﺍﻥ ﻣﺮﻣﺮﻱ(‬ ‫ﺍﺳﺘﺌﻮﭘﺘﺮﻭﺯ ﺑﻴﻤﺎﺭﻱ ﺍﺭﺛﻲ ﻭ ﻧﺎﺩﺭﻱ ﺍﺳﺖ ﻛﻪ ﺩﺍﺭﺍﻱ ﺍﺷﻜﺎﻝ ﻓﻨﻮﺗﻴﭙﻲ ﻭ ژﻧﻮﺗﻴﭙﻲ ﻣﺘﻔﺎﻭﺗﻲ ﺍﺳﺖ‪.‬ﺍﻳﻦ ﺑﻴﻤﺎﺭﻱ‬ ‫‪‬‬ ‫ﺑﺮ ﺍﺛﺮ ﻛﻤﺒﻮﺩ ﻓﻌﺎﻟﻴﺖ ﺍﺳﺘﺌﻮﻛﻼﺳﺖ ﻫﺎ ﺑﻮﺟﻮﺩ ﻣﻲ ﺁﻳﺪ‪.‬ﺑﻨﺎﺑﺮﺍﻳﻦ ﺍﻓﺰﺍﻳﺶ ﺗﺮﺍﻛﻢ ﺍﺳﺘﺨﻮﺍﻧﻬﺎ ﺍﻳﺠﺎﺩ ﺷﺪﻩ ﺑﻪ‬ ‫ﻧﺤﻮﻱ ﻛﻪ ﺍﺳﺘﺨﻮﺍﻧﻬﺎ ﺑﻪ ﺁﺳﺎﻧﻲ ﻣﻲ ﺷﻜﻨﺪ‬ ‫‪Dr. Maria Zahiri‬‬  ‫ﻣﻔﺎﺻﻞ )‪(JOINTS‬‬ ‫‪‬‬ ‫ﻣﻔﺼﻞ ﻧﺎﺣﻴﻪ ﺍﻱ ﺍﺳﺖ ﻛﻪ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎ ﺑﻪ ﻳﻜﺪﻳﮕﺮ ﻣﺘﺼﻞ ﻣﻲ ﮔﺮﺩﻧﺪ‪.‬ﻣﻔﺎﺻﻞ ﺑﺪﻥ ﺑﻪ ﺳﻪ ﮔﺮﻭﻩ ﺍﺻﻠﻲ‬ ‫ﺗﻘﺴﻴﻢ ﻣﻲ ﺷﻮﻧﺪ‪:‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫*ﻣﻔﺎﺻﻞ ﺛﺎﺑﺖ ﻳﺎ ﻟﻴﻔﻲ )ﻓﻴﺒﺮﻭﺯ(‬ ‫*ﻣﻔﺎﺻﻞ ﻧﻴﻤﻪ ﻣﺘﺤﺮﻙ ﻳﺎ ﻏﻀﺮﻭﻓﻲ‬ ‫*ﻣﻔﺎﺻﻞ ﻣﺘﺤﺮﻙ )ﺳﻴﻨﻮﻭﻳﺎﻝ(‬  ‫‪Dr. Maria Zahiri‬‬ ‫ﺧﺴﺘﻪ ﻧﺒﺎﺷﻴﺪ ﻋﺰﻳﺰﺍﻥ‬ Dr. Maria Zahiri  ‫ﺑﻪ ﻧﺎﻡ ﺧﺎﻟﻖ ﻣﺘﻌﺎﻝ‬ ‫ﺍﻧﺪﺍﻡ ﻓﻮﻗﺎﻧﻲ‬ ‫ﺩﻛﺘﺮ ﻇﻬﻴﺮﻱ‬ ‫ﺍﻧﺪﺍﻡ ﻓﻮﻗﺎﻧﻲ ﺷﺎﻣﻞ ﺑﺨﺸﻬﺎﻱ ﺯﻳﺮ ﻣﻲ ﺑﺎﺷﺪ‪:‬‬ ‫‪.‬‬ ‫ ﻣﻲ‬Deltoid ‫ ﻭ‬Scapular ،Pectoral ،Axillary ‫ ﻧﺎﺣﻴﻪ‬4 ‫ ﺩﺍﺭﺍﻱ‬:(Shoulder) ‫ﺷﺎﻧﻪ‬ .‫ﺑﺎﺷﺪ‬ Dr. Maria Zahiri  ‫‪SHOULDER‬‬ ‫ﻳﻜﻲ ﺍﺯ ﭘﻴﭽﻴﺪﻩ ﺗﺮﻳﻦ ﻣﻔﺎﺻﻞ ﺑﺪﻥ ﻣﺤﺴﻮﺏ ﻣﻲ ﺷﻮﺩ‪.‬‬ ‫‪‬‬ ‫ﻣﻮﺟﺐ ﺍﺗﺼﺎﻝ ﺍﻧﺪﺍﻡ ﻓﻮﻗﺎﻧﻲ ﺑﻪ ﺗﻨﻪ ﺍﺳﺖ‪.‬‬ ‫‪‬‬ ‫ﺑﻴﺸﺘﺮﻳﻦ ﺩﺍﻣﻨﻪ ﺣﺮﻛﺖ ﺭﺍ ﺩﺭ ﺑﻴﻦ ﻣﻔﺎﺻﻞ ﺑﺪﻥ ﺩﺍﺭﺩ ﻭ ﺑﺮﺍﻱ ﺣﺮﻛﺖ ﺩﺭ ﻫﺮ ﺟﻬﺘﻲ ﺑﺎﻳﺪ ﻋﻀﻼﺕ ﺧﺎﺻﻲ ﺑﺎ‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﻫﻤﺎﻫﻨﮕﻲ ﻛﺎﻣﻞ ﺑﺎ ﻳﻜﺪﻳﮕﺮ ﺣﺮﻛﺖ ﻛﻨﻨﺪ‪.‬‬ ‫ﺑﺮﺍﻱ ﺍﻳﻨﻜﻪ ﺑﺘﻮﺍﻧﺪ ﺩﺍﻣﻨﻪ ﺣﺮﻛﺘﻲ ﺯﻳﺎﺩﻱ ﺩﺍﺷﺘﻪ ﺑﺎﺷﺪ ﺑﺎﻳﺪ ﺑﺮﺍﻱ ﺣﺮﻛﺖ ﻛﺮﺩﻥ ﺁﺯﺍﺩ ﺑﺎﺷﺪ ﭘﺲ ﺧﻮﺩ ﻣﻔﺼﻞ‬ ‫‪‬‬ ‫ﻧﺎﭘﺎﻳﺪﺍﺭ ﻣﻲ ﺑﺎﺷﺪ ﻭ ﺗﻮﺳﻂ ﺭﺑﺎﻁ ﻫﺎ ﻭ ﻋﻀﻼﺕ ﺍﻃﺮﺍﻑ ﺷﺎﻧﻪ ﺣﻤﺎﻳﺖ ﻣﻲ ﺷﻮﺩ‪.‬‬  ‫ﺍﺟﺰﺍء ﺍﺳﺘﺨﻮﺍﻧﯽ ﺷﺎﻧﻪ‪:‬‬ ‫ﺷﺎﻧﻪ ﺍﺯ ﻛﻨﺎﺭ ﻫﻢ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻦ ﺳﻪ ﺍﺳﺘﺨﻮﺍﻥ ﺩﺭﺳﺖ ﺷﺪﻩ ﺍﺳﺖ‪.‬‬ ‫‪‬‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﻛﺘﻒ ﻳﺎ ﺍﺳﻜﺎﭘﻮﻻ ‪ Scapula‬ﺩﺭ ﻃﺮﻑ ﭘﺸﺖ‬ ‫‪‬‬ ‫ﻗﺴﻤﺖ ﺑﺎﻻﻳﻲ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﺯﻭ ﻳﺎ ﻫﻮﻣﺮﻭﺱ ‪ Humerus‬ﺩﺭ ﻃﺮﻑ ﺧﺎﺭﺝ‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﺗﺮﻗﻮﻩ ﻳﺎ ﻛﻼﻭﻳﻜﻞ ‪ Clavicle‬ﺩﺭ ﻃﺮﻑ ﺟﻠﻮ‬ ‫‪‬‬  ‫‪SCAPULA‬‬ ‫ﻛﺘﻒ ﺍﺳﺘﺨﻮﺍﻧﻲ ﭘﻬﻦ ﻭ ﻣﺜﻠﺜﻲ ﺍﺳﺖ ﻛﻪ ﺩﺭ ﻗﺴﻤﺖ ﺧﻠﻔﻲ ﻓﻮﻗﺎﻧﻲ ﻗﻔﺴﻪ ﺳﻴﻨﻪ ﺭﻭﻱ ﺩﻧﺪﻩ ﻫﺎﻱ ‪ 2-7‬ﻗﺮﺍﺭ‬ ‫‪‬‬ ‫ﺩﺍﺭﺩ‪.‬‬ ‫ﺩﻭ ﺳﻄﺢ )‪ ،(Ant,Post‬ﺳﻪ ﻛﻨﺎﺭ )‪ ،(Sup, Med,Lat‬ﻭ ﺳﻪ ﺯﺍﻭﻳﻪ )‪ (Sup, Inf, Lat‬ﺩﺍﺭﺩ‪.‬‬ ‫‪‬‬ ‫ﺑﺮ ﺭﻭﻱ ﺳﻄﻮﺡ ﻗﺪﺍﻣﻲ ﻭ ﺧﻠﻔﻲ ﺍﺳﻜﺎﭘﻮﻻ ﻣﺤﻞ ﺍﺗﺼﺎﻝ ﻋﻀﻼﺕ ﻣﺘﻌﺪﺩ ﻣﻲ ﺑﺎﺷﺪ‪.‬‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬  ‫ﺩﺭ ﻗﺴﻤﺖ ﺧﺎﺭﺟﻲ ﺍﺳﺘﺨﻮﺍﻥ ﻛﺘﻒ ﻳﻚ ﺣﻔﺮﻩ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻛﻢ ﻋﻤﻖ ﻭﺟﻮﺩ ﺩﺍﺭﺩ ﻛﻪ ﺑﻪ ﺁﻥ ﺣﻔﺮﻩ ﮔﻠﻨﻮﺋﻴﺪ‬ ‫‪‬‬ ‫‪ Glenoid fossa‬ﻣﻴﮕﻮﻳﻨﺪ‪.‬‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﺍﺳﻜﺎﭘﻮﻻ ﺍﺯ ﻧﺎﺣﻴﻪ ﺣﻔﺮﻩ ﮔﻠﻨﻮﻳﻴﺪ ﺑﺎ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﺯﻭ ﻣﻔﺼﻞ ﺷﺪﻩ ﻭ ﻣﻔﺼﻞ ﺷﺎﻧﻪ ﺭﺍ ﻣﻴﺴﺎﺯﺩ ﻭ‬ ‫‪‬‬ ‫ﺳﻄﺢ ﺩﺭﻭﻧﻲ ﺁﻥ ﭘﻮﺷﻴﺪﻩ ﺍﺯ ﻏﻀﺮﻭﻑ ﺍﺳﺖ‪(Glenohumeral joint).‬‬ ‫‪ Acromion process‬ﺑﺮﺟﺴﺘﮕﻲ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻣﻮﺟﻮﺩ ﺩﺭ ﺑﺎﻻﻱ ﺣﻔﺮﻩ ﮔﻠﻨﻮﻳﻴﺪ ﻣﻲ ﺑﺎﺷﺪ‪.‬‬ ‫‪‬‬ ‫‪ Coracoid process‬ﺑﺮﺟﺴﺘﮕﻲ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻣﻮﺟﻮﺩ ﺩﺭ ﺟﻠﻮﻱ ﺣﻔﺮﻩ ﮔﻠﻨﻮﻳﻴﺪ ﻣﻲ ﺑﺎﺷﺪ‪.‬‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬  ‫‪CLAVICLE‬‬ ‫ﺗﺮﻗﻮﻩ ﺍﺳﺘﺨﻮﺍﻧﻲ ﺍﺳﺖ ﺑﻪ ﺷﻜﻞ ‪ S‬ﺧﻮﺍﺑﻴﺪﻩ ﻛﻪ ﺩﺭ ﻗﺴﻤﺖ ﻗﺪﺍﻣﻲ ﻓﻮﻗﺎﻧﻲ ﻗﻔﺴﻪ ﺳﻴﻨﻪ ﺑﻄﻮﺭ ﺍﻓﻘﻲ ﻗﺮﺍﺭ‬ ‫‪‬‬ ‫ﮔﺮﻓﺘﻪ ﺍﺳﺖ‪.‬ﺩﺭ ﺗﻤﺎﻡ ﻃﻮﻟﺶ ﺍﺯ ﺭﻭﻱ ﭘﻮﺳﺖ ﻗﺎﺑﻞ ﻟﻤﺲ ﺍﺳﺖ‪.‬‬ ‫ﺩﻭ ﺳﻄﺢ )‪ ،(Sup,Inf‬ﺩﻭ ﻛﻨﺎﺭ)‪ (Ant,Post‬ﻭ ﺩﻭ ﺍﻧﺘﻬﺎ )‪ (Med,Lat‬ﺩﺍﺭﺩ‪.‬‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺍﺯ ﻃﺮﻑ ﺩﺍﺧﻞ ﺑﺎ ﺍﺳﺘﺨﻮﺍﻥ ﺟﻨﺎﻕ ﻣﻔﺼﻞ ﺍﺳﺘﺮﻧﻮﻛﻼﻭﻳﻜﻮﻻﺭ ﻭ ﺩﺭ ﻃﺮﻑ ﺧﺎﺭﺝ ﺑﺎ ﺯﺍﺋﺪﻩ ﺁﻛﺮﻭﻣﻴﻮﻥ ﺍﺯ‬ ‫‪‬‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﻛﺘﻒ ﻣﻔﺼﻞ ﺁﻛﺮﻭﻣﻴﻮﻛﻼﻭﻳﻜﻮﻻﺭ ﺭﺍ ﻣﻲ ﺳﺎﺯﺩ‪.‬‬ ‫ﺗﺮﻗﻮﻩ‪+‬ﻛﺘﻒ= ‪Shoulder Girdle‬‬ ‫‪‬‬  ‫ﺁﻧﺎﺗﻮﻣﯽ ﺷﺎﻧﻪ ‪ -‬ﻏﻀﺮﻭﻑ‬ ‫ﺳﻄﺢ ﺩﺍﺧﻠﻲ ﺣﻔﺮﻩ ﮔﻠﻨﻮﻳﻴﺪ ﻭ ﺳﻄﺢ ﺧﺎﺭﺟﻲ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﺯﻭ ﺑﺎ ﻋﻀﺮﻭﻑ ﻫﻴﺎﻟﻦ ﭘﻮﺷﻴﺪﻩ ﺷﺪﻩ ﺍﺳﺖ‪.‬‬ ‫‪‬‬ ‫ﻏﻀﺮﻭﻑ ﺑﺼﻮﺭﺕ ﻻﻳﻪ ﺻﺎﻑ ﻭ ﻟﻐﺰﻧﺪﻩ ﻭ ﺳﻔﻴﺪ ﺭﻧﮕﻲ ﺍﺳﺖ ﻭ ﻭﻇﻴﻔﻪ ﺁﻥ ﺗﺴﻬﻴﻞ ﺣﺮﻛﺖ ﺩﺭ ﻣﻔﺼﻞ ﺍﺳﺖ‪.‬‬ ‫ﻏﻀﺮﻭﻑ ﻣﻔﺼﻠﻲ ﺑﺎ ﺍﻳﺠﺎﺩ ﻛﺮﺩﻥ ﻳﻚ ﻻﻳﻪ ﺻﺎﻑ ﻭ ﻟﻐﺰﻧﺪ ﻣﻮﺟﺐ ﻣﻴﺸﻮﺩ ﺗﺎ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﺗﺸﻜﻴﻞ ﺩﻫﻨﺪﻩ‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﻣﻔﺼﻞ ﺑﻪ ﺭﺍﺣﺘﻲ ﺭﻭﻱ ﻳﻜﺪﻳﮕﺮ ﺣﺮﻛﺖ ﻛﻨﻨﺪ‪.‬‬  ‫ﺁﻧﺎﺗﻮﻣﯽ ﺷﺎﻧﻪ ‪ -‬ﮐﭙﺴﻮﻝ‬ ‫ﻛﭙﺴﻮﻝ ﻣﻔﺼﻞ ﻳﻚ ﭘﺮﺩﻩ ﺑﺎﻓﺘﻲ ﻛﻠﻔﺖ ﻭ ﻣﺤﻜﻢ ﺑﻪ ﺷﻜﻞ ﻛﻴﺴﻪ ﺍﺳﺖ ﻛﻪ ﺩﻭﺭ ﺗﺎ ﺩﻭﺭ ﻣﻔﺼﻞ ﺷﺎﻧﻪ ﺭﺍ ﮔﺮﻓﺘﻪ‬ ‫‪‬‬ ‫ﺍﺳﺖ‪.‬ﺩﻭ ﺳﺮ ﺍﻳﻦ ﻛﻴﺴﻪ ﺑﺎﺯ ﺍﺳﺖ ﻭ ﺩﺭ ﻭﺍﻗﻊ ﺑﻪ ﺷﻜﻞ ﻳﻚ ﺑﺸﻜﻪ ﺍﺳﺘﻮﺍﻧﻪ ﺍﻱ ﺑﺪﻭﻥ ﺩﻭ ﻗﺎﻋﺪﻩ ﺑﺎﻻ ﻭ ﭘﺎﻳﻴﻦ‬ ‫ﺍﺳﺖ‪.‬ﺩﺍﻳﺮﻩ ﺑﺎﻻﻱ ﺍﻳﻦ ﻛﻴﺴﻪ ﺍﺳﺘﻮﺍﻧﻪ ﺍﻱ ﺑﻪ ﺩﻭﺭ ﺗﺎ ﺩﻭﺭ ﺣﻔﺮﻩ ﮔﻠﻨﻮﺋﻴﺪ ﻣﻴﭽﺴﺒﺪ ﻭ ﺩﺍﻳﺮﻩ ﭘﺎﻳﻴﻦ ﺁﻥ ﺑﻪ ﺩﻭﺭ ﺗﺎ‬ ‫ﺩﻭﺭ ﮔﺮﺩﻥ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﺯﻭ ﻣﻴﭽﺴﺒﺪ‪.‬ﺑﺪﻳﻦ ﺻﻮﺭﺕ ﻳﻚ ﻓﻀﺎﻱ ﻛﺎﻣﻼ ﺑﺴﺘﻪ ﺑﻮﺟﻮﺩ ﻣﻴﺎﻳﺪ ﻛﻪ ﺩﺭ ﺩﺭﻭﻥ ﺁﻥ‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺣﻔﺮﻩ ﮔﻠﻨﻮﻳﻴﺪ ﻭ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﺯﻭ ﻗﺮﺍﺭ ﺩﺍﺭﻧﺪ‪.‬‬  ‫ﻟﻴﮕﺎﻣﻨﺖ ﻫﺎی ﺷﺎﻧﻪ‪:‬‬ ‫ﺭﺑﺎﻁ ﻫﺎ ﻳﺎ ﻟﻴﮕﺎﻣﺎﻥ ﻫﺎ ﻧﻮﺍﺭ ﻫﺎﻱ ﺑﺎﻓﺘﻲ ﻛﻠﻔﺖ ﻭ ﻣﺤﻜﻤﻲ ﻫﺴﺘﻨﺪ ﻛﻪ ﺩﺭ ﺍﻃﺮﺍﻑ ﻭ ﺭﻭﻱ ﻛﭙﺴﻮﻝ ﻣﻔﺼﻠﻲ ﻗﺮﺍﺭ‬ ‫‪‬‬ ‫ﺩﺍﺭﻧﺪ‪.‬ﻳﻚ ﺳﺮ ﺍﻳﻦ ﻧﻮﺍﺭ ﻫﺎ ﺩﺭ ﺑﺎﻻ ﺑﻪ ﻳﻚ ﺍﺳﺘﺨﻮﺍﻥ ﻣﻴﭽﺴﺒﺪ ﻭ ﺳﺮ ﺩﻳﮕﺮ ﺁﻧﻬﺎ ﺩﺭ ﭘﺎﻳﻴﻦ ﺑﻪ ﺍﺳﺘﺨﻮﺍﻥ ﺩﻳﮕﺮ‬ ‫ﻣﻴﭽﺴﺒﺪ‪.‬ﺍﻳﻦ ﺭﺑﺎﻁ ﻫﺎ ﺩﺭ ﻭﺍﻗﻊ ﺑﻪ ﻛﭙﺴﻮﻝ ﻣﻔﺼﻞ ﭼﺴﺒﻴﺪﻩ ﺍﻧﺪ ﻭ ﺟﺰﺋﻲ ﺍﺯ ﺁﻥ ﺷﺪﻩ ﺍﻧﺪ‪.‬ﻭﻇﻴﻔﻪ ﻋﻤﺪﻩ ﺭﺑﺎﻁ‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﻫﺎ ﺍﻳﻨﺴﺖ ﻛﻪ ﺍﻃﺮﺍﻑ ﻣﻔﺼﻞ ﺭﺍ ﻣﺤﻜﻢ ﺑﮕﻴﺮﻧﺪ ﺗﺎ ﺩﺭ ﻧﺮﻭﺩ‪.‬‬  ‫ﻣﻬﻤﺘﺮﻳﻦ ﺭﺑﺎﻁ ﻫﺎﻱ ﺷﺎﻧﻪ ﻋﺒﺎﺭﺗﻨﺪ ﺍﺯ ‪:‬‬ ‫‪Glenohumeral ligaments ‬‬ ‫ﺍﻳﻦ ﻫﺎ ﺳﻪ ﺭﺑﺎﻁ ﻓﻮﻗﺎﻧﻲ‪ ،‬ﻭﺳﻄﻲ ﻭ ﺗﺤﺘﺎﻧﻲ ﻫﺴﺘﻨﺪ ﻭ ﻭﻇﻴﻔﻪ ﺗﻘﻮﻳﺖ ﻛﭙﺴﻮﻝ ﻣﻔﺼﻞ ﮔﻠﻨﻮﻫﻮﻣﺮﺍﻝ ﺭﺍ ﺩﺍﺭﻧﺪ‪.‬‬ ‫‪Coraco-acromial ‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺍﻳﻦ ﺭﻳﺎﻁ ﺑﻴﻦ ﺯﺍﺋﺬﻩ ﻫﺎﻱ ﻛﻮﺭﺍﻛﻮﻳﻴﺪ ﻭ ﺁﻛﺮﻭﻣﻴﻮﻥ ﺍﺳﺘﺨﻮﺍﻥ ﻛﺘﻒ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﻧﺪ‬ ‫‪Transverse Humeral ligament ‬‬ ‫ﺍﻳﻦ ﺭﺑﺎﻁ ﺑﻴﻦ ﺩﻭ ﺗﻮﺑﺮﻭﺯﻳﺘﻪ ﻛﻮﭼﻚ ﻭ ﺑﺰﺭگ ﺑﺎﺯﻭ ﻗﺮﺍﺭ ﮔﻔﺘﻪ ﺍﻧﺪ ﻭ ﻣﻮﺟﺐ ﻣﻴﺸﻮﺩ ﺗﺎﻧﺪﻭﻥ ﻳﺮ ﺑﻠﻨﺪ ﻋﻀﻠﻪ ﺩﻭ‬ ‫ﺳﺮ ﺑﺎﺯﻭ ﺩﺭ ﺩﺍﺧﻞ ﻧﺎﻭﺩﺍﻥ ﺑﺎﺯﻭﻳﻲ ﺛﺎﺑﺖ ﺑﺎﻗﻲ ﺑﻤﺎﻧﺪ‪.‬‬  ‫ﺭﺑﺎﻁ ﺁﻛﺮﻭﻣﻴﻮﻛﻼﻭﻳﻜﻮﻟﺮ ‪Acromioclavicular ligament‬‬ ‫‪‬‬ ‫ﺍﻳﻦ ﺭﺑﺎﻁ ﺑﻴﻦ ﺍﻧﺘﻬﺎﻱ ﺑﻴﺮﻭﻧﻲ ﺍﺳﺘﺨﻮﺍﻥ ﺗﺮﻗﻮﻩ ﻭ ﺯﺍﺋﺪﻩ ﺁﻛﺮﻭﻣﻴﻮﻥ ﺍﺳﺖ ﻭ ﺩﺭ ﻭﺍﻗﻊ ﻛﭙﺴﻮﻝ ﻣﻔﺼﻞ‬ ‫ﺁﻛﺮﻭﻣﻴﻮﻛﻼﻭﻳﻜﻮﻟﺮ ﺭﺍ ﺗﻘﻮﻳﺖ ﻣﻴﻜﻨﺪ‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺭﺑﺎﻁ ﻛﻮﺭﺍﻛﻮﻛﻼﻭﻳﻜﻮﻟﺮ ‪Coracoclavicular ligament‬‬ ‫‪‬‬ ‫ﺯﺍﺋﺪﻩ ﻛﻮﺭﺍﻛﻮﻳﻴﺪ ﺍﺳﺘﺨﻮﺍﻥ ﻛﺘﻒ ﺭﺍ ﺑﻪ ﺳﻄﺢ ﺯﻳﺮﻳﻦ ﺍﺳﺘﺨﻮﺍﻥ ﺗﺮﻗﻮﻩ ﻣﺘﺼﻞ ﻣﻴﻜﻨﻨﺪ‪.‬‬  ‫ﻻﻳﻪ ﺳﻴﻨﻮﻭﻳﺎﻝ ﻭ ﻣﺎﻳﻊ ﺳﻴﻨﻮﻭﻳﺎﻝ‬ ‫ﻻﻳﻪ ﻳﺎ ﭘﺮﺩﻩ ﺳﻴﻨﻮﻭﻳﺎﻝ ‪ Synovial membrane‬ﻳﻚ ﭘﺮﺩﻩ ﻧﺎﺯﻙ ﺍﺳﺖ ﻛﻪ ﻣﺎﻧﻨﺪ ﻓﺮﺵ ﺳﻄﺢ ﺩﺍﺧﻠﻲ ﻛﭙﺴﻮﻝ‬ ‫‪‬‬ ‫ﻣﻔﺼﻠﻲ ﺭﺍ ﭘﻮﺷﺎﻧﻴﺪﻩ ﺍﺳﺖ‪.‬ﻭﻇﻴﻔﻪ ﺍﻳﻦ ﻻﻳﻪ ﺗﺮﺷﺢ ﻣﺎﻳﻊ ﺳﻴﻨﻮﻭﻳﺎﻝ ﺍﺳﺖ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﻣﺎﻳﻊ ﺳﻴﻨﻮﻭﻳﺎﻝ ‪ Synovial fluid‬ﻣﺎﻳﻊ ﺷﻔﺎﻑ ﻭ ﻏﻠﻴﻆ ﻭ ﻟﺰﺟﻲ ﺍﺳﺖ ﻛﻪ ﺑﻪ ﺗﻮﺳﻂ ﭘﺮﺩﻩ ﺳﻴﻨﻮﻭﻳﺎﻝ ﺗﺮﺷﺢ‬ ‫‪‬‬ ‫ﻣﻴﺸﻮﺩ‪.‬ﺍﻳﻦ ﻣﺎﻳﻊ ﺩﻭ ﻭﻇﻴﻔﻪ ﻋﻤﺪﻩ ﺩﺍﺭﺩ‬ ‫ﻣﺎﻳﻊ ﺳﻴﻨﻮﻭﻳﺎﻝ ﺳﻄﺢ ﺭﻭﻱ ﻏﻀﺮﻭﻑ ﻣﻔﺼﻞ ﺭﺍ ﻟﺰﺝ ﻭ ﺳﺮ ﻭ ﻟﻐﺰﻧﺪﻩ ﻣﻴﻜﻨﺪ‪.‬ﺍﻳﻦ ﻛﺎﺭ ﻣﺜﻞ ﺭﻭﻏﻦ ﻛﺎﺭﻱ ﻣﺎﺷﻴﻦ‬ ‫‪‬‬ ‫ﻫﺎﺳﺖ ﻭ ﻣﻮﺟﺐ ﻣﻴﺸﻮﺩ ﺗﺎ ﻣﻔﺼﻞ ﺭﺍﺣﺖ ﺗﺮ ﺣﺮﻛﺖ ﻛﻨﺪ‪.‬‬ ‫‪ ‬ﻣﺎﻳﻊ ﺳﻴﻨﻮﻭﻳﺎﻝ ﺳﺮﺷﺎﺭ ﺍﺯ ﻣﻮﺍﺩ ﻏﺬﺍﻳﻲ ﻭ ﺍﻛﺴﻴﮋﻥ ﺍﺳﺖ‪.‬‬ ‫ﻏﻀﺮﻭﻑ ﺭگ ﺧﻮﻧﻲ ﻧﺪﺍﺭﺩ ﻭ ﺗﻐﺬﻳﻪ ﺳﻠﻮﻝ ﻫﺎﻱ ﺁﻥ ﺑﻪ ﺗﻮﺳﻂ‬ ‫ﺍﻧﺘﺸﺎﺭ ﺍﻛﺴﻴﮋﻥ ﻭ ﻣﻮﺍﺩ ﻏﺬﺍﻳﻲ ﺍﺯ ﻣﺎﻳﻊ ﺳﻴﻨﻮﻭﻳﺎﻝ ﺍﺳﺖ‪.‬‬  ‫‪BURSA‬‬ ‫ﺑﻮﺭﺱ ﻫﺎ ﻛﻴﺴﻪ ﻫﺎﻱ ﻧﺎﺯﻛﻲ ﻫﺴﺘﻨﺪ ﻛﻪ ﺳﻄﺢ ﺩﺍﺧﻠﻲ ﺁﻥ ﻫﺎ ﺑﺎ ﭘﺮﺩﻩ ﺳﻴﻨﻮﻭﻳﺎﻝ ﭘﻮﺷﻴﺪﻩ ﺷﺪﻩ ﻭ ﺩﺭ ﺩﺭﻭﻥ ﺁﻧﻬﺎ ﻛﻤﻲ‬ ‫‪‬‬ ‫ﻣﺎﻳﻊ ﺳﻴﻨﻮﻭﻳﺎﻝ ﻗﺮﺍﺭ ﺩﺍﺭﺩ‪.‬ﺑﺮﺍﻱ ﺗﺠﺴﻢ ﺍﻳﻦ ﺳﺎﺧﺘﻤﺎﻥ ﻫﺎ ﻳﻚ ﻛﻴﺴﻪ ﻓﺮﻳﺰﺭ ﺭﺍ ﺩﺭ ﻧﻈﺮ ﺑﮕﻴﺮﻳﺪ ﻛﻪ ﺩﺍﺧﻞ ﺁﻥ ﻛﻤﻲ‬ ‫ﺭﻭﻏﻦ ﻣﺎﻳﻊ ﺭﻳﺨﺘﻪ ﻭ ﻟﺒﻪ ﺁﻧﺮﺍ ﺩﻭﺧﺘﻪ ﺍﻳﺪ‪.‬ﺩﺭ ﺍﻳﻦ ﻭﺿﻌﻴﺖ ﺩﻭ ﺳﻄﺢ ﺍﻳﻦ ﻛﻴﺴﻪ ﻓﺮﻳﺰﺭ ﺑﻪ ﺭﺍﺣﺘﻲ ﺭﻭﻱ ﻫﻢ ﺳﺮ ﻣﻴﺨﻮﺭﻧﺪ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﻛﻴﺴﻪ ﺑﻮﺭﺱ ﻫﻢ ﻫﻤﻴﻨﻄﻮﺭ ﻋﻤﻞ ﻣﻴﻜﻨﺪ‪.‬‬ ‫ﺑﻮﺭﺱ ﻫﺎ ﺩﺭ ﻣﻨﺎﻃﻖ ﻣﺨﺘﻠﻔﻲ ﺩﺭ ﺍﻃﺮﺍﻑ ﻣﻔﺎﺻﻞ ﺷﺎﻧﻪ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﻧﺪ‪.‬ﺑﻌﻀﻲ ﺍﺯ ﺁﻧﻬﺎ ﺑﺰﺭگ ﻭ ﺑﻌﻀﻲ ﺩﻳﮕﺮ ﻛﻮﭼﻚ‬ ‫‪‬‬ ‫ﻫﺴﺘﻨﺪ‪.‬ﺑﻮﺭﺱ ﻫﺎ ﺩﺭ ﺟﺎﻫﺎﻳﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﻧﺪ ﻛﻪ ﺩﻭ ﺳﺎﺧﺘﻤﺎﻥ ﺑﺎﻳﺪ ﺭﻭﻱ ﻫﻢ ﺑﻠﻐﺰﻧﺪ‪.‬ﺑﻄﻮﺭ ﻣﺜﺎﻝ ﺩﺭ ﻣﺤﻠﻲ ﻛﻪ ﻋﻀﻠﻪ‬ ‫ﺳﻮﭘﺮﺍﺍﺳﭙﻴﻨﺎﺗﻮﺱ ﺍﺯ ﺯﻳﺮ ﺯﺍﺋﺪﻩ ﺁﻛﺮﻭﻣﻴﻮﻥ ﻋﺒﻮﺭ ﻣﻴﻜﻨﺪ ﺑﻴﻦ ﻋﻀﻠﻪ ﻭ ﺍﺳﺘﺨﻮﺍﻥ ﻳﻚ ﺑﻮﺭﺱ ﻣﻬﻢ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﺳﺖ‪.‬ﺍﻳﻦ‬ ‫ﺑﻮﺭﺱ ﻣﻮﺟﺐ ﻣﻴﺸﻮﺩ ﻟﻐﺰﺵ ﻋﻀﻼﺕ ﺑﺮ ﺭﻭﻱ ﺍﺳﺘﺨﻮﺍﻥ ﺭﺍﺣﺖ ﺗﺮ‬ ‫ﺍﻧﺠﺎﻡ ﺷﻮﺩ‪.‬‬ ‫ﺑﺎﺯﻭ )‪ : Upper Arm (Brachium‬ﺷﺎﻣﻞ ﺍﺳﺘﺨﻮﺍﻥ ‪ Humerus‬ﺍﺳﺖ ﻛﻪ ﺩﺭ ﺑﺎﻻ ﺑﺎ ﺍﺳﺘﺨﻮﺍﻥ‬ ‫‪‬‬ ‫ﺍﺳﻜﭙﻮﻻ ﻣﻔﺼﻞ ﺷﺪﻩ ﻭ )‪ (Shoulder Joint‬ﺭﺍ ﻣﻲ ﺳﺎﺯﺩ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬  ‫‪HUMERUS‬‬ ‫ﺑﺎﺯﻭ ﺍﺳﺘﺨﻮﺍﻧﻲ ﺑﻠﻨﺪ ﺍﺳﺖ ﻛﻪ ﺩﺍﺭﺍﻱ ﻳﻚ ﺗﻨﻪ ﻭ ﺩﻭ ﺍﻧﺘﻬﺎ )‪ (Sup,Inf‬ﻣﻲ ﺑﺎﺷﺪ‪.‬‬ ‫‪‬‬ ‫ﺩﺭ ﺍﻧﺘﻬﺎﻱ ‪ Sup‬ﺍﺟﺰﺍء ﺯﻳﺮ ﻗﺮﺍﺭ ﺩﺍﺭﻧﺪ‪head, Neck, Tubercle :‬‬ ‫‪‬‬ ‫ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺩﺭ ﻧﺎﺣﻴﻪ ﺷﺎﻧﻪ ﺑﻪ ﺷﻜﻞ ﻧﻴﻤﻜﺮﻩ ﺍﻱ ﺑﺎ ﺭﻭﻳﻪ ﻣﻔﺼﻠﻲ ﺍﺳﺖ ﻛﻪ ﺩﺭ ﻣﺠﺎﻭﺭﺕ ﺣﻔﺮﻩ ﮔﻠﻨﻮﺋﻴﺪ ﺍﺳﻜﭙﻮﻻ ﻗﺮﺍﺭ‬ ‫‪‬‬ ‫ﮔﺮﻓﺘﻪ ﻭ ﺑﺎ ﺁﻥ ﻣﻔﺼﻞ ﻣﻴﺸﻮﺩ ﻭ ﺩﺭ ﺁﺭﻧﺞ ﺑﺎ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﺳﺎﻋﺪ ﻳﻌﻨﻲ ﺯﻧﺪ ﻳﺎﻻﻳﻲ )ﺭﺍﺩﻳﻮﺱ( ‪ Radius‬ﻭ ﺯﻧﺪ ﺯﻳﺮﻳﻦ‬ ‫) ﺍﻭﻟﻨﺎ( ‪ Ulna‬ﻣﻔﺼﻞ ﻣﻴﺸﻮﺩ‪.‬ﺍﻳﻦ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺰﺭﮔﺘﺮﻳﻦ ﺍﺳﺘﺨﻮﺍﻥ ﺍﻧﺪﺍﻡ ﻓﻮﻗﺎﻧﻲ ﺍﺳﺖ‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺩﺭ ﺯﻳﺮ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﺯﻭ ﺩﻭ ﺑﺮﺟﺴﺘﮕﻲ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻳﻜﻲ ﺩﺭ ﺳﻄﺢ ﺧﺎﺭﺟﻲ ﺑﻪ ﺁﻥ ‪Greater tubercle‬ﻭ ﺩﻳﮕﺮﻱ‬ ‫‪‬‬ ‫ﻛﻪ ﻛﻮﭼﻜﺘﺮ ﻭ ﺩﺭ ﺳﻄﺢ ﺟﻠﻮﻳﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ‪Lesser tubercle‬ﻧﺎﻡ ﺩﺍﺭﺩ‪.‬‬ ‫ﺑﻴﻦ ﺍﻳﻦ ﺩﻭ ﺑﺮﺟﺴﺘﮕﻲ ﻳﻚ ﺷﻴﺎﺭ ﻳﺎ ﻧﺎﻭﺩﺍﻥ ﺑﻪ ﻧﺎﻡ ‪ Bicipital groove‬ﻗﺮﺍﺭ ﺩﺍﺭﺩ ﻛﻪ ﻣﺤﻞ ﻋﺒﻮﺭ ﺗﺎﻧﺪﻭﻥ ﺳﺮ ﺑﻠﻨﺪ‬ ‫ﻋﻀﻠﻪ ﺩﻭ ﺳﺮ ﺑﺎﺯﻭﻳﻲ ﺍﺳﺖ‪.‬‬ ‫‪ :Anatomic neck‬ﺩﺭ ﻭﺍﻗﻊ ﺑﺨﺶ ﺟﺪﺍ ﻛﻨﻨﺪﻩ ﺳﺮ ﺍﺯ ﺑﻘﻴﻪ ﻗﺴﻤﺖ ﻫﺎﻱ ﺍﻧﺘﻬﺎﻱ ﻓﻮﻗﺎﻧﻲ ﺍﺳﺖ‪.‬‬ ‫‪‬‬ ‫‪ :Surgical neck‬ﺟﺪﺍ ﻛﻨﻨﺪﻩ ﺍﻧﺘﻬﺎﻱ ﻓﻮﻗﺎﻧﻲ ﺍﺯ ﺗﻨﻪ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﺯﻭ ﺭﺍ ﮔﻮﻳﻨﺪ‪.‬‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺗﻨﻪ )‪ :(Body‬ﻗﺴﻤﺖ ﻭﺳﻂ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﺯﻭ ﺭﺍ ﺗﻨﻪ ‪ Humeral shaft‬ﺁﻥ ﻣﻴﮕﻮﻳﻨﺪ‪.‬ﺗﻨﻪ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﺯﻭ‬ ‫‪‬‬ ‫ﺩﺭ ﻗﺴﻤﺖ ﻫﺎﻱ ﺑﺎﻻﻳﻲ ﺷﻜﻞ ﺍﺳﺘﻮﺍﻧﻪ ﺍﻱ ﺩﺍﺭﺩ ﻭﻟﻲ ﺩﺭ ﻗﺴﻤﺖ ﭘﺎﻱ ﭘﺎﻳﻴﻦ ﭘﻬﻦ ﻣﻴﺸﻮﺩ‪.‬ﺗﻨﻪ ﻋﻤﺪﺗ ًﺎ ﺗﻮﺳﻂ‬ ‫ﻋﻀﻼﺕ ﭘﻮﺷﻴﺪﻩ ﺷﺪﻩ ﻭﻟﻲ ﺑﻪ ﺳﺎﺩﮔﻲ ﻗﺎﺑﻞ ﻟﻤﺲ ﻣﻲ ﺑﺎﺷﺪ‪.‬‬ ‫ﺩﺭ ﻭﺳﻂ ﺗﻨﻪ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﺯﻭ‪ ،‬ﺍﺳﺘﺨﻮﺍﻥ ﻛﻤﻲ ﺑﺮﺟﺴﺘﻪ ﻣﻴﺸﻮﺩ‪.‬ﺍﻳﻦ ﺑﺮﺟﺴﺘﮕﻲ ﻛﻪ ﺩﺭ ﺳﻄﺢ ﺧﺎﺭﺟﻲ ﻭ‬ ‫‪‬‬ ‫ﻗﺪﺍﻣﻲ ﺍﺳﺘﺨﻮﺍﻥ ﺍﺳﺖ ﺭﺍ ﺗﻮﺑﺮﻭﺯﻳﺘﻪ ﺩﻟﺘﻮﻳﻴﺪ ‪ Deltoid tuberosity‬ﻣﻴﮕﻮﻳﻨﺪ ﻭ ﻣﺤﻞ ﺍﺗﺼﺎﻝ ﻋﻀﻠﻪ‬ ‫ﺩﻟﺘﻮﻳﻴﺪ ﺑﻪ ﺍﺳﺘﺨﻮﺍﻥ ﺑﺎﺯﻭ ﺍﺳﺖ‪.‬ﺩﺭ ﺳﻄﺢ ﺧﺎﺭﺟﻲ ﺑﺎﺯﻭ ﻗﺎﺑﻞ ﻟﻤﺲ ﻣﻲ ﺑﺎﺷﺪ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺍﭘﻲ ﻛﻨﺪﻳﻞ ﺩﺍﺧﻠﻲ )‪ :(Medial epicondyle‬ﭼﻮﻥ ﻋﻀﻼﺕ ﺧﻢ ﻛﻨﻨﺪﻩ )‪ (Flexors‬ﺑﻪ ﺁﻥ ﻣﺘﺼﻞ‬ ‫‪‬‬ ‫ﻣﻲ ﺷﻮﻧﺪ‪ ،‬ﺑﻪ ﺁﻥ ‪ Flexor epicondyle‬ﻧﻴﺰ ﻣﻲ ﮔﻮﻳﻨﺪ‪.‬ﺍﻳﻦ ﺑﺮﺟﺴﺘﮕﻲ ﻧﺴﺒﺘ ًﺎ ﺑﺰﺭگ ﺯﻳﺮ ﭘﻮﺳﺘﻲ ﺑﻪ‬ ‫ﺭﺍﺣﺘﻲ ﺩﺭ ﺳﻤﺖ ﺩﺍﺧﻞ ﺁﺭﻧﺞ ﻗﺎﺑﻞ ﻟﻤﺲ ﺑﻮﺩﻩ ﻭ ﺩﺭ ﭘﺸﺖ ﺁﻥ ﺷﻴﺎﺭﻱ ﺍﺳﺖ ﻛﻪ ﺍﺯﺁﻥ ﻋﺼﺐ ﺍﻭﻟﻨﺎﺭ‬ ‫)‪ (Ulnar nerve‬ﻋﺒﻮﺭ ﻣﻲ ﻛﻨﺪ ﻭ ﻓﺸﺎﺭ ﺑﻪ ﺁﻥ ﻣﺨﺼﻮﺻﺎً ﺩﺭ ﺍﻓﺮﺍﺩ ﻻﻏﺮ ﻣﻤﻜﻦ ﺍﺳﺖ ﺍﺣﺴﺎﺱ‬ ‫ﻓﺸﺎﺭ ﺭﻭﻱ ﻋﺼﺐ ﻳﺎ ﺍﺣﺴﺎﺱ ﻧﺎﺧﻮﺷﺎﻳﻨﺪ )ﺑﺮﻕ ﮔﺮﻓﺘﮕﻲ( ﺑﺪﻫﺪ‪.‬ﺑﻪ ﻫﻤﻴﻦ ﺧﺎﻃﺮ ﺑﻪ ﺍﻳﻦ ﻗﺴﻤﺖ‬ ‫ﺍﺳﺘﺨﻮﺍﻧﻲ‪ ،‬ﺍﺳﺘﺨﻮﺍﻥ ﻣﻀﺤﻚ )‪(Funny bone‬‬ ‫ﻣﻲ ﮔﻮﻳﻨﺪ‪.‬‬ ‫ﺍﭘﻲ ﻛﻨﺪﻳﻞ ﺧﺎﺭﺟﻲ )‪ :(Lateral epicondyle‬ﻛﻮﭼﻜﺘﺮ ﺍﺯ ﺍﭘﻲ ﻛﻨﺪﻳﻞ ﺩﺍﺧﻠﻲ ﺍﺳﺖ‪.‬ﻭﻗﺘﻲ ﻛﻪ‬ ‫‪‬‬ ‫ﺁﺭﻧﺞ ﺑﺎﺯ ﺑﺎﺷﺪ )‪ (Extended‬ﺩﺭ ﻗﺴﻤﺖ ﭘﺸﺘﻲ ﺧﺎﺭﺟﻲ ﺁﺭﻧﺞ ﻳﻚ ﻓﺮﻭ ﺭ ﻓﺘﮕﻲ ﻗﺮﺍﺭ ﺩﺍﺭﺩ ﻛﻪ ﺩﺭ ﻋﻤﻖ‬ ‫ﺍﻳﻦ ﻓﺮﻭ ﺭﻓﺘﮕﻲ ﺍﭘﻲ ﻛﻨﺪﻳﻞ ﺧﺎﺭﺟﻲ ﻗﺎﺑﻞ ﻟﻤﺲ ﻣﻲ ﺑﺎﺷﺪ‪.‬‬ ‫ﺑﻴﻦ ﻛﻨﺪﻳﻞ ﺧﺎﺭﺟﻲ ﻭ ﺩﺍﺧﻠﻲ‪ ،‬ﺷﻜﻞ ﺍﺳﺘﺨﻮﺍﻥ ﺗﻐﻴﻴﺮ ﻛﺮﺩﻩ ﻭ ﺑﺸﻜﻞ ﻳﻚ ﻗﺮﻗﺮﻩ ﺩﺭﻣﻴﺎﻳﺪ‪.‬ﺍﻳﻦ ﺳﺎﺧﺘﻤﺎﻥ ﺭﺍ‬ ‫‪‬‬ ‫ﻗﺮﻗﺮﻩ ﻳﺎ ﺗﺮﻭﻛﻠﺌﺎ ﻣﻴﮕﻮﻳﻨﺪ‪.‬ﺳﻄﺢ ﻗﺪﺍﻡ )ﺟﻠﻮ( ﻭ ﺯﻳﺮ ﻭ ﺧﻠﻒ )ﭘﺸﺖ( ﻗﺮﻗﺮﻩ ﭘﻮﺷﻴﺪﻩ ﺍﺯ ﻏﻀﺮﻭﻑ ﻣﻔﺼﻠﻲ ﺍﺳﺖ‬ ‫ﻭ ﺑﺎ ﻗﺴﻤﺖ ﺑﺎ‪Troclea‬ﻻﻳﻲ ﺍﺳﺘﺨﻮﺍﻥ ﺯﻧﺪ ﺯﻳﺮﻳﻦ ﻳﺎ ﺍﻭﻟﻨﺎ ﻣﻔﺼﻞ ﻣﻴﺸﻮﺩ‪.‬‬ ‫ﺳﻄﺢ ﺟﻠﻮﻳﻲ ﻭ ﭘﺎﻳﻴﻨﻲ ﻛﻨﺪﻳﻞ ﺧﺎﺭﺟﻲ ﻛﻤﻲ ﺑﺮﺟﺴﺘﻪ ﺗﺮ ﺑﻮﺩﻩ ﻭ ﭘﻮﺷﻴﺪﻩ ﺍﺯ ﻏﻀﺮﻭﻑ ﺍﺳﺖ‪.‬ﺍﻳﻦ ﻗﺴﻤﺖ ﺭﺍ‬ ‫‪‬‬ ‫ﻛﺎﭘﻴﺘﻠﻮﻡ ‪ Capitulum‬ﻣﻴﮕﻮﻳﻨﺪ ﻭ ﺑﺎ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺭﺍﺩﻳﻮﺱ ﻣﻔﺼﻞ ﻣﻴﺸﻮﺩ‪.‬ﺑﺎﻻﻱ ﻛﺎﭘﻴﺘﻠﻮﻡ ﺩﺭ ﺳﻤﺖ‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺟﻠﻮ‪ ،‬ﻳﻚ ﻓﺮﻭﺭﻓﺘﮕﻲ ﺑﻪ ﻧﺎﻡ ﺣﻔﺮﻩ ﺭﺍﺩﻳﺎﻝ ﻳﺎ ﺭﺍﺩﻳﺎﻝ ﻓﻮﺳﺎ ‪ Radial fossa‬ﻭﺟﻮﺩ ﺩﺍﺭﺩ ﻛﻪ ﻭﻗﺘﻲ ﻣﻔﺼﻞ‬ ‫ﺁﺭﻧﺞ ﻛﺎﻣﻼ ﺧﻢ ﻣﻴﺸﻮﺩ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺭﺍﺩﻳﻮﺱ ﺩﺭ ﺁﻥ ﻗﺮﺍﺭ ﻣﻴﮕﻴﺮﺩ‪.‬ﺩﺭ ﺑﺎﻻﻱ ﺗﺮﻭﻛﻠﺌﺎ ﺩﺭ ﺳﻤﺖ ﺟﻠﻮ ﻳﻚ‬ ‫ﻓﺮﻭﺭﻓﺘﮕﻲ ﺑﻪ ﻧﺎﻡ ﻛﻮﺭﻭﻧﻮﻳﻴﺪ ﻓﻮﺳﺎ ‪ Coronoid fossa‬ﻭﺟﻮﺩ ﺩﺍﺭﺩ ﻛﻪ ﻭﻗﺘﻲ ﻣﻔﺼﻞ ﺁﺭﻧﺞ ﻛﺎﻣﻼ ﺧﻢ‬ ‫ﻣﻴﺸﻮﺩ ﺯﺍﺋﺪﻩ ﻛﻮﺭﻭﻧﻮﻳﻴﺪ ‪ Coronoid process‬ﺩﺭ ﺁﻥ ﻗﺮﺍﺭ ﻣﻴﮕﻴﺮﺩ‪.‬ﺩﺭ ﺑﺎﻻﻱ ﺗﺮﻭﻛﻠﺌﺎ ﺩﺭ ﺳﻤﺖ ﭘﺸﺖ‬ ‫ﻳﻚ ﻓﺮﻭﺭﻓﺘﮕﻲ ﻋﻤﻴﻖ ﺑﻪ ﻧﺎﻡ ﻓﻮﺳﺎﻱ ﺍﻭﻟﻜﺮﺍﻧﻮﻥ ‪ Olecranon fossa‬ﻭﺟﻮﺩ ﺩﺍﺭﺩ ﻛﻪ ﻭﻗﺘﻲ ﺁﺭﻧﺞ ﻛﺎﻣﻼ‬ ‫ﺻﺎﻑ ﻣﻴﺸﻮﺩ ﺯﺍﺋﺪﻩ ﺍﻭﻟﻜﺮﺍﻧﻮﻥ ‪ Olecranon process‬ﺩﺭ ﺁﻥ ﻗﺮﺍﺭ ﻣﻴﮕﻴﺮﺩ‪.‬‬ ‫ ﻭ ﻳﻚ ﻧﺎﺣﻴﻪ ﺧﻠﻔﻲ ﻳﺎ‬Cubital Fossa ‫ ﺩﺍﺭﺍﻱ ﺩﻭ ﻧﺎﺣﻴﻪ ﻗﺪﺍﻣﻲ ﻳﺎ‬:Cubitus (Elbow) ‫ﺁﺭﻧﺞ‬ .‫ ﻣﻲ ﺑﺎﺷﺪ‬Olecranon Region Dr. Maria Zahiri ‫ﺳﺎﻋﺪ ‪ Forearm‬ﻗﺴﻤﺘﻲ ﺍﺯ ﺍﻧﺪﺍﻡ ﻓﻮﻗﺎﻧﻲ ‪ Upper limb‬ﺍﺳﺖ ﻛﻪ ﺑﻴﻦ ﻣﻔﺎﺻﻞ ﺁﺭﻧﺞ ‪ Elbow‬ﻭ ﻣﭻ‬ ‫‪‬‬ ‫ﺩﺳﺖ ‪ Wrist‬ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﺳﺖ‪.‬ﺳﺎﻋﺪ ﺍﺯ ﺩﻭ ﺍﺳﺘﺨﻮﺍﻥ ‪ Radius‬ﻭ ‪ Ulna‬ﺗﺸﻜﻴﻞ ﺷﺪﻩ ﺍﺳﺖ‪.‬ﺍﻳﻦ ﺩﻭ‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﺩﺭ ﻛﻨﺎﺭ ﻳﻜﺪﻳﮕﺮ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﻭ ﺩﺭ ﺳﻪ ﻧﺎﺣﻴﻪ ﺑﺎ ﻳﻜﺪﻳﮕﺮ ﻣﻔﺼﻞ ﻣﻴﺸﻮﻧﺪ ﻛﻪ ﻋﺒﺎﺭﺗﻨﺪ ﺍﺯ‬ ‫‪Dr. Maria Zahiri‬‬  ‫ﻣﻔﺼﻞ ﺭﺍﺩﻳﻮﺍﻭﻟﻨﺎﺭ ﭘﺮﮔﺰﻳﻤﺎﻝ‬ ‫‪‬‬ ‫‪Proximal radioulnar joint‬‬ ‫‪‬‬ ‫ﺍﻳﻦ ﻣﻔﺼﻞ ﺍﺯ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻦ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺭﺍﺩﻳﻮﺱ ﺩﺭ ﺳﻄﺢ ﻣﻘﻌﺮ ﺑﺎﻻﻳﻲ ﺍﺳﺘﺨﻮﺍﻥ ﺍﻭﻟﻨﺎ ﺑﻪ ﻧﺎﻡ ﺭﺍﺩﻳﺎﻝ ﻧﺎچ ﺑﻮﺟﻮﺩ ﻣﻴﺎﻳﺪ‪.‬‬ ‫‪‬‬ ‫ﻟﻴﮕﺎﻣﺎﻥ ﺁﻧﻮﻟﺮ ﻛﻪ ﺩﻭﺭ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺭﺍﺩﻳﻮﺱ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﺳﺖ ﺑﻪ ﺟﻠﻮ ﻭ ﻋﻘﺐ ﺭﺍﺩﻳﺎﻝ ﻧﺎچ ﻣﺘﺼﻞ ﺷﺪﻩ ﻭ ﺍﺳﻨﺨﻮﺍﻥ‬ ‫ﻫﺎﻱ ﺭﺍﺩﻳﻮﺱ ﻭ ﺍﻭﻟﻨﺎﺭ ﺭﺍ ﺩﺭ ﺍﻳﻦ ﻣﻔﺼﻞ ﺩﺭ ﻛﻨﺎﺭ ﻫﻢ ﻧﮕﻪ ﻣﻴﺪﺍﺭﺩ‪.‬‬ ‫‪‬‬ ‫‪Dr. Maria Zahiri‬‬  ‫ﻣﻔﺼﻞ ﺭﺍﺩﻳﻮﺍﻭﻟﻨﺎﺭ ﺩﻳﺴﺘﺎﻝ ‪Distal radioulnar joint‬‬ ‫‪‬‬ ‫ﺍﻳﻦ ﻣﻔﺼﻞ ﺍﺯ ﻗﺮﺍﺭ ﺭﻓﺘﻦ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﺍﻭﻟﻨﺎ ﺩﺭ ﺳﻄﺢ ﻣﻘﻌﺮ ﭘﺎﻳﻴﻨﻲ ﺍﺳﺘﺨﻮﺍﻥ ﺭﺍﺩﻳﻮﺱ ﺑﻪ ﻧﺎﻡ ﺍﻭﻟﻨﺎﺭ ﻧﺎچ ﺑﻮﺟﻮﺩ‬ ‫‪‬‬ ‫ﻣﻴﺎﻳﺪ‪.‬ﻟﻴﮕﺎﻣﺎﻥ ﺭﺍﺩﻳﻮﺍﻭﻟﻨﺎﺭ ﻗﺪﺍﻣﻲ ﺩﺭ ﻗﺪﺍﻡ ﺍﻳﻦ ﻣﻔﺼﻞ ﻭ ﻟﻴﮕﺎﻣﺎﻥ ﺭﺍﺩﻳﻮﺍﻭﻟﻨﺎﺭ ﺩﻭﺭﺳﺎﻝ ﺩﺭ ﭘﺸﺖ ﺍﻳﻦ ﻣﻔﺼﻞ ﻗﺮﺍﺭ‬ ‫ﮔﺮﻓﺘﻪ ﻭ ﺁﻥ ﺭﺍ ﭘﺎﻳﺪﺍﺭ ﻣﻴﻜﻨﻨﺪ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬  ‫ﭘﺮﺩﻩ ﺑﻴﻦ ﺍﺳﺘﺨﻮﺍﻧﻲ ‪Interosseous membrane‬‬ ‫‪‬‬ ‫ﺍﻳﻦ ﻳﻚ ﭘﺮﺩﻩ ﺑﺎﻓﺘﻲ ﭘﻬﻦ ﻭ ﻧﺎﺯﻙ ﺍﺳﺖ ﻛﻪ ﺩﺭ ﺑﻴﻦ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﺭﺍﺩﻳﻮﺱ ﻭ ﺍﻭﻟﻨﺎ ﻭ ﺩﺭ ﺳﻪ ﭼﻬﺎﺭﻡ ﭘﺎﻳﻴﻨﻲ ﺁﻧﻬﺎ ﻗﺮﺍﺭ‬ ‫‪‬‬ ‫ﮔﺮﻓﺘﻪ ﺍﺳﺖ‪.‬‬ ‫ﻭﻇﻴﻔﻪ ﺍﻳﻦ ﺳﻪ ﻣﻔﺼﻞ ﺑﺮﻗﺮﺍﺭﻱ ﺍﻣﻜﺎﻥ ﭼﺮﺧﺶ ﺍﺳﺘﺨﻮﺍﻥ ﺭﺍﺩﻳﻮﺱ ﺣﻮﻝ ﺍﺳﺘﺨﻮﺍﻥ ﺍﻭﻟﻨﺎ ﺍﺳﺖ‪.‬‬ ‫‪‬‬ ‫ﺑﺮ ﺭﻭﻱ ﺍﻳﻦ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎ ﻋﻀﻼﺕ ﺳﺎﻋﺪ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﻭ ﺩﺭ ﺑﻴﻦ ﻋﻀﻼﺕ ﻋﺮﻭﻕ ﻭ ﺍﻋﺼﺎﺏ ﻗﺮﺍﺭ ﺩﺍﺭﻧﺪ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬ hand proper ‫ ﺩﺳﺖ ﻭﺍﻗﻌﻲ‬-wrist (carpus) ‫ ﺷﺎﻣﻞ ﻣﭻ‬:Hand ( Manus) ‫ﺩﺳﺖ‬  Digits ‫ ﺍﻧﮕﺸﺘﺎﻥ‬-( Metacarpal bones) Dr. Maria Zahiri  ‫ﺁﻧﺎﺗﻮﻣﻲ ﺩﺳﺖ ‪ -‬ﻛﻠﻴﺎﺕ‬ ‫‪‬‬ ‫ﺩﺳﺖ ﻣﻬﻤﺘﺮﻳﻦ ﺍﺑﺰﺍﺭ ﺣﺮﻛﺘﻲ ﺍﺳﺖ ﻛﻪ ﺍﻧﺴﺎﻥ ﺑﻪ ﺗﻮﺳﻂ ﺁﻥ ﻣﻴﺘﻮﺍﻧﺪ ﻣﺤﻴﻂ ﺍﻃﺮﺍﻓﺶ ﺭﺍ ﺗﻐﻴﻴﺮ ﺩﻫﺪ‪.‬ﺩﺳﺖ‬ ‫‪‬‬ ‫ﻫﻢ ﻣﻴﺘﻮﺍﻧﺪ ﺑﺮﺍﻱ ﻛﺎﺭﻫﺎﻳﻲ ﻛﻪ ﻧﻴﺎﺯ ﺑﻪ ﻧﻴﺮﻭﻱ ﺯﻳﺎﺩﻱ ﺩﺍﺭﻧﺪ ﺑﻜﺎﺭ ﺭﻭﺩ )ﻣﺎﻧﻨﺪ ﮔﺮﻓﺘﻦ ﺍﺷﻴﺎء ﺳﻨﮕﻴﻦ ﻭ ﺟﺎﺑﺠﺎ‬ ‫ﻛﺮﺩﻥ ﺁﻧﻬﺎ( ﻭ ﻫﻢ ﺑﺮﺍﻱ ﻛﺎﺭﻫﺎﻱ ﻇﺮﻳﻒ ﻣﺎﻧﻨﺪ ﺧﻠﻖ ﺁﺛﺎﺭ ﻫﻨﺮﻱ ﺍﺯ ﺁﻥ ﺍﺳﺘﻔﺎﺩﻩ ﻣﻴﺸﻮﺩ‪.‬ﻧﻮﻙ ﺍﻧﮕﺸﺘﺎﻥ ﺍﻧﺴﺎﻥ‬ ‫ﺑﻴﺸﺘﺮﻳﻦ ﻭ ﻣﺘﺮﺍﻛﻢ ﺗﺮﻳﻦ ﭘﺎﻳﺎﻧﻪ ﻫﺎﻱ ﺣﺴﻲ ﺭﺍ ﻧﺴﺒﺖ ﺑﻪ ﺩﻳﮕﺮ ﻣﻨﺎﻃﻖ ﺑﺪﻥ ﺩﺍﺭﺩ ﻭ ﻧﻮﻙ ﺍﻧﮕﺸﺘﺎﻥ ﺩﺳﺖ‬ ‫ﺑﻴﺶ ﺍﺯ ﻫﺮ ﺟﺎﻱ ﺩﻳﮕﺮ ﺑﺪﻥ ﺍﻧﺴﺎﻥ ﻣﻴﺘﻮﺍﻧﺪ ﺩﺭ ﻣﻮﻗﻌﻴﺖ ﻫﺎﻱ ﺩﻟﺨﻮﺍﻩ ﻓﻀﺎﻳﻲ ﻗﺮﺍﺭ ﮔﻴﺮﺩ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬  ‫ﺩﺳﺖ ﻗﺴﻤﺖ ﺍﻧﺘﻬﺎﻳﻲ ﺍﻧﺪﺍﻡ ﻓﻮﻗﺎﻧﻲ ﺍﺳﺖ ﻭ ﺗﺸﻜﻴﻞ ﺷﺪﻩ ﺍﺯ ﻳﻚ ﻛﻔﻲ ﭘﻬﻦ )ﻛﻒ ﺩﺳﺖ ‪ (Palm‬ﻭ ﭘﻨﺞ‬ ‫‪‬‬ ‫ﺍﻧﮕﺸﺖ ‪.Digit‬‬ ‫ﺩﺭ ﺍﻧﺘﻬﺎﻱ ﻛﻒ ﺩﺳﺖ ﭼﻬﺎﺭ ﺍﻧﮕﺸﺖ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﻛﻪ ﻣﻴﺘﻮﺍﻧﻨﺪ ﺭﻭﻱ ﻛﻒ ﺩﺳﺖ ﺧﻢ ﺷﺪﻩ ﻭ ﺗﻮﺍﻧﺎﻳﻲ ﮔﺮﻓﺘﻦ‬ ‫‪ Grasping‬ﺭﺍ ﺑﻪ ﺍﻧﺴﺎﻥ ﺑﺪﻫﻨﺪ‪.‬ﺍﻧﮕﺸﺖ ﻧﺰﺩﻳﻚ ﺷﺴﺖ ﺍﻧﮕﺸﺖ ﺩﻭﻡ ﺍﺳﺖ ﻭ ﺑﻪ ﺁﻥ ﺍﻧﮕﺸﺖ ﺍﺷﺎﺭﻩ‬ ‫‪ Index finger‬ﻫﻢ ﻣﻴﮕﻮﻳﻨﺪ‪.‬ﺍﻧﮕﺸﺖ ﻭﺳﻄﻲ ‪ ، Middle finger‬ﺍﻧﮕﺸﺖ ﺳﻮﻡ ﻳﺎ ﺑﻠﻨﺪﺗﺮﻳﻦ‬ ‫ﺍﻧﮕﺸﺖ ﺩﺳﺖ ﺍﺳﺖ‪.‬ﺍﻧﮕﺸﺖ ﭼﻬﺎﺭﻡ ﺍﻧﮕﺸﺖ ﺣﻠﻘﻪ ﻳﺎ ﺍﻧﮕﺸﺘﺮﻱ ‪ Ring finger‬ﺍﺳﺖ ﻭ ﺍﻧﮕﺸﺖ ﭘﻨﺠﻢ‬ ‫ﺍﻧﮕﺸﺖ ﻛﻮﭼﻚ ‪ Small finger‬ﺍﺳﺖ‪.‬ﺷﺴﺖ ﻳﺎ ﺍﻧﮕﺸﺖ ﺍﻭﻝ ﺑﻪ ﻛﻨﺎﺭﻩ ﻛﻒ ﺩﺳﺖ ﻣﺘﺼﻞ ﺷﺪﻩ ﻭ‬ ‫ﻣﻬﻤﺘﺮﻳﻦ ﺍﻧﮕﺸﺖ ﺩﺳﺖ ﺍﺳﺖ‪.‬ﺷﺴﺖ ﺩﺭ ﻣﻘﺎﺑﻞ ﭼﻬﺎﺭ ﺍﻧﮕﺸﺖ ﺩﻳﮕﺮ ﻗﺮﺍﺭ ﻣﻴﮕﻴﺮﺩ ﻭ ﺗﻘﺮﻳﺒﺎ ﺩﺭ ﻫﻤﻪ ﻛﺎﺭﻫﺎﻳﻲ‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﻛﻪ ﺑﺎ ﺩﺳﺖ ﺍﻧﺠﺎﻡ ﻣﻴﺪﻫﻴﻢ ﺷﺮﻛﺖ ﻣﻴﻜﻨﺪ‪.‬‬ ‫ﻫﺮ ﺍﻧﮕﺸﺖ ﺍﺯ ﺳﻪ ﺑﻨﺪ ﺗﺸﻜﻴﻞ ﺷﺪﻩ ﺍﺳﺖ‪.‬ﺑﻨﺪ ﺍﻧﺘﻬﺎﻳﻲ ﻳﺎ ﺩﻳﺴﺘﺎﻝ ‪ Distal‬ﺑﻨﺪﻱ ﺍﺳﺖ ﻛﻪ ﻧﺎﺧﻦ ﺑﺮ ﺭﻭﻱ‬ ‫‪‬‬ ‫ﺁﻥ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﺳﺖ‪.‬ﺑﻨﺪ ﻭﺳﻂ ﺭﺍ ﺑﻨﺪ ﻣﻴﺪﻝ ‪ Middle‬ﻫﻢ ﻣﻴﮕﻮﻳﻨﺪ ﻭ ﺑﻨﺪﻱ ﻛﻪ ﺑﻪ ﻛﻒ ﺩﺳﺖ ﻣﺘﺼﻞ‬ ‫ﻣﻴﺸﻮﺩ ﺭﺍ ﺑﻨﺪ ﭘﺮﮔﺰﻳﻤﺎﻝ ‪ Proximal‬ﻣﻴﻨﺎﻣﻨﺪ‪.‬ﺷﺴﺖ ﺍﺯ ﺩﻭ ﺑﻨﺪ ﺗﺸﻜﻴﻞ ﺷﺪﻩ ﻭ ﺑﻨﺪ ﻭﺳﻂ ﻧﺪﺍﺭﺩ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬  ‫ﺁﻧﺎﺗﻮﻣﻲ ﺩﺳﺖ ‪ -‬ﺍﺳﺘﺨﻮﺍﻥ ﻭ ﻣﻔﺎﺻﻞ‬ ‫‪‬‬ ‫ﺩﺭ ﻛﻒ ﺩﺳﺖ ﺍﻧﺴﺎﻥ ﭘﻨﺞ ﺍﺳﺘﺨﻮﺍﻥ ﺩﺭﺍﺯ ﺑﻪ ﻧﺎﻡ ﻣﺘﺎﻛﺎﺭپ ‪ Metacarp‬ﻭﺟﻮﺩ ﺩﺍﺭﺩ ﻭ ﻫﺮ ﺍﻧﮕﺸﺖ ﺳﻪ‬ ‫‪‬‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﺩﺍﺭﺩ ﺑﺠﺰ ﺷﺴﺖ ﻛﻪ ﺍﺯ ﺩﻭ ﺍﺳﺘﺨﻮﺍﻥ ﺗﺸﻜﻴﻞ ﺷﺪﻩ ﺍﺳﺖ‪.‬ﺑﻪ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﺍﻧﮕﺸﺖ‪ ،‬ﻓﺎﻻﻧﻜﺲ‬ ‫‪ Phalanx‬ﻣﻴﮕﻮﻳﻨﺪ‪.‬ﻫﺮ ﻣﺘﺎﻛﺎﺭپ ﻭ ﻫﺮ ﻓﺎﻻﻧﻜﺲ ﺍﺯ ﺳﻪ ﻗﺴﻤﺖ ﺳﺮ‪ ،‬ﺗﻨﻪ ﻭ ﻗﺎﻋﺪﻩ ﺩﺭﺳﺖ ﺷﺪﻩ ﺍﺳﺖ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﺩﺭ ﺑﻌﻀﻲ ﺍﺯ ﻧﻘﺎﻁ ﻛﻒ ﺩﺳﺖ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﮔﺮﺩ ﻛﻮﭼﻜﻲ ﺑﺎ ﻧﺎﻡ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﺳﺰﺍﻣﻮﺋﻴﺪ ‪Sesamoid‬‬ ‫‪‬‬ ‫‪ bones‬ﻭﺟﻮﺩ ﺩﺍﺭﺩ ﻛﻪ ﺩﺭ ﻣﺴﻴﺮ ﺗﺎﻧﺪﻭﻥ ﻫﺎ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﻭ ﻛﺎﺭﺍﻳﻲ ﺁﻧﻬﺎ ﺭﺍ ﺑﻴﺸﺘﺮ ﻣﻴﻜﻨﻨﺪ‪.‬ﺗﻌﺪﺍﺩ ﺍﻳﻦ‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﺳﺰﺍﻣﻮﻳﻴﺪ ﺩﺭ ﺩﺳﺖ ﺍﻓﺮﺍﺩ ﻣﺨﺘﻠﻒ ﻣﺘﻔﺎﻭﺕ ﺍﺳﺖ‪.‬‬ ‫‪Dr. Maria Zahiri‬‬  ‫ﻣﻔﺎﺻﻞ ﺩﺳﺖ‬ ‫‪‬‬ ‫ﺩﺳﺖ ﺳﻪ ﻧﻮﻉ ﻣﻔﺼﻞ ﺩﺍﺭﺩ‬ ‫‪‬‬ ‫ﻣﻔﺎﺻﻞ ﻣﺘﺎﻛﺎﺭﭘﻮﻓﺎﻻﻧﮋﻳﺎﻝ ‪ Metacarpophalangeal joints‬ﻛﻪ ﺑﻴﻦ ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﻣﺘﺎﻛﺎﺭپ ﻭ‬ ‫‪‬‬ ‫ﺍﺳﺘﺨﻮﺍﻥ ﻫﺎﻱ ﺑﻨﺪ ﭘﺮﮔﺰﻳﻤﺎﻝ ﺍﻧﮕﺸﺘﺎﻥ ﻭﺍﻗﻊ ﺷﺪﻩ ﺍﻧﺪ‬ ‫ﻣﻔﺎﺻﻞ ﺍﻳﻨﺘﺮﻓﺎﻻﻧﮋﻳﺎﻝ ﭘﺮﮔﺰﻳﻤﺎﻝ ‪ joints Proximal interphalangeal‬ﻛﻪ ﺑﻴﻦ ﺑﻨﺪ ﻫﺎﻱ‬ ‫‪‬‬ ‫ﻣﻴﺎﻧﻲ ﻭ ﭘﺮﮔﺰﻳﻤﺎﻝ ﺍﻧﮕﺸﺘﺎﻥ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﻧﺪ‬ ‫‪Dr. Maria Zahiri‬‬ ‫ﻣﻔﺎﺻﻞ ﺍﻳﻨﺘﺮﻓﺎﻻﻧﮋﻳﺎﻝ ﺩﻳﺴﺘﺎﻝ ‪ Distal interphalangeal joints‬ﻛﻪ ﺑﻴﻦ ﺑﻨﺪ ﻫﺎﻱ ﻭﺳﻄﻲ ﻭ‬ ‫‪‬‬ ‫ﺍﻧﺘﻬﺎﻳﻲ ﺍﻧﮕﺸﺘﺎﻥ ﻫﺴﺘﻨﺪ‬  ‫‪Dr. Maria Zahiri‬‬ ‫ﺧﺴﺘﻪ ﻧﺒﺎﺷﻴﺪ ﻋﺰﻳﺰﺍﻥ‬