علل و پيامدهاي درمان 47 مورد چنگالي شدن انگشتان پا پس از تروما در بيمارستان سينا تهران

Causes and Outcomes of Treatment of 47 Cases of Post Traumatic Clawing of Foot in Sina Hospital Tehran

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﭼﻨﮕﺎﻟﻲ ﺷﺪﻥ ﺍﻧﮕﺸﺘﺎﻥ ﭘﺎ ﻣﻌﻤﻮﻻﹰ ﺩﺭ ﺑﻴﻤﺎﺭﻱ ﻫﺎﻱ ﻋﺼﺒﻲ ﻋﻀﻼﻧﻲ ﺩﻳﺪﻩ ﻣﻲ ﺷﻮﺩ ﻭ ﺩﺭ ﺑﻌﻀﻲ ﺍﺯ ﻣﻮﺍﺭﺩ ﻣﺎﻧﻨﺪ ﺿﺮﺑﻪ ﺑﻪ ﺳﺎﻕ ﭘﺎ ﺑﺎ ﻳﺎ ﺑﺪﻭﻥ ﺷﮑﺴﺘﮕﻲ ﻭ ﻳﺎ ﺑﻪ ﺩﻧﺒﺎﻝ ﺑﻬﺒﻮﺩ ﺷﮑﺴﺘﮕﻲ ﻳﺎ ﺁﺳﻴﺐ ﻫﺎﻱ ﺑﺎﻓﺖ ﻧﺮﻡ ﻧﻴﺰ ﻣﻤﮑﻦ ﺍﺳﺖ، ﺩﻳﺪﻩ ﺷﻮﺩ. ﻣﺎ ﺗﻼﺵ ﻣﻲ ﮐﻨﻴﻢ ﮐﻪ ﻋﻠﻞ ﻭ ﻳﺎ ﺩﺭﻣﺎﻥ ﻫﺎﻱ ﻣﻨﺎﺳﺐ ﺁﻥ ﺭﺍ ﺗﻌﻴﻴﻦ ﮐﻨﻴﻢ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﻣﺎ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺳﻴﻨﺎ ﺗﻬﺮﺍﻥ 47 ﺑﻴﻤﺎﺭ ﺭﺍ ﺩﺭ ﺳﺎﻝ ﻫﺎﻱ 1382 ﺗﺎ1386 ﺑﺮﺭﺳﻲ ﮐﺮﺩﻳﻢ. ﭘﺲ ﺍﺯ ﮐﺴﺐ ﺍﺟﺎﺯﻩ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﺩﺭ ﻧﻈﺮ ﺩﺍﺷﺘﻦ ﻣﺴﺎﺋﻞ ﺍﺧﻼﻗﻲ ﺁﻧﻬﺎ ﺭﺍ ﻭﺍﺭﺩ ﻣﻄﺎﻟﻌﻪ ﮐﺮﺩﻳﻢ. ﺗﻤﺎﻡ ﺁﻧﻬﺎ ﺑﻴﻤﺎﺭﺍﻥ ﺍﻭﻟﻴﻪ ﻣﺎ ﺑﻮﺩﻧﺪ ﮐﻪ ﭘﺲ ﺍﺯ ﺁﺳﻴﺐ ﺍﻭﻟﻴﻪ ﺑﻪ ﺍﻭﺭﮊﺍﻧﺲ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻣﺎ ﻣﺮﺍﺟﻌﻪ ﻧﻤﻮﺩﻩ ﺑﻮﺩﻧﺪ 42 ﻣﻮﺭﺩ ﺁﻧﻬﺎ ﺩﺍﺭﺍﻱ ﺷﮑﺴﺘﮕﻲ ﻭ 5 ﻣﻮﺭﺩ ﻧﻴﺰ ﺑﺪﻭﻥ ﺷﮑﺴﺘﮕﻲ ﺑﻮﺩﻧﺪ ﺩﺭ ﻭﻳﺰﻳﺖ ﻫﺎﻱ ﭘﻴﮕﻴـﺮﻱ ﭼﻨﮕﺎﻟﻲ ﺷﺪﻥ ﺩﺭ ﺁﻧﻬﺎ ﻣﺸﺎﻫﺪﻩ ﺷﺪ. ﺑﻨﺎﺑﺮﺍﻳﻦ ﻣﺎ ﺁﻧﻬﺎ ﺭﺍ ﺍﺯ ﻧﻈﺮ ﻋﻤﻠﮑﺮﺩ ﺣﺴﻲ ﻭ ﺣﺮﻛﺘﻲ ﻣﻌﺎﻳﻨﻪ ﮐﺮﺩﻩ ﻭ ﺑﺮﺍﻱ ﺁﻧﻬﺎ ﺭﺍﺩﻳﻮﮔﺮﺍﻓﻲ ﻭ ﻧﻮﺍﺭ ﻋﺼﺐ ﻭ ﻋﻀﻠﻪ ﺍﻧﺠـﺎﻡ ﺩﺍﺩﻳﻢ. ﺑﺮﺍﻱ ﺁﻧﻬﺎ ﺗﻨﻮﺗﻮﻣﻲ ﻓﻠﮑﺴﻮﺭﻫﺎ ﻭ ﺩﺭ ﺻﻮﺭﺕ ﻟﺰﻭﻡ ﺑﺮﺩﺍﺷﺘﻦ ﮐﺎﻟﻮﺱ ﺍﻧﺠﺎﻡ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﺎ ﻫﻴﭽﮕﻮﻧﻪ ﺍﺧﺘﻼﻝ ﻋﻤﻠﮑﺮﺩ ﺣﺴﻲ ـ ﺣﺮﮐﺘﻲ ﻭ ﻳﺎ ﺍﺧﺘﻼﻝ ﺩﺭ ﻧﻮﺍﺭ ﻋﺼﺐ ﻭ ﻋﻀﻠﻪ ﺁﻧﻬﺎﭘﻴﺪﺍ ﻧﮑـﺮﺩﻳﻢ. ﺩﺭ ﺭﺍﺩﻳﻮﮔﺮﺍﻓﻲ ﺁﻧﻬﺎ ﻫﻴﭽﮕﻮﻧﻪ ﮐﺎﻟﻮﺱ ﻭﺍﺿﺢ ﻭﺟﻮﺩ ﻧﺪﺍﺷﺖ ﻭ ﺩﺭ ﮔﺮﺍﻓﻲ ﭘﺎ، ﻫﻴﭽﮕﻮﻧﻪ ﺷﮑﺴﺘﮕﻲ ﺍﺳﺘﺨﻮﺍﻧﻲ ﻭ ﺩﻳﮕﺮ ﻣﺴﺎﺋﻞ ﻏﻴﺮ ﻃﺒﻴﻌﻲ ﻣﺎﻧﻨﺪ ﺟﻮﺵ ﻧﺨﻮﺭﺩﻥ ﺍﺳﺘﺨﻮﺍﻥ ﻭ ﻳﺎ ﺗﺨﺮﻳﺐ ﻣﻔﺎﺻﻞ ﮐﻮﭼﮏ ﭘﺎ ﻭﺟﻮﺩ ﻧﺪﺍﺷﺖ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻣﺎ ﺗﻼﺵ ﮐـﺮﺩﻳﻢ ﮐﻪ ﺑﻌﻀﻲ ﺍﺯ ﻋﻠـﻞ ﭼﻨـﮕﺎﻟﻲ ﺷـﺪﻥ ﭘﺎ ﺭﺍ ﮐﻨﺎﺭ ﺑﮕـﺬﺍﺭﻳﻢ. ﻫﻴﭽﮕـﻮﻧﻪ ﺍﺛـﺮ ﮐﺎﻟـﻮﺱ ﻭﺟـﻮﺩ ﻧﺪﺍﺷﺖ. ﺩﺭ ﻧـﻮﺍﺭ ﻋﺼﺐ ﻭ ﻋﻀـﻠﻪ، ﺁﺳﻴـﺐ ﻋﺼﺒـﻲ ﻭ ﺩﺭ ﺭﺍﺩﻳﻮﮔـﺮﺍﻓﻲ، ﻣﺸـﮑﻼﺕ ﺍﺳﺘﺨـﻮﺍﻧﻲ ﻭﺟـﻮﺩ ﻧﺪﺍﺷـﺖ. ﺗﻤـﺎﻣـﻲ ﻣـﻮﺍﺭﺩ ﻳﮏ ﻃـﺮﻓﻪ ﺑـﻮﺩﻩ ﮐـﻪ ﺑﻌـﺪ ﺍﺯ ﺗـﺮﻭﻣﺎ ﺍﻳﺠـﺎﺩ ﺷـﺪﻩ ﺑـﻮﺩ ﮐﻪ ﺧـﻮﺩ ﺍﻳﻦ ﺣﺎﻟـﺖ، ﺑﻴﻤـﺎﺭﻱ )ﻋﺼﺒﻲ ﻋﻀـﻼﻧﻲ( ﻧـﻮﺭﻭﻣﺎﺳﮑـﻮﻟﺮ ﺭﺍ ﺭﺩ ﻣﻲ ﮐـﺮﺩ. ﻣـﺎ ﻓﮑـﺮ ﻣﻲ ﮐﻨﻴـﻢ ﮐﻪ ﻳـﮏ ﻭﺍﻗﻌـﻪ ﻓﻴﺒـﺮﻭﺗﻴـﮏ ﺑﻌـﺪ ﺍﺯ ﺁﺳﻴـﺐ ﻫﺎﻱ ﻟـﻪ ﮐﻨﻨـﺪﻩ ﺩﺭ ﻋﻀـﻼﺕ ﺳـﺎﻕ ﺍﻳﺠـﺎﺩ ﻣﻲ ﺷـﻮﺩ ﮐﻪ ﻣﻲ ﺗـﻮﺍﻧﺪ ﺑﺎﻋـﺚ ﺍﻳﻦ ﺩﻓـﻮﺭﻣﻴﺘﻲ ﺷﻮﺩ.

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