مجله جراحی استخوان و مفاصل ایران

تعویض کامل مفصل زانو در بیماران مبتلا به ناهنجاری‌های خارج‌مفصلی )چالش‌ها، روش‌ها و نتایج(

نوع مقاله : مروری

نویسندگان

محمد عزیزی
هوشمند زارعی
مهیار مهدوی
سید محمد میثاق متشکره
میعاد نصرت پور
مانا ذاکر مشفق
حمیدرضا مصلح
سید مرتضی کاظمی

مرکز تحقیقات استخوان، مفصل و بافت های مرتبط بیمارستان اختر، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

10.22034/ijos.2026.243324
چکیده
چکیده
اجرای جراحی تعویض کامل مفصل زانو (TKA) در بیمارانی که با ناهنجاری‌های خارج‌مفصلی مواجه هستند، با چالش‌های جراحی پیچیده و قابل‌توجهی همراه است که می‌تواند تأثیرات مستقیم و غیرمستقیمی بر نتایج درمانی داشته باشد. این ناهنجاری‌ها اغلب مستلزم برنامه‌ریزی دقیق‌تر و اتخاذ راهبردهای جراحی متناسب با شرایط هر بیمار هستند تا هم‌راستایی بیومکانیکی اندام حفظ شده و عملکرد مطلوب مفصل تضمین شود. از جمله این راهبردها می‌توان به اصلاحات داخل‌مفصلی و استئوتومی‌های خارج‌مفصلی اشاره کرد که انتخاب هر یک بر اساس ویژگی‌های بالینی بیمار، محل و شدت ناهنجاری صورت می‌گیرد. در این راستا، فناوری‌های نوین نظیر جراحی با کمک رایانه و سیستم‌های روباتیک به‌عنوان ابزارهای پیشرفته مطرح شده‌اند که با افزایش دقت در برنامه‌ریزی و اجرای عمل، احتمال بروز خطاهای جراحی را کاهش داده و به بهبود پیامدهای بالینی کمک می‌کنند. این مقاله با هدف ارائه مروری جامع بر رویکردهای درمانی و الگوریتم‌های تصمیم‌گیری در مدیریت TKA در بیماران مبتلا به ناهنجاری‌های خارج‌مفصلی تدوین شده است و در عین حال بر اهمیت ارزیابی دقیق پیش‌ازعمل، تصویربرداری پیشرفته و برنامه‌ریزی چندرشته‌ای تأکید دارد. همچنین، راهکارهای عملی برای بهینه‌سازی نتایج عملکردی، کاهش عوارض احتمالی و افزایش طول عمر پروتز ارائه می‌شود.


کلیدواژه‌ها

آرتروپلاستی کامل زانو
زانو
استئوتومی
نتایج
موضوعات

عنوان مقاله English

Total Knee Arthroplasty in Patients with Extra-articular Deformities (Challenges, Techniques, and Outcomes)

نویسندگان English

Mohammad Azizi
Hooshmand Zarei
Mahyar Mahdavi
Seyed Mohammadmisagh Moteshakereh
Miad Nosratpour
Mana Zaker Moshfegh
Hamidreza Mosleh
Morteza Kazemi
Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده English

Abstract
Performing total knee arthroplasty (TKA) in patients with extra-articular deformities presents complex and significant surgical challenges that can have both direct and indirect impacts on treatment outcomes. These deformities often require more meticulous planning and tailored surgical strategies to maintain biomechanical alignment of the joint and ensure optimal patient function. Among these strategies are intra-articular corrections and extra-articular osteotomies, with the choice depending on the specific characteristics of the patient and the severity of the deformity. In this context, advanced technologies such as computer-assisted surgery and robotic systems have emerged as innovative tools that enhance accuracy in surgical planning and execution, minimize the risk of surgical errors, and facilitate improved clinical outcomes. This article provides a comprehensive review of current best practices and emerging trends in managing TKA for patients with extra-articular deformities, while also emphasizing the importance of multidisciplinary preoperative planning, advanced imaging assessment, and patient-specific risk evaluation. It further discusses structured decision-making algorithms to guide the selection of appropriate corrective techniques, with careful attention to soft-tissue balance, implant positioning, and long-term stability. Collectively, these considerations aim to optimize functional outcomes, reduce complications, and improve implant longevity in this challenging patient population.

کلیدواژه‌ها English

Total knee arthroplasty
Knee
Osteotomy
outcomes
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مجله جراحی استخوان و مفاصل ایران
دوره 23، شماره 4
پاییز 1404
صفحه 189-199

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