界面螺钉与可调节襻钛板重建前十字韧带的研究进展

Comparative research progress on the application of interference screws and adjustable-length loop in anterior cruciate ligament reconstruction

对于前十字韧带(anterior cruciate ligament,ACL)损伤患者,关节镜下ACL重建是恢复其运动功能的主要方式。骨隧道的定位与制作、移植物的选择及固定方式是影响ACL重建手术效果的三个关键因素。移植物固定不当会引起骨隧道扩大、移植物松弛,从而导致ACL重建手术失败以及导致的翻修手术。因此,对ACL重建术中移植物的固定方式更为重要。过去40年采用ACL重建不断取得进展,手术理念趋于一致,手术技术逐渐规范,移植物固定方式为最常用的界面螺钉和可调节襻钛板。界面螺钉属于骨隧道内挤压固定,可调节襻钛板是最常用的骨皮质外悬吊固定。相较于界面螺钉,可调节襻钛板具有固定牢靠、强度高、不损伤移植物、有利于腱-骨愈合、降低炎症反应、减少骨隧道扩大、减少皮质骨膜破坏、减轻术后疼痛等优势,受到越来越多的临床医生关注和采用。目前,股骨侧固定方式已基本统一,而胫骨侧的最佳固定方式仍有争议。国内的指南认为界面螺钉和可调节襻钛板固定均可接受,但手术医生应对固定方式充分了解。

For patients with anterior cruciate ligament(ACL)injuries,arthroscopic anterior cruciate ligament reconstruction(ACLR)is the primary method to restore function.The positioning and creation of bone tunnels,graft selection,and fixation methods are crucial to the effectiveness of ACLR.Improper graft fixation can lead to bone tunnel enlargement,graft laxity,and ultimately,ACL reconstruction failure and revision.Thus,the graft fixation method is pivotal for ACLR.Over the past 40 years,significant progress has been made in ACLR under arthroscopy,leading to a more consistent surgical philosophy and more standardized surgical techniques.The most commonly used graft fixation methods are interference screws(IS)and adjustable-length loops(ALP).IS involves compression fixation within the bone tunnel,while ALP is a widely used cortical suspensory fixation method.Compared to IS,ALP offers advantages such as more secure fixation,higher strength,no graft damage,and promotion of tendon-bone healing.It also reduces the inflammatory response,minimizes bone tunnel enlargement,cortical bone membrane damage,and postoperative pain.Consequently,ALP has gained increasing attention and adoption in clinical practice.Currently,the fixation method on the femoral side has been generally unified,while the optimal fixation method on the tibial side remains controversial.Domestic guidelines suggest that both IS and ALP fixation are acceptable.However,surgeons should have a comprehensive understanding of each fixation method.This article systematically compares the clinical applications and research progress of IS and ALP fixation,providing clinicians with a more suitable choice for fixation method.