无单一最佳技术：股骨端界面螺钉固定骨-髌腱-骨前交叉韧带重建中的权衡
简介
这篇系统综述探讨了骨-髌腱-骨ACL重建术中股骨端界面螺钉的选择策略，包括置入方向（由内向外 vs 由外向内）、骨道形态（圆形 vs 矩形）、螺钉位置（前 vs 后）及材质（金属、可吸收、PEEK、镁合金），分析了各方案在固定强度、解剖复位和翻修可行性之间的权衡。结论是尚无统一最优方案，术者需根据术中视野、骨量保存、预期翻修策略及患者年龄、活动水平和骨质情况…
英文摘要
This review presents how surgeons should choose femoral interference screw in anterior cruciate ligament (ACL) reconstruction - insertion direction (inside-out vs outside-in), tunnel shape (round vs rectangular), screw position (anterior vs posterior), and screw material (metal, bioabsorbable, PEEK, magnesium) - to balance fixation strength, anatomic fidelity, and revision feasibility. Inside-out maximizes aperture compression and preserves the lateral femoral cortex but requires deep flexion and precise trajectory (risk of iatrogenic cartilage contact/posterior wall breach). Outside-in improves visualization and guide control yet needs a large lateral cortical socket and can push the bone plug intra-articularly as the screw advances from cortex to joint. Rectangular tunnels better match the native footprint, improving rotational control and interface congruity, while round tunnels simplify preparation but allow plug rotation and may use bone less efficiently at the aperture. Posterior screw placement (particularly with the inside-out technique) enhances cancellous-to-cancellous compression but risks posterior cortical breach injury; anterior placement protects fibers and favors footprint fidelity but may reduce cancellous compression. Metal offers high stiffness and no tapping but creates MRI artifact and requires removal if present at revision. Bioabsorbable materials avoid artifact/removal yet are weaker and may fracture in sclerotic tunnels. PEEK (metal-like without artifact) and magnesium (osteoconductive/resorbable) are promising but lack long-term data. No single method is universally optimal. Decisions should be individualized to visualization needs, cortical/bone-stock preservation, expected revision strategy, and patient factors (age, activity, bone quality).