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关键词： 椎弓根螺钉内固定疲劳， 生物力学
随着脊柱外科经后路内固定手术普遍开展，各种椎弓根螺钉固定系统已广泛应用于临床，但Esses等通过临床应用调查这些固定器械发现没有哪一种椎弓根螺钉固定比较完善，大量病例的远期随访表明并发症多。主要是螺钉松脱、断钉、内固定不牢固、矫正度丢失、椎体间融合形成假关节、脱位术后复发、椎弓根断裂等。Wittenberg认为椎弓根螺钉固定产生并发症多的原因是螺钉内固定疲劳的结果。内固定器械受周期性负荷而导致疲劳。结合国内外在椎弓根螺钉内固定疲劳生物力学方面的研究综述如下：
1 椎弓根螺钉疲劳指标
Yamgata等认为要研究椎弓根螺钉内固定生物力学疲劳特性，应从下面3个方面确定：①螺钉强度——疲劳次数关系：就是测定螺钉植入后其强度与周期性负荷次数（疲劳次数）关系；②测定螺钉旋入/出力矩。这具指标能表明螺钉固定疲劳前后的力矩变化，代表期疲劳程度；③螺钉最大轴向拔出力，表示钉一骨界面紧握力牢固性。Wittenberg等也研究了强度一疲劳次数关系，并发现螺钉固定强度随疲劳次数增加而下降。Zdeblick等研究螺钉旋入/出力矩与疲劳次数关系，并指出力矩随疲劳总人数增加下降。轴向拔出力也下降；钉一骨界面轴向拔出力也随疲劳次数增加而下降。
目录：
1 椎弓根螺钉疲劳指标
2 影响椎弓根螺钉内固定生物力学疲劳特性的因素
3 预防椎弓根螺钉固定疲劳的措施
4 椎弓根螺钉疲劳研究存在问题
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