腰骶移行椎上一节段腰椎的形态学特点及临床意义

中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (4): 392-395.

腰骶移行椎上一节段腰椎的形态学特点及临床意义

杨立辉¹，　柳　伟¹，　王　瑞¹，　张继宗²，　孔晓川¹，　安立琨¹，　杜心如¹

1.首都医科大学附属北京朝阳医院骨科，北京 100020； 2.中国公安部物证鉴定中心，北京 100080

收稿日期:2010-09-09 发布日期:2011-07-26
通讯作者: 杜心如，教授，博士后，Tel:(010)85231703, E-mail:duxinru@yahoo.com.cn E-mail:mr_yanglihui@126.com
作者简介:杨立辉（1972-），男，吉林省德惠市，硕士，主治医师研究方向：脊柱外科，创伤骨科，Tel：（010）51718262
基金资助:
北京市教委资助项目（KM200610025019）；首都医科大学基础临床联合资助项目

Morphological characteristics of the lumbar segment above the lumbosacral transitional vertebrae and its clinical significance

YANG Li-hui¹, LIU Wei¹, Wang Rui¹, ZHANG Ji-zong², KONG Xiao-chuan¹, AN Li-kun¹, DU Xin-ru¹

1.Department of Orthopaedics, Chaoyang Hospital, Capital Medical University, Beijing 100020, China; 2. Institute of Forensic Science of Ministry of Public Security, People's Republic of China, Beijing 100080, China

Received:2010-09-09 Published:2011-07-26

摘要/Abstract

摘要：

目的　研究腰骶移行椎上一节段腰椎的形态特点，为腰骶移行椎合并腰椎滑脱、不稳症时椎弓根螺钉内固定术提供依据。方法　对59例腰骶移行椎上一节段腰椎标本的矢状径、横径，峡部的高度、厚度；椎弓根的纵径、横径；椎板的高度、厚度；脊椎指数及退变情况等进行观测。结果　腰骶移行椎上一节段椎体前后径(34.1±2.7)mm，横径(47.5±4.6)mm；峡部高度(12.9±1.6)mm；峡部厚度(9.0±1.2)mm；椎弓根纵径 (10.6±2.4)mm，椎弓根横径 (14.0±2.4)mm；椎板高度(18.2±2.6) mm，椎板厚度 (5.7±1.2)mm。脊椎指数：1：4.35； 81.4%（48例）发生椎体增生，未发现峡部裂。结论　腰骶移行椎上一节段腰椎椎体各径线及椎弓根横径较正常L4椎体大，可选择直径稍大的椎弓根螺钉;峡部厚度较正常L4增加;峡部不存在发育薄弱和局部缺损。

关键词: 腰椎, 腰骶移行椎, 上一节段腰椎, 第4腰椎

Abstract:

Objective　To study morphological characteristics of the lumbar segment above the lumbosacral transitional vertebrae, and provide anatomic basis for the clinical treatment in the spondylolisthesis, lumbar disc herniation and pedicle screw fixation.　Methods　59 specimens of dry lumbar segment above the lumbosacral transitional vertebrae were anatomically evaluated. The anteroposterior diameter, the transverse diameter, the thickness and height of the vertebral isthmus, the longitudinal diameter and transverse diameter of the vertebral pedicle, the height and thickness of the vertebral lamina, the spine index, and the degeneration state were measured with the caliper and the protractor in all specimens.　Results　The anteroposterior diameter and transverse diameter of vertebral isthmus were（34.1±2.7）mm and（47.5±4.6）mm respectively. The height of vertebral isthmus was（12.9±1.6）mm, and the thickness (9.0±1.2）mm. The longitudinal and transverse diameters of vertebral pedicle were（10.6±2.4）mm and (14.0±2.4）mm respectively. The height of the lamina was（18.2±2.6）mm, and the thickness （5.7±1.2）mm. The spine index was （1：4.35）. The hyperplasia of upper vertebra appeared in 48 specimens. Spondylolysis was not found in all specimens.　Conclusions　The vertebral body of lumbar segment above the lumbosacral transitional vertebrae and the transverse diameters of the vertebral pedicle are larger than that of the fourth lumbar vertebrae，which is the support for selecting the larger screws for pedicle fixation. The isthmus thickness of lumbar segment above the lumbosacral transitional vertebrae is larger than that of the fourth lumbar vertebrae，however, congenital developmental defects and weak are not found.

Key words: Lumbar vertebrae, Lumbosacral transtional vertebra, Lumbar segment above the lumbosacral transitional vertebrae, Lumbar vertebrae IV

中图分类号:

R323.43，R682.13

杨立辉, 柳　伟, 王　瑞, 张继宗, 孔晓川, 安立琨, 杜心如. 腰骶移行椎上一节段腰椎的形态学特点及临床意义[J]. 中国临床解剖学杂志, 2011, 29(4): 392-395.

YANG Li-Hui, LIU 　Wei, WANG 　Rui, ZHANG Ji-Zong, KONG Xiao-Chuan, AN Li-Kun, DU Xin-Ru. Morphological characteristics of the lumbar segment above the lumbosacral transitional vertebrae and its clinical significance[J]. Chinese Journal Of Clinical Anatomy, 2011, 29(4): 392-395.

参考文献

[1] Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitionnal vertebrae and their relationship with lumbar extradural defects
[J].Spine ,1984,9(5)：493-495 .

[2] Taskaynatan MA, Izci Y, Ozgul A, et al. Clinical significance of congenital lumbosacral malformations in young male population with prolonged low back pain
[J]. Spine, 2005, 30 (8) : E210 -213.

[3] Pekindil G, Sarikaya A, Pekindil Y, et al. Lumbosacral transitional vertebral articulation:.evaluation by planar and SPECT bonescintigraphy
[J]. Nucl Med Commun, 2004, 25 (1) : 29-37

[4] 王东来，黄土中，乐林山，等.腰骶部移行椎与椎间盘突出症关系探讨
[J].中国脊柱脊髓杂志，1992，2（3）：110-113.

[5] 刘淼.伴腰骶部移行椎的腰椎间盘突出症
[J].骨与关节损伤杂志，1993，8（3）：154-155.

[6] Elster AD Bertolotti's syndrome revisited.Transitional vertebrae of the lumbar spine
[J].Spine，1989，14（12）：1373-1377.

[7] Chang HS,Nakagawa H.Altered function of lumbar nerve roots in patients withtransitional lumbosacral vertebrae
[J].Spine, 2004, 29(15):1632-1635.

[8] Otani K, Konno S, Kikuchi S. Lumbosacral transitional vertebrae and nerve-root symptoms
[J].JBone Joint Surg Br,2001,83(8):1137-1140.

[9] Oguz H, Akkus S, Tarhan S, et al. Measurement of spinal canal diameters in young subjects with lumbosacral transitional vertebra
[J].Eur Spine J, 2002,11(2):115-118.

[10]Aihara T, Takahashi K, Ogasawara A, et al. Intervertebral disc degeneration associated with lumbosacral transitional vertebrae: a clinical and anatomical study
[J].J Bone Joint Surg Br, 2005, 87(5): 687-691.

[11] 刘春生，杜心如，赵玲秀，等.腰骶移行椎类型与腰椎间盘突出、椎管狭窄及滑脱节段关系的临床研究
[J]. 中国骨肿瘤骨病杂志，2009,8(1):6-10.

[12] 杜心如.腰骶移行椎临床解剖学研究进展
[J].中国临床解剖学杂志，2007，25（5）：606-608.

[13] 杜心如，赵玲秀，张继宗，等.腰骶移行椎椎弓根螺钉进钉方法的解剖学研究
[J].中华骨科杂志，2009，29(1):17-21.

[14] 杜心如，赵玲秀，赵离钟，等.腰骶移行椎椎体及椎板的形态学特点及其临床意义
[J].中国临床解剖学杂志，2009，27(2):89-93.

[15]杜心如，叶启彬，赵玲秀，等.腰椎人字嵴顶点椎弓根螺钉进钉方法的解剖学研究
[J].中国临床解剖学杂志，2002，20(2)：86-88.

[16]郭世绂.骨科临床解剖学
[M].济南：山东科技出版社，2006：149-160.

[17]杜心如，赵玲秀，顾少光，等. 222例腰骶移行椎影像学形态特点及其临床意义
[J].解剖与临床2010，15（2）：80-83.

[18] 郝毅，郑海潮，任国良，等.腰椎峡部的解剖学研究
[J].中华骨科杂志，2000,20（9）：562-565.