腰椎平片漏诊的腰椎骶化及骶椎腰化

目的：探讨脊柱全长片对腰椎平片漏诊的腰骶移行椎的诊断作用.方法：184例（男99例,女85例）腰腿疼患者接受脊柱全长影像检查.利用脊柱全长影像资料,明确是否存在Castellvi分型之外的腰椎骶化或骶椎腰化.结果：9例（4.9%）非矩形化完全型腰椎骶化依据腰椎平片无法辨出,其中6例L5与S1椎板融合,3例L5～S1椎板间结构残留.12例（6.5 %）S1完全腰化为L5样外观,出现S1～2间盘及椎板间结构,横突宽度小于19 mm,腰椎平片会漏诊.结论：临床上存在两种单纯腰椎平片可能漏诊的腰骶移行椎,一种是非矩形化完全型腰椎骶化,（可进一步分为L5～S1椎板残留与椎板融合两种亚型）,一种是双侧横突均小于19 mm的彻底型骶椎腰化,只能通过脊柱全长片发现.

The Missed Diagnosis of Lumbarization and Lumbar Sacralization by Lumbar Plain Radiographs

Objective：To explore the diagnostic value of whole spinal radiographs on lumbosacral tran- sitional vertebrae missed by pure lumbar radiographs. Methods：IS4 cases （99 males and 85 females） who accepted whole spinal conventional radiographic checkup for lower back pain and/or radiculopathy were enrolled in the study to verify whether there existed some new types of lumbarization or sacralization which were not included in Clastellvi Classification Types. Results：Nine cases （4.9%） with non-squaring complete sacralization missed by conventional lumbar radiographs were ascertained by whole spinal radiographs. The L5 and S1 lamina were fused together in six cases. While the structure between L5 and Sl was remained in other three cases. Twelve cases （6.5%） whose S1 vertebra exhibited normal lumbar vertebral configuration with well-developed S1-2 intervertebral disc and clear interlaminar structures were missed as normal lumbar sequence by conventional lumbar radiographs as the width of their transverse processes of the lumborized S1 less than 19 mm. Conclusions ： There are two kinds of lumbosacral transitional vertebrae which could only be detected by whole spinal radiographs meanwhile be missed by conventional lumbar radiographs. One is non-squaring complete sacralization （which can be further divided into two subtypes： one with intact L5 and S1 lamina, another one with fused L5 and S1 lamina）. Another one is well-developed lumbarization with the width of bilateral transverse processes less than 19 mm.