腰骶移行椎的临床影像研究进展

腰骶移行椎(lumbosacral transitional vertebrae, LSTV)是一种较常见的脊柱先天性变异,依据移行方向分为腰椎骶化及骶椎腰化,前者指向尾侧移行,后者则是向颅侧移行。据报道 LSTV 在人群中的出现率约4%~30%[1]。随着医学影像技术的发展,在影像学上对 LSTV 的诊断及其相关机制进行了一定的研究分析。LSTV 涉及腰椎数目变化及 L5、S1的形态学变化,易被漏诊及造成椎体定数错误,同时也发现 LSTV是腰骶痛、椎间盘突出及腰椎滑脱的诱因。由于目前在临床上对 LSTV 的认识及重视程度不足,临床工作中 LSTV 常影响术中定位、腰骶痛及其他一些症状相近疾病的诊断和治疗[2]。本文就近年来对 LSTV 的临床与影像研究作一综述。     

椎旁定位腰骶体感诱发电位在腰椎间盘突出症中的诊断作用

目的探讨椎旁定位腰骶体感诱发电位（LSSEP）在腰椎间盘突出症中的诊断作用.方法对54例有L4、L5和S1神经根损害表现的腰椎间盘突出症患者进行胫后神经体感诱发电位（SEP）、皮节体感诱发电位（DSEP）和椎旁定位LSSEP检查,测定其P40的潜伏期.结果胫后神经SEP检测异常率为40.74%,其中多水平突出的异常率明显高于单水平突出者（P＜0.01）;L5S1 DSEP异常率为87.04%,明显高于胫后神经SEP异常率（P＜0.01）;椎旁定位LSSEP异常率为96.30%,显著高于胫后神经SEP和DSEP异常率（P＜0.01）.在L3～4椎间盘突出中,以L4 LSSEP异常为主,L4～5椎间盘突出中,以L5 LSSEP异常为主.结论椎旁定位LSSEP是诊断腰椎间盘突出症快捷、可靠、敏感的检测方法,其结果与神经根受累水平相一致,对多水平突出手术入路的定位较为准确.     

歼击机飞行员腰骶角增大与腰椎峡部裂关系探讨

目的探讨腰骶角增大与腰椎峡部裂的关系。方法研究组为18例患腰椎峡部裂的歼击机飞行员,取站立侧位X线片采用Ferguson方法测量腰骶角度;对照组为182例无峡部裂的歼击机飞行员,取站立侧位,X线片采用同样方法测量腰骶角。比较两组腰骶角的差异及研究组腰骶角与腰椎峡部裂的关系。结果研究组腰骶角平均为43.57±6.89°。对照组100例无滑脱腰骶角平均为37.51±6.340。两者比较差异有显著统计学意义P〈0.01。结论腰骶角增大是歼击机飞行员腰椎峡部裂的促进因素之一。     

腰骶蛛网膜下腔异物存留游走一例

患者男，１８岁。因左臀部手枪子弹击伤后双下肢活动受限８天，于１９９３年１１月１２日入院。查体：左臀部外下象限见０．６ｃｍ×０．６ｃｍ皮肤裂口，裂口周围红肿，左小腿三头肌肌力Ⅲ级，右小腿三头肌肌力Ⅳ级。腰骶椎正侧位片示第１骶椎椎管前侧有一上端呈圆弧形的...     

腰骶段后纵韧带的解剖学与骨化

本文用34具成尸脊柱,对其中10具进行了CT扫描,解剖观测了腰骶段的后纵韧带,其宽度呈上宽下窄趋势,L_5以下均聚集成京,最后抵止于S_2背面.其厚度如纸,坚韧,表面光滑.与椎体后面不直接比着,留有不足1mm之间隙,与间盘附着紧密,不易剥离.有3例后纵韧带骨化者,与CT影对照相符,提示应与间盘后突及椎间盘脱落物相鉴别.     

腰骶髂间隙与下肢运动性肌损伤

几年来,我们在运动创伤的医疗实践中,注意到腰骶髂间隙在下肢运动性肌损伤中的重要意义。所谓腰骶髂间隙,是指第5腰椎横突以下,腰骶关节平面以上,内起第5腰椎椎体外缘,外至髂骨及嵴的骨性间隙。通过对36例下肢运动性肌损伤患者分别施以局部常规处理,和以腰骶髂间隙处理为主,辅以局部处理的方法进行对比治疗观察,结果前者治疗优良率为55.6%,疗程3周至2年,后者全为优良,疗程2—4周。而且对8例经局部常规处理久治不愈者,改用以腰骶髂间隙处理为主的综合治疗后,经2—4周皆获优     

介绍一种腰骶角过大者腰骶椎间盘突出的CT扫描测算法

随着CT机的普及应用,腰骶椎间盘扫描已成为诊断椎间盘突出及椎管狭窄必不可少的重要检查方法。但准确测量间盘突出值及椎管狭窄程度的前提是扫描层面须与间盘平行并垂直于椎管长轴,而临床常遇到部分患者腰骶角较大(超过框架最大倾斜角度),使扫描层面不能做到与L5/S1间盘平行,导     

改善腰骶关节照片质量的方法

要获得一张满意的腰骶关节侧位片甚难,因为每个病人腰骶关节平面都有其独特的角度,所以摄片时必须予以矫正。常用的投照技术是投照者必须确定病人的脊椎是否平行于台面。其方法是触摸病人每个腰椎的棘突并在其间画一假想线,如果该线平行于台面,则脊椎是平直的。反之,投照者必须用可透过射线的物体垫平脊椎;或者倾斜中心线以矫正腰骶关节间隙的角度。多数病人需要矫正。因为在一般情况下肩部和髋部的宽度是不等的,致使脊椎向下弯曲有些病人不需调整中心线,有些则需向尾侧倾斜3～25°,还有的需向头侧倾斜25°左右。摄好每一张腰骶关节侧位片的关键在于确定腰骶关节的角度。如有需要,曝光前调整球管的方向和角度则是必须的。作者提出下面简单易行的方法:     

Lumbosacral transitional vertebra in a population-based study of 5860 individuals: Prevalence and relationship to low back pain

Purpose

To investigate the prevalence of lumbosacral transitional vertebra (LSTV) within the Chinese Han population, and to determine whether LSTV correlates with low back pain (LBP) and gluteal pain.

Materials and methods

Typical standing pelvic radiographs were obtained for 5860 volunteers between 18 to 60 years of age. The lumbosacral region of each spine was evaluated to identify LSTV, which was classified into types I, II, III, and IV based on Castellvi's method. Histories of low back symptoms were obtained using a questionnaire. The association of different subtypes of LSTV with LBP and gluteal pain was explored.

Results

LSTV was found in 15.8% (928 of 5860) of our study population. Of the 928 individuals with LSTV, 44.8% were type I (dysplastic transverse process with height >19 mm), 43.2% were type II (pseudoarticulation), 7.2% were type III (fusion), and 4.8% were type IV (a unilateral type II transition with a type III fusion on the contralateral side). Type II LSTV were closely associated with LBP and gluteal pain, with respective odds ratios (ORs) of 2.56 (95% CI: 2.17–3.89) and 5.38 (95% CI: 4.29–8.43). Similarly, types IV LSTV also demonstrated a significant correlation with LBP and gluteal pain, with respective ORs of 4.28 (95% CI: 3.21–6.35) and 6.82 (95% CI: 5.17–16.59).

Conclusions

In this population-based study, the prevalence of LSTV was 15.8%, with type I being the most common. Importantly, LSTV types II and IV were significantly associated with LBP and gluteal pain.     

Management of the athlete with low back pain

The evaluation of an athlete with LBP using the classification system proposed by Delitto et al has been outlined. For outpatient orthopaedic practice, evidence in the literature is available documenting the reliability and the effectiveness of treatment guided by TBC. This classification system provides framework for the clinician to evaluate athletes with LBP because it investigates the presence of serious pathology, considers the severity of the disease process, and provides matched treatment based on the athlete's clinical presentation. When treating athletes with episodes of acute LBP, pain modulation and return to daily function are the primary treatment goals. When treating athletes with episodes of chronic LBP, return to sport and prevention of recurrence are the primary treatment goals.     

Rehabilitation of the athlete with low back pain

The rehabilitation of athletes with low back pain should be considered an essential component of their care. Comprehensive rehabilitation begins at the time of acute injury and encompasses the period of acute care through sport-specific training and return to competition. Rehabilitation of athletes with spinal pain should include a thorough psychosocial evaluation to identify potential barriers to clinical improvement. For athletes with low back pain, establishing effective core stability is central to optimizing the functional performance of the athlete.     

Recurrent postdiskectomy low back pain: MR-surgical correlation

The preoperative MR findings in 11 patients, all of whom had developed recurrent low back pain after surgery for herniated lumbar intervertebral disk, were correlated with the surgical findings to determine possible criteria for distinguishing recurrent disk herniation from postoperative scar (extradural fibrosis). The preoperative MR findings agreed with the surgical findings in seven of eight patients with recurrent disk herniation and in six of nine individuals with extradural fibrosis. The most important parameters in differentiating recurrent herniated disk from extradural scar were the configuration and margination of the extradural mass rather than its signal characteristics. The most reliable MR sign for recurrent herniated disk was the presence of a sharply marginated focal polypoid disk protrusion beyond the posterior margins of the adjacent vertebral bodies shown to best advantage on sagittal T1- and T2-weighted and axial T1-weighted spin-echo MR images. Disk herniations usually maintained isointensity with the intervertebral disk of origin, while extradural fibrosis exhibited variable signal intensity. The preoperative diagnosis of extradural fibrosis on MR was based primarily on its irregular configuration and extension. This study suggests that preoperative differentiation between scar and recurrent herniated disk is possible with MR when morphology and topography are considered in addition to signal intensity.     

Physcial exercise and low back pain

Health care providers often prescribe exercises as treatment for nonspecific low back pain. However, the effectiveness of this treatment is poorly documented in the literature. While the evidence suggests that exercise in general is beneficial, there is a lack of knowledge about the types, frequency and duration of exercises that should be prescribed and at what stage of injury they are most helpful. In addition, few studies have dealt with exercise treatment alone rather than in combination with other treatments, making it hard to decipher the unique contribution of exercise. Inadequate study designs also make conclusions difficult. Conversely, the literature clearly shows that inactivity has detrimental effects (i.e. delayed return to normal activity, and negative physiological and psychological effects) for low back pain patients.     

Multi-segment spine kinematics: Relationship with dance training and low back pain

BackgroundSpine posture, range of motion (ROM) and movement asymmetry can contribute to low back pain (LBP). These variables may have greater impact in populations required to perform repetitive spine movements, such as dancers; however, there is limited evidence to support this.Research questionWhat is the influence of dance and LBP on spinal kinematics?MethodsIn this cross-sectional study, multi-segment spinal kinematics were examined in 60 female participants, including dancers (n = 21) and non-dancers (n = 39) with LBP (n = 33) and without LBP (n = 27). A nine-camera motion analysis system sampling at 100 Hz was used to assess standing posture, as well as ROM and movement asymmetry for side bend and trunk rotation tasks. A two-way ANOVA was performed for each of the outcome variables to detect any differences between dancers and non-dancers, or individuals with and without LBP.ResultsCompared to non-dancers, dancers displayed a flatter upper lumbar angle when standing (p < 0.01, ηp² = 0.15), and achieved greater frontal plane ROM for the upper lumbar (p = 0.04, ηp² = 0.08) and lower thoracic (p = 0.02, ηp² = 0.09) segments. There were no differences between dancers and non-dancers for transverse plane ROM (p > 0.05) or movement asymmetry (p > 0.05). There was no main effect for LBP symptoms on any kinematic measures, and no interaction effect for dance group and LBP on spinal kinematics (p > 0.05).SignificanceFemale dancers displayed a flatter spine posture and increased spine ROM compared to non-dancers for a select number of spine segments and movement tasks. However, the overall number of differences was small, and no relationship was observed between LBP and spinal kinematics. This suggests that these simple, static posture, ROM, and asymmetry measures often used in clinical practice can provide only limited generalisable information about the impact of dance or LBP on spinal kinematics.