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

目的探讨不同类型的腰骶移行椎与腰椎间盘突出症、腰椎管狭窄症及滑脱节段的关系，为临床诊治提供参考。方法2004～2008年临床资料、影像资料完整腰骶移行椎91例，男46例，女45例；年龄男48．3±12．5（28～85）岁，女48．4±10．6（21～68）岁。按Castellvi分类进行分析。结果91例共发现病变217处。腰椎间盘突出症共51例占56％，其中L3／4，2例占2．2％，均为Ⅱ型移行椎；L4／5，41例占46．2％（Ⅰ型4例，Ⅱ型9例，Ⅲ型25例，Ⅳ型3例）；L5／S1，8例占8．8％，均为Ⅰ型移行椎。腰椎管狭窄症31例占34．1％，其中L3／4，9例占9．8％（Ⅱ型5例，Ⅲ型3例，Ⅳ型1例）；L4／5，11例占12．1％（Ⅰ型1例，Ⅱ型3例，Ⅲ型5例，Ⅳ型2例）；L5／S1，9例占9．8％（Ⅰ型3例，Ⅱ型6例）。腰椎滑脱节段：L4滑脱25例占27．5％（Ⅰ型4例，Ⅱ型9例，Ⅲ型10例，Ⅳ型2例）；L3滑脱3例占3．3％（Ⅱ型1例，Ⅲ型2例）；L2滑脱4例占4．4％（Ⅱ型2例，Ⅲ型2例）；L1滑脱1例；各型均无L5滑脱病例。结论Ⅰ型移行椎L4／5、L5／S1节段均可发生腰椎间盘突出症，Ⅱ型、Ⅲ型、Ⅳ型则只发生在L4／5节段和L3／4节段，L5／S1节段没有突出。Ⅰ型和Ⅱ移行椎以L5／S1节段狭窄及退变多见，L4／5次之；而Ⅲ型和Ⅳ型移行椎时腰椎管狭窄症于L4／5节段最多，L3／4次之，L5／S1节段没有狭窄，所有移行椎病例没有L5滑脱及峡部裂发生，L4滑脱最多，以Ⅱ型、Ⅲ型占主要，其次为L2、L3滑脱。

The classification of lumbosacral transitional vertebrae and their relationship with the lumbar disc herniation, lumbar spinal stenosis and the spondylolisthesis

Objective To investigate the relationship between the lumbosacral transitional vertebrae and the lumbar disc herniation lumbar spinal stenosis and the spondylolisthesis. Methods Ninty-one patients （male 46, female 45） presented abnormalities of the transverse process to satisfy the critica for lumbosacral transitional vertebrae according to Castellvi＇s classification. The average age was 48.3±12.5（28-85） in male, and 48.4±10.6（21-68） in female. All patients had low back pain and sciatica. X-film, CT and MRI were reviewed. Results There were 51 （56%） cases with the herniated lumbar disc, including 2 cases （2.2%） involving L3/4 （both in typeⅡ）, 41cases（46.2%）involving L4/5（4 cases in type; 9 cases in typeⅡ, 25 cases in type Ⅲ; 3 cases in type Ⅳ）, and 8 cases（8.8%） involving L5/S1 （all in type Ⅰ）. There were 31 patients（34.1%） with spinal canal stenosis, including 9 cases（9.8%） involving L3/4 （5 cases in typeⅡ, 3 cases in type Ⅲ, 1 case in type, 11cases （12.1%） involving L4/5（1 case in type Ⅰ, 3 cases in typeⅡ, 5 cases in type Ⅲ, 2 cases in type Ⅳ）; and 9 cases（9.8%） involving L5/S1（3 cases in type Ⅰ, 6 cases in typeⅡ）. Thirty-three patients（36.3%） had spondylolisthesis, including 25cases（27.5%） involving L4 （4 cases in type Ⅰ, 9 cases in typeⅡ, 10 cases in typeⅢ, 2 cases in type Ⅳ）, 3cases（3.3%） involving L3 （1 case in typeⅡ, 2 cases in type Ⅲ）; 4 cases（4.4%） involving L2 （2 cases in type Ⅱ, 2 cases in type Ⅲ）; and lcase involving L1. There was no case of the spondylolisthesisat involving L5. Conclusions As for type Ⅰ, herniation can occur in L4/5, L5/S 1. As for type Ⅱ, type Ⅲ and type Ⅳ, herniation only occur in L4/5 and L3/4. As for type Ⅰ and type Ⅱ, stenosis and degeneration are the most common in L5/S1, and less common in L4/5. As for type Ⅲ and type Ⅲ, stenosis is the most common in L4/5, less common in L3/4 and no occurrence in L5/S 1. There was no case of the spondylolisthesis in L5 in all types, but most common in L4, less common in L2 and L3.