222例腰骶移行椎影像学形态特点及其临床意义

目的：探讨腰骶移行椎的影像学形态特点，为腰椎间盘突出症、腰椎滑脱症的诊治提供参考。方法：对临床及影像资料完整的腰骶移行椎222例，根据横突形态特点，按Castellvi法进行分类，并对病变节段进行分析。结果：Ⅰ型79例，占35．6％，其中L4～5突出8例，L5～S1突出15例，L4峡部裂、滑脱3例；Ⅱ型51例，占23％，其中L4～5，突出20例，L3～4突出4例，L4峡部裂、滑脱12例；Ⅲ型80例，占36％，其中L4～5，突出38例，L4峡部裂12例，L3～4突出3例；Ⅳ型9例，占4．1％，其中L4～5突出4例；特殊类型3例，占1．3％，均为L4～5突出。结论：Ⅰ型移行椎L4-5，L5～S1均可能发生腰椎间盘突出症，与正常腰椎无明显区别，Ⅱ、Ⅲ、Ⅳ型只发生L4～5和L3～4节段腰椎间盘突出，而不发生L5～S1椎间盘突出，即移行椎以上的节段可发生病变。本组中没有L5部裂及滑脱病例，均为L4峡部裂和L4～5以上节段滑脱，据此提出了腰骶移行椎的特殊类型，即单纯椎间融合型。

The Radiological Characteristics of Lumbosacral Transitional Vertebrae and Its Clinical Relevance

Objective：To study the radiological characteristics of lumbosacral transitional vertebrae and provide some evidence for the diagnosis and treatment of lubar intervertebral disc protrusion （LIDP） and spondylolisthesis. Methods ：222 patients presented as lumbosacral transitional vertebrae with completely clinical and imaging data. Based on the morphological features of transverse processes, according to Castellvi＇ s classification, the affected segments were analyzed. Results：Seventy-nine cases （35%） belonged to type I and included 8 LIDP in L4_5 and 15 in L5 -Sl, 3 spondylolisthesis and isthmic effracture in L4. Type Ⅱ occurred in 51 cases （23%） which included 20 LIDP in L4-5 ,4 in L3 -4,12 spondylolisthesis and isthmic effracture in L4. There were 80 cases with type Ill, which consisted of 38 LIDP in L4-5 , 12 isthmic effracture in L4, 3 spondylolisthesis in L4-5. Type IV accounted for d. 1% （9 cases）, included 4 cases of LIDP in L4-5. We also found that 3 cases with LIDP in the L4_5 segments can not be classified into any types according to Castellvi＇ s system, so we named them as ＂the disc fusion type＂. Conclusions：The herniation can occur in L4_5, L5 - S1 as type Ⅰ transitional vertebrae, but only occur in L4-5 as types H , In, 1V transitional vertebrae, not in L5 - S1 segments, namely the segments above the transitional verte brae could happen pathological changes. In this study, there was not any cases with spondylolisthesis or isthmic effracture in L5, however, many cases had isthmic effracture in L4 and spondylolisthesis in the segments above L4-5. Based on the observation, we propose a special type of lumbosacral transitional vertebra, namely, the simple disc fusion.