髂腰韧带的横断位CT表现及其在腰骶部椎体节段定位中的价值

目的：初步研究髂腰韧带的横断位CT表现，重点探讨髂腰韧带在腰骶段移行椎中的定位作用。方法：选2008年5月至2010年3月因腰背部症状拟诊椎间盘病变来院行CT扫描的706例患者，其中男436例，女270例；年龄25～82岁，平均44岁。所有患者均进行单层螺旋CT横断位扫描，其中移行椎患者78例，均经X线摄片或透视证实。在横断面CT图像上观察髂腰韧带的形态、位置及走行，了解其位置是否相对恒定；研究髂腰韧带与腰椎节段的关系，并与另外4种常用的腰骶椎节段CT定位方法作对照。结果：628例具有正常腰骶节段的患者其髂腰韧带的主要部分均起自L₅横突，止于髂嵴，3例可见髂腰韧带细小分支从L_4,5椎间盘后外缘同时发出，其形态可分双束型占71.8%(451/628)及单束型占28.2%(177/628);78例移行椎患者的髂腰韧带亦起源于L₅横突；以髂腰韧带作为L₅椎体水平的定位标记，均得到准确定位，其准确率明显高于其他定位方法，与髂嵴定位法比较差异具有统计学意义(P<0.05).结论：髂腰韧带主体起源于L₅横突，其解剖位置相对恒定，可将其作为L₅的解剖定位标志，以判断腰骶部移行椎类型和进行椎间盘定位。

CT axial imaging of the iliolumbar ligament and its significance on locating lumbosacral vertebral segments

Objective: To study the CT axial manifestations of iliolumbar ligament(ILL) and discusses its clinical effects on locating lumbosacral vertebral segments. Methods: From May 2008 to March 2010,706 adult patients diagnosed lumbar disc disease were performed with axial scans by single slice helical CT. Among the patients,436 patients were male and 270 patients were female,ranging in age from 25 to 82 years,the median age was 44 years,78 cases with lumbosacral transitional vertebrae(LSTV)were verified by X-radiography or fluoroscopy. The morphology,origin and insertion,courses of ILL and the relationship of ligament and spinal segments on axial plane images were used to study. The location method of spinal segments by ILL was compared with the other four location methods on CT. Results: Of the 628 cases with normal lumbosacral segmentations sides of ligament,the main part of ILL originated from L₅ transverse processes and terminated at the iliac crest,the morphological characters were divided into two types:double band(71.8%,451/628) and single band(28.2%,177/628). The tiny branches from posterior and outside edge of L₄,lumbar disc were seen simultaneity in 3 cases. The ILL of 78 cases with LSTV all also originated from L₅ transverse processes. Using ILL as a marker of the L₅ vertebral level,78 cases with LSTV were correctly numbered,the accuracy rate was higher than the other location methods,there was statistical significance between the location method by ILL and the location method by iliac crest(P<0.05). Conclusion: The main part of ILL originates from L₅ transverse processes,the anatomic location is relatively steady and can be clearly displayed on axial CT,which can be used as a measure in the idenlification of LSTV in clinical practice,it is worthy to be applied widely in basic-level hospitals.