腰骶移行椎患者腰骶神经根支配区域变化的临床研究

Distribution variation of lumbar nerve roots in patients with transitional lumbosacral vertebrae

目的探讨腰骶移行椎(LSTV)患者腰骶神经根支配区域的变化规律。方法 2008年5月至2010年3月经脊柱全长片证实为LSTV,CT和/或MRI明确存在间盘突出的腰腿痛患者。查体明确其受压腰骶神经根支配区域的变化规律。不含C-I型腰椎骶化(SZ)和C-ⅢB型骶椎腰化(LZ)。结果 12例SZ和12例LZ纳入研究。12例SZ中,5例C-ⅢB、3例非矩形化型及1例ⅢA型的受压神经呈非LSTV者同节段和/或下一节段神经受压表现,3例C-IIB受压神经呈非LSTV者同神经受压表现。12例LZ中,10例完全型受压神经呈非LSTV者同节段和/或上一节段神经根受压表现,1例完全型S1～2神经受压呈非LSTV者L4～S2神经受压表现,1例C-IV型受压神经呈现正常个体同神经受压。结论 SZ时,腰神经根呈现正常个体同和/或低一节段神经根功能;LZ时,腰骶神经根易表现出正常个体同和/或高一节段神经根功能。

Objective To detect the distribution variation patterns of lumbar nerve roots in patients with lumbosacral transitional vertebrae（LSTV）. Methods From May 2008 to March 2010,lumbosacral disc herniation was confirmed by CT and/or MRI scanning on LSTV patients verified by conventional whole spinal radiographs.For those SZ cases,physical examination was performed to detect distribution variation of lumbosacral nerves,including false LSTV cases of C-I sacralization（SZ） or C-IIIB lumbarization（LZ）. Results 12 SZ and 12 LZ cases were enrolled in the study.Among SZ cases,5 C-IIIB,3 non-squaring well-configured and 1 IIIA cases existed the disturbances caused by lumbar nerve compression（s） resembled those by the same and /or one level distal nerve（s） in non-LSTV ones.The disturbances caused by lumbar nerve compressions in 3 C-IIB ones resembled that in non-LSTV ones.Among 12 LZ ones,the distributions caused by lumbosacral nerve compression（s） in 10 total-lumbarization ones resembled that by the same and/or the lower proximal nerve（s） in non-LSTV ones,and the disturbances caused by S1~2 nerve root in one total-lumbarization resembled that by L4~S1 nerve root compression in non-LSTV one.The disturbance caused by lumbar nerve compressions in one case of C-IV LZ resembled that in non-LSTV one.Conclusions In patients with sacralization,lumbosacral nerve roots tend to act as the usual function of nerves at the same level and/or lower level in non-LSTV ones,especially in those with decreased mobile segment ones.In patients with lumbarization,the lumbosacral nerve roots tend to act as the usual function of nerves at the same level and/or upper level in non-LSTV ones,especially with increased mobile ones.