腰骶部移行椎与腰椎间盘突出症的关系

Relationship between lumbosacral transitional vertebra and lumbar disc herniation

背景：目前,腰骶部移行椎与腰椎间盘突出症的关系尚存争议。目的：探讨腰骶部移行椎与腰椎间盘突出症的关系和腰骶部移行椎对腰椎间盘再突出的影响。方法：本研究共分为三组：腰椎间盘突出症组193例,选取2008年6月至2010年8月初次行手术治疗的腰椎间盘突出症患者,包括有腰骶部移行椎患者111例和无腰骶部移行椎患者82例;对照组220例,选取同期健康查体的无症状人群;腰椎间盘再突出组33例,选取2004年4月至2010年8月手术治疗的腰椎间盘再突出患者,包括有腰骶部移行椎患者18例和无腰骶部移行椎患者15例。分别对三组行影像学检查,统计腰骶部移行椎的发生率和类型,观察椎间盘突出部位与腰骶部移行椎的关系。结果：腰椎间盘突出症组、对照组和腰椎间盘再突出组的腰骶部移行椎的发生率分别为：57.51%、51.82%和54.55%,相比较无统计学差异（χ2=1.34,P〉0.05）。其中CastellviⅠ型的发生率分别为38.86%、45.00%和36.36%,相比较无统计学差异（χ2=2.01,P〉0.05）;Ⅱ型的发生率分别为：12.95%、4.55%和15.15%,腰椎间盘突出症组与对照组比较有统计学差异（χ2=9.35,P〈0.01）,而腰椎间盘突出症组与腰椎间盘再突出组比较无统计学差异（χ2=0.12,P〉0.05）;Ⅲ型的发生率分别为5.18%,2.27%和0,相比较无统计学差异（χ2=3.92,P〉0.05）;Ⅳ型的发生率为0.52%、0和3.03%,相比较无统计学差异（χ2=5.94,P〉0.05）。腰椎间盘突出症组中腰骶部移行椎患者L4~5节段突出71.17%、L5~S1节段突出26.13%,分别与无腰骶部移行椎患者L4~5节段突出48.78%、L5~S1节段突出47.56%,比较均有统计学差异（χ2=10.00,P〈0.01;χ2=9.49,P〈0.01）。腰椎间盘突出症组中Ⅰb和Ⅱa型腰骶部移行椎患者的腰椎间盘突出节段以L4~5多见,分别为30.63%和12.61%,与L5~S1节段发生率为11.71%和1.80%相比较均有统计学差异（χ2=11.90,P〈0.01;χ2=15.20,P〈0.01）。结论：CastellviⅠ型不诱发腰椎间盘突出;Ⅱ型由于腰骶部生物力学结构异常可诱发L4~5节段腰椎间盘突出,同时保持L5~S1节段的相对稳定性;Ⅲ型和Ⅳ型因具有腰骶部骨性融合而不诱发腰椎间盘突出,易造成腰椎节段序数判断错误,应引起注意。腰骶部移行椎并不是腰椎间盘再突出的诱发因素。

Background： At present, the relationship between lumbosacral transtional vertebra and lumbar intervertebral disc herniation has been unclear. Objective： To investigate the relationship between lumbosacral transtional vertebra and lumbar intervertebral disc hernia- tion, and the influence of transitional vertebra on lumbar disc re-herniation. Methods： The present study included three groups. There were 193 patients in group Ⅰ, including Ⅲ with lumbosacral trans- tional vertebrae and 82 without lumbosacral transitional vertebrae, who underwent primary surgical treatment for lumbar disc herniation from June 2008 to August 2010. There were 220 healthy controls who took physical examination in our hospi- tal in group Ⅱ. There were 33 patients with revision surgery for lumbar disc herniation from April 2004 to August 2010 in group Ⅲ, including 18 cases with lumbosacral transtional vertebrae and 15 without lumbosacral transitional vertebrae. The in- cidence and the type of lumbosacral transitional vertebrae by imaging examination were recorded in the three groups. The re- lationship between the position of lumbar disc herniation and lumbosacral transtional vertebrae was investigated. Results： The incidence of lumbosacral transitional vertebrae was respectively 57.51%, 51.82% and 54.55 % in group Ⅰ, Ⅱ and Ⅲ, and there was no significant difference between groups （X2=1.34, P〉0.05）. The incidence of CastellviⅠ was 38.86%, 45.00% and 36.36%, respectively in group Ⅰ , Ⅱ and Ⅲ （X2=2.01, P〉0.05）. The incidence of Castellvi Ⅱ was 12.95%, 4.55% and 15.15%, there was significant difference between group Ⅰ and group Ⅱ （X2=9.35, P〈 0.01）, while no sta- tistical difference was found between group Ⅰ and group Ⅲ （X2=0.12, P〉0.05）. The incidence of Castellvi Ill was 5.18%, 2.27% and 0 in group Ⅰ, Ⅱ and Ⅲ （X2=3.92, P〉0.05）. The incidence of Castellvi IV was 0.52%, 0 and 3.03% in group Ⅰ, Ⅱ and Ⅲ （X2=5.94, P〉0.05）. In group Ⅰ , the incidence of lumbar intervertebral disc herniation was 71.17% at L4-5 seg- ments and 26.13% at L5-S1 segments in patients with lumbosacral transitional vertebrae, which was significantly different from that in patients without lumbosacral transitional vertebrae （48.78% at L4-5 segments, 47.56% at L5-S1 segments （X2= 10.00, P〈0.01; X2=9.49, P〈0.01）. In group Ⅰ, the incidence of lumbar disc herniation at L4/5 segments was 30.63% and 12.61% in the Castellvi I b and Ⅱ a patients, which were significantly higher than that at L5/S1 segments （11.71% and 1.80%, X2=11.90, P〈0.01; X2=15.20, P〈0.01）.