腰椎手术中的移行椎问题

The Problem of Transvertebra in Lumbar Operation

目的 :探讨移位椎的定位方法和移行椎对腰椎手术的影响。方法 :回顾性分析了 5 2例腰椎疾患手术治疗的病例 ,其中腰椎间盘突出症 2 6例 ,腰椎骨折 15例 ,腰椎滑脱 9例 ,腰椎结核 2例 ,术前均经过X线摄片、CT或MRI检查。结果 :腰部疾患合并移行椎的病例并不少见 ,本组病例占同期腰椎手术病人的 5 .3%。腰椎出现移行椎 ,其定位则有L4～S1,L5～L6,L6～S1。结论 :腰部疾患合并移行椎时 ,腰椎数量发生改变 ,定位诊断非常重要。要确定手术部位 ,X线定位片 (包括术中X线透视定位 )、CT或MRI片缺一不可 ,但必须注意的是 ,腰椎CT和MRI检查结果是以骶椎为基准定位 ,也就是从下往上定位 ,普通X线片是从上往下序列 ,两者定位诊断的差异 。

Objetive:To discuss the orientation of transvertebra and its affection to lumbar operation.Methods:52 cases with lumbar suffering were retrospected.Among them 26 cases were suffered with intervertebral disc herniation,15 cases with lumbar fracture,9 cases with spondylolisthesis,and 2 cases with lumbar tuberculosis.X ray?CT or MRI examination were taken before operation.Results:It was not few in lumbar disease combined with transvertebral.The rate of this group was 5.3 % to occupy the same term of lumbar operation.The location had L 4S 1?L 5,6 ?L 6S 1 when the lumbar was occurd transvertebra.Conclusion:The location diagnosis was very inportant when lumbar disease combined with transvertebra and lumbar quantity was changed.It was necessary for X ray photo(include X ray located on operation),CT or MRI to decided operative position.It was different for X ray photo located diagnosis to CT or MRI.The different located diagnosis between X ray photo and CT or MRI must be recognized on operation.