腰椎横突间综合征解剖研究

Anatomical study on the syndrome of among the lumbar vertebral transverse process

目的 :阐明腰椎横突间综合征引起腰痛的可能机理。方法 :正常成人 2 0例中男女各 10例 ,腰椎正、侧位 X摄片 ;10副成人尸骨腰椎椎体横径和横突长度测量 ;男尸 4具 8侧 ,腰椎横突间相关结构的解剖。结果 :X线正位片显示第 3腰椎横突两侧末端间距最长 ,为 10 5 .2± 4 .5 mm,其他依次为 L5,L4 ,L2 ,L1 。 X线侧位片显示腰椎横突 1～5排列与腰椎前凸一致 ,第 3腰椎位于脊柱腰部前凸的顶端 ;尸骨第 1～ 5腰椎椎体横径依次递增 (38.6± 4 .4 mm～4 4 .8± 3.6 mm。) ;腰椎左、右侧横突长度以第 3腰椎最长 ,为 36 .9± 4 .6 mm ,36 .8± 4 .9mm。其他横突长度排列依次为L5,L4 ,L2 ,L1 ;尸体腰椎横突间区解剖见腰大肌、腰方肌和胸腰筋膜附着于腰椎 1～ 4横突末端 ,其中以第 3腰椎横突末端最为集中 ,并与脊神经后支 ,横突前动、静脉相邻。结论 :第 3腰椎横突长度最长 ,腰部外伤时可累及第 3腰椎横突处 ,与之相连处的肌肉、筋膜和神经发生损伤。

Objective:To study the mechanism of the syndrome of among the lumbar vertebral transverse process.Methods:The anteroposterior and lateral X-ray films of 20 adults(male 10,female 10) lumbar vertebraes were made.The transverse diameters of vertebral body and lengths of the lumber vertebral transverse process in 50 dry cadaveric bones were measured.The relative structures among the lumbar vertebral transverse process were observed in 4 male adult cadavers(8 sides).Results:The anteroposterior X-ray films showed that the distance between the end of L 3 right and left transvers process were the longest(105.2±4.5mm),the others are:L 5,L 4,L 2,L 1.The lateral X-ray films showed that the third lumbar vertebrae lies at the top of the lumbar protrusion of the vertebral column.The arrangement of lumbar vertebral transverse process from L 1 to L 5 were in correspondence with the lumbar protrusion of vertebrae column.In the cadaveric bones,the lengths of L 3 transverse process(left and right) were the longest(36.9±4.6mm,36.8±4.9mm).The transverse diameters of L 1～5 vertebral body increased gradually from 38.6±4.4 to 44.8±3.6mm.The psoas major muscle,the quadratus lumborum muscle and the thoracolumbar fascia attached the end of L 1～4 lumbar vertebral transverse process.These structures attached mainly to the end of third lumbar vertebral transverse process.The spinal nerves posterior branch,transverse anterior artery and vein also adjoined to the lumbar vertebral transverse process.Conclusion:The length of third lumbar vertebral transverse process is the longest.When the waist is hurt,the third transverse process will be involved.The structures attaching to third transverse process were also hurt.This may be the mechanism of the syndrome of among the lumbar vertebral transverse process giving rise to the lumbago.