CAJ | 학술논문

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。揹景：目前，腰骶部移行椎與腰椎間盤突齣癥的關繫尚存爭議。 　　目的：探討腰骶部移行椎與腰椎間盤突齣癥的關繫和腰骶部移行椎對腰椎間盤再突齣的影響。 　　方法：本研究共分為三組：腰椎間盤突齣癥組193例，選取2008年6月至2010年8月初次行手術治療的腰椎間盤突齣癥患者，包括有腰骶部移行椎患者111例和無腰骶部移行椎患者82例；對照組220例，選取同期健康查體的無癥狀人群；腰椎間盤再突齣組33例，選取2004年4月至2010年8月手術治療的腰椎間盤再突齣患者，包括有腰骶部移行椎患者18例和無腰骶部移行椎患者15例。分彆對三組行影像學檢查，統計腰骶部移行椎的髮生率和類型，觀察椎間盤突齣部位與腰骶部移行椎的關繫。 　　結果：腰椎間盤突齣癥組、對照組和腰椎間盤再突齣組的腰骶部移行椎的髮生率分彆為：57.51%、51.82%和54.55%，相比較無統計學差異（χ2=1.34, P＞0.05）。其中CastellviⅠ型的髮生率分彆為38.86%、45.00%和36.36%，相比較無統計學差異（χ2=2.01, P＞0.05）；Ⅱ型的髮生率分彆為：12.95%、4.55%和15.15%，腰椎間盤突齣癥組與對照組比較有統計學差異（χ2=9.35, P＜0.01），而腰椎間盤突齣癥組與腰椎間盤再突齣組比較無統計學差異（χ2=0.12, P＞0.05）；Ⅲ型的髮生率分彆為5.18%，2.27%和0，相比較無統計學差異（χ2=3.92, P>0.05）；Ⅳ型的髮生率為0.52%、0和3.03%，相比較無統計學差異（χ2=5.94, P＞0.05）。腰椎間盤突齣癥組中腰骶部移行椎患者L4~5節段突齣71.17%、L5~S1節段突齣26.13%，分彆與無腰骶部移行椎患者L4~5節段突齣48.78%、L5~S1節段突齣47.56%，比較均有統計學差異（χ2=10.00, P＜0.01；χ2=9.49, P＜0.01）。腰椎間盤突齣癥組中Ⅰb和Ⅱa型腰骶部移行椎患者的腰椎間盤突齣節段以L4~5多見，分彆為30.63%和12.61%，與L5~S1節段髮生率為11.71%和1.80%相比較均有統計學差異（χ2=11.90, P＜0.01；χ2=15.20, P＜0.01）。 　　結論：CastellviⅠ型不誘髮腰椎間盤突齣；Ⅱ型由于腰骶部生物力學結構異常可誘髮L4~5節段腰椎間盤突齣，同時保持L5~S1節段的相對穩定性；Ⅲ型和Ⅳ型因具有腰骶部骨性融閤而不誘髮腰椎間盤突齣，易造成腰椎節段序數判斷錯誤，應引起註意。腰骶部移行椎併不是腰椎間盤再突齣的誘髮因素。
배경：목전，요저부이행추여요추간반돌출증적관계상존쟁의。 　　목적：탐토요저부이행추여요추간반돌출증적관계화요저부이행추대요추간반재돌출적영향。 　　방법：본연구공분위삼조：요추간반돌출증조193례，선취2008년6월지2010년8월초차행수술치료적요추간반돌출증환자，포괄유요저부이행추환자111례화무요저부이행추환자82례；대조조220례，선취동기건강사체적무증상인군；요추간반재돌출조33례，선취2004년4월지2010년8월수술치료적요추간반재돌출환자，포괄유요저부이행추환자18례화무요저부이행추환자15례。분별대삼조행영상학검사，통계요저부이행추적발생솔화류형，관찰추간반돌출부위여요저부이행추적관계。 　　결과：요추간반돌출증조、대조조화요추간반재돌출조적요저부이행추적발생솔분별위：57.51%、51.82%화54.55%，상비교무통계학차이（χ2=1.34, P＞0.05）。기중CastellviⅠ형적발생솔분별위38.86%、45.00%화36.36%，상비교무통계학차이（χ2=2.01, P＞0.05）；Ⅱ형적발생솔분별위：12.95%、4.55%화15.15%，요추간반돌출증조여대조조비교유통계학차이（χ2=9.35, P＜0.01），이요추간반돌출증조여요추간반재돌출조비교무통계학차이（χ2=0.12, P＞0.05）；Ⅲ형적발생솔분별위5.18%，2.27%화0，상비교무통계학차이（χ2=3.92, P>0.05）；Ⅳ형적발생솔위0.52%、0화3.03%，상비교무통계학차이（χ2=5.94, P＞0.05）。요추간반돌출증조중요저부이행추환자L4~5절단돌출71.17%、L5~S1절단돌출26.13%，분별여무요저부이행추환자L4~5절단돌출48.78%、L5~S1절단돌출47.56%，비교균유통계학차이（χ2=10.00, P＜0.01；χ2=9.49, P＜0.01）。요추간반돌출증조중Ⅰb화Ⅱa형요저부이행추환자적요추간반돌출절단이L4~5다견，분별위30.63%화12.61%，여L5~S1절단발생솔위11.71%화1.80%상비교균유통계학차이（χ2=11.90, P＜0.01；χ2=15.20, P＜0.01）。 　　결론：CastellviⅠ형불유발요추간반돌출；Ⅱ형유우요저부생물역학결구이상가유발L4~5절단요추간반돌출，동시보지L5~S1절단적상대은정성；Ⅲ형화Ⅳ형인구유요저부골성융합이불유발요추간반돌출，역조성요추절단서수판단착오，응인기주의。요저부이행추병불시요추간반재돌출적유발인소。
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 groupⅠ, including 111 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 groupⅡ. There were 33 patients with revision surgery for lumbar disc herniation from April 2004 to August 2010 in groupⅢ, 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 groupⅠ,Ⅱand Ⅲ, and there was no significant difference between groups (χ2=1.34, P>0.05). The incidence of CastellviⅠ was 38.86%, 45.00% and 36.36%, respectively in group Ⅰ, Ⅱ and Ⅲ(χ2=2.01, P>0.05). The incidence of CastellviⅡ was 12.95%, 4.55%and 15.15%, there was significant difference between groupⅠand groupⅡ(χ2=9.35, P<0.01), while no sta-tistical difference was found between groupⅠand groupⅢ(χ2=0.12, P>0.05). The incidence of CastellviⅢwas 5.18%, 2.27%and 0 in groupⅠ,ⅡandⅢ(χ2=3.92, P>0.05). The incidence of CastellviⅣwas 0.52%, 0 and 3.03%in groupⅠ,ⅡandⅢ(χ2=5.94, P>0.05). In groupⅠ, 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 (χ2=10.00, P<0.01;χ2=9.49, P<0.01). In groupⅠ, the incidence of lumbar disc herniation at L4/5 segments was 30.63%and 12.61% in the CastellviⅠb and Ⅱa patients, which were significantly higher than that at L5/S1 segments (11.71% and 1.80%,χ2=11.90, P<0.01;χ2=15.20, P<0.01). Conclusions:CastellviⅠcan not induce lumbar disc herniation. CastellviⅡcan induce lumbar disc herniation at L4~5 seg-ments, and maintain the relative stability of L5~S1 segments. CastellviⅢandⅣcan not induce lumbar disc herniation, but lumbar sequences will be confused because of osseous fusion. The lumbosacral transtional vertebra is not the inducing fac-tor of lumbar dics re-herniation.