Ⅰ型腰骶移行椎与正常第5腰椎的形态学比较及其临床意义

目的　探讨Ⅰ型腰骶移行椎与正常第5腰椎椎体的形态学差异，为临床应用提供形态学依据。 方法　选取Ⅰ型腰骶移行椎和正常第5腰椎标本各60例，观测：椎体上下终板前后径、横径；椎体前缘高度、后缘高度及其前/后高比值；椎弓根纵、横径。统计学分析并进行t检验。 结果　I型移行椎与正常第5腰椎相比，椎体上、下终板前后径及横径差异均有显著意义（P<0.01）；椎体的上、下前后径大1~2 mm，上、下横径大2~3 mm，前高大0.7~1.2 mm，后高大0.8~1 mm，统计均有显著意义；椎体的前/后高度比值及椎弓根纵横径I型移行椎与正常第5腰椎之间差异均无显著意义。 结论　I型腰骶移行椎椎体各径线较正常第5腰椎椎体稍大, 但形态相近； I型移行椎椎体与正常第5腰椎椎体无明显区别，I型腰骶移行椎椎弓根螺钉进钉可按正常第5腰椎方法进行。

The anatomical observation on the morphological difference between the type I lumbosacral transitional vertebra with the normal fifth lumbar and its clinical significance

Objective　To investigate the morphological differences between the body of the type I lumbosacral transitional vertebrae(type I LSTV) with that of the fifth lumbar vertebrae for the clinical diagnoses of the type I LSTV.　Methods　60 cases of the type I LSTV and 60 specimen of the fifth lumbar vertebrae were obtained, all of which had relative intact structure in birth. All specimen were measured by the uniform criterion for the following items: (1) the anteroposterior diameter and the transverse diameter of the vertebrae(both sides); (2) the anterior-vertical diameter, the posterior-vertical diameter and the anterio-posterior vertical diameter ratio of the vertebrae. The pedicle diameters of the type I LSTV All data were analyzed with the SPSS13.0 by the independent sample t-test. Results Compared with the fifth lumbar vertebrae, the superior antero-posterior diameters of the type I LSTV are 1~2 mm longer in average than the normal L5; its inferior antero-posterior diameters, longer 1mm; its superior transverse diameters, 2～3 mm longer; its inferior transverse diameters, 2~3 mm longer; its anterior-vertical diameters, 0.7~1.2 mm higher; its posterior- vertical diameters, 0.8~1 mm higher. There is significant difference between the type I LSTV and the normal L5（P<0.01）; There are no significant differences between each group of the those in the anterio-posterior vertical diameter ratio of the vertebrae. Conclusion Most diameters of the type I LSTV is larger than the normal L5 but they have the similar shapes, it is difficult to identify them only on the lumbar lateral X-ray, CT and MRI film because of those similar morphologic characters . The pedicle screw of the lumbosacral transitional vertebrae type I is the same as that of the normal fifth lumbar vertebrae in clinical practice.