Bertolotti综合征的诊断与治疗研究进展
Research progress in the diagnosis and treatment of Bertolotti syndrome
林奕成 1陈哲 2张爱琪 1陈家豪1
作者信息
- 1. 浙江中医药大学第二临床医学院,杭州 310053
- 2. 浙江中医药大学附属第二医院骨科,杭州 310005
- 折叠
摘要
腰骶移行椎(lumbosacral transitional vertebra,LSTV)为单侧或双侧横突异常肥大而导致的腰椎变异.当肥大横突改变了 LSTV的局部生物力学时,可能会产生一系列临床症状,称为Bertolotti综合征,主要表现为腰骶部、臀部、下肢后外侧疼痛、麻木以及坐骨神经症状.LSTV常采用Castellvi分型.而LSTV存在腰椎骶化和骶椎腰化的情况可能会导致难以准确定位和编号.于是多种解剖学标志及脊柱参数被提出并应用于辅助LSTV定位及编号,但均存在一定的错误率.即使在明确编号腰椎后,手术前脊柱参数的基线选择也常存在争议.目前认为最佳的测量基线选择水平是S1,但该结论需结合临床进一步证实.LSTV诊断的主要依据是影像学征象,而Bertolotti综合征的诊断需要对假关节局部注射局麻药物或类固醇激素,且需排除其他腰椎退行性疾病.Bertolotti综合征的治疗包括保守治疗及手术治疗,常用手术方式是融合术和减压术,两种术式均可获得较好的短期疗效.但由于患者样本有限或缺乏直接比较,因此很难确定这两种方法的中远期疗效的优越性.本文通过对Bertolotti综合征的症状及原因、术前的LSTV定位及编号、术前脊柱参数测量中测量基线的选择以及治疗方法进行综述.
Abstract
The lumbosacral transitional vertebra(LSTV)is a common lumbar vertebral variation characterized by unilater-al or bilateral enlarged transverse processes.When the enlargement of the transverse processes alters the local biomechanics of LSTV,it may give rise to a series of clinical symptoms known as Bertolotti syndrome.The main manifestations include pain in the lumbosacral region,buttocks,outer side of the lower limbs,numbness,and symptoms related to the sciatic nerve.LSTV is often classified using the Castellvi classification.The presence of lumbosacralization and sacralization of vertebrae in LSTV makes it challenging to accurately locate and number LSTV.So various anatomical landmarks and spinal parameters have been proposed to assist in the localization and numbering of LSTV,but they all have a certain error rate.Even after the lumbar vertebrae is clearly numbered,there is often controversy over the baseline selection for preoperative spinal parameters.Currently,the horizontal level of S1 is considered the optimal measurement baseline,but this conclusion needs further confirmation in a clinical context.The main basis for LSTV diagnosis is imaging signs,while the diagnosis of Bertolotti syndrome requires local injection of local anesthet-ics or corticosteroids into the pseudo-joint and the exclusion of other degenerative diseases of the lumbar spine.The treatment of Bertolotti syndrome includes conservative and surgical approaches.Common surgical procedures include fusion and decompres-sion,both of which can achieve good short-term outcomes.However,due to the limited number of patients studied or a lack of di-rect comparisons,it is challenging to determine the superiority of these two methods in terms of medium to long-term effectiveness.This article provides a comprehensive review of the symptoms and causes of Bertolotti syndrome,preoperative localization and numbering of LSTV,baseline selection for preoperative spinal parameter measurements,and treatment methods.
关键词
腰骶部/椎体/综述Key words
Lumbosacral region/Vertebral body/Review引用本文复制引用
出版年
2024
NETL
NSTL
万方数据