腰椎峡部裂(lumbar spondylolysis)为腰椎一侧或两侧椎弓上下关节突之间的峡部骨质缺损不连续。
确 诊
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/20d56dd1-4f78-4a24-ab4c-dcee856d0bee.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/c99f672d-b8e4-4fed-a52b-8828be6375db.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/9972fcf6-0156-4c3a-ac47-f47264ecd6de.jpg)
图:箭头所指为苏格兰狗脖子断了
腰椎斜位片上苏格兰狗脖子=腰椎峡部
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/0bf74fec-68dc-494a-854c-78851491ff21.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/d07da0aa-55c5-4a46-868a-131719a71556.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/f57b87dc-7a88-4c18-be8f-323280ed9878.jpg)
早期 (early):可见峡部骨折线
进展期 (progressive):骨折断端间隙增宽
终末期(terminal):假关节形成
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/b5522bc5-67b2-48a6-8062-514f9f4729cb.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/e8f23700-89c6-453d-9c43-2da9fa580d60.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/0060852d-238c-49b1-b592-fa3fc6054e29.jpg)
三、Hollenberg教授于2002年提出腰椎峡部裂的MRI分级:
0级:正常峡部,无水肿信号改变。
1级:因应力反应导致的骨髓水肿信号, 但没有骨折线,表现为T1低信号和T2高信号。
2级:不完全骨折
3级:完全反应性骨折
4级:骨折不愈合 (fracture nonunion)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/8d885d6b-18a0-4010-8deb-8ce83ea0b8a6.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/a4c60748-6a45-43be-8a82-b4aab571e7ba.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/6f0ed7a8-5e82-4d91-9675-e9c1a5b4712a.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/4ef33107-9511-4e0e-a356-1a8c83a00547.jpg)
A型为单纯型峡部裂,无椎间盘突出及腰椎滑脱;
B型为峡部裂伴有轻度椎间盘突出或I度滑脱,无神经压迫症状及体征;
C型为峡部裂合并I度或Ⅱ度滑脱并椎间盘突出同时有神经压迫症状及体征。
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/f56161f1-59f0-4eb5-b2d4-9beb6544ce48.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/c9c0d071-cee0-4406-9643-5c6c9aa92589.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/2c7ae9da-7cce-4166-9849-7f1e514b0192.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/451742a9-ead2-48f2-95d2-f28956b34b42.jpg)
早期诊断
一、椎弓根出现T2高信号改变
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/c2b8bcb6-92b3-45dc-8188-b2a0007c7502.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/0ff1b27d-4c1a-469e-971b-7b6c60dc0d17.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/54bda250-73ef-492f-8282-80562c4f97e6.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/f03ccd84-90bf-45a8-9882-42bce901dbdd.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/4e606816-fd21-4268-920c-e60676c96112.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/0671321a-3634-49db-bf14-26a30ef2b181.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/8a80d303-e599-407c-bfba-5432e98d6c02.jpg)
![从诊断到治疗:全面解析腰椎峡部裂(lumbar](https://img-a.haoyishu.com/article/content/4998/0ad25935-913e-4124-9d51-bbb48ed84dc3.jpg)
左图:在矢状位T1加权像上,硬膜外脂肪延申到椎板内缘外(虚线);右图:横断位T2像上,硬膜外脂肪增多明显压迫硬膜囊。
来源:Spine 脊柱,作者李永超,未经授权禁止转载!
作者介绍:
李永超
同济大学附属东方医院博士生
师从谭军教授和彭宝淦教授。