Avimadje M, Goupille P, Jeannou J, Gouthière C, Valat J P
Rheumatology Department, Trousseau Teaching Hospital, Tours, France.
Rev Rhum Engl Ed. 1999 Jan;66(1):35-9.
Although anomalous lumbo-sacral articulations are present in 5 to 7% of the population at large, their clinical relevance remains a matter of debate. Articulation between the L5 transverse process and the sacrum or ilium has been implicated as a cause of low back pain.
To define symptoms and effects of steroid injections in patients with an articulation between a L5 transverse process and the sacrum or ilium.
Patients with low back pain and an expanded L5 transverse process articulating with the sacrum or ilium were studied retrospectively. Patients with an expanded transverse process that did not articulate with the sacrum or ilium were excluded. Demographic data, symptoms, physical findings and results of investigations were recorded. Efficacy of steroid injections into the anomalous articulation performed under fluoroscopic monitoring was evaluated in the short, medium and long term.
Twelve patients (seven men and five women) with a mean age of 41.1 years (17-90 years) and a mean time since symptom onset of 1.9 years (0.2-4 years) were studied. All 12 patients reported pain on the side of the anomalous articulation (left, n = 10), either in the low back (n = 6) or in the buttock (n = 6). Eight patients had pain radiation to all (n = 1) or part (n = 7) of the lower limb on the same side. One patient had mild motor loss (4/5) and another had paresthesia in the foot. Radiographs were obtained in all 12 patients, computed tomography in six, magnetic resonance imaging in two, myelography in two, a bone scan in two and an electromyogram in one. Three of the 11 patients treated by steroid injection experienced pain during the procedure. Ten patients were improved in the short term and nine reported a 50% decrease in their pain after one month. Of the eight patients who were reevaluated after six to 24 months, seven were improved or free of symptoms and one was unchanged.
An anomalous transitional articulation should be considered as a possible factor in the genesis of low back pain in patients who do not have the degenerative lesions classically responsible for this symptom. Local steroid injections should be tried before surgery is considered.
虽然腰骶关节异常在一般人群中的发生率为5%至7%，但其临床相关性仍存在争议。L5横突与骶骨或髂骨之间的关节已被认为是腰痛的一个原因。
明确L5横突与骶骨或髂骨之间有关节的患者接受类固醇注射后的症状及效果。
对患有腰痛且L5横突增宽并与骶骨或髂骨相关节的患者进行回顾性研究。排除横突增宽但未与骶骨或髂骨相关节的患者。记录人口统计学数据、症状、体格检查结果及检查结果。评估在透视监测下对异常关节进行类固醇注射的短期、中期和长期疗效。
研究了12例患者（7例男性和5例女性），平均年龄41.1岁（17至90岁），症状出现后的平均时间为1.9年（0.2至4年）。所有12例患者均报告异常关节一侧（左侧，n = 10）疼痛，部位在腰部（n = 6）或臀部（n = 6）。8例患者疼痛放射至同侧下肢全部（n = 1）或部分（n = 7）。1例患者有轻度运动功能丧失（4/5），另1例患者足部有感觉异常。12例患者均进行了X线检查，6例进行了计算机断层扫描，2例进行了磁共振成像，2例进行了脊髓造影术，2例进行了骨扫描，1例进行了肌电图检查。11例接受类固醇注射治疗的患者中有3例在治疗过程中出现疼痛。10例患者短期内病情改善，9例报告1个月后疼痛减轻50%。在6至24个月后接受重新评估的8例患者中，7例病情改善或无症状，1例无变化。
对于没有典型导致该症状的退行性病变的患者，异常的过渡关节应被视为腰痛发生的一个可能因素。在考虑手术之前应尝试局部类固醇注射。
