薦椎腰椎化：案例報告

人體的脊椎發育是一種骨化過程，從出生開始，脊椎包括腰椎和薦椎均是未完全骨化成功的，一般要在17-23歲方可完成。成人脊椎通常由七個頸椎，十二個胸椎，五個腰椎，一個薦椎和一個尾椎組成(發育過程薦椎由五節融合成一塊，尾椎由四節融合成一塊)。而有些胚胎在發展的過程中，會因為第十二節胸椎或第一節薦椎腰椎化，而有了六節腰椎，這種先天異常的情形稱為腰薦移行脊椎又稱過渡脊椎。案例是63歲男性，就醫前1-2週曾跌倒，因背部疼痛求診。經X光攝影顯示胸椎第十二節壓迫性骨折，隨後安排的磁振造影檢查過程並未察覺病人有六節腰椎，因此將壓迫性骨折誤為胸椎第十一節，比對X光時才發覺骨折是胸椎第十二節而非第十一節，若非壓迫性骨折明顯可辨識，類似情況可能影響臨床診斷與治療結果。有幾種方法可以幫助辨識，一是透過第二種影像如X光的輔助，二是以髂腰韌帶來辨識腰椎第五節位置，三是從頸椎開始往下數，而不是從腰椎第五節向上倒數。影像基礎來自於神經，肌肉和骨骼的發育變化，也包含基因變異，學習一些遺傳學的基礎，常見變異的知識，有助於診斷與規劃治療。

關鍵字

腰薦移行脊椎；過渡脊椎；髂腰韌帶

並列摘要

The development of the human spine, known as the process of ossification, is not fully ossified in the lumbar spine and sacrum before the adolescence, and is usually completely ossified in the period of 17 and 23 years. The vertebrae in the human vertebral are divided into different regions, including cervical, thoracic, lumbar, sacrum and coccyx, and the lower nine are fused in adults where five in the sacrum and four in the coccyx. The lumbosacral transitional vertebrae (LSTV) are a relatively common variant and can vary the number of vertebrae in a region. Depending on the number of lumbar vertebrae, it can be thought of as a lumbarized T12 segment or lumbarized S1 segment. In this variant, the number of lumbar spine will be six instead of five. This case was a 63 years old man who visited our medical office due to back pain after fall around 1 or 2 weeks age. After a compression fracture in T12 was noticed in the X-ray examination, a MRI examination had been arranged for further investigation. However, the MRI examination misinterpreted the fracture was in T11 instead of T12 from the beginning, and corrected the report after cross comparison with X-ray films. Through the case study, there are several ways could be used in preventing this kind of near missing. First of all, second photography such as X-ray examination could be used as supporting evidence. In addition, using an iliolumbar ligament (ILL) as addition mean to cross verify the location of L5 could be helpful. Finally, counting downward the location from cervical spine instead of upward from L-5 would be another resource to help the diagnosis. The foundation of imaging examination is composed of nerves, muscles, skeletal development, and gene mutation. Therefore, study the Genetics Science, including the knowledge of common variant, could assist the diagnosis and treatment plan.

並列關鍵字

LSTV ； ILL

國際替代計量

薦椎腰椎化：案例報告

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