第五腰椎横突肥大综合征的诊疗现状
[摘要]第五腰椎橫突肥大（HTPL5V）是一种脊柱先天性发育畸形，初期单纯性肥大无临床表现，当年龄增长、发生外伤或劳损时可能出现下腰痛及下肢放射痛，则称为HTPL5V综合征。既往临床工作中对此综合征认识不足，常误诊为腰背筋膜炎、梨状肌综合征、腰肌劳损，甚至为腰椎间盘突出症或腰椎管狭窄症。HTPL5V的临床发病率男性略高于女性，可发病于青、中、老年人群。HTPL5V的诊断需结合患者临床表现以及影像学X线片、多层螺旋CT（MSCT）、高分辨CT（HRCT）或MRI综合考虑。HTPL5V分为四种类型：Ⅰ型（单纯型）、Ⅱ型（假关节型）、Ⅲ型（融合型）、Ⅳ型（混合型）。HTPL5V综合征的治疗主要有：①一般保守治疗，平卧休息和热敷、非甾体类抗炎止痛药、局部封闭和牵引治疗;②中国传统医学治疗，手法推拿、五禽戏、频谱照射;③微创治疗，小针刀松解治疗;④手术治疗，单纯HTPL5V切除减压术、HTPL5V切除+L5～S1椎间融合植骨椎弓根系统内固定术、假关节融合术或椎间融合术。本研究通过总结前辈关于HTPL5V诊断和治疗的经验，对本病进行了系统的介绍，旨在提高广大医疗工作者对HTPL5V的认识并为进一步研究提供参考。
[关键词]第五腰椎横突肥大综合征;假关节;局部阻滞;微创治疗;手术治疗
[中图分类号] R681.5 [文献标识码] A [文章编号] 1674-4721（2019）10（b）-0031-05
[Abstract] Hypertrophy of the transverse process of the fifth lumbar vertebra （HTPL5V） is a congenital deformity of the spinal column. Simple hypertrophy has no clinical manifestations at the initial stage. Low back pain and lower limb radiation pain may occur when age grows， trauma or strain occurs， which is called HTPL5V syndrome. In the past clinical work， there was insufficient understanding of this syndrome， which was often misdiagnosed as lumbar back fasciitis， piriformis syndrome， lumbar muscle strain and even lumbar disc herniation or lumbar spinal stenosis. The clinical incidence rate of HTPL5V is slightly higher in men than in women， and it can be found in young， middle-aged and elderly people. The diagnosis of HTPL5V should be considered in combination with the clinical manifestations of patients and imaging X-ray films， multi-slice spiral CT （MSCT）， high-resolution CT （HRCT） or MRI. HTPL5V is divided into four types： type Ⅰ （simple type）， type Ⅱ （pseudoarthrosis type）， type Ⅲ （fusion type） and type Ⅳ （mixed type）. The treatment of HTPL5V syndrome mainly includes： ①General conservative treatment， recumbent rest and hot compress， non-steroidal anti-inflammatory analgesic， local blocking and traction treatment; ②Chinese traditional medical treatment， manipulative massage， wuqinxi， spectrum irradiation; ③Minimally invasive treatment， small needle knife lysis treatment; ④Surgical treatment， simple resection and decompression of the transverse process of HTPL5V， resection of the transverse process of HTPL5V + L5-S1 interbody fusion and bone graft pedicle system internal fixation， pseudoarthrodesis or interbody fusion.
[Key words] Hypertrophy syndrome of the fifth lumbar transverse process; Pseudarthrosis; Local anesthesia block; Minimally invasive treatment; Surgical treatment