颈椎横突孔骨折合并椎动脉损伤

目的：研究颈椎横突孔骨折患者椎动脉损伤的发生率及椎动脉损伤的临床特征。方法：选择2000年8月-2003年6月，CT证实的25例急性颈椎横突孔骨折患者进行颈部动脉磁共振血管造影(MRA)检查。结果：12例患者发生椎动脉损伤(48％)，其中8例为单侧损伤，4例为双侧损伤；椎动脉损伤的发生率在横突孔骨折伴小关节绞锁脱位组与横突孔骨折无小关节绞锁脱位组之间有统计学差异(P=0．03)。2例椎动脉损伤患者出现椎基底动脉缺血症状。结论：急性颈椎横突孔骨折患者椎动脉损伤的发生率较高，尤其伴小关节绞锁脱位者；大多数椎动脉损伤患者无特异性临床表现。     

测量MRA椎动脉及CT横突孔探讨椎动脉型颈椎病发病原理

目的测量MRA椎动脉及CT横突孔直径探讨椎动脉型颈椎病发病原理。方法测量对象分二组：①正常组50例,②椎动脉型颈椎病组26例。结果正常人MRA椎动脉左侧4．10±0．79 mm,右侧为3．20±0．83 mm。正常人CT横突孔正常值左侧：6．30±0．41mm,右侧：6．55±0．83 mm。椎动脉型颈椎病异常椎动脉直径1．70±0．81 mm。椎动脉型颈椎病CT横突孔直径：5．78±0．60 mm。结论椎动脉本身受压是椎动脉型颈椎病的主要原因。但是椎动脉无受压及横突孔无狭窄也不能完全排除椎动脉型颈椎病,可考虑某些特殊原因。     

介入栓塞椎动脉在颈椎横突部肿瘤的术前应用

目的：针对临床上处理颈椎横突部肿瘤术中椎动脉所采用的解剖、结扎的方法尚存在着许多并发症，提出并应用血管内介入技术于术前栓塞椎动脉，为临床处理椎动脉提供一种新的方法。方法：对７例颈椎横突部肿瘤病人，术前１周行血管内介入可脱性球囊＋钨丝弹簧圈进行椎动脉栓塞，并与传统方法进行比较。结果：７例均获成功而且无任何并发症发生，保证了手术的顺利进行。结论：经术中证实，血管内栓塞椎动脉方法简单、安全可靠、可避免术中椎动脉损伤后的致命性大出血，从而缩短了手术时间，降低了手术难度，利于肿瘤切除及避免神经系统并发症，是一种临床处理椎动脉的新方法     

颈椎骨折脱位并发的椎动脉损伤

目的：分析颈椎骨折脱位并发的推动脉损伤的发生率及易发因素,方法：11例颈椎骨折脱位患者均接受颈椎MRI及颈部磁共振血管成像（MRA）检查。结果：3例合并有椎动脉损伤（均为单侧）,由屈曲暴力致伤及存在小关节脱位。嵴髓损伤均为A级（ASIA标准）。结论：颈椎骨折脱位可能并发椎动脉损伤、脊髓完全性损伤及颈椎小关节脱位患者,应常规进行MRA检查,以明确是否合并椎动脉损伤。     

颈椎横突孔及椎动脉的观察及其在椎动脉型颈椎病发病学上的意义

颈椎横突孔及椎动脉的观察及其在椎动脉型颈椎病发病学上的意义湖北中医学院（武汉４３００６１）李景银本文试通过对颈椎横突孔及椎动脉的测量，并通过统计学处理，找出其正常值及变异度，探索其在椎动脉型颈椎病发病学上的意义。材料与方法取用福尔马林防腐固定的成年尸...     

颈椎闭合性创伤合并椎动脉损伤的机制及MRA诊断

目的 探讨颈椎闭合性骨折脱位继发椎动脉损伤的机制及MRA诊断。方法 本组95例颈椎闭合性创伤，男76例，女19例，年龄16－65岁，平均34岁。所有患者接受MRI和椎动脉MRA检查，当椎动脉预期位置完全无血流成像，MRIT2横断面上椎动脉内有高信号血栓影像时，即确诊为椎动脉阻塞。结果 本组95例中，19例合并有椎动脉闭塞，均为单侧，左侧9例，右侧10例，其中颈椎骨折5例，双侧小关节突脱位6例，单侧小关节突脱位7例，无放射影像异常的脊髓损伤1例。18例椎动脉损伤患者无任何症状，1例有轻度头昏，嗜睡。结论 椎动脉损伤易继发于有小关节突脱位的颈椎创伤，前瞻性MRA检查是首选的方法。     

颈椎小关节脱位与闭合性椎动脉损伤的相关性研究

[目的]探讨颈椎小关节脱位与闭合性椎动脉损伤的相关性。[方法]本组319仍颈椎创伤患者，颈椎骨折261例；小关节脱位46例，其中单侧小关节脱位22例，双侧小关节脱位24例；无放射影像异常的脊髓损伤12例。所有患者接受了颈椎MRI和椎动脉2DTOF MRA的前瞻性检查。动物实验建立犬颈椎小关节脱位的撞击模型，撞击后摄颈椎X线片，24—36h后行椎动脉2DTOF MRA检查。[结果]临床319例颈椎创伤患者，52例继发有椎动脉损伤，单侧51例，双侧1例。发现有椎动脉损伤的患者中，34例（65．4％）原始损伤为颈椎小关节脱位，16例为颈椎骨折，2例为无放射影像异常的颈髓损伤。动物实验14只犬撞击后发生颈椎小关节脱位，12只犬无小关节脱位。14只发生小关节脱位犬中，8只继发有单侧椎动脉损伤，12只无小关节脱位犬均无椎动脉损伤。[结论]闭合性椎动脉损伤最常继发于颈椎小关节脱位，瞬间位移使椎动脉受到过度牵张是主要的致伤因素。     

介入栓塞椎动脉在颈椎横突部肿瘤术前的应用（2例报告）

介入栓塞椎动脉在颈椎横突部肿瘤术前的应用（２例报告）李长青梅芳瑞谷诚周政＊例１男性５９岁因左上肢麻木１０个月，活动受限３个月，发现左颈部包块１个月入院。颈椎正侧位Ｘ线摄片及ＣＴ显示，颈５、６椎体左侧横突破坏，和颈部软组织肿块影，约８ｃｍ×５ｃｍ×５ｃ...     

颈椎闭合性创伤合并椎动脉损伤的机制及MRA诊断

目的探讨颈椎闭合性骨折脱位继发椎动脉损伤的机制及MRA诊断.方法本组95例颈椎闭合性创伤,男76例,女19例,年龄16～65岁,平均34岁.所有患者接受颈椎MRI和椎动脉MRA检查,当椎动脉预期位置完全无血流成像,MRI T2横断面上椎动脉内有高信号血栓影像时,即确诊为椎动脉阻塞.结果本组95例中,19例合并有椎动脉闭塞,均为单侧,左侧9例,右侧10例,其中颈椎骨折5例,双侧小关节突脱位6例,单侧小关节突脱位7例,无放射影像异常的脊髓损伤1例.18例椎动脉损伤患者无任何症状,1例有轻度头昏、嗜睡.结论椎动脉损伤易继发于有小关节突脱位的颈椎创伤,前瞻性MRA检查是首选的方法.     

Occlusion of the vertebral artery in cervical spine dislocations

We studied 12 consecutive patients with facet joint dislocation in the cervical spine to assess the incidence, site and clinical sequelae of occlusion of the extracranial vertebral artery. Intra-arterial digital subtraction angiography was performed after the orthopaedic management of the dislocations. This demonstrated vertebral artery occlusion (one bilateral) in five of the seven patients with bilateral dislocations and in four of the five patients with unilateral dislocations. Two of the nine patients with vertebral artery occlusion had neurological deficits above the level of the injury, all of which resolved spontaneously within two months. In our experience, a distraction-flexion injury appears to be the most common cause of closed traumatic vertebral artery occlusion.     

Simultaneous bilateral vertebral artery occlusion in the lower cervical spine manifesting as bow hunter's syndrome

A 59-year-old male had suffered near-syncopal episodes for more than one year that occurred immediately on turning his head to the left. Cerebral magnetic resonance (MR) imaging did not detect any contributing lesions with well-developed posterior communicating arteries. Dynamic radiography of the cervical spine showed mild instability at C5-6 and concomitant intramedullary hyperintensity confirmed by T(2)-weighted MR imaging. Cervical computed tomography demonstrated an osseous protrusion in the right foramen transversarium at C5. Dynamic cerebral angiography revealed simultaneous vertebral artery (VA) occlusion at C6 on the right and C5 on the left associated with leftward head rotation. The VA showed an intact course at the C1 to C2 levels. The patient underwent anterior fusion followed by decompressive foraminotomy at C5-6 and C6-7 and meticulous resection of the markedly thickened fibroligamentous structure which was considered to contribute to the rotational VA occlusion. Postoperatively he no longer suffered near-syncope during head rotation. Bow hunter's syndrome is an infrequent type of vertebrobasilar insufficiency that may need surgical management for potential threat of ischemic stroke. Simultaneous VA occlusion at the lower cervical level can cause bow hunter's syndrome. Dynamic cerebral angiography is a useful modality for evaluating bow hunter's syndrome even if the patient cannot tolerate dynamic examination for the immediate symptom. Accurate anatomical knowledge of the uncovertebral foraminal region combined with intraoperative dynamic study is essential for safe surgery to the VA and favorable outcome.     

Lateral cervical spine dislocation and vertebral artery injury.

Although anterior and posterior traumatic displacement of cervical vertebrae are commonly noted, and the devastating neurological deficits associated with these injuries have been amply defined, lateral displacement with fractures has been rarely recognized, and the clinical significance of this injury has been overlooked. This report describes five cases of cervical spine fractures with lateral dislocation. All patients had lateral and anteroposterior cervical spine radiographs as well as cervical angiography or postmortem study demonstrating either complete occlusion or significant impairment of flow of the vertebral arteries. Two cases had traumatic vertebral artery occlusion with secondary medullary and cerebellar infarction resulting in the patient's death. Vertebral artery injury apparently is not uncommon in this particular type of fracture. The diagnosis of these vascular injuries may require angiography or magnetic resonance angiography. A vertebral occlusion or dissection is a problem of considerable complexity, requiring individualized management depending on the patient's symptomatology, location and nature of the injury, and time lapsed since the injury.     

颈椎不稳在椎动脉型颈椎病发病中的意义

椎动脉型颈椎病是中老年颈椎病患者中最常见的类型,长期以来医学界对其发病机制认识不统一,因此导致此病命名各异,如颈性眩晕,Barre—Lieou综合征,椎一基底动脉缺血综合征,颈交感神经综合征等。门诊经常见到眩晕的患者经多科室诊治仍不能确诊,即使诊为椎动脉型颈椎病,也给予扩血管药物、中药、制动、理疗、牵引等保守治疗,使得症状反复发作,给患者带来极大痛苦和精神压力。将其他型颈椎病合并有头痛、眩晕,旋颈试验阳性,有猝倒病史的患者进行手术治疗,疗效满意,现将结果报告如下。     

正常椎动脉解剖特点及其变异概况

椎动脉由锁骨下动脉发出,左右各一,穿过颈椎体侧方第6～第1横突孔,经枕骨大孔上升到颅内后行于延髓腹侧,两条椎动脉在脑桥下缘汇合在一起,形成一条粗大的基底动脉,即通常所称的椎-基底动脉系统。椎-基底动脉系统是脑血液供应的重要组成部分,分布于脑干（延髓到间脑尾侧1/3）、大脑半球的后1/3（包括部分颞叶、枕叶和小脑）。椎动脉与颈椎有着密切的关系,颈椎的横突孔保护着椎动脉,但颈椎的的病损也可以危及椎动脉。随着颈椎外科和内固定技术的发展,手术操作或内置物置入过程损伤椎动脉是椎动脉损伤的常见原因之一[1～3],尤其在椎动脉有变异的情况下,损伤的几率会明显增加。     

颈椎手术中并发椎动脉损伤的诊断与治疗

 目的 探讨颈椎手术中并发椎动脉损伤的发生原因、治疗及预防。方法 回顾性分析2002年10月至2012年4月颈椎手术中并发椎动脉损伤的7例患者资料,男6例,女1例;年龄23～65岁,平均48.9岁;脊髓型颈椎病5例,颈椎外伤合并C^4,5半脱位1例,氟骨症致颈椎管狭窄1例。椎动脉损伤均为单侧,左侧4例,右侧3例。分析颈椎手术中并发椎动脉损伤的原因、处理过程及预后。结果颈椎前路手术4例,其中2例用环钻减压时偏离中线损伤椎动脉,1例切除椎间盘时刮匙过于偏外损伤椎动脉,1例颈椎外伤患者由于Ｃ^4,5半脱位造成椎动脉迂曲,减压时冲击式咬骨钳损伤椎动脉。颈椎后路手术3例,其中2例为行C4侧块螺钉固定时钻头偏外损伤椎动脉;1例氟骨症致颈椎管狭窄者在切除寰椎后弓时咬骨钳损伤椎动脉,术中出现椎动脉损伤后,迅速填塞压迫止血并关闭伤口,但术后4周发生迟发性出血,采用椎动脉栓塞止血及颈后路血肿清除术治疗。7例患者均未发生脑梗塞,其中2例患者术后出现一过性头晕。结论 椎动脉损伤是颈椎手术的严重并发症,其损伤原因与手术失误、解剖变异等有关;采用直接压迫及椎动脉栓塞治疗效果确切。     

Bilateral vertebral artery occlusion following cervical spine trauma--case report

A 41-year-old female presented with a rare case of bilateral vertebral artery occlusion following C5-6 cervical spine subluxation after a fall of 30 feet. Digital subtraction angiography showed occlusion of the bilateral vertebral arteries. Unlocking of the facet joint, posterior wiring with iliac crest grafting, and anterior fusion were performed. The patient died on the 3rd day after the operation. This type of injury has a grim prognosis with less than a third of the patients achieving a good outcome.