闭合性颈椎骨折脱位并发椎动脉损伤的机制及影像学诊断

椎动脉损伤可继发于颈部贯通伤、手术损伤，亦可发生于按摩、瑜珈、气管插管、癫痫发作、产伤、颈部绞勒、体育运动和交通伤。关于闭合性颈部创伤与椎动脉损伤之间的关系最早是由Suechting(1955)所描述的。Carpenter(1961)通过尸体解剖首次证实闭合性颈椎创伤后发生的椎动脉损伤。由于椎动脉损伤后临床症状的非特异性，在早些时候被认为是罕见的，20世纪90年代以后，随着影像学技术的发展，特别是磁共振血管成像(MRA)等技术的应用，关于此类损伤的系统性研究和报道逐渐增多。国内首先关于这方面的报道始于20世纪末。     

颈椎创伤继发椎动脉损伤核磁共振血管成像诊断及实验研究

目的 探讨二维时间飞逝效应核磁共振血管成像（2D TOF MRA）对闭合性椎动脉损伤的诊断价值。方法 319例闭合性颈椎创伤患者，采用2D TOF MRA技术进行椎动脉前瞻性检查。14只犬建立颈椎屈曲损伤的撞击伤模型，撞击后摄X线片，24～36h后行椎动脉2D TOF MRA检查及椎动脉血管造影。结果 319例颈椎创伤患者中，52例伴有椎动脉损伤。单侧椎动脉损伤51例，左侧22例，右侧29例；双侧椎动脉损伤1例。14只犬均造成颈椎小关节脱位，MRA检查7只犬一侧椎动脉损伤；2只犬一侧椎动脉成像不完整，MRA诊断为可疑阳性；5只犬双侧椎动脉正常。血管造影显示，8只犬一侧椎动脉损伤，6只犬正常。MRA诊断为阳性的7只犬和阴性的5只犬，血管造影与之一致。MRA诊断为可疑阳性的2只犬，血管造影证实1只为阳性，另1只为阴性。结论 2D TOF MRA检查是诊断闭合性椎动脉损伤可靠、首选的方法，对血管痉挛和小面积内膜损伤尚难以准确鉴别。     

闭合性颈部创伤并发椎动脉损伤的临床症状和治疗

闭合性颈部创伤并发椎动脉损伤并不少见,随着影像学诊断技术发展及对椎动脉损伤的认识和研究的深入,关于闭合性颈椎创伤后椎动脉损伤的文献报道逐渐增多。闭合性颈椎骨折脱位并发椎动脉损伤的发生率目前尚无统一意见,椎动脉损伤后应采取何种治疗仍存在着争议。     

颈椎横突孔狭窄与椎动脉供血、临床症状的关系探讨

目的提高颈椎横突孔直径变化对椎动脉型颈椎病影响的认识。方法颈椎椎间盘联合椎体扫描,在颈椎常规扫描椎间盘的基础上同时加扫C4～6椎体,测量C4～6椎体横突孔直径及观察横突孔周围组织的CT改变。结果 60例颈椎横突孔狭窄病例中,横突孔先天狭窄32例,增生性狭窄28例;轻度狭窄28例、中度狭窄21例、重度狭窄11例;C4椎体横突孔狭窄10例,C5椎体横突孔狭窄26例、C6椎体横突孔狭窄24例;一侧狭窄49例,两侧狭窄11例。结论改进后的CT扫描不仅可观察颈椎椎间盘、颈椎横突孔的变化,而且对椎动脉型颈椎病的病因诊断有较高的临床价值。     

椎动脉损伤致中枢神经系统损伤的临床探讨

目的：通过随访3年的60例椎动脉损伤患者的临床表现,以此确定椎动脉损伤是否会导致中枢神经系统（脑、颈髓）损伤。方法：对颈椎骨折脱位患者行颈椎正侧位X片、椎动脉磁共振血管成像（magnetic resonance angiography,MRA）检查以确定患者并发椎动脉损伤,同时行脑CT或脑MRI检查以除外颅脑损伤。结果：单侧椎动脉损伤患者在对侧椎动脉能代偿的情况下,其中枢神经系统受损症状较轻,在失代偿情况下,其中枢神经系统受损症状相对较重,双侧椎动脉损伤患者,其中枢神经系统受损症状重,并可能出现死亡。结论：椎动脉损伤可能会导致中枢神经系统一定程度的损害。     

优秀男子业余拳击运动员颈椎损伤流行病学调查及X线特征分析

目的:研究优秀男子业余拳击运动员颈椎损伤情况,分析其常见症状、体征的分布特征及X线特征。方法:以国家拳击队、河南省拳击队61名优秀男子业余拳击运动员为研究对象,由运动创伤专业医师对其进行颈部损伤的症状调查和体征检查;并为其中30名有头部受重击受伤史且伴有颈痛症状者拍摄颈椎X线正侧位、双斜位片进行观察和测量。对所获数据进行统计分析。结果:共计61例样本中,有头部受重击史49人,占80.3%。列前4位的症状依次是颈痛(68.9%)、颈性头晕(62.3%)、颈性头痛(49.2%)和颈部活动受限(39.3%)。C2棘突旁压痛、C2-3小关节压痛、枕下三角压痛等3个阳性体征出现频率最高,皆为38人(62.3%);颈性头痛、颈性头晕、颈痛、颈部活动受限、枕下三角压痛、C2棘突压痛、C2-3小关节压痛等7个症状和体征的发生与头部受重击密切相关。30例X线样本中,棘突偏离中线以C2最多(96.7%),棘突偏歪整体分布自上而下逐渐减少;小关节双边征以C3-4分布频率最高(53.3%);颈曲均值为26.59±1.93°,明显小于正常人群;椎间孔狭窄以C3-4最多(40%)。结论:优秀男子业余拳击运动员颈椎损伤特点是上位颈椎损伤几率较高;X线特征是棘突偏歪自上而下逐渐减少,小关节双影以C3-4出现率最高,颈椎曲度明显小于普通人群,C3-4和C4-5椎间孔狭窄发生率较高;头部受重击是拳击运动员颈椎损伤的主要致病因素之一。     

早期后前路联合手术治疗难复性下颈椎骨折脱位临床分析

下颈椎损伤多见于患者从高处坠落致使头颈部直接撞击地面,或者重物直击颈部致颈枕部在高能量的冲击过程中产生屈曲性骨折。因此,此类暴力使颈椎过度屈曲后中后柱韧带断裂,脱位的关节突超越至下一节段小关节的前方与上方形成关节绞锁,     

CT观察横突孔狭窄对椎动脉型颈椎病的诊断价值

椎动脉型颈椎病目前影像研究多侧重于ＭＲＩ和椎动脉造影 ,有关ＣＴ诊断的研究报道相对较少。本文总结我院 48例椎动脉型颈椎病的临床与ＣＴ资料 ,分析横突孔狭窄的形态、分型及其与椎动脉型颈椎病的关系 ,并对ＣＴ观察横突孔狭窄对椎动脉型颈椎病的诊断价值进行评价。1　资料与方法男 2 9例 ,女 19例 ,平均年龄 48岁 ( 2 6～ 75岁 )。 48例( 10 0 % )出现眩晕、耳鸣、黑矇等椎基底动脉供血不足症状 ,36例 ( 75 % )伴肩颈酸痛、手部发麻等一般症状 ,2 3例 ( 4 7.9% )伴胃肠饱胀、胸闷、恶心等植物神经功能失调症状。采用岛津45 0 0—ＴＥ型…     

颈椎病致椎-基底动脉供血不足的影像表现

目的依据临床与影像表现，探讨颈椎病致椎一基底动脉供血不足的机制及防治要点。方法122例颈椎病患者均经磁共振血管成像(MRA)和常规x线检查，部分病例还经CT扫描检查。分析影像表现与临床经过的关系。结果122例患者中，颈椎动脉MRA显示正常者106例(86.89％)，各种异常者共16例(13．19％)，其中，先天性发育不良3例，扭曲纤细6例，单侧缺如1例，畸形1例，硬化性改变2例，以及狭窄3例。约85％(103／122)的病例经保守性治疗后，于2周至2个月期间临床症状明显缓解或消失。结论虽然颈椎骨质增生与横突孔狭窄可导致颈椎病发生。但是，作者认为临床上较多遇到的、更为重要的病因是颈交感神经受到激惹引起椎动脉痉挛进而诱发本病。临床上最关键的防治措施是防止颈椎失稳。     

椎动脉型颈椎病的磁共振成像研究

目的:研究磁共振成像对椎动脉型颈椎病的诊断价值.材料和方法:椎动脉型颈椎病患者48例(病例组),非椎动脉型颈椎病患者78例(对照组),正常人62例(正常组),全部行颈部MRI和椎动脉MRA.结果:(1)MRA显示病例组椎动脉出现变细、扭曲、局限性狭窄或走行失常等改变.(2)病例组感兴趣区血管直径平均值为1.94±0.78mm,较对照组和正常组减小.(3)病例组和对照组分别有31例、10例出现钩椎关节增生硬化,两组比较有明显差异.结论:椎动脉MRA与颈椎MRI联合应用是诊断椎动脉型颈椎病较为理想的检查手段.     

Cerebral stroke in a semi-pro football player: a case report.

Cervical spine trauma can clearly result in neurologic injury. An unusual traumatic event is a vascular insult of the vertebral arteries, potentially leading to stroke. The vertebral arteries are vulnerable to compression at several sites in the cervical spine. The high degree of physiologic rotation at the atlanto-axial joint places the vertebral artery at risk through normal daily activities as well as following forceful trauma, including manipulative treatment. Cerebrovascular insufficiency is an uncommon but serious complication of cervical spinal manipulation, which can lead to posterior circulatory impairment. Comprehensive diagnostic studies may be required to differentiate primary intracranial pathology from cerebral symptoms secondary to vascular compromise.     

椎动脉型颈椎病的MRI分析

目的 探讨椎动脉型颈椎病的ＭＲＩ诊断价值及其限度。材料与方法 选取我院近２年来经临床诊断为椎动脉型颈椎病患者４２例,全部行颈部ＭＲＡ检查,其中２３例同时行颈椎ＭＲＩ,观察椎动脉全段ＭＲＡ表现及颈椎横突孔以及钩椎关节的变化情况。选择２６例正常人作为对照组。全部行颈椎ＭＲＩ及椎动脉ＭＲＡ检查,方法条件和观察内容同病例组。结果 （１）４２例中７例椎动脉ＭＲＡ正常,其余３５例（３５／４２）分别显示不同程度     

Incidence of vertebral artery thrombosis in cervical spine trauma: correlation with severity of spinal cord injury

BACKGROUND AND PURPOSE: The incidence of blunt traumatic vertebral artery dissection/thrombosis varies widely in published trauma series and is associated with spinal trauma. The purpose of this study was to determine the frequency of traumatic vertebral artery thrombosis (VAT) in cervically injured patients by using routine MR angiography (MRA) and MR imaging and identify associations with the severity of neurologic injury. METHODS: A retrospective review of 1283 patients with nonpenetrating cervical spine fractures with or without an associated spinal cord injury (SCI) was performed. Imaging consisted of routine cervical MR imaging and 2D time-of-flight MRA of the neck. The cervical injury level, neurologic level of injury, and American Spinal Injury Association (ASIA) grade were recorded. RESULTS: In this study, 632 patients met the inclusion criteria, 83 (13%) of whom had VAT on the admission MR imaging/MRA. Fifty-nine percent (49/83) of VAT patients had an associated SCI. VAT was significantly more common in motor-complete patients (ASIA A and B, 20%) than in neurologically intact (ASIA E, 11%) cervical spine-injured patients (P = .019). VAT incidence was not significantly different between motor-incomplete (ASIA C and D, 10%) and neurologically intact (ASIA E, 11%) cervical spine-injured patients (P = .840). CONCLUSION: The absence of neurologic symptoms in a patient with cervical spine fracture does not preclude VAT. VAT associated with cervical spinal injury occurs with similar frequency in both neurologically intact (ASIA E) and motor-incomplete patients (ASIA C and D) but is significantly more common in motor-complete SCI (ASIA A and B).     

急性颈椎外伤的MRI诊断

目的 分析急性颈椎外伤的MRI征象,评价MRI在急性颈椎外伤诊断中的价值及限度。方法收集急性颈椎外伤150例,均有MRI检查和X线平片,15例有CT片,采用14个参数进行分析记录。结果150例中MRI检出骨折51个,小关节脱位30个,椎体脱位35个;外伤性椎间盘突出40个,硬膜外血肿2例;脊髓损伤69例;脊髓受压迫20例;前、后纵韧带损伤21例;棘间韧带和黄韧带损伤15例;椎前血肿或水肿30例;椎旁和背侧软组织损伤40例;X线平片发现椎体骨折55个,椎体脱位35个;小关节脱位35例,附件骨折25个,椎前软组织肿胀20例。15例CT均发现骨折,小关节脱位,椎管狭窄。结论MRI在显示脊髓、韧带、椎间盘和软组织损伤方面优于CT和X线平片。MRI能全面反映颈椎各种损伤的病理特征,为评估颈椎稳定性提供充分的依据;MRI和X线片的骨折检出率没有明显差异,CT应该用于复杂的颈椎骨折检查。     

MR Imaging for Assessing Acute Vertebral Trauma

Magnetic resonance imaging (MRI) has revolutionized the imaging assessment of patients sustaining acute vertebral injury and is indicated for all hemodynamically stable patients with acute neurologic deficits related to spinal column injury, particularly in the cervical region. MRI defines the presence and extent of lesions involving osseous structures, ligaments and other soft tissues, and the spinal cord parenchyma. Information obtained from MRI is useful in assessing the indication for and best approach to surgical management of vertebral injury by revealing herniated disc material, epidural hematoma, significant osteophytes, and level(s) of probable or potential spinal column instability. The appearance of spinal cord lesions by MRI provides prognostic information regarding likely extent of recovery of neurologic function. Magnetic resonance angiography (MRA) can reliably demonstrate vertebral artery injuries not uncommonly associated with cervical spine subluxation/dislocation and fractures crossing the foramen transversarium. Improvements in speed of MR image acquisition and patient physiological support and monitoring compatibility in the MR-environment is making MRI more available and safe for use in the setting of acute major trauma.     

无脊髓损伤下颈椎脱位的手术治疗

目的 探讨无脊髓损伤下颈椎脱位的手术方法选择及疗效.方法 分析总结2004年1月-2009年6月手术治疗的无脊髓损伤下颈椎脱位患者11例.根据Allen分类均为牵开屈曲型损伤,其中Ⅰ度脱位7例,Ⅱ度脱位1例,Ⅲ度脱位3例.陈旧性脱位8例,新鲜脱位3例,均为单纯颈椎外伤,不合并其他脏器损伤.单纯前路复位内固定椎间植骨融合7例,前后路联合复位内固定植骨融合4例.术后随访观察临床疗效.结果 11例患者手术经过顺利,术前11例Frankel分级E级,术后11例Frankel分级E级.X线片示11例患者均恢复颈椎正常序列和曲度.随访3～31个月未出现脊髓损伤症状及再脱位.术后3.5～5.5个月(平均4.3个月)达植骨融合.结论 合并关节突交锁的下颈椎脱位宜Ⅰ期行前后路联合复位内固定,无关节突交锁者可单纯前路复位椎间植骨融合.复位及内固定植骨融合术是治疗无脊髓损伤型下颈椎脱位的有效方法.     

头颈部血管闭塞性疾病的MRA与DSA对照研究

目的通过与DSA对照,探讨MRA在头颈部血管闭塞性疾病的应用价值与限度。方法回顾性分析头颈部血管检查的病例32例,均进行2D-TOFMRA和DSA检查,检查结果进行对照分析。结果32例经DSA检查8例为正常,余24例中病变血管共38支,其中轻度狭窄12支,中度狭窄8支,重度狭窄8支,闭塞10支;MRA正确诊断26支,总体准确率为约70%。椎动脉假阳性较高,达62.5%。结论MRA可以作为颈动脉和大脑动脉环闭塞性疾病的筛选方法,但不适宜应用于椎动脉。     

Cervical internal carotid artery injuries due to blunt trauma

Blunt or nonpenetrating trauma to the head and neck occasionally results in damage to the cervical segment of the internal carotid artery. This may produce neurologic signs and symptoms that mimic acute craniocerebral injury. The mortality and morbidity associated with these injuries are alarmingly high. These injuries may be missed if one relies only on computed tomography. Angiography is still the definitive procedure to diagnose these lesions. The clinical and radiographic features as well as the pathogenesis and mechanism of injury are discussed for 21 cases of injury to the cervical internal carotid artery due to blunt trauma.