| 陈长青,冯万强,王 成,林灿斌,何明长,成伟科.后路内固定复位治疗上颈椎骨折脱位发生椎动脉损伤的临床分析[J].中国脊柱脊髓杂志,2018,(7):607-612. |
| 后路内固定复位治疗上颈椎骨折脱位发生椎动脉损伤的临床分析 |
| 中文关键词: 上颈椎骨折 椎动脉损伤 临床分析 |
| 中文摘要: |
| 【摘要】 目的：分析后路内固定复位治疗上颈椎骨折脱位发生椎动脉损伤的原因、外科治疗策略及其预防措施。方法：2013年1月~2017年12月，我院采用后路复位内固定术治疗上颈椎骨折脱位患者96例，其中6例术后出现椎动脉损伤，男4例，女2例，年龄32~57岁（39.8±8.3岁），病程18~26d（22.0±2.5d）。2例术前行磁共振血管成像（MRA）检查未见椎动脉损伤，4例术前未行MRA检查。术后3~42h出现脑缺血症状，其中4例切口渗血或周围血肿形成，行颈后路探查止血后行CT血管造影（CTA）和数字减影血管造影（DSA）检查，2例直接行CTA和DSA检查，明确椎动脉损伤后行血管腔内介入治疗，随访观察患者脑缺血症状改善情况。结果：1例寰枢椎复合型骨折和1例混合型骨折患者复位内固定难度较大，其余4例患者手术均顺利。4例椎动脉V3段血管壁损伤（双侧1例，单侧3例），行覆膜支架置入；2例单侧椎动脉V3段假性动脉瘤形成，行椎动脉闭塞术。6例患者行介入治疗后椎动脉损伤出血均有效止血，出院后均获随访，随访6~12个月（10.0±2.2个月），1例双侧血管壁损伤患者术后1年随访仍诉头晕、头痛，面部麻木；3例单侧血管壁损伤患者脑缺血症状明显缓解，术后1年随访时未诉特殊不适；2例单侧假性动脉瘤形成患者行椎动脉闭塞术后6个月及9个月随访时诉脑缺血症状逐渐缓解。2例患者椎动脉损伤为内固定手术术中所致，4例患者因术前未行MRA或CTA检查，无法明确椎动脉损伤原因。结论：上颈椎骨折脱位及手术复位内固定可能造成椎动脉损伤，根据影像学检查结果行介入治疗可取得较好效果；对上颈椎骨折患者术前需进行详细的影像学检查及评估，术中需谨慎操作，避免椎动脉的损伤。 |
Vertebral artery injury of upper cervical spine fracture with posterior internal fixation |
| 英文关键词:Upper cervical spine fracture Vertebral artery injury Clinical analysis |
| 英文摘要: |
| 【Abstract】 Objectives: To analyze the reasons, surgical treatment strategies and preventive measures of vertebral artery injury of upper cervical spine with posterior internal fixation. Methods: From January 2013 to December 2017, 96 patients who suffered from upper cervical fracture and dislocation were treated with posterior internal fixation in our hospital. Among them, 6 patients were diagnosed vertebral artery injury after the posterior instrumentation, 4 males and 2 females, aging from 32 to 57 years(39.8±8.3 years) old. The length of stay ranged from 18 to 26d(22.0±2.5d). Before surgery, 2 patients had no vertebral artery injury in MR angiography(MRA), other 4 patients had no MRA examination. All the 6 patients were treated with posterior internal fixation, and cerebral ischemia appeared at 3 to 42 hours after surgery. Four patients had incision bleeding or hematoma formation and accepted exploratory operation. After CT angiography(CTA) and digital subtraction angiography(DSA) examination showing the vertebral artery injury, all the 6 patients were given interventional treatment. Cerebral ischemia improvement was observed in follow-up after discharged. Results: In addition to 1 case of atlantoaxial compound fracture and 1 case of mixed fracture, all the other patients were smoothly treated. Four patients who had V3 part of vertebral artery injury(bilateral damage in 1 case, unilateral damage in 3 cases) accepted membrane stent implantation, two patients with pseudoaneurysm in unilateral V3 part of vertebral artery accepted artery occlusion operation. The hemorrhage of vertebral artery was effectively controlled after interventional therapy. All patients were followed up after discharge with the time of 6-12 months(10.0±2.2 months). One patient with bilateral vascular wall injury still suffered from dizziness, headache and facial numbness at one year after discharged. Three patients with unilateral vessel wall injury were relieved of cerebral ischemia when discharged and complained no special discomfort during 1-year followed-up. Two patients with unilateral vertebral artery pseudoaneurysm experienced gradually relieved of cerebral ischemia at 6 months and 9 months after vertebral artery occlusion. In the patients with vertebral artery injury, 2 cases were caused by internal fixation, 4 cases were undefined about the reason due to no MRA and CTA examination before surgery. Conclusions: Vertebral artery injury can be caused by upper cervical fracture dislocation and internal fixation in surgical reduction. According to the imaging examination, interventional therapy can achieve an optimal outcome. A detailed imaging examination and evaluation should be performed before the surgery for upper cervical spine fracture. The operation should be carefully regulated to avoid the vertebral artery injury. |
| 投稿时间：2018-01-26 修订日期：2018-03-07 |
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