闭合性颈椎创伤伴椎动脉损伤的临床研究

目的　研究椎动脉损伤在闭合性颈椎创伤中的发病率及其与颈椎损伤机制、类型、损伤程度的相关性 ,观察椎动脉损伤后的临床症状、体征 ,探讨早期正确诊断的方法。　方法　于2 0 0 0年 8月～ 2 0 0 2年 2月间 ,利用颈部动脉磁共振血管造影 (MRA)技术 ,连续观察 4 6例闭合性颈椎创伤患者 ,结合颈椎X线、MRI、CT检查及患者的临床症状、体征综合分析。　结果 4 6例闭合性颈椎创伤中 ,12例 (2 6 % )伴椎动脉损伤。其中 7例为双侧损伤 (4例一侧未显影、一侧狭窄 ,3例双侧狭窄 ) ,5例为单侧损伤 (均为一侧狭窄 ) ;10例椎动脉损伤患者无任何症状 ,2例出现眩晕、恶心呕吐、面部麻木、偏盲等症状。椎动脉损伤与屈曲型损伤及颈椎严重不稳定相关 (P <0 .0 5 ) ,与小关节绞锁、横突孔骨折及脊髓完全性损伤明显相关 (P <0 .0 1)。　结论　椎动脉损伤是闭合性颈椎创伤的较常见并发症 ,其临床症状体征缺乏特异性。颈椎创伤中的颈椎严重不稳定、屈曲型损伤、伴有脊髓完全性损伤、小关节绞锁和 (或 )横突孔骨折应高度怀疑椎动脉损伤。临床医师应对此类损伤有较高的警惕性 ,常规进行颈部动脉MRA检查是最有效的早期正确辅助诊断方法。

A clinical study of vertebral artery injury after closed cervical spine trauma

Objective To determine the incidence of vertebral artery injury in the closed cervical spine trauma and its correlation with injury mechanism, injury type and injury severity of cervical spine trauma, evaluate the clinical symptoms and physical signs, and explore the methods of early diagnosing vertebral artery injury. Methods From August 2000 to February 2002, 46 patients with closed cervical spine trauma were observed continually on the neck arteries with magnetic resonance angiography (MRA). The MRA findings in combination with data of X ray films, MRI, CT and the clinical records were comprehensively analyzed. Results Of 46 patients, 12 (26%) had abnormal MRA,of which seven had bilateral vertebral artery injuries (four with non visualization of one side and focal stenosis of another side, and three with bilateral focal stenosis) and five unilateral vertebral artery injuries (all with unilateral side focal stenosis). Ten patients with abnormal vertebral arteries showed no any clinical signs and symptoms. Vertigo, nausea, vomiting, facial paralysis and homonymous hemianopia occurred in two patients. Vertebral artery injury was correlated with cervical flexion injury and serious cervical instability ( P <0.05), and significantly with locked facet dislocation, foramen transversarium (FT) fracture and complete spinal cord injury ( P <0.01). Conclusions As a common complication of closed cervical spine injury, vertebral artery injury is short of specificity in clinical signs and symptoms. Patients with serious cervical instability, cervical flexion injury, complete spinal cord injury, locked facet dislocation and/or FT fracture should be highly suspected of having vertebral artery injuries, to which the clinicians must keep highly alert. The most effective method to early diagnose vertebral artery injury is the routine examination on the neck arteries with MRA.