椎动脉型颈椎病的发病机理初探  

Pathogenic Study of Vertebral Arterial Insufficiency of Cervical Spondylosis

作　　者：徐德永[1] 栾红梅[1] 李联忠[1] 徐爱德[1] 曹来宾[1] 张忻宇[1] 

机构地区：[1]青岛医学院附属医院

出　　处：《实用放射学杂志》1999年第1期2-4,共3页Journal of Practical Radiology

摘　　要：目的：探讨椎动脉型颈椎病的发病机理。方法：（１）对４具鲜尸进行双侧椎动脉Ｘ线造影、双侧颈椎横突孔ＣＴ平扫，并对其大体解剖和病理进行观察。（２）对３８例眩晕病人进行椎动脉ＭＲＡ检查，并对其中３例进行了ＣＴ颈椎横突孔平扫。（３）另以２８例正常人为对照组，进行ＭＲＡ检查，方法和条件同病人组，ＭＲＡ采用二维时间飞越法（２ＤＴＯＦＭＲＡ）。结果：（１）尸体解剖及椎动脉造影显示血管壁粗糙变硬４处，弯曲８处、血管壁含有胆固醇结晶２处（Ｃ１，２处）、纤维粘连带６处、钩突关节增生８处、关节突骨刺５处。（２）ＭＲＡ如传统血管造影一样能显示椎动脉闭塞、狭窄和扭曲。病人组与对照组椎动脉的ＭＲＡ表现有显著差异（Ｐ＜０．００１）。结论：椎动脉粥样硬化而致血管狭窄、管壁僵硬、血管弹性减弱应是椎动脉型颈椎病的一个重要的病理基础；椎动脉周围的骨性结构和软组织的增生、肥厚以及椎体移位直接和／或间接所致椎动脉管径狭窄应属椎动脉型颈椎病发病的外在因素，而体位的异常如颈椎伸屈。Objective:To study the pathogenesis of vertebral arterial insufficiency of cervical spondylosis.Methods:(1)Four cadavers were studied with vertebral arteriogrphy,pathomorphologcal examination and CT scanning of transversus foramen.(2)MRA of vertebral artery were performed in 38 patients with vertigo by Resonex 0.38T MR machine,three of them,CT of transversus foramen were done.(3)28 normal people were also examined with MRA of vertebral artery as the control group,whose scanning methods as same as patients group.MRA was accomplished using a two-dimensional time-of flight gradient-echo technique.Results:(1)Pathomorphological examination and vertebral angiography in 4 cadavers showed that four segments in the wall of vertebral artery were sclerosis and rough,two of them contained cholesterol crystals,eight vertebral artery twists,eight hyperosteosis of Luschka joint and five of zygapophysieal joint.(2)MRA correctly identified all occlusions,stenoses and twists.There was significant difference between patient′s group and control group in MRA of vertebral artery(P<0.001).Conclusion:Vertebral artery arteriosclerosis which led to vertebral artery stenosis and sclerosis as were as reduced elasticity is an important pathological base of vertebral arterial insufficiency of cervical spondylosis.Proliferation of 'peri-vertebral artery'bone tissue and soft tissue and movement of cervical spine directly or/and indirectly causing vertebral artery stenosis are considered to be the external cause.Whereas abnormal position such as flex,extension and rotation of neck is an elicited cause for the ecrvical arterial insufficient attack.

关 键 词：椎动脉 颈椎病 发病机理 

分 类 号：R681.550.2[医药卫生—骨科学]