对上颈椎后路手术并发椎动脉损伤防治策略的探讨  

Prevention and treatment of vertebral artery injury after posterior upper cervical surgery

作　　者：何艺坚 陈志达[1] 黄砖枝[1] 蔡弢艺[1] 蒋元杰 林斌[1] He Yijian;Chen Zhida;Huang Zhuanzhi;Cai Taoyi;Jiang Yuanjie;Lin Bin(Orthopedic Center of PIA Joint Logistic Support Unit,Department of Orthopedic,Southeast Hospital affiliated to Xiamen University,Zhangzhou 363000,China)

机构地区：[1]联勤保障部队第九O九医院暨厦门大学附属东南医院骨科全军骨科中心,福建省漳州市363000

出　　处：《骨科临床与研究杂志》2022年第5期287-291,共5页Journal Of Clinical Orthopedics And Research

摘　　要：目的 探讨上颈椎后路手术并发椎动脉损伤的防治策略。方法 2012年01月至2020年01月联勤保障部队第九〇九医院暨厦门大学附属东南医院骨科行上颈椎后路内固定手术治疗患者144例;其中6例术后发现椎动脉损伤;男4例,女2例;年龄32~57(39.8±8.3)岁。入院时行X线、CT及MRI检查。其中寰椎骨折伴寰枢关节脱位1例、枢椎齿状突骨折并寰枢关节半脱位3例、枢椎骨折1例、寰枢椎复合骨折1例。术前3例行椎动脉CT血管造影(CTA)检查;3例患者未行CTA检查;6例患者均行椎动脉介入治疗。随访观察患者脑缺血症状改善情况。结果 所有患者均行介入治疗。术后椎动脉损伤出血均有效控制。患者术后获得3~6(4.0±2.2)个月随访。椎动脉损伤均为单侧,左侧2例,右侧4例。3例术前行CTA检查患者中2例存在C2椎动脉高跨变异。术后行CTA或数字减影血管造影(DSA)检查发现2例存在C2椎动脉高跨变异。4例患者术后切口有不同程度渗血。6例患者术后均伴不同程度头晕症状。经神经内科会诊予扩血管对症治疗后,2例患者6个月仍间歇出现头晕、头痛;其余在随访期间脑缺血症状逐渐缓解。结论 椎动脉损伤是上颈椎后路手术的严重并发症,椎动脉介入治疗效果确切。术前应常规行CTA检查,详细评估椎动脉情况,避免椎动脉的损伤。Objective To analyze and summarize the prevention and treatment strategies of vertebral artery injury complicated by posterior upper cervical surgery. Methods From January 2012 to January 2020, 144 patients underwent upper cervical posterior internal fixation surgery in Department of Orthopedic, Southeast Hospital affiliated to Xiamen University, of which 6 patients had postoperative vertebral artery injury. There were 4 males and 2 females aged from 32 to 57(39.8±8.3) years. X-ray, CT, and MRI were performed on admission, including 1 atlas fracture with atlantoaxial dislocation, 3 axial odontoid fracture with atlantoaxial subluxation, 1 axial fracture, and 1 atlantoaxial compound fracture. CT angiography(CTA) was performed on admission in 3 patients, and CTA was not performed in 3 patients. All 6 patients received vertebral artery interventional therapy. The improvement of cerebral ischemia symptoms was observed during follow-up. Result All patients received interventional therapy, and postoperative vertebral artery injury and bleeding were effectively controlled. All patients were followed up for 3-6(4.0±2.2) months. All vertebral artery injuries were unilateral, with 2 cases on the left and 4 cases on the right. High span variation of C2 vertebral artery was found in 2 of the 3 patients who underwent preoperative CTA examination. After operation, CTA or digital subtraction angiography(DSA) showed that 2 patients had high span variation of C2 vertebral artery. Four patients had different degrees of bleeding through the incision after surgery;6 patients were all accompanied by different degrees of dizziness after surgery. After the consultation of the neurology department and symptomatic treatment of vasodilation, 2 patients still had intermittent dizziness and headache after 6 months. The rest of the patients experienced gradual remission of cerebral ischemia during follow-up. Conclusion Vertebral artery injury is a serious complication of posterior upper cervical surgery. Preoperative routine CTA examination

关 键 词：动脉损伤 椎动脉 寰椎 枢椎 后路内固定 

分 类 号：R687.3[医药卫生—骨科学]