摘要
目的探讨颈椎手术中并发椎动脉损伤的发生原因、治疗及预防。方法回顾性分析2002年10月至2012年4月颈椎手术中并发椎动脉损伤的7例患者资料，男6例，女1例；年龄23-65岁，平均48．9岁；脊髓型颈椎病5例，颈椎外伤合并C405半脱位1例，氟骨症致颈椎管狭窄1例。椎动脉损伤均为单侧，左侧4例，右侧3例。分析颈椎手术中并发椎动脉损伤的原因、处理过程及预后。结果颈椎前路手术4例，其中2例用环钻减压时偏离中线损伤椎动脉，1例切除椎间盘时刮匙过于偏外损伤椎动脉，1例颈椎外伤患者由于C4.5半脱位造成椎动脉迂曲，减压时冲击式咬骨钳损伤椎动脉。颈椎后路手术3例，其中2例为行C4侧块螺钉固定时钻头偏外损伤椎动脉；1例氟骨症致颈椎管狭窄者在切除寰椎后弓时咬骨钳损伤椎动脉，术中出现椎动脉损伤后，迅速填塞压迫止血并关闭伤口，但术后4周发生迟发性出血，采用椎动脉栓塞止血及颈后路血肿清除术治疗。7例患者均未发生脑梗塞，其中2例患者术后出现一过性头晕。结论椎动脉损伤是颈椎手术的严重并发症，其损伤原因与手术失误、解剖变异等有关；采用直接压迫及椎动脉栓塞治疗效果确切。
Objective To investigate cause, diagnosis, treatment and prevention of vertebral artery injury in cervical spine surgery. Methods Data of 7 patients with vertebral artery injury caused by cervical spine surgery from October 2002 to April 2012 were retrospectively analyzed. There were 6 males and 1 female, aged from 23 to 65 years （average, 48.9 years）. The reasons of cervical spine surgery were as follows： cervical spondylotic myelopathy （5 cases）, traumatic subluxation of C4 and C5 （1 case）, and cervical spinal stenosis due to skeletal fluorosis （1 case）. All cases had unilateral vertebral artery injury, including 4 cases in the left side and 3 cases in the right side. The cause, treatment and prognosis of vertebral artery injury in 7 patients were analyzed. Results Four patients suffered from vertebral artery injury during anterior cervical spine surgery; 2 cases were caused by excessive lateral trepanation, 1 by excessive lateral discectomy using a curette, and 1 by Kerrison punch during decompression in a patient with anomalous vertebral artery due to traumatic subluxation of C4 and C5. Three patients suffered from vertebral artery injury during posterior surgery; 2 cases were caused by a drill bit during drilling lateral mass of C4 and 1 by a rongeur during removing posterior Ci arch in a patient with cervical spinal stenosis due to skeletal fluorosis. After vertebral artery injury, all patients were immediately treated by hemostatic tamponade, and then the incisions were closed. However, 1 patient occurred delayed cervical hemorrhage 4 weeks after operation. Then he underwent vertebral artery angiography, balloon embolization and evacuation of hematoma. All cases had no cerebral infarction. However, two of them had postoperative temporary dizziness. Conclusion Vertebral artery injury in cervical spine surgery is a rare but serious complication, which is associated with surgical mistakes and anatomical variations. Hemostatic tamponade and embolization are effective for this complication.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2012年第10期911-915,共5页
Chinese Journal of Orthopaedics
关键词
颈椎
椎动脉破裂
手术中并发症
Cervical vertebrae Vertebral artery dissection Intraoperative complications
