颈椎小关节脱位与闭合性椎动脉损伤的相关性研究

Study of the correlation between cervical facet dislocation and closed vertebral artery injury

[目的]探讨颈椎小关节脱位与闭合性椎动脉损伤的相关性。[方法]本组319例颈椎创伤患者,颈椎骨折261例;小关节脱位46例,其中单侧小关节脱位22例,双侧小关节脱位24例;无放射影像异常的脊髓损伤12例。所有患者接受了颈椎MRI和椎动脉2DTOFMRA的前瞻性检查。动物实验建立犬颈椎小关节脱位的撞击模型,撞击后摄颈椎X线片,24～36h后行椎动脉2DTOFMRA检查。[结果]临床319例颈椎创伤患者,52例继发有椎动脉损伤,单侧51例,双侧1例。发现有椎动脉损伤的患者中,34例(65.4%)原始损伤为颈椎小关节脱位,16例为颈椎骨折,2例为无放射影像异常的颈髓损伤。动物实验14只犬撞击后发生颈椎小关节脱位,12只犬无小关节脱位。14只发生小关节脱位犬中,8只继发有单侧椎动脉损伤,12只无小关节脱位犬均无椎动脉损伤。[结论]闭合性椎动脉损伤最常继发于颈椎小关节脱位,瞬间位移使椎动脉受到过度牵张是主要的致伤因素。

[ Objective] To evaluate the correlation between cervical facet dislocation and closed vertebral artery injury. [ Method] A total of 319 cases of human cervical trauma were reviewed retrospectively. In all the cases, there were 261 cervical spinal fractures, 12 spinal cord injuries （without radiographic abnormality） , 46 cervical facet dislocations （including 22 unilateral facet dislocation and 24 bilateral facet dislocation）. All cases underwent the prospective examination of MRI and 2D TOF MRA. In animal experimental group, cervical facet dislocation model of dog was established by force impingement. Cervical spine radiography was taken immediately after injury, 2D TOF MRA was taken in 24 - 36 hours. [ Result] Vertebral artery injury was diagnosed by 2D TOF MRA in 52 of all 319 patients. Unilateral vertebral artery injury occurred in 51 cases and bilateral one occurred in another one case, In all the 52 cases, there were 34 （65.4%） initial cervical facet dislocations, 16 cervical spinal fractures and 2 spinal cord injuries without radiographic abnormality. In animal experiment, cervical facet dislocation occurred in 14 dogs while other 12 dogs hadnt shown the same trauma. In the 14 dogs with cervical facet dislocations, 8 dogs had unilateral vertebral artery injuries. In the 12 dogs without cervical facet dislocations, no vertebral injury had been found. [ Conclusion] Cervical spine dislocation oceurred secondarily after vertebral artery injury the most commonly. The over extension of vertebral artery due to displacement is the most important reason leading to vertebral artery injury.