椎动脉型颈椎病的血管造影表现及其临床意义

Vertebrarterial cervical spondylosis:angiographic features and the impact on treatment

目的探讨椎动脉型颈椎病(VCS)的血管造影表现及其临床意义。方法对76例VCS患者行椎动脉造影检查,观察椎动脉的走行、管径、是否存在狭窄及狭窄的部位等。结果76例患者中,67例有异常血管造影表现,包括:①椎动脉V2、V3段外压性狭窄50例;②椎动脉单纯硬化性狭窄10例;③椎动脉纡曲63例;④椎动脉走行异常8例;⑤椎动脉细小或缺如21例。结论VCS的血管造影表现非常复杂,椎动脉V2、V3段的受压、纡曲是诊断VCS的最主要依据。在此基础上,还应综合考虑患者椎-基底动脉系统的代偿机能,同时结合患者的病史、临床症状和体格检查,方能做出较为准确的诊断。

Objective To discuss the angiographic features and the impact on the treatment of vertebrarterial cervical spondylosis （VCS）. Methods Thirty-six consecutive patients with VCS were included in this study. Angiography of bilateral vertebral artery （VA） were obtained in all patients and the radiographs were reviewed. Results Of the 76 patients in the registry, 67 showed abnormal VA angiographic signs, which can be classified into 5 groups： （1）Stenosis or occlusion due to extrinsic compression at the V2, V3 segment of VA （n = 50）. （2）VA stenosis secondary to intrinsic VA lesions, such as atherosclerotic plaques （n= 10）. （3）Angiographic tortuosity or kinking of the VA （n=63）. （4）Congenital absence or thinning of VA （n= 21）. （5）Aberrant VA or VA terminating in the posteroinferior cerebellar artery （n= 8）. Conclusion Of the many angiographic signs of VCS, stenosis and tortuosity involving the V2, V3 segment of VA, sometimes secondary to head rotation, is the most common and significant one. In addition, vertebrobasilar autoregulatory capacity and clinical manifestation of the patients are also helping to diagnose.