颈后伸对椎动脉流速影响的研究及意义

Changes and implications of blood flow velocity of vertebral artery during extreme extension of head

目的：探讨颈部推拿手法在极度后伸时对椎动脉血流的影响。方法：应用椎动脉滴注实验，观察颈极度后伸对椎动脉血流的影响，并在活体上进行经颅多普勒（ＴＣＤ）检测验证。结果：颈极度后伸时，双侧椎动脉滴数均明显减少（Ｐ＜０．０５）。在极度后伸位上的旋转，可使部分对侧椎动脉完全闭塞。ＴＣＤ检测显示颈后伸位时双侧椎动脉血流，特别是右侧椎动脉血流均明显减少（Ｐ＜０．０５）。结论：颈极度后伸和极度后伸旋转有造成椎动脉供血不足的危险。

Objective:To study the effects of extreme extension of head to the blood flow velocity of vertebral artery experimentally and clinically. Method: The instillative experiment in 10 cases of the fresh cervical spines was made. The blood flow velocity of vertebral artery with TCD in the 27 asymptomatic subjects with routine physical examination and 23 students were measured and recorded.Result: During extreme extension of head, the drops of the bilateral vertebral arteries reduced obviously in the instillative experiment. The blood flow velocity of bilateral vertebral arteries decreased when the arteries were provoked by extreme extension and extreme extension rotation of head.Pulsatility index of right vertebral arteries increased more than that of the left vertebral arteries in extreme extension and that of bilateral vertebral arteries in neutral position. Conclusion:Extreme extension is dangerous to the patients who have abnormal vertebral arteries when the extremely extensive manipulations are applied. Doctors should be very careful when rotating the head to the right side. Author′s address\ Institute of Clinical Anatomy and Biomechnics, the First Military Medical University,Guangzhou, 510515