先天性椎动脉发育不良所致椎动脉型颈椎病

Vertebral Artery Insufficiency of Cervical Spondylosis Relating to Congenital Hypoplastic Vertebral Artery

目的 :探讨椎动脉发育不良所致椎动脉型颈椎病的诊断和治疗。方法 :1999年 1月～ 2 0 0 0年 8月 ,3 3例拟诊为椎动脉型颈椎病患者接受椎动脉磁共振血管造影 (MRA )检查 ,男 2 4例 ,女 9例 ,年龄 3 2～ 70岁 ,平均 5 3岁 ,在MRA上观测椎动脉成像走行并测量椎动脉内径。结果 :本组 3 3例 ,2 8例椎动脉发育正常 ,其左侧椎动脉内径平均为4.1mm ,右侧平均 3 .8mm。 5例先天性椎动脉发育不良 ,左侧椎动脉 1例 ,右侧 4例。发育不良侧椎动脉在MRA上显示为全程均匀性纤细、狭窄 ,内径 1.1～ 1.7mm ,平均 1.5mm ,为正常椎动脉的 1/ 3～ 1/ 4。 5例患者临床症状与转颈无明显相关性 ,药物保守治疗可缓解症状。结论 :先天性椎动脉发育不良可表现出椎动脉型颈椎病的临床症状 ,目前尚无理想的药物和手术治疗方法。

Objective: To evaluate the diagnosis and treatment of vertebral artery insufficiency of cervical spondylosis relating to congenital hypoplastic vertebral artery.Methods:33 cases suspected as vertebral artery insufficiency of cervical spondylosis were examined by Magnetic Resonance Angiography (MRA) from January 1999 to August 2000.24 of them were male and nine were female.The age of the patients was 32～70 years with an average age of 53 years.The course and inner diameter of the vertebral artery were measured on MRA scan.Results:In 28 of 33 cases had normal vertebral artery,the average inner diameter was 4.1mm in left vertebral artery and 3.8mm in right side.Five cases had one unilateral hypoplastic vertebral artery,one left and four right.The hypoplastic vertebral artery showed general thin and stenosis of whole course on MRA scan.The inner diameter was 1.1～1.7mm with average 1.5mm.It was one third to one quarter as normal vertebral artery.The clinical symptom of the five cases was not related to the head position.Medical conservative treatment could relieve the symptom.Conclusions:Congenital hypoplastic vertebral artery could cause the symptom as vertebral artery insufficiency of cervical spondylosis.At present,there are still absent of optimal medical and surgical treatment for this condition.