椎动脉CT血管成像在颈椎横突孔区骨折中的临床应用

The clinical application of vertebral artery CT angiography in fracture of transverse foramen of cervical vertebra

目的探讨在颈椎横突孔区创伤中CT血管成像(CTA)对椎动脉(VA)损伤的评估价值。方法回顾性分析2016年1月至2019年12月玉溪市人民医院收治的56例因颈椎外伤行椎动脉CTA检查的临床及影像资料,运用容积再现(VR)、图像融合、曲面重建(CPR)、多平面重建(MPR)及血管分析等后处理技术,观察VA有无损伤及其程度、横突孔区骨折与VA损伤的关系。结果56例患者中,横突孔狭窄阳性组35例,狭窄阴性组21例,狭窄阳性组VA损伤19例,狭窄阴性组VA损伤5例,差异具有统计学意义(P<0.05);狭窄阳性组中横突孔不同狭窄程度组VA损伤率比较差异均有统计学意义(P<0.05);VA损伤分布为:V1段3例,V2段16例,V3段5例;管腔狭窄程度为:轻度狭窄9例,中度狭窄7例,重度狭窄5例,闭塞3例。结论椎动脉CTA可以清晰显示VA的解剖走行、损伤程度、范围及其与颈椎横突孔区骨折断端的毗邻关系,为脊柱外科医师病情评估、治疗方案的制定提供客观、可靠的影像学资料。

Objective To evaluate the value of CT angiography(CTA)for vertebral artery(VA)injury in the transverse foramen region of cervical vertebra.Methods The clinical and CTA imaging data of 56 patients with cervical spine trauma in People's Hospital of Yuxi City from January 2016 to December 2019 were retrospectively analyzed.To observe the VA were or not injuried and their degrees,and the relationship between fracture in transverse foramen region and injured of the VA by applying post processing techniques such as volume reconstruction(VR),image fusion,curved planar reconstruction(CPR),multi-planar reconstruction(MPR),vascular analysis and so on.Results There were 35 cases in the positive group of transverse perforation stenosis among the 56 patients,and 21 cases in the negative group.There were 19 cases injuried the VA in the positive group of stenosis,but just 5 cases′VA were injuried in the negative group of stenosis,with statistically significant differences(P<0.05).The risk of VA injuried caused by different degrees of transverse perforation stenosis in the positive stenosis group was statistically significant(P<0.05).The VA damaged distribution were:3 cases in V1 segment,16 cases in V2 segment,5 cases in V3 segment.The degree of luminal stenosis were:9 cases of mild stenosi,7 cases of moderate stenosis,5 cases of severe stenosis,and 3 cases of luminal occlusion.Conclusions The CTA of VA can clearly show its anatomical route,degree of injury,range and its adjacent relationship with the fracture end of the transverse foramina of cervical vertebra,which can provide evidences of objective and reliable imaging for spinal surgeons to assess their conditions and select the treatment plans.