摘要
目的：探讨不同病理形态的椎动脉型颈椎病手术方式与手术技巧及术中如何保护椎动脉。方法：椎动脉型颈椎病患者32例，男18例，女14例；年龄26～65岁，平均54岁；病程6个月～10年，平均3．5年。32例患者临床表现均有眩晕、旋颈试验阳性或猝倒、头痛、头晕、恶心、呕吐；27例视力、记忆力减退，10例伴有脊髓症状，8例伴有神经根症状，3例伴有脊髓和神经根症状。X线片示钩椎关节横向增生30例，颈椎失稳2例，椎间孔狭小8例。均行X线、CT、MRI、MRA检查，据不同病理形态及椎动脉受累的影像学特点选用了7种手术方式治疗，其中横突孔切开椎动脉减压术2例，钩椎关节切除术2例，钩椎关节切除及横突孔切开椎动脉减压术3例，椎间植骨融合术2例，钩椎关节切除及椎1孔扩大术8例，前路减压及钩椎关节切除、植骨融合术12例，横突孔切开、钩椎关节切除、颈椎椎体次全切除术3例。结果：全部手术顺利完成并经1～2年随访，依据疗效标准，优22例，良8例，可2例，总优良率93．8％。术中2例误伤椎动脉，其中1例行缝扎，另1例骨块外包明胶海绵填塞压迫止血，未见明显椎动脉缺血症状。结论：对不同病因的椎动脉型颈椎病选择不同的手术方式均能取得满意疗效。术中使用显微手术环钻，环钻直径1．3—1．4cm，术中要注意安全区解剖标志才能不误伤椎动脉。
Objective： To explore different methods and skill of surgical operation for cervical spondylosis involving the vertebral artery and how to protect vertebral artery. Methods： Thirty-two patients with cervical spondylosis involving the vertebral artery included 18 male and 14 female with average age of 54 years ranging from 26 to 65 years. The course were from 6 months to 10 years （mean 3.5 years）. The clinical manifestation of all patients were vertigo and positive of rotatory cervical test, or cataplexy, headache, dizzness, nausea and vomiting. Of all the patients, acuity of vision and remembrance decreaced in 27 cases, spinal cord symptoms occurenced in 10, radicular symptoms in 8, spinal cord and radicular symptoms in 3. X-ray film showed transversal hyperplasy of uncovertebral joint in 30 cases, cervical vertebral destabilizing in 2, intervertebral foramen stenosis in 8. All patients were scanned by X-ray, CT, MRI and MRA, 7 kinds of operative method were selected according to the imaging characteristics of vertebral artery. Transverse foramen were cut-off for vertebral artery decompression in 2 cases, uncovertebral joint excision in 2, transverse foramen decompression and uncovertebral joint excision in 3, fusion with bone graft in 2 cases, both uncovertebral joint excision and vertebral foramen decompression in 8, anterior decompression and uncovertebral joint excision in 12, transverse foramen decompression and uncovertebral joint excision and subtotal vertebrae resection in 3. Results： All operations were successful and all patients were followed-up for from 1 to 2 years. According to the effective standard, the operative results were excellent in 22 cases, good in 8, fair in 2, the excellent and good rate was 93.8%. The vertebral artery of 2 cases were hurted by mistake during operation, respective bundled and compressed by gelatin sponge immediately. There were no ischemia symptoms of artery after operation. Conclusion： Cervical spondylosis involving the vertebral artery caused by deferent etiological factors should be treated with defferent operative methods. During operation, micro trephine of 1.3 to 1.4 cm diameter is used, safty area should be cared to lest injury the vertebral artery.
出处
《中国骨伤》
CAS
2006年第8期469-471,共3页
China Journal of Orthopaedics and Traumatology
关键词
椎动脉
颈椎病
外科手术
Vertebral artery
Cervical spondylosis
Surgical procedures, operative
作者简介
通讯作者：韩伟Tel：0754—8384880
