术前椎动脉CT血管造影检查在上颈椎手术置钉中的应用

摘要

Objective To study the application of cervical vertebral artery CT angiography(CTA) preoperatively in the screw setting of upper cervical spine.Methods The data of 170 patients who underwent upper cervical spine surgery from January 2014 to December 2015 in our hospital were retrospectively analyzed,of whom 80 cases with typeⅡodontoid fractures,90 cases with atlantoaxial dislocation;20 cases were operated with occipitocervical fusion,150 cases treated with atlantoaxial fusion.Seventy-eight cases were examinated by cervical vertebral artery CTA before sugery(observation group) but the other 92 cases(control group).The rate of the vertebral arterial lesion between the two groups were compared.Results Six cases with vertebral artery injury in control group,the incidence of arterial injury was 7％;unilateral vertebral artery was found in 3 cases,small congenital development of left cervical vertebral artery in 5 case,abnormal branch in 5 cases.The rate of dysplasia was 17％,and the rate of vertebral artery injury was 0.The rate of vertebral artery injury in control group was higher than observation group,the difference was significant(P<0.05).Conclusion Vertebral artery CTA examination preoperatively may become a routine examination,in order to make the operator carefully evaluate the relationship between the vertebral artery with atlantoaxial vertebral,choose the accurate screw-setting and avoid the vertebral artery injury in the upper cervical spine surgery.%目的 探讨术前椎动脉CT血管造影(CTA)检查在上颈椎置钉中的指导作用.方法 回顾性分析我院自2014年1月至2015年12月收治的170例上颈椎手术患者资料,其中Ⅱ型齿突骨折80例,寰枢椎脱位90例;20例行颈枕融合术,150例行寰枢椎融合术.92例术前未行椎动脉CTA检查(对照组),78例术前行椎动脉CTA检查(观察组).比较2组术中椎动脉损伤情况.结果 对照组有6例椎动脉损伤,椎动脉损伤发生率为7％;观察组椎动脉单侧缺如3例,左侧先天性发育细小5例,异常分支5例,椎动脉发育异常的比率为17％,椎动脉损伤率为0.对照组椎动脉损伤率明显高于观察组,2组比较差异有统计学意义(P<0.05).结论 在上颈椎手术中,术前椎动脉CTA检查可作为一项常规检查,便于术者术前仔细评估椎动脉与寰枢椎的毗邻关系,以便指导术者选择正确的置钉方式,从而避免椎动脉损伤.