Parent A D, Harkey H L, Touchstone D A, Smith E E, Smith R R
Department of Neurosurgery, University of Mississippi Medical Center, Jackson.
Neurosurgery. 1992 Sep;31(3):501-9. doi: 10.1227/00006123-199209000-00012.
Although anterior and posterior traumatic displacement of cervical vertebrae are commonly noted, and the devastating neurological deficits associated with these injuries have been amply defined, lateral displacement with fractures has been rarely recognized, and the clinical significance of this injury has been overlooked. This report describes five cases of cervical spine fractures with lateral dislocation. All patients had lateral and anteroposterior cervical spine radiographs as well as cervical angiography or postmortem study demonstrating either complete occlusion or significant impairment of flow of the vertebral arteries. Two cases had traumatic vertebral artery occlusion with secondary medullary and cerebellar infarction resulting in the patient's death. Vertebral artery injury apparently is not uncommon in this particular type of fracture. The diagnosis of these vascular injuries may require angiography or magnetic resonance angiography. A vertebral occlusion or dissection is a problem of considerable complexity, requiring individualized management depending on the patient's symptomatology, location and nature of the injury, and time lapsed since the injury.
虽然颈椎的前、后创伤性移位较为常见，且与这些损伤相关的严重神经功能缺损已得到充分界定，但伴有骨折的侧方移位却很少被认识到，且这种损伤的临床意义一直被忽视。本报告描述了5例颈椎骨折伴侧方脱位的病例。所有患者均进行了颈椎正侧位X线片检查以及颈椎血管造影或尸检研究，结果显示椎动脉完全闭塞或血流严重受损。2例患者因创伤性椎动脉闭塞继发延髓和小脑梗死而死亡。在这种特殊类型的骨折中，椎动脉损伤显然并不少见。这些血管损伤的诊断可能需要血管造影或磁共振血管造影。椎动脉闭塞或夹层形成是一个相当复杂的问题，需要根据患者的症状、损伤的部位和性质以及受伤后的时间进行个体化治疗。
