Inamasu Joji, Guiot Bernard H
Department of Neurosurgery, University of South Florida College of Medicine, Tampa, FL 33606, USA.
Surg Neurol. 2006 Mar;65(3):238-45; discussion 245-6. doi: 10.1016/j.surneu.2005.06.043.
Vertebral artery injury (VAI) after blunt cervical trauma has been considered to be rare. The incidence of VAI has increased dramatically within the last decade after a heightened awareness of this entity on the part of spine surgeons. Diagnostic or therapeutic guidelines for VAI have not been established fully, however.
A review of the literature published between 1990 and 2004 was conducted.
The incidence of VAI among total blunt trauma admissions ranged from 0.20% to 0.77%. Most VAI patients remained asymptomatic, but sudden unexpected deterioration was often reported. Distraction/extension, distraction/flexion, and lateral flexion injuries were the major mechanisms of injury. Dissection and occlusion were the frequent vascular injury patterns. Facet joint dislocations and the fractures extending into the transverse foramen were the spine injury patterns closely associated with VAI. Digital subtraction angiography was the most sensitive imaging study, but because of invasiveness, its role as a screening study remained questionable. Neuroradiological intervention was used successfully to treat hemorrhagic VAI and progressing vertebrobasilar stroke. Systemic anticoagulation with heparin was the preferred treatment for mild ischemia. Treatment of asymptomatic patients has been controversial because the natural history of VAI has not been elucidated. Prophylactic anticoagulation with heparin or the use of antiplatelet agents was advocated in recent studies.
Preemptive treatment may be reasonable in selected patients considering the devastating potentials of VAI. The potential risks of heparin or antiplatelet agents in relation to early cervical spine surgery have not been addressed fully, however, and spine surgeons have to weigh the risk and benefit of such treatment cautiously.
钝性颈部创伤后椎动脉损伤（VAI）一直被认为较为罕见。在脊柱外科医生对该病症的认识提高之后，过去十年间VAI的发病率急剧上升。然而，VAI的诊断或治疗指南尚未完全确立。
对1990年至2004年间发表的文献进行综述。
在全部钝性创伤入院患者中，VAI的发病率为0.20%至0.77%。大多数VAI患者无症状，但常报告有突然意外恶化的情况。牵张/伸展、牵张/屈曲和侧屈损伤是主要的损伤机制。夹层和闭塞是常见的血管损伤类型。小关节脱位和延伸至横突孔的骨折是与VAI密切相关的脊柱损伤类型。数字减影血管造影是最敏感的影像学检查，但由于其侵入性，其作为筛查检查的作用仍存在疑问。神经放射介入已成功用于治疗出血性VAI和进展性椎基底动脉卒中。肝素全身抗凝是轻度缺血的首选治疗方法。无症状患者的治疗一直存在争议，因为VAI的自然病程尚未阐明。近期研究提倡使用肝素进行预防性抗凝或使用抗血小板药物。
考虑到VAI的潜在破坏性，对选定患者进行预防性治疗可能是合理的。然而，肝素或抗血小板药物与早期颈椎手术相关的潜在风险尚未得到充分探讨，脊柱外科医生必须谨慎权衡此类治疗的风险和益处。
