Zou Hong-Jun, Wu Jun, Hu Yong, Cheng Dong, Liu Jin-Bo
Department of Orthopaedics, The First People's Hospital of Changzhou, School of Medicine, the Third Affiliated Hospital of Suzhou University, No. 185 of Juqian Street, Changzhou, 213000, China.
Eur Spine J. 2018 Jul;27(Suppl 3):409-414. doi: 10.1007/s00586-017-5386-y. Epub 2017 Nov 8.
To report a novel treatment method for vertebral artery injury. Vertebral artery injuries may be caused during trauma by fracture and excessive motion with subluxation from C2 to C6 in spite of vertebral artery deeply seated and normally well protected inside the transverse foramen. Optimal medical management of the occluded vertebral artery has yet to be determined.
We report on a severely displaced C2-C3 fracture that was found to have a vertebral artery injury. Medical records and imaging were reviewed.
A 50-year-old lady was hit by steel tube without loss of consciousness, but complaining of severe cervical and bilateral periscapular pain. Physical examination identified a neurologically intact patient with frontotemporal ecchymosis and posterior cervical tenderness. MRA and DSA showed an occluded left vertebral artery. After 3 days of observation, the patient showed no symptoms of brain ischemia or abnormal sensation and motor at four limbs. To ensure safety, we took the left vertebral artery embolism at the C2 and C5 levels before operation.
To our knowledge, this is the first report of a displaced C2-C3 fracture in which transcatheter unilateral VAI embolization was used to prevent VAI bleeding during operation.
报告一种椎动脉损伤的新型治疗方法。尽管椎动脉深埋于横突孔内且通常受到良好保护，但在创伤过程中，C2至C6的骨折和过度活动伴半脱位仍可能导致椎动脉损伤。对于闭塞性椎动脉的最佳药物治疗方案尚未确定。
我们报告了一例发现有椎动脉损伤的严重移位的C2-C3骨折病例。回顾了病历和影像学资料。
一名50岁女性被钢管击中，未失去意识，但主诉颈部及双侧肩胛周围剧痛。体格检查发现该患者神经功能完好，有额颞部瘀斑和颈后部压痛。MRA和DSA显示左侧椎动脉闭塞。观察3天后，患者未出现脑缺血症状，四肢感觉和运动也无异常。为确保安全，我们在手术前对C2和C5水平的左侧椎动脉进行了栓塞。
据我们所知，这是首例关于移位的C2-C3骨折采用经导管单侧椎动脉损伤栓塞术预防术中椎动脉损伤出血的报告。
