Hatzitheofilou C, Demetriades D, Melissas J, Stewart M, Franklin J
Department of Surgery, Baragwanath Hospital, Johannesburg, South Africa.
Br J Surg. 1988 Mar;75(3):234-7. doi: 10.1002/bjs.1800750315.
Twenty patients with penetrating injuries of the vertebral artery who were treated as emergencies were subjected to the following operative approaches: five cases, Henry's approach (posterior) and modified Henry's approach (anterior); five cases, limited exposure and application of metal clips; four cases, plugging of the arterial defect with Oxycell or crushed muscle; three cases, control with ligatures and non-conventional exposure of the artery; one case, inflation of a balloon catheter within the vertebral canal; one case, repair of the lacerated first extraosseous part of the vertebral artery. One patient died from exsanguination on the operating table, before any repair was possible. The overall mortality was 20 per cent and the mean hospital stay 6.1 days. Thirty-five per cent of the patients presented with neurological complications, and 55 per cent left the hospital well. No advantage of Henry's classical approach over limited exposure and control with metal clips was shown, when mortality, hospital stay and long-term problems were compared. Because of its relative simplicity we suggest that the metal clipping of the vertebral artery, above and below the site of injury, is an effective technique that can be used to stop the bleeding. One case presented as a false aneurysm of the vertebral artery, following a stab wound. This was successfully treated with excision of the aneurysm and vertebrovertebral artery bypass, using a saphenous vein graft.
20例因椎动脉穿透伤而接受急诊治疗的患者采用了以下手术方法：5例采用亨利氏入路（后路）和改良亨利氏入路（前路）；5例采用有限暴露并应用金属夹；4例用氧化纤维素或碾碎的肌肉堵塞动脉缺损；3例用结扎法控制出血并非常规暴露动脉；1例在椎管内对球囊导管进行充气；1例对椎动脉第一骨外部分的撕裂伤进行修复。1例患者在手术台上因失血过多死亡，未能进行任何修复。总死亡率为20%，平均住院天数为6.1天。35%的患者出现神经并发症，55%的患者康复出院。在比较死亡率、住院天数和长期问题时，未显示出亨利氏经典入路相对于有限暴露并应用金属夹有任何优势。由于其相对简单，我们建议在损伤部位上下对椎动脉进行金属夹闭是一种可用于止血的有效技术。1例患者在刺伤后出现椎动脉假性动脉瘤，通过切除动脉瘤并用大隐静脉移植进行椎动脉-椎动脉旁路移植术成功治疗。
