Johnson C P, Scraggs M, How T, Burns J
Sub-Department of Forensic Pathology, Royal Liverpool University Hospital.
J Clin Pathol. 1995 Jul;48(7):637-40. doi: 10.1136/jcp.48.7.637.
To establish whether abnormalities in the course of the vertebral artery occur and whether they are relevant to arterial injury associated with head and neck movements.
Twenty vertebral arteries were carefully dissected at necropsy and abnormalities in course were noted, along with any other bony or cartilaginous cervical anomalies. The effect of head and neck movement on these vessels was studied before a detailed histomorphometric examination was undertaken on sections of the excised arteries.
Five vessels had an abnormal course. One vessel entered the transverse foramina of the fifth cervical vertebra rather than the sixth, but was otherwise normal. In two subjects both vertebral arteries were abnormal in the upper cervical portion with, in each case, a straight left vertebral artery and a right vertebral artery with a deficient loop, closely applied to the atlanto-axial joint. Both of these subjects also had completely ossified stylohyoid ligaments and the arteries visibly stretched with modest head and neck movements. Histology revealed variable degrees of smooth muscle disarray in the tunica media of two of the arteries with loop deficiencies. The circumference of one of the straight arteries was smaller than expected but in all other measured histomorphometric parameters these vessels appeared normal.
Vertebral artery loops are deficient in a number of subjects. This finding is important given the recently described biomechanical susceptibility of the vertebral artery to longitudinal extension and may explain the smooth muscle changes, in that this may represent attempts at arterial wall remodelling. Subjects with such loop deficiencies may be more susceptible to a variety of head and neck insults and such abnormalities should be sought at necropsy in subjects who die as a result of fatal vertebral artery injury.
确定椎动脉走行是否存在异常，以及这些异常是否与头颈部运动相关的动脉损伤有关。
在尸检时仔细解剖20条椎动脉，记录走行异常情况以及其他任何颈椎的骨性或软骨性异常。在对切除的动脉切片进行详细的组织形态计量学检查之前，研究头颈部运动对这些血管的影响。
5条血管走行异常。1条血管进入第5颈椎横突孔而非第6颈椎横突孔，但其他方面正常。在2名受试者中，双侧椎动脉在上颈椎段均异常，其中1例左侧椎动脉走行笔直，右侧椎动脉袢缺如，紧贴寰枢关节。这2名受试者的茎突舌骨韧带均完全骨化，并且在头颈部轻度运动时可见动脉明显拉伸。组织学检查显示，2条有袢缺如的动脉中膜平滑肌排列紊乱程度各异。1条笔直动脉的周长小于预期，但在所有其他测量的组织形态计量学参数方面，这些血管看起来正常。
许多受试者存在椎动脉袢缺如的情况。鉴于最近描述的椎动脉对纵向伸展的生物力学易感性，这一发现很重要，并且可能解释了平滑肌的变化，因为这可能代表动脉壁重塑的尝试。有这种袢缺如的受试者可能更容易受到各种头颈部损伤，在因致命性椎动脉损伤死亡的受试者尸检时应寻找此类异常情况。
