CAJ | 학술논문

目的探讨颈椎手术中并发椎动脉损伤的发生原因、治疗及预防.方法回顾性分析2002年10月至2012年4月颈椎手术中并发椎动脉损伤的7例患者资料,男6例,女1例；年龄23～65岁,平均48.9岁；脊髓型颈椎病5例,颈椎外伤合并C4.5半脱位1例,氟骨症致颈椎管狭窄1例.椎动脉损伤均为单侧,左侧4例,右侧3例.分析颈椎手术中并发椎动脉损伤的原因、处理过程及预后.结果颈椎前路手术4例,其中2例用环钻减压时偏离中线损伤椎动脉,1例切除稚间盘时刮匙过于偏外损伤椎动脉,1例颈椎外伤患者由于C4,5半脱位造成椎动脉迂曲,减压时冲击式咬骨钳损伤椎动脉.颈椎后路手术3例,其中2例为行C4侧块螺钉固定时钻头偏外损伤椎动脉；1例氟骨症致颈椎管狭窄者在切除寰椎后弓时咬骨钳损伤椎动脉,术中出现椎动脉损伤后,迅速填塞压迫止血并关闭伤口,但术后4周发生迟发性出血,采用椎动脉栓塞止血及颈后路血肿清除术治疗.7例患者均未发生脑梗塞,其中2例患者术后出现-过性头晕.结论椎动脉损伤是颈椎手术的严重并发症,其损伤原因与手术失误、解剖变异等有关；采用直接压迫及椎动脉栓塞治疗效果确切.
목적 탐토경추수술중병발추동맥손상적발생원인、치료급예방.방법 회고성분석2002년10월지2012년4월경추수술중병발추동맥손상적7례환자자료,남6례,녀1례；년령23～65세,평균48.9세；척수형경추병5례,경추외상합병C4.5반탈위1례,불골증치경추관협착1례.추동맥손상균위단측,좌측4례,우측3례.분석경추수술중병발추동맥손상적원인、처리과정급예후.결과 경추전로수술4례,기중2례용배찬감압시편리중선손상추동맥,1례절제치간반시괄시과우편외손상추동맥,1례경추외상환자유우C4,5반탈위조성추동맥우곡,감압시충격식교골겸손상추동맥.경추후로수술3례,기중2례위행C4측괴라정고정시찬두편외손상추동맥；1례불골증치경추관협착자재절제환추후궁시교골겸손상추동맥,술중출현추동맥손상후,신속전새압박지혈병관폐상구,단술후4주발생지발성출혈,채용추동맥전새지혈급경후로혈종청제술치료.7례환자균미발생뇌경새,기중2례환자술후출현-과성두훈.결론 추동맥손상시경추수술적엄중병발증,기손상원인여수술실오、해부변이등유관；채용직접압박급추동맥전새치료효과학절.
Objective To investigate cause,diagnosis,treatment and prevention of vertebral artery injury in cervical spine surgery.Methods Data of 7 patients with vertebral artery injury caused by cervical spine surgery from October 2002 to April 2012 were retrospectively analyzed.There were 6 males and 1 female,aged from 23 to 65 years (average,48.9 years).The reasons of cervical spine surgery were as follows:cervical spondylotic myelopathy (5 cases),traumatic subluxation of C4 and C5 (1 case),and cervical spinal stenosis due to skeletal fluorosis (1 case).All cases had unilateral vertebral artery injury,including 4 cases in the left side and 3 cases in the right side.The cause,treatment and prognosis of vertebral artery injury in 7 patients were analyzed.Results Four patients suffered from vertebral artery injury during anterior cervical spine surgery; 2 cases were caused by excessive lateral trepanation,1 by excessive lateral discectomy using a curette,and 1 by Kerrison punch during decompression in a patient with anomalous vertebral artery due to traumatic subluxation of C4 and C5.Three patients suffered from vertebral artery injury during posterior surgery; 2 cases were caused by a drill bit during drilling lateral mass of C4 and 1 by a rongeur during removing posterior C1 arch in a patient with cervical spinal stenosis due to skeletal fluorosis.After vertebral artery injury,all patients were immediately treated by hemostatic tamponade,and then the incisions were closed.However,1 patient occurred delayed cervical hemorrhage 4 weeks after operation.Then he underwent vertebral artery angiography,balloon embolization and evacuation of hematoma.All cases had no cerebral infarction.However,two of them had postoperative temporary dizziness.Conclusion Vertebral artery injury in cervical spine surgery is a rare but serious complication,which is associated with surgical mistakes and anatomical variations.Hemostatic tamponade and embolization are effective for this complication.