Vertebral artery injuries in cervical spine surgery.
Vertebral artery injuries in cervical spine surgery.
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DOI：
10.4103/2152-7806.120777
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发表时间：
2013
影响因子：
--
通讯作者：
Hsu WK
中科院分区：
文献类型：
--
作者：
Schroeder GD;Hsu WK
颈椎手术中椎动脉损伤是罕见的，但可能是致命的。在进行颈椎手术时，外科医生必须有一个系统的方法来避免，如果必要的话，处理椎动脉损伤。这是一篇综述论文。上后路颈椎手术使椎动脉面临的风险最高，而下颈椎前路手术则使动脉面临的风险最低。在进行颈椎手术之前，必须彻底了解椎动脉的复杂解剖结构，并且由于椎动脉可以具有可变的路线，特别是在上颈椎中，外科医生必须通过术前使用计算机断层扫描（CT）扫描或磁共振成像（MRI）评估动脉来最大限度地减少动脉损伤的可能性。术中，外科医生必须了解椎动脉何时最危险，并采取预防措施以避免损伤。在动脉损伤的情况下，外科医生必须有一个行动计划，以（1）控制出血。(2)预防急性中枢神经系统缺血。(3)预防栓塞和假性动脉瘤等术后并发症在进行颈椎手术之前，必须了解椎动脉损伤的四个A：解剖、评估、避免和行动。
Vertebral artery injuries during cervical spine surgery are rare, but potentially fatal. When performing cervical spine surgery, it is imperative that the surgeon has a systematic approach for avoiding, and if necessary, dealing with a vertebral artery injury. This is a review paper. Upper posterior cervical spine surgeries put the vertebral artery at the highest risk, as opposed to anterior subaxial cervical spine procedures, which put the artery at the least risk. A thorough understanding of the complex anatomy of the vertebral artery is mandatory prior to performing cervical spine surgery, and since the vertebral artery can have a variable course, especially in the upper cervical spine, the surgeon must minimize the possibility of an arterial injury by preoperatively assessing the artery with a computed tomography (CT) scan or magnetic resonance imaging (MRI). Intraoperatively, the surgeon must be aware of when the vertebral artery is most at risk, and take precautions to avoid an injury. In the event of an arterial injury, the surgeon must have a plan of action to (1) Achieve control of the hemorrhage. (2) Prevent acute central nervous system ischemia. (3) Prevent postoperative complications such as embolism and pseudoaneurysm Prior to performing cervical spine surgery, one must understand the four A's of vertebral artery injuries: Anatomy, Assessment, Avoidance, and Action.