The Complexity of Trauma to the Cranio-Cervical Junction: Correlation of Clinical Presentation with Doppler Flow Velocities in the V3-Segment of the Vertebral Arteries
The Complexity of Trauma to the Cranio-Cervical Junction: Correlation of Clinical Presentation with Doppler Flow Velocities in the V3-Segment of the Vertebral Arteries
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颅颈交界处创伤的复杂性：临床表现与椎动脉 V3 段多普勒血流速度的相关性
DOI：
10.1007/s007010200078
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发表时间：
2002
影响因子：
2.4
通讯作者：
C. Matula
中科院分区：
文献类型：
--
作者：
M. Reddy;B. Reddy;A. Schöggl;W. Saringer;C. Matula
Summary.Background:颅颈交界处（CCJ）创伤包括广泛而复杂的损伤谱，临床表现范围更广，由于该区域创伤与神经外科主要关注领域接壤，因此这些相对罕见的损伤可以被忽略。事实上，自从查尔斯·贝尔爵士在1817年首次报道了一例枕骨髁骨折的病例以来，文献中就有大量的文献记载。在该病例中，一名患者在离开医院时，转过头去感谢医生和护士，突然死亡。死亡是由于压缩的延髓骨折枕髁。方法：在我们的部门，我们一直在应用专门的诊断程序，在我们的临床工作中的急性和慢性情况下，孤立的损伤CCJ以及多发性创伤CCJ参与共33例患者在整个3年期间（1997年至2000年）。在这篇文章中，我们提出了我们的一些经验，这些诊断程序，介绍了应用V3段多普勒的椎动脉（VA），我们认为这是一个有效的补充方法，在一个精确的工作了CCJ损伤。椎动脉的V3段，特别是在其穿过寰椎上级关节面后面的沟的地方，特别容易受到损伤。作者测量流速的V3段从一个点下面，大约2至3厘米背乳突profiles.Findings：所有患者进行了调查的发生率的变化，在V3段的VA后遭受CCJ损伤的血流量。有一个增加或减少的流速在创伤患者的挥鞭伤以及枕骨髁骨折和相关韧带损伤的患者。在严重的损伤，一些致命的结果，夹层或血栓形成的VA被发现与损失的V3-多普勒血流信号，或更确切地说，流voice.Conclusion：CCJ损伤多发伤患者以及在患者出现延迟发作的症状往往仍然不被承认，尽管在医学上的进步。CCJ损伤具有潜在的致命性，如果早期发现可以治疗。V3方法能够在CCJ损伤的初步检查中进行快速、有效、可行和廉价的诊断。
Summary.Background: Trauma to the craniocervical junction (CCJ) encompasses a wide and complex spectrum of injury with an even broader range of clinical presentation, and since trauma to this area borderlines neurosurgical main areas of interest, these relatively rare injuries can be overlooked. In fact, there has been an abundance of documentation in the literature since Sir Charles Bell first reported on a case of occipital condyle fracture in 1817 in which a patient suddenly dropped dead as he turned his head to thank physicans and nurses while leaving the hospital. The death was attributed to compression of the medulla oblongata by a fractured occipital condyle.Method: At our department, we have been applying specialized diagnostic procedures in our clinical work-up in the acute and chronic situation of isolated injury to the CCJ as well as polytrauma with CCJ involvement in a total of 33 patients throughout a 3-year period (1997 to 2000). In this article, we present some of our experiences with these diagnostic procedures, introducing the application of V3-segment Doppler of the vertebral artery (VA), which we consider to be an effective supplementary method in a precise work-up in CCJ injury. The V3-segment of the vertebral artery, especially where it courses through its' groove behind the superior facet of the atlas is particularly vulnerable to injury. The authors measured flow velocity of the V3-segment from a point just below and roughly 2 to 3 centimeters dorsal to the mastoid process.Findings: All patients were investigated for the occurence of changes in the blood flow in the V3-segment of the VA after suffering a CCJ injury. There was an increase or decrease in the flow velocity in trauma patients with whiplash injuries as well as in patients with occipital condyle fractures and associated ligament injury. In severe injuries, some with fatal outcome, a dissection or thrombosis of the VA was found with a loss of the V3-doppler flow signal, or rather flow void.Conclusion: CCJ injuries in the polytrauma patient as well as in patients presenting with delayed onset of symptoms often remain unrecognised, despite the advances in medicine. CCJ injuries are potentially lethal and can be treated if detected early. The V3 method enables rapid, effective, feasible and inexpensive diagnosis in the initial work-up of CCJ-injury.