超声诊断椎动脉起源及走行异常的临床应用价值

摘要

Objective To evaluate the ultrasonic diagnosis value of congenital variation of extracranial vertebral artery(VA).Methods The VA in 8557 patients with vertebra artery type of cervical spondylosis were examined by ultrasonography.The rate of the congenital variation of VA were analyzed.The vascular morphological changes and hemodynamics of the vertebral artery which involves the diameter,route,starting point,peak systolic velocity(PSV),end diastolic velocity(EDV) and resistance index(RI) were also observed.The blood flow parameters of patients with vertebral artery origin variation were statistically analyzed and compared to the control group.Results In the 8775 cases with doubtful vertebrobasilar insufficiency,the rate of abnormal entrance position into the transverse foramen was 6.8％ (581/8557),the rate in left side was 43.0％ (250/581),the rate in right side was 35.8％ (208/581),the rate in both sides was 21.2％ (123/581).The rate of original variation was 1.1％(99/8557),96.9％ (96/99),the rate of original variation in right side was 3.1％ (3/99).The vertebral artery diameter and intervertebral paragraphs in case group were less than the normal control group [starting segment:(3.0 ±0.7)cm vs (3.9 ±0.7)cm,intervertebral segments:(3.1 ±0.7)cm vs (3.7 ±0.6)cm],RI were greater than those in normal control group [starting segment:(0.72 ± 0.08) vs (0.68 ± 0.07),intervertebral segments:(0.69 ± 0.07) vs (0.65 ± 0.07),P ＜ 0.01 or P ＜ 0.05),and PSV,EDV of starting period of vertebral artery in the case group of were higher than the normal control group (RSV):(73 ± 22) cm/s vs (66 ± 22) cm/s,EDV (20 ±7)cm/s vs (20 ±6)cm/s,P＜0.01 or P＜0.05)],intervertebral PSV,EDV were lower than those in normal control group [RSV:(52 ± 15) cm/s vs (53 ± 14) cm/s,EDV (16 ± 5) cm/s vs (18 ± 6) cm/s,P ＜ 0.01 or P ＜ 0.05].Conclusions Ultrasonography is a rapid,non-invasive,and no radioactive method for the diagnosis of anomalous origin of vertebral artery.The original variation of VA which the vascular morphological and hemodynimics has often happened in the left side.%目的 探讨彩色多普勒超声在椎动脉起源及走行异常中的临床应用价值.方法 对8557例椎基底动脉供血不足患者进行颅外段椎动脉彩色多普勒超声诊断检查,分析椎动脉起源及走行异常的发生率,观察起源异常椎动脉起始部位、内径、走行、收缩期峰值血流速度(PSV)、舒张期峰值(EDV)及血流阻力指数(RI),并且与65例正常对照组进行比较.结果 8557例椎动脉供血不足患者中椎动脉入横突孔位置异常的发生率为6.8％(581例),其中左侧发生率为43.0％ (250/581)、右侧发生率为35.8％ (208/581),双侧发生率为21.2％(123/581).椎动脉起源异常的发生率为1.1％(99例),其中左侧发生率为96.9％(96/99)、右侧发生率为3.1％ (3/99).病例组椎动脉起始段及椎间段内径均小于正常对照组[起始段:(3.0±0.7)cm比(3.9±0.7)cm,椎间段:(3.1±0.7)cm比(3.7±0.6)cm],RI均大于正常对照组[起始段:(0.72±0.08)比(0.68±0.07),椎间段:(0.69±0.07)比(0.65 ±0.07)],椎动脉起始段PSV、EDV均高于正常对照组[RSV:(73±22) cm/s比(66±22) cm/s；EDV:(20±7)cm/s比(20±6) cm/s,P＜0.01或P＜0.05],椎间段PSV、EDV均低于正常对照组[RSV:(52±15) cm/s比(53±14) cm/s,EDV:(16±5) cm/s比(18±6)cm/s],差异均有统计学意义(P＜0.01或P＜0.05)].结论 彩色多普勒超声能快速、无创、无辐射地诊断椎动脉走行及起源变异.椎动脉起源异常主要位于左侧,起源变异的椎动脉常伴有入椎间孔异常、内径纤细,阻力指数增高.