彩色多普勒超声在单侧双支椎动脉中的诊断价值及临床意义

doi:10.3877/cma.j.issn.1674-0785.2021.05.005

目的

探讨彩色多普勒超声在单侧双支椎动脉中的诊断价值及临床意义。

方法

选取2020年1月至2021年1月首都医科大学附属北京朝阳医院疑诊为椎动脉型颈椎病并接受颈部动脉彩色多普勒超声检查的患者1139例，采用彩色多普勒超声对颈部血管进行检测，重点观察椎动脉起始部位、走行情况、入横突孔位置、各个节段的内径、血流速度及频谱形态，并测量和记录。

结果

（1）1139例疑诊为椎动脉型颈椎病的患者中发现9例（0.79%）单侧双支椎动脉。（2）左侧双支椎动脉4例，内侧支均起自主动脉弓，外侧支均起自左侧锁骨下动脉，2例于C4水平汇合，2例于C5水平汇合。右侧双支椎动脉5例，4例内侧支起自右侧锁骨下动脉，1例起自右侧颈总动脉，5例外侧支均起自右侧锁骨下动脉，3例于C4水平汇合，2例于C5水平汇合。（3）4例左侧双支椎动脉中，内侧支的内径均大于外侧支。5例右侧双支椎动脉中，仅1例内侧支的内径小于外侧支，其余4例内侧支的内径均大于外侧支。（4）内侧支起始处的峰值流速均高于外侧支，内侧支汇合前的峰值流速均高于外侧支。

结论

彩色多普勒超声能够对单侧双支椎动脉进行明确诊断，并获得血流动力学信息，具有很高的应用价值及临床意义。

关键词: 彩色多普勒超声, 单侧双支椎动脉, 椎动脉变异, 血流动力学

Objective

To explore the diagnostic value and clinical significance of color Doppler ultrasound in duplication of vertebral artery.

Methods

From January 2020 to January 2021 a total of 1139 patients in Beijing Chaoyang Hospital, Capital Medical University suspected of cervical spondylosis of vertebral artery type underwent color Doppler ultrasound examination of the cervical artery were selected. Color Doppler ultrasound was used to detect the cervical blood vessels. The starting position of the vertebral artery, the course, the position of entering transverse foramen, the inner diameter of each segment, the blood flow velocity and the spectrum morphology were observed, then measured and recorded.

Results

(1) Among 1139 patients suspected of cervical spondylosis of vertebral artery type, 9 cases (0.79%) were found with duplication of vertebral artery. (2) There were 4 cases of duplication of vertebral artery on the left. The medial limbs were all from the aortic arch, and the lateral limbs were all from the left subclavian artery. 2 cases were combined at the C4 level, and 2 cases were combined at the C5. There were 5 cases of duplication of vertebral artery on the right. There were 4 cases of medial limbs from right subclavian artery, 1 case from right common carotid artery, 5 cases of lateral limbs were all from right subclavian artery, 3 cases were combined at the C4 level, and 2 cases were combined at the C5. (3) In 4 cases of left duplication of vertebral artery, the inner diameter of the medial limb was larger than that of the lateral limb. In 5 cases of right duplication of vertebral artery, the inner diameter of the medial limb was smaller than that of the lateral limb in only 1 case, and the inner diameter of the medial limb was larger than that of the lateral limb in the other 4 cases. (4) The peak velocity at the beginning of the medial limb was higher than that of the lateral limb, and the peak velocity before the confusion of medial limb was higher than that of the lateral limb.

Conclusion

Color Doppler ultrasound can clearly diagnose duplication of vertebral artery and obtain hemodynamic information, which has high application value and clinical significance.

Key words: Color Doppler ultrasound, Duplication of vertebral artery, Vertebral artery variation, Hemodynamics

表1 9例单侧双支椎动脉的彩色多普勒超声特征

编号	性别	年龄（岁）	发生变异侧	内侧支					外侧支					汇合后
编号	性别	年龄（岁）	发生变异侧	起源	汇合水平	内径（mm）	起始处PSV （cm/s）	汇合前PSV （cm/s）	起源	进入椎间隙的水平	内径（mm）	起始处PSV （cm/s）	汇合前PSV（cm/s）	内径（mm）	PSV （cm/s）
1	女	50	左	Aortic arch	C5	2.4	83	61	LSCA	C6	1.9	66	45	3.4	58
2	女	55	左	Aortic arch	C4	2.7	88	67	LSCA	C6	1.8	65	49	3.1	68
3	男	49	左	Aortic arch	C5	2.5	87	65	LSCA	C6	1.5	57	48	2.9	66
4	女	46	左	Aortic arch	C4	2.6	75	55	LSCA	C6	1.9	60	48	3.0	61
5	女	63	右	RSCA	C4	3.1	82	58	RSCA	C6	1.9	79	42	3.2	59
6	男	56	右	RSCA	C5	2.0	68	50	RSCA	C6	2.2	59	48	3.1	58
7	男	46	右	RSCA	C5	2.5	83	66	RSCA	C6	1.8	63	45	3.0	69
8	女	49	右	RSCA	C4	3.0	79	62	RSCA	C6	1.6	59	46	3.2	65
9	男	54	右	RCCA	C4	2.2	68	53	RSCA	C6	2.0	84	47	3.2	56

表1 9例单侧双支椎动脉的彩色多普勒超声特征

编号	性别	年龄（岁）	发生变异侧	内侧支					外侧支					汇合后
编号	性别	年龄（岁）	发生变异侧	起源	汇合水平	内径（mm）	起始处PSV （cm/s）	汇合前PSV （cm/s）	起源	进入椎间隙的水平	内径（mm）	起始处PSV （cm/s）	汇合前PSV（cm/s）	内径（mm）	PSV （cm/s）
1	女	50	左	Aortic arch	C5	2.4	83	61	LSCA	C6	1.9	66	45	3.4	58
2	女	55	左	Aortic arch	C4	2.7	88	67	LSCA	C6	1.8	65	49	3.1	68
3	男	49	左	Aortic arch	C5	2.5	87	65	LSCA	C6	1.5	57	48	2.9	66
4	女	46	左	Aortic arch	C4	2.6	75	55	LSCA	C6	1.9	60	48	3.0	61
5	女	63	右	RSCA	C4	3.1	82	58	RSCA	C6	1.9	79	42	3.2	59
6	男	56	右	RSCA	C5	2.0	68	50	RSCA	C6	2.2	59	48	3.1	58
7	男	46	右	RSCA	C5	2.5	83	66	RSCA	C6	1.8	63	45	3.0	69
8	女	49	右	RSCA	C4	3.0	79	62	RSCA	C6	1.6	59	46	3.2	65
9	男	54	右	RCCA	C4	2.2	68	53	RSCA	C6	2.0	84	47	3.2	56

图1 左侧双支椎动脉内侧支起自主动脉弓

图2 左侧双支椎动脉外侧支起自左侧锁骨下动脉

图3 左侧双支椎动脉内侧支与外侧支于C4水平汇合

图4 左侧双支椎动脉内侧支与外侧支于C5水平汇合

图5 右侧双支椎动脉内侧支起自右侧锁骨下动脉

图6 右侧双支椎动脉内侧支起自右侧颈总动脉

图7 右侧双支椎动脉外侧支起自右侧锁骨下动脉

图8 右侧双支椎动脉内侧支与外侧支于C4水平汇合

图9 右侧双支椎动脉内侧支与外侧支于C5水平汇合

图10 内侧支起始处峰值流速（图a）大于外侧支（图b）

图11 内侧支汇合前峰值流速（图a）大于外侧支（图b）

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Diagnostic value and clinical significance of color Doppler ultrasound in duplication of vertebral artery

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Diagnostic value and clinical significance of color Doppler ultrasound in duplication of vertebral artery