椎动脉旋转性压迫的超声诊断：适应证、检查方法、诊断标准与算法（俄罗斯专家共识文件）

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本文为俄罗斯专家就椎动脉旋转性压迫的超声诊断所形成的共识文件。椎动脉旋转性血管外压迫的发生率为5–17%。该病变是椎-基底动脉供血不足的重要原因之一，但亦可呈无症状经过。其临床表现缺乏特异性，但必然与头部位置改变相关，并在头部恢复至中立位后迅速缓解。当受压血管为优势椎动脉时，发生临床症状的风险显著增加。最常见的受压水平为：青年及中年患者以第三段（V3）为主，老年患者多见于第二段（V2）。椎动脉旋转性压迫的病因包括先天性骨骼异常、获得性骨骼畸形、颈部肌肉肥厚或痉挛，以及颈部各种占位性病变对血管的压迫。

由于缺乏统一的诊断标准，且临床医师对椎动脉旋转性压迫的临床表现及其诊断方法认识不足，临床实践中常出现该状态的过度诊断。

本文阐述了在应用头颈部旋转试验条件下进行超声检查的方法学（包括受检动脉、所使用的探头、患者与检查者的体位以及头部与颈部的旋转方式），并描述了在不同头位旋转情况下椎-基底动脉系统血管可视化的拓扑解剖学限制，以及所得结果的评估标准（压迫前、压迫后及压迫期的血流变化）。此外，文中提出了诊断算法，并明确了检查报告中需要注明的主要内容，同时提供了临床病例。作者强调，应对椎动脉各段、基底动脉或后脑动脉的血流动力学参数进行动态评估，以明确压迫的部位及其区域性血流学意义。所提出的算法有助于规范椎动脉旋转性压迫的超声诊断，并降低临床实践中的诊断错误风险。

作者简介

Andrey O. Chechetkin

Russian Сenter of Neurology and Neurosciences

编辑信件的主要联系方式.
Email: andreychechetkin@gmail.com
ORCID iD: 0000-0002-8726-8928
SPIN 代码: 9394-6995

MD, Dr. Sci. (Medicine)

俄罗斯联邦, Moscow

Tatyana V. Balakhonova

National Medical Research Centre of Cardiology named after Academician E.I. Chazov

Email: tvbdoc@gmail.com
ORCID iD: 0000-0002-7273-6979
SPIN 代码: 3738-3289

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow

Tatiana N. Enkina

North-Western District and Scientific Clinical Center named after L.G. Sokolov

Email: tatiana.enkina@yandex.ru
ORCID iD: 0009-0004-7739-1684
SPIN 代码: 7594-1380

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Vladimir P. Kulikov

Altai State Medical University

Email: kulikov57@mail.ru
ORCID iD: 0000-0003-4869-5465
SPIN 代码: 9224-1959

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Barnaul

Irina E. Timina

A.V. Vishnevsky National Medical Research Center of Surgery

Email: timina68@mail.ru
ORCID iD: 0000-0001-7026-9417
SPIN 代码: 1100-8854

MD, Dr. Sci. (Medicine)

俄罗斯联邦, Moscow

Ludmila E. Shulgina

Polyclinic No. 1 of the Presidential Administration of the Russian Federation

Email: ofd-shulgina@yandex.ru
ORCID iD: 0009-0009-6325-8766
SPIN 代码: 7757-2071

MD, Dr. Sci. (Medicine)

俄罗斯联邦, Moscow

Margarita V. Shumilina

National Medical Research Center for Cardiovascular Surgery named after A.N. Bakulev

Email: Shumilinamv@yandex.ru
ORCID iD: 0000-0001-9871-8173
SPIN 代码: 8102-9042

MD, Dr. Sci. (Medicine)

俄罗斯联邦, Moscow

参考

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2. Fig. 1. Head positions during ultrasound examination of the vertebral arteries with rotational tests: a — rotation to the right with extension; b — extension; c — left rotation with extension; d — right rotation; e — neutral position; f — left rotation; g — right rotation with flexion; h — flexion; i — left rotation with flexion. "+" — optimal visualisation; "+/−" — limited visualisation; "−" — visualisation impossible. V1 — first segment of the vertebral artery; V2 — second segment of the vertebral artery; V3 — third segment of the vertebral artery.

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3. Fig. 2. Patterns of prestenotic (a), stenotic (b), poststenotic (c) blood flow, and preocclusion blood flow (d).

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4. Fig. 3. Diagram of the algorithm for conducting an ultrasound examination with rotational samples.

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5. Fig. 4. Recording of blood flow in the arteries of the vertebral-basilar basin in a patient with functional compression of the left vertebral artery in the V3 segment. Recording of blood flow in the left vertebral artery: a — in the V2 segment with the head in a neutral position; b — in the V2 segment with the head turned to the right; c — in the V2 segment with the head turned to the right with extension; d — in the V3 segment with the head in a neutral position; e — in the V3 segment with the head turned to the right; f — in the V3 segment with the head turned to the right with extension. Registration of blood flow in the right vertebral artery: g — in the V1 segment with the head in a neutral position; h — in the V1 segment with the head turned to the right with extension. Blood flow recording in the left posterior cerebral artery: i — in the P1 segment with the head in a neutral position; j — in the P1 segment when turning the head to the right with extension; k — in the P2 segment with the head in a neutral position; l — in the P2 segment when turning the head to the right with extension; m — a 2-fold increase in blood flow velocity in the P1 segment during compression of the ipsilateral common carotid artery (the yellow arrow indicates the moment of compression). PPS — peak systolic velocity; IR — resistance index; LBA — left posterior cerebral artery.

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6. Fig. 5. Results of functional angiography (a) of the left vertebral artery and computed tomography (b) of the cervical spine: a — subtotal stenosis of the vertebral artery lumen above the second cervical vertebra (the site of compression is indicated by an arrow) when turning the head to the left with simultaneous extension; b — rotational subluxation of the second cervical vertebra (indicated by a dotted square).

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