[1]刘培太 张军 吴硕柱 杨永辉△.颈性眩晕发病机制探讨[J].中国中医骨伤科杂志,2019,27(06):13-17,22.
　LIU Peitai ZHANG Jun WU Shuozhu YANG Yonghui.Study on the Clinical Characteristics and Pathogenesis of Cervical Vertigo[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2019,27(06):13-17,22.
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颈性眩晕发病机制探讨()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第27卷
期数:
2019年06期
页码:
13-17,22
栏目:
临床研究
出版日期:
2019-06-04

文章信息/Info

Title:
Study on the Clinical Characteristics and Pathogenesis of Cervical Vertigo
文章编号:
1005-0205(2019)06-0013-05
作者:
刘培太1 张军1 吴硕柱1 杨永辉2△
1安徽蚌埠市第一人民医院(安徽 蚌埠,233000) 2陕西宝鸡市中医医院
Author(s):
LIU Peitai1 ZHANG Jun1 WU Shuozhu1 YANG Yonghui2△
1The First People's Hospital of Bengbu,Bengbu 233000,Anhui China; 2 Baoji Traditional Chinese Medicine Hospital,Baoji 721000,Shaanxi China.
关键词:
颈性眩晕;  颈椎病;  颈椎不稳;  磁共振成像;  发病机制
Keywords:
cervical vertigo;  cervical spondylosis;  cervical instability;  magnetic resonance imaging;  pathogenesis
分类号:
R681.5
文献标志码:
A
摘要:
目的:探讨颈性眩晕(CV)的临床特点及其发病机理。方法:前瞻性收集60例颈性眩晕患者,将颈性眩晕又分为一般性头晕和旋转性头晕2种。观察患者颈肩部压痛、颈椎不稳定和颈椎管内神经压迫情况。颈椎管内神经压迫根据颈椎间盘突出或椎体后缘增生部位分为2类,即中央椎管区髓性压迫(5型8亚型)和侧方椎管区根性压迫(3型)。结果:大部分患者为轻型椎管内神经压迫(1-2型髓性压迫或1型根性压迫,57例),有颈椎不稳定(41例)和重型颈肩部压痛(48例)。另外,一般性头晕46例,旋转性头晕14例,前者椎管内神经压迫多数为中央型压迫(42例),后者多数为非中央型压迫(11例),两组比较差异有统计学意义(P<0.05)。结论:颈性眩晕是与颈椎间盘轻度退变相关的临床综合征,轻度颈椎间盘退变、颈椎不稳定、颈肩部疼痛对颈交感神经刺激的综合效应足够强大是颈性眩晕发病的充分必要条件,旋转性头晕可能与颈椎间盘非中央型轻度退变性压迫有关。
Abstract:
Objective:To study the pathogenesis of cervical vertigo(CV). Methods:Sixty patients with cervical vertigo were collected prospectively. Their situations about neck and shoulder tenderness,cervical instability and nerve compression within cervical spinal canal were studied. Cervical vertigo was divided into general dizziness and rotation dizziness. According to the position of cervical disc herniation or posterior edge hyperplasia,the nerve compression within cervical spinal canal was divided into two categories:medullary compression at central spinal canal(5 types,8 subtypes)and root compression at lateral spinal canal(3 types).Results:Most of the patients had mild nerve compression(type 1-2 medullary compression or type 1 root compression,57 cases),cervical instability(41 cases)and severe cervical and shoulder tenderness(48 cases). There were 46 cases of general dizziness and 14 cases of rotational dizziness in the observation group. In the classification of the nerve compression,the former was mostly central compression(42 cases),the latter was mostly non-central compression(11 cases),the difference between the two groups was significant(P<0.05). Conclusion:Cervical vertigo is a clinical syndrome associated with mild degeneration of cervical intervertebral disc. The comprehensive effect of mild cervical disc degeneration,cervical instability and neck and shoulder pain on cervical sympathetic nerve stimulation is strong enough,which is a necessary and sufficient condition for the pathogenesis of CV. Rotational CV may be associated with mild non-central type degenerative compression of the cervical intervertebral disc.

参考文献/References:

[1] RYAN G M,COPE S. Cervical vertigo[J]. Lancet,1955,31:1355-1360.
[2] 叶洁,顾小华,许金海,等. 颈性眩晕的中医证型与脑血流动力学的相关性研究[J].中国中医骨伤科杂志,2014,22(3):7-10.
[3] 谢辉,马善治,郭剑华.颈性眩晕中医证治研究进展[J].实用中医药杂志,2014,30(12):1184-1186.
[4] HAIN T C. Cervicogenic causes of vertigo[J]. Curr Opin Neurol,2015,28(1):69-73.
[5] REILEY A S,VICKORY F M,FUNDERBURG S E,et al. How to diagnose cervicogenic dizziness[J]. Archives of Physiotherapy,2017,7:12-17.
[6] STULIN I D,TARDOV M V,KUNELSKAYA N L,et al. Cervical vertigo:a neurologist's point of view[J]. Zhurnal Nevrologii I Psikhiatrii Imeni SS Korsakova,2018,118(3):97-102.
[7] 中华医学会神经病学分会. 眩晕诊治专家共识[J].中华神经科杂志,2010,43(5):369-374.
[8] 刘延青,刘希海,孙宇,等. 交感型颈椎病患者颈椎不稳定的X线测量[J].中国脊柱脊髓杂志,2003,13(10):600-603.
[9] 宋佳,宋滇文,贾连顺,等.颈椎间盘源性疼痛的研究进展[J].中国脊柱脊髓杂志,2013,23(5):468-471.
[10] 彭宝淦,杨亮. 颈性头晕的发病机制[J]. 武警医学,2017,28(5):433-435.
[11] YANG L,YANG C,PANG X,et al. Mechanoreceptors in Diseased Cervical Intervertebral Disc and Vertigo[J]. J Spine,2017,42(8):540-546.
[12] 孙胜,张强,赵昌松,等. 低温等离子射频消融术治疗颈性眩晕的疗效观察[J]. 颈腰痛杂志,2014,35(3):170-173.
[13] 罗展鹏,郭立新,鲍达,等. 低温等离子射频消融髓核成形术治疗颈性眩晕的疗效[J].实用临床医药杂志,2015,19(21):56-58.
[14] LAURIKAINEN E A,KIM D,DIDIER A,et al.Stellate ganglion drives sympathetic regulation of cochlear blood flow[J]. Hearing Research,1993,64(2):199-204.
[15] 冷思宏,严国强,秦烨,等.针刺结合颈交感神经阻滞治疗椎动脉型颈椎病及其对血流动力学的影响[J].中国医药科学,2012,7(2):19-21.
[16] 常飞燕,谢晟,李中实,等. 利用三维伪连续脉冲动脉自旋标记测量颈性眩晕相关的脑血流量改变的初步研究[J].中华放射学杂志,2014,48(1):25-28.
[17] 顾韬,王新伟,袁文,等. 颈椎间盘与后纵韧带上交感神经分布的特点及临床意义[J]. 中华实验外科杂志,2007,24(6):665-668.
[18] 顾韬,王新伟,袁文,等. 颈椎间盘与后纵韧带上交感神经的解剖学观察及在颈椎间盘源性疼痛中作用的探讨[J]. 脊柱外科杂志,2008,6(1):36-39.
[19] 袁文,梁磊,王新伟.对伴交感神经症状颈椎病的认识与治疗探讨[J].中国脊柱脊髓杂志,2013,23(1):3-5.
[20] 王新伟,顾韬,袁文,等.伴交感神经症状颈椎病的治疗及其机制[J].中华外科杂志,2008,46(18):1424-1427.
[21] 薛睿,申勇,王林峰,等. 伴交感神经症状的脊髓型颈椎病前路手术中切除后纵韧带的早期疗效研究[J]. 中华骨科杂志,2013,33(2):105-110.
[22] 梁磊,王新伟,袁文,等. 前路经椎间隙减压固定融合术治疗伴交感神经症状颈椎病的的疗效分析[J].中国脊柱脊髓杂志,2012,22(1):14-19.
[23] 何阿祥,谢栋,蔡晓敏,等. 伴颈性眩晕颈椎病手术治疗[J]. 中国矫形外科杂志,2016,26(21):1927-1931.
[24] 孟阳,张琰,沈彬,等. 颈前路椎间盘切除减压融合术治疗交感型颈椎病[J]. 颈腰痛杂志,2013,34(3):210-212.
[25] 钟卓霖,胡建华,翟吉良,等.伴随颈椎病颈性眩晕的手术治疗[J].中华医学杂志,2015,95(25):2014-2017.
[26] 黄素芳,王朝亮,刘翠翠,等.椎枕肌-椎动脉疼痛反射弧在颈性眩晕中意义及临床应用[J].中医临床研究,2017,9(31):20-23.
[27] MORINAKA S. Musculoskeletal diseases as a causal factor of cervical vertigo[J]. Auris Nasus Larynx,2009,36(6):649-654.
[28] YAHIA A,GHROUBI S,JRIBI S,et al. Chronic neck pain and vertigo:is a true balance disorder present?[J].Ann Phys Rehabil Med,2009,52(7-8):556-567.
[29] 李曙明,张银刚,吴学元,等. 颈部疼痛在颈性眩晕的发病机制中的作用[J].西安交通大学学报:医学版,2009,30(3):356-358.
[30] 金坚,赵玲丹. 手法推拿联合针灸治疗老年颈性眩晕的效果及对椎-基底动脉血流动力学的影响[J].中国老年学杂志,2014,34(9):2403-2405.
[31] HE Y S,MA L Y. Therapeutic observation of acupuncture plus tuina for cervical vertigo[J].J Acupunct Tuina Sci,2018,16(5):323-328.
[32] 姬成茂,袁小华,高有安,等. 龙氏正骨手法加星状神经节阻滞治疗颈源性眩晕38例[J].中国中医骨伤科杂志,2017,25(12):31-35.
[33] 左金良,韩建龙,马英文,等. 交感神经在兔椎动脉被膜节段性分布的实验研究[J].泰山医学院学报,2006,27(2):107-109.
[34] ZUO J,HAN J,QIU S,et al. Neural reflex pathway between cervical spinal and sympathetic gangliain rabbits:implication for pathogenesis of cervical vertigo[J]. Spine J,2014,14(6):1005-1009.

备注/Memo

备注/Memo:
△通信作者 E-mail:yangyonghui0917@163.com
更新日期/Last Update: 2019-06-04