枕神经痛发病的相关因素及其机制分析

Evaluation on related factors and pathogenesis of occipital neuralgia

目的:总结165例枕神经痛患者发病的临床特点,探讨其发病机制。方法:用预先制订的诊断标准及观察表,对成都5家大型综合性医院神经科门诊枕神经痛患者进行治疗观察及记录,病情判定采用患者自评101点数字评分法(NRS),医生评估采用六点行为疼痛测定法(BRS)。自评和医评在治疗前进行1次,以后每周进行1次,观察治疗3周。结果:符合纳入标准的165例,其中以枕大神经痛占绝大多数(92.7%),男女比为0.6:1,年龄发病高峰40～70岁(58.8%),职业以工、农及文职人员占多数为72.1%,冬春发病为高峰,分别为60.9%和22.4%,无明显诱因者为73.3%,病情1周内缓解者为54.7%,2周内缓解79.5%,其余在三四周内缓解。结论:枕神经特殊的解剖特点与包裹它的结缔组织悬浮网结构是其发病的基础,颈椎病、颈部肌肉慢性劳损及创伤是发病的主要原因,其次是天气寒冷,劳累及职业等因素。

AIM:To summarize the clinic characters of 165 patients with occipital neuralgia in order to investigate the pathogenesis. METHODS:Patients with occipital neuralgia from five large general hospitals in Chengdu were observed and recorded by using diagnostic criteria and investigating tables made in advance. Patients' conditions were determined by the 101 point numeric rating scale (NRS) by patients themselves and the six point behavior pain rating scale (BRS) by doctors before treatment, and once a week followed. The observation treatment lasted for 3 weeks. RESULTS:Totally 165 cases consistent with the inclusion criteria were adopted,the majority were patients with greater occipital neuralgia (92.7%), the ratio of male to females was 0.6∶1,morbidit age was mainly from 40 to 70 years old(58.8%). Occupations distribute mainly occurred in workers, peasants and civil servants, and the percentage was 72.1%. The morbidity season was mainly in winter or spring, the percentages were 60.9% and 22.4% respectively. Among these patients,73.3%patients had no evocative factors,54.7%patients were improved within one week,and 79.5% patients were improved within two weeks, and the others took a turn for the better within 3-4 weeks. CONCLUSION:The onset basis of occipital neuralgia is the special anatomic features of occipital nerve and the connective tissue suspension networks which surrounding it.The main etiological factors are cervical spondylosis,chronic straining or trauma of cervical muscles, and the second is cold weather, tiredness, occupations etc.