颈部疼痛及颈性眩晕与交感神经反射弧的联系

Correlation of cervical pain and cervical vertigo with reflex arc of sympathetic nerve

目的:根据颈椎病患者的临床症状、体征及影像学检查结果探讨颈部疼痛和交感神经反应在颈性眩晕发病中的作用。方法:收集2003-05/2004-03西安交通大学第一医院骨科门诊及住院的颈椎病患者100例。发生眩晕时间超过1d为持续性眩晕47例,发生眩晕时间在1d之内为短暂性眩晕34例,晕厥(眩晕时发生晕倒)19例。根据主诉和临床表现记录颈部疼痛特点及与颈性眩晕的关系;观察椎动脉供血情况行彩色多普勒检查;观察颈椎骨质增生和椎间盘突出情况采用拍摄颈椎正侧、双斜及过屈过伸位X射线片及进行颈椎MRI检查的方法。结果:按意向处理分析,100例患者均进入结果分析。①颈部疼痛的特点:100例患者均有颈部疼痛,部分合并有枕、肩、胸背部或上肢疼痛。②颈椎疼痛与颈性眩晕的关系:49例患者先有颈部疼痛加剧,继而颈部僵硬后再发生眩晕,27例在颈部活动旋转和屈伸时诱发眩晕,1例在仰头劳作1周后诱发眩晕,1例在头部由前下向后上伸颈时诱发短暂性眩晕,22例无明显诱因,但发病前有一侧或两侧颈部明显的紧张性条索。③彩色多普勒检查:显示有椎动脉供血不足、狭窄、迂曲、粥样斑块形成以及入孔异常75例;椎动脉供血正常25例。④X射线片检查结果:均显示单间隙或多间隙颈椎骨质增生。⑤MRI检查结果:64例患者行颈椎MRI检查,均显示单个或多个椎间盘突出。结论:在颈部疼痛、交感神经和颈性眩晕之间有一个反射弧的存在。颈部疼痛可通过感觉与交感神经节之间的纤维联系,刺激交感神经使之兴奋,可使椎动脉发生短暂或持续的收缩,造成椎基底动脉供血不足,发生颈性眩晕。

AIM： According to the clinical symptom, physical sign and screenage test result in patients with cervical syndrome, discuss the effects of cervical pain and sympathetic nerve on the onset of cervical vertigo. METHODS： 100 patients from out-patient clinic of Department of Orthopedics of First Hospital of Xi＇an Jiaotong University and cervical syndrome inpatients between May 2003 and March 2004. The patients whose vertigo time was over one day were lasting giddy about 47 cases. The patients whose vertigo time was within one day were brief vertigo about 34 cases. There were 19 cases of faintness who fell in a faint at a state of vertigo. Based on the chief complaint and clinical situation, the relation between the character of cervical part ache and nuchae vertigo were recorded; The condition of supplying blood of vertebral artery with color Doppler test was observed; The condition of cervical vertebra bone matrix proliferation and protrusion with the shooting of right side, diploslope and over-flexion and over-extension X-ray sheet of cervical vertebra and cervical vertebra MR1 test technique was recorded. RESULTS： According to intention-to-treat analysis, 100 patients were all involved in the analysis of results. ① The character of cervical part ache： All 100 patients ached in cervical part, and part of them having the ache of occiput, shoulder, chest, back and epipodite. ② The relation between cervical vertebra ache and neck vertigo： Forty-nine of them cervical part ache intensified at the beginning, and then vertigo occurred after cervical part stiffness; Twenty-seven of them had giddy induced by cervical part active conbolution and extension; One of them was giddied one week after raising head work; One of them was giddied briefly when extended head from front to back; There were insignificant reason of induction in 22 cases, but tension cord was occurred obviously on one side or double side before the onset of illness. ③ Color Doppler test： Seventy-five of them appeared lack of blood, constriction, winding eyrvature of vertebral artery, formation of atheromatous plaque and abnormity of entering hole; Twenty-five of them had normal supply of blood of vertebral artery. ④ Check result of X-ray sheet： Cervical vertebra bone matrix hyperplasia with single interspace or multi-interspace was displayed fully. ⑤ Check result of MRI： Sixty-four patients were treated with cervical vertebra MRI check and single protrusion or multi-protrusion was displayed completely. CONCLUSION： There is a reflex arc between cervical pain, sympathetic nerve and the cervical vertigo. The cervical pain can contact with fiber of sympathetic ganglion through sense, stimulate sympathetic nerve to make it excite, make vertebral artery brief or lasting contraction, induce vertebrobasilar arterial insufficiency and lead to neck vertigo.