外伤后头痛238例临床及实验研究

The clinic and laboratory study on 238 cases of headache after trauma

为探讨脑外伤后综合征的发病机制，对２３８例外伤后头痛患者进行临床及实验研究。凡有外伤史的头痛患者在排除其他器质性病变后，先作颈椎、枕神经和臂丛３部５处１１点压痛试验进行初步诊断。有２处或２点以上压痛者行颈椎５位或４位片拍摄、经颅三维彩色多普勒（ＴＣＤ）及血清β内啡呔（βＥＰ）检查。结果：颈椎的异常改变是多方面的，其最重要的是环枢椎单相或双相半脱位（１００．０％）；ＴＣＤ显示９８．８％有脑血管供血异常；血βＥＰ示８９．２％降低；经颏枕牵引治疗９８．８％有效。治愈者３０例复查张口位片，齿突已复位居中。提示：脑外伤均合并颈外伤，即环枢椎半脱位等。移位的齿突刺激、牵拉及压迫颈上节的交感神经传出纤维导致头痛，或因其功能失常致脑血管舒缩障碍，脑供血不足，内源性镇痛物质βＥＰ等降低。

o explore the pathological mechanism of post traumatic brain syndrome, an experimental study on 238 cases of headache after brain trauma was carried out. For all the headache patients who had a history of trauma without organal etiology, the tenderness test of cervical vertebra, pillow nerve and brachial plexus of 3 parts, 5 places, and 11 spots had simple preliminary diagnostic value. The abnormal changes were various in several ways. The most important was atlantoaxial semi dislocation in one or two ways (100%). TCD showed that 98.8% of these had abnormal blood supply of the brain vessel. The spasm of vertebra basis artery system was 77.1%. The slowness of neck artery blood supply was due to the lack of blood supply (20.6%). The difference of the two was significant (P<0.01). It showed that odontoid process deviation and other cervical abnormal changes had bad effect on sympathetic nerve and then on brain blood supply, thus making 89.2% of these cases have β EP drop, i.e endogenous analgesic matter reduction. It is possible to be related to the hinder of brain blood supply. By using chin pillow traction treatment, the effective rate accounted for 98%. The 30 cases reexamined showed odontoid process reposition. It is suggested that brain trauma may always be accompanied with cervical trauma, that is , atlantoaxial subluxation, etc. The stimulation, traction and constrict of the sympathetic efferent fibers of gonglia by the dislocated odontoid process lead to function hinder of the brain vessels, insufficient supply of brain blood, the decrease of endogenous analgesic matter, β EP, which is liable to make headache take place.