40岁以下头痛患者颈椎曲度异常及相关检测分析

Analysis of relevant factors for headache patients under 40 with abnormal cervical curvature

目的观察40岁以下原发性头痛患者颈椎生理曲度异常的发生率以及引起的脑血流动力学改变,探讨中青年原发性头痛病因及指导治疗。方法 40岁以下头痛患者332例及健康对照组131例,均行颈椎X线检查,对颈椎曲度异常头痛患者根据严重程度分为轻度、中度、重度3组,行经颅多普勒超声(TCD)检测脑血流变化,分析各组患者的脑血流异常发生率并进行比较。结果头痛患者颈椎曲度异常检出率与对照组有明显统计学差异(P<0.005),颈椎曲度异常发生率达77.71%,脑血流异常检测率为72.48%,3组脑血流异常检测率比较有统计学差异(P<0.005),中度组和重度组脑血流速异常发生率分别高达83.91%和93.94%;颈椎曲度异常轻度组与中、重度组脑血流异常检测率均有统计学差异,中度与重度组之间无明显统计学差异;流速异常以血管痉挛、血流增快为主。结论颈椎曲度异常可能在40岁以下原发性头痛患者发病中起重要作用,其与颅内血流流速异常密切相关,临床上应重视颈椎曲度异常的治疗价值。

Objective To observe the incidence rate of abnormal cervical physiological cur- vature in primary headache patients under 40 and the causes of cerebral hemodynamics, and further explore causes of and treatment for primary headache. Methods A total of 332 headache patients under 40 were included in the study group and another 131 healthy subjects were included in the control group. All subjects received cervical X - rays examination. According to the severity of headache, patients with abnormal cervical curvature were divided into three groups （mild, moderate and severe groups）. The cerebral blood flow was further detected by transcranial Doppler ultrasound （TCD）. The incidences of abnormal cerebral blood flow were analyzed and compared in above three groups. Results The difference with abnormal cervical curvature detection between headache pa- tients and the control group was statistically significant （P ~ 0. 005）. The incidence rate of cervical abnormal curvature was 77.71%, and the detection rate of cerebral blood flow anomaly was 72. 48 %. The difference among three groups of cerebral blood flow anomaly was significantly different （ P 〈 0. 005）. Abnormal incidence of cerebral blood flow velocity of the moderate group and the se- vere group were 83.91% and 93.94 %, respectively. The incidences of cerebral blood flow anomaly between mild group and other groups were significantly different and no significant difference be- tween the moderate and severe group was observed. Flow velocity anomaly showed vasospasm, and blood flow increased. Conclusion Abnormal cervical curvature may play an important role in the pathogenesis of primary headache patients under 40, and is closely related to abnormal intracranial flow velocity. Clinical attention should be paid to the treatment of abnormal cervical curvature value.