伴随颈椎病颈性眩晕的手术治疗

Therapeutic effect and mechanism of the surgical treatment for cervical vertigo with cervical spondylosis

目的 分析伴随颈椎病的颈性眩晕手术治疗效果.方法 回顾分析2004年1月至2013年12月中国医学科学院北京协和医学院北京协和医院骨科伴颈性眩晕的颈椎病患者35例,男13例,女22例,平均年龄55.5（37 ～77）岁;平均随访时间40.6（9～ 119）个月,术前以Ishihara法测定颈椎曲度指数（CCI）,测量相邻椎体后缘滑移距离及椎间角,术前术后以Cobb法测量颈椎前凸角.采用美国耳鼻咽喉头颈外科学会听力及平衡委员会（CHE）标准,记录患者术前及术后眩晕评分,分析不同手术方案及不同影像学特点眩晕症状缓解情况及其机制.结果 35例患者中有33例患者有颈椎不稳,术后有29例患者症状改善满意,满意率82.9％,术前术后颈椎侧位片前凸角差值与眩晕改善程度正相关（r =0.434,P ＜0.05）.结论 颈椎不稳可能是颈性眩晕的主要机制,颈部交感神经可能在颈性眩晕中扮演重要角色,手术可能缓解伴随颈椎病的颈性眩晕症状.

Objective To investigate the therapeutic effect and mechanism of the surgical treatment for cervical vertigo with cervical spondylosis.Methods Thirty-five patients in Department of Orthopaedics,Peking Union Medical College Hospital,Peking Union Medical College,who received surgical treatment for cervical spondylosis concomitant with cervical vertigo from 2004 to 2013 were reviewed retrospectively.The preoperative cervical curvature index （CCI）,slip distance and intervertebral angle,as well as the pre-and-postoperative Cobb angle were measured.The pre-and-postoperative degree of vertigo was reported according to the American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium standard.The therapeutic effect and mechanism for patients with different imaging features and thus underwent various surgical approaches were analyzed.Results The mean follow-up was 40.6 months.Cervical instability was found in 33 patients.29 of 35 （82.9%） patients had a satisfied recovery from cervical vertigo.The difference in Cobb angle in pre-and postoperative neutral cervical X-ray images was positively associated with the improvement for the vertigo （Pearson＇s test,P 〈 0.05）.Conclusions Cervical instability may be the major cause of cervical vertigo in the context of cervical spondylosis.Cervical sympathetic nerves may have played an important role in the cervical vertigo.Surgery may relieve the cervical vertigo accompanying the cervical spondylosis.