颈椎病性眩晕的临床治疗

Clinical characteristics and treatment of cervical vertigo

[目的]探讨颈椎病性眩晕的临床特点及相关治疗策略。[方法]收集2012年1月~2015年3月因颈椎病性眩晕至本院诊治的32例患者一般资料,用X线片评估颈椎失稳情况,用MRI评估颈椎退变程度,均行颈椎前路减压融合内固定术加后纵韧带切除术,用JOA评分法评估神经功能改善情况,用交感神经症状评分法评估眩晕改善情况,分析颈椎失稳及颈椎退变程度与眩晕程度相关性及颈椎前路减压融合内固定术治疗颈椎病性眩晕的临床疗效。[结果]32例患者中26例为女性,平均年龄（48.02±2.35）岁,平均随访时间为（18.70±0.63）个月;术前有17例患者颈椎不稳,其中11例存在C4、5节段不稳,显著多于其余节段（P〈0.05）。颈椎退变影像学评分C4、5显著高于其余节段（P〈0.05）。术后1个月JOA评分显著高于术前（P〈0.05）;而末次随访JOA评分又显著高于术后1个月评分（P〈0.05）。术后1个月眩晕评分显著低于术前（P〈0.05）;而末次随访眩晕评分又显著低于术后1个月评分（P〈0.05）。[结论]颈椎病性眩晕多发于围绝经期女性,C4、5节段的椎间盘退变及颈椎不稳是发病的危险因素。颈椎前路减压融合内固定术加后纵韧带切除术是治疗颈椎病性眩晕的有效手段。

[Objective] To discuss the clinical characteristics and therapy methods of cervical vertigo. [Methods] Thirty- two patients undergoing surgeries for cervical vertigo in our hospital from January 2012 to March 2015 were retrospectively analyzed. Patients consisted of 26 females and 6 males. Average age was（ 48. 02 ± 2. 35）. Plain X ray was taken to evaluate cervical stability and MRI was used to evaluate disc degeneration. Each patient underwent anterior cervical discectomy and fusion（ ACDF） with the removal of posterior longitudinal ligament（ PLL）. The JOA score was used to evaluate the neurological symptoms and a 20- point system was applied to evaluate the severity of vertigo before and after surgery. Cervical instability happened in 17 patients before surgery and 11 patients were found with instability at C4、5level,which was significantly more than any other level（ P〈0. 05）. The average Miyazaki score was highest at C4 /5（ P〈0. 05）. Data were analyzed by SPSS 19. 0. [Results]The average follow- up time was（ 18. 70 ± 0. 63） months. The average JOA score at 1 month after surgery was higher than that of pre- surgery（ P〈0. 05） and lower than that of the last follow- up（ P〈0. 05）. Furthermore,vertigo at 1 month after surgery was less server than that of pre- surgery（ P〈0. 05） and became the mildest at the last follow- up（ P〈0. 05）. [Conclusion] Cervical vertigo mainly happen in perimenopause females. Disc degeneration and instability at C4 /5 is a risk factor for it and anterior cervical discectomy and fusion with removal of posterior longitudinal ligament（ PLL） is an effective method to treat this disease.