颈源性头痛程度与颈椎生理曲度异常的相关性研究

Correlation of cervicogenic headache with abnormal physiological curvature of cervical vertebrae

目的探讨颈源性头痛(CEH)与颈椎生理曲度异常的相关性。方法随机选取2014年3月至2016年3月于我院神经内科收治的伴有颈椎生理曲度异常的CEH患者116例,根据X线侧位平片将其分为颈曲变直组、前凸组、反弓组和S型组,对患者头痛程度采用数字分级法(NRS)进行评分;同时根据头痛程度将患者分为轻度、中度、重度三组,分析颈源性头痛程度与颈曲异常的相关性;同时对其进行保守治疗,观察治疗前后NRS评分的变化及治疗效果。结果 116例患者中颈曲变直51例(43.97%),颈曲前凸32例(27.59%),反弓20例(17.24%),S型13例(11.21%),其NRS评分分别为(5.81±3.20)分、(4.89±1.89)分、(5.07±2.11)分、(6.74±3.32)分;随CEH头痛程度的加重,NRS评分与生理弧度(D)、颈椎曲率(CI)、颈椎角(CSA)呈负相关(r=-0.325,r=-0.425,r=-0.342,P<0.05),且夹角越小,疼痛越严重;10例患者因各种原因中断治疗,其余106例中治愈率为48.11%,显效率为28.30%,好转率为13.21%,总有效率为89.63%;四组患者治疗后的NRS评分均较治疗前明显降低,差异均有统计学意义(P<0.05),但治疗后组间比较差异均无统计学意义(P>0.05)。结论颈源性头痛与颈曲异常改变关系密切,头痛程度与生理弧度、颈椎曲率及颈椎角有相关性,治疗颈源性头痛时应辅以对颈椎生理曲度异常的矫正。

Objective To explore the relationship between cervicogenic headache（CEH） and abnormal physiological curvature of cervical vertebrae. Methods From March 2014 to March 2016, 116 CEH patients accompanied by abnormal cervical physiological curvature were recruited from our hospital, which were divided into the straightened group, lordosis group, reversed group and S group, according to the X-ray plain film. At the same time, according to the degree of headache, the patients were divided into mild, moderate, severe group. The relationship between CEH and abnormal physiological curvature of cervical vertebrae was analyzed. The patients all underwent conservative treatment.The NRS scores before and after treatment were observed, as well as therapeutic effect. Results Among the 116 cases,the cervical vertebral physiological curvature became straight in 51 cases（43.97%）, showed lordosis in 32 cases（27.59%）, became reverse in 20 cases（17.24%）, and was of S type in 13 cases（11.21%）, with NRS scores of（5.81 ±3.20）,（4.89 ± 1.89）,（5.07 ± 2.11）,（6.74 ± 3.32）, respectively. With the aggravating of CEH, NRS scores were negatively correlated with physiological radian（D）, cervical curvature（CI）, cervical spine angle（CSA）（r=-0.325, r=-0.425,r=-0.342, P〈0.05）, and the smaller the angle, the more serious the pain. Ten patients discontinued the treatment for various reasons. The remaining 106 cases showed a cure rate of 48.11%, markedly effective rate of 28.30%, recovery of13.21%, and a total effective rate of 89.63%. NRS scores of the four groups after treatment were significantly decreased,as compared with those before treatment（P〈0.05）, but no statistically significant difference were observed in the comparison between groups after treatment（P〉0.05）. Conclusion CEH is closely related to abnormal changes in physiological curvature of cervical vertebrae, and the degree of headache is correlated with physiological radian, cervical curvature,and cervical spine angle. Treatment of CEH should be supplemented by correction of the abnormal physiological curvature of cervical vertebrae.