头颈部血管超声在评估突发性聋合并颈椎病中的应用

Application value of head and neck vascular ultrasound in evaluation of sudden deafness complicated with cervical spondylosis

目的探讨头颈部血管超声在评估突发性聋合并颈椎病中的应用。方法前瞻性选取2016年8月至2017年8月于首都医科大学附属北京朝阳医院耳鼻喉科确诊为伴有椎动脉型颈椎病的突发性聋患者58例设为A组,无颈椎病的突发性聋患者58例设为B组;另收集同期确诊为椎动脉型颈椎病而无突发性聋的患者58例设为C组。患者取平卧位和坐位+头部屈位40°体位,行颈部血管超声检查;患者取俯卧位行经颅多普勒超声检查,并进行转颈试验。记录双侧颈内动脉、双侧椎动脉、基底动脉的平均血流速度,同一血管血流速度不同体位前后比较采用配对t检验,多组血管间血流速度比较采用方差分析。结果坐位+低头40°体位颈部血管超声检查发现,与平卧位检查相比,双侧颈内动脉流速3组均出现不同程度减低。其中存在椎动脉型颈椎病的2组双侧颈内动脉流速变化差异有统计学意义(A组左侧颈内动脉P=0.004,右侧颈内动脉P=0.011;C组双侧颈内动脉P=0.000);无颈椎病突发性聋组双侧颈内动脉流速变化差异无统计学意义(B组双侧颈内动脉P均>0.05)。俯卧位经颅多普勒超声检查结果显示,3组间基底动脉、双侧椎动脉流速比较,差异均有统计学意义(P均=0.000)。在转颈试验中,3组的基底动脉和双侧椎动脉流速与俯卧位相比,均有不同程度减低,其中伴有椎动脉型颈椎病的2组基底动脉和双侧椎动脉流速,转颈试验前后比较差异均有统计学意义(A组基底动脉P=0.039,双侧椎动脉P=0.001;C组基底动脉P=0.042,右侧椎动脉P=0.000,左侧椎动脉P=0.011);无颈椎病突发性聋组基底动脉和双侧椎动脉流速变化差异无统计学意义(B组P均>0.05)。结论头颈部血管超声结合患者体位变化可以较好地反映颈内动脉以及椎动脉、基底动脉流速变化情况,从而为明确突发性聋患者是否存在椎动脉型颈椎病提供诊断依据。

Objective To evaluate the value of head and neck vascular ultrasound in the evaluation of sudden deafness complicated with cervical spondylosis.Methods From August 2016 to August 2017,a total of 58 patients diagnosed with sudden deafness complicated with vertebral artery type cervical spondylosis were selected as group A at the Department of Otolaryngology,Beijing Chaoyang Hospital,Capital Medical University.Fifty-eight patients with sudden deafness without cervical spondylosis were assigned to group B.In addition,58 patients diagnosed as having vertebral artery type cervical spondylosis without sudden deafness during the same period were collected as group C.Neck vascular ultrasound was performed in the supine position and sitting+head flexion position(40°).Transcranial Doppler ultrasonography was performed in the prone position and a neck rotation test was performed.The mean blood flow velocity of the bilateral internal carotid arteries,bilateral vertebral arteries,and basilar artery was recorded.Paired t-test was used to compare the vascular velocity in the same artery before and after position change,and ANOVA was used for statistical analysis among multiple groups of vessels.Results Ultrasonography of cervical blood vessels in sitting position+lowering head at 40°position showed that the bilateral internal carotid artery flow velocity in all three groups decreased to different degrees compared with that in supine position,among which,the difference of bilateral internal carotid artery flow velocity changes in the 2 groups with vertebral artery type cervical spondylosis was statistically significant(Group A:left internal carotid artery P=0.004,right internal carotid artery P=0.011;Group C:bilateral internal carotid artery P=0.000).There was no statistical significance in the changes of bilateral internal carotid artery flow velocity in sudden deafness patients without cervical spondylosis(Group B:bilateral internal carotid artery P>0.05).The results of prone transcranial Doppler ultrasound showed that there were statistically significant differences in basilar artery and bilateral vertebral artery flow velocity among the three groups(P=0.000).In the cervical rotation test,the basilar artery and bilateral vertebral artery flow velocity in the three groups decreased to varying degrees compared with those in the prone position,among which,the difference in basilar artery and bilateral vertebral artery flow velocity changes in the 2 groups with vertebral artery type cervical spondylosis was statistically significant(Group A:basilar artery P=0.039,bilateral vertebral artery P=0.001;Group C:basilar artery P=0.042,right vertebral artery P=0.000,left vertebral artery 0.011).There was no significant difference in in the changes of basilar artery and bilateral vertebral artery flow velocity in patients with sudden deafness without cervical spondylosis(Group B:P>0.05).Conclusion Head and neck vascular ultrasound combined with the changes in the patient's position can better reflect the changes in the flow velocity of the internal carotid artery,basilar artery,and vertebral artery,so as to provide a diagnostic basis for determining the existence of vertebral artery-type cervical spondylosis in patients with sudden deafness.