颈性眩晕发病机制的最新研究进展

A review on the pathogenesis of cervical vertigo

颈性眩晕在临床上多见,以颈椎的眩晕和不平衡为特点,与颈部活动有关,又称“椎动脉压迫综合征”“椎动脉缺血综合征”“颈后交感神经综合征”。颈性眩晕是中老年群体就诊的首要原因,患者的主诉以眩晕的交感神经症状为主,并且常伴头痛、注意力不集中、呕吐等症状。由于交感神经症状复杂多样,加上获得的体格检查和影像学检查有限,颈性眩晕与高血压病及耳石症等病的鉴别诊断有一定的难度。此外,颈性眩晕从提出到现在,其发病机制和治疗仍存在多种争议,缺乏确切统一的标准,给临床医生的诊断治疗带来一定的困难。因此,有必要对颈性眩晕的发病机制进行深入的研究与分析,加强对其病因的认识,从而为临床治疗提供理论依据。文章通过文献回顾,全面归纳其可能的发病机制,分别是椎基底动脉供血不足学说、颈部交感神经刺激学说、本体感受器学说、神经体液因子学说、生物力学学说、肌筋膜链学说。尤其是从肌筋膜链的角度阐述颈性眩晕的发病原因,丰富了颈性眩晕的发病机制。

Cervical vertigo is common in clinical practice,which is characterized by vertigo and imbalance of the cervical spine,and related to neck activity,it is also known as“vertebral artery compression syndrome”,“vertebral artery ischemia syndrome”,“posterior cervical sympathetic syndrome”.Cervical vertigo is the primary reason for middle-aged and elderly people to seek medical treatment.The main complaints of patients are sympathetic symptoms of vertigo,and often accompanied by headache,inattention,vomiting and other symptoms.Because of the complex and diverse sympathetic symptoms,coupled with the limited availability of physical and imaging studies,the differential diagnosis of cervical vertigo from hypertension and otoliths is difficult.In addition,the pathogenesis and treatment of cervical vertigo are still controversial and lack of exact and unified standards,which brings certain difficulties to the diagnosis and treatment of clinicians.Therefore,it is necessary to deeply study and analyze the pathogenesis of cervical vertigo and strengthen the understanding of its etiology,so as to provide theoretical basis for clinical treatment.Through literature review,the possible pathogenesis of vertebrobasilar insufficiency,cervical sympathetic nerve stimulation,proprioceptor,neurohumoral factors,biomechanics and myofascial chain are summarized.Especially from the perspective of myofascial chain,the pathogenesis of cervical vertigo is expounded,and the pathogenesis of cervical vertigo is enriched.