颈源性头痛的临床表现及影像学分析

Clinical manifestations and imaging analysis of cervicogenic headache

目的:探讨颈源性头痛的临床特征及机制。方法:选取2013年5月至2017年12月就诊并有完整影像学资料的颈源性头痛患者57例,男18例,女39例;年龄20～63(43.26±10.39)岁;病程4个月～35年,平均(11.74±9.47)年。分析患者的疼痛情况、影像学、Tinel征情况。结果:颈源性头痛患者疼痛多为双侧出现,区域主要集中在颞部,多伴发枕部、头顶、眼眶疼痛;VAS评分有随病程增加而下降趋势;影像学有椎间盘突出(91.30%)、椎体不稳(73.91%)、寰枢椎移位(56.52%)、颈椎曲度变化(54.35%)等改变;Tinel征诱发点数量为3～24(13.58±5.8)个/人,存在健侧与患侧的个数及程度差异,患侧个数及程度显著大于健侧(P<0.05);颈源性头痛患者多在C2,3关节突关节(92.98%)、乳突后(89.47%)、枕大凹(89.47%)、C3,4关节突关节(84.21%)、第3枕神经(80.70%)等区域有Tinel征阳性诱发点。结论:颈源性头痛患者多伴有双侧而非单侧疼痛,并存在影像学改变和Tinel征阳性诱发点,Tinel征试验是否可作为临床诊断的客观指标尚需进一步研究。

To investigate the clinical characteristics and mechanism of cervicogenic headache.Methods:Fiftyseven patients with cervicogenic headache who were treated from May 2013 to December 2017 and had complete imaging data were selected,including 18 malesand 39 females with an average age of(43.26±10.39)years old ranging from 20 to 63 years old.The duration of the disease was 4 months to 35 years with a mean of(11.74±9.47)years.The pain situation,iconography and Tinel sign were analyzed.Results:The patients with cervicogenic headache often had bilateral pain.The regions mainly concentrated in the temporal region,with occipital,head or orbit pains.The VAS scores decreased with the duration of the disease.There were many cases of disc herniation(91.30%),vertebral instability(73.91%),atlantoaxial displacement(56.52%),curvature change of cervicogenic vertebra(54.35%).The number of positive Tinel sign points was between 3 and 24(13.58±5.8)perpatient.The number and extent of Tinel sign were significantly different between the affected side and healthy side(P<0.05).C2,3 facet joints(92.98%),post mastoid(89.47%),occipital concavity(89.47%),C3,4 facet joints(84.21%),third occipital nerve(80.70%)were the positive Tinel sign points in patients with cervicogenic headache.Conclusion:The iconography changes of cervicogenic headache and Tinel sign may contribute to the clinical diagnosis and mechanism of the disease.