颈性眩晕发病机制探讨

Study on the Clinical Characteristics and Pathogenesis of Cervical Vertigo

目的:探讨颈性眩晕(CV)的临床特点及其发病机理。方法:前瞻性收集60例颈性眩晕患者,将颈性眩晕又分为一般性头晕和旋转性头晕2种。观察患者颈肩部压痛、颈椎不稳定和颈椎管内神经压迫情况。颈椎管内神经压迫根据颈椎间盘突出或椎体后缘增生部位分为2类,即中央椎管区髓性压迫(5型8亚型)和侧方椎管区根性压迫(3型)。结果:大部分患者为轻型椎管内神经压迫(1-2型髓性压迫或1型根性压迫,57例),有颈椎不稳定(41例)和重型颈肩部压痛(48例)。另外,一般性头晕46例,旋转性头晕14例,前者椎管内神经压迫多数为中央型压迫(42例),后者多数为非中央型压迫(11例),两组比较差异有统计学意义(P<0.05)。结论:颈性眩晕是与颈椎间盘轻度退变相关的临床综合征,轻度颈椎间盘退变、颈椎不稳定、颈肩部疼痛对颈交感神经刺激的综合效应足够强大是颈性眩晕发病的充分必要条件,旋转性头晕可能与颈椎间盘非中央型轻度退变性压迫有关。

Objective:To study the pathogenesis of cervical vertigo(CV).Methods:Sixty patients with cervical vertigo were collected prospectively.Their situations about neck and shoulder tenderness,cervical instability and nerve compression within cervical spinal canal were studied.Cervical vertigo was divided into general dizziness and rotation dizziness.According to the position of cervical disc herniation or posterior edge hyperplasia,the nerve compression within cervical spinal canal was divided into two categories:medullary compression at central spinal canal(5 types,8 subtypes)and root compression at lateral spinal canal(3 types).Results:Most of the patients had mild nerve compression(type 1-2 medullary compression or type 1 root compression,57 cases),cervical instability(41 cases)and severe cervical and shoulder tenderness(48 cases).There were 46 cases of general dizziness and 14 cases of rotational dizziness in the observation group.In the classification of the nerve compression,the former was mostly central compression(42 cases),the latter was mostly non-central compression(11 cases),the difference between the two groups was significant(P<0.05).Conclusion:Cervical vertigo is a clinical syndrome associated with mild degeneration of cervical intervertebral disc.The comprehensive effect of mild cervical disc degeneration,cervical instability and neck and shoulder pain on cervical sympathetic nerve stimulation is strong enough,which is a necessary and sufficient condition for the pathogenesis of CV.Rotational CV may be associated with mild non-central type degenerative compression of the cervical intervertebral disc.