背景:青少年头痛患者中颈椎曲度异常的检出率较高,提示颈椎曲度异常可能是引发青少年颈源性头痛和头晕等临床症候群的潜在病因,其相关性研究有待深入研究.目的:探讨颈椎曲度异常与青少年头痛等临床症状、体征的相关性,并探索有效的治疗方法.设计:以诊断为依据的病例对照研究.地点和对象:选择1999-06/2002-02解放军空军总医院神经内科门诊12～35岁头痛头晕并有颈椎曲度异常的患者120例,男43例,女77例,分为轻度异常41例,中度异常40例,重度异常39例,平均年龄(25±6)岁.干预:对所有患者询问头痛病程、病史、测量血压和进行神经科体检、给予脑电图、经颅血管彩色超声检查,并对其中100例给予牵引、手法按摩等综合治疗.主要观察指标:颈椎曲度异常和伴随位置结构异常的分类;分析比较颈椎曲度异常轻、中、重三组病程、临床症状(头痛程度、头晕、晕厥、记忆力减退等)的阳性积分;异常体征(血压、Hoffmann征、闭目难立征)的阳性积分;脑电图、经颅血管彩色超声检查的阳性积分;对颈椎曲度异常与临床症状、体征进行相关分析;并对其中100例接受治疗者的疗效进行了比较.结果:颈椎位置结构异常:120例颈椎曲度异常头痛患者中89例为颈椎反向,29例颈椎变直,2例过曲;同时合并其他各类颈椎位置结构异常,依次为序列差、侧弯、椎体间隙变窄、旋转等.颈椎曲度异常3组比较:随颈椎曲度异常程度加重,头痛病程、头痛程度、伴随症状、阳性体征、实验室检查异常均相应增加,各组比较差异显著.轻、中、重3组的病程分别为(8.0±9.0),(20.6+21.0)和(30.3+31.0)个月(F=10.777,P＜0.01);3组头痛积分均值分别为(1.8±1.0),(4.0±1.4)和(4.7±1.1)分(F=9.811,P＜0.01).头痛病程与积分均与颈椎异常程度呈正相关(相关系数分别为0.286和0.686,P均＜0.01).颈椎曲度异常源性头痛伴随症状中以头晕(81例)最多见,其中记忆障碍21例,晕厥发作17例和其他症状39例,3组间积分差异显著(P＜0.05～0.01).3组患者中Hoffmann征(40例)和Romberg征(58例)阳性积分比较差异显著(P＜0.05～0.01).随颈椎曲度异常加重,120例患者中血压呈上升趋势,收缩期血压3组分别为(108.6±13.1),(112.6±13.4)和(118.5±17.9)mmHg(1mmHg=0.133 kPa),组间比较差异显著(F=4.374,P=0.015),舒张期血压3组分别为(72.6±6.8),(77.1±9.5)和(78.8±10.2)mmHg,组间比较差异显著(F=5.219,P=0.007).颈曲异常各组的脑电图和经颅血管彩色超声检查比较差异显著(F=8.243,P＜0.05和F=11.983,P＜0.01),重度颈曲异常组阳性积分值最高.疗效分析:100例接受治疗的患者中9例因路途远,学习忙而中断治疗,其余91例中,痊愈55例(60%),显效22例(24%),好转9例(10%),无效加重5例,总有效率95%;曲度异常轻、中、重三组间疗效差异不显著(X2=2.865,P=0.239).结论:颈椎曲度异常与青少年头痛的异常临床症状、体征密切相关,与脑电图、TCD检查异常有关,可能是青少年颈源性头痛一个不可忽视的潜在病因;牵引、按摩的物理治疗对减轻此类头痛有效.
揹景:青少年頭痛患者中頸椎麯度異常的檢齣率較高,提示頸椎麯度異常可能是引髮青少年頸源性頭痛和頭暈等臨床癥候群的潛在病因,其相關性研究有待深入研究.目的:探討頸椎麯度異常與青少年頭痛等臨床癥狀、體徵的相關性,併探索有效的治療方法.設計:以診斷為依據的病例對照研究.地點和對象:選擇1999-06/2002-02解放軍空軍總醫院神經內科門診12～35歲頭痛頭暈併有頸椎麯度異常的患者120例,男43例,女77例,分為輕度異常41例,中度異常40例,重度異常39例,平均年齡(25±6)歲.榦預:對所有患者詢問頭痛病程、病史、測量血壓和進行神經科體檢、給予腦電圖、經顱血管綵色超聲檢查,併對其中100例給予牽引、手法按摩等綜閤治療.主要觀察指標:頸椎麯度異常和伴隨位置結構異常的分類;分析比較頸椎麯度異常輕、中、重三組病程、臨床癥狀(頭痛程度、頭暈、暈厥、記憶力減退等)的暘性積分;異常體徵(血壓、Hoffmann徵、閉目難立徵)的暘性積分;腦電圖、經顱血管綵色超聲檢查的暘性積分;對頸椎麯度異常與臨床癥狀、體徵進行相關分析;併對其中100例接受治療者的療效進行瞭比較.結果:頸椎位置結構異常:120例頸椎麯度異常頭痛患者中89例為頸椎反嚮,29例頸椎變直,2例過麯;同時閤併其他各類頸椎位置結構異常,依次為序列差、側彎、椎體間隙變窄、鏇轉等.頸椎麯度異常3組比較:隨頸椎麯度異常程度加重,頭痛病程、頭痛程度、伴隨癥狀、暘性體徵、實驗室檢查異常均相應增加,各組比較差異顯著.輕、中、重3組的病程分彆為(8.0±9.0),(20.6+21.0)和(30.3+31.0)箇月(F=10.777,P＜0.01);3組頭痛積分均值分彆為(1.8±1.0),(4.0±1.4)和(4.7±1.1)分(F=9.811,P＜0.01).頭痛病程與積分均與頸椎異常程度呈正相關(相關繫數分彆為0.286和0.686,P均＜0.01).頸椎麯度異常源性頭痛伴隨癥狀中以頭暈(81例)最多見,其中記憶障礙21例,暈厥髮作17例和其他癥狀39例,3組間積分差異顯著(P＜0.05～0.01).3組患者中Hoffmann徵(40例)和Romberg徵(58例)暘性積分比較差異顯著(P＜0.05～0.01).隨頸椎麯度異常加重,120例患者中血壓呈上升趨勢,收縮期血壓3組分彆為(108.6±13.1),(112.6±13.4)和(118.5±17.9)mmHg(1mmHg=0.133 kPa),組間比較差異顯著(F=4.374,P=0.015),舒張期血壓3組分彆為(72.6±6.8),(77.1±9.5)和(78.8±10.2)mmHg,組間比較差異顯著(F=5.219,P=0.007).頸麯異常各組的腦電圖和經顱血管綵色超聲檢查比較差異顯著(F=8.243,P＜0.05和F=11.983,P＜0.01),重度頸麯異常組暘性積分值最高.療效分析:100例接受治療的患者中9例因路途遠,學習忙而中斷治療,其餘91例中,痊愈55例(60%),顯效22例(24%),好轉9例(10%),無效加重5例,總有效率95%;麯度異常輕、中、重三組間療效差異不顯著(X2=2.865,P=0.239).結論:頸椎麯度異常與青少年頭痛的異常臨床癥狀、體徵密切相關,與腦電圖、TCD檢查異常有關,可能是青少年頸源性頭痛一箇不可忽視的潛在病因;牽引、按摩的物理治療對減輕此類頭痛有效.
배경:청소년두통환자중경추곡도이상적검출솔교고,제시경추곡도이상가능시인발청소년경원성두통화두훈등림상증후군적잠재병인,기상관성연구유대심입연구.목적:탐토경추곡도이상여청소년두통등림상증상、체정적상관성,병탐색유효적치료방법.설계:이진단위의거적병례대조연구.지점화대상:선택1999-06/2002-02해방군공군총의원신경내과문진12～35세두통두훈병유경추곡도이상적환자120례,남43례,녀77례,분위경도이상41례,중도이상40례,중도이상39례,평균년령(25±6)세.간예:대소유환자순문두통병정、병사、측량혈압화진행신경과체검、급여뇌전도、경로혈관채색초성검사,병대기중100례급여견인、수법안마등종합치료.주요관찰지표:경추곡도이상화반수위치결구이상적분류;분석비교경추곡도이상경、중、중삼조병정、림상증상(두통정도、두훈、훈궐、기억력감퇴등)적양성적분;이상체정(혈압、Hoffmann정、폐목난립정)적양성적분;뇌전도、경로혈관채색초성검사적양성적분;대경추곡도이상여림상증상、체정진행상관분석;병대기중100례접수치료자적료효진행료비교.결과:경추위치결구이상:120례경추곡도이상두통환자중89례위경추반향,29례경추변직,2례과곡;동시합병기타각류경추위치결구이상,의차위서렬차、측만、추체간극변착、선전등.경추곡도이상3조비교:수경추곡도이상정도가중,두통병정、두통정도、반수증상、양성체정、실험실검사이상균상응증가,각조비교차이현저.경、중、중3조적병정분별위(8.0±9.0),(20.6+21.0)화(30.3+31.0)개월(F=10.777,P＜0.01);3조두통적분균치분별위(1.8±1.0),(4.0±1.4)화(4.7±1.1)분(F=9.811,P＜0.01).두통병정여적분균여경추이상정도정정상관(상관계수분별위0.286화0.686,P균＜0.01).경추곡도이상원성두통반수증상중이두훈(81례)최다견,기중기억장애21례,훈궐발작17례화기타증상39례,3조간적분차이현저(P＜0.05～0.01).3조환자중Hoffmann정(40례)화Romberg정(58례)양성적분비교차이현저(P＜0.05～0.01).수경추곡도이상가중,120례환자중혈압정상승추세,수축기혈압3조분별위(108.6±13.1),(112.6±13.4)화(118.5±17.9)mmHg(1mmHg=0.133 kPa),조간비교차이현저(F=4.374,P=0.015),서장기혈압3조분별위(72.6±6.8),(77.1±9.5)화(78.8±10.2)mmHg,조간비교차이현저(F=5.219,P=0.007).경곡이상각조적뇌전도화경로혈관채색초성검사비교차이현저(F=8.243,P＜0.05화F=11.983,P＜0.01),중도경곡이상조양성적분치최고.료효분석:100례접수치료적환자중9례인로도원,학습망이중단치료,기여91례중,전유55례(60%),현효22례(24%),호전9례(10%),무효가중5례,총유효솔95%;곡도이상경、중、중삼조간료효차이불현저(X2=2.865,P=0.239).결론:경추곡도이상여청소년두통적이상림상증상、체정밀절상관,여뇌전도、TCD검사이상유관,가능시청소년경원성두통일개불가홀시적잠재병인;견인、안마적물리치료대감경차류두통유효.
BACKGROUND: The detective rate of abnormal cervical curvature in adolescent patients with headache is comparatively high, which suggests that cervical curvature abnormality may be the potential pathogenesis inducing the clinical symptoms of cervicogenic headache(CEH) and dizziness. The correlation between cervical curvature abnormality and the clinical symptoms of adolescent headache requires thorough researches.OBJECTIVE: To investigate the correlation between cervical curvature abnormality and the clinical symptoms and physical signs of adolescent headache for the exploration of effective therapeutic methods.DESIGN: A case-controlled trial based on diagnosis.SETTING and PARTICIPANTS: A total of 120 patients including 43 male and 77 female cases suffered from headache, dizziness and cervical curvature abnormality aged from 12 to 35 years[mean age of(25±6) years ] were selected from the Outpatient Department of the Department of Neurology during June 1999 to February 2002 from the General Hospital of PLA Air Force. Patients were divided into mild abnormality(n=41), moderate abnormality ( n =40) and severe abnormality( n = 39).INTERVENTIONS: All cases received enquiries about headache course and case history, blood pressure measurement, neurologic physical check-up, and electroencephalogram (EEG) and transcranial Doppler (TCD)tests. One hundred of the 120 cases received integrated therapy of traction and professional massage, etc.MAIN OUTCOME MEASURES: The classifications of cervical curvature abnormality and cervical curvature abnormality complicated with structural abnormality, the comparisons of the positive integrals for course of the disease and clinical symptom(headache, dizziness, apsychia, and hypomnesia,etc. ) among three groups of mild, moderate and severe cervical curvature abnormality, the positive integrals of abnormal physical signs(blood pressure, Hoffmann sign, and Romberg sign), positive integrals of EEG and TCD, the correlation between cervical curvature abnormality and the clinical symptom and physical signs, and the comparison of the therapeutic effect among 100 patients that received treatments.RESULTS: Cervical vertebral structural abnormality: Eighty-nine patients of 120 cervical curvature abnormalities suffered from inversed cervical vertebra, 29 cases suffered from straightened cervical vertebra and 2 cases suf fered from over-curved cervical vertebra. Other kinds of cervical vertebralstructural abnormalities were complicated simultaneously, which were wrong sequencing, lateral curvature, narrowed, intervertebral space and rotation, etc.. The comparisons among three groups of cervical curvature abnormality: With the increase of the severity of cervical curvature abnormality,headache course, headache severity, complicated symptoms, positive physical signs, and laboratorial abnormities increased correspondingly with significant differences among groups. The courses of the disease of the three groups were(8.0±9.0), (20.6±21.0) and(30.3±31.0) months respectively( F = 10. 777, P＜ 0.01 ). The mean value of headache integrals of the three groups were (1.8±1.0), (4.0±1.4), and(4.7±1.1) points respectively ( F = 9. 811, P＜0.01) . The headache course and integral positively correlated with the abnormal degree of the cervical curvature abnormality(correlation coefficient was 0. 286 and 0. 686, P＜0.01) . In the complicated symptoms ofcervicogenic headache, dizziness(n=81) was thecommonest, memory impairment was found in 21 cases, apsychia was found in 17cases and other symptoms were found in 39 cases. There were significant differences of the integrals among three groups( P＜0.05-0.01) . The positive integrals of Hoffmann sign(n=40) and Romberg sign(n=58) among three groups had significant differences (P＜0.05 -0.01). The blood pressure of the 120 cases had an ascending tendency along with the aggravation of the cervical curvature. The systolic pressure of the three groups were(108.6 ± 13.1),(112.6 + 13.4) and(118. 5 ± 17.9) mm Hg(1 mm Hg =0. 133 kPa) respectively, which were significantly different among the groups( F =4.374,P=0.015) .the diastolic pressure of the three groups were(72.6±6.8),(77.1±9.5) and (78.2 + 10. 2)mm Hg, which were significantly different among the groups(F=5.219, P = 0.007). There were significant differences of the EEG and TCD among three groups ( F=8.243,P＜0.05; F= 11.983, P ＜0.01) . The severe cervical curvature abnormality group had the highest positive integral. Therapeutic effect analysis: Nine cases of the 100 treated patients stopped their treatments due to far journey and busy study. In the rest 91cases, 55 cases (60%) were cured, 22 cases(24%) had marked effectiveness,9 cases(10%) had improvements and 5 cases had no effectiveness or aggravation. The total effective rate was 95%. There was no significant difference of the therapeutic effect among three groups(x2 = 2. 865, P = 0. 239).CONCLUSION: Cervical curvature closely correlates with the abnormal clinical symptoms and physical signs of adolescent headache, which relates with the abnormalities in EEG and TCD. It may be a potential pathogenesis of adolescent CEH that cannot be neglected. Physiotherapies like traction and massage are effective in relieving this kind of headache.
