伴随颈椎病的颈性眩晕手术治疗

发布时间：2018-10-10 20:30

【摘要】：[目的]分析伴随颈椎病的颈性眩晕手术治疗效果及其影响因素。[方法]对我科2004年01月～2013年12月因颈椎病行手术治疗的共621例患者进行筛选,对其中以眩晕为主要症状,同时伴随神经根型和/或脊髓型颈椎病,排除洱源性眩晕及神经血管性眩晕,予保守治疗效果不佳并行手术治疗的共35例患者进行回顾性分析。其中男13例,女22例,平均年龄55.5岁,平均随访40.6个月,采用美国耳鼻咽喉头颈外科学会听力及平衡委员会(CHE)标准,记录患者术前及术后眩晕评分,以Ishihara法测定术前颈椎侧位X片的颈椎曲度指数(cervical curvature index, CCI),在术前的颈椎侧位、动力位X片上测量相邻椎体后缘滑移距离及椎间角,在颈椎侧位及动力位X片上以Cobb法测量颈椎曲度及术前颈椎活动度(cervical range of motion, CROM)。分析手术疗效及影响因素,并探讨颈性眩晕的可能机制。[结果]临床功能评价：术前眩晕评分平均4.3分,术后平均1.6分,平均改善2.7分,术后疗效满意为29例患者,满意率为82.9%。影像学结果：35例患者中有33例患者有颈椎不稳。统计学分析：术前术后颈椎侧位X片曲度改善程度与眩晕缓解程度正相关(r=0.434,P0.05)。术后眩晕缓解程度与术前颈椎侧位X片颈椎曲度、CCI值、CROM值、颈椎不稳节段位置、颈椎不稳节段个数及术后颈椎侧位X片颈椎曲度无明显相关性。[结论]手术可缓解伴随颈椎病的颈性眩晕症状,颈椎不稳可能与颈性眩晕相关,术前术后颈椎侧位X片颈椎曲度改善程度与眩晕缓解程度正相关。
[Abstract]:Objective: to analyze the effect of surgical treatment of cervical vertigo associated with cervical spondylosis and its influencing factors. [methods] A total of 621 patients with cervical spondylosis were selected from January 2004 to December 2013. Vertigo was the main symptom and accompanied by cervical spondylopathy of nerve root type and / or myelopathy. 35 patients with eryuan vertigo and neurovascular vertigo who were treated with conservative treatment and surgical treatment were analyzed retrospectively. Among them, 13 males and 22 females with an average age of 55.5 years were followed up for an average of 40.6 months. The score of vertigo before and after operation was recorded according to the (CHE) standard of hearing and balance Committee of the American Academy of Otolaryngology and head and neck surgery. The cervical curvature index (cervical curvature index, CCI),) was measured by Ishihara method. The posterior margin slip distance and intervertebral angle of adjacent vertebrae were measured on dynamic X ray. Cobb method was used to measure cervical curvature and preoperative cervical motion (cervical range of motion, CROM). On lateral and dynamic radiographs of cervical spine. Objective: to analyze the effect of operation and its influencing factors, and to explore the possible mechanism of cervical vertigo. [results] Clinical function evaluation: preoperative vertigo score averaged 4.3 points, postoperative average score 1.6 points, average improvement score 2.7 points, postoperative satisfactory effect in 29 patients, satisfaction rate was 82.9%. Imaging results: 33 out of 35 patients had cervical instability. Statistical analysis: there was a positive correlation between the improvement of cervical lateral X-ray curvature and the degree of relief of vertigo before and after operation (P 0.05). There was no significant correlation between the degree of relief of postoperative vertigo and preoperative cervical curvature, CCI value, CROM value, the position of unstable cervical spine segment, the number of unstable cervical vertebra segment and the cervical spine curvature of lateral position X ray after operation. [conclusion] Cervical vertigo symptoms associated with cervical spondylosis can be alleviated by operation. Cervical instability may be related to cervical vertigo, and the improvement of cervical spine curvature in lateral position before and after operation is positively correlated with the degree of relief of vertigo.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687

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