颈源性头痛的诊治体会  

Diagnosis And Treatment of Cervicogenic Headache

作　　者：周际[1] 冯大雄[1] 康建平[1] 叶飞[1] 雷飞[1] 张戈[1] 屈一鸣[1] 

机构地区：[1]泸州医学院附属医院脊柱外科,四川泸州646000

出　　处：《华西医学》2010年第9期1628-1631,共4页West China Medical Journal

摘　　要：目的探讨颈源性头痛的特点、病因及治疗效果。方法 2005年1月2009年1月收治颈源性头痛患者153例,经X线平片、CT和MRI检查,病变位于上颈椎23例,下颈椎130例,其中上颈椎先天畸形11例,类风湿3例,肿瘤2例,结核3例,陈旧性骨折脱位4例,颈椎管狭窄23例,C4-5椎间盘突出35例,C5-6椎间盘突出22例,C6-7椎间盘突出6例。手术治疗129例,非手术治疗24例。随访3个月～4年,平均2.1年。结果手术治疗组129例中91例头痛明显好转,36例头痛部分好转,2例缓解不明显。非手术治疗组24例中11例头痛部分缓解,13例无效。结论上颈椎病变所致头痛主要表现为枕部疼痛,部分患者同时伴有前额及眼眶胀痛,可伴有颈部旋转活动受限。下颈椎病变所致头痛表现多样化,无明显的特点,可表现为枕颈部、头顶、额部疼痛或一侧的偏头痛,多伴肩部疼痛,部分有脊髓及神经根受压表现。颈源性头痛保守治疗效果不佳,手术治疗效果较好。Objective To explore the causes,characteristics and therapeutic effeets of cervicogenic headache. Methods A total of 153patients with cervicogenic headache from January 2005to January 2009were examined by X-ray,CT,and MRI.The focus was located in upper cervical vertebra in 23cases,and in lower cervical vertebra in 130 cases.In the 153patients,there were 11had congenital deformity,3had rheumatoid,2had tumor,3had tuberculosis,4had fracture dislocation,23had cervical stenosis,35had C4-5DH,22had C5-6DH,and 6had C6-7DH.A total of 129patients underwent operations,and 24received expectant treatment.Results All the patients were followed up from 3months to 4years,averaging 2.1years.Among 129cases in the operation group,91patients＇headache disap-peared completely,36disappeared partly,and 2didn＇t disappear.Among 24cases in the expectant treatment group,11patients＇headache disappeared partly,13didn＇t disappeare.Conclusions The headache from upper cervical chan-ging mainly appears pain in occiput;part of them combind pain in forehead or fossa orbitalis,accompanying limitation of neck rotation.Headache from lower cervical changing appears varied,having no feature,and appearing pain in cervical part,corona capitis,forehead or one lateral;many of them combind pain of shoulder,partly showing appearance from spinal cord or root compression.The efficacy of expectant treatment is bad and the efficacy of operation is good.

关 键 词：颈源性头痛 颈椎病 治疗 

分 类 号：R681.55[医药卫生—骨科学]