CLICK THE BLUE WORD TO FOLLOW US
定义Cervicogenic vertigo is the false sense of motion that is due to cervical musculoskeletal dysfunction. The symptoms may be secondary to post-traumatic events with resultant whiplash or postconcussive syndrome. Alternatively, cervicogenic vertigo may be part of a more generalized disorder, such as fibromyalgia or underlying cervical osteoarthritis.
颈源性眩晕是由颈部肌肉骨骼功能失调而产生的非正常的虚假或失真的运动感觉。症状可能是继发于挥鞭伤或脑震荡后综合症等创伤后事件。另外,颈源性眩晕的临床表现可能是一些更常见疾病的一部分症状,例如纤维肌痛或潜在的颈椎骨关节炎。 Cervicogenic vertigo is thought to result from convergence of the cervical and cranial nerve inputs and their close approximation in the upper cervical spinal segments of the spinal cord.
颈源性眩晕被认为是由于颈神经和颅神经在椎管内输入后汇合,并在脊髓的上颈椎节段处距离紧密所致。 Dizziness and vertigo, common presenting symptoms, are said to affect approximately 20% to 30% of the general population and account for 8 million primary care visits to physicians in the United States each year. In addition, these symptoms represent the most common presenting complaint in patients older than 75 years. Vertigo following neck trauma is extremely common, with estimates as high as 40% to 80%. Particularly, the incidence of symptoms of dizziness and vertigo after whiplash injury has been reported as 20% to 58%. 头晕(dizziness)和眩晕(vertigo)是常见的症状,据称影响了大约 20% 到 30% 的普通人群,并且每年在美国造成 800 万人次初级门诊就诊。此外,这些症状在75岁以上患者中是最常见的主诉。既往发生过颈部创伤后出现眩晕症状则更加普遍,估计高达40%到80%。特别是在发生追尾挥鞭伤后出现头晕和眩晕症状的发生率被报道为20%到58%。 许多这类患者会对损伤提起诉讼,通常也意味着他们的症状和预后可能较差。
症状颈源性眩晕患者会感受到虚假的运动感,通常是旋转或转动的感觉。一些患者会感受到漂浮、上下晃动、倾斜或漂移等感觉。其他人可能会出现恶心、视觉运动敏感和耳内充盈感。
颈源性眩晕患者通常在颈部侧面和后部以及枕部感到疼痛,有时伴有颈部僵硬。 颈部疼痛通常向顶颞区放射,呈香蕉形状分布,可能仅在颈部的深层触诊时出现。 症状通常呈阵发性出现,持续数分钟至数小时,并经常由颈部运动或长时间保持不适头部姿势引发或触发。有时,伴有颈椎神经根炎的患者可能会抱怨上颈部皮肤神经分布区的感觉异常,但这并不是颈源性眩晕的特异性症状。
体格检查体格检查的基本要素是正常的神经功能、耳朵以及眼部检查是否存在眼球震颤。在这些检查中一旦发现异常,都提示有必要排除其他耳科或神经系统疾病,如美尼尔氏病、良性阵发性位置性眩晕(BPPV)和中风。 功能限制功能限制可能包括步行困难、动作稳定困难或身体平衡困难。因此,患者可能对诸如驾驶之类的活动缺乏信心,因为颈部转动可能引发症状。 颈部疼痛或头痛可能会影响睡眠,导致疲劳、情绪紊乱和整体生活质量下降。 一些需要平衡和协调的职业(如建筑)通常受到限制。对失衡发生的焦虑可能会导致活动回避或运动恐惧症,从而加重残疾。
诊断检查颈源性眩晕是一种临床诊断;因此,诊断工作的大部分工作是排除其他诊断。
治疗
初始基础治疗- 对于有存在颈部骨关节炎的患者,非甾体类抗炎药对于帮助控制疼痛很有用。
- 肌肉松弛剂如异丙基甲丁双脲以及低剂量三环类抗抑郁药可在睡前使用,以促进睡眠和肌肉松弛以治疗筋膜疼痛。
- 如果存在失衡感伴明显恶心,可以尝试使用5-HT3受体拮抗剂昂丹司琼(根据需要每8小时4至8毫克)进行治疗。
康复理疗康复旨在减少肌肉痉挛,增加颈部活动范围,改善姿势,以帮助减轻眩晕的强度,最终恢复功能。 应由接受过包括手法治疗、筋膜和触发点治疗以及颈部和躯干稳定技术等训练和具有经验的物理治疗师对患者进行评估,并对患者进行治疗,以恢复正常的颈部功能。 Mulligan SNAGs | Maitland mobilization | | |
一项评估这两种疗法方案的随机对照试验(RCT)发现,在慢性颈源性眩晕的强度和频率的即时减少和持续减少(12周)方面,这两种治疗方案没有显著差异,即在短期和长期内都没有表现出明显的疗效差异。 然而,另一项RCT在颈源性眩晕患者中比较SNAGs和PJM的两种方法,评估了在ROM、头部重定向和动作平衡方面的治疗效果,研究发现,SNAG治疗改善了颈部ROM,并且治疗后的效果在12周内能够获得维持,但PJM对颈部ROM的影响非常有限。同时,该研究并未发现SNAGs或PJM对颈源性眩晕患者的关节重定位的准确性或动作平衡感有任何确凿的疗效。 重要的是,也有报道称,SNAGs和PJM在治疗慢性颈源性眩晕方面,在治疗后12个月能够减少眩晕的频率,这表明这两种形式的手法治疗在长期来看是具有益处的。
将手法治疗与作业疗法和前庭康复结合起来以优化结果的理念是合理的,但需要进一步研究以阐明潜在的协同作用。
注射疗法
外科手术目前没有手术适用于治疗这种疾病; - 然而,一个备受关注的方法是经皮激光椎间盘减压术(PLDD)。
然而,关于此方法治疗颈源性眩晕的疗效和安全性仍需要进一步的证据支持。
疾病潜在并发症治疗潜在并发症非甾体抗炎药与胃肠道相关副作用。 肌肉松弛剂和低剂量三环抗抑郁药可能会引起嗜睡。 如果局部注射执行不当,可能会导致局部疼痛、瘀伤、血管内注射或气胸。
1. Norre M. Cervical vertigo. Acta Otorhinolaryngol Belg. 1987;25: 495–499. 2. Revel M, Andre-Deshays C, Mingeut M. Cervicocephalic kinesthetic sensibility in patients with cervical pain. Arch Phys Med Rehabil. 1991;72:288–291. 3. Colledge NR, Barr-Hamilton RM, Lewis SJ, et al. Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ. 1996;313:788–793. 4. Chawla N, Olshaker J. Diagnosis and management of dizziness and vertigo. Med Clin North Am. 2006;90(Emergencies in the outpatient setting: part 1):291–304. 5. Wrisley D, Sparto P, Whitney S, Furman J. Cervicogenic dizziness: a review of diagnosis and treatment. J Orthop Sports Phys Ther. 2000;30:755–766. 6. Post RE, Dickerson LM. Dizziness: a diagnostic approach. Am Fam Physician. 2010;82:361–368. 7. Karlberg M, Magnusson M, Malmström EM, et al. Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin. Arch Phys Med Rehabil. 1996;77:874–882. 8. Li Y, Peng B. Pathogenesis, diagnosis, and treatment of cervical vertigo. Pain Physician. 2015;18(4):E583–E595. 9. Yacovino DA, Hain TC. Clinical characteristics of cervicogenic-related dizziness and vertigo. Semin Neurol. 2013;33:244–255. 10. Jongkees L. Cervical vertigo. Laryngoscope. 1969;79:1473–1484. 11. Praffenrath V, Danekar R, Pollmann W. Cervicogenic headache—the clinical picture, radiological findings, and hypotheses on its pathophysiology. Headache. 1987;25:495–499. 12. Sjaastad O, Frediksen T, Praffenrath V. Cervicogenic headache: diagnostic criteria. Headache. 1990;30:725–726. 13. Froehling DA, Silverstein MD, Mohr DN, Beatty CW. Does this dizzy patient have a serious form of vertigo? JAMA. 1994;271:385–388. 14. Zito G, Jull G, Story I. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Man Ther. 2006;11:118–129. 15. Matsui T, Ii K, Hojo S, Sano K. Cervical neuro-muscular syndrome: discovery of a new disease group caused by abnormalities in the cervical muscles. Neurol Med Chir (Tokyo). 2012;52:75–80. 16. Simons DG, Travell JG, Simons LS. Upper Half of Body. In: Travell & Simons’ myofascial pain and dysfunction: the trigger point manual. 2nd ed. Vol. 1. Baltimore: Williams & Wilkins; 1999. 17. Weidt S, Bruehl A, Straumann D, Hegemann S, Krautstrunk G, Rufer M. Health-related quality of life and emotional distress in patients with dizziness: a cross-sectional approach to disentangle their relationship. BMC Health Serv Res. 2014;14:317. 18. Ernst A, Basta D, Seidl RO, et al. Management of posttraumatic vertigo. Otolaryngol Head Neck Surg. 2005;132:554–558. 19. Reid SA, Rivett DA. Manual therapy treatment of cervicogenic dizziness: a systematic review. Man Ther. 2005;10:4–13. 20. Reid SA, Rivett DA, Katekar MG, Callister R. Comparison of mulligan sustained natural apophyseal glides and maitland mobilizations for treatment of cervicogenic dizziness: a randomized controlled trial. 2014;94:466–476. 21. Reid S, Callister R, Katekar M, Rivett D. Original article: effects of cervical spine manual therapy on range of motion, head repositioning, and balance in participants with cervicogenic dizziness: a randomized controlled trial. Arch Phys Med Rehabil. 2014. 22. Reid S, Callister R, Snodgrass S, Katekar M, Rivett D. Manual therapy for cervicogenic dizziness: long-term outcomes of a randomised trial. Man Ther. 2015;(1):148. 23. Karlberg M, Persson L, Magnusson M. Impaired postural control in patients with cervico-brachial pain. Acta Otolaryngol Suppl. 1995;520:440–442. 24. Lystad RP, Bell G, Bonnevie-Svendsen M, Carter CV. Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review. Chiropr Man Therap. 2011;19:21. 25. Borg-Stein J, Rauch S, Krabak B. Evaluation and management of cervicogenic dizziness. Crit Rev Phys Med Rehabil. 2001;13:255–264. 26. deJong P, de Jong M, Cohen B, Jongkees LB. Ataxia and nystagmus induced by injection of local anesthetics in the neck. Ann Neurol. 1997;1:240–246. 27. Carlson J, Fahlerantz A, Augustinsson L. Muscle tenderness in tension headaches treated with acupuncture and physiotherapy. Cephalalgia. 1990;10:131–141. 28. Sycha T, Kranz G, Auff E, Schnider P. Botulinum toxin in the treatment of rare head and neck pain syndromes: a systematic review of the literature. J Neurol. 2004;251(suppl 1):I19–I30. 29. Karada O, Öztürk B, Ula UH, et al. The efficacy of botulinum toxin in patients with cervicogenic headache: a placebo-controlled clinical trial. Balkan Med J. 2012;29:184–187. 30. Ren L, Guo B, Zeng Y, et al. Mid-term efficacy of percutaneous laser disc decompression for treatment of cervical vertigo. Eur J Orthop Surg Traumatol. 2014;(1):153. 31. Trelle S, Reichenbach S, Wandel S, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011;342:c7086.
|