颈性眩晕患者颈部肌肉影像学及力学特征改变与眩晕症状的相关性

Changes in imaging and mechanical characteristics of neck muscles in patients with cervical vertigo and their correlations with vertigo symptoms

中文关键词:  头晕  颈痛  弹性模量  回归分析  肌肉力量

英文关键词:Dizziness  Neck pain  Elastic modulus  Regression analysis  Muscle strength

中文摘要:

  【摘要】 目的：比较颈性眩晕患者与健康人颈部肌肉的斜径、横截面积、硬度、力量及颈椎旋转度差异，探讨颈性眩晕患者颈部肌肉功能障碍与眩晕程度的相关性。方法：选择2019年1月～2020年12月中国康复研究中心北京博爱医院门诊诊断为颈性眩晕的30例患者作为观察组，年龄25～65岁。招募相同年龄范围内健康志愿者30名作为对照组。两组受试者分别进行颈部MRI、超声实时剪切波弹性成像、颈椎旋转度、颈部肌肉力量评估，同时观察组进行眩晕残障量表（dizziness handicap inventory，DHI）和视觉模拟量表（visual analog scale，VAS）评估眩晕程度。MRI测量包括：枕下肌群（头后小直肌、头下斜肌）的肌肉斜径，颈部前后方肌肉（胸锁乳突肌、颈长肌、头夹肌、头半棘肌）的横截面积（cross-sectional area，CSA）。超声实时剪切波弹性成像检测胸锁乳突肌、头夹肌、头半棘肌及头下斜肌的肌肉硬度（弹性模量）。两组间比较采用独立样本t检验，不符合正态分布者采用Mann-Whitney U检验，选择组间比较存在显著性差异的指标，分别进行多重线性回归分析与logistic回归分析，显著性水平为0.05。结果：两组间性别、年龄和BMI比较无显著性差异（P>0.05）。观察组右侧颈长肌CSA显著小于对照组（z=2.262，P<0.05），其余肌肉CSA两组间比较无显著性差异。双侧枕下肌群（头后小直肌、头下斜肌）肌肉斜径组间比较无显著性差异（P>0.05）。观察组双侧胸锁乳突肌弹性模量显著小于对照组（t左= -2.543，t右=-3.549，P<0.05），双侧头下斜肌（t左=2.755，z右=-3.838）、左侧头夹肌（t=2.071）、左侧头半棘肌（t=2.324）弹性模量观察组显著大于对照组（P<0.05），而右侧头夹肌、右侧头半棘肌弹性模量组间比较无显著性差异（P>0.05）。颈椎旋转度组间比较无显著性差异（P>0.05）。观察组颈部前屈（z=-3.550）、后伸（z=-4.785）、侧屈（z左=-5.258，z右=-5.060）及旋转（t左=-5.398，t右=-4.905）力量显著小于对照组（P＜0.001）。多重线性回归分析显示，DHI评分与右头下斜肌弹性模量（β=0.412）和后伸力量（β=-0.357）存在线性回归关系。VAS评分与后伸力量（β=-0.371）、右头下斜肌弹性模量（β=0.373）、右胸锁乳突肌弹性模量（β=-0.204）存在线性回归关系。Logistic回归分析显示，右头下斜肌弹性模量（OR=17.863）和前屈力量（OR=2.555）为发生颈性眩晕的危险因素，而后伸力量（OR=0.244）则为保护因素。结论：颈性眩晕患者颈椎前方肌肉硬度下降，颈后方肌肉（尤其枕下肌群）硬度增加。颈性眩晕患者颈部肌肉力量在前屈、后伸、左右侧屈和旋转时明显减弱；而颈部肌肉形态和颈椎旋转度无明显变化。眩晕障碍的发生与严重程度与右头下斜肌硬度和颈部后伸力量存在相关性。

英文摘要:

  【Abstract】 Objectives: To investigate the correlation between neck muscle dysfunction and vertigo severity in patients with cervical vertigo(CV) by comparing the oblique diameter, cross-sectional area(CSA), stiffness, strength of neck muscles, and cervical rotation range between CV patients and healthy individuals. Methods: From January 2019 to December 2020, 30 outpatients diagnosed with CV (aged 25-65) were enrolled as the patient group from the outpatient clinic of Beijing Bo′ai Hospital, China Rehabilitation Research Center, and 30 age-matched healthy volunteers were recruited as the control group. All participants underwent assessments including cervical MRI, real-time shear wave elastography(SWE), cervical rotation range of motion(ROM), and neck muscle strength testing. The patient group also completed the dizziness handicap inventory(DHI) and visual analog scale(VAS) to quantify vertigo severity. MRI measurements included oblique diameter of the suboccipital muscles(rectus capitis posterior minor, obliquus capitis inferior) and CSA of the anterior and posterior neck muscles(sternocleidomastoid, longus colli, splenius capitis, semispinalis capitis). SWE was used to assess the stiffness(elastic modulus) of the sternocleidomastoid, splenius capitis, semispinalis capitis, and obliquus capitis inferior muscles. Independent sample t-test was used for inter-group comparison, and Mann-Whitney U test was used for data that did not conform to a normal distribution. Indicators that showed significant inter-group differences were subsequently included in multiple linear regression and logistic regression analyses, with a significance level set at P<0.05. Results: There was no significant difference between sex, age and BMI between the two groups(P>0.05). The CSA of the right cervical longus colli muscle in the patient group was significantly smaller than that in the control group(z=2.262, P<0.05), and no significant differences were found in the CSA of the remaining muscles between the two groups. There were no significant differences in the oblique diameter of bilateral rectus capitis posterior minor and obliquus capitis inferior between the two groups(P>0.05). The stiffness of bilateral sternocleidomastoid in the patient group was significantly lower than that in the control group(tL=-2.543, tR=-3.549, P<0.05), the stiffness of bilateral obliquus capitis inferior(tL=2.755, zR=-3.838), left splenius capitis(t=2.071) and left semispinalis capitis(t=2.324) in the patient group was significantly higher than that in the control group(P<0.05), and the stiffness of right splenius capitis and right semispinalis capitis was not significantly different between the two groups(P>0.05). There was no significant difference in cervical rotation between the two groups(P>0.05). The strength of flexion(z=-3.550), extension(z= -4.785), lateral bending(zL=-5.258, zR=-5.060) and rotation(zL=-5.398, zR=-4.905) of cervical spine were significantly lower in the patient group than in the control group(P<0.05). Correlation and multiple linear regression analyses: There was a linear regression relationship between the DHI score and the stiffness of the right obliquus capitis inferior muscle(β=0.412) and the strength of the extension(β=-0.357). The VAS score, had a linear regression relationship with the strength of the extension(β=-0.371), the stiffness of the right obliquus capitis inferior muscle(β=0.373), and the stiffness of the right sternocleidomastoid muscle(β=-0.204). Logistic regression analysis showed the stiffness of the right inferior oblique muscle(OR=17.863) and the strength of flexion(OR=2.555) were the risk factors for CV, while the strength of extension(OR=0.244) was a protective factor. Conclusions: In CV patients, the stiffness decreases in the anterior neck muscles and increases in the posterior muscles(especially the suboccipital muscles). Neck muscle strength is significantly impaired in all directions, while muscle morphology and cervical rotation ROM remain largely unchanged. The severity of vertigo is correlated with the stiffness of the right obliquus capitis inferior and posterior extension strength.