Objective:We aimed to describe the clinical features of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo(HC BPPV-AG)in a cluster of patients with restrictive neck movement disorders an...Objective:We aimed to describe the clinical features of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo(HC BPPV-AG)in a cluster of patients with restrictive neck movement disorders and a new therapeutic manoeuvre for its management.Methods:In a retrospective review of cases from an ambulatory tertiary referral center,patients with HC BPPV-AG in combination with neck movement restriction that prevented any classical manual repositioning procedure or who were refractory to canalith repositioning manoeuvres,were treated with a new manoeuvre comprised of sequential square-wave pattern of head and body supine rotations while nystagmus was being monitored,until either an apogeotropic to geotropic conversion or resolution of the nystagmus was observed.Results:Fifteen patients were studied.All but one[14/15 cases]showed a positive therapeutic response to the repositioning procedure in a single session.In two cases,a direct relief of vertigo and elimination of nystagmus was observed without an intermediate geotropic phase.Although in three patients the affected ear was not initially identified,it was ultimately identified and successfully treated by the square wave manoeuvre in all of them.Conclusions:The square-wave manoeuvre is an alternative for HC BPPV-AG treatment in either cases with neck restriction,where the affected side is not well identified at the bedside or when other manoeuvres fail to resolve the HC BPPV-AG.展开更多
Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down...Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down nystagmus(LDN)to identify the affected side in horizontal canal benign paroxysmal positional vertigo(HC-BPPV).Methods In our prospective study,we performed a testing profile(PSN,BLT,LDN,SRT)on 59 HC-BPPV patients using videonystagmography.We compared the accuracy and sensitivity of these tests in HC-BPPV lateralization.Data from 30 healthy patients were collected as the control group.Results When performing positional tests,the elicited nystagmus coinciding with Ewald’s second law was defined as a“positive response”.In 44 patients with geotropic nystagmus,the rates of positive response in LDN,PSN,and BLT were 22/44(50%),19/44(43%),and 18/44(41%),respectively,while in 15 patients with apogeotropic nystagmus,the positive response rates of these three tests were 10/15(66.7%),9/15(60%),and 4/15(27.00%),respectively.The sensitivity of LDN(54.38%)was higher than that of PSN(47.37%)and BLT(38.60%)but lower than that of SRT(89.47%).Notably,the accuracy rate of PSN(71.8%)was higher than that of the other APTs.In 6 patients with symmetrical nysgtamus during the roll test,5 patients showed a positive response in both LDN and BLT(83.34%),whereas 4 patients showed a positive response in PSN(66.67%).Conclusion All positional tests are helpful for determining the affected side of HC-BPPV,but SRT carries the highest accuracy of lateralization followed by PSN.展开更多
目的系统评价Epley手法复位联合倍他司汀与单独Epley手法复位治疗后半规管良性阵发性位置性眩晕(PC-BPPV)的疗效。方法检索PubMed、Web of Science、中国知网、维普和万方等中英文数据库2012—2024年发表的文献,将单独Epley手法复位治疗...目的系统评价Epley手法复位联合倍他司汀与单独Epley手法复位治疗后半规管良性阵发性位置性眩晕(PC-BPPV)的疗效。方法检索PubMed、Web of Science、中国知网、维普和万方等中英文数据库2012—2024年发表的文献,将单独Epley手法复位治疗PC-BPPV者纳入对照组,而将Epley手法复位联合倍他司汀治疗者纳入研究组。运用Stata 16.0软件对有效率、复发率、DHI评分及VAS评分等4个结局指标进行Meta分析。结果最终纳入11项研究进行Meta分析。Meta分析结果显示,Epley手法复位联合倍他司汀相较于单独Epley手法复位可以改善患者的1周有效率(RR=1.19,95%CI:1.02~1.37)、1个月复发率(RR=0.37,95%CI:0.19~0.73)、DHI评分(SMD=-0.98,95%CI:-1.54~-0.42)及VAS评分(SMD=-1.21,95%CI:-1.45~-0.96),两组比较差异均有统计学意义(P<0.05),但两周有效率、1个月有效率及6个月复发率比较差异均无统计学意义(P>0.05)。结论Epley手法复位联合倍他司汀治疗PC-BPPV患者具有更好的短期疗效,但长期疗效仍需大样本的随机对照研究进一步证实。展开更多
目的探讨传统滚转试验(supine roll test,SRT)、低头-抬头试验(bow and lean test,BLT)和快速轴位滚转试验(rapid axial roll test,RART)在水平半规管良性阵发性位置性眩晕(horizontal semicircular canal benign paroxysmal positional...目的探讨传统滚转试验(supine roll test,SRT)、低头-抬头试验(bow and lean test,BLT)和快速轴位滚转试验(rapid axial roll test,RART)在水平半规管良性阵发性位置性眩晕(horizontal semicircular canal benign paroxysmal positional vertigo,HSC-BPPV)责任半规管判定中的临床价值。方法选取2021年3月至2022年4月西安交通大学第一附属医院HSC-BPPV患者328例,根据不同的变位试验分为SRT组(113例)、BLT+SRT组(104例)和RART+SRT组(111例),BLT+SRT组和RART+SRT组分为2个阶段,第一阶段进行BLT或RART,第二阶段进行SRT。比较不同组别眼震引出率,采用Kappa一致性检验比较BLT/RART与SRT眼震引出结果的一致性。结果328例患者中,男95例,女233例,年龄18~86岁,平均(55.5±13.8)岁。RART+SRT组眼震引出率高于BLT+SRT组和SRT组(94.59%比81.73%比74.34%);RART+SRT组第一阶段眼震引出率、第二阶段SRT眼震引出率、责任半规管判定一致比例均高于BLT+SRT组,差异均有统计学意义(P<0.05);对责任半规管判定一致的患者进行复位治疗,BLT+SRT组痊愈率为92.59%(50/54),RART+SRT组为97.96%(96/98),两组痊愈率的比较,差异无统计学意义(χ^(2)=2.645,P=0.187)。Kappa一致性检验结果显示,RART与SRT在眼震引出率方面具有较好的一致性,一致率达94.59%(Kappa=0.638,P<0.001)。结论RART具有加速度大、安全性好、眼震引出率高的特点,能够有效诱发出HSC-BPPV特征性眼震,提高半规管定侧定位的准确性,为HSC-BPPV的临床实践提供更优化的检查方案,值得在临床中广泛推广。展开更多
目的探讨良性阵发性位置性眩晕(BPPV)患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的影响因素。方法采用前瞻性队列研究,选取2022年4月至2023年4月于西宁市第一人民医院进行SRM-IV眩晕诊疗系统治疗的BPPV患者100例为研究对象,分析治疗后...目的探讨良性阵发性位置性眩晕(BPPV)患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的影响因素。方法采用前瞻性队列研究,选取2022年4月至2023年4月于西宁市第一人民医院进行SRM-IV眩晕诊疗系统治疗的BPPV患者100例为研究对象,分析治疗后患者的眩晕残障现状及相关影响因素。结果与治疗前相比,BPPV患者治疗后眩晕残障程度量表(DHI)评分较低(68.36±13.14 vs 45.29±8.20)分。与治疗有效的BPPV患者相比,治疗无效的BPPV患者治疗后DHI评分较高(43.32±7.01 vs 67.89±14.01)分。单因素分析显示,≥60岁、病程≥3个月、有头部外伤史、有高血压、高血脂、高血糖、半规管轻瘫CP值≥20%、25羟维生素D3[25-(OH)-D3]<30μg/L、同型半胱氨酸(Hcy)≥13μmol/L、嵴帽型、雌二醇(E2)<100 pmol/L的BPPV患者SRM-IV眩晕诊疗系统治疗后DHI评分较高。多因素Logistics回归分析显示,年龄、病程、头部外伤史、高血压、高血脂、高血糖、半规管轻瘫CP值、25-(OH)-D3、Hcy、疾病类型、E2为影响BPPV患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的主要因素。结论BPPV患者经SRM-IV眩晕诊疗系统治疗后眩晕残障现状改善,合并症、病情严重程度、外伤史等均与眩晕残障现状相关。展开更多
目的探讨绝经妇女良性阵发性位置性眩晕(BPPV)与骨密度(bone mineral density,BMD)变化的相关性。方法随机选取50例年龄50~80岁原发性BPPV(idiopathic BPPV,iBPPV)绝经妇女作为病例组,选取同年龄段本院体检中心绝经后健康体检者为对照组...目的探讨绝经妇女良性阵发性位置性眩晕(BPPV)与骨密度(bone mineral density,BMD)变化的相关性。方法随机选取50例年龄50~80岁原发性BPPV(idiopathic BPPV,iBPPV)绝经妇女作为病例组,选取同年龄段本院体检中心绝经后健康体检者为对照组,采用双能X线吸收法分别对腰椎正位(L1~L4)及股骨颈进行测量,测量结果以T值表示。将病例组和对照组分成3个年龄段,分别对3个年龄段的T值进行统计学分析。结果病例组3个年龄段T值与对照组比较,差异均有统计学意义(t分别为-3.68、-5.98和-3.33,P均<0.05),Pearson相关性分析显示iBPPV与BMD存在负相关性(r=-0.496,P<0.05)。结论绝经妇女iBPPV与BMD变化存在相关性,研究结果对iBPPV诊断、治疗、预后评定和预防具有一定指导意义。展开更多
目的应用站立海绵垫的方法干扰人体直立时的本体觉,探讨后半规管良性阵发性位置性眩晕(be-nign paroxysmal positional vertigo of the posterior semicircular canal,BPPV-PSC)患者在本体觉受到干扰时的姿势平衡。方法39名确诊为BPPV-...目的应用站立海绵垫的方法干扰人体直立时的本体觉,探讨后半规管良性阵发性位置性眩晕(be-nign paroxysmal positional vertigo of the posterior semicircular canal,BPPV-PSC)患者在本体觉受到干扰时的姿势平衡。方法39名确诊为BPPV-PSC患者进行以下四种感觉条件下的姿势稳定性定量测量:T1:睁眼站立于坚硬平板;T2:闭眼站立于坚硬平板;T3:睁眼站立于海绵垫;T4:闭眼站立于海绵垫,所有测试均于姿势描记仪上完成。采用身体直立时足底压力中心的平均晃动速度(sway velocity,SV)为研究参数,并与39名正常人姿势稳定性作为对照。结果①应用海绵垫干扰本体觉后,BPPV-PSC组睁眼(t=11.905,P<0.001)及闭眼(t=11.457,P<0.001)时的SV均增加,对照组睁眼(t=9.701,P<0.001)及闭眼(t=17.604,P<0.001)时的SV亦均增加;②相同感觉条件下两组SV比较,除T1外(t=1.810,P=0.078),T2～T4条件下BPPV-PSC组的SV均高于对照组,差异有显著统计学意义(t=3.279～5.177,P=0.002～0.000)。结论BPPV-PSC患者的姿势稳定性在视觉和/或本体觉受到干扰时低于正常人,其机制可能与患者半规管流体动力学变化导致的前庭终器传入感觉改变有关。展开更多
文摘Objective:We aimed to describe the clinical features of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo(HC BPPV-AG)in a cluster of patients with restrictive neck movement disorders and a new therapeutic manoeuvre for its management.Methods:In a retrospective review of cases from an ambulatory tertiary referral center,patients with HC BPPV-AG in combination with neck movement restriction that prevented any classical manual repositioning procedure or who were refractory to canalith repositioning manoeuvres,were treated with a new manoeuvre comprised of sequential square-wave pattern of head and body supine rotations while nystagmus was being monitored,until either an apogeotropic to geotropic conversion or resolution of the nystagmus was observed.Results:Fifteen patients were studied.All but one[14/15 cases]showed a positive therapeutic response to the repositioning procedure in a single session.In two cases,a direct relief of vertigo and elimination of nystagmus was observed without an intermediate geotropic phase.Although in three patients the affected ear was not initially identified,it was ultimately identified and successfully treated by the square wave manoeuvre in all of them.Conclusions:The square-wave manoeuvre is an alternative for HC BPPV-AG treatment in either cases with neck restriction,where the affected side is not well identified at the bedside or when other manoeuvres fail to resolve the HC BPPV-AG.
基金the National Natural Science Foundation of China(No.81500794,No.81271078 and No.81500791)Scientific Research Project of Hubei Province Health and Family Planning(No.WJ2015MB062).
文摘Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down nystagmus(LDN)to identify the affected side in horizontal canal benign paroxysmal positional vertigo(HC-BPPV).Methods In our prospective study,we performed a testing profile(PSN,BLT,LDN,SRT)on 59 HC-BPPV patients using videonystagmography.We compared the accuracy and sensitivity of these tests in HC-BPPV lateralization.Data from 30 healthy patients were collected as the control group.Results When performing positional tests,the elicited nystagmus coinciding with Ewald’s second law was defined as a“positive response”.In 44 patients with geotropic nystagmus,the rates of positive response in LDN,PSN,and BLT were 22/44(50%),19/44(43%),and 18/44(41%),respectively,while in 15 patients with apogeotropic nystagmus,the positive response rates of these three tests were 10/15(66.7%),9/15(60%),and 4/15(27.00%),respectively.The sensitivity of LDN(54.38%)was higher than that of PSN(47.37%)and BLT(38.60%)but lower than that of SRT(89.47%).Notably,the accuracy rate of PSN(71.8%)was higher than that of the other APTs.In 6 patients with symmetrical nysgtamus during the roll test,5 patients showed a positive response in both LDN and BLT(83.34%),whereas 4 patients showed a positive response in PSN(66.67%).Conclusion All positional tests are helpful for determining the affected side of HC-BPPV,but SRT carries the highest accuracy of lateralization followed by PSN.
文摘目的系统评价Epley手法复位联合倍他司汀与单独Epley手法复位治疗后半规管良性阵发性位置性眩晕(PC-BPPV)的疗效。方法检索PubMed、Web of Science、中国知网、维普和万方等中英文数据库2012—2024年发表的文献,将单独Epley手法复位治疗PC-BPPV者纳入对照组,而将Epley手法复位联合倍他司汀治疗者纳入研究组。运用Stata 16.0软件对有效率、复发率、DHI评分及VAS评分等4个结局指标进行Meta分析。结果最终纳入11项研究进行Meta分析。Meta分析结果显示,Epley手法复位联合倍他司汀相较于单独Epley手法复位可以改善患者的1周有效率(RR=1.19,95%CI:1.02~1.37)、1个月复发率(RR=0.37,95%CI:0.19~0.73)、DHI评分(SMD=-0.98,95%CI:-1.54~-0.42)及VAS评分(SMD=-1.21,95%CI:-1.45~-0.96),两组比较差异均有统计学意义(P<0.05),但两周有效率、1个月有效率及6个月复发率比较差异均无统计学意义(P>0.05)。结论Epley手法复位联合倍他司汀治疗PC-BPPV患者具有更好的短期疗效,但长期疗效仍需大样本的随机对照研究进一步证实。
文摘目的探讨传统滚转试验(supine roll test,SRT)、低头-抬头试验(bow and lean test,BLT)和快速轴位滚转试验(rapid axial roll test,RART)在水平半规管良性阵发性位置性眩晕(horizontal semicircular canal benign paroxysmal positional vertigo,HSC-BPPV)责任半规管判定中的临床价值。方法选取2021年3月至2022年4月西安交通大学第一附属医院HSC-BPPV患者328例,根据不同的变位试验分为SRT组(113例)、BLT+SRT组(104例)和RART+SRT组(111例),BLT+SRT组和RART+SRT组分为2个阶段,第一阶段进行BLT或RART,第二阶段进行SRT。比较不同组别眼震引出率,采用Kappa一致性检验比较BLT/RART与SRT眼震引出结果的一致性。结果328例患者中,男95例,女233例,年龄18~86岁,平均(55.5±13.8)岁。RART+SRT组眼震引出率高于BLT+SRT组和SRT组(94.59%比81.73%比74.34%);RART+SRT组第一阶段眼震引出率、第二阶段SRT眼震引出率、责任半规管判定一致比例均高于BLT+SRT组,差异均有统计学意义(P<0.05);对责任半规管判定一致的患者进行复位治疗,BLT+SRT组痊愈率为92.59%(50/54),RART+SRT组为97.96%(96/98),两组痊愈率的比较,差异无统计学意义(χ^(2)=2.645,P=0.187)。Kappa一致性检验结果显示,RART与SRT在眼震引出率方面具有较好的一致性,一致率达94.59%(Kappa=0.638,P<0.001)。结论RART具有加速度大、安全性好、眼震引出率高的特点,能够有效诱发出HSC-BPPV特征性眼震,提高半规管定侧定位的准确性,为HSC-BPPV的临床实践提供更优化的检查方案,值得在临床中广泛推广。
文摘目的探讨良性阵发性位置性眩晕(BPPV)患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的影响因素。方法采用前瞻性队列研究,选取2022年4月至2023年4月于西宁市第一人民医院进行SRM-IV眩晕诊疗系统治疗的BPPV患者100例为研究对象,分析治疗后患者的眩晕残障现状及相关影响因素。结果与治疗前相比,BPPV患者治疗后眩晕残障程度量表(DHI)评分较低(68.36±13.14 vs 45.29±8.20)分。与治疗有效的BPPV患者相比,治疗无效的BPPV患者治疗后DHI评分较高(43.32±7.01 vs 67.89±14.01)分。单因素分析显示,≥60岁、病程≥3个月、有头部外伤史、有高血压、高血脂、高血糖、半规管轻瘫CP值≥20%、25羟维生素D3[25-(OH)-D3]<30μg/L、同型半胱氨酸(Hcy)≥13μmol/L、嵴帽型、雌二醇(E2)<100 pmol/L的BPPV患者SRM-IV眩晕诊疗系统治疗后DHI评分较高。多因素Logistics回归分析显示,年龄、病程、头部外伤史、高血压、高血脂、高血糖、半规管轻瘫CP值、25-(OH)-D3、Hcy、疾病类型、E2为影响BPPV患者SRM-IV眩晕诊疗系统治疗后眩晕残障现状的主要因素。结论BPPV患者经SRM-IV眩晕诊疗系统治疗后眩晕残障现状改善,合并症、病情严重程度、外伤史等均与眩晕残障现状相关。
文摘目的探讨绝经妇女良性阵发性位置性眩晕(BPPV)与骨密度(bone mineral density,BMD)变化的相关性。方法随机选取50例年龄50~80岁原发性BPPV(idiopathic BPPV,iBPPV)绝经妇女作为病例组,选取同年龄段本院体检中心绝经后健康体检者为对照组,采用双能X线吸收法分别对腰椎正位(L1~L4)及股骨颈进行测量,测量结果以T值表示。将病例组和对照组分成3个年龄段,分别对3个年龄段的T值进行统计学分析。结果病例组3个年龄段T值与对照组比较,差异均有统计学意义(t分别为-3.68、-5.98和-3.33,P均<0.05),Pearson相关性分析显示iBPPV与BMD存在负相关性(r=-0.496,P<0.05)。结论绝经妇女iBPPV与BMD变化存在相关性,研究结果对iBPPV诊断、治疗、预后评定和预防具有一定指导意义。
文摘目的应用站立海绵垫的方法干扰人体直立时的本体觉,探讨后半规管良性阵发性位置性眩晕(be-nign paroxysmal positional vertigo of the posterior semicircular canal,BPPV-PSC)患者在本体觉受到干扰时的姿势平衡。方法39名确诊为BPPV-PSC患者进行以下四种感觉条件下的姿势稳定性定量测量:T1:睁眼站立于坚硬平板;T2:闭眼站立于坚硬平板;T3:睁眼站立于海绵垫;T4:闭眼站立于海绵垫,所有测试均于姿势描记仪上完成。采用身体直立时足底压力中心的平均晃动速度(sway velocity,SV)为研究参数,并与39名正常人姿势稳定性作为对照。结果①应用海绵垫干扰本体觉后,BPPV-PSC组睁眼(t=11.905,P<0.001)及闭眼(t=11.457,P<0.001)时的SV均增加,对照组睁眼(t=9.701,P<0.001)及闭眼(t=17.604,P<0.001)时的SV亦均增加;②相同感觉条件下两组SV比较,除T1外(t=1.810,P=0.078),T2～T4条件下BPPV-PSC组的SV均高于对照组,差异有显著统计学意义(t=3.279～5.177,P=0.002～0.000)。结论BPPV-PSC患者的姿势稳定性在视觉和/或本体觉受到干扰时低于正常人,其机制可能与患者半规管流体动力学变化导致的前庭终器传入感觉改变有关。
