CAJ | 학술논문

目的探讨动态平衡仪在良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者平衡功能评价及康复治疗中的应用价值.方法回顾性分析2007年5月至2008年12月48例后半规管BPPV患者的临床资料.所有患者分别于Epley法复位前后行动静态平衡仪及冷热试验检查,并对结果进行分析比较.对于复位后眼震消失但仍有平衡障碍的患者采用动态平衡仪进行平衡康复训练,3周后再行动态平衡仪检查.结果 48例BPPV患者,Epley法复位前,冷热试验异常12例,占25.O%;静态平衡仪异常16例,占33.3%;动态平衡仪异常34例,占70.8%.经统计分析,动态平衡仪异常率高于冷热试验及静态平衡仪,差异具有统计学意义(χ2值分别为4.84和7.88,P值均＜O.05).Epley法复位治疗后,冷热试验异常7例,静态平衡仪异常4例,动态平衡仪异常8例.复位治疗后动态及静态平衡仪测试结果异常率明显降低,差异具有统计学意义(χ2值分别为24.04和1O.08,P值均＜0.05);而冷热试验结果无明显变化,治疗前后差异无统计学意义(χ2=3.2,P＞0.05).运用动态平衡仪对复位治疗后仍有平衡障碍的8例患者进行平衡康复训练,3周后所有患者平衡不稳感均消失,复查动态平衡仪结果均正常.结论动态平衡仪可定量分析姿势平衡状态,有助于全面评价BPPV患者的平衡功能;BPPV患者多伴有平衡功能的降低,Epley法复位治疗可改善大部分患者的平衡功能,但并非所有患者平衡功能均恢复正常.运用动态平衡仪进行平衡康复训练对于已行耳石复位但仍有平衡障碍的患者有益.
목적 탐토동태평형의재량성진발성위치성현훈(benign paroxysmal positional vertigo,BPPV)환자평형공능평개급강복치료중적응용개치.방법 회고성분석2007년5월지2008년12월48례후반규관BPPV환자적림상자료.소유환자분별우Epley법복위전후행동정태평형의급랭열시험검사,병대결과진행분석비교.대우복위후안진소실단잉유평형장애적환자채용동태평형의진행평형강복훈련,3주후재행동태평형의검사.결과 48례BPPV환자,Epley법복위전,랭열시험이상12례,점25.O%;정태평형의이상16례,점33.3%;동태평형의이상34례,점70.8%.경통계분석,동태평형의이상솔고우랭열시험급정태평형의,차이구유통계학의의(χ2치분별위4.84화7.88,P치균＜O.05).Epley법복위치료후,랭열시험이상7례,정태평형의이상4례,동태평형의이상8례.복위치료후동태급정태평형의측시결과이상솔명현강저,차이구유통계학의의(χ2치분별위24.04화1O.08,P치균＜0.05);이랭열시험결과무명현변화,치료전후차이무통계학의의(χ2=3.2,P＞0.05).운용동태평형의대복위치료후잉유평형장애적8례환자진행평형강복훈련,3주후소유환자평형불은감균소실,복사동태평형의결과균정상.결론 동태평형의가정량분석자세평형상태,유조우전면평개BPPV환자적평형공능;BPPV환자다반유평형공능적강저,Epley법복위치료가개선대부분환자적평형공능,단병비소유환자평형공능균회복정상.운용동태평형의진행평형강복훈련대우이행이석복위단잉유평형장애적환자유익.
Objective To explore the clinical value of dynamic posturography in the evaluation and rehabilitation of vestibular function of patients with benign paroxysmal positional vertigo (BPPV). Methods A total of 48 patients with BPPV of posterior semicircular canal in vertigo clinic of our hospital from May 2007 to December 2008 were retrospectively analyzed in this study. All patients underwent the inspection of caloric test, static posturography, and dynamic posturography. The vestibular tests were performed at two different time points: at onset when patients had typical nystagmus provoked by the Dix-Hallpike maneuver before treatment with the Epley maneuver (canalith repositioning maneuver, CRM ), and at one week after treatment with CRM as their nystagmus disappeared. And results at theses two time points were compared.Eight patients whose dynamic balances were still abnormal after CRM accepted vestibular rehabilitation exercise using dynamic posturography, and re-examined 3 weeks later with dynamic posturography. Results Among 48 cases of BPPV, the abnormal rates of caloric test, static posturography, and dynamic posturography before CRM were 25.0%, 33.3% and 70.8%, respectively. The abnormal rate of dynamic posturography was much higher than that of caloric test or static posturography, and the differences were statistically significant ( χ2 = 4.84, 7.88; P ＜ 0. 05 ). After CRM, the abnormal rates of caloric test, static posturography, and dynamic posturography were 14.6%, 8.3% and 16.7%, respectively. After CRM, the abnormal rate of static and dynamic posturography showed signi? Cant reduction (χ2 = 24.04, 10.08; P ＜0.05 ), however, the results of caloric test showed no significant change (χ2 = 3.20, P ＞ 0. 05 ). Eight patients whose dynamic balances were still abnormal after CRM, accepted vestibular rehabilitation exercise lasting 3 weeks using dynamic posturography. The dynamic balances were all improved to normal after vestibular rehabilitation. Conclusions Dynamic posturography can quantitatively analyze postural balance,and is helpful in comprehensive evaluation of the vestibular function of BPPV patients. Impaired balance often presents in patients with BPPV. Treatment of BPPV using the canalith repositioning maneuver results in improved postural stability in static and dynamic posturography. However, not all patients have normal dynamic stability after successful CRM. The vestibular rehabilitation exercise using dynamic posturography is a helpful adjunct to the treatment for these patients.