主观视觉水平线在单侧前庭周围病变中的应用研究
发布时间：2018-07-25 08:02
【摘要】：目的 前庭功能是人体重要的感觉功能,前庭感受器包括耳石器和半规管,半规管主要感受角加速度的变化,耳石器主要感受线加速度和头部位置的变化。前庭功能评定是前庭系统疾病诊治的重要环节,既往只侧重于半规管功能的检查,由于耳石器特殊的解剖、生理特性和技术的限制,耳石器功能检查在临床难以有效开展。近年的研究发现主观视觉垂直线(subjective visual vertical, SVV)在判断耳石器功能、特别是双侧耳石器功能不对称性方面有十分重要的意义。主观视觉水平线(subjective visual horizontal,SVH)是否具有同样的评定功能鲜有报道。本文通过对正常人主观视觉水平线、主观视觉垂直线的正常值范围进行总结,对单侧外周前庭功能减退患者的主观视觉水平线、主观视觉垂直线进行定性、定量分析并探讨其影响因素,为临床上前庭系统的功能评估及眩晕的诊断、前庭康复等方面提供可靠有效的依据。 方法 设立正常人为对照组和单侧外周前庭功能减退患者为试验组,进行对照试验研究。正常对照组为我院医护人员及家属共39例,女21例,男18例,要求视力正常,既往无眩晕、平衡障碍、听力障碍、中耳炎等耳科疾患病史,无神经科及肌肉骨骼系统疾病史。试验组病例于2009年3月至2010年5月来自天津市第一中心医院耳鼻咽喉头颈外科眩晕中心,共计85例,男性38例,女性47例；其中突发性聋50例、前庭神经炎18例、Hunt综合征4例、单侧慢性中耳炎4例、梅尼埃病9例；耳科及神经科学、影像学检查鉴别诊断除外前庭中枢性病变、外伤性耳聋等,且末次眩晕发作距就诊时间一个月内的患者。应用法国Synapsys视频眼震电图仪及其主观视觉垂直线、主观视觉水平线插件、德国ATMOS冷热气刺激仪,按常规要求行冷热试验(Caloric test, CT)和主观视觉垂直线、主观视觉水平线检测。对照组单独进行主观视觉垂直线、主观视觉水平线检查,试验组先行主观视觉垂直线、主观视觉水平线检查,然后完成冷热试验。观测正常人主观视觉垂直线、主观视觉水平线的正常值范围,以主观视觉垂直线、主观视觉水平线的偏斜角度、冷热试验优势偏向(directional preponderance, DP)、单侧半规管轻瘫(unilateral weakness, UW)值为评定参数,对主观视觉水平线及主观视觉垂直线的偏斜角度、冷热试验优势偏向、单侧半规管轻瘫值进行定性、定量分析,分析主观视觉水平线与主观视觉垂直线之间的相关性,且各自与优势偏向、单侧半规管轻瘫值之间的相关性。 结果 1.正常对照组主观视觉水平线、主观视觉垂直线向左和向右的偏斜角度呈正态分布,以x±s表示,右向偏斜分别为0.80±0.58°、0.93±0.54°,左向偏斜分别为1.13±0.44°、0.94±0.53°,健康对照组主观视觉水平线、主观视觉垂直线右向偏斜角度的95%可信区间分别为0°-1.94°、0°-1.99°；左向偏斜95%可信区间分别为0.27°-1.99°、0°-1.98°,故本研究以主观视觉水平线、主观视觉垂直线在—2.00°-2.000为正常参考范围。85例试验组的主观视觉水平线、主观视觉垂直线偏斜角度范围分别为—22.20°-20.33°、—18.90°-20.40°,右向偏斜分别为4.26±4.56°、4.40±4.67°,左向偏斜分别为4.10±4.69°、4.32±4.80°,健康对照组与试验组主观视觉水平线、主观视觉垂直线右向及左向偏斜角度分别进行两组独立样本资料的t检验,差异均有统计学意义(t值分别为-4.31、—4.83、3.98、3.32,P值均0.05)。 2.试验组主观视觉水平线与主观视觉垂直线之间行Pearson积差相关分析显示,二者之间呈正相关(r=0.939,P值0.01)。试验组DP值、UW值均呈正态分布,Pearson积差相关分析显示,主观视觉水平线、主观视觉垂直线偏斜角度分别与DP值呈正相关(r分别为0.648、0.658,P值均0.01),而与UW值无相关性(r值分别为0.048、0.085,P值均0.05)。 3.根据主观视觉水平线或主观视觉垂直线、DP、UW 3个参数的阳性或阴性组合,可分别构成三种主要结果形式：主观视觉水平线(+),主观视觉垂直线(+),DP(+)UW(+)；主观视觉水平线(一),主观视觉垂直线(一),DP(+),UW(+)；主观视觉水平线(一),主观视觉垂直线(一),DP(一),UW(+),其病程中位数分别为5、10、15 d,5、9.5、14.5 d,分别行多样本秩和检验,差异均有统计学意义(χ2水平线=8.80,P=0.012；χ2垂直线=6.26,P=0.040)。 结论 主观视觉水平线可以评估耳石器(椭圆囊)功能；单侧外周前庭功能减退患者的主观视觉水平线、主观视觉垂直线偏斜角度随病程和前庭代偿进程呈动态变化,可用于前庭静态代偿评定。
[Abstract]:objective
Vestibular function is an important sensory function of the human body. The vestibular receptors include the otolith and the semicircular canal, the semicircular canals mainly feel the change of angular acceleration. The otolith organs mainly feel the change of the line acceleration and the position of the head. Vestibule function evaluation is an important link in the diagnosis and treatment of vestibular system diseases, with a previous emphasis on the examination of the function of the semicircular canal, because The special anatomical, physiological and technical limitations of the otolith are difficult to carry out in clinical practice. In recent years, it is found that the subjective visual vertical line (subjective visual vertical, SVV) is of great significance in judging the function of the otolith, especially the function of the bilateral otolith. It is rarely reported whether (subjective visual horizontal, SVH) has the same evaluation function. By summarizing the normal visual horizontal line of the normal person and the subjective visual vertical line, the subjective visual horizontal line and the subjective visual vertical line of the patients with unilateral peripheral vestibule dysfunction are qualitatively, quantitatively analyzed and discussed. The influencing factors can provide reliable and effective evidence for clinical evaluation of vestibular system function, diagnosis of vertigo and vestibular rehabilitation.
Method
The normal control group was established as the control group and the unilateral peripheral vestibule hypofunction in the experimental group. The normal control group was 39 cases, 21 women and 18 men in our hospital, with normal visual acuity, no previous vertigo, balance disorder, hearing impairment, otitis media and other ear disorders, no neurology and musculoskeletal system. From March 2009 to May 2010, the experimental group came from the vertigo center of the otolaryngology head and neck surgery in Tianjin First Central Hospital, including 85 cases, 38 males and 47 females, including 50 cases of sudden deafness, 18 cases of vestibular neuritis, 4 cases of Hunt syndrome, 4 cases of unilateral chronic otitis, 9 cases of Meniere's disease, and the ear and neuroscience, and the shadow of neuroscience. Patients with vestibule central lesions, traumatic deafness, and the duration of the final vertigo interval for one month were excluded. The French Synapsys video lngg and the subjective visual vertical line, the subjective vision horizontal line plug-in, the German ATMOS cold heat irritation instrument, and the cold and heat test (Caloric test) were performed according to the routine requirements. CT) and subjective visual vertical line, subjective vision horizontal line detection. The control group performed subjective visual vertical line, subjective vision horizontal line examination, subjective visual vertical line, subjective vision horizontal line examination before the test group, and then completed the cold and heat test. Subjective visual vertical line, skew angle of subjective vision horizontal line, directional preponderance, DP, and unilateral semicircular canal hemiplegia (unilateral weakness, UW) value as evaluation parameters, skew angle of subjective visual horizontal line and subjective visual vertical line, advantage bias of cold and heat test, unilateral semicircular canal hemiplegia value Qualitative and quantitative analysis, analysis of the correlation between the subjective visual horizontal line and the subjective visual vertical line, and the correlation with the dominant bias and the unilateral semicircular hemiplegia.
Result
1. the subjective visual horizontal line of the normal control group, the subjective visual vertical line has a normal distribution to the left and right oblique angles, with x + s, the right deviation is 0.80 + 0.58, 0.93 + 0.54 degrees respectively, the left oblique deviation is 1.13 + 0.44, 0.94 + 0.53 degrees respectively, and the subjective vision horizontal line of the healthy control group and the 95% of the subjective visual vertical line right deviation angle are 95% The interval of the letter is 0 -1.94 and 0 -1.99, and the 95% confidence interval of the left oblique deviation is 0.27 -1.99 and 0 -1.98, respectively. Therefore, the subjective visual horizontal line and the subjective visual vertical line from 2 to -2.000 are the subjective visual horizontal lines of the normal reference range, and the angle range of the visual vertical line deviation is 22.20 degrees respectively. 20.33 degrees, 18.90 degrees -20.40 degrees, the right deviation was 4.26 + 4.56, 4.40 + 4.67 degrees, the left deviation was 4.10 + 4.69 degrees, 4.32 + 4.80 degrees respectively. The subjective visual horizontal line of the healthy control group and the experimental group, the t test of the subjective visual vertical line right direction and left oblique angle respectively, the difference was statistically significant (t value). They are -4.31, - 4.83,3.98,3.32, and P values are 0.05).
2. the correlation analysis of Pearson product difference between the subjective visual horizontal line and the subjective visual vertical line showed that there was a positive correlation between the two groups (r=0.939, P value 0.01). The DP value of the experimental group, UW values were all positive distribution, and the Pearson product difference correlation analysis showed that the subjective visual horizontal line and the subjective visual vertical line deviation angle were positively correlated with the DP value (r score). The values were 0.648, 0.658, P 0.01, respectively, but no correlation with UW values (r values were 0.048, 0.085, P values were 0.05).
3. the positive or negative combinations of the 3 parameters of the subjective visual horizontal line or the subjective visual vertical line, DP, UW can form three main forms: subjective vision horizontal line (+), subjective visual vertical line (+), DP (+) UW (+); subjective vision horizontal line (1), subjective visual vertical line (1), DP (+), UW (+); subjective vision horizontal line (1), master Visual vertical line (1), DP (I), UW (+), the median of the course of disease were 5,10,15 D and 5,9.5,14.5 D respectively, and the different rank and test were performed respectively. The difference was statistically significant (=8.80, P=0.012, =6.26, P=0.040) of the x 2 horizontal line.
conclusion
The subjective visual horizontal line can evaluate the function of the otolith (oval SAC); the subjective visual horizontal line of the unilateral peripheral vestibule dysfunction patients, the subjective visual vertical line deflection angle with the course of disease and the vestibular compensatory process, can be used for the vestibular static compensatory assessment.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764.04
本文编号：2143160
[Abstract]:objective
Vestibular function is an important sensory function of the human body. The vestibular receptors include the otolith and the semicircular canal, the semicircular canals mainly feel the change of angular acceleration. The otolith organs mainly feel the change of the line acceleration and the position of the head. Vestibule function evaluation is an important link in the diagnosis and treatment of vestibular system diseases, with a previous emphasis on the examination of the function of the semicircular canal, because The special anatomical, physiological and technical limitations of the otolith are difficult to carry out in clinical practice. In recent years, it is found that the subjective visual vertical line (subjective visual vertical, SVV) is of great significance in judging the function of the otolith, especially the function of the bilateral otolith. It is rarely reported whether (subjective visual horizontal, SVH) has the same evaluation function. By summarizing the normal visual horizontal line of the normal person and the subjective visual vertical line, the subjective visual horizontal line and the subjective visual vertical line of the patients with unilateral peripheral vestibule dysfunction are qualitatively, quantitatively analyzed and discussed. The influencing factors can provide reliable and effective evidence for clinical evaluation of vestibular system function, diagnosis of vertigo and vestibular rehabilitation.
Method
The normal control group was established as the control group and the unilateral peripheral vestibule hypofunction in the experimental group. The normal control group was 39 cases, 21 women and 18 men in our hospital, with normal visual acuity, no previous vertigo, balance disorder, hearing impairment, otitis media and other ear disorders, no neurology and musculoskeletal system. From March 2009 to May 2010, the experimental group came from the vertigo center of the otolaryngology head and neck surgery in Tianjin First Central Hospital, including 85 cases, 38 males and 47 females, including 50 cases of sudden deafness, 18 cases of vestibular neuritis, 4 cases of Hunt syndrome, 4 cases of unilateral chronic otitis, 9 cases of Meniere's disease, and the ear and neuroscience, and the shadow of neuroscience. Patients with vestibule central lesions, traumatic deafness, and the duration of the final vertigo interval for one month were excluded. The French Synapsys video lngg and the subjective visual vertical line, the subjective vision horizontal line plug-in, the German ATMOS cold heat irritation instrument, and the cold and heat test (Caloric test) were performed according to the routine requirements. CT) and subjective visual vertical line, subjective vision horizontal line detection. The control group performed subjective visual vertical line, subjective vision horizontal line examination, subjective visual vertical line, subjective vision horizontal line examination before the test group, and then completed the cold and heat test. Subjective visual vertical line, skew angle of subjective vision horizontal line, directional preponderance, DP, and unilateral semicircular canal hemiplegia (unilateral weakness, UW) value as evaluation parameters, skew angle of subjective visual horizontal line and subjective visual vertical line, advantage bias of cold and heat test, unilateral semicircular canal hemiplegia value Qualitative and quantitative analysis, analysis of the correlation between the subjective visual horizontal line and the subjective visual vertical line, and the correlation with the dominant bias and the unilateral semicircular hemiplegia.
Result
1. the subjective visual horizontal line of the normal control group, the subjective visual vertical line has a normal distribution to the left and right oblique angles, with x + s, the right deviation is 0.80 + 0.58, 0.93 + 0.54 degrees respectively, the left oblique deviation is 1.13 + 0.44, 0.94 + 0.53 degrees respectively, and the subjective vision horizontal line of the healthy control group and the 95% of the subjective visual vertical line right deviation angle are 95% The interval of the letter is 0 -1.94 and 0 -1.99, and the 95% confidence interval of the left oblique deviation is 0.27 -1.99 and 0 -1.98, respectively. Therefore, the subjective visual horizontal line and the subjective visual vertical line from 2 to -2.000 are the subjective visual horizontal lines of the normal reference range, and the angle range of the visual vertical line deviation is 22.20 degrees respectively. 20.33 degrees, 18.90 degrees -20.40 degrees, the right deviation was 4.26 + 4.56, 4.40 + 4.67 degrees, the left deviation was 4.10 + 4.69 degrees, 4.32 + 4.80 degrees respectively. The subjective visual horizontal line of the healthy control group and the experimental group, the t test of the subjective visual vertical line right direction and left oblique angle respectively, the difference was statistically significant (t value). They are -4.31, - 4.83,3.98,3.32, and P values are 0.05).
2. the correlation analysis of Pearson product difference between the subjective visual horizontal line and the subjective visual vertical line showed that there was a positive correlation between the two groups (r=0.939, P value 0.01). The DP value of the experimental group, UW values were all positive distribution, and the Pearson product difference correlation analysis showed that the subjective visual horizontal line and the subjective visual vertical line deviation angle were positively correlated with the DP value (r score). The values were 0.648, 0.658, P 0.01, respectively, but no correlation with UW values (r values were 0.048, 0.085, P values were 0.05).
3. the positive or negative combinations of the 3 parameters of the subjective visual horizontal line or the subjective visual vertical line, DP, UW can form three main forms: subjective vision horizontal line (+), subjective visual vertical line (+), DP (+) UW (+); subjective vision horizontal line (1), subjective visual vertical line (1), DP (+), UW (+); subjective vision horizontal line (1), master Visual vertical line (1), DP (I), UW (+), the median of the course of disease were 5,10,15 D and 5,9.5,14.5 D respectively, and the different rank and test were performed respectively. The difference was statistically significant (=8.80, P=0.012, =6.26, P=0.040) of the x 2 horizontal line.
conclusion
The subjective visual horizontal line can evaluate the function of the otolith (oval SAC); the subjective visual horizontal line of the unilateral peripheral vestibule dysfunction patients, the subjective visual vertical line deflection angle with the course of disease and the vestibular compensatory process, can be used for the vestibular static compensatory assessment.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764.04
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