良性阵发性位置性眩晕患者三维视频眼震图特征分析  

Three-dimensional videonystagmography characteristics in patients with benign paroxysmal positional vertigo

作　　者：郑育金 陈克光 蒋康伦 徐枫[2] 戚颖[2] 黄新生[2] 蒋怀礼 ZHENG Yujin;CHEN Keguang;JIANG Kanglun;XU Feng;QI Ying;HUANG Xinsheng;JIANG Huaili(Department of Otolaryngology,Zhongshan Hospital(Xiamen Branch),Fudan University,Xiamen 361015,Fujian,China;Department of Otolaryngology Head and Neck Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院厦门医院耳鼻喉科,厦门361015 [2]复旦大学附属中山医院耳鼻咽喉头颈外科,上海200032

出　　处：《中国临床医学》2025年第2期177-182,共6页Chinese Journal of Clinical Medicine

基　　金：国家重点研发计划“常见多发病防治研究”重点专项(2023YFC2508000/8005)。

摘　　要：目的通过三维视频眼震图(three-dimensional videonystagmography,3D-VNG)分析良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者Dix-Hallpike试验与Roll试验中的眼震特征,以优化BPPV诊断与治疗策略。方法回顾性纳入94例BPPV患者,观察后半规管BPPV患者(n=68)在Dix-Hallpike试验,水平半规管BPPV患者(n=26)在Roll试验中的眼震变化,记录垂直、水平及扭转分量的方向,分析反转率。结果后半规管BPPV患者三维眼震特征高度一致:垂直眼震分量均向上,轴向眼震分量以顺时针(左侧BPPV,17/23)或逆时针(右侧BPPV,44/45)为主,水平眼震分量多为对侧向(50/68);由悬头位转为坐起位后,垂直眼震分量均反转,约50.0%或50.0%以上的患者轴向及水平眼震分量反转。右侧水平半规管BPPV患者水平眼震分量均右向(向地性),垂直向上为主(16/19);左侧水平半规管BPPV患者水平眼震分量多向左(6/7),垂直向下为主(6/7)。健侧转头时,水平半规管BPPV患者水平眼震分量多反转(25/26),强度小于患侧,3例垂直分量反转,轴向分量不典型。结论3D-VNG技术可精准量化分析BPPV患者的三维眼震特征,提高定位定侧精度,尤其适用于后半规管BPPV的诊断。Objective To analyze the characteristics of nystagmus during the Dix-Hallpike and Roll tests in patients with benign paroxysmal positional vertigo(BPPV)using three-dimensional videonystagmography(3D-VNG),in order to to optimize diagnostic and therapeutic strategies of BPPV.Methods A retrospective analysis was conducted on 68 patients with posterior semicircular canal(PSC)-BPPV and 26 patients with horizontal semicircular canal(HSC)-BPPV.Nystagmus data obtained from 3DVNG were reviewed for all patients,with a focus on the eye movement components during the Dix-Hallpike test in PSC-BPPV patients and the Roll test in HSC-BPPV patients.The direction and reversal rates of the vertical,horizontal,and torsional components were recorded and analyzed.Results All PSC-BPPV patients exhibited highly consistent three-dimensional nystagmus characteristics during the Dix-Hallpike test:vertical nystagmus was uniformly upward,torsional nystagmus was predominantly clockwise in left-side BPPV patients(17/23)and counterclockwise in right-side BPPV patients(44/45),while the horizontal component was mostly directed contralaterally(50/68);upon transitioning from the head-hanging to the sit-up position,vertical nystagmus components in all patients reversed,and torsional and horizontal nystagmus components reversed in approximately 50.0%or more patients.Among HSC-BPPV patients,right-side BPPV patients all showed right-beating(geotropic)horizontal nystagmus with predominantly upward vertical component(16/19),while most left-side BPPV patients showed left-beating horizontal nystagmus(6/7)with predominantly downward vertical component(6/7).During head rotation toward the healthy side,most(25/26)HSC-BPPV patients exhibited a reversal in the horizontal nystagmus direction,reduced intensity compared to the affected side,with a reversal in vertical components in 3 patients,and atypical torsional components.Conclusions 3D-VNG could precisely quantitative analyze three-dimensional features of nystagmus in BPPV patients,improve diagnostic accuracy

关 键 词：三维视频眼震图 良性阵发性位置性眩晕 后半规管 水平半规管 

分 类 号：R764.34[医药卫生—耳鼻咽喉科]