上半规管良性阵发性位置性眩晕诊断试验分析和物理引擎耳石运动观察

杨晓凯

doi:10.16098/j.issn.0529-1356.2020.05.011

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解剖学报 ›› 2020, Vol. 51 ›› Issue (5) : 699-704. DOI: 10.16098/j.issn.0529-1356.2020.05.011

解剖学与耳鼻喉科学

上半规管良性阵发性位置性眩晕诊断试验分析和物理引擎耳石运动观察

杨晓凯*

作者信息 +

Analysis the diagnosis maneuver of anterior semicircular canal benign positional paroxysmal vertigo and observation on the otolith movement using physical engine#br#

YANG Xiao-kai*

Author information +

文章历史 +

摘要

目的对上半规管良性阵发性位置性眩晕（BPPV）诊断试验进行分析，了解其诊断机制。方法建立标准空间坐标系的膜迷路模型，设定膜迷路不同位置结石，基于物理引擎三维物理仿真，分析DixHallpike试验和仰卧悬挂头位试验耳石运动情况，进而推断所诱发眼震表现。结果 Dix-Hallpike试验和仰卧悬挂头位试验所有位置的结石都有一定程度的运动，并能诱发椭圆囊的结石经总管进入半规管。出现下跳眼震的情况，包括结石从椭圆囊进入后半规管，对侧后半规管结石向壶腹运动，上半规管的结石从壶腹嵴帽底部滑动到顶部，后者重复诊断实验仍为下跳眼震。重复10次观察，试验结果一致。结论对于上半规管BPPV的诊断标准，还需要重新评估，观察眼震动态变化是必要的，其诊断方法需要改良。

Abstract

Objective Analysis of the diagnosis maneuver of anterior semicircular canal benign positional paroxysmal vertigo(BPPV) and explore the diagnostic mechanism. Methods The three-dimensional membrane labyrinth model was established in standard space coordinate system, and the otolith in different positions of the membranous labyrinth was set up. The otolith movement in different positions during the Dix-Hallpike maneuver and straight head-hanging test were analyzed based on the physical engine, and the induced nystagmus could be inferred. Results During the Dix-Hallpike maneuver and straight head-hanging test, the otolith in all positions had a certain degree of movement, and it could induce otolith in the utricle to enter the semicircular canal through the common canal. The occurrence of down-beating nystagmus included the otolith enters the posterior semicircular canal from the utricle, the otolith in opposite posterior semicircular canal move towards the ampulla, the otolith in anterior semicircular canal slide from the bottom to the top of the cupula, and the latter still showed downbeating nystagmus in repeated diagnostic tests. The result of 10 repetitions were consistent. Conclusion The diagnostic criteria for anterior BPPV needs to be reassessed. It is necessary to observe the dynamic changes of nystagmus, and the diagnostic maneuver needs to be improved.

导出引用

杨晓凯. 上半规管良性阵发性位置性眩晕诊断试验分析和物理引擎耳石运动观察[J]. 解剖学报. 2020, 51(5): 699-704 https://doi.org/10.16098/j.issn.0529-1356.2020.05.011

YANG Xiao-kai. Analysis the diagnosis maneuver of anterior semicircular canal benign positional paroxysmal vertigo and observation on the otolith movement using physical engine#br#[J]. Acta Anatomica Sinica. 2020, 51(5): 699-704 https://doi.org/10.16098/j.issn.0529-1356.2020.05.011

中图分类号： R322.9+3

参考文献

［1］ Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update) executive summary［J］. Otolaryngol Head Neck Surg, 2017, 156(3): 403-416.
［2］ Imai T, Takeda N, Ikezono T, et al. Classification, diagnostic criteria and management of benign paroxysmal positional vertigo［J］. Auris Nasus Larynx, 2017, 44(1): 1-6.
［3］ Anagnostou E, Kouzi Ⅰ, Spengos K. Diagnosis and treatment of anterior-canal benign paroxysmal positional vertigo: a systematic review［J］. J Clin Neurol, 2015, 11(3): 262-267.
［4］ Yang XK, Wu ShZh, Chen XS, et al. 3D visualization of membranous labyrinth from voxel models［J］. Acta Anatomica Sinica, 2017, 48(2): 170-174.(in Chinese)
杨晓凯, 吴曙智, 陈晓素, 等. 基于内耳体素模型的膜迷路三维可视化［J］. 解剖学报, 2017, 48 (2): 170-174.
［5］ Wu ShZh, Li X, Zheng YY, et al. Establishment of membrane labyrinth model in standard three-dimensional coordinate system［J］. Zhejian Medical Journal, 2018, 40 (8): 792-795，899. (in Chinese)
吴曙智, 李熹, 郑炎焱, 等. 标准立体空间坐标系膜迷路模型的建立［J］. 浙江医学, 2018, 40 (8): 792-795，899.
［6］ Li X, Wu ShZh, Zheng YY, et al. A statistical shape model of the bilateral inner ear［J］. Acta Anatomica Sinica, 2018, 49 (6): 736-739. (in Chinese)
李熹, 吴曙智, 郑炎焱, 等. 双侧内耳统计形状模型［J］. 解剖学报, 2018, 49 (6): 736-739.
［7］ Yang X, Ling X, Shen B, et al. Diagnosis strategy and Yacovino maneuver for anterior canal-benign paroxysmal positional vertigo［J］. J Neurol, 2019, 266(7): 1674-1684.
［8］ McClure JA. Horizontal canal BPV［J］. J Otolaryngol, 1985, 14(1): 30-35.
［9］ Steddin S, Brandt T. Benign paroxysmal positional vertigo. Differential diagnosis of posterior, horizontal and anterior canalolithiasis［J］. Nervenarzt, 1994, 65(8): 505-510.
［10］ Honrubia Ⅴ, Baloh RW, Harris MR, et al. Paroxysmal positional vertigo syndrome［J］. Am J Otol, 1999, 20(4): 465-470.
［11］ Califano L, Salafia F, Mazzone S, et al. Anterior canal BPPV and apogeotropic posterior canal BPPV: two rare forms of vertical canalolithiasis ［J］. Acta Otorhinolaryngol Ital, 2014, 34(3): 189.
［12］ Imbaud-Genieys S. Anterior semicircular canal benign paroxysmal positional vertigo: a series of 20 patients ［J］. Eur Ann Otorhinolaryngol Head Neck Dis, 2013, 130(6): 303-307.
［13］ Herdman SJ, Tusa RJ. Complications of the canalith repositioning procedure［J］. Arch Otolaryngol Head Neck Surg, 1996, 122(3): 281-286.
［14］ Park S, Kim BG, Kim SH, et al. Canal conversion between anterior and posterior semicircular canal in benign paroxysmal positional vertigo.［J］. Otol Neurotol, 2013, 34(9): 1725-1728.
［15］ Cakir BO, Ercan Ⅰ, Cakir ZA, et al. What is the true incidence of horizontal semicircular canal benign paroxysmal positional vertigo［J］? Otolaryngol Head Neck Surg, 2006, 134(3): 451-454.
［16］ Helminski JO. Peripheral downbeat positional nystagmus: apogeotropic posterior canal or anterior canal BPPV［J］. J Neurol Phys Ther, 2019, 43（Suppl 2）: S8-S13.
［17］ Yacovino DA, Hain TC, Gualtieri F. New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo［J］. J Neurol, 2009, 256(11): 1851-1855.