肌电传感器加速度计在良性阵发性位置性眩晕患者平衡功能检测中的应用

摘要

目的 用肌电传感器加速度计评估良性阵发性位置性眩晕(BPPV)患者平衡功能.方法 选择2017年11月至2018年11月确诊的单侧原发性BPPV患者25 例(病例组)和健康者18例(对照组);病例组再按病变部位分为后半规管-BPPV(PC-BPPV)亚组(20例)和水平半规管-BPPV(HC-BPPV)亚组(5例).采用可穿戴式嵌入肌电传感器的加速度计观察动静态平衡功能.肌电传感器分别固定在患者左脚、右脚、头部和腰部,加速度计采集模块有前后、左右和垂直方向3个轴,采集站立和运动过程中的加速度信号,采样频率148 Hz.静态平衡试验包括睁眼静止站立和闭眼静止站立(用时各30 s),动态平衡试验为自然状态往返行走2次(距离20 m).主要采集站立时的静态平衡参数:加速度的均方根(RMS)、平均速度(MV)、姿势摆动平滑度指标(Jerk);行走时的动态平衡参数:步态周期、步频、单步时、支撑相所占百分率(% )等数据.结果 PC-BPPV亚组和HC-BPPV亚组睁眼、闭眼时静态平衡参数与对照组比较均有差异.PC-BPPV 亚组睁眼和闭眼站立期间摆动的RMS、MV和Jerk参数均显著大于对照组(P<0.05),且闭眼站立期间的差异更大(P<0.01). HC-BPPV亚组睁眼站立期间摆动的RMS、MV和Jerk参数与对照组比较差异无显著性,闭眼站立期间摆动的Jerk参数显著大于对照组(P<0.05).与对照组比较,PC-BPPV和HC-BPPV亚组的步态周期和单步时间显著延长(P<0.05),步频显著较小(P<0.05),而左脚、右脚支撑相所占百分率以及双脚支撑相所占百分率差异无显著性(P>0.05).结论 BPPV患者的静态和动态平衡功能均存在缺陷,BPPV 也许并不良性.平衡功能检查可为BPPV的诊断、治疗和康复提供客观依据.%ABSTRACT Aim To observe the difference of balance in patients with benign paroxysmal positional vertigo( BPPV) and that of the normal people by using accelerometers. Methods Individuals who were diagnosed as idiopathic unilateral semicircular canal BPPV from November 2017 to November 2018 in our dizziness outpatient department and healthy subjects were included in this study. The patients’ group was divided into two subgroups according to the location of heterotopic otolith: posterior semicircular canals ( PC-BPPV) and horizontal semicircular canals( HC-BPPV) . Acceleration patterns at the head and lower trunk were measured during standing and walking at self-selected speed. Temporospatial parameters, root mean square ( RMS ) , mean velocity ( MV ) , Jerkinesssway ( JERK ) , gait cycle, stride frequency, percentage of stand phase were calculated to indicate standing and walking stability. Standing and gait patterns derived parameters were evaluated between the two groups. Results The temporospatial parameters of standing were different between BPPV patients and the healthy individuals. The RMS, MV and JERK in patients with PC-BPPV are much higher than those of the healthy individuals( P <0.05) , specially when eyes closing( P<0.01). The RMS, MV and JERK in patients with HC-BPPV are similar with those of healthy individuals when eyes opening, but the JERK is much higher in the patients group when eyes closing( P<0.05) . The gait cycle in BPPV patients is much longer than the healthy individuals (P<0.05) and the stride frequency is much lower( P<0.05) . However, there was no difference of the percentage of stand phase between the two feet in BPPV patients( P>0.05) . Conclusion The balance in patients with benign paroxysmal positional vertigo is impaired, so the benign paroxysmal positional vertigo may be not so benign. Aaccelerometers are good way to observe the balance of the patients with BPPV.