人体重心动摇平衡仪在部分神经系统疾病诊断和治疗中应用价值的临床研究
摘要
平衡功能是人体神经、运动系统的一项重要功能。许多神经系统疾病均表现出不同程度的平衡功能障碍。以往由于对平衡功能障碍的检查主要通过一些物理检查手段(如：Romberg’s征等)完成，缺乏客观有效的定量判定指标，因而导致人们对不同神经系统疾病中平衡功能障碍的程度和特点往往缺乏足够的认识。如何对平衡功能障碍进行定量检查长期以来始终是广大医务工作者面临的一道难题。
重心动摇检查(Postural sway)是近年来兴起的一种对前庭系统、视觉系统和本体感觉系统病变引起的平衡功能障碍进行检查的新方法。该检查的临床意义在于可以为人体平衡功能的综合判断提供有价值的客观的定量资料。目前，该项检查在国内刚刚进入起步阶段，对其在临床中的应用价值和应用范围尚缺乏清楚的认识及统一的诊断标准。
第 四 旱 匡 大 学 硕 士 学 位 论 文
一
为此，本研究通过使用 EAB－100型重心动摇平衡仪对部分神
经系统疾病的平衡功能进行定量测评，进行了以下几方面的研
究，①确立其临床检测正常参考值：①探讨重心动摇平衡仪在共
济失调患者诊断中的应用价值：①探讨人体重心动摇平衡仪在椎
基底动脉供血不足性眩晕治疗中的应用价值。
主要方法和结果如下：
1）健康人重心动摇的轨迹形态以球心型居首位，其次为弥漫
型，再次为前后型。将各年龄组正常人的参数进行比较，30
岁组平衡功能最佳，与50岁以上组相比有显著性差异。
2）对185例不同类型的共济失调患者平衡功能进行检测，并与
正常人的检测结果相比较后发现正常人的人体重心动摇轨
迹的图形为球心型，感觉性、小脑性共济失调以弥散型多见，
前庭性共济失调介于两者之间，正常人与患者各参数比较，
共济失调患者动摇轨迹长，速度快，差异显著性强o＜
0刀1X 感觉性、小脑性共济失调组间的参数差异无显著性
（P＞0刀5）。
3）50例椎基底动脉供血不足性眩晕患者采用西比灵治疗前、后
的平衡功能检测发现正常人重心动摇轨迹以球心型多见，椎
基底动脉供血不足性眩晕患者重心动摇轨迹呈弥散型；重心
动摇的面积大，速度快与正常人比较差异有显著性（功刀5）；
椎基底动脉供血不足性眩晕患者闭眼时重心动摇面积明显
增大，与睁眼相比有显著差异（功．01卜椎基底动脉供血不足
性眩晕患者经西比灵治疗后，症状有明显改善（功刀1），静立
姿势图治疗前后的变化与临床症状、颈部血管B超、经颅多
普勒（TCD）检测结果相符。
6
第 四 旱 匡 大 学 硕 士 学 位 论 文
一
上述研究结果表明：
1）人体平衡能力随年龄老化逐渐衰退．尤以 60岁以后明显，
正常人50岁以后前庭功能开始减退；
2）人体姿势图对定量分析各种共济失调患者的前庭脊髓反射
功能有较重要的意义，可用于对共济失调患者进行粗筛，对
鉴别共济失调的类型可以提供帮助。
3）重心动摇检查中的重心动摇面积大小可能是反映椎基底动
脉供血不足性眩晕患者姿势平衡障碍程度的一个最为有效
的指标，其不仅对鉴别患者眩晕的类型具有重要意义，而且
对客观评价治疗前后病情变化也有一定价值。
总之，重心动摇平衡仪使对直立平衡功能进行客观、定量检查
成为可能，为检测人体平衡功能提供了一个新的综合性判定手段，
具有传统检查不可替代的特点。随着平衡功能的检测在各系统疾
病的诊断、鉴别诊断、防治和康复等领域中的应用，其训练功能
也将会被有效地开发和利用。重心动摇平衡检查具有无创、快速、
简单，结果可靠、重复性好，有助于病变的早期发现、早期诊断、
早期治疗，因此，该项检查值得神经科进一步研究椎广应用。
Equilibration is one of the most important functions of nerve system and locomotor system. Dysfunction of equilibration is often seen in many nerve system diseases.Detection of balance dysfunction used to be performed by some physical methods, such as Romberg's sign, which is insufficient in objective and effects and often leads to bad acknowledgements of the extent and the properties of balance dysfunction in different neural diseases. How to detect the balance dysfunction in quantity is always a problem for a long time. Postural sway is new method for detection of balance dysfunction from vestibule, visual or body-sensory diseases. The clinical purpose of this method is that it can offer some valuable date in quantity for diagnoses of human balance dysfunctions. Up to now, the application of this method is just at its start point. The value and range of its application is not well known, and a united criterion is in need.
So, a evaluation for the application of EAB-100 stabilometer in some nerve system diseases is given there. All the work is divided into three parts: 1.set-up for the normal value. 2. discussion of the values of stabilometer's application in diagnosis of ataxia. 3. discussion of the values of stabilometer's application in therapy of vertigo from vascular diseases.
Methods and Results:
l)In this study, 240 cases healthy persons different in their ages were examined for their equilibration function. Most of the indexes of equilibration in open-eyes condition are lower than in close-eyes condition. These indexes are gradually decreasing with the increasing of ages and increasing with aging. The 20-29 years group owes the lowest indexes, which is significantly different from the data of 30-39 years group(P<0.05),but isn't from 10-19 years group. Centripetal type is the most common type of postural sway, succeeding the diffusive type and forward-backward type. Comparing the indexes of common people from all three groups, we found the equilibration ability is the best in 30 years group, and significantly different from over-50 years group.
2)Study of 185 cases of ataxia show that the postural sway tract of sensory or cerebellum ataxia is diffusive type while for healthy people is centripetal. The tract of vestibular ataxia is between the two groups mentioned above. Difference between data from healthy people and patients is significant and that the tract of vestibular ataxia is longer and faster than healthy people (PO.01). There is no
significantly difference between sensory ataxia and cerebellum ataxia
3)Data from 50 cases of vascular vertigo patients showed that the tract is diffusive type and the center of gravity can reach to a wider range and a faster velocity (.PO.05). Swaying area of vascular vertigo patients hi opening-eyes is very bigger than in closed-eyes (P<0.01).Treated by Sibium, symptoms turned better. Changes of standing stable picture between before and after therapy match the changes of clinical symptoms and results from B ultrasound of cervical vessels and TCD.
Proofs mentioned above seemly demonstrated that:
l)The ability of equilibration decrease with aging, which is significantly after 60 years old. The function of vestibule decrease after 50 years.
2)Postural sway is very useful in analyzing the function of vestibule-spinalcord reflex in all kinds of ataxia patients. It can be used to perform a gross selection for ataxia patients, and help to differ the types of ataxia.
3) RMS Area maybe the most important index in postural sway to reflex the extent of equilibration dysfunction of vascular vertigo patients. It is not only benefit to differing the types of vertigo but benefit to objectively valuing the changes before and after therapy.
In a word, the utilization of stabilometer made it possible to detect the function of equilibration in quantity objectively, and bring us a new method to synthetically value the function of equilibration.
With the utilization of stabilometer in diagnosis, differential diagnosis, prevention and rehabilitation, their
重心动摇检查(Postural sway)是近年来兴起的一种对前庭系统、视觉系统和本体感觉系统病变引起的平衡功能障碍进行检查的新方法。该检查的临床意义在于可以为人体平衡功能的综合判断提供有价值的客观的定量资料。目前，该项检查在国内刚刚进入起步阶段，对其在临床中的应用价值和应用范围尚缺乏清楚的认识及统一的诊断标准。
第 四 旱 匡 大 学 硕 士 学 位 论 文
一
为此，本研究通过使用 EAB－100型重心动摇平衡仪对部分神
经系统疾病的平衡功能进行定量测评，进行了以下几方面的研
究，①确立其临床检测正常参考值：①探讨重心动摇平衡仪在共
济失调患者诊断中的应用价值：①探讨人体重心动摇平衡仪在椎
基底动脉供血不足性眩晕治疗中的应用价值。
主要方法和结果如下：
1）健康人重心动摇的轨迹形态以球心型居首位，其次为弥漫
型，再次为前后型。将各年龄组正常人的参数进行比较，30
岁组平衡功能最佳，与50岁以上组相比有显著性差异。
2）对185例不同类型的共济失调患者平衡功能进行检测，并与
正常人的检测结果相比较后发现正常人的人体重心动摇轨
迹的图形为球心型，感觉性、小脑性共济失调以弥散型多见，
前庭性共济失调介于两者之间，正常人与患者各参数比较，
共济失调患者动摇轨迹长，速度快，差异显著性强o＜
0刀1X 感觉性、小脑性共济失调组间的参数差异无显著性
（P＞0刀5）。
3）50例椎基底动脉供血不足性眩晕患者采用西比灵治疗前、后
的平衡功能检测发现正常人重心动摇轨迹以球心型多见，椎
基底动脉供血不足性眩晕患者重心动摇轨迹呈弥散型；重心
动摇的面积大，速度快与正常人比较差异有显著性（功刀5）；
椎基底动脉供血不足性眩晕患者闭眼时重心动摇面积明显
增大，与睁眼相比有显著差异（功．01卜椎基底动脉供血不足
性眩晕患者经西比灵治疗后，症状有明显改善（功刀1），静立
姿势图治疗前后的变化与临床症状、颈部血管B超、经颅多
普勒（TCD）检测结果相符。
6
第 四 旱 匡 大 学 硕 士 学 位 论 文
一
上述研究结果表明：
1）人体平衡能力随年龄老化逐渐衰退．尤以 60岁以后明显，
正常人50岁以后前庭功能开始减退；
2）人体姿势图对定量分析各种共济失调患者的前庭脊髓反射
功能有较重要的意义，可用于对共济失调患者进行粗筛，对
鉴别共济失调的类型可以提供帮助。
3）重心动摇检查中的重心动摇面积大小可能是反映椎基底动
脉供血不足性眩晕患者姿势平衡障碍程度的一个最为有效
的指标，其不仅对鉴别患者眩晕的类型具有重要意义，而且
对客观评价治疗前后病情变化也有一定价值。
总之，重心动摇平衡仪使对直立平衡功能进行客观、定量检查
成为可能，为检测人体平衡功能提供了一个新的综合性判定手段，
具有传统检查不可替代的特点。随着平衡功能的检测在各系统疾
病的诊断、鉴别诊断、防治和康复等领域中的应用，其训练功能
也将会被有效地开发和利用。重心动摇平衡检查具有无创、快速、
简单，结果可靠、重复性好，有助于病变的早期发现、早期诊断、
早期治疗，因此，该项检查值得神经科进一步研究椎广应用。
Equilibration is one of the most important functions of nerve system and locomotor system. Dysfunction of equilibration is often seen in many nerve system diseases.Detection of balance dysfunction used to be performed by some physical methods, such as Romberg's sign, which is insufficient in objective and effects and often leads to bad acknowledgements of the extent and the properties of balance dysfunction in different neural diseases. How to detect the balance dysfunction in quantity is always a problem for a long time. Postural sway is new method for detection of balance dysfunction from vestibule, visual or body-sensory diseases. The clinical purpose of this method is that it can offer some valuable date in quantity for diagnoses of human balance dysfunctions. Up to now, the application of this method is just at its start point. The value and range of its application is not well known, and a united criterion is in need.
So, a evaluation for the application of EAB-100 stabilometer in some nerve system diseases is given there. All the work is divided into three parts: 1.set-up for the normal value. 2. discussion of the values of stabilometer's application in diagnosis of ataxia. 3. discussion of the values of stabilometer's application in therapy of vertigo from vascular diseases.
Methods and Results:
l)In this study, 240 cases healthy persons different in their ages were examined for their equilibration function. Most of the indexes of equilibration in open-eyes condition are lower than in close-eyes condition. These indexes are gradually decreasing with the increasing of ages and increasing with aging. The 20-29 years group owes the lowest indexes, which is significantly different from the data of 30-39 years group(P<0.05),but isn't from 10-19 years group. Centripetal type is the most common type of postural sway, succeeding the diffusive type and forward-backward type. Comparing the indexes of common people from all three groups, we found the equilibration ability is the best in 30 years group, and significantly different from over-50 years group.
2)Study of 185 cases of ataxia show that the postural sway tract of sensory or cerebellum ataxia is diffusive type while for healthy people is centripetal. The tract of vestibular ataxia is between the two groups mentioned above. Difference between data from healthy people and patients is significant and that the tract of vestibular ataxia is longer and faster than healthy people (PO.01). There is no
significantly difference between sensory ataxia and cerebellum ataxia
3)Data from 50 cases of vascular vertigo patients showed that the tract is diffusive type and the center of gravity can reach to a wider range and a faster velocity (.PO.05). Swaying area of vascular vertigo patients hi opening-eyes is very bigger than in closed-eyes (P<0.01).Treated by Sibium, symptoms turned better. Changes of standing stable picture between before and after therapy match the changes of clinical symptoms and results from B ultrasound of cervical vessels and TCD.
Proofs mentioned above seemly demonstrated that:
l)The ability of equilibration decrease with aging, which is significantly after 60 years old. The function of vestibule decrease after 50 years.
2)Postural sway is very useful in analyzing the function of vestibule-spinalcord reflex in all kinds of ataxia patients. It can be used to perform a gross selection for ataxia patients, and help to differ the types of ataxia.
3) RMS Area maybe the most important index in postural sway to reflex the extent of equilibration dysfunction of vascular vertigo patients. It is not only benefit to differing the types of vertigo but benefit to objectively valuing the changes before and after therapy.
In a word, the utilization of stabilometer made it possible to detect the function of equilibration in quantity objectively, and bring us a new method to synthetically value the function of equilibration.
With the utilization of stabilometer in diagnosis, differential diagnosis, prevention and rehabilitation, their
引文
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42．燕铁斌主编．现代康复治疗技术．合肥：安徽科学技术出版社，1994，28-30
43．王宁华，殷秀珍．正常人平衡定量评测及相关因素初探．中华理疗杂志，1995；18：24-26
44．王宁华，殷秀珍，黄永善．正常人平衡定量评测及相关因素初探．中国康复医学杂志，1995；10：17-19．
45．孟晓落，朱艳等，中国人重心平衡动摇检查的正常值测定．临床脑电学杂志，1999；8(3)：137-139．
46．文诗广，陈伟群，蒋云．帕金森病患者姿势平衡障碍的定量研究．现代康复，2000；4(2)：190-191
47．文诗广，陈伟群．多发性硬化患者姿势平衡障碍的定量研究．现代康复，1999；3(2)：36-37
48. Wang LJ,Pei JC,Tong BL,Liu ZQ.Physiological evaluation of vestibular training load.Space Med Med Eng,2000;13:249-254
49. Ear Associates,Inc.,Seattle,Wa Voorhees RL.The role of dynamic posturography in neurotologic diagnosis.Laryngoscope,1989;99(10 Pt 1):995-1001
50．刘萍 汤君彦等．国人(195例)中心动摇计检查正常值的测定．中国耳鼻咽喉颅底外科杂志．1998．4(1)：53-55
51．大川刚，时田乔．重心摆动检查-单位面积轨迹长的意义-健康对照研究(日)．Equilibrium Res，1995；54：296-306
52. Alpini D, Caputo D, Pugnetti L, Giuliano DA, Cesarani A. Vertigo and multiple sclerosis: aspects of differential diagnosis. Neurol Sci 2001;22(Suppl 2):S84-87
53. Longridge NS, Mallinson AI, Denton A. Visual vestibular mismatch in patients treated with intratympanic gentamicin for Meniere's disease. J Otolaryngol, 2002;31(1):5-8
54. Di Girolamo S, Picciotti P, Sergi B, D'Ecclesia A, Di Nardo W.Postural control and glycerol test in Meniere's disease. Acta Otolaryngol, 2001;121(7):813-817
55. Makker R, Bailey P, Royston R, Kulinskaya E. Computerised dynamic posturography to assess recovery comparing general
anaesthesia with sedation and local anaesthesia for day case nasal surgery. Anaesthesia, 2001;56(11) :1097-1102
56． Johansson R, Magnusson M, Fransson PA, Karlberg M. Multi-stimulus multi-response posturography. Math Biosci, 2001 ;174(1) :41-59
57． Cass SP, Kartush JM, Graham MD. Patterns of vestibular function following vestibular nerve section. Laryngoscope, 1992; 102 (4) :388-394
58． Giordano C, Gonella ML, Macchieraldo A, Fomaseri V, Bosio C, Juliani E. Wallenberg's syndrome: an assessment of the dysphagic and postural Symptomatology.Acta Otorhinolaryngol Ital, 1992; 12 (2) : 165-174
59． Barin K, Seitz CM, Welling DB.Effect of head orientation on the diagnostic sensitivity of posturography in patients with compensated unilateral lesions. Otolaryngol Head Neck Surg, 1992;106(4) :355-362
60． Clinica Otorinolaringoiatrica, Universita di Roma Tor Vergat a. Alterations in postural control: the use of spectral analysi s in stability measurement.Acta Otorhinolaryngol Ital, 1998; 18 (2) :83-87
61． O'Neill DE, Gill-Body KM, Krebs DE. Posturography changes do not predict functional performance changes. Am J Otol, 1998;19(6) :797-803
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40．张蕲 人体平衡功能研究进展．神经病学与神经康复学杂志，1997；2(1)：35
41．裴静琛，杨天德，常磊等．动态姿态平衡检查及应用前景．中华航空医学杂志，1996；7(4)：252～256
42．燕铁斌主编．现代康复治疗技术．合肥：安徽科学技术出版社，1994，28-30
43．王宁华，殷秀珍．正常人平衡定量评测及相关因素初探．中华理疗杂志，1995；18：24-26
44．王宁华，殷秀珍，黄永善．正常人平衡定量评测及相关因素初探．中国康复医学杂志，1995；10：17-19．
45．孟晓落，朱艳等，中国人重心平衡动摇检查的正常值测定．临床脑电学杂志，1999；8(3)：137-139．
46．文诗广，陈伟群，蒋云．帕金森病患者姿势平衡障碍的定量研究．现代康复，2000；4(2)：190-191
47．文诗广，陈伟群．多发性硬化患者姿势平衡障碍的定量研究．现代康复，1999；3(2)：36-37
48. Wang LJ,Pei JC,Tong BL,Liu ZQ.Physiological evaluation of vestibular training load.Space Med Med Eng,2000;13:249-254
49. Ear Associates,Inc.,Seattle,Wa Voorhees RL.The role of dynamic posturography in neurotologic diagnosis.Laryngoscope,1989;99(10 Pt 1):995-1001
50．刘萍 汤君彦等．国人(195例)中心动摇计检查正常值的测定．中国耳鼻咽喉颅底外科杂志．1998．4(1)：53-55
51．大川刚，时田乔．重心摆动检查-单位面积轨迹长的意义-健康对照研究(日)．Equilibrium Res，1995；54：296-306
52. Alpini D, Caputo D, Pugnetti L, Giuliano DA, Cesarani A. Vertigo and multiple sclerosis: aspects of differential diagnosis. Neurol Sci 2001;22(Suppl 2):S84-87
53. Longridge NS, Mallinson AI, Denton A. Visual vestibular mismatch in patients treated with intratympanic gentamicin for Meniere's disease. J Otolaryngol, 2002;31(1):5-8
54. Di Girolamo S, Picciotti P, Sergi B, D'Ecclesia A, Di Nardo W.Postural control and glycerol test in Meniere's disease. Acta Otolaryngol, 2001;121(7):813-817
55. Makker R, Bailey P, Royston R, Kulinskaya E. Computerised dynamic posturography to assess recovery comparing general
anaesthesia with sedation and local anaesthesia for day case nasal surgery. Anaesthesia, 2001;56(11) :1097-1102
56． Johansson R, Magnusson M, Fransson PA, Karlberg M. Multi-stimulus multi-response posturography. Math Biosci, 2001 ;174(1) :41-59
57． Cass SP, Kartush JM, Graham MD. Patterns of vestibular function following vestibular nerve section. Laryngoscope, 1992; 102 (4) :388-394
58． Giordano C, Gonella ML, Macchieraldo A, Fomaseri V, Bosio C, Juliani E. Wallenberg's syndrome: an assessment of the dysphagic and postural Symptomatology.Acta Otorhinolaryngol Ital, 1992; 12 (2) : 165-174
59． Barin K, Seitz CM, Welling DB.Effect of head orientation on the diagnostic sensitivity of posturography in patients with compensated unilateral lesions. Otolaryngol Head Neck Surg, 1992;106(4) :355-362
60． Clinica Otorinolaringoiatrica, Universita di Roma Tor Vergat a. Alterations in postural control: the use of spectral analysi s in stability measurement.Acta Otorhinolaryngol Ital, 1998; 18 (2) :83-87
61． O'Neill DE, Gill-Body KM, Krebs DE. Posturography changes do not predict functional performance changes. Am J Otol, 1998;19(6) :797-803