上半规管良性阵发性位置性眩晕的诊断及治疗  

Diagnosis and therapy for benign paroxysmal positional vertigo of the anterior semicircular canal

作　　者：高波[1] 宋海涛[1] 周金梅[1] 龚霞[1] 黄魏宁[1] 

机构地区：[1]卫生部北京医院耳鼻咽喉科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2007年第6期428-431,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨上半规管良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的诊断和治疗。方法回顾性分析了上半规管 BPPV 患者31例,并对所有患者采用管石复位法治疗后的效果进行评估。结果在 Dix-Hallpike 检查中,所有患者均诱发出垂直向下的眼震。22例(70.97%)患者一侧诱发出眼震,其中17例眼震伴有扭转成分,5例眼震不伴扭转成分。其余9例(29.03%)患者双侧诱发出现眼震,眼震伴有扭转成分的7例,其中2例眼震扭转方向指向同一侧,4例眼震的扭转方向不同定,1例患者仅一侧出现扭转成分。另外2例患者眼震不伴扭转成分。受累侧别明确诊断的19例(61.29%),其中11例为左侧上半规管受累,8例为右侧上半规管受累。受累侧别未明确诊断的12例(38.71%)。所有患者中,11例(35.48%)患者同时合并后半规管受累。对所有患者采取管石复位法治疗,21例(67.74%)痊愈,29例(93.55%)有效、2例(6.45%)无效。其中首次治愈14例(45.16%),平均治愈次数为1.71次。随访期间5例复发。结论上半规管 BPPV临床中少见。在变位检查中,眼震的扭转成分较弱,临床中不易观察。在部分单侧上半规管 BPPV 患者中,双侧检查均能诱发眼震。管石复位法是治疗上半规管 BPPV 简单有效的手段。Objective To analyse the video-oculographic findings of positional tests and evaluate the efficacy of canalith repositioning procedure （CRP） in patients with paroxysmal positional vertigo （BPPV） of the anterior semicircular canal （ASC）. Methods A retrospective study of 31 patients with ASC BPPV. Then the CRP was performed. Results Twenty-two individuals （70. 97% ） presented a unilateral positional nystagmus during the Dix-Hallpike test, in 17 individuals had torsional nystagmus component, 5 individuals only had pure positional down beat nystagmus. Nine patients presented bilateral positional nystagmus,7 individuals had torsional component positional nystagmus, in 2 patients the direction of the torsional component were the same during right and left Dix-Hallpike test, in 4 patients the torsinal component were concurrent with positional down beat nystagmus but the direction could not be ascertained clinically, in 2 patients had pure positional down beat nystagmus. Nineteen patients （61.29%） had unilateral lesion, 11 patients had the left ASC BPPV, 8 patients had right ASC BPPV. Eleven patients had with beth ASC and PSC BPPV in the ipsilateral. Twenty-one patients （67. 74% ） were cured, 29 patients （93.55%） were improved,2 （6.45%）patients were inefficacy. CRP effectively resolved the nystagmus and vertigo in 14 patients （45.16%） when applied only once,The average number of CRP was 1.7 times, there were 5 patients recurrence during the follow-up. Conclusions ASC BPPV was not a common condition. The torsional nystagmus component of ASC BPPV might be weak during the Dix-Hallpike test. The positional nystagmus of ASC BPPV was triggered bilaterally. Based on these findings, CRP could be one of the most effective treatment methods for ASC BPPV.

关 键 词：半规管 眩晕 治疗学 

分 类 号：R764[医药卫生—耳鼻咽喉科]