良性阵发性位置性眩晕手法复位并发耳石异常移位的临床分析  

Clinical analysis of otolith abnormal migration during canalith repositioning procedures for benign paroxysmal positional vertigo

作　　者：陈志凌[1] 陈艳春[1] 吴华为[1] 蔡若琼 黄丽琴[1] 尹文华[1] 徐世影[1] 钱亚昇[1] 刘素琴[1] 王干[1] 

机构地区：[1]杭州市中医院耳鼻咽喉科,浙江杭州310007

出　　处：《中国耳鼻咽喉头颈外科》2016年第12期691-695,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的研究对良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）患者行手法复位时并发耳石异常移位的临床特征,探讨其诊断、治疗和预防的方法。方法收集2010年1月~2015年12月期间356例单侧BPPV患者在手法复位治疗中并发耳石异常移位的资料,并进行分型和危险因素分析。结果 356例患者中耳石异常移位发生率为4.78%（17/356）,其中管异常移位发生率2.8%（10/356）,原嵴帽结石转变为管结石发生率0.84%（3/356）,折返回原半规管发生率1.12%（4/356）。并发耳石异常移位的影响因素分别是复位后立即行DixHallpike试验（χ~2=27.512,P〈0.05）和立即再次行复位治疗（χ~2=26.386,P〈0.05）,而性别、年龄、病程、受累半规管和是否按标准完成复位对并发耳石异常移位影响不明显（P均〉0.05）。结论 BPPV患者在手法复位中会并发耳石异常移位,应及时观察症状并识别眼震方向来判定耳石移位的发生与类型。为预防其发生,不建议在耳石复位后立即行Dix-Hallpike试验或再次手法复位治疗。OBJECTIVE To investigate the clinical characteristics of otolith abnormal migration following canalith repositioning procedures（CRPs） for benign paroxysmal positional vertigo（BPPV） patients.The diagnosis,treatment and preven-tion approaches are also discussed.METHODS Totally 356 cases of unilateral BPPV patients were treated by CRPs between January,2010 and December,2015.Otolith abnormal migration following CRPs were recorded and analyzed with type and risk factors.RESULTS The incidence rate of otolith abnormal migration in 356 cases was totally 4.78%（17/356）,with canal conversion in 2.8%（10/356）,cupulolithiasis and canalolithiasis conversion in 0.84%（3/356）,and primarily canal reentry in 1.12%（4/356）.The risk factors were DixHallpike test immediately performed after CRPs（χ~2=27.512,P〈0.05） and another CRPs after treatment（χ~2=26.386,P〈0.05）.Sex,age,course,involved semicircular canals and whether CRPs in accordance with the standard was not significant（P〉0.05）.CONCLUSION Otolith abnormal migration is a complication following CRPs for BPPV.Diagnosis is based on careful assessment of the symptom and the pattern of nystagmus observed after CRPs.To prevent the occurrence of otolith abnormal migration,another Dix- Hallpike test or CRPs imme-diately performed after treatment is not recommended.

关 键 词：眩晕 半规管 临床方案 耳石复位法 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]