水平半规管良性阵发性位置性眩晕的患侧定位方法与临床价值探讨  

Affected side location and clinical value of horizontal semicircular canal benign paroxysmal positional vertigo

作　　者：李婷[1,2] 刘吉祥[2] 毕巍[2] 邢轶卓[2] 武斐[2] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市人民医院耳鼻咽喉头颈外科，天津300121

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第8期612-615,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨滚转试验(HRT)、俯曲仰头试验(BLT)及患者主观眩晕感觉(SVS)在水平半规管良性阵发性位置性眩晕(HSC-BPPV)中对于患侧定位的临床价值。方法:HSC-BPPV患者138例,其中HSC-Can 94例、HSC-Cup 44例,对所有患者先行HRT并询问患者SVS,随后行BLT。根据HRT、SVS及BLT结果,HSCCan、HSC-Cup分别采用Barbecue法、改良Kim法复位。分析分别经HRT、BLT、SVS患侧的检出率及疗效。结果:94例HSC-Can患者和44例HSC-Cup患者,分别经BLT诱发出BN和/或LN眼震81.91%、84.09%,经HRT诱发出双侧强弱不对称眼震90.43%、88.64%,SVS诉眩晕症状重侧60.64%、63.64%。经列联表χ~2检验和两两比较,HRT及BLT检出率差异无统计学意义(P>0.05),与SVS比较差异均有统计学意义(P<0.05)。排除4例经HRT、BLT、SVS均无法定位患侧的病例,将92例HSC-Can患者和42例HSC-Cup患者进行复位治疗,仅HRT阳性者首次治愈率分别为66.67%、60.00%,仅BLT阳性者分别为71.43%、66.67%,仅HRT阳性、仅BLT阳性与HRT、BLT均阳性且患侧为同侧(70.37%、62.50%)的差异无统计学意义(P>0.05),而与HRT、BLT均阳性且患侧为异侧(37.50%、30.00%)的差异有统计学意义(P<0.05)。结论:HRT为HSC-BPPV患侧定位最有效的体位检查方法,但BLT及SVS作为HSC-BPPV定位方法也具有一定的辅助诊断价值。Objective：To explore the clinical value of rolling test（HRT）, bow and lean test（BLT） and subjec- tive vertigo sensation（SVS） for affected side localization of patients with horizontal semicircular canal benign par- oxysmal positional vertigo（HSC-BPPV）. Method： One hundred and thirty-eight patients（94 HSC-Can and 44 HSC- Cup）with HSC-BPPV were enrolled. Patients were tested with HRT and then were asked about SVS, followed by BLT. According to the results of HRT, SVS and BLT, HSC-Can and HSC-Cup were repositioned by Barbecue method and modified Kim method respectively. The detection rate of the affected side of HRT, BLT, SVS and the curative effect were analyzed. Result：In 94 HSC-Can patients and 44 HSC-Cup patients,BN and / or LN were in- duced by BLT to be 81.91% and 84.09% respectively. HRT induced bilateral asymmetric nystagmus 90.43%, 88.64%, SVS told vertigo symptoms worse side 60.64% ,63.64%. There was no significant difference in the de- tection rate of HRT and BLT（P^0. 05） ,but have significant difference with SVS（P〈0.05）. Excluding four pa- tients in whom the comparison among HRT,BLT, SVS were inconclusive,we compared the curative effect of first treatment in 92 HSC-Can patients and 42 HSC-Cup patients. The curative effect of HRT positive only were 66.67% and 60.00% respectively , BLT positive only were 71.43% and 66.67% respectively , HRT and BLT both positive with ipsilateral affected side were 70.37% and 65.50% respectively , HRT and BLT both positive with contralateral affected side were 37.50% and 30.00% respectively. The curative effect of HRT positive only and BLT positive only had no significant difference with that of HRT and BLT both positive with ipsilateral affect- ed side , but they both had significant difference with that of HRT and BLT both positive with contralateral affect- ed side . Conclusion.. HRT is the most effective method for detecting affected side of HSC-BPPV, but BLT and SVS also have auxiliary diagnostic value as HSC-BPPV localization method

关 键 词：眩晕 半规管 管石症 嵴帽结石症 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]