后半规管良性发作性变位性眩晕的临床研究

The clinical study of posterior semicircular canal benign paroxysmal positional vertigo

目的探讨后半规管良性发作性变位性眩晕(PC-BPPV)的临床特点和治疗方法。方法回顾分析2003年1月至2004年11月在第二军医大学附属长征医院神经内科确诊的120例PC-BPPV的临床特点与治疗效果。结果PC-BPPV患者眩晕发作具有短暂性、变位性、潜伏期和疲劳性等特点。Dix-Hallpike诱发试验时108例出现旋转向地性眼震,12例出现旋转向上性眼震,前者给予Epley手法复位治疗,后者给予Semont手法复位。前者88例经1次治疗后症状消失,12例经2次治疗、6例经3次治疗后症状也消失,2例无效;后者8例经1次治疗,2例经2次治疗,1例经3次治疗症状缓解,1例无效。总治疗成功率为97.5%(117/120)。随访1年,15例复发,复发率12.5%(15/120),复发者再行手法复位治疗仍有效。结论根据典型临床特点和Dix-Hallpike诱发试验可确诊PC-BPPV,手法复位治疗PC-BPPV安全有效,凡诊断明确均应给予手法复位治疗。

Objective To evaluate the clinical features and treatment of posterior semicircular canal benign paroxysmal positional vertigo （PC - BPPV）. Methods To retrospectively analyse the clinical features and therapy results of 120 patients with PC - BPPV from January 2003 to November 2004 in the Chang Zheng Hospital of the Second Military Medical University. Results Vertigo attack of PC - BPPV had such characters as brief period, positioning, latency and fatigability. Geotropic rotatory nystagmus occurred in 108 patients and apogeotropic rotatory nystagmus in 12 patients in the test of Dix - Hallpike, and the former received the repositioning maneuver therapy of Epley and the later received the therapy of Semont maneuver. The symptoms disappeared completely in 88 patients after a single session and 12 patients after twice, 6 patients after triple sessions of Epley repositioning maneuver therapy in the former, no effectiveness in 2 patients; the symptoms remitted in 8 patients after once, 2 patients after twice and 1 patient after triple sessions therapy of Semont repositioning maneuver in the later, no change in 1 patient. The total success rate was 97.5% （117/120）. Fifteen patients had relapse during followup and the recurrence rate was 12.5% （15/120）. They also responded to repositioning maneuver therapy. Conclusion The diagnosis of PC - BPPV is based on the typical clinical features and the test of Dix - Hallpike. The repositioning maneuver therapy is safe and effective for PC - BPPV and should be used for all patients when the diagnosis is clearly made.