水平半规管良性阵发性位置性眩晕的眼震特点和治疗

Characteristic of nystagmus and treatment of horizontal semicircular canal benign paroxysmal positional vertigo

目的:探讨水平半规管良性阵发性位置性眩晕(HSC-BPPV)的眼震特点和治疗方法。方法:对43例HSC-BPPV患者应用红外线视频眼动记录仪分析其变位试验诱发的眼震特点,进行分型、定侧,并采用相应的耳石复位法治疗。结果:43例患者中:①水平向地性眼震患者27例,其中19例接受Barbecue翻滚疗法,或结合强迫侧卧体位疗法,8例不适于翻滚或体位维持困难者接受Asprella法治疗;②水平背地性眼震16例,其中自行或采用Gufoni疗法后转变为水平向地性眼震12例,方向不能转换4例,采用Barbecue翻滚和(或)强迫侧卧体位疗法。1周后随访总有效率为72.1%,3个月后总有效率为81.4%。结论:HSC-BPPV的诊断和治疗应根据不同变位试验诱发的眼震特征判别耳石位于半规管的不同部位及不同发病机制类型,并选择合适的耳石复位技术治疗。

Objective： To investigate the characteristic of nystagmus and treatment of horizontal semicircular canal benign paroxysmal positional vertigo （HSC-BPPV）. Method： The positioning nystagmic features in 43 patients with HSC-BPPV treated between April 2004 and October 2006 were recorded and analyzed with videonystagmography. After the subtype and the effect side were determined, the appropriate repositioning maneuvers were chosen. Result：（1）Geotropic nystagmus was recorded in 27 cases,of whom 19 cases were treated with barbecue maneuver and/or combined forced prolonged position maneuver, while the others were treated with Asprella＇s maneuver. （2） Apogeotripic nystagmus was recorded in 16 cases with two types, one of which could turn into geotropic nystagmus with Gufoni＇s maneuver or spontaneously （in 12 cases）, the other type could not （in 4 cases） transform acceptted barbecue maneuver and/or combined forced prolonged position maneuver. The total improve ment rate was 72.1% after 1 week and 81.4% 3 months later respectively. Conclusion：The otolith＇ position and the pathogenesis could be distinguished according to the nystagmic characteristics and type of HSC-BPPV. It was necessary to apply the appropriate repositioning maneuvers to treat HSC-BPPV.