俯屈仰头试验在水平半规管良性阵发性位置性眩晕诊断中的意义

Significance of the 'bow and lean test' for the diagnosis of benign horizontal semicircular canal paroxysmal positional vertigo

目的观察及评价俯屈仰头试验在水平半规管良性阵发性位置性眩晕诊断中的阳性率及准确性。方法收集2010年10月1日—2011年9月30日眩晕门诊确诊的水平半规管良性阵发性位置性眩晕患者92例,对入组对象先行平卧侧头试验(HRT),随后行俯屈仰头试验(BLT)。根据HRT及BLT结果,采用Barbecue手法复位或Brandt-Daroff锻炼并随访。统计分析经BLT诱发出眼震的患者比例以及对比HRT与BLT在患侧判断中的准确性和治疗成功率。结果 92例患者中,83例(90.2%)经BLT后诱发出眼震,其中68.7%(57/83)的患者兼具俯屈位眼震和仰头位眼震,21.7%(18/83)仅有俯屈位眼震,9.6%(8/83)仅有仰头位眼震。92例患者中,HRT可明确患侧者74例(80.4%),其中69例BLT阳性,5例BLT阴性。BLT阳性的69例患者,60例与HRT患侧判断一致,经手法复位治疗成功;9例BLT与HRT结果不一致,先按HRT判定结果行手法复位3次,未成功,随后按BLT判断结果行手法复位成功。HRT无法判定患侧者18例(19.6%),其中14例经BLT明确后手法复位治疗成功,4例经BLT后仍未诱发出眼震,嘱患者进行Brandt-Daroff锻炼,随访3d后患者诉眩晕发作消失且HRT未诱发出眼震。92例患者中按HRT判断结果复位成功者65例(70.7%),按BLT判断结果复位成功者83例(90.2%),差异有统计学意义(P<0.05)。结论 BLT在诱发水平半规管BPPV眼震时阳性率高,在HRT无法判断受累侧时,BLT能较为便捷地确定受累半规管,从而为选择有效的手法复位提供依据。

Objective To observe and assess the positive rate and accuracy of bow and lean test in the horizontal semicircular canal benign paroxysmal positional vertigo （HSC-BPPV）. Methods Ninety-two HSC-BPPV patients who were diagnosed by head roll test （HRT） were enrolled, and then further tested with ＇bow and lean test＇ （BLT） between Oct 1, 2010 and Sep 30, 2011. They were treated by Barbecue maneuver or Brandt-Daroff exercise on the basis of HRT and BLT tests. The positive rate of BLT test was analyzed, and its accuracy for diagnosis and success rate for treatment of HSC-BPPV were compared between HRT and BLT. Results Among the 92 patients, 83（90.2%） of them showed BLT nystagmus. Fifty-seven of 83 （68.7%） patients showed both bowing nystagmus and leaning nystagmus, and 18（21.7%） and 8（9.6%） respectively showed bowing nystagmus alone or leaning nystagmus alone. Among 92 patients, 74（80.4%） of them the affected side could be determined by HRT with 69 BLT positive and 5 BLT negative. Among the 69 BLT-positive patients, 60 patients showed the same result of HRT, and successful result was achieved by manipulation. 9 patients showed different result between BLT and HRT, in whom manipulation failed according to the result of HRT, but succeeded when manipulation was performed according to BLT. In 18 patients（19.6%） it was not able to determine the affected side by HRT, but in 14 patients manipulation was successful when BLT result was applied. In 4 patients BLT failed to evoke nystagmus, but after practicing Brandt-Daroff exercise, vertigo and HRT nystagmus disappeared 3 days later. Among the 92 patients, 65（70.7%） were cured according to HRT, while 83（90.2%） got successful result according to BLT（P〈0.05）. Conclusion The positive rate and accuracy for HSC-BPPV by BLT are high. It is a useful method for determining the affected side in HSC-BPPV, and to provide the basis for selecting effective manipulation treatment.