后半规管良性阵发性位置性眩晕诊疗中并发耳石异常移位的临床研究

Clinical research of the otolith abnormal migration during canalith repositioning procedures for posterior semicircular canal benign paroxysmal positional vertigo

目的:研究后半规管良性阵发性位置性眩晕(PSC-BPPV)诊疗中并发耳石异常移位的危险因素、类型和眼震变化特征,探讨其治疗和预防方法。方法:分析2009-03-2012-03期间479例确诊为单侧PSC-BPPV采用Epley法治疗中出现耳石异常移位的患者的资料,对异常移位进行分型和相应的手法复位治疗,1周后评估治疗的成功率。诊断依据为Epley法复位过程异常的眼震变化及变位试验中的眼震。结果:耳石异常移位发生率为8.1%(39/479),其中易位管转换发生率为5.4%(26/479),易位于水平半规管和前半规管的发生率分别为4.8%(23/479)和0.6%(3/479);原发半规管折返发生率为2.7%(13/479)。患者均获治愈。耳石异常移位发生的危险因素包括治疗中的错误头位转动、治疗后立即复查Dix-Hallpike试验和自行不当头位。结论:采用Epley法治疗BPPV的过程应按特定的头位及偏转角度进行;治疗后适当的体位和头位限制对预防耳石异常移位的发生是有必要的,不建议立即复查Dix-Hallpike试验;细致的眼震特点观察有助于发现和诊断耳石异常移位。

Objective：To investigate the risk factor,type and characteristic nystagmus of the ototith abnormal migration during diagnosis and treatment for posterior semicircular canal benign paroxysmal positional vertigo （PSC-BPPV）. The therapy and prevention is also discussed. Method： Four hundred and seventy-nine patients with PSC-BPPV were treated by Epleys canalith repositioning procedures（CRP） from March 2009 to March 2012. We observed ototith abnormal migration complicating during diagnosis and treatment. According the type of otolith ab- normal migration, the additional repositioning maneuver was performed. Result： The rate of complication was 8.1%（39/479） ,with canal conversion in 5.4%（26/479） and primarily canal reentry in 2.7%（13/479）. The rate of incidence of conversion to horizontal canal conversion and anterior canal were 4.8% （23/479）and 0.6% （3/479） respectively. All the patient was cured in follow up. The risk factors were unappropriated head movement during or after CRP, including another Dix-Hallpike were performed immediately. Conclusion： To prevent the complica- tions,the pathognostic positioning sequence and angle of head rotation are commenced during CRP. Appropriate short time postural restrictions post treatment is necessary. Careful observation of nystagrnus variation is crucial to determine the otolith abnormal migration.