快速手法复位治疗多半规管良性阵发性位置性眩晕的近远期疗效分析

Short and long-term outcome of the rapid repositioning manoeuvre for multiple canals benign paroxysmal positional vertigo

目的探讨多半规管良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的诊断和快速手法复位的疗效。方法回顾性分析2009年7月~2014年7月诊治的317例行快速手法复位的BPPV患者的临床特征,其中单半规管BPPV 258例,两个或两个以上半规管BPPV 59例,根据变位试验检查确定受累半规管并行快速手法复位治疗,随访1周至3个月。结果 59例多半规管BPPV患者,双侧后半规管BPPV 1例（1.7%）,双侧水平半规管BPPV6例（10.2%）,后半规管合并上半规管BPPV10例（16.9%）,水平半规管合并上半规管BPPV 14例（23.7%）,后半规管合并水平半规管BPPV 28例（47.5%）。所有患者随访1周,总有效52例（88.1%）,随访3个月总有效56例（94.9%）,与同期258例单半规管BPPV患者的近远期疗效差异无统计学意义（P〉0.05）。结论多半规管BPPV并不罕见,并对临床医生的诊断提出了更高的要求,明确诊断后快速手法复位法对治疗多半规管BPPV效果确切能获得与单半规管BPPV同样好的治疗效果。

Objective To investigate the short and long-term outcome of rapid repositioning manoeuvre for multiple canals benign paroxysmal positional vertigo（ BPPV）. Methods The clinical data of 59 patients with multiple canals BPPV treated with rapid repositioning manoeuvre between July 2009 and July 2014 were analyzed retrospectively. According to the type and laterality of the involved semicircular canals by positioning tests,the patients were treated with the different rapid repositioning manoeuvres. Results Of all the patients,one（ 1. 7%） had bilateral posterior canal BPPV,6（ 10. 2%） had bilateral horizontal canal BPPV,10（ 16. 9%） had posterior and anterior canal BPPV,14（ 23. 7%） had horizontal and anterior canal BPPV,and 28 patients（ 47. 5%） had horizontal and posterior canal BPPV; the effective rates were 88. 1%（ 52 /59） and 94. 9%（ 56 /59） after following up for one week and 3 months respectively. Compared with 258 cases of single canal BPPV during the same period,their differences of both short and long-term outcome were statistically insignificant（ P〉0. 05）. Conclusion The multiple canals BPPV is not rare in clinic. It puts forward higher requirements to doctors for the diagnosis. The rapid repositioning manoeuvre is effective for multiple canals BPPV,and can get equal results corresponded to the single canal BPPV.