2118例良性阵发性眩晕患者手法复位疗效观察

Canalith repositioning outcomes in 2118 patients with benign paroxysmal positional vertigo

目的收集在2008年1月~2013年12月广西医科大学第一附属医院耳鼻咽喉-头颈外科确诊并治疗的2118例BPPV患者的资料进行疗效分析。方法对2118例BPPV患者分别应用改良三步快速手法复位法、Epley复位法和Barbecue复位法进行复位治疗,于诊治后随访6个月。结果 12118名患者中男971例（45.85%）,女1147例（54.15%）;年龄8~87岁,发病平均年龄（49.36±11.73）岁,后半规管BBPV 2005例（94.66%）、水平半规管BBPV 88例（4.16%）、上半规管BBPV 14例（0.66%）、混合半规管BBPV 11例（0.52%）。2有1366例后半规管BPPV行传统Epley法治疗,639例行改良三步快速手法复位法治疗,两组首次有效率分别为90.6%、89.8%,远期（半年）有效率93.8%、95.8%,两组远期效率无统计学差异（χ~2=3.293,P〉0.05）;水平半规管Barbecue和Gufoni治疗,首次有效率92.7%,远期（半年）有效率98.6%;上半规管Epley治疗,首次有效率78.6%,远期（半年）有效率85.7%;混合型半规管联合复位治疗,首次有效率78.6%,远期（半年）有效率85.7%;3传统Epley手法复位组复发率为19.39%,改良三步快速手法复位组复发率为18.3%,两组复发率比较无统计学差异（χ~2=1.865,P〉0.005）。4复发患者回院治疗率,传统Epley手法复位组为100%,改良三步快速手法复位组为18.3%,两组比较统计学差异显著（χ~2=1.865,P〉0.005）。5复发患者复发1~2次的所占比例传统Epley手法复位组及三步快速手法复位组分别为43.4%、71.2%,复发次数≥3次的比例两组分别为56.6%、27.9%。两组复发次数≥3次的比例进行比较,有统计学差异（χ~2=32.34,P〈0.01）。结论 BPPV患者采用手法复位治疗疗效肯定,见效快,方法简单,远期疗效好,手法复位是BPPV患者的最佳的治疗方法。

Objective To report outcomes in 2118 patients with BPPV treated by the authors from January 2008 to May 2013. Methods Data from 2118 patients with BPPV who were treated with either modified canalith repositioning or traditional Epley, Barbecue or Gufoni maneuvers were retrospectively studied. All patients were followed up for 6 months. Results （1）Of the 2118 patients, 971were male and 1147 female, with a mean age of 49.36 ± 11.73 （8 to 87） years. The lesion was located to the posterior semicircular canal in 2005 patients （94.66%）, horizontal semicireular canal in 88 patients （4.16%）, anterior canalsemicireular in 14 patients （0.66%）, and multiple semicircular canals in 11 patients （0.52%）. （2）Of the 2005 patients with PC-BBPV, 1366 were treated with the traditional Epley maneuver, yielding a first time treatment effective rate of 90.6% and a long-term （6 months） effective rate of 93.8%; and 639 were treated with the modified three steps fast canalith repositioning maneuver with a first time effective rate of 89.8% and a 6 months effective rate of 95.8% （x2= 3.293, P 〉 0.05）, （3）At six months following up, the rate of recurrence was 19.3% for those who received traditional Epley maneuvers and 18.3% for those who underwent the modified canalith repositioning maneuvers （x2=1.865, P 〉 0.05）. （4 All patients with recurrences in the Epley maneuver group returned for treatment, while only 18.3% of those with recurrences in the modified maneuver group returned for treatment （x2=2.824, P 〈 0.005）. （5）The rate of 1 to 2 recurrences was 43.4% with traditional Epley treatment and 71.2% with the modified three steps fast canalith repositioning; the rate of 3 recurrences or more was 56.6% and 27.9%, respectively, for the two therapies （x2=32.34, P 〈 0.01）. Conclusion The three-step fast repositioning for PC-BPPV is effect, easy to learn and operate and well accepted by most patients, with improved long term efficacy. It is the treatment of choice for PC-BPPV patients.