Epley管石复位法和Semont管石解脱法及其联合治疗后半规管良性阵发性位置性眩晕的疗效比较研究

Comparison of the Efficacy in the Treatment of Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo Among Epley Maneuver,Semont Maneuver and Combined Epley-Semont Maneuver

目的探讨Epley管石复位法、Semont管石解脱法及其联合治疗对后半规管良性阵发性位置性眩晕(PC-BPPV)的治疗效果。方法选取2013年1月—2014年12月在温州医科大学附属第一医院耳鼻咽喉科确诊为单侧PC-BPPV患者182例为研究对象,根据治疗方式,将患者分为Epley治疗组(52例)、Semont治疗组(50例)、联合治疗组(45例)和对照组(35例)。各组患者均口服甲磺酸倍他司汀片作为基线治疗,对照组不采用其他治疗方法。Epley治疗组采用Epley管石复位法,Semont治疗组采用Semont管石解脱法,联合治疗组患者先行Semont管石解脱法,再行Epley管石复位法。患者于治疗1周和1个月后复诊,评价疗效。治疗6个月时进行电话随访,询问症状复发情况。结果各组PC-BPPV患者治疗1周及1个月后有效率比较,差异有统计学意义(P<0.05),其中Epley治疗组、Semont治疗组和联合治疗组治疗1周及1个月后有效率高于对照组,差异有统计学意义(P<0.001)。各组管结石症患者治疗1周和1个月后有效率比较,差异有统计学意义(P<0.05);其中Epley治疗组、Semont治疗组和联合治疗组管结石症患者治疗1周及1个月后有效率高于对照组,差异有统计学意义(P<0.001)。各组嵴顶结石症患者治疗1周和1个月后有效率比较,差异无统计学意义(P>0.05)。治疗6个月后随访发现,各组复发率比较,差异无统计学意义(P>0.05)。结论 Epley管石复位法、Semont管石解脱法及联合治疗手法可有效治疗管结石症的PC-BPPV患者。

Objective To compare the efficacy in the treatment of posterior semicircular canal benign paroxysmal positional vertigo（PC-BPPV）among Epley maneuver,Semont maneuver and combined Epley - Semont maneuver. Methods From January 2013 to December 2014,we enrolled 182 patients who were definitely diagnosed with unilateral PC-BPPV in the Department of Otorhinolaryngology of the First Affiliated Hospital of Wenzhou Medical University. According to treatment mode, the patients were divided into Epley group（n = 52）,Semont group（ n = 50）,Epley - Semont group（ n = 45）and control group（n = 35）. Patients of all the groups were given Betahistine mesilate tablets orally as baseline treatment,while control group was not administrated with other therapies. Epley group was administrated by Epley maneuver,Semont group was administrated by Semont maneuver,and Epley - Semont group was administrated by Semont maneuver first and then by Epley maneuver. The patients had consultation again after one - week and one - month treatment respectively,and efficacy was evaluated. After 6 - month treatment,telephone follow - up was conducted to inquire about the recurrence. Results The four groups were significantly different in effective rate after one - week and one - month treatment（P 〈 0. 05）,with Epley group,＆amp;nbsp;Semont group and Epley - Semont group higher than control group（P 〈 0. 001）. The four groups were significantly different in the effective rate of canalithiasis patients after one - week and one - month treatment（ P 〈 0. 05）,with Epley group,Semont group and Epley - Semont group higher than control group（P 〈 0. 001）. The four groups were not significantly different in the effective rate of patients with cupulolithiasis after one - week and one - month treatment（P 〉 0. 05）. By follow - up after 6 -month treatment,it was found that the four groups were not significantly different in recurrence rate（P 〉 0. 05）. Conclusion Epley maneuver,Semont maneuver and combined Epley - Semont maneuver are effective in the treatment of PC-BPPV patients with canalithiasis.