16例非典型眼震表现的后半规管良性阵发性位置性眩晕的临床分析

Clinical analysis for 16cases with atypical nystagmus of posterior semicircular canal benign paroxysmal positional vertigo

目的:探讨非典型眼震表现的后半规管良性阵发性位置性眩晕(PSC-BPPV)患者的临床特点和治疗效果。方法:回顾性分析16例非典型眼震表现的PSC-BPPV患者的临床资料并观察手法复位的疗效,与同期治疗的28例伴有典型眼震表现的PSC-BPPV患者进行对比,并追踪随访3个月。采用SPSS 20.0统计学软件对数据进行分析。结果:16例非典型眼震表现的PSC-BPPV患者中左侧后半规管5例(31.25%),右侧后半规管11例(68.75%)。其中5例为激发位出现扭转成分指向患侧的垂直上跳性眼震,坐位时转为无明显垂直下跳扭转方向指向健侧的眼震,4例为激发位出现扭转成分指向患侧的垂直上跳性眼震,坐位时转为垂直下跳方向但无明显扭转成分的眼震,1例激发位出现无扭转成分的垂直上跳性眼震,回复至坐位时转为无扭转成分的垂直下跳性眼震,2例激发位及回复坐位时均未观察到明显眼震,行水平滚转试验时出现带扭转成分指向患侧的垂直上跳性眼震,4例激发位出现扭转成分指向健侧的垂直下跳性眼震,回复至坐位时出现眼震方向逆转。眼震持续时间>1min者1例、<1min者15例。28例伴有典型眼震的患者在激发位均出现扭转成分指向患侧的垂直上跳性眼震,回复至坐位时观察到方向逆转的眼震,持续时间全部<1min。2组患者均无双侧同时受累情况。所有患者根据眼震方向及持续时间分别采用改良Epley法、Semont解脱法复位治疗。眼震表现不典型组治疗后首日评估复位有效率为62.50%(10/16),眼震表现典型组为92.86%(26/28),差异有统计学意义(χ~2=5.134,P=0.015)。多次复位后总有效率分别为93.75%(15/16)和100.00%(28/28),组间差异无统计学意义(χ~2=2.780,P=0.095)。不典型组首次复位成功时所需平均循环次数为(2.76±1.13)次,而典型组为(1.68±0.61)次,差异有统计学意义(t=4.293,P=0.000)。随访3个月后眼震不典型组与典型组复发率分别为18.75%和14.28%,差异无统计学意义(χ~2=1.681,P=0.509)。结论:非典型眼震的PSC-BPPV患者临床表现较为复杂,治疗过程中部分患者亦可转变为典型眼震表现,手法复位治疗可取得较为满意的疗效,但首次复位有效率较典型眼震表现患者低,且复位成功需较多循环次数,随访后两者复发率无明显差异。

Objective：To study clinical features and evaluate the efficacy of manual reduction in treatment of atypical nystagmus in patients with posterior semicircular canal benign paroxysmal positional vertigo（PSC-BPPV）.Method：Sixteen cases of atypical nystagmus in patients with PSC-BPPV were retrospectively analyzed.The results were compared with 28patients of typical nystagmus with PSC-BPPV.All the patients were followed up for 3months.Statistical data analysis was carried out with SPSS 20.0.Result：Sixteen cases of atypical nystagmus patients with PSC-BPPV included 5cases of left 31.25%（5/16）and 11cases of right 68.75%（11/16）,5patients showed typical nystagmus in the straight-head hanging position and without vertical down-beating in returning to the sitting positions with torsional component pointed to intact side,4patients showed same nystagmus in hanging position and vertical down-beating in returning to the sitting positions without torsional component,one patient showed nystagmus of vertical up-beating and vertical down-beating in Dix-Hallpike test without torsional component,2patients showed unobservable nystagmus in Dix-Hallpike test but showed nystagmus of vertical up-beating with torsional component pointed to affected side in the roll test position,4patients showed nystagmus of vertical down-beating in the straight-head hanging position with torsional component pointed to intact side and reversible direction nystagmus in returning to the sitting positions.One patient＇s nystagmus time of duration was longer than1min,while 15patients＇nystagmus duration were shorter than 1min.Twenty-eight patients with typical nystagmus in PSC-BPPV nystagmus duration were shorter than 1 min.No patient had been affected bilateral in two groups.All patients received manual reduction treatment according to the nystagmus direction and time of duration.The effective rate after the first day was 62.50%（10/16）in atypical nystagmus patients with PSC-BPPV group and 92.86%（26/28）in typical nystagmus with PSC-BPPV group,the difference was significant（χ2=5.134,P=0.015）.The total effective rate was 93.75%（15/16）after more than once in atypical group and100.00%（28/28）in typical group,the difference was not significant（χ2=2.780,P=0.095）.The numbers of circulation of first success in manual reduction management were（2.76±1.13）times in atypical group and（1.68±0.61）times in typical group.The difference was significant（t=4.293,P=0.000）.The recurrence rate was18.75%in atypical group and 14.28%in typical group after during follow-up for 6months,the difference was not significant（χ2=1.681,P=0.509）.Conclusion：It showed that clinical manifestation with atypical nystagmus in patients with PSC-BPPV was complicated.Some patients＇nystagmus could change to typical after treatment.The manual reduction was an effective treatment.The effective rate after first manual reduction was lower than typical group,it＇s needed more circulation of first success in manual reduction management.The recurrence rate was not significant in two groups.