后半规管短臂侧和长臂侧良性阵发性位置性眩晕的诊治

Diagnosis and treatment of posterior semicircular canal short-arm type and long-arm type benign paroxysmal positional vertigo

目的 探讨后半规管短臂侧和长臂侧良性阵发性位置性眩晕(BPPV)的诊治策略。方法 Dix-Hallpike试验确诊后半规管BPPV患者240例,行低头摆头试验区分和治疗后半规管短臂侧BPPV,对其他可能长臂侧BPPV予以Epley法复位。结果 36%患者行低头摆头试验后复查Dix-Hallpike试验阴性,考虑短臂侧BPPV;其他可能长臂侧BPPV用Epley法复位,78%复位1次成功,9%复位3~5次成功。结论 制定后半规管BPPV的诊断和治疗策略,能够将大部分短臂侧和长臂侧BPPV进行区分并采取不同的治疗方法,总体治愈率接近100%,且短臂侧BPPV患者可以免除低头摆头试验复位过程中的眩晕不适。

OBJECTIVE To diagnose and treat posterior semicircular canal short-arm type and long-arm type benign paroxysmal positional vertigo(BPPV).METHODS 240 cases were diagnosed as posterior semicircular canal BPPV with Dix-Hallpike maneuver,then distinguish and treat the short-arm BPPV with bow-and-yaw maneuver,and then treat other probable long-arm BPPV with Epley maneuver.RESULTS Results showed that 36%cases cured by bow-and-yaw maneuver with repeated Dix-Hallpike maneuver converting to negative were diagnosed as short-arm BPPV,the others diagnosed as probable long-arm BPPV were treated with Epley maneuver,78% perform only 1 cycle and 9% repeat 3-5 cycles until the Dix-Hallpike converts to negative.CONCLUSION The strategy for diagnosis of posterior semicircular canal benign paroxysmal positional vertigo can distinguish most short-arm BPPV from long-arm BPPV and take different treatments.The overall cure rate is close to 100%,and the patients with short-arm BPPV can avoid dizziness and discomfort during the bow-and-yaw maneuver treatment.