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目的探讨上半规管良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的诊断和治疗。方法回顾性分析了上半规管 BPPV 患者31例,并对所有患者采用管石复位法治疗后的效果进行评估。结果在 Dix-Hallpike 检查中,所有患者均诱发出垂直向下的眼震。22例(70.97%)患者一侧诱发出眼震,其中17例眼震伴有扭转成分,5例眼震不伴扭转成分。其余9例(29.03%)患者双侧诱发出现眼震,眼震伴有扭转成分的7例,其中2例眼震扭转方向指向同一侧,4例眼震的扭转方向不同定,1例患者仅一侧出现扭转成分。另外2例患者眼震不伴扭转成分。受累侧别明确诊断的19例(61.29%),其中11例为左侧上半规管受累,8例为右侧上半规管受累。受累侧别未明确诊断的12例(38.71%)。所有患者中,11例(35.48%)患者同时合并后半规管受累。对所有患者采取管石复位法治疗,21例(67.74%)痊愈,29例(93.55%)有效、2例(6.45%)无效。其中首次治愈14例(45.16%),平均治愈次数为1.71次。随访期间5例复发。结论上半规管 BPPV临床中少见。在变位检查中,眼震的扭转成分较弱,临床中不易观察。在部分单侧上半规管 BPPV 患者中,双侧检查均能诱发眼震。管石复位法是治疗上半规管 BPPV 简单有效的手段。
Objective To investigate the diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) in the upper semicircular canal. Methods Retrospective analysis of 31 cases of upper semicircular canal BPPV patients, and all patients treated with pipe-stone reduction after treatment to assess the effect. Results In the Dix-Hallpike test, all patients developed vertical downward nystagmus. Nystagmus was induced on one side in 22 patients (70.97%), including 17 with nystagmus and 2 with nystagmus without torsion. The other 9 patients (29.03%) were induced bilateral nystagmus and nystagmus with torsion components in 7 patients. Among them, 2 had nystagmus reversed to the same side, 4 had nystagmus with different torsion directions and 1 patient had One side appears to reverse the composition. The other two patients had nystagmus without torsion. Twenty-nine patients (61.29%) were diagnosed correctly on the affected side. Eleven patients had upper semicircular canal involvement on the left side and 8 upper semicircular canal affected on the right side. The affected side was not diagnosed in 12 cases (38.71%). In all patients, 11 (35.48%) patients had concurrent semicircular canal involvement. Twenty-one patients (67.74%) were cured, and 29 (93.55%) were effective, while two patients (6.45%) were ineffective. Among them, 14 cases were cured for the first time (45.16%), the average number of cure was 1.71 times. Five patients relapsed during follow-up. Conclusions Upper BPPV is rare in clinical practice. In the displacement examination, the twisting component of nystagmus is weak, difficult to observe clinically. In some unilateral semicircular canal BPPV patients, bilateral examination can induce nystagmus. Stone reset method is the treatment of upper semicircular canal BPPV simple and effective means.