按眼震特点选择手法复位治疗水平半规管良性阵发性位置性眩晕疗效观察
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摘要
目的分析水平半规管良性阵发性位置性眩晕(HC-BPPV)患者的眼震特点,并观察根据眼震特点选择手法复位治疗的疗效。方法根据红外线视频眼震电图仪(Chartr 200Type1068,丹麦尔听美公司)记录的56例HC-BPPV患者变位试验诱发的眼震特点进行定侧和分型,其中水平向地性眼震患者38例,有28例接受Barbecue翻滚法治疗,10例不适于翻滚或体位维持困难者接受Gufoni法治疗;水平背地性眼震18例,采用Appiani法复位后转变为水平向地性眼震13例,再按Barbecue翻滚法治疗或Gufoni法进行复位,方向不能转换者5例,按李氏复位法进行复位;每种方法循环复位2次。观察治疗效果。结果 1周后,治愈33例(58.93%,33/56),有效16例(28.57%,16/56),无效7例(12.50%,7/56),总有效率为87.50%(49/56);3个月后治愈42例(75.0%,42/56),有效8例(14.29%,8/56),无效2例(3.57%,2/56),复发4例(7.14%,4/56),总有效率为89.29%(50/56)。结论根据变位试验诱发的眼震特点选择不同的手法复位治疗HC-BPPV,可取得满意的疗效。
Objective To analysis the characteristic of nystagmus of horizontal semicircular canal benign paroxysmal positional vertigo and the effect of repositioning maneuvers.Methods The positioning nystagmic features of56 patients with HC-BPPV were recorded and analyzed with videonystagmography.Geotropic nystagmus was recorded in38 cases,of whom 28 cases were treated with Barbecue maneuver,while the others were treated with Gufoni maneuver.Apogeotropic nystagmus was recorded in 18 cases,of whom 13 cases could turn into geotropic nystagmus with Appiani maneuver,the other 5 cases who could not transform acceptted Li's repositioning maneuver.Results After 1 week,33 cases were cured(58.93%,33/56),16 cases were effective(28.57%,16/56),7 cases were invalid(12.50%,7/56).The total effective rate was 87.50%(49/56).After 3 months,42 cases were cured(75.0%,42/56),8 cases were effective(14.29%,8/56),2 cases were invalid(3.57%,2/56),4 cases relapsed(7.14%,4/56).The total effective rate was89.29%(50/56).Conclusion It is necessary to apply the appropriate repositioning maneuvers to treat HSC-BPPV according to the nystagmic characteristic and type of HSC-BPPV.Satisfactory curative effect can be obtained.
Objective To analysis the characteristic of nystagmus of horizontal semicircular canal benign paroxysmal positional vertigo and the effect of repositioning maneuvers.Methods The positioning nystagmic features of56 patients with HC-BPPV were recorded and analyzed with videonystagmography.Geotropic nystagmus was recorded in38 cases,of whom 28 cases were treated with Barbecue maneuver,while the others were treated with Gufoni maneuver.Apogeotropic nystagmus was recorded in 18 cases,of whom 13 cases could turn into geotropic nystagmus with Appiani maneuver,the other 5 cases who could not transform acceptted Li's repositioning maneuver.Results After 1 week,33 cases were cured(58.93%,33/56),16 cases were effective(28.57%,16/56),7 cases were invalid(12.50%,7/56).The total effective rate was 87.50%(49/56).After 3 months,42 cases were cured(75.0%,42/56),8 cases were effective(14.29%,8/56),2 cases were invalid(3.57%,2/56),4 cases relapsed(7.14%,4/56).The total effective rate was89.29%(50/56).Conclusion It is necessary to apply the appropriate repositioning maneuvers to treat HSC-BPPV according to the nystagmic characteristic and type of HSC-BPPV.Satisfactory curative effect can be obtained.
引文
1 Parnes LS,Agrawal SK,Atlas J.Diagnosis and management of benign paroxysmal positional vertigo(BPPV)[J].CMAJ,2003,169:681.
2 陈瑛,庄建华,赵忠新,等.水平半规管良性阵发性位置性眩晕的临床特点[J].中华耳鼻咽喉头颈外科杂志,2012,47:987.
3 Moon SY,Kim JS,Kim BK,et al.Clinicalcharacteristics of benign paroxysmal positional vertigo in Korea:a multicenter study[J].J Korean Med Sci,2006,2:539.
4 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉科学分会.良性阵发性位置性眩晕的诊断依据和疗效评估(2006年,贵阳)[J].中华耳鼻咽喉头颈外科杂志,2007,42:163.
5 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.良性阵发性位置性眩晕诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志,2017,52:173.
6 唐小武,黄秋红,区永康.轻嵴帽:解释持续向地性变向性位置性眼震的新理论[J].中华耳科学杂志,2016,14:469.
7 刑光前,陈智斌,卜行宽.水平半规管性良性位置性眩晕的治疗[J].中华耳鼻咽喉科杂志,2001,17:28.
8 Testa D,Castaldo G,De Santis C,et al.Treatment of horizontal canal benign paroxysmal positional vertigo:a new rehabilitation technique[J].Scientific World J,2012,2012:160475.
9 Ciniglio Appiani G,Catania G,Gagliardi M,et al.Repositioning maneuver for the treatment of the apogeotrepie variant of horizontal canal benign paroxysmal positional vertigo[J].Otol Neurotol,2005,26:257.
10 李进让,李厚恩.良性阵发性位置性眩晕的手法复位治疗[J].中国耳鼻咽喉头颈外科,2007,14:619.
11 Giusti G,Proietti S,Peschechera R,et al.Prospective study on outcomes of retrograde intrarenal surgery(RIRS)in the treatment of renal calculi between 2and 3cm[J].Eur Urol,2014,13 (Suppl):923.
12 施天明,王奕琪,黄月虹,等.Gufoni法与Barbecue法治疗向地性眼震型水平半规管良性阵发性位置性眩晕的疗效比较[J].浙江医学,2017,39:1557.
13 Escher A,Yeux CR,Maire R.Efficacy of the barbecue manoeuvrein benign paroxysmal vertigo of the horizontal canal[J].Eur Arch Otorhinolaryngol,2007,264:1239.
14 任颖川.Barbecue翻滚法治疗水平半规管良性位置性眩晕疗效探讨[J].中国耳鼻咽喉颅底外科杂志,2014,20:356.
15 Casani AP,Nacei A,Dallan J,et al.Horizontal semicircular canal benign paroxysmal positional vertigo:effectiveness of two different methods of treatment[J].Audiol Neurootol,2011,16:175.
16 Ciniglio Appiani G,Catania G,Gagliardi M.A liberatory maneuver for the treatment of horizontal canal paroxysmal positional vertigo[J].Otol Neurotol,2001,22:66.
17 Li J,Li H.New repositioning techniques for benign paroxysmal positional vertigo:the Li repositioning manoeuvres[J].J Laryngol Otol,2010,124:905.
18 张昊,李进让,郭鹏飞.李氏复位法治疗良性阵发性位置性眩晕的远期疗效分析[J].中华耳科学杂志,2015,13:488.
19 邹世桢,李进让,王志斌,等.李氏复位法治疗水平离地性眼震BPPV的短期疗效[J].中华耳科学杂志,2016,14:481.
20 Imai T.Light cupula:the pathophysiological basis of persistent geotropic positional nystagmus[J].BMJ Open,2015,5:e006607.
21 SeoT.Clinical course of persistent geotropic direction-changing positional nystagmus with neutral positional-light cupula[J].Acta Otolaryngol,2016,136:34.
2 陈瑛,庄建华,赵忠新,等.水平半规管良性阵发性位置性眩晕的临床特点[J].中华耳鼻咽喉头颈外科杂志,2012,47:987.
3 Moon SY,Kim JS,Kim BK,et al.Clinicalcharacteristics of benign paroxysmal positional vertigo in Korea:a multicenter study[J].J Korean Med Sci,2006,2:539.
4 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉科学分会.良性阵发性位置性眩晕的诊断依据和疗效评估(2006年,贵阳)[J].中华耳鼻咽喉头颈外科杂志,2007,42:163.
5 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.良性阵发性位置性眩晕诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志,2017,52:173.
6 唐小武,黄秋红,区永康.轻嵴帽:解释持续向地性变向性位置性眼震的新理论[J].中华耳科学杂志,2016,14:469.
7 刑光前,陈智斌,卜行宽.水平半规管性良性位置性眩晕的治疗[J].中华耳鼻咽喉科杂志,2001,17:28.
8 Testa D,Castaldo G,De Santis C,et al.Treatment of horizontal canal benign paroxysmal positional vertigo:a new rehabilitation technique[J].Scientific World J,2012,2012:160475.
9 Ciniglio Appiani G,Catania G,Gagliardi M,et al.Repositioning maneuver for the treatment of the apogeotrepie variant of horizontal canal benign paroxysmal positional vertigo[J].Otol Neurotol,2005,26:257.
10 李进让,李厚恩.良性阵发性位置性眩晕的手法复位治疗[J].中国耳鼻咽喉头颈外科,2007,14:619.
11 Giusti G,Proietti S,Peschechera R,et al.Prospective study on outcomes of retrograde intrarenal surgery(RIRS)in the treatment of renal calculi between 2and 3cm[J].Eur Urol,2014,13 (Suppl):923.
12 施天明,王奕琪,黄月虹,等.Gufoni法与Barbecue法治疗向地性眼震型水平半规管良性阵发性位置性眩晕的疗效比较[J].浙江医学,2017,39:1557.
13 Escher A,Yeux CR,Maire R.Efficacy of the barbecue manoeuvrein benign paroxysmal vertigo of the horizontal canal[J].Eur Arch Otorhinolaryngol,2007,264:1239.
14 任颖川.Barbecue翻滚法治疗水平半规管良性位置性眩晕疗效探讨[J].中国耳鼻咽喉颅底外科杂志,2014,20:356.
15 Casani AP,Nacei A,Dallan J,et al.Horizontal semicircular canal benign paroxysmal positional vertigo:effectiveness of two different methods of treatment[J].Audiol Neurootol,2011,16:175.
16 Ciniglio Appiani G,Catania G,Gagliardi M.A liberatory maneuver for the treatment of horizontal canal paroxysmal positional vertigo[J].Otol Neurotol,2001,22:66.
17 Li J,Li H.New repositioning techniques for benign paroxysmal positional vertigo:the Li repositioning manoeuvres[J].J Laryngol Otol,2010,124:905.
18 张昊,李进让,郭鹏飞.李氏复位法治疗良性阵发性位置性眩晕的远期疗效分析[J].中华耳科学杂志,2015,13:488.
19 邹世桢,李进让,王志斌,等.李氏复位法治疗水平离地性眼震BPPV的短期疗效[J].中华耳科学杂志,2016,14:481.
20 Imai T.Light cupula:the pathophysiological basis of persistent geotropic positional nystagmus[J].BMJ Open,2015,5:e006607.
21 SeoT.Clinical course of persistent geotropic direction-changing positional nystagmus with neutral positional-light cupula[J].Acta Otolaryngol,2016,136:34.