眼震方向可转换型外侧半规管良性阵发性位置性眩晕35例临床分析
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摘要
目的探讨眼震方向可转换型外侧半规管良性阵发性位置性眩晕(LSC-BPPV)患者的临床特点和治疗效果。方法回顾性分析2016年1月至2017年6月诊治的35例眼震方向可转换型LSC-BPPV患者(可转换型组)的临床资料并观察手法复位的疗效,与同期治疗的38例眼震方向不变型LSC-BPPV患者(不变型组)进行对比,并追踪随访6个月。患者根据眼震方向及持续时间分别采用Barbecue翻滚法、Gufoni法或强迫持续卧位法复位治疗。采用SPSS 19.0对数据进行统计分析。结果 35例眼震方向可转换型患者中可自动转换型7例,主动可转换型28例,眼震由离地型转为向地型31例,眼震由向地型转为离地型2例,眼震方向反复多次转换型2例,眼震持续时间>1 min者6例、<1 min者29例。38例眼震方向不变型均为向地型,眼震持续时间全部<1 min。可转换型组首次复位有效率为62.86%(22/35),不变型组为86.84%(33/38),两组比较差异有统计学意义(χ2=5.642,P=0.018)。多次复位后有效率分别为91.43%(32/35)和97.37%(37/38),组间比较差异无统计学意义(χ2=1.241,P=0.265)。可转换型组、不变型组复位成功时所需平均循环次数分别为(2.81±1.21)、(1.56±0.69)次,两组比较差异有统计学意义(t=4.053,P<0.001)。随访6个月后可转换型组与不变型组复发率分别为17.14%和23.68%,两组比较差异无统计学意义(χ2=0.478,P=0.490)。结论准确判断受累半规管侧别及耳石类型是诊治眼震方向可转换型LSCBPPV患者的关键,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眼震方向不变患者低,且复位成功需较多循环次数。
Objective To investigate clinical features of transformable-direction eye shock and to evaluate the efficacy of manual reduction in its treatment in patients with lateral semicircular canal benign paroxysmal positional vertigo( LSC-BPPV). Methods A retrospective analysis was performed on thirty-five transformable-direction eye shock patients with LSC-BPPV( the transformable group) and thirty-eight invariant-direction eye shock patients with LSC-BPPV( the invariant group) from Jan. 2016 to Jul. 2017 in our hospital. The results were compared between these two groups. All patients were followed up for 6 months. Statistical analysis was performed using SPSS 19.0 software. Results The transformable group included 7 cases of spontaneous eye shock and 28 cases of intentional eye shock. Apogeotropic eye shock was changed to geotropic eye shock in 31 patients,and geotropic eye shock was changed to apogeotropic eye shock in 2 patients. Other 2 patients showed transformable-direction eye shock,which was repeated many times. The eye shock duration was more than 1 min in 6 patients,but it was less than 1 min in 29 patients. All patients were administered manual reduction treatment according to the eye shock direction and duration with the Barbecue maneuver,Gufoni maneuver,and forced prolonged position maneuver. The efficacy after the first manual reduction treatment was 62.86%( 22/35) in the transformable group and 86.84%( 33/38) in the invariant group,and the difference in the treatment efficacy was significant between these two groups( χ2= 5.642,P = 0.018). Total efficacy was 91.43%( 32/35) in the transformable group and 97.37%( 37/38) in the invariant group after manual reduction treatment for more than once,and no significant differences in total efficacy were observed between these two groups( χ2= 1.241,P = 0.265). The number of circulation of first success was 2.81±1.21 in the transformable group and 1.56±0.69 in the invariant group after manual reduction management,and a significant difference was found between these two groups( t = 4.053,P = 0.000). The recurrence rate was 17.14% in the transformable group and 23.68% in the invariant group at the 6-month follow-up visit,but no significant differences were observed between these two groups( χ2= 0.478,P =0.490). Conclusion The key step for successful treatment is to determine which otolith and canal types are accurately affected. The efficacy after the first manual reduction treatment was lower in the transformable group than in the invariant group. More circulation of first success was needed in the manual reduction management. The total efficacy and recurrence rate did not showsignificant differences between these two groups. Therefore,manual reduction is an effective treatment for transformable-direction eye shock patients with LSC-BPPV.
Objective To investigate clinical features of transformable-direction eye shock and to evaluate the efficacy of manual reduction in its treatment in patients with lateral semicircular canal benign paroxysmal positional vertigo( LSC-BPPV). Methods A retrospective analysis was performed on thirty-five transformable-direction eye shock patients with LSC-BPPV( the transformable group) and thirty-eight invariant-direction eye shock patients with LSC-BPPV( the invariant group) from Jan. 2016 to Jul. 2017 in our hospital. The results were compared between these two groups. All patients were followed up for 6 months. Statistical analysis was performed using SPSS 19.0 software. Results The transformable group included 7 cases of spontaneous eye shock and 28 cases of intentional eye shock. Apogeotropic eye shock was changed to geotropic eye shock in 31 patients,and geotropic eye shock was changed to apogeotropic eye shock in 2 patients. Other 2 patients showed transformable-direction eye shock,which was repeated many times. The eye shock duration was more than 1 min in 6 patients,but it was less than 1 min in 29 patients. All patients were administered manual reduction treatment according to the eye shock direction and duration with the Barbecue maneuver,Gufoni maneuver,and forced prolonged position maneuver. The efficacy after the first manual reduction treatment was 62.86%( 22/35) in the transformable group and 86.84%( 33/38) in the invariant group,and the difference in the treatment efficacy was significant between these two groups( χ2= 5.642,P = 0.018). Total efficacy was 91.43%( 32/35) in the transformable group and 97.37%( 37/38) in the invariant group after manual reduction treatment for more than once,and no significant differences in total efficacy were observed between these two groups( χ2= 1.241,P = 0.265). The number of circulation of first success was 2.81±1.21 in the transformable group and 1.56±0.69 in the invariant group after manual reduction management,and a significant difference was found between these two groups( t = 4.053,P = 0.000). The recurrence rate was 17.14% in the transformable group and 23.68% in the invariant group at the 6-month follow-up visit,but no significant differences were observed between these two groups( χ2= 0.478,P =0.490). Conclusion The key step for successful treatment is to determine which otolith and canal types are accurately affected. The efficacy after the first manual reduction treatment was lower in the transformable group than in the invariant group. More circulation of first success was needed in the manual reduction management. The total efficacy and recurrence rate did not showsignificant differences between these two groups. Therefore,manual reduction is an effective treatment for transformable-direction eye shock patients with LSC-BPPV.
引文
[1]Bhattacharyya N,Gubbels SP,Schwarts SR,et al. Clinical practice guideline:benign paroxysmal positional vertigo(update)[J]. Otolaryngol Head Neck Surg,2017,156(3S):S1-S47.
[2]Parnes LS,Agrawal SK,Atlas J. Diagnosis and management of benign paroxysmal positional vertigo[J]. CMAJ,2003,169:681-693.
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[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(3):173-177.Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Society of Otorhinolaryngology Head and Neck Surgery Chinese Medical Association.Guideline of diagnosis and treatment of benign paroxysmal positional vertigo(2017)[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2017,52(3):173-177. doi:10.3760/cma.j.issn.1673-0860.2017.03.003.
[5]Lempert T. Horizontal benign positional vertigo[J]. Neurology,1994,44(11):2213-2214.
[6] Gufoni M,Mastrosimone L,Di Nasso F. Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal[J]. Acta Otorhinolaryngol Ital,1998,18(6):363-367.
[7]Asprella LG. Diagnostic and treatment strategy of lateral semicircular canal canalolithiasis[J]. Acta Otorhinolaryngol Ital,2005,25(5):277-283.
[8] Schuknecht HF. Cupulolithiasis[J]. Arch Oto-laryngol,1969,90:765-778.
[9]Hall SF,Ruby RR,Mc Clure JA. The mechanics of benign paroxysmal vertigo[J]. J Otolaryngol,1979,8(2):15l-158.
[10] Mc Clure JA. Horizontal canal BPV[J]. Otolaryngol,1985,14(1):30-35.
[11]Baloh RW,Yue Q,Jacobson KM,et al. Persistent direction-changing positional nystagmus:another variant of benign positionalnystagmus[J]. Neurology,1995,45(7):1297-1301.
[12]Ogawa Y,Ichimura A,Otsuka K,et al. Spontaneous inversion of nystagmus witllout a positional change in the horizontal canal variant of benign paroxysmal positional vertigo[J]. J Vestib Res,2015,25(3-4):169-175.
[13]Kim CH. A newmethod for evaluating lateral semicircular canal cupulopathy[J]. Laryngoscopel,2015,125(8):1921-1925.
[14]Oh SY,Kim JS,Jeong SH,et al. Treatment of apogeotropic benign positional vertigo:comparison of therapeutic head-shaking and modified Semont maneuver[J]. J Neurol,2009,256(8):1330-1336.
[15]Seok JI,Lee HM,Yoo JH,et al. Residual dizziness after successful repositioning treatment in patient with benign paroxysmal positional vertigo[J]. Clin Neurol,2008,4(3):107-110.
[16]Kansu L,Avci S,Yilmaz I,et al. Long-term follow-up of patients with posterior canal benign paroxysmal positional vertigo[J]. Acta oto-laryngologica,2010,130(9):1009-1012.
[2]Parnes LS,Agrawal SK,Atlas J. Diagnosis and management of benign paroxysmal positional vertigo[J]. CMAJ,2003,169:681-693.
[3]Moon SY,Kim JS,Kim BK,et al. Clinical characteristics of benign paroxysmal positional vertigo in Korea:a multicenter study[J]. J Korean Med Sci,2006,21(3):539-543.
[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(3):173-177.Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Society of Otorhinolaryngology Head and Neck Surgery Chinese Medical Association.Guideline of diagnosis and treatment of benign paroxysmal positional vertigo(2017)[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2017,52(3):173-177. doi:10.3760/cma.j.issn.1673-0860.2017.03.003.
[5]Lempert T. Horizontal benign positional vertigo[J]. Neurology,1994,44(11):2213-2214.
[6] Gufoni M,Mastrosimone L,Di Nasso F. Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal[J]. Acta Otorhinolaryngol Ital,1998,18(6):363-367.
[7]Asprella LG. Diagnostic and treatment strategy of lateral semicircular canal canalolithiasis[J]. Acta Otorhinolaryngol Ital,2005,25(5):277-283.
[8] Schuknecht HF. Cupulolithiasis[J]. Arch Oto-laryngol,1969,90:765-778.
[9]Hall SF,Ruby RR,Mc Clure JA. The mechanics of benign paroxysmal vertigo[J]. J Otolaryngol,1979,8(2):15l-158.
[10] Mc Clure JA. Horizontal canal BPV[J]. Otolaryngol,1985,14(1):30-35.
[11]Baloh RW,Yue Q,Jacobson KM,et al. Persistent direction-changing positional nystagmus:another variant of benign positionalnystagmus[J]. Neurology,1995,45(7):1297-1301.
[12]Ogawa Y,Ichimura A,Otsuka K,et al. Spontaneous inversion of nystagmus witllout a positional change in the horizontal canal variant of benign paroxysmal positional vertigo[J]. J Vestib Res,2015,25(3-4):169-175.
[13]Kim CH. A newmethod for evaluating lateral semicircular canal cupulopathy[J]. Laryngoscopel,2015,125(8):1921-1925.
[14]Oh SY,Kim JS,Jeong SH,et al. Treatment of apogeotropic benign positional vertigo:comparison of therapeutic head-shaking and modified Semont maneuver[J]. J Neurol,2009,256(8):1330-1336.
[15]Seok JI,Lee HM,Yoo JH,et al. Residual dizziness after successful repositioning treatment in patient with benign paroxysmal positional vertigo[J]. Clin Neurol,2008,4(3):107-110.
[16]Kansu L,Avci S,Yilmaz I,et al. Long-term follow-up of patients with posterior canal benign paroxysmal positional vertigo[J]. Acta oto-laryngologica,2010,130(9):1009-1012.