水平背地性眼震良性阵发性位置性眩晕的诊断和手法复位

发布时间：2018-12-15 01:20

【摘要】：目的:验证一种新的用于治疗水平背地性眼震良性阵发性位置性眩晕(apogeotropic HSC-BPPV)的手法复位方法。方法:该研究采取改良的Supine Roll Test(M-Roll Test)方法共诊断出178例水平半规管良性阵发性位置性眩晕(HSC-BPPV)患者,其中37例apogeotropic HSC-BPPV纳入该研究样本,占发病数的20.79%。采用管石重置手法先将37例apogeotropic HSC-BPPV患者水平背地性眼震转变为水平向地性眼震;此后,施行传统barbecue法进行手法复位。管石重置手法如下:①患者取仰卧头垫高30°体位静卧;②10min后头快速向患侧转90°;③2min后头向中线回旋45°;④保持体位2min后患者恢复仰卧头高30°体位;静卧10min后,采用MRoll Test检查验证患者是否出现双侧水平向地性眼震。如管石重置失败,重复以上手法多次,直至出现双侧水平向地性眼震为止。结果:36例双侧水平背地性眼震经水平背地性眼震管石重置手法全部转变为双侧不同强度的水平向地性眼震,其中,18例经1次,11例经2次,4例经3次,3例经4~6次。1例经1次管石重置手法后自觉症状减轻,再次行M-Roll Test检查证明水平眼震消失,但Dix-hallpike手法复位检查出现同侧上跳性扭转性眼震,确诊为同侧后半规管良性阵发性位置性眩晕(PSC-BPPV)。该组管石重置成功率为为97.3%。36例HSC-BPPV患者经barbecue法手法复位全部一次性获得成功,1例PSC-BPPV患者经Epley管石复位法一次性获得成功。结论:该研究设计的水平背地性管石重置手法是治疗apogeotropic HSC-BPPV的必要手段,简便易学、成功率高,患者舒适度好,相对依从性高。
[Abstract]:Objective: to verify a new manual reduction method for horizontal nystagmus benign paroxysmal positional vertigo (apogeotropic HSC-BPPV). Methods: a total of 178 patients with horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) were diagnosed by modified Supine Roll Test (M-Roll Test method. 37 cases of apogeotropic HSC-BPPV were included in the study sample, accounting for 20.79% of the total incidence. The horizontal back nystagmus of 37 patients with apogeotropic HSC-BPPV was first converted into horizontal to ground nystagmus by using tracheolithiasis, and then the conventional barbecue method was used to perform manual reduction. The resetting maneuver of tubules was as follows: 1 the supine head pad was 30 掳high in rest position, the head of 210min turned 90 掳quickly to the affected side, the posterior head of 32min turned 45 掳to the middle line, and the patient recovered 30 掳position of supine head height after keeping the position of 2min. After lying still for 10min, MRoll Test examination was used to verify the occurrence of bilateral horizontal nystagmus. If the tubules fail, repeat the above techniques many times until bilateral horizontal nystagmus occurs. Results: all the 36 cases of bilateral horizontal nystagmus were changed into horizontal lateral nystagmus of different strength, including 18 cases once, 11 cases twice, 4 cases 3 times. The symptoms of 3 cases were relieved after 4 times 6 times, and 1 case was relieved after one reset of tubules. M-Roll Test examination proved that horizontal nystagmus disappeared again, but Dix-hallpike manual reduction examination showed ipsilateral torsional nystagmus. Benign paroxysmal positional vertigo (PSC-BPPV) was diagnosed as ipsilateral posterior semicircular canal. The success rate of resetting trachea in this group was 97.3%. All the 36 cases of HSC-BPPV were successfully treated by barbecue manual reduction, and one case of PSC-BPPV was succeeded by Epley tracheolithotomy at one time. Conclusion: this method is necessary for the treatment of apogeotropic HSC-BPPV. It is easy to learn, has high success rate, good comfort and high relative compliance.
【作者单位】：佛山市禅城区中心医院耳鼻咽喉科;
【分类号】：R764.3

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