上半规管良性阵发性位置性眩晕的诊断及治疗

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固定，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。

Diagnosis and therapy for benign paroxysmal positional vertigo of the anterior semicircular canal

OBJECTIVE: To analyse the video-oculographic findings of positional tests and evaluate the efficacy of canalith repositioning procedure (CRP) in patients with paroxysmal positional vertigo ( BPPV) of the anterior semicircular canal (ASC). METHODS: A retrospective study of 31 patients with ASC BPPV. Then the CRP was performed. RESULTS: Twenty-two individuals (70.97%) presented a unilateral positional nystagmus during the Dix-Hallpike test, in 17 individuals had torsional nystagmus component, 5 individuals only had pure positional down beat nystagmus. Nine patients presented bilateral positional nystagmus, 7 individuals had torsional component positional nystagmus, in 2 patients the direction of the torsional component were the same during right and left Dix-Hallpike test, in 4 patients the torsinal component were concurrent with positional down beat nystagmus but the direction could not be ascertained clinically, in 2 patients had pure positional down beat nystagmus. Nineteen patients (61.29%) had unilateral lesion, 11 patients had the left ASC BPPV, 8 patients had right ASC BPPV. Eleven patients had with both ASC and PSC BPPV in the ipsilateral. Twenty-one patients (67.74%) were cured, 29 patients (93.55%) were improved, 2 (6.45%) patients were inefficacy. CRP effectively resolved the nystagmus and vertigo in 14 patients (45.16%) when applied only once, The average number of CRP was 1.7 times, there were 5 patients recurrence during the follow-up. CONCLUSIONS: ASC BPPV was not a common condition. The torsional nystagmus component of ASC BPPV might be weak during the Dix-Hallpike test. The positional nystagmus of ASC BPPV was triggered bilaterally. Based on these findings, CRP could be one of the most effective treatment methods for ASC BPPV.