不同类型良性阵发性位置性眩晕的诊断和治疗

目的探讨不同类型良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的诊断和治疗方法。方法对我科2004年4月-2006年3月就诊的BPPV病人131例．应用红外线视频眼动记录分析变位试验诱发的眼震特点，进行分型、定侧，并采用相应的耳石复位技术治疗。结果（1）后半规管BPPV94例（71．8％），随机分组采用Epley管石复位法和Semont管石解脱法各47例。（2）水平半规管BPPV29例（22．1％），水平向地性眼震者16例，另13例为水平背地性眼震者，自行或采用Gufoni疗法后转换为水平向地性9例，方向不能转换4例。采用barbecue翻滚和／或强迫侧卧体位疗法。（3）前半规管BPPV6例（4．6％），采用Epley管石复位法。（4）混合型BPPV2例（1．5％），行上述相应半规管的疗法。1周后随访总有效率85．5％（112／131），3个月后92.4％（121／131）。结论BPPV的诊断和治疗应根据不同变位试验诱发的眼震特征判别不同半规管及不同发病机理类型，并选择合适的耳石复位技术治疗。

Diagnosis and treatment of various benign paroxysmal positional vertigo variants

Objective To investigate the diagnosis of each type of benign paroxysmal positional vertigo (BPPV ) and the results of treatment by appropriate repositioning maneuvers. Methods The positioning nystagmic features in 131 patients with BPPV treated between April 2004 and March 2006 were recorded and analyzed with video- nystagmography. After the BPPV types and the affected side were determined, the appropriate repositioning maneuvers were chosen and performed. Results Of 131 patients, 94(71.8%) with posterior canal involvement were randomly divided into 2 groups and treated with canalith respositioning procedure and Semont liberatory maneuver, respectively. Twenty nine(22.1%) with horizonial canal involvement including 3 subtypes of nystagmus were treated with barbecue maneuver alone or combined forced prolonged position maneuver. If with apogeotripic nystagmus, Gufoni's maneuver was performed firstly. Six(4.6%)with anterior canal involvement were treated with Epley's maneuver. Two(1.5%) had the mixed type and were treated with corresponding repositioning maneuvers. After 1 week the total improvement rate was 85.5% (112/131) and 3 months later was 92.4%(121/131). Conclusion The different BPPV variants including their pathogenesis can be diagnosed according to the nystagmus characteristics during the appropriate provoking maneuvers and it is necessary to apply the appropriate repositioning maneuvers for their treatment.