门诊复位加自我复位治疗后半规管良性阵发性位置性眩晕

目的：比较首次治疗时单纯门诊复位法（改良Epley法）与门诊复位加自我复位法（自我改良Epley法）治疗单侧原发性后半规管良性阵发性位置性眩晕（PC-BPPV）的疗效。方法：我科眩晕门诊确诊为原发性单侧PC-BPPV的150例患者中，147例符合条件并配合随访。将其随机分为单纯门诊复位组（73例）和门诊复位加自我复位组（74例），前者在门诊采用改良Epley法治疗，后者采用门诊改良Epley法复位加自我复位法（自我改良Epley法）治疗。结果：1周时，单纯门诊复位组治愈率为53．4％，门诊复位加自我复位组治愈率为83．8％（P〈O．01）。单纯门诊复位组中，手法复位与复位椅复位成功率分别为45．9％和61．1％（P〉0．05），风险比为0．752，95％CI为0．486～1．163；门诊复位加自我复位组中，手法复位与复位椅复位成功率分别为87．5％和81．O％（P〉0．05），风险比为1．081，95％CI为0．8881．316。两组严重不良反应发生率：单纯门诊复位组0，门诊复位加自我复位组为1．3％（P〉O．05）。结论：门诊复位配合自我复位比单纯门诊复位法能更快、更有效地治愈后半规管BPPV，能有效地减少患者的就诊次数；两组患者严重不良反应发生率无明显差异。单纯复位椅比手法复位效果更好，但自我复位可减少两种复位方法的效果差距，可用于配合程度较好的后半规管BPPV患者。

Complementary self-treatment for posterior canal benign paroxysmal positional vertigo

Objeetive：To examine the value of self-treatment for Posterior canal benign paroxysmal positional vertigo（PC-BPPV） . The treatment effect was compared between patients treated with modified Epley in outpatient clinic combined with self treatment at home and patients treated by modified Epley alone. Method： A randomized controlled trial were carried out in the Department of Otolaryngology Head and Neck Surgery, the Affiliated Sixth People＇s Hospital of Shanghai Jiao Tong University from December 2012 to May 2013. 147 out of 150 patients with unilateral idiopathic BPPV-PSC were enrolled in follow-up. Among which,73 patients were allocated in modified Epley-alone group and 74 were allocated in slef-treatment group. Result .. The success rate was 53.4% in modified Epley-alone group vs 83.8% in self-treatment group（P〈0.01）after 1 week treatment. In the modified Epley-alone group,the success rate of hand repositioning group and chair-assisted repositioning group was 45.9% vs 61.1% （P〉0.05） ,the risk rate was 0. 752, 95%CI（0. 486-1. 163）. In the self-treatment group, the success rate of hand repositioning group and chair-assisted repositioning group was 87.5% vs 81.0% （P〉0.05）, the risk rate was 1.081,95 %CI（0. 888-1. 316）. Incidence rate of serious complications was 0 % in the modified Epley-alone group and 1.3 % in the self-treatment group （P〉0.05）. Conclusion：Complementary self-treatment with modified Epley maneuver treated PC-BPPV sooner and more effectively, Compared with modified Epley maneuver alone. And its incidence rate of serious complications didn＇t increase. Chair-assisted repositioning showed better result than hand repositioning alone, and self-treatment at home can reduce the effect of the gap. We found that complementary self-treatment with modified Epley maneuver had more benefits for patients with PC-BPPV.