| 261 | 8 | 27 |
| 下载次数 | 被引频次 | 阅读次数 |
目的收集在2008年1月~2013年12月广西医科大学第一附属医院耳鼻咽喉-头颈外科确诊并治疗的2118例BPPV患者的资料进行疗效分析。方法对2118例BPPV患者分别应用改良三步快速手法复位法、Epley复位法和Barbecue复位法进行复位治疗,于诊治后随访6个月。结果 12118名患者中男971例(45.85%),女1147例(54.15%);年龄8~87岁,发病平均年龄(49.36±11.73)岁,后半规管BBPV 2005例(94.66%)、水平半规管BBPV 88例(4.16%)、上半规管BBPV 14例(0.66%)、混合半规管BBPV 11例(0.52%)。2有1366例后半规管BPPV行传统Epley法治疗,639例行改良三步快速手法复位法治疗,两组首次有效率分别为90.6%、89.8%,远期(半年)有效率93.8%、95.8%,两组远期效率无统计学差异(χ2=3.293,P>0.05);水平半规管Barbecue和Gufoni治疗,首次有效率92.7%,远期(半年)有效率98.6%;上半规管Epley治疗,首次有效率78.6%,远期(半年)有效率85.7%;混合型半规管联合复位治疗,首次有效率78.6%,远期(半年)有效率85.7%;3传统Epley手法复位组复发率为19.39%,改良三步快速手法复位组复发率为18.3%,两组复发率比较无统计学差异(χ2=1.865,P>0.005)。4复发患者回院治疗率,传统Epley手法复位组为100%,改良三步快速手法复位组为18.3%,两组比较统计学差异显著(χ2=1.865,P>0.005)。5复发患者复发12次的所占比例传统Epley手法复位组及三步快速手法复位组分别为43.4%、71.2%,复发次数≥3次的比例两组分别为56.6%、27.9%。两组复发次数≥3次的比例进行比较,有统计学差异(χ2=32.34,P<0.01)。结论 BPPV患者采用手法复位治疗疗效肯定,见效快,方法简单,远期疗效好,手法复位是BPPV患者的最佳的治疗方法。
Abstract：Objective To report outcomes in 2118 patients with BPPV treated by the authors from January 2008 to May 2013. Methods Data from 2118 patients with BPPV who were treated with either modified canalith repositioning or traditional Epley, Barbecue or Gufoni maneuvers were retrospectively studied. All patients were followed up for 6 months. Results 1Of the 2118 patients, 971 were male and 1147 female, with a mean age of 49.36 + 11.73(8 to 87) years. The lesion was located to the posterior semicircular canal in 2005 patients(94.66%), horizontal semicireular canal in 88 patients(4.16%), anterior canalsemicireular in 14 patients(0.66%), and multiple semicircular canals in 11 patients(0.52%). 2Of the2005 patients with PC-BBPV, 1366 were treated with the traditional Epley maneuver, yielding a first time treatment effective rate of 90.6% and a long-term(6 months) effective rate of 93.8%; and 639 were treated with the modified three steps fast canalith repositioning maneuver with a first time effective rate of 89.8% and a 6 months effective rate of 95.8%(x2=3.293, P>0.05), 3At six months following up, the rate of recurrence was 19.3% for those who received traditional Epley maneuvers and 18.3% for those who underwent the modified canalith repositioning maneuvers(x2=1.865,P>0.05). 4 All patients with recurrences in the Epley maneuver group returned for treatment, while only 18.3% of those with recurrences in the modified maneuver group returned for treatment(x2=2.824,P<0.005). 5The rate of 1 to 2 recurrences was 43.4% with traditional Epley treatment and 71.2% with the modified three steps fast canalith repositioning; the rate of 3 recurrences or more was 56.6% and 27.9%, respectively, for the two therapies(x2=32.34, P<0.01). Conclusion The three-step fast repositioning for PC-BPPV is effect, easy to learn and operate and well accepted by most patients, with improved long term efficacy. It is the treatment of choice for PC-BPPV patients.
1 Lee NH,Ban JH,Lee KC,Kim SM:Benign paroxysmal positional vertigo secondary to inner ear disease.Otolaryngology--head and neck surgery:official journal of American Academy of Otolaryngology-Head and Neck Surgery 2010,143(3):413-417.
2 von Brevern M,Radtke A,Lezius F,Feldmann M,Ziese T,Lempert T,Neuhauser H:Epidemiology of benign paroxysmal positional vertigo:a population based study.Journal of neurology,neurosurgery,and psychiatry 2007,78(7):710-715.
3 Devaiah AK,Andreoli S:Postmaneuver restrictions in benign paroxysmal positional vertigo:an individual patient data meta-analysis.Otolaryngology--head and neck surgery:official journal of American Academy of Otolaryngology-Head and Neck Surgery 2010,142(2):155-159.
4刘秋玲,王跃建,周晓娓,林枫,梁海荣,虞幼军:1240例良性阵发性位置性眩晕患者手法复位治疗.中华耳科学杂志2011(4):427-430.
5头颈外科编辑委员会中华医学会耳鼻咽喉:良性阵发性位置性眩晕的诊断依据和疗效评估(2006年贵阳)[J].中华耳鼻咽喉头颈外科杂志2007,42(7):163-164.
6 Bhattacharyya N,Baugh RF,Orvidas L,Barrs D,Bronston LJ,Cass S,Chalian AA,Desmond AL,Earll JM,Fife TD et al:Clinical practice guideline:benign paroxysmal positional vertigo.Otolaryngology--head and neck surgery:official journal of American Academy of Otolaryngology-Head and Neck Surgery 2008,139(5 Suppl 4):S47-81.转703页
7吴子明:美国耳鼻咽喉头颈外科学会BPPV诊疗指南介绍.听力学及言语疾病杂志2009,17(5):502-503.
8李华,陈贞君,方嘉阳:良性阵发性位置性眩晕1120例手法复位治疗复发率分析.内科急危重症杂志2012,18(3):171-172.
9 Korres S,Balatsouras DG,Kaberos A,Economou C,Kandiloros D,Ferekidis E:Occurrence of semicircular canal involvement in benign paroxysmal positional vertigo.Otology&neurotology:official publication of the American Otological Society,American Neurotology Society[and]European Academy of Otology and Neurotology2002,23(6):926-932.
10 Dispenza F,Kulamarva G,De Stefano A:Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of posterior semicircular canal:advantages of hybrid maneuver.American journal of otolaryngology 2012,33(5):528-532.
11 Froehling DA,Silverstein MD,Mohr DN,Beatty CW,Offord KP,Ballard DJ:Benign positional vertigo:incidence and prognosis in a population-based study in Olmsted County,Minnesota.Mayo Clinic proceedings 1991,66(6):596-601.
12 Epley JM:The canalith repositioning procedure:for treatment of benign paroxysmal positional vertigo.Otolaryngology--head and neck surgery:official journal of American Academy of Otolaryngology-Head and Neck Surgery 1992,107(3):399-404.
13 Mandala M,Santoro GP,Asprella Libonati G,Casani AP,Faralli M,Giannoni B,Gufoni M,Marcelli V,Marchetti P,Pepponi E et al:Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo.Journal of neurology 2012,259(5):882-885.
14 Parnes LS,Agrawal SK,Atlas J:Diagnosis and management of benign paroxysmal positional vertigo(BPPV).CMAJ:Canadian Medical Association journal=journal de l'Association medicale canadienne 2003,169(7):681-693.
15田颖,张涛,姜学钧:318例良性阵发性位置性眩晕的诊治分析.临床耳鼻咽喉头颈外科杂志2012,26(1):13-15.
16 Nunez RA,Cass SP,Furman JM:Short-and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo.Otolaryngology--head and neck surgery:official journal of American Academy of Otolaryngology-Head and Neck Surgery 2000,122(5):647-652.
17 Beynon GJ,Baguley DM,da Cruz MJ:Recurrence of symptoms following treatment of posterior semicircular canal benign positional paroxysmal vertigo with a particle repositioning manoeuvre.The Journal of otolaryngology 2000,29(1):2-6.
18孙良颖:良性位置性眩晕手法复位治疗的复发探讨.求医问药(学术版)2013(4).
19章燕幸,吴承龙,肖桂荣,钟芳芳:后半规管良性阵发性位置性眩晕三种自我治疗手法的疗效比较.中华耳鼻咽喉头颈外科杂志2012,47(010):799-803.
基本信息:
中图分类号:R764.3
引用信息:
[1]尹时华,韦顺莲,舒竞铖,等.2118例良性阵发性眩晕患者手法复位疗效观察[J].中华耳科学杂志,2015,13(04):707-711+703.
基金信息:
广西自然科学基金;2015GXNSFAA414004
2015-12-15
2015-12-15