各型BPPV诊断手法与复位技巧.ppt

各型BPPV 的诊断手法及复位技巧 Dr Xiaofeng Mei Fushan hospital of traditional chinese medicine, Department of otorhinolaryngology—head and neck surgery Overview 发病率约1/10000, 占外周性眩晕的50% 属周围性旋晕 多为自限性，能自行缓解，故称为良性 三个月不愈或丧失劳动力者为顽固性 男:女 = 1:2～3 Background Barany (1921)[1]: 首次描述benign paroxysmal positional vertigo (BPPV): The attacks only appeared when she lay on her right side. When she did this, there appeared a strong rotatory nystagmus to the right. The attack lasted about thirty seconds and was accompanied by violent vertigo and nausea. If, immediately after the cessation of these symptoms, the head was again turned to the right, no attack occurred, and in order to evoke a new attack in this way, the patient had to lie for some time on her back or on her left side. Dix M.R. Hallpike C.S.(1952) [2] : 介绍了BPPV特点和Dix—Hallpike Test Schuknecht H.F. (1969) [3] : 病人颞骨病理见后半规管壶腹嵴致密颗粒 cupulolithiasis Hall SF，Ruby RRF，McClure JA. (1979) [4] : 根据重复刺激疲劳性提出半规管结石症canalithiasis Brandt T，Daroff RB (1980) [5] : 首推体位治疗 Semont A， Freyss G， Vitte E (1988) [6] ：耳石解脱法 liberatory maneuver Epley JM (1992) [7] : 耳石复位法canal reposition procedures (CRP) Parnes LS，McClure JA. (1990) [8] : 描述后半规管阻塞术治疗难治性BPPV Parnes LS，McClure JA. (1992) [9] : 难治性BPPV手术中发现后半规管中嗜碱性颗粒 Gacek RR (1995) : singular neurectomy [*] Moriarty B，Rutka J，Hawke M. (1992) [10] :大量颞骨病理发现其他半规管也见嗜碱性颗粒 BPPV 假说 Schuknecht H.F. (1969) [3] ：壶腹嵴帽结石症学说, 后半规管壶腹嵴cupulolithiasis. Hall SF. (1979) [4] : 半规管结石症学说, 后半规管canalithiasis. BPPV can be caused by either canalithiasis or cupulolithiasis and can theoretically affect each of the 3 semicircular canals, although superior canal involvement is exceedingly rare. The cupulolithiasis and The canalithiasis BPPV 病理生理 正常耳石代谢：耳石膜含许多碳酸钙结晶，耳石含大量钙离子，酷似骨组织，是一动态结构，维持迷路内离子动态平衡，正常情况下耳石也会少量脱落，为吞噬细胞所消灭，这种情况多发生在囊斑、胶状壶腹嵴[11] [12]和内淋巴囊[13] 。 BPPV 病理生理：耳石脱落过多或吸收障碍时, 异位进入半规管，当达到或超出临界状态时“critical mass” [图1] [图2] ？ BPPV后半规管开窗所见耳石团块 The otoconia BPPV 分类 原发性：占34～68％. 继发性：以头部外伤为多见，约17%，其他可见发生于梅尼挨病、迷路炎、偏头痛、中耳术后、头颅外伤等. 按