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目的研究对良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者行手法复位时并发耳石异常移位的临床特征,探讨其诊断、治疗和预防的方法。方法收集2010年1月~2015年12月期间356例单侧BPPV患者在手法复位治疗中并发耳石异常移位的资料,并进行分型和危险因素分析。结果 356例患者中耳石异常移位发生率为4.78%(17/356),其中管异常移位发生率2.8%(10/356),原嵴帽结石转变为管结石发生率0.84%(3/356),折返回原半规管发生率1.12%(4/356)。并发耳石异常移位的影响因素分别是复位后立即行DixHallpike试验(χ~2=27.512,P<0.05)和立即再次行复位治疗(χ~2=26.386,P<0.05),而性别、年龄、病程、受累半规管和是否按标准完成复位对并发耳石异常移位影响不明显(P均>0.05)。结论 BPPV患者在手法复位中会并发耳石异常移位,应及时观察症状并识别眼震方向来判定耳石移位的发生与类型。为预防其发生,不建议在耳石复位后立即行Dix-Hallpike试验或再次手法复位治疗。
Objective To study the clinical characteristics of benign paroxysmal positional vertigo (BPPV) patients with abnormal otolith displacement after manual reduction and to explore the methods of diagnosis, treatment and prevention. Methods Data of 356 patients with unilateral BPPV who underwent manual reduction and otolith abnormalities during January 2010 to December 2015 were collected, and their typing and risk factors were analyzed. Results The incidence of anomalous metastasis of otolith in 356 patients was 4.78% (17/356), the incidence of abnormal tube displacement was 2.8% (10/356), and the incidence of tuberculous calculus was 0.84% (3) / 356), return to the original incidence of semicircular canal 1.12% (4/356). The influencing factors of anomalous shift of otolith were DixHallpike test (χ ~ 2 = 27.512, P <0.05) and immediate reattachment (χ ~ 2 = 26.386, P < The course of the disease, the involvement of the semicircular canal, and the completion of standard resection had no significant effect on the abnormal otolith displacement (P> 0.05). Conclusion Abnormal otolith displacement may occur in patients with BPPV during manual reduction. The occurrence and type of otolith displacement should be determined by observing the symptoms and identifying the direction of nystagmus. To prevent its occurrence, it is not recommended to perform the Dix-Hallpike test immediately after the otolith reset or to manually reposition it again.