良性阵发性位置性眩晕的眼震图定位诊断【摘要】目的:探讨眼震图（Videonystagmograph，VNG）对良性阵发性位置性眩晕（BPPV）的定位诊断价值。方法：回顾126例BPPV患者的眼震图资料，分析总结各型BPPV在Dix-Hallpike和滚转试验中眼震图上的眼震特点。结果：126例BPPV患者中，后半规管（PSC）BPPV98例(77.8%)、水平半规管（HSC）BPPV17例(13.5%)、前半规管（ASC）BPPV仅5例(3.9%)、混合型BPPV6例(4.8%)，28例PSC-BPPV记录到反转相眼震。眼震图上显示PSC和ASC管石症Dix-Hallpike悬头位垂直相眼震分别向上、向下，水平相眼震均向对侧，回到坐位时眼震反向。HSC-BPPV滚转试验向两侧转头均可诱发出眼震，眼震与转头方向相同时，可判断为水平半规管管石症，以能够诱发较强眼震的转头侧为患侧；眼震与转头方向相反时，则为水平半规管嵴顶结石症，以能够诱发较弱眼震的转头侧为患侧。结论：眼震图能够客观的记录BPPV患者眼震情况，准确判断耳石所在的半规管，并且保存了眼震数据资料，可以进一步指导临床实践，值得广泛推广。【关键词】视频眼震图；良性阵发性位置性眩晕；半规管；耳石通讯作者：陈太生（cts501@sina）PositioningdiagnosisofbenignpositionalparoxysmalvertigobyVNGWangNa1,LinPeng2,ChenTaisheng2,SongWei2,DongHong2(1ThefirstcentercliniccollegeofTian激nMedicalUniversity,Tian激n,300192,China;2Otolaryngology-HeadNeckSurgery,Tian激nFirstCenterHospital,Tian激n,300192,China)【Abstract】ObjectiveToanalyzethevalueofpositioningdiagnosisofVNG(Videonystagmograph)inpatientswithbenignparoxysmalpositionalvertigo(BPPV).Methods126patientswithBPPVwereenrolledinthisretrospectivestudy.TheirpositionalnystagmusrecordedbyVNGinDix-HallpikeandrolltestswereanalyzedtosummarizethecharacteristicsofnystagmusonnystagmographofvariousBPPV.ResultsOf126patientswithBPPVdiagnosedinourcenter,theposteriorsemicircularcanals(PSC)wereinvolvedin98patients(77.8%),whereasthehorizontalsemicircularcanal(HSC)andanteriorsemicircularcanal(ASC)wereinvolvedin17(13.5%)and5(3.9%),respectively.6patients(4.8%)confirmedcombined-BPPVhadHSC-BPPVandipsilateralPSC-BPPV.28patientswithPSC-BPPVhadreversalphaseonnystagmograph.ThenystagmusofpatientswithP/ASC-canalithiasisshowedupward/downwardontheverticalphaseofnystagmographandorientatedtheoppositesideonhorizontalphaseintheheadhanggingposition,andthenystagmusreversedwhenreturnedtosit.NystagmusonhorizontalphasecanbeprovokedwhentheheadturnedtobothsidesoftherolltestsinpatientswithHSC-BPPV.Ifthenystagmusandthehead-turningsharedthesamedirection,thenHSC-canalithiasiswasconfirmed,andthedirectionofthehead-turningwhichprovokedthestrongernystagmusindicatesthelesionside.Ifthenystagmusandthehead-turninghadtheoppositedirection,thenHSC-cupulolithiasiswasconfirmed,andthedirectionofthehead-turningwhichprovokedtheweakernystagmusindicatesthelesionside.ConclusionPositionalnystagmuscanberecordedobjectivelyusingVNG.Positioningthesemicircularcanalinvolvedwillbeeasierandmoreaccurateaccordingtoit.TherecordingconservedalsobehelpfulforclinicaldiagnosisandrepositioningofBPPV.【Keywords】Videonystagmograph(VNG)；benignpositionalparoxysmalvertigo(BPPV)；semicircularcanal；otolithCorrespondingauthor:ChenTaisheng(cts501@sina)良性阵发性位置性眩晕(benignpositionalparoxysmalvertigo，BPPV)是头部运动到某一特定位置时诱发的短暂眩晕，是一种具有自限性的周围性前庭疾病[1]。该病发病率较高，约占所有周围性眩晕的17%～20%[2]。BPPV耳石复位治疗技术已经成熟，成功复位治疗的基础是对耳石累及半规管的准确定位。目前BPPV的定位诊断和复位都基于医者目测患者的眼震，但旋转性眼震的方向常常不易辨别，加之一些细小眼震容易被肉眼所忽...