摘要
帕金森病的手术疗法于90年代初复兴 ,苍白球腹后部取代丘脑腹外侧核成为原发性PD的最佳治疗靶点。苍白球腹后部切开术 (PVP)不仅能改善以震颤、僵直和异动症为代表的运动增多症 ,还能改善以行动迟缓、步僵和“关”状态为代表的运动减少症。苍白球和丘脑手术的结合适用于合并顽固性震颤的PD患者。双侧PVP手术似乎并不存在类似于双侧丘脑手术所导致的严重并发症 ,如构音障碍和严重的认知障碍 ,但明显增加语音低下和吞咽困难的风险。同期双侧PVP对那些年龄较轻、身体一般状况好的PD患者具有不可比拟的优势。手术治疗是一种非多巴胺能的代偿机制 ,并不能完全取代药物疗法 ,二者能发挥协同作用。
Posteroventral pallidotomy (PVP) replaced ventrolateral part of thalamus and became the optimal target for surgical treatment of idiopathic PD since 1990’s. PVP improves not only hyperkinetic symptoms (such as tremor, rigidity and dyskinesia) but also hypokinetic symptoms(such as akinesia, gait freezing and 'off' state). Combination of PVP and thalamotomy is advisable for PD patients with intractable tremor. Bilateral pallidotomy may not have complications of dysarthria and cognitive impairment similarly as thalamotomy, but has a significantly higher risk of hypophonia and swollen difficulty. Contemporaneous bilateral pallidotomy is only suggested for treatment on younger patients. Surgical treatment, which is likely a non-dopaminergic compensation, can not replace pharmaceutical therapy. Synergism of surgery and drug is current strategy for treatment of Parkinson's disease.
出处
《现代康复》
CSCD
2000年第3期332-335,共4页
Modern Rehabilitation
关键词
帕金森病
立体定向
苍白球切开术
治疗
Parkinson's disease
stereotactics
pallidotomy
thalamotomy
basal ganglia
