摘要
目的研究在帕金森病患者丘脑底核脑深部电刺激术(subthalamic nucleus deep brain stimulation,STN-DBS)中,同期植入双侧电极,其先后两侧的精确度是否有明显差异,并分析术后疗效。方法收集2016-2018年本院29例接受双侧STN-DBS术的帕金森病患者,所有患者于术中植入双侧电极后复查头部CT,并与术前3T-MRI图像(手术计划靶点)融合;测量并计算植入电极与计划靶点的误差距离。术前及术后6个月采用统一帕金森病评分量表中的第三部分(the Unified Parkinson’s Disease Rating ScaleⅢ,UPDRSⅢ)对患者的症状改善情况进行评估。采用Pearson相关分析研究年龄、性别、起病年龄及病程长短与改善率及偏差之间的相关关系。结果最终共纳入27例患者,54侧电极均成功植入,患者年龄、性别、起病年龄及病程长短与改善率及偏差均无明显关系(P>0.05)。第1侧植入电极与第2侧植入电极之间的平均偏差比较差异无统计学意义(t=1.437,P>0.05)。所有患者的症状得到明显改善,术后6个月药物开期,全身症状的改善率为(78.10±10.25)%,等效剂量左旋多巴平均减少45.07%。第1侧对应肢体症状改善率为(83.15±9.16)%,第2侧为(83.52±11.21)%,两侧肢体症状的改善情况差异无统计学意义(P>0.05)。结论帕金森病STN-DBS中同期植入双侧电极,其先后两侧电极之间精确度并无较大差异,且可以达到较好的临床效果。
Objective To investigate whether there is a significant difference in the accuracy of the two-sided electrode implanted during the same period in Parkinson’s disease(PD)with subthalamic nucleus deep brain stimulation(STN-DBS),and whether the accuracy affects the bilateral postoperative effects.Methods Twenty-nine PD patients admitted in our department from January 2016 to December 2018,who underwent bilateral STN-DBS surgery were re-examined with CT scanning on the head after bilateral electrodes were implanted during the operation.The results were merged with preoperative 3T-MRI images(with planned targets).The implanted electrodes were measured and calculated for error distance from the planned targets.Unified Parkinson’s Disease Rating ScaleⅢ(UPDRSⅢ)was used to evaluate the improvement of the symptoms before and in 6 months after operation.Pearson correlation analysis was used to study the correlation among age,gender,onset age and course of disease with improvement rate and deviation.Results Finally,27 patients were enrolled,and 54 electrodes were implanted successfully.There were no significant differences in the age,gender,onset age and course of disease and the improvement rate and deviation among these patients(P>0.05).No obvious difference was seen in the mean deviation between the first implanted electrodes and second implanted electrodes(t=1.437,P>0.05).The symptoms of all patients were obviously improved.In 6 months after surgery,the average improvement rate of systemic symptoms was(78.10±10.25)%with drug on,and the average decrease of the equivalent dose of levodopa was 45.07%.The improvement rate was(83.15±9.16)%for the first side,and(83.52±11.21)%for the second side.There was no significant difference in the improvement of limb symptoms between the 2 sides(P>0.05).Conclusion The accuracy of simultaneous implantation of bilateral electrodes in STN-DBS is not significantly different from that of the electrodes implanted sequentially,while still achieving good clinical outcomes.
作者
向怡
蒋理
覃彬
王宽
廖忆思
石全红
谢延风
詹彦
XIANG Yi;JIANG Li;QIN Bin;WANG Kuan;LIAO Yisi;SHI Quanhong;XIE Yanfeng;ZHAN Yan(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2020年第5期517-522,共6页
Journal of Third Military Medical University
关键词
帕金森病
丘脑底核
脑深部电刺激术
同期植入
治疗效果
Parkinson&rsquo
s disease
subthalamic nucleus
deep brain stimulation
simultaneous implantation
treatment outcome
