单侧苍白球、丘脑腹外侧中间核联合同期毁损治疗帕金森病

目的 :探讨单侧苍白球内侧部 (Gpi)、丘脑腹外侧中间核 (Vim)联合同期毁损治疗帕金森病 (PD)的疗效 ,以及安全性与可行性。方法 :① 5 0例患者分为以震颤为主伴肢体僵硬者为AB型 ,肌僵硬为主伴震颤者为BA型。术前后开、关状态采用UP DRS评分和HoehnYehr分级。②手术在局麻下进行 ,采用CRW定向仪 ,应用PhilipsGyroscanNT 1,0teslaMR扫描仪解剖靶点定位。术中靶点微电极纪录及行电刺激验证靶点。制作毁损灶达 4～ 6mm圆柱体。结果 :术后 1～ 2周开、关状态UPDRS分别改善为 13.2± 5 .1和 15 .2± 2 .5。随访 6～ 14个月 ,UPDRS分别改善为 14.2± 3.1和 16 .2± 2 .5。HoehnYehr分级为 1.4± 0 .5 ,震颤完全消失 ,肌僵硬及运动迟缓改善 ,肢体活动灵活 ,步态和身体姿势进步显著。无语言障碍及视野缺损。结论 :本方法未增加手术危险性 ,两个靶点作用互补 ,“开”“关”状态改善显著。对Gpi、丘脑Vim核的毁损的先后次序、毁损范围、毁损的程度应该依据患者的症状而定。     

帕金森病立体定向丘脑腹外侧核射频毁损手术疗效分析

目的探讨影响帕金森病立体定向丘脑腹外侧核射频毁损手术的疗效因素。方法分析20多年来我院采用立体定向手术治疗帕金森病的影像学改变及影响疗效的因素。结果本组病例症状完全控制950例（74．21％）,症状控制伴有肢体麻木、发音、情感、智能障碍270例（21．09％）。无效50例（3．9％）,恶化10例（0．78％）。结论CT及MRI靶点定位法与脑室造影定位法无显著差异,而靶点定位、毁损范围与手术疗效及并发症密切相关。     

帕金森病CT表现及微电极导向脑内核团毁损术后CT影像分析

目的探讨帕金森病(PD)的CT表现及微电极导向脑内核团毁损术后CT影像特点。资料与方法(1)对240例PD患者术前CT影像进行回顾性分析。(2)30例PD患者在术后3~12个月(平均6·5个月)CT扫描,观测脑内核团毁损灶33个(其中3例患者为双侧手术):右苍白球腹后内侧核(Gpi)毁损灶14个、左Gpi核毁损灶6个,右丘脑腹外侧核(Vim)毁损灶2个、左Vim核毁损灶11个,对毁损灶最大层面积、术侧CT值(任意值)、健侧对应点CT值(标准值)测量,并算出毁损灶与健侧CT值的差值。结果(1)PD的CT表现主要为中央型弥漫性脑萎缩,以脑室系统扩大为主,轻度脑萎缩46.67%(112/240),中度脑萎缩40%(96/240),重度脑萎缩3.33%(8/240),正常10%(24/240)。(2)33个毁损靶灶之圆形占27·27%(9/33);类圆形占60·61%(20/33);片状不规则形占12·12%(4/33)。毁损灶的面积Gpi核平均(28·01±2.15)mm2,Vim核平均为(14.03±1.24)mm2,两者对比有显著性差异(P<0.01);毁损灶Gpi核CT值较健侧平均下降(11.80±0.87)HU,Vim核CT值较健侧平均下降(10.80±1.28)HU,两者亦有差异性(P<0·05)。结论PD患者术前CT扫描对掌握手术适应证较重要,重度脑萎缩患者提示不宜做外科手术治疗。术后CT扫描观察毁损灶之形态、面积、密度变化等影像学改变,有利于对手术疗效、并发症等评估提供一定证据。     

帕金森病的外科手术治疗

帕金森病的外科手术治疗近十年来再度兴起 ,本文就英文文献将其综述如下 :1　历史的回顾帕金森病 ( Parkinson's Disease,简称 PD)的外科治疗始于二十世纪初。早期仅限于锥体系 ,锥体外系概念产生后才转移到基底节。 1 939年偶然发现毁损尾状核可缓解震颤。 1 953年又偶然发现结扎脉络膜前动脉疗效较好 ,当时以为此动脉仅供血苍白球 ,便开始了苍白球毁损的探索 :苍白球毁损术发展分三阶段 :( 1 ) 50年代的前背侧苍白球毁损术 ;( 2 ) 60年代腹后侧苍白球毁损术 ( PVP) ;( 3) 90年代后的PVP。50年代的苍白球毁损术疗效不佳 ,1 954年Hassl…     

丘脑及苍白球腹后部毁损术中CT的定位作用

目的探讨CT在帕金森病丘脑腹外侧核及苍白球腹后部毁损术中的定位作用。方法应用微电极导向技术，对150例帕金森病患者行同侧丘脑腹外侧核及苍白球腹后部同期毁损术，术中CT影像学定位，测出毁损靶点三维空间的X、Y、Z值。结果术中靶点CT定位与微电极电生理记录的靶点吻合率达80%，其余20%误差均小于2mm。结论利用普通CT扫描，术中能准确地进行靶点的影像学定位。其费用较利用SPCT或MRI定位低50%左右     

50例苍白球和丘脑联合靶点毁损术治疗帕金森病的手术配合体会

帕金森病 (Ｐａｒｋｉｎｓｏｎ’ｓｄｉｓｅａｓｅ,ＰＤ)是一种慢性神经系统常见病 ,多发于中年以上人群。现在我院采用脑内苍白球侧部和丘脑腹外侧核区联合靶点毁损术治疗 5 0例帕金森病 ,达到较好的效果 ,现将 5 0例该手术配合体会总结如下。1　临床资料自 2 0 0 1年 3月～ 7月 ,共 5 0例ＰＤ患者接受了手术治疗 ,其中男性 39例 ,女性 11例 ,年龄 4 5～ 78岁 ,病程 1～ 2 8ａ,术前有高血压史 8例 ,糖尿病史者 3例。2　护理2 1　术前护理2 1 1　心理护理　根据患者的各种心理状态 ,我们以优质的服务态度对待患者 ,与患者及家属充分沟通。…     

微电极导向脑立体定向术治疗帕金森病近期疗效观察

目的　探讨微电极导向脑立体定向术治疗帕金森病 (PD)近期疗效及安全性。方法　应用微电极导向技术对 6 9例PD患者实施脑立体定向术 ,采用UPDRS评分量表及Schwab和英格兰日常生活活动量表对所有患者进行术前术后的病情评分 ,分析手术对PD的改善情况及并发症情况。结果　手术后所有患者症状均得到不同程度改善 ,对震颤和强直的改善率达到 10 0 % ,并发颅脑出血 1例 ,占 1 45 %。结论　微电极导向脑立体定向术是一种安全、有效的治疗PD的综合手段之一。     

磁敏感加权成像对帕金森病脑核团的显示及其铁沉积差异测定

目的 评价磁敏感加权成像(SWI)对帕金森病(PD)患者苍白球内侧部、丘脑底核和丘脑腹中间核的显示能力并测定不同核团铁含量差异.方法 收集PD患者15名作为研究组,性别和年龄匹配的健康志愿者15名为正常对照组,采用3.0T MR对两组行SWI及常规MR序列成像,根据核团与周围脑组织间的信号对比、边界清晰度、核团信号均匀性等方面,由两名有经验的影像科医师对图像的质量进行评分,共分为1、2、3、4四个等级;比较SWI与常规MR各序列对三个核团的显示能力,并在SWI校正后的相位图上测量研究组与正常对照组间核团之间的相位值,采用独立样本t检验比较分析差异.结果 在SWI序列,PD患者各个核团显示清晰;在FSE-T2 WI及T2 WI-FLAIR像,大多数患者的核团显示欠佳;在T1WI-FLAIR像大多数患者的核团难以分辨;经秩和检验,四组间对诸核团的显示质量存在显著差异.研究组与正常组比较所得相位值差,在苍白球内侧部及丘脑底核有统计学意义(t值分别为11.693,6.958,P＜0.05),提示存在铁质沉积改变;在丘脑腹中间核无统计学意义(t=0.755,P＞0.05),提示无明显铁质沉积改变.结论 磁敏感加权成像较常规MR序列在显示帕金森患者苍白球内侧部、丘脑底核和丘脑腹中间核结构方面更准确,且能够检测不同核团铁沉积量的差异.     

微电极引导立体定向丘脑Vim切开术治疗震颤麻痹的围手术期护理

震颤麻痹因其病程长和长期服用抗帕金森病 (ＰＤ)药 ,不仅表现运动障碍 (震颤、肢体僵硬、行动迟缓 ) ,常伴有植物神经、消化、心血管系统等功能紊乱 ,使多数患者意志和生活质量发生各种变化。现代立体定向治疗震颤麻痹是在局麻下边观察边治疗下进行的。本文报告我科采用微电极引导Ｖｉｍ切开治疗震颤麻痹的围手术期病人的护理体会。1　临床资料1.1　一般资料 :本组男 39例 ,女 36例 ;年龄 5 0～ 74岁 ,病程2～ 10年。单纯震颤型 38例 ,震颤 +肢体僵硬 37例 ;患病累及单侧肢体 18例 ,双侧肢体 5 7例 ;其中伴有肢体麻木、肢痛2例 ,12例生活半…     

丘脑下核和苍白球直接靶向立体定位的最佳MRI方法

目的丘脑下核(STN)和苍白球(GPi)的明确认定对于这些结构的深部脑刺激(DBS)非常重要。本研究的目的正是比较各种MRI技术对STN和GPi的显示,并评价每种技     

Bilateral subthalamic stimulation improves gait initiation in patients with Parkinson's disease

Impaired gait initiation is one of the typical sign of advanced Parkinson's disease (PD). This is the first study to examine quantitatively the effect of deep brain stimulation of the subthalamic nucleus on the performance of gait initiation for patients with advanced PD. A total of 11 patients after surgery of bilateral deep brain stimulation of the subthalamic nucleus (STN) were tested in both the deep brain stimulation (DBS) ON and OFF conditions and/or in both the medication ON (i.e., with the usual dosage of antiparkinsonian medications administered) and OFF (i.e., with the usual dosage of antiparkinsonian medications withheld) conditions. DBS had no effect on the onset of anticipatory postural adjustment (APA). The effect of DBS approached significant level for the onset of swing foot lifting, but reached significant level for the delay of swing foot lifting. DBS significantly increased the amplitude of the APA, amplitude of reactive shear forces on both feet, and amplitude of COP in both anterior–posterior and medial–lateral directions. It is concluded that DBS significantly improved the performance of patients with advanced PD in gait initiation.     

丘脑底核电刺激治疗帕金森病时发音信号的动态分析

 目的 探讨丘脑底核(STN)DBS治疗PD发音障碍的效应.方法 19名PD患者,在服药和未服药状态下,开和关闭DBS,记录声音文件.用扰动和非线性动态分析方法进行分析.结果 t检验显示:植入双侧、左侧和右侧DBS的PD受试者在服药和未服药状态下,分析数值指标在DBS开和关之间没有显著的差异.结论 提示STN DBS对PD患者的周期性和非周期性发音障碍都没有显著改善.     

帕金森病立体定向手术靶点定位软件

目的设计并验证帕金森病立体定向手术靶点定位软件.方法推导出任意靶点两种坐标(大脑原点,即AC-PC线中点坐标系坐标和立体定位架坐标系坐标)之间的相互换算;数字化三维坐标重建Schaltenbrand-Wahren人脑立体定向图谱,形成随AC-PC长度缩放的导航图谱.编成软件实现(1)图谱中选靶点,得出其两种坐标;(2)输入两种坐标中的一项,得出另一项,并在图谱中显示靶点.对软件的实用性、准确性进行了验证.结果帕金森病立体定向手术靶点定位软件,靶点定位直观准确,消除了定向架的影响、简化了计算、提高了SW图谱的适应性.     

Ambulatory monitoring of left ventricular function in patients with Parkinson's disease and postural hypotension

Left ventricular (LV) function was continuously monitored using a radionuclide detector (VEST) after intravenous injection of 25 mCi technetium-99m labelled red blood cells in nine patients with Parkinson's disease and postural hypotension (group 1) and ten patients with Parkinson's disease but without postural hypotension (group 2). LV function and blood pressure were monitored in the supine position for 15 min (period A), upon changing posture from the supine to the upright position for 10 min (period B), and upon returning to the supine position for 10 min (period C). In group 1, the passage from period A to period B induced a significant decrease in end-diastolic volume, end-systolic volume and ejection fraction (allP<0.01). In group 2, ejection fraction increased (P<0.05) upon changing posture from the supine to the upright position. Ejection fraction (F=33,P<0.01), end-diastolic volume (F=9,P<0.05) and end-systolic volume (F=10,P<0.05) were significantly different between the two groups. In group 1, stroke volume, cardiac output and vascular peripheral resistance decreased from period A to period B (allP<0.001). In group 2, no changes in stroke volume, cardiac output and vascular peripheral resistance were observed from period A to period B. All parameters were similar in the two groups during the periods A and C. Upon changing posture from the supine to the upright position, patients with Parkinson's disease and postural hypotension showed marked changes in parameters of LV function induced by vascular abnormalities. The results of this study may help to clarify the potential risk of sudden postural changes in such patients, which may cause fainting, syncope and increased risk of ischaemic coronary and cerebrovascular attacks and of lower limb fractures.     

Coordination of axial rotation and step execution: deficits in Parkinson's disease

To determine why parkinsonian patients (PP) present some difficulties to initiate locomotion, a diagonal step has been investigated in two tasks in five control subjects (CS) and in ten PP. In the first task, the subjects had to perform one diagonal step without change in their orientation (WR); in the second task, they had to perform one diagonal step with a body rotation in the step direction (RO). The defended hypothesis is that the gait initiation deficits in Parkinson disease are a consequence of their difficulties to coordinate al the component of a complex movement. The analysed parameters were the duration of the postural and movement phases, the step length and velocity, and the amplitude of the horizontal ground reaction forces during each phase. Compared to CS, the PP showed a lengthening of the postural phase, a decrease in the step length and velocity and a reduction of the horizontal forces. The comparisons between the performances obtained in the WR versus those obtained the RO show in CS that the performances remained unchanged, whereas in PP the performances were significantly more altered in the RO. It illustrates the specific deficit occurring in PP while performing complex tasks where coordination between several components has to be achieved simultaneously.     

高压氧综合治疗帕金森病患者认知功能障碍68例疗效观察

目的 探讨高压氧(HBO)治疗对帕金森病(PD)患者认知功能障碍的康复作用.方法 将68例有认知功能障碍的PD患者分为HBO组(38例)和对照组(30例),2组均给予吡拉西坦治疗.HBO组每周治疗5次,连续8周.2组治疗前后均进行韦氏成人智力量表(WAIS-RC)、韦氏成人记忆量表(WMS-RS)、帕金森病统一评分量表(UPDRS)评定及P300听觉事件相关电位检测.结果 2组治疗后总智商、言语智商、操作智商、记忆评分、UPDRS精神、行为和情绪、UPDRS日常生活活动及UPDRS运动检查评分均较治疗前有改善(P＜0.05),其中HBO组改善程度更为显著(P＜0.05);HBO组治疗后潜伏期各组数据均较治疗前有显著改变(P＜0.05),对照组仪P3Fz、P3Cz有显著改变(P＜0.05).结论 HBO治疗有助于改善PD患者的认知功能障碍.     

Early biomechanical markers of postural instability in Parkinson's disease

Current clinical assessments do not adequately detect the onset of postural instability in the early stages of Parkinson's disease (PD). The aim of this study was to identify biomechanical variables that are sensitive to the effects of early Parkinson's disease on the ability to recovery from a balance disturbance. Ten adults diagnosed with idiopathic PD and no clinically detectable postural instability, and ten healthy age-range matched controls (HC) completed the study. The first step in the response to a backwards waist pull was quantified in terms of strategy, temporal, kinematic, kinetic, and center of pressure (COP) variables. People with PD, compared to HC, tended to be less consistent in the choice of stepping limb, utilized more time for weight shift, used a modified ankle joint motion prior to liftoff, and the COP was further posterior at landing. The study results demonstrate that PD changes the response to a balance disturbance which can be quantified using biomechanical variables even before the presence of clinically detectable postural instability. Further studies are required to determine if these variables are sensitive and specific to postural instability.     

丁苯酞治疗帕金森病合并抑郁症的临床效果

目的 探讨帕金森病合并抑郁症采用丁苯酞治疗的临床效果及对脑源性神经营养因子(brain-derived neurotrophicfactor,BDNF)、5-羟色胺(5-hydroxytryptamine,5-HT)、血清神经营养因子-3(serum nerve nutrition factor-3,NT-3)、C反应蛋白(C reactive protein,CRP)的影响.方法 选取2013年9月-2014年9月在我院接受治疗的80例帕金森病合并抑郁症患者,采用数字表法将患者分为对照组和观察组,每组40例.2组患者入院后均给予常规治疗,对照组患者给予美多芭和盐酸舍曲林片口服,观察组患者在对照组治疗的基础上给予丁苯酞软胶囊口服,疗程均为12周.对比2组临床治疗效果以及治疗前后汉密尔顿抑郁量表(HAMD)和帕金森统一分量表(UPDRS)评分、BDNF、5-HT、血清NT-3和CRP水平.结果 观察组临床总有效率与对照组相比明显较高,差异具有统计学意义(P＜0.05).观察组患者治疗后的HAMD评分和UPDRS评分与对照组相比明显较低,差异具有统计学意义(P＜0.05).2组患者治疗后的血清NT-3、BDNF、5-HT水平明显高于治疗前(P＜0.05),2组患者治疗后的CRP水平明显低于治疗前(P＜0.05);观察组患者治疗后的血清NT-3、BDNF、5-HT水平明显高于对照组,CRP水平明显低于对照组,差异具有统计学意义(P＜0.05).结论 丁苯酞可以明显改善帕金森病合并抑郁症患者的抑郁症状,明显降低血清CRP水平,明显提高BDNF、5-HT、血清NT-3水平,效果显著,建议推广.     

Relationships between gait and dynamic balance in early Parkinson's disease

This study examined the relationships between gait and dynamic balance in people with early-stage Parkinson's disease (PD). We assessed 18 participants diagnosed with stage I–II idiopathic PD and 17 healthy age-matched volunteers. Temporo-spatial gait variables were analyzed using the GAITRite^® system and participants were asked to walk at a comfortable walking speed. Dynamic balance was assessed using the Balance Master^®. Movement velocity (MV), maximal excursion (ME), and directional control (DC), obtained through the limits of stability test, quantified dynamic balance. People with early stage PD exhibited significantly slower walking speed, shorter stride length, and smaller forward MV than the comparison group. In the PD group, stride length and speed significantly correlated with forward MV, forward ME, and forward DC. Thus, in people with early PD, gait speed and stride length are correlated with dynamic balance, particularly in the forward direction in standing.     

Raclopride在帕金森病PET中的应用

帕金森病是发生于中年以上的中枢神经系统的变性疾病,由于多巴胺产生不足,引起多巴胺D2受体功能异常。Raclopride(雷氯必利)对中枢神经系统D2受体具有高度的选择性和亲和力,是研究D2受体分布的理想示踪剂。11C-raclopridePET可在分子水平直观地显示D2受体的分布、密度及变化情况,对帕金森病的病情分析、序列运动的多巴胺机制分析、运动波动合并症的机制分析、药物作用机制分析、外科治疗的机制分析等方面具有重要意义。