不可见靶点计算软件的临床应用

目的分析自行编制的不可见靶点计算软件STZ确定脑内靶点坐标与实际手术靶点坐标的一致性.方法应用STZ软件对手术效果良好的7例8组帕金森病苍白球/丘脑Vim核切开术靶点坐标进行计算.并与实际靶点进行比较.采用随机化配对设计资料均数t检验法对两组坐标值进行统计学处理.结果两组坐标数值无统计学差异(P＞0.05).结论应用STZ计算软件计算脑内不可见靶点与实际靶点具有良好的一致性,具有准确、迅速、易于使用的优点,且不要求AC、PC两点在同一影像平面上.     

脑立体定向术脑内靶点CT定位的初步探讨

脑立体定向术脑内靶点ＣＴ定位的初步探讨顾明，段承祥，徐元昌，何乾文，袁树斌，胡威夷，马宗黎，白小红，王开祥，郭爱华锥体外系疾病（ＥＰＤ）的功能性立体定向手术中，ＣＴ正在逐步取代常规Ｘ线脑室造影成为脑内靶点定位的影像学方法￣［１，２］。笔者使用Ｌｅｋｓ...     

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。     

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。     

立体定向手术技术结合伽玛刀治疗颅内病变

应用立体定向手术技术与伽玛刀结合治疗颅内病变患者55例，其中男33例，女22例，年龄12－72岁，平均41岁。病变部位：鞍区21例，大脑半球10例，基底节区9例，小脑半球5例，脑干4例，多发6例。治疗方式为立体定向活检和（或）囊腔穿刺抽吸囊液＋伽玛刀治疗。结果47例活检中44例获得明确的病理诊断，阳性活检率为93.6%。囊腔穿刺抽出囊液1－30ml，穿刺后症状明显缓解，．无严重并发症和手术死亡。说明该联合治疗技术在可在病人接受伽玛刀治疗的同时做出病理学诊断，利用治疗计划的制定和预后判断；囊腔穿刺可迅速降低颅内压力，改善病人症状，减少病变体积及周围 脑组织放射性损伤，扩大了伽玛刀治疗适应症，值得推广。     

锥体外系疾病脑立体定向术靶点的影象学定位

影象技术的发展，使锥体外系疾病的立体定向手术治疗重新受到重视。本综述立体定向手术的颅内靶点、参照系统的选择及解剖生理基础、Ｘ线脑室造影、ＣＴ、ＭＲＩ对脑深部核团定位的运用；着重介绍了ＣＴ的作用和方法，并简述了三种影象学方法的运用价值。     

立体定向脑损毁术治疗帕金森病的研究进展

立体定向脑损毁术或称消融术(LT)是指通过立体定向微创技术损毁脑内特定组织结构从而治疗神经系统疾病的手术方法,主要包括磁共振引导超声聚焦消融术(MRgFUS)、伽马刀(GK)及射频消融术(RF)等.对于药物反应欠佳的帕金森病(PD)患者,LT可明显改善临床症状(如僵直、震颤、异动症等),减少药物用量,提高长期生活质量,...     

动静脉畸形立体定向放射外科治疗

立体定向放射外科是近下来伴随计算机、现代影像学和现代放疗学发展起来的一门新技术,临床应用治疗肿瘤和一些良性疾病具有靶区剂量高和周围正常组织损伤小的特点。本文就立体定向放射外科治疗动静脉进行综述。     

Primary brain lymphoma presenting as Parkinson's disease

Neoplasm is an uncommon cause of a parkinsonian syndrome. We report a woman with primary brain B-cell lymphoma presenting as Parkinson's disease. After 1 year of the illness, CT and MRI showed lesions without mass effect in the basal ganglia and corpus callosum. The patient did not respond to levodopa and right cerebellar and brain-stem signs appeared, which prompted further neuroimaging, showing an increase in size of the lesions and a right cerebellar and pontine mass. Stereotactic biopsy of the basal ganglia showed high-grade B-cell lymphoma. Despite the basal ganglia frequently being involved in lymphoma of the brain, presentation with typical or atypical parkinsonism is exceptional. Received: 17 September 1999/Accepted: 26 June 2000     

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.     

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。     

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.     

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.     

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.     

帕金森病的脑灰质体积改变的VBM研究

目的 分析帕金森病(PD)患者的全脑灰质体积的变化,探讨PD患者的脑灰质结构异常模式.方法 选取符合入组标准的46例PD患者和19例年龄、性别与之相匹配的正常对照(NC)被试者作为研究对象.46例PD患者按改良的Hoehn-Yahr (H-Y)分级标准又分为2个亚组,25例早期PD(ePD)组和21例中晚期PD(maPD)组.所有受试者在3.0T超高场磁共振仪进行常规磁共振扫描,并获取三维高分辨T1WI数据,采用VBM-DARTEL(voxel-based morphometry-diffeomorphic anatomical registration through exponentiated lie)方法分析比较PD组与NC组、ePD组与maPD组间的脑灰质体积差异.结果 与NC组相比,PD组双侧额叶、颞叶、岛叶、扣带回、海马、梭状回、小脑及右侧楔叶、楔前叶等脑区的灰质体积减小,全脑灰质未见体积增加.与ePD组相比,maPD组双侧额叶、颞叶、岛叶、扣带回、直回、舌回、梭状回、海马、杏仁核及小脑等脑区的灰质体积减小.结论 VBM方法客观提示了PD存在广泛的脑灰质萎缩,且随病程的进展更为显著.PD脑结构的变化存在特定的空间分布模式,可能与PD的病理基础有关.     

帕金森病的丘脑腹中间核电生理特性及术中定位意义

目的 研究帕金森病患者丘脑腹中间核(Vim)的电生理特性,寻找应用微电极来确定丘脑腹中间作为核毁损术靶点的方法。方法 在对23例震颤型帕金森病患者进行的微电极引导选择性丘脑腹中间核毁损术中,比较Vim与其周围结构背景放电、放电幅度和放电频率的差异,比较运动觉神经元和震颤细胞对微刺激的反应。结果 腹中间核与腹外侧核、腹后核和内囊的背景放电和放电幅度不同,根据神经元在主动和(或)被动活动对侧肢体时放电是否变化,将震颤细胞分为两类,两类震颤细胞的分布及微刺激时引起对侧肢体震颤的变化情况存在明显差异。运动觉神经元和震颤细胞在微刺激时引起对侧肢体震颤的变化情况也存在明显差异。结论 微记录能确定Vim前界,联合应用微刺激和微记录才能迅速、准确的确定Vim后界及手术靶点内外侧界。毁损靶区应包括在主动和(或)被动活动对侧肢体时放电变化的震颤细胞和运动觉神经元。     

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.     

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.