成人型肌张力障碍的手术治疗(附16例分析)  

Surgical treatment for adult-onset dystonia:analysis of 16 cases

作　　者：张宇清[1] 李勇杰[1] 李建宇[1] 朱宏伟[1] 马凯[1] 

机构地区：[1]首都医科大学宣武医院功能神经外科北京功能神经外科研究所,北京100053

出　　处：《中国微侵袭神经外科杂志》2006年第11期488-490,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：首都医学发展基金(2002-3023)

摘　　要：目的探讨立体定向核团毁损手术及脑深部电刺激手术治疗成人型肌张力障碍的疗效。方法将16例成人型肌张力障碍病人按受累部位分成3组:A组:书写痉挛,12例;B组:节段性肌张力障碍,3例,A、B组采用立体定向核团毁损手术治疗;C组:痉挛性斜颈,1例,采用脑深部电刺激手术治疗,并根据颈部痉挛肌群肌电活动强度,进行脑深部电刺激参数的调整。随访1年,观察运动功能改善情况。结果A组均治愈;B组平均改善率59.7%;C组在肌电监测之前,临床改善率为23.1%,根据肌电活动强度调整双侧脑深部电极刺激参数后临床改善率为67.3%。结论立体定向丘脑腹外侧核毁损手术是治疗书写痉挛的有效手段。肌电活动强度是设定和调整脑深部电刺激参数的量化指标,可以缩短反复调整的时间,减少电池耗费。Objective To explore clinical efficacy of stereotactic nucleus lesioning and deep brain stimulation for adult dystonia. Methods Sixteen adult dystonia patients were divided into three groups according to involved sites. Stereotactic nucleus lesioning was performed for 12 writing cramp patients in group A and 3 segmental dystonia patients in group B, Bilateral subthalamic nucleus deep brain stimulation was performed for one spasmodic torticollis patient in group C, and the stimulation parameter were adjusted based on the intensity of electric activity in the cramp muscle group recorded by EMG. One-year follow-up was performed for observing changes in motor function in all the patients. Results Significant improvement of motor abilities was observed in group A. The mean improvement rate was 59,7% in group B. In the patients of group 3, the clinical amelioration rate was increased from 23.1% to 67.3% after adjustment of the stimulation parameter. Conclusion Stereotactic nucleus lesioning displays a satisfactory therapeutic effect in the patients with writing cramp. The stimulation intensity may be a sensitive and quantitive predictor for adjusting the stimulation parameter, and quantitative indexes for setting the intensity and adjusting the stimulation parameter can shorten the time of adjustment and decrease the consumption of the battery cell.

关 键 词：张力障碍 变形性肌 立体定位技术 深部脑电刺激法 肌电描记术 斜颈 

分 类 号：R687.2[医药卫生—骨科学]