全身性肌张力障碍的立体定向手术治疗回顾分析  

Retrospective analysis of stereotactic surgery in general dystonia

作　　者：王云鹏[1] 张宇清[1] 李建宇[1] 李勇杰[1] 

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

出　　处：《立体定向和功能性神经外科杂志》2016年第4期203-207,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的对全身性肌张力障碍接受脑深部电刺激治疗患者进行回顾性分析，进一步了解不同表现形式肌张力障碍治疗的特点。方法回顾分析从2008年4月至2015年4月就诊首都医科大学宣武医院功能神经外科并接受脑深部电刺激治疗患者临床特点，对患者的治疗靶点及特点进行分析，采用Burke—Fahn—Marsden肌张力障碍运动（BFMDRS）评分标准进行评分，分别对术后初期、术后3个月及术后1年后症状改善率做评估。结果23名患者接受脑深部电刺激植入后，症状均得到了不同程度的改善，术后初期改善程度从25．6％～85．7％，平均改善达52．5％；3个月时患者改善程度从40．0％～78．6%，平均58．1%；1年后患者改善率从37．8％～94．7％，平均达到77．1％，23例患者中18位患者的症状在长期随访中均能达到相对稳定的状态，占74．9％。16例患者接受B—GPi靶点刺激，2例患者采用B—Vim，另外5例为B—STN。结论随着对肌张力障碍疾病认识的更深入和细致，选择不同的手术靶点为不同运动形式的患者实施脑深部电刺激治疗，以提高全身性肌张力障碍患者症状改善率，从而达到更理想的治疗效果。Objective To analyze patients with deep brain stimulation retrospectively, and to further understand the characteristics of different forms of dystonia treatment. Methods Clinical characteristics were analyze from patients after DBS treatment in the department of functional neurosurgery of Xuanwu Hospital of Capital Medical University by 2008.04-2015.04. treatment targets and the characteristic for patients carried on the analysis, score by using standard Burke- Fahn-Marsden dystonia rating scale（BFMDRS）, and evaluate the improvment rate at the early postoperative stage, three months after and year after respectively. Results 23 patients have been improved in various degree after DBS surgery, early postoperative improvement is range from 25.6%-85.7%,the average rate is 52.5%. After three months the improvement is from 40.0% -78.6% ,mean 58.1%; improvement rate year after is from 37.8-94.7% averaged 77.1%. A relatively stable state can be reached with 18 patients in long-term follow up, account for 74. 9% of all patients. 16 patients were drawn to accept the B GPi target,2 patients were treated with B Vim,and the other 5 patients were selected by B-STN stimulation. Conclusion As the understanding of dystonia has become more in depth and detailed,different surgical targets are chosen for patients in different forms of movement in order to bring up the improvement rate of generalized dystonia patients and to achieve ideal treatment effect.

关 键 词：肌张力障碍 脑深部电刺激 苍白球 丘脑底核 

分 类 号：R746[医药卫生—神经病学与精神病学]