双侧丘脑底核脑深部电刺激术治疗原发性颈部肌张力障碍的疗效分析  

Outcome analysis of bilateral deep brain stimulation of subthalamic nucleus for primary cervical dystonia

作　　者：赵明明 曲志峰 程岗 赵虎林 于新 张剑宁 尹丰 Zhao Mingming;Qu Zhifeng;Cheng Gang;Zhao Hulin;Yu Xin;Zhang Jianning;Yin Feng(Deparment of Neurosurgery,Aerospace Central Hospital,Bejing 100049,China;Deparment of Neurosurgery,the Chinese PLA General Hospital-Sixth Medical Center,Beijing 100048,China;Depurtment of Neurosurgery,the Chinese PLA General Hospital-First Medical Center,Bejing 100853,China)

机构地区：[1]航天中心医院神经外科,北京100049 [2]解放军总医院第六医学中心神经外科,北京100048 [3]解放军总医院第一医学中心神经外科,北京100853

出　　处：《中华神经外科杂志》2021年第4期360-364,共5页Chinese Journal of Neurosurgery

基　　金：首都临床特色应用研究与成果推广(Z151100004015219)。

摘　　要：目的初步探讨双侧丘脑底核(STN)脑深部电刺激术(DBS)治疗原发性颈部肌张力障碍(CD)的安全性和有效性,并观察不同亚型CD的疗效.方法回顾性分析2014年9月至2019年4月在解放军总医院第六医学中心神经外科采用双侧STN-DBS治疗的9例原发性CD患者的临床资料.分别于术前,术后刺激器开机后1、3、6及12个月采用西多伦多痉挛性斜颈评分量表(TWSTRS)评估患者的痉挛严重程度、功能障碍以及疼痛评分,计算TWSTRS评分改善率,并采用混合效应线性模型分析比较手术前、后评分的差异,以评估STN-DBS治疗CD的有效性,并初步观察不同亚型CD的症状改善情况.记录刺激相关不良反应,以评估治疗的安全性.结果9例患者均顺利完成双侧STN-DBS治疗.术后头颅MRI均显示植入电极位于或接近计划靶点.术后无一例患者出现感染、过敏反应及排异反应.术后8例患者出现异动症状,1例出现躁狂症状和睡眠障碍,2例出现轻微的单手乏力伴协调性差,程控后均缓解.9例患者的随访时间中位数(范围)为37(12~62)个月.9例患者开机后1、3、6及12个月TWSTRS总分的改善率中位数(上、下四分位数)分别为15.7%(11.6%,37.2%)、53.5%(42.8%,71.8%)、87.5%(53.2%,100.0%)以及100.0%(84.1%,100.0%);随着随访时间的延长,TWSTRS总分、痉挛严重程度、功能障碍及疼痛评分均呈逐渐下降的趋势(均P<0.05).在开机后12个月随访时,4例活动型CD患者的TWSTRS评分改善率均为100.0%,5例紧张型CD患者的改善率中位数(上、下四分位数)为94.2%(72.3%,100.0%).结论初步研究发现,双侧STN-DBS治疗原发性CD较为安全、有效,且活动型和紧张型CD患者均可获益.Objective To preliminary evaluate the safety and efficacy of bilateral deep brain stimulation(DBS)of subthalamic mucleus(STN)for the treatment of primary cervical dystonia(CD)and to preliminarily investigate its efficacy for different subtypes of CD.Methods The dlinical data of 9 patients with primary CD treated with bilateral STN-DBS at Neurosurgery Department of Chinese PLA General Hospital-Sixth Medical Center from September 2014 to April 2019 were retrospectively analyzed.The severity,disability and pain were assessed with the Toronto W esterm Spasmodie Toricollis Rating Scale(TWSTRS)before and at 1,3,6 and 12 months after the stimulator was turned on.The improvement rate of TWSTRS scores was calculated,and the linear mixed model was used to compare the difference before and after operation to evaluate the effect of treatment and preliminarily explore the improvement for different subtypes of CD.Stimulation-related adverse events were documented to evaluate the safely.Results 9 patients underwent bilateral STN-DBS successfully.Post-operative MRI scan showed that the electrodes were ideally located at or close to the planned targets.No infection,anaphylaxis or rejection reaction was observed.Eight patients experienced dyskinesia,1 patient experienced manic symptoms and sleep disturbance,and 2 patients experienced mild weakness with poor coordination in unilateral hand.All of those were alleviated by programming.The median fllowup time(range)for the 9 patients was 37(12-62)months.The median(P2s,P3s)improwement rates of total TWSTRS scores of 9 patients at 1,3,6 and 12 months after the stimulator was turmed on were 15.7%(11.6%,37.2%),53.5%(42.8%,71.8%),87.5%(53.2%,100.0%)and 100.0%(84.1%,100.0%)respeetively.With the prolonging of fllow-up time,the scores of total TWSTRS,severity,disability and pain showed a trend of gradual decrease(all P<0.05).At the 12-month fllow-up,the improvement rate of TWSTRS score was 100.0%in 4 patients with phasie-type CD and 94.2%(72.3%,100.0%)in 5 patients with tonic-type CD.Conclusi

关 键 词：斜颈 深部脑刺激法 丘脑底核 治疗结果 

分 类 号：R651.1[医药卫生—外科学]