脑深部电刺激术治疗痉挛性斜颈的远期疗效分析  

Long-term postoperative efficacy of deep brain electrical stimulation for the treatment of spastic torticollis

作　　者：江潮 崔志强[1] 凌至培[3] 潘隆盛[1] 毛之奇[1] 王健[1] 徐欣[1] 许百男[1] 张剑宁 Jiang Chao;Cui Zhiqiang;Ling Zhipei;Pan Longsheng;Mao Zhiqi;Wang Jian;Xu Xin;Xu Bainan;Zhang Jianning(Department of Neurosurgery,the First Medical Centre,Chinese PLA General Hospital,Bejing 100853,China;Basic Medical College of North China University,Tangshan 063210,China;Department of Neurosurgery,Hainan Hospital,Chinese PLA General Hospital,Sanya 572013,China)

机构地区：[1]解放军总医院第一医学中心神经外科医学部,北京100853 [2]华北理工大学基础医学院,唐山063210 [3]解放军总医院海南医院神经外科,三亚572013

出　　处：《中华神经外科杂志》2022年第4期384-387,共4页Chinese Journal of Neurosurgery

基　　金：国家重点研发计划(2019YFC0118503)。

摘　　要：目的探讨脑深部电刺激术(DBS)治疗痉挛性斜颈的远期疗效。方法回顾性分析2012年6月至2019年12月解放军总医院第一医学中心神经外科行DBS手术治疗的53例痉挛性斜颈患者的临床资料,其中3例患者合并帕金森病。根据临床症状及合并症,49例选择双侧苍白球内侧核(GPi)靶点,2例选择双侧丘脑底核(STN)靶点,1例选择双侧STN和GPi靶点,1例选择双侧丘脑腹中间核(Vim)靶点。术后随访西多伦多痉挛性斜颈量表(TWSTRS)和Tsui量表评分,以评估患者的症状改善情况。结果53例患者的术中头颅MRI均显示植入电极位置与手术计划靶点一致。手术并发症:术中发生外囊血肿1例;术后合并脑梗死1例头皮切口感染1例;术后2年,1例患者出现颈部导线牵拽感。53例患者的随访时间为(40.5±19.8)个月。至末次随访,49例行GPi-DBS的患者的TWSTRS和Tusi量表评分的改善率[M(Q_(1),Q_(3))]分别为59.4%(51.0%,72.3%)和61.7%(54.4%,73.9%),与术前比较,评分均下降(Z值分别为-6.29和-6.21,均P<0.001);2例行STN-DBS患者的TWSTRS评分改善率分别为100%和71.6%,Tusi量表评分的改善率分别为100%和83.3%;1例行Vim-DBS患者的TWSTRS和Tusi量表评分的改善率分别为92.3%和50.0%;1例行双侧STN和GPi靶点DBS的患者,TWSTRS和Tusi量表评分的改善率分别为72.5%和100%。结论DBS治疗痉挛性斜颈的远期疗效较好,患者的颈部姿势、颈部疼痛、生活质量均有明显改善。Objective To explore the long term eficacy of deep brain electrical stimulation(DBS)for the treatment of spastic torticollis(ST).Methods A retrospective analysis was conducted on the clinical data of 53 patients with TS who underwent DBS surgery from June 2012 to December 2019 in the Department of Neurosurgery,the First Medical Centre,Chinese PLA General Hospital.Among the patients,3 were complicated with Parkinson's disease.According to clinical symptoms and comorbidities,49 patients underwent DBS of bilateral globus pallidus intermnus(GPi),2 patients underwent DBS of bilateral subthalamic nucleus(STN),1 patient underwent DBS of bilateral STIN and GPi targets,and 1 patient underwent DBS of bilateral thalamic ventral intermediate nucleus(Vim)targets.The Westerm Toronto Spastic Torticollis Rating Scale(TWSTRS)and Tsui Scale scores of the patients were followed up postoperatively to assess the improvement of the patients'symptoms.Results Intraoperative MRI of the 53 patients showed that the positions of implanted electrodes were consistent with the surgical plans.Surgical cormplications included 1 case of external capsule hemorrhage occurring during operation;1 case of postoperative cerebral infarction and 1 case of scalp wound infection.At 2 years after operation,1 patient developed wire pulling feeling in the neck area.The follow-up time of 53 patients was 40.5±19.8 months.By the last follow-up,the improvement rates of TWSTRS and Tusi scale scores[M(Q_(1),Q_(3))]in 49 GPi-DBS patients were 59.4%(51.0%,72.3%)and 61.7%(54.4%,73.9%)respectively.Compared with preoperative conditions,those two scores were decreased(Z values:-6.29 and-6.21 respectively,both P<0.001).The improvement rates of TWSTRS scores in 2 patients who undervent STN-DBS were 100%and 71.6%respectively,and the improvement rates of Tusi scale scores were 100%and 83.3%respectively.The improvement rates of TWSTRS and Tusi scale scores in 1 patient with Vim-DBS were 92.3%and 50.0%respectively.In 1 patient with bilateral STN-and GPI-DBS,the improvement ra

关 键 词：斜颈 深部脑刺激法 治疗结果 

分 类 号：R651.1[医药卫生—外科学]