苍白球腹后部切开术治疗帕金森病靶点定位规律探讨  

Target localization at posteroventral pallidotomy in treatment of Parkinson's disease

作　　者：王绍梁[1] 陈来照[1] 薛乃照[1] 刘跃亭[1] 李守缄[1] 朱宏伟[2] 李勇杰[2] 

机构地区：[1]山西医科大学第一医院,山西太原030001 [2]首都医科大学宣武医院

出　　处：《中华神经医学杂志》2004年第3期185-187,共3页Chinese Journal of Neuromedicine

摘　　要：目的研究苍白球腹后部切开术(PVP)治疗帕金森病(PD)的靶点定位方法及其规律.方法45例原发PD患者接受手术,采用MRI进行靶点解剖定位,术中用电生理方法对靶点做必要的调整,同时在MRI操作台上准确测量AC-PC线的长度(L)、三脑室的宽度(W)、头颅的长度和宽度.结果本组患者UPDRS评分改善率大于35%,手术效果满意;依据术中电生理方法调整靶点20例,调整范围1～3mm;靶点横坐标(X)与L和W之间存在线性依从关系即:X=10.09+0.30L+0.48W,决定系数R2=0.7258.结论PVP术中应用电生理方法调整靶点是非常重要的,实现了靶点的功能定位:X坐标值随L和W的增加而增大,且W对X的贡献大于L,靶点Z坐标与L和W之间无相关性,靶点坐标与颅长、颅宽无相关性.Objective To study the target localization at posteroventral pallidotomy (PVP) in order to treat Parkinson's disease (PD) and explore the law of the target coordinates. Methods 45 cases of idiopathic Parkinsonian patients received PVP which was aided with target coordinates of anatomic localization derived from MRI and adjusted with electrophysiologically. The length of AC-PC line and the width of the third ventricle as well as the length and width of the skull were measured accurately with MRI. Results The operative effects were satisfactory, for the improvement rate of UPDRS rose to more than 35 %. Microelectrode recording (MER) and microelectrode stimulation (MES) provided important target information in 20 cases for performing PVP, which resulted in adjusting targets from 1 to 3 mm. The relationship of target horizontal coordinate (X) with the third ventricle width (W) and AC-PC length (L) was established as: X=10.09+0.30 L+0.48 W, R2=0.7258. Conclusion The electrophysiological methods play a very important role in the target localization at PVP. The lateral position of the desired targets in the GPi is correlated positively with the third ventricle width and AC-PC length, the former more contributive to x-coordinate than the latter, though. Neither the skull length nor the skull width is correlated with the target z-coordinates.

关 键 词：苍白球 腹后部切开术 帕金森病 靶点定位 PVP PD 微电极 

分 类 号：R651.1[医药卫生—外科学]