继发性全身性肌张力障碍的手术治疗分析

Analysis on surgical treatment of secondary generalized dystonia

目的探讨采用立体定向核团毁损和核团毁损加选择性脊神经后根切断术治疗兼有锥体系统损害的继发性全身性肌张力障碍的手术疗效。方法18例病人随机分成两组:a组12例,单纯采用立体定向核团毁损手术治疗;b组6例,采用核团毁损加选择性脊神经后根切断术。随访3个月,观察并对比术后运动功能改善情况。结果单纯立体定向核团毁损手术治疗效果不明显,核团毁损手术加选择性脊神经后根切断术能使病人运动功能得到明显提高。结论联合采用核团毁损手术与选择性脊神经后根切断术,对兼有锥体系统损害的继发性全身性肌张力障碍病人近期疗效较好。

Objective To analyze the efficacy of stereotactic nucleus lesioning and combination of stereotactic nucleus lesioning with selective posterior rhizotomy for secondary generalized dystonia patients complicated with pyramidal system impairment. Methods Eighteen secondary generalized dystonia patients complicated with pyramidal system impairment were divided into two groups in random. Stereotactic nucleus lesioning was performed for 12 patients of group A. Combination of selective posterior rhizotomy with stereotactic nucleus lesioning was performed for 6 patients of group B. The patients' motor function was investigated and compared between two groups after 3 months follow-up. Results Significant improvement in motor abilities was observed in patients of group B. In contrast, patients in group A developed mild amelioration in general. Conclusion Combining application of selective posterior rhizotomy and stereotactic nucleus lesioning displays a satisfactory short-term therapeutic effect for secondary generalized dystonia patients complicated with pyramidal system impairment.