选择性丘脑毁损术治疗运动失调症36例临床分析

Use of selective thalamotomy for various kinds of movement disorder

目的探讨选择性丘脑毁损术治疗不同类型运动失调症的方法和疗效。方法仔细分析36例不同类型运动失调的病人(帕金森病23例、书写痉挛症10例、痉挛性斜颈2例、全身扭转性痉挛症2例)等运动失调的临床特征,选择正确的丘脑靶核团,运用脑深部微电极引导下的立体定向技术准确定位靶核团,并对其进行微小体积的射频毁损,有效控制了运动失调。结果全部病人的症状术后立即得到改善,随访2～16个月,1例帕金森病人震颤复发,同一病人出现较长时间的术后感觉异常并发症。无偏瘫和永久的构音障碍。结论选择性丘脑毁损术对治疗不同类型运动失调症是十分有效的。

Objective To discuss the selective thalamotomy with Vim and Vo as targets for Parkinson＇s disease and other movement disorders. Methods Using the thalamotomy with microrecording , 36 cases with movement disorders were treated between 2007 and 2009. They were 23 cases of PD , and 10 cases of writer＇s cramps , 2 cases of spasmodic torticollis, 1 case of torsion spasm. The patients with tremor as a major manifestation underwent the thalamotomy with Vim as target , the patients with rigidity or dystonia as a major manifestation underwent the thalamotomy with Vo and Vim as targets. Results In all of the cases ,the tremor and rigidity were abolished or reduced to a considerable extent without remarkable complications. During a 2-24 months follow up , only a male patient whose tremor recurred. 2 months after his operation. Conclusion Practically the effect of Vim thalamotomy is more marked in cases with tremor type movement disorders , Vo and Vim thalamotomy is more marked in cases with rigidity type cases.