丘脑腹中间核毁损术治疗帕金森病的长期疗效观察

Observation of long-term curative effect of radiofrequency thermocoagulation of ventrointermediate nuleus of thalamus on Parkinson’s disease

目的探讨丘脑腹中间核(Vim)毁损术治疗帕金森病(PD)的临床疗效及手术并发症。方法 PD患者151例在采用MRI丘脑长度比例法定位Vim后行射频热凝毁损Vim治疗。术前、术后1周、1年、3年、6年在未服药状态下行统一PD评定量表Ⅲ(UPDRSⅢ)评分评估疗效。结果不同Hoehn-Yahr分级患者术后1周UPDRSⅢ评分较术前均明显下降(P<0.05)。术后1周不同级别Hoehn-Yahr分级UPDRSⅢ评分改善率均差异显著术后6年,震颤型和震颤僵直型PD患者UPDRAS评分分别为(35.75±2.30)%和(27.27±2.02)%;震颤型近期及远期疗效较震颤僵直型好(P<0.05)。随着Hoehn-Yahr分级的增加和术后时间的延长UPDRSⅢ评分改善率下降。术后并发症包括术后毁损灶少量出血6例,构音功能障碍8例,手术同侧口周及对侧肢体麻木7例。结论经MRI丘脑长度比例法定位后行丘脑Vim毁损术治疗PD近期疗效显著,有较好的远期疗效,并发症较低。

Objective To observe the long-term curative effect of thermocoagulation of ventrointermediate （Vim） nucleus of the thalamus on Parkinson＇s disease （PD）. Methods The radiofrequency thermocoagulation of Vim nuclei was performed after Vim nuclei were located by MRI-guided thalamus length ratio-targeting in 151 patients with PD, who were divided into 6 groups according to Hohen-Yahr stages and clinical types （tremor or tremor-rigidity type）. The movement function was determined by the unified Parkinson＇s disease rating scale Ⅲ （UPDRS Ⅲ） before the thermocoagulation and 1 week and 1, 3 and 6 years after the thermocoagulation in all the patients who did not receive the administration of any medicine. Results The scores of UPDRS Ⅲ were significantly lower 1 week after the operation than those before the operation in all the patients with different Hoehn-Yahr stages. With inerease in Hoehn-Yahr stage and the lapse of the postoperative time, the improvement rate of the movement function was decreased. The improvement rates of the movement function in the patients with tremor type and ones with tremorridity type were （35.75±2.3）% and （27.27±2.02）% respectively 6 years after the operation. The curative effect of the thermocoagulation of Vim nuclei on the patients with tremor was significantly better than that on the patients with tremor-rigidity type （P〈0.05）. The main recent complication after the operation was hemorrhage in the lesioned cerebral areas （2.9%, 6/206 which was the number of the operations）, and the long-term complication after the operation was articulation disorders （5.6%, 8 in 142 patients who were protracctedly followed up）. Conclusion The recent and long-term curative effect of the radio frequency thermocoagulation of Vim nuclei located by MRI-guided thalamus-length ratio targeting on the patients with PD is good.