改良Webster症状评分量表评估帕金森病的手术疗效

Modified Webster Score to Evaluate the Surgical Effect of Parkinson Disease

目的：通过改良Ｗｓｂｓｔｅｒ记分量表评价电生理引导脑内核团毁损术治疗帕金森病的疗效。病人与方法：应用改良Ｗｅｂｓｔｅｒ症状评分表，对帕金森病人分别在手术前后进行１０组症状记分，１～１０分为轻度障碍；１１～２０分为中度障碍；２１～３０分为重度障碍；术后改善２５％以下为无效，２６％～５０％为有效，５１％～７５％为显效，７５％以上为特别显效。结果：术前评分为１９．９０±５．２７，术后评分１０．５７±６．１０，平均改善（８．９５±３．３７）分，差异非常显著，但无１例症状完全消除：其中特别显效４例（９．５％）；显效１７例（４０．５％）；有效１６例（３８．１％），总有效率为８８．１％，单靶点毁损３４例，改善８．５９±３．５３，双靶点８例，改善（１０．００±４．１４）分，两组差别无统计学意义。分组统计结果表明，症状轻者术后改善的百分比较高。讨论：电生理引导脑内核团毁损术尚不能完全消除帕金森病的症状，但可使其明显改善；单侧双靶点毁损与单靶点毁损的疗效差别无显著意义，可能与病例数较少有关；症状较轻者术后改善明显。本文对手术适应症、禁忌症、并发症以及手术注意事项也进行了讨论。结论：对于药物疗效降低以及出现毒副作用的帕金森病患者?

Objective: Use Modified Webster Score to evaluate the effect of electrophysiology guided coagulation of brain nuclear to the treatment of Parkinson disease. Patients and methods: With Modified Webster Score, the patients suffered from Parkinson disease were examined before and after operation respectively. The symptoms were divided into 10 groups. 1-10 points was taken as slight disability; 11-20 was taken as medium; 21-30 was taken as severe. Improvement less than 25% was taken as no effect, 26%~50% was taken as effective. 51%~75% was taken as significant effective. More than 75% was taken as very significant effective. Results: The score was 19.90±5.27 preoperatively and 10.57±6.10 postoperatively. The mean improvement was in 8.95±3.37. The difference was very significant; But no one's symptoms despaired totally; Very significant effective was obtained in 4 cases (9. 5t~)~ Significant effective was obtained in 17 cases (40. 5%). Effective was obtained in 16 cases (38.1%). The total effective rate was 88. 1%. One target coagulation was performed in 34 cases. The mean improvement was in 8. 59± 3. 53. Two targets coagulation in one side was performed in 8 patients. The mean improvement was in 10. 00±4. 14. No significant difference was found between this two groups statistically. The subgroup statistical results showed that the less symptoms appeared, the better improvement was obtained in percentage. Discussions: Electrophysiology guided stereotactic coagulation of brain nuclear to the treatment of Parkinson Disease can not remove all symptoms. But can improve them significantly; The effect of two targets coagulation in one side was not differentiate from that of one target coagulation significantly. It maybe due to the little number of cases. The less symptoms o the better improvement was obtained. The indications, contraindicstions, complications and what should be noted during opertion were discussed. Conclusions: For Parkinson Disease who were no longer benefit from drug treatment because of the decreased effect or increased side effect, Modified Webster Score is very efficiency to evaluate and follow-up the effect of operation. This scale is very easy to use especially for neurosurgeons. It's a very efficient method for evaluation.