电生理功能定位在帕金森病手术治疗中的应用

The application of electrophysiological functional target localization in surgery for Parkinson's disease

目的 探讨神经元电生理功能定位在手术治疗帕金森病中的应用价值。方法 120例帕金森病患者,在微电极导向立体定向手术中分别应用运动电刺激和光反射电刺激检测方法,确定手术靶点位置,而后施行热频毁损术。手术后1年根据UPDRS评分评估疗效;手术后2周～3个月行MR检查比较手术前影像学定位与实际毁损靶点的偏差范围。结果 在手术中,微电极可在苍白球外侧和苍白球内侧记录到特征性的神经元电活动,有效确定靶点。手术前MRI解剖定位实际毁损靶点偏差<3mm,手术后1年UPDRS评分下降32.10％(P<0.01),症状改善程度依次为对侧肢体异动症(95％)、僵硬(72％)、震颤(72％)、运动迟缓及行走姿势(54％)。结论 微电极记录能有效地反映苍白球内侧的电生理学特征,提供细胞水平的“功能定位”。“有效针道”可以应用于苍白球腹后部切开术治疗帕金森病,从而提高治疗靶点的准确性,减少并发症的发生。

Objective To study the application impact of the electrophysiological functional target localization of neuron on surgical treatment for Parkinson's disease (PD). Methods The motor electric stimulation or light reflection electric stimulation measure was applied in microelectrode guided stereostaxic surgery respectively to identify the target localization in 120 PD patients. Then the thermal radiation frequency damaging technique was performed. The therapeutic effect was evaluated with unified Parkinson's disease rating scale (UPDRS) at 1 year postoperatively. The comparasion of preoperative imaging localization with the deviation range of real damaged target was examinated by MR in 2 wk-3 mon postoperatively. Results The characteristic electric activity of neuron would be recorded by microelectrode at the globus pallidus interims and externus to identify the target in operation. While the real damaged target deviation < 3 mm in preoperative localization by MRI, the UPDRS score was reduced 32.10% (P < 0.01) in 1 year postoperation. The improvement of symptoms were as follows: contralateral abnormal motion sickness of extremities (95%), rigidity (72%), tremor (72%), bradykinesia and walking posture (54%). Conclusion The electrophysiological characteristics of globus pallidus may be effectively expressed by microelectrode and defined the 'functional localization' at cellular level. The effective pathway may be applied to the posteroventral pallidotomy for PD, hence the accuracy of therapeutic target is improved and the occurence of complications is reduced.