单纯影像定位与微电极辅助定位在帕金森病手术中的应用

Simple imaging-guided versus microelectrode recording-guided deep brain stimulaton for patients with Parkinson's disease

目的比较单纯影像定位与微电极辅助定位(MER)进行丘脑底核脑深部电刺激术(STN-DBS)治疗帕金森病(PD)的疗效。方法回顾性分析2017年1月至2019年12月STN-DBS治疗的112例PD的临床资料。70例通过单纯影像定位(影像组),42例通过MER辅助定位(MER组)。术前与术后3个月,进行“关”状态下统一帕金森病评定量表(UPDRS)运动部分(Ⅲ)评分评估疗效,症状改善率=(术前评分-术后评分)/术前评分×100%。结果影像组手术时间[(125±17)min]较MER组[(158±23)min]明显缩短(P<0.05)。两组电极尖端位置、术后3个月刺激参数(电压、频率、脉宽)均无统计学差异(P>0.05)。与术前药物“关”状态基线数据相比,术后3个月药物“关”状态DBS开启时,两组运动功能评分无统计学差异(P>0.05)。影像组运动功能评分改善率(56.3%)、震颤症状改善改善率(79.5%)、僵直症状改善率(57.9%)、运动迟缓评分改善率(44.8%)与MER组(分别为56.4%、75.4%、60.9%、47.6%)均无统计学差异(P>0.05)。两组术后均未发生出血及感染。结论对于STN-DBS治疗PD,单纯影像学定位与MER辅助定位技术对脑深部电极埋置位置和运动症状改善无明显差异,但是单纯影像定位技术可以缩短手术时间。

Objective To compare the clinical efficay of simple imaging(SI)-guided versus microelectrode recording(MER)-guided subthalamic nucleus deep brain stimulation(STN-DBS)for the patients with Parkinson's disease(PD).Methods The clinical data of 112 PD patients who undewent STN-DBS from January 2017 to December 2019 were analyzed retrospectively.Of 112 patients,70 received SI-guided STN-DBS(SI group)and 42 received MER-Guided STN-DBS(MER group).The clinical efficacy was assessed by unified Parkinson Disease Scale(III)Score before and 3 months after the surgery,with symptom improvement rate as:(preoperative score-postoperative score)/preoperative score×100%.Results The operation time in SI group[(125±17)min]was significantly shorter than that[(158±23)min]in MER group(P<0.05).There was no significant difference in the position of electrode,and stimulating parameters and symptom improvement rate 3 months after the operation between the two groups(P>0.05).There was no psotoperative bleeding and infection in both groups.Conclusions For the PD patients receiving STN-DBS,there were no significant differences in the clinical motor outcomes and positions of electrodes between the two techniques,but the SI positioning technique can shorten the operation time.