陶氏DBS手术评分法在帕金森病疗效评估的应用

Application of Tao’s DBS surgery scale in evaluating the therapeutic efficacy of Parkinson’s disease

目的研究陶氏DBS手术评分法是否可有效评估深部电刺激术(deep brain stimulation,DBS)与预估疗效。方法回顾性分析73例帕金森病(Parkinson’s disease,PD)病例资料,均在ROSA机器人辅助下完成DBS,靶点选择丘脑底核(subthalamic nucleus,STN)42例,苍白球内侧部(globus pallidus internus,GPi)31例。均应用陶氏DBS手术评分法进行手术评分。分析术后程控参数、左旋多巴等效日剂量(levodopa equivalent daily dose,LEDD)减量情况、统一帕金森病评定量表(unified Parkinson’s disease rating scale,UPDRS)和UPDRS-Ⅲ变化、程控副作用,并与评分进行相关性分析。结果术后程控电压:STN平均为(2.3±0.6)V,GPi平均为(3.7±0.6)V。LEDD减量平均为(119.9±64.2)mg。改善率:UPDRS平均为(40.0±17.9)%,UPDRS-Ⅲ平均为(63.6±17.8)%;DBS前后药物减量与量表变化差异均具有统计学意义(P <0.05)。陶氏DBS手术评分平均为(83.6±9.0)分,评分与术后6个月UPDRS和UPDRS-Ⅲ改善率具有线性相关关系(分别为r=0.5798,P <0.0001;r=0.7107,P <0.0001)。结论陶氏DBS手术评分法可有效评估DBS治疗PD的疗效,可作为衡量手术成功与否的一项综合评分,指导功能神经外科医生提高手术技术。

Objective To study whether the Tao’s DBS surgery scale can effectively evaluate deep brain stimulation(DBS) and predict the therapeutic efficacy. Methods The data of 73 patients with Parkinson’s disease(PD) were analyzed retrospectively. The DBS was completed with the assistance of ROSA robots. The subthalamic nucleus(STN) was selected as the target in 42 cases, and the globus pallidus internus(GPi) in 31. The Tao’s DBS surgery scale was used for surgical scoring. The postoperative programming parameters, levodopa equivalent daily dose(LEDD) reduction, unified Parkinson’s disease rating scale(UPDRS) and UPDRS-Ⅲchanges and thus program control side effects, and correlation with the score were analyzed. Results Postoperative programmable voltage averaged 2.3 ± 0.6 V in STN, averaged 3.7 ± 0.6 V in GPi. The average LEDD reduction was 119.9 ± 64.2 mg. The improvement rate averaged 40.0 ± 17.9 % in UPDRS, and 63.6 ± 17.8 % in UPDRS-Ⅲ. The differences in drug reduction and scale changes after DBS were statistically significant(P < 0.05). The average Tao’s DBS surgery scale was 83.6 ± 9.0 points, and the score was linearly correlated with the improvement rate of UPDRS and UPDRS-Ⅲ at 6 months after surgery(r = 0.5798, P < 0.0001;r =0.7107, P < 0.0001). Conclusions The Tao’s DBS surgery scale can effectively evaluate DBS surgery to predict the therapeutic efficacy and prognosis of PD patients. It can be used as a comprehensive evaluation standard to measure the operation and guide neurosurgeons to improve their surgical techniques.