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目的 总结微电极导向立体定向手术治疗帕金森病的临床经验及治疗效果。方法 自 1 999年 4月至 2 0 0 1年 2月采用微电极导向立体定向手术治疗帕金森病 350例 ,其中苍白球腹后部毁损术 (PVP) 2 78例 ,丘脑腹中间核 (Vim)毁损术 35例 ,同期同侧PVP和Vim毁损术 1 5例 ,行同期双侧PVP 1 1例 ,分期双侧PVP 8例 ,分期一侧PVP或另一侧Vim毁损术 3例。对手术前后的“关”状态和“开”状态进行生活能力评分、UPDRS评分 ,并进行门诊随访。结果 术后日常生活能力评分“关”状态提高 2 9.8% ,“开”状态提高 2 5 .9%。UPDRS :在“关”状态下 ,总的改善率为 57.3 % ,其中精神行为情绪改善率为 50 .8% ,日常活动改善率 59.1 % ,运动功能改善率 58.2 %。结论 PVP对震颤效果不如Vim毁损术 ,对震颤明显 ,无明显僵直的患者可选择Vim毁损术 ,对震颤僵直型患者可分期双侧PVP毁损术。
Objective To summarize the clinical experience and therapeutic effect of microelectrode guided stereotactic surgery on Parkinson’s disease. Methods From April 1999 to February 2001, 350 patients with Parkinson’s disease were treated with microelectrode-guided stereotactic surgery. Among them, 78 were PVP, ), 35 cases of lesion, the same period of ipsilateral PVP and Vim damage surgery in 15 cases, simultaneous bilateral PVP 11 cases, staging bilateral PVP 8 cases, staging PVP or Vim damage on the other side in 3 cases. The patients were scored on the ability of life and UPDRS before and after “off” and “on” status, and outpatients were followed up. Results Postoperative daily living ability score “off” state increased by 2 9.8%, “open” state increased by 25.9%. UPDRS: In the “off” state, the overall improvement rate was 57.3%, including mental behavior mood improvement rate was 50.8%, daily activity improvement rate of 59.1%, exercise function improvement rate of 58.2%. Conclusions PVP is not as effective as Vim in tremor, and Vim can be used in patients with obvious tremor and no obvious stiffness. PVP can be performed in patients with tremor stiff type.