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目的 探讨选择性丘脑腹中间核 (Vim)毁损术的手术方法及对震颤型帕金森病的疗效。方法 对 33例震颤型帕金森病应用CT行Vim解剖定位 ,以微电极作神经电生理校对后 ,进行小灶性毁损。手术前后进行UPDRS分项计分、手指拍击实验和行走试验并计算改善率。结果 33例震颤型帕金森病患者术中完全控制震颤。UPDRS计分、手指拍击实验和行走试验的改善率分别为 0 69± 0 2 2、0 31± 0 2 6及0 1 1± 0 1 7。两周后复发 1例。轻度构音障碍 1例。结论 选择性丘脑Vim毁损术对震颤型帕金森病有显著疗效。严格掌握手术适应征 ,合理应用微电极技术 ,适当的毁损体积是手术成功的保障。
Objective To investigate the surgical methods of selective thalamic Vim denervation and its effect on tremor-like Parkinson’s disease. Methods 33 cases of tremor-like Parkinson’s disease were treated with CT Vim anatomical localization. After the microelectrode was electrophysiologically calibrated, small focal lesion was performed. UPDRS sub-score, finger flapping and walking tests were performed before and after surgery and the rate of improvement was calculated. Results Thirty-three patients with tremor-type Parkinson’s disease underwent complete control of tremor during surgery. The improvement rates of UPDRS score, finger tapping test and walking test were 0 69 ± 0 2 2,01 1 ± 0 2 6 and 0 1 1 ± 0 1 7, respectively. One case relapsed two weeks later. A case of mild dysarthria. Conclusions Selective selective thalamic Vim ablation has a significant effect on tremor-like Parkinson’s disease. Strict control of surgical indications, the rational use of microelectrode technology, the appropriate volume of damage is the guarantee of successful operation.