Mandybur G, King W M, Moore K
Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Missippi 39216, USA.
Stereotact Funct Neurosurg. 1999;72(2-4):233-40. doi: 10.1159/000029731.
Postural instability is arguably the most debilitating symptom of Parkinson's disease (PD). Recently, posterioventral pallidotomy/pallidoansotomy (PVP) has been advocated to improve a multitude of symptoms associated with PD. Dyskinesias, rigidity and bradykinesia are the most talked about improved symptoms, but posture and gait are also affected after PVP. To analyze the effect of PVP on postural control, 14 patients with PD were prospectively studied using a computerized dynamic posturography machine. Seven males and 7 females underwent a total of 18 procedures, 6 left PVP, 6 right PVP, 2 bilateral and 2 had Vim thalamotomies in addition to PVP. Data were collected pre- and postoperatively after a 12-hour drug-free interval ('off' period) and 1-2 h after medications ('on' period). Postoperative analyses were performed between 1 and 3 months postoperatively. As a group, patients' balance, in the off period, improved after surgery in a dynamic setting. Prior to surgery, patients' anterior-posterior sway exceeded their stability limits (patient fell) on 31% of the trials. After surgery, the fall rate decreased to 23%. Anterior-posterior sway decreased significantly (p < 0.05) postoperatively when the platform was sway referenced. In comparing the effect of surgery in decreasing sway with that of medication preoperatively, improvement after surgery (off period) was better than the preoperative on period (p < 0.05). Patients also improved in ostoperative off state when compared to preoperative off state with the platform sway referenced (p < 0.05), controlling for improvement in dyskinesia-induced imbalance. In conclusion, PVP improves standing balance performance better than that achieved with medications preoperatively. Since central input parameters were improved, the mechanism of PVP may be centralized.
姿势不稳可以说是帕金森病（PD）最使人衰弱的症状。最近，有人主张采用后腹侧苍白球切开术/苍白球丘脑切开术（PVP）来改善与PD相关的多种症状。异动症、僵硬和运动迟缓是最常被提及的改善症状，但PVP术后姿势和步态也会受到影响。为了分析PVP对姿势控制的影响，使用计算机化动态姿势描记仪对14例PD患者进行了前瞻性研究。7名男性和7名女性共接受了18次手术，6例左侧PVP，6例右侧PVP，2例双侧手术，2例除PVP外还进行了丘脑腹中间核切开术。在12小时无药间隔期（“关”期）和服药后1 - 2小时（“开”期）术前和术后收集数据。术后分析在术后1至3个月进行。作为一个整体，患者在“关”期的平衡在动态环境下术后得到改善。术前，患者在31%的试验中前后摆动超过其稳定极限（患者跌倒）。术后，跌倒率降至23%。当平台摆动作为参考时，术后前后摆动显著降低（p < 0.05）。在比较手术减少摆动的效果与术前药物治疗的效果时，术后（“关”期）的改善优于术前“开”期（p < 0.05）。在平台摆动作为参考的情况下，与术前“关”状态相比，患者在术后“关”状态下也有改善（p < 0.05），同时控制了异动症引起的失衡改善情况。总之，PVP比术前药物治疗能更好地改善站立平衡表现。由于中枢输入参数得到改善，PVP的机制可能是中枢性的。
