雙側深部腦刺激手術對巴金森患者步態之影響

Abstract

巴金森氏病是常見的神經退化性疾病，動作遲緩、肌肉僵直、靜止性震顫、姿勢不穩等為常見之動作症狀，也常發生走路困難的問題，雖然藥物可以改善巴金森症狀，但長期服用藥物會出現藥效減退的現象，而深部腦刺激手術則是常用來解決此問題的手段，不少文獻指出手術對步態的改善，然而所用評估多數為Hoehn and Yahr量表和統一巴金森氏症評定量表，無法精準量化改善程度，此外疾病對兩側影響程度不一，少有文獻分別探討主要患側肢段為與輕微患側肢段，更無文獻透過立體攝影的定量分析研究兩側的步態異同。因此，本篇研究的目的是分別探討深部腦刺激對晚期巴金森個案的主要患側肢段與輕微患側肢段術前術後之步態影響。 研究結果發現深部腦刺激對步態時空參數而言，僅輕微患側肢段之步寬下降趨勢有達顯著差異，然術前術後步態分期比例變化則無達統計上明顯差異。另外，研究果顯示深部腦刺激對於兩側有不同的影響，深部腦刺激對主要患側肢段角度變化或力矩之影響多發生於髖關節與踝關節，而對輕微患側肢段角度變化之影響多發生於膝關節，於擺盪期開始時改變最多，對於力矩變化之影響則發生於髖關節與踝關節，於單側支撐其開始時改變最多。因此，兩側皆出現巴金森氏病症狀者，其兩側受影響程度不同，會導致深部腦刺激對其治療成效不同或是出現不同的代償策略，建議未來巴金森氏病研究可區分主要患側邊肢段與輕微患側邊肢段作討論。

Pariknson’s diease is one of common neurodegenerative disorder, and the most obvious symptoms are bradykinesia, rigidity, resting tremor, posture/gait imbalance. Although medication can improve Parkinson's symptoms, but long-term efficacy of medication will appear the phenomenon of wearing-off. Subthalamic deep brain stimulation (DBS surgery) was proved to an effective treatment to overcome difficulties in the medical management of motor complications in advanced Parkinson’s disease. Although there are literatures about Parkinson's disease or surgery on gait in Parkinson's disease, there is very limited study on investigation of the changes of gait characteristics during level walking between major affected and minor affected side by using quantitative analysis of the stereophotogrammetry in the literature. Therefore, the study aimed to compare the changes of gait characteristics in advanced PD patients on minor affected side and major affected side at pre- and post- DBS surgery, respectively. Now this research find that step width is decreasing in minor side (P<0.05), however statistics has not yet reached significant in other gait parameter, such as gait velocity, gait step, gait stride and cadence. DBS surgery has more effects on hip joint and ankle joint in the major side, and it has more effects on knee joint in the minor side. The research results suspect that DBS surgery puts different influence on the major side and the minor side, so it is need to distinguish the major side and minor side to discuss in the future.