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神经影像教学：脑室旁结节状灰质异位伴“Transmantle带”征

脑深部电刺激对帕金森病认知功能的影响

【摘要】帕金森病（Parkinson’s disease， PD）是中老年人常见的神经系统变性疾病。脑深部电刺激（deep brain stimulation， DBS）可以改善中晚期或药物难治性PD患者的运动症状、生活质量，并且丘脑底核脑深部电刺激（subthalamic nucleus deep brain stimulation， STN DBS）还可减少术后多巴胺能药物的治疗剂量，但DBS术后同时可出现认知功能、行为、情绪和精神等方面的变化。目前DBS对认知功能如语言功能、执行功能、记忆力、注意力、视功能和精神运动速度等方面的影响尚无一致的结论，现就DBS对认知功能各方面的影响进行综述。

MRI在早期帕金森病诊断中的价值

MRI因其无创性及对大脑解剖结构清晰的成像在神经系统变形疾病中得到广泛的应用。过去二十年中，功能性磁共振技术在常规MRI的基础上迅速发展起来。这些新的MRI技术提供大脑物质能量代谢、功能区体积测量和灌注等方面的信息，使得MRI在研究疾病的病理生理、分子学水平得到很大提高。现结合近几年国内外研究，对MRI在早期帕金森病诊断中的价值作一综述。

Treatment of irreducible intertrochanteric femoral fractures in elderly by novel bone hook combined with finger-guided technique

Objective To investigate the feasibility and effectiveness of the novel bone hook combined with finger-guided technique in the treatment of irreducible intertrochanteric femoral fractures in elderly. Methods Between January 2021 and August 2023, 23 elderly patients with irreducible intertrochanteric femoral fractures were treated with the novel bone hook combined with finger-guided technique. There were 10 males and 13 females; the age ranged from 68 to 93 years (mean, 76.2 years). The time from injury to operation ranged from 36 to 76 hours (mean, 51.2 hours). According to the classification standard proposed by TONG Dake et al in 2021, there were 10 cases of typeⅠA, 1 case of typeⅠB, 6 cases of type ⅡA, 4 cases of type ⅡB, and 2 cases of type ⅡC. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequences, and quality of fracture reduction were recorded. The fracture healing time and occurrence of postoperative complications were observed during follow-up. At last follow-up, the Harris scoring system was used to evaluate the hip joint function. Results The operation time was 42-95 minutes (mean, 52.1 minutes). The intraoperative blood loss was 40-420 mL (mean, 126.5 mL). Intraoperative fluoroscopy was performed 14-34 times (mean, 20.7 times). According to the criteria proposed by Chang et al, the quality of fracture reduction was rated as good in 20 cases and acceptable in 3 cases. All patients were followed up 6-20 months (mean, 10.2 months). X-ray film showed that all fractures healed with the healing time of 3.0-5.5 months (mean, 4.0 months). At last follow-up, the Harris score of the hip joint ranged from 82 to 97 points (mean, 90.4 points). Among them, 14 cases were rated as excellent and 9 cases as good. No complication such as coxa vara, cutting of the cephalomedullary nail, nail withdrawal, or nail breakage occurred during follow-up. Conclusion The treatment of elderly patients with irreducible intertrochanteric femoral fractures by using the novel bone hook combined with finger-guided technique can achieve high-quality fracture reduction and fixation, and has a good effectiveness.