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神經影像教學：腦室旁結節狀灰質異位伴“Transmantle帶”征

MRI在早期帕金森病診斷中的價值

MRI因其無創性及對大腦解剖結構清晰的成像在神經系統變形疾病中得到廣泛的應用。過去二十年中，功能性磁共振技術在常規MRI的基礎上迅速發展起來。這些新的MRI技術提供大腦物質能量代謝、功能區體積測量和灌注等方面的信息，使得MRI在研究疾病的病理生理、分子學水平得到很大提高。現結合近幾年國內外研究，對MRI在早期帕金森病診斷中的價值作一綜述。

腦深部電刺激對帕金森病認知功能的影響

【摘要】帕金森病（Parkinson’s disease， PD）是中老年人常見的神經系統變性疾病。腦深部電刺激（deep brain stimulation， DBS）可以改善中晚期或藥物難治性PD患者的運動癥狀、生活質量，并且丘腦底核腦深部電刺激（subthalamic nucleus deep brain stimulation， STN DBS）還可減少術后多巴胺能藥物的治療劑量，但DBS術后同時可出現認知功能、行為、情緒和精神等方面的變化。目前DBS對認知功能如語言功能、執行功能、記憶力、注意力、視功能和精神運動速度等方面的影響尚無一致的結論，現就DBS對認知功能各方面的影響進行綜述。

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.