微创清除颅内血肿对皮质脊髓束的影响

The Influence of Minimally Invasive Removal of Intracranial Hematoma on Corticospinal Tract

目的:观察微创清除颅内血肿对皮质脊髓束的影响。方法:基底节区脑出血患者14例,随机分为微创治疗组和药物治疗组,微创治疗组在入院当天行颅内血肿清除,两组患者均在发病1周时行全脑弥散张量(DTI)成像检查并测量患者内囊和大脑脚病灶侧及其对侧的FA值。结果:微创治疗组患者患侧内囊和大脑脚皮质脊髓束FA值分别为0.516±0.040和0.523±0.029,药物治疗组分别为0.433±0.061和0.487±0.049,两组比较有显著性差异(P<0.05〉,提示微创清除颅内血肿减轻皮质脊髓束的损害;微创清除颅内血肿后受血肿压迫移位的皮质脊髓束基本恢复到正常位置。结论:微创清除颅内血肿能有效减轻皮质脊髓束的损伤,使受血肿压迫移位的皮质脊髓束及时复位,减轻患者运动功能的损害。

Objective： To observe the influence of minimally invasive removal （MIR）of intraeranial hematoma （ICH） on cortical spinal tract （CST） Methods： Fourteen patients with ICH in basal ganglia of which the hematoma volume ranged 30 - 50 ml, with an average of 38.30 ± 4.78ml, were selected and divided into minimally invasive treatment group （group M ） and drug treatment group （group D） randomly, with 7 patients in each. MIR was carried out on patients of group M on the day of admission. All the patients underwent whole brain diffusion tensor imagine （DTI） in one week after onset. At the same time, FA values of lesion and eontralateral side of internal capsule and cerebral peduncle in group M were determined and compared with those in group D. Results： The CST FA values in internal capsule and cerebral peduncle on the focal side of group M （0. 516 ± 0. 040 and 0. 537 ± 0. 055） were significantly higher than those of group D （0. 433 ± 0. 061, 0. 480 ± 0. 040） respectively （P 〈 0.05）, which meant that minimally invasive surgery could reduce the damage of CST. At the same time, the displaced CST returned to normal position partly or completely after MIR of intracranial hematoma. Conclusions： The CST changes of ICH patients could be observed clearly with DTI technique. MIR of intracranial hematoma could effectively reduce the injury of CST and restore CST to its normal position.