DTT早期评价经侧裂-岛叶入路显微手术对高血压脑出血患者术后运动功能恢复的影响

Early evaluation of motor function by diffusion tensor imaging in patients with hypertensive intracerebral hemorrhage after microsurgery of split—insular approach

目的采用弥散张量纤维束成像技术(DTT)早期评价经侧裂-岛叶入路显微手术对高血压脑出血(HICH)患者术后运动功能恢复的影响。方法选择经侧裂-岛叶入路显微手术的HICH患者46例,术前均行DTT检查计算基底核区皮质脊髓束(CST)条目数,术后1d均行CT检查,术后2周再行DTT检查计算基底核区CST条目数,6个月后根据Fugl-Meyer(FM)评分评判患者运动功能的恢复情况。结果 46例患者均未发现严重并发症;术后2周基底核区相对剩余CST条目数(73.98±12.71)与术前(72.07±13.35)相比未见统计学差异(t=0.570,P=0.572);术后6个月患者FM评分平均为(84.22±12.81)分;所有患者术后2周的患侧相对剩余CST条目数(73.98±12.71)与6个月后FM评分之间呈正相关(r=0.845,P<0.01)。结论 采用经侧裂-岛叶入路显微手术治疗HICH患者,术中能保留更多的相对CST条目数,这可能是该法治疗的患者术后6个月运动功能恢复更佳的原因之一。DTT用于HICH患者能在术后早期对其肢体运动功能恢复情况作出预后评估,有助于合理制定术后康复方案。

Objective To evaluate the postoperative motor outcome by using diffusion tensor imaging （DTT） technique in patients with hypertensive intracerebral hemorrhage （HICH） undergoing microsurgery of split- insular approach. Methods Forty six HICH patients underwent microsurgical surgery by split- insular approach. DTT examinations were performed before opera-tion, 1 day, 2 weeks and 6 months after operation. Fugl- Meyer （FM） score was used to evaluate the postoperative motor func-tion. Results No serious complications were found in al 46 patients. There was no significant difference in the numbers of cor-ticospinal tract （CST） after 2 weeks before and after operation （73.98±12.71 vs. 72.07±13.35, t=0.570, P=0.572）. The mean FM score of patients was 84.22±12.81, 6 months after operation. The numbers of CST 2 weeks after operation were closely corre-lated with FM score 6 months after operation （r=0.845, P〈0.01）. Conclusion The split- insular approach for microsurgical surgery can preserve more CST numbers for HICH patients. DTT technique can make early evaluation of postoperative motor function for HICH patients undergoing microsurgery.