应用DTI评估钻孔引流和小骨窗两种术式治疗中等量基底节区脑出血的预后情况

Application of DTI to evaluate the prognosis of moderate basal ganglia hemorrhage treatment by borehole drainage and small bone window

目的通过弥散张量成像技术（diffusion tensor imaging，DTI）评估钻孔引流和小骨窗两种术式治疗中等量基底节区脑出血的临床效果。方法回顾性分析我科自2013年6月-2015年9月，共收治中等量（30～60m1）基底节区脑出血58例，其中28例采用钻孔引流手术（A组），30例采用小骨窗显微手术组（B组），所有患者均在术前及术后2周进行DTI扫描，获取双侧皮质脊髓束（corticospinal tract，CST）的各项异性分数（fractional anisotropy，FA），分别观察对比两者术后第1天血肿清除率、手术时间、术中出血量、再出血、颅内感染、术后2周患侧FA值、术后3个月GOS评分。结果在血肿清除率方面，B组优于A组（P〈0．05），在再出血及颅内感染方面，二者并无明显区别（P〉0．05），而在手术时间，术中出血量，术后2周患侧FA值，术后3个月GOS评分，A组均优于B组（P〈0．05）。结论DTI是可以早期评估基底节区脑出血预后的一项有效技术，钻孔引流治疗中等量基底节区出血血肿创伤更小，手术时间短，术后恢复快，疗效确切。

Objective To investigate the clinical effect of borehole drainage versus small bone window in the treatment of moderate basal ganglia hemorrhage evaluated by diffusion tensor imaging （DTI）. Methods A retrospective analysis was performed for the clinical data of 58 patients with moderate （30 -60 ml） basal ganglia hemorrhage. Among these patients, 28 were treated with borehole drainage （group A） and 30 were treated with small bone window mierosurgery （group B）. All the patients underwent DTI before surgery and at 2 weeks after surgery to obtain the fractional anisotropy （FA） score of bilateral corticospinal tracts （CSTs）. The hematoma clearance rate, time of operation, intraoperative blood loss, rebleeding, intracranial infection, FA score of diseased side at 2 weeks after surgery, and Glasgow Outcome Scale （GOS） score at 3 months after surgery were observed. Results Group B had a significantly better hematoma clearance rate than group A （ P 〈 0.05 ） , and there were no significant differences in rebleeding or intracranial infection between the two groups （P 〉 0.05）. Compared with group B, group A had significantly better results in the time of operation, intraoperative blood loss, FA score of diseased side at 2 weeks after surgery, and GOS score at 3 months after surgery （ P 〈 0.05 ）. Conclusions DTI is an effective technique in early prognostic evaluation of basal ganglia hemorrhage. In the treatment of moderate basal ganglia hemorrhage, borehole drainage has small trauma, a shorter time of operation, rapid postoperative recovery, and a definite therapeutic effect.