磁共振弥散张量成像技术对手术清除基底节区脑出血的应用性研究

The application of magnetic resonance diffusion tensor imaging in the removal of intracerebral hemorrhage in the basal ganglia region

目的通过磁共振弥散张量成像技术（DTI）检测手术与非手术治疗基底节区脑出血患者皮质脊髓束（CST）神经纤维特性的改变，进一步探讨其临床意义。方法试验组81例，采取手术清除血肿；对照组68例，采取非手术治疗。所有患者在起病2周内行DTI检查，观察双侧CST性状并进行分级，评估手术与非手术对血肿侧CST的作用。起病6个月后对存活病例进行日常生活能力量表（ADL）分级判断（其中Ⅰ、Ⅱ及Ⅲ级定为恢复良好），分析CST性状与日常生活能力的关系。结果血肿侧DTI检查显示，其中试验组：1级5例，2级21例，3级38例，4级17例；对照组：1级1例，2级4例，3级27例，4级36例；两组CST性状上差异有统计学意义（P〈0．05）。试验组随访65例，恢复良好率为63．53％；对照组随访54例，恢复良好率为38．89％；两组恢复良好率比较差异有统计学意义（P〈0．05）。在恢复良好的试验与对照组中，DT1分级差异有统计学意义（P〈0．05）。结论手术清除基底节区脑出血对CST神经纤维起到保护作用；术后DT1分级越低，ADL分级也越低，患者的恢复越好，后遗症状越轻。

Objective Through the magnetic resonance diffusion tensor imaging （DTI） to study the alteration in the nerve fibers of the eortieospinal tracts and to explore its clinical significance of the patients with hematomas in basal ganglia region taken after surgical and non - surgical treatment. Methods The experimental group included 81 cases who were taken surgical removal of hematoma. The control group included 68 cases who taken non - surgical treatment. All the cases were checked by DTI in two weeks, and were observed the characters and conducted the level - oriented of bilateral eorticospinal tract, evaluated the corticospinal tract function of the hematoma side by surgery and non surgery treatment. The ability of daily life of survival （ADL） classification was taken to evaluate after 6 months of the onset （the classification of Ⅰ , Ⅱ and Ⅲ were defined for the good recovery）. The relationship between the corticospinal tract characters to the daily life of survival was analyzed. Results The DTI examination of the hematoma side showed that 5 cases were 1 grade and 21 cases were 2 grade and 38 cases were 3 grade and 17 cases were 4 grade in the experimental group, 1 case was 1 grade and 4 cases were 2 grade and 27 cases were 3 grade and 36 cases were 4 grade in thecontrol group. There was statistically significant difference at the two groups of cortieospinal tract character（ P 〈 0.05 ）. 65 cases were followed up in the experimental group and the good recovery rate was 63.53% , 54 cases werefollowed up in the control group, the good recovery rate was 38. 89% （ P 〈 0. 05 ）. There was statistically significant difference at the experimental and control group of the good recovery（ P 〈 0.05 ）. Conclusion Surgical removal of cerebral hemorrhage in basal ganglia can protect the corticospinal tract nerve fibers. The lower postoperative DTI grade, and the lower ADL grade, the recovery of case will be better and the sequelae will be more light.