功能神经导航DTI技术在基底节区脑出血显微血肿清除术后肢体运动功能恢复的临床评价

Clinical evaluation of functional neuronavigation DTI technique in recovery of limb motor function after microhematoma removal in basal ganglia hemorrhage

目的评价功能神经导航及弥散张量纤维束成像(DTI)技术在基底节区脑出血显微血肿清除术后肢体运动功能恢复的临床作用。方法 41例基底节区脑出血(ICH)患者随机分为显微手术组(21例)和药物治疗组(20例),手术组发病后1~3d内均行显微镜下脑内血肿清除术,术后1d复查头颅CT,药物治疗组接受标准药物治疗如镇静、止血、脱水等治疗。所有患者在发病后2周应用功能神经导航技术均行全脑扩散张量成像(DTI);分别确定显微手术组血肿侧和对侧CST在内囊、大脑脚分数各向异性(FA)值,然后与药物治疗组比较。结果术后第二天常规复查头颅CT,血肿清除率在80%以上,显微手术组显示患侧CST在内囊、大脑脚FA值分别为(0.526±0.046)和(0.532±0.044),药物治疗组,FA值分别为(0.443±0.069)和(0.456±0.059)。血肿清除2周后手术组内囊及大脑脚的FA值显著增加,与药物治疗组比较差异有统计学意义(P<0.05)。这些结果表明,显微手术在基底节区血肿清除后增加FA值,并减少对内囊及CST损伤破坏。被压迫移位的CST大部分复位。结论通过功能神经导航DTI技术可以观察到脑出血患者CST的形态的变化及FA值的变化,颅内血肿微创清除术能有效减少CST的损伤,可以使被压迫和移位的CST恢复到正常位置,功能神经导航DTI技术可以作为评价基底节区脑出血患者显微血肿清除术后肢体运动功能恢复的一种方法。

Objective To evaluate the clinical effect of functional neuronavigation and diffusion tensor imaging in the recovery of limb motor function after removal of hematoma in basal ganglia area. Methods Forty-one 41 patients with basal ganglia intracerebral hemorrhage（ICH） were randomly divided into microsurgical group（n=21） and drug treatment group（n=20）.Intracerebral hematoma clearance under microscope was performed in the operation group within 1 to 3 days after the onset of the disease,and the head CTs were re-examined 1 day after operation.The drug treatment group was received standard drug therapy such as sedation,hemostasis,dehydration and so on.All patients were treated with global brain diffusion imaging（TDI） and DTI with functional neuronavigation at 2 weeks after onset.The fractional anisotropy（FA）in the internal capsule and the cerebral peduncle of the hematoma side and contralateral CST in the microsurgery group were determined,and then compared with the drug treatment group. Results The head CT was reexamined second days after operation,and the clearance rate of hematoma was above 80%.The FA values of the ipsilateral CST in the internal capsule and the cerebral peduncle were （0.526±0.046） and （0.532±0.044） respectively in the microsurgery group,and the FA values were （0.443±0.069） and （0.456±0.059） in the drug treatment group respectively.After 2 weeks of hematoma clearance,the FA value of the internal capsule and the cerebral foot was increased significantly in the operation group,and the difference was statistically significant compared with that in the drug treatment group（P 〈0.05）.After removal of hematoma in basal ganglia,microsurgery FA value was increased and damages to internal capsule and CST were reduced.Most of CST were reduced by compression and displacement. Conclusion The changes of CST morphology and FA value in patients with intracerebral hemorrhage can be observed by functional neuronavigation DTI technique.Minimally invasive clearance of intracranial hematoma can effectively reduce the damage of CST.Functional neuronavigation DTI technique can be used to evaluate the recovery of limb motor function after microhematoma removal in patients with basal ganglia intracerebral hemorrhage.