方体定向置管联合核磁共振弥散张量成像微创血肿清除术治疗内囊血肿的临床研究

Treatment of Lateral Internal Capsule Hemorrhage by Cubic Oriented Stereotactic Tube Indwelling in Combination with Diffusion Tensor Imaging

目的:观察方体定向置管联合核磁共振弥散张量成像(DTI)微创血肿清除术对内囊外侧血肿治疗的临床疗效。方法:高血压脑出血患者90例随机分为内科保守组(内科保守治疗)、单纯微创组(在内科保守治疗基础上给予方体定向置管微创血肿清除术)、联合微创组(在内科保守治疗基础上给予方体定向置管联合DTI精确定位穿刺微创血肿清除术),各30例。比较术后5 d各组血肿大小。入院时及术后第5天进行DTI检查,比较各组出血侧内囊锥体束的微小各向异性(FA)值。比较各组入院时、术后第5天和第56天的改良美国国立卫生院脑卒中量表(m NIHSS)评分,比较术后第56天的改良Barthel指数(mBI)评分。结果:治疗前,3组的血肿大小、PT的FA值、神经功能缺损和日常生活能力差异无统计学意义(P>0.05);治疗后,单纯微创组和联合微创组的血肿体积较保守治疗组显著减小、PT的FA值显著增高、神经功能缺损程度显著改善、日常生活能力显著提高(均P<0.05),且联合微创组优于单纯微创组(均P<0.05)。结论:方体定向置管联合DTI微创血肿清除术是治疗高血压脑出血的有效方法。

Objective:To study the clinical effectiveness of cubic oriented stereotactic tube indwelling in combination with diffusion tensor imaging(DTI)as a minimally invasive surgical treatment for lateral internal capsule hemorrhage.Methods:A total of 90 patients with lateral internal capsule hemorrhage were collected and randomly divided into three groups with 30 patients per group according to treatment received.Group A was treated with standard drug therapy,Group B with minimally invasive surgery of cubic oriented stereotactic tube indwelling and standard drug therapy,and Group C with minimally invasive surgery of cubic oriented stereotactic tube indwelling plus DTI for accurately locating puncture site in addition to standard drug therapy.Hematoma size in all groups was compared 5 days after treatment.DTI was performed before treatment and 5 days after treatment in all groups,and the lateral internal capsule hemorrhage in the pyramidal tract was evaluated by fractional anisotropy(FA).The modified National Institute of Health Stroke Scale(mNIHSS)score of each group before treatment and 5 and 56 days after treatment was compared,and the modified Barthel Index(mBI)of each group 56 days after treatment group was compared.Results:There was no significant difference in the hematoma size,FA of the pyramidal tract,neurological impairments,and self-care ability among the three groups before treatment.After treatment,there was a significant increase in FA,recovery of functional impairment,and self-care ability in group B and group C compared to those in group A,and furthermore,there was a greater increase in group C compared to group B(all P<0.05).Conclusion:Minimally invasive surgery of cubic oriented stereotactic tube indwelling in combination with DTI is an effective method of treating hypertensive intracerebral hemorrhage.