立体定向与神经导航技术在少量大脑半球出血患者中的应用

Application of stereotactic and neuronavigation techniques in a small number of patients with cerebral hemisphere hemorrhage

目的对于少量自发性脑出血伴明显功能障碍的患者是采取保守治疗还是手术,通常有争议性,探讨通过立体定向技术清除血肿对患者预后的改善作用。方法选取近5 a大脑半球出血患者150例(出血量20~30 mL),其中50例采用立体定向技术给予血肿清除术,50例采用导航技术给予血肿清除术,分别为手术组1、手术组2,另50例为药物保守治疗组,对比3组患者的改良Barthel指数评分及mRS评分。结果入组患者单侧肢体肌力<3级,出血量≤30 mL,出血部位为基底节区或丘脑。通过6个月随访,手术组改良Barthel指数评分、mRS评分显著优于保守治疗组。手术组相对保守组有更好的功能改善,差异有统计学意义(P<0.05)。结论对于少量自发性脑出血伴明显功能障碍的患者,通过立体定向手术、神经导航技术能显著改善患者的日常生活功能,其中立体定向技术并发症及血肿清除率优于神经导航技术。

Objective It is controversial whether conservative treatment or surgery should be used in patients with a small amount of spontaneous intracerebral hemorrhage with significant dysfunction.Methods 150 patients with cerebral hemisphere hemorrhage(bleeding volume of 20 to 30 mL)were selected in recent 5 years.Among them,50 patients were treated with hematoma removal by stereotactic technique and 50 patients were treated by navigation technique.The other 50 patients were in the drug conservative treatment group.The modified Barthel index score and mRS score of the three groups were compared.Results All patients in the study had unilateral limb muscle strength less than grade 3,blood loss less than or equal to 30 mL,and the bleeding site was basal ganglia or thalamus.After 6 months follow-up,the improved Barthel index and mRS score in the surgical group were significantly better than those in the drug group.The surgery group functional improvement is significantly better than those in the drug group.Conclusion Stereotactic surgery and neural navigation technology can significantly improve the daily life function of patients with a small amount of spontaneous intracerebral hemorrhage.The complication of stereotactic technique and hematoma clearance rate were better than that of neural navigation technique.