3D打印导板辅助微创穿刺治疗高血压性脑出血的临床研究

A clinical study on minimally invasive puncture for hypertensive cerebral hemorrhage assisted by 3D-printed guide plate

目的应用3D打印导板辅助精准定位微创穿刺治疗高血压性脑出血,手术前达到精准定位、方案设计,提高手术微创穿刺的治疗效果。方法回顾性研究2018年6月-2021年6月临泉县人民医院神经外科收治的71例高血压性脑出血患者的临床资料,按照不同的治疗方法随机分为3D打印导板辅助穿刺组(实验组)和单纯CT定位穿刺组(对照组)。实验组(36例)采用3D打印导板辅助下行血肿微创穿刺术治疗;对照组(35例)根据CT模拟头颅体表定位,穿刺点选择位于血肿最大层面,明确穿刺方向及深度,沿骨孔行血肿徒手穿刺置入带针心的14号引流管,拔除针心,轻微回抽见暗红色血性液体或陈旧性血凝块后接引流装置。对两组患者的血肿穿刺准确率、术后第三天的血肿清除率和拔管时间的比较情况。结果应用3D打印导板实验组的穿刺准确34例,不准确2例,准确率为94.4%。CT引导对照组穿刺准确25例,不准确10例,准确率为71.4%。实验组中术后3天血肿有效清除35例,未有效清除1例,清除率97.2%。对照组中血肿有效清除29例,未有效清除6例,清除率82.9%。实验组术后拔管时间4±1.23天,对照组拔管时间6±1.35天。手术后3D打印导板实验组手术穿刺准确率以及血肿清除率均高于CT定位对照组,拔管时间低于CT定位对照组(P<0.05)。结论通过使用3D打印导板辅助微创穿刺治疗高血压性脑出血,可提高脑内血肿精准穿刺定位,术后研究显示血肿清除率高、拔管时间早,临床治疗效果好,适宜在没有手术机器人系统、导航或立体定向设备的基层医院推广应用。

Objective To use 3 Dprinted guide plates to assist with precise positioning of minimally invasive puncture treatment of hypertensive cerebral hemorrhage,so as to achieve precise positioning and plan design before surgery,and improve the therapeutic effect of surgical minimally invasive puncture.Methods A retrospective study of the clinical data of 71 patients with hypertensive intracerebral hemorrhage admitted to the Department of Neurosurgery of Linquan County People’s Hospital from June 2018 to June 2021 was randomly divided into 3 Dprinted guide plate assisted puncture group according to different treatment methods(experimental Group)and pure CT positioning puncture group(control group).The experimental group(36 cases)was treated with 3 Dprinted guide plate assisted by minimally invasive hematoma puncture;the control group(35 cases)was based on CT simulation of the cranial body surface location,the puncture point was selected at the largest level of the hematoma,and the puncture direction and depth were clearly defined along the bone hole.The hematoma was inserted into a No.14 drainage tube with a needle core by hand.The needle core was removed,and a dark red bloody fluid or old blood clot was slightly withdrawn,and then the drainage device was connected.Comparison of hematoma puncture accuracy,hematoma clearance rate and extubation time on the third day after the operation of the two groups of patients.Results The puncture in the experimental group using the3 Dprinted guide plate was accurate in 34 cases and inaccurate in 2 cases,with an accuracy rate of94.4%.CT guided puncture in the control group was accurate in 25 cases and inaccurate in 10 cases,with an accuracy rate of 71.4%.In the experimental group,35 cases of hematoma were effectively cleared 3 days after operation,and 1 case was not effectively cleared.The clearance rate was97.2%.In the control group,29 cases of hematoma were effectively removed,6 cases were not effectively removed,and the removal rate was 82.9%.The extubation time in the experimental group was 4±1.23 days,and the extubation time in the control group was 6±1.35 days.After the operation,the accuracy of surgical puncture and hematoma clearance in the 3 Dprinted guide plate experimental group were higher than those in the CT positioning control group,and the extubation time was lower than that in the CT positioning control group(P<0.05).Conclusion The use of 3 Dprinted guide plates to assist minimally invasive puncture treatment of hypertensive intracerebral hemorrhage can improve the precise puncture and localization of intracerebral hematomas.Postoperative studies have shown that the hematoma clearance rate is high,the extubation time is early,and the clinical treatment effect is good.It is suitable when there is no surgical robot,the promotion and application of systems,navigation or stereotactic equipment in primary hospitals.