3D打印导板辅助血肿穿刺置管引流治疗中等量基底节区高血压脑出血的临床研究

Treatment of a moderate volume of hypertensive intracerebral hemorrhage in the basal ganglia by 3D printed guide plate-assisted hematoma puncture and catheter drainage

目的探讨3D打印导板辅助血肿置管引流治疗中等量基底节区高血压脑出血的临床效果。方法回顾性分析川北医学院附属大竹医院2016年1月至2021年1月收治的中等量基底节区高血压脑出血微创穿刺治疗患者42例的临床资料,其中传统穿刺组(根据术前头颅CT阅片定位)19例,3D打印穿刺组23例。比较分析两组患者术前准备时间(入院到手术开始时间)、手术时间、血肿穿刺次数、血肿的抽吸比率、术后引流管留置时间、血肿的残留率、发生穿刺道出血及颅内感染情况,并随访患者术后3 d、7 d格拉斯哥昏迷(GCS)评分、1、3、6个月格拉斯哥预后(GOS)评分。结果两组患者术前准备时间和手术时间差异均无统计学意义(t=0.25、0.40,均P>0.05);3D打印导板辅助血肿穿刺可减少术中再次血肿穿刺置管概率,但其差异无统计学意义(χ^(2)=0.48,P>0.05)。两组患者术后发生穿刺道出血及颅内感染概率差异均无统计学意义(χ^(2)=0.05、0.03,均P>0.05)。3D打印导板缩短了术后血肿引流时间[(3.10±0.38)d比(3.46±0.52)d]及降低血肿的残留率[(32.04±5.33)%比(37.37±5.51)%](t=2.65、χ^(2)=3.20,均P<0.05)。两组患者术后第3、7天GCS评分[(12.04±1.19)分比(11.26±0.93)分、(13.65±0.88)分比(12.94±0.97)分]差异均有统计学意义(t=2.33、2.46,均P<0.05)。3D打印穿刺组患者术后1、3、6个月GOS评分(18分、21分、22分)均明显优于传统穿刺组(9分、11分、12分)(χ^(2)=4.34、4.69、5.17,均P<0.05)。结论3D打印导板辅助血肿穿刺置管引流治疗中等量基底节区高血压脑出血可提高穿刺的精准率、降低血肿的残留率,改善患者的短期及远期预后,不会延长术前准备时间,同时具有经济、安全、学习曲线短等特点。

Objective To investigate the clinical efficacy of 3D printed guide plate-assisted hematoma puncture and catheter drainage in the treatment of a moderate volume of hypertensive intracerebral hemorrhage in the basal ganglia.Methods The clinical data of 42 patients with a moderate volume of hypertensive intracerebral hemorrhage in the basal ganglia who received treatment with 3D printed guide plate-assisted hematoma puncture and catheter drainage in Dazhu Hospital of North Sichuan Medical College from January 2016 to January 2021 were retrospectively analyzed.In the traditional puncture group,there were 19 patients who received traditional punctures according to preoperative cranial CT findings(traditional puncture group).In the 3D printed guide plate puncture group,there were 23 patients who received hematoma puncture and catheter drainage assisted by a 3D printed guide plate.Preoperative preparation time(from admission to operation),operative time,the number of hematoma punctures,hematoma clearance rate,postoperative indwelling time of drainage tube,residual hematoma rate,the occurrence of puncture canal bleeding,intracranial infection,Glasgow Coma Scale score measured at 3 and 7 days after surgery,and Glasgow Outcome Scale score measured at 1,3 and 6 months after surgery were compared between the two groups.Results There were no significant differences in preoperative preparation time and operative time between the two groups(t=0.25,0.40,both P>0.05).3D-printed guide plate-assisted hematoma puncture reduced the probability of reveiving one more hematoma puncture during the surgery.There was no significant difference in the number of hematoma puncture between the two groups(χ^(2)=0.48,P>0.05).There were no significant differences in the probabilities of puncture canal bleeding and intracranial infection between the two groups(χ^(2)=0.05,0.03,both P>0.05).Postoperative indwelling time of the drainage tube in the 3D printed guide plate puncture group was significantly shorter than that in the traditional puncture group[(3.10±0.38)vs.(3.46±0.52)days,t=2.65,P<0.05].The residual hematoma rate in the 3D printed guide plate puncture group was significantly lower than that in the traditional puncture group[(32.04±5.33)%vs.(37.37±5.51)%,χ^(2)=3.20,P<0.05].There were significant differences in Glasgow Coma Scale score measured at 3 and 7 days after surgery between the two groups[(12.04±1.19)points vs.(11.26±0.93)points,(13.65±0.88)points vs.(12.94±0.97)points,t=2.33,2.46,both P<0.05].Glasgow Outcome Scale score measured at 1,3,and 6 months after surgery in the 3D printed guide plate puncture group was 18,21,and 22 points,respectively,which was significantly higher than 9,11,and 12 points in the traditional puncture group(χ^(2)=4.34,4.69,5.17,all P<0.05).Conclusion 3D printed guide plate assisted hematoma puncture and catheter drainage for treatment of a moderate volume of hypertensive intracerebral hemorrhage in the basal ganglia can increase the accuracy of puncture,decrease hematoma residual rate,improve short-and long-term prognosis,does not prolong preoperative preparation time.Moreover,it costs low,is safe,and is easy to learn.