神经导航辅助小骨瓣开颅内镜下治疗高血压性基底节区脑出血的效果

Efficacy of Neuronavigation-Assisted Small Bone Flap Craniotomy in the Treatment of Hypertensive Basal Ganglia Intracerebral Hemorrhage

目的 探讨神经导航辅助小骨瓣开颅内镜术在高血压性基底节区脑出血(HBGH)治疗中的应用价值。方法 选取2020年1月至2021年8月商丘市第一人民医院收治的78例HBGH患者作为研究对象,按照随机数字表法分为两组。常规组(39例)接受显微镜开颅术,导航组(39例)接受神经导航辅助小骨瓣开颅内镜术。观察两组手术指标、神经功能指标、血流动力学、神经缺损程度[美国国立卫生研究院卒中量表(NIHSS)评分]、格拉斯哥昏迷评分(GCS)、日常生活活动能力量表(ADL)评分及并发症情况。结果 导航组血肿清除率高于常规组,手术时间、住院时间短于常规组,术中出血量少于常规组(P<0.05)。术前两组血清巨噬细胞炎性蛋白(MIP-1α)、神经元特异性烯醇化酶(NSE)、S100钙结合蛋白(S100β)水平比较,差异无统计学意义(P>0.05);术后7 d两组血清NSE、MIP-1α、S100β水平降低,导航组水平低于常规组(P<0.05)。术前两组收缩期峰值流速(PSV)、平均流速(Vm)、搏动指数(PI)比较,差异无统计学意义(P>0.05);术后7 d两组PSV、Vm、PI升高,导航组高于常规组(P<0.05)。术前两组NIHSS、GCS、ADL评分比较,差异无统计学意义(P>0.05);术后3个月两组NIHSS、ADL评分降低,GCS评分升高,导航组NIHSS、ADL评分低于常规组,GCS评分高于常规组(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论 神经导航辅助小骨瓣开颅内镜术能优化HBGH患者手术情况,增强血肿清除效果,改善血液循环,降低神经功能损伤程度及昏迷风险,提高日常生活能力,且安全性较高。

Objective To investigate the application value of neuronavigation-assisted small bone flap craniotomy in the treatment of hypertensive basal ganglia hemorrhage(HBGH).Methods A total of 78 HBGH patients admitted to the First People’s Hospital of Shangqiu from January 2020 to August 2021 were selected as the research subjects and divided into two groups using a random number table method.The conventional group(39 cases)underwent microscopic craniotomy,while the navigation group(39 cases)underwent neuronavigation assisted small bone flap craniotomy endoscopy.Surgical indicators,neurological function indicators,hemodynamics,degree of neurological impairment[National Institutes of health stroke scale(NIHSS)],Glasgow coma scale(GCS),activity of daily living scale(ADL)scores,and complications of the two groups of were observed.Results The hematoma clearance rate in the navigation group was higher than that in the conventional group,and the surgical time and hospitalization time were shorter than those in the conventional group.The intraoperative blood output was lower than that in the conventional group(P<0.05).Before surgery,there was no statistically difference in levels of serum macrophage inflammatory protein(MIP-1α),neuron-specific enolase(NSE)and S100 calcium binding protein(S100β)in the two groups(P>0.05).Seven days after surgery,the levels of serum NSE and MIP-1α、S100βdecreased in the two groups and the navigation group’s levels were lower than that of the conventional group(P<0.05).There was no statistically difference in peak systolic velocity(PSV),Vmean(Vm)and pulse index(PI)between the two groups before surgery(P>0.05).Seven days after surgery,the PSV,Vm and PI increased in both groups,and the navigation group was higher than the conventional group(P<0.05).There was no statistically difference in NIHSS,GCS,and ADL scores between the two groups before surgery(P>0.05).Three months after surgery,the NIHSS and ADL scores in both groups decreased,while the GCS score increased.The navigation group had lower NIHSS and ADL scores than the conventional group,while the GCS score was higher than the conventional group(P<0.05).There was no statistically significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion Neuronavigation-assisted craniotomy with small bone flaps can optimize the surgical conditions of patients with HBGH,enhance the effect of hematoma removal,improve blood circulation,reduce the degree of neurological damage and the risk of coma,and improve the ability of daily life with high safety.