个性化定制3D打印定位导板在幕上自发性脑出血手术中的应用

Application of personalized 3D printing positioning guide plate in spontaneous supratentorial intracerebral hemorrhage surgery

目的探讨个性化定制3D打印定位导板在幕上自发性脑出血微创、精准治疗中的应用价值。方法回顾性分析2022年12月至2023年6月我院行血肿穿刺抽吸引流术治疗的自发性幕上脑出血患者52例,按手术方式分为研究组(n=24)和对照组(n=28),分别行3D打印定位导板辅助血肿穿刺和CT定位血肿穿刺。比较两组首次穿刺成功率、血肿清除率、住院时间、术后颅内感染、肺部感染、再出血、非计划再次手术率等,术后3个月采用改良Rankin评分量表(mRS)进行预后评估。结果研究组24例患者均一次穿刺成功,首次穿刺成功率为100%;对照组一次穿刺成功23例(82.1%),5例患者调整穿刺进针角度和深度后再次穿刺成功。组间比较,研究组首次穿刺成功率、血肿清除率均高于对照组,差异具有统计学意义(P<0.05),而两组住院时间比较无统计学差异(P>0.05)。研究组术后再出血4例(16.7%),行非计划再次手术(开颅血肿清除术)3例(12.5%),保守治疗1例;对照组术后再出血5例(17.9%),行非计划再次手术(开颅血肿清除术)3例(10.7%),保守治疗2例。术后研究组颅内感染2例(8.3%),肺部感染14例(58.3%),对照组颅内感染3例(10.7%),肺部感染16例(57.1%);两组术后再出血、非计划再手术率、颅内感染及肺部感染率比较,差异均无统计学意义(P>0.05)。所有患者均获随访,随访时间3~6个月。术后3个月mRS评分:研究组预后良好17例(70.8%),预后不良7例(29.2%),对照组预后良好24例(85.7%),预后不良4例(14.3%),组间比较差异无统计学意义(P>0.05)。结论对于幕上自发性脑出血,应用个性化定制3D打印导板辅助血肿穿刺能够提高血肿穿刺成功率及血肿清除率,并不增加颅内感染及再出血风险,值得临床推广应用。

Objective To investigate the value of personalized 3D printing positioning guide plate in minimally invasive and precise treatment of spontaneous supratentorial intracerebral hemorrhage.Methods A retrospective analysis was conducted in 52 patients with spontaneous supratentorial intracerebral hemorrhage who underwent hematoma puncture and aspiration surgery from December 2022 to June 2023.According to surgical procedure,all patients were divided into the research group(n=24)and the control group(n=28),and performed hematoma puncture and aspiration assisted by 3D printing positioning guide plate and CT-guided hematoma aspiration,respectively.The first puncture success rate,hematoma clearance rate,hospitalization time,postoperative intracranial infection,pulmonary infection,rebleeding and unplanned reoperation rate were compared between the two groups.Prognosis was evaluated based on the modified Rankin scale(mRS)3 months after surgery.Results The first puncture success rate of the research group was 100%(24/24),while the control group was 82.1%(23/28),and other 5 cases achieved re-puncture success after adjustment of puncture angle and depth.The first puncture success rate and hematoma clearance rate of the research group were higher than those of the control group(P<0.05),but there was no statistical significance in hospitalization time between the two groups(P>0.05).Rebleeding was found in 4 cases(16.7%),and treated by non-planned reoperation(craniotomy hematoma evacuation)in 3 cases(12.5%)and conservative treatment in 1 case in the research group,while rebleeding was found in 5 cases(17.9%),and treated by non-planned reoperation in 3 cases(10.7%)and conservative treatment in 2 cases in the control group.Postoperative intracranial infection was found in 2 cases(8.3%),and pulmonary infection was in 14 cases(58.3%)of the research group,and postoperative intracranial infection was in 3 cases(10.7%),and pulmonary infection was in 16 cases(57.1%)of the control group.There were no significant differences in the incidence of postoperative rebleeding,unplanned reoperation,intracranial infection and pulmonary infection between the two groups(P>0.05).All cases were followed up for 3 to 6 months.According to mRS,the prognosis showed that good was in 17 cases(70.8%)and poor was in 7 cases(29.2%)of the research group,and good was in 24 cases(85.7%)and poor was in 4 cases(14.3%)of the control group,and no statistical difference was found in prognosis between the two groups(P>0.05).Conclusion The application of personalized 3D printing guide plate assisted hematoma puncture can improve the success rate of hematoma puncture and the clearance rate of hematoma for supratentorial spontaneous cerebral hemorrhage,and does not increase the risk of intracranial infection and rebleeding,which is worthy of clinical application.