Diffusion tensor tractography （DTT） in diffusion tensor imaging （DTI） examination allows for the three-dimensional visualization of cerebellar peduncles. The present case-control study analyzed the relationship be...Diffusion tensor tractography （DTT） in diffusion tensor imaging （DTI） examination allows for the three-dimensional visualization of cerebellar peduncles. The present case-control study analyzed the relationship between functional recovery of intracerebral hematoma patient and cerebellar peduncle injury, as detected by DTI. The enrolled patient could not sit at 3 weeks after onset, but was able to walk independently and perform most daily activities after 4 months. The 3-week DTT images revealed that all six cerebellar peduncles were compressed by the hematoma, posterior portions of all three left cerebellar peduncles were shortened, and the left middle cerebellar peduncle was interrupted in the mid-portion. The 4-week DTT images showed that all compressed cerebellar peduncles were ameliorated, although injured posterior portions of the three left cerebellar peduncles did not recover. The fractional anisotropy value of the right inferior cerebellar peduncle increased from two standard deviations below the normal control value to within two standard deviations of the normal control value. These findings suggested that functional recovery was primarily due to decompression of compressed cerebellar peduncles, and not to recovery of injured cerebellar peduncles. DTI evaluations of cerebellar peduncles could be helpful when cerebellar peduncle injury is suspected.展开更多
目的观察小脑出血不同手术治疗方案的临床疗效。方法本研究为回顾性病例对照研究,收集2018年1月至2022年1月住院手术治疗的小脑出血患者60例,采用枕下骨瓣开颅清除血肿的20例患者设为开颅组;采用锁孔小骨窗入路清除血肿的20例患者设为...目的观察小脑出血不同手术治疗方案的临床疗效。方法本研究为回顾性病例对照研究,收集2018年1月至2022年1月住院手术治疗的小脑出血患者60例,采用枕下骨瓣开颅清除血肿的20例患者设为开颅组;采用锁孔小骨窗入路清除血肿的20例患者设为锁孔组,采用软通道穿刺置管引流术清除血肿的20例患者设为穿刺组;观察3组患者手术时间、术中出血量、术后术区残余血肿量、术后术区再出血例数、术后并发症发生例数、住院天数、重症监护病房时间、术前术后7 d格拉斯哥昏迷评分(GCS)、美国国立卫生院卒中量表评分(NIHSS);术后6个月格拉斯哥预后评分(GOS)。结果3组患者术后7 d GCS、NIHSS评分较术前明显改善(P<0.05);开颅组和锁孔组明显优于穿刺组(P<0.05);锁孔组明显优于开颅组(P<0.05);3组患者术后6个月GOS评分差异无统计学意义(P>0.05)。穿刺组手术时间、术中出血量明显小于开颅组和锁孔组(P<0.05),锁孔组手术时间、术中出血量明显小于开颅组(P<0.05)。穿刺组术后术区残余血肿量、术后术区再出血例数明显多于开颅组和锁孔组(P<0.05)。锁孔组术后并发症发生例数明显小于穿刺组和开颅组(P<0.05)。锁孔组住院天数、症监护病房时间明显小于穿刺组和开颅组(P<0.05),开颅组住院天数、症监护病房时间小于穿刺组(P<0.05)。结论临床上要根据小脑出血患者的具体情况选择手术方式,条件允许的情况下优先选择锁孔小骨窗入路显微镜或内镜下清除血肿,近期疗效、住院天数和重症病房时间均优于骨瓣开颅和穿刺置管引流清除血肿。展开更多
目的探讨两点三线交叉定位法在微创穿刺小脑血肿清除术中的应用。方法回顾性分析35例高血压性小脑血肿病人的临床资料,均在术前应用两点三线交叉定位法定位血肿,并行微创穿刺血肿清除术,分析定位的准确率、治疗效果、并发症等。结果 35...目的探讨两点三线交叉定位法在微创穿刺小脑血肿清除术中的应用。方法回顾性分析35例高血压性小脑血肿病人的临床资料,均在术前应用两点三线交叉定位法定位血肿,并行微创穿刺血肿清除术,分析定位的准确率、治疗效果、并发症等。结果 35例穿刺针均一次性到达血肿腔中心,穿刺准确率达100%。术后6 h复查CT:与术前设置的穿刺靶点和进针方向偏差≤0.5 cm 22例(62.9%),偏差>0.5～1 cm 13例(37.1%)。术后NHISS评分明显降低,而Barthel指数较术前明显升高,差异均有统计学意义(P<0.05)。术后并发症包括肺部感染3例,消化道出血2例,泌尿系统感染2例,心力衰竭1例。治愈26例(74.3%),好转6例(17.1%),差2例(5.7%),死亡1例(2.9%);总有效率达91.4%。结论应用两点三线交叉定位法对微创穿刺小脑血肿清除进行术前定位,血肿穿刺定位准确率高、创伤小、操作简单、清除血肿快、并发症少,可提高临床疗效和改善病人预后,具有较高的临床应用价值,值得推广应用。展开更多
基金the National Research Foundation of Korea Grant Funded by the Korean Government, No. KRF-2008-314-E00173
文摘Diffusion tensor tractography （DTT） in diffusion tensor imaging （DTI） examination allows for the three-dimensional visualization of cerebellar peduncles. The present case-control study analyzed the relationship between functional recovery of intracerebral hematoma patient and cerebellar peduncle injury, as detected by DTI. The enrolled patient could not sit at 3 weeks after onset, but was able to walk independently and perform most daily activities after 4 months. The 3-week DTT images revealed that all six cerebellar peduncles were compressed by the hematoma, posterior portions of all three left cerebellar peduncles were shortened, and the left middle cerebellar peduncle was interrupted in the mid-portion. The 4-week DTT images showed that all compressed cerebellar peduncles were ameliorated, although injured posterior portions of the three left cerebellar peduncles did not recover. The fractional anisotropy value of the right inferior cerebellar peduncle increased from two standard deviations below the normal control value to within two standard deviations of the normal control value. These findings suggested that functional recovery was primarily due to decompression of compressed cerebellar peduncles, and not to recovery of injured cerebellar peduncles. DTI evaluations of cerebellar peduncles could be helpful when cerebellar peduncle injury is suspected.
文摘目的观察小脑出血不同手术治疗方案的临床疗效。方法本研究为回顾性病例对照研究,收集2018年1月至2022年1月住院手术治疗的小脑出血患者60例,采用枕下骨瓣开颅清除血肿的20例患者设为开颅组;采用锁孔小骨窗入路清除血肿的20例患者设为锁孔组,采用软通道穿刺置管引流术清除血肿的20例患者设为穿刺组;观察3组患者手术时间、术中出血量、术后术区残余血肿量、术后术区再出血例数、术后并发症发生例数、住院天数、重症监护病房时间、术前术后7 d格拉斯哥昏迷评分(GCS)、美国国立卫生院卒中量表评分(NIHSS);术后6个月格拉斯哥预后评分(GOS)。结果3组患者术后7 d GCS、NIHSS评分较术前明显改善(P<0.05);开颅组和锁孔组明显优于穿刺组(P<0.05);锁孔组明显优于开颅组(P<0.05);3组患者术后6个月GOS评分差异无统计学意义(P>0.05)。穿刺组手术时间、术中出血量明显小于开颅组和锁孔组(P<0.05),锁孔组手术时间、术中出血量明显小于开颅组(P<0.05)。穿刺组术后术区残余血肿量、术后术区再出血例数明显多于开颅组和锁孔组(P<0.05)。锁孔组术后并发症发生例数明显小于穿刺组和开颅组(P<0.05)。锁孔组住院天数、症监护病房时间明显小于穿刺组和开颅组(P<0.05),开颅组住院天数、症监护病房时间小于穿刺组(P<0.05)。结论临床上要根据小脑出血患者的具体情况选择手术方式,条件允许的情况下优先选择锁孔小骨窗入路显微镜或内镜下清除血肿,近期疗效、住院天数和重症病房时间均优于骨瓣开颅和穿刺置管引流清除血肿。
文摘目的探讨两点三线交叉定位法在微创穿刺小脑血肿清除术中的应用。方法回顾性分析35例高血压性小脑血肿病人的临床资料,均在术前应用两点三线交叉定位法定位血肿,并行微创穿刺血肿清除术,分析定位的准确率、治疗效果、并发症等。结果 35例穿刺针均一次性到达血肿腔中心,穿刺准确率达100%。术后6 h复查CT:与术前设置的穿刺靶点和进针方向偏差≤0.5 cm 22例(62.9%),偏差>0.5～1 cm 13例(37.1%)。术后NHISS评分明显降低,而Barthel指数较术前明显升高,差异均有统计学意义(P<0.05)。术后并发症包括肺部感染3例,消化道出血2例,泌尿系统感染2例,心力衰竭1例。治愈26例(74.3%),好转6例(17.1%),差2例(5.7%),死亡1例(2.9%);总有效率达91.4%。结论应用两点三线交叉定位法对微创穿刺小脑血肿清除进行术前定位,血肿穿刺定位准确率高、创伤小、操作简单、清除血肿快、并发症少,可提高临床疗效和改善病人预后,具有较高的临床应用价值,值得推广应用。
