摘要
目的利用磁共振扩散张量成像(DTI)技术对经外侧裂岛叶(TS-TI)及颞叶皮质(TC-TT)手术入路的单侧高血压壳核脑出血患者术后锥体束损伤程度进行分级比较,结合日常生活活动(ADL)质量标准评价患者术后恢复情况,判断该两种手术入路优劣。方法连续性前瞻性入选2016年1月至2017年6月西南医科大学附属中医医院神经外科收治的63例首次发病的单侧高血压基底节区壳核出血患者,入院时血肿体积26~45 ml。按随机数字表将患者完全随机分为A组与B组,A组(31例)患者采用TS-TI入路,B组(32例)患者采用TC-TT入路,术者为同一位医师。排除术后再出血者(A组4例,B组7例),实际纳入患者共52例,A组27例,B组25例。DTI检查为术后5~8 d,影像数据经PHILIPS Extended MR Workspace 2.6.3.4(EMW 2.6.3.4)软件进行后处理,重组双侧锥体束,分别观察锥体束损伤程度及其与血肿、手术入路关系;利用ADL质量标准评价患者术后3个月恢复情况。采用SPSS 17.0软件对两组术后锥体束损伤分级行秩和检验,术区再出血例数、ADL质量标准评价行χ~2检验。结果 A组术后再出血率(12.9%,4/31)与B组(21.9%,7/32)比较,差异无统计学意义(χ~2=0.367,P=0.545)。术后A组锥体束损伤程度轻于B组,差异有统计学意义(U=180.00,P=0.004);术后两组ADL质量评价比较,A组术后预后良好率(81.5%,22/27)优于B组(56.0%,14/25),差异有统计学意义(χ~2=3.957,P=0.047)。结论利用DTI观察血肿病灶与锥体束的三维立体关系,可判断锥体束受损程度;TS-TI入路治疗高血压壳核脑出血在术后锥体束损伤及ADL质量方面优于TC-TT入路。
Objectives To conduct grading comparison for the damage degree of pyramidal tracts after procedure in patients with unilateral hypertensive putamen hemorrhage via transsylvian-transinsular （TS-TI） approach and transcortical transtemporal （TC-TT） approach using magnetic resonance diffusion tensor imaging（ DTI） and to evaluate the postoperative recovery of the patients according to the quality criteria of the activities of daily living（ ADL）,and to identify the advantages and disadvantages of both surgical approaches. Methods Sixty-three consecutive patients with first onset of unilateral hypertensive basal ganglia putamen hemorrhage admitted to Department of Neurolsurgery in Affiliated Hospital of Southwest Medical University of Traditional Chinese Medicine were enrolled prospectively. The volume of hematoma at admission was 26-45 ml. They were randomly divided into group A and group B by random number table. The patients in group A（n=31） were treated via the TS-TI approach,and those of group B（n=32） were treated via the TC-TT approach. The operator was the same surgeon. The patients of rebleeding were excluded（ 4 in group A,7 in group B）,and 52 patients were actually included,including 27 in group A and 25 in group B. The DTI examinations were performed 5 to 8 d after procedure. The image data were processed by PHILIPS Extended MR Workspace 2.6.3.4（ EMW 2.6.3.4） software. The bilateral pyramidal tracts were reconstructed,the damage degree of pyramidal tract and its relationship with hematoma and surgical approach were observe respectively. The ADL quality criteria were used to evaluate the recovery at 3 months after procedure. The SPSS 17. 0 software was used to conduct rank sum test for the pyramidal tract injury grade after procedure in both groups. The number of rebleeding in the operation areas and the ADL quality criteria evaluation were tested by Chi-squared test. Results There was no significant difference in the postoperative rebleeding rate between group A（ 12.9%,4/31）
作者
顾应江
侯小林
杨东东
李定君
李成勋
曾林
Gu Yingjiang , Hou Xiaolin, Yang Dongdong, Li Dingjun, Li Chengxun, Zeng Lin(Department of Neurosurgery, the Affiliated Hospital of Traditional Chinese Medicine, Southwest Medicine University, Sichuan Province, Luzhou 646000, Chin)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2018年第3期129-133,139,共6页
Chinese Journal of Cerebrovascular Diseases
关键词
弥散张量成像
脑出血
壳核出血
颅内出血
高血压性
锥体束
外侧裂岛叶入路
颞叶皮质入路
Diffusion tensor imaging
Cerebral hemorrhage
Putaminal hemorrhage
Intracranialhemorrhage,hypertensive
Pyramidal tract
Transsylvian-transinsular approach
Transcortical transtemporal approach
