BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHOD...BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHODS:A total of 1 310 patients,who had been admitted to six hospitals from January 2004 to January 2008,were divided into six groups according to different surgical methods:craniotomy through bone fl ap(group A),craniotomy through a small bone window(group B),stereotactic drilling drainage(group C1 and group C2),neuron-endoscopy operation(group D) and external ventricular drainage(group E) in consideration of hemorrhage position,hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods.RESULTS:The effectiveness rate of the methods was 74.12% for 1 310 patients after onemonth follow-up. In this series,the disability rate was 44.82% 3–6 months after the operation. Among the 1 310 patients,241(18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours,the mortality rate of group A was signifi cantly lower than that of groups B,C,D,and E(P<0.05). If hematoma volume was 50–80 mL and the operation was performed within 6–12 hours,the mortality rate of groups B and D was lower than that of groups A,C and E(P<0.05). If hematoma volume was 20–50 mL and the operation was performed within 6–24 hours,the mortality rate of group C was lower than that of groups A,B and D(P<0.05).CONCLUSIONS:Craniotomy through a bone f lap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.展开更多
目的:对采取股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)和动力髋螺钉(dynamic hipscrew,DHS)内固定方法治疗的老年股骨粗隆间骨折的术中及术后显性、隐性失血量进行分析,为临床围手术期处理提供必要的数据支撑。方...目的:对采取股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)和动力髋螺钉(dynamic hipscrew,DHS)内固定方法治疗的老年股骨粗隆间骨折的术中及术后显性、隐性失血量进行分析,为临床围手术期处理提供必要的数据支撑。方法:回顾性分析2001年12月30日至2010年9月30日间采用PFNA内固定手术治疗的216例及采用DHS内固定手术治疗的168例股骨粗隆间骨折患者的临床资料,对患者术前、术后血常规以及术中及术后失血、输血情况等指标进行分析,同时对围手术期的显性、隐性失血情况做出评估。结果:采用PFNA治疗的患者平均术中失血(48.9±2.8)mL;术后平均显性失血量为(62.3±3.8)mL,平均隐性失血量为(385.0±6.2)mL。采用DHS治疗的患者平均术中失血(124.9±7.8)mL;术后平均显性失血量为(73.9±4.7)mL,平均隐性失血量为(243.4±6.3)mL。两组相比,DHS术中出血量及术后的显性出血量均多于PFNA(P<0.01),但PFNA术后隐性出血量及PFNA总体出血量均多于DHS(P<0.01)。结论:PFNA和DHS内固定治疗股骨粗隆间骨折均存在较多的术后隐性失血量,提醒临床医生注意术后患者的生命体征监测以减少并发症的发生。展开更多
基金supported by a grant from Shanghai Pudong New Area(PWZxkq2011-01)
文摘BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHODS:A total of 1 310 patients,who had been admitted to six hospitals from January 2004 to January 2008,were divided into six groups according to different surgical methods:craniotomy through bone fl ap(group A),craniotomy through a small bone window(group B),stereotactic drilling drainage(group C1 and group C2),neuron-endoscopy operation(group D) and external ventricular drainage(group E) in consideration of hemorrhage position,hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods.RESULTS:The effectiveness rate of the methods was 74.12% for 1 310 patients after onemonth follow-up. In this series,the disability rate was 44.82% 3–6 months after the operation. Among the 1 310 patients,241(18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours,the mortality rate of group A was signifi cantly lower than that of groups B,C,D,and E(P<0.05). If hematoma volume was 50–80 mL and the operation was performed within 6–12 hours,the mortality rate of groups B and D was lower than that of groups A,C and E(P<0.05). If hematoma volume was 20–50 mL and the operation was performed within 6–24 hours,the mortality rate of group C was lower than that of groups A,B and D(P<0.05).CONCLUSIONS:Craniotomy through a bone f lap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.
文摘目的:对采取股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)和动力髋螺钉(dynamic hipscrew,DHS)内固定方法治疗的老年股骨粗隆间骨折的术中及术后显性、隐性失血量进行分析,为临床围手术期处理提供必要的数据支撑。方法:回顾性分析2001年12月30日至2010年9月30日间采用PFNA内固定手术治疗的216例及采用DHS内固定手术治疗的168例股骨粗隆间骨折患者的临床资料,对患者术前、术后血常规以及术中及术后失血、输血情况等指标进行分析,同时对围手术期的显性、隐性失血情况做出评估。结果:采用PFNA治疗的患者平均术中失血(48.9±2.8)mL;术后平均显性失血量为(62.3±3.8)mL,平均隐性失血量为(385.0±6.2)mL。采用DHS治疗的患者平均术中失血(124.9±7.8)mL;术后平均显性失血量为(73.9±4.7)mL,平均隐性失血量为(243.4±6.3)mL。两组相比,DHS术中出血量及术后的显性出血量均多于PFNA(P<0.01),但PFNA术后隐性出血量及PFNA总体出血量均多于DHS(P<0.01)。结论:PFNA和DHS内固定治疗股骨粗隆间骨折均存在较多的术后隐性失血量,提醒临床医生注意术后患者的生命体征监测以减少并发症的发生。
文摘背景与目的:核磁共振成像(magnetic resonance imaging,MRI)图像对软组织结构具有较高的分辨率,但由于失真和缺乏剂量计算所需要的电子密度而限制了其在脑部肿瘤放射治疗中的应用,而MRI和CT图像融合可解决这一问题。本研究探讨MRI与CT的图像融合精度,及其对脑胶质瘤术后患者放疗临床靶区(clinical target volume,CTV)及危及器官(organs at risk,OARs)体积和中心位置的影响。方法:9例颅内胶质瘤术后患者MRI和CT图像采用标点法进行融合,评价其融合精度,分别采用体积法及几何中心法(center of geometry,COG)研究融合前后临床靶区和危及器官体积和中心的变化,测定病灶MRI-CT融合图像的COG与CT定位图像COG的距离,体积法测定病灶MRI与CT图像融合部分体积(VMRI-CT)占总体积(VMRI+CT)的百分比(PMRI-CT)。结果:采用人工标记法进行融合的精度小于1.5mm,完全达到脑部肿瘤的误差要求。融合后各危及器官体积无明显改变(P>0.05);9例患者中8例融合界面勾画的CTV体积比CT定位图像CTV体积减小13.85%～73.59%,1例体积增大10.35%;平均体积比较差异有统计学意义(P<0.05);融合后CTV的中心位置变化最大[(8.74±6.60)mm],其次为双眼[左右眼分别为(5.25±2.38)mm和(5.65±2.56)mm],脑干位置变化最小[(1.83±1.06)mm]。结论:采用人工标记的方法进行图像融合具有较高的融合精度,MRI与CT融合的方法可明显减少脑胶质瘤术后放疗CTV勾画的不确定性。
