摘要
目的探讨小骨窗微创治疗高血压脑出血与内科保守治疗相比,在缩短患者住院时间、降低住院费用方面的优势;并初步探讨DTI技术在高血压脑出血患者肢体功能预后评估中的应用价值。方法 35例高血压脑出血患者(观察组)入院后6 h内行小骨窗微创治疗,与同时期行内科保守治疗的30例高血压脑出血患者(对照组)进行对照研究,比较平均住院时间及住院费用。微创治疗组患者于术后第1 d、第7 d复查头颅CT了解血肿清除情况。术后1个月行DTI锥体束成像,通过锥体束损伤情况评估患者肢体功能预后。结果观察组35例患者小骨窗微创手术均顺利完成,无术后再出血及死亡病例;术后复查头颅CT,血肿清除率在70%以上。术后1个月行DTI锥体束成像显示锥体束均存在不同程度损伤。6例患者以锥体束受压为主,术后肢体功能明显改善;24例患者锥体束受压、破坏同时存在,术后肢体功能有所改善;5例患者以锥体束破坏为主,术后肢体功能无改善。结论小骨窗微创治疗与传统内科保守治疗相比,可以显著缩短患者平均住院时间、降低住院费用,且手术效果满意。DTI技术能够形象直观地显示锥体束损伤情况,对肢体功能预后进行评估。
Objective To explore the advantage of treatment for hypertensive intracerebral hematoma by small bone flap craniotomy in shortening hospital stay and reducing hospital costs,compared with conservative treatment,and to discuss the value of diffusion tensor imaging（ DTI） technology in evaluating the prognosis of extremities function of patients with hypertensive intracerebral hematoma. Methods All patients with hypertensive cerebral hematoma were randomly divided into observed group（ 35 cases） and control group（ 30 cases）. 35 patients in observed group were treated with small bone flap craniotomy in 6 hours after admission,while 30 received the treatment of conservative treatment. The two groups of shortening hospital stay and reducing hospital costs were compared. The observed group on postoperative 1 and 7 day,the observed group were examined with CT to observe the situation of hematoma removal,and after 1 month,the patients were examined by DTI to observe fiber bundle,the purpose was to evaluate the prognosis of extremities function. Results The observation group of 35 cases were successfully completed with no postoperative bleeding and death cases. The rate of hematoma clearance was over 70% in CT images. Fiber bundles had different degrees of damage in DTI images. Of 35 cases in the observation group,the fiber bundles of 6 were mainly compressed,and the prognosis of extremities function was improved obviously after surgery. The fiber bundles of 24 cases were compressed and damaged at the same time,and the prognosis of extremities function was improved slightly after surgery.The fiber bundles of 5 cases were damaged mainly,and the prognosis of extremities function was not improved after surgery. Conclusions Small bone flap craniotomy could significantly shorten the average hospitalization time and reduce hospital expense,and surgical effect is satisfactory. The DTI technique could visually display the fiber bundle and evaluate the prognosis of the patients.
作者
左常阳
张卫
金浩
柴学
ZUO Chang-yang ZHANG Wei JIN Hao et al(Department of Neurosurgery, Nantong University Affiliated First People＇s Hospital of Wujiang, Suzhou 215200, China)
出处
《临床神经外科杂志》
CAS
2016年第6期466-469,共4页
Journal of Clinical Neurosurgery
基金
南京医科大学科技发展基金面上项目(2012NJMU106)
关键词
高血压脑出血
小骨窗微创
DTI
预后
hypertensive intracerebral hematoma
small bone flap craniotomy
diffusion tensor imaging
prognosis
