浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2014年
18期
1509-1512,1534
,共5页
徐杰%阎仁福%沈小勇%周跃%苏忠周%邱晟%李丽琴%潘旭炎%沈健%戴利成%张建民
徐傑%閻仁福%瀋小勇%週躍%囌忠週%邱晟%李麗琴%潘旭炎%瀋健%戴利成%張建民
서걸%염인복%침소용%주약%소충주%구성%리려금%반욱염%침건%대리성%장건민
高血压脑出血%显微手术%运动功能恢复%弥散张量纤维束成像
高血壓腦齣血%顯微手術%運動功能恢複%瀰散張量纖維束成像
고혈압뇌출혈%현미수술%운동공능회복%미산장량섬유속성상
Hypertensive intracerebral hemorage%Microsurgery%Motor function recovery%DTT
目的：采用弥散张量纤维束成像技术（DTT）早期评价经侧裂-岛叶入路显微手术对高血压脑出血（HICH）患者术后运动功能恢复的影响。方法选择经侧裂-岛叶入路显微手术的HICH患者46例，术前均行DTT检查计算基底核区皮质脊髓束（CST）条目数，术后1d均行CT检查，术后2周再行DTT检查计算基底核区CST条目数，6个月后根据Fugl- Meyer（FM）评分评判患者运动功能的恢复情况。结果46例患者均未发现严重并发症；术后2周基底核区相对剩余CST条目数（73.98±12.71）与术前（72.07±13.35）相比未见统计学差异（t=0.570，P=0.572）；术后6个月患者FM评分平均为（84.22±12.81）分；所有患者术后2周的患侧相对剩余CST条目数（73.98±12.71）与6个月后FM评分之间呈正相关（r=0.845，P＜0.01）。结论采用经侧裂-岛叶入路显微手术治疗HICH患者，术中能保留更多的相对CST条目数，这可能是该法治疗的患者术后6个月运动功能恢复更佳的原因之一。DTT用于HICH患者能在术后早期对其肢体运动功能恢复情况作出预后评估，有助于合理制定术后康复方案。
目的：採用瀰散張量纖維束成像技術（DTT）早期評價經側裂-島葉入路顯微手術對高血壓腦齣血（HICH）患者術後運動功能恢複的影響。方法選擇經側裂-島葉入路顯微手術的HICH患者46例，術前均行DTT檢查計算基底覈區皮質脊髓束（CST）條目數，術後1d均行CT檢查，術後2週再行DTT檢查計算基底覈區CST條目數，6箇月後根據Fugl- Meyer（FM）評分評判患者運動功能的恢複情況。結果46例患者均未髮現嚴重併髮癥；術後2週基底覈區相對剩餘CST條目數（73.98±12.71）與術前（72.07±13.35）相比未見統計學差異（t=0.570，P=0.572）；術後6箇月患者FM評分平均為（84.22±12.81）分；所有患者術後2週的患側相對剩餘CST條目數（73.98±12.71）與6箇月後FM評分之間呈正相關（r=0.845，P＜0.01）。結論採用經側裂-島葉入路顯微手術治療HICH患者，術中能保留更多的相對CST條目數，這可能是該法治療的患者術後6箇月運動功能恢複更佳的原因之一。DTT用于HICH患者能在術後早期對其肢體運動功能恢複情況作齣預後評估，有助于閤理製定術後康複方案。
목적：채용미산장량섬유속성상기술（DTT）조기평개경측렬-도협입로현미수술대고혈압뇌출혈（HICH）환자술후운동공능회복적영향。방법선택경측렬-도협입로현미수술적HICH환자46례，술전균행DTT검사계산기저핵구피질척수속（CST）조목수，술후1d균행CT검사，술후2주재행DTT검사계산기저핵구CST조목수，6개월후근거Fugl- Meyer（FM）평분평판환자운동공능적회복정황。결과46례환자균미발현엄중병발증；술후2주기저핵구상대잉여CST조목수（73.98±12.71）여술전（72.07±13.35）상비미견통계학차이（t=0.570，P=0.572）；술후6개월환자FM평분평균위（84.22±12.81）분；소유환자술후2주적환측상대잉여CST조목수（73.98±12.71）여6개월후FM평분지간정정상관（r=0.845，P＜0.01）。결론채용경측렬-도협입로현미수술치료HICH환자，술중능보류경다적상대CST조목수，저가능시해법치료적환자술후6개월운동공능회복경가적원인지일。DTT용우HICH환자능재술후조기대기지체운동공능회복정황작출예후평고，유조우합리제정술후강복방안。
Objective To evaluate the postoperative motor outcome by using diffusion tensor imaging (DTT) technique in patients with hypertensive intracerebral hemorrhage (HICH) undergoing microsurgery of split- insular approach. Methods Forty six HICH patients underwent microsurgical surgery by split- insular approach. DTT examinations were performed before opera-tion, 1 day, 2 weeks and 6 months after operation. Fugl- Meyer (FM) score was used to evaluate the postoperative motor func-tion. Results No serious complications were found in al 46 patients. There was no significant difference in the numbers of cor-ticospinal tract (CST) after 2 weeks before and after operation (73.98±12.71 vs. 72.07±13.35, t=0.570, P=0.572). The mean FM score of patients was 84.22±12.81, 6 months after operation. The numbers of CST 2 weeks after operation were closely corre-lated with FM score 6 months after operation (r=0.845, P<0.01). Conclusion The split- insular approach for microsurgical surgery can preserve more CST numbers for HICH patients. DTT technique can make early evaluation of postoperative motor function for HICH patients undergoing microsurgery.
