中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2012年
12期
1255-1259
,共5页
任思颖%王丽琨%伍国锋%毛远红
任思穎%王麗琨%伍國鋒%毛遠紅
임사영%왕려곤%오국봉%모원홍
丘脑出血%皮质脊髓束%弥散张量成像%部分各向异性值
丘腦齣血%皮質脊髓束%瀰散張量成像%部分各嚮異性值
구뇌출혈%피질척수속%미산장량성상%부분각향이성치
Thalamic hematoma%Corticospinal tract%Diffusion tensor imaging%Fractional anisotropy values
目的 通过弥散张量成像(DTI)白质神经纤维示踪方法观察立体定向微创技术治疗丘脑出血对患者内囊神经纤维及运动功能的影响.方法 将贵阳医学院附属医院自2010年12月至2011年8月收治的22例丘脑出血患者按随机数字表法分为微创手术组(MI组)和药物治疗组(MT组).MT组采用常规药物治疗,MI组在入院后24 h内行立体定向微创手术清除颅内血肿,同时给予药物治疗.分别在入院时、入院后2周对2组患者进行DTI扫描,观察病灶侧及病灶对侧内囊皮质脊髓束(CST)的完整性并测定其部分各向异性值(FA值),在人院时、入院后2周及1月进行改良的美国国立卫生研究院卒中量表(mNIHSS)评分.结果 入院时2组患者DTI均显示病灶侧内囊CST数量减少或中断,其FA值与正常相比明显降低(MI组和MT组分别为0.432±0.022和0.410±0.028).MI组患者血肿清除后2周,病灶侧内囊CST的FA值与人院时相比均明显增加,与MT组比较差异有统计学意义(P＜0.05).随着术后病灶侧内囊CST的FA值增加,mNIHSS评分减少,患者运动功能明显好转.结论 立体定向微创技术治疗丘脑出血能有效地减少患者运动功能的损害程度,应用DTI技术可直观地观察到丘脑出血患者微创清除血肿后内囊CST变化情况.
目的 通過瀰散張量成像(DTI)白質神經纖維示蹤方法觀察立體定嚮微創技術治療丘腦齣血對患者內囊神經纖維及運動功能的影響.方法 將貴暘醫學院附屬醫院自2010年12月至2011年8月收治的22例丘腦齣血患者按隨機數字錶法分為微創手術組(MI組)和藥物治療組(MT組).MT組採用常規藥物治療,MI組在入院後24 h內行立體定嚮微創手術清除顱內血腫,同時給予藥物治療.分彆在入院時、入院後2週對2組患者進行DTI掃描,觀察病竈側及病竈對側內囊皮質脊髓束(CST)的完整性併測定其部分各嚮異性值(FA值),在人院時、入院後2週及1月進行改良的美國國立衛生研究院卒中量錶(mNIHSS)評分.結果 入院時2組患者DTI均顯示病竈側內囊CST數量減少或中斷,其FA值與正常相比明顯降低(MI組和MT組分彆為0.432±0.022和0.410±0.028).MI組患者血腫清除後2週,病竈側內囊CST的FA值與人院時相比均明顯增加,與MT組比較差異有統計學意義(P＜0.05).隨著術後病竈側內囊CST的FA值增加,mNIHSS評分減少,患者運動功能明顯好轉.結論 立體定嚮微創技術治療丘腦齣血能有效地減少患者運動功能的損害程度,應用DTI技術可直觀地觀察到丘腦齣血患者微創清除血腫後內囊CST變化情況.
목적 통과미산장량성상(DTI)백질신경섬유시종방법관찰입체정향미창기술치료구뇌출혈대환자내낭신경섬유급운동공능적영향.방법 장귀양의학원부속의원자2010년12월지2011년8월수치적22례구뇌출혈환자안수궤수자표법분위미창수술조(MI조)화약물치료조(MT조).MT조채용상규약물치료,MI조재입원후24 h내행입체정향미창수술청제로내혈종,동시급여약물치료.분별재입원시、입원후2주대2조환자진행DTI소묘,관찰병조측급병조대측내낭피질척수속(CST)적완정성병측정기부분각향이성치(FA치),재인원시、입원후2주급1월진행개량적미국국립위생연구원졸중량표(mNIHSS)평분.결과 입원시2조환자DTI균현시병조측내낭CST수량감소혹중단,기FA치여정상상비명현강저(MI조화MT조분별위0.432±0.022화0.410±0.028).MI조환자혈종청제후2주,병조측내낭CST적FA치여인원시상비균명현증가,여MT조비교차이유통계학의의(P＜0.05).수착술후병조측내낭CST적FA치증가,mNIHSS평분감소,환자운동공능명현호전.결론 입체정향미창기술치료구뇌출혈능유효지감소환자운동공능적손해정도,응용DTI기술가직관지관찰도구뇌출혈환자미창청제혈종후내낭CST변화정황.
Objective To observe the changes of nerve fibers of internal capsule and motor function in patients with thalamic hematoma treated by minimally invasive procedures using diffusion tensor imaging (DTI).Methods Twenty-two patients with thalamic hematoma were randomized into minimally invasive treatment group (MI group) and medication treatment group (MT group).The patients in MT group were given conventional medical treatment,and those in MI group were performed intracranial hematoma elimination by the minimally invasive procedures within 24 h of admission and medical treatment was also given.The patients in both MI group and MT group underwent a whole-brain DTI on admission and 2 weeks after the admission.The integrity of corticospinal tract (CST) in the internal capsule ipsilateral to the hematoma side and the contralateral side and their fractional anisotropy (FA) values were determined.The modified National Institutes of Health Stroke Scale (mNIHSS) were performed on admission,2 weeks and 1 month after onset of initial hemorrhage.Results DTI showed that fibers in the internal capsule ipsilateral to the hematoma either decreased in number or interrupted because of hematoma-induced damages in both groups,and the CST FA values on admission were significantly lower (0.432±0.022 and 0.410±0.028 for MI and MT groups,respectively) than the control values.The number of fibers and the FA values of CST in the internal capsule 2 weeks after the hematoma being evacuated were increased significantly as compared with those on admission.As FA values of CST in internal capsule increased,the mNIHSS scores decreased after the surgery and the motor function improved gradually.Conclusion Minimally invasive procedures for thalamic hematoma evacuation can effectively reduce the degree of injury to the motor function,and DTI can observe the changes of CST after the surgery directly.
