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  

Effect of minimally invasive procedures on motor function changes and nerve fibers of internal capsule in patients with thalamic hematoma

作　　者：任思颖[1] 王丽琨[1] 伍国锋[1] 毛远红[1] 

机构地区：[1]贵阳医学院附属医院急诊医学教研室,贵阳550004

出　　处：《中华神经医学杂志》2012年第12期1255-1259,共5页Chinese Journal of Neuromedicine

摘　　要：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组在人院后24h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、人院后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O．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。Objective To observe the changes of nerve fibers of internal capsule and motorfunction 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 fi＇actional 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.

关 键 词：丘脑出血 皮质脊髓束 弥散张量成像 部分各向异性值 

分 类 号：R743.34[医药卫生—神经病学与精神病学]