【摘要】 目的 探讨3D打印导板辅助中少量高血压基底节区脑出血微创穿刺引流术的临床疗效。方法 选择2020年10月至2023年10月自贡市第四人民医院收治的78例中少量高血压基底节区脑出血患者(出血量15～30 ml),根据患者家属意见，分为手术组32例和对照组46例。手术组患者采取3D打印导板辅助微创穿刺手术治疗，对照组患者采取保守治疗，分析两组患者术后血肿清除效率及术后并发症，并进行美国国立卫生研究院卒中量表(NIHSS)及改良Rankin评分量表(mRS)评分。结果 术后头颅CT复查结果证实手术组穿刺成功率100%,且血肿清除率显著高于对照组，血肿清除时间显著缩短，差异有统计学意义(P<0.001)。手术组入院7天及3月的NIHSS评分均明显低于对照组(P<0.005),随访3月后的预后良好率显著高于对照组(P=0.007),住院时间显著少于对照组(P<0.001)。两组患者并发症发生率比较差异无统计学意义(P=0.402),均无死亡病例。进一步分析出血部位累及内囊后肢患者群体，手术组随访3月后的预后良好率显著高于对照组(P=0.012)。结论 3D打印辅助导板能有效提高中少量高血压基底节区脑出血微创穿刺准确率并提高血肿清除率，有助于缩短血肿清除时间和患者住院时间，改善患者神经功能的早期预后，疗效优于保守治疗，可进一步推广应用。更多还原

【Abstract】 Objective To investigate the therapeutic effect of 3D-printing technology in minimally invasive puncture for moderate to small amount of hypertensive intracerebral hemorrhage in basal ganglia.Methods A total of 78 patients diagnosed with moderate and slight hypertensive intracerebral hemorrhage in basal ganglia(hemorrhage volume of 15～30 ml) admitted to our hospital from October 2020 to October 2023 were selected. The patients were assigned to a surgical treatment group(n=32) and a control group(n=46) according to the opinions of the patients’ family. The surgical treatment group was treated with minimally invasive puncture with 3D-printed guide board. The control group was treated with conservative treatment. The postoperative hematoma evacuation efficiency and complications were analyzed. NIHSS and mRS scores were also used for evaluation.Results Postoperative CT scans confirmed that success rate for punctures in the surgical treatment group was 100%. The hematoma clearance rate in the surgical treatment group was significantly higher and the hematoma clearance time was significantly shorter than those in the control group(P<0.001). The NIHSS score after 7 days and 3 months in the surgical treatment group was notably lower than those in the control group(P<0.005). The rate of good prognosis after 3 months in the surgical treatment group was higher than that in the control group(P=0.007). The average time of hospital stays of the surgical treatment group was shorter than that of the conservative treatment group(P<0.001). There was no statistically significant difference in the incidence of complications between the two groups(P=0.402). No deaths occurred in either group. Further analysis of the group of patients whose bleeding site involved the posterior limb of the internal capsule showed that the good prognosis rate in the surgical treatment group after 3-month follow-up was significantly higher than that in the control group(P=0.012).Conclusions The use of 3D-printing guiding plates can effectively improve the accuracy of minimally invasive puncture for moderate and slight hypertensive intracerebral hemorrhage in basal ganglia and enhance the hematoma clearance rates. This approach helps to shorten both the hematoma clearance time and hospital stays. It also improves the early neurological outcomes. The efficacy of this technology surpasses that of conservative treatment. It can be further promoted and applied.更多还原