【作者】 孙毅；

【导师】 周海军；

【作者基本信息】 南华大学 ， 影像医学与核医学（专业学位）， 2016， 硕士

【摘要】 目的:运用DTI评价基底节区脑出血对皮质脊髓束损伤程度的影响;对比研究神经导航血肿清除与内科保守治疗的效果。方法:收集2015年3月至2016年1月期间南华大学附属郴州市第一人民医院脑科医院收治的中小量(15-40ml)基底节区高血压脑出血住院患者94例为研究对象。根据临床治疗方法不同,分为实验组(神经导航组,47例)和对照组(内科治疗组,47例)。依据皮质脊髓束的完整性将实验组(神经导航组)分为A1、A2两个亚组:A1亚组22例;A2亚组25例。所有研究对象在发病48小时内及14天分别进行颅脑CT扫描、弥散张量成像(DTI)扫描和NIHSS评分,并分组及亚组对比研究。得到各组及亚组双侧皮质脊髓束(corticospinal tract,CST)的各向异性值(fractional anisotropy,FA)、纤维束示踪成像(diffusion tensor tractography,DTT)、瘫痪分级(paresis grading,PG),采用SPSS19.0统计软件及独立样本t检验进行数据统计分析及比较。结果:通过分析、比较实验组(神经导航组)与对照组(内科治疗组)以及实验组A1、A2两个亚组间相关性研究,发病48小时内首次DTI成像,发现实验组与对照组受累侧内囊区及大脑脚FA值均降低,两组比较,差异无统计学意义(P>0.05)。发病14天DTI成像,实验组FA值(受累侧内囊区0.49±0.02、大脑脚0.47±0.02)较对照组(受累侧内囊区0.39±0.04、大脑脚0.42±0.04)明显升高,两组比较,差异有统计学意义(P<0.05)。通过DTT证实,实验组皮质脊髓束损伤恢复程度好于对照组;在临床表现上,实验组受累侧肢体运动功能PG评分(3.85±1.16)好于对照组(5.01±0.95),两组比较,差异有统计学意义(P<0.05)。实验组A1亚组发病14天受累侧内囊区FA值(0.50±0.02)高于A2亚组(0.48±0.02),差异有统计学意义(P<0.05)。结论:DTI可以较好的评价脑出血患者皮质脊髓束损伤的程度及范围;对于中小量基底节区脑出血患者而言,神经导航血肿清除疗效优于内科保守治疗。更多还原

【Abstract】 Objective:To evaluate the relationship between the basal ganglia hemorrhage and corticospinal tract injury;To evaluate the di fferent effects between neuronavigation-assisted and the medical trea tment group.Methods:During March 2015 to January 2016,We collected 94 patients in Brain Hospital of First People’s Hospital of Chenzho u Affiliated with Nanhua University admitted small amount(15-40 m l) basal ganglia hypertensive intracerebral hemorrhage hospitalized.A ccording to choice of treatment were divided into experimental grou p(neuronavigation-assisted treatment group, 47 cases) and control g roup(medical treatment group, 47 cases).Based on the integrity of t he corticospinal tract neuronavigation-assisted treatment group was d ivided into A1, A2 two subgroups: A1 group of 22 cases; A2 grou p of 25 cases.All patients within 48 hours after onset and 14 days Brian CT DTI scan and NIHSS scores were to give bilateral cortic ospinal tract(corticospinal tract, CST), anisotropy value(fractional anisotropy, FA), fiber tractography(diffusion tensor tractography, DT T), grading paralysis(paresis grading, PG).Using SPSS 19.0 statistic al software and independent samples T test was used for statistical analysis and comparison.Results:Through the analysis, comparison between the experime ntal group(neuronavigation-assisted treatment group) and control gro up(medical treatment group) and neuronavigation two subgroups co rrelation was found within 48 hours after the initial onset DTI ima ging showed that the experimental group and the control group the affected side of the cerebral peduncle and internal capsule FA value s were reduced, no significant difference(P> 0.05) groups.14 days after the onset of DTI imaging revealed that the experimental group FA values(internal capusar 0.49 ± 0.02, cerebral peduncle 0.47 ± 0.02) than the control group(internal capusar 0.39 ± 0.04, cerebral peduncle 0.42 ± 0.04) was significantly higher, the two groups ther e were significant differences(P <0.05),DTT from the experimental group show cortical spinal tract injury recovery better than the cont rol group.On the clinical manifestations, the experimental group(M G score 3.85 ± 1.16) muscle recovery better than the control group(PG score 5.01 ± 0.95), There were significant differences(P <0.05) groups.Neuronavigation A1 group after FA values(0.50 ± 0.02) i s higher than the A2 group(0.48 ± 0.02), the difference was statist ically significant(P <0.05).Conclusion:DTI can assessment the extent and scope of the CST injury very well in patients with cerebral hemorrhage;Neuronavigation-assisted treatment effect were better than the medical treatme nt for small to medium basal ganglia hemorrhage.更多还原