中国医学装备2025，Vol.22Issue(11)：87-91,5.DOI:10.3969/j.issn.1672-8270.2025.11.014
神经导航系统引导下微创穿刺术与开颅血肿清除术在创伤性脑出血中的疗效对比
Comparison of curative effects of NNS-guided MIP and CHE in traumatic intracerebral hemorrhage
摘要
Abstract
Objective:To investigate the differences of comprehensively curative effect of neuro navigation system(NNS)-guided minimally invasive puncture(MIP)and conventional craniotomy hematoma evacuation(CHE)in treatment for traumatic intracerebral hemorrhage,and analyze the mechanisms of affecting the differences of the trajectories postoperative neurologically functional recovery between two kinds of surgical methods.Methods:Based on the design of multicenter prospective cohort study,a total of 240 patients with traumatic intracerebral parenchymal hemorrhage,who admitted to the Neurosurgery Center of Rugao Hospital of Traditional Chinese Medicine between June 2021 and May 2024,were selected.They were randomized into the NNS group(n=120)and the CHE group(n=120)by using a stratified block randomization method.The NNS group underwent NNS-guided surgical intervention,while the CHE group received conventional craniotomy.The primary endpoint was hematoma evacuation rate at the postoperative 7th day.The secondary endpoints encompassed surgical parameters,complications,and the prognostic indicators of function.Microstructural assessment was performed by using three-dimensional image fusion technique[three-dimensional-T1weighted imaging magnetic resonance imaging(3D-T1WI MRI)combined with thin-slice computed tomography(CT)]and tract-based spatial statistics(TBSS).Results:At the dimension of hematoma evacuation,the average hematoma evacuation rate of NNS group was(88.37±6.52)%at the postoperative 7th day,which was significantly higher than(76.15±10.32)%of CHE group,and the residual hematoma volume of NNS group was(5.23±2.15)mL at the postoperative 7th day,which was less than(11.49±4.78)ml,and the differences of them between two groups were significant(t=9.843,7.015,P<0.05),respectively.The surgical trauma parameters appeared polarization:the mean incision length in the NNS group was(3.15±0.73)cm,which reduced 76.3%of(13.24±2.15)cm of the CHE group,with statistically significant difference(Z=15.327,P<0.05).The operative duration of NNS group was(68.34±15.32)min,which was shorter than(142.56±23.48)min,and the difference was significant(t=29.846,P<0.05).The radiation dose of NNS group was(312.45±85.32)cGy·cm2,which was significantly higher than(45.23±12.15)cGy·cm2 of CHE group,and the difference was significant(Z=24.156,P<0.05).The volume of intraoperative blood transfusion of NNS group was(50.34±25.36)ml,which was significantly less than(325.67±158.32)ml,and the difference was significant(Z=18.943,P<0.05),The result of complication genealogy analysis indicated that the re-bleeding incidence of the NNS group was 6.67%,which decreased by 9.16%than 15.83%of the CHE group,and the difference of that between two groups was statistical significance(x2=5.627,P<0.05).However,there was not significant difference in infection rates and incidences of deep vein thrombosis between the two groups(P>0.05).For functional recovery,the proportion of patients whose modified Rankin Scale(mRS)scores was≤2 at the postoperative 90th day was 52.50%in the NNS group,which increased 13.33%than 39.17%in the CHE group,and the difference of that between two groups was statistical significance(x2=4.302,P<0.05).Additionally,the improvement value of National Institutes of Health Stroke Scale(NIHSS)was(9.34±4.156)in the NNS group,which existed marginal advantage of 2.19 points than(7.15±5.327)of the CHE group,and the difference was significant between two groups(Z=3.842,P<0.05).Conclusion:NNS-guided MIP appears notable advantages in enhancing hematoma evacuation efficiency and improving prognosis of neurological function.However,its increased amount of radiation exposure,and risks of specific complication should be considered.The craniotomy approach remains indispensable for complex hematoma morphologies.关键词
神经导航系统/微创穿刺术/开颅血肿清除术/创伤性脑出血/改良Rankin量表Key words
Neuro navigation system(NNS)/Minimally invasive puncture(MIP)/Craniotomy hematoma evacuation(CHE)/Traumatic intracerebral hemorrhage/Modified Rankin scale分类
临床医学引用本文复制引用
贾琛,许中华,贾雪,张鹏..神经导航系统引导下微创穿刺术与开颅血肿清除术在创伤性脑出血中的疗效对比[J].中国医学装备,2025,22(11):87-91,5.基金项目
2023年度江苏省卫生健康委医学科研项目(Z2023090) Medical Research Project of Jiangsu Provincial Health Commission in 2023(Z2023090) （Z2023090）
