| Objective: To observe the efficacy of operation with hypertensive intracerebral hemorrhage(HICH) patients by diffusion tensor imaging(DTI)Method: 50 patients with HICH in basal ganglia was randomly divided into the conservative group(24 cases, 1 ~ 24 cases), surgical group(26 cases, 26 ~ 50 cases), hematoma volume was 13 ~ 37 ml, with an average of(24.36 ± 6.94)ml.Inclusion criteria:(1) all patients were the onset of first time,are characterized by sudden headache, nausea, with or without vomiting, at the same time with the contralateral limb paralysis of different levels;(2) no cerebral hernia, all patients can be examinated successfully;(3) the hematoma region was located on the same side;(4) clinical performance: the contralateral limb’s myodynamia was lower. Conservative group of 24 cases, male13 cases, female 11 cases, aged 30 ~ 75 years old, average 55.8 years old; The surgical 26 cases: male 17, female 9, 31-74 years old, average 56.3 years. Conservative group of patients were in routine medical treatment, surgical patients minimally invasive surgery on the basis of stable vital signs. All patients were evaluated by the US National Institutes of Health Stroke Scale(NIHSS)’s(paresis grading) PG. All patients were examinated DTI scan within 48 hours, measured FA in the region of interest of bilateral internal capsule area, which could find the reconstruction FA maps, color coded map directions, bilateral 3D CST map. All patients were evaluated by the United States National Institutes of Health Stroke Scale(NIHSS) of paresis grading after the onset of three weeks, all patients were reviewed DTI, and were assessed neurological disorders according to FA values, DTT image. All patients were analysised CST’s damage, Statistical software SPSS 17.0 was utilized to analyze the correlation between the intensity of CST injury and the degree of neural dysfunction and recovery.Result: there were not significant differences in two groups(P>0.05) The first DTI scan displayed that affected side were significantly decreased as compared with the other side by FA values of CST capsule and cerebral peduncle(p <0.001),CST 3D showed clearly and contralateral CST was full. Ipsilateral respectively were pressured, deformated, displaced, fracture. CST was divided into 3 grade based on integrity. grade 1: CST continuited Completely; grade 2: partial of CST disrupted but not less than 2/3; grade 3: CST mostly or completely interrupted. The conservative treatment group divided into Medicine A(1 ~ 2 level 12 cases), in the Medicine B(3 level, 12 cases) surgical group Surgery A(1 ~ 2 level 12 cases), Surgery B(3 level, 14 cases) the difference between the two subgroups, comparing minimally invasive surgery group and the conservative treatment group.1 Ipsilateral CST of FA value was positively correlated with PG value(p <0.05); the extent of ipsilateral CST was significantly correlated with paresis grading(P<0.05).2 Medical treatment group FA values(0.39 ± 0.02), minimally invasive surgery group FA values(0.49 ± 0.03). medical therapy group PG values(5.18 ± 0.73) minimally invasive treatment group PG values(3.92 ± 0.79) ipsilateral CST area FA values decrease was positively correlated(p <0.05) with PG value; ipsilateral injury of CST was significantly correlated with PG value(P<0.05). Medical treatment group: midicine A PG value(4.16 ± 0.57), midicine B PG value(5.48 ± 0.62), minimally invasive surgery group: surgery A PG value(3.38 ± 0.59). Surgery B PG value(4.52 ± 0.55) CST(1 ~ 2 level) in patients with no matter give conservative or operative treatment PG value all recovered well.3 A level 3 are preferred(2) medical treatment group PG value B(5.48+ 0.62) within the minimally invasive treatment group PG value(B(4.52+0.55) medical treatment group within the FA value(0.37+0.02) for minimally invasive treatment group B FA value B(0.47-0.03). The patient’s(CST, level 3) prognosis was poor. But PG value of minimally invasive surgical patients improved significantly to the internal medicine conservative group, which show us that surgical treatment is helpful for the patients(CST 3lever) recovery of neurological function.Conclusion: CST’s damage can be indentified in the early state via DTI\ DTT examination. There is a correlation between CST damage and the prognosis of the patients, the CST grade level is higher, the prognosis is worse. Minimally invasive operation treatment can obviously improve the quality of life of patients with cerebral hemorrhage in basal ganglia. |
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