多功能颅脑导向定位装置的临床应用

目的:自行研制简易多功能颅脑导向定位装置并用于临床。方法:采用自制简易多功能颅脑导向定位装置及头皮标记定位仪,根据颅内病灶和头皮标记物的关系,计算CT最大病灶在头皮标记定位仪的位置,将其标记在头皮上对应的部位,依据两点一线的原理,头颅两侧分别设置穿刺点和瞄准点。两点连线恰通过颅内靶点中心,控制穿刺针深度并沿此线运行,能准确抵达靶点。结果:(1)穿刺精确度的模拟试验,在人体颅骨标本基底节区埋置椭圆形"十字"标记橡皮泥块,以中心为靶点,行CT扫描后用定位仪确定穿刺点,垂直及改选穿刺点穿刺,总平均误差在5mm以内。(2)穿刺针损伤模拟试验,选择不同的曲度骨面进行钻孔试验,YL-1型微创穿刺针表面与限位孔摩擦仅有轻微螺旋压痕,无明显损伤及变形。经模拟试验后应用该装置与目测导向穿刺治疗高血压脑出血,对临床资料完整并得到随访的79例进行对比分析,治疗前后血肿清除两组比较差异有显著性(P<0.05),生存质量观察组优于对照组(P<0.05)。结论:应用该导向定位装置将YL-1型微创穿刺针和引流套管集定位穿刺多功能于一体,能满足目前国内多数医院进行的颅内血肿微创治疗、囊肿等定位穿刺及引流的需要;避免了目测导向的误差带来的医源性损害,穿刺成功率达100%,符合微侵袭神经外科原则,结构简单,操作方便,适宜临床推广。

Clinical application of multipurpose brain targeted location device

Objective To manufacture simple multipurpose brain targeted location device for clinical application. Methods Using the simple multipurpose brain targeted location device and scalp mark position indicator, we computed the maximum of diseased region in scalp mark position indicator by computerized tomography, according to the relationship between intracal diseased region and scalp marker. Then we marked the corresponding positions in scalp, installed pricking and aiming points in the two sides of skull. The link of two points was through the intracal targeted centers, by which we could control the depth of transfixion pin, along this line, and reach the target exactly. Results (1)the model test of pricking accuracy rating: we embed oval marked rubber mud in basal nuclei of skull sample, the center of rubber mud was regard as the intracal target, then we located pricking points by position indicator after computerized tomography, and pricked vertically or reelected the pricking point, the mean error was within 5 mm. (2) the model test of lesion in transfixion pin: we chose different curvature to make drilling test, YL-1 typed transfixion pin has the little spiral pressure mark merely, no obvious lesion and deformation. We applied this location device and eye-measurement pricking in 79 hypertensive cerebral hemorrhage patients. There were significant differences in the clearance rates of hematoma and the life quality between two groups after treatment (P < 0.05). Conclusions This location device integrates YL-1 typed transfixion pin and draining tube and located pricking, fulfills the needs of intracal hematoma located pricking and draining in most domestic hospitals at present, avoids the iatrogenic damage by error in eye-measurement pricking. The pricking achievement ratio is 100% . It is consistent with the principle of microinvasion in neurosurgery, and fits for clinical application with its simple structure and convenient operation.