| BackgroundThe incidence of spontaneous intracerebral hemorrhage(SICH)is about 30%-38%of the stroke and is a common type of stroke.Since the 21st century,with the population aging trend obviously,the number of the onset of spontaneous cerebral hemorrhage are also rising,become one of the main difficult problem which harm to people's health.With the development of modern technologies such as microdevices,bipolar electrocoagulation,endoscopy and imaging,the therapeutic effect of spontaneous intracerebral hemorrhage is developing.Surgical methods mainly include:to bone disc decompression,under a microscope for removal of hematoma,nerve endoscopic or small bone window craniotomy under microscope for removal of hematoma,nerve navigation or stereotactic technique hematoma drainage.The surgical method of spontaneous intracerebral hemorrhage has many shortcomings,which is not to the patient's trauma,which is expensive and difficult to be popularized in the basic hospital,which is more difficult to be mastered by the low-skilled doctors.So far,the choice of surgical options remains controversial,and scholars at home and abroad are still trying to explore a small wound,low-cost,and high precision surgical approach.In recent years,along with the computer three dimensional digital imaging and multi-level continuous printing technology development,three dimensional printing(3 DP)technology as a new application of rapid rise,and gradually used in medical fields.Three dimensional printing technology can read two dimensional raw data through computer aided design,and then make the physical model with the help of three dimensional printer through data transformation design.Under the three dimensional printing technology,two dimensional image digital data become visualization,from two dimensional to three dimensional,from virtual to reality,from plane to solid transformation,the doctor can be directly on the three dimensional entity model preoperative surgery simulation,good for the doctor to develop ideas,skilled operation,improve the success rate of surgery.In order to improve the effect of the treatment of spontaneous cerebral hemorrhage,depth to explore new method,which has simple operation,low technical requirements for operation personnel experience,and can shorten the operation time,reduce the trauma and cost and so on merits.The rise of three dimensional printing technology,which laid a foundation for the feasibility of this method.ObjectiveCompared with traditional small bone window hematoma removal,to explore a kind of based on computer aided design(CAD)of three dimensional printing individualized guide positioning under the new methods of invasive puncture drainage and its effect on the treatment of patients with spontaneous cerebral hemorrhage.Further discussed under the three dimensional printing individualized guide positioning of invasive puncture treatment of spontaneous cerebral hemorrhage is individualized,precise,minimally invasive,shorten the average length of hospital stay and other advantages.MethodsOur department were retrospectively analyzed from January 2016 to December 2017,the diagnosis and treatment of 128 cases of spontaneous cerebral hemorrhage patients,divided into two groups,61 patients treated with three dimensional printing individualized guide guided puncture for the experimental group,67 patients of small bone window for removal of hematoma treated as control group,compared two groups of patients with postoperative complications and clinical curative effect.1.Puncture surgery is performed in three dimensional printing personalized guide plate.?The collection of brain image data and three dimensional printing individualized guide plate design.Take a case of spontaneous intracerebral hemorrhage in my department.The computed tomography(CT)scan of the craniocerebral CT was performed using 64 row high resolution helical CT,and the original CT image data was imported into the Digital Imaging and Communications in Medicine(DICOM)format for three dimensional printing medical special design software Materialise's interactive medical image control system(Mimics)18.0,computer aided design for craniocerebral and hematoma areas of image segmentation and three dimensional reconstruction,choosing the appropriate puncture needle into points and puncture channel,precision measuring puncture depth and perspective,the options include the part of the bridge of the nose,zygomatic arch and other facial signs for individualized model,finally in the STL format output with a puncture hole extracranial individualized guide.?Three dimensional printing and post-processing of individual guide plates.Using Acrylonitrile Butadien Styrene(ABS)resin as raw material,three dimensional printer is applied to print layer by layer.After printing,take out the individual model,remove the printing support,and carefully check whether the printing information is correct;The face guide is placed on the face of the patient to ensure that the guide plate is pressed against the patient's face,and then the patient's intracranial CT is checked to ensure that the position of the intracranial hematoma is in the same side as the guide plate.?The treatment of spontaneous intracerebral hemorrhage by puncture surgery in three dimensional printing individualized guide plate.The patient took the supine position and applied the individualized facial guide to the patient's face,and the puncture passage was marked with the puncture point of the patient's forehead.Routine disinfection,spread towels,after the success of the local anesthesia,the puncture point do a crosscutting mouth is about 0.5 cm long,in order to cut the scalp each layer,and then will be individualized guide with aseptic bag,well,in the patients with facial skin and try to close to patients,especially markers in place,as far as possible along the individualized puncture channel guide direction with craniotomy drill drill hole of a bone,take the hematoma puncture drainage tube along the direction of the puncture channel on the guide slowly Pierce about 115 mm(measuring puncture channel in advance the total length of about 115 mm,the puncture channel to extracranial puncture hematoma at the end side),see a dark red hematoma outflow,to connect the drainage bag,the procedure smoothly,conscious patients without a significant change.Record the time of the operation.2.Treatment of spontaneous intracerebral hemorrhage by small bone window hematoma removal.?All patients were treated with intravenous intravenous anesthesia in the tracheal tube.?According to the patient's head CT three-dimensional quantitative numerical calculation,hematoma the hematoma largest level as the center,to determine the hematoma edge of specific parts of the body surface projection,choose hematoma cortex nearest level important function,at the same time avoid the cortex design scalp straight incision,about 3 x 3 cm bone Windows open,hanging around after epidural cross incision;?According to the preoperative hematoma center and general range,the temporal gyrus was cut into the hematoma cavity.Avoid function and blood vessel area,and open area window with microscope,remove hematoma of hematoma,and pay attention to the protection of important lateral fissure vessels and branches of the cerebral artery;?The dipole electrocoagulation is as small as possible,so as to avoid damage to normal brain tissue.Select the thinner suction device,adjust the small suction,carefully and slowly remove the hematoma,reduce the brain tissue and blood vessel damage.lt is obvious that bleeding blood vessels give electrocoagulation,and the smaller blood seepage is compressed for a few minutes,then it can be applied to stop the bleeding gauze,which can achieve the effect of hemostasis and minimize the electrocoagulation.?After hematoma removal,after thorough hemostasis,saline injection temperature,once again check the presence of active bleeding,take a side with a hole of the silicone drainage tube in the hematoma cavity shallow,layered close small incisions.?Postoperative support for the treatment of the same puncture surgery.After the operation,the head CT was reviewed regularly and the drainage tube was removed according to the drainage condition.Results1.Preoperative general data of the two groups,including gender,age,systolic blood pressure,hematoma volume,and GCS score at admission were not significantly different(P>0.05).2.In the experimental group,the operation was performed under local infiltration anesthesia,while the control group was treated with intravenous injection of intravenous anesthesia;Compared with the control group,the operation time was significantly shortened(0.51± 0.20 h vs.3.27 ± 1.14 h),the cost of surgery decreased significantly(3805.4 + 461.2 yuan vs.9326.7 + 949.3 yuan),with significant difference(P<0.05).3.Through the comparison of two groups of patients with postoperative data,experimental postoperative complication rates significantly lower than the control group(18.0%vs.34.3%),30 days after surgery group patients have better GCS score(P<0.05),hospitalization time after surgery(20.54 ± 7.08 h vs.20.54 ± 10.72 h),there are significant differences(P<0.05)..ConclusionCompared with small bone window hematoma clearance,three dimensional printing individualized guide plate puncture treatment of spontaneous intracerebral hemorrhage can accurately puncture depth and Angle,treat individual,minimally invasive and accurate,reduced operating costs and improve the postoperative curative effect of patients.The operation is simple and easy to be popularized in the primary hospital,and the young doctors without clinical experience can successfully complete the operation. |
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