目的 探究手机普视3D SLAM AR软件在颅内幕上浅表肿瘤术前定位的价值.方法 分析10例颅内幕上浅表肿瘤患者的临床资料,病变直径2.3～6.8cm.术前利用MRI或CT扫描数据对肿瘤、头部轮廓、鼻部及双侧耳廓进行三维重建,载入普视3D SLAM软件,进行肿瘤术前定位(实验组),同时利用传统定位方法进行徒手定位(对照组),最后利用神经导航定位病变中心点作为评价标准,普视3D SLAM软件与徒手定位的中心点与导航定位的中心点之间的距离为定位误差,对结果进行统计学分析.结果 普视3DSLAM软件的定位误差[(0.48±0.04)cm]小于徒手定位法[(2.08±0.23)cm](P＜0.05).结论 普视3D手机AR软件Slam模块对颅内幕上浅表肿瘤定位较传统徒手定位法更准确,此外还能直观显示病变周围的皮层静脉、纤维束等结构,有助于合理地制定术前计划,最大程度地减小手术创伤.

目的 评估3D打印个体化穿刺导板辅助经皮微球囊压迫半月节治疗原发性三叉神经痛术中的准确性和疗效.方法 前瞻性研究2019年2月至2021年8月于我院治疗的35例原发性三叉神经痛患者,随机分为试验组和对照组,试验组18例,对照组17例.所有患者术前均行头颅CT薄层扫描,试验组采用3D打印个体化穿刺导板辅助经皮穿刺,对照组在移动C臂引导下徒手穿刺;记录所有患者穿刺针到位所用时间,术中穿刺针调整次数,术中球囊一次性成梨例数,术中移动C臂照射次数,记录患者术后并发症情况,术后BNI分级评分评估疗效.结果 与对照组相比,试验组穿刺到位所用时间、术中穿刺针调整次数及术中移动C臂照射次数均低于对照组(P<0.05),且术中球囊一次性成梨率明显高于对照组(P<0.05).根据BNI分级标准,两组患者术后治疗效果和并发症发生情况的差异无统计学意义(P>0.05),所有患者均未发生严重并发症.结论 3D打印个体化穿刺导板辅助经皮微球囊压迫半月节治疗原发性三叉神经痛手术,其精确度高,能有效提高穿刺成功率,缩短手术时间,降低手术风险,临床操作更简便、安全,值得向临床应用推广.

目的 探讨基于多模态影像三维重建技术辅助功能区及其毗邻部位脑肿瘤手术中的作用.方法 回顾性分析2019-04—2021-06宜宾市第二人民医院神经外科收治的21例功能区及其毗邻部位脑肿瘤患者的临床资料.术前使用多模态影像三维重建技术,根据重建影像进行综合评估并实施手术,通过与术中所见与术后疗效综合评估有效性.结果 所有患者术中所见与术前重建影像均高度一致.其中19例患者术前均成功实现颅骨、脑组织、肿瘤、血管及白质纤维束走行的三维重建和融合,2例患者无法辨认功能区脑回和肿瘤的关系.21例患者中,肿瘤全切17例,次全切1例,3例部分切除.术后出现1例一过性肢体活动障碍和1例一过性语言障碍,均恢复良好.结论 利用多模态影像三维重建技术有助于在术前对于肿瘤与功能区脑回、锥体束及脑血管之间的关系进行精确评估,制定完备的手术方案,最大程度保护神经功能,并能提高肿瘤的全切除率.

1临床资料 患者,男,64岁,因"双下肢肌痛伴乏力10 d"于2021年9月23日入院.10 d前,患者无明显诱因出现双侧下肢肌肉酸痛伴乏力,休息后稍有缓解.伴反酸、呃逆,咳嗽、咯少量白色痰.患者既往体健,吸烟30年,20支/d,饮酒40年,100 ml/d.入院查体:T 36.3℃,P 91 次/min,R 20 次/min,BP 116/69 mmHg.

目的 分析优化手术流程在深低温保存钴-60灭菌自体颅骨修补颅骨缺损手术降低近期(1个月)并发症发生率的方法、优点及意义.方法 回顾性分析我院2018年10月～2020年10月收治的46例颅骨缺损病人的临床资料,全部采用深低温保存自体颅骨修补颅骨缺损.根据术前颅骨处理方式不同分为两组,实验组24例,采用80℃无菌生理盐水1000 ml+地塞米松20 mg复温30分钟;对照组22例,采用传统处理方式.结果 实验组皮下积液1例;对照组硬膜外血肿2例,皮下积液11例,其中严重皮下积液1例,颅骨感染1例(再手术).通过80℃无菌生理盐水+地塞米松20 mg复温30分钟,大大减少手术近期并发症,提升手术效果及病人舒适度.随访证实无骨瓣塌陷、无骨髓炎、无皮下积液.结论 改进颅骨处理方式能大大降低深低温保存自体颅骨修补颅骨缺损近期并发症.对于有条件开展自体颅骨修补的单位值得推荐,是一种简便、经济、安全、可行的方法.

Objective:To study the diagnostic value of MR diffusion weighted imaging (DWI) and CT and MR perfusion imaging in patients with different degrees of liver cirrhosis.Methods:A total of 60 patients with liver cirrhosis,who were treated in Ziyang Hospital of West China Hospital of Sichuan University from August 2015 to February 2017 were selected.According to the Child-Pugh classification,32 cases of grade A were mild cirrhosis (denoted as group A),16 cases of grade B and 12 cases of grade C were moderate to severe cirrhosis (denoted as group B),30 healthy volunteers were selected as group C in the same period.All the subjects in the three groups were examined by DWI,CT and MR perfusion imaging.The ADC value,hepatic portal perfusion ratio [SSr (CT) and SSr (MR)] were compared among the three groups,and Spearman correlation analysis was used to analyze the correlation between the indexes.Results:There was no significant difference in ADC values among the three groups (P＞0.05),and the ADC values of group A and B were lower than those of group C,but the difference was not statistically significant (P＞0.05).There was no significant difference in ADC values between group A and B (P＞0.05).The levels of SSr (CT) and SSr (MR) in the three groups were compared,the difference was statistically significant (P＜0.05);the levels of SSr (CT) and SSr (MR) in group B were significantly higher than those in group A and C,the difference was statistically significant (P＜0.05).There was no significant difference in the levels of SSr (CT) and SSr (MR) in group A and C (P＞0.05).Spearman correlation analysis showed that SSr (CT) was positively correlated with SSr (MR) in the patients with liver cirrhosis (r=0.687,P=0.000).Conclusion:CT and MR perfusion imaging can reflect the lesion degree of liver cirrhosis,and diagnostic effects of the two are better than DWI imaging,which is worthy of clinical promotion.