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目的 探讨基底节内囊区血肿发生部位、责任血管与临床症状、体征、影像学特点及临床预后之间的相互关系。方法 依据患者影像中原发出血灶的部位与责任血管将基底节内囊区出血分为 6个亚型 :( 1)前部型 ;( 2 )中间型 ;( 3)后中间型 ;( 4)后外侧型 ;( 5 )外侧型 ;( 6 )大量出血型。通过改良Rankin量表 (MRS)评价患者病初临床表现及近期预后。结果 前部型占 12 15 %,6 8 18%患者MRS =0～ 2分 ,1例死亡。中间型出血占 6 6 3%,5 0 %患者MRS =5分 ,没有死亡病例。后中间型占10 5 0 %,5 2 6 3%患者MRS =0～ 2分 ,没有死亡病例。后外侧型出血占 18 78%,76 47%患者MRS =5分 ,17 6 5 %患者死亡。外侧型出血最为常见 ( 39 2 3%) ,38 0 3 %患者MRS =5分 ,8 45 %患者死亡。大量出血型发病率亦较高 ( 12 71%) ,47 82 %患者MRS =5分 ,47 83%患者死亡。结论 血肿的位置及所侵犯的临近区域是影响纹状体内囊出血预后的决定要素 ,六型分类法为预测临床预后和指导治疗提供了简易可靠手段。
Objective To investigate the relationship between the site of hematoma, the relationship between responsible vessels and clinical symptoms, signs, imaging features and clinical prognosis in basal ganglia. Methods According to the site of the primary bloodstream in the patient’s image and the responsible vessels, the hemorrhage in the basal ganglia was divided into six subtypes: (1) anterior type; (2) intermediate type; (3) middle type; (4) ) Posterolateral; (5) lateral; (6) a large number of bleeding. Patients were evaluated for initial clinical presentation and near-term prognosis by modified Rankin Scale (MRS). Results The anterior type accounted for 12 15%, while 6 8 18% of the patients had MRS 0 to 2 and 1 died. Intermediate bleeding accounted for 6 6 3%, 50% of patients with MRS = 5 points, no deaths. After the intermediate type accounted for 10 5 0%, 52 6 3% of patients with MRS = 0 to 2 points, no deaths. Post-lateral hemorrhage accounted for 18 78%, 76 47% of patients with MRS = 5 points, 17 65% of patients died. Outlying hemorrhage was the most common (39.23%). 383% of patients were MRS = 5 and 8 45% of patients died. The incidence of massive bleeding was also high (12 71%), with 47 82% of patients having MRS of 5 and 47 83% of patients dying. Conclusion The location of the hematoma and its adjacent area are the determinants of the prognosis of intrastriatal hemorrhage. The six-type classification provides a simple and reliable method for predicting clinical prognosis and guiding treatment.