应用移动AR定位系统辅助高血压脑出血定位穿刺引流的临床研究

Clinical Study on the Application of Mobile AR Positioning System to Assist the Positioning Puncture and Drainage of Hypertensive Intracerebral Hemorrhage

摘要: 目的：探讨移动增强现实(AR)定位系统在高血压脑出血(HICH)定位穿刺引流的临床应用价值。方法：回顾性分析16例移动AR定位系统辅助HICH定位穿刺引流的临床资料。术前将CT薄层扫描并用3D-Slicer软件对DICOM格式的头颅CT资料进行三维模型重建，测量穿刺深度、血肿体积，并模拟穿刺路径。利用移动AR定位系统投影三维重建模型与患者头颅位置吻合，标记血肿体表与穿刺路径投影，辅助血肿穿刺。结果：16例均成功穿刺血肿达目标位置，顺利完成穿刺引流手术操作。本组病例靶点偏移小于2 mm共13例，平均手术时间(30 ± 4.5) min，平均术中失血(12 ± 3.0) ml；术后72小时与术前意识状态、肌力、GCS评分均有显著改善，P值 < 0.05；未发现穿刺道再出血及穿刺相关性颅内感染并发症。结论：移动AR定位系统可为HICH血肿穿刺引流手术提供更为精确的穿刺定位，提高手术穿刺成功率。

Abstract: Objective: To explore the clinical application value of mobile augmented reality (AR) positioning system in localized puncture and drainage of hypertensive intracerebral hemorrhage (HICH). Methods: The clinical data of 16 cases of HICH positioning puncture and drainage assisted by mobile AR positioning system were analyzed retrospectively. Before operation, CT thin-slice scanning and 3D-Slicer software were used to reconstruct the 3D model of DICOM-formatted skull CT data, measure the puncture depth and hematoma volume, and simulate the puncture path. The three-dimensional reconstruction model projected by mobile AR positioning system is consistent with the patient’s skull position, marking the projection of hematoma body surface and puncture path, and assisting hematoma puncture. Results: All the 16 cases successfully punctured hematoma to reach the target position, and successfully completed the puncture and drainage operation. In this group, the target deviation was less than 2 mm in 13 cases, with an average operation time of (30 ± 4.5) min and an average blood loss of (12 ± 3.0) ml. 72 hours after operation and before operation, the conscious state, muscle strength and GCS score were significantly improved (P < 0.05). No complications of rebleeding and puncture-related intracranial infection were found. Conclusion: Mobile AR positioning system can provide more accurate puncture positioning for HICH hematoma puncture and drainage operation, and improve the success rate of puncture.