摘要：

目的 介绍角尺分规定位法并总结其在神经外科急诊手术中的应用经验。方法 纳入2018年10月至2019年10月共33例患者行神经外科急诊手术，术前采用角尺标画实际CT扫描基线、病灶上下界和中心层面，分规通过弦距定位法标画病灶前后界，进而标画病灶体表投影，以此针对不同病变采取开颅手术或血肿穿刺引流术；术中记录角尺分规定位法操作时间、与术中实际所见的准确率，以及与校准CT和（或）MRI的误差。结果 共33例患者均于术前采用角尺分规定位法准确定位病灶，平均操作时间为（3.70 ±1.17）min。其中，20例开颅手术患者（急性硬膜外血肿14例、脑叶出血5例、脑转移瘤1例）根据病灶体表投影设计骨窗，并据此骨窗中心找到病灶，定位准确率达100%（20/20）；13例血肿穿刺引流术患者（亚急性额颞部硬膜下血肿2例、自发性基底节区和丘脑出血11例）定位靶点后贴体表标记，经CT校准，预设靶点与体表标记之间的平均误差为（3.71 ±1.62）mm。结论 角尺分规定位法仅需角尺和分规工具，操作简便迅速、准确可靠，对于急诊患者的术前定位和手术治疗，该定位方法实用性较强，误差在可接受的范围内。

关键词: 急症, 神经外科手术, 立体定位技术

Abstract:

Objective To introduce a localization method for intracranial lesions using a square ruler and dividers. The experience of using this method for emergency neurosurgery is presented. Methods A total of 33 cases of emergency neurosurgery from October 2018 to October 2019 were retrospectively analyzed. The baseline at each scan as well as the upper, lower and middle level of the lesion is marked by a square ruler, and the chord length is measured by dividers to point out the anterior and posterior border. Then the lesions are projected to the cranial surface treating by puncture or open surgery. The time spent on location, the accuracy compared with the actual location during operation, and the error compared with the calibration CT or MRI were recorded. Results The lesion of 33 patients was localized successfully by this method, and the average time spended was (3.70 ±1.17) min. Among them, the bone window was designed according to the surface projection of the lesion in 20 cases of open surgery (including 14 cases with acute epidural hematoma, 5 cases with cerebral lobe hemorrhage and one case with brain metastasis), and all lesions (20/20) were found in the center of the bone window intraoperatively. Besides, 13 cases of hematoma puncture surgery (including 2 cases with subacute frontotemporal subdural hematoma and 11 cases with spontaneous basal ganglia and thalamus hemorrhage) were corrected by CT scan after the target was located and marked by surface markers. The average error between the marker and the preset target was (3.71 ±1.62) mm. Conclusions This localization method only needs a square ruler and dividers, which is simple, rapid, accurate and reliable. The method is practical and the error is acceptable for location and surgical treatment in emergency cases.

Key words: Emergencies, Neurosurgical procedures, Stereotaxic techniques