手术治疗急性脑外伤合并视神经损伤的疗效分析  

Analysis of Clinical efficacy of operative treatment for the acute craniocerebral trauma associated with optic nerve injury

作　　者：徐建民[1] 吴江[1] 黎国雄[1] 林晓元[1] 

机构地区：[1]广东省深圳市西乡人民医院神经外科,518102

出　　处：《岭南现代临床外科》2003年第2期139-141,共3页Lingnan Modern Clinics in Surgery

摘　　要：目的探讨急性颅脑外伤合并视神经损伤的有效治疗方法。方法手术治疗29例颅脑损伤合并视经损伤患者,15例行额部冠状切开减压,12例行额颞部开颅清除眶骨骨折片或血肿,矫正额眶骨折错位畸形。有视神经管骨折者,用微钻磨开视神经管,切开视神经鞘进行神经减压。2例眶尖综合征者行额颞切口,经眶尖外侧壁磨开眶上裂和视神经管神经减压。结果25例有效,其中1例眼球突出、3例眼球内陷均得到矫正,总有效率86郾2%。结论眶部CT检查对管内段视神经损伤具有重要诊断价值,CT检查阴性不能除外该病;疗效与视神经损伤程度和手术时机等因素有关;经额部或额颞入路手术行视神经减压,结合术后高压氧治疗对颅脑损伤合并视神经损伤的患者可取得良好效果。Objective To study the effective methods in the treatment of the acute craniocerebral trauma associated with optic nerve injury.Methods From January1993to February2003,29cases with acute cranio cerebral trauma associated with optic nerve injury were analyzed retrospectively.Among them,15cases underwent frontal coronal incision decompression,12cases underwent cranotomy to clean out the fragnemt of orbital bone or hematoma via fronto-temporal part,and corrected deformation caused by deplacement of fronto-orbital fracture.Through the fronto-temporal incision and lateral wall of orbital apex to open the superior orbital fissure and optic nerve canal for decompression,which were performed in2cases with orbital apex syndrome.Results25cases were effective.The total effective rate was86.2%.Conclusion CT scan of orbital part has an important diagnos-tic value for optic nerve injury of intratubular segment.But the negative result of CT scan cann' t exclude the optic nerve injury.The efficacy correlated with the degree of optic nerve injury and selection of operative timing etc.Via frons or fronto-temporal approached operation of optic nerve decompression combined with hyperbaric oxygen treatment,it can get a good efficacy for the craniocerebral trauma associated with optic nerve injury.

关 键 词：急性颅脑损伤 视神经损伤 治疗 

分 类 号：R651[医药卫生—外科学]