外伤性视神经病265例临床特征分析  

Clinical features of traumatic optic neuropathy in 265 cases

作　　者：陈敏[1] 姜彦[1] 温君凤[2] 李娜[1] 邱杰[1] 张念凯[1] 鞠建宝[1] 

机构地区：[1]青岛大学附属医院耳鼻咽喉头颈外科,青岛266003 [2]青岛大学附属医院手术室,青岛266003

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第9期659-663,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金（81170895）

摘　　要：目的 分析外伤性视神经病（traumatic optic neuropathy,TON）患者的临床特征,探讨其发病规律.方法 回顾性分析1999年4月至2015年8月于青岛大学附属医院耳鼻咽喉头颈外科治疗的265例（275眼）TON患者的资料,并对疗效的影响因素进行Logistic回归分析.结果 TON患者以男性多见（235/265,88.68%）,青年人居多（194/265,73.21%）,家庭区域以农村乡镇为主（209/265,78.87%）.致伤原因多为交通事故（197/265,74.34%）,其次为击打伤（36/265,13.58%）和坠落伤（17/265,6.42%）,多合并颅面外伤或全身其他损伤.治疗后视力改善总有效率为53.45%（147/275）.伤后有光感以上残余视力、视神经管骨折、眶壁骨折是治疗有效的影响因素（χ2值分别为24.674、19.755、9.175,P值均〈0.01）.伤后有光感以上视力是视力有效的保护因素（OR=5.008,P〈0.001）,而存在视神经管骨折和眶壁骨折是视力无效的危险因素（OR值分别为0.110、0.329,P值均〈0.01）.结论 TON多见于青年男性,多由交通事故引起,预后较差,需注意预防.Objective To analyze the clinical features and the pathogenetic law of traumatic optic neuropathy through epidemiologic study.Methods 265 cases （275 eyes） with TON treated in Department of Otorhinolaryngology Head and Neck Surgery,the Affiliated Hospital of Qingdao University from April 1999 to August 2015 were retrospectively analyzed.Multiple Logistic regression analyses were used to evaluate potential prognostic factors on visual acuity.Results TON occured mostly in young （194/265,73.21%） man （235/265,88.68%）,the majority of patients came from villages and towns （209/265,78.87%）.Traffic accident （197/265,74.34%） remained the main etiology,with strike （36/265,13.58%） and fall （17/265,6.42%） as the common etiology.Most patients had head injuries.The effective rate of vision improvement was 53.45%（147/275）.Multiple logistic regression analyses identified that initial visual acuity with light perception or better vision,optic canal fracture and orbital wall fracture were visual acuity key factors of TON （χ2 value was 24.674,19.755,9.175,respectively,all P〈0.01）,initial visual acuity with light perception or better vision was the protective factor on visual acuity recovery （OR=5.008,P〈0.001）,the presence of optic canal fracture and orbital wall fracture were the risk factors on visual acuity recovery （OR value was 0.110,0.329,respectively,all P〈0.01）.Conclusions Ton occurs mostly in young man because of traffic accident.Visual impairment of TON is severe.The suitable preventive measures should be carried out according to its epidemiological features.

关 键 词：视神经疾病 视神经损伤 疾病特征 

分 类 号：R774.6[医药卫生—眼科]