视神经管减压术与激素冲击疗法治疗视神经损伤的疗效比较  

Comparison of optic canal decompression and hormone shock therapy in the treatment of optic nerve injury

作　　者：秦虎[1] 汪永新[1] 李亚宾[1] 刘冬[1] 朱晓锋[1] 徐丹书 王增亮[1] 

机构地区：[1]新疆医科大学第一附属医院神经外科,乌鲁木齐830054

出　　处：《中华眼科医学杂志（电子版）》2017年第6期263-268,共6页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

基　　金：新疆医科大学科研创新基金(XYDCX2015120)

摘　　要：目的比较视神经管减压术与激素冲击疗法治疗视神经损伤的效果。方法纳入2010年12月至2017年5月于新疆医科大学第一附属医院神经外科接受治疗的68例(68只眼)视神经损伤患者的临床资料,全部患者均为单眼受损。其中,男性49例,女性19例;左眼患病者38例,右眼患病者30例;交通伤患者31例,高处坠落伤患者22例,摔倒损伤患者15例。患者年龄为21~58岁,患者平均年龄为(35.6±3.4)岁。于伤后12 h内就诊者22例,12~24 h就诊者8例,1 d^3 d就诊者15例,4 d^7 d就诊者15例,7 d^30 d就诊者8例。按照不同的临床治疗方法,将患者分为手术治疗组与激素冲击治疗组。其中,手术治疗组41例,男性28例,女性13例,平均年龄(36.1±3.8)岁,平均病程(6.2±2.8)d,均行视神经管减压术治疗;激素冲击治疗组27例,男性6例,女性21例,平均年龄(34.5±3.1)岁,平均病程(6.7±3.1)d,均给予单纯激素冲击疗法治疗。均于术后或开始治疗后3 d、7 d及30 d时观察两组患者的视力及眼底情况。手术后或治疗后视力好转者判为有效,手术后或治疗后视力无好转者则判为无效。两组有效率采用百分比描述,治疗有效率的比较采用χ2检验。结果手术治疗组患者术后19例有效,22例无效,视力恢复有效率为46.34%。激素冲击治疗组患者治疗后8例有效,19例无效,视力恢复有效率为29.63%。将两组患者的视力恢复有效率进行比较,差异无统计学意义(χ2=1.90,P>0.05)。在手术治疗组中,术前仅有光感至视力0.02者25例,术后有13例患者视力有所提高。其中,受伤时间在3 d以内者18例,术后11例为有效;受伤时间在3 d及以上者7例,术后2例为有效。术前无光感者共16例,术后有6例患者不同程度地恢复了部分视力;其中,受伤时间3 d以内者10例,术后4例为有效;受伤时间3 d及以上者6例,术后2例为有效。在激素冲击疗法组中,治疗前视力有光感至视力0.02者13例,治疗后视力提高5例;Objective To observe the effect of optic canal decompression and hormone shock therapy on visual prognosis of the patients with optic canal fracture. Methods The clinical data of68 patients with optic nerve injury treated in the Department of Neurosurgery,the First Affiliated Hospital of Xinjiang Medical University from December 2010 to May 2017 were included. All were monocular damage.Among them,there were 49 males,19 females,38 left eyes,and 30 right eyes. The age of the patients was21 ~ 58 years,and the average age of the patients was（ 35.6± 3.4） years. In the cause of injury,including31 cases of traffic injury,22 cases of falling injury and fall injury in 15 cases; in 12 hours after injury in22 patients,12 ~ 24 hours were 8 cases,15 cases of injury after 1 to 3 days of treatment,15 cases in 4 to7 days after injury patients in 8 cases,seventh to thirtieth days after injury patients. According to the different methods of clinical treatment,the patients were divided into surgical treatment group and hormone shock treatment group. The surgery group 41 cases,male 28 cases,female 13 cases,average age（ 36. 1 ±3.8） years old,the average duration of（ 6. 2 ± 2. 8） days,were treated with optic nerve decompression therapy; hormone impact treatment group of 27 cases,6 cases were male,21 were female,the average age（ 34.5±3.1） years old,average course（ 6.7±3.1） days,were treated with hormone shock therapy. The two groups of patients all observed their visual acuity and fundus on the third,seventh and 30 days after the operation or the beginning of the treatment. After surgery or after treatment,visual improvement is found to be effective. No improvement in visual acuity after surgery or after treatment is found to be invalid. The effectiveness of the two groups was described by the number and percentage of cases,and the efficiency of the treatment was compared with the chi square test. Results In the operation group,19 cases were effective,22 cases were ineffective,and the recovery rate of visual ac

关 键 词：视神经管减压术 激素冲击疗法 视神经管骨折 视力 

分 类 号：R774.6[医药卫生—眼科]