颅眶联合异物损伤的临床分型及治疗策略（附62例报告）  

Clinical classification and treatment strategy of cranio-orbital foreign body injury （62 cases ）

作　　者：徐勇[1] 李永[1] 张家亮[1] 董浩[1] 刘浩成[1] 王卫[1] 张天明[1] 康军[1] Xu Yong;Li Yong;Zhang Jialiang;Dong Hao;Liu Haocheng;Wang Wei;Zhang Tianming;Kang Jun(Department of Neurosurgery ＆ Cranial-Facial Trauma Center, Beifing Tongren Hospital, Capital Medical University, Beijing 100730, China)

机构地区：[1]首都医科大学附属北京同仁医院神经外科、颅面创伤中心,100730

出　　处：《中华神经外科杂志》2018年第6期586-590,共5页Chinese Journal of Neurosurgery

基　　金：国家重点基础研究发展计划（973计划）（2005CB724302）;首都临床特色应用研究专项（Z131107002213085）

摘　　要：目的 探讨颅眶联合异物损伤的常见临床分型、神经外科治疗策略及预后.方法 回顾性分析首都医科大学附属北京同仁医院神经外科2007年1月至2017年6月收治的62例颅眶联合异物损伤患者的临床资料,根据异物存留位置分为眶内型（Ⅰ型）及眶-颅型（Ⅱ型）,其中Ⅱ型根据异物入颅位置分为眶上壁型（ⅡA型）、眶尖型（ⅡB型）及眶外侧壁型（ⅡC型）.经眶手术12例,神经内镜经鼻手术8例,开颅手术39例,异物直接拔除3例.术后均给予抗感染等治疗.结果 62例患者中,Ⅰ型20例;Ⅱ型42例,其中ⅡA型17例,ⅡB型20例,ⅡC型5例.59例完整取出异物.39例开颅者术后均无脑脊液漏、迟发性颅内出血、新发神经功能缺损表现.随访2个月至2年,Ⅰ型及ⅡA型预后相对良好,20例ⅡB型患者遗留眶尖综合征15例（75.0％,15/20）,5例ⅡC型患者遗留神经功能缺损4例.术前视力丧失者视力恢复率低（33.3％,8/24）,有残存视力者恢复率高（88.9％,24/27）,差异有统计学意义（x2=3.81,P＜0.01）.30例眼动障碍患者,部分恢复15例（50.0％,15/30）.18例ⅡB型眼动障碍患者中,15例遗留眶尖综合征.经抗感染治疗无一例患者发生颅内外迟发性感染.结论 颅眶联合异物损伤分型有助于术前制定手术方案;早期诊断、治疗及术中尽可能完整取出异物,有助于患者的预后.Objective To investigate the clinical classification,neurosurgical treatment and prognosis of cranio-orbital foreign body injury.Methods The clinical data of 62 patients with cranio-orbital foreign body injury were retrospectively analyzed who received treatment at Department of Neurosurgery and Cranio-facial Trauma Center,Beijing Tongren Hospital,Capital Medical University between January 2007 and June 2017.According to the positions of residual foreign bodies,all cases were divided into orbit type （type Ⅰ） and orbitalcranial type （type Ⅱ）.Type Ⅱ was further divided into 3 subtypes including the supra-orbital type （type Ⅱ A）,orbital apex type （type Ⅱ B） and the lateral orbital type （type ⅡC） based on the position where the foreign bodies invaded the cranial cavity.All cases underwent surgical treatment and included 12 cases of trans-orbital surgeries,8 cases of trans-nasal surgeries,39 cases of craniotomy and 3 cases of direct removal.After the surgical treatment,all cases were administered anti-inflammatory and neurotrophic drugs.Results Among all 62 cases,20 cases were classified as type Ⅰ and 42 cases as type Ⅱ including 17 cases of type Ⅱ A,20 cases of type ⅡB and 5 cases of type Ⅱ C.Foreign bodies were completely extracted in 59 cases.Thirty-nine cases undergoing craniotomy had no cerebrospinal fluid leak,delayed intracranial hemorrhage or neurologic deficit post operation.Followed up for 2 months to 2 years,type Ⅰ and ⅡA were associated with better prognosis.Fifteen out of 20 cases （75.0%） of type ⅡB cases reported orbital apex syndrome and 4 out of 5 cases of type Ⅱ C developed neurological deficits.The visual recovery in remnant cases （88.9%,24/27） was better than that in vision loss cases （33.3%,8/24） （x2 =3.81,P 〈 0.01）.Fifteen out of 30 cases with eye movement disorder had partial recovery （50.0%）.Out of 18 cases of type Ⅱ B with eye movement disorder,15 reported orbital apex syndrome.None of the patients had late-onset intracra

关 键 词：创伤和损伤 异物 颅脑损伤 神经外科手术 颅眶联合 

分 类 号：R651.1[医药卫生—外科学]