颅脑外伤合并视神经损伤85例临床分析  

Clinical analysis of 85 patients with craniocerebral injury combined with traumatic optic neuropathy

作　　者：董浩[1] 李松峰[2] 李永[1] 赵景武[1] 康军[1] DONG Hao;LI Songfeng;LI Yong;ZHAO Jingwu;KANG Jun(Department of Neurosurgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Ophthalmologic Center,Beijing 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,北京100730 [2]首都医科大学附属北京同仁医院眼科中心,北京100730

出　　处：《新乡医学院学报》2021年第5期441-444,共4页Journal of Xinxiang Medical University

基　　金：北京市科委首都市民健康培养项目(编号:Z151100003915153)。

摘　　要：目的探讨颅脑外伤合并视神经损伤的治疗措施及预后影响因素。方法选择2016年7月至2018年7月北京同仁医院神经外科收治的85例(94眼)颅脑外伤合并视神经损伤患者为研究对象,其中男76例,女9例;年龄6~58(29.60±10.35)岁;受伤部位:左眼39例,右眼43例,双侧6例;受伤原因:车祸伤61例,坠落伤10例,打击伤6例,爆炸伤3例,其他5例;无光感63眼,有残余视力31眼。患者均给予药物联合经鼻内镜视神经管减压术治疗;治疗后3个月检查患者视力,根据视力改善情况判断治疗效果,并比较治疗前眼无光感患者与治疗前有残余视力患者的治疗有效率;分析不同骨折部位对患者治疗效果的影响。结果治疗前,无光感63眼,有光感5眼,残存视力为手动9眼,残存视力为眼前数指15眼,残存视力>0.052眼;蝶骨大翼骨折40例,蝶骨平台骨折36例,额骨骨折33例;额叶脑挫伤11例,创伤性动脉瘤1例,颈内动脉海绵窦漏2例,脑脊液鼻漏6例。85例(94眼)患者中,治疗有效42眼,治疗总有效率为44.68%(42/94眼)。治疗前眼无光感患者的治疗有效率为34.92%(22/63眼),治疗前有残余视力患者的治疗有效率为64.52%(20/31眼);治疗前眼无光感患者的治疗有效率低于治疗前有残余视力患者(χ^(2)=7.363,P<0.05)。伴视神经管骨折、蝶骨平台骨折与不伴视神经管骨折、蝶骨平台骨折患者治疗有效率比较差异无统计学意义(P>0.05),伴蝶骨大翼骨折患者治疗有效率显著低于不伴蝶骨大翼骨折患者(P<0.05)。结论颅脑外伤合并视神经损伤患者视力受损比较严重,有残存视力患者治疗后视力恢复好于无光感患者;伤后视神经管周围骨质骨折情况对颅脑外伤合并视神经损伤患者的视力恢复有一定影响。Objective To investigate the treatment and prognostic factors of craniocerebral injury combined with traumatic optic neuropathy(TON).Methods A total of 85 patients(94 eyes)with craniocerebral injury combined with TON admitted to the Department of Neurosurgery of Beijing Tongren Hospital from July 2016 to July 2018 were selected as the research subjects,including 76 males and 9 females,aged 6-58(29.60±10.35)years old.The injury site included 39 cases of left eye,43 cases of right eye,6 cases of bilateral eye;the injury causes included 61 cases of traffic accident injury,10 cases of falling injury,6 cases of strike injury,3 cases of explosion injury,and 5 cases of other injuries.There were 63 eyes without light perception and 31 eyes with residual vision.All the patients were treated with drugs combined with endoscopic optic canal decompression.Three months after treatment,the visual acuity of the patients was examined,and the treatment effect was judged according to the improvement of visual acuity;the efficiency of patients without light perception before treatment and patients with residual visual acuity before treatment were compared,and the effect of patients with different fracture sites on the efficiency was analyzed.Results Before treatment,there were 63 eyes without light perception,5 eyes with light perception,9 eyes with manual vision,15 eyes with fingers in front of eyes,2 eyes with vision>0.05;40 cases had sphenoid wing fracture,36 cases had sphenoid plateau fracture,33 cases had frontal bone fracture;11 cases had frontal lobe contusion,1 case had traumatic aneurysm,2 cases had internal carotid cavernous sinus leak,6 cases had cerebrospinal fluid rhinorrhea.In the 85 cases(94 eyes)patients,42 eyes were effective of treatment,and the total effective rate was 44.68%(42/94 eyes).The effective rate in patients without light perception before treatment was 34.92%(22/63 eyes),and 64.52%(20/31 eyes)in patients with residual vision before treatment.The effective rate of patients without light perception befor

关 键 词：视神经损伤 颅脑外伤 合并症 视神经减压术 

分 类 号：R651.1[医药卫生—外科学]