颅脑损伤患者合并眼部损伤的临床特征分析  

Analysis of the clinical features of head injury coupled with eye trauma

作　　者：何鑫 武秀权 吴霜 郇宇 杜伟 费舟 高大宽 费霏 He Xin;Wu Xiuquan;Wu Shuang;Huan Yu;Du Wei;Fei Zhou;Gao Dakuan;Fei Fei(Department of Neurosurgery,The First Affiliated Hospital of Air Force Medical University,Xi’an 710032,China;Department of Ophthalmology,The First Affiliated Hospital of Air Force Medical University,Xi’an 710032,China)

机构地区：[1]空军军医大学第一附属医院神经外科,西安710032 [2]空军军医大学第一附属医院眼科,西安710032

出　　处：《创伤外科杂志》2022年第4期254-258,共5页Journal of Traumatic Surgery

基　　金：空军军医大学科技发展基金课题(2021XB013)。

摘　　要：目的分析颅脑损伤患者合并眼部损伤的临床特征。方法回顾性分析2011年2月—2019年9月空军军医大学第一附属医院神经外科收治的中、重型颅脑损伤患者704例,其中合并眼部损伤121例(眼部损伤组),无眼部损伤583例(无眼部损伤组)。回顾两组患者的临床和影像学资料,临床资料包括患者的年龄、性别、病史、视力、临床表现、实验室检查、手术记录及病情转归;影像学资料主要包括眼眶及头颅CT、MRI表现。比较两组患者伤因、伤型、临床病理、视觉功能及预后等方面差异。结果颅脑损伤患者以中年男性为主,道路交通伤为首要致伤原因,眼部损伤以单眼伤较多(80.2%)。与无眼部损伤组比较,眼部损伤组患者爆炸伤(3例)和锐器伤(4例)较多(P<0.001),均与眼部损伤直接相关,开放性颅脑损伤(58例)比例较高(P<0.001),前颅底硬脑膜破裂(57例,47.1%)和眶骨骨折(112例,92.6%)发生率更高(P<0.001),并出现多种眼部软组织和视神经损伤,但经治疗,视力恢复效果不容乐观。眼部损伤组总体预后(GOS评分)优于无眼部损伤组,院内病死率更低(P<0.001),虽也更影响伤者的生活质量。结论爆炸伤和锐器伤所致的颅脑损伤患者更易合并眼部损伤;颅脑损伤合并眼部损伤的患者更易出现前颅底硬脑膜破裂和眶骨骨折,影响视觉功能。因此,神经外科与眼科医师需采取多学科诊疗方式,早期介入,加强协作,努力提高救治水平。Objective To explore and analyze the clinical features of head injury coupled with eye trauma.Methods Totally 704 cases of moderate and severe head injury admitted to Department of Neurosurgery,The First Affiliated Hospital of Air Force Medical University from Feb.2011 to Sep.2019 were retrospectively analyzed,of whom 121 cases had eye trauma as eye trauma group,and the remaining 583 cases without eye trauma were selected as no eye trauma group.Clinical and imaging data of the patients were reviewed.The clinical data were evaluated including patient age,gender,clinical history,vision,clinical features,laboratory examination,surgical record and prognosis.Imaging data included orbital and head CT,MRI image features.The differences in cause,type,clinicopathology,visual function and prognosis were compared between the two groups.Results The patients with head injury were mainly middle-aged males,road traffic injury was the primary injury factor,and eye trauma was mostly monocular(80.2%).Compared with the group without eye trauma,the group with eye trauma had more explosive injuries(3 cases)and sharp instrument injuries(4 cases,P<0.001),which were directly related to eye trauma,and more open craniocerebral trauma(58 cases,P<0.001),and the incidence of anterior skull base dural rupture(57 cases,47.1%)and orbital bone fracture(112 cases,92.6%)was higher(P<0.001).In addition,a variety of ocular soft tissue and optic nerve injuries occurred,but after treatment,the vision recovery effect was not satisfactory.The patients with eye trauma had better effect and lower in-hospital mortality(P<0.001),but was more likely to affect the quality of life of patients.Conclusion Patients with head injury caused by explosive injury and sharp instrument injury are more likely to be complicated with eye trauma,and patients with head injury and eye trauma are more likely to have anterior skull base dural rupture and orbital bone fracture to affect the visual function.Therefore,neurosurgeons and ophthalmologists should adopt multidisciplina

关 键 词：颅脑损伤 眼部损伤 临床特征 

分 类 号：R651.15[医药卫生—外科学] R77[医药卫生—临床医学]